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B-2017-0607CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0607 10136 ORANGE AVE CUPERTINO, CA 95014-2839 (357 17 103) ZIBA DESIGN AND DEVELOPMENTINC SAN JOSE, CA 95155 OWNER'S NAME: BAI GUOFENG AND LI QING DATE ISSUED: 06/23/2017 OWNER'S PHONE: 510-474-2966 PHONE NO: (408) 348-9942 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lie. #$6155$ Contractor 7_IBA DESIGN AND DEVELOPMENT INC Date 03/31/2019 X BLDG —ELECT _PLUMB — MECH X RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: 1 ST FLOOR MASTER BEDROOM ADDITION (178 S.F.); REMODEL I hereby affirm under penalty of perjury one of the following two declarations: MASTER BATHROOM (98 S.F.); REMODEL EXISTING MASTER 1. I have and will maintain a certificate of consent to self -insure for Worker's BEDROOM AND CLOSETS (192 S.F.). 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 Sq. Ft Floor Area: 178 Valuation: $68000.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 357 17 103 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 regulationsp Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature - Date 06-23-2017 Issued by: Kim Dunbar OWNER -BUILDER DECLARATION Date: 06/23/2017 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 t. 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) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 06-23-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 47 3. I certify that in the performance of the work for which this permit is issued, I C Health & Safety Code, Section 25532(a) should I store or handle hazardous Additionally, I devices hazardous shall not employ any person in any manner so as to become subject to the material. should use equipment or which emit 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, etions 25505, 25533, 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: 06-23-2017 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 Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed SiSignature Date 06-23-2017 g Professional CONSTRUCTION PERMIT APPLICATION 50'O -©60�f COMMUNITY DEVELOPMENT DEPARTMENT ` BUILDING DIVISION 10300 TORRE•AVENUE - CUPERTINO, CA 95014-3255 1-1 408).777-3228 • FAX (408) 777-3333 • buildino oDcupertino.org CUPERTtt�tCs r [I NEW CONSTRUCTION ADDITION ;- 11 TiR4T]ON / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT ri F 'ET PROJECT ADDRESSt O J .3 L O ru v\�?i A V,9., 0,u �ei lit MO IAP O\1i'NERNAME` PHONE l0'�`Cr'1 � f3al cin d_ 19%j" �•\-`�.- Li I '710 - c.17t_I E-KAIL �p17Y} f jq I 'vi 9 _ ----- STREF.TADDRESS CITY, STATE, ZIP FAX 5 -,M -Q- C; ;s c< b '�. V'a' CONTACT N.0.MEL r _t _ � C � V OS I P 0?� E-KAIL b�'� -z.; bf� 06ye- I* kn C1 i j c4 rrl - STRF.ETADDRESS CITY, STATE, ZIP FAX �Ix © 0%11,TR 13 OWNTR•BUMER ❑ OAWRAGETT CONTRACTOR ❑ CONITRACTORAGFNT ❑ ARCHITECT ❑ EN'GUEER ❑ DEVELOPER ❑ TENANT COl\TRACTORNAME I✓lp}T'^ 1 V� LICENSENUA0FR LSC£NS£TYPE S.LIC BUo r bto R>z%;1F•N cr n (�GV.4o P r*tZ ti) INC i7 1►j 5 `� GarLe ru.Q J3 V Collo ANYNAME &1i6AIL otVe�.�PkZx1i FAX z,IG tNC. zlbAc�2VE�o�,'�grnatt�,t✓orrl STREET ADDRESS CITY, STATE, ZIP 1165 l-inColn Ave, -*'3415 Sgn '73 CA °I05155 PHO\ �Fo - �1$� Ry2Z ARCHITECTOMNEE? NIA]ME 111C TSE NIAGER BUS. I.IC.'. . AZ o� ate- M ct sr— v'r --- --- - --- -- — ---- COfPANMYNAS ME e � -- E•M.AIL .f,LL� C: O �n — TAX —�-- - SrRFE'TADDRESS 2275 S• 13otS�rn 5toiTer ir1o6 Criy.S'P.AT ZSppC --- P}30N1E ' e A „� -j`6 DESCRIPTION OF WORK —d411i_�6SLI/i —_ o r�..—%��S�L_�LL 1 �o .n e✓ C�/ S 4- ►� 2t^% —Cl ] e L—S.LI_ and, neN e4!-eLs —127$ S t�rl^ 9 O F_XISTLHG USE PROPOSED USE CONST.R. tYPE STORIES �— USE � TYPE OCC. SQ.FT, VALL'AT10N (S) --�--- FXISTG NEW FLOCP DEA+o —�` TOTAL -- --" -- - AREA AREA l6 AREA NET AREA BATHROOM REA40DELAREA REMODELAREA OTHER RFI+90DELAP.EA _ PORCHARE•A DECK AREA TOTALDE.CIVPORCHAREA GP:RAGEAREA: DETACH ❑ ATTACH L)A'ELLE\'GUNITS: ISA SECOND UK IT ❑YES SECONDSTORY ❑1'ES "" BUNG ADDED? ❑';O ADDITION? ❑ NO PF.E-APPLICATIONE] YES JF YES, PROVIDE COPY OF IS THE BLDC AIN E] YES TOTAL VALUATION: PLA1\0" GAPP1i E)*ao PL4`,'R'P:G APPROVAL LETTER � EICHLER HOAIE? NO L' By my signature below, I certify to each of the following: I am the property owner or authcrized agent 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 Avith all applicable local ordinances and state laws relating to buil iir.Qrlc�_onstruction. i authorize representatives of CupertinO to enter the above -identified property for inspection purposes, Signature of Applicant/Agent: _ Date: S1JPPLEME\1TAL W1 CIRMATI01\t REQUIRED A� CHECK�TY PE. .. . 1 xr.: r ROUTINGSLI 4�; _ New SFD or Multifamily dwellings: Appl), ] , for demolition permit for p existing building(s). Demolition permit is required prior to issuance of building O\ Fat THE COLTERDING 1 a PLN\ IE art r perntit for new buildino.{ .PJtESS�.Er --.tea 3''i'^3.. Pi.