B-2016-2255CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2255
10570 LARRY WAY CUPERTINO, CA 95014-2035 (316 02 027) T I MANAGEMENT
GROUPINC
LOS GATOS, CA 95030
OWNER'S NAME: DIEC SUONG H AND SHERRIE C
OWNER'S PRONE: 408-464-9125
LICENSED CONTRACTOR'S DECLARATION
License Class.B Lic. #24D674
Contractor I MANAGEMENT GROUP INC Date 12/31/2097
hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
lith Section 7000) of Division 3 of the Business & Professions Code and that my
cense is in full force and effect.
I 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
pennit 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 pe�the Cupertino Municipal Code, Section 9.18.
Date 10/17/2016
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).
I hereby affirm under penalty of perjury one of the following three declarations:
s. 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 snaking 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 10/17/2016
ISSUED: 10/17/2016
NO: (408) 402-5080
BUILDING PERMIT INTO:
h.
X BLDG X ELECT X PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
IST FLOOR ADDITION OF (1413 S.F.); REMODEL (1200 S.F.); (N)
PORCH (30 S.F.); RELOCATE GAS AND ELECTRIC METERS;
RELOCATE GARAGE (429 S.F.); (N) WATER HEATER; ADD
SKYLIGHT IN HALLWAY; (N) A/C UNIT NEW LOCATION;
UPGRADE PANEL TO 200 AMPS - NEW LOCATION
Sq. Ft Floor Area: 1413 1 Valuation: $250000.00
APN Number: Occupancy Type:
316 02 027 Deferred Submittal (R -3),R-3 (Custom),R-3
(Custom),Deferred Submittal (R-3),peferred Submittal
(R-3),Deferred Submittal (R-3),Deferred Submittal (R-
3),Deferred Submittal (R-3),Deferred Submittal (R-
3),Deferred Submittal (11-3),Deferred Submittal (R-
3),Deferred Submittal (R-3)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 10/17/2016
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: 10/17/2016
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 with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: _ V
Date: 10/17/2016
CONSTRUCTION LENDING AGENCY
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.
•
1
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,./,/ CONSTRUCTION PERMIT APPLICATION
11.....107/ COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION
10300 TORRE AVENUE*CUPERTINO,CA 95014-3255
777-3333.building@cupertino.orct (1. -2--(:)
CUPERTINO (408)777-3228.FAX(408) i C°—22,55
0 NEW CONSTRUCTION Li ADDITION Ej ALTERATION/TI [-.] REVISION/DEFERRED ORIGINAL PERMIT#
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PROJECT ADDRESS )0 6 IC) La Yr' WO' i G fiftNto APN# ..3\6-0 _097
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OWNERNAME % (0)
11/4A-On 1*0 I e c plioNE405,...464....91,p5, i E-MAIL Scottirec cjabott.co)1.,,.
STREET ADDRESS 10570 „/ ci,,,,a3
tan r I CITY,STATE,ZIP Oxpetii A(2,c49.5-0))t,
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CONTACT NAME
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0 OWNER El OWNER-BUILDER El OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER CI nEvEr..mms. El TENANT
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CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
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ARCHITEINEE NAME iato, iT... , LICENSE NUMBER BUS,LIC#
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COMPANY NAME E-MAIL .7n ro,D,cceqr, Corn FAX
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EXISTO i...re 1 NEW PL,p4DIIt+ DEMO TOTAL
AREA / if 10/ AREA 0 AREA NET AREA
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BATHROOM 117() KITCHEN I go °ThER N.'12,00 .,
REMODEL AREA R
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POACH AREA DE K AREA TOTAL DEcFJPORCII AREA GARAGE AREA:0 DETACH 'FZ,...,,,.,!,•;!..„.,,,!,,,,frj: -,:,-f,.....: ::-,....,-:!:,..,,..:-_:,,,,,t....,..,::,::::, ,:sr.::_,::,,zi;::..2. ,,:i,...,;.,,,,„,-...„:„:::,. ...::::::,,,.-,.;.:::::::::_:.,
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ft DWELLING UNiTS I IILSPCOi4D vmr 0 YES SECOND STORY
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plis-AiwcstioN El YES IF YES,PROVIDE COPY OF PLANNEIES NAME: ".--''' '''.9'''''''',"-'.: '....;:: :;-;Y•f:''''(:.:',V.i",., :.14,814.:i4":;
MANNINO APIS." 0 NO PLANNING APPROVAL LETTER I(i., L : •,L • :. ,_- - i,,,Fir.;,,'.:::,.sri:4,4,,,• ,:,.,, ia71,-)....:;.,:v.
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prope ty ONyner'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 mlatingto building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection putposes.
Signature ofApplicantiAgent: * 07-" )•-: Date: err LIL/ I
SUPPLEMENTAL INFORMATION REQUIRED 1.- ..iLAN 61E6C.TYPt.4:11:i,,ej.,:', ':::..f!,.,:.•,-;i;;-;:-..-,- eitibijiloo.§tri-..:!..,ji::: :,...,..:.
