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10080010 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19714 AMHERST DR CONTRACTOR:JACK N BATINICH PERMIT NO: 10080010 MASONRY INC f`'vNER'S NAME: KING ARTHUR J AND RUTH E TRUST 1383 CAMINO RAMON DATE ISSUED:08/02/2010 JER'S PHONE: 4083159529 SAN,OSE,CA 95125 PHONE NO:(408)998-0218 O LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT F PLUMB F License Class C_ 1(� Lic.# _33 S a 36 MECH r- RESIDENTIAL COMMERCIAL Contractor s C 13a �-r H r G k Date $ " oZ`!�Z I hereby.affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPAIR CHIMNEY-BROKE AT ROOF LINE (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.FI Floor Area: Valuation:$4800 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 permit is issued. APN'Vumber:31628019.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save `'VITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-po' t sour regulations pert Cupertino Municipal Code,Section Issued byC: Date: �� LJ 9.18. AK ��'� ��r store4 ate �� -1 d �gzz� RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All ro ifs 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspec tion. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signa ure of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I hay.:read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safet;i Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Addiiionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will main ain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. 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 O;r or a h i2 e Compensation laws of California. If,after making this certificate of exemption,1 ate: become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for w rich this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lend-r's Name 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 Lend Ws Address the above mentioned property for inspection purposes.(We)agree to save .inify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply I und.rstand my plans shall be used as public records. with all non-point source regulations per th9F Cupertino Municipal Code,Section i 9.18. Licei sed Professional Signature Date CITY OF CU'ERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: ( 9n 1—+ 4 DATE: '31Z110 TRFIEWED BY: APN: 31 LO as 019 1 BP#: M190010 "1111114TION: $4,800 PERMIT TYPE: Minor Building Permit PLAN CI[ECK TYPE: Chimney/Chimney Repair PRIMARY f_ APPLICATION OLCHIMRP USE: SFD or Duplex , ,t� ;f��_ TYPE: as o � 3 � APPLIANCE/EQUIP TYPE FEE ID QTY BP FEES Chimney Repair 1CHIMNEYR 1 $507 TOTALS: NOTE. Thesefees are based on the preliminary information availa Ve and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 0.9-051 Elf 71/09) FEE QTY/FEE MISC ITEMS V, Permit Fee: $507.00 ! E Work Without Permit? Q Yes (E) No $0.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $508.50 $0.00 TOTAL FEE; $508.50 Revised: 7/27/2010 CITY OF CUPE RTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lc,t: APN 31628019. 00 DATE ISSUED. . . . . . . : 08/02/: 010 RECEIPT #. . . . . . . . . BS00007.1054 REFERENCE ID # . . . : 1008001.0 SITE ADDRESS . . . . . : 19714 134HERST DR SUBDIVISION . . . . . . CITY CUPERT::NO IMPACT AREA . . . . . . . OWNER KING ARTHUR J AND RUTH E TRUST ADDRESS 19714 !NHERST DR CITY/STATE/ZIP . . . : CUPERT::NO CA, 95014-2410 RECEIVED FROM . . . . : JACK N BATINICH MAS CONTRACTOR JACK N BATINICH LIC # 25229 COMPANY JACK N BATINICH MASONRY INC ADDRESS 1383 aiMINO RAMON CITY/STATE/ZIP . . . : SAN JOl3E, CA 95125 TELEPHONE . . . . . . . . : (408098-0218 FEE ID UNIT QUANTITY AMOU]JT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---------- ---------- -------- 1BCBSC VALUATION 4, 800 .00 1.00 0 .00 1 .00 0 .00 1BSEISMICR VALUATION 4, 800 .00 0.50 0. 00 0 .50 0. 00 1BUSLIC FLAT RATE 1.00 114. 00 0.00 114 .00 0 . 00 1CHIMNEYRE EACH 1 .00 5D7.00 0 . 00 507 .00 0.00 ----- ----- ---------- ---------- ---------- TOTAL PERMIT 622 .50 0 . 00 622 .50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 622 .50 10378 --------------- TOTAL RECEIPT 622 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------------------------- 101 FOUNDATION 312 CHIMNEY REBAR & STRAPS 517 FINAL CHIMNEY CITY OF CUI. ERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # F�>' 0\9 Date: Building Address: fq7iy ��sf r Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work only) Yes ❑ No yes, provide letter from HOA Owner's Name: Phone#: -f (Zlo B) 3ls"- 9sa Contractor: Phone:fyo 9,?,?--D2/ + � V 4' '(JV ry Fax: Contractor License#: 3 3 9 3 6 `� Cupertino Business License#: Contact: Phone: Fax: Residential 91 Commercial El Job Description: Re--PO-1,1- C k;M ney 6 ro �-e 4c-1- r)oa f,rn of- Building Per/mit Info: ' Bldg C Elect ❑ Plumb ❑ Mech ❑ Type of Cons'struction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ❑� �_ Valuation: / , o Square Footage: Project Size: Express �dard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Bu' ding/LEED Checklist& attach it to the application or if applicable, inc.ude in plan set & the sheet index. 13oints Achieved: For help, contact Build it Green at www.builditgreen.o Revised 07/14/09 M.lndoDr Air Quality and Finishes 1 IAC/Health pts y—yes 0 2.Use Low VOC,Water-Based Wood shes 2 IAC/Health pts yeses 0 Fini 3IAC/Health pts y=yes p 4.Use Salvaged Materials for Interior Finishes 3 Re;;ource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AC/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAC/Health pts y=yes 0 4IAC/Health pts y=yes p B.Use FSC Certified Materials for l6terior Finish 4 Rei;ource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Re!;ource pts y=yes 0 10.Install Whole House Vacuum System 31A(VHealth pts y=yes 0 N.Flooring 1.Select FSC Certified Wood Flooring -e Resnurce pts y=yes — Iti 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resc urce pts y=yes 0 4.Install Natural linoleum in Place of Vinyl 5 IAQ Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resc urce pts y=yes 0 B.Install Recycled Content Carpet with Low VOCs 4 Resc urce pts y--yes 0 1 ! 1 Total Points Available: 401. 1301--- 57 Total Points Project Received: 1 91 01 0 G:1aWprogslgreenbullc11nc guiderinestremodelaWgref6iintsfinaI2.121.04proteledxls 2 —/ Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 10171 Am fn PERMIT# OWNER'S NAME: A a on Ga P1 a 4- PHONE# GENERAL CONTRACTOR: Jc,c k f i�l•`C.Gt L?, r BUSINESS LICENSE# ADDRESS: /-3 ,-3 CrarA,'-No, RamoeL CITY/ZIPCODE: ,S h-.To5 ^ 9 *Our municipal code requires all businesses working in the :ity to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INS1'ECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTOR E OBT NED A CITY OF CUPERTINO BUSINESS LICENSE. _ �-� _ 1 am not using any subcontractors: ignature Date Please check applicable subco t actors and complete the following information: SUBCONTRACTOR BUSINESS ?`AME 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 Owner/Contractor Signature Date