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10110008 I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20771 SHELLY DR CONTRACTOR�� PERMIT NO: 10110008 ED OWNER'S NAME: CONNIE WATERS ULA DATE ISSUED: 11/01/2010 NER'S PHONE: 4082348639 PHONE NO: 19/ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALII License Class C,— (� Lic.# S 7 2, POOL DEMO 375 SQ FT Aon � * SEE NOTES* Contractor Aon i �ZI' Date 1/ 1-1 Z 01 0 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:$3750 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:35911030.00 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 relating 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=ST 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 granting of this permit. Additionally,the applican understands and will comply Issued by: Date: with all non-point source re I tions p=6_4 tion 9.18. /' RE-ROOFS: Signature 0 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. 13OWNER-BUILDERDECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, 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 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 de,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 5505 553 and 34. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: ;U 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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must 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 relating to building construction,and hereby authorize representatives of this city to enter unon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION inify and keep harmless the City of Cupertino against liabilities,judgments, 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.Add'ionally,the applicant understands and will comply with all non-point sourc gulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature __ Date DEMOLITION CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 20771 shelly drive 7 DATE: 11/01/2010 REVIEWED BY: larry s APN: BP#: "VALUATION: 1$3,750 PERMIT TYPE: Demolition Permit Pi (""IFCK . , PRIMARY Swimming Pool, Res. PENTAMATION 1SFPOOLDEM USE: PERMIT TYPE: WORK remove res pool 3 feet down SCOPE FEE ID #POOLS 1DEMOPRES l.fc-c rr F _—', Lj I 01/,'('s'1_lc° 'lazy NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolutio»09-051 Elf. -7'L� FEE QTY/FEE MISC ITEMS P/on Chcc; supp/. PC FCC, Phflrzl3.;:l,lc,c°11.,`Elcc:Plall Chcck: Permit Fee: $291.00 Suppl. Insp. Fee-0 Reg. 0 OTFO, hrs $0.00 Pllrllzh%;t1�<11. "IIct; Ii'i7it F'��': P/11111h,14c t 11.:F?c'c f'crt711rI I�t'cr; (.'012S1171C'[i0i7 I JV F-1 "Icouslicul 1ii'victt 11"Or1, 11"ithow Pc rrniO Irut c'l Fcc.5': Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $292.00 $0.00 TOTAL FEE: $292.00 Revised: 10/17/2010 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35911030 . 00 DATE ISSUED. . . . . . . : 11/01/2010 RECEIPT #. . . . . . . . . : BS000011888 REFERENCE ID # . . . : 10110008 SITE ADDRESS . . . . . : 20771 SHELLY DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CONNIE WATERS ADDRESS . . . . . . . . . . : 20771 SHELLY DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2923 RECEIVED FROM . . . . : LASSITER EXCAVATING CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 750 .00 1 . 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 3, 750 .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 ----------------- --------------- -------------------- CHECK 292 . 50 33909 --------------- TOTAL RECEIPT 292 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO 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: 20 :77 f PERMIT# OWNER'S NAME: . (f,X PHONE# L;-17 "7 GENERAL CONTRACTOR: ; BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: ]' r *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCO TRACT RS H OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date RESIDEN'T'IAL PROJECT COVER SHEET Assessor's Parcel Number: Name of owner. c ,yy:, 2 <�� Project address. ��< �� Contact person. Phone. 2-,C-2,j Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N Is privacy protection planting required for the project? Y N Build it Green Total Points On what floor(s) is work being done? Brief description of work. "Ae'D_k , � �✓�� r.