New SED or Multifamily dwellings: Apply for demolition permit for ":ti-:'Oiti,..4ritt i.riiikiiii::7.::--f:',,... .:-Itkr..iiiiiiiitRaibiriikiVii :f.;::;. :
existing building(s). Demolition permit is required prior to issuance of building i7,;.:.,..:,-..,-f.iK,t.,•..,..f,,3,,i.1:,,,,:-.- -41,4,_,.:::::::-(4,:_:.:7, ,:'i!,:,:',4:,,,;„ ,-.--,';f:.,:e.,-, ,id-,..?.!...i:,;:.:. ;..-.:: .,j:,:,:,::,: :,:
permit for new building. L--.ES-'.,:iXiSOS:i.'....:E;I::::;LY..1L..- -iiLF1:::: •tV,',0.1*-,:i,:00144i..ariii*4 *--
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Cmmercial Bldgs: Provide a completed Hazardous Materials Disclosure •Tlt...1-;.'*i..kiSfi'Atini.;;::2:;Z ,-;;:;8..-.,,i-i:-1-Z-:; .j;-,r,:-.,t04pc*oifoi,:,,g.,,,,,,,,,,,,,,,:,..:.,,,,,...-..::::,,, ,
form if any Hazardous Materials are being used as part of this project. !f:-,',.,:,'';'-.',ff.::..:::.,::.. i-il'.V-rTYf:'.',.'--.' ,„,','-',„,•-•:.--;,-;,,,z,:.3.:',:z!,:::-:.,...':....,.,....--..:,-.:-:.;,:.,, ..,,•,
UJ.F.I.AUcig -i44tif,F.. ...?::OY;fa:ftf,, Li, .•TiiUeliiiii*
-copy of Planning Appmval Letter or Meeting with Planning prior to
-4q,-,MISITAgY.$:glyi,A.pi.si.mc77..4.-4:::
submittal of Building Permit application. t4T... . ikffi,.:;:.Z.,:' -. :7!..-. .i'...,!':•4:-2:::: 4 .5..T,';'i,:.,...1-4 .1-',.. ,:...,K.:-,:,:3:;-;:i',2,
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BldgApp_2011.doe revised 03/16/11
December 15, 2016
City of Cupertino
Att: Building Official
_ SUBJECT: 10570 Larry Way
Cupertino, California
Letter of Building Setback Certificate for the addition to the residence.
This letter is to confirm in writing that SMP ENGINEERS, Civil Engineers and
Surveyors, has field checked the building foundation footprint setbacks at the above
mentioned address. The building footprint for the additions has been placed within the
setback lines, in accordance with the approved plans.
If you have any questions regarding this matter, please contact me at your convenience.
If you have any questions„ please call me at (650) 941-8055
Sincerely,
SMP ENGINEERS
By: Saeid Razavi
Principal Civil Engineer
C-52724 -
Exp: 12-31-2018
1534 Carob Lane
Los Altos
California, 94024
650.941.8855 P
650.941.8755 F
www.smpengincers.com
E77
NGINEERS
December 15, 2016
City of Cupertino
Att: Building Official
SUBJECT: 10570 Larry Way
Cupertino, California
Letter of Building Setback Certificate for the addition to the residence.
This letter is to confirm in writing that SMP ENGINEERS, Civil Engineers and
Surveyors, has field checked the building foundation footprint setbacks at the above
mentioned address. The building footpyint for the additions has been placed within the
setback lines, in accordance with the approved plans.
If you have any questions regarding this matter, please contact me at your convenience.
If you have any questions, please call me at (650) 941-8055
Sincerely,
SMP ENGINEERS
By: Saeid Razavi
Principal Civil Engineer
C-52724
Exp: 12-31-2018
1534 Carob Lane
Los Altos
California, 94024
650.941.8855 P
650.941.8755 F
www.srapengineers.com
Uffiff
P.Clc.
P.C.C. ENGINEERING
www.pcceng.com
Fast Cad Drafting
1610 Blossom Hill Rd. #7 February 12, 2017
San Jose, CA 95124
Subject: Special Inspection Certificate for retrofit HD
10570 Larry Ave., Cupertino, CA
U
info@pcceng.com
In accordance with Section 1704 of the California Building Code (C.B.C.), on February 9, 2017, P.C.C.
Engineering has performed-inspection-of-the-retrofit-boldo�"m,subject-project. As required by-the,contract—
T-1
drawings and engineer specification, the inspection was for 5/8" threaded rod drilled and epoxy into 3/4"
1
1 drilled hole at existing foundation with 12" embedment with Simpson "SET -XP" epoxy.
Contractor drilled 3/4"x14" hole at several locations in existing foundation. Fill the hole with "Simpson"
SET epoxy and placed 5/8" threaded rod.
3- HD AB along grid B.
2- HD AB along grid C
P.C.C. Engineering observed the work for conformance with the Building Department approved drawings
and specifications and applicable workmanship provisions of the C.B.C. The installation of the anchor
rod and reinforcement with Simpson "SET -XP" epoxy was in compliance with manufacturer
recommendation and lateral design requirements.
Please do not hesitate to call me, if you have any question.
Sincerely,
P.C.0 En
Kambiz Kouchesfahani, P.E.
Principal Engineer
4229 Boxelder P1. Davis, CA 95618 Tel.(530) 758-3832, Fax:(530) 231-0104
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: % 0 5:10 PERMIT # 2.0 _ 21Z 55
-OWNER'S-NAME: Q 1eC yie C PHONE # 40f-
6?
GENERAL
0 -
GENERAL CONTRACTOR:` j ,UaRC1• <w-" V- d r— f (,AIC-' BUSINESS LICENSE # 4- O �
ADDRESS: 12 -5 , S C -A ,9312' CITY/ZIPCODE: '-)5014
*Our municipal code requires all businesses Working in the:city to have a 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 CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: l 2 D f
Signature Date
Please check applicable subcontractors and complete the following information:
Owner /Contractor Signature
61 4,1 "I
Date
SUBCONTRACTOR
BUSINESS_ NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation,
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving -
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner /Contractor Signature
61 4,1 "I
Date