13080195 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10801 W ESTATES DR CONTRACTOR:LIFETIME POOLS INC PERMIT NO: 13080195
OWNER'S NAME: PICKETT CHARLES E AND SARA L 910 SAN ANTONIO RD DATE ISSUED:08/2612013
OWNER'S PHONE: 4082553829 PALO ALTO,CA 94303 PHONE NO:(408)738-1576
VLICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALD
License Class 3 Lic,li fi ° REMODEL(NO SIZE CHANGE)(E)POOL TO INCLUDE(N)
DESIGNATED GAS LINE,INSTALL(N)ELECTRICAL
Contractor Dat4
(DESIGNATED CIRCUIT)&RE-PLUMB&RE-PLASTER
I hereby affirm th t 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.
I hereby afl7rm under penalty of perjury one of the following two declarations:
1 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:$20000
-Tbave 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:36923033.00 Occupancy Type:
permit is issued. ' p y yp
APPLICANT CERTIFICATION
1 certify that 1 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 VMBM1I 180 DAY T 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 ISO DAYS LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Is V: Date:
with all non-poi a regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS-
Signature DatAll 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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)
I.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 25505,25533,and 25534. I will
I 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)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,shonld I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air eontamiaants as defined by the Bay Area Air Quality Management District 1
performance of the work for which this permit is issued. will maintain compliance w"505,25M533,
pal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agentDa�"1'1
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 CONSTRUCTION LENDING AGENCV
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
1 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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
SWIMMING POOL 1 SPA PERMIT APPLICATION `q
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION (]Q
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 � S P
CUPERTiN4 (40B)777-3228• FAX(409)777-3333•building(Mcupertino.org \4,76
PROTECT ADDRESS1 0B0I APN M ` Z� M 2
OWNERNAME n tA Z r5 PHOPfE eU Lr7 -3��2 E-MAIL 7
STREETADDRESS �II CITY,STATE ZIP r� FAX
CONTACT NAME PHONE E-MAIL
STREETADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-GUILDER Cl OWNERAGENT *�l CONTRAC70R ❑CONTRACTORAGENT ❑ ARCHrTECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTIACTORNAME 1 1 � LI SENUMBER LICE*ISETYPE BUS.LIC
i^ P�Ls �� y c-s �y
COMPANY NAME E N� F:}x� g4`O�p`
STREETADDRESS C STATE,ZIP aHppOI 1E
4`i 1'o S e.�.� ��a ca sZt�- A to ikt,�a Cl�rr "1 `��°3 (o5p-h`�q .7p�O
ARCHrrECrIENGTNEER NAME LICENSE NUMBER SUS.LIC a
COMPANY NAME E-MAIL FAX
STREET•ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
USE OF SFD or Duplex ❑ Multi-Family TYPE MATEMAL ME(CODE) AREA (SQ.Fr.) VALTJA770N(S)
STRuCIURE: ❑ Commercial POOL ,,ii�
` qzo
POOLISPA MATERIAL TYPE CODE& SPA
V - VINYL-LINED
F - FMERGLASS DEMO
0 - GUNITE
P - PREFABRICATED hECE -._ ..s�,f };x.t TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner qpofaorized agent to act on the property owner's behalf. I have read this
application and the information I have ct I have read the Description of Work and verify it is accurate. I agree to comply withal]applicable local
ordinances and state laws relating to td' ns on. I authorize representatives of Cupertino toenter the above-identified property for inspection purposes.
Signature ofApplicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUMED
Commercial or Multi-Family Buildings with Public Swimming Pools:
Department of Environmental Health approval required. -❑ R sTla o c B� Ir cv> y � i, �;
_ rP7 ANNN DEPT xr f
R.� t ri
STANDARD 1 T Y +��PUBLTG1t{'ORKS EPr i,;- .
Q -
a
{�,�EN-MONNIENTAlf REALTI 4-
❑ MATO r '+a r
.'SANITARYEFV R➢ISTItLi T 4 .
SwfmPoolApp_2011.doc revised 03/16111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10801 W ESTATES DR DATE: 08/26/2013 REVIEWED BY: MELISSA
APN: 369 23 033 BP#: 13oi501fS *VALUATION: 1$20,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration 1 Repair
PRIMARY SFD or Duplex PENTAMATION 1RPGAS
USE: I PERMIT TYPE:
WORK REMODEL NO SIZE CHANGE E POOL TO INCLUDE N DESIGNATED GAS LINE INSTALL N
SCOPE ELECTRICAL (DESIGNATED CIRCUIT) & RE-PLUMB & RE-PLASTER ENTIRE POOL
Ifech.Plan Cheek Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 0.0 hrs $0.00
jucel,.Permir Fee: Plumb.Permit Fee: IPPERMIT Elec.Permit Fee; IEPERMIT
Oiher blech.Imp. Other Plumb Insp. OA hrs $47.04 Other Elec.Insp. El�hrs $47.00
,ldech.Insp,Fcc: Plumb. lisp.Fee: Elec.Insp.I,ee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These ees are based on the relnnina information available and are only an estimate- Contact the De t or addn'1 hi o.
