03070199 (2) CI'T'Y OF CUPER'f'INO
BUILDING DIVISION PERMIT C�N,,TRACTQI2INFOR1VTt�TI N
0u11-DING ADDR17SS: GARY CORBETT CONSTRUCTION PERMIT N003070199
99-1 TA 7nT,T,A rT
FR'S NAME: 413 ESMERALDA DR PERMIT ISSUE DATE
SAM & CONNIE CANTON 07/9.5/2003
NE: (831) 420-1148 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
0 0 0 0
+Op LICENSED CONTRACTOR'S DECLARATION )obD Intron
i W F I hereby affirm that I am licensed under previsions of Chapter 9(commencing
c `uj with 5cc ion 7(A11B of Diviaion Sof Ne ncas and Pmfcsainns Cs dc,and myliccnu is ■
'em mmnfn ndcrfea�shalkdc
�4a4ga{ 3 BATHROOM REMODEL
;� Licen C 2 8 2003
are^ 1Y xtor AION <oA F OCT
CLARmend.)wU1 untlensanJ mypublic rccbrJs
to Licensed Professional
po OWNER-BUILDER DECLARATION Eil1ILDING
2<E 1 hereby affirm that I am exempt from the Comracto's License Law I'or the
0 0 follnwing reason.(Section 703 1.5,Business and Professions Coda:Any city or county
3: which requires s permit to construct,altar,improve,demolish,or repair any swctum
_Zo" prior to it issuance,also mgtima the applicant for such Permit to file a signed statement
ppZ< that he is licensedpursuanttotheprovisionsoftheContractorsLicenseLaw(Chapter9 Sq. Ft. Floor Area Valuation
zt- (commencing with Section 70N))of Division J of the Business and Pru(essiom Code)us
e R$E that he is exempt therefrom and the basis for the alleged exemption.Any violation of 35621044 . 00
Section 7031.5 by any applicant for a permit subject the applicant m a civil penalty of
nor mnmmanfive hundred daBarsn5NB. - - ppN Number Occupancy Type
�
I,u owner or the property,or my employees with wages as their sole compensation,
.will do the work,and theswcwre is not intended or offered for (Sec.1044,Business — d Inspections
and Professions Code:The Cobol License Law does not apply to an owner of 10 2 — PIERS P
property who builds or improves tbemon,and who doesauch work himself or through his
awn employees,provided that such improvement are not intended or offered for Sate.It, 103 — UFER
however,She building or improvement Is Said within one year of completion,the owner.
builder will have the burden of proving that he did not build or Improve for purpose of 104 - REBAR
sale')' 105 - ANCHOR BOLTS
D1.as owner of the property,am exclusively contracting with licensed contractors t0 106 - SEWER & WATER
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cc=taw does not apply in an owner of property who Wilds or improves Bureau.and, 202 — UNDERFLOOR PLUMBING
who contract for such project with a contractor(O licensed pursuant to Ne Contractor'sLicxm.Law. 203 - UNDERFLOOR MECHANICAL
❑Ism exempt under Sec. ,B&PC for this reason 204 - UNDERFLOOR FRAME
1371 Da1e 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
Ihereby affirmunder penaltyofperjuryaaenfthe fallowing deearauom: 301 - ROUGH PLUMBING
ave and will maintain.Ceofemm of COment,.se16Wum for WOheM1 Compen. 302 — TUB & OR SHOWER
,u Provided for by Section 37M of the Tabor Code.(or the perfamtana of the 3 03 - ROUGH MECHANICAL
for which this permit is issued.
ave and will maintain Workers Compensation Insurance.u occulted by Section 3 04 - -ROUGH ELECTRICAL
of NC Labor Code. Ne performance of the work for which this permit is issued. 305 — FRAME
rkersCompensationlnsunnecc...andPolicynumber 306 — HOLDOWNS
r rn,'7K�'rS�LS� Pofi.yNPR ;q � 307 - INSULATION
CE TIFICATEOFEAEMPnON ORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
ffhisrecuon need aur to cnmplcmd if the permit is for one hundred dollars p$TO) 309 — EXTERIOR LATH
Icenir) 310 - INTERIOR LATH
employ any
Just erthe
nanymanner a Ne work for which this the PermitisIssued,lShall nut 311 SCRATCH COAT
employ any person in any manner m u to become subject m the Workeri Campensatlon
Laws.[California.Dam
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT.If,after making this Certificate of Exemption.you should 501 - FINAL ELECTRICAL ENERGY
become subject 10 the Worker's Compensation provisions of tM Lahm Code,you mast
=Z forthwith comply with such provisions orthis Permit Shall ledeemed revoked, 502 — FINAL PLUMBING ENERGY
?0 CONSTRUCrONLENDINGAGENCY 503 - FINAL MECHANICAL ENERGY
I hereby M.Nat there is a construction lending agency for the performance of 504 - FINAL BUILDING ENERGY
z> the Under,for NameichNispermithivuedfScc,309],Civ.CJ 505 - FINAL ELECTRICAL
31 Q Lenders Nam.
�Z anaera ddmt 506 - GAS TEST
p 1 certify Nat 1 have r.ad this applicasion end sum that the be.infosmawn is 507 - FINAL PLUMBING
Fconed 1 agree to comply with all city and county ominarm..and stat laws relating to
7 U building construction,and hereby authorize representatives of this city to enter upon the FIWNWG'� L
Na "hove-mentioned property for inspecion purposes.
(We)agree to saw,indemnify and keep harmless the City of Cupertino against 0 9 FI
cn liabilities,judgmenu,costs and expenses which may in any way accrue against Said City 5
U z APPL CANT UNDERSTANDSof due Standing of IArs Permit,ND WILL COMPLY WITH ALL NON-POINT Issued by:5RKS Date
SOURCERE
Re-roofs
me ofA plican .est nor v Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ser future building occupant store or handle mobdous material
u de0ned by the Cupertino Municipal Code,Chapter 9.12,and the Hearth and Safety
e,semina 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Yea �Nu
Will the applicant or future building occupant use equipment or Jcviccs which
If a roof is installed without first obtaining an inspection,I agree to remove
It hamNous air conuminann u defined by the Bay Area Air Quality Managem<nt all new materials for inspection.
strict?
DYea o
I have mail the ham ousmamriels mcm
uireent under Chapter 6.'15.1 that
'n.
Can.
nia HcaIN&Seciy Cwlc,S dou25.505,25533a 23534.1undentndthairdo IeiIJing
does note cunemlyyarratpnant.Nel it i apeaslhlllly In notify N.aYupant 0(the
yOmer chm NS .t triase un"C n mar coancy. - Signature of Applicant Date
o rar,atnna,<Jc /� � Dam All roof coverings to be Class"B"or better