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B-2016-1143CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1143 10402 LAS ONDAS WAY CUPERTINO, CA 95014-3130 (369 28 034) JAHAN CONSTRUCTION MORGAN HILL, CA 95038 OWNER'S NAME: MEHTA HARSHAD AND BHAVNA DATE ISSUED: 06/13/2016 OWNER'S PHONE: 610-304-7188 PHONE NO: (408) 375-9694 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic. #620150 Contractor JAHAN CONSTRUCTION Date 03/31/2018 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: REMODEL (E) 1904 S.F. AT 1 ST FL; ADD 2ND STORY ADDITION (790 I hereby affirm under penalty of perjury one of the following two declarations: S.F.) TO CREATE 3 (N) BEDROOMS & 2 (N) BATHS; UPGRADE 200 t. I have and will maintain a certificate of consent to self -insure for Worker's AMP ELECTRICAL PANEL; INSTALL (2) NEW FURNACES; INSTALL Compensation, as provided for by Section 3700 of the Labor Code, for the (N) AC UNIT AND WATER HEATER. performance of the work for which this permit is issued. 6-1-2017- DEFERRED TRUSSES- ISSUED 07-05-2017 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by REV #1 - CHANGE FOUNDATION LAYOUT - ISSUED 3/8/2017 Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: 800 Valuation: $400000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 369 28 034 Deferred Submittal (R -3),R-3 (Custom) 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 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�=.� :^C _ �. Date 07-5-2017 Issued by: Abby Ayende Date: 06/13/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 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) 2. 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: 07-5-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. 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 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous 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, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall ` be deemed revoked. 1 Owner or authorized agent: APPLICANT CERTIFICATION Date: 07-5-2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance 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 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 Signature Date 07-5-2017 Professional CUPERTINO ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION `'S S e S COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - bulldinaQcupertino.ora ❑ ADDITION ❑ ALTERATIO'N i TI YfREVISIO 1 DEFEI Drr ORIGINAL PERMIT # PROJECT ADDRESS �7 O — L` APN # OWNER NAME PHONE �} h' E-MAIL CJ o r STREET ADDRESS r © GCD % C , STATE, ZIP FAX CONTACT NAME/ Y ( ' PHONE / G/ E -MAID. j STREET ADDRESS CiTY,STATE ZIP �I2(7' FAX ❑ OWNER ❑ OWNER -BUILDER 11 OWNERAGENT 93CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVPL.OPER ❑ TENANT CONTRACTOR NAME =LJCENSE2N:UUM3ER LICEN E TYPE BUS, LIC # ILD / COMPANY NAME j AQ_ r "mac /! A E MPJ FAX 1 � /I $f 7v pv ! pC !! l- Q.+V11 . 0,V\ik STREET ADDRESS CITY, STATE, ZIP HONE ARCHITECT/ENGINEER NAME LICENSE NUMAER BUS. LIC # COMPANY NAME E-IVIAII. FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE N STORIES USE TYPE OCC. SQ,FT, VALUATION (S) EXISTO NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCHAREA DECK AREA TOTALDECK/PORCHAREA GARAGEAREA; DETACH I ATTACH P DWELLING UNITS: IS A SECOND UNIT El YES SECOND STORY ❑ YES ]BEING ADDEU? [:]NO ADDI'T'ION? ElNO PRE -APPLICATION [)YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION: PLINNINGAML# ❑NO PL.ANNINGAPPROVAL LETTER EICHLERHOME? NO By my signature below, I certify to each of the following: I am the property oamer orautbor&d agent to act on the property oumer'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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection. purposes. Signature of Applicant/Agent: ` ` Date: 26 1`7 SUPPLEMENT - FORMATION REQUIRED Q T - ' Y PL�_CHECIC.fiYPE"„,ROUTIhGSLiP,;;, New SFD or Multifamily dwellings: Apply for demolition permit for Y h p © ovE1; rBcoUn*rER arm nu�GPiANxE«W existing building(s). Demolition permit is required prior to issuance of buildrng permit for new building.SSsY _ �, —t - PITtf1GxI ANxEv�y Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STAItsDARD � �; r uBLTCR oxxs _ form if any Hazardous Materials are being used as part of this project. - Q _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. 