13010146 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20810 PEPPERTREE LN' CONTRACTOR:LP CONSTRUCTION CO PERMIT NO: 13010146
OWNER'S NAME: MICHELE LUM 360 E EVELYN AVE STE 440 DATE ISSUED:01292013
OWNER'S PHONE: 4083152960 SUNNYVALE,CA 94086 PHONE NO:(408)720-1111
13 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL
License Class_ Lie.!'#.
SFDWL POOL DEMO 429 SQ FT
Contractor L/" Ld n S '{/UG 7`d7 Date 1 27
I hereby affirm that I am licensed under the provisions of Chapter 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. Sq.Ft Floor Area: Valuation:$6950
1 have.and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for the performance of the work for which this APN Number:35911041.00 Occupancy Type:
permit is issued.
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 WITIIIN 180 DAYS OF PERMIT ISSUANCE OR
to building concoction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS LAST CALLED INSPECTION.
indemnify and keep limitless the City of Cupertino against liabilities,judgments, (/�j'.
costs,and expenses which may accrue against said City in consequence of the issued by: Date:
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.
RE-ROOFS:
Signafur �� ,m�.x.:; Date._- 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
Signature of Applicant: Date:
1 hereby affirm that I am exempt from the Contractor'sLicense Law for one of
the following two reasons: - ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,or my employees'vvith wages as thew 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(See.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
I 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 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ageut,.y, �Date:�
permit is issued: Ir
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 CONSTRUCTION LENDING AGENCY
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 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(See.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state thaf the above information is
correct.I agree to comply with all cityand 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 Cupertion 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 applicani understands.and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18. :
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20810 pepper tree DATE: 01/2912013 REVIEWED BY: Mendez
APNc I BP#: -VALUATION: $6,950
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY SFD or Duplex PERMIT TYPE: 1SFPOOLDEM
USE: p PERM :
WORK SFDWL POOL.DEMO 429 SQ FT
SCOPE
rl ti il��Y i' X& �Ie4M� v i' -t sz x , �'6- +I.6E vh�F.cs•'�,A(�$`
d o " .W
,,tech. Plan Check Plumb. Plan Check Elec. Plan Check
rLfcclr. Peron!Fee: Plumb.Permit Fec: lilex. Permit ree:
Other Meth.Insp. Other Plumb Insp. Other Elec.insp.
Mech. Insp. Fee: Plumb. Insp.Fee: Elea.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc). Thesefees are based on the preliWna information available and are on! an estimate. Contact the Dept f6r addn'l info.
FEE ITEMS(Fee Resolution 11-053 Eff 7/1112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Swimming Pool
Suppl.PC Fee: Q Reg. Q OT 0.0 lus $0.00 $306.00 1DEMOPRES Demolition
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Fee: O
Work Without Permit? Yes Q No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fees: Building or Structure Q,
Strong Motion Fee: 111SEISAI7CR $0.70 Select an Administrative Item
Blda Stds Commission Fee: IBCBSC $1.00
$1.701 $306.00 '� f �LOTA)PFEE. $307.70
Revised: 10101/2012
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION U
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 �01a S P
CUPERTINO (408)777-3228•FAX(408)777-3333•building0cuoertino.org \��
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DESCRIPTION OF WORKa l PO) Vd n n TE
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USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAI-TYPE(CODE) AREA (SQ.FT.) VALUATIONS)
S-MUCrUm: ❑ Commercial POOL
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POOVSPA MATERIAL TYPE CODES: SPA
V - VMYL-LINED
F - FIBERGLASS DEMO
P - PREFABRICATED WIN
" fit. TO/T V CATION:
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By my signature below,I certify to each of the following: I am the property owdera thorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct I have read the Descriptio of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and State laws relating to building construction. I authorize representatives of Cupertino to enter the above-!pentifi/ed p perry for inspection purposes.
Signature of Applicano'Agent: Date: // ./t) �/l
SUPPLEMENTAL INFORMATION REQUIRED w
1 W0 � yl'CHB- T. _ RCUIYN�G;$p
_Commercial or Multi-Family Buildings with Public Swimming Pools:
Department of Environmental Health approval required.
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