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10030157 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1401 ASTER LN CONTRACTOR:CORBY GOULD POOLS, PERMIT NO: 10030157 INC. r-"'NER'S NAME: JEFFREY A&RUTH J MORGAN 2515 NEDSON CT DATE ISSUED:03/26/2010 V-NER'S PHONE: 4082537584 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)967-7665 ❑ LICENSED CONTRACTOR'S DECLARATfION BUILDING PERMIT INFO: BLDG F ELECT F PLUMB r -, 17 D "1 G/ License Class L_ � � Lic.# S� ' MECH RESIDENTIAL r COMMERCIAL Contractor Ctnnh V C"7�;_�fl�r'C�4hDate � I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SWIMMING POOL DEMO **SEE NOTES** (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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$9500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36617087.00 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 to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue again aiC- y_in ence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additional] applicant G ands and will comply with all non-point source re ions e Cup rtino Municipal Code,Section 9.18. /�� Issued by: Date: Si¢^eture / Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I*eby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,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, Signature of Applicant: Date: 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 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air 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 I certify that in the performance of the work for which this permit is issued,I shall Health&Safe 9-e-cjlons 25505,25 ,and 25534. not employ any person in any manner so as to become subject to the Worker's d� Compensation laws of California. If,after making this certificate of exemption,I Ow or author' become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter up- 'he above mentioned property for inspection purposes.(We)agree to save Lender's Address ii ify and keep harmless the City of Cupertino again iabilities,judgments, cosi.,and expenses which may accTgaganyt saUjMin consequence of the ARCHITECT'S DECLARATION granting of this permit.Addi' y,the y I erstands and will comply with all non-point sour egulatio upertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signatur ' � Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36617087 . 00 DATE ISSUED. . . . . . . : 03/26/2010 RECEIPT # . . . . . . . . . : BS000010041 REFERENCE ID # . . . : 10030157 SITE ADDRESS . . . . . : 1401 ASTER LN SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : JEFFREY A & RUTH J MORGAN ADDRESS . . . . . . . . . . : 1401 ASTER LN CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5216 RECEIVED FROM . . . . : CORBY GOULD POOLS CONTRACTOR . . . . . . . : CORBY GOULD LIC # 22776 COMPANY . . . . . . . . . . : CORBY GOULD POOLS, INC. ADDRESS . . . . . . . . . . : 2515 NEDSON CT CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043 TELEPHONE . . . . . . . . : (650) 967-7665 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 9, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 9, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1DEMOPRE SQUARE FEET 0 . 00 490. 00 0 . 00 490 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 492 . 00 0 . 00 492 . 00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 492 . 00 #16201 --------------- TOTAL RECEIPT 492 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO 5 CITY OF CUPERTINO li-a-6 DEMO CITY OF CUPEkTINO PERMIT APPLICATION FORM APN# �� 1 ��2��(C Date: '7 Building Address: lqC't 4 -5 Mailing Address (if different from building address): Owner's Name: Phone: ILI("':f,10 "z Contractor: Phone (C7 ll (C) C h v - 7 0(.) C(' /"Ci � Fax: Contractor License #: Cupertino Business License#: Contact: Phone: ( tv) r5o V\Z-,+L\.A 11A I..) Fax: Residential Sq Footage Commercial ❑ Sq Footage Job Description: Z�h"(IVI oxf,/k !PIC i Yt I-) Valuation: Project Size: Express ❑ Standard7 Largeo Majoro 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 Yee GroupPermit Type IDEMORES Demo-Residential B ISFDWL-DEM IDEMOPRES Pool Demo Residential B 1SFP00L-DEM- IBCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES IBSEISMICRE Seismic Residential B Revised 01/07/09 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: /tic I c)f�r },x. PERMIT# L OWNER'S NAME: �.tii %C � ��<� PHONE# � � -,5 �S 7 ' GENERAL CONTRACTOR: )cr15 _Z<,c BUSINESS LICENSE# ADDRESS: 2,5-1-5- ll�'�<<sc-r C CITY/ZIPCODE: / Lc� ✓ ��C w �' *Our municipal code requires all businesses working in the cit ave a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY SPE ILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCTRAC- A AINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontra�cs 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