06080228 (2) CITY OF CUPERTINO *�*
aU1LDING 131 VISION PERMIT CONTRA(;;'R INFORMATIpN =:
BUILDING ADDRESS: J K MASONRY, A PARTNERSHII PERMITNO.06080228
10360 STOKES AV
NER'S NAME: PERMIT ISSUE DATE
OW
DINELLI DAVID W AND BARB J521 S BASCOM AVE #A 08/28/2006
ONE: SANITARY N0, CONTROL NO.
(408) 287-2398
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Hipp LICENSED CONTRACTOR'S DECLARATION lob Description
mC 1 hereby affirm Wt 1 an licensed under provisions of Chapter 9(commencing
sew wiNScction70sR)of Dividon3ofthc Businuc and PrafctSjlrm Cg c,' d ylic u
�� infull force ander( _ CI OVObY TEAR DOWN TO ROOF LINE, IF NO STEEL, THEN WILL
'pz ""nmOaW of L"'" — ALL THE WAY DOWN TO FOUNDATION. REBUILD TO CITY
F C Dolc Comrxbr
I�tJ' ARCHITECTS DECLARATION CODES .
i c 1 immoir id my plans shall W used az public records
i U
G y Licensed Pmfcssional
g WeOWNER-BUILDERImaandrh DECLARATION
Continues
I hereby aRrm Nm 11. ocmpt s a Nc Concoctofs License Law far de
O O (allowing mason.(Section]fD L5.Business and Rofusinm Calc:Any oily or county
m which require a permit to construct.alter,improw,demolish,or repair any structure
r—rn priarmiskuuamre.alsorequireathe appinant for such permitm�il�asiered summer
:�a that he is licensed pursuant to de pmvisiou of dm Canuacmr's license law(Chapter9 Sq.Ft.Floor Area Valuation
%reF0 (commencing with Sation 7000)M Division 3 of We Business and Professions Com)or
Nat be u exempt thmcfrom and de basis for the alleged exemption.My violation of 315
Section?031.5 by my applicant for a permit mbjecu the applicam to a civil penalty,of AI)N Number Occupancy Type
not more that five hundred dollars($500h
0 I,mowerofth operty,mmyemplaycuwithma uNe'usolecompensation,
will do the work.md dinMoore is notm¢nded or offered for sar,(Sec.7W.Business Required Inspections
and Pmfcsimas Cade:The cm
Conuar's Licewe Law does ml apply man owner e of - 9 P
property who bisildsw improves Winner.and who doessuchwarthimeelfwthrough his
own employces,provided Nal such impmsemenb am nal inemi woRered forale.If.
howr.
build., Ul Wildingt , anN.o fpreMtY Wald within aK Wild
oT improve compleumi.
penman of /y
builder wiB have tle burden of proving War M did nos WiW err imRow for puryou of WM/1/IyJ AL
cons). 'aceta /wD(([(yyyy����
0 1,as awner of We Property,me exclusively concocting with licensed conuactors an [
comm tithe hot (Sec.7W.an cBusinessandrty who
Code:)The dinner. cad L/
oche Taw dace not apply m ts owns of property who Wires or impmm derean.and
who contracts for such projects with aconuacsor(s)licensed purwantm We Contractor's / in
[nosy Law. 2 ^L_ n
❑lam acmes undo See .B&PCfw Nu maven /T a}�ppp
owner Date 1Fg/a�,f�f/ j�
WORKERS COMPENSATION DECLARATION gL�J��' �95�
I hereby a(Bco under perWty of perjury ane of We following declantlou: afJ_ V
I haw and will maintain a Ceaificam of Conecnt an elf-insure for Warkefs Compen-
sation,as provided for by Section 37M of We labor Code.for the performance of We
work for which this Permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,az required by Section
37(10 of We labor Code,far We performance of de work for which Nu permit is issued
My Wailan,CoCompemstionylnsuranj�nOn Policy number am: ( 7
Carie' q � ' icy No.:��7yOp_��d
CERTIFICATE OF EXEMPTION FROM WORKERS'
S'
COMPENSATION INSURANCE -
('fbix section need nus be complcmd if de permit is forone hundred ddlnrs(SIM)
loss.)
1 ccrifv that in the performance of We work for which Nis permit u issued I shall not
employ any person rainy mannerse as in bccomc subject m the Workers Compensation
Laws of California,Dae
Applicant
NOTICE TO APPLICANT:If,after making this Ccriflcam of Exemption.You should
become mbjcn m the Workers Gampedadaa provisions of the labor Cada you muse
.J z foMwith comply with such provisions or Nis perms sball W dtsmcd rewled.
z O CONSTRUCTION LENDING AGENCY
'f~•, I hereby affirm Nat Bert is a construction lending agency for the performance of
D:
on work for which this Permit is issued(Sec.3097,Civ.C.)
