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D-2017-0044CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2017-0044 19710 DRAKE DR CUPERTINO, CA 95014-2434 (316 32 020) DIG & DEMO INC SAN RAMON, CA 94583 OWNER'S NAME: NAGARAJAN SUBRAMANIAN AND ANURADHA DATE ISSUED: 07/19/2017 OWNER'S PHONE: 408-806-8197 PHONE NO: (925) 933-4448 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #993947 Contractor DIG & DEMO INC Date 06/30/2018 —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: POOL DEMO - (470 SF) - SITE TO BE USED FOR FUTURE I hereby affirm under penalty of perjury one of the following two declarations: STRUCTURE 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 Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $17000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 31632 020 316 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 regulation per the Cupe . Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature o, Date 07/19/2017 Issued by: Kim Dunbar OWNER-BUILDER DECLARATION Date: 07/19/2017 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: t. 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 (Scc.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: 07/19/2017 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. HAZARDOUS MATERIALS DISCLOSURE 2. I 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. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should 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 equipment or devices which emit hazardous 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 Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 2550 33, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 07/19/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction 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 SiSignature Date 07/19/2017 9 Professional 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 • building@cugertino.org 1b'2�)1;q--04Y�f PROJECT ADDRESS ( ^ ' `�(� L APN # I(/ ! vv OWNER NAME S baa �I,ra�� PHON �lo�-�o(,-�I 9 E-MAIL ��vQSa r►�,tl STREET ADDRESSCITY, 11-710 r • STATE, ZIP D 1 FAX CONTACT NAMES I PHONE q33-/ g4fp E-MAIL Q1 s STREET ADDRESSL31 J ,�1y� + h T' CITY, STATE, ZIP ann A(J! � /❑7 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT/ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I _ - /-Ja�.y��` )LICE SE NUMBER 99 3� y LICENSE TYPE BUS. LIC # (�y`� �Z COMPANY NAME � J1M,a :TA G . E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORKSnn t W I M VV% b0 k= Vt e a.5 't" 0 Krc c'e-1- 1r_tA1)0 o A wi 1( rte-A�- USE OF SFD or Duplex ❑ Multi -Family TYPE MATERIAL TYPE (CODE) AREA (SQ. FT.) VALUATION (S) STRUCTURE: ❑ Commercial POOL / POOUSPA MATERIAL TYPE CODES: SPA V - VINYL -LINED F - FIBERGLASS DEMO ()00 0- GUNITE RECEIVED B TOTAL VALUATION: P - PREFABRICATED By my signature below, I certify to each of the following: I am the property Aner 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 rSp4 the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons au representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 7—)/ —47 SUPPLEMENTAL INFORMATI R 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-THE-COUNTER ❑ BUILDING DEPT ❑ EXPRESS ❑ PLANNING DEPT ❑ STANDARD ❑ PUBLIC WORKS DEPT ❑ LARGE ❑ ENVIRONMENTAL HEALTH ❑ MAJOR ❑ SANITARY SEWER DISTRICT SwimPoolApp_201 1. doc revised 03/16/11