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11070190 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10165 BONNY DR CONTRACTOR: PERMIT NO: 11070190 OWNER'S NAME: GAYNOR EDWARD G TRUSTEEC)c 1 DATE ISSUED:07/26/2011 (UVNER'S PHONE: 4085512122 , ✓ e I' (�{ ,� /�"-' PHONE NO: L LICENSED CONTRACTOR'S DECLARA/ThON BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# l tl MECH RESIDENTIAL COMMERCIAL Contractor t/l f/K• tem C I hereby afwlm that I am license under the provisions of Chapter 9 JOB DESCRIPTION:DEMO EXISTING SWIMMING POOL(600SQFT) (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 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.Ft Floor Area: Valuation:$7900 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35912029.00 Occupancy Type: 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 state laws relating to building construction,and hereby authorize representatives of this 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 of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the„applicant understands and will comply with all non-point source re the Cuper?ino Municipal Code,Section 9.18. �-- ` Issued by;--' Date• Signa Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A”OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous 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 as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Scooja25505,25533,and 25534. 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 o a kvl)ate:_71�4// 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. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, r and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION .ig of this permit.Additionally,the applicant understands and will comply w­i all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35912029. 00 DATE ISSUED. . . . . . . : 07/26/2011 RECEIPT #. . . . . . . . . : BS000014193 REFERENCE ID # . . . : 11070190 SITE ADDRESS . . . . . : 10165 BONNY DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : GAYNOR EDWARD G TRUSTEE ADDRESS . . . . . . . . . . : 10165 BONNY DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : GOLDEN STATE GENERA CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 900 .00 1 . 00 0 . 00 1 .00 0. 00 1BSEISMICR VALUATION 7, 900 . 00 0 . 79 0 . 00 0 .79 0. 00 1DEMOPRE EACH 1. 00 300 . 00 0 . 00 300 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 301.79 0. 00 301 .79 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 301.79 #1107 --------------- TOTAL RECEIPT 301. 79 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO I � k3-7 SWIMMING POOL / SPA PERMIT APPLICATION LM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 S P (408)777-3228•FAX(408)777-3333•building acugertino.or4 CUPERTINO PROJECT ADDRESS y / SO I O OWNER NAME Wichar ! U s I �+ 7-1Z EMAIL _ STREET ADDRESS/_ <` �A-/ ` � CrTY,STATE,ZIP r j 248 FAX CONTACT NAMEe � • v PHONE ��� E-MA y �r� I rig STREET ADDRESS /f_ ( ! V CITY,STATE,ZIPS J �� /�r � FAx ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME C�e `e CJJ�,`, /Co LICENSE NUMBER 6� 6 LICENSE TYPE BUS.LIC# COMPANYNAMFy Q Ic�e{�j .�+I//Y�f`le e�L�/'a/ E-MAu U IO�erZ S7GZle t' � ( FAX 2_( - ?COJ� /ee�r�✓L �f ? Q STREET IDD COYI/^GZ[� V� s CFAR CJ _ A 'i 2 PHONE /- 7 - t1�64 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC (# COMPANY NAME E-MAIL FAX ----fJW FET ADDRESS CITY,STATE,ZIP /J ONE DESCRIPTION OF WORK USE OF SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION(S) STRUCTURE: ❑ Commercial POOL POOL/SPA MATERIAL TYPE CODES: SPA V vv V - VINYL-LINED F - FIBERGLASS DEMO G - GUNTTE P - PREFABRICATED RECEIVED BY: 1)46 1 TOTAL V UATI N: By my signature below,I certify to each of the following: i am the property owner orauth6rized agent to act on the property owner's behalf. I have read this application and the information I have provided enp of Work and verify it is accurate. I agree to comply with all applicable local orditr&wes and state t' of Cupertino to enter the above fieri pr4etty for inspection purposes. - Date: Signature of Applica+It!}C�ent•= - .,.""` SUPPLEMENTAC INFORMATION REQUIRED OFFWE IISE ONLY PLAN CIIK"TVPE JMXTUNG SLW _Commercial or Multi-Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. THE-ecx)NT�R �UKDPIG DEPT ❑ ruPREss ❑ PLAN WW,DEPT ❑ STANDARD ❑ PLJBLJC WORKS DEPT ❑ LARGE ❑ ENVIRONMENTAL HEALTH ❑ MAJOR ❑ SANITARY SEWER DISTRWr SwimPooUpp 2011.doc revised 03116/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10165 bonny dr. DATE: 07/26/2011 REVIEWED BY: bobs. APN: BP#: VALUATION: 1$7,900 *PERMIT TYPE: Demolition Permit PRIMARY Swimming Pool, Res. PENTAMATION 1SFPOOLDEM USE: PERMIT TYPE: WORK demo existing sfd pool SCOPE FEE ID FLR AREA s.f. 1DEMOPRES 1 NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept-for addn I info, FEE ITEMS (Fee Resolution 11-053 1jf, 7'1.,11) FEE QTY/FEE MISC ITEMS Permit Fee: $300.00 Suppl.Insp. Fee4@ Reg. 0 OT 0.0 hrs $0.00 i Stronfz Motion Fee: $0.00 Select an Administrative Item Bldg) Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $301.001 $0.00 TOTAL FEE: $301.00 Revised: 07/04/2011 (D 0 a C) z Q; r7 T, -0 z :3 0 0 (1) 0 CO 0 S G CC R1 - a) (-) > C G_J3 C's CL cj 0 ZZ -0 16 U) 0 b Z C cUn 7 C, > 31 ID O -j LU Q in uSE- 1 to PL