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15090171BUILDING ADDRESS: 20674 HOMESTEAD RD (326 10 066) CITY OF CUPERTINO BUILDING PERMIT TIGO CONSTRUCTION COMPANY SAN JOSE, CA 95112 NO: 15090171 I OWNER'S NAME: SOBRATO INTERESTS ET AL I I DATE ISSUED: 02/08/2016 I I OWNER'S PHONE:. JULI SATOH I I I PHONE NO: (408) 487 -0700 I III Lei ma 04 Ixome I vax"1191,4-1 1 �.:_• es License Class 5 Lie. #595540 Contractor TICO CONSTRUCTION COMPANY INCORPORATED Date 06/30/2016 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: . 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. 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 E— permit is issued. r 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 Ctypertino Municipal Code, Section 9.18. Date 4/6/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three declarations: 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 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. 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 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. (vile) 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 4/6/2016 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: 1000 DEGREES PIZZA - T.I. TO RECONFIGURE/UPDATE (E) A -2 OCCUPANCY (2,036 S.F.), INCLUDING (N) ADA REV #1 - REVISED MECHANICAL TO SHOW TYPE 1 HOOD. Sq. Ft Floor Area: Valuation: $200000.00 "N Number: Occupancy Type: 326 10 066 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ABBY AYENDE Date: 02/08/2016 QI& 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: 4/6 /2016 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. f Ow; er or authorized agent: Date: 416 /20 1 CONSTRUCTION LENDING AGENCY I 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 Professional - - - -- CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE. • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 building(a�cupertino,orq �% CUPI =RTIN0 - f q i f ❑ NEi�W CONSTRUCTION ❑ ADDITION F ALTERATTnN / TT V �FvI�TnlJ�r nFFi RRFn r) T , ST p�nr rr r /5o9 01� ) PRO D 7J APN ry !y /� / 3 v •- ( OEC) 7 `7 ` 6 G� e T L �l .o iL OWNER NAME t , (i ISOL+o k PHONE ti 7 J 1p Lo 4 E vAIL JaS0 H t STREET ADDRESS CITY, STATE, ZIP FAX CCA CONTACT NAME C�a p � V,%k CkZ C%► PHONE I E -MAIL. `!°Y STREET ADDRESS CITY, STATE, ZIP FAX El OWImR 11 OWNER- BULLDER ❑ oWNERAGEN"r {CONTRACTOR - ❑ CONTRACTOR AGENT ❑ ARCHITECT El ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME L_f2 C)\ P ®C Z LICEI3SENIJMBER LICENSETYPE So I U5� BUS. LIC9 COMPANYNAI E E -MAIL Go ls►2 @Ti r l� C FAX STREET ADDRESS i5t5S PWP- IS XjdV , CO3 �S%\ � PHONE 41C ARCHITECT/ENGINTTEER NAME LICENSE NUMBER BUS. LIC R COMPANY NAME E -MAIL FAX _ STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK a -j i �'�► ! ✓C -�r/� P/'�1N�4d�T -P\0V-% CL 4-c- ([- �V ihM�FI` EXISTING USE PROPOSED USE CONSTR. TYPE #STORIES _ USE TYPE OCC. ( SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA •- BATHROOM KITCHEN .OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH - - - - - ATTACH - DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? EINO ADDITION? EINO - PRE- APPLICATION ❑.YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL V U TION• - PLANNINTTGAPPLm []NO PLANNINGAPPROVAL LETTER I EICHLERHOME? NO - I By my signature below, I certify to each of the following: I am the property owner or auth onzf, agent to a o '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 nd verify it is ccurate. I agree to comply with all applicable local ordinances and state laws relating to building c tiom I authorize representatives of Cupertino e above - identified property for inspection purposes. Signature of Applicant/Agent: Date: 3l ;L-5 % OLD 1Cp SUPPLEMENTAL INFORMATION REQUIRED - 'New SFD or Multifamily dvv>ellings: Apply for demolition permit for -� oFER T�COLIhTEx � i BUILDLIGPL4NRESW existing buildings ). Demolition permit is required prior to issuance of building MO _ permit for new building. I]xPxr ss 0 rLanxiLhGPZ FLU vI1 w Commercial Bldgs: Provide a completed Hazardous Materials Disclosure =� sTD 17 PLaBroRxs form if any Hazardous Materials are being used as part of this project. %................. ialiG §- _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.R _ u .. EIViLtOTtNlEAT_4LHEAISTA BldgApp_2011.doc revised 06 /21111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15090171 20674 HOMESTEAD RD CUPERTINO CA 95014 (TICO CONSTRUCTION COMPANY INCORPORATED) SAN JOSE, CA 95112 OWNER'S NAME: SOBRATO INTERESTS ET AL DATE ISSUED: 02/08/2016 OWNER'S PHONE: 408- 278 -1166 PHONE NO: 408 - 200 -6920 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 5 Lic. #52554Q Contractor ( TICO CONSTRUCTION COMPANY INCORPORATED Date —BLDG —ELECT _PLUMB — MECH — RESIDENTIAL _ COMMERCIAL 2/8/2016 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. 1000 DEGREES PIZZA - T,I. TO RECONFIGURE/UPDATE (E) A -2 OCCUPANCY (2,036 S.F.), INCLUDING (N) ADA I hereby affirm under penalty of perjury one of the following two declarations: RESTROOM(S) 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. 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 Sq. Ft Floor Area: Valuation: $200000.00 this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will 180 DAYS FROM LAST CALLED INSPECTION. comply with all non -point source regulations per the Cupertino Municipal - Code Section 9.18 Issued by: PAUL O'SULLIVAN j l� '�W J-�w Signature l Date 2 /8/2016 Date: 2/8/2016 OWNER - BUILDER DECLARATION RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of the installed without first obtaining an inspection, I agree to remove all new materials for following two reasons: inspection. 1. 1, 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 Signature of Applicant: for sale (Sec.7044, Business & Professions Code) Date: 2/8/2016 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code), ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: 1. 1 have and will maintain a Certificate of Consent to self - insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will 2. I have and will maintain Worker's Compensation hnsmance, as provided for maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the by Section 3700 of the Labor Code, for the performance of the work for which Health & Safety Code, Section 25532(a) should I store or handle hazardous this permit is issued. material. Additionally, should I use equipment or devices which emit hazardous 3. 1 certify that in the performance of the work for which this permit is issued, I air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the 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, ode, S n 503, 25533, a d 25534. exemption, I become subject to the Worker's Compensation provisions of the I Labor Code, I must forthwith comply with such provisions or this permit shall Owner or authorized agent- be deemed revoked. Date: 2/8/2016 CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance I certify that I have read this application and state that the above information is of work's for which this permit is issued (Sec. 3097, Civ C.) correct. I agree to comply with all city and county ordinances and state laws Lender's Name relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Address to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally, the applicant I understand my plans shall be used as public records. understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed . Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVE_l.l..}P (AE N T DEPAR I ltlEit}`1 BU1LDiNG DIVISION '10300 -i O RE AVENUE • CUP ER E (NO, CA 9,50 H -3255 (40,8) 777-3228 , FAX (i08) 71-7-3333 t�uilr}i}tcl(�ilc utae- riino.nrt� /o '7 CLJEtRi1hI G .t.