12050104 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21746 NOONAN C'I (:ON FRACfOR:'I"B1T'7tf Hf•.i31:;CJ:1(M INF.D PER%I I 'NO: 12050104
OWN'ER'S NAME: KENDLIi VERN K AND BELINDA J n --Trl,2 DATE. ISSUED:05/10/3012
O VNER'S PHONE: 4089823981 J PuONE:No
LICEN'SEI)CONTRACTOR'S DECLARATION r r r
l t/` _� BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic,#- 92 b 6 r r (—
�if MFCII RESIDENTIAL COMMERCIAL.
Contractor _ Date -_9 —/0—/1-)—
I hereby affirmall am licensed under the provisions of Chapter 9 JOB DESCRIPTION: DFM0I.11]ON OI'I(XIS'I'ING 450 SQFI"IN-GROUND
(commencing with Section 7000)of Division 3 of the Business&Professions SWIMMING
Code and that my license is in full force and effect. POOL,
hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate ol'conscm to self-insure far 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.
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 Sq. Ft Floor Area: Valuation:$5000
permit is issued.
APPLICANT CERTIFICATION APN Number:35719067,00 Occupancy Type:
I certify that I have read this application mid 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)ugrcc to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
gramingofthisPermit. Additionally,the applicant underst:mdsand will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source r ulations per the Cupertino Municipal Code-Section
t< Issued by: %�/V ,`7/�tG>� Date:✓'%D - ig
Signature �f7—
❑ OWNER-BUILDER DF-CLARArill ON
RE:ROOFS:
I hereby affirm that I am exempt from the Contractor's License law for one of All root's shall be inspected prior to any roofing material being installed If it roof is
m
the following two reasons: installed without first obtaining an inspection.I agree to reove all rte%% nunerials Ibr
1,as owner of the property,or my employees with"'ages as their sole compensation, inspection.
will do file work,and the structure is not intended or offered for sale(See 7044,
Business&Professions Code) Signature ol'Applicant: Dale:
I,as owner of the properly,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business&Professions Code),
ALL ROOF COVERINGS TO BE;CLASS"A" Oil[It,1-1
hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Ccrtilicate of Consent to sclkinsure for Worker's HAZARDOUS NIA FERIALS DISCLOSURE:
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 695 of the
performance of the Mork lir which this permit is issued, California I lealth&Sefct% Code,Seclions 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapler 9.12 and the Health&
Section 3700 ol'the Labor Code,for the performance of the work for which this Safety Code.Section 25532(a)should I store or handle hazardous material.
\dditiomdly,should 1 use equipment or devices which emit hazai dons air
permit i5 issued. contaminants as defined by the Bay Arca Air Quality Management District I will
I certify'that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's I lealth&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of Culitbrnia. 11;after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Ownrr or au haze a
forthwith connply with such provisions or this permit shall be deemed revoked. ,
A PPIJCAN'T CERTIFICATION CO:NSTRUCIION LENDING AGENCY
I certify that I have rend this application and slate that the above information is I hereby affirm that there is a construction lending agencv Ibr[lie performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating lir which this permit is issued(Sec.3097,Civ CI
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We-)agree to save
indemnify'and keep harmless the City of Cupertino against liabilities,Judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additiomlly,the applicant understands and will comply ;\RCI I I"I'F.C'I"S UF.CL.U(A'IION
with all non-point source regulations per the Cupertino Municipal Code.Section
9.18. 1 understand nry plans shall be used as public records
Signature Date- Licensed Professional
CITY OF CUPERTINO D
191 . FEVESTIMATOR— BUILDING DIVISION
ADDRESS: 21746 Noonan Ct DATE: 05/10/2012 REVIEWED BY: Sean
APN: b BP#: a0 5 V D -VALUATION: 1$5,000
*PERMITTYPE: Demolition Permit 1 PL,INCl/ECKTTPE:
PRIMARY Swimming Pool, Res.' PENTAMATION 1SFP00LDEM
USE: PERMIT TYPE:
WORK Demolition of existing 450 sq ft in round swimming pool.
