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12110093CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19419 STEVENS CREEK BLVD CONTRACTOR: SOUTH BAY PERMIT NO: 12110093 CONSTRUCTION, INC OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR 1711 DELL AVE DATE ISSUED: 06/19/2014 OWNER'S PHONE: 6503441500 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ —7 License Class- Lic, # @ 4 MAIN STREET- FLEX I -CONSTRUCTION OF A NEW TWO STORY OFFICE/RETAIL BUILDING SHELL 9,676 SQ FT REV # 1 - ADD ROOF WALK PADS TO PLANS (RFI 504)- ISSUED 9/25/15 Contractor�() U�(t ` C l,,14 Date ` J 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. I have and will maintain a certificate of consent to self-insure for Worker's Sq. Ft Floor Area: Valuation: $1223285 Compensation, as provided for by Section 3700 of the Labor Code, for the fonnance of the work for which this permit is issued. ve and will maintain Worker's Compensation Insurance, as provided for by Fect APN Number: 31620109.19419 Occupancy Type: ion 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAYS FROM LAST CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, •nst costs, and expenses which may accrue a said City in consequence of the : Date: granting of is emtit. ilio lly, applicant understands and will com all non -poi ertino Municipal Cod , Secti .1Signature Date �/ 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 ❑ OWNER-BUILDER DECLARATION inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: i. I, as owner of the property, or my employees with wages as their sole ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) HAZARDOUS MATERIALS DISCLOSURE 2. I, as owner of the property, am exclusively contracting with licensed contractors to 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 maintain I hereby affirm under penalty of perjury one of the following three declarations: compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Safety Code, Section 25532(a) should I store or handle hazardous material. Compensation, as provided for by Section 3700 of the Labor Code, for the Additionally, should I use equipment or devices which emit hazardous air performance of the work for which this permit is issued. 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 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Health & Safety Code, Sqctions 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 6w'�e ed . ent: s. I certify that in the performance of the work for which this permit is issued, I shall Date <L 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 I hereby affirm that there is a construction lending agency for the performance of work's must forthwith comply with such provisions or this permit shall be deemed for which this permit is issued (Sec. 3097, Civ C.) revoked. Lender's Name Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating ARCHITECT'S DECLARATION to building construction, and hereby authorize representatives of this city to enter I understand my plans shall be used as public records. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Licensed Professional 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.ora ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI 0 REVISION /DEFERRED PR07ECTADDRESS Flex 1 19419 Stevens Creek Blvd APN# 3 v V 1 OWNERNAMEMain Street Cupertino Aggregator, LL PHONE (650)344-1500 E-MAIL STREETADDRESS2882 Sand Hill Rd, Suite 241 CITY, STATE, ZIP Menlo Park, CA 94025 FAX CONTACT NAME Paul Hansen PHONE E-MAIL phansen@shcmllc. Com STREET ADDRESS 2882 Sand Hill Rd, Suite 241 CITY,STATE,ZIP Menlo Park, CA 94025 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT 13 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Mark Avila LICENSE NUMBER B3 3 6 9 74 LICENSE TYPE BUS. LIC # 5655 COMPANYNAME South Bay Construction E-MAIL