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12110082i} CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19459 STEVENS CREEK BLVD CONTRACTOR: SOUTH BAY PERMIT NO: 12110082 CONSTRUCTION, INC OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LL 1711 DELL AVE DATE ISSUED: 05/28/2014 OWNER'S PHONE: 6503441500 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 IJ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL C, u ti MAIN STREET SHOP 7-7,078 SQFT NEW ONE STORY License Class — r L,�. �3 ^ ! RETAIL BLDG SHELL Contractor Date Z / 16 DEFERRED #2- TRASH ENCLOSURE - ISSUED 7/21/15 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 Sq. Ft Floor Area: Valuation: $0 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 permit is issued. APN Number: 31620085.19459 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D ERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 18 T CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, -'� costs, and expenses which may accrue against said City in consequence of the _ I granting of this permit. Additionally, the applicant understands and will comply I�� Date:��' J with all non -point source regulations per the Cupertino Municipal Code, Section , 9.18. �—J RE -ROOFS: Signature Date—) All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. 13OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the C-qpertino Municipal Code, Chapter 9.12 and 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 the Health & Safety Code, Sectio 25S 5, 25533, and 25534. 1 permit is issued. Owner or authorized agent: Date: 11 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date ilm- -I CUP15ERTINO ❑ NEW CONSTRUC CONSTRUCTION PERMIT APPLICATION 013. COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building a(-cupertino.org Gf CION ❑ ADDITION ❑ ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT 9 P S 'C P � � P d gy APN # O E C w .r. — E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME r PHO 'tF [,� �ff d STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OVJA>ER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCMTECT/ENGINEER NAME LICENSE NUMB BUS.BUS. LIC # COMPANY NAME �� ` i%Q� FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTINGUSE I PROPOSE USE C E #STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTGNEW AREA FL O D 0 AREA AREA TOTAL NET AREA 2 J BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH A DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF 1S THE BLDG AN ❑YESIUED NO RECE B I ""��` �t;t..r V UA I PLANNING APPL 4 Fl NO PLANNING APPROVAL LETTER EICHLERHOPTE? ❑ By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have red this application and the information I ha provided is corre have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws re d c n c ' n. h z representatives of Cupertino to enter the above -identified p oy for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATIOfPEQUIRED WIN= New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building k� r a OVER T$ "OUnTER + t �x07 �q� ENEMA f BUIISD L 1 EV�iVi r permit for new building. C DExPI2 S� x �y� um__ 1kl .l -y' L �AN}.i1VcrLAIz�XtEw 34� Bldgs: Provide a completed Hazardous Materials Disclosure iCommercial Sum form if any Hazardous Materials are being used as part of this project.E{ _ Copy of Planning Approval Letter or Meeting with Planning prior to QIJOR x ��SA1�TtAR25E9E�i�iSTRIC� submittal of Building Permit application. x �-�I.TH ��'�'���.: `� � ��'"`��.:'���;'�*��� #n'�"o ���. _ _ .�EL�VIRO15➢fENT' BldgApp 2011. doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION r12�M ! b f - 1r T i ✓F yj ia. •;.. ..�._ ,�.U.: .n7 t. .�,r .: H .n ,.� r, Q�,.x'�..,.. % ri .4n.�* 6h 5 !} �. �>. �.; � E K .:'d- ADDRESS: 19459 scb DATE: 01/29/2015 REVIEWED BY: Mendez Ah,,cTz, P,arrnft 1'er., ATN: BP#: *VALUATION: 1$40,000 *'PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY Commercial Building USE: Civil / Religious activities in B zone? 0 Yes Q No PENTAMATION 1 GENCOM PERMIT TYPE: A WORK DEFERRED #- TRASH ENCLOSURE SCOPE r12�M ! b f - 1r T i ✓F yj ia. •;.. ..�._ ,�.U.: .n7 t. .�,r .: H .n ,.� r, Q�,.x'�..,.. % ri .4n.�* 6h 5 !} �. �>. �.; � E K .:'d- FEE QTY/FEE MISC ITEMS Ah,,cTz, P,arrnft 1'er., 1'?r.zr,ri;. ,s' ec, � P?:rta;' Fee: .}gs`t'ic't Other Numb, MIT. f�riher Elec. In p. : �L ��i: {. � isp. l�F:e ,�'�f �()}'��). [:fi .Sp. I'f."f'.: liL N:. ht 4o, F'O,e; NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer Distric4 School District, etc.). These fees are based on the nreliminary information availahle and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $572.00 Deferred Submittal IDEFSUBM Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(j) Reg. Q OT p,p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC F7 $0.00 Administralive 11'ee: 0 E) Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 p� i'4I%£')£3(:I£?7IEiii'ldi#i3il Fees: Strong Motion Fee: 1BSEISMICO $11.20 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 y ^f ! J tr4 y qn 21, �` STJBTOTALS $1320 $57200 .