14020094 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10306 NORWICH AVE CONTRACTOR:A ONE CONSTRUCTION PERMIT NO: 14020094
GROUP
OWNER'S NAME: VIKAS MINGLANI 14717 PALOMINO DR DATE ISSUED:02/14/2014
OWNER'S PHONE: 4089739564 SAN JOSE,CA 95127 PHONE NO:(408)449-9841
121- LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
�, DEMO(E)SWIMMING POOL,641 S.F.
License Class Lic.# J 8
Contractor
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:$3500
I have and will maintain Worker's Compensation Insurance,as provided for by
l Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31629092.00 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 PE T 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 D LLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue gains said City in consequence of the
granting of this permit. Additi �1111e applicant understands and will complyZZ Date:with all non-point source reg ar the Cupertino Municipal Code,Sect'
9 18.
RE-ROOFS:
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
1,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)
1,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(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 C Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections25 05,25533,and 3Sction 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent �— Date: O Z
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
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION n ,
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ` O v
]
DUPER (408)777-3228•FAX(408)777-3333•buildinga?cupertino.ong
PROJECT ADDRESS lo 3 n / (Y I cr, .11)C 7 [� "c. APN N Ij I 6 _ �7 0-12—-1 27
OWNER NAME '\/ , K AS VM I N � Y 6 PHONE D O 1 7 ,� 5' E-MAIL
—
STREET ADDRESS 1 D 31)6 Norwich
�. iT h A V e CITY, STATE,ZIP /'t q CAL r O /'/1 9SO//, FAX
CONTACT NAME N) 1<&g
U,A^I�W �^^) PHONE I,O? 2 L1 2- 7 rV E-MAIL ,1 m � Pa V1� shoo
STREET ADDRESS 10306
D 30 6 S l ,0)'(A�'I4 � CITY,STATE,'Z'(IP ( r_��y,0., C.4 qS-01� FAX
Mk OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME 5(4 kh w cw 1L S;'r9 ]_ LICENSE NUMBER 9 -7 6 ^ 6 � LICENSE TYPE BUS.LIC#
COMPANY NAME Q MC, /'0 Ll �C /L,°\OA EMAIL I G FAX
STREET ADDRESS P6d O M;"o 7 1�7, CITY,STATE,ZIP J C. �D Se <^ 9 s Z PHONE [,b g q U Q q 6t, I
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#I
COMPANY NAME E MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK �)
1 2xi's oa /
USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION(S)
STRUCTURE: ❑ Commercial POOL
t
POOLISPA MATERIAL TYPE CODES: SPA
V - VINYL.LINED
F - FIBERGLASS DEMO &C(/
G - GUNITE
y AL VAL T19Di_ O
P - PREFABRICATED F _;� - �a .�, TOT
-35 FFM
By my signature below,I certify to each of the following: the propertywnero,r authorized o act on the property owner alf. I have read this
application and the information I have provid is cone t I have read the Description of WQfjrvff verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil4 n con ction.J aut orize representatives of Cupertino to enter the above-identified
t property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATM REQUIRED v =
r{a OFFICE USE ONLY
_Commercial or Multi-Family Buildings with Public Swimming Pools: ] ' 4 s z ❑Department of Environmental Health approval required. DNGDEPT }
r
' M P>ANNiNG.DEP!
r
4 31ANDARDEe x t rPUB>LC KS,DEP!
ARGE)nYr 3h Q �I
EiV[RONMFTALHEALTH ;€
Q iNATOIt' _ ❑ SAMTARY'SEWERDISTRICr'
SwimPoolApp_201 1.doc revised 03/16/11
CITY OF CUPERTINO D
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10306 NORWICH AVE DATE: 02/14/2014 REVIEWED BY: MELISSA
IQJAPN: 31629092 BP#: *VALUATION: $3,500
*PERMIT TYPE: Demolition Permit W-1 N('//F("x 7TPh
PRIMARY SwimmingPool, Res. PENTAMATION 1SFP00LDEM
USE: PERMIT TYPE:
WORK DEMO E SWIMMING POOL 641 S.F.
SCOPE
FEE ID #POOLS
1DEMOPRES
�hxcs �
._ 4w
I'le:Ir. r"' 'a<'.ck 1'/ntttl.Nun("heck :111ai4 Chock
vl"> hi P °1W1 Fee: Permi71'�tr:
O'ttrer Plumb L-up. L olhc-r 1,11"'(' lwq).
Plumb_h,,p. Fee. f leo.Inst, 1,c.
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees 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 . 7ff 11113) FEE QTY/FEE MISC ITEMS
:i'ttzri=T, P 'f`z
Permit Fee: $319.00
Suppl. Insp.Feer Reg. 0 OT 0,0 hrs $0.00
Permit Fee:
,plc{n2iil.��ocrfivc f�:e:
ff"o 1c 11"'idiozu F'�r arty
� GiL'tJ7tt't'iltit'filirW
IY.t 'f.'I &)£iC'tftYtf'illrl !{)Yt Fees:
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
'
$320.50T $0.00 °TOTAL FEE: ` $320.50
Revised: 01/15/2014
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/SUBCONTRACTOR LIST
JOB ADDRESS: 10306 /& ru)) A V e Ctfh6nRW0 M1 PERMIT# Z'0 01
OWNER'S NAME: V)'kotS /V I M Q" e PHONE# 40 8 2 12 2,6 9 4I
GENERAL CONTRACTOR: O BUSINESS LICENSE#
ADDRESS: r 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 INSPECTIO ( LL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTO OBTAINED A-CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: "ilG r—��
ignature Date
Please check applicable subcontractors and complete the following information:
V 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
tuA-Pve- OkcLs MJh5'&%4i
A91045M 10306 Alorwkh Ave) C64whlro,� CA UOILy
Fot M'Sh'l-ij PF91,
POOL to be removed
Area= 640.54 sq ft
Perimeter= 104.67 ft 0
lak,
104.00 M/ --
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10306 Norwich
NeatN 1 o,CA 95014
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DATEK 8y
PERMIT NO. 0