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03050005 ' CITY OF CUPERTINO BUILDING DIVISION PERMIT Wo: „, TORI � BUILDING ADDRESS: LEON MASONRY INC PERMIT NO 03050005 2294 CARTA RT.ANr.A RT OWNER'S NAME: 240 MOSELLE CT ”En2/2003 RKLAND BEVERLY J ET AL ONE: (408) 365-1660 SANITARY NO. CONTROL NO. ARCHmIC 79NGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p O O Z. LICENSED CONTRACTOR'S DECLARATION Ib Description tIu I hemby affirm IMI I am O licensed under provision of Chapter 9(cu.mons ng p with Section 70M)of Division 3.fft Busimstand profusion Code,and my license is nkf.11fforce�deffet--Z9, Llea 23 CCHIMNEY REPAIR FINALwE® Date M AZ=/'S'�Contractor D G ACTS DELLA ATION 1 undersand my plan shall W used ae public records MAY 0.7 2003 3 w Licensed Professional 5O OWNER-BUILDER DECLARATION I hereby io .(iced that 11. .u sin from the Cession h Licence Law for th wn BUILDING SCO which nC mason. (anti. .Centeno.ater. and Profession Code:Any city a o.umy w whores requires a e.Alto re es theller.Improve,demolWt.ri e a sig sty ssucture tprior hatW its cened!prsuinquires theapplicant for Cola punts.. fdeasigned(ststemenf < thathsMeuW pursuant to the of Division nrlMcnnusines9L0.<nmLaw(Cods)9 Sq.Ft.Floor Area �`2�Ig�jlgtion $ (came"I',mSwiNScdfan70nddi DTvlsi.n3 o(thegednundon.AnyProfession Cmle)or — Out h s exerrdpt thcte(rom and d0)Msis fm IM alleged exemp0an.Any Woledon of Section 70313 by any applicant for a permit subjects the applicant to a civil penally of 3WN34b"er00 Occupancy Type not mom thin five huMred do1Wa(5500's 0 L u owner of dte property,in my employees with xgu as thels axle compevudon, will do the work and the eUntmre Is not imembed or offered forsalo(Sec.7044,Business I U1 — IIjI$S ectio and Profession Code:Th Crearwhofe Ussnse Law don not apply w an owner of 3 12 — CH I MN n & S TRAP S preperty who builds or im proves thereon.end who does such work hi mal f or through his own employees.provided that such improvements are not intended oroffeml house.if. 514 — FINAL PUBLIC WORKS however.the Wilding or improvement is sold within aro year of completed,the owner- Wilder will Mw the banden of proving that be did me build or Improve(or purpose of ole.). ❑1,Or ownu of the property,am esclusively contracting with licensed cenlracwn to couuuct the pmject(Sec.7044.Business and Profusion Cade:)The Contractor's U. cense Law does not apply w an owncr of property who Wilda or improves thereon,and, who cemoses for such projects with a contrtemr(s)licensed pursuant an the Conmioes License Law. ❑lamuemptunder See .B&PCruthsreum Owner Date WORKERS COMPENSATION DECLARATION I hereby same under penalty of perjury one of the following declarations: 1 have and will main W o•C.NBnuofCommet teself-inure for WmkersComPen- sadun,u provided fu by Section 37M of the labor Code.for the performance of 00) work for which this permit is issued. ❑1 have and will m dmdn Worker's Compensation Wurame,u required by Section 37W of the LsWrCude.for Ne performance of the work for which this permit Is issued. My%rac(e$�c'on��pewdymn 1."�� tamer and Policy number are: Carver. CERTI�11JG Policy No.: Dgit, 3 L21ffIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE CDusmeuan need net h completed dthe Permit s forone hundmddolla s($100) m leu) I certify that in the puremenu a of the work for which this permit is issued.l shall not employ any person in any mannerw as he become Object o the Worked ComPCianden tawscr California.Date Applicant NOTICE TO APPLICANT.If,du r making this Cediacate of Exemption,you should become subject to the Worker's Compensation previsions of the labor Code.you mud ,J O forthwith comply with such provision m this permit shall bo deemed revoked. . Z` CONSTRUCTION LENDING AGENCY �.+ IMmby.111rm that dee 4 a conlndNnn lending agency for the performance of pS> the work for which this permit is issued(Sm.3097,Civ.C.) LE Lender's Namc O z I<nder's Address U0 I misty that 1 have read this application sed sou that the above information is ' tL U correct.I agree to comply with all city and county ordinances and sure laws relating to O Wilding eonsweuon.and hereby sullied=mpremu purposes ofthu City a enter open 00) LT7 above-mendoned property for inspection G (We)age to save,indemnify and kup harmless the City of Cupertino against Vh liabllides,judgments,toes and eapemn which may In any way scene against said City in consequence of me grenung of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE ULATIONS Z— Re-roots assure ofAppl"'HAZ Mcwr m of Roof HAZARDOUS MATg occup OISCLOSUR Type WIII the applicant or future Municipal Co e,Chapter a 9,1 or haMle havardaun daredty n dented DY 00)Cupertino MunidPat Code.Clupter 9.12.and the Health and Safety .d.,Section 2553:(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes No Will the applicant o uwre Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hanardnu air conumimms M deancd by the Bay Amo Air Quality Management all new materials for inspection. District? ❑Ym `U No I have read the hexudoumateriats requiremems un err Chaprerd.B5 of the Califor- McHoden&Safety Calc,Scnino 75505,355330,125534.I understand ihsifrhe Wilding dace not currently have a W94 that it is my responsibility 700fy the occupant of the mg== m m wnwn m.d I whimance.Tacenincate Cultures. Signature of Applicant Date mg== w r.r,.th.dm sent D.teo All roof coverings to be Class "B"or better r CITY OF CUPERTINO CITY Of PERMIT APPLICATION FORM CUPEkTINO APN # Date: Building Address: I Owner's Name: ` ,p hone Contracto • Lem /JV V License#: pl% - ,�,e Contact:90'� / Cupertino Business License#: Build' Permit Info: Bld Elect ❑ Plumb ❑ Mech ❑ Job es , tion: ential ❑ L Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction. Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V > IOOOA 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 Z� 7G -z I of 3 7. CITY OF CUPERTINO arr of CUPEI�TiNO PERMIT APPLICATION FORM Ouantitv 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 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 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 Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN 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 BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 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, Mar uee 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 Insection 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