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07060053 CITE'OF CUPERTINO 'TRpl�C`T��I��}RMATI4�N� BUILDINODIVIS!CNPERMIT PERMIT NO. BUIL¢jl�i,,4LlI 'aOHN DR LEON MASONRY INC 07060053 G U l j l pERMIT ISSUE DATE OWNER'S NAME: 06/07/2007 TONY VISCOMI 240 MOSI;LLE CT SANTTARY NO. CONTROL NO. NE: (408) 365-1660 BUILDING PERMIT INFO ARCHITECrIENGINEER: BLDG ELECT PLUMB MECH Cc,ZO LICENSED CONTRACTOR'S DECLARATION Job DBSCTIptlOn U I hereby affirm that I am licensed under provisions of Chapter 9(commencing CHIMNEY REPAIR SHOULDER UP W/REBAR. CONTRACTOR U with Section 7000)of Division 3 of the Business and Professions Code,arn�d my license is "I'll, in full force and c ZLic x LEON MASONRY #17323 RENEWED BL. Z License Class DateContractors �"'� �►+ald!?it.l� f w CHITELTS DECLARATION L4 jU I understand my plans shall be used as public records a U.N Licensed Professional OWNER-BUILDER DECLARATION aI hereby affirm that 1 am exempt from the Contractor's License Law for the cc 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 n prior to its issuance,also requires the applicant for such permit to Glc a signed statement $, ,Ft.Floor Area Valuation -?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 1 $2400 ti F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 369330 41 � not more than five hundred dollars(5500). 0 1,as owner of the property,or my employees with wages as their sole compensation, Required Inspections 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 docs not apply to an owner of property who builds or improves thereon,and who does such work himself or duough his own employees,provided that such improvements are 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.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contmctor(s)licensed pursuant to the Contractor's License Law. B&P C for this reason 0 I am exempt under Sec Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a Certificateof Conscnt to self-insure Cor Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 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 Workees Compensation Insurance carrier and Policy number are: Cartier L4 tJ�Nr/t Policy No.:Q1"��1—�-� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for anc hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this CcniGcatc of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY Ham-+ I hereby affirm that there is a construction lending agency for the performance of r7 the work for which this permit is issued(See.3097,Civ.C.) [ta Q Lender's Name Z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to (D building construction,and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspccuon purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consegttence of tit of this permit Date APPLICANT ERSTA S AND WILL COMPLY WITH ALL NON-POINT Issued by SOURCE ULATION 7 �� Re-roofs Sig ore of A scan on Dale Type of Roof HAZARDOUS MATERIALS DISCLOSURE YP I the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. 0YesIf a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection. District? (�. ❑Yes �E� 1 hav the rdous materials requirements under Chapter 6.95 of the Califor- nia Heal SafetyCodc, cc, 25505,25533 and 25534.1 understand that if the building docs n currently have tenant.Ih it is my responsibility to notify the occupant of the Date mqu' mems whit st be m or w issuance of a Certificate o.rxeupancy. Signature of Applicant ((1! All roof coverings to be Class"B" or better ner or a oared agent D te CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 369= 3041 . 00 DATE ISSUED. . . . . . . : 06/07/2007 RECEIPT #. . . . . . . . . BSO(i0001574 REFERENCE ID # 07060053 SITE ADDRESS 20161 JOHN DR SUBDIVISION CITY CUPERTINO IMPACT AREA OWNER TONT VISCOMI ADDRESS . . . . . . . . . . CITY/STATE/ZIP CUP:-sRTINO CA, 95014-4414 RECEIVED FROM . . . . : LEON MASONRY/RICHAR CONTRACTOR . . . . . . . : DAV-, LEON LIC # 17323 COMPANY . . . . . . . . . . : LEO:J MASONRY INC ADDRESS . . . . . . . . . . : 240 MOSELLE CT CITY/STATE/ZIP . . . : SAN JOSE, CA 95119 TELEPHONE . . . . . . . . : (403) 365-1660 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ---------- -------- BPERMFEE VALUATION 2,400 .00 83 . 16 0 . 00 83 .16 0 . 00 BSEISMICRE VALUATION 2,400 . 00 0 .50 0 .00 0 . 50 0 . 00 BUSLIC FLAT RATE 1. 00 107 . 00 0 .00 -- 107_00 -- -- 0_00 -- -------- ---------- TOTAL PERMIT 190 . 66 0 . 00 190 .66 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 190 . 66 VISA --------------- TOTAL RECEIPT 190 .66 CITY OF C UPERTINO cffYof PERMIT APPLICATION FORM CUPERTiNO APN# Date: Building Address: Mailing Address (if different from building address): Owner's Name: 7 ?)qy/ Phone#: cbs cc.)� . _-:s 2- Contractor: License #: i✓ h7!. 'Oloe to.Z.3 3 9c7 Contact: I Phone: Cupertino Business License#: 04v�-,- c. Fax: 3 65-- !� Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: )3A g, Residential `�� Sjl��d�r / Comm/rXia'l El Sq.Ft. Floor Area: Sq.Ft.: Cost of Prqject: Occupancy Group: 6) Type of Construction: Please check this box if the project is a S t% second-story addition: ❑ Project Size: Standard ❑ Large ❑ Maj cr ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER O.her Appliances MECHANICAL BBOILERI Boil,-r<= 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 E otel and Motel BUILDING BCONSTAXR Con,-tax —Resi/Mobile BUILDING BELEC 1000 Elec 600V <= l OOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec �,vcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF C UPERTINO 4CIWFO PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME InEpection Overtime BUILDING BPBACKFLOW Atniospheric 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 flan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plar Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM S:orm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER W iter Heater/Vent PLUMBING BPWSVCS M iin Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI f�ppliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT bighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relc Furnace> l OK btu MECHANICAL BREMHEAT B eater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Vlisc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pol e/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc 11, Switch & Outlets ELECTRICAL BREMRELOCA Ri,location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF C UPERTINO CUPEkTINO PERMIT APPLICATION FORM (Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmd Signs Add Branch ELECTRICAL BREMSIGNS Remc del Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Ven t Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL SrecialInspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporag Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mecti Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC PlanningI,R Comme/Multi-Fam PLANNING PLLONGRNGR Planning L ong Range Residential PLANNING 3 of 3