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05050002 CITY OF CUPERTINO "t^ ti< '', BUILDING DIVISION PERMIT CONTRACTOR INFORMATION BUILDING ADDRESS: PERMIT NO. LEON MASONRY INC 05050002 OWNERS NAME: PERMIT LgUE DATE ONE: SANITARY OL N0. 7AFCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATIONlob Descri [100 1 Mreby affirm that 1 am licensed under provisions of Chapter 9(commencing ph Scction]OW)of Division 3ef the BmircssW Proftssiuns Code.and my license is ®�� s,full Tutee antic [■I�sOMggV[9p1 ��® Dt, aeelasa�'�� tie.is (Past �[jCHIMNEY REPAIR sp-� te ✓VWe ARC.f ELTSDEC19WIFbH- - iiK U 1 understand my plans shall W used a public teem& ;u� Licensed Professional 2005 A0 OWNER-BUILDER DECLARATION . to F 1 hereby affirm Nm I em exempt from to Contractors Licenm Law for(be 00 following mason.(Section 7031.5,Business and Professions Code:Any city or county K$� which q.i.a permit to mnsvuct,elmp improve,demolish.or.pair any structure Pti6pdorto its issuanec.a4u rcquimslM spPlieans for such permit file asigncJ sammcm Nat Wis licenuJ pursuant sO the p.visions of Ue,Conuacmr's License law(Chapmr9 Sq. Ft. Floor Area n ¢�0 (commencing with Section TWO)of Division 3 rfthe Businessand Professions Count or y that he is exempt therefrom and Be basis for the alleged Ostrander.Any violation of Seedoa 7031.3 by airy applicant for a Pamir subjects the applicant in a civil penalty of 3�t�belp Occupancy Type nos..Nan five hundred dollars($500). ❑1.an owner of the property,m-my employees with wages as their sole compensation, will do the watt,and the structure us not intended or offered for sale(Sac.]0aa,Business and Rofessions Code:The Cemescmra Lierese law does net apply to an Owner of Required Inspections property who buildsorimprows thereon,and who doessuch work himself ortheough his Own employ=,provided that such improvements art nos intended oroffered forsale.If, however,the Wilding or impowmens is sold within can year of completion.the owner- Wide,will have de,Wrdcn of proving that W did nos Wild or improve for purpose Of sale.). 1,as Owner of the property,am exclusively contracting with licensed contractors to convect the project(Sec.7044.Business and Profes oro Code:)The COnvacwts Li nss Lew dw not apply to an owner of property who Wilds or improves thereon.and who contracts for such projects with a contrachu(s)licensed promumn to the Contractor's Licen.¢Law. ❑1 am exempt nder Sec. .B&P C for this mason Owner Data WORKER'S COMPENSATION DECLARATION I hcmby affirm under penalty of perjury one Of the following declarations: 1 bsve and will maintain a Certificate of Consent to self-insum for WorkcrsCampcn- ation,an provided for by Section 3700 of the labor Codc,for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 371W of the labor Code,for Ne performance of the work for which this permit is issued. My Warkcrs Compensation�I�ns...tO eamien end Policy number s.: Carmr..�'44-faIa AVWVf Policy Na9f20723!/_ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (this section need Ives W completed if the permit is for one hundred dollars(SIM) or kest) 1 certify Our in the peffarro nee of the work for which this M,.I,is issued.I sh.11 nut employ any person in any manner so as to hecumc subject to the,Workers'Campensadon Law s of California.Date Applicvm NOTICE TO APPLICANT.If,after making this CeniGotc Of Exemption,you should Wceme subject in the Worker's Compensation previsions of the IaWr Code,you must �Z foMwith comply with such provisions of Nis Permit shall W decmod revokcd. z•O CONSTRUCTION LENDING AGENCY j-. I hereby affirm Nat them is a construction lending ageney for to performance of R' On work for which Nu permit is issued(Sec.309],Civ.C.) [[7 A Lender's Name =z Lcader's Addreas O C) I certify Nal 1 have mad Nice application and sum in.,the move infom anon is Ftorten.l agree ro comply with all city and county on inances and sum laws relating to 0U building convection.and hereby authorize representatives of this city to enter upon the } .1Womcmmncd property for ingccton purposes. H gy (We)agree to save,indemnify and keep hsrml.the City of Cupertino against Iq liabilities,judgmcnu,costs and expenses which may in any wey accmc ag.mst card City U ineonsegnencc Sranting ufthisperm.I. r. APPLICA ND RSTANDS AND L COMPLY WITH ALL NON-POINT Issued by: Date SOUR 73EGU 0 Re-roofs s n plicant/C or talc H RDmOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or for=Wilding occupant time or handle hazardous material Cu defined by use Cupertino Municipal Code.Chapter 9.11,and the Health and Seen, COJc,Seem.15531(a)? All roofs shall be inspected prior to any roofing material being installed. Yes Ne� Win the applicant mfnt reb building occupant uxequipmcm or devices which If a roof is installed without first obtaining an inspection,I agree to remove our hazardous air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection. Distrin? ❑Yes I have marl Or hanN�ws materials requirements under Chapter 6.95 of the Calif x, m Health&Safcs '=255115,15533 and 25534.l undersand Our ifthc Wilding d¢5 not c you .nano Nat it u mY msprnsihiliry to ramify the occupant rf Jte re,we h.which storantprimmissmrmtef.cartifxLor6p� Signature of Applicant Date (cert JJ�� O SDO. All roof coverings to be Class"B"or better , Community Development 10300 Torre Avenue pe Crtino CA 95014 Telephone(408)777-3228 CITY OF� Fax(408)777-3333 UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # /(06// ,fir} g-/Ow O o0 OWNER'S NAME: G PHONE # 3 (o J--/G G o GENERAL CONTRACTOR: FAX # 3 6 I am not using any subcontractors: Zf bS Signature Date Please check applicable subcontractors and complete the following information: 60 SUBCONTRACTOR BUSINESS 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 J Owner tractor Signature Date r^r Cv CITY OF CUPERTINO CUP TYOF NO PERMIT APPLICATION FORM 0 APN # 3 & P / 0 / 02- 0 ` O2- Date: In 4y Z -OS Building Address: Mailing Address (if different from building address): 16 L Owner's Name: Phone #: 6A) I� Contractor: f License#: / evr✓ /sigrown, 62-.-S36-7 Contact: Phone: 3 6 r-/b G o Cupertino Business License#: Qui 0/, npvL Fax: g6-164(o</ Building Permit Info: Bld ,RT'- Elect ❑ Plumb ❑ Mech ❑ Job Description: ' 7,1�� G ��i,u Residential El C, //1M F�ii SLiO�sG. rCommercial ❑ 5 Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: 3- S-00Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard ❑ Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI 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 1 of 3 1 d CITY OF CUPERTINO CITY OF 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 Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg 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 BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK 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 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 2of3 p• , d CITY OF CUPERTINO CITY PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Si s, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3of3