B-2018-1650 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-1650
10060 PHAR LAP DR CUPERTINO,CA 95014-1112(326 18 038) FIVE STAR KING
CORPORATION
SAN JOSE,CA 95132
OWNER'S NAME: DATE ISSUED:06/05/2019
OWNER'S PHONE: PHONE NO:(408)515-2638
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#998350
Contractor FIVE STAR KING CORPORATION Date 11/30/2020 X BLDG X ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X 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:
ONE STORY ADDITIONS(431 SF);(N)COVERED PORCH(40 SF);
I hereby affirm under penalty of perjury one of the following two declarations: KITCHEN REMODEL-INCLUDES PANTRY INTO GARAGE(200 SF);
1. I have and will maintain a certificate of consent to self-insure for Worker's REMODEL HALF BATHROOM,DINING RM,AND MASTER
Compensation,as provided for by Section 3700 of the Labor Code,for the BEDROOM(304 SF);CONVERT(E)DINING RM INTO OFFICE BY
performance of the work for which this permit is issued. ADDING DOUBLE DOOR IN(E)OPENING;PANEL UPGRADE(200
2. I have and will maintain Worker's Compensation Insurance,as provided for by AMP);(N)FURNACE IN ATTIC.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area:431 Valuation:$180000.00
APPLICANT CERTIFICATION
1 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 Number: Occupancy Type:
326
and state laws relating to building construction,and hereby authorize 326 18 038 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 6-5-2019 Issued by:Kim Dunbar
Date:06/05/2019
OWNER-BUILDER DECLARATION
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.
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:6-5-2019
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
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:6-5-2019
1 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 works for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lenders 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. I understand my plans shall be used as public records.
Signature Date 6-5-2019 Licensed
Professional
CAPER ENGINEERING INC.
PO BOX 14198, FREMONT, CA 94539
Tel: (408) 609-1115
E-mail: capexinc888@gmail.com
Building Department
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3232
Subject: Remodel and addition at
10060 Phar Lap Dr.
Cupertino, CA
Dear Sir:
_J F
Ntc�:+Jgill
July 8, 2019
(Permit no. B-2018-1650)
SPECIAL INSPECTION FINAL AFFIDAVIT FOR ALL
THREADED ROD BOLTS INSTALLATION WITH EPDXY
CAPEX ENGINEERING INC., has provided testing and special inspection services at
the subject site in accordance with section 1704A of the California Building Code (2016
Edition) as listed below:
(1) Inspection of (6) 5/8" o x 36" (through bolts) and (4) 5/8" o x 12" min. embedment;
all threaded rod bolts installation W/Epoxy for anchor bolts placement at specific
locations.
(2) Inspection (8) # 4 x 5" min. embedment; dowels installation with Epoxy for
connection of new and existing footings at specific locations.
(3) The drilled hole for receiving all threaded rod bolts/ dowels installation with Epoxy
were cleaned of dust and debris and adequate in depth to embed into existing
concrete.
Personnel under the general supervision of a registered Civil Engineer performed this
inspection. Based on the inspections performed and upon our substantiate reports that the
inspected work was performed, to the best of our knowledge, in conformance with the
approved plans and specifications and the applicable workmanship provisions of the
California Building Code.
Sincerely,
CAPEXGINEERING INC.,
Gary su, 'PE
Principal
a VROFESS U
RY
No. C48709 m
OF CAUV)