The URL can be used to link to this page

03120094 CITY OF CUPERTINO awLDINc DtvlsloN PERMIT * CON `RACTOR INk'C1RIVIATIC)N - - BUILDING ADDRESS: _ PERMIT NO0 3 12 0 0 94 OW NEWS NAME: PERMIT ISSUE DATE LONE: SANITARY N0. CONTROL NO. AR CHITELTTINGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH t3 0 0 0 a00 • LICENSED CONTRACTOR'S DECLARATION Job Description C I hereby affirm that 1 am licensed u'n'�fr provisions Cf Cox p¢r 9(commencing U with Scco )nf Division3of SC Bus�,x dProfcssions Codc,mdmylacnscis j zo. infall ccl areae`. Liavv«��,R �_3v�2 DEMO THE EXISTING POOL _ License CI a n r C plye� C tier ✓Y a ARCHITECTS D ATION 1 understand my plena shell M uuJ as ic rccnNs seLi T1g Licensed Pordeshereby 2 9 OWN ER-BUILDER DECLARATION (p H 2 0 1 naso .(item on I am exempt from the Contractor's o License Law for the p o following retina. (anti t ](131.5,Business and improve, ions Code:Any city or county 1:20 m which its requires n permit to uin s the glue imprrsu,h permit t at repair any swcture u Z N prior r he is i issuance,pursuant nt to the thnvista s nt of me such permit m Nc se Law wd nammcm that ancocccnudpurction7 h)ofDiviormnfNeContriness ndPnselaw(C oacr9 Sq.F[.Floor Area. Valuation (commencing with Seniors]000)of Division 3 of Be Business send Professions Coda)or Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant IC a civil penalty of 3 en.D#.irTl...*qro o Occupancy Type net more Nan five hundred dollars($500). 1 3Zl' Y.J V•'V r W ❑1,as owner arms prepcny,or my employees with wages u their sole compensation, will do the work,and theauucture is not intended or offered for sale(Sec.7W,Business and Professions Code:The Contractor'.License Law does net apply las an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvement are not intended oroffered for sale.IL howeveA the building or improvement is told within ane year of completion,the owner- builder will have the burden of proving that he did not build or improve for puryose of Sale.). - ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the pmject(Sec.]066,Business and Professions Code:)The Contractors Li. cense Taw does not apply to an owner of property who buil"or improves thereon.and, who contracts for such projects with a contractorls)licensed pursuant to the Contractors License law. 0 I but exempt under Sec. ,B&P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury are of the following declarations: 3 have and will maintain a Contrition,of Consent to self-insure for Worker'.Compen- sation,as provided for by Section 37M of the Labor Code,for Ne perfannmu:c of the work for which this penult is issued. ❑I ban and will maintain Worker's Compensation Insurance,as required by Section 370!1 or Ne Labor Code.for Ne performance of the rk for which this permit is issued. kers CMmpensation�[Insnow.carticr licy number am: r IL � Poli No.: inn _ 3 C RTIFI� LATE OF EXEMPf10 FRO W RKE / N COMPENSATION INSURANCE (Thisseekers need not he completed if the Permit Is forme,hundred dolma H000) to less.) I certify Bal in the performance of the work for which this permil 1.issued,1 shall am employ any Person in any manncrse as to become subject no the Workers Compensation Laws of Califomia.Date Applicant NOTICE TO APPLICANT:It,after making this Certificate of Exemption,you should - become object to the Worker's Conorcowdon provisions of Ne Labor Code,you most .,O forthwith comply with such provisions or this Permit shall be deemed revoked. z r~N. CONSTRUCTION LENDING AGENCY [-i Iherch,.Mrm Bat Bere i..connotation lending agency l'or the performance of Cli > dm work for which this permit is lasuc l(Sec.3097,Civ.C.) Ian O Usudn's Name U 0 Lender's Address VP V� 1 agree that I have rod This application and sum thin Bid above information is 0 U building I agree miComply,and with all city andnti county ordinances and sum laws relating10 he V above-menng tioned construction, hemby fornprposesenutiws of this to enter clean the shove-mentioned property for i randfy an purposes. (~ (We)agree to cove,indemnify and keep harmless the City of Cupertino against I �� N incon iequence of uang of this csmit, may in any wayaccrue against said City V z A consequence of Bc UNDERSTANDS of this Permit, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-P INT Issued by: Date SOUR BGULATIONS. /Lv C C / e-roofs nature of ApPlican✓Cenuaemr am HAZARDOUS MATERIALS DISCLOSUR pe of Roof Wi11Bc"'dicem or future building occupant slur,or he nd avardous material AItst defined by the Cupenine Municipal Code.Chapter 9.12,and the Health and Safety cnde.Seeaen25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yea Will the applicant or lulv'a building octupanl use equipment Cr devices which If a roof is installed without first obtaining an inspection,I agree[o remove It Karam on'air conuminant as cfmcJ by the Bay Arca Air Quality Management all new materials for inspection. Ion" ❑Ycs 1 have raw Be hammous materials requirements under Chapncr695 orthe Califpn ria Healba&Sffimy Code,Sections 25505,25533 and 25536.1 understand Buif the building docs not currently have a thorn.that it is my marvinsihility W notify the Occupant of Be require CruswhichmusthemetpriorInissuancCe(aCCniEC capon=r. Signature of Applicant Date O crmau orizcd agcm Dam All roof coverings to be Class "B" Or better CITY OF CUPERTINO _ OCITY DEMO CUPERTINO PERMIT APPLICATION FORM APN# Date: 3 i 6-rs--�� '� ►T-�� - � 3 Building Address: t.711 SbUM T�2 s� n ✓ Owner's Name: Phone# �..,�,c,-snNy ce-tz� C��id�-6•.t�-/moi. Contractor: I License#: !Es /ti z-4 W /13 3 p 3 D" Contact: -` � Phone: 6 �K? � c ev PO 40 6 ApplicanYC�: 6 wN aA- g Permit Info: c f Bldgp16Gt 7°�� Elect Plumb Mech 7a escription:/eZ--/,t&vf- Grlls'LlA/$ /A76 . r`/,-/S ?C+ -Ref denti f Commercial: or Area:(-i °t X C0� jf}�jIO SGvIMtLj rd1 S $/Sq.Ft.: — Architec Val n: -- ' r Type of Construction: �L- d P(SpL70 15� Occ' y Grou H Qty i A 1 abl Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILIDNG BSEISMICOM Seismic Commercial BUILIDNG BSEISMICRE Seismic Residential BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business License / BUILIDNG - 4- # 2 FRANK LEE & ASSOCIATES GEOTECHNICAL CONSULTANTS 10 KOOTENAI COURT, FREMONT, CA 94539 (510) 657-7792 January 19, 2004 Job No. IN-12 / Mrs. Betty Chen 10911 Santa Teresa Drive Cupertino, California 95014 SUBJECT: INSPECTION OF SWIMMING POOL BACKFILL COMPACTION 10911 Santa Teresa Drive Cupertino, California Dear Mrs. Betty Chen: This letter is to confirm that we provided inspection and testing during the grading operation of the swimming pool backfill at the subject site. The results of field density testing performed by our firm indicated that a minimum of 90 per cent of relative compaction was achieved on the swimming pool backfill. We appreciate the opportunity to work with you on this project. If you have any questions or if we can be of further service, please do not hesitate to call. Thank you. Very truly yours, FRANK LEE & ASSOCIATES QEF FO ZtiONG Hlyh�F2 Fra i � q�tV hn 'k�Laa a N0. C 34975 Professional Engineer CE34975 ///�y409 T VV�L �FOF CAa�FO