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04070124 CITY OF CUPERTINO a-x+:: 4e&7777'- �y�'�'/"'�I ` BUILDING DIVISION PE COI VTOR�N 511 ON. BUILDII UADDRES^l LIFETIME POOLS INC """'04070124 OWNER'S NAME: PERMIT LEVE DATE EARL SUT7ON/S11TT0N SWIM SC (7)(7,910 SAX ANTON TO RD /21 /2004 NE: SANrfARY O. CONTROL NO. (408) 73R-1 576 ARCHnEC(ENGINEER: BUILDING PERMIT INFO BLDG O BLECTO PLUMS MECHO 00 LICENSED CONTRACTORS DECLARATION Job Descri tion W I hereby affirmt I am reaction d under Provisions or ChPrer 9(commene ng p NN Swum 70x10)of Division 3 of the Business and Profesan.Code,and my It==u b force effect. 30-DAYS TEMP PERMIT (EXPIR. 08/21/04)Uclass Lu.a Dzte cam DEC ORIG. #04050116 ARCHITECTS hand DECLARATION 1 undcrmnd my plans Msil h used u public records by Licensed Professional OWNER-exempt fr DECLARATION 1 hmby.(Su an 1 am exempt from to Conlon,CoLicense: Law for Ih county B O which masa&. (anion couRe.Business and Professions Cade:Any city an $ which requims a permit m c me,din slur.Impmse,demnlW,Il mpsig ed structure �^ primmsliensedp penman 10 prevision of reattach ramor Llcmo Ill. gLaw(Chumrnt - �< thamhlcllttnteJ pumsnua Ore prevision of the Conrmmrt littnxe Uw(Chepur9 Sq.Ft.Floor Area Valuation $0 $ (commencing with Scubm TOM)of Dbiion 3 of the Busineaana Prafessinns Cotle)ur Out em is mompl rhernfrom and the basis for the alleged exemption.Any violNon of Section 7031.5 by any,applicant for a permit Wbjam the APphanl m a cw0 penalty of APN Number - Occupancy Type at more Jason Ove hMmd dollars(5500). ❑Lasowneroftheproperty,mmyemplaym with wagessidnabolecompewtion, 32633102 . 00 will do the work.amd theamclure ltnot Intended ofoflewid fertam(Sec.70",Business Required Inspections and PmTh fassions Caen: e Commute,Licettae raw docs Mr apply m an owmr Of q p prepenywh Wilasorimproms themmt.and who doesauhwmthimulf m Waugh his awn employees.Moulded snit such impmsetvrnu art hem misread aroRered for sale If. hawems.the building or h&prommrnl is sold within aro Kar of uampution,the aw au- r builder will hive the burdah of proving that he did act build or improv for purpose of C1.u owner of du Properly am oeluaivcly canmmmfng with licensed contnn m em )` mm du project(See.7041.Bounce;and professiom Code:)The CanrrumYs U. terse raw does not apply an an owner of property went Wllda or improms tamer,and. ;!n,�Ulicmc ehproja with eonuamor(O licenced Pu ma&m dre CammrnoYt oer .B se PC fm is recon I�DauORK 5 al ofpedurya DECD :n&antler peulmy of perjury ane of Ilrc following dalentiws:maintain eCatiResu of Consu n.M self-insum forwodreh Campen-- 13widen,u provided for by Section 3700 of the labor Caac.Ion m the perfoana,o work for which Nu Permit is Wood. ❑I love sed will maintain Wa lmr's Compensation Imursoce,as required by Suwon 3700 of Om Labor Code,fm the performance of the work for which this permit Is laud. My Worker's Compensation Insurance carrier and Policy number arc: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('Ihbuaion need not her mpleud lite permit is foram hmearddollan(5100) or ossa) I unify that in the performance of to wart for which this permit is leaned,I Nall ha employ any person in any manner an u to become subject an Ou Watters'Computsemon Laws of California.Date AMPilrsm NOTICE TO APPLICANT:If.after making this Certificate of Exemption,You should become subject m the Warker'a Companantiun provisions of the Labor Cade.you am Oforthwith comply with each provivons Or thea permit shall be demand mmked. CONSMUCION LENDING AGENCY I herebywhich m Nat than b s ad(seem 30 lending agency for the performance of ZI thewart fm which Wtpamiluiwiutl(ses.3097.Civ.C.) lender's Name z Ianddt Address I cenify Out 1 hue read this city and coup dna tau Nat Inc sbon Information u !' coon.I omm m comply wire all city and county ordinances and suer law, m VC building ndoned pro and hammy nuNon p mpsnenuOtes of Nis clay m tour upon Os (L1 anove.