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13040087 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10408 BRET AVE CONTRACTOR:CALWEST LANDSCAPE PERMIT NO: 13040087 DEMOLITION OWNER'S NAME: OREN&MARIANNE SHELLEY 21103 BRUSH RD DATE ISSUED:04/10/2013 OWNER'S PHONE: 4084979353 LOS GATOS,CA 95033 PHONE NO:(408)375-2809 13 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALU License Class/7 6Z% .# `1 SZ 3./ REMOVE&FILL(E)SWIMMING POOL,HANDOUT PROVIDED dotte :Y Contractor�0 tl L�l�c� a fes ' 0 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:$7900 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:37510030.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I 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 OF 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 DAYSFStON ST 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 the bio granting of this permit. Additionally,the applic t understands and will comply with all non-point source regulations per theydpertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 3 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 Signature of Applicant: Date: I 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 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) . 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 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 petmit.is 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,Sectio 2 05,25 , d; 34. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Date: permit is issued. . U 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 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 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ` O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 `n� UI?ERT1N4 (408)777-3228• FAX(408)777-3333•building(acupertino.org b ` PROJECT ADDRESS APN# ,fir_S /O / 1 OWNER NA - P 1 �S J-3 E MAII, C STREET ADD SS i C ,STATE ZIP,, FAX CONT CT't�I PHO Q q, E�L� STREET ADDRE_S�S � ,,lJ J C ,3STA IP V i 5 �� , �� FAX 11 OWNER ❑ OWNER-BUILDER ❑/(OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRA 0 NAME LICENSE E LICENSE TYPE BUS.LIC# C A NAME E-MA FAX STREET A D S /G n I'rY,ST ;ZIP PHO `, G! -..�OD ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS - CITY,STATE,ZIP PHONE DESCRIPTION OF WORK USE OF ❑ SFD or Duplex. ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION(S) STRUCTURE: ❑ Commercial POOL POOLJSPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO G - GUNITE �20G COV C✓ P - PREFABRICATED TIONY By my signature below,I certify to each of the following: am the pr rty owner or authorize ge act on the property owner's behalf. I have read this application and the information I have provided is correct. I h ve read t Description of Work verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil Ing construction. tho ' presentatives of Cupertino to enter the above-id e tified roperty for inspection purposes. Signature of ApplicanUAgent: Date: (� SUPPLEMEN AL ORMATION RE Q Dk Commercial or Multi-Family Buildings with Public Swimming Pools: �� z Department of Environmental Health approval required. x TiGuNT�ER u3ag ,u➢nvsa3E>rr � � r ��.S�AI�IDARD��"�„ "� �0 PUBLIC°WO"RIfB➢EPT � ''i SANITARYSEW.ERDISTRICT SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTING FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10408 BRET AVE DATE: 04/10/2013 REVIEWED BY: MELISSA APN: 375 10 030 BP#: *VALUATION: $7,900 *PERMIT TYPE: Demolition Permit PLAN CHECK TYPE: PRIMARYSwimming PoolResPENTAMATION 1SFPOOLDE USE: , . PERMIT TYPE: WORK REMOVE & FILL E SWIMMING POOL HANDOUT PROVIDED SCOPE FEE ID #POOLS 1DEMOPRES Kim- - Ltech.*'tan Check PhimL Plan Check F'l�c.Plan Check llec,h.1'c>rrait Fee.` I'Iumlr.Permit I c:e: Elec.Permit Fee: FcIf,h tech.Insp. Other Plumb Insp. Other El".Imp. Li .Insp.Fee- Plumb.hal).Fee: Elea.Insp.Pee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the relimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS('Fee Resolution 11-053 Ef.. 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC F'ee Plumb.Avfech./Elec Permit Fee: $306.00 Suppl. Insp.Fee.0 Reg:. Q OT0.0 hrs $0.00 Plumb.11fech:1E'lee Plumb.1IWech.1Elec Pere it Ier Consimction :Tai: Adininistr ative Fee: f,Vork Without Permit? Advanced Planning Fees: Travel Documentation Fees'.- Strong ees':Strong Motion Fee: IBSEISMICR $0.79 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $307.79 $0.00 = $307.79 \ Revised: 04/01/2013 0 i co r POOL- 0 I w i i CUNITY DEVELOPMENT DEPATM -c--y BUILDING DIVISION-CUPERTINO APPROVED This set of plans and specifications MUST be kept at the f �A� job site during construction. It is unlawful to make any chanoes or alterations on same,or to deviate therefrom,-withn"+appro"al from the Bu:,.j:-g�f#t F Th,�stamp g of this plan and specifications SHALL NOT '4�'vi OR C be held t=Qfany e an approval of the violation FCO of a. rCit Ordinan 0py�dey Mp Y Ordinance or State Law. Y DATE PERMIT NO.'/ D y O��- 1 j i AV l i i I I 1 i 41WO I n AM I C PLMNG 5 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 ELI] Telephone: 408-777-3228 C U P E RT 1 N O Fax:408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST , JOB ADDRESS: PERMIT# OWNER'S NAME: PHONE# Z/01- 75 T GENERAL CONTRACTOR: UA / BUSINESS LICENSE# ` ;� yyv ADDRESS: ��/. CITY/ZIPCODE: (50 Q10 3 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRA TO HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. l� I am not using any subcontractors: SignatioKe liate Please check applicable subcontractors and complete the following-information: . G/ 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