✓ y x ��TQAL FEE $5 5.20 Revised: 01/06/2015 I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 19459 STEVENS CREEK BLVD I CONSTRUCTION, SOUTH BAY I PERMIT NO: 12110082 I OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LL 11711 DELL AVE Y DATE ISSUED: 05/28/2014 1 I OWNER'S PHONE: 6503441500 I CAMPBELL, CA 95008 1 PHONE NO: (408)379-5500 1 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. #� 6r5T Contractor o . Date . 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 permit is issued. 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 Lregulations per the upertino Municipal Code, Section 9.18. Signature" K Date' ❑ OWNER -BUILDER DECLARATION 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) 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: 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 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 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 JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL E] MAIN STREET SHOP 7-7,078 SQFT NEW ONE STORY RETAIL BLDG SHELL Sq. Ft Floor Area: Valuation: $0 APN Number: 31620085.19459 1 Occupancy Type: PERMIT EMPIRES IF WORK IS NOT STARTED WITHIN 80 DAYS OF PERMIT ISSUANCE OR 180 DAS;F M LAST CALLED INN°S'PEECTIIOON./ Issued by: Date: T j 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: 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, a d 25534. I _\ Owner. or authorized agent. Dater 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 70RRE 1'IVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildina(aDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # ar' PROJECT ADDRESS APN #i •,q • ))So()E-MAIL OWNER NAME 560l� � P - 3-1q �r bcs LL -c— STREI �D2RES� ^LU�J� 5�10�eslr�l �V CITY, ST _gW6� � t CA q,10(0 _ I FAX 3� /nCp� Lp5bD �KJ CONTACT NAME , ��4 PHONE E- AIL rch14e&L5 en c h Qv I'. Ur a ° r-lr2Kr .Com STREI � DM L 1� J I1 (2-J �S t,4e 2-00lmotlt;�� CITY, STATEZIP V1eA1 -,q Q q01- 1050 FAX - q(06-019-7 ❑ OWNER ❑ OWNER -BUILDER ❑ OWIMR AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGWEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK e � ® 2-21�^ . 7, Ze77 ,14a EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE I OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN TOTHER REMODEL AREA REMODEL AREA REMODEL AREA I PORCH AREA DECK ARP TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ATTACH #DWELLINGUNTIS: CONDIT ❑YES SECO\D STORY ❑YES ADDED? ❑NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG ANEl YES RECEIVED B RW q,,g gr- � �R�t TOTAL VALUATION: PLANNING APPL F ❑NO PLANNING APPROt AL LETTER EICHLER HON E,' ❑ NO By my signature below, I certify to each of 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 agree to comply with all applicable local ordinances and state laws relating wilding constructiont constructionI authorize representatives of Cupertino to enter the above-identifie property for inspection purposes. G `r�-��% Date: Signature of Applicant/Agent; v (' _ SUPPLEMENTAL INFORMATION REQUIRED irrt"Exv,., t 'h ; pea for pitoceit for t `Kmc xrxfg`RsTsr} P eai exisnDemol tion Prmit is required prior toissuanofbuilding building(s). ��c r�" �f t� x , ❑ ff permit for new building. 0 Ex�xEss � r t P.LANAIhGP, Yli}}>-�+"i.�iv��� N �s 1 ��S3 {.�3..5 .=2si n�� Y0f � ,u43 +Li Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Y TsDR " ❑�w _ form if any Hazardous Materials are being used as part ofthis project. D � iE : GkIly F❑��IREDEP� _ Co of Planning Approval Letter or Meeting With Planning prior to��2, PY � PP � � P submittal of Building Permit application. ._ys,k:? B1dgxXpp_2011.doc revised 06/21/11 CUPERTINO El -NEW CONSTRUC CONSTRUCTION PERMIT APPLICATION f COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 /� B. (408) 777-3228 • FAX (408) 777-3333 • buildingPcupertino.org CION ❑ADDITION ❑ALTERATION/TI ❑REVISION / DEFERRED b ORIGINAL PERMIT #. _ - PROIECF ADDRE S r �j % APN 4 MCI) `T7 1 V' STREET ADDRESS CITY, STATE, ZIP FAX Mxk1 - - '"" —1500 a 5kCMtic. - STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNM AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT ONS , -TRA.0=TORNA LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE I' �^] I EXISTING USE PROPOSED USE CONSTR. TYPE 9 STORIES USE TYPE OCC. SQ.FT. VALUATION (5) 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: DDETACH ❑ ATTACH R DWELLING UNrfS:IS A SECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? EINO ADDITION? EINO PRE -APPLICATION El YES IF YES, PROVIDE COPY OF 1S THE BLDG AN ❑YES rREGEIVED13YFALA UATION: PLANNING APPL ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO-;':, xr r �+;�, By my signature below, I certify to each of the following: I am the property owner or authorized agent to act ie pr erty owner's behalf. I have read this application and the inforniation I have provide s correct. I have read the Description of Work and verify it a e. I agree to comply with all applicable local ordinances and state laws relating t brill- truction. I au t ize r pre e t'ves f Cupertino to enter the abov -identified property for inspection purposes. SignatulIeDfp�ll anfilAdaltt: Date: �> m.t 11�" `—SUPPLEMENTAL INFORMATION REQTJ=D { s a' ❑,s,O�ERT$E-COUNTER��.