mavila@sbci.com FAX (408)379-3256 STREET ADDRESS 1711 Dell Avenue CITY,STATE,ZIP Campbell, CA 95008 PHONE (408)379-5500 ARCHITECT/ENGINEER NAME Keri Rodrigues LICENSE NUMBER C12,818 BUS. LIC # COMPANYNAME Kenneth Rodrigues & Partner, INC E-MAIL kenr@krparchitects.com FAX (650) 960-0707 STREETADDRESS 445 N Whisman Rd, Suite 200 CITY,STATE,ZIP Mountain View, Ca 94043 PHONE (650)965-0700 DESCRIPTION OF WORK 1.) Add walking pads to roof -mounted equipment, sheet A4.1 - RFI #504 EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES I USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM KITCHEN REMODEL AREA REMODELAREA OTHER REMODEL AREA PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: LIDETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES BEING ADDED? []NO SECOND STORY ❑YES ADDITION? ❑NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized a o act pro Wne ehalf. I have read this } application and the information I have provided is co ect. I have read the Description of Wor is as e. I agree to comp ith all applicable local ordinances and state laws relating to ildin on tm 'on. I allthonze representatives of Cuperti rrttFie above-ide tified property fort ection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PI A1V CHEcxTVPE ROUTING SLIP. : ❑ OVER THE -COUNTER zo BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STA?6A" ❑ .PUBLIcwoxxs form if any Hazardous Materials are being used as part of this project. ❑! LARG& ` PFIRE DEPT: _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ,D SANITARY SEWERIIISTRICT ENVIRONMENTAL HEALTH . BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — RTTTEDIrNf T)1V1C1(1N 1AADDRESS:* 19419 STEVENS CREEK BLVD DATE: 08/28/2015 REVIEWED BY: MELISSA I*PERMIT.TYPE: APN: 31.620109.19419 BP#: 12110093 *VALUATION: Iso ' Building PermitPLAN CHECK TYPE: Alteration / Addition/ Repair PRIMARY Commercial Building USE: Civil/, Religious activities in BQ zone? 0 Yes E) No PENTAMATION 1GENCOM PERMIT TYPE: i WORK REV # 1 - ADD ROOF WALK PADS TO PLANS RFI 504 SCOPE 1/ech..Plan Cheek 1'lutnb. I'1zin C'heeIc Islee. Man Check keh. Permil hee: I I Per'rrur I l lcc. Perrreit Fee: Other .A'Iec lz. Ins1>. Aft?,. h. /rasp. Fee: Other I'lurnb.t isp. Plumb. h7.sp. Fee: Other Elee. lose. 15'lec. 1nsp. Fee: NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc-)- Those fooc aro hacod nn tho nroliminary infnrmaffnn mmilahlo and aro nnhv an octimato !'nntart tho Dont far adds'l info_ FEE ITEMS (Fee Resolution I1-053 Ej. 7/1/13 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? O Yes (j) No $0.00 hours Plan Check, Hourly $286.00 ISTPLNCK Suppl. PC Fee: e) Reg. O OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. O OT F0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 Ahninisfrath;e F(,(,?: 0 E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 TY('1VE'/I�OL1(!'I7c'Y1X("ldCt)lT �`E'c',S': Strong Motion Fee: $0.00 1 Select an Administrative Item Bldg Stds Commission Fee: $0.001 ;SUBTOTALS $0.00 $286.00 kTOTAL FEE. $286.00 Revised: 07/02/2015 W1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19419 STEVENS CREEK BLVD CONTRACTOR: SOUTH BAY PERMIT NO: 12110093 CONSTRUCTION, INC OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LL 1711 DELL AVE DATE ISSUED: 06/19/2014 OWNER'S PHONE: 6503441500 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 ALICENSED CONTRACTOR'S DECLARATION F r License Class_ Lic. # �J�h BUILDING PERMIT INFO: BLDG ELECT PLUMB Contractor SuUn� &q')k)S Date L5 MECH RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: MAIN STREET- FLEX 1 -CONSTRUCTION OF A NEW TWO (commencing with Section 7000) of Division 3 of the Business &Professions STORY OFFICE/RETAIL BUILDING SHELL 9,676 SQ FT Code and that my license is in full force and effect. DEFERRED #1- INSTALL (1) GLASS AWNING-ISSD 4/15/2015 