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D-2016-0374 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2016-0374 11107 LINDA VISTA DR CUPERTINO,CA 95014-4753(356 06 019) MIN �I N V i{�� OWNER'S NAME: XING MIN I V /� '`A DATE ISSUED:04/05/2016 OWNER'S PHONE: �- u S _22_02_ PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor Date _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: POOL(900 S.F.)AND SPA(53 S.F.)DEMO-FOR LANDSCAPE I hereby affirm under penalty of perjury one of the following two declarations: PURPOSES ONLY 1. 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. z. 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. Sq.Ft Floor Area: Valuation:$14000.00 APPLICANT CERTIFICATION VI 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 356 06 019 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 regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSP CTION. Signature Date Issued by:Alex Vallelunga Date:04/05/2016 r OWNER-BUILDER DECLARATION I hereby affirm that I am 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 1. 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) 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: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 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 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,Sections 25505,25533,an 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revolted. •w, ec odwauthoriztsdlragd-nP APPLICANT CERTIFICATION Date: I certify that I have read this application and state that the above information is C ere is ION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is 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 I understand my plans shall be used as public records. Code, Section 9.18. Licensed gnatre v Date professional SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 S P CdJPERT[NO (408)777-3228• FAX(408)777-3333•building(d.)cupertino.org -U _ 0 PROJECT ADDRESS V� � t o p J)t . APN!! / r OWNER NAME � n X 1 11PHONE61 f'!- 6��- Z ! E-MAIL�/ 1 v 3�3(��l�/ , STREET ADDRESS-a f �y ap LAI d/4-4 CITY, STATE,Z1P�,B e� `�v , 9�a1� FAX CONTACT NAME v L/ H JA o PHONE/�_�V1L/ l r 2�� E-vfAIL��e�O/ O _/O�, o STREET ADDRESS ��O -t Wr t� -PIN r �•� CITY,STATE,ZIP� - r6i n O ` CA Qs� 1$X ❑ OWNER OWNER-BUILDER (� ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# C � COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSENUMBER BUS.LIC# ° COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK J/ / FAA Q F ( J / T q A D 'Fok IM0,56APIAMt Pdk.0:� 7 . 5 s F WAC, USE OF SFD or Duplex El Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION (S) STRUCTURE: ❑ Commercial POOL C 00 000 / POOLISI`kI IATERIALTYPE CODES: SPA /'/7/I J GP L F TIE 53 2 OF V - VINYL-LINED ��(/�v ' F - FIBERGLASS DEN40 C'- GUNITE 1' - PREFABRICATED TOTAL VALUATION: By my signature below,I certify to each of the following: I am the prope _ ner or au ed as o act on the io owne read this I have rethis D application and the information I have provided is correct. I have read the escr i o and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construe; . I authoriz represents ryes of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: ��3 �'�14 SUPPLEMENTAIPRFORMATION REQUIRED o`FHICE use oNn PLAN CHECK TYPE ROUTI\G SLIP _Commercial or Multi-Family Buildings with.Public Swimming POOLS: A' Department of Environmental Health approval required. ❑ OVER THI+r.0 TER ❑ !BUILDWG DEPT ❑':EaPRESS ❑ PLANAING DLPT.' STANDARD ❑::�.PUBLIC:WORICS DEPT ❑ LARGE ❑' ENVIRONMENTAL HEALTH ❑i,D4AJOR.' ❑ •LR DISTRICT SwimPoolApp_201].doe revised 03116/11 � r 1� �ALS + tFi�CilfAi'�.�1�� r NA An.r � tcr:a � .fasYri � �k s}. ra.t3e�� ' ra rpt a€ la's z gs It Wtl3 aal"i®aaa mad,fni►.►¢I ►�t t# ��r f� fi►�"�3d��1 w�z��el��t43 �r��t� iGa�a�� a�r 1#Et' i� i"rr�lte '��. � �.a�t��ar�aa,.t��f�,+7 .f^a�►^��:uEat :�• 7,Vg�w1-T o2" f,i r '+ m 'err�:w i; �ram tc�+ w;•4 ' i �ai¢ r>ra 'xitsi 'lt �l.tifcstsydt�txr#t'st �3 : E s t ; t t d° r r:E �t n'i wr:rsr a•rty.