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12120101-F • I'T CJI ®]F CUP]E IIN° I:��.TI LIlDlNC PERMITBUILDING ADDRESS: 20863 STEVENS CREEK BLVDTY CONTRACTOR:BARRON BUILDERS INC PERMIT NO: 12120101 OWNER'S NAME: STEVENS CREEK OFFICE CENTER ASSOC 415 CLYDE AVE STE 104 DATE ISSUED:01/29/2013 OWNER'S PHONE: 4089961010 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)269-7061 61/ • LICENSED CONTRACTOR'S DECLARATION/ JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL License Class 6 Lic.# 9/3(o STE 250-APPLE-COMMERCIAL TENANT IMPROVEMENT Contractor lofa7 6'pi Date / 2 9'/ OFFICE SPACE(4,400 SQFT)MIIN0R STRUCTURAL I hereby affirm that I am licensed under the provisions of Chapter 9 IINCLUDES MIECIHIANCI[AIL/IE]WECTRIICAIL./]PILUI`VIl I:ING (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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$350000 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 APN Number:32632053.20863 Occupancy Type: permit is issued. p y APPLICANT CERTIFICATION . I certify that I have read this application and state that the above information is PERMIT]EXPIRES h]F WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating �� 1 ll ]��OF PERMIT ISSUANCE SIE®� • to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 1180 DA1 ]FP'iojyl[LAST CALLED 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 fel:I granting of this permit, Additionally,the applicant understands and will comply Issued by: / '' Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Li 42 9-/2 RE-ROOFS: Signature \ 4, • �~ J Date All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. 1:1OWNER UI DER DECLARATION Signature of Applicant: Date: I hereby affirm that!am pt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BET'T'ER 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure isnot 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 maintain compliance with the Cupertino Municipal Code,Chapter 912 and the declarations: 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 T 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,Sectio \ 5505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this 12?—/' permit is issued. Owner or authorized age-'." = Date: ilir 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,1 CONST.'UCTI,ON LENDING AGENCY NW become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a tion 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(Sec.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 1 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 CITY OF CUPIERTIINO it UILDING PERMIT BUILDING ADDRESS: 20863 STEVENS CREEK BLVD CONTRACTOR:BARRON BUILDERS INC PERMIT NO: 12120101 OWNER'S NAME: STEVENS CREEK OFFICE CENTER ASSOC 415 CLYDE AVE STE 105 DATE ISSUED:01/29/2013 OWNER'S PHONE: 4089961010 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)269-7061 ❑ LICENSED CONTRACTOR'S DECLARATION I BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.4 MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:STE 250-APPLE-COMMERCIAL TENANT IMPROVEMENT (commencing with Section 7000)of Division 3 of the Business&Professions OFFICE SPACE(4,400 SOFT)MINOR STRUCTURAL Code and that my license is in full force and effect. INCLUDES MECHANCIAL/ELECTRICAL/PLUMBING I hereby affirm under penalty of perjury one of the following.twb'declarations: 2/26/2013-REV 4 1 ISSUED OVER-THE-COUNTER 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. 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 Sq.Ft Floor Area: Valuation:$350000 permit is issued. - - APPLICANT CERTIFICATION APN Number:32632053.20863 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: Signature Date ❑ OWNER-BUILDER DECLARATION • RE-ROOFS: I hereby affirm that l am exempt from the Contractor's License•Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: • installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should 1 use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: • CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and.state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. l understand my plans shall be used as public records. Signature Date Licensed Professional ‘-‘"?......0) .0,0; CONSTRUCTION PERMIT APPUCATIO H +, ? COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION j E SY'IPt 10300 TORRE AVENUE^CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228 a FAX(408)777-3333-buildin (a, qcupertiro.orq ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION�/TSI REVISIOrNy/ EFERRED ORIGINAL PERMIT# _ PROJECT ADDRESS (2OD)3Smvais p-g-N4:-L/ ✓ 3 Lf - 0 OWNERNAME5 ais ( g ,t2� cm. Arsce, PHONE0� 9% /o/() E-MAIL STREET ADDRESS q 7( Axgc n �/ac �� C ,S�TE�I Of Iro)0 FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR� AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME/ I ti ed e .vf ! LICENSE NUMBER 9/1 e�_ LICENSE TYPE BUS.LIC# COMPANY NAME Ming) jB�D�� E-MAIL / �/Y/ d/ FAX �N �y STREET ADDRESS��qs ��n yAvg.� �@ S� Crj�,pS�pi��l,[p / /'� ��/R�/y� PHI ,/ J berL f�� F7 jKblJ (/7�Q J 1� ,/ / 4 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS �] CITY,STATE,ZIP PHONE DESCRIPTION OF WORK„5-,,k /6'/ /4,41,w6,..- ,e4,7 5-A re,V 1 5 I LlS EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: U DETACH 0 ATTACH ti DWELLING UNITS: ISASECONDUNIT ❑YES SECOND STORY OYES BEING ADDED? 