08120096CITY OF CUPERTIvaO
v x<->: e �•�9 u aid'-�' `�' " '
BUILDING DIVISION PERMIT
CONTRA CTQRINI+'ORMATIQN�
,eJr.El'-'f.^°T's
BUILDING ADDRESS:
PERMITNO.
19333 VALLCO PARKWAY
TBD — TO BE DETERMINED
08120096'
OWNERS NAME:
PERMIT ISSUE DATE
NE:
S A CONTROL NO.
ARCHTECrrENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 hereby affirm Nat 1 am licensed under provisions of Chapter 9 (commencing
with Section 70.M1) of Division S of tW Business and Pmfcmiom Code, and my license is
infullfurteandoffett-1 G (
$WINNING POOL DEMO(1500SQ)
License Class Lea
Dale - — Gentrxmr
,
**BOB'S BOBCAT SERVICE, INC. PD FOR BUSLIC
AR CrSDECI.ARA Of I
I understand my plans shall W used ss Public rvmrtls 5'.o.0 Vir,.�, /
j? / 15 / 8
Licensed Professional
OWNER -BUILDER DECORATION
I hereby affirm that 1 am exempt from the Contractor's Lkcnse Law for to
following reason. (S,cdon 703 1.5, Business and Professions Code: Any city or county
which mquims a permit m construct, alter, improve, dcmollsh, or mpair any Motors
.
poor m its Issuance, shm mquirta the applicant far such permit to fill a signed naemens
Cnwelm" U«ate lxw(C
Sq. Ft. Floor Area
Valuation
that W is licensed patmam W the Proviskns of the Pt"9
(commencing with Section 7000) of Division J Of the Businm and Professions Coda) Or
$14000
Nal h. is exempt mien( eni and the Otis far the alleged ceemption Any violation Of
APN Number
Occupancy Type
Section 7031.5 by airy applicant far a Furth mbjccts N. applicant to a civil penally of
not mom than BK huMrtd dollar (5500).
31620075 APL
-
❑ Lo Owner of Use I, .,intended withwages Needrole cempewness
.
Required Inspections
will thes"ty, structure r (Sec. 7014,
tinLi
Newodt and NeheCatu
Owner o•
Law cid , at aside
Code: The Catamount, License Law dons not apply ff an owner
and Pr u
is
Property whobuilds impowsen and who work his
_
oroffaarNrough
sem not induessuch
Nattachimprovementsartnot ear do oro@red fora
own i improvements
Own
Ie ownv-
however. the building or impmvemmt u cold within ore year Of c au -
ver. th building or
prove far
W e.). vi0 haw Use When 0[ proving that K did Ct Wild a improve Iv purpose of
side.).
0 1, as manor a the property and udusively contracting with licensed centncmrs to
constmet the project (Sec. 7064, Business and Profico amu Code:) The Conuava's U -
cause Law does not apply to an owner of property who builds or improves Nemon, and,
who contacts for such projects with acontmcmr(s) licensed purmant m the Contractors
Lkcn c Law.
❑ I am exempt under Sec ,B&PC far Nis tenon
Own" Date
WORKER'S COMPENSATION DECORATION
1 hereby airum under penalty of Perjury ono of the following declantionc
I bare and will mammon a Certificate a(Coment to self-Wum for Wertr sCompere
an, as provided (or by Section 37M Of the Labor Code. for the performance of the
work for which this permit is issued.
❑ I have and will maintain Workers Compensation Insurance, as required by Section
3700 Of the labor Cade, for the performance of Out work for which this Formula; Issued.
'
Ca irMyWorkcrs CgTperpaI�mtance a Polic No.:num (nW
?1
CEJmFlCATE OF EMPTON FROM WORKERS'
COMP SATION INSURANCE
(This scenimm need nal he campked ifft permit Is fame, handrail dollars ($100)
or less.)
1 mnify Nat in the performance of the work for which Iia Permit is issued, I shall not
employ any person in my manner an as m bacoma subject to the WorYms' Compenmdon
Laws Of Califomia. Dam
Applicant
NOTICE TO APPLICANT: If, afkr making this Certificate of Exemption, you should
become subject m One Workers Compensation pmvisimu of the labor Code, you muse
' forthwith comply with such provisimn; or No permit shall x accrued mated.
CONSTRUCTION LENDING AGENCY
1 hereby that Vert is conswc.3 lending agency for Ue Pcrfomance of
s
' Ue work for which Nis permit b Issued (Sec. J09T, Civ. CJ
rwhich
'
Lender's Name
lenders Add.
