14010117f/
CITY OF CUPERTINO BUILDING PERMIT
RI I.DING ADDRESS: 10177 MYER PL
CONTRACTOR: BURKETT'S POOL
PERMIT NO: 14010117
PLASTER INC.
OWNER'S NAME: ROBERTA SKANDALIS
600 N FRONTAGE RD
DATE ISSUED: 01/21/2014
OWN 'S PHONE: 4082551819
RIPON, CA 95366
PHONE NO: (209)529-6944
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
REPLASTER 430 S.F.(E) SWIMMING POOL WITH (N)
License Class (J Lic. # (A 18 Z
QUARTZ FINISH. REPLACE ALL (E) POOL EQUIPMENT,
((�� 1 , �- ?
J� v C 1L Q� ) 5 Date I "Z, �"O
POOL LIGHT & INSTALL SUCTION OUTLET COVER
C )ntractor
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.
I 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: $15000
1 have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 31623051.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is
PERMIT EXPIRES RK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 18 S O ERMIT 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 D F ALLED 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
Iss d Date: 2
granting of this permit. Additionally, a licant understands and will comply
with all non -point source re tions er Cupertino Municipal Code, Section
RE -ROOFS:
9.18.
l'— 1 �
Signature Date
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:
I 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) .
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. 1 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(x) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25 255 3, and 25534.
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
, �
"--V )— W y
Date.
Owner or authorized agent:
permit is issued.
I certify that in the performance of the work for which this permit is issued, l shall
not employ any person in any manner so as to become subject to the Worker's
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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
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
CUPERTINO
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O
(408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino.org
PROJECT ADDRESS G >� -^7 ^� �A
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❑ OWNER ❑ OWNER -BUILDER 13OWNER AGENT ElCONTRACTOR ONTRACTOR AGENT 11 ARCHITECT ❑ENGINEER 1:1 DEVELOPER 11 TENANT
CONTRACTOR NAME �1 �,{.7_ ��OI I\��
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LICENSE NUMBER` 0����
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PHONE
DESCRIPTION OF WORK
r
USE OF ❑ SFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
TYPE
MATERIAL TYPE (CODE)
AREA (SQ. FT.)
VALUATION (S)
POOL/
j
`.i
1 ov o
POOUSPA MATERIAL TYPE CODES:
V - VINYL -LINED
F - FIBERGLASS
G - GUNITE
P - PREFABRICATED
SPA
DEMO
TOTAL VALUATION:
S
By my signature below, I certify to each of the following: I
rrec
ordinances and state laws relating to buildinction. I
application and the information I have proviu�_
Signature of Applicant/Agent
perty own r aut nt to act on the pope wner's behalf. I have read this
a ead the Description of Work and verify it is accurate. I agree to comply with all applicable local
orw representatives of Cupertino to enter the above-idenjjtified prope or inspection purposes.
Date: '� 1�2-�
SUPPLEMENTAL INF RMATION REQ RED
Commercial or Multi -Family Buildings with Public Swimming Pools:
Department of Environmental Health approval required.
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
❑ LARGE
❑ MAJOR
❑ BUILDING DEPT
❑ PLANNING DEPT
❑ PUBLIC WORKS DEPT
❑ ENVIRONMENTAL HEALTH
❑ SANITARY SEWER DISTRICT
SwimPoolApp_2011.doc revised 03/16/11
�����,,,�,,,�,,��, CITY OF CUPERTINO
IW"W'-4/./�I FEE ESTIMATOR - BUILDING DIVISION
liaADDRESS:
10177 MYER PL
DATE: 01/21/2014
REVIEWED BY: MELISSA
Mech. P, : _-: ,
APN: 316 23 051
BP#:/7
*VALUATION: 1$15,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
USE: p
Plumb. lavri V,
PENTAMATION RBSP
PERMIT TYPE:
WORK
REPLASTER 430 S.F. E SWIMMING POOL WITH N QUARTZ FINISH. REPLACE ALL E POOL
SCOPE
EQUIPMENT, POOL LIGHT & INSTALL (N) SUCTION OUTLET COVER
NOTE: This estimate does not includefees due to other Departments (i.e. Planning, Public Works, fire, Sanitary Sewer District, School
n:c.r:n. ofn Thoco %oc nro hncod on tho nroliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 &7`1/13)
Ir. t'lar� C'm ch
Plumb. Plan Check
Elee..Plan Check
Mech. P, : _-: ,
Plumb. Permit Fee:
Elec. Permit Fee,
Other Alech. Insp.
