15080025I CITY OF CUPERTINO BUILDING PERMIT
1 BUILDING ADDRESS: 21613 LA PLAYA CT I PCONSTRA FOR: BURKETT'S POOL PERMIT NO: 15080025
I OWNER'S NAME: LUBBEN RICHARD T AND GALE L 1 600 N FRONTAGE RD I DATE ISSUED: 08/04/2015 1
OWNER'S PHONE: 4084463838 1 RIPON, CA 95366 1 PHONE NO: (209)529 -6944
LICENSED CONTRACTOR'S DECLARATION
License Class ` �i Lic.4 Cob
Contractor BtArke S P0Q 1 P , Jej
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
erformance of the work for which this permit is issued.
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. / p�
Signature `G� /" Date
❑ OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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.
Date
JOB DESCRIP'T'ION: RESIDENTIAL ❑ COMMERCIAL
REMODEL (E) SWIMMING POOL, INCLUDING RE-
PLASTER,
TILE & CHANNEL DRAIN
Sq. Ft Floor Area: Valuation: $12200
APN Number: 35623009.00 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FRO SPECTION.
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 2.5534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the
Health & Safety Code, Section 25532(x) 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 1
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 2550 s 25533, and 25534.
Owner or authorized agent: ate: —'�
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
CUPERTINO
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE > CUPERTINO, CA 95014 -3255
(408) 777 -3228 ^ FAX (408) 777 -3333 ^ buildings Dcupe rtino. org 5'_0 9�' 00 Z_5
PROTECT ADDRESS
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C1 OWNER 1-1 OWNER-BUILDER 11 OWNER AGENT El ❑, CONTRACTOR ACONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME AO L BLAB— LICENSE NUMBER
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ARCHITEC'UENGINEERNAME LICENSE NUMBER
BUS. LIC #
COMPANY NAME
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STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
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USE OF ❑ SFD or Duplex E] Multi - Family
TYPE
MATERIAL TYPE (CODE)
AREA (SQ.FT.)
VALUATION (f)
STRUCTURE: ❑ Commercial
POOL
POOLISPA MATERIAL TYPE CODES:
SPA
V - VINYL -LINED -
DEMO
F -FIBERGLASS
O - GUNITE
P - PREFABRICATED
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TOT VUA�TI�OpN{:
By my signature below, I certify to each of the following: I am the property owner
ed agent to act on the property owner's ehalf. I have read this
application and the information I have provided is correct. I have read the Descr'
of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bmng construc Non. I authorize representatives of Cupertino to enter the above- iRdeentifiied roperty for inspection purposes.
d
Signature ApplicantlAgent C.y� /rGfi2
Date: r—
of /gam,.
SUPPLEMENTAL INFORMATION REQUIRED
r4s oFFlcEUSEOIVLr
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_ Commercial or Multi- Family Buildings with Public Swimming Pools:z
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Department of Environmental Health approval required.❑
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Sw iinPoolApp_201 1. doc revised 03116111
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FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21613 LA PLAYA CT DATE: 08/0412015 REVIEWED BY: MELISSA
Phunh. flan Check
APN: 356 23 009
BP#:
"VALUATION: 1$12,200
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Other Elec. hasp.
1PENTAMATION 1GENRES
PERMIT TYPE:
WORK
REMODEL E SWIMMING POOL INCLUDING RE- PLAS -rER "FILE & CHANNEL DRAIN
SCOPE
PME Plan Check:
$0.00
Permit Fee: Hourly Only? ()Yes 0 No
$0.00
Suppl. Insp. Fee:G Reg. Q OT
Fo.oThrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C'ansiruct ion Tax:
A(ltninislralive Fee:
0
0
Work Without Permit? C) Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
0
0
Travel l)ocumentalion Fees:
Strong Motion Fee: IBSEISMICR
$1.59
3.0 hrs
$429.00
Inspections
ISTINSP Inspection, Hourly
I'
Alech, Plan Check.
Phunh. flan Check
Flee. Plan Check
,1.111 111. Fermi[ Fee:
Fl,'Itimb. Permit Few
Fclec. Permit Fee:
Other Aflech..Insp.
Other Plunlb hasp.
