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CITY OF CUPERTINOBUILDING DIVISION DIVISION PERMITCONTRACT(TI2INFURNIATIOI�i"
n
BUILD DD FSS:
PERMIT NO.
j.4�4'� ANSON AVE
MP3 MASONRY
08050110
R'S NAME:
PERMrr ISSUE DATE
MICHAEL CHU
4530 FAIRVIEW RD
05/13/2008
PHONE:
SANITARY NO. CONTROL NO.
(831)637-6663
ARCHITECTYENGLNEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Chapter 9
Job Description
1Um P
1 hereby afftat I am licensed under provisions of (Commencing
with section 7000)ofoidson3ofineBusiness and Profeuions Cods. and mylicenseis
REPAIR EXSTNG MASNRY CHMNY FRM 2' ABV FNDTN
in full faro an,
dDeer/."a� 5� 1
Li¢ns CJys l�Lk. N
'
Dae /rf>fZ ConwMr
ARCHRECI-S DECLARATION
I understand my plans "I be used as Public records
Licensed Prefessional
OWNER -BUILDER DECLARATION
1 herby affirm that I am caempl from the Contractors License Law for IIB
following mason (section 703 13, Busines arW Professions Cade: Any city or county
which mgoims a permit to conavucL ater. Impmw. dem od. or repair any smetur,
Prier to its essuanec, alae requires the spplaont for such permit in Elea signed suremcnl
Hu to is licensed We ofde Contractor's license Law (Chapter 9
Sq. Ft. Floor Area Valuation
pursuant u, plovisiwu
(cwnmencty with Section 7000) dDivisiun J of the BuuM.. end Professiav Code) w
$5000
Net a u emmpt tMsefrwn and the baso for the alloged exemption My violation of
Number
Occas e
ane T
Occupancy Type
Section 7031.5 by arty applicant for a permit subjects the applicant in a civil penalty of
eros fume than 11. hundred dollars ISM
32641113--W
1, u owner of ask property, a my employcn with wages as theirsek compewuon,
will da tbcwofikl ifid dustmctum isnor Hendedormtered forsak(Sec.7044,1hesimss
Required Inspections
and Pmressfans Code: The Co nnicmra License Law does not apply to an owno of
Ncman.wmmudonsuchwmk haroff a his
pmpcmploy
own em.l .pmol dm at nuorenotinended or forulc.ugh
fheown If.
k6on.
thebualdteLorierofMaisissaidediinaneyearofcprovefrtheowner-
eW.Win&wdthatimhi tiswld
Wildfi�er
will haw Ice border of poring tat K did net build or improve for purpose of
.iilder
sekd.
❑ 1, u owner of the Property, shot ca.hiswly contracting with Be nsed con0actmrs to
construct the project (Sec. 7044, Business and Professions Cade:) Ta Cost acmes U.
.
terms Law does not apply 0 an owner of property who builds or Improvca Hereon. and,
who contracts for such projects with a convacmr(s) licensed parma , to the Contrscmrs
Laos. Law.
❑ lamesemplundu See .B&PCfor His.
IDw Dau
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations
❑ 1hawaMw lmainwn&Ce Ammo( Consentmulf-insertf"WorkerrCampen-
swan, as provided for by Sectian 3700 of the labor Coda, for the ped.. of He
work for which Har permit is issued.
ave and will maintain Workers Compensation Insuranw, u rwuird by Section
3700 of He labor Cade. for the pctformanee of the work for which this permit is iuued.
'
My Workces Compensation lmmcance candor ad Policy number arc:
m
Cacr11-�U,-70 Policy No
CERTIFICATE OF EXEMPTION FROM WORKERS �^
COMPENSATION INSURANCE
(r d,wasslon heed not Ise compkmd if the permit Is forms, hundred dollar (SIM)
or less.)
1 teNry Hnt in the performance of the work for which His permit u issued. l shall nm
emPloyanyperanin anyma rwumb cmb*tmlh WoM1vYCompenuuon
Laws of Califamis Otic
Applicants
NOTICE TO APPLICANT: If, after making this Certirleau of Eaernpuon, you 9muk
become subject to the Workers Canpenution pravisioru a He labor Code, you mind
forthwith comply with such Mormons or this peanut shall be deemed Iewked.
