Loading...
15070199CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15070199 20156 MERRITT DR CUPERTINO CA 95014 (316 33 101) IGLD CONSTRUCTION CO SAN JOSE, CA 95132 OWNER'S NAME: KOAY MAUREEN AND CHID NATHAN I JDATE ISSUED: 12/07/2015 1 OWNER'S PHONE: (408) 881-3180 1 1 PHONE NO: (408) 595-2584 111 Lim w -i al - a It i_ I. Class $ Lic. # 7$ 1558 or G L D CONSTRUCTION CO, Date 07/31/2017 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ith Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. hereby affirm under penalty of perjury one of the following two declarations: 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 p - rformance 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. 1-1 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. Date 01730/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three declarations: 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. 3. 1 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 code, Section 9.18. Signature Date 01/30/2017 BUILDING PERMIT INFO: BLDG —ELECT _ PLUMB MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: 1 ST FLR ADDITION (249 S.F.), 2ND FLR ADDITION (1059 S.F.), REMODEL (E) 972 S.F.), UPGRADE PANEL (200 AMPS), REPLACE HVAC & RE -ROOF (E) 7 SQ'S. #2 -REVISE ROOF SLOPE & ELEVATION- 1/REMOVE/CHANGE LOCATIONS OF WINDOWS; SUBMIT °HANICAL PLAN FOR HVAC SYSTEM; WORK; REVISE 2ND MASTER BATH LAYOUT; SUBMIT TRUSS CALCULATIONS. IED 01/30/2017 REVISION #1 - EXPANSION OF 2 EXISTING BATHROOMS; FIREPLACE REMOVED FROM LIVING ROOM AND ADDED IN FAMILY ROOM; CHANGE OF STAIR DISTRIBUTION OF STEPS; REDUCE OPENING BETWEEN HALLWAY TO BEDROOMS AND DINING ROOM ISSUE DATE: 5/9/2016 Sq. Ft Floor Area: I Valuation: $300000.00 APN Number: Occupancy Type: 31633 101 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: Leeacv RE -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 gi inspection. F Signature ofApplic ant. Date: 01/30/2017p ALL ROOF COVERINGS TO BE CLASS "A" 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 wit} the Cupertino Municipal Code; Chapter 9.12 and the Health & SafetyiCade, Sectidq_s 25505''J5533; and 25534. Owner or authorized Date: 01/30/2017 I hereby affirm that there is a constFuction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) CONST RUCTION PERMIT APPLICATION EON COMMUNITY DEVELOP10ENT DEPARTMENT • BUILDING D1 ON AqB 10300 T ORRE AVENUE CUPERTINO, CA 95014-3255 r (408) 777-3228 - FAX (408) 777-3333 • buildino(q�cugerflno.ora CUP Erb EtatO ❑ M:W CONSTRUCTION ❑ ADDITION AI-TER.OTION / TI AF-REZ%TSIO'\ / EFERRED nn TGT ?t_.LPtR4IT- c� 10 PR0IECT,ADDRESS APS r . apt x�li.6--_��/ 01MNSR I\. -kit . STR=ET.ADDRESSf I CITY, TATE. ZIP �q� FAX L (teat t o �' Prc1l/Z OA o- c t4- CONTACT N.3.h4E P::O'\'E Es�4ag';L p pp i��°'� - � j� , NL! 15 2 ja yea l STREET ADDRESSL!_� ) � t CITY, STATE, ZIP I Q C� cy� 1 to t _ Pt i _ ❑ A" -\TM OAn.-I;t-BT-MDER ❑ OANER AGENT ❑ CO1\7R.4CT0R ❑. CON7KACTOR AGENT ❑ ARCHITECT ❑ D:GT"EER. ❑ DE1 ELepER ?\,T CON-MkCTOR NA-ME4_�)p-AfLICENSE?\UMMER 97 71 —.^ ( LICEIISETYPE BUS. LIC STREETAD O� f, CITY. TATE GQ� 14 i/ILiz ^RCri1ECT/ENGiTEER Kk',4E I LICENSE XUR,'BER I BUS, LIC:' COAPA1YN.Ah4E E -14 -TL I FAX STREETADDRESS ( CITY, STATE, ZIP I PHONE DHSCP,PTION OF A'OR A,�, ``� �(E5'f13'I C49, ) lN►l1.Nt,0�1 EXIST LNG LSE PROPOSED USE CONSTR. i�PE a STORIES - USE TYPE I OCC, SQ:FT, I VALUATION (S) EXISTG 1\'EW..FLOOR DE1,40 TOTAL - AREA AREA I - hREA L'ETAREA i BATr'P,001,4 KIrCFEN OTHER - P��40DELARE A RE,140DELAREA I FFMODELAREA I. PORCr_:P.EA DECKAREA TOT.ALDECKPORCHAREA GARAGE AREA,: [3 DETACH- ---DWELL-N-GUNITS: I ❑ ATTACH ISASE.CONDUNIT []YES SECOND STORY ❑1tS - BEING ADDED? [3 NO ADDITIO?? ❑?zo - PRE _ P iCATIO\1 YES IF YES PROVIDE COPY OF 1S THE BLDG A -N -- � �� < TOTAL PL:4\?,'1G.t??L.. 17\--O PL.