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04090085 (2)
CITY OF CUPERTINO ,"�Tr"rkk'.*.'` �♦"�"+t "" ^' ]k,g ]��r'' BUILDING DIVISION PERMIT ;CONIlRI'>CTOR INF,ORMATIOI�,a"n au ILDING ADDRESS: LEON MASONRY INC PERMIT No 04090085 c;-A- 7AMES TOWN DR OWNER'S NAME: PERMIT L4UE GATE ONE: SANITARY 907 C NTROL NO. ARCHI'IECr/ENGINEER: BUILDING PERMIT INFO B DG E PLUMB MECH 0 uo0 LICENSED CONTRACfOR'SDECLARATION Job Descri o u C 1 Maby air,—uwt 1 am licensed under provisions of Chapter 9(Or mm.rel.9 P b iN Settle.'Bad)of Division 3 of Ne Business and professional Cade.and my license is n, in mummeaaee(�k�2'1 �0_23? g CHIMNEY REPAIR ;E2 Licma.Clear Lie.. SEP aJ 2004 n F•0 Dam��Jap S_'1 Comms, PSL./ H'IM�aI y i ARCHITECTS DECLARATION ?W 1 understand my plain W dull uusedn, mN d public cos U BUILDING 3 a Licensed Professional O OWNER-BUILDER DECLARATION f 1 acachy alarm Nn 1 am exempt foam He Canvamo',License Law for IW e00 following motor.(Section](D1.5,Business and Professions Cade:Any city at county S which rrquims a permit In cans mU,alter,improve,demolish.or repair any structure prior N its issuance,also acclaims Ne applicant for such permit to Glc a signed statement �s< mathcislicenmd punuantsathc Mm isioesurthc CVavacmr,IJamclaw(Chaplef9 Sq. Ft. Floor Area Valera[on ce, (commencing wiH Seaion]OW)af DivixionJof the Business and Rvfesaiam Code)o y that he i,exempt Herefrom and the basis far the alleged exemption.Any violation of rA.n rM.m.y, sector 7031.5 by any applicant for a permit subjects the applicant m a civil Penalty of 36WVC Dlhr00 Occupancy Type not more man fiva hundred dollen ❑1,as owner of the pmpeny,or my employees wiO wage M Neir sole compensation, willdo the Onfli and Heswaum is not intended oroRemd Britain(Sec.7044.Business Required Inspections and Professimu Code:The Contractors Li.law des aint apply m an owner of q P Napery who builds orimpa ms Nercon,and who doessuch warkhimself or through his own employees,provided thin such improvemems are not Intended mideaed foraale.11. however.the building or improvement is said within one year of completion.the owner. builder will have the hand.of proving that he did nm build or improve far purpose of sale.). ❑I,as owner of the propeny,am exclusively contracting with licensed convectors to comamet the pmjem(Sec.]Ilad.Business and Profession,Code:)The Contractors Li. mn,e law does nut apply to an owner of property who Wilds or improves Hereon.rod. who contracts for such pmjecu wain a cootn0or(s)Iicamed pursuant to the Commuctor's License Law. ❑I and exempt und1er_See .B&P C Im His tessera Owncr STN Ie– SUN d Data l ION WORKER'S COMPENSATION DECLARATION 1 hemby air=under peesfy,of perjury one of t e following due arauon,: 1 have and will maintain aCenificom ofConsenuo mif-imam for Worke'sCompen- sation,as provided for by Section 37W of He labor Code,for the performance of the work for which His permit is issued. ❑1 have and will maintain Workers Compen,aliom].a....Is acquired by Section IPof He work for which this Karnit is issued. My Workers CmmApoggqtio/p`I_nsurmoccarrierand Policynumberare: CortiseW of He Labor Code,far the per(ormarcc Policy No.Q O0 7,17 9 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu acefiao need notbe completed tribe permit is future hundred dollen(SIM) or Its..) I certify Hat in the performance of He work for which this permit is issued.I shall not employ anypcnon in any manner an as in become subject to the Workan'Compeesauon taws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Cmipeate,of Exemption,you should become subject to He Worker Compcesztion provision,or the Labor Code,you muse O forthwith comply with such provision,or His permit hall be deemed revoked. Z N CONSTRUCTION LENDING AGENCY PI hereby alarm that Here is a construction lending agenry,for rte Performance of C 7 the,work(ser which this permit u Indent(Sex.3M.ON.C.) fgl Q L.ndcr's Name C lander',Add.. U O I certify that I have read His application and sum Hat the above information Is U.P calmest.1 agme 1.comply with all city and county oNin,nma and sou laws relating to 0 U building construction,and hcmby amhorim mpmXaftsives of this city to enter upon He If] aWve-mentioned pmperry far harfacuon purposes. indemnify and keep lesS Cifirm tri mkppli.m %em andcr,pormsw hmeyinmywayattmeagCity of p ruts dCitsy U thc ming of this it. " STANDS WILL COMPLY WITH ALL NON-POINT Issued by: Date TIONS. / Re-roofs c Contractor Date HAZARDOUS MATERIA DISCLOSURE Type of Roof pllsam or future be upant atom of handl.havaAom maoaial as defined by the Cupenum Municipal dc.Chapter 9.l],and ted Hcalth and Safety Cede,Section 2553$0)'! All roofs shall be inspected prior to any roofing material being installed. Yes u Will He applicant or(wum buil ing occupant use"N"pmcnt or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit harardnd,air cantominan s as toed try the Bay Arca Air Quality Management all new materials for inspection. District? ❑Ye, I hum read He hannious marcrials requirements under Chapter 6.95 of the Califor, ,is Health&Safety Coe,Sections 2550.25533 and 25534.1 senders this' the Wilding does oat c.fly have a unmI.d u spon,ihiliry in n f t of He req m ntawhie `ou 1some. f3ccrtfiesm Signature of Applicant Date Owner or HoenN agent Dam All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue !i .✓ Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: PES© �- 6.q op S S_ OWNER'S NAME: PHONE # 3 6 S-/b 4- GENERAL CONTRACTOR: C�J� FAX # 6 I am not using any subcontractors: L7/l�f`d 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile er/Contrignature Date t / S CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM N # � Date: � 9/i5/o y Building Address: Mailing Address (if different from building address): /535 _OAmesowri Owner's Nam Phone #: r 1/ Contractor: License #: eoa M AsO,ag jAJC- Contact: n Phone: � f_/66p Cupertino Business License#: UGC 06L P-IL Fax: (oc/ Building Permit Info: Bldg e� Elect ❑_ Plumb ❑ Mech ❑ Job Description: Residentialo, ,.,1 P a a Commercial ❑ Sq.Ft. Flo t ea: $/Sq.Ft.: Cost of Project: ccupancy Gr p: Type of Construction: Please check this roject is a kr second-sto addition: t Siz : Stanojecedard ❑ Lar e ❑ Ma or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERl Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK 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> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING B19VESTIGA Investigation fee BUILDING s-7 1 of 3 SRI- CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO 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 BLUDING 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 Aft BPTRAP Kitchen Trap PLUMBING IMP BPVENT Alt of Drain & Vent PLUMBING BPWATER InstalUAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAEU-AN A/C Units <= 10,000 cfm MECHANICAL .BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMEIXT 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 BREMNR.APP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BRE EPRc tl, Switch & Outlets ELECTRICAL BRE OCA Relocation of Hood MECHANICAL BRI Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 x CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 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 ZADDCHG Address Chane BUILDING 3 of 3