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04090018 (2) CITY OF CUPERTINO - CC1N171 +,CTE)Xt INFOtM�TTUN ' BUILDING DIVISION PERMIT ! - ng,6,lz BUILDING ADDRESS: _ LEONMASONRY INC PERMIT NO.040900I.8 OWNER'S NAME: PERMIT ISSUE DATE YUSKEN E: SANITARY 0 OL NO. ARCHI7ECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 +�aop LICENSED CONTRACTOR'S DECLARATION 1 hemby affirm that I am Ii does!under provision of Chapter 9(commatioug Job Desc with Sam i )of DMidiom Softhe Bus=T.'dPru ens Code,and my lice..is I effect 23 Fl CHIMNEY REPAIR pn Z_ Licenu a 2 Lie,is nF Date z- ,t Cardona( d' a 'ai' F SEP ✓t4 2004 QQ �j A CHTI.0S DECLARATION /J 2 ✓14rldanl8nd mY Plen:ansa be used as punbc rLs (.-----. N ' U '• Gt; Licensed Prfut...I I 'I1 �<3 Oat I am BUILDER DECLARATION V L f 1 heehy.(firm that 11. exempt from tiro Conuamors Licenu Law Tor the 0 o following season.(Saito 7031.5,Business and R,dem li Code:Any city nr county uRSV which myulres a permit m cnnssrucl.etre.impmw,demolish.or repair any awemm Fly pd.m its issuance.Mr.require she applicant far such permit to file.signed statement F < that he is licensed pursuant to the pmvisionsofNCCanlracmr'sLiacn.Law(Chapter9 Sq.Ft. Floor Area Valuation r4 S (commencing with Section 7")of Division 3 afthe Business and Praresions Cunt)or i that he is exempt'thcmfmm and the basis for Inc alleged exemption.Any violation of " A�,�,p Section 7031.5 by any applicant far a Permit subject the applicant m a civil penally of 3 MniID 3�tl�erO O Occupancy Type not mo.Nan five hundred dollen($50(r). El L as owncrof the property.or my employcm with wages n thelrsele compeas ition, will do she work.and thewumue isnot intended oraffered rurulc(Sec.7044,Business Required Inspections and Profusionse Code:The Contractor's License Law does not apply m an owner of q p property,who builds or improves demon,end who does such work himsel f or through his awn employee,provided Nat such improvement am not intended oroBered fhri ream lf. however,the building or improvement is sold edidnone Wild of Improve the owncn builder will have the burden of proving Nat he did not build or improve for purpose of sola.). ❑I,as Owner of the property,am exclusively conducting with licensed contractors to coaouct the pmjecs(Sec.7044,Business and Professions Cade:)The Contractor's Li. cense law does not apply in an owner of proper who builds or improve Neuron.and, who contracts for such pmjecs with a contractons)licensed pursuant in the Con socmYs License Law. ❑I sur exempt under Sea ,B&P C for this mase. Owner Dam WORKER'S COMPENSATION DECLARATION 01 hereby affirm under penally of perjury one of she following declarations: have and will maintain a Certificate ornament toulf-insure fro Worker's Cooper- ion,u provided for by Section 37W of the Labor Code.for the performance of On work for which this permit is issued. ❑1 have and will maintain Worker's CompenwGon Insurance,u required by Section 3700 of the labor Code,for the do....Of she work for which this pmmil is iuued. My Workers Compensation Inwnnce artier end Polay number am: Caade0 �%t'�'C �ud Poli a:67�Y CERTIFICATEOF (EMP. OM WORKERS' ' COMPENSATIONINSURANCE (Thissection need not he completed Ifthe permit is for one hundred dollars($1010 or less.) I certify Out in the performance of she work for which this permit is bound,l shall not employ any person in any manner se as to become subject to the Workers'Campemadon Laws of California.Data Applicant NOTICE TO APPLICANT`.IL after making this Ceri ficam of Exemption,you should became subject in the Worker's Compensation provisions of the Labor Code,you must QroMwith comply with such provision or this permit shell be demand revoked. y t"' CONSTRUCTION LENDING AGENCY Iherehy affirm Nat Nem is a construction lending agency for the performance of fyi> the work for which this permit is issued(Sm.3DO,Civ.C.) W 0 Lender's Name =z Lender's Address f.)p I codify that I have mad this application mal sack toot the shove infamtauon is [I. F cornet.1 agree to comply wish all city and county ordinance and sum laws relating in - C V building conswcsion,and hereby authodm mpomenutives of this city reenter upon the �a above-memioned propcny for inspection