D-2017-0009CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: D-2017-0009
5950 SUTTON PARK PL CUPERTINO, CA 95014-3531 (375 35 030)
A MUNOZ
LANDSCAPE
CONSTRUCTION INC
MORGAN HILL, CA
95037
OWNER'S NAME: MARLEY DAVID AND VIRGINIA
DATE ISSUED: 03/23/2017
OWNER'S PHONE: 408-499-3111
PHONE NO: (408) 779-2900
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C27 Lic. #989729
Contractor MUNOZ LANDSCAPE CONSTRUCTION INC Date 03/31/2019
—BLDG —ELECT _ PLUMB
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
DEMO/FILL POOL FOR LANDSCAPE PURPOSES ONLY
I hereby affirm under penalty of perjury one of the following two declarations:
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.
tA\1Z2. - '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
Sq. Ft Floor Area:
Valuation: $4300.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
75
375 35 030
3
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, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per the upertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION. .
Signature Date 03/23/2017
Issued by:
Date: 0 /23
OWNER-BUIL DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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: 03/23/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF 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.
I have and will maintain Worker's Compensation Insurance, as provided for by
HA?ARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter of the
2.
Section 3700 of the Labor Code, for the performance of the work for which this
34.
25533, and ter 9.1 I will
California Health &Safety Code, Sections Municipal
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the CupertinoXunicipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
the Health & Safety Code, Sectio 9,255059 25533, and 25534.
j
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 03/23/2017
LENDING AGENCY
I certify that I have read this application and state that the above information is
CONSTRUCTION
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed -
Signature Date 03/23/2017
SWIMMING POOL I SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 S
(408) 777-3228.- FAX (408) 777-3333 - building
(a cupertino.org
CUPERTINO 9 — Zol —0009
PROfFCT ADDRESS 6656 &-V7 _(0 tJ A& P4_4 C6 -7
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TYPE
MATERIAL TYPE (CODE)
AREA (SQ. Fr.)
VALUATION
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POOL/SPA MATERIAL TYPE CODES:
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P - PREFABRICATED
By my signature below, I certify to each of the following: lai;the property own AOIE6or �Oagent to act on the property owner's behalf. I have read this
application and the infbrmati-T�ve provided is correct. I have read the Description 64?6rk and verify it is accurate. I agree to comply with all applicable local
, 601 authori representatives of Cupertino to enter the above -identified property for inspection purposes.
's relating
ordinances and state lav _ I tin
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Date:
Signature ofApplicant/A
SUPPLEMENTAL INFORMATION RE QUIRED
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Ving
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Commercial or Multi -Family Buildings with Public Swim I P o o I s:
Department of Environmental Health approval required.
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SwimPoolApp__2011.doc revised 03116111