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12030121 CITY OF CUPERTINO BUILDING PERMIT 1111ILDNGADDRESS: 959 NOVG1111BER DR CILNTRAC'l'OR:LEETAIDAIi AND P 1711t1ITNO: 12030121 FUNYOUNG OWNEIVS NAME: L[ETAIDAI:AND HUNYOUNG 959 NOVIi?IRI?R DR DATE ISSIIED:030P012 ONN'S R'S Pl IONE: 4086421806 CUPERTINO,CA 950144121) Irl ION I.'N0: ❑ LICENSE.])CONTRACTOR'S DECI.AR, TION• 1— r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic..q J1ECIi r ItESIDEN'1'L\L r COMMERCIAL r Contractor Date I hereby affirm On I am licensed under the provisions of Cha per 9 J0It 1)ESC ItI PTI ON: DEM01.1'I'[ON OI'SWINIMING 1'001.400 SO I7. (Co nun encing wish Section 7000)of Division 3 of the Busimes%& Professions Code and that are license is in full force and effect. I hereby affirm under penalle of perjury one of the following two declarations: I have luted will noinninit ccrti licate of consent to sell'insure for Worker's Compensation,as provided far by Section 3700 of the Labor Celle,for the performancc of the work for which this permit is issued. Sr FI Fluor Area Valuation:$5000 1 have and will maintain Worker's Compensation Insurance,its provided[mby h ,Section 3700 of the Labor Code,1'or the performance of the work for which this permit is issued. AIT'Number:3621304400 OccupancyType: APPLICANT C1IRTIFICATION I certify that I have read this app lie,, and slate that the above inl'ornmtion is correct.l agree to comply with all cityand county ordinances and state laws relating PERA9l'1' EXPIRES IF WORK IS NOT STrU2'1'ED to building construction,laid hereby authorize representatives ol'this city to enter upon the above mentioned property for inspcctimt purposes. (We)agree m save WITHIN hill DAYS OF PERIMI I ISSUANCE OR indemnity and keep harmless the City ofCuperlino against liabilities,judgments, r t costs,and expenses which may accrue against said City in consequence ofthe 1811 DAIS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant undcrslmnls laid will comply ��55// N Gq � a with all non-point source regulations per the Cupertino Municipal Code,Section issued by: / W �/ Date: 3•03-/ - 9.18. Signature Doc Illi-ROOFS: 01VNh;12-Ii1111.UElt DICCL,ULy'ITUN All roofs shall be inspected prior to airy roofing material being installed. If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby all-11-111 than 1 nun exempt from the Contractor's License Lao far otic of inspection. the fallowing Iwo reasons: I,as owner of the property,or my employees with Wages as their sole compensation, Sign:pure of Applicator Date: will do the work,and the structure is not intended or ollired for sale(Sec.7044, Business&Professions Code) 1,as owner of the propery,and exclusively contracting with licensed contractors to ALL ROOF CONT'.RINGS TO BE CLASS"A"Olt IIE I'Elt constnst the project(Sec.7044,Business K Professions Code). I hereby affirm under penally of perjury line of the following Ihrcc HAZARDOUS MATERIALS DISCLOSURE dechu'atio s: I have read lite hazardous maum'iaLs requirements under Chapter 6495 of the I have:aid will maintain a Certificate of Consent to self-insure for Worker's California I Inlet&Safety Code,Secliuns 25505,25533.and 25534. 1 will maintain Compensation.as provided for by Section 3700 ol'the Labor Code,for the compliance with the Cupertino Municipal Code.Chapter 9.12 and the IIc:dlh K performance of the work for%%hiclh this permit is issued. Safety Code.Section 25532(10 should I%lure or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use cquiprnew or devices which emit hazardous air Section 3700 of the Labor Code,for the performancc ol'lhe Work fix which this c'ontaminu is:is defined In the Bay Area Air Quality,Maaegemenl District,I Will permit is issued. maintain trona plin lice wish the Cup ertin o Municipal Code,Chn)ucr 9.12 and the lleahh$Safes•Code.Secliuns 25505,20533,and 25534. 