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08050184CITY OF CUPERTINO BUILDING DIVISION PERNIIT+CrTIi: W. BUILDING ADDRESS: 20800 HOMESTEAD RD BLDG 69 HWES:T.BUILDERS, INC. PERMIT NO. 08050184 OW FERM417ISSUE DATE PROMETHEUS 1608 4TH ST STE 120 07/09/2008 PHONE: SANITARY NO. CONTROL NO. (510) 525-9378 ARCHITEC IENGINEER: BUILDING PERMIT INFO BLDG . ELECr PLUMB MECH LICENSED CONTRACT'OR'S DECLARATION I hereby affirm that I are licensed under provisions of Chapter 9 (commencing rith Section 700M of Division 3 of the Business and Professions Code, and my license is a full form and effort /S s dcensc a Lk. r C! )ate Contractor ARCHI78CPS DECLAF A71ON I understand my plans shall be used its public records .1ccnacd Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the ollowing mason. (Section 70313, Business and Professions Code: Any city of county vhich requites a permit to consuac4 alter, improve, demolish, or repair any structure uior to its issuance, also requires the applicant for such permit to file a signed statement hat be is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 commencing with Section 7000) of Division 3 of the Business and Professions Code) or hat he is asempt therefrom and the basis for the && ed esernpfioa Any violation of iecdon 7031.5 by any applicant for a permit subjects the applicant m a Civil penalty of tot more than five hundred dollars (5500). ] L as owner of the property, or ray employees with wages as their sole compensation, will do the wort, and the structure is trot intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law dots not apply to an owner of ,property who builds or improves thereon, and who does such work himself or through his rwu 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 ale). ] L as owner of the property. am exclusively contracting with licensed contractors to construct the project (See 7044. Business and Professions Code:) The Contractors Li - =rise Law does not apply to an owner of property who builds or improves tbamon, and. who contracts for such projects with a contractor(s) licensed punaaant to the Contractor's [.kenae Law. ❑ I am exempt under Sec , B & P C for this mason Owner Due WORKER'S COMPENSATION DECLARATION 1 hereby afrtrm under penalty of perjury one of the following declaration ❑ 1 hive and will maintain a Certifiare of Consent to self -insure for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performane: of the work for which this permit is issued ❑ I have and will maintains Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is ixaned My Worker's Compensation rnsamince artier and Policy number are: carrier 77"F—:" FIJA)0 Policy No.: i3/ I z - Alia N, CERTIRCATE OF EXEMP ION FROM 0 S' COMPENSATION INSURANCE (This section need not he completed if the permitis fa• one hundred dollars (S10D) 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. Due Appfiont NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be dtxmed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097, CW. C-) Lenders Name [.enders Address I certify that I have read this application and state that the above information is correct 1 agree to comply with all city and county ordinances and state laws misting to building construction, and hereby authorize representatives of this city to enter upon the above-mendoned 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 wry way accrue against said City in consequence of the granting of permit. APPLICANT UNDERSTAND WILL LY WITH ALL NON -POINT SOURCE REGULA770N5. Signature of Applicant/Contractor Date HAZARDOUS MA77MALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as deemed by the Cupertino Municipal Codc, Chapter 9. It and the Health and Safety Code, Section 25532(x)? ❑ Yes �"o Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes &No I have mus ad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & SafetyCodc, Sections 25505.25533 and 75534. I undcrsmnd that if the building deer not curtendy hats; a tep�n4 tfAat it " myMsibility u notify tie occupant of the requirements which must U or m iss Ceftrficaw of Occupancy. Owner or authorized Dae Job Description INSTALLATION OF EXTERIOR TEMPORARY PROPANE TANKS TEMPORARY UNDERGROUND PIPES. Ft. 32609056.