06010031 CITY OF CUPERTINO '-r ��"
' BUILDING DIVISION PERMIT .4CONTRACTOI2 TNk'O.ILMATI(yr
BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO 'lqf(^'NO 06010031
20400 MMIMI AV
OWNER'S NAME: PERMIT ISSUE DATE
we
APPLE COMPUTER PHASE A 170 KNOWLES DRIVE STE 12C 01/06/2006
SANITARY NO. CONTROL NO.
(408) 379-5500
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
G LICENSED CONTRACTOR'S DECLARATIONJob Descri
1 hereby affirm that I am limned under provisions of Chapter 9(commexci P
with Section 70)))oMtvialon 3 of the Busimmand Profeaelons Code,and my lice is
^�H in fallfareeamefrem. 30-DAYS TEMP PERMIT.
`I""° ns `k'g EXPIRES 02/05/06, ORIG. #0511011
y�y..
Is. Contramor
, Q ARCHITECTS DECLARAPIUIT
i5 tyi I understand my piens,hell be used As public remrN
5 c] Licensed Profm ionat
q OWNER-BUILDER DECLARATION
i 2 I hereby affirm that 1 em exempt from the Committees License Law for the
C p O following mason.(Suction 7(171.3,Business and Ro(cssinu Cam:Any city m County
$ which requires a permit ro construct.alter.improve.demolish.or repair any structure
prurm its latwnce.alm requires thes,iicant forsuch pc Meh1af1leaetgMd,ummont
�< dust he le licensed pursuant(0 de provisions of de Contractor':I.imnic Law(Chapter 9 Sq.Ft. Floor Area Valuatio
$ (commencing with Section 7000)of Division 5 of the Business and P,ofewtner Code)or
— that he is exempt therefrom and the basis for the alleged exemption Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant m a civil penalty of Ar N mber Occupancy Type
not more than fiw hundred dollars(53001. 316 2 2�18 . 00
01,uoweroftlmpmpeny,mmyemploycuwithmrg uthehcelemmpensadan,
will do the worltend Neatmnua isnot imended oroRered larntle(Sm.7044,Business Required Inspections
and Profession,Code:The Contractornslae ns
Contractors Lkee w does not apply an an owner of tl P
property who builds orimprovesthereon,and who dons such work himself or through his
awn employees,provided that such lmprowmenu are nwimeaded reoffered fsrsale If.
however.the building or improvement is mid within ane you of completion,the owner
builder will haw the burden of proving that be did rot build or Improve for purpose of
sats.).
❑1,As owner of the property.em exclusively contracting with licensed commosan to
consu but the project(Sec.7044,Business and Profession Cade:)The Contractor's U.
come law does not apply in an owner of property who builds or Improve,dwrmn,and
who contracts for such pmjem with a com etor(q Ikenmd pursuant An site Contractors
Libenm Law.
❑I am exempt under Sec. ,B Is P C for this mown
er
Data
WORKER'S COMPENSATION DECLARATION
I hereby ARrm under peulty of perjury can of the following declarations:
❑Thaw and will mtlnuin aCWfiamafCo,tsembaelf-InsumforwortersCampen-
Amon,u provided for by Section 7700 of the tabor Cade,for the performance of the
work for which this permit Is lured.
❑1 hew and will maintain Workers Comperration Insurance,an mquired by Section
3700 of the Labor Cade,for the performance of the work for which this permit is issued
My Workers CompensattioonnIIn�serrantt carrier and Policy number am:
Cartier.�r. �_Poliry Na.; d _5LP2M-t
CER FI TE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sectione teed mthecompleed ifus:remit Isfmone hundred Emla,($100)
or mss)
I certify that In the perfomance of the work for which this pewit is Issued,I shall not
employ any person In any mannerm As m become subject to the Woftus Compensation
Laws of Calif main.Dae
Applicant
NOTICE TO APPLICANT:If,efmr making this Cenificew of Exemption,you should
become subject m the Waher's Compensation provisions of the Labor Code,you must
.J O forthwith comply with such previsions or this pcmtt shall W deemed revoked.
z r CONSTRUCTION LENDING AGENCY '
F Thor by which
that them uaed(Sec.30 lending .) for de Per(omatNe of
ai the wuek for which Nis pewit it issued(Sec.3077,Civ.C.)
