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10110062 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10299 MILLER AVE APT 1 CONTRACTOR:J K MASONRY PERMIT NO: 10110062 OWNER'S NAME: ROBERT NAKAMURA 400 HODGES AVE DATE ISSUED: 11/09/2010 NER'S PHONE: 4088889223 SAN JOSE,CA 95128 PHONE NO:(408)287-2398 ❑ LICENSED CONTRACTOR'S DECLARATIONr– r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class — Lie.# u�L� r MECH RESIDENTIAL COMMERCIAL —�— Contractor � ) �(' /lam C v Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COMPLETELY TEAR DOWN OF FIREPLACE CHIMNEY (commencing with Section 7000)of Division 3 of the Business&Professions DOWN TO THE FOUNDATION AND REBUILD BACK UP TO CITY BLDG Code and that my license is in full force and effect. CODE I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,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 provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$11265 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36914023.1 Occupancy Type: correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature ! �' C�DateV_/2 Issued by:; Date: LJ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner a 0 ized gggq�l�2— // ��JJ Date: l lJ APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name muify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . 36914023 .1 DATE ISSUED. . . . . . . : 11/09/2010 RECEIPT #. . . . . . . . . : BS000011963 REFERENCE ID # 10110062 SITE ADDRESS . . . . . : 10299 MILLER AVE APT 1 SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ROBERT NAKAMURA ADDRESS . . . . . . . . . . : 10299 MILLER AVE APT 1 CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JAMES KELLEY CONTRACTOR . . . . . . . : KELLEY, JAMES LIC # 11823 COMPANY . . . . . . . . . . : J K MASONRY ADDRESS . . . . . . . . . . : 400 HODGES AVE CITY/STATE/ZIP . . : : SAN JOSE, CA 95128 TELEPHONE . . . . . . . . : (408) 287-2398 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 11, 265. 00 1. 00 0. 00 1 . 00 0 .00 1BSEISMICR VALUATION 11, 265. 00 1.13 0. 00 1.13 0 . 00 1CHIMNEYRE EACH 1. 00 507. 00 0. 00 507. 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 509.13 0. 00 509. 13 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 509 .13 #648 --------------- TOTAL RECEIPT 509 .13 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------------------------'--- 101 FOUNDATION 312 CHIMNEY REBAR & STRAPS 517 FINAL CHIMNEY CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10299 miller ave. DATE: 11/09/2010 REVIEWED BY: APN: BP#: "VALUATION: Iso *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Chimney/Chimney Repair PRIMARYT{1 . PENTAMATION 1CHIMNEYR USE: SFD or Duplex 1 �A"',41N, L PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY BP FEES Chimney Repair 1CHIMNEYR 1 $507 TOTALS: r, 1.1� /'!an Cia�rfl 1, P, 11i r . t)t;rcr1 a sir I "; h. r, ,,, 1'', NOTE. Thesefees are based on the preliminaty information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 09-05I Eff. 7.7.-701 FEE QTY/FEE MISC ITEMS P/4111 C'licc /,-cc: PI(m C.7icci;: Permit Fee: $507.00 Supp/. hisp Fc°c F'lttirrlt.%_11'c1t. �Ifcc Iirrir FE>e: /'lui�if7.;`%ticclt.:""t�lcc Pe�rrjrit 1-'cc': L�r�tasti•ricrir�tt 7t�:� .-Icouslical Rcvi,,�v FCC. Work Without Permit? 0 Yes E) No $0.00 Plran iii""T 71-avcl0ocuiticniolion I Strong Motion Fee: IBSEISMICR �,$ Select an Administrative Item 131dy;Stds Commission Fee: $0.00 SUBTOTALS: 547:0 $0.00 TOTAL FEE: $507. 0 Revised: 11./68/2010 . n oor Air ua by an Finishes 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Seal all Exposed Partioleboard or MDF 4 IAQ/Health. pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 1 J 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2 Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y--yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 1 t t Total Points Available: 1 1401 130 57 Total Points Project Received: 0 0 0 �v G:data/progs/greenbuilcingguidelineslremodelersrgreenpointsfina1212.D4proteoted.xls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: lo a cl'q H i 1,1A"= PERMIT# / v / / t-' 11 6 2-- OWNER'S NAME: 4c, PHONE# '1 - GENERAL CONTRACTOR: . ; BUSINESS LICENSE # ADDRESS: Z&O , _ =` CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO C17Y 0'F CUPEKTINO GENERAL BUILDING PER IIT APPLICATION FORM APN r -� Date: - � 1 Lt C - ) I 11 Building Address: ( S Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes No 17 HOA: (Exterior work only) Yes ❑ No 12/ If yes, provide letter from HOA OW er' Name: Phone* rI I ," CA ryi- r-41 (q� Contractor: -- Phone:Phone: (q a z 7- a-7 K- ' � i\ Fax: v _ r Contractor License* Cupertino Business License* g Contact: Phone: 6ctO Y �-7 - -;�a SLS 1 Fax: Residential Commercial Job Description: COrL e �e c<c p 7414ce_ CL // ILe_ ,M 4z y cak Building Permit Info: ' Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/IMV-A ❑ II/VI B, N-HT, V-B Valuation: t i( Square Footage: S. Project Size: Express []__.& a idard ❑ Large ❑ Major ❑ 0't- Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Ants Achieved: For help, contact Build it Green at www.builditzreen.oriz Revised 07/14/09 3