04090022 J
SIGNET
Testing Labs, Inc.
March 10, 2010 D Q
MAR 17 2010
COPY TO: By
CUPERTINO BLDG INSP DEPT
10300 TORRE AVENUE
CUPERTINO, CA 95014
PROJECT: 46224944 VILLA SERRA APARTMENTS BLDG 4 A-B
20800 HOMESTEAD ROAD
CUPERTINO, CA 95014
PERMIT NO: 7120199
SUBJECT: WEEKLY SUMMARY OF SPECIAL INSPECTIONS
Special inspections were performed for the above referenced project. The inspections were performed by our
certified inspector(s)as described in the attached daily report(s)week ending 02/26/2010.
The work completed or in progress for this report is in accordance with the approved plans,specifications,and/or any
approved change orders. This is a progress report of our special inspections. A final report will be issued upon
request at the completion of the special inspection/testing requirements provided that all outstanding issues have
been resolved and/or corrected.
Respectfully submitted,
Signet Testing Laboratories,Inc.
Michael Everson
Division Manager
TO: PROMETHEUS REAL ESTATE GROUP I
CC: 'FILE COPY
CC: CUPERTINO BLDG INSP DEPT
3121 DIABLO AVENUE HAYWARD,CA 94545 MAIN:(510)887-0484 FAX:(510)783-4295
J
* 0000000 1 * Form VT 1001, Rev.4
SIGNET Page 1 of Z-
Testing Labs
DATE: - `/- (0 STL NO: Il 4 y y DISPATCH NO.: 5'f q ko
PROJECT:;11,; SO arc. A �t" +4-:410
RMIT NO.: APPL.NO.:
PROD. ADDRESS: &4v 2r-41 ry df C4q SHIFT:'DAY ❑SWING ❑GRVYD. HOURS:
STRUCTURAL STEEL / WELDING INSPECTION REPORT
❑ Shop Inspection O-On-Site Inspection
Contractor: LV&64' Erector: AP-G&A;4( 4y1z'0ip'L Fabricator:
Type of Inspection: ❑ ContinuousPeriodic ElAfter-the-Fact
❑ Material ID ❑ Sampling ❑ High Strength Bolting
❑ Ultrasonic Testing ❑ Magnetic Particle Testing ❑ Penetrant Testing
❑Show-up Time: ❑Stand-by Time: '®Corrective/Rework Time: '/z �+r
Explain: ✓),i!s s.r+6 C;V�-c•v�
Certified Welder(s): ❑ Refer to the attached list. Welding Process: Electrode Type/Dia.
Name(s) - Print Clearly Identification ❑SMAW:
�N say s910 CAW: 67 r7-
IL(� ✓e a.�Cn G�O✓14-� 1672 ❑GMAW:
❑SAW:
❑ESW:
Type of welding performed:
No.of welder(s)on job this date?: Z Fillet Q&P OMP•Penetration:❑PJP ❑CJP
All WPS Sheets Verified: Yes ❑ No,Explain on page 2. ❑Arc Spot Weld • ❑Seam • ❑Shear Stud
Attachment(S): ❑ UT Report(s) • ❑ MT Report(s) • ❑ PT Report(s)
❑ Material ID Sheet(s) • ❑ Sampling Form • ❑ Member Completion Sheet(s).
❑ Exceptions noted,final acceptance is pending written approval of the item(s) noted on
❑ Exceptions noted,final acceptance is pending corrective action of the item(s) noted on
❑ Non-Conformance Report(s)attached:
❑ Request For Information report(s)attached:
❑ All work inspected❑WAS/❑WAS NOT performed in accordance with the DSA approved plans,specifications and
regulatory requirements.
�- To the best of my knowledge,the work performed during this inspection periodJKWAS/❑WAS NOT performed in
accordance with the approved plans,specifications and regulatory requirements.
Inspector: Representative/Superintendent:
3121 Diablo Ave. 1417 N.iklarket Suite 1 1320 Simpson Cir.
Hayward.CA 94545 Sacramento,CA 95834 Anaheim,CA 92707
Norm VT 1002', Rev.0
SIGNET Structural Steel / Welding (Field) Inspection Report PAGE 2 of 2-
Testing Labs
PROJECT: L/i 610.
INSPECTOR: /-t/X E w I LS Q►-• DATE: 1 -L4 - 10
ITEM INSPECTED LOCATION DWG.NUMBER STATUS/REMARKS
)F IVELD/HIGH STRENGTH BOLTING (Floor/Roof/Elev.) LINE NUMBER &DETAIL (In-Progress/Comp.)
�.�: • CdY.ca �. _ eticl -,Ro"'d F (oPA... ?�12.
