03050140 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT* GLONTRACTURIIVT'�()RMAI'
BUILDING ADDRESS: HIGHLAND CONSTRUCTION ANDZtIRN003050140
OWNER'S NAME: 20073 NORTHCREST SQ : , PB"" t) / a8/2003
OM & SONIA MAIELL
ONE: 4082411858 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION
fi {1 by of irm Net I am Minced under provisions of Chapter 9(commencing Job Description
with"'��(,,,"!�{'`,7=)af Divtdo 3ofthe0 dPo.I.Mon Code, mylso emis Q �—
to,
a "deco" PVISION--IN HOUSE USE ONLY
r5 Dam T NO NEW PERMIT ISSUED, ORIG. #01050188
3
ARCHrrE LAR 10
�i 1 uhacrsund my plans mull be public retard
It Licensed Professional.
OWNER-BUILDER DECLARATION
jU I barony am.that 1 em exempt from site Comranoes Lienee Law for 1M C
COO following rerun.(9ecdon 7031.5,Buslonsand Professions Cade:My city or county \
which roquves a permit in ennuruc4 altar.Improve.demolish,or minor my strctum
—ZC prior in its issuance,sive requires the applicant for each permit to file a signed statement
F < the,Wislicensedpu.an,tothcpmvistovaftheContrctor'sLiessamLaw(CMpca9 Sq.Ft. Floor Area Valuation
e( s (commencing with section 700(Eof Drishm 3 of the Bud•...and Professions Cade)or $500
that M a exempt therefrom and the Weis for the alleged....,.,pda.My vimade.of
Scnln 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy�
not mom than Eve hundred dollars($50B.
P y ']I
�
❑I.Mowner afWproperry,mmy employaa with weguutheu sole campcwtion, 32618040 . 00 -
willdothewoh,and the strunureisnot7nanxiedaraame!ImMic(Sec.7044,Businum d Inspections
and Profndoa Code:The Contncmr's License Law don not apply m an owner of 101 - FOUNDA" IAF p
property who builds a impmvn therton,end who das ouch wont himsel f ar through his
own employ=.provided thatauch improvements and,not intended oroRered feature.if. 102 — PIERS
however,the building or improwmc n.la old within ane you of campleda,the owner-
-builder will haw da burden of proving that he did not Mid or improve far purpose of 103 - UFER
.10.). 104 - REBAR
❑1,as owner of the property,em exclainly convening with licenced nnboten he 105 — ANCHOR BOLTS
coatmet the project(Sec.7044,Business and Profusions Code:)The Catro m's U.
=has Law does am apply 0 n.of property wW builds or hormones tleea.ad. 106 — SEWER & WATER
who eonuacu for such pmieeu with a eontrsear(a)licensed(mune,in the Commoners
Laenmisw. 202 - UNDERFLOOR PLUMBING
❑l am exempt under Sec. .B k P C far this Lesson 203 - UNDERFLOOR MECHANICAL
Own" Data 204 - UNDERFLOOR FRAME
WORK ERS COMPENSATION DECLARATION 205 - UNDERFLOOR. INSULATION
Ihereby afRmr underpevby,of perjury one of the avowing declarations: 301 — ROUGH PLUMBING
❑1 bow end will summers.
ein W n aCeNfina o(Cavent ascii-loom fm WahefeCmnpcn-
aatian,as provided fm by Section 37M or Lou Labor Cade,for the performance of the 302 - TUB & OR SHOWER
work for which this permhia iuued. 303 - ROUGH MECHANICAL
pMM ua LaIbrICeae'faTWE aPmachars"0,`"moca"�mmhwxaupte-reinaimsen 304 — ROUGH ELECTRICAL
waheracampensationwmavacarrierredPolicy"umxram: 305 — FRAME
"eB Po' _ 306 - HOLDOWNS
C'ERTIFlGMPENSATIONINS RANCE RKERS 307 - INSULATION
(This suction need not M completed lftltelocal,isfaonc hundred dollan(gIW) 308 - SHEETROCK
nr1CM) 309 - EXTERIOR LATH
1 ueniry that In the performance of the work for which this permit is issued.I atoll not 310 - INTERIOR LATH
employ any person in any manor o u a become object to the Workers'Compensstion
Laws of Califarah,Dam311 - SCRATCH COAT
Applicant
NOTICE TO APPLICANT:If,after making this CeniOeate of Exemption,you should 313 - ROOF NAIL
become subject 0 the Worker's Compensation provisions of the labor Code,you mum
.Jz forthwith comply with such Protrusions;"this Permit shall bedaemednwoked. 501 — FINAL ELECTRICAL ENERGY
z` CONSfRUCTONLENOINGAGENCY 502 — FINAL PLUMBING ENERGY
F� Ihemhy aRnm that there its consouctan lending gcmy for dw performance,of 503 - FINAL MECHANICAL ENERGY
the work for which this permit isissued(Sm 7l57,Civ.C.) 504 - FINAL BUILDING ENERGY
kg1 r Landue,Name
�z Iander'sMdness 505 - FINAL ELECTRICAL
U p I testify that I haw mad this appliatan and rete thea the be.infarmNun is 506 - GAS TEST
4.r! coned.I agree to comply wit all city and county on inams and one laws rotating to
C rV': building construction,and hereby ao artorepr"entadvnofaucityaenterupont o — FINAL PLUMBING
W aha.-mentl0ad papery far ia(M1Noa prnpaaa 0 FI L
gL (We)came m soils,indemnify and keep harmless the City of Cupertino against
t/h Ilabilitiet,judgments,costs and expenses which may In my way seam against old City I
()7 Ia consequence of the Sooting of this PermlL
APPLICANT tMDERSTANDS AND WILL MP Y WITH ALL NON-POINT Issued by:5 NG Date
SOURCENS.
NS.
Re-roofs
gnauro of Applin _HAZARDOUS
MATERIALS DISCLOSUR Daa Type of Roof
Will the applicant or furore building occupant mom or handle hazardous material
u deRned by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Code.sealer 25532(a)7
❑Yoe ❑Nu 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
emit h"ardnus air contaminants as dc0ned by the,Bay Area Air Quality Management all new materials for inspection.
District?
❑Yrs ON.
111 mad the havardousmamrialstequlromcna under Chapmr695 oftheCeli(or-
niaHnith&SafmyCadc,Sa.M505,25533eM 53/.1adcnanddwifdm building
dooseen'tami'mne se an4multumy ren aulitym Wfythe onupat ofdm
mgniral It vibe-metpdar eau r Hca f" Pacy. Signature of Applicant Date
nerunmhorbad egenl a All roof coverings to be Class"B"or better
• OK CH/AN STRUCTURAL ENGINEERING Page
2752 Sheffield Place Project:
Castro Valley, CA 94546 Project No:
Tel: (510) 881-1818 By: Date:
Fax:(510) 881-1818 Chck By: Date:
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on sem@ wlthAOt written P erHno. m
the 11 'in Pept., City of Cup ` Dep
the stamPinB of iltis Pian and speciticaffatPi * 1p.
v
SHALL NO'T be held fo permit or to ba eni ,OCTUPP�P
approval of the violatior. of any Gro ff 9lCOr CA
of any City Ordinance or Stats
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Tel: (510) 881-1818 By: Date:
Fax:(510) 881-1818 Chck By: Date:
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2752 Sheffield Place Project:
Castro Valley, CA 94546 Project No:
Tel: (510) 881-1818 By: Date:
Fax:(510) 881-1818 Chck By: Date:
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