D-2017-0024CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2017-0024
10404 MELISSA CT CIJPERTINO, CA 95014-2620 (342 45 020) X - T]tEME
CONCRETE
SOLUTIONS
MILPITAS. CA 95035
OWNER'S NAME: OH JAMES AND ASHLEY TRUSTEE
OWNER'S PHONE: 408-476-6243
License Class C$ 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:
t. 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
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
source regulations per the Cupertino Municipal Code, Section 9.18.
Signature a Date 05/8/201Z
DATE ISSUED: 05/08/2017
PHONE NO: (408) 594-3049
BUILDING PERMIT INFO:
—BLDG —ELECT —PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
DEMO POOL (817 SF) - FOR FUTURE CONSTRUCTION
Sq. Ft Floor Area:
Valuation: $12950.00
APN Number: Occupancy Type:
342 45 020
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. 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:
t. 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
Date 05/8/2017
RF 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: 051$!2012
ALL ROOF COVERINGS TO BE CLASS "A" OR BE
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 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 Healtlk& Safety Ckod& Sections 25505, 25533, and 25534.
Owner or authorized agent
Date: 05/$/2412
CON'STRLTCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino orq
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STREET ADDRESS CITY, STATE, ZIP FAX
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STREET ADDRESS t wq C � ' /' [vtbi"� I� a CITY, STATFp (I J, � /�/1 � P( '((Y(/a
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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CONTRACTOR NAME _�� LICENSE 1 b -q1-7 LICE rft)o10 BUS. LIC#
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STREET ADDRESS 10 1 O �I li ff II � d I
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ARCHITECT/ENGINEEkNRME LICENSE NUMBER ..
FAX
COMPANY NAME
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CITY, STATE, ZIP PHONE
STREET ADS" %� p �i / !) ��/�►j
DESCRIPTION OF WORK NrnV %1— D M n I �Y b(JI orea)
USE of ❑ SFD or Duplex ❑ Multi -Family
TYPE MATERIAL TYPE (CODE) AREA (SQ. FT.) VALUATION ($)
Commercial POOL Crl�l �dell (� ('i(j�
STRUCTURE: ❑ til
POOL/SPA MATERIAL TYPE CODES: SPA
V - VINYL -LINED
F - FIBERGLASS DEMO
G - GUNITE
P - PREFABRICATED ;RECEIVED TIVLff, t9i..
By my signature below, I certify to each ofthe following: I apro rtY o er or authorized agent to act on the property owner's behalf. I have read this
application and the infonnatio�,�avpmvided i orrect. I have read the Description of Work and verify it is accurate. IagreetOcomply with all applicable local
ordinances and state laws rela g con ction. I authorize representatives of Cupertino to enter the aboven pro erty for inspection purposes.
Date:Signature ofApplicant/Agent
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
PLAN CHECK TYPE ROUTING SLIP
_ Commercial or Multi -Family Buildings With Public Swimming Pools: ❑ OVER-THE-COUNTER ❑ BUILDING DEPT
Department of Environmental Health approval required. EXPRESS ElPLANNING DEPT
❑ STANDARD ❑ PUBLIC WORKS DEPT
❑ LARGE ❑ ENVIRONMENTAL HEALTH
El MAJOR ❑ SANITARY SEWER DISTRICT
STFimpoolApp_2011.doc revised 03116111
CUPERTINO
SMOKE 1 CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section 8314, 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 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: I 0 y 0 Ll m.t bs to c^�. ' _� r '► ®, C i�g �� 1 y Permit No. ®" Zy f 7 - 00 2 [�
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:
i..8./...r.7..
je�,n 0
Signature ..................................................................................... Date:S.
...........
Contractor Name:
Signature...................................................................... Lic.#........................................ Date:...................
Smoke and CO form.doc revised 01/10/2017
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a.cupertino.ora
Owner Name Jarn_eS 0, Permit No V ` 2017-0oLr
Address l D Y o y v✓i e J, s a C_ C'v p-� ✓ e �3 y 7 y
1. Is your real property 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 form.
C3 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 form.
[:�'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.
'R 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.
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 form..
Please check ONE of the following:.
,43' Myproperty is a single fancily 7•esidential 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-conseiving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ Mypropertyis a niultifwnily 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-cornpliant 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 conmiercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or irnprovernents shall require non- cormpliant
plumbing fixtures to be replaced with water-conse-iving 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 properly undergoes alterations or improvements).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures 'vill be
replaced prior to date specified above with «Tater-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 110 1.8, the current California Plumbing Code and California Green Building Standards Code, and nnanufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the
table on the followin-a mace.
Owner or Owner Agent's Signature: wzk4l 6 Date: �;- 4 9/ 7-d%i
Upon completing and signing thisrtifrcate, please return it to the Building Division in order to final vour building Uermit.
SB407 2015.doc revised 01105117
SILICON VALLEY SOIL ENGINEERING
GEOTECHNICAL CONSULTANTS
File No. SW 069K
May 16, 2017
X-Treme Concrete Solutions
2189 Sepulveda Avenue
Milpitas, CA 95035
Attention: Mr. Rigo Beltran
Subject: Existing Residence
10404 Melissa Court
Cupertino, California
TESTING AND INSPECTION SERVICES
DURING THE BACKFILLING OPERATION
OF THE SWIMMING POOL REMOVAL
Dear Mr. Beltran:
Pursuant to your request, we have performed testing and inspection services
during the backfilling operation of the swimming pool removal. The subject site
is the existing residence located at 10404 Melissa Court in Cupertino,
California.
