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B-2016-2513CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2513 22445 CUPERTINO RD CUPERTINO, CA (326 15 130) TRIPLE APLUM SING SERVICES LET STINKY DO IT CORP SANTA CLARA, CA 95054 OWNER'S NAME: FRONT PORCH COMNS & SERVS DATE ISSUED: 08/15/2016 OWNER'S PHONE: 408 593 6043 PHONE NO: (408) 855-8099 LICENSED CONTRA TOR' DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic. #943638 Contractor TRIPLE A PLUMBING SERVICES LET STINKY DO IT CORP Date X BLDG _ELECT —PLUMB X MECH _ RESIDENTIAL X COMMERCIAL 07/31/2018 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 JOB DESCRIPTION: license is in full force and effect. REPLACE (E) TWO BOILERS AND TWO CIRCULATION PUMPS I hereby affirm under penalty of perjury one of the following two declarations: WITH (N) BOILERS AND PUMPS, SAME LOCATIONS. 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 performance of the work for which this permit is issued. r 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 Sq. Ft Floor Area; Valuation: $75000,00 permit is issued. APPLICANT CERTIFICATION - APN Number: Occupancy Type: 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 32615 130 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 PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities, judgments, costs, and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source regulations per the Cupertino Municipal Code, Section 9.18. /i -// n Signature i�lA-Y1/W 1� Vl -- Date 08/15/2016 Issued by: PAUL O'SULLIVAN r41 Date: 08/15/2016 OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sce.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 08/15/2016 contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the 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 Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Code, Sections 25505, 25533, and 25534. exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such or this shall } '04 ` -fi provisions permit owner or authorized agent' JJ `�i be deemed revoked. Date: 08/15/2016 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the.granting of this permit. Additionally, the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.. Code, Section 9.18. Licensed CUPERTINO GENERAL PERMIT APPLICATION &%/67901_3 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 a building(c)cupertino.org PROJECT ADDRESS rd/Ya APN—# j OWNERNAME C) ti ONE v t EMAIL STREETADDRESS " A D 1\4� CITY, STATE,ZIP (r- Ury goo CONTACT NAME R PHONE P STREET ADDRESSg Y�( G4✓ ®W YL ZIP CI T TE'Cr � C 03' .. FAX ❑ OWNER ❑ OWNER-BURDER ❑ OWNER AGENT ❑ CONTRACTOR L'I .CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ./ ❑ TENANT CONTRACTOR / e n LICENSE NUMBER_ „� yj [� LICE TYPE BUS. LIC l COMPANY NAME % p✓/ EMAIL /� %/% 7 © 6�2Qf! n Gf%s�✓/ y FAX",, �. 3 STREET ADDRESS i�/ltra^ec�00 9d CITY, ST E, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD Or DUpleX ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: L'J Commercial URBAN INTERFACE AREA ❑ Yes No FLOOD ZONE ❑, Yes NO DESCRIPTION OF WORK (., w 5 AVIA&ya ) .I1 ' = _ _- By my signature below, I certify to each of the following: lam the property owner or authorized agent to, act on the property owner's behalf. T 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 buil cons ct. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. q-, a Signature of Applicant/Agent: �{, — Date: SUPPLEMENTAL INF016.ATION REQUIRED ""w` n w r ^` OFFICE USE ONLY LO I - �, ,�ivER-THE�COUNTER MEPMiscApp 2011.doc revised 03/16111 �' leACHIEVEMENT ENGINEERING Date: February 17, 2017 Proiect No: 2970 Chief Building Official City of Cupertino Subject: Dear Sir, Expansion Bolt For Installi-ng-Heafmg-Boifers 22445 Cupertino Road, Cupertino, CA, Permit #: B-2016-2513 Based on owner representative's request we visited the above job site on February 17, 2017 and observed the progress of embedding expansion Bolts and performed torque test for new heating boilers per approved plans and manufacturer recommendations according to the following Table: TYPE Min. EMBEDDED (In.) Length Quantity Torque ( ft -Ib) 1/2"Hilti KB -TZ 3-1/4" 3-3/4" 8 40 vve used the manufacturer recommendation for required torque test as it was not specified in the approved plans. In general, work was in compliance with page P1 dated 02/22/2016 and manufacturer recommendations. Inspection was performed periodically and on call basis as requested by the owner's representative. We claim no responsibility or liability for damages from improper use of the results or findings.We do not undertake the guarantee of construction nor do we relieve thecontractor_ of his primary responsibility to produce a completed project in ~accordance with plans and specifications. Our findings refer to locations that were inspected by Achievement Engineering representative. If you have any questions or need any additional information, please feel free to call us at your convenience. Sincerely Yours, Farshad Safaian, P.E. State of California Licensed Civil Engineer CC: The Owner AT Address: 2455 Autumnvale Drive, Unit E, San Jose, CA 95131 -Tel: (408) 217-9174, Fax: (408) 217-9632 www.achieveng.com Form R-11