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B-2016-159461 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1594 18840 TILSON AVE CUPERTINO, CA 95014-3653 (375 16 047) CIMA BUILDERS GROUP INC SAN JOSE, CA 95110 OWNER'S NAME: Mr & Mrs Sanjeev And Chawla Seema Sahni DATE ISSUED: 11/10/2016 OWNER'S PHONE: 408-242-2154 JPHONE NO: (408) 594-1161 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #898686 Contractor CIMA BUILDERS GROUP INC Date 03/31/2017 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH X RESIDENTIAL COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONSTRUCT (1) 1 STORY SFD (1,960 S.F.), ATTACHED GARAGE I hereby affirm under penalty of perjury one of the following two declarations: (414 S.F.) WITH FRONT PORCH/COVERED PATIO (161 S.F.) 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 REV #1 - CHANGE SOILS ENGINEER OF RECORD AND REVISE THE performance of the work for which this permit is issued. FOUNDATION DESIGN TO REMOVE PIERS. (ISSUED 12/20/2016) 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 DEF #1 - ROOF TRUSS.- ISSUED 3/3/2017 permit is issued. _ REV #2 - REDUCE THE SQUARE FOOTAGE AT MASTER APPLICANT CERTIFICATION BATHROOM BY 7 SQ F1 (REVIEWED WITH DEF #1) - ISSUED certify that I have read this application and state that the above 3/3/2017 information is correct. I agree to comply with all city and county ordinances Sq. Ft Floor Area: 2535 Valuation $200000.00 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 APN Number: Occupancy Type: City of Cupertino against liabilities, judgments, costs, and expenses which 375 16 047 Deferred Submittal (R -3),R-3 (Custom),R-3 (Custom),U may accrue against said City in consequence of the granting of this permit. (Private Gar / Ag Bldg),U (Private Gar /Ag Bldg) Additionally, the applicant understands and will comply with all non -point source regul tions per the Cupertino Municipal Code, Section 9.18. 4 PERMIT EXPIRES IF WORK IS NOT STARTED Signature^��- TM Date 3/3/2017 WITHIN 180 DAYS OF PERMIT ISSUANCE OR OWNER -BUILDER DECLARATION 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by: Abby Aygnde following two reasons: 1. I, as owner of the property, or my employees with wages as their sole Date: 11/10!2016 compensation, will, do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) RE -ROOFS- 2. I, as owner of the property, am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed. If a roof is contractors to construct the project (Sec.7044, Business & Professions Code). installed without first obtaining an inspection, I agree to remove all new materials for inspection. 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 Signature of Applicant: performance of the work for which this permit is issued. Date:/3 3/2017 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER permit is issued. s. I certify that in the performance of the work for which this permit is issued, I HAZARDOUS MATERIALS DISCLOSURE shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the Worker's Compensation laws of California. If, after making this certificate of California Health & Safety Code, Sections 25505, 25533, and 25534. I will exemption, I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Labor Code, I must forthwith comply with such provisions or this permit shall Health & Safety Code, Section 25532(a) should I store or handle hazardous be deemed revoked. material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I certify that I have read this application and state that the above information is the Health & Safety Cod Sections 25505, 25533, and 25534. 