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15100047CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22106 LINDA VISTA PL CONTRACTOR: VIA BUILDERS INC. PERMIT NO: 15100047 OWNER'S NAME: RAJARAM GOKUL TRUSTEE & ET AL 4600 EL CAMINO REAL STE 209 DATE ISSUED: 10/06/2015 OWNER'S PHONE: LOS ALTOS, CA 94022 PHONE NO: (650)948-1077 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ DEMO/FILL (E) SWIMMING POOL & FILL FOR FUTURE US- License Class Lic. k 7 l _DUs CONSTRUCTION TO CERTIFIED 90% COMPACTION Contractor 4Date 11)- 6 ' fS I hereby afflUn 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. Sq. Ft Floor Area: Valuation: $5000 1 hereby affirm under penalty of perjury one of the following two declarations: 1 1 have and will maintain a certificate of consent to self-insure for Worker's APN Number: 35608009.00 Occupancy Type: Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAY T ISSUANCE OR APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is180 CALLED INSPECTION. 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 ente upon the above mentioned property for inspection purposes. (We) agree to sa Date: l indemnify and keep harmless the City of Cupertino against liabilities, judgmen , costs, and expenses which may accrue against said City in consequence of the granting of this pe it. Additionally, the applicant understands and will comply with RE-ROOFS: all non-point sou regula ions per upe ino Municipal Code, Section 9.18. All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature o Date l0 6 " / installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: t. 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 HAZARDOUS MATERIALS DISCLOSURE sale (Sec.7044, Business & Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the 2. I, as owner of the property, am exclusively contracting with licensed contractors to California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain construct the project (Sec.7044, Business & Professions Code). compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally, should I use equipment or devices which emit hazardous air 1 I have and will maintain a Certificate of Consent to self-insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation, as provided for by Section 3700 of the Labor Code, for the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the lealth & Safety Code, Sections 25505, 25533, and 25534. I performance of the work for which this permit is issued. 2 1 have and will maintain Worker's Compensation Insurance, as provided for by Owner a Section 3700 of the Labor Code, for the performance of the work for which this Date: `6 permit is issued. 3 1 certify that in the performance of the work for which this permit is issued, I shall CONSTRUCTION LENDING AGENCY 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, 1 I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, I for which this permit is issued (Sec. 3097, Civ C.) Lender's Name must forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 I icensed Professional upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date CUPERTINO SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build ing(cDcupertino.org /�r� 0 0 0 SP V_�_ PROJECT ADDRESS / APN a 3 C5& - O t oO q OWNER NAME & Ok1)/ '4�6tIabeoj % P (f rf �J�� i E-MAIL �oKo/rLq .►y/� . ro„� STREET ADDREZZ1 O(a Z4 h,A 11'1A ���� C��, STAT O[ ^(' a C 7 FAX CONTACT NAME Q,' 0 ere PHONE 650 -2Z2 -o/65 E -MAIC mull. V/44v8dea 6PAr"48-yA STREET ADDRESS�0 p 16161#** a t a C'ITY.vsTE, IP t � FAX ❑ OWNER ❑ OIYNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Qo,1,wA gLvramv LICENSE NUMBER A,C LICE N Ji �s BUS. LIC'N �(►�Ja���•CO/N C'OMPANYNAME 1//a CIi,VerSJ .f��lG. E-MAIL 1//abu�l�er,� FAX��O pTp' 6 STREET ADDRES 61 &(m,yi G /_ _ /' Sur ��� /�.ea CITY. STATE. P/ ' ^ 9'to2_� W (A `T PHONE ARCHITECT/ENGINEER NAME oe J►/A �/ -X LICENSENUMBER BUS. LICr COMPANY NAME SDS ^r� ��7�� +Q H E-MAl i jt/ SIS CQ2t/ N �v G� FAX �j �& ST ADD ES g 't , J6 tri lie.. rySTATE. ZII� W T 0�,� (� 690 _�6� / Z DESCRI TION F WORK are/ -IV htt cbe_.,H�C,fr o -t G2=a-1 a 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 DEMO F - FIBERGLASS G - GUNITE TOTq VALUATION: P - PREFABRICATED RF.CEIVF By my signature below, l certify to each of the following: I am the propertyow ze agent to act on the property owner's behalf. 1 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 hni ine constU Ction. authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of A licanVA enr. OIX4 Date: 9-Z.5,4 SUPPLEMENTAL NFORMATION REQUIRED OFFICE USF. ONLY Commercial or Multi -Family Buildings with Public Swimming Pools: PLAN CHECK TYPE ROUTING SLIP Department of Environmental Health approval required. ❑ OVER -THF: -COUNTER ❑ BUILDING DEFF ❑ EXPRESS ❑ PLANNING DEPT ❑ STANDARD ❑ PUBLIC WORKS DEPT ❑ LARGE ❑ ENVIRONMENTAL HEALTH ❑ DL4JOR ❑ SANITARY SLWF,R DISTRICT SuviniPoolApp_2011.doc revised 03//6/11 �S CITY OF CUPERTINO � 0 FEE ESTIMATOR - BUILDING DIVISION FEE ID # POOLS 1DEMOPRES 1 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public N orks, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (bee Resolution 11-053 ? 1 13) ADDRESS: 22106 LINDA VISTA PL DATE: 10/06/2015 REVIEWED BY: MELISSA APN: 356 08 009 BP#: 'VALUATION: 1$5,000 PERMIT TYPE: Demolition Permit PRIMARY Swimming Pool, Res. USE: PENTAMATION 1SFP00LDEM PERMIT TYPE: WORK DEMO/FILL E SWIMMING POOL & FILL FOR FUTURE CONSTRUCTION TO CERTIFIED 90% SCOPE I COMPACTION FEE ID # POOLS 1DEMOPRES 1 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public N orks, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (bee Resolution 11-053 ? 1 13) FEE QTY/FEE MISC ITEMS Permit Fee: $329.00 Suppl. Insp. Fee:Q Reg. O OT $0.00 T -- A Strom Motion Fee: 1BSE/Sti11CR $0.65 Select an Administrative Item 131dg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $330.65 $0.00 TOTAL FEE: F $330.65 Revised: 10/01/2015 o� cz 'a Z mZ �O zo Om K O 7 �& (D :: \-/ m > Q cpO O O� tTj �1 N 0 Co 1 C.T1 M Lin m p O 7 �& (D :: c; m > Q cpO '- 0 o co cn Co 1 1 r O G. T v C) �., D00 CD < 1 Q � r o ff N Z C O 3 � v r� m.,z �L3W?p (n CD 2 Q O O '�O<-� 0=- c� d Z y y m 0 co =3-i — CD .0 rp -i U �- - - O. cpO G.