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B-2016-1568CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 11204 MOUNT CREST DR CUPERTINO, CA 95014-4755356 26 017 ( ) CONTRACTOR: PERMIT NO: B-2016-1568 OWNER/BUILDER OWNER'S NAME: CHOPRA SANDEEPAND TORAL DATE ISSUED: 08/31/2016 OWNER'S PHONE: 415-420-4156 - LICENSED PHONE NO: CONIRACTOWS D Cr ARATrnn* BUILDING PERMIT INFO: License Class Lic. # Contractor OWNER/BUILDER Date X BLDG —ELECT I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business —PLUMB — MECH X RESIDENTIAL _ COMMERCIAL & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: INSTALL (I) ABOVE GROUND PRE-FAB, SPA/POOL (150 S.F.) m. 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. 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. APPLICANT CERMCATIOl�T Sq. Ft Floor Area: Valuation: $25000.00 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 APN Number: Occupancy p y Type. construction, and hereby authorize representatives of this city to enter upon the above mentioned property for 356 26 017 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. PERMIT EXPIRES IF WORK IS NOT STARTED Additionally, the applicant understands and will comply with all non-point source WITHIN 180 DAYS OF PERMIT ISSUANCE OR regulations per the Cupertino Municipal Code; Section 9.18. 180 DAYS FROM LAST PECTION. Signature Date 08/31/2016 Issued h3i+' ISSA N OWN .R-B Iii D R DECLAR ATM Date: O 1/2 1 - -- HE-ROOFS- I hereby affirm that I am exempt from the Contractor's License Law for one of the two reasons: i. I, as owner of the property, or my employees with wages as their sole All All roofs shall be inspected prior to any roofmg material being installed. If a roof is 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) ✓ v� 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: I hereby affirm under penalty of perjury one of the following three declarations: m. 1 have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter Section 3700 of the Labor Code, for the performance of the work for which this 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will :.permit is issued. LS I certify that in the performance of the work for which this permit is issued, I maintain compliance with the Cupertino Municipal Code, Chapter 4.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous d 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 Worker's Compensation laws of California. If after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health &SafetyCode, S tions 255 , 25533, and 25534. be deemed revoked. Owner or authorized agent., APPLICANT CERIMCATION Date: I certify that I have read this application and state that the above information is 08/31/2016 *" CONSTRUCTM, LENDING A FNCY 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 . tmg to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) j 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' ]DECLARATION Code, Section 9 1 understand my plans shall be used as public records. Signature%i' Date 08/31/2016 Licensed Professional SWIMMING POOL 1 SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 950143255 - - CUPi Ri[NQ (408) 777-3228 • FAX (408) 777-3333 - buildinci@cupertino.org 81— Jam - KIP-? 1 .�� PROJECT ADDRESS O APN $ V L�j OWNER NAMESiN A e e (� PHONE ' E t� ' ! I J ! J li (� W u ` f 1Li� LA STREET ADDRESS ,-„- CITY, STATE, ZIP FAX CONTACT NAME c Y PHONE --7 MAIL STREET ADDRESSCITY,STATE, ZIP FAX OWTtb'R -❑ oWNER-BUB.AER ❑ OWNER. AGENT ❑ CONTRACTOR 11 CONTRACTOR AGEW ❑. ARCHITECT © ENGINEER ❑ DEVELOPER 13 TENANT C TRACTORNAME LICENSENUMBER LICENSE TYPE BUS. LIC k COMPANY NAMB E-MAIL FAX STRF.ETADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRCSS CITY, STATE, ZIP PHONE DESCRIPTION OC WORK R CfAA Yn o Ak,Q a, — -S��. V11" t �� lne�� USE OF SFD or Duplex ❑ Multi -Family TYPE MATMUAL TYPE (CODE) AREA (SQ. FT.) VALUATION ($) STRUCTURE: ❑ Commercial POOL POOL/SPA MATERIAL TYPE CODES:. - ' SPA P r o Q0 '21 V - VINYLLINED DEMO F _ FIBERGLASS G - OUNITE P -PREFABRICATED 4 fes: �' � TOTAL VALUATION. 11 Y .. .. _. _. _ .. .... - u�-... � .. By my signature below, I certify to each of the following: I am the property owner or authorizddagent to act on the property owner's behalf. I have read this application and the information I have prov ed 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 relatin i in constru .- uthorize representatives of Cupertino to enter the above -id e tiff property for inspection purposes, Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMA'T'ION REQUIRED Commercial or Multi -Family Buildings with Public Swimming Pools:RRN Department of Environ mental Health approval require_ d, SwhnPoo1App 2Q11.doe revised 03116111 �i T OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-32.28 • FAX (408) 777-3333 • buildina(d),cupertino.ora CUPERTINO 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 s �.