11060204 CITY OF CUPERTINO BUILDING PERMIT
BI ILDING ADDRESS: 1 127 S STELLING RD CONTRACTOR:STEVEN&LANE PERMIT NO:11060204
KRUMPOTICH
OM NER'S NAME: STEVEN&LANE KRUMPOTICH 1 127 S STELLING RD DATE ISSUED:06/24/201 1
ON%NER'S PHONY:8317687711 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED(ONTRACTOR'S DECLARAI-ION
Bl'l1.DING PERMIT INFO: DLUG F ELECT r PLDMB r-
mcnsc Clus, Lic.M F r- r
MECH RESIDENTIAL COMyf EFRIAL
C'nm+cu+r._ Date
—
I hereby affirm that I am licensed under the provisions I'Chapter 9 JOB DESCRIPTION.SWIMMING POOL RLMOVAL 400 SQ Ff
commencing with Section 7000)of Division 3 of the Business&Professions
Cade and that my license is in full roll,and effect.
1 hunch,affirm under penalty of perjury one ofthe following two declarations:
I have and mill nmhnuin 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:$3500
1 hale and will maintain Worker s Compensation Insurance,as provided for by
ticetion 3700 of the Labor Code.for the performance of the work or which this
panni
t is iS,ued APN Number:36222011-00 Occupancy Type:
APPLICANT CERTIFICATION
I anip that I la,e read Ih s application and smte that he above infnrmat—i, PERMIT EXPIRES IF WORK IS NOT STARTED
e+r—L I agree it,comply with all city and county ordinance%and%late laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of'tilts city to enter
upon the above mentioned property I'or inspection purposes.(We)agree to save 180 DAYS F LAST CALLED INSPECTION.
uid,a,n 6 and keep harmless the City of Cupertino against liabil ices,judgments,
costs,and expenses which may accrue against said City in consequence of the �/
n,uuna Ortho permit Additionally,the applicant understands and will comply Issued by: Date: LB 29—
wah till noir-point source regulations per till Cupertino Municipal Code.Section
yl%
So'namrt•_ Date RE-ROOFS:
All roof's shall be inspected prior to any roofing material being instal led If a roof is
installed without first obtaining an inspection,I agree to remove all new motorial,for
inspection.
OW.\ER-BOILUER UECLAR.4TIOV
hereby air,,,that I am rxrmpt from the Contractor's license Law for one of Signature ofApplicanL Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I.a,„+ of the property-or my emplovecs with wage,as their sole uompansation,
,,,If do the work.and the,fracture is not intended or ot7cred tier sale(Se,7044.
Dusmes,&Prolcssior,Code)
1.as owner of the focally,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
roll—the project(See 7044,[rosiness&Professions Code). Ihave read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 herehy affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declaration's' Health IS,Safety Code,Section 25532(a)should i store or handle hazardous
I hale and will mamtmn it C'enificate of Consent to self-msurc for Worker's material.Additionally,should 1 use equipment or devices which runt hazardous
Compensation.as provided til by Section 3700 of the Labor Code,for theair ontaminants as defined by the Bay Area Air Quality Management District I
peili+unince of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I hays and will maintain W'orker's Compensation Insurance,as provided for by the II'll IS,Safety Code,Sections 25505.25533,and 25534.
Kenton 7700 0l the labor Code,fbr the performance ofthe work for which this /
pelma ulssued. Owner or authrized agent: �i'fr//Date:b'�L
I unit
that in the performunce ol'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 Cahlbrnol If cher making this e,rificate efexcnoption,l CONSTRUCTION LENDING AGENCY
h—an,sublecl to the W'orker's Compensation provisions ofthe labor Code,I must 1 hereby affirm that there is a construction lending agency for the performance of
fi+mhwoh comPly with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Cr,C.)
Leader's Name
APPLICAN'T'CERTIFICATION Lender's.Address
I certils Earl 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 buildlne nstiuction.mtd hereby authorize representatives ofthls city tr enter
rupon the ahoye mentioned property for inspection purposes.(We)agree to save
ode,, I),and keep harmless the Col of Cupertino against liabilities,judgnri ARC'HITECT'S DECLARATION'
cost,.and-pen.—which mm accrue against said City in consequence of the I understand nny plans shall be used as public record,.
framing nl Ills permit.Additionally-the applicant understands and will comply
+uta all non-pour source regulations per the Cupertino Municipal Code.Section Licensed professional
tri
Signawr•. r-1�/ Date `L z—/
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Elk: Lot:
APN .. ... . .. : 36222011.00
DATE ISSUED. ... . .. : 06/24/2011
RECEIPT #... ... . .. : BS000013885
REFERENCE ID # ... : 11060204
SITE ADDRESS .. . ..: 1127 S STELLING RD
SUBDIVISION . .. . ...