0N ADDITION? ONO I PRE-APPLICATION DYES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑ --;.. D B ' TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? o By my signature below,I certify to each of the following: I am the pro er or.:i orized age 0 oproperty owner's behal have read this application and the information I have provided is correct. ave read the Description of Work and fy it is accurate. I agree to comply with all applicable local ordinances and state laws relating : •u1.m: ..ns 1 I.n. I.I thorize re'resentatives of Cupertino to enter the abovednt_ if ed p / for inspection purposes. Signature of Applicant/Agent: ��%�, Date: SUPPLEMEN PAL INFO:: ATION REQUIRED PLAN CHECK TYPE ��/ ROUTING SLIP New SFD or Multifamily Ings: Apply for demolition permit for VER-THE-COUNTER BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of buildin ,/ permit for new building. 0 EXPRESS 0 PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STANDARD 0 PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE IRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR `� ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. 0 ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 I i2 V2— LD\ k::',,,1, ED r,, f`Tr CONSTRUCTION PERMIT APPLICATION 39a ` _= COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION "g`x" 10300 TORRE AVENUE•CUPERTINO, CA 95014-325: e�°x Sq�gs,3`a CUPERTINO (408) 777-3228• FAX(408)777-3333• buildinq(a)cupertino.orq ❑NEW CONSTRUCTION ❑ ADDITION )ALTERATION//T-I 51 r,$EVISION/DEFERRED ORIGINAL PERMIT#_ PROJECT ADDRESS J "0 020 4,"7APN 02/62 f l 17 OWNER NAME AIIPPCE .PPH qq /6/Q E-MAIL STREET ADDRESS i CITY, ST E,ZIP FAX /,UF/Nl Ler+ - y1--pet211®ate CONTACT NAME i ...-- f N f� , PH S 4?may,-�,,.,yz/ E-MAIL /�e.��` ��' 6 (J a STREET ADDRESS CITY.STATE. ZIP FAX u 1 . S '' 6 5° 4 4 l Ci ❑ OWNER 0 OWNER-BUILDER 0 OWNER AGENT fn• CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME CENSE NUMBER LICENSE TYPE J BUS.LIC' ,�nI bA) /54/mss C'/&116 - r-1- COMPANY NAME e,i jl/r K� FAX E y ie e- r t r44- �,� S1'"76 -1-13f STREET ADDRESS '��'�°�`��G/r/ S /e s- CIT,y, , u H ` 3 P44-__ ARCHITECT/ENGINEER NAME /+ e� oe i f LICENSE NUMBERC,. 2 g 35 BUS.LIC# COMPANY NAME v ki is. 4 E-MAILe ei�o - `r/64,44 FAX STREET ADDRESS5�� /A ��g /. CITY 3;T •IP cA Y1//0 PHONEi45-. ��tv,24 Fes_ DESCRIPTION OF WORK 74c ,JY1 u7 /, pi '¢ ` //,it �/U J Di-y /(/ ` �L J/ e'Z-�' r Hg-z '-/f ; S e-4,e1-ri4-( - "-A--ng/f EXISTING USE PROPOSED USE CO STR TYPE #STORIES 0( _ -2 �� I� A USE TYPE OCC. SQ.FT. VALUATION($) EXISTG — NEW FLOOR "� DEMO ll�� TOTAL U � /J �( ��-i� AREA AREA*4,:r0 4,:r0 AREA NET AREA 0 r!—Sl.r.+ ' `/\ � W BATHROOM ]�j�CHEHENw OTHER IY ( Y W REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH 0 ATTACH #DWELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORY EYES BEING ADDED? 0N ADDITION? ❑NO • PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑'YESRECEIVED BY a� a '' �i I �` TOTAL VALUATION: PLANNNGAPPL# ONO PLANNING APPROVAL LETTER EICHLERHOME? 0N Ciai * SN+4 x3.'�; � '� z . s6 rl By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to builting construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: <- •. _ Date: /2 c--••19 9 "/2 - SUPPLEMENTAL 1 ►. NATION REQUIRED A ' .`' = G ta?ifi k£..:P IMIT CAECh,TITPE ',.... , r� ;,, vRO IT1ING SLLP" r >. New SFD or Multifamily dwelli •s: Apply for demolition permit for .` r� �5 +f OVER THE-COUt\TER ❑`- Ai:;. REVIEW existing building(s). Demolition permit is required prior to issuance of building i > k� r `v%' " permit for new building. '.❑ E\PRESS ..0 x ' L°,'PLA1 I?,GPLATrREVIEW 6'iF s F 3 ' 4 /'�5�, s a"K It .r2.'h 3-'t i;w Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ANAt1RD : ❑ PUBLICWOR[�S ., form if anyHazardous Materials are being used as part of this project. .: t, % fF} f r ,' . ; ' ® LAR`GE b`° Q+r a+. ,,,i I EPT r Copy of Planning Approval Letter or Meeting with Planning prior to t e ' � - , .: - -i sr '> ,'' 1k1� MAJOR t 14P a.� cAksANITiiii;is �ERDI5TRICT submittal of Building Permit application. .- , .. . w - .,; `s, z ,.st , ...t.f.. ,i; , ;: .ii❑, ENVIRONMENTAL IIEA:L,TH ,:,::,, BldgApp_2011.doc revised 06/21/11 i CITY OF CUPTERTINO -., : FEE ]ESTIMATOR— I:,V_TI LIDfNG DIVISION ADDRESS: 20863 stvns crk blvd. ��0 DATE: 12/19/2012 REVIEWED BY: bob s. 9)9 `.,'rte APN: BP#: /A470/0/ *VALUATION: $350,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: 1 B T I WORK .t.i. comm office space minor structural includes M,E,Ps SCOPE OCCUPANCY TYPE: TYPE OF IFLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. (s.f.) B (Tenant Improvements) II-6,111-B,IV,V-B 4,400 $2,258.04 1BTIPLNCK $3,497.22 1BTIINSP 1 TOTALS: 4,400 $2,258.04 $3,497.22 MECii,HOURLY 0 Yes 0No 'PLUMB,HOURLY 0 Yes 0 No ELEC,HOURLY 0 Yes 0 No ',tech Mai i Creek Plan?i,.Pica;-Cheek II E'k;c, Plan Cir"i 'IAA./.;mit Fe:: 1'iwnh.Pei nit 1.,cc: Elec.I'erruiz Fee: i Other:l feel! 1;;sp. odic, Plumb.lacy. Other Lk,.Insp. rtdech.Imp./''e': Plumb.Insa;.Fee: Elec. lap Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the preliminary information available and are only an estimate Contact the De ttfor a d d n'1 info. 1 FEE ITEMS (Fee Resolution 11-053.EL 7/1/12) FEE QTY/FEE MIISC ITEMS Plan Check Fee: $2,258.04 Select a Misc Bldg/Structure Suppl:PC Fee: C) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building i PME Plan Check: $0.00 Permit Fee: $3,497.22 Suppl. Insp.Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 {.`onstrtutipia Tay: : Admi;usiroliveFee:. 0 Work Without Permit? 0 Yes C) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel 17nc,utatcntrzlion rees Building or Structure 0 t. Strong Motion Fee: 1BSEISMICO $73.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $14.00 ,: ,:z4,:,:.:, ' „„,,,,,sqrTOTALS $5,842.76 $0.00 TOTAL PEE: $5,842.76 Revised: 10/01/2012 • • • CITY OF CU FIEIRUNO FEE ESTIMATOR — IriTITL)INO IDI�ISIOIY ADDRESS: 20863 stevens creek blvd DATE: 02/26/2013 REVIEWED BY: melissa ta,rr� APN: 326 32 053 IBP#: • .2 020 0 / *VALUATION: $0 . *PERMIT TYPE: ., Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY PENTAMATION Commercial Building1GENCOM USE: PERMIT'TYPE: . WORK **REV 1**SITE ADA HANDRAIL & SHEARWALL REVISIONS SCOPE r • • • 4 — - i --_J • Mc:ch.•Plan Check Plumb.Plan Check Flee.Plan Check • ;Week,Permit Fee: Plumb. Permit Fee: Elec. Permit Pee: [ 1 I Other Mech.Insp., Other Plumb Insp. Other Elec.Insp. Mech.Insp. Fee: Plumb. Insp.Fee: Elec.Insp.Fee: 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 preliminary information available and are only an estimate. Contact the De•tfor addn't info. •'FEE ITEMS(Fee Resolution 11-053 al 7/1/12) FEE QTY/IFIEE MISC ITEMS • . Plan Check.Fee: Hourly Only? 0 Yes Q No $0.00 2 hours Plan Check,Hourly Suppi.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $266.00 ISTPLNCK • A PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee:® Reg. 0 OT 0,0 hrs $0.00 • PME Unit Fee: • $0.00 `PME Permit Fee: $0.00 Consiruction-Tax: Administrative.Fee: 0 Work Without Permit? 0 Yes C) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential .0 Building or Structure . O Travel Documentation Fees: . • • Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $266.001 TOTAL FEE: $266.00 Revised: 01/01/2013 I:tuilding Departnnnent `e 4`� City Of Cupertino a 10300 Torre Avenue f4119s 1 Cupertino,CA 95014-3255 ..:_. Telephone: 408-777-3228 C UU IF(E P T I.I N 0 Fax: 408-777-3333 CONMA CTOR I SUM CONTRACTO2 LIST JOB ADDRESS:► /I i c• s' s • y -- -; PERMIT# ! /2 , 0 OWNER'S NAME: JAMMIIIIIMIMMEM PHONE# wee -761-4t— GENERAL CONTRACTOR: ,O/1prmi , ,11,.,W,f BUSINESS LICENSE# ADDRESS: %/ r.0 CITY/ZIPCODE: ` %, //l c) b -'' *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO r:UILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL I:lE SCIHIIEDULEID UNTIL THE GENERAL CONTRACTOR AND ALL SU I CONTRACTORS HAVE OIs TAMED A CITY OF CUPERTINO a USINIESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: c/ SUI CONTRACTOR InUSIINESS NAME l::USINIESS LICENSE# Cabinets &Millwork Vii. ,r y f Cement Finishing Electrical 'V/i -) /ia34- Excavation Fencing Flooring/Carpeting 5? Gc,/v y e.r7.—.) W 0 Linoleum/Wood co i Glass/ Glazing S,a.__ 6 4--fS 5-8- (,2 Heating Oki I 7M9 7 Insulation Landscaping Lathing Masonry Painting/Wallpaper /4A9 _i 07579'(40 Paving Plastering Plumbing 0-JL5/1/At-- c 99 Roofing Septic Tank Sheet Metal p� Sheet Rock 4 /4177— f -'f o2�P/ tr.%— Tile Wit, /'",-2 e—/3 ow,t, contractor Signature Date 1 e. ' �' STATEfi�liEHT OF SPECIAL mspECTI]O�IS, 201 CBC ~;WP A' COMMUNITY DEVELOPMENT DEPARTMENT"BUILDING DIVISION 4,s."'',., ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL CUPERI1NO 10300 TORRE AVENUE^CUPERTINO,CA 95014-3255 a (408)777-3228 o FAX(408)777-3333 o building(�cuoertino.orq SITE _)/.• G 4-x-(-) G/ ,0 s_ Ca.e- APN BP# ADDRESS C .-�/�o/h/ Owner d-7 P s/6 Contractor G/ 791 57 cam / Address t�/A'+7I"' ri Address"��,� J71.. 671911:1 C� City/St...Liir'.`f " 7 A-0 Zip - �Je7:15 J Phone ' City/St. h (W2.4-2---)7 ) �4 �97 -`5: 4--1 � --- Zip Applicant Z�.cL.�O� '7Gl../.c�! %S Engineer/Architect .�-'--' / Si 'c --i Address It.J..S C.:41. .. ....... .a0-.......S1.-.../.�.,S.- Address./7572 Com-"*. $c?,,,r 1-0 City/St./W.1/61V C Zip. Q.51 7 P'f rc�e.7�ta. 17013 City/Std.4/o 54 .Zip 3OPhon;1 '''. PROJECT DESCRIPTION: l ,o b 2.5 ,T77,/c/ re-_sh lya�-// I / t �`S g .L s - �'7/ Y�' , U This"STATEMENT OF SPECIAL INSPECTIONS"is submitted in fulfillment of the requirements of CBC Sections 17and 1705. This form is structured after and used by permission from the Structural Engineer Association of Northern California's(SEAONC)mode statement of Special Inspections. Also, included with this form is the following: El "LIST OF SPECIAL INSPECTION AGENCIES(page 2). A list of testing agencies and other special inspectors that will be retained to conduct the tests and inspections for this project "SCHEDULE OF SPECIAL INSPECTION"(page 3-6). The Schedule of Special Inspections summarizes the Special Inspections and tests required. Special Inspectors will refer to the approved plans and specifications for detailed special inspection requirements. Any additional tests and inspections required by the approved plans and specifications shall also be performed. Special Inspections and Testing will be performed in accordance with the approved plans and specifications,this statement and CBC Sections 1704, 1705, 1706, 1707,and 1708. Interim reports will be submitted to the Building Official and the Registered Design Professional in Responsible Charge in accordance with CBC Section 1704.1.2. A Final Report of Special Inspections documenting required Special Inspections,testing