D-2018-0059 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CON'T'RACTOR: PERMIT NO:D-2018-0059
20105 FOREST AVE,CUPERTINO,CA 95014-2008(31633068) O
ER'S NAME:DONG LUN AND ZHANG LU DA 06/2018
OWNER'S PHONE:408.585-9966 PHONE No:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Up.#
Contractor OWNER/BUILDER Date —BLDG_ELECT_PLUMB
1 hereby officer that 1 am licensed to der tire, nisloiis of Chapter 9(commencing —MECH$RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. SOB DESCRIPTION:
DEMO POOL&SPA-(300 SF)FOR LANDSCAPE PURPOSE ONLY
I hereby affirm tinder 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 Seetimu 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
a. 1 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:$10000.00
APPLICANTCERTIFICATION
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 316 33 068
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City In consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 8-6-2018 Issued by:Kim Dunbar
Date:08/06/2018
OWNER-BUILDER DECLARATION
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.of is
r. wner 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)
a I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date:8-6-2018
I hereby affirm under penalty of perjury one of the Following three dedaratimrs: ALI,1300E COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
/ Tl, z. 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 25534.1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter
ertify that in the performance of the work far which this permit is issued,[ Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ m crson in an manner so as to become subject to the material.Additionally,should 1 use equipment or devices which emit hazardous
p y` y p y ma J air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will mainhtin compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25.505,2 5 3,and 25534.
Labor Code,l must forthwith comply with such provisions or this permit shall
be deemed revoked Owner or authorized agent:
APPLICANT CERTIRFCATION- Date:BB-6-2018
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGICNCV
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there Is a construction lending agency 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 Lender's Name
to save Indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City In - Lender's Address
consequence of the granting of this permit.Additionally,the applicant understands
and w111 comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. �QX 1 understand my plans shall be used as public records.
Signature P� C.J Date8 6-2018 Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2018-0059
20105 FOREST AVE CUPEXFINO,CA 95014-2008(316 33 068)
ER'S NAME:Dong Lou And Zhang Lu DAT 6/2018
OWNER'S PHONE:408-585-9966 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lid.#
Contractor OWNER/BUILDER Date _BLDG_ELECT_PLUMB
I hereby affirm that I em licensed under the provisions of Chapter 9(commencing MECII X RESIDENTIAL COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
DEMO POOL&SPA-(300 SF)FOR LANDSCAPE PURPOSE ONLY
1 hereby affirm under penalty of perjury one of the following two declinations:
n. I have and will maintain a certificate of consem to self-insure for Worker's REV#1-POOL AREA FOR FUTURE CONSTRUCTION(PROVIDE
Compensation,as provided for by Section 3700 of the Labor Code,for the ENGINEER COMPACTION REPORT PRIOR TO FINAL)-ISSUED 8-
performance of the work for which this permit is issued. 16-2018
x. 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 poor Are.: 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 APN Number: Occupancy Type:
and stale laws relating to building construction,and hereby authorize 31633 068
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this perm
Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 8-16-2018 Issued by:Kim Dunbar
Date:08/06/2018
OWNER-BUILDER DECLARATION
I hereby affirm that turn exempt from the Contractor's License Law for one at the RE-HOOFS:
]'allowing two reasons: - All roofs shall be inspected prior to any roofing material being installed.If a roof is
n. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an nspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for mspeetion.
sale(Sec.7044,Business&Professions Code)
1 11, x. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
cli/ contractors to construct the project(Sec.7044,Business&Professions Cade). Date:8-I6-2018
1 hereby nflirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z I have and will maintain Worker's Compensation Insurance,as provided for by I have read the ha ander s 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 25534.1 will
permit is issued - maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work far which this permit is issued,l health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ an a an mttnner so as to become subject to the nnuterla.Additionally,should I use equipment or devices which emit hazardous
p y• y person i y J air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California.If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: •e�1"'-�—•XX
APPLICANT CEWOFICATION Date:8-16-2018
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to buil 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 Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's 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.
Signature Date 8-16-2018 Licensed
9 Professional
Friar Associates, Incorporated
Soils . Foundations
Engineers Consultants
Geotechnoloqv
2656 Nicholson Street, San Leandro, CA 94577
Tel: (510) 351-3930 Fax: (510) 351-1020
DEABREU CONSTRUCTION
2308 Asilomar Drive
Antioch CA 94509
Gentlemen:
October 23, 2018
Project 1854-20105ForestAv
Field and Laboratory Testing
Swimming Pool Backfill
20105 Forest Avenue
Cupertino California
FILE
As requested, we were at the subject residence on Tuesday, October 2, 2018 and Thursday,
October 4, 2018 to test the backfill for the demolished swimming in the backyard area. The
residence is located on the north side of Forest Avenue between Randy lane and Toni Court in
Cupertino, California.
The backfill was placed after the demolition and removal of the swimming pool shell. The soil
exposed at the bottom of the pool (after demolition) was scarified, water conditioned and
compacted. Import soil used for the backfill was then placed in about eight -inch uncompacted
lifts, water conditioned, compacted and tested. The field compaction tests were done using
ASTM Test Method D6930-10 (Nuclear Method, Shallow Depth). To monitor the field
compaction, specimens of the soils used in the backfilling were tested in the laboratory in
accordance with ASTM Test Method D1557-12. The results of the field and laboratory testing
are attached.