-,I�'�LT�GPLAT�RE\IE1H Bldgs: Provide a completed Hazardous Materials Disclosure ." siA��AeD w� ❑ i t�itc t\oxTs^ \ _Commercial form if anv Hazardous Materials are being used as part of this project. ❑ x - - _ Copy of.Planning Approval Letter or Meeting With Planning prior to LARGE'. i r r. r Cr '❑E FIRE DEPT ' s " k MWR submittal of Building Permit application. �. ,Latour sJraRi sE Icrlucr� rx;. �.r:.a,, r „ n.,;::• C� ENY-1 0�n7Ei`TA)JHEALTJi - Bldglpp 2011.doc revised 05121/11 7104 AMS DESIGN LLP 1920 Geary Rd Pleasant Hill, CA (415) 254-2634 armin@amsdesignllp.com Re:. Changes in Foundation: 101'36 Orange Ave., Cupertino, CA To whom it may concern, To' level the new foundation with the existing foundation, a 2x4 is installed on top of PT mud sill.' The 2x4 should be attached to the mud sill by a A35 or LTP4 every 12" o. c. to transfer shear. The same detail can be applied on top of the 4x8 Girders to level the foundation. This detail is accepted by structural point of view. Please contact me if there is any concern or question regarding this change. Sincerely, Armin Masroor, PhD, PE (415)254-2634 j armi'n2amsdesign11P.com 'i J t/f EM ENIpz AGF'{E - MEN1 u �=NGlNEER NG Cd �j4d�CVRP. Egg ' • ,Y Date: July 18, 2017 '"17` Project No: 3102 •IIIMIRA Chief Building Official City of Cupertino Subject: Epoxy Grouting Rod For Residential Building 10136 Orange Ave, Cupertino, CA Permit#: B-2016-2177 Dear Sir, Based on owner representative's request we visited the above job site on July 17, 2017 and observed the progress of all-threaded rods embedment into the existing concrete footing along grid lines C/1-2 according to the following Table: TYPE Length Diameter(In.) Hole Size(In.) Min. EMBEDDED(In.) Quantity All-threaded Rod 36" 5/8" 3/4" 12.5" 4 The type of epoxy was SET-XP with expiration date on 10/11/2018. In general work was in compliance with detail 7 on plan sheet page S2 dated 04/17/2017. Inspection was performed periodically and on call basis as requested by the owner's representative. We claim no responsibility or liability for damages from improperiiuse 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. Our findings refer to locations that were inspected by Achievement Engineering representative. If you have any questions or need any additional information, please feel free to call us at your convenience. Sincerely Yours, © aFEs,;,0 �¢.`,, ,toQV ( Sina Hooshdar, P.E. D/i<`~ G, r.= r,s7s , State of California Licensed Civil Engineer t(k( E.(1 s� CC: Engineer of Record, 1 22 CC: The Owner `� ;Z . AT ` ` -N. `1viL s< Address: 2455 Autumnvale Drive, Unit E, San Jose, CA 95131 -Tel: (408)217-9174, Fax: (408)217-9632 www.achleveng.com Form R-11 0 ..11.: i , 16' s t ,,,* ,44104,4*.PArikkatm•Inr4.,,446,,,,,t,. -. ,.. _- — ' 141-' ' ''-i, 414,41giiiik*•004&Aillt , ---rr- - • , a .1. , A. I ..,, 41414k 'I 11 1 . 7 tE-• Allil- . 1;7,-: , 4474 0 7,c.,o• ,. ''''; (--27 ' .. -- 11 I “ • ,,. CC- /n ,• 1/4..i.„„...- , .k• ,'4.,4, 1 • , 1 I I 1 . \ ' tot', t r WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 44, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUP1GRTt Nty (408)777-3228•FAX(408)777-3333•buildinqacupertino.orq Owner Name (ilzi O../- Lg' G-' Permit No. Z-0 Address 1®) 3 C o rrs t9 , e P eawo 2 C 1 Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101 1 through 1101.8 do not apply Skip the rest of the form and sign bottom of form. X No Go to Question 2. 2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its plumbing,installation of water-conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. XNo Go to Question 3 3 Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101 1 through 1101:8 do not apply Skip the rest of the form and sign bottom of form. Igt No Go to Question 4 4 Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994 Civil Code Sections 1101 1 through 1101.8 do not apply Skip the rest of the form and sign bottom of form. Yes My real property is built and available for use or occupancy on or before January 1, 1994 Civil Code Sections 1101.1 through 1101.8 apply Check one of the three following statements and sign bottom of form. 5 Please check ONE of the following: My property is a single-family residential real property See Civil Code Section 1101 4 On and after January 1, 2014,building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,. all non- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property See Civil Code Section 1101.5 On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property See Civil Code Section 1101.5 On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements) I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be replaced pnor to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101 1 through 1101 8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's installation requirements, and that the water-conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. ?/� t Owner or Owner Agent's Signature. `VP Date. / vv 'I Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB407 2015.doc revised 01/05/17