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11040098 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7561 NEWCASTLE DR CONTRACTOR:XTREME CONCRETE PERMIT NO: 11040098 SOLUTIONS OWNER'S NAME: SOLY RETTER 2189 SEPULVEDA AVE DATE ISSUED:04/14/2011 ER'S PHONE: 4087993248 MILPITAS,CA 95035 PHONE NO:(408)594-3049 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r PLUMB � i License Class C Lic.# / I( � MECH F RESIDENTIAL COMMERCIAL Contractor ( Date I hereby affirm that I aw licensed under the provisions of Chapter 9 JOB DESCRIPTION:SWIMMING POOL DEMO (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. Sq.Ft Floor Area: Valuation:$6500 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 permit is issued. APN Number:36617074.00 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 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 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino 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 wit - oint source regulations per the Cupertino Municipal Code,Section Issued by: Date: k18.r. . nature Date RE-ROOFS: V OWNE - ER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I 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& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will �.� maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. &Safety Code,Sections 25505,25533,and 25534. 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 or authorr agent: 1 Compensation laws of California. If,after making this certificate of exemption,I Date /Jr 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 I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) 1 certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save unify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36617074 . 00 DATE ISSUED. . . . . . . : 04/14/2011 RECEIPT #. . . . . . . . . BS000013188 REFERENCE ID # . . . : 11040098 SITE ADDRESS . . . . . : 7561 NEWCASTLE DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SOLY RETTER ADDRESS 7561 NEWCASTLE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RIGOBERTO R BELTRAN CONTRACTOR . . . . . . . : RIGO BELTRAN LIC # 29141 COMPANY XTREME CONCRETE SOLUTIONS ADDRESS . . . . . . . . . . : 2189 SEPULVEDA AVE CITY/STATE/ZIP . . . : MILPITAS, CA 95035 TELEPHONE . . . . . . . . : (408) 594-3049 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 500 .00 1.00 0.00 1 .00 0. 00 1BSEISMICR VALUATION 6, 500.00 0.65 0. 00 0 .65 0. 00 1DEMOPRE EACH 1 .00 291. 00 0. 00 291.00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 292 .65 0.00 292 .65 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO DEMOLITION CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7561 New Castle Dr. DATE: 04/14/2011 REVIEWED BY: gs APN: BP#: '"VALUATION: 1$6,500 ;'PERMIT TYPE: Demolition Permit PRIMARY Swimming Pool, Res. PENTAMATION 1 SFPOOLDEM USE: PERMIT TYPE: WORK SCOPE FEE ID #POOLS 1DEMOPRES 'I NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info, FEE ITEMS (I*ee Resolution 09-051 11L 7,-1;'10) FEE QTY/FEE MISC ITEMS Permit Fee: $291.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 Strom Motion Fee: IBSEISMICR $0.65 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $292.651 $0.00 TOTAL FEE: $292.65 Revised: 01/15/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ,QI,(� (,[� PERMIT# d 0 OWNER'S NAME: PHONE# GENERAL CONTRACTOR: t BUSINESS LICENSE# ADDRESS: C6 CITY/ZIPCODE: *Our municipal code requires alfbilsinesses 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 CONTRACTO A LL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractor e Date 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 �1 Own /Contractor Signature Date i1 v C/ 9� SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 S P CUPERTINO (408)777-3228• FAX(408)777-3333•building(cDcupertino.org PROJECT ADDRESSOb F/� 0 1 � I f1 I- � C e D( APN# / 0OWNER NAME • PHONE r '/1 �� E-MAIL STREET ADDRESS 1 KW C/I C' 1 Q CITY, STATE,(ZItPP u l �A FAX '�^-�J NCS ' I �(J CONTACT NAME PHONE 14 E-r .eMt C/^ STREET ADDRESS CITY, 9 3� FAX a7Q_,q_ /U lJtrl {j�/ (v00 1:1 OWNER OWNER-BUIDDER OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ARCHITECT 11 ENGINEER 11 DEVELOPER El TENANT �'L CONTRACTOR NAMI{ ►� I �I• ^ LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME �I�1�( �/I I �1� a�Uhd�i1s E MA �t-7r /aic�l\p JfiVI' FAX {�,/J��+��(7��1� J` 1! j' ` w C V colt PHONE tom//IyQ �r/Vy(/'/ STREET ADDRESS [}-I S( CITY,STATE IP Y / LLvJ ARCHITECTIENGWEER NAME LICENSE NUMBER sC L i BUS.LIC# COMPANY NAME E-MAIL ` /l `� STREET ADDRESS CITY,STATE,ZIP PHONE ? DESCRIPTION OF WORK / og, USE OF SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION($) STRUCTURE. ❑ Commercial POOL oc7 00 6500, POOLISPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO G - GUNITE P - PREFABRICATED RECEIVED BY: TOT V TI N 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 info 9a ve provided is correct. �nv e read the Description of Work and verify it is accurate. I agree comply with all applicable local ordinances and state laws relating to bu on ction. horize representatives of Cupertino to enter the abov i t}t�fig property for inspection purposes. Signature of Applicant/Agent: Date: i`/'�I CI SUPPLEMENTAL INFORMATION RRVUIRED OFPIC9USE ONLY PLAN CHECK TYPE ROUTING SLIP _Commercial or Multi-Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. ❑ OVER-THE-COUNTER ❑ BUILDING DEPT ❑ EXPRESS ❑ PLANNING DEPT ❑ STANDARD ❑ PUBLIC WORKS DEPT ❑ LARGE ❑ ENVIRONMENTAL HEALTH ❑ MAJOR ❑ SANITARY SEWER DISTRICT SwimPoolApp_201 Ldoc revised 03/16/11