}i }21'f`1W11 ' .:11'ITF7#` WOK I'll 1-1 ii11q<1112a 1'%Vl,lrlmr:n t'rRlrijlf .tf ar. f�aain, PROJL} I Ai l)RENiS 1 t }rV.a .J 0 _. - }} t t't F tSll tl }tr11: ti s I^' i 7: tt Nil p _ J i Sitii`ta r1 }115ti t.�S t�, y y jj SIAI }.,ZIP ,} ' g,>g UD L7 3V 7;1 j# j I_•tilrVi r'� � t.: ibb d J.. j' i br t I cot . S.}13 " Jos, 1 -5 1 .. _ 133-1\ _ 01 . 0 Cwm.fl- I11LD1Q{ tWM \ri -::1 01 {i); ZA(hit !­LO,` IRA TIJRAGIz ?•I na „ Ati {'ttlr };ti 11 HNGI IA—A m.vrliii'LR 1 Iis` ?itit - CQXIi{.tCIO t.:}.ff; I RI at- t. 114111 I HCO4$17 1lPF ............ . . ... _ ......... .. .l ........... . ,, i Lit C:iR ii t,M �A,%ll. 1 111 tit p t j°o FAX ..... ........................ "II{I:i: }-- ii)i3RI:S5 C:f }i.M1.1}k l:-fi` % i'i }tltil� -Ib .t } {tlil"FF i [3 (1'vl F tt hA\ }i .�3 y1 1 I(i St ^Jt tlkil k 143 }3F S L1C'r` CUM V t } lltSt1 1 §I II ._ tiERCI:Thl)151iC;5S�i ?* (h Ave, :11` }. IAIr:.7i1' i lit {}tiij, $U'7 111 St RI IIO 01 WORK N:sE�r1 i i. tit f} {[71 flSl ttl�li �. CoN.slIL rymi I olms, 1 }SI TYPE t t OCC. - Sri T. 4 rI i } I ION IS! G \hl[ til ri }t +J {)I. � 3A tilt lffl ARE \ .iRl i g :tltl 1 �I I lRl i V .13 I � �„ZQ _.�.. -_ ... .. ._..... } }lE 11ill} { ....4.,,., ._._... ... - >_. C 4 1 t it iU1I idtl �l } ;} tt {N}I t.S4{I t � t{F S[Uiit t AREA ....... ,_ ...... __. ,-- ­---.---­­,J .. _.. _.._. I'd Kl ii ARLA Cil:€#: ti i t i 11)7 i }. f7fL7t..i fi[t(II Alli t ! Cisll.a t,F �.ii3 f31i1 IAC91. ....._..._,.._ ...__._.y ... . _ _.,.. .____ .._....._.. ...._ ............................ . t � j„yt.lac'n i 1S ,t S[;c i)SR t' \I7 Y7a ti1;i1)fibtirt)RY' ]} };S .. .._. -, ] ilf'.l.\(:,tlllil ; ll ", (...]. [) :1tim ITim! i'iil t3 }i s \111 C11:. SF ti`4,iit {> 611 i! ri)l} [sl Is 1111: 111 ist tN EY }.. P }A�Mi I.,.ill - :C> FiA,; }- .[,,111 },uS'1L 31 ii } +1 }It'fIL].IL IRilll.' HECI_ �,y �ll')I' L \r'f;l , \TIC - By m 412;A311tra: bclnw. I certify to each 01 1110 lcillowi1 - *, } : ;ITY i]7C j11 S1jiCi'ID' ti75'fi�Y a �Sv7EV Ult fivr'� belialf. } li ;t'C wad On, :1 111ti3i:ta[7: =1111 tilt ltili�ltll3iltii7 ! have � t'1 ed en cci l 17i11C read tilt: D X71 F1. ` }} oti. nuid velif,% l ':. I .11rale.. ! j c- to comply with all .111111icable.lill;l} ortllll' net"; and tl lw late '.1. l l'�t11 1 I) 3 171St rtf`v }1{ 15 I .ltiil11Yr11t f l %iC3cilt IIIF t 1. i IIl1 It 177(1 Lx( Il:ti tliL tl'!{3tt KI 7111111 tl I1CUIltiri \` itii7 illWlit Lli rilr1�111lUt1ji1t71�L',,jv.. %. kv Aicaul 1 at !), tl `t � J 1 .._ .. ., .._... ..... _,. ..._..._ _ - ,•�.z E/ V SUPPLINIINTAI I N I 7R.N4A -1 "ION RI-- .Ql.JIIt11) PLASctit.-CK TYPE Rt7IAT"C: IYVIII New S1 i) Or N'I01li RRiiily Clt ell i3 Apply lo}' demolition 11tH ?lit lt)J t7t kii FIIE.Ctri \Tk)t El Ot tl.Pt;-Nt.. F L.tV it},ti'}(_1V exislim, building,0 , Mmoliil Sit .riD}l is i'e(pirud prior to i'..Ii inev Af fmildillu permil 1111 "lh =R' 0 PLAJNt'at. PLAN HLVIt -at' { ollimeteii;d BILIgs: I'lovide a complefed 114ini-t11)lls'Mal.liak Disclosure SFA-1 )\RD PUBLIC WORKS form it any I l<Izart ous Nlitterial_1 me 11l`.}R}S tlti['d as Imrt o. "tltl); prtliitil. r-'�i L-1 t AItUE tr��-li El rita. iw -ri' Cop y of Plannin}a Approval Letter or- Mccliftg % illl prior it) El :t1,t,u)je n str'ralt}'sl:ttr;klut• °r }{tet ' ubmillal of Building 11crit}it lipplicatioll. IWAL'I It li/rtg: iph ?llll,rfrm r`[•rl.cc<( flhr',?1 -;11 ff �5 CITY OF CUPERTINO . I XT"-V, -V c7TTl%/if A T11D TPUTT "IIVP —' IITVTCTfIN OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. 20674 HOMESTEAD RD DATE: 09/2t/2015 REVIEWED BY: MELISSA LWADDRESS: PN: 320 10 066 BP #: *VALUATION: $200,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building $1,253.60 PENTAMATION 1A TI PERMIT TYPE:. i USE: hrs $0.00 WORK 1000 DEGREES PIZZA - T.I. TO RECONFIGURE /UPDATE (E)A-2 OCCUPANCY (2,036 S.F. PME Unit Fee: PME Permit Fee: $0.00 SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID A (Tenant Improvements) II- B,Iit- B,IV,V -B 2,036 $2,495.72 IATIPLNCK $1,253.60 IATIIIVSP 0 ,01 hrs $0.00 Suppl. Insp. Fee:Q Reg. Q OT PME Unit Fee: PME Permit Fee: $0.00 $0.00 c_onsiruction Try:.' Atlinini.stralive i''ee: Work Without Permit? 0 Yes (D No Advanced Planning Fee:: $0.00 $0.00 TOTALS: 2,036 $2,495.72 $56.00 $1,253.60 .liech. Plan ('heck I I 1'12amb. Plan Check Is`Iea. ]'!an Check 1.3e€ rt F et gait ee: F11hin b. Per rnt Fee: hICC, Pei-Wit FCe: aller A4. Clthw, Eke. Iup 1z �1u� [a klech, Instl Fee, Plumb. Imp. Fee: Elea lrrsp. Fee: a..,, i- „ih, nannrtivmonty /i_v_ Plannine. Public Works, Fire, Sanitary Sewer District, Ivvll" 1 /cif GJL4 /I.— wv— ,.vv...........,... •,— ----- -- - - - -- a' - District, etc:. These fees are based on the reliminar information available and are only an estimate. Contact the D ept or a n into. FEE ITEMS (Fee Resolution 11 -053 E . 7111131 FEE QTY /FEE MISC ITEMS Plan Check Fee: $2,495.72 Select a Misc Bldg /Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT F07 70:is:: $0.00 PME Plan Check: - $0.00 Permit Fee: $1,253.60 0 ,01 hrs $0.00 Suppl. Insp. Fee:Q Reg. Q OT PME Unit Fee: PME Permit Fee: $0.00 $0.00 c_onsiruction Try:.' Atlinini.stralive i''ee: Work Without Permit? 0 Yes (D No Advanced Planning Fee:: $0.00 $0.00 Select allon- Residential Building or Structure 0 Tr(ivel Docurnerilalion Fees Strong Motion Fee: IBSEISMICO $56.00 Select an Administrative Item _ Bldg Stds Commission Fee. IBCBSC $8.00 UBTQTAZ : v $3,813.32 $0.00 TOTALFFE.R $3,813.32 Revised: 07/0212015 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 -777 -3333 JOB ADDRESS:20674 HOMESTEAD RD PERMIT # °UGOG94 — OWNER'S NAME :JULI SATOH PHON8 #650- 743 -8962 GENERAL, CONTRACTOR:TICO Construction BUSINESS LICENSE # 595540125279 ADDRESS: 1585 Terminal Ave CITY /ZIPCODE: San Jose, CA 95912 *Our municiipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) QUILL BE SCHEDULED UNTIL THE, GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following hiforiaiation: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # X Cabinets & Millworlc Bayside Commercial Caseworks Inc. -9883 -D /v7 Cement Finishing X Electrical Huff Electric —55'8 = Excavation Fencing X Flooring / Carpeting T &J Floors Inc. Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry X Painting / Wallpaper JB Painting Inc. 449383- - Pawn* g Plastering X Plumbing Tri- Valley Plumbing Roofing Septic Tank Sheet Metal X Sheet Rock Precision Drywall Interiors�3. X Tile T & J Floors Inc. 858,__486 _ caner / Contractor Siguat ire 1170 1.913 (- 1 (0 Date CUPERTEWO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408-777-:3333 JOB ADDRESS:20674 HOMESTEAD RD SUBCONTRACTOR OWNER'S NAME:JULI SATOH pj4ONE #650- 743 -8962 GENERAL, CONTRACTOR:TICO Construction BUSINESS LICENSE #25271 ADDItESS:1585 Terminal Ave CTTY /ZIPCODE: San Jose, CA 95112 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license, NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION($) WM-L BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF` CUPVkTIN.® BUSINESS LICENSE, I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 3/30/2016 caner /Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # X Cabinets & Millwork Bayside Commercial Caseworks Inc. 40131 Ceinent Finishing X Electrical Huff Electric 40276 Excavation Fencing X Flooring / Carpeting T & J Floors Inc. 31988 Linoleum / Wood Glass / Glazing Heating Iristilation Landscaping Lathing Masonry X Painting / Wallpaper JB Painting Inc. 26738 {/ Paving Plastering X Plumbing Tri- Valley Plumbing 28167 V Roofing Septid Tank Sheet Metal X Sheet Rock Precision Drywall Interiors 36935 e X Tile T & J Floors Inc. 31988 3/30/2016 caner /Contractor Signature Date ALBERT SALVADOR, P.E., C.B.O„ BUILDING OFFICIAL 0 2015 10300 TORRE AVENUE - CUPERTINO, CA 95014.3255 (408) 777 -3228 • FAX (408) 777.3333 - huiidinnfa cupenino.orn fir. 517E �C APN Bpi) - 0 Uil� �� owner k ....l .. ............. �r} , rp%l m ........... Contractc or............ �/� M.- ,l .....v..�f22 .. ........ .... ... ............Address.. iT�r.n�� ..:. . .......2ip ?v(+ i "lm...... ............... ........... City /st. aQSF. .. `. � .k D 'Citylst..... Applicant..... ..c;7:r . 1 . .. 21 ................... ........... ....... .,........... Address..C_.... 11!1.�l�i.t At r.........,.,........., BngineerlpArchlloct...... .. ....., �,... ,., ..... , Addrass. t. .q. ,.... ... ..,.�,1 oftyl5t... 7/ V30sa; 1. �c� ................. 1..5 ...... Phono.��.:��.0 .. ..: p�.., i r,,....• ..................... OitylSt,. ..7Jp.,....q. ..Zip ... :yvr..%411an>,... ............ PRCUEi'7'ISESCRIPT1,QN: 4b� p,� ��}p1ttiL•d �1 This "STATEit✓SNT OF SPECIAL INSPECTIONS" Is submitted in fulfillment or the requirements of CBC Sections 1704 end 1705, This form Is structured after and used by permission tram the SlnrcltrEal jDgjneer 62s0clallon of Nontin 9811foalla's (SI:AONC) rr:ode statement or special inspections, Also, included with this form Is the following: L1 'LIST OF SPECIAL INSPECTION AGENCIES (pa.ga 2), A Ilst of testing agenclas and other spoclal inspectors that will be retalned to conduct the tests and lnspeollons for this project ❑ 'SCHEDULE OF SPECIAL. iNSP]<C'rION- (page 3 — 5). The Schedule of Special Inspectlons summarizes the Special inspections and tests required. Spacial Inspectors will refer to the approved plans and specifications for dstalled special Inspeciion requirements. Any additional tests and inspections required by the approved plans and specifications shall 13190 be performed. Spacial Inspections and Testing will be performed In accotdence wilh the approved plans and specifications, Hs statement and CBC Sections 1704,1765, 1706,1707, and t708. interim reports will be submitted to the Building Official and the Registered Desfgn Professional In Responsible Charge in sccordance with CBC Section 1704.1.2. A Final Report of Special Inspections documenting required special lnspeollons, testing and correction or any discrepancies noted in Ilia inspections shell be submitted prior to Issuance of a Certificate of Use and Occupancy (Section 1704,12). The Final Report will document: Required special lnspeollons. r Correction of discrepancies noted In inspections. That Owner recognizas his or her obligation to ensure that Ilia construction complies with the approved permit documents and to implement this progrgm of spacial inspections. In partial fulfillment of tilaso obligations, the Owner will retain and directly pay for the Spacial fnspectlons as required in CBC Suction 1704.1. This plan has been developed wflh the understanding that the Sulfding Official milli: a Radlaw and approva the qualifications of the Special Inspectors who wilt perform the Inspections. Monitor special inspection activities on the Job site to nssura that Ilia: Special Inspectors are quaUfied and era performing lhpir duties as called for in this Statement of Spacial Inspection. Review submitted Inspection repeats. is Parform Inspectlons as required by the lord building code, 5pecialnspcc11oeFarn:_2DI2.doe rasped 09106112 LIST OF SPECIAL INSPECTION AGENCIES APPROVAL OF SPECIAL INSPECTORS: Each special inspection agency, testing facility, and special inspector shall be recognized by the Building Official prior to performing any duties. Special Inspection agency's listed on this form must be pre- approved and listed on Cupertino's approved Special Inspector's list. Special inspectors shall carry approved identification when performing the functions of a special inspector. Identification cards shall follow the criteria set by the California Council of Testing and Inspection Agencies. No personnel changes shall be made without first obtaining the approval of the Building Official. Any unauthorized personnel changes may result in a "Stop Work Order' and possible permit revocation. To be pre- approved by the City of Cupertino, refer to the SPECIAL INSPECTION CRITERIA handout. Please allow two weeks to complete the application process. The following are the testing and special inspection agencies that will be retained to conduct tests and inspection on this project: EXPERTISE FIRM I INSPECTOR INFORMATION' 1. Special Inspection (except for Firm ..................................................................... Addr.......................................................... ............................... geotechnical) City ............................. ............................... State .......................Zi Telephone....... ............................... Fax............. ............................... Email.......................... ............................... 2. Material Testing Firm ..................................................................... Addr.......................................................... ............................... City........................................................................... ............................... State .......................Zip ...................... Telephone........ ............................... Fax............. ............................... Email.......................... ............................... 3. Geotechnical Inspections Firm ..................................................................... Addr.................................................:........ ............................... City........................................................................... ............................... State .......................Zip ...................... Telephone....... ............................... Fax ............................................ Email ......................................................... 4. Other: Firm ..................................................................... Addr.......................................................... ............................... City........................................................................... ............................... State .......................Zip ...................... Telephone....... ............................... Fax............. ............................... Email.......................... ............................... *All agencies specified on this form must be pre- approved and listed on the City of Cupertino's Approved Special Inspector's List. SEISMIC REQUIREMENTS (Section 1705.3.6) Description of seismic - force - resisting system and designated seismic systems subject to special inspections as per Section 1705.3: The extent of the seismic - force - resisting system is defined in more detail in the construction documents. WIND KtQUIKtMtN I S Description of main wind- force - resisting system and designated wind resisting components subject to special inspections in accordance with Section 1705.4.2: The extent of the main wind - force - resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionFonn 2012.doc revised 09106112 SCHEDULE OF SPECIAL INSPECTION SITE APN BP# ADDRESS PROJECT DESCRIPTION: Notation Used in Table: Column headers: C Indicates continuous inspection is required. P Indicates periodic inspections are required. The notes and /or contract documents should clarify. Box entries: X Is placed in the appropriate column to denote either "C" continuous or "P" periodic inspections. - -- Denotes an activity that is either a one -time activity or one whose frequency is defined in some other manner. Additional detail regarding inspections and tests are provided in the project specifications or notes on the drawings. VERIFICATION AND INSPECTION C p REFERENCED IBC REFERENCE STANDARD INSPECTION OF FABRICATORS 1. ❑ Inspect fabricator's fabrication and quality control - -- 1704.3 procedures. INSPECTION OF STEEL 1. Material verification of high- strength bolts, nuts and washers. • Identification marking to conform to ASTM stds AISC 360, specified in the approved construction documents. - -- X Section A3.3 and applicable ASTM material standards • Inspect fabricator's fabrication and quality control procedures. X 2. Inspection of high- strength bolting: ❑ Snug -tight joints. - -- X ❑ Pretensioned and slip - critical joints using turn -of -nut with matchmarking, twist -off bolt or direct tension - -- X AISC 360, indicator methods of installation. 1704.3.3 Section M2.5 ❑ Pretensioned and slip - critical joints using turn -of -nut without matchmarking or calibrated wrench methods X - -- of installation. 3. Material verification of structural steel and cold- formed steel deck. ❑ For structural steel, identification markings to conform AISC 360, to AISC 360. X Section M2.5 ❑ For other steel, identification markings to conform to Applicable ASTM ASTM standards specified in the approved - -- X material standards construction documents. ❑ Manufacturer's certified test reports. - -- X SpecialnspectionFonn_2012.doc revised 09106112 VERIFICATION AND INSPECTION C P REFERENCED STANDARD IREFERENCE IBC 4. Material verification of weld filler materials: ❑ Identification marking to conform to AWS specification in the approved construction documents. - -- X AISC 360, Section A3.5 and applicable AWS A5 documents -� ❑ Manufacturer's certificate of compliance required. - -- X - -- - -- 5. Inspection of welding: a. Structural steel and cold- formed steel deck: ❑ Complete and partial joint penetration groove welds. X --- AWS D1.1 1704.3.1 ❑ Multipass fillet welds. X --- ❑ Single -pass fillet welds > 5/16" X - -- • Plug and slot welds. X --- ❑ Single -pass fillet welds <= 5/16" - -- X • Floor and roof deck welds. - -- X AWS D1.3 b. Reinforcing steel: ❑ Verification of weldability of reinforcing steel other than ASTM A 706. - -- X AWS D1.4 ACI 318: Section 3.5.2 • Reinforcing steel resisting flexural and axial forces in intermediate and special moment frames, and boundary elements of special structural walls of concrete and shear reinforcement. X - -- • Shear reinforcement. X --- ❑ Other reinforcing steel. - -- X 6. Inspection of steel frame joints details for compliance: • Details such as bracing and stiffening. - -- X - -- 1704.3.2 • Member locations. - -- X • Application of joint details at each connection. - -- X VERIFICATION AND INSPECTION C p REFERENCED STANDARD IBC REFERENCE INSPECTION OF WELDING 1. ❑ Welded studs when used for structural diaphragms. - -- X - -- 1704.3 2. ❑ Welding of cold- formed steel framing members. - -- X 3. ❑ Welding of stairs and railing systems. - -- X Speciah7spectionFonn_2012.doc revised 09106112 ❑ Inspection of screw attachments, bolting, anchoring, and other fastening of components within the seismic- -__ X force - resisting system including shear walls, braces, diaphragms, collectors (drag struts) and hold- downs. 4. Storage racks and access floors ❑ Anchorage of storage racks 8 feet or greater in height X 1707.5 and access floors. 5. Architectural components • Inspect erection and fastening of exterior cladding weighing more than 5 psf and higher than 30 feet - -- X above grade or walking surface. • Inspect erection and fastening of veneer weighing more than 5 psf.and higher than 30 feet above grade - -- X or walking surface. -__ 1707.6 • Inspect erection and fastening of all exterior non- bearing walls higher than 30 feet above grade or - -- X walking surface. ❑ Inspect erection and fastening of all interior non- bearing walls weighing more than 15 psf and higher - -- X than 30 feet above grade or walking surface. 6. Mechanical and Electrical Components • Inspect anchorage of electrical equipment for emergency or stand -by power systems. - -- X • Inspect anchorage of non - emergency electrical X equipment. _ _ ❑ Inspect installation of piping systems and associated mechanical units carrying flammable, combustible, or - -- X - -- 1707.7 highly toxic contents. ❑ Inspect installation of HVAC ductwork that contains X hazardous materials. ❑ Inspect installation of vibration isolation systems X where required by Section 1707.7. 7. ❑ Verify that the equipment label and anchorage or mounting conforms to the certificate of compliance ___ 1707.8 when mechanical and electrical equipment must be - -- seismically qualified. 8. ❑ Seismic isolation system: Inspection of isolation -_- X - -- 1707.9 system per ASCE 7 — Section 17.2.4.8 9. ❑ Obtain mill certificates for reinforcing steel, verify compliance with approved construction documents, - -- - -- - -- 1708.2 and verify steel supplied corresponds to certificate. 10. ❑ Structural Steel: Invoke the QAP Quality Assurance requirements in AISC 341. ___ 1708.3 11. ❑ Obtain certificate that equipment has been seismically qualified. __- 1708.4 12. ❑ Obtain system tests as required by ASCE 7 Section 17.8. - -- - -- 1708.5 SpeciahispectionForm 2012.doc revised 09106112 VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE INSPECTION OF CONCRETE 1. ❑ Inspection of reinforcing steel, including prestressing ___ X ACI 318:3.5,7.1-7.7 1913.4 tendons and placement. 2. ❑ Inspection of reinforcing steel welding in accordance AWS D1.4 ACI 318: with Table 1704.3 Item 5b. 3.5.2 3. ❑ Inspection of bolts to be installed in concrete prior to and during placement of concrete where allowable X - -- ACI 318: 8.1.3, 1,911.5, 1912.1 loads have been increased or where strength design 21.2.8 is used. 4. ❑ Inspection of anchors installed in hardened concrete. - -- X ACI 318: 1912.1 5. ❑ Verifying use of required design mix. 1904.2.2,1913.2, X ACI 318: 1913.3 6. ❑ At time fresh concrete is sampled to fabricate ASTM C 172 specimens for strength tests, perform slump and air X - -- ASTM C 31 1913.10 content tests and determine the temperature of the concrete. ACI 318: 5.6, 5.8 7. ❑ Inspection of concrete and shotcrete placement for X - -- ACI 318: 5.9, 5.10 1913.6, 1913.7, proper application techniques. 1913.8 8. ❑ Inspection for maintenance of specified curing - -- X ACI 318: 5.11 =5.13 1913.9 temperature and techniques. 9. Inspection of prestressed concrete: ❑ Application of prestressing forces. X - -- ACI 318:18.20 ❑ Grouting of bonded prestressing tendons in the X - -- ACI 318:18.18.4 seismic force - resisting system. 10. ❑ Erection of precast concrete members. - -- X ACI 318: Ch. 16 - -- 11. ❑ Verification of in -situ concrete strength, prior to stressing of tendons in posttensioned concrete and - -- X ACI 318: 6.2 - -- prior to removal of shores and forms from beams and structural slabs. 12. ❑ Inspect formwork for shape, location, and dimensions _ -_ X ACI 318: 6.6.1 - -- of the concrete member being formed. 13. ❑ Bolts Installed in Existing'Masonry or Concrete • Direct tension testing of existing anchors. - -- X See ICC ES Reports form special inspection requirements for proprietary • Direct tension testing of new bolts. --- X • Torque testing of new bolts. - -- X products • Prequalification test for bolts and other types of anchors. _ -- X 14. ❑ Other: SpecialnspectionForm_2012.doc revised 09106112 SpeciahispectionForin_2012.doe revised 09106112 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402 1ACI TMS 402 /ACI SECTION 530 /ASCE 5 530 /ASCE 6 INSPECTION OF LEVEL 1 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved - -- X - -- - -- Art. 1.5 submittals shall be verified. 2. ❑ Verification of fm and fac prior to construction - -- X - -- -- Art. 1.413 except where specifically exempted by this code. 3. Q Verification of slump flow and VSi as delivered to X - -- - -- - -- Art. 1.513.1.b.3 the site for self consolidating grout. 