Q LendoeeNme
7 z IendeM1Addm•.
()Q 1 calory due 1 have mad this applicark.andante that the above Infomadon is '
W^� comet,T agree to comply with all city and county amounts,and some laws notating to
Q V building construction,and hereby authorize mpreaenutives of this city to enter uPna the
W above-mentioned property for inspection pwleees.
k�.r gL (We)aSme m save,indemnify and keep hamlets the City of Cupertino against
i..
In liabilities,judgments,carts and expenses which may in my way see=against said City
tJ 7 in Coosa
a mom of the grentine ar lnH pewit. D
r7 Al? of
S AND W1 COMPLY WITH AL NON-POINT Issued by: Date — 6
50 CE EGULATIONS '
—N34vzo
Al �Okl.. Re-roofs ✓'--
si o A Ilam nuact m
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will theeCupentnr futureipal Code.
Chaptnoneor handle Health defined by the Cupertino Municipal Code.Chapter 9.11.and the Hcelth and Safely '
otic,Section 25531(&)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yen Otho
Will the applicant or fm building mcupam use equipment or devices which If a roof IS installed without first obtaining an inspection,I agree to remove
emit haumnw all contaminants As defined by the Bay AMA Air Quality Maugcmcni all new materials for inspection.
Diwict7
C3 Yes u
I have real the buoumou materials requirements undo,Chapter 6.95 or the Califar.
nie BSefctycode.Secdm]]]�I25505,25533 and25514.1ummumrdthatrthc building
J 'u which
an�tltlt iss�w'wW bl.Mr..00u tify omupant ver the
mm whichm m omlss oflCcrtifmamof Signature of Applicant Date
Owno,or emhonzed gent Gg All roof coverings to be Class"B" or better
CITY OF CUPERTINO ^?�: a YcsH �'15- „ "�� ^t 'sp
'�x
BUILDING DIVISION PF COINTItACTOR INFO 'ON a'
BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO ND'06010031
20400 MARIANI AV
W NER'S NAME: PERMIT ISSUE DATE
APPLE COMPUTER PHASE A 170 KNOWLES DRIVE STE 12C 01/06/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 379-5500
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
0 0 0
ups LICENSED CONTRACTOR'S DECLARATION lb Description
U 1 hereby affirm No
at 1 am li¢nacd under provisions of Chapter 9(commend g
With Section 7IXIU) I'Divielon 3 ofthc Businass and Professions Cbde.and my lice is
^ � in full forte and tried. ( 30-DAYS TEMP PERMIT,
Z License ass Lia,g
�� 46
Dice conmcwr I EXPIRES 02/05/06 , ORIG. #05110117
re1) ARCHITECT'S DECLARA
y;ISS33< I end crstend my plans shall M usod"public rtco or
J U
Lp� Licensed Pmfessimal
g S OWNER-BUILDER DECLARATION
4<F I hereby affirm mel 1 am exempt from the Commodes License law for the
r.O O following person.(Section 7031.5,Business and Professions Code:Any city or county
S$ which requires a permit to consumer,slum improve,demolish,or repair any structure
prinrm its ivuance,alto requires the applicant for such Permit to asigned staremenl
Z< that he is licensed puravam to the provision of the Canwcmr'sUdom LAw(Chapter 9 Sq.Ft. Floor Area Valuatio
FE$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
.•
that he Is exempt decrefmm and du basis for she alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more man five hundmd dollars($500). 31622018 . 00
0 I,u owner Dfthe property,or my employees with wages u their able compemadon,
will do the work.and the arrucwm is not Intended or offered for sale(Sec.7044.Business Required Inspections
my Professions Code:The Cmmactoes Licensee Law does not apply to an owner of q P
property who builds or Improves thereon,and who duea mch work himulf or through his
own employcos,provided that such Improvements are not intended mbffund for vie.IL
however.the building or improvement Is mid within one year of completion,the Owner,
builder will have the burden of proving that be did not build or improve for purpott of
salt I.
