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13080223CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1107 KENTWOOD AVE CONTRACTOR: TUQ—ZQ BE PERMIT NO: 13080223 DFT� ERMINED OWNER'S NAME: MORGAN BARBARA N TRUSTEE �' DATE ISSUED: 08/29/2013 OWNER'S PHONE: 4088325436 PHONE NO: ❑ LICENSED CONTRACTOR'S DEC�,LA�RATION JOB DESCRIP'T'ION: RESIDENTIAL COMMERCIAL EI License Class� Lie.. # % Z-4 Z,j REMOVAL OF RESIDENTIAL POOL 448 SQ FT /� ,,7 Contractor t¢A,tz/d E KM L.l�f'ee-? Dat I hereby affirm that I am licensed under the provisio sof 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 Sq. Ft Floor Area: Valuation: $4500 performance of the work for which this permit is issued. 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: 35931003.00 Occupancy e: p y Typ 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 10 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 DAYM LAST CALLED INSTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the �7 Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point sour ns r Cupertino Municipal Code, Section RE -ROOFS: 9.18. i Signature Date 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 25 0 , 534. 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I 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 10hh 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �/ V - (408) 777-3228 • FAX (408) 777-3333 • building cupertinG.org CUPERTINO +� PROJECT ADDRESS APN # 5�] 3100? OWNERNAME ION MSNE ��� I L�• E-MAIL S94, 17/1D SS C FAX uTATE,11 �^ CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME Pc- n O LICENSE NT'i Z 4 LICEN E TYPH 0 I z A BUS. LIC 7 7 2 •Ll l,�C COMPANY NAME E- FAX CQ I PLIClON STREET ADDRESS ( CITY, ST"ZIP I PHONE 74L 6a ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAM FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTIONOF WORK #-u_(At4a- (jjQ 'P^nt- 7(7KAC�� USE OF SFD or Duplex ❑ Multi -Family TYPE MATERIAL TYPE (CODE) AREA (SQ. FT.) VALUATION (S) STRUCTURE: ❑ Commercial POOL POOL/SPA MATERIAL TYPE CODES: SPA V - VINYL -LINED DEMO F - FIBERGLASS G - GUNITE P - PREFABRICATED By my signature below, I certify to each of the fo0owing.: I am the p operty owner uthorized agent to act on the property owner's behal . I have read this application and the information I have ec I e d the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating tos n. r9( rize representatives of Cupertino to enter the above -id tified pr erty for inspection purposes. Signature of Applicant(Agent:Date: n, SUPPLEME TAL INFORMATI N REQUIRED x ' E,QCTYE ROTJTINGSLIP� _ Commercial or Multi -Family Buildings with Public Swimming Pools: "_� Department of Environmental Health approval required. � R A �� - �I:ANIVNIG a. a 't -' *f �" `� S "`A�iDARD � �-�; �' s � ^ a ❑,PUBLIC R'ORKS DEPT � & �E�vVII20NMENTAL,i�ALTH���` ❑���A126k��i � .� ���-� �� . 1 JOA _ .tom 'SAIiITARY SEWERDiSTRICT' q SwimPoolApp_201 Ldoc revised 03/16/11 CITY OF CUPERTINO FM-� FEE ESTIMATOR — BUILDING DIVISION im,ADDRESS: 1107 kenwood ave DATE: 08/29/2013 REVIEWED BY: Mendez Plan Check Fee: APN: BP#: *VALUATION: 1$4,500 *PERMIT TYPE: Demolition Permit PLAN CHECK TYPE: PRIMARY Swimming Pool, Res. USE: PENTAMATION 1SFP00LDEM PERMIT TYPE: WORKremoval of residential pool 448 s ft SCOPE 0.0 x� Mech. Plan Check Phimb. Plan Check Elec. Plan Check Flecll. Permit Fee.. Plumb. Permit Tee: Elec. Permit Fie: r�lkl','k a1e<h. Insp. .(litter PXumb Insp.Li Other Elec. XnsP. hssp� Fire: Plumb. Insp. Fee: Eke. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (tie. Planning, ruottc worKs, Ptre, sanitary sewer uisiricr, acnooi District. etc 1 These fees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: S7,1111 -V. PC Fee Plumb.iMech./Elec Permit Fee: $319.00 Suppl. Insp. Fee -0 Reg. Q OT 0.0 hrs $0.00 Plumb./Mech./Dec Plumb.A,Vlech./Elec Permit Fee: Consiruction .Ta: Administrative Fee: Mork Without.Permit? Advanced Planning? Fees: TrUvel Documentation Fees: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 0"n ON st N m3 f $320.50 $0.00 O =LEE $320.50 Revised: 07/01/2013 I1 04 K-i--ouic)&6 AVG CuPEefiNo ca . q 509 P (D UsC--� CUPERTINO F Building Department AUG 2 9 2013 REVIEWED FOR COD COMPLIANCE Reviewed By: ?oo L- �(-, /,-A (0 4+8 � S Q, --v-. COMMUNITY DnIELOPhR-ENT DEPARTMENT BUILDING LIP UCIN - CUPERTiNO This set of plans and specifications MUST be kept at the job alts during constrUctivn. It is unlawful tom ;e any 6 Inges or alteraticE is on same, or to deviate therefrom, without approval from the Building Official. Th` stamping of this Plan and specifications Sl -ALL NOT be field to t: ,reit or to be. an a' proval of the vlcic. ion of any provisions of any City Ordinance or Law. BY V) ERMIT NO. ladX622 '� Man rz! i �� -1-V I PLOT PLADZ�-t' CHECKED �,PpILAN 1°d(G DEP'11'-1 1- :,.