-MNTENGAPPROVALLETTER I EICHLERHOME? ❑�\O + By my s4e-natare below, I certiy to each of the folloN ine: I a; e properVty owner or authorized agent to act on The proppe ), o-wile.'s behalf. I have read this application and the infonnation I have provided is cor I e read the Description of Work and verify it is accurate. I agree to comply with all applicable local prope,j, for inspection Purposes. ordinances and state 12Nvs relating to buil Ina cons tI authorize representatives of Cupertino to enter the above-id-ntif7161, Signature of Applicant!Agent: a Date; (` -� SUPPLE -ME rtTAL INFORMATION REQUIRED y PLA\ CHECK TIPE<ROUTING CLIP; Ne -,v STD or'Mul ifaiiiily dwellings: Apply for demolition permit for 4ginft .__ . ; �:1_(s�, Demolition `ior p= n ` 1c r=eLi.>A n-;ortbs�L�n obLllc_�tre1I '7 c n,1zg 9 -,ER TIS COL \TEP. BL LDI�G PLA BETTER perTiit for new building. 'C01ll17 erC421 Bldgs: Provide a completed Hazardous I�2_teriels Disc1_osurenLTELIC r ORhS - fora,] ;f any Hazardous Matonals are being used as pa, t off illi_ project. - T RGE FIRE IF Copy of Planning Approval Letter or Rfeeting ,with Planningprior to v ll Sbillittal Of Building Permit application, S�'\ITAR1SEZj'ERDicTRICT F Bldglpp_2011.doc revised 06/21111 RE -V 0 1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15070199 20156 MERRITT DR CUPERTINO CA 95014 (316 33 101) OWNER/BUILDER OWNER'S NAME: KOAY MAUREEN AND CHIU NATHAN OWNER'S PHONE: 408-881-3180 LICENSED CONTRACTOR'S DECLARATION License Class LIG. # Contractor OWNER/BUILDER Date 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. hereby affirm under penalty of perjury one of the following two declarations: 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. 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 Date 5/11/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. 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) c2? I, as owner of the property, am exclusively contracting with licensed y�;contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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. ,�_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. 1 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. iature �� ���✓� Date 5/11/2016 DATE ISSUED: 12/07/2015 PHONE NO: BUILDING PERMIT INFO: —BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: . 1ST FLRADDITION (249 S.F.), 2ND FLR ADDITION (1059 S.F.), REMODEL (E) 972 S.F.), UPGRADE PANEL (200 AMPS), REPLACE HVAC & RE -ROOF (E) 7 SQ'S REVISION #1 - EXPANSION OF 2 EXISTING BATHROOMS; FIREPLACE REMOVED FROM LIVING ROOM AND ADDED IN FAMILY ROOM; CHANGE OF STAIR DISTRIBUTION OF STEPS; REDUCE OPENING BETWEEN HALLWAY TO BEDROOMS AND DINING ROOM ISSUE DATE: 5/11/2016 Sq. Ft Floor Area: Valuation: $300000.00 APN Number: Occupancy Type: 31633 101 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSP TION. Issued by: ALEX VALLELUNGA Date: 12/07/2015 r RE -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: 5/11/2016 TO BE CLASS "A" OR BETTER 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 MunicipaiPCo Chapter 9.12 and the Health & Safety Code, Sections 255255 Baud 25534. CONSTRUCTION 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. CONSTRUCTION PERMIT APPLICATION COMMUNITY 10300 TORRE AVENUE MCUPERTINO, CA 95014-3255 ENT DEPARTMENT - 1DING DREVI ION TT _1B CUPERTINO I (408) 777-3228 • FAX (408) 777-3333 • building(aicupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ® REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN # 20156 MERRITT DRIVE, CUPERTINO, CA 95014 15070199 OWNER NAME PHONE 7mAL MAUREEN KOAY & NATHAN CHIU 408-881-3180maureenkoay@gmail.com STREET ADDRESS CIIY, STATE, ZIP FAX 20990 VALLEY GREEN DR., APT. 717 CUPERTINO CA 95014 CONTACT NAME PHONE E-MAIL MAUREEN KOAY & NATHAN CHIU 408-881-3180 maureenkoay@gmail.com STREET ADDRESS CrrY, STATE, Zn' EAX 20990 VALLEY GREEN DR., APT. 717 CUPERTINO, CA 95014 ❑ OWNER IX OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 1 