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10080197 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18781 ARATA WAY CONTRACTOR:XTREME CONCRETE PERMIT NO: 10080197 SOLU TIONS .P'vNER'S NAME: EDWARD LIN AND WEN-YU HUANG 2189'-EPULVEDA AVE DATE ISSUED:08/27/2010 a i ..NER'S PHONE: 4084101848 MILPITAS,CA 95035 PHONE NO:(408)594-3049 ❑ LICENSED CONTRACTOR'S DECLARATION r F BUIL DING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# � / MECH(- RESIDENTIAL COMMERCIAL Contractor �� Date I hereby affirm th1q I am licensed under the provisions of hapte 9 JOB DESCRIPTION:POOL DEMO&FILL(I OOOSQ) (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 performance of the work for which this permit is issued. Sq.FI Floor Area: Valuation:$7500 I have and will maintain Worker's Compensation Insurance,as provided fo by Section 3700 of the Labor Code,for the performance of the work for w his permit is issued. gy APN Number:37512027.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply r r� with all non brut source regulations per the Cupertino Municipa Code,Section Issue d by:.--- �� Date:c�-y 9.18. - -- gignatu Date RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All ro As shall be inspected prior to any roofing material being installed.If a roof is install M without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signal ure of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's Califs rnia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the comp iance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safet,,Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. mains ain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& fety Code,Sections 25505,25533,and 25534. 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 Ow i r r auth ' ed agent: / Compensation laws of California. If,after making this certificate of exemption,I Date: / become subject to the Worker's Compensation provisions of the Labor Code,I must 1 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I here iy affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lend;r's Name 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 Lend:r's Address -in the above mentioned property for inspection purposes.(We)agree to save mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION usts,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I und,;rstand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licer sed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RE--EIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: LDt: APN 37512027 .00 DATE ISSUED. . . . . . . : 08/27/2010 RECEIPT #. . . . . . . . . BS000011307 REFERENCE ID # . . . 10080197 SITE ADDRESS . . . . . : 18781 ARATA WAY SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : EDWARD LIN AND WEN-YU HUANG ADDRESS 18781 ARATA WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RIGOBERTO R BELTRAN CONTRACTOR . . . . . . . : RIGO BELTRAN LIC # 29141 COMPANY . . . . . . . . . . : XTREME CONCRETE SOLUTIONS ADDRESS . . . . . . . . . . : 2189 SEPULVEDA AVE CITY/STATE/ZIP . . . : MILPITAS, CA 95035 TELEPHONE . . . . . . . . : (408) 594-3049 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 500. 00 1 .00 0.00 1. 00 0 .00 1BSEISMICR VALUATION 7, 500 . 00 0 .80 0 .00 0 .80 0. 00 1DEMOPRE EACH 1. 00 291 . 00 0 .00 291. 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 292 .80 0. 00 292 . 80 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 292 .80 VISA --------------- TOTAL RECEIPT 292 .80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO CITY OF CUPERTINO DEMO CU cm Of]NO-, PERMIT APPLICATION FORM APN# _ Date: 7 - 1 k) � 6�] /0 Building Address: t�-J Mailing Address (if different from building address): Owner's Name: � ,`� Phone: q,98-q1 0 Contractor: Phone : Lq Fax: Contractor License #: Cupertino Business License #: Contact: l j ,,•„ Phone: Fax: 0 Residentig-54, Footage Corrmercial ❑ Sq Footage Job Description: Demj) rF4 I Valuation: Project Size: Express ❑ standNKZ LargeEl Major ❑ Please complete relevant portions of the Green Building Checklist & attach it to the application or if applicable, include on the plan set & the sheer: index. Quantity Fee ID Fee Description Fee Group Permit Type 1DEMORES Demo-Residential B 1SFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFP00L-DEM- 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES 1BSEISMICRE Seismic Residential B Revised 01/07/09 CITY OF CUPHRTINO FEE ESTIMATOR- BUILDING DIVISICDEMOLITION ADDRESS: DATE: REVIEWED BY: APN: BP *VALUATIO J$7,500 %PERMIT TYPE: Demolition Permit !3t. `. < li! r ' P" PRIMARY PENTAMATION 1 SFPOOLDEM USE: Swimming Pool, Res. PERMIT TYPE: WORK SCOPE FEE ID #POOLS 1DEMOPRES 1 d� a 'Now, N. A. l'icu;Chci�ti ?'Minh. Pc,!'a l liltrr. l'o-mit p,c lirrh. irstl. NOTE: These fees are based on the prelindnary in ormation availal le and are only an estimate. Contact the De t or addn'l info. FEE ITEMS(Fee Resolution 09-051 Eff. 7/1;10) FEE QTY/FEE MISC ITEMS Phiii /'ltnnl�.'