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11010023 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 851 HYDE AVE CONTRACTOR:JOHN MOLINA CONCRETE PERMIT NO: 11010023 OWNER'S NAME: YUNXIANG WU 30 CLAREVIEW AVE DATE ISSUED:01/04/2011 (157►'NER'S PHONE: 4083821226 SAN JOSE,CA 95127 PHONE NO:(408)729-3642 L. LICENSED CONTRACTOR'S DECLARATION r— f— r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C-'9 Lic.# 23169r MECH RESIDENTIAL COMMERCIAL Contractoraotjt,� „ ,-j_/1M4 C_►Ct Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: DEMO POOL DECK,BACKFILL POOL(515SQ) (commencing with Section 7000)of Division 3 of the Business&Professions *SEE NOTES** Code and that 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$7000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:37541001.00 Occupancy Type: 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 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 regulations per the Cupertino Municipal Code,Section —? 9.18. Issued b .``- � ) j� Y _ `,� �...------ .__._...__,.. Date: Signature _z7. i "/�! r Date / OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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(Sec.7044, Signature of Applicant: Date: Business&Professions Code) I,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 HAZARDOUS MATERIALS DISCLOSURE declarations: 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. I 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 contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. 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 Owner or aut ed en become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I 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, c, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ng of this permit.Additionally,the applicant understands and will comply �:.:..all 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 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37541001. 00 DATE ISSUED. . . . . . . : 01/04/2011 RECEIPT #. . . . . . . . . : BS000012389 REFERENCE ID # . . . : 11010023 SITE ADDRESS . . . . . : 851 HYDE AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . YUNXIANG WU ADDRESS . . . . . . . . . . : 851 HYDE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JOHN MOLINA CONCRET CONTRACTOR . . . . . . . : JOHN MOLINA LIC # 28594 COMPANY . . . . . . . . . . : JOHN MOLINA CONCRETE ADDRESS . . . . . . . . . . : 30 CLAREVIEW AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95127 TELEPHONE (408) 729-3642 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 000. 00 1.00 0. 00 1. 00 0 .00 1BSEISMICR VALUATION 7, 000. 00 0 . 70 0. 00 0. 70 0 .00 1DEMOPRE EACH 1. 00 291.00 0. 00 291. 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 292 .70 0 . 00 292 .70 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 292 .70 #3227 --------------- TOTAL RECEIPT 292 .70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO DEMOLITION CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ;*PERMIT ADDRESS: 851 hyde ave. DATE: 01/04/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: $7,000 TYPE: Demolition Permit PL-1,V C111t_'x ITI'k- PRIMARY Swimming Pool, Res. PENTAMATION 1SFP00LDEM USE: PERMIT TYPE: WORK demo existing sfd pool at rear yard location. SCOPE FEE ID #POOLS 1 DEMOPRES 'I f, 1. ;lf,�<.Tr. !'laac t`Lit-cn I, 1. .rr C:n:rh f2c. I zsz t rt:°t',t VI"(t._ PC'rmif F"Y" t r tuft. �'3 F"t?'Z t�`t't:,: �;it'C'. Pt;3"mi l,"2. L /n.a,>. 01/1"rPbir h Itr,?�. C),la t f ie(. 11? /�. ch. lnzp. FC"" /',irrrth. h;"/). 1"""" I!(e( Ir7v), [C(I" NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (&e Resolution 09-051 Ef'. 7/7110) FEE QTY/FEE MISC ITEMS Platz Check Fea: Szrppl. PC.'Fee Plzrrnh.;':11e</z.i7 Cet:Plaii ("heck: Permit Fee: $291.00 Suppl. Insp. Fee4G) Reg. 0 OT 0.0 hrs $0.00 f'lzrrtlh.%�let�h.;'I;Icc l'1�ir f�'t��: Plztnth.%a�lec/r.i1:7c�e f't�rzrit Fcc: C'on.s11'11cii«tt TU rlc;oustic'al Rc vic>.iv FCC,, 11"or"k ff"ithow P r roil? I'lcznrrtt2�r Vices.- I1"trt el 1)(>t`zllrr{n1a77t1r'! Fees. Strong Motion Fee: IBSEISMICR $0.70 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS; $292.70 $0.00 TOTAL FEE $292.70 Revised: 12/07/2010 Building Department City Of Cupertino Lis 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: S �. PERMIT# OWNER'S NAME: G 1j PHONE# GENERAL CONTRA TOR: BUSINESS LICENSE# ADDRESS: eele4zt , 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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. �/�//` I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V 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 Owner/Contractor Signature t b'` CITY OF 7 vZ J CITY OF CUPERTINO DEMO CUPERTINO PERMIT APPLICATION FORM APN# 41001 Date: y Building Address: oe C V PP1L Mailing Address (if different from building address): Owner's Name: Phone: e 3&2- 172-16 Contractor: Phone Fax: Contractor License #: `�3 1 49qsr- Cu ertino Business License #: Contact: Phone: Fax/e-mail: Residential ❑ Sq Footage_ Commercial ❑ Sq Footage fi Job Description: g b9ckL t� Valuation: v Project Size: Counter �xpress ❑ Standard ❑ Large ❑ Major ❑ Please complete relevant portions of the Green Building Checklist & attach it to the application or if applicable, include on the plan set & the sheet index. Quantity Fee ID Fee Description Fee Group Permit Type 1DEMORES Demo-Residential B 1SFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFP00L-DEM 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES 1BSEISMICRE Seismic Residential B Revised 12/06/10