SCOPE
FEE ID /l POOLS
1DEMOPRES 1
dlech. Plan Chrck Plumb. Plun Check /ileac. Plan Check
llrch_ A,m it Foe' Piumb. Permit Fac': I Flet. Pennit Fre:
Otho Much. /n.rp. Ocher Plumb Insj,. Other F.lec.1nsp. El
,Ilar/r. Imp. Fcc: Plumb- Imp. Fee: Elec./aSp. Farr:
NOTE: This estimate does not ineludejees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prellmina information available and are only an estimate Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Chuck l•ee: -
Suppl. PC lire
l'hnn h.1,l'leCh./Clea.
Permit Fee: $300.00
Suppl. Insp. Feefl Reg. Q OT p,0 hrs $0.00
PhImh.h1tech./lolac
l'lumh.iildecll./E!c•c Purntit Fec"
C onstru tion Tax.
Arhnimsnvuive Fec:
Itork Without 1'ermiI7
,I dl-om-ed Plulmin,g Fees:
Trovel Doctnnewolinn Fees:
Saone Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: i IBCBSC $1.00
SUBTOTALS: $301.50 $0.00 TOTAL FEE: 1 $301.50
Revised: oa /
SWIMMING,POOL I SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 S P
CUPERTINO (408)7T7-3228- F AX(408)777-3333!buildingecuoertino.oro
PROJECT ADDRESS 1 -7 Li riI AM a 35 n Y O/
PFWNE EMALL
O b -9 g q P,I ✓Y ov%ICC, — lu It-r u�toT
m4wrADDRESS I CITY, STATE,ZIP FAX
C+ •1-f
CONTACT NAME I PHONE E-MAD.
STREET ADDRESS CITY.STATE,ZIP FAX
❑OWNER ❑ owNE-BUILDER ❑ OWNERAGENT I ❑ CONTRACTOR ❑CON RACfOR AGENT ❑ ARCNIT CT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMELICENSE NUMBER LICENSE E HUS.LIC a
N - (fr/�✓6T
COMPANY NAME X E-MAIL FAX
1i. �d0 t ti -� H.. 1 I
STREET ADDRESS .STA ZD' PHONE
lo, a e SS 3
ARC}DTECC/ENCNEERNANTE LICENSE NUMBER BUS.LIC a
COMPANY NAME E-MAIL FAX
STREET ADDRESS CTIY,STATE,ZIP PHONE
DESCRIPTION OF WORK
-�i �ti � eey cr U) DesLv r f '
I
USE OF )(SFD or Duplex ❑ Multi-Family TYPE MATPRIALTYPE(CODE) AREA (SQ.FT.) VALUATION(5)
i
STRUCTURE: ❑ Commercial POOL
G Use s �
POOIJSPA MATERIAL TYPE CODES: SPA
V - VINYL-LINED
P - FIBERGLASS DEMO
0 - GUNITE
P - PREFABRICATED p^REEESVBQH.Y r ^ - S'- r :''" TOTAL VALU TION:
b"�i2e."
By my signature below.I certify to each of the following: I aim 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 laws relating to building constru cm. I authorize representatives of Cupertino to enter the above-identified!prroperty forinspectionpurposes.
Signature afApplicanUAgent r�/ -��/� Date:
SUPPLEMENTAL INFORMATION.REQMED t"'�a.,; -r aaEi casco• i'+cv�"r,�5 i v><L=;
_Commercial or Multi-Family Buildings with Public Sw®ming Pools:
60
Department rc+slTiU®4YG.DHZC-lEnr .� hy .'
Department of Environmental Health approval required.
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Vicky r�\ Co � PC, MAY 102012
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'i'o-CA-cp co OFFICE COPY,
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BUI TWO I c' 108.00 J
� APPROVED �
This set of pian9 and specifications MUST be kept at the
Job site during bonstruction. It is unlawful to make any
changes or alterations on same,or to deviate
therefrom,without approval from the Building Official.
The stamping ofIthis plan and specifications SHALL NOT I _
Cor(-vcG�ov CO�t`�liC-�
be held topenhitortobeanapproval ofthe violation I ���e Sirnr^u^S 4ZS SSD 3D
of any prroovislors of any
//City Ordinance or State Law. I
BY. , '/L Z- o+.\ CC,
1 DATE - .o / 21746 Noonan Ct., Cupertino, CA 95014
PEAMrr NO. o Santa Clara County, USA
scale 1 : 200ft