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10090096
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10886 LINDA VISTA DR C ONTRACTOR:A TO Z POOL AND SPA PERMIT NO:10090096 R EPAIR 10289 MENHART LN DATE ISSUED:09/14/2010 °ER'S NAME: GARY&BARBARA JONES PHONE NO:(408)3746268 CUPERTINO,CA 95014 OwNER'S PHONE: 4082575821 Fhemby LICENSED CONTRACTOR'S DECLARATION IIUILDING PERMIT INFO: BLDG ELECT rPLUMB ss l �3Lic.# MECH r- RESIDENTIAL COMMERCIAL lamDateIOB DESCRIPTION:POOL DEMO 6500SQ firm that I am licensed under the provisions of Chapter 9 ng with Section 7000)of Division 3 of the Business&Professions hat my license is in full force and effect. ffirm 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 Valuation:$6500 performance of the work for which this permit is issued. Sq.Ft Floor Area: 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:35614046.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county hereby authorize representatives of this city to enter to building construction,and perty for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned pro the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply �_.__...._ Date: with all non-point source regulations per the Cupertino Municipal Code,Section Issued by, '� 9.18. Date S' �+ure , 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: Date: I,as owner of the property,or my employees with wages as their sole compensation 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 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 I have and will maintain a Certificate ofn Consent of theself-insure for Worker's the s compliance eawitthe Safety Cupertino icipal Code,Chapter 9.12 and the Health maintain Compensation,as provided for by Section 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 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 shall not employ any person in any manner so as to become subject to the Worker's Owner or thor aggnt: Date: Compensation laws of California. If,after making this certificate of exemption,1 06 t must become subject to the Worker's Compensation provisions of the Labor Code, 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 relati ng to building construction,and hereby authorize representatives of this city to enter Lender's Address 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 costs,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 Licensed Professional 9.18. Signature Date__ CITY OF C UPERTINO FEE ESTIMATOR- BUILDING DIVISIQ)iMOLITION ADDRESS: DATE: REVIEWED BY: APN: BP#. "VALUATION: $6,500 xPERMIT TYPE: Demolition Permit PENTAMATION 1 SFPOOLDEM PRIMARY Swimming Pool, Res. PERMIT TYPE: USE: WORK SCOPE FEE ID #PC OLS 1DEMOPRES I A4,c,l< Pl(m Ch,f4 i,. Pcrmil i'`c, lc f Oih 3 %h,rt t t�P 1,iec i,rilz (c�� v :ft. Inti; PCV fees are based on the relimina in ormation available and are onlyan estimate. Contact the Deptor addn'l into. NOTE: These MISC ITEM FEE ITEMS (FeeResolution 09-051 Eff ''1,101 FEE QTY/FEE F'lon Chc'.A ['e": .sulk/ PC 1"Ce Plztrislr.::11ec1r..'I:1ec; full Check $211.00 Permit Fee: Suppl.Insp.Feer Reg. 0 OT 0.0 hrs 60.00 P1trmla. :11 c1r. '1 lec ('rrir F(,c': Plunrf7,:t Fec°h.;7 1c c Perini! 1",c c: (,O11,S17Tf('[il)f1 77t L\' 1r:r>tt.tilit:crl Rcvicw 1-CC: Work Withoul Pcr toil? Planning Vc'c : I Tz`CrrE'f Doc tz,ticrrrfutirrrt 1'`crE'�`= 1 BSEISMICR $0.65 Select an Administrative Item StromT Motion Fee: Bldv Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $; 92.65 $0.00 TOTAL FEE: $292.65 Revised: 9/14/2010 CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 3 ITEMS OF 3 COPY # : 1 Sec: Twp: Rng: Sub: Blk . Lot: APN . . . . . . . . : 35614046 .00 DATE ISSUED. . . . . . . : 09/ L4/2010 11456 RECEIPT #. . . . . . . . . REFERENCE ID # 10030096 SITE ADDRESS 10886 LINDA VISTA DR SUBDIVISION • • • . . CUPERTINO CITY . . . . . . . . . . . . IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GARY & BARBARA JONES ADDRESS . . . . . . . . . . : 10F-86 LINDA VISTA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : A "0 Z POOL AND SPA CONTRACTOR . . . . . . . : MICHAEL L. LINZELL LIC # 28953 COMPANY . . . . . . . . . . : A TO Z POOL AND SPA REPAIR ADDRESS 10289 MENHART LN CITY/STATE/ZIP CU?ERTINO, CA 95014 TELEPHONE (438) 374-6268 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL- ---------- ____ ---------- 1.00 0 .00 ---------- 0 .00 6, 500 . 00 1.00 0 .70 0 .00 1BCBSC VALUATION 6, 500 . 00 0 .70 0 .00 1BSEISMICR VALUATION 0 .00 291. 00 0 .00 1. 00 291 .00 ----_-__-- 1DEMOPRE EACH --- 0 .00 0 .00 292 .70 -----0 .00 292 .70 TOTAL PERMIT : AMOUNT REFERENCE NUMBER METHOD OF PAYMENT __-------- - ----------------- CASH 292 .70 TOTAL RECEIPT 292 .70 --- VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------- 704 DEMO Building Department City Of Cupertino 10300 Torre Avenue Is Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: f(j `'✓ '' s C G OWNER'S NAME: GENERAL CONTRACTOR: rtX—s RtEINS LICENSE# CODE: ADDRESS: L e *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. WILL BE UNTIL THE NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) HCITY OF CUPERTINO GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A BUSINESS LICENSE. �` 1 am not using any subcontractors: Signature Date Please check applicable subcontractors and compl ate 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 Date Owner/Contractor Signature CITY O]v CUPERTINO 3 ITEMS OF 3 PERM::T RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B.Lk: Lot: APN . . . . . . . . : 3.5614046 .00 DATE ISSUED. . . . . . . : 03/14/2010 RECEIPT #. . . . . . . . . B,3000011456 REFERENCE ID # . . . 1 )090096 SITE ADDRESS . . . . . : 1)886 LINDA VISTA DR SUBDIVISION . . . . . . . CITY CJPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : G%RY & BARBARA JONES ADDRESS . . . . . . . . . . : 13886 LINDA VISTA DR CITY/STATE/ZIP . . . : CJPERTINO, CA 95014 RECEIVED FROM . . . . : A TO Z POOL AND SPA CONTRACTOR . . . . . . . : MICHAEL L. LINZELL LIC # 28953 COMPANY . . . . . . . . . . : A TO Z POOL AND SPA REPAIR ADDRESS . . . . . . . . . . : 10289 MENHART LN CITY/STATE/ZIP . . . : CJPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 374-6268 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 500. 00 1. 00 0. 00 1 . 00 0 . 00 1BSEISMICR VALUATION 6, 500. 00 0 .70 0. 00 0 .70 0 . 00 1DEMOPRE EACH 1. 00 291 .00 0 .00 291. 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 292 .70 0. 00 292 .70 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CASH 292 .70 --------------- TOTAL RECEIPT 292 .70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO CITY OF C,UPERTINO A F DF MO �' p f PERMIT APPLICATION FORM ..v � Date: APN# C, Building Address: Mailing Address (if different from building address): Owner's Name: Phone: Anja Z 1 Contractor: Phone L rt �'� %� Fax: Contractor License #: "7S S-7 Cupertino Business License#: =Fax: ne: ?,j,o 51?91 Contact: FootageCommercial ❑ Sq Footage Residential Sq - tJobDescription: Valuation: 0 727 Project Size: Express ©-.-- ,��Lixge ❑ 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. !ffl= Fee Description Fee Group Permit Type RES Demo-F.esidential B 1SFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFP00L-DEIVr 1BCBSC Cal BlCg Standards B ALL PERMIT Commi3sion Fee TYPES 1BSEISMICRE Seismic Residential B Revised 01/07/09