❑I,as owner of the property,am exclusively contracting wire licensed contractors in
comma the project(Sec.70 ,Business and ProfessionsCode:)TheContractorsLI-
ame law does not pply to an owner of property who builds or improves themon,and
who contracts for such projects with a emunicmr(s)licensed pursuant to the Conuantoh
License Law.
0 I am exempt under Sec. .B&P C for this recon
Fir Dau
WORKER'S COMPENSATION DECLARATION
I hereby arm under Penalty of perjury one of the following declarations: '
0 I have and will maintain a Cenifcato of Conacnuoself-insure for Workers Cumpen.
anion,v provided for by Section 37110 of the Labor Code,for the Performance of the
work for which this permit is issued.
0 1 have and will maintain Worke's Compensation Instrument,c required by Section
3700 of me labor Cada,for the performance of me work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier: S L 911 V I_ Policy No.: ✓ I ZZ��
CE FI MTE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu unim need not ho mmpicud If the Permit Is forone hundred dollars($1011)
or loss.)
1 certify that in the performance of me work for which this permit be issued,10111 not
employ any person in my manner an as;to become subject to the Workeri Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cemirmate of Exemption,you si
become subject to the Worker's Compensation provisions of me labor Code,you must .
.Jaz fpMwith comply with such provisions or this Permi(shall to deemed revoked.
CONSTRUCTION LENDING AGENCY
(-+ I hereby affirm that mets is a construction lending agency for the Performance of
CL blue work for which this permit is issued(Sec.3097,Civ,C.)
W�Q Lordcfs Name
Z Lender's Address
V Q 1 certify that I have read the application and staue ren the above information is
I4 F context.l agree to comply with all city and county ordinances and sou laws relating to
0U building construction,and hereby authorize mpresematiws of this city to enter upon the
U above mentioned Property for inspection puspous.
lL—^t a (Wc)agree to save,indemnify and keep homeless me City of Cupcni O against
rn liabilities,judgments,costs and eardrums which may in any way tecme against said City
V z in cno
of the Granting u(this Permit.
�^ APUNDERSTA S AND WI COMPLY WITH ALy NON-POINT Issued by: Date
50Sa� Re-roofs
Sqn o Applman ntsacm,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will fie applicant or future building Occupant store or handle hazardous..most
c defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safcty
Code,Section 11532(a)9 t) All roofs shall be inspected prior to any roofing material being Installed.❑Yea ®No
Wilding occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or fest
emit hazardous air commourants as defined by the Bay Area Air Quality Management all new materials for inspection.
