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04080227 CITY OF CUPERT[NO �a*?>h BUILDING DIVISION PERMIT U CONTRACTOR INFORMATION =.. BUILDING ADDRESS: JONES MASONRY PERMITN004080227 7513 HPATHEIRWOOD DR OWNER'S NAME: PERMITISSURDATE Alk M HE: SANITARY W07 CONTROL NO. AR CHITECT/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH to, LICENSED CONTRACTOR'S DECLARATION Job Descri tion yMiI hereby affirm Nu 1 Am Hamed wider prov''ons of Chapter Y(commencing < with Scet on]OfN))Of Diviaionlof dm BuvncvaIcssium Cook.And is w , ® °L<a„ imm�m � (Q REPAIR CHIMNEY & ROOFLI ,eet{Etgm{gt(� pqZ Licensa c.N z F pp Oam Of C.mh. WSje< ARC I IS DECLARAT] N U3< 1 undersand my plans mail he used u public records SW /r eyoo4 ;u� Licensed PndessionaI �7 C O OWNER-BUILDER DECLARATION <f 1 hereby Affirm that I am exempt from the Cnnlrenah License Law for the 0O following reason.(Sec ..7031.5.Business and Pmfesamns Coda:Any city or county EMO m P which requires a permit to eaneVu,,altar,improw,demolish,lir repair any Structure On prior m its cam.ace,also segooashc applicant for each permitm fleasi,mil statement Va Ualon FSC that he is Beamed pursuant to the provisions of the Connector's U..Law(Chapter Y . 'Sq.Ft. Floor Area ash- (commencing with Section 7000)of Division 3 of the Business And pretensions Cods)or i dui he is exempt thc¢fmm and the basis far the alleged exemption.My violation of Section 7031.5 by any Applies,for a pemnh subjmrs the applicant to a civil penalty of 3,3�)gl�lCrl$e7O O Occupancy Type not more than Bw handled dollars(5500). L as own.of the property a my employees with wages a their sok compensate , will do the work.end theguuaure is not intended or offered for sale Sec.7W.Business Required Inspections and Professions Code:The Contractors Liame law dam not apply to an owner or q P property who builds or improv thereon,and who does ouch work himself or through his own employ=,provided rim such impmvemo.ta Are not intended or ofa.d for tale.If. however,the building or impmvcmcni is said within arc Year of completion,the owner- builder will have d¢burden of proving that be did not build or improve for purpose of sale.). ❑1.as owner of the property.am exclusively contracting wish licensed contractors m magmet the project(Sec.7044,Business and Prefewons Code:)The Contmeaga Li. came law does not apply m an owner of property who builds or improv thereon,and who contracts for such pmjmiA witha mmus cmr(s)licensed punuam m she Comrxmra License law. I ern exempt undo Sec. .B&P C fa this team. Owner Data WORKERS COMPENSATION DECLARATION 1 hereby affirm under penally of perjury ane of the following declargince 1 haw and will maintain ACutiGare or Consent to self-insure for WedkefsCompen- ution,a provided for by Section 3700 of the labor Code.for the performance of the work for which this permit is issued. ❑1 haw and will maintain Worker's Compensation InwrAna,as required by Section 37W of one labor Code,for the performance of the wmk fm which this permit is iise�mad. My War ACary�p/eJn�ti-o,ns In fmrrue carrier and Policy no mall/R IID• I A 'cr. re s� fI�C - poli !t/ CERTIFICATE OF EI(EMPION MWORKERS' COMPENSATION INSURANCE ('Otis xenon need not becompleted trim Permit is for one hundred dollen(SIM) ar lass) 1 unify,dist in tic performance of tad work for which this Permit is issued,l shell not employ any person in my manner an az to become subject in the Workers'COmperuadon Laws of California.Dan Applicant NOTICE TO APPLICANT:If,After making this Certificate of Exemption,you should become aobjen or the Worker's Compewtion previsions or Ota Labor Code,you muse .J Z faMwith comply with such Provi m.or this Permit shall M deemed revalmd. z O CONSTRUCTION LENDING AGENCY [r Iheshy oMrm the f.iso mnstrvninn lendingagmey for the performance of (5: 7 the work fur which this permit is issued(Sec.3097,Civ.C.) D.) A t<ndcfs Name- a Lenders Add. U O I certify dint 1 have rtad this application and sum that the game infotmNon Li U.P correct.I ago,to comply with all city and county ordinances and seta laws slating to 0U building construction.and hereby aothonw representatives Ofthis city to enter upon the r Dd above-mentioned propany for inspection Purposes (We)agree m saw,indemnify and kap harmless the City of Cupertino agaitm rh liabilities,judgmenu.aosu and A.N.which may is any way AOaae against said City U in consequence of thc granting or this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO1{-POINT Issued by: gOUR�i —N�,LeyJ/',hI4n Re-roofs sin c AppliandC ler ta H RDOUS MATERIALS DISCLOSURE Type of Roof Will im applicant or rums Wilding occupant store or handle haardoas material As defined by the Cupertino Municip!Code.Chapter 9.11.end the Health and Safety We-,Sec tion 23532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant r future Wilding Oaupam use equipment or deviccs which If a roof is installed without first obtaining an inspection,I agree to remove it Im.dam air contaminants As defined by the Bay Asa Air Quality M...Im e, all new materials for inspection. Disnin7 ❑Yes I have read the has✓Haus mawrialesquimmenm under Chapmr 6.95Of she Califon nu Health&Sdcty Cade.Sections 25505.25533 and 25534.1 undentaW that if the Wilding does ore,olocati,haw A tenant,that it is my resp righility m notify do t Or drc re xwb ch mug et porn m issuance Ora ccn+Bcamafc=u—. Signature of Applicant Date All roof coverings to be Class"B"or better @anxcJ a6 I DA Community Development 10300 Torre Avenue xY' Cupertino CA 95014 '' TM Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPERTINO . Building De artment JOB ADDRESS: PERMIT # --7513 Pit v of 0 q o ej c) d � OWNER'S NAME: tgA -Z:W—pw-4PHONE # "- 3-7 7 - 1 S GENERAL CONTRACT FAX # rro y - 7 -► I am not using any subcontractors: Si tuneDa' tJ Please check applicable subcontra rs and com Tete 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 _ C Contractor Signature ate CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM APN# G �2� Date: Building Address: Mailing Address (if different from building address): Owner's Name: �S Q Phone#: Contractor: License#:39035 9 �/Cf�07 Contact://� ,� Phone: 3 77-7 N-./--2-1 Cupertino Business License#: (SLP �nsa Fax: 3-27- ,7s-1-3 Building Pe rt Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: `` /��a6a�1/ Residential u Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: 3SODA Cost of Project: Occupancy Grou Type of Construction: / Please check the roject is a I second-story addition: ❑ Pro'ect Size: Standard ❑ Lare Ma or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K 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> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Enerry Add Multi BUILDING BINVESTIGA Investi ation fee BUILDING 1 of CITY OF CUPERTINO CITY0 PERMIT APPLICATION FORM CUPERTINO JIM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMIvIE New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTEVIE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 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> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Ap2aratus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 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 2 of 3 CITY OF CUPERTINO CUP OF TYO PERMIT APPLICATION FORM Quantity Fee 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