LICENSE TYPE BUS. LIC # LONG PHUONG 871558 B COMPANY NAME E-MAIL FAX GLD CONTRUCTION gldconst@yahoo.com STREET ADDRESS CITY, STATE, ZIP PHONE 3113 BALMOSAL DR. SAN JOSE CA 95132 408-595-2584 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAH, FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK II /��tD V� r EXISTING U PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKJPORCH AREA GARAGE AREA: DETACH ATTACH # DWELLING UNITS: IS A SECOND UNIT OYES SECOND STORY YES BEING ADDED? ❑NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES D Y: TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LEITER EICHLER HOME? ❑ NO 1 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 co7ct. lave the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildinconstrucC L I a e representatives of Cupertino to enter the above -identified propertyfor inspection purposes. Signature of Applicant/Agent: Date: �G SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER -THE COUNTER BUILDING PLAN REVIEW permit for new building. ❑ EXPRESS ❑ PLANNWG PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure X STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ M.UOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH Bldg4pp_2011.doc revised 06/21111 BidgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 20156 MERRIT DR DATE: 0712812015 REVIEWED BY: MELISSA Suppl. PC Fee: Reg. 0 APN: 316 33 101 BP#: hrs 'EVALUATION: 1$300,000 *PERMIT TYPE: Building Permit Permit Fee: PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: O,Q 2nd Unit? -` Yes No OTC? Yes (E)No PME Unit Fee: PENTAMATION PERMIT TYPE: 1 R3SFDADD WORK 1ST FLR ADDITION 249 S.F.),2ND FLR ADDITION 1059 S.F.),REMODEL E 972 S.F. SCOPE UPGRADE PANEL (200 AMPS), REPLACE HVAC & RE -ROOF (E) 7 SQ'S OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,III-B,IV,V-B 1,348 $2,736.52 1R3PLNCK $1,961.64 IR3INSP I TOTALS: 1,348 I ' $2,736.52 ( = I $1,961 64 Mech. Plan Check 10.0 1 hrs $0.00 Plumb. Plan ('heck Mech. Permit Fee: IMPERMIT Plumb. Peamil1 =e: Other Mech. Insp. F-61hrs $48.00 Other Plz nib hasp. ; 'ek Insp. 7 'e: Plumb. Imp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Plaa District, etc.. These ees are based on the pieliminarj FEE ITEMS (Fee Resolution 11-053 Eff. 711113) Plan Check Fee: Suppl. PC Fee: Reg. 0 OT 0.0 1 hrs PME Plan Check: 1 # Mechanical $143.00 IMFR=<loo Furnace, Forced -Air Permit Fee: $1,961.64 Suppl. Insp. Feer Reg. 0 OT O,Q hrs PME Unit Fee: 700 s. f-. Re -roof $119.00 1 REROOFRES PME Permit Fee: Ct)7'Z,5`truclion tlx: 0 O F-1 $0.00 ACdai inisirf,dive Lee: Select a Non -Residential. Building or Structure A Work Without Permit? 0 Yes (F) No Advanced Planning Fee: IPLLONGR Travel Documentation Fee: ITRAVDOC Strong Motion Fee: IBSEISMICR Bldg Stds Commission Fee: 1BCBSC Elec. Plan Check 10.0 1 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp.0.0 hrs $48.00 Elec. Insp. Fee Works, Fire, Sanitary Sewer District, School brmation available and are only an estimate. Contact the Dept for addn't into. FEE QTY/FEE MISC ITEMS $2,736.52 1 200 1 amps Electrical $48.00 IBELEC200 Services $0.00 $0.00 1 # Mechanical $143.00 IMFR=<loo Furnace, Forced -Air $1,961.64 $0.00 = # Mechanical $72.00 IBREMAIR A/C Units (<=10K cfin) $0.00 $96.00 700 s. f-. Re -roof $119.00 1 REROOFRES 0 O $0.00 $188.72 Select a Non -Residential. Building or Structure A $48.00 $39.00 Select an Administrative Item $12.00 $5,081.88 $382.00'+ $5,463.88 Revised: 07/02/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20156 MERRITT DR CONTRACTOR: KOAY MAUREEN AND PERMIT NO: 15070199 CHID NATHAN OWNER'S NAME: KOAY MAUREEN AND CHIU NATHAN 20156 MERRITT DR DATE ISSUED: 12/07/2015 OWNER'S PHONE: 4088813180 CUPERTINO, CA 95014-2011 PHONE NO; JOB DESCRIPTION: RESIDENTIAL COMMERCIAL LICENSED CONTRACTOR'S DECLARATION 1ST FLR ADDITION (249 S.F.), 2ND FLR ADDITION (1059 S.F.), REMODEL (E) 972 S.F.), UPGRADE PANEL License Class Lic. # (200 AMPS), REPLACE HVAC & RE -ROOF (E) 7 SQ'S Contractor Date 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 Valuation: $300000 performance of the work for which this permit is issued. Sq. Ft Floor Area: 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: 31633101.00 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 WORD IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter ALLED INSPECTION. 