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03100076CITY OF CUPERTINO BUILDING DIVISION PERMIT COlV['RACT(1R iNF'QRMATI®N BUILDING ADDRESS: JONES MASONRY PERMIT N0.03100076 OWNER'S NAME: ROD FATnnRT 1049 DELL AVE PERMIT ISSUE DATE ONE: 4083777512 SANITARY N0. CONTROL NO, ARCHITECDENGINEER; BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION lob Descri n0 'IFINALE® I hereby affirm that I am licensed under provisions of Chapter 9 (commencing P with Scottun 7000) of Division 3 of Ne Business and retaliation., Code, and my license is mmummean .,ores. Q License ' Lic, YJ� CHIMNEY REPAIR DEC 1 2 2003 Dam Gmantant ��77 ARCH ECrSI CL TION 1 umy plans shall he umJ m u lie records RaIi BUILDING Licensed Pmfcesional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Cmaracrors License Low for the following reason. (Section 7031.5. Business and Pmfcxsions Code: Any city or county which requires a permit to Constrct, alar, improve, demolish, or repair any structure prior to its issuance, also requires the applesou for such permit to rile a signed statement Sq. Ft. Floor Area Valuation that he is licensed pursuant m the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7W0) of Division 3 of the Business and Prufesumas Code) or that he Is exempt Baereriam and Ne basis for the alleged esemption. Any violation of APN Number Occupancy Type P y YP Stedman 7031.5 by any appltcml for a Permit subjects the applicant to a civil racially of nor more Nan five hundred dollars (SSW). ❑ I, as owner oftheproperty, army employees with wages as Neirsalc compensation, 101 -- FOUNDN�Q;id will do the work, and lie muclure is not inteaded or offered for sale (Sec. 7W, Business and Professions Code: The Comraeors Litman Law does not apply in an owner of property who builds or improves thereon, and who doessuch work himselfor through his Inspections 312 — CHIMNEY REBAR & STRAPS own employees, provided that such Improvements are not intended or offered for sale. If. 514 — FINAL PUBLIC WORKS however, the building or improvemeal is sold within am year of completion, the owner. builder will have the burden of proving Nat he did not Wild or improve for purpose of salol. ] 1, as owner of the properly, am exclusively contracting with licensed contractors to consuuct the project (Sec. 7044, Business and Professions Code:)no Contractor's U. mese law docs not apply to an owner of property who builds or ins praves themon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors _ License L. 1 am exempt under Sec , B h P C far this roman Owner Data WORKER'S COMPENSATIONOECLARATION I hereby affirm under penalty or pejury one of the following declarations: I hive and will maintain a CeniOcaa of Consent to ulGimum for WmkcrsCasumn- amian, m provided for by Section 37W of the Labor Code, for Ne performance of the work far which in. permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, m required by Section 3700 of he Labor Code, for Bic performance of the work far which this Permit is issued. My orker'a Cr retention lmurenm carrier and Policy numb�e1r am: c ant 4kPolicy CERT FICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Oris section need not hccomplcmd if the permit is (omni hundred dollen SIM) Ices. 1 certify that in the perrommnce, of the work for which this Permit is humid, l shall not employ any person in any manner an as to Immune subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If. afar making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Cade, you must forthwith comply with such previsions or this permit shall be deemed maraca. CONSTRUCTION LENDING AGENCY 1 hereby apron that here is n construction lending agency lot the Performance of Nc work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name ' Lender's Address 1 tardily that 1 have read this application and shim that the above infmmuion is correct. I agree to comply with all city and county ordinances and state laws mining to building construction, and hereby authorise representatives of this city to enter upon the above-mentioned property for impaction purposes. (We) agme m save, indemnify and keep harmless the City of Cupertino against liabilities judgments. coats and expenses which may in any way accrue against mid Ci ty