03060192 (2) CITY OF CUPERTINO :9•tt,
BUILDING DIVISION PERMIT -ONTRACTORINFORMATION�,
BUILDINGADDRESS: LEON MASONRY INC PERMIT NO 03060192
12 COTTONWimm
GWNER's NAME: 240 MOSELLE CT PERMIT ISSUE DATE
NE: (408) 365-1660 SANITARY NO. CONTROL NO.
ARCHITECffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION Job DBSCTI [[QI1.B
I hcmby affirm Nat 1 am licensed under previsions of Chapter 9(commencing p Iflg7r���—
with section 1")of Division 3 of the Business and PrefesffieCode.and my license is 'f�\`A�gI
in(ull force and off t. ' V ''k�.aaE
�gz unmwcam �2 Lic.g b733Ff9 CHIMNEY REPAIR
q Dow Cumrwmr4 JUL I1
e 7W ARCHm:CrS DECLARATION O 9 ZOO']
L
UI uMcretsnJ my plans mall he used u public meet& J
s w Licensed Prommu mal BUILDING
5, y g�y
uN was
exempt OWNER-BUILDER Cont ION ID��LW�1�1/+
COO hereby.('firm Nat 1 1. exempt item we Cstions o License taw far the I��ttto
LOO following masa.(Sadao]o L5,Business and vO.do oli Code:Any oily her county
one
3$ whim equina issuance.pcait re coawm,sag imprese,demolish,nr repair ed nmctare
imy that hpnortn,l ensedpelmntto She
the
ovisiosofcant for Co mnti'toicese Lew(ahaptert
ggFaNatheitcingwitpunuantlathofDiviomofthe eBusinesiLlnnwlJw(GhodlerY Sq. Ft. Floor Area Valua[1on
gy (cat he Is(commencing Scclion70nd the iaiiion?nf theeged exemption.
Any
Coda)or
$
that he la exempt therefrom and the baso for the alleged eemp0on.Any violation of-
Section 7031.5by any applicant for apetmltsubjects the applicant toacivil penaltyof APN Number Occupancy Type
nal mom than live hundred dollars(S500).
❑1.u owner offt property.Or my employee with wages as she's wit compensation. nm
willdo0c.,k..nd N,.".,..itemtinmr doroacndforulc(Sec,7W,Busineu — DACc; dInspections
and Prolesaioa Code:The Conoacme.License Law docs not apply to an owner of
property who builds or improvesthmon,and whodoewch work himselfor through his312 — CHIMNEY REBAR & STRAPS
own employee.prodded that uch improvements aenot Intended orortued orale.If. 514 — FINAL PUBLIC WORKS
however.the building or improvement is sold within one)ear of completion,Ne owner.
builder will have the burden of proving That he did not Wild at improve for purpose of
ole.).
❑1,a owner of the pmpeny,am exclusively contracting wish licensed contractors to
coetwcl INC project(Sec.7044.Business and Prefesaunt Code:)The Coneracmrs Li.
seem Taw does not apply wan owner of pmMny who W Ilds or improve there n,and, .
who contracts for such pmjects wish a contractor(,)licensed pursuant to she Contractor's .
License L."
❑I as.exempt under Sec. .B IS,P C ler this recon
Owner Dale
WORKER'S COMPENSATION DECLARATION
I Aeby allhm under pemlly of perjuryone of the following dcclu.1ioe:
I have and will maintain aCcnifinreof Convent loulfdnwre for Workers Compote -
10371,30
ion,u provided for by Section 37W of she Lwo,Cade.for Use peRurmaoec of the
rk for which this permit is issued.