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 t ' e: granting of this permit. Additionally, the applicant understands and v co ' with all non -point source regulations per the Cupertino Municipal e, Sec 9.18. Date RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature _ installed without first obtaining an inspection, I agree to remove all new materials for f DECLARATION inspection. OWNER -BUILDER Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: I, as owner of the property, or my employees with wages a"s their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) HAZARDOUS MATERIALS DISCLOSURE I, as owner of the property, am exclusively contracting with licensed contractors to the hazardous materials requirements under Chapter 6.95 of the construct the project (Sec.7044, Business & Professions Code). I have read California Health & Safety Code, Sections 25505, 25533, and 25534. I will Municipal Code, Chapter 9.12 and the I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Health & Safety Code, Section 25532(a) should I store or handle hazardous declarations: 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 Quality as defined strict I the Bay Area Management 9i12 Compensation, as provided for by Section 3700 of the Labor Code, for the air Code, Chapter and �contaminantsmaintain compliance with the Cupertinoy performance of the work for which this permit is issued. the Health & Safety Code, Sectio 25505, 9 33 nd 25534. I have and will maintain Worker's Compensation Insurance, as provided for by 6 7 9 Section 3700 of the Labor Code, for the performance of the work for which this Date: Owner or authorized agen . - permit is issued. 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I I hereby affirm that there is a construction lending agency for the performance of become subject to the Worker's Compensation provisions of the Labor Code, I must work'sfor which this permit is issued (Sec. 3097, Civ C.) forthwith comply with such provisions or this permitshall be deemed revoked. 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 the above mentioned property for inspection purposes, (We) agree to save ARCHITECT'S DECLARATION upon indemnify and keep harmless the City of Cupertino against liabilities, judgments, my shall be used as public records. costs, and expenses which may accrue against said City in consequence of the I understand plans granting of this permit. Additionally, the applicant understands and will comply the Cupertino Municipal Code, Section Licensed Professional with all non -point -source r lations per 9.18. Signature Date s`� 7 CcS CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE ° CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 ° building .cupertino.org CUPI`EiT040 J( NEW CONSTRUCTION 29 ADDITION ALTERATION / Ti . ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN # - .. 9 OWNER NAME PHONE C-14) est MCLUK moa!A (E A Coal Oro STREETADDRESS CITY, STATE, ZIP FAX _7015c, D12- CL)IPU-VTtk32oQ- C -A CISOVA17 CONTACT NAME PONE '51 0oi- 909All e 1 , STREET ADDRESS CITY, STATE, ZIP FAX 0) S�`v ❑ ENGINEER 0 DEVELOPER ❑ TENANT 11 OWNER E3OWNER-BUILDER❑ OWNER AGENT ❑ CONTRACTOR El CONTRACTOR CONTRACTOR AGENT CONTRACTORNAME /2 LICENSE NUMBER LICENSE TYPE BUS. LIC # T. 7 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE; ZIP PHONE ARCHITECTlENGINEERNRME LICENSE NUMBER BUS. LIC COMPANY NAME # E-MAIL FAX CITY, STATE, ZIP PHONE STREET ADDRESS u DESCRIPTION OF WORK � � Cj 1161-y-60 of--C-tf�L40 16 .. u� h A -PJ o� EXISTING el— U PROPOSED USE CONSTR TYPE # STO�S USE TYPE OCG. SQ.FT. VALUATION ($) EXISTG p Q NEWFLgOOR DEMO TOTAL TAREA AREA. t3 i}�_ `I AREA 4 .