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15100244CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10445 BREWER AVE CONTRACTOR: JING CAOYU AND MANG PERMIT NO: 15100244 MENGPING OWNER'S NAME:`JING CAOYU AND JIANG MENGPING 10445 BREWER AVE DATE ISSUED: 10/30/2015 OWNER'S PHONE: 6503181166 CUPERTINO, CA 95014 -1306 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL License Class Lic. # Demo (e) pool and fill for landscaping (400 SF) Contractor. Date 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 Sq. Ft Floor Area: Valuation: $2000 , performance of the work for. which this permit is issued. 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: 32641063.00 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 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 DAYS FROM LAST 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 j Issued by: Date: 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. 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 6 Signature of Applicant: Date: I hereby affirin •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, ormy 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 construcYthe 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 C 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,willInaiintain a Certificate of Consent to self - insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compeusation;i 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`forwhich this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will;maintain Worker's Compensation hisurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 37,00, of the Labor Code,.for the performance of the work for which this permit is issued.; `; ,; t�zed agent: Date. Owner or au 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 Califomia. 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 indemnify'"and keep; harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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. e Signs '' /' Date:_!4 dyer CUPERTINO SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 •FAX (408) 777 -3333 • buildingP-cupertino.org 15 10 02- PROJECT ADDRESS j , ,,i_� tvwu Avo- `t ! ( APN # L I' OWNER NAME ( � f �u — PHONE � •- i ( E -MAIL �� Cif i�� 1lAGlil,�'��• l STREET ADDRESS Fr1 lV CITY, STATE, ZIP C" oi FAX CONTACT NAME r C�6 PHONE -3ig� (LL E -MAIL ^1 f), c ,. STREET ADDRESS i r` �� n , �` n CITY, STATE, ZIP C _ �� i � /t I� grgb �] - FAX OWNER ❑ OWNER - BUILDER ❑OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER El TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME " E -MAIL FAX STREET ADDRESS . CITY, STATE, ZIP PHONE DESCRIPTION OF WORK De vv�� 1 i� s ' wk,1L.c � 4eK 16LA � USE of ❑. SFD or Duplex ❑ Multi - Family STRUCTURE: ❑ Commercial TYPE MATERIAL TYPE (CODE) AREA (SQ. FT.) VALUATION ($) POOL POOUSPA MATERIAL TYPE CODES: V - VINYL -LINED F - FIBERGLASS G - GUNITE P - PREFABRICATED SPA DEMO RECEIVED BY TjgAL VALUATION: By, my signature below, I certify to each of the following: I am the property owner or authorized age 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 venTy it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b n construction. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant(Agent: Date: ld/ (_)00� SUPPLEMENTAL INFORMATION REQUIRED Commercial or Multi- Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. OFFICE USE ONLY PLAN CHECK`TYPE ° ROUTING krp °. ovi it -THE co'UvTER ,- ❑ EXPRESS STANDARD ❑ LARGE` MAJOR ❑' BUILDING DEPT; li' PLANNING DEPT= ❑y PUBLIC WORE ,DEPT �` ENVIRONMENTAL HEALTH ❑' ` SANITARY SEWER DISTRICT , '. SwimPoolApp_2011.doc revised 03116111 CITY OF CUPERTINO D FEE ESTIMATOR — BUILDING DIVISION ,> ADDRESS: 10445 Brewer Ave DATE: 10/30/2015 REVIEWED BY: Phuong �' crn 'Check Fce: '' APN: 326-41 -063 BP #. *VALUATION: $2,000 PERMIT TYPE: Demolition Permit P1,11N, cIHECK T)'PE. PRIMARY USE: " Swimming Pool, Res. P1#mh.111ech./E1ec ' PENTAMATION PERMIT TYPE: 1 SFPOOLDE WORK Demo a pool and fill for landscaping 400 SF SCOPE Suppl. Insp. Fee:Q Reg. Q OT ;blech.l'lan Check i6lech. Permit Fee Other Alecch..Insh. blecla. Ins/). Fee Phuuh. Plan Check Plumb. Permit Fee: Other Plumb Insp. Plumb. Insp. Fee: Elec. Plan Check lslec. Permit Fee: Othef- Elec. Insp. Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These feet are hosed on the nreliminary information available and are only an estimate Cantact the Dent for addn'l info. FEE ITEMS (Pee Resolution 11 -053 E . 711113) FEE QTY/FEE MISC ITEMS �' crn 'Check Fce: '' Sttj)1�l..PC� Fee P1#mh.111ech./E1ec ' Permit Fee: $329.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 Plumb.12.,fech.fElee Plumb:%Mech. /Elec Permit Fee: (OWVI)'ilgtiU31 Tax" Administrative Fee: ff ork With, but Perrnii? Advanced Planning I ees: i Trc i =el Do umentation 1'ees: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg'Stds Commission Fee: IBCBSC $1.00 k 'SUBTOTALS.'