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13110032 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1092 MILKY WAY CONTRACTOR:PHILLIP D.BJURMAN PERMIT NO: 13110032 OWNER'S NAME: XIANG WU 1250 HIGHWY 101 DATE ISSUED: 11/05/2013 OWNER'S PHONE: 4086663967 AROMAS,CA 95004 PHONE NO:(650)906-7533 -ff LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic.# �'� 2� DEMO(E)CONCRETE SWIMMING POOL.LANDSCAPE PURPOSES ONLY,NO FUTURE BUILDING Contractor. �- Date II— '-1_3 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. hereby affirm under penalty of perjury one of the following two declarations: ell I have and will maintain a certificate of consent to self-insure for Worker's V Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$6000 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 APN Number:36220009.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application 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 WITHIN 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 DAYS AST CALLED INSPECTION. 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 Y: Date: with all non-point source regulations per the Cupertino Municipal Code,Secti 9.18. --� RE-ROOFS: Signature �� 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 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) 1,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. I 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 the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Z— Date: 1 I 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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 V SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION o0 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 S P\ CUPERTINO (408)777-3228• FAX(408)777-3333•buildinq(a_)cugertino.org \ PROJECT ADDRESS , O C` APN# j / � Q i OWNER NAME '6 r `! * 114 P -310 11p0 E-MAIL STREET ADDRESS h G M w V CITY, STATE,ZIP la FAX CONTACT NAM �,�� PHONE E-MAIL STREET ADD S � CITY,STATE,ZIP / t �J L t FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NA 6 LICENSE LICENSPNEPE BUS.LIC# CQ NAME E-MAIL FAX ul— STRENT.ADDRESS CITY,STATE,ZIP _ P ONE CIA k�o ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK -E�-c v, C USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION(S) STRUCTURE: ❑ Commercial POOL POOUSPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO G - GUNITE ~� P - PREFABRICATED RECEIVED TOTAL VALUATION: By my signature below,I certify to each of the following: I am the properti owner or authoOE6 aWnt 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- Wo and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relati mg t tion. I authorize representatives of Cupertino to enter the above-ide tified roperty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED 0610EUSEONLY PLAN CHECf{TYPE ROUTING SLIP Commercial or Multi-Family Buildings with Public Swimming Pools: 777 Department of Environmental Health approval required. ❑ OVER-THE COUNTER `8U LDING D$P1 {= E7LPR>3s © PLANNIING DEPC,'- '- D STANDARD PU$LICi 6n `13EPT LARG$ ., RONhiEMTAL UEALTH MAJOR D SANITARY SEWER DISTRICT SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINO D FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1092 MILKY WAY DATE: 11/05/2013 REVIEWED BY: MELISSA APN: 362 20 009 BP#: *VALUATION: $6,000 *PERMIT TYPE: Demolition Permit PRIMARY Swimmin PoolRes. PENTAMATION 1 SFPOOLDEM USE: 9 , PERMIT TYPE: WORK DEMO E CONCRETE SWIMMING POOL. LANDSCAPE PURPOSES ONLY NO FUTURE SCOPE BUILDING FEE ID #POOLS 1 DEMOPRES I hf Bch. Port Ckre�ca Plw�!b N m C G� fe<.h. 1' t;rrit Fc>< ° 7, Vc," FA Chha r;tfcch.Ins, C)thcr Pr`�;t'tb IrraClthcr �.��< Irtsp. ltccir.Ini��, l �e� t'hrnt?}. Tiz�lz (�<;- Islec. Init (.z�: 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 prelimina information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS(Fee Resolution 11-053 E f 7.%1/13) FEE QTY/FEE MISC ITEMS flan Chcck pore: Slippl. PC"Fec Flrtinh. <ticfclr.il;lec Permit Fee: $319.00 Suppl. Insp. Fee-0 Reg. Q OT 0.0 hrs $0.00 f'Ittrril7.;'11ec h.;'llet: I'lunth.%";l tech.-Z1ec Permit F(T. Constrrrciion Tax: Adrnitiistrative Fee: Work 4 ithout Pr i'mit? 11dvouc0 1 Plavinir'g Fees: Travel 0octmicritotiol'i l'et's: � Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $320.60 $0.00 TOTAL FEE $320.60 Revised: 10/01/2013 Building Department City Of Cupertino Is 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 1012, 1 rCc PERMIT# 0032 OWNER'S NAME: PHONE# 666 - 96 GENERAL CONTRACTOR: i7- �;� r-- BUSINESS LICENSE# ADDRESS: '35'Y-3 CITY/ZIPCODE: ' 1u f^! C( `f62 *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: 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 Date CUPERTINO k- �i-`./ [ li-L- Ln LAM Get C4 r 3race�� L4 l � 47 S'33 PLOT NLAI'%-- CHECKED BY f uA j + . - LANNINi; D T. GATE Ri,14G. f1RPT