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15060034 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7569 KIRWIN LN CONTRACTOR:DIG AND DEMO PERMIT NO:15060034 OWNER'S NAME: NIAN ZHOU 231 MARKET PLACE DATE ISSUED:06/04/2015 OWNER'S PHONE: 4085135092 SAN RAMON,CA 94583 PHONE NO:(877)933-4448 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL POOL DEMO AND BACKFILL-LANDSCAPE PURPOSES License Classq�iTr. Lic.# ONLY ContractorLti3'1 a Date 6,0 ,)_`15 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:$8000 i" 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:35921004 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 WITIHN 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 1807X0O M LASTCALLED INSP CT ON. indemnify and keep harmless the City of Cupertino against liabilities,judgments, Icosts,and expenses which may accrue against said City in consequence of the Issued by: lJJ/?6___Date: (f I✓� granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 918. "tg!7F 1 . . - U � RE-ROOFS: Signature Date / OMM Imf 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 2 ;2553_ nd 2553 . 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I 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 918. Signature Date SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �� (408)777-3228• FAX(408)777-3333•building(o1cupertino.org (50"3f"3 CUPERTINO l" �/`"/r PROJECT ADDRESS f�0 j n APN{i ^/ 1 L, C� Y 1 OWNER NAME `�r>,, PHONE L/D C�2. y a9Z E MAIL q�;A Vj`' 7 A I&A/�Y `J0A 1 V 4 �'tJ yvttu �'�' STREET ADDRESS CITY,STATE,Z � W 1O FAX ; } L t CONTACT NAME E-MAILPHONE STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ACONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME �' `� � �/ LICENSE NUMBER y yH LICENSE TYPF��j I e / BUS.LIC# (�/V31 I� rJf r- E-MAIL /�l C� FAX COMPANY NAME ` � ` Wn �, ;,��/•�� STREET ADDRESS CITY,STATE,ZIP �,/] �j�tSJ PHO F TZ ) 3 e-1 2(i e, 32 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK `5/r • �O� _ I'• `Irr 14//Ll / IJ�giyr 6i J7riY USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION (S) STRUCTURE: ❑ Commercial POOL POOL/SPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO GUNITE P - PREFABRICATED -iRECEMD BY TOTAL VALUATION: By my signature below,I certify to each of the following: I amtheproperty o cr 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 c struction. thorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORM ION REQUIRED 'r� Commercial or Multi-Family Buildings with Public Swimming Pools: Y h r R VEIL THE COUNTER `tBUIIDINGD�PT e Department of Environmental Health approval required. x s Y ,t ❑ I XPRESS r a r} t t#❑ PLANNING DEPT.,xt} 1 { a t -_ STANDARD i } c �tyPUBLIC WORKS DEPT ❑�LARGE `I}r � xj +^ENViRONMENTA'HEAL�H . h � �� i u��r rr.�r y t. �` ae -� r fir, r d y r J; A• MA�OR_ ..SSANITARM!SK R<DTSTRICT SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-EUILDING DIVISION ADDRESS: 7569 KIRWIN LN DATE: 06/04/2015 REVIEWED BY: PAUL APN: BP#: 3 *VALUATION: 1$8,000 *PERMIT TYPE: Demolition Permit P1,I N CH CK 7 YP . PRIMARY PENTAMATION 1 SFPOOLDEM USE: Swimming Pool, Res. PERMIT TYPE: i WORK POOL DEMO AND BACKFILL- LANDSCAPE PURPOSES ONLY SCOPE FEE ID #POOLS 1DEMOPRES 1 Hech. Phan Check Phwrb.1'kin Cheek Elec...('lan C'hc�ck Wech. l'emiit Fee: F'h inb. Permit Fee: Elec. I'ernait Fey:: EI-L-(}r7�cr ED--L-- Oler lec. ?sp.Insp. Other fluyah Insrp ttecl:. Lrzsp. Li Fee: P waw.hisp. Fee: kc.111sp.Fee: 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 on1v an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E f. 7/f 1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: suppl. PC Fee .Plurnb./illech.iTlee Permit Fee: $329.00 Suppl. Insp.Fee-0 Reg. Q OT Fo7o hrs $0.00 Plum b./lhfeeh.;E'Iec Plunih./11 Aech./lslee Pernil Fee: Construction Tax: Adininlstralive.1"ee: 6t'ork Without.Permit Advanced Pl n rdm;Fees: 7rovel Doetanentaflon Fees: Strong_Motion Fee: IBSEISMICR $1.04 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: `' $331.04 $0.00 TOTAL I EE: A r. Revised: 05/07/2015 1. 1 - . 1 1 JUN 0 4:2015 t , 1 .9y ' DIGI & DEM) ' D 1 1 1 General` ngineerxngContrarto, E 1 1 License#993947,925-93348 109.00 0 `IENT D ARTMENT Es3Lf I'G0V--i: V-CUP-3TIN0 ✓ --------------------- ---------------------------------------------------------------� 1 kSc-' , 1 1 3tions MJST be kept at the ioi, ;1 a du,;!n:i f o'st Uct1On it IS un1,mrfui to M a.ke Eny -IS it Sar 07 ne t0 C E31+12A Mi`31C0"T1,F`lNitilOut apprcw From th 'Building Otl'icl 1- C14 .N ' 1 � ,,, r e , T{ i_,!lL O` OT ti11S Plan all specific atiOns SFiAI_L C i n. 1 y „i., .a. ' a r�t HOUSE 1 1" c o i,��r to irdin b 31 or�,� -a-to La,n v: i or i' O e`ions off any`"i l:r:lln�lC0 or SiGt2 La, Eaves line P - ---- - ' D�Z _ — 1 _ 1 1 1 1 ' J 1 e O 1 1 LO LID C o ® �N Line f will o 1 CD Z 1 _, Lc co 6.7 Y qj �1J,Sif' (D 1 1 1 1 1 1 0 1 1 1 O1 1 � 1 M A 1 1 1 V �'j ® 1 ' 1 1 1 1 1 1 1 1 1 � 1 1 1 .33 16.48 1 I 1 1 1 , L--------------------- ----------------- Property line 109.00 1 7569 Kirwin Ln Cupertino,CA 95014 scale V=10'