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03070199
CPfy OF CUPEW11NQ BUILDING DIVISION PERMIT 1C+ONFTz RAwCxa T�O,•R�ZIN,Ir O-?RMAT+Jn'O BUILDING ADDRESS: a GARY CORBETT CONSTRUCTION PERMITNO03070199 OWNER'S NAME: 413 ESMERALDA DR PERMIT LSEUE DATE SAM & CONNIE CANTON 3 "ONE: (831) 420-1148 SANITARY NO. CONTROL NO. ARCHITECT/CNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH CT +Oo LICENSED CONTRACTOR'S DECLARATION lob Description ZC 1 hereby affirm that I am limmord under provisions of Chapter 9(commencing <U wmimh uS�7MeB,rroe_)fLDivison Sof!:,Ria � C� 3myliccnm iscQBATHROOM REMODEL FINp LE® Pa. Co.,o ARCHITECTS CLARATION DECO 1 2003 W U 1 undersand my plans shall he tete ar public records r O E; Licensed Pmfessional 1 g OWNER-BUILDERexemptDECLARATacN BUILDING 2 00 I masa alarm thin I oro.mane from the Contractor's :Any c Law for Inc 00 following reason.IstttiuI 7fo3L5,Business and pr improve, damn.COdc:Any oily or county 5$ whim requires n peau.reponslruc, apes improve,demolish nr aptly any structure that he its iensedpaBumquime lit,applicant of for such Contractor's icensle ae ned Law .mem thathelicensed pursuant 70the of Division to G)etrmlesand Porf IoW(ChapteraCode) Sq.Ft. Floor Area _ Valuation Com$ teat he is(commencing hereon and the basis r t the the Busalleged exempt on.Any Crede)ter 35621044 . 00 that he is exempt therefrom and to basis for to tllegcd exemption.Any vinladan of Section 7031.5 by any applicant[or a permit mbjcca the applicant o A Civil penalty of APN Number Occupancy Type not more than five hundred dollars(S500). ❑I,a Owner of the propmy,Or my employee with wages n their sale compensation, willdotcwork.andthe.w.umiamainandedoreffcredfouale(S.C.70hA,niainea — d Ins ections and Professions Code:The Comracmh License raw docs net apply to an owner Of 102 — PIERS p propeny who builds or improves thereon,and who does such work him elfor through his own employees,provided that such Improvements are not Intended or offered for sale.If. 103 — UFER however,the building or improvement is mid within one year of completion,the Owner builder will have the burden of proving that W did not Wild or improve for purpose of 104 - REBAR sale')' 105 - ANCHOR BOLTS O 1,as owner of the property,am exclusively contracting wit licensed convectors to Consvun the projet(Sec.70da,bum.. ad Professions Codex no Commutators U. 106 — SEWER & WATER came law doe not apply to an owner or property who build.or improve Rieman,rod, 202 — UNDERFLOOR PLUMBING who contracts for such projects with a conaramm(s)licensed torment to me Concur. License L.w. 203 — UNDERFLOOR MECHANICAL O l am exempt under Sec. BA PC for this moron 204 — UNDERFLOOR FRAME' OwnerData 205 — UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION Ihereby air.under penally of perjury one of to following declarations: 301 — ROUGH PLUMBING ❑]have and will maintain a CeNfsom of Consent to selbinaure for Workah'.Compere 302 — TUB & OR SHOWER anion,u provided for by Section 5700 of the Lo Wr Code,for to pertarmancc of the 303 — ROUGH MECHANICAL work for which this permit is issued' 304 — ROUGH ELECTRICAL D 1 have and will maintain Worker's Compensation Insurance,as aeyvimel by Section 37W of to labor Code.for the performance of the work for which this permit is Issued, 305 — FRAME MyW rker.CnmpemationlmumnceearrierandPolicy�nsumberam: 306 — HOLDOWNS or ; J'ud PolicyN Y—o�r579'!G. 307 — INSULATION CC TIFICATEOFEXEMPTIONFt15RKERS' COMPENSATION INSURANCE 306 — SHEETROCK (fhissectioneecd not hecomplemd ifahe Permit isfmonehundmdd011us(SLUB 309 — EXTERIOR LATH orlesa) 310 — INTERIOR LATH 1 ecnify tot in the performance of the work for which this permit is issued,l shall nut employ any person in any manner an as u hemmciubject to the Workers'Comp,"adon 311 — SCRATCH COAT Laws of C.11rcomis.Data 313 — ROOF NAIL Applicant NOTICE TO APPLICANT:If.atter making this Cenifcate of Exemption,you should 501 — FINAL ELECTRICAL ENERGY become subject 10 the Wahera Campensetion previsions or dm V Wr Ghee,you must D forthwith comply with such provisions or this permit shall be deemed revoked. 