B-2016-2999CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2999
19409 STEVENS CREEK BLVD STE 110 CUPERTINO, CA 95014 (316 20 112)
MAVIN BUILDERS INC
TORRANCE, CA 90505
OWNER'S NAME: MAIN STREET CUPERTINO
DATE ISSUED: 06/07/2017
OWNER'S PHONE: 626-445-7232
PHONE NO: (310) 422-5651
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class a Lic. #1011125
Contractor MAVIN BUILDERS INC Date 02/28/2018
X BLDG —ELECT —PLUMB
—
MECH RESIDENTIAL X COMMERCIAL
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.
JOB DESCRIPTION:
SUITE 110 HAIDILAO HOT POT; T.I. (N) RESTAURANT (6389 S.F.)
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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
JQ�Section 3700 of the Labor Code, for the performance of the work for which this
"/L►' is issued.
permit
Sq. Ft Floor Area:
Valuation: $1900000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
31620 112
A (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 of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino nicipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature A66�� Date 06-07-2017
r
Issued by: Kim Dunbatl
IV
OWNER -BUILDER DECLARATION
Date: 06/07/2017
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 of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 06-07-2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
t. 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.
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 so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 2550V5511,d 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 06-07-2017
I certify that I have read this application and state that the above information is
CONST CTIO LENDVrG AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction 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.
Licensed
Signature Date 06-07-2017
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
OUPERTINO I (408) 777-3228 •FAX (408) 777-3333 • buildinaCcDcupertino.org'71! / r� G
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TES'T'ING ENGINEERS, INC.
2811 Teagarden St. 510-835-3142 510-834-3777 fax
San Leandro, CA 94577' 800-660-3142
San Leandro • San Jose • Martinez
INSPECTION REPORT Week Ending: 6/23/17
PROJECT # 65454
PROJECT:
19409 Stevens Creek Blvd.
HaiDiLao Cupertino Blvd.
Permit # B2016-2999
DATE 6/20/17
HOURS 4
INSPECTOR F. Quintana
Reported to Train at the jobsite as requested.
TYPE OF II ,TSPECTION:
Concrete Placement / Epoxied Anchors
PLACE OF INSPECTION:
Jobsite
Monitored loads arriving at the jobsite for correct mix and proper slump. Inspected placement operations. Performed 1 slump
test (4") and cast 1 set of compression test specimens (5 each), Sample # 260247, for Concrete Mix # 6.5 Sk from Concrete Ready
Mix, (specified strength 3000 psi, slump 4" maximum) for concrete placed at pad footings. Total cubic yards placed: 16.
NOTE: No vibrator used, manually consolidated.
The preceding work, as noted, was to the best of my knowledge, in compliance with approved plans and specifications,
including revisions by engineer and Drawings S-1 and S-2, dated 6/5/17.
Inspected predrilled holes for proper diameter and depth. Observed the cleaning of holes and the injection of Simpson Set
XP epoxy (exp. 2/19). Witnessed the proper insertion of twelve (12) 5/s" diameter Allthread anchors, 14" in length,
embedded 12" at wall columns /stud metal; and four (4)1-1/s' diameter Allthread anchors, 16" in length, embedded 12"
at Hardy frame.
The preceding work was, to the best of my knowledge, in compliance with approved plans and specifications, including
revisions by engineer and Drawings S-5, Detail 3 and 14FX1S, Detail 1, dated 6/5/17.
Reviewed by:
D ppero ,
Special Inspection ionanag
1cc: Mavin Builders, Inc. / J. Tran JUL ���7
A & G Structural Engineers, Inc. / A. Pirbadian
City of Cupertino / Bldg. Inspection Dept.
11Y L
The results presented in this report relate only to the items) tested/inspected and
can be reproduced only in its entirety unless written permission from TEI is obtained.
Page 1 of 1
ANIL
110;�
TESTING ENGINEERS, INC.
2811 Teagarden St. 510-835-3142
San Leandro, CA 94577 800-660-3142
San Leandro ® San
PROJECT # 65454
PROJECT:
19409 Stevens Creek Blvd.
HaiDiLao Cupertino Blvd. Suite 100
ertino,_CA
HOURS
Permit # B2016-2999
6/29/17
4
INSPECTOR B. Muzika
510-834-3777 fax
® Martinez
INSPECTION REPORT Week Endik- 6/30/17
TYPE OF INSP
Visual
PLACE OF INSPECTION:
Fine Steel Products
Reported to Javier Alcaraz of Fine Steel Products at the shop as requested.
Checked welder qualification papers (Antonio Lopez, ID # 9642, Francisco Hernandez, ID # 3657, Mario Esparza, ID # 9942).
Checked WPSs and verified welding parameters. Verified proper electrode storage. Verified proper preheat. Visually
inspected joint preparation and fit -up. Performed continuous visual inspection of the in -progress welding performed by
three qualified welders using the FCAW process with E71T-8 wire electrode.
Weldments consist of single pass fillet welds joining -1/8" base plates (10) to 4" x 4" x 1/4' HSS column shop marked A1;1/2"
Allthread studs to 10" x 4" x 3/8" HSS beam shop marked B1, 10" x 4" x 1/4" HSS beam shop marked C1, 10" x 4" x 5/8" HSS
----beam shop- -marked D1,-10'-'-x-4"x-5/16' HSS beams shop -marked F1-and'G1 and 10" x 4" x 3/16' HSS beams shop marked -H1
and J1; square butt groove welds joining 1/4" plate end caps to seven (7) HSS 10" x 4" beams shop marked B1, C1, D1, F1, G1,
H1 and J1 for wall thicknesses 3/16",1/4", 5/16", 3/8" and ,%" (complete).
The preceding work was, to the best of my knowledge, in compliance with engineer approved plans and specifications,
including revisions by engineer and shop drawings E1 and D1.
Reviewed by: -
avid Chippero
Special Inspectio la
ED
1cc: Mavin Builders, Inc. / J. Tran J U L 2 4 2017
A & G Structural Engineers, Inc. / A. Pirbadian
City of Cupertino / Bldg. Inspection Dept.
BY
The results presented in this report relate only to the item(s) tested/inspected and
can be reproduced only in its entirety unless written permission from TO is obtained.
Page 1 of 1
Testing Engineers, Inc. Quality Assurance Services
Materials Consulting
Since 1954
Regular Concrete Compression Test Report
Project No.: 65454 Client: MAV003 Sample No.: 260247 / Page 1 of 1
Project Name: Report Date : 07/1$/17
19409 Stevens. Creek Blvd. Sample Date :06/20/17;
HaiDiLao Cupertino Blvd. Suite 100. Time Sampled: 0745AM
Cupertino, CA Date Received :.06/21/17
Permit # 132016-2999° I Inspector : F. Quintana, TEI
Supplier: Concrete Ready Mix
Mix: 5-6.5 SK
Ticket No.: 226918
Location:
(sampled at east most of building)
Specimens Cast (ASTM C-31) : 5
Air Temperature (ASTM C-1064) : 76 deg F
Mixture Temperature (ASTM C-1064) : 78 deg F
Slump (ASTM C-143) : 4 inches
Capping Specimens ASTM C-617 ;l ASTM C-1231
Date Tested
06/27/17
07/18/17
07/18/17
07/18/17
HOLD
ID Number
1A
1 B
1 C
1 D
1 E
Mark Sample
Dimension, Inches
Diameter
4
4
4
4
Length
8
8
8
8
Area, sq. inches
12.57
12.57
12.57
12.57
Ultimate Load, lbs
39000
63000
69000
64000
Ultimate Str., psi
3100
5010
5490
5090
Average, Str., psi
5200
Age Tested, Days
7
28
28
28
HOLD
Fracture Type
1
1
1
1
Dry Unit Weight, pcf
_ _
_.-
_
Specified Strength, psi
y
3000
3000
3000
/ SPECIMENS NOT SCHEDULED FOR TESTING WILL BE DISCARDED AFTER 28 DAYS OLD
The Material V WAS WAS NOT The Material Tested MET DID NOT MEET THE
SAMPLED AND TESTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS
REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS.
Remarks: Samples Tested in General Conformance with ASTM C-39
1 cc. City of Cupertino
1 cc. A & G Structural Engineers,RECEIVED Reviewed By:
1 cc. Mavin Builders, Inc.
J,UL 2 5 2017
�-! r�ober�reen
Concrete Lab Supervisor
The results preste ort relate only to the item(s) tested.
This report can be reproduced only in its entirety unless written permission from TEI is obtained.
Corporate Office - 2811 Teagarden Street, San Leandro, California 94577 - (510) 835-3142 - Fax (510) 834-3777
Testing Engineers, Inc. Quality Assurance Services
Materials Consulting
Since 1954
Regular Concrete Compression Test Report
Project No. : 65454 Client : MAV003 Sample No. : 260247/Page 1 of 1
Project Name: Report Date :07/18/17
19409 Stevens Creek Blvd. Sample Date :06/20/17
HaiDiLao Cupertino Blvd.Suite 100 Time Sampled : 0745AM
Cupertino, CA Date Received : 06/21/17
Permit#B2016-2999 ; Inspector: F. Quintana, TEI
Supplier:Concrete Read Ili Specimens Cast(ASTM C-31) : 5
Mix : 5-6.5 SK Air Temperature(ASTM C-1064) : 76 deg F
Ticket No. : 22691: c:::3 Fll L ,:;,,,,,_
Mixture Temperature(ASTM C-1064) : 78 deg F
Slump(ASTM C-143) : 4 inches
Location: g-11-/.17
---Pad footings
(sampled at ea-t most of uilding) .12k Capping Specimens ASTM C-617 / ASTM C-1231
Date Tested /17 17 /18/17 07/18/17 07/18/17 HOLD
ID Number 1A 1B 1C 1D 1E
Mark Sample
Dimension,Inches
Diameter 4 4 4 4
Length 8 8 8 8
Area, sq.inches 12.57 12.57 12.57 12.57
Ultimate Load,lbs 39000 63000 69000 64000
Ultimate Str., psi 3100 5010 5490 5090
Average, Str., psi 5200
Age Tested, Days 7 28 28 28 HOLD
Fracture Type 1 1 1 1
Dry Unit Weight, pcf _ _ _
Specified Strength:psi 3000 3000 3000
/ SPECIMENS NOT SCHEDULED FOR TESTING WILL BE DISCARDED AFTER 28 DAYS OLD
The Material Zf WAS I WAS NOT The Material Tested /MET DID NOT MEET THE
SAMPLED AND TESTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE BLDG.DEPT.OR DSA APPROVED DOCUMENTS.
REQUIREMENTS OF THE BLDG.DEPT.OR DSA APPROVED DOCUMENTS.
