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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRA-TORIN'FORMATIO,�N
BUIL DING ADDRESS:
DOUGLAS ROSS CONSTRUCTION Fytp(1T"904050174
1
OWNER'S NAME:
PERMIT' ISSUE DATE
MENLO EQUITIES
E:
SANITARY NO. CONTROL NO.
(650)470-47
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 hereby affirm that 1 am ]imn.¢'d'{yOder provisions of Chapter 9 (commencing
with Section 1000Fof Divlalan 3mf NCB.p=mal Professions Cram. and my IIecom is
in full fa d effect. V
Lianacl ue.x3804i-
UNDERGROUND GARAGE 66,266 SQ.FT.
a
Dale — CmdMcmr ;_A'7C 01.,7AAa'
`
A CHDEC7rS DECLARATION
1 undersand my plans slash he-W-P-a�cawards
-
Licensed Pmfmsional
OWNER -BUILDER DECLARATION
1 hereby affirm Thal 1 am exempt firm the Contractor's License Law for the
fallowing reason. (Section IBJ 1.5, Business and Pmfemiume Calc: Any city or County
which squires a permit to conswct, alar, improve, demolish. Or repair any structure
prior in its ismana. also nuItin m the applicant for such permit o file a signed sediment
is licensed of the Contractor's Uccnoc Law (Chapter 9
Sq. Ft. Floor Area
aluation
that he pursuant o the Provisions
(commencing with Section 7") of Division 3 of Oc Business and Professional Cade) or
Nat he Is exempt themffom and the basis fa the alleged exemption. Any violation of
3 J AfP?Z?0tn{b6r4c
cy Type
Semon 1m1.5 by ay applicant for a Permit subjects the applicant to a civil penalty of
not mare an Ba hundred dollars (S50F.
❑ I, as ow erofthe pari army employees with wagesMmev sole compensethan,
Required Inspections
will do the work, and thcawmure is nolimended or oRcsd f e som (Sal. 1064, Buaineas
and Professions Code: The Conmetor's Liame Law dam not apply to an owner of
property who buildalorimpmons theann.andwha doessuch work himselfar through his
/
WO employees, provided Out Such improvements all not Intended oraRtad formic. If,
- O
however, the building or improvement is sold within one year of completion, the owner -
builder will hilae the human of proving Nat Im did not build or improve for purpose of
sale.).
❑ 1. as owner of the property am exclusively contracting with licensed canuacmrs to
V
`J
construct Ne project (Sec. 1064, Business and Professions Code:) The Convector's Li-
-
Came Law dam not apply in an owner or property who builds or Improves wemon. and,
X\
who contracts for such pmiccn with a commemr(s) licensed pursuant to the Connectors
License Law.
❑ 1 am exempt under Sec. . B & P C fm this Oman
Owner Das
WORKERS COMPENSATION DECLARATION
1 Mreby affirm under penalty of perjury one of this following declaration:
have and will maintain a Certificate of Consent to self -Insure for Werke'sL'ampan-
ratian, as provided for by Section 37M of the lobar Code, for On pen omana of Ne
work for which this permit is issued.
❑ 1 have and will mountain Walker's Compensation Inurame. as required by Section
37M afthe tabor Code. for she performance of the work for which this permit is issued.
My Worker's Compensation Inumomen carrierandPolicy number art:
r. �1 11ky 10 %iLak� /9i4�rgncy NO.: 00000 s/
_
CERTIFICATE OF EXEMPTION FRWk$ORKERS'
COMPENSATION INSURA E
(r u s section need not m com plemd lobe permit is for ono hundred dollars (SIM)
or IessJ
1 certify that in the performance of On, work for which this permit is issued. I shall not
employ any person in any manner so as in become subject to the Workeri Compcnation
Laws of California. Dila
Applicant
NOTICE TO APPLICANT: IL after making this Cenifrcate of Exemption, you should
become subject in the Wohcr's Compensation provisions of the Labor Code you must
forthwith comply with such provisions or this Permit shall be deemed revoked.
I
CONSTRUCTION LENDING AGENCY
I hereby affirm Nat thea is a comwctinn lending agency for the performance of
!
the work fur which this permit is issued (Sec. 3091, Civ. C.)
Lender's Namc
I<nder'saddtess
1 certify that 1 have Mad this applieamn and sae Nat the show information is
coned. l agree to comply with all City and county ominuras and sus laws Mating to
building Construction. and hereby mdumi a mprmemA iim Of this City to enter upon me
ahovcmentioned property for inspection purposes
(We) agree to save, indemnify and keep humless the City of Cupertino against
liabilities, judgments, costs and exponses which may in any way eccmc against said City
in con"Cionse, of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCEREgU
-LATIONS.�/
� '2'7`o
Re -roofs
Type of Roof
"71"
in ofd linedndc; ntramor\ m
HAZARDOUSMATERIALS DISCLOSURE J
Will handle
f fmuniipal
yOCCportinant
Chaptrtomor
Code, HeaAousmaarial
u defined by the Cupertino Municipal Code, Chapar 9.12, and me Health and Safety
Code. Section 25532(a)?
