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D-2017-0022I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2017-0022 19661 VICKSBURG DR CUPERTINO, CA 95014-3321 (369 08 017) DANEB CORPORATION MORGAN HILL, CA 95037 OWNER'S NAME: DIAMOND DIANE M TRUSTEE I I DATE ISSUED: 04/27/2017 1 OWNER'S PHONE: 408-252-5340 License Class A Lic. #4= Contractor DANEB CORPORATION Date 04/30/2019 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 PHONE NO: (408) 779-1461 BUILDING PERMIT INFO: —BLDG —ELECT _ PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: DEMO SWIMMING POOL (560 SF) FOR LANDSCAPE PURPOSES ONLY 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 611V Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $10000.00 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 pe the Cupertino Municipal Code, Section 9.18. kV�ASignature./ i A e Date 04/27/2017 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) i. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 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. 3. 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 ANT 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 04/27/2017 APN Number: Occupancy Type: 369 08 017 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: 04/27/2017 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: 04/27/2017 ALL ROOF COVERINGS TO 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 Cod�Secti'5, 255A3, and 25534. �a Owner or authorized agent: Date: 04/27/2017 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 w SWIMMING POOL 1 SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinq_acupertino.orq PROIECTADDRES5a� ! 6 4 / V®^ *j r'8 o A /� 4� APV 1 7 - OWNER NAME � fw® _ (� �, d/ �J pI �� 01 sl—�'r�(� E-MAIL STREET ADDRESS ag �pA. CITY, STATE, ZIPr/,J//L # FAX SON -TACT NAME- bI3 q40' S7 aW 011 7Ej1L (� a® uyj STREET ADDRESS e �j /l [ - / a� CITY,ST E, 9, / A _ ` l 'c /v❑ fAX ❑ OWNER ❑ OWNER -BUILDER ❑//OWNEERRAGEFNT{J �VT'R.ACiOR ❑ CONTRACTOR(AjGFNT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ 7ENANT C(sg ® I EiRPS '�tJl l�R ((EJM17AiL LI \S�1 TjF� �r] aj ( ( / S / COMP . YAM "'rJ FAX STREET ADDRESS W— r_ CITY, STATE. ZIP PHONE ARCIHTECDENGINEERNAME LICENSE NUMBER BUS. LIC .n COMPANY NAME E ,MAIL FAX STREET ADDRESS CITY. STATE, ZIP PIfONE i� DESCRIPTION OF WORK �. • � ((�_-)- \ M �o T ri 6 ® S f-- N�J! U ®O`er USE OF ❑ SFD or Duplex ❑ Multi-FamilyTYPL' STRUCTURE: ❑ COm1riCYCial MATERIAL TYPE (CODE) AREA (SQ. FT.) VALUATION (x) POOL POOLJSPA MATERIAL TYPE CODES: V - VINYL -LINED F FIBERGLASS G GUNITE P - PREFABRICATED SPA DEMO ^ / RECEIVED BY- - > '•� y+�r�y I 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 ac ee to comply with all applicable local ordinances and state laws relating to bu it ' g nstruction, kqhorizere esentatives of Cupertino to enter the above-identifiedpropertyfofor inspection purposes. Signature of Applicant/Agent: /�\_ �? !� Cha X, Date: �/—� 2_ l SUPPLEMENTAL INFORMATION REQUIRED Commercial or Multi -Family Buildings with Public Swimming Pools: Department of Environmental Health approval required. OFFICE USE ONLY PL AIN CHECK •TYPE ROUTING SLIP © OVER-TIIE C(3UNTER © EXPRESS ❑ STANDARD ❑ LARGE Q MAJOR ❑ IjuzLnlxc DEPT 1:1 PLANNING DEPT 0 PURLICi30RKS DEPT ❑ ENVIRONMENTAL HEALTH ❑ SANITARY SEWER DISTRICT SwimPool,41)p_201 Ldoc revised 03116111 SMOKE I CARBON MONOXIDE ALARMS E OWNER CERTIFICATP®M CMPNCCOMMUNITYDEVELOPMENTDEAENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 -3333 - bujj'd!ngg&g_perKtinio-orq, (408) 777-3228 - FAX (408) 777 rms for required Smoke and Carbonw AlPURPOSE astallation of all - ere no interior access This affidavit is a self -certification for the installation ti R314; R315, 2016 CBC Sections 4:20.6 and 907.2.11.2- compliance with 2016 CRC Section for inspections are required, arms and Carbon GENERAL INFORMATION dwellings shall be provided with smoke Al 0 exceeds and multi family dwe b or repairs to existing dwelling Existinz, single-family I additions, alterations, Alarms and/or When the valuation of a -5 and 4? -0.6 require that Smoke ,Monoxide alarms Section R314, 8315, and