02030075 (3) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMfT NO.
10280 PHAR LAP DRIVE H.D. MILLER CONSTRUCTIO CO 02030075
WNER'S NAME: APPLICATION SUB DATE
RUTTER, GILLIAN 745 CHIMALUS DR 03/14/2002
PHONE: (650) 968-0291 SANITARY NO, CONTROL NO.
G Q ARCHITECTIENGINEER: BUILDING PERMIT INFO
z - BLDG ELECT PLUMB MECH
�< _ I� u
S "' LICENSED CONTRACTOR'S DECLARATION
y z 1 hereby a01rm that 1 am livered under provisions of Chapter 9(eommencing Job Description
nL w'ithSlltion70W7ofDiivixmn3oftheBathe and Professins�.andmylicense WINDOW REPLACEMENT, SERSMIC UPGRADE
o w u License I l r"'I !� LEE)
1 3 c.h D e I DEC tar tY w 7N.
ARCloill T'S DECLl ON
g 1 undemmmd my plans shall m used as public records 2 2003
xO O Licensed Professionnl
.6. OWNER BUILDER DECLARATION
1 hertby v.Rrm that 1 nm exempt from the Convector's License Law for the
C Z following mason.(Section 7031.5,Business and Professions Code:Any city or county ��
F C which requite a permit m construe,alter,improve,demolish,or rvptr any swnurc �I NG $20000 OOOO
i3 prior to its issuance,also require the applicant forsuch permluo file a signed statement
that hes licensed pursuarlto the pm4isions ofthe Convenors License Law IChapter9 (( i Valuation
(commencing with Senion]0g0)afDivision Jofthellmincu'nd ProfSssons Code) 1.��/,`'p tl (:3'Si`$3F.t9� ,�.• $ ,2.T1'i:1a Ls-ve.
of Shut
-'nf Smim70315 M1pyf any applicant
d fare period ssuthbjeects the aePnpelimcuWnifhto A"y violation t
v civil penulty-
ofnnrmomtnanrvehnndreadmlanrs5lw). 10�PNNpDATION )""= ' Occupancy Type
13 1. fthep me structure stye isotnfrdeith wortseas theirsokle(Sensoon, _
"willin the work, i the ode:ThContractor's nor intended en a Law Tor snot(Sec 7o44;' - —- - - --e _- -
'Bua a a ady a:ions Code Tne &tem ,ced w o d data not apply to an 103 - UFER Required Inspections
ow cr of progeny Who wilds or improves at such and who ams such work himself
m through his own employees.Provided that ease intents<mema.m not mtwaea or 104 — REBAR i
,o erect or sale:lf:Eow<veithehBeingoitmvtuvememvsold-w'nhinoneywrof 105 - ANCHOR BOLTS +-� ) -0'. "d "
completion,the owner-bender will Nevada burden of proving tem he dm nm wild or '
imponverorpnmoae"rsak.). 106 - SEWER & WATER
---owner_.____ .__.-.- ...
_._wren__wren
ner
. a ; oroovhepof rojheP(set.7,vmB..,irvelycoeingwithlicensedconmmont° 202 - UNDERFLOOR PLUMBING
onmmn me project Isec.7B Bedstead dna Prof-rmomna Code:)The Comptemr: 2 03 - UNDERFLOOR MECHANICAL'f'
License Low does not apply m an owner of property who builds or improves Ihemon, '
i :. ..ane who conwess ch Projects,.wilh conwnogs)licensed,pursuam.m.the __ ..............,
Contractors ..2 04"- -UNDERFLOOR--FRAME---' _„ ,"- -"'-__-'-
it cennsee L La
131..c.cmuWdarS,dT " ' a&refrms aeon 205 - UNDERFLOOR"3NSULATION
oriror;..t:, ., ,e: ....,, ,,none me: 301 - ROUGH PLUMBING
'r "WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm under penalty of perjgry than,of the following aeclmatiana: 303 — ROUGH MECHANICAL
❑ 1 mrJc'°nd'will maintiin a'Ceninmict of 6dwnt to self insum for Worker's 3 04 - ROUGH ELECTRICAL
Camperami......,-provided for by Section 3700 ofthe Labor Code; for She
performance of rhe work for which this perod,is issued.t 305 _ FRAME
121 h midwill rdn nh W rk r, npcasau n 7 Insurance, a Widmer!by Section 306 — HOLDOWNS
My Lb cod r Slept. aance of the 'Por mthis a d MyW lee o pe dd crur. a tha(n�}�'Pol y qbe c ''
307 INSULATION
SA?7kfFuUDtfrlNmier � �� �Z3 U�r 308` ;SHEEROCK +._
til
WORKERS
-
-COMP
0 FROM
t-9-��'TS 4-x30'9'`—' ''EXTERIOR'LtATH 1.
