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03030029 (4) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATI : BUILDING ADDRESS: JOHN K BARBEAU PERMITNO. 10589 CULBERTSON PERMTISBUEDATE OWNER'S NAME: 10589 CULBETSON DR. JOHN K BARBEAU E: SANITARY N0. C,l 117 12 ONTROL N0. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 loo LICENSED CONTRACTOR'SDECLARATION Job Description m I hereby affirm Na I am licensed under provisions or Chapter 9(commencing with Section 7")of that 3 of NC Business and Prufeuiom Code.and my license is mfull mm and effect. KIT REMODEL/ELECT/GASLINE/REFRAME WALL p t2? License Class Lic.0 Daleoillfru R .��lm5 ARCHITECTS DECLARATION gB101�1' 1 understand my plana shall be used.u public recoNa >aO Lianud Professional NOVs0< OWNER-BUILDER DECLARATION I� Y 1 2 �� <P I booby drop but 1 em exempt from the Contractor's Licenu law xemfor the -00 following mason.(Sectiun 703 L.S.Business and Pofessions Cade:Any city or county 'e m which toquiv a permit to com rent,alter,improve,dcmnlLah,fir.pair any slructum prior in its issuance.also retinues the applicant for such permit to File a signed statement s -�a that he is licensed puruanun the pmvislom of she Contrum',Licenu Law(Chap or 9 Sq.Ft. Floor Area BUILD10t3��tion xFo (commencing with Section 70[10)of Division 3 of NC Business and Pofess isms Code)or y $ Nat he is exempt motorman and the buss for the alleged cxcmption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o•civil penalty of 3—APNd`I1ihbcr00 Occupancy Type not mom than five hundred drill(5500). ❑1.as;owner of the property,or my employees with wages as deb ulc compenestian, will do Ne workand theswetu.un or intended oroRemed rental.(Sen.7014,Business lui - d Inspections and Professional Code:The Ci ntraemrs License Law dos Mt apply m an owner of 102 - PIERS P proailds or ny who buimprov thereon,and wh.dauuch wast himself ar though his awn employers,provided Nat such impovemenu are not inmltdedoroRerrd for isle If. 103 - UFER however,Ne building or improvement is sold within one year of completion,the owner- buiwer will have the burden of proving wt M did not wild or improve for Purpose of 104 - REBAR sal". 105 — ANCHOR BOLTS u owner of On property.am exclusively contracting with licensed conmemars to comment tw p.jcci(Sm.7W.Business and prefesuons Cod.:)Thin Convacwn Li. 106 — SEWER & WATER Lme Law dors or apply m bn owner of proany whe wilds a improves thereon,and 202 — UNDERFLOOR PLUMBING boeraenuwal rw sum projects with acontracmr(s)neemceptusuam mo the Convenors 203 — UNDERFLOOR MECHANICAL ❑ism sem dtt5 .B6PCfa Nis maven 204 - UNDERFLOOR FRAME Owner �i%y �`� .E-cam Date 205 — UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I byes imundcrpcmltyo(Nduryomofthefollowingdalm,iom: 301 — ROUGH PLUMBING have and will maintain a Ccourate.fComcmtoself-imus fm WerkalaCirel 302 — TUB & OR SHOWER sation,as provided for by Section 1700 of do,labor Code.far the Performance of the 303 — ROUGH MECHANICAL work for whim this Permit is issued. 304 — ROUGH ELECTRICAL 1 ham and will maintain Workers Compcmation Imunnce,u requirtd by Simian 305 - FRAME 37M of d.Labor Code,for dm m pe ro usim of Our work for which this permit is Issued. My workce,Compensation In,. a carrier and Policy number are: 306 — HOLDOWNS came Policy No.; 307 - INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE 308 — SHEETROCK (Nissection mid not he completed ifde permit is for one hundred dollao(glIX) 309 — EXTERIOR LATH teles:) 310 — INTERIOR LATH I certify bar in the permrm•aa of the work for whim was .it is issaC.1:hall nal 311 - SCRATCH COAT employ any person in any manner m as o become subject to the Workeri Compensation Laws of California.Date Applicant 313 — ROOF NAIL NOTICE TO APPLICANT:If,after making this Conviction or Escmption,you should 501 — FINAL ELECTRI CAL ENERGY berome subject to the Worker's Comaosssion provisions or the Labor Code.you..at JZ ronnwritcomply with such provisions ormisPermit shall wcounted mvnmd. 