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14080035 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10570 WHITNEY WAY CONTRACTOR:JOHN MOLINA PERMIT NO: 14080035 CONCRETE OWNER'S NAME: JASTI RAJA V AND PADMA 30 CLAREVIEW AVE DATE ISSUED:08/05/2014 OWNER'S PHONE: 4084406100 SAN JOSE,CA 95127 PHONE NO:(408)729-3642 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑ p REMOVAL OF SFDWL POOL 578 SQ FT License Class C—S Lic.# �23 ( �Sf Contractor�16 t1sJ G64G.Date 6-5—W 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 derformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4000 I have and will maintain Worker's Compensation Insurance,as provided for by PI-on 3700 of the Labor Code,for the performance of the work for which this APN Number:36939023 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 IM-S 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 DAYS .RO ZAST CALLED INSP TION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: ° Date: t with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signature .AtDate 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: t ` Date: S 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 112 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 S P (408)777-3228•FAX(408)777-3333•building(ftupertino.org CUPERTINO PROJECT ADDRESS,O n o 1M1J,. `wrrk APN# OWNERNAME ' PHONE �O E-MAIL v STREET AD bI ! CITY, STATd J /N� FAX CONTACT NAM' `/ JL/ PI-IQNiy�� 'S� E-MAIL STREET A111� V CITY,S(TSA�T�� ' - .,, rAQ ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NA LICEN E NUMBER LICEN T BUS.LIC# COMPANY NAML__ E-MAIL FAX �� loot STREET ADDRESSa' � E CITY,STATE,ZIP • 1/ P" .0 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK REMO Vg PoOL ja U1 PA4.9t4T ACk FILL PWL 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 G - GUNITE P - PREFABRICATED CEIYED SY TOTAL T10 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 D�"� ription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin st tion. I�autth�orize epresehtatives-of Cupertino to enter the above-identified 'p property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED _ OFFICE USE ONLY PLAN CHECKTYPE ROUTING SLIP _Commercial or Multi-Family Buildings with Public Swimming Pools: �i Department of Environmental Health approval required. D oVEReE couri?ER ❑ B,uILDINc,bEPT `❑ F�XPRESS °�� f ❑ "PLANNTNGDEPT STANDARD ,- ❑ PUBLIC WORKS DEPT LARGE ❑ ENVIRONMENTAL HEALTH ,0 MAJOR ❑ SANITARY SEWER DISTRICT SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINO D FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10570 whitney way DATE: 08/05/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$4,000 *PERMIT TYPE: Demolition Permit PIA V(:711,,t'h PRIMARY PENTAMATION USE: Swimming Pool, Res. PERMIT TYPE: 1SFPOOLDE WORK removal of sfdwl pool 578 sq ft SCOPE FEE ID #POOLS 1DEMOPRES a , 14'c Pip"Cheek 11tw/h. Non Chet-i' Z ec' llkin E"faeek tr.>elr. T'ef`nrid Fees 1 fumlr. T'c:,mat; e: r 3!rc " °+Icc° . Irts,n (hher Aumb Irls'"zLi CJ'isei st�t WY(ia hlv'� F'7urtsh, hlspp Fee NOTE: This estimate does not include fees due to other Departments(Le.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 Ef. 7.if 1/13) FEE QTY/FEE MISC ITEMS Permit Fee: $329.00 Suppl. Insp. Fee:Q Reg. OT 0 0 hrs $0.00 Permit Fee: :'f.% dirart I Strong Motion Fee: 1BSEISMICR $0.52 Select an Administrative Item Bldg Stds Commission.Fee: 1BCBSC $1.00 0, 511MAN . S $330.52 $330.52 $0.00 TOTAL FEE: 15 ..E_ . . Revised: 07/10/2014 N r'D w� i s ,� p �� Niviole 968 5:90 B- :? K 80 S V F F k 1 o P60L tQ01P TMEIk:T SCUP O ENT DER'!'1� { OVED pin ions MUST be kept xt the constrt is unlawrul to maze ally Site / or a tions o same, or to j daz'Lji`G�tei ' M tuna i ��J CC5 t aPpro rom is plan Stain a be he . � c. it o e a approval rov io any ci 0rdin BY SUP .. TlC Building Department T AUG 0 5 2014 REVIEWED FOR CODE C OM PI...IA 'Ct: Reviewed By: a j