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12110089CITY OF BUILDING ADDRESS: 19379 STEVENS CREEK BLVD OWNER'S NAME: MAIN STREET CUPERTINO AGGREGA' OWNER'S PHONE: 6509650700 ❑ LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. # TINO BUILDING PERMIT Contractor Date_ I hereby affirm that I am licensed and , 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 eerformance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provid d for by tSection 3700 of the Labor Code, for the performance of the work for v hich this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above inforr iation is correct. I agree to comply with all city and county ordinances and stat laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequen a of the granting of this permit. Additionally, the applicant understands and w ll comply with all non -point source regulations per the Cupertino Municipal Co e, Section 9.18. Signatu - Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License aw for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale ( ec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed ontractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is ssued, I shall not employ any person in any manner so as to become subject to the orker's Compensation laws of California. If, after making this certificate of xemption, I become subject to the Worker's Compensation provisions of the Lab r Code, I must forthwith comply with such provisions or this permit shall be deeme revoked. CONTRACTOR: SOUTH BAY PERMIT NO: 12110089 CONSTRUCTION, INC 1711 DELL AVE DATE ISSUED: 07/21/2014 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 APPLICANT CERTIFICATION I certify that I have read this application and state that the above info ation 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) a ree to save indemnify and keep harmless the City of Cupertino against liabilitie , judgments, costs, and expenses which may accrue against said City in conseque ce of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date. JOB DESCRIPTION: RESIDENTIAL n COMMERCIAL E] MAIN STREET- SHOP #4- CONSTRUCTION OF A NEW ONE STORY RETAIL BUILDING SHELL 12,846 SQ FT Sq. Ft Floor Area: I Valuation: $1223695 APN Number: 31620109.19379 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 0 DAYS OF PERMIT ISSUANCE OR 180 DA F M LAST CALLED INSPE Issued by: Date: l RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized age Dater CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 19379 STEVENS CREEK BLVD I CONSTRUCTION, SOUTH BAY I PERMIT NO: 12110089 I OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR ( 1711 DELL AVE I DATE ISSUED: 07/21/2014 1 OWN ,R'S PHONE: 6509650700 I CAMPBELL, CA 95008 I PHONE NO: (408)379-5500 I License Class' , 1 Lic. #/_ _� d� IP TV Contractor e)/1. 7'F1A \/ 6"t—Date C? /Z:� I hereby affirm that I am licensed Imiler the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Prot Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two de l' i. I have hod will maintain a certificate of consent to self -insure for Wor er': Compensation, as provided for by Section 3700 of the Labor Code, fo the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by '—Section 3700 of the Labor Code, for the performance of the work for Which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of, granting of thi etmit. Additionally, the plicant understands and will comply�l all non -p t o ce r ons a the ertino Municipal C de, Se tion 9.1�. Signature Jv'l Date ( v ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License La for one of the following two reasons: t. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or oftered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed i construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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, fo the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provid d for by Section 3700 of the Labor Code, for the performance of the work for hich this permit is issued. 