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15060089 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21084 MARCY CT CONTRACTOR:ZL CONSTRUCTION CO PERMIT NO: 15060089 OWNER'S NAME: KIMURA KENNETH H AND SHARILYN 1765 ARKELL RD DATE ISSUED:06/12/2015 OWNER'S PHONE: 4082576159 WALNUT CREEK,CA 94598 PHONE NO:(925)899-5704 4 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL "1 DEMO OF EXISTING SWIMMING POOL(BACKFILL FOR License ClasLic.# r gqm� 4 LANDSCAPE PURPOSES ONLY) cJ ,.gird'" _ 4:s_p x",�r��_ '= -...-_�,:nom- +ca*�.�.x-•---`�`..ST Contractor f^ N'C:tN4,s�: Date l� 2T i;y, 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:$4500 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:32654028.00 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 FROM LAST CALLED 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 t I �� granting of this permit. nally,the applicant understands and will comply Issued by: Date: with all non-point so a regu tions per the Cupertino Municipal Code,Section 918. RE-ROOFS: Signature ;, - � Date 1. 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- ILDE9 DECLARATION I here y affirm that I n empt from the Contractor's License Law for one of Signature of Applicant: Date: the following two rea s: 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 o devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Ar it uality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cup mo in Pal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 0592 3 a d 25534. Section 3700 of the Labor Code,for the performance of the work for which this N a'=^r- `. } ;;''•; permit is issued. Owner or authorized agent: w 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 C034 rUCTIOXENDIING 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 918. 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•buildingacupertino.org CUPERTINO PROJECT ADDRESS �r CA__ APN# 2 OWNER NAME l U PHONE �I S, E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX CONTACT NAME PHONE E-MAIL �ll S- Cd v C_ a�3 ce Z(G Co� CCAl STREET ADDRESS CITY, TATE, ZIP FAX W w„ C" cA- ❑ OWNER ❑ OwNER-BuiLDER ❑ OWNER AGENT ONTRACTOR ❑CONTRACTOR AGENT ❑ ARC=CT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME / E-MAIL FAX Ci G oar -FI' C Gd STREET ADDRESS 1 ^ CTTY_ ST� ZICae !:�j G PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK OG �tO 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 G — GUNITE TOTAL VALUATION: P — PREFABRICATED09 RECEIVED B By my signature below,I certify to each of the following: I am the property owderNor authorized agent to act on the property owner's behalf. I have'iead this application and the information I have prov' Is con t. 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 .17 ding construct' n. thorize representatives of Cupertino to enter the above-ide pified pro erty for inspection purposes. Signature of Applicant/Agent: Date: S=r = QUI _ROt7TING!SLII'' _Commercial Swimming Pools: Department of Environmental Health approval q re uired. C7 row T�couNTER' Or BUILDING DEPT rya.rr �' t � '� :� a, � �© EXPRESS k� '" 5� �'hr�j'A�TNINCiDEBT';i 5 3 'd k '❑�STANDARD ��� r�aa�, :�,� ''��r,P�UBLICWORFtS DEPT � �"ett L❑ I ARGE 4xt "❑tENVHtONMENTAL HEAT�H SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21084 Marcy Court DATE: 06/12/2015 REVIEWED BY: Paul APN: 326 54 028 BP#: 6 *VALUATION: 1$4,500 *PERMIT TYPE: Demolition Permit PI1 P;`C fll,C:'K 7'YPE. PRIMARY PENTAMATION USE: Swimming Pool, Res. PERMIT TYPE: 1SFP00LDEM WORK Demo of existing swimming pool Backfill for Landscape Purposes Onl SCOPE FEE ID #POOLS 1DEMOPRES ,Tech. Plan Check Plum h. Plan Cheek Elec..Plan Check FI-111-111Permit Fee: Plumb. Permit Fee: Elec.Permit Fee: Other iltech.Insp:, Other Plumb Imp. Either E,lcc.Imp. !14ech.Insp. 1-'ee: Plumb. Insp. Fee: 1lec.Insp. Pee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the relimina in ormation available and are onl an estimate. Contact the Det or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: suppl. PC Fee Plumb./il,feeh./LZec Permit Fee: $329.00 Suppl. Insp.Fee:Q Reg. Q OT 0.0 hrs $0.00 1'l�.imb.lil�leeh.,'T?lec• Plunib./Mech./Flee Permit Fee: Construction Tax: Administrative Fee: T,Vork Without.I'erniit? Advanced Plarming Fees: Travel Documentation fees: � Strong Motion Fee: IBSEISMICR $0.59 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS, $330.59 $0.00 TOTAL...... FEE: Revised: 05/07/2015 i v�V� SCO�E' '�� vJPi� IST l� ��> JW t atw r err - I-Ad COMMUN1 Y DEVELOPMENT DEPARTME T �. BUILDING DIVISION - CUPERTINO BY - BUILDING This set of ns and specifications P u T be kept at the jcI site Burin -i�struc ion. is � i it�ttu y ' Chan or to devi i;e _ therefr m, without approval from the Building Official. The StIniping of this plan and specificationsecifications SHALL NOT be hel to permit or to be an approval of the violation UFFICE Omy of any visions of any CiLy Orinance or State Law. BY DAT PER 11T# 'Q=Sdev�Gz 1 N