0 TOR �° _ SAIQLTARI sEw> RnlsrRl cT Bldgripp_2011.doc revised 06/21/11 y- CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1143 10402 LAS ONDAS WAY CUPERTINO, CA 95014-3130 (369 28 034) HOMEOWNER BUILDER OWNER'S NAME: MEHTA HARSHAD AND BHAVNA DATE ISSUED: 06/13/2016 OWNER'S PHONE: PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor HOMEOWNER BUILDER Date 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: REMODEL (E) 1904 S.F. AT 1 ST FL; ADD 2ND STORY ADDITION (790 I hereby affirm under penalty of perjury one of the following two declarations: S.F.) TO CREATE 3 (1) BEDROOMS & 2 (I) BATHS; UPGRADE 200 1. I have and will maintain a certificate of consent to self -insure for Worker's AMP ELECTRICAL PANEL; INSTALL (2) NEW FURNACES; INSTALL Compensation, as provided for by Section 3700 of the Labor Code, for the (1) AC UNIT AND WATER HEATER. performance of the work for which this permit is issued. i. I have and will maintain Worker's Compensation Insurance, as provided for by REV #1 - CHANGE FOUNDATION LAYOUT - ISSUED 3/8/2017 Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: 800 Valuation: $400000.00 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 369 28 034 Deferred Submittal (R -3),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 3/8/2017 Issued by: Abby Ayende OWNER -BUILDER DECLARATION Date: 06/13/2016 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. ale (Sec.7044, Business & Professions Code) z.. % I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: e� Ci contractors to construct the project(Sec.7044, Business &Professions Code). Date: /3 8/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1 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 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 6 Section 3700 oi'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 s. I certify that in the, performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous 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, 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: 3/8/20117 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 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance s 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 shhallall bbe e used as public records. Code, Section 9.18. Date 3/8/2017 Licensed Si nature 9 _ Professional r COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c_cupertino.org•� ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI 0. REVISION / DEFERRED ORIGINAL PERMIT # 0-1) PROJECT ADDRESS >i_� i U� Q), 1 _ n i a t - C_L_�, s APN # ?, / ®��� ® 3 ✓/ pb e 1„ OWNER NAME j,-�ya y.-� � �10� PHONE D� ✓ d t "' E-MAIL STREET ADDRESS © © G- (� W 7 C{CL CITY, STATE, ZIP ^ . � p� � �a, W FAX CONTACT NAME l I PHONE E-MAIL STREET ADDRESS •,.._ n lU 3S A }+ QIP �ly� CITY, STATE, ZIP rt1 �r 140 �- FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE YPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK +j �C3 ' t 'VtC n U t1 �Nl Y\ EXISTING USE PROPOSED USE CONSTR TYPE I # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER - REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLING UNITS: ISA SECOND UNIT E] YES SECONDSTORY ❑YES BEINGADDED? ONO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES • RECEI�EF - - - _. t TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following:- I am the property owner or authorized ager o act on the pr perty 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 with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: i. F Date: r SUPPLEMENTAb,NFORMATION REQUIRED PLAN CHECK TYPE, ROUTING SLIP ❑ ovER-THE COUNTER ❑ BUILDING PLAN RFVIFW _ 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. l] EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. - ❑ ENVIRONMENTAL HEALTH - BldgApp 2011.doc revised 06/21/11 Abby Ayende From: Harshad Mehta <Harshad_Mehta@siliconpower.com> Sent: Tuesday, March 07, 2017 9:56 PM To: Abby Ayende Cc: jahan.f01@gmaii.com Subject: 10402 Las Ondas Way, Cupertino Hi, Thanks for all your help to Jahan. I do authorize Jahan Faridnia as my contractor to take care of any renovation related issues on my behalf. Please elt me know if you need any more information. Regards. Harshad Total Control Panel Loin To: abigaila(ci)cupertino.org Message Score: 45 From: harshad—mehta@siliconpower.com My Spam Blocking Level: Medium Block this sender Block siliconpower.com This message was delivered because the content filter score did not exceed your filter level. 