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15070109 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10159 S BLANEY AVE CONTRACTOR:ADAMS POOL PERMIT NO:15070109 SOLUTIONS OWNER'S NAME: LAKE BILTMORE APARTMENTS 3675 OLD SANTA RITA RD DATE ISSUED: 10/06/2015 OWNER'S PHONE: 6509313400 PLEASANTON,CA 94588 PHONE NO:(925)928-3100 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ r c— BILTMORE-RENOVATE(E)SWIMMING POOL(1150 S.F.) License Class l J Lie.# �p WITH NEW PLASTER,TILE AND COPING ADD(N)DETACHED SPA(88 S.F.) Contractor A D A iqi e PO(J(-!S 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: Sq.Ft Floor Area: Valuation:$120000 t. 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. APN Number:36903008.10159 Occupancy Type: 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. APPLICANT CERTIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED I certify that I have readthis application and state that the above information is WITHIN 180 DAY IT ISSUANCE OR correct.I agree to comply with all city and county ordinances and state laws relating 180 DA M CALLED INSPECTION. 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,judgme costs,and expenses which may accrue against said City in consequence of the granting of this p it. Addition-1. applicant understands and will comply with all non-point sourc`j re ulatio�`er the Cu ertino Municipal Code, ection 9.18. f _S_ RE-ROOFS: All roofs shall be inspected nor to an roofing material being installed.If a roof is Signature � �^� Date 1� p p y g g installed without first obtaining an inspection,I agree to remove all new materials for inspection. ® OWNE -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. 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 HAZARDOUS MATERIALS DISCLOSURE sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project(Sec.7044,Business&Professions Code). California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I hereby affirm under penalty of perjury one of the following three declarations: Safety Code,Section 25532(a)should I store or handle hazardous material. 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Additionally,should I use equipment or devices which emit hazardous air Compensation,as provided for by Section 3700 of the Labor Code,for the contaminants as defined by the Bay Area Air Quality Management District I will Compensation, nance of the.work for which this permit is issued. maintain compliance with the Ckkpertino Municipal Code,Chapter 9.12 and the p p Health&Safety Cedes, ectionC 505,25533,and 25534. 2. I have and will maintain Worker's Compensation Insurance,as provided for by y Section 3700 of the Labor Code,for the performance of the work for which this 4,+ i horized agent•. '1 1 Q permit is issued. Date: s. I certify that in the performance of the workfor which this permit is issued,.I shall .a not employ any person in any manner so as to become subject to the Worker'sj CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I 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.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct.I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Licensed Professional 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 SWIMMING POOL I SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE,CUPERTINO, CA 95014-3255 GIJPI=RTIhfO (408)777-3228.FAX(408)777-3333•buildingQcugertino.org PROJECT ADDRESS 1,ro g'57 5 . B /� A l �a P APN#�/� OWNER NAME �/p/g/ )I✓C 1d A E L !J l✓C�l�!�V�� PHOj/NE& c)w�-jj -, q o E-MAIL STREET ADDRESS [® 1D O S . N c> F 0(_K Sr CITY,STATE,ZIP C P q M [A T-E0 FAX CONTACT NAME Cc°sy-•/� ®s 11 1J�g�� PHONECOM ���JJ" tV� 1`�p` E-MAIL ` C`¢ tJ C)1,3S@ g�9 al� a STREET AD "s_,Jd - YS# �`�A N�a kp"m K_�LD CITY,STATE, ZIP .�a !a K 9 �$•?`�FAX . .. Sed a^8 9 �L�gy�rV N�d flV OWNER ❑OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR WONTRACTORAGENT 11 ARCHITECT El ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME A D A P®®g S®LU_J LICENSE NUMBER -7 7-(P�7 9 LICENSETYPE, _ BUS.LIC COMPANY NAME �E j E SA`,`aeQ�(D 1 4 LS E-MAIL FAX `a e" SCJ ®Zb� STREET ADDRESS-S t -7 S 0 L e p t Y�-e'a RMA C ;STATE,ZIP PL�P1 S A�TD tJ CA PHONE�,Z-S R'ZZ 9 g O ARCHITECT/ENGINEERNAMdg� / ETO�D a�lVK[°eLl14EP 9!LIICCENSENUMBER �`3 f !�( 1 BUS.LIC i O O S COMPANY NAME Poo L_ — �5`�� t E-MAIL [ 4Q mCJ FAX n ^ STREET ADDRESS ,,�0 1 e .T 9 E T �t � AVE: CITY,STATE,ZIP ry M/ r g E I y1/l �� PHONE71q���q A p 0 DESCRIPTION OF WORK 1� C) JE L... E^)( r '� l j I ) �®®L — i)e W LAS 1 IDOL-G HOPI tLl USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.Ff.),�s VALUATION(S) tri STRUCTURE: Commercial POOL � I S' C) s o 0 ap� POOL/SPA MATERIAL TYPE CODES: SPA -7 0e D 0 0 V - VINYL-LINED F —FIBERGLASS DEMO G - GUNITE - b �UNN { TOTAL VALUATION: FABRICATED RECEIVEDB ��� r ;. ggy+ pp-pp ppqq pp-qq By my signature below,I certify to each of the following: I am the property okmer or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating ilding c structio I authori e representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofAppiicant/A Date e/d d t SUPPLEATION REQUIRED -t �'"PLANC$F'rCK3'S;PE �' �5• �s..G� r,_�S>QTINU'SLIP Y' �� ; hA i3 5 Commercial or Multi-Family Buildings with Public Swimming Pools: i slruDnacDE , Department of Environmental Health approval required. M - 12ES5' - i': s3� w� ` PANNII�GDEP h ..y T.❑�STA?VDARD�`�''���'°`` a,� �. EUBLIGii'ORKS DEPT, ., _�. � ❑yJ;�,RGE���� �����`,,,� x��.�E1WIR0�„NMMI"�AI`'IIEAL'7'H �� SwimPoolApp 2011.doc revised 03/16111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10159 S Blaney Ave DATE: 07/15/2015 REVIEWED BY: Paul APN: 369 03 008 BP#: *VALUATION: 1$120,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY Multi-Family Dwelling Building is PENTAMATION USE: >3 Stories 0 Yes Q No PERMIT TYPE: 1 GENRE i WORK BILTMORE- Renovate E swimming pool 1150 S.f. with new plaster, tile and coping Add N SCOPE Detached Spa (88 S.f.) ML ,6tr. Mari Ct c:ck i'lr.?,,1.Plan Chcc I:C-c._h'uf>Cheek ;Lleeh Ilerr?t%t Fee: It mh.Permit Fee: (:lec. llerr,.zr Fee: Ocher Alech. rots... O ler h1wrzh h7sp. Jute? Inc.b srt. Wech.Msl).Fee: 'it!??:Zj. ,?ta l7. f c': g lee.1?7sp'.hire: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l into. FEE ITEMS O7' e Resolution 11-053 Eff.' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (j) No $0.00 hours Plan Check,Hourly Suppl.PC Fee: Reg. 0 OT 0.0 hrs $0.00 $429.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes (F)No $0.00 Suppl. Insp.Fee-(D Reg. 0 OT 0.0 Frs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ("onsrrttc°tion Tax: Administrative Fee Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: $0.00 © hour's Inspections Tnn)el 1}ortcmentcalLm Fees: 858.00 ISTINSP Inspection,Hourly OA Strong Motion Fee: IBSEISMICR $15.60 Select an Administrative Item Blda Stds Commission_Fee: 1BCBSC $5.00 SUHTQTI". $20.60 $1,287.00 ©TAv r $1,307.60 Revised: 07/02/2015