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09080138 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1211 STAFFORD DR CONTRACTOR:BAY AREA PERMIT NO:09080138 HAULING&BOBCAT SERVICE �WNER'SNAME. t�l��Jfl��i, P O BOX 36143 DATE ISSUED:08/17/2009 OWNER'S PHONE: 4087250116 SAN JOSE,CA 95158 PHONE NO:(408)592-9755 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG� ELECT I— PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date JOB DESCRIPTION: FILL IN POOL FOR NEW LANDSCAPING 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: 1 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:$3500 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:36211031.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I 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 relatin; 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 Issued by: Date: 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. 17 a`j RE-ROOFS: nature _Date 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. 07 OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,or my employees with wages as their sole compensatio i, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: (7I o y 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 CONSTRUCTION LENDING AGENCY 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 mist I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 rela&ig to building construction,and hereby authorize representatives of this city to enter t the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION .rmnify and keep harmless the City of Cupertino against liabilities,judgments, \costs,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 �tl�loq Community Development 10300 Torre Avenue ,abi-0 . Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 %HkTINO Building Department JOB ADDRESS: (2 t k STAff--o 20 p(i�vir PERMIT # cvr ercv l P C A Obi 1 if OWNER'S NAME: k Pis exJ PHONE # �� "► 2s-- i b GENERAL CONTRACTOR: -L--� f-Z" FAX# 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 CITY OF CUPERTINO DEMO CITY OF CUPETRINO PERMIT APPLICATION FORM APN# 3�a Date: D 9/1-7 i 03/ o0 1 Building Address: l 2l Mailing Address (if different from building adcb•ess): Owner's Name: Phone: 4 _-7 L S:---o t t Contractor: K,.�e Phone : q o-z ---- -71,3-Ls- 1 Fax: Contractor License #: b,It 3.4 3-o Cupertino Business License #: Contact: Phone: Fax: Residential Je Sq Footage Commercial ❑ Sq Footage Job Description: f'l LL_-t, f U V 7z-2 Leh sc 6'I J61 P--0e s C1 Valuation: 2 500 Project Size: Express ❑ Standard ❑ L,-xge ❑ 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 Deno Residential B 1SFP00L-DEM_ 1BCBSC Cal Bldo, Standards B ALL PERMIT Commission Fee TYPES 1BSEISMICRE Seismic Residential B Revised 01/07/09