and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy(Section 1704.1.2).The Final Report will document: o Required special inspections. o Correction of discrepancies noted in inspections. The Owner recognizes his or her obligation to ensure that the construction complies with the approved permit documents and to implement this program of special inspections. In partial fulfillment of these obligations,the Owner will retain and directly pay for the Special Inspections as required in CBC Section 1704.1. This plan has been developed with the understanding that the Building Official will: o Review and approve the qualifications of the Special Inspectors who will perform the inspections. O Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are performing their duties as called for in this Statement of Special Inspection. a Review submitted inspection reports. a Perform inspections as required by the local building code. I have read and agree to comply with the terms and conditions of this statement Prepared By: Project ❑ Engineer ❑ Architect Registered Design Professional in Charge Signature Lic.# Date: Owner Name: keOwner's Authorization Signature . .. ,,,.� Date: �t...�. Inspection Agency/Inspector Name: Signature Lic.# Date: Building Official or designee: Signature Date: SpecialnspectionForm 2012.doc revised 09/06/12 • LIST OF SPECIAL INSPECTION AGENCIES APPROVAL OF SPECIAL INSPECTORS: Each special inspection agency,testing facility,and special inspector shall be recognized by the Building Official prior to performing any duties.Special Inspection agency's listed on this form must be pre-approved and listed on Cupertino's approved Special Inspector's list. Special inspectors shall carry approved identification when performing the functions of a special inspector. Identification cards shall follow the criteria set by the California Council of Testing and Inspection Agencies. No personnel changes shall be made without first obtaining the approval of the Building Official.Any unauthorized personnel changes may result in a"Stop Work Order"and possible permit revocation. To be pre-approved by the City of Cupertino, refer to the SPECIAL INSPECTION CRITERIA handout.Please allow two weeks to complete the application process. The following are the testing and special inspection agencies that will be retained to conduct tests and inspection on this project: EXPERTISE FIRM/INSPECTOR INFORMATION* 1.Special Inspection(except for Firm f ti =C-i4o'-' .75-77/11j Addr.1/......A. ?''a 0�- geotechnical) State.C/8A. Zip Telephone9St ..442- -.Of/Fax Email 2. Material Testing Firm SktiML.77 Addr City State Zip Telephone Fax Email 3. Geotechnical Inspections Firm Addr City " State Zip Telephone Fax Email 4. Other: Firm Addr City State Zip Telephone Fax Email *All agencies specified on this form must be pre-approved and listed on the City of Cupertino's Approved Special Inspector's List. SEISMIC REQUIREMENTS (Section 1705.3.6) Description of seismic-force-resisting system and designated seismic systems subject to special inspections as per Section 1705.3: The extent of the seismic-force-resisting system is defined in more detail in the construction documents. WIND REQUIREMENTS (Section 1705.4.1) Description of main wind-force-resisting system and designated wind resisting components subject to special inspections in accordance with Section 1705.4.2: itOr The extent of the main wind-force-resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionForm_2012.doc revised 09/06/12 SC CIC DD ULIE OF SPECDAL IIIMS ECTDOIM SITE ADDRESS Q�O/ 73 57E� APN BP# PROJECT DESCRIPTION: v Notation Used in Table: Column headers: C Indicates continuous inspection is required. P Indicates periodic inspections are required. The notes and/or contract documents should clarify. Box entries: X Is placed in the appropriate column to denote either"C"continuous or"P"periodic inspections. — Denotes an activity that is either a one-time activity or one whose frequency is defined in some other manner. Additional detail regarding inspections and tests are provided in the project specifications or notes on the drawings. VERIFICATION AND INSPECTION C P REFERENCED IBC REFERENCE STANDARD INSPECTION OF FABRICATORS 1. 0 Inspect fabricator's fabrication and quality control 1704.3 procedures. INSPECTION OF STEEL 1. Material verification of high-strength bolts, nuts and washers. 0 Identification marking to conform to ASTM stds AISC 360, specified in the approved construction documents. --- X Section A3.3 and applicable ASTM material standards ❑ Inspect fabricator's fabrication and quality control -- X -_- -- procedures. 2. Inspection of high-strength bolting: ❑ Snug-tight joints. --- X ❑ Pretensioned and slip-critical joints using turn-of-nut with matchmarking,twist-off bolt or direct tension --- X AISC 360, indicator methods of installation. 1704.3.3 Section M2.5 ❑ Pretensioned and slip-critical joints using turn-of-nut without matchmarking or calibrated wrench methods X --- of installation. 