Loading...
07080235 CITY'OF CUPERTINO BUILDING DIVISION PERMIT TC) i INF ?RMr4TIQEN. BUILD N� �D KESS: PERMIT NO. � STAFFORD DR LEON MASONRY INC 07080235 OWNER'S NAME: PERMIT ISSUE DATE JEFF CAI 240 MOSELLE CT 08/27/2007 VE: SANITARY NO. CONTROL NO. (408) 365-1660 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o a LICENSED CONTRACTOR'S DECLARATION U F- I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description ;Zwith Section 7000)o(Division 3 of the Business and Professions Code,and my license is CHIMNEY REPAIR (SHOULDER) N in full force and nHec�t, 3 i ysi ? License Class Lic.N p DateContractor�l _�J R HITECTS DECLARATION 1-4 1 understand my plans shall be used as public records i aU m E„ Licensed Professional y OWNER-BUILDER DECLARATION 3 a 1 hereby affirm that I am exempt from the Contractors License Law for the :00 following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure z} prior u)its issuance,also requires the applicant for such permit to file a signed statement x o that he is licensed pursuant to the provisions of the Contractor's License law(chapter 9 Sq.Ft.Floor Area Valuation t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $3000 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 36206016 `��Number Occupancy Type not more than five hundred dollars($500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements arc not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractees License Law. ❑I am exempt under Sec. B tit P C for this reason Owner Date 2V,2!410 ECLARATION 1 here tem under penalty of perjury one of the following declarations t_I I have and will maintain a Certificate of Consent to self-insure for Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Polity number are: Cartier. fk.L,* Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workcrs'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked- Z"" CONSTRUCTION LENDING AGENCY E~—u I hereby affirm that there is a construction lending agency for the performance of (1w> the work for which this permit is issued(Sec.3097,Civ.C.) Q Lender's Name Z Lender's Address U C) I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the a shove-mentioned property for inspection purposes. /17 (We)agree to save,indemnify and keep harmless the City of Cupertino against r/1 liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the ranting of this permit. ►'+ APPLICANT U SANDS AND WILL COMPLY WITH ALL NON-POINT Issued b-/: Date SOURCE LA S. �jZd/ems- Re-roofs Sign u pelican ctor HAZARDOUS MATERIALS DISCLOSURE Type of:Zoof Will the applicant or future building occupant store or handle hazardous material as dcfrned by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed. ❑Yes •-8+ro Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new i naterials for inspection. District? ❑Yes No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Calc 5505.25533 and .1 understand thatif the building docs not currently a tenant, at it is my ibility to notify the occupant of the rcquiremensw i in bent riorw' ofaCcrUricatcafac panty Signature;of Applicant Date Owner a zed agent Dare All roof coverings to be Class"B"or better CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN 36206016 . 00 DATE ISSUED. . . . . . . : 08/27/2007 RECEIPT #. . . . . . . . . . BSC00002485 REFERENCE ID # . . . : 07080235 SITE ADDRESS . . . . . : 11; 9 STAFFORD DR SUBDIVISION . . . . . . . CITY CUIERTINO IMPACT AREA . . . . . . . OWNER JEFF CAI ADDRESS . . . . . . . . . . : 11:59 STAFFORD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4911 RECEIVED FROM . . . . : RICHARD LEON CONTRACTOR . . . . . . . : DN'E LEON LIC # 17323 COMPANY . . . . . . . . . . : LEON MASONRY INC ADDRESS . . . . . . . . . . : 24 ) MOSELLE CT CITY/STATE/ZIP . . . : SAN JOSE, CA 95119 TELEPHONE . . . . . . . . : (4 )8) 365-1660 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ------- ---------- -- BPERMFEE VALUATION 3, 000. 00 83 .16 0. 00 83 .16 0.00 BSEISMICRE VALUATION 3, 000. 00 0.50 0. 00 -----0_50 ------0_00 ---------- ---------- - TOTAL PERMIT 83 . 66 0. 00 83 . 66 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------- CREDIT CARD 83 . 66 VS --------------- TOTAL RECEIPT 83 . 66 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ____ _ -- ---------- 101 FOUNDATION 312 CHIMNEY REBAR & STRAPS 514 FINAL PUBLIC WORKS Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 ''UPEkTINO Building Department JOB ADDRESS: /r PERMIT #01 G�o Zz ��- OWNER'S NAME: PHONE # -3 G 4 ,4> GENERAL CONTRACTOR: FAX # 3 s-—/4-- 4�y I am not using any subcontractors: ignature Date Please check applicable subcontractors and coir. lete the following information: SUBCONTRACTOR BUSI:vESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Til 2 �d Own actor e Date ` CITY OF CUPERTINO ����� ( PERMIT APPLICATION FORM d -]0pQZ3S ' PN # Date: Building Address: Mailing Address (if different from building address): Owner's Name: Phone#: 'Te-44C A- Contractor: Contractor: License #: �-eco.-+ M ASS v �n.(� _ G .2- 3 3 S Contact: Phone: 36 --�'�;� b Cupertino Busipess License#: Vrz �tL Fax: 3 s — - V f 2 Building Permit Info: Bldg Elect ❑ :'lumb ❑ Mech ❑ Job Description: C �,,�.,� �„2 �,i d r�-) Residential E-1 "-� Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: CJ © Occupancy Group: Type of Construc on: Please check this box if the project is a second-story addition: El roject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Dther Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 P oiler> 1.75M Btu MECHANICAL BCONSTAX -onstruction Tax BUILDING BCONSTAX In 3/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co nstax —Resi/Mobile BUILDING BELEC1000 El cc 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 1 of 3