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11050080 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7712 ROBINDELL WAY CONTRACTOR:GARY G SLUDER INC PERMIT NO: 11050080 OWNER'S NAME: WATKINS JEFFREY C AND MARSHA A 1955 DOMAINE DR DATE ISSUED:05/12/2011 '`INER'S PHONE: 4082034319 MORGAN HILL,CA 95034 PHONE NO:(408)779-3301 LJ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class C'�� Lic.# r G l/ DEMO SFDWL POOL 480 SQ FT Contractor� �/c ��t a r C) -� Date S— 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 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$9000 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 whi h t s APN Number:36223013.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXP WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 0 DAYS O PERMIT 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 F M LED INSPE TION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, / costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all no poi s=ns tions per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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 inspection. OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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, Business&Professions Code) 1,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 Certificate 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 3700 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 permit is issued. will maintain compliance with the Cuperal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 2550 2 33 and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: permit is issued. 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 construction 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 :o building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION -*s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. .ting of this permit.Additionally,the applicant understands and will comply .pith all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36223013 . 00 DATE ISSUED. . . . . . . : 05/12/2011 RECEIPT # . . . . . . . . . : BS000013433 REFERENCE ID # . . . : 11050080 SITE ADDRESS . . . . . : 7712 ROBINDELL WAY SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : WATKINS JEFFREY C AND MARSHA A ADDRESS : 7712 ROBINDELL WAY CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5013 RECEIVED FROM . . . . : GARY SLUDER CONTRACTOR . . . . . . . : GARY G SLUDER LIC # 25263 COMPANY . . . . . . . . . . : GARY G SLUDER INC ADDRESS . 1955 DOMAINE DR CITY/STATE/ZIP . . . : MORGAN HILL, CA 95034 TELEPHONE . . . . . . . . : (408) 779-3301 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 9, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 9, 000 . 00 0 . 90 0 . 00 0 . 90 0. 00 1DEMOPRE EACH 1 .00 291 . 00 0 . 00 291 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 292 . 90 0 .00 292 . 90 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 292 . 90 visa --------------- TOTAL RECEIPT 292 . 90 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO SWIMMING POOL / SPA PERMIT APPLICATION Is COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 GUPERTINp (408)777-3228• FAX(408)777-3333•building acupertino.org PROJECT ADDRESS N -771 V I^ 1C`— 3 `1 J O OWNER NAME HE-MAIL TILS :203, `(3f [Y-chrWA STREET ADDRESSCITY, STATE,ZIP - FAX u QT/Nv GS,CONTACT NAME PHONE E-MAIL - STREET ADDRESS CITY,STATE, ZIP F ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT 2 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO�� , O NAME LICE NSE+ LICENSE TYPE BUS.LIC# f C. i�C1^�. l7'7 // 19 CO ANY NAME E-MAIL A A03) -moi STREET ADDRESS CITY,STATE,ZIP PHONE - 1Z64M to LL CkA 9 03 ?7x'-3301 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK USE OFD Or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION(S) STRUCTURE: ❑ Commercial POOL POOUSPA MATERIAL TYPE CODES: SPA V - VINYL-LINED _ F - FIBERGLASS �M� (bA,7PL.'PfC-" (d""L- G - GUNITE P - PREFABRICATEDREGEIVEDBY: TOTAL VALUATION 71111 i�11­111 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 building construction. I authorize r presentati of upertino to enter the above-id2/-) fie property for inspection purposes. Signature of Applicant/Agent: t f Date: �- it SUPPLEMENTAL INFORMATION REQUIRED Qv FscE USK ONLY PLAN CI3ECIC i YpE ROI2ITNG SI_; _Commercial or Multi-Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. ER-TaE courlTExnvGnEPT `❑ WRESS © PLANNING DEPT ❑' STANDARD ❑,PUBLIC WORKS DEPT ❑ LARGE 0`vENYIIttONMENTaI.REAL[H.. ❑'MAJOR ❑ SANITARY.SEWERDISTRICT SwimPoolApp_2011.doc revised 03/16/11 DEMOLITION CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7712 robindell way DATE: 05/12/2011 REVIEWED BY: bobs. APN: BP#: `VALUATION: 1$9,000 xPERMIT TYPE: Demolition Permit PRIMARY SwimmingPool, Res. T PENTAMATION 1SFPOOLDEM USE: PERMIT TYPE: WORK demo residential pool. SCOPE FEE ID #POOLS 1DEMOPRES 1 Li NOTE. Thesefees are based on the prelindnary information available and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (l ee Resolution 09-05/ Eff'. 7-%1%10) FEE QTY/FEE MISC ITEMS Permit Fee: $291.00 Suppl.Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 i Strom Motion Fee: IBSEISMICR $0.90 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $292.90 $0.00 TOTAL FEE: $292.90 Revised: 04/29/2011 GARY G. SLUDER, INC a Q � j r 77fZ Ro6 �Ot�ti4� . vim, ALL 1U 6 R. D s 1955 Domaine Drive • Morgan Hill, CA 95037 • (408) 779-3301 VUTTIMJOB: Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: .-77PERMIT# OWNER'S NAME: �,AAQ�4A \-rVArT1<I�A PHONE# ?602 GENERAL CONTRACTOR: C`q (Z - S BUSINESS LICENSE# c ADDRESS: ) r�.-�' 1r z (l. CITY/ZIPCODE: ./ o,A0 &;AA1 11:LL CA qst *Our municipal code requires all businesses 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 A UBCONTRACTORS HAV TAINED A CITY OF CUPERTINO BUSINESS LICENSE. r� " r I am not using any subcontract rs: Signature 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 Owner/Contractor Signature Date