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15060034 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7569 KIRWIN LN CONTRACTOR:DIG AND DEMO PERMIT NO:15060034 OWNER'S NAME: SAN RAMON,CA 94583 PHONE NO:(877)933-4448 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL POOL DEMO AND BACKFILL-LANDSCAPE PURPOSES License Classq�iTr. Lic.# ONLY ContractorLti3'1 a Date 6,0 ,)_`15 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:$8000 i" 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:35921004 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 WITIHN 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 1807X0O M LASTCALLED INSP CT ON. indemnify and keep harmless the City of Cupertino against liabilities,judgments, Icosts,and expenses which may accrue against said City in consequence of the Issued by: lJJ/?6___Date: (f I✓� granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 918. "tg!7F 1 . . - U � RE-ROOFS: Signature Date / OMM Imf 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 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 2 ;2553_ nd 2553 . 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 CONSTRUCTION LENDING AGENCY 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 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 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 918. Signature Date 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(o1cupertino.org (50"3f"3 CUPERTINO l" �/`"/r PROJECT ADDRESS f�0 j n APN{i ^/ 1 L, C� Y t CONTACT NAME E-MAILPHONE STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ACONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME �' `� � �/ LICENSE NUMBER y yH LICENSE TYPF��j I e / BUS.LIC# (�/V31 I� rJf r- E-MAIL /�l C� FAX COMPANY NAME ` � ` Wn �, ;,��/•�� STREET ADDRESS CITY,STATE,ZIP �,/] �j�tSJ PHO F TZ ) 3 e-1 2(i e, 32 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK `5/r • �O� _ I'• `Irr 14//Ll / IJ�giyr 6i J7riY USE OF ❑ SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION (S) STRUCTURE: ❑ Commercial POOL POOL/SPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEMO GUNITE P - PREFABRICATED -iRECEMD BY TOTAL VALUATION: By my signature below,I certify to each of the following: I amtheproperty o cr 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 c struction. thorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORM ION REQUIRED 'r� Commercial or Multi-Family Buildings with Public Swimming Pools: Y h r R VEIL THE COUNTER `tBUIIDINGD�PT e Department of Environmental Health approval required. x s Y ,t ❑ I XPRESS r a r} t t#❑ PLANNING DEPT.,xt} 1 { a t -_ STANDARD i } c �tyPUBLIC WORKS DEPT ❑�LARGE `I}r � xj +^ENViRONMENTA'HEAL�H . h � �� i u��r rr.�r y t. �` ae -� r fir, r d y r J; A• MA�OR_ ..SSANITARM!SK R<DTSTRICT SwimPoolApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-EUILDING DIVISION ADDRESS: 7569 KIRWIN LN DATE: 06/04/2015 REVIEWED BY: PAUL APN: BP#: 3 *VALUATION: 1$8,000 *PERMIT TYPE: Demolition Permit P1,I N CH CK 7 YP . PRIMARY PENTAMATION 1 SFPOOLDEM USE: Swimming Pool, Res. PERMIT TYPE: i WORK POOL DEMO AND BACKFILL- LANDSCAPE PURPOSES ONLY SCOPE FEE ID #POOLS 1DEMOPRES 1 Hech. Phan Check Phwrb.1'kin Cheek Elec...('lan C'hc�ck Wech. l'emiit Fee: F'h inb. Permit Fee: Elec. I'ernait Fey:: EI-L-(}r7�cr ED--L-- Oler lec. ?sp.Insp. Other fluyah Insrp ttecl:. Lrzsp. Li Fee: P waw.hisp. Fee: kc.111sp.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 prelimina information available and are on1v an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E f. 7/f 1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: suppl. PC Fee .Plurnb./illech.iTlee Permit Fee: $329.00 Suppl. Insp.Fee-0 Reg. Q OT Fo7o hrs $0.00 Plum b./lhfeeh.;E'Iec Plunih./11 Aech./lslee Pernil Fee: Construction Tax: Adininlstralive.1"ee: 6t'ork Without.Permit Advanced Pl n rdm;Fees: 7rovel Doetanentaflon Fees: Strong_Motion Fee: IBSEISMICR $1.04 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: `' $331.04 $0.00 TOTAL I EE: A r. Revised: 05/07/2015 1. 