� APNBP# — zG—oto— _f—c OWNER NAME E P Ro OWNER ADDRESS 12_0 j� /� `� L �-t- DESCRIPTION OF WORK: UO V [ &"Joi 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, initialed your understanding of each provision, signed, and returned this form to 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. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an 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 insurance coverage for injuries to workers on my property. 2. 1 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. . 1 understand as an "Owner -Builder" 1 am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk 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 numbers on permits and contracts. _11;�. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. V_6. 1 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 "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. ` 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family 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 is performed under contract with a licensed general building Contractor. Ck� _aZ 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. O nerBuildeiForm 2010. doe revised 04114/10 X9. f understand 1 may obtain more information regarding my obligations as an "employer" from the Internal evenue 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.cslb.ca.gov for more information about licensed contractors. ��L10. I 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. C/ 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide V 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 understand 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: 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 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 sim2ature. 1-11k Property Owner's Signature: -!V 1' Date: �' I�1, ------------------------------------------------- --------------------------------------------------------------------------------------- (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): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I 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: Ow neiBuildeiFonaz 2010. doe revised 04114/10 Cn FIL, oi- American Soil Testing, Inc. 1-� 1 Soil, Foundation and Environmental Engineers 2734 S. Bascom Avenue, San Jose, CA 95124 408-559-6400 - Fax 408-559-6688 www.americansoiltestingi:nc.com 16 ®1 File No. 16-3698-5 October 3, 2016 Mr. Sandeep Chopra 862 Trenton Drive Sunnyvale, CA 94087 Subject: Proposed 'Spa & deck 11204 Mount Crest Drive, APN: 356.-26-017' Cupertino, California Pier drilling observation services Gentlemen: Per your request, our firm has , performed field observations and inspections services during pier drilling operations for the proposed spa & deck for the above- mentioned project. Our final pier inspections performed on October3, 2016. Totally ten (10) piers were drilled, using a 16- inch diameter auger. Number of Piers 6 4 Auger Diameter 16" 16" [Depth ft 12' 10, Piers were drilled below the bottom of the pool per approved foundation plan. At the time of our inspection, no water was accumulated at the bottom of the pier holes. The City inspector should inspect and approve the reinforcing bars prior to placement of concrete. Aa File No. 16-3698-5 American Soil Testing, Inc. We are pleased to have been of service to you in this matter. Should you have -any question or require additional information, please feel free to call our office at your convenience. Very truly yours, American Soil Testing, Inc. Ben Rahimi 4A Andrew A. Ghofrani, P.E. R.C.E. # 38159 Expire: 3-31-17 California Code of Regulations, Title 16, Division 5, a, x400-476 Article 1. General Provisions 411. Seal and Signature. (Partial) (e) The Seal shall be capable of leaving an electronically -generated representation on the documents. The signature may be applied to the documents electronically. Please contact American Soil Testing if Authenticity is questionable: 408-559-6400 2 Rahman & Associates Inc. Design & Structural Engineering Consultants City of Cupertino Building Inspection Division Cupertino, CA RE: New Spa Pier Reinforcing Observation The Chopra Residence New Spa 11204 Mount Crest Drive Cupertino, CA Dear Building Official: y �! October 5, 2016 Project No. 2016-102 In regard to the above referenced project and per the request of field contractor our office representative made an on-site observation of 10 pier reinforcing per information shown on the approved plans by the City of Cupertino, Building Department. Our scope of services was limited to visually observe the vertical pier reinforcing and horizontal tie size and spacing. We have achieved the following conclusion after completion of our field observation: The pier vertical reinforcing plus tie size and spacing is in general conformance with requirements of the approved plans by the City of Cupertino, Building Department. If we can further assist you, please do not hesitate to call. Very truly yours, Mohammad H. Rahmani, P.E. Cc: Project file 1870 Hamilton Avenue, San Jose, CA 95125 Tel: 408 377-4000, Fax: 408 377-4001 Email: mrahmani@rahmaindesi ng com www.rahmanidesi