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10100136 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10950 SANTA TERESA DR CON'TRACTOR:PHILLIP D.BJURMAN PERMIT NO: 10100136 OWNER'S NAME: MAGUIRE TERRENCE J AND CARROLL 1250 HIGHWY 101 DATE ISSUED: 10/18/2010 IER'S PHONE: 4082524387 ARO VIAS,CA 95004 1 PHONE NO:(650)906-7533 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT[_ PLUMB License Class '' Lic.# - 6 2 MECH[_ RESIDENTIAL[_ COMMERCIAL F PA 'J T 'J �i t v(N+wn Date O—1l-IV JOB DESCRIPTION:POOL DEMO 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.It Floor Area: Valuation:$13000 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 permit is issued. (7 APT Number:35613004.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating „ERMIT 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 O`llJ with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date: 9.18. Signature /J Date RE-ROOFS: Li OWNER-BUILDER DECLARATION All:oofs shall be inspected prior to any roofing material being installed.If a roof is inst�Llled 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 insp ection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Sigr iature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,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 hs.ve 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 con ipliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Sat ety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Ad Iitionally,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 cor taminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. He►Ith&Safety Code,Sections 25505,25533,and 25534. I 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 OV n author' d aggTtf: Compensation laws of California. If,after making this certificate of exemption,I Date: 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 h;reby 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 Le ider'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 Le rider's Address upon the above mentioned property for inspection purposes.(We)agree to save mnify 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 u nderstand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Li sensed Professional Signature Date DEMOLITION CITY OF CUFERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: D,kTE: REVIEWED BY: APN: BP#: *VALUATION: $13,000 PERMIT TYPE: Demolition Permit p' `' `-IIS C1 !'I-" PRIMARY PENTAMATION 1 SFPOOLDEM USE: Swimming Pool, Res. PERMIT TYPE: WORK SCOPE FEE ID #POOLS 1DEMOPRES I Clic,k F 1711 �.,,. P :r Pci'l F c, I;1<c. P rma l:e. ,�rrarit f� Oflus ticrc'It. rN� � Li D71:�j , "") p i'lo,Pop0"hur/"Ic(, Iny, , Fcc NOTE: These fees are based on the preliminaigy in ormation avail<<ble and are only an estimate. Contact the De t or addn'1 into. FEE ITEMS (Fee Resolution 09-051 1:'10) FEE Q TY/FEE MISC ITEMS �1 Permit Fee: $291.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 'Irttrzla.'��1 "ll."Elcc 1 ail 1. 1C%- t"'t`trrsr.l}.I_ fc h.-/1c'( 't,t;:ti�t'trc'Non Ta'� --E= �r'bld,S/ZiXfi I�f'Plr'�t' FCC.' Work I'Vitholl! Strong,Motion Fee: IBSEISMICR $0.61) Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.01) SUBTOTALS: $292.6 $0.00 TOTAL FEE: 2.60 Revised: 9/29/2010 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: [O 175'0 Te-rese% lir. PERMIT# l �-4 OWNER'S NAME: '1- re, PHONE# 106) 2 TZ— y G I GENERAL CONTRALTO a„ Ems„ BUSINESS LICENSE# ADDRESS: ZSR Fliq CITY/ZIPCODE: ev%oS *Our municipal code requires al 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 SUBCONT CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. /?� /v &-I() I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete rhe following information: SUBCONTRACTOR BUSINESS 14AME 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 CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 3 ITEMS OF 6 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Loft: APN 35613004 . 00 DATE ISSUED. . . . . . . : 10/18/ 2010 RECEIPT #. . . . . . . . . BS0000L1775 REFERENCE ID # . . . : 10100136 SITE ADDRESS 10950 SANTA TERESA DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MAGUI&E TERRENCE J AND CARROLL ADDRESS . 10950 SANTA TERESA DR CITY/STATE/ZIP . . . : CUPER'IINO, CA 95014-4768 RECEIVED FROM PHILLIP D. BJURMAN CONTRACTOR . . . . . . . PHILLIP D. BJURMAN LIC # 23653 COMPANY PHILLLIP D. BJURMAN ADDRESS 1250 HIGHWY 101 CITY/STATE/ZIP AROMAS, CA 95004 TELEPHONE (650) 906-7533 FEE ID UNIT QUANTITY AM013NT PD-TO-DT THIS REC- --NEW-BAL- ---------- ------------- ---------- ---- ------ ---- 1. 00 0 .00 1BCBSC VALUATION 13, 000 . 00 1 .00 0 . 00 1.30 0 .00 1BSEISMICR VALUATION 13, 000 . 00 1 .30 0 . 00 1DEMOPRE EACH 1 . 00 291 . 00 0 .00 291. 00 0 .00 ---------- ---------- ---------- TOTAL PERMIT 293 .30 0 . 00 293 .30 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -- --------------- ---- CASH 100 .00 CREDIT CARD 485 .90 --------------- TOTAL RECEIPT 585 . 90 VOICE ID DESCRIPTION VOICE ID -------DESCRIPTION ---- -------- ------------------------ -------- - ----------- 704 DEMO CITY OF CUPERTINO DEMO CUPEI�TINO PERMIT APPLICATION FORM APN# Date: ! 2 0 vL+ Building Address: 1015'0 Mailing Address (if different from building address): Owner's Name: Phone: ZS2 _ Y3 il-" Terry ivy#9 v"re- (4y0,-) Contractor: Phone : (4 oar) 6 YY- 6 f I Fax: Contractor License #: $ 62S o Cupertino Business License #: Contact: `'J ] Phone:(LI&O 6'1(1- -1- 615- ra►,1 �'�'t��cn S Fax: Residential ❑ Sq Footage Ccmmercial ❑ Sq Footage Job Description: `'� r,0oi �r►►� Valuation: $ 13, 000 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 she et index. Quantity Fee ID Fee Description Fee Group Permit Type 1DEMORES Demo-Residential B 1SFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFP00L-DEMV 1BCBSC Cal Bldg St uidards B ALL PERMIT Commission Fee TYPES 1BSEISMICRE Seismic Residential B Revised 01/07/09