B-2016-1277 I
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1277
10384 MELISSA CT CUPERTINO,CA 95014-2620(342 45 022) CHANA
CONSTRUCTION
UNION CITY,CA 94587
OWNER'S NAME: AVALANI BHAVEN AND RAJUL TRUSTEE DATE ISSUED:07/12/2016
OWNER'S PHONE:408-531-7392 PHONE NO:(5 10)487-3254
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#554005 X BLDG _ELECT X PLUMB
Contractor CHANA CONSTRUCTION Date 01/31/2017 —
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:
Construct a one story addition(493 sq ft):Covered Porch(66 sq ft);
I hereby affirm under penalty of perjury one of the following two declarations: Bathroom remodel(58 sq ft);Other interior remodel(319 sq ft);tankless
i. 1 have and will maintain a certificate of consent to self-insure for Worker's water heater.
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by
9—Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area:493 Valuation:$150000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances 42 Number: Occupancy Type:
3
and state laws relating to building construction,and hereby authorize 342 45 022 R-3(Custom)
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 7/12/2016 Issued by:Abby A,ewe GLQ ,
Date:07/12/2016 tlL(
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a 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:7/12/2016 .
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
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. 1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
Health&Safety Code,Section 25532(a)should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued,I
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 25505,2553 ,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:7/12/2016
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to 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
I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 7/12/2016 Professional
-- CONSTRUCTION PERMIT APPLICATION
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By my signature below,I Cerny to each of the following: I am the proper),mmer.or authorized zge,:to act on the property o'Amer's behal, I have read this
application and the infornation I have provided is correct. I hee-read the Description of Work and N)erify it is accurate. I a4 w to-comply with all applicable local
ordinances and state lads relating to buMing eonsumction. I authorize representatives of Oulperrino to enter the above-identiiiled prop--,;y for inspection purposes.
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i Otm if z"y IAazzrdouS hdateriais are.being used as part Of this Project.
Copy of Planning Approval Letter or with Planning prior to
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American Soil Testing, Inc.
fill Y,
2734 S. Bascom Avenue, San Jose, CA 95124 -*�—=�-=--
408-559-6400- Fax 408-559-6688- www.americansoiltesting.com
I
I Piers Drilling Filed Memo
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d
Project Ad ress: 163 (-i ffiF i_S 5 A CT City (c) Cr io e T, Vt
E File No.:
1 Our firm representative has performed a foundation inspection for the above mentioned
project ons /Y-9 /2016
Our inspection revealed that --$ -Piers were drilled substantially in accordance with
approved foundation plans and recommendations contained in our Soil and Foundation
Investigatic n Report.
at �
Auger than Total piers drilled depth of the piers 9- refusal .—
T
The City Inspector should inspect and approve the reinforcing bars prior to pouring
concrete.
The formal Foundation Inspection Letter will be mail to our client as soon as possible.
P
If you have any questions regarding this inspection, please call our office after, 4.30 PM.
Sincerely,
American Soil Testing, Inc. OL
y
I'
ASTI, Representative, -` -- t=om-ISLE-- -`=� `_JA
Date: — 9—I
Time: 11 goo AM/