3. Material verification of structural steel and cold-formed steel deck. O For structural steel, identification markings to conform X AISC 360, to AISC 360. Section M2.5 ❑ For other steel, identification markings to conform to Applicable ASTM ASTM standards specified in the approved' -- X material standards construction documents. O Manufacturer's certified test reports. --- X SpecialnspectionForm_2012.doc revised 09/06/12 M VERIFICATION AND INSPECTION C p REFERENCED IBC STANDARD REFERENCE 4. Material verification of weld filler materials: ❑ Identification marking to conform to AWS specification AISC 360, in the approved construction documents. X Section A3.5 and applicable AWS A5 documents ❑ Manufacturer's certificate of compliance required. --- X --- --- 5. Inspection of welding: a. Structural steel and cold-formed steel deck: ❑ Complete and partial joint penetration groove welds. X --- ❑ Multipass fillet welds. X ❑ Single-pass fillet welds>5/16" X --- AWS D1.1 1704.3.1 ❑ Plug and slot welds. X ❑ Single-pass fillet welds<= 5/16" --- X ❑ Floor and roof deck welds. --- X AWS D1.3 b. Reinforcing steel: ❑ Verification of weldability of reinforcing steel other than -- X ASTM A 706. ❑ Reinforcing steel resisting flexural and axial forces in intermediate and special moment frames, andX __ AWS D1.4 ACI 318: boundary elements of special structural walls of Section 3.5.2 concrete and shear reinforcement. t?Shear reinforcement. X --- ❑ Other reinforcing steel. --- X 6. Inspection of steel frame joints details for compliance: ❑ Details such as bracing and stiffening. --- X ❑ Member locations. --- X --- 1704.3.2 ❑ Application of joint details at each connection. --- X VERIFICATION AND INSPECTION C p REFERENCED IBC STANDARD REFERENCE INSPECTION OF WELDING 1. 0 Welded studs when used for structural diaphragms. --- X 2. 0 Welding of cold-formed steel framing members. --- X --- 1704.3 3. 0 Welding of stairs and railing systems. --- X SpecialnspectionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTION REFERENCED IAC STANDARD REFERENCE INSPECTION OF CONCRETE 1. 0 Inspection of reinforcing steel, including prestressing X ACI 318: 3.5, 7.1-7.7 1913.4 tendons and placement. 2. 0 Inspection of reinforcing steel welding in accordance AWS D1.4 ACI 318: with Table 1704.3 Item 5b. 3.5.2 3. `t'' Inspection of bolts to be installed in concrete prior to and during placement of concrete where allowable X ACI 318: 8.1.3, 1911.5, 1912.1 loads have been increased or where strength design 21.2.8 is used. 4. 0 Inspection of anchors installed in hardened concrete. --- X ACI 318: 1912.1 5. 'Verifying use of required design mix. X ACI 318: 1904.2.2,1913.2, 1913.3 6. 0 At time fresh concrete is sampled to fabricate ASTM C 172 specimens for strength tests, perform slump and air X --- ASTM C 31 1913.10 content tests and determine the temperature of the concrete. ACI 318: 5.6, 5.8 7. 0 Inspection of concrete and shotcrete placement for 1913.6, 1913.7, proper application techniques. X --- ACI 318: 5.9, 5.10 1913.8 8. 0 Inspection for maintenance of specified curing X ACI 318: 5.11-5.13 1913.9 temperature and techniques. 9. Inspection of prestressed concrete: ❑ Application of prestressing forces. X --- ACI 318: 18.20 ❑ Grouting of bonded prestressing tendons in the -- X __ ACI 318: 18.18.4 seismic force-resisting system. 10. 0 Erection of precast concrete members. --- X ACI 318: Ch. 16 -11. 0 Verification of in-situ concrete strength, prior to stressing of tendons in posttensioned concrete and X ACI 318: 6.2 --- prior to removal of shores and forms from beams and structural slabs. 12. 0 Inspect formwork for shape, location, and dimensions X ACI 318:6.6.1 --- of the concrete member being formed. 13.'Bolts Installed in Existing Masonry or Concrete ❑ Direct tension testing of existing anchors. --- X ❑ Direct tension testing of new bolts. -- X See ICC ES Reports form special ❑ Torque testing of new bolts. ___ X inspection requirements for proprietary products ❑ Prequalification test for bolts and other types of X anchors. 14. 0 Other: SpecialnspectionForm_2012.doc revised 09/06/12 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION 530/ASCE 5 530/ASCE 6 INSPECTION OF LEVEL 1 MASONRY 1. 0 Compliance with required inspection provisions of the construction documents and the approved --- X --- --- Art. 1.5 submittals shall be verified. 2. 0 Verification of f'mand fp,,,,c prior to construction --- X -- -- Art. 1.4B except where specifically exempted by this code. 3. 0 Verification of slump flow and VSI as delivered to X --- --- --- Art. 1.5B.1.b.3 the site for self consolidating grout. 4. As masonry construction begins, the following shall be verified to ensure compliance: ❑ Proportions of site-prepared mortar. -- X -- --- Art. 2.6A ❑ Construction of mortar joints. --- X --- --- Art.3.3B ❑ Location of reinforcement, connectors, -- X --- --- Art. 3.4, 3.6A prestressing tendons, and anchorages. ❑ Prestressing technique. --- X --- --- Art. 3.6B O Grade and size of prestressing tendons and __ X -- --- Art.2.4B,2.4H anchorages. 5. During construction the inspection program shall verify: ❑ Size and location of structural elements. --- X --- --- Art. 3.3F ❑ Type, size, and location of anchors, including Sec. 1.2.2'e), other details of anchorage of masonry to --- X --- 1.16.1 structural members, frames or other construction. ❑ Specified size, grade, and type of reinforcement, anchor bolts, prestressing tendons and --- X --- Sec. 1.15 Art. 2.4, 3.4 anchorages. ❑ Welding of reinforcing bars. X --- 0 --- Preparation, construction and protection of masonry during cold weather(temperature below __ X Sec. 2104.3, Art. 1.8C, 1.8D 40 degrees F)or hot weather(temperature above 2104.4 90 degrees F). O Application and measurement of prestressing X ___ ___ ___ Art. 3.66 force. 