Remarks: Samples Tested in General Conformance with ASTM C-39
1 cc. City of Cupertino
1 cc. A&G Structural Engineers, Inc. Reviewed By:
1 cc. Mavin Builders, Inc
,�.! obe reen
Concrete Lab Supervisor
The results presented in this report relate only to the item(s)tested.
This report can be reproduced only in its entirety unless written permission from TEI is obtained.
i
Corporate Office-2811 Teagarden Street, San Leandro, California 94577- (510)835-3142-Fax(510)834-3777
I
I
16; TESTING ENGINEERS, INC
2811 Teagarden St 510-835-3142 510-834-3777 fax
San Leandro,CA 94577 800-660-3142
San Leandro • San Jose • Martinez
INSPECTION REPORT Week Ending: 6/23/17
PROJECT#65454 TYPE OF INSPECTION:
Concrete Placement/Epoxied Anchors
PROJECT: � . .
PLACE OF INSPECTION:
19409 Stevens Creek Blvd. S-//'-/_ jobsite
HaiDiLao Cupertino Blvd.Sui� t t
Cupertino,CA.
Permit#B2016-2999
DATE 6/20/17
HOURS 4
INSPECTOR F.Quintana
Reported to Train at the jobsite as requested.
Monitored loads arriving at the jobsite for correct mix and proper slump. Inspected placement operations. Performed 1 slump
test(4")and cast 1 set of compression test specimens(5 each),Sample#260247,for Concrete Mix#6.5 Sk from Concrete Ready
Mix,(specified strength 3000 psi,slump 4"maximum)for concrete placed at pad footings. Total cubic yards placed: 16.
NOTE: No vibrator used,manually consolidated.
The preceding work,as noted,was to the best of my knowledge,in compliance with approved plans and specifications,
including revisions by engineer and Drawings S-1 and S-2,dated 6/5/17.
Inspected predrilled holes for proper diameter and depth. Observed the cleaning of holes and the injection of Simpson Set
XP epoxy(exp_2/19). Witnessed the proper insertion of twelve(12)°/8-diameter Allthread anchors,14"in length,
embedded 12" at wall columns/stud metal;and four(4)1-1/s"diameter Allthread anchors,16"in length,embedded 12"
at Hardy frame.
The preceding work was,to the best of my knowledge,in compliance with approved plans and specifications,including
revisions by engineer and Drawings S-5,Detail 3 and 14FX1S,Detail 1,dated 6/5/17.
Reviewed by:
Dadfdp o
Special Inspection Division Manager
Ice: Mavin Builders,Inc:/J.Tran
A&G Structural Engineers,Inc./A.Pirbadian
City of Cupertino/Bldg.Inspection Dept
The results presented in this report relate only to the item(s)tested/inspected and
can be reproduced only in its entirety unless written permission from TEI is obtained
Page 1 of 1
TESTING ENGINEERS, INC.
2811 Teagarden St 510-835-3142 510-834-3777 fax
San Leandro,CA 94577 800-660-3142
San Leandro • San Jose • Martinez
INSPECTION REPORT Week Ending. 6/30/17
PROJECT#65454 TYPE OF INSPECTION:
Visual Welding
PROJECT: PLACE OF INSPECTION:
19409 Stevens Creek Blvd. Fine Steel Products'(shop)
HaiDiLao Cupertino Blvd.Suite 100
Cupertino,CA _ _
Permit#B2016-2999 F L
DATE 6/29/17 _
HOURS 4
INSPECTOR B.Muzika < ',
Reported to Javier Alcaraz of Fine Steel Products at the shop as requested.
Checked welder qualification papers(Antonio Lopez,ID#9642,Francisco Hernandez,ID#13657;Mario Esparza,ID#9942).
Checked WPSs and verified welding parameters. Verified proper electrode storage. Verified proper preheat Visually
inspected joint preparation and fit,up. Performed continuous visual inspection of the in progress welding performed by
three qualified welders using the FCAW process with E71T-8 wire electrode.
Weldnients consist of single pass fillet welds joining 5/8"base plates(10)to 4"x 4"x1/4"HSS column shop marked Al;1/z"
Allthread studs to10"x 4"x3/8"HSS beam shop marked B1,10"x 4"x1/4"HSS beam shop marked Cl,10"x 4"x%"HSS
beam shop marked D1,10"x 4"x 5/16"HSS beams shop marked Fl and G1 and 10"x 4"x 3/16"'HSS beams shop marked H1
and J1;square butt groove welds joining 1/4"plate end caps to seven(7)HSS 10"x 4"beams shop,marked Bi,Cl,Dl,Fl,G1,
H1 and J1 for wall ithicknesses 3/16",1/a',5/16",3/8"and 5/s"(complete).
The preceding work was,to the best of my knowledge,in compliance with engineer approved plans and specifications,
including revisions by engineer and shop drawings El and Dl.
Reviewed by: .
•avid Chippero
Special Inspection Division Manager
1cc: Mavin Builders,Inc./J.Tran
A&G Structural Engineers,Inc./A.Pirbadian
City of Cupertino/Bldg.Inspection Dept.
The results presented in this report relate only to the item(s)tested/inspected and -
can be reproduced only in its entirety unless written permission from TEl is obtained.
Page 1 of 1
Emma
TESTING ENGINEERS, INC.
2811 Teagarden St. 510-835-3142 510-834-3777 fax -
San Leandro,CA 94577 800-660-3142 . =
San Leandro • •Sari Jose • Martinez
INSPECTIONREPORT- Week
Ending: 8117 '
•
PROJECT#65454 = TYPE OF INSPECTION:
Visual Welding
PROJECT: PLACE OF INSPECTION:
19409 Stevens Creek Blvd. Fine Steel Products(shop)
HaiDiLao Cupertino Blvd.Suite 100
Cupertino,CA
Permit4LB20162999 .-- - - ---- - - --- -• -- - = - - - -
DATE 8/12/17 8/14/17
HOURS 8 4
INSPECTOR B.Muzika
Reported to Javier Alcaraz of Fine Steel Products at the shop as requested.
8/12/17(Saturday)
Checked welder qualification papers(Francisco Hernandez,ID#3657,Mario Esparza,ID#9942,Antonio Lopez,ID#9642,Jesus
Alcaraz,ID#7818). Checked WPSs and verified welding parameters. Verified proper electrode storage. Verified proper preheat.
Visually inspected joint preparation and fit-up. Performed continuous visual inspection of the in-progress welding performed by
four qualified welders using the FCAW process with E71T-8 wire electrode.
Weldments consist of complete joint penetration groove welds joining/splicing 8"x 6"x 3/4"HSS roof level rafter shop assemblies
(mitered joint)11C2 beams;splicing MC10 x 22 stringers at landing hip stringers;single pass fillet welds joining 1/a"and 5/s"base
plates to five(5)4"x 4"x1/4"HSS columns shop marked A2;1/4"end plates to 8"x 4"x 1/"HSS beams shop marked D2,F2 and G2;
7/s"coupling nuts to eleven roof beams shop marked C2 and G2;and single pass fillet welds joining 2"x 2"x 1%"angle tread seats
and 3"x 3"x 14"and nosing clips to MC10 x 22 stringers(complete).
8/14/17
Checked WPSs and verified welding parameters. Verified proper electrode storage. Verified proper preheat. Visually inspected
joint preparation and fit-up. Performed continuous visual inspection of the in-progress welding performed by four qualified
welders using the FCAW process with E71T-8 wire electrode.
Weldments consist of complete joint penetration groove welds joining/splicing 8"x 6"x 3/e HSS roof rafter assemblies shop marked
B2;and single pass fillet welds joining 7/s"coupling nuts to 8"x 6"HSS beam/rafters shop marked B2(complete).
The preceding work was,to the best of my knowledge,in compliance with engineer approved plans and specifications,including
revisions by engineer and shop drawings E2,E3,SK1 and SK3.
Reviewed by: -N o�
avls i ie.', ---t
Special Inspection 1 �'_'.� ' .YIE
1cc: Mavin Builders,Inc./J.Tran
A&G Structural Engineers,Inc. /A.Pirbadian SEP 14 2 17
City of Cupertino/Bldg.Inspection Dept.
The results presented in this report relate only to the item(s)tested/inspected and
can be reproduced only in its entirety unless written permission from TEI is obtained. BY
Page 1 of 1
. "pi,i,,' . _ ..
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Date: ` DSA File:: , .,/DSA App.#: ,
Project No.:
1,-, L'1 p t OSHPD Nom
Project Name r . ,
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Address: 07` 1. I ,.c..:17-p. it 0 a 1 g ,
_ � Cr"� �r t - r'�� c 1 Tow Code:.
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City: r' _ ) .0 is : Start Time: 1 c''''' .
Requested'by: `' 9 'Hours: '
Reported to:
i ) F F� 0f:'_ i 'PI 1 9 i P-*' tai e t (-- Y g
F
PO,
XIED'DOWELS`- 125: '7 EPDXIED ANCHORS - 126 E -EXPANSION ANCHORS 127
❑Witnessed the drilling of holes of proper diameter and depth. '
or ,..
Ar's i ,' ire
`nspected predrilled holes for proper diameter and depth: 6 Expiration Date of Epoxy `•f t:-) , r
t Ty ,f" _
Observed`the cleaning of holes and the injection of. - .^.`T X.P.. epoxy.
or .
the;insertion of - . epoxy capsules:
Witnes
Ksed dthe proper insertion of:
Oty' r#.1 TypeLength, JEned 4„ Lotion k Y• A6
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4
•
•
. . . Notes: ❑''Type. ❑ Do not type • . • . •'
•
The work,. ',was❑was not inspected in accordance with the E wilding Department-or❑DSA or❑OSHPD approved documents.
The;work inspected `met❑dad not meet thei equirements of the`t Building Department or❑.DSA or'❑OSHPD ,,'approved documents,
?kIaterztal am noted g 'Was - was not N/A'-er ormed in
P os
p g ❑ ❑ p f accordance with the Building Department or, DSA or GSHPD approved
iocuments -
• •
Drawin s , „' t!„„." v,! 1 to'?.S Dated City❑County,-
Drawings g
Inspector: =°1 '� l�` �' pt f;;° Certification# `) e2 '
�_4 P 5 a € i Date
r _
,
t
'' 2iIL,4ti
f" jDate: . 10 `ff• •
Received•by � : , lilac
I / . ' : , .
•
Cor orate Office - 2811 Tea arden�Street-San Leandro;California 94577 (510)835-3142—FAX(510)'834-3777
P g • „ .
1 -, www.Testing-Engineers.com•,
In; TESTING ENGINEERS, INC.
