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12100213 CITY OF CUPERTINO BUILDING PERMIT RUILDING ADDRF,SS: 21123 CHRISTENSEN DR CON I'RACI'OR: PI IILLIP D.BIURMAN PERMIT NO: 12100213 OWNER'S NAME: CI'IENG FENG B HUEI KING 1250IIIGIIWY 101 DATE ISSUED: 10/302012 OWNER'S PDONF,: 4085698336 AROMAS,CA 95004 PII0NE N0:(650)906-7533 ❑ LICENSED C0N'1'RAC`fOR'S DECLARATION .ION DF,SCRIPPION: RESIDE\PIAL El COMMERCIAL LicenseClassA y� Lie.9 R7 (�S0 SFDWL POOL DEMO 600 SQ FT Contmctof--- Q2270?2, Date 1 hereby affirm that 1 am licensed tinder the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business S Professions Code and that my license is in full force and effect. hereby affirm under penally of perjury one of the following heo 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 Otis permit is issued. Sq.Fl Flour Area: Valuation:$6000 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 far which this ANN Number:3265401 L00 OccupancyType: permit is issued. APPLICAN I'CERTIFICATION I certify that l have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 16gree to comply with all city and county ordinances and state laws relating WITHIN ISO DAPS 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 FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said Ctry•in consequence of the f G� fO granting of this permit. Additionally,the applicant understands and will comply Issued by: ✓✓✓GfT`r / ,�/ Date: J with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. � ��y{ p J //�� RE-ROOFS: Signature 44" r/ _ _ Date (. rL All roofs shall be inspected prior to any roofing material being installed.Ifo roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that I am exempt from the Contractor's License hoafor one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR RE'ITER 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 d Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to IIAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business C Professions.Code). I have read the hazardous materials requirements tinder Chapter 6.95 of the California Ileallh S Safety Code,Section.+25505,25533,and 25534. I will 1 hereby'affirm ander penalty of perjury one of the follomng there maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Ileallh S Safety Code..Section 25532(x)should 1 store or handle hazardous I hive 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 M'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 Ileallh S Safety Code,Se ions 255115,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this0/'� permit is issued. Owner or authorized agent: F/ ' Date: 7c- 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 CONS'I'11IICI'ION 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 AI'I'LIC,\N'1'CER'1'IFICA'1'ION 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 suite Imus 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, ARCRITECt"S DECLARATION 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 I SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION P 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 S P O� CUPERTINO (408)777-3228 • FAX(408)777-3333 • buildinoOcuDerino.ora ^ 1 PRO!