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14080087 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21950 RUCKER DR CONTRACTOR:ROYAL POOLS INC OF PERMIT NO: 14080087 SANTACLARA OWNER'S NAME: OLEARY JOHN E AND CYNTHIA A TRUSTEE 2258 CAMDEN AVE DATE ISSUED:08/18/2014 OWNER'S PHONE: 4089969370 SAN JOSE,CA 95124 PHONE NO:4083718000 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ J �� ` CONSTRUCT INGROUND SWIMMING POOL(480 SQ FT). License Class J � Lie.# �Z Contractor a/AI r` TirC?(5 Date 1 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. 1 hereby affirm under penalty of perjury one of the following two declarations: 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. Sq.Ft Floor Area: Valuation:$42000 1 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 APN Number:356]402].00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT_.EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITH 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA S FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses whi i ay accrue against said City in consequence of the granting of this permit. Ad itionally,the applicant derstands and will comply Issued by: / Date: 1z with all non-point sou ce gulations dr t Cup e 'no Municipal Code,Section 9.18. RE-ROOFS: Signature Date t / l All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: 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 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 sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,2.5533,and 25534. 1 will hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)s u d 1 store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use eq pro nt or devices whic it hazardous Compensation•as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Ba Ar Air lit Man, ent District I performance of the work for which this permit is issued. will maintain compliance with the C er no M Cod apter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5 5,25 ,a 553 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: l l permit is issued. 1 certify that in the performance of the work for which this permit is issued,I shall 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,I CO STRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I 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 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, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION S' 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 �l EUPERTINO (408) 777-3228 • FAX(408)777-3333• buildinanc cuoertino.ora , RNEW CONSTRUCTION ❑ ADDITION ❑/ALTERATION/Ti ❑ REVISION/DEFE.RRED ORIGJINAL PER1\4IT n FVNIERNAME OTtCT.ADDRESS 3L (� t/ , f PHONE �J�j� �G�/_�Q�zi t NkZ —C5 STREET ADDRESS ! c),� 0 G,t CIT,Y, STATE,Zi? ` I. FAX CONTACT NPV-E r r 0PHOINE[l ,�Z/ �G�-�J E p irTV /✓_ ,Q L STREET r'.DDRESS CITY,STA , ZIP FAX �1� � ❑ OWN---R ❑ O,;N=-B1JILDzR ❑OWTMR AG-=N-r AONr"CTOR ❑CO1rr?0.CTOR AGE-1\7 ❑ ARC3i'T_CT ❑ENGNTER ❑ DEVELOPER(�❑ T=N'A.1,7 CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC 6X COMPANY N.4A4E E-141AIL F.4X STRE T ADD F S ` /J CITY,STATE,ZI c� '--y- L APHOTG5 �y� RCH'T'cCT/ENC-I EER NIQME ` (� /L� LICENSENLI'MER BUS.LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP' I PHONE DESCRIPTION OF WORK EY.STING USE PROPOSED USE CONSTR TYPE STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTAREA T,�AOOR AREADEN4O TOTAL NET AREA BA 001,1 KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK,PORCH AREA GARAGE.AR.A: LJ DETACH E]ATTACH Dt4 ELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORY ❑YES BETNG ADDED? E]NO ADDITION? NO -PR$-r1bPLiC-AT-ION-( �'F�—�r�'S,�'-ROS.IDE.LOELOF _]SPIE BLDG.-1,\ n 1 tS �EGEI1 FDBY ,-� - TOT.a. PLATNING APPL: ❑NO PLATTLN'G APPROVAL L ER EICHLER HOME? ❑NO { `'By my sianztu;e below,I certify to each of th fol ��ing: I a , property CNN n r authorized aeent to act on the property o amer's behalf. I have read this application and the information i have provi ed' correct. I , re the Dese on Df�Zork and verify it is accurate. I armee to c mply with all applicable local ordinances and state laws relating to build' Q onstruction. t e repres ,_tives of Cupertino to enter the above-ide ified p- pe, for inspection purposes. Signature of Applicant/Agent: — Date: � Al C SUPPLEIvIENIT;,"'llings: INFO RMA ON_ y PLATS CHF CIZ T E__ �- - t_r„ROUTLG,�LIP._ New SFD or lvlultifamily Apply for demolition permit for °© OVER`TF71rC0U1�TER � � � BUII,IIL\GPL4'�:REidEtY���'�`� existing building(s). Demolition permit is required prior to issuance of building I � permit for new building. ©KEMRESSPLq�I�l1GPL�*iREt �' _ _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �` E,-, n �uB �aR1<s form if any Hazardous Materials are being used as part of this project, Copy of Planning Approval. Letter or Meeting witlI Planning prior to a ❑ N3TSRI`GERRDISIRICT � . submittal of Building Pennit application. Bldo4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21950 rucker dr DATE: 08/12/2014 REVIEWED BY: Mendez AN: BP#: 'VALUATION: 1$42,000 PPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION RBS USE: PERMIT TYPE: WORK construct in round pool 480 sq ft SCOPE F] Lj -t_ NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the preliminar information available and are only an estimate. Contact the DZ_/or or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eft 7;1;13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 480 s.f. Swimming Pool Suppl. PC Fee: Q Reg. C) OT 0.0 hrs $0.00 $1,574.00 IPOOLGUNIT Gunite PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(D Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 T__F_ 0 Work Without Permit? Yes ) No $0.00 E) Advanced Planninux Fee: $0.00 Select a Non-Residential E) Building or Structure 0 i Strom]\lotion Fee: IBSEISMICR $5.46 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $7.46 $1,574.00 TOTAL FEE: $1,581.46 Revised: 07/10/2014