1 - . 1 1 JUN 0 4:2015 t , 1 .9y ' DIGI & DEM) ' D 1 1 1 General` ngineerxngContrarto, E 1 1 License#993947,925-93348 109.00 0 `IENT D ARTMENT Es3Lf I'G0V--i: V-CUP-3TIN0 ✓ --------------------- ---------------------------------------------------------------� 1 kSc-' , 1 1 3tions MJST be kept at the ioi, ;1 a du,;!n:i f o'st Uct1On it IS un1,mrfui to M a.ke Eny -IS it Sar 07 ne t0 C E31+12A Mi`31C0"T1,F`lNitilOut apprcw From th 'Building Otl'icl 1- C14 .N ' 1 � ,,, r e , T{ i_,!lL O` OT ti11S Plan all specific atiOns SFiAI_L C i n. 1 y „i., .a. ' a r�t HOUSE 1 1" c o i,��r to irdin b 31 or�,� -a-to La,n v: i or i' O e`ions off any`"i l:r:lln�lC0 or SiGt2 La, Eaves line P - ---- - ' D�Z _ — 1 _ 1 1 1 1 ' J 1 e O 1 1 LO LID C o ® �N Line f will o 1 CD Z 1 _, Lc co 6.7 Y qj �1J,Sif' (D 1 1 1 1 1 1 0 1 1 1 O1 1 � 1 M A 1 1 1 V �'j ® 1 ' 1 1 1 1 1 1 1 1 1 � 1 1 1 .33 16.48 1 I 1 1 1 , L--------------------- ----------------- Property line 109.00 1 7569 Kirwin Ln Cupertino,CA 95014 scale V=10' f Owner Name ■ WATER -CONSERVING PLUMBING FIXTURES � OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ( 3333 • building(alcupertino.org w ..r 1,' 't Address yz7 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. F r. Owner' Signature:r Date:'/=f 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 -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: a_ ~ { f( No Go to Question 3.'"/ Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. Owner' Signature: Go to Question 4.�� Date, Sign below and skip the rest of the form. Date �_6 /,1- �� 2.915 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. 'Owner' Signature: '� _ Date: mlii�:l r,; Yes 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. .-:X Myp opeiV, is a single family residential real properly. See Civil Code Section 1101.4. "^ Ori- and after, January 1, 2014, building alterations or improvements shall require all non-compliant plumbing .`fix{iiesto lye, replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 20_1fi7,-,a-f�n-compliant plumbing fixtures shall be replaced with water-conservingplumbin fixtures (regardless . of whether property undergoes alterations or improvements). ❑ Myproperty 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-conseiving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conseiving plunbing 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. SB40 7 2 015. doc revised 02/04/15 r- On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving r --plumbrig 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 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 -conserving plum ' .g fu�turescomply with the requirements as indicated in the table below. - Owner's (or Owner Agent's) Signaturte:- 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. SB40 7 2015.doc revised 02/04/15 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 maybe; used to achieve `unavailable, aerators or duction-.,'-` other means may be uSed`to'achieVd 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. SB40 7 2015.doc revised 02/04/15 CUPERTINO Address 7 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 ^ FAX (4 08) 777-3333 • building(o-cupertino.org ,Pe rmi1AID OC,.Wl�C(A/ L/W 6 APERf#of Alarms CmnkP• -'C FILIE 29 %3-r 1� 6lbC_'> _�_ 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 8314 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 Outside of each separate sleeping area in the immediate vicinity of the SMOKE ALARM X CO ALARM X bedroom(s) Contractor Name: On every level of a dwelling urdt 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 in.onoxide 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 .......... ......... ......... .................'.... �Y Contractor Name: ? dyL�7 99J.,!„ J / 1..(........... Q..�-2-3 t.. V (S Ll C- Sign ..................................................Lic.# .... Date: Smoke and CO form.doc revised 03/18/14 J' 42,1r