101/
2811 Teagarden St. 510-835-3142 510-834-3777 fax
San Leandro,CA 94577 800-660-3142
San Leandro • San Jose • artinez
INSPECTION REPORT Week Ending: 10/13/17
PROJECT# 65454 TYPE OF INSPECTION
Epoxied Dowels
PROJECT PLACE OF INSPECTION.
19409 Stevens Creek Blvd. Jobsite
HaiDiLao Cupertino Blvd.Suite 100
€upertino7 CA
Permit#B2016-2999
DATE 10/10/17
HOURS 4
INSPECTOR L.Granillo
Reported to John of Mavin Builders at the jobsite as requested.
Inspected predrilled holes for proper diameter and depth. Observed the cleaning of holes and the injection of Simpson Set XP
epoxy(exp 9/16). Witnessed the proper insertion of two hundred sixty-four(264)#5 reinforcing steel bars,29"in length,
embedded 8"at pipe trench.'
The preceding work was,to the best of my knowledge,in compliance with engineer approved plans and specifications,
including revisions by engineer,and Drawing S-5,Detail 8.
Reviewed by
---Davd—Chippero
Special Inspection Division Manager
I ` C ISE'
1cc: Mavin Builders,Inc.'/J Tran
A&G Structural Engineers,Inc. /A.Pirbadian OCT 3 0 2017
City of Cupertino/Bldg.Inspection Dept.
BY
The results presented in this report relate only to the item(s)tested/inspected and
can be reproduced only in its entirety unless written permission from 1'l;l is obtained.
Page 1 of 1
IL; TESTING ENGINEERS, INC.
2811 Teagarden St. s 510-835-3142 510-834-3777 fax
San Leandro,CA 94577 800-660-3142
San Leandro • San Jose • Martinez
INSPECTION REPORT Week Ending: 11/3/17
Cfj r:A•77.
PROJECT#65454 TYPE OF INSPECTION.
Visual Welding
r..;y
tl.
PROJECT: PLACE OF INSPECTION: < l�1 7
19409 Stevens Creek Blvd: Fine Steel Products(shop)
HaiDiLao Cupertino Blvd.Suite 100
Cupertino,CA
Permit#B2016-2999
DATE 11/3/17
HOURS 4
INSPECTOR B.Muzika
Reported to Steve Eldridge of Fine Steel Products at the shop as requested.
Checked welder qualification papers(Francisco Hernandez,ID#3657,Alejandro Alcaraz,ID#9158). Checked WPSs and
verified welding parameters. Verified proper electrode storage. Verified proper preheat. Visually inspected joint
preparation and fit-up. Performed continuous visual inspection of the in-progress welding performed by two qualified
welders using the FCAW process with E71T-1 wire electrode.
Weldments consist of square butt groove welds joining mitered 6"x 6"x 1/4"angle bottom framing for mechanical frames A
and B;single pass fillet welds joining 4"x 4"x 1/4"HSS legs(6)to W8 x 15 top framing;6"x 6"x 1/4'angle bottom framing;3"
x 3"x 1/4"diagonal angle braces to form mechanical frames shop marked A and B(complete).
The preceding work was,to the best of my knowledge,in compliance with approved plans and specifications,including
revisions by engineer and Drawings SK 1B,SK-1A,SK2 and shop drawings D1 through D3.
Reviewed b Oft
i :. . 4 ppero
Special Inspection Division Manager
RECEIVED
1cc: Mavin Builders,Inc./J.Tran
A&G Structural Engineers,Inc./A.Pirbadian N O V 21 2017
City of Cupertino/Bldg.Inspection Dept.
_ I3Y
The results presented in this report relate'only to the item(s)tested/inspected and
can be reproduced only in its entirety unless written permission from TEI is obtained.
Page 1 of 1
Alto CALGREEN NON-RESIDENTIAL CHECKLIST Fitz,
• MANDATORY ITEMS
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION R-2/
CUPERTiNcr ALBERT SALVADOR.RE.,C.13,0,, BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•bvildinaecunertino,crit
PURPOSE:
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: Haidilao Hop Pot Restaurant
Project Address: 19409 Stevens Creek Blvd. Suite 110
Project Description. Tenant improvement of(E)space with new equipment interior finishes,toilet rooms
Instructions:
1 The Owner or the Owner's agent shall employ a licensed professional experienced with the 2013
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
Column 2 Column3 .
MANDATORY FEATURE OR MEASURE Project Verification
Re•uirements
CHAPTER 5 — NONRESIDENTIAL MANDATORY MEASURES
General Requirements
The project meets all the requirements of Divisions 5.101 through 5.508. 0
Division 5.1 PLANNING AND DESIGN
Planning and Design-Site Development
5.106.1 Storm water pollution prevention.For projects of one acre or less,
develop a Storm Water Pollution Prevention Plan(SWPPP)that has been
designed,specific to its site,conforming to the State Storm water NPDES
Construction Permit or local ordinance,whichever is stricter, as is required for
projects over one acre.The plan should cover prevention of soil loss by storm
water run-off and/or wind erosion,of sedimentation and/or of dust/particulate
matter air pollution.
fagc 1 oI'Q Cara een M10-ReClreekti,sidec wised 01/23/14
CALGREEN SIGNATURE DECLARATIONS
Project Name: i tl t Pot Restaurant
Pr eject Address.. 19409 Steverts Creek Blvd Suite 120
Project Descd tfon:: Restaurant Tenant Improvement 01 3 mace withaenV equipment interior mons
SECTION 1 —DESIGN VERIFICATION
cmplete all tines of Section I--Design Verification'end submit the completed checklist(Columns I and with the
plans and building permit application to the Building Department.
The owner and design professional reresponsible for compliance with CalGreen Standards have revised the plans and
certify that the items ked above are hereby y incorp ted into the project plans and will be implemented into the
project in accordance with the requiremnts set forth in the 2013 California Green Building Standards Code as
adopted by the City of Cupertino..
4r, it
OWrieenet°gre - at
mer' o (Please Print)
1*�
Design Professlonars signature Dote
;via tdi
Deno Professional's Name iPleasePrint)
3
stratum of License Professlo a res, •i-bse ors lG �t are Date
Name of Litense Professional responsible to CalGreen compliance(Please P rai) Phore
Ema.t Address
for License 'ref�rat responsible r trs�cptnre
SECTIO 2—IMPLEMENTATION--VERIFICATION et
Complete,.sign and submit the competed checklists including column 3,together with all original signatures.on Section
to the Building Departinerit prior to Building Department final inspection,
I have inspected the work and have received Sufficient docornentat'on to verify and certify that the project identified
above was constructed to accordance with anis Green autlthrig Checkiist and in accordance with the r ilrs end of
the 21,13 California Green Suiiidin Stan-cords Code as OdOpted`by the city of CLipeititle
Signature el License.Prolessionat responsible for CalGreen compliance Dale
weer ,all ri' r r r �C ice r-„ rc�,P� epm/
-�t�s � � oe.�ar��a sit f�a�..� e�7.'?1�� �e�`�3r8;+a?�.�i= 1=➢ *:r��
' Aartrett; fortzeople Piniew rlrtr#1 ter a G6-ion<4.-``'o'iriny'4
4"'j»,..i s`,S 9 §4¢ as"PFS`.°4cr..rte ,.
Outdoor Air Quality
6,508.1 Ozone depletion aridgreenhouse gas reductions.Installations of
HVAC,refrigeration and fire suppression equipment shall comply with Sections
5E08,1. and 5.508:1,24
6.508.1.1 Chlorofluorocarbons(CFCs).Install HVAC and refrigeration
E3 E:4
equipment that does not contain CFCs.
If'
5H.508.-1.2 Melons. Install fire suppression equipment that does not contain
aioI.
a* 1 Ca1 'reel Non Res `h ist d c revised 01/23/14
04.4,5 Composite wood products.Hardwood plywood,particleboard
I and medium density fiberboard composite wood products used on the
interior or exterior of the building shall meet the requirements forMI gi
formaldehyde as specified in Table 5.504A.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
. 4. ,. a
.504.4.8 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. Et
5.504.7 Environmental tobacco smoke(ET )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, o 51
California Community College,campus of the California State University or
campus of the University of California,whichever are more stringent
Indoor Moisture and Radon Control
. 05.1 indoor moisture control.Buildings shall meet or exceed the
provisions of California Building Code=CCR,Title 24,Part 2,Sections 1203
and Chapter 14,1
Air Qu lwity and Exhaust
$.505.1 Outside air delivery.For mechanically or naturally ventilated spaces
in buildings,meet the minimum requirements of Section 121 of the California
Energy Code,.CCR,Title 24,Part 8 and Chapter 4 of CCR,Title 8 or the
applicable local code,whichever is more stringent.
I 5062 Carbon dioxide(CO2)mmonitoring.For buildings equipped with i
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 .1
Environmental Comfort
5..507.4 Acoustical control.Employ building assemblies and components
with SIC values determined in accordance with ASTM E 90 and ASTM E 413.. 0 Ca
5.507A.1 Exterior noise transmission.Wall and floor ceiling assemblies
making up the building envelope shall have an STC of at least 50 and
exterior windows shall have a minimum STC of 30 for any of the building 0 El
locations listed in items 1 through 3 in Section 5.507.5.1.
.507.4,2 Interior sound.Wall and floor-ceiling assemblies separating
tenant spaces and tenant spaces and public places shall have an STC of
at least 4 .
?ago 7 of 9 CalGreen rr-Res Checklisidac revised 01/23/14
Fireplaces
5.543.1 install only a direct-vent sealed-combustion gas or sealed wood-
.121
burning
o -
burning fireplace or a sealed woodstave and refer to residential requirements
in the California Energy Coda,.Title 24,Part.6,Subchapter 7,Section 150.
5.503.1,1 Wooristoves,W odstoves shall comply with US EPA Phase I
emission limits. '1
Pollutant Controt'
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
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 5.504A.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
13
iSCAOMD Rule 11 :voc limits,as shown in Tables 5.504.4.1 and E3
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
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 5.504.4A 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
945 a)(3)and other requirements,including prohibitions on use of
certain toxic compounds and ozone depleting substances(CCR,Title 17,
Section 94520 et seq).
5.504.4.32 Verification.Verification of compliance with this section
shall be provided at the request of the enforcing agency. Its'
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.
5,504.44.1 Carpet cushion.All carpet cushion installed in the building
interior shall meet the requirements of the Carpet and Rug Institute
Green Label program.
5.504.4.4,2 Carpet adhesive_All carpet adhesive shall meet the
requirements of Table 5,5044.1. C3 121
Pogo 6 of 9 C l seen Noll-Res Cheekiistdoe revised 01/23114
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 5410.4.
