10100135 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1463 ASTER LN CONTRACTOR:PHILLIP D.BJURMAN PERMIT NO: 10100135
1250 HIGHWY 101 DATE ISSUED: 10/18/2010
OWNER'S NAME: HEIDI HUI
-;
AROMAS,CA 95004 PHONE NO:(650)906-7533
VER'S PHONE: 4084167665
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r
License Class Lic.# (� bZ MECH r RESIDENTIAL r COMMERCIAL r
Contractor P4* 11 vCwl�til Date jd—L&—�V
JOB DESCRIPTION:DEMO POOL
I hereby affirm that I am licensed under the provisions of Chapter 9
(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:$6000
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:36624003.00 Occupancy Type:
permit is issued.
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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save
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:
9.18.
Date V' '�V
Signature
RE-ROOFS:
G 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: Date:
1,as owner of the property,or my employees with wages as their sole compensati�.n, Signature of Applicant:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,am exclusively contracting with licensed contractors t i
construct the project(Sec.7044,Business&Professions Code).
HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm under penalty of perjury one of the following three
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. I 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&
Safety Code,Section 25532(a)should I store or handle hazardous material.
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
I certify that in the performance of the work for which this permit is issued,I sha 1
not employ any person in any manner so as to become subject to the Worker's Owr ' autho ' agent: Dater v
Compensation laws of California. If,after making this certificate of exemption,
become subject to the Worker's Compensation provisions of the Labor Code,I n ust
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 work'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 ente Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
•unify and keep harmless the City of Cupertino against liabilities,judgment ARCHITECT'S DECLARATION
and expenses which may accme 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,Sectior
Licensed Professional
9.18.
Signature Date
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone. 409-777-3229
Fax. 408-777-3333
E RT I N SUBCONTRACTOR LIST . v 3
c u P CONTRACTOR I v l
PERMIT# S'"
PHONE# (Yo$) ylb" 6Zso
JOB ADDRESS. S y Nv BUSINESLICENSE
OWNER'S NAME: Ne�c+�� ,.rw+�i► E1111P L,
CITY/ZIPCODE: 11111� I.
Of Cupertino business license.
GENERAL CONTRACTOR: dol in the city to have a City UNTIL THE
ADDRESS: 2So H' a WILL BE SCHEDULED CIIPERTINO
Our
municipal code require all businesses working INSPECTION(S) A CITY OF
L S ON'CRACTORS HAVE OBTAINS �
FINAL OR FINAL OCCUPANC'�
NO BUILDING CTOR AND AL to-
GENERAL
D
CONTRACT �----��-�' _ Date
BUSINESS LICENSE contractors: Signature
I am not using any Tete the following information:
BUSINESS LICENSE #
e check applicable subcontractors and corn ESS NAME
Pleas BUS]N
SUBCONTRACTOR
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
Date
Owner/Contractor Sign<<ture
CITY OF CUPERTINO
DDEMO
CITY°F PERMIT APPLICATION FORM
CUPEkTINO
Date:
Building Address: 6 3 A54e-r Ln , (�,peri,^ d
Mailing Address (if different from building address):
Phone:
Owner's Name: flt',d; Nv
(Yai-) y/6- -f,665-
Phone
�-bb s'
Phone :(yot) 6`ice-6915-
Contractor:
s
Contractor: (6ro) qo6 7s33
Pk-11 J.rw»n Fax:
Contractor License #: 8747-C-0
Cu ertino Business License#: Phone: (tyok) 6Yy -69 r
Contact: PJ
A�
Fax:
Residential ❑ Sq Footage
Commercial ❑ Sq Footage
Job Description: Pooh
Valuation: p d v :"
Project Size: Express ❑�tandard ❑ Large ❑ Major❑
onions of the Green Building Checklist & attach it to the application
Please complete relevantp
or if applicable, include on the plan set & the sheet index.
Quantity Fee ID
F,,-e Description Fee Group Permit Type
1 DEMORES Den io-Residential
B 1SFDWL-DEM
1DEMOPRES Pool Demo Residential
B 1SFPO0L-DEM
B ALL PERMIT
1BCBSC Cal Bldg Standards mTYPES
Comission Fee B
1BSEISMICRE Seismic Residential
Revised 01/07/09