Disrict7 /
❑Yes �fJu
I have nul the hazardous materials mquiremcn9 under Chapter 6.95 of the Califon
nia &Safety Com,Sectionj;t25505,8533 and 25534.1 understood mal if the building
d st ..owhi hmust tin�m�y ,pbetslccitywnntify t111111��F��Fee occupant of me
uircmc whichmust(Oby�m Abrwis�sCymccofaCcnificateof�{upmrySigna[ureofApplicant Date
Owner or authorized irgccl (( Date All All roof coverings to be Class"B" or better
• �5
PCITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31622018 . 00
DATE ISSUED. . . . . . . : 01/06/2006
RECEIPT # . . . . . . . . . : 32690
REFERENCE ID # . . . : 06010031
SITE ADDRESS . . . . . : 20400 MARIANI AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : APPLE COMPUTER (PHASE A)
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014
RECEIVED FROM . . . . : SOUTH BAY CONSTRUCTI
CONTRACTOR . . . . . . . : RICHARD FURTADO LIC # 5655
COMPANY . . . . . . . . . . : SOUTH BAY CONSTRUCTION CO INC
ADDRESS . . . . . . . . . . : 170 KNOWLES DRIVE, STE 120
CITY/STATE/ZIP . . . : LOS GATOS, CA 95032-1833
• TELEPHONE . . . . . . . . : (408) 379-5500
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BTEMPPERM FLAT RATE 1 . 00 200 . 00 0 . 00 200 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 200 . 00 0 . 00 200 . 00 0 . 00
METHOD OF PAYMENT AMOUNT ' NUMBER
----------------- ------------ ------------------
CHECK 200 . 00 50216
TOTAL RECEIPT 200 . 00
•
CITY OF CUPERTIN
CITY O PERMIT APPLICATION F
CUPERTINO
Date: 1 16 106 /
Building Address: Mailing Address (if different from building address):
20 k Ajg
Owner's Name: Phone#:
Lf — 21 -51
Contractor: License#: �--�6
Sa .,
Contact: Phone: 6qo-8 6 ZZ Cupertino Business License#:
g Fax: q —11 13r 1 5(0 755
Building Permit Info: '�'� P � r U,'d v r g f o J►J V{i �`�j ps '�'._
"'F-r f C0kA1(le'C1laV-
Bid Elect ❑ Plumb Mech ❑
Job Description: TA uw p fe,4v .i-r Fo-r 049,1TOVAIJ11fi1�Fi�St�. a�+aYtteci _ .
Residential ❑ Commercial
Sq.Ft. Floor Area: q.Ft.: Z 37(p
Cost of Proiect: Occupancy Groun:
Type of Cons ction: Please check this box if the project is a
V
second-story addition. ❑
ro'ect Size: Standard ❑ Large ❑ Major ❑
uant ity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
13BOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1,75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTA)MQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3
r CITY OF CUPERTIN
CUPEfZTINO PET APPLICATION F
MRM
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMIvM New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMv2 New Comm Plumb PLUMBING
BOVERTUAE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum . PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
MIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
13PLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Re eat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
13PSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Instal/Alter Water Pie PLUMBING "
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BRENLADGIAN A/C Units<= 10,000 cfln MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY .. Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV ReloFumace> IOKbtu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREABNE00D Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREN20LE Pole/Platfonn Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 of 3
gry OF CUPERTINO
CUPI,TINO
PERMIT APPLICATION FORM
E
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Sigas, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special hispection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs .ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
'MPERMTTFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plambing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
•
3 of 3
'dame s Associates, Inc. PROJECT: APPLE GRAPHIC, SHT. OF
9trnoturel Engineers
DESIGN STUDIO DATE 2/'1/06
eee.ademoessocietes,cod PROJECT # 2K505-7
1685 Plymouth Street Suite 150
• —
Mountain -6800 California 8 1"
MountainT,1,650-93View.
f'ex.850•BO94043 BY TA
2otiOQ
nlr-_ I
I
P5L 51/4 P05T w/ GB
BA5E
(E) BLDG. LOW SLUMP GONG.
GOL. F
1
2'-O"x2'-O"
MIN. �(E) SLAB
• z
Q
I
I
IY:!
ji
;I
{ 2—#4 DOWELS 1,4112"
_ !? HOOK ON OPP.
ir.
SIDES OF ANCHOR
EPDXIED TO (E)
GONG.
(E) GONG. FT6.
RETROFIT POST BIOSE o/ (E)
K:YG513
ETC, .
