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14080040 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22149 RAE LN CONTRACTOR--Te--+Q44 : PERMIT NO: 14080040 ^'�=a�rT'Qvxn�TED OWNER'S NAME: CHI SIM TANG D G DATE ISSUED:08/06/2014 OWNER'S PHONE: 6581832808 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL F] COMMERCIAL F] �y 2 �1 t REMOVAL OF SFDWL POOL,500 SQ FT License Classy IC d T Lic.# � a O, 11 0 Contractor CICr1 PLC p Date 19-6 6 I hereby affirm that I am licensed under the provisions of Chapter 9 (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:$7500 G• 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 APN Number:35607070 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXP S IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 18 A OF PERMIT ISSUANC OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS O AST CALLED INSPEC IO . indemnify and keep harmless the City of Cupertino against liabilities,judgments, /� costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: S i g n a t u r Date 84- 1 q 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 inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: b� permit is issued. I certify that in the performance of the work for which this permit is issued,I shall 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,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address — 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date SWIMMING POOL / SPA PERMIT APPLICATION - COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION C 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 Q`vl (408)777-3228• FAX(408)777-3333•building(cDcupertino.org CUPERTINO PROJECT ADDRESS q{ JI APN# �f 07670 7G70et OWNERNAME ` L TPHONE E-MAIL 1-► S�M as 6S 08 STREET ADDRESS CITY, STATE,ZIP Lao A FAX CONTACT NAMEfU / __{� SQ II � E IL _ftn99f"11 f0 60stxg I 10�I. STREET ADDRESS O• �O (I rjGCITY,STATE,ZIP � '�� v FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME M LICENSE NUMBER Cl I 07 LICENSE TYPE c ;it. BUS.LIC# Cot COMPANY NAME ( E-MAIL FAX t��G/l A(,0 S / / 6c lcba 7 .OT AD ESS S I5S CTTxQSTATE ZA ( �A I / 36)1 PHON L9 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE r DESCRIPTION OF WORK OO ±' �4. r o 111 L LI USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT. VALUATION($) STRUCTURE: ❑ Commercial POOL 5vr POOL/SPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO G - GUNITE M � � � �P ��h ?� w� � Vi��ih 6)lTOTAL V IL�ATION: P - PREFABRICATED 7/ 00 By my signature below,I certify to each of the following: I am the property owner or akhorized agent to act o he property owner's beha . ad th application and the information I have provided is correct. III e read the Description ofV73or6auj verify it is acc te. I agree to comply with all applicable local ordinances and state laws relating to building c struction. authorize representatives of Cupertino tom above- need property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEM L INFORMATION RE RE �' �_ , ''1' Q w, OFFICE USE ONLY ' PLAN,CHECK TYPE ROUTING SLIP _Commercial or Multi-Family Buildings with Public Swimming Pools: `', t Department of Environmental Health approval required. x COUNTER ❑ BUILDINGDEPT .D `LxPRESS 'y - ❑ PLANNING-DEPT _a TANDAZZ11 ❑ PUBLIC WORKS DEPT hAR!GE ❑ ENVIRONMENTALHEALTH O�if ��ri'i ii;)i1�dl�)" ❑ SANITARY-SEWERDTSTRICT ,F SwimPoolApp_201 1.doc revised 03/16/11 CITY OF CUPERTINO D FEE ESTIMATOR-BUILDING DIVISION JJJJADDRESS: 22149 rae In DATE: 08/06/2014 REVIEWED BY: Mendez APN: BP#: "VALUATION: 1$7,500 xPERMIT TYPE: Demolition Permit PRIMARY PENTAMATION USE: Swimming Pool, Res. PERMIT TYPE: 1SFPOOLDE WORK removal of sfdwl pool, 500 sq ft SCOPE FEE ID #POOLS 1DEMOPRES nrmmwx war, L' =rte, 4 t. 1'lumb. Plan C/rec/, 1'`(:,. Piwl t`fzrc?t 11/1>-h Pet'Inil Fee: F�)erm;r 1'e Oil 1 iC c 1. Other Nvinb Irrsrt 01J,e;'1 CC bsp, 11111mb. fee: P,1-- h7sp. NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the relimina information available and are on l an estimate Contact the Det or addn'l info, FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Permit Fee: $329.00 Suppl. Insp. Feer Reg. C) OT 0,0 hrs $0.00 i!!ti°n'" o'i 7if?<ri'l f'c7"t711P %r'< l of a K "2iult on/°�?es: Strom;Motion Fee: IBSEISMICR $0.98 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 IN, I $330.98 $0.00 TOTAL FEE: $330.98 N TO �. _ Revised: 07/10/2014 I, 0- a �� .d CPERTINO Iuil, Ing Department 4'. REV1EWEC FOR :ODE OMPLIANCE Reviewed By: x° Tani DEVELOPMENT A FNT SUiLDING DIVISION-CUPERTINO A �D : t of plans and spcificatians MUST be kept aDan construction. it is unlawful to make cor eitarations on same,or to deviate SCO��RrF bout r a1:roval from the Building Offi1/{z �,L /gypO1nfixationsSHAL Lc Oval of th1 vioi�Ee1jS (af-r- pUyV4)0 ! n::. �O.ir.,i.nance or�«.-t of an U cy .e L ��r�oSC