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15070064CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19333 VALLCO PKWY CONTRACTOR: CUPERTINO ELECTRIC PERMIT NO: 15070064 INC OWNER'S NAME: APPLE INC 1132 N 7TH ST DATE ISSUED: 07/29/2015 OWNER'S PHONE: 4153105791 SAN JOSE, CA 95112 PHONE NO: (408)991-1000 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL —� APPLE - REPLACEMENT OF AN EXISTING GENERATOR License Class_ Lie. # { WITH Contractor C fid, ct4 '• A b�Date % , �� g A NEW STANDBY GENERATOR (250 KW / 312.5 KVA — TIER 3) I hereby affirm that am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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 pe rmance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $20000 ave and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 31620076.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DA T ED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply sued by: e; with all non -point source regulations er the Cupertino Municipal Code, Section 9.18. SignatureDate Z. U %>` RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If is a roof installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three declarations: maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sec ' ns 5505, 25533, a 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: °V1 VQ/ Date. I " I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (See. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I 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 and state laws relating to building construction, and hereby authorize 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date C CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT' • BUILDING DIVISION 40300 TORRE AVENUE • CUPERTINO, CA 950143255 (408) 777-3228 • FAX (408) 777-3333 • building.0cupeMno.org El pwmma ❑MECHANICAL tABLECTRICAi mise 1 IMIISCELLANP01IS / PROJECT ADDRESS - - 19333 Vallco Pkwy. O�ANIe - - APN I- PHO EMAIL - — - - - STREET ADD SS One Infinite o CITY, AZIP u ertino CA 95014 FAX CONTACT NAiv! !�1 STREET ADDRESS /1 B mp 3 2. ®VNFRAamr TTY, STATE, ZIP FAX ❑ OWNER 11OWNER-BUILDER11Ol IXCONTRACTOR ❑CONTRACTORAOENr ❑ ARCHITECT ❑ ENGINEER ❑ DEYELOPP1t ❑ mwANT CONTRACfORNAME John Walters LICENSENUMBER 746.27 LICENSETYPE BUS. LIC 9 1397 COMPANY NAME Cu ertino Electric E-MAIL lohn walters cei FAX 408-275-6492 STREET ADDRESS 1132 N 7th St. CITY STATE, ZIP San JOSe CA 95112 PHONE 408-808-8016 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC R COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑SFDorDUPLEX ❑ MUL'rl-FAMIL, BUILDING: IRCOMMERCIAL )LAND ❑ YES TERFACEAREA ❑ NO PROJECTM ❑ YES FLOODZONL• ❑ NO ISTHEBLDGAN ❑ YES EICHLERHOME? ❑ NO DESCRIPTION OF WORK lamp R��=,FLCeorb aC k7 � 13 srrae ra,to TOTAL VALUATION: $20,000.00 By my signature below, I certify to each of the following: I am the property owner or authorized igen act on the pro er's behalf. I have read this application and the infomlation I have provided is correct. I hav read the Doseription of Work and verify it is accurategree to comply with alt applicable local ordinances and state laws relating uildi g constru 'on. I au orize representatives of Cupertino to enter th e -identified property for inspection. purposes. Signature of Applicant/Agent: Data: 7-7-15 PLEMENTAL INFORMATION REQUIRED OFFICc USE ONLY ❑ OVER TNGCOUNTER EXPRESS ❑ STANDARD LARGE MAJOR MEPMiscApp 201 Ldoc revised 06/21/11 vl CITY OF CUPERTINO FEE ESTIMATOR — BITUMING nTvTCTnN ._. ' 19333 VALLCO PKWY DATE: 07/09/2015 REVIEWED BY: PAUL PADDRESS: APN: 316 26 076 BP#: ,50 *VALUATION: 1$20,000 TYPE: Building Permit PLANCHECKTYPE: Alteration /Addition/ Repair RIMARY Commercial Building USE: Civil / Religious activities in BQ zone? 0 Yes Q No PENTAMATION PERMIT TYPE: 1 GENCOM WORK Replacement of an existing generator with a new Standby Generator 250 Kw / 312.5 KVA - Tier 3 SCOPE 1 $179.00 ._. ' Ifech. Plan Check PIwO. Plan (:'heck Elec. PlanCheck 0.0 hrs $0.00 iech. Nrmit Fee: --L-- Plumb. Permit Fee: Elec. Permit Fee: IEPERMIT ofhe:r 1/eeh. lrup. Other Plumb hnp. Other Elea Insp. 0.0 hrs $48.00 A4ech. hisp. Yee: Plumb. htap. Fee<.: L'A-w. 11, p. Yee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the relfmina in ormation available and are oniv an estimate. Contact the De t or addn'l infn FEE ITEMS (Fee Resolution 11-053 Ef . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 [__?_] hours $286.00 Plan Check, Hourly 1STPLNCK Suppl. PC Fee: (F) Reg. C) OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 $179.00 Electrical 1BREMPOWER Generators Permit Fee: $0.00 Suppl. Insp. Feer Reg. () OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Construction Tax: IBCONSTAXC $0.00 Administrative Fee: (ADMIN $45.00 0 G) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee - $0.00 Select allon-Residential Building or Structure 0 i Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICO $5.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 "SUBTOTALS: $147.60 $465.00 TOTAL FEE.`; $612.60 Revised: 07/02/2015 Testing Engineers, Inc. FILLQuality Assurance Services Cr ` Materials Consulting Since 1954 Regular Concrete Compression Test Report Project No.: 62439 Client: CUP023 Project Name: 19333 Vallco Parkway Apple VP 02 Building C Generator Pad Cupertino, CA Permit # 15070064 Supplier: Central Concrete Mix: H30H21321 Ticket No.: 18145953 Location: Generator pad. 'JAN 2 8 2016 Sample No.: 255761 / Page 1 of 1 Report Date : 01/15/16 Sample Date: 12/18/15 Time Sampled: 0330PM Date Received : 12/21/15 Inspector : M. Ardizzone, TEI Specimens Cast (ASTM C-31) : 5 Air Temperature (ASTM C-1064) : 74 deg F Mixture Temperature (ASTM C-1064) : 61 deg F Slump (ASTM C-143) : 4 inches Date Tested 12/21/15 01/15/16 01/15/16 01/15/16 HOLD ID Number 1A 1B 1 C 1 D 1E Mark Sample Dimension, Inches Diameter 4 4 4 4 Length 8 8 8 8 Area, sq. inches 12.57 12.57 12.57 12.57 Ultimate Load, lbs 62000 125000 122000 123000 Ultimate Str., psi 4930 9940 9710 9790 Average, Str., psi 9810 Age Tested, Days 3 28 28 28 HOLD Fracture Type 1 1 1 1 Dry Unit Weight, pcf Specified Strength, psi 3000 3000 3000 3000 JJ SPECIMENS NOT SCHEDULED FOR TESTING WILL BE DISCARDED AFTER 28 DAYS OLD The Material /' WAS WAS NOT The Material Tested -'<- MET DID NOT MEET THE SAMPLED AND TESTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS. REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS. Remarks: Samples Tested in General Conformance with ASTM C-39 1 cc. City of Cupertino 1 cc. Cupertino Electric, Inc. Reviewed By: 14 4"'I'l 1 Robert Green Concrete Lab Supervisor The results presented in this report relate only to the item(s) tested. This report can be reproduced only in its entirety unless written permission from TEI is obtained. Corporate Office - 2811 Teagarden Street, San Leandro, California 94577 - (510) 835-3142 - Fax (510) 834-3777 Testing Engineers, Inc. FILLQuality Assurance Services Cr ` Materials Consulting Since 1954 Regular Concrete Compression Test Report Project No.: 62439 Client: CUP023 Project Name: 19333 Vallco Parkway Apple VP 02 Building C Generator Pad Cupertino, CA Permit # 15070064 Supplier: Central Concrete Mix: H30H21321 Ticket No.: 18145953 Location: Generator pad. 'JAN 2 8 2016 Sample No.: 255761 / Page 1 of 1 Report Date : 01/15/16 Sample Date: 12/18/15 Time Sampled: 0330PM Date Received : 12/21/15 Inspector : M. Ardizzone, TEI Specimens Cast (ASTM C-31) : 5 Air Temperature (ASTM C-1064) : 74 deg F Mixture Temperature (ASTM C-1064) : 61 deg F Slump (ASTM C-143) : 4 inches Date Tested 12/21/15 01/15/16 01/15/16 01/15/16 HOLD ID Number 1A 1B 1 C 1 D 1E Mark Sample Dimension, Inches Diameter 4 4 4 4 Length 8 8 8 8 Area, sq. inches 12.57 12.57 12.57 12.57 Ultimate Load, lbs 62000 125000 122000 123000 Ultimate Str., psi 4930 9940 9710 9790 Average, Str., psi 9810 Age Tested, Days 3 28 28 28 HOLD Fracture