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 Owner or authorized agent: to enter upon the above mentioned property for inspection purposes. (We) agree u Date: 3/3!2017 to save indemnify and keep harmless the City of Cupertino against liabilities, CONSTRUCTION LENDING AGENCY judgments, costs, and expenses which may accrue against said City in I hereby affirm that there is a construction lending agency for the performance consequence of the granting of this permit. Additionally, the applicant understands of work's for which this permit is issued (Sec. 3097, Civ C.) anis will comply with all non -point source regulations per the Cupertino Municipal Lender's Name Code, Section 9.18. Lender's Address Signature Date 3/3/2017 ARCHITECT'S DE L RATION I understand my plans shall be used as public records. lv-, it . ............. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTI'JEW - 5,UfLDftG- :NASION 10300 TORRE AVENUE -'CUPERTINO, CA Ct)PFRTINO (4 0,R) 77,E-3^ 8 - FAX (4065) 777-.. !�4,s�v Ave,, 1"VIT"'2, M). L SIM V 'A A, 'tml, us; gp 0; Vt A _9 0 _6D4�t 6�cu A A iZ- ki (�l VYIA -1 _e, ,11'REETADOF . M LIP -E CA I CO MY '1\11(5,�, 1)yto) CITY r.vm.= CAN CIS 27 , Revision A2. R�dklcc the -Nuarc Rxita-Lc at alaster bx.hftvlll tl1 11- Y' -M IN—" AKFSt A K EA AREA A' *A XEMWEL AKEk XINODC-1- AKrA F0WL7s.;i_NxD, ............................. T 1AVELLVIG ljxltll';,� oyl_ 15 A SECOND V.NTr 's coNu S`rtwl Lit IN(; A Df)Vjft.' oxvl VDl;M0.v C),\v • Mv.,Vpuckwx 0),E�5 -­B­Gv% El)li C)NU WTI 01-4pmpcn u ppli=iosi �mJ V�c inform u6n I haw pr V1 cn-r.:-ct orditoiccsand Slate bA�_l rclatl1q; to bDE axilc,mtr L.,i­pE I III tv I.l. El j.T-s, Ic." o ctj "01 Sq,,fwtune ofApplic�nl Age€ff - I . . :�41 — , SUPPLEMPNITAL INFORMATIONREQUD'U'D k �11 �Nlt� 9 NNOV SFD 60.1ultifamily ti VIlinp; Apply for dcnwrtilion, Nomit 'im, is i�lluxuv, ll,uitdia-, cxistiing building(s). Demolition Nrmit prifir to t:If Nrmit for new building, iU­­:?Y Cwnnu:r6al Bldgs. hv' id,i a comp.bned. llazardoiLi Maw-riafs D;,Z,aoso:v lbrm if any llazw; lous Materials are Ivim, usst','j w; part .it illii P:-,+:zti'z, z Copy of P'ainiv- Approval Lettur orMwimg 111,Ianin,, rriortuo " submirtil ot'lluilding Penith applii:atitvi. 11 CtA-)-v; 'JX 1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT ® BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • auildin cu ertino.or WdOV.P �--y ' CION I -j I ADDTTioN F-1 AT.TRRATT(1N/TT P RFVTCTn / TIRPRT?T?T:M ') nTJTI_TMAT DL'DT.4Tr44 B1dgApp_2011.doc revised 06121/11 M e OWNER NAME ,' f� ,J g^� { - Jt 9 a _ � %'� ,� `f "HT 9-i/ P ONE U �S �- �p � � E-MAIL a e � � �'� i Sit '►� 1 lu STREET ADEP - 1 0 9 I -S 0 CITY, STAIT ZIP A ` /' (A ��l �/ FAX CONTACT NAME 1 I Y( L PHONE, E -MAH, Cab -t s f `std ° ' * CITY, STA�f t � ^, 1 FAX '.R ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME le a Js5q� LICENSE NUMBER q j (, a _ �j LICENSE TYPE BUS. LIC # COMPANY