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: $1223285 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by 11 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 31620109.19419 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FR AST 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 granting of this Additionally, Issued by: Date: permit. the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature � Date ROOFS: All roofs shall be inspected prior to anyny roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, 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 I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will declarations: maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous 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 perfonnance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sons 25505, 25%33, an 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent I Date. 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 Califomia. 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 Lender's Address 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, ARCHITECT'S DECLARATION 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 4p CCUPERTINO I I NEW CONSTRI ICTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (4018-)) 777-3228 • FAX (408) 777-3333 • building(3cupertino.org 1 I ADDITION F -1 I AI.TFRATION/TI R1 REVISION/DEFERRED FWX I ORIGINALPERMIT# I'2-11rn -2, PROTECT ADDRESS101-1 C APN N O6VNERNAME ��MT_ PHONE /I v iJ ��I (' E-MAIL STREET ADDRESS � r�, \ tqaL tk�� CITY, STATE, ZIP ^�, mmaul CK ctm � PHONE ' I 94 ARCHITECT/ENGINEER NAME V-t-AuN STREET ADDRESS (�)oOsom q CITY, STATE, ZIP FAX CONTACT NAME `vim ` STREET ADDRESS �� uv PHONE �D Z • Z�Z 4 Vp � Cm LLC. a E MAI[ wo 'y " -s-f k@ � J STREETADDRES" -S� CITY, STATE, ZIP 9) �lyr(L �/►A FAX IXOWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT I CONTRACTOR NANIE 2�WT* /1�^ ,� `® y LICENSE NUMBER �/��j, a(�� jJ,O LICENSETYPE BUS. LIC H �V C�� COMPANY NAME wm 'V E-MAILC_ TMO@ S� -^ /v ` FAX STREET ADDRESS � r�, \ tqaL tk�� CITY, STATE, ZIP ^�, mmaul CK ctm � PHONE ' I 94 ARCHITECT/ENGINEER NAME V-t-AuN LICENSE NUMBER BUS. LIC # COMPANY NAME � 1 � Sri E-MAIL iol � � '^ 1. FAX STREET ADDRESS �� uv CITY, STATE, ZIP P�`�� I ,. W X115 PHONE,,,.,, d DESCRIPTION OF WORK I EXISTING USE PROPOSED USE CONSTR. TYPE 1 k STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER ARE" REMODEL A REMODEL AREA REMODEL AREA PORCH AREA ) DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: 0 DETACH ❑ ATTACH k DWELLING UNITS IS A SECOND UNIT ❑ YES SECOND STORY OYES BEING ADDED? ANO ADDITION? ONO i PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES CEIVED BY: V�ION: PLANNING APP! r-1+: NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NOrrvvl, �O�L By my signature below, 1 certify to each of the following: I am the property owner or authorized agen o act ie 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 rt is accurate. I agree to comply with all applicable local ordinances and sate laws relati to ttruction. authAonzU representatives of Cupertino to enter the above -identified property for inspection purposes. �biiildingcO Signature of Applicant/Agent: �1 6 -A . W \ Date: I[)[ SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER U{.DINGPLANREVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior t0 issuance of building permit for nc,,v building. -1EXPRESS LANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ PUBLICWORKS _ form if am' Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIREDEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ DIAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTALHEALTH Bldg,4pp_2011.doc reviser! 