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11030103 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19781 BIXBY DR CONTRACTOR:CALVIN&BROS PERMIT NO: 11030103 CONSTRUCTION,INC OWNER'S NAME: WENDY WU 1194 FARGATE CIR DATE ISSUED:03/22/2011 < `ER'S PHONE: 4082558388 SAN JOSE,CA 95131 PHONE NO:(408)582-4988 LICENSED CONTRACTOR'S DECLARATIONs O� � �,/!1i BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# "j' MECH I— RESIDENTIAL� COMMERCIAL Contractor �� YMAI QA Date J,: •1I I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SWIMMING POOL DEMO;FILL-IN (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:$6200 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36909052.00 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 LAST 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 L 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) 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 1 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 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. Section 3700 of the Labor Code,for the performance of the work for which this 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 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,1 Ownerthorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Y 'If Date: forthwith comply with such provisions or this permit shall be deemed revoked. 61 CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work'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 i-',mnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the g—aing of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with 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 —150f (_) 3 LUSWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 GUPERTIN© (408)777-3228• FAX(408)777-3333•building [@cupertino.orq PROJECT ADDRESS N0 APN# OWNER NAME S 1 PHONE `)[�Q 7 Q Q /�E-MAIL STREET ADDRESSI V 1�1 CITY, STATE,ZIP a ,� CA sot FAX CONTACT NAME l+ '( N n/1/� PHONE i l n Q rQ Z �i E-MAIL STREET ADDRESS JJJ"`M l D CITY,STATE,ZIP �Jn,, Jo /IJf ( (Z`� FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME J) `��(Q Al � LICENSE NUMBER �0 LICENSE TYPE BUS.LIC# COMPANY NAME ,^„/,/ I y j`, � (JQ''_ / � I/J E-MAIL T FAX STREET ADDRESS 1 A5 �� CITY,STATE,ZIP �a CS� /J� ��z�. PHONE ARCHITECT/ENGINEER NAME IN„ LICENSE NUMBER 0 (�J / 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($) STRUCTURE: ❑ Commercial POOL T �Ieqo POOL/SPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO G - GUNITE P - PREFABRICATED RECEIVED BY: AL AWATION: 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 Cupertino to enter the 3above-identified proper for inspection purposes._7 _ Signature of Applicant/Agent: .w Date: SUPPLEMENTAL IN ORMATION REQUIRED OMCE USE ONLY PLAN CHECK TYPE ROUTING SLIP Commercial or Multi-Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. OVER-THE-COUNTER ❑ BUiLDING DEPT ❑ EXPRESS PLANNING DEPT ' ❑ STANDARD ❑ PUBLIC WORKS DEPT ❑ LARGE 1 ENVIRONMENTAL HEALTH ❑ MAJOR ❑ SANITARY SEWER DISTRICT SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36909052 . 00 DATE ISSUED. . . . . . . : 03/22/2011 RECEIPT #. . . . . . . . . : BS000012957 REFERENCE ID # . . . : 11030103 SITE ADDRESS . . . . . : 19781 BIXBY DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . WENDY WU ADDRESS . . . . . . . . . . : 19781 BIXBY DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CALVIN & BROS CONST CONTRACTOR . . . . . . . : YI YUAN XU LIC # 30047 COMPANY . . . . . . . . . . : CALVIN & BROS CONSTRUCTION, IN ADDRESS . . . . . . . . . . : 1194 FARGATE CIR CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 582-4988 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6,200 .00 1. 00 0. 00 1.00 0 .00 1BSEISMICR VALUATION 6,200 .00 0.62 0 . 00 0.62 0. 00 1DEMOPRE EACH 1 .00 291. 00 0 . 00 291 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 292.62 0. 00 292 .62 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ' j X bg P cA 10 PERMIT# O 03 OWNER'S NAME: W"1 Vitt PHONE# -S —8 GENERAL CONTRACTOR: Ca44 i /A/C. BUSINESS LICENSE# ADDRESS: j?-�l D�. � pie- C' rl32 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. �) f I am not using any subcontractors: Signature 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