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12070222 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10699 LARRY WAY CO"PRACPOR:FOUR SEASONS PERMITNO: 12070222 GARDENING OWNER'S NAME: RAJPALI SAVITA ET AL 2429 LASTOAK DR DATE ISSUED:07/302012 OWNER'S PHONE: 4082429676 SAN JOSE.CA 95124 PDONESO:(408)426-1131 ❑ LICENSED CONTRACT'OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class %C— Zl Lic.4 & O _Iliys r r r ,,�� '_ �� pp pIECFI RESIDENTIALCOMMERCIALContractor /SZ41L�— P>� Date LI..jZ 1 hereby affirm that I am licensed under the provisions of Cha peer 9 d06 DESCRIPTION:DEMOLITION OF IN-GROUND GUN ITE S\1'Ib1M1IING POOL (cummencing with Section 7000)of Division 3 of the Business S Professions (595 Code and that y license is in full force and effect. SQFf) m I hereby affirm under penally 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 perfommnce of the work for which this Sq. FI Floor Area: Valuation:$6200 permit is issued. A PPLI CANT CF.RTI FICATION APN Number:31602008.00 OccupancyTpr. I certify that I have read this application and stale that the above infmnation is correct.I agree to comply with all city and county ordinances and state law's 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments. WITHIN IHO DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the gmnline of this permit. Additionally,the applicant understands and will comply IHO DAYS FROM LAST CALLED INSPECTION. with all non-point source regulaliams per the Cupertino Municipal Code,Section 9.18. ` J 92 �__g�� .�b Issued by: JGs�/\� A%GAJ Date: 3C •! Signature !�/��P� Date JrdY 7��-11 ❑ OR'NER-BIIILDER DECLARA'T'ION RE-ROOFS: herebv affirm that I am exenmpl from the Contractor's License Law formic of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following Iwro reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,ormy employees with wages as their sole compensation, inspection, will do the work,and the structure is not intended or offered for sale(Sec.7044- Business 3 Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business g Professions Code). ALI,ROOF COVERINGS TO 13E CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE? 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued California Ileallh&Safely Code,Sections 25505,25533,and 25534. 1 will maintain 1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Cade,Chapter 9.12 and the Ileallh S Safety Code.Section 25532(a)should I store or handle hazardous material. Section 3700 ofthe Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is Issued. contaminants as defined by the Bay Area Air Quality Management District I will 1 certify that in the perfommnce of the work forivhich this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health J Safety Code.Sections 25505.25533,and 25534. Compensation law's of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or: prizeda 11: forthwith comply with such provisions or this permit shall be deemed revoked Daly. J� CONSTRIICPION LENDING AGENCY .\PI'LICA\f CISRT'II'IC.\"PION I cenify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the perfnmiance of work's correct.I agree to comply with all city and county ordinances and state Imes relating for which this peril is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs.and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCIIITFC`I"S DECLARATION with all nun-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Sianaturc Date Licensed Professional C�.Po W 4- N--5 —�Zoe v Z Zz_ SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228 • FAX(408)777-3333 •buildine(d)cuperino.or0 PROJECT ADDRESS G APN a OWNERNAJ.e14-t PHONE t� - ' E��V L `/ Z VA- J STREET ADDRESS /V/ ! CITY.FATE,LZIP, . �..� � IL71FAX f77 'rIGJI"" CONTACT NAME �y _ ` PHONE /,CGU" EMAB. STREET ADDRESS Z Y2 5 1- C� C`TV SA7 JOrf/'e GA TAX ❑0w. ❑ OWNER-BMDER ❑ OWNERAGEM qkcONTRACTOR ❑CONIAACrORAGENT Cl ARCHRECT ❑ENGINEER ❑ DEVELOPER Cl TENANT CONCRACTOR NAME LICENSE LICEtSETYPE'Z BITS.LIC 3 COMPANY NAME 1 1 CLM JJ � E-MAll. .J FAX LLV'•SYLUh (TC/ K! �iX flS•R, .,•� �[{jU✓ �' f^7^��Q STREET ADDRESS 2, v Z e? /L`� LrC(- CRY.ST TE ZIP U 7s- 4r3/Z� PHONE BTLIC [l X ✓ �U� ARC' ECTIENOTN, NAME 7� LICENSE NUMHER / BUS.LIC0 •- COMPANY NAME E-MAIl. FAX STREET ADDRESS CRY,STATE,ZB PHONE DESC UPTION OF WORK USE OF �SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.Fr.) VALUATION (S) 'STRUCTURE: ❑ Cornmercial POOL POOLISPA MATERIAL TYPE CODES: SPA V - ViNYL-LINED F - FIBERGLASS DEMO G - GUNRE _ y��.M,ll Qa�tYty sm ,.;, '3� P - PREFABRICATED 1"+9'cc* 9 M-0, '�. -" By my signature below,I certify to each of the following: I am the property owner or authorized agent to act an the property owner's behalf. I have read this application and the information I have provided is correct I have read the Description of Wark and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildi g conswction, authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signammof Applicant/Agent: Date: L SUPPLEMENTAL INFORMA ION REQUIRED ," 'm""""" •""a^ - iy.�- gzYe�aurerCEuSE:O.YLY ,,��i;PC\NCLIECK.TYPE��.r��s.±�?ftOOTLY 9I:IP" B Commercial or Multi-Family Buildings with Public Swimming Pools: NO, ".,�sT Department of Environmental Health approval required. ovER rBscoD�� nt�IB'.DUYc uP QEAYRESS, �•` kMi��"lP.L�AN.�NLY LJ!STAYpARDe �Fa R�`IEUB�GJC W1 EPT Zcmc5 �S m Ashy Jai y '[..YRG -ani �� E�Y�ONY�,Y'�T�A}�GF�\L'CB :•`. ❑t\N,\JOrt�'_'� � .SANLT\RYSEWEitO[�SGH[CTvC.�w Swim PooUpp_2011.doc revised 03/16/11