<Ci ADDRESS C4\(' IV1. I APNe 32L9 O ) I 0 NAME n HONE _ _ E-MAIL I SrAE_ET ADDRESS n I Q � i CITY. STATE,ZIP I FAX l� /1 CONTACT NAME I PHONE I E-MAIL STTL'T ADDRESS CITY,STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT XcowrucrOR ❑CONT ACiORAGENT ❑ AACHITEcr ❑ENGNEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSENUMSER LICENSETYPE I BUS.LIC s' cowW NAME E-MAB. FAX STREET D S CITY. ATE.ZIP PHONIi L AR=CTIENONEERNAME LICENSE NLDIMER BUS.LIC F CONVANYNAME E-MAIL FAX SrREEZT ADDRESS CRY.STATE,ZZP I PHONE \ / DESCRIPTION OF WORK USE OF q/-SFD or Duplex ❑ Muld-Family TYPE MAMIUALTYPE(CODE) I AREA (SQ.Fr.) I VALUATION (S) X STRUCTURE: /❑ Commercial POOL C77 POOLSPA MATERIAL TYPE CODES: SPA V - VWYL.LINED F - FIBERGLASS/ DEMO �RETOTAL ALVATION: P - PREFABRICATED CE �, Y ^� By my signaru c below,I certify to each of the following: I am the pmpery owner or authomed agent to act on the papery, owner's behalf. I have read this application and the information I have provided is comet I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatiP .buildin cocti uthodze representatives ofCuperino to enter the eboVX.'dantifi d property for inspection purposes. Signature ofApplicantlAgene / Date: Q �t SUPPLEMENTAL INFO TION R6 q PTJIR.ED �- x-_- OFFICEIIISE,ONZY . �=�-^pCA.V�,CHEIXT:YPE-sti '.Y<"�'ga�` ROU'"TLAG IlY _ •� _Commercial or Multi-Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. 'OVER-TB-;:CO U `rt-..� BtIIEDrac ❑')E-�REss�'�,�.. �z�^:eLA,vy c-•DEPT'_ z" Qz G� - Erevuton�r I T.-cH# - e�,e�rvua��'F-a�b .r�-'�� _�'rsa.�A1T YRa�:SEV•ERDISEaI - SwimFoo1App2011.doc revised 03116/11 RECEIVED OCT g 0 2012 BY: Okit L Sop LL � 23crr �5 �r. -5 CM W �txcar cc-A 'IFFICE CO" ll . -- Ras�cH Ni�cI�VAnA'� tlPck. 2u i3 �tar�5z��J �ctv� Iry NCA\ gt�lCn/1er1 C5� � �d(r ��J Q�1\LLtP b. COMMUNITY DEVELOPMENT DEPARTMENT �`S� 'AtLIALX q ID1 m m wr nnnclON-CUPERTINO NWAIV,IV, E J�j `1S 67 < 1 9 PROVED LhSI>> `\Ob- 1533 This se!Gfjk s specifications MUST be kept at the Job site during construction. It Is unlawful to make any `I changes or alterations on same,or to deviate z1�a5� therefrom,without approval from the Building Official. The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any provisions of any City Ordinance or State Law. BY �rI/Y f7� 4��/ DATE PERMIT NO. U _l� CITY OF CUPERTINO D FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 21123 CHRISTENSEN DR DATE: REVIER'ED BY: MENDEZ APN: BP#: 'VALUATION: $6,000 *PERiMITTYPE: Demolition Permit PLdNCI1ECKTYPE: PRIMARY Swimming.Pool, Res. PENTAMATION 1SFP00LDEM USE: PERMIT TYPE: At 1VORKSFDWL.POOL DEMO 600 SQ FT SCOPE FEEID #POOLS 1DEMOPRES 1 ,Neth. Plan Check Plumb.plan C'hcek Elec.Plan Check Meth. Permit Fee: Plumb.Permit Fee: Elac.Permit Fee: Other Mech.Insp. Other Plumb Insp. Other Elec.Insp. ,Nath.Insp.'Fee: Plumb. htrp. Fee: Elec.htsp. Fee: AWE: This evtinmte doev not include jeer(lite to other Departments(i.e. Planning, Public (Forks, Fire,Sanitary Scnver District.School District,etc.). These feav are based on the prefindnan information available and are only an estinmte. Contact the De t or adihn'l info. FEE'ITEMS (Fee Resolution 11-053 E/! 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee Plumb./A/ech./F.lec. Permit Fee: $306.00 Suppl. Insp. Fee.0 Reg. Q OT 0.0 hrs $0.00 Plumb.htdech./Clec Plumb./Adech./Elec Permit Fee: Construction Tax: Administrative Fee: Work Withow Permit? Advanced Planning Fecs: Travel Doctanentaiion Fees: A Strong Motion Fee: IBSEISh1ICR $0.60 Select an Administrative Item Bldg Stds Commission Feci IBCBSC $1.00 SUBTOTALS: 1 $307.60 $0.00 TOTAL FEE: $307.60 Revised: 10/01/2012 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,'CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O FaX 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: PL'RMIT# /c;?/Z90f OWNER'S NAME: PI-IONS # -4 GENERAL CONTRACTOR: BUSINESS LICL'NSL' # ADDRESS:/,,7U / CITY/ZIPCODE: *Our municipal code requires II 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 HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. ( I am not using any subcontractors: S g re Date Please check applicable subcontractors and complete the following information: 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