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15060193 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10239 PALO VISTA RD CONTRACTOR:A-1 POOL REMOVAL PERMIT NO: 15060193 OWNER'S NAME: TAMBE ATUL A AND ROHINI A P O BOX 1212 DATE ISSUED:06/30/2015 OWNER'S PHONE: 4089961956 CAMPBELL,CA 95009 PHONE NO:(408)978-2903 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL _ �i DEMO OF EXISTING POOL(540 S.F.)-FOR LANDSCAPE License Class C �� Lic.# /�� T PURPOSES ONLY 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 C9nl nsation,as provided for by Section 3700 of the Labor Code,for the p ormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7500 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:35701072.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 FROM LAST CALLED INSPECTIO indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued b ���/rrLt`U L5. granting of this permit. Additionally,the applicant understands and will comply Y Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Sign re Date % r� 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) 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 1 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 25 05,255339 534. j Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized a nt �� Date 67 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 LENDIlVG 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 CUPERTtNO (408)777-3228• FAX(408)777-3333•building(o1cupertino.org FRADDRISS / ^7 / , f ' /� APN# ' - /-© ClG L/ O1 E-MAIL��/ Q!�/ �) PHONE STREET ADDRESS CITY, STATE,ZIP / FAX CONTACT NAME PHONE E-MAIL / r STREET ADDRESS CITY,STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE BFR % LICENSE P� BUS.LIC# l� l po / / COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP / PHONE 7� >SQ3 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC k 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 POOLISPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO ( 7 G - GUNITE f TOTAL VALUATION: P - PREFABRICATED IPC T!1�'Ei)13Y': / j h 1 `' ice 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 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 co I au resentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: (� Z ~- SUPPLE ENTALORM IO QUIRED OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP Commercial or Multi-Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. OVER-TITE-COUNTER ❑ BUILDING DEPT /❑ EXPRESS ❑ PLANNING DEPT ❑ STANDARD ❑ PUBLIC WORKS DEPT ❑ LARGE ❑ ENVIRONMENTAL HEALTH ❑ MAJOR ❑ SANITARY SEWER DISTRICT SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINO 1 5060 f 13 FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10239 POLO VISTA DRIVE DATE: 06/30/2015 REVIEWED BY: PAUL APN: 357 01 072 BP#: "VALUATION: $7,500 PERMIT TYPE: Demolition Permit PLAN CHECK TYPE: PRIMARY Swimming Pool, Res. PENTAMATION 1 SFPOOLDEM USE: PERMIT TYPE: WORK Demo of existing pool 540 S.f. - FOR LANDSCAPE PURPOSES ONLY SCOPE FEE ID #POOLS 1DEMOPRES I Mech. Plan Check Phrmh. Plan Check Elec.Plan Check Vo.-h P�,rm;f Foo- I(T' la. "'rmlr V Other Hech. Insp. Other Plumb Insp. Other Llec.Insp. Ll I :1,1ech. Insp. Fee: Plumh. /rasp. Fee l;lec.Insp. Fee: NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees 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 a.' 711,173) FEE QTY/FEE MISC ITEMS Plan Check Fee. SUPPL PC I't� Plumb. lec Permit Fee: $329.00 Suppl. Insp. Fee.0 Reg. Q OT 0.0 hrs $0.00 Plunth.:f11<ch.-`Flee Permit Pee: Construction Tax: F-1 Administrative Fee: ffFork Without Permit? Advanced Planning Fees.- Travel ees:Travel Documenlalion Fees: � Strong Motion Fee: 1BSEISMICR $0.98 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $330.98 $0.00 TOTAL FEE: $330.98 Revised: 05/07/2015 / I N--v 1 CUPERTINO Building Department s3o?C16 �s ' Yo eA4 i_At JAN 3 0 20155 .4 To r3 C .4/vou�f3v1/'P4 REQ S 1-4"0 Sg xl� �R VIEWED FO� ODE COMPLIANC bAIZ 1/ I i we y. OF CE C 1-7 I /VOTE: EQ(7 rPMt-KT 2 7"o 8F- CAP PED 4-kFMoVFD I J -t- U T L s Thr/ L � r'!�1� ,1MUNITY DEVELOPMENT DEPARTMENT 'v R BUILDING DIVISION - CUPER INO I 1, APPROVED Q is set of plans and specifications MUST b kept at the O b site during construction. It is un[awful t make any QI changes or alterations on same, or o deviate 2 therefrom,without approval from the Buil ing Official. The Stamping of this plan and specifica':onsHALL NOT be held to permit or to be an approval of tion I ' of any isions o�an City Ordinance or State aw. S BY ( ✓pDATE 11 TP � 8 PERMIT # I5 3 ` 10237 PhL0 V.TSTA- P Cop r5P T ,•"10 �701v l � I i F RO"T 1 � I � S � R r E No T T o COMPACTION REPORT IS REQUIRED SHOULD THE SCA - � � _ ABATED AREA BE DECLARED!BUILDABLE,-- N THE FUTURE,