D-2016-0380 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2016-0380
7540 BARNHART PL CUPERTINO,CA 95014-5239(366 24 026) NO PROBLEM POOLS
SERVICES
SAN JOSE,CA 95123
OWNER'S NAME: LI CHENG-CHUNG ET AL DATE ISSUED:05/02/2016
OWNER'S PHONE:408-893-1484 PHONE NO:(408)202-1372
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class SWIMMING POOL Lic.#896358
Contractor NO PROBLEM POOLS SERVICES Date 05/31/2017 —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/FILL(E)SWIMMING POOL(FOR LANDSCAPE PURPOSES
I hereby affirm under penalty of perjury one of the following two declarations: ONLY)
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.
BPI
. 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 66 Number: Occupancy Type:
3
and state laws relating to building construction,and hereby authorize 366 24 026
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 SUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS N.
SignatureDate 05/02/2016 Issued by:MELISSA N
Date:05/02/2016
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(Sce.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:05/02/2016
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. I 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
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
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. Owner or authorized agent:
APPLICANT CERTIFICATION Date:05/02/2016
I certify that I have read this application and state that the above information is CONSTRUCTION LE AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction Tending 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 05/02/2016 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(a7cupertino.org
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ElOWNER ElOWNER-BUILDER ❑ OWNERAGENT ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER 1:1 TENANT
CONTRACTOR NAME . A n LICENSE NUMBE C �C LICENSE T)' E BUS.LIC#
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DESCRIPTION OF WORK
ratnu LjCA_&,A-5CAe_-::� R/ t2--s
USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION (S)
STRUCTURE: ❑ Commercial POOL o/
r
POOL/SPA MATERIAL TYPE CODES: SPA
V - VINYL-LINED
F - FIBERGLASS DEMO
G - GUNITE _
r u
P - PREFABRICATED RE II UATION:
By my signature below,I certify to each of the following: I am the propertyowr error ufor-ized-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 Dron of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to build' const . n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE US oNL>
P.LANC11ECK T1 PE ROUTI\G'SLTP;
_Commercial or Multi-Family Buildings Nvith Public Swimming Pools:
Department of Enviromnental Health approval required. ;;ovER THEcouNrsR ❑ BUILDING DEPT
❑`EaPRLSS` ❑ PLANAINGDLPT`
❑ STANDARD ❑;PUBLIC SYORKS DEPT,
❑sLARGE ❑•":E\VIRONMENTALHEALTH .
❑:MAJOR; ❑;;SAN1TARI SENVI, DISTRICT
SmimPoolApp_2011.doc revised 03/16/11
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13
CUPERTINO
� ;E Building Department
F.
REVIEWED FOR CODE COMPLIANCE
Reviewed By:
E IIL ANG ulU moi,- - Nl ; P,4^TIIMENT
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