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15040045 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19766 VICKSBURG DR CONTRACTOR:CORBY GOULD POOLS, PERMIT NO: 15040045 INC. OWNER'S NAME: MAYANK GUPTA 2515 NEDSON CT DATE ISSUED:04/07/2015 OWNER'S PHONE: 6508617871 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)967-7665 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ d RESURFACE(E)SWIMMING POOL WITH FIBERGLASS, License Classc:�'1a C Lic.# ADD ��-� Date �-7-15VGB COVERS(650 S.F.) Contractor �$y � 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 ,I performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8000 1 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:36910008.00 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 WITBEIN 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 FR ED INSPEC ION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of thes granting of this permit. Additionally,the applicant understands and will comply 00, e' with all non-point source regulations per the Cupertino Municipal Code,Sec 9 18. RE-ROOFS: Signature Date 7 All roofs shall beinsp prior to any roofing material being installed.If a roof is installed without firs 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 25-534. �1 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: G%�^"� Date: 7 7 permit is issued. 1 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 \ D 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building0Xupertino.org \� PROJECT ADDRESS /Q r APN# /D OWNER NAME _ A PHONE►•_ EM71 VRvy� STREET ADDRESSK126 49MCITY,STATE ZI�$w Cot— `5V/ � FAX CONTACT NAME^ •^` ® �L PHONE 'W ! E-MAIL <o r39G-'/39 �r-rtr� ec��C1�8 � .�o•� STREET ADDRESSCITY,STATE,ZIP FAX '�- ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSENUMBERLI�SETYPE BUS.LIC# COMPANYNAME� E-MAIL��y>� FAX '�o ®� �0�5 STREET ADDRESS 2575 C� CITY,STATE,ZIP �'��!'Q PHONE 41- 7 &4 ft ARCHITECT/ENGINEER NAME LICENSE NUMBER ! BUS.LIC# COMPANY NAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION($) STRUCTURE: ❑ Commercial POOL POOLJSPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS D GUNITE P - PREFABRICATED �RFCE TOTAL kL7��[O 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 rread td 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 relatirepresentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: ng to building constru orize Date: 11-7-16— SUPPLEMENT ORMATION REQUIRED OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP Commercial or Multi-Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. �R HE_COUNTER El BUILDING DEPT 4-i EXPRESS ❑ PLANNING DEPT - ❑ STANDARD ❑ PUBLIC WORKS DEPT El LARGE' ❑ ENVIRONMENTAL HEALTH El MAJOR' ❑ SANITARY SEWER DISTRICT SwimPooMpp 2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 19766 VICKSB1tRG DR DATE: 04/07/2015 REVIEWED BY: MELISSA APN: 369 10 008 BP#: *VALUATION: 1$8,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION USE: p PERMIT TYPE: WORK RESURFACE E SWIMMING POOL WITH FIBERGLASS ADD VGB COVERS 650 S.F. SCOPE r a6,01,, 3: r _ th tech. Plan Check Plumb. Placa Check Elec.t'/( Check y ech. Permit Fee' Plumb. Permit Tire: I fea Permit Fee CJrher AIr.<k Tnsp- Other Plumb 1rup. 0 10" ier Elec. Imp. Li slack. hasp. Fee: Pharaab. hasp, fee: t"lec.Insp. Tee: ]��j NOTE:This estimate does not include fees due to other Departments(Le.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 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl.PC Fee: (E) Reg. ® OT 0.0 ms's $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: Hourly Only? ®Yes Q No $0.00 Suppl. Insp.Fee-.19 Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: T_T_ $0.00 C onstruction Tux: Administrative Fee: Work Without Permit? ® Yes (E) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential 0 Building or Structure 0 Travel Doeuinenlaliort Fees: Strong Motion Fee: IBSEISMICR $1.04 2.0 I hrs Inspections Bldg Stds Commission Fee: 1BCBSC $1.00 $286.001 ISTINSP Inspection,Hourly Tw_ TO: AZ FEE. 288.04 s $2.04 $286.00 t . $ Revised: 02/14/2015 GUPTA RESIDENCE 19766 VICKSBURG DRIVE CUPERTINO' CA 95014 SCOPE WORK DRAIN POOL SPLIT THE FLOOR DRAINS NEW VGB COVERS RESURFACE POOL WITH FIBERGLASS COATING C/4 Zoi 3 t3 DH C�'DC PP�� comNit-Ji"MrY D ELOPMENT DEPARTMENT RUILUIN DIVISiGN-CUPERTIiNO P'MOVIEQ Th.17 5r--t of,,! ^s d sPecific ations MUST be kept at the } lstructic:n. It is unlawf+al to i� '=t arty Iterations on same,or tocluiliate F, t approv l from the Building C�icicial. QO 7- t fis plan a.n7 s;ocifications Sl I_NOT 0. to t En sae Law. V ,f 0 O a0�a��9 0�5 00 v I rr EIVED APR 0 7 2015 0-RBY POOLS CA 826868 13Y CLASS C10, C53