13100214 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10619 LA RODA DR CONTRACTOR: PREMIER POOLS AND PERMIT NO: 13100214
SPAS
OWNER'S NAME: DON&TERI PHILLIPS 5057 KIERNAN CT STE D DATE ISSUED: 10/31/2013
OWNER'S PHONE: 4082521116 SALIDA,CA 95368 PHONE NO:(209)545-7727
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALE]
License Class .Lie.4 q9'(f 9 Z?_ REMODEL PEBBLE QUARTZ FINISH IN THE(E)
--,�� SWIMMING
Contractor &!g Date POOL&SPA,REPLACE(E)DRAIN,INSTALL 1 (N)DRAIN
I hereby affirm that Lam licensed under the provisions of Chapter 9 &INSTALL(N)DESIGNATED GAS FOR FUTURE BBQ&
(commencing with Section 7000)of Division 3 of the Business&Professions FIRE
Code and that my license is in full force and effect.
I hereby aflirin 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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8000
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:36933028.00 Occupancy Type:
permit is issuod.
APPLICANT CERTIFICATION
I 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 WITHIN 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 DAYS + CALLED 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 ssue Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 3 3 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
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)
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 25505,25533,and 25534. I will
1 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,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
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 255 4.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Dater
permit is issued.
I certify that in the performance of the work for which this permit is issued,1 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,1 CONSTRUCTION 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
1 certify that I have read this application and state that the above information is
correct.1 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 / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION `0
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 /�„ v
CUPERTINO (408)777-3228• FAX(408)777-3333•building(cDcupertino.org �� ►'/
PROJECT ADDRESS / D r r APN N / (D - �\•� �}
OWNERNAME _ PHONE U„`g_2 _ . E-MAIL
(�
STREET ADDRESS J� O Q CITY, TATE,ZIP ` 6 e�o/ FAX S l�
CONTACT NAMEPHON E-MAIL
(9V1 12
STREET ADDRESSr CITY,STATE,ZIP � ' FAX r
i
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ONTRACTOR AGENT ❑ ARCHrrECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONVR tJ4 ( + LICENSE NUMBER �Z LICENSE TYPE BUS L/ICN
COMPANY NAM ' E-MAIL ,J C61-4,
STREET ADDR,FySS CITY,STAIP _ _„ PHONI �Y�� 3C.
on
ARCHITECT/ENGINEERNAM E LICENSE NUMBER , BUS.LIC N
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK Regoc\e\
1 r � v) a
USE OF ❑ SFD Or Duplex fM Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION ($)
STRUCTURE: ❑ Commercial POOL
07q a
POOUSPA MATERIAL TYPE CODES: SPA 0
V - VINYL-LINED
F - FIBERGLASS DEMO - -
G - GUNITE -
P - PREFABRICATED °' I #`I`-: s TOTAL VALUATION:
By my signature below,I certify to each of the follow.in I am the perty owner d agent to act on the property owner's behalf. 1 have read this
application and the information 1 have provided is correct. I have read the Descriptl of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin.C etion. I aut rine esentatives of Cupertino to enter the above-identi ied prop for inspection purposes.
Signature of Applicant/Agent: Date: Lo
SUPPLE INFORMATION REQUIRED OFFICE USE ONLY
PLAN CHECK TYPE ROUTING SLIP
Commercial or Multi-Family Buildings with Public Swimming Pools:
Department of Environmental Health approval required. EXPRESS
❑ BUILDING DEPT
❑ EXPRESS ❑ PLANNING DEPT
,❑ STANDARD ❑ PUBLIC WORKS DEPT
❑ LARGE ❑ ENVIRONMENTAL HEALTH
❑ MAJOR ❑ SANITARY SEWER DISTRICT
SwimPoolApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10619 LA RODA DR DATE: 10/31/2013 REVIEWED BY: MELISSA
APN: 369 33 028 BP#: 'VALUATION: 1$8,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
woRK REMODEL PEBBLE QUARTZ FINISH IN THEE SWIMMING POOL & SPA REPLACE E DRAIN
SCOPE INSTALL 1 (N) DRAIN & INSTALL (N) DESIGNATED GAS FOR FUTURE BBQ & FIRE PIT
Alecrh. flan Ch;-' Plnmh. Plaii Check E=lec. Plica Crczk
4 Perfrtil Fere: Phimb. Permit Fee. lalerPermit Fee.
Other A1ech.Insp- EI-L- Other Plumb Insp lac.Insp. E3
ATech.Insp. Fee: plumb, Insp. I ea: Elec.Insp.
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc.). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (F) No $0.00 1 hours Plan Check,Hourly
Suppl. PC Fee: (F) Reg. 0 OTT0.07 hrs $0.00 $139.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? ()Yes Q No $0.00
Suppl. Insp. Fee-.0 Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Conswuction Tax.
4dministrative Feta: 0
Work Without Permit? 0 Yes 0 No $0.00 0
Advanced Planniny-Fee: $0.00 Select a Non-Residential
Trca,el Documentation Fees. Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $0.80 3.0 firs Inspections
Bldp_Stds Commission Fee: IBCBSC $1.00 $417.00 ISTINSP Inspection,Hourly
SUBTOTALS: $1.80 $556.00 TOTAL FEE: 1 $557.80
Revised: 10/01/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: ( ✓• PERMIT# 1 -3,100 Z(
OWNER'S NAME: pyt ykS PHONE #
GENERAL CONTRACTOR:` * `u , BUSINESS LICENSE# $�
ADDRESS: CITY/ZIPCODE: _ `C Q —
*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 VE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: J 1 As.
