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15060193CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10239 PALO VISTA RD CONTRACTOR: A-1 POOL REMOVAL PERMIT NO: 15060193 OWNER'S NAME: TAMBE ATUL A AND ROHINI A P O BOX 1212 DATE ISSUED: 06/30/2015 OWNER'S PHONE: 4089961956 CAMPBELL, CA 95009 PHONE NO: (408) 978-2903 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL _ �i License Class C �� Lic. # /�� % DEMO OF EXISTING POOL (540 S.F.) - FOR LANDSCAPE PURPOSES ONLY (� Contractor Date 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 C9rq nation, as provided for by Section 3700 of the Labor Code, for the p ormance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $7500 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: 35701072.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 180 DAYS FROM LAST CALLED INSPECTIO . indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ���/ `U granting of this permit. Additionally, the applicant understands and will comply rrLt CJ. Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. % r� RE -ROOFS: Sign re 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 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. I will 1 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 for the Health & Safety Code, Sections 25 05, 255339 534. 67 Section 3700 of the Labor Code, for the performance of the work which thisOwner or authorized a nt �� 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 LENDIlVG 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 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 • building(a1cupertino.org SP / ^7 / � APN #' -�,%- ©fE-MAIL ' FRADDRISS ��/Q!�/ �) PHONE / STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL / r STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME l� ) f UUl LICENSE BFR % / LICENSE P� / BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP / PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ❑ SFD or Duplex ❑ Multi -Family TYPE MATERIAL TYPE (CODE) AREA (SQ. FT.) VALUATION (S) USE OF POOL STRUCTURE: ❑ Commercial POOLISPA MATERIAL TYPE CODES: SPA V - VINYL -LINED DEMO ( F - FIBERGLASS 7 G - GUNITE P - PREFABRICATED f IPC T!1�'Ei)13Y': / j h 1 `'ice TOTAL VALUATION: 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 relating to building co I au resentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: (� Z ~- SUPPLE ENTALORM IO QUIRED OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP ❑ Commercial or Multi -Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. OVER-TITE-COUNTER BUILDING DEPT /❑ EXPRESS ❑ PLANNING DEPT ❑ STANDARD ❑ PUBLIC WORKS DEPT ❑ LARGE ❑ ENVIRONMENTAL HEALTH ❑ AIAJOR ❑ SANITARY SEWER DISTRICT SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINO 150601q3 D FEE ESTIMATOR - BUILDING DIVISION FEE ID # POOLS 1DEMOPRES i ADDRESS: 10239 POLO VISTA DRIVE DATE: 06/30/2015 REVIEWED BY: PAUL Vo. -h P�,rui! { oi- APN: 357 01 072 BP#: "VALUATION: $7,500 c PERMIT TYPE: Demolition Permit LAN CHECK TYPE: PRIMARY Swimming Pool, Res. USE: Plumh. /rasp. Fee PENTAMATION 1 SFPOOLDEM PERMIT TYPE: WORK Demo of existing pool 540 S.f. - FOR LANDSCAPE PURPOSES ONLY SCOPE Suppl. Insp. Fee.0 Reg. Q OT FEE ID # POOLS 1DEMOPRES i 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 preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 a.'711,173) Afech. Plan Check Phunh. Plan Check Elec. Plan Check Vo. -h P�,rui! { oi- P"onit T: iTc l71. "' rmir V Other Hech. Insp. Other Plumb Insp. Other Llec. Irup, Alech. Insp. Fee: Plumh. /rasp. Fee l;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 preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 a.'711,173) FEE QTY/FEE MISC ITEMS Plan Check Fee. SUPPL PC I't� Plumb.lec Permit Fee: $329.00 Suppl. Insp. Fee.0 Reg. Q OT 0.0 hrs $0.00 Plumh.:`f11<ch.-`Flee Permit Pee: Construction Tax: Administrative Fee: ifFork Without Permit? Advanced Planning Fees.- ees:Travel � TravelDocumenlalion Fees: Strong Motion Fee: 1BSEISMICR $0.98 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $330.98 $0.00 TOTAL FEE: $330.98 Revised: 05/07/2015 CUPERTINO Building Depa►tment JUN 3 0 2015 IR VIEWED F05 RQDE COMPLIAW I i we _ OFACE COPY u J I S N 30XIS 'v -s - To r3 C � /vou�f3v1 tr��l 0 �2 L 4" L) S C ,4,P f� OAIZ 1-7 . /VOT � : CC Q (Ur/PNI t -KT 7"o $E CAPPED 4-kFMoVFD 't'UTLsThr/ f- ,/" 5---- C (P CQ 12' ',1MUNITY DEVELOPMENT DEPARTMENT R BUILDING DIVISION - CUPER FINO APPROVED -is set of plans and specifications MUST b kept at the .b site during construction. It is unlawful t make any changes or alterations on same, or o deviate therefrom, without approval from the Buil ing Official. The Stamping of this plan and specificat:ons SHALL NOT be held to permit or to be an approval of IIM77e ition of any isions o an City Ordinance or State -aw. S BY L>( l✓pDATE• T in 8 I: PERMIT # I5 PhLo V.TSTA- P CoP r -P T ru0 � 7 0 I y F RO^T r- E T lSb�b13 COMPACTION REPORT IS REQUIRED SHOULD THE ABATED AREA !3E DECLARED."BUILD,4BLE"-MI THE FUTURE, �� ,- L—_ CUPERTINO Address 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 • buildingaC_.cuyertino.org 1V rf'- Permit No. ' ISr'� # of Alarms Smoke: j- Carbon Monoxi,�Ie: H IE 0; iT (ANNOT BE FINAIA t)�_� �i) COI\SI'LLt 1.I) l 1 I IL ��III� i I.izTII�1C.�"I I r � II S EILE °' < ( 1 i ALN f) J, I t it h LU I IiF I3C IL1)I'�(i MVI it)ti PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section 8314, 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 a ree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: _ ��----77 Signature...................... :!. �................................................• .....�//SDate: ................... Contractor Name: Signature...................................................................Lic.#...................................... Date:................... Smoke and CO form.doc revised 03/18114 CUPERTIN© WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.org Owner Name At L) ( Pen -nit No. GO 60 / 93 Address 2 3 y ()a (u v i 51" LL fey �-j ria C �'`1 �i S A I 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. G Date: 71611-5- 2. /6%/s 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: 7 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 form. Owner' Signature: No Go to Question 4. Date: 4. Is your real properly 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: Date: 74611-5— Yes Yes My real property is built and avaia�or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. Myproperty is a single family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or irnprovements shall require all non-compliant plumbing fixtures to be replaced with water-conseiving 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 nzultifanzily 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-conseiving 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 coninwrcial 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. SE40 7 20J5. doc revised 02/04/15 I On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving t� plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). 1/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 1101.1 through 110 1.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table below. Owner's (or Owner Agent's) Signature: Date: �7/& /ej Upon completing and signing this Certificate, please return it to the Building Division in order to final your pen -nit. 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. SB4072015.doc revised 02/04/15 F a, Non -Compliant Water -Conserving Plumbing Fixture PlumbingFixture (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 maybe 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. SB4072015.doc revised 02/04/15 F a,