NAME l {'AA I�'YL� E-MAIL FAX STREET ADDRESS 1P CI Y, STATE, I � PROUNE A✓ v. ARCHITECT/ENGINEER NAME p. ( ; LICENSE NUMBER BUS. LTC # COMPANY NAME � P� j � a s f ,�q (�� E-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 FLOORDEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: ISA SECOND UNrr ❑ YES SECOND STORY [:]YES BEINGADDED? ONO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY2, TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO ,P3 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the properly wner'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 mldin tauc 'o fl a�thorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 2-13 f 2-0 t -4- SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1:1STANDARD ElPuBLic WORKS fo_rm 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVH2ONMENTAL HEALTH B1dgApp_2011.doc revised 06121/11 M CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: I PERMIT NO: B-2016-1594 18840 TILSON AVE CUPERTINO, CA 95014-3653 (375 16 047) CMA BUILDERS i GROUP INC SAN JOSE, CA 95110 OWNER'S NAME: Mr & Mrs Sanjcev And Chawla Seema Sahni OWNER'S PHONE: 408-242-2154 LICFNSFD CONTRACTOR'S DECLARATION License Class $ Lic. #B9$M Contractor LIMA BUILDERS GROUP INC Date 03)31/2017 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 1s in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: z. I have and will maintain a certificate of consent to self -insure for Worker's c . Compensation, as provided for by Section 3700 of the Labor Code, for the i performance of the work for which this permit is issued. z. 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 regulatihs per the Cupertino Municipal Code, Section 9.18. Date 12/2012016 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. I, 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. 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 Code, Section 9.18. Signature Date 12/2012016 ISSUED: 11/10/2016 NO: (408) 594-1161 BUILDING PERMIT INFO: X BLDG _ ELECT PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTI9N: CONSTRUCT (N) STORY SFD (1,960 S.F.), ATTACHED GARAGE (414 S.F.) WITH FR ONT PORCH/COVERED PATIO (161 S.F.) REV #1 - CHANGE SOILS ENGINEER OF RECORD AND REVISE THE FOUNDATION DEIGN TO REMOVE PIERS. -ISSUED 12/20/2016 Ft Floor Area: 2535 1 Valuation: $200000.00 I Number: Occupancy Type: 16 047 Deferred Submittal (R -3),R-3 (Custom),R-3 (Custom),U (Private Gar / Ag Bldg),U (Private Gar / Ag Bldg) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 18Q DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: RE -ROOFS: All roofs shall be inspeppted prior to any roofing material being installed. If a roof is installed without fust Maining an inspection, I agree to remove all new materials for Iinspection. Signature of Applicant: Date: 12/2012016 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health &I 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 Health & ISafety e, Sections 25505, 25533, and 25534. Owner or authorized 8gen . Date: 12/20/2016 ION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the' performance of work's for which thispermit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my planshall be used as public records. Licensed CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT -BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 t j CUPERT►NQ (408) 777-3228 • FAX (408) 7.77-3333 • huilding(acupertino ora 111 (J j ❑ NEW CONSTRUC'f10M �} anril rTnr i I-1 A r ,, . rid 1 BldgApp_2011.doe revised 06/21/11 u 'J"nRHr Ic�ry I I IGS REV1SION DEF D ORIGINAL PE_ RMiT # EPROJECrADDRESS y 40 ► APN#NAME `•'j PHONEE-�jMA! IL 0"9 Mal I STREET ADDRESS CITY, STATE,ZIP FAX rACT NAME PHONE E-MAIL 40 2Q?