06./21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19419 STEVENS CREEK BLVD CONTRACTOR: SOUTH BAY PERMIT NO: 12110093 CONSTRUCTION, INC OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LL 1711 DELL AVE DATE ISSUED: 06/19/2014 OWNER'S PHONE: 6503441500 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ License Class � - MAIN STREET- FLEX 1 -CONSTRUCTION OF A NEW TWO Lic. #1 rJ STORY OFFICE/RETAIL BUILDING SHELL 9,676 SQ FT Contractor5�tPl. (T l.(%b1S1 Date al J4- 1 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: 31620109.19419 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 1 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY LAST 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 Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regul ns p the ipertino Municipal Code, Section 9.18. 6 Signature Date 1� 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. ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous 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 upe ti o M ici I Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Se io 2 0 5 5534. ' Section 3700 of the Labor Code, for the performance of the work for which this /(� permit is issued. Owner. or.authorized agent: t Date:6 �f 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CONSTRUCTION PERMIT APPLICATION 3 � . COMMUNI I Y DEVELOPMENT DEPARTMENT •BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(d)cupertino.ora \�- ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT n PROJECT ADDRESS APN N `®^ �7 f`i / OT 62 ONVNER NAME 566� r bC-S L-� PH01 S -b (,Y 3�f� . Iso � L STREET ADDRESS p �l� �,�.f Shares �1�,•lr �V CITY CITY, ST � /� I FAX NAME tA16� l.H IgQ0S .3_7 0U5,9 CONTACT e ti h Rr, r a �� i'1 e�'S PHONE - [�- D�� v n r 2Kr rc h ,4 e&6- .COM sT Ays N WhisrtKrn Q -d S v4e- ?��1M0v^V,-&A CITY, STATE, ZIP ` ie -V\1 A (34101 FAX "so- a(,7b 0�G ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGEN-r ❑ ARCHITECT ❑ ENGiNmER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 75C) LICENSE NUMBER LICENSE TYPE BUS. LIC 9 COMPANY NAI.4E E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGTNEER NAME LICENSE NUMBER BUS. LTC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE R 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 I PORCH AREA DECKAREA TOTAL DECKIPORCH AREA G.ULkGE AREA: DETACH E]ATTACH R DWELLING UNITS: IS A SECONDUNIT ❑ YES SECOND STORY []YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES "REGEIVED`$Y ae '?,F� :._M '' _ }= ^?== "" 5= TOTAL VALUATION: PLANNING APPL R []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO w� vi��-� �'r �-� '� ..f �.K�.'.r 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 ha - ,,rovided 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 utlQ connstrucia I auth ize representatives of Cupertino to enter the above -i entifie "property for inspection purposes. Sian ature of Applicant /Aeent: f E _'(f l.�%M�� Date: SUPPLEMENTAL INFORI\IATION REQUIRED101�,U?p cc�E�tiIT G SLIP „,�fi`„;ROVT.- �- , _ New SFD or Multifamilydwellings: Apply for demolition permit for w = A� � ,v ; ` h ryt ':vu existing building(s). Demolition permit is required prior to issuance of building 5 �OA`]COU1\I�ERY��{ r �5�� BUIL;DrIhGPI� REVIE�V� rS Res x permit for new building. ' ❑A ExPREss sr cc'`h xr, s-N�f ar`k , YA7 LA]M1CPLAN j2EVIEw yr ' F r 5 r }r tiles _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �r ST41CpARD ter” r ❑ PUBLIC�i ORhS form if any Hazardous Materials are being used as part of this project. ❑SRGE,�°f ❑FTRFDEP",trt,4.> Copy of Planning Approval Letter or Meeting with Planning prior to y .�'"3_?t ,'r a .�73p , _ submittal of Building Permit application. A�� ? ti i� � 3 EI; DISTRICT r� Y��54TTAR�� Bld,;9pp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 19419 scb FEE DATE: 10/28/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$16,850 PERMIT TYPE: Building Permit 01?flfi' Phll"16, N':Ll PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building T?.rnu5. Ir.