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B-2016-1786CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19600 VALLCO PKWY STE 170 CUPERTINO, CA 95014 (316 20 108) CONTRACTOR: C C C S INC PERMIT NO: B-2016-1786 SACRAMENTO, CA 95822 OWNER'S NAME: (CUPERTINO PROPERTY DEVEL I LLC) DATE ISSUED: 08/17/2016 OWNER'S PHONE: 916-243-8879 PHONE NO: (916) 457-6111 LICENSED CONT A TOR' DEcLARATION BUILDING PERMIT INFO: License Class B & C-10 Lic. #826872 Contractor C C C S INC Date 10/31/2017 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH — RESIDENTIAL X COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that. my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: SUITE 170, T.I.2352 SQ FT - ATLAS HEALTH r. I have and will maintain a certificate of consent to self -insure for Worker's REV #1 -MOVE WALL & INSTALL (1) DOOR IN ROOM 2; REVISE HVAC UNIT (1); ADD TRANSFORMER (1) - ISSUED 10/18/2016 Com do for by Section 3700 of the Labor Code, for the pe ce of the work f which this permit is issued. ave and will Worker's Compensation Insurance, as provided for by L ' 00 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $270000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 316 20108 A (Tenant Improvements),B (Tenant Improvements) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting this permit. Additionally, the. applicant unders nd willl comply with all non -point all WITHIN 180 DAYS OF PERMIT ISSUANCE OR source egulations pe upertino Munici I Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. 8ignatu e; Date 10/18/2016 Issued by: AbbyAygnde OWNER -B MD .R DECLARATION Date: 08/17/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) " 2. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Scc.7044, Business & Professions Code). Date: 10/18/2016 I hereby affirm under penalty of perjury one of the following three declarations:ALL 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner o as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cu ' Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health &SafetyVode ons 255 33, and 25534. Labor Code, I must forthwith- comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION"Date: 10/18/2016 1 certify that I have read this application and state that the above information is CONSTRUC, ION G AGENCY correct. I agree to comply with all city and'county ordinances and state laws I hereby affirm that there is a constructi _p lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 10/12016 8/ Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19600 VALLCO PKWY STE 170 CUPERTINO, CA 95014 (316 20 108) CONTRACTOR: C C C S INC PERMIT NO: B-2016-1786 SACRAMENTO, CA 95822 OWNER'S NAME: (CUPERTINO PROPERTY DEVEL I LLC) DATE ISSUED: 08/17/2016 OWNER'S PHONE: 916-243-8879 PHONE NO: (916) 457-6111 LICENSED CONT A TOR' DEcLARATION BUILDING PERMIT INFO: License Class B & C-10 Lic. #826872 Contractor C C C S INC Date 10/31/2017 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH — RESIDENTIAL X COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that. my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: SUITE 170, T.I.2352 SQ FT - ATLAS HEALTH r. I have and will maintain a certificate of consent to self -insure for Worker's REV #1 -MOVE WALL & INSTALL (1) DOOR IN ROOM 2; REVISE HVAC UNIT (1); ADD TRANSFORMER (1) - ISSUED 10/18/2016 Com do for by Section 3700 of the Labor Code, for the pe ce of the work f which this permit is issued. ave and will Worker's Compensation Insurance, as provided for by L ' 00 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $270000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 316 20108 A (Tenant Improvements),B (Tenant Improvements) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting this permit. Additionally, the. applicant unders nd willl comply with all non -point all WITHIN 180 DAYS OF PERMIT ISSUANCE OR source egulations pe upertino Munici I Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. 8ignatu e; Date 10/18/2016 Issued by: AbbyAygnde OWNER -B MD .R DECLARATION Date: 08/17/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) " 2. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Scc.7044, Business & Professions Code). Date: 10/18/2016 I hereby affirm under penalty of perjury one of the following three declarations:ALL 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner o as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cu ' Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health &SafetyVode ons 255 33, and 25534. Labor Code, I must forthwith- comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION"Date: 10/18/2016 1 certify that I have read this application and state that the above information is CONSTRUC, ION G AGENCY correct. I agree to comply with all city and'county ordinances and state laws I hereby affirm that there is a constructi _p lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 10/12016 8/ Licensed Professional 0111 CUPERTINO F-1 NEW (-n1,JS7R 1 JrTT()M CONSTRUCTION PERMIT APPLICATK; COMMUNITY DEVELOPMENT DEPARTMENT BUILDING 13]' 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 777-•3228 • FAX (408) 777-3333 - buil dingPoupertino,orq I 7S F-1 n nnTTrnar n AT TT'TT F TT1lTi ) mi Pyj. ••. [.iJ �]v]T r ]rt:n"Ltltcl=.i.t VISIUFIVfiL. YbK1VlI I # PRC)JECT ADDRESS / ^ APi~ ii ) --D- ' eS t� r>fY 7C { I OV I�F.1tNAIvfE J tE-MAiL -1PHONE STRL•ETADDRESS CITY, STATE, ZIP tar 1l� s,4 .,� /�3 � C?tly03 FAx i>2� CONTACT NAME � PHONE STREET ADDRESS' CITY, STATE, ZIP FAX tk Ow"TER ❑ OR'NER-I3iII1DER ❑ OWNERAOFAIT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCMrECP ❑ ENGfi*EER. ❑ DEVELOPER ❑ TEt "Ir CONT CJJTT,,Z IT %j f/ LICENSENUMBER LICENSETYPE MS. LIC I COMPANYNAME } ^ ^� H-AfAIL FAX --� STREETADDRESS CITY, STATE, ZIP PHONE _ 7 6f 3 'Z.. f ZLz) ARCHITECT/ENGINEER NAM : ) j LICENSE NUMBER BUS. LIG i{ COMPANYN. E E-MAIL PAX STREET ADDRESS % iS�j;,9 ..,�..:.�:�• 1 `n •" CITY, STATE, ZIP �, c- I' fT✓4 y✓Lpd rpt �+.' f-'"' f .7. d' / t; % /• 1.�+� / !y 7 J tv :3 fes�•-C.� T)ESCRIPTIOM IORK - - - - - _---------� �7lEy'� G✓c�....Lx^� fJ!-?�i�c(,•U Ce•.f N. l�tDv+t Z OtU C. � f� rnleCtl 77 EXISTING USE PROPOSED USE CONSTR. TYPE R STORIES USE TYPE OCC, SQ.FT. -- - - VALUATION ($) NEW FLOOR I]EMO TOTAL AREA AREA AREA NET, AREA - - — - :BATHROOM - KITCHEN OTHER REMODELAREA REMODELAREA MMODELAREA PORCH AREA DECK AREA TOTAL DECK)FORCHARr:A GARAGE AREA; DETACH El ATTACH - - 3 DwELLA:G UMTS: I5 A SECOND UNIT U YES STTCOND STORY ❑YES • "'•- BEING ADDED? j,1I,,O ADDITION? ❑NO PRE -APPLICATION j_] S'FS IF YES, PROVIDE COPY OF I'LAN INGAPPL# [:]NO PLANNTIIdOAPPROVAL LEITER IS THE BLDG AN ❑ YES ".EICRLERROME? j�NO RE Ep B t TOTAL VALUATION; By my signature below, I certify to each of the following: 1 ain the property owner or authomi .ed gent to.act on the property owners behalf. I have read this application and the information I have provid V is co�rrect IFa�v .read fire Description of lArork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cge3#i1, I` tfthorize representatives of Cupertino to enter the above -identified prop ity for inspection purposes. Signature of Applicant/Agent: Date Sum —7777T IIrFORMATION RE -Q l) PLA CAEGKT.S PE - ROLiTIMG`SI I]' - EI o�EltTrr>rcov� R ❑Burrni.GrLa�x£T 1\?ewSFDorlvlultifanTil}]clwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building �v perm for Dery building,-Rxss p p PI�,�Incpz �n IiE�IEe Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ srAMD�RD ❑ Ps�314c ti�oRRs fozin if any I3azardous Materials are being used as part of this project. e ❑ _ - ; L�. LARGL �` FlI2$ DEPT � � _Copy of Planning Approval Letter or Meeting with Planni ig prior to - `fl'�ni�a� 7] S4�IT�ARIISERERT)ISTRTCT submittal of Building Permit application. 's - BidgApp_2011.doc T•erised.06121/11 ,J CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1786 19600 VALLCO PKWY STE 170 CUPERTINO, CA 95014 (316 20 108) C C C S INC SACRAMENTO, CA 95822 OWNER'S NAME: (CUPERTINO PROPERTY DEVEL I LLC) I I DATE ISSUED: 08/17/2016 { I OWNER'S PHONE: 916-736-6920 I I PHONE NO: (916) 457-6111 I LICENSED CONTRACTOR'S DECLARATION License Class C-110 Lic. #826872 Contractor C C C S INC Date 10/31/2017 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: 1. I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which 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 reguiationsge�igepe�unicipal Code, Section 9.18. BUILDING PERMIT INFO: X BLDG _ ELECT —PLUMB _ MECH RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: SUITE 170, T.I. 2352 5Q FT -ATLAS HEALTH Sq. Ft