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03050119 r CITY OF CUPERTINO `°`�*�^ ' >� BUILDING DIVISION PERMIT f'CO irnA,CxQR TN' C RMATIUNs .: BUILDING ADDRESS: PERMIT NO. LEON MASONRY INC 03050119 , bV*Eks PERMIT ISSUE DATE 240 MOSELLE CT 05/27/2003 (408) 365-1660 SANITARY NO. CONTROL NO. ARCHITEC IE:NGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH io0 LICENSED COMRACIOR'SDECLARATION Job Description FFy 1 hereby affirm that I Am limned under Provisions of Chapter 9(commencing 6 with5dd 7 I of Division Sof the Boal rad Profcadom Code.and my license is �A p SSSz umus�Lv s �! 2°f u.•�233ff�1 FUUMALF-0 mmnr c 1 CHIMNEY REPAIR D u S777�,�RCITTECTS LAS MAY 3 0 t I understood` my plans shall be and at public records 2003 y u `o Licensed Profcuional OWNER-BUILDERexemptDECLARATION BUILDING I:a 1 thereby aRrm o n 1 I exempt from the Co License law for the L tit VI p o which noon.(Salon 7fD1$Business and Improve.Priced.. do Cade:Any Nty err county I: $ which requires n e,anir at iumuect slur.imProse-O permit m e a sig any suumurt °zL^ prior uits isswaeennant[atriums eproapions o fm uchpermrt LimuseLaw(Cned statement £( C that he is iictnwit puruam taut a provisions acme CouraCterS arta law(Chgam P Sq.Ft.Floor Area �'S O O O IIon C�$ (eanmeaing with Salon 7000)NDivision3ef the Busineuand Pmfeuians Code)or d m be u asempt timsefrom uW the basis for he alleged exnnptiom Any vlblaUon of �pl (� �0 Section 7031.5 by any Applicant in a permit subjects the applicant to a civil penalty of 3 6-`JOccupancy Type .at mare dun Ow hundned dollars(SM. ❑1,a owes of the property.or my employes with wags As heir Ole compewdon, Ne PPrroffeenhurs and nae CCo�a:norL icense mlaoffered Out Apppiy.tol�.�err 101 — FOUNDAIUaj Ued Inspections property who Wilds urimprowa uerton.aM whodoeswchwork hlmselfor through his 312 - CHIMNEY REBAR & STRAPS own employees,provided that such imptowmenu Am aminunded aortemal fmaale.If. 514 — FINAL PUBLIC WORKS however,the Wilding or improvemOt Is Old within oroyearyof completion,he ora er- Wilder will have the burden of proving teal he did rot Wild Or improve for purpose of ask.). ❑1,As owns of she property am exclusively contracting with licensed contrOtosa to construct the project(Sea.70N,Business and Professions Cade:)710 Contncur's U, cane Law does not apply to an owner of property who Wilds or Imposes thereon.and. who contracts for such projects with a conuetorfs)licensed pursuant to he Conuetofs Lics.Law. ❑l nn exempt under Ste .B h P C for this moon Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby alTme under penalty of perjury one of the following declaration: 1 haw and will mainuin•Certifiuse of Cement or sel6buuse far Worker's Carrier. sation,As provided for by Section 37M of he Labor Code.fa he performance of the work fm which this permit is Issued. ❑I haw and will maintain Worker's Compensation Insurance,As required by Section 3700 of he LAWr Code,for the performaneapf h5 wish fa which hie permit isIssued. My orkeft Compena0nl sura=came policy oumher are: u olky No.: cY y 6 ER' FICATEOFE7,EMPnON FROM WORKERS' COMPENSATION INSURANCE (This section mad notal completed if the permit is two=hundred dollam($10n) or less.) 1 terrify that In the performance of the work for which this permit is Issued.I shall not employ any person In any manner an As to become object to the Workers'Compenutlon - Lawa of CalifornlA.Dau Applicant NOTICE TO APPLICANT:If,After making thisocairs au of Exemption,you should become Object O the Worker's Compensation provisions of he labor Code,you mug .,O forhwith comply with such provisions m this permit shall be deemed awaked. iCONSTRUCTION LENDING AGENCY F+ I hereby Affmm thatthere Is.construction lending gency for the performance of lx 7 the work for which this permit is issued(Ser.3097,Civ,C.) QUnder.haeme z Lender's Actions . V I comfy inn I have read this application and sure that the abuw laimstNun is V.F correct.1 All to comply with all city and county ordinances nd sate law minting to C V building construction,and hereby authoriempmsentsdsesorthis City 10enter upon the Liz above-mentioned property for inspection purimms. (We)agree to use,indemnify and kap harmless dm City of Cupenino aGinst yTd'q liebilidu.ludgmenu.casts and expenses which may in my my'come against old City canU APPLipe U ERSTANOS Rof IND WILL COMPLY WITH ALL NON-POINT Issued by: Date ors no . -5/Z Re-roofs i{ntl of AlNliuMCantrOa Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof . Will the applicant or future building occupant stem Or handle hazardous material u defined by he Cupertino Municipal Cade.Chapter 9.11.and the Health and Safety Code.Section 25331(x)1 All roofs shall be inspected prior to any roofing material being installed. ❑Yes o Will tirc Applicw or future ' g oecupam rte equipmcm m dcvio-a which If a roof is installed without first obtaining an inspection,I agree to remove It h.T air 1i:AO rinsnts ss fined by the Bry Area Alr Oualiry Management all new materials for inspection. D g im7 ❑Yes No I haw real he ft. r usmateriais requirements 4.1 u hapmr& i fheamon- nisHeslhd: Cotle.Savaa23305.u573arW2353d.1 underttsnte oKum Wiling s tloa ro My w•moot.this is my resgwglMllty m notify he asupant of One rcqu' menu whit mugMntet prior issuutee ora 'cons or Signature of Applicant Date ax roti agent Dam All roof coverings to be Class"B"or better •' A st CITY OF CUPERTINO cuP TYOF o PERMIT APPLICATION FORM " 3 N# Date: lU Building Address: l 03 CAt�.f�•� lew�oa Owner's Name: Phone#: Contractor: License#: eC.)rJ ho r-kr .Z 3 " 8q Contact: Cupertino Business License#: IZ.c� ti 2 <-- Buildin Permit Info: ld `r'— Elect ❑ Plumb ❑ Mech ❑ Ak Desc ' on: Res` ential El �✓t /� Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Gi/ �- Occupancy Group: Type of Construction: / J Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM 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 1 of 3 /D 7 CITY OF CUPERTINO CUPCITY PERMIT APPLICATION FORM QuantityAdh 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 BOVERTRAE 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 Inv BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo 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 din MECHANICAL BREMAMIAN 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 BREMNRA.PP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEI,TINO Quantity Fee 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 BSPECLU Special Inection 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3