` i�er Issued by: Re -roofs Type of Roof $4000 valuation Occupancy Type Required Inspections Date % _%` 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'n" or better �90-ale, CITY OF CUPEkTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM 0905 oily APN# � �i n I ( l0`� Date:s•�Z•�� Building A dress: $(a0 vrtiGs z� ��C .1�� mks Owner's Name: Phone #: ����tf� (�50 •g3/• 3loS7 Contractor: Phone #: qo , -7q&. sa L(�qr W Fax #: 110b • %LAP• 5033 Contractor License #: Cupertino 13usiness License #: &§ y 5 z4W& Contact: Phone #: 51D , ib!Z . 2853 N0�1 L— 1J( Fax #: C) • 550.2(9 Building Permit fo: Elect ❑ Plumb Mech ❑ Residential Commercial Job Description ������� 6� ' ✓I' /�' �I �, _ _ I For Residential Installations: Attic ❑ 0 floor n 2nd floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Re uired ❑ Cost of Project: Type of Construction (Usage Class): q p()(7 -0 () W- �W f, --c Strapped On Platform 7 Bonded New Location Replacement Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Zany CUPEI,TINO CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of controls regulated by this code. 1MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial Install/Relocate ea M suspended heater,recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1 BPGAS For each gas piping system of 5 or P . more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit. 1BSEISMICO Commercial Seismic B 1 MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, r cooling unit,absorption unit,or ea ` heating, cooling, absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MRSUSHTR Residential Install/Relocate ea M suspended heater,recessed.wall htr, or floor mounted unit heater. 1 MRAPPVNT Residential for the install/relocate/ or M replacement of ea appliance vent install & not incl in an appl permit. CITY OF CUPERTINO Sys FURNACE/AC CUPEVINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of 1-4 Outlets P 1 BPGAS For each gas piping system of 5 or more per outlet. P 1BSEISMICR Residential Seismic B 1 MECPLNCK Mechanical Plan Check M 1 MFR=<100 Furnace Syst <=100k BTU install or relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h M 1 MFRN> 100 Furnace Syst > 100k BTU install or relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h M 1 EPERMITFEE Electric Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M / 1 PPERMITFEE Plumbing Permit P / 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B Z CITY OF CUPEkTINO CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type AIR CONDITIONING FURN/AC 1 BCAIRHAN Commercial A/C Units <= I Ok CFM B 1 MCRAA Commercial Mech Repair/alt/add M 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System 1-4 outlets P 1 PGASRES Residential for ea gas piping system of 1-4 Outlets P 1BPGAS For each gas piping system of 5 or more per outlet. Comm/Resid P, 1 BREMAIRHAN Residential A/C units <= I Ok CFM B 1 MRRAA Residential Mech Repair/alt/add M 1BSEISMICR Seismic Residential B 1 EPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B x.71 GAET February 25, 2009 IL COPY TO: CUPERTINO BLDG INSP DEP 10300 TORRE AVENUE ,0 CUPERTINO, CA 95014 `3' PROJECT: VILLA SERRA APARTMENTS BLDG 69 TNK 20800 HOMESTEAD RD, CUPERTINO, CA SUBJECT: WEEKLY SUMMARY OF SPECIAL INSPECTION(S) STL NO.: 0024656 D)� 2T"71"L�' SIV �l MAR U 2 2009 Special inspections were performed for the above referenced project. The inspections were performed by our certified inspectors as noted below. Please see the attached daily report(s). Date Inspection Tyne 07/21/08 Reinforcing Steel and