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03110024 (2) CITY OF CUPERTINO ✓t �` ¢ Y 'ins'"`, BUILDING DIVISION PERMITCONTRACTOR`INF,QRMA�ION BUILDING ADDRESS; LEON MASONRY INC PERMIT N003110024 OWNER'S NAME: 240 MOSELLE CT PERMIT ISSUE DATE 11/05/2003 "E' (408) 365-1660 SANITARY NO, CONTROL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH t� 100 LICENSED CONTRACTOR'S DECLARATION Job Description U I heroby affirm that I am licensed under provisions Of Chapter 9(commencing P .m whh Scc ory7")o(Dlvision 3orft Beamcu d Professions Code,ud my license is < in full fa and -L a� I.mena 1 .�Lie,e/ &�7/ �� CHIMNEY REPAIR eI- Dale - Cuntra:for1/ LARCHITECTS DEa6AQ'JGN 2 I undcnu plans$hall he save hTic rccnrds y� / G Ike mf 1 5 OWNER-BUILDER DECLARATION Y 2<� hemhy oMrm that 1 am exempt from the Contractor's License Lew for use Q\-� 5 o o wing noon.(Section 7131.5.Business and Professions Code:Any city or county which V h mquins a Permit m construct,eller,improve,demnli$h,car repair any structure C,o o �y prior o its issuance,also requires she applicant for such permit to rile a signed statement < that he is licensed Pursu uanatheprevisionsn(sheContractor'sLicense Law(Chapter 9 Sq. Ft.Floor Area Valuation 'ti-0 (commencing wi th Section 7")of Division 3 or the B usincas and Professions Cnle)ur L Out he is exempt therefrom and be,hats for the aIlcgcd crampoon.Any violation of 36509049 . 00 Section 7031.5 by any Applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not mon than five hundred dollars($50)). P Y YP I,uOwner of the property,or my amploycee with wages$ sole eompensstlan, will do the work,mtl theewnum is not intended or offered fonalor c.]M4,Business Required Inspections and Profeutons Code:The Conuazmri License Law docs not app I.an owner of q p property who builds or improves deareon.ind who doessuch work himself.,through his own employees,provided that such improvements arc not intended or offered for sale.If. however.Ne building or improvement is sold within one year of completion.Ne owner. Wilder will have tsa burden of proving that be did not wild or improve fa pur mosso of plcJ. Cl I.a owner of the property,am exclusively contracting with licensed contracrofs to construct the project(Sec.7044,Business and professions Code:)The Convenor's Li. cense taw does not apply to an owner of property who builds or improves themon,and - who contracts for such projects with a conincmr(s)licensed pursuant t.the Contractor's License law. ❑Into exempt under Sec. ,B&PCfmthismsun Owner Data Afts WORKER'S COMPENSATION DECLARATION 'notary air,_under penally of perjury one of the following outstations: 1 hove end will maintsln a Cenircau of Consent to self insum foriamkers Compcn. "I all sstion,as provided for by Section 3700 of the labor Code,for the peAormence of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the labor Code,for the performance of Ne work for which this permit is issued. My Work f Com enation IInunnc,carrier and Policy number art: Canicr fa'L�✓t Policy No.: C3 7 CERTIFICATEOFEXEMPTION FROM KERS' COMPENSATION INSURA (Thuseetion need not hccompleted if the permit is Irene hundred dollars p$IW) or kss.) 1 cenify that in the performaae of Ne work for which this Permit is issued.l stall nm employ any person in any manner an a to become subject I.the Workers'Compenution Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making ibis Ccr ificate of Exemption,you should become subject I.the Worker's Compensation provisions of the Labor Code,you moat 0z forthwith comply with such PutwoAoa or Nis Permit hall he deemed revoked. Z tiCONSTRUCTION LENDING AGENCY I hereby affirm then there its construction 3 lending agency Iter the performance of V x the Lenders Name watch this permit is issued(Sec.309],Civ.C.) V]Q Lenders None i Z Lender's Address U Q 1 cenify that I have read This application sad sou that the above information is Is.,P correct.I agree to comply with all city sad county°Nina¢,and auto,laws relating 1. pU building convection,and herebyauNorin mpresenutiw of this city m enter upon the ri a as.ve-mentionul pmpeny for inspection PerTmses (Wed agree m save,indemnify and keep harmless the City of Cupertino against I U V1 in C.O.ues,ju0 oeuanpending ex 'us which may in anyway accuc against said Citynim („)7 IAnPPA�eofs ERSTAN n AND WILL COMPLY WITH L NON-POINT Issued by: Date F7 RC R LATIO IS. er Re-roofs tau of Applica r m HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII the applicant or future building Occupant,Chpnon or handle Health an material u dented by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes No wits the apphgam.r future building Occupant use equipment.r devices which If a roof is installed without first obtaining an inspection,I agree to remove h ea our,oiI conlamimants as dermal by the Bay Area Air Quality Management all new materials for inspection. ISI,IC17 ❑YCS `Ipr+v I have mad the hazardous materials requirements under Chaptar 6.95 of the Califs. nia HulthffiSafcty dots25505,25533ond25534.1undcmwdthotifthchuilding deea nos tuneolI sew neat,Nm i! mspoalbility u noul'y the kg;or of the nquin rata rfiics Int mel Cord nc.le.rye aped . Signature of Applicant Date // owns . th.dzed ret Dam All roof coverings to be Class"B"or better r CITY OF CUPERTINO o z amo PERMIT APPLICATION FORM CUPEkTINO N# / Q Date: U Build' Address: S Owner's Name: 0 1Phone#: Contractor: License#: OU SD/U 2 Contact: Cupertino Business License#: ty� Building Permit Info: Bl Elect ❑ Plumb ❑ Mech ❑ J06 Description: El A -t, — — 1" pe Commercial ❑ Sq.Ft. Floor Are J $/Sq.Ft.: _ Cost of Pr Iect: Occupancy Group: Type of C -truction* 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> IM 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 � a37 � lof3 f" CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM QuantityFee 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 BOVERTWE 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 Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo 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 of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREN MISC Misc Apparatus ELECTRICAL BRENU-4 PP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO 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 Si s, Marquee ELECTRICAL BREMTHEATR Theatrical Ligaiting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISNUCOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM SwimminE 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 EPERNIITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot TAECH N IICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERNUTFEE lumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3