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15100087I CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 21070 MANITA CT I CONSTRUCT ON BARRIOS I PERMIT NO: 15100087 I OWNER'S NAME: TSAI SHANG-HSIEN AND LI-YU TRUSTEE 17041 ROSANNA ST j DATE ISSUED: 10/13/2015 OWNER'S PHONE: 4085090844 1 GILROY, CA 95020 J PHONE NO: (408) 337-7664 1 LICENSED CONTRACTOR'S DECLARATION License Class Lic. #TGA 3 Contractor lAlWh o f �jFp �-r� p g Date 0 4 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. 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. APPLICANT CERTIFICATION 1 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 C 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 so u a ' ns per the Cupertino Municipal Code, Section 9.18. Signatur Date15— ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusibely contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 2. 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. 3. 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 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. Signature Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ DEMO (E) SWIMMING POOL & FILL FOR LANDSCAPE PURPOSES ONLY Sq. Ft Floor Area: I Valuation: $3500 APN Number: 36223049.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM INSPECTION. Date: 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: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 horized agent: P_�_ Date: > CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) 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 (408) 777-3228 • FAX (408) 777-3333 • buildinga(�cupertino.org CUPERTINO `S 10 U PROJECT ADDRESS APN # 27 -3O C o n` C)n d L� 'i OWNER)IAME PHONE E-MAIL 1!�!2g O -Q STREET ADDRESS CITY, STAT , ZIP FAX STNTAC NAME e� � n ` t -o PHONE E-MAIL 'a o WR ET ADDRESS CITY, STATE, ZIP FAX ❑ ARC9MELT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT V W iV LII �� a(Pi/ ��r+ a des a he, dn- a erk-e- a ana� 4// 001 L -r �.tJi/1 Y d e C1 CONTRA OR N ME LICENSE NUMBER LICENSE TYPE BUS. LIC # 2G O U VALUATION (S) USE OF POOL COMPANY NAME E -D AIL FAX O i�� 'com V - VINYL -LINED STREET ADDRESS TTY; STATE, ZIP PHONE o - _ E - VALUATION: O ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK; ©Coto /O�0 46p�j 2 �� a(Pi/ ��r+ a des a he, dn- a erk-e- a ana� 4// 001 L -r �.tJi/1 Y d e C1 GpI 4P ON4-y 16 ❑ SFD or Duplex ❑ Multi -Family TYPE MATERIAL TYPE (CODE) AREA (SQ. FT.) VALUATION (S) USE OF POOL STRUCTURE: ❑ Commercial POOL/SPA MATERIAL TYPE CODES: SPA V - VINYL -LINED F - FIBERGLASS G - GUNITE RECE - _ E - VALUATION: P - PREFABRICATED By my signature below, I certify to each of the following: I am the prope o orized agent to act on the property owner's behalf. I have 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 applicab cal ordinances and state laws relating to b nstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: D SUPPLEMENTAL INFORMATION REQUIRED u��� _- _ „ q oFiICE USE oNLY vz-- t rPIAIV_CHECK TYPE �� . __,: " - s'F R9UTING SIIPa""k-k, I Commercial or Multi -Family Buildings with Public Swimming � Pools:�O`, yy �h"`i"T a.-K� �SdL t Er 3Y'T D tr'F y t; �3z t'a2vsY,T.C.:S1r�y�R-}..,'S.cy_ 'Y Bi7ILDI1V3G — Department of Environmental Health approval required. rHECOUNTERr LE SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINO D FEE ESTIMATOR -BUILDING DIVISION f ADDRESS: 21070 MANITA CT DATE: 10/13/2015 APN: 362 23 049 I BP#: REVIEWED BY: MELISSA *VALUATION: 1$3,500 *PERMIT TYPE: Demolition Permit 7- 1'L141y CHECK 1111 -IL": PRIMARY USE: Swimming Pool, Res. _��`ec. Permit Fee: PENTAMATION PERMIT TYPE: 1 SFPOOLDE WORK DEMO E SWIMMING POOL & FILL FOR LANDSCAPE PURPOSES ONLY SCOPE Pla,b�a ��_ h7sp. Fee: FEE ID # POOLS 1 DEMOPRES 'I 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 nreliminary information available and are onlv an estimate. Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 11-033 E . 7f /1/13) Alech. Plan CheekIF I QTY/FEE 14ech. Permit Fee: Plumb. 1'er'rltil Fee: _��`ec. Permit Fee: (Aiier iaeeh..Insp. Other l'lur?ib Insp. ("?Iher I lec. Insp. Afec�h, Insp. Fee,- Pla,b�a ��_ h7sp. Fee: 1,1ec.-. Insp. 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 nreliminary information available and are onlv an estimate. Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 11-033 E . 7f /1/13) FEE QTY/FEE MISC ITEMS Plan Check ee: tSrlppl.ly'ee Plumb. /.?tech. /Elec Permit Fee: $329.00 Suppl. Insp. Feer Reg. OT Q 0 hrs $0.00 /'lamb. %��eclr.%Flee. Permit Fee: ("On.ytruelion Tux: F-1 -1(hniniv1r(,#h,e Fe(?: 4"ork GYithf)ul Permit? .Advanced Planning Fees: 1rrr.[V(l Doc °mentation feev. Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: F $330.50 $0.00 TOTAL FEE: $330.50 Revised: 10/01/2015 0 /--; 5 , q1 CAI 0 PC C) r Lan d�q fl 5 C PV11P1045e-5 OY)Z.,9 OFFICE COPY /< -IT LMN11 ..AREA POOL 12@ LMNG AREA Paean CvpF r//Vo 13 'z:oar&77,,t 5 cc)4F C mp AVCE ------------------------------------------------------------- I FWD x LrL-j z----------------------------------------------------------- y 21070 ------------------------------------------------------------ 21070 MANITA CT CUPERTINO CA. COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION - CUPERTINO APPROVIED This set of plans and specifications MUST be kept at the job site during construction. It is unlawful to make any changes or alterations on same, or to deviate therefrom, without approval from the Building Official. The stamping of this plan and specifications SHALL NOT be"A held to permit or t n r--. � al of the violation of r ns of Or inance or State Law. DAT'E PERM11T NO. L22