14020149CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21373 DEXTER DR
CONTRACTOR: HAULING PROS
PERMIT NO: 14020149
OWNER'S NAME: PARK AND JOAN B CHAMBERLAIN
PO BOX 4033
DATE ISSUED: 02/25/2014
OWNER'S PHONE: 4084464704
WALNUT CREEK, CA 94596
PHONE NO: (925) 682-8987
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
S 3(030
REMOVE (E) SWIMMING POOL & FILL TO 90%
License Class Lie. #
COMPACTION,
Contractor.a :r+ Date �S
FULLY ENGINEERED FOR FURTURE BUILDING
�,
POSSIBILITIES
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
Sq. Ft Floor Area:
Valuation: $9000
erformance 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
APN Number: 32641087 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
ST D 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
rLs /
granting of this permit. Additionally, the applicant understands and will comply
ed by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
RE -ROOFS:
Signature Date 9 02�
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)
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. 1 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 and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner
permit is issued.
or authorized agent:
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION (t
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10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.org
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PROJECT ADDRESS APN # �J / r y / _
OWNER NAME � W/4 - I /// .417
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STREET ADDRESS �I ?j Dye CITY, STATE, ZIP�U C // FAX
CONTACT NAME (j- PHONE E-M/ARIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER-BURDER ❑ OWNER AGENT (.oCLCONTRACTOR
❑CONTRACTOR AGENT
❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �/' /
LICENSEC fNER
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LICENN TT PE
BUS. LIC #
COMPANY NAME
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CITY, STATE, ZIP �2T.N/dG �
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
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COMPANY NAME
1 STREET ADDRESS
1 DESCRIPTION OF WORK
E-MAIL
CITY, STATE, ZIP
IUSE OF ❑ SFD or Duplex ❑ Multi -Family ITYPE
STRUCTURE: ❑ Commercial POOL
FAX
PHONE
MATERIAL, TYPE (CODE) I AREA (SQ. FT.) I VALUATION ($)
TION REQUIRED
_ Commercial or Multi -Family Buildings with Public Swimming Pools:
Department of Environmental Health approval required.
SwimPoolApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
1 FF.F. FCTTMATnR—RTTTIDING DIVISION
Ic
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FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
ADDRESS: 21373 DEXTER DR
DATE: 02/25/2014
REVIEWED BY: MELISSA
I'lari C hck 1• ce:
APN: 326 41 087
BP#:
*VALUATION: 1$9,000
PERMIT TYPE: Demolition Permit
PL4N CHECK 7T1'f_�:
PRIMARY
USE: Swimming Pool, Res.
PENTAMATION
PERMIT TYPE: 1SFP00LDE
WORK
REMOVE E SWIMMING POOL & FILL TO 90% COMPACTION FULLY ENGINEERED FOR
SCOPE
FURTURE BUILDING POSSIBILITIES
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11himtr. flermi! Feer.
0111 r Numb Irz,sp.
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fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
_ mr_ _ _ r__.. L ---a .. sl .. ../:..... .:.f:,.. ..t:.... n n:InRln na.d n o park, nn octiavinto Cn"mrt thn Dant far oddn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
I'lari C hck 1• ce:
:5'uppl. PC. Fee
Permit Fee:
$319.00
Suppl. Insp. Fee.(Reg. tOT
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hrs
$0.00
/QIP Ydll3.ir E'L'lT.;'/:lf'C' l➢E'rnlit Fee:
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Brs<rja.�/l.ft3c:zatrac�t�tt�tit�rt Fees:
Stronp, Motion Fee: IBSEISMICR
$0.90
Select an Administrative Item
Bldp- Stds Commission .Fee: IBCBSC
$1.00
NN
ON i
$320.90
$0.00 TOTAL FEE:
$320.90
Revised: 01/15/2014
GeoEngineering Consultants (GEC)
7567 Amador Valley Blvd., Suite 108
Dublin, CA 94568
Phone: 925-321-5550
Mr. Ryan Crownholm
Hauling Pros, Inc.