3. I certify that in the performance of the work for which this permit is is ued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state lass relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ MAIN STREET- SHOP #4- CONSTRUCTION OF A NEW ONE STORY RETAIL BUILDING SHELL 12,846 SQ FT REV # 1 - ADD ROOF WALK PADS TO PLANS (RFI 504)- ISSUED 9-25-15 Sq. Ft Floor Area: ' I Valuation: $1223695 APN Number: 31620109.19379 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS RMIT ISSUANCE OR 180 DA37.SYROM­iCALLED INSPECTION. Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Hea th &Safe de ecti s 25505, 25533, and 2 534. / O ei a ge ; � I Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildincl(o)cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Tl © REVISION /DEFERRED ORIGINAL PERMIT # 12110089 PROJECTADDRESS Shops 4 19379 Stevens Creek Blvd APN# I 14 7-6 ( O� 3� (( OWNERNAME Main Street Cupertino Aggregator LLC PHONE (650)344-1500 7 E-MAIL STREETADDRESS 2882 Sand Hill Rd, Suite 241 CITY, STATE, ZIP Menlo Park, CA 94025 FAX CONTACT NAME Paul Hansen PHONEE-MAIL (408)442-2121 STREETADDRESS 2882 Sand Hill Rd, Suite 241 CITY,STATE, ZIP Menlo Park, CA 94025 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT M CON CTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME Mark Avila CENSENUMBER B336974 LICENSETYPE BUS.LIC# 5655 COMPANY NAME South Bay Construction E-MAIL mavila@sbci.com FAX (408)379-3256 STREETADDRESS 1711 Dell avenue CITY, STATE, ZIP Campbell, CA 95008 PHONE (408)379-5500 ARCHITECT/ENGrNEERNAME Kell Rodrigues, FAIR LICENSENUMBER C12, 818 BUS. LIC# COMPANY NAMEKenneth Rodrigues & Partners, INCE-MAIL kenr@krparchitects.com FAX (650)960-0707 STREET ADDRESS 445 N Whisman Rd Suite 200 CITY, STATE, ZIP Mountain View, CA 94043 PHONE (650) 965-0700 DESCRIPTION OF WORK 1.) Add walking pads to roof -mounted equipment, Sheet A4.5 -- RFI #504. EXISTING USE PROPOSED USE CONSTR.TYP #STO RIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NT AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH # DWELLING UNITS: IS A SECOND UNrr []YES BEING ADDED? ❑NO SECOND STORY ❑ YES ADDITIO ? []NO PRE-APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE B DG AN [3 YES EICHLER HOME? [3 NO IV AL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorize agent to act on the erty o s behalf. I have read this application and the information I hav provided is c ect. I have read the Description of Work and verify it is a rate. ee to comply with all applicable local ordinances and state laws relating to uildin o s t n. I authorize representatives of Cupertino to enter a-iden ' ed to erty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. —Commercial Bldgs: Provide a completed Hazardous Ma erials Disclosure form if any Hazardous Materials are being used as part of thi project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ EXPRESS El STANDARD ❑ LARGE ❑ MAJOR ❑ BUILDING PLAN REVIEW ❑ PLANNING PLAN REVIEW El PUBLIC WORKS ❑ FIRE DEPT l❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO rz��j. FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the preliminar in ormation available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/131 ADDRESS: 19379 STEVENS CREEK BLVD DATE: 08/28/2015 REVIEWED BY: MELISSA 1:7ee. Plan Check Elec. Permit Fee: Other 1, ec. Irak. Elea Insp. Fee APN: 31620109.19379 BP#: 12110089 "VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Commercial Building (Civil / Religious activities in BQ zone? 0 Yes (j) No PENTAMATION PERMIT TYPE. 1 GENCO WORK REV # 1 - ADD ROOF WALK PADS TO PLANS RFI 504 SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the preliminar in ormation available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/131 :tlech. Plan Check 4celt. Permit Outer illech. Insp. Hech. lisp. Fee Phimb. Ian Check Plumb. Permit Fee. urnb lisp.L sp. Fee: 1:7ee. Plan Check Elec. Permit Fee: Other 1, ec. Irak. Elea Insp. Fee Fzer P umb. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the preliminar in ormation available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (j) No $0.002 hours hours Plan Check, Hourly $286.00 1STPLNCK Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. 0 OT 0.0 firs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 Administrative Fee: 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure (D 0 i !ravel Documemation Feet. Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: 1 $0.001 $286.001 TOTAL FEE: 1 $286.00 Revised: 07/02/2015 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUFJItvs, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aecupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED PROJECT ADDRFSS APN N 31 cc 2-c) O OWNER NAME 66 PHOID5-b - +T . /,SoU E-MAIL STREET A DRESS �� W v SKI CITY, ST((,,((// ZI FAX 3 [�C Snores 2ovwocx� C CA R�iUeoS •.3y • D� CONTACT NAME PHONE 4-o �( 4I L �nr'0Kr �h 0 Lr z )OC, cr5 0150- -C)�0U n rCh,4ec45CoM QJ SIRE A4 I �/ NhLSIY) 1X1 � <S �I,-{e ?lam cI p�lni i PVlek�/ �R 1 �lo� AX FSa' 9(06' 4-9 __7 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 12 8, J' ^ L � "i lY 7 O N skr C o U a vv U nc 5r} o r re i( b k i l d I n She1 1 EXISTING USE PROPOSED USE CONSTR TYPE STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA TREMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDFTACH ❑ ATTACH R DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY �� r x�a,=,� �• TOTAL VALUATION: PLANNING APPL: ❑NO PLANNAG.APPROVAL LETTER I EICHLER HOME? []NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I hav provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating ildin. construction. I authorize representatives of Cupertino to enter the above-idfritifiel property for inspection purposes. Signature of Applicant/Agent: Date: ` SUPPLEMENTAL INTORMATION REQUIRED p 'cPzecl.xaPE. �. . , .,.a -vRouriNGSLIP , ❑ s ❑ _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER THE COUNTER t > r� P BWLDINGRE1IEw permit for new building. ❑ Ess ❑ PLANNINGPLANRE�IE�F J _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTai\DARD ❑ PUBLICRORLS r To if any Hazardous Materials are being used as part of this project. LAit $ ha h ❑ FIRE DEPT : -5, _ Copy of Planning Approval Letter or Meeting with Planning prior to '' ❑ x r ❑ submittal of Building Permit application. �oR x STARYSE))ERDISTRICT W ❑..ENVIRONNNNfENTALHE_kL,TH BldgApp_201 1. doc revised 06/21/11 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS:19379 Stevens Creek Blvd - Shop 4 PERMIT # 1211008q OWNER'S NAME:Sand Hie Management PHONE # GENERAL CONTRACTOR: South ea Construction Y BUSINESS LICENSE # 5655 ADDRESS: 1711 Dell Ave CITY/Z[PCODE:Campbell, CA 95008 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license.. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL. BE SCHEDULED UNTIL. 1 -Hu." GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPLRTINO BUSINESS LICENSE. 1 am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork X Cement Finishing Techcon 23513 ................. X Electrical �. Redwood Electric Group 21108 X Excavation Doyle's 35611 Fencing Flooring / Carpeting Linoleum / Wood X Glass / Glazing Classic Glass 25840 _ _ X Heating The Trillo Company 29816 X Insulation Central California Insulation 557 Landscaping X Lathing Cen Cal Plastering 33021 X Masonry American Tile & Brick Veneer 35158 34391 X Painting / Wallpaper G&G Painting Paving _ X Plastering Cen Cal Plastering 33021 X Plumbing Fresno Plumbing & Heating 32000 X Roofing Statewide Roofing 23509 Septic Tank X Sheet Metal The Trillo Company 29816 X Sheet Rock South Bay Interiors 25499 Tile Owner / Contractor Signature 5/12/15 Date PROJECT DATA- Cl' MMERCIAL COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building Ca7cupertino. orq PROJECT ADDRESS Northwest Corner of Tantau Ave and Stevens Creek Blvd. APN # 316-20-078, 316-20-079, 316-20-085 OWNER NAME 500 Forbes LLC PHONE 650-344-1500 E-MAIL STREET ADDRESS 203 Redwood Shores Parkway, Suite 200 CITY, STATE, ZIP Redwood City CA 94065 FAX 650-344-0652 CONTACT NAME)Kenneth Rodrigues &Partners, Inc PHNE (650) 965-0700 E-MAILkenr@krparchitects.com STREET ADDRESS 445 N. Whisman Road, Suite 200 CITY, STATE, ZIP Mountain View, CA 94043 FAX (650) 960-0707 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT TENANT CONTACT NAME PHONE E-MAIL BUSINESS NAME FAX BUILDING OR TENANT SPACE DIMENSIONS Main Street Cupertino Shop4: 12,846SF DESCRIPTION OF WORK Construction of a new one story retail building shell. EXISTING USE(S): None V PROPOSED USE(S): Retail f ` OCCUPANCY(S): ^ n IV' OCCUPAN ------ TYPE OF V-13 LOAD: CONSTRUCTION AREA OF�___ FLOOR(S) ------ HAZARDOUS Y REMODEL SPACE: OF REMODEL SPACE: MATERIALS FIRE N WUI Y ® FLOOD Y I SIESMIC Y N