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13090122 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1150 STAFFORD DR CONTRACTOR:A-1 POOL REMOVEAL PERMIT NO: 13090122 OWNER'S NAME: RAJA VENKATESH P O BOX 1212 DATE ISSUED:09/17/2013 OWNER'S PHONE: 4083662124 CAMPBELL,CA 95009 PHONE NO:(408)978-2903 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Cl!. Lic.# 6 zqy o POOL DEMO 874 SQ FT Contractor^a.nz Date / Z 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:$6000 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:36207006.00 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 DAYSf"LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, 64 costs,and expenses which may accrue against said.City in consequence of the 17 7/ 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. y� RE-ROOFS: Signature — Date r!' 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. ❑ OWN -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 ' jr' It l Owner or authorized permit is issued. ent: Date: 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 � - 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (408)777-3228-FAX(408)777-3333-buildingecugertino.org CUPERTINO \� PROJECT ADDRESS S / n® APN# 74ICA011-i Onom ` axr OWNERNAME AV, �F� f TS: / PHONEY20 34_Z/� E-MAIL STREET ADDRESS Sim yL CITY, STATE,ZI�prc(�oJ��4 /� FAX CONTACT NAME `/ PHONE S� E-MAIL {4`-� /��v/R�►�'►D I GK 751 Z I �0I 3 STREET ADDRESS 090 CITY, Y,STATE,ZIPo FAX _419@<R ❑ OWNER-BUILDER ❑ OWNER AGENT I � ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENS=E LICENSE TY1 Z BUS.LIC# COMPANY NAME „^ ,e E-MAIL FAX STRFET ADDRESS _ , CITY,STATE,ZIP PHONE 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($) STRUCTURE: ❑ Commercial POOL POOL/SPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO 7 G - GUNITE P - PREFABRICATED TOTAL VA]UUAATIJJN: By my signature below,I certify to each of the following: I am the property owner 6r 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 being ing contra . I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent Date: � 7 13 SUPPL ramily L O ON REQUIRED _Commercial or Multi- Buildings with Public Swimming Pools: Department of Environmental Health approval required. SwimPoolApp 2011.doc revised 03/16/11 CITY OF CUPERTINO D FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 1150 stafford dr DATE: 09/17/2013 REVIEWED BY: Mendez APN: BP#: EVALUATION: $6,000 *PERMIT TYPE: Demolition Permit PLAN CHECK TYPE: PRIMARY Swimming Pool, Res. PENTAMATION 1SFP00LDEM USE: PERMIT TYPE: WORK � ool demo 874 sq ft SCOPE FEE ID #POOLS 1 DEMOPRES 'I llech. Plan Check !7PIumb. Plan Check Elec.Plan Check FIT,/, Fee: Plumb.Permit Fee: Elec Permit Tee: Other l9ech.Insp. Other Plumb Insp. 0 Other Elec.Insp. A11ech. Insp.Fee: Plumb. Insp.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,eta). Theseees are based on the prellmina information available and are only an estimate. Contact the Det fiv addn I info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC.Fee Plumb.11fechJE.tee Permit Fee: $319.00 Suppl. Insp.Fee-.0 Reg. ®OT 0,0 hrs $0.00 Plumb.itkiech./1Eec Plum b.AVfech./Elec Permit Fee: Construction Icry-: Administrative.Fee: YYork. Without Permit? Advanced Planning Fees: 7'1-avel Docurrrentation Fees: Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item Bldp-Stds Commission Fee: 1BCBSC $1.00 $320.60 $0.00 ru $320.60 Revised: 08/01/2013 NOS' S ` 0IV -p5 WT/"hMZ �C9 LTp ICE 1 COFNI"I l?F M A-r/V Fo k /v':-7 vV CUPERTINO C- A taa IV& IDE516N Building Department To fat R L 'e2 �. . SEP 17 2013 ` )3y `�"� � AtoT�� VIEWED FOR CODE COMPLIANCE J�fM�N-r 7o 13 G Reviewed BY. F D A NP R EMOV O f eLOT PLAN C P t: 70 CHECKED R)& ` > 8,A)"I DoAl IF L COPJf`UNITY DEVELOPMENT DSP, Ar t3 \ BUILDING DIVISION-CU APPROVE PL IlVG DEPT, This set of plans and specifications MUST be kept at the \ j)RATAl 1-to , vonstruction. It is u�lX, I to make any '7"o BE 6QL0 k t TIlt ci I%f i 1 or alterations on same.oro vlarT, o the3rGf r"om,without approval from the Building Official _ ®�'' RW,T)G. DEPT. s�o L Tho of this plan and specifications SMALL NOT b: !:,'t+e i_^rrnit or to be a i approval.of the violation of any provisions of any Cit I Ordinance or State Law. 1'r Y _ lA F1 T 14 R f- � yYlR ,✓ENKA7CSH .ro A = OM1 ": < <s0 ST^ �lroR r3 V' i °�'` Cup aRTTV0 I� S F � ii Yoh` 3G6-Zt zY /� f F 7� 1=aoIVT 3z va✓ VVAX 3 i STE- F 1 COMPACTION REPORT IS REQUIRED SHOULD THE u SCA L E ABATED AREA BE DECLARED "BUILDABLE" IN THE FUTURE,