15090110I CITY OF CUPERTINO BUILDING PERMIT I
IBUILDING ADDRESS: 11146 PALOS VERDES DR I FCOONLTRACTOR: RICHIE BOBCAT & ING I PERMIT NO: 15 0901 10
OWNER'S NAME: LIN SHING-FEN
OWNER'S PHONE: 4083900827
LICENSED CONTRACTOR'S DECLARATION
License Class CC, /- /24Y Lic. # 3 / o
Contractor k i uC� .ate 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:
t. 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
Verformance of the work for which this permit is issued.
2. 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.
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.
Signature y7j Date � fSZ
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t. 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)
2. 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.
2. 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.
3. 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.
Signature Date
396 PATCH AVE I DATE ISSUED: 09/17/2015
SAN JOSE, CA 95128 1 PHONE NO: (408) 529-2531
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
DEMO (E) SWIMMING POOL (FOR LANDSCAPE PURPOSES
ONLY)
Sq. Ft Floor Area: I Valuation: $6500
APNNumber: 35620040.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS� /F�RCOfM LAST CALLED INSPEC IOjN.
Issued by: V(Jl�� Date: 1 05
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 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 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 I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
O r or authorized agent:
Date:
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
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 [Tg0110
(408) 777-3228 • FAX (408) 777-3333 • building @_cupertino.orq
SP
PROJECT ADDRESS
OWNER NAME
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PHONE
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME fi '-
LICENSE NUMBER
LICENSE TYPE
BUS. LIC !!
COMPANY NAME,?,,,,, /�
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PHONE
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ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC H
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
all
o t y4�CM
USE OF ❑ SFD or Duplex ❑ Multi -Family
TYPE
MATERIAL TYPE (CODE)
AREA (SQ. FT.)
VALUATION (S)
POOL
STRUCTURE: ❑ Commercial
POOL/SPA MATERIAL TYPE CODES:
SPA
V - VINYL -LINED
F - FIBERGLASS
DEMO
G - GUNITE
RECEIVEDBYTALVA
VALUATION:,, C�j
P - PREFABRICATED
By my signature below, I certify to each of the following: I am the property o er or authorized agent to act onthe property owner's behalf. 1 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 buildi g construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: — \ 4 — �,_s--
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING DEPT
_ Commercial or Multi -Family Buildings with Public Swimming Pools:
Department of Environmental Health approval required.
❑ EXPRESS
❑ PLANNING DEPT
❑ STANDARD
❑ PUBLIC WORKS DEPT
❑ LARGE
❑ ENVIRONMENTAL HEALTH
❑ MAJOR
I❑ SANITARY SEWER DISTRICT
SwimPoolApp_2011.doc revised 03/16/11
IRMO,
CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION
Ic
LM_
ADDRESS: 11146 Palo Verde
DATE: 09/17/2015
REVIEWED BY: PAUL
,,tech. Permit 1,ee:
APN: 356 20 040
BP#:
'VALUATION: 1$6,500
*PERMIT TYPE: Demolition Permit
PL, I,% i )'PE:
PRIMARY
USE: Swimming Pool, Res.
Plumb. Insp. V
PENTAMATION
PERMIT TYPE: 1SFPOOLDEC;
WORK
Demo E swimming pool For Landscape Purposes Only)
SCOPE
Suppl. Insp. Fee:Q Reg. Q OT 10.0
FEE ID # POOLS
1DEMOPRES
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 onlv an estimate. Contact the Dew for addn'1 info.
FEE ITEMS (Fee Resolution I1-053 E�' 7/1/13
.1?ech. Plan Check I I
Mutnb. flan Check
lJec. Plan Check
,,tech. Permit 1,ee:
Plumb. I'er•rnit Fee:
Elec. Permit lee:
!Bier illech. hisp.
Other Plumb last?.LJ
Other Elec. hap. LJ L
Insp. Fec
Plumb. Insp. V
. ln'vp - ,
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 onlv an estimate. Contact the Dew for addn'1 info.
FEE ITEMS (Fee Resolution I1-053 E�' 7/1/13
FEE
QTY/FEE
MISC ITEMS
`iuu Check Fee:
Suppl. PC:' Fee
l'h+mb. /Meeh./Floc
Permit Fee:
$329.00
Suppl. Insp. Fee:Q Reg. Q OT 10.0
1 hrs
$0.00
Plumb.iMech.%Elee
Plumb. !Mech.!Elec Permit Fee:
Construction Tcxx:
Administrative Fee:
WorkWithout Permit'
itIvonced Plan iiin Fee,S:
i ravel Documentation Fees:
Strong Motion Fee: IBSEISMICR
$0.85
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS: 1
$330.851
$0.00 TOTAL FEE:
$330.85
Revised: 07/02/2015
CA*v Vtil-tr95
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ICAL" 10 Z" ii..11Lr4
COMBO BNITY UILDING DEVELOPMENT
VISIION - C PERTINO ENT
This set of plans and specifications MUST be kept at the
job site during construction. It is unlawful to make a y
changos or alterations from the Bun same, or ilding Offici I.
deviate
therefrom, without approval
The stamping of this plan and specifications
of the vioiatio T
be held to permit or to be an app vara t State ti .
f provisions of U.,!7g C)Fdin _
B ..L� invJ
b— DTE _
!2 P RMi-f NO.
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2
SEP 1 A 2015
E BY
V (P e -Kr -1 ii o <A
5 A I , 11-& 'r L r K ge s IJe,6 see
oFFrce eaPY
CUP/ER,rl
r4,urlenr
SEP 17 2015
REVIEWE FOR CODE COMPLIA�
.- - - _.. _ __ ___ _.Reviewed By: Tkv, VCE
CUPERTINO
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(a)cupertino.org ,
Owner Name <IL/,�4C—nZ 41,Z A/ Permit No.
Address
PP,. CA4UZ9 //iGU rA C.4rl
Is your real property a registered historical site?
Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No 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.
Skip the rest of the form and sign bottom of form.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
XNo Go to Question 4.
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. Skip the rest of the form and sign bottom of form.
l 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. Check one of the three following statements and sign
bottom of form..
Please check ONE of the following:
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.
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).
I, as the owner or owner's agent 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 plumbing fixtures cornply with the requirements as indicated in the
table on the following page. ),
Owner or Owner Agent's Signature: Date:��'"7` J
i lnnn rmmnletinn and sipninQ this Certificate_ nIea6,, >1'eturn it to the RuiIdin P d)ivisinn in order to final vnur huiIdin c, permit
SB407 2015.doc revised 08126115
BUILDING PERATIT CANNOT BE FINALED AND COA'IPLETED UNTIL THIS
CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION
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 08126/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixturel
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type
Water U
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
/Flow Raatete
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.
SB4072015.doc revised 08126/15
CUPERTINO
Address
PURPOSE
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 • buildinq(d)cupertino.org
�f(9y'0//0
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION
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
e:
Owner (or Owner Agent' NamLA
/�
Sign ture ..........:. ...................................................................................... Date: G•...'...7.(.....
ConTractor Name:
�Q
1 t�a/If M 0..c S
Si natuf�.......... .... .......................Lic.# ......?J.....119........... Date: Y14 .I.
1"
Smoke and CO form.doc remised 03/18/14