- TESTING ENGINEERS, INC. DSA File#
2811 Teagarden Street,San Leandro,California DSA Appl.#
• (510)835-3142 Fax(510)834-3777
Project No.: 47597 Project Name: 20400 Madani Ave. Date: 02-08-06
Project Address:20400 Madan!Ave. City: Cupfrtino Hours: 4
Work Location: b4 Jobsite LJ Shop Miles: 80
Pennit# : tem 06010031 Tow Code: 106
Insp: T. Schaar
Work as Requested by: Spencer of: South Bay Const. N0. 8010
Reported to: Same of: Same Schd. Arrival Time' 7:30
Arrival Time: 7:30
Departure Time: 11:30
STRUCTURAL STEELANELDING INSPECTION REPORT
❑ Collected certified mill test reports and verified against material heat numbers.
Checked welder(s)qualification papers of the following individuals: On file(Glazier Iron Works)
Checked WPSs and verified welding parameters. X
Verified proper electrode storage. X
Verified proper preheat. X
Visually inspected joint preparation and fit-up. X
Performed t[periodic❑continuous; visual inspection of the in- (Note: If any of the above items without check-boxes
progress.welding were not performed, line out the item and explain why)
performed by _qualified welders)usin the ❑ SMAW ® FCAW ElGMAW F1 SAW [I SW process(es)with
E- electrodes. E- 71T-8 wire electrode. 5a F- 6 flux.
Work is in-progress. This is the final steel inspection report for the❑ SHOP ❑ FIELD.
Weldments consist of: Single pass fillets joining wood beam buckets to tube steel columns(mid height)A 21 line—C to C.5
lines&along 21 &22 lines from I to 1.5&J.5 to K lines(2 per area) w//all complete w/exception of 1 weld A J.5&21 north
side of bucket,which has insufficient weld size and length on vertical. Also single pass fillets ioinina tube steel beams to
columns(w/angles Cao t/b welded w/same)(ra 22&21 lines from 15 to J.5 lines "complete" Flare bevel groove welds ioinina
tube steel collector splice sections to collector tubes a roof level along E line from 3 to 17(aporox)w 17 splices total-
"complete".Also single pass fillets ioinina oudin tie in clips to tube steel collectors Cal 13 locations Ca roof level along E line
,from aimrox'6 to 14 lines, "in progress" (see notes).
NOTES: ❑ Type ER Do not type Welds A roof collectors to Durlin tie in clips.are shown on detail CS12 (attached)
dated1/30106 as reouirinci a weld completely around the clips.The"as Is"condition has only one side of each clip welded
(field access problems)and in some area's only as much as 2"of weld length was established. This access problems)and in some area's only as much as 2"of weld lenoth was established. This will�uire enaineersen�ineers
written approval before final acceotanceapproval before final acceptance.
The work was was D(Lt EJ inspected in accordance with the requirements of the approved documents.
The work inspected met IS did not meet El the requirements of the approved documents.
Drawing Nos: Dated:
Discrepancies reported-to: at the'obsite. Form required&attached
i
Ins or's si 'ature: ICC/ICBG#: 5042217-XX,AWS CWI#05070751
Q: School District
Project Architect
Structural Engineer
Project Inspector
DSA Regional
SSNO.DSA OB1703
- DSA File#
DSA Appi.#
� TESTING ENGINEERS, INC.
Project No.: 47597 Project Name:20400 Mariani Ave. (AGDS) Date: 02-08-06
Project Address:20 400 Mariani Ave. Ci!X: Cupertino Hours: 4
Work Location: U Jobsite Shop Miles: 80
Permit# : TEMP 06010031 Tow Code: 125
Insp: T.schaar
Work as Requested by: Spencer of: South Bay Const. No:8010
Re rted to: Same of: Same Schd. Arrival Time:7:30
Arrival Time: 7:30
De artm Time: 11:30
EPDXIED DOWELS ❑ EPDXIED ANCHORS ❑ EXPANSION ANCHORS
❑ Witnessed the drilling of holes of proper diameter and depth.
or
Inspected predrilled holes for proper diameter and depth. Expiration Date of Epoxy 07/06
S Observed the cleaning of holes and the injection of Hilti HY 150 epoxy.
or
the insertion of epoxy capsules.
r-Witnessed the proper insertion of
uantity Bar Size/Dia,in. Length, in. Embedment,in. Allthread anchors,reinforcing steel bar
expansion anchors.