CONsTRucnoN LENDING AGENCY
I hereby affirm the the. isacons 9. kndi,tipnc, for We performaleeof
'
He wart fur which this Permit is issues (Sac. 3097, Civ. C)
Lenders Nam.
Lenders Address
1 certify that I and nu d His application and sue that He sand im'omauon is
-
correct. 1 agree to comply with all city and county ardinencu and sue laws rotating to
building construction, and hereby authodm mposenlatines of thir city to enter upon He
aave-menuaned property for ie pe purycaes
(We) ague to saw, Indemnify and yrep hamJem Ik City of Cupertino against
Iic..,,JWgme expenses
swhtch may In any waYamuse against mid City
thecostsandof this
Acansequente of the RSTAN of Hu pemJL
APPLICA DERSTANOS AND L COMPLY WITH ALL NON -POINT
SOUR EG ONS..
Issued by: Date -�
o
Re -roofs
Si tau eApprcanuContracmr Date
HAZARDOUS MATERIALS DISCLOSURE
_
Type of Roof
Mil Oe applicam or future building occupant score orluMle hasallom maeriH
by He Copan". Municipal Cade. chapter 9.12 and the Health and Safety.
Fdollocil
section 25532(a)7
❑Yee
All roofs shall be inspected prior to any roofing material being installed.
Will theapplicant or fretum building oaepanl use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit auNnu air comumiwru as defied by the Bay Area Air Quality MmaSemcnl
all new materials forins ection.
District]
P
Dyer a
I hew mol the bas r materialsrequimmcnuunJuChaprcrQ95oftheCslifw-
nhHCa1W&Safety Cud.. Sections 25505.25533rm1255M. I undctaend thstifthe Wilding
dao not c.Vqy how a term, that it u my rcepeouNitty, to miry de amupenl or the
require u be m r m issuance of a Cerufee sof Occupancy.
�
Signature of Applicant Date
All roof coverings to be Class 'W' or better
OA er or authar;>td agent Doe
O2 ITEMS OF 2
•
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 32641113.00
DATE ISSUED.......: 05/13/2008
RECEIPT #.........: BS000004758
REFERENCE ID # ...: 08050110
OPERATOR: patg
COPY # : 1
SITE ADDRESS .....: 10447 ANSON AVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER MICHAEL CHU
ADDRESS ..........: 10447 ANSON AVE
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1346
RECEIVED FROM ....:
MP3 ENTERPRISES
CONTRACTOR .......:
PATRICIA GERE
LIC #
27197
COMPANY ..........:
MP3 MASONRY
ADDRESS ..........:
4530 FAIRVIEW RD
CITY/STATE/ZIP ...:
HOLLISTER, CA
95023
TELEPHONE ........:
(831)637-6663
FEE ID UNIT QUANTITY
---------- --
AMOUNT PD
-TO -DT
THIS REC
NEW BAL
---
1BSEISMICR VALUATION 5,000.00
-------------
0.50
0.00
---------
0.50
------
0.00
1CHIMNEYRE EACH 1.00
490.00
0.00
490.00
0.00
TOTAL PERMIT
490.50
0.00
490.50
0.00
METHOD OF PAYMENT
--------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
490.50
---------------
490.50
REFERENCE NUMBER
--------------------
#3739
•
•
D�o� oiio
` CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # � / / / � / D O
Date:
Building Address:
D / /5;�I/SO-f / AJ--�
Mailing Address (if different from building address):
6W�—
Owner's Narge:
/a, G�
Phone #:
U
Contractor:
Phone: F3) "3
r13 -7P3 �f S017I
Fax:
Contractor License #:
Cupertino Business License #: :27197
Contact: /
P� 77 ll G�
Phone:
Fax:
Residential Commercial
Job Description: //,q�� /e J
O
(�74.�Z),o9 77 �
Is the pr9ject in the Wildland- Urban Interface Fire Area? Yes ❑ No 0-�
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1 FR, I lFR ❑ 11, 111, V-lHR ❑ 11, 111, lV V -N M
( -S
Valuation: I'3DdD Square Footage:
Project Size: Standard arge ❑ Major ❑
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.
