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10020098 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1157 SCOTLAND DR CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10020098 '1WNER'S NAME: MENACHO VICTOR M AND MARY DATE ISSUED:02/16/2010 .r'ER'S PHONE: 4083936663 PHONE NO: LICENSED CONTRACTOR'S DECLARATIONr- �� / n 27 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class (:06 !��OlLic.# �!Q /y MECH r RESIDENTIAL r— COMMERCIAL� Contractor R"ie A� t� Date z— �- j d I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE POOL(600S%RICHIE BOBCAT&HAULING PD (commencing with Section 7000)of Division 3 of the Business&Professions FOR BUS LIC 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:$4000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36229019.00 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 against said City in consequence of the 180 DAYS OM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: o / Date: Signature q , . .2 �`3 Date LI OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby 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. I,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 construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I Owner or authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: y— 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 upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address unify and keep harmless the City of Cupertino against liabilities,judgments, .,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. `` , Licensed Professional Signature �-�� Date 2-t 4 ` (a CITY OF CUPERTINO 4 ITEMS OF 4 PERMI" RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B11c: Lot: APN . . . . . . . . : 36:229019 . 00 DATE ISSUED. . . . . . . : 02,/16/2010 RECEIPT #. . . . . . . . . BS )00009766 REFERENCE ID # . . . : 10 )20098 SITE ADDRESS . . . . . : 11 -37 SCOTLAND DR SUBDIVISION . . . . . . CITY CU?ERTINO IMPACT AREA . . . . . . OWNER ME:QACHO VICTOR M AND MARY ADDRESS 1157 SCOTLAND DR CITY/STATE/ZIP . . . : CU?ERTINO CA, CA 95014-5061 RECEIVED FROM . . . . : RI2HIE BOBCAT AND H 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 4, 000 .00 1. 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 4, 000 . 00 0 . 50 0 . 00 0 .50 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 .00 114 . 00 0 . 00 1DEMOPRE SQUARE FEET 600 .00 490 . 00 0 . 00 490 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 605. 50 0 . 00 605 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 605 .50 VISA --------------- TOTAL RECEIPT 605.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO �. CITY OF CUPERTINO DEMO CUPEkTINO PERMIT APPLICATION FORM APN# �. Date: Building Address: S ] Mailing Address (if different from building addri;ss): Owner's Name: Phone: qo,q ._ 3 9 Z E� ,il�r ti mss!21 ��a m q, c�q Contractor: ��, Q��c � ( � Phone : Flo g _ i cp - z 531 Fax: L 4-,� .- scz cy i 4 C) Contractor License #: 'I I I1)0 Cupertino Business License#: � `_ Contact: Phone: Fax: Residential Sq Footage G) Commercial ❑ Sq Footage Job Description: Valuation: L-� 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 Doscription Fee Group Permit Type 1DEMORES Demo-R,;sidential B 1SFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFPOOL-DEM 1BCBSC Cal Bldj; Standards B ALL PERMIT Commis:;ion Fee TYPES 1BSEISMICRE Seismic Residential B Revised 01/07/09 aC10F CITY OF CU PERTINO DEMO CUPEkTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Des,.-ription Fee Group Permit Type 1DEMOCOM Demo-Conunercial B 1COMML-DEM 1DEMOPCOM Pool Demc Commercial B 1CPOOL-DEM 1BCBSC Cal Bldg Standards B ALL PERMIT Commissic n Fee TYPES 1BSEISMICOM Seismic Commercial B 1BUSLIC Business L.cense B Revised 01/07/09 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,UPEKTINO Building Department JOB ADDRESS: tl SZ PERMIT # OWNER'S NAME: Mr 4�.d PHONE # Q,-6 s.- S zt- z s 11 GENERAL CONTRACTOR: µ 1 FAX # "7- I am not using any subcontractors: 1 Si;;nature 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