Floor Area: I Valuation: '$270000.00 APN Number: Occupancy Type: 316 20 108 1 A (Tenant Improvements),B (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. r ignatia 1 Date 8/17/2016 Issued by: AbbyAvende \. Date: 08/17/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the 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 (See.7044, Business & Professions Code), hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, l 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. nature Date 8/17/2016 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: 8/17/2016 BE CLASS "A" OR 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 Cup_ ' Code, Chapter 9.12 and the Health &Safety Code, S ons 25505, 2553 and 25534. Owner or authorized ent: Date: 8/17/2016 NS TI END A EN Y I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Seo. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPIERTINO --7 t I NAW(_nNCTR1Tr'TTnN CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT, BUILDING DIVISION ' 10300 TORRE AVENUE- CUPERTINO, CA 135014.3255 {E (448) 777-3228 •FAX (408) 777-3333 buildinoC7n.cupertlno.org � � >— I-1 e nnTTTr)W F-1 A T 1-M1 A-PrM%T vrr r7 D T7SrieTni, l nmv- nn>rr 1 1--1 PRojEcTADDRass 19600 Vallco Parkway, Suite 17DAP" 316-20-037 & 316-20-038 OWNERNAPIE Stephen Beckwith, MD. PHoNH (916) 243-8879 A sieve a@atiesphysic ans.com STREFTADDRESS 507 Oxford Street CITY, sTA.TE,z>P San Francisco, 'CA 94934 FAX CONTACT NA"E Randy Williams P"Ot& (916) 736-6926 E-MAIL randy@arktegraf.com STREET ADDRESS 1800 2l tt l Strut CITY, STATE ZIP Sacramento, CA 95816 FAx (916) 736-6924 ❑ owNER 13 owNER-BUiLmE. IX OwNERAOmT d CONTRACTOR ❑ CONTRACTORAOENT A ARCHITECT 13 EwimaER ❑ DEVELOPER ❑ TENANT CONTRACTOR"NAMB To be determined Inter LICENSENUMBER LICBNSETYPH DUS.LIce COMPANYNAME E:MA1L FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHTTECTIEN01NIsERNAM6 Richard Carlile S Carlile LTCBNsENUMEER C-9236 BUS. LTC# comIANYNAME Arkte9raf, Inc, R.mAm rick a@arktegraf.com FAx (916) 738-6924 sTREETA"DRESS 180027th Street CITY, STATE, ZIP Sacramento, CA 95818 PHoNE(916) ?36-6920 --DESOR-R?T14NOFW4:- - _ -,--='`--- l�iewTcna��lt1��Ipro�et�enti shetf-�itt�irrg---medical'o�Fices EMSTINO USE vacant PROPOSL�b rr5t3 - - officesBryryne N TR. TYPE #STORIES USE TYPE OCG SQ.FT. VALUATION (S) ARA 2,352 AREA NEW LOOK n1a TOIAL rr�, DAREA EMO nla NET AREA L.,3JG Office i^A � 'Z ,3rJ2 $270,000 BATHROOM I1/a KITCHEN n1a. OTHER - n/a - - REMODELAREA AHtvIDDALAREA REMODELAREA PORCHAREA DECKAREA TOTAL, DECKIYORGti ARRA GARAOEAPEAt DETACH -- ❑ ATTACH 9 DWELLING UNITS: ISA SECOND UNIT YES SECOND STORY ❑ YES BEING ADDED? QNO. ADDITION? ❑NO PRE4XI'LICAVON ❑t'ES IF YES, PROVIDE COPY OF PLANNING ADPL# ONQ PLANNING APPROVAL I.BTiffii ISTBEBLDGAII ❑YES ErCBLERHONIE? QNO ,=v'�. '' tYEC£sIVt31]Bv .r:s•sw-u 'y' = ='=3=' -�-_•: TOTAL VALUATION: ] By my signature below, I certify to each of flse fallowing. T am the property owner or authorized agent to not on the propoft owner's behalf. I have read this application and the information I have 'dad is correct. I have read the I]escription of Work and verify it is accurate. I agree to cornplywith all applicable local ordinances and state laws reg construe ' n. I au Ionze kr I `rves of Cupertino to enter the above-ide pro erty for'suspeotion puTpose'& [tified SigliptureofApplictult/[�genC:�.�`�-'�s"+ Date: 1 z SUPPLEIvMNTAL,INFORMATION Q IJIR D RL STirHECK-I'Y.P)y' `"RCSFiT�G-3L1R � = :_. `New SFA ar Multifalllily dtveliillgs: Apply for demolition permit for ` mcistin build B s . Demolition erinit is required prior to issuance of building ..TIIt r��rit i Iot1V�t .. I3�v5 PLANvtll permit for new buflding, X Commercial BIdgs. Provide a completed 1ia2aedous Materials Disclosure p ;.... grl�irc _ farm if any Hazardous Materials are being used as part of this project.RE ;. ,rr;Y_ _ _ _� ofPlannilgApprvaIIetterorMeetingwith.Planuingpriorto r`�:t-3� �''�=�W��y���-�`�_��===�-'�=�;� _= _n!aCopy -_-- __ _ __ _.:• =° submittal of Mid ng Permit application. --' ;,-,,:.:::::::-.:::.... :. ,.,.:_.<:_.:c:_.:.::•: _-::•-s _�:__:::_-,-;ice..__-.