01070128 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:,
BUILDING ADDRESS: PERMIT NO,
10280 PHAR LAP DR HIGHLAND CONSTRUCTION ANM PLUM01070128
OMUM4 RUTTER 20073 NORTHCREST SQ APP}1�IfOJ $ �jAft
PHONE: 4082411858 SANITARY
NO.
Lt U CONTROL NO.
Matz ARCHITECf/ENGINEER: BUILDING PERh11T INFO
he w I D E ECT PI,
<<a L 1-A L I
LICENSED CONTRACTOR'S DECLARATION
1 nareb Irirtn Net 1 am licensetl undo JJob Descr tion
O�-o Ya provisions o(Chapmr9(commencing REROOF & NEW FURNACE1KC &
pw Cj with Section 9000)of Divi"an 3ofin Businasend Professions Code,and my license
m fall forcawd aBec 7�� 4 WINDOWS/ 1 SLIDING DOOR &
s e,a License Class Lic,p
°'o a U Date Co. -or r ��
3 u�''. ' •
ARCHITECT'S D[CLARAT
to
g 1 understood my plans sit pgla pis Its: Gp Js��� p .
a4o o Licensed Professional ®IGI`•iYl 9� N�E'E At 0 g��/VS T O{Z �' G/G C.C.i/T7
o a OWNER-BUILDER DECLARATION nsc law for the /-
-w 1 hardly affimt mat 1 am ate t�pp�tit`� y( ;�
fall.—, scci Do 1031.5.BD'�Punya,V a`7"Aolc ty a...r.
rr S �� �(�s.K. O.�LeC
sl d y Ix n s at omr ipm,e Jcml p yon uurc
a3=.'prior t i's issue 'e,adsrequiresmeapplcant for such portae to file a signed sarin.., -
that bar Icenscrl pursuantt9 the pa f Convectors License Low(Chaperi) Y4 �..r.,.f Sq:Ft. Floor-AAr 5 [ r• 350 br41uation
(eo anteing with Sat ]IMP)of D $ �i��/Ik profesatons Code) f,.i.s Y t\:k L i a, i '! t f}+� l:"1 s. •k
or mat he is exempt therefrom and ihei{w�j��U41�uon Any violation
of Section 7031.5 by any applicant fora cmil ubje,nithe wrdicrshm a civil penalty
,of not more Nan five hundred dollars($50(1)), Occupancy Type
❑L as owner of the properly,or my employees with wage.ss Nei, In compensation,
will do the,work:and the structure is not intended or offered for sale(Sec.1tw;
'Rostra.and Professions Co101 - FOUNDRYde:The Commnor',License Law does not apply 10 an wired Inspections(D I$S(.,,�f )Jy
owner of property Who builds or improves thereon,and who does such work himself 102 - PIERS
or through his own employeesprovided that such improvements are not dumbed or ��L
ccriticalompletion,
ion sale.IL haweaeo the buildings improvement o moot n sold he did hot year or - - - R' --'
__ 'T _ ... _".. .
`nlooseion,the owner-builder will have me burden of proving that he did trot build or "
reprove fm purpose Dr wla.l. 104 - REBAR
_ _._ ____TOS ..._.—ANCHOR -BOLTS . .
❑I u he f the P(See
Businanselisessrly
t t g lit Ii huh ciamtoo to I ,
v. construct the prosect(S 70W Basin and Pr fesnon Wild,
The Contmemr's 106 - SEWER & WATER
License law does not apply to an owner of properly who butltls or improves thereon,
andwnD cnntmrts"mr seen projects witn..contract°r(s)licensed pursuant to.the.._ ..._.. ..-_-202 - -UNDERFLOOR •PLUMBING-- -._..- .".__ . ..._ - ... _.....
