08090048 CITY OF CUPERTINO2'�t->' ''' '
BUILDIW,;DIVISIPN PERMIT CO1�I'TItA TSR I1VFOR�MATI �'.
PERMIT NO.
Bu"TIIbc TT"A BLANEY AVE A TO Z POOL AND SPA REPAIR 08090048
OWNER'S NAME: FERMTT ISSUE OATS
RAJ MAISURIA 10289 MENHART LN 09/10/2008
NE: (408) 374-6268 SANITARY NO, CONTROL NO.
ARCNITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOWS DECLARATION O O O
8I hereby affirm that l and limmcd under prnv z mu of Chepxr 9(commencing Job Description
with SeclWo7 0)Of DhAhmnJofthe Etmomaod Profeaciou Code.andmyl4enzcu DEMO OF POOL
5'q Liceneclu�deffxt LIC.g NOTE:A TO Z POOL BSL GOOD THRU END 9/2008
Dao: Conlrxlor
7W ARCHITECTS DECLARATION
I understand my pions Nall W uaod an public records
SdV .
h o
Licensed Pmfcssional
y O211are UIIDER OE CLARATION
1 hcmby aRrm Nat 11. uempt iron the Contractor's License law for the
r'n o following mason.(Section 703 1.5,Budxeu and m,c.do au Cade:Any city or county
whd,u sin moo a permit amid.mmNuct aIle.,impmw,demur W,or rtpdr any armmm
_ pat he iss lensed p,alwnttft lhcapplis of for wchpumitbfkce Lawdzummcm
p�< (come u angwit parnanl trail of Dortau of de CanusinessalJccuelsws Cutle9 Sq.Ft. Floor Area Valuation
y�g (commcneing with Section]000)af DivuionJnftW Business and Rofessiau Cutlet at S5500
e 5l that heti exempt therefrom and Ne had,for the a mired cssmptiou.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of
comom than Bw hundred dellars(M). 31633008 .ApVI Number Occupancy Type
01,uawnoroftheproperty,mmywploymwithwrAufte miccompewllon,
will do thcwotk, tture and the muIs area intended oroRexA rorule(Sec.7O14,Basi.
and Pmfeumas Code:The Ci nso mss Li..Law dam ml apply m an ower.of Required Inspections
prvpcny wW Wilda a impmws thereon,andwW tlmssmh work himself or through
his
awnemployees,pmaded NatsuchimpmwmensarenotinmM muttered fusads.IL
lawmwr,the Wilding or Improvement is sold within one year ofcompinion.the owtte-
Insider will haw the Wrden of proving deal he did or,Wild or improv for hurricane of
nk.)..
i
Ku mute of the property.am exclusively contracting with licensed contractors m
not the project(Sec.7044.Business and Poefeulou Code:)The Commcmrs Li.
cehae Law does hot apply to an owner of property who builds or Improv themun,and.
who contracts For aush'Pajecu 'th aeontranor(s)licensed pummnl to the Contractors
License law.
or.. bdicur I B&PSC jImmisoment�
caner Dam lou r
WO 'S S COMPENSATION DECLARATION
I hereby affirm under Pewry of perjury one of the following declarations:
❑Ihave and will mainuina Certificsm of Conxentmxlf-IuuxfmWartdsCampcn-
mum.as providW for by Section 3700 of the Latest,Code,For the performance of the
week for which this permit is issued.
0 1 haw and will maintain Workers Compeuatian I..u regldrod by Section '
37W of tW labor Coder forNe performance of the wort for which this permit is issued.
My WorkeY.COmPeessdon Ir ew.carrier and Policy number am:
Carrier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu xNon teed not W completed ifdte Permit uforone hundred dollen($100)
or less)
1 certify dml in the Mr..of the work for which this pezmit is Whom.I And out
employ any Person ipini maonersou in bccomo48ijctmth Warkcri Compesatian
Laws of
Caifom a.'Daie /�PAm
Appti=
NOTICE TO Cy� �J�6ft�t�r making Nu Ccnitmaw of Exemption,you should
becmne ser m tM—®Va�r!lCampemtation provisions of the labor Code,you moo
.,O forthwith ply with each pmvitlau m mu permit shall be deemW rowkc 1.
zv" CONSTRUCTION LENDING AGENCY
I hereby affirm Wt dert is a construction lendingfor the, rformar of
ai the wort for which dais a.) Pe
i[7
Under,Name p`r"it is Wand(Set 709],Civ.C.)
