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D-2017-0023CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2017-0023 21618 ROSARIO AVE CUPERTINO, CA 95014-4769 (356 19 015) PHILLIP D BJURMAN SARATOGA, CA 95070 OWNER'S NAME: PARTHASARATHY MOHAN AND PADMAPRIYA TRUSTEE OWNER'S PHONE: 408-813-1600 License Class GENERAL ENGINEERING CONTRACTOR Lic. #87(1250 Contractor PHILLIP D BJURMAN Date 04/30/2018 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. V 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 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 relat nRto building construction, and hereby authorize representatives of thisity 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. n Signature \— Date 5/1/2017 OWNER -BUILDER DECLARATION 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: i. 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 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 5/1/2017 DATE ISSUED: 05/01/2017 PHONE NO: (650) 906-7533 BUILDING PERMIT INFO: —BLDG —ELECT _ PLUMB MECH X RESIDENTIAL COMMERCL4,L JOB DESCRIPTION: DEMO SWIMMING POOL (450 S.F.) - LANDSCAPE PURPOSE ONLY Sq. Ft Floor Area: Valuation: $8000.00 "N Number: Occupancy Type: 35619 015 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende 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:/15 /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(x) 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, ections 25505, 25533, and 25534. Owner or authorized agent: D Date: 5/1/2017 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 • C 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 • buildingAcupertino.org PROJECT ADDRESS z mtT f "i,o J J V � APN # a 1 OWNER NAME 4 � por PHONEC_ j 0e 313-1610d a3 d / E-MAIL 1 f m 6 STREET ADDRESS i / /F? f,Jr� f) „ CITY„ STATE, ZIP r "j,7�" l� l � ( FAX CONTACT NAME Alt G,5 �"`vY PHONE E-MAIL l ., Y�z.� � 0(� GIN,D•C!3 t STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT _ r (1 ` CONTRACTOR NAME Pa LICENSE NUMBER [ �} 7�� LICENSE TYPE BUS. LIC # yl �^ !`,fir l (J (X/ L t COMPANY NAME E-MAIL I r�(c� ��! jGv FAX /rl f 1P v�v�a��u� V 4L STREET ADDRESS CITY, STATE, ZIP lc Ptow) � I, ev, S ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK USE OF SFD or Duplex ❑ Multi -Family TYPE MATERIAL TYPE (CODE) AREA (SQ. FT.) VALUATION ($) STRUCTURE: ❑ COmmereial POOL POOUSPA MATERIAL TYPE CODES: SPA V - VINYL -LINED F - FIBERGLASS DEMO G - GUNITE P - PREFABRICATED (p�� RECEIVEDBY: 4' (, TOTAL VALUATION: AR +� 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 agree to comply with all applicable local ordinances and state laws r bm , e struc n. nze representatives of Cupertino to enter the above-idjentified_property for inspection purposes. f Signature of Applicant/Agent:-- Dater (� SUPPLEMENTAL INFORM TION REQUIRED OFFICE USEONLY PLAN CHECKTI'PE ROUTING SLIP _ Commercial or Multi -Family Buildings with Public Swimming Pools: ©OVER-THE-COUNTER ET BUILDING DEPT Department of Environmental Health approval required. ❑ EXPRESS ❑ PLANNING DEPT ❑ STANDARD ❑ PUBLIC WORKS DEPT ❑ LARGE ❑ ENVIRONMENTAL HEALTH ❑ MAJOR ❑ SANITARY SERER DISTRICT SwimPooUpp_2011.doc revised 03/16111 LUJ SMOKE I CARBON MONOXIDE PLIAN OWNER CERTIFICATE OFCOE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 ( 08cu eKno.or (408) 777-3333 - buildin 4 ) 77 7-3228,FAX §­, Q�11 ­�RI*11 � _f ­­ - Ajfor PURPOSE f or the installation of an required Smoke and Carbon Monoxide arms terior access This affidavit is a self -certification 2016 CBC Sections 420.6 and 907.2-11.2.wheie no I compliance with 2016 CRC Section R314; R315, for inspections are required. INFORMATION Smoke Alarms and Carbon GENERALINFO gs shall be provided with SMO dwelling units exceeds, 'tin, single-family and multi -family amily dwelling alterations, Or repairs to existing b and/or Exi 0 arms. When the valuation of