-- C 1 ley fn 3/ f. TADDRESS 2-•5 1+ CIT TATE, ZIP FAX J or> 511 ❑ OWNER ❑ OWIQER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER El DEVELOPER =—A -T CONTRACTOR E at,t)sL�� LICENSF E LICE SE Pfi EUS. LIC # COMPANYNAME E-MAIL cc \ FAX STREET ADDRESS CITY, ST TE, ZIP v� P On S- ARCIITTECTIENGINEER NAME LICENSE NUMBER EUS. LIC # COMPANY NAME E-MAIL FAX STREHTADDItESS CITY, STATE, ZIP PHONE DESCRiETI0N-0E-!1MRK_ --- EXISTING USE PROPOSED USE CONSTR. TY!'H N STORIES USE YPH OCC. SQ.FT, VALUATION ($} HxISTG AREA NH49 FLOOR AREA DEMO TOTAL AREA NETAREA HATHROOM KITCHEN OTHER RE•MODELAREA REMODELAREA REMODELAP.EA - PORCH AREA DECK AREA OTALI7ECK/POILCHAREA GARAGE AREA; DETACH - ❑ ATTACH # DWELLING UNITS:_ IS A SECOND UNIT DYES SECOND STORY DYES - BEING ADDED? ❑ NO ADDI'T'ION? ❑ NO _ PRE -APPLICATION [j YES W YES, PROVIDE COPY OF IS THE BLDG AN []YES _ nELVED$Y;;'.; ;= ;.- PLANNINGAPPLO No PLANNING APPROVAL LETTER EICIII.ERHOME? ❑NO _ - _-_ -- >:_ _ TOTAL VAL TION: =..-'t .; :_;:.__: :; - - By my signature below, I certify to each of the fallowing: lain ib ' praparly owner or authorized agent t act on fl ` b property owner's behalf•. I have read this. application and the information I have provided is correct. I have r ad the Description of Work and verify it is acc rate. I agree to comply wi th all applicable local ordinances and state laws relating to building • tr cti . I authardze representatives of Cupertino to enterthe ab we -identified property for inspection purposes. Signature of Applicant/Agent: Dale: SUPPLEMENTAL INFORMATI tQUJ=-D s:=::::_: ;::;==•s :>-::-:>:_: _ : =;:r::=:: r::,:: -._::: ;.r:;:;;:.:::::_,.:._:....:-:::.-.:- - .: ,:_..::,.._._ w S or Multlfamnly dwellings, Apply for demolition ernut for - pp Y p - - - - - - - -- --- - - :- - - - -- - - - - existing building(s). Demolition pen -nit is required prior to issuance of buildin IERJ = permit for new building. _.. .-:...:r :PLCommercial ANTING -- Bldgs. Provide i]�sT;iivnniv��:�_=':�>_-=i'f7� •-.`_:-:>:_:---:..:::;::_;=,-'•_;;�,_ •:_-:_ P.uBLIc sYalucs fOnll if all Hazardous Materials are Y being used as pati of tons protect. ._: _.:..:.-.:::_;_..:._.... . ....................::::.:: ___._.._ ... _.., ._...,.... .-.:. LARG:_::-.,._-' ;t:._. Pt- Copy of Planning Approval Letter al Meeting with Planning prior to -C_.::_:_:;-._, .:-:.;::_:,.;.i.:.. _-,,0:::.:`.::}:'•I•:RED:..:. SU1Jrllittal ofBuilding Fel-Illit application.... -.:±: _: `.-;°: .; ;;: :;: ::. ;: .