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11060054 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10289 RICHWOOD DR CONTRACTOR:CHEN SUNG-MING AND PERMIT NO: 11060054 CHIA-JUNG L OWNER'S NAME: CHEN SUNG-MING AND CHIA-JUNG L 10289 RICHWOOD DR DATE ISSUED:06/07/2011 ( :R'S PHONE: 4086776618 CUPERTINO,CA 95014-1657 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION9'_ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH r RESIDENTIAL r- COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:DEMOLITION OF SWIMMING POOL(560SQFT) (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:$1500 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. APN Number:36908048.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: _' :-. .._:......._•---_"z. ._...... Date: ?- L 9.18. Signature Date RE-ROOFS: L OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for oe inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,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.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for WorkerV California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. 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 Owner or r-zed agent- Compensation laws of California. If,after making this certificate of exemption,I 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 I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save ip' inify and keep harmless the City of Cupertino against liabilities,judgments, znd expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION gr_ong of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. _ 1 Licensed Professional Signature� Date � CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36908048. 00 DATE ISSUED. . . . . . . : 06/07/2011 RECEIPT #. . . . . . . . . : BS000013684 REFERENCE ID # 11060054 SITE ADDRESS . . . . . : 10289 RICHWOOD DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CHEN SUNG-MING AND CHIA-JUNG L ADDRESS . . . . . . . . . . : 10289 RICHWOOD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1657 RECEIVED FROM . . . . : CHIA-JUNG LI CHEN CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : CHEN SUNG-MING AND CHIA-JUNG L ADDRESS . . . . . . . . . . : 10289 RICHWOOD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1657 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 500 . 00 1. 00 0. 00 1 .00 0. 00 1BSEISMICR VALUATION 1, 500 . 00 0.50 0 . 00 0 .50 0. 00 1DEMOPRE EACH 1 . 00 291. 00 0 . 00 291. 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 292 . 50 0. 00 292 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 292 . 50 #0154 --------------- TOTAL RECEIPT 292 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO DEMOLITION CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10289 richwood dr. DATE: 06/07/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$1,500 'PERMIT TYPE: Demolition Permit PRIMARY Swimming Pool, Res. PENTAMATION 1 SFPOOLDEM USE: PERMIT TYPE: WORK demo sfd swimming pool SCOPE FEE ID #POOLS 1DEMOPRES Li NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 09-05I I ff. '-1.-10) FEE QTY/FEE MISC ITEMS Permit Fee: $291.00 Suppl.Insp.Fee-0 Reg. 0 OT 0.0 hrs $0.00 i Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: i $292.00 $0.00 TOTAL FEE: $292.00 Revised: 04/29/2011 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 950143255 C U P E RT!N O (408)777-3228-FAX(408)777-3333-buifdinci a cunertino.or4 Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRqSS APN41 Cf A00 DIM BP# OWNER NAMECIIZ"V OWNER ADDRESS DESCRIPTION OF WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read,Initialed your understanding of each provision,signed,and returned this form to us at our official address Indicated. An agent of the owner cannot execute this notice unless you,the property owner,obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS.Please read and initial each statement below to signify you understand or verify this information.) 41. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- uilder"building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I,as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. � 2�1 understand building permits are not required to be signed by property owners unless they are responsible for e costruction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that i may rote ct myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. I understand Contractors are required by law to be licensed and bonded in California and to list their license umbers on permits and contracts. QI understand if I employ or otherwise engage any persons,other than California licensed Contractors,and the b �lvalue of my construction is at least five hundred dollars($500), including labor and materials, I may be I ered an"employer"under state and federal law. Iunderstand if i am considered an"employer"under state and federal law, I must register with the state and l government,withhold payroll taxes, provide workers'compensation disability insurance,and contribute to unemployment compensation for each"employee."I also understand my failure to abide by these laws may subject me to serious financial risk. 'A( I understand under Califomia Contractors'State License Law,an Owner-Builder who builds single-family esidentiai structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year,or all of the work is performed under contract with a licensed general building Contractor. I�L- I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for CaZy-dri-Ancial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. Ox eerBuilderForm 2010.doc revised 04/14/10 D,ov?67� T r o0L Re / l SsUoo Tt�o �� d fA 000 UL do O PUL 0140 46 �/t7M�°aw,��o'j/elo,�, s1y�1o6�°lp1e4©�O Cq� f4R s� UO Sd 0f8�n � wo(qa J.'SUo�o Spy J� eray; o SAU 6' �d�o 1 .Nai dp/br do�s Sqo/ d07, 0 � V � W V 102 $9 ,RicpNoo.D DR. � j C61POAT/NO CA J.s011 L.■ :!tl �� a DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPERT'IINO (408)777-3228-FAX(408)777-3333-building0cupertino.om PROJECT ADDRESS ��,� R 1 6V/,t1 1 % J A�e APN# 1 /o vi It OWNER NAMEsHONE u'/V6-1'1/r'/4j C�' ii A/ FP 4-o,) 6 7'-6 61/E E STREET ADDRESSCny.ST TE,ZIP FAX 3 * � U -TTA M. - CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX OWNER ❑ OWNER-BUILDER ❑OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE,ZIP PHONE DESCRIPTION OF WORK '/C L dStk)1iv1 1il itis POOL Q RESIDENTIAL #DWELLING ONLY FLOOR AREA UNITS 71 USE OCC. TYPE S VALUATION COMMERCIAL _ 1^ FLOORA A `�C� TYPE OF CONSTRUCTION #STORIES AQMD JOB NUMBER RECEIVED BY: TOTAL VALUATION: J#: aA r t�. 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 authorize representatives_of upertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: P�T i� f Date: SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY _Provide Job Number from Bay Area Air Quality Management District www.baagmd.org @ 415-7494762. PLAN CHECK TYPE _Provide three copies of a site plan showing protection for any trees 10"in diameter or more at 3'above grade. _Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. ❑ SrAMARD _Provide a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be initiated by person(s) ❑ LARGE certified in asbestos,mercury and/or hazardous material examination. ❑ MAJOR Planning Dept clearance to verify building is not considered an historical landmark.Allow 10 business days. Provide letter of clearance of all vermin from a licensed pest control contractor. _Applicant shall call the Public Works Department at 408-777-3104 and schedule a"habitable dwelling"inspection. Provide signed Debris Bin and Recyclable Materials form. Commercial Buildings Only: Provide Fire Dept clearance for fire suppression/alarm system review. DemoApp 201 Ldoc revised 03/16/11