Signature Dat
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum/Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting /Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature Date
106ft POOL SPECS
SIZE:70 x 16 x 16 SQFT: 1079
DEPTH: 3-8 PERIMETER: 183
EST TOTAL GALLONS: SKIMMERS:�1
RETURNS: 3 INTERIOR MATERIAL:Pebble
BBQ s • SPECIAL: TILE: 6 x 6
NOTES: Remodel
SPA SPECS
SIZE: 7 x 7 SQFT: 41
DEPTH: PERIMETER:
FENCING EST TOTAL GALLONS: SPILLWAY: 23
RAISED HEIGHT: SKIMMERS:
N ALL FENCING TO MEET COUNTY OR RETURNS: 4 TILE: 6 x 6
CITY CODES INTERIOR MATERIAL: Pebble
Fire PitALL (3A I SPECIAL:
AND EUCKING NOTES: Remodel
ALL:GATES 10 OPEN 10 1 HE FRON I� � PLUMBING
New Main
- . RETURNS: 3 SKIMMERS_ 1
Att DOORS WITHIN POOL AREAS TO POOL MAIN DRAINS: 2 SPA MAIN DRAINS: N/A
BE ALARMED CLEANING SYSTEM: HEADS:
VAC LINES: N/A ROBOT VAC: N/A
WATER FEATURES: SPA SPILLWAY: Yes
LIGHTS IN POOL: LED 2 LIGHTS IN SPA: LED 1
New Gas BARRIER NOTES -A) TOTAL PIPE: N/A
BARRIER NOTE: POOL AREA SPECIAL: 2 Sheer2ft,Autofill (New Pool Plumbing)
0) COMPLETLY ELNCLOSED BY NOTES: Making the one main drain into 2 main drains
DECK
DECK TYPE: Travertine ELEVATION:
TOTAL DECK SQFT: 2248 PERIMETER:
DOORS tEADING TOPOOL HAVE RAISED BEAM: LIP STYLE:AtARIVIS AND Aft GATES ARE _
MATERIAL 1:Travertine MATERIAL 2: Pavers
SELF CLOSINGSELF bkTCHING-- SPECIAL:
'
Meter NOTES:
o EQUIPMENT
60"FRGIVITHE GROUND POOL PUMP: Jandy 2hp 2sp 2ND PUMP: N/A
FILTRATION: Jandy 580 FILTER SIZE: CV
INLIN
Equipment Pad • ' HEATETIMER:R Dual GAS:
GAS:E Yes
s
Philli Residence SPECIAL: Upgrade easy touch 4 to an 8
Phillips NOTES:
Gunite Washout359-33-028 -A
WADDLES & FILTER BAGS PER CODE
ORDERSCHANGE
%5551e: 118 TO BE USED IF NEEDED.
NO GUNITE
CD# DESCRIPTION DATE
107ft �. �� 10
z
O
= NAME: Premier Pools&Spas
Cts PERTINO BUILDER INFO: 5057 Kiernan Ct,Salida,Ca 95368
B:.iild ng DemartTle; t SUPER: Noha/Jeremy
COMMUNITY DEVELOPMENT DEPARTMENT ,,, 4 ;s
Sales Person: Donald Boucher
�. s
BUILDING DIVISION-CUPERTiNO PHONE: 408409-9972
APPROVED REVIEWED FOR CODE COMPLIAN JOB NOTES:
This set of plans and specifications MUST be kept at the Reviewed By.
job site during construction. It is unlawful to make any
changes or alterations on same,or to devia e �R
therefrom,without approval from the Building Official.
The stamping of this plan and specifications SHALL NOT • INFORMATION',
be helot to permit or to be an a^ I of the violation FFICE CU
of any prove it finance or State Law. /�� / NAME: Don Phillips
��/ / l/ ADDRESS: 10619 La Roda Dr
DATE
117
3/ 13 (/ CITY: Cupertino STATE: Ca
1 06ft PERMIT NO. t 310 OZ! PHONE: 408-252-1116 ZIP: 95014
V -------------------------------------------------------------------------------------- WORK:
;Ail Construction shall comply with:
2010 CALIFORNIA BUILDING CODE ; CELL:
2010 CALIFORNIA REISENTIAL CODE JOB#:
FENCESiANOAROS
Gas Line
2010 CALIFORNIA ELECTRICAL CODE
_ ( 2010 CALIFORIA MECHANICAL CODE
etas s 2010 CALIFORNIA PLUMBING CODE •
_Zr4TOPPA a Ing a one am rain Ino ; 2010 CALIFORNIA ENERGY CODE
:X4 TOP FAR -, : ...... . f���u�A� 1 . Gas Line is 120 Linear Feet � 2010 CALIFORNIA FIRE CODE � 0 r d and I give m approval to proceed
Main rains In Pool ; ; �� a 9 y
2. Gas Line is a 1 1/2in Line Pool an awl Quartz All other state and local ordinances and W t.4, q�r�s c this project.
2.3. Gas Line will Tie in from the Meter to the Fire Pit an( Remodeling N regulations OCT
r31
i. vEarrcF� t0 the BBQ 3. PuttinginGas L-iT�foT�ar�Firms 20
,,� �;, � i ;In accordance with CBC Sec. 3109.4.4.2 Item #4. The residence ��
VERTIG:LPit
;shall be equipt with exit alarms on those doors providing direct
f New and uipment
;access to the pool.
. f1
EIE.FTiC
."iE::'tIC4i