06050247 CITY OF CUPERTINO x ssw�* s' set;''' i±Ll'� t'S -`'.
BUILDING DIVISION PERMIT e G'aN,`T.R'"GTOR1I1�11''-QRM II�I„ON.. ,
BUILDING ADDRESS: PERMIT NO.
ABCO CONST 06050247
0 E: PERMIT MUE DATE
E: cli-IFIT "ITT 1488U LLAUAS AVE _SZFA_RY_N0_T7T17 20@pfioLN5.
ARCHITECT/ENGINEER: — BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
S 0 LICENSED CONTRACTOR'S DECLARATION Job De rip ton
1F�B 1 im,7 ) fm that I ser fthe Bu under. provisional of Caepur 9(commencing
iGwith Smmeand Bof Division NC Buainrss and P z/, do,and my�',eGek n vED
in full face and etfmt. 6 l� -/ ( 1# 'LLL0TTT+++,,,
3 p F l-nz,O__ DEMOLITION OF SWIMMING POOL
2 ARCHnECrS DECLARfi IAP(�i ,• ,� n
d l underwnd my plans shell he used an public records
i
Licensed Pmfcuiond
OWNER-BUILDER DECLARATION
9 I herohy,.affirm(Sec Nn I am exempt from No Conusumr, :Any c Lew for the
o whichfollowinggmmme.Permit
a 7W 1.5,Business and Proremove.
daon Cole:Any oily or roomy 1\�:J 1L1`ct pL}"!:J�l{lt Ifyl
it t4i whish its issuance.
•e.ane a cmmuer,Ww,Applicant
trt for mu demolish,or repels any awmum
sit
pd.uiu iuusmprsu requiv theevision ora much Permit no Bance Law(Chapter
2< 16atheklkerucdpurwenitaNepmvitlonsoflheConuecmtaLkenxlawlClupur9 Sq.Ft.Floor Area Valued
O (commencing wish Section 7000)of Division 3 crime BGlneuand Promem.Cede)or
t S Nu he b exempt Morefrom and the bub for the alleged exemption.Any violadm of
Section 7031.5 by airy applicant for a permit subjects the applicant In a civil penalty MP y TYP
ax mac Mm five hundred d.1mrs s5�-
f0fali 3• lW"il 00 CCU anC e
❑L u owner of the property,ormy cmploycn with ngG u Netr sole eompeustm.
willdo the wark,snd the swnurt is notinunded cro0ared missk(Sec.7044,Busmen Required Inspections
and Professde:ions CaThis Committee,License law coin not apply a e an owner of q P
property who breiuls or imposes thereon.andwas,downewhoonklibrunfrourmaccogth his
own employaa,provided that such impmvemenu K rot intended renewed for oak.R.
however,the building or improvement is sold within cause yen of mmpledon,the owner-
builder will have the burden of proving that he did oat Mid or Improve for purpose of '
❑L an ower of the property.mo exclusively wntasdial with liaoced eonnuran a
coGOuct the project(See.7044.BGiMa and Profcasiou Code:)The Co r anofs Li-
mesa law dna not apply m an awner of property who builds or improv thereon.and,
who consacu for such projects with a contract licensed personal to the Communes
Limmen law.
[3I as Gempt under See .B d:P C For this mason
Own" Dau
WORKERS COMPENSATION DECLARATION
I hereby drum under penalty of perjury arc of the following dmlentaa:
haw and will maintain a Certfiwm or Consent in self-tamre far worker,Cmnpen-
on,
as provided for by Student 3700 of the Labor Code.for the performance of the
work for which this permit Is heued.
❑1 have and will maintain Worker,ComperuNon Insurance,as required by Suction
3700 of the labor Code.for the pufamnnce of the wok forwhlch this permit is lacued.
