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12030018CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10387 AVENIDA LN I S O T CLARA CTOR: ROYAL POOLS INC OF I PERMIT NO: 12030018 OWNER'S NAME: 1 SAN JOSE, CA 95124 1 PHONE NO: 4083718000 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # �Y Contractor L Date / I hereby affirm that I am licensed under the provisions of xhapter 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. 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. 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 harmle City of Cupertino against liabilities, judgments, costs, and expenses whic may crue against said City in consequence of the granting of this permit Additi - nally, t 9 applicant un r tands and will comply with all non -point so ce reg lations(/ erupert' o/Municipal Code, Section 9.18. % . w s ❑ / OWN'�ylj2-BlIgUYE t�DECLARATION III by affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. 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 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 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. BUILDING PERMIT INFO: BLDG r ELECT J_ PLUMB f— MECH r RESIDENTIAL r COMMERCIAL JOB DESCRIPTION: HILLSIDE- CONSTRUCT IN GROUND SWIMMING POOL 426 SQ FT W/ 38 SQ FT SPA W/ HOT WATER SOLAR PANELS c Sq. Ft Floor Area: I Valuation: $42500 APN Number: 34245040.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: � � '/ /� � : U ' �j'' RE -ROOFS: 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. 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, shoouse equipment or devices which emit hazardous air contaminants de f ned ExpeBayZ'5533, iir Quality Management District Iwill maintain co Tian a wit upeMunicipal Code, Chapter 9.12 and the Health & S etv ode, 55 and 25534. I". W_ L�'� /hereby affirm that there is a construction lending agency for the performance of nnork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION Signature Date I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO W-M-241 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10387 AVENIDA LN DATE: 03/05/2012 REVIEWED BY: SYLVIA APN: —3 5 01 BP#: a()3�� *VALUATION: $42,500 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION RBS PERMIT TYPE: 14 WORK CONSTRUCT INGROUND SWIMMING POOL & SPA W/ HOT WATER SOLAR PANELS SCOPE NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public If'orks, Fire, Sanitary Seiver District, School District. etc ). These fees are hnsed on the nreliminary information availahle and are only an estimate. Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 D64 s.f. $1,435.00 Swimming Pool 1POOLGUNIT Gunite i Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 = # $0.00 Swimming Pool 1 Spa or Hot Tub (Pre -Fab) Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? O Yes No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure O Strong Motion Fee: IBSEISMICR $4.25 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC 1 $2.00 SUBTOTALS: $6.25 $1,435.00 TOTAL FEE: 1 $1,441.25 Revised: 1 /19/2012