02050099 (2) OF
CI BUILDI c DIVISSIIONNOPERMIT CONTRACTOR INFORMATION:
Bl11LJJlf:(Cs(,QDRBP$:_-R LAP DR HIGHLAND CONSTRUCTION AN eRRN 02050099
( p0�lfLLt2�5uU Nt RUTTER 20073 NORTHCREST SQ lff)Ti 7YM2
5I PHONE: 4 0 B 2 4 110 5 B SANITARY NO. CONTROL NO.
O O ARCHITECTM-NGINEF.R: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O h Z LICENSED CO,NTRACfOR'S DECLARATION R —�h D 7p
i�-� 1henby affirm that l am licenced under provisions of Chapter 9(commencing (271 OOA SbB)?ANEDS,/ i K SEMENT/2ND FL.
-yC with Section7"qof Diviion Softhe Business uWfirm"Ip nis Codaandmylicense
xS is in full force and effect 'JS7O Z
e z rrW 6 Licen ass ((((((!!!!!! Lic.N
Date J /!� 4 Contractorf( \\\
LL 0 t T ARCHITECT'S DECLARATION f I
ej 1 understand my plans shall he used E LAR mbfienee.mis
i p p Licensed Professional �nJ+
OWNER BUILDER DECLARATION J
w I hereby.(firm on 1 1. exempt form the Contractor's e:Any c Law for the
O which r�rtamn (Section)onstr Business and Pmfde o demolish,
Cad,:Any city or county $25000
P^otmi aims a.,idso to .im.,construct..1m,improve,demolish, file
eipair any structure
h 2�
following
�3 u purl q prapnsofthrmchpemuofienseLaedamtment m
n n _n - _
slut he 3lcn dpurspn drcP!o mons of the Comrtnoh License Law(Chepter9 3: q_F9.Tk&�a •. t y Valuation
(comment g with Seco ]0110) f Divis on 3 of the Boulness pad Profesoons Code) [ t 1 "., + .,a a\
or thai he Is exempi therefrom and the basis far the alleged exmnpuod.Any violation
of o)03 any applicant for n penniuubjmu the epplicem to a civil penalty-
of not.tmore than
five hundred dollars(ssfio). 3044PNNtdWe 'f ELECTRI AL,.'. t Occupancy Type
01,as owner of the propeny,ormyemployees with wages astheir sole compensatinn, 501 - FINAL ELECTRI AL ENERGY
—.will do Ne"work:and the structure is not'inmrWed'or offered for sale(Sec:7044; 505 _ -
Business and Professions Code:The Cuntmnora License law does not apply m nn tiODS I• •• '
owner of property Who builds or improves thereon,and who does such work himself
or ter ugh h' ploy provided that such improvements an not intended or
t R red f sale wf.n- e l thebuilding e reproof nicatProv issoldthat
w thm one yearbuild or
improve
for the owne.builder will have the burden of proving that he did not build or
improve for purpose of,ale.1.
.O L as owner of the progeny,an exclusively contracting wit licensed contmctom to . ,. ..
_-_ construct the prof no(Sec. to a Business andpro Professions Cadc:)The C.improves
thencon,
License law does of apply man owner th progeny,who builds or improves Norton,
1 wlm.vmmfictfi(Law, Projecu.with a.commemds)licensed pursuant to Om
Contractors License Low,t ..
❑late caempt under Sec. � ;B:4 PQfor this reason - i' I,1.,' :.
Owner ,
..WORKER'S COMPENSATION DECLARATION
♦ I hereby aRrm under penalty of perpiry one of the following dalonaier s:
Ya "•.3 0 1 have and will maintain o Cenifcam of Consent to self-insure for Worker's
Compensation, ea provided-for by Section 37W of the labor Code, for Ne
performance of the work far which this gamut is issued.
01 have find will nidinmm Worker's Compensation Insumnce,'ai required by Section
' 37W of the Labor Code:(r the performance of the work for'which
Cam r 57Mf'l Frx�1�= :. Nthis Permit
c t
issued My W k riCompensation Insu c .He, ad Polcyn ' rae
Pnl
%63o
..._i
_ _ , _ _
ey . -
CERTIFICATIONOF EXEMPTION FROM WORKERS': . s i t �.
COMPENSATION INSURANCE e-•t-I> t
I"IThis'union need"noi lie completed if the permit is for ane hundred dollars ``; -` . .f. : u'l: .,']jt
(5100)or I...)
I
cavity than the perfo' c f th work f -Which 0t perm t is its ed'1
shall not employ any Person to any manner so as to become subject to the Workers `
Compensation Laws of California.Date,
._APPlicanf. . .. __.._ _ ..._
NOTICE TO APPLICANT:If,after making this Canificiaof Exemption,you should .
Become subject to the Worker's Compensation probisimrs of Ne labor Code,you must
cc fdnh6iN 6roply'with such provisions or this permit shall be deemed rooked.
GGG>777 �" ' - - ";MNSTRUCfION LENDING AGENCY ' -�I -
rrd� 1 he far firm that From,
is'.imurd Se6. lending v.C) f the performu e
.(the okfrwhich this permi sd(SeE 309] Cv.Cj '
� Lede N ale .• 1 , _. .. . .. . _ .. ._ __ _' Z Leader's Add
1 certify that I have rted Ni application and suit that above mfommt an s
t4+' a it 1 gree r comply with all city and county minaordinances and nam lows er t g
�. to budd g coast
tion antl hereby on ,hon r p senmwes of flos my m enter upon
y W the ebo e e e t nod propend farihisfy nal o para ms.
Ey (y ., eg a t11 a e idem ify and keep harmless the City f cru a agai against 1
ti li it f n s g u cos a d expect h ch may in any way cane against said /\)
V City c 'e oftl m g spermu n /
'APPLI LL COMPLY WITH ALL O
o Issued by: Date ct (/ v
at. Appli ommmor : Re-roofs /
ZARDOUS'MATERIALS DISCLOSURE Will the applicant or fifinfic Wilding occaperu store or handle hares does mate rid _Type Of ROOF _._.-
as def ed by the Cupertino Municipal Code Chapter 9.12.and the Health and Safety
Coda:Sect o 35532(a) .. .. +• -1 S" 1; '+: •: I,.
.t 2
°Ye f �" ' t 1 , • !y-r i', All roofs shall be inspected p;wr to any roofing material being installed
theapplicontorfuturebuldtnd occupant use component ordevi,aswhich
ous air comemmams as defineby the Bay Arta Air Quality Management
----All-roofs
a roof is installed without first obtaining an inspection; hagree'to remove
ten hazard
District? all new materials for inspection. Applicant_ und_erstands and will comply with
oY<s' — P .. . P.Y.
�•:, all source7egulations. �t ,
1 1 have read the hazardous matcrids requiremenu under Chapter 6.95 of the
CNifomia Heath&Safety C ,S
odeecifi ns 35505.25533 and 25534.I undersmnd thn
ifthebm in docs no nen0y atenant that It is my responsibility to notify the
occulia' f' requir 1 w must be meiprior m issuu c of a Can iflcat of
eto
Signature of Applicant._ Date
;+
Ow r th ad gent Dam All roof coverings to be Class "B"or better
-.OFFICE