in cmom uene. of the gmming of this permit. s d1h; APP CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PpIN'r sovcLATf� S. Issued by:9 Date / / - hl' 4 K Re-roofs Type of Roof Signa of Applica 'Comncmr D.0 I AZARDOUS MATERIALS DISCLOSURE Will the applicant or future building Occupant store or handle h Ommus material as &flood by the Cuperl' o Municipal e, Chapter 9.12, and the Health cad Safely Section 255320)?0Yes All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applic or future had g occupant use equipment or Devices which r it hasardoes air contend. fined by the Bay Area Air Quality Management all new materials for inspection. strict? ❑Yes No I have mad the haoardous materials reNinommus undo,Chapbe, 95oUdc Cuba, i nim Health & Safcty Calc Sections 25505.25533 and 25534,1 undcamnd that him building Jars not curtcndy have a anent that it is my responsibility to nah'y the occupant of the nequiremcnts ichm bcmet prior 1.issmn¢nfaCmifcamof0,Rmy, Signature of Applicant Date tl 6ate All roof coverings to be Class "B" or better Ow n authmarir geme1l tbusti us 2' rram< ble material 6' min. to f 12' from ape . more than Above roof 2' at 10' (See opening. en material projecting ch I' 3 Table No. 37-B.) o N Claeranct Anchorage Strap. 14i a 1' - Number 2 Embedment into chimney 12' hooked around Futon to 4 joists Bolts 71vo Wdiameter ext. Claararica ffective flue ares (hued on area ROund lining—SMF or 30 sq. in, min. of fire lace opening) Reenngular lining—Via or 64 sq, in min Unlined or lined with fuebdck-44 or 100 sq. in. min. rr Lintel Noncombustible material. Hearth extension (front of opening) 16' fueplaco opening <6 sq. fir 20' fireplace opening a 6 sq. ft. Footing Thickness 12' min. Width 6' each side of fireplace SparkAneslef Steen When Rea SEE ATTACHMENT BCP Mortar Cap. Bond Beam j Horizontal y:ties 8' tl Asinforting vcrrical 4 L,U----s VMit71 rvur Na. 1-11 Reinforcing 1040' each a, or cad Anchor I)S" Min. grout 4" etmerata megon and c�ay flat lining Yr" .. 6- A * 1 1 Hearth 2H" a Min ; and two tin at each bend in xl. full-length ban for chimney ide. Add two No. 4 bars for hiona140' or fraction of wid- additional flue. HorizonW Reinforcing Tres 1:" ties @ 18" O.C. and two ties @ ea. Gerd in verticle steel. Required steel lap, 1'o• ta_ds with 8" min, extentla. 4" Thick Masonry Unit . Vertical Rainfotcing Four No.4full-iengtbbantorcnimocyt 20" Lap it spliead to to 40' wide. Add two No. 4 ban for tooting dowslL each additional 40' or fraction of wide OT each additional flue. Provide revised detail for rhimmeys over 40" wide. Fireholt Wail 10' common brick or 8' where a firebrick Thickness lining is used. Joints in firebrick %' mu. Footing Width 1S' Min. around Ino standing finolan •. • '.�' a� a Natural •� 1 . �'. ' ....; Grade a '_s;.� •• '• ..a► Bars in Concrete Footing W Slim Altirttant for Fran Standing Finplact BRICK FIREBOX AND CNItiINEY— SECTIONAL SIDE VIEW ON CONCRETE SLAB 7i •'v CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 03 oa o LJ Quantity Fee ID APN #3m--- �T Date: BAPPLOTHER Other Appliances i0 r g -o3 BBLDGFEE Building Address: a�/619' BUILDING Owner's Name: d y 7'Dolr� Phone #: q/17y— HOS9 MECHANICAL Contractor: License #: MECHANICAL BBOILER3 390859 MECHANICAL Contact: Cupertino Business License#: MECHANICAL b�-� x/0705 MECHANICAL Building Permit Info: Construction Tax BUILDING BCONSTAX Bldg Elect ❑ Plumb ❑ Mech ❑ BUILDING Job Description: Con. Tax for BQ Zone Residential ER' Comm eX al ❑ BCONSTAXH Sq.Ft. Floor Area: $/Sq. t.: o2(ooa„ oD � BCONSTAXR Cost of Project: Occup Type of Construction: I Elec 600V <= 1000A LJ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING 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 Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 CITY OF CUPERTINO TM OF COPE TINO PERMIT APPLICATION FORM in Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING 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 Sewa e.Dis osal 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 HeaterNent 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 ofFumace MECHANICAL BREMFURNOV Relo Fumace > 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 2of3 I aj-,, Cin OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 •