- t It ❑�DUILD�GPL'�eiNRE�'IE�Y'� New SFD or Multifamilyciwellin s: Apply for demolition permit for g PPY P ?'gno � r'' existing building(s). Demolition permit is required prior to issuance of building ry P ermit for new building. EaPRESS 4a ❑t PL}1nI�II�G PLA1� n R❑ € REYiEwr Commercial Bldgs: Provide a completed Hazardous Materials Disclosure i .h ;y f �'�}F ❑ sT nRn �n Pihlumc\Nvfx�1RKS 3 3sx _ form if any Hazardous Materials are being used as part of this project. nEr of Planning Approval Letter or Meeting with Planning prior to LES �" " f r s 4 p fI _Copy Y ❑" SAi�TTARY SEAS ER DISTRICT submittal ofBuilding Permit application. $QzAgR {r` ter` yea wx t8 A� its B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FM -7 FEE ESTIMATOR — BUILDING DIVISION 19 ADDRESS: 19459 scb DATE: 02/19/2015 REVIEWED BY: Mendez APN: BP#: "VALUATION: 1$20,000 i *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: Commercial Building Civil /Religious activities in BQ zone? 0 Yes •, No PENTAMATION PERMIT TYPE: 1 GENCOM A WORK install Trellis #9 w/ foundation located between Shops 7& 8. SCOPE $0.00 NOTE. This estimate does not include fees due to other Departments (La Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef'. 7/1/13) Mech. Plan Check Afech. Permit Fee: Other Alech. Imp. :Llech. Insp. f'e.e: Plumb. Plan Check Plumb. Permit c<e: Other Plumb Insp. 1'lurnb. lase. Fee: Elec. Plan Check Idea Permit Fee: Other Elec. Insp. Vec. lnsp. fire: Plan Check Fee: Hourly,Only? 0 Yes (F) No $0.00 NOTE. This estimate does not include fees due to other Departments (La Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef'. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly,Only? 0 Yes (F) No $0.00 4 hours $572.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: Q Reg. () OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes (E) No $0.00 Suppl. Insp. Feer Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i Construction Tax: IBCONSTAXC $0.00 i Administrative Fee: i E) Work Without Permit? ® Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 T rm,el Documentation Fees: Strong Motion Fee: IBSEISMICO $5.60 =hrs $572.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $6.601$1,144.00 , . , , TOTAL FEEc . $1,150.60 Revised: 02/14/2015 STATEMENT OF SPECIAL INSPECTIONS, 2010 CBC COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B4O., BUILDING OFFICIAL CUPERTIN© 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building0cupertino.org SITE 9-4 ADDRESSADDRESSf 5 S bu APN B 2012-5/ owner. Q...W\1 L..C.QZTY1)M. JN .... M ft"TT Contractor ... SDQTV.�... C71 ...................................... Address, 7i ..�Xnlgtfvt�... .%%t....,Z-41.......................... Address ... 1: t,K\...OvoL.."..,iE..,,..................................................I............ i.Zip.,01-JW— .......... Phone.18.-..M . City/St ... C. P.M.L..,.CA ........ Zip.:`.00.0&.... Phone .-.10& 3.H Applicant .S..%),-. ���..kA\(...1/...o&,)ST................................................ Engineer/Architect..f u w..\ t,'. w, .i.f Address..i 11.................................................................... Address............................... CltylSt &WLT.......... ZIp. `�.? .......,Phone`(kS �City/SLW...� I..,.C:........Zip.1.11B Phone�j)rJ:. PROJECT DESCRIPTION: 1 P-�U1.1, #°1 This "STATEMENT OF SPECIAL INSPECTIONS" is submitted in fulfillment of the requirements of CBC Sections 1704 and 1705. This form is structured after and used by permission from the Structural Engineer Association of Northern California's (SEAONC) mode statement of Special Inspections. Also, included with this form is the following: "LIST OF SPECIAL INSPECTION AGENCIES (page 2). A list of testing agencies and other special inspectors that will be retained to conduct the tests and Inspections for this project "SCHEDULE OF SPECIAL INSPECTION" (page 3 — 6). The Schedule of Sp P�?,!;aMqpections summarizes the Special Inspections and tests required. Special Inspectors will refer to the approved. aii'd specifications for detailed special Inspection requirements. Any additional tests and inspections required by i a pfdved plans and specifications shall also be performed. Special Inspections and Testing will be performed In accordance with the approved a"�� specifications, this statement and CBC Sections 1704, 1705, 1706, 1707, and 1708. Interim reports will be submitted to the uildin' i Official and the Registered Design Professional In Responsible Charge in accordance with CBC Section 1704.1.2. r. A Final Report of Special Inspections documenting required Special Inspections, testing and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Qccl a ,coy (Section 1704.1.2). The Final Report will document:' • Required special inspections. • Correction of discrepancies noted In Inspections. The Owner recognizes his or her obligation to ensure that the construction compltes.