Other Elec. hasp.
dlech. Insp. Fee;
0.0
lec Insp. Fee.-
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 nreliminarv, information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolulion 11 -053 Eff. 711113)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes 0 No
$0.00
�-J hours
$143.00
Plan Check, Hourly
ISTPLNCK
Suppl. PC Fee: 1E) Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? ()Yes 0 No
$0.00
Suppl. Insp. Fee:G Reg. Q OT
Fo.oThrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C'ansiruct ion Tax:
A(ltninislralive Fee:
0
0
Work Without Permit? C) Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
0
0
Travel l)ocumentalion Fees:
Strong Motion Fee: IBSEISMICR
$1.59
3.0 hrs
$429.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.591
$572.001
TOTAL FEE:
$574.59
Revised: 07/02/2015
CUPERTINO
S r1021, E CAMo EOr` r10O NOXIDE A AM S
OO ivy I 2E ET CEr1II a ICA ITI wool WCO PLIa CE
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014 -3255
(408) 777 -3228 ^ FAX (408) 777 -3333 > building(a)cupertino.org
Address `� I G � 3 L R-- �-L �ly✓� �� C� � hl
PERMIT CANNOT BE 1FE4A1L]EID AND COMPLETED UNTIL TMS CERTIFICATE
lE1Ir� 1 K1�1 AND >�lE ���?l� TO THE BUIDLIDIl�IO I[D1[�][SIOlY
PURPOSE
This affidavit is a self- certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single - family and multi - family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to comply with the terms and conditions of this statement
wner (or Owne Agent' ame:
&
Signature ...... . . . ......
...... .............. .........................Date: .t
Contractor Name:
Signature.................................... ...............................
Lic.# ....... ............................... Date: ........... I.......
Smoke and COfwnz.doc revised 03118114
CUPERTINO
Owner Name t c
\I
r'!.•, � -� -C � `I '� ;- ����'V;!G F'LU�'JE iJG F X UF'�ES
iIT ,4i (", '-i31111 LI OUNIIO W NOW W I URI A arffl E
COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255
(408) 777 -32 8 e FAQ 008) 777 -3333 ^ buildinaCc)cuoertino.oro
Address `� 1 3 L#q PL 4 r A a. Cc., 1 Vk 0 �'
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIYISION
Please refer to the attached California Civil Code Sections 1101.1— 1101.8 which are part of this Certification form.
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature:
No Go to Question 2.
Date:
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation of water - conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Sign below and skip the rest of the form.
Owner' Signature:
No Go to Question 3.
Date:
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the fonn.
Owner' Signature:
No Go to Question 4.
Date: -1-16-157
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the fonn.
Yes
Owner' Signature:
Date: q _l t— I'S
My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached.
3 My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non - compliant plumbing
fixtures to be replaced with water - conserving plumbing fixtures throughout the building. On or before January 1,
2017, all non - compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures (regardless
of whether property undergoes alterations or improvements).
• My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water - conserving plumbing fixtures.
On or before January 1, 2019, all non - compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
• My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water - conserving plumbing fixtures.
SB407 2015.doe revised 02104115
On or before January 1, 2019, all non - compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
UWe, the owner(s) of this property, certify under penalty of perjury that non- compliant plumbing fixtures will be replaced
prior to date specified above with water - conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through
1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation
requirements, and that the water- conservin mbi ,g fix s cojp ith the requirements as indicated in the table below.
Owner's (or Owner Agent's) Signature: Date:
Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit.
1. If the existing plumbing fixture water usage /flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015. doc revised 02104115
Non - Compliant
Water- Conserving Plumbing Fixture
Plumbing Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage /Flow Rate
Fixture Type
Water Usage
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
/Flow Rate
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
Single- Family
Multi- Family
Commercial
Residential
Residential
Water Closets
Exceed 1.6
Single flush toilets: 1.28 gallons /flush
(Toilets)
Gallons /flush
Dual flush toilets: 1.28 gallons /flush effective flush volume (the composite,
average flush volume of two reduced flushes and one full flush
Urinals
Exceed 1.0
0.5 gallons /flush
Gallons /flush
Showerheads
Exceed 2.5
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per minute
U.S. EPA WaterSense Specification for Showerheads
(A hand -held shower is considered a showerhead.)
For multiple showerheads serving one shower, the combined flow rate of all
showerheads and /or other shower outlets controlled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
allow only one shower outlet to be in operation at a time.
Faucets —
Exceed 2.2 gallons
Maximum 1.5 gallons per
Within units:
0.5 gallons per minute @ 60
Lavatory
per minute
minute @ 60 psi; minimum
Maximum 1.5 gallons
psi
Faucets
0.8 gallons per minute @
per minute @ 60 psi;
20 psi
minimum 0.8 gallons
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
60 psi
Faucets —
Exceed 2.2 gallons
1.8 gallons per minute @
1.8 gallons per minute
1.8 gallons per minute @ 60
Kitchen
per minute
60 psi
@ 60 psi
psi
Faucets
May temporarily increase
May temporarily
up to 2.2 gallons per
increase up to 2.2
minute @ 60 psi, and must
gallons per minute @
default to maximum
60 psi, and must
1.8 gallons per minute @
default to maximum
60 psi
1.8 gallons per minute
Where faucets meeting
@ 60 psi
the above are unavailable,
Where faucets meeting
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction..
other means may be
used to achieve
reduction.
1. If the existing plumbing fixture water usage /flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015. doc revised 02104115
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