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07060127 CITY OF CUPERTINO l^� p BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 10353 MILLER AVE J K MASONRY, A PARTNERSHIP 07060127 OWNER'S NAME: PERMIT ISSUE DATE KIRKMAN JAMES C AND ALETHA M 521 S B1,SCOM AVE 06/14/2007 VE: SANITARY NO. CONTROL NO. (408) 28; -2398 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o O LICENSED CONTRACTOR'S DECLARATION U K I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description UW with Section 7000)of Division 3 of the Business and Professions Code,and my license is FIREPLACE CHIMNEY REPAIR. in full force and cffec License Class LIC. ff F Date " Contractor AR HITEC7'S DECLAR' O a< 1 understand my plans shall be used as public records ruJU O y Licensed Professional y OWNER-BUILDER DECLARATION i a 7 1 hereby affirm that I am exempt from the Contractors License Law for the p o following reason.(Section 7031.5,Business and Professions Code:Any city or county $8! which requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior leo its issuance,also requires the applicant for such permit to rile a signed statement S o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;q.Ft.Floor Area Valuation F$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $3875 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 Number Occupancy Type not more than five hundred dollars($500). 3691403— C] 691403-:❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractors License Law does not apply to an owner of Q p property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.IL however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractors)licensed pursuant to the Contractors License Law. ❑I am exempt under Sec B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations. ,J I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workermpensation Insygnce ca 'r and Policy number a� /IQ� Carrier. 1(6`�"''�rf��QJ�� Policy No.?0 0 �70 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Phis section need not be completed if the permit is forone hundred dollars($I00) 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.Date 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 z forthwith comply with such provisions or this permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY F-t►� I hereby affirm that there is a construction lending agency for the performance of IY. the work for which this permit is issued(See.3097,Civ.C.) ALender's Name z Lenders Address U 0 1 certify that 1 have read this application and state that the above information is GI ►- correct.I agree to comply with all city and county ordinances and state laws relating to O J building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against tiliabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. ? v" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ,.f SOURC EGULATIONS. Re-roofs Sigilature ofPkplicant/Contrabtor Dae HAZARDOUS MA IALS DISCLOSURE Type of Ro:)f 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. ❑Yes ,.0' .—_. If a roof is nstalled without Will the applicant or future building occupant use equipment or devices which . first obtaining an inspection,I agree to remove -mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new mal erials for inspection. District? ❑Yes CPK 1 have read the hodrdous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requircments ich must be met prior to t trance of a Certificate of cu Signature o f Applicant Date �� % e� All roof coverings to be Class"B"or better Owner err author xcd agent DatJ CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36914035 .00 DATE ISSUED. . . . . . . : 06/ L4/2007 RECEIPT #. . . . . . . . . : BSO)0001662 REFERENCE ID # . . . : 07050127 SITE ADDRESS . . . . . : 10353 MILLER AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER KIRKMAN JAMES C AND ALETHA M ADDRESS 19900 MEADOWWOOD CT CITY/STATE/ZIP . . . : JACKSON, CA 95642 RECEIVED FROM . . . . : J K MASONRY CONTRACTOR KELLEY, JAMES & GUADALUPE LIC # 11823 COMPANY J k MASONRY, A PARTNERSHIP ADDRESS 521 S BASCOM. AVE CITY/STATE/ZIP SArf JOSE,- CA 95128 TELEPHONE (4(18)287-2398 FEE ID UNIT QUANTITY IMOUNT PD-TO-DT THIS REC --NEW-BAL- --------- ------ --- ------ BPERMFEE VALUATION 3, 875 . 00 104 .76 0. 00 104 .76 0. 00 BSEISMICRE VALUATION 3, 875 . 00 0.50 0. 00 0.50 ------ - TOTAL PERMIT 105 .26 0. 00 105 .26 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- CHECK 105.26 #3428 --------------- TOTAL RECEIPT 105.26 VOICE ID DESCRIPTION VOICE ID DESCRIPTION _ _ ------ ------------------------ -- -- ---------_____ 101 FOUNDATION 312 CHIMNEY REBAR & STRAPS 514 FINAL PUBLIC WORKS CITY OF C'UPERTINO TY OF PERMIT APPL:[CATION FORM CUPEkTINO APN# Date: 5(o91 403g oo Building Address: Mailing Address (if different from building address): Ow er's Name: Phone`#�: Contractor: License#: �1S Contact: Phone: Cupertino Business License#: �I Male Fax: 0AO�Yr l,k vLk —_A9 a3 Building Pi--•n;+ Bldg Elect ❑ r iumD u Mech ❑ Job Description: Residential 42�" ;Yn 1"Lqxd.,Lnes Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: rN �x� Y� `�Y i-w -te,id,V% Please cheell this box if the project is a second-story addition: ❑ Project Size: Standard Large ❑ Maier ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boi:er<= 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 BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Con;tax—Resi/Mobile BUILDING BELEC 1000 Ele,; 600V <= l OOOA ELECTRICAL BELEC1001 Ekc 600V> 1000A ELECTRICAL BELEC200 Elec ,'5vcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA hivestigation fee BUILDING 1 of CITY OF CUPERTINO Iff OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Descri tion Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Conun. 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 131d 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 PI,,n Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewa a Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTR.AP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pipe PLUMBING BPWHEATER NVater 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 Re to Furnace> IOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD I nstallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Re n 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 I:epair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 A CITY OF CUPERTINO TY OF PERMIT APPLICATION FORM CUPEkTINO 2uantity Fee ID Fee Description Fee Group BREMSIGNAD Rm 31 Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Th.-atrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS V m ilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection 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 Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG P umbing Fee sq foot PLUMBING PLLONGRNGC PlanningLR Comme/Multi-Fam PLANNING PLLONGRNGR Planning,Long Range Residential PLANNING 3 of 3 Community Development 10300 Torre Avenue r Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ''UPE�TINO Buildi:n DLe art, JOB ADDRESS: PERMIT # OWNER'S NAME: �,,,�5 c - �I HONE # �g - 6' 756 GENERAL CONTRACTOR: 'YY` s �► FAX # I am not using any subcontractors: ,J�11 �- Sigmature ll Date Please check applicable subcontractors and complete the followinginformation: SUBCONTRAC'T'OR 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 Date Owner/Contractor Si ture