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14050164CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 937 BROOKGROVE LN CONTRACTOR: EDWARD PERMIT NO: 14050164 CONSTRUCTION OWNER'S NAME: SMITH STEPHEN C AND PRESLEY JENNIFE 2533 AMETHYST DR DATE ISSUED: 05/29/2014 OWNER'S PHONE: 4083132725 SANTA CLARA, CA 95051 PHONE NO: (408) 985 -0731 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] FOUNDATION REPAIR 4 FT License Class /3—/ Lic. #_-V 2 / - Contractor .0 Dat o R D 1_0,-511 Date .5_- X 9'- / 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: 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. Sq. Ft Floor Area: Valuation: $4000 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 APN Number: 37539028 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS LAST CALLED INSP CTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, / costs, and expenses which may accrue against said City in consequence of the Issued by: Date`' �f 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. RE- ROOFS: Signature Date - s'o?�- ��! 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. ❑ OWNER- BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self - insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. 0) will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as providdfor by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: permit is issued. I certify that in the performance of the work for which this'perniifis issued, I shall not employ any person in any manner so as to become -subject to the Worker's CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C ) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9 18. Signature Date CUPERTINO r—T CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building @_cupertino.orq F-1 I-1 . T -pn A Tnm / TT F-1 AAViQTC)M / TIFFFRRFT) i (�I U RIGINAL PERMIT # LJ NEW C,UNSIKUCI1UN LJ H1J1J111U1V L� r,, .navaaa tea. r a u -� -- rr— - -- APN # PROJECT ADDRESS 62r. 17 OWNERNAME ry; PHONE _ �i EI --SCE Lo /- C STREET ADDRESS X m 7h CITY, STATE, ZIP FAX 17 tg, CONTACT NAME PHONE o s" — d E -MAIL LdAPD ouw? : wj/ f dirr c .ver STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME C1201"--t �s f Ales LITE NUMBER LICENSE TYPE BUS. LIC # w,g COMPANY NAME E-MAIL Fo Ui✓(�9 TO .✓ O/h �y C FAX 2% W �d O STREET ADDRESS CITY, STATE, ZIP -r4- PHONE h' S 9 J y e c.� ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME &MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK . EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA DECK/PORCH AREA GARAGE AREA: DETACH �TOTAL ❑ ATTACH # DWELLING UNITS: ND UNIT []YES SECOND STORY [:]YES BEING ADDED? ❑ NO ADDITION? []NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑NO �CEIV a•�w,' '-s. , . � TO� V UATION: PLANNING APPL# []NO PLANNING APPROVAL a By my signature below, I certify to each of the following: I am the property owner or authorized age 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 laws relating to building construction. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: r, SUPPLEMENT FORMATION REQUIRED x:TYPE ,. - IiouTiNGSGIP,.. ,., .. New SFD or Multifamily wellings: Apply for demolition permit for k, coitNTt Ii � BUILDINGPil!44 i ' _ a a existing building(s). Demolition permit is required prior to issuance of building u * N fi r ma for new building.�xrs ! A Q "NNINCpclt> vlEts permit Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Ot T`aliutti kUBLIC WORKS form if an y Hazardous Materials are being used as part ofthis project. ,m�, ti ,, ❑ FIRE DEPT. -°'* -, ' e _ Copy of Planning Approval Letter or Meeting with Planning prior to� i ❑SANITARY sEwER nISTRIeT Building Permit submittal of application. ; ,g��`�;yrti��a „'i��a.£ �,3i gr�`.Y ❑ x” ElYVIRONII 'IEIVTAI:'HEALTHa`4,. BldgApp_2011.doc revised 06121111 �, FORM CITY OF CUPERTINO T'i TT Ti QT1I1Vi A Tn]P — RITII .11INf DIVISION ADDRESS: 937 BROOKGROVE LN DATE: 05/29 /2014 REVIEWED BY: mendez APN: BP #: *VALUATION: $4,000 *PERMIT TYPE: Building Permit L_!