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09100043 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22066 LINDA VISTA PL CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09100043 OWNER'S NAME: YIZHENG ZHOU DATE ISSUED: 10/07/2009 ER'S PHONE: 4089731388 , PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH F RESIDENTIAL F_ COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:DEMOLISH POOL (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 1 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 Sq.Ft Floor Area: Valuation:$8000 performance of the work for which this permit is issued. I 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 APN Number:35608005.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued y: —----' Dater/ 7 o,5 with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Signature of Applicant: Date: I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Section 3700 of the Labor Code,for the performance of the work for which this Health&S Code,Sections 25505,25533,and 25534. permit is issued. I certify that in the performance of the work for which this permit is issued,I shall Ow er or ar o ' ed ager not employ any person in any manner so as to become subject to the Worker's Date: FJ�J� Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) APPLICANT CERTIFICATION Lender's Name 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 Lender's Address to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION unify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. gilanting of this permit.."itionally,the applicant understands and will comply with all non-point"6urce c gu; ons per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date 0 �� CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35608005. 00 DATE ISSUED. . . . . . . : 10/07/2009 RECEIPT #. . . . . . . . . BS000008849 REFERENCE ID # . . . : 09100043 SITE ADDRESS . . . . . : 22066 LINDA VISTA PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : YIZHENG ZHOU ADDRESS . . . . . . . . . . : 22066 LINDA VISTA PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : YIZHENG ZHOU 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 8, 000. 00 1 . 00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 8, 000 . 00 0 .80 0 . 00 0 . 80 0 .00 1DEMOPRE SQUARE FEET 0 . 00 490 .00 0 .00 490. 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 491.80 0. 00 491 . 80 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 491 . 80 american express --------------- TOTAL RECEIPT 491 .80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO CITY OF CUPERTINO DEMO CUPEkTINO PERMIT APPLICATION FORM q3 APN# d� 00 Date: Building Address: ©� V,5tq Z2 � �- In �a Mailing Address (if different from building address): Owner's Name: Phone: yizkenq D014 Contractor: Phone - D Fax: Contractor License #: Cupertino Business License #: Contact: Phone: Fax: Residential Sq Footage Commercial ❑ Sq Footage Job Description: �SiCll,�.hl i� J W �►vt i � I �1'I�iN'�O � r 5 Valuation: ?-D O O Project Size: Express JW 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 1SFP00L-DEM_ 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES 1BSEISMICRE Seismic Residential B Revised 01/07/09 ENTER PROJECT , w Enter description here,and enter points avatiaba for measure In appropriate categories to the right 0 0 0 0 D 0 Enter description here,and enter points available for measure in appropriate_... categories to Dte right 0 0 0 tl 0 0 Enter description here,and enter points available for measure in appropriate categories to Die right 0 0 0 V 0 0 w Enter description here,and enter points available for measure in appropriate categories to Dre right 0 0 0 0 " 0 0 Build It Green Checklists and 4.Innovation:List innovative measures that meet the green building objectives of the Guidelines.Enter up to a ,rid.lines maximum combined total of 20 pts.See Innovation Checklist for suggested measures,using the link to the right. Innovation in Community:Enter description here,and enter points available for measure in appropriate categories to the right 0 0 0 0 0 0 I Innovation in Energy:Enter description here,and enter points available for measure In appropriate categories to the right. 0 0 0 0 0 0 Innovation in IAOlHeatth:Enter description here,and enter points available for measure in appropriate categories to the fight 0 0 0 0 0 0 }—�---Innovation in Resources:Enter description here,and enter points available for measure in appropriate categories to the right. 0 0 0 0 0 0 nnovallon in Water:Enter description here,and anter points available for measure in appropriate categories to the right 0 0 0 0 y 0 -0` ` Total Available Points in Other=4 0 Summary Total Available Points in Specific Categories' 4+ 96+ 42+ 66+ 43+ Minimum Points Required in Specific Categories 0 30 5 69 otal Points Achieved 010 t i 1 1 1 jProject has not yet met the following recommended minimum requirements: / -Total Project Score of At Least 50 Points / - Required measures: -A3a: 50% waste diversion by weight -J2: 15%above Title 24 -N1:Incorporate Green Point Rated Checklist into blueprints Minimum points in specific categories: -Energy(30 points) i -IAQ/Health(5 points) r -Resources (6 points) r -Water(9 points) ®2007 Build It Green Single Family GreenPoint Checklist 2007 Version Page 7 of 7 Community Development 10300 Torre Avenue �w Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 'UPEkTINO Building Department JOB ADDRESS: PERMIT# �� y .ZZo6 6 L),� ), V;"sta l C e 1 no) C'� q' 041 � v OWNER'S NAME: l'z A en PHONE # - Y73 — /3,2 GENERAL CONTRACTOR: FAX # 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date