B-2016-2597CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2597
10041 PHAR LAP DR CUPERTINO, CA 95014-1111 (326 18 027)
NOR-CAL
RENOVATION AND
CONSTRUCTION INC
SAN JOSE, CA 95118
OWNER'S NAME: KIM JOO W AND MEEJA Y
I
BATE ISSUED: 08/26/2016
OWNER'S PHONE: 408-257-9979
PHONE NO: (408) 979-9595
LICENSED ONTRA TOR' DECLARATION 1
BUILDING PERMIT INFO:
License Class CC-27 Lic. #768413
Contractor NOR-CAL RENOVATION AND CONSTRUCTION INC Date 07/31/2017
X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH 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:
REMOVAL OF POOL/SPA; REMOVAL OF POOL EQUIPMENT;
I hereby affirm under penalty of perjury one of the following two declarations:
REMOVAL OF CONCETE
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.
Sq. Ft Floor Area:
Valuation: $6500.00
APPLICANT CERTIFICATION
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
32618027
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 Cup*go Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature 1 Date 08/26!2016
Issued by: Kim Dunbar
OWNER-BUILDER DECLARATION
Date: 08/26/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
-ROOFS:
following two reasons:
All roofs shall be inspected to
Pe prior y 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. 1, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 08/26/2016
1 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
s. l certify that in the performance of the work for which this permit is issued, I
Health &i Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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
APPLICANT CERTIFICATION
Date: 08/26/2016
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
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
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
1 understand my plans shall be used as public records.
Code, Section 9.1$.
Licensed
Signature Date 08/26/2016
Professional
SWIMMING POOL 1 SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT ® BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 95014-3255 S P
408 777-3228 • FAX 408, 777-3333 - buildina cu ertino.or
L/
PROJECT ADDRESS 0 °
OWNER NAMEPHONE
R�kqoly
STREET ADDRESS CITY, TATE ZIP a �-A S/ FAX
CONTACT NAME@
c�►g P0S g��7� EMAI[�?�g r/vtS ,
STREET ADDRESS �- CIT STATE ZIP FAX
1:1 OWNER ❑ OWNER -BUILDER ❑. OWNERAGENT CONTRACTOR _E CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER n DEVELOPER TENANT
CONTRACTOR NAME LICENSE NUMBER IEZ
BUS. LIC #
'7'C -0-Y13 C- S` 3
COMPANY NAA Eo
E MAu, � g I✓� Y' � w; � pis . Hca FAx
STREET ARRSIS i �EecsC-� CITY, STATE, ZIP - y PgH�ONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTION OF WORK
�k vR � r '
USE OF SFD or Duplex p Multi -Family
STRUCTURE: Il Commercial
TYPE MATERIAL TYPE (CODE)
POOL z_/
-
AREA (SQ. FT.) I VALUATION ($)
POOL/SPA MATERIAL TYPE CODES: SPA
V - VINYL -LINED
F FIBERGLASS DEMO
cr' } GUNITE
P - PREFABRICATED TOTAL VALUATION:010
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. lhavemd the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating I g construction. o " e representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of ApplicantiAgent: Date:
4VS-3 pm
SwimPool4pp_2011.doc revised 03/16111
CUPERTINO
Address
PURPOSE
This affidavit is a 'self -
compliance with 2013
inspections are requir
FfKE / CARBON,MONOXIDE ALARMS
ER CERTIFICATE OF COMPLIANCE 9
JNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
0300 TORRE AVENUE • CUPERTINO, CA 95014-3255
408) 777-3228 • FAX (408) 777-3333, buildingC@cupertino.org
Permit No. — 20 `6 , `9
IPPER # of Alarms Smoke: 2-- Carbon Monoxide:
for the installation of all required Smoke and Carbon Monoxide Alarms for
L R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
GENERAL INFORMATION
Existing single-family aid 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 8314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be in in the following locations:
Carbon Monoxide alar
do not have an attache
CBC Section 420.6 and
Power Supply: In dwe
In existing dwelling w
not result in the remoi
space. Refer to CRC SE
alarms which must be
not required in dwellings which do not contain fuel -burning appliances and that
�e. Carbon monoxide alarms combined with smoke alarms shall comply with
be approved by the Office of the State Fire Marshal.
ind units with no commercial power supply, alarm(s) may be solely battery operated.
ts, I alarms are permitted to be solely battery operated where repairs or alterations do
1 of wall and ceiling finishes or there is no access by means of attic, basement or crawl
tion R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
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 ResidenrfialCodes. The alarms have been tested and are operational, as of the date signed
below.
1 h d d ae to com I with the term. s qnd conditions of this statement
ave rea an gne
Owner (or Owner Agent')
f AREA
SMOKE ALARM
CO ALARM:
Outside of each sen rate
bedroom(s)
sleeping area in the immediate vicinity of the
X
X
On every level of a divellin
unit including basements
X
X
Within each slee inaroom
X
Signature........... ........................................................ Lic.4...................................... Date:...................
