S 3365 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CI'T'Y OF CUPERTINO BUILDING.ELECTL P
RICAlt I'1'NO.
�tIJu.DING DIVISION APPLICATIONMERMIT PLUMBING-MECHANICAL � 3365
BUILDING PROJECT IHESfIFI [ON
BUILDING ADDRESS: SANITARY NO. APPLICATIONSUBMI'1"I'Ah UA'I'IC
ICU-S33 C)Z—: S CT QJ
OWNER'S NAME PHONE CONTRACTOR'S NAME: LIC NO:
NIC coNTROLa
\NCI IT I FCTIENGINBER: LIC N(l: ADDRESS: ❑ /
f1V tib (iEP1J4 c2i -r g G
CON'1'AC'I': PHONE, BUILDING PERMIT INFO
1_l'ot/ltl �� 446�� rfi ❑ Consultant Fees Paid by Applicant(Initial) BLDG HL,FCT PLUMB M
LICENSED P CON' ACTORS DECLARATION QTY ELECTRIC PERMIT FEE
�zj Inereny ardm+matlam han.�ed ander Pnwisinn.of enapmr9(eammendng JOB DESCRIPTION
ly�p wilt,SecunnV00o.fDof,ion 3 afire Macioce,and Pnfexsium Cudo.undnry license is PERMII'1SSUANCI3 RESIDENTIAL: KK
=U~ i!i c'hlw'ClysnJ el fy.?fI 3 O ❑SFDW'L NKITCHEN RE IODE1,
1y] Lic.a y
T . U APPLIANCES-NESIUIiNI'IAL ADDIT'1ON pSTRUCTUR L I'll'li
Vn L W Date— Cnntmc
mQL �MGLT1-UNIT El STRUCTURAL
r.Dm ARCIII'IliCl"SDI[ hA N'IOM1' PANELS
Z O y,5 I unJcrmmrd my plans xhull be wad as public rccnnk MODIFICATION
'i
OZ.� UP'f021N)AMPS `f+LIN'TERIOIi [I CHIMNEY It I?('Alk
FY W hkemo+l l'rnl'essional 201-Ig10AMPS IMPROVEMENT SWIMMING POOLS
hH
OWNER-EUII.UEk DITCI.ARAIION
tY OVER ION)AM1f 1'S ATH RF.MOIIF:IJRIiI'AB ❑DEMOLITION
Q I hereby affix thus 1 ant exempt Irmo the Contra¢....Lkense Ino for Inc
X3 a U follow Ing reason.(Section)0315.Buvinea and Professions Cade:Any city or county SIGNS ELECTRICAL ❑17fHEk
W kc ti which requires a peril to cnngmct.alter,improve,demolish,or repair any sttctore
F Q prior to in issuance,also requires the applicant for uch peril to file a signed statement SPECIAL CIRCUIT/M ISC.
that he is licensed pursuant o the provisions of the Conumears License Law(Chapter 9
0 Iconm¢ncing with Section TN(Bof Dmkio 13 ofthc Business and Pndcaions Code)nr TEMP.MGI'13R OR POLE INS COMMERCIAL:
d d z that he is elempl Ihemfrmn end Lha basis lin the alleged exemption.Any violafn.of ❑NEW BLDGIADDITION ❑DEMOLITION
X'" Section 20315 by any applicant fnr-.+pera i(whjens the applicant to a civil penally of POWER DEVICES
^rte tel nu+ro shun live hnndrN dollurn(.551X1). ❑TENANT C:1 FOOD SIiRVICE
`Z Y IMPROVEMENT'
Q ❑ Lae owner of the property,or my cnmloycex wish wages ufair eir iris conu
ntpcndon, SWIMMING I'UOIJ31,Ii
CC'I'RIC
0c willdolmd
hew... ,ard,hv,Imduknrn imm� ul or offered tar sale(Sce 21}14,Boo— ❑OTHER
Wta.3~m and 1'rutcssions Coda:The Conuuctore icmuo Law docs nm apply ,,an owner tel' OUTLETS-SWI'ICIIHS-IIX'i'UkES
propeny no heilds ter improves thereon,and who dues such work himself or Through
his own employees,provided that such improvements are not intended or offered for NEW RES1DEN'I'IAL 1:1. SV ir1'.