-SANITARl: SEX E$`DISTI2iCT.:�:"; - - -- -- - - --- AL HI;ALTII= BldgApp_2011.doe revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-1594 18840 TILSON AVE CUPERTINO, CA 95014-3653 (375 16 047) CIMA BUILDERS n GROUP INC SAN JOSE, CA 95110 OWNER'S NAME: Mr & Mrs Sanjeev And Chawla Seema Sahni OWNER'S PHONE: 408-242-2154 LICENSED CONTRACTOR'S DECLARATION License Class B.C17 Lic. #898686 Contractor LIMA BUILDERS GROUP INC Date 03/31/2017 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 ISSUED: 11/10/2016 NO: (408) 594-1161 PERMIT INFO: X BLDG —ELECT —PLUMB — MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: CONSTRUCT (l) 1 STORY SFD (1,960 S.F.), ATTACHED GARAGE (414 S.F.) WITH FRONT PORCH/COVERED PATIO (161 S.F.) Compensation, as provided for by Section 3700 of the Labor Code, for the prformance of the work for which this permit is issued. J/� I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: 2535 Valuation: $200000.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances 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 re0qlations per the Cupertino Municipal Code, Section 9.18. APN Number: Occupancy Type: 37516647 Deferred Submittal (R-3),11-3 (Custom),R-3 (Custom),U (Private Gar / Ag Bldg),U (Private Gar / Ag Bldg) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Date 11 /10/2016 C�1�� ued by: Abby Ayo�k Date: 11/10/2016 hereby affirm that I am exempt from the Contractor's License Law for one of the illowing 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. 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: 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. 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 11/1012016 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 ofApplicant: Date: 11/10/2016 ALL ROOF COVERINGS 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 Municipal Code, Chapter 9.12 and f the Health & Safety Cod Sections 25505, 2553 , and 25534. Own' er or authorized agent: Date: 11/10/2016 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 understand my plans shall be used as public records. Licensed Professional t i � CUPERTING - M ! mpw rr)vQ-mitrrrnlS COKSTRUCTI N PERMIT APPLICATION COM10UNIT`( DEVELOPMENT DEPARTIVtENT • BUILDING DIVISION 1030DTORRE AVENUE • CUPERTINO, CA 0,5014-3255 (408) 777-3228 • FAX (408) (4108) 777-3333 buIIdi� nocuueriino.or xct I. 1 a nnrr5n1.T 1 i Al -Mn x. •rrnwt 1-, 71 — '— rau. y y;.t11vi11 tt PROMCf AAAPESS Qq �p y j APN )� ovrnlrlA1�E� l:..�!,, pxcxE� g 2� Si L-tr n ria : .DDRPSS E 9 D L % ) 00--r IN 0 CA Pli 8 ' 2.3n11 E-MA3L �/ry IQ �j CONTACT HAM AL L E 1, hl-649CIA STREET ADDRESS CITY, STATE, ZIP FAX 0awA Q o1iRER-BUILDER - 1:Ot NER.AGENT ❑ CONTRACTOR ❑ CONTFJCTORAGENT f3.CHiTirCT `E ENC&MM ❑ DEVELOPER ❑ TEXANT ucC Mr 5 s -SE YP� •�E i' . C01 TRA R rAh4$ y pp @@ LP BUs. C41vSPA1 . N 4E y ESP,F, A � � l INd 2 —• EMAIL PAX STREET AD KESS CITY SpT�A 7pI1 /°s ARCHFMCTIENGINIM NAME LICENSE MUMMER BUS. me COWANY NAME E-KUL FAX _ STREET ADDRESS CITY, STATE, ZIP PF30i IE (/-J 14- 5r EVSTINGUSE PROPOSED USE CONSTRTYPE ?STORIES USE TYPE OCC.I SQ.FT. I VALUATI014 (S) F3O5i'G NEW FLOOR DEMO TOTAL - - AREA AREA I AREA NIT AREA BATHROOM KITCHEN OTI-MR REMODEL AREA REMODEL AREA RE14ODEL AREA ` PORCH AREA DECKAREA TOTALLDECKMOP,CH AREA GARAGE AREA; LJDETACH - - - ©ATTACH I ' 4 DIMLINGUNTIS; IS A SECOND UNIT © YES SECm�D STORY - ❑YES - - BEINGADDED? []NO ADDITION? ❑NO PRE -APPLICATION [1YES IF YES. PROVIDE COPY OF IS THE BLDG AN ❑YES --k'Tj g7g'o - �- -.