0 lender's Name
D z Lender's Address
U C 1 certify that I have road this application and sae dor the above information is
ly F Corea.I agree to comply with all city and county endurances es and suss laws missing to
0U building consuiction,and hereby authorize representatives of Nis city m emerupnnthe
r above mentioned property for inspection purposes. ,
(•-m LL (We)agree marc,indemnify and kap hi mincs the City of Cupertinoagainst
Tq limilitiu,judgment,cuss and expenses which may in any way scenic against aid City
U Z APPLICANTeUN UNDERSTANDS AND Permit.
COMPLY WITH ALL NON-POINT Issued by: Date
SOURCERF.GUytTIONS.
Re-roofs
Signature o(ApplicarruiContrannor Data
HAZARDOUS MATER" DISCLOSURE Type of Roof
Will We applicant m future Wilding aceupamsmm or handle haradous material
az derided by de Cupenimo Municipal Code.Chapter 9.11,and the Health and Safety
code.sago"25532(a)7
0y. All roofs shall be inspected prior to any roofing material being installed.
Ne
Will the apPlimn or fumrt Wilding oupant use equipment rkvicwhich If a roof is installed without first obtaining an inspection,I agree to removeOequipmedevices
emit haxardaus air contaminants u defined by We Bay Area Air Quality Management all new materials for inspection.
District?
❑Y¢
Ihavereadflchax aomacrialsmquimmensunder Chaper6.95ofthe Cdifor- ..../
nia HcalN&SafctyCade,Sccdou15505,25533and25534.1undcrsundthaifdce Wilding
dao not currently haw a edam Nat it is my respamihiliry to notify We uccup rt of the
rcquimmcnsw ichmuaMmet pdormi arcane Is ceroid..of coca Signature of Applicant Date
Own
crd,aamwirx agent Dao. All roof coverings to be Class"B"or better
r
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
/e 60 ,D60 C3Z�-
OWNER'S NAME: Q ONE # 5'o9 28 - "3Qy
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors:
ignature 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
• - 2-9-- v-C
Owner/Contractor SigAature Date
CITY OF CUPERTINO
em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32647015 . 00
DATE ISSUED. . . . . . . : 08/28/2006
RECEIPT # . . . . . . . . . : 35796
REFERENCE ID # . . . : 06080228
SITE ADDRESS . . . . . : 10360 STOKES AV
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DINELLI DAVID W AND BARBARA J
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : J K MASONRY
CONTRACTOR . . . . . . . : KELLEY, JAMES & GUADALUPE LIC # 11823
COMPANY . . . . . . . . . . : J K MASONRY, A PARTNERSHIP
ADDRESS . . . . . . . . . . : 521 S BASCOM AVE #A
CITY/STATE/ZIP . . . : SAN JOSE, CA 95128
TELEPHONE . . . . . . . . : (408) 287-2398
eFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------- - ---- ---------- ---------- ------ -- -- -- -------- --- ------ -
BENERGY PERMIT FEE 104 . 76 50 . 28 0 . 00 50 . 28 0 . 00
BPERMFEE VALUATION 3 , 150 . 00 . 104 . 76 0 . 00 104 . 76 0 . 00
BSEISMICRE VALUATION 3 , 150 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- -- -- ------ ---- ------
TOTAL PERMIT 155 . 54 0 . 00 155 . 54 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
------------- - - -- ------------ ------- - --- ---- ---
CHECK 155 . 54 3104
TOTAL RECEIPT 155 . 54
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CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEk�TINO
'qWAPN # Date:
BIZs loco
Building Address: Mailing Address (if different from building address):
lb3foc� S-ro kes e .
Owner's Name: Phone 9-
CA\4
:rnvhe\\� (L 00 2fS - 23 18
Contractor: License #:
K maSohY gU(oqS �I
Contact: Phone: L101 al -?'As Cupertino Business License#:
\-1011eY1e (-CMN Fax: 4oY-'12W-cgvo
Building Permit Info: Y Q ,,� t-v vo �"
✓/�e 8 u ✓ep to C I�7 00-rho
Bldg p' Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential l� Commercial ❑
Sq.Ft. Floor Area: S/Sq.Ft.:
Cost of Project: Occupanc Gro
A3, \so '5
Type of Construction: CNim" �� r : rt.k a 0 Please check this box if the project is a
>tw0,\ 'a 1rSA-M �4Fu5Yr s 41Gbv� �buildiN second-story addition: ❑
o ke•
Project Size: Standard Ir Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILER1 Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1 M 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
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CITY OF CUPERTINO
CITY or PERMIT APPLICATION FORM
CUPERTINO
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 Permit 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 Storm/Rain Water PLUMBING
Aft BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER InstalUAlter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFDCT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace > I OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc A azatus ELECTRICAL
BREMNRAPP Rem Non-Res A liance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/A aratus ELECTRICAL
BREMRECEPT Rep
tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BRENIREPALT Re air/Alter Heating MECHANICAL
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A,.
Eur ` CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL
BREMSIGNS Remodel Sips, 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
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 s foot PLUMBING
ZADDCHG Address Change BUILDING
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