�{.. AREA . _ - BATHROOM -KITCHEN OTHER - REMODEL AREA REMODEL AREA REMODEL AREA, PORCH AREA DECK AREA TOTAL DECKf/'PORCH AREA GARAGE AREA: j_ DTrA_CH U # DWELLING UNITS: - IS A SECOND UNIT ❑YES SECOND STORY nd Y tS BEINGADDED?- []NO ADDITION? NO -_ VALUATION: PR&APPLICATION S IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL PLANNING APP L # NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO Ci " e read this. By my signature below, I certify to each of the following: I am the property owner or au orized agent to act roperty owner application and the information I have provided is correct. I have read the Description of Work and ve accurate. I agree to comply with all applicable local ordinances and state laws relating to b i ding construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. 014 Signature of Applicant/Agent: o SUPPLEMENTAL INFORMATION REQUIRED 'PLtiNOIIECIZTiE ROUT ggil;TP New SFD or Multifamily dwellings: Apply for demolition permit for Ct)>x L�Emcv;PlGr1 ANtI vlEw existing building(s). Demolition permit is required prior to issuance of building 4 mssrLANrI NGfLAN' �Ew° permit for new building. -77 _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Cl srrAt�nAttlt II PTJB)'1IC`tVi}IIKS: form if any Hazardous Materials are being used as part of this project. C vPr _ Copy of Planning Approval Letter or Meeting with Planning prior to ItAsoR3 cXNITAgytFylRl3isItICT submittal of Building Permit application. Ei?e+Niui�ErlT�r Ht Air1I BldgApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20156 MERRIT DR 7 DATE 07128/2015 REVIEWED BY MELISSA 1 APN: 316 33 101 BP#: *VALUATION: 1$300,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? Yes !' No PENTAMATION USE: pOTC? Yes No PERMIT TYPE: 1 R3SFDADD WORK 1ST FLR ADDITION 249 S.F. ' 2ND FLR ADDITION 1059 S.F. REMODEL E 972 S.F. SCOPE UPGRADE PANEL (200 AMPS), REPLACE HVAC & RE -ROOF (E) 7 SQ'S OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 1,348 $2,736.52 IR3PLNCK $1,961.64 IR3INSP $0.00 PME Plan Check: $0.00 =# $143.00 Mechanical 1 1MFR=<100 Furnace, Forced -Air Permit Fee: $1,961.64 Suppl. Insp. Feer Reg. 0 OT 0,0 hrs $0.00 # Mechanical $72.00 IBREMAIR A/C Units (<=10K efin) PME Unit Fee: $0.00 PME Permit Fee: $96.00 700 s.f. Re-roof $119.00 IRERODFRES TOTALS: 1,348 $2,736.52 . ` $1,961.64 fIf{F1 inh7 *.Wive 1 gee: MECH,HOUI2LY ` �, Yes " ; leo PIrITiVIB, TI[IJRLY r'Y+ No¢ tIf, HtJC7I2L . Yes ..Ne Mech. Plan Check 0.0 hrs $0.00 I'r:rr ah. Pian ("/lec;ti Elec. Plan Check 0.0 hrs $0.00 Mech. Permit Fee: IMPERMIT Elec. Permit Fee: IEPERMIT Other Mech. Insp. 1 0.0 1 hrs $48.00 OtIzer 1'( wib Iry "/ . Other Elec. Insp. 0.0 hrs $48.00 lft, h. I z:sr1. F e:I?tcrnalt. l�a;sT). !'ec t ec.. /nsp1 Fce: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etcI These ees are based on the reliminar information available and are on1v an estimate. Contact the Dept for addn'l in o. FEE ITEMS (Fee Resolution .11-053 Eff. 7/1/132 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,736.52 200 amps $48.00 Electrical 1BELEC200 Services Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 =# $143.00 Mechanical 1 1MFR=<100 Furnace, Forced -Air Permit Fee: $1,961.64 Suppl. Insp. Feer Reg. 0 OT 0,0 hrs $0.00 # Mechanical $72.00 IBREMAIR A/C Units (<=10K efin) PME Unit Fee: $0.00 PME Permit Fee: $96.00 700 s.f. Re-roof $119.00 IRERODFRES 'r�a:�tr°ucti(3� Iixx:F-1 fIf{F1 inh7 *.Wive 1 gee: 0 0 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: • IPLLONGR $188.72 Select a Non -Residential Building or Structure i Travel Documentation Fee: 1TR,4VDOC . $48.00 Strong Motion Fee: IBSEISMICR $39.