Subject: Proposed Pool Demolition
21373 Dexter Drive,
Cupertino, CA
GRADING REPORT
Dear Mr. Crownholm:
FILE
3-i7 /y
GeV
2
Project No. P14.0146
Mar. 13, 2014
In accordance with your authorization, GEC has provided observation and testing services during mass
grading on the subject property. This report summarizes our observations and the results of the
laboratory and field density tests.
The existing pool was completely demolished. All the decking and swimming pool equipments, pool
structure bond beam, swimming pool walls and slab, electric conduit and gas lines were removed. The
pool was backfilled with import fill.
All fill soils were compacted to a minimum relative compaction of 90% at or above optimum moisture
content.
The satisfactory placement of fill was determined by visual observation, manual probing, and
performing in-place field density tests and laboratory compaction tests. Laboratory compaction tests
were performed to determine the maximum dry density and optimum moisture content for the subgrade
and fill materials. The compaction tests were performed in accordance with Laboratory Test Procedure
ASTM D1557-91.
In order to determine the percentage of maximum dry density (relative compaction) and moisture
content achieved during compaction, in -placed densities and moisture contents were measured using
nuclear gauge density test methods generally in accordance with ASTM 6938-08a. The in-place test
results, including the relative compaction achieved, are summarized in Table II.
Project No. P14.0146 21373 Dexter Drive, Cupertino, CA Mar. 13, 2014
The subject grading operations have been performed in accordance with the referenced report.
Should you have any questions relating to the contents of this report or should you require
additional information, please do not hesitate to contact our office at your convenience.
Very truly yours,
GEC
K
Kamran Ghiassi, Ph.D., P.E., G.E.
Registered Geotechnical Engineer
Attachment: Tables I and II
GEC. Page 2
TABLE I
Geo Engineering Consultants
Client: Ryan Crownholm Hauling Pros Date: March 12, 2014
Project: Pool Backfill 21373 Dexter Drive, Cupertino, CA Project No.:
Project Location: 21373 Dexter Drive Cupertino CA
Maximum Density/Optimum Moisture Determination
Sample Material Description Max Dry Density Optimum Moisture
#1* Dark Brown Clayey Silty Sand & Gravel 136.1 7.5
#2** Reddish Brown Sandy Clayey Silt W/Fine Gravel 127.7 11.4
*Testing performed in accordance with ASTM D1557-07 C
**Testing performed in accordance with ASTM D1557-07 B
TABLE II
Geo Engineering Consultants
Client: Ryan Crownholm Hauling Pros Date: March 12, 2014
Project: Pool Backfill, 21373 Dexter Drive, Cupertino, CA Project No.:
Project Location: 21373 Dexter Drive, Cupertino CA
Density Determination
Testing performed in accordance with ASTM D6938 -08a
Percent
Comp. Curve
90 #1
90 #1
92 #1
94 #1
96 #2
95 #2
95 #2
94 #2
Moist. Dry
Test
Date
Elevation
Test Location
Cont.
Dens.
2014
Pool Area Fill
#1
3/07
FG -4'
33' N & 24'E of the N W House Corner
15.4
122.7
#2
3/07
FG -4'
30'N & 15' W of the N E House Corner
16.2
123.1
#3
3/07
FG -3'
27'N & 21' E of the N W House Corner
12.6
125.3
#4
3/07
FG -3'
36'N & 12'W of the N E House Corner
12.0
127.3
#5
3/10
FG -2'
33'N & 24'E of the N W House Corner
11.5
122.7
#6
3/10
FG -2'
33'N & 9'W of the N E House Corner
13.8
121.8
#7
3/10
FG -1'
27'N & 18'E of the N W House Corner
12.2
120.7
#8
3/10
FG -1'
36'N & 12'W of the N E House Corner
13.1
120.2
Testing performed in accordance with ASTM D6938 -08a
Percent
Comp. Curve
90 #1
90 #1
92 #1
94 #1
96 #2
95 #2
95 #2
94 #2