�i rith the approved permit documents and to implement this program of special inspections. In partial fulfillment of these obligations, the Owner will retain and directly pay for the Special Inspections as required In CBC Section 1704.1, This plan has been developed with the understanding that the Building Official will: • Review and approve the qualifications of the Special Inspectors who will perform the inspections. • Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are performing their duties as called for in this Statement of Special Inspection. • Review submitted Inspection reports, • Perform Inspections as required by the local building code. 1 have read and agree to comely with the terms and conditions of this statement Prepared By: Project }fit Engineer Q Architect ���---� S5166 03/18/15 Registered Design Professional in Charge Signature ............................................................... Lic.#,...................................... Date:..............,.......,... Owner C/ J Owner's Authorization Signature-- ......................................... Date: Inspection Inspector Nam/e: /� JAgeenccy/ Cori5ot /C/l ple LF ma!r t e.6S k Signature .... ..7� • .... �' fir .............................. Uc.# ....... Date:. Building Official or designee: � 3 Signature.. ..................� .......... ................................,......... Date:.....,.,.................. dSpecialnspectionForm 2012.doc revised 09/06/12 , 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 dutles. 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 f 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 arolect: EXPERTISE . FIRM! INSPECTOR INFORMATION 1. Special Inspection (except for 0 2. r G ocJ en d - !Y.........�............................. Firm ... .....11Sc!�iQ�Ge�tlf<.., RA�jlltedrlN�;:::::;;;Addy.::;::. geotechnical) ::::::::::::::...... Cit �G3aa...tQ�}40+1.............. state s��.,....,......,Zi 4y58. � y..... p . ...-7......I Telephone...................................... Fax............... ......... Email............,..... 2. Material Testing Firm.....................6 f:.d�-..-............................. Addr........................ ' I State....................... Telephone.9Af-.3.fY7:.W ...... Fax..!R-.��, 71YL........ Emailterr a- u a'.A.C!�-%o?S i 3. Geotechnical Inspections Firm.....................................................................Addr.............................I............ I City...............I-- .................................................................................... State .......................Zip ...................... Telephone...................................... Fax ............................................ Email ......................................................... I 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 REQUIREMENTS (Section 1705.4.1) 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. i i SpecialnspectionF'orrn_2012.doc revised 09/06/12; CDM SCHEDULE OF SPECIAL INSPECTION ADDRESS � 5f cs C? R)t V 0 .ADDRESS BP# I PROJECT DESCRIPTION: I Notation Used in Table: j Column headers: I 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 approprlate column to denote either"C' continuous or "P" periodic inspections. j --- 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. VERIFICATfON AND INSPECTION C P STANDARD REFERENCED IBC REFERENCEi INSPECTION OF FABRICATORS 1. Inspect fabricator's fabrication and quality control 1704.3 j procedures. INSPECTION OF STEEL 1. Material verification of high-strength bolts, nuts and washers. M Identification marking to conform to ASTM stds AISC 360, specified in the approved construction documents. q X Section A3.3 and applicable ASTM material standards X Inspect fabricator's fabrication and quality control X procedures. _- —_ -- 2. Inspection of high-strength bolting: j ❑ 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. Section M2.5 1704.3.3 ❑ 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. �1 For structural steel, identification markings to conform X AISC 360, to AISC 360. Section M2.5 ❑ For other steel, Identification markings to conform to . Applicable ASTM ASTM standards specified in the approved -- X material standards construction documents. 