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10010070 UILDING PERMIT IT NO:10010070 CIT Y OF CUpERTIN O B PERM CONTRACTOR:BJURMAN CO O1/1512010 DATESSUED: ISSUED. 21702 LINDY LN 1250 HIGHWY 101 -9907 PHONE IF NO:(831)'726 PBUILDINGADDRESS* CA 95004 WANG MIKE W AROMA PLUMB R'S NAME: ELECT 41527988$7 BLDG �1ER'S PHONE: RATION BUILDING PERMIT INFO' COMMERCIAL LICENSED CONTRACTOR'S'DECLARATION MECH RESIDENTIAL' ❑ L Lic.# '© ING POOL DEMO License Class Date / �s '-— JOB DESCRIPTION:SFR SWC t,1�'rvYy"' ter 9 Contractor provisions of Chap hereby affirm that I am licensed under the p er 0 of Division 3 of the Business&Professions Ih Y (commencing with Section 700 Code and that my license is in full force and effect. o declarations: penalty of perjury one of the following Valuation:$7000 I hereby affirm under p de for the certificate of consent to self-insure Worker's I have and will maintain a ce Section 3700 of the Labor Sq,Ft Floor Area: Compensation,as provided for by Occupancy Type' Comp permit is issued. provided for by performance of the work for which C this Insurance,as rk for which this P will maintain Work ce of the wo APN Number:35624035.00 I have and performance Section 3700 of the Labor Code,for the p STARTED permit is issued. CERTIFICATION SIF WORK IS NOT EOR p PERMIT EXPIRE IT ISSU AN C APP' CER d state laws relating OF PE N lication and state that the above is O • I certify that I have read this aPP and county ordinances to enter WITHIN 180 DAYS CALLED INSPECTI agree to comply with all city representatives of this i to save S FROM LAST correct.I ag and her authorize to building construction, Propel y for inspection purposes. (We). g ud mems, 180 DAY Of Cupertino against liabilities'jencof he -- Date: upon the above keepmet ion he City against said City in conseq accrue aga t understands and will comply indemnify anapplicant Section costs,and expenses which may the app al Code, Issued by. of this permit. Additionally,per the Cupertino Municip grantingulations p with all non-point source reg 9.18• i Date RE ROOFS* installed.If a roof is r roofing material being 1 be inspected prior to any ion I agree to remove all new materials for Signature All roofs shall an inspect , CLARATION installed without first obtaining OWNER-BUILDER DE Date: U he Contractor's License Law for one of inspection. t from tApplicant-.------------- I licant: I hereby affirm that I am exempt compensation, Signature of App two reasons: to ees with wages as their sole comp CLASS"A"OR BETTER the following ro erty,or my employees I, I owner of the property, is not intended or offered for sale(Sec.704 , ALL ROOF COVERINGS TO BE will do the work,and the Code)structure n with licensed contractors to ALS DISCLOSURE Business&Profess contracts g MATER[ ALS erty,am exclusively HAZARDOUS MA ter 6.95 of the I,as owner of the p P Business&Professions Code). requirements under Chap I will ma construct he project(Sec.7044, three 25533,and 25534. e of the following fe Code,Sections 25505, I have read the hazardous materials re Chapter 9.12 and the Health penalty of perjury on Code, P hereby affirm under p for Worker's California Health&S Cupertino Municipal her y ure nce with the Cup should I store or handle hazardous d us air l• I compliance show declarations: for the Safety Code,Section 25532(x) ement District I 0 of the Labor Code, should I use equipment or devices u Quality Manag and ill maintain a Certificate of Consent to sel-ins u JrI have and�'�' Section 37 Additionally,sho the Bay Area Ai Q Chapter 9.12 Compensation,as provided for by Code, Comp permit is issued. provided for by ertino Municipal the work for which this p Insurance,as P contaminanmpliance with the Cup 25533,and 25534. performance of Compensation maintain compliance e erformanCe of the work for which this Health&Safety Code,Sections 25505, I have and will maintain