502 — FINAL PLUMBING ENERGY z0 CONSfRUCTIONLENDING AGENCY 503 — FINAL MECHANICAL ENERGY I hereby affirm that then its construction Pending agency In,the perfximamz or 504 — FINAL BUILDING ENERGY :4 the work'it which this permitisissued(See.30D.Civ.C.) Lender's Name 505 — FINAL ELECTRICAL Ua t7 jz Lender.Add., 506 — GAS TEST p I Certify tel I have read this application and sate Thal Lot above IOfmtnadna is 507 — FINAL PLUMBING L (~ correct.I agree a comply with All city and county oNinanan and sum laws mitring to JU building construction,and hereby atuhorim repfcsenali.es of tis City to enter upon the RN FIN MEC CAL Gabove-mentioned properly for inspection purposes. (We)agree le eve.indemnify and keep harmless the City of Cupertino against *9F rq liobi l dies,judgment,costs and expenses which may in any way moue against mid CityJ z APPLICANT)of the granting of UNDERSTANDS AIs Permit.ND WILL COMPLY WITH ALL NON-POINT Issued by: CNWORKS Date t SOURCE RE �`t Re-roofs J• ' mofA plica ontracmr 110, HAZARDOUS MATERIALS DISCLOSURE v Dare Type of Roof Will the applicant or future building occupant store or handle havardous material La defied by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety Code,Section 255320)+ All roofs shall be inspected prior to any roofing material being installed. Oyes ?Nu Will the appdcanl Or fulure building oceupam use equipment or devices whim If a roof is installed without first obtaining an inspection,T agree to remove emit hazardous air Contaminator as dermcd by the Bay Area Air Quality Management all new materials for inspection. District O Yea I hevc read tc hen n smamrials reyuircmcnt under Chapvr 6.9S of the Califon ilia Hctlth @ Sarcty Codc,Sccduns 25%5,25533 and 2553x.]undcrsund taiOnc Wilding �� Jas not cuncnll sea tlnent,thot't�iSm .ponsibilhy m nndfy the a)cupmt of tc gmrtme In On w at tnrTuisso c))f.0 B9leor mpxr y. - Si gnature of Applicant Date roc utonnJagcm All roof coverings to be Class"B" or better 0 aOne CQ- AY OF CUPERTINO 07 o 1 q � Q 0 � • CUPE�INo PERMIT APPLICATION FORM APN # Building Address: Mailing Addres (g differe t from uilding address): 2 LA Owner's Name: Phone#: ©% 3 Contractor: License#: v 2B V Contact: Phone:(33 42IDk0cC6 Cupertino Business License#: ,2 Fax:e- 4a Building Permit Info: Bld Elect Plumb Mech ❑ Jobes ' tion: esi ential fD J3 -5 Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cof Project: Oc stgcupancy Group: 02 aa � o � Type of Construction: Please check this bo roject is a second-sto addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Elec 600V> I OOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING AOL BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING I of 3 S6 (� COY OF CUPERTINO CUPEYOF PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb)g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINfERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL Aft BREMPOWER Power Device/Apparatus ELECTRICAL low 2 of 3 GG CITY OF CUPERTIA CUP TYOF O PERMIT APPLICATION FORM Qu t' Fee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC• Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3 J ' t SUBMITTAL - f ►uL o0 t � 1 E F 0 2t .� U)_ 2003 100 i I I } f, t OFFICE COP, r� i uu in ' ANCE WITH TH CITY 08 GlURT'fy0 CODES AN MANCES 4 O DATEED SIGNEU_ I ti►PAt-As This set of`'lan ,nd specifi,ations MUST Do kept on he I b at all tin ao and it is un ? t5(4c5"/e;k Inwful to maF ,any chanes or alteration: ; on sAnFdina ut written ?i9 tss from thA hupt., City of Cupertim . Tho at, f this plan and specil cation5? SHALL a ei o perm ur Be An approval Or re viunuoull ul ony pluvialvor '• I�.L�..� 41 ,f any City Ordinance or State law.