B-2016-1187 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS- CONTRACTOR: PERMIT NO:B-2016-1197
20370 TOWN CENTER LN CUPERTINO,CA(36940 059) (PARAGON
MECHANICAL INC)
SANTA CLARA,CA
95050
OWNER'S NAME: FUND VIII CUPERTINO LLC DATE ISSUED:01/14/2016
OWNER'S PHONE: PHONE NO:
LICENSED CONBUILDING PERMIT INFO:
License Class Lie.# °4.,
Contractor(PARAGON M �
HAW ,AI i C)Da er,, X BLDG —ELECT —PLUMB
( -/ ( XMECIT RESIDENTIAL X COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commenting
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in fall force and effect, JOB DESCRIPTION:
TOWN CENTER-REMOVE&REPLACE(E)ROOF T P 50 TON A/C
I hereby affirm under penalty of perjury one of the following two declarations; UNIT
a. 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
performance of the work for which this permit is issued.
z. I have 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. Sq.Ft floor Area: Valuation:$129110,00
APPLICAKT CERTIFICATION
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 AiPN Number: Occupancy Type;
ordinances and state laws relating to building construction,and hereby 369 40 059
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,costs,and PERMIT EXPIRES IF WORK IS NO STARTED
expenses which may accrue against said City in consequence of the WITHIN 18Q DAYS OF T ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will
comply with all n -point source regulations per the Cupertino Municipal 180 DAYS INSPECTION.
Code,Section 9bb.
Issu 445
Signature Date t Tj t Date:
7-
OWNER-BUILDER. a CLAR
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being' stalled,If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all now materials for
i• 1,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the-structure is not intended or offered
for sale(Sec.7044,Business&Professions Code) _ Signature ofApplicant:
z. I,as owner of the property,am exclusively contracting with licensed Date:
contractors to construct the.project(Sec•7044,Business&Professions Code).
I hereby affirmunder penally of perjury one of the following three declarations:
ALL ROOR-COVERINGS TO BE CLASS"A:"OR BETTER
1, 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 HAZARDOUS MATERIALS DISCLOSU E
performance of the work for which this permit is issued, I have read the hazardous materials requirements under C apter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,E nd 25534. I will
by Section 3700 ofthe Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,C rapter 9.12 and the
this permit is issued. Health&Safety Code,Section 25532(a)should I store or h andle hazardous
3. 1 certify that in the performance of the work for which this permit is issued,I material.Additionally,should I use equipment or devices wb ich emit hazardous
shall not employ any person in any manner so as fe become subject to the air contaminants as defined by the Bay Area Air Quality Ma agementDistrict I
will maintain compliance with the Cu ertino Municipal Cod ,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Cod eetions 25505,25533,a ad 25534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed revoked. Date: J
APPLICANT'CERTIFICATION IIt�J((p CO 3TR F C
carfffy that I have read this application and state that the above information is I hereby nm that there is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(See,3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes, (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally,the applicant
understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records.
Cupertino Municipal Code,Section 9.18.
Licensed
Signature Date
Professional
s �
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION MEF
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUE*ER i"f hCG (408)777-3228- FAX(-06)777-M33• build!MOCUDeriino:ora
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DtscP.PTlon OF WORK
70TA1 VALUATION: ��� x_�� � �
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By Iny sisaa i re below,I cer iy to each of the folio A im!: I an the property mmDer or authorized ag5pt'-to gtt—on the prop -n�F s ti all an_has
application and the i7for a ion I have provided is correct. I neve read he Descipdoa of,-1s,&ar r"� eu�,�Iy ith I pp}iesGle 1asa1�
ordi�aaces and state laws relei,_�to bpildiro �ctio� au` e representzdyes of Cupe"iao to enter 1deatined property for inspection purposes,
Si�ea:re ofApplic4..JAg=t: Date: �tt0
ST J-PPL Eh I-'T?f INTTFORMATION REQUIRED 1-M.
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1vfERAfisc4vp_2011.a o revised 061-PI/I1
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20370 TOWN CENTER LN DATE: 0111412076 REVIEWED BY: M LISSA
APN: . 369 40 059 DP#c B-2016-1187 "VALUATION: F$129,110
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration./Addition/ Repair
PRIMARY Commercial Building PENTAMATION FlJRN1AC
USE: PERMIT TYPE:
WORK TOWN CENTER- REMOVE & REPLACE E ROOF TOP 50 TON A/C UNIT
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (>10K cfm) 1MCAIRHAN 3 #1 $143
TOTALS: Lj
$143 0
_.
Mech.Plan Check 0.0 hrs $0.00 1'?tatrt}3. t';cr=r{ Y�:ck 1�sc:..('f�rrr C:Ftr:i°k
Mech.Permit Fee: IMPERMIT 1'lrarl;b. Permit Fee l tes..1'a r,lrit r ev
Other Mech.Insp. D.0 hrs $48.00 0thar pharlb 1,sr. Ll
f1,trf:�I•:trr 311s1�.
