13060139I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10424 NORWICH AVE I CONTRACTOR: PHILLIP D. BJURMAN PERMIT NO: 13060139
I OWNER'S NAME: CHAN PETER H AND DONNA Y 1 1250 HIGHWY 101 I DATE ISSUED: 06/17/2013 I
OWNER'S PHONE: 4088678827 AROMAS, CA 95004 PHONE NO: (650) 906 -7533
❑ LICENSED CONTRACTOR'S DECLARATION
License Class A Lic. #
Contractor r �—, _—�� Date _q t 7 /
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:
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.
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
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 + f /9 Date /% ! 7
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following 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).
I hereby affirm under penalty of perjury one of the following three
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.
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.
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.
JOB DESCRIPTION: RESIDENTIAL
COMMERCIAL
POOL REMOVAL 700 SQ FT ENGINEER BACK FILL
Sq. Ft Floor Area: I Valuation: $10000
APN Number: 31629101.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITIIE"80 DAYS OF PERMIT ISSUANCE OR
180 DAY$ FOOM LAST CALLED INSPECTION.
Issued by:
Date: 62, / -� /-,?.
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 or authorized agent -"� X Date: f7 !
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ry,�
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
UPER71N4 (408) 777 -3228 • FAX (408) 777 -3333 • building an rti
cupenD.Grg
PROJECT - A �/ w t C/I A-�E.
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OWNER NAME Ay I
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CONTACT NAME
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❑ OWNER El OWNER-BUILDER OWNER AGENT NTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑'ENGINEER ❑ DEVELOPER ❑ TENANT
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LICENSE NUMBER
LICENSE TYPE
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ARCHITECTffiNGINEER NAME
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BUS. LIC #
COMPANY NAME
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FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK '
CiA � t-L
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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
DEMO
F - FIBERGLASS
G - GUNTTE
a.
P - PREFABRICATED
TOT VaA1ATION:
By my signature below, I certify to each of the following: I am the property owner or authorized agent 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 relati ' ,cons do authorize representatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of Applicant/Agent: Date: tj,, -l.l'7
SUPPLEMENTAL INFORMATION REQUIRED_.
F c>tlso
-�
_ Commercial or Multi- Family Buildings with Public Swimming Pools:
Department of Environmental Health approval required.
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T" ARD ` �I�
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SwimPoolApp_2011.doc revised 03116111
CITY OF CUPERTINO
EM FEE ESTIMATOR - BUILDING DIVISION
Xlech. Plan Check I I
.MecA.Pennif Fee:
Other Alech. Imp,
Hech. lnsj). Fee:
1DEMOPRES
Plumb. Plan Check I I
Plumb. Permit Fee:
Other Plumb Insp.
Plumb. Insp. Fee:
Elec-Plan Check
Elec. Permit Fee:
Other Elec. Imp,
Elec. Insp. Fee:
VOTE. 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 preliminary information available and are only an estimate contact the ueptjoraaan'tinfo.
FEE ITEMS (Fee Resolution 11-053 Eff 711112)
ADDRESS:
DATE: 06/17/2013
REVIEWED BY: mendez
Plan (..heck Fee:
APN:
BP#:
*VALUATION:
1$10,000
*PERMIT TYPE: Demolition Permit
PLAN CHECK TYPE:
PRIMARY
Swimming Pool, Res.
USE:
I
PENTAMATION
1SFP00LDEM
I PERMIT TYPE:
WORK
removal 700 sq ft engineer back fill
�ool
SCOPE
0.0
Xlech. Plan Check I I
.MecA.Pennif Fee:
Other Alech. Imp,
Hech. lnsj). Fee:
1DEMOPRES
Plumb. Plan Check I I
Plumb. Permit Fee:
Other Plumb Insp.
Plumb. Insp. Fee:
Elec-Plan Check
Elec. Permit Fee:
Other Elec. Imp,
Elec. Insp. Fee:
VOTE. 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 preliminary information available and are only an estimate contact the ueptjoraaan'tinfo.
FEE ITEMS (Fee Resolution 11-053 Eff 711112)
FEE
QTY/FEE
MISC ITEMS
Plan (..heck Fee:
Suppl—pC17ce
Permit Fee:
$306.00
Suppl. Insp. Fee.(E) Reg. 0 OT
0.0
hrs
$0.00
Plumb. / JVfech./E1ec
Plumb.lMech.lMec Permit Fee:
Construction Tax:
A dininistrative Fee:
Work Without.flermiO
Advanced Planning Fees:
Travel Documentation on Fees:
Strong Motion Fee: IBSEISAffCR
$1.00
Select an Administrative Item'
Bldg- Stds Commission Fee: IBCBSC
$1.00
, P
go
$308. oto
0.00 - 211 " - U;p-7"TAK 04
M &4n,
MI-0
$308.00
Revised: 04/29/2013
Building Department
City Of Cupertino
10300 Torre Avenue
LM Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
C U P E RT I N O Fax: 408- 777 -3333
CONTRACTOR / SUBCONTRACTOR LIST
*Our municipal code requires all businesses working iii the city to have a City of Cupertino. business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILD- BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND A C TRACTORS HAVE OBTAINED A;CITY O CU ERTINO
BUSINESS LICENSE.
