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13070066 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10452 SCENIC CIR CONTRACTOR:HAULING PROS PERMIT NO:13070066 OWNER'S NAME: CAROLINE MA PO BOX 4033 DATE ISSUED:07/10/2013 OWNER'S PHONE: 4089405889 WALNUT CREEK,CA 94596 PHONE NO:(925)682-8987 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE] License Class Lic.# � `—t REMOVE(E)SWIMMING POOL FOR FUTURE BUILDING. ENGINEERED SOIL COMPACTION WILL BE CERTIFIED Contractor�>�tcJ (��CCiS Date ` 1 TO 90 I hereby affirm that I am licensed under the provisions of Chapter 9 %COMPACTION BEFORE FINAL (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 which this APN Number:35707010.00 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 O RMIT 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 save180 DAYS FR 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 Is e: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date ( �rU r3 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 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,Sections 25505,25533,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 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 O COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 -- - C1,�P1 R�'1N4 (4.08)777-3228• FAX(408)777-3333•building(d)-cuperti !no.or4 r�o � PROJECT ADDRESS APN# OWNER NAME Cmi-t3 \-N e OA a PHONE E-MAIL c.v STREET ADDRESS CITY, STATE,ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ptywN LIC ER © ``LICENSE TYPE BUS.LIC# COMPANY NAME E-MAI. IAC G1°1J Cw�!O FAX C-/K'<1 l e: rtn STREET ADDRESS C STATE,2`I PHONE 91.0 RRoc) tA- Ito 9 _C93 41Clq AR HTTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COI,JP ,NY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK c� 0 USE OF ❑ SFD 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 P - PREFABRICATEDOTALVALUA T TION: .00 By my signature below,I certify to each of the following: I am the property owner or autho ze ent 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 ofWork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property/for inspection purposes. Signature of Applicant(Agent: Date: 7 - 10 — !_3 SUPPLEMENTAL INFORMATION REQUIRED _ E K T]P....:z NO ROSI,Tuyc iN _Commercial or Multi-Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. ROO 5 E0� °:JOM..SANIT?;-RY SEW:ERvDISTRIGT. u� SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINO D FEE ESTIMATOR-BUILDING DIVISION jjUTADD7R"ESS: 10452 SCENIC CIR DATE: 07/10/2013 REVIEWED BY: MELISSA N: 357 07 010 BP#: 'VALUATION: $9,000 *PERMIT TYPE: Demolition Permit PLAN CHECK T)'PE: PRIMARY PENTAMATION USE: Swimming Pool, Res. PERMIT TYPE: 1SFP00LDE A WORK REMOVE E SWIMMING POOL FOR FUTURE BUILDING. ENGINEERED SOIL COMPACTION WILL SCOPE BE CERTIFIED TO 90 % COMPACTION BEFORE FINAL FEE ID #POOLS 1DEMOPRES 'I xi 4 ech. Plan Cher..•k Plumb.Plan Check Elec.Plan Check Ltech.Permit Fee.' Plumb.Permit Pee: Elec. Permit Fee: Other•'Ucch.Insp. Other Plumb Insp. Li Other Elec.Insp. Afech.Insp.Fee: Plumb. hrsp.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prelhWdna information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E f 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: suppl. PC Fee Plumb.11fech./Glee. Permit Fee: $319.00 Suppl. Insp. Fee-.(j) Reg. ®OT 0.0 hrs $0.00 Tlurnb.;ri!lec':h./Flee. Plumb./11ech./Elee Permit Fee: Constrztction Tax: Administrative Fee: Work Without Permit? Advanced f larrningT Fees: Travel Documentation Fees: Strong Motion Fee: IBSEISMICR $0.90 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $320.90 $0.00 $320.90 Revised: 07/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U PE RTI N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST."r JOB ADDRESS: `,r� PERMIT# fieC� OWNER'S NAME: hr PHONE.#..- R GENERAL CONTRACTOR: _BUSINESS LICENSE# ADDRESS: P U3 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 INSPECTION(S). .W:ILI: BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED AfaCITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ! ! \ Signature Date 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 I ` COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTiNO PPReVED (� (� r� ( r� _ / This Set of plans and specifications MUST be kept at the �C) Y) -s C,(7 /�,�-C��- �� /� S L o b o L� �` C) (� t lt1sunlawfulto make any ar pes or alterations on same,or to deviate +"r-+F Dn , without approval from the Building Official. iclinn of this plan and specifications SHALL NOT ~: nit or toel an -approval of the violation DIG .'I DEED an%i, Ordinance or State Law. Uoenee#834630,9254034"S -�---a ! /3 ,��. — s66 "Poo� C—cty t(��.ev. — — 102.05 - ? CUPERTI O pm"kw j Building Department -SN\e-l` -o. d1 c Coo V0 --c- �� / JUL 10 2013 yr:c / _ — — - - as REVIEWED FOR CODE COMPLI NCE .S ve c\ ;F<C'�o�,.s _ �r„��E c� � � e 2 Reviewed By: r� ,/� vlii O 11.431. 'rc� �� PJv�� `��cJ/ QG 1 r 0.64 removed (� immF1 . G i t CA; HOUSE j � � i GNECY BY SATE p'LANN; r propelty1w _ � DATE 123.05-- -- - Ame=567.47 sqR. BLDG• INEPT; Perimeter=100.10% 10452 Scenic Cir., Cupertino, CA 95014 Santa Clara County, USA scale 1 :200ft Af 3S- ?- - O - OtO