10090152 CITY OF CUPERTIN O BUILDING PERMIT
BUILDING ADDRESS: 10940 SANTA TERESA DR CONTRACTOR:PHILLIP D.BJURMAN PERMIT NO: 10090152
OWNER'S NAME: NORBERG JAMES C AND REGINA A 1250 HIGHWY 101 DATE ISSUED:09/16/2010
QER'S PHONE: 4082533539 AROMAS,CA 95004 PHONE NO:(650)906-7533
❑ LIICCENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT I— PLUMB r
License Class / r Lie.# 71
MECH F RESIDENTIAL F COMMERCIAL r—
Contractor f'ti' C,ey %y`-r~ Date q 114-11-1
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:POOL FILL-IN(SOOSQ)
(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:$5000
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. APN Number:35613005.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above in ormation is
correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
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,SectionIssued by.-� l Date: � y�t
9.18.
Signature r' R �/ ��- Date � �•
RE-ROOFS:
LJ 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 of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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(x)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
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
P Health&Safety Code,Sections 25505,25533,and 25534.
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 �t3. r} thorize - ent:
Compensation laws of California. If,after making this certificate of exemption,I 0Date: Q
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. 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
unify 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 OF CUPERTINO
3 ITEMS OF 3 PERM--T RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B:-k: Lot:
APN . . . . . . . . : 35613005 .00
DATE ISSUED. . . . . . . : 09/16/2010
RECEIPT #. . . . . . . . . : B!3000011475
REFERENCE ID # . . . : 10090152
SITE ADDRESS . . . . . : 10940 SANTA TERESA DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : NORBERG JAMES C AND REGINA A
ADDRESS . . . . . . . . . . : 10940 SANTA TERESA DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4768
RECEIVED FROM . . . . : P'-LLIP D BJURMAN
CONTRACTOR . . . . . . . : PHILLIP D. BJURMAN LIC # 23653
COMPANY . . . . . . . . . . : PHILLIP D. BJURMAN
ADDRESS . . . . . . . . . . : 1250 HIGHWY 101
CITY/STATE/ZIP . . . : A]2OMAS, CA 95004
TELEPHONE . . . . . . . . : (6350) 906-7533
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 5, 000. 00 1. 00 0. 00 1. 00 0 .00
1BSEISMICR VALUATION 5, 000 . 00 0 .50 0. 00 0. 50 0 .00
1DEMOPRE EACH 1. 00 291.00 0. 00 291. 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 292 .50 0. 00 292 . 50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 292 .50 VISA
---------------
TOTAL RECEIPT 292 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- --------------------------- - -------- ----------------------------
704 DEMO
CITY OF CUPERTINO
FEE ESTIMATOR -BUILDING DIVISICDEMOLITION
its, ADDRESS: DATE: REVIEWED BY:
APN: BP#: ''VALUATION: 1$5,000
*PERMIT TYPE: Demolition Permit Ptt�1I1�C1 I�11
PRIMARY PENTAMATION
USE: Swimming Pool, Res. PERMIT TYPE: 1SFPOOLDEM
WORK
SCOPE
FEE ID #:'OOLS
1 DEMOPRES
- -TPbwAm?Cc .7T-T Plan Ch"11< hr�(Icc cit
14"c:h. t'c>r,u t f'cr: Pht?ih, Permit 1""(" Floc P,emit I C
O,hcr 31c. h, Inv, 01hcr-t'ir.roll)Its;' Li Olhc r 1,`icc. Inv"
11".h Ir NP, 1""' Phrruh, b?"p. I ear: 1,Y"(, I...e.
NOTE. Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Fee Resolution 09-051 Ej'. 7/1.110) FEE QTY/FEE MISC ITEMS
Pluu Chc'c'k fe':
Stt/,Itl. PC.'f ec
-T
1111117!.:1 cch.,Fier Flail Che(,
Permit Fee: $211.00
Suppl. Insp.Feer Reg. 0 OT0.0 hrs 90.00
f'lr�mt�.;:lloch.-7lct: (,::reit h'�c:
Plunrh. Pcrrtuit he,"
('011, 7rrrcfion Tcla
<Icou:Slical R('vic( l'1"ee:
I'Fork 4"ithout A, nrif?
Planning Fccs:
7/wi el 0ocuincrrfolinrt
I
Strong Motion Fee: 1BSEISMICR 9,0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $25 2.50 $0.00 TOTAL FEE: $292.50
Revised: 9/14/2010
ENTER PROJECT
■ , m Y u
s o:
Enter desvlption here,and anter points availeie for rreeasrre b appropriate categories to Dee right D ll D
Ender desaipibn teen,and ardor pblnls available for msasure in appropriate categories to the dphL
Ender desrrlption here,and ender points available for measure In appropriate categories to the right D� �D. 0, 0 0
Enter description here,and enter points available for measure in appropriate categories to the dghL p —p
4.Innovation:List innovative measures that meet the green building object ves of the Guidelines.Enter up to a Build It Green Checklists and
maximum combined total of 20 pts.See Innovation Checklist for suggested measures,using the link to the right. ridelin-e
Innovalbn in Community.Enter dewriplion here,and anter poirds avallable for measure in appmpriale mfegories to the 44L 0 D 0 0 D 0.
Innovation in Energy:Enter description here,and enter ponds available for measure In appmpriale cola;Dries to the right - ll 0 D - D__ _ . D D
Innwafron In IAOINaalth:Enter dasalptbn here,and enter points available for measure in appmpriais,alagories to pee right
Innovation In Resources:Enter description here,and enter points available for measure In appropriate ategwies to the right _ 0 0 D 0 p 0
Innovation In Water:Ender description here,and enter points available for mmure In apprepniale caleg roes to he right It
Total Available Points h ODeer=4 - 0
Total Available Points in Specific Categories' 4+ 96+ 42+ 66+ 43+
Minimum Points Required in Specific Categories L0 30 5 6 9
Total Points Achieved 11 1 1 1 I 1
E Project has not yet met the following recommended minimum requi-ements: ^
Total Project Score of At Least 50 Points
-Required measures: /1
-A3a:50% waste diversion by weight
-32. 15%above Title 24
-NI:Incorporate GreenPoint Rated Checklist into blueprints
r -Minimum points in specific Categories: '
-Energy(30 points) [ /�
IAQ/Health(5 points) �Q
-Resources(6 points)
-Water(9 points)
0 2D07 Build It Green Single Family GreenPoint Cheddist 2007 Version Page 7 of 7
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: l Q q S PERMIT#
OWNER'S NAME: 1vvo\ N\.)0104PHONE#
GENERAL CONTRACTOR: Ak% BUSINESS LICENSE#
ADDRESS: 111-11 i::Nt F Or CITY/ZIPCODE: Ar o
*Our municipal code requires all b sinesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: ate
Sil,nature
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
7 DEMO
CUPEkTINO PERMIT APPLICATION FORM
APN# .-s Dat
Building Address:
I C> z-> S
Mailing Address (if different from building addb•ess):
Owner's Name: Phone:
Contractor: Phone
Ph f, _D i3 (y, Fax:
Contractor License #: q-7 62 0
Cupertino Business License#: a��o
Contact: Phone:
Fax.
Residential Sq Footage Commercial ❑ Sq Footage
Job Description:
003
L 1N
Valuation:
Project Size: Express Afandard ❑ L&-ge ❑ Major ❑
Please complete relevant portions of the Gree a 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_
1BCBSC Cal Bldg Standards B ALL PERMIT
Commiss'.on Fee TYPES
1BSEISMICRE Seismic Residential B
Revised 01/07/09