SPRINKLERS: AREA: AREA: AREA: NUMBER OF CHILDREN < 2 YRS OLD: NUMBER OF STUDENTS >= 2 YRS OLD UP TO 12"' GRADE: LEARNING CENTERS AND EDUCATIONAL OPERATIONS: 24 HOURS CARE? Y ® NUMBER OF ADULT CLIENTS: NUMBER OF EMPLOYEES: TOTAL OCCUPANTS: Governing Codes: 2010 California Building Code (based on the 2009 International Building Code) 2010 California Residential Code (based on the 2009 International Residential Code) 2010 California Plumbing Code (based on the 2009 Uniform Plumbing Code) 2010 California Mechanic Code (based on the 2009 Uniform Mechanical Code) 2010 California Electrical Code (based on the 2009 International Electrical Code) 2010 California Energy Code 2010 California Green Building Standards Code Cupertino Municipal Code ProjectData-CommerciaLdoc revised 12/01/11 yJ - ul STATEMENT OF SPECIAL INSPECTIONi, t0 86d COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE - CUPERTINO, CA 950143255 (406) 7T7-3228 - FAX (408) 777-3333 - b4gilding0cupertincorn SITE ADDRESS/5,�4,�9/­7 APNI Si nature ... ......... . ..... U.0 ... Bps 1.211ea-715 to Owner Ad ZWJ .. .. ....... ... cankract), as Addre R.- oi— . . . ..... ckytst. 014 1 .2. -- J31W —Fft Sig r.34 Lic 9 ,7,9 ............ . . ..Zip. Apprnant_. jai_ . ... . ............... ........... ...... Address- J?A 2W.r.... City/st . ............. . ................. Zip ........ Adclress..a.\ . . ..... "AWY4 ... ...... . ... ......... .......... . ......... ................_.........Phone....._....._... CltylSt.SF...4 .... 1;& ......... ....... Zip.qtkkiP01 Phi PRCJKT DESCRIFTION: This 'STATEMENT OF SPECIAL INSPECTIONS* Is submitted in fulfillment of the requirements of CBC Sections 1704 and 1705. This form is structured alter and used by permission from the Structural Engineer Association of Northern California's (SEAONC) made statement of Special Inspections. Also, included with this form Is the following: ❑ 'LIST OF SPECIAL. INSPECTION AGENCIES (page 2). A list of testing agencies and other special Inspectors that will be retained to conduct the tests and inspections for this project E] *SCHEDULE OF SPECIAL INSPECTION' (page 3 - 6). The Schedule of Special Inspections summarizes the Special Inspections and tests required. Special Inspectors will refer to the approved plains and specifications for detailed special Inspection requirements. Any additional tests and Inspections required try the approved plans and specifications shell also be performed. Spacial Inspeclions. and Testing will be performed in accordance with the approved plans and specificadone, this statement and CBC Sections 1704, 1705, 1706, I707, and 1708. Interim reports will be submitted to the Building Official and the Registered Design Professional in Responsible Charge in accordance with CBC Section 1704.12 A Fine( Report of Special Inspections documenting required Special Inspections, testing and correction of any discrepancies noted In the Inspections shall be submitted prior to Issuance of a Certificate of Use and Occupancy (Section 1704.1,2). The Flinal Report will document • Required special Inspections. Correction of discrepancies noted In inspections. The Owner recognizes his or her obligation to ensure that the construction compiles with the approved permit documents and to implement this program of special Inspectors. In partial fulfillment of these obligations, the Owner will retain and directly pay fur the Special Inspections as required In CBC Section 1704. 1. This plan has been developed with the understanding that the Building Official will: • Review and approve the qualificabons of the Special Inspectors who will perform the inspections. • Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are performing their duties as called for in this Statement of Special Inspection. • Review submitted inspection reports. • Perform inspections as required by the local building code, I haves rpAtl anti AMPP in rnme4v with the larms and --nt7yVKrjnsnf this afah-mmit Prepared e:., Project Engineer Q ArcNtect RogItterod n'Professional In Chorue Si nature ... ......... . ..... U.0 ... Date: Owner Na Sign2twe .. . ............ Mite: IntIpection Agency I Inspector N Sig r.34 Lic 9 ,7,9 Building Official or designee: Signatone .... .. I ...... ... 7 le EWe. 5DecWrupectiv)LF;rxt-2012 doe revWd09,,06J2 �9 tsa C - LIST OF SPECIAL INSPECTION AGENCIES APPROVAL OF SPECIAL INSPECTORS: Each special Inspection agency, testing faci7ty, and special inspector shall be recognized by the Building Official prior to performing any duties. Special Inspection agency's listed on this form must be pre -approved and listed on Cupertino's approved Special Inspector's list Special inspectors shag carry approved identification when performing the functions of a special inspector. Identification cards shat follow the criteria set by the Carrfomia Council of Testing and Inspection Agencies. No personnel changes shall be made without first cbtaining the approval of the Building Official. Any unauthorized personnel changes may result In a'Stop Work Order and possible perrrdt revocation. To be pre- sppraved by the City of Cupertino, refer to the SPECIAL INSPECTION CRITERIA handout Please allow two weeks to complete the application process. The foliowino are the testing and soedal inseeetion aaendes that will be retained to cnndrrrt tpctc and incnM 'nn nn Chic nrniurF EXPERTISE FIRM / INSPECTOR INFORMATION 1. Spacial Inspection (except for Firm ... »................... .................................... Addr..............»......._.............._»...............»»..._...»»....»». geowchnlrst) City.......... ......... ........................ .........._...... ..»................... _._.............. Stara .......................Zip ......._........... Telephone........................»».....».» Fax ..... ........ ___ ................. _ Ernall.».............................................. ..... 2. Material Testing Firm. ('Or'l1 K/2I—D07 �5».,la»Addr.. 7_et ,vc ^�'w''....: D.......1�. , rr ............. ........... _.State ...... .. Telephone..`7..c1l..:3��f..��4;�.Fax.J'�:.`.:r.>t1... ..mp .. _.1����....EnYdli:,� �.._�i.�..J1l?:.C' 3. Geotecthnicel lnspectiorm F1rrn............... »...........»......_..............................Addr....._..._.._......._._.._.............._......».....................»... » city......... ...... ........................ ................................................__.....__ Slste .... .................. Zip ..................... Telephone.................»»................. Fax ..... »................. -................ E rat!._................._.........._......._ ..... 4. Other. Firm _ .................................... _......... ................ _. Add r._....,.,,.......,......._._._....,................................_..._............ city........,».................. ................ _...................... -.................. ............ State .... ................. Zip »....»........».... Telephone...................................... Fix ............................................ Ernall .......... _............ _............................... Ah agencies spec fred on this torn must be pre -approved and listed on the City of Cupertino'sApproved Special Inspector's List SEISMIC REQUIREMENTS (Section 1703.3.6) Qescriptlon of selsmic-force-reststin0 system and designated seismic "arm subfect to special Inspectlorn its per Section 1705.3: The extent of the selsrric-force-reafsting system to dented in mora detall In the construction documenh. Description of min Mnd4orce-ms[dng system and designated wind restating components subject to special inspections in accordance with Section 1705.42: The extort of the rnaln wind -force -resisting system and wind resisting components is defined in more detail In the tonstnrflon documents. SpecirrinspectionFonrr_1012.doe rvvised 09,0612 SCHEDULE OF SPECIAL INSPECTION SITE I AFN BPS ADDRESS PROJECT DESCRIPTION: Notation Used In Table: Column headers: C Indicates continuous inspection is required. P Indicates periodic inspections are required. The notes and/or contract documents should clarify. Box entries: X Is placed In the appropriate column to denote either'C" continuous or'P' periodic Inspections. Denotes an activity that is either a onetime activity or one whose frequency is defined in some other manner. Additional detail regarding inspections and tests are provided in the project specifications or notes on the drawings. VERIFICATION AND INSPECTION C P