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15050009 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20220 JOHN DR CONTRACTOR:BUSTER BUILDING PERMIT NO: 15050009 OWNER'S NAME: SAN JOSE,CA 95127 PHONE NO:(408)251-5446 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ DEMO/FILL(E)SWIMMING POOL&FILL TO 90% License Class Lic.# ::�' ,�t,�J� .�� 3 CERTIFIED COMPACTION FOR FUTURE CONSTRUCTION Contractor d04-, P a � 7, -. 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 pe mance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2500 I 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:36935005 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 WITIIIN 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 ED 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 - l granting of this permit. Additionally,the applicant understands and will comply Is Date: S with all non-point source regulations per the Cupertino Municipal Code,Section 918. r RE-ROOFS: Signature Date 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) 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(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,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: V J_A-- _- Date: S'--,i`I 5' 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 CITY OF CUPERTINO D FEE ESTIMATOR-BUILDING DIVISION JUJADDRESS: 20220 JOHN DR DATE: 05/04/2015 REVIEWED BY: MELISSA APN: 369 35 005 BP#: *VALUATION: $2,500 *PERMIT TYPE: Demolition Permit P1,,-1 N CHECK 7TPE. PRIMARY PENTAMATION USE: Swimming Pool, Res. PERMIT TYPE: 1 SFPOOLDEM WORK DEMO/FILL E SWIMMING POOL& FILL TO 90% CERTIFIED COMPACTION FOR FUTURE SCOPE CONSTRUCTION FEE ID #POOLS 1DEMOPRES 1 /tech. Plan Check Plrunla.flan Check 1,lec.Plan Check mech. Permit Fee: Plumb. Permit Fee: Elec. Permir Fee: Other A/ech. Insp. Other Plumb Insp. Other Elec.Insp. 1.1lech.Insp. Pee: Phimb. hasp. Fee: Elec.Insp.lee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS(Fee Resolution 11-053 E{f. 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Sz ppI. P(I Fee Phanh.&Iech.iElec Permit Fee: $329.00 Suppl. Insp.Fee-(D Reg. Q OT 0.0 hrs $0.00 Plumb.111ech./Flee Plumb,/.Wech.iElee Permit Fee: Construction Tax: Adrninistrative Fee: 14,'ork kNthout Permit? Advanced Planning Fees: Travel Documentation Fees: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 suBTOTALs: $330.50 $0.00 TOTAL FEE: F $330.50 Revised: 04/01/2015 SWIMMING POOL / SPA PERMIT APPLICATION OD COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 S P CUPERTINO (408)777-3228• FAX(408)777-3333•build i ng(cbcu perti no.org r \ PROJECT ADDRESSAPN# 6 3 O z o22� - 1041701-. OWNER NAME STREET / n CITY, STATE,ZIP / FAX Z O 2 U J J n I/r. �i. ,tr f�'�'� d C Y�9 -Z7� /r CONTACT NAME;/ PHONE E-MAIL /( c rj 9 FAX STREET ADDRESS /��1,-4 /-L,_ CITY,STATE,ZIP (.�� /vSe' C, g!/t8' 7-1/a 1,-2 7 - ?IF _0 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR BIC'ONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME / LICENSENUMBER LICENSE TYPE BUS.LIC# aJJ 4 y i Ae,-j J ^2 vJ 3 L G COMPANY NAMEy� E-MAIL / FAX �t 9"S A., iJ✓//rJ'ry b t ld/%a ems" 14Ile, 0e_ t/LTJ—Z7 STREET ADDRESS CITY,STATE,ZIP PHONE Z s /t/, r,'i ��, J�3z L$ uoS�- z z ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK i UI(d- G 6 le e ;l( ��" /O +t C-e-i % /ems/ �✓ u G��3 r y�f'C�� / e ¢'1 USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION($) STRUCTURE: ❑ Commercial POOL POOUSPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO G - GUNITE P - PREFABRICATED TO"�IrYALU®TI@J�•, [,�� By my signature below,I certify to each of the following: I am the property owner or authori nt to act on the property owner's behalf. ave read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agerit: Date: SUPPLEMENTAL INFORMATION REQUIRED „ „oFPicE irsE oNLs UTI - _Commercial or Multi-Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. ❑ OVER-THEcoINTEx ❑ BUILDING DEPT 4 EXPRESS k ❑;PLANNING DEPT ❑X;PUBLIC W' ORKS'DEPT ❑� LARGE � ❑�ENVIRONMENTALHEALTH �. MA7UR F ❑.-SAI31TARYrSEWE$iDLSTRICT , SwimPoolApp_2011.doc revised 03/16/11 A ! Z f! CUPERTi IiV0 Building Departnent MAY 0 4 2015 REVIEWED FOR CODE COMPI-V NCE Reviewed By. 5 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION - CUPERTINO APPROVED This set of plans and specifications MUST be kept at the job site during construction. It is unlawful to make any changes or alterations on same, or to deviate `v therefrom,without approval from the Building Official. <` ® The Stamping of this plan and specifications SHALL NOT Al - ----beheld to permit or to be violation of any provi ' 7,rS tate Law. PERMIT# /-rO