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B-2016-2781CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2781 19000 HOMESTEAD RD UNIT 1 CUPERTINO, CA 95014-0716 (316 09 036) AXIS MECHANICAL INC SANTA CLARA, CA 95050 OWNER'S NAME: ARC KFCPTCA001 LLC I DATE ISSUED: 09/22/2016 OWNER'S PHONE: 408-851-0671 PHONE NO: (408) 573=7400 License Class =- Lie. #974024 Contractor AXIS MECHANICAL INC Date 06/30/2018 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. I 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 BUILDING PERMIT INFO: X BLDG —ELECT _ PLUMB X MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: UNIT 1- REPLACE (E) HVAC UNIT (SAME LOCATION, ROOF TOP) - KAISER Compensation, as provided for by Section 3700 of the Labor Code, for the �J performance of the work for which this permit is issued. A,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. Sq. Ft Floor Area Valuation: $180000.00 APPLICANT CERTIFICATION 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 9-22-2016 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) 2. 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 Consentto 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. s. 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 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. Signature Date 9-22-2016 ATN Numberi Occupancy Type: 316 09 036 1 A ('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 Date: 09/22/2016 RE -ROOFS: 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: 9-22-2016 ALL ROOF COVERINGS TO BE CLASS "A" 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(a) 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: 9-22-2016 CONSTRUCTION LENDING AGENCY 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 understand my plans shall be used as public records. Licensed COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building@cupertino.onq PROJECT ADDRESS APN# 34-07- c-36 OWNER NANM/ 4, rC p7j� %1 1_ 1-0 N( E-MAILPHO 4� d7i STREET ADDRESS CITY, S�TE ZIP V FAX 2— CONTACT NAME STREET ADDRESS P CITY FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 11 CONTRACTOR 13 CONTRACTORAGENT 13 ARCHITECT 11 ENGINEER 0 DEVELOPER 11 TENANT CONTRACTOR NAME LICENSE NUNME!4,, LICENSE TYPE BUS. "ro(03, COMPANY NAME A E-MAIL .7 FAX STREET 2 , STATE, ZIP ARCHITECT/ENGINEERNAME kLICENSE NUMBER qUI%OER BUS. LIC # CONIPANYNAME E-MAIL PF � '0 2 STREET ADDRESSP 0 USE OF ❑ SFT) or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN El YES is T<M BLDG AN El YES BUILDING: ACOMMERCIAL, URBAN INTERFACE AREA NO FLOOD ZONE NO HICHLERHOME? NO DESCRIPTION OF WORK TOTAL-VALUATION� By my signature below, I certify to each f 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,,gree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-i4pfitified p perty for inspection purposes. Signature of Applicant/Agent: iqry it C1 wle&4 +W1:1 MEPMiscApp 1. doc revised 06121111 2001 Crow Canyon Road, Suite 100 PME// San Ramon, CA 94583-5387 CONSOLIDATED ENGINEERING G Tel. 925 314-7100 Fax. 925 855-7140 L A B O R A T O R I E S www.ce-labs.com INSPECTION/TESTING REPORT Date Of Issue: 5/22/2017 RE: Kaiser SCH Tantau AC -1 Rpt City of Cupertino To: 10300 Torre Avenue Cupertino, CA 95014 Attn: Building Department Inspection Date(s): 5/6/2017 Location: Jobsite Report # 170512Field Inspector(s): Carl Madriaga 11DUD ov� FIELD WELDING On the above date, our representative inspected the referenced project. Permit B-2016-2781 CEL# 1032246 Please refer to the attached reports for details and locations of our testing and/or inspection services for the above noted date. Work inspected was in compliance with approved plans and specifications. CC: Enclosures (3) Axis Mechanical Inc. (ER) City of Cupertino (P) MSI Consulting Engineers Inc. (ER) Kaiser Capital Projects (ER) Reviewing Engineer: Greg D. LeRoy, PE Axis Mechanical Inc. (ER) RECEIVED MAY 3 0 2017 i All reports are submitted as the confidential property of our clients. Publications of statements, conclusions, or extracts is revised pending written approval. Form ID 017 Rev.0 CONSOLIDATED ENGINEERING L A B © R A T 0 R 1 E S Structural Steel Welding Project Name (Kaiser SCH Tantau AC -1 DSA File # CEL Project # (1032246 DSA Appl # — Project Location C19000 Homestead Road, Cupertino, CA 95014 — JI LEA # - — Contractor xis Mechanical OSHPD # Date %06/20.17 _ Day Saturday IR # ( Permit/Appl # �113-2016-2781 