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15080169CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21426 HOLLY OAK DR CONTRACTOR: EDEN LANDSCAPE PERMIT NO: 15080169 MANAGEMENT OWNER'S NAME: KIM YONG T AND JIN Y 12550 PASEO CERRO DATE ISSUED: 08/24/2015 OWNER'S PHONE: 4088056838 SARATOGA, CA 95070 PHONE NO: (408)858-9085 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL DEMO (E) SWIMMING POOL (FOR LANDSCAPE n License Class C Lic.# t d C19 EDe,; tAj!e e p�'Da 1241lg Contractor G ONLY) I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions 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 Sq. Ft Floor Area: Valuation: $7000 performance of the work for which this permit is issued. I have and will main ' rker's Compensation Insurance, as provided for by e, for the performance of the work for which this Section 370Wrd APN Number: 36202034.00 Occupancy Type: permit is iss ICANT CERTIFICATION I certify that haveplication 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 WIT�IIN 180. DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 FROM LAST CALLED INSP CTI N.indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs, and expenses which may accrue against said City in consequence of the��/�� JYS (�granting of this permit. Additionally, the applicant understands and will comply Issued by:- t: S�t`-�'l Date: with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. p o�4c� RE-ROOFS: Signature 104 — Date 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. ❑ OWNER-BUILDER DECLARATION 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 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, Business & Professions Code) I, 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. Additionally, should I 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 Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 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 the Health & Safety Code, Section 5, 2�55j33, and 25534. . t� Owner or authorized agen <7 Date: permit is issued. 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that 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 which 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I 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 SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE + CUPERTINO, CA 95014-3255 1651 (408) 777-3228 * FAX (408) 777-3333 • building(ftupertino.org SP PROJECT ADDRESS Z i L�Z / R j S C)LL .�( VprK, Pg U e. APN .. 3oa OWNER NAME ,/� -t.4 E 1 11�14 K- J% i E-MAIL PHONE J 9K-- GO STREET ADDRESS CITY, STATE, ZIP /', 6� q Sv FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER-BULDFR ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ` LIC MB 7C) Gj �� i LICENSE TYffrj ^� --^ BUS. LIC # COMPANY NAME rnY -' ^ e}- Y�1 E-MAIL e Jf e,i / M 7 oNS O� FAX STREET ADDRESS �2l�T� �ODRPS CITT ,Z0 67+ O PHONE4OS O ARCHITECTIFNGINEERNAME LICENSE NUMBER BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ��** n 71n71fnMtN Ott ge/n0✓AL. USE OF X SFD or Duplex El Multi -Family TYPE MATERIAL TYPE (CODE) AREA (SQ. FT.) VALUATION (S) POOL sTRUCrURE: ❑ Commercial POOLSPA MATERIAL TYPE CODES: SPA V - VINYL -LINED F - FIBERGLASS DEMO G - GUNITE 3ti P - PREFABRICATED RECEIVED BY TOTALV UATION r ; . MSW � . .-a;.tw� _��_ „ts.�I By my signature below, I certify to each of the following: 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 provi sect. ave read the Description of Work and verify it is accurate. I agree to comply ith all applicable local ordinances and state laws relating to bu g c cti . authorize representatives of Cupertino to enter the above-identWed roperty r inspection purposes. Signature ofApplicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE aSE ONLY PLAN CHECK LATE, ROLLING SLIP - f ❑ BUILDING DEPT _ Commercial or Multi -Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. OVFR TJIE-COUNTER jE] EXPRESS ❑ I'LANNING DEI'L '❑ STANDARD ❑ PUBLIC N ORES DEPT' ❑ LARGE ❑ LNVIRONMEN FAL IIEAL.TII ❑ 1L9JOR ❑ SANITARY SEWER DISTRIC"1'. SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINOQ FEE ESTIMATOR — BUILDING DIVISION 1A, ADDRESS: 21426 Hollyoak Dr. DATE: 08/24/2015 REVIEWED BY: PAUL 44ech. Permit Fee: APN. 36202034 BP#: "VALUATION: $7,000 PERMIT TYPE: Demolition Permit PLAN CHECK TYPE: PRIMARY USE: Swimming Pool, Res. Plumb.iMech.lElec PENTAMATION PERMIT TYPE: 1SFP00LDE i WORK Demo E swimming pool For Landscape Purposes Only) SCOPE Suppl. Insp. Feer Reg. Q OT FEE ID # POOLS 1DEMOPRES 1 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13,) ilech. Pkat (.'heck Phanb. Plan C'hecr Z<lec. Nan Check: 44ech. Permit Fee: Fn—b. Permit Fee.: FE111. Permit Fee: ')flier ltfech. Insp. >iher 111unib [nsp. Other Elec. Insp, Plumb.iMech.lElec NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13,) FEE QTY/FEE MISC ITEMS 'lan Check Fee: Ott vl. PC. Fee Plumb.iMech.lElec Permit Fee: $329.00 Suppl. Insp. Feer Reg. Q OT Q.0 hrs $0.00 Plumb.lMech.lElec a,'1umb.1Mech./E1ec Permit Fee: C'onstruclion Tia: ir,hninisirtztive Fee: fork Without Permit:' Jdvaneed .Planningr Fees: � 'r��'c�l h�1c`ttttrt>1�EitEit�lt r'- >��: Strong Motion Fee: IBSEISMICR $0.91 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $330.91 LE00 TOTAL FEE: $330.91 Revised: 07/02/2015 PIAT PLANS kr=D BY DATE L PLANNING DEPT CUPERTINO 9EV,00x k. W V ),"IV r Imo. u rl 7 7� d �7,g' -Pc)vL �E+KJI�'1i{► Sc ` -N-3 2 COMMUNITY DEVELOPMENT DEPARTMENT 4�1ygli VISiC� P,F�TINO 11 lkluv _u This set of plans and specifications MUST be kept at the 14J-6 tt%K+�cltiWges Jo -'`Q during construction. It is unlawful to make y or alterations on same, or to deviate �i�EQ�FNO therofrom, without approval from the Building Offici if. The stamping of this plan and specifications SHALL r OT be held to permit or to be an approval of the v;olatic n of a rovislons of an City rdinance or State La . BY !.SIl QATF 0 PifilMiT O. 7� CUPERTINO �LA&,z Building Department W.4 AUG 2 4 2015` VIEWED FOR CODE COMPLIANCE Reviewed By: TA4�i11 w a TW.., a. C!q �y_ �-- HoLLY04K -PP1vt --P-