03030029 (3) CITYOFCUPERTINOMI
BUILDING DIVISION PERTS
BUILDING ADDRESS: JOHN K BARBEAU PERMIT NO.
10589 CULBERTS
R'S NAME: 10589 CULBETSON DR. PERMITESUEDA•IE
JOHN K BARBEAU
NE:
SANITARY NO. cONTROLNO.
ARCHITeLT/ENOIN88R: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300
LICENSED CONIRACIORSDECLARATION Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 70(X1)o(Divitlon 3 of dw Hudnesa aM Profeta=Code,and my Ilttnm 4
n
I.
rduwtt ad erten KIT R L/ELECT/GASLINE/REFRAME WALL
ameclau
D
3 q DammconTS DECLARATION
'[yy7 ARCHITECTS
1 understand my prom still N used u public records
LkawdProfcuinnai Nuu i 2003
5 OWNER-exempt RDE Ce Conu ON
1 hereby.(Sero that 11. exempt from the Comes Co e:A License Law for the
a O fallowing wen.(Sadat 703 L6,Business and Professions Code:Any city or county EWI ^
$ IN
whmM1 in issu n ee,tha re enmuuc4 elect,Improve,demolish,or repair any struned comment m a
_ S^ priortofu Wuantt.anto requires the applicant for such Contramdt Liccom aw(Chmmrnt tion
< thatWIslicensedpursuanttotheprovidonsoftheConlracmr',Llttnselaw(Chapler9 $Q.Ft.Floor $13�b'@
$ b, mmewingwlth Secdon7000)of DrvWon3of Ne Bud=aand Profeta=Cade)m
3 Nu he is ucmpt Nemfrom and the bunt for the alleged ewmptien.Any violation of
Section 7031.5 by any app sent fm a permit subjects the applicant o a civil pantry of 3'Aisbi (t18T8erO 0 Occupancy Type
not mon than five hundred dollar(M).
O 1,ua of Ne Fopwy.wmyemploy=wINvngesu Neuwleampewden,
willdo Nework.and Naavucmm 6notimended oroQewd forale(Sec.70N,Buaineu — Inspections
and Prolmdmu de:coThe connector,Lkun ww owner
me law dot apply an .r 102 - PIERS p
property who builds or Impresses,thereon,endwhodoe ateMwort Idmul(or0uough his
cum employ=.provided that such improvements art not intended motfemd for ale If. 103 — UFER
ho=mer,tic building or Improvement is sold within one year of completion.Ne newer
builder Sm"Ne bum.of proving that W did not Wild or improw for pulp=of 104 — REBAR
iaa'°) 105 — ANCHOR BOLTS
owmr of Ne property,w uelusiwly conuaming with Ikensed commount to 10 6 - SEWER & WATER
comwct Ne pmject(see.7014,Business and PmfcWms Cade:)T1m conuaamra U-
mnwLaw does not apply toanownerofproperty who Wilds Or improve,income.and. 202 — UNDERFLOOR PLUMBING
who tw.for such pwjecu wlNaconuslor(sl licensed puruunlwNe Convamors
LiccmelA203 - UNDERFLOOR MECHANICAL
ameam Mea ,B&PCImMs. 204 - UNDERFLOOR FRAME
Dam3� 205 - UNDERFLOOR INSULATION
WORKER'SCOMPENSATIONDECLARATION 301 - ROUGH PLUMBING
hyamm nndcr pewty or pe je yoro or he mnowdor WorkeesCo 302 - TUB & OR SHOWER
Iltsw and Will tion 3wm of Me 11tlloCode.for Me PC
mke...f the
nation,u provided Ire by Section 3700 0(dm labor Cade.(m Ne pedo,mance of the 303 - ROUGH MECHANICAL
wmk for which this permit Is leaned. 304 - ROUGH ELECTRICAL
0 1 haw and will maintain Workers compensation Insurance,as required by Section
3700 or the Labmcme.rer the performance ofMeweak for which this permhntiaumd. 305 — FRAME
MyW.,kcra Compe..da Insurance nmimand Policy number am: 306 — HOLDOWNS
Camict: Policy No.; 307 - INSULATION
CESTHICATE OF EKEMPnON FROM WORKERS'
COMPENSATION INSURANCE 308 — SHEETROCK
(lTtssecdon wed wt heaompleted title permit tsforowhundred dutlan(SIM) 309 — EXTERIOR LATH
Orleans) 310 - INTERIOR LATH
I certify that in the perfomunee of the woh for which this permit Is bound.1 dull not 311 — SCRATCH COAT
employ anypenon in soy manner=u m Wcomesubjectto dw Worker'Compcmimo
Laws of Colifomla.Dam 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT:.If.after making this Certificate of Exemption,you AmW 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of Ne labor Code,you meso
Z. foMwith comply with such provisions or this permit 0.11 Incremoved.
wremoved. 5 0 2 — FINAL PLUMBING ENERGY
.J
CONSTRUCTION
ont LENDING AGENCY
Z4 0 503 - FINAL MECHANICAL ENERGY
F� Ihembyemrm Na aresak.aomwcdnn lending agency for Ne pertorm.me of 504 - FINAL BUILDING ENERGY
a� the work for which this permit1.iauW(Sec.3M.Cl,C.) 505 - FINAL ELECTRICAL
W Q lender's Namc
az LeadersAddmas 506 - GAS TEST
UO I certify that l haw rand this application and atom that tic above Information nt 507 - FINAL PLUMBING
W Fcorrect.l agree w comply with all city and county on Inas sue lm
slaws misting to
building construction•and hereby representatives of this city tomer upon the FINA MECHAN CAL
OU
0.W ,hove-nundomd Property for Inspection puytoses.
(Wa)agme to save,indemnify and kanp homiest Ne City of Cupertino against 0 9 FIN
it t/ai Ilabilides,judgments,costs andexpemes which may many way smuc against WdCity 5 G
in U
;Alln�ANTeof the UNDER3fi NDS Aof ISD WILL COMPLY WITH ALL NON-POINT Issued byS WORKS Dale
RE L407pRe-roofs
AppHesnuCOnlramm amHAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appli=t or future building mcupant store or ha dle huudous mamddfined by de Cupertino Municipal Code.Chapter 9.13.mtl Ne Health ad Safety
section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
Oyes ONo
WI11 rite applicmt or fumes building accuPam saw cyulpmenl m devi=whichIf a roof is installed without first obtaining an inspection,I agree to remove
hazardous air comeminsnts u dcfincd by Ne Bay Ama Air Quality Mansgement all new materials for inspection.
District]
OY. ON.
Ihawmad the lineament maurlakmquimmemsunder Chapter6.95oftic Cdifor.
nk HanINBSafelyCodc,Seed=25505.25533ad25531.Iundcaand NBlribc building
d=not currently have a tart,Net It Is my responsibility to notify Ne oce,sat of Me
me no be ctpim IuuanttafacmdGesmof n Signa[ureofApplicant Date
r or auNONycda ant Dam All roof coverings to be Class"B"or better