4. As masonry construction begins, the following shall be verified to ensure compliance: • Proportions of site- prepared mortar. - -- X - -- - -- Art. 2.6A • Construction of mortar joints. - -- X - -- - -- Art.3.313 • Location of reinforcement, connectors, X --- - -- Art. 3.4, 3.6A prestressing tendons, and anchorages. ❑ Prestressing technique. - -- X - -- - -- Art. 3.6B ❑ Grade and size of prestressing tendons and X - -- - -- Art. 2.413, 2.4H anchorages. 5. During construction the inspection program shall verify: • Size and location of structural elements. - -- X - -- - -- Art. 3.3F • Type, size, and location of anchors, including Sec. 1.2.2(e), other details of anchorage of masonry to --- X - -- 1.16.1 ___ structural members, frames or other construction. • Specified size, grade, and type of reinforcement, anchor bolts, prestressing tendons and - -- X -- Sec. 1.15 Art. 2.4, 3.4 anchorages. • Welding of reinforcing bars. X - -- - -- -- ❑ Preparation, construction and protection of masonry during cold weather (temperature below X Sec. 2104.3, - -_ Art. 1.8C, 1.8D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing - -- ___ Art. 3.613 force. 6. Prior to grouting the following shall be verified to ensure compliance: • Grout space is clean. - -- X - -- - -- Art. 3.20 • Placement of reinforcement and connectors and ___ X - -- Sec. 1.3 Art. 3.4 prestressing tendons and anchorages. • Proportions of site - prepared grout and ___ X - -- - -- Art. 2.613 prestressing grout for bonded tendons. • Construction of mortar joints. - -- X - -- - -- Art. 3.313 7. Grout placement: • Grout placement shall be verified ensure X - -- - -- - -- Art. 3.5 compliance. • Observe grouting of prestressing bonded X ___ ___ ___ Art 3.6C tendons. SpeciahispectionForin_2012.doe revised 09106112 SpecialnspectionForin_2012.doe revised 09106112 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402 /ACI TMS 402 /ACI SECTION 530 /ASCE 5 530 /ASCE 6 8. ❑ Preparation of any required grout specimens, Sec. mortar specimens, and /or prisms shall be - -- X 2105.2.2, - -- Art. 1.4 observed. 2105.3 INSPECTION OF LEVEL 2 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved - -- X - -- - -- Art. 1.5 submittals. 2. ❑ Verification of f m and f aac prior to construction and for every 5,000 square feet during - -- X - -- - -- Art. 1.413 construction. 3. ❑ Verification of proportions of materials in premixed or preblended mortar and grout as - -- X - -- - -- Art. 1.513 delivered to the site. 4. ❑ Verification of slump flow and VSI as delivered to X - -- - -- - -- Art. 1.5B.1.b.3 the site for self consolidating rout. 5. The. following shall be verified to ensure compliance: ❑ Proportions of site - prepared mortar, grout, and - -- X - -- - -- Art. 2.6A prestressing grout for bonded tendons. ❑ Placement of masonry.units and construction of - -- X - -- - -- Art. 3.313 mortar joints. • Placement of reinforcement, connectors and - -- X - -- Sec. 1.15 Art. 3.4, 3.6A prestressing tendons and anchorages. • Grout space prior to grouting. X - -- --- - -- Art. 3.2D • Placement of grout. X - -- _ - -- - -- Art. 3.5 ❑ Placement of prestressing grout. X - -- - -- - -- Art. 3.6C ❑ Size and location of structural elements. - -- X - -- - -- Art. 3.3F • Type, size, and location of anchors, including other details of anchorage of masonry to X - -- - -- Sec.1.2.2(e) structural members, frames and other construction. • Specified size, grade, and type of reinforcement, anchor bolts, prestressing tendons and - -- X -- Sec. 1.15 Art. 2.4, 3.4 anchorages. • Welding of reinforcing bars. X - -- __ Sec. 2.1.9.7.2, - -- 3.3.3.4 (b) ❑ Preparation, construction, and protection of masonry during cold weather (temperature below ___ X Sec. 2104.3, - -- Art. 1.8C, 1.8D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing X - -- - -- - -- Art. 3.613 force. 6. ❑ Preparation of any required grout specimens, Sec. mortar specimens, and /or prisms shall be X - -- 2105.2.2, - -- Art. 1.4 observed. 2105.3 SpecialnspectionForin_2012.doe revised 09106112 VERIFICATION AND INSPECTION C p REFERENCED STANDARD IBC REFERENCE INSPECTION OF WOOD 1. ❑ Inspect prefabricated wood structural elements and assemblies in accordance with Section 1704.2. - -- 1704.6 2. ❑ Inspect site built assemblies. - -- - -- 3. Inspect high -load diaphragms: ❑ Verify grade and thickness of sheathing. - -- --- ❑ Verify nominal size of framing members at adjoining panel edges. - -- 1704.6.1 ❑ Verify nail or staple diameter and length, - -- - -- ❑ Verify number of fastener lines, - -- --- ❑ Verify spacing between fasteners in each line and at edge margins. 4. ❑ Metal- plate- connected wood trusses spanning 60 feet or greater: Verify temporary installation restraint/bracing and the permanent individual truss - -- X - -- 1704.6.2 member bracing are installed in accordance with the approved truss submittal package. REQUIRED VERIFICATION AND INSPECTION OF SOIL 1. ❑ Verify materials below footings are adequate to - -- X achieve the desired bearing capacity. 2. ❑ Verify excavations are extended to proper depth and have reached proper material. X 3. ❑ Perform classification and testing of compacted fill materials. X - -- Table 1704.7 4. ❑ Verify use of proper materials, densities and lift thicknesses during placement and compaction of X - -- compacted fill. 5. ❑ Prior to placement of compacted fill, observe subgrade and verify that site has been prepared properly. - -- X REQUIRED VERIFICATION AND INSPECTION OF DEEP DRIVEN FOUNDATION ELEMENTS 1. ❑ Verify element materials, sizes and lengths comply X with the requirements. 2. ❑ Determine capacities of test elements and conduct X additional load tests, as required. 3. ❑ Observe driving operations and maintain complete X and accurate records for each element. 4. ❑ Verify locations of piles and their plumbness, confirm type and size of hammer, record number of blows per - -- Table 1704.8 foot of penetration, determine required penetrations to X - -- achieve design capacity, record tip and butt elevations and document any damage to foundation element. 5. ❑ For steel elements, perform additional inspections in accordance with Section 1704.3. 6. ❑ For concrete elements and concrete filled elements, perform additional inspections in accordance with - -- - -- Section 1704.4. SpecialnspectionForm 2012.doc revised 09106112 VERIFICATION AND INSPECTION C p REFERENCED IBC STANDARD REFERENCE 7. ❑ For specialty piles, perform additional inspections as determined by the registered design professional in - -- - -- - -- Table 1704.8 responsible charge. REQUIRED VERIFICATION AND INSPECTION OF CAST -IN -PLACE DEEP FOUNDATION ELEMENTS 1 ❑ Observe drilling operations and maintain complete and X - -- accurate records for each element. 2. ❑ Verify placement locations and plumbness, confirm element diameters, bell diameters (if applicable), lengths, embedment into bedrock (if applicable), and X - -- - -- Table 1704.9 adequate end - bearing strata capacity. Record concrete or grout volumes. 3. ❑ For concrete elements; perform additional inspections in accordance with Section 1704.4. HELICAL PILE FOUNDATIONS 1. ❑ Record installation equipment used, pile dimensions, X - -- - -- 1704.10 tip elevations, final depth, final installation torque. SPRAYED FIRE - RESISTANT MATERIALS Physical and visual tests 1. Condition of substrates. ❑ Inspect surface for accordance with the approved fire - resistance design and the approved manufacturer's - -- - -- written instructions. ❑ Verify minimum ambient temperature before and after _ -_ X application. - -- 1704.12.1 ❑ Verify ventilation of area during and after application. - -- X 2. ❑ Measure average thickness per ASTM E605 and Section 1704.12.4. 