08050136 BUILDING DIVISION PERMIT �CONTRAC' 'OR IAI'N'URMATION
"""IN""SkSTACRES DR BJURMAN CORP P�08050136
NER'S NAME: PERM1fff ISSUE DATE
MAIDEN THOMAS S AND GLADYS R T 1250 HIGHWY 101 05/16/2008
ONE: SANITARY NO. CONTROL NO.
ARCHITECIENGINEER: BUILDING PERMIT INFO
POOL REMOVAL/BACK FILL BLDG ELECr PLUMB MECH
D D O O
too LICENSED CONTRACTORS DECLARATION
uC 1 mrary affirm Wt r an Berta"stub"pmvidaug of Ch""a 9(commencing Job Description
ZW with Saban 70(g)of Div;uon3ofdro Busmen ably Profeuiav Code,and my licase is
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I.fall race ena.flan.
L;anm ClueIY.I-19
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on ARCHITECTS OECLA ATI01
1 understand my plans sh&11 W used m Public maids
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daH Liccnttd Prursammal
3 OWNER-BUILDER DECLARATION
a� f I hereby alTmt Nat I am exampt from to ConuactOeS Licnse Law for the
COC following ess Cason.(Sccdon 7In 1.5.BusinAna Prefcuioes Cade:Any city or county
19( which mqulres a permit a constant.Alla.improve,dcmulish,or.:pair any auctuM
prior an its I"..,arm".i.te&pplieant rarauch permit a fistivshodausment
£ < that he is licensed pursom,otho Provisions oftoContractor's LiccaeLaw(CMpmr9 Sq.Ft. Floor Area Valuation
y�g (commencing with Sadao 700D)of Division 3 of the BuvM..aM Prefunions Conic)Or
`< Nat he is exempt therefrom and to basis for the allegaa rumptim.Any violation of
Section 7031.5 by sty applicant for a,amlt mbjccu the applicant m a civil penally of APN Number Occupancy T
not mom loan fsw hutldMa dollars(SSW). P y YPe
Q 1,u owner of lh.pmpmty,a my mployw wah cages u Utev sola mnpewda,
will do the woks Ana tesheCa isnot s Li aea ora w do
forsasply TIN.,owmar,v
Na atywiProfessions Coat The wotmocan. ndw1ho Law uch Oa apply ll N Puna(0( Required Inspections
mancon whoburinsor;mpawsthman,andwho Passuch was mollc dthmagh his
oowass.Oyas,pmvidea Nm such imPmwmw t art n;ym Or c maaMd formic.If.
builder,Ne building O;m i of pro mts bola within arc yugr or compsua.the p son of
builder will haw to burden of paving out k tlia not build a impmw for puryos of
ale.).
Q 1.u awn(or the pmpeny,am exclusively aumacm,;with licensed enact..m
coonmct the parer(Sec 7W.Buginm and Prafesdaru Code:)Toe Casr&eala U. .
cense taw dao not apply a an owner of property who builds or improves lkra t.and
who contacts for much pmjems with a conusuar(s)Iicaued Portugal m the Contractor's
Licens law.
Q l am exempt unda SM. .B&PC for tNa awn
Das
WORKER'S COMPENSATION DECLARATION
1 hcteby aDtrm under Porosity of perjury We of Has following dalaommuc
Q immaMwillmainwnacr ruamof Comenttowir.l tmfawakcfaCMM.
salon,as Provided for by Secdan 37W of du labor Code,for too Ndoommon of the
work for which Nisp rmit is Wuea.
Q I haw and will maintain Workers Companatian Insuaanc,to taluirod by Section
3700 of the Mbar Code.for to palunmumo of the ugh forwbich thin Penitis issued. '
MyW. Cono'caadon Imo.carrier and Policy numb t am:
Cartier.C'Sti Policy No.:
CERTIFICATE OF EXEMPTION FROM WORK
COMPENSATION INSURANCE
Thisscctia abed trot ba compsmd ifthe permit is foronc hawkscidollars($10M
or I.)
1 comity Not in to paformancc of to work for which Nis pcmnit is muco,l shall not
employ any Pavan in any m cob rso as in baame subjat to to wmimnr COnpewdon
Laws of Ca tfomis.Dau
Applicant
NOTICE TO APPLICANT:If.afar making this Catificac of Esemption,you should
become subject in the Wooers Compabodon provisions of the Law,Coda,you am
.J O ramhwit amply with such wavi Ions a Nu perm;(shall be damca mvoked.
