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04060202CITY OF CUPERTINO ` co BUILDING DIVISION PERMIT BUILDING ADDRESS: L122 YORKSHIRE DR LEON MASONRY INC PERMIT NG04060202 OWNER'S NAME: PERMIT' MUB DATE ROY PR ONE: SANITARY O. CONTROL NO, 408 36 -1660 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION lob Description with Semlerbyafirm thatunder provision of.0 d.. 9 (commencing 1 hereby affirm Nel l am ofMe I t3ofthesod Business and Pro¢nsiOf Cade,andmylicenseis I. fall ap0c �L� \\ I. fall " CHIMNEY REPAIR OClu( Lk.X Dam Contractor ,�.ye�a� f1ECT5 DEC IO, y I undcnond my plans hell W used o public s Limned Prefcssionala/ OWNER -BUILDER DECLARATION 0v 1 hereby affirm that I am exempt from the ComractoYs License Law far the following mason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to consumer, altar, improve, demolish, or repair any structure prior to its issuance, also naMires the applicant for such permit to file a signed sivuhmenl Must he is licensed pursuant to the provision of de Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with herder 7000) of Division 3 of the end Profos vi Code) m asr therefrom and basis for the alleged exemption. Any platiun of that he u alleged l any applicant fora permit subjects the applicant to a civil penally of on 703 or 31.5 b 3 5620IH'G "crO 0 Occupancy Type P Y YP n five not more Nen fvc hundred dollars (g500). not ❑ 1, as owner of the property, or my employees with wags as their sole compenutlon, will do the work and t e straclare is not intended mattered farads (Sec. 7044, Business Required Inspections and Profession Code: The Contractor's Licanse Law don not apply to an owner of property who builds or irepmvn thereon, and who doossuchworkhi andfarthrough his own employees, provided that such improvements are not intended oroffered fnsale. If, however, the building or improvement is sold within one year ofcompletion, theownen builder will have the burden of proving that M did rat Wild or improve for purpose of , sale.). ❑ 1. as Owner of Ne property, am exclusively contracting with licensed contractom to consumer die project (Sec. 71)x4. Business and lemfessions Code:) The Contractor's Li. cease Law don not apply to an owner of iereperty who Wilda or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant o the Contractor's License Law. , ❑ I not exempt under See. ,B@P C for this moon Owner Data WORKER'S COMPENSATION DECLARATION I hereby Same under penalty of perjury one of the fallowing declaration: 1 have and will maintain 2Certif000 of Consent to sel4insure for Worker's Compcm lor. o provided for by Section 37M of the Labor Code. far the porformanco of the rk for which this permit is issued. 1 have and will maintain Workers Compensation Insurance, o required by Section 1C37]"M mance of the work for which this Permit is issued. y eamierand Policy number a m}: Policy NoF- AN. EMPTION FROM ORW KERS' INSURANCE pATION ('DaB.110 n dolem inomphisforonehundreddallao(S10(1) 4.111' nr less.) I certify that in the perremanec of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workerf Compensation Laws .(California Data Applicant NOTICE TO APPLICANT: If, after making this Certificam of Exemption, you should become subject to the Wcumcr's Compenolian provisions of the Loan, Cade, you nun foMwith comply with such provisions or this Permit shall W deemed mocked, CONSTRUCTION LENDING AGENCY 1 hereby affirm Out then is a construction lending agency for the porfurmanm of the work for which this Permit is issued (Sec. 3097, Civ, C.) Unders Namc Lender's Address I certify that 1 have read this application and sok Net the above information is correct. 1 agree to comply with all city and county Ordinances and sate laws relating In Wilding construction, and hereby authorlm representatives of this city to enter upon the abow-menlloned pmperry, for Inspection purposes. (We) agree to save, indemnify and keep hummer, the City of Cupertino against liebilitiea,judgmeno rad expenses which may in any way ammo against said City in canuqucncc of cgr mgofthispermil. APPLICANT,eND TANDS ANJJJ2}}/WILL COMPLY WITH ALL NON -POINT Issued by: Date Re -roofs Type of Roof or ,� i n u Applican a orVale HAZARDOUSMATERIALS LStstom mo or handle Will Me applicant Or funum buildings. fd Chapter Safety az defined by the Cupertino Man el Code. Chapter 9.12, and No Health end Safety Health .&, Section All roofs shall be inspected prior to an roofing material being P P ❑vas Na Y g $ Installed. 'lung If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or futen b occupant use equipment or dcvims which mil hazardous air conmminano Med by Ne Bay Area Air Quality Management all new materials for inspection. 'o n? "'on Dyes No I have mai the haoardousmatorials requirements under Chapmr6.95 Of the Califor. ria HcxWdt Sa(ctyC o25YJ5. 533.d25534.1undcmandthmifft Wilding docs not cunend mu rent. that it' my responsibility to notify the occupant of the mtIM menu ocl .1W melpri uissuance ofaCeN ¢eumby Signature of Applicant Date C -412 All roof coverings to be Class "B" or better r sero agent arc i1 Community Development 10300 Torte Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building De artment JOB ADDREQS-, It 2-2 Yordkrti w' PERMIT # OWNER'S NAMW PaAc� PHONE t2 ro S--16 b a GENERAL CONTRACTOR FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: /Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & MillwoA, . N Cement Finishin/ Leu ✓ 4toav� 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 /Contractor Signature Date I CUPERTINO af CITY OF CUPERTINO PERMIT APPLICATION FORM N# 3 62— _ Og _ 006p Date: lo�Z3/0 e/ ddres Building A : Mailing Address (if different from building address): zL `�C�ce IKshiv Owner's Name: Phone #: P r i &- s 4-c,-4� BBOILERI Contractor: License #: 4- ec,))J j�4 A 'TO VV E Boiler > 100K to 500K Btu Contact: Phone: 3 �� Cupertino Business License#: 2le-IN vFv` Fax: MECHANICAL Building Permit Info: Bld Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential ❑ C, 1►n C o air S �,��o�. +— Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: 20 v 7 Occupancy Grou Construction Tax Type of Construction: Please check this box if the project is a Ind/Off/Comm/Quasi second -story addition: ❑ ro'ect Size: Standard ❑ Large ❑ Major ❑ Con. Tax for BQ Zone Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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 1 of -0-2�`3� G-0 CUPEIiiTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 2of3 Ouantitv 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 BOVERTME 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 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 din MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace 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 R air/Alter Heatin MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO 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 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3