-TOTAI,VA.LUATION:PL"SNN[NGAPPLR ❑N'O PLAl�dhZnG APPROVAL Lcir£R EICHLERHOn2E? ❑YE_= IN, -"2,9 n�..j A. i! By my signature below, I certify to each of the fol]owing: i am the property ovmer or authorized a ant o act &n the proparty ownar's behalf. I have read this application and the information T have provided is correct. I have read the Description of Work and verify it is accurate, I agree tocomply•-Nvith all applicable local ordinances and state laNA s relating to wilding constructi n, Vautholize representatives of Cupertino to enter the above -identified propel for inspection purposes. Signature of Applicant Aeent: _gi p / Date: tU SUPPLEMENTAL. INTrORMATIOAI REQUIRED ..........�-�.�-.�-r New SFD or Multifamily dwellings; Apply for demolition permit for --- .. � ��=� R � OVER Z'�COTyhrER?='� � �3 � � � �� �?� • w;B �DL1G PL iZES"iEGiT �. existing buriding(s).. Demolition permit is required' prior to issuance of.builoing permit for new building. M - Commercial Bld6s: Provide a completedPlazardous Materials Disclosure 1 o -r -m if any Hazardous Materials are being used as part of this project. �:. s s — Copy of Planning Approval. Letter or 7M"ting with Planning prior to submittal of Building Permit application. B1dgZpp_2011.doe revised 06/21/11 M CONSTRUCTION PERMIT APPLICATION Ka COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300TORRE AVENUE CUPERTINO, CA 95014-3255 GC�R I�Ttbd� (408)777-3228 - FAX (408) 777-3333 o buildincl(cDcuperCho.orct 4)` A d ^ 1 ❑ taw CONSTRUCTION ❑ ADDITION ❑ ALTERATION 1 TI ❑ REVISION t DEFERRED OitIGINAL p'PRMIT n pRorcr ADDRESS V • � APN n �' � � a Ot�'NER NAhSE ' V b 1 Af ! ` PH NEo g 2 + ! 2_�l SI E -i II rnSON _adosmaf J, �^ S 7 Z1DR£SS f— C17Y, �Tj4T Z S I �' �{ 0 j ! `F CONTACT, N . T PHOhm E -MAH' STREET ADDRESS CITY, STATE, ZIP FAX OFI'HER 0. 013'NI:R-BUILDER ❑ OWERAGENT ❑ CONTRACTOR ❑ C0X7P.ACTORAGENT .lam A ,= T ❑ MGI11MER ❑ DEVELOPM' 0 1zNANr CONTRACTORNAN,E LICENSP,NUIMER I I:ICENSBTYPE LIC .9 60I,0ANY NAhB E•MlsIL FAX STREET ADDRESS CITY, STATE, ZIP PHONTE ARCHrMWENGINEER NP.I..E LICENSE NUMBER BUS. LIC 9 COWANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHOTffi DESCRIPTION OF WORK V �- ,�"�� ._ �Jl�.t%�1. =MOUSE PROPOSED USE I CONSTRTYPE 5STORtES 1J I USE TYPE ` I OCC. I SQ.FT. � I VALUATION(S) )=To NEW MOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCIi N - OTMR REMODFLARFA REM ODBLMEA R MODELAREA PORCH AREA. TOTAL DlC"OP CH AREA GARAGE AREA; ODFTACH - - - 7AREA ©ATTACII I ;'• DWLLING WITS: IS A SEMNII UNIT © YES SECOND STORY ❑YES BEINGAIDDED? 111`0 ADDITION? EINO PRE -APPLICATION DYES 1E YTS, PROVIDE COPY OF 1S THE BLDG AN El YES Iova' ;may u .�_ r TOTAL VALLI ATldl l; PLANNINIGAPPLK ONO PLAN INGAPPROVALLETTER EICHLERHOSIE? ENO now 216 0 00 0 av • By my signature belmv, I certify to each of the fall owing; I am the. property oN mer or authorized aganttio act an 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 Nvith all applicable local ordinances and state la,.vs relating fo wilding construction, autho ize representatives -of Cupertino to enter the above -identified propel for inspection purposes. Signature of ApplicanUAgent; 1 Date: 6 SUPPLEMENTAL INFOnh ATION REQUIRED � .. °....0 cry s _otinc LIY New SFD or Multifamily d-wallings: Apply for demolition permit for ��� ��� . - ;� � �M-r= _ 0�7 R-SHICDLshTE£t o-• tB Di�G PLS RE47ECSr� E3:IStInQ building(s). Demolition permit IS required prior to issuance of building permit for neva building _ Commercial Bldgs: Provide a ca nplefed Hazardous Materials Disclosure MAIN form if any Hazardous Materials are being used as part of this project _Copy of Planning Approval Leiter or Fleeting with Planning prior to T;RISTT2.i'Ck;��. submittal of Building Permit application. �� i .'