�_--- :::.. _ E,I!t�71tONIVIENT;iTz:FIE'-,e37iTF�s;-_ � _�_ B1dgApp 21111,doc revised 06121111 CUPERTINO PURPOSE: CALOREEN NONRESIDENTIAL CHECKLIST — MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 950143255 (408) 777-3228 • FAX (408) 777-3333 - buildinrl&a cuperting.orp The non-residential provisions of the 2013 CalGreen Code outline planning, design and development methods that include environmentally responsible site selection, building design, building siting and development to protect, restore and enhance the environmental quality of the site and respect the integrity of adjacent properties; establishes the means of conserving water used indoors, outdoors and in wastewater conveyance; outlines means of achieving material conservation and resource efficiency; and outlines means of reducing the quantity of air contaminants. Project Name: Project Address: ATLAS HEALTH 19600 VALLCO PARKWAY, SUITE 170, CUPERTINO, 95014 Project Description: MEDICAL OFFICE TENANT IMPROVEMENT Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2093 California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. REVIEWED FOR CODE COMPLIANCE Page [ of Reviewed By:Arnold Horn CalGreenNon-Res Checklist.docrevised 01123/14 Date: 07/25/16 Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Requirements CHAPTER MANDATORY G,enerall�Re�ulrrements ��� `` The project meets all the requirements of Divisions 5.101 through 5.508. ❑ ❑ Division 5.1 PLANNING AND DESIGN Piar rtin arCT © ��gn $itwi ve►relopment 5.106.1 Storm water pollution prevention. For projects of one acre or less, develop a Storm Water Pollution Prevention Plan (SWPPP) that has been designed, specific to its site, conforming to the State Storm water NPDES Construction Permit or local ordinance, whi stric��for projdcts over one acre. The plan should co p ntionWfl r ❑ ❑ water run-off and/or wind erosion, of sedim r.0i6ldfrt4ZpprdiirkriF6vt matter air pollution. REVIEWED FOR CODE COMPLIANCE Page [ of Reviewed By:Arnold Horn CalGreenNon-Res Checklist.docrevised 01123/14 Date: 07/25/16 5.106.4 Bicycle parking. Comply with Sections 5.106.4.1 and 5.106.4.2; or local is ❑ ❑ meet ordinance, whichever stricter. 5.106.4.1.1 Short -Term bicycle parking. If the qualified project is anticipated to generate visitor traffic, provide permanently anchored bicycle racks within 200 feet of the visitors` entrance, readily visible to passers-by, ❑ ❑ for 5 percent of visitor motorized vehicle parking spaces being added, with a minimum of one two -bike capacity rack. 5.106.4.1.2 Long -Term bicycle parking. For qualified buildings with over ❑ ❑ 10 tenant -occupants, provide secure bicycle parking for 5 percent of tenant vehicle parking spaces being added, with a minimum of one space. 5.106.5.2 Designated parking. Provide designated parking for any combination of low -emitting, fuel-efficient and carpool/van pool vehicles as ❑ ❑ shown in Table 5.106.5.2. 5.106.6 Light pollution reduction. Outdoor lighting systems shall be ❑ ❑ designed and installed to comply with the following: 1. The minimum requirements in the California Energy Code for lighting zones E]❑ 1 — 4 as defined in Chapter 10 of the California Administrative Corse; and 2. Backlight, Uplight and Glare (BUG) ratings as defined in IES TM -15-11; and ❑ ❑ 3. Allowable BUG rating not exceeding those shown in Table 5.106.8, or ❑ ❑ Comply with a local ordinance lawfully enacted pursuant to Section 101.7, whichever is more stringent. 5.106.10 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how ❑ ❑ site grading or a drainage system will manage all surface water flows. Div P, �nts 5.201.1 Scope. The California Energy Commission will continue to adopt ❑ ❑ mandatory building standards. Division ■ - EFFICIENCY AND CONSERVATION lnifior Vlfater lyse__ W 5.303.1 Meters. Separate meters shall be installed for the uses described in Sections 503.1.1 and 503.1.2. 5.303.1.1 New building or additions in excess of 50,000 square feet. ❑ ❑ Separate submeters shall be installed as follows: 1. For each individual leased, rented or other tenant space within the ❑ ❑ building projected to consume more than 100 gal/day. 2. Where separate submeters are un - for water supplied to the following systems: CSU P E RTI N O a. Makeup water for cooling tow Built ng�epgrretment ❑ ❑ than 500 gpm. \ b- Makeup water for evaporative �- reater than 6 gpm. c. Steam and hot-water boilers WUmEwpq PVHtc=0RIOMM 0tL4N.CE Page 2 of 9 Kevlewea by: /Hrn01Q I JUM CalGreen Non -Res Checklist.doc revised 01123/14 Date: 07/25/16 5.303.1.2 Excess consumption. A separate submeter shall be provided for any tenant within a new building or within an addition that is projected ❑ ❑ to consume > 1,000 galtday. 