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14100097CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 874 BROOKGROVE LN CONTRACTOR: ZL CONSTRUCTION CO PERMIT NO: 14100097 OWNER'S NAME: WALNUT CREEK, CA 94598 PHONE NO: (925) 899-5704 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class_ Lic.# G Ci3 Z SFDWL POOL REMOVAL 300 SQ FT 'Z L C- a 1 ( LA Contractor t Date 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 Sq. Ft Floor Area: Valuation: $4500 of the work for which this permit is issued. LIerformance Ia will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this APN Number: 37539042.00 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 D YS OF IT 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 LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses ch may accrue against said City in consequence of the granting of this mit. dditionally, the applicant understands and will comply Issued by: Date with all non -p nt sourc regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9 18. FF d t� 6 Signat e Date l 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. b7 E]OWNER-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 usea ment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the ay rea Air Quality Management District I performance of the work for which this permit is issued. o Municipal Code, Chapter 9.12 and will maintain complianAons I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Co5533, and 25534.Section 3700 of the Labor Code, for the performance of the work for which thisOwner or authorized agDate: 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 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION v\ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building()cupertino.org SP PROJECT ADDRESS (,G. -( /p APN # -3-75 OWNERNAME _ STREET ADDRESS 3,rPv w{ ,,oar L 7�JJ CITY, ✓TE, ZIP y�•,,�J1 c, I� FAX CONTACT NAME G� SCU xG vE1 PHONE G�. S (O ' 3 cL E-MAIL �irc•n CAIrCV 2 L� C ' C G STREET ADDRESS ,� i Z CITY, STATE, ZIP o.✓at�.,� �e� �, CiAr FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEt� LICENSE NUMBER 3 Z-3,- 7 LICENS TYPE BUS. LIC # C - C c4r \1<0Q�4o COMPANY N4bl6-- cV-\ C, CC)� E-MAIL �v�,n Ws c� 2C, G ' Cc FAX STREET ADDRESS CITY, P ONE ( /� f 7 b ' eC� �O b ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Lz USE OFD or Duplex ❑ Multi -Family TYPE MATERIAL TYPE (CODE) AREA (SQ. FT.) VALUATION ($) POOL STRUCTURE: ❑ Commercial POOL/SPA MATERIAL TYPE CODES: SPA V - VINYL -LINED F - FIBERGLASS DEMO G - GUNITE P - PREFABRICATED R'���Y,b J P ii TOTA TON: iv - By my signature below, I certify to each oft llowing: I am the property owner or authonze to act o roperly owner's behalf. I have read this application and the information I have vided i correct. I ha ead the Description of Work and verify it is a I agree to comply with all applicable local ordinances and state laws relating t uilding co struction. u orize representatives of Cupertino to enter the abovve-intified p operty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTFO ATI REQUIRED o ,ICE USE ONLY K TYPE }°' ROUTING SLIP Commercial or Multi- amily Buildings with Public Swimming Pools:77 " Department of Environmental Health approval required. OVFd2 T HE MUNTER �� ���,� � ❑ B�JILDING DEPT �, EXFI2'S5 r ❑ PLANNING DEPT IISTANDARD ❑ PUBLIC WORKS DEPT LARGE: ❑ ENVIRONMENTAL HEALTH MA7.OR�`=� , -. ' "�' ❑ S,'�NITARYSEWERDISTRIC!T SwimPoolApp_201 Ldoc revised 03/16/11 CITY OF CUPERTINO FM -7 FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School �f' I 'rh— f ". -- A—d — fho rnlim nnru ;afn—nt;n" —iMhfa and "ro n"hy a" pvt;mato rnntart tho Dont for addn'l info_ FEEITEMS (Fee Resolution 11-053 Eff. 711113) 847 BROOKGROVE LN DATE: 10/1612014 REVIEWED BY: MENDEZ IVAADDRESS: APN: I BP#: *VALUATION: 1$4,500 *PERMIT TYPE: Demolition Permit P/AN 0 11, CK PRIMARY Swimming Pool, Res. USE: I PENTAMATION M I PERMIT TYPE: 1SFP00LD WORK SFDWL POOL REMOVAL 300 SQ FT SCOPE Suppl. Insp. Feer Reg. 0 OT"00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School �f' I 'rh— f ". -- A—d — fho rnlim nnru ;afn—nt;n" —iMhfa and "ro n"hy a" pvt;mato rnntart tho Dont for addn'l info_ FEEITEMS (Fee Resolution 11-053 Eff. 711113) -2 PfUr" 'ke Phwib. Plan Checi, I I — P W", Pbzn i.'heck Fee: 11ho'ni". Perlil 11,'. 1-�*Ie< Fl-(- L<h/�cs11c,h, Other Plumb fraP. 0he�� lllcc h' fao'�- I "C" Plufjlb. hul). Fee: fhx. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School �f' I 'rh— f ". -- A—d — fho rnlim nnru ;afn—nt;n" —iMhfa and "ro n"hy a" pvt;mato rnntart tho Dont for addn'l info_ FEEITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan (heck Fee: 'A suppl. 1'(1' FOCI Phovb Permit Fee: $329.00 Suppl. Insp. Feer Reg. 0 OT"00 hrs $0.00 Porinit Fee: Fee: H"ork 'ees. Strong Motion Fee: IBSEISMICR $0.59 Select an Administrative Item 1 Bldp- Stds Commission Fee: IBCBSC $1.00 42513 '1f1�- MAN x0;W'fl1 $330.59 TOTAL E $0.00 F E: $3 Revised: 08/20/2014 GW \NkN, E��e b i Q 30 0 This of pi ns aPp lab Site sPe�i,`icat;a,?s T �L`rt^� COnu R#11Sr ch, n z^trUct. it is be kept at the theret�� pewit ;oj'`teratiorrs cn saE�'��°i torf.ke an t a� ce�/ Same, cr t; Y .r rt c Cf �,� ;i S; ,fi�atz > e n AU 00, i'L'cr. c3 Gv1G� sc6pc, 3�It `t > ov CL{3cc�= air.\\ 4 1) 0 o �. CUPERTINO uiirlincr nepartmenf 2014 '.;C)DE COMPLIANCE. r iwecs By: