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11070094 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10817 LINDA VISTA DR CONTRACTOR:PHILLIP D.BJURMAN PERMIT NO: 11070094 OWNER'S NAME: YANG STEPHEN N 1250 HIGHWY 101 DATE ISSUED:07/15/2011 G`AINER'S PHONE: 4089967865 AROMAS,CA 95004 PHONE NO:(650)906-7533 L, LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# r MECH` RESIDENTIAL' COMMERCIAL Contractor 1 �� Date ,3"" I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:DEMO SWIMMING POOL&ASSOCIATED (commencing with Section 7000)of Division 3 of the Business&Professions EQUIPMENT(384SQFT) 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 Sq.Ft Floor Area: Valuation:$5000 permit is issued. APPLICANT CERTIFICATION APN Number:35607033.00 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(� r( / -/L-- Date1(rh, Issued by. .`Date:7 ���/7 r 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 1,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 Applicant: 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: HAZARDOUS MATERIALS DISCLOSURE 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 I 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 by the Bay Area Air Quality Management District I will 1 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 Owr thorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date• APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 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 Hork'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 cr and expenses which may accrue against said City in consequence of the g of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION wi;..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 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35607033 . 00 DATE ISSUED. . . . . . . : 07/15/2011 RECEIPT #. . . . . . . . . : BS000014055 REFERENCE ID # . . . : 11070094 SITE ADDRESS . . . . . : 10817 LINDA VISTA DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : YANG STEPHEN N ADDRESS . . . . . . . . . . : 10817 LINDA VISTA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4748 RECEIVED FROM . . . . : PHILLIP D BJURMAN CONTRACTOR . . . . . . . : PHILLIP D. BJURMAN LIC # 23653 COMPANY . . . . . . . . . . : PHILLIP D. BJURMAN ADDRESS . . . . . . . . . . : 1250 HIGHWY 101 CITY/STATE/ZIP . . . : AROMAS, CA 95004 TELEPHONE . . . . . . . . : (650) 906-7533 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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 301.50 VISA --------------- TOTAL RECEIPT 301.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO i,L4 i 1:5LT,- 1 ENY DEPARNV ENT - FLOP�_CUPER7 COM�quiLLA D D VI51U EiUiLUINU QED at the S MUS ,, ;,t4jtion ?r,',any Ir ns and ' �� unla��ful to , _s cyL of� 6 It 1_> � r c� cn:�.ruc,,or n Same,or to ©1 , ,i,, t1or-, th Gti C1;3�. • oval from � i ,},,�,�f., _rlo�t app. SFiA�.�NOT Y t ,�,re,t an and Sl,ecifications vsolation Tv, °:,~� ,r?t�c LYIi'S t r raroval of ttie F> n IPP hrdUTanc State LaW. d,.n cera,i,.o. e or G!'�y �. C! any r I No---- — - -- SWIMMING POOL REMOVAL REQUIREMENTS COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333 •buildinqCd)cupertino.orq PURPOSE The purpose of this guideline is to clarify the minimum requirements to allow for the removal of an existing swimming pool. A construction permit is required for the removal of all swimming pools. PLAN REQUIREMENTS 1. Provide a completed swimming pool (SP)permit application. 2. Provide three sets on minimum 8-1/2"x 11" sheets of a completely dimensioned site plan showing all property lines, all existing structures, location of existing swimming pool and setback dimensions from the pool to the existing structures and property lines. 3. Owner-Builder Disclosure Form(for property owners applying for their own building permit) GENERAL INFORMATION—IF THE POOL SHELL IS TO REMAIN • Drill a minimum of three (3) - 12" diameter holes evenly spaced along the center line of the pool bottom. • Backfill the remaining pool shell with 3/4"maximum size crushed rock for a minimum of 8" deep at the bottom of the pool. Gravel shall be packed into place. Clean fill may be added beyond the initial crushed rock backfill. • Backfill shall be moistened and tractor rolled or tamped with a wacker compacting plate iu o • Two inspections are required. The initial inspection is to verify the required drain holes at the bottom of the pool. The last and final inspection should be scheduled after all the work is complete. • No fill dirt shall be stored on the street or public right-of-way without an encroachment permit issued by the Department of Public Works. • Owner agrees the backfill over the existing swimming pool shell may have differential settlement t' and agree to use the area for landscape purposes only and not use the area for any structural or floor slab support until the pool shell is removed in its entirety and the backfill is certified with 90% compaction. FEE ESTIMATE FOR DEMOLITION OF SWIMMING POOL: The calculated fees are only an estimate. Contact the Bldg Dept for additional info. *USE OF BUILDING: Residential Permit Fee $0.00 *VALUATION: $0 Strong Motion Fee $0.00 Bldg Stds Commission Fee $0.00 *#OF SWIMMING POOLS: 0 # TOTAL $0.00 SwimrningPoolRemoval.doc revised 06121/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: OaZ-) (_rn U�, l>> PERMIT# OWNER'S NAME: PHONE ttQV, c? 7�� GENERAL CONTRACTOR ,\1 n _ ; u,. ,.. BUSINESS LICENSE # ADDRESS: (v O 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: - � .- ( �— ignature Date Please check applicable subcontractors and complete the folio ing information: 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 CITY OF CUPERTINO D FEE ESTIMATOR- BUILDING DIVISION [JaJADDIRESS: 10817 linda vista DATE: 07/15/2011 REVIEWED BY: bobs. BP#: 'VALUATION: 1$5,000 PERMIT TYPE: Demolition Permit PRIMARY SwimmingPool, Res. PENTAMATION 1 SFPOOLDEM USE: PERMIT TYPE: WORK demo swimming pool and associated equipment SCOPE FEE ID FLR AREA s.f. 1DEMOPRES 1 NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 f.�;tf. '"11) FEE QTY/FEE MISC ITEMS Permit Fee: $300.00 Suppl. Insp.Fee-0 Reg. 0 OT 0.0 hrs $0.00 Strong Mention Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC 0 i SUBTOTALS: $301.00 $0.00 TOTAL FEE: $301.00 Revised: 07/04/2011 � 0_700 � + 2 SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 GUPERTINl3 (408)777-3228• FAX(408)777-3333•building aacupertino.org PROJECT ADDRESS �~$1 �r� Vt APN# (P O OWNER NAME ,e l l PHONE Q(] ��v E-MAIL 5 STREET ADDRESS LS p� v CITY, STATE,ZIP FAX CONTACT NAME , PHONE _ C' E-MAIL Pig L STREET ADDRESS �1 �a.��; f,: C1TY,ST �P SC1lZ FAX ❑OWNER /❑ OWNER-1 BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT C CTOR NAME _ LI TS,E�IUMBE�t� LICE TYPE BUS.LIC# �i. b A _' ,CQMPANY NAME IL FAX i C IP STATE, 6 ' /� { STREET A SS 14 4m, TZ3 c- n'�� C/ 4 S-I Z ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK �7 USE OF q or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION (S) STRUCTURE: ❑ Commercial POOL POOUSPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO G - GUNITE r RECEIVED BlrTOTAL V ALU N P - PREFABRICATED �k ;-,� 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 accura ' I agree to comply with all applicable local ordinances and state laws relatin ction. I authorize representatives of Cupertino to enter the abov -identid property for inspection purposes. Signature of Applicant/Agent: Date: N SUPPLEMENTAL INFORMATION REQLevD 4kICESZQL�FL •, ' =Pf AN CZ3ECIC PYP itQ11TING'STT>y _Commercial or Multi-Family Buildings with Public Swimming Pools: '_ � N Department of Environmental Health approval required. ' M, M I • SO ANDARD ' PUBLIC&ORIC DEPTT ®°t;�ARc>; �EN.v>�tQrllvtiENTA�>�A>;TA Qm IvrAJOK tSA14TAR r99WERRDIS'II MICT': SwimPooUpp_2011.doc revised 03/16/11