The URL can be used to link to this page

11070180 CITY OF CUPEkcTINO BUILDING PERMIT BUILDING ADDRESS: 10934 NORTHVIEW SQ CONTRACTOR:J K MASONRY PERMIT NO: 11070180 OWNER'S NAME: MICHELLE BENTO-JACKSON 400 HODGES AVE DATE ISSUED:07/25/2011 `1ER'S PHONE: SAN JOSE,CA 95128 PHONE NO:(408)287-2398 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11COMMERCIALE] `Z License Class C— Lic.# U qL9 REPAIR CHIMNEY FROM ROOF LINE Contractor � Date l l� I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3165 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31636061.00 Occupancy Type: permit is issued. _v APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I t—� RE-ROOFS: Signature /ti( Date l gS All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio s 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this WAR Owner or authorized agent: Date: permit is issued. 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 Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, ts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. ,ntmg of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date Building Department City Of Cupertino LM 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: q PERMIT# — OWNER'S NAME: j — pyv PHONE # GENERAL CONTRACTOR: — BUSINESS LICENSE# ADDRESS: `iS lTY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: �5& Signature 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 Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile � k Owner/Contractor Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 31636061. 00 DATE ISSUED. . . . . . . : 07/25/2011 RECEIPT #. . . . . . . . . BS000014173 REFERENCE ID # . . . : 11070180 SITE ADDRESS . . . . . : 10934 NORTHVIEW SQ SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MICHELLE BENTO-JACKSON ADDRESS 10934 NORTHVIEW SQ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JK MASONARY CONTRACTOR . . . . . . . : KELLEY, JAMES LIC # 11823 COMPANY J K MASONRY ADDRESS 400 HODGES AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95128 TELEPHONE (408) 287-2398 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 165 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 3, 165 .00 0 .50 0 . 00 0 . 50 0 . 00 1CHIMNEYRE EACH 1 . 00 523 . 00 0 . 00 523 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 524 . 50 0 . 00 524 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 524 . 50 845 --------------- TOTAL RECEIPT 524 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 101 FOUNDATION 312 CHIMNEY REBAR & STRAPS 517 FINAL CHIMNEY a CITYOF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM 1'N# Date: Building Address: Mailing Address (if different from building address): Owner's Name: Phone _ Contractor: License#: L Qqo ?6 Contact: Phone OV 7-4S 8' Cupertino Business License#: Fax: o Building Permit Info: , Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: ' QIC'ce CLI MWi Qf F Residential _ e Commercial ❑ Sq.Ft. Floor Area: �. $/Sq.Ft.: Cost of Project: •� Occupancy Group:� Type of Construction: l2 Please check this box if the project is a le �� trcN f second-story addition: ❑ o'ect Size: Standard ,4 Lar e ❑ 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 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAB Con. Tax for BQ Zone BUII.DING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BU>ZDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD EnergyAddMulti BUILDING BRWESTIGA Investigation fee BUILDING' 1 of 3