D-2016-0396CITY OF CUPERTINO
BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: D-2016-0396
10394 DENISON AVE CUPERTINO, CA 95014-2429 (316 29 070)
X - TREME
CONCRETE
SOLUTIONS
MILPITAS, CA 95035
OWNER'S NAME: KUO, WEN AN AND TAMI NOZAWALIV TR
DATE ISSUED: 07/19/2016
OWNER'S PHONE: 619-203-0479
PHONE NO: (408) 594-3049
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CONCRETE RELATED SERVICES Lic. #8754 17
TREME CONCRETE SOLUTIONS Date 03/31/2018
—ELECT _ PLUMB
Contractor X -
—BLDG
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 POOL (468 SQ FT) - LANDSCAPE ONLY
I hereby affirm under penalty of perjury one of the following two declarations:
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. ,
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
Sq. Ft Floor Area:
Valuation: $8500.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the abovei
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
316 29 070
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 tions perth e ' o Municipal Code, section 9:118.
180 DAYS FROM LAST CALLED INSPECTION.
Signatur Date 7 1 2016
Issued by: Abby A ende
Date: 07/19/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License L: for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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. 1, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business &professions Code).
Date: 7/19/2016
I hereby affirm under penalty of perjury one of the following three declarations:
I have a Certificate of Consent to self-insirre for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. and will maintain
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
z. Lhave 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 ofthe work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
3. I certify that in the performance of the work for which this' ermit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to becom, subject to the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after ra in � this certificate of
will maintain comp a with the Cope ' o Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensatio provisions of the
the Health & Co ec " n 505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agen .
APPLICANT CERTIFICATION
Date: 7/19/2016
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 arib state laws
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representtatives 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 agaipst 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 Cu � ertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
be used a
I understand my plans shall be used as public records.
Licensed
Signature Date 7/19/2016
Professional
CUPERTINO
SWIMMING POOL I SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 S P
(408) 777-3228 • FAX (408),777-3333 • building a.cupertino.org 03
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PROJECT ADDRESS 0 39/'7i n
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DESCRIPTION OF WORK Po V t >m
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❑ SFD or Duplex ulti-Family
TYPE
MATERIAL TYPE (CODE)
AREA (SQ. FT.)
VALUATION (8)
USE OF
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POOLJSPA MATERIAL TYPE CODES:
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By my signature below, I certify to each of the following: I am tIe property owner or authorized agent to act on the property owner's behalf. I have read this
application and the info have pr vided is corn t. 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 g constructs
orize representatives of Cupertino to enter the above lentifigd property for inspection purposes.
Signature of Applicant/Agent:
Date:
11 ..,.T
SUPPLEMENTAL INFORMATION REQUIRED f oFFICEUSEONtY 1 at
Buildings with Public
Commercial or Multi -Family gs w
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Swimming Pools:s&
Department of Environmental Health approval required.
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COMMUNITY DR/ELOPMENT DEPARTMENT
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BUILDING DIVISIG""', - CUPERTINO
AlnprviaVED
�jons MUST be, kept't t the
specifications
A- -�
This sp any
,t of p!a-ns and unlawful to make
divifl,g construction. It is
or P-Itereftions on same, or to deviat6l-
vjitijout appi—oval from the J30dinc 00I !al.
NOT
of this pla,, and specifications SHAL
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Address to � t
SMOKE J 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 • buildingCa)cupertino.org
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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
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
Owner (or Owner Agent's) Name:
ILJZ
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,
Signature ...... em ......1"7 ......... .................... Date:
Contractorgame:
'
Sinature................................................................... Lic.#...................................... Date: ...................
Smoke and CO fonn.doc revised 03118114
Owner Name
WATER -CONS ERVIN G 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.orp'
Address
1. Is your real property a registered historical site?
0 Yes ' Civil Code Sections 1101. 1, through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
INo 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 nottechnically 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.
V 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.
Lv1 No 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.
—A Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
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. Check one of the three following statements and sign
bottom of form..
Please check ONE of the following:
iK My property is a single-family residential real property. See Civil Code Section 1101.4.
Ori 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).
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 naee. _ A
Owner or Owner Agent's Signature: A\i° 4_ AA, ff,/,, ",-) Date: i%i fya, 2a 20/o �
Upon completing and signing this Certificate, please return it to the Building Division in order to final your buil4fng permit.
SB407 2015.doc revised 08126115
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.doe revised 08126115
Non-Compliant
Water-Conserving Plumbing Fixture
PlumbingFixture
(Fixture Complying with Current Code Applicable to New Construction)
Fixture Type
Maximum Water Usage/Flow Rate
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
Water Usage
/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
Gallons/flush
0.5 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
@ 60psi
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.doe revised 08126115