- Bldg.4pp_2011,doc revised 06121/11 LS PURCHASE ORDER NO: 1028453 CUSTOMER: I EARED PRODUCTS INC. COMMODIT L THREAD ROD ADE B7 STANDAq, : ASTM Al`93 QTY: 550 PCS 1:CHEMICAL ELEMENTS(%) HEAT N0:6101198 SIZE; l 1/8-7 X 144" PLAIN S/C NO: I6US32ZJ905011 INVOICE NO: SUZ16905011 MATERIAL: B7 CHEMICAL ELEMEN C Mn Si P S Cr MO SPEC 0.37 0.65 0.15 MAX MAX 0.75 0.15 121 0.49 1.10 0.35 0.035 0.04 1.20 0.25 TEST REPORT 0.42 0.90 0.26 0. Q 17 0.004 1. 0.99 0.20 2:MACHINICAL PROPERTIES HEAT NO: TEST NO:160523-03 ITEM TESILE STRENGTH MIN(ksi) YIELD STRENGTH MIN(ksi) ELONGATION MIN (96) RDUCE MIN N TEMPERING MIN (°F) HARDNES MAX (HRC) STANDARD 125 105 16 50 1100 35 TEST REPORT 1 144 121 18 51.0 1139 30 2 142 120 19 51.6 1137 29 3 141 119 18 51.2 1140 28 `1-TRgTFO RTZ.R: ITEM LENGTH MAJORDIA GO NO STRAIGHTNESS STANDARD 144.25" 1,123 2A 2A MAX ADD 143.75" 1.108 0.72 TEST REPORT 1 144.03" 1.118 OK OK 0.30 OK 1. 116 - OK �OK 0.31 OK 3 144.05" 1.117 OK 10K 0.29 OK PCS : 8 4 143.95 " 1. 115 OK OK O.32 OK 5 144.08" 1.120 OK OK 0.33 OK 6 143.92" 1.118 OK OK 0.35 OK 7 144.06" 1.111 OK OK 0.:35 OK 8 143.93" 1.112 OK OK 0.31 OK REPORT ACCEPT GEC Page 1 �l C 6FILE g„ing GeoEngineering Consultants (GEC) _- -- ---- 4125 4125 Blackford Avenue, Suite 145 San Jose, CA 95117 800 -GEC -3752 Project No. P16.0378 January 18, 2017 i Sahni Sanjeev 18840 Tilson Avenue Cupertino, CA I Subject: Proposed Residential Improvements 18840 Tilson Avenue f Cupertino, CA FOUNDATION OBSERVATION DearSanjeev: I At your request, GeoEngineering Consultants (GEC) has visited the subject site", on January 18, 2017 and observed the bottom of footings. The footings were prepared in accordance with our recommendation letter dated October 17, 2016. The subgrade is ready to receive steel and concrete. Should you have any questions relating to the contents of this report or should you require additional information,. please do not hesitate to contact our officeat your convenience. Sincerely yours, GeoEngineering Consultan � pFESSt PN Gytgss fi� j No. G98379 i C3 No, GE2792 Exp. 6/3412018 � �iT EGH Q1 GAS! Kamran Ghiassi, Ph,.D., G. . Principal i I I I i GEC Page 1 GreenBluEarth, Inc. 284 Bromley Cross Drive, San Jose, CA 95119 Ph.: 408.772.4381 Email: osunaengineerinq a)am�ail.com Building Department City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 Re: 18840 Tilson Ave, Cupertino CA To Whom It May Concern: This is to certify that the house foundation for the property measured setbacks of the forms are as follows: 7 January 30, 2017 Job No. 1225 above was surveyed. The • Front Property Line Setback: Measured, 20.06'; per Plan 20.00' • Northerly Side Properly Line Setback: Measured, 5.00'; per Plan 5.00' • Southerly Side Property Line Setback: Measured, 5.01'; per Plan 5.00' i • Rear Property Line Setback: Measured, 20.01'; Min. Setback