0 Manufacturer's certified test reports. -- X I ` I SpecialnspeciionForm_201246c revised 09/06/121 VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE 4. Material verification of weld filler materials: 1 ❑ Identification marking to conform to AWS specification in the approved construction documents. X 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 --- X Single -pass fillet welds > 5116" X --- 13 Plug and slot welds. X -- ❑ Single -pass fillet welds <= 5116" --- 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 1:1 Other Other reinforcing steel. -- X 6. Inspection of steel frame joints details for compliance: ❑ Details such as bracing and stiffening. -- X -- 1704.3.2 d Member locations. --- X ❑ Application of joint details at each connection.. --- X VERIFICATION AND INSPECTIONC p REFERENCED STANDARD IBC REFERENCE INSPECTION OF WELDING 1. 0 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 SpecialnspectionForm_2012.doc revised 09106/12 i VERIFICATION AND INSPECTIONC p REFERENCED STANDARD IBC REFERENCE INSPECTION OF CONCRETE 1. X 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. MI Inspection of bolts to be installed in concrete prior to and during placement of concrete where allowableX __- ACI 318: 8.1.3, 1911.5, 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 j 5. X1 Verifying use of required design mix. 1904.2.2,1913.2,E X ACI 318: 1913.3 6. 1 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 7.1 Inspection of concrete and shotcrete placement for X --- 9 510 ACI 318: 5., . 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: 1 ❑ Application of prestressing farces. 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. X 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 ❑ Direct tension testing of new bolts. --- X ❑ Torque testing of new bolts. -- X ❑ Prequalification test for bolts and other types of - _ X anchors. 14. ❑ Other: See ICC ES Reports form special inspection requirements for proprietary products SpecialnspectionFonn 2012. doe revised 09106112 SpecialnspectionForm 2012.doc revised 09/06/12 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 4021ACI SECTION 5301ASCE 5 5301ASCE 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 f'n, and f'A c prior to construction _ — X """ - Art. 1.413 except where specifically exempted by this code. 3. ❑ Verification of slump flow and VSI as delivered to X "-- -_- _._ Art. 1.513.1.1b.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. 3.66 ❑ 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 r _ X Sec. 2104.3, Art. 1.8C, 1.81D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing X --- _"- __ Art. 3.613 force. 6. Prior to grouting the following shall be verified to ensure compliance: ❑ Grout space is clean. --- X --- --- Art. 3.21D la 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. 3.3B 7. Grout placement: ❑ Grout placement shall be verified ensure X __ __ Art. 3.5 compliance. ❑ Observe grouting of prestressing bonded X -__ _ __- Art 3.6C tendons. SpecialnspectionForm 2012.doc revised 09/06/12 SpecialnspeclionForm 2012.doc revised 09/06/12; REFERENCE FOR CRITERIA j VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION 530/ASCE 5 5301ASCE 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 i of the construction documents and the approved -- X -- -- Art. 1.5 submittals. 2. ❑ Verification of f'm and f'A,c prior to construction and for every 5,000 square feet during --- X --- — Art. 1.41 construction. i 3. ❑ Verification of proportions of materials in premixed or preblended mortar and grout as -- X -- --- Art. 1.51 delivered to the site. I I I I II 4. ❑ Verification of slump flow and VSI as delivered toX the site for self consolidating rout. Art. 1.51.'1 .b.3 5. The following shall be verified to ensure compliance: ❑ Proportions of site -prepared mortar, grout, and X r Art. 2.6A prestressing grout for bonded tendons. ❑ Placement of masonry units and construction of X __ _-_ Art. 3.3B 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. 3.213 ❑ 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) i ❑ Preparation, construction, and protection of masonry during cold weather (temperature below _ _ X Sec. 2104.3, — Art11 40 degrees F) or hot weather (temperature above 2104.4 . .8C, .8D , 90 degrees F). ❑ Application and measurement of prestressing X --_ Art. 3.6B 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 SpecialnspeclionForm 2012.doc revised 09/06/12; EFERENCE JIBC —1 VERIFICATION AND INSPECTIONC P RSTANDARDD I R FERENCE INSPECTION OF WOOD 1. ❑ Inspect prefabricated wood structural elements and --- --- _– X assemblies in accordance with Section 1704.2. --- 1704.6 2. ❑ Inspect site built assemblies. --- 1704.6.1 13. Inspect high -load diaphragms: ❑ Verify grade and thickness of sheathing. --- --- _– X ❑ Verify nominal size of framing members at adjoining panel edges. achieve the desired bearing capacity. 