5.303.2 Water reduction. Plumbing fixtures shall meet the maximum flow rate values shown in Table 5.303.2.3. X❑ ❑ Exception: Building that demonstrate 20 -percent overall water use reduction. 5.303.2.1 Areas of addition or alteration. For those occupancies within the authority of the California Building Standards Commission, as specified in Section 103, the provisions of Section 5.303.2 and Section 5.303.3 shall Q apply to new fixtures in additions or areas of alterations to the buildings. 5.303.4 Wastewater reduction. Each building shall reduce by 20 percent wastewater by one of the following methods: 1. The installation of water -conserving fixtures or 0 ❑ 2. Utilizing non -potable water systems. ❑ 5.303.6 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code ❑ ❑ (CPC), and shall meet the applicable standards referenced in CPC Table 1401.1 and CalGreen Chapter 6. 5.304.1 Water budget. A water budget shall be developed for landscape irrigation use. El El 5.304.2 Outdoor potable water use. For new water service or for addition or alteration requiring upgraded water service for landscaped areas of at least ❑ ❑ 1,000 sq.ft. but not more than 5,000 sq.ft., separate submeters or metering devices shall be installed for outdoor potable water use. 5.304.3 Irrigation design. In new nonresidential construction or building addition or alteration with at least 1,000 but not more than 2,500 sq.ft. of cumulative landscaped area, install irrigation controllers and sensors which ❑ E3include the following criteria, and meet manufacturer's recommendations. 5.304.3.1 Irrigation controllers. Automatic irrigation system controllers installed at the time of final inspection shall comply with the following: 1. Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as ❑ ❑ weather conditions change. 2. Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicates ❑ ❑ with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. 5.407.1 Weather protection. Provide a weather -resistant exterior wall and foundation envelope as required by Callr g Code Section 1403-2 and California Energy Code Section 150, IN er'sGrERTINO instructions or local ordinance, whichever rtget=,.-_ REVIEWED FOR CODE COMPLIANCE Page 3 of 9 Reviewed By: Arnold Hom CalGreen Non -Res Checklist.doc revised 01/23/14 Date: 07/25/16 5.407.2 Moisture control. Employ moisture control measures by the following methods; 5.407.2.1 Sprinklers. Prevent irrigation spray on structures. ❑ ❑ 5.407.2.2 Entries and openings. design exterior entries and/or openings ❑ ❑ to prevent water intrusion into buildings. 5.407.2.2.1 Exterior door protection. Primary exterior entries shall be covered to prevent water intrusion by using nonabsorbent floor and wall finishes within at least 2 ft around and perpendicular to such openings plus at least one of the following: 1. An installed awning at least 4 ft in depth. 2. The door is protected by a roof overhang at least 4 ft in depth. 3. The door is recessed at least 4 ft. 4. Other methods which provide equivalent protection. 5.407.2.2.2 Flashing. Install flashings integrated with a drainage El 1:1plane. Go'n JU6 ion Waste RLductIS�n, Di paeai and Recyclrn_- 5.408.1 Construction waste management. Recycle and/or salvage for reuse a minimum of 50 percent of the nonhazardous construction and demolition waste in accordance with Section 5.408.1.1, 5.408.1.2, or 5.408.1.3; or meet a 0 ❑ local construction and demolition waste management ordinance, whichever is more stringent_ 5.408.'1.'1 Construction waste management plan. Submit plan per this ❑ ❑ section to enforcement authority. 5.408.1.2 Waste management company. Utilize a waste management company that can provide verifiable documentation that the percentage of ❑ construction and demolition waste material diverted from the landfill complies with CalGreen Section 5.408. 5.408.1.3 Waste stream reduction alternative. The combined weight of new construction disposal that does not exceed two pounds per square ❑ foot of building area may be deemed to meet the 50 percent minimum requirement as approved by the enforcing agency. 