01090109 CITY OF CUPERTINO
BUILDING DIVISION' PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
823 CANDLEWOOD DR JIM HIGGS 01090109
OWNER'S NAME: APPLICATION 5 B DATE
JIM HIGGS 09/25/2001
PHONE: SANITARY NO. CONTROL NO.
N:OC ARCHITECT/ENGINEER: BUILDWG PERMIT INFO
&w G BLDG ELECT PLUMB MECI
LICENSED CONTRACTOR'S DECLARATION
z,_ I h<r<b (Srm that 1 am licensed under o f Chapter 9(commencing lob Description
:n ra 'awislonao p e &qD 995 . 60 SQ. FT.
with Section]000)of Division 3 of Ne Business and Professions Code,and my license
is
in full
Class a
force and eRe{)
0 d Licenu _p Lic.
LL O N
Date
_V I_ Camruco' ,w�
ARCHITECT'S DECLARAT Tr
,� _ 1 understand my Plans Shan be used a public re rds JUN 1 0
' 2004
i c o C Licensed Professional
OWNER-exempt R m the CoATION
I=K w 1 hereby.(Sect that 1 1. exempt ,wr the C Profession,
i s License law for the pp
_ =O following requires
reason.(Semon)031 S.Business and Profdcmola h,or Any city or county I/ ®Bp�/r� $97129
_-
,CS wh n y Per ttconstrict,.err nprnve ecmur.n p anrawnure rl� Itl`IIWw
i 3� ..p t t cc,of y the appl cent for such perp uofleas6 rd stammrnt. __ �as�,.�k,,,, _e _ - sees_--------
ththellCnud pi mltolnc provlsaonsoflh<Convacto Lc Law,(Chapter 9 s-♦ r .C...1Gs'(.'10Nk.A� 'T ,>� Valuation)
(commencing with Section,7000)of Division 3 of the Busmr./(and Pmfienions Code) t `p� t1y 07 'C1 7dW _l7 �f�.jl_ils(.)_
or that he is exempt Ihemfmo and the basis for the alleged alemptlod.Any violation
-of Section]031.5 by any applicans for a permit arra ecu the applicant to a civil Penalty
rofend mnrtthan five hundred dollars(s5BB). 101APN NN )�ATION Occupancy Type
01.as owner.1 the pmpeny,or my employees with wages anhcir sole compensating 102 PIERS
will do the"work,"and the'structure"is"a.,imendeaor bRertd'for sale(sec.700A,
'Business and Pmfcssions Code:The Contractor's License law does not apply to an 103 - UFER Required Inspections
owner of progeny Win builds or improves thereon:and who does such work himself' 104 - REBAR
o rbo gh his employ..p d d that such mpmv t s intended or _ _
_
.. . maiden ' 1 war a sh loior,ohunded f,m,i - IJ ih" racy 1O5 - ANCHOR BOLTS _ - •� _ -'.
i- �pintn,the awn nmlJer will nave tnc nurecn of Prov ng that hedid not build nr '
mprove for farrow of.ales). 106 - SEWER & WATER
yaw�6,nt -.. ._._. - -' - -"- ' -' 202 =UNDERFLOOR""PLUMBING- —.--re;prope y.am exclusively
• :\lr k'." !.
_ = construct the pmjem(sec.Jaw.Business and Profession.Code:)The Contractor: 2 03 - UNDERFLOOR MECHANI CAL
License Lew does not apply to an owner of propeny who builds or impmves director. -
' orc nets.for such o'ects.wilb.a.conurnswu r(x).11ce..ed
` . anewno.< Prj pnrsn rid e. .-----. __. 204- --'UNDERF-LOGR-FRAME--- _....._.__.
Conmannr's Licenu law. .,
re
❑I am exempt under Sec .B(&PCfor this rcuson 205 - UNDERFLOORn INSULATION
301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION .302 - TUB & OR SHOWER
Ihertby a(Stec under penalty of perjury one of the following declarations:
303 - ROUGH MECHANICAL
D I have an.d wili"maintain'a Cenifcme'of consent to self-insure for Workers 3 04 - ROUGH ELECTRICAL
Compensation, as,provided for by Section 37W of the Labm Code, for the
'performance of the.work fm which this permit is issued. 3 0 5 - FRAME
❑1 have and will maintain worker's Compensation Insurance,a;required by Section 306 - HOLDOWNS
- - 3700 of the labor Code;for the pciformance of the work for which this perotit is
307 - INSULATION
a -ass cd M"W k 'wC p t„ Imo nJP y bet are ..-, ..