Concrete Placement 08/05/08 Concrete Placement [Except as noted below, the] The work completed or in progress for this report is in accordance with the approved plans, specifications, and/or any approved change orders. This is a progress report of our special inspections. A final report will be issued upon request at the completion of the special inspection/testing requirements provided that all outstanding issues have been resolved and/or corrected. EXCEPTIONS: Daily Reports Dated: N/A Previous Reports Dated: N/A If you have any questions or if we can be of further assistance, please do not hesitate to contact our office. Respectfully submitted, Signet Testing Laboratories, Inc. J Michael Everson Division Manager /r c: PROMETHEUS REAL ESTATE GROUP/MIKE DUCOTE CUPERTINO BLDG INSP DEPT FILE COPY' 0024656.001 STL PM: BOBBY HAYNES, A 3121 Diablo Avenue • Hayward, CA 94545 • (510) 887-8484 • Fax: (510) 732-5060 ti Testing Labs, Inc. DATE: 7 -2,) -'U U DSA FILE/APPL. NO. PROJECT N0. 2S I OSHPD NO.Pt PROJECT PERMIT NO. V OS O i UY LOCATION: WEATHER: TEMP: 91 REBAR ❑ TENDON ❑ TENDON STRESSING 'j� Inspected the placement o� FyCI_N 61��NDONS / AS'S / HD'S / TIE DOWNS for the following location: ❑ Observed post -tensioning operations, measured and recorded elongations of tendons for the following location: [R CONCRETE iE cip ❑ Pc ❑ PT ❑ SHOTCRETE ❑ NS GROUT ❑ Inspected the batch plant operations. Batch Plant / Location: Fri Observed placement NC OTCRETE / NON -SHRINK GROUT at the following location: Cast _�_set(s) of compressive strength samples. I Slump(s): `[ % Ain. Mix # f -'>IT Z i b Total cu. yds. placed G-± ❑ Show up / Stand by time. Job Canceled I Delayed due to: ❑ All non-compliance items were brought to the attention of: _ Unit wt(s): at the job site. To the best of my knowledge, the o WAS I S NOT performed in accordance with the approved plans, specifications, and regulatory requirements. ❑ Except As Noted Superintendent/Representative: 3121 Diablo Avenue 1417 No. Market Blvd. #1 Hayward CA 94545 Sacramento CA 95834 (510) 887-8484 (916) 568-5858 Inspector/Technician: 520 Mercantile Dnve #A 3 1 i S. Main qf. 7580 Metropolitan Dr. #205 Cotati CA 94931 Santa Ana CA 9 707 San Diego CA 92108 (707) 665-3950 (714) 957-9512 (619) 682-3820 FORM # 304 (REV 121001 r�r S I G rT P T Testing Laos, Inc. DATE: '� 1 S log DSA FILEIAPPL. NO. PROJECT NO. /2-3-2-91 1 t�,1 OSHPD NO. PROJECT: \/I LL,9 5 MLA I7r /gyp MI'r 1 U"TS PERMIT NO, 0_5 LOCATION: 20 00 gaMG79r"Q (LD. CvPe1tr1 U0 WEATHER: C.LE)+fL TEMP: $� ❑ REBAR ❑ TENDON ❑ TENDON STRESSING ❑ Inspected the placement of REINFORCING STEEL / TENDONS / AB'S / HD'S / TIE DOWNS for the following location: ❑ Observed post -tensioning operations, measured and recorded elongations of tendons for the following location: CONCRETE )Glp ❑ Pc ❑ PT ❑ SHOTCRETE ❑ NS GROUT ❑ Inspected the batch plant operations. Batch Plant / Location: Observed placement of 46 E / SHOTCRETE I NON -SHRINK GROUT at the following location: re -W. Pao PAW' I-,tXJK P,3 D 806. i 3 PEO -M i ; 4t` OR05 0196 -recap- r(UP&Air rAMK 'AP 13um') . 22 PE+ertri 11"-05650187' P4ZOP Ak; t rALT9 PA -10 SOP(ban BL -06. 67 Cast set(s) of compressive strength samples. Mix # ` Total cu. yds. placed U Slump(s). 7 %Air: Unit wt(s): ❑ Show up / Stand by time. Job Canceled / Delayed due to: ❑ All non-compliance items were brought to the attention of: _ NOTES: at the job site. To the best of my knowledge, the abov A I WAS NOT performed in accordance with the approved plans, specifications, and regulatory requirements. ❑ Except As Noted 0Superintend tative: Inspector/Technician: 3121 Diab Avenu 17 No. Market Blvd. #1 520 Mercantile Drive #A Hayward Sacramento CA 95834 Cotati CA 94931 (510) 887-8484 (916) 568-5858 (707) 665-3950 d MtLLrR 1320 Simpson Circie 7580 Metropolitan Dr. #205 Anaheim, CA 92806 San Diego CA 92108 (714) 399-1500 (619) 682-3820