5.410.22 Basis of Design(BOD),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.
.410$ . ommissoning 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 54102.1
5.410.2.4 Functional'performance testing. Functional performance
testing shall demonstrate the correct installation and operation of each
component,system and system-to-system interface in accordance with the
approved plans and specifications.
5.414.2.5 Documentation and training.A Systems manual and systems
operations training are required, 0 ►1
5410.2.5.1 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 .410. . ,.1,
54112.52 Systems operations training.The training of the
appropriate maintenance staff for each equipment type andlor system rpt
shall include items listed in Section 5410.2.52.
{ 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,
5.410A Testing and adjusting.Testing and adjusting of systems shall be
required for buildings less than 10,000 square feet or new systems to serve an
addition or alteration subject to Section 303.1..
5.410.4,2 Systems.Develop a written plan of procedures for testing and
adjusting systems, Systems to be included for testing and adjusting shall
include,as applicable to the project,the systems listed in Section
5.410.3.2.
5410.43 Procedures. Perform testing and adjusting procedures in
accordance with industry best practices and applicable national standards
on each system,
5.410.4.3.1 HVAC balancing.Before a new space-conditioning system
serving a building or space is operated for normal use,the system
should be balancedin accordance with the procedures defined by
national standards listed in Section 5.410.3.3.1.
5410.4.4 Reporting.After completion of testing,adjusting and balancing,
provide a final report of testing signed by the individual responsible for
E3 131,
performing these services..
5.410.4.5 Operation and maintenance manual. Provide the building
owner with detailed operating and maintenance instructions and copies of
guarantiesfarranties for each system prior to final inspection.
5.410.4.5.1 Inspections and reports.Include a copy of all inspection
verifications and reports required by the enforcing agency. 17.3limit
Pap 5 of 9 CaI tem Nut ss Check/lake revised DI/2311
5.407.2 Moisture control,Employ moistUre control measures by the following
methods;
• 5.4072.1 Sprinklers. Prevent irrigation spray on structures.
Lt.I
5.407,22 Entries and openings. Design exterior entries and/or openings
to prevent water intrusion into buildings,
54072,2.1 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 fleshings integrated with a drainage
0
plane.
Constmction Waste Reduction,Disposal and Recycling
5408.1 Construction waste management.Recycle and/or salvage for reuse
aminimum of 50 percent of the nonhazardous construction and demolition
waste in accordance with Section 5408.1.1,5.408.1.2,or 5408.1.3;or meet a 0
local construction and demolition waste management ordinance,whichever is
more stringent.
5408,1.1 Construction waste management plan.Submit plan per this
121
section to enforcement authority.
5408.12 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.
5-4081.3 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.
5.40L1.4 Documentation,Provide documentation of the waste
management plan that meets the requirements listed in Section 5.408,11
through 5.408.1.1
5408.3 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.
Suliding Maintenance and Operation
• £410.1 Recycling by occupants.Provide readily accessible areas that serve
the entire building and are identified for the depositing,storage and collection
• of nonhazardous materials for recycling.
5.410.2 Commissioning.For new buildings 10,000 square feet and over,
building commissioning for all building systems covered by T24, Part 6,
process systems and renewable energy systems shall be included in the jJ
• design and construction processes of the building project.Commissioning
• requirements shall include items listed in Section 5.410.2.
Page 4 o19 CalGreen Nim-Res Checklistdric.rxnised 01/23/14
e„303,1.2
. O ,1.2 excess consumption,
nsum tion, separate submeter shall be provided
for any tenant within a new building or within en addition that is projected
to consume>1,000 galiday3
5303.2 Water reduction;Plumbing fixtures shall meetthe maximum flow rate
values shown in Table 53032.3, E3ii
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 5.3032 and Section 5.303.3 shall
apply to new fixtures in additions or areas of alterations to the buildings.
5.303.4 Wastewater reduction, Each building shall reduce by 0 percent
wastewater by one of the following methods:
1.The installation of water-conserving fixtures or
2.Utilizing non-potable water systems.
5.303.6 Standards for plumbing fixtures and fittings.Plumbing fixtures and
fittings shall be installed in accordance with the California Plumbing Code
(CPC),and shall meet the applicable standards referenced in CPC Table
1401.1 and CalOreen Chapter 6,
Outdoor Water thl
5.304.1 Water budget.A Crater budget shall be developed for landscape
irrigation use.
5. 04.2 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_ ,but not more than 5,000 sq.ft,separate submeters or metering
devices shall be installed for outdoor potable water use,
5304.3 Irrigation design.In new nonresidential construction or building
addition or alteration with at least 1,000 but not more than 2,500 sq ft.of
cumulative landscaped area,install irrigation controllers and sensors which
include the following criteria,and meet manufacturer's recommendations. I<J
5.304;3.1 Irrigation controllers.Automatic irrigation system controllers
installed at the time of final inspection shall comply with the following
1,Controllers shall be weather-or soil moisture-based controllers that
automatically adjust irrigation in response to changes in plants°needs as
weather conditions change*
2,Weather-based controllers without integral rain sensors or
communication systems that account for local rainfall shall have a
separate wired or wireless rain sensor which connects or communicates
with the controller(s).).Soil moisture-based controllers are not required to
have rain sensor input.
Weather Resistance and Moisture Management
.407.1 Weather pr=otectiion.Provide a weather-resistant exterior wall and
foundation envelope as required by California Building Code Section 1403.2
and California Energy Code Section 150,manufacturer's installation
instructions or local ordinance,whichever is more stringent.'
Pup or v C it r.e Nim-Rgy azerklisidoc-iwi.wd 01/23/14
5106.4 Bicycle parking. Comply with Sections 5.106.4.1 and 6.106.4.2;or
meet local ordinance,whichever is Stricter. ra
5106.4.1 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 tiro-bike capacity rack.
106.4.1.2 Long-Term bicycle parking.For qualified buildings with over
10 tenantoccupants provide secure bicycle parking for 5 percent of tenant
vehicle parking spaces being added,with a minimum of one space.
5.166.52 Designated parking,Provide designated parking for any
combination of low-emitting,fuel-efficient and carpool/van pool vehicles a ►'�+
shown in Table .106. . .
5106,8 Light pollution reduction,Outdoor lighting systems shall be
Zif
designed and installed to comply with the Following.
1. The minimum requirements in the California Energy code for lighting zones
1—4 as defined in Chapter 40 of the California Administrative Code;and
2. Backlight,Uptight and Glare(BUG)ratings as defined in IES TM-15-11;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.Constnuction plans shall indicate how
site grading or a drainage system will manage all surface water flows.
Division 5.2 ENERGY EFFICIENCY
Performance Requirements
=.201.1 Scopes The California Energy Commission will continue to adopt h�
mandatory building standards,
Division 5.3 WATER EFFICIENCY AND CONSERVATION
indoor Water Use
5.303.1 Meters,Separate meters shall be installed for the uses described in
Sections 503101 and 503A. _
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 they
building projected to consume more than 100 gallda :
2.Where separate submeters are unfeasible,for water supplied to the
following systems:
a. Makeup water for cooling towers where flow through is greater
than 500 gpm.
b. Makeup water for evaporative coders greater than 6 gpm.
c. Steam and hot-water boilers with energy input 500,000Btu/h.
Page of 9 CalGreen nn-Res(Theeklistdoe revised 01123,14
0E cn
D p 0 0 0 ,Oi, m ,3m„ 0 s 0, p, s ® CD W o. m C) err D G
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STATE OF CALIFORNIA
HVAC SYSTEM REQUIREMENTS
CEC-NRCC-MCH-02-E(Revised 05/15)' CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-MCH-02-E
HVAC Dry System Requirements (Page 1 of 3)
Project Name: HAI DI LAO Restaurant Date Prepared: 11/21/2016
A.Equipment Tags and.System Description! System 1 Restaur System 2-Kitcher
R.MANDATORY MEASURES T-24 Sections Reference to the Requirements in the Contract Documents2
Heating Equipment Efficiency3 110.1 or 110.2(a)
Cooling Equipment Efficiency3 110.1 or 110.2(a)
HVAC or Heat Pump Thermostats 110.2(b),110.2(c)
Furnace Standby Loss Control 110.2(d)
Low leakage AHUs 110.2(f)
Ventilation4 120.1(b)
Demand Control Ventilations 120.1(c)4
Occupant Sensor Ventilation Controls 120.1(c)5,120.2(e)3
Shutoff and Reset Controls' 120.2(e)
Outdoor Air and Exhaust Damper Control 120.2(f)
Isolation Zones 120.2(g)
Automatic Demand Shed Controls 120.2(h)
Economizer FDD 120.2(i)
Duct Insulation 120.4
C.PRESCRIPTIVE MEASURES
Equipment is sized in conformance with 140.4(a&b) Y YJN Y YJN Y/N
140.4(a&b)
Supply Fan Pressure Control 140.4(c)
Simultaneous Heat/Cools 140.4(d)
Economizer 140.4(e)
Heat and Cool Air Supply Reset 140.4(f)
Electric Resistance Heating9 140.4(g)
Duct Leakage Sealing and.Testing.10 140.4(1)
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 May 2015
STATE OF CALIFORNIAk
HVAC SYSTEM REQUIREMENTS
CEC-NRCC-MCH-02-E(Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-MCH-02-E
HVAC Wet System Requirements rt C (Page 3 of 3)
Project Name: HAIDILAO Restaurant Date Prepared: 11/21/2016
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:Ors Gyene Documentation Author Signature:
Company: Controlled Environment Signature Date: 11/21/2016
Address: 1904 Broadview Drive CEA/HERS Certification Identification(if applicable):
City/State/Zip: Glendale, CA 91208 Phone: 818 5410920
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design
identified on this Certificate of Compliance(responsible designer).
