The URL can be used to link to this page

B-2016-0424CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: D-2016-0424 20727 RODRIGUES AVE CUPERTINO, CA 95014-2964 (359 10 059) M S CONSTRUCTION SAN JOSE, CA 95129 OWNER'S NAME: LI XIAOCHUN AND ZHANG XIN IDATE ISSUED: 12/07/2016 OWNER'S PHONE: 408-306-5656 I PHONE NO: ,(408) 230-5080 LICENSED CONMACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 6-B Lie. #884933 Contractor M S CONSTRUCTION Date 09/30/2018 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: 1. 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. y2, --1 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 permit is issued, 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. Date 12R/2016 hereby affirm that I am exempt from the Contractor's License Law for one of the illowing two reasons: 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three declarations 1. 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. 2. 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 permit is issued. s. I certify that in the performance of the work for which this permit is issued, I shall riot 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. Date 12/7/2016 _ BLDG — ELECT _ PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: DEMO SWIMMING POOL (200 S.F.) - FOR LANDSCAPE PURPOSE ONLY Ft Floor Area: l Valuation $10000.00 APN Number: Occupancy Type: 359 10 059 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abbyvende Date: 12/07/2016 . RE -ROOFS: 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. Signature of Applicant: Date: 12/7/201 ALL ROOF COVERINGS TORE CLASS "A" HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 12/7/2016 CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ Ca Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 S P (408) 777-3228 • FAX (408) 777-3333 • building(a-cupertino.om PROJECT ADDRESS Oj /` OWNERNAME wo�L' C—`� � PHONE Z ,r6 �MgIL STREET ADDRESS X • 0-3 � �� CITY, STATE, ZIP �p c f( �j 'FY�a �� - FAX CONTACT NAME �`��: PHONE .'' EMAIL STREET ADDRESS r CITY, STATE, ZIP gp y ❑ OWNER ❑. OwNER-BUIIAER ❑ OWNERAGENT ❑ CONTRACT6R ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # IVAa0 �- urs ,-Zl COMPANY NAME �} E-MAIL c LLs'�.Sd� `<G' t. dr� FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LiC # COMPANY NAME E-MAIL FAX STREET ADDRESS :CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Jlakv USE OF ua AFD or Duplex ❑ Multi -Family TYPE MATERIAL TYPE (CODE) AREA (SQ. FT.) VALUATION ($) STRUCTURE: ❑ Commercial I POOL POOL/SPA MATERIAL TYPE CODES: SPA V - VINYL -LINED F - FIBERGLASS DEMO G - GUNTTE P-PREFABRICATED2ECEIVED BY T 6A1� N: By my signature below, I certify to each of the following: I am the property owner or authoYized ageht to act on the property owner's behalf. I have read this application and the information I have provided 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApplicant/Agent: Date: �Z'�> -r6' SUPPLEMENTAL, INFORMATION REQUIRED �' .. _ � � � cl�Fi'rF.trcxtaxr v _ Commercial or Multi -Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. SwhnPoo1App_2011.doc revised 03116/11 pure Sim 39 CURB (Q PXL 10 BE REUpVO I I I rvani i its 12'1 i e -6',141 i i .....--..FF=106.15 ................ i i 1 s] 1% i =--- -� (E) NOOSE TO BE REMNM i i 1 S1UR7' H4FXi GAR. FF -10b EO i RO0F-PEAK=115.50 CUi 6-.8T FF IAN=101.00�� i i E— i i 189'1 b A 6T- -- __--�.--T7,r-------- _j1A N RODRIGUES 0 AC _ —Tr V9 TAR WALL LEGEND: ----- ,__-� WALL TO BE R&MM EXISTING SITE PLAN / DEMOLITION PLAN 1116 2 CUPERTINO Building Department REVIEWED FOR CODE COMPLIANCE Reviewed By:Abby Ayende �— Date.