.; $330.50 $0.00 'TOTAL FEE: $330.50 Revised: 10/01/2015 �u 1,A OWNER- BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building cuoertino.org — Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS APN... BPm OWNER NAMEVY.. Y1N. ( � ... :.._ ._ ..::OWNER ADDRESS_ DESCRIPTION OF WORK: )vv \ A-1 I •` �"A d s Cel ' We are providing you with an Owner- Builder AckhoMedgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner- Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) C, . I understand a frequent practice of unlicensed persons is. to have the property owner obtain an "Owner - ;r" building permit that erroneously implies that the property owner is providing his or her own labor and material nally. I, as an Owner - Builder, may be held liable and subject to serious financial risk for any injuries sustained by licensed person and his or her employees while working on my property. My homeowner's insurance may not le coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my ince coverage for injuries to workers on my property. . I understand. building permits are not required to be signed by property owners unless they are responsible for nstruction and are not hiring a licensed Contractor to assume this responsibility. . I understand as an "Owner- Builder" I am the responsible party of record on the permit. I understand that I may t myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her instead of my own. I understand Contractors are required by law to be licensed and bonded in California and to list their license rs on permits and contracts. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the ue of my construction is at least five hundred dollars ($500), including labor and materials, I may be red an "employer" under state and federal law. >. I understand if I am considered an "employer" under state and federal law, I must register with the state and al government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to ployment compensation for each "employee." I also understand my failure to abide by these laws may subject serious financial risk. 7. 1 understand under California Contractors' State License Law, an Owner - Builder who builds single - family ential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by sed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work rformed under contract with a licensed general building Contractor. �8. 1 understand as an Owner - Builder if I sell the property for which this permit is issued, I may be held liable for anyyfinancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/19/10 _9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal ,enue Service, the United States Small Business Administration, the California Department of Benefit Payments, the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State mse Board (CSLB) at 1- 800 - 321 -CSLB (2752) or www.cslb.ca.gov for more information about licensed tractors. _10. 1 am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I the party legally and financially responsible for proposed construction activity at the site address listed above. _11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide 311 applicable laws and requirements that govern Owner - Builders as well as employers. L12. I agree to notify the issuer of -this form immediately of any additions, deletions, or changes to any of the inormation l have provided on this form. Licensed contractors are regulated bylaws designed to protect.the..public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a. result of a complaint-Your only remedy against unlicensed Contractors maybe in civil court. If is also important for you-to understand that if an unlicensed Contractor or employee of that individual or firm is injured .while working on your property, you maybe held liable for damages. If - you obtain a permit as Owner - Builder and wish to hire Contractors, you will be responsible for verifying whether or note those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY _ (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owners driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's si natur . Property Owner's Signature: Date: 10/'30LZL- --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner - Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner - Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the pen-nit is issued to verify the property owners signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04114110 "VELOPMENT DEPARTMENT ')1\11SION - CU ERTINO, M PFRTINC� �4LJOII a Dppartment 0 site specih��-ations riu be kept at the 8'61' 21 L "nanges (-)f 10PI. It is unlAwl 'I to make any jur 3 0 15 :Itt2rcltions on sa,,11(i. I r to deviate vprovai from ,,the ES3 -�e C1,1'1 and specii1c,V, ilding official, REVIEWED OR CODE 'OMPUANGk s SHALL NOT -0-TO dr approva;l( Review By pro, the violation ;,'an-y City Ordina!lce or State Law. Y — --- T– — M S�3'0'5 :ATE 40 16' 6,10„ 1 T # T2 L-7 C7 L-3 10 19 j L M � Mr 100I MA '2" AL it 144 -54!0" 18'11" 01:17 Oft 24ft 48ft 176-M 100'2" .71 ED ;:PT N MGn `-t" N' ING DEPT CUPERTINQr*pianneir 0 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING- FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO' BUSINESS LICENSE. I am not using any subcontractors* - Signature Date Please check applicable subcontractors and complete the following information: JOB ADDRESS: j� ?f eoe,41 hxg, CA-_ejS-k"A-b , cA SO+ PERMIT# Is 10 0 BUSINESS LICENSE # OWNER'S NAME- C&O"-f� P PHONE : # I . GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING- FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO' BUSINESS LICENSE. I am not using any subcontractors* - Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date - SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date -