•ajy ;"'zr: PENTAMATION USE: PME Plan Check: PERMIT TYPE: 1 GENCOM� WORK [ffq?��install 1 lass awnings SCOPE Permit Fee: $0.00 NOTE: This estimate (toes not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the Dent or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef.' 711/13) FEE QTY/FEE :.'c No,7 (.r2 •.: `. s 7)Ii -P .e. .' 1 7.,. f'L'' :.: Fee. F- , :. Arniit Fi'�.�: $0.00 01?flfi' Phll"16, N':Ll vk, k i%,.k Pee. T?.rnu5. Ir.•ajy ;"'zr: i. •%..,.. Itzst, �.:, ,. NOTE: This estimate (toes not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the Dent or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef.' 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Awning / Canopy (Support'd by Bldg) WV06 IAWNATTBLD I Awning Suppl. PC Fee: Q Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -Q) Reg. 0 OT 00 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 "°<1t1sr'."?lt:'Ll� it "i' «-• 0 Work Without Permit? 0 Yes (j) No $0.00) Advanced Planning $0.00 Select a Non -Residential Building or Structure E) 0i.'3'itt:d%7 / f i17 l''e't'1'.. Strong Motion Fee: IBSEISMICO $4.72 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS:, $5.72b0 TOTAL FEE: '6472' Revised: 07/10/2014 DR CONSOLIDATED ENGINEERING L A B O R A T O R 1 E S 6/4/2015. City of Cupertino Albert Salvador 10300 Torre Avenue -Cupertino, CA 95014 RE: Main Street Cupertino Flex Building 1 .19419 Stevens Creek Boulevard Cupertino, CA 95014 Permit# 12110093 CEL#: 1028289A FINAL REPORT FOR SPECIAL INSPECTION AND MATERIALS TESTING SERVICES (Effective Through 04/21/15) JUN 2 g 2015 BY In accordance with Section 1704 of the California Building Code, Consolidated Engineering Laboratories has provided the requested special inspection and testing on the subject project as listed below: 1. Reinforcing steel placement 2. Anchor bolts installed in concrete 3. Concrete placement and testing 4. Structural steel shop and field welding, including non-destructive testing (UT & MT) and material ID 5. Grout placement and testing (base plates) These inspections were performed by personnel under the general supervision of a Registered Civil Engineer in the State of California. Details of our work on this project are contained in our testing and inspection reports, issued during the course of construction. Based solely upon the inspections and tests performed and upon our substantiating reports, it is our professional judgment that the inspected work was performed substantially in conformance with the approved plans and specifications, approvals by the Engineer of Record and the applicable workmanship provisions of the California Building Code. Special inspection and materials testing is the observation of construction for general conformance with the approved design drawings and specifications. It should not be relied upon by others as acceptance or as a guarantee of work, nor should it in any manner relieve any contractor, or any other party, from their obligations and responsibilities under either the construction contract or generally accepted industry custom/practice. 2001 Crow Canyon Road, Suite 100 • San Ramon, CA 94583 • TEL (925) 314-7100 • FAX (925). 855-7140 CONSOLIDATED ENGINEERING L A B O R A T O R 1 E S We appreciate the opportunity of working with you. If you have any questions or require additional information, please feel free to contact us at your convenience. REVIEWING ENGINEER: CHRIS KAVALARIS, R.C.E. CC: Main Street Aggregator LLC (E) Main Street Aggregator LLC (E) . Kenneth Rodrigues & Partners, Inc. (E) South Bay Construction (E) Inspection & Valuation International, Inc. (E) South Bay Construction (E) Main Street Aggregator LLC (E) Hohbach-Lewin, Inc. (E) All reports are submitted as the confidential property of clients. Publication of statements, conclusions, or extracts is reserve e—Qg our written approval W. 033179 e Exp. 06/30/16 �T CIVIL OF r.AL\F� 2001 Crow Canyon Road, Suite 100 • San Ramon, CA 94583 • TEL (925) 314-7100 • FAX (925). 