purposes. (we)agree m ave,indemnify and keep hstmlea the City of Cupertino against wy liabilities judgments,costs and expensm which may in any way acedia agahrl aid City t)7 in consequence of she granting of this permit. n7 APPLICANT UNDERSTANDS AVD WILL COMPLY WITH ALL NON-POINT Issued by: 62i Date OURGBAEG CATIONS en" "o Re-roofs rgn reef Ap,1lmuWC.mpRmr Dem HAZARDOUS MATERIAL$OISCLOSU Type of Roof Will toe applicant or imus building e.Chapter 9.1 or handle Health and o defined io to Cupertino Municipal Code.Chapter 9.13,and Bre Health ad Safely Code,Sorties 35532(a All roofs shall be inspected prior to any roofing material being installed. E]yes No Will the applicant ortum building Occupant use equipment in devices which If a roof is installed without first obtaining an inspection,I agree to remove hazardous air contaminants as dclin d by the Bay Arca Air Quality Management all new materials for inspection. mint? ///JJJ El Yes (No I have mad the hanN.uusmaterials mquimm,nt under Chapmr6.95 of she Califon. die Health&Safety CWc,Sceuon2550515533and8534.lundcmmndthatifdm Wilding docs not cu milly term,a mil t. t it u my raaponihility m nose' Nc occupant n!the mytieorens which must t ' rmiuuacc ofa Ccnificate of adpumr. Signature Of Applicant Date 7� —o I All roof coverings to be Class"B"or better Owner or authorind ag Dam CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36615048.00 DATE ISSUED. . . . . . . : 09/07/2004 RECEIPT #. . . . . . . . . : 26937 REFERENCE ID # 04090018 SITE ADDRESS 7465 PROSPECT RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER YUSKEN JOSEPHINE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5241 RECEIVED FROM . . . . : LEON MASONRY CONTRACTOR DAVE LEON LIC # 17323 COMPANY LEON MASONRY INC ADDRESS 240 MOSELLE CT CITY/STATE/ZIP . . . : SAN JOSE, CA 95119 TELEPHONE (408) 365-1660 .E ID UNITQUANTITY AMOUNT PD-TO-DT THIS REC 'NEW BAL ------------- - ______ _ _____ _ BENERGY PERMIT FEE 83.16 39.92 0.00 39.92 0.00 BPERMFEE VALUATION 3,000.00 83.16 0.00 83.16 0.00 BSEISMICRE VALUATION 2,100.00 0.50 0.00 0.50 0.00 __________ __________ __________ ---------- TOTAL PERMIT 123 .58 0.00 123 .58 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ___ __________________ CHECK 123.58 6160 TOTAL RECEIPT 123.58 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 101 FOUNDATION 312 CHIMNEY REBAR & STRAPS 514 FINAL PUBLIC WORKS • I A CITY OF CUPERTINO CUPEkTINO PERMIT APPLICATION FORM N# te:Da 2 r � l/ d S r - o Building Address: Mailing Ad ss (if different from building address): 5/ RO5 ec14 Owner's Name: Phone #: us e 2 s — 3063 Contractor: License#: I-COAJ /YIA So.,,R Z-/JC 6 ), 3 3 F ' Contact: /� Phone: 9'6 8' 36S-J640 Cupertino Business License#: OR Ri(A Fax: ds' 66 Building Permit Info: Bldg I9 Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential 5 ' Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: �-+� Occupancy Gro p: — Type of Construction: Please check this box i e project is a second-story addition: ❑ ro'ect Size: Standard ❑ Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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 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 • 1 of ` CITY OF CUPERTINO CUPERTINo PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Pernut 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 rinklerBackflo PLUMBING BPSTORM Stonn/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent 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 Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BRENMAPP 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 App liance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEt�riNO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL i 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 sg foot PLUMBING ZADDCHG Address Chane BUILDING • j i i 7 3of3 Community Development 10300 Torre Avenue 4 Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 41UPEkTINO Building Department JOB ADDRESS: 0 O PERMIT # Q /WNER'S/ 6,5NAME: PHONE # GENERAL CONTRACTOR: G C�> soN 2 FAX # 365 6 E I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting • Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile e /Contractor Signature Date