Other Plumb Insp.
ether Elec. Insp.
lnsu /`r'r'
Plumb. lavri V,
r.-, . b"?, 1,cr
NOTE: This estimate does not includefees due to other Departments (i.e. Planning, Public Works, fire, Sanitary Sewer District, School
n:c.r:n. ofn Thoco %oc nro hncod on tho nroliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 &7`1/13)
FEE
QTY/FEE
7 MISC ITEMS
Plan Check Fee:
$0.00
= s.f.
$0.00
Swimming Pool
Gunite
Suppl. PC Fee: (F) Reg. o OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? ()Yes Q No
$0.00
Suppl. Insp. Fee -0 Reg. Q OT
I 0,0
I hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction :Tax:
Administrative Fee:
1 1
O
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure 0
A
Travel Documentation l'
Strong Motion Fee: 1BSEISMICR
$1.50
3.0 hrs
$417.00
Inspections
1STINSP Inspection, Hourly
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$2.50
$417.00
TOTAL FEE:
1
$419.50
Revised: 01/15/2014
0
�
_� SITE PLAN
- -4 SCALE 1/8" = 1`
.--.... ----. ----. ---.. ---_ --- .-_. ---_ ---_ 108 ft.
Pool Specifications
Perimeter: 84 Ft
Depth: 3'6" to??
Detail: 32 Ft
Area: 430 Sq Ft
Replace Waterline Tile and Coping
Install Rock Coping
ellite Image
:A
SCOPE OF WORK
Resurface Existing Swimming Pool
Replace Waterline Tile
Replace Coping with Rock Coping Lilt Aff&Ut
Install New Anti -Entrapment Suction Outlet Cover
ANSI/APSP/ASME Approved Drain Cover (Aquastar Channel Drain)
Replace Pool Light - GFCI Protected
Replace Pool Equipment
Pump -Variable Speed Pentair 4 x160
Filter -Jandy Cartridge Filter
Panel/Time Clock - Intermatic
Booster Pump (pool sweep) - % hp Polaris
Light - standard
Abandon Existing Heater - Remove and Haul Away
ALL CONSTRUCTION WILL FOLLOW THE STANDARDS SET
IN THE CALIFORNIA BUILDING CODE 2013, TITLE 24
NEW CONSTRUCTION COMPLIANT WITH 2013 Green
Building Standards
POOL BARRIER REQUIREMENTS
SWIMMING POOL BARRIER COMPLIANT WITH 2013 BUILDING
CODE STANDARDS
GATE AND FENCING REQUIREMENT
BARRIER WILL BE MAINTAINED AND INTACT
3109.4.4.3 Enclosure; required characteristics. An enclosure shall have all of the
following characteristics:
REVISIONS
1. Any access gates through the enclosure open away from the swimming pool and
are self-closing with a self -latching device placed no lower than 60 inches (1524 mm)
above the ground.
2. A minimum height of 60 inches (1524 mm).
3. A maximum vertical clearance from the ground to the bottom of the enclosure of
2 inches (51 mm).
4. Gaps or voids, if any, do not allow passage of a sphere equal to or greater than
4 inches (102 mm) in diameter.
5. An outside surface free of protrusions, cavities or other physical characteristics
that would serve as handholds or footholds that could enable a child below the age of
five years to climb over. - - -' " ,-, N
APPROVED
Authority: Health and Safety Code Section 18942(b) t of plans and specifications MUST r LU W
;., S 7 r, ng construction It is unla^ ' Q
c` ryes or alterations on same, c
Reference: Health and Safety Code Section 115923 ar,_ without approval from .! Q
Ab 3305, Statutes 1996, C.925 C
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Sheet # 1
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REVIEWED izCFi CODE COiyiF W-11NGE
Reviewed By,
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