F l o ok L , c s4At y 14 of ss '
� ''vh r' � �c 'e-r]
CITY OF CUPERTINO *°+
- ,¢C, ONa,T.R, A.,,C5�TOkR. I..NJ,.FOateR: Mso+ATION'---,BUILDINGDIVISION PERMIT '
BUILDING ADDRESS: DUBOIS ROOFING INC PERMITNO.04090022
OWNER'S NAME: PERMIT ISSUE DATE
P
NE: SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHITECUENGIN BIER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
_op LICENSED CONTRACTOR'S DECLARATION ]Ob Description
y F I hereby afnnn Nal I am limed under pmv m of Uapler 9(commencing p
�Zw with See�on,'lMh.fDivision3of Jle Businux rpfessium Code.and my license is
n« in dor
jq�_ u«nIseclaaii Lie.a 81Z- Soy T/0 EXISTING SHAKES-INSTALL
o� Dale Gontfacto�� '
nF� ARCHffECI'S DECLARATION NEW 30 YR ASPHALT ROOF
wU I tubers=`3my plans shall W used az public remfds
a.
o Licensed Pndcssional
5 OWNER-BUILDER DECLARATION
1 hereby affirm Nal I am exempt from de Conlncmr's License Law for the101,
O o following mason.(Section](01.5.Business and Professions Code:Any city rr county
M m which requires a permit to construct,alter,improve.demolish,or repair any structure
w '^ prior N its issuance.also requires be applicant for such Permit to file a signed statement
that be is licensed pursuant to the previsions of the Contractor's Li rose i�w(Chapter 9 Sq.Ft. Floor Area Valu
QFC (commencing with Section 7")of Division 3 of de Business and prehistoric;Code)or
/ p9os2
Nat he is exempt therefvm and the basis for Be alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nan five hundred dollar(55110).
1,uowneroftheprepmy,ormycmplOyc=withwagesutheirsolecompcnsellon, 32609056 00
will do thework.end the structure is nolinended oroRered forsale(Sec.70/4,Business
and PMfessions Code:The CrntraClrr]Licosa law does not apply to in owner of Required Inspections
pvpeny who builds or impvmsdmmnn,and whodressuch work himself orduough his
own employers,provided that such improvements ate not inyndcal oro@red for sale If.
however,the Wilding or impmvemant is sold within one year of completion,the Owner-
builder will have de burden of preving that he did not Wild or improve for purpose of
sale.).
❑I,as Owner of de pmpeny am=elusively contracting with licensed crntracmrs to
construct the project(Sec.70 4,Business and Prof.m.Cod[:)The C.M.Usea Li- _
cove law does not apply On an Owner of pvpeny who Guilds or Improvea Uemon.add.
who concocts for such projects with a eontrsctor(e)licensed pursuant m Ne Comractoh
License Taw.
❑I am exempt under Sec. ,B&PC for this mason
Owner One
WORKER'S COMPENSATION DECLARATION
Ihereby affirm under penalty of perjury,am of the following declarations: 4� / `�
have aro will maintain aCCNO=e of Covent toCode.for tIre W rkeeirlforma ceCourtlier-
Don,as provided for by Section 3700 of the tart Code,for the Performance of the t
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Code.for the performance of the work foo which this porrit i.issued.
CQ
My W--o{{rkeGr'snCompensad/g.p�InsumtnTo canner and Poli umber are:
CaTrY: J t ATQ t"VI.kT Policy No. -3z �
JJ CERnRCATE OFEXEMPf10N FROM WORKERS
COMPENSATION INSURANCE
(This section need not W completed if the permit is for one hundred dollars(i;00)
(IT less.)
I Cenlfy that in the performance of the work for which this Permit is issued,1 shall or
employ any pctmn in any mennerso at an become subject to the Worked Compensation
laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,.are,making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of the Labor Code.you must
.JO forthwith Comply with such provisions or this permit shall W deemed revoked.
Z'" CONSTRUCTION LENDING AGENCY
[-vim I hereby affirm that dere is a construction lending agency for the performance of
C7 the work for which this permit u issued(Sec.3091,Civ.C.)
W 25 lenders Name
Z Lenders Address
V r 1 certify that 1 have read this city
and county
and sine thin the above information is /
0 f•' building
1agree to comply with all cityand countyoNimeri of and sue laws relating upon Be lv/
pU abovengntioned propend hereby euthorimmpresentsti.rsof this city menerupnn
T' above-mention agree
to lowrty.
for inspection a purposes
(~ C
We)agree to sass,and c., and kith harmless the City of Cupertino e,city
to in
juceofth,c=tsandof Bois remay in any way attve against said City
U z A PLICANT ofthe Permit. V
^ APPLICANT U RSTANDS AND WILL COMPLY WITH ALL NO P INT Issued by: Date
SOURCE ATION ��P
�/ Re-roofs
cure of ApplicaHC RDor y /✓•M
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Cu,antro fount Municipal
Co e.Chapter
and Me Heafdousmaafety
stral
az defined by the Cupertino Municipal Code.Uaper 9.R,and the Health and Safety
Code Section Dy.25532(a)? All roofs shall be inspected prior to any roofing material being installed.
