03050140 CITY OF CUPERTINO
T
BUILDING DIVISION PERMIT
BU IL DING ADDRESS: HIGHLAND CONSTRUCTION AND SEIMNO03050140
090 PHAR TAP 12
ERS NAME: 20073 NORTHCREST SQ "'i"'"`f3FTn8/2003
M & SONIA MAIELLA
E: 4082411858 SANITARY NO. CONTROL NO.
ARCHMECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLO
LMECH
LOo LICENSED CONTRACTORS DECLARATION
Ile b in fluil- licensediankc,sm,fithoes.dChaple,19(commenting
Job Description
IMNtW70,W)o1`DIvId 3o:rffieB
in fulom ad effect. n Code) 'rylice"Is
,14 Licensee). L 71— IIEVISION--IN HOUSE USE ONLY
IIIData Contractor NO NEW PERMIT ISSUED, ORIG. #01050188
A LAR 0
�Psbll.named,
ARCH
LVf 11 und. nd my planeshallh�c C n7
lt�q Licensed Professional
I
iL 0 OWNER-BUILDER DECLARATION
�x I thereby affiren that I am muceript from Me Commemes License Law for the
i.A O following matter.(Section 70313,Business and Professions;Code:Any city or county
which amounts a Permit to comadomm.altar,Improve,demolish.or repair any summum
prior to its issuance.also requires the applicant forstach permit he rile asilroul statemeni
that he is liumsed pursuant to Met provisions of Me,Commucton's Uamo Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 70013)of Division 3 of Mat fluirmesmul Professions Code)or
that he It exempt thearefecen and the buis four ft alleged exemption.My vlouti,on of $500
Section 7031.5 by my,applicant far a permit subjects the applicant to a civil formally of APN Number Occupancy Type
not...Man five hundred dollars($500)), 32618040 . 00
0 1.as owner of the pmpserry,or my employ=with wages It their sale compensation,
will do the work.and We I"clum is mointembut confirmed for safe(Sm.7044.Business
and Profession,Code:The Contractor's License law dead net apply W an owner of 101 — F OUNDKA�2�ffdins pections
property who bulldsorimpormas Memon,and who does such wroklosex dfor Enough his
own employ=,provided Met such improvements am not Intended mothered formle.If. 102 — PIERS
however,We building or Improvement is sold within one ynor ofcomplcdon,me owner-
builder will low me human or proving that No did not build or Improve(or purpose of 103 — UFER
safl'.). 104 — REBAR
E]1.as owner or that property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Ruslocam and Prefectures Code:)The Commemses Li. 105 — ANCHOR BOLTS
cents Low doca not apply to an owner of promeny who build,or Improws Manor.and 106 — SEWER & WATER
who contracts;for such projects with a contramer(s)licensed pursuant to Me Commerce.
License Law. 202 — UNDERFLOOR PLUMBING
to exempt women Sm _.B&P C for this ocams 203 — UNDERFLOOR MECHANICAL
I Data— 204 — UNDERFLOOR FRAME
WORKERS COMPENSTnON DECLARATION
I hereby Afrom under pentafty of penjury am offt following duclantlimur 205 — UNDERFLOOR INSULATION
'..am will ourtimmin.Cenliksme.fCcureacra 1°scif-inaure,forworlaces Co
301 — ROUGH PLUMBING
I neve a provided for by Section 37M of the labor Code,for that performance of Me 302 — TUB & OR SHOWER
�'mr
work for which this Permit 1.issued. 303 — ROUGH MECHANICAL
work
I'-w ane will maintain worker's Compensation firesuramoo,Is required by Section
')Ih 304 — ROUGH ELECTRICAL
371,f Me Labor Code,for the performance of wralic for which this permit Is Issued,
Wmrlme.Compensation huntrunce carthumul Policy mumba,me: 305 — FRAME
P"hr:_P
0N
CERnFICATE FMEMPTIC7RAN
W ' 306 HOEDOWNS
R 'W
COMPENSATION INS RANCEORKERS307 — INSULATION
(rals;section need not becomplead ifflue permit isforonchundooddollars(SIM) 308 — SHEETROCK
or kSL) 309 — EXTERIOR LATH
I certify that In the Krfomum of the work for which this permit is Wood.I Mail not
employ any person in my meaner an a in become subject to the Workers'Compmeashon 310 — INTERIOR LATH
Laws of California.Dan, 311 — SCRATCH COAT
Applicant
NOTICE TO APPLICANT.If.after anteing this Certificate,or Exemption,you shm.15 313 — ROOF NAIL
become subject to the Worker's Compensation provisions;of Me Labor Code,you most
z r0rhwith=reply with such provisions or this permit Mail be deemed revoked. 501 — FINAL ELECTRICAL ENERGY
Z 0
P:7) CONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
1 barchy.frizen out ftn is.monsinalim lending agency f.rhc perfornmirccid 503 — FINAL MECHANICAL ENERGY
C4 Me ourit for which this permit b,Wood sec.3097,Ch,Q
W Lender's Name 504 — FINAL BUILDING ENERGY
M Under.Add.
::) z 505 — FINAL ELECTRICAL
1 comfy that I haw mad this application and sum that the show information is 506 — GAS TEST
IL correct.I agree to comply with all city and county ordinances and state laws hitting 1a
building construction,and hereby mumonce mprosentativem of this city won:., 5� r FINAL PLUMBING
Irl U alurva-mentioned prof cry for inspection purposses. ::I: r
fag We)agree in saw,indemnify and keep lormandeser,the City of Curer %OA 4F L
I
yr,A lublififlea,judgencrus.costs and expenses which may in any waymcrue against aid City
in consequence of tho grunfing of this Permit. I WNG
APPLICANT WDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEr
I �XNS.
_JI Re-roofs
)VIturtoo al'ApplicamVICconmor I s' /VDAM Type of Roof
HAZARDOUS MATERIALS DISCLOSURS'
Will the.pplicamm for.building occupant arm or haddle humenterms co mod
N coined by ft Cupertino Municipal Code.Clumor 9.12,and the Health and Safety
IDi &m..25532(.)?
Oyu ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
11 harandous,air comemitunts as derincol by the Bay Area Air Quality Management all new materials for inspection.
c
Wet?
so'
0 Yea r-1 No
Ih�read the losanimar noted.ls requirements under Chapin,6.95.flhc Califor.
Iv
It I
�i.H�.lffi,Safely C�,S.d.i25505,25533mdU534.lun&amdthuifthe building
.'c
J=not currently haw a Imam,ustau;my.1 risibilityto notify Me occupant of Me
m4ubc me,prior I,
m4ui. hc ter,be, u f . Ica foccuparacy. Signature of Applicant Date
no, All roof coverings to be Class "B"or better
..I.ImMmi.dogmt