15060033 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10563 ESQUIRE PL CONTRACTOR:DIG AND DEMO PERMIT NO: 15060033
OWNER'S NAME:
SAN RAMON,CA 94583 PHONE NO:(877)933-4448
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E]
POOL DEMO AND BACKFILL-LANDSCAPE PURPOSES
License Classrs��..tI GZ' e #
r=�V�rt aNk ONLY
Contractor Dat 7-,x
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 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:32644020 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 180 D S FROM LAST CALLED INSP CT ON.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, �(��(� '
costs,and expenses which may accrue against said City in consequence of the Issued by:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per a Cupertino Municipal Code,Section
918. - RE-ROOFS:
Signature �. Date P All roofs shall be inspected prior to any roofing material being installed.If a roof is
CO r
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION Date:
Signature of Applicant:
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)
HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
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
the Health&Safety Code,Sections 25505,25533,and 25534.
I have and will maintain Worker's Compensation Insurance,as provided for by IN=51
—
�,
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ''�� � - ate:
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
CIJPERTINO
(408)777-3228^ FAX(408)777-3333•building(@cuprti
eno.Grg M&Q93�
PROJECT ADDRESS ash r®�` P� APN# �`J C)9
OWNER NAMEc � L PHONE/
;
STREET ADDRESS VA®r•1_ �^� 1 a? CITY, STATE,ZIP /' � � e. �g �7 FAX
CONTACT NAME `�• PHONF qZ ) �a@Ly �v E-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 'A
A CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPES �Z BUS.LIC#
COMPANY NAME / ® _ L� E-MAIL t I dC � FAX
li
STREET ADDRESS /jam �� i / 9_ .ef �� CITY,STAT ,ZIP go ®� �jPHONE
ARCHITECT/ENGINEER NAME if 1.( 1 `7,C• °}P LICENSE NUMBER r V, BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK e Boo f znt o k'H o n � 3 ` ,1 6
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
e
F - FIBERGLASS DEMO
G - GUNITE LUQ
P - PREFABRICATED RECEIVED BY - t TOTAL VALUATION:„-[7�
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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: ( �5
SUPPLEMENTAL INFORMATION REQUIRED
__4
� ., rr,
PLAN CHECK TYPE ` I' .,ROtJTING:SLIP
Commercial or Multi-Family Buildings with Public Swimming Pools:
-- OVER THE COUNTER " + G UILDINDEPT s
Department of Environmental Health approval required. £x 4 x i r x
�❑ EXPIIES5' �.,.° a� �� * , �� PLANNING DEPT � � �' � q `
$ x
❑ LARGE w ;' i�, ElYVIRONMENTAL HEALTH '+
LT
❑„MA70R_ . ` +0.SANITARY S40
EWERDISTRICT
SwimPoolApp_201 1.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10563 ESQUIRE PL DATE: 06/04/2015 REVIEWED BY: PAUL
APN: 326 44 020 BP#: "VALUATION: $8,000
*PERMIT TYPE: Demolition Permit PL4N C 11hCK TYPE.
PRIMARY Swimming PoolRes. PENTAMATION 1 SFPOOLDEM
USE: 9 , PERMIT TYPE:
WORK POOL DEMO AND BACKFILL- LANDSCAPE PURPOSES ONLY
SCOPE
FEE ID #POOLS
1DEMOPRES 1
Mech.Plan Check Plumb. Plan Cheek Elec.Plan(.°{zeck
Lgech. Permit Fee: Plumb. Permit Fee: Vec.Permit Fee:
Other Rech.hasp. Other Plumb Insp. Other Elec.Insp.
Li
lleclz.Insp.Fee: Plumb.Insp.Fee: Lilec.Insp. Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS
Plan Check Fero:
Suppl. .P(l Fee
Plumb.1,11ech.IElec
Permit Fee: $329.00
Suppl. Insp.Fee-(E) Reg. 0 OT F0701 hrs $0.00
Plum b./ilfech.IElee
Plumb.iillfech.iElec Perni t Fee:
Construction Tax:
Administrative Fee:
YY(.)rk Without.Permit?
Advanced Planning Flees:
Travel Documeniation glees:
Strong Motion.Fee: IBSEISMICR $1.04 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
y
4 SUBTOTALS: $331.04 $0.00 TOTAL"°FEEL 1
Revised: 05/07/2015
PmutIVED
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JUN 0 4 2015
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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 • building cupertino.org
��d E
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
Wifl- n.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 arid 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.
x
................. . .Date: "
Smoke and CO forn:.doc revised 03/18/14
IP
�1
FIL
11
WATER -CONSERVING PLUMBING FIXTURES /�-�S
OWNER CERTIFICATE OF COMPLIANCE r
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPERT1RO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
1y4; Y ('408} 777 3228,.FAX.(408)777;3333 buildinaCa�cupertino,ora�
Owner Name
Address
rb&Y� t-:�>Ar
160
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: Date:J,�-
No`' Go to Question 2. - ✓) -rxREM �
2. Does your real properly 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: Date:.
" � ��
®moo Go to Question 3. v .
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: _ Date:
M ;_No' . Go to Question 4. 20
4. Is your real property built and available for use or occupancy on or before January 1, 1994? U�
❑ 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: (,v^ZtJ
YesMy 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.
ya-Myproperty is asingle fancily residential real properly. See Civil Code Section 1101.4.
On. anclMr-Zanuaiy 1, 2014, building alterations or improvements shall require all non-compliant plumbing
,1x. to -es be re laced with water -conserving plumbing fixtures throughout the building. On or before January 1,
'2017, all nona compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless
of whetherpi:operty undergoes alterations or improvements).
{..
®!rM.yp;opeity rs a multifamily residential real property. See Civil Code Section 1101.5.
0n 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.
SB40 7 2 015. doc revised 02/04/15
----0A-6r before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving 16
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 -conserving plumbing frxtures-coinply with-the.requirements.as,indicated in the table below.
Owner's (or Owner Agent's) Sightur� ��_ - 'S = Date: (s- _/ WA
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 7-evised 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,.,maximurn
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
:tle"a66ve'are'
may be used to achieve
.unavailable, aerators or
reduction: `
other means, may be
--
:0.:
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 7-evised 02/04/15