Ym
All roofs shall be inspected prior to any roofing material being installed.
Will On of fu 3eea
applicanfuturebuildin "".4 --pant sea equipment or devices which
If a roof is installed without first obtaining inspection, I agree to remove
g an iection
P $
E hazardous air contaminants m defined by the Bay Area Air Quality Management
all new materials for inspection.
atricty s�
❑Yes /j�5isa\
1 have mad the huamum materials requimments under CTapar 695 or the Caliror
ria Health & Safety Cade, Section 25505,25533 and 25534.1 undersand mat ifmc Wilding
does am currently have a ansa, mu it is on, respeashility to Country the occupant of We
Myuimments which mus he at p/rior imauta ora certiheam ora ancy
Signature of Applicant Dale
5�LliG� r,/ 1r'2
All roof coverings to be Class "B" or better
Owner lir authorized agcm W.
,NAL
1V LI�Yu uu •�.: • ����
ANNEX E _
IL �
� I /b6
Company Noms -42
Wowing Prom"(ee)_
t3ttppextk+q PGR No.(s)
FAX N0. : 7077655993 Aug. 25 2006 09:55AM. P2
/�"`"
WING PCED-
L�CJFICATJONsDOd7UE
MQUALIFIM ,��� QUAUFMD BY TESTING
or PROCEDURE QUAUPICATION REC00111(PQR) YN
ANT DMON UM
ralor
single 0?oouble WeldD
smoing; Y44 t3 NOCK
Ila*" Mnt*mall:
Root opsr*vl .A, -.. Root Few Dimerwton_ . �—
Croove Angle; ROAM (J-0)
Boo ttAupinD: ve■ No:a Method
BADE MOTAL.S
Metertoi
41M- A
Thblateoe: Groove PON
.--�-
Dirrow(Pti*)
Al1ER METALB
AWS Spedficetion-
AWS 04961111C400n
t3tHE1.DIN6
,..-
�
Lae
Type B Am or Wire
Con�pesmon _.
E1ee�rodaFlu>t (Cleee`�..
_ _ FlaMr f4ats ,.,;,.� ..^
Go$ Cup Stse
�r�AT
'7X r,
preheat'hmp.r MinA�&r_
(nterpaeb Temp., Min_ZC.,,_. Max 7 a
was or
Weld
Lm"r(o) Proane
Form Ert V"m)
D1,1ID1.1NC10q
IdentMaatlon S A W, fW t: `-=is
Revieipn QeAe
Awlharized by 084
Typo—Manuel so"111AuWn'legc
Naohino ❑
POSITION •
PoeltW of Gro4Mo;.�E. TIS FMiet: .-.
WAtoat tato mm ion; Up K Down D
KCAL WARACTERISTIC&
TrsnAff Mode (0MA" QhO?t-ChVAIVU
Globular
Curren: AC [] DCEPfiC] DOME] Puleod D
Other
Tunflstsn electrode (GTAW)
Size: -
Typo:
TBCMNIGUB
stringer or Weave sead:.,,����GL.....•
Mu*"" Of Single Pass (per *A) 0200 m
NurttW of Mootreess 1
EISat OCIS SpoGIng Lateraldinel _ •�._ •.
AnQtS .�
K r,
Contact Tubs to Work Olstence ZA Tb L —
Peening
interpose trieening; _Itt /!
POSTWELD NEAT 'f AAi:Nr
T.
wriE ,DINt3 PROCEDURE
FW W Me"
Cturent
Type B Am or Wire
Cies
Dorm•
Polarity Food Speed
334
Travel
vats ap"d Joint Deish
-NAL FAX N0. : 7077655993 Aug. 25 2006 09:55AM P3
. TesdAs h WVOCWn 54r1k"
ruy Conud • CerWW A.W.S. WNW VOP -Om
,,Jay xC Cor>aruna AI,ay INSPECTIONt INC. . CzrUr*d t.C.s.o• trapecWn
ti 1Je. t 23371 • Coaan cuw lrepead-
• CerdAed Nmn"twcuve T"ma
326 Woodrow Avenue . Cemw A.C.I. Car""&
Vallap, CA 94591-7302 . pmo(yomd ToWns
Telephone: (707) $52-7037 . Welder Cain
Fax: (707) 552.7022
WELDER & WELDING OPERATOR OUALIFICATION TEST RECORD
Welderorweldlnpoperaorm
snae Cesar Juarez Identification No -34R -;0-55_t30
Welding Prod
A Manual Semiautomatic _1L Machine
Position1 1 or downward)
(Flat, horizontal, overhead or vertical if vortical, state whether upward
in accordance with procedure speclication no.
