15010122 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10378 KRISTA CT CONTRACTOR:TaT', —4�-,n RE— PERMIT NO: 15010122
DET-gIZMINED
OWNER'S NAME: JIANGXIA LIU AND LIKUM FENG I✓lG2 A OG DATE ISSUED:01/22/2015
OWNER'S PHONE: 5105825486 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
License Class (� J
�s 77 Lic.# U _ DEMOLITION OF SFDWL POOL 480 SQ FT(LANDSCAPE)
7 � � �pt C1
Contractor <
I hereby affirm that I am license 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:$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 APN Number:34245006.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 PERMIT ISSUANCE 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 ! CALLED INSPECTION.
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:
Signature Date 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. 1 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 255 5,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Da
permit is issued. te:
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
Y
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building
(ftupertino.org
PROJECT ADDRESS � � � �� APN#
OWNER NAMEI• N R L`" PHONE �,C7 2y5C-��p E-MAIL V
STREET ADDRE ^w_ , ^ L),(p n CITY, STATE,ZIP ` �l FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS V /�_ ® CITY,STATE,ZIP FAX
1 C,Q�C r
❑OWNER ❑ OWNER-BUILDER ❑ OwNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME M LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-M11 'OOZFAX
e( 10-
STREET ADDRESSCIT'R,STATE,;IP K_ PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER •T BUS.LIC Al
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK '^ S CaA ailv,&e
Ac N -
USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION($)
STRUCTURE: ❑ Commercial POOL
POOL/SPA MATERIAL TYPE CODES: SPA
V - VINYIrLINED
F - FIBERGLASS DEMO
G - GUNITE
P - PREFABRICATED TOTA��—�_
By my signature below,I certify to each of the following: I am the property owner or authori d age t 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 W rk and v ify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I autho representatives of Cu no to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION QUIRED `'
s ,�
_Commercial or Multi-Family Buildings with Public Swimming Pools: '. '"
Department of Environmental Health approval required.
so ° iz ,. TT' Ew�1UDTSTRTGT"
SwimPoolApp_2011.doc revised 03/16/11
CITY OF CUPERTINO D
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10378 krista ct DATE: 01/22/2015 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$1,500 —�
*PERMIT TYPE: Demolition Permit 111A N CHE---CK IT/11-::
PRIMARY PENTAMATION
USE: Swimming Pool, Res. PERMIT TYPE: 1 SFPOOLDE
WORK demolition of sfdwl pool 480 sq ft ( landscape)
SCOPE
FEE ID #POOLS
1DEMOPRES I
-3
/"'J=. T'On Chef,f,1 1,11110. Platt('her.'i. 1',r'E't'. Nan C.�1rrcis
L'>c0=,
Cithc' ;t t?,�br. Insr>. Cltheii Plumb 1nsn. Utlaer°ie;c-I st:�.
I�crz
f"111,11111"
�ia . t"�>�': Phinib. Trash. Fee: 1'f/ec-h s, FL%:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prelimina information available and are only an estimate Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS
Plan CThucJ? �,ce
Fee F-1
Permit Fee: $329.00
Suppl. Insp. Fee: Reg. ® OT 1 0.0 hrs $0.00
Permit T'ee:
-1CX'1i2i1?1gLi"tX!('�'t�'t,'t:
14'ork H/ilhoul Permit?
"LPvtX Rt` C!Ptrrnuing Fees:
Travel Doeu me=nfalhm Fees:
Stron,a Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
n $330.50 $0.00 '` g TOTAL FEE: $330.50
sh
Revised: 01/06/2015
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