��Ic'ch.:'Tlcc flan C"!leek: Permit Fee: $291.00 Suppl. Insp. Fee.0 Reg. 0 OT 0.0 hrs $0.00 EhV ( rtri 1 cue: f'Itrn?h '-11��h. 7 1i't' 1'�'rrnit FCC., t.'unsir-rrrtron 7irA 1 c'o"wic a/ 1&'vic'ti' I cc. 16'ork PJtlrnut Pr,r•ntii: Building Department City Of Cupertino LM 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBC ONTRACTOR LIST JOB ADDRESS: ( ( W PERMIT# t' OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: 3 *Our municipal code requires a 1 businesses working in the :ity to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR "--ALL SU ONTRACTORS HAVE OBTAINED A CITY F CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: attire Date Please check applicable subcontractors and complete t ie following information: V SUBCONTRACTOR BUSINESS I`AME 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 i404 i► UNITED SOIL ENGINEERING, INC. Geotechnical and Environmental Consultants File No. 5981I-S2 August 31 , 2010 X-Treme Concrete Solutions 2189 Sepulveda Avenue Milpitas, CA 95035 Attention: Mr. Rigo Beltran Subject: Existing Residence 18781 Arata Way Cupertino, California TESTING AND INSPECTIO14 SERVICES DURING THE BACKFILLING OPERATION OF THE ABANDONED SWIMMING POOL Dear Mr. Beltran: Pursuant to your request, we have perfc rmed testing and inspection services during the backfilling operation of the akandoned swimming pool. The subject site is the existing residence located at 18781 Arata Way in Cupertino, California. The existing swimming pool area was approximately 17 by 32 square feet with depths ranging from 5 to 7 feet below existing ground elevation. First, the entire pool was removed. Then, the excavated bottom was compacted. Next, the excavated area was backfilled with import soil material to the existing ground surface. The import soil material was moisture conditioned as necessary and compacted in uniform 8 to12 inch lifts to at least 95% relative maximum density. The compaction for the backfill riaterial was achieved with a hand held mechanical compactor. The backfilling operation was performed by X-Treme Concrete Solutions on August 30 and 31 , 2010. A total of 12 in-place field moisture/density tests were performed by our field engineer using a nuclear gauge (CPN MC-1 DR). These tests showed values in excess of 95% relative maximum density of the backfill material as determined using the laboratory compaction test prccedure ASTM D1 557-91 . The results 3476 Edward Avenue • Santa Clara. California 9 ')054 9 1408; 988-2990 • Fax ;48) 980-; 3-30 File No. 59811-S2 of the field moisture/density tests are summarized in Table 1 . Approximate locations of these tests are shown on the Site Plan - Figure 1 . As a result of our testing and inspection services, the contractor has performed the backfilling operation of the abandoned swimming pool according to our recommendations. If you have any questions or require additional information, please feel free to contact our office at your convenience. Very truly yours, UNITED SOIL ENGINEERING, INC. Sean Deivert " ' RCF- Project CEProject Manager 32295 Vien Vo, P.E. 5981 I.BF/Copies: 3 to X-Treme Concrete Solutions 2 United Soil Engineering, Inc. File No. 59811-52 TABLE I SUMMARY OF FIELD MOISTURE/DENSITY TEST RESULTS Test Date Test Moisture Dry Rel. Comp. Soil Type No. 2010 Location/ % Dry Density % of Max. & Remark Elevation Weight p.c.f. SWIMMING POOL BACKFILL 1 8/30 X1/11. 11 .2 110.7 95.4 B 2 IfX2/11. 14.6 112.7 97.1 B 3 IfX3/11. 12.6 111 .6 96.2 B 4 IfX4/31. 12.1 110.6 95.3 B 5 itX5/31. 11 .1 111 .9 96.5 B 6 IfX6/31. 11 .6 112.6 97.1 B 7 8/31 X7/6.L. 14.0 112.8 97.3 B 8 ItX8/61. 14.2 111 .6 96.2 B 9 AdX9/61. 12.8 111 .8 96.4 B 10 ifX10/F.L. 11 .0 112.3 96.8 B 11 64X11/F.L. 13.0 1 1 1 .9 96.5 B 12 itX12/F.L. 13.4 112.3 96.8 B NOTES: 11. = FIRST LIFT B: Brown C ravelly Sandy SILT 3.L. = THIRD LIFT 61. = SIXTH LIFT F.L. = FINAL LIFT 3 United Soil Engineering, Inc. PROPERTY BOUNDARY r�_� •. I I I I EXISTING RESIDENCE I IX4X11 I X3 X9 X2 X10 X8 I I X5 X12 X�1 X6 I I ABANDONED SWIMMING POOL I I I ARATA WAY NOTE: X DENOTES APPROXIMATE TEST LOCATION United Soil Engineering, Inc. SITE PLAN File No.: 5981I-S2 FIGURE Existing Residence 3476 Edward Avenue Drawn by: E.S. 1 Santa Clara, CA 95054 (408) 988-2990 18781 Arata Nay Cupertino, California Scale: NOT TO SCALE August 2010 4 135 --- --------- — --- ---- --------------------- it 130 -------- a N 125 - ---- c D � ❑ 120 -- - ' Ili I Ij I 115 - 16 18 20 22 24 26 28 Moisture Content: (% of Dry Weight) SAMPLE: B DESCRIPTION: Brown Quarry FINES LABORATORY TEST PROCEDURE: ASTM D1557-91 MAXIMUM DRY DENSITY: 128.0 p.c.f. OPTIMUM MOISTURE CONTENT: 22.0% United Soil Engineering, Inc. COMPACTION TEST B File No.: 5981 I-S2 FIGURE Existing Residence 3476 Edward Avenue Drawn by: E.S. 2 Santa Clara, CA 95054 (408) 988-2990 18781 Arata Way Cupertino, California Scale: NOT TO SCALE August 2010 5