12040006 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7595 HEATHERWOOD DR CONTRACTOR:C A PERM I No: 12040006
CONSTRUCTION
OWN'ER'S NAME: KROEGER ROBERT L AND JUANITA M 579 BREEZYGLEN CT DA IF. ISSUED:04/02/2012
OWN'ER'S PRONE: 4082252219 SAN JOSE, CA 95133 PIIONE NO:(408)835-3923
❑ LICENSED CONTRAC"I OR'S DECLARATION F- F
BUILDING PERMIT INFO: I FLECPLUMB
License Class 2b6
Lic.q 3 r r r
CPsaY / 51f:C11 Nf:SIDE\fh\L COyL\If:NCh
Contractor Uatc Z
hereby a(Rrm that 1 am licensed under the provisions of Chapter 9
.IOU D4SCRIPI[ON: DI'MO 1'001.A'1SFDWL 600 Sp FI'
(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
perlormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:59800
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 I'or which this
APN Number:35929008.00 Occupancy Type:
Permit is issued
:\PPI,ICAN I'CER'I'IFICA-1'ION
I certify that I have read this application and stale Thal the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply'with all city and county ordinances and state haws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city m 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
granum"of this pr Jditionally, licant understands and will comply Issued by:a�F�/✓ AT�l7 Date: 41-
Willi all non-you n:rcgula c Cupert' IprmraStt:tion
9.18.
RE-ROOFS:
Signature Dale All tools shall be inspected prior to any roofing material being installed. If a roof is
installed without first Obtaining an inspection.I agree to renuwc all new materials for
inspection.
❑ 0"'NF.R-BtAIA)•:R DECLARA'T'ION
:
I hereby alY nn That 1 am exempt from the Cnntrnctor's License Law for one of Signature of ApplicantDale:
the following two reasons: ALL ROOF COVERINGS'1011E CLASS 'A"OR BE ER
1,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 oflhe pruperlyl am exclusively contracting with licensed contractors to 11%ZARDOUS?IA'I ERIALS DISCLOSURE
construct[lie project(Sec 7044.BnfII1e55&Professions COde)- I have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safetw Code,Sections 25505,25533,and 25534. 1 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&Safely Code,Section 25532(x)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 I,abor Code,I-r the air contaminants ns defanrd by the Iia tea Air Quality'\Ianngemcut District 1
performance of the work for which this permit is issued will maintain knoll li:ocr with the rliniwNluode, :hapten 9.12 and
haveand will maintain Worker's Compensation Insurance,as provided fir by the Ilealth&Safcty Code,Sect' 5505,2Section 3700 011hc Labor Cudc 1'or the performance ofdue work for which this 2
Owner or authorized agent air.
permit i5 issued.
I certify that in the performance of clic work for which this permit is issued,I shall
1101 employ any person in any manner so as to become subject to the Worker's
Compensation laws ot'California, Il:ullernaking this certificate ofexellption.I CONS I RUCI ION'LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code.I must I Iterebv afrm that there is a construction lending agcnev for the pedarniance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097.Civ CJ
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 count)'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 ,\RCllll'F.CI".S DF:(:LARAIION'
indemnify and keep harmless the City ofCupertino against liabilities,judgments.
costs.and expenses which may accrue against said City in consequence of the I understand nmv plans shall be used as public records.
granung 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
X17
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CAMNl#DD
BILDING DIVVISION/ i ffON opm O
�- B
APPROVED _
This set of plans and specifications MUST be kept aith
J b site during construction. It Is unlawful to make�
changes or alterations on same,or to deviate
th refrom,without approval from the Building Offici I.
e s mping of this plan and specifications SHALL
e h Id to permit or to be an approval of the violaf Z z z --
fany provisions of any City Ordinance or State Law.
By
DA
PERMI NO.
RECEIVED
OR 0 2 2012
7585 He6Ae,r%✓ood Pr.
CA ;7t i
—09 9 �-H
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35929008 . 00
DATE ISSUED. . . . . . . : 04/02/2012
RECEIPT #. . . . . . . . . : BS000016425
REFERENCE ID # . . . : 12040006
SITE ADDRESS . . . . . : 7595 HEATHERWOOD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KROEGER ROBERT L AND JUANITA M
ADDRESS . . . . . . . . . . : 7595 HEATERWOOD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5840
RECEIVED FROM . . . . : CESAR AVILA
CONTRACTOR . . . . . . . : CESAR P AVILA LIC # 33387
COMPANY . . . . . . . . . . : C A CONSTRUCTION
ADDRESS . . . . . . . . . . : 579 BREEZYGLEN CT
CITY/STATE/ZIP ... . : SAN JOSE, CA 95133
TELEPHONE . . . . . . . . : (408) 835-3923
FEE ID UNIT .QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------- ------ --------- - --- ---------- ----------
IBCBSC VALUATION 9, 800. 00 1 . 00 0 . 00 1 .00 0 . 00
1BSEISMICR VALUATION 9, 800 . 00 0 . 98 0 .00 0 . 98 0 . 00
1DEMOPRE EACH 1 . 00 300 . 00 0 .00 300 . 00 0. 00
--- -- ---- -- -- ---------- ----------
TOTAL PERMIT 301 . 98 0 . 00 301 . 98 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
------------ ----- ----------- ---- --------------------
CASH 301 . 98 CASH
--------- ------
TOTAL RECEIPT 301 . 98
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------ ---------- - -------- ----------------------------
704 DEMO
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 7595 Heatherwood Drive DATE: 04/02/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $9,800
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION 1SFPOOLDEM
USE: PERMIT TYPE:
WORK Demolition of pool 600 sq ft).
