D-2017-0007CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO: D-20174007
21356 AMULET DR CUPERTINO, CA 95014-1301 (326 43 020) BEYOND
CONSTRUCTION
SAN JOSE, CA 95112
OWNER'S NAME: NATHANI LATIF AND SHARMIN I I DATE ISSUED: 02/28/2017 I
OWNER'S PHONE: 650-750-4055 I I PHONE NO: (408) 898-0662 I
License Class a Lic. #1005442
Contractor BEYOND CONSTRUCTION BUILDERS Date 07/31/2017
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.
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
performance of the work for which this permit is issued.
2. '�lhave 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_
Date 02/28/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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:
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 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 1 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 02/28/2017
PERMIT INFO:
BLDG —ELECT _ PLUMB
MECH X RESHIENTLAI. _ COMMERCIAL
JOB DESCRIPTION:
REMOVE/FILL (E) SWIMMING POOL TO 90% CERTIFIED
COMPACTION
Sq. Ft Floor Area: I Valuation: $7500.00
APN Number: Occupancy Type:
326 43 020
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLE INSPECTION.
Issued by: MELISSA NAME -
Date: 02/28/2017
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: %
Date: 02/28/2017 /
BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
i
Owner or authorized agent"
Date: 02/28/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CUPERTINO
SWIMMING POOL i SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingC�cupertino.org
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STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
USE OF ❑ SFD or Duplex ❑ Multi -Family
TYPE
MATERIAL TYPE (CODE)
AREA (SQ. FT.)
VALUATION ($)
POOL
7_57()r, ()e 69
STRUCTURE: ❑ Commercial
POOL/SPA MATERIAL TYPE CODES:
SPA
V - VINYL -LINED
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as
F -FIBERGLASS
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G - GUNITE
P - PREFABRICATED
RECEIVED
TOT A IQN:
By my signature below, I certify to each of the following: I am the property owner or orized agent to e property owner s I have read this
application and the information I have provided is correct. I have read the Des c ' ro verify it is accurate. I agree to comply with a applicable local
ordinances and state laws relating to build' g con structi . I authorize representativ f Cupertino to enter the above -"d tified pr perry for inspection purposes.
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Signature of Applicant/Agent: _ Date:/
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.
0
❑ EXPRESS
❑ PLANNING DEPT
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❑ STANDARD
❑ PUBLIC WORKS DEPT
❑ LARGE
❑ ENVIRONMENTAL HEALTH
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MAJOR
El❑ SANITARY SEWER DISTRICT
SwimPoolApp_2011.doc revised 03/16111
SMOKE.1 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 • building(c-)cupert! no.ora-
PURPOSE
This affidavit is a, self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with. 2016 CRC Section 8314, R315, 2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single4amily 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 42.0.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed.in the following locations:
-- — AREA j SMOKE ALARNI I CO ALARA/1 I
Outside of each separate sleeping area in the i ediate vicinity of the X —� X
bedroomver(s) - (Smoke alarms shall not be l ated within 3 feet of bathroom door) ;
PT level of a dwellu1au3zit incl�x g basements and habitable attics — X j- h
Within each sleeping room: --�L
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-bun-dng appliances a:, nd i'la t
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply -,vitin
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 ceilinng finishes or there is no access by rn�ans of attic, basement or craw!
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 'B aild:ilg
and. California Residential Codes. The alarms specified below Have been tested and are operational; -as of the "
date sib Zed below. "
l
AddrPermit No 617- 60
ess 4 A
Specit3 1�Tum er of Alarms: _ _ r Smoke Alarinz -1 4 Carbon'TNI
have read and agree to com with the terms nd conditions of this statement
Owner (or Owner Agent's) Name: j
Ci �l 1�Sinatur ........... Date �........ .
Contractor Name:
~Lic,#.............._...................... Date:.........._.......
/ s
�'/n(A, �.i Sionature.
' r�iJ,s / ..., .t/��`�. �............
Smoke and COfonal.doc remised JIi1012017
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
f (408) 777-3228 • FAX (0) 777-3333 • building(-)cupertino.org
Owner Naine �4 I ) ter °o i ) ,a Permit No. L . , _" 2 7
Address
IM
0
1 Is your real property a registered historical site?
❑ Y s Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
4 _ J
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 plumbingfixtures is not technically feasible?
Q Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
The licensed plumber's certification has been provided to the Building Division.
f Skip the rest of the form and sign bottom of form.
c "C 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 fonn and sign bottom of form.
C:31 -11o' Go to Question 4.
4. .Is your real property built and available for use or occupancy on or before January 1, 1994?
0 No 1\4y 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.
r aF_ es 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 forma.
5: Please check ONE of the following:
,,--__j,&-My property is a single-family residential real property, See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or irnproveinents shall require all non-coinpliant 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-conseiving 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
Q 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 properly, certify under penalty of perjury that non-compliant plumbing -fixtures, will be
replacedprior 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 rnia Green Building Standards Code, and manufacturer's
installation requirements, and that the w�,te�conservi pluinbin fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature: �d�C. `"
Upon completing and signing this`C / r rfrcate, pleas to the Building Division in order to final your building pen -nit.
