12120045I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10460 STOKES AVE
OWNER'S NAME: YUK YUNG
OWNER'S PHONE: 4083681042
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #� L
Contractor Date/ �-
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.
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 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 �/ J Date
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
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
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
CONTRACTOR: PHILLIP D. BJURMAN PERMIT NO: 12120045
1250 HIGHWY 101 DATE ISSUED: 12/10/2012
AROMAS, CA 95004 PHONE NO: (650) 906 -7533
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
SFDWL POOL DEMO 700 SQ FT
Sq. Ft Floor Area: I Valuation: $6000
APN Number: 32647024.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY M LAST CALLED INSPECTION.
Issued by: G Date: Ja 1,49�
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, 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, Chap r 9.12 and
the Health & Safety Code ectio 25533, and 25534. r
Owner or authorized agent:
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
X
X
x
CUPERTINO
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildingCacupertino.org
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CONTACT NAME
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STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRA 'NAME
LICENSE ER
LICENIATYPE
BUS. LIC #
COMPMJ A E /
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ARCHTTECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC H
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
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USE OF ❑ SFD or Duplex
❑ Multi - Family
TYPE
MATERIAL TYPE (CODE)
AREA (SQ. FT.)
VALUATION (S)
POOL
STRUCTURE: ❑ Commercial
POOLISPA MATERIAL TYPE CODES:
SPA
V - VINYL -LINED
F - FIBERGLASS
DEMO
G - GUNTTE
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VALUAaON' l
P PREFABRICATED
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behaft I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws rel ng
Ildi c ction. I au representatives of Cupertino to enter the above -i nntifi d property for inspection purposes.
Signature of Applicant/Agent: _
Date: / -19112,
SUPPLEMENTAL INFORMAIHON REQUIRED'
Commercial or Multi - Family Buildings with Public Swimming Pools:
_
Department of Environmental
Health approval required.
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11
SwimPoolApp_2011.doc revised 03116111
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CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
FEE ID #POOLS
IDEMOPRES
ADDRESS: 10460 stokes ave
DATE: 12/10/2012
REVIEWED BY: mendez
Plan Check Fec"..
APN:
I BP#:
*VALUATION: 1$6,000
TYPE: Demolition Permit
11[ A "V C/ 1111'('K T)Tj;'.
PRIMARY Swimming Pool, Res.
1""c"
PENTAMATION 1SFP00LDEM
USE:
Permit Fee:
PERMIT TYPE:
WORK
F 0,0
SCOPE
I
$0.00
FEE ID #POOLS
IDEMOPRES
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, school
District - -tr-) These ees are based on the prelimina information available and are on1v an estimate. Contact the Dep for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff.711,112)
A,Icch, Ilan ('h,:(k
Pbwlb, 1"loo
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Plan Check Fec"..
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MAP.
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117c(, ln,y, Fce:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, school
District - -tr-) These ees are based on the prelimina information available and are on1v an estimate. Contact the Dep for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff.711,112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fec"..
Silly/. P(1' Fee
F
Permit Fee:
$306.00
Suppl. Insp. Fee,0 Reg. Q OT
F 0,0
hrs
$0.00
F—T
Jinhiistrativv Fee:
T
ff"ork 11"ithout Permit"
"Idvanced Planning Fces:
travel Dociftnenlolion FC(18.'
Strong Motion Fee: IBSEISM-ICR
$0.60
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$307.60
$0.00 TOTAL FEE:
$3
Revised: 10/01/2012
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