B-2016-1320 Permit, App, Fee EstCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1320.
6611 IOHN DR CUPERTINO, CA 95014-4562 (369 24 024)
(A-1 HAULING)
CAMPBELL, CA 95009
OWNER'S NAME: HU PING AND WEI
DATE ISSUED: 02/08/2016
OWNER'S PHONE: 408-889-3426
PHONE NO: 408-978-2903
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class D12 Lic. 4618640
Contractor (A-1 HAULING ) Date 2/8/2016
X BLDG —ELECT —PLUMB
—
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
DEMO (E) SWIMMING POOL (FOR LANDSCAPE PURPOSES ONLY)
I hereby affirm under penalty of perjury one of the following two declarations:
•i. 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.
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
Sq. Ft Floor Area:
Valuation: $6500.00
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
APN Number:
Occupancy Type:
ordinances and state laws relating to building construction, and hereby
369 24 024
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
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulations per the Cupertino Municipal
180 DAYS FROM LAST CALLED INSPECTION.
Code, Section 9.18 J
Issued by: PAUL O'SULLPJAN
Signat Date 282
Date: 2/8/2016
RE -ROOFS:
ER-B LDE DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
i. I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 2/8/2016
contractors to construct the project (Sce.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
r. 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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and tine
this permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by tile Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California, If, after making this certificate of
the Health & Safety Code, Sections 25505, 25 and 25534.
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
.s
Owner or authorized age
be deemed revoked.
Date: 2/8/2016 —
APPLICANT CERTIFICATION
C ST CTIO LE D E
I certify that I have read this application and state that the above information is
I hereby affirm that there I, a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned propertyfor inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
ARCHITECT'S DECLARATION
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date 2/8/2016
CUPERTINO
SWIMMING POOL I SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300TORREAVENUE •CUPERTINO,CA95014-3255 fi„-61Ra1t/v
6-9a5 1
(408) 777-3228 • FAX (408) 777-3333 • buildina(a)cupertino.org O�-�l ✓
PROJECT ADDRESS
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENf LJ CONT/RACTOR ❑ CONfRACTORAGENF ❑ ARCWTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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S'fREEr ADDRESS
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DESCRIPTION OF WORK p
USE OF ❑ SFD or Duplex ❑ Multi -Family
STRUCI'URP.: ❑ Commercial
TYPE
MATERIAL TYPE (CODE)
AREA (SO FT.)
77VALUATION IS)
POOL
POOLISPA MATERIAL TYPE CODES:
V - VINYL -LINED
F - FIBERGLASS
G - GUNITE
P - PREFABRICATED
SPA
DEMO
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RECEIVED BY
TOTA
'ALUADON��,
By any signature below, I certify to each of the following: I am the property ow r or authorized agent to act on the property owner's behalf. I havc rdad 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 boil 'ng eonsti o . I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
SignatureofApplicanNAgent Date: /
SUPPLEWNT�OkMACON REQUCRED
_ Commercial or Multi -Family Buildings with Public Swimming Pools:
Department' of Envirormnental Health approval required.
-.oFFlcE
USE oNly
' PLAN CHKECTYPE 7-
` , ROUTING SLIP
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0WR T9&,COUNTER -
❑ DXPRESS
' STANDARD
` ❑ LARGE
511 MAJOR
BUILDING Darr
] .PLAN'NINGDEPT
❑ PUBLIC WORKS-DEPT
EN\ORONh1ENTALIEALTH
Q SANITARY SEWER DISI RICT, '
SmnnPooNjop 2011.doc revised 03/16/1(
I CITY OF CUPERTINO j3 -X/)6 - laqoD
Ir'S FEE ESTIMATOR - BUILDING DIVISION
6611 John Dr
DATE: 02108/2016
REVIEWED BY: PAUL
,ADDRESS:
I APN: 369 24 024
1 BP#:
"VALUATION:
*PERMIT TYPE: Demolition Permit
I V. , I V Cffl-£, K T)TE:
PRIMARY
USE: Swimming Pool, Res.
PFNTAMATION
E RMIT TYPE: ISFPOOLDEM
WORK I
DEMO (E) SWIMMING POOL FOR LANDSCAPE PURPOSES ONLY
SCOPE�
FEE ID 4POOLS
IDEMOPRES
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Plea.11"'-p kee:
NOTE: This estimate does not include fees due to other Departments (ix. Planning, Public Works, Fire, Sanitary Selper District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addit'l info.
FEE ITEMS Lee Resolution 11-053 Fff. 7,11113)
FEE
QTY/FFE
MISC ITEMS
1'klrl Check Fe,?:
A
SuppL P('Fee
Permit Fee:
$329.00
SLIPPI. Insp. Fee-.(j) Reg. 0 OT
FO-0-1
hrs
$0.00.
Plumb.
Permit Fee:
Construrlion Tay:
Acfinhustraii�e 1"ce:
4"ork permit'
,Hwwced Plannhi,,, PL,,,C:
A
7ravel I)ocumentation Pees,
S, 1BSFjS"1Cj?
$0.85
Select an Administrative Item.
Bldg Stds Commission Fee: IBCBSC
$1.00
$330.85
$0.00
1- TO T AIL M1, TE 1
1' $330.85
Rev