04020079 (2) CITY OF CUPERTINO
Buamrvc mvlslon PERMIT CONTRACTOR INFORMATION
- x s
BUILDING ADDRESS: JONES MASONRY PERMIT NO 04020079
OWNER'S NAME: PERMTT ISSUE DATE
SERV
WE:
SANITARYNO. CONTROL NO.
4 8
ARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLOC ELECT PLUMB MECH
0 0 0 0
u in LICENSED CONTRACTOR'S DECLARATION Job Description
U F 1 hereby affirm mer I am licensed under provision of Chapter Y(commencing p
`uf wimnf.mc. sdxff.Division of me Buainusand cu' n coot.rad �rcanaa is
in full tome and effect. a J}j %
;qi Lire tee , tic.. mon"I REBUILD CHIMNEY FROM GROUND UP
a sDate u pRCHiTECT'SC07DEQ RATION �a��a®��Ass®
1 understand my plans shall M used n�ic rcenNs a T1� I ��s7Ss1
OyU
LL t; Licensed Pm(CtSlnna
s'03 OWNER-BUILDER DECLARATION FEB 2. 3 2004
1 hereby affirm that I am exempt from the Contractor's License Law for the
no following meson.(Section 703 1.5.Business and Pm@ssiom Code:Any city or county
K$ which mquims•permit to cowruct,alter,improve,demolish,or rtput,any structure
m—'^ prior to is nomue.Also mquims the applicant for such permit in rile a signed statement
�P�S< mat he is licensed pursuant o the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area
liou
(commencing with Section 7")of Division 3 of the Business and Professions Cole)or
a, $ that he H exempt therefrom and the bats far the alleged escmption.Any violation of
notore 7031.5
five hundred)dolars(S500 it subjects me applicant toacivil penalty of 3MN ttbgr00 Occupancy Type
❑L as owner ofthe property,army employees with wageses theirsolecompmaktion.
will do the work and me smnemm is not intended ora0emd Inside(Ste.]044,Business
and Profassian,Cade:The Con=mes License Law does not apply m matter er of Required Inspections
propcnywho Wildsorimprovesthcmen,and whodoessuchwort himadfor through his
own employers,provided that such improvements an,not intended or offered for ak.If,
however,the building or improvement is sold within one year of completion,the owner-
Wilder will have Use burden of proving that he did not Wild or improve for purpose of
ale.).
0 I,a owner of Oc property.she exclusively convecting with licensed contractors to
,Wnmet the project(Sec.7014.Business and Profession,Code:)The Contra mrh Li.
rcme Law docs not apply in in owner of property who Wilds or improves Merton,and.
who contracts for such pmjeco with a eonsnesor(s)licensed pursuant to the Comae
Lice.Law.
❑1 am exempt under Sec. .B&P C for this nazon
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Cutifieste of Consent to mlr.insum for WorleeriCompen-
saumn,u Provided far by Secdon 3700 of dte Labor Code.for the pedmmaa a of the
work for which this permit is issued.
❑1 have and will maintain Worker's Comper amm Insurance,az mquimd by Section
37W of the labor Code.for the pctfarmanec of the work for which this permit is wood.
My Wor 's m nsauo Insurance amu end Polity nu he M:
art AOM Na.:RTZ 1 ai
CERTIFICATED EK °"FROM WORKERS'
COMPENSATIO INSURANCE
('Otis section need notbeeompleted if the Permit is intone hundred dollars($100)
or less.)
I certify mat in the performance of Ne work for which this Permit is issued.l shall not
employ any Aman in any m comer m a m become subject to the Worker Compcnahma
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject se the Worker's Compensation provisions of the Labor Code,you mind
.JZ, forthwith,comply with mch provisions or this Permit shall he deemed revoked. --
Z CON5misa cIONLENDINGAGENCY ,
(-. 1 hereby which
thi Net them is s convection lending agency for the Performance of
uC the work for which this Permit u issued(Sec.7097.Civ.C.)
tt) 0 danders Namc
a IsndcrS Address
J2
U Q I certify o c 1 have rad thirty and county
and sate Net and
above information is
0 rj rnsmeng agree 10 comply with all city and county o moves or and cute laws r upon t e
DU WildingConstruction.
mpmly hereby auNon urpo^aennti�is of this city to cntertrPnn the
�� aW.e.(W)agee toave mrmupccd an keep
(s.ju acmes.ave,indemnify end Rech marinas the City of Cupertino id City
fM raq liabilities.judgmcns.eoss and expenses which may in any way accrue>gaint aid City
U z con,egmme of the gnnung of this pemtit.
^ A LICANf UNDERSTANDS AND WALL COMPLY WITH ALL NON-P01 Issued by: Date
;L
EJt GPLA ONS. / `O
10qII/- ` _ Re-roofs
tor
ignvum of Applic HNARDOUS MATERIA ISCLO RE Date Type of Roof
Will me apphrant m future Wilding occupant store at handle haverdous material
az Ocfincd by thc Cupertino Munipupel Code.Chapter 9.13,and me Health and Safety
We.Seewn zss3z(o? -�h``(({{''//�q`q All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant or future building occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection.
District ll //
❑Yes \rd No
1 have mail me ha ardonul7su'm'aterialsoequiremems under Chancr6,95 of the Califor-
nia llcslth&SafctyCode,Satins 25515.35533 and 35534.1 undcnuM dmiNhc Wilding
docs n t comndy have a annum,that it is my maconibilty m notify m,occupant f the
mrmswpfnn ptr mpriormi: app- ac n;ratrnf0c,7y. Signature of Applicant Date
Owne oralu�mmiudx,mu Mt' ADD All roof coverings to be Class"B"or better
t� I
Spark Arrester SEE ATTACHMENT BCP
Screen When Required
races 2" 37-3- (h) .
frame .., kl�rtnr Gq,
ustible material 6'min.to f lace opening. '�► -� -.•.• - Bond
12"from ope ' en material projecting t= I• Baam
more than t or each I'
Above roof 2'at 10'(Sm U.B.C.Tabic No.37-B. o
rr •— Horizontal V. ties at 18"and[wo ties al each bend in
t Rfin forting /verdeal steel.
Cleararscf � :4t� / �
1('B" Min. l Vertipi \sour No.,full-length bars for chimney
Reinforcing\t04T wide.Add two No.4 bars for
IL, each additional 4(r or fracdon of wid:
Flashing I '. or each additional nue.
s — I
Anchor
1 _ Strap
j T
I Anchorage -
Strap FII x V I 1R'Min.grout .
Number 2 between I - 4 eoconc '
Embedment into ehimn 12'hked around outer bar w/6'est. — {clay flUtllrete.mning .
matortry and
Hsten to 4 joists
Botts TWO 1Y diametar Fluff Lining
Claanrica —
• I
ecdve flue aru(used on area Round lining-142 or50 sq,in.min. I 6•' Min.
rf fueplaee op...) Rectangular lining_",or 64 sq.in min. I .
Unlined or lined with frcbrick--Lt or 100
sq. in.min. t
HorisonW
r�`, a• Reinforcing Ties
% ties @ 18" o.c. ar>drtro ties @ ea.
1 vertic] tend in
�1 L e steel.
�tl'on steel I
. r .(t•.' � With 8" min. exterttim. al), °0' tends
Mid MiThick
llaunry Unit
—) 6' •I ' Vertial Reinforcing 9 Four No.4 full-length bars for I c 20 if spliced to to 4T;w de. ar,f, t
Lined I Add two Nc.4 ban foe
Noncombustible fooling dowalc each additional 4P or fraction of widL
material. I or each additional flue.
Prrnlde revised d' tail
Hearth
— I chitmeys Over 40"
atemioo RrttMielc wi C2.
(front of opening)
16'fire lace o Hearty .
P opening<6 sq. ft fioerth 2i • Fireboxknass lrornrrI brick or 8'where a firebrick
20'fireplace opening a 6 sq,h• Min. Thieknas fining is used.
F-xPansion Joints in firebrick'/.'
'. ... .a �. ..• � '� Footin .
9 Width
Min.around
%'•.` :aT �•;i •'.• T Ir"standin fireplace
,��•— 9
Footing ' •;I '• •.: • '.I': .�. '4 Natural
es
Thickns 12*min. '. �'.�'•. Grade
width 6'each side of fireplace wa1 a• .' -� .. '•. . '
•�� -si ' Bars in
•. Concnu Footing .
1 w square Altarnate for Fm
r'--'-- Standing Fireplace
SEC
FIREBOX AND CHIMNEY—
SECTIONAL SIDE VIEW ON CONCRETE SLAB
L ���- ' CITY OF CUPERTINO c�
CITY OF PERMIT APPLICATION FORM ( � /
CUPEkTINO
APN# 02^1 _� Date /�v y
Building Address: L
03�d 7�-;7&,2A4
Owner's Name: ; 5. Phone#:
, .¢ r v ct "!Cz/C� C ct Lii c�
Contractor: c License #:
es �9o3�y
Contact: I Phone#:
Applican ontractor A.
Fax #: 3 7 7-75/ 3
Building Permit Info:
Bldg p-'� Elect Plumb Mech
Job Description: &I'
Residential:,/ S Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuatioti�'-5,/,
Type of Construction: Occupancy Group: -
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances 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 Ener BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb C�PLUMBING
1of3
2 ,
C CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BNUMULTI New Multi-family Res PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
/17 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 Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storni/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 Fumace MECHANICAL
BREMFURNOV Relo Fumace> 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
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
IREVL BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
2of3
CITY OF CUPERTINO i • .
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSF&2FAM Single &2 Family BUILDING
BSFNA Single Family New Add 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 Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75 M Btu MECHANICAL
3 of 3