09090152 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRE; 10604 LA RODA DR CONTRACTOR:BOB'S BOBCAT SERVICE, PERMIT NO:09090152
INC.
r"L'NER'S NAME: ANDREWS TONI 567 ARLETA AVE DATE ISSUED:09/22/2009
-NER'S PHONE: 4082522284 SAN JOSE,CA 95128 PHONE NO:(408)998-8766
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class f2� Lic.# �" t MECH RESIDENTIAL COMMERCIAL
Contractor Date —
JOB DESCRIPTION:GUN ITE POOL REMOVAL
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 Sq.Ft Floor Area: Valuation:$12000
performance of the work for which this permit is issued.
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:36933018.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issuecj f---- Date: " P
with all non-point s urc regulati pe he Cupertino Municipal Code,Section
9.18.
Si--iture Dateq-,.,'2—
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
❑ OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: Signature of Applicant: Date:
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, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
constrict 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 Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Compensation,as provided for by Section 3700 of the Labor Code,for the 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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Sections 25505,25533,and 25534.
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall Ow r o ag 't:
not employ any person in any manner so as to become subject to the Worker's Date:
Compensation laws of California. If,after making this certificate of exemption,I fu f
become subject to the Worker's Compensation provisions of the Labor Code,1 must CONSTRUCTION LENDING AGENCY
forthwith comply with such provisions or this permit shall be deemed revoked. I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued(Sec.3097,Civ C.)
APPLICANT CERTIFICATION Lender's Name
I certify that I have read this application and state that the above information is Lender's Address
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
III 'ie above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
i; uify and keep harmless the City of Cupertino against liabilities,judgments,
cosw,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36933018 . 00
DATE ISSUED. . . . . . . : 09/22/2009
RECEIPT #. . . . . . . . . BS000008733
REFERENCE ID # 09090152
SITE ADDRESS 10604 LA RODA DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . ... . .
OWNER ANDREWS TONI
ADDRESS 10604 LA RODA DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4416
RECEIVED FROM BOB'S BOBCAT SVC IN
CONTRACTOR ROBERT L ASHBY LIC # 30638
COMPANY BOB'S BOBCAT SERVICE, INC.
ADDRESS 567 ARLETA AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95128
TELEPHONE (408) 998-8766
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ------
1BCBSC VALUATION 12, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 12, 000 . 00 1 .20 0 . 00 1.20 0 .00
1DEMOPRE SQUARE FEET 0 . 00 490 . 00 0 . 00 490 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 492 .20 0 . 00 492 .20 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 492 .20 #5185
---------------
TOTAL RECEIPT 492 .20
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- --------------------
704 DEMO
CITY OF CUPERTINO 0?0? 0
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CUPERTINO PERMIT APPLICATION FORM
APN# .5O/ U v Date:
Buil��Address:
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Mailing Address (if different from building address):
Owner's Name: Phone: _
Contra tor: Phone
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Contractor License #: (� / 3o(o3ff
Cupertino Business License #:
Contact: Phone: is
Fax:
Residential Sq Footage Commercial ❑ Sq Footage
Job Description: /
Valuation:
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 1SFDWL-DEM
/ 1DEMOPRES Pool Demo Residential B 1SFP00L-DEM-
I
1BCBSC Cal Bldg Standards B ALL PERMIT
Commission Fee TYPES
1BSEISMICRE Seismic Residential B
Revised 01/07/09
9 T = ■ n
ENTER PROJECT NAME
Enter description here,=points points available for measure W appropriate categories to the right.
Enfar desa�tion here,and enter points available for measure N appropriate categories b the right
_..,...._:...-.._..__..,anile.erpoi_..-_...aeIna._.
Enter description here,and enter points available for measure in appropriate categories to the right
Enter description here,and enter points available for measure In appropriate categories to the right
_ _ .—._. -tall.._- - ---.. .. ---- --•--- --
Build It Green Checklists and
4.Innovation:List innovative measures that meet the green building objectives of the Guidelines.Enter up to a ,rid-lin.s
maximum combined total of 20 pts.See Innovation Checklist for suggested measures,using the link to the right.
Innovation in Community.Enter description here,and enter points sealable for measure in appropriate categories to the right 0 TO 0. 0 0 0.,
Innovation in Energy:Enter description here,and enter points satiable for measure In appropriate categories to he right - 0 w 0^
innovation In IAO/Health:Enter description here,and enter ponds avo We for measure in appmprele categories to the right 0- 9:. _.00
Innovation In Resources:Enter description here,and enter points available for measure In appropriate categories to the right JO 0— D 0 0 0�
Innovation In Water:Enter description here,and enter points avallabte for measure In appropriate categories to the right. 0 0 0 0
Total Available Points In Other=4 0
Total Available Points in Specific Categories'
Lj 96+ 42+ 66+ 43+
Minimum Points Required in Speck Categories 30 5 6 9
• • • 1 I I 1 1 1
Project has not yet met the following recommended minim m requirements-
-
Total Project Score of At Least 50 Points
-Required measures:
-A3a: 50%waste diversion by weight
-J2: 15%above Title 24
-Nl:Incorporate Green Point Rated Checklist into blueprints n
t -Minimum points in specific categories: -- Q
-Energy(30 points)
-IAQ/Health(5 points)
7 -Resources(6 points)
-Water(9 points)
0 2DD7 Build It Green Single Family GreenPoint Cheddist 2DD7 Version Page 7 of 7
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
„UPEIRTINO
Buildin De artment
JOB ADDRESS: PERMIT# 0
la(o te
OWNER'S NAME: 2 C -<-'-S PHONE # of -F 7 _
GENERAL CONTRACTORviFAX # S
I am not using any subcontractors:
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