Cam " at .j 9 Ij rI ; sP is 308'_ . 308: SHEETROCK
..CERnPTCATIONOF,EX1:MPnON FROM WORKERS';- f l 3091 1.E TERIOR-�liATHi•
COMPENsnnoN lNsuRANCE,t , ---.--3-10,- `-INTE R-I'(DR—LATH-_-_..__. _--
,•t.f,Crus aec4m ked not k vonphted if he permit is for one hundred dollars I 31 lr,l-y SCRATCH COAT u t t �.,,. ,..} 1 a Ir`.
_.._....313--- -.ROOF- NAI_L....
1"'or.f, LIT t n N Pe fore f the k f wh ch di pe 1's i. ed 1 ...........,.._.. t
h ll i employ any pe m any ma m is io been subjectto rhe Workers 501 - FINAL ELECTR'I CAD; `ENERGY
Cam
pcmerinoIi f C l f Dam
-'Apel rat T - . . - --502- .-. .FINAL-PLUMBING _ENERGY
-NOTICE TO APPLICANT.If.mle,making this C n f t f E.,niqui.n.you should
O be subjeet to' tn w k c� provisions the Labor Code,you must'
503. _ FINAL MECHANICAL' ENERGY
rnmply mnp omx t shallb deemed revoked 504FINAL BUILDING ENERGY7 -
_
-:71 "o" 1 ' CONSTRUCTION LENDING AGENCY "" 505 - FINAL ELECTRICAL r
F-
W7 'I hereby.(SImthan them is.conidunion ldndinj agency for fie Verfnrmance'i 506 - GAS TEST �•
� of the work for'Nichthis pertnts i... (Sec 709] Civ C)
0.
gZ LersdiCs Nm . __.. ._... -
z 5077- FINAL- PLUMBING
8 - FINAL
0 I-) Pan h .. y p« q ppo, upon 5010 - FINAL PLANNING funders AJd s::� I
,,,, 1 nfyOut lha read this city
a state thatthebra information g 509 FINAL GRADE
[- c n 1 gr m comply,with II sy d county,ordinances al sure 1 rclaun
Q soWildings'no andh b and
keert um tv sof of Cts smru st ANNING
N ebo e <i cd n f - ton
(W) g s tdemnfy andk pharmless NeCryofC peri 'oe against
T-i Vj li i j,dg, is s ilexpenu A h.my' any y me ginsg sad 514 - FINAL PUB C WORKS --
V C y Ci c quence STAN ' g of th x p" "t • n
A LIC NTU'DERSTANDS ANb WILL COMPL-Y WITH ALL hON-POIhT'" 1 -
so REG' ons - .2 �+ Issued by: Date
Signa.. fA I ✓Contractor ;, .,.•.• -.. .Date- ..• Re-roofs '---- -. - .
t. J ,HAZARDOUS NlATERIALS DISCLOSURE ' -
- nthevvu t rmeW"lag p do namen.zara a imicrad .,Typeof_Roof ...
asdf byN Cpen M t pICod Chld 9.12 and the Health and Safety
Codc, action 55320sy, ' - •� i -
y 'I7Ys
t .Elo.rl° roofing
-material being.installed_
will me.pcb t future total g occow or
use ry pmeat or
devices which If a roof is installed'Without first obtaining an inspectidfi; Pagree:to remove
son thaw'do sair cont ms as deft W by the Bay Are ArQ alny M...g t
m t] all new materials for inspection.. Applicant understands and will cold I with
n
,• , ❑Y<_ ,y ,; f t or I t � ' ,� l ,I:,. ; "-all�no -point source iegulahons'. k. 1' � - "
ha 'onal die hazardous matenals requirement, oder Ch4oar'6.95 of the
Cad
Imie NeaIN&Safety Code.Sectio..25505:25533 and 2553aL I understand this
'ifsh ing does natcprrcntly have n actual.the,if is my rciparoubility to notify the -----
ac p r o to m ni which no s hem,Pnof w. e f e Cenifcnm df
« p y _ Signature of Applicant Date
Il ?�1 roof coverings to be Class "B"or better
Owner ho(Ld s Dasr, All f -
r
cT ;'=t-L;.'; r .-..r' _:•,.,�. ..: ::.. .:...'_ ,., . ...f_. ..- . OFFICE-