My WorkeY Compemmon l m amer and Polity-nu'mu al
Carrier. ele'L C Policy No.; 7l
CERTIFICATE OF EMPION FROM WORKERS'
COMPENSATION INSURANCE
Crab emion read nate eanpkud if tit permit U fooc hundred doom($100)
M leas.)-
1 certify slut In the performance of ter work for which this permit is issued.l shill non
employ anymnon in my manoran as to become subject in the WoMcn'Compensation
laws of Califomia.Data
Applicant
NOTICE TO APPLICANT:If,niter making this CenlOcau or Exemption,you should
become subject in the Worker's Compensation provisions or the Lebo Code,you muse
O forthwith comply with much provisions or thin permit Nm
Shall be decreed revoked. -
CONSTRUCTION LENDING AGENCY
I hereby&film that tau is a construction lending agency for the performance or
the work for which We permit is Issued(Sm.3097,Cly.C.)
Qlattices Name
Lundeen Address
QI minify that I have rad this application and sure ter tae above information Is
r" comet.l egme a comply with all city and county,dinner and main laws elating to
VC
building construction.and hereby mhorin mpreunudv ofthis city in our upon the
above-mendo ed property fm mpenio purpose
(We)agree to name,indemnify and time humlas the City of Cupertino again"
I,) IOM'tu.Jsuchumedgmmu,fibecGu antis[ which may In my wayamroc against said City
1 Ac ICANTeUNDERSTANOS Aof s WILL COMPLY WITH ALL NON-POINT Issued by: Date
S CE REGUI.A77 N
Re-roofs
g turcor Al
on USMATERIALSDISCLOSURE uric Type of Roof
WIII eppit t Earn building occupmtatoro orlundlehauNou material
u find b C unicipel Cade.Chapter 9.11.and Ne Halon and Safely
Seton (a)7 All roofs shall be inspected prior to any roofing material being installed.
❑YG a
Will the replicant or forum building Occupied um equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
t hdoallom air coummants u defined by the Bay Asa Air Quality Manalcmem all new materials for inspection.
Wrict1
❑Yes
hmc read Ne hvaNma meteslain requirement underCMpier6.95 of the Odifor.
non d:Saf iyCode.SeNw25505 333 aa125534.1 undersand destitute building
dao t eurmntly Im s wank I y responsibility to wary the catment of the
aqui mscrus which Musxjc r name tear Om may. Signature of Applicant Date
C f
rormmariti. ant Date All roof coverings to be Class"B"or better
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35618063 . 00
DATE ISSUED. . . . . . . : 05/31/2006
RECEIPT # . . . . . . . . . : 34625
REFERENCE ID # . . . : 06050247
SITE ADDRESS . . . . . : 21643 CASTLETON ST
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : JOHN SHI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ABCO CONSTRUCTION
CONTRACTOR . . . . . . . : LANA CULJIS LIC # 24759
COMPANY . . . . . . . . . . : ABCO CONST
ADDRESS . . . . . . . . . . : 14880 LLAGAS AVE
CITY/STATE/ZIP . . . : SAN MARTIN, CA 95046
TELEPHONE . . . . . . . . : (408) 779-7577
*EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW 'BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 4, 000 . 00 104 . 76 0 . 00 104 . 76 0 . 00
BSEISMICRE VALUATION 3 , 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 105 . 26 0 . 00 105 . 26 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 105 . 26 MASTERCARD
TOTAL RECEIPT 105 . 26
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
704 DEMO
•
Community Development
10300 Torre Avenue
/' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
IOUPEI�TINO
Building Department
JOB AI LEySs`13 �C���� � J--t- PERMITGZf SO 2—LT 7
OWNER'S NAME: o,\y\ I PHONE #,/o g-. 7 7?- 75 77.
GENERAL CONTRACTOR )j/3C Q0 FAX #
I am not using any subcontractors: +_ --31 -0
Date
Please check a licable subcontr cto s and opt�; followin informationSUBCONTRACTO B 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 n
• l I
er Contractor Signature Date
CITE' OF CUPERTINODEMO
CUPEk INO PERMIT APPLICATION FORM
• APN# n I Date:713 t
Building Address:
Owner's Name: 17 Phone#:
Contractor: License
Contact: Phone#: 7 z
� oo Lv, G� 1� r � L� Yo
Applicant/Contractor: I
Q O CON6' �I'� rip-;
Building Permit Info:
1 1 ]u
Job Description:
Residential: ev.o 1 .w Swim Pow �- Commercial:
Sq.Ft. Floor Area:
Architect/Engineer: U uation: Ob
�5.
• Type of Construction: ccupancy Grou
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BLTILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
•