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15030004' CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10100 N TANTAU AVE I CONTRACTOR: NOVO CONSTRUCTION I PERMIT NO: 15030004 OWNER'S NAME: CUPERTINO GATEWAY PARTNERS LLC 11460 O'BRIEN DR I DATE ISSUED: 03/02/2015 1 OWNER'S PHONE: 4087834731 1 MENLO PARK, CA 94025 ( PHONE NO: (650)701 -1500 LICENSED CONTRACTOR'S DECLARATION License Class 3 Lic. # -7q 1 ODD Contractor A-)cVe COhf- n", ,— Date 31pols 1 hereby affirm that 1 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 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 permit is issued. APPLICANT 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature _Date__3Zd adlr ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three declarations: 1 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. 1 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. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date JOB DESCRIPTION: RESIDENTIAL [-] COMMERCIAL ❑ APPLE- 1ST FLOOR DEMO OF MECH. DUCT WORK AND MODIFY ELECTRICAL DISTRIBUTION SYSTEM Sq. Ft Floor Area: Valuation: 560000 APN Number: 31619061.10100 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FRO ALLED INSPECTION. Issued by: Date: 2 RE- ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 2 3, and 25534. Owner or authorized agent- Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professional COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 CUPERTINO (408) 777 -3228 ^ FAX (408) 777 -3333 • building(a.cupertino.org 0 1 ❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT N PROJECT ADDRESS 10100 N. Tantau APN # l..P O &/ OIL) . OWNER NAME Apple, Inc. PHONE 408. 783.4731 E-NIAIL gallen @apple.com STREET ADDRESS 1 Infinite Loop CITY, STATE, ZIP Cupertino, CA 95014 FAY CONTACT NAME Mike DiMonaco PHONE 650 - 399 -5449 -7 & MAILmdimonaco @novoconstruction.com STREET ADDRESS 1460 O'Brien Dr. CITY, STATE, ZIP Menlo Park, CA 94025 FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNERAGENT 1.] CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Mike DlMonaco LICENSE NUMBER 791022 LICENSE TYPE B BUS. LIC N COMPANY NAME. Novo Construction E -MAIL mdimonaco @novoconstruction.com FAX STREET ADDRESS 1460 0'Brien Dr. CITY, STATE, ZIP Menlo Park, CA 94025 PHON' 650- 399 -5449 ARCHITECT /ENGINEER NAME David Whitney LICENSE NUMBER BUS. LIC b COMPANY NAME David Whitney Architects E -MAIL david@davidwhitneyarch.com FAX STREET ADDRESS 2185 The Alameda, Suite 100 CITY, STATE, ZIP San Jose, CA 95126 PHONE 408- 627 -9123 DESCRIPTION OF WORK Demolition of mechanical duct work and modifications to the electrical distribution system. EXISTING USE PROPOSED USE CONSTR. TYPE N STORIES Office /Lab Office /Lab VB I 1 USE TYPE OCC. SQ.FT, VALUATION ($) EXISTG AREA 780 NEW FLOOR AREA 780 DEMO AREA 786 TOTAL NETAREA 0 Lab B V 780 60,0oO BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PURCH AREA GARAGE AREA: DETACH H ATTACH # D \YELLING UNITS: _.._..� a � IS A SECOND UNIT YES SECOND STORI' YES BEING ADDED? []NO ADDITION! ❑NO PRE - APPLICATION ❑YES IFYES. PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: rWAL VALUATION: PLANNING APPL# ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO V60, 000 By my signature below, I certify to each of the following: I am the property owner or authorized agent to a96. the perry 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 i ' orate. I agree to comply with all applicable local ordinances and state laws relating to building con representatives of Cupertino to enter the above- 'dentifi d�Tproperty for inspection purposes. =ze Signature of Applicant/Agent: D. o� a �� SUPPLEMENTAL INFORMATION REQUIRED CHECKTYPE RouTINGSLIP New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER -'THE- COUNTER BUILDING PLAN REVIEW permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW — Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD ❑ PUBrICWORKS fonn if any Hazardous Materials are being used as part of this project, 11 LARGE FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 0612 //// FM_7 CIT Y OF cCUPERTINO FEE ESTIMATOR — BUILDING DIVRSION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Eire, Sanitary Sewer District, School District. etc.). These fees are based on the Dreliminary information available and are only an estimate Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11 -053 E ..� 711113) 10100 n tantau ave (DATE: 03/02/2015 REYIilEWEID BY: Mendez JimADDRESS: APN: EP #: 'VAILUATION: 1$60,000 *PERMIT TYPE: Building Permit PLAN CHECK Tenant Improvement PRIMARY Commercial Building USE: =VPERMffT PIENTAMATION 1GENCOM TYPE: woRx 1st floor demo of mech. duct work and modify electrical distributions stem [qppje- SCOPE Suppl. Insp. Fee-.0 Reg. 0 OT NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Eire, Sanitary Sewer District, School District. etc.). These fees are based on the Dreliminary information available and are only an estimate Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11 -053 E ..