o1c.11,bowevcr.IM1e buildingorimpmvcmcmivaddwithinoneyetul completion.the SQ.E4.FLOOR AREA 5/SQ IrL
owner-builder will have the burden of proving that he did not build or improve for per-
pnve ol 1117
I.as owner of The Inceptor,for exclusively contracting with Iicenval contractors to l D To".: O A
instruct the protect(See.201.Business and Proesniam Ccd J The Cenwelor's Li- TT r
se Law does not apply n)an owner of proi<ny who builds or i mprovcs thereon,and QTY PLUMBING PERMIT FEE
who c nnn¢Is for such projects with a coulmemds)licensed pursuant o The Cnntrwlar',c
U'r,",Law PERMIT ISSUANCE
[� Iran esonpn under Sec. .B&PCfor this rennin
ACIE1d-DRAIN&V17N'I'-W 'TER IEA) VALUA11ON
Owner hate
WORKER'S COMPENSATION DYCLARATION PACK FLOW 1'Nf YfI:CI'.Dli i �+ OQp
I hereby affirm under pcnuhy tel perjury one of the fallowing Jeelaratiana: !
O Ihavc and will maintains Ccrtilicuteof Cnnwnun sell-imuu.lin Workar'sCmnpen- DRAINS-FLOOR,ROOT( RE.. ND. S'IORI&S TYPE CONS IRUCI ION
Notion,as provided for by Section 3201 n1 the L boor Corp.for me performance of Inc
rtk fur which this perit is issued FIXTURES-PER TRAP 'Z H
Fl have and will maintain Winter's Cmna
penlion Insurance,as required by Section
3200of the Labor fordeforthe Knonwnceof The work for which this peril is isxued, GAS-EA.SYSTEM-I INC.4 OUTLET'S OCC.GROUP APy�'
My Worker" on Inarance sorrier and Policy /��. 'J y J'Q
Currier, nc + Policy No.: J G GAS-EA SYSTEM 41F:A) R"'�� 9
CERTIFICATE Olt EXEMP LION FROM WORKERS' �I
COMPENSA'EON INSURANCE GREASUIN'DUS'I'RI.WASTE INTHRCEPIU
RATING DIVISION FERS
fl'hisswlinn Bird nut bccninplomA 11 the permit in lbn+nc hunA¢A dullury(R 1010 GREASETRAP 3
Irl ) PhANCHLC t •V
(fyel i' It, par ul0 kl rwhicn lh R t':'::ncJ Ish.11
SLWCk SANITARY-$'C(1RM LA.2W Irl'. 2 O
nut PI yany p Y n':t lacunae-subject It, Work...'Co+pmt IiNC 1,11
z vat lawsof Calfa m.Date WATER HEATER WIVENTIELCCTR !
Q Applicant C A G E
Z = N(YIICE:T'OAPPLICANT:ILapermakingthis Certificateof Exemption.youshould WATER SYSTEi RHATING
> hecome object t The Worker's Compensation provisions of the Labor Code,you must S 1 S
forthwith comply want such Provisions or this peril shallh deemed corked. WATER SERVICE
a �
CONSTRUCTION LENDING AGENCY NEIN RESIDENT AT.PLMIi, SQ,Er. PAID
U O Ibcruby utfinn Wuuhmc ieunmstmsnion lcndivg agency for We perinnuunae of )me Receipt
0c work for which tors porta is t..unl(Sec.3092.Co.C) O
P. H I.mdef,Nurse 0 L'
r.O, V IsnderT Address .I.
W I eenity that I have mad this application amt cute(hat the above inlannallon,s r BUILDING FP
1" vaj correm I agree To comply with all sky and county ordinanae_v and cam laws minting to QTY. MECHANICAL PERMIT FEE
U ,7. building construction,and hereby authorim representatives of this city to enter upon the SEISM( E
al,ve-mention d property for inspection purry+sec PERAIIT ISSUANCE
1 We)agree t save,indemnify and keep nameless the City of Cupcnino against EL[-RIC +E
Iiabilities.juJgmena.corn and espenxs which may in any way a<cmc against sail City ALTER OR ADD'IOMECH.
ne e o.the gmnlmg of this'nod. PITY .'G IFIi
AI'I'LIC aNT UNDERSTANDS D WILL COMPLY N'1'fH AL1.NON-POINT BIR HANDLING UNIT(T )
SOI1N', EGUL\TION- M11E ANICAL FRE
"a AIR H G UNI' 3 IILIX -M) DNSTRU(7HON'I'A%
Signmuro of Appli UCnnvudnr Dnlc IiXHAII' 10111 IUCD HO ..INC MI'I'IGA'1'ION FI31?