855-7140 I Building Departinent 'City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: -408-777-3333 JOB ADDRES S:1 9419 Stevens Creek Blvd - Flexl PERMIT # 12110093 OWNER'S NA ME:Sand Hill Management PHONE4 GENERAL CONT. RACTOR: South Bay Construction BUSINESS: LICENSE '# 5655 ADDRESS: 1711 Dell Ave -Campbell, CA 95008 *Our niunic . ipal code requires all businesses working. in the city to have,a City of Cupertino business license. NO BUILDING FINAL OR FINIAL OCCUPANCY INSPECTION(S) WILL BE SCIIEDULED UNTIL THE GENERAL CONTRACTOR AND ALI, SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 1, �'144 - Owner / Contractor Signature 5/12/15 M SUBCONTRACTOR BUSI.NESS NAME . . ..... .... BUSINESS LICENSE # Cabinets .& Millwork X Cement Finishing Techcon 23513 X Electrical Redwood Electric Group 21108 X Excavation Doyle's 35611 Fencing Floorin.g, [Carpeting. Linoleum / Wood X Glass Glazuig Classic Glass 25840 X Heating The Trillo Company 29816 X Insulation Central California Insulation 557 Landscaping X Lathing Cen Cal Plastering 33021 X Masonry Pacific Bay Masonry 25509 K Painti:ngJ Wallpaper G&G Painting 34391 Paving X Plastering Cen Cal Plastering . . . ... ..... 33021 X Plumbing Fresno Plumbing & Heating 32000 X Roofing Statewide Roofing 23509, 'Septic Tank X Sheet Metal The Trillo Company 29816 Sheet Rock South Bay Interiors 25499 Tile 1, �'144 - Owner / Contractor Signature 5/12/15 M c- '0 s0UDATED,iENCI,NEERIN6 INSPECTION/TESTING REPORT Date Of Issue: 4/16/2015 RE: Main Street Cupertino - Flex Building 1 Rpt City of Cupertino To: 10300 Torre Avenue Cupertino, CA 95014 Attn: Albert Salvador Inspection Date(s): 4/10/2015 Location: Jobsite Report # 0410Field Inspector(s): William Marlik On the above date, our representative inspected the referenced project. 2001 Crow Canyon Road, Suite 100 San Ramon, CA 94583=5387 Tel. 925 314-7100 Fax. 925 855-7140 www.ce-labs.com Permit 12110093 CEL# 1028289A Please refer to the attached reports for details and locations of our inspection services for the above noted date. Work inspected was in compliance with approved plans and specifications. CC: Enclosures (3) reviewing Engineer: Chris Kavalaris, PE City of Cupertino (P) Kenneth Rodrigues & Partners, Inc. (ER) South Bay Construction (ER) Main Street Aggregator LLC (ER) Inspection & Valuation International, Inc. (ER) South Bay Construction (ER) Main Street Aggregator LLC (ER) Hohbach-Lewin, Inc. (ER) All reports are submitted as the confidential property of our clients. Publications of statements, conclusions, or extracts is revised pending written approval. yl Form ID 017 Rev.0 L' -A, W 0. ATPD IENG_LNFV.EEF{II -Gs Structural Steel Welding Project Name Main Street Cupertino - Flex Building 1 DSA File # CEL Project # 1028289A DSA Appl # Project Location 19419 Stevens Creek Boulevard, Cupertino, CA 95014 LEA # Contractor OSHPD # Date 0411012015 Day Friday IR # Permit/Appl # 12110093 Drawing No. Detail No. Other Work at: ❑ Shop ® Jobsite Type of work: ® Structural Steel For shop inspections: Shop Name: Reported to (Name): John McGowan Address: Company: South Bay const. ❑ Collected ❑ Checked mill certificates Sampled: c Verified: ® Welder qualification ❑ Procedure qualification ❑ Weld procedure specification 0 Visually inspected the: ® In progress Welding performed by: 1 -welder v ® Completed Qualified welders using: NR -232 c 22 SMAW ❑ Filler Metal Type(s) E SAW ❑ Filler Metal Type(s) E �a y FLAW IN Filler Metal Type(s) E 71T-8 GMAW ❑ Filler Metal Type(s) E �a 2 Other ❑ Fillet Metal Type(s) E ® Verified proper electrode storage. Preheat temperature maintained ❑ at ❑ Maintained per