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15060143 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10823 WILKINSON AVE CONTRACTOR:NOECON PERMIT NO: 15060143 OWNER'S NAME: ALVISO,CA 95002 PHONE NO:(650)630-5967 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL DEMO AND BACKFILL EXISTING SWIMMING POOL-600 License Class Lic.# a ,��� S.F.(LANDSCAPE PURPOSES ONLY) Contractor Date 5 Y 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. Sq.Ft Floor Area: Valuation:_SX�00 NI 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:35613019.00 OccupancN ]'N pe: 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 WITBIN 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 180 PANf FROM LAST CALLED INSPE TIO . indemnify and keep harmlessa City of Cupertino against liabilities,judgments, costs,and expenses which m accrue against said City in consequence of the 6 Date: granting of this permit. Add' ' ally,the applicant understands and will comply Issued by: with all non-points urce re la ns the Cupertino Municipal Code,Section 9.18. �r 1 RE-ROOFS: Signature Date 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) 1,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. I 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 usAqu r devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the i Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with th M nicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 53 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this , Owner or authorized agent: Date: 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 1 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 1 SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 i ' (408) 777-3228•FAX(408)777-3333•building(a)cupertino.org CUPERTINO PROJECT ADDRESS jo (J / lI//C/ APN 4 OWNER NAME �(/ '.[ PHO /(�'5-) 3 G Q q 'j E-MAIL I ( 1 J STREET ADDRESS CITY, STATE,ZIP/� ��� ��/ FAX to �2 3 GI/ C CONTACT NAME PHO S )%3 Q_5- E-MAIL C C",5�Y4 1 /V /�O✓Y1 STREET ADDRESS �JO CI CY,STATE, ZIP / FAX // l r G O ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBS LICENSE TYPE BUS.LIC# X12 spa ' COMPANY NAME E-MAIL FAX n v n STREET ADDRESS IP CITY,STATE,Z -317 so 3Od G& G 6 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC H COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK erno J A'11 /_0 /I zalls m0eyn C pdy,2 63c O'YI USE OF )1�SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION (S) STRUCTURE: ❑ Commercial POOL POOIISPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO 6 G - GUNITE P - PREFABRICATED RECEIVED BY TOTAL VALUATION: T By my signature below,I certify to each of the following: I 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 co ec read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building constru i t orize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: y",' 1 2 SUPPLEMENTAL INFORMAT N REQUIRED OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP Commercial Or Multi-Family Buildings with Public Swimming Pools: E'ER-THE-COUNTER ❑ BUILDLNG DEPT Department of Environmental Health approval required. ❑ EXPRESS ❑ PLANNING DEPT ❑ STANDARD ❑-PUBLIC WORKS DEPT ❑ LARGE ❑ ENVIRONMENTAL HEALTH ❑ MAJOR ❑ SANITARY SEWER DISTRICT SwimPoolApp_2011.doe revised 03/16/11 I CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10823 Wilkinson Ave DATE: REVIEWED BY: Paul APN: 35613019 BP#: `VALUATION: $8,500 ;*-PERMIT TYPE: Demolition Permit PIAN PRIMARY Swimming Pool, Res. PENTAMATION 1 SFPOOLDEM USE: PERMIT TYPE: WORK Demo and backfill existing swimming pool - 600 S.f. (Landscape Purposes Only) SCOPE FEE ID #POOLS 1 DEMOPRES 1 ,ltech. flan Check Plumb. Plan Check Elec..Plan Check :Meeh. Permit Fier Plumb. Permil Fee. (/,-c Permit Fee Other Hec•h. Insp. Other Plumb Insp. Other Elec.Insp. L1ech. Insp. Fee: Plumb, Insp. Fec Glec.Insp. free: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelimina information available and are only an estimates Contact the De t or addn'1 info. FEE ITEMS(Fee Resolution 11-053 E . 7/1/131 FEE QTY/FEE MISC ITEMS Check Fee: rppl. .PC Fee '111mh./111eeh./E lec Permit Fee: $329.