The URL can be used to link to this page

12070249 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 1284 PRIMROSE WAY CONI'R%CI'OR:ZHANG JOHNNY PERMIT N0: 12070249 OWNER'S NAME,: ZIIANG JOIINNY 1284 PRIMROSE,WAY DATE ISSUEID:07(3112012 OWNER'S PRONE: 4082571081 CUPERT'INO.CA 95014 PHONE NO: ❑ LICENSED CON 1'RACI'OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lie.q iYI F,CII r RESIDENTIAL r COMMERCIAL r.— Contractor Contractor Date hereby aflinn That Into licensed under the provisions of Chapter') JOB DESCRIPTION:DEMOLITION OF IN-GROUND GUNITL'SWIMMING POOL (commencing with Section 7000)of Division 3 Of the BusinessS &Professions OF Code and that y license is in full force and effect. SOFT) m herchy 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, , I have and will maintain Worker's Compensation Insurance,as provided far by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$7000 permit is issued. ,\I'I'LICAN'I'CER'1'IEICA'1'I0N AI'N Number:36618014.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep hamdcss the City of Cupeninm against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will complyr with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Issued by: . Ste / ��ii� Date: 731-12— Signature Date ❑ O\VNER-III IILDE.R DECLARATION Rh:ROOFS: herchv affirm that I 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 the following two reasons: installed withou first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner ofthe 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 herchy affirm tinder penalty of perjury one of the following three I have and will I fAIZARDOUSIMATERIAIS DISCLOSURE/ I have and will maintain a Certificate of Consent to self-insure for Worker's - Compeinsation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this pennit is issued. California Health&Safety Code.Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided Ibr by compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilealth& Safely Code.Section 25532(x)should I store or handle hazardous material. Section 3700 of the Labor Code,for the perlbmmnce of the work for which this Additionally,should I use equipment or desires which emit hazardous air permit is issued contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of die work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the not enmploy any person in any manner so as to become subject to the Worker's Ilealth&Safely Code.Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the\Parker's Compensation provisions of the Labor Code,I must O"ser author.z d a ent: torthwith comply with such provisions or this permit shall be deemed revoked Dated iL 1 APPLICANT CERTIFICATION CONST'RUCT'ION LENDING AGENCY I certify that I have read this application and state that the above information is I rebs ammo that there is a construction lending agency for the performance of work's correct,'[agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097.Cir C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, " Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicau undersnnds and will comply ARCII ITECI"S DECLARA'T'ION with all non-point ounce regulations per the Cupertino Municipal Code,Section 9.18. - ' 1 understand my plans shall be used as public records. 2/ t Signature Date Licensed Professional ■■■ ■"m iMEE ■■fi"ii� ■■■■■■■ 0= ■■ ■ ■■ Em ■■■M0■■ ME MEM N■■ ■■ ® ■■■ ■ mm MEME MMMMlFpp..41 EMOM 111101111111111111 ONE 0 ONES EN aloa ■■■ ■■■■■■■■■NNE ■■■■ ■■■■■ ■■■■ ■■■■■■■■■■ ■■EMOMMESSOM ME ME ■ ■■■■ ■■■■■ ■■ O ■■■■■ � ■■■■■ ■■ ■■■■E■■■ ■■■■ ■■■■ ■�'r ■■■■■■■■ ■■■ ■'ri - �' Imo■■■■ ■■■■ ■■■ ■■■ ■■ o ■■■ a '• ■ ■ ■■■■■■■■■■■■■■ OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 • buildino8cuoertino.orc Dear'Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS n✓'rr�S f- ! ray APN ?6 6 G �� BP# OWNER NAME (Jk nN r W OWNER ADDRESS r/ DESCRIPTION OF WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION IB ECT'ONSPlease read and initial each statement below to signify you understand or verify this information.) 1Iunderstand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- IIder" building permit that erroneously implies that the property owner is providing his or her own labor and material ersonally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. Ad-3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 95. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. _6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. O_7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is pR rmed under contract with a licensed general building Contractor. //U7�{l�( 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. O)rnerBuilderFomi 10f0.docrevised04//4/l0 9. 1 understand I may obtain more information regarding my obligations as an "employer"from the Internal evenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors'State License Board (CSLB)at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed 1coptractors. _10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am e'party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide Enfor'rInation applicable laws and requirements that govern Owner-Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verificatiot acceptabl o the city may be required to be presented when the permit is issued to verify the roe owner's sin re. Property Owner's Signature: Date:; y ---- ------------------ ----- ----------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other . verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: Oil'AerBuilderFo,wi 1010.doc revised 04//4/10 Iz�7v2�9 SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228 N FAX(408)777-3333 •buildinGlc cuoerino.org CUPERTINO �y I PROJECT ADDRESS �r APN 3 OWNER NAhff O I �U')✓1 C� PHONE.�OR .Jr v�I E-MAIL STREET ADDRESSATE.Z8 J FAX MZG�C v i o G CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX wNER ❑ oW' -BUILDER ❑ OWNER AGENT ❑ CONTRA(-OR ❑CON CORAGENr ❑ ARCHITECT 11 ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER I LICENSE TYPE I BUS.LIC s' COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECTJENGINEER NAME LICENSE NUMBER I BUS.LIC I CONffA.NY NAME _.( L)C J JN E-MAn. FAX !� t STREET ADDRESS CITY,SLATE,ZIP PHONE DESCRIPTION OF WORK t✓ww�� W � n-I• 2%31 lam/• Y1 v i F_ USE OF Ta SFD or Duplex Multi-Family TYPE IMATERIAL TYPE(CODE) AREA (SQ.'FT.) ALUATION (S) 'STRuCrURE: ❑ Commercial POOL 6yD0 e-o� POOLISPA MATERIAL TYPE CODES: SPA V - VTNYL-LINED F - FIBERGLASS DEMO G - G[1NITE - "-Lv 'NJ n�•tis�s P - PREFABRICATED WED'$Y- _. as TOT GVAIO R7ION� By my signature below,I certify to each of the following: I am the propeny owner or authorized agent to act on the property owner's behalf. I have(read this application and the information I have p vided 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 b ing cons I authorize presentatives of Cupertino to enter the above-i enfified prtpetry or inspection purposes. Signature of ApplicentlAgent: Date: `/)r/S7 SUPPLEMENFOR, ION REQUIRED ; _ y '-PF,Ap'IX�T:LRE' Y - ._2ftOIYCLYGSBIP^ - Commercial or Multi-F y Buildings with Public Swimming Pools: •z+��'�' alw- u�, Department Of Environmental Health approval required. 4 ovER'I7comR., aSS Btin:nLyE '�� 3-- FYPRESS '•,1X�c� PLA.Y'� 4ID��t v.., R0. ? eub J� tiEPl' - •' _��E"L.tRG£' � coF�'VBiOYYffYTAL' GCFi e�% rti _ ht RVS EXIDISTRIQ SwimPo&4,p_201(aloe revised 03/16/11