U z Landefs Addmsa
U O I comfy that I haw mad this application aod state dw the allow iNmhudon is
LL, comocs.I apee to comply with all city and county onficu acs and stay laws relating an
.O Wildingcom ration.and hereby autho me mprnentatiwa of Nis city to color upon de
[37 arrow-mentioned PouNrtya fan iuPeetion which a
(We)agree to nw,indemnily tad keep harmless the City of Cupertino against
to liabilitie;judgmf dWloseing of this
may in any way Co.aagilnslsdd City
Uz SAPLICANTIofalaegrantingo(this per mit.
APURLSR E,UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date N
SOURfz6 REGUld'ISO �
' `} Re=roofs
HAZARDOUS MATERIALS DISCLOSURE am
Type of Roof •%��
trial
W11111e apPBanl or ruuuc Wilding oe mpantslmm or harbld huallous material
u defined by the Cuprtitm Munidleal Code.Chapter 9.13,and the Health and Safety
Code,OYoran 25573(x)7 da 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
Will tW applicant or future Wilding occupantux eyuipmentmdevixa which g P
e0mit tousrdnua air conuminse,as defined by the Bay Arta Air Quality Management all new materials for inspection.
OYcz [�Alti
I have toad the iu"o rumaxdas nooirtmens under Otaper6.95 ofde Califor.
riaHalm&Safoy Cpd,,Section 35505.25533 and 35534.1 uMmuM mostror Wilding
does out curmnd w•trnant Nat i� my ropmmibility m nedfy de oceuput or the
nombcrecnta 'mmlbn 'psi issuxrccor.Cetifaacoroccupaey. Signature of Applicant Date
C /�20011
0w fhmre5 V,em Dox- All roof coverings to be Class';W'or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B1k: Lot:
APN . . . . . . . . : 31633008 . 00
DATE ISSUED. . . . . . . : 09/10/2008
RECEIPT # . . . . . . . . . : BS000006038
REFERENCE ID # . . . : 08090048
SITE ADDRESS . . . . . : 10311' N BLANEY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RAJ MAISURIA
ADDRESS . . . . . . . . . . : 10311 N BLANEY AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2331
RECEIVED FROM . . . . : RAJESH MAISURIA
CONTRACTOR . . . . . . . : MICHAEL L. LINZELL LIC # 28953
COMPANY . . . . . . . . . . : A TO Z POOL AND SPA REPAIR
ADDRESS . . . . . . . . . . : 10289 MENHART IN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 374-6268
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 5, 500 . 00 0 . 60 0 . 00 0 . 60 0 . 00
1DEMOPRE SQUARE FEET 0 . 00 490 . 00 0 . 00 490 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 490 . 60 0. 00 490 . 60 0 . 00
METHOD OF PAYMENT AMOUNT . . . REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 490 . 60 — #113 '
---------------
TOTAL RECEIPT 490. 60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
704 DEMO
•
CITY OF CUPERTINO
�au DEMO
• OF
CUPERTINO PERMIT APPLICATION FORM
APN# / r ^ ooeoLo n Date:
Building Address: I�� I N �,U, �UyJ� AJC , C.JR
\NOS `1+, JSrsw
Mailing Address (if different from building address):
Owner's Name: Phone:
4o?,
Contractor: Phone :gog 3 61 QS
or,'?: Paa�_wSPA U,c Fax:
Contractor License #:
Cupertino Business License #:
Contact: d � Phone:
Fax:
• Residential [� Sq Footage 20�� Commercial ❑ Sq Footage
Job Description:
S7Cia-� df- &„A1 MM%NL
Valuation:
Project Size: Express Q'Standard ❑ Large ❑ Major❑
Please complete relevant portions of the Green Building Checklist& atta it o he application
or if applicable, include on the plan set& the sheet index.
Quantity Fee ID Fee Description Fee Group Permit Type
1DEMORES Demo-Residential B 1SFDWL-DEM
I IDEMOPRES Pool Demo Residential B 1SFPOOL-DEM
1BSEISMICRE Seismic Residential j B
•
Revised 6/16/08
CITY OF CUPERTINO
e' DEMO
OF
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
iDEMOCOM Demo-Commercial B 1COMML-DEM
1DEMOPCOM Pool Demo Commercial B 1CPOOL-DEM
IBSEISMICOM Seismic Commercial B
1BUSLIC Business License B
•
•
Revised 6/16/08
Community Development
10300 Torre Avenue
,1 Cupertino CA 95014
Telephone(408) 777-3228
* CITY OF Fax(408)777-3333
Building Department
JOB ADDRESS: PERMITO#6PO ?OO L't 04—
OWNER'S NAME: PHONE # Qolf 4
GENERAL CONTRACTOR: MFAX #
I am not using any subcontractors:
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
Ornamental SheetMetal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
e
Glia1�Y
Owne Contractor Signature Date