additions, .2.11.5 and 4? -0.6 -require that Smoke Alarms Monoxide al and CBC Sections 907 $1000.00, CRC Section 8314f 8315' e installed in the following locations' ZE—AL—AR-11"47 ALARM Carbon Monoxide Alarms b STY101 CO A AT? -PA. X Outside ate sleeping area in the immediate vicinity of the oom door) de of `each s -ed within 3 feet of bath, X X edroom (s) - oke alarms shall not be located _,ts and abitable attics b basements X On every level of a dwellin(FI, nitirlcluclinc`r Within each .sleepircr room wl-d ch (10 not contain luel-burning appliances and that Carbon . on Monoxide alarms are not required in dwellingscomb with smoke alarms Shan comply with C attached -arage. Carbon monoxide alarms CO do not have an attacl 0 0 d by the Office of the State Fire Marshal -rove CBC Section 4206 and shall be app jy, alaym(s) may be solely battery operated. commercial power supp . or alterations do units with no ry operated where repairs awl Power Supply: 'n dwelling are permitted to solely battery ellin, units, alarms - ori or there is no access bymeans of attic, basement Or clin existing d�v 0 -dt is required for I,.:) ofwall and ceilin" fir"not -result in the ieInOval 0 .11.4 and 420.6-2. An electrical pernspace. Refer to CRC Section R7,14 and.CBC sect907.2 alarms which mustbe connected to the buildiliS Wiring' the ala-rm(s) referenced above has/ha-ve been certify that ce with the California Building 0 f the above -referenced property, I hereby d in complian erational, as oft he As owner 0 th the n-Lanuf actarer's instructions an installed in accordance fied below have been tested and are op Codes. The alarn-'s mss oe z 4 and California Residential date signed below. Avk -9 � A - T) etp-ctors: Fi:D Address' Detectors: - Specify Number of Alarms', Name: Owner (or Owner (-,_2,ReLor Name. # Ca ox T 7 f with the terms and conditions of this staterne" - with a ................ ............. I have read and agree to nature.... ... ....... Date-: ................... I ature .................. Smoke and Cojro ...... d,,,.,,i,,d 01/10/201; WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION J�j I 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 cupeR.TtNO Aj (408) 777-3 28 - FAX (408) 777-3333 • building cDcupertino.org Owner Name -f—C H-f� SP" f -A 7 wy Permit No. Address 2-I lb I'i' (I,rf'a -A'e- C e- nD A 220 1. Is your real properly 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 fonn. $L No 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 fonn. 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. XI 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. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. � 1 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 fora.. 5. Please check ONE of the following:. My properly 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). ❑ Mypropel y 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). I, as the owner or owner's agent of this property, certify under penalty of peijury 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 page. Owner or Owner Agent's Signature: f� �� Date: lid '9- 17 4;-1 ­­ T,,i;1(iinanrn-nit_ Upon completing and signing mis L-erailcalc, ptca�,c icLU1111L w Lily. 1,LLll--1 5.. .­.. --- -- --- _- --- - , SB4072015.doc revised 01/05/17 /P� AZI'S 9S f p,4 C UID E 11 11140 �3ufldhng l3epartirinein't REWEMED F�Ul CODECWMI[AANCE RevkMe�J ByAbby Ayeinde Date, 05/007 3 M NIITY DZr LOtEN]- DEPARTMENT G OPROVED -7-7 —sit of j�� T ',- , et -A -C iLHing ("On Oar f �L,,A � %cf , 7ful to i nalke any changes or ("fl7 It is 'ink'i baits w i sai T i c, or to deviate the refroi r, wi tho Lit alp proval from the Building Official. "T"i'm starnpling of this plan and spocificaboi is SI-IAI I 1140T Itc held to perm4 or to t�c an approval oP the violation or ai y provision of any Cl1y Oidinance oState Law By DA TE gl Coo ?-V"AVwq 55*3 �-A^