01040139 CITY OF CUPF.RTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMII'NO.
10910 E ESTATES DR LEON MASONRY INC 01.0401.39
OW'NER'S NAME: APPLICATION SUB DATE
240 MOSELLE CT 04/25/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 3
65-1660
O O ARCHITFCT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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<d L.l l� Cl CI
LICENSED CONTRACTOR'S DECLARATION
0Z a 1 hers'hydlirm that int Mcrae«caller p....Wonsof Chaser n Ic:mlmchad, Job Description .
F=CC 12 with Section 71130)0&Divlxinn]ofthc BusiuessmW 'rnfeesinn,Cial,and erry licemo '
ax Loc, rereeantee(`5.� _ CHIMNEY REPAIR
ne Liceaxe loss Z{/_' Ide.a 2 3
ARCIII'1'ECrS DECLAT
¢�e I understand ter plans xnnE be a<ea as pantie menr
❑O LmenvaJ I'ndcssional
S OWNIiR BUILDER DECLARATION
u� I heresy oilman Ihm I ante exempt from the Contractor's Elective law for the
following regmn.(Section 7031.5.Business and Professions Cale:Any city Or county
E F O
which acquiresperm t tconstruct, It r p o J m demolish, p any structure _
as6� prim , .t.a. 1 lm ,happlicantl t suchPe 'u flsigned:taterrcnt
w
that he is I ccowdp tt lie prov sionsof the ComeachorsLeen Law Chapter S Ft. Floor Area
(commencing with Section 7lN)llldllh'sm3 el the Bus'net.and I'ral.exanre Codd fl' Valuation
or that he Is raempl therct'nnIt and the basis for the alleged exemption,Any violation
of Serum 7031.5 by any applicant for a permit subjects the applicant as a civil penalty
.fuel more omn five hundred dollars($500). APN Number Occupancy Type
°I,as osvnenaf the property,or my employees with wages as their sole comp rection, 'J D
will do the work,and the structure is not intended or ofined for sale(Sec,7044, -
Rusinesa end Prafexxmns Cuda rhe Convector's Lican,e Law discs not apply m an Required Inspections
cncroficrolunj Who builds oes f improvthereon,and who does such work himself
or through his own employees,provided that such ianpmvemenr,am not intended or 1,01 — FOUNDATION
offered far for vale.If,howevee m
the building or intprovecnt is sold within one year of
mmplibum,the owner-Wilder will have Ne landed of proving thin hedid no builder 312 CHIMNEY REBAR d STRAP'S
Impmvc for purpae.rule).
°has unpin(If the property,an.e.eweivelr conat,ing with hcenud oranaucmrs,o 514 — FINAL PUBLIC WORKS
construct the pnject(Sec.70,14.Business and VtOlessions Coale:)The CII mr's
License Low does not apply to un nwn.r of property who builds it,improves theme..
c
who contractsand wvmccontractsnn
for such projes with z nnrnnnrfs)IiccnscA pursuant m rsuthe d
and
Contractor,License law.
°I am eventful under See ,B&P C far this reason
Owner Date
W'OR Kaler pC'flty'I?NSAI'ION ofthe RA'r10N
I hemhy anima under penally of perjury one of the following Jcdamtions:
° I have and will mainmin a CeniBcn¢Of Cause., to self-insure for Workers
Cnmpcnsation, as provided for by Section 3700 Of the Labor Cale for the
perfmnmace of the work far which this permit N iswcd. /
301h7DO I ;he will nwi roan Wurkcr'i -num!enwtinn lnsyllncIKGlrcs3 s(y i
1]IIB til the i.ahor Je,b the erlhrmance til the//MMWWRROO�r 1/�rrli tp£m'
issued.My a Inw mance camier-a (icy number ore:
Co.
F� Policy No.: /�O -
CERTIFICATION OPP.%EMPrIONrRO. W'ORKE S'
COMPENSATION INSURANCE
(Th(,w"ina need nn,lir completed if permit ie for one hm.dred dullacs -
($]W)orle,s.)
I minify aha,in the perfnmmare of the work for which this permit is issued,l
shall Out employ any Persian in any..one, an become s.hjc,,m the Workers
Compensation Laws s of California IT t
Appl I
NOI IC17 TO AIILICAN I 11,11a nickingll Cruill,ane Ill Lsunpfoa,you should
z beco : til a theta kCompensationp f the labor Code.you must
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forthwith t IIIY with such protons or this prnt shall be deenal resokcd,
F CONS'IRUCI'ION LENDING AGENCY
Ihereby albrm,hat them iso construction lending agency for[lie ferfrmance -
W of the work for whichhis pemna is i...ed(See 3097,Co,CJ _
Q Lender's Name
z Lender's AJdrese
I certify that l have read this application and,'air that,he aWve information is
[r curter I alae m comply with all city arta county ordinances tad stair laws miming
O V mbuddingcunnmchon a -by amhorim representatives of city to enter upon
>aW the above-oaenhone manly r inspection purows.
E., 9L. ".ja, asv, n moi' and who h nay in the ay:,Crua, glo,t.it O
ter (A liabilities,jus rents,esus 4nA peau 1 which array in any way accrue ngainpl saiA
Col City in co qucnce Of eg t is p. nil.
PLIC NT UN S COMPLY WITF�A1 NPO(. Issued by; Date t]
OU .BRP A G
m fApphcan Co of I ate Re-roofs
BAZARI)OUS MATERIALS DISCLOSU F. '
Will he npplieam nr heare III:ec.pnnI xln a nNandle lmenrdtntx naatodal Type of Roof
.as defined by the Cupertino Municipal Cuda Chu tie,9,12,vad,lie Hcallh and Safety
Curie,Section 25532(alt
11 yes 11 No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future budding occupant use equipment or devices which If a roof is installed without first obtaining an on,
inspection,ectiI agree to remove
emit[visitations air commonia,as defined bydm B.y Arca Air Quality Management
Ili,tnrO all new materials for inspection. Applicant understands and will compI with
°Yes` "O all non-point source regulations.
PP y
1 have tend h.ze ,a,council requirements under Chapter 6.95 of the
California[]call Safer Me.Seen 25505.25513 and 25534.I undemmnd that
ifthe Wildon oe,am re,By in, a,that it is an,respamibilit mnmifyte -
Occupant a vel vast be ref prior,.iss ance n CeniBe of
Occupa l/
Z O Signature of Applicant Date
Q m .ram mire age All roof coverings to be Class `B"or better
OFFICE