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03040090CITY OF CUPERrINO , +aim „z '�°' ` �' .• BUILDING DIVISION PERMIT CON,TRACTOR,INFORMATION'.,�, - B�I�bN��DD Es:CKSBURG DR LEON MASONRY INC PERMITN0'03040090 HOWARD 240 MOSELLE CT PERMrr`'fl'716/2003 NE: (408)365-1660 SANITARY NO. CONTROL NO. ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACIDECLARATION Job Description 1 Wmhy arfirm thin 1 am licensed underderp provisions of Chapter 9 (commencing p with Section ]fXM)nf Division 3.fO. Business and Professions Crum , and yliccna is in full fops and cc Lieena claJ/�Lm.« .� 33 �{ /� I CHIMNEY REPLACE FII�lat� LE® Dawlnf Cunvacmr� _ l IT ' AITECTS DELL 'TTS undo sandmyplans shall W used as publicnismas APR 2 12003 Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 em exempt from the Contractor's License Law her the p following reason. (Section 703 I.S. Business and Pmfessiont Code: Any city or county BUILDING which requires a Permit to construct, alter, improve, demolish, or repair any structure - pr10r to its 1591ance, also mgUiMS the applicant for such Permit In rile a signed statement that he is licensed pursuant o the provisions Of the Contractors License Law (Chapter 9 Sq. Ft. Floor Area $Yool6ion (commencing with Section 7(M) of Division J of the Business and Professions Code) or that he is exempt avaefrom and the buts for the alleged exemption. Any violation of Section 703 1.5 by any applicant for a permit subjects the applicant to a civil penalty of. ,,yk gD,,1]��gg �ysii ks....,, 3 AN 91011 t -r 0 0 Occupancy Type not more than five hundred dollars ($508). ❑ I,uowncrofthep.Nny,ormyempioyceswitbwaguuNcirsolecomN=tlon, will do the work. and the struawreis not inhibited or offered formic (Sec. 104,1. Business 101 — FOUND�s{T� (�T�T and Profeisiou Code: The Contractor's License Law docs not apply to an owner of `IFCJI]Wd Inspections property who builds or improves thereon, and who drop uch work himselfor through his 312 - CHIMNEY REBAR & STRAPS owncmplayess. Provided thouuch improvements arc notinanded oroffemd impale. If. 514 — FINAL PUBLIC WORKS however, Ne building or improvement is sold within one year of completion, Ne owner. . . builder will have the burden of proving That he did not build or improve for puryosse or .is.). ❑ 1, as owner of the proper, am exclusively contracting with licensed conoactom to construct the project (Sec. ]Wa, Business and Profusions Code:) The Contortion's U. . cense Law does not apply to in owner of property who Wilde or improves dranom, and who enntmcu for such projects with a convactor(s) licensed pursuant w lite Contractor's License law. ❑ I am exempt under Sec. . B A P C for this moon Owner Data WORKER'S COMPENSATION DECLARATION I hemby affirmunder Penally of perjury one of the following desehM oon I have and will maintain a Certificate of Consenuo set Gimme for Worker's Currant. etion. as provided for by Section J]W of Ne labor Code: for Ne Performance of the work which this permit is issued. hats and will maintain Worker's Compensation Insurance, as required by Section J]W of Ne labor Cade, for On performance of the work for which this Permit is issued. My Worker's Cnm,nsalio Insurance Cartier and Policy number am: Carrier: Polity No.: �"� t0 . CERTIFICATE OF EXEMPCON FROM WORKERS' COMPENSATION INSURANCE . (This action need not be completed if rhe Permit is burns, hundred dollars (SIM) or less.) 1 certify that in the performance of the work for which this permit is issued, I shall nut employ any person in any manner so as It) WLoele subject to dustWorkers'Compensation Laws of Califomia. Dam Applicant NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Worker a Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this Permit shall W deemed revoked. - CONSTRUCTION LENDING AGENCY I hereby affirm Out Nem is a comtructibn lending agency for the performance or ' due work for which this permit Is issued (Be.. 7097, Civ. C.) Lenders Name Landers Address 1 certify thu 1 have read this application and sum Out above intormaliun is correct. I agree to comply with all city and county uNinances and stip laws relating to building up dhereby authoint rtpreamatives ofdtis city to enter upon the above-menJw cd Props y (or inspection purposss. Wc) agree m vc, indemnify and keep harmlcas the City of Cupertino Against links rmajudgmeb ,coatsandespc s which may In any way accrue against said City t obscquenee a graining s permit. NO AND WILL COMPLY WI ALL N N POINT Issued by: Date (� SOURCE SOURCE GU / Type of Roof ZGRe-roofs gnamrc ofApplicaH ZARDOUS MATERIALS DISCLOSURE D m Will thcapplicant fuwm builJing occupant smrc or handle hauNuus mepriel as defined by the Cupeniin Municipal Code. Chapte, 9.11, and the Health and Safety eWe. Sectea 25552007 ❑Yea No All roofs shall be inspected prior to an roofing material beim p p Y g g installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant fuwm building occupant use equipment or devices which It havardous air contmk amp as defined by the Bay Arca Air Quality Management all new materials for inspection. enicl? ❑Yes No IIt mad dm r�yua materials requirements under Chapter 6.95 of the Caliber. ria Health 6 Safra .whores 15505, 25577 and WX l undcrrand thr, if dtc Wilding OurOutcurt ttyh hinmL Nat it is mtsihili1, un noel ythep`cuPanl of the _ mquirem L «most WMet Pon ss Is Certifies aa_a Or.6 Signature of Applicant Date All roof coverings to be Class "B" or better 0 rte rauthoriasdagent Q, u"k, CIT OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 03d C?,'6�7C W Quantity Fee ID #O I # 3 6a - Date: BAPPLOTHER 7APN Building Address: pQ MECHANICAL kSb Bldg Permits . foot Owner's Name: Phone #: Boiler <= 100,000 Btu �- watt 9 ijoN 6- l oo Boiler> 100K to 500K Btu Contractor: License #: Boiler > 500K to 1M Btu Qo ASo c (,23 39 Boiler> 1M to 1.75 M Btu Contact: Cupertino Business License#: Boiler> 1.75M Btu V4Z. BCONSTAX Construction Tax Building Permit Info: BCONSTAX Bldg 29— Elect ❑ Plumb ❑ Mech ❑ BUILDING Job Description: Con. Tax for BQ Zone Residential ❑10(j.Commercial ❑ BCONSTAXH Sq.Ft. Floor Area: $/Sq.Ft.: BCONSTAXR Cost of ProjccW Occupancy Group: BELEC1000 Q ELECTRICAL BELEC1001 Type of Constructio : ELECTRICAL BELEC200 ct ELECTRICAL W 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. HousingMit. Fee BUILDING 1 of 3 -77-P D L -j 1 1 '� �� CITY O CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM uantity 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 Pi in S stem Fee PLUMBING BPINTERCEP Ind Waste Interce for 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 StonnJRain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pipe 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 BREMFD{T Lighting Fixtures ELECTRICAL EMFURN Relocation of Furnace MECHANICAL Relo Furnace > 1 OK btu MECHANICAL Heater Installation MECHANICAL RABIRREMPOLE Installation of Hood MECHANICAL Misc A azatus ELECTRICAL Rem Non -Res Appliance ELECTRICAL Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTINO n oF' PERMIT APPLICATION FORM f I IPFRTINO Auk I 3 of 3 t