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B-2017-1685 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1685 20663 CHERYL DR CUPERTINO,CA 95014-2909(359 15 039) AQUATEC POOLS FREMONT,CA 94536 OWNER'S NAME: DIONNE JOSEPH MAND DONNAY DATE ISSUED:09/28/2017 OWNER'S PHONE:408-831-8728 PHONE NO:(510)612-1875 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-53 Lic.#933359 Contractor AQUATEC POOLS Date 06/30/2019 X 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: RE PLASTER SWIMMING POOL(660 S.F.) 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 ot 0s-, <,•. of the work for which this permit is issued. ra. 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:$21750.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 359 15 039 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 rCity 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 regulatiois per the Cupertino Municipa`�CCoode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. 4i :nature if / - t Q�� Date 9/28/2017 Issued by:Abby Ayende Date:09/28/2017 OWNER-BUILDER DECLARATION 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 owier 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:9/28/2017 I I hereby affirm uiider penalty of perjury one of the following three declarations: „ „ 1. I have and will..maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS A OR BETTER 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. 1'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 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 Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall 1/2 seal L - �'n� � be deemed revoked. , er or authorized agent: i,.y5 ,4. �r t / APPLICANT CERTIFICATION ®Date:9/28/2017 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. I understand my plans shall be used as public records. Licensed Signature Date 9/28/2017 Professional CONSTRUCTION PERMIT APPLICATION \\rk/ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION - B V10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 5`"4..s VAS (408) 777-3228 • building@cupertino.org PEMIT#B- `� - CUPERTINO REV# DEF# ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑mEp ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS I APN 8 r s . Zv�4 CrazyL Dr - f�N �— ► �3�' . OWNER N\05E PH t �✓Zi ,'1 1 b I D/J`"E P/d��j© ) s/ 'it_ Z t E M��t701I t® ,'os-, 1 P �0t73A�1 STREET ADDRESS l CITY, STATE,ZIP , • ��fff i. �." C i1&z.yL D r-- Per 7 viz r C `y' p•CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE KrTer- ,po S _ fi y�i�✓►ro 1q - 9,10/1 . 9333.,J c - _.3 I STREET ADDRESS . 9e9 ^ ter i i^ n (. CITYXATE, ZIP c q rsL I E-MAIL `J PHONEf f]N' t Ij_( BUS.LIC# ' v dAS CO Prk al 0 ) 612- I r f;...."'"'"- 40 4to s&q- lol ta(I� 0 ARCHITECT 0 OWNER ❑OWNER AGENT IffCONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT CONTACT N• % d n/ E-MAIL r.4 A . A ,, o:,, TEC !co lsD _ d0 • v Pri STREET AD DRESS ^�f CITY1 �� CA f c( t3 C PHONE &p, I f7-Li �IId'' :sfeli r 4(Jl/J 1 1/ DECRIPTON c4.)0I 6-:e t f` g-f / 6) ee-s ley o (1'1� c ._ rS v l`� u� (jpia mbi R)2 Poo 'i • , ❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED . BATHROOM SF SF SF SF ❑DETACHED EXISING EICHLER SECOND STORY ADDmON El❑YES El YES FIRE SPRINKLERS 0 NO 0 NO 0 NO I DWELLING SECOND;DWELLING UNITS# UNIT ADDITON: ❑YES ❑ATTACHED❑DETACHED OTHER ❑NO S F POOLS' ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE 0 PREFABRICATED I POOL-SF SPA:SF I SPA ATTACHED❑YES 0 NO TOTAL-SF _ R E Y ).-01 ALUpTT7nUN: Commercial or Multi-Family Buildings with Public Srnimminy Pools requires Department of Environmental Heath approval i ew rI A •' `�'�J 1 1 RE-ROOFS EXISTING ROOF TYPE: El BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES TILE OTHER'(SPECIFY)��4YY� U�l VVV REMOVE/REPLACE Q NO IF NO PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS yEs #OF LAYERS THICKNESS❑5/8" OTHER III OSE ❑CDX OTHER .12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES 0 OTHER . *Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES By my signature below I certify to each of the following: I am the property owner 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 read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordin. ces and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for 4.ection purposes. I ...,jwled`ge.and authorize all information cont fined n this application form to be made available for public record lor Signature of Applicarit/Agent: ' , ‘a2 %'�'`� Date: T SUPPLEMENTAL INFORMATION EQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings:,Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. *HOA-Provide a letter of approval from the Home Olnmer's Association BldgApp_2017.doc revised 08/01/17