10090015 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10734 MARTINWOOD WAY CONTRACTOR:A TO Z POOL AND SPA PERMIT NO: 10090015
REPAIR
OWNER'S NAME: ANTHONY BACHMAN 10289 MENHART LN DATE ISSUED:09/02/2010
WNER'S PHONE: 4085824425 CUPERTINO,CA 95014 PHONE NO:(408)374-6268
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
License Class C s 3 Lic.# �'�' �y��7 MECH RESIDENTIAL r COMMERCIAL
Contractor 411/ Date
JOB DESCRIPTION:POOL DEMO(660SQ)
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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$6500
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 anc Type:Occu APN Number:36935031.00 P Y
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 relatin; PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
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 Issued by Date: L�
9.18. A
Signature✓ y� � Date°- Z--- �
RE-ROOFS:
Li OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one A inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensati(n, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,am exclusively contracting with licensed contractors tt
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this 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
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
I certify that in the performance of the work for which this permit is issued,I shat I
not employ any person in any manner so as to become subject to the Worker's Owurr or authorize agent: -Z -/C-2
Compensation laws of California. If,after making this certificate of exemption,I Date: y
become subject to the Worker's Compensation provisions of the Labor Code,I mast
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
inify and keep harmless the City of Cupertino against liabilities,judgments ARCHITECT'S DECLARATION
,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY 01' CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B_.k: Lot:
APN . . . . . . . . : 36935031.00
DATE ISSUED. . . . . . . : 09/02/2010
RECEIPT #. . . . . . . . . B;3000011369
REFERENCE ID # 1)090015
SITE ADDRESS 1)734 MARTINWOOD WAY
SUBDIVISION . . . . . . .
CITY C JPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ANTHONY BACHMAN
ADDRESS . . . . . . . . . . : 10734 MARTINWOOD WAY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : A TO Z POOL AND SPA
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 6, 500 .00 1. 00 0.00 1. 00 0 .00
1BSEISMICR VALUATION 6, 500 .00 0 .70 0.00 0.70 0.00
1DEMOPRE EACH 1. 00 291.00 0 .00 291. 00 ------0 .00
---------- ---------- ---------- ----
TOTAL PERMIT 292 .70 0 .00 292 .70 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- -------------- - ----
CASH 292 .71)
-------------- -
TOTAL RECEIPT 292 .7)
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- -------------------------- -- -
704 DEMO
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISICDEMOLITION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: $6,500
PERMIT TYPE: Demolition Permit rpt r1rt:<.� i�e�
PRIMARY PENTAMATION 1 SFPOOLDEM
USE: Swimming Pool, Res. PERMIT TYPE:
WORK
SCOPE
FEE ID #POOLS
1 DEMOPRES 'I
�f,`c.-/t, lei c171 t l'tt't.fi t— trti i.�
T h v,,( b,
Pomll
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i Ck`rc�r Pi,;, I, r� )tt t i�)r_imp,
El
C�It E'7`-�lC t'.7< tett:!. '
NOTE. These fees are based on the preliminarv,information available and are only an estimate. Contact the Dept for addn'l info,
FEE ITEMS(Fee Resolution 09-051 Et ?/I 10 F11E QTY/FEE MISC ITEMS
/Pi"m (,hc'c:k FCC.,
slipp/. PC Fce
Fhrr��h -.�1et°Ir 7�1`Cc Plan Chcck,
Permit Fee: $1.91.00
Suppl. Insp.Fee.e Reg. 0 OT 0.0 hrs $0.00
F'lufrrh '.�1cc11 'I;Icc; (�r7ir f�'cc:
Plunttr.'11cch J,Icc 1'crtslif FCC:
C.)11l ruction Tax
"IcolIstic of
11"or-k 6J ithoul Pc'imit"
I'Lctrtniti,<, l'CCS.,
I'No'cl Dcxtut7crratf�tiurt l`e'es`:
Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
131dgLStds Commission Fee: IBCBSC $1.00
SUBTOTALS: $.?92.65 $0.00 TOTAL FEE: $292.65
Revised: 9/01/2010
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 7 ERMIT# f.
OWNER'S NAME: ot/ /¢A?�� PHONE# �'Z-
GENERAL CONTRACTOR: ;f- BUSINESS LICENSE#
ADDRESS: c Z.. CITY/ZIPCODE: G -
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANC"' INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCON l RACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. P—7?_-lo
1 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
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
R:- DEMO
cup TYOf PERMIT APP]�ICATION FORM
APN# ,.� ,, J Date: r
Building Address:
/n �►-
Mailing Address (if different from building address):
Owner's Name: Phone:
14,,y-r/Civ lg4-L IK.44At s,'Z !� Z-S
Contractor: p v e /4".v L �•x � �,,/ ,,�,Z Phone : 3 Cl
Fax:
Contractor License #:
Cupertino Business License #:
Contact: Phone: 5;34q
Fax:
Residential Sq Footage Commercial ❑ Sq Footage
Job Description:
POO L v
Valuation: 6,50' 0
Express
Project Size:
ProJjEx Standard [Large ❑ Major ❑
P ❑
Please complete relevant portions of the Green Building Checklist & attach it to the application
or if applicable, include on the plan set & th,: sheet index.
Quantity Fee ID Fee Description Fee Group Permit Type
1DEMORES Demo-F:esidential B 1SFDWL-DEM
1DEMOPRES Pool Demo Residential B 1SFP00L-DEM-
1BCBSC Cal B16g Standards B ALL PERMIT
Commission Fee TYPES
1BSEISMICRE Seismic Residential B
Revised 01/07/09