COMP MNSATIONINSURANCE" r
-- --._3.1.0INTERIOR-'IATH -'----- -- —
u I(P(1Tts
seen
need not be comPktfd d the permit iz for one hundrtd dollars ';a5 -----_—
a!ao)ormaa,) 311 - SCRATCH COAT , - '
--
rc nrty met n theperf- f m work t which thispermit s auedl- —-T"313 — 'ROOF"NA3-Ii = t - -;" .... •�- .• - ,_ _
hillnot pl-yany,pe y in...rto'm to61cbmc subjecto6th.Workers' 501 - FINAL ELECTRICAL'• ENERGY' -
Compensmio"law.of Cal fumm.Date
-Arr't°"' - 502 ---FI-NAL- PLUMBINGG'ENERGY- -----, - --. .- -
rNOTICE TOAPPLICANT If rt eknp thisCertificate ofE npton you muld f
hecome shhlcct to the W rkcrs Cnmpcn.mionl rovs fthe Labo Cone you nuist 503 FINAL MECHANICAL ENERGY
sn(;n,no-forthwith thshp tin or his pemitshll be ------ --504_-.._FINAL-BUILDING. ENERGY.
"*CONSTRUCTION LENDING AGENCY "' 505 - FINAL ELECTRICAL ' " "s •` '`' "" -
I hertby offrm that there is vohsvue on lending agency for the pert imams r, . 1,
afth ork f hmh this forma is issiodisec 3W7 Cm.C) ,
w —5 0 6— — GAS _TEST_.
d,_Q -I:end rnN me - `•_..•' � -.-
Linde Addmis 507 - FINAL PLUMBING
U-O I<coifythmlheverttdthisapPlicminnaMsmmthatNeeove
information is 508 - FINAL MECHANICAL'
:Iant.y cdireai:1°gree to comply with vol ciry and county mdinancesand stare laws relining 5 0 9 - FINAL GRADE
'0atJ mbuilding construction:and heretij�'momiirim mmemmatives of this ciry to enter upon
-lel thgb ement Abp prpnyrr pectin psor 510 — FINAL PLANNING
G ( ).-joce'to save dm dy and k ep hurml `rhe C tai of C pchm.igainsS
Ui Gvbil )- mens,c at,a t pcnscs which may n any y m agni tt said 514 - F INA PU IC WORKS
U'z Ciry n n ends Shea g d"Th Pwmo
AP L _A NDER Nf IND WILL COMPLY AI NON DINT'"" JSSUed b O�
:uLAr ?' 3 Q Z Y Date
Sig tu TAP a no Mono , l ate'. . Re-roofs
1_ „l,."ed" ' AZARDOUSMATERIALSDISCLOSURE;`' ,"'"
_. Will thein cantor(uni.e wiltlirig'mcupant stmt«,hvxfk havNohs mincnA _,-,Type Of Roof
d On by,N Cupert M ipal Code Ch pt 912 nd the Health end SefetY '•' - -' ........ - - " _:---
as
Code Swoon 255J21a1 t ' -• r -1`k• } r :y }I - st —
Alit. ave, l i 4, fi ,}' All_roofs shall_be inspected prior to-any oofing material being installed_
r:w'"
Will Iheepplicam fait rob ildingoccupantuseequ t e p, nice If a roof is installed'without first obtaining p g an'ins ec[ion'I'a ree'to remove _
mit he duserc roam nam.akdT cd M1y ih BayA wA QalnyM eget t -
Di'hc' all new materials for inspection Applicant understands and will comply with
( ❑Yes - S' ' ... ._ -. ., .,
alCnon-pomCsource regulations' :1 ,1
I hiJefread'the'bazmdausemon,ali requvembnts undo Chapter of the
Califomra Heilth&Safety Code.Secuon,25505,25533.W 25534:I.ndentend thin
.ifihe but ingdmsn 'curtcndy nota meant;Shat it is my responsibility to notify the-
1 .
hC
mcuPa' t e iequi 'c Si bh'mdv be met nor m issue ce a e Cenilost.of
p .., ,. ..
"^ Signature of Applicant Date
auth :deg t D All roof coverings to be Class "B"orbet[er
..OFFICE._ ,. .....
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__... .- neer.. .. ....