15100129CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10384 PARADISE DR CONTRACTOR: RICHIE BOBCAT & PERMIT NO: 15100129
HAULING
OWNER'S NAME: NGUYEN LEE HOAI TRUSTEE
OWNER'S PHONE: 4084826830
Lk`--- LICENSED CONTRACTOR'S DECLARATION
License Class e=G/ b G'/ Lie. # -'l / tel' ? / y
Contractor �tC,4 4 ^ of ,_ l4 e_p Date / v –i y, -- ♦ s°
-
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:
1. 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.
2. 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
permit is issued.
APPLICANT CERTIFICATION
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
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 with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature . _]�'L Date l ems— t 7 – t .T
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. 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
permit is issued.
s. 1 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
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
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
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 with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature
Date
396 PATCH AVE I DATE ISSUED: 10/15/2015
SAN JOSE, CA 95128 ! PHONE NO: (408) 529-2531
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
DEMO (E) SWIMMING POOL (FOR LANDSCAPE PURPOSES
ONLY)
Sq. Ft Floor Area: I Valuation: $7500
APN Number: 35916030.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 YS FROM LAST CALLED INSP CT N.
Issued by: L -1J �-`Date:
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
e _ J- Date: -3 Sr
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION'
SCJ � I
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(aDcupertino.orq
SP
PROJECT ADDRESS 1.3 f
APN # f& OCT.
OWNER NAMEPHONE E-MAIL
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CITY, STATE, ZIP FAX
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FTRFERESS
AME
PHONE
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RESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
ONTRACTOR ME
LICENSE NUMBER
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LICENSE TYPE
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BUS. LIC #
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ARCHITECT/ENGINEER NAME
ARCHITECT/ENGINEER
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK %
d Pt
❑ SFD or Duplex ❑ Multi -Family
TYPE MATERIAL TYPE (CODE)
AREA (SQ. FT.)
VALUATION ($)
USE OF
POOL
71 Qd pJ
STRUCTURE: ❑ Commercial
POOUSPA MATERIAL TYPE CODES
SPA
V - VINYL -LINED
F - FIBERGLASS
DEMO
G - GUNITE
P - PREFABRICATED
RECEIVED BY: t°� y f� C{ r �
TOTAL7I UATIO0
'�`
By my signature below, I certify to each of the following: I am 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 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 relatingt ilding construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Si nature of Applicant/Agent: I--- Date: 1 aD — 1 7 – t Tr -
g
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
'ROUTING SLIP
Commercial or Multi -Family Buildings with Public Swimming Pools:
_
Department of Environmental Health approval required.
VOVER-THE-COUNTER
BUILDING DEPT
❑ EXPRESS
PLANNING DEPT
❑ STANDARD
❑ PUBLIC WORKS DEPT
❑ LARGE
❑ ENVIRONMENTAL HEALTH
❑ MAJOR
❑ SANITARY SEWER DISTRICT
SwimPoolApp_2011.doc revised 03/16/11
CITY OF CUPERTINO 0100laq,
IJ
FEE ESTIMATOR - BUILDING DIVISION
i.tei'. Plan Check
Plan Check h'ee:
ADDRESS: 10384 Paradise Dr. DATE: 10/15/2015 REVIEWED BY:
PAUL
APN: 359 16 030 BP#:
*VALUATION:
1$7,500
*PERMIT TYPE: Demolition Permit
13G_):1- l"tllt.'K 7Tt'I{::
PRIMARY
Swimming Pool, Res.
$329.00
PENTAMATION
1 SFPOOLDE i
USE:
hrs
PERMIT TYPE:
WORK
Demo E swimming pool For Landscape Purposes Only)
Plumb. 1A!ch./Elec Permit Fee:
SCOPE
C yonstruction Tax:
FEE ID # POOLS
1 DEMOPRES
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 preliminary information available and are onlv an estimate. Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff TT"IL
t Tech. Plart Check
1'111111hl kin i. ilt ch"
i.tei'. Plan Check
Plan Check h'ee:
Flumb. Permit
Other Alec°7=r. Insp.
Other Plumb Irtsp.
Other I lex. InslJ.
Num h../illlech./Elee
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 preliminary information available and are onlv an estimate. Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff TT"IL
FEE
QTY/FEE
MISC ITEMS
Plan Check h'ee:
uf7rl..P(' Fee
Num h../illlech./Elee
Permit Fee:
$329.00
Suppl. Insp. Fee -0 Reg. O OT
10.01
hrs
$0.00
/ lei:
Plumb. 1A!ch./Elec Permit Fee:
C yonstruction Tax:
Idministr~utive 14'ee:
11"oi'k W lthout .Permit?
. idwinced Planning- Dees:
Strong Motion Fee: 1BSEISMICR
$0.98
Select an Administrative Item
1
Bldg Stds Commission Fee: IBCBSC
$1.00 1
SUBTOTALS:
$330.98
$0.00 TOTAL FEE:
7 $330.98
Revised: 10/01/2015
2
m -J7 �y
CHEC ED B
3 ING D PT
4 •.
c'UPERTINO
OFFICE SOP
COMMUNITY DEVELOPNY
BUILDING DIVISION
APPROVED
ENT DEPARTMENT
- CUPERTINO
_
This set sof plans a^" specifications NI U S T be kept
at the
job site daring con. truction. It is unlawful to make
any
changes or alterations on same, or to deviate
therefrom, withcut pproval from the Building Official.
The Stamping of thi plan and specifications SHALL
NOT
be held to pern'iit o to be an approval of the viol
ition
of anyT} sions q any ity Ordinance or State
i aw.
BY WJW.
DATE S 1LO45
PERMIT # !211I I
Review
7�
RTINO
lepartment
2015
LIANCE