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13090039P/ CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19925 STEVENS CREEK BLVD CONTRACTOR: BARRON BUILDERS INC PERMIT NO: 13090039 OWNER'S NAME: STEVENS CREEK INVRS LLC 415 CLYDE AVE STE 105 DATE ISSUED: 09/27/2013 OWNER'S PHONE: 4089961010 MOUNTAIN VIEW, CA 94043 PHONE NO: (650) 269-7061 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL y License Class Lic. # APPLE- 2ND FLOOR- INSTALL MULTI UNIT ON ROOF TO FEED 7 FAN COIL UNITS, 1ST FLOOR- ADD A NEW 20 KVA Contractor Date � ��� P—P UPS CABINET I hereby affirm that I am licensed under the provisions of Cha (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 Sq. Ft Floor Area: Valuation: $10000 performance of the work for which this permit is issued. ve 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: 31621089.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I 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 WITHIN 180 D + P + T ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAM LAST,_C.LLED INSPECTION. indemnify and keep harmless Cupertino against liabilities, judgments, costs, expenses whichmay eagainst said Cityinconsthe will grantingof this permit. Additionally,applicanttd PIy ed by: with all non -point source regulations per the Cupertino Municipal Code, Section ...._,_......w _.,.....tl__ 9.18. � RE -ROOFS: Sign Date ii All roofs shall be inspected p"0 d prior to any roofing material being installed. If a roof is a " 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 BETTER 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 tinder 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 9.12 and the declarations: Health & Safety Code, Section 25532(a) should 1 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 1 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 Co Section 505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date: 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 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 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 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 CONSTRUCTION PERMIT APPLICATION Ov COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION a 00 07 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • build ingPcupertino. org \� ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 1`1QrL �+ „�.�� /� { (" �w pl/ QI �/ J Y �1 J ��1�- (� Al""� OWNER NAME I� /ZJ�__IL E PHONE 409_916- ( 010_ 1 E-MAILG � ICKM 6 t LVEV E STREET ADDRESS tot -12-5 s-rvj"S CSX 6LU O . CITY T E ZIP FAX 2 �'C 1 a c� a cosi - 46¢ - CONTACT NAME � PHI_ O.. -70 E-MAIL STREET ADDRESS CITY, SITUATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT A CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT n CONTRACTOR NAME t"F�� FY+��F'R-V� LICENSE NUMBED r I `e'[ 1rJ.f0 �,. BUS, LIC H COMPANYNAME �f (1' Vd �LIC�EpNSE 4TYpPE E-MAIL p CCTV e6,A,0rf4,1ptI1OG�S• �O4 STREET` ; DS� L ��E ' O S CILS�E�KJV-A,1 4�► M IE-tJ T4 / _ ff? p PHONE D -T4* {6I�- ( J ARCHITECT/ENGINEER NAME SOfAA LICENSE NUMBER BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE � DESCRIPTION OF WORK MSW C , `/ MULTI U N I, T WILL QE t xIST& I-V" CA -rH e R01* TO FEE h (1 FAN Got( ulurs AE3oJE Tl1F t esuof 1ndESEc4DA10 fuMa- wlAII� 'Tb gr. -Z6AC- i� oft ICF AN p 'fKE AOOi'n oQ of NE W Sok:* UP,s Co tkJf!V W ILL SE t&1 tALLEYJ 10 IXE 44T Fcao EXISTING USE PROPOSED USE C�%NST TYPE t! STORIES USE TYPE OCC. SQ.FT. VALUATION (S) Y — EXISTG AREA NEW FLOOR DEMO TOTAL AREA AREA NETAREccl D SF l BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA ORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH �#—D ❑ ATTACH WELLING UMTS: IS A SECOND UNIT OYES SECOND STORY []YES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION OYES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES i,/i/�j��/��/ 'n/%�/��//" TOTAL VALUATION: PLANNING APPL k ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO / i n5 ,,, ,� 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 building constru�ctlsgQ. I authorize representatives of Cupertino to enter the above-ide tlfied roperty for inspection purposes. Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED ' ''' ,", /%/DO"//'/ i' 411 Ii%% ,,/i/% %/ a /i // //, / New SFD or Multifamily dwellings: Apply for demolition Permit for issuance building '% ' '%i a „/ I, /%i % 1 existing building(s). Demolition permit is required prior to of -mit for new building. Pe g ✓ j/ %�%/�j��i//, i�/,�/oi��//%%.. �,�// �i�,/i/. moo/ /i%�'%��/+ii: Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to submittal al of Building Permit application. BldgApp_201 Ldoc revised 06/21/11 W CITY OF CUPERTINO FM_711 FEE ESTIMATOR - BUILDING DIVISION $cr h Plap� Cho', A, C'fr( b' 1'f(w (/w(�( 1I��P/ a Ow"�Fu("'. f'��nW) 'c,�: I'l`r rnh Perrin r,' 1 �'r. F"( Li( //u'r U'(kz In')'. ()f (r F,f<r ln", ' 'lc/r, for p' fuer. f vc 0o( ln�p P"c NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Di.ctrirL etch Thece feet are h¢ced nn the nreliminary inf)rmatian available and are nnly an estimate_ Cnntact the Dent far addn'l into_ FEE ITEMS (Fee Resolution 11-053 Ef. 711112) 19925 scb DATE: 09/06/2013 REVIEWED BY: larry s jia�ADDRESS: 'Jl APN: BP#: 3G] �� �' `VALUATION: $100,000 }PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial BuildingPENTAMATION USE: 0.0 PERMIT TYPE: 1GENCOM WORK apple- 2nd floor- install multi unit on roof to feed 7 fan coil units 1st floor- add a new 20 kva ups cabinet SCOPE $cr h Plap� Cho', A, C'fr( b' 1'f(w (/w(�( 1I��P/ a Ow"�Fu("'. f'��nW) 'c,�: I'l`r rnh Perrin r,' 1 �'r. F"( Li( //u'r U'(kz In')'. ()f (r F,f<r ln", ' 'lc/r, for p' fuer. f vc 0o( ln�p P"c NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Di.ctrirL etch Thece feet are h¢ced nn the nreliminary inf)rmatian available and are nnly an estimate_ Cnntact the Dent far addn'l into_ FEE ITEMS (Fee Resolution 11-053 Ef. 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes Q No $0.00 2 hours $278.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: (F) Reg. 0 OT 0.0 1us $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? © Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 "k(a'mr iIryo"':qiv(' 1, cc: Q E) Work Without Permit? © Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 I Strong Motion Fee: IBSEISMICO $21.00 4.0 hrs $556.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $4.001 $25.001 $834.00 TOT SEE: $859.00 Revised: 07/01/2013 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: SUBCONTRACTOR PERMIT# 2 OWNER'S NAME: PHONE# ii GENERAL CONTRACTOR: Ail' BUSINESS LICENSE# 32880 ADDRESS: CITY/ZIPCODE. "Our municipal code reqijires'all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors; Signature Please check applicable subcontractors and complete the following information: Date t/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing 2- Roofing Septic Tank Sheet Metal 0 (IA 2 Q (D Sheet Rock Tile . . ...... ....... 7 A ''owner / Contractor Signature Date : San Ramon (925) 314-7100 INSPECTOR ST I M E SHEET Windsor (707) 838-1115 F -f Consulting (510) 436-7626 F_ Hawaii (808) 864-5778 r7 Oakland (510) 436-7626 C2ONSOLIDA9ED ENGINEERING r__ Ie, &I ». Revision #: "Partners in Quality" F_ Salt Lake City (801) 972-8200 Date: 10/15/2013 DaY: Tuesday Project Number: 10280,62 „,"`° Perm it/Application#: 1 13090039 Expand Code:" Travel Time to Job -site: Inspector's Name: (Print) Ray saucedo ATIPS Job Name: (Required) Apple hvc modification and ups installation Shop Name: Time Start: 6:00PM Lunch Start: Job/Shop Address: (Required) Equipment Pick-up: 0�Yes C No Lab Site: Type of Equipment: Pick-up Time: r AM a PM Travel Time to Job -site: Mileage to Job -site: From Home C- From Lab C, Last Job Ci From Home (' From Lab Last Job Time Start: 6:00PM Lunch Start: Lunch Stop: Time Stop: 10:00 o PM ( Waived Lunch Enter all codes and tasks for inspections performed and show actual hours worked for each task. 13101 Anchor installation 4 Equipment Dro off: C` Yes �- No p- Drop-off Time: p ° AM Lab Site: a PM If Yes: Travel time to lab drop-off equip.: Mileage to lab drop-off equip.: Reimbursable Expenses: Parking: $ Tolls: $ Subsistence: C` Yes C No Is this the last job of the day? G YES C No Notified Dispatch? C YES C No Travel time to home: Mileage to home: Remarks: Inspector Signature: Verification Signature: Print Name/Company: Francisco W/Barron builders REIMBURSEMENT REQUEST Name: Date: From Lab/Project# Lab/Project Address: To Lab/Project# Lab/Project Address: Type of Equipment: Inside Travel Time to Job: Inside Miles to Job: Reimbursable Expenses: (Attach Receipts) Parking: $ Tolls: $ Supervisor Approval: Revised 03/2013 Form ID 10 Rev.0 DOWELIAN Page of co )NSOLIDATED ENGINEERING A B O R A T O R 1 E S STA L LATI O N DSA FILE# Apple hvac modification and ups installation DSA APPL# 2013-07-30 LEA# 1028012 OSHPD# 19925 Stevens creek cupertino PERMIT/APPL# 113090039 Project Name: Apple hvac modification and ups installation Testing/Inspection Date(s): 2013-07-30 CEL Project#: 1028012 Project Location: 19925 Stevens creek cupertino Contractor: Reported to: Francisco Company: Barron builders Drawing No.: Detail No.: Other: Engineer/Letter Fax dated: Matthew Knutson 10/11/13 Other: Insert Type: j— Rebar � All -Thread Anchor F— Wedge Anchor F-' Shot Pin/Assembly r Other Hilts re 500 Notes/ Type of Adhesive: rnmm, Expiration date: 6/2014 The Work: R7 WAS C WAS NOT INSPECTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE F_ DSA rOSHPD F)K' CITY APPROVED DOCUMENTS The Work Inspected: FX-' MET F_ DID NOT MEET THE REQUIREMENTS OF THE F_ DSA F— OSHPD R CITY APPROVED DOCUMENTS CC: Project Architect Structural Engineer Project Inspector DSA Regional Office School District Signature of Special Inspector: Date: 2013-07-30 Print Name/Title: Ray Saucedo CERTIFICATION#: