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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