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11090188 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21484 SHANNON CT CONTRACTOR:PETER'S CONSTRUCTION PERMIT NO: 11090188 OWNER'S NAME: LIN JOSEPH T AND GINA T 100 CONCORD CIR DATE ISSUED:09/26/2011 OWNER'S PHONE: 4083189493 MOUNTAIN VIEW,CA 94040 PHONE NO:(650)906-8788 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT PLUMB I— License Class Lic.# �U MECH RESIDENTIAL COMMERCIAL Contractor Date '-ZC _ I hereby affirm that I am licensed 1,nr the provisions of Chapter 9 JOB DESCRIPTION:POOL DEMO THREE 12 X 12 IN HOLES(EVEN ACROSS THE BOTTOM) (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 Sq.Ft Floor Area: Valuation:$6000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36202018.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM L T CALLED INSPECTION. 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. Issued by: ' Date: Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.70441 Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or a► hor' ed a e Date: 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. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 1 hereby affirm that there is a construction lending agency for the performance of"ork's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, cots,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ing of this permit.Additionally,the applicant understands and will comply all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36202018. 00 DATE ISSUED. . . . . . . : 09/26/2011 RECEIPT #. . . . . . . . . BS000014867 REFERENCE ID # . . . : 11090188 SITE ADDRESS . . . . . : 21484 SHANNON CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER LIN JOSEPH T AND GINA T ADDRESS 21484 SHANNON CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4920 RECEIVED FROM . . . . : PETER'S CONSTRUCTIO CONTRACTOR . . . . . . . : PETER WANG LIC # 25511 COMPANY . . . . . . . . . . : PETER'S CONSTRUCTION ADDRESS . . . . . . . . . . : 100 CONCORD CIR CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94040 TELEPHONE . . . . . . . . : (650) 906-8788 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 000 .00 1. 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 6, 000 . 00 0 .60 0. 00 0 .60 0. 00 1DEMOPRE EACH 1.00 300 . 00 0 . 00 300 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 301. 60 0. 00 301 .60 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CASH 301.60 --------------- TOTAL RECEIPT 301.60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO t1 �� SWIMMING POOL I SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildingCa�cupertino.org CUPERTINO PROJECT ADDRESS `� ] /I ��j/I �? TAPN#� '3(PA O U OWNER NAME >2 - E-MAIL STREET ADDRESS 2_ 1 a C /V/ C LLtYy) C7' CITY, STATE,ZIP FAX �-1' K 1 E-MAIL CONTACT NAMEp� Sf1/1 S IIv�LI�'� P C �v/ D 6 �� Af P .��D Y"/ ^ ( J CITY,STATE. ZIP ' ^^ v i i , . I FAX STREET ADDRESS I (T C3 OWNER 1:3 OWNER-BUILDER t/❑( OWNERA`G+-ENT / CONTRACTOR ❑CONTRACTOR AGENT Cl ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ' ,1 n, ,, LICENSE NUMBER LICENSE TYPE BUS.LIC# 9-O ? O COMPANY NAME / / A �. E-MAIL FAX STREET ADDRESS (�, /�^ YL ��✓ CITY.STATE,ZIP �/1/I /1 H o6 41X ARCHITECT/ENGTNEER NAME CL ,` LICENSE NUMBER (� (/ BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION (S) STRUCTURE: ❑ Commercial POOL (Tl� POOLJSPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO G - GUNTIE TOTAL VALUATION: P - PREFABRICATED 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 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 building construction. Ia1VNnze representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date SUPPLEMENTAL INYORMATION REQUUZED ' x r. ,,::�- 'r�.'•�.�"`. @�'ECI�al�.�+@7L�1`'7�:�..z�,!a�,;�_s�s,." ?Y::�_ ,° - _Commercial or Multi-Family Buildings with Public Swimming POOIS: _ Department of Environmental Health approval required. Ns Mg �C SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21484 shannon court 7DATE: 09/26/2011 REVIEWED BY: larry s APN: BP#: "VALUATION: 1$6,000 y°PERMIT TYPE: Demolition Permit PRIMARY SwimmingPool, Res. PENTAMATION 1SFP00LDEM USE: PERMIT TYPE: WORK three 12 x 12 in holes even across the bottom SCOPE FEE ID FLR AREA s.f. 1DEMOPRES 1 F, NOTE: This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.). Thesefees are based on the preliminary in ormadon available and are only an estimate. Contact the De t or addn7 info, FEE ITEMS (Fee Resohition 11-053&'-7j/1 F FEE QTY/FEE MISC ITEMS Permit Fee: $300.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 A Strona Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee:-: IBCBSC $1.00 SUBTOTALS: $301.00 $0.00 TOTAL FEE: 1 $301.00 Revised: 09/02/2011 t m D -�G J ( cD m Q V/ N t1D Z fl. 3 �` J, o ooa 3 � CL ;. a f f g7 �. z� p`Q CT moo • pq a w O CL to o D o °`' x 3 �. 7�4 o iv b ,