02080107 77t�F cUueERTTINO CONTRACTOR INFORMATION:
SION PERMIT
BUILDINGADDRESS: I PERMIT NO.
10589- CULBERTSON DR. -JOHN K BARBEAU• -- - - - --- - - -- 02080107 -"- "'-
ItDWNER'SNAME: APPLICATION SUB DATE
JOHN K BARBEAU 10589 CULBETSON DR. 08/20/2002
( PHONE: SANITARY NO. CONTROL NO.
4088738175 CUPERTINO, CA 95014
'0 ZO ARCHITEC(ENGINEER: BUILDING PERMIT INFO
�F REPLACE WINDOW/DOOR/FENC e #VEW PLUMB MECH
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Z O y Z LICENSED CONTRACT'OR'S DECLARATION Job DBSCrIpIIOn
0,_pp I hereby affirm that I am licensed under provisions
of Chapter 9(commencing
`sin fallSectionme and effect. an J of the Business and Professions Cade,and my license -
77<< sinful) le'i end ef&a
ig U DataLicaClasi r Lic.stm
Dere - S DECLARATION h7 3 w G ARCHITECT'S DECLARATION
g 1 understand my plans shall be used as public records
u�Nf
6 p p Licensed Professional
requires OWNER-BUILDER DECLARATION
I hereby affum that I.exempt from the C
taw for the
followingmission,(Section 7031.5 Business and Professions Code;Any cry or county
which rano sea a permit to construct,alter,improve.demolish, any structure pnorwits issuance, a requires the such permi LBleamLg
thmlm ul ansedliammdnt bodepmnsionirdthe Conowme,Lanae law(Chupur
t ll f Sq.,Ft Floo{-Are{27 Valuation
(comms c gp'th Section 7")of Division 3 of he Buun ia.asdf fmmans code) '(r•� a I(:rt i, i l i.i a I:. I .1P3�'.:�"�: '
or Thai he is exempt therefrom and the basis for the alleged.cxempuon.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty - Occupancy Type
of not wit than five hundred dollars 15500). APN Number„ - :r ,
❑1,as owner of the property,or my empl:iyen with wags ss they sole compensation,',
-will-do the'workt-and the structure is am1manded or attend'for'w1c'(Sec:-7044: Required Inspections"'
Business and Profession Code:The Contractor's License Law does not apply to an Q p `
owner of property Who builds or improves Neeson.and who does such work himself
a=gIs h's own employs p dad
' that h p vemews sum MI Intended r
offted f le If,however.the building rrap m Is aold w Nm one ye oL - -
co'pli the ne b Id will have theburden f proving Nat he did notbul1c R")
improve for Purpose f ) tr
—
.D I us,gwn f the propertm y.aexclusively contracting 'N heeded canvas rt,ro - - - _ 1: "
co w r th p j ct fSec 7D ,Bused and Prof ns Cade I The Cont or s
License Taw does not apply to an owner of property who builds or Improves n V
Wd.whoconvects per awh.pro3mu.wida a contraaor(s)licensed Furrow, Ire. `ser., '"•- ----- -
1.
Cavactf Lima.
und' Sm'_ B PC halos .
- y�� ..
O Date ,,n� --
f E C0 PERSwT]AN �N �• )
" emhy aRrm under,penalty of peeduTTry oneof the
^fall ing declarations.
D 1 have and will maintain a Certificate of Coram to self-insum for Worker's j
Compensation, as provided for by Section 37M of the labor Code, for the ,
performance of the work for which this Permit is issued.
D 1 have'and•will maintain Warker'a Campenmtion Insurance,as required by Section
3700 of the Lnitor Code,far we Perfmmance of the work far which this permit is
isami My Workf'Compensation Insurance tamer and Policy number are',y
POI cy No.... .. - I f:a.p V i
f•l I I CERTIFICATION OF EXEMPTION FROM WORKERS' I .
COMPENSATION INSURANCE .. _. ......_ _ _. _ __ _ _ -.
(Th a imuon neetl not be complemd frhe permit i.for one hundred dollars
yr '
1 Pen fy t in thepeffonTgdat rof the work far which th perm t is issued,l '
r smell not amp y ny perwo i yyaaf�__ nlln a ub)ect_to the Workers '
mer so come I•,
to s I , Ih is me
_ PPp�kpe���yy'ssJtyy . . _ .. __ _ ... . _ _... . ..
'NPO'1'Ig®TO' C T: ,atter making this Certificate of Exemption,you should
Q Obmoine sub tithe Worker's Compensation provisional'Ne Labor Codc.you must
forthsvnh mply with such provisions m this Permit shall be deemed revoked.
r ... -_ .. .. ._ _..
y -
CONSTRUCTION LENDIN GAGENCY-
1 hereby affirm that them Is a construction lending agency for the performance
-of the A for whichrNls Permit' issued(So..3097,Civ.C.)
QLenders
_ e. . _.
Lender's Address
1 certify thin 1 have read this application and state that the above information is
OE comate 1 agree to comply with all city and county ordinances and state Taws mining
U m building construction;and hetehy euthorian representatives ofthis city to enter upon
the above-mentionml property for inspection puryous. -
(We)agree to save:indemnify and keep harmless the City of Cupertino against
Fri V4 liabilities,judgments,cos¢end expenses which may in any way acerae against said
U Z City in consequence of the granting of this permit.' yr7
_ '�_' APPLI INDERSTANDS ANOWLL COhIPLY WITHALL\0'POLT [SSlledb Dat
T/ L/
SOt 'E REG' TION. Y:
o I
..n I ed 1. thLe n
Si or PplClicant future Wil Care.Chapter 9.12,end N ^� Re-roofs
HAZARDOUS M g DISCLOSURE U.
ind
ATERIAIS DISC
11 IM applmam m(rose buddrn a t mart or herldle hazanbus mmentl 'Type Of Roof - - - - •...-. e _-- - ••^Health and Safety r
Coda DYi n125532(al ''•' - ♦i d. k s I', t v `. i n. s C f.l t; L•"1 L �1 c
"° a All roofs shall be inspected prior.to,any roofing matenal being installed.
Will the applicant or furore building occupant use equipment atdevuce which If a roof is installed'without first obtaining an'inspecnon;'[agree to remove
emit hazardous air c maminann as defined by the Bay Arca Air Quality Management
'Di,mt,? - " all new materials for inspection:-Applicant understands and will,comply,with
" DYa -- - • ZNo -; all non-poini'souice regulations.,
I have reed the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code.Sections 25505,25533 and 25534.1 understand Nnt
'if the bu0ding does not cunemly have a tenant.(hot it is my responsibility to notify the - -
acuPaul of the uirtments which mu be met prior to issuance of a Cenifcam of
Si nature of Applilpant. Date-
n au orizedage1 De All roof coverings to be Class"B"ki,better
:..::... :..... . _ .. . _. _.... . . . . OFFICE '- .... ... . _ ..