6. Prior to grouting the following shall be verified to ensure compliance: ❑ Grout space is clean. --- X --- --- Art. 3.2D ❑ Placement of reinforcement and connectors and __- X __ Sec. 1.3 Art. 3.4 prestressing tendons and anchorages. ❑ Proportions of site-prepared grout and --- X __ ___ Art.2.6B prestressing grout for bonded tendons. ❑ Construction of mortar joints. --- X --- --- Art. 3.3B 7. Grout placement: ❑ Grout placement shall be verified ensure X --- __ ___ Art. 3.5 compliance. ❑ Observe grouting of prestressing bonded X --- __ ___ Art 3.6C tendons. SpecialnspectionForm_2012.doc revised 09/06/12 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION 530/ASCE 5 530/ASCE 6 8. 0 Preparation of any required grout specimens, Sec. mortar specimens, and/or prisms shall be -- X 2105.2.2, --- Art. 1.4 observed. 2105.3 INSPECTION OF LEVEL 2 MASONRY 1. 0 Compliance with required inspection provisions of the construction documents and the approved --- X --- --- Art. 1.5 submittals. 2. 0 Verification of fn,and fAAc prior to construction and for every 5,000 square feet during --- X --- --- Art. 1.4B construction. 3. 0 Verification of proportions of materials in premixed or preblended mortar and grout as --- X --- --- Art. 1.5B delivered to the site. 4. 0 Verification of slump flow and VSI as delivered to X --- --- --- Art. 1.5B.1.b.3 the site for self consolidating grout. 5. The following shall be verified to ensure compliance: ❑ Proportions of site-prepared mortar,grout, and X — Art. 2.6A prestressing grout for bonded tendons. ❑ Placement of masonry units and construction of X --- Art. 3.3B mortar joints. ❑ Placement of reinforcement, connectors and _ X --- Sec. 1.15 Art. 3.4, 3.6A prestressing tendons and anchorages. ❑ Grout space prior to grouting. X --- --- --- Art. 3.2D ❑ Placement of grout. X --- -- --- Art. 3.5 ❑ Placement of prestressing grout. X --- --- --- Art. 3.6C ❑ Size and location of structural elements. -- X --- -- Art. 3.3F ❑ Type, size, and location of anchors, including other details of anchorage of masonry to X --- --- Sec.1.2.2"e) structural members, frames and other construction. ❑ Specified size,grade,and type of reinforcement, anchor bolts, prestressing tendons and -- X --- Sec. 1.15 Art. 2.4, 3.4 anchorages. ❑ Welding of reinforcing bars. X - __ Sec. 2.1.9.7.2, -- 3.3.3.4(b) ❑ Preparation,construction, and protection of masonry during cold weather(temperature below ___ X Sec. 2104.3, ___ Art. 1.8C, 1.8D 40 degrees F)or hot weather(temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing X --- __ __ Art. 3.6B force. 6. 0 Preparation of any required grout specimens, Sec. mortar specimens, and/or prisms shall be X --- 2105.2.2, --- Art. 1.4 observed. 2105.3 SpecialnspectionForm 2012.doc revised 09106112 VERIFICATION AND INSPECTION C p REFERENCED IBC STANDARD REFERENCE INSPECTION OF WOOD 1. 0 Inspect prefabricated wood structural elements and assemblies in accordance with Section 1704.2. --- 1704.6 2. tpinspect site built assemblies. --- -3. Inspect high-load diaphragms: ❑ Verify grade and thickness of sheathing. - - ❑ Verify nominal size of framing members at adjoining panel edges. ❑ Verify nail or staple diameter and length, --- --- --- 1704.6.1 Verify number of fastener lines, 7 Verify spacing between fasteners in each line and at edge margins. 4. 0 Metal-plate-connected wood trusses spanning 60 feet or greater: Verify temporary installation restraint/bracing and the permanent individual truss --- X --- 1704.6.2 member bracing are installed in accordance with the approved truss submittal package. REQUIRED VERIFICATION AND INSPECTION OF SOIL 1. 0 Verify materials below footings are adequate to _ X achieve the desired bearing capacity. 2. 0 Verify excavations are extended to proper depth and -- X have reached proper material. 3. 0 Perform classification and testing of compacted fill materials. X --- Table 1704.7 4. 0 Verify use of proper materials,densities and lift thicknesses during placement and compaction of X --- compacted fill. 5. 0 Prior to placement of compacted fill, observe subgrade X and verify that site has been prepared properly. REQUIRED VERIFICATION AND INSPECTION OF DEEP DRIVEN FOUNDATION ELEMENTS 1. 0 Verify element materials, sizes and lengths comply X with the requirements. 2. 0 Determine capacities of test elements and conduct X -- additional load tests, as required. 3. 0 Observe driving operations and maintain complete X and accurate records for each element. 4. 0 Verify locations of piles and their plumbness, confirm type and size of hammer, record number of blows per --- Table 1704.8 foot of penetration,determine required penetrations to X --- achieve design capacity, record tip and butt elevations and document any damage to foundation element. 5. 0 For steel elements, perform additional inspections in accordance with Section 1704.3. --- 6. 0 For concrete elements and concrete filled elements, perform additional inspections in accordance with --- Section 1704.4. SpecialnspectionForm 2012.doc revised 09/06/12 • VERIFICATION AND INSPECTION C P REFERENCED IBC STANDARD REFERENCE 7. 