03060003 (2) CITY OF CUPERTINO -a�y�a� /g++(�� y�Pn�kya,�
BUILDING DIVISION PE {..I,IS?Il��vryg`�arfQ1QA�AtYd„,
Y
BUILDING ADDRESS: PERMIT NO0 3 060003
22394 RwnNA (,.T
OWNER'S NAME:. PERMIT I..8V T62/2003
�ahLIN MAO H AND PI Y
ONE: SANITARY NO. CONTROL NO.
11111 RCI-11=/ENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
0 0 0 0
uOp LICENSED CONTRACTOR'S DECLARATION 7obDescrip[ion
rd I hereby affirm Nat 1 am Reamed under provisions of Chapter 9(commencing
with Section 10)0)of Division 3 of the Business and Professions Code.and my license is
in full force and CffCCL POOL DEMOLITION
,R4 License Class tie..
Date Centrad.,
ARCHITECTS DECLARATION
1 understand my plans shall W used u public records
oto
G Licensed Profcse Tonal
OWNER-BUILDER DECLARATION _
rayny 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
`p 0 following reason.(See on W 1.S,Business and Professions Code:Any city or county
which mquima a permit to conumct.alcor,improve,demolish,or repair any suocmrc
_Zus prior to its issuance,also requires the applicant for such Permit to file a signed statement 1I,�''
F O ;hal he is licensed pursuant to the provisions of the Co moor's License law(Chapter 9 Sq.Ft.Floor Area $�(y®tion
y $ (commencing with Section 7”)of Division 3 of the Business and Professions Code)or
Nat Ire is;exempt thuefmm and the hub for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Npp9Tmme applicant to a civil penalty of 3,yt�ka4 OTO 0 Occupancy Type
not more than five hundred dollars($500).
❑I.u owns of the property,or my employees with wages u their sole compensation,
will do the work and the structure,structure,is not intended oroffered for sale(Sec.9044,Business Required'Insp eChODS
and Professions Cade:The Convacmm r's License Law docs not apply an owner of
progeny who builds or improves Mercian,and who does such work himself or thmugh his
Own employees,provided Mel such improvemenu snout intended uaffered forsale.If. FINAL
ED
Ne building or improvementis void within one year of compledan,the owner- GECf
builder will have the burden of proving that W did not build or improve for puryose of
Ell, - JUN 2 6 2003
❑1,as owner ej the property,am exclusively convening with licensed contractors to
come La d project(Sec.loan,Business and Professions Code:)Theves;Me tons Li-
cense law does notchp r loan owner of progeny who Wilda m improves thereon,and,
whocontractsLaCY for such projects with aCanlnCtar(a)licensed purSeant m IhC Contractor's BUILDING
0 1 sue Law.
❑l em exempt under Sec✓—/—���_�,B&P C for this won
`r I'�
WORKER'S COMPENSATION DECLARA teN z- O�
I hereby&foam under penalty of perjury one of Oe following declarations: -
I have and will maintain aCeniflema of Consent to self-intim far WarkeezCompcn-
don,as provided for by Section 3100 of the Labor Code.for Me performance of the
ork for which this permit is issued
1 have and will maintain Worked Compensation Insurance,as required by Section
3100 of the Labor Code.for the performance of Ne work for which this permit is Issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier. Policy No.: -
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mairectian aced not W completed If the permit Is furore hundred dollars(SI W)
or less.)
I certify Net in the perf9ryr!!nnarm of the work for which this permit is issued.I shall not
Lawso Califs son{vygamanncr ass to b�c subjecuo Ne Workmi Compensation
Laws of Calierno lTYrete b
Applic, - AJ
t20T1 a APPLICAN IL a er making this Certificate of Exemption,you should
become subject to the Workers ComFormi on previsions of Ne Labor Code,you must
Oforthwith comply with such provisions or this Permit shall be deemed mvokcd.
z CONSTRUCTION LENDING AGENCY
[r I Wmhy affirm Nm Nem is a construction lending agency for the Performance of
Iya> Me work far which this permit is issued(Sec 3Wl,Co,C.) �`
W� A Lender's Nave
D z LenJerE Address
U O 1 certify flal 1 have read Nis application antl stale Net the above infam ition is
ly P correct 1 agree to comply with all city and County ordinances and sure laws relating m
O U building construction,and hereby amhome mpmsent ives of Nis city to enter upon Ne
W above-merioned property for inspection Purposes.
g, (We)agme to sive,indemnify and keep harmless the City of Cupertino against
p) Imbilitt",judgmcias.costs and expenses which may in any way accrue against said City /\/
U',Z, inconsequence of the granting of this Permit.