SCOPE
11ech. Plan Check Plumb. P/an Check Etc,. Plan Ch,rck
rHrdr. Perwit Fee: I'Purnh. Permit Fre: Parc. P✓mit Fre:
Other,Vech. Imp. Other Plumb Insp. Usher Pilee. Imp.
,Hath. Glary Fce: Plumh. harp. Fre: Ele,. Insp. Fre.'
NOTE: This estimate does not include fees due to other Departments(Le. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prellmina information available and are only an estimate Contact the De 1 or addn'l info.
FEE ITEMS (Fee Resolulion 11-053 Ffl. 7/l/l 1) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Swimming Pool
Suppl. PC Fee: Q Reg. O OT 0.0 hrs $0.00 $300.00IDEMOPRES Demolition
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee.0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Ta
:I dininicuralive Fee: Q
Work Without Permit? O Yes Q No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential
T ort/ Documewellion Firs: Building or Structure
Strong Motion Fee: IBSEISMICR $0.98 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.98 $300.001 TOTAL FEE: $301.98
I
Revised: 1/19/2012
DEMOLITION PERMIT APPLICATION D
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228 • FAX(408)777-3333-•buildingacupertino.ora
n I_ .%00g -00
^2v�OD�C�
PROJECT AODRESS 7575 Peah e rwopal . 9,r APNI 35 q —Z lG — VOg —O0
OWNER NAME Roper + ky-oe nr PHONE Vog-- 225_22/(, E.NA[L
s�AFFT ADORE51 75 955 /)&4 fit eYwOo c� //r =.SI'A 7rE�.rb YL7L.lrn6( C-1� FAx
CONTAR NAME ` I �r a �V J FHONE`LIOB-Z 23
E,t"'A°-
STREET ADDRESS 7s95'f Heti l/e{,wUO` CnY.STATE,,W CA FAX
T'1 C. e? .n.0 �I
OWNER ❑ OWNER-aU1LOER ❑ OOWN///E��JR AGENT ClcoM c-roR 11 CONTRACTOR AGENT 11 ARCHM(.'f ❑ENGINEER ❑ OEVELOFER ❑TENANT
CONTRACTOR NAME Cesar !//lv% a, LICENSE NUhIDEFtg230l3 LICENSE TYPE Bus.uCa 233
COMPANY NAME CA Can5-h-kc t,6 e7 E-M M _I V V FAX [j
STREET ADDRESS C, �79 e! r`ez le, (—-r CITY-STATES 115 e C14
SIS/?� PHONE-
DESCRnTION OF WORK DD �fI/ M \�C WA'[P� /'r `� f r �/ /
U O 4 Of d�,(cC4l-rc I
ems. ove dret;.t ao / c,- C-A oto/es Pdol 1a lose
RFSIDEN71AL aDWELL.Nr a :`: +OPFI L NOK s ti 1�'• - .
FLOOR AREA UNTfS - '! el - E a ..vAW ON-
'•
�CONQRCW
FLOOR
"
TYPE OF CONSTRUCTION I STORIES Q'-uy, ; n
AQNM JOB NUNMER
Lq, T VALUATION:
By my signature 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 provi correct I Descripd of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil ' answ u refv of Cupertino to enter the above-identipmp for inspection purposes.
Signatureof Applicanr/Agent Date:
SUPPLEMENTAI.INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLII'[ON PERNU-( aL�aseoNLx��..
Provide Job Number from Bay Area Air Quality Management District wvrw.baapmd.ors Q 415-749-4762. z- erw.r CK TYPE
fi W
_Prbvide three copies of a site plan showing protection for any trees 10"in diameter or more at 3'above grade
_ Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. --=�_—
_Provide a letter of inspection,t y y person(s)
msp ests,and abatement of an Hazardous Materials.Letter in be initiated b
certified in asbestos,mercury and/or hazardous material examination. rruox- -r- `'t
ate-
_ Planning Dep[clearance to verify building is not considered an historical landmark Allow 10 business days. r_'ti_..'x+•--• '.---�,-�,«. R'
lu'nrl'-
_Provide letter of clearance of all vermin from a licensed pest control contractor.
_Applicant shall call the Public Works Department at 408-777-3104 and schedule a"habitable dwelling'inspection. `"sr==�er•i=' ``-
_Provide signed Debris Bin and Recyclable Materiels form.
_Commercial Buildings Only: Provide Fire Dept clearance for fire suppression/alarm system review.
DemoApp_20ll.doc revised 03//6//1