Con oamra License law. '
❑Iamesemptmndwsac: t_ -"T" em'PCtnrmiyreawn 203 - UNDERFLOOR' MECHANICAL
owner . 'D,ate ' '
204 - UNDERFLOOR FRAME
WORKEWSCOMPENSATIONDECLARlTION 205 - UNDERFLOOR INSULATION
hereby affiran under penalty of perjury one or the fallowing declarations: 301 _ ROUGH PLUMBING
❑ 1 have and will maintain a Cenificale or Consent to se,li-insum for Worker's 302 TUB & OR SHOWER
Compensation, as provided-for by Section 3700 of the labor Code, for the
performance of the workfor%inchthispannitisissued. 303 - ROUGH MECHANICAL
❑1 have and will maintain worker's Compensation Insurance,as required by Section 304 - ROUGH ELECTRICAL
noes of the Labor code,for the performance or the work for whim this permit is 305 - FRAME
,. issued My Workers Compensation Insurance tamer and Pohc number ere ,, „-
Srn�EFuu4, t. 306 ,,..,.HOLDO.WNS'
c XFMP`nO F M 623-17/ :i ; ;30.7' ':- :'INSULATION
.CERTIFICACOMPEN COMPENSATION
INSURANCE WORKERS'y !"Ll"': '
COMPENSATION INSURANCE' _;1;-
q I\• _. . ------308---SHEETROC&...-"- - -- __ __� _ ------
frit isecuan need am be completed finepcmm is for one hundred dollars 309 - EXTERIOR LATH
ai 11 less.).,
310_ ---INTERIOR--LATH .. .(.. ..
1 comfy that of the performance of the work for which his permit is issued.1 f _.."-
'shall not employ any person n any manner se as to become subject to the Workers 311 - SCRATCH iCOAT '
CDmpenn 11, Laws of cslm.I..Dara,' -.313.. - ROOF ..NAIL
.Aliplicant ° ' `. '
NOTICE TO APPLICANTO ftrmarking this Certificate f Encimprion.you should 501 - FINAL ELECTRICAL ENERGY
Z ti
� beta bject to the Worker's Compensationprevisions- of the IaM Code,y
O
forthwith cplywiin suchvm i ons or this permit shallnaaecmeareked 502 - FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY' '
a � byDfrmmmma 'sPaga tmnlendngageneyfDrmeprfDmarce 3097 504 - FINAL BUILDING ENERGY
Irl Q of the work for wit cit Nn porta t is sued(See. .Civ.[.1
y: -Lada :Node • ' -- I -- 505 - " FINAL' ELECTRICAL. '
Lend r AJJrcx.."
�L0 506 - GAS TEST 'd
V w. , " 1 cedily mot 1 have read ih s i ppl sod un wall nam that the above information is
Lv.Fi cortin:Lagree to comply,with all city and county ordinances and state laws relating 507 - FINAL PLUMBING
O.0 in building construction,and herebymilitarize presentatives of this citytoenter upon 508 - FINAL MECHANICAL
[y the above tinned properly f inspection purposes.
spec yah p P nnagaia,t 509 - FINAL GRADE
E.-Gs (W e) m. a dem If Jkcc barmlein the Ci fC ii
z It,[ It j dgmem. calls J eI ll his
hrunit. in any ay accrue against said
U.Z C tY m a f the grad Ill mi permit. _
..
so tied
I1NDE. T,. NDWTLLCOMPLYWITHALL -POI? Isstied��;O - NA ING ate
Z Q/
Si at f UCommcbsr "" Data Re-roofs
DISCLOSURE
C a,saatiDn 25s3_ta1 handle narallous mamrlW Type of Roof
AZARDOUS MATERIALS reci se
Wdl the appl cant (tart building n.Chart u o
aside
fined by m Carcinoma Municipal Cad Ch pt r 9.12 end the Health and Safety
°YeS °N ` _-All roofs shall be inspected.pnor.to.any.roofing material being installed.,,_-,-._ ..
nVill the applteam or future building occupant use equipment or devices which If a roof is installed without first obtainingan inspection I'soiree to remove
e h b air coram nems as defined by the Bay A.A Quality Management P o
oxtrialove. --❑No all new materials.for Applicant und_erstands.ancl w_ ill comply with. _
.. .. - -.
q; ., & all no -point ource re u.[Ions.-
1 have read Ne harerduus materials requirements under Chapter 6.95 of the
California HealthSof Coda.Sections 25505,25573 and 25534.1 understand that _ ,1
if Ile
buil g.Joes not a emltr yacarch that ilitany
mnst,be responsibility to notify the
occupan f require ¢wit' tan prior r°issuance of a Certificate of
Ol
d ." - tur Applicant _ Date
utnnri gain ' 1, i. Data , All roof coverings to be Class "B"or better
... _d. - . .OFFICE. .