15010103I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10497 ANSON AVE I CONTRACTOR: NOECON I PERMIT NO: 15010103 I
OWNER'S NAME:
I ALVISO, CA 95002 I PHONE NO: (650) 630-5967
t, LICENSED CONTRACTOR'S DECLARATION
License Class A Lie. # _L 0
Contractor Date 11 20VZ
I hereby affirm that I am licensed and 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.
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.
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned propprty for inspection purposes. (We) agree to save
indemnify and keep harmless t ity of Cupertino against liabilities, judgments,
costs, and expenses which may c against said City in consequence of the
granting of this permit. Additi ally a applicant understands and will comply
with all non -point source re er upertino Municipal Code, Section
9 18.
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
DEMOXILL IN (E) SWIMMING POOL, FILL FOR
LANDSCAPE
PURPOSES ONLY
Sq. Ft Floor Area: I Valuation: $8900
APN Number: 32641110.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS IT ISSUANCE OR
180 DAYS F CALLED INSPECTION.
Z
--RI ROOFS:
Signature Date h .(9� All roofs shall be inspected prior to y 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
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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.
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
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.
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
Signature Date
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) sho d I store or handle hazardous
material. Additionally, should I use equip t or devices which emit hazardous
air contaminants as defined by the Bay Are Quality Management District I
will maintain compliance with the Cuperti M 'cipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 2550 nd..g534.
Owner or authorized agent: Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
UVIV Tr c'T71Vi A mnID — RTTTT ."1NC 111V1g10N
101
ADDRESS: 10497 ANSON AVE
FEE
DATE: 01/20/2015
REVIEWED BY:
MELISSA
APN: 326 41 110
BP#:
ttr ll..l'f F'c cr
*VALUATION:
$8,900
*PERMIT TYPE: Demolition Permit
111AN 011 CK / PE,
PRIMARY
USE: Swimming Pool, Res.
Permit Fee:
$329.00
PENTAMATION 1 SFPOOLDEM
PERMIT TYPE: i
WOR*
I DEMO/FILL IN E SWIMMING POOL
FILL FOR LANDSCAPE PURPOSES ONLY
SCOPE
Wumh. ;I'Lc.'1=r./Fle'c. Permit Fee:
Wec". I'Irrrt Check
�th'c h' t'errnil Fee:
(:)"h("r r1'1(xh. errs, r_
_1<J��c7z. Iras17. Jd�e::
llhunb- Phan t'hcch
111i'Kb' Pernn(T ee:
Other Plumb Trisp.
PIUM& kyj)- l"ie:
esw
NOTE: This estimate does notineludefees due to omeruepartments (I.E. dunning, -uucac
tl, Ly- I.. A, — ovt;m"tora"tart the Dent for addn'l info.
utstrtet, etc. mese ees ure uuseu via
FEE ITEMS (Re Resolution 11-053 F,ff.' 7/1/13)
FEE
-
QTY/FEE
MISC ITEMS
1,16171 Check Fe>:
ttr ll..l'f F'c cr
P/rrindY.,':l
Permit Fee:
$329.00
Suppl. Insp. Fee:Q Reg. ® OTQ,Q
hrs
$0.00
Wumh. ;I'Lc.'1=r./Fle'c. Permit Fee:
2 ;drain?1,4/i"cXi(l'c' Fee:
i,vor^k if'itl"row Permit?
- cdb'ctrr'vc l Plunfling Fees:
I ;r wf vl 0oc°w",aa{jnfulion Fees:
Strong Motion Fee: 1BSEISMICR
$1.16
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
:
$331.16
TONAL
$0 FJE:
00
$331 16
Revised: 01/06/2015