13010116 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6397 MYRTLEWOOD DR CONTRACTOR:A-1 POOL REMOVEAL PERMIT NO:13010116
OWNER'S NAME: SUDHEER GUNDANNA P O BOX 1212 DATE ISSUED:01222013
- OWNER'S PHONE: 9256382418 CAMPBELL,CA 95009 PHONE NO:(408)978-2903 "
LICENSED CONTRACTOR'S DECLARATIONA JOB DESCRIPTION:.RESIDENTIAL LJCOMMERCIAL
License Class C'�7 Lic.# 7��yG 450 SQ FT-REMOVE/DEMO(E)POOL,HANDOUT
PROVIDED
Contractor /r' `7 �X/ti u�s - Date Dl
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty 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 3766 of the Labor Code,for the
performance of the work for which this permit is issued. - Sq.Ft Floor Area: Valuation:$5500
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 APN Number:36917006.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and.county ordinances and state laws relating WITHIN 180 DAYS O RMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for'inspection purposes. (We)agree to save 180 DAYS CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of theZ Z
granting of this permit. Additionally,the applicant understands and will comply sue te:��3
with all non-point source regulations per the Cupertino Municipal Code,Section Z4 z
9.18.
_ RE-ROOFS:
Signature Date Z 2 3 All roofs shall be inspected prior to any roofing material being installed.If roof is
installed without first obtaining an inspection,I agree to remove all new materials for
i inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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(Sce.7044,
Business&Professions Code)
I,as owner of the property;am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: - - Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a.Certifrcate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 21700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I "
performance of the work for which this permitis issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,2W,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued Owner or authorized agerr� Date: Z
I certify that in the performance of the work for which this permit is issued,I 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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a concoction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address _
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 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.. ..
Signature - Date
SWIMMING-POOL / SPA PERMIT APPLICATION b
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION S P�
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 \
CIJPER71N0 (408)777-3228• FAX(408)777-3333•buildina(acupertino.orcl
PROJECT ADDRESS 42, Q77
2, Q77 GPH _ APN R -3 & aQ / 16
OWNER NAME MJ
STREET ADDRESS , AV CTTY,�STATE. �. O 15-0t FAX
CONTACT NAME / ®` PHOTO y 51
STREET ADDRESS CrTY, TATE,ZIP FAX
Q dAO. o
IF
OWNER ❑ OWNER-BUILDER ❑ OwNBRAGENT ❑ CONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER ❑ DEVELOPER 11 TENANT
CT
CONTRAOR NAME LICENSENUM161 �0 LICENSETYPE BUS.LIC#
<e w G ! 2—
COMPANY NAME n ` /^ / E.MAIL FAX
STREETAD6DRESSa �L L CITY,STATE,ZIP '/ PHONEZZ r Z Q
ARCHn'ECDENGINEERNAME LICENSENUMEER BUS.LIC#
COMPANY NAME ;Z FAX
STREET ADDRESS CITY,STATE.ZIP PHONE
DESCRIPTION OF WORK 10n
USE OF "� SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.Fr.) VALUATION(S)
-STRUCTURE: /❑_ Commercial POOL
POOLISPA MATERIAL TYPE CODES: SPA
V - VINYL-LINED
F - FIBERGLASS DEMO Ilr� CO y�Q
G - GUNIE
P - PREFABRICATED - - TOTAL VALUATIONSL
:
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 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' g cons 1 . I But orize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicandAg Date:
SUPP EM TAL 0 ION REQUIRED
_Commercial or Multi-Family Buildings with Public Swimming Pools: _ -
Department of Environmental Health approval required.
-. �rtBrlsveoRx�n��a�-�a�r
SwimPooL4pp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 6397 MYRTLEWOOD DR DATE: 01/22/2013 REVIEWED BY: MELISSA
APN: 369 17 006 BP#: 'VALUATION: $5,500
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY PENTAMATION
SFD or Duplex 1SFPOOLDEM
USE: � PERMIT TYPE: �
WORK. REMOVE/DEMO E POOL HANDOUT PROVIDED
SCOPE
Xfech.. Plan Check Plumb.Plan Check Elec.Plan Check
Mech. Permit Fee. Plumb.Permit Fee: -1 c.Permit Fee
OthenMuch.Insp., Other Plumb Insp. Other Elec.Insp. El
.tlech.Insp.Pee: Plumb. htsp. Fee: Elee.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(ie.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F 1-1 # Swimming Pool
.Suppl. PC Fee: Q Reg. O OT r0.0T1vs $0.00 $306.00 IDEMOPRES Demolition
PME Plan Check: $0.00
Permit Fee; $0.00
SuppL Insp.Fee Q Reg. Q OT0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tar.
Administrative Fee: (�
Work Without Permit? Q Yes 19 No $0.00
Advanced Planning Fee: $0,00 Select a Non-Residential
Travel Documentation Fees: Building or Structure O
i
Strong Motion Fee: 1BSEISMICR $0.55 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
„+. 1 1 $1.55 $306.00 � TOAL� $307.55
\ Revised: 10/01/2012
COMPACTION REPOKT IS REQUIRED SHOULD 'I'ME AHAMD
AREA BE DECLARED "BUILDABLE" IN THE FUTURE.
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CHECKED BY
DATE as
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JAN 2 2 2013
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Building Department
City Of Cupertino
11n030(0� Torre Avenue
CUPWINO " II1 lll�:1. �l�llf '111
t'uX: 4V8- SJY
CONTRACTOR'1 SUBCONTRACTOR LIST
JOB ADDRESS: 07 0 #0 PERMIT#
OWNER'S NAME: Vf IA. PHONE#
GENERAL CONTRACTOR:-' _ _ oa BUSINESS LICENSE#
ADDRESS: o O ('2 Z e .6 CITY/ZIPCODE: pe
*Our municipal code requires=alf.busiuesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND" ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: 777
gnatui Date
Please check applicable subcontractors a d co plete the following information:
SUBCONTRACTOR- � BUSINESS NAME BUSINESS LICENSE#
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting ='
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper`
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
/ZZ Z/
11190Kncr/G tractor-Signature Date