09090202CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10716 S STELLING RD CONTRACTOR: A TO Z POOL AND SPA PERMIT NO: 09090202
REPAIR
1--NER'S NAME: NAVEEN & MEENAKSHI SAXENA
OtvNER'S PHONE: 4083430116
❑ LICENSED CONTRACTOR'S DECLARATION
License Class 4::�. Lic. #�
Contractor
I hereby affirm that 1 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.
1 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
Section 3700 of the Labor Code, for the performance of the work for which this
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
r
5' 1tu'.- ADate &'2-7_
❑ OWNER -BUILDER DECLARATION
I Ikereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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
Compensation laws of California. If, after making this certificate of exemption, I
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.
APPLICANT CERTIFICATION
I certify that 1 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
I `he above mentioned property for inspection purposes. (We) agree to save
r. inify 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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature_
Date
10289 MENHART LN
CUPERTINO, CA 95014
DATE ISSUED: 09/28/2009
PHONE NO: (408) 374-6268
BUILDING PERMIT INFO: BLDG r— ELECT f— PLUMB t—
MECH r— RESIDENTIAL r— COMMERCIAL f—
JOB DESCRIPTION: POOL DEMO (300SQ)
Sq. Ft Floor Area: I Valuation: 54500
APN Number: 35922064.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issue
o.{
RE -ROOFS:
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
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
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
Health & Safety Code, Sections 25505, 25533, and 25534.
Date: 0"I —2'T -�%
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
4 ITEMS OF 4
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35922064.00
DATE ISSUED.......: 09/28/2009
RECEIPT #......... BS000008779
REFERENCE ID # ...: 09090202
SITE ADDRESS 10716 S STELLING RD
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER NAVEEN & MEENAKSHI SAXENA
ADDRESS 10716 S STELLING RD
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: THE POOL GUYS, INC
CONTRACTOR .......: MICHAEL L. LINZELL LIC # 28953
COMPANY A TO Z POOL AND SPA REPAIR
ADDRESS 10289 MENHART LN
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
TELEPHONE (408) 374-6268
FEE ID
UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
----------
NEW BAL
----------
----------
1BCBSC
-------------
VALUATION
----------
4,500.00
----------
1.00
----------
0.00
1.00
0.00
1BSEISMICR
VALUATION
4,500.00
0.50
0.00
0.50
0.00
1BUSLIC
FLAT RATE
1.00
114.00
0.00
114.00
0.00
1DEMOPRE
SQUARE FEET
0.00
490.00
0.00
490.00
----------
0.00
----------
TOTAL PERMIT
----------
605.50
----------
0.00
605.50
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
605.50
---------------
605.50
REFERENCE NUMBER
--------------------
#248
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ---------------------------
704 DEMO
•:
CITY OF
CUPEkTlNO
CITY OF CUPERTINO
DEMO
PERMIT APPLICATION FORM
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APN#
Date:
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Building Address:
1 SSI- S'7"ll�� Qc�
Fee Group
Mailing Address (if different from building address):
Owner's Name:ItPhone:
Demo -Residential
Contractor:
Phone: V' 3 7
%
Fax:-�
Contractor License #: 7 6 5 7
B
Cupertino Business License #: .5 3
Contact:
Phone: -3-96
M lKk- I-
Fax:
Residential Fr Sq FootageCfV S� Commercial ❑ Sq Footage
Job Description:
Seismic Residential
Valuation: Nu S Ov
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-DEN_
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT
TYPES
1BSEISMICRE
Seismic Residential
B
Revised 01/07/09
1. aw-, 1 "
CITY Of
CUPERTINO
CITY OF CUPERTINO
DEMO
PERMIT APPLICATION FORM
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
1DEMOCOM
Demo -Commercial
B
1COMML-DEM
1DEMOPCOM
Pool Demo Commercial
B
1CPOOL-DEM
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT
TYPES
1BSEISMICOM
Seismic Commercial
B
1BUSLIC
Business License
B
Revised 01/07/09
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Total Available Points in Specific Categories' 4+ 96+ 42+ 66+ 43+
Minimum Points Required in Specific Categories 0 30 5 6 9
iProject has not yet met the following recommended minimum requirements:
- Total Project Score of At Least 50 Points
- Required measures:
-A3a: 50% waste diversion by weight
-12: I5010 above Title 24
-Nl: Incorporate Green Point Rated Checklist into blueprints
r - Minimum points in specific categories:
-Energy (30 points)
-IAQ/Health (5 points)
? -Resources (6 points)
-Water (9 points)
011
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0 2007 Build It Green Single Family GreenPoint Checklist 2007 Version Page 7 of 7
".R PROJECT NAME i u
u7
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0
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0
Ender descriptlon hare, and erhlar points available for measure In, appropriate categories to the right u-0 ...
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4. Innovation: List innovative measures that meet the green building objectives of the Guidelines. Enter up to a
Auild It Green Che
Guidelines
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 anter points avalaoie for measure in appropriate categorbs to the right
- 0
0
0
0
Innovation in Energy: Enter desaiptbn here, and enter points evalable for measure In appmpnale categories to the right
0
0
0~
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V 0
0
Innovation In IACIHealth: Enter descrlplbn here, and enter points avalable for measure in appropriate calagories to the right
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Innovation In Resources : Enter description here, and enter points rabble for measure In approprlale categories to the right
M-0
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Innovation In Water : Enter description here, and enter points available for measure In appropriate categories to the right
0
_ 0 0 0`:
Total Avalable Points In Other 44
0
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0
d'
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Total Available Points in Specific Categories' 4+ 96+ 42+ 66+ 43+
Minimum Points Required in Specific Categories 0 30 5 6 9
iProject has not yet met the following recommended minimum requirements:
- Total Project Score of At Least 50 Points
- Required measures:
-A3a: 50% waste diversion by weight
-12: I5010 above Title 24
-Nl: Incorporate Green Point Rated Checklist into blueprints
r - Minimum points in specific categories:
-Energy (30 points)
-IAQ/Health (5 points)
? -Resources (6 points)
-Water (9 points)
011
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0 2007 Build It Green Single Family GreenPoint Checklist 2007 Version Page 7 of 7
CITY OF
tX PEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
6 Pdcr� a S' w
PERMIT #
0
OWNER'S NAME: % V/-- e l ,irk �,�,�
PHONE # 3 a t f L
GENERAL CONTRACTOR:
FAX # � C 0
I am not using any subcontractors: 6,4 — zS-^��
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
bc, - -DIf
Date
60
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
bc, - -DIf
Date