Carbon Monoxide alar
do not have an attache
CBC Section 420.6 and
Power Supply: In dwe
In existing dwelling w
not result in the remoi
space. Refer to CRC SE
alarms which must be
not required in dwellings which do not contain fuel -burning appliances and that
�e. Carbon monoxide alarms combined with smoke alarms shall comply with
be approved by the Office of the State Fire Marshal.
ind units with no commercial power supply, alarm(s) may be solely battery operated.
ts, I alarms are permitted to be solely battery operated where repairs or alterations do
1 of wall and ceiling finishes or there is no access by means of attic, basement or crawl
tion R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
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 ResidenrfialCodes. The alarms have been tested and are operational, as of the date signed
below.
1 h d d ae to com I with the term. s qnd conditions of this statement
ave rea an gne
Owner (or Owner Agent')
Nme:
p )
/VNSignature
t
....... ...... Date. ......:
Contractor Name: I
!
Signature........... ........................................................ Lic.4...................................... Date:...................
Smoke and CO form.doc remised 03/18/14
0
WATER -CONSERVING PLUMBING FIXTURES (� LP'
O NER CERTIFICATE OF COMPLIANCE I P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
1 (4018) 777-3228 • FAX (408) 777-3333 • buildinga-cupertino.org
Owner Name 00 1,r j 41 /I,/- Permit No.
c_
Address C i D CA-. ilml
1. is' your real_property a registered historical site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. -Skip the rest of the form and sign bottom of form.
..) ANO Go to Question 2. :
2. Does your real property have �a licensed plumber certifying that, due toz the age or configuration of the property or its
plumbing, installation of water -conserving plumbing fixtures is not technically feasible?
Yes Civil Code Secltions 1101.1 through 1101.8 do not apply.
E The licensed phunber's. certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
-,, No Go to Question 3.
3. Is water service permanentlydisconnected 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.
No Go to Question 4.
4. Is your real property built, and available for use or occupancy on or before January 1, 1994?
E 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.
Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 110 1. 1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
r?CV My property is a single family resid6ntial 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).
My property 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 comrtaercial real property. See Civil Code Section 1101.5.
On and after January l;, 20114, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 12019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures t..hre;,tghout the building (regardless of whether property undergoes alterations or improvements).
1
I, as the owner or owner'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 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, andl that#e water-conservnig plumbing fixtures comply with the requirements as indicated in the
table on the following page.' e.'
Owner or Owner Agent's Signature: Date: /
Upon completing and signing this Certi�ca , please return it to the Building Division in order to final your building permit.
` SB407 2015.doc revised 08126115
a
If the existing plumbing fixture
usage/flow rate is equal to or lower than the rigure snown,
i
i
it is not rrquircu iv uc up6laucu.
S&407 2015.doc revised 08/26/15
Non-CoMplint
Water -Conserving Plumbing Fixture
Plumbing .Fixturel
(Fixture Complying with Current Code Applicable to New Construction)
Fixture Type
1 1
Maximum Water Usage/Flow Rate
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 GPC Ch. 4
Water Usage
/Flow f ate!
2013 CALGreen Div. 4.3 -
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
Single -Family
Multi -Family
Commercial
Residential
Residential
Water Closets
Exceed 1.6
Single flush toilets: 1.28 gallons/flush
(Toilets)
Gallons/flush
Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite,
average flush volume of two reduced flushes and one full flush
Urinals
Exceed 1.61
0.5 gallons/flush
Gallons/flush
Showerheads
Exceed 2.5 i
20 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per,minute
U.S. EPA WaterSense Specification for Showerheads
(A hand-held shower is considered a showerhead.)
For multiple showerheads serving one shower, the combined flow rate of all
showerheads and/or other shower outlets controlled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
allow only one shower outlet to be in operation at a time.
Faucets —
Exceed 2.2gall6ns
Maximum 1.5 gallons per
Within units:
0.5 gallons per minute @ 60
Lavatory
per minute
minute @ 60 psi; minimum
Maximum 1.5 gallons
psi
Faucets
0.8 gallons per minute @
per minute @ 60 psi;
20 psi
minimum 0.8 gallons
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
'
60 si
Faucets—
Exceed 2.2 gallons
1,8 gallons per minute @
1.8 gallons per minute
1.8 gallons per minute @ 60
Kitchen
per minute
60 psi
@ 60 psi
psi
Faucets
May temporarily increase
May temporarily
1
up to 2.2 gallons per
increase up to 2.2
minute @ 60 psi, and must
gallons per minute @
default to maximum
60 psi, and must
?f
1.8 gallons per minute @
default to maximum
60 psi
1.8 gallons per minute
Where faucets meeting
@ 60 psi
the above are unavailable,
Where faucets meeting
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction.
other means may be
used to achieve
{
reduction.
If the existing plumbing fixture
usage/flow rate is equal to or lower than the rigure snown,
i
i
it is not rrquircu iv uc up6laucu.
S&407 2015.doc revised 08/26/15