03050139 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �.C11S. .ILTN�+`C? 1'IA' 'XO�J
BUILDING ADDRESS: HIGHLAND CONSTRUCTION AND W003050139
;R's NAME: 20073 NORTHCREST SQ PBRA°T1`bb 'y'28/2003
SON
PHONE: 4082411858 SANITARY NO. CONTROL NO.
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u�o LICENSED CONTRACIDR'S DECLARATION Job Description
I hereby splice dal I ser Iltt d or provlaiam of Chapter 9(commencing ,
with Section] ) fDMslon Sof and Profcssious Code,[nd mYlicenkia .� Z-
a Imm�roreem ! al j� 9EVISION--ADD BEAM (4X12)
a E Lit oak Cormcmr NO NEW PERMIT ISSUED, ORIG. #03030080
9 ARCHffECI'S DA N
�i undZurdmyplace shallbeumlu 1 meads
; U
Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby amara that 1 1. uusin s an the Contractor's Code:
nae Law for the
p o following lesson.(Section 7031.5.Business end an.dual Cade:Any oily rr county
$ which requires a permit re Gnus line eller,hnprow,l Permit t,m repair any awmuro
Ny pdarkits lasmncoursu requires the roappos of formathe Conikemiuoimmoit a gacdmkmcnt
g�F< (commlacingwilicensed pursuant 7")proviciouso of the
Larcener law(Chapter e)or Sq.Ft. Floor Area Valuation
S O (cat he is
(commencing Section]0n d the
Division s of the alleged
ass and Professions Code)or $500
$ this he la exempt therefrom and the buts for the a1kgW assumption.Any vloladon of
Sudan 7031.5 by any applicant for a permit subjects the applicant an a civil penalty of APN Number Occupancy Type
not mare Nan five hundred dollars(5500).
❑I,as owner ofthe property,or my employees with"gun NNrsole compensation, 31623041 . 00
will do the work and thestrumure is notinknded moRered rorsele(Sec.7044,Business Re�
and Professions Code:The Conmctors License Law does nut apply k an owner of 101 - FOUNDA" fid Inspections
property who builds or improves theraan,and who does ouch work himael f or through his
awn employees,provided that such improvements aknatinknded malTmed torsade.If. 102 — PIERS
however,the building m improvement is mid within once year of compledon,the owner-
builder will have W burden of proving that W did amt build m improve for purpose of 103 — UFER /
.to 1. 104 - REBAR
❑L as owner of the property am,Business uand Professorate with Ocanmd conuamoaa to 105 — ANCHOR BOLTS
comwct theproject(Sec.7044, "elusiand commetona Code:)73k Cmmanca U.
man Law does not apply to an owner of Property who builft or improves liveracen,and 106 — SEWER & WATER \
who comment for such projects with a comamor(s)Iianaed pursuant to the Contractors 202 - UNDERFLOOR PLUMBING
License Law.
❑Iamexemptundm Sec ,B&PCfmthBmaten 203 - UNDERFLOOR MECHANICAL
110, Dale 204 -UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
I 1 hereby affirm under penalty of perjury,oro or dk following declarations:
❑Ilaveand will numwn.Cenlncatear Gonscatkself-mune fmworke's Compen. 301 — ROUGH PLUMBING
satlon,M provided for by Section 3700 of the labor Code,for the performance of the 302 - TUB & OR SHOWER
work forwhmh this permit is intend. 303 - ROUGH MECHANICAL
❑I have and will maintain workers Compensation Insurance,as required by Section � 304 — ROUGH ELECTRICAL
3700 of the labor Code.for the paramount or the work fmwhich this permit is issued.
My Workers Cumpemeron Insursnce Patric'and Polic umbe,red: 305 — FRAME
Carer: Policy 306 - HOLDOWNS
CERTIPICC MPENSA ONI URANCE
olll ORKERS'
307 — INSULATION
crisis motion need net he completed lithe permit is fmanchuadred 011.(5100) 308 — SHEETROCK
.ole") 309 - EXTERIOR LATH
I codify that in the performance of the work for which this permit is issued,l And not 310 - INTERIOR LATH
employ any person in my manner m u m become subject to the Workers'Compensation
Laws atcadram+a.Dam
Applicant 311 - SCRATCH COAT
NOTICE TO APPLICANT:If.after making this i n of on,you should
313 ROOF NAIL
become[object Workers Compewtion provisions of de Labor Codyou mutt
OZ fomwithcomply witthsuch
Provisinmorthis Permit
mailhPdmmcdrevoked.
501 — FINAL ELECTRICAL ENERGY
z CONSTRUCI30NLENDING AGENCY 502 - FINAL PLUMBING ENERGY
1bemby&Timthat them 1.acmarmarnlending agency for the performance of 503 - FINAL MECHANICAL ENERGY
the work far whim this Permit issued(Sec.Som,afar.C.)
loader504 — FINAL BUILDING ENERGY
W Q 's Nmc
7Z
Leader Address 505 - FINAL ELECTRICAL
U O I certify that 1 have read this appdcamr and auk that the above Information is 506 - GAS TEST
W coma I agree to comply with all city and county ordinances and sok lam missing to
O buildingconstruction,and hereby authodx representatives of this city in enter open the 54N — FINAL PLUMBI G
abavc-mc.d...d property for inspection purposes. O F I L
FCy'a (We)agree to an.indemnify and kmp harmless the City of Cupertino against
ti rA liabilities judgments,costs and espouses which may in any my acme against mid City
U 7 In consequence of the gnndng of this permit.
'7 APPLICANT UNDffffffrrrrrrRSTANDS AND WI MP ALL NON-POINT Issued by: 5 NG Date
SOURCE RF —
Re-roofs
'lure of ApplicantuConnecfor
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fissure building weapons store orhandl.loati material
4enncd by the CupeNno Municipal Code.Chapter 9.13,and the Health and Safety
Section 255324)?
❑Yes ❑No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or dcviPm which 'If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as de0ned by the Bay Area Air Quality Management all new materials for inspection.
Dlavict?
C3 Yes No
I hew road the hamadou.makrals requirements undcrChepkr6.95 of the Califor.
ilia Health&Safety Cade,geedous35505,25533.d3534.1uadcrstand aifthebuilding
Jam not currently haw a knan4 thus it is reepom]bill, he notify attupant of the
requirarmnts why m b prior to son a ale of Occu Py. Signature of Applicant Dale
as narand agent All roof coverings to be Class "B"or better