u
Will thea applicant or mere building Occupant use equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
np b D a Air Quality
t haraAnus air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
vin? `
pYcs (�`Vu
Ihav Sacl thcha.Seen.
i534.1rs r Uaper6.95 thadifthc Wilding _ J�
ria Healthumend,C w aSccdov255f15. myrsnd25534.1.ruddundth occup Willing
does not curmnJy hose a Ienan4 Nal it is my rmprnsihilily m nntll'y IW mcupent of the O
requimmen mstW sprior missu...is ccB`e'eo cu cy -�
�" "�� .�` a. Signature of Appllcan[ 'Date
o�oraul odaed s —� �� All roof coverings to be Class "B"or better
CITY OF CUPERTINO
S� 4 of 5 PERMIT RECEIPT OPERATOR: suem
COPY # 1
Sec: Twp: Rug: Sub: Elk: Lot:
APN . . . . . . . . : 32609056.00
DATE ISSUED. . . . . . . : 09/07/2004
RECEIPT #. . . . . . . . . : 26941
REFERENCE ID # . . . : 04090022
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 1
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PROMETHEUS PROPERTIES INC
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : MARK DUBOIS
CONTRACTOR . . . . . . . : DUBOIS, MARK LIC # 20514
COMPANY . . . . . . . . . . : DUBOIS ROOFING INC
ADDRESS . . . . . . . . . . : 99 DUARTE AVE
CITY/STATE/ZIP . . . : FREMONT, CA 94536
TELEPHONE . . . . . . . . : (510) 793-9760
I'E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
BPERMFEE VALUATION 20, 000.00 277.56 0.00 277.56 0-00
BSEISMICRE VALUATION 20, 000.00 2.00 0.00 2.00 0.00
TOTAL PERMIT 279.56 0.00 279.56 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
CITY OF CUPERTINO
SID
REROOF
CUPCITY OF
EkTINO PERMIT APPLICATION FORM �c �OZZ
N# 3 , ` (J,c DF—/ Date:
o i
Building Address: J(�
Zo o � Q1/t INC SJ Ci C �S
Owner's Name: Phone#:
C�,✓ 'f'G �v ' orPl - /k�c. �l5�- S `} �' S3cx
Contractor: Phone#: Ucense #:
—70) 6 iZ 3 oY
Contact: Phone #: Cupertino Business License #:
t1/1h21� a��o,5 510 •111A It 8 Oct
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
'� Wood Shakes El Wood Shakes
�❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
I To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
b Description:
1 eo r oFF EXrsT,� 5t�es ,>Jsrj r [ ew 7 ib" os3 iNs%ate ,veW 3U ec,� aS��.ACT JF
Residential ❑ Commercial rt� NntT� EXl S"L N� r GJF
Fire Zone: Yes ❑ No ❑ Confirmed with Planni e t. if
there are any res r tons:
Co r""^'�— e of Constructs Occupancy groAr ^ 7
Qty. if
Ap p I ab e Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
Community Development Department
Building Division
° City of Cupertino
10300 Torre Avenue
,
Telephone: (408)777-3228
TCITY OF Fax: (408)777-3333
UPEkTINO
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
• 3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: ,�/ P►�Pe�r�S, uC
Job Site Address: 70 $00 pp�-ts'�'epp_S7-e� �A �C PM T�0
Roofing Company Name: wbu 1! Foci_ ?J 10�
A plicant's Signature: __IL= Date:
eal q 7 DY
® Greg t
Building Official
Revised 1/30/03
Printed on Recycled Paper
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408) 777-3333
Building Department
REROOF TEAR OFF POLICY
1. You must schedule an inspection for the tear off the day before
you wish the inspection to be made. The procedure is to call the
Building Division (408) 777-3228 between the hours of 7:30 a.m. and
4:00 p.m. to request a next-day inspection.
2. When the roof is torn off, the nails have been removed or driven in,
and all of the dry-rotted wood has been replace, you must call the
City Building Division. An inspector will be there within one hour.
There are special hours for this service: from 7:30 a.m. to 10:30 a.m.
and 1:00p.m. to 3:30 p.m., Monday through Thursday and from
7:30 a.m. to 10:30 a.m. and 1:00 p.m. to 2:30 p.m. on Friday. (Note:
Building inspectors are on lunch break from 11:30 a.m. to 12:30 p.m.
and will not be called during that time. City Hall is closed between
12:00 and 1:00 p.m. daily.)
3. If you call for a tear-off inspection and the job is not ready, you will
be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
Greg Casteel
Building Official
Revised 8/13/04
TIM
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