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150701399# CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11395 CANYON VIEW CIR CONTRACTOR: A -I POOL REMOVAL PERMIT NO: 15070139 OWNER'S NAME: HOPKINS JOHN N AND CAROLYN S P O BOX 1212 DATE ISSUED: 07/20/2015 OWNER'S PHONE: 4087252496 CAMPBELL, CA 95009 PHONE NO: (408) 978-2903 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL p /6 License Class C Z Lie. # C0 / 0 '1 0 REMOVAL OF ABOVE GROUND PREFAB SWIMMING POOL WITH T O � ASSOCIATED UTILITIES. Contractor ,�} �� 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 Sq. Ft Floor Area: Valuation: $3000 erformance of the work for which this permit is issued. 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: 35627022.00 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 WITfIIN 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 FROM LAST 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 4Z—z�- Date: granting of this permit. Additionally, the applicant understands and will comply Issued by:iQ/✓ with all non -point source re lations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. +� b Signatu Data �� 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 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) 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 a lid 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 Zo permit is issued. Owner or authorized ager Date: 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 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 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 (408) 777-3228 • FAX (408) 777-3333 • building( cupertino.org J ,o7o1 3q PROJECT ADDRESS ))r RC Lle ^� C 'lyf —APN# .�I�� T , ,) cP� Owt,� AMZ /�D / C� P � _ 9T/ E-MAIL STREET ADDRESS / TT CITY, STATE, ZIP /(d ^ FAX K CONTACT NAME/ PHONE E-MAIL iq . / �46 - - O STREET ADDRESS p CITY, STATE, ZIP FAX IV ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ff-c-,-NTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEG /1� ` /�� LICEN MBE LICENSE EZ BUS. LIC # COMPANY NAME �, lr STREET ADDRESS E-MAIL CITY, STATE, ZIP FAX PHONE 4/0 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL 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 (S) STRUCTURE: ❑ Commercial POOL POOL/SPA MATERIAL TYPE CODES: SPA V - VINYL -LINED F - FIBERGLASS DEMO G - GUNITE RECEIVED BY - - L_..x 7 { TOTAL VALUATION: P - PREFABRICATED ,r>pv 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 readd 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 buildin struction. I a ze representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEME14TArFOr7lON REQUIRED Commercial or Multi -Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. SwimPoolApp_2011.doc revised 03/16/11 r CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION WdADDRESS: 11395 Canyon View Cir DATE: 07/20/2015 REVIEWED BY: Sean ;blech_ Permit Fee: APN: BP#: `VALUATION: 1$3,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Suppl. PC Fee: Reg. OT PENTAMATION 1GENRES PERMIT TYPE: Al WORK Removal of above ground prefab swimming pool with associated utilities. SCOPE $0.00 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 nreliminary information available and are onlv an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 ETf' TT"13) Me& Plan Checi_ Phunb. flan (, Elec. Plan Check ;blech_ Permit Fee: Plumb. Permit Fee: Elec. Permit Fee Other Mec•h. IrrP Other Plumb Insp )then 1,,'lec. Insp. Suppl. PC Fee: Reg. OT 0.0 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 nreliminary information available and are onlv an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 ETf' TT"13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ® Yes (j) No $0.00 hours $0.00 Plan Check, Hourly Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consiruetion Tax: Administrative Fee: Q 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 0 hours Inspections $143.00 ISTINSP Inspection, Hourly fraivi Documentation Fces. Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $143.00 TOTAL FEE: $144.50 Revised: 07/02/2015 l000L S ��11 l > 2 AlC-7w t'o 6 A 0 A. Le✓e d SCgP' ".9 SY Q,/ -T P �_ �► -r T o F3 C C '4 P-tq _ q.vD M0t/t;r7 AlvD UT-1-L,Zfv L�aF� To fj E 4J3.4AI%�caA) L u =Oq4�7 ,� yar 5' l�Ptt�' nr,5 ! [ 3 p,s- Cq Iv yo Al f/- r Cv�o r_ ,e �' FFICE Copy' COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION - CUPERTINO - This set of plans and APPROVED - jsite Burin specifications MUST be kept at the chan es 9 construction. It is unlawful to make any 9 or alterations on same. or to deviate Iherefrom, without approval from the _rmrt Buildin The Stamping of this p Dfany provisi ,an ands 9 Official. ` t% held to pP pecifications SHALL NOT or to be an approval of the violation BY s of any City 0 di ance or St to Law. DATE �� 0 �T RFRM1T # o G D/ Ivo T- 't o COMPACTION REPORT IS REQUIRED SHOULD THE S � �a I- r--- ABATED AREA BEDECLARED. 9BU1LDA6I INJTHE FUTURE.