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12080255 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRF,SS: 20320MICUAE1,0' CON'I'RACI'OR:AMIT JAIN PF,RMITNO: 12080255 OR'NEWSNAME: AMITIAIN 20320MICIL\I:I.CI' DATE ISSUED:08242012 O\\'NER'SPIIONl?: 6507430931 CUPERT'INO,CA 950144423 PHONF,NO: ❑ LICENSED COY fRAC`I'OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUDIB[ License Class Lie.q M ECII r RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm ilial I ant licensed under the provisions of Chapter 9 JOB DESCRIPTION:DEMOLITION OF IN-GROUND SWIMMING POOL(500 (commencing with Section 7000)of Division 3 of the Business S Professions SQFr) Code and that nn% license is in full force and effect. hereby:rffirm under penalty(if 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 lar by Section 3700 oflhc Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Connpensation Insurance,as provided for by Sy. Ft Ploor Arca: Valuation:$7000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ,V'N Number:36936024.00 Occurymq•Typc: APPLICANT CEIRTI FICATION I certify that Ihave read this application laid state that the above information is correct.I agree to comply with till cityand county ordinances and state Imes relating to building construction.laid herebyauthorize representatives ofthis city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for.inspection purposes. (We)agree to save indemnify and keep harmless the City or Cupertinoagainst liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accuc against said City in consequence Of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands laid will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: p '�7 Signature Dam � O\\'NIiR-6111 I,DIiK DF.CLAIL\'1'IfLN RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is herehw affirm that 1 anti exempt from the Contractor's License law formic of installed without first obtaining an inspection,I agree to remove all new materials for the.following two reasons: inspection. 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, Signature of Applicant: Date: Business S Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business& Professions Code). AL1,ROOT+CO\'Ii1tINCS TO BE CLASS".\"012 Illa't7iR I hereby affirm under penalty of perjury one of the following three dccla rations: IIA'LARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's 1 ha,c read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 ofthe Labor Coyle,for the California Ilcdth&Safety Code,Sections 255(15.25533,and 25534. 1 will mainhnin perfomtance of the work for which this permit is issued. compliance with the Cupertino Municipal Codc,Chapter 9.12 and thedlcalth S I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle haz urdou,s.material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants is defined by the Ray Arca Air Quality Management District 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chnpter 9.12 and the I certify that in the performance of Ute work for which this permit is issued,I shall health S Safety Code.Sections 25505.25533.and 25.534. 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 Owner w amh rued agrnh become subject to the Worker's Compensation provisions of the Labor Code,I must I)all,: forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LIiNDINC ACENCY .\I'1'I,IC.\N'I'CEIfI'I PIG\'1'10\ I hereby affirm that there is a construction lending agency for the performance of work's I certify that 1 have read this application and state that the above information is for which this permit is issued(Sec.3097,Cir C.) correct. I agree to comply with all city and county ordinances mid state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property Ivor inspection purposes,(We)agree to sae Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments• costs,and expenses which may accrue against said City in consequence of the ARCIIITEX-1"S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. �• `�� U LI ,` Licensed Professional Signature Date y l CITY OF CUPERTINO D FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20320 Michael Ct DATE: 08/2412012 REVIEWED BY: Sean ® APN: BP#: -VALUATION: $7,000 *PER%11T TYPE: Demolition Permit PLAN CHECK TYPE: PRIMARY PENTAIIIATION USE: Swimming Pool, Res. PERMITTYPE: 1SFPOOLDEt; WORT: Demolition of in-ground swimming pool 500 sq ft). SCOPE FEE ID #POOLS 1DEMOPRES 1 Mech.Plan(:'heck Plunhh.Plan Check Flec.Plan Check mech. Permit Fee: Plumb.Permit ree: Flec. Permit ree: Other Alech.Insp. Other Plump Insp. Other r-lcc. leap. ,llech.lnep. Few: Phmth.lasp. ree: Elco.Insp. ree: NOTE: This ectiuutte does not include fees due to other Departments(i.e. Planning, Public Works, Fire.Sanitary Sewer District,School District, etc.). These feev are hosed on the prelitnintan information available and are onlr an ettinmte. Contact the Dept for nthln'I info. FEE ITEMS (Fee Rerohuion 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS /'/un Check Fee: Supp/. PC Fee Planth./A/ech./Elec Permit Fee: $306.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 Plumh.id/ech./F_lec Plumh.hblech./Elec Permit Fee: Consntterion tits: Administrative ree: /Perk Without Permit? Advanced Planning Fees: Travel Docaunentaiion Fees: I A Strong Motion Fee: IBSEISh11CR $0.70 Select an Administrative Item 131de Stds Commission I've: IBCBSC $1.00 SUBTOTALS: $307.70 $0.00 TOTAL FEE: F $307.70 Revised: 07/01/2012 � 1 �l AMI FJf\ItV AYRJNN 5 N�WO46R J •I I I I I� I— —I——I—I—i— ADDITION TO FMIILY ROOM AND KITCHEN SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �• 10300 TORRE AVENUE •CUPERTINO, CA 950143255 E11A 5 (408)777-3228 • FAX(408)777-3333 • buildinG r!�-cuoerino.ora CUPERTINO _ ' / PRO]ECTAD� ^eye „\^,x.11�'l- � CAi EPnk)D1 -Nvrv, I APNI ) 17ef- 36'02 OWNER NAME -RMI-, -JAINI I �SD x-43 0131 amr tYarn @ ho+>hc<i/• SIREE7 ADDRESS CITY, STATELW FAX 20320 M/CHREC C[^ Ct/ ,rvo Gu /Mo cy1-a,�l[ CONTACT AME PHONE E-MAIL rT SiA.�'ADDRESS - CITY.STATE, ZIP FAX 20 20 c G fup6eT/n]u qsD ❑ OWNER �Ow, -BUTLDER ❑ O0.NERAGEVT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ T, Axr COTnRACTOR NAA¢ (ti/vL LICENSE NUMBER I LICENSE TYPE I BUS.LICA COMPANY NAME L E-MAIL FAX STREET ADDRESS CRY,STATE,ZIP PHONE ARCI-0MMENOINEER NAME . / /I LICENSE NUNMER BUS.LIC M COMPANYNAME �V J7 E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP I PHONE DESCRIPTION OF WORK Pio vo-4 USE OF SFD or Duplex ❑ Multi-Family TWE MATVUALTWE(CODE) AREA (SQ.FT.) VALUATIONS) STRUCI"UKE: ❑ COrnmereial POOL oU 7000 POOLISPA MATERIAL TWE CODES: SPA - V - VINYL-LINED F - FIBERGLASS DEMO G - OUNTTE P - PREFABRICATED 41EGELVED flY•., ,,,^/'-` - T07A OZfN: ((JJ By my signatum below,I certify to each of the following: I am the property owner or authoriad agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. 1 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 bu ding consrction. I authorize representatives of Cupertino to enter the above-identified propertyforinspection purposes. Signaure of Applicant/Agent WDate: 912-41Wt Z SUPPLEMENTAL INFORMATION REQUIRED • -PL-i,�ICHEa[TSRE: -�y� ROI}iL1'GSI:IY%�� Commercial or Multi-Family Buildings with Public SwLTuning Pools: f ,-,,,�_ ,-.,,,rte' '. 1�_ " Department of Environmental Health approval required. 'ocER _coot B u =� ^,E,�eXP�'s � 2 ]OA' �r �:--w-�-F SEN�YA'--_DISIAICL,. Sw6nPoolApp_ Ol Ldoc revised 03/16/11 O Q � O_ Ix m ��^—p--CLIFOEN O 1 I CD rn 0 11 O. Q 2 M t l � t •HT1 - Q > '�^ ' I C�.I ED F /ts `gYY z �f— —�--- = C 71 4ty ILHAEL' ANTOINETTE AVONDALE 'j ter! 1' 'y COVHT NIVE ST. a C a C O 14 6z L N /�' r ° z ;' g a ° R COMMUN DEVELOPMENT DEPARTMENT z N / L-- -- BUILD NG DMSION-CUPERTINO c p--M AR INW000—T "'— WAY w 3 / APPROVED This Illfrom,s t of plans d specifications MUST be kept q n < during c nstruction. It is unlawful to make N'ohanges or•iterations on same,or to deviate ao wfthc it approval from the Building Offs lal .a The stamping of is plan and specifications SHALL N( o a _ be held to pens t or to be an approval of the viola or r_ lop� IML of any provision 3 of any City Ordinance or State L iw 0 BYE DATE 0 PERMIT NO. 1 < I r i, -----.. 