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03040005 CITY OF CUPERTINO '�'" BUILDING DIVISION PERMIT t GONTUCTOR II '..'' r TIO T en.. ,"psRYd' •<,r4?• ,>N,aF✓ru d�K.- BUILDING ADDRESS: PERMIT NO. 6355 ATHERWOOD AV BOB GERE MASONRY 03040005 OWNER'S NAME; PERMITAiNk L4UE DATB FONTENOT COLVIN TRUSTEE 480 CROSSLEES DR 04/01/2003 E; SANITARY NO. CONTROL NO. (408) 972-1285 ARCHITECTIENOINEER: BUILDING PERMIT INFO RLza ELECT UMB MECH =3 O PLIC l� 300 LICENSED CONTRACTOR'S DECLARATION JbDescri tion 1 Inanity affirm Nn 1 am licensed under Provisions of ChaoP Chapter 9(commencing with Section 70110)of Division 3 ofthe Business" fesCode.and my tlecnmts d� aiono ss�s nr1 in fall ioeande REPLACE CHIMNEY FROM FOUNDAT ��p: LIcense Lic Fal �j� _��D B Des ARCHITECT'S DECLA �1`V■ �i I undemand my piano mail W used or public record Licensed Professional SEP 1 .5 2003 OWNER-exempt Dow the Com ION f 1 mooy anirm o n 1 am exempt from the fewdo Co License 4w for 1W °o allowing mason.(Section 70313,Busher. and Improve. demon Cale:Any tm or ncounty owns $ which in isonane.also toconstants.do aim,WPmw,h N.11t mI air signed Manure Fly,+ lona m its issue d pursuant acquires the tui applicant for such Permit to filem Lad wmmem F < thatha Islicensedpantion 7M:)ryoMnon.arofft Buinesss JtcGelawsCade)9 Sq.F[.Floor Area C6a V18,1 y ° that gopt Section and Dais ar th alleged exsadan.my vilatMe)or Y / � Mut W ts eumpt tMefrom and Ute bus fa she aile{W ewnpdoe.My viohdon of Section e mac ON.31.Ow nurse padivor a permit subjects MK appiman m.civil pally of 3-6'11bVV�JT 00 Occupancy Type ❑I,uowneror Mx PrgP y,amyemplaywwiLb gMuftirs lecompe am. wllldo Newark,and the stmctum U notmtended conflicted formic(See.7044,11w oro and Pm(eWaa Cade:The Contraction Liccue Law does sot apply m an owner of 10 1 — FOUND LAZ?TJ4Bid Inspections properl Wild crimpmwa memon,.nd whodoessuch work himselfa0vough his 312 - CHIMNEY REBAR & STRAPS awnernployces,provided Nat such Improvements Me not intended wormed fatale.If. however,Ne building or Improvement is mid within oro you ofrompledom.the owner- 514 — FINAL PUBLIC WORKS Wild"will haw the burden of proving that M did Trot build a Improve for purpose of tale.). ❑1,as owner of the property.am eselusiwly ea encing with licensed ronualan m construct the project(Sec.7064.Bumess and Probation Code:)The Corusc aY U. come Law does not apply to an owner of property who Wild or impmns der"n,and who contacts for such projects with awnuamr(s)licensed punwnt an the Committees I.Icmum law. m ❑I aesempt under Sec .B&P C for this,cuon Owner Dote WORKER'S COMPENSATION DECLARATION 1 hamby Man under penalty of perjury as of the following declarations: haw and will maintain a CertlOca n of Consent to self-Ilium fa Wortn'sCampen- m,u provided far by Section 3700 of the LAW,Code,far Ne perfarmantt of the wo for which Nis permit 1,Issued. haw and will maintain Worker's Compensation Lnsunmn,as,required by Section 37or Ne Labor Code,for the performance of Oa work for which this pemB is blued. My Work va'a compensation umwmol cooler and Policy.rym/be Card er✓ (JCS PoPnONlicy No.FltOY Id ERTig"c;7E OP EKEMM WORKERS' COMPENSATION INSURANCE (This cadre need not W romphowd litW permit is fosse hundred dollen(SIM) or lea.) 1 certify that In Ne performance of the work for which this permit is issued,I Nell not employ any person In any moneran as On become subject to the Warkeri Compenmlon Law,of California.Data Applicant NOTICE TO APPLICANT:If,afar making this Certificate of Exemption,you should became subject to the Worker's Compensation provisions of we labor Cod,you mum ,J 0 forthwith comply with such provisions or this permit snail W deemed mwk ad. z E., CONSTRUCTION ENDING AGENCY r I hereby aRi Nn Nem is a commucdno lending agency for the performance or r7 the work for which this peals is Issued(Ste.3097,Civ.C.) (y Q Lender's Name �t z Leaden Addmu ✓U Q 1=try that I haw mad this application and mute that the salve Information Is G.E'+ arm°.I alone to comply with all city and county onlinsncea and sate laws rclming m 0 C) building construction,and herebyMutanm mpresenatives of NU City as enter upon the above-mentioned PMPcny for inspection pupates. (We)agree to save,indemnify and keep function Ne City of Cupertino against 0 liabilities judgments,cons and expenses which may in ay only aceagainst laid City V AP In cwnocUNDEof the RSTAN of NlsD WILL COMPLY WITH ALL ON DINT Issued by: Date U CE Re-roofs gnuurt ofApp nbunfir HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof Will we applicant or future Wilding aeupat name or handle Intonations material u ddinod by she Cupertino M icipal Codc,Chapter 9.1x.and Ne HGIIh ad Safety Code.Benyon 25532(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant, alum Wudingue"mmom equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It haamauasi,comem' amuu dorsad by the Bay A.At,QuWly Management all new materials for inspection. arid? ❑Yes No Ihavereadde amouanmedalt"uimmenuunder Chapsr&93o(NeCaliror- nuNatib&SafctyCaM,Scc a=25305,25533uW25534.1und thaifNc Wilding don an,currently Mw a carat. t It h my MPomibllhy m nodfy 1W aauPar m the mqm ata itn aaaroar.c"Mnesma Signature of Applicant Date owner ar.atnany .gent D.a All roof coverings to be Class"B"or better r CITY OF CUPERTINO o e o 0 CUPEY�TINO PERMIT APPLICATION FORM 3 APN# Date: '3 ( f � t7 n 7 Building Address:. 35,7 e1-Z1ioa2 Owner's Name: Phone#: X199 Contractor: License#: h / 0? Q oh Contact: ^G — Cupertino Business License#: Building Permit Info: Bld Elect ❑ Plumb ❑ Mech ❑ Job escription: � Residential Commercial ❑ Sq.Ft. Flqdr Area: $/Sq.Ft.: Cost of Project: Occupancy Group: 7s Type of Construction: Quantity 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 Comm. Housing Mit. Fee BUILDING I of 3 CITY OF CUPERTINO a-CITY0, PERMIT APPLICATION FORM CUPERTINO Quantity 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 BIdg 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 rinkleAackflo 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 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 din MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> 10K 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 SimCITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM QuantityFee 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 Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, 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 I 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 F e sq foot PLUMBING ZADDCHG Address Chane ' BUILDING 3 of 3