3. ❑ Verify density of material for conformance with the approved fire- resistant design and ASTM E605. (Ref. - -- - -- Section 1704.12.5) 4. ❑ Test cohesive /adhesive bond strength per Section 1704.12.6. 5. ❑ Condition of finished application. s MISCELLANEOUS 1. Mastic and Intumescent Fire - Resistant Coating. - -- - -- - -- 1704.13 2. Exterior Insulation and Finish Systems (EIFS). Water - resistive barrier coating when installed over a sheathing - -- - -- - -- 1704.14 substrate. 3. Special Cases - -- - -- - -- 1704.15 4. Smoke Control System - -- - -- - -- 1704.16 5. Seismic Resistance ❑ Suspended ceiling systems and their anchorage. - -- - -- - -- 1705.3 [4.3] Speciab7spectionForm_2012.doe revised 09106112 VERIFICATION AND INSPECTION C P REFERENCED IBC STANDARD IREFERENCE 6. Wind Resistance ❑ Roof cladding and roof framing connections. - -- - -- --- 11 Wall connections to roof and floor diaphragms and framing. ❑ Roof and floor diaphragm systems, including collectors, drag struts and boundary elements. ❑ Vertical wind - force - resisting systems, including braced frames, moment frames, and shear walls. ❑ Wind- force - resisting system connections to the foundation. ❑ Fabrication and installation of systems or components required to meet the impact resistance requirements - -- - -- - -- of Section 1609.1.2. SPECIAL INSPECTION FOR WIND REQUIREMENTS 1. Structural Wood • Inspect field gluing operations of elements of the main X - -- wind- force - resisting system. - -- 1706.2 • Inspect nailing, bolting, anchoring, and other fastening of components within the main windforce- resisting - -_ X system, including wood shear walls, wood diaphragms, drag struts, braces and hold- downs. 2. Cold- Formed Steel Framing • Welding of elements of the main wind- force - resisting - -- X system. • Inspection of screw attachments, bolting, anchoring, and other fastening of components within the main --- 1706.3 wind - force- resisting system including shear walls, - -- X braces, diaphragms, collectors (drag struts) and hold - downs. 3. Wind- resisting components ❑ Roof cladding. - -- X - -- 1706.4 ❑ Wall cladding. - -- X SPECIAL INSPECTIONS FOR SEISMIC RESISTANCE 1. ❑ Special inspection for welding in accordance with the X - -- 1707.2 quality assurance plan requirements of AISC 341. 2. Structural Wood • Inspect field gluing operations of elements of the X - -- seismic- force- resisting system. • Inspect nailing, bolting, anchoring, and other fastening of components within the seismic - force - resisting 1707.3 system, including wood shear walls, wood - -- X diaphragms, drag struts, braces, shear panels and hold- downs. 3. Cold- Formed steel light -frame construction ❑ Welding of elements of the seismic- force - resisting X 1707.4 system. SpecialnspectionForm_2012.doe revised 09106112 w CALGREEN NON - RESIDENTIAL CHECKLIST -4 M i iTTAL MANDATORY ITEMS °' COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION C U P E RT I N O ALBERT SALVADOR, P.E., C.B.O.. BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building0cupertino.org PURPOSE: The non - residential pr men oz;dgu . f t i e�p a ni g, design and deve�oP�`n_ RIApd4 that include environ FesJR10 s'x a cti Idin - , es lgnM uilding siting and development to protect, restore and en ance the environ e t uat it and spect the integrity of adjacent j , properties; establishes the means of conserving water used indoors, outdoors and in wastewater conveyance; outlines means of achieving material conservation and resource efficiency; and outlines means of reducing the quantity of air contaminants. Project Name: `0010 mref,S t` Q �W - Project Address: c �t end 4Ad Project Description: Q vtp,W Ce�ar�rf�nw, Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2013 Califomia Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. MANDATORY FEATURE OR MEASURE General Requirements The project meets all the requirements of Divisions 5.101 through 5.508. Planning and Design - Site Development 5.106.1 Storm water pollution prevention. For projects of one acre or less, develop a Storm Water Pollution Prevention Plan (SWPPP) that has been designed, specific to its site, conforming to the State Storm water NPDES Construction Permit or local ordinance, whichever is stricter, as is required for projects over one acre. The plan should cover prevention of soil loss by storm water run -off and/or wind erosion, of sedimentation and /or of dust /particulate matter air pollution. Page I of 9 Column 2 Column 3 Project Verification muirements ❑X ❑ ©�Mm 'i CulGreeu ,Vela -Res Checklisl.1)c rc wse el 011231 14 5.106.4 Bicycle parking. Comply with Sections 5:106.4.1 and 5.106.4.2: or local is ❑X ❑ meet ordinance, whichever stricter. ❑ 5.106.4.1.1 Short -Term bicycle parking. If the qualified project is ❑ anticipated to generate visitor traffic, provide permanently anchored bicycle ❑X ❑ racks within 200 feet of the visitors' entrance, readily visible to passers -by, X❑ ❑ for 5 percent of visitor motorized vehicle parking spaces being added, with © ❑ a minimum of one two -bike capacity rack. ❑ ❑ 5.106.4.1.2 Long -Term bicycle parking. For qualified buildings with over M El 10 tenant - occupants, provide secure bicycle parking for 5 percent of tenant ❑ ❑ vehicle parking spaces being added, with a minimum of one space. 5.106.5.2 Designated parking. Provide designated parking for any combination of low- emitting, fuel - efficient and carpool /van pool vehicles as shown in Table 5.106.5.2. ® ❑ 5.106.8 Light pollution reduction. Outdoor lighting systems shall be ❑ designed and installed to comply with the following: ❑ 1. The minimum requirements in the California Energy Code for lighting zones ❑X ❑ 1 — 4 as defined in Chapter 10 of the California Administrative Code; and 0 ❑ 2. Backlight, Uplight and Glare (BUG) ratings as defined in IES TM- 15 -11; and © ❑ 3. Allowable BUG rating not exceeding those shown in Table 5.106.8, or ❑ ❑ Comply with a local ordinance lawfully enacted pursuant to Section 101.7, whichever is more stringent. ❑ ❑ 5.106.10 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how 0 ❑ site grading or a drainage system will manage all surface water flows. Performance Requirements 5.201.1 Scope. The California Energy Commission will continue to adopt ❑ mandatory building standards. Indoor Water Use 5.303.1 Meters. Separate meters shall be installed for the uses described in Sections 503.1.1 and 503.1.2. 5.303.1.1 New building or additions in excess of 50,000 square feet. ❑ Separate submeters shall be installed as follows: 1. For each individual leased, rented or other tenant space within the 0 ❑ building projected to consume more than 100 gal /day. 2. Where separate submeters are unfeasible, for water supplied to the following systems: a. Makeup water for cooling towers where flow through is greater ❑ ❑ than 500 gpm. b. Makeup water for evaporative coolers greater than 6 gpm. c. Steam and hot -water boilers with energy input > 500,000 Btulh. Page 2 of 9 C[1lGreen Nan -Res Checklist.doc revised 01,123114 5.303.1.2 Excess consumption. A separate submeter shall be provided for any tenant within a new building or within an addition that is projected © ❑ to consume > 1,000 gal /day. 5.303.2 Water reduction. Plumbing fixtures shall meet the maximum flow rate ❑ values shown in Table 5.303.2.3. Exception: Building that demonstrate 20- percent overall water use reduction. 5.303.2.1 Areas of addition or alteration. For those occupancies within the authority of the California Building Standards Commission, as specified in Section 103, the provisions of Section 5.303.2 and Section 5.303.3 shall ❑X ❑ apply to new fixtures in additions or areas of alterations to the buildings. 5.303.4 Wastewater reduction. Each building shall reduce by 20 percent wastewater by one of the following methods: 1. The installation of water - conserving fixtures or ❑ 2. Utilizing non - potable water systems. ❑ 5.303.6 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code ®�� El (CPC), and shall meet the applicable standards, referenced in CPC Table 1401.1 and CalGreen Chapter 6. Outdoor Water Use 5.304.1 Water budget. A water budget shall be developed for landscape ® ❑ irrigation use. 5.304.2 Outdoor potable water use. For new water service or for addition or alteration requiring upgraded water service for landscaped areas of at least ❑ ❑ 1,000 sq.ft. but not more than 5,000 sq.ft., separate submeters or metering devices shall be installed for outdoor potable water use. 5.304.3 Irrigation design. In new nonresidential construction or building addition or alteration with at least 1,000 but not more than 2,500 sq.ft. of cumulative landscaped area, install irrigation controllers and sensors which ❑ include the following criteria, and meet manufacturer's recommendations. 5.304.3.1 Irrigation controllers. Automatic irrigation system controllers installed at the time of final inspection shall comply with the following: 1. Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as © ❑ weather conditions change. '2. Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicates ❑ with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. Weather Resistance and Moisture Management 5.407.1 Weather protection. Provide a weather - resistant exterior wall and foundation envelope as required by California Building Code Section' 1403.2 ❑ and California. Energy Code Section 150, manufacturer's installation instructions or local ordinance, whichever is more stringent.' I Pap 3 of 9 CulGrcen Nun -Res Checklist.duc revised 01,23114 5.407.2 Moisture control. Employ moisture control measures by the following V-1/1 ❑ methods; i 5.407.2.1 Sprinklers. Prevent irrigation spray.on structures. ❑X ® 5.407.2.2 Entries and openings. Design exterior entries and /or openings Q to .prevent water intrusion into buildings. ❑ 5.407.2.2.1 Exterior door protection. Primary exterior entries shall 5.410.2 Commissioning. For new buildings 10,000 square feet and over, be covered to prevent water intrusion by using nonabsorbent floor and 11771 ❑ wall finishes within at least 2 ft around and perpendicular to such Q ❑ openings plus at least one of the following: design and construction processes of the building project. Commissioning 1. An installed awning at least 4 ft in depth. requirements shall include items listed in Section 5.410.2. I 2. The door is protected by a roof overhang at least 4 ft in depth. 3. The door is recessed at least 4 ft. 4. Other methods which provide equivalent protection. 5.407.2.2.2 Flashing. Install flashings integrated with a drainage Q ❑ plane. Construction Waste Reduction, Disposal and Recycling 5.408.1 Construction waste management. Recycle and/or salvage for reuse a minimum of 50 percent of the nonhazardous construction and demolition waste in accordance with Section 5.408.1.1, 5.408.1.2,,or 5.408.1:3; or meet a —X] ❑ local construction and demolition waste management ordinance; whichever is I more stringent. 5.408,1.1 Construction waste management plan. Submit plan per this ❑ ❑ section to enforcement authority.. 5.408.12 Waste management company. Utilize a waste management company that can provide verifiable documentation that the percentage of V-1/1 ❑ construction and demolition waste material diverted from the landfill 5.410.1 Recycling by occupants. Provide readily accessible areas that serve complies with CalGreen Section 5:4013. the entire building and. are identified for the depositing, storage and collection ® 5.408.1.3,Waste stream reduction alternative. The combined weight of of nonhazardous materials for recycling. new construction disposal thaYdoes not exceed two pounds per square ❑ foot of building area may deemed to meet the 50 percent minimum 5.410.2 Commissioning. For new buildings 10,000 square feet and over, requirement as approved by the enforcing agency. building commissioning for all building systems covered by T24, Part 6, 5.408.1.4 Documentation. Provide documentation of the waste Q ❑ management plan that meets the requirements listed in Section 5.408.1.1 design and construction processes of the building project. Commissioning through 5.408.1.3. requirements shall include items listed in Section 5.410.2. 5.408.3 Excavated soil and land clearing debris: 100 percent of trees, stumps, rocks and associated vegetation and soils resulting primarily from land clearing shall be reused or recycled. QX c ❑ ' Building Maintenance and Operation 5.410.1 Recycling by occupants. Provide readily accessible areas that serve the entire building and. are identified for the depositing, storage and collection ® ❑ of nonhazardous materials for recycling. 5.410.2 Commissioning. For new buildings 10,000 square feet and over, building commissioning for all building systems covered by T24, Part 6, process systems and renewable energy systems shall be included in -the ❑ ❑ design and construction processes of the building project. Commissioning requirements shall include items listed in Section 5.410.2. Page 4 of 9 Cal Given Non -Res C.hecklisr.doc revised 01'23114 5.410.2.1 Owner's Project Requirements (OPR). Documented before the �� E] design phase of the project begins the OPR shall include items listed in 0 ❑ Section 5.410.4. 5.410.2.2 Basis of Design (BOD). A written explanation of how the design ^,� E] of the building systems meets the OPR shall be completed at the design phase of the building project and updated periodically to cover the systems 0 ❑ listed in Section 5.410.2.2. 5.410.2.3 Commissioning plan. A commissioning plan describing how the project will be commissioned shall be started during the design phase of ® ❑ the building project and shall include items listed in Section 5.410.2.3. 5.410.2.4 Functional performance testing. Functional performance testing shall demonstrate the correct installation and operation of each component, system and system -to- system interface in accordance with the 0 ❑ approved plans and specifications. 5.410.2.5 Documentation and training. A Systems manual and systems operations training are required. I 0 ❑ 5.410.2.5.1 Systems manual. The systems manual shall be delivered to the building owner or representative and facilities operator and shall 0 ❑ include the items listed in Section 5.410.2.5.1. 5.410.2.5.2 Systems operations training. The training of the appropriate maintenance staff for each equipment type and/or system ❑ shall include items listed in Section 5.410.2.5.2. 5.410.2.6 Commissioning report. A complete report of commissioning process activities undertaken through the design, construction and ❑ reporting recommendations for post- construction phases of the building project shall be completed and provided to the owner or representative. 5.410.4 Testing and adjusting. Testing and adjusting of systems shall be required for buildings less than 10,000 square feet or new systems to serve an addition or alteration subject to Section 303.1. 5.410.4.2 Systems. Develop a written plan of procedures for testing and adjusting systems. Systems to be included for testing and adjusting shall include, as applicable to the project, the systems listed in Section OX .10 ❑ 5.410.3.2. —� 5.410.4.3 Procedures.. Perform testing and adjusting procedures in accordance with industry best practices and applicable national standards r� �, ❑ on each system. 5.410.4.3.1 HVAC balancing. Before a new space- conditioning system serving a building or space is operated for normal use, the system should be balanced in accordance with the procedures defined by X9 ❑ national standards listed in Section 5.410.3.3.1. 