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B-2016-0369 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2016-0369 7875 CREEKLINE DR CUPERTINO,CA 95014-4155(362 17 050) RICHIE BOBCAT& HAULING SAN JOSE,CA 95128 OWNER'S NAME: QU JING AND ZHAO JING DATE ISSUED:03/28/2016 OWNER'S PHONE:408-203-3557 PHONE NO:(408)529-2531 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CONSTRUCTION CLEAN-UP Lic.#919310 Contractor RICHE BOBCAT&HAULING Date 07/31/2016 —BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL 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: t. 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 Iq-- 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 permit is issued. Sq.Ft Floor Area: Valuation:$7500.00 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 Number: Occupancy Type: 362 17 050 and state laws relating to building construction,and hereby authorize 362 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 3/28/2016 Issued by:ABBY AYENDE Date:3/28/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:3/28/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous 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 the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall ,�, be deemed revoked. 0.t1�et or authorized agent: APPLICANT CERTIFICATION fate:3/28/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 3/28/2016 Professional 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(b)-cupertino.org CUPERTINO w,p,0a�q PROJECT ADDRESS /- ,ry APN 9 3(,�`� O OWNERNAME PHONE f E-MAIL STREET ADDRESS p CITY, STATE,ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUII DER El OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME e3 LICENSE NUMBER l q LICENSE TYPE BUS.LIC# 1 /�-/Gist_r ''-j' '6ti �o C/ 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 (! tlf USE OF SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION ($) STRUCTURE: ❑ Commercial POOL POOUSPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO G - GUNITE � P - PREFABRICATED RECEIVED BY TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or autho ized ageht 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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date:— -3 - SUPPLEMENTAL 3 SUPPLEMENTAL INFORMATION REQUIRED �oFFICE us> oNiY. . PLAN CHEC I{TYPE = # ROUTING SLIP - h As Commercial or Multi-Family Buildings with Public Swimming Pools: ' Department of Environmental Health approval required. 0 OVER THE-COUNTER ❑ BUILDING DEPT EXPRESS i PLANNING DEPT" j STANDARD t, �PUBLICWORKS DEPT i r �❑ LARGE�'°� "a �� - i i '❑� E]WIR�ONMENTAL HEALTH + 0, Mr1J.OR D,vSANTfARY SEWER DISTRICT SwimPoolApp_2011.doc revised 03/16/11 A COMMUNITY DEVELOPMENT DEPARTMENT I BUILDING DIVISION-CUPERTINO APPROVED This set of plans and specifications MUST be kept at the job site during construction. It is unlawful to make any I E changes or alterations on same,or to deviate } therefrom,without approval from the Building Official. The stamping of this plan and specifications SHALL NOT ba held to per it or to be an approval of the violation I of any pro ',,icnsnof any Cit Ordinance or State Law. DATE �( f PERMIT NO. i }CJ-J I i l X F 1 { t t I 6 - I jCtC'-e �J Nun 7 OFFICE co:P 9 l V ..-�—_ ..�_...-.o....--.��.....—�.�e.�-• ..—�.....«....�—.•. _........................-a-.r�....u...n..o.r... .�............-._.._r.�.�....-- .-.er-_.r.�_,-..i._.. .....-a.<r..._.....1-..-v.r...+r.-...-..-+.-„