WPS requirements ® Maintained per AWS D1.1 ❑ Groove welds ❑ Complete penetration ❑ Partial penetration ❑ Flare -bevel p Fillet welds: ® single -pass ❑ multi -pass ❑ Direct ❑ Indirect butt splice on reinforcing steel +; ❑ Other For: ❑ Base plate ❑ Gusset plate ❑ Connection plate ❑ Moment plate ❑ Plate -to -plate Splices 0 0 ❑ Stiffener plate ❑ Reinforcing steel ❑ Brackets ❑ Bent plate ❑ Beam to column connections W r_ ® Other: Stair stringers to Stair STRUCTUAL framing m at: ❑ Wide flange columns ❑ Wide flange beams ❑ Tube steel columns ❑ Tube steel beams ❑ Embeds ❑ Beam to column ❑ Girder to column ❑ Column to column splice ❑ Chord bar splices ❑ Diagonal brace to ❑ Angle to ❑ Studs to ❑ Other v 0 Inspected on metal decking rn ❑ Arc spot welds ❑ Stitch welds ❑ Shear studs ❑ Button punch L Form ID 017 Rev.0 C'C7NSOILIDATICD.E`NGINEEFt]NG Structural Steel Welding Refer to the attached: ® Field Inspection Record ❑ Member Completion Record ❑ Material Identification Record Work inspected was: ® Completed ® In progress ❑ Pending approval ❑ W.I.P. punch list E E ❑ Non-compliance report was left with contractor M V1 ❑ Items were reinspected and ❑ Accepted ❑ Remain in progress C. See the attached ❑ Punch list ❑ Non-compliance Item # m W Issues/Problems? Notified: Company Name: J This Work Was INSPECTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE CITY APPROVED DOCUMENTS The Work Inspected Met THE REQUIREMENTS OF THE CITY APPROVED DOCUMENTS Material Sampling PERFORMED IN ACCORDANCE WITH THE O APPROVED DOCUMENTS CC: Project Architect Structural Engineer Project Inspector DSA Regional Office School District Signature of Special Inspector 2 Signature 4/10/2015 8:50:10 AM.png Date 4/10/2015 Print Name/Title William Marlik Certification #: 1085171-85 STAIR STRINGERS ONLY WELDED TO STRUCTUAL FRAME FOR LANDINGS FILLET WELDS THE REST OF STAIRS ARE IN PROGRESS c m E E O U N O Z This Work Was INSPECTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE CITY APPROVED DOCUMENTS The Work Inspected Met THE REQUIREMENTS OF THE CITY APPROVED DOCUMENTS Material Sampling PERFORMED IN ACCORDANCE WITH THE O APPROVED DOCUMENTS CC: Project Architect Structural Engineer Project Inspector DSA Regional Office School District Signature of Special Inspector 2 Signature 4/10/2015 8:50:10 AM.png Date 4/10/2015 Print Name/Title William Marlik Certification #: 1085171-85 1 O O N O E O U. MO L O♦+ AV W ■0 AV W CLw, ,u I a LL 0 U d N E ❑ LO T N O a O N c Z o v m 0 mCL J o J U U CL U aCL ` �cm ci a . .z ` M------------ O o T w N� _ lnnan��SS� Y N L y LL a w Q J a = a N N j Q m` U) i ❑ fn ❑ O E . E y E" _c LL m E uE ' Q C i 2 o' .off Y 3 0 U d N E ❑ LO T N O a O N c Z o v m 0 mCL J o J U U CL U aCL ` Vl c N 'E Z U W W D D In In ❑ In LU LU a a Q Q U = W r- _ a ~ O u- O F- U, Z w Z W LU LUCC G W 7 W O F.. LL �_.. W LO 0 N O v N co ❑ m C n Q Lo 00 Lo 0404 m c m C CL Vl C m U (D CL U) 0 m io C _2) U) N J C O O L CU N C WN O N Q C �❑ o 'o Q r IL U) CL In n U U a . ` w Y N L m` O o Q C 2 Y 3 V d 0 0 R d N J �N d O. E 0 �(D CL a n ii N 2 Q w O. Q) V a Wo Ca Z F � > N 2. C 0 0 CE d AR m m w 0 cn C C l0 0 d O C N N m � n a E C LL N d U F � C o � ani C c U LL d 0 N T Vl c N 'E Z U W W D D In In ❑ In LU LU a a Q Q U = W r- _ a ~ O u- O F- U, Z w Z W LU LUCC G W 7 W O F.. LL �_.. W LO 0 N O v N co ❑ m C n Q Lo 00 Lo 0404 m c m C CL Vl C m U (D CL U) 0 m io C _2) U) N J C O O L CU N C WN O N Q C �❑ o 'o Q r IL U) CL In n U U CONSOLIDATED ENGINEERING L A B-0 R A T O R I E S DATE OF ISSUE: 5/19/2015 RPT TO: City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 ATTN: Albert Salvador A1bertS(ncupertino.org 534 23rd Avenue Oakland, CA 94606-5307 (510) 436-7626 COMPRESSION TEST REPORT RE: Main Street Cupertino - Flex Building 1 19419 Stevens Creek Boulevard Cupertino, CA 95014 Permit#: 12110093 Additional#: CEL #: 