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 Plumb.iAllech./Elec Phimb lllech./Elec Permit Fee: Construction Tax: Adininisttrative Fee: 1,Vork Without Permit? �Ivancecl Planning,Fees: ravel Documentation Fees: � Strom Motion Fee: IBSEISMICR $1.11 Select an Administrative Item B1d Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $331.11 $0.00 TOTAL FEE: $331.11 Revised: 05/07/2015 S Ouit)et-•` CAcjtiiCe, Gheo� COQ e wiir►m�rl�° f od / �v �c v'rn�o /rFh 10qg:13 Willci/Jso+� ave �o� �Gn�4 (4Pe PUKPOSc� an /rY (UP-er4-100 CA 9570)y _ FI �`� �.� IVI.D 650) 3y9 - 5-3 �3 JUN 22 2015 LBY i� OFFICE COPY Io 71 l4 S o n A Ue, i s- CJif UNITY DEV- ARTMENT UILDING DI's ;PERTINO �, APS=, 1` I? This set of pl s and MUST be ke tat t N job site duri unlawful to make a/! changes or alterations on.same,or to devi� CUPERTINO ther©from,without approval from the Building e- �O � J � � Building Department The stamping of this plan and specifications Si i,r� v t-(Ar c r�mpv be held to permit or to be an approval of the violation ;;, JUN 2 2 2015 of a ovisions of any City Ordinance or State Law. BY REVIEWED FOR CODE COMPLIANCE DATE I Reviewed By: �s PERMIT NO. "� D�S({GC1v6� Scale; Address r � 0 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a.cupertino.org n 6itl,� Q1 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 includin 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: L -L 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 operate where .repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by eans of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. ec NIEL, permit is re uired for alarms which must be connected to the building wiring. L 1P As owner of the above -referenced property, I hereby certify that the alar e r nce 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 withthe terms_andconditons;;of this;stafeinen;f; Owner (o �errA ent'S;3'a e, a•ti! ....... Sigoature............ t� ....... ., :•Date t.Zl� ....... WW -0 Contracto .. Date: tek.}Signature ......... cu /' ......... Smoke and CO form.doc revised 03118114 J CUPERTINO. Owner Naive Address 17 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 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 110 1. 1 through 110 1. 8 do not apply. Sign below and skip the rest of the form. Owner' Signature: `t.' Date: / OWN Go to Question 2. 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-consery ❑ Yes Civil Code Sections 110 1. 11 ❑ The licensed plumber's c Sign below and skip the rest OfOwner' Signature: N Go to Question 3. 3. Is water service permanently disconnec ❑ Yes Civil Code Sections 110 1. 1 1 y Owner' Signature:. orb], No Go to Question 4. Date: 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 form. Owner' Signature: l y ' 7 Date: I�/ J asp aJ % Yes My real property is built and available or se or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. yproperty is asinglefamily residential real property. See Civil Code Section 1101.4. Qn Mier January 1, 2014, building alterations or iunprovements shall require all non-compliant plumbing -s 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 f thetlrer property undergoes alterations or improvements). ❑- lvl property is a multifamily residential real properly. 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 plurnbing 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). ❑ Myproperty 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. doc revised 02/04/15 On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving R plumbing fixtures throughout the building (regardless .of whether property undergoes alterations or improvements). I/We, 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 110 1. 1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water=Conserv gsplu. f iur oxxlplyK th�the�requ reinent_s, a�ndica ed in the ble�belaw Owner's (or Owner Agent's) Signature: �� " d "' Date: �` C 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. s - SE40 7 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 @.69 psi,'and must .. gallons per,minute @ default to maximum 60 psi, and, must .1.8 gallons per minute @ . default,to: maximum 60 psi1;8 gallons'per minute Where faucets meeting &,60,psi the above are unavailable,' 'Where faucets meeting `aerators or other means` the above are maybe used to achieve unavailable, aerators or reduction', other may be - _means used to achieve �eduction' 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. s - SE40 7 2015. doc revised 02104115