SB4072015.doe revised 08125/15
SILICON VALLEY SOIL ENGINEERING
GEOTECHNICAL CONSULTANTS
File No. SW 631
March 10, 2017
I
Beyond Construction Builders
779 N. 21st Street
San ,Jose, CA 95112 -7 � j1
Attention: Mr. Saul Hernandez
Subject: Swimming Pool Removal
Existing Residence
21356 Amulet Drive
Cupertino, California
TESTING AND INSPECTION SERVICES DURING
THE BACKFILLING OPERATION OF THE
SWIMMING POOL REMOVAL
Dear Mr. Hernandez:
Pursuant to your request, we have performed testing and inspection services
during the backfilling operation for the swimming pool removal. The subject
site is the existing residence located at 21356 Amulet Drive in Cupertino,
California.
The existing swimming pool area was approximately 650 square feet to the
depth of 4 to 8 feet below existing ground elevation. First, the entire pool was
removed. Then, the excavated bottom was compacted. Next, the excavated area
was backfilled with import soil material to the existing ground surface. The
import soil material was moisture conditioned as necessary and compacted in
uniform 12 inch lifts to at least 90% relative maximum density. The backfilling
operation was performed on March 7, 8, 9, and 10, 2017.
A total of 8 in-place field moisture/density tests were performed by our field
engineer using a nuclear gauge (CPN MC -1 DR -P). These tests showed values in
excess of 90% relative maximum density of the backfill material as determined
using the laboratory compaction test procedure ASTM D1 557-12. The results
of the field moisture/density tests are summarized in Table 1. Approximate
locations of these tests are shown on the Site Plan - Figure 1.
2391 ZANKER ROA®, SUITE 350 • SAN JOSE, CALIFORNIA 95131 • (408) 324-1400 • F (408) 324-1404
File No. SV1631
March 10, 2017
As a result of our testing and inspection services, the contractor has performed
the backfilling operation accordingly.
If you have any questions or require additional information, please feel free to
contact our office at your convenience.
Very truly yours,
SILICON VALLEY SOIL ENGINEERING
Sean Deivert
Project Manager
Vien Vo, P.E.
SV163l.BF/Copies
pFtOFESSjp- I
elf M
EXP, '
'�T CtVil �Q-
�T��F CAL1Fd
3 to Beyond Construction Builders
2 SILICON VALLEY SOIL ENGINEERING
File No. SV1631
March 10, 2017
TABLE I
SUMMARY OF FIELD MOISTURE/ DENSITY TEST RESULTS
Test
Date
Test
Moisture
Dry
Rel. Comp.
Soil Type
No.
2017
Location/
% Dry
Density
% of Max.
& Remark
14.5
Elevation
Weight
p.c.f.
X4/51.
11.3
NOTES:
31. L.
SWIMMING POOL BACKFILL
51. L.
1 3/8
X1/3.L.
13.6
108.5
93.5 B
2 91X2/3.L.
15.7
106.9
92.2 B
3 99X3/3.L.
14.5
104.8
90.3 B
4 3/9,
X4/51.
11.3
106.3
91.6 B
5 19X5/5.L.
13.0
106.6
91.9 B
6 3/10
X6/F.L.
11.6
106.6
91.9 B
7 99X7/F.L.
10.2
105.8
91.2 B
8 99Xs/F.L.
12.8
108.6
93.6 B
NOTES:
31. L.
= THIRD LIFT
51. L.
= FIFTH LIFT
F.L. =
FINAL LIFT
B: Light Brown Gravelly Sandy Clayey SILT
3 SILICON VALLEY SOIL ENGINEERING
AMULET DRIVE
I
E
E
C
X3 X7 `
L:X2
X6
X1 X4 X8
ABANDONED SWIMMING POOL
NOTE: X DENOTES APPROXIMATE TEST LOCATION
Silicon Valley Soil SITE PLAN File No.: SV1631 FIGURE
Engineering
Existing Residence
2391 Zanker Road, #350 Drawn by: M.H. 1
San Jose, CA 95131
(408) 324-1400 21356 Amulet Drive
Cupertino, California Scale: NOT TO SCALE March
2017
125
120
ti
L
110
105 +
5
Silicon Valley Soil
Engineering
7 9 11 13
Moisture Content (% of Dry Weight)
15
SAMPLE: B
DESCRIPTION: Light Brown Gravelly Sandy Clayey SILT
LABORATORY TEST PROCEDURE: ASTM D1557-12
MAXIMUM DRY DENSITY: 116.0 p.c.f.
OPTIMUM MOISTURE CONTENT: 11.0%
2391 Zanker Road, # 350
San dose, CA 95131
(408) 324-1400
COMPACTION TEST B I File No.: SV1631
Existing Residence
21356 Amulet Drive
Cupertino, California
Drawn by: M.H.
Scale: NOT TO SCALE
17
FIGURE
2
March
2017