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D-2017-0005CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2017-0005 21590 FITZGERALD DR CUPERTINO, CA 95014-1240 (326 47 008) BOB'S BOBCAT SERVICE INC SAN JOSE, CA 95128 OWNER'S NAME: DICKMAN LLOYD I TRUSTEE & ET AL OWNER'S PHONE: LICENSED CONTRACTOR'S DECLARATION License Class CC -12 Lie. #530421 Contractor BOB'S BOBCAT SERVICE INC Date 05/31/2018 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: 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. 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 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 pgr the Cupertino Municipal Code, Section 9.18. Date 02/14/2017 ISSUED: 02/14/2017 NO: (408) 998-8766 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REMOVAL OF SWIMMING POOL - (FOR LANDSCAPE PURPOSE ONM Sq. Ft Floor Area: I Valuation: $14000.00 "N Number: Occupancy Type: 326 47 008 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 02/14/2017 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) 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: 02/14/2017 hereby affirm under penalty of perjury one of the following three 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. 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. s. 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 tothe Worker's Compensation laws of California. If, after snaking 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 02/14/2017 ALL ROOF COVERINGS TO BE CLASS "A" 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(a) 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, 255331 and 25534. Owner or authorized agent; Date: 02/14/2017 CONSTRUCTION LE ING ACE I hereby affirm that there is a construction lending agen y for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DEC LAR ATION I understand my plans shall be used as public records. Licensed Professional SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinaPcupertino.org D- J,11A) j PROJECT ADDRESS � 1 C " LIL U J _ APN # 3 2 q -- -OOff e/ /f-q� OWNERNAME L / [�C �� FL Er�U STREET ADDRESS C �` M j� PH O8) le CITY, STATE, ops 6vc/t� FAX CONTACT NAME 0 ` r/nIe1c7�i PHONE C r EMAIL STREET ADDRESS (� /� p LB ( /�-�, /AGENT}� CITY, STATE �,4 ''F ^7C 11OWNER El OWNER -BUILDER El ER OWNV CONTRACTOR 11 CONTRACTOR AGENT El ARCHITECT ❑ ENGINEERR ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME "Ie f� / /� rl n/ LICENSE, NUMB15-3 ER 6t; LICENSE1Ty> E BUS. LIC # / `j COMPANY NAME (' jj^^ r � C FIS (� t�666 �/ rJ (✓'/G� E MAIL ! G JG t � � t l/} s ce-z-, FAX k , i'�� e! S STREET ADDRESS / / n J j G CITY, TAT a J� [J ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK :`� �r�b-� PC6L &..4�_ C USE OF El SFD Or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial TYPE MATERIAL TYPE (CODE) AREA (SQ. FT.) VALUATION ($) POOL` POOUSPA MATERIAL TYPE CODES: V - VINYL -LINED F - FIBERGLASS G - GUNITE P - PREFABRICATED SPA DEMO RECEIVED BY: TOTAL VALUATION: t%d 6W. By my signature below, I certify to each of the following: I am the property owner or autAorized hgent to act on the property owner's behalf. I have read this application and the information I have provide iS correct.ey have reed theDescription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil ' cti I auth fiZe resentafives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: `— �� — SUPPLEMENTAL INFORMATION REQTJlft#D _ Commercial or Multi -Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. OFFICE USE ONLY PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ EXPRESS ❑ STANDARD ❑ LARGE ❑ MAJOR ❑ BUILDING DEPT ❑ PLANNING DEPT © PUBLIC 1VORKS DEPT ❑ ENVIRONMENTAL HEALTH ❑ SANITARYSER'ERDISTRICT - Swi7nPoo1App_2011.doe revised 03/16/11 CUPERTINO PERIM ` ' s PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with.2016 CRC Section R314, R315, 2016 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 8314, R315, 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 j Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) -- (Smoke alarms shall not be located within 3 feet of bathroom door) X X , On every level of a dwelling unit including basements and habitable attics _ X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burrihig 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 alterationns do not result h -i the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section 8314 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 specified below have been tested and are operational, as of the date signed below. Address: ® Ft -120 wa. ICL ---D✓j -t Specify Number of Alarms: # Smoke Alarms: Cupe 0 Permit No. 2 ®/7-Z— OOOS # Carbon Monoxide Detectors: I have read and agree to comolvyvith the terms and conditions of this statement Ow6er (or O ner Agen 's) Name: �" 40 G y'IGt✓S Si nature ...................... �..... ......................Date: 49 ...1 . Cor3jractor Name: % n�1 Signature............U!� ........... .... �...... ........................... Lic.# .....1.!�Z...�.......... Date:! +,.7..:%. �- - Smoke and CO forna.doc remised 0111012017 0/71t Owner Name Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408 777-3 8 - FAX (408) 777-3333 • build ina(a.cupertino.ora 1P "� tstn n v! Permit Nn .. ✓ai 9 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. fro 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. C+ Ko 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. Lid' 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.. r I 1 5. Please check ONE of the following: NMy 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 prdperty undergoes alterations or improvements). ❑ My property is a co»amercial 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 a d California Green Building Standards Code, and manufacturer's installation requirements, and that the �ix water -cons plurmt}ifies co� y with the requirements as indicated in the table on the following nage. �� , o Owner or Owner Agent's Signature: Date: Upon completing and signing this rfncatb, ple# fetum it to the Building Division in order to final your building permit. SB4072015.doc revised 08126/15 1. it the existing plumbing fixture water usage/t_low rate is equal to or lower than the figure shown, it is not required to be upgraded. SB4072015.doc revised 08/26/15 Non-Compliant Water-Conserving Plumbing Fixture Plumbing Fixturel (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 @ 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. it the existing plumbing fixture water usage/t_low rate is equal to or lower than the figure shown, it is not required to be upgraded. SB4072015.doc revised 08/26/15 '�- COMMUNITY DEVE_OPI c.WDEPAPTMENT BUILDING DIVISION -CUPERTIN0 - - -- - - T" ,,,t of p!--rs and spF lfic ions MUST be kept at the I_,._ ->T�.- '^,'-t� ter.--+t"';m^L:.»-.-.•a^1•_U k--lrY _ —.— y. �_. _ ._ _._ � _..--__..,........<_ t �... r Oil a'M), or to dENia d - �� u,msu�ap i cval frofn thq 3ijilding Official. n this h ... Mics inns SMALL NOT i v AI 0 I - ion i c i provisions of any C i y din riea r State Law. f y,,t €-1 •lug\s. N £ mn to 9lIlmft OFFICE CO .� _-� �i q