2. ❑ Determine capacities of test elements and conduct -- 1704.6.1 ❑ Verify nail or staple diameter and length, — --- ❑ Verify number of fastener lines, — — ❑ Verify spacing between fasteners in each line and at have reached proper material. and accurate records for each element. edge margins. - - 3. ❑ Perform classification and testing of compacted fill 4. ❑ Metal -plate -connected wood trusses spanning 60 feet type and size of hammer, record number of blows per materials. or greater: Verify temporary installation X --- Table 1704,7 4. ❑ restraint/bracing and the permanent individual truss -- X --- 1704.6.2 member bracing are installed In accordance with the X --- approved truss submittal package. compacted fill. REQUIRED VERIFICATION AND INSPECTION OF SOIL 1. ❑ Verify materials below footings are adequate to _– X with the requirements. achieve the desired bearing capacity. 2. ❑ Determine capacities of test elements and conduct X additional load tests, as required. 2. ❑ Verify excavations are extended to proper depth and 3. ❑ Observe driving operations and maintain complete X have reached proper material. and accurate records for each element. X 3. ❑ Perform classification and testing of compacted fill type and size of hammer, record number of blows per materials. --- X --- Table 1704,7 4. ❑ Verify use of proper materials, densities and lift achieve design capacity, record tip and butt elevations thicknesses during placement and compaction of X --- compacted fill. accordance with Section 1704.3. --- 5. ❑ Prior to placement of compacted fill, observe subgrade_-- 6. ❑ For concrete elements and concrete filled elements, and verify that site has been prepared properly. --- X REQUIRED VERIFICATION AND INSPECTION OF DEEP DRIVEN FOUNDATION ELEMENTS I 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 09/06112 VERIFICATION AND INSPECTION C P REFERENCED IBCSTANDARD 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. Cl 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. ❑ Verify ventilation of area during and after application. -- X 2. ❑ Measure average thickness per ASTM E605 and Section 1704.12.4. –" _"" --- 1704.12.1 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. 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] SpectainspectionForm 2012.doc revised 09/06/12 VERIFICATION AND INSPECTIONC X p REFERENCED STANDARD IBC REFERENCE 6. Wind Resistance ❑ Roof cladding and roof framing connections. --- --- --- ❑ Inspect nailing, bolting, anchoring, and other fastening ❑ Wall connections to roof and floor diaphragms and of components within the main windforce-resisting and other fastening of components within the main X framing. --- --- -__ --- 11 Roof Roof and floor diaphragm systems, including diaphragms, drag struts, braces and hold-downs. braces, diaphragms, collectors (drag struts) and hold- collectors, drag struts and boundary elements. downs. ❑ Vertical wind -force -resisting systems, including braced 3, Wind -resisting components ❑ Roof cladding. frames, moment frames, and shear walls. - — 11 Wind -force -resisting Wind -force -resisting system connections to the -- 1706.4 ❑ Wall cladding. foundation. X -- 1. ❑ Special inspection for welding in accordance with the X _ _ ❑ Fabrication and installation of systems or components 1707.2 quality assurance plan requirements of AISC 341. required to meet the impact resistance requirements --- -- --- _ of Section 1609.1.2. seismic -force -resisting system. SPECIAL INSPECTION FOR WIND REQUIREMENTS 1. Structural Wood ❑ Inspect field gluing operations of elements of the main X wind -force -resisting system. system. --- 1706.2 ❑ Inspect nailing, bolting, anchoring, and other fastening ❑ Inspection of screw attachments, bolting, anchoring, of components within the main windforce-resisting and other fastening of components within the main X --- system, including wood shear walls, wood -__ --- X diaphragms, drag struts, braces and hold-downs. braces, diaphragms, collectors (drag struts) and hold- 2. Cold -Formed Steel Framing ❑ Welding of elements of the main wind-force-reslsting system. X ❑ 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. SpecialnspectionForrn 2012.doc revised 09106112 ❑ Inspection of screw attachments, bolting, anchoring, ❑ Inspect anchorage of electrical equipment for - X and other fastening of components within the seismic- -� X force -resisting system including shear walls, braces, ❑ Inspect anchorage of non -emergency electrical --- X equipment. diaphragms, collectors (drag struts) and hold-downs. more than 5 psf.and higher than 30 feet above grade --- 14, 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 ❑ Inspect anchorage of electrical equipment for - X weighing more than 5 psf and higher than 30 feet --- X above grade or walking surface. ❑ Inspect anchorage of non -emergency electrical --- X equipment. ❑ Inspect erection and fastening of veneer weighing more than 5 psf.and higher than 30 feet above grade --- X mechanical units carrying flammable, combustible, or or walking surface. X --- --- 1707.6 ❑ Inspect erection and fastening of all exterior non- ❑ Inspect installation of HVAC ductwork that contains hazardous materials. bearing walls higher than 30 feet above grade or -- X ❑ Inspect installation of vibration isolation systems walking surface. where required by Section 1707.7. --- X ❑ Inspect erection and fastening of all interior non- 7. ❑ Verify that the equipment label and anchorage or bearing walls weighing more than 15 psf and higher --- X mounting conforms to the certificate of compliance than 30 feet above grade or walking surface. 