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06020001 CITY OF CUPERTINO ^'' y'm^na .�* z* " BUILDINd DIVISION PERMIT fCONPRACTOR INFIDRMATION ; v BUILDING ADDRESS: PASCAL TECH DBA AAA TECH PERMITNO,06020001 0440 LINDSAY AV R'S NAME: FERMI ISSUE DATE FILANOWSKI PAUL S AND DONNA L2998 SCOTT BLVD 02/01/2006 PHONE: SANITARY NO. CONTROL NO. (408) 727-7225 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH C= 30x9 LICENSED CONTRACTOR'S DECLARATION JobDescrition ee 1 heruby,aMmo Net 1 ser licensed under Provisions of Chapter 9(conow"In{ P with Section 7010)of Division 3 of the Business and Professions Cook,and my license is in fullforaandeffecl. RELOCATE POOL EQUIPMENT-ADHERING TO MINIMUM f Z License Cleat Lk.Y Date Cut.. SETBACK REQUIREMENTS 9 ARCHITECPS DECLARATION 1 understand my plana shall he used.public records � U +g.G Liansstl hereby oval or OWNER-BUILDER DECLARATION .�>• I hreaso affirm on 1 em exempt from the Cnnins;Co Licence taw for to p whfollich ms•an.Permit i 703 L3, t.slims and Improve. demolish. h.or wind,any or V which regviru n peak tar requires ct alter,iupmsu,demmsh,nr e a sig any awmme (� —zi poor mis itsueneu.aim rrquires the applicant for such permit file a,igrcd statement £ c thralve Whereat!pursuant in the provisions offtComosetor's Licurse Uw(Chapacti) Sq.Ft.Floor Area Valuatio 40 Y (commencing with Sccdon70XBo(Division3 olio Businessand Pnefe"imn Codc)m tiro he is exempt the¢(mm and the basis for 0e alleged exemption,Any violadoi of Section 7031,3 by arty applicant for a permit subjects the applicant to a civil penalty of pPN Ngr�her Occupancy Type nm more than five hundred dolWs($500). 3 6 912 U 18 . 0 0 ❑I,U owner ofthe pmpeny.or my eropioyw with wages u their sok compesse0on, will do thework,and the Mucture is amintenAed mortared fanale(Sm.70M,Busircu Required Inspections and Professions Code:The Conuacthes Litems Law does not apply inan Owemr of 9 P propenywh0 bulldsorimprom Ncrrmn,andwhodocssuchwmkhimself orthrough his own employees,provided that such Impmveuants are not Intended mWerW forcak.If, however.to building or improvement issold within one year of completion,the owner. builder w' have the burden of proving that K did not build or Improv¢for purpose of Vtale.)• n comer of the property,am exclusively canincting with licensed comncturs m he pmjm(Sec.70M,Basin.and Professional Cede:)The ConlfNbr'!Li- mase Law does not apply to an eater of propenriwho bullds or improves themes,and, who contracts for such pmjeca with s conmctar(G licensed punuam to the Commerce, License Law. D I am exemptundeyB ,B k P C for 01. T Date 11 WOVKEWS COMPWSATION DECLARATION I bemby affirm under penalty of perjury ane of tie following declan ham ❑1 have and will maintain aCeNOean of Consent tuse161nsum fm Workers Compere cation,u provided for by Section 3700 of the Labor Code,for lie performance of dm work for which this permit is ieued. ❑1 hart,and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Cade.for to performance of the work furwhich this permit Is Issued. My Workers COmpenution Insurance carrier and Palley number see: ' Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This sued.need rot becompleted If tie permit is fora..hundredd.B.($1001 or leu.) 1 anify that In the per(.rmance of tc work for whit in a permit is load.I shall not employ any Poison,in any matter 0asw,beto f a�er�a%wolams Compmution Lawsof Calf. ' Dt �i b Applicant /7 ---- NOTICE TO APP A��Rcj m in this CcnlOute of Eaemption.you should become subject in the Workers Compensation provisions of the labor Codc,you must ,JO forthwith comply with such provisions or thin permit shall W construct revoked. Z CONSTRUCTION LENDING AGENCY (-r4 IMreby01rm Nn there its commuctia lending agency for the perlmmuue of C> the work for which this permit Is issued(Sm.3097.Civ.C.) GQ Lender's Name 0.Z Lenders AdNeas U0 1 certify that 1 have read this application aha sum that the above Information is D,(~ cormtt I ag.n to comply wit all city and county ordinance,and State laws.1,11.2 In OV building construction,and hereby autarin mpmwnutiws of this city to enter upon live W shove-mentioned pmpe,ty for inspection purposes. (We)agree m save,indemnify and keep humieu the City of Cupertino against I Q if rA liabilities judgments,cost,and expounds which may in my way we=against aid City U Z In consequs.c of to granting of this permit ti APPLICANT UN ER DS AND COMPLY WITH ALL. Issued by: Date ofCd SO IR N Y+ // Re-roofs f� Sign ofAppli id HAAZARDOUSMATERIAL4DISCLOSURE a— Type of Roof Will Ne applicant or future building a cupantsure or handle hasudous material u defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety .Saetian x5s3x(a)7 �Na All roofs shall be inspected prior to any roofing material being installed. ❑Yat Will the applicant or future building acupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove cult hacardnu,sit mu dro nants M dunned by the Bay Arca Air Quality Management all new materials fo inspection. District] ❑Yvs To I he.read the hmatdnm materisism .k0rent,undorChaptu R9Saftha Califon nk Health Sefctyfioa ,x5503.xi and3353/.lundcnwbdwlflM building dace not cumn f a ten .Nu i 'f m onslmnty m rmdfy dm eaapant of dre requlremcn rot etpd ofICurdficamofOccupancy, Signature of Applicant Date Owner •mhoimdsgent Date I All roof coverings to be Class nBn or better CITY OF CUPERTINO It• 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # : 2 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36912018.00 DATE ISSUED. . . . . . . : 02/01/2006 RECEIPT #. . . . . . . . . : 33031 REFERENCE ID # . . . : 06020001 SITE ADDRESS . . . . . : 10440 LINDSAY AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : FILANOWSKI PAUL S AND DONNA L ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4518 RECEIVED FROM . . . . : PAUL FILANOWSKI CONTRACTOR . . . . . . . : MIKE ZAIDI LIC # 27036 COMPANY . . . . . . . . . . : PASCAL TECH DBA AAA TECH ADDRESS . . . . . . . . . . : 2998 SCOTT BLVD CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050 • TELEPHONE . . . . . . . . : (408) 727-7225 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34 .86 0.00 34.86 0.00 BSEISMICRE VALUATION 400.00 0.50 0.00 0.50 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 112.10 0.00 112.10 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 112.10 5437 TOTAL RECEIPT 112 .10 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • Wiryo CITY OF CUPERTINO CUP PERMIT APPLICATION FORM N # Date: Building Address: Mailing Address (if different from building address): /oY U L /^/V57 /tj ✓G 1C0/9Ckr1005-0 Ower's N Phone.#: �Aac- �LMtAj;k) Yal- - 9 FS/ - 26 ya Contractor: License#: S C?/ 44A -Te C,/, U Co tact: Phone: 7-02 - 679x/ Cupertino Business Licenset ��,11141l,e Z&, o Fax: 2-70 36 KG�Ifo- �d ale Pd o e_�j 1/// / ti1iy/wf VAI Z, ac�/r Pr iK Bldg El Elect Plumb Mech El Job Description: Residential I Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Proiect: -// ;�o Occupancv Grow: Type of Construction::! Please check this boa if the project is a k—. second-story addition: ❑ ro•ect Size: Standard 10 Laze ❑ Major ❑ Quant Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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 BBOILERS Boiler> 1.75MBtu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/ uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-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 BINVESTIGA Investigation fee BUILDING 1 of 3 • ��� CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING ' BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interce for PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAMIAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV •ReloFurnace> 10Kbtu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINEOOD Installation of Hood AIECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREEMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO ' cuPEkTiNo PERMIT APPLICATION FORM ouantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL / EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot I MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING • 3of3 10440 Lindsay Avenue Cupertino, CA 95014 February 23, 2006 City of Cupertino Building Department 10300 Torre Avenue Cupertino, CA Re: Permit 06020001 This letter is to inform you that I decided to install the pool equipment referenced in the above building permit by myself. When I applied the building permit, I thought that I may use a subcontractor to do this work. After receiving a quotation, I decided to not use Genie Pool and Spa to do this work, and do this work by myself. • Regards, Paul Filanowski et C-Y` i OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child) will perform: A. YAll the work authorized by this permit B. _ A portion of the work C. _ None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the work (complete section below) Contractor Address/City, Phone # State License # Type of work to be performed 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or • portions of the authorized work. I understand that I may be an employer(see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/F=m Address/City . Phone Number Type of work to be erformed ..................................................................................................................................................................................... I declare under penalty of perjury that the above i e and correct I have read and understand the Owner-Builder Information(rev Property Owner's Signature: y� Date: -701a -6 Job Address: . I Q /O L/N�Sn / A# Permit# Any changes to the information Rrovided on this form shall be submitted to the City of CHRertino Build Department. City of Cupertino Building DepartmetIM OCITYF 10300 Torre Avenu CUPERTINOPhone: ` '�73 Dear Property Owner. An application for a budding permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally perforating their own work. if your work is being performed by someone other than yourself,you may protect yourself from possible liability if that person applies for the proper permit in his or her name. , Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family,and the work (including materials and other costs)is$200 or more for the entire project,and such persons are not licensed as contractors or subcontractors,then you may be an employer. , If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal inmate tax withholding,federal social security taxes,workers compensation insurance,disability insurance costs,and unemployment compensatic• contributions. There may be financial risks for you if you do not carry out these obligations,and these risks are especially serious with respect to workers compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the US.Small Business Adint++stration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit,erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing . their own work personally. Information about licensed contractors may be obtained by contacting the Contractors'State License Board in your community or at 1020 N Street Sacramento,California 95814 Please complete and return tate enclosed ownerbuilder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours Building Department • City of Cupertino Prkod an Recydad Paper