B-2017-1388 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1388
22330 HOMESTEAD RD CUPERTINO,CA 95014-0137(326 59 999) CABLECOM LLC
WOODINVILLE,WA
98072
OWNER'S NAME: JACKIE MCGARRY DATE ISSUED:08/24/2017
OWNER'S PHONE:408-866-4357 PHONE NO:(360)668-1300
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class A:C-7 Lic.#826295
Contractor CABLECOM LLC Date 07/31/2019 X BLDG _ELECT _PLUMB
—MECH X RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
' GARAGE-INSTALL 2"EMT IN PARKING STRUCTURE TO
I hereby affirm under penalty of perjury one of the following two declarations: FACILITATE CATV SERVICE TO THE 2ND FLOOR IDF ROOMS
i. 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
001000Performance of the work for which this permit is issued.
/I. 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. • Sq.Ft Floor Area: Valuation:$12701.38
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 APN Number: Occupancy Type:
and state laws,relating to building construction,and hereby authorize 326 59 999
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrueainst said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,to applic nt understan and will comply with all non-point
source regula•ons per he Cupe ' o Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
'' re: Ni,'" / Date 8/24/2017 Issued by:Abby Ayende •
Date:08/24/2017 _
OWNER-BUILDER DECLARATION •
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
i. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
' compensation,will do the work,and the structure is not intended or offered for inspection.
' sale(Sec.7044,Business&Professions Code) ,
2. ; I,as,owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:8/24/2017
I hereby'affirm underipenalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section,3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,,25533,and 25534. I will
permit is issued.' maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. Ice tifyithat'intheperforinance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
• air contaminants as defined by t,e Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with th\Cupertino unicipal Code,Chapter 9.12 and
exemption,Itiecome subject to the Worker's Compensation provisions of the the Health&Safety Co. Section/5505,25533,. and 25534.
Labor Code I.must forthwith comply with such provisions or this permit shall
be deemed revoked
tom er or authorized agent: mi
APPLICANT CERTIFICATION Date:8/24/2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and,keep.harmless the City of Cupertino against liabilities,
judgments,costs,and;expenees which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section,9.18. I understand my plans shall be used as public records.
Signature Date 8/24/2017 Piceessd
Professional
Wil-- (r2J7�
\, GENERAL PERMIT APPLICATION ME
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ' ' p
4g-i.Iast 10300 TORRE AVENUE.• CUPERTINO, CA 95014-3255 MIS
CUPERTINO (408)777-3228•FAX(408)777-3333•buildingt cupertino.om
❑PLUMBING ❑MECHANICAL ®ELECTRICAL Q MISCELLANEOUS `
PROJECT ADDRESS APN#
22330 Homestead Rd 326-59-999
OWNER NAMEJackie McGarry PH°NE 408-866-4537 E-MAIL jmcgarry@archwaytmc.biz
STREET ADDRESS CITY, STATE,ZIP FAX
251 Hacienda Ave. #B Campbell, CA 95008 408-866-4619
CONTACT NAME Jackie McGarry PHONE 408-866-4537 E-MAIL jmcgarry@archwaytmc.biz
STREET ADDRESS P.O. Box 320819 ' CITY;STATE,ZIP Los'Gatos;'CA, 95032 FAX 408-866-4619
❑OWNER , 0 OWNER-BUILDER a OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT'.' 0 ARCHITECT 0 ENGINEER 0,DEVELOPER 0 TENANT
'CONTRACTOR NAME Stephen Scholberg LICENSE NUMBER 826295' LICENSE TYPE BUS.LIC E.
General-A and C-7 • ' 33537
COMPANY NAME ,Cable Corn &MAIL Stephen.Scholberg@cablecomllc.net, FAX
STREET ADDRESS - CITY,STATE,ZIP ' PHONE
• 650 Aldo Ave.. Santa:Clara, CA, 95054 408-609-1197
ARCHITECT/ENGINEER NAME Brock Dickie LICENSE NUMBER BUS.LIC# '
COMPANY NAME. Engineering Ehen.scholber FAX
Jakabyste
p g@cablecomllc:net
STREET ADDRESS,1885 S. Winchester Blvd,Ste a CITY,STATE,ZIP Campbell, CA, 95008 PHONE 408-374-61,49
USE OF 0 SFD or DUPLEX RI MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN 0 YES IS THE BLDG AN : I ❑,YES
BUILDING: 0 COMMERCIAL URBAN INTERFACE AREA ® NO FLOOD ZONE O[NO. EICHLER HOME? 1 '' •Ca NO
DESCRIPTION OF WORK Install 2" EMT in parking structure to facilitate CATV service to the 2nd floor IDE : ,
By •
my VALUATION: RECEIVED BY ,,"��� d',
$12,701.38 , �' ^'l
signaturebelow,,I certify,to each of the following: I am the property owner or authorized agent to act on the property owne's behal I have read this
application and the information Lhave 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 I-elating.to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant('Agent: : 3z ?� - �CIZ�G'l5P/l C Date: 6/8/2017
' ',i SUPPLEMENTATCFORMATION REQUIRED
OFFICE USE ONLY`'
+' • w '❑,_OVER-THE-COUNTER - _ ' •
i •
• , H ; ❑ EXPRESS '
' I ' .i 0.-STANDARD '.
