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15040181 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10356 TONITA WAY CONTRACTOR:SCL CONSTRUCTION PERMIT NO: 15040181 CO OWNER'S NAME: MING-TSONG TIEN 1664 SAMEDRA ST DATE ISSUED:04/24/2015 OWNER'S PHONE: 4083152855 SUNNYVALE,CA 94087 PHONE NO:(408)497-1556 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL DEMO(E)SWIMMING POOL&FILL FOR LANDSCAPE License Class r! Lic.# PURPOSES ONLY Contractor ��®wL. -,< Date 1 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 per ormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2500 kli4ve and will maintain Worker's Compensation htsurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35915048.00 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 T 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 18 FROM LAS LED INSPECT ON. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of granting of this permit. Additionally,the applicant understands and will comply tIssuuedb Da e: with all non-point source regulations per the Cupertino Municipal Code,Section 918. RE-ROOFS: Signature - Date �S 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: 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,atter 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 918. Signature Date SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �l 10300 TORRE AVENUE a CUPERTINO, CA 95014-3255 CUPERTIN0 (408)777-3228• FAX(408)777-3333•building(Dcupertino.org PROJECT ADDRESS �ADDRESS -7N# / / C� OWNER NAME / ate/-( L �� PHONE��/S1 C)� E-M(AIL r d r �S �/'✓ Z'V Q/ STREET ADDRESS CITY, STATE,ZIP FAX CONTACT NAME 7 1 PHONE fpm �j /�' E-MAIL STREET ADDRESS CITY,STATE,ZIP ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENTCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT t CONTRACTOR NAME LICENSE NUMBER 7CFN7SETYPE BUS.LIC# COMPANY NAME4_. /__ / �� 1 Z� E-MAIL FAX STREET ADDRESS > (� / G / „gyp CITY,STATE,ZIP (�(J J//LSC[A1/1/ PHONE ARCHITECT/ENGINEER NAME JLIIC`ENSE NUMBER �— BUS.LIC# /S COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK j11 USE OF ElSFD or Duplex El Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION($) f�. FTRUCTURE: ❑ Commercial POOL PO SPA MATERIAL TYPE CODES: SPA V V1, LINED F - FIBERGLASS DEMO V " G -,.:..flUNITE 7 P PREFABRICATED ,LONw,_ - my signature below,I certify to each of the following: I am ro er or autho agent to act on the property owner's behalf. I have read this lication and the information I have provided is correct. ave rea the Descripti ork and verify it is accurate. I agree to comply with all applicable local ornances and state laws relating to building construction. I authorize representa Ives of Cupertino to enter the above-identified property for inspection purposes. S. ature of Applicant/Agent: Date: r ��`SYJPP'LMENTAL INFORMATION REQUIRED USF�QNLhw,N, PI,AIWHECKTYPE, t,,. „ROjTrING'SLYP"¢, 4, Awa $ a r p x _Commercial or Multi-Family Buildings with Public Swimming Pools: COVERT COUNTER ❑`BU�LDIN �DEPT t Department of Environmental Health approval required. EXpM,,"S s s < ]] 'PLANNING DEPT, +� STANDARD�I i PUBLIC WORKS DEPTH 3',� (] LARGE � a�� s ,� ❑r,�{EIVVI.RONI�IENTAL HEALTH i a 4. . ❑ MA70R ,„ , � � ❑ SANITARY,SEWER DISTRICT SwimPoolApp_2011.doe revised 03/16/11 CITY OF CUPERTINO D FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10356 TONITA WAY DATE. 04/24/2015 REVIEWED BY: MELISSA APN: 359 15 048 BP#: *VALUATION: $2,500 *PERMIT TYPE: Demolition Permit PLAN CHEW 7P11t": PRIMARY PENTAMATION USE: Swimming Pool, Res. PERMIT TYPE: 1 SFPOOLDEM WORK DEMO E SWIMMING POOL & FILL FOR LANDSCAPE PURPOSES ONLY SCOPE FEE ID #POOLS 1DEMOPRES I Mech, Pharr Check I'huub. Hein Check Elea:.Man Check itlach. Peralit Fee: Plumb. Permit free: f lee. Permit Fee. OPher,'tech, frup. Other Plumb fnp. Li Other E1ec.Imp. Li 140ch.117s)).lee: Pha 0. Inst). lee: L x.Insp. Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 in o. FEE ITEMS (Fee Resolution 11-053 Eft 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: Sappl. .PC Fee Plztrnb./t�<�ech./Elcfe. Permit Fee: $329.00 Suppl. Insp. Fee.-E) Reg. Q OT Q,Q hrs $0.00 1'lztraah.ir'Vleclz.;'Elc�c Pladnzlzlllech.!I'lec Pern7il Fee: Consiruction Tax: Administrative Fee: Yl'ork H,'ithoW Permit? Advanced Planning Fees: Travel Docivnenlalion Fees: � Strong Motion.Fee: IBSEISMICR $0.50 Select an Administrative Item 131dy Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS $330.501 $0.00 TOTAL F]E:: $330.50 Revised: 04/01/2015 � COMMUNITY DEVELOPMENT DEPARTMENT r�oPC: /-4- �� .5-W BUILDING DIVISION - CUPERTINO APPROVED hv � L� i1I Ly This set of plans and specifications MUST be kept at th I' job site during construction. It is unlawful to make an S40 13 731-D C7 C d o aFS 4/°)0L changes or alterations on same, or to deviate therefrom,without approval from the Building Official. The Stamping of t .is plan be held to permit proval of tr.e violation of -- -- BY S D E PERMIT # J r CJJP FO Re��e�ed R co�F CO SCE