MaterWspecitication A36 Groove late
Diameter and wait thickness (if pipe) ^ otherwise, joint thickness
Thickness range this qualifies Unlimited
Awl +t r #tl ks„ «�3tt +a,i �' 3� # KgW-i FILLER METAL " � ` � ►'i���i�'i36 I���e� lE
$peciCication ra
AWS A5.20 Classd"lon E 7 1 T-8 F no.
Describe fiUar metal ()f not covered by AWS specdiication)
d bsddrq suip used?
Filler metal diameter and trade name . Lincoln .072 Flux for submerged arc or gas for gas metal arc or flux
NR2 3 2 cored arc welding
At4,g,�M'AWX VISUAL NNSPt;:CT10N (
0.25.1)&rNon�e t4
�ara� Good Undercut None Piping porosity
GUIDED BEND TEST RESULTS 40m��4atY- i?rff,
Type
Result Type Aasutt
Two 2) Side GOOd
Test conducted by Carroll-, Strickland Laboratory test no.
Dir AlgS Q1 -1-g002 , Test data 10/3105
FILLFT TEST RESULTS MMUMN ' d ',<- ��
�
Appearance Fillet size
Fracture test root penetration Macroetch
(Describe the location, nature, and size of any crack or tearing of the specimen.)
Test conducted by Laboratory test no.
Per Test data
RADiGGRAPNIC'TES7 RESULTS ON
Film Flkn
ldentdication Results Remarks Identification,&^ Results
Test condvaod by
Tsst
Per .
We, the undersigned, certify that the statements in this reoorti era ocrted acothe welds were prepay tested in
accordance with the requlremems Of SQction 5. Part C or 0 of ANSUAWS DIA, ( 2002 t Structural Welding Code -Steel.
yar
Date
Authorized by —�
NAL
FAX N0. : 7077655993 Aug. 25 2006 09:55AM P4
CWWUn� ALLEY iNSP INC.
:Tom`' ".W
.CrION,
Cerdnee LC.B.a kapecdon
lie. t 233714
• consumum kdpecdnn
326 Avenm•
Vallejo, CAA $459 •7302
TeleptMW (707)552-7037
Fan: (707) 552-7022
Cwaffed Ilan -D uumm" Teaana
• Cerffied A.C.I. Coacmw
•FinarLaid Ttsdns
• Welder Ceri fkadon
WELDER & WELDING OPERATOR QUALIFICATION TEST RECORD
Weldor or welding operator's name, Cesar Juarez Identification No. 3 0-= 3 0 – 5 8 0
Welding process FCAW Manual Semiautomatic xMachine
Position 4G Overhead
(Flat, horW mtai, overhead or vertical lt verticil, state whether upward or downward)
In accordance with procedure specification no. A WS 01 . 1 – 2 0 0 2
Material specification A 3 6
Diameter and wall thickness (if pipe) — otherwise, joint thickness 110 Groove Plate
Thickness range this qualifies Unl i I ted
i <mFILLER METAIL AMAMMOM" . i MOM MM -1- `
Specification no. AWS A5.20 Classification E 7 1 T-8 F no.
Describe filler metal (if not covered by AWS specification)
N backing strip used? Yes
Filler metal diameter and trade nameLi ncoln .072 Flux for submerged arc or gas for gas metal am or flux
MR2 3 2 cored arc welding
s o k " " '14i`t �'', *:N. »"►e t a ` VISUAL INSPECTION (9.25.1) iceft- HW -'A l.,s;iMW-.' 99000 iD(At
Appearanoo Good Undawut None piping porosigN ao
GUIDED BEND TEST RESULTS
Type Result Type Result
Two L ) Side Good
Test oonducted by Carroll Strickland Laboratory test no.
per AWS 01.1-2002 Test date 10/3/05
FILLET PEST RESULTS 0%,VM4 Mai
Appearance Fillet size.
Fracture tat root penetration Macroetch
(Describe the location, nature, and size of any crack or tearing of the specimen.)
Test conducted by Laboratory test no.
per Test date
T#sa'ix�i� T RADIOGRAPHIC TEST RESULTS
Film Film
Identification Results Remarks Identification / ft
Its
)66b.�
Test oonducted by Test no. 1 +ricom
per — .`!•�
We, •the undersigned. certify that the statements in this reowd arse eonea and that the welds were prepared and tested in
accordance with the requirements of Section 5. Part C or 0 of ANSVAWS 01.1, ( 2002 )Structural Welding Code -Steel
A y6fir
Authorized by Date