0 For specialty piles, perform additional inspections as determined by the registered design professional in --- --- --- Table 1704.8 responsible charge. REQUIRED VERIFICATION AND INSPECTION OF CAST-IN-PLACE DEEP FOUNDATION ELEMENTS 1 0 Observe drilling operations and maintain complete and X --- accurate records for each element. 2. 0 Verify placement locations and plumbness, confirm element diameters, bell diameters(if applicable), lengths, embedment into bedrock(if applicable), and X --- --- Table 1704.9 adequate end-bearing strata capacity. Record concrete or grout volumes. 3. 0 For concrete elements, perform additional inspections in accordance with Section 1704.4. HELICAL PILE FOUNDATIONS 1. 0 Record installation equipment used, pile dimensions, X --- --- 1704.10 tip elevations,final depth, final installation torque. SPRAYED FIRE-RESISTANT MATERIALS Physical and visual tests 1. Condition of substrates. ❑ Inspect surface for accordance with the approved fire- resistance design and the approved manufacturer's written instructions. ❑ Verify minimum ambient temperature before and after --- X application. ❑ Verify ventilation of area during and after application. --- X 2. 0 Measure average thickness per ASTM E605 and Section 1704.12.4. -'- — 1704.12.1 3. 0 Verify density of material for conformance with the approved fire-resistant design and ASTM E605. (Ref. -- --- Section 1704.12.5) 4. 0 Test cohesive/adhesive bond strength per Section --- - 1704.12.6. 5. 0 Condition of finished application. MISCELLANEOUS 1. Mastic and Intumescent Fire-Resistant Coating. --- --- --- 1704.13 2. Exterior Insulation and Finish Systems(EIFS). Water- resistive barrier coating when installed over a sheathing --- --- --- 1704.14 substrate. 3. Special Cases -- --- --- 1704.15 4. Smoke Control System --- --- --- 1704.16 5. Seismic Resistance 0 Suspended ceiling systems and their anchorage. --- --- --- 1705.3[4.3] SpecialnspectionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTION C p REFERENCED IBC STANDARD REFERENCE 6. Wind Resistance ❑ Roof cladding and roof framing connections. --- --- --- ❑ Wall connections to roof and floor diaphragms and ___ ___ --- framing. ❑ Roof and floor diaphragm systems, including ___ ___ ___ collectors, drag struts and boundary elements. ❑ Vertical wind-force-resisting systems, including braced _ --- frames, moment frames, and shear walls. ❑ Wind-force-resisting system connections to the ___ ___ ___ foundation. ❑ Fabrication and installation of systems or components required to meet the impact resistance requirements --- --- --- of Section 1609.1.2. SPECIAL INSPECTION FOR WIND REQUIREMENTS 1. Structural Wood ❑ Inspect field gluing operations of elements of the main X __ wind-force-resisting system. L Inspect nailing, bolting, anchoring, and other fastening --- 1706.2 of components within the main windforce-resisting -_ X system, including wood shear walls,wood diaphragms,drag struts, braces and hold-downs. 2. Cold-Formed Steel Framing ❑ Welding of elements of the main wind-force-resisting Y- X system. ❑ Inspection of screw attachments, bolting, anchoring, and other fastening of components within the main --- 1706.3 wind-force-resisting system including shear walls, --- X braces, diaphragms,collectors(drag struts)and hold- downs. 3. Wind-resisting components ❑ Roof cladding. --- X --- 1706.4 ❑ Wall cladding. --- X SPECIAL INSPECTIONS FOR SEISMIC RESISTANCE 1. 0 Special inspection for welding in accordance with the X --- 1707.2 quality assurance plan requirements of AISC 341. 2. Structural Wood ❑ Inspect field gluing operations of elements of the X seismic-force-resisting system. fii . Inspect nailing, bolting, anchoring,and other fastening of components within the seismic-force-resisting 1707.3 system, including wood shear walls, wood --- X diaphragms, drag struts, braces, shear panels and hold-downs. 3. Cold-Formed steel light-frame construction ❑ Welding of elements of the seismic-force-resisting __ X 1707.4 system. SpecialnspectionForm 2012.doc revised 09/06/12 I a • ❑ Inspection of screw attachments, bolting, anchoring, and other fastening of components within the seismic- X force-resisting system including shear walls, braces, diaphragms, collectors(drag struts)and hold-downs. 4. Storage racks and access floors ❑ Anchorage of storage racks 8 feet or greater in height X 1707.5 and access floors. 5. Architectural components ❑ Inspect erection and fastening of exterior cladding weighing more than 5 psf and higher than 30 feet --- X above grade or walking surface. ❑ Inspect erection and fastening of veneer weighing more than 5 psf.and higher than 30 feet above grade -- X or walking surface. --- 1707.6 ❑ Inspect erection and fastening of all exterior non- bearing walls higher than 30 feet above grade or --- X walking surface. ❑ Inspect erection and fastening of all interior non- bearing walls weighing more than 15 psf and higher --- X than 30 feet above grade or walking surface. 6. Mechanical and Electrical Components ❑ Inspect anchorage of electrical equipment for --- X emergency or stand-by power systems. ❑ Inspect anchorage of non-emergency electrical --- X equipment. ❑ Inspect installation of piping systems and associated mechanical units carrying flammable, combustible, or --- X --- 1707.7 highly toxic contents. ❑ Inspect installation of HVAC ductwork that contains X hazardous materials. ❑ Inspect installation of vibration isolation systems X where required by Section 1707.7. 