3. The energy features and performance specifications,materials,components,and manufactured devices for the building design or system
design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the California Code of
Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s)issued for the
building,and made available to the enforcement agency for all applicable inspections.I understand that a completed signed copy of this
Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: Ors Gyene, P.E. Responsible Designer Signature:
Company: Controlled Environment Date Signed:
Address: 1904 Broadview Drive License:
City/State/Zip: Glendale, 91208 91208 Phone: 81 5410920
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015
STATE OF CALIFORNIA
HVAC WET SYSTEM REQUIREMENTS
CEC-NRCC-MCH-02-E(Revised 06/14) CALIFORNIA ENERGY COMMISSION "0:-
CERTIFICATE OF COMPLIANCE NRCC-MCH-02-E
HVAC Wet System Requirements (Page 2 of 3)
Project Name: HAIDILAO Restaurant Date Prepared:
11/21/2016
A.Equipment Tags and System Description)
B.MANDATORY MEASURES T-24 Sections Reference to the Requirements in the Contract Documents2
Heating Hot Water Equipment Efficiency3 110.1
Cooling Chilled and Condenser Water 110.1, 140.4(i)
Equipment Efficiency3
Open and Closed Circuit Cooling Towers 110.2(e)1
conductivity or flow-based controls
Open and Closed Circuit Cooling Towers 110.2(e)2
Maximum Achievable Cycles of
Concentration(LSi)6
Open and Closed Circuit Cooling Towers 110.2(e)3
Flow Meter with analog output
Open and Closed Circuit Cooling Towers 110.2(e)4
Overflow Alarm
Open and Closed Circuit Cooling Towers 110.2(e)5
Efficient Drift Eliminators
Pipe Insulation 120.3
C.PRESCRIPTIVE MEASURES
Cooling Tower Fan Controls 140.4(h)2,140.4(h)5 Y/N Y/N Y/N
Cooling Tower Flow Controls 140.4(h)3
Centrifugal Fan Cooling Towers4 140.4(h)4
Air-Cooled Chiller Limitations 140.4(j)
Variable Flow System Design 140.4(k)
Chiller and Boiler Isolation 140.4(k)
CHW and HHW Reset Controls 140.4(k)
WLHP Isolation Valves 140.4(k)
VSD on CHW,CW&WLHP Pumps>5HP 140.4(k)
DP Sensor Location 140.4(k)
Notes:
1. Provide equipment tags(e.g.CH 1 to 3)or system description(e.g.CHW loop)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.For chillers operating at non-standard efficiencies provide the
Kadj values. For chillers also note whether the efficiencies are Path A or Path B.
4. Identify if cooling towers have propeller fans. if towers use centrifugal fans document which exception is used.
5. If air-cooled chillers areaused,document which exceptions have been used to comply with 140.4(j)and the total installed design
capacity of the air-cooled chillers in the chilled water plant.
6. Identify the existence of a completed MCH-06-E\when open or closed circuit cooling towers are specified to be installed,
otherwise enter"N/A"
I'.
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015
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UUi
STATE OF CALIFORNIA
COMMERCIAL KITCHEN REQUIREMENTS let
CEC-NRCC-PRC-03-E(Revised 07/15) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-PRC-03-E
Commercial Kitchen Requirements (Page 1 of 2)
Project Name:HAIDILAO Restaurant __ Date Prepared. 11/21/2016
VENTILATION COMPLIANCE METHOD:
Small Kitchens(5_5,000 CFM Type I and II Hood Exhaust)check one 140.9(b)2 A i 140.9(b)2Aii
n
Large Kitchens CFM Type I and II Hood Exhaust) 140.9(b)2Bi 140.9(b)2Bii(a), 140.9(b)2Biii 140.9 b 2Biv
g (>5,000YP (b),(c)and(d) ( )
check one
KITCHEN ROOM NUMBER1 Kitchen
TOTAL INSTALLED TYPE I and II KITCHEN HOOD EXHAUST(CFM)2: 16,200
TOTAL BYPASS HOOD MUA(CFM)3: 0
TOTAL TRANSFER AIR AIRFLOW(CFM)4: 5,000
TOTAL MECHANICALLY HEATED OR COOLED MAKE UP AIR(CFM)5: 12,200
TOTAL AIR NEEDED FOR HEATING OR COOLING(CFM)6: 12,200
TOTAL EXHAUST AIR WITH DEMAND VENTILATION SYSTEMS: 11,200
Equipment Tags and System
Descriptions
PRESCRIPTIVE MEASURES T-24 Sections Reference to the Requirements in the Contract Documents9
Bypass Hood Exhaust and MUA 140.9(b)1A M-1 M-1
Type I/II Hood Exhaust 140.9(bM-1 M-1
Table 140.9-A
Mechanically heated or cooled make 140.9(b)2A M-1 M-1
up air
Replacement Air/Transfer Air Exhaust 140.9(b)2Bi M-1 M-1
Demand Ventilation Systems, 140.9(b)2Bii M-1 M-1
Energy Recovery Systems 140.9(b)2Biii M-1 M-1
Tempered/Non Mechanical Cooling Air 140.9(b)2Biv MAU-1 &2 M-1
Systems
Notes:
1.Fill in one form for each kitchen in the project.
2.Enter the total installed type I and II kitchen hood exhaust airflow in cubic feet per minute(cfm).
3.Enter the make-up air to bypass hoods(cfm).
4.Enter the total transfer air(cfm).
5.Enter the total mechanically cooled or heated make up air(cfm).
6.Enter the maximum air needed for heating or cooling loads(cfm).
7 Enter the design airflow(cfm)of exhaust with demand ventilation system controls
8.Provide equipment tags(e.g.,AHU 1&2 or Hoods 1 to 5)for all equipment that is covered by these requirements. Equipment
that is similar in requirements and compliance can be grouped in a single column.
9.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.Explicitly list any
exceptions used to avoid a requirement.
2
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance July 2015
STATE OF CALIFORNIA
COMMERCIAL KITCHEN REQUIREMENTSi `F,��p
CEC-NRCC-PRC-03-E(Revised 05/15) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-PRC-03-€
Commercial Kitchen Requirements (Page 2 of 2)
Project Name:F I/t l DI i A o Restaurant Date Prepared:11/21/2016
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:Ors Gyene Documentation Author Signature:
Company'Controlled Environment Signature Date:11/21/2016
Address: 1904 Broadview Drive CEA/HERS Certification Identification(if applicable):
City/State/Zip:Glendale,CA 91208 phone: 818 5410920
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design
identified on this Certificate of Compliance(responsible designer).
3. The energy features and performance specifications,materials,components,and manufactured devices for the building design or system
design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the California Code of
Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
5. I will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s)issued for the
building,and made available to the enforcement agency for all applicable inspections.I understand that a completed signed copy of this
Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:Ors Gyene, h.E. Responsible Designer Signature:
Company:Controlled Environment Date Signed:
Address: License:
1904 Broadview Drive
City/State/Zip:Glendale, 91208 91208 Phone:81 5410920
r �
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015
1
I CI 0 CI
kei 1 4)
STATE OF CALIFORNIA •
INDOOR LIGHTINGM
CEC-NRCC-.LT101,-E(Revised 08115) ..-. ._. _ _. ._.. -. CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTI-01-E:
Indoor Lighting (Page:1 of 6)
ProjeetName:. 'HAIDILAO' CUPERTIND -._ Date Prepared: 12/1812016..
A.General inforrimatiots,
Climate Zone: Conditioned Floor Area: 5,143
4 Unconditioned Floor Area: 0
Building Type: II Nonresidential 0 High-Rise Residential 0 Hotel/Motel
Q Schools fl Relocatable Public Schools Cr Conditioned Spaces 0 Unconditioned Spates
Phase of Construction: [ New Construction ti Addition ` 0 Alteration
Method of Compliance: 0 Complete Building CI Area Category Q Tailored
Project Address: 1904 STEVENS CREEK RD
D.Lighting Compliance Documents(select yes for each document included)
For detailed instructions on the use of this and all Energy Efficiency Standards compliance documents,refer ta the Nonresidential Manual published by the California Energy-Commission..
YES NO FORM TITLE
✓ NRCC-LTI-01-E Certificate of Compliance. All Pages required on plans for all submittals.
✓` NRCC-1T1-02-E Lighting Controls,Certificate of-Compliance,and PAF Calculation.All Pages required on plans for all submittals.
NRCC-LTI-03-E Indoor Lighting Power Allowance
✓ NRCC-LTI-04-E Tailored Method Worksheets
NRCC-LTI-05-E tine Voltage Track Lighting Worksheets
•
CA Building Energy Efficiency Standards-7013 Nopresidential Compliance August 2015
STATE OF CALIFORNIA
INDOOR LIGHTING
CEC-NRCC:-1-11-01 E(Revised 08/15)1. CALIFORNIA ENERGY COMMISSION -- I
CERTIFICATE OF CQMPLIANCE NRCC-L1-01-E
Indoor Lighting (Page 2 of 6)
Project Name', HAIDILAO CUPERTINO.. . . Date Prepared' 12/18/2016 --. -
C.Summary of Allowed Lighting Power
Conditioned and Unconditioned Space Lighting must not be combined for compliance
Indoor Lighting Power for Conditioned Spaces Indoor Lighting Power for Uncohditiorted Spaces
Watts Watts
Installed Lighting Installed Lighting
1. NRCC-LTI-01-E,page 4 + 5;094 NRCC-LTI-01-E,page 4 + ,0
PORTABLE ONLY FOR OFFICES
2.
NRCC-LTI-01-E,page R
3 Minus Lighting Control Credits _ Minus Lighting Control Credits Q.
NRCC-LTI-02-E,page 2 NRCC-LTI-02-E,page`2
Adjusted
!Installed Lighting PowerAdjusted Installed Lighting Power
__ _ 4
row plus row 2 minus row 3)
54 (row 1 minus row 3)"
5. Complies ONLY if installed a Allowed Complies ONLY if Installed 5 Allowed
6.
Allowed Lighting Power 5 308 Allowed Lighting Power
Conditioned NRCC-LTi-03-E,page 1 Unconditioned NRCC LTI03-E,page 1 0
D.Declaration of Required Installation Certificates.
Declare by selecting yes for all Installation Certificates that will be submitted.;(Retain copies and verify forms are completed and signed.)
YES NO Form/Title
NRCI-LTI-01-E-Must be submitted for all buildings 0 Field Inspector
NRCI-LTI-02-E-Must be submitted for a lighting control system,orfor an Energy Management Control System(EMCS),
to be recognized forcom'pliance Ll' eldinspector
NRCI-LTI-O3-E-Must be submitted for a line-voltage track lighting integral current limiter,or"for a supplementary
v Li Field Inspector
overcurrent protection panel used to energize only line-voltage track lighting,to be recognized forcornpliance.
NRCI-LTI-04-E Must be submitted fortwo interlocked systems serving an auditorium,a convention centera
0 Field Inspector
conference room,a.multipurpose room,or a theater to be recognized for compliance.
v NRCI-LTI.05-E-Must be submitted for a Power Adjustment Factor(PAF)to be recognized far compliance, 0 Field Inspector
NRCI-LTI-06-E-MUst be submitted for additional wattage installed in a video conferencing studio to be recognized for
✓'
El Field inspector
compliance.
•
CA Building Energy Efficiency Standards-20131onresidential Compliance August 2015
r
STATE OF CALIFORNIA
INDOOR LIGHTING.
CEC-NRCC-LTi-61-E(Revised 681`15); -- ___ ._. _._ _. .. __. ._ ..___.. _.._. .__._ _...._._ _ _._. _.__._._ CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC LTI-01-E
Indoor lLighting (Page 3 of 6)
Proiect Name: HAIDILAO CUPERTINS2 Date Prepared: 12/18/2016
E.Declaration of Required Certificates of Acceptance
Declare by checking all of the Certificates of Acceptance that will be submitted.(Retain copies and verify forms are completed and signed.)
YES NO Form/Title
NBCA-LTI-02 A-Must be submitted for occupancy sensors and automatic time switch Controls, Li Field Inspector
NRCA-LTI-03-A-Must be submitted for automatic daylight controls. It Field.Inspector
NR,CA-LTI-04 A-Must be submitted for de]nand responsive lighting controls. Li Field Inspector
Aseparpte Lighting Schedule Must Be Pilled Out for Conditioned.and Unconditioned Spaces. installed Lighting Power listed on this Lighting Schedule is only for:.
IJ CONDITIONED SPACE 0 UNCONDJTIONEDSPACE
F.Indoor Lighting Schedule and Field inspection Energy Checklist
o The actual indoor lighting power listed onthis page and on the next page includes all installed permanent and plapned portable lighting systems.
❑.When Complete Building Method is used for compliance list each different type of luminaire on separate lines.
El When Area Category Method or Tailored Method is used for compliance,list each different type of luminaire by each different function area on separate lines.
Q Also include track lighting in schedule,and submit the track lightingcompliance form(NRCC-LTI-05-E)whenline-voltage track lighting is installed.
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance August 2015,
STATE OF CALIFORNIA
INDOOR LIGHTING -
CEC-NRCC-LTi-01-E(Revised 08115) _.. ... -,.. _ ._ _.._... _ -... CALIFORNIA ENERGY COMMISSION '
CERTIFICATE OF COMPLIANCE NRCC-L11-01-t
Indoor Lighting (Page 4 of 6)
Project Name: HAIDILAO CUPERTINO pate Prepared: 12/18/2016
G.Installed Portable Luminaires in"Offic>es—Exception to Section 140.6(a)
0 This section shall be filled out ONLY for portable luminaires in offices(As defined in§100.1). All other planned portable luminaires shall be documented on next page of
this compliance form.
0 This section is used to determine if greater than 0.3 watts of portable lighting is planned for any office
Q Fill out a separate line for each different office.Small offices that are typical(having the same general and portable lighting)maybe grouped together.This allowance
shall not be traded between offices having different lighting systems.
Office Portable Lumigaire:Sctiedule Office installed Portable Luminaire Watts Per Square Foot Office Location Field Inspector
1 2 3 4 5 6. 7 $ 9 10
Installed, If F
portable Watts enter '
° v luminaire a per zero; Identify Office area in
s c,; watts in ;u square o65 x007 which these portable Pass Fail
Complete Luminaire Description z this office g. foot ifGOS> luminaires are installed,
N p
(Le.,LED,under cabinet,furniture mounted Watts per (G02x (604/ 0.3,
direct/indirect) Luminaire G03), 005) (G06-0.3)
El
❑ ❑
❑ ❑
0 ❑..
Enter slim total of all pages into I4RCC-LTI-
Total installed portable luminaire watts that are greater than 0.3 watts per square foot per office: 01-E;"Page 1;
CA Building Energy Efficiency Standards=2013 Nonresidential Compliance August 2015
i >
STATE OF CALIFORNIA
INDOOR LIGHTING
CEC NRCC-LTl-01-E(Revised 08/15) _ _.. . __._ . _ _..__ __.. . .CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC LTI-01-E
Indoor Lighting (Page 5 of 6)
ProiectName: _... HAIDILAD CUPER11N0 - _. . ; _Date Prepared: 12118/2016
A separate Lighting Schedule Must fie Filled Oct for Conditioned and Unconditioned Spaces. Installed,Lighting Power.listed on this.Lighting Schedule is only for;
La CONDITIONED SPACE 0 UNCONDITIONED SPACE
li.INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST
Luminaire Schedule installed Watts Location. Field Inspector
A
C D E F - - G H
How wattage was
determined
Y o
°,3- Complete Luminaire Description n a ¢
C E (Le,3 lamp fluorescent troffer, @ o m E E ; o - Primary Function area in Which
ur o
z '` F32T8,one dimmable electronic ballast); c ° z3 ".12 -T- these luminaires are installed Pass Fail
ARECESSED IOOWNLIGHT LED 10.5 ° g 14 147 - Dining
B GIANT INC 50.0 II g 3 150 Dining CJ C1
C,CE I PENDANT DOWNLIGHT LED 8.0 0 l 4 32 Kitchen,Food Preparation 0 L�
C.CE PENDANT DOWNL IGHT I FD 8.0 0 Q 18 144 Corridor/Restroom/Support ❑ 0
D LED UP IN GRADE 19,0 0 g 20 380 Dining. Q I
E. LEDUP IN GRADE 19.0 0 g 24 456 Dining 0 - 0
F RECESSED SPOKES 1 LED 5.0 Cl g 5 25 Dining 0 0
G _
RECESSED SPOKES 2 LED 5.0 U Q 4 20 Dining ❑. 0
H' LINEAR LED 4.51N/FT 4:5 n 44. -198 Dining 0 0
INSTALLED WATTS PAGE TOTAL: 552 Enter sum total of all pages into
NRCC-LTI D1-E;Page 2
•
•
CA Building Energy Efficiency Standards 2013 Nonresidential Compliance August2015
STATE OF CALIFORNIA
INDOOR LIGHTING
CEC-NRCC-LTI-01-E(Revised 08/15) CALIFORNIA ENERGY COMMISSION -
CERTIFICATE OF COMPLIANCE _ _ NRCC-LTI-01.-E
Indoor Lighting (Page 5 of 6)
Project Name: HAIDILAO CUPERTINO Date Prepared: 12/18/2016
A separate Lighting Schedule Must Be Filled gut for Conditioned and Unconditioned Spaces. Installed Lighting Power listed on this Lighting Schedule is qnlyfor:
CONDITIONED SPACE 0 UNCONDITIONED SPACE
If.INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST
Luminaire Schedule Installed Watts
Location Field InSpector
A
E G H
How wattage was
determined 2
Si IS
ws"
Complete Luminaire Description
ci .a
E E (Le,3 lamp fluorescent troffer, E u E Eis 5 Primary Furiction area In which
w
z F32T8,onedirnmable electronic ballast) 3 d ‘St z- 3 -12 these luminairesare installed Pass Pail
J PENDANT INC0 fp
50.0 25 1.250 Dining 0 0
K PFNEriANT(3)I Fr) 37_5 CI 22 825 Dining 0 0
L PENDANT DOWNLIGHT LED 8.0 El CI 3 24 Corridor/Restroom/Support °
L PENDANT DOWN)IGHT FD 8.0 El 131 1 8 Kitchen,Food Preparation El
L PENDANT DOWNLIGHT LED 8.0 La rP1 26 208 Dining
M.ME RECESSED 2X4 LED 39.0 E 11 18 702 Kitchen.Food'Preparation
N 4'STRIP LED 35.0 13 El 15 525 Commercial,Industrial Storage El
0 0 • 0 0
•
0 0 0 C7
INSTALLED WATTS PAGE TOTAL- 3 542 Enter sum total of all pages into
,
NRCC-LTP0l-E;Page 2
, •
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance August 2015
•
STATE OF CALIFORNIA
INDOOR LIGHTING
CEC-NRCC-LTI-01-E(Revised 46/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTI-01-E
Indoor Lighting (Page 6 of 6
Project Name: I-IAIDTLAO CUPERTINO -Date Prepared' 10/10/2016
•
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. I certify that this Certificate of Compliance documentation is accurate and complete..
oar-meat-410n Authar Name: JOSEPH NASR Documentation Author Signature:
CompanyJ,NASR ELECTRICAL ENGINEERS, INC. :pile 5 tu
re ate:
10/10/2016
Address: 1411 N. BATAVIA STREET, SUITE 220
CEA/HERS Certification Identification Of applicable):
City/State/Zip:
ORANGE, CA. 92867 Phone: (714) 289-2621
RESPONSIBLE PET1SON'S DECLARATION STATEMENT'
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance
(responsible designer),
3. The energy features and performance specifications,materials,components,and manufactured ctevices for the building design or system design identified on this Certificate of
Compliance conform to the requirements of Title 24,Part 1 and Part 6 ofthe California Code of Regulations.
4. The building design-features or system design features identified on this Certificate of Compliance are consistent with thejnformation pr ided on other applicable compliance
documents,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with this building applicatiOn,
5. I will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s)iss fof the building,and made available to the
enforcement agency for all applicable inspections.I understand that a completed signed copy of this Certificate of Compliance is qurifrd to be included with the documentation the
builder provides to the building owner at occupancy. _
Responsible Designer Name: JOSEPH NASR Responsible Designer 5.5nature.
rsinPanY' J.NASR ELECTRICAL ENGINEERS, INC. Date Signed: 10/10/2016
: _ .
1411 N. BATAVIA STREET, SUITE 220 LicenseE-14879
cityisteteizip: ORANGE, CA. 92867 Ph cc: • ' (714) 289-2621
June 2014
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance
STATE OF CALIFORNIA
INDOOR LIGHTING—LIGHTING CONTROLS
CEC-NRCO-LTI-02-E(Revised 05/15) . .
CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTI-02-E
Indoor Lighting-lighting Controls (Page 1 of 3)
Amidct Name.
HAIDILAO CUPERI1NO - DatePrepared'
12/18/2016
The NRCC-121-1-02-E shall be used to document all mandatory and prescriptive lighting controls that are applicable to the project.
Mandatory Lighting Control Declaration Statements (Indicate if the measure applies by checking yes or no below.)
YES NO Control Requirements
Lighting shall be controlled by self-contained lighting control devices which are certified to the Energy Commission according to the Title 20 Appliance
Efficiency Regulations in accordance with Section 110.9.
lighting shall be controlled by a lighting control a system or energy management control system in accordance with§110.9.An Installation Certificate
shall be submitted in accordance with Section 130.4(b).
One or more Track Lighting Integral Current Limiters shall be installed which have been certified to the Energy Commission in accordance with§110.9 and
§130.0.Additionally,an Installation Certificate shall be submitted in accordance with Section 130.4(b).
ATrack Lighting Supplementary Overcurrent Protection Panel shall be installed in accordance with Section 110.9 and Section 130.0.Additionally,an
" Installation Certificate shall be installed in accordance with Section 130.4(b).
All lighting-controls and equipment shall comply with the applicable requirements in§110.9 and shall be installed in accordance with the manufacturer's
instructions in accordance with Section 130.1.
All luminaires shall be functionally controlled with manually switched ON and OFF lighting controls in accordance with Section 130.1(a).
General fighting shall be separately controlled from all other lighting systems in an area. Floor and wall display,window display,case display,ornamental,
and special effects lighting shall each be separately controlled on circuits that are 20 amps or less.When track lighting is used,general,display,
ornamental,and special effects lighting shall each be separately controlled;in accordance with SectiOn 130.1(a)4.
The general lighting of any enclosed area 100 square feet or larger,with a connected lighting load that exceeds 03 watts per square foot shall meet the
multi-level lighting control requirements in accordance with Section 130.1(h).
All installed indoor lighting shall be equipped with controls that meet the applicable Shut-OFF control requirements iii Section 130.1(c):
‘er Lighting in all DaylitZones shall be controlled in accordance with the requirements in Section 130_1(d)and daylit zones are shown on the plans.
Lighting power in buildings largerthan 10,000 square feet shall be capable of being automatically reduced in response to a Demand Responsive Signal in
accordance with Section 130.1(e).
Before an occupancy permit is granted for a newly constructed building or area,or a new lighting system serving a building,area,or site is operated for
normal use,indoor lighting controls serving the building,area,or site shall be certified as meeting the Acceptance Requirements for Code Compliance in
accordance with Section 130.4.(a).The controls required to meet the Acceptance Requirements include automatic daylight controls,automatic shut-OFF
controls,and demand responsive controls.
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015
STATE OFCALIFORNIA.
INDOOR LIGHTING—LIGHTING CONTROLS
CEG-NRCC-LT1-02-E(Revised OS/ISS T CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-L11-02-E;
Indoor Lighting-Lighting Controls
f: (Page Zof3)
PuilecLNafine:
HAIDILAO CUPER11NO oa,ePre�t d:12/18/2016
A separate document must be filled out for Conditioned and Unconditioned Spaces,This page is used only for the following:
El CONDITIONED SPACES ID UNCONDITIONED SPACES
!MANDATORY AND PRESCRIPTIVE INDOOR LIGHTING CONTROLSCHEDULE,PAF CALCULATION,and FIELD INSPECTION CHECKLIST
PAF Credit Calculation
=n73. 2_.
N 3
O 2
17 43
Standards Complying With' o G. iu
Lighting Control Schedule (✓ell that apply,or enter-'E'if Exempted) as a ° >, = °
A B C DEF 6 H I J K L M N O
Type/Description of Lighting
Control(Le.:occupancy sensor, # ;°; 'A F; N
Location in Building automatic time switch, of N
o
,fl 0 0- q o � o
co r� s-' i-+ m
dimmer,automatic daylight, Units v
etc...)
DINING AREA DIMMER,ATS.DAYLIGHT J V V Q Lt,
KITCHEN AREA. DIMMER.ATS V. a ./ 0 0
CORR/RESTROOM/SUPPORT DIMMER,ATS V 0 ❑
Q ❑
7 ❑ '
CI
Control Credit PAGE TOTAL(Sum of Column M): p
IF MULTIPLE PAGES ARE USED,ENTER SUM TOTAL OF Control Credit for all pages FIERE(Sum of all Column M): 0
Enter Control Credit total
into NRCC-LTI-01-E Page
I
1.,§130.1(0)=Manual area controls;5130.0(b):=Multi Level;5130.1(c)=Auto Shut-Off. §130.1(d)=Mandatory Daylight;5130.1(e).,-,-Demand Responsive;§140.ffd)
Additional lighting coritrol installed to earn a PAF;§140.6(d)=Prescriptive Secondary Sidelit Daylight Controls.
2.Check Table 140.6-A for correct Factor.PAFs shall not be traded between conditioned and unconditioned spaces.As a condition to earn a PAF,an Installation Certificate is
also required to be filled out signed,and submitted..
SCA Building Energy Efficiency Standards-2013 Nonresidential Compliance _ May 2015
'STATE OF CALIFORNIA
INDOOR LIGHTING-LIGHTING CONTROLS
CEC-NRCC-LTi-02-E(Revised 06114) —CALFORNIA ENERGY COMMISSION M
CERTIFICAT€OF COMPLIANCE IRCC-LTI-02-E
Indoor Lighting-Lighting Controls
(Page:3 of 3)
ProeRNape 'HAIDILAO CUPERTINO Date Prepared
10/10/2016
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. I certify that this Certificate of Compliance documentation is accurate and complete;
Documentation Author Naive: -
JOSEPH NASR Dacrirnentation:AuthorSignatorec
company.J.NASR ELECTRICAL ENGINEERS, INC.. Signature.Date
10/10/2018
Address' - -_ - CEA/HERS Certification Identification(if applicable)...-.-- - -- - -- -
1411 N. BATAVIA STREET SUITE 220
City/State/Zip: Rhos€s _ - - __.
ORANGE, CA. 92867 (714) 289-2621
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury,-under the laws ofthe State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. I am eligible under Division 3 of the Business and Professions Codeto accept responsibility for the building design orsystem design identified on this Certificate of Compliance
(responsible designer).
3. The energy features and performance specifications,materials,components,and manufactured devices for theibuilding design or system design identified on this Certificate of
Compliance conform to the requirements of Title 24,Part and Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information rovided on other applicable compliance
documents,worksheets calculations,plans and specifications submitted to the enforcement agency for approval with this buildi Grp mit application.
5, I will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s)i .e for the building,and made available to the
enforcementagency for Al applicable inspections.I understand that a completed signed copy'of this Certificate of Complianc:/ re aired to be included with the documentation the
builder provides to the building owner at occupancy.
Responsible:DesignerName: - Responsible Designer Signature:
JOSEPH NASR ILtiL
company'J.NASR ELECTRICAL ENGINEERS, INC. Date Signed:
10/10/2016
Address:, ;License: ,.
1411 N. BATAVIASTREET SUITE 220: E-14879
city/state/2iP: Phone,
ORANGE, CA. 92887 (714) 289-2621
CA Building Energy Efficiency Standards 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA a'`
INDOOR LIGHTING POWER ALLOWANCE
CEC-NRCC-Ln-03-E(Revised 05/15) _ _.. CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC--LTi-03-E
Certificate of Compliance-Indoor Lighting Power Allowance (Page 1 of 4)
ProlectNamel HAIDILAO CUPERTINO oatePceaared: 12/18/2016
A separate page most be filled outfox Conditioned and Unconditioned Spaces.This page is only for-
53 CONDITIONED spaces 0 UNCONDITIONED spaces
IA.SUMMARY TOTALS OF LIGHTING POWER ALLOWANCES
❑ if using Complete Building Method for compliance,use only the total in column(a)as total allowed building watts.
❑ If using Area Category Method,Tailored Method,or a combination of Area Category andTailoredMethod for compliance,use only the total in column(b)as the total
allowed building watts
(a) (b)
1. Complete Building Method Allowed Watts.Documented in section B of NRCC LTI 03-E(below on this page)
2. Area Category Method Allowed Watts.Documented in section C-1 of NRCC-LTI-03-E(below on this page) 5,308
3. Tailored Method Allowed Watts.Documented in section A of NRCC-LTI-04-E 8
TOTAL ALLOWED BUILDING WATTS.Enter number into correct cell on NRCC-LTI-01,Page 2,Row 1 .5,308
�❑ Check here if building contains both conditioned and unconditioned areas_
B.COMPLETE BUILDING METHOD LIGHTING POWER ALLOWANCE
1
2 3 4
WATTS X COMPLETE _ ALLOWED
TYPE OF BUILDING(From§140.6 Table 140.6-B) PER(ftl BLDG.AREA WATTS
Total Area
Total Watts.Enter Total Watts into section A,row I(Above on this page)1
CAL AREA CATEGORY METHOD TOTAL LIGHTING POWER ALLOWANCES(R plus E) Watts
Total front section C-2 . 5,303
• Total from section C-3 0
Total Watts-Enter Total Watts into section A,TOW 2(Above on this page) 55,303
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015
4
STATE OF CALIFORNIA
INDOOR LIGHTING POWER ALLOWANCE .0-
CEC-NRCC-LTI-03-E(Revised 05115) CALIFORNIA ENnGY COMMISSION - -
CERTIFICATE OF COIV1PLIANCE NRCC-LTI-03-E
Certificate of Compliance-Indoor Lighting Power Allowance _ _ _ (Page 2 of 4)
Pmjea N.,n% HAIDILAO CUPERTI110 Date PrePered` 12/18/2016
A separate page must be filled out for Conditioned arid Unconditioned Spaces,This page is only for_
E3 CONDITIONED spaces 0 UNCONDITIONED spaces
C-2 AREA CATEGORY METHOD GENERAL LIGHTING POWER ALLOWANCE
0 Do not include portable lighting for offices.Portable lighting for offices shall be documented only in section B of NRCC-LTI-D1=5.
El Separatelylist lighting for each primary function area as defined in§100.1 of the Standards. _
A B C 13
AREA CATEGORY(From§140.6 Table 140.6-C) WATTS ALLOWED
•
Location in Building Primary Function Area per Table 140.6-C PER(ft} - X AREA(ft) ' WATTS
DINING AREA Dining 1.10 1,903 2,093
, KITCHEN AREA Kitchen,Food Preparation 1.60 1,271 2,034
C0i:R/RESTRC)0M/SLIPPC)RT Corridor/Restroom/Support 0.60 609 365
_
INDUSTRIAL STORAGE Commercial,Industrial Storage 0.60 1,360 816
TOTALS 5,143
Enter sum total Area Category allowed watts into section C-I of NRCC-LT1-03-E(this compliance form) : 5,308
WATTS
CA_Building Energy Efficiency standards-2013 Nonresidential Compliance May 2015
'
i
,.
•
STATE OF CALIFORNIA
INDOOR LIGHTING POWER ALLOWANCE
CEC-NRCC-LTI-03-E(Revised 05/15) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTI-03-g
_ .
Certificate of Compliance Indoor Lighting Power Allowance
(Page 3 of 4)
PrOjdtt Nant.
HAIDILAO CUPERTINO EP,epard 12118/2016
A separate page Must be filled out for Conditioned-and Unconditioned Spaces This page is only for
T3 CON CfrTIONED spaces la UNCONDITIONED sPaCeS
C-3 AREA CATEGORY METHOD ADDITIONAL LIGHTING WATTAGE ALLOWANCE(from Table 140.6-C Footnotes) _
A R C
ALLOWED
Additional Wattage WAi I
Primary Sq Ft or Watts Allowance Description(s)and Quantity of special Total Design Smaller of
Function linear ftl Allowed (B XC) LurninaireTypes in each Primary Function Area Watts _ D or F
_ —
TOTALS—Enter into TOTAL AREA CATEGORY METHOD ADDITIONAL ALLOWANCES—Section C-1 0
1.Use linear feet onlyfor additional allowance for white D,Oard or chalk board. All other additional Area Category allowances shall use watts persquare foot-.
2.Additional watts are available only when allowed according to the footnotes oh bottom of Table 14R-C,which include: Specialized task work;Ornamental lighting;
Precision Commercial and industrial work;per linear foot of white board or chalk board;Accent,display and feature lighting;and Videoconferencing Studio lighting..
3.Luminaire classification and wattage shall be determined in accordance with§130.0(c)of the Standards. -
_
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015
In; TESTING ENGINEERS, INC. '
2811 Teagarden St. 510-835- 142 0-834-3777 fax
San Leandro,CA 94577 800-660- 42 IP /10
San Leandro • San Jo • M. re
INSPECTION\WORT Week Ending: 6/30/17
PROJECT#65454 TYP OF INSPECTION:
Visual Welding
PROJECT: PLACE OF INSPECTION:
19409 Stevens Creek Blvd. Fine Steel Products(shop)
HaiDiLao Cupertino Blvd.Suite-
Cupertino CA
uite-CupertinoCA
Permit#B2016-2999
DATE 6/29/17
HOURS 4
INSPECTOR B.Muzika
Reported to Javier Alcaraz of Fine Steel Products at the shop as requested.
Checked welder qualification papers(Antonio Lopez,ID#9642,Francisco Hernandez,ID#3657,Mario Esparza,ID#9942).
Checked WPSs and verified welding parameters. Verified proper electrode storage. Verified proper preheat. Visually
inspected joint preparation and fit-up. Performed continuous visual inspection of the in-progress welding performed by
three qualified welders using the FCAW process with E71T-8 wire electrode.
Weldments consist of single pass fillet welds joining 5/8"base plates(10)to 4"x 4"x 1/4"HSS column shop marked Al;1/2"
Allthread studs to 10"x 4"x3/8"HSS beam shop marked Bl,10"x 4"x 1/4"HSS beam shop marked Cl,10"x 4"x 5/8"HSS
beam-shop-marked D1;10"x 4-"-x 5/r6 HSS beams shop marked Fl and-6-1--and-10"--x-4"-x-3/f6"-HSS beamsshop i arkedHT
and J1;square butt groove welds joining 1/4"plate end caps to seven(7)HSS 10"x 4"beams shop marked B1,Cl,D1,Fl,G1,
H1 and J1 for wall thicknesses 3/16",1/4",5/16",3/8"and 5/8" (complete).
The preceding work was,to the best of my knowledge,in compliance with engineer approved plans and specifications,
including revisions by engineer and shop drawings El and Dl.
Reviewed by: = :
•avid Chippero
Special Inspection Division Manager
1cc: Mavin Builders,Inc./J.Tran
A&G Structural Engineers,Inc./ A.Pirbadian
City of Cupertino/Bldg.Inspection Dept.
The results presented in this report relate only to the item(s)tested/inspected and
can be reproduced only in its entirety unless written permission from 1E1 is obtained.
Page 1 of 1
le; TESTING ENGINEERS, INC. 17/ fiy
2811 Teagarden St. 510-835- 142 �- J 0-834-3777 fax
San Leandro,CA 94577 800-660- 42 / I,
San Leandro • San Jo•e • M. . e
INSPECTIOIV4 ORT / Week Ending: 6/30/17
PROJECT#65454 TYP OF INSPECTION.
Visual Welding
PROJECT PLACE OF INSPECTION
19409 Stevens Creek Blvd. 4,2 Fine Steel Products(shop)
HaiDiLao Cupertino Blvd.Suite
_ CupertinoLCA
Permit#B2016-2999
DA 1'ti 6/29/17
HOURS 4
INSPECTOR B.Muzika
Reported to Javier Alcaraz of Fine Steel Products at the shop as requested.
Checked welder qualification papers(Antonio Lopez,ID#9642,Francisco Hernandez,ID#3657,Mario Esparza,ID#9942).
Checked WPSs and verified welding parameters. Verified proper electrode storage. Verified proper preheat. Visually
inspected joint preparation and fit-up Performed continuous visual inspection of the in-progress welding performed by
three qualified welders using the FCAW process with E71T-8 wire electrode.
Weldments consist of single pass fillet welds joining 5/s"base plates(10)to 4"x 4"x 1/4'HSS column shop marked Al,1/2"
Allthread studs to 10"x 4"x 3/4"HSS beam shop marked Bl,10"x 4"x 1/4'HSS beam shop marked Cl,10"x 4"x 5/s"HSS
beam shop mark-ed D1;10"x 44x 5---r6--HSS beans-shop-marked F1 and G1 and 10"x-4"x3/16'HSS-beams-shop marked Fit-
and J1,square butt groove welds joining 1/4"plate end caps to seven(7)HSS 10"x 4"beams shop marked Bl,Cl,D1,Fl,Gl,
H1 and J1 for wall thicknesses 3/16",1/4',5/16',3/R"and 5/8" (complete).
The preceding work was,to the best of my knowledge,in compliance with engineer approved plans and specifications,
including revisions by engineer and shop drawings El and Dl.
Reviewed by
f avid Chippero
Special Inspection Division Manager
1cc: Mavin Builders,Inc./J Tran
A&G Structural Engineers,Inc./A.Pirbadian
City of Cupertino/Bldg.Inspection Dept.
The results presented in this report relate only to the item(s)tested/inspected and
can be reproduced only in its entirety unless written permission from TEI is obtained.
Page 1 of 1
TESTING ENGINEERS, INC.
2811 Teagarden St. 510-835-3142 510-834-3777 fax
San Leandro,CA 94577 800-660-3142
San Leandro • San Jose • Martinez
INSPECTION REPORT Week Ending: 6/23/17
PROJECT#65454 TYPE OF INSPECTION:
Concrete Placement/Epoxied Anchors
PROJECT: PLACE OF INSPECTION::
19409 Stevens Creek Blvd. Jobsite
HaiDiLao Cupertino Blvd.Suite 100
Permit#B2016-2999
DALE 6/20/17
HOURS 4
INSPECTOR F.Quintana
Reported to Train at the jobsite as requested.
Monitored loads arriving at the jobsite for correct mix and proper slump. Inspected placement operations. Performed 1 slump
test(4")and cast 1 set of compression test specimens(5 each),Sample#260247,for Concrete Mix#6.5 Sk from Concrete Ready
Mix,(specified strength 3000 psi,slump 4"maximum)for concrete placed at pad footings. Total cubic yards placed: 16.
NO1'h: No vibrator used,manually consolidated.
The preceding work,as noted,was to the best of my knowledge,in compliance with approved plans and specifications,
including revisions by engineer and Drawings S-1 and S-2,dated 6/5/17.
Inspected predrilledholesfor proper diameter and depth. Observed the cleaning of holes and the injection of Simpson Set
XP epoxy(exp.2/19). Witnessed the proper insertion of twelve(12)5/s" diameter Allthread anchors,14"in length,
embedded 12" at wall columns/stud metal;and four(4)11/s" diameter Allthread anchors,16"in length,embedded 12"
at Hardy frame.
The preceding work was,to the best of my knowledge,in compliance with approved plans and specifications,including
revisions by engineer and Drawings S-5,Detail 3 and 14FX1S,Detail 1,dated 6/5/17.
Reviewed by: .D. •`el 'ppero
Special Inspection Division Manager
1cc: Mavin Builders,Inc.:/J.Tran
A&G Structural Engineers,Inc./A.Pirbadian
City of Cupertino/Bldg.Inspection Dept.
The results presented in this report relate only to the item(s)tested/inspected and
can be reproduced only in its entirety unless written permission from TEI is obtained.
Page 1 of 1
Testing Engineers, Inc. Quality Assurance Services
n\ Materials Consulting
Since 1954
Regular Concrete Compression Test Report
- I
Project No. : 65454 Client : MAV003 Sample No. : 260247/Page 1 of 1
Project Name: Report Date : 07/18/17
19409 Stevens Creek Blvd. Sample Date : 06/20/17 `
HaiDiLao"Cu ertino Blvd.Suite
p 100 Time Sampled :0745AM
Cupertino,CA Date Received :06/21/17
Permit#B2016-2999 . Inspector : F. Quintana, TEI
Supplier: Concrete Ready Mix Specimens Cast(ASTM C-31) : 5
Mix : 5-6.5 SK Air Temperature (ASTM C-1064) : 76 deg F
Ticket No. : 226918 Mixture Temperature (ASTM C-1064) : 78 deg F
Slump (ASTM C-143) : 4 inches
Location:
-P � _
ad�#eoti ngs �
(sampled at east most of building) Capping Specimens_ASTM C-617 . ASTM C-1231
Date Tested 06/27/17 07/18/17 07/18/17 07/18/17 HOLD
ID Number 1A 1B 1C 1D 1E
Mark Sample
Dimension,Inches
Diameter 4 4 4 4
Length 8 8 8 8
Area, sq.inches 12.57 12.57 12.57 12.57
Ultimate Load,lbs 39000 63000 69000 64000
Ultimate Str., psi 3100 5010 5490 5090
Average, Str., psi 5200
Age Tested, Days 7 28 28 28 HOLD
Fracture Type 1 1 1 1
D Unit_Weight, pcf - - —— _ _�_ __,____2„, __
Specified Strength;psi 3000 3000 3000
SPECIMENS NOT SCHEDULED FOR TESTING WILL BE DISCARDED AFTER 28 DAYS OLD A
The Material / WAS WAS NOT The Material Tested 7! MET DID NOT MEET THE
SAMPLED AND TESTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE BLDG.DEPT.OR DSA APPROVED DOCUMENTS.
REQUIREMENTS OF THE BLDG.DEPT.OR DSA APPROVED DOCUMENTS.
Remarks: Samples Tested in General Conformance with ASTM C-39
1 cc. City of Cupertino
1 cc. A&G Structural Engineers, Inc. Reviewed By:
1 cc. Mavin Builders, Inc.
--- --__,-
,,, Is- reen
Concrete Lab Supervisor
The results presented in_this report relate only to the item(s)tested.
This report can be reproduced only in its entirety unless written permission from TEI is obtained.
Corporate Office-2811 Teagarden Street, San Leandro, California 94577- (510)835-3142 - Fax(510)834-3777