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13110100 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10123 N WOLFE RD 2013 CONTRACTOR?-- P6 E PERMIT NO:13110100 OWNER'S NAME: VALLCO SHOPPING MALL LLC Aha-hand DATE ISSUED: 11/14/2013 OWNER'S PHONE: 4087773081 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALLJ License Class Ca o Lic.# f,?,9 3 a FAMOUS FOOTWEAR-REPLACE 2 HEAT PUMPS Contractor/Uf�-FmiVf)'L CCUAITS Date f I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$38450 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31620107.2013 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN AV DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. itionally a applicant understands and will comply Issued by: Date: with all n -point er he Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature kq�r Date 4/' /✓ All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from'the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cu r' o Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S fti ns 2 nd cf Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: i Date: / permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will.comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date GENERAL.PERMIT APPLICATION CP MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION r,` 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 `\! (408)777-3228.•FAX(408)777-3333•building(a�cugertino.org \ MIS CUPERTINO \� ❑PLUMBING MECHANICAL �" ❑ELECTRICAL [:]MISCELLANEOUS [� PROJECT ADDRESS O ,_/�l�� /�12 APN# �f Lp !�f Q 1/C �J. /f/L/ 3 OWNER NAME ,^` r li0 n,/�I/„{`l7 �/ /�) P—O*4(� -7 3E� E-MAIL STREET ADDRESS 1,91;23 /�/, t of Vf'6 - V CTTY, ATF„Za� )ry© n Ai O/ CONTACT NAM I'l/TJ V V 1 PHONE// f / /� MAIL S �►`"S�VG`'��� Uv1� lljtE STREET ADDRESS / e `� gy STATE,ZIP 2 _ n„.—'! FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT I CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT �❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME a-d ` Q,��0�A/m I A/C LICENSE V 3 LICEN E TYP��E BUS.LIC# //"/�-,.r E-MAIL �f FAX COMPANYMa a (, I N(r vV STREET D �3 G6 � C STATE,ZIP r c:F c sfl 2 �s a y` P ° � 0�2 1 q39 6 ARCHITECT/ENGINEER NAME - LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS - CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY _ PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YESFEICHLER THE BLDG AN ❑YES BUILDING. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO HOME? ❑NO DESCRIPTION OF WORK / PS ` ZI TOTAL VALUATION: Ad By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on operty owner's behalf I have read this application and the information I have rovide rrect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to 1 g ctio I authorize representatives of Cupertino to enter the abo a-iden fled property for inspection purposes. Signature of Applicant/Agent: Date: 1 7 13 EMENTAL INFORMATION REQUIRED 41 oycEusO `;_ . .� 11"1110 - MEPMiscApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10123 n Wolfe rd#2013 DATE: 11/14/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$38,450 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial BuildingPENTAMATION FURN/AC USE: PERMIT TYPE: WORK famous footwear replace 2 heat pumps SCOPE IS E N� a 1 M -•va Mech.Plan Check 0.0 hr71AWPERMT Phunb. Plan C'hesk Elec.Plan{,heck Mech.Permit FePlumb.Permit Fee: llec•. Permit Fee: Other Mech.Insp. 0.0 hrOther Plumb Insp. Other Elec.Insp. Lj�1lech-Insp.1�ee: Plumb. hul).Tee: Elec.Insp.Fee: NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc . Theseees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS(Fee Resolution 11-053 E : 7f 11113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.002I # Mechanical Suppl. PC Fee: (E) Reg. 0 OT FO.0 ht's $0.00 $278.00 IBCAIRHA Heat Pump(<=10K cfin) PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Feer Reg. Q OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Conso-fiction T ax. Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes (E) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure i Strong Motion.Fee: IBSEISMICO $8.07 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 - $148.071 $278.00 T�OTAT.F ) 6 $426.07 Revised: 10/01/2013 CERTIFICATE OF COMPLIANCE MECH-IC-ALT-HVAC Prescriptive HVAC Alterations (Page 2 of 2) Project Name/Address: Date: is Aaro / d 1,2 3 411,14�6_ ,� f Y !3 Installation Certificate requirement: Ae installing contractor shall complete and sign an Installation Certificate(MECH-INSI) to certify that the installed HVAC features,materials, components, or manufactured devices(the installation)conforms to all applicable codes and regulations,and the installation is consistent with any required plans and specifications approved by the enforcement agency Certificate of Acceptance requirement:After completing the installation, all required acceptance testing shall be completed, and all applicable Certificate of Acceptance forms are required to be filled out completely,signed,and made available to the enforcement agency at final inspection. Copies of the completed,signed Certificate of Acceptance forms shall also be made available to the building owner. ❑ Step 3-MECH-2A-Outdoor Air Acceptance—This testis required for newly installed or replacement HVAC Systems(HVAC equipment and ducts)to verify minimum outside air is provided in accordance with Section 125 of the Energy Standards. AStep 4—MECH-3A- Constant Volume,Single Zone Unitary A/C and HP Controls Acceptance—This test is required for new or replaced constant volume,single-zone unitary air conditioners and heat pumps to verb controls function, including:thermostat installation and ro rammin ,supplyfan,heating,cooling,and damper operation in accordance with Section 125 of the Energy Standards. O Step 5—MECH-4A-Air Distribution Systems Acceptance—This test is required when the new or altered system is a sinvle zone,constant volume system serving 5,000f?or less,and 25%or more of the duct rfgce area is located in the outdoors,unconditioned space, or a ventilated attic in accordance with Section 125 of the Energy Standards. ❑ Step 6-MECH-4-HERS-Air Distribution System Leakage Di gnostic—This test is required to be completed by a HERS Rater when the new or altered system meets the criteria in Step 5 to verify duct leakage in actor c�with Section 125 of the Energy Standards. The HERS Rater shall register the MECH-4-HERSForm with an ap roved HERSProvider. ff ❑ Step 7-MECH-5A Economizer Testing Acceptance-This test is required f r newly installed or replacement HVAC equipment when an economizer is installed in accordance with Section 125 of the Energy Standards. .