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13040028 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11127 LINDA VISTA DR CONTRACTOR:A-1 POOL REMOVEAL PERMIT NO: 13040028 OWNER'S NAME: INHWAN OH P O BOX 1212 DATE ISSUED:04/03/2013 OWNER'S PHONE: 4085477525 CAMPBELL,CA 95009 PHONE NO:(408)978-2903 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class 2 Lic.# �! to Y POOL DEMO,HANDOUT PROVIDED Contractor r1 e6d Date 3 Z 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:$6500 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 APN Number:35626003.00 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 WITHIN 180 F 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 A3�S ROM T CALLED INSPECT ON indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against City in consequence of the Iss Date: 3 3 granting of this permit. Additionally,the applicant understands and will compl with all non-point source regulations a Cupertino Municipal Code,Section 9.18. _ U RE-ROOFS: Signre Date ( 3 All roofs shall be inspected prior to any roofing material being installed.If a roof is Ile— installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETT*R 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.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. 1 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(x)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 Munici Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 505,25533, 2 534. �/ Section 3700 of the Labor Code;for the performance of the work for which this Owner or authorized age Date: 7//�// 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 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(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION 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 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.Cupertino 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 applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date ' V - SWIMMING-POLL / SPA PERMIT APPLICATION �Q COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 GUPERTIN (408)777-3228• FAX(408)777-3333•building acupertino.org PROTECT ADDRESS -2 7 1 C{JO 1 r5�A D/L - APN 356 Z-6 o O OWNER NAME T h t.-I PHONE E-MAIL SI M yoS117- 7sZ5- STREET ADDRESS CITY,STATE,ZIPFAX CONTACT NAME �/L ��I PHONE E-MAIL Yo Y- 97�-z9o3 STREET ADDRESS CITY,STATE,ZIP FF ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT PEDCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMELICENSE LICENSE TYPE BUS.LIC# _ f as I Z 33 9 S COMPANYNAME �� E-MAIL FAX /L tt 1 STREET ADDRESS o /Z r 2 la4M,ff s-oO _ONE AOsClzZARCHITECT/ENGINEER NAME LICENSE NUMBER trBOUS.LIC# Y COMPANY NAME A E-MAIL FAX STREET ADDRESS CITY-,STATE,ZIP J / PHONE DESCRIPTION OF WORK USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION(S) STRUCTURE: ❑ Commercial POOL POOLISPA MATERIAL TYPE CODES: SPA 7 V - VINYL-LINED F -FIBERGLASS DEMO G - GUNITE P - PREFABRICATED _ �: TOTAL VALUATTON: By my signature below,I certify to each of the following: I am the prope wrier ora ze 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 Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b ']ding cons ctio I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant/Age Date: SUPP M TAL 0 TION REQUIRED r U � „ IN OPENS- .ter -. Commercial or Multi-Family Buildings with Public Swimming Pools: =69 �, Department of Environmental Health approval required. �"RTe�i`IDARIk�-.- � - ��PUBIICWOARSxfDEPT".�--�y,� liE�� '-- "�"_.0 E1�VIR0>S1GIFi�AL. x"173; 21'IITARI SF,WERDISTRICT =. SwimPooL4pp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 11127 LINDA VISTA DR DATE: 04/03/2013 REVIEWED BY: MELISSA APN: 35626003 BP#: *VALUATION: $6,500 *PERMIT TYPE: Demolition Permit PLAN CHECK TYKE: PRIMARY SwimmingPool, Res. PENTAMATION 1 SFPOOLDEM USE: PERMIT TYPE: i WORK POOL DEMO HANDOUT PROVIDED SCOPE FEE ID #POOLS 1DEMOPRES I e Mech.Plan Check 7777 Alec.Plun Checkllech.Permit Pee: Permit Fee: fZec. Permit Fee: t)therrt9ech.Insp. C)tlrer L lec.Insp.,13ech.Insl)..£'ee: I;lec.Insp.I'ee: NOTE:This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prefintin information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E�' 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: :Suppl. PC. Fee Plumh.11fech.11slecr Permit Fee: $306.00 Suppl.Insp.Fee-.0 Reg. Q OT 0,0 hrs $0.00 Plum h.1jWech.,'Llec: PlumbAllech.lElec Permit Fee:. Contraction :Tax: Administrative Fee: Work Without Permit? Advanced Planning Fees: Travel Documentation Fees: � Strong Motion Fee: 1BSEISMICR $0.65 Select an Administrative Item Bldiz Stds Commission Fee: IBCBSC $1.00 $307.65 $0.00 RM ®771 EKE $307.65 Revised: 04/01/2013 ©PF, -t'Y LI�RNITYOE 'T PARTIVIENT %lLuit+NG Gi'•,,` :;ON-CUPERTiNO ..r This yet Of pians and-nn— ! ,7,--Ions t � { JO ,,r,�yuf fc IVUST be k pit at th �. 'ng OOnsil L'cVOn. ii 1S Uni�a1N`(Lfi t0, rr ci lt,rg'cS Or ahsrc::it?i?= ;�fl �:•�O any ne, or to d2:�i,:e N/1'f10U1`�^":�O•. f ©,` r - ✓al ro„"the T Building i'�iciai. ! V _ r;: �t ;,P this P ir' O`r 1 C D 1 N Au S D '�:i? .i ;M1tO Y T ' plan r.i1C'.SAF': flCBtlOn5 vCi i. �_�NOT WALL S © ' S = an ;.=rOval o.the vi i ��[A�/� T/� /^( (G, f t�1 �,/1�SY Of at ,�v;siOns n , �.. c )!Ition �W� I lJ /'�'" I A: l t_O� ' /J inCi�Cie Or Sta- Lai✓. Fok NEW/4NQSCAP,�NG- � gra ( DATE -T— LIS LISJ)A� 5J/ P.= ,iT No. 30 00 Z g OFFICE ( 1 i ( i CUp ,. { rnrr . 1111vc) i j��7 E z> K AD�par��� � A `�°. PR 03 2013 t A-mons }5 �.9,I�QED FOR C ( i l =L1) R13L RRF-A- F p OD CO ? I ��� ;Gq p✓ By. MPLI,gyC� f ! O L 1� i ( s� S f , SiM O til OR yo ! 11127 L-SAJ DA- V. 5?'AOR. I CvpEeT-TA10 cA gsotq ( 4/0Q— 7t2-4/21Z ! ( qoS"q7- 75"2 r a � :�N De Pf5A(O-- � i �QUj pnNtf-NT l—Td 6T CASE — — - — — — - - — --- - - - - -_I R,5MOVEO f}Nb VTj :r'r 7- �- �= ` &.4 T TO Llnr6s ro- &r- ABANDONED LT AIPA Vase 09, �s LFG COMPACTION REPORT IS REQUIRED SHOULD THE ABATED AREA BE DECLARED "BUILDABLE" IN THE FUTURE. Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR ST JOB ADDRESS: //Z L, ;h PERMIT# 3(9L(00Z OWNER'S NAME: PHONE GENERAL CONTRACTOR: BUSINESS LICENSE#' ADDRESS: P0130k 12 1 z CITY/ZIPCODE:. *Our municipal code requires all 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 SUBCONT CTO:RS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractor . Signature Date Please check applicable subcontractors and complete the following"information, ✓ SUBCONTRACTOR. BUSINESS NAME BUSINESS LICENSE# Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting -0H . Linoleum/Wood F Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper �< Paving Plastering Plumbing Roofing Septic Tank - Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date