D-2016-0373 -CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2016-0373
1158 SCOTLAND DR CUPERTINO,CA 95014-5026(362 28 008) DIG&DEMO INC
231 MARKET PLAZA
SAN RAMON,CA
94583
OWNER'S NAME: HE JINGQING DATE ISSUED:03/31/2016
OWNER'S PHONE:469-500-1255 PHONE NO:877-933-4448
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class A.C-21 Lic.#293247
Contractor DIG&DEMO INC Date 06/30/2016 _BLDG _ELECT _PLUMB
MECH X_RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
DEMO(E)SWIMMING POOL-FOR LANDSCAPE PURPOSES ONLY
I hereby affirm under penalty of perjury one of the following two declarations: (560 S.F.)
r. 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
ection 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area:560 Valuation:$8000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN
information is correct.I agree to comply with all city and county ordinances Number: Occupancy Type:
362
and state laws relating to building construction,and hereby authorize 362 28 008
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source re do per e Cupertino nicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 03/31/2016 Issued by:ALEX VALLELUNGA
Date:03/31/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I atm exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
t. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:03/31/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Se t' 05,25533 and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. wner or authorized agent:
APPLICANT CERTIFICATION Date:03/31/2016
1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 03/31/2016 Professional
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 S P
CUPERT[[VO (408)777-3228 • FAX(408)777-3333•buildincl(a.cupertino.org
PROJECT ADDRESS j t 5� _DAPN s O(5,6
OWNERNAME ��>N►D� Sk,� 64'rnol He, PHONE /6Y—:5oo �cG E-MAIL eoil
STREET ADDRESS I/ CITYSTATE nD C �! FAX
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CONTACT NAME 5 1 , PHONF�8 77_ -3_4/Lq O E-MAIL
STREET ADDRESS K CITY,STATE, ZI -1 O FAX
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME/ I e 5 LICENSE NUMBER 3 u 7 7LICENSE TYPE�Z I BUS.LIC# 1
COMPANY NAME (��{� �. E-MAIL - 7 FAX
STREET ADDRESS P1 CITY,ST�TE,Zn' cm C A ����2 PHONE 33—
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ARCHITECTIFNGWEER NAME LICENSE NUMBER > BUS.LIC#% / O
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK n
'Pon �o ✓t2
USE OF Ek SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUA ION (S)
STRUCTURE: ❑ Commercial POOL 1
C
(Wy_k 'e14,. S
POOLISPA MATERIAL TYPE CODES: SPA
V - VINYL-LINED
F - FIBERGLASS DEMO
GUNITE
P - PREFABRICATED RECEIVED BY l TOTAL VALUATION:y{/
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 buildi a tion. I au ize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORNPATION REQUIRED oizr 1cE us> onLv'r
PLAN`CAECK T1 PI R0
L7TING SLI P
_Commercial or Multi-Family Buildings with Public Swimming Pools:
:
Departmentn
of Enviromental Health approval required. ovER THE courlTER BUILDING DEPT
❑_EXPRESS ❑;:PLANNING DEPT'
❑`STANDARD , ❑'PUBLICWORKS DEPT,
❑ LARGE ' ❑` EN VIRONNIENTAL HEALTH
❑ \4AJOR,:'. ❑ :SANITARI SEWER DISTRIC.r
Si+,imPoolApp_2011.doe revised 03/16/11
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1158 Scotland Dr
Cupertino,CA 95014
Scale 1"=10'
SMOKE / CARBON MONOXIDE ALARMS
0 011 NER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building(a.cupertino.org
�li'erznzt Via.�
ess- �sLrw�� `. bya` 7a 3�f #oTlarms Smoke = Crb�n Monoie
FERMIT 1(jAN QTBE FINALES AND C(3NIPLETED "TILTHISCERTIIi ICATE
HAS3 EN ANDNTD To ° �OI1II.,D*G D:MSIOX
f'
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 X X
bedroom(s)
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.
1 have read and agree to comply with the terms and conditions of this statement
TQumer�or Owner,4gent'�_Name��
.... ..... ............. . .... ....................... ......... ..............Date; .... ..........
- ntracf4oc.Name: 1
;Si nafC€6 .................................................. ....,,.Lice# ............................... t ................
Smoke and CO fonn.doc revised 03118/14
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WATER-CONSERVING PLUMBING FIXTURES I F I LL-Eg
OWNER CERTIFICATE OF COMPLIANCE4f_1
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)77773333•building&cupertino.org
Owner ame i i�C ', r2 Cel'rmit j d-Z-7 9
dr s 11-5-Y §wdaad r-, C.yeA �9.L v/�l
Is your real property a registered historical site?
El 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.
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?
El 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.
liq No .Go to Question 3.
L Is water service permanently disconnected for your building?
11 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 4.
L 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.
[; 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. Checkone of the threef following statements and sign
bottom of form..
Please check ONE of the following:
l Myproperty 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 Januaiy 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).
El 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 comply with the requirements as indicated in the
table on the following page.
Pwnet or`Owner Agenf s Signa�tu e (D-a� �/�j 11
Upon completing and signing this Certificat6,please return it to the Building Division in order to final your building permit.
SB407 2015.doe revised 08/26115