CBC Sections 907.2.11.5 $1000.00, CRC Se =_—SMOC�E-: ALARM CO ALARM Carbon Monoxide &janns be installed in the following locations: AREA ------ X tv of the in the immediate vicinity I -11y area door) X Outside of each separate sleeph .1 withianahabitable rmu XX noke alarms shall not be locatecIcsb-�droom(s) - (Sr Xcluding basemeatt!CS foorn=,ev=eir level of a dwelUnIc-Y, unit :y and that :)iy,Lcr roam fiances a :W=ith:�ina�eacdh sle�emoj �'L` al -s which CIO not contain ukeburnit) -acompwith d in dwellin43 alarms shy comply Carbon Monoxide alarms are not require 0 C monoxide alarms combined with SMO an attached -aragl- Carbon of the State Fire Marshal. do- not have approved by the office operate I d. CBC Section 420.6 and shall be appro alarm(s) may be solely battery units no commercial power supply, rations do Po Supply' In dwelling permitted to be solely battery operated where repairs Or alte �ut rnd-Wellhacr,unIts, alarms are or there is -no access by mel�tn is required for In existing 0 finishes alpe the -removal of %vall and ceiling Ons 907.2-11.4 and 420.6-2. An not result in to CRC Section R7314: and CBC Sections space. Refer must be connected to the building wiring -v. e has/have been alarms which the alann(s) referenced above o Bf t1-je above -referenced property, I hereby certify thatliance with theCalifoofAs olvi-ter c, ,,,Titll tmfactiIrer's instructions and in cOmPal, as the d below have . been tested and are installed in accordance W des. The alarms SPecifie and California Residential Co date signed below, ,, ,o Address: Permit NI -0- # Carbon Moyjox ide- Detectors: # Si3oke Alarms'. I Specify Number of Alarms: an I have read and agconditions of this statement ree to c ply with t . he termsDate' 0 ,(OrOwner AgAnts)Narnb 1141ni9lV�si nature .... . .. .......... ............................. Date: ................. 'T'S Llc.# . ........................ ............... ...... ** .... " Contractor Name:sigr�ature .............. ....... * .................. I ............ snake and Cofol-in.doc 1-4sed 01/10/-1,01; CUPER,TINO Owner Name Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 tFAX (408) 777-3333 - building(c cupertino.ora 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. KNo 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. �1�To Go to Question 3. 3. Is water service permanently disconnected for your building? - El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. (k 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. �ACivil 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. Check one of the three following statements and sign bottom of fonn, i heck ONE of the following:property is a single fancily residential real prope . See Civil Code Section 1101.4. and after Jan 1�-�Olurg alt r ons or unprovernents shall require all non-compliant plumbing fixtures oe 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 propeity is a multifancily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant Pplumbing 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). ❑ My property is a conancercial 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 irmprovernents). I, as the owner or oivner'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 110 1. 1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the watAconserving plumbf{i'g fixtures comps with the requirements as indicated in the table on the following i)aQe. / f ; Owner or Owner Agent's Signature: Upon completing and signing this Certificate, please return it to the Building Division in order to final your bu;;ling permit. SB407 2015. doc remised 011'05117 Lr 4 ., . (+vu+u#' i rW7,s r ....�..._ ' �q,.IP11B14Tzn— ',";ISION G r'r_lfINrJ �*a. APPROVE - D1 ArX PROVE —,D1ArX IAMZ)1�0 y� lGC3!i r. �T'ekeptitthe w CK3 u P`%- It is " to make any l' �• Mons on s le ;r to deviate �1 Jkng official, �^�y SHALL NOT T"b ZSZ 53 ! ar �r a ar c(the violation 16r EMT1iy— C' 4rJr r;;^ce or State Law. �,� 4 +n� sb o s4. IF -i 6v o pia t� wrA L13 To ry I Q� VAIVEWAY "?'yga'����r�f ;UPER NO 9uildin.� •tJc1f�TP1�17� �! ?` PZ:, '' FVI( it lt_u C()Ut COMPLIANCE eviewed By V i KS bUR6d' D *