1707.8 when mechanical and electrical equipment must be 6. Mechanical and Electrical Components ❑ Inspect anchorage of electrical equipment for - X emergency or stand-by power systems. ❑ 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 hazardous materials. _-- X ❑ Inspect installation of vibration isolation systems where required by Section 1707.7. --- X 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 _-_ __ ___ 1708.3 requirements in AISC 341. 11. ❑ Obtain certificate that equipment has been seismically _ -_ 1708.4 qualified. 12. ❑ Obtain system tests as required by ASCE 7 Section ___ _— __ 1708.5 17.8. SpecialnspecrionPorm 2012.doe revised 09/06/12 +Associates Date: March 5, 2015 To: Sylvia Mendez City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 sylviam(cD-cupertino.org (via email) . Cc: Melissa Names melissan ancupertino.org (via email) RE: Plan Review for: Project Address: Agency App. No.: FRB+ Project No.: Agency: City of Cupertino TRB+ Project Number. 15.014.104.1 Final Plan Review Page 1 of 2 Install Trellis #9 w/ Foundation located between shops 7 & 8 19459 Stevens Creek Blvd 15020125 . 15.014.104.1 The following documents were received for review: Plans: (1 set) Sheets dated 02/17/15: S1.0, S2, S5.1, S5.2, S10, A9.5, A9.6 Structural Calculations: (1 copy) Stuart A. Lowe, dated 02/17/15 Plans have been reviewed for compliance with the Building Department requirements contained in the 2013 CBC, 2013 CPC, 2013 CMC, 2013 CEC, 2013 CRC, 2013 Green Building Standards Code, 2013 Energy Code, and City of Cupertino Ordinances. There are no further comments; however, the conditions cited on the following page apply. Sincerely, TRB + ASSOCIATES, INC., Keith Ma, PE, SE Plan Review Engineer BUILDING SOLUTIONS for. MUNICIPALITIES TRB + Associates, Inc. 3160 Crow Canyon Place + Suite 216 + San Ramon, CA 94563 T 925 866.2633 F 925 790.0011 www.TRBp/us.com Agency: City of Cupertino TRB+ Project Number.• 15.014.104.1 Agency App. No.: 15020125 Project Address: 19459 Stevens Creek Blvd CONDITIONS: Prior to permit issuance, applicant to submit Special Inspection Form for the following items: a. Concrete Testing and Placement. b. Epoxy Anchors. C. Structural Steel Welding. Page 2 of 2 TRQ + G111 - I CONSOLIDATED ENGINEERING L A B O. R A T O R. I E S S. Oakland, (5 DATE OF ISSUE: 3/18/2015 j RPT TO: City of Cupertino RE: Main Street Cupertino - Trellis 9 10300 Torre Avenue Stevens Creek and Finch Cupertino, CA 95014 Cupertino, CA 95014 ATTN: Albert Salvador Permit#: 1502012 l Y Alberts cu ertino.or Additional#:. P g CEL #: 1028288SW Lab #: 004036 PLACEMENT DATA Placement #: 1 40,300 1.00 3,210 Side fracture atend Placement date: 03/10/2015 Mix Number 5550FWR50 i Sample date: 03/10/2015 Strength Spec: 4000 psi @ 28 days Total sets: 1 Agg. Size/Src: 1" / star Material type: Concrete Compression Cyl. ASTM C 39 2113234626 / 68 004036E H Lab 4.00 X 8.00 Material Supplier: STAR Slump spec: 6.00 in j 004036A 7 03/17/15 Lab 4.00 X 8.00 SET DATA 40,300 1.00 3,210 Side fracture atend r Set number: 1 of 1 Slump: 5.75 in ASTM�C143 Sample time : -= 11:28 Air temp: 68 deg F 1.00 Sampled by: Mix temp: 68 deg F ASTMIC1064 Ticket/Truck : 2113234626 / 68 004036E H Lab 4.00 X 8.00 12.57 0 Mold type: CYL Unless otherwise noted, samples tested in accordance with ASTM C39 Placement Location Building 6, stairs 7 and 8, trellis 9, line A-E at 1-4 RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER j Sample Location: 1.25 at B Comments: i i Cylinder Test Test Cure Dimensions (in) Area Max Load Corr Strength Fracture # Age Date Type Diameter X Height (int) (lb) Factor I (psi) Type 004036A 7 03/17/15 Lab 4.00 X 8.00 12.57 40,300 1.00 3,210 Side fracture atend 004036B 28 04/07/15 Lab 4.00 X 8.00 12.57 0 1.00 0 1 '004036C 28 04/07/15 Lab 4.00 X 8.00 12.57 0 1.00 0 004036D 28 04/07/15 Lab 4.00 X 8.00 12.57 0 1.00 0 004036E H Lab 4.00 X 8.00 12.57 0 1.00 0 Unless otherwise noted, samples tested in accordance with ASTM C39 j RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER j CC:City of Cupertino - Albert Salvador City of Cupertino - Albert Salvador E -Reports placeholder - APR Y 5 13Y I i All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. Form ID 07 Rev.O/4� Ip 1 t— S CO OLIDATED ENGINEERING —rkSA o w a r o w e s CONCRE PRE,REINFORCING Page 1 of 1 DSA FILE# DSA APPL# LE PD# .I PERMIT/APPL# 1502012S Project Name: Main