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B-2016-2538 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2538 20173 APPLE TREE IN CUPERTINO,CA 95014-2001(316 33 095) ROYAL POOLS OF SANTA CLARA SAN JOSE,CA 95124 OWNER'S NAME: ARPAT GUVEN B AND TAHAEI ANOUSHKA DATE ISSUED:08/17/2016 OWNER'S PHONE:408-313 4601 PHONE NO:(408)371-8000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-53 Lic.#278052 Contractor ROYAL POOLS OF SANTA CLARA Date 12/31/2016 X BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I he y affirm under penalty of perjury one of the following two declarations; CONSTRUCT(N)SWIMMING POOL(97 S.F.) I have and will ma"mtain 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. 2. 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. Sq.Ft Floor Area: Valuation:$30000.00 APPLICANT ERTIFI ATIiON 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 "N Number„ Occupancy Type: and state laws relating to building construction,and hereby authorize 316 33 095 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 agai iabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against aid ity in co quence oft granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the ap'lica t unders nds and ill Ply with all non-point source regulation pe he Cup no cipa C de,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 08/17/2016 Issued by:PAUL O'SULLIVAN Date:08/17/2016 WNER-B DER DE LARA I N I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:08/17/2016 1 hereby affirm under penalty of perjury one of the following three declarations: ALLIROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)sh I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equip nt device hich it haz _dous air contaminants as defined by the B5P. EFtrict I Worker's Compensation laws of California. If,after making this certificate of will maintain Compliance with the Cu .12 and exemption,I become subject to the,Worker's Compensation provisions of the the Health&Safety Code, ; Labor Code,I must forthwith comply with such provisions or this permit shall (, be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:08/17/2016 certify that I have read this application and state that the above information is M TR N IN E correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is onstruction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 08/17/2016 Professional' SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228 FAX(408)777-3333•building(a)cupertin4.org �� e PROJECT ADDRESS 2-o 17 . L/ o l � APN# -- c OWNERNAMEA P v B D PHONE `�'3•! E-MAIL STREET ADDRESS _ CI Y,STATE,ZIP FAX S. CONTACT NAME [C-1q o- z'7 C PHONE ✓< R anlU STREET ADDRESSCITY STATE,ZIP �l FAy ❑OWNER ❑ OwNER-BUILDER ❑ OWNER AGENT JPKONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICE E TYPE BUS.LIC# ` b L o S 3 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP clase a` 2 p ARCHITECT/ENGINEERNAME 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($)' STRUCTURE: ❑ Commercial POOL POOUSPA MATERIAL TYPE CODES: SPA V - VINYL-LINED c� -FIBERGLASS DEMO G - GUNITE P PREFABRICATED. ,RECEIVEDB - r TOTAL DATION: By my signature below,1-certify to each of e fo g: the pr erty er or authorized agent to act on the property owner's behalf. I have read this application and the information I have pro de correc. I av the sc ption of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t ,buil construe I au rize re ntatives of Cupertino to enter the above-idem'fled pro erty for inspection purposes. Signature of ApplicantlAgent: Date: r SUPPLEMENT/L INFOR>IATIFN27REQWD QTY... LANHECK TYPE ROUTING SLIP _Commercial or Multi-Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. 10VER-TSE-COUNTER VBTBFILD1NGr EPT I " ❑"EXP72ESS i�r YT,ANNIIUG DEPT �', I].' STANDARD ❑ T UBT1C'V4Q_S DEPT h ❑' LARGE fNVIROIYNIENTALFIEALTII T ©.'.,I1IAJi)R ❑ "SAN!TARI SEWERDISTRICT SwimPoolApp_2011.doc revised 03/16111