Points Achieved:
For help,
contact Build it Green at www.builditgreen.org
O CITY CI
of
CUPEkTINO
4
r
L
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1GENCOM
1 BTEMPPER
Temporary Building Permit (good for
B
30 days)
1BBOILERI
For the installation or relocation of ea
M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
1 BBOILER2
Installation /relocation of ea
M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3
Installation/relocation of ea
M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1 BBOILER4
Installation/relocation of ea
M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5
Installation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH
For ea appliance or piece of equip
M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP
Other Electrical Inspections (per hour)
E
1 MECHINSP
Other Mechanical Inspections (per
M
hour)
1 PLMBINSP
Other Plumbing & Gas Inspections
P
(per hour
1MEETINGIHR
Application Meeting
B
CITY OF
•
CU
PEkTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW
SFDWL/Duplex New
B
IACOUSRESAD
SFDWUDuplex-Addition/Alteration
B
IACOUSCOM
Multi-Family/Commercial
B
CHIMNEY'S
1CHIMNEY
Chimney
B
/
1CHIMNEYR
Chimney Repair
B
FENCES
1 FENCE>6FT
Non -masonry, over 6 ft in height
B
1 FENCEMAS>6
Masonry, over 6 ft in height
B
FIREPLACES
1FIREPLMAS
Fireplace Masonry
B
IFIREPLFAB
Fireplace Pre-Fabricated/Metal
B
I FLAGPOL>20
Flag pole (over 20 ft in height)
B
1MODUSTRU
Modular Structures
B
FOUNDATIONS
1FOUNDREP
Foundation Repair
B
1 PILECAST
Pile Foundation Cast in place concrete
B
1 PILEDRIV
Pile Foundation Driven (steel, pre-
stressed concrete
B
3 of 5
vt
• CRYOF
CUPEf�TINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1 RETSTN
Standard (up to 50 ft)
B
IRETSP310
Special Design, 3-10' high (up to 50 `)
B
1RETSP10
Special Design, over 10' high (up to
50'
B
1RETCRB<
Gravity/Crib Wall, 0-1O'high (up to
50 ft
B
1RETCRB>
Gravity/Crib Wall over 10' high (up to
50 ft
B
SIDING
1SIDESTBK
Siding, Stone & Brick Veneer
(interior/exterior)
B
1 SIDEOTHER
Siding all other
B
SKYLIGHTS
1 SKYL<l0 SF
Skylight less than 10 sf
B
1 SKYL>10SF
Skylight greater than 10 sf or
structural
B
1STAIRS
Stairs -first flight/ea addt'l
B
STORAGE RACKS
1 SRACKS<=8
Storage Racks 0-8' high (up to 100 sf)
B
1 SRACKS>8
Storage Racks over 8' high (up to 100
st)
B
1STUCOAP
Stucco Applications (up to 400 sf)
additional stucco application
B
4of5
` • � �YYi'J
CITY OF
OCU
PEkTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
1 WINREP
Replacement windows/sliding glass
door (ca 8 windows)
B
1 WINMEWSTR
New Window -structural shear
wall/masonry (includes plan ck fee
B
1 EPERMITFEE
Electrical Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
1 PPERMITFEE
Plumbing Permit Fee
P
1 ELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1MECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
1PLMBLNCK
Stand Alone Plumbing Pln Ck (hrly)
P
1 STPLNCK-(3 Hr Min
when not over counter)
Standard Plan Check (when no E/M/P)
hourly -stand alone
B
1BSEISMICR
Seismic Residential
B
1BSEISMICO
Seismic Commercial
B
1TRAVDOC
Travel & Documentation
B
1BUSLIC
Business License
B
5 of 5
9
10
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
1,69W7 0i�.sor?
PERMIT #
Ej &-b S"a r �0
OWNER'S NAME: N1if,17R ej CA 14
PHONE # 031-6, 37-407&63
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signat a 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
Tile
Owner/ Contractor Signature
Date