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06010024It CITY OF CUPERTIN(- CIrr of PLI.MIT APPLICATION FORM CUPERTINO APN 4 Fee Description Date: BAPPLOTHER Other Appliances MECHANICAL Building Address: Mailing Address (if different from building address): tool 15r,a.,, Cpv -E;4S 14 - Owner's Nape: MECHANICAL Phone #: +-jetinft QL�,, MECHANICAL % -10F1 •-I ontr t r: M ..C'T-TANTC'AT. License #: 76sOAn ysr r C_ '1`57 IP k G 1-7 Contact: LAPM� Phone:S) o -,q `j- 7013 Cupertino Business License#: Fax: 50--Mz uilding Permit Info: 13ldg'rkf Elect Plumb ❑ Mech EQ-,' - Job Description: ex J!"', Residential ❑ P V►���� wed Sq.Ft. Floor Area: q.Ft.. Cost of Proiect: Occupancy Group: Type of Construction: Please check this bog if the project is a " second -story addition: ❑ Project Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOELER1 Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BB0ILER3 Boiler > 500K to 1M Btu MECHANICAL RRCM.RRA Rni1Pr > 17V( to 1-75 M Rbi M ..C'T-TANTC'AT. BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 r 17 fr CIO CUPERTINO CITY OF CUPERTINC PLnIWIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUC0hCvSI New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIIvlE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste lnterce for PLUTMING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstalUAlter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT LigMing Fixtures ELECTRICAL BREI\gURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREARNHOOD Installation of Hood MECHANICAL BREMIvlISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance. ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPEVINO C .t i Y OF CUPERTINO PERMIT APPLICATION FORM Quantity . Fee ID Fee Description Fee Grou BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFA.N Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISNIICOM Seismic Commercial BUELDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEM P Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING `I kO ELECTRIC Electrical sq foot ELECTRICAL EPERAUTFEE Elec Permit Issuance ELECTRICAL /Ona MPER.NvIFEE Mechanicals . foot MECHANICAL MPERMITFEE Alech Permit Issuance MECHANICAL PPERNIITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fe -e. sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3 CITY OF CUPERTINO CdITiC1"f.�I2.IC�TT�N. BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. RUDOLPH & SLETTEN j -"C 06010024 o &lE: TANTAU AVE 4 5 N - L PERMIT rsSUE DATE PHONE: PORT B LVD , S TE 3 0NITARY N®3 1 6 2*IQ'PL NO. ARCHrIECT/ENGINEER: (6bU)216-3643 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70(10) f DIV S' 3 of the Business and P fes�iom; CCo a my license is in full force and of c1 S License Class tee. a T I - ME CHANI CAL/ ELE CTR I CAL /ARCHETE CTUAL DateC FL TRAINING ROOMS 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Profusions Calc: Any city or county which requires a permit to cnnstruct, alter, improve• demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement Contractor's License Law 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the (Chapter (commencing with Section 70DO) of Division 3 of the Business and Professions Code) or $485091 that he is exempt therefrom and the basis for the alleged exemption- Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (55001 ❑ 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 Required Inspections and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who doessuch work himself or through his own employees• provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of the property. am exclusively contracting with licensed contractors to convect the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec. , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compcn- sation, 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 required by Section 3700 of theLabor Code. for the performance of the work for which this permit is issued. AIyl ore% Compensation Insutana acr_and Poli number me . of icy Na 1.4i CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is fa one hundred dollars (5100) or less.) 