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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. W TE ✓ p N0. UL ( 16' PEEP ENO +i 0136� 14 IS Si DE r - FeN'GC - i 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