12050205CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10320 LOCK WOOD DR
OWNER'S NAIVE: POMPOSOGAETANO F
OWNER'S PHONE: 4089103189
❑
LICENSED CONTRACTOR'S DECLARATION
License Class
Contmet" Dale '� Z
I here elfir al I am licensed under the provisions of Cho
pter9
(co en ' g wtlh Seclion 7000) of Division 3 of the Business & Professions
Code an That my license is in full force and effect.
1 hereby affirm under penally 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
performance of the work for which this permit is issued.
I have and will maintain Workers Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and stoic 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source r mo Municipal Code, Section
per the
9.18. / / i
❑ V OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
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)
h as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
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
permit is issued.
1 certify that in the performance of the work for which this permit is issued, 1 shall
not employ any person in any manner so as to become subject to the Worker's
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
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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 stale 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
CONTRACTOR: HAULING PROS
PERMIT NO: 12050205
PO BOX 4033
DATE- ISSUED: 05/29/2012
WALNUT CREEK, CA 94596
Pi [ONE NO: (925)682-8987
BUILDING PERMIT INFO: BLDG r
ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: DEMOLITION OF EXISTING IN -GROUND GUNITE POOL
519
SQFT
Sq. 171 Floor Area: I Valuation: $5000
APN Number: 34215053.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: �1Dele: ;4 J -67Q -/1
RE -ROOFS:
All roofs shall be inspected prior to any rooting material bchg installed- If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applictim Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapler6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Ileallh & Safety Co4E,5ections 25503, and 25534.
Dole: V 2 AJ _�
CONSTRUCTION LENDING AGENCV
1 hereby affirm that there is a construclion lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 34215053.00
DATE ISSUED ....... :,05/29/2012
RECEIPT #.........: SS000016930
REFERENCE ID # ...: 12050205
SITE ADDRESS .....: 10320 LOCKWOOD DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # 1
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
301.50
301.50
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
704 DEMO
OWNER ............:
POMPOSO GAETANO F
ADDRESS :......... :
10320 LOCKWOOD DR
CITY/STATE/ZIP ...:
CUPERTINO, CA 95014-2669
RECEIVED FROM ....:
RYAN E CROWNHOLM
CONTRACTOR ........:
RYAN CROWNHOLM
LIC #
33516
COMPANY ..........:HAULING
PROS
ADDRESS..........:
PO BOX 4033
CITY/STATE/ZIP'...:
WALNUT CREEK, CA
94596
TELEPHONE ........:
(925) 682-8987
FEE ID
UNIT QUANTITY
AMOUNT PD -TO -DT
THIS REC
NEW SAL
----------
1BCBSC
------------- ----------
VALUATION 5,000.00
--------------------
1.00
0.00
----------
1.00
----------
0.00
1BSEISMICR
VALUATION 5,000.00
0.50
0.00
0.50
0.00
1DEMOPRE
EACH 1.00
300.00
0.00
300.00
0.00
TOTAL PERMIT :,
---------- ----------
301.50
0.00
----------
301.50
----------
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
301.50
301.50
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
704 DEMO
CI•TY OF CUPERTINO
FEE ESTIMATOR -BUILDING DIVISION
WIADDRESS:
10320 LOCKWOOD'DR. DATE: 05129/2012
APN: BP#:
REVIEWED BY: SEAN
`VALUATION: $5,000
*PERMIT TYPE: Demolition' Permit
PL.INCHECK 7'YPE:
PRIMARY Swimming Pool, RBS.
USE:
lilec. Permi( Fre:
PENTAMATION 1SFP00LDEM
PERMIT TYPE:
WORK
DEMOLITION OF EXISTING IN -GROUND GUNITE POOL 519 SQ FT
SCOPE
Phmrh. /nvp. Fee:
FEE ID #POOLS
1DEMOPRES 1
NOTE: This estimate does not includefees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the areliminary information available and are on/v an estimate Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11)
,llr,:lr. Non C'herk
Phmrh. Plan Check
Elm. Plan Ch rk
III led). Perruit Fee
Hwnh. Permil Fee:
lilec. Permi( Fre:
Odrur .1'lmh. lap.
011ier Plumb Imp.
Olhrr Elel'. beep,
;I Ice h. bap. fl: a:
Phmrh. /nvp. Fee:
lace. Insp.
NOTE: This estimate does not includefees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the areliminary information available and are on/v an estimate Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fac:
.`upp/. PC F'vc
l'hl111/).ia'lECI,.!l:leC
Permit Fee:
$300.00
Suppl. Insp. Fee:Q Reg. Q OT
'.0,0,
hrs
$0.00
Plun,h. blech.il'lec Piavlil Fee.