CITY . ... ... ... . ..: CUPERTINO
IMPACT AREA ... . ...
OWNER ... ... ... . ..: STEVEN & LANE KRUMPOTICH
ADDRESS . ... ... . ..: 1127 S STELLING RD
CITY/STATE/ZIP . .. : CUPERTINO, CA 95014
RECEIVED FROM . . .. : STEVEN KRUMPOTICH
CONTRACTOR . ... . ..: LIC # *OWNER*
COMPANY . ... ... . ..: STEVEN & LANE KRUMPOTICH
ADDRESS . ... ... . .. : 1127 S STELLING RD
CITY/STATE/ZIP ... : CUPERTINO, CA 95014
TELEPHONE .. ... ...:
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -----—--- ---------- ---------- ---------
1BCBSC VALUATION 3,500.00 1.00 0.00 1.00 0.00
1BSEISMICR VALUATION 3,500.00 0.50 0.00 0.50 0.00
1DEMOPRE EACH 1.00 291.00 0.00 291.00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 292.50 0.00 292.50 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ------—------- --------------------
CHECK 292.50 2CO2
---------------
TOTAL RECEIPT 292.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----- -------- -----
-------- --------------------------
704 DEMO
DEMOLITION
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS:1127 s.stelling rd. DATE: 06/24/2011 REVIEWED BY: bob s.
12 APN: BP#: VALUATION: $3,500
'PERMIT TYPE: Demolition Permit
PRIMARY Swimming Pool,Res. PENTAMATION iSFPOOLDEM
USE: PERMIT TYPE:
WORK demo swimmano pool rear yard of sfd
SCOPE
FEE ID #POOLS
1DEMOPRES 1
NOTE:Thesefees are based on the prefilninary in ornurdon available and are on( an estimate. Contact the De t or addn7 info.
FEE ITEMS(P-R—haion 09-951 EjT 7�1:'l0) FEE QTY/FEE MISC ITEMS
Permit Fee: $291.00
Suppl.Insp.Feer Reg. 0 OT 0.0 hrs $0.00
Strome Motion Fee: $6:60 Select an Administrative Item
Bldg Stds Commission Fee: lecltsC $1.00 V.,5 1)
SUBTOTALS: $292.00 $0.001TOTAL FEE:1 $292.00
Revised:04/29/2011
SWIMMING POOL/SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 S P
GUPERTINO (408)777-3228•FAX(408)777-3333•buildinc cuoertino.orG
p U 20°1
PROBi3 ADDRESS '/y
o each FLI.Ac�^nu'r"1— 3� syn c'r
ADD s 4 srl a /C�1' CIT�/SfATE.Z a// 'tD J -/r
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STREET ADDRESS � CITY,SATE.ZIP FAX
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WNER ❑OWNER-BUILDER ❑OwNERAGENT ❑CONTRACTOR ❑CWORACTORA— ❑ ARCHRECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME LICENSE NUMBER LICETISETYPE Bus.LICI
COMPANY NAME E-MAIL FAX
STREET ADDRESS V c—,STATE,Zm PHONE
ARCHITEC/ENG—S.NAME LICENSE NUMBER BUS.LIC p
COMPANY NAME E-MA6 FAX
STREET AOURESB C—,STATE,ZIP PHONE
DESCRIPTION OF WORK
USE OF )�SFDor Duplex ❑Multi-Family TYPE MATERIA.ME(CODE) AREA(SQ.FT.) VALUATION(5)
SrRLCNg ❑Commercial POOL
POO VSPA MATERIAL TYPE CODES. SPA
V -VMYL-LMD
F -FIBERGLASS DEMO '
CrN
P -PREFABRICATED r$'m '. TOTAL LVA MONO '
By my sigreture below,I certify to each of the following: I am the property owner or authorized agent 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 Description of Work and verify it is accurate.I agree to comply with all applicable local
ordinances and state'.aws mlatingt ing com; n a horize rcprcse mtives ofCupertino ro cnror Ne abor-identifid property Car inspection purposes.
Signatureof Applicant/Agent Date:
SUPPLEMENTAL INFORMATION REQUIRED '
-Iiilrrr4,Y.etscvtviie-mss :.zt i
Commercial or Multi-Family Buildings with Public Swimming Pools:
Department of Environmental Health approval required.
II�sd,m�Rn� ,�r�„ ¢were wanrc€FD�r
"�iYBONM@NT Ll'fSACiv.
.�-MAJOR" �SAN1T.tRY SEWRBD6TR[CT
S.,mPooLlpp_2UI I.doe revised 03/16/11