1 High (60): Fzss Medium (75): Pass Low (90): Pass CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1143 10402 LAS ONDAS WAY CUPERTINO, CA 95014-3130 (369 28 034) HOMEOWNER/BUILD ER OWNER'S NAME: MEHTA HARSHAD AND BHAVNA DATE ISSUED: 06/13/2016 OWNER'S PHONE: 610-304-7188 PHONE NO: LICENSED C'ONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor HOMEOWNER/BUILDER Date X BLDG _ELECT _PLUMB MECH X RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapte r 9 (commencing _ with Section 7000) of Division 3 of the Business & Professions Co a and that my license is in full force and effect. JOB DESCRIPTION: REMODEL (E) 1904 S.F. AT 1ST FL; ADD 2ND STORY ADDITION (790 I hereby affirm under penalty of perjury one of the following two declarations: S.F.) TO CREATE 3 (N) BEDROOMS & 2 (N) BATHS; UPGRADE 200 1. I have and will maintain a certificate of consent to self -ins a for Worker's AMP ELECTRICAL PANEL; INSTALL (2) NEW FURNACES; INSTALL Compensation, as provided for by Section 3700 of the Labor Code, for the (1) AC UNIT AND WATER HEATER. 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 a work for which this Sq. Ft Floor Area: 1600 Valuation: $400000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above , AFN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 369 28 034 369 Deferred Submittal (R -3),R-3 (Custom) and state laws relating to building construction, and hereby autlorize representatives of this city to enter upon the above mentioned'roperty for inspection purposes. (We) agree to save indemnify and keep armless the City of Cupertino against liabilities, judgments, costs, and expe rises 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 allon-point source regulations per the Cupertino Municipal Code, Section .18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 6(] Issued 1 Abby Ayende C Date: 06/6/13/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Iraw for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: z. 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 inspection. y L� compensation, will do the work, and the structure is not i4ended or offered for 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 (See.7044, Business &! Professions Code). Date: 6/1 I hereby affirm under penalty of perjury one of the following thr I e declarations: Consent for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. I have and will maintain a Certificate of to self -insure Compensation, as provided for by Section 3700 of the La or Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z. 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 of the work for which this California Health & Safe Code, Sections 25505, 25533, and 25534. 1 will �' performance permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I I shall not employ any person in any manner so as to become subject to the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of air contaminants as 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, 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: M - CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the abo a information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances aid state laws 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 pur�oses. (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. f 2 �n Licensed Signature r Date 6 Professional CONSTRUCTION PERMIT APPLICATION ... i ,•• CO1VNrUNITf DEVECbPYItNi �D�f'Ri1JcNT� SU3CDfhTG Q1V151of�i -_ . 10300 TORRE AVENUE • CUPER i 1NO, CA 95414-3255 CUP'ERTINO• (408) 777-3228 a FAX (408) 777-3383 buildino0ouuer'Llno.dro 13-7,0(6— 1 1 ❑ N£VJ CO? iST2UC i ION ❑ A7Di i ION ❑ I i r� ATIO? ! T I ❑ R.EV iSIOIq / ra'–ER sr) O IGi r� e y PORAfiTsENEA.th)DP,ESS O� � 1 rle ONOAS WA OP�r�/ /tiL3NR •I- k�F�lJilT a .74 ` WWII SFR.:it fbDP.PSS h' j !t 88i Of t' A S Ci-iY, STS7e', Z P I FAX FSTREM—EADID)RIESS nL,`1 t2P f CIT, Y. STATE, 2,p _ ij�/.J}���P+ry��7 rkY a�d i.��" ©ptl9raa3 Q Op'J�P.•h117.D}„•"it ❑ ONR.•-=RhC=ivZ C] co1,-,��c�o;� C] �� Cal �iCTi7RAG T ARChr=T ❑ t.0 _ D 1 -LO? "R ❑ r/ �e I LEC 2 Si 1vLgJ3�R .L1CshSE iYP BIOS. LIC J CdtJy d1aY A! 1rr a + - - - • , a 'yam../` .. N .ii. fi �� � 1 � � rh.Y STRFEThDDRSS CQ -Y, STAT -P, ZIP As YsY�1 ,, I P?iOhe -- r c at�t.rrl Gr?;f�J; LIC g ® CO1+,PAW MUM K MLI FalVl� �Ei v I e•1�HsLFAX STR'sETADDP SS k574(2d#ILS I CTY,�aA�z,ZIP `'ice / PI30A DwSCR�i70h Or WORK. 0 -- CAWIQ) FUO(2eA4ob � .t. C677 G% r __ aszn c vs= PROPOSED Asa calas;x ; }�M € s4dx>s }Sti'/V7; 1pl use Txrs OCC. I SQ.r`T. � VAi113.T1m (S) t ��7Cs •f�� �NcW Fi.00R DFMO I i 6RcA 'IC Jam► h}'C9© ;L= cA �A*I T,OTA3 GGG6 7i(%�C(J h -T fizh 3ATT-ADO��IT REMO_ .Rc] SQDELFR=A c� { �� a,r+}!-•D_L.AREA L.C.ti� I p),IDDEL.,-%s}"Z 70 1 �. 757-3;- -3;-' DV,?LL1NGu?ia $; 1S A SECOND IJXrrYES SECOND STORY' 1.S SEAvG"Dwo ANO ADDrrION? Lj PP APPLICATION ❑YZE 1; 1aS PRONW COPY OF ,E - PL<_I.fi,7I+G 4PPL m O p a LI i BLDG J.N - - ,,•+� _ ONO L �?.Z�GFPPP01�hr L to ? E1CFdLE$ HOhf^a? ?;'0 •„�� 4 U �� TOs�.T�rr/SS-. Vy..LU4 1OIi; BY my strn_tue below, I c rtly to each or aha cello„ Yang: I ern the propel y 0aIncr or author zed n t to act on the property oWner s beha)E I have ;ead this oplicatioq and the in,ormetion I have provided is cc,,cot, I have read the Description of WFark arid verH5, it is accurate. I agree to -Co nply },ith all applicable local arelna Ices and state laws ra)a ng to building construction, I authorize repr esen`^.tivts'of Cupertino to enter the Property for inspection purposes, SJmatoreofApplieanttAgenC Udt �a A.►i �//� UTL11,I.rr. n,oRMra§ =dem! n_ {- �xf'-�dt3�1GSL�nn �- hetvSFiJ �h or „it1_a,,i!y c�:�teitr nnc Apply fpiDn aer:�it�� -fi eaistma building(s) De-mohtion per mit is reau red _Prier to iLs'ance of but ding m �S—`- 'T-•'.�C.OL-�42{'a _ ' � '" pe u it far sew bolding, - �_oa Rl v {:oMmi'iercial Didg-5: Provide a completed Hazardous Materials DiSC!oi`,?re . tOI-7 1? any I-1cZOOLS bfriP 1815 r"S2 being used ES G?rt ai ihiS project, a� — Capy oa t lznnig Approv 1 Letaer or Areeting with Planlig prior to stil t..,.,- t 7012 •moi -sr,. ' :submittal of 13t...diy Pe_a�t a =�=3 PplipbttDn, -�� �� � ,yTr•_�.RrS�'��.-�.r Br'ca�Av_20-11. doc revised O6/2Jlll COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408) 777-3228• FAX (408) 777-3333 • budding(a)cupertino.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 I C3,4 e z: !- c � 0 a oto c�Ja APN 6 9. 2-® BP# 6 r OWNER NAME 14"Skft M G I OWNER ADDRESS' 6 L F4 14.361 DESCRIPTION OF WORK; 0-d. V-yi 6 atpj 1 ' . -� J Cpm( of 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, initiated your understanding of each provision, signed, and refiurned this form t.o 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. Please read and initial.each statement below to signify you understand or verify this information.) „f1. 1 understand a frequent practice of'unlicensed persons is to have the property owner obtain an "Owner ' u"ildee' building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as on 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 i surance coverage for injuries to workers on my property. I 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. e3. myself from as an ofential"Owner-Builder" finan -B i risk I am the responsible party of record on the permit. 1 understand that I may y p 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 C_�'nu ers on permits and contracts. Atota-1value 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the of my construction is at least five hundred dollars ($500); including labor and materials, I maybe onsidered an "employer" under state and federal law. 6. I 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 "em'ploYee." I also understand my failure to abide by these laws may subject e to serious financial risk. T 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family 9 Y 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 1 erformed under contract with a licensed general building Contractor. (� ` any 8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship, or materials. OwnerBuilderForm 2010. doe revised 041141.10 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..csib.ca.gov for more information. about licensed contractors: 10. 1 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. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, C 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 I 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_undeestand 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: 1 '' 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 issuing the permit. Note: A Jpy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be re red to be presented when the permit is issued to verify the property owner's si 1 Property Owner's Signature: Date: 61 l 1 14 --------------------------------------- ----------- - --- - - ---------------=---------------------- (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): 6 OW 1:`it �► Project Location or Address: 1 b 4a Z LA, 4_7 W--� Yai Name of Authorized Agent:`i- lit 'jg Tel No 4 o 9 -- � I - 9 % 6. Address of Authorized Agent: '7 `2'Z I ril or ­n c4 wy-v4 