1028289A Lab #: 006564 PLACEMENT DATA Placement #: 5 SET DATA Placement date: 04/21/2015 Mix Number 7038LWRP Sample date: 04/21/2015 Strength Spec: 3000 psi @ 28 days Total sets: 1 Agg. Size/Src: 3/8/ Material type: Concrete Compression Cyl. ASTM C 39 Cement factor: 7.00 sack Material Supplier: STAR Slump spec: 4.00 in Samples MEET specified 28 DAY strength requirement at 28 DAYS. Avg=5210 Unless otherwise noted, samples tested in accordance with ASTM C39 RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER CC:City of Cupertino - Albert Salvador E -Reports placeholder - RECEIVED Ni JUN 0 2015 All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. SET DATA Set number; 1 of 1 Slump: 4.00 in ASTM C143 Sample time : 13:23 Sampled by : Jerry Risenhoover Mix temp: 80 deg F ASTM C1064 Ticket/Truck : 214743/36 Mold type: CYL Placement Location Flex building A upper deck.and 3 mid span landing and sairs Sample Location: Upper deck landing 3' in front of last stair step overall stair location at gridline 3 -4/D1 -E1 Comments: Cylinder Test Test Cure Dimensions (in) Area Max Load Corr Strength Fracture # Age Date Type Diameter X Height (int) (lb) Factor (psi) Type 006564A 7 04/28/15 Lab 4.00 X 8.00 12.57 47,740 1.00 3,800 Cone one end 006564B 28 05/19/,15 Lab 4.00 X 8.00 12.57 66,210 1.00 5,270 Double side fracture 006564C 28 05/19/15 Lab 4.00 X 8.00 12.57 65,370 1.00 5,200 Side fracture at end 006564D 28 05/19/15 Lab 4.00 X 8.00 12.57 64,780 1.00 5,150 Side fracture at end 006564E H Lab 4.00 X 8.00. 12.57 0 1.00 0 Samples MEET specified 28 DAY strength requirement at 28 DAYS. Avg=5210 Unless otherwise noted, samples tested in accordance with ASTM C39 RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER CC:City of Cupertino - Albert Salvador E -Reports placeholder - RECEIVED Ni JUN 0 2015 All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. co CONSOLIDATED ENGINEERING L A B O' R A T O R: I E S DATE OF ISSUE: 4/28/2015 RPT TO: City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 ATTN: Albert Salvador A1bertSp,cupertino.org 534 23rd Avenue Oakland, CA 94606-5307 (510) .436-7626 COMPRESSION TEST REPORT RE: Main Street Cupertino - Flex Building 1 19419 Stevens Creek Boulevard Cupertino, CA 95014 Permit#: 12110093 Additional#: CEL #: 1028289A Lab #: 006564 PLACEMENT DATA Placement #: 5 Slump: 4.00 in Placement date: 04/21/2015 Mix Number 7038LWRP Sample date: _ 04/21/2015 Strength Spec: 3000 psi @ 28 days Total sets: 1 Agg. Size/Src: 3/8/ Material type: Concrete Compression Cyl. ASTM C 39 Cement factor: 7.00 sack Material Supplier: STAR Slump spec: 4.00 in SET DATA Set number: 1 of 1 Slump: 4.00 in ASTM C143 Sample time: 13:23 006564C 28 05/19/15 Lab 4.00 X 8.00 12.57 0' 1.00 Sampled by: Jerry Risenhoover Mix temp: 80 deg F ASTM C1064 Ticket/Truck : 214743/36 1.00 0 Unless otherwise noted, samples tested in accordance with ASTM C39 Mold type: CYL RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER :Placement Location Flex building A upper deck and 3 mid span landing and sairs Sample Location: Upper deck landing 3' in front of last stair step overall stair location at gridline 3 -4/D1 -E1 Comments: Cylinder Test Test Cure Dimensions (in) Area Max Load Corr Strength Fracture # Age Date Type Diameter X Height (W) (lb) Factor I (psi) Type 006564A 7 04/28/15 Lab 4.00 X 8.00 12.57 47,740 1.00 3,800 Cone one end 006564B 28 05/19/15 Lab 4.00 X 8.00 12.57 0 1.00 0 006564C 28 05/19/15 Lab 4.00 X 8.00 12.57 0' 1.00 0 006564D 28 05/19/15 Lab 4.00 X 8.00 12.57 0 1.00 0 006564E H Lab 4.00 X 8.00 12.57 0 1.00 0 Unless otherwise noted, samples tested in accordance with ASTM C39 RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER CC:City of Cupertino - Albert Salvador E -Reports placeholder - IgECEIYED MAY 2j BY All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval.