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15060143 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10823 WILKINSON AVE CONTRACTOR:NOECON PERMIT NO: 15060143 OWNER'S NAME: LI WENHAI AND CHENG YUN PO BOX 317 DATE ISSUED:06/22/2015 OWNER'S PHONE: 6503995393 ALVISO,CA 95002 PHONE NO:(650)630-5967 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL DEMO AND BACKFILL EXISTING SWIMMING POOL-600 License Class Lic.# a ,��� S.F.(LANDSCAPE PURPOSES ONLY) Contractor Date 5 Y 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:_SX�00 NI 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:35613019.00 OccupancN ]'N pe: 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 WITBIN 180 DAYS OF 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 PANf FROM LAST CALLED INSPE TIO . indemnify and keep harmlessa City of Cupertino against liabilities,judgments, costs,and expenses which m accrue against said City in consequence of the 6 Date: granting of this permit. Add' ' ally,the applicant understands and will comply Issued by: with all non-points urce re la ns the Cupertino Municipal Code,Section 9.18. �r 1 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) 1,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 usAqu r devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the i Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with th M nicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 53 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this , Owner or authorized agent: Date: 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 1 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 1 SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 i ' (408) 777-3228•FAX(408)777-3333•building(a)cupertino.org CUPERTINO PROJECT ADDRESS jo (J / lI//C/ APN 4 OWNER NAME �(/ '.[ PHO /(�'5-) 3 G Q q 'j E-MAIL I ( 1 J STREET ADDRESS CITY, STATE,ZIP/� ��� ��/ FAX to �2 3 GI/ C CONTACT NAME PHO S )%3 Q_5- E-MAIL C C",5�Y4 1 /V /�O✓Y1 STREET ADDRESS �JO CI CY,STATE, ZIP / FAX // l r G O ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBS LICENSE TYPE BUS.LIC# X12 spa ' COMPANY NAME E-MAIL FAX n v n STREET ADDRESS IP CITY,STATE,Z -317 so 3Od G& G 6 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC H COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK erno J A'11 /_0 /I zalls m0eyn C pdy,2 63c O'YI USE OF )1�SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION (S) STRUCTURE: ❑ Commercial POOL POOIISPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO 6 G - GUNITE P - PREFABRICATED RECEIVED BY TOTAL VALUATION: T By my signature below,I certify to each of the following: I 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 co ec 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 constru i t orize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: y",' 1 2 SUPPLEMENTAL INFORMAT N REQUIRED OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP Commercial Or Multi-Family Buildings with Public Swimming Pools: E'ER-THE-COUNTER ❑ BUILDLNG DEPT Department of Environmental Health approval required. ❑ EXPRESS ❑ PLANNING DEPT ❑ STANDARD ❑-PUBLIC WORKS DEPT ❑ LARGE ❑ ENVIRONMENTAL HEALTH ❑ MAJOR ❑ SANITARY SEWER DISTRICT SwimPoolApp_2011.doe revised 03/16/11 I CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10823 Wilkinson Ave DATE: REVIEWED BY: Paul APN: 35613019 BP#: `VALUATION: $8,500 ;*-PERMIT TYPE: Demolition Permit PIAN PRIMARY Swimming Pool, Res. PENTAMATION 1 SFPOOLDEM USE: PERMIT TYPE: WORK Demo and backfill existing swimming pool - 600 S.f. (Landscape Purposes Only) SCOPE FEE ID #POOLS 1 DEMOPRES 1 ,ltech. flan Check Plumb. Plan Check Elec..Plan Check :Meeh. Permit Fier Plumb. Permil Fee. (/,-c Permit Fee Other Hec•h. Insp. Other Plumb Insp. Other Elec.Insp. L1ech. Insp. Fee: Plumb, Insp. Fec Glec.Insp. free: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelimina information available and are only an estimates Contact the De t or addn'1 info. FEE ITEMS(Fee Resolution 11-053 E . 7/1/131 FEE QTY/FEE MISC ITEMS Check Fee: rppl. .PC Fee '111mh./111eeh./E lec Permit Fee: $329.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 Plumb.iAllech./Elec Phimb lllech./Elec Permit Fee: Construction Tax: Adininisttrative Fee: 1,Vork Without Permit? �Ivancecl Planning,Fees: ravel Documentation Fees: � Strom Motion Fee: IBSEISMICR $1.11 Select an Administrative Item B1d Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $331.11 $0.00 TOTAL FEE: $331.11 Revised: 05/07/2015 S Ouit)et-•` CAcjtiiCe, Gheo� COQ e wiir►m�rl�° f od / �v �c v'rn�o /rFh 10qg:13 Willci/Jso+� ave �o� �Gn�4 (4Pe PUKPOSc� an /rY (UP-er4-100 CA 9570)y _ FI �`� �.� IVI.D 650) 3y9 - 5-3 �3 JUN 22 2015 LBY i� OFFICE COPY Io 71 l4 S o n A Ue, i s- CJif UNITY DEV- ARTMENT UILDING DI's ;PERTINO �, APS=, 1` I? This set of pl s and MUST be ke tat t N job site duri unlawful to make a/! changes or alterations on.same,or to devi� CUPERTINO ther©from,without approval from the Building e- �O � J � � Building Department The stamping of this plan and specifications Si i,r� v t-(Ar c r�mpv be held to permit or to be an approval of the violation ;;, JUN 2 2 2015 of a ovisions of any City Ordinance or State Law. BY REVIEWED FOR CODE COMPLIANCE DATE I Reviewed By: �s PERMIT NO. "� D�S({GC1v6� Scale;