48 ea. #4's hooks 4"min Rebar hooks
for the following applications and/or at the following locations: Rebar hooks set horizontally into existing S.O.G.
@,E& F lines- 19.5, 20& 20.8 w/6 total spread footings cut into existing concrete S.O.G.
Notes: ❑ T e ❑ Do not Ve
The preceding work was 0 was not Lj in compliance with approved plans and specifications.
Drawing Nos: Dated:
Discrepancies re ortedto:_" at the'obsite. Form required&attached
Ins tot's si true: ICC/ICBO#: 5042217-XX
•
Corporate Office-2811 Adeline Street,Oakland,Califomia 94608-(510)835.3142 Fax(510)834-3777
South/West Bay-2123 Bering Drive,Suite E-San Jose,California 95131 .(408)451-2420-Fax(408)451.2425
Ewt/North-827 Arnold!hive,Bay 4-Martinez,California 94553-(925)370-7000 Fax(925)229-2951
C.V)owmem,ud Saris\TMe.kmpinulY RsyoeU 023006LL'.pmy Doweia®20106 Mu.niari Arc.02-0!-06 doc
Adak
TESTING ENGINEERS, INC. DSA File#
2811 Teagarden Street,San Leandro, California DSA Appl. #
• (510) 835-3142 Fax (510) 834-3777
Project No.: Project Name: i , ,; „ , ^ •., Date:
Project Address: C) -qc; �,,, City: i' , t , . Hours:
Work Location: Jobsite LJ Shop Miles:
# - 1 G cj Tow Code:
Ins
Work as Requested by: °. -r 1,> L AWS CWI #
Reported to: P, S r r._ of: (' -uc- / Schd. Arrival Time:
Arrival Time:
De arture Time:
STRUCTURAL STEELMELDING INSPECTION REPORT
❑ Collected certified mill test reports and verified against material heat numbers. (see attached list)
X.Checked welder(s) qualification papers of the following individuals: j)'1 a,4,n j-'(o.-c J 6,6 'S Z
Checked WPSs and verified welding parameters. —, y
/'.Verified proper electrode storage. Lei ( I i r 34
iti Verified proper preheat.
Visually inspected joint preparation and fit-up.
Performed,2continuous ❑constant visual inspection of the in- (Note: If any of the above items without check-boxes
progress welding were not performed, line out the item and explain why)
performed by i qualified welder(s) using the ❑ SMAW FCAW [IGMAW El SAW El SW process(es)
,performed
❑ E- electrodes. ;@ E- 2/ i S wire electrode. ❑ F- Flux.
[' Work is in-progress. ❑ This is the final steel inspection report for the❑ SHOP ❑ FIELD.
Weldments consist of:
� N/r/2. ✓.. -�. /r.' •/i .•d s_;. /�/: I%- •/•d+ 9J ifs.., !-'/ri o /D z2 .b(;, 3-
-)c
i
1e4 C-, ASJ `;x:� 1�c' S {r N•-,v VIn.1�..: .. aZN K z
l iy J l,: r', I ,3� I ! (i, Y1 �tll'+ •al jr •�� l"- �.t - -\- - �Irti' -�c, i +F �s
:'h i, + I�� xL2 �• i MlS - i id-s �� V "1' ✓ICS-: 3 C` C•IJY , L3'v ' /iff1LU .21
td.y,- -?1 r.14 !_ /s7,
��'/ ,w/L 1' -_.� .%�,�
L' � /-F i- x4 %.: /. _ //.i... L. ,.'L 7" / H3-5
NOTES: Q Type ❑ Do not type
l `
The work wa was not❑ inspected in accordance with the requirements of the DSA approved documents.
