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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 • VIP 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 1 of 3 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 2 of 3 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 • 3 of 3