REFERENCED IBC REFERENCE STANDARD INSPECTION OF FABRICATORS 1. X Inspect fabricator's fabrication and quality control — — I 1704.3 procedures, INSPECTION OF STEEL 1. Material verification of high-strength bolts, nuts and washers. Identification marking to conform to ASTM stds AISC 360, specified In the approved construction documents. — x Section A3.3 and applicable ASTM material standards Inspect fabricator's fabrication and quality control procedures. — x — — 2. Inspection of high-strength bolting: Snug -fight joints. — x Pretensioned and slip -critical joints using tum -of -nut with match marking, twist -off bolt or direct tension — X RISC 360, Indicator methods of installaflon. Section MZ.S 1704.3.3 ❑ Pretensioned and slip -critical joints using tum -of -nut without matchmarking or calibrated wrench methods X of installation. 3. Material verification of structural steel and cold -formed steel deck. For structural steel, identification markings to conform X AISC 360, to AISC 360. Section M2.5 For other steel, identification markings to conform to ASTM standards specified in the approved — X Applicable ASTM construction documents. material standards ManufactrJrer's certified test reports. — x Saecialnspec,idnFb i. 2012 doe revised 09,06 12 VERIFICATION AND INSPECTION CTI, C REFERENCED I 18C REFERENCED STANDARD JISC IREFERENCE STANDARD IREFERENCE 4. Material verilication of weld filler materials: Identification marking to conform to AWS specification 1704.3 2. Welding of cold -formed steel framing members. — X AISC 380, in the approved construction documents. — X Section A3.5 and ` applicable AWS A5 documents Manufacturer's certificate of compliance required. — X — — 5. Inspection of welting: a. Structural steel and cold -formed steel deck: Complete and partial joint penetration groove welds. X — Multipass fillet welds. X — 13 Single -pass fillet welds > 5116' X — AWS D1.1 1704.3.1 Plug and slot welds. X — �sj Single -pass fillet welds — 511 S' — X ';iZ Floor and roof deck welds. — X AWS D1.3 b. Reinforcing steel: ❑ Verification of weldability of reinforcing steel other than ` X ASTM A 708. ❑ Reinforcing steel resisting flexural and axial forces in intermedlate and special moment frames, and X AWS D1.4 ACI 318: boundary elements of special structural walls of Section 3.5.2 ` concrete and shear reinforcement. ❑ Shear reinforcement X — 13 Other reinforcing steel. —+ — X 6. Inspection of steel frame joints details for compliance: X Details such as bracing and stiffening. — X — 1704.3.2 Member locations. — g Application of joint details at each connection. 7 — Hxx VERIFICATION AND INSPECTION C P REFERENCED STANDARD JISC IREFERENCE INSPECTION OF WELDING 1. ❑ Welded studs when used for structural dlephragms. — X — 1704.3 2. Welding of cold -formed steel framing members. — X 3.3 Welding of stairs and railing systems. -- X SpecinlrspeclionForm_2011 doc revised 09'06'11 Speclalrupectivi Form_2012.doc mired 09 06'12 VERIFICATION AND INSPECTION C I P REFERENCED JIBC STANDARD IREFERENCE INSPECTION OF CONCRETE 1, Inspection of reinforcing steel, including prestressing tendons and placement. X ACI 318:3.5,7.1-7.7 1913.4 2. ❑ Inspection of reinforcing steel welding In accordance_ AWS D1.4 ACI 318: with Table 1704.3 Item 5b. — 3.52 — 3, �r, Inspection of boas to be Installed in concrete prior to and during placement of concrete where allowableX ACI 318: 8.1.3, loads have been increased or where strength design — 212.8 1 Q1 i 5 19121 Is used. 4. �Z Inspection of anchors inatafled in hardened concrete. — X ACI 318: 1912.1 5. Verifying use of required design ma, 1904.2.2,19132, — X ACI 318: 1913.3 6. At time fresh concrete is sampled to fabricate ASTM C 172 specimens for strength tests, perform slump and air content tests and determine the temperature of the X — ASTM C "s1 1913.10 ccncrete. ACI 318: 5.6, 5.8 7. Inspection of concrete and shoterete placement for 1913.6, 1913.7, proper application techniques. X— ACI 318: 5.9, 5.10 1913.8 8. K Inspection for maintenance of specified curing temperature end techniques. X ACI 318: 5.11 5.13 1913.9 9. hspection of prestressed concrete: 17 Application of prestressing forces. X — ACI 318: 18.20 0 Grouting of bonded prestressing tendons in the seismic farce -resisting system. x __ ACI 318: 18.18.4 10.0 Erection of precast concrete members. I -- X ACI 318: Ch. 16 — 11, 13 Verification of in-situ concrete strength, poor to stressing of tendons in posttensioned concrete and prior to removal of shores and forms from beams and — X ACI 318: 62 structural slabs. 