1 certify Ilial in the performance of the work for%%[rich this permit is issued,I shall not employ tiny person in any manner so Is to become subject to the Worker's Ooner lir authorized agent: I Z Compensation laws of California, If,after making this certificate ol'esentption,1 Dme: 3 become subject to the Worker's Compensation provisions of the Labor Code,I most forthwith comply with such provisions or this permit shall be deemed revoked. CONS'I'It1ICl'IO.N LF;NUINO AGENCY I hereby affirm that there is a construction lending agency for the perfomtanee of work's It IT LICA Yl,CI921'IFICAT'ION for which this permit is issued(Sec.3097,Civ C.) I certify,that I have lead this application and state that the above information is Lender's Name correct. I agree to comply with;dl city and county ordinances and state laws relating to building construction,and hereby luthorizc rcpresenuitives oflllis city to eater Lender's Address upon the above mentioned properly for inspection purposes.(We)agree to save indemnify and keel,harmless the City,of Cupertino against liabilities,judgnhcnts. ,\ItCa I1'I'ICC'I"S DECLARATIONcosts,and cxpcnscs Which may accncC against said City in c0nscquehcc 01 the granting of this pennil Additionally,the applicant understands and will comply I understand my plans shall be used a public records. Witt all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 3 3" OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DfVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)7T7-3333- buildino0cuoenino.ora 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 ADDRESS �✓���� �Y. Aent 19_5 PN //! BPO OWNER NAME ' n^ OWNER ADDRESS DESCRIPTION OF WORK: Ern(.JfiCXL/V V,4Y/ /✓ 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.) 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- ��� elder" 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 homeowners 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. zr,4L2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. �3. 1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial nsk by hiring a licensed Contractor and having the permit riled in his or her name instead of my own. XVL4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. W5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars (S500), including labor and materials, I may be considered an "employer" under state and federal law. 4 1 understand if I am considered an "employer"under state and federal law, I must register with the state and f eral 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. 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family r sidential 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. —WB. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. O)+nerBuildaForm_2010.doc revised 04/14/10 9. 1 understand I may obtain more information regarding my obligations as an "employer"from the Internal RiKenue Service, the United States Small Business Administration, the Califomia Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors'State License Board (CSLB)at 1-800-321-CSLB (2752)or vA w.cslb.ca.gov for more information about licensed contractors. 410. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. /411. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the in rmation I have provided on this form. Licensed contractors are regulated by laws designed to protect he public. If YOU contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or irm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not those Contractors are properly licensed and the status of heir workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to veri, the property owner's sin Property Owner's Signature: Date: 3 ' — SDI 2- ---------- --------- ------------------- ------- ­­---......... ..................................-------- ---------------------------- (NOTE., The following Authorization Form is required to be completed by the property owner only v✓hen,designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize he following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am he property owner for he address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of he property owner's driver's license, form notarization, or other ven5cation acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: f Oi+•nerBuilderFornr 2010.doc revied 04114110 tJover�beY 'Dr. p Wz, Ae, hotA SP- /irmo fwi•��i�✓E7 IJECEIVED �^` POOL MAR 2 3 2012 5 Zi , BY: \ ISS - M G � 121 FrQYt V�br M H 0 W; COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTINO APPROVED This set of plans and sPecifications MUST be kepiet Job site during construction. it is unlawful to make Eu y changes or alterations on same,or to deviate therefrom,without approval from the Building Officl The stamping of this plan and specifications SHALL Ni 7T V be held to permit or to bean approval of the violatio of any provlalona of any City Ordinance or State La BY E /✓ G DAA .a �IMIT N0. O/off C rk POb�- �$' OFF6CE COPY 661 I0263 0 999 Oovam beY 'Pr. Cup wb*wa, 'CA of OtI4 F2ECEIVEI� : hDN S� P°°L MAR 2 3 2012 ; .f-e-m ce— Z BY: M 6 l2� M H 0US� s l 6 ' ►s' o 6 ' a CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew COPY 4 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36213044 . 