The URL can be used to link to this page

11110035 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10290 WESTACRES DR CONTRACTOR:LEON MASONRY INC PERMIT NO: 11110035 OWNER'S NAME: HONKAI TAM 240 MOSELLE CT DATE ISSUED: 11/07/2011 ,, ER'S PHONE: 6508689350 SAN JOSE,CA 95119 PRONE No:(4ma)365-1660 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r' PLUMB r Lici;cing LiofDivision 4_O u MECH r RESIDENTIAL r COMMERCIAL r CoDate�l�7 1 hm that I am licenser the provisions of Chapter 9 JOB DESCRIPTION: DEMO CHIMNEY DOWN TO EXISTING REBAR,REBUILD (co with Section 7000) 3 of the Business&Professions CHIIMNEY Code and that my license is in full force and effect. I hereby offirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance ofthe work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 ofthe Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$5000 permit is issued. APPLICANT CERTIFICATION APN Number:35911031,00 Occupancy Type: I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAY OM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 77 / Signature Date 1117111 Iss/e by: 2G�i/ �/ Date: p OWNER-BUILDER DECLARATION RE-ROOFS: eby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner ofthe property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant Date: 1,as owner ofthe property,am exclusively contracting with licensed contractors to constmct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance ofthe work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain 1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 ofthe Labor Code,for the performance ofthe work for which this Safety Code,Section 25532(x)should I store or handle hazardous material, permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance ofthe work for which this permit is issued,I shall maintain coon ith the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health& ety Zg,en 'ons 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions ofthe Labor Code,1 must Ow r ar or ///,// forthwith comply with such provisions or this permit shall be deemed revoked. Dale: / j APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address c,dill,,and expenses which may accrue against said City in consequence of the :g of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION II non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional • CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp': Rng: Sub: Blk: Lot: APN . . . . . . . . : 35911031. 00 DATE ISSUED. . . . . . . : 11/07/2011 RECEIPT #. . . . . . . . . : BS000015254 REFERENCE ID # . . . : 11110035 SITE ADDRESS . . . . . : 10290 WESTACRES DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HONKAI TAM ADDRESS . . . . . . . . . . : 10290 WESTACRES DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RICHARD LEON CONTRACTOR . . . . . . . : DAVE LEON LIC # 17323 COMPANY . . . . . . . . . . : LEON MASONRY INC ADDRESS . . . . . . . . . . : 240 MOSELLE CT CITY/STATE/ZIP . . . : SAN JOSE, CA 95119 TELEPHONE . . . . . . . . : (408) 365-1660 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ------- 1BCBSC VALUATION 5, 000 .00 1. 00 0 . 00 1 . 00 0 .00 1BSEISMICR VALUATION 5, 000 .00 0.50 0 . 00 0 .50 0 . 00 1CHIMNEYRE EACH 1 .00 523 . 00 0. 00 523 .00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 524 .50 0 . 00 524 .50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 101 FOUNDATION 312 CHIMNEY REBAR & STRAPS 517 FINAL CHIMNEY • CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 •CUPERTINO (408)777-3228•FAX(408)777-3333 •buildinO(acuoertino.oro ❑NEW CONSTRUCTION ❑ ADDI•RON 10 ALTERATION/TAI •-❑ REVISION/(-D�EFE= ORIGINAL PERMIT# PROJECT ADDRESS 10 O WOS C?i K.. IN // ' D OWNER NAME �� ` VVIPNESb .. A3 EMAIL STREET ADDRESS ` C1TY, STA.TEJ,ZIP l.` FAX q'ily1.L a® v�-( CONTACT NAME O Aue or K.1 r, PHONE 365-16 (a d E-MAIL STREET ADDRESS t(/'lo rn OS�` I�. ` 1 CITY,STATE ZIP �� C� ,��` F - -166 ' ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT �-XcoNTRACTOR ❑CONTRACTORAGENT ❑ ARCHTTECT 1❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRA 0R NAME • LICENSE NUMBER LICENSE TYPE BUS.LIC# alu MAso r NL ol G- Z- COMPANY NAME C S E-4.eo M&%Ur y FAX :] / �-!/ / STREET ADDRESS^ CITY, 10 Zip C-A °l,S ('C PHONE T06 —1,,0(0 cab ARCHITECr/ENG OONEIE.R I NAME LICENSE NUMBER BUS.BUS.UC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE t ESCRIPTION OF WORK clfl Ke ro X 6 Rt- o-6ul �' CH AlXISTING USE PROPOSED USE CONSTR.rYPE I YSTORIES USE TYPE 0 C. EQFT. VALUATION(s) EXISTO NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHENOTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECKAREA TOTAL DECKIPORCH AREA GARAGE AREA DETACH ATTACH N DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY YES BEING ADDED? ❑NO ADDITION? ONO POE-APPLIGTION ❑YES DYES,PROVIDE COPYOF is THE BLDG AN U RECEIVED BY: TOTAL VALUATION: PLANNPIGAPPLO []NO PLANNING APPROVAL LETTER EICBLERHOME? ❑NO 50 By my signature below,I certify to each of the�� 'ng: I am the property owner or authorized agent to act on the prpperty owner's behalf. I ha read this application and the infeanatio¢I have ptyTyvfded i omet I have read the Descripcon of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating m rtildin nstmctio thorize representatives of Cupertino in most the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLANCRECHTYPE ROITINr FLIP New STD or Multifamily dwellings: Apply for demolition permit for ❑mOVER-THE-COUNTER ❑ Briu.Dmc PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building perni t for new building. ❑ EXPRESS ❑ PLANNING PLAN RRIVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project 11 LARGE ElME mGT . Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ snrvrrARY sawRR DLsrRlcr mittal of Building Permit application. ❑ ENVBoNMENTAL HEALTH. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION • ADDRESS: 10290 Westacres DATE: 11/07/2011 REVIEWED BY: RDW APN: BP#: `VALUATION: $5,000 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Chimney/Chimney Repair PRIMARY SFD or Duplex PENTAMATION 1CHIMNEYR USE: PERMIT TYPE: WORK Demo chimney down to existing re-bar, rebuild chimney. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY BP FEES Chimney Repair 1CHIMNEYR 1 $523 TOTALS: E Un h. Plan Check i'Iunrb. Pian Check Elec.Pian Chctx :Mx.h. Perm F(e: 1'iund�' Permu Pier Fla,. Pernta f>ee: 01her dfech,htap. r)ther Phtwh Insp, Li QBurr 1h". hncp. Lj Meeh.Inti. Fee: Plund>. h;ap.Fee: Flee.,Int), Fee' NOTE: This estimate does not Include fees due to other Departments(le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelinina information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 11-053 Elf 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fce: suppl. PC Fee Plumb,-h:lech.;'LYe<: Permit Fee: $523.00 Supp/. hasp Fee FAunb.Lldcch.%Isle, Permit/,ce: Construction '/"rix Administrative Fee: Work Without Permit? () Yes E) No $0.00 ACtr'MWet/Planning Fres: 7-7 Travel Documentation r'ees: Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item • Bidg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $524.50 $0.00 TOTAL FEE: 1 $524.50 Revised: 10/01/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: IC>ck pn 4/a5f Apt, PERMIT# 5 OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZI PCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND AL7SUB VTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: T 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner-/Contractor Signature Date