12070105CITY OF CUI'BR•I' NO BUILDING PERMIT 1
IMILDING ADDRESS: 7625 NEWCASTLE UR
CONTRACfolt: XIRIiN1I7 CONCRETE
pll? CNIIT NO: 12070105
SOLUnoi,lS
OWN'EIVS NAME: PIiCKO PATRICIA ,M AND DONALD J
2189 SEPOINEIM AYE
DATE ISSUED:07/162012
OWNEWSPHONE: 4088071410
.NIIIYITAS.CA 95035
PHONE NO: Nuel 594-3049
LICI':.SED COI'ItACI'OIfS UICCLA RATION
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BUILDING PERMIT L\'PO: BLDG ELECT PLUMB
License Class\ C�.Lic: q
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81ECIi r RESIDENTIAL COMMERCIAL
Conmletor + � rl -Date
1 hereby'affirm that9 am licensed under the pro%isions ul'Chaptrr9
JOB DESCRIPTION`., RESIDES 'I']Al. POOI1 IMMO AND. FII.I.
(commencing will, Section 7000) of Division 3 of the Business & r'nlfe»ions
Code and thin nn' license is in full furee and effect.
I hcrcbv aflirin under penalty of perjury one of the 6)IhV.ing nen decbuotiunn:
I have and will maintain a certificatc o(consem to self insure fior Worker's
Compensation. as provided leu by Section 3700 ofthe Lahor Code• for the
pertbrnlanee of the work for which this permit is issued.
Sq. FI IInar,\tea:
Valuation: $7500
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
AVN Number: 36617081.00
Occupancy'fvpe:
permit is issued.
AppLICANT-CE lt'I'I FI CATI ON
I certify that I have read this application Laid state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
It L Ii!�'I I I IBX P I R ES I I` �YOItK I S N� I S I t� It I Is D
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
WITHIN HIN 180 DAYS OF PI'.RA'II I' ISSUANCE OR
indene fy and keep harmless the City ol'Cupertino against liabilities. judgments
180 DM'S FR Al Lr1 S"I' CALLED INSPECTION.
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally the applicant understands and still comply
with a - oinl source regulations per the Cupertino Municipal Code. Section
Issued 1) V: Date:
9.18. �
'
Signature _ Date UG �J—
1
It 17-ROOFS:
❑ Oii :S'E1b It IIII.DER DECI.ARATION
All roofs shall he inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection. I ngrce to remove all new materials for
I hereby aflirin.lhet I am Exempt from the Contractor's License Lar for one of
inspection.
[lie following Iwo reasons:
I, as owner of the property, or my employces with wage's as their sole compensation.
Signature ol'Applicant: Date:
will do the work, and the structure is not intended or filleted for sale (Sce.7044,
Business & Professions Code)
L as owner of the.property, am exclusively contracting M41 licensed contractors to
A1A, HOOF COVERINGS TO Iili CLASS "A" OR BETI'ER
constrict the project (Sec.70,14, Business & Professions Code).
I hereby affirm under penally of perjury flue of the following three
I IA%A It DONS MA'lIOt IA I.S DISCLOSORE,
declarations:
1 ha, It read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's
California I Iclth & Sarety Code. Sections 255115, 25533. and 25534. 1 will maintain
Compensation, as provided for by Section 3700 of the Labor Code• for the
cliff]Ilia lice with the Cupertino dlunicipa) Code. Chapter 9.12 and the I Ie;dth &
performance of the work for which this permit is issued,
Safely Code. Section 25532(a) should 1 store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should 1 use Equipment or devices which emit hazardous air
Section 3700 o'tlnc Labor Code, for the performance of the work leu which this
contaminants as defined by the Ilay Arca Air QualityManagement District I will
P snit is issued.
maintain compliance wilh the Cupertino Municipal Code, Chapter 9.12 and the
I certify that in the pertbnnanee of the work for which This permit is issued. I 51(Ti�—\
Ilcalth & Sa'ety CI dc, Sections 255115, 25533, and 25534.
1101 employ any in manner to become to the Worker's
_
person any so its subject
Ow ,en ;Iutho d r.
t g li
Compensation Imes ofcal8omia. If. after making this cenilic:le ol'cxemption. I
D Ity/
'ale: `
became subject to the Worker's Cunnpnamtion provisions of the Lahor CodE. I nal sl
forthwith comply with such provisions or this permit shall be deemed revoked.
CO\'S RUM1O\ I.h:\'DI\'G AGENCY
I hereby aflinm that there is ;I construction lending agency for the perimmumcc of work's
\I'I'I IC NT CPRTH IC \TION
lir which this permit is issued (Sec. 3097• Cir C.)
I ccrld)'that I have lead this application find sults• that Lite above mliumialon is
1'ender's Naille
correct. I agree to comply with all city and county ordinances and state huts relating
no building construction, and hereby authorize reprocruaLices ofthis city to enter
Lender's Address
upon the above mentioned property for inspection purposes. (We.) agree to save
indenmiN and keep harmless the City of Cupertino against Iiabilities,judgments.
costs• and expenses which may accrue against said City in consequence of the
AItCI II'I'FCI"S DICCL,t It.\'IlU\
granting of this permit. Additionally. the applicant understands and will comply
I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
[Accused Professional
signature Date
L- ✓ q� . 0IJID - 6 (/ /I
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vU CUPERTINO
Building Department
JUL 16 2012
REVIEWED FOR CCIDE COMPLIANCE
Reviewed By:
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CAP
JUL 16'107
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SWIMMING POOL / SPA PERMIT APPLICATION P
COMMUNITY DEVELOPMENT DEPARTMENT' BUILDING DIVISION
10300 TORRE AVENUE' CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinG(d)cuoertino.orcl
CUPERTINO
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DESCR=ON OF WORK !t yy�� tJy,�ryl1
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USE OF )OM or Duplex ❑ Nfuld-Family
TYPE
MATERIAL TYPE (CODE) AREA (SQ. FT.)
VALUATION (S)
=UGrURE: Cl Commercial
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POOLISPA MATERIA. TYPE CODES:
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F - FIBERGLASS
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By my signature below, I certify to each of the fallowing:
I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the infortnado vided 'a -correct I have read the Description of Work and verify it u accurate. I agree to comply with all applicable local
ordinances and state laws m uildi <o
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thorize representatives of Cupertino to enter the above-iden `�,e �ppe�rt l impecuon purposes.
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Signatu®of ApplicantfAgent
_ Date: I
5UPPLE'V¢ ORIVIA
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_ Commercial or Muld-Family Buildings with Public
Department of Environmental Health approval
Swimming Pools:
required.
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SwimPoolApp_201 Lacc revised 03/16/11
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