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14080041CITY OF CU PIER'Il INO BUILDING PERMIT
BUILDING ADDRESS: 10200 S DE ANZA BLVD
CONTRACTOR: VULCAN PERMIT NO: 14080041
CONSTRUCTION INC
OWNER'S NAME: SEAGATE TECHNOLOGY LLC
346 MATHEW ST DATE ISSUED: 12/05/2014
OWNER'S PHONE: 4082830100
SANTA CLARA, CA 95050 PHONE NO: (408) 499-6039
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL, E]
TENANT IMPROVEMENT (SEAGATE) FIRST FLOOR FOOD
License Class 13 Lic. # 01� f�
SERVICE AREA SEAGATE CAFE (1050 SQ FT).
�
`uI
Contractor V C. C-0-51- Date oL S III
I hereby affirm that 1 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 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: $200000
performance of the work for which this permit is issued.
1 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
APN Number: 36901035.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 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
W1T�1� 1�0 DAYS ®� PERMIT ISSUANCE ®R
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
150 OAFS FROM ]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 b ��C� Date:
granting of this permit. Additionally, the applicant understands and will comply
Y �7Y
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
ignature Date 9a S
Signature_""
All roofs shall be inspected prior to any rooting 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
Signature of Applicant: Date:
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
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered 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
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
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 Cupertino Municipal Code, Chapter 9.12 and
[ 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, Sections 25505, 25533, and 25534.
Owner Date: ja/S /y
permit is issued.
or authorized agent:
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, 1
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
CITY OF CUPIERT'INO BUILDING PERMIT
BUILDING ADDRESS: 10200 S DE ANZA BLVD
CONSTRUCTION INC
0:14080041
OWNER'S NAME: SEAGATE TECHNOLOGY LLC 1 346 MATHEW 9%U Ls L DATE ISSUED: 12/05/2014
OWNER'S PHONE: 4082830100
❑ LICENSED CONTRACTOR'S DECLARATION
License Class b Lie. # 93 1, ?LI&XG
Contractor If 10 tt°id`%1>6W4, Date �i4i
I hereby affirm that 1 am licensed under the provision 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.
1 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
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 ofthis permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18. —
Signature y Date f9
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered 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).
1 hereby affirm tinder 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.
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, t 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
SANTA CLARA, CA 95050 [PHONE NO: (408) 499-6039
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
TENANT IMPROVEMENT (SEAGATE) FIRST FLOOR FOOD
SERVICE AREA SEAGATE CAFE (1050 SQ FT).
DEFERRED SUBMITTAL #1: UPDATED ENERGY
COMPLIANCE DOCUMENTATION. ISSUED 12/19/14.
Sq. Ft Floor Area: I Valuation: $200000
APN Number: 36901035.00 1 Occupancy Type:
PERMIT ]EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM (LAST CALLED INSPECTION.
Issued by:
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
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the
Health & Safety Code, Section 25532(a) should 1 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 1
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 2550 _ 34.
Owner or authorized agent: Date:
CONSTRUCTION LENDING AGENCY
1 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 APPLICA RRE.
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDIwaSION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building aQcupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED
ORIGINAL PERMIT 4
PROJECT ADDRESS
APN
14%�, tJb
OWNER NAME PHONE
E-MAIL
cvt�a, Y02 Z9
3 O (ov
STREET ADDRESS CiTY STATE, ZIP
FAX
f� D1
CONTACT NAME PHONN9.
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
OWNER ❑ OWNER -BUILDER ❑ OIAWER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGEA'T ❑ ARCI-m`ECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBS
LICENS PE BUS. LIC k
i,/vLCA-J q
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
- G t AvZaA- car f5Z6D
4r Z I L
ARCPBTECTIENGTNEER NAME LICENSE NUMBEf5,.yA��
BUS. LIC H
✓Iv f //V
COMPANY NAME
E-MAIL
FAX
STREFLA0DDRESS
C Y. STATE,
15PHONE
1.
DESCRIPTION OF WORK ��� �� �/ •e
EXISTING USE
PROPOSED USE CONSTR.
TYPE
I STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODELAREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECKAREA
TOTAL DECKJPORCH ARE
A GARAGE AREA: DETACH
❑ ATTACH
DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑NO
ADDITION? NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
y RECEIVED » t 3 -.
