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14120056 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10564 METEOR PL CONTRACTOR:Tr.. IQ RE PERMIT NO: 14120056 �D OWNER'S NAME: GUPTA MOHIT AND NIDHI QI ,, Cem u DATE ISSUED: 12/11/2014 OWNER'S PHONE: 8779334448 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIALE] �,a) POOL REMOVAL 620 SQ FT License Class//Lic.# T290212 Contractor Z7/4 Date 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:$5000 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:32644016 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 18PERMIT 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 F LAS ALLED INSPECTION. 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: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signature Date l 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. 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,Sec' �55533, 534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: I'67-11/ 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 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 S (408)777-3228 FAX(408)777-3333-building (ftupertino.orq CUPERTINO PROJECT ADDRESS APN 4 OWNER NAME PHO19 E-MAIL STREET ss CITY, S ATE,ZIP FAX _7E-MAIL CONTACT NAME PHONE STREET ADDRESS CITY,STATE,ZIP FAX OWNER OWNER-BUILDER OWNER AGENT 1:1 CONTRACTOR 0 CONTRACTOR AGENT El ARCHITECT El ENGINEER 11 DEVELOPER El TENANT CONTRACTO NAME LICENSE1W57,7.Z/-e7 LICENSE TYPE BUS.LIC 9 COMPANY NANV E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGrNEER NAME LICENSE NUMBER BUS.LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRI�� ot USE OF SFD or Duplex El Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION STRUCTURE El Commercial POOL POOLISPA MATERIAL TYPE CODES: SPA V VINYL-LINED F FIBERGLASS DEMO 0 �_P�- �ATil) TOTAL Y,�,LUATION: M X1,111" V� By my signature below,I certify to each of the following: I am the property owner or author'j-ze'd—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 ofWork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil g ction. I authorize representatives ofCupertino to enter the above-i'deptified property for inspection purposes. Signature ofApplicant/Agent: Date: 1A 7 4- SUPPLEMEN)4L INFORMATION REQUIRED �OFFICE USE ONLY ROUTING SLIP Commercial or Multi-Family Buildings with Public Swimming Pools: El BU`ILDINGDEPT Department of Environmental Health approval required. OVEECTHE-�COUNTIER- El _0_1 PLANNING DEPT PUBLIC WORKS DEPT n_u Eh- LJ ENVIRONMENTAL HEALTH X �ANITARY SEWER DIS TRICT SwimPoolApp_201 I.doc revised 03116111 CITY OF CUPERTINO D FEE ESTIMATOR—BUILDING DIVISION jaj7RESS: 10564 meteor pl DATE: 12/11/2014 REVIEWED BY: Mendez BP#: 'VALUATION: 1$5,000 'PERMIT TYPE: Demolition Permit PIA V(-'//1"C PRIMARY PENTAMATION 1 SFPOOLDEM USE: Swimming Pool, Res. PERMIT TYPE: i WORK pool removal 620 sq ft SCOPE FEE ID #POOLS 1DEMOPRES I e l•'e;e>: f Er 0--Jac icc•h. I othef.Plumb In,11ytsj-. 14"'h' faq). l c:: Thonb. Tine. Fee: 1_k1c. Ins,"",1 NOTE: This estimate does not include fees due to other Departments(i.e.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 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Permit Fee: $329.00 Suppl. Insp. Fee-.(E) Reg. ® OT Q,Q hrs $0.00 Lc Pernrit FeLV: t`$ork" 11'fhow f t'f"r'btrl Strong Motion Fee: 1BSEISMICR $0.65 Select an Administrative Item Bldy,Stds Commission Fee: IBCBSC $1.00 iN L- Ti�1S $330.65 $0.00 = TOTAL FEE: $330.65 Revised: 10/01/2014 DKII ' llENO Q License#993947,925-9334448 `O �0T POOL to be removed des 11(�e + Area=620.00 sq ft + Perimeter= 103.10 ft vp ERT1No + N V + rn DEC 9 4epare�t + 6p 3.30 REVD 2014 CD o� Pro ert , 6. + WEL7�p �+- + R COU O line �+ I` Reviewer By: COMPLIANCE —s "4 ` line ` N viCOMMUNMY DEVEL PMENT DEPARTMENT - BUILDING DIM ION-CUPERTINO APP OVED - This set of plains and specif cations MUST be kept at tot job site during Construction it is unlawful to make an _ 100.28 changes or alterations on sane, or to deviate therefrom, without appro,,,ea from the Buildirig }*'Rolal. F U The Sbrnping n a d speclffcatic' s Sf1#�';'L NOT 0 FICE C&ftPy b' h; d- to pn, ;d t be n approval of tha lei iia1LJkaf1 Of ar r-c,is;,O any Ci Ord;'na,:e'A, or State Lai. iits-SI IiL. - "77 10564 Meteor PI Cupertino,CA 95014 scale 1"=20'