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14090194 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10825 STEVENS CANYON RD CONTRACTOR:A-1 POOL REMOVEAL PERMIT NO: 14090194 OWNER'S NAME: CHAITANYA POTHIMENI P O BOX 1212 DATE ISSUED:09/29/2014 OWNER'S PHONE: 4085170543 CAMPBELL,CA 95009 PHONE NO:(408)978-2903 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ / FILL/DEMO(E)SWIMMING POOL. FILL FOR LANDSCAPE License Class Lic.# PURPOSES ONLY Contractor -Z ate S l I hereby affirm that I m 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 e fiormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$6500 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:34217075 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 DAYS FRO D 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 Z l y granting of this permit. Additionally,the applicant understands and will comply-,,- with omply with all non-point source regulations per the Cupertino Municipal Code,Secti 9 18. c -ROOFS. Signature Date 7 z �/ All roofs shall be inspecte to any roofing in being installed.If a roof is installed without first ob awing an inspection,I agree to remove all new materials for inspection. ❑ OWNER- UILDER 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) 1,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(x)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,ag34. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized a t: Date: 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 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 [a COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 111 (408)777-3228•FAX(408)777-3333•building(a)-cupertino.org \ CUPERTINO PROJECT ADDRESS2� API�'�! 3 p OWNERNAME ,�� PHON '(�O�,��' _ E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX tj ek® CONTACT NAME A / ^ PHONE 0 2 E-MAIL e 'c (?�f STREET ADDRESSa / CITY,STATE,ZIP / d 0c,tl FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NULICENSE TYPE BUS.LIC# /- oc> BE f C COMPANY NAME -MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 579 Q ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# 7 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK nOo Ave-k / c 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 G - GUNITE 'C:✓ P - PREFABRICATED ISE ^ TOTAL VALUATION: u- By my signature below,I certify to each of the folio g: I am the pro own orized 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 relatin �bufldin�onstruc�t �rize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: - Date: Pi l SUPPL MEN AL TI REQUIRED oPFICEUSE ONLY 1i CTIE�CK TYPE .ter-! ROIJTING SLIP _Commercial or Multi-Family Buildings with Public Swimming Pools: - Department of Environmental Health approval required. R THE IJIVTER ❑ BLiILDixc pEPT 0 E RESS ❑ PLANNINGDEPT A k`UBLLC WORKS DEPT ,❑ LARGES ❑ ENVIRONMENTAL HEALTH [] MAALOR ;F Me. El_SANITARY,SEWER DISTRICT SwimPoolApp_201 1.doc revised 03/16/11 CITY OF CUPERTINO D FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10825 STEVENS CANYON RD DATE: 09/29/2014 REVIEWED BY: MELISSA APN: 34217075 BP#: *VALUATION: $6,500 *PERMIT TYPE: Demolition Permit /'IAN CHECK I "'F. PRIMARY PENTAMATION USE: Swimming Pool, Res. PERMIT TYPE: 1 SFPOOLDE WORK FILL/DEMO E SWIMMING POOL. FILL FOR LANDSCAPE PURPOSES ONLY SCOPE FEE ID #POOLS 1DEMOPRES 205 L"T r 'd vT A Mr,tea _ . 1 s� Phf ld" 1'lcrrt C heei L c.. i'at_C'1«> i€ P.;;uit F'c:e� Tlaam/>. t�icx :1ecFr. his,r_ F-1 I E3 �!�:c. 17est1 i eI'Iumb, Insp. Fee- NOTE: ee NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eft.' 711113) FEE QTY/FEE MISC ITEMS Plan Chcck Fee-: stippl, PC Fee A Permit Fee: $329.00 Suppl. Insp. Feer Reg. ® OT F0--01 hrs $0.00 <°POrtnii Fee: {on,-o,,,cfio?a '7'c;XFA T'(Ts. Strom Motion Fee: IBSEISMICR $0.85 Select an Administrative Item Bldg Stds Commission.Fee: IBCBSC $1.00 $330.85 $0.00 T0FEE: $330.85 1L Revised: 08/20/2014 ,I •BEST 330 S F- .3oXli t 5 6 r4F3rEFAA15Al?- A- "oN/ V 13 6 � 1 ►=�� it�Nd S c nth�h,� \ I NoTr p R-Eve w' 1EQ 01'ptIA W T Ll -.ri> 13 C/+FPE L vtvr,S Afi3AND40A1er �0TJ4 1 ,A/E All- w 1 a S25 �t vr�ivs C,9�6'v 90 C YoE- 9/7- OS-L13 CUPERTINO o auildina Dpoart►nen I f I _ REVIEWED FOR CODE COMPLIA t Reviewed By: C;OfvIMUNITY DEVELOPMENT DEPA MENT I j BUILDING DIVISION - CUP INO ' APPROV This set of plans and spe ons MUST be kept at the eb site durin ruction. It is unlawful to make any O Y ch - s or alterations on same, or to deviateICE I erefrom. withc.,; a,�proval from the Building Official. The Stamping of:h. . p!an and specrf,ca'jons SHALL NOT be held to per, al of the violation 5 o a r i ce or State Law. r 1 `E_RMIT.#_ -- -�1 W — — RECEIVED I SEP 2 9 264 SWEE r nV COMPACTION REPORT IS REQUIRED SHOULD THE IVor" T 6 Sys ARAT;:n AR;:A RIF mri ARFn am III nm c33 mi Tuc ct rn tote