'Z' ^ CONMUCTION LENDING AGENCY
(ter 4 1 betty glint,Nat there;.a conwatinn lending ager)for to performuxa of
a> to work fur which this Parma is issued(Sa.3097.Civ.C.)
U8 Q LcMCYs Name .
7 z Lontse.Add.
U O I carry Nal I haw mad to application and sus Nu the&bow iNomtaom u
IL E COMM.1 agra in comply with all city and county oNbsous s and sus laws raising to
O Wilding...s uctian,and wood,androrim rtprsattiws Or Nu city m ausupnncis
Uj Alain-mentioned pmperty for inspection purpm,
QL (We)ago.m Un.halamnify and keep harmlev the City of Cupertino against
h IiabilitiMPHIgmcutscotsandeapax which may In anywayacsueagaingraid City
U z in consequaMe of No go nting of this pemnit. /
^ AP UNDER5T ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S RCE U O
'I1" Og Re-roofs
Sign rcagpli N o mU IALSDISCLOSURE Des Type of Roof �.
Willthe applicant r factum built occupant stom or handle bavrtlous mmHg
as dcMcd by the Cuperia Municipal Cade.Chapter 9.12.and tis Hat and Wry
All roofs shall be inspected prior to any roofing material being installed.
o buildingOccupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
!2��
D'trict? u defined by toe Bay Atex Air Quality Managcmem all new materials for inspection.
QYos Asir
l have mad to hscatdmon000Aals mqumancnts under Chansrd.95 ofthe Califon.
OUR Halt&Safety Codc.Srnau 25505,25533 and 25534.1 undaaand boards,building
m an it s my vesih
poiliry a notify the occupant of the
M nirtmcnu h w l '0 minuaR<afaccrurica spay. Signature of Applicant Date
o abDam All roof coverings to be Class'{{."or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35914027 . 00
DATE ISSUED. . . . . . . : 05/16/2008
RECEIPT # . . . . . . . . . : BS000004800
REFERENCE ID # . . . : 08050136
SITE ADDRESS . . . . . : 10401 WESTACRES DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MAIDEN THOMAS S AND GLADYS R T
ADDRESS . . . . . . . . . . : 10401 WESTACRES DR
CITY/STATE/ZIP . . CUPERTINO CA, 95014-2938
RECEIVED FROM . . . . : BJURMAN
CONTRACTOR . . . . . . . : PHILLIP 0 BJURMAN LIC # 23653
COMPANY . . . . . . . . . . : BJURMAN CORP
ADDRESS . . . . . . . . . . : 1250 HIGHWY 101
CITY/STATE/ZIP . . . : AROMAS, CA 95004
. TELEPHONE . . . . . . . . : (831) 726-9907
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- -------- ---------- ---------- ---------- ---------- ----------
1DEMORES SQ FEET 0 . 00 490 . 00 0 . 00 490 . 00 0 . 00
BSEISMICRE VALUATION 7, 000 . 00 0 . 70 0 . 00 0 .70 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 490 . 70 0 . 00 490 . 70 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 490. 70 1123
---------------
TOTAL RECEIPT 490 . 70
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- - - -------- ----------------------------
704 DEMO
•
=1 CITY OF CUPERTINO
DEMO
OF
*CUPEIITINO PERMIT APPLICATION FORM
X05 o /a Lo
APN# p27 Date:
3� `
Building Address:
0L1 O k
Mailing Address (if different from building address):
Owner's Name: Phone:
S cOn fid\ y-�Q yo(6" 2SS - L15Q )
Contractor: Phone : (05(7 901. --153
PF>1 \�( 9 '7 U 9—t-.k k VI Fax: Gal -7ZL ' ctclbg
Contractor License #: S-1625C7 — A
Cupertino Business License #:
Contact: Phone:{pQj- 103- (�1P IC(
Fax: -lZle- Gq0
Residential 0 Sq Footage— g L58 Commercial ❑ Sq Footage.
Job Description:
TRe C-'V-' N::�k
Valuation: 7 )(_
Please complete relevant portions of the Green Building Checklist & attach it to the 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
1BSEISMICRE Seismic Residential B
1DEMOCOM Demo-Commercial B 1COMML-DEM
1BSEISMICOM Seismic Commercial B
1BUSLIC Business License B
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
�UPE(�TINO Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT#
toLto� 0��Sal3
OWNER'S NAME: K PHONE #408 253 L(S? 1
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
*aatilre 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 Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
• Tile
Own ctor Signature Date