01090043 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMITNO.
1636 PRIMROSE WY LEON MASONRY INC 01090043
OWNER'S NAME: APPLICATIONS BPATE
QING J. 240 MOSELLE CT 09/11/2001
i PHONE; (408) 365-1660 SANITARY N0, CONTROL NO.
p z Oi ARCHITEC'UHNGINEER: BUILDING PERMIT INFO
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ur- ELECT PLUMB MECN
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,�z LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm Ina 1 am licensed under provisions of Chapter 9lcommencing
„r8 wnhSM,im70k7lafoi,sianJnfm<HaressandProrodamCrdr.,ndni,license CHIMNEY REPAIR TO FOOTING.
-a
i cs is in full rode and eRegJ.. 6 3 K9
ae a License. CI L °I Lic.n
'o V Date Cr• I - A! Cnmmc or ,a o�
I-0� '� ARCII1TECu e DECLARATION %1�� ` ,.
::0 4 1 understand my plans shall m used as public records lO /—
Y
1 S O$O Lircnsd I'roks,ional
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OWNER-BUILDER DECLARATIONaffirm1 heresy em NI ii
at am empl from tm Coates«'.License Low for the
following
aa pet«mr-eawn. awtn7031.5,Business and eiun.Cade:Any ciy or ounty
$5000
S which permireconstruct.
r a cI Iteq' p v.de I;h.orrepairany structure
aa�e -
0.3 -
(Mmmsl"nsdp n H previsions.. .,Cot i L Iz ICmpter9 r' a r Valuation
(cam n gwrmsect oipal)orDaal J nneHa,ine= and Pn.Anyvsedm ('41�'["ti3�k�'l ( ®t12 yT.LC!-�' k
or Hot he is enempi therefromand Hes Ma for the a are i,fica m Any violation
of not mo]OJ n iv any hundred
d ll fours permit subjects Nc applicant m a civil penalty
I or not mart man R«nanarea aolmrs ls5ouj. 101APN NIOl�9bATION Occupancy Type
O 1.as owner of Wproperly,M my empicyees with wages as their aole compea smion. 102 - PIERS
-will do the w«krad the structureis not intended or ofrercd for sale(Sic.7011.'
'Bminess and Profession.,Come:The Comcannr',License Law does not apply man 103 - UFER Required Inspections"`
or OR
r of propcny Who builds or improves thereon.and bubo dues such work himself 10 4 - REBAR
or Hrw h hiss own em to ees. rovided that such ire rovements arc not intended or
pffc oe sale.If,hamoMcm the wading or improvement is sold within one year or 10 5 - ANCHOR BOLTS •t„I°;' . ..
completion,the owner W ilder will have the burden of proving that he did not Wild or !
impmveforpurposeofsac.). 106 - SEWER & WATER
o1:+sawn<id'rNep� r.mr xda;iddY<,intractingwimre<n ai,v
act. __. _.-202' UNDERFLOOR- PLUMBING
- - _ cstroct the project(Sec.7041.Business and Prore.,,ans Cdcd The CoManwo"s 2 03 - UNDERFLOOR MECHANICAL,
License,Law docs eta apply to an owner of properly who builds or improves Hereon,
r
ad,,h. t t,.h,r m p j t m, t t l,l licensed p .at t he .- - 204-- -...UNDERFLOOR--FRAME-
Coni t License La
❑1 pt a see ,e&Pefar this re.... 205 - UNDERFLOOR" INSULATION .2,
owner " - Date ' ' 301 - ROUGH PLUMBING T O
WORKER'SCOMPENSATION DECLARATION 302 - TUB & OR SHOWER
I hembyaffrm order py�,Ity ar perju:y,a��afine rauawing eamm11O"s' 303 - ROUGH MECHANICAL
❑ 1 have and wiil mdntam a Cemficme of Coa,atl Iia sell-mum for w«kre, 304 - ROUGH ELECTRICAL
Compensation, az provided for by Section 3700 of the Labor Code, for the
- 'arrannamr ansa w«k r«wli�n this puna i, >gyra.,
305 - FRAME
❑In as nidamta wok 's e�mpe to I 'taaa�.a,regaima ny secdan 306 - HOLDOWNS
crrx.(t:x,.l L er iae rNe Petr«,nr "r �o/rk6fo-r'wuh ch+Hu,pe
is
iucd My WmkrsCo pc sat on[r,armric carrier and Policy umm e � - 307 - INSULATION
308-Lt SHEEFROCK<11 kca cP.a NoO O91 = I'OR yL- A
TH".,CERTIFICATION OF EXEMPTION FROM.WORKERS I3R
... ...�.. __
.:s COMPENSATION INSURANCE"
. , 310 -' •INTERIOR--liATH"'- ;_____-- ---_._._...__._..-- _---
''''+ ITbsc'cmrmlcanotm<omplcteafthepen,mt ,foronehanartadollars 31111- SCRATCH COAT
alw3 I .,
e I 3-13- ROOF NAIL ...
r I seri ry N(in the peR rpr c or H< ork f h cA H. pe t I,
shall
of en lo' I_s u ,
y,any .' nary n„n ler am<a pe mnlrelmmc wark<r 501 - FINAL ELBCTRICAli`ENERGY
Compensation
omp rpnLawsorclm 502- - FINAL PLUMBING ENERGYApplicant .-
NONCEIOAPYLICANTA fter 'kingm cerliti5atearEa ptian,yapsnaala 503 - FINAL MECHANICAL ENERGY
O pbecome'a"re,to the Worker',Compensation provisions of the Labor Cde,you must'
vrwi provisi°'° prnni °ked. 5.04 - FINAL BUILDING ENERGY--
CONSTRUCTION
ENERGY__
farm H I HsucM1 n rN. tshallmdttmd
.. -. --- -
p..� CONSTRUCTION'LENDINGAGENCY 505 - FINAL ELECTRICAL„ '
1 hereby Rrm that mart is a construction lending agency furthe pe form - "t
Lithe work For .n enNspermtelse 3097 c' cj 506 GAS TEST
y p Lena Name
Lentle sAdd 507 FINAL PLUMBING -
U z
U OIcesiryNatlham mail tn.sapplication and.talehatsheabove information is 508 - FINAL MECHANICAL'`
muco.I agree c<omNy with en ety and vaunt,midu ancc,and state laws r<Imins' 509 - F I NAL GRADE
O U to Wilding construction.aria hereby audioi ;:e mprewatatives of city to enter.,. 510
t - FINAL PLANNING
y -
(s7 the aWve-mcati°ned prpppny for inspection purposes..
CL. (Welugrecm.ave.indemnifyacidkeephamlewtheCityufCuperiinoagain., 514 - FINAL PUBLIC WORKS
W liabilities,judgments,costs and expenses vInch may in any way aceme against said
U'.Z City in conuqucnc f@cF sting of ilia pumila // l7
APPLICANTUN
STA SAND WILL COMPLYW'RH'ALL NON-POINT Issued by: Date l/
$ C HEGC A IO'+Jf-yL SfO I ��"Ol
Sig t of Applican/f tucmr - " I Daatte Ke-roots
HAZARDOUS MATERIALS DISCLOSURE
wrlllhcapplicant«fiat - wldiny pant t ladle mmrd a,nutend Type of Roof
M defined by tat Cuperano Municipal Code.Chapter 9,12.and the Health and Safety
Cale Section 25532.,11 - •� J ° ' 't
'L7 Ye. All roofs.shal]bevinspected pnor,to any-roofing materia] being.installed.
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Will ffie.ppific.ramrryture Wilding occupant use equipment a ,which If a roof is ii s[Uled'without first obtaining an inspection;I agree'to remove
emu h rd umwmmant,as def sed y h B y Aica A Quality M agement
Dista l _ all new materials for inspection. Applicant understands and will comply with
1 A . 0Y ,. ,. f. all non-point source regulations.,
email Ne ham d u.,mu¢dals rcQmrcmenu and Chapter ti.95'of'Hc•
Cdifdrde McdN&'Safety C&fa Scnions'3505:2551J anal 255J1. understand that
if the building does not currently,haven am.that it is my responsibility 1.unify the
-ix<up m f He requi.< ni hich m be mei p' r Io iseuonec of a Ccn ficom of '
CM c3' Signature of Applicant - Date
M ',o`error auHorimd gem`J (. Da//ro All roof coverings to be Class"B"or'better
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, : , .OFFICE
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