B-2017-0869 •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0869
10878 SYCAMORE CT CUPERTINO,CA 95014-6558(342 57 036) ROYAL POOLS OF
SANTA CLARA
SAN JOSE,CA 95124
OWNER'S NAME: MEHUYS DAVID G TRUSTEE&ET AL DATE ISSUED: 10/20/2017
OWNER'S PHONE:408-718-0679 PHONE NO:(408)371-8000 •
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class SWIMMING POOL Lic.#278052
Contractor ROYAL POOLS OF SANTA CLARA Date 12/31/2018 X BLDG _ELECT X PLUMB
MECH X RESIDENTIAL COMMERCIAL
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. JOB DESCRIPTION:
INSTALL POOL&SPA(490 SF);GAS LINE FOR FIRE PIT
I hereby a i m under penalty of perjury one of the following two declarations:
1: I ave and will maintain a certificate of consent to self-insure for Worker's
ompensation,as provided for by Section 3700 of the Labor Code,for the •
`'performance of the work for which this permit is issued.
/4 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. Sq.Ft Floor Area: Valuation:$52000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 342 57 036
representatives of this city to enter upon the above mentioned property for
inspection purposes. - agree to save indemnify and keep harmless the
City of Cupertino ag.' st li=bilities„judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue agains said r ity in cons-quence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the a.plic-•t underst.'ps'an. • ill comp) 4th all non-point
source regu dors p- the Cupe 1.0., ni .al Cod: -ection 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
•
Signat a / ✓ Date 10-20-2017 Issued by:Kim Dunbar
Date: 10/20/2017
� . ►ER-t. I_D Rt ' L• ' • ►
I hereby:ffirm.that I ant 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,amexclusively contracting with licensed Signature of Applicant: •
contractors to construct the project(Sec.7044,Business&Professions Code). Date: 10-20-2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A”OR BETTER
•
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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)sho d I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equip .•nt or devices which emit hazardous
air contaminants as defined by the Bay • ea •it Quality 4:nagement Dis 'et I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cup: tin s Municipa apter' and
exemption,,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,,S'ctis 25505, 3,•• 25534
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agen __Az
Cil
APPLICANT CERTIFICATION Date:10-20-2017I �
I certify that I have read this application and state that the above information is a .TR�� ate` `t'' �' -��
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is - construction'.ending agenc or the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this per it is Issued(Sec.3097,Civ C.)
to enter upon the above mentioned'property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,'and ezpenses:,which:may accrue against said City in Lender's Address
consequence of the granting of;this permit. Additionally,the.applicant understands
and will complywith;all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18.t I understand my plans shall be used as public records.
Signature Date 10-20-2017 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0869
10878 SYCAMORE CT CUPERTINO, CA 95014-6558 (342 57 036)
ROYAL POOLS OF
SANTA CLARA
SAN JOSE, CA 95124
OWNER'S NAME: MEHUYS DAVID G TRUSTEE & ET AL
DATE ISSUED: 10/20/2017
OWNER'S PHONE: 408-718-0679
PHONE NO: (408) 371-8000
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class SWIMMING POOL Lic. #278052
Contractor ROYAL POOLS OF SANTA CLARA Date 12/31/2018
X BLDG —ELECT $ PLUMB
MECH $ RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
INSTALL POOL & SPA (490 SF); GAS LINE FOR FIRE PIT
I hereby affirm under penalty of perjury one of the following two declarations:
REV #1 - CHANGE ROUTE OF GAS LINE - ISSUE 1/18/2018
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 Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $52000.00
emmit is issued.
APPLICANT CERTIFICATION
I certify, hat I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
342 57 036
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 again bilities, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against s d it in 0?-quence of the gr ting of this permit.
"ng
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the app ca unders sand will coin y all non-point
source regulations er a Cup i o M al C e action 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature c��ate 1/18/2018
1 ��'
Issued by:..Kd� Ulv' �{MG
OMNER-BUIDER DECLARATION
Date: 10/20/2017
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
t. 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: 1/18/2018
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous.=
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equ t or devices which emit hazardous
air contaminants as defined by the Ba Are Air Quali anagement Dis t=I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the C e o Munic a Chapter and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Cod Se ons 2550 , 2553
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized
APPLICANT CERTIFICATION
Date: 1118/2018
1 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
I hereby affirm that therolls a construction lending agen for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lenders Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, -and expenses which may accrue against said City in
Lenders Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 1/18/2018
Professional
CUPERTINO
PURPOSE
SMOKE / 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( cupertino.org
PERT HT CANNOYBETINALED.1 UNTIL : THIS CERTIFICATE HAS BEEN
GONIP .! TED; SIGNEWD AND,I2ETITRNED_TO THE' BITII.RIil'GDiVIS10N
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 R314, 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
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 -burning 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 cominercial power supply, alarm(s) may be solely battery operated.
In existing dwelling s units, alarmare 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: A47 k C1 Cr/� ����� Permit No. -2617 Y67
Specify Number of Alarms: # Sinoke Alarms: = 4 Carbon Monoxide Detectors:
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
✓/,P, eG%f
�y
Signature ........... ... ... .... Date:.�.l..�rf
Contractor Name:
Signature ...... ... ......... I. . ....... Lic.# ....... ..... Date:
Smoke and COfonn.doc remised 0111012017