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 Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Lahor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 1 certify that 1 have read this application and stare that the above information is corecL I agree to comply with all city and county ordinances and stare laws relating to building convection, and hereby authorise 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 in an y accrue against said City in co ence of the gi this perms LICA UNDERST S L M L ITH ALL NON -POINT Issued by: Date SOUR EGUL Re -roofs 'd St pplicanVC ntra t Ditc HAZARDOUS MATERIALS DISCL RE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal c, Chapter 9.12, and the Health and Safety Code. Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. [:]Yes o If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as delin� y the Bay Area Air Quality Management / all new materials for inspection. District? �.,/ -1 Yes Qnu 1 have read the hazardous materials mquiremenls under Cha r 6.95 of tfte Califor- niaHcalth&SafctyCodeS tions 25505.255 5 .Its d that if the building d not c mIy hose nt, th it i ponslbil y fy the occupant of the r i cntswnich p r of t o o(oaar -Q Signature of Applicant Date All roof coverings to be Class "B" or better 0 ortza eat Date CITY CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: N\x- PERMIT # (')(C) 0 t O QV14 OWNER'S NAME: PUC.' PHONE# GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date 12 I Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating VV -01 -- Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 12 I Owner/ Contractor Signature Date TEST AND BALANCE REPORT HP Classrooms 10955 Tantau Road Cupertino, CA TEST AND BALANCE REPORT DATE: 6/23/2006 PROJECT: HP Classrooms 10955 Tantau Road Cupertino, CA ENGINEER: NS BALANCING TECHNICIAN: HVAC CONTRACTOR: NEBB CONTRACTOR: Therma 1601 Las Plumas Ave. San Jose, CA 95133 (408) 347-3400 Chris Coatsworth THERMA THERMA 1601 LAS PLUMAS AVE. SAN JOSE, CA 95133 (408) 347-3400 PROJECT NUMBER: 271848 PROJECT: HP Classrooms 10955 Tantau Road Cupertino, CA THE DATA PRESENTED IN THIS REPORT IS A RECORD OF SYSTEM PERFORMANCE WHICH WAS OBTAINED UTILIZING NEBB STANDARD PROCEDURAL GUIDELINES. THE PERSON(S) RESPONSIBLE FOR PROVIDING THE DESIGN QUANTITIES WAS NOTIFIED OF ALL VARIANCES FROM DESIGN QUANTITIES WHICH EXCEED SPECIFIED PROJECT TOLERANCES. EACH VARIANCE HAS BEEN NOTED THROUGHOUT THIS REPORT. THE AIR & HYDRONIC DISTRIBUTION SYSTEMS HAVE BEEN TESTED, BALANCED AND ADJUSTED IN ACCORDANCE WITH "NEBB PROCEDURAL STANDARDS FOR TESTING, ADJUSTING -BALANCING OF ENVIRONMENTAL SYSTEMS" AND THE PROJECT SPECIFICATIONS. NEBB CONTRACTOR: REG NO: CERTIFIED BY: DATE: THERMA 2472 Chris Coatsworth 6/23/2006 SUBMITTED & CERTIFIED BY: NEBB CONTRACTOR: TAB SUPERVISOR: REG NO: DATE: Copyright NEBB 1983 THERMA CORP. RONALD J. SIMENS 2472 6/23/2006 ,�herma, Ing, F13 RONALD J. SIMENS CERTIFICATION 2472 EXP- 12/31/07 0c ABBREVIATIONS AK ............................................ Area x Constant BTUH....................................... British Thermal Units per Hour CC / HC / RHC ........................ Cooling Coil / Heating Coil / Reheat Coil CED / CEG ............................... Ceiling Exhaust Diffuser / Ceiling Exhaust Grille CFM ......................................... Cubic Feet per Minute CRD / CRG .............................. Ceiling Return Diffuser / Ceiling Return Grille CSD / CSR ............................... Ceiling Supply Diffuser / Ceiling Supply Register CV ............................................ Calibration Value (DDC Air Flow Sensor) EA ............................................ Exhaust Air ESP ........................................... External Static Pressure FO ........................................... Full Open (Damper or Valve) FPM .......................................... Feet Per Minute FSG .......................................... Floor Supply Grille GPM ......................................... Gallons Per Minute HP / BHP .................................. Horsepower / Brake Horsepower HEPA....................................... High Efficiency Particulate Air (Filter) L1, L2, L3 ................................ Motor Lead LSD .......................................... Linear Slot Diffuser MBH ......................................... BTUH x 1000 NA ............................................ Not Applicable NP............................................. Nameplate NS / NOT SPEC . ..................... Not Specified OA / OSA................................. Outside Air PSI / PSIG................................ Pounds per Square Inch / Gauge PD ............................................. Pressure Drop RA ............................................ Return Air RH............................................ Relative Humidity RPM ......................................... Revolutions Per Minute RND......................................... Round SA............................................. Supply Air SP ............................................. Static Pressure SWE......................................... Sidewall Exhaust SWR ......................................... Sidewall Return SWS.......................................... Sidewall Supply VD ............................................ Volume Damper VLF .......................................... Vertical Laminar Flow VP ............................................. Velocity Pressure ABBREV.XLS(5-06) GENERAL NOTES VAAFAWA 1601 Las Plumas Ave. San Jose, CA 95133 (408) 347-3400 PROJECT: HP Classrooms DATE: 6/23/2006 All diffusers, grilles and registers are read with the Shortridge F1owHood unless the "K" or "AK" factors are shown. Duct sizes, diffusers and diffuser neck sizes are listed in inches unless shown otherwise. All areas are listed in square feet unless shown otherwise. Filename: GENEFALI.XLS W:\data\BALANCE\REPORTS\2006UuneW P\HP Classrooms 271848\ general.XLS Dale: 612612006 11:28 AM Created by msootl Page 1 of 3 AIR DISTRIBUTION TEST REPORT 16 MERW" 1601 Las Plumas Ave. San Jose, CA 95133 (408) 347-3400 PROJECT SYSTEM: HP Classrooms Supply (Existing) Remarks: Filename: Air Distribution.xls Readings By: Chris Coatsworth W:\data1BALANCE\REPORTS12006VuneWPWP Classrooms 271848\ air distribution.As Date: 6/26/2006 1:01 PM Created try mscon Page 2 of 3 Outlet Data Design Data Title: As Found Date: 06/23/06 Title: Final Date: 06/23/06 Identification Number / Area Served Face / Neck Size Type Ak FPM CFM FPM CFM FPM CFM Notes Supply - 1 / Room 1236 24 x 24/6 CSD 50 55 55 Full Open 2 /Room 1210 24 x 24/10 CSD 350 105 330 3 /Room 1210 24 x 24/10 CSD 350 105 340 4 / Room 1216 24 x 24/10 CSD 350 685 360 Remarks: Filename: Air Distribution.xls Readings By: Chris Coatsworth W:\data1BALANCE\REPORTS12006VuneWPWP Classrooms 271848\ air distribution.As Date: 6/26/2006 1:01 PM Created try mscon Page 2 of 3 PROJECT INSTRUMENTATION 7WAV 1601 Las Plumas Ave San Jose, CA 95133 (408) 347-3400 Instrument Calibration Date Recalibration Date ADM #11 05/08/2006 05/08/2007 Filename: TAB Project Instrumentation.xls Page 3 of 3 W:\dataZALANCE W E PORTS\2006`lune\HP\HP Classrooms 271846\ project insimmenlation.XLS Dale: 6/26/2006 1:01 PM Crealed by mscotl ADA - H Calibration Report I Customer: THERMA CORPORATION SAN JOSE, CA, 95133-1613 Instrument AIRDATA MULTIMETER Manufacture Model SHORTRIDGE INSTR ADM -860 MPC Control V5916 565148 Received Condition:In tolerance Iw I - RO PRECISION C BRATION INC. 220 Devcon Drive, San Jose CA 9.5112 Account:20951 Serial Number Report Date/Number M95664 050906 309362 Returned Condition:In tolerance Function Tested Readings Before Velocity: Temperature: Pressure: Control Standards Used All Parameters Meet or Exceed Manufacturer's Specifications. Instrument Model V6500 PRESSURE CALIBRATOR 33 AD6255 ACCUBALANCE BALOMETE 8370 Work Performed: Inspected and Calibrated Parts Replaced:None Environmental:680f,40%rh Uncertainty: Accuracy Ratio > 4:1 Cal Procedure:33K6-4-1769-1 Technician: BRADLEY CHARLES Customer Purchase Order 33333 -TAB Customer Control NA ENHANCED Location/Department Service Location:MC Readings After All Parameters Meet or Exceed Manufacturer's Specifications. Tolerance Due Date Trace Ref. 080106 04030124 011909 0409198-05 Calibration cycle and resulting due date were submitted/approved by the customer. Any number of factors may cause the instrument to drift out of tolerance before the next scheduled calibration. Recalibration cycles should be based on frequency of use, environmental conditions and customer expected accuracies. Services provided comply with ISO 17025:1999, ISO 9001:2000, ANSI/NCSL Z540-1, MPC QA Manual Rev 3 (MPC QM 540-94 for work performed before 2004) and with customer purchase order requirements. Uncertainties reported if the accuracy ratio is less than 4:1. Uncertainties estimated using a 95 percent confidence level (K=2). Cal Report Rev 2006.1 Page 1 of 1 All standards used are either traceable to the National Institute of Standards and Technology or have Intrinsic accuracy. All services performed have used proper manufacturer and industrial service techniques and are warranted for no less than (30) days. This report may not be reproduced in part without written permission of Micro Precision's Quality Assurance Manager.