12110142 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11088 CATALANO CT CONTRACTOR:GRAND LAND MASTERS PERMIT NO: 12110142
/GLM
OWNER'S NAME: HSU KARL C AND JENNIFER ANN RING14AN 1263 SYLVIA DR DATE ISSUED:05/31/2013
OWNER'S PHONE: 4083980498 SAN JOSE,CA 95121 PHONE NO:(408)378-2515
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALS
COMMERCIAL
rim",Class d::f Lie.# b S INSTALL NEW PRE-FAB POOL AT REAR YARD-
PARTIALLY IN
Contractor Date GROUND
I hereby affirm that 1 am licensed under the provisions oChap r 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and(hat 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
performance of the work for which this permit is issued. Sq.Ft Floor Arca: Valuation:$25000
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:36218068.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I havc 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 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enterupon the above mentioned.property for inspection purposes. (We)agree to save �=N,480
O DAJOM LAST CALLED INSP C ION.
indemni an eep harmless the City of Cupertino against liabilities,judgments,
costs, d e ses which may accrue against said City in consequence of the a �/
grantin of is ermit, Add' ' applicant understands and will comply Issued by: Date:
with all on i t so regulation per the Cupertino Municipal Code,Section
9.18.
r RE-ROOFS:
�goatu .. t +Lr; 177 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,
El % R- ILDER ECLARATION
Signature of Applicant: Date:
I hereby affirm 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,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sce.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the 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. 1 will
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 will maintain a Certificate of Consent to self-insure for Worker's material. Additioually,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Arca Air Quality Management District I
performance of the work for which this permit is issued, will maintain compliance with the Cupertino Municipal.Code,Chapier 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Heal( Saf Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Otvr mor-m-..l- 'a cut, Date:
radu
permit is issued. 1,L7,
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 California. If,after making this certificate of exemption,I CONSTRL3CT O UNG AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 must I hereby affi at 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 whi 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 1 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.
Signature Date
� z2-L �
SWIMMING POOL I SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPER71N0 (408)777-3228 • FAX(408)777-3333 •building aQcupertino.org
PROSECT ADDRESS ]R / 1 �'fl` C'+L APN / r / 0 �Q
OWNERNAME� L� 1I]L-[e r S l V wo - !E--MAIL
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STREET ADD Crre.STAT$ZA �' '^\ �I n FAX
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STREET ADDRESS 1,STATp�,ZIP F
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❑OWNER ❑ OWNER-aUILDEit pc�OWNERAGENT ❑ coNrRAGToR ❑CONTAALMRAcENT ❑ AxcHrrEcr ❑ENGINEER ❑ DEVELOPER ❑TENANT
CO CrOA ii ii LICENSE NUMBER LICENSEME BUS.LIC!
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COMPANYNAME E-MAIL FAX
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_ CITY,STATE ZIP
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ARCHTTECTIENGTNEER NAME LICENSE NUMBER BUS.LIC a
COMPANY NAME EMAIL FAX
STF=ADDRESS CITY,SCATS,ZIP Y PHONE
DESCRIPTSON OF WORK �_1 I �,sS El ��` �I 5•p�1 l Irl
X17 u V%C� I OU Go Y: cL uc 1
USE OF or Duplex ❑ Multi-Family TYPE MA7ERLAL TYPE(COBB) AREA (SQ.FT.) VALUATION(S)
STRUCTURE: ❑ Commercial POOL / /
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PO $PA MATE.AIAL'rY'PE CODES: SPA
V - VINYL-L
F - FIBERGLASS DEMO
G — GUNTTE PREFABRICATED
rtE BY rr- - � Tp rdt y�
P - PREFA8RICATrZIM
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By my signature below,I certify to each of the fallowing: 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 relating ttoo`bu.Idin�constm n. I authorize representatives of Cilpertino to enter the above-id tifed g perty for inspection purposes.
Signature of Applicant/Agenty Date: 1\ 2� �,
SUPPLEMENTAL INFORMATION REQUIRED _ "
+
Commercial or Multi-Farnily Buildings with Public SwimmingPools: N—
Department of Environmental Health approval re fired,
P PP gut r-
osLr-vL� L) � ?t�'lr.�_JvilS3OR.�`-_�T�.`�L '�+--a�"F•^�hTILr.C}T4IFYSIJVE'1,RDISTHLC�s
SwimPooUpp jOl l.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR--BUILDING DIVISION
ADDRESS: 11088 catalona ct. DATE: REVIEWED BY: bobs.
APN: BP#: / a_ 'VALUATION: 1$25,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration I Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: RBS
WORK install new re-fab pool at rear Vard.
SCOPE
Mech. Plan Check Plumb. Plan Check Elec. Platt Check
hfech.Permit Feu: Plumb.Perm;t Fee: Etec,Permit Fee.
Other hlec:h,Insp. Other Plumb lnsp. Other flee.In"P.
.11ech.Insp.Fee: Plumb. Inslt,Fee: Elec.Irrsp.Fee:
NOTE: This estimate does not includefees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prelimina Information available and are only an estimate. Contact the De t or addn'l in o.
FEE ITEMS (Fee Resolution 11-053 Gf 7/1/121 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Swimming Pool
Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 $334.00 ISPAPREFAB Spa or Hot Tub(Pre-Fab)
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee:Q Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Fee: Q
Work Without Permit? Yes Q No $0.00
Advanced Plannin Fee: $0.00 Select a Non-Residential E)
Travel DOCrl117entatiO17 Fees: Building or Structure O
Strong Motion Fee: IBSEISMICR $2.50 Select an Administrative Item
131dg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $3.50 $334.00 TOTAL FEE: $337.50
Revised: 1010112012
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUP ERT I N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: 1 Q PERMIT# [ 101-4Q
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses ti orking i o have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL P CY I ON(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND AL CONTRA O S AVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors-
Signal u e Date
Please check applicable subcontractors a complete th ollowing information:
V SUBCONTRACTOR BUSINESS AME 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