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05080014Z, <oH jqz [e[f� >�U LLL O� �pC0R <mtr n'N Y�C 0 Z C CITY OF CUPERTINO�-:inE CONaTRACTnR�INFORMATION BUILDING DIVISION PERMIT BUILDING ADDRESS: LEON MASONRY INC PERMIT NO. 05080014 10936 LINDA VISTA OWNER'S NAME: PERMIT ISSUE DATE RODNEY FERNANDEZ 240 MOSELLE CT 2005 NE: SANITARY NO. CONTROL NO. (408)365-1660 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED COMRACIOR'S DECLARATION OeSCrIP Ib Description I hereffi mmencing by arm that 1 am liwved under provision of Chapter 9 (co with Socumt7Qt0) of Division 3 of NC Bush. and Prohessi e, Code,and on, license is in mu form and eC�l­2�9 Limmo Class LiaX CHIMNEY REPAIR p�{�t}a'�� p pkv D.¢ Contractor I in,' ARCHITECTS DECLA ION I understand my plans shall heuuJupuhlic rtcnNs ((Feer jilt' nd Prefcuional Liccu OWNER -BUILDER DECLARATION 1 hereby al'fnm that 1 am e&empl from the Contractor's License Law for the V (� Profession Cole: Any J following moon. (Section 703 .5, Business and city or county which mqun a Permit to consirumer, alter, improve, demolish, or .,air any mute m 0 n A$4000 prior to its issuance. also inquire, the applicant for such permit to file a signed statement that he is licensed pursuant to the previsions of the contractors License Law (Chapter 9 Sq. Ft. Floor Area �, '�t �(d"• Valuation (commencing with Section 7(30() of Division J of the Business and Professions Code)or tae �/ •li q Nu at he commit, therefrom and N moss ss for the alleged exemption. Any violation of Y d Yi ivZ? ? r tlIU OccU anC Type P Y YP Section 7031.5 by any applicant for a permit subjects the applicant to a civil acidly of oat more than rivc hundred della. (5500). -] ❑ I, az owmr of die propcny, m mY cmplaycu with wage u their sole compensation, e Required Inspections will do OcworL and the structure is not intended moRered for sole(Sec.]064, Business and Professions Cede: The Contractor's License Law dues not apply to an owner of 9 P property who builds or improves Nemon, and who does such work himself or through his ownemplayera, provided Nat such improsumenus arenm imended a.Rered forule. If, however. We building or improvement is sold within ore year of completion, the owner. builder will have use burden of proving that he did not Wild or improve for purpose of side.). ❑ 1. as owner of the property, am exclusively contracting with licensed mnuacton to couwct the project (Sec. 7064, Business and Profusions Cade:) The Contractors Li. roe law dors not apply to in owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License law. ❑ 1 am exempt under Sec. . B & P C for Nis noon Owner Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: J I have and will maintain a Certificate of Consent in self -insure for Woftes Cori sation. u provided for by Section 3700 of the Labor Cade, for the pelfmmanco of the work for which Nis permit is issued. . have and will maudlin Worker's Compensation Insurance, u reyuiud by Section 37M of the Labor Code. for the: perfarmmec of the work far which this permit is issued. My Worker's Compensation Ina.m. carrier and Policy number are, ] Comer. �- {`L �f�N(i Policy No.: 0 E0 -71 /V CERTIFICA— TE OF�PfION FROM WORKERS' COMPENSATION INSURANCE (TTissection need not becomple¢d if the Permit is for one hundred dollars (SIM) or less.) 1 unify that in the perfmmanec of the work for which this permit is issued. 1 shall nm employ any person in any manner o az to become object to the Worki ri Compensarion Laws of California. Dau Applicant NOTICE TO APPLICANT: If, after making this Certificate of Eaemption. you should become subject to the Worker's Compensation provisions of the Labor Cndc, you must ' fanhwiN comply with such provision or Nis Permit shall W deemed onmool. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is lending agency for the performance of s ed (S..l3 ' the work for which Nis permit is issued (Sec. J(N], Civ. CJ Lender's Name , Larder's Address I renify that 1 have read this application and sure that the above information is ' cooter. I agree to comply with all city and county onfirearms and sou laws milting to building cenlmerion, and hereby suthorimrepresc Wocsi of this city to enter upon the t alrovrmentioned property for inspection purposes. (We) ague to save, indemnify and keep harmless the City of Cupertino against j Iiabilitin,judgments. costs and c&penes which may in any way accmc against mid City in consequence of Nc Hoang of Permit. ' APPLICANT STAN D WILL COMPLY WITH ALL NON POINT iOURCER Issued by: Date �- 62.-0 `1— L IONS. Re -roofs Type of Roof Sign er Appli antnctm Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hamidlous material az defined by Use Cupertino Munici al Code. Chapter 9.12, and The HcaIN and Safety edc. Section 5532 M, All roofs shall be inspected prior to an roofing material bei. Installed. P P Y g ❑Tea Na g If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or forum ding occupant tau cyuipmcm or rkvicca which it harardnus air conuminan. rlfrted by Ne Bay Arca Air Quality Management all new materials for inspection. 1[17 C] Yes No 1 have mad the hanldous materials nequimments under Chapter 6.95 of the Califon 1d,r ealth&Sefmy Code, Secuon 25505.25537 and 25534.1 understand Nat if the Wilding not tune sit a termer. that it is my responibilily to notify the occupant of the uimmc mtrss 1primfaiuwancciracemfica ofaction, Signature of Applicant Date 6� All roof coverings to be Class "B" or better r ser awhorim Dau x y CITY OF UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: 0 36 L -'N -/a D2 PERMIT # C-) -T-ok ob(U, OWNER'S NAME: od PHONE # Yom 3 -A6 C U GENERAL CONTRACTOR [ o o Tu< FAX # 6 /6 I I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: G� Date 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 G� Date ann' CITY OF CUPERTINO CUP TYOf O PERMIT APPLICATION FORM 0 APN # r / Fee Description Fee Group BAPPLOTHER Date _ v Building Address: BBOILER1 Boiler <= 100,000 Btu Mailing Addres (if different from building address): o L,VCICL Boiler > 100K to 500K Btu v.,'s-1 BBOILER3 Owner's Name: MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu Phone #: BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX 6 YY Contractor: I BCONSTAX Ind/Off/Comm/Quasi BUILDING License #: o d iJ Ry ZQC Hotel and Motel 6 Contact: Constax — Resi/Mobile I Phone: yog 36S-_1660 _Cupertino Business License#: I)iAVC Q c_k BELEC1001 Fax: ELECTRICAL BELEC200 Building Permit Info: ELECTRICAL BENERGY Energy Bld Elect ❑ Plumb ❑ Mech ❑ Job Description: Investigation fee BUILDING Residential ❑ Remetle cklmtjel Commercial ❑ Sq.Ft. Floor Area: V S/Sq.Ft.: Cost of Project: Occupancy Group: Type of Constructio . Please check this box if the project is a second -story addition: ❑ Pro'ect Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to IM Btu MECHANICAL BBOILER4 Boiler> IM 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 I of 3 I amm, CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO 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 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BRENWRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace 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 2 of 3 CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 Ternp 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----- —Plutubin -Permithsue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3 1 •