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D-2017-0053CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2017-0053 1100 ELMSFORD DR CUPERTINO, CA 95014-4909 (362 06 004) X - TREME CONCRETE SOLUTIONS MILPITAS, CA 95035 OWNER'S NAME: VENKAT BHARAT K AND BHARAT APARNA TRUSTEE OWNER'S PHONE: 408-859-1616 LICENSED CONTRACTOR'S DECLARATION License Class C-8: D-06 Lic. #875417 Contractor X - TREME CONCRETE SOLUTIONS Date 03/31/2018 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. I have and will maintain Worker's is 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 sourregulations pe...r the Cupertino Municipal Code, Section 9.18. `�lgnature Date 8/10/2017 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. 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 (See.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: r. 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 perfonnance 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. 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. Date 8/10/2017 DATE ISSUED: 08/10/2017 PHONE NO: (408) 594-3049 PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTIAL COMMERCIAL JOB DESCRIPTION: DEMO SWIMMING POOL (600 S.F.) - LANDSCAPE PURPOSE ONLY Sq. Ft Floor Area: I Valuation: $7500.00 APN Number: Occupancy Type: 362 06 004 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Avende Date: 08/10/2017 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 ofApl Date: 8/10/2017 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 ase equipment or devices which emit hazardous air contaminants as defined bythe Area Air Quality Management District I will maintain compliance with the Cup rtino Municipal Code, Chapter 9.12 and the Health & Safety Co a tions 25505, 25533, and 25534. caner or authorized agent: Date: 8/10/2017 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 CUPERTINO SWIMMING POOL / SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-322.8 • FAX (408) 777-3333 • building(Mcupertino.ora PROTECT ADDRESS I S Ln �� IAPN# 3W - 0 -, 0 [ 4 OWNER NAME re. J V�"n I& a, PHO���+r����" IY E I' fVGNKA If 4 1/ STREET ADDRESS 57 L _ /J�y �LL�n CITY, STATE, ZIP FAX CONTACT NAME �1 . 1(a, PHONEq iit/ STREET TRIM 3 l /jt d ! , - CITY, STATE, /J 1 -(Z313 F*69-7' C1 ^ 1O_ 11 OWNER OWNER-BUILDER❑l OWNERAGENT ONTRACTOR 11 CONTRACTOR AGENT ARCHITECTENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM l i NUMBER LICENSE NUMBER LICENSE �6 BUS. LIC # a COMPANY N:``� —Trima Con Ci- +i SO JiI�%(I , ` NN —Tri M� to CUrkc+C� 1C So 1v laq(g) C YrIC%�� Ft)d '�� / -Id, t9/ " STREET 9G� ' L CITY, STAMP PHq(rat � ARCMTECT/F.NGINEERNAME LICENSE NUMBER BUS. LIC# COMPANY NAME E-MAIL FAX PHONE STREET ADDRESS CITY, STATE, ZIP DESCRIPTION OF WORK rtM6L— i v USE OF L-kSFD or Duplex ❑ Multi -Family TYPE MATERIAL TYPE (CODE) AREA (SQ. FT) VALUATION ($) STRUCTURE: ❑ Commercial POOL POOLISPA MATERIAL TYPE CODES: SPA V - VINYL -LINED DEMO Cprr-e .� U00 F - FIBERGLASS G - GUNITE P - PREFABRICATED EGEII7EDBY r kR, TOTAL VALUATI yJ l 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 law., relating t uildin nstmction. I authorize representatives of Cupertino to enter the above -i enti ed pro erty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION OFFICE,USEONLY .' PLAN CHECK:TYPE _ , ROUTING _ Commercial or Multi -Family Buildings with Public Swimming Pools: ❑ OVER TxE CouNTER� suILDING DEPT Department Of Environmental Health approval required. ,� #A , ❑'" EXPRESS "@a❑Pi ANNING pPPT ©'e STANAARD� '�ILiC WOiiKS DEPT ` ❑' LARGE ❑ ENVIRONMENTAL HE�,�,TII k " ✓,;ss>'� ❑;' ��<.�.� ❑ �` `� MAJOR% .� r ;,SANITARY,S.EWERD.ISTRICT SwimPoolApp_2011.doc revised 03/16/11 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTItNO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino ora PERMi f CANI�I.OTSt" F.INA :ED I7NTIIJ PIIS CERTIETCATE. HAS BEAN C©iVfLEEI➢, ,A1�TD RF TTTR7UTs 1)p T BT1IVISIO _.m...._ ..,.__ . w................._..._... PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,2016 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 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 anattached 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 907.2.114 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 hasihave 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: -A-yl Permit NT Specify Number of Alarms: Alanns: # Carbon Monoxi( I have read and agree to comply with the terms and conditions of this statement Detectors. Owner (or Owner Agent's) Name:t�� 4- — ' 1HA i,R 4 ��� Signature 9` 1� Date: X��3/ Contractor Name: Signature Lic.# Date: Smoke and CO fonn.doc revised 12/15/16 SMOKE / CARBON MONOXIDE ALARMS rip OWNER CERTIFICATE OF COMPLIANCE 4# COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION UPTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 ER (408)777-3228•FAX(408)777-3333•buildinqcupertino.orq Mgr 5_ a - j -*: 5 t_. *3 ,, g, x d t:_ ate0E0ji3'EANANOT 3E Th El TILS T$iS CERTIFICATE.MAS BEE+1 r PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family arid 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 X X the bedroom(s) 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 anattached 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 specified below have been tested and are operational, as of the date signed below. Address: //&O `>-fejt r � r Permifll� � 0/ 7--' .6`'-.7 Specify Number of Alarms: #Smoke Alarms: .�1 �� #Carbon Monoxide Detectors: I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: SHA A C k i s signature Date: y/ �� {fy Contractor,Name: Signature`- Lic.# Date: Smoke and CO fonn.doc revised 12/15/16 f Abby Ayende 08/10/17 08/10/17 D-2017-0053 Abby Ayende