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14020003 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10822 WILKINSON AVE CONTRACTOR:A-1 POOL REMOVEAL PERMIT NO: 14020003 OWNER'S NAME: LEARN ARTHUR J AND BETTY J P O BOX 1212 DATE ISSUED:02/03/2014 OWNER'S PHONE: 4082539821 CAMPBELL,CA 95009 PHONE NO:(408)978-2903 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION RESIDENTIAL El COMMERCIALE] License Class C Z Lic.# goo 500'40 REMOVAL OF SFDWL POOL 462 SQ FT Contractor77&0�� S�• DIO/"-/- I hereby affirm that/I am li11censed 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:$5500 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:35613037 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 ROM LAST CALLED INSPECTI N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the �f/ 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. RE-ROOFS: Sign a Date Z 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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. 1 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(x)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 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 505,255 and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorize Date. 3 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 CONS UCT N 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 AVd NUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•PAX(408)777-3333•building(ftupertino.orp dol PROJECT ADDRESS © 1 �� O PN# 2�1. 3 03-7.0C, OWNERNAME / � PHO G-3— Qom----;- EAAIL STREET ADDRESS (^ ` CITY, STATE,ZIE 7 : /�C�/ 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�- j^ A ` LICENSE NUMBER U I LICE SE E BUS.LIC# COMPANY NAME ` .M 12 /�, Q V A L E-MAIL FAX STREET ADDRESS f.� '`!/�� CIT STATE,ZIP / r r PHONE 2 Q Po o)c /Z/2 C t4 l \ o 97fs" ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK I .. M d 0 ( � USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION($) STRUCTURE: ❑ Commercial POOL POOLISPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLAS DEMO / G - GUNITE �p P - PREFABRICATED TOTAL VALUATIO w B0 By my signature below,I certify to each of the following: I am the property owner or authorize?n. t to act onye e property owner's behalf. I have read this application and the information I have provided is corn ct.:I have read the Description of Workverify it i curate. I agree to comply with all applicable local ordinances and state laws relating to bu'ding co cti n. I authorize representatives of Cope to ent a above-identified property for inspection purposes. Signature of ApplicanUAgent: Date: l SUPPLEMnENrORNfATION REQUIRED ' Commercial or Multi-Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. ' b r �.r SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINO D FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10822 Wilkinson ave DATE: 02/03/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$5,500 *PERMIT TYPE: Demolition Permit PZ,3;1 C;'111"CK PRIMARY PENTAMATION USE: Swimming Pool, Res. PERMIT TYPE: 1SFPOOLDE WORK removal of sfdwl pool 462 sq ft SCOPE FEE ID #POOLS 1DEMOPRES ft";,r. I'crwil Fee: Other Tnsy'. 01h,"P,l tec Insp Lj NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS(Fee Resolution 11-053 E f 7/1/13, FEE QTY/FEE MISC ITEMS Slippl, PC Permit Fee: $319.00 Suppl. Insp. Fee:Q Reg. C) OT QQ firs $0.00 ;f. o Mfnvntol;on Fees: , Strong Motion Fee: IBSEISMICR $0.55 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 41160215 . A)C.S- $320.55 $0.00 TOTAL FEE: $320.55 Revised: 01/15/2014 Y i-:r KI I -70 ot 7Z I T o . 3x� y �s—�— Y� �s� TO Mt5A Sc gP�:ni� o.�ty NaTr I ELEtcT24-y 5-- - d A�' !/NjtA- &2ow To 2erl alW A L i 1 ! S yq R � c�j J S F I LEACk 4 /�0 e622 WT-L1<j1V 5oN M/ C,oPER—r--LAI V N o%— 25 3 — gc6Z t ,I 1 1 i0 R��� A� (-2iv Al T 1 I CUPERTINO i f<Oding Department I .,. CODE COMPLIANCE Reviewed By: 5T EC1 COMPACTION REPORT IS REQUIRED SHOULD THE IVoT-'o-Cc—,4 ABATED AREA BE DECLARED "RUILDARLE" IN THF FI ITI IRF