11110039 i CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10403 S BLANEY AVE CONTRACTOR: ?ERMIT NO: I I 110039
OWNER'S NAME: QUTAO IINYUAN&LI RUI & DATE ISSUED: 11/08/2011
OWNER'S PHONE: 4085683076 PHONE NO:
04 Lr rICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT PLUMB
License Class 017 Lie.# 6 SLII87 r- r_1 r
pp n_ MECH RESIDENTIAL COMMERCIAL
Contractor%OuOO 1AyDc1�Oaj6T Date
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SINGLE FAMILY DWELLING_ 9EMO(442SQFT)
(commencing with Section 7000)of Division 3 of the Business&Professions
Code \-
and that my license is in full force and effect. Ddw
I hereby affirm under penalty of perjury one of the following two declarations:
1 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 Sq.Ft Floor Area: Valuation:$6500
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION APN Number:36928039.00 Occupancy Type:
I certify that 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source r*igulations per the Cupertino Municipal Code,Section
9.18. Issued
�^
Signatur '��' Date �� D I�
OWNER-BUILDER DECLARATION RE-ROOFS:
by affirm that 1 am exempt from the Contractor's License Law for one of 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
the following two reasons: inspection.
1,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(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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 O n r r authori d C /
become subject to the Worker's Compensation provisions of the Labor Code,I r 4 Date:
forthwith comply with such provisions or this permit shall be deemed revoked. 114
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION 1 hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
cand expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
g of this permit.Additionally,the applicant understands and will comply
v1W.11 non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
• CITY OF CUPERTINO
3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36928039. 00
DATE ISSUED. . . . . . . : 11/08/2011
RECEIPT #. . . . . . . . . : BS000015260
REFERENCE ID # . . . : 11110039
SITE ADDRESS . . . . . : 10403 S BLANEY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : QUTAO JINYUAN& LI RUI
ADDRESS . . . . . . . . . . : 10403 S BLANEY AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . .
CONTRACTOR . . . . . . . : TSD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 6, 500.00 1. 00 0. 00 1 .00 0.00
1BSEISMICR VALUATION 6,500. 00 0 .65 0 . 00 0 .65 0. 00
1DEMOPRE EACH 1. 00 300. 00 0. 00 300.00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 301.65 0. 00 301.65 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
704
--------------------------
704 DEMO
•
i 1 I I °c-'31
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION k
.7'F
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildinefcDcu a ino.or
•CUPER71N0
/ PROJECT ADDRESS 1p o 3 S• A�\N AV C . APN q I _J /1
OWNER NAME I lA I t,
FN 9%NO
•S�o S -307 E--MMAJL V
STREET AD°REBS IONO3 S . BINNE'Y )111L I u�ERP NO 0-0 95or-f FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE. ZIP FAX
❑OWNER Cl OWNER-BtILDER ❑ OWNERAGENT ❑ CONTRACr°R ❑CONIRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACT° Ne�tu LICENSENUMD19,5(1gJ cSETSE BUS.LIC4
C"AN "nL o C llum9c71 E-n+na ��✓✓�DDQttottlk &,.ioL,coM F o-917-/829
sTRE ADD ss gyp ) COlJ07i4GTr0 crrr,STATE,z P,/"Ot {il 0 17 -/82 /
ARC=Cr/ENOINEER NAME LICENSE NUMBER BUS.LIC a
COMPANY NAME E-MAIL FAX
STREET ADDRESS Crr(.STATE,ZIP PHONE
DESCRIPTION OF WORK
11111 JPokr r7oh kotLS IA-) CX4srJnf6, pool WLr
F 4omi> goo � -ILL (1717'1{ . Ic1SrlNfn IL .
USE OF FD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION(S)
STRUCTURE: ❑ Commercial POOL /_SQ
POOUSPA MATERIAL TYPE CODES: SPA (f/
V - VINYL-LINED �L
-
FIBERGLASS DEMO LXI �Y 7
't—
RECEyLVEII➢1`,`Y5'
P - PREFABRICATED TOTAL V
By my signature below,I certify to each of the following: I am the property own or authorized agent to act on the property owner's behalf. I have-read this
application and the information I h ve provided is carr et. I have ead the Description of Work and verity it is accurate. I agree to comply with a0 applicable local
ordinances and sffite laws mletin ingcons➢u io ut rize representatives of Cupertino to enter the shot
*c-i entified property for inspection purposes.