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
50URCE REGULATII A � � 6ie1Dl
I a - Re-roofs
i arorc of ApPlicoDate
HAZARDO UR
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will theapplicant orfuture building occupantstore or handle Health and
6zo�
as defined io the 32(4)7 na Municipal Code,Chapter 9.12.and the Health end Safety
Code,Section x 25532(a)7 /,y�\f�No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil havardaus air Contaminants as defined by Ne Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes
1 have mad the havafdcus materials requircmenLs under Chapar6.95 of the Califon
nin Health&Softly Code,Sections 25505,25533 and25534.1 undenund Nal if Ne Wilding
does not currently haw a¢pant.Nat it is my responsihilil m roti l' tW acupanr of the
rc remanuwhiah bane normiaaa eofaCeni ate occaona. Signature of Applicant Date
Owner Lir mlhori ed&gem Date p' All roof coverings to be Class"B" or better
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng: Sub: Blk: Lot :
APN . . . . . . . . .
DATE ISSUED. . . . . . . : 06/02/2003
RECEIPT # . . . . . . . . . 22018
REFERENCE ID # . . . : 03060003
SITE ADDRESS . . . . .
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . :
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : PETER LIN
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
E ID-- --- UNIT -- -- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- --- ---------- - --------- ---------- ------ -
---- ----- ----
BPERMFEE VALUATION 5, 000 . 00 107 . 00 0 . 00 107 . 00 0 . 00
BSEISMICRE VALUATION 5 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 107 . 50 0 . 00 107 . 50 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
------------- - --- ------------ ------------------
OTHER 107 . 50 VISA
TOTAL RECEIPT 107 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
704 DEMO
a
CITY OF CUPERTI v 3 �
DEMO
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
Owner's Name: Phone#:
1451UaGt L L
Contractor: License#:
G6.UJcS-f � msct�P� 75 -26 / /
Contact: . Phone#:
-J6/� W IjG-c7o cJ
Applicant/Contractor:
Buildin Pe t Info:
Bld Elect lumb Mech
- - escription: — - - -
Residential: Tf)o I &toL l l O/JU'''— Co c' :
Sq.Ft. Floor Area: $/Sq• .
Architect/Engineer: Valuation: _1�55
Type of Construction: y/ Occupancy oup: AKA
Qty.
A c le Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
ID0257,From:408-853-6555, To:
May 26 03 10: 34a JOHN WADDINGTON JR 408-353-4142 P. 1
Demo: Estimate/Contract
DATE ESTIMATE#
5/28/2003 G-12149
21CALWE5T 39 vi,AND50AP033 o c� ,;- _F
(405) 446-25&2
Lio.152311 J 02 2003 ' If
BU'
Ll
E7AD
PE
• PETE LININ
22394 Ramona Ave
Cupertino, CA95016d ffl (�l (E Copy TERMS POC
ITEM UU !I!� IIID"ItL� DESSCRIPTION TOTAL
Fiberglass Pool Remove fiberglass pool and spa, cut Into pieces and dispose of debris.fill 5,250.00
pool and spa with soil in small lifts of 4 to 6 inches and compact,fill last 6
inches with top soil, remove equipment. City requires the removal of the
fibergalss pool body and spa. Cover lawn and pool deck access with
plywood for damage protection
Unknowns Calwest will not be responsible for unknown structures underground ,
such as irrigation lines, house water service lines, water distribution
boxes, drain lines,septic tanks, electrical orgas lines underground or
any other structure, undisclosed ,unmarked�ortiinsii or any sections
\Y
offence removed for access to work area.N/ork.areais.to,be;eleared
„a„ ,�,��,., t i�;�
prior to start, an hourly charge ofd$75:0 a hours R bei)mposed to
move non contracted items. '09 {I DES f u
Payment on complex... Payment is due on completion:
-
gIQNH� •,.fi ei Ib119
Fitts ;plans and aped'
Ae kept eml the job at all tilni is Ao'W is un
Javuful%malle any changes of 5lteratmns
An same Vildtrlat Written PeuPmartino.itsjun flore.
Zhe building DeA, ►Yof
Jho.stamping o't this plan and specgications
,, h.id m nermit or to be an
IF ACCEPTED PLEASE SIGN AND FAX TO (408)35 I Q,L6BOVEany prOylSi� n5
ADDRESS. spPlov C 06110109d 5late Law- TOTAL $5,250.00
Calwest Landscape is Bonded and has in force Insurance covering the following: Public Liability, Property Damage and
Workmans Compensation. Calwest Landscape is State licensed in the following categories: C27 Landscape.C12
Excavation, C21 Demolition and HiC Certification. It is the responsibility of the buyerto provide access for demolition.
Any damage in the access area only, is not the responsibilty of Calwest Landscape (notwithstanding negligence). Any
alteration or deviation from above specifications involving extra costs will be executed only upon written change order
and will become an extra charge over and above the estimate.All agreements are contingent upon delays beyond our
control. It is the resonsibility of the buyer to obtain all necessary permits and to disconnect all utilities in the work area
prior to the start date of complete demolition. For small demolition all water should be shut off in all work areas four
days prior to start date.
Acceptance of Proposal, Signature / Date: