04080137 CITY OF CUPER'I'INO
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nmt.nlrvc mvls(ory Pi✓RMIT dCONTRACTnR INP'QRMATIQN
BUILDING ADDRESS: PERMIT NO
JOE S BARRAZA MASONRY INC 04080137
TN PERMIT ISSUE DATE
OWNER'S NAME:
SANITARY OL N0.
ONE:
BUILDING PERMIT INFO
ARCH TECT/L•NGINEER: BLDG ELECT PLUMB MECH
0
co, LICENSED CONTRACTOR'S DECLARATION Job Desc [p[4Q /�
so F I M1erepy a(Rrm That I am I;l R.undee,Provisions nr Chapter 9(commencing V r�\ /AI �l D
`uj with Se tion]Dlggnf Division Jol l6c nus'tie}61nd Professions Codc,anU my Read.is TN
\Uvl✓//C�],\O\IILII7
_zo, .fun m deffep.� / /1 11 REBUILD CHIMNEY
D g z License.0 _ Lif g fst
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ARCHITECTS DECLA$ATION
< 1 understand my plans shall Wused as, c rtcnrds 1004
DyU
o�
Licensed p r/n QM�C�D
g OWNS - UILDER DECLARATION (\ n
dCo he by (Sa, thatI 1. exempt from the Contractor's Any
Law Tonne II\\\�Vlfff
E:. following mann(Sccdon]II]LS,Business and Pmfeainns Code:Any can or county
I
=� which requires a permit W consuun,eller,improve,demolish,..pair any swctum
t-¢r prioru juissuance.also mquit.the applicant for such permitmrileasigned statement Sq. Ft. Floor Area Valera[on
< that he is liccnxJ pursuanuo Nc provisin.of NC Cam.ums Limnx law lChepmrY
IE n (commencing with Section 7W)of Division 3 of the Busintmand Prnressinns Coda)nr
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that M is exempt therefrom and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicanno a civil penalty of 3 5B11PbMtB;r0 0 Occupancy Type
not mem dun f humbled della.(5300).
❑I,as owner of the property,m my employees with wag.as Multitude compensation,
will du the work.and the structure is not intended or offend for sale(Sec.]O14,Business Required Inspections
and Professions Codc:The Conuxreri License dao not danot apply to an owner of q P
property who builds or improves thereon,and who docs such work himself or through his
own employers,provided that such impmvemenu are not intended or offered for sola If.
however,Ne building or improvement is sold within one year of completion.Ne owner
builder will have the boosted of proving Nat he did not Wild or improve for purpose Of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors t°
constmel the project(Sec.7014.Business and Professions Code:)Tic Cmal acmr's U
se law does not apply to an owner of pruperty who Wilds or improveir themon,and
who contracts for such projects with a conuacmr(s)licensed pursuant in Ne Contractor's
License Law.
❑l am exempt under Sec. B k P C for this mann
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby aff on under penalty of perjury one of Ne following declarniotn:
L]1 M1°ve and will maintain a Ccnificme of Conserv to selhi.um for Winlaw's Compen-
xtion,a provided far by Section 3700 of Ne Labor Code,for Ne performance of the
walk for which this pemtit is issued.
I have and will maintain Workers Compensation Insurance,in mquimd by Section
3700 of the Labor Code,for the perfmmance of the work fnr which this permit is issued.
My Work ex Cnml,ansation Insuch m carrier and Policy numhcr art:
Cp , er�d't✓['( LK'VVTW\ Policy No.
TV/ CERTIIICATEOFT(EM—Pr1ONFROMWORKERS'
COMPENSATION INSURANCE
(Th¢section need not W completed ift (armitis Room,hundred dollars(SIM)
nr less.)
I eeNfy that in the Performance of the wO,k for which this Permit is issued.I shall not
employ any person in any manner so as in become subject o the Workcri Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Certs ncam of Exemption,you should
become subject to the Worker's Com pensatiun previsions of the La her Coda you must
Z forthwith comply with such provisions or this Permit shall he deemed revered.
Z O CONSTRUCTION LENDING AGENCY
'r. I hereby affirm that Ncre is a eonstsuaion lending agency Iter the performance of
IY, 7 the work for which this permit is issued(Sec.3097,Cie Q
W QLender's Name
11 Lender's Address
U 0 I eenify that I have read this application and some that the above information is
W F convect.1 agree to comply with all city and county ordinances and state laws relating W
0U building construction,and hereby auNarise reprrsenutivix of this city to enter upon Ne
r W ahovelmentioned property for impaction purposes.
G (We)agree W save,indemnify and keep hmmlesa the City of Cupertino aglow
„F„ N liabilities,judgmen..costs and expenus which may in any way accrue against said City /
C.1 Z in consequence of the granting of this permit.
'-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG LIONS.
Re-roofs
S' a f pphwH actor D°te Type of Roof
H ARDOUS MATERIALS DISCI
ill the applicant or future building.cupant store or handle Wea dons material
defined by Ne Cupertino Municipal Code,Chapter 9.12.and Ne Health and Safety
code,Second 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
El Yes [�u
Will me applicant or future budding..part ae egwpmem m devices which
If a roof is installed without first obtaining an inspection,I agree to remove
mit hamrdom air conmminant5 as defined by the Bay Arta Air Quality Manigcmcm all new materials f r in ection.
Dianict'!
❑Yes /N 'v
I have mad the hocirdo amadenids myuiremcnts under Chapter 6.95.1'me CAirm v v
niaHealth de SafctyCode.Scedons25505.25533 and 25574.1 understand that ifthe Wilding
does not currently have a umam,that it is my responsibility W army Ne.cupant of the
requimmen hi ch must be met pdorvaissualmiCcnificamafOccupanry Signet fApp ant Date
All of coverings to be Class "B" or better
Ow out ¢ gem Data
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
"UPEkTIN®
113-luilldinDepartment
JOB ADDRESS: PERMIT#
O R'S NAME: jpo5e4= PHONE # 40 -72"]-- 1\V9 ZI
GENERAL CONTRACTOR: FAX # 407
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete 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
er/Contr for Signature Date
.I
a CITY OF CUPERTINO
CITY r PERMIT APPLICATION FORM
CUPEI�TINO
APNt
Dae:
�3sS- •zt o1
Building Address: Mailing Address (if different from building address):
h 2 1/J L
Owner's Name: Phone #:
U
Contractor: License#:
A A GW 4:)(D 2qI
Contact: Phone:407- 72-1-1147 Cupertino Business License#:
,�2-w F1CYA Fax06 7Z-7- 1%545
Building Permit Info:
Bldg Z- Elect ❑ Plumb ❑ Mech ❑
Job Description: n
Residential 11 �VJmLe�, I\ Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Co of Project: Occupancy Group:
----------
Type of Construction: Please check this project is a
V-4Y second-story addition: ❑
O
Project Size: Standard ® Large ❑ Major ❑
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
BELE 200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
# v0OF
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CITY OF CUPERTINO
CUPaClak
WO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
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
BREMA]RHAN 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
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
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CITY OF CUPERTINO
CUPEYOf PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMSIGNAD Rmdl Sips 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
BSW1M 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
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