1 u �'•i7 't ITTe i i I � Tri AMIT JAIN a i g ADDITIONTO FAMILY ROOM AND KITCHENMI � i i " 20320 MICHAEL Cr,CUPERTINO,CA 95014 "nom' J _ 7 / SWIMMING POOL REMOVAL REQUIREMENTS COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 •buildinq(alcuoertino.orq PURPOSE The purpose of this guideline is to clarify the minimum requirements to allow for the removal of an existing swimming pool. A construction permit is requiied for the removal of all swimming pools. PLAN REQUIRENIENTS 1. Provide a completed swimming pool (SP) permit application. 2. Provide three sets on minimum 8-1/2" x 11" sheets of a completely dimensioned site plan showing all property lines, all existing structures, location of existing swimming pool and setback dimensions from the pool to the existing structures and property lines. 3. Owner-Builder Disclosure Form (for property owners applying for their own building permit) GENERAL INFORMATION —IF THE POOL SHELL IS TO RENIALN • Drill a minimum of three (3) - 12" diameter holes evenly spaced along the center line of the pool bottom. • Backfill the remaining pool shell with 1/4" maximum size crushed rock for a minimum of 8" deep at the bottom of the pool. Gravel shall be packed into place. Clean fill may be added beyond the initial crushed rock backfill. • Backfill shall be moistened and tractor rolled or tamped with a Wacker compacting plate into place. • Two inspections are required. The initial inspection is to verify the required drain holes at the bottom of the pool. The last and final inspection should be scheduled after all the work is complete. • No fill dirt shall be stored on the street or public right-of-way without an encroachment permit issued by the Department of Public Works. • Owner agrees the backfill over the existing swimming pool shell may have differential settlement and agree to use the area for landscape purposes only and not use the area for any structural or floor slab support until the pool shell is removed in its entirety and the backfill is certified with 90% compaction. FEE ESTIMATE FOR DENIOLITION OF SNVININI NIS POOL: The calculated fees are only an estimate. Contact the Bldg Dept for additional info. *USE OF BUILDING: Residential Permit Fee $0.00 *VALUATION: gp Strong Motion Fee $0.00 Bldg Stds Commission Fee $0.00 OF SWIMMING POOLS: 0 # TOTAL $0.00 SwimmingPoolRemovol doe revised 06/21/11 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333" buildln OIE)CUDertlno.oro CUPERTINO 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 2,% , A.r APN BP# -1 AK cT CWmam 36 - 6-o2 ty OWNER IJAME OWNER ADDRESS r 3 ArN DESCRIPTION OF WORK: &&L 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.) 7 1 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder" 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. 2. 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. D` 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. �l C-5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total 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. 'K-6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal 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. # 7. 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 9p erformed under contract with a licensed general building Contractor. understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm ?010.doc revised 04/14/10 9. 1 understand I may obtain more information regarding my obligations as an "employer"from the Internal venue 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.cslb.ca.gov for more information about licensed contractors. 1-10. 1 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. �1 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. _�--12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information 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: 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 driver's 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 owner's si natu Property Owner's Signature: `r_ Date: 1c/ l2 - ----------------------------------------------rm-i------------------ -- - - ---- -- --------- oThe following Authorization Form is required to be completed by the property owner&nly 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: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's 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 owner's signature. Property Owner's Signature: Date: OwnerBuilderForn: zoro.docrevisedoanano