The existing swimming pool area was approximately 580 square feet with
depths ranging from 4 to 7 feet below existing ground elevation. First, the
entire pool was removed and inspected on May 1 1, 2017. Then, the excavated
bottom was compacted. Next, the excavated area was backfilled with import
soil material to the existing ground surface. The import soil material was
moisture conditioned as necessary and compacted in uniform 8 to 12 inch lifts
to at least 90% relative maximum density. The backfilling operation was
performed by X-Treme Concrete Solutions on May 12, 15, and 16, 2017.
A total of 8 in-place field moisture/density tests were performed by our field
engineer using a nuclear gauge (CPN MC -1 DR -P). These tests showed values in
excess of 90% relative maximum density of the backfill material as determined
using the laboratory compaction test procedure ASTM D1 557-12. The results of
the field moisture/density tests are summarized in Table 1. Approximate
locations of these tests are shown on the Site Plan - Figure 1.
As a result of our testing and inspection services, the contractor has performed
the backfilling operation of the swimming pool removal according to our
recommendations.
2391 ZANKER ROAD, SUITE 350 • SAN JOSE, CALIFORNIA 95131 • (408) 324-1400 • F (408) 324-1404
File No. SV1069K
May 16, 2017
If you have any questions or require additional information, please feel free to
contact our office at your convenience.
Very truly yours,
SILICON VALLEY SOIL ENGINEERING
Sean De ive rt
Project Manager
Vien Vo, P.E.
SV1069K.BF/Copies
N M.
Co
c�
C 32296fn
* EXP.
\�T CIVIC �P
\TCF CALIF
3 to X-Treme Concrete Solutions
2 SILICON VALLEY SOIL ENGINEERING
File No. SV1069K
May 16, 2017
TABLE I
SUMMARY OF FIELD MOISTURE/ DENSITY TEST RESULTS
Test
Date
Test
Moisture
Dry
Rel. Comp.
Soil Type
No.
2017
Location/
% Dry
Density
% of Max.
& Remark
91.0 B
4
Elevation
Weight
p.c.f.
90.1 B
5
SWIMMING POOL BACKFILL
1 5/12
X1/31.
6.6
123.7
93.7 B
2 it
X2/3.L.
7.4
122.9
93.1 B
3 5/15
X3/3.L.
5.7
120.1
91.0 B
4
X4/5.L.
6.0
118.9
90.1 B
5
X5/5.L.
6.5
123.6
93.6 B
6 5/16
X6/ F. L.
7.6
119.0
90.1 B
7 itX7/F.L.
6.8
122.3
92.7 B
8 ItXs/F.L.
4.1
119.7
90.6 B
NOTES:
21. = THIRD LIFT
51. L. = FIFTH LIFT
F.L. = FINAL LIFT
B: Bluish Gray Quarry FINES
3 SILICON VALLEY SOIL ENGINEERING
7" -*,-**-"-*,-,,-,*--,-
MELISSA COURT I
f
\ ABANDONED SWIMMING POOL
j\\J 8
NOTE: X DENOTES APPROXIMATE TEST LOCATION
Xz
X4
X3 X6
Silicon Valley Soil SITE PLAN File No.: SV1069K FIGURE
Engineering
Existing Residence
2391 Zanker Road, #350 Drawn by: M.N. 1
San dose, CA 95131
(408) 324-1400 10404 Melissa Court
Cupertino, California Scale: NOT TO SCALE May
2017
El
120 ' '
0 2 4 6 8 10 12
Moisture Content (% of Dry Weight)
SAMPLE: B
DESCRIPTION: Bluish Gray Quarry FINES
LABORATORY TEST PROCEDURE: ASTM D1557-12
MAXIMUM DRY DENSITY: 132.0 p.c.f.
OPTIMUM MOISTURE CONTENT: 6.0%
Silicon Valley Soil COMPACTION TEST B File No.: SV1069K FIGURE
Engineering
Existing Residence
2391 Zanker Road, #350 Drawn by: M.H. 2
San .Jose, CA 95131
(408) 324-1400 10404 Melissa Court
Cupertino, California Scale: NOT TO SCALE May
2017
5
140
135
ci
c.
N
130
m
0
0
125
120 ' '
0 2 4 6 8 10 12
Moisture Content (% of Dry Weight)
SAMPLE: B
DESCRIPTION: Bluish Gray Quarry FINES
LABORATORY TEST PROCEDURE: ASTM D1557-12
MAXIMUM DRY DENSITY: 132.0 p.c.f.
OPTIMUM MOISTURE CONTENT: 6.0%
Silicon Valley Soil COMPACTION TEST B File No.: SV1069K FIGURE
Engineering
Existing Residence
2391 Zanker Road, #350 Drawn by: M.H. 2
San .Jose, CA 95131
(408) 324-1400 10404 Melissa Court
Cupertino, California Scale: NOT TO SCALE May
2017
5