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11080111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10390 CALVERT DR CONTRACTOR:RICHIE BOBCAT& PERMIT NO: 11080111 HAULING OWNER'S NAME: PAMELA CHIANG 396 PATCH AVE DATE ISSUED:08/15/2011 ER'S PHONE: 4087779083 SAN JOSE,CA 95128 PHONE NO:(408)529-2531 ❑ LICENSED CONTRACTOR'S DECLARATIONr- BUILDING PERMIT INFO: BLDG ELECT' PLUMB License Class (7 - ( Lic.# Q ( cf S I o I- r r MECH RESIDENTIAL COMMERCIAL Contractor 1, Date 16 - 1 5 ^ // I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:POOL REMOVAL(500SQFT) (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5000 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:37518007.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued by. — Date��l>�� 9.18. Signature Date f s if RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the p Health&Safety Code,Sections 25505,25533,and 25534. 1 certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Owner or authorized agent: Compensation laws of California. If,after making this certificate of exemption,) 12 Date: °O�^»' — t become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of mrk's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save mify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37518007. 00 DATE ISSUED. . . . . . . : 08/15/2011 RECEIPT #. . . . . . . . . BS000014434 REFERENCE ID # . . . : 11080111 SITE ADDRESS . . . . . : 10390 CALVERT DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : PAMELA CHIANG ADDRESS . . . . . . . . . . : 10390 CALVERT DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RICHIE BOBCAT CONTRACTOR . . . . . . . : RICHARD MAES LIC # 31554 COMPANY RICHIE BOBCAT & HAULING ADDRESS . . . . . . . . . . : 396 PATCH AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95128 TELEPHONE . . . . . . . . : (408) 529-2531 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 000 . 00 1. 00 0. 00 1 .00 0. 00 1BSEISMICR VALUATION 5, 000 .00 0.50 0. 00 0 .50 0. 00 1DEMOPRE EACH 1 .00 300. 00 0. 00 300 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 301.50 0 . 00 301 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 301.50 VISA --------------- TOTAL RECEIPT 301.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- --------- ---------------------------- 704 DEMO - ELOPMENT DEPA�MENS commUN11Y DEQ CUPERTINO BUILS:ING ON'SION- E� y APPFlav MUST be k0'pt at the lens and specifications e any This set of P It IS unlawful �o rY. rin constructiosnon salne,or to dQvi ate doh site du, the Buildinc�Official. chan(.3es°t alterat. oval from without app tiOT the1etrom' sr�ecif+cations S'�tRLL fh^=Yarm r"'0,th+s plan and royal of tht'vitiation �, ni car to ��;anNp e or"tate b<a=, c; t of any CItY OrdananC t { ,...,,..1..- Y R r t j 6 I F �=8 SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 2 (408)777-3228• FAX(408)777-3333•buildingacupetno.org CUPERTINO PROJECT ADDRESS APN# 3 C[b C_ Q 2. 7 OWNER NAMEe l h l PHONE 7 77 _ G E-MAIL STREET ADDRESS L CITY, STATE,ZIP l � FAX 0 3 ©' "4Q LVec i to �� C"/,�,-/,.u. , CONTACT NAME PHONE E-MAIL r�+aIIJ AA a a 17 2 C) — STREET ADDRESS C STATE, ZIP FAX 37(. P ��% a-,�. ��y�- C- ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME Q LICENSE NUMBER LICENSE TYPE BUS.LIC N�i �,.� �. C L G:- �C.l ri c 3 t 'n. L 4,4 1 COMPANY NAME r E-MAIL FAX ��CI+�� d�G4'F ( [4 C Y�c-- STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK Q 40� � r�,...�,.--- � •r`a vim- (o v c-� --��e� USE OF -OFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION(S) STRUCTURE: ❑ Commercial0—OP) rr c5 y OG POOLISPA MATERIAL TYPE CODES: SPA V — VINYL-LINED F — FIBERGLASS DEMO G — GUNITE x e ra P — PREFABRICATED RECEIVED BY TOTAL VALU TION: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b Ming`construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: ty -" ��� Date: - - SUPPLEMENTAL INFORMATION REQUIRED cc>;>Jstar�rx .: u � " PF:A'I�F•CSECK TkP$ NiFl .F7ItOIkTING SLIP,.....;. _Commercial or Multi-Family Buildings with Public Swimming Pools: k Department of Environmental Health a royal re uired. Tf1E OIJI�FT>rI k,1 '� PP 9 iT -<SFANDARD a ' PUBLIC WORKS DEPT �#LelRGE` J�u$PIVIROLYLVIENTAt HEALTH: MAIQIi Q:sQiIYI TARY S$W ER DISTIUCT SwimPoolApp_2011.doc revised 03/16/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: v d > ver (/� r� ,� ,,,� PERMIT# 3 ® 1 d OWNER'S NAME: �P ,, PHONE # 1{oS - S 9 _ S 7 / GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date