15040114 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10325 DEMPSTER AVE CONTRACTOR:BOB'S BOBCAT PERMIT NO: 15040114
SERVICE,INC.
OWNER'S NAME: CHANG PETER C AND MAI H 567 ARLETA AVE DATE ISSUED:04/16/2015
OWNER'S PHONE: 5108253261 SAN JOSE,CA 95128 PHONE NO:(408)998-8766
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E]
j y� DEMO(E)SWIMMING POOL&FILL FOR LANDSCAPE
License Class �' Lic.4 O J�� �y PURPOSES ONLY
Contractor �SX1y�G/���J�p�J Date
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 by affirm under penalty of perjury one of the following two declarations:
e 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. Sq.Ft Floor Area: Valuation:$12000
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:32647081 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 F ED INSPE TION.
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 - "Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
V_ S RE-ROOFS:
Signature Date`f �6 I All roofs shallspected 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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)
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. 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,Sectio s 2 505,2 533, nd 25534. _
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 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
918.
Signature Date
SWIMMING POOL / SPAPERMIT APPLICATION 1�
12 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 1
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (�V�
(408)777-3228•FAX(408)777-3333•buildin-ga-cupertino.org \S
CUPERTINO
PROJECT ADDRESS 'P1A`N"
3
OWNERNAME I�IA�f �I / ILN PHO 5i0 F�L�- Lj
2�� MAID /•' �_.
STREET ADDRESSC��j ('►//1 I,n CITY,STAT Eg b f_nkYhL 9,�- G/�l1 /1 FAX J, J
CONTACT NAME 1 mob-ee,7 7► 4 7✓ 1�G Pe, E-MAIL
STREET ADDRESS -��.�„�le�,r �/ �
CTTY,STA7, _�f �� _ /�G FAX
11OWNER ❑ OWNER BUILDER ❑ OWNER AGENT - PC ONTRACTOR ❑CONTRACTOR AGENT 13 ARCHITECT [❑ENGINEER ❑ DEVELOPER ❑ DTENANT
CONTRACTOR NAME
Galt,
� LICENSENUMBERLICENS/ETYPE BUS.LIC ii
COMPANY NAME E-MAIL h� V�A.{c /_ /• F L1 � �eQ�7(<j C/5
S Ub (�
STREET ADDRESS CITY,S TE,ZIP PHONE
Ve -� �6 Cry- �S�j �9-7
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA`(SQ.FT.) VALUATION($)
STRUCTURE: ❑ Commercial POOL
POOLISPA MATERIAL TYPE CODES: SPA
V - VINYL-LINED l3
F - FIBERGLASS DEMO
G - GUNITE - -
P - PREFABRICATED
By my signature below,I certify to each of the following: I am the property-owner or razed agent to act on the property owner's behalf. I have read this
application and the information I have rovided is correct. ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to i tion. aut rize representatives of Cupertino to enter the above dproDe r inspection purposes.
Signature of Applicant/Agent: Date
SUPPLEMENTAL INFORMATION RKUIRED �oFACE`Isiv�Y. ..,,
n 4F r
Commercial or Multi-Family Buildings with Public Swimming Pools:
Department of Environmental Health approval required. m uimncbE �
PP
,$ANITARY'SEWERDLSTRIGT;..
SwimPoolApp_2011.doc revised 03/16/11
CITY OF CUPERTINO D
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10325 DEMPSTER AVE DATE: 04/16/2015 REVIEWED BY: MELISSA
APN: 326 47 081 BP#: "VALUATION: 1$12,000
*PERMIT TYPE: Demolition Permit pl-A AN CHECK 7'YPF.
PRIMARY PENTAMATION
USE: Swimming Pool, Res. PERMIT TYPE: 1 SFPOOLDE
WORK DEMO E SWIMMING POOL& FILL FOR LANDSCAPE PURPOSES ONLY
SCOPE
FEE ID #POOLS
1DEMOPRESOk
1
PEN
X1ec:1a. Plan Check Plumb. Picea C'/reek £iet:_Plan Cheek
Xlecb. Pei wit Fee: Plumh.Permit Fife: rice. Permit Fee:
other Ale:crh.Insp. Other Plumb Insp. C)rher Elec.Insp.
.11ech.Insp.fete: Plumb.Insp.Fee:: l lcc.Insp. Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc).. Thesefees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Supp). N.,Fee
Plumb.11Iech./I;lec
Permit Fee: $329.00
Suppl. Insp.Fee-0 Reg. ® OT0 0 hrs $0.00
Hurn b.,:��leela.%Is lee;
Plumb.-'VlechJE1ec Perm Fee:
C'onslruction Tax:
Administrative Fee:
Work Without.Permit?
Advanced Planning Fees:
T rurel DOCumcntrziion Tees:
Strom;Motion Fee: IBSEISMICR $1.56 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
OF
$331.56 $0.00 i TOT} L FEE: $331.56
Revised: 04/01/2015
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CUPERTIN®74
MAX T feAC i� l}RJv S Suildinq Department
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, ,VG/YI S e r`` e - EXISTING ARCHITECTURAL SITE PLAN r APR 16 2015 _-I VED
rfjNo �A- l
U r l S^0�y G �/ 4 �l�f/ON 1141r-� REVIEWED FOR CODE COMPLIANCE APR 6 2015
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? Reviewed BY: -