❑ Step 8-MECH-6A-Demand Control Ventilation Systems(DCV)Acceptance-This test is required for newly installed DCV systems or replacement of HVAC equipment with the following characteristics to verify controls and sensors function in accordance with 125 of the Energy Standards. : A. They have an air economizer;and B. They serve a space with a design occupant density,or a maximum occupant load factor for egress purposes greater than or equal to 25 people per 1000 ftp(40 square foot per person);and C. They are either: i.Single zone systems with any controls;or ii.Multiple zone systems with Direct Digital Controls(DDC to the zone level. Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accura a and gqmplete. Namg:��E S3�� /A t Z-TF/ Company: �v C , �Date: 1�03 Address:: Appli able �✓?3.3 /v' gc_G s PA-L-,157 b. CEPE# City/State/Zip Pho e: C-15ZK. f? 73 Principal Mechanical Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the mechanical design. • This Certificate of Compliance identifies the mechanical features and performance specifications required for compliance with Title 24,Parts 1 and 6 of the California Code of Regulations. • The design features represented on this Certificate of Compliance are consistent with the information provided to document this design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with this building permit application. Name: Signature: Company Name: Date: Address: License# City/State/Zip: Phone: 2008 Nonresidential Compliance Form July 2010 CERTIFICATE OF COMPLIANCE MECH-IC-ALT-HVAC Prescriptive HVAC Alterations (Pae 1 of 2) Project Name/Address: Date: ops �oia3 rnJ �9• � r Enforcement Agency: Permit Number: Climate Zone NOTE:This form may be used only for single zone constant volume systems. This form shall not be used for newly constructed buildings,additions, or VA multi-zone systems. Select one"Existing Building Project Type"and complete the corresponding steps listed in the"Complete Steps"column below. Note:After installation of HVAC units and/or ducts, the Installation and the applicable Acceptance Forms are required to be submitted or veri tcation by thefield inspector and a copy shall be made available to building owner. Existing Building Project Type select one): Complete Steps: A New or Replacement HVAC unit 1,4,5 and 6(If criteria is met), 7(When economizer is installed) ❑ New or Replacement ducts 1,4,5 and 6(If criteria is met) ❑ New Space Conditioning System(HVAC and ducts) 1,2,3,4, 5 and 6(If criteria is met), 7(When economizer is installed),8(DCP) lk Ste 1—Ducts and HVAC E ui ment Equipment Type,Efficiency Floor Area Distribution Type Duct Insulation Thermostat Configuration and Capacityl Served' and Lo tion3 R-Value4 Types (Central,Split,Package) 1.Indicate Equipment Type;Air Handler,Condenser,Heat Pump,Evap.Cooling,Boiler,Electric Resistance,etc.&HVAC Capacity;or Ducts (new or replaced). 2.If the Floor Area Served(per duct system)exceeds 5,000 square feet,skip Steps 5 and 6. 3.Indicate Type and Location(Ducts on roof,ducts in conditioned space,ducts in attic,etc.) 4.Newly installed or replaced duct insulation:R-8 in unconditioned space or in buried concrete slab;R-4.2 in indirectly conditioned space;and R-0 for conditioned space. 5.Existing non-setback thermostats shall be replaced with setback thermostats for all altered units,and all newly installed space conditioning systems requiring a thermostat shall be equipped with a setback thermostat. Setback thermostats shall meet the requirements of Section 112(c). ❑ Step 2—Mechanical Ventilation Calculations Both options(Area and Occupancy Basis)shall be completed to determine the minimum mechanical ventilation rates and Column I must be the greater of either Column E or H. - AREA BASIS OCCUPANCY BASIS A B C D E F G H I Zone/ Type of Use Condition CFM Min Num of CFM Min Design Vent.CFM System Area(ft) Per ft' CFM2 People2 per CFM' Larger of C x D Person F x G E or H A D 15 35;. 15 15 AREA BASIS 1. Minimum ventilation rate(CFM/ft2)for the Type of Use in the Table below. 2. The conditioned floor area of the space multiplied by the applicable minimum ventilation rate from Table 4-1 CFM/fr Column below. For additional ventilation rates,see Table 4-3 and use the values listed in the Required Ventilation Column in the Nonresidential Compliance Manual. This provides dilution for the building-borne contaminants like off-gassing of paints and carpets. OCCUPANCY BASIS 2.For spaces with fixed seating such as a theater or auditorium,the expected number of occupants is the number of fixed seats. 3.The expected number of occupants or people multiplied by 15 cfin per person. Type of Use a ;. . CFM per'ftZ Type of Use CFM per ft' Auto repair workshops 1.50 High-rise residential Ventilation Rates Specified by the CBC Barber shops 0.40 Hotel guest rooms less than 500 ft) 30 cfm/guest room Bars,cocktail lounges,and 0.20 Hotel guest rooms(500 ft'or greater) 0.15 casinos Beauty shops 0.40 Retail stores 0.20 Coin-operated dry cleaning 0.30 All Others 0.15 Commercial dry cleaning 0.45 1.For additional ventilation rates,see Table 4-3 in the Nonresidential Compliance Manual 2008 Nonresidential Compliance Form July 2010