(We)as property far Insinuation keepho . (We)agm r m an.and dna trap hanmkss the y are of Cupertino against �� yary Ilabllidu,lodgmenu,cosu antlesperm which may in any myaceme agdnnwiia City j7 in comequntt of the g 'ng of pe r'r APPLICA NDE NO ND ILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE S. Re roofs gig not Applign m D HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ou appliont or in=Wilding=upset sore or handle humorous Material wi defimd by the Cupm1m.Municipal Code.Chapter 9.12.and the Health and Safety Cale.S«tion 25532(a)7 cJ All roofs shall be inspected prior to any roofing material being installed. 'o Will the applicant or future Wilding occupant um equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove it hr❑urYes yJ {dnus air cmmminanu an de0ncd by the Bay Ares Air Quality Management all new materials for inspection. District? ❑Yes I have mad Ne heturdoua maurielamquimmew underChpurli.95 of te Cables. nu Health Sain bm25 5,25533 and25534.Intimation!thaifthe Wilding docs no lly a 4 it u my rctpomlhilily m nndfy W aot cupof the mgmrc y1�'mt miammnanCertificate oraN Signature of Applicant Date was or aarnadr em D„6 All roof coverings to be Class"B" or better • • Community Development 10300 Torre Avenue s✓ Cupertino CA 95014 Telephone(408) 777-3228 �UPCITY C�T1N0 Fax(408)777-3333 Building De artment JOB ADDRESS. PERMIT # 6VO-5701 ib. OWNER'S NAMEV PHONE # GENERAL CONTRACT FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving 1-4 Plastering Plumbin Roofing Septic Tank Sheet Metal Sheet Rock z! Owner/&—a or Signature Date • CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 32633102 . 00 DATE ISSUED. . . . . . . : 07/21/2004 RECEIPT 4 . . . . . . . . . : 26382 REFERENCE ID # . . . : 04070124 SITE ADDRESS . . . . . : 10455 BANDLEY DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER EARL SUTTON/SUTTON SWIM SCHOOL ADDRESS . . . . . . . . . . : 10455 BANDLEY DR CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : SUTTON SWIM SCHOOL CONTRACTOR . . . . . . . : WHITFORD, KENNETH LIC # 39 COMPANY LIFETIME POOLS INC ADDRESS 910 SAN ANTONIO RD CITY/STATE/ZIP . . . : PALO ALTO, CA 94303 • TELEPHONE . . . . . . . . : (408) 738-1576 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ------ ---- ------------- ---------- ---------- --------- - ---------- ---------- BTEMPPERM FLAT RATE 1 . 00 200 . 00 0 . 00 200 . 00 0 . 00 ---------- -- -------- - --------- ---------- TOTAL PERMIT 200 . 00 0 . 00 200 . 00 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 200 . 00 136 TOTAL RECEIPT 200 . 00 • (# 04bj� ri6 � *CITY OF CUPERTINO� •CUPE PERMIT APPLICATION FORM RTINO ° z APN# _�7Date: J 0 Building Address, Mailing Address (if if rent m buil i g address): 0 y5"S KiJI fir. Owner's Name: Phone #: &,( S o/f/ Contractor:M License#: /v �-;W-e ad/S Contact Phone: 409-3)3- Z Cupertino Business License#: �F-0$,I Fax: �041-297400 Building Permit Info: Bldg ❑ Elect ❑ PWmb ❑ Mech El— Job Job Description: Residential ❑ C erci 1 Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occuparicy Grou : Type of Construction: Please check this box roject is a second-story addition: ❑ Pro'ect Size: Standard ❑ Lar e ❑ Ma'or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M•Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 ' *ITY OF CUPERTINOO CUPEI�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOM IP New Comm Plumb PLUMBING BOVERTI1v1E Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING . BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackf10 PLUMBING BPSTORM StomvRam Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAMIAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BRENMEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BRE OCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 WITY OF CUPERTIN(O CUPEI�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECLAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mecb Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3