15030123 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10191 PARLETT PL CONTRACTOR, I B15 BE PERMIT NO:15030123
DF�AfINED
OWNER'S NAME: CARY GEE �n DATE ISSUED:03/20/2015
OWNER'S PHONE: 4084643799 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
POOL REMOVAL 700 SQ FT
License Class_ Lic.# 57 l 3 Z t7 3�
Contractor 2 3 011 I ` J- Date 3—2o—I S
1 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:$12500
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:31626046.00 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 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 F AST CALLED 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.
^2®^ CS RE-ROOFS:
Date All roofs shall be inspected prior to
Signature 1 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)
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: Date: 3
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
918.
Signature Date
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 0
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildind(Mcupertino.oro
PROJECT ADDRESS APN#
10191 Parlett PI (V LIP Oq(t7-
OWNER NAME PHONE E-MAIL
Gary Cee 408 464 3799
STREET ADDRESS CITY, STATE,ZIP FAX
10191 Parlett PI Cupertino,CA
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑OwNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR Cl CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER 71C
SE TYPE BUf ''^"
John Peterson 513203
COMPANY NAME E-MAIL FAX
Buster Building busterbn@pacbell.net 408 251 5446
STREET ADDRESS CITY,STATE,ZIP PHONE
298 North Cragmont Ave San Jose CA 95127 408 234 2922
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
Pool Demo
6H GV /Y�o,j m 4 c9m
USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION(S)
STRUCTURE: ❑ Commercial POOL
POOLISPA MATERIAL TYPE CODES: SPA
V - VINYL-LINED
F - FIBERGLASS DEMO �J
G - GUNITE
P - PREFABRICATED RECEIVED BY: TAL VALUATION:
�2_-5 C:;ej
By my signature below,I certify to each of the following: 1 am the property owner or iuthorizell_aSentioadon the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: e - - cy� Date: 1—2_o— 1 s
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
PLAN,edCKTYPE ROUTING SLIP
_Commercial or Multi-Family Buildings with Public Swimming Pools:
Department of Environmental Health approval required. OVER-TW COUNTER ❑ BUILDING DEPT
11 EXPRESS ❑ PLANNING DEPT
❑ STANDARD ❑ PUBLIC WORKS DEPT
❑ LARGE ❑ ENVIRONMENTAL HEALTH
❑ MAJOR ❑ SANITARY SEWER DISTRICT
SwimPoolApp_2011.doc revised 03/16/11
CITY OF CUPERTINO D
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10191 parlett pl DATE: 03/20/2015 REVIEWED BY: Mendez
APN: BP#: "VALUATION: $12,500
*PERMIT TYPE: Demolition Permit PLAN CHECK
PRIMARY Swimming Pool, Res. PENTAMATION 1 SFPOOLDEM
USE: PERMIT TYPE:
WORK Pool removal 700 sq ft
SCOPE
FEE ID #POOLS
1DEMOPRES1,777777,
1
A4„
Nkch. flan Check Plumb.Play Check Elec.P/an Check
Meeh. Perinit Fee: Plumb. Permit Fee: Elac_Permit Fe"
other Alec h. Insp. Cather Plumb Insp. tither Elec.Insp.
Llech. Insp. Fee: Plurnb. Insp. Fee: A/cc.Insp. Fee:
NOTE:This estimate does not include fees due to other Departments(ie.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the prelindna information available and are only an estimate. Contact the De t or addn'1 in o.
FEE ITEMS(Fee Resolution 11-053 E . 7111131 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
,Su/pJl. P(.'Fee
1'lu3n lr.,��11ech.%:1,Zec
Permit Fee: $329.00
Suppl. Insp.Fee-0 Reg. ® OT O,p hrs $0.00
Permit Fee:
COIISIFUCtiOP7 Tax:
,ldininistrative Fee:
Yf"ork Without Permit?
,1dvaneed Planning Fees:
Travel Documentalion Pees:
Strong Motion.Fee: 1BSEISMICR $1.63 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
� �'I.
$331.631 $0.00 TES $331.63
v ..
Revised: 02/14/2015
1 ,
C?C4 /
APPROVED
'041c P"s nd specifications MUST be kept at the
construction. It is unlawful to make any
or alterations on same, or to deviate
thcrLf;c n, al from the Building Official.
n :, -:.�; ;.F ',', plan and specifications SHALL NOT
rr to be an approval of the violation
ar,y Ciiq Ordinance or State La v.
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