per Plan 20.00' Sincerely, i Oscar Osuna, US., P.E., P.L.S. President RCE C70829 PLS L8921 i 284 Bromley Cross Drive, San Jose, CA 95119 • 408.772.4381 • Email: josunaengineering@gmail.com RC Consulting Engineers, Inc. Structural & Earthquake Design 7007 Realm Dr. B-3 San Jose, CA 95119 Date: May 24, 2017 To: City of Cupertino Building Division 10300 Torre Ave. Cupertino, CA 95014 Re: Sahni Residence 18840 Tilson Ave. Cupertino, CA 95014 (Project No: 15-215) To Whom It May Concern: �.' tel 408-229-8155 fax 408-229-8157 e-mail: rcengr@aol.com This letter is to confirm that we have performed construction observation for the building as referenced above. This included a review of the basic wood framing construction. The wood framing, joist beams, columns and shear walls observed by us for the project were to be found to be in general conformance with the city approved plans. LIMITATIONS: The information and opinions contained herein are based upon the limited observation described at the beginning of this report. No warranties are expressed or. implied regarding the existence of other unknown conditions not specifically addressed. Our work is in accordance with generally accepted engineering standards and is not, intended to be relied upon or transferred to individuals other than the addressee. Should information or conditions become known which differ from the discussion herein, they may alter the opinions or conclusions of the undersigned. If you have any questions, or if we may be of further assistance, please do not hesitate to call at (408) 229-8155. Sincerely, RC Consulting Engineers, Inc. r� Romeo C. Cabalar, P.E. Principal Consulting Engineer C4B yl Na C 46956 EXP. 09-30-1 `f 1 of 1 • rs.k‘ Building Department 1: Cit, Capertinc 10300 Torre Avenue Ova-tint),CA 95014-3255 Telephone.408-777-3228 ckiPERTINO Fax 408-777-3333 CONTRACTOR[SUBCONTRACTOR LIST JOB ApPRESS. I go(4 0 T1kVeNV:6 PERMIT;:/ 72-1, 151 II_ t..\/ Al—f. N./ PHONE.it t--VA 2—'2454 GENERALCONTRACTOR cm A goo EIZS 42-04) BUSINESS LICENSE it 0 22:71 5 4pD.R.p;;5S:416S- .F77)( kit E r5kft, C1TY:14..W.ODE: - A,IV 40St. *Qui-municipal code requires all%usitiesses working in the ci4 to have a City of Cupertino business Ikèn CA 1_11 ID NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL TUE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 ain not using any subcontractors: -, Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets&Millwork Cement Finishing , . Electrical Excavation Fencing :Flooring Carpeting — :Linoleum/Wood Glass./Glazing: Heating Insulation: Landscaping :Sepl Gt./ 4/ 4-6-3 Z/ Lathing NA/An:4w Masonry Painting/Wallpaper , - Paving Plastering Plianbing Roofing Septic Tank __ Sheet Metal Sheet Rock co OAC9/1\' ---- Gc(64 irA/VgevkniAp-) ' gi 201/ ' b D wner/Conittivtor.Signature og 01A) TVAl Hial\)r/ I- •.,�j SI --..-:'-'7, v i , ,. yy avy V_ ' 'x • ar' y, '' Ya x` 1.• t$' • -te i. :'I amu_,% " W13 + _ k nt=J ' �,--„, • , ij4 i" 3ST- '4‘,.,','''...'. • • •c.I . u iJ wi•1 iZ rn ys� . f , ay •a,S F 'T•sa3." ; i•' •': • } �'T om, �aRG ,,:-1-:,..•:';'-‘,":",:' ^ `1: : s �4,: 'jati < i iY '�fs4Fn 'a.' ,. � � A) x wa: rzv• f.v ;, _ L •�v ,.� • > " , a , z5ice: 'Vil L< . 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