12. 13 Inspect fomnYork for shape, location, and dimensions of the concrete member being formed. —" X ACI 318: 6.6.1 — 13.�1 Bolts Installed in Exfsfng Masonry or Concrete C3 Direct tension testing of existing anchors. — X Direct tendon testing of new bolts. — X See ICC ES Reports form special inspection requirements for proprietary product Torque testing of new boll. — X ❑ PrequaGfication test for bolts and other types of anchors. — X 14. 17 Other: Speclalrupectivi Form_2012.doc mired 09 06'12 Speeiab spertioiL ami 1012.coc rrv4wd 09"06 12 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TNtS 402/ACI TMS 4021ACi SECTION 330IASCE 5 MASCE 6 INSPECTION OF LEVEL 1 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved — X — — Art. 1.5 submittals shall be verified. 2. ❑ Verification of fn, end f&Az prior to construction — X� — Art, 1.48 except where specifically exempted by this code, 3. ❑ Verification of slump flow and VSl as delivered to the site for self consolidating grout X — — — Art 1.58.1 b.3 4. As masonry construction begins, the following shall be verified to ensure compliance: ❑ Proportions of site -prepared mortar. — X — — Art 2.5A ❑ Construction of mortar joints. — X — — Art.3.3B ❑ Location of reinforcement, connectors, prestressing tendons, and anchorages. — X — — Art. 3.4, 3.6A ❑ Prestressing technique. — X — — Art. 3.6B ❑ Grade and size of prestressing tendons and anchorages. ' X — — ort 2.46, 2.4H 5, During construction the inspection program shall verify: ❑ Size and location ofstrucfural elements. — X — — Art, 3.3F ❑ Type, size, and location of anchors, including other details of anchorage of masonry to — X — Sec. 1.2.2(e), — structural members, frames or other construction. 1 161 ❑ Specified size, grade, and type of reinforcement, anchor boils, prestressing tendons and — X — Sec. 1.15 Art. 2.4, 3.4 anchorages, ❑ Welding of reinforcing bars. X— ❑ Preparation, construction and protection of masonry during cold weather (temperature below X Sec, 2104.3, 40 degrees F) or hat weather (temperature above _ 2104,4 — Art 1.8C, 1.8D 90 degrees F). O Application and measurement of prestressing force. X — — — Art, 3.68 S. Prior to grouting the following shall be verified to ensure compliance: ❑ Grout space is dean. I — X — -- Art 3.21) ❑ Placement c( reinforcement and connectors and prestressing tendons and anchorages. (— X — Sec. 1.3 Art. 3.4 ❑ Proportions of site -prepared grout and prestressing grout for bonded tendons. — X — Art, 2.66 ❑ Construction of mortar Joints. — I X I — — Rrt. 3.38 7. Grout placement: ❑ Grout placement shall be verified ensure compliance. I X — — -- Art. 3.5 ❑ Observe grouting of prestressing bonded tendons, X — — Art 3.6C Speeiab spertioiL ami 1012.coc rrv4wd 09"06 12 5perialraperrionForni_2012.dor revised 09 06 12 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION CP BC TMS 402/ACI TMS 402/ACI SECTION 5301ASCE 5 I 5301ASCE 6 B. ❑ Preparat;on of any required grout specimens, Sec. mortar specimens, and/or prisms shad be — X 2105.2.2, — Art. 1,4 observed. 2105.3 INSPECTION OF LEVEL 2 MASONRY 1. ❑ Comp'lance vft required inspection provisions of the construction documents and the approved — X — — Art. 1.5 submittals, 2. ❑ Verificaeon of f and PA..c prior to construction and for every 5,000 square feet during — X — — Art, IAB construction. 