10070045CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10300 PALO VISTA RD I CONTRACTOR: LIFETIME POOLS INC PERMIT NO: 10070045
OWNER'S NAME: GREG & AMY EVERETT 19 10 SAN ANTONIO RD I DATE ISSUED: 09/17/2010 1
OWNER'S PHONE: 4082422611 PALO ALTO, CA 94303 1 PHONE NO: (408)738-1576
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
BUILD NEW SWIMMING POOL (410SQ)-SOLAR PANELS ARE
License Class G �57—,? Lie. # 2 ZO 48'2- NOT PART OF THIS PERMIT -THEY WILL BE DEFERRED.
Contractor Date g /% l�
I hereby affirm that I am lic sed under the provisions of Chapter 9
(commencing with Section 00) 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:
t. 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.
2. 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
permit is issued. A�
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 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature ,4jL2 Date % /D
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t. 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)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
t. 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.
2. 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
permit is issued.
3. I 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
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
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 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature.
Date
Sq. Ft Floor Area: I Valuation: $56000
APN Number: 35702055.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b Date: f-17-6
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, l agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized ent:
Date: / l�
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF
CITY OF CUPERTINO
SWIMMING POOL/SPA
,F, CFY.vED
'"-'_ I PERMIT APPLICATION FORM
C U PEIMI NO BY:
APN # OZ— DSS
Date:/Zg l O
Building Address:
Mailing Address (if different from building address):
Permit Type
1500 Me�;aJOW
1POOLCOMM
Owner's Name:� �
Phone # -
Contractor: Phone#&50
Contractor License #:
--� 1i q<I �-'70 "70
1—►��-�-1MP� fi'ook5, Sr�G,
ZZO a 8 Z
Fax
1BSEISMICO
Contact: Phone#(4,5o>
Cupertino Business License #:
4 9-A' - 1-101-701-101-70Tb
P
Ion
Fax
Residential Commercial
Job Description:
1POOLVINYL
Unci �,Iemj -6wIMMI-nq
B
Valuation (cost of project): 4 5-6"� CO Square Footage:
Project Size: Express Standard L Large Major 17
1 POOLFIBER
Green Building: Please complete relevant portion of the Green Building
Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
1POOLCOMM
Commercial Pool
B
CBSP
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT
TYPES
1BSEISMICO
Seismic Commercial
B
1POOLVINYL
Vinyl -lined (up to
800 s
B
RBSP
1 POOLFIBER
Fiberglass
B
loc)7 0 o H
FM-7
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS:
APN:
DATE:
BP#:
REVIEWED BY:
`VALUATION: Iso
*PERMIT TYPE: Building Permit
BP FEES
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
USE:
II-B,111-B,IV,V-B
OVER THE
.,
COUNTER. Q Yes 0 No
APPLICATION
1 R3SFDADD/REM
TYPE:
MECHANICAL Q Yes Q No
PLUMBING IQ Yes No
ELECTRICAL QYesNo
$0.00
PME Plan Check:
aW
a
00
3�
Permit Fee:
$0.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s .ft.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,111-B,IV,V-B
0
$0.00
Suppl. PC Fee: 0 Reg. 0 OT0.0
$0.00
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
0
$0.00
Tai,
$0.00
F
;1•Ic•rr.l?, fllw; C ho k
AV"cit
Usher fec'h. Insp.
Milmh. phn" Check
Pilowh_ Perim! i re"
Nun 0'.ti
-777
Uc(
01hcrFlec, hasp.
NOTE. These fees are based on the areliminary information available and are onlv an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 Ef : 7/1,'09)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
410 s.f.
$1,393.00
Swimming Pool
IPOOLGUNIT Gunite
Suppl. PC Fee: 0 Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Tai,
F
Acoustical Fee: Q Yes Q No
$0.00
Q
0
Work Without Permit? Q Yes (2) No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
Trtrt•vl Or.ict.rn ewotion F'cVN.
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$1,393.00J
TOTAL FEE:
$1,393.00
Revised: 6/30/2010