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15030129 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10301 RICHWOOD DR CONTRACTOR- - PERMIT NO: 15030129 OWNER'S NAME: SHIVAUN&BHUPESH PATEL �' ,�y,� � DATE ISSUED:03/20/2015 OWNER'S PHONE: 7817526914 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATIONF_ ��© Z 2� BUILDING PERMIT INFO BLDG ELECT PLUMB License Class Lic.# j / MECH RESIDENTIAL COMMERCIAL F Contractor�1�1 I �y`1 c"(�'�— Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE POOL FOR FUTURE ADDITION 375SQ (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:$13000 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. APN Number:36908049 00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN IV DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAY OM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. 'tionally,the applicant understands and will comply n `� with all non-poin ur regulatio Cupertino Municipal Code S ed by: Date: 9 18. c� ' M Signatur Date 2 � RE-ROOFS: ❑ OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health ty Code,Sections 25505,25533,and 25534. 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 n a11 d Compensation laws of California. If,after making this certificate of exemption,I Date` 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. Licensed Professional Signature Date 0 _21-9 SWIMMING POOL / SPA PERMIT APPLICATION its COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228-FAX(408)777-3333-building(a)cupertino.org CUPERTINO PROJECT ADDRESS /0-.?0 0 //� 1 G`/ ) 0 �r APN# ..• G —C) .�` (_,j �� /k (/V `E-MAII. v OWNER NAME J Cit ,PIC iC C4 STREET ADDRESS '301 PHONEn ��� n CITY,STATE, r 250 1 q FAX CONTACT NAME P O i j ^f �'? E L S 1 C cd ;yLa I`�, t �r 3^Gn•'M c- 7 !J STREET ADDRESS, 0 t / C} ,STAZIP ] /� �jr1 y ; FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT M<`oNTRACroR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME f I LICENSE NUMBER LI TYPE BUS.LIC# J_ AD+t i/L+ .. A 0 COMPANY AME E-MAIL FAX �l v ec STREET ADDRESS [ CxY.�IIT,ZIP G✓ ` oz ,r PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK USE OF L" ,FD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION(S) STRUCrURE: ❑ Commercial POOL POOIISPA MATERIAL TYPE CODES: SPA V - VINYL-LINED y F - FIBERGLASS DEMO 13�� T f 3 �I/�f©e G - GUNTTE Cw A I v t tiff r TOTAL VALUATION: P - PREFABRICATED RECEIVED BY _ By my signature below,I certify to each of the following: I property o i=•or authorized agent to act on the property owner's behalf. I have read this application and the information I have pro ' is coffee av ead the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to d constru ' n. thorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL TION REQUIRED OFFICE USE ONLY .Y PIAN CHECIf TYPE � ItOiIT'ING SIdP Commercial or Multi-Family Buildings with Public Swimming Pools: o eco Department of Environmental Health approval required. _ ❑ EXpg Eh PLANNIPG DEPT `❑ STANDARD = ❑'�PUBLIC WORKS'DEPT ❑ LARGE L3'?ENVIRONMENTAL HEALTH ❑ MAJOR ❑}SANITARY SEWER DISTRICT SwimPooh1pp_2011.doc revised 03/16/11 CITY OF CUPERTINO D FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10301 richwood dr DATE: 03/20/2015 REVIEWED BY: Mendez APN: BP#: '`VALUATION: 1$13,000 *PERMIT TYPE: Demolition Permit I'LA 1'CCIIEsCC. TYPE.: PRIMARY PENTAMATION 1 SFPOOLDEM USE: Swimming Pool, Res. PERMIT TYPE: i WORK Remove pool for future addition. SCOPE FEE ID #POOLS 1DEMOPRES 1 x OR ..,:. /ech. 111ari Check Plumb.Plon Check Elec.Plan(:heck l9ech. Permit Fee: Plumb. Permit Fee: Flec. Permit Fee: tither,k,kwh. Imp. Other Plumb InT 01hea,klec.Insp. �1 tech.I1asp./gee: Plumb. hasp. I Eco: E-lec Insp.Fee: ELLLJ NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc). These ftes are based on the prelimina information available and are onl an estimate Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check hese: supp[ Pt.'Fire I'latm h.%:1lecla.:'1lec Permit Fee: $329.00 Suppl. Insp.Fee-0 Reg. ®OT km hrs $0.00 Plut71h. lec I'hrnih.%�j :clr.�Flec Permit Fee: Construction 7,ax: Administrative Pee: Dark Without Permit? �Wvanced Planning Fees: :gavel Documenlation Fees: � Strong Motion Fee: IBSEISMICR $1.69 Select an Administrative Item B Stds Commission Fee: IBCBSC $1.00 Nt $331.69 $0.00 Ai 1FEE� $331.69 Revised: 02/14/2015 K2 (2 Dr. Cu fer)loo CA . q50/9 `4c OFFICE uopyiter -�vr✓�� Q �C�.`� ipr! CUPERTINO } Ruilding De Parkment MAR 2 0 2015 REVIEWED FOR CODE COMPLIANCE i !j Reviewed gy. II I POOE ASA i i IN .............. 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