IT
BUOIIS MA'I'M TALS DISCLOSURE
Willthe applicml terfrim bnllding:xctq+Urs suncmhandlc N:nTrtlnus mnlcrial HEATIN 1�, ff01lNII ll1'li 1'101
ice defined ni
by the Caroni—Mucipal Code.Chapter 9.12,old the Heathen,
S:lery
Code.Serino 25532(x)'! HEATINGAA 1'f(O IiR I00.IMp BTU)
Yes d lr
PAID
-n VENTI LA' 'FAN(SINGLE RESID) A 51
l (l V
Will The applicant or furore building t use equipment of doses which
hate
it hurnmrdoua air comaminaby the Bn¢as defined by the Bay Area Air VualitY Managanon BOILER-C A@)1711' U)
Dotnm7 BOILER-C(,II'1OVE 100,04 RTU)
❑Yes QNn
I hove matlmc hmatdoe feabowl,up rntms under Chapter 4.95of The Cul,- AIR CONIII'iIONER ISSUANCE DATE (�
fnrniallcollh&Seem Code.Sea'tion "'55o5,25533;rad 25534.1 undcotmnl taw ifthe NEW RIISIDEN'HALMITCH. SQ FE � (]4
builAin•Jn Icvrmmly1 sa.umm'p lhuto innrytce(11 itCrnfiCrp oil'OCcalsctip;mt
no
Xnl'mc 1/li iumm�ls sublet + iso bent 'prior to (11 it ollkaipuncY.
/ Owne or euthor'. agent Die T Ts ISSUED BY..
OFFICE
TESTING ENGINEERS, INC.
2811 Adeline St. PO Boz 24075 510 835-3142 510 834-3777 fax
Oakland,CA 94608 Oakland,CA 94623 800660-3142
Oakland Santa Clara Diablo Valley
INSPECTION REPORT Week Ending: 8/6/99
PROJECT# 41964 TYPE OF INSPECTION:
Visual Welding
PROJECT_ _ _ PLACE OF INSPECTION:
10333 A Degas Court(Home Remodeling) Jobsite
Cupertino,CA 95014"
Permit#S3365
DATE 8/3/99
HOURS 4
INSPECTOR J.Hardy
AWS CWI#97120841
(10,
Reported to Barry Lo of L&B Construction at the jobsite as requested.
Checked welder qualification papers(Chen Xi Kang SSN 622-44-1156). Verified proper electrode storage. Performed
continuous visual inspection of the in-progress welding and periodic visual inspection of previously completed welding
performed by 1 qualified welder using the SMAW process with E-7018 electrodes.
Weldments consist of flare bevel groove welds joining tube steel beam to two(2)tube steel columns for rigid frame at the
south end corner of room addition;partial joint penetration groove welds joining two cap plates to tube steel beam.
The preceding work was to the best of my knowledge in compliance with approved job plans and specifications including
revisions by engineer and drawing numbers S1 and S-3.8,dated 12/7/98.
r
Reviewed b .
Davi
Palf
Spec H.Inspection
Special Inspection Division Man e
`71 cc: L& B Construction Co./B. Lo
City of Cupertino/Bldg.Inspection Dept.
AML
TESTING ENGINEERS, INC.
2811 Adeline St. PO Box 24075 510 835-3142 510 834-3777 fax
Oakland,CA 94608 Oakland,CA 94623 800660-3142
Oakland Santa Clara Diablo Valley
INSPECTION REPORT Week Ending: 8/13/99
PROJECT# 41964 TYPE OF INSPECTION:
Proof Load Testing
PROJECT: PLACE OF INSPECTION:
10333 A Degas Court(Home Remodeling) Jobsite
Cupertino,CA 95014
Permit#S3365
DATE 8/7/99
HOURS 4 a
INSPECTOR J. Hardy
Reported to Barry Lo of L&B Construction at the jobsite as requested.
Applied a tension proof load of 5,600 lbs.to 7/8" diameter epoxied Allthread anchors located in the floor. Three(3)anchors
of a total of three(3)installed were tested,representing 100%,without visually apparent distress or failure.
Proof load values and rate of testing were supplied by structural engineer.
The preceding work was to the best of my knowledge in compliance with approved job plans and specifications including
revisions by engineer and drawing numbers S-1 and S-3.8,dated 12/7/98.
Reviewea b
Da alfini
Special Inspection Division Manaz�
1cc: L & B Construction Co./B. Lo
City of Cupertino/Bldg. Inspection Dept.
�1.