The work inspected met did not meet❑ the requirements of the DSA approved documents.
Drawing Nos: ; r �. Dated: -ri
Discrepancies reported to: at the'obsite. Form required&attached
Inspector's si na re: .. . AWsBVtlhfdo: p
cc: School District
Project Architect
Structural Engineer
Project Inspector
DSA Regional
SSPN.DSA 081703
Alh TESTING ENGINEERS, INC.
14 F
Project No.: t,1C. Project Narne:.4\ , to l
Project Address:;2Cit
Work Location: Jobsite ❑ ShopMiles
A licatio e ' SA/OSHPD No. CCC,I c)� ' Tow Code: a
Work as Requested by Of:
Reported to: J n c 12 C- 5 c of Q _ -t Schd Arrival;Trme:
Amval Timer
Di arture'Time
❑ STRUCTURAL STEEL/WELDING INSPECTION- 106 REPORT-FORM A
❑ Collected certified mill test reports and verified against material heat numbers. (see attached fist)
NAME: SSN.
Checked welders)qualification papers of the following individuals:
• tV"1 G.('-�-�:� j• ]neo ;;
❑ Checked WPSs.
�J Verified proper electrode storage.
Verified proper preheat.
Visually inspected joint preparation and fit-up.
OFPerformed continuous visual inspection of the in-progress welding
❑ Performed penodic visual inspection of previously completed welding
performed by 1 qualifiedwelder(s)using the ❑ SMAW 51 FCAW ❑ GMAW ❑ SW process(es)With
❑ E- electrodes. E-& ?/ 1-J wire electrode.
Work is in progress. ❑ This is the final steel inspection report for the❑ SHOP ❑ FIELD.
Weldmentsconsistof:(�g� /u / ', d/ - r w F/r/� �- r ./ b•/k I,/ 6 _
^n i,'i0x22 6i S Je fvo rz3el b'•PFe �'!C•'3,,� ,� /G�xZ2 b (`` hS]'
y%uA_�:_c- A1J'. y: C Fl �c e•, Fi�S StS ✓: i 4 . � .Ho.
�--trit J' r � i i-•x 2 a v- �-J—.S i�V�'.' S''lt,-i i a l k t' � -+ :�I r�-
�" 1 -+xZb - b ajr'1
NOTES: ,�B Type ❑ Donot4 /)
Pe
Tlie preceding work was to the best of my lmowtecige m compliance with approved plans and specifications including revisions by '
erigincer.Drawings: Mted:: C oved'
DiscTepancies reported to: at the'obsite..(Fbrm re 'red.&bnaehedJ e
inspector's s
Corporate Office—281 ITeagarden Street,California 94577.(510)835.3142 Fax(510)834.3777
South/West Bay-2123 Bering Drive,Suite E-San Jose,California 95131.(408)451-2420.Fax(408)451-2425
East/North.827 Arnold Drive,Bay 4-Martinez,Califomia 94553-(925)370-7000 Fax(925)229-2951
Ul\ _ k
k■
• � . ` �� � . .
� . .
— % ® DSA File#
TESTING ENGINEERS, INC. DSA Appl.#
Project No.: 47597 . Project Name:20400 Mariani Ave. (AGDS) Date: 01-18-06
Project Address:20 400 Mariani Ave. Ci!X: Cupertino Hours: 8
Work Location: to Jobsite Shop Miles: 80
Permit# : (TEMP)06010031 Tow Code: 125
Insp: T.schaar
Work as Requested by: Spencer of South Bay Const. No:8010
Reported to: Same of: Same Sc d. Arrival Time:7:00
Arrival Time: 7:00
De arture Time: 3:00
b]c EPDXIED DOWELS ❑ EPDXIED ANCHORS ❑ EXPANSION ANCHORS
❑ Witnessed the drilling of holes of proper diameter and depth.
or
[�Inspected predrilled holes for proper diameter and depth. Expiration Date of Epoxy 07/06
Observed the cleaning of holes and the injection of Hild HY 150 epoxy.
or
the insertion of epoxy capsules.