,U
a0 LARGE
-MAJOR
MEPMiscApp 2011.doc revised 06/21/11
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www baggenctineers corn info@bagg2ngineers corm, ,,
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847 West Maude Avenue ,�� l�
w ,a Sunnyvale California 94085 2911
� � phon `650:82 9133'
SPECRL INSPECTIONI eREP®RT
t'•Special,InspectiontReports must'be given to the contractor on the_day of the inspection and!distnbutedto the other parties listed below within 7 days of the
"' ins ection ,die orts:of non com leant conditions:must be
p p p ports shall be,prepared for each type of,special inspection,ori
a daily;basis Each report shall`be completed and signed'1_,).1.40e
ey theuspec al inspector cort�uct ng th'e inspection.,; :'
Y p
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,
� 61:!;'6!A!-../ ,Re ort'1Date �,, s ,c;
Client`' � 1�,r�>` '�€�' r`y���.a�t x ' ' p � �,�' ,�` '� C'� �.,
Address ' I+Q ,.` i' : . C; .) c,i.+,u''`lle f ?' is h;.,,' BAGG Job#;+ `. s € ` ='�°"r,,. r
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:i'',...4',..:",,.;:..,"4' Time Arrived �:,
Attn' `b � �. �? a, i,��•', r,~.s��� t� P �, r Time Departed • L
Tr'avef Time.
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•
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Protect°Name.-.&::"..--4/41,0y6-4,',44-.: t�r i ow 1 irp rD Bldg Permit# 6/9- /3
Project Location. �' rxrTrr��r� c' a fa
• C
Contractor' •• Fab'ricator:
Inspection -._,.....;..,'•',..
❑Concrete ;' ❑Reinforcing Steel , , ❑Epoxy Bolts/Dowel ❑Wlding-Shop
�t ,ts • overage • ' ❑Weldi Field
.1.,',':0 'a CQritititaQis� r. f,
❑Post tensioned Concr,ete ❑,Masonrys ❑Engineered Fill 9,
'-;!fl ❑Batch Plant ❑Hi h Stren th Boltin .:•
❑Deep.Foundation ? ,c+ ar •'
rq 5�
'�x t eltt9d � g - g g , cif / : Ir mo` ria.,,
thl 3.Zr�R'� 1 - , - r II;
i:(, De"scribe inspe•ctions made•,,. dinge locations: ,7"'/O . .,,,' t' '1
'....',".''''"-'.`'','.11,'
6 s 4'r .'.- . Fri ffr"r' 'id `l,4;e-g- • ?J f , ,/— ,1,-,:.'..-..:0...- .' ,, ' �I ft ✓' S ti
r p,t,I af
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` y 1 � [ actvlr 1 `,, / d r�t./,4i,:".,er ! a'F L`!`; e 'r1G 1i D „,!.....,:":"....i-.•.4,!-94..',.,',2 '
M
' Tests Imade '.1
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� V1/2";//.
gyp,
1 I' / '!. ''s ': 1r..1 .1w"kn..e '°2 •'.G , •,k', ,' l
lten s requiring correction, corrections of previously listed.items,and previo•usly listed uncorrected items:; i I
I f •�•.
y _ I ! Ir
;° List changes to approved`plans by architect or engineer, .
,
Comments • �.
� f t
TheLWork WAS ❑WAS NOT
in•spcted,n,accordance
withthe reiairements;of the approved site plans'and .` ✓% r ,�'
SnPr.if caions' ,, �..„..„ r fie , a✓s ° ' ^ >' r
'i�at�r�al �ae>i�pOa�g was '• ❑.WAS NOT:. N/a � Si` na 'ue of Special Irspector !
Performed in accordance with approved site plans and specifications G� +t!y'da?: ` � ,,°� , .: ( i,
W.,”'MET;.` El DID NOT MEET :,
:-: ',,the:*,e rlk Ins�ecte� �� Prim Name/Title ,
The requirements of the approved site plans and.specifications • ,"i 1
yr ,.� ,,,ec Project�Architect , 1, ,., a :.7 .
Certific,tion#',
st ; Structural Engineer'. r r r,, "'
Protect inspector
C"; ci,ent • Page-'1 of`1
3I 1 '''.;3",...
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fN S I rnnn } F,-,62:.1,:f!..::‘1'.,.lIp L( i
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