Drawing No. (1,21S3 -- Detail No. i _ Other Work at: ❑ Shop ® Jobsite Type of work: ® Structural Steel For shop inspections: Shop Name: 1 Reported to (Name) —__- Address: ( Company: Axis Mechanical ❑ Collected ❑ Checked mill certificates Sampled: Verified: ® Welder qualification ❑ Procedure qualification ❑ Weld procedure specification 0 Visually inspected the: ❑ In progress Qualified Welders: cardo r ® Completed Using Electrodes: ., c 'a SMAW ❑ Filler Metal Type(s) E SAW ❑ Filler Metal Type(s) E I M FCAW ® Filler Metal Type(s) E ( T-8 GMAW ❑ Filler Metal Type(s) E D —� — — — Other ❑ Fillet Metal Type(s) E ❑ Verified proper electrode storage. Preheat temperature maintained ❑ at ❑ Maintained per WPS requirements ® Maintained per AWS D1.1 d Verification of E ❑ Wire Speed ❑ Are Voltage ❑ Current and Deposit ® Proper Fit Up IL rRate per WPS ❑ Groove welds ❑ Complete penetration ❑ Partial penetration ❑ Flare -bevel Fillet welds: ® single -pass ❑ multi -pass ❑ Direct ❑ Indirect butt splice on reinforcing steel a- - ---- -- - - -- - a; ❑ Other N For: ❑ Base plate ❑ Gusset plate ❑ Connection plate ❑ Moment plate ❑ Plate -to -plate Splices 0 ❑ Stiffener plate ❑ Reinforcing steel ® Brackets ❑ Bent plate ❑ Beam to column connections m ❑ Other: E at: ❑ Wide flange columns ® Wide flange beams ❑ Tube steel columns ❑ Tube steel beams ❑ Embeds ❑ Beam to column ❑ Girder to column El Column to column splice El Chord bar splices ❑ Diagonal brace to ( ❑ Angle to , ❑ Studs to ❑ Other v Inspected on metal decking 0 N ❑ Arc spot welds ❑ Stitch welds ❑ Shear studs ❑ Button punch s: Form ID 017 Rev.O CONSOLIDATED ENGINEERING L A B O R A T O R 1 E S Structural Steel Welding Refer to the attached: ® Field Inspection Record ❑ Member Completion Record ❑ Material Identification Record RWork inspected was: ® Completed ❑ In progress ❑ Pending approval ❑ W.I.P. punch list E E ElNon-compliancereport was left with contractor 3 ❑ Items were reinspected and ❑ Accepted ❑ Remain in progress oSee the attached El Punch list ElNon-complianceItem # m W Issues/Problems? KUYes OO Notified: �_ ,i Company Name: (Observed and visually inspected the completed welding of the angle brackets to the wide flange beams for the placement of the new AC unit All work was performed in accordance with the contract drawings and AWS D1.1 All completed work was marked VT OK CEL 27 5-6-17 c m' E; E' o U w m O Z This Work *as INSPECTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE PROJECT APPROVED DOCUMENTS The Work Inspected (et J THE REQUIREMENTS OF THE PROJECT APPROVED DOCUMENTS Material Sampling PERFORMED IN ACCORDANCE WITH THE APPROVED DOCUMENTS Signature of Special Inspector 2 Date '5/6/2017 Print Name/Title Carl Madriaga CWI Certification #: AWS 07061161 G CONSOLIDATE© ENGINEERING L A ® O R A T O R 1 E S Field Inspection Record Form ID 020 Rev.0 Project Name (Kaiser SCH Tantau AC -1 DSA File # CEL Project # 11032246 J DSA Appl # Project Location 19000 Homestead Road, Cupertino, CA 95014 J LEA # I- Contractor (Axis Mechanical OSHPD # I( Date (05/06/2017 j Day (Saturday IR # ___--- ,i Permit/Appl # (B-2016-2781 ® Field Inspection - --------------------------••-------o Weld/Connection Type CCCCo eette P n pati Grao WWeltl HSB H h stye m SC BoRColumn ��� --- 9 ----------- - ----------- Member/Joint Type iu e tee n le be o B eDar S li a j8 `�f�oto�eam N.D.E. V'sual r kr Note: Use seperate line for each rejected weld. pr�a�Penr anon e, Io g gI� hWaig a gouge Ire e 1 Groove WeQ� BG 9 ck au a tg y 11il. te t PP e e e m%� n S mm t�e }u�e tel � e s�e're c$s§�roa: o e t Steel set to lumn 5 irectc a ar p ice j� tt 6 E c t c art gTestin g ' 6 �e an snn Vo� Upon reinspection, W weld is rejected, list weld as a Slee?g�� eltl omumn e m F @}'7�} Stu to eaMDeck Wet' t C ec lona o$r�pe f es4ngg u n --i—t.el —1,1 MSF/D M ta1VtuSFreming/Ury—II --------------------------------------------------------------------------------- Level Weld/ Member/ Locations Visual NDE Accept/ Repaired/ Status Remarks Connection Type Joint Type Type Re'ect Reinspected Roof FW L -BM Roof AC Unit Yes Accept Complete Notes/ Comments: This Work as INSPECTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE PROJE APPROVED DOCUMENTS The Work Inspected Met J THE REQUIREMENTS OF THE (PROJECT APPROVED DOCUMENTS Signature of Special Inspector Date `5/6/2017 Print Name/Title (Carl Madriaga CWI Certification #: i�I WS 07061161