rWorker's o e,for the p Section 3700 of the Labor C I shall t; permit is issued. this i,ermit is issued, Ow a orize a, Date: f n the performance of the work fore ome subject to he Worker's I I certify that s manner so as to b tion, t employ any person in any this certificate of exemption, no pf,after making Labor Code,I must CONSTRUCTION LENDING AGENCYperformance Compensation laws of California.ifrniaCompensation provisions of the La agency for the subject to the Worker's Comp r this permit shall be deemed revoked. c 3097,Civ C.) e J b affirm that there is a construction lending g become rovisions o I here y l with such p Penn is issued(Sec. forthwith comply for which this p Lender's Name AppLICANT CERTIFICATIONtte pVe information relating lication and s ordinances and state law Lenders Address I certify that I have read this app and county to enter TION agree to cc with all city representatives of this city correct.I and hereby auhorize rep ores.(We)agree to save ARCHITECT'S DECLARA to building construction, property for inspection purP ud mems, Cupertino against liabilities,j g Pu records. upon he above mentharremdless he City of Cup in consequence of the I understand my Plans shall be used as p nnify and keep accrue against said City d expenses which may the applicant understands and ode comply Professional ,anp granting of his permit.Additionally,per the Cupertino Municipa Licensed Pr with all non-point source regulations p 9.18. Date 0 Signature CITY OF CUPERTINO RECEIPT OPERATOR: patg PERMIT RE COPY # � 1 4 ITEMS OF 4 Sec: Twp: Rng: Sub: Blk: Lot: 35624035 .00 APN • " " ' • • 01/15/2010 DATE ISSUED. . . . . - BS000009572 RECEIPT REFERENCE• ID' # ; 10010070 SITE ADDRESS 21702 LINDY LN SUBDIVISION • : : : : ; : : CUpERTINO CITY . • • • IMPACT AREA • • • • • WANG MIKE W OWNER 21702 LINDY LN ADDRESS • " ' 95014-4808 CITY/STATE/ZIP • • • : CUPERTINO CA, RECEIVED FROM PHILLIP BJBJ RURU LIC # 23653 AN ; pHILLIP 0 CONTRACTOR • • ; BJURMAN CORP COMPANY • " " • ; 1250 HIGHWY 101 ADDRESS ' • ZIP• . . . � AROMAS, CA 95004 CITY/STATE/ • • . . • • • ; (831) 726-9907 TELEPHONE PD-TO-DT' THIS REC NEW BAL IT QUANTITY AMOUNT___ __-____--- ---------0 ----- 0 . 00 FEE ID UN __ ---------- - 1 . 0 ------- 1.00 0 .00 0 .70 0 .00 ---- 7, 000 .00 0 .70 0 .00 0 . 00 1BCBSC VALUATION 7 000 .00 0 .00 114 . 00 114 .00 490 .00 0 . 00 1BSEISMICR VALUATION 1 .00 0 .00 -__---__- 1BUSLIC FLAT 0 .00 490 . 00 1DEMOPRE --_ _ SQUARE FEET 605 .70 0 .00 _ _-_----- 605 .70 0 .00 TOTAL PERMIT : OST, REFERENCE_NUMBER METHOD OF PAYMENT ---- --- 605 .70 CASH ----------605.70----- TOTAL RECEIPT' : VOICE ID DESCRIPTION DESCRIPTION --------- VOICE ID ---------------------------- 704 DEMO CITY OF CUPERTINO y` DEMO CUPEI�TINO PERMIT APPLICATION FORM APN# Date: Building Address: a2 / r7 0 Z ('4'J'F Mailing Address (if different from building address): Owner's Name: Phone. %,M (��-� �-- �tf �'i 27 r�YYr I v t- 7 Contractor: Phone U��►n�� (6,�Z') 7r3 ?3j ax: Contractor License #: 2 jv Cupertino Business License #: Contact: Phone: ?kt(c (/1 ?)L,&,r Iv-\P k-� ((./--&) 470 J Fax: Residentia'1�f Sq Footage Commercial ❑ Sq Footage Job Description: Valuation: Project Size: Express ❑ Standard Q 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 l 1DEMOPRES Pool Demo Residential B 15FP00L-DE1Vr 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES I 1BSEISMICRE Seismic Residential B Revised 01/07/09 Community Development 10300 Torre Avenue ;r Cupertino CA 95014 w= Telephone(408)777-3228 Fyh Y• Fax(408)777-3333 CITY OF '"UPEkTINO Buildion De artment OB ADDRESS: PERMIT # �� -7 ,q:q / -� d � � � d �� a f �- � OWNERS NAME: � PHONE # � � � GENERAL CONTRACTOR: t �� 61*V e J( FAX # I am not using any subcontractors: 1 Date Signature Please check applicable subcontractors and comlete the f ollowin information: E:0 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