Street Cupertino Testing/Inspection Date(s): 2015-01-13 CEL Project#: 1028288 -SW Project Location: 19600 Vallco Pkwy. Cupertino, CA 95014 i Contractor: South Bay Construction Reported to: John McGowan Company Name: South Bay Construction Inspected rebar placement at: Trellis #9 Footings between Shop 7 & Shop 8 Drawing No.: S2 Detail No.: 1&4/S5.2, 2&3/S10 Other: Inspected placement of: rlAnchor bolts r; Hold-downs r Tie -downs Inspected: RiCast-in-place r—,1 Precast Operations [71 Monitored loads for correct mix and proper slump. rl Fresh concrete properties report left with IOR Inspected placing and vibrating of cubic yards of concrete Inspected placing of cubic feet of grout Performed r slump r air entrainment (—;Unit weight tests Cast set(s) of rl cylinders rl grout cubes Cast set(s) of shrinkage beams i Concrete Mix Number: lum s in tolerance. Yes p ? K! r' No ri Returned to plant for duration Work inspected was: r; Completed F1 In Progress rI Pending Approval WIP Punchlist dated: Non=compliance report dated: r was left with contractor rl Items were reinspected and: FXJ accepted r See attached ['Tremain in progress Issues/Problems? F] Yes rR No (Describe below) Notified: I John McGowan with South Bay Construction Notes/ Comments: Rebar Concrete Placement Type (slab, wall, footing) Structure Bldg./Level 'Location (Grid Lines) FJi Trellis footings Foundation Trellis 9 footings between shops 7 & 8 The Work: CK. WAS I - WAS NOT INSPECTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE CITY APPROVED DOCUMENTS The Work Inspected: 91 MET r� DID NOT MEET THE REQUIREMENTS OF THE CITY APPROVED DOCUMENTS Material Sampling: r WAS r; WAS NOT iR N/A PERFORMED IN ACCORDANCE WITH THE CITY APPROVED DOCUMENTS CC: Project Architect Signature of Special Inspector: ►✓�(�/�., Date: 2015-03-09 Structural Engineer . Brandon T. Wells Project Inspector Print Name/Title: DSA Regional Office , ACI 01026503 ICC 5286350 School District CERTIFICATION#. i "'TRC _ d afly Mold Repo ly—' Mountain View 3 C I— C� cord f— San Francisco T: (650) 967-2365 ,/ 925) 688-1200 T. (415) 644-3000 F: (650) 967-2785 : (925) 688-0388 F: (415) 541-9378 Project Number Daily Field Report Number Page Date 195281.2 251 1 of 2 3/27/2015 Project Location Time Day Main Street Cupertino Cupertino 8:00 AM Friday Client Inspector of Record Technician Assistant Sand Hill Development Company GV General Contractor Superintendent Project Engineer South Bay Construction John McGowan Scott Leck, P.E., G.E. Grading, Excavation, or Other Contractor - I Contractor Foreman -1 Weather/Temperature Techcon Jose Octavio clear/70's Grading. Excavation, or Other Contractor - Il Contractor Foreman - II Gauge ID Field Observations: Site visit as requested Techcon continues with footings for trellis b6tmen Shops 7 and 8. Footings have been cleaned as needed to remove unsuitable loose soils from footings. Bottom of footing are firm and stable, sides hava been trimed, sides are straight and plumb. Contractor drilling holes for dowels into existing Shops 7 and 8 footings. Final clean up to remove loose soil will be done after re bar is placed and before concrete placing. [� Continued on Next Page i Number Report Number Date 195281.2 1 251 1 March 27, 2015 Field Obsei vaatlons. (Continued) Day Technician Fridav I GV of I 1 Site Visit Requested By: Original Requested Work: SBC footings Copy of DFR to Superintentent/IOR: Additional Requested Worts: Return Visit Requested By: Return Visit Scheduled: WERE THERE -ANY FAILING TESTS? ❑ Yes F/I NO IF "YES", PLEASE ENUMERATE: WHICH TEST LOCATION(S) NEED(S) RE -TESTING? FOLLOW-UP FROM PRIOR REPORT? ❑ Yes [] No ID YOU OBSERVE EVERYTHING YOU EXPECTED TO? (EXPLAIN) DID YOU OBSERVE ANYTHING UNEXPECTED? (EXPLAIN) HAT, IN PARTICULAR, SHOULD BE OBSERVED, CHECKED, ANDIOR TESTED (OR RE -TESTED) DURING THE NEXT SITE VISIT? THIS DFR IS PRELIMINARY A preliminary report is provided solely as evidence that we performed field observations. Observations and/or conclusions and/or recommendations conveyed in the final report may vary from and shill take precedence over those indicated in a preliminary report. ❑ THIS DFR IS FINAL A final rert Is an instrument of professional service. Any conclusion drawn from this report should be discussed with and evaluated by the professional involved. Notice: Our firm's professionals are represented on site solely to observe operations of the contractor identified, to form opinions about the adequacy of those operations, and to report those opinions to our client. The presence and activities of our field representative(s) do not relieve any contractor from its obligation to meet contractual requirements. The contractor retains safe responsibility for site safety and the methods, operations, and sequences of construction. FIELD REPRESENTATIVE: DATE: =_ Gabe Velas uez March 27, 2015 LREVIEVED-BY: DATE: ❑ Continued on Next Pagei'�"__