5.408.1.4 Documentation. Provide documentation of the waste ❑ E]management plan that meets the requirements listed in Section 5.408.1.1 through 5.408.1.3. 5.408.3 Excavated soil and land clearing debris. 100 percent of trees, stumps, rocks and associated vegetation and soils resulting primarily from land ❑ clearing shall be reused or recycled. -Sul Idtrig Malnte�anCe=and Qperatran 5.410.1 Recycling by occupants. Provide readily accessible areas that serve the entire building and are identified for the depositing, storage and collection ❑ ❑ of nonhazardous materials for recycling. 5.410.2 Commissioning. For new building square feet and over, building commissioning for all building syst( iredT o process systems and renewable energy sy m. all ben ❑ ❑ design and construction processes of the b ojauiildimgn ent requirements shall include items listed in St 1. 10.2. PPWIF\AlFn rnR rnnF rnnnDI IANrF Page 4 of 9 Reviewed By: Arnold Hom CalGreen Non -Res Checklist. doe revised 01123/14 Date: 07/25/16 5.410.2.1 Owner's Project Requirements (OPR). Documented before the design phase of the project begins the OPR shall include items listed in ❑ ❑ Section 5.410.4. 5.410.2.2 Basis of Design (BO©). A written explanation of how the design of the building systems meets the OPR shall be completed at the design phase of the building project and updated periodically to cover the systems ❑ ❑ listed in Section 5.410.2.2. 5.410.2.3 Commissioning plan. A commissioning plan describing how the project will be commissioned shall be started during the design phase of ❑ ❑ the building project and shall include items listed in Section 5.410.2.3. 5.410.2.4 Functional performance testing. F=unctional performance testing shall demonstrate the correct installation and operation of each component, system and system -to -system interface in accordance with the ❑ ❑ approved plans and specifications. 5.410.2.5 Documentation and training. A Systems manual and systems operations training are required. ❑ ❑ 5.410.2.5.1 Systems manual. The systems manual shall be delivered to the building owner or representative and facilities operator and shall ❑ ❑ include the items listed in Section 5.410.2.5.1. 5.410.2.5.2 Systems operations training. The training of the appropriate maintenance staff for each equipment type and/or system ❑ ❑ shall include items listed in Section 5.410.2.5.2. 5.410.2.6 Commissioning report. A complete report of commissioning process activities undertaken through the design, construction and ❑ ❑ reporting recommendations for post -construction phases of the building project shall be completed and provided to the owner or representative_ 5.410.4 Testing and adjusting. Testing and adjusting of systems shall be required for buildings less than 10,000 square feet or new systems to serve an addition or alteration subject to Section 303.1. Page 5.410.4.2 Systems. Develop a written plan of procedures for testing and adjusting systems. Systems to be included for testing and adjusting shall include, as applicable to the project, the systems listed in Section ❑X ❑ 5.410.3.2. 5.410.4.3 Procedures. Perform testing and adjusting procedures in accordance with industry best practices and applicable national standards E] 1:1on each system. 5.410.4.3.1 HVAC balancing. Before a new space -conditioning system serving a building or space is operated for normal use, the system should be balanced in accordance with the procedures defined by ❑X ❑ national standards listed in Section 5.410.3.3.1. 5.410.4.4 Reporting. After completion of testing, adjusting and balancing, provide a final report of testing signed by the individual responsible for En 1:1performing these services. 5.410.4.5 Operation and maintenance manual. Provide the building owner with detailed operating and maintenance instructions and copies of ❑ ❑ guaranties/warranties for each system al inG�U tion. O 5.410.4.5.1 Inspections and reports affgN i@Ib*i@ @q nt ❑ ❑ verifications and reports required by t ing agency. REVIEWED FOR CODE COMPLIANCE 5 of 9 Reviewed By: Arnold Hom CalGreen Non -Res Checklist. doc revised 01123/14 Date: 07/25/16 5.503.1 Install only a direct -vent sealed -combustion gas or sealed wood - burning fireplace or a sealed woodstove and refer to residential requirements ❑ ❑ in the California Energy Cade, Title 24, Part 6, Subchapter 7, Section 150. 