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07080177 CITY OF CUPERTINO BUILDING DIVISION PERMIT �G� `]Et��TORQR1k�ATI�N. BUILDING ADDRESS: PERMIT NO. 1174 ELMSFORD DR LEON MASONRY INC 07080177 PERMIT ISSUE DATE OWNER'S NAME: MCCARGO MATTHEW AND ANNE 240 MOSELLE CT 08/20/2007 SANITARY NO. CONTROL NO. JE: (408) 365-1660 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 C4 ZLICENSED CONTRACTOR'S DECLARATION 0 o Job Description F I hereby affirm that I am licensed under provisions of Chapter 9(commencing UU with Section 7000)of Division3ofthcBusinessandProfessionsCode,andmylicenseis CHIMNEY REPAIR BELOW SHOWER a y in full force andCeffect.2 3 L' F. License Class Lic• +fir' Date Contractor RCHITECTS DECLARATION 1 a 4 I understand my plans shall be used as public records t�U s 0 y Licensed P c na a OWNER-BUILDER DECLARATION XrcbynatTirm that I am exempt from the Contractor's License Law for the 00 folio ng reaso .(Section 7031.5,Business and Professions Code:Any city or county $P which requires a permit to construct,alter,improve,demolish,or repair any structure t Zprior to its issuance,also requires the applicant for such permit to file a signed statement R� that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area 3 0 0 O Valuation t_ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of q(� 36209008 . Number Occupancy Type not more than five hundred dollars(5500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or thmugh his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- ccnse Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contraetoes License Law. ❑I am exempt under Sec .B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: J I have and will maintain a Certificate of Consent to self-insure for Workers compen. sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0--have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation/Insurancc carrier and Policy number are: Cartier: �T'1 f?fvrN Policy No. b- CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(5100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California.Dae Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY E.t I hereby affirm that there is a construction lending agency for the performance of . y> the work for which this permit is issued(Sec.3097,Civ.C.) ALender's Name a z Lender's Address U 0 1 certify that I have read this application and state that the above information is A H correct.1 agree to comply with all city and county ordinances and state laws relating to ',�U building conswction,and hereby authorise representatives of this city to enter upon the ahovc-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against I liabilities,judgments,costs and expenses which may in any way accrue against said City U in consequence of ting of this permit. Date ►- APPLICANr••tJFIDE ANDS AND WILL COMPLY WITH ALL NON-POINT Issued b) SOU�FjREGUL ONS. � � - 6 Re-roofs gra o Appli on Date r HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. C3 Yes Will the applicant or future building occupant use equipment or devices which If a roof .s installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r iaterials for inspection. District? ❑Yes 1 have read the haia/rdous materials requirements under Chaptcr6.95 of the Califor- nia Health&Safety C tions 25505,25533 and 25534.1 understand that if the building does not content ave a ant,shay responsibility m notify the occupant of the requiremeny,;,4 ch mu metpn tssmaneeoraCcrtifreate fOcc panty. Signator(,of Applicant Date 5( 24r 0,7 Ow r o thorircd agent Date- All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "UPEkTINO Building Department JOB ADDRESS: PERMIT�D o� �� 1 r 7 Flh, � 4Y� �v OWNER'S NAME: Vz4j, PHONE # 3& .5--/E 6- -6 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: S gnature 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 i,, -e6lffontractor Signature Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMI" RECEIPT OPERATOR: nancyc COPY ## 1 Sec: Twp: Rng: Sub: B1}:: Lot: APN 36209008. 00 DATE ISSUED. . . . . . . . 08,'20/2007 RECEIPT #. . . . . . . . . BS000002424 REFERENCE ID # . . . : 07080177 SITE ADDRESS 11'74 ELMSFORD DR SUBDIVISION . . . . . . CITY CU:?ERTINO IMPACT AREA . . . . . . OWNER MCCARGO MATTHEW AND ANNE ADDRESS 1114 ELMSFORD DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4950 RECEIVED FROM . . . . : R=ARD LEON CONTRACTOR DAJE LEON LIC # 17323 COMPANY LEDN MASONRY INC ADDRESS . . . . . . . . . . : 240 MOSELLE CT CITY/STATE/ZIP . . . : SAV JOSE, CA 95119 TELEPHONE (408) 365-1660 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ---------- ----- BPERMFEE VALUATION 3, 000 .00 83 .16 0 . 00 83 .16 0. 00 BSEISMICRE VALUATION 3, 000 .00 0 .50 0. 00 0.50 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 83 .66 0. 00 83 .66 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 83 .66 VISA --------------- TOTAL RECEIPT 83 .66 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO PN# �� Date: Building Address: Mailing Address (if different from building address): I I E� S ,o r� p ►�' Owner's Name: Phone#: a- trrl WLA In'1 C (-0A ?S-I Contractor: License #: Contact: Phone: '3 0 4' Cupertino Business License#: 0(*ve- o r 14c t-x Fax: -56 Building Permit Info: Bldg Z' . Elect ❑ Plamb ❑ Mech ❑ Job Description: Residential ❑ GN M rfl a t r b z1U w �J v*/(ommercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: -oject Size: Standard ❑ Large ❑ Major ❑ Quanti Fee ID F ee 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 Bc iler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind'Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTA CH hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 El!c 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 A3