I have and will maintsn Workefs Compensation Insurnce,a required by Section
of the labor Code,for the petlormanee of the work fu which mh permit is issued.
y Wokce,Comj�n�t��io^^n lnwnnIm C. crandpalirynmbcran:
ner. -S4sal F C f^i..av G1 Policy No.:/5 y C O�_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thhsection need not becomplewd If the permit is for..hundmddollan(SIM)
ort Ieaa)
I certify that in we performance of Ne work for which this Permit H Issued,1 Jail not
employ any permn in my waver an as in become wbpXI to the Worker(COmPtnsadam
Laws of caifomla.Dam _ -
Applicant
NOTICE TO APPLICANT.IL after making this Ccnincato of Exemption,you should
become abject to the workers Compensation provisioe of the lain Code.YOU must
.J z forthwith comply with such provisions or this Permit shall he deemed rerotrd.
nCONSTRUCTION LENDING AGENCY
(—t 1 hereby affirm that there Is a construction lending agency for da performance of
�i
the work for which this permit is issued(See.3097,Civ.C.) _
W Q Undoes Name
z Lenders Address
V 0 1 certify th.l 1 have tend this application and naw that the me"wform iliun la
IL,H correct.I agree to comply with all city and county ordinances and slue Ire elating to
O U Wilding construction,and hereby authonae representatives of this city to enter upon the
Tal above-mentioned preperly for impaction purposes.
W
(We)agree m save,indemnify and kap armlets the Ci LY of Cup:nine against ail
to IiabllWes,judgmenu,costs and expenan which may in any way ansa against aid City
V z fing,or this permit.
APPLt consequence
ANDS
cUNDERSor we TIAND WILL COMPLY WITH ALL NON-POINT Issued by: Dale V
OURCER UL TIONS.
6-3vG Re-roofs
SiSmdwcof pplinnnConuwmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applinnl or!arum Wilding Occupant sten her.odic harudon material
a deflad by the Cupertino Municipal Code.Chapter 9.13.ad the Health and Safely
Code, E3 Yet 33533(a)? No All roofs shall be inspected prior to any roofing material being installed.
Will
the.ppbnmheram Wading o .pant hew eyainm=est her u d n wmm� If a roof is installed without first obtaining an inspection,I agree to remove
h huerdous air contaminants ss defined by the Bay Arca Air Quality Management all new materials for inspection.
W,ict?
❑Yes No
I have read the haardm smatenah eyuimmems undo Chapter 6.95 of the Califor.
nia Hcal"Safety Code.Sections 35505,35573 and 25534.1 undcrslmW that if the Wilding
docs not convoy have a tenant,that It is my esponvhillly le notify to Occupant of the
remenu m metpnorwissuannofaCcnifteateofOccupaney. Signature of Applicant Date
ono 630-03
Owner or mthmiad agent. Date All roof coverings to be Class "B" or better
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEPTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
2. .New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector.A final inspection and
approval shall be obtained from the building inspector when the reroofing is
completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City the following steps are required.
1) Preinspection and/or tear off approval.
2) In progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,will
require the removal of all new material down to the sheathing so that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of YV per foot slope and demonstrate that
there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:
Address: AriSRR Cirum (ewL-tr .(�e j'i1kn C-A
Reroofing Company Name: i D R oo jp; „
Applicants Signature: Date: 6 30 0 3
• Joe Antonucci
(Chief Building Official)
6/25/01
�\ CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
APN # Dat C Q
Building Address: ' 1
Co�O W o
Owner's Ne: Phone#:
I L�- 66v
Contractor: I I License :
Le-c, m Masooky3 g
Contact: Cupertino Business License#:
B i ing e it Info:
B] Elect ❑ Plumb ❑ Mech ❑
Job scription:
esidential ❑ &' Commercial ❑
Sq.Ft. Floor Area: S/Sq.Ft.:
Cost of Project: Occupancy Gro :
Type of Construction
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to IM Btu MECHANICAL
BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL
BBOILERS Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comni/ uasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1O00A ELECTRICAL
BELEC1001 Elec 600V> IOOOA 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
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CITY OF CUPERTINO
c oo PERMIT APPLICATION FORM
CUPEkTINO
uanti 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
BOVERTRvIE 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 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 WaterHeater/Vent PLUMBING
BPWSVCS. Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 chn MECHANICAL
BREMARMAN 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 Fumace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
AEk BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
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CITY OF CUPERTINO
CUPEI�TINO
PERMIT APPLICATION FORM
QuantityFee 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 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 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
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