5.503.1.1 Woodstoves. Woodstoves shall comply with US EPA Phase II I ❑ ❑ emission limits. 5.504.3 Covering of duct openings and protection of mechanical equipment during construction. At the time of rough installation or during storage on the construction site and until final startup of the heating and cooling equipment, all duct and other related air distribution component ❑X ❑ openings shall be covered with tape, plastic, sheet metal or other methods acceptable to the enforcing agency to reduce the amount of dust or debris which may collect in the system. 5.504.4 Finish material pollutant control. Finish materials shall comply with Sections 5.504.4.1 through 5.504.4.4. 5.504.4.1 Adhesives, sealants, caulks. Adhesives and sealants used on the project shall meet the requirements of the following standards. 1. Adhesives, adhesive bonding primers, adhesive primers, sealants, sealant primers and caulks shall comply with local or regional air pollution control or air quality management district rules where applicable or ❑ ❑ SCAQMD Rule 1168 VOC limits, as shown in Tables 5.504.4.1 and 5.504.4.2. 2. Aerosol adhesives and smaller unit sizes of adhesives and sealant or caulking compounds (in units of product, less packaging, which do not weigh more than one pound and do not consist of more than 16 fluid ounces) shall comply with statewide VOC standards and other ❑X ❑ requirements, including prohibitions on use of certain toxic compounds, of California Code of Regulations, Title 17, commencing with Section 94507. 5.504.4.3 Paints and coatings. Architectural paints and coatings shall comply with Table 5.504.4.3 unless more stringent local limits apply. ❑ 5.504.4.3.1 Aerosol paints and coatings. Aerosol paints and coatings shall meet the Product -Weighted MIR Limits for ROC in Section 94522(a)(3) and other requirements, including prohibitions on use of ❑ ❑ certain toxic compounds and ozone depleting substances (CCR, Title 17, Section 94520 at seq). 5.504.4.3.2 Verification. Verification of compliance with this section shall be provided at the request of the enforcing agency. Q ❑ 5.504.4.4 Carpet systems. All carpet installed in the building interior shall meet the testing and product requirements of at least one of the standards ❑ listed in Section 5.504.4.4. 5.504.4.4.1 Carpet cushion. All carpet cushion installed in the building interior shall meet the requirements of the Carpet and Rug Institute ❑ ❑ Green Label program. CUPERTINO 5.504.4.4.2 Carpet adhesive. All car -_ . i'W, WhWgOlMment requirements of Table 5.504.4.1. ❑X ❑ REVIEWED FOR CODE COMPLIANCE Page 6 of 9 Reviewed By: Arnold Hom CalGreen Non -Res Checklist.doc revised 01/23/14 Date: 07/25/16 5.504.4.5 Composite wood products. Hardwood plywood, particleboard and medium density fiberboard composite wood products used on the interior or exterior of the building shall meet the requirements for ® ❑ formaldehyde as specified in Table 5.504.4.5. 5.504.4.5.3 Documentation. Verification of compliance with this section ❑ ❑ shall be provided as requested by the enforcing agency. Documentation shall include at least one of the following standards listed in Section 5.504.5.3. 5.504.4.6 Resilient flooring systems. For 80 percent of floor area receiving resilient flooring, installed resilient flooring shall meet at least one ❑ ❑ of the following standards listed in Section 5.504.4.6. 5.504.5.3 Filters. In mechanically ventilated buildings, provide regularly occupied areas of the building with air filtration media for outside and ® ❑ return air prior to occupancy that provides at least a MERV of 8. 5.504.7 Environmental tobacco smoke (I=TS) control. Prohibit smoking within 25 feet of building entries, outdoor air intakes and operable windows where outdoor areas are provided for smoking and in buildings; or as enforced ❑ ❑ by ordinances, regulations or policies of any city, county, city and county, California Community College, campus of the California State University or campus of the University of California, whichever are more stringent. 5.505.1 Indoor moisture control. Buildings shall meet or exceed the provisions of California Building Code, CCR, Title 24, Part 2, Sections 1203 0 ❑ and Chapter 14.1. 