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B-2016-3135CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3135 10218 IMPERIAL AVE CUPERTINO, CA 95014-5909 (357 18 035) OWNER/BUILDER 555 BURKE ST SAN JOSE, CA 95112-4102 OWNER'S NAME: ALJM ENTERPRISES LLC OWNER'S PHONE: 408-3334952 LJ-CENSED CONMACTOR'S CONTRACTOR'SDECLARAXION License Class Lic. # Contractor OWN /B I DER Date I hereby affirm that I 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. hereby affirm under penalty of perjury one of the following two declarations: 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 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 03-21-2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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 construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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 performance of the work for which this permit is issued. 2. 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. 3. 1 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. Date 03-21-2017 DATE ISSUED: 03/21/2017 PHONE NO: None BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: 1 ST FLOOR; T.I. - OFFICE/WAREHOUSE (2500 S.F TOTAL)REMOVE/REPLACE (E) DROP CEILING; ADD 30 LIGHT FIXTURES/60 OUTLETS/SWITCHES +/-; 2ND STORY REPLACE SIDING (300 S.F.); ADD (l) DROP CEILING - PAN AMERICAN COLLISION CENTER Sq. Ft Floor Area: Valuation: $135000.00 APN Number: Occupancy Type: 357 18 035 A (Tenant Improvements),B (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar RF�O All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Appli Date: 03-21-2017 ALL ROOF COVERING$ 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. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I 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 I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505 25533, and 25534. Owner or authorized agent: Date: 03-21-2017 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 I understand my plans shall be used as public records. Licensed Professional " ICLI.PERTINQ L_.? K -FP COT STRUC �I;olEer AnnR.Ess � O\Vm t A m STPZET. =ESS. -4—, CONSTRUCTION PERMIT APPLICATION, COf\HUNITY DEVELOPIOENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 05014-3255 ('408) 777-3228 - EA,X (408) 777-3333 • bt111(�ll']c0cL •DBrilnOAr4 //A DITIOt, A T� E�T70?~,f / T� I I� }�:EZj3Si0?d 1DEF RitED OTUGINAL PE-RI41T ' tyl L / ar=_i•ZJt�,AkI 11.if))i I - 1Cia-1�.�� PxO��,tI–A-tL 1, 71FCU-�"-E-I,i '15=k* OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingAcupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRES/0'Z1 ® 'Z 1 q � 7M X 62/ .4 {- APN � � BP# OWNER NAME OWNER ADDREpW DESCRIPTION OF WORK: We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) `�-iy I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2- I understand building permits are not required to be signed by property owners unless they are responsible for ttheWconstruction and are not hiring a licensed Contractor to assume this responsibility. "I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. I& "�4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. _!!kL I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. _6.. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. ,Skon understand under California Contractors' State License Law, an Owner -Builder who builds single-family= residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. lk . I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04114110 V 9. 1 understand I may obtain more information regarding my obligations as an "employer"from the Internal nue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. '10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I a the party legally and financially responsible for proposed construction activity at the site address listed above. Iqg�11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. -92. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: _ Date: 5/Z/// -------------------------------- I The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwneYBuilderFonn 2010.doc revised 04114110 f / TOAIA GONCERENCO STRUCTURAL ENGINERING 5936 Chesbro Ave. --San Jose, CA 95123 (408) 629 — 4355 April 3 -2417 City of Cupertino - Building Division Regarding to: 10218 Imperial Ave Cupertino, CA. This letter certified that I inspected foundation work at the above address and I found the job compliant according to the project and minor adjustments were verified and approved by me Toma Goncerenco 4g0r�Sfpry Structural Engineer rzp PdCF�,9l No. 00 15, E 03-31-1-3 *j TOMA GONCERENCO STRUCTURAL ENGINERING 5936 Chesbro Ave. San Jose, CA 95123 ( 408 ) 629 - 4355 Apri 16 2017 City of Cupertino Building Division Inspection Division Cupertino, CA 95014 Regarding to: Project Pan American Collision Bldg 1021.8 Imperial Ave - Cupertino, CA. This letter confirms the following: 1. The existing off set concrete from the main foundation has to stay. This concrete is only to protect the foundation from crack during the drill of hole for anchor bolt 2 The back plate for full weld penetration of W beam flange may stay after the weld I done. This not absolves the welder and weld inspector for not complete full penetration. Very truly yours Toma Goncerenco Structural Engineer �ROFESSlp�,9! �P 0 N No. 003542 FXP. 03-31- r tl i TOMA GONCERENCO STRUCTURAL ENGINERING 5936 Chesbro Ave. San Jose, CA 95123 (408) 629— 4355 April 3 -2017 City of Cupertino Building Division Regarding to: 10218 Imperial Ave Cupertino, CA. This letter certified that I inspected foundation work at the above address and I found the job compliant according to the project and minor adjustments were verified and approved by me Toma Goncerencor Structural Engineer0 N C 4. 0435Y2C:)03-31- �� � ACHEVEMEN-4 ' ENGINE_FRINC CC'sRF Date: June 9, 2017 Proiect No: 2955 Chief Building Official City of Cupertino Subject: Structural Steel Welding For New Opening Framing 10218 Imperial Avenue, Cupertino, CA Permit #: B-2016-3135 Dear Sir, Based on owner representative's request we visited the job site on March 04, 05, 07, 24, 25 and May 05, 2017 and performed NDE test on the structural steel elements welded prior to this inspection. - Mike Chism was the certified welder. - Material verified based on received mill cert report - Shop and field welding was observed per plans and specifications. - Ultrasonic Testing was performed for all new steel framing that were connected using Complete Joint Penetration welds. In general work was in compliance with approved details M1, M3, and M4 on plan sheet page S1. Inspection was performed periodically and on call basis as requested by the owner's representative. We claim no responsibility or liability for damages from improper use of the results or findings. We do not undertake the guarantee of construction nor do we relieve the contractor of his primary responsibility to produce a completed project in accordance with plans and specifications. Our findings refer to locations that were inspected by Achievement Engineering representative. Address: 2455 Autumnvale Drive, Unit E, San Jose, CA 95131 - Tel: (408) 217-9174, Fax: (408) 217-9632 www.achieveng.com Form R-11 AC H EVEMEd i t ENGINEERING CORP.cup If you have any questions or need any additional information, please feel free to call us at your convenience. Sincerely Yours, Farshad Safaian, P.E. State of California Licensed Civil Engineer AT Address: 2455 Autumnvale Drive, Unit E, San Jose, CA 95131 - Tel: (408) 217-9174, Fax: (408) 217-9632 www.achieveng.com Form R-11 TOMA GONCERENCO STRUCTURAL ENGINERING 5936 Chesbro Ave. a, San Jose, CA 95123�- ( 408) 629 - 4355 `� June 8 2017 City of Cupertino Building Division Inspection Division Cupertino, CA 95014 Regarding to: Project Pan American Collision Bldg 10218 Imperial Ave - Cupertino, CA. This letter confirms the all embeded epoxy bolts at the above project was done under my supervision according to the project Very truly yours Toma Goncerenco StructuutI Enainee �ROf ESSI pNq` o 121 - No. 003542 a EXP. 03-31- !"1 rRUp �p OF CAM