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $12.00 7777-7 SBTO`�AI�S.` $5,081.88 $382.00O`AY•T $5,463.88 rtevisea: uiiuucu u Building Department City Of Cupertino 10300 Torre Avenue - Cupertino, CA -95014-3255 _ Telephone: 408-777-3228 C U P E RTIN O Fax: 408-777-3333` CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS. SZ- +S II rAR4 ' 1 PERMIT #k _ !�b 7 J OWNER'S NAME: "A y IVIA1.41,6F� X_ U Al L r PHONE# GENERAL CONTRACTOR: 64btt�yYj"n c,'/�eA3 BUSINESS LICENSE # V7217'1% ADDRESS; - CITY/ZI_PCODE:� *Our municipal code requires alltiusnessesworling in the=city to hay ea City of Cupertino business license. NO BUILDING FINAL OR FINAL: OCCUPANCY INSPECTION{S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CJPERTINO BUSINESS LICENSE. . - I am not using any subcontractors: Signature` ��� _ Date _ Please check applicable subcontractors and complete the following information B Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork zir Cement Finishing C L -D 6-6N 1 ' ���f\( (-,Cs , 5 �- Electrical Excavation _ GIN� � q ) Fencing tt Flooring / Carpeting Linoleum / Wood C1 W ninz— Glass / Glazing N -- Heating C L i f 1 W Q b6V C` %( 5 5 S Insulation i Landscaping'V`1Ii l7 -TZ Lathing C�6'b�S'aC Masonry _ Painting / Wallpaper Paving Plastering Plumbing' C 61-� �-1CLV UrTgr4 - 9 7) fTF Roofing ` C (A _7-0 G Z �p Septic Tank Sheet Metal Sheet Rock C M � 4—tN c1d Z � Tile B Date OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building(aDcuoertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS) f2 l T'b Pzf 6 OWNER NAME �. OWNER ADDRESf S DESCRIPTION OF WORK: We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) ez� 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. �2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. ,3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. /�4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. OLS I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. frs _7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. )f`::-8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 ,g��9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. X10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. ,.et�11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information l have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint._ Your only remedy against unlicensed Contractors may be in civil court. It is also important for you -to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuinA the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification accept the city may be required to be presented when the permit is issued to verifthe property owners si na re. Property Owner's Signature: - Date: !:'Z f --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: OwneYBuilderForm 2010.doc revised 04/14/10 CUPERTIINO PURPOSE UTILITY RELEASE REQUEST FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(o)cupertino.oM For residential single family or duplex construction, there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign -off of the building. INSTRUCTIONS 1. Downloadethis form at: http://www.cupertino.org/index.aspx?page=297. 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3. Fax, E -Mail, Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Form 408-777-3228 office 10300 Torre Ave. 408-777-3333 fax Cupertino, CA 95014 buildinsZ(i�cupertino.or�,, 4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (#404). Please note, a Gas Test inspection (#506) is required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information): APN BLDG PERMIT #: t Q DATE: l 2 Q 1 b SITE ADDRESS: j R �1 Q l OWNER'S NA E:w PH NE #: FAX #: 4l — Lt3 —2 R 2 - MAILING ADDRESS (if different from site address): CONTRACTOR: C' TR T C7,9 FAX #E #. O8 — s -q CONTACT: LoA)4 TA 04 PHONE #: FAX #: I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of I the building cannot move into t resi nce until they receive all of the required final sign -offs and the City has issued a certificate of occupancv for the building. IOwner:......... .. ..