13080093 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10580 TANTAU AVE CONTRACTOR:LP CONSTRUCTION CO PERMIT NO: 13080093
OWNER'S NAME:
SUNNYVALE,CA 94086 PHONE NO:(408)720-1111
❑ LICENSED CONTRACTOR'S DECLARATION J" F
BUILDING PERMIT INFO: BLDG ELECT PLUMB '
License Class c'eo_ A Lic.#
�yy MECH RESIDENTIAL F COMMERCIAL
Contractor p��S�i"h�l/d Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: DEMOLISH IN-GROUND GUNITE SWIMMING POOL.512
(commencing with Section 7000)of Division 3 of the Business&Professions SQFT
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$8300
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION APN Number:37537015.00 Occupancy Type:
I certify that I have read this application and state that the above information is
correct. 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section .J
9.18. �/ Issued by: �✓ Date: r '1�/3
110-1
Signatu Date95/'/
Z?
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,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, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I 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 I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the 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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25.505,25533,and 25534.
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 Owner authorized a n • /
become subject to the Worker's Compensation provisions of the Labor Code,I mustDater
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section 1 understand my plans shall be used as public records.
9.18.
Licensed Professional
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•building(ftupertino.org
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❑OWNER ❑ OWNER-BUILDER' '❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
I SE TYPE BUS.LIC# _,2q03,7
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ARCHITECTIENGINEER 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(S)
STRUCTURE: ❑ Commercial POOL C�/
POOLISPA MATERIAL TYPE CODES. SPA `J/
V - VINYL-LINED
F -FIBERGLASS DEMO
G - GUNITE
P - PREFABRICATED TOTAJVTION:
By my signature below,I certify to each.of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I`have " 'vided 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 Tiding cons ion. I author ere se es o mo to enter the above-identified property for inspection purposes.
Signature ofApplicant/Ag •
en Date:
SUPPLEMENTAL INFORMATION REQUIRED ` _ -�
�t�.�� Q�k1'�:Fr.TjSFc'9NI:X
Commercial or Multi-Family Buildings with Public Swimming Pools: � �� `
Department of Environmental Health approval required.
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a QB-PUBLIamORKSDEPT �,
� SAh'T?:RYSEW:ERDISTRICT - x-E=
SwimPoolApp_2011.doc revised 03/16/11
CITY OF CUPERTINO D
IIFEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10580 S Tantau Ave DATE: 08/13/2013 REVIEWED BY: Sean
APN: BP#: �60 �� "VALUATION: $8,300
*PERMIT TYPE: Demolition Permit PLAN CHECK TYPE:
PRIMARY PENTAMATION
USE: Swimming Pool, Res. PERMIT TYPE: 1SFP00LDE
WORK Demolish in- round unite swimming pool 512 sq ft
SCOPE
FEE ID #POOLS
1DEMOPRES
01
Xtech. Plan Check Phsmb.Plan Cheek Elec.Plan Check
:idiech.Permit Fee: Plumb. Permit Fee: Elec.Permit Fee:
Ffil",h.
Afech.Irasp. Other Plumb Insp. Other Elec.Inap.
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,etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff 11112) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. C I ee .
Plurnh.11fech.%Elec
Permit Fee: $319.00
Suppl. Insp.Fee:Q Reg: ® OT 0,0 hrs $0.00
f lumbAl,fech.lLlec
Plumb.lMech.iF;lee Permit'.ee.
Construction Tax:
Administrative Fee.
Work Without.Permit.
Advanced Planning Fees:
Travel Doetrtnentation Fees:
StromMotion Fee: 1BSEISMICR $0.83 Select an Administrative Item
B1dp-Stds Commission Fee: 1BCBSC $1.00
m _
$320.83
Revised: 07/01/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
;':Telephone: 408-777-3228
L U P E RT 1 N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: dd n PERMIT#
OWNER'S NAME A hd'e PHONE# 0-` 7,
GENERAL CONTRACTOR: C' BUSINESS LICENSE# 4/
ADDRESS: YCv e, !J I a V CITY/ZIPCODE: ,,0,A p/'
*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(S) WILL; BE SCIiEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED. A" CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: ��
Signature Date
Please check applicable subcontractors and complete the following information
s/ 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
r Contractor Signature Date
Atli � � AA r�
03' eo P�0\
f1A e7)eel y
Ale
rTY DEVELOPMENT DEPA RTMENT
BUILDING DIVISION-CUPERT iNO
7 APPROVED
y4FIhis set of plans and specifications MUST b i kept at th
job site during construction. it is unlawful to make
changes or alterations on same, or to deviate
therefrom,
out approval from the Buil inn Official
The Stamping of this plan and specifications SHALL NO
be held to permit or to be an approval of the violatio
of any provisions of any City Ordinance or State Law
BY 4zy
DATE �'' 3 '/ p�,OT PLAINS
PEtZMIT G CRECKED BY yo13
LANNjNG
DE
DATE
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