� hours $139.00 PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p Suppl. PC Fee: (j) Reg. 0 OT I PENTAMATION 1GENRES PERMIT TYPE: A WORK I FOUNDATION REPAIR 4 FT PME Plan Check: SCOPE $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. rtammng, ruottc nvorKs, rtre, outtttury —wer "twtr —P z.... -.4 ,.. ..z.,.....- ► :..... Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11 -053 E . 7111131 FEE QTY /FEE MISC ITEMS Plan Check Fee: Hourly Only? ® Yes (F) No $0.00 L_!� hours $139.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: (j) Reg. 0 OT I 0.0 1 s $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ® Yes E) No $0.00 Suppl. Insp. Fee: Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 <c ;1721:21'li "ciitL'i?'s t': E) Work Without Permit? ® Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential E) Building or Structure 0 In we" e DeC'iwn,'t1 whoa Fees: Strong Motion Fee: IBSEISMICR $0.50 2.0 hrs $278.00 Inspections ISTINSP 7 Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $1.001 ®X $1.50 $417.00 r TOTAL FEE: $418.50 Revised: 04/01/2014 BIGGS CAROOSA ASSOCIATES INC STRUCTURAL ENGINEERS 8B5 7- he Alameda San Jose, CA 95126 -3133 Telephone 408- 296 -5515 Facsimile 40B-296-B114 Edwards Construction -4j�� 00), 2533 Amethyst Drive Santa Clara, CA 95051 Attention: Chris Jones ?.1 / Subject: Special Inspections and Materials Testing — Fi al Report Smith Residence 937 Brookgrove Lane Cupertino, CA Permit No. 14050164 Gentlemen: June 4, 2014 2014136 I -F-d EI) JUN 0 6 2014 In accordance with Section 1704.2 of the California Building Code and as specified in the structural contract drawings, Biggs Cardosa Associates, Inc. has performed the following special inspections. Adhesive anchor /dowel installation The completed inspections were performed under the supervision of the undersigned Registered Engineer. Based both upon inspections performed and our substantiating reports, it is our professional judgement that, to the best of our knowledge, the inspected work was performed in accordance with the applicable workmanship provisions of the California Building Code and the approved plans and specifications. Should you have any questions, please do not hesitate to call. Sincerely, BIGGS CARDOSA ASSOCIATES, INC. Mark A. Cardosa Vice President cc: Building Division, City of Cupertino M:\2014 \136\lnsp \Sp Insp Final Ltr Smith Resid.doc QROF ESS /6 CA R� F w m No. S2279 '♦ Exp. 3/31/16 STRUCT�RP��P OF CP�-�F BIGGS CAROOSA ASSOCIATES INC STRUCTURAL ENGINEERS B 6 5 The Alameda San Josa, CA 959 26-3133 Telephone 40B- 296 -5515 Facsimile 40B- 296 -8114 JOB #: Z /V /J& Page 1 of _I SPECIAL INSPECTION DAILY REPORT Project Name: ��"� r'f /��'' c� Date: Zo IV Project Address: 93'I1'eme 690yr &1457 Time Arrived: Tao, C4 Time Departed: Location of Inspection: Za J/TE" Ft X67 S� o So / b / AM Inspections made: A14-2-4fT,oni OP T 60V✓GZJ 9 s8 X If X0,2 �n y�l4A�i e..1 .2R�PijyQ &f tjr&, VM n�P7 /� �/�- C�+�ri�(�oMcanlT si �,,rFAn/uNP'J'1 0� �Lot�. J .' <Jin�P ✓�,✓ c/�'7 JI�P Samples Taken: Items Complete: -,IV az6Z 1 1// ArR OWD) S! A1bgej,o bal,I W17 -.rti�a - - - Deficiencies/Items Pending:" Comments: To the best of my knowledge, the work completed or in progress for this report was done in general conformance with the intent of the approved design documents and specifications and applicable workmanship provisions of the C.B.C. except as noted above. INSPECTOR: RM One story 4.00, ft Re air area Edward's Construction V� Office # 408 - 985 -0731 ANA Email: edwardsfoundation @comcast.net O State Contractor License #763218 Cupertino Business Licence #29469 QML, qrj e OF DEPARTME BUILDING DI)ASION - CUPERTINO APPROVED Owners: Stephen & Jennifer Smi is set of Plans and specifications MUST be kept at I 408 - 313 -2725 Ja site during construction. It is unlawful to make changes or alterations on same, or to deviate Email: jlp- scs @pacbell.net refrom, without approval from the Building Offici . Stamping of this plan and specifications SHALL N btl held to permit