`......................................... Print: .... OU�"CK.&N...... CK t'" - ................ Date:.....1.1 . q' .. I Contractor:.....1. Print:..... UtilityReleaseForm_2011.doc revised 08109/11 Cupertino Union School District 10301 Vista Drive, Cupertino, CA 95014 Tel (408) 252-3000 • Fax (408) 865-0326 10995 Developer Impact Fee Compliance The Cupertino Union School District has adopted Resolution Nos. 1403, 1404, and 141501, imposing developer impact fee pursuant to Government Code 53080. Building Permit Request The City of h,f) has received a request for a Building Permit described as follows: esidential Development Project Commercial/Industrial Development Project Name of DeveloperQ���A�t G'1' Project Address: Z 01-5 Description: Square Footage: 0Lot/Parcel #: h -13 - /O/ Permit #: / Date: f i Square footage will be verified by the city prior to iss Representative fees may be adjusted accordingly. Important Notice: Bring this form and payment to 10301 Vista Drive, Property Office. Cupertino Union School District gives no credit for total demolition of existing square footage area, which makes way for new construction as mandated in the Government Code Sections 53080, 53080.6 and 65995. SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OF COMPLIANCE The authorized representative of the Cupertino Union School District has reviewed the City Of C-v.A R7 -#J0 Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District's Developer Impact Fee requirements. Dated: 711 f .�� x Certificate not valid without District seal, initial, and date. By: Authoiized Representative Cupertino Union School District Fee: S 4e, 6442. !ftp Check No.: / 193 Facilities Planning - White City - Yellow Requestor - Pink Accounting - Gold FREMONT UNION HIGH SCHOOL DISTRICT 589 WEST FREMONT AVENUE SUNNYVALE, CALIFORNIA 94087 408-522-2200 Developer Impact Fee Compliance Building permits will not be issued without a completed Certificate of Compliance Building Permit Application The City of / &Aes %.-!�' \ has received a request for a Building Permit described as follows: leo _ New Residential Development ,r Residential Addition (501) sq. ft. or more _ Commercial Development Name of wnerJDeveloper. �E� / . %� %�' i ?T ✓- ��' Lot/Parcel # ' ! i - Z 3c7�` Description: t`it% - �.ZcP.i u�'►G Project Address Square Footage Permit / Plan Check Z 2 9 -- Date: _j B Y: - City Building Inspector -- Square footage verified by the city prior to issuance of a building permit; fees may be adjusted accordingly. Feeder LE-7ieiiieiita^ y viStriCt ��t -j ....................................:.........»............................... SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OF COMPLIANCE The authorized representative of the Fremont Union High School District has reviewed the City of , Orl V1(.) Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District's Developer Impact Fee requirements. Dated: Y c_ V" Certificate not valid without District Seal, Initial, and Date Distribution: Facilities Planning —White City — Yellow By: Fremont Union High School District Authorized Representative Fee $ 1-7� Z. 71 Requestor — Pink Accounting — Gold Dev. Impact Fee Compliance (Rev. 11/22/05) [1 2/08 — 10001 EQ ENGINEERING STRUCTURAL ENGINEERS July 14, 2017 City of Cupertino Building Department 10300 Torre Avenue Cupertino, CA 95014 Subject: 20156 Merritt Drive Gentlemen: f<67©111 EQ Engineering has performed series of site visits to review the framing for the above subject project. The framing appears to be in general conformance with the intent of the structural plans. Our certification was based on a visual inspection of the construction, as it existed at the time of our review. The review was made