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13090183 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10370 CHERRYTREE LN CONTRACTOR:HOMEOWNER PERMIT NO: 13090183 OWNER'S NAME: MORENO NELDA J &'71 be e- I' DATE ISSUED:09/24/2013 OWNER'S PHONE: 5102621260 v (�rj�- Cw q0✓ PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH f— RESIDENTIAL F COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:DEMOLITION OF A POOL (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:$39000 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 permit is issued. APN Number:31633043.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FR ALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply ��Y,45 with all non-point source regulations per the Cupertino Municipal Code,Section Iss Date: 9.18. Signature Date RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. thyfiollowing two reasons: as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: ill do the work,and the structure is not intended or offered for sale(Se'c.7044, I Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). . I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& -peffon-nance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 1 certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owner or authorized a ent- 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUC ION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ty Licensed Professional —2 Signature Date I SWIMMING POOL / SPA PERMIT APPLICATION 10 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building(a_cupertino.org PROJECT ADDRESS /� 7 --7v C/ C -771 /�� APN OWNER NAME e_i K�ItiC (!� PHONE �, Z jrZ.L�(, E-MAIL —` V STREET ADDRESS O _ CITY,STATE,ZIP S /J 3�7 FAX ONCE CONTACT NAME �r (A&N PHONE ^ 53 �'mAk., STREET ADDRESS CITY,STATEZIP FAX y art ' 'mac. L,u Cir r,�l- ❑OWNER WNER-BUII.DER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR N ME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET 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 41J l r�H^� G USE OFt4o&D or Duplex [I Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION($) STRUCTURE: ❑ Commercial POOL POOUSPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO GUNrr_ t �� P - -PREFABRICATED TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or 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 building construction. I authorize sentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: /lo/j.� ,._ �a� Date: — /4-/ "l SUPPLEMENTAL INFORMATION REQUIRED S ir _Commercial or Multi-Family Buildings with Public Swimming Pools: ��r Department of Environmental Health approval required. Q �n SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINO D FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10370 cherry tree In. DATE: 09/24/2013 REVIEWED BY: bobs. APN: BP#: 'VALUATION: 1$39,000 *PERMIT TYPE: Demolition Permit P[.f9N CHECK TYPE: PRIMARY Swimming Pool, Res. PENTAMATION 1 SFPOOLDEM USE: PERMIT TYPE: WORK residential swimming pool demo SCOPE FEE ID #POOLS 1 DEMOPRES 'I URr e, i w _ . _ S blec-h.Plan Check Plumb,Plan Check Elec,Plan Check ,,Vkch.Permit Fee: Plumb. Permit Fee: Elec.Permit Fee: Ft)11"'.,/Yeah.Insp. (Other Plumb Insp. Other Elec,Insp. 14ech.Insp. Fee: Plumb. Insp.Tee: Elec.Insp.F'ee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only an estimate Contact the Dept-for addn'1 info. FEE ITEMS(Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. .PC Fee Phnnb.1A,fech✓Elee Permit Fee: $319.00 Suppl. Insp. Fee-.0 Reg. ® OT Fo,Q hrs $0.00 Plumb./Vech.ILlec PluYnfrJM�:ch.i;7ee Permit Fee: Constrtie ion Tax: F71 I L Adinirrislralive Fee: Work Without Permit-' ,Idvanced Plarming Fees: Travel Documentation Fees: � Strong Motion Fee: IBSEISMICR $3.90 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 a $324.90 $0.00 p TAI ' : $ 0 Q 324.90 Revised: 08/01/2013 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408),777-3333 a 77-3333•buildina .cup4 ertino.or Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS 10 370 Clie�r-� LN APN3 BP#!5o 0�$3 OWNER NAME k I i (a 5� n WWNER ADDRESS C S7— F","al rr -A- DESCRIPTION DESCRIPTION OF WORK: SCAP LmJ*7JQ0 1 ,d We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,signed,and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) W/ S 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder"building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. HN2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. +rV3. 1 understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. V.4.5,4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. ids. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars($500), including labor and materials, I may be considered an"employer"understate and federal law. .5; 6. 1 understand if I am considered an"employer'under state and federal law, I must register with the state and federal government,withhold payroll taxes,provide workers'compensation disability insurance, and contribute to unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. , 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwneYBuilderFonn 2010.doc revised 04/14/10 \0!5.9. I understand I may obtain more information regarding my obligations as an"employer"from the Internal Revenue Service,the United States Small Business Administration,the California Department of Benefit Payments, and the California Division of Industrial Accidents. 1 also understand I may contact the California Contractors'State License Board(CSLB)at 1-800-321-CSLB(2752)or www.csib.ca.gov for more information about licensed contractors. v\l" 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name,and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that,as the party legally and financially responsible for this proposed construction activity, 1 will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. N/25_, 12. I agree to notify the issuer of this form immediately of any additions,deletions,or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license,the Contractors'State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property,you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a constructs merfd g agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) ' Lender Name- Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to vers the property owner's signature. Property Owner's Signature: Date.--? 1!4 -( f -- -- iThe following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, 1 hereby authorize the following person(s)to act as my agent(s)to apply for,sign,-and file the documents necessary to obtain an Owner-Builder Permit for my project. _ Scope of Construction Project(or Description of Work): Sw 1� m(el�, 12", �-P"4, F,11 (,wAl 6141�� Project Location or Address: 10-370 Name of Authorized Agent: �� r/L. �l//r/1 Tel No Address of Authorized Agent: U!'s arc 3t1a / ��1�.r &Sf I declare under penalty of perjury that I am the property owner for the address listed above and 1 personally filled out the above information and certify its accuracy.Note:A copy of the property owner's driver's license, form notarization,or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature L/ 1 Date l�f 2 0 t z, 0"erBuilderForm 2010.doc revised 04/14/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTORLAST JOB ADDRESS: `D-7/4-7-70 PERMIT# 0,. OWNER'S NAME: 2/— tatPHONE-# !O' Z GENERAL CONTRACTOR: 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 INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE ,OBTAINED'"A'CITY 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 s f. �� -------- 10 rill /� -i2 PC 7 21L�E ]PIA�� C " 3 COMMUNITY DEVELOPMENT DEPj RTMENTUE Cur I", BUILDING DIVISION-CUPER INO —f APPROVED - This,�et Of Plans 9'nd speGifleatiens MU T be kept at the job site during construction. it is unlawful to make any changes or alterations on same,or to deviate �� therefrom,without approval from the Building Official. The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any provisions of any City Ordinance or State Law. ��P� SEP BY f� Ge e 2� 2Q13 DATE �°� PERMIT NO. Gv�� Y �> A �< S W � t\A t N b 0 LEM 0 I 1 t-7 v), G r,-�EA1�-'L l U 3 `7U GNL ARS'' Tri � LAnI