502 - FINAL PLUMBING ENERGY ZO CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY I hereby affirm that there us eomwetion lendingbecay for her performance of 504 — FINAL BUILDING ENERGY rL> live work for which this pcnnitisissued(Sec.3W7.Civ.C.) W Lende505 - FINAL ELECTRICAL r's Name z Lcndcr',Add. 506 — GAS TEST U O 1 certify that:have read this application and sum thm the above infomtaliun b 507 — FINAL PLUMBING L-. rr correct.I agree to comply with all city and county ordinances and some laws minting to p abovengconmnidion.andhc.byauthorpurpossentetivafUisoirymcnurupnnthc FINAL 0Ubuildinmrnnstruc pmand for imaction purposes.(We)bgme to sum,indemnify and keep harmless the City of Cupertino against 0 9 FI F' y liabilities,judgments,costs and exianseswhich may inany way scenic against said City 5 G U Z in consequence of the grand ng alibis permit. '-' APP ANT UNDERSTANDS A//,Jry)�;D WILL COMPLY WITH ALL NON-POINT Issued by51 WORKS Date 5 R RE LA?TIOfIE`tN�{ 7 �, - Re-roofs Sigfloor fApplicanUCommetto ell HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant sore or handle harurdoue material as dcrmed by tw Cupertino Municipal Code,Chapter 9.12,trod the Health and Safety Code,Section 35532(aTl All roofs shall be inspected prior to an roofing material beim Ayes 0 N P P Y g g installed. Will the applicant or future building...pant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it harardnus or,commitments as defined by the Bay Arca Air Quietly Management all new materials for inspection. District? ❑Yes ❑Nu I have mad the humus requirements under Chapter 6.95 of the Califor- niaHmlth h Safety Code,Sections 25S)5,25533 and 25534.1 undersund this if the building - does not cunendy ham a tenant,tum it is my mspomihility on notify the occupant of the req . wmmuslbe elpnor issuanccolaCcnlfiateo7upaa. Signature of Applicant Date '7e f�4e anmorfvaa agent Date All roof coverings to be Class "B" or better FTE gii �75 C,2 O0) 'A. cli IIJui CD � JE .a, E Zt. ir. oQ, EO ------ 2= Ewa cr M: 0 .2 ui co C4 -K-7-h JL CD E/) SNI cl AQ o LU M,m K : m -6 m 2 4p m a m 0 < V-5 AX - w "a %J C- 0) 0 5 0 m 0 0 1p • ME - Y-0 CSI co 04 .6 CD —------- =m V w tCC� RTY OF CUPERTINO 0 3 ark PERMIT APPLICATION FORM INO CUPEf�T 7J3AjPN # Date: G Oding Address: cf-A alN Owner's Name: Phone#: Contractor: License #: do(-/ t' oc,e>yP Contact: Cupertino Business License#: J o HAc tjAZ t3� PSI c t_ Building Permit Info: Bld� Elect CY Plumb [D-' Mech ❑ Job Description/ /j� m O �/g C �( ;q L Residential P �/ � � 1 Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: ��'� �fZA ,,,? 3 0 L) Cost of Project: _ Occupancy Group: � ori G-o Type of Constructio uantit Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M 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 <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC I Comm. Housing Mit. Fee BUILDING 2i �I l I of 3 i SIRECITY OF CUPERTINO c'TMk CUPE TTINO PERMIT APPLICATION FORM I Quanti Fee 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 BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE —Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING I BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo 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 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFDCTLigbting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> IOK 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 2 of 3 CITY OF CUPERTINO G n°F PERMIT APPLICATION FORM CUPEINO Ask Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSC13LVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection 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 J • 3 of 3