3. ❑ Verification of proportions of materials In premixed or preblended mortar and grout as — X — — Art. 1.53 delivered to the site. 4. ❑ Verification of slump flow and VSI as delivered to the site for self consoridafing grout X — — — Art. 1.5B.i .b.3 5. The following shall be verffied to ensure compliance; ❑ Proportions of site -prepared mortar, grout, and prestressing grout for bonded tendons. — X — ( — Art, 2.6A ❑ Placement of masonry units and construction of mortarjoints. _ X — ( — Art. 3.3B ❑ Placement of reinforcement, connectors and prestressing tendons and anchorages. — X — Sec. 1.15 Art 3.4, 3.5A ❑ Grout space prior to grouting. X — — — Art. 3.2D ❑ Placement of grout X — — Art. 3.5 ❑ Placement of prestressing grout. K — — — Art. 3.6C O Size and location of structural elements. — X — — Art. 3.3F ❑ Type, s:ze, and iccation of anchors, including other detaifs of anchorage of masonry to X structural members, frames and other — — Sec.1.2 2(e} — construction. ❑ Specified size, grade, and type of reinforcement, anchor baits, prestressing tendons and — X — Sec. 1.15 Art. 2.4, 3.4 anchorages. ❑ Welding of reinforcing bars. K _ — Sec. 2.1.9,7.2, — 3.3.3.4 (b) ❑ Preparation, construction, and protection of masonry during cold weather (temperature below_ X Sec. 2104.3, — Art, 1,8C, 1.8D 40 degrees F) c hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing force. X 5. ❑ Preparation of any required grout specimens, Sec. mortar specimens, andlor prisms shall be X — 2105.2.2, — Art, 1.4 observed. 2105.3 5perialraperrionForni_2012.dor revised 09 06 12 VERIFICATION AND INSPECTIONC p REFERENCED 18C STANDARD REFERENCE INSPECTION OF WOOD 1. ❑ Inspect prefabricated wood structural elements and assemblies in accordance with Section 17042. — 1704.6 2. ❑ Inspect site built assemblies. — — 3. Inspect high -load diaphragms: ❑ Verify grade and thiclmess of sheathing. — — ❑ Verify nominal size of framing members at adjoining panel edges. — — — 1704.6.1 ❑ Verify nail or staple diameter and length, — — ❑ Verify number of fastener fines, — — ❑ Verify spacing between fasteners In each line and at edge margins. — — 4. ❑ Metal-plata-conneyted wood trusses spanning 60 feet or greater. Verify temporary Installation restraint/bracing and the permanent Individual truss — X — 1704.62 member bracing are Installed in accordance with the approved truss submittal package. REQUIRED VERIFICATION AND INSPECTION OF SOIL 1. ❑ Verify materials below footings are adequate to — X achieve the desired hearing capacity. 2. ❑ Verify excavations are extended to proper depth and — X have reached proper material. 3. ❑ Perform classification and testing of compacted fill _ X materials. — Table 1704.7 4. ❑ Verify use of proper materials, densities and lift thicknesses during placement and compaction of X — compacted flU. 5. ❑ Prior to placement of compacted fill, observe subgrade — X and verify that site has been prepared properly. REQUIRED VERIFICATION AND INSPECTION OF DEEP DRIVEN FOUNDATION ELEMENTS 1. ❑ Verify element materials, sizes and lengths comply X — with the requirements. 2. ❑ Determine capacities of test elements and conduct X additional load test, as required. 3. ❑ Observe driving operations and maintain complete X and accurate records for each element 4. ❑ Verify locations of piles and their plumbness, confirm type and size of hammer, record number of blows per — Table 1704.8 foot of penetration, determine required penetrations to X — achieve design capacity, record tip and butt elevations and document any damage to foundation element. 5. ❑ For steel elements, perform additional inspections In accordance with Section 1704.3. _ 6. ❑ For concrete elements and concrete filled elements, perform additional Inspectors in accordance with -- — Section 1704.4. Speclalnsprctic rFomr_2012.cbc rm,,d 017,0b'!2 VERIFICATION AND INSPECTION C I P REFERENCED I IBC STANDARD IREFERENCE 7. ❑ For specialty piles, perform additional inspections as determined by the registered design professional in — — — Table 1704.8 responsible charge. REQUIRED VERIFICATION AND INSPECTION OF CAST4N-PLACE DEEP FOUNDATION ELEMENTS 1 ❑ Observe drilling operations and maintain complete and X — accurate records for each element. 2, ❑ Verify placement locations and plumbness, confirm element diameters, bell diameters (if applicable), lengths, embedment into bedrock (if applicable), and X — -- Table 1704.5 adequate end -bearing strata capacity. Record concrete or grout volumes. 3. ❑ For concrete elements, perform additional inspections In accordance with Section 1704.4. — — HEUCAL PILE FOUNDATIONS 1. ❑ Record Installation equipment used, pile dimenslors,X — — 1704.10 tip elevations, final depth, final Installation torque. SPRAYED FIRE-RESISTANT MATERIALS Physical and visual tests 1, Condttionofsubstrates. ❑ Inspect surface for accