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10030081 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1508 ASTER CT CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10030081 OWNER'S NAME: SANDRA PANG DATE ISSUED:03/15/2010 4ER'S PHONE: 4082192833 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT I— PLUMB License Class A Lie.# 4-751 "P (�, ,, n _ MECH F RESIDENTIAL F COMMERCIAL Contractor PAAE-U COIF 00� 0tJ Date � 1- JOB DESCRIPTION:POOL DEMO-**SEE NOTES** 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:$6400 1 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:36616045.00 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 upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 so rce regulations per the Cupertino Municipal Code,Section Issued by / Date: 9.18. Signature d�►'1 Date S t7 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: I,as owner of the property,or my employees with wages as their sole compensation, Signature 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 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& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,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 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 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 r a orized ent: Compensation laws of California. If,after making this certificate of exemption,I Date: 3 1 b A, 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 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 enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save i-'-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 g....aing 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 9.18. Licensed Professional Signature /�aM \. Date CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN 36616045 . 00 DATE ISSUED. . . . . . . : 03/15/2010 RECEIPT # . . . . . . . . . BS000009938 REFERENCE ID # . . . : 10030081 SITE ADDRESS . . . . . : 1508 ASTER CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SANDRA PANG ADDRESS 1508 ASTER CT CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5213 RECEIVED FROM . . . . : DANIEL T ROTH 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 6, 400 . 00 1 . 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 6,400 .00 0 . 70 0 . 00 0 .70 0 . 00 1DEMOPRE SQUARE FEET 0 . 00 490 . 00 0 . 00 490 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 491 . 70 0 .00 491 . 70 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO CITY OF CUPERTINO RECEIPT NUMBER: BS000009938 RECEIVED BY: PATRICIAG PAYOR: DANIEL T ROTH TODAY' S DATE: 03/15/10 REGISTER DATE: 03/15/10 TIME: 11:26 4 1BCBSC 10030081 $1 . 00 1BSEISMICR 10030081 $ .70 1DEMOPRE 10030081 $490 . 00 BUSINESS LICENSE TAX DANEB CORPORATION $114 .00 ---------------- TOTAL DUE: $605 .70 CREDIT CARD: $605 .70 REF NUM: VISA TENDERED CHANGE $605 . 70 $ .00 CITY OF CUPERTINO DEMO CUPEkTiNO PERMIT APPLICATION FORM APN# ( Date: Building Addre s:_ p S/ c - Mailing Address (if different from building address): Owner's Name: Phone: J_,q ,,,J4AA A,,� 6- a/5--1-933 c.JI . Contractor: ,)A M C a C, )A f o Phone : 11� o _ �,S�, cci b)"Q3Z:M Fax: Contractor License #: WU 16 7 Cupertino Business License#: Contac : Phone: tJ - R ofd `��0 _L��S Fax: Residential [�J- Sq Footage Commercial ❑ Sq Footage Job Description: ro o L, o Valuation: p v 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 sheet index. Quantity Fee ID Fee Description Fee Group Permit Type 1DEMORES Demo-Residential B ISFDWL-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 Community Development sa,, � 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF ;UPE�TINO Fax(408)777-3333 Building Department JOB ADDRESS:_ e _ PERMIT # /J^O8 A5� � /� � - jr, ( ,) -j `:; r~ �� I OWNER'S NAME: f 4 rJ 0R A fA rl Cr PHONE # a/ -z 83 5 Cellr-� GENERAL CONTRACTOR: DA W C (SoFAX# I am not using any subcontractors: T 3 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