to verify compliance with the basic parameters of the design. No measurements were taken, nor did we attempt to verify the overall quality of the work. Uniform compliance with the designs and specifications is the responsibility of the contractor and is not guaranteed by this letter. Exclusion of warranties: Our services consist of professional opinion only. No WARRANTY, EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR THE PURPOSES is made or intended. Please contact us should you have additional questions. Thank You. Very truly yours, -11 lisQuebral, P.E., S.E Princi 1 Engineer S 5447 Ut� g C 69478 r w * C_, Exp. 6/30/18 P.O. Box 51342, San Jose, CA 95151 (408) 613- 2136 Tel (408) 882-6405 Fax ACHIEVEMENT bass/Fail In arCORP.[EEF:t�lG CORP. s� � Date: July 10, 2017 JUL 2 6 2017 Proiect No: 3014 �— Chief Building Official 5Y -2d-1 City of Cupertino Subject: Pull Out Test For Single Family Residence 20156 Merritt Drive, Cupertino, CA Permit #: 15070199 Dear Sir, Based on owner representative's request we visited the above job site on July 07, 2017 to perform pull out test for all -threaded rod holdowns. Test pressure calculated 3200 Psi based on 7400 Lbs. design load. No ' Location [ Diameter —f—Quantity Existing Footing 1 5/8',- 2 DL(LBS) bass/Fail 7400 Passed Our findings refer to locations that were inspected by Achievement Engineering representative. In general work was compliance with approved plan sheets S2 and detail 1 of sheet S9 dated 10/27/15 and revision date 05/05/16 Inspection was performed periodically and on call basis as requested by the owner's representative. We claim no responsibility or liability for damages from improper use of the results or findings. We do not undertake the guarantee of construction nor do we relieve the contractor of his primary responsibility to produce a completed project in accordance with plans and specifications. It is our pleasure to provide you with your services. If you have any questions or need any additional information, please feel free to call us at your convenience. Sincerely Yours F'arshad Safaian, P.E. State of California Licensed Civil Engineer CC: Engineer of Record AT Address: 2455 Autumnvale Drive, Unit E, San Jose, CA 95131 - Tel: (408) 217-9174, Fax: (408) 217-9632 www.achieveng.com Form R-11 ACHIEVEMENT ENGINEERING CORP.IR Date: April 4, 2017 Proiect No: 3014 Chief Building Official City of Cupertino Subject: Dear Sir, Pull Out Test For Single Family Residence 20156 Merritt Drive, Cupertino, CA Permit #: 15070199 RECEIVED s.ftV8 J JUL `6 2017 ��.`.f Based on owner representative's request we visited the above job site on March 29, 2017 to perform pull out test for all -threaded rod holdowns. Test pressure calculated 3200 Psi based on 7400 Lbs. design load. No Location Diameter Quantity DL(LBS) Pass/Fail Existing Footing 5/8" 9 7400 Passed .Our findings refer to locations that were inspected by Achievement FnninPprinn ranrPcantntivo .7 ` —F In general work was compliance with approved plan sheets S2 and detail 1 of sheet S9 dated 10/27/15 and revision date 05/05/16 Inspection was performed periodically and on call basis as requested by the owner's representative. We claim no responsibility or liability for damages from improper use of the results or findings. We do not undertake the guarantee of construction nor do we relieve the contractor of his ,primary responsibility to produce a completed project in accordance with plans and specifications. It is our pleasure: to provide you with your services. If you have any questions or need any additional information, please feel free to call us at your convenience. Sincerely Yours Farshad Safaian, P.E. State of California Licensed Civil Engineer CC: Engineer of Record AT Address: 2455 Autumnvale Drive, Unit E. San Jose, CA 95131 - Tel: (408) 217-9174, Fax: (408) 217-9632 www_achieveng.com Form R-11