FEE ITEMS(Fee Resolution 11-053 EfT 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F 17 # Plumbing
Suppl.PC Fee: (F) Reg. () OT 0.0 hrs $0.00 $70.00 1PGASRES Piping,Gas<=4 Outlets
PME Plan Check: $0.00 F 1-1 Electrical
Permit Fee: Hourly Only? o Yes Q No $0.00 $139.00 1BREMMISC Special Circuits
Suppl. Insp. Fee-.0 Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $94.00
Conslruction Tax:
Administrative Fee: IADMW $44.00 Q
Work Without Permit? Q Yes Q No $0.00 G)
Advanced Planning Fee: $0.00 Select a Non-Residential Q
Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure 0
Strony-Motion Fee: IBSEISWCR $2.00 2.0 hrs Inspections
BldgSStds Commission Fee: IBCBSC $1.00 $278.00 ISTINSP Inspection,Hourly
SUBTOTALS: 1 $1$$.00 $487.00 TOTAL FEE: 1 $675.00
Revised: 0710112013
Building Department
City OF Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U PERTI N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: Ogo( Uj . U-9 2 , PERMIT# i 308d t9 S
OWNER'S NAME: PHONE# & 50 -494--707 c7
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS:91 0 S A�.n-a�,3.z C,0, CITY/ZIPCODE: - 945a
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
✓ SUBCONTRACTOR BUSINESS NAME - BUSINESS LICENSE #f
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum I Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owq r I Contractor Signature Date
Building Department
' Gity'Of=Cupertino,'
rt
10300 Torre Avenue
Cupertino, CA 9501'4-3255
Telephone: 408=777-3228
C U P E RT I N O Fax: 408-777-3333'
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: Oho( w PERMIT# 13o Sd 1 q 17
OWNER'S NAME: [ PHONE;# & 50 - 4-q-+-7070
GENERAL CONTRACTOR: L1 r1 _ �� BUSINESS LICENSE
ADDRESS: 9l0 CITY/zrPQODE': Act.O *cam A� -ge{-W
"Our municipal code requires all businesses workingin the city to have a City of,Cupertino business license.
NO- BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUB-CONTRACTORS ONTRACTORS HAVE OBTAINED A CITY-OF CUPERTINO
BUSINESS LICENSE.
I am not using.any subcontractors: -
Signature Date
Please check applicable subcontractors and complete the,following information:
V SUBCONTRACTOR BUSINESS NAME' BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical 1�i
Excavation
Fencing
Flooring/Carpeting r . '
Linoleum/Wood _
Glass /Glazing
�T u Ste.
Heating _ -
Insulation
Landscaping - _}
Lathing,
%✓
Masonry -�Painting'/Wallpaper
Paving
V Plastering - ')A 6KMTt__ Z, Z
V Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
1" Tile
Own r 1 Contractor Signature � r . � - �� '_, � Z Date
..
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EXPANSION JOINT : . ,' s' a PXff'G POOL 910 San Antonio Road,
BYO xisT G g.a Pala Alto, Calif. 94303 DRAAN BY. Off BY.
.a•; ( �XIST'G ) -�i_ '=- — Phone (650) 494-7070 (510) 795-7070 (408) 738-1576 0
10Fax.......(650) 494-0508 license 220382, C-53
DECKING 1l�IITI COPING CANTILEVER DECK .life a ools.com CA
NTS NTSI CHARLES & LYNN PICKETT DESIGN NO.
NOTE : EXISVG 93-498
A; IN B, D YOUR DG COMMR !, 10841 �. ESTATES DR N0.
OPTIONS AVABABLE TO DECK XO /CRA G. ® "��� � -�� ° _--� CUP 0, CA 95014 SHEET
B. CM LOCAL BUIBING DZPAMENI CODES FOR POOL AM TO BE FENCED PER CITY OR COUM ORD CE: EXIST'O POOL PROFILE (408) 255-3829 (408) 861-2072 JOB NO.
ADDITIONAL REQ NTS . GATE TO BE -CLOSING AND SEY-IAMHNG, BY OM NTS Thomas Ya 185242 40104