�L'C' 11no. 1` 1`2t: j:.le'C'. 1f5j7. FRL•.'.
NOTE:This estimate does not include,fees clue to other Departments(i.e.Planning,Public Works,Dre,Sanitary Sewer 1striet,School
District,etc. . These,fees are based ori the reliminar in ormadon available and are on2 art estimate. Contact the De t or addn't info,
FEE ITEMS (Fee Restlution 11-053.Lff 7/1/13_ FEE QTY/FEE MISC ITEMS
111a T f7beG'lC.i'C'L'•
PCFee
PI\M Plan Check: $0.00
Baal lrl. In sus.1"ce
PME Unit Fee: $143.00
PME Permit Fee: $48.00
t::onmruction :Mita::
Administrative Fee: JADMIN $45.00
Work Without Permit? 0 Yes e No $0.00
����'ultc°t.>tl l'lcrral�trr,�.1"E�es:
Travel Documentation Fee: IT]MVDOC $48.00
Strong Motion Fee: IBSEISMICO $36.15 Select an Administrative Item
13ldg Stds Commission Fee: McBse $6.00
-:... .
M SUBTOTALS: $326.15 $0.00 TO�A.L I'EE: $326.15
Revi ed: 01/01/2016
FILE
START UP SHEET
FAN
Job Name: Center Job Number: 16098CL
Job Addr ss: 20370 Town C ter Ln. Cu ertino
Section 5: art Descri tion
Sec.#: Submittal No.: P&ID/Dw .#:
Area Served:Whole Bulding
Data Design Actual On Site
Unit Tag# AHU-1
Manufacturer Trane
Model# CSAA050UBL00
Serial# K15L92246
Belt Description
Size &Quantity I B56
Section 6: Equipment Pre-Installation Inspection
Step Inspection Description Yes No N/A Performed By
(Initials& ate
6.2 Nameplate data matches vendor specifications F
�C
6.3 All parts are received. F
6.4 No visible signs of damage,leak,or defective parts.
6.5 Verify electrical service for correct voltage,current and
thermal overload protection.
Operational and Maintenance(O&M)manual is
6.6 available in the field, r
Comments/
Observations:
Print Name Signature Date
Performed By: Kent McKinnon , 3/22/16
Reviewed By
(Owner/Representative)
1
FN 99.032.1
Step Inspection Description Yes No N/A Performed By
(Initials&Date
6.7 Start-up technicians reviewed factory start-up F r r
AW
procedures in the O&M manual
If Paragon Mechanical,Inc.provided Variable c
6.8 Frequency Drives(VFDs)that are controlling the fans, F F 1—
complete FN-99.029.1 VFD start up form(s)
Section 7: Installation Inspection
Step Inspection Description Yes No N/A Performed By
(Initials& ate)
7.2 Unit is installed level. F I® F
7.3 Tag#is attached to the unit F r rU
7.4 Service clearance is adequate for maintenance. F r F
7.5 All access panels and covers are in place F F r
7.6 Vibration isolators are installed and adjusted.
7.7 Ductwork and flex connections are connected and F F F
sealed
7.8 Fan drive belt tension is correct. F
7.9 Sheaves are aligned. F F F
7.10 Fan hub, sheaves and bearing setscrews are tight. F r
7.11 Motor and blower bearings are lubricated.
7.12 Electrical connections are secure F F F
7.13 Fan shaft bearings angular alignment is correct
F r7
and bolts are tight.
7.14 Auxiliary drain pan is installed and its F
connections are piped.
Comments/
Observations:
4
f
"r 2
IN 99.032.1
a
Print Name Signature Date
Performed By: Kent McKinnon _ 3/22/16
Reviewed By
(Owner/Representative)
Section 8: Operational Inspection
Step Inspection Description Yes No N/A Performed By
(Initials&Date)
8.2 Unit vibration is acceptable. F r,
13 .- ?6
8.3 Each fan rotation is correct.
8.4 Heating water and cooling water control valves are F F F.
functional
8.5 Fire dampers are functional
8.6 Supply,return and outside air dampers are functional 17 F r
8.7 Smoke detector is tested and is able to shut the unit down..
8.8 Make sure thermostat is set F
8.9 Make sure time clock is set iv
Record start-up operating parameters in the Supplementary F
8.10 Forms(FN 99.028.2 or FN 99.028.3)
Data Design Actual On Site
Unit Voltage 208 206 207 10
Current 82 48 46 46
Phase 3 3
End of Section
Comments/
Observations:
3
FN 99.032.1
Print Name Signature Date
Performed By: Kent McKinnon 3!22/16
s
Reviewed By
(Owner/Representative)
4
FN 99.032.1