13060192 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11790 UPLAND WAY CONTRACTOR:PHILLIP D.BJURMAN PERMIT NO:13060192
OWNER'S NAME: AMIT GOEL 1250 HIGHWY 101 DATE ISSUED:06/24/2013
OWNER'S PHONE: 4089969002 AROMAS,CA 95004 PHONE NO:(650)906-7533
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL❑
License Class Lic.# � `�� SWIMMING POOL DEMO 600 SQ FT,CAP GAS
ContractorDate
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:$7000
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:36603034.00 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 80 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 DAY F 6M LAST 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
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature I)-_R--_Date Z 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)
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. 1 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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti*aks 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Dater
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
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 I SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ` n01
V1
11FE TINS (408)777-3228• FAX (408)777-3333•building( cuoertino.ong 00
PROJECT ADDRESS /f I f o / ' l�d / f APN# J n/ w 6> o-34
OWNER NAME `v vO W PH r w e� E-MAIL
STREET ADDRESS CITY, STATE,ZIP (C U� (r FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRA N ` r�� LICENSE NUMBER LICEIIi�E TYPE BUS.LIC#
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ARCHITECT/ENGINEER NAME LICENSE NUMBER t BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
(-GudLl
USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION($)
STRUCTURE: ❑ Commercial POOL
POOUSPA MATERIAL TYPE CODES: SPA
V - VINYL-LINED
F - FIBERGLASS DEMO / Uv
G - GUNITE (O V
P - PREFABRICATED — _ TOTA VALUATION:
MINE
By my signature below,I certify to each of the following: I am the property o er r 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 Des rip6>4 of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatI nstruction. orize representatives of Cupertino to enter the abov identifi property for inspection purposes.
Signature of Applicant1Agent: Date: l�
SUPPLEMENTAL ORMATTONREUIRED
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Commercial or Multi-Family Buildings with Public Swimming Pools: w _
Department of Environmental Health approval required. R 1s>%co G DEPT`__
.S• <tRD . - r 1'GBLIG ORICS DEPT�Y;=M,
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+ �SANiTATLY SEW; RDISTRIGT"
SwimPoolApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 11790 upland way DATE: 06/24/2013 REVIEWED BY: mendez
APN: I BP#: *VALUATION: 1$7,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
SFD or Duplex 1SFPOOLDEM
USE: I I PERMIT TYPE: �
WORK �sfdwl swimminq pool demo 600 sq ftcap gas
SCOPE
01 y, R 191
L/sch. flan Check Phimb. Plan Check FT Elec.Plan C"hc:ek
L1i>ch. Permit Fee: Plumb. PeTmi7 l=ee: Llec.Permit Fee:
Otherr;Tech.Insp. Other^Plumh Insp, Lj Other Flec.Insp.
.ilech.Insp. Fe . Plumb. Insp.Fee: Elec.Insp.Fre:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelhWdna information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS 6Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Swimming Pool
Suppl.PC Fee: (E) Reg. ® OT 0.0 hrs $0.00 $306.00 IDEMOPRES Demolition
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Feer Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
C:onstruc,tion Tax:
Administrative Fee.:
Work Without Permit? 0 Yes (E) No $0.00 E)
Advanced Planning Fee. $0.00 Select a Non-Residential G
Travel Documentation Fees: Building or Structure 0
Strong Motion Fee: IBSEISMICR $0.70; Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
g,- ® Ev
$307.70 o _$1.70 $306.00
Revised: 04/29/2013
�7S-33
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PLOT P"NS1
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¢ YE JUN 2 4 2013
Revievied By: -
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N OFax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: (�.j PERMIT#
OWNER'S NAME: rA L____- PHONE#
GENERAL CONTRACTOR: P� %Cv Q BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*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 SUBCONTRACTORS HAVE OBTAINED Q,-CITY F CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: �' Z
q11-
Signature Da
Please check applicable subcontractors and complete the.following information:
-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