Type 1 1 1 1 Dry Unit Weight, pcf Specified Strength, psi 3000 3000 3000 3000 JJ SPECIMENS NOT SCHEDULED FOR TESTING WILL BE DISCARDED AFTER 28 DAYS OLD The Material /' WAS WAS NOT The Material Tested -'<- MET DID NOT MEET THE SAMPLED AND TESTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS. REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS. Remarks: Samples Tested in General Conformance with ASTM C-39 1 cc. City of Cupertino 1 cc. Cupertino Electric, Inc. Reviewed By: 14 4"'I'l 1 Robert Green Concrete Lab Supervisor The results presented in this report relate only to the item(s) tested. This report can be reproduced only in its entirety unless written permission from TEI is obtained. Corporate Office - 2811 Teagarden Street, San Leandro, California 94577 - (510) 835-3142 - Fax (510) 834-3777 Admbk TESTING ENGINEERS, I 2811 Teagarden St. 510-835-3 510-834-3777 fax San Leandro, CA 94577 800-660-31 San Leandro • San Jose • "Wartinez INSPECTION REPORT�. Week Ending: 12/18/15 PROJECT # 62439 TYPE OF INSPECTION: Epoxied Dowels / Concrete Placement PROJECT: PLACE OF INSPECTION: 19333 Vallco Parkway Jobsite Apple VP 02 Building C Generator Pad - -Cupertino;=CA- - --- Permit Permit # 15070064 DATE 12/18/15 HOURS 8 INSPECTOR M. Ardizzone Reported to Russ Beasley of Cupertino Electric at the jobsite as requested. Inspected predrilled holes for proper diameter and depth. Observed the cleaning of holes and the injection of Hilti HY 200 A epoxy (exp. 7/16). Witnessed the proper insertion of sixty-one (61) # 5 reinforcing steel bars, various lengths, embedded 6" for mechanical pad at back of building generator pad. Monitored loads arriving at the jobsite for correct mix and proper slump. Inspected placement operations and vibrating procedures. Performed 1 slump test (4") and cast 1 set of compression test specimens (5 each), Sample # 255761, for Concrete Mix # H30H2B21 from Central Concrete Supply Co., (specified strength 3000 psi, slump 4") for concrete placed at generator --- --pad.- Total cubic-yards=plaeed:w7-1/2.- --- ------ —__ -,---_--------- ---- Inspected _-_- Inspected the placement of reinforcing steel for the above. The preceding work was, to the best of my knowledge, in compliance with approved plans and specifications, including revisions by engineer. Reviewed by: David Chippero Special Inspection Division Manager 1cc: Cupertino Electric, Inc. / R. Beasley City of Cupertino / Bldg. Inspection Dept. The results presented in this report relate only to the item(s) tested/inspected and can be reproduced only in its entirety unless written permission from TEI is obtained. Page 1 of 1 Adllbk r, LF TESTING ENGINEERS, INC. `?` 2811 Teagarden St. 510-835-31510-834-3 fax San Leandro, CA 94577 800-660-3142 San Leandro San Jose Mar�ir�e� PROJECT # 62439 PROJECT: 19333 Vallco Parkway Apple VP 02 Building C Generator Pad - _-- — -(✓ pertino; Com`_-__ Permit # 15070064 DATE 12/21/15 HOURS 4 INSPECTOR M. Ardizzone INSPECTION REPO eek Ending: 12/25/15 TYPE OF INSPECTION: Epoxied Dowels PLACE OF INSPECTION: jobsite Reported to Russ Beasley of Cupertino Electric at the jobsite as requested. Inspected predrilled holes for proper diameter and depth. Observed the cleaning of holes and the injection of Hilti HY 200 A epoxy (exp. 7/16). Witnessed the proper insertion of six (6) 3/4" diameter stainless steel Allthread anchors, various lengths, embedded 6" for generator at mechanical pad at back of building generator pad. The preceding work was, to the best of my knowledge, in compliance with approved plans and specifications, including revisions by engineer. Reviewed 1cc: Cupertino Electric, Inc. / R. Beasley City of Cupertino / Bldg. Inspection Dept. David Chippero Special Inspection Division Manager The results presented in this report relate only to the item(s) tested/inspected and can be reproduced only in its entirety unless written permission from TEI is obtained. Page 1 of 1