00 DATE ISSUED. . . . . . . : 03/23/2012 RECEIPT 4 . . . . . . . . . : BS000016344 REFERENCE ID # . . . : 12030121 SITE ADDRESS . . . . . : 959 NOVEMBER DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : LEE TAEJAE AND EUNYOUNG ADDRESS . . . . . . . . . . : 959 NOVEMBER DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4120 RECEIVED FROM . . . . : TAE JAE LEE CONTRACTOR . . . . . . . : LIC R *OWNER* COMPANY . . . . . . . . . . : LEE TAEJAE AND EUNYOUNG ADDRESS . . . . . . . . . . : 959 NOVEMBER OR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4120 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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 301 . 50 307 --------------- TOTAL RECEIPT 301 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO CITY OF CUPERTINO D FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 959 NOVEMBER DR DA'Z'E: 0312312012 REVIEINVEiD BY: SEAN AI's: 36213044 131'#: 12030121 'VALUATION: $5,000 *E'I,101IT' ETF: Demolition Permit /'L.INC71ECK'TYPE: PRIdiARY 1'IiN'I'Ai�IATION 1SFP00LDEM USE,. Swimming Pool, Res. PEIt:�trr'rYPE: A WORK DEMOLITION OF RESIDENTIAL SWIMMING POOL 400 S.F. SCOPE FEE 11) # POOLS 1DEMOPRES 1 iterh. PInn Chock Phoah l ion C'hork Eke. Plate Check ,lic:.lr Permit Fre• l'hmmlr Pei nrit 14. lilr(. Kana he. Other 1tcr-h Insp Other Plamb/erap Other Eler lncp ET—L- 3 lech. T—L-3lech. hi).Fee. I'hunb. bop. Fro: 1.1a Ihalr. rn A'OTE: This estimate does not include feev due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District,School District,etc). These fees are baser/on lime prethninarl information tion available and are onh•an estinhate. Contact the Det )r addle•!info. FEE ITEMS (Fee Resnhaion 11-053 E-ti UI/lII FEE QTY/FEE NIISC ITEMS Plan C'hack Fu SuppL PC Pee Pl n n d),h11er•h./!Slee. Permit Fee: $300.00 Suppl. Insp. FeeQ Reg. Q O'1' 0.0 hos $0.00 Plnnth.hhlecdr./F.ler. /'lunch.:14ec•h./Elec• Permit Fee: Coresmtc•liun Tag. ddminisvrntive Pee: PFork 14Vilhoul Permit? kIvanced Planning Pees: Travel Docnonewation Fern: Strone Motion Pee: IBSEISMICR $0.50 Select an Administrative Item 131dtt Sids Commission Fec: IBCBSC $1.00 SUBTOTALS: $301.501 $0.001 TOTAL FEE: $301.50 Revised: 1/19/2012 SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 IS P (408)777-3228 • FAX(408)777-3333 • buildin0(cDcuoerino.om CUPERTINO PROJECT ADDRESS%'9 {��O.ILm r D1�. t^ 1%�(1'VO VIA I LAPN4 OWNER NAME -v-V'"V6{�, ,rte PHO ` . Q \V�'�L/IK—�Q ) E MAR- RL �L N1Cy��Gr�,N r STREET ADDRESS 1 \F� /l'r UyLV'•�C.y ✓Y' CITY.STATE Z� 1 FAX CONTACT NAME / 1 PHONE E-MAIL A4- lri STREET ADDRESS CTTY,STATE, ZW FAX L7 OWNER ❑ OWNER-BUILDER ❑ OWNERAGE+T ❑ CONTRACTOR ❑CONTRACmR AGER ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACT ^O/^ LICENSE LIE BIDS.LIC i C . NA r;S�n '`C- (,il E-MAB. FAX STRE DD S r� "r\Oc CnYSFhSE"^Z^ �T A PH 1 1 l � / ARCHITECl/ENGINEE0.NAME LICENSE NUMBER BUS.LIC i COhWA.NY NAME E-MAB. FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPnON OF WORK vE/Y/JG/i/On/ O /M //✓ �OG. �IUU �. , USE OF SFD or Duplex ❑ Muki-Family TYPE MATERIALTYPE(CODE) AREA (SQ.FT.) VALUATION(S) 'STRUCTURE: ❑ Commercial POOL L yoo � �000 POOUSPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO G - GUNITE �127, yg,+� P - PREFABRICATED AECELYED 7J.Y fl-"-�'„ ..ir.M TOY_ 1U ONS By my signature below,I certify,to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicandAgen[ Date: ?— 7-3 SUPPLEMENTAL i ORJMATIONREQUIRED 8 .`"'cv'�s�EEF[CEUSE,ONLY �' `$�i �'Pf:AN;CHECK:TYP ". " - a-L.-" �.ROrIIQ.YG'SL'@-• Commercial or Multi-Family Buildings with Public Swimming Pools: 01101 _ Department of Envirommental Health approval required. l DYER Tae-GOBYTEIL -- mss rtt_j _= E�CP{RE � -•-�-+'ice n^ !'SCAYOARD'�t�'j A®HEUBLIC WORES DEPT EYY eBJAYtTARY.SF,WERDISTRI- - Swim Poa4lpp_2011.doc revised 03/16/11