13090122 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1150 STAFFORD DR CONTRACTOR:A-1 POOL REMOVEAL PERMIT NO: 13090122
OWNER'S NAME: RAJA VENKATESH P O BOX 1212 DATE ISSUED:09/17/2013
OWNER'S PHONE: 4083662124 CAMPBELL,CA 95009 PHONE NO:(408)978-2903
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License Cl!. Lic.# 6 zqy o POOL DEMO 874 SQ FT
Contractor^a.nz Date / Z
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:$6000
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:36207006.00 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 DAYSf"LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 64
costs,and expenses which may accrue against said.City in consequence of the 17 7/
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
y� RE-ROOFS:
Signature — Date r!' 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.
❑ OWN -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
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 Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this ' jr' It l
Owner or authorized
permit is issued. ent: Date:
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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,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.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION � -
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)777-3228-FAX(408)777-3333-buildingecugertino.org
CUPERTINO \�
PROJECT ADDRESS S / n® APN#
74ICA011-i Onom ` axr
OWNERNAME AV, �F� f TS: / PHONEY20
34_Z/� E-MAIL
STREET ADDRESS Sim yL CITY, STATE,ZI�prc(�oJ��4 /� FAX
CONTACT NAME `/ PHONE S� E-MAIL
{4`-� /��v/R�►�'►D I GK 751 Z I �0I 3
STREET ADDRESS 090
CITY,
Y,STATE,ZIPo FAX
_419@<R ❑ OWNER-BUILDER ❑ OWNER AGENT I � ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENS=E LICENSE TY1 Z BUS.LIC#
COMPANY NAME „^ ,e E-MAIL FAX
STRFET ADDRESS _ , CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION($)
STRUCTURE: ❑ Commercial POOL
POOL/SPA MATERIAL TYPE CODES: SPA
V - VINYL-LINED
F - FIBERGLASS DEMO 7
G - GUNITE
P - PREFABRICATED TOTAL VA]UUAATIJJN:
By my signature below,I certify to each of the following: I am the property owner 6r authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to being ing contra . I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent Date: � 7 13
SUPPL ramily
L O ON REQUIRED
_Commercial or Multi- Buildings with Public Swimming Pools:
Department of Environmental Health approval required.
SwimPoolApp 2011.doc revised 03/16/11
CITY OF CUPERTINO D
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 1150 stafford dr DATE: 09/17/2013 REVIEWED BY: Mendez
APN: BP#: EVALUATION: $6,000
*PERMIT TYPE: Demolition Permit PLAN CHECK TYPE:
PRIMARY Swimming Pool, Res. PENTAMATION 1SFP00LDEM
USE: PERMIT TYPE:
WORK � ool demo 874 sq ft
SCOPE
FEE ID #POOLS
1 DEMOPRES 'I
llech. Plan Check !7PIumb. Plan Check Elec.Plan Check
FIT,/, Fee: Plumb.Permit Fee: Elec Permit Tee:
Other l9ech.Insp. Other Plumb Insp. 0 Other Elec.Insp.
A11ech. Insp.Fee: Plumb. Insp.Fee• Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Theseees are based on the prellmina information available and are only an estimate. Contact the Det fiv addn I info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC.Fee
Plumb.11fechJE.tee
Permit Fee: $319.00
Suppl. Insp.Fee-.0 Reg. ®OT 0,0 hrs $0.00
Plumb.itkiech./1Eec
Plum b.AVfech./Elec Permit Fee:
Construction Icry-:
Administrative.Fee:
YYork. Without Permit?
Advanced Planning Fees:
7'1-avel Docurrrentation Fees:
Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item
Bldp-Stds Commission Fee: 1BCBSC $1.00
$320.60 $0.00 ru $320.60
Revised: 08/01/2013
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Building Department To fat R L 'e2 �. .
SEP 17 2013 ` )3y `�"� �
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VIEWED FOR CODE COMPLIANCE J�fM�N-r 7o 13 G
Reviewed BY.
F D A NP R EMOV O
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COPJf`UNITY DEVELOPMENT DSP, Ar t3 \
BUILDING DIVISION-CU
APPROVE PL IlVG DEPT,
This set of plans and specifications MUST be kept at the \ j)RATAl 1-to
, vonstruction. It is u�lX, I to make any '7"o BE 6QL0 k t TIlt
ci I%f i 1 or alterations on same.oro vlarT,
o
the3rGf r"om,without approval from the Building Official _ ®�''
RW,T)G. DEPT.
s�o L
Tho of this plan and specifications SMALL NOT
b: !:,'t+e i_^rrnit or to be a i approval.of the violation
of any provisions of any Cit I Ordinance or State Law. 1'r
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COMPACTION REPORT IS REQUIRED SHOULD THE u SCA L E
ABATED AREA BE DECLARED "BUILDABLE" IN THE FUTURE,