00010104 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY QQQ 10/ O 41
CITY OF CUPERTINO BUILDING.ELECTRICAL Is
BUILDING DIVISION APPLICATION/PERMIT PLUMBING.MECHANICAL
BUILDING PROJECT,IDEN UFICATION
B U1 G A3RF'_ti5: � �� � &,"'X
�r � SANITARY NO, APPLICATION SUBMITTAL DATE
NE;4A PHON COM1TRACI'OR'S NAME: LIC NO:
NIC
CI iC I, t: LIC O: ADDRESS:
CONTACT. PHONE: r}i Je.��i -BUILI)INNG-PLLRMIT.INIFFO.'-
�l ❑ Consultant Fees Paid by Applicant(initial) HI DG ELECT PWM MECHH
6 a _ d f ,f L9
LI ENSCDC RACI ORS DECLARATION QTY l;� + EIFCTRIC PERMITJt;' r r. •ELF
1 hereby alfrm that 1 ant licensed under provisions d Chapter 9 he o g s -. s + J f !•} , Tor ..a l'n JOB DESCRIPTION
� '��Z in Sec1oa 90(0)ol Dtvt 4 3ofthe Bus essund s ms odeandm
full(,'cell� lfet PERMIT ISSUANCE SFDWL KITCHEN REMODEL
F UnU case so
s Lich APPLIANCES-RESIDENTIAL ❑ADDITION ❑PLUh1BING RE-PIPIT
F.Z yj Dme�_Conttacu -
Imo'--jy AI2C111'fECI"S DEC PANELS ❑MULTI-UNIT ❑STRUCTURAL
O Z.N. Iuudersm dilly,funs ehnl1 he uaed us pubmrecoups MODIFICATION
11P TO 200 AMPS
9-1q cl Licensed Profaliomd ❑INTERIOR ❑CHIMNEYRITAIR
aY2-�L1 OWNER-BUILDER DI!CLARAI'ION 201-Ig1UAMPS IMPROVEMENT L]SWIMMING POOLS
gC 6 I remby mfinn mat I am exempt from the Contractors License law for the OVER Ill AMPS ❑BATH REMODELIREPAIR ❑DEMOLITION
Wd U following reason.(Section 7031 5,Business and Professions Code:Any city or county SIGNS 17LEM-RICAL ❑OTHER
U.H which requires a permit m compact.aIle',improve,demolish,or repmr any dmcmre
prior to its issuance,also requires the applicant for such pertmun file a signed atammm�i
0 SPECIAL CIRCUIT IMISC.
apaPthut he is licenseda—ut m the provisions of the Contractors Liunsc Law(Chapter 9
KW ay,O (commencing with Section pull Division 3ofthe Business and pland.ions Code)or TEMP.ME'TERORPOLF.INST. COMMERCIAL
6 X c W that he is csr.,,mercnom and me basis for the alleged exemption.Any violation of ❑N17W BLDG/ADDITION ❑DEMOLITION
Second 9031.5 hymy h,lamt for.permit sobjecu t he applicant lenivil penalty nl POWER DEVICES t [I TENANT ❑FOOD SERVICE
m man five hundred dollars(SSllfll.
$=O LI as owner of the property,or my employees with wages as their sole compensation, SWIMMING POOL EL IMPROVEMENT
W- will do lifewois
cook,audthearricare not intended.rolfemdI ..ale(Sole]044,no.inews El OTHER
mand Professions Cn rv: the Contractors License Law does.,or apply to an owner of OUITTTS-SWITCHES FD(TI pill
prapeny who builds or improves thereon,and who does such work himself or through
his own employees,provided that such improvements are not intended or offered far NEW RESIDENTIAL ELECfR
.sale.If,however,the building or improvement is sold within one year of colophonn4be SQ FT.FLOOR AREA $/SQ.FT.
vx-builder will lure the burden of„owing that he did nut build or improve for par-
❑I of
nproperty, exclusivelycontracting 'ith, licensedcontractors,
< st tatpj t(SuHolmes, dPf :CdmCt t I , '-
I'lt
res , / ` ' CERMIT 'nx tl :no(apply to
etfpptynn ip d F
F
who
cotcontracts for such itoenncontractions) pr ,,,,he Contractors ,
'
❑batsei �71 e,emptudduSe ....nt PERMITISSUA
ALTER-DRA & -WATER(EA) VALUATION
,
woe Date IN
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTF.C'I'. E I� ���
I hereby affirm under penalty of perjd ury one the following declarations: + 4q. .
