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11070214 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10565 SAN LEANDRO AVE CONTRACTOR:ROYAL POOLS INC OF PERMIT NO: 11070214 SANTA CLARA OWNER'S NAME: ANTHONY MONTEFUSCO&LISA BACKUS 2258 CAMDEN AVE DATE ISSUED:07/27/2011 O -��PHONE: 4155096767 SAN JOSE,CA 95124 PHONE NO:4083718000 LICENSED CONTRACTORS DECLARATION BUILDING PERMIT INFO: BLDG ELECT f- PLUMB License Class -5 3 Lic.# 2 G -FOS *- MECH RESIDENTIAL COMMERCIAL Contractor L Date � �� ovisio s of C apter 9 JOB DESCRIPTION:REMOVE AND REPLACE POOL EQUIPMENT,RE-GUNITE I hereby affirm thar,am licensed under the pr (commencing with Section 7000)of Division 3 of the Business&Professions EXISTING POOL,ADD NEW GAS LINE AND ELECTRICAL. Code and that my license is in full force and effect. 1 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:$20000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35705058.00 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 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 he b authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned perty for inspection purposes. (We)agree to save indemnify and keep harm ss Mallt pertino agai st liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses whi mast said C' m consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additt derstands and will comply with all non-point sou ce reg p no Municipal Code,Section 9.18. Issued by: - Date:?, -L-� Signature Date _7 ? �� ❑ OWNE UILD DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1 herZyfr,,m 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. 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&Professions Code) 1,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,sh I use equipment or devices which emit hazardous air contaminants s d med by the Bay Are it Quality Management District I will permit is issued. maintain c pli ce with a Cuperti unicipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health& afe Code,S ti 50 5533,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 r thorized e become subject to the Worker's Compensation provisions of the Labor Code,I must lGvDate: forthwith comply with such provisions or this permit shall be deemed revoked. O STRUCTION LENDING AGENCY APPLICANT CERTIFICATION hereby aff 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 ind- -ify and keep harmless the City of Cupertino against liabilities,judgments, cc d expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granLdag 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. Licensed Professional Signature Date CITY OF CUPERTINO 13 ITEMS OF 13 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35705058 . 00 DATE ISSUED. . . . . . . : 07/27/2011 RECEIPT #. . . . . . . . . : BS000014221 REFERENCE ID # . . . : 11070214 SITE ADDRESS . . . . . : 10565 SAN LEANDRO AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ANTHONY MONTEFUSCO & LISA BACK ADDRESS . . . . . . . . . . : 10565 SAN LEANDRO AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2701 RECEIVED FROM . . . . : ROYAL POOLS OF SANT CONTRACTOR . . . . . . . : SHEDHERD JR, WILLIAM G LIC # 20983 COMPANY . . . . . . . . . . : ROYAL POOLS INC OF SANTA CLARA ADDRESS . . . . . . . . . . : 2258 CAMDEN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95124 TELEPHONE . . . . . . . . : 4083718000 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1. 00 41 . 00 0 . 00 41. 00 0 . 00 1BAPPLOTHE NO OF APPLIAN 1 . 00 65 . 00 0 . 00 65. 00 0 . 00 1BCBSC VALUATION 20, 000. 00 1. 00 0 . 00 1. 00 0 . 00 1BREMMISC EACH 1. 00 130 . 00 0 . 00 130. 00 0 . 00 1BSEISMICR VALUATION 20, 000. 00 2 . 00 0 . 00 2 . 00 0 . 00 1BUSLIC FLAT RATE 1 . 00 115 . 00 0 . 00 115. 00 0 .00 1EPERMITFE FLAT RATE 1. 00 44 . 00 0 . 00 44 . 00 0 .00 1MPERMITFE FLAT RATE 1. 00 44 . 00 0 . 00 44 . 00 0 .00 1PGASRES OUTLETS 1. 00 65 .00 0 . 00 65 .00 0 .00 1PPERMITFE FLAT RATE 1. 00 44 . 00 0 . 00 44 .00 0 .00 1STINSP UNITS 1. 00 130 .00 0 . 00 130 .00 0 .00 1STPLNCK HOURS 1. 00 130 .00 0 . 00 130 . 00 0 .00 1TRAVDOC FLAT RATE 1. 00 44 . 00 0 . 00 44 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 855 . 00 0 . 00 855. 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 855 . 00 2300 --------------- TOTAL RECEIPT 855 . 00 1 - .I - --- I [hn AA I I n r /_ __ A A-:._ V-- Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: `d vDro _ PERMIT# OWNER'S NAME: sGd PHONE # = (3©O GENERAL CONTRACTOR L Poo(,S BUSINESS LICENSE# ADDRESS: "ce �$„S; CITY/ZIPCODE: *Our municipal code requires all businesses working in the city o 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: ( . D•�• - -1/5 7 'ar Signature ate Please check applicable subcontractors and complete the following information: V 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 �--, - /- Own /C ct Signature Dat SWIMMING POOL I SPA PERMIT APPLICATION 1� LM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION `, 4 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 GUPERTINU (408)777-3228- FAX(408)777-3333•buildinG(a�cupertino.org 64U_U:�> LtShr -4- °AcN-TC. f-t�cc) PROJECT ADDRESSc APN# OWNER NAME mw*s to PHONES/[r�ba 00 E-MAIL STREET ADDRESS trCITY, STATE,ZIP FAX CONTACT NAME , ` V� -1370"(CA PHO g7l E-MAIL STREET ADDRESS I ,In CITY,STATE, ZIP �� a s�j✓/ AX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT wcolNTRICTOR ❑CONTRACTOR AGENT ❑ ARCHrrECT ❑ENGINEER ❑,DEVELOPER ❑TENANT CONTRACTOR NAME•t'1t14M ( r Er� LICENSE C� LICENSE TYPl f<4 BUS.LIC# COMPANY NAME l �„L iso E-MAIL FAX STREET ADD S CITY,STATE,ZIP P �jv 7/ ARCHITECT/ENGINEERNAME LICENSE NUMBER O• ( BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WO r ' 'Wow i; f' 6oG USE OF LSD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION(S) STRUCTURE: ❑ Commercial POOL /�-� � POOLISPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO G - GUNITE al � c y^ t21RV P - PREFABRICATED TOTAL RE E FEIJBS' ; �lz li By my signature below,I certify to each of fofo ng: I pr o r authorized agent to act on the property owner's behalf. I have read this application and the information I have pro, ed i orr'ct. I v rea a Des c pt' n of Work and verify it is accurate. I ee to co ply with all applicable local ordinances and state laws relating to buildi g nstruction. thori a pres t ves of Cupertino to enter the above-id tified ro erty for i/nspection purposes. Signature of Applicant/Agent: ��� Date: � A 241 r SUPPLEME7,lvBuil, ORMA ON „QMC>bu5>r:ONT_ ., 1' tl!6CHECKTSCPE � .If'OIITIN3LTTy. _Commercial or Multi-Fings with Public Swimming Pools: Department of Environmental Health approval required. E�€PItESS r £' PLAIIl`41PiG DEPT Y STAPIDARD + ® PiTBLIC wORIfs`DEPT s LARGE 1�IYIROLYR4EFkTAT«HEACTH 0.`MAJOR. =$ I�IITAItYSEWE&DISTRICT SwimPoolApp_2011.doc revised 03/16/11