� 711113) FETE QTY/FEE MIScC ITEMS Plan Check Fee: Hourly Only? ()Yes 0 No $0.00 2 hours Plan Check, Hourly $286.00 ISTPGNCK Suppl. PC Fee: (E) Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes E) No $0.00 Suppl. Insp. Fee-.0 Reg. 0 OT Efl hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 0 Work Without Permit? Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure (� G Trut,el Uocumentation Fees: Strong Motion Fee: IBSEISMICO $16.80 6.0 hrs Inspections $858.00 ISTINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $19.80 $1,144.00 TOTAL FEE: �1, 9 63.80 Revised: 02114/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10100 N TANTAU AVE CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 15030004 OWNER'S NAME: CUPERTINO GATEWAY PARTNERS LLC 1460 O'BRIEN DR DATE ISSUED: 03/02/2015 OWNER'S PHONE: 4087834731 MENLO PARK, CA 94025 PHONE NO: (650)701 -1500 C LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ i� o APPLE -1ST FLOOR DEMO OF MECH. DUCT WORD AND License Class Lic. # MODIFY / G � t ELECTRICAL DISTRIBUTION SYSTEM Contractor Date 0 D i o�Li�l'� e I hereby affirm that I am licensed under the provisions of Chapter 9 7000) REVISION #1 - Add additional CDA hook up and outlet, (commencing with Section of Division 3 of the Business & Professions including structural design for anchorage 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 Sq. Ft Floor Area: Valuation: $60000 performance of the work for which this permit is issued. 1 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: 31619061.10100 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 WITHIleI 180 DAYS OF PERMIT ISSUANCE OR building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 D S FROM LAST CALLED INSP indemnify and keep harmless the City of Cupertino against liabilities, judgments, ,� ^ ! glo. costs, and expenses which may accrue against said City in consequence of the J �.1�dA(n�1 �' granting of this permit. Additionally, the applicant understands and will comply C3 J� Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ? j RE- ROOFS: Signatta Date J ` 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. ❑ OWNER- BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BE'T'TER 1, 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) 1, 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. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 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 ➢ 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 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 255 5533, and 25534. i Section 3700 of the Labor Code, for the performance of the work for which this Owner Date: permit is issued. or authorized agent: - 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 (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that 1 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 T�CO1P�Jt »Rl2TPINT1A3602 W 0911018 COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE - OUPER`rINO, CA 08014.3205 ' 1 (408) 777 -3228 • FAX (400) 777 -3333 ^ buildinq Cacupertino.org CUPERTINO ❑ NEW CONSTRUCTION ❑ ADDITION []ALTERATION/TItoEl REVIqlLIJIDEVERRED OR Ia I NAL PERMIT 415030004 PROJECT ADDRESS 10100 N. Tantau APN k Oc g OWNER NAME Apple, Inc. FIONE 408 - 783.4731 I� �IAIL gallen @apple.com STREET ADDRESS 1 Infinite Loop CITY, STATE, ZIP Cupertino, CA 95014 FAX CONTACT NAME. Mike DiMonaco PHONE 650 - 399 -5449 E-MAIL mdimonaco@novoconstruction.com STREET ADDRESS 1460 O'Brien Dr. CITY, STATE, ZIP Menlo Park, CA 94025 FAX ❑ OWNER ❑ OWNER - BUILDFR ❑ OWNERACENT In CONTRACTOR ❑ COMI'RACTOR AGENT ❑ ARCHITECT ❑ FNGINCF'R ❑ DEVELOPER ❑ TFNAN`I' CONTRACTOR NAME Mike DlMonaco LICENSE NUMBER 791022 LICENSE TYPE B BUS LIC N COMPANYN.AME Novo Construction F -MAIL mdimonaco @novoconstruction.com FAX STREET ADDRESS 1460 O'Brien Dr. CITY, STATE, ZIP Menlo Park, CA 94025 PHGNE 650 - 399.5449 ARCHITECT /ENGINEER NAME David Whitney LICENSE NUMBER BUS. LIC N COMPANY NAME David Whitney Architects E-MAIL david @davidwhitneyarch.com FAX STREET ADDRESS 2185 -rhe Alameda, Suite 100 CITY, 51'ATF, ZIP San Jose, CA 95126 PHONE 408.627 -9123 DESCRIPTION OF WORK Revision to add additional CDA hookup and electrical outlet. Includes structural design for anchorage. EXISTING USE PROPOSED USE CONSTR. TYPE k STORIES Office /Lab Office /Lab VB 1 USE TYPE occ. s2.Fr. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL 0 AREA 780 AREA 780 AREA 760 NETAREA Lab B V 780 $60'000 BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKNORCH AREA GARACEAREA: DETACH BAnACH # DWELLING UNITS' IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑NO ADDITION? []NO PRE - APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES :D B '' TOTAL VAL TION: PLANNING APPL d []NO PLANNING APPROVAL LETTER EI CH LER HONI E? $60 By my signature below, I certify to each of the following: I am the property owner or authorized ageeto ac! on roperty, owner' �. I have read this application and the information I have provided is correct. have read the Description of Work and verify it is tkgjur to comply wl I applicable local ordinances and state laws relating to building con I authorize representatives of Cupertino to enter the above -i ntified pr perry for inspect-) n purposes. Signature of Applicant /Agent: Date: 7z SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECKTNPE ROCTINCSLIP ❑ OVER - THE - COUNTER New SFD or Multifamily dwellings: Apply for demolition permit for ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building perniit for new building. ❑ EXPRESS ❑ PLANNING PLAIN REVIBIV Commercial Bidgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ nlarOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BkgApp_2011.doc revised 06 2/. !! CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10100 N TANTAU AVE DATE: 0712812015 REVIEWED BY: MEI -ISSA APN: 316 19 061 BP #: 15030004 *VALUATION: Iso 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1GENCOM USE: PERMIT TYPE: WORK REV # 1 - ADD ADDITIONAL CDA HOOK UP & OUTLET, INCLUDING STRUCTURAL DESIGN FOR SCOPE ANCHORAGE 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 hated an the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff 7/1/13) AUech. Phnt Check Nwnb. Plan Check F,Ie-c. Plan Check Adech. Permit h'ee: Plumb. Permit F'eF Ilec. Permit Fee: Other Alech. 1rup. Other Plul 1h hzsp. Other A' /ee. hisp. feeh. Msp. Fee: Ph.lmb. lisp. Fee: h:lec. Insp. 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 hated an the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (F) No $0.00 1 hours $143.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: O Reg. C) OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes O No $0.00 Suppl. Insp. Fee:Q Reg. () OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: f1clrninistrative Fee: 0 Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure Travel Documentation Fees: Strong Motion Fee: $0.00 1.0 hrs $143.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: $0.00 SUBTOTALS: L $0.00 $286.00 TOTAL FEE: 1 $286.00 Revised: 07/02/2015 k U_,.73 Date: Project #: Project Name: Address: City: 7TS_T,fNV GJ V9,fJ E&R 11VC DSA File #: DSA p. #: OSHPD #: Permit / SF App. #: ' t 'thou Code: 'Start Time: iKequesteaa Dy: Hours: Reported to: tom': \/ 1 of (Company blame): PirooT Lead T'soling 11 Ream (ISO) Applied a Q tension proof or torque load of � ! ❑ lbs. or,❑ ft. -lbs, to (size) diameter I ! ( brand) E] epoxied dowels E] epoxied Allthread anchors ❑ expansion anchors ❑ powder actuated pins other: Located in the .floor ❑wall ❑ ceiling F1 other at �i_;� location ) for L - i Nil ° ( No. ) anchors /dowels of a total of installed were tested representing' N? r percent without visually apparent distress or failure. ❑ (No. ) anchors /dowels failed to meet proof load requirements. Identified and reported failing anchors /dowels to at the jobsite for appropriate action. Applied a ❑ tension proof or ❑ torque load of ❑ lbs. or ❑ ft. -lbs, to (size) diameter ( brand) ❑ epoxied dowels ❑ epoxied Allthread anchors ❑ expansion anchors ❑ powder actuated pins ❑ other: Located inthe F1 floor E] wall El ceiling ❑ other at ( location ) for ( No. ) anchors /dowels of a total of installed were tested representing percent ❑ without visually apparent distress or .failure. ❑ ( No. ) anchors /dowels failed to meet proof load requirements. Identified and reported failing anchors /dowels to at the jobsite for appropriate action. Proof loading values and rate of testing were supplied by =, Other +' �( `; �i ❑ Drawings ❑ Final acceptance is pending written approval or corrective action as noted_ ❑ See attached RFI. ❑ All non - compliance items were brought to the attention of r Note:( (_ 'Ll N (.(L I r S ❑ Showup; ❑ Stand -by time; ❑ Job Cancelled; ❑ Re- inspection; Hours: No(s) at the job site. The work Nillvas ❑ was not inspected in accordance with the 0. uil ing Department or ❑ DSA or ❑ OSHPD approved documents. The work inspected met ❑ did not meet the requirements of the Building Department or ❑ DSA or ❑ OSHPD approved documents, ❑ except as noted above. Drawings G` �_N 1— Dated ❑ City ❑ County ❑ DSA ❑ Shop Inspector: ? ,S F J N 1 Certification # Date Received by: Date: Corporate Office — 2811 Teagarden Street — San Leandro, California 94577 — (510) 835 -3142 — FAX (510) 834 -3777 www.Testing-Engineers.com