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03060191 (2) r CITY OF CUPERTINO BUILDING DIVISION PERMIT riGONTRAGTMINFORMATIDN y+I BUILDING ADDRESS: LEON MASONRY INC PERMITNo03060191 049C) DIA-17TRQN PAT OWNER'S NAME: 240 MOSELLE OT PERM"[SUEDATE HOANn qTNT4 RT AT, ONE: SANITARY 0. CONTROL NO. (408) 365-1660 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 300 LICENSED CONTRACTOR'S DECLARATION 1 hereby affrm that 1 am licensed under proviuom of Chapter 9(commencing lob Description with Section 7")iof0 D.ivision J of the Business and Normaioa Code,and my limner is Lt. anl `clu� d`ne\ ? Lica /t.1 33 99 CHIMNEY REPAIR Date Cbpimcr L TON iNASoNs JAy ARC HITECrS mDECLARATION JAI N I understand my plans shall be used a public records, 9 7 2003 JyU gQ Licensed Professional i OWNER exempt from On RATION BUILDING I COO henry affirm 1 1, aurin from Ne Contractor's Co License Law co the p o which re reason.(Sado.RIJLS,Business and Professions Code:Any city or county 5$ which requires;a permit to cnnstrmt.aimr,impmsu h mnluh,or mash any nrocmre �Ln poor m its i licensed pursuant al uant to res provisions visio s o Teeth petit to Dense Late a w(Chapter stammem s�F< that he is licensed puation7 the of Dislnm of theConnector'sBusiness License loCode)or Sq. Ft. Floor Area Valuation 2 $ thathe(Comms exemith Section7")the basis ofr of Otheegedexeandon.AnProfessions Cndc)ar tl That he k exempt U¢refmm and Ne buts for the alleged exemption.Any vlaltllon of 36926034 . 00 Section 7031.5 by a" pplicant for a Petit subjects the applicant to a civil penalty of AIIN Number Occupancy Type not fort Nan B.hundred della.(5500). - 0 L as owner or the property,or my employee,with wages as their suit mmpenutlon, will do the work.and theswnum is ant intended or offered for as].(See IDN,Basin.• 101 — FOUNDA&VgAd Inspections and Profession,Code:The Conoacmls Liceae Law den not apply m an owner of property who builds or improm thereon,atW whodoes,uchwork himselfer through his 312 - CHIMNEY REBAR & STRAPS awn employees,proaided mat such improwments are not intended conRmed for sale.If. 514 — FINAL PUBLIC WORKS however,me building or Improvement Is mid within one you of completion,the owner builder will have the Women of proving met he did not build or improve for purpose of steer). 0 1.as Owner of the property,am exclusively eonu•eang with licensed contractors to construct the project(See.7044,Business and prefadom Code:)The Conuacwfs LL teats Law docs not apply to an owner of property who builds or improm themon,and, who contracts for such projects with a contractor(&)licensed pursuant to the Contractor. License Law. 0 I am eumpt urWm Sm. .B k P C for thl,moon Owner Data WORKER'S COMPENSATION DECLARATION 1 hercbY•f Bt under parody of peryvry one,of the following decimation: , I haw and will an •Certificate o(Consent to selbinsum for Worker$Compere sation,as provided for by Section 3700 of the labor Code,fm the performance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compmantion Insurance,a required by Section 3700 of the Labor-Cade,for the perfomanceaf the work for which this permit is loved. , My Workces Compensation Insurance carrier and Policy number am: Carrier, Soft-,—FUM Policy No.:ON '-16 CEFICATE EXEMMON FROM WORK1u 5 COMPENSATION INSURANCE (This section need not be cmplemd if the permit is foram hundred dollars($100) or las.) 1 mrtffy that in Jre perfonamm of the work for which this permit Is issued.l shall not employ any person in any manneru as an become subject to dm Workers'Compaaadon Laws of California.Data Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should - bcmmc subject to the Worker's Compensation provisions of On Labor Code,you must .J O forthwith comply with such prnvi,ina m this Permit M dmmed mwked. ti CONSTRUCTION LENDING AGENCY 'rr Iherehy afnrm that there its construction lending agency far the performance of c 5� the work for which this permit is issued(Sm.3097,Civ.C.) {f] 0 Lcndcr's wroth = z boder,A". V Q 1 certify that I have read this mpliCloom and sum that the above information is IP. correct,I agree to comply with all city and county ordinances and state laws.lana{to Q building construction,and hereby anthorire mpreuntnim of this city to enter upon the A {la aiavomentiuncd property for iapeOlon purposes. (We)agree m save,indemnify and keep harmless the City of Cupertino against CA liabllllla,judgments,costs and expenses which may In any way eccmc against mid City fJ in consequence of the grating of this Permit. APPLICANT U ERS NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date RCER J� 630-63 Re-roofs Signature of ApplicanKmatrutor Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will On applicant or future building ottuPant smrc or handle herudou,material as de0ned by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety I�F�jCrack,Section 15531(,)? All roofs shall be inspected prior to any roofing material being installed. DYa No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it misamus air contaminants a dc0ned by dm Bay Area Air Quality Management all new materials for inspection. lz lrict] DYes �No 1 haw read the boxanous materials requirements under Chapter 6.95 of the Calirnr. HwlthBSafety Code.Smaau75505.1553J and 23534.1 underatsM that if the building does not currently haw a mount.mat it is my responsibility m unary the Occupant of the prion.issuance of a CeNRam of Gcmpancy. Signature of Applicant Date 6.10 p3Owner tar authorbed Date All roof coverings to be Class"B"or better CITY OF CUPERTINO �3 d CUPERTINO PERMIT APPLICATION FORM N# � � � � Date: Building Addre : ' O Owner's Name: Phone #: Si 14 Q0 C 361 6 � Contractor, License#: 'Lcoo A- oN 2 z•N C 6 2 3 3 Contact: / Cupertino Business License#: LPC Solr, � Building Permit Info: Bldg 59.- Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential ❑ Q�Q i t Commercial ❑ Sq.Ft. Floor Area: F f $/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 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 13CONSTAX 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 2.20 1 of 3 a �, CITY OF CUPERTINO °TMO PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMTTIGATR 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 BOVERTINM 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 AIL BPREPIPE Re i e Of Fixtures PLUMBING vp 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 BREMAII2HAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFD{T 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 2 of 3 %mr CITY OF CUPERTINO cu PERMIT APPLICATION FORM 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,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 BSPECLU Special Inection 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 ee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3