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03060163 (2) CITY OF CUPEWrINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION + BUILDINGADDRESS: JONES MASONRY PERMIT ND.03060163 • OWNER'S NAME: 1049 DELL AVE PERMITLSSUEDATE FRED TEP NE: 4083777512 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Op LICENSED CONTRACTOR'S DECLARATION gP ryq wF I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Deserip�'p{I� RIa.I ' �2a� with Section 7IXM))of Division J oft, Businesanup ru( in sCr�m,�std yliccnse is w ; = L11 force andefr�n, Q 3 CHIMNEY REPAIR LmenxGl Lic.g JUL 1 0 200 =t-,❑ Date Cun DEC ARC ll Muse DEC ATION 2< 1 understand my plans[hell W Saud as public records BUILDING te.Gr^ Licensed Pmfcssionel OWNER-BUILDER DECLARATION IO O 1 nasoereby.(Sec that 11. caternu5.Busin from the fesntressCo e:Any c law for Nc <0 0 followhich re ,fres,.(Section III] ucti,Since, and Professions Code:Any city or county $ which requires a permit m cnnswn,aline improve,demnlisR or,:pair any Structure poor or its issuance,also requires the applicant for such Permit to file a signed statement ss< that he is licensed pursuant othe provisions offire Connector's License Law(chapter 9 Sq. Ft. Floor Area - Valuation " FO (commencing with Section 7000)of Division 3 or the Businm rend Professions ewe)or 15F that he is exempt therefrom and the basis for the alleged exemption.Any violation of 36908037 . 00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type not more Nen five hundred doll..($500). ❑1,as owner of the pmpeny,or my employees with wages as their sale compcnsad,n, will do the work and the suucture is not intended or offered rot a].(Ste.7W.Businm iUi — FOUNDA d Inspections NARA on and Professions Code:The Comuacmrs License Taw does not apply m an owner of 312 - CHIMNEY REBARp c STRAPS property who builds or improves there ,and who d,easuch work himself or um hugh his own employees,provided that tech improvements ate not intended or olfe.a for Sale.It. 514 — FINAL PUBLIC WORKS however,the building or improvement is Sold within one year of completion.Ne owner- builder will have the burden of proving that M did not Wild w improve for purpose of sale.). O h as owner of the property,am exclusively contacting with licensed conyacmrs to convect the pmject(Sec.70441,Business and Pmtmions Code)The Contnatoh Li. cem,law docs not apply to an owner of property who Wilds or improws Nemo,,and ' who contacts for such pmjecta with a conoaaorfs)licensed pursuant m Ne Conuact,h License law. ❑1 am exempt under Sm. .B&P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penury of pesjur,..of the following declantioes: I bass and will maintain a Cenifiate of C.rose nuo self-insure for WotIM'aCompen- sation,as provided for by Section 3700 of the labor Code,rear use Nor..,.of She woh for which Of,permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued My Workers Compensation In...artier and Policy number .: sTA f4 1� " Z- Camer. Polity No.: CERTIFICATE OF EXEMPTION FROM W ORKERS' COMPENSATION INSURANCE OTIs section need not Iccompleted if the permit is for ane hundred dollus(gl W) or las) 1 certify.that in the Performance of She,work for which this Permit U Issued,1 shall not employ any person in any manner x Is In become subject to IM Worker'Compensatlon Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation previsions of the Labor Cede,you most .JO forthwith comply with such provisions or this Permit shall W deemed rented. r`" CONSTRUCTION LENDING AGENCY (•+`N•' I hereby aRrm that there is a construction lending agency for the performanceof Ci the,work for which this permit Is issued(Sec.3097,Civ.C.) W Q Landers Name jz Lcndces Address U 0 1 mnify that 1 Mw read this application and sum that the AWw information is U. F correct.l agree to comply with all city and County mNinances and state laws Mining 10 0 U building convection,and hereby.uthmiae representative,of this city to come upon tM W ahowe mentiuncd properly for inspection purposes. (We)agree to an,indemnify and keep harmless the City of Cupertino against wFy y liabilities,judgments,costs and capemes which may in any way accmc against Said City 6) in conso ocncc of the granting of this permit. PLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOB-POINT Issued by: Date 5 Fv REGfdLA ONS.ky / -Z /./ G7� f--C{LQ /(i(Q �I C.F` J Re-roofs T Signature,(ApplicanUContracmr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the APpltcam Lir future building occupant store or handle hared..material as dol ed by dm Cupenino Monte pal,Code,Chapter 9.11.and the Health and Safmy cmm,section 1ss3z(a)? ❑Yes NAll roofs shall be inspected prior to any roofing material being installed. u' Will the applicant or future Ilding«capam uac cyuipmenl or device,which 'If a roof is installed without first obtaining an inspection,I agree to remove 7nia t hmardnus air conmm rturns cd by the Bay Arca Air Quality Management all new materials for Inspection. rief? C]Yeas Nm I have mad the hamNnus materials mquimmen6 under Chapter 6.95 of the Cali for _ Health&Safety Codit,Seeuom 25505,25577 and 25534.1 understand that if the Wilding a nut currently how a tenant.Nat his my respunsi hit ity m anti ly the uecup eau of the lcnksw 'ch uatW oofmisaa eemracon"" Signature of Applicant Date �c �T ht L- I,rswner or auNorircd ascm Dna All roof coverings to be Class„B" or better p CITY OF CUPERTINO J 6 0 CITY OF PERMIT APPLICATION FORM CUPERTINO APN # �p �� Date: b Building Address Owner's Name: Phone#: Fred7- L/ao - -2F(7& Contractor: w icense#: 39oas9 Contact: Phone#: Ap ant/Contras or: / Fax#: Wle S 377- '7S/ 3 ildin ermit Info: Idg,// 5-.vo V'� Elect Plumb Mech Job ription: Residential: Commercial: Sq.Ft.Floor Area: $/Sq.Ft.: Architect/Engineer: Valuation4 19G 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<= 1O00A ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD EnergyAddMulti 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 PLUMBING 1 of 77S-D �r CITY OF CUPERTINO 4 C' °F 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 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 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 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 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 BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Li ting Fix ELECTRICAL 2 of 3 ZCITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO 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> 100K 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