The URL can be used to link to this page

12080188CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 77091IUNTRIDGE LN CONTRACI'OR: RICIIARDS DAVID A AND PERMITNO: 12080188 FUMIRO T OWNER'S NAME': RICIIARDS DAVID A AND FUMIKOT 7709 IIILNTRIDGE. LN DATE ISSUED: 08/162012 OWNER'S PlION1i: 4082575956 CUPERTINO,CA 950144262 PIIONENO: ❑\ LICENSED CO\ I'RACI'OR's D6:CLARATION [ r r.— BUILDING PERMIT INFO: BLDG ELECT PLUMB License License Class Lic.H r r (— -. DIECFI RESIDENTIAL COMMERCIAL Contractor Dane I hereto' affirm [hall am licensed under the provisions of Cha pier JOB DESCRIPTION: DEMO SWIMMING POOL (Coil] %%ith Section 7000) of Division 3 of the Business .f Professions Code and that tar license is in fall force :rad effect. I hereby affirm under penally of perjury one of the folho%ing two declarations: Ihave and will maintain a ceriftcale 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 Sq. FI Fluor Aren: Valualion: $2500 Section 3700 of the Labor Code, for the performance of the Work for which this ANN Number: 35906020.00 Occupancy'I'ype: permit is issued. \I'I'LIC.\\ I' CP:R'I'IFIC,\'PION I certify that I have read this application :rad state than the above information is correct. l agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED 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 180 DAN'S OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupenino against liabilities, judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 regulation per the Cupertino Municipal Code, Section n Issued I)v. Date: O '/�4/J 9.18. Signature Date RI ROOFS: 1�( ,�I` OWNER-BUILDERDGCL,UL\'1'IfIN All root's shall be inspected prior to any roofing material being installed. 11 n roof is installed without first obtaining an inspection. I agree to remove all nev% materials for hereby affirm that I :un exempt from the Contractor's License La. for one of inspection. (lie following tutu reasons: I, as owner of the property, or my employees With wages as their sole compensation, Signature of Applimm: Date: will do the %cork, and the structure is not intended or offered for sale (Sec.7044, Business R Professions Code) 1, as owner of the property, am exclusively contracting %with licensed contractors to ALL ROOT' COVERINGS TO BE CLASS "A" OR BETTER construct the project (Sec.7044, Business - Professions Code). hereby affirm under penally of perjury one of the follmring three IL\ZARDOUS MATERIALS DISCLOSURE declarations: I have Certificate Consent for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the and %vi11 maintain a of to self -insure California Health & Safety Code. Sections 25505, 25533, and 25534. 1 will maintain Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health S performance ofthe work for which this permit is issued Safely Code, Section 25532(x) should 1 store or handle hazardous material. I have and Will maintain Worker's Compensation 1115maoCe, as provided for by Additionally, should I use equipment or devices ahich emir hazardous air Section 3700 of the Labor Code, for the pertonmanme of the work for which this contaminants as defined by the Bay Arca Air Quality Management District I %% ill permit is issued aunt '' cum pli:umce with the Cupertino Municipal Code. Chapter 9.12 and the 'ofd)' I certify that in the performance of die work for which this permit is issued, I shall udlh S Cade. Sectio �55U5, 2$$33. and 25534, not employ any person in any manner so as to become subject to the Worker's n h ri Compensation laws of California. If. alter making this certificate of exemption, I )ate: become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this penin shall be deemed revoked. CONS"I'RI1CI'ION LENDING AGENCI' I hereby affirm that there is a construction lending agency for the performance of vork's APPLICA\ I' CERTIFICVfION for which this permit is issued (Sec. 3097, Civ C.) I cenify that'l have read this application and state that the above infomhation is Lender's Name correct. I agree to comply with all city and county ordinances and slate laws relating to building construction, mid hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes. (We) agree to save indenmi(y and keep harmless the City of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the ,UiCIII'1liCf'S DECLARATIONcosts, granting of this permit. Additionally, the applicant tmderstsnds and will comply I understand my plans shall be used as public records. Willi all no ' it source regulations per upertino Municipal Code, Section 9.18. Licensed Prrdessiunal Signaaeq CITY OF CUPERTINO D FEE ESTIMATOR -BUILDING DIVISION FEE ID # POOLS 1DEMOPRES 1 ADDRESS: 7709 huntridge In. DATE: 08/16/2012 REVIEWED BY: bobs. \ APN: BP#: 'VALUATION: $2,500 *I'ERMITTYPE: Demolition Permit PLdNCHECK TYPE: PRI11ARl' USE: Swimming Pool, Res. Elec. Insp. Fee: PENTAMATION PERMITTYPE: 1SFP00LDE WORK $306.00 SCOPE 0•0 FEE ID # POOLS 1DEMOPRES 1 NOTE: This echinate clues not includejeev Clue to other Departments (i.e. Planting, Public /forks, Fire. SanitarySaver District, Schaal District, etc.). 