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11080163 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 925 NEW HAVEN CT CONTRACTOR: ...nu PERMIT NO: 11080163 OWNER'S NAME: LIU MING S AND GRACE C DATE ISSUED:08/22/2011 Oik'NE ' PHONE: 4082526263 PHONE NO: L, LLCUNSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG� ELECT PLUMB� License Class Lic.# 0 Z �� 2Z 1 l MECH f— RESIDENTIAL COMMERCIAL � Contractor Date _ IOKS'I"�u� I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:POOL REMOVAL(460 SQFT)AT SINGLE FAMILY (commencing with Section 7000)of Division 3 of the Business&Professions DWELLING Code and that my license is in full force and effect. **SEE NOTES** 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 Sq.Ft Floor Area: Valuation:$5000 permit is issued. APPLICANT CERTIFICATION APN Number:35611045.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. , Signature Date ZZ f/ Issued by; --G � ---� Date: Signature OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Appli �r' Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined b the Ba Area Air y y Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 Owe horized agent: / forthwith comply with such provisions or this permit shall be deemed revoked. ' Date.-,?/2 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address c,— and expenses which may accrue against said City in consequence of the Ig of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION �• all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35611045. 00 DATE ISSUED. . . . . . . : 08/22/2011 RECEIPT #. . . . . . . . . : BS000014523 REFERENCE ID # . . . : 11080163 SITE ADDRESS . . . . . : 925 NEW HAVEN CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LIU MING S AND GRACE C ADDRESS . . . . . . . . . . : 925 NEW HAVEN CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4023 RECEIVED FROM . . . . : ZL CONSTRUCTION COR CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 000 . 00 1. 00 0 . 00 1 .00 0. 00 1BSEISMICR VALUATION 5, 000 . 00 0. 50 0 . 00 0 .50 0. 00 1DEMOPRE EACH 1 .00 300. 00 0. 00 300. 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 301.50 0. 00 301 .50 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO c/h, V 61 SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 S P CUPERTINO (408)777-3228• FAX(408)777-3333 •buildingacupertino.org PROJECT ADDRESS 9Z,5 Hc\\)en APN ?� / Ll yl OWNER NAME PHONE E-MAIL c� fVji LI08 ZS? -(;LG3 STREET ADDRESSCITY STATE,ZIP FAX ZS Neto Hek/co <o4�- �� ho CONTACT NAME j/ PHONE // E-MAIL STREET ADDRESS f CITY,STATE,ZIP j FAX ❑OWNER 1:3 OWNER-BUILDER 11 OWNERAGENT CONTRACTOR 1:1 CONTRACTOR AGENT ❑ ARCHITECT C3 ENGINEER 11 DEVELOPER ❑ TENANT CONTRACTOR N ,,, , r +�C Z LICENSE NUMBER RcIO 7G 7 ICEN LSE TYPE ; BUS.LIC# COMPANY NAME / 1 E-MAIL //�� i 1 FAX ZL Cc�rtS�c'c-LC�U✓1 O ��.\� C.W l�O.�s+�LLI.�Cir�-GL. STREET ADDRESS CITY STATE,Z PHO 1 XC-6 1(_ wk a- C�eeq C ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK USE OF W SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION(S) STRUCTURE: ❑ Commercial POOL POOLlSPA MATERIAL TYPE CODES: SPA V - VINYL-LINED 1 F - FIBERGLASS DEMO /,W.N ` -v G - GUNITE l/1 ` P - PREFABRICATED RECETUEk?,BY. TOTAL VALUATION 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. I aut ' e representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: — SUPPLEMENTA ATIO REQUIRED oF>fICE70 ;ONLY Commercial or Multi-Family Buildings with Public Swimming Pools: 2 ftTmF Department of Environmental Health approval required. :S F fDARIY ° YUBLIG R OF, DEP ®- L�tRGE _� � ,�BNVIItOLF1VtEEI�Tek>x,HILkLTH';, 4., � 3 •ni. �.='1vraYJQii - SANITARY-sEwER-Br3T1�Icr SwimPooUpp 2011.doc revised 03/16/11 10 .1 Pow 4o re ro` I S New Hckvcn r .30� CITY OF CUPERTINO D FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 925 new haven ct. DATE: 08/22/2011 REVIEWED BY: bob s. APN: BP#: 'VALUATION: 1$5,000 'PERMIT TYPE: Demolition Permit PRIMARY Swimming Pool, Res. PENTAMATION 1 SFPOOLDEM USE: PERMIT TYPE: WORK demo sfd swimming pool. SCOPE FEE ID FLR AREA s.f. 1DEMOPRES 1 NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS (f'ee Resolution 11-055 I;f': '-1.11) FEE QTY/FEE MISC ITEMS Permit Fee: $300.00 Suppl. Insp.Fee4D Reg. 0 OT 0.0 hrs $0.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $301.50 $0.00 TOTAL FEE: $301.50 Revised: 07/04/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 LM Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: �,,1 � �- PERMIT# OWNER'S NAME: PHONE #(CfZ.s -57 r GENERAL CONTRACTOR: L vn j-C-L LG cM 't) , BUSINESS LICENSE # ADDRESS: 17&(s HVt.�l✓ rCk C1eAt L 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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: - ature Date Please check applicable subcontractors and complete the following information: V 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