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04020097 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACT 3kfms OR*FORMATION BUILDING ADDRESS: J K MASONRY, A PARTNERSHIP PF b"b"b4020097 OWNER'S NAME: PERMIT ISSUE DAIS ONE: SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH lop LICENSED CONTRACTOR'S DECLARATION ❑ I homey affirm that I am licensed under provisions of Chapter 9(commencing Job Description iW with pion]IX10)nf Division3of Nc taxi ass and Profmsiom ode,end myliccn.,a p Eqy in ren ,anaerrece�l mar a�`a5 REBUILD CHIMNEY TO ROOFLII�OO P4 ® Eq z Licensee clsss V ��mLL[[@@�� U Date ARCHIECTSZZ@ RATION I nnderslan l my plans shall W used as public records MAR 012004 3Ot; Licensed Professional OWNER-BUILDER DECLARATION 'v a q I hereby affirm Nat 1 am exempt from Ne Contractors License Law for the �U��®Bptlp�� 00 following mason.(Section](131.5,Business and Professions Code:Any city or county XE:m which requires a permit to comnuct,eller.improve,demolish,of mpeir any swmum y—w prior to its issuance.also requires the applicant for such permit to file a signed statement that he is licensed pursuant o the previsions of the Creamieri License Law(Chapter 9 Sq.F[. Floor Area Valuation x n� (commencing with Section Tl W)of Division 3 of the Business and ProfesuousCrxle7 or i $ that he u exempt therefrom and the basis for Ne alleged exemption.Any violation of Section 7031.5 by any application for a permit subjects the applicant to a civil penalty of 3 6V"191JMb910 0 Occupancy Type not mole Nan fin hundred dollars($500). - 0 I,as owner of the p aqp ny,or my employees with wages as Heir sole compensation, will do Ne work and the swcmre is not intended m offered forsake(Sec.]041,Business and Professions Code:The Contractor's License law does.1 apply to an owner of Required Inspections property who builds m improves thereon,and who docs such woi k himself ar through his awn employees.provided Nat such improvements arc not intended oroRered forsake.If, however,the building or improvement is said within one year of eamplcuon,the owner builder will have the burden of proving that he did not build or improv,for purpose of sale.). 0 1,as owner of the propcny,am exclusively connecting with licensed comrutors to construct the project(See.7(44,Business and Professions Cade:)The Connacou's Li. came law does not apply to an owner of property who Guilds or improves thereon,and who contracts for such projects with acentractor(s)licensed pursuant to the Convectors - License Law. 0 I am exempt under Sec. .B&P C for Nis reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 37W of the Labor Code,for the performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insunnce,a required by Section 37W of the Labor Code,for the performance of the work for which this permit is issued. t My Worker's Compensation Insuran/m,artier ollry mberam: 5 -lwFc i CER IFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ClTusection need not kcomplcwd if the permit is turner,hundreddollars($I W) is,less.) 1 certify Nat in the performance of the work for which this permit is issued,I shall not employ any person in any manner on as to bacome subject to the Workeri Compensation Laws of Califomia.Daic Applicant NOTICE TO APPLICANT:IL after making Nis Cenificam of Exemption,you should became subject in the Worker's Compensation provisions of the labor Chile.you most .JO foNwith comply with such provisions or this pc.I,she][be dccmcd mv.kcd. z� CONSTRUCTION LENDING AGENCY [r I hereby aRtm that there is a construction lending agency for Ne performance of C'7 the work for which this permit is issued(Sec.309],Civ.C.) [t] lender's z Name Lender's Address � V Q 1 certify that I have read this application and sure Net Nc above information is 0 F cording I agree ct comply with all city and county ordinances and cute laws r upon r pU buildingconstruction.proend hereby auNon prcpmscnurivcs of this city tocnmrupnn th, W above-mentioned)a agree in inspection keep ha (We)agree m save,indemnify and keep harmless the City of Cupertino against ,,l liabillniesjudgmenu,costs and expenses which may in any way see=against mid City U Z in consequence of the granting of this permit. F-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH NON-POINT Issued by: Dat O SOURCE`_ CATIONS. cLr- Re-roofs a,urc of Applic ✓Convector Dote' HAZARDOUS MA ALS DISCLOSURE Type of Roof Will the applicant ser futurebuilding cupoatstomorhandlchavardousmatedal as defined by the Cupenino Municipal Code,Chapter 9.12.and the Health and Safety I de,Section s z5532(a)? _Qyp/ All roofs shall be inspected prior to any roofing material being installed. ❑yes Will the applicant at future building occupant use equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants as dcOncd by the Bay Area Air Quality Management all new materials for inspection. svicn? /O Ycs _[�yu'1 have read the he ardous materials requrcmenrs under Chapter695 of the Califary Health&Safety Code.Sceuom 25505.25533 and 25534.1 understand thisdNe buildingcs not currently have a tenant.Nat it is my respomihility to notify the occupant of theuimm_�� stxmmpi; i::m�ccmrlcstenTQdyryangy2_V1 Signature Of Applicant Date Owner rorauthomed agcm Dred All roof coverings to be Class'B"or better ' Community Development 10300 Torre Avenue aorn Cupertino CA 95014 ° Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building Department JOB ADDRE n PERMIT # U ,�-°c�,2° ,) � 7 OWNER'SN ( 'JH " 0 � �49 �_`23yY GENERAL CONTRACTO : T # `� a -0 yc"d I am not using any subcontractor , Z' Z Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork 5 K -/)1&50`� U Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping athing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Si ature Date 10/28/03 CITY OF CUPERTINO CU CiTYOF No PERMIT APPLICATION FORM APN# Date: Building Address: Owner's Name: Phone #: Contractor: Licens #: �O 5y Contact: �1 Cupertino Business License#: rt tiob 2�1-23q 1 � 2 Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description 'T(N\ "N\V.) .-\ o �fl 'RAS r\c, OSL V-ev-lD Residential Commercial ❑ Sq.Ft. Floor Area: S/Sq.Ft.: Cost of Project: `�� Occupancy Group: Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 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/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 lof3 �� p CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity 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 Pb1g 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 Disosal 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 cfrn MECHANICAL BREMAHZHAN 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> 1 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 qw 2 of 3 a- CITY OF CUPERTINO t CITY OF -PERMIT APPLICATION FORM CUPEkTINO 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 Signs,Mar uee 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 Insection 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3