5.506.1 Outside air delivery. For mechanically or naturally ventilated spaces in buildings, meet the minimum requirements of Section 121 of the California 0 ❑ Energy Cade, CCR, Title 24, Part 6 and Chapter 4 of CCR, Title 8 or the applicable local code, whichever is more stringent.' 5.506.2 Carbon dioxide (CO2) monitoring. For buildings equipped with demand control ventilation, CO2 sensors and ventilation controls shall be ❑ ❑ specified and installed in accordance with the requirements of the latest edition of the California Energy Code, CCR, Title 24, Part 6, Section 121(c).' 5.507.4 Acoustical control. Employ building assemblies and components with STC values determined in accordance with ASTM E 90 and ASTM E 413. ❑ ❑ 5.507.4.1 Exterior noise transmission. Wail and floor -ceiling assemblies making up the building envelope shall have an STC of at least 50 and exterior windows shall have a minimum STC of 30 for any of the building ❑ ❑ locations listed in Items 1 through 3 in Section 5.507.5.1. 5.507.4.2 Interior sound. Wail and floor -ceiling assemblies separating tenant spaces and tenant spaces and public places shall have an STC of ❑ ❑ at least 40. Page 7 of 9 CUPERTINO Building Department REVIEWED FOR CODE COMPLIANCE Reviewed By: Arnold HOM CalGreen Non -Res Checklist.doe revised 01123114 Date: 07/25/16 5.508.1 Ozone depletion and greenhouse gas reductions. Installations of HVAC, refrigeration and fire suppression equipment shall comply with Sections 5.508.1.1 and 5.508.1.2. 5.508.1.1 Chlorofluorocarbons (CFCs). Install HVAC and refrigeration` equipment that does not contain CFCs. 5.508.9.2 Halons. Install fire suppression equipment that does not contain ElHalons. Page 8 of 9 CUPERTINO Building Department REVIEWED FOR CODE COMPLIANCE Reviewed By: Arnold HOm CalGreen Non -Res Checklist.doc revised 01123/14 Date: 07/25/16 Project Name: Project Address. Project Description: CALGREEN SIGNATURE DECLARATIONS ATLAS HEALTH 19600 VALLCO PARKWAY, SUITE 170 MEDICAL OFFICE TENANT IMPROVEMENT SECTION 1 - DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by City Cup�-�nlo. _y Owner'sXgnature v Date rs NArpe S easg.Print) Destn F°Yofes (yai's Signature Date 7 L—L,E--- D i},Pr�f ssi nal's Name (Please Print) Fg,ft4t6ff of 1-t se Professional responsible for CalGreen compliance Date Name of License Professional responsible for CaiGrT�, compliance (Please Print) Phone C I C- (0Y h< T� f"q t�.� Y� Email Address for License Professional re nsible for CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional res REVIEWED FOR CODE COMPLIANCE Page 9 of 9 Reviewed By: Arnold HOm CalGreen Non -lies Checkhst.doe revised 0123 i a Date: 07/25/16 CUPERTINO PURPOSE HAZARDOUS MATERIALS CHECKLIST COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building kupertino.org To minimize possible delays that would result for the Fire Department plan review, please complete the following checklist to determine if an additional level of Hazardous Materials plan review will be required. MARK `YES' IF THE PROPOSED SCOPE OF WORK INCLUDE ANY OF THE FOLLOWING? PLEASE MARK YOUR ANSWER WITH AN `X' IN THE YES OR NO BOX ON THE SIDE BELOW. YES NO 1. Use, dispensing, mixing or storage of flammable or combustible liquids or gases, hazardous materials, etc. 2. Battery back-up rooms or racks. 3. Propane tanks. 4. Gasoline stations with underground tanks. 5. Installation or replacement above ground or underground storage of liquid petroleum products, liquefied petroleum gases, compressed natural gas, explosives or other regulated hazardous materials. 6. Gas rooms for dentist, doctors or veterinarians. 7. Generators with back-up diesel or other fuels. 8. Large refrigeration systems. 9. Fuel cell systems. 10. Commercial pool systems. 11. Chemical Storage areas. 12. Flammable liquid storage. 13. Compressed Gases. Possible small amount of oxygen cylinders on site 14. Dry cleaners. 15. Print Shops. 16. Auto Repair and Auto Body Shops. 17. Research and Development. For any additional information regarding thi t, pl�aTAPl�rdous Materials Specialist, Santa Clara County Fire Department, at (408) 37 -11,14 Building Department REVIEWED FOR CODE COMPLIANCE Reviewed By:Arnold Hom HasMat_2011.doc revised 03107111 Date: 07/25/16