-° o esu.• r €s r0. ` iriy :tawf Wr� tTid :a Fx Pro "vert zomw-'rm"I'm l A wef"- w Olt*04T ti.* p4n.:pt--a: ai in tt e pwmy J�14s Y''nVter-sur. 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E:� `��t a C.e R Y.m pity+�i�Pi . ;vm sem., �Ia I6w ed Cid+",I,m m&-;b}a;z taa V I> ' 4 r 'ab VON!,.30 -towd Ice. ".z ei LaF MomCt .� :44 toot cAra',"ia�f Whim t �er�IdSGa� 1C " S tarp: rr r V r 01011744 int t car ihe pmmw ,,docur fair:e rr^ *ri 443'1 �i ''�%"3't �iCT �9e �a�sf{�. ��s.,�:i..='�� .�t�k�a,>�+'� •�`¢�'�` 't�i�j�3f•4�P"�"1�a°d C ��'�°��'uX"I{�� it�S'�i i#1,}.I�(4 H �+�6+9�`�t.*' i"�+.i��`R)a�s'�r'`t+.��a."��.'Bj�a�.'!9's`•Ai.�'.6:'��.tC.�ar�li.lt.i 's�iir�.�.i� �?�l`� "�.�' �itfiS YI`V d*..�.18�i�' ?'a�Fi`C .�.tt�3i ..�d�'f�..yl��.:i��. No'w� �r' s"�}}tiC L2 / —— - ®. \ ( 1 ' 1 1 ,' f( 1 lbw\` - l /'' -- -�- p p•.:� ��r 1 Al M \ ;Nxc.pNmvpeSe[Om] \. ETV-4 -------__� ---------------- --- ---- Wl $ � I ��5(' x�\ i P ttUilliTY , r� R�nr f`Y }�RTU1�N\\ \; ��✓'�� /_ __ i COM' t� .1 �c ii li\l0 �• �� 1� ""0' ^ \\L\ i J ��✓� I\ G' o the J I a I I Thin U, �f l,`c!!nS a. s Y h s� tli;iaVLit!1 ii;; t. l r`ICI, �IIC�,\ tl tll� 1 1 ''\N!F na T1 art 1111 o �C ) i ..', io is i -o a a� � yboy �;,► s� Pi,�d �`l�C' , = U '�rz OW � y N XING RESIDENCE ~ 11107 Linda Vista Dr. .77 6WV i Cupertino, CA 95014 �-� � SII III SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE F11 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERT[talGy 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333 building(a)cupertino.org Aa_ Permit No. lC, +6 q dr-ess—� 7 LkOCPA IS Smoke Carbon Mo oxide? PERMIT CANNOT BE E HALED AND COMPLETED UNTIL THIS CERTIFICATl+ . HAS BEEN SL ''�L AND RST TRNFD TC3 THE BUILDING 13IYISIflN ILL.. _ 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 interioi 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 an /or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM C0 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 appliai ices 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)maybe solely batter 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 ha /have been installed in accordance with the manufacturer's instructions and in compliance with the Californi i 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 I-Ownerl-0of Owne Agents)Name:-D, Si nature f...... . . ........ .... .. .... ........ ? Date ....... Gorifr,,actor Name: Sinature ...... LiC 7.................................... ate.................. Smoke and CO forni.do rei4sed 03/18/14 WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE FILE COMMUNITY DEVELOPMENT DEPARTMENT,BUILDING DIVISION r CUpERTINp 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 VI (408)777-3228•FAX(408)777-3333 a bullding(aD_CUpertino.org _ Owner Namei Permit Non b®"QG� _. Address Q_V�VnST �, 1. 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. ~� 16No 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? 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. 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. No Go to Question 4. Li 4. Isyourreal property built and available for use or occupancy on or before January 1, 1994? 3 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 Jorm. 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.. 5. Please check ONE of the following: C 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). DMy 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). 1,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 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 on the following page. Owner or Owner Agent's Signature,[ Date: Upon completing and signing this Ceiti ate,pl e return it to the Building Division in order to final your bu ilaing permit. SB4072015.doc revised 08/26115