13110042 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 924 SAGE CT CONTRACTOR:HAULING PROS PERMIT NO: 13110042
OWNER'S NAME: MIRANDA HANSEL.AND MANNE PO BOX 4033 DATE ISSUED:11/07/2013
OWNER'S PHONE: 4083821055 WALNUT CREEK,CA 94596 PHONE NO:(925)682-8987
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL[]
License Clas .. Lic.# lX/ S DWL POOL REMOVAL 634 SQ FT
Contractor Date
I hereby affirm that I am licensed under the provisions o /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
erf rmance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5000
ave 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:35906007.00 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 WIT 80 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 D F OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 2
costs,and expenses which may accrue against said City in consequence of the Issued by: Date: l� ?
granting of this permit. Additionally,the applicant undestands and will comply
with all non-point source regulations perthe Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Dated 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.
❑ 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 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,Section 55 ,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ages Date: 7
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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
111 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION v
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 S
CUPERTINO (408)777-3228•FAX(408)777-3333•building aacupertino.org
PROJECT ADDRESS • APN# S U
y�
(v�
OWNERNAME [ �'f���A/ PHONE �ea /0� E-MAIL `„Jy
STREET ADDRESS 1�IBJ rl C Y, STATE,ZI FAX
r
CONTACT NAME 7 PHONE E-MAIL
STREET ADDRESS �/��( CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ACONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER Q LIC SE TYr BUS.LIC#
COMPANY NAMEXpR J^
E-MAIL 1 ��_/_/ t` FAX
07
STREET ADDRE6r / ,, CITY,STATE ZIP �(Uj v ^A PHONE �g
ARCHITECT/ENGINEER NAME LICENSE NUMBERL v L 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
POOUSPA MATERIAL TYPE CODES: SPA
V - VINYL-LINED
F - FIBERGLASS DEMO .
GUNITE
P - PREFABRICATED TOTAL V.
By my signature below,I certify to each of the following: I am the property a authorize ent 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 esc' n of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bui ' g nstruction. I authorize representatives of Cupertino to enter the above-'den'fled property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMEFA INFORMATION REQUIREDa
,I
Commercial or Multi-Family 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: 924 sage ct DATE: 11/07/ 0013 REVIEWED BY: Mendez
APN: BP#: "VALUATION: $5,000
*PERMIT TYPE: Demolition Permit PLAN CHECK TYPE:
PRIMARY Swimming Pool, Res. PENTAMATION 1SFP00LDEM
USE: PERMIT TYPE:
WOR* ool removal 634 sq ft
SCOPE
FEE ID #POOLS
1DEMOPRESou
1
X Bar
:"a.v r
.tech. Plan Check Phanb.Plan Check Elec.Plan Check
;Ltech.1'ennit Fee: Plumb.Permit-Pee: Elec. Permit Fee:
Flf,ch.
-kfech.Insp Other-Plumb Insp. C)tltet Elec.InInsp.Fee: Plumb. Insp. Pee: Elec,Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These&es are based on the prelindna information available and are only an estimate Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. N..:'Fen
Plumb.11fech./Elec
Permit Fee: $319.00
Suppl. Insp.Fee-.0 Reg. ® OT F070 hrs $0.00
Plumb./illfech./Elec
P1umhAWech./1'1ec Permit P'ee
Construction Tax:
Adininistrative Fee:
Work Without Permit?
Advanced Planning Fees:
Travel Documentation Fees: . .
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Feer 1BCBSC $1.00
n
_ ;w $320.50 $0.00 ' OALTEE $320.50
Revised: 10/01/2013
102.20
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