TOTAL VAL TION:
PLANNINGAPPLX ❑NO PLANNING APPROVAL LETTER
EICHLERHOME? E] NO
Tu_;Ck ,� ( <yi �"J,
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 to building const�,,sk_err-�-a+i ize representatives of Cupertino
to enter the above-identifi property for inspection purposes.
Signature of Applicant/Agent: c -�
Date: l
SUPPLEMENTAL INFORMATION REQUIRED
PLATlCAECKTXP ._ .`r..
- rN,,ROUTIIvGSIIP,.,�_.,,,,,_..
New SFD or Multifamily dwellings: Apply for demolition permit for
x µk��` �S4'j
OVERTAE-COUNTER f
_
4 BUILDING PLANRD!'IEw
existing building(s). Demolition permit is required prior to issuance of building
<x X337 nrs r Y r
I k_ .
permit for new building.
I� E.lPRESSrsr'��+a r-
❑PLANT\INGYLAN REVIEW. e
'GV
k�S fL t+14
>r
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
sTANnnRD xI 3
❑ ruBLIC!loRxs L
_
form if any Hazardous Materials are being used as part of this project.
1s�
❑ L ARGE �`� T � �''K a �
r ❑ TIRE DEI T ��,8 ash '' t
of Planning Approval Letter or Meeting with Planning prior to
-I
_Copy
submittal of Building Permit application.
MASOR *'+
$�� U �� j "
+`'��
❑ SATITARXSER'ER.I)]TWCT .y r
'; r
�4t•�-� ,r4
��;
� � �, �.�r � 5 f a��
'r.k,"�,€5 ,n�;.;, ?., ... ti��1� {tic+, , �'�:
•*'.❑;r:ENVIR01lT'IEI�T,AI'NEALTA'"I: x f,..
B1dgApp 20/ l.doc revised 06/21/11
CITY OF CUP ERUNO
II�i 1
FEE ESTIMATOR - BUI LMNG DIVISION
OCCUPANCY TYPE:
ADDRESS: 10200 s de anza blvd
DATE: 08/06/2014
REVIEWED BY: Mendez
PC FEE ID
APN:
BP#:
B (Tenant Improvements)
"VALUATION: 1$200,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
$1,134.88
PENTAMATION
PERMIT TYPE: 1 B Th
WORK
sea ate• 1st floor- comm t.i toe cafeteria
Suppl. Insp. Fee:Q Reg. Q OT p p
SCOPE
$0.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
1,050
$2,139.08
IBTIPLVCK
$1,134.88
IBTIINSP
t�
$1,134.88
Suppl. Insp. Fee:Q Reg. Q OT p p
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? © Yes C) No
$0.00
Advanced Planning? Fee:
TOTALS:
1,0:5:0=$2,139.08
i r.a,/ l;c,•r.�r�rt!ulhrn FcC's
$1,134.88
$56.00
MIECH, HOURLY 0 Yes Eo No
IPLlUMB, HOURLY Q Yes Q No
EL1EC, HOURLY Q Yes Q No
_,r, ="C', (-� ci.
!Trail, I'lnn Cbz � 4
Eley. F'lan Check
ltr fi Pr, un(I ,
Pr„;nh P.rnu/ I rG:
Vie Permit Fec
hrs
$0.00
Other lie' . Insp.
l,:r ;.�; j.,,
Phrurh, r,r,la. /•c•i�'
t�
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolulion 11-053 Eff 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,139.08
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: C) Reg. OT
0.0
hrs
$0.00
�PPME Plan Check:
$0.00
Permit Fee:
$1,134.88
Suppl. Insp. Fee:Q Reg. Q OT p p
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? © Yes C) No
$0.00
Advanced Planning? Fee:
$0.00
Select a Non -Residential E)
Building or Structure
i r.a,/ l;c,•r.�r�rt!ulhrn FcC's
Strom Motion Fee: IBSEISMICO
$56.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$8.00
SUBTOTALS:
$3,337.96
$0.001
TOTAL FEE:
$3,337.96
Revised: 07/10/2014
CITY OF cCUP E1[S' INO
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1.13)
FEE
P/loith. Part Choc!
(.,'h '.4c
Plan Check Fee:
ADDRESS: 10200 S Deanza Blvd
DATE: 12/19/2014
REVIEWED BY: Sean
w
APN:
�P#:TH
*VALUATION:$0
: eration / Addition / Repair
*PERMIT TYPE: Building Permit PLAN CHECK TYPEAlt
PRIMARY
Commercial Building
$0.00
PENTAMATION
1 GENCO a
us
$0.00
PERMIT TYPE:
WORK
rSCOPE
Deferred Submittal #1: Updated energycompliance documentation.
PME Permit Fee:
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1.13)
FEE
P/loith. Part Choc!
(.,'h '.4c
Plan Check Fee:
Yttim%, Pee,
GIP<'. PP, z;=F F`c""':
Wio JA, . i6,pOther
Plurnh hash.El
C)titerL:"dec'. /nsp.
$0.00
PME Plan Check:
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1.13)
FEE
QTY/FEET
MISC ITEMS
Plan Check Fee:
$0.00
1 # Deferred Submittal
$286.00 IDEFSUBM
Suppl. PC Fee: (E) Reg. 00:T
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:CReg. 0 OT Q Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
1C,/EiiR1Pt7'G1'!Ct I'r_'E"
Work Without Permit? 0 Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure 0
d
�1YlYf l F�®Ci(177t'ntLlt/U;9 Fees:
Strong Motion Fee:
$0.00
Select an Administrative Item
Blda Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$286.00
TOTAL]F)EE: $286.00
Revised: 10/01/2014
CITY OF CU PIER'Il INO BUILDING PERMIT
BUILDING ADDRESS: 10200 S DE ANZA BLVD
CONTRACTOR: VULCAN PERMIT NO: 14080041
CONSTRUCTION INC
OWNER'S NAME: SEAGATE TECHNOLOGY LLC
346 MATHEW ST DATE ISSUED: 12/05/2014
OWNER'S PHONE: 4082830100
SANTA CLARA, CA 95050 PHONE NO: (408) 499-6039
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL, E]
TENANT IMPROVEMENT (SEAGATE) FIRST FLOOR FOOD
License Class 13 Lic. # 01� f�
SERVICE AREA SEAGATE CAFE (1050 SQ FT).
�
`uI
Contractor V C. C-0-51- Date oL S III
I hereby affirm that 1 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 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: $200000
performance of the work for which this permit is issued.
1 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
APN Number: 36901035.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 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
W1T�1� 1�0 DAYS ®� PERMIT ISSUANCE ®R
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
150 OAFS FROM ]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 b ��C� Date:
granting of this permit. Additionally, the applicant understands and will comply
Y �7Y
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
ignature Date 9a S
Signature_""
All roofs shall be inspected prior to any rooting 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
Signature of Applicant: Date:
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
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered 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
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
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 Cupertino Municipal Code, Chapter 9.12 and
[ 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, Sections 25505, 25533, and 25534.
Owner Date: ja/S /y
permit is issued.
or authorized agent:
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, 1
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
CITY OF CUPIERT'INO BUILDING PERMIT
BUILDING ADDRESS: 10200 S DE ANZA BLVD
CONSTRUCTION INC
0:14080041
OWNER'S NAME: SEAGATE TECHNOLOGY LLC 1 346 MATHEW 9%U Ls L DATE ISSUED: 12/05/2014
OWNER'S PHONE: 4082830100
❑ LICENSED CONTRACTOR'S DECLARATION
License Class b Lie. # 93 1, ?LI&XG
Contractor If 10 tt°id`%1>6W4, Date �i4i
I hereby affirm that 1 am licensed under the provision 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.
1 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
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 ofthis permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18. —
Signature y Date f9
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered 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).
1 hereby affirm tinder 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.
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, t 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
SANTA CLARA, CA 95050 [PHONE NO: (408) 499-6039
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
TENANT IMPROVEMENT (SEAGATE) FIRST FLOOR FOOD
SERVICE AREA SEAGATE CAFE (1050 SQ FT).
DEFERRED SUBMITTAL #1: UPDATED ENERGY
COMPLIANCE DOCUMENTATION. ISSUED 12/19/14.
Sq. Ft Floor Area: I Valuation: $200000
APN Number: 36901035.00 1 Occupancy Type:
PERMIT ]EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM (LAST CALLED INSPECTION.
Issued by:
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
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the
Health & Safety Code, Section 25532(a) should 1 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 1
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 2550 _ 34.
Owner or authorized agent: Date:
CONSTRUCTION LENDING AGENCY
1 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 APPLICA RRE.
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDIwaSION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building aQcupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED
ORIGINAL PERMIT 4
PROJECT ADDRESS
APN
14%�, tJb
OWNER NAME PHONE
E-MAIL
cvt�a, Y02 Z9
3 O (ov
STREET ADDRESS CiTY STATE, ZIP
FAX
f� D1
CONTACT NAME PHONN9.
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
OWNER ❑ OWNER -BUILDER ❑ OIAWER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGEA'T ❑ ARCI-m`ECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBS
LICENS PE BUS. LIC k
i,/vLCA-J q
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
- G t AvZaA- car f5Z6D
4r Z I L
ARCPBTECTIENGTNEER NAME LICENSE NUMBEf5,.yA��
BUS. LIC H
✓Iv f //V
COMPANY NAME
E-MAIL
FAX
STREFLA0DDRESS
C Y. STATE,
15PHONE
1.
DESCRIPTION OF WORK ��� �� �/ •e
EXISTING USE
PROPOSED USE CONSTR.
TYPE
I STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODELAREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECKAREA
TOTAL DECKJPORCH ARE
A GARAGE AREA: DETACH
❑ ATTACH
DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑NO
ADDITION? NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
y RECEIVED » t 3 -.
TOTAL VAL TION:
PLANNINGAPPLX ❑NO PLANNING APPROVAL LETTER
EICHLERHOME? E] NO
Tu_;Ck ,� ( <yi �"J,
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 to building const�,,sk_err-�-a+i ize representatives of Cupertino
to enter the above-identifi property for inspection purposes.
Signature of Applicant/Agent: c -�
Date: l
SUPPLEMENTAL INFORMATION REQUIRED
PLATlCAECKTXP ._ .`r..
- rN,,ROUTIIvGSIIP,.,�_.,,,,,_..
New SFD or Multifamily dwellings: Apply for demolition permit for
x µk��` �S4'j
OVERTAE-COUNTER f
_
4 BUILDING PLANRD!'IEw
existing building(s). Demolition permit is required prior to issuance of building
<x X337 nrs r Y r
I k_ .
permit for new building.
I� E.lPRESSrsr'��+a r-
❑PLANT\INGYLAN REVIEW. e
'GV
k�S fL t+14
>r
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
sTANnnRD xI 3
❑ ruBLIC!loRxs L
_
form if any Hazardous Materials are being used as part of this project.
1s�
❑ L ARGE �`� T � �''K a �
r ❑ TIRE DEI T ��,8 ash '' t
of Planning Approval Letter or Meeting with Planning prior to
-I
_Copy
submittal of Building Permit application.
MASOR *'+
$�� U �� j "
+`'��
❑ SATITARXSER'ER.I)]TWCT .y r
'; r
�4t•�-� ,r4
��;
� � �, �.�r � 5 f a��
'r.k,"�,€5 ,n�;.;, ?., ... ti��1� {tic+, , �'�:
•*'.❑;r:ENVIR01lT'IEI�T,AI'NEALTA'"I: x f,..
B1dgApp 20/ l.doc revised 06/21/11
CITY OF CUP ERUNO
II�i 1
FEE ESTIMATOR - BUI LMNG DIVISION
OCCUPANCY TYPE:
ADDRESS: 10200 s de anza blvd
DATE: 08/06/2014
REVIEWED BY: Mendez
PC FEE ID
APN:
BP#:
B (Tenant Improvements)
"VALUATION: 1$200,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Tenant Improvement
PRIMARY
USE: Commercial Building
$1,134.88
PENTAMATION
PERMIT TYPE: 1 B Th
WORK
sea ate• 1st floor- comm t.i toe cafeteria
Suppl. Insp. Fee:Q Reg. Q OT p p
SCOPE
$0.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
B (Tenant Improvements)
II-B,III-B,IV,V-B
1,050
$2,139.08
IBTIPLVCK
$1,134.88
IBTIINSP
t�
$1,134.88
Suppl. Insp. Fee:Q Reg. Q OT p p
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? © Yes C) No
$0.00
Advanced Planning? Fee:
TOTALS:
1,0:5:0=$2,139.08
i r.a,/ l;c,•r.�r�rt!ulhrn FcC's
$1,134.88
$56.00
MIECH, HOURLY 0 Yes Eo No
IPLlUMB, HOURLY Q Yes Q No
EL1EC, HOURLY Q Yes Q No
_,r, ="C', (-� ci.
!Trail, I'lnn Cbz � 4
Eley. F'lan Check
ltr fi Pr, un(I ,
Pr„;nh P.rnu/ I rG:
Vie Permit Fec
hrs
$0.00
Other lie' . Insp.
l,:r ;.�; j.,,
Phrurh, r,r,la. /•c•i�'
t�
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolulion 11-053 Eff 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,139.08
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: C) Reg. OT
0.0
hrs
$0.00
�PPME Plan Check:
$0.00
Permit Fee:
$1,134.88
Suppl. Insp. Fee:Q Reg. Q OT p p
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? © Yes C) No
$0.00
Advanced Planning? Fee:
$0.00
Select a Non -Residential E)
Building or Structure
i r.a,/ l;c,•r.�r�rt!ulhrn FcC's
Strom Motion Fee: IBSEISMICO
$56.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$8.00
SUBTOTALS:
$3,337.96
$0.001
TOTAL FEE:
$3,337.96
Revised: 07/10/2014
CITY OF cCUP E1[S' INO
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1.13)
FEE
P/loith. Part Choc!
(.,'h '.4c
Plan Check Fee:
ADDRESS: 10200 S Deanza Blvd
DATE: 12/19/2014
REVIEWED BY: Sean
w
APN:
�P#:TH
*VALUATION:$0
: eration / Addition / Repair
*PERMIT TYPE: Building Permit PLAN CHECK TYPEAlt
PRIMARY
Commercial Building
$0.00
PENTAMATION
1 GENCO a
us
$0.00
PERMIT TYPE:
WORK
rSCOPE
Deferred Submittal #1: Updated energycompliance documentation.
PME Permit Fee:
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1.13)
FEE
P/loith. Part Choc!
(.,'h '.4c
Plan Check Fee:
Yttim%, Pee,
GIP<'. PP, z;=F F`c""':
Wio JA, . i6,pOther
Plurnh hash.El
C)titerL:"dec'. /nsp.
$0.00
PME Plan Check:
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1.13)
FEE
QTY/FEET
MISC ITEMS
Plan Check Fee:
$0.00
1 # Deferred Submittal
$286.00 IDEFSUBM
Suppl. PC Fee: (E) Reg. 00:T
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:CReg. 0 OT Q Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
1C,/EiiR1Pt7'G1'!Ct I'r_'E"
Work Without Permit? 0 Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure 0
d
�1YlYf l F�®Ci(177t'ntLlt/U;9 Fees:
Strong Motion Fee:
$0.00
Select an Administrative Item
Blda Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$286.00
TOTAL]F)EE: $286.00
Revised: 10/01/2014
F [BUIiiLDIIIJAG ENIERGY ANALYS11S REPORT u
Seagate
10200 S. De Anza Blvd
Cupertino, CA 95014
prro�ect Designer:
Studio G Architects, Inc.
90 Railway Ave
Campbell, CA 95008
408-2830100
Report Prepared by:
DQE
Nicholas L Bignardi NR08-12-3847
FRB Energy Consultants, LLC
21 N. Harrison Ave, Suite 210
Campbell, CA 95008
408-866-1620
i
Job dumber:
NOV a @ 2014
BY
Qu"dir,9 0epartmen4
DEC 19 2m
RFVI1z: n,?ED FOR 6UDP COMPLIANICLz
, RevreweCy By:
o�m.rool%��9��� Copy
12/16/2014
The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is
authorized by the California Energy Commission for use with both the Residential and Nonresidential 2013 Building Energy Efficiency Standards.
This program developed by EnergySoft, LLC — www.energysoft.com.
Ener Pro 6.3 by Ener Soft User Number: 1315 ID: 0140902
TABLE OF CONTENTS
Cover Page 1
Table of Contents 2
Nonresidential Performance Title 24 Forms 3
EnergyPro 6.3 by EnergySofl Job Number. ID: 0140902 User Number: 1315
PERFORMANCE CERTIFICATE OF COMPLIANCE (Part 1 of 3) PERF-1 C
Project Name
Date
Seagate
12/16/2014
Project Address Climate Zone
Total Cond. Floor Area
Addition Floor Area
10200 S. De Anza Blvd Cupertino CA Climate Zone 04
2,900
n/a
GENERAL INFORMATION
Building Type: m Nonresidential 0 High-Rise Residential [3 Hotel/Motel Guest Room
13 Relocatable - indicate O specific climate zone [3 all climates
Phase of Construction: [3 New Construction 0 Addition [3 Alteration
STATEMENT OF COMPLIANCE
This certificate of compliance lists the building features and specifications needed to
comply with Title 24, Parts 1 and 6' of the California Code of Regulations. This
certificate applies only to a Building using the performance compliance approach.
The documentation author hereby certifies that the documentation is accurate and complete,
Documentation Author
Name Nicholas L Bignardi NR08-12-3847
Signature xal;i
Company FRI Energy Consultants, LLC
Date 12116/2014
Address 21 N. Harrison Ave, Suite 210
Phone 408-866-1620
City/State/Zip Campbell, CA 95008
rhe Principal Designer hereby certifies that the proposed building design represented in this set of
construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with
any other calculations submitted with this permit application. The proposed building has been designed to meet the energy
efficiency requirements contained in sections 110.0, 116.0 through 118.0, and 140.0 through 149.0 of Title 24, Part 6.
Please check one:
ENV. LTG. MECH.
hereby affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code to
® ® ® sign this document as the person responsible for its preparation; and that I am licensed in the State of
California as a civil engineer, mechanical engineer, electrical engineer, or I am a licensed architect.
I affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code by section
® ® ® 5537.2 or 6737.3 to sign this document as the person responsible for its preparation; and that I am a licensed
contractor performing this work.
I affirm that I am eligible under Division 3 of the Business and Professions Code to sign this document
® M ® because it pertains to a structure or type of work described as exempt pursuant to Business and Professions
Code Sections 5537, 5538 and 6737.1.
Principal Envelope Designer
Name
Signature
Company Envelope Compliance Not In The Scope Of This Document Date
Address License #
City/State/Zip Phone
(Principal Mechanical Designer
Name
Signature
Company Performance Air Services Date
Address 350 Mathews Street License #
City/State/Zip Santa Clara, CA 95050 Phone 408-920-6170
Principal Lighting Designer
Name
Signature
Company Lighting Compliance Not In The Scope Of This Submittal Date
Address License #
City/State/Zip Phone
INSTRUCTIONS TO APPLICANT COMPLIANCE & WORKSHEETS (check box if worksheets are included)
® ENV-01 Certificate of Compliance. Required on plans. 0 MCH-01 Certificate of Compliance. Required on plans.
® LTI-01 Certificate of Compliance. Required on plans. m MCH-02 HVAC Air/Water Side Requirements.
® LTI-02 Lighting Controls Credit Worksheet. m MCH-03 Mechanical Ventilation and Reheat.
® LTI-03 Indoor Lighting Power Allowance. m MCH-08 Mechanical Equipment Details.
EnergyPro 6.3 by EnergySoft User Number: 1315 RunCode: 2014-12-16715:26:05 ID: 0140902 Page 3 of 10
PERFORMANCE CERTRCATS OF COMPUANCE (Part 2 of 3) PERF-iC
Project Name Date
Seaaate 12/16/2014
ANNUAL TDV ENERGY USE SUMMARY kBtu/sgft- r
Standard Proposed Compliance
Energy Component Design Design Margin
Space Heating
Space Cooling
Indoor Fans
Heat Rejection
Pumps & Misc.
Domestic Hot Water
Lighting
Receptacle
Process
Process Lighting
TOTALS
0.00
0.02
-0.01
80.77
110.72
-29.95
103.82
61.42
42.40
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
182.30
182.30
0.00
181.78
181.78
0.00
0.00
0.00
0.00
0.00
0.001
0.00
548.68
536.24
12.44
Heating
Cooling
Fans
Heat Rej
Pumps
DHW
Lighting
Receptacle
Process
Process Ltg
Percent better than Standard 2.3% 2.3 % excludin rocess
UDLOOMO COMPLOCES
GENERAL INFORMATION
Building Orientation (NKK 315 deg Conditioned Floor Area 2900 sqft.
Number of Stories 1 Unconditioned Floor Area 0 sqft,
Number of Systems 1 Conditioned Footprint Area 2,900 sqft.
Number of Zones 1 Natural Gas Available On Site Yes
Front Elevation
Left Elevation
Rear Elevation
Right Elevation
Total
Roof
Orientation Gross Area
(NKK
0
(NE)
0
(SE)
0
(S K9
0
0
2,900
sqft.
sqft.
sqft.
sqft.
sqft.
sqft.
Glazino Area
0
0
0
0
0
0
sqft.
sqft.
sqft.
sqft.
sqft.
sqft.
Glazino Ratio
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
Standard Proposed Prescriptive Values for
Prescriptive Lighting Power Density 1.600 W/sgft. 1.600 W/sgft. Comparison only. See
LTI-01 for allowed LPD.
I Remarks:
EneMg Pro 6.3 by EnergySoft User Number: 1315 RunCode: 2014-12-16T15:26:05 ID: 0140902 Page 4 of 10
PERFORMANCE C EeRT[IRCATE OF CO PIL ANCEE Pari 3 of 3) PERF -1 C
Project Name
Seagate
Date
12/16/2014
ZONE INFORMATION
System Name
Zone Name
Occupancy Type
Floor
Area
s ft.
Inst.
LPD
W/sf 1
Ctrl. Allowed LPD
Credits Area Tailored
W/Sf 2 W/Sf 3 (W/S4
Proc.
Loads
W/sf
Carrier 40RUS
Cafe
Kitchen, Food Preparation
2,900
`1.600
Notes: 1. See LTI-01 2. See LTI-02 3. See LTI-03 4. See LTI-04
items marked with asterisk see LTI-01 b others b others
Items above require special documentation
IEXCEETIONAL CONDITIONS COMPLIANCE CHECKLIST
The local enforcement agency should pay special attention to the items specified in this checklist. These items require special written
justification and documentation, and special verification to be used with the performance approach. The local enforcement agency
determines the adequacy of the justifications, and may reject a building or design that otherwise complies based on the adequacy of the
special justification and documentation submitted.
The exceptional features listed in this performance approach application have specifically been reviewed. Adequate written justification and
documentation for their use have been provided by the applicant.
Authorized Signature or Stamp
EnergyPro 6.3 by EnergySoft User Number: 1315 Run o e: 2014-12-16T15:26:05 ID: 0140902 Page 5 of 10
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HVAC SYSTEM REQUIREMENTS,
CEC-NRCC-MCH-02-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-MCH-02-E
HVAC Dry System Requirements (Page 1 of 3)
Project Name: Seagate Date Prepared: 12/16/2014
Equipment Tags and System Description'
Carrier 40RUS
MANDATORY MEASURES
Heating Equipment Efficiency3
Cooling Equipment Efficiency3
HVAC or Heat Pump Thermostats
Furnace Standby Loss Control
Low leakage AHUs
Ventilation
Demand Control Ventilations
Occupant Sensor Ventilation Contro16
Shutoff and Reset Controls'
Outdoor Air and Exhaust Damper Control
Isolation Zones
Automatic Demand Shed Controls
Economizer FDD
Duct Insulation
PRESCRIPTIVE MEASURES
T-24 Sections
Reference to the Requirements in the Contract Documentsz
110.1 or 110.2(a)
SEE PLANS
110.1 or 110.2(a)
SEE PLANS
110.2(b), 110.2(c)
SEE PLANS
110.2(d)
SEE PLANS
110.2(f)
SEE PLANS
120.1(b)
SEE PLANS
120.1(c)4
SEE PLANS
120.1(c)S, 120.2(e)3
SEE PLANS
120.2(e)
SEE PLANS
120.2(f)
SEE PLANS
120.2(g)
SEE PLANS
120.2(h)
SEE PLANS
120.2(i)
SEE PLANS
120.4
SEE PLANS
Equipment is sized in conformance with 140.4(a & b) y
140.4(a&b)
Supply Fan Pressure Control 140.4(c) SEE PLANS
Simultaneous Heat/Cool$ 140.4(d) SEE PLANS
Economizer 140.4(e) SEE PLANS
Heat and Cool Air Supply Reset 140.4(f) SEE PLANS
Electric Resistance Heating9 140.4(8) SEE PLANS
Duct Leakage Sealing and Testing.10 140.4(1) SEE PLANS
Notes:
1. Provide equipment tags (e.g. AHU 1 to 10) and system description (e.g. Single Duct VAV reheat) as appropriate. Multiple units
with common requirements can be grouped together.
2. Provide references to plans (i.e. Drawing Sheet Numbers) and/or specifications (including Section name/number and relevant
paragraphs) where each requirement is specified. Enter "N/A" if the requirement is not applicable to this system.
3. The referenced plans and specifications must include all of the following information: equipment tag, equipment nominal
capacity, Title 24 minimum efficiency requirements, and actual rated equipment efficiencies. Where multiple efficiency
requirements are applicable (e.g. full- and part -load) include all. Where appliance standards apply (110.1), identify where
equipment is required to be listed per Title 201601 et seq.
4. Identify where the ventilation requirements are documented for each central HVAC system. Include references to both central
unit schedules and sequences of operation. If one or more space is naturally ventilated identify where this is documented in the
plans and specifications. Multiple zone central air systems must also provide a MCH -03-E form.
5. If one or more space has demand controlled ventilation identify where it is specified including the sensor specifications and the
sequence of operation.
6. If one or more space has occupant sensor ventilation control identify where it is specified including the sensor specifications and
the sequence of operation
7. If the system is DDC identify the sequences for the system start/stop, optimal start, setback (if required) and setup (if required).
For all systems identify the specification for the thermostats and time clocks (if applicable).
8. Identify where the heating, cooling and deadband airflows are scheduled for this system. Include a reference to the
specification of the zone controls. Provide a MCH -03-E form.
9. Enter N/A if there is no electric heating. If the system has electric heating indicate which exception to 140.4(g) applies.
10. If duct leakage sealing and testing is required, a MCH -04-A form must be submitted.
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
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(408) 777-3228 ^ FAX (408) 777-3333 • buildino(a)cuoertino.orG
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*!D'ALLING UNITS:
IS A SECOND UNIT [l YES
SECOND STORY ❑ YES
VIA_A_
BEENG ADDED? E1240
ADDITION? []NO
RE DF
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ISTHE BLDG 4N F7'M
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PLANNTINGAPPL9 01\10 PLA>\1,2NLETTI
EICF.LERHOME? ❑NO90
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By my signature below, I certify to each of the following: 1 am the property owner or authorized a nt to act oy e property o �mer's behalf, I have read this
application and the information 1 have provided is correct. I have read the Description of Work an riry it is accu te. 1 agree to comply with all applicable local
Ordinances and state laws relating to buil " Q colstruction. 1 authorize representatives of Cupertino to enter ve-ide/ntifCie�d property for inspection purposes.
Signature of Applicant/A.gent: Date: 94 7
SUPPLEMENTAL rNTFORMATION REQUIRED
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�'";� PL}�.'z CFtiCK TIPE> �;,"�+-"�ROIIi'L�G,sLIP
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BUII�TiiGP1REiTEW#
New SFD or Multifamily cl-wellings: Apply for demolition permit for
existing
existing building(s). Demolition is issuance building
permit required prior to of
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Mu
permit for new building.
`iw
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
g� rA nARD }
�uBL7c olt s
fo_rm if any Hazardous Materials are being used as part of this project,fio
,
&�
_Copy of Planning Approval Letter or Meeting with Planning prior to
Q
submittal of Building Permit application.
fAJflIRS`SExiERDISTRTCTcs
B1dgApp_2011.doc revised 06.21/11