�_,. �`T J�'�'� �✓ �-lC � ,� ��7�,'�,� � Code editions:2007 CBC (Y-N)2007 CFC (Y -N)2007 CMC (Y-N) 2007 CPC (Y -N)2007 NEC (Y-N) Effective 1/1/08 IN AC(OHDAN,i31;; ; ; (;IN k�-�°' CUPEHTINU LODES AND ORDINANCE, F-AD DATE--I(_— i — z%)( Li SIGNED this set of plans and�Zpeclcs ions m,w ✓' is �� kept on the job at all times and it i� inlawful to make any changes or alterations on same without wntten permission from the Building Department,City of Cupertino The stamping of this plan and specifications 6HALL NOT be held to permit or to be an approval of the violation of;-tnv provisions ,,t my City Ordw,;ncp;;; ..... <jw Plan Review Process Work Book Page-8-Revised 8/05/08 LP � \ i 'A 1 ,V 1 r� CUPETI0 CITY OF CUPERTINO POOL REMOVAL A demolition permit is required for the removal of all pools. If the pool frame is to remain, three holes (minimum one foot in diameter) shall be drilled into the bottom of the pool floor. The pool is to be filled in with crushed rock (maximum 3/4" size) for a minimum of 8" deep at the bottom of the pool, then clean fill may be added. Two inspections are required for pool removals. The in-progress inspection should be scheduled when the holes along the pool floor have been drilled and before the pool is filled. The final inspection should be scheduled after all work is completed. If you have any questions, please call the City of Cupertino Building Department at (408) 777-3228 between 7:30 a.m. to 12:00 noon and 1:00 p.m. to 4:30 p.m. STORMWATER POLLUTION CONTROL AND NOISE CONTROL COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228 • FAX(408)777-3333•buildin4(c,cupertino.orQ GENERAL INFORMATION All construction work must meet certain conditions related to maintaining environmental quality and public health and safety. This policy described the two most common inquiries regarding construction: Stormwater Pollution Control and Noise Control. STORMWATER POLLUTION CONTROL State law requires that the City of Cupertino, along with 12 other Silicon Valley cities, Santa Clara County and the Santa Clara Valley Water District control stormwater pollution. Educating local residents and businesses and enforcing stormwater pollution control laws are key parts of the City's compliance efforts. Stormwater pollution prevention: It's up to us! In northern Santa Clara Valley, storm drains flow directly to local creeks and into the San Francisco Bay without going through a water filtering/treatment process. Stormwater pollution is a serious problem for wildlife dependent on our waterways, for people living near streams and baylands, and for the local water supply. Common sources of stormwater pollution include; • Dripped oil, fuel, and antifreeze from vehicles and heavy equipment; • Construction debris, including dirt, concrete and paint; • Landscaping runoff containing pesticides or weed killers; and • Any material dumped or spilled into streets or storm drains. The property owner and the contractor share ultimate responsibility for activities occurring at a construction site and will be held responsible for any environmental damage caused by subcontractors or employees. For more information on construction-related stormwater requirements, see the Stormwater Quality Regulations section of the City of Cupertino website at: hqp://www.cuperfno.org/indox.aspx?paize=487 COMMUNITY NOISE CONTROL Construction noise is limited to: • Residential daytime noise levels from complaint site—60 dBA • Non-residential daytime noise levels from complaint site—65 dBA ' Daytime hours are defined as being between the following hours: • Weekdays—7:00am to 8:00pm • Weekends—9:00am to 6:00pm Construction, other than street construction greater than 750 feet of a residential area, is prohibited on holidays, except that construction conducted by a homeowner or resident of a single family dwelling using domestic construction tools is allowed on holidays between the hours of 9:00am to 6:00pm. For more information on noise control, please refer to Chapter 10.48 of the Cupertino Municipal code, which can be accessed at http://www,amle.al.com/cupertino ca. Stormwater/Noise Control 2010.doc revised 09/22/10 CITY Of CITY OF CUPERTINO DEMO CUPERTINO PERMIT APPLICATION FORM /y� / lv�l000bp APN# 'I 030Date: li za� v Building Address: 2 d Az Mailing Address (if different from buildin ddress): AW gulob 40N� a Owner's Name: Phone: J &_ 1 >`. Contractor: Phone Fax: �1 Contractor License#: Cupertino Business License #: Contact: Phone: -� Fax: Residential ❑ Sq Footage Commercial ❑ Sq Footage Job Description: 1) Valuation: C) Project Size: Express ❑ Standard ❑ 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 1DEMOPRES Pool Demo Residential B 1SFP00L-DEM 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES 1BSEISMICRE Seismic Residential B Revised 01/07/09