15060046 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10181 WESTERN DR CONTRACTOR:EDWARD PERMIT NO: 15060046
CONSTRUCTION
OWNER'S NAME: WANG WEI TRUSTEE 2533 AMETHYST DR DATE ISSUED:06/05/2015
OWNER'S PHONE: 5105012248 SANTA CLARA,CA 95051 PHONE NO:(408)985-0731
® LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
VOLUNTARY SEISMIC REPAIR AND UPGRADE
License ClassLic.#15% T€
Contractor 1_-,1,V .1 S
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.
I hereby affirm under penalty of perjury one of the following two declarations:
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. Sq.Ft Floor Area: Valuation:$5000
F
_ 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 APN Number:35911004.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 18 OM LAS LLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, r ��
costs,and expenses which may accrue against said City in consequence of the Issued b Date S �,�
granting of this permit. Additionally,the applicant understands and will comply 3''
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
ROOFS:
6,10/5 any r
Signature /,^^� Date �
All roofs shall be inspected prior to y roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 05,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: d00 Date: 4*9
permit is issued. `;a;W,
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
918.
Signature Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildina(aDcupertino.orq /✓ /�v y�
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGIINTAL PERMIT 4
PROJECT ADDRESS Y� � CPN � APN O
OWNER NAME �j�e V✓�C �c P U$ PHONE C j6 �U l L/ E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
.X"G
CONTACT NAME PHONE r _ E-MAIL
hr�3_._ .'`��'; >= —`7�5 X33/. �'/�r,sc'c%✓arel cdw,es !/
STREET ADDRESS CITY,STA�Tf;?7'L
FAX
7'Lw, .
OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT 1 + CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINMER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER• J LICENSE TYPE BUS.LIC#
COMPANY NAME / f�J� �4 i6t EMAIL / f�S `�y47 �VS FAX
STREET ADDRESS �? �Y `� CITY,STA E,��]P PHONE
f r
ARCHITECT/ENGLNEERNAME LICENSENUMBER - BUS.LIC
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK f J
t,. G
EXISTING USE PROPOSED USE CONSTR TYPE -'STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
E),aSTG NEW FLOOR• DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM. KITCHEN., OTHER.
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
. ❑ATTACH .
R DWELLING UNTIS: IS A SECOND UNIT ❑YES SECOND STORY []YES
BEING ADDED? NO ADDITION? ❑NO .
PRE-APPLICATION ❑YES IF YES,PRO VIDE COPY OF IS THE BLDG AN ❑ RECEpr� - - - TOTAL VALUATION:
PLANNING APPL-, ❑NO' PL.ANI.TING APPROVAL LETTER EICHLER HOi,fE? 0 _ _ - r
By my signature below,I certify to each of the following: I am the property owner or d �th
„ erty oHmer's behalf. I have read this
application and the information I have provided is correct. I have read the Descri can veI agree to comply v ith all applicable local
ordinances and state laws relating to bui� g construction. I authorize represe es of Cupertino to entified property for inspection purposes.
Signature of Applicant/Aeent: Date:
SUPPLEMENTAL ORIIATION REQUIRED - L
New SFD or Multifamily dwellings: Apply for demolition permit for r❑ Buunu�GPL41tx1 vi>cv,Y
iL�x04ERTH1rCOiinSER r r
existing building(s). Demolition permit is required prior to issuance of buildingznvl A
�z
permit for new building. I� �xrxEss PLArfii.GPLAr1REvr>�ti
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure GD sTAnAxD �� PUB1 o3vFoxr �
form if any Hazardous Materials are being used as part of this project. `t T—SM �
_Copy of Planning Approval Letter or Meeting with Planning prior to
I✓IA�aoR T sr>�.rr101 sEaER�Is�xlcr a
submittal of Building Permit application. _ v
. �� �:�`` �.��g -�`• �_�`-En�VII:oNMSxraiL.FIEf17T.H,,xr��£.
BldgApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10181 WESTERN AVE— bi(L-, DATE: 06/05/2015 REVIEWED BY: MELISSA
APN: 359 11 004 BP#: "VALUATION: 1$5,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair
PRIMARY PENTAMATION 1GENRES
USE: SFD or Duplex PERMIT TYPE: i
WORK VOLUNTARY SEISMIC REPAIR AND UPGRADE
SCOPE
�
Afech. Plan Check Phuub.Plan Check :/Ele
Plan Chock
klech. Permit Fee: Plumb.Permit Fee: Elec. Permit Pee:
Other h ecFa, lrasfa. ET
Other Plumb Ins,(). F,lec.Insp.
Llecla.Insp� Fee: Phinib. hull).Tee: Insra.Fe
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These Lees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E{f. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Foundation Repair
Supp/.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $859.00 IFOUNDREPA
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.FeelD Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Adininistr°ative Tee: 0
Work Without Permit? 0,Yes No $0.00 L E)
Advanced Planning Fee: $0.00 Select a Non-Residential G
Building or Structure 0
Tavel Docurnentall gin 11e es:
Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.001 1
a� SUBTO�ALSt` $1.65 $859.00 , TOALFEE: $860.65
P e
Revised: 05/07/2015
Edwards Construction -- A-2 Stem Wall Repair Detail
edwardsfoundation@comeast.net - A-1 Stem Wall Repair Detail p
(408)985-0731 C�e _ ___s!b qa ____
State Contractor License#763218 CO __=sv_b-boor_
Cupertino Business License#29469 Foundation Footprint
General Liability Insurance#002188-15 Existing wood sideliag , 1 5/8°Hot Dipped Galvanized Threaded Rod Qa 4 OC
#9127547- 5Y Galvanized 'OC Existing 'Maoist PP
Workers Compensation1 1 518"Hot Dipped Gal @�
Existing nm_J°is-t_F. PP
3"x3'x174"Hot Dipped Galvanized Washer 3'x3°x114"Hot Dipped Galvanized Washer
Existing sill plate Existin sill late
A-3 A-3 A-3 A-3 Remove&Replace aMinimum of 8'from top RSI Standard
d square holescr to into the 2,800
with 2,900 PSI Standard Wei ht Concrete PSI Standard Wei ht Concrete into the void
8.0 in #4 Rob or •``` Existing#4 Rebar
�.W.. ! It
12.00 in
- .m°_
t''� ° '''�l �•1� #4 Rebar with Hook 16°OC
Rebar&Threaded Rods Epoxy Set utilizing Simpson Threaded Ijgds Epoxy Set utilizing Simpson Set XP
Set XP with a Minimum Embedment Depth of 6" with anim Am Embedment Depth of 6"
... v
6.06 inPi
'Jr-
4
J a
� 5
'v-
One Story r�
1240Exisng footing / ��_ 8.00 in w �
3 — Existing footing @� �U� 0
ea CO � �
A- &� OF
16.00 in 16.00 in
Repair Area A-2 .
UNIVERSAL FOUNDATION PLAT,
01-3 MNt UNITY a , ,
��Ac,� can���ra� uN�.►r��sa� �v 7p)
BUI�pt DEV�LOP A-3 Adjusts for foundation width versus mudsill widthdAFfarentlalsfrom+21/2"to-1/2".
4 t; /�
DING Cj D` A4 I Se a%usta para ane os de•oimientos versus dllarencras de nachos de solera de+2 Y/2"a-Y/Z
P A_3 j'1— t/�S'I rVT.O INSTRUCTIONS;
App
�N� EPA Before Installing check conB(tion otfoundation and muds(II Repairlreplaca as necessary:Using UFP plate as template,mark position of holes on
/$$et of App CUP RTME 7� foundation and mudsill.
plan$ �® ERT ! FOUNDATION:For epoxy with 1/2'-X6'RFO's,drill two 5/8'x 4114`holes into foundation at template marks;drill 1/2'x 4'holes for 1/2'x51/2'
S/ an N Wedge-All's;or drill 1/2'x4112'F Dies for 1/2'x 5'Titen HD's. Place plate in position,assuring plate holes align with holes in foundation,
Repair Area A-1 to Burin specifioa �® O MUDSILL:Attach top of UFP to mudsill with five SDS1/4`x 3'wootl screws.