C'0l,Sn-u(J1017 Ten'.
Admini.m alit e Fee:
IForh Without Permit?
Adrom ell Pla/min,g hoes:
A
7nivel Doclmnewalinn Fees:
Strone Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Olds Stds Commission Fee: IBCBSC
$1.00
s' -, SUBTOTALS:
$301.50
$0.00 TOTAL FEE:
$301.50
Revised: 05/01/2012
CUPERTINO
W P-04 -J r-�
SWIMMING POOL'FSPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300.TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinaCdcuoertino.orQ
12c�-:5 02cU�
SP
PROJECT ADDRESSAPNa
(032o Loc�c.�oo ..D�•
OWNERNA&M ajeS C/ ^NO/
-J/ /CCe./_L1Qp
PHONE (�/ate?�� DQE
-MAIL
E-MAIL
STREET'ADDRESS �%
j
CIPI. STATE Zip /�/ rO /rO/ —.
J
FAX
/0-^20 Y�
s lJ C/_U F
_
CONTACT NAME -
PHONE
E-MAIL
STREET ADDRESS
CITY. STATE, EP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
/,
CONTRACTOR NaV&•, \4h
LICENSE NURID�
GCf,NSECE
BUS. LICA
u^/
{�Tf
�6
�•t
CM0ANYNAh@ - U /n �S
(]� h �,�.
E -MALL
FAX
STREET ADDRESS `
73 �G
CTIY.2 L
x-5"3
PONE_
ac �.
�,
2 -
Sb
ARCH TECTIENGINEER NAME 'LICENSE NUMBER
BUS. LIC a
CONeANYNAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE UP
PHONE
DESCRnMONOF WORX - aU � 14e
a /�•� VS
USE OF FD or Duplex ❑'Multi -Family
TYPE
MATERLV.TYPE(CODE)
AREA (SQ. FT.)
VALUATION(S)
STRUCTURE: ❑ Commercial
POOL
POOLJSPA MATERIAL TYPE CODES: -
SPA
V - VDJYL-LRAM
DEMO
F - MERGLASS
O - GUNRE
P - PREFABRICATED
aRECEIYIRF[iY_F
TOr moo:
��.��+.
3�..nY.a•.
Q
By my signature below, I certify to each of the Follow ng: I a property owner or au ba zed agent to act on he proper y owner's behalf I have read his
application and the information I have provided u v the Descrrj�ork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil ' eton. tarize r of Cupertino to enter the above-iid/dd��ntified p pent' for inspecton purposes.
Signature of Applicant/Agent - Date: %2
SUPPLE ORMATIONREQUIRED
.moi`'.; "',"�"`.�- ,�`•
.``'•..v,._�'.�a."'.�._-�asaiGSTVSG.vNcx�sS`...
"_.,'`"- ' 4,'�
��i�,•sc
_ Commercial or Multi -Family Buildings wiff Public Swimming Pools:
;-^ yy t,•;fi '=-'tip, .
'z-'baVJfl['-C1�60
' Rl crys� �. , •v -.
Htnm¢(GDE�eTM�,^F
Department of Eovirmtmental Health approval required.
-
a
sFA.7nARt1+,'x,pDaCiwo"Rt�ta'Bt-me
LlD
�-.•i
'I "�NA]dlt: ': �Tn£' �-'�Al'NIrRRti
EBWERD6GRIQ.-��
SwimPoolApp_201 Ldoc revised 03/16/11
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
aM01iy
changes or alterations on same, or to deviate
therAfrom-
The stamping of this plan and specifications SHALL NOT
be held to {aermd or to be an approval of the violation
of any pro o! sof any City Ordinance or State Law.
DIG ,� 1�ED10 py / N PL
General Engineering Contractor, Q
Q ERMIT N0. - ---� MAY 2 9 2012
Ucarm983483.9 4448 1 BY:CPO
.00
CV
0
i
(ps
HOUSE
i
— i v601 �o ilea
his �......... ....
L
PLOT PLANS Pta S iF-sy FI
BY removedt� Area 519.58 SCOL
CflECt(£D Perimeter 94.74 R
DATE_
01
PLANNIrG D' � � CE
K�
COmy
naeE
Raw_ "Fr.
10320 Lockwood Dr., Cupertino, CA 95015
Santa Clara County, USA
scale 1 :2008