❑ I have and wit l maintain o Coatlticutc of Consent la self-inset,for Worker's Conifer- DRAINS-FLOOR.ROOF,AREA,COND.
,cation,as provided far by Section 3900 of no,Labor Coda,for he perfamtanec of the S'IOx1ES TYPP,CONSTRUCTION
stork fur x6ich this permit is i...on Fix G-1 RLS-PER TRAP
❑I have and will mountain Workers Compen..atlon Insurance,as required by Section
391M)ol'the akar Cndo,for the p fnnnu 'eofthaworkhtr%h hill sen is
issued. GAS-EA.SYSTFM-I INC.4 OUTLETS OCC.GROUP APN
My Wo t c t' �n Inn n 'sed lo umb e `
Cameo ` eec 1 yyg �- GAS-P.A.SYSTEM-OVER4(EA)
CER i' iT 1' ROM '1 CERS'
S IC GREASE/INDUS TRL WASTE INTERCEPTOR
.. BUILDING DIVISION FEFiSe
('Rtis'ection neednot cocomple¢d if tl permit is arnne hundred
don, BUILDING Ito) GREASE'IRAP
or less.) d.I hill PI,ANCI IBCK FEE -
• Loy ally the'in the pieffaany
its t wockforsubjeta,permit totheWrkers'Con"ch-
not employ SEWER-SANITARY-STORM EA.ZIMI PT.
P Ymry poison in tory mm�nu.o tee to hen+me subject to Workcrs'Cnnt,cn- ENERGY FEE
0 Z 'mind Laws of California.Dole WATER HEATER WNENT/T:LECfR
Z 2 Applicant GRADING FEE
f/j NCTICE TO APPLICANT:If,after staking this Certificate sf E'emptimt,yrs.should WATER SYS'IEM/I'12BA'I'ING
become suhjut In the While,Compensation powmi ns of the[..bill Code,you most SOILS FEE
ti forthwith comply with such provision,,nhis permit shall he deemed revoked. WATER SERVICE:
aQ
CON51'RUC'TION LENDING AGENCY Zoo) Z NIiW RES IPEN UAL PLMI{, SQ.FT. PAID
" I for
mnhonnit i Tisamn(Sec.3nlenoing agency forthe Pcrformnneen( Date Ituciptp
W theworkfor which this permit is issued(Sec.l09],Civ.Cd
ULender's Name TtYI'AI:
L) Londe AJtl TOTAL:
0. 1 readily hill I ho,acrad this ,l t d and run the M f urn is b r t BUILDING EEE
ZqA Correa,1'g t ply -1 11 city d countyordinancesa d don I 1 t' g t QTY MECHANICAL PFRMI'T, s ) .i./' •FEE t(+'
U Z buildingconmercial,and family.uthanzc representatives of this by to enmruPon the it r t t le• SEISMIC FI3B
above-foul mal property for impcctian purposes, t
(We)agree to Inst,indemnify unit keep ha'raw the City of Cu,vidno ogainn PERMIT ISSUANCE ELECTRIC FEE
liabilities,judgments,ensu and a„eases which may in any way dame against said City ALTER OR ADD"rO MECH,
in asequence of the granting of this penniL PLUMBING FEE
APPLICAIA UNDERSTANDS AND WILL COMPLY WITH PILL N)N-POINT AIR HANDLING UNIT(TO 10.000 CFM)
SOURCE ULATIONS. ^ MECHANICAL.FEE
UAIR HANDLING UNIT(OVER 10,(MO CFM) CONSTRUCTIGNTAX
Signori e p Cntnruc Dam EXHAUST HOOD(W/DUCT') HOUSING MITIGATION PEE
HAZARD ATFRIALS DISCLOSURE
Will no applicant or future building occupant store or handle Inardous material U17NI-ING UNIT(TO 100,000 BTU)
as defined by the Capistrano Municipal Code,Chapter 9.12,and the Health and Safety
Cowie,Section 25532mC HEA"I'INC,UNIT(OVER 100,030 BTU)
❑YesPAID
VENTILATION PAN(SINGLE RESID) Data Receipt
Will the appli'm le fat buiiding occupant use national or devices which
mit hanmpdous air c,ntanonmas c defined by the Ilay Area Air Quality Management BOILER-COMP OUP OR 100,M)BTU)
Disui,l? ROIhER-COMP LOVER 1f0,OW 13TU7 '101'AL:
❑Yes pp So
I have read the hicandous materials requirement'trader Chapter 695 ofthe Cali- AIR COBIN GONER ISSUANCE
formal t th&Safety Chile,Secteal 25. .25533 trod 25534.1 on ticall that if the NEW RESIDENTIAL MECI1, Q.SFT. �-f^
ballot J es set currently have a lenum, a tismyres,omibiS 1. fy t((((��,�c path L p D
ofd which w , be, issuance o co' fyp y,
Owner or moderated agent Data TOTAL: ISSUED BY:
OFFICE
ENGE0GEOTECHNICAL ENVIRONME TAL TANTS
Ah N C O R P O RATE D n N ERIALS TESTING
• L OCT 2 0 2000 D
oject No.
By 41 6.4.050.01
October 17, 2000
Mr. Pat Burke
The O'Brien Group
2001 Winward Way, Suite 206
San Mateo, CA 94404-2473
Subejct: I'ot3-0_ T act-Oak Valley, Permit Number 00010109
21 131 Canyon Oak Way
Lot 3-11,Tract—Oak Valley, Permit Number B-0495
22101 Canyon Oak Way
Lot 2-01,Tract-The Estates, 22200 Canyon Oak Way
Permit Number 99110169
Cupertino, California
SEISMIC FRAME INSPECTIONS
• Dear Mr. Burke:
• With your authorization,ENGEO Incorporated performed special inspections and ultra-sonic testing
related to the seismic frame installation at the subject property location in Oak Valley in Cupertino,
California. This report is submitted in accordance with Chapter 17 of the Uniform Building Code.
Observation and testing services were provided using the approved plans for the following:
• Field welding of the seismic frame moment connections.
• Field welding of the framing straps.
• Ultra-sonic testing of the seismic moment connections.
All field welding of the two moment frames at Lot 3-11 was completed prior to the ENGEO
representative being notified. The ultra-sonic testing of the complete penetration welds and the
visual inspection of the fillet welds at Lot 3-11 revealed no weld discontinuities.
To the best of our knowledge and based on our observations, the work requiring special inspection
and testing is in conformance with the approved plans, field recommendations of the Structural
Engineer, and the applicable workmanship provisions of the Uniform Building Code, except as
noted.
We make no representation as to the accuracy of dimensions, calculations or any portion of the
• design for this project.
•
2401 Craw Canyon Road •Suite 200 • San Ramon,CA 94583-1545 • (925)838-1600 • Fax(925)838-7425
www.engeo.com 9 E-mail:engstaff@engeo.com
• The O'Brien Group 4136.4.050.01
Lot 3-07, Oak Valley; Lot 3-11, Oak Valley; Lot 2-01,The Estates October 17, 2000
• SEISMIC FRAME INSPECTIONS Page 2
If you have any question or comment, please do not hesitate to contact us.
Very truly yours,
ENGEO INCORPORATED Reviewed by:
1
RobertX. Jo on Daniel S. Ha sch
rxj/jd:lots 3-07,3-11,2-01E* 3 31 dl ,.r
cc: I —City of Cupertino
1 —The O'Brien Group, Mr.Gerry Ploof l�OF CA1���1
•