SignamreofApplicant/Agent. Dam: D ��
SUPPLEMENTAL INFO ON REQUIRED
.a9� �+..t...�.,..L.�ER..'.'���losretceNBs�QNE'><•G�x.s_�•�_
a• u�,a, . v.
JRmdc�rc__a 7'y
_Commercial or Multi-Family Buildings with Public Swimming Pools: ; *�'" 5 s•`V ,teWil R ne
Department of Environmental Health approval required. ,; VINE — -. y�'t"Ts:~,
.-
a�l 0, d
R.Gbh?i ��..Nc'tF.a18 �W$Na`LTkRI"S@wEBID
[SYRLQ'�? �il'`
SwimPooL4pp 2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
• ADDRESS: 10403 s. blaney ave. DATE: 11/08/2011 REVIEWED BY: bob s.
APN: BPk: "VALUATION: $6,500
*PERMIT TYPE: Demolition Permit PLALb'Z'HECK7'FPl7:
PRIMARY Swimming Pool, Res. PENTAMATION 1SFP00LDEM
USE: PERMIT TYPE:
WORK I sfd ool demo
SCOPE
FEE ID FLR AREA
5.f.
1DEMOPRES 1
Ale,•A. Pknr CherR Numb. Plan Check Elea. Phw Chcc6°
meth. Permit Pxe: Plumb. Peon it Fee: t.12c. Permit Fie'
01ho ;lleclt,Asp. other Plumh bap. Li I - Oth<a l7ac. Drsp.
Alech Inc?, Fee, 116i!b.' 'p. /eet /ilee.Inv,. Fee: -
NOTE: This estimate does not Include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelindina In ormation available and are only an estimate. Contact the Dept for addn 7 infa
FEE ITEMS dee Resolution 11-053 L'fi 7/U/Il FEE QTY/FEE MISC ITEMS
Llan Check Fce
flumh_-1�E>eh.;2s tz<;
Permit Fee: $300.00
Suppl. Insp. Feee. Reg. Q OT 0,0 hrs $0.00
F'lnmbr'ridech./llac
Phlmh_'ltech:FlecParn ivi"ce:
C onstructhm 7tr.c
Administrative Fee:
61•urk f+7thout Pern0?
Ae11'anced Planning Fees:
Travel Documeniation Fe<ts:
Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
• Bldk Stds Commission Feel IBCBSC $1,00
SUBTOTALS:
$301.65 $0.00 ,: TOTAL•FEE: $301.65
Revised: 10/01/2011
S&quoio•londscaping & Construction 5
P. O. Box A- 1
Los Altos, CA 94023
•
BLANsY Avc.
10403 S. BLA!!E:!�AvE
CUPERTINO CA 95014
COM�UNTfY DEVELOPMENT DEPARTMENT
UIWING DIVISION-CUPERTINO
APPROVED
Is set of plana and specifications MUST be kept at the
fob site durl constructlon. It is unlawful to make any
changes or alterations on same,or to deviater tha m,wthoutapproval from
1 >
the Building official, _
e stamping P an and specifications SHALL NOT
• be held to permit or to be an a
Of any provielone of PProval of the violation
��City Ounce or State Law.
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NOV �8 2011
-- - REAR FENCE .
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 0YO-5 S • t<Y 14 UC U T' PERMIT# I ( O V
OWNER'S NAME: r�,� PHONE# $y0 3
GENERAL CONTRACTOR: [ U'qOf Hryh�. e luz t • BUSINESS LICENSE#
ADDRESS: PA• 3aX 1350 Coo 6LT C&4 401 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 SUBCO TRA TORS HAVE OBTAINED A CITY F CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: "�" 9 4/
Signature Date
Please check applicable subcontractors and complete the following information:
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
fI r
Owner/Contractor Signature Date