I am not using any subcontractors: f�
gnature D to
Please check applicable subcontractors and complete the following information:
JOB ADDRESS: Z UYLJ 1
PERMIT #
BUSINESS LICENSE #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
j r,.��
BUSINESS LICENSE ##
Electrical
ADDRESS: 353 /O kJ 6Q-7
CITY /ZIPCODE:,' lbgk J U
*Our municipal code requires all businesses working iii the city to have a City of Cupertino. business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILD- BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND A C TRACTORS HAVE OBTAINED A;CITY O CU ERTINO
BUSINESS LICENSE.
I am not using any subcontractors: f�
gnature D to
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
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
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JUN 1 2013
RE-N .'APED FOl C -.E COMPLIANCE
Fie, ?'icwo -d By:
G�An Res; den ce
to `i'1L1 Norw;cL Avt
phi l l i f IJ (Wh d%n
35S3 l-%ve,, Ave, 47
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660-106-7533
106 -7533
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DATE
Ri,nc*. DEPT.
SILICON VALLEY OIL ENGINEERING
S
GEOTECHNICAL CONSULTANTS
File No. SV1016M
FILE
June 26, 2013 t7- 13
Bjurman General Engineering Corporation
1250 Highway 101
Aromas, CA 95004
Attention: Mr. Phil Bjurman
Subject: Swimming Pool Removal
Existing Residence
10424 Norwich Avenue
Cupertino, California
TESTING AND INSPECTION SERVICES DURING
THE BACKFILLING OPERATION OF THE
SWIMMING POOL REMOVAL
Dear Mr. Bjurman:
Pursuant to your request, we have performed testing and inspection services
during the backfilling operation, for the swimming pool removal. The subject
site is the existing residence located at 10424 Norwich Avenue in Cupertino,
California.
The existing swimming pool area was approximately 600 square feet with
depths ranging from 4 to 9 %2 feet below existing ground elevation. First, the
entire pool was removed and inspected. 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 12 inch lifts to at least 90% relative
maximum density. The backfilling operation was performed by Bjurman General
Engineering Corporation on June 24 and 25, 2013.
A total of 9 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 90% relative maximum density of the backfill material as determined
using the laboratory compaction test procedure ASTM Dl 557 -91. The results
of the field moisture /density tests are summarized in Table 1. Approximate
locations of these tests are shown on the Site Plan - Figure 1.
2391 ZANKER ROAD, SUITE 350 9 SAN JOSE, CALIFORNIA 95131 • (408) 324 -1400 • F (408) 324 -1404
File No. SV1016M
June 26, 2013
As a result of-our testing and inspection services, the contractor has performed
the backfilling operation of the swimming pool removal accordingly.
If you have any questions or require additional information, please feel free to
contact our office at your convenience.
Very truly yours,
SILICON VALLEY SOIL ENGINEERING
Sean Deivert
Project Manager
Vien Vo, P.E.
Rey no
32296
SV1016M.BF /Copies: 3 to Bjurman General Engineering Corporation
2 SILICON VALLEY SOIL ENGINEERING
File No. SV1016M June 26, 2013
TABLE I
SUMMARY OF FIELD MOISTURE/ DENSITY TEST RESULTS
Test
Date
Test
Moisture
Dry
Rel. Comp.
Soil Type
No.
2013
Location/
% Dry
Density
% of Max.
& Remark
3 6/25
X3 /2.L.
Elevation
Weight
p.c.f.
4 it
X4 /2.L.
NOTES:
I.L.
= FIRST LIFT
SWIMMING POOL BACKFILL
= SECOND LIFT
1 6/24
X1 / I.L.
14.1
108.6
93.6 B
2 is
X2/11.
15.3
106.8
92.1 B
3 6/25
X3 /2.L.
13.9
106.2
91.6 B
4 it
X4 /2.L.
12.8
107.6
92.8 B
5
X5/41.
14.1
108.5
93.5 B
6
X6 /41.
15.1
106.1
91.5 B
7
X7/F.L.
12.8
107.6
92.8 B
8 is
Xs /F.L.
12.1
108.1
93.2 B
9 is
X9 /F.L.
14.9
105.9
91.3 B
NOTES:
I.L.
= FIRST LIFT
21.
= SECOND LIFT
41.
= FOURTH LIFT
F.L.
= FINAL LIFT
B: Brown Gravelly Sandy SILT
3 SILICON VALLEY SOIL ENGINEERING
C K
w
D
z
w
Q
U_
ce
O
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ABANDONED SWIMMING POOL
Silicon Valley Soil
Engineering
2391 Zanker Road, #350
San Jose, CA 95131
(408) 324 -1400
SITE PLAN
Existing Residence
10424 Norwich Avenue
Cupertino, California
X6 X9
X1
X5
X2
X4 X8
X7 X3
File No.: SV1016M I FIGURE I
Drawn by: M.N. 1
Scale: NOT TO SCALE June
2013
1K1]
115
N 110
m
0
`[11~y
100 +
7
Silicon Valley Soil
Engineering
9 11 13 15 17
Moisture Content (% of Dry Weight)
SAM PLE: B
DESCRIPTION: Brown Gravelly Sandy SILT
LABORATORY TEST PROCEDURE: ASTM D1557-91
MAXIMUM DRY DENSITY: 116.0 p.c.f.
OPTIMUM MOISTURE CONTENT: 13.0%
2391 Zanker Road, # 350
San .Jose, CA 95131
(408) 324 -1400
COMPACTION TEST B I File No.: SV1016M
Existing Residence
10424 Norwich Avenue
Cupertino, California
5
Drawn by: M.N
Scale: NOT TO SCALE
19
FIGURE
2
,June
2013