01030088 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITNO.
10100 PHAR LAP DR HIGHLAND CONSTRUCT( N AND PLU 1030088
. OWNER'S NAME: APPLICATION SUIT DATE
I_
MILLER CAROLYN TRI.ISTE 2007, NORTHCREST Ein 03/1.6/2001
PHONE. SANITARY NO. CONTROL NO.
4082411858
O z 2 ARCIInECT/ENGINEER:
BUH U ,1'IiRMI'I'INFO'
uF O O ItLDG '.LE PLUMB MECTI
FZi I-1 L I 1=1 I_1
to to y= LICENSED CoN'rRALTOR'S DECLARATION Job Description
ZO L�K 1 heruhy,alRrn,than 1 am licensed ander prov,.ion.of Chapter 9(e,n,n ercing,ah Ilion 7gg11 1' hoo . (the Ineine—ed 1' ff ,i is l.andhay tic
n full fort'an ❑tt
� I:... 1(S( _ Lie .7$7ssd Z klAIN PANEL 200 A
Be. '.ia'.L�/�._bt comm'mr_IJw1�(/��_('vQft(b,
t7i 3 m ARCH 11iC1"S DECLAHAI l
C taa. 1 midelomid my quo.shall he used it,public m,sml,
pp Liccnsd I'm@suiooal
OWNERIBUILDER DECLARA'I'[ON
at I hereby allinn than I anclo npl from IM1e Cmnrnaor's Li,enxc Law for the
F z G hollowing maam.(Section 71131.5.Business and Prolesions Cot Am•city of county
F G which mgnim,;I.....I In conamm one,improve,demolish,or repair any grvcmre
ce
toprion.it,I...ance,ulxorc4ui,es too applicum lbrxuchntetntn
,Prn,ia filen signed sme
c. than he is licensed pursuant o the provisions of the Contractors License Lw(Chapre 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7000)ob Divi xion 3 ob she Bloioess IoW Prole,one,Cn Is)
or that he is clempl therefrom and the basis for the.ailegcd eacmpdon.Any violation $0
of Sohl 7031 S by hny opplleam fon,)moil subjects Ihu applicant to a civil p'n:dly
of not more man five hundred rich—0,5001. APN Number Occupancy Type
0I.0, ref the prnpl:ny.or Illy Cloploy Ces with wages as their sole conionamion.
will Jo the work,and the structure is nm intended or nfrercd for sale(Sec.Tut
Business and Process""'
rofaxi "'Code:'I W Cm.I...or Llcenw Lew dues lilt apply to an Required Inspections
ooWnvr of Properly WIm builds or improves lemon.and who don such work himself
ongh his own cmlployces.provided that such improvements are not intended or - 304 — ROUGH ELECTRICAL
offered file sale.If,however,me budding or improvement is sold within one yearor �O 1 ' — F I NAI_ ELECTRICAL ENERGY
onnpl,ron,the,remcr-build',is W,cthe hmd'oof proving mbar he did nm build or J
improve litviono while.). 505 — FINAL ELECTRICAL
Cl I. I h p pry N,I, t r y,,It I' ,elms to
consumer thprejectR 70,14.Business andl f- ns Ciskei) IheControl l
L'cc '.Los t hqqq,I of property n build%or imp thereon
and who cortexesItu such protects nh a contractor(%)licensed purtiont as me
Contractor s License Lax. '7
I71 an,cscmpl lender Sec. - .m&PC for this re
Owner Uam TYA\
WORKER'S COMPENSATO
ION DECLARAI ION /
I hereby elf nn under penally of perlurY one of the Following dcdnnninns.- kI
❑ 1 have and will it,;..made a CcelRcutc ob Conuvn to xclf-(roma for Wutker's
Compensation. as provided liar by Scullion 37(1) of the Labor Code, lot the
peflboumee of IM1e work fo,wield,nils perutit is issued
O 1 have and sum alaimain W horr's Compenxmion memmmer,as required by Section
371X1 ol'she Labor Code,for me Nibs rnmore of the work liar which mix permit is
wed.My Workers Compra,don Insurance carrier all Policy number am:
Poliry No.:
Ken CERPIVICn'I'ION OF ExCMI9'ION FROM WORKERS'
COMPENSATION INSURANCE _
This Winn need nut la,el gdemd il'the permit Is Ga one hundred dollars
(S 100)or less.) ..
1 reach by that in theperformance of the work for which this Permit is issued,l
shall nal employ any plot
n in any i oho,, a to ryyyn subject w the WutkeM
CompcnwrICulirpmDonc li f l
npnc�,m //H.all,LL
Non6z T( LICAN'I':H.once looking this Ccrlilicale nb[?xeunpnon,you should
laconic subtler to the Workers Compensation provisions of the Labor Code.you must
Q Q lothwill,comply with such pmvlxioo,or Ili,lnonil xhil I he deene,drevowell.
zi'!.
f CONSTRUCTION LENtined IAGENCY
Q. I I hcrchy allich this lhcrc is,'wed(Site
097.hominy e.C.) for he Performance
of rule wild for wM1ich this p'rndt ix issued(Sec.31N7.Cie.CJ
S ndave
r',N
7 Z Le
Lcnder'x Address
V O 1 candy that 1 have read this application laud state that the aMwe maceration is
4. correct.I agno n.comply with all city and courtly mohnances and xtam laws rotating
Q C.1 rebuilding clinometer.and hereby authorize reprcsenl:nivesof ibis city u)unterupnn
�„ R7 theaMxo-tncntionW pruseny lot inileclinn purposes.
E,x A. (We)mgr a to save,in bloody and keep hunnlesv the City ol'Cuplaran aguuna
Vi tiabilities,jud ems,cuvx and egnnses which may in any way accrue against said
(� Z Cil,In col ur cf tIt,a. tia,cel "no,. .
APPLI r x N L COMPLY WITH ALLLNNNOOjf-POINT Issued by: Date
ppli.a mTmen.r - - Da Re-roofs
.ARDOUS MATBIt1AISAISCLOSURE
iH the aphlicam or future Molding xaeupmn stem m handle homedous mamriul Type of Roof
its delined by the Cupertino Municipal Celtic,Cltapher 9,12,and the Health and Sully
Code.Section 25132PC
DYes "° All roofs sit be inspected prior to any roofing material being installed.
W'Iu the applicant or future building occupant use equipment or devices which If a root'is insta without first obtaining an mspecli agree to remove
nail haaarJnox air cold; doanisax defnod by the Bay Arca mfr Qmlhy Managemmot
Hornet, all new materials for 1 .bolt. Applicant un � , ands and will comply with
ID Yes [I N,, all non-point source regulatio ..
I have rola the trnmdnnx mmerialx minimmens coder Chapter,6.95 of ma
CWhorria Heultl Sil'ny Code.Seel is s 25505,25517 end 25534.1 malennmd(hat
ifine..it oIng havcalen. hmm itis myresgmsibililym 1- 1the
erupma al n 11 ,cots x, 1 n act prior m relforc of, Ccnilicatche
Ore.
— 3/j/ L Signature of Applic•1a Date
'= d � roof coverings to be Class `Ba' or better
OFFICE