03010138 CI'T'Y OF CUPERTINO ' SoArcw
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: HIGHLAND CONSTRUCTION AND FLUNNO.
10280 PHAR LAP DR 03010138
OWNER'S NAME: 20073 NORTHCREST SQ APPLICATION SUB DATE
GILLIAN RUTTER 01/23/2003
HONE: 4082411858 SANITARY NO. CONI ROL NO.
ARCIRTCCTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
CJ 0 0
woo LICENSED CONTRACTOR'S DECLARATION Job Description
K U G 1 hereby altirm that I am licensed under provisions oo
f Chapter 9(commencing
�<iwith Section700Onf Division Sad Bic Busincssand P Code.und my license is
in full tortes bcffccr� 7654 RE—STUCCO HOUSE
F?F Dae Contractor TION �IOVN A��D
b+-a
� pa l understand my plans shall Is,used as public records
APR 2 4 2003
3 u.G Licensed Profcssimml
F u.0 OWNER-BUILDER DECLARATION
3 MI hereby aflirnl'but 1 net eanmpt from the C....Ime(or's License I.uw ln ithe BUILDING
�'���y,
'V o following mamn.(Section 0031.5.Business and Professions Code:Any city or county
X m E which rectums a fermis m construct,alter,improve,demolish,or repair any struaurc
—� poor Or its issuance.also requires the applicant lorxuch permi to file a signed Statement
Fsp that heislicensedpursuantmthe provisionsofNcContractors License aw(Chapter9 Sq. Ft. Floor Area $450'010ation
,.a (commencing with Section 7000)of Division 3 of the Business and Professions Gavle)nr
that he is exempt therefrom and Ne basis for the alleged exemption.Any violation oI
Section 7031.5 by any applicant for a permit subjects Nc applicant to acivil penalty of bC Occupancy Type
not mom Nan Five hundred doll..l$Sro).
h as owner of the pmpcn Sonoran Or is intended
with wages as Nei((Sec.
nrm.Business
will Bothe work.and theoCmaisnotintended lirawit for saltpplyto44,Business of
dPmreaaonaGd: Teconmaetnralicen Law it.not apply to an ownernr 102 - PIERS egwredlnspections
property who builds or improves thereon.and who doessuch work himaelfor through his
own employees.provided that such improvements are not intended or offered for Sale.If. 103 — UFER
however,the building or improvement is sold within one year of completion,the owner- 104 — REBAR
builder will have the burden of proving Nat he did not build or improve for purpose of
ate.). 105 — ANCHOR BOLTS
❑1,as owner M the propero,am exclusively contracting with licensed can me a.m 106 — SEWER & WATER
concoct the project(Sec.70W4.Business and Pool essiuvs Code:)The Contracmr's Li-
coastlawJoeesnotapNymanownerofpropenywhoWildsorimprovesNcrconand. 202 — UNDERFLOOR PLUMBING
who commutes for such projects with a contractors)licensed pursuant o the Contractor's
License La203 — UNDERFLOOR MECHANICAL
w.
C]I am exempt under Sec. .B&PC for Nis match 204 — UNDERFLOOR FRAME
OwnerDate 205 — UNDERFLOOR INSULATION
WORKER'S COMPENSATIONDECLARATION 301 - ROUGH PLUMBING
I hereby afford under Penalty of perjury one of the following declarations: 302 — TUB & OR SHOWER
t
1have and will maintaineCeniBcam of Conserve Cook.
tfor Workers Compete
cation,as provided for by Scninn 3700 of the labor Cudc,for the p<Rormancc of the 3 0 3 — ROUGH MECHANICAL
I
nm which this Permit isiaxaca 304 — ROUGH ELECTRICAL
El I have and will maintain Worker's Compensation Insurance,as required by Section 305 - FRAME
3001 of the labor Cade,for Nc performance of the work for which this permit is issued.
My Workers Colse
mnaatinn In urunm cu or c,and Policy mfmber arc: 306 — HOLDOWNS
Cam e ✓tiA PolicyPr� 307 — INSULATION
CER1'II'I ATEOFEPEMPIION FROM WORKERS'
COMPENSA'I ION INSURANCE 308 — SHEETROCK
(This Section need not live completed if the Permit is for one hundred dollars($1 TO) 309 — EXTERIOR LATH
or less.) 310 — INTERIOR LATH
1 cenify Nur in the Performance mum work for which Int:potion is bound,I shill not 3 11 — SCRATCH COAT
employ any Person in any manner So ax to become subject n the Workers'Compensation
Laws of California.Dale 313 — ROOF NAIL
Applicant
NOTICE TO APPLICANT:IL after making this Cenilicate of Exemption,you should 501 — FINAL ELECTRICAL ENERGY
become subject to the Worker a Com penodan PrOVIS Ons of the labor Code,you mass' 502 — FINAL PLUMBING ENERGY
,7, foMwith comply with such provisions or this Permit hall be deemed revoked.
O p 503 — FINAL MECHANICAL ENERGY
z CRUCnONLENDINGAGENCY
[-+� Ibemhy affirm Naattdrum isaconstruction lending agency for the pennrmancc of 504 — FINAL BUILDING ENERGY
W' > the work for which this permiIisissued(See 309Y.Civ.C.) 505 - FINAL ELECTRICAL
Under's Name 506 — GAS TEST
Z Lender's Address
U O 1 certify that 1 have read this application and:'am that the shove information is 507 — FINAL PLUMBING
W t"' correct.1 agree m comply with all city and county nNinanccs and state laws totaling to
O U building conswction,and hereby solution isprescriodwsOfdiscilytoenteruponft 5 FINAL MECHANICAL
W above.memioncd property for inspection purposes. 09 — FIN E
(We)agree m save,indemnify and keep harmless the Cif,Of Cupenino.,it mt
„Fy H liabilities.judgments,costs and expenses which may in any way accrue against said City 5 N G vL
U Z inconsequence,, thcloolingnflhi, it.
.. APPLICAN' iRST DS WILL COMPLY WITH ALL N POINT Issued byG 1 WORKS DaIC
SOUR
03 Re-roofs
Signature t tea ommelor Date
I LARDOUS MAT[RIAIS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the CoNdino Municipal Code,Chapter 9.12,and the Ilcal'h and Safety
Gde,SemoYes YI n 25532OV Nn All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or Twort building acupam use equipment or devices which If a roof is installed without firs[obtaining an inspection, I agree to remove
emit hamrdous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District? ( u
Vcs
I have real gre hamNaus madruNicquircmcnti underChipmr 6.95 of the Califon
mallcalN&Safe n�C.'c�donS 55115,2+S33and25534.1 understand Natil the huildmg
doo,amrcu by moa / at iti rcsrysmihility mnntil Yt 'cupant of the
rcyni •me .e tic SI hen it mneeor.cenificamof a cy� Signature of Applicant Date
ownerm min rzcda e ' All roof coverings to be Class "B"or better
.arc