5.410.4.4 Reporting. After completion of testing, adjusting and balancing. provide a final report of testing signed by the individual responsible for �� E] performing these services. 5.410.4.5 Operation and maintenance manual. Provide the building owner with detailed operating and maintenance instructions and copies of ^,� E] guarantiestwarranties for each system prior to final inspection. 5.416.4.5.1 Inspections and reports. Include a copy of all inspection verifications and reports required by the enforcing agency. ❑%� ,� ❑ Page 5 org CalGreen Non -Res Cderklist.docrevised 01/13/14 Fireplaces 5.503.1 Install only a direct -vent sealed- combustion gas or sealed wood - burning fireplace or a sealed woodstove and refer to residential requirements © ❑ in the California Energy Code. Title 24, Part 6, Subchapter 7, Section 150. 5.503.1.1 Woodstoves. Woodstoves shall comply with US EPA Phase II emission limits. ❑X ❑ Pollutant Control 5.504.3 Covering of duct openings and protection of mechanical equipment during construction. At the time of rough installation or during storage on the construction site and until final startup of the heating and cooling equipment, all duct and other related air distribution component ❑X ❑ openings shall be covered with tape, plastic, sheet metal or other methods acceptable to the enforcing agency to reduce the amount of dust or debris which may collect in the system. 5.504.4 Finish material pollutant control. Finish materials shall comply with Sections 5.504.4.1 through 5.504.4.4. 5.504.4.1 Adhesives, sealants, caulks. Adhesives and sealants used on the project shall meet the requirements of the following standards. 1. Adhesives, adhesive bonding primers, adhesive primers, sealants, sealant primers and caulks shall comply with local or regional air pollution control or air quality management district rules where applicable or ❑�D ❑ SCAQMD Rule 1168 VOC limits, as shown in Tables 5.504.4.1 and 5.504.4.2. 2. Aerosol adhesives and smaller unit sizes of adhesives and sealant or caulking compounds (in units of product, less packaging, which do not weigh more than one pound and do not consist of more than 16 fluid ounces) shall comply with statewide VOC standards and other X❑,,D ❑ requirements, including prohibitions on use of certain toxic compounds, of JJ Califomia Code of Regulations, Title 17, commencing with Section 94507. 5.504.4.3 Paints and coatings. Architectural paints and coatings shall comply with Table 5.504.4.3 unless more stringent local limits apply. �X -D ❑ 5.504.4.3.1 Aerosol paints and coatings. Aerosol paints and coatings shall meet the Product - Weighted M I R Limits for ROC in Section 94522(a)(3) and other requirements, including prohibitions on use of ❑�� ❑ certain toxic compounds and ozone depleting substances (CCR, Title 17, Section 94520 et seq). 5.504.4.3.2 Verification. Verification of compliance with this section shall be provided at the request of the enforcing agency. n ❑ 5.504.4.4 Carpet systems. All carpet installed in the building interior shall meet the testing and product requirements of at least one of the standards ❑, ❑ listed in Section 5.504.4.4. 5.504.4.4.1 Carpet cushion. All carpet cushion installed in the building interior shall meet the requirements of the Carpet and Rug Institute K/1 ❑ Green Label program. 5.504.4.4.2 Carpet adhesive. All carpet adhesive shall meet the requirements of Table 5.504.4.1. X❑ ❑ Page 6 of 9 Cal Green Nor -Res Checklist.doe revived 01123114 5.504.4.5 Composite wood products. Hardwood plywood, particleboard and medium density fiberboard composite wood products used on the interior or exterior of the building shall meet the requirements for ©,}D formaldehyde as specified in Table 5.504.4.5. 5.504.4.5.3 Documentation. Verification of compliance with this section ❑�� ❑ shall be provided as requested by the enforcing agency. Documentation shall include at least one of the following standards listed in Section 5.504.5.3. 5.504.4.6 Resilient flooring systems. For 80 percent of floor area receiving resilient flooring, installed resilient flooring shall meet at least one t� 42b of the following standards listed in Section 5.504.4.6. D 5.504.5.3 Filters. In mechanically ventilated buildings, provide regularly occupied areas of the building with air filtration media for outside and return air prior to occupancy that provides at least a MERV of 8. D 5.504.7 Environmental tobacco smoke (ETS) control. Prohibit smoking within 25 feet of building entries, outdoor air intakes and operable windows where outdoor areas are provided for smoking and in buildings; or as enforced ❑ ❑ by ordinances, regulations or policies of any city, county, city and county, California Community College, campus of the California State University or 7� campus of the University of California, whichever are more stringent. Indoor Moisture and Radon Control 5.505.1 Indoor moisture control. Buildings shall meet or exceed the provisions of Califomia Building Code, CCR, Title 24, Part 2, Sections 1203 ® ❑ and Chapter 14.1. Air Quality and Exhaust 5.506.1 Outside air delivery. For mechanically or naturally ventilated spaces in buildings, meet the minimum requirements of Section 121 of the California Dip ❑ Energy Code, CCR, Title 24, Part 6 and Chapter 4 of CCR, Title 8 or the applicable local code, whichever is more stringent.' 5.506.2 Carbon dioxide (CO2) monitoring. For buildings equipped with demand control ventilation, CO2 sensors and ventilation controls shall be n L^� ❑ specified and installed in accordance with the requirements of the latest edition D of the California Energy Code, CCR, Title 24, Part 6, Section 121(c).' Environmental Comfort 5.507.4 Acoustical control. Employ building assemblies and components in E ® ❑ with STC values determined accordance with ASTM 90 and ASTM E 413. 5.507.4.1 Exterior noise. transmission. Wall and floor - ceiling assemblies making up the building envelope shall have an STC of at least 50 and exterior windows shall have a minimum STC of 30 for any of the building 0 ❑ locations listed in Items 1 through 3 in Section 5.507.5.1. 5.507.4.2 interior sound. Wall and floor - ceiling assemblies separating tenant spaces and tenant spaces and public places shall have an STC of ®'� at least 40. Page 7 of 9 CalGreen Non-Res Checklim.dac revised 01123114 ti Outdoor Air Quality 5.508.1 Ozone depletion and greenhouse gas reductions. Installations of HVAC, refrigeration and fire suppression equipment shall comply with Sections 5.508.1.1 and 5.508.1.2. 5.508.1.1 Chlorofluorocarbons (CFCs). Install HVAC and refrigeration �J equipment that does not contain CFCs. 5.508.1.2 Halons. Install fire suppression equipment that does not contain ❑ Halons. Page 8 0r9 CalGreen Non -Res Checklisr.doc revised 01113114 I W CALGREEN SIGNATURE DECLARATIONS Project Name: - -- Project Address: _ _ Z,o 6� �Vmt_gaA 40 Project Description: f e " _G_AAIW. II�S SECTION 1 — DESIGN VERIFICATION Complete all lines of Section 1 —"Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the City of Cupertino. er's Signature Juli Satoh Owner's Naqp-(Pt9ase Print) Signature Design Professional's Name (Please Print) Signature of License Professional responsible fL. James Blomquist Name of License Professional responsible for CalGreen compliance (Please Print) pm(wapges.com Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION 12/9/15 Date L I 10 Date 1/5/2015 Date 408 - 310 -00801 Phone Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection: I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 9 of 9 CalGreen Non -Res C lirrkUsLdoc revised 01123114