7. 0 Verify that the equipment label and anchorage or mounting conforms to the certificate of compliance 1707.8 when mechanical and electrical equipment must be seismically qualified. 8. 0 Seismic isolation system: Inspection of isolation X --- 1707.9 system per ASCE 7—Section 17.2.4.8 9. 0 Obtain mill certificates for reinforcing steel, verify compliance with approved construction documents, --- --- -- 1708.2 and verify steel supplied corresponds to certificate. 10. 0 Structural Steel: Invoke the QAP Quality Assurance —_ 1708.3 requirements in AISC 341. 11. 0 Obtain certificate that equipment has been seismically 1708.4 qualified. 12. 0 Obtain system tests as required by ASCE 7 Section --_ 1708.5 17.8. SpecialnspectionForm_2012.doc revised 09/06/12 - . j:'0 uz, Fg o TESTING s CONSTRUCTION tt _ ; o INSPECTION LC R TESTING SERVICES V �/� APR 0 5 2013 smikimaim- yin a ENGINEERING $I leo Summary eport#2 February 25,2013 Barron Builders Attn:Dave Scott 415 Clyde Ave.,Ste. 105 Mountain View, CA 94043 Job No: J8923 Job Name: Apple—SC03 20863 Stevens Creek Cupertino,CA Permit No.: 12120101 February 20,2013 Ramon Carrillo reported to Dave Scott with Barron Builders at the jobsite. Observed placing of Hilti KBTZ bolts for shearwall at lines A-B/5.5 total of(19)bolts 5/8"diameter x 8 '/z"embed 4 1/8"ICCES ESR#1917 lot #12187582. Bolts spaced at 16"on center. Note:there are(2)hold downs one on each end of shear wall. Reference 53 detail#3, and 4/S3 plans date 12/14/12. (Hold downs=HDU14). Torque tested bolts for shearwall to 60 ft.-lbs. Work observed was,to the best of Ramon's knowledge,in conformance with approved plans,specifications and applicable standards of workmanship. February 21,2013 Donald Shirley reported to Dave with Barron Builders at the jobsite. Observed shearwall nailing at line A-B/5.5. Shearwall was nailed at 3"on center at edge and 12"on center at field nailing per schedule on S2 and strap details on 5,6,7/S3. Work observed was,to the best of Donald's knowledge,in conformance with approved plans,specifications and applicable standards of workmanship. 2118 Rheem Drive,Pleasanton, CA 94588 o Phone(925)462-5151 o Fax(925)462-5183 4770 Duckhorn Drive, Sacramento,CA 95834 o Phone(916)419-4747 o Fax(916)419-4774 One Embarcadero Center,Suite 535,San Francisco,CA 94111 o Phone(415)438-2357 o Fax(415)334-4747 246 30th St.,Suite 101, Oakland,CA 94601 o Phone(510)444-4747 o Fax(510)835-1825 1 `p44 CONSTRUCTION 0 TESTING - 1 TESTING SERVICES ° TESTI G ° ENGINEERING Laboratory test results are enclosed if testing was done during the period covered by this report. Limitations: These inspections were performed in accordance with requirements,but please note this report shall not be relied upon by others,as acceptance or guarantee of the work. Even with diligent inspection techniques,the contractor is solely liable for defects or failures to adhere to the code. '-- SL-- --- 4/2/2013 Reviewed by Stephen Stroup Date Staff Engineer Technical Contact: Timothy Casey,Senior Engineer(tcasey@cts-1.com) Administrative Contact: Yolanda Deras(yderas@cts-1.com) cc: Building Department—City of Cupertino CTS PM—David Zetterlund(email) CTS Staff Engineer—Stephen Stroup(email) RA 2174 Rheem Drive,Suite A,.Pleasanton,CA 94588 ° Phone(925)462-5151 0 Fax(925)462-5183 4770 Duckhorn Drive,Sacramento,CA 95834 0 Phone(916)419-4747 0 Fax(916)419-4774 One Embarcadero Center, Suite 535,San Francisco,CA 94111 0 Phone(415)438-2357 0 Fax(415)334-4747 246 30'1'St., Suite 101, Oakland,CA 94601 0 Phone(510)444-4747 0 Fax(510)835-1825 Lc 7 S, CONSTRUCTION '.E ` TESTING o INSPECTION BeEssmito TESTING SERVICES a ENGINEERING Summary Report#1 February 18,2013 c CEIEVED Barron Builders Attn:Dave Scott ,SPR 00 LJ,.:) 415 Clyde Ave.,Ste. 105 Mountain View, CA 94043 Job No: J8923 Job Name: Apple–SC03 20863 Stevens Creek Cupertino,CA Permit No.: 12120101 February 13,2013 Edward Bindert reported to Dave with Barron Building at the jobsite. Observed placement of rebar for footing under existing grade beam at lines A-B/5.5. Reference:5-2;S3 detail 2;S3 detail 3. Work observed was,to the best of Edward's knowledge,in conformance with approved plans,specifications and applicable standards of workmanship. Laboratory test results are enclosed if testing was done during the period covered by this report. Limitations: These inspections were performed in accordance with requirements,but please note this report shall not be relied upon by others,as acceptance or guarantee of the work. Even with diligent inspection techniques,the contractor is solely liable for defects or failures to adhere to the code. — 4/2/2013 Reviewed by Stephen Stroup Date Staff Engineer Technical Contact: Timothy Casey,Senior Engineer(tcasey@cts-1.com) Administrative Contact: Yolanda Deras(yderas@cts-1.com) cc: Building Department–City of Cupertino CTS PM–David Zetterlund(email) CTS Staff Engineer–Stephen Stroup(email) Cl 2118 Rheem Drive,Pleasanton,CA 94588 o Phone(925)462-5151 o Fax(925)462-5183 4770 Duckhorn Drive,Sacramento,CA 95834 0 Phone(916)419-4747 o Fax(916)419-4774 One Embarcadero Center,Suite 535,San Francisco,CA 94111 o Phone(415)438-2357 o Fax(415)334-4747 246 30`x'St.,Suite 101,Oakland,CA 94601 o Phone(510)444-4747 o Fax(510)835-1825