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09060011 CITY OF CUPERTINO BUILDING DIVISION PERMIT W. BUILDING ADDRESS: PERMIT NO. 910 COTTONWOOD DR J K MASONRY, A PARTNERSHIP 09060011 OWNER'S NAME: PERMIT ISSUE DATE --IONE: SA A O. 9 CONTROL NO. (408) 237-2398 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a p C LICENSED CONTRACTOR'S DECLARATION Job Description ul U p I hereby affirm that I am licensed under provisions of Chapter 9(commencing w with Section 7000)of Division 3 of the Business and Professions Code,and my license is Q=Zy in full force and e(C L „ - FIREPLACE CHIMNY TEAR DOWN, 1FT ABV SHLDRS — J K z LicenseClass Lle•* MASONR't RENWD BUS LIC 6/2/9 Dale Contractor s' ARC rrECrS DECLARATION a< 1 understand my plans shall be used as public records �yU LU ti Licensed Professional n y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following mason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct alter,improve,demolish,or repair any structure _ prior to its issuance,also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $3240 y - 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 APN Number Occupancy Type not more than five hundred dollars(5500). 3 6 918 0)7 . 00 ❑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 trot 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.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 Contractor's la- cense 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 Contractor's License Law. ❑I am exempt under Sec. B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- .cion,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 Worker's Compensation Insurance carrier and Policy number are: Cartier. F� Policy No.: S �S� CERTIFICA OF EXEMPTION FRO ORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) 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.Dam— Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workces Compensation provisions of the Labor Code.you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z . CONSTRUCTION LENDING AGENCY [~.m I hereby afTirm that there is a construction lending agency for the performance of a the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name ]z Lcndees Address U 0 I certify that 1 have read this application and state that the above information is w cormcL I agree to comply with all city and county ordinances and state laws relating to C)Vbuilding construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against col liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date ""J '09"'0 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: '. SOURc EGULAMONS. / o A A) Re-roof; Si aro of Apphcanucon for 'Date 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. ❑Yes o If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which ,mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. +strict? ❑Yes ID-No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant.that it is my responsibility to notify the occupant of the requireme lith must be met . to issuance of a Certificate of Oce panty. SignatuI a of Applicant Date All roof coverings to be Class'``or better Owner or authorize agent Date 090 c) C', 1 l in CITY OF CUPERTINO CITY 'YOF PERMIT APPLICA'T'ION FORM CUPS TINO .PN # (e Date: a I o Building Address: R �JQ Mailing Address (if different from building address): Owner's Name: Phone#: _ Contractor: License#: =4,____� Contact: Ge-Q,; ' Phone: a k-7 -.�,?�� [Cuertino Business License#: �1,�-CBzly Building Permit Info: Fax: Bld I' I Elect ❑ Plumb ❑ Mech ❑ Job Description: `�1 ce.P 1�C r✓�� - + c(ot�n� esidentia Commercial ElSq.Ft. Floor Area: $/Sq.Ft.: Cost of Project:1 1; 3� ag0.00 Occupancy Group: Type of Construction: 5otic -3 Please check this box if the project is a second-story addition: ❑ coject Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boile:-> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Inc/Off/Comm/Quasi BUILDING BCONSTAXBQ COIL. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Cor.stax—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 L BE WESTIGA Investigation fee BUIL'DING' 1 of 3 t CITY OF CUPERTINO C U CITY OF O GENERAL BUILDING APPLICATION FEE S41HEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM ACOUSTICAL REVIEW IACOUSFDW SFDWL/Duplex New B IACOUSRESAD SFDWL/Duplex-Addition/Alteration B 1 ACOUSCOM Multi-Fz mily/Commercial B CHIMNEY'S 1 CHIMNEY Chimney B 1 CHIMNEYR Chimney Repair B I FENCES 1 FENCE>6FT Non-ma;onry, over 6 ft in height B 1 FENCEMAS>6 Masonry, over 6 ft in height B FIREPLACES I FIREPLMAS Fireplac,-Masonry B 1 FIREPLFAB Fireplac,-Pre-Fabricated/Metal B 1 FLAGPOL>20 Flag pol-.(over 20 ft in height) B 1 MODUSTRU Modular Structures B FOUNDATIONS IFOUNDREP Foundat,on Repair B 1PILECAST Pile Foundation Cast in place concrete B 1 PILEDRIV Pile Foundation Driven (steel, pre- B stressed concrete) 3 of 5 CITY OF CUPERTINO CITY Of GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ez 8 windows) 1 WINMEWSTR New Wi Zdow-structural shear B wall/masonry(includes plan ck fee) 1 EPERMITFEE Electricz 1 Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand A:one Electric Pln Ck (hourly) E 1 MECPLNCK Stand A one Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand A one Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1 BCBSC Cal Bldl; Standards Commission Fee B ALL PERMIT TYPES C 1 BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1 BUSLIC Busines; License B 5 of 5 _ Community Development `4 10300 Torre Avenue �. .; Cupertino CA 95014 Telephone(408)777-3228 C1T1(OF Fax(408)777-3333 rUPEkTINO Building Department JOB ADDRESS: PERMIT # o CQf4o&) �oOS � � OWNER'S NAME: S PHONE-#—(a- =GENERAL CONTRACTOR: L (,(, FAX # I am not using any subcontractors: 2A ��, , a ) c 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 .� oL- Owner/Contractor Signature Date