I catify Nat I haw mad tis applicuion and some can tW above information is
• canWt I agree m comply with all city and county ordinances; and sate laws mlating to
building comminution, and hereby authorise representatives of Nu city to eater upon th
above-mNYmled prapany far inspection pafp0Y1
(We) agree no mw, Indemnify mal trap harreley the Lily Of CUP,nim) against
0 liabilities, judgments. costs and expenses which may in any way urns again said City
r in cmum,u.Ce f the granting of this permit
APPLICANT E NDS AJ10 WILL COMPLY WITH ALL NON -POINT
_
Issued by: Date l l�
SOURCEIR O� //may– t� R!
�/ / 1
Re -roofs
Lot
Signurt of ApplicanUCon tar Dam
xnznRDDus MATERIALSDISCLOSUILE
Type of Roof
Yi0 the no future Wilding e.chaptstom or haMk mamriil
Heardoan
u defined by N, Cupertino MunidWl Cade. Captor 9.12. and Nc HdN and Safety
c Cupertino
Code. SCtion 25533(x)7
All roofs shall be inspected prior to any roofing material being installed.
Yes
ri /}5�,�(.
If a roof is installed without first obtaining an inspection, I agree to remove
Will tW applicant a mF tort0building occupant use equipment or devices which
't horardnus air contaminants as dclined by to Bay Am. Air Quality Management
all new materials for inspection.
❑Yes NO
Ihaveread Ne h" materiaisrtquirtmuns undcrCNpmvd.95ofUeCaii(mr-
nuHealUt&Safety Code.Savans25505. SJl 25 .l wbemm�d UmBUme Wilding
'
does not curmnU aveit' y Y 'fy to occupant of to
mquircmcntsw tpriar eaeefOcMcy.
SignatureofApplicant Date
All roof coverings to be Class'/W' or better
Dam
ownerar as rima ascot
0
• 3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31620075.APL
DATE ISSUED.......: 12/15/2008
RECEIPT #.........: BS000006819
REFERENCE ID # ...: 08120096
SITE ADDRESS .....: 19333 VALLCO PARKWAY
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: APPLE COMPUTER
ADDRESS ..........: 19333 VALLCO PKWY
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: BOB'S BOBCAT SVC IN
CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096
COMPANY ..........: TBD - TO BE DETERMINED
ADDRESS ..........:
CITY/STATE/ZIP ....
TELEPHONE ........:
•
FEE ID
----------
UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
1BSEISMICO
-------------
VALUATION
----------
14,000.00
----
2.94
----
0.00
--------
2.94
----
0.00
1BUSLIC
FLAT RATE
1.00
114.00
0.00
114.00
0.00
1DEMOPCO
SQUARE FEET
0.00
490.00
0.00
490.00
0.00
TOTAL PERMIT
----
606.94
----
0.00
----------
606.94
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
606.94
---------------
606.94
VOICE ID DESCRIPTION
----------------------------
704
---------- -
704 DEMO
•
REFERENCE NUMBER
--------------------
#4929
VOICE ID DESCRIPTION
F
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building De artment
JOB ADDRESS:
1 5 L; (cry PV-Kt,,ocj
PERMIT #
/ ,�. 0 0 9 Co
OWNER'S NAME:
PHONE # �tU 2p6 F 7 ci t
GENERAL CONTRACTOR:
FAX # 4og - Fo -7 (P Y S-
I am not using any subcontractors: /�2 —/6 -GF-
Signature Date
Please check applicable subcontractors and complete the following information:
-Owner/Contrac or Signature
Date
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
-Owner/Contrac or Signature
Date
EN't
Cl OF
:CUPEkTINO
CITY OF CUPERTINO
DEMO
PERMIT APPLICATION FORM
oJPia 0C)9 (a
APN#2/ �02 �7�' �Q�
Fee ID
Date:
Building ddres /4cc
Permit Type
Mailing Address (if different from building address):
1DEMORES
Demo -Residential
B
Owner's Name:
Phone: 017�(
Pool Demo Residential
B
1SFPOOL-DEM
Contractor:
1BSEISMICRE
Phone : �c S s`�_ F 7(lE
L
0SS (�j6CA (1` �e%✓1 4 rKC
Fax: %C c/ S
Contractor License #: 5-30 U 2 /
Cu ertino Business License #:
Contact:
Phone: (67 ,F - 7e 6
Fax: biro -7E 45—
esidential ❑ Sq Footage Commercial
® Sq Footage
Job Description:
-
1. 46
Valuation:
Ll 6-&0
Project Size: Express&( Standard ❑ Large ❑ Major ❑
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
1DEMOPRES
Pool Demo Residential
B
1SFPOOL-DEM
1BSEISMICRE
Seismic Residential
B
Revised 6/16/08
I OF
CUPERTINO
CITY OF CUPERTINO
DEMO
PERMIT APPLICATION FORM
0
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
1DEMOCOM
Demo -Commercial
B
1COMML-DEM
1
1DEMOPCOM
Pool Demo Commercial
B
1CPOOL-DEM
/
IBSEISMICOM
Seismic Commercial
B
1BUSLIC
Business License
B
•
0
Revised 6/16/08