Aan 9 Co� nstr tion$ t' Refer to Simpson Anchoring Systems Literature for post-Installed anchorage solutions
il -e 9 S or alts uCtion- It i MAST be INSTRUCCIONES
ratio s unta kept at .Antes de Insalar la plata,veri/iqua la cond/e/dn del clmiento y de la solera.Repare o cambie tomo necesano.Use la plata UFP tomo planilla para
e Stara Withle
appy ns on Sam wfut to make tl] CIMIENTO:Para removeerl a b qu lla de niabla 27:Gieros on of dmianto alas pla oestafias grandes de la bo tla de niebla hacia la derecha o haca la Izquierda.Alines las
b n oV fro e, an pestafias y la 1lecha de la Salida de arabin con lays llechas del anillo que este alrededorde a safida de niebia.Una vez que as llechas esten alineadas,tire de
\� e held to 8 of this pia al Om fh or t0 de la pasafia dela Salida de niabla hada Arriba Cologce la plata en su posicidn,asegurandose de que Ips agu/eros dela place se alineeq con los del clmiento.
J Of an De Is n and$ e Buildin V/atQ SOLERA:Use cinco tornilfos SDS de 1/4'x 3'para only to parte superior de la UfP a Ja solera.
8 Y t I0 @ an a eciflcatl- Sy 0mciaf vee Publica@lones de Simpson sobre Sus Sistemas de Anclaje para saluc/ones apropiadas de natio/es past-fnsefttt.s.
A 6YA8NINGS Always wee aYeproledl1nd fnp! laird! misG educt canal ria
nil .
the Ital(mown to Ne SWIG or Calitornla to So drN detects or..
I TE
a p°duc Na ha m.C.rt.irveemlmnme le. p aret Der at ah,.r cheml els
L r ': tlnUudlnO same wo dpreservallveel may wu arty la0ure Seawwv.atronAlle.eoMln(o
D V l°f the viLf N� HI1LI �IGXS-�IG TZ _ 11 r.roper use,limitatl s,xaminps and r.arranues -
° ((�>r` ABYEerENCI11S:5lImVVre usarC otea/dncdarde.steMMd.lsddn.Fslasn(cul.-
P atl(� , \4 rAmlene ulMcos conocl4os en el ESWdo tleCaldornla p.reausar e3ncey tlelectos tle
J °r Sta n Wed eAnchors - �. 1k naclmlen[oyohas leslo es reproductivae.Las emNlenters c.rtoslvos,W eapos'Nd al apu'
�O T# to r.\ -jv -'"r� - IairesaWdo ala....milds(1wd n9e.1Qenee,a fva,d1tu ra matlera)pueden musar
�( Cagy \ -r : MAX lahna Cr mamra.Pamver las in,"ec assabre su use adecuado,sus llmirzdanea.
Addition Garage 66 `MAX, &2nUaayaavenandas v www.mm�aes.camnm..wa
C3' v 2?h"MAX c'-tle /2 UFP10-SDS3
o 6 `M".-cle 21/2' II III II III I II IIIII I I I I,I I�III II 3� P.n.B 210789E C9.
'P E NTON,CA 94588
U.3+PATENT:5,732,619 9.6os9.
4/1oAc o 4431528810 4
Scope of Work a
Edward's Construction s�
edwardsfoundation@comeast.net
(408)985-0731 1. Remove and replace approximately 3 linear feet of horizontally cracked foundation stem4kll in the ,
State Contractor License#7632I8
San Jose Business License 96480251210 rear left of the garage (see detail A-1).