Sincerely,
FRIAR ASSOCIATES, INCORPORATED
John H. Friar
/ 'fT�
CE 52281
;' No. C0122i 'O
�I
Attachment
Exp.
C I V L
���
OF CA��F���
B. HILLEBRANDT SOILS TESTING, INC.
PROJECT NO.
DAILY FIELD REPORT
PAGE NO.
1 OF 2
PROJECT NAME
CLIENT OR OWNER
DFR SEQUENCE NO.
20105 Forest Ave, Cupertino
1
GENERAL LOCATION OF WORK
OWNER OR CLIENTS REPRESENTATIVE
DATE
DAY OF WEEK
Swimming pool backfill
10/2/2018
Tuesday
GENERAL CONTRACTOR
GRADING CONTRACTOR
PROJECT ENGINEER
Bye Bye Pools
GEN'L CONTRACTOR'S SUPERINTENDENT OR FOREMAN
CONTRACTOR'S SUPERINTENDENT OR FOREMAN
TECHNICIAN
Alec Boliver
SOURCE AND DESCRIPTION OF FILL MATERIAL (IMPORT OR SITE)
WEATHER
TYPE OF WORK
Clouds, mild
Compaction
DESCRIPTION OF EQUIPMENT USED
FIELD TESTING REFERENCE CURVE
Dry Moisture %. of Max Max. Dry Optimum
Test Elev. Density Content Dry Curve Density Moisture
No. Test Location (ft) (pcf) N Densit No. (pcf) M Comments
1 Pool in Rear Yard FG -3.5' 105.1 19.3 91.0% 1 115.5 14.2
2 Pool in Rear Yard FG -3.5' 104.2 18.8 90.2% 1 115.5 14.2
3 Pool in Rear Yard FG -3.5' 106.6 17.4 92.3% 1 115.5 14.2
NOTES (Describe work completed during the day, including problems and their resolution)
I arrived at the site at approximately 11:30 am, as requested, to check compaction of the fill that was placed in the excavation
where a pool was removed. I performed a standard count to calibrate my gauge and the then took 3 tests. The soil felt firm
when driving my slide hammer and the tests passed the relative compaction requirement. I left the site at 12:00.
�.v ,. •,`,. � � I mrd ';
.jt-
r
�) ' r ! t✓
�
rte_ � I
ter{ � � .•
TIME BILLED
MILEAGE
NO. OF VISITS
PHOTOS
1yes
COPY GIVEN TO:
3.25
1100
1
The locations and elevations of testing are approximate and are based upon grade stakes established by others in the field or from Information provided by the contractor.
Horizontal and vertical limits of operations performed were determined by others. Locations are referenced by description or by grid.
B. HILLEBRANDT SOILS TESTING, INC • 29 SUGARLOAF TERRACE, ALAMO, CA 94507• EMAIL: SOILTESTING@AOL.COM • CELL: 510409.2816 • FAX: 925-691-9267
B. HILLEBHANU I WILa I w, InO, m., . �� �........�.,._. . _... -..--• - -- --- - .
PROJECT NO
B. HILLEBRANDT SOILS TESTING, INC.
PAGE NO.
DAILY FIELD REPORT
1
1 OF
PROJECT NAME
CLIENT OR OWNER DFR SEQUENCE NO.
2
20105 Forest Ave, Cupertino
GENERAL LOCATION OF WORK
OWNER OR CLIENTS REPRESENTATIVE DATE DAY OF WEEK
10/4/2018 Thursday
Swimming pool backfill
GENERAL CONTRACTOR
GRADING CONTRACTOR PROJECT ENGINEER
Bye Bye Pools
GEN'L CONTRACTOR'S SUPERINTENDENT OR FOREMAN
CONTRACTOR'S SUPERINTENDENT OR FOREMAN
TECHNICIAN
Alec Boliver
SOURCE AND DESCRIPTION OF FILL MATERIAL (IMPORT OR SITE)
WEATHER
TYPE OF WORK
Clouds, mild
Compaction
DESCRIPTION OF EQUIPMENT USED
FIELD TESTING REFERENCE CURVE
Dry Moisture % of Max Max. Dry Optimum
Test Elev. Density Content Dry Curve Density Moisture
I
No. Test Location (ft) (pcf) (°/,) Density No. (cf) (%) Comments
4 Pool in Rear Yard FG 104.2 15.2 90.2% 1 115.5 14.2
5 Pool in Rear Yard FG 107.0 14.4 92.6% 1 115.5 14.2
6 Pool in Rear Yard FG 106.6 14.0 92.3% 1 115.5 14.2
NOTES (Describe work completed during the day, including problems and their resolution)
to compaction of the fill that was placed in the excavation
I arrived at the site at approximately 11:30 am, as requested, check
where a pool was removed. I performed a standard count to calibrate my gauge and the then took 3 tests. The soil felt firm to
stiff when driving my slide hammer and the tests passed the relative compaction requirement. I left the site at 11:50.
t,
TIME BILLED MILEAGE NO. OF VISITS PHOTOS COPY GIVEN TO:
3.00 1100 11yes
elevations of testing are approximate and are based upon grade stakes established by others in the field or from information provided by the contractor.
The locations and
Horizontal and vertical limits of operations performed were determined by others. Locations are referenced by description or by grid.
wu re oarm. FLIAII - SOILTESTINGO.AOL.COM • CELL: 510-409-2816 • FAX: 925-891-9267
B. HILLEBHANU I WILa I w, InO, m., . �� �........�.,._. . _... -..--• - -- --- - .