or to be an annrnvil nr,•c,a ,,;,,I.,+; ormy provi of any City Ordinance or State Law. BY MATE c5 P IPAIT NO. D� Scope of Work 1. Remove and replace approximately 4 linear feet of fractured foundation located along the center left side. 2. All work is to comply with the 2013 CRC and be inspected by the Cupertino Building Department. Slab Fo R e p air Detail qd" Existing sidling New 5/8" all threa4' on center Existing sill late New 3" x 3" x 1/4" 2alvanized washer Remove a minimum of 8" from top & replace with 2500 psi concrete possible radiant heath g pipes possible radiant heatinj pipes possible radiant heath g pi es possible radiant heatinj pipes #4 rebar 8" # 4 rebar 16" on center with a hoo Existing 2" ABS shower dr #5 threaded rod & #4 rebar epoxy set using p Y Simpson Set XP epoxy with a minimum MAY 2 g 2014 embedded of 6" into existing concrete 6" Existing footing M-Y =' �FICE G"6F MAY 2 9 o14 �E.VIE.�VEU rqR GUUE Gt31VSPoAN Reviewed 937 Brookgrove Lane BIGGS CAROOSA ASSOCIATES INC STRUCTURAL ENGINEERS BBS The Alameda San Jose, CA 95'126 -3133 Telephone 40B -296 -5515 Facsimile 40B-296-8114 Edwards Construction 004 2533 Amethyst Drive Santa Clara, CA 95051 Attention: Chris Jones ?. 1 Subject: Special Inspections and Materials Testing — Fi al Report Smith Residence 937 Brookgrove Lane Cupertino, CA Permit No. 14050164 Gentlemen: June 4, 2014 2014136 RECEIVER JUN 0 6 2014 BY In accordance with Section 1704.2 of the California Building Code and as specified in the structural contract drawings, Biggs Cardosa Associates, Inc. has performed the following special inspections. Adhesive anchor /dowel installation The completed inspections were performed under the supervision of the undersigned Registered Engineer. Based both upon inspections performed and our substantiating reports, it is our professional judgement that, to the best of our knowledge, the inspected work was performed in accordance with the applicable workmanship provisions of the California Building Code and the approved plans and specifications. Should you have any questions, please do not hesitate to call. Sincerely, BIGGS CARDOSA ASSOCIATES, INC. Mark A. Cardosa Vice President cc: Building Division, City of Cupertino M:\2014 \136\Insp \Sp Insp Final Ltr Smith Resid.doc Q 'OFESS /pNq� CAR F No. S2279 * Exp. 3/31/16 STRUCT��P��P OF CP�-�F =d - BIGGS CAROOSA ASSOCIATES INC STRUCTURAL ENGINEERS B B 5 The Alameda San Jose, CA 95126 -3133 Telephone 408- 296 -5515 Facsimile 408- 296 -8114 SPECIAL INSPECTION DAILY REPORT JOB #: Z"� /3� Page I of I_ Project Name: �"'� ry / ' °�'"`� c - Date: � � 3, Zo I SC Project Address: 937 Setm&�� Time Arrived: C9 Time Departed: Location of Inspection: zr. a JTF — c So i 6 Inspections made: 1A1J- e4U4r,01V of 14(j 60tAIGZJ A-9, J "At 101*1c 0^1 2e�P�jyQ � !�E`��/�OF� i DPvJ4�— .' ✓C-,� /�iC =� Or be z* �,r [�ri ? ��►- ��n17' atp dw yew oe-- dam! .' �/i -, P ✓�,✓ J�7 XP Samples Taken: Items Complete: 1414 /A22i &, zv4VEZ/ ill 'fr m• ew-0) Deficiencies/Items Pending: Comments: To the best of my knowledge, the work completed or in progress for this report was done in general conformance with the intent of the approved design documents and specifications and applicable workmanship provisions of the C.B.C. except as noted above. INSPECTOR: r CUPERTIN Address 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(akupertino.org F1 PURPOSE This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 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 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 have been tested and are operational, as of the date signed below. I have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name. n �1 C YI l • J Si g na e ............... ....... ........................... ............................... ..........................Date: �..�...�.... Contractor Name: 6441 r ' c3 r Si nature .... .......................... ............................... Lic.# ................. Date: C/ Smoke and CO form. doc revised 03118114