[�Wimessed the proper insertion of:
Quantity Bar Size/Dia, in. Length,in. Embedment,in. Allthread anchors,reinforcing steel bar
expansion anchors.
390 ea. #4's Varies 4"min Rebar Dowels
for the following applications and/or at the following locations: Rebar Dowels set horizontally into existing
S.O.G. along lines:J.5 & G.8 from lines 16 to 22.8 . 20.8& 22.2 from GA to G.8 lines,&along C.6 from 18.3 to
20.5 lines.
Notes: [] Type ❑ Do not e
The preceding work was Xwas not Lj in compliance with approved plans and sP5 jiff tion��.
DrawingNos: Dated: � �1
Discreancien rted to: at the'obsite.(Form required&attached
Ins ctor's attue: -- — ICC/ICBO#: 5042217-XX
Corporate Office-2811 Adeline Street,Oakland,Califomia 941508-(510)835-3142 Fax(510)834-3777
South/West Bay-2123 Bering Drive,Suite E-San Jose,California 95131 -(408)451-2420-Fax(408)451-2425
EnVNorth-827 Arnold Drive,Bay 4-Martinez,California 94553-(925)370.7000 Fax(925)229-2951
C:Vbamems sM Saunas\TN Ai.p\D61y 1eports01-200&Eposyt d,®20100 Musniui Ave.01-1&06 d.
DSA File#
DSA Appl.#
. ` TESTING ENGINEERS, INC.
Project No.: 47597 Project Name:20400 Mariam Ave. (AGDS) Date: 01-19-06
Project Address:20 400 Mariani Ave. City: Cupertino Hours: 8
Work Location: b4 Jobsite Shop Miles: 80
Permit# : (TEMP)06010031 Tow Code: 125
Insp: T.schaar
Work as Re uested by: Spencer of: South Bay Const. No:8010
Reported to: Same of. Same Schd. Arrival Time:7:00
Arrival Time: 7:00
Departure Time: 3:06-
54
EPDXIED DOWELS ❑ EPDXIED ANCHORS ❑ EXPANSION ANCHORS
❑ Witnessed the drilling of holes of proper diameter and depth.
or
Inspected predrilled holes for proper diameter and depth. Expiration Date of Epoxy 07/06
Observed the cleaning of holes and the injection of Hilti HY 150 epoxy.
or
the insertion of epoxy capsules.
Witnessed the proper insertion of:
Quantity Bar Size/Dia, in. Length, in. Embedment,in. A]Ithread anchors,reinforcing steel bar
expansion anchors.
347 ea. #4's Varies 4"min Rebar Dowels
for the following applications and/or at the following locations: Rebar Dowels set horizontally into existing
S.O.G. along lines 22.8 from A to J.5 , F.1 & E.9 from 22 to 22.8 C.6 from 20.5 to 22.8, 19.5 &20.5 from E.8 to
C.6.F.1 from 18.1 to 18.9 lines(utility trenches).
Notes: ❑ Type ❑ Do not type
The preceding work was 9 was not 0 in compliance with approved plans and specifications.
Drawing Nos: Dated: 01-06-06
Discrepancies at the j obsite.(Form required&attached
Ins ector' si ature: ICC/ICBG#: 5042217-XX
•
Corporate Office-2811 Adeline Street,Oakland,California 94608-(510)835-3142 Fax(5 10)834.3777
South/West Bay-2123 Bering Drive,Suite E-San Jose,Califomia 95131-(408)451-2420-Fax(408)451.2425
East/North-827 Amold Drive,Bay 4-Martinez,California 94553-(925)370-7000 Fax(925)229-2951
C.Ommems and Seninp\TMeAt*17enly rep9n1013005We y elt®30100 Mer.nivi Ave.01-19.05 da