w SOL- Joi-t kS I U 1 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 owner's signature. Property Owner's Signature: Date: 11 CJwnierBuildetFornt 2D10.doc revised 04/14110 Reza Sharifzadeh, P.E. P.O. Box 20453 EI Sobrante CA 94820 510 860 9750 Date: July 6, 2017 Subject: Inspection of shear wall anchors bolts installed 10402 Las Ondas Way Cupertino, CA 95014 Dear Ms. Phuong P.E., Building Plans Engineer Please take notice that I have inspected all lateral shear wall anchor bolts installed by Mr. Jahan Faridnia and/or his associates for the project located in 10402 Las Ondas Way in the city of Cupertino, CA 95014. All anchors bolt sizes, embedment's lengths, etc. are installed per plans and regulations. Please feel free to let me know of any concern you may have. With Respect, �OFESSIOA(i C �Q p,RIF2q�cc Reza Sharifzadeh P.E.W,vP y ►- � _..tea I STATEMENT OF SPECIAL INSPECTIONS, 2013 CBC COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.&O., BUILDING OFFICIAL um C.UPERTit 10 LD300 TORRE AVENUE • GL7PERTtNO. CA,95014�3255 (408) 777-3228 • FAX:(408) 777-3333-bulding9pcs!2g&o ora SITE 10402 LAS ONDAS WY CUBE TiNO ADDRF38, APR Idfiff 35 �-©34 B-2016-1143 ...... Canvactor•,J !jN, FARIDNIA WAHAN•C STUCTIOM Address. P. SL 1 7M ot�t .•..� c ✓t 1 200 BURNETT AVE SPC 71 Address ......, lf, Sp . �• �t o ?ay. t t P(1O"e .... .... G+tyt$t19R�fIN..HII ..C91 iF11BNCA . ZIp. 951)37. ph 408 179 4866 VAHID KHALILI (ARCHITECT) Applicant ........ .........• .,.. Address•••2574 OAK ROAD SUITE#100 I Engineer/Ar dacl.f�CZd Sik3Tf�23(�fl�. ....,... M CxytSY„•,• VALNUT_ CREEK CA• __ �p.94597_ __• •__ • Pt,«1e 202, 4312202 Address � ••"�'�"�"""'""" "' cttyist.l.r".r�%�'G....zip..btd'..�o PROJECT DESCRIPTION: This "STATEMENT OF SPECIAL.INSPECTIONS" is submitted in fulfillment of the requirements of CBG' -$actions 1704 and 1105. This form Is structured after and used by permission from the Structural Engineer Association of Northern California's (SEAONCI mode statement of Special inspections. Also, included with this form is the following: 11`LIST OF SPECIAL INSPECTION AGENCIES (page 2). A list of testing agencies and other special inspectors that will be retained to conduct the tests and inspections for this project ❑ 'SCHEDULE OF SPECIAL INSPECTION" (page 3 — 6). The Schedule OfSpeciaf Inspections summarizes the Special Inspections and tests required. Special Inspectors will refer to the approved plans and, specifications'for detailed speGal inspection requirements. Any additional tests and inspections required by the approved plans and specifications..shall also be perforated. Special Inspections and Testing will be performed in accordance with the approved plans and specifications, this statement and CBC Sections 1704, 1705, 17176, 1707, and 1708, interim reports w II be submitted to the Building Official and the Registared Design Professional in Responsible Charge in accordance with CBC Section 1704.1.2. A Final Report of Special lnspectIOW documenting required Special Inspections, te5",and correction of any disgrepattties noted in docuumentt:: the Inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy (Section 1704-1 JI Final Roport will • Requited spe`ialalInspections. • Correction of discrepancies, noted in Inspections. 'he Owner recognizes his or her obligation to ensure that the construction complies with the approved permit documents and to imp!ement this program of special inspections. In partial fulfillment of these obligations, the Owner wilt retaln and directly payiior$he Special Inspections as required in CBC Section 1704.1. Trils plan has been developed with the understanding that ttte BUlidIng Official will: • Review and approve the qusRecations of the Special Inspectors who will perform the inspections. • Monitor special Inspection aetivRIes on the job site to assure that the Special lnspectors are qualified and are performing their duties as called for In this Statement of Special inspection. • Review submitted inspection reports. Perform inspections as required by the local building code I have read and agree to comply with the forms and condWons of this: statement Project 0 Engineer ■ Architect H iAaR s �•� Ar, Owners AutnorizicVT InspeClon Agency f Inspector Name: ReZa n hadfndeh Buildng Official ordesignee: (ARCHITECT) VAHID KHALILI C 31165 JUNE/7/16 I-- ................ . nate ")fl Building Departrfff fupectionFornt_2014:docM,,4edogIO6✓12 REVIEWED FOR CODE COMPLIANCE Reviewed By: Phuong DeVrleS aie: