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13090006 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10341 WESTACRES DR CORACTOR Si�C.v PERMIT NO: 13090006 Gt.t/ n C OWNER'S NAME: LECOUNT RONALD L AND JOAN A DATE ISSUED:09/03/2013 OWNER'S PHONE: 4084553307 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class L��E'vt# �9�O DEMO(E)500 S.F.SWIMMING POOL.HANDOUT PROVIDED, Contractor .' Date NO FUTURE BUILDING,LANDSCAPE PURSPOSES ONLY I hereby affirm that I am licensed miller the provision of hapter 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 e formance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3800 ave and will maintain Worker's Compensation Insurance,as provided for by / ection 3700 of the Labor Code,for the performance of the work for which this APN Number:35914023.00 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 DAY �ALLED 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 Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulatioper the Cup ino Municipal Code Section 9.18. 100, 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 Puality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cuperti 11 icipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255.10 ,215X-3,,and 2 4. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ag 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 K� SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 S P CUPEttTINO (408)777-3228-1 FAX(408)777-3333•building0cupertino.org PROJECT ADDRESS ,9APN# 3 J CC]. t —0 7 OWNERNAMES PHONE O / E-MAIL L a� v STREET ADDRESSC.rG CITY,STATE,Z ,A ` FAX CONTACT NAME O` PHO V I E-MAIL STREET ADDRESS J ry I CITY,SCTA`/TE,ZIP ( 0 Ig -] FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENTft�QNTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME n�sl �� ,LICENSE NUMBER 7777�A+ BUS.LIC# COMPANY NAME / E-MAIL FAX Ck&S STREET ADDRESS(-,, `v L , CITY,STATE,ZIPZ V PHO q'�ctl q'I ARCHITECT/ENGINEERNAME lJ 7 LICENSE NUMBER BUS.LIC#[.� 7 COMPANY NAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ' ring f4� yY1 a G�icG�S 2 dr �SQd' a�rrLy � d Fvlzv v/t-D/ 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 rBy - FIBERGLASS DEMO � � Z02 - GUNITE U Y) r 1500 - - PREFABRICATED TOT�i.� YAATI(3�: my signature below,I certify to each of the fol wi g: I amope weer uthor' ent to act on the property owner's behalf. I have read this application and the information I have provided c ect. I h ter d the Descrip ork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil ' uc n. authon representatives of Cupertino to enter the above-idenf ied pro rty for inspection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL ORMATION REQUIRED _Commercial or Multi-Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. ` SwimPoolApp_201 Ldoc revised 03/16/11 CITY OF CUPERTINO D FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10341 WESTACRES DR DATE: 09/03/2013 REVIEWED BY: MELISSA APN: 359 14 023 BP#: *VALUATION: 1$3,800 *PERMIT TYPE: Demolition Permit PEAK CHECK TYPE: PRIMARY Swimming Pool, Res. PENTAMATION 1 SFPOOLDEM USE: PERMIT TYPE: WORK DEMO E 500 S.F. SWIMMING POOL. HANDOUT PROVIDED NO FUTURE BUILDING SCOPE LANDSCAPE PURSPOSES ONLY FEE ID #POOLS 1DEMOPRES ��, 1-.� 1 Wt L1ech. flan Check Plumb. Plan Check Elec.Plan Check iL1ecl1. Permit Fee Plumb. Permit Few: Elec. Permit fee: rOnc�rr Meth.Insp. Other Plumb Insp. L—j Olher Elec,Insp. Ll 11ech. Insp. Fee: Plumb. luspl. 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). Theseees are based on the relimina information available and are only an estimate. Contact the Dept for addn'l info, FEE ITEMS(Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: S'r.ppl. .PC.Fee Plurnb.i.'�lech.%Floc; Permit Fee: $319.00 Suppl. Insp. Feer Reg. ® OT0,Q hrs $0.00 Plum b./:l to ch./Flee: Plumh./;1,1ech.1E7ec Permit Fee,: (.onslruction Tari: Administrative Fee: Work k6'ithout Permit.,' Advanced Planning Fees: TrUvel Docutnentatt.on Fees: � Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $320.501 $0.00 j u OTFEE� $320.50 Revised: 07/01/2013 � c T.. guildin.9 ORr/No �3 Q�a�enf REv, 13 Ew ?0ED FOR CODE T)21 U fI,vf P�ieCOMPL/ANCE a//,P1 ty?i 0""/ A6/ ,1 60 7 r IzCma?4% hyeae 60440;," o -r SC/imr✓► im-7 Pau cvqll r'rL GPVVDs GATE- pdp-po'�IF-s 00,/A-( , �o-r Bu i PGP 61,eS 71 !F�F'ICE COPY COMMUNITY DEVELOPMENT DEPARTMENT Qh5 BUILDING DiVIaiON-CUPERTiNO r OE-1 R� ag- 'P P S 14��r��s'�;�® CHECKED BY Tbls sPt of plans and specifications MUST be kept t the �` job site during construc ion. it is unlaw`:uf to n' , 'any changes or alterations on same,or to 63 therefrom,without approval from the Building 0 ;'Cial. LANNING F.P + The stamping of this plan and specifications SH!�,i-_ NOT be heid to permit or'to be an :approval of t#}e',i-,°ao •' n Ilr+\TEa v hof any prov'�` ity Ordinance or Stunt Law. BLOF.—DRTT. DATES � � i3�aoo�e� PERMIT NO. r,(eC 2tc_ PAPS 9,VJ BY: 5Ca&rA i rq Po"l L J