77iese fees are bused on the arelinhinan• information available and are only au estlnutte. Contact the Dept for acldn'I info. FEE ITEMS (Fee Resolution 11-053 EIf 7/1/11) Alec.h. Plan Check Plumb. Plan Creek Elec. Plan Cheek Meth. Permit Fee: Plumb. Permit Fee: Flee. Permit Fee: Ocher dlech. Insp. Other Plume /nep.Ej Other Elec. bhsp. ,latch, Insp. Fac: Plumb. hr.+p. Fee: Elec. Insp. Fee: NOTE: This echinate clues not includejeev Clue to other Departments (i.e. Planting, Public /forks, Fire. SanitarySaver District, Schaal District, etc.). 77iese fees are bused on the arelinhinan• information available and are only au estlnutte. Contact the Dept for acldn'I info. FEE ITEMS (Fee Resolution 11-053 EIf 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Stippl. PC Fee Phlimb./dlech.lElec Permit Fee: $306.00 Suppl. Insp. Fee:Q Reg. Q OT 0•0 hrs $0.00 Plumb.htlech./Elec Plumh.lklech./Elea Permit Fee: Construction Tar: Administrative Fee: IVork Without Permit? Arlvrinced Planning Fees: Travel Documentation Fees: Suona Motion Fee: IRS61SUICR $0.50 Select an Administrative Item 131de Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $307.50 $0.00 TOTAL FEE: $307.50 Revised: 07/01/2012 CUPERTINO DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinD(r. cucertiro.oro 1,20k C -DI k -'k :11 d ( 6 Z- C -D PROJECT ADDRESS OwNERN I PHONE // �/ /yE-MAIL STREET ADDRESS CITY. STATE, LEP �- FAX r ' CONTACT NA. I PHONE QA mnih STA ADDRESS CITY, STATE, ZIP FAX ❑ OWNER OWNER -BUILDER ❑ DUNERAGENr ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGNEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LICA COWANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, Za' PHONE DESCRIPTION OF WORK / RESIDENTIAL xDWELLING FLOOR AREA UNn's CONQ`ERC FLOOR AREA °i�'y 14CeY sPP-,. ems TYPE OF CONSTRUCTION N SiOR1ES A";ybib�''°'C^ i�jp' .,'{j.'� A __ NEW AQ4W JOB NUMBER m'EDTBY/, J 9. _:�.�Gat'.i .ir'e_ 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 provided is correct I hav •d the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relatin ing construction. I a4hor4 representatives of Cupertino to enter the above-identi0ed property for inspection purposes. Signatureof Applicant/Agent - Date: SUPPLEMENTAI" INFORbIATION Q D PRIOR TO ISSUANCE OF DEbfOLITION PERS i' !7_ �, x nC2 E u Kia,-��: �r�,aoFElce.aseo.T;Y� i' urcH`E'txivPE.+a - _ Provide lab Number from Bay Area Air Quality Management District o�v.banamd.oro Q 415-7494762. _ Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade. �SrANDAIU),- _ Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. ®.aLfACE —Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter io be initiated by persons) '-- cenified in asbestos, mercury and/or hazardous material examination. Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days. _ Provide letter of clearance of all vermin from a licensed pest control contractor. Applicant shall call the Public Works Department at 403-777-3104 and schedule a "habitable dwelling' inspection. < - Provide signed Debris Bin and Recyclable Materials form. Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review. j r DemoApp_2011.doc revised 03/16/11 ms/0, C'o117-1 , CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building gAcuoertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS APN ,y BPk OWNER NAM OWNER ADDRESS DESCRIPTION OF WORK: E5 / We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) �%1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builde r"r" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. hA2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an "Owner -Builder' I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. W711/ 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. bk5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. r 6. 1 understand if I am considered an "employeunder state and federal law, I must register with the state and WI government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. "T 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. #8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for nyinancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderFOrm 1010.dw revised 04/14/10 299. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.r-slb.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. QI1�,11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide y ail applicable laws and requirements that govern Owner-Buildersas well as employers. W12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the ation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: N Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's drivers license, form notarization, or other verificati eptable to thecit ay be required to be presented when the permit is issued to verify the property owners sigriature., Property Owner's Signature: 2 Date: / - 2w - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personalty filled out the above information and certify its accuracy. Note: A copy of the property owners drivers license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.dw revised 04/14/10 _T"I . - -- - - -- : - -- Y : f •II - - `i �,�',J i h Z�i2 � �tA�c� AUG 1 2 12 - 1+ _,nos COMP r