General Liability Insurance#002188-15
Workers Compensation#9127547-15 2. Install two 5/8ths inch threaded anchoring rods were two holes have been punched through the or' inal
intermediate foundation stem wall for an unknown reason (see detail A-2).
3. Install eleven Simpson Universal Foundation Plates with 5-1/2x1/2 inch Hilti TZ Wedge Anchors with
1 foot of plumbing bore holes or sill plate ends that are lacking a poured in place anchor (see detail A-3).
Owner: Rebecca Wang Fang 4. All work shall comply with the 2013 CRC and be inspected by the Cupertino Building Department.
10 181 v Ave (510) 501-2248
CUPERT1NCU
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • building(c)cupertino.oLg
Owner Name i ~ - ' v� �( ^T�(1�t Zk-�- Permit No. 0 6
r
Address Q 9
Please refer to the attached California Civil Code Sections 1101.1-1101.8 which.are part of this Certification form.
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 110 1. 1 through 1101 o not apply. Sign below and skip the rest of the form.
Ownei'`S'ig714—F-17�
�o 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 plumbeZthe
'been provided to the Building Division.
Sign below and skip the Ow f"' Siig
-o __"Queion 3 Ip
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 110 1. 1 through 1 1.8 do not apply. Sign below and skip the rest of the form.
>s
O,�vner Signature
No oto Question
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 u,!sq or occupancy after January 1, 1994.
Civil Code Sections 1101.1 thr?ailab'le
h l l do not apply. Sign below and skip the rest of the form.
1� AYes _ My real property is built a for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached.
My -property is a single fancily 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
fixturebe: replaced with water -conserving plumbing fixtures throughout the building. On or before January 1,
�X417;=allwnoncornpliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless
of='whether property undergoes alterations or improvements).
❑ My property is a ncultifamily 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 concncercial 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.
SB4072015.doc revised 02/04/15
BIGGS CAROOSA
ASSOCIATES INC
STRUCTURAL ENGINEERS
B B 5 The Alameda
San Jose, CA 95128-3133
Telephone 40B -29B-551 5
Facsimile 40B -29B -B1 14
SPECIAL INSPECTION DAILY REPORT
JOB #:
Page 1 of
IV/
V [0I0r-
Project Name: t 4✓l.' ; {�vA�re TV Date: a
Project Address: /' '`°� 1vrie-"Zlvr D pfye-=- Time Arrived:
✓1:r rrtl _ Time Departed:
Location of Inspection: r r 4.���ce1 f
s
Inspections made:
7
fd -2- J!✓« J �` ��a #i(%/ e -e- p4,7- A ?i'yo y v1 --P + y t / r
/f
I✓5,> s�`i � .P v %".�`i � f� L r:? du1 a'l a�� �rlL.3 �r'. £..�'.? /� /�2`r +� dr� - � � _ � J' /�".r�s�.,�G -ttf J� f '� ��Gt d., i �` %f � � ax % i�
Vii''✓ c <a r�°
r
Samples Taken:
Deficiencies/Items Pending:
Comments: �4'�`r' �'•rr'
f r
To the best of my knowledge, the work completed or in progress for this report was done in general
conformance with the intent of the approved design documents and specifications and applicable
workmanship provisions of the C.B.C. except as noted above.
INSPECTOR:
CUPERTINO
Address
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building a-)cupertino.org
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
1 have read and agree to comply with the terms and conditions of this statement
I
rk i
1 Owner (or Owner Agent's) Name:
Iffl
e c�� e« �i✓1
Si nature.... .,...' .........I ...................................... Date: ... .. ...
.... ........... ....
Contractor Name::
Lic.# f. ............ Date:Si nature ............ ..
Smoke and CO form.doc revised 03/18/14
J