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05060174 (2)r L F� a C �z UC D. F � Cr U 4 CITY OF CUPERTINO �• .�• f '' f �' ��:: BUILDING DIVISION PERMIT ' Ci1NTRACTQR INFORMATIQN BUILDING ADDRESS: JONES MASONRY PERMIT N005060174 10464 BREWER OW NeR'S NAME: PERMIT MUE DALE LAWRENCE GILMORE 1049 DELL AVE 2005 ONE: SANITARY NO. CONTROL NO. 4083777512 ARCHITEC ,ENGINEER: BUILDING PERMIT INFO BLOC ELECT PLUMB MECH 0 0 0 0 LICENSEDCGNTRACrOR'SDECLARATION 9 Job Description P I hereby affirm that I em licensed undo provisions of Chapter (commenting with Section 7000) fl) Divisi n3of the BusinesaanO Profession Code.and mYliccnse is [— �y - LED in full foreland cffett (fi License Lec.N CHIMNEY REPAIR tl B� �r.fl`" ra'bai�{a' , Lisp Dam 2 o Co..., ARCHITECTS DECLARATION used as public rds I understand my plans shall be mm �� , 2905 i {� Licensed Professional OWNER -BUILDER DECLARATION (jIVI, n y I hereby affirm that 1 am exempt fru. Ne Contractor's License Law for the [DJ�JJIHj I L following reason (Section rio 1tr Business and Pmfdemoli Calc: Any city of county IItJIQ-C,'JJ7/L which rite vau a permit construct, pimp Impraw. demolish, me mummiNG 2 9 O O Sq. Ft. Floor Area Valuation re a signed at prior to its issuance, alw req. the the applicant for such permit m Gees signed suumcm that hoescing wit PursLion7 do Lsw Code) or (commencing with hereon ]0(10) tar Division and Profession CMc) or of Divisiuofthcne Business 3 of tic Business and on. An that he u exempt therefrom and the baso for the alleged exemption. Any violation of f nr Occupancy YP ane Occu Type Section 7031.3 by airy applicant for a permit subjects the optical to a civil penalty Of not more man five hundred dollars (M). 1, as owme of the prapeny, Or my employees with wage as their sole compcnvdon, will do the work, and me structure, is not intended or offered for sale (Sec. 7060, Business Required Inspections and limitations Code: The Contractor's Littme Law does not apply to an owner of property who builds Or impmvu thereon, and who docs such work himself or through his Own employees, provided that such impravcmenu arc not intended or offered for We. IL however, the Wilding or improvement is said within one year of completion, the owner. builder will have do burden of proving that he did not Wild or improve for purpose of arm ). ❑ 1, as Owner of the property, am exclusively contracting with licensed cutworms; m construct the project (See. ]Baa. Business and Professions Code:) The Contractors Li- cense Lw docs not apply to an owner of property who Wilds or improves demon, and who contracts for such projects with a comeamorts) licensed pursuant to the Contractor's Lice se Law ❑ I am exempt under Sec. . B & P C for this mason Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury One or the following decimations: L haw and will maintain a CcrtiGcam of Consent to self-imum fat Worker's Compcn- urian, as provided for by Section 3700 of the Labor Code, for the performance of do wo work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, as required by Section 310 Or the Libor Code. for the Performance of dper e work for which this mit is issued. - MyWOhfs ompemation lnaurana carrier and Policy numbersae: —1 Carrier: 1 D O Policy No.: low I I I I I Id -I , CER IFICA EOF ^XEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section reed not W completed ifuse, permit is foram hundred dollars ($100) or less.) , 1 ccnify that in the periomunm of the work for which this Permit is Issued. I shall not employ any person in any manner se as to become subject to the Workers' Compensation Laws Of Califomia. Dau Applicant NOTICE TO APPLICANT: If, arm, making this Ceni0cate of Exemption, you should become subject to the Worker's Compensation previsions of the Labor CMC, you must forthwith comply with such provisions or this Permit shall be deemed invoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that them is a construction lending agency for the performamz of the work for which thu .it is issued (Ser. 3097. Civ. C.) Under's Name finder's Address " I ccnify that 1 have rwd this application and sum for dm show information is coned. 1 agree or comply with all city and county on inamef and sum laws acting in building construction, and hereby autimea representatives of this city to enter upon the abovo-memiuned pmpcny for inspection purposes. (We) agree m saw, indemnify and keep harmless the City o(Cupenino against liabilities. judgment. costa and expcntes which may in any way acerae agairut said City in loose bmirme of the granting of this permit. APP ICANT UNDERSTANDS AND WILL COMPLY WITHAL NON -POINT Issued by: Date SO E REGULAT DNS1.,, I /�r I 6/�(�� Re -roofs lI,[ 71Lf�✓LrP %�f? Signaruinof AppricanUCommoutor Data i HAZARDOUS MATERIA ISCLOSURE Type of Roof Will the applicant of future Wilding Occupant store or handle havndous material as dcfined by the Cupertino Municipal Code. Chapter 9.12, and the Health and safety Mc. Section 255324)? All roofs shall be inspected to an roofing material being installed.❑Yes prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or building pp g occupant use, equipment or devices which it havardnus air contaminants do ncd by to Bay Area Air Quality Management all new materials for inspection. District? u Q Yes I have raw the havawrms materials requirements underamurreS.95 of the Califor- re. Health & Sarney Code, Secumu 25505,25533 and 25536.1 understand dmifdc Wilding does not currently hand a Imam that His my ratimnslbllily b fully 1W MCUPW L of the �/Iy/�'r�e�m�,n/g�Idehmtra metpr;orw aaneeoraceraBcaleor pan Signature of Applicant Date "-rat "Gn � �iDat All roof coverings to be Class "B" or better Owner or aurhoriacJ aged Date .o Ic Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS. 164M w PERMIT # Q so 60i-7 C -X OWNER'S NAME: LaWiCVt t L rA PHONE # GENERAL CONTRACTOR: S M(yl Cabinets & Millwork FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing 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 Owner/ Contractor Signature Date 4 tall ; . CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO os--oK>/7� APN # 3 Z� 410 o Fee Description Date: Building Address: , I � � r Mailing Address (if different from building address): Owner's Name:( -c m(-,e,l /i( / (� II /}) 0 �— Phone #: 14 57 3 — 5 3 Contractor: j�5 �,S� � License #: 3q 0 3s� Contact:_ Phone: �j?7— Sia Fax: 377— -7 S-1 3 Cupertino Business License#: Building Permit Info: ckI`/ywl Bldg Elect ❑ �-Pyu ( �S huu — W Plumb ❑ Mech ❑ Job Descripti n: (ki'm Residential 51 _ �� Vl e 5 ✓� Commercial ❑ Sq.Ft. Floor Area: BBOILER5 $/Sq.Ft.: Cost of Project: LV (5-0 BCONSTAX Occupancy Group: Type of Construction: BCONSTAX Please check this box if the project is a second -story addition: ❑ Project Size: Standard ❑ Laze ❑ Major ❑ Con. Tax for BQ Zone Quantity Fee ID Fee Description Fee Group BAPPLOTHER OtherAppliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Corin/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 3 alum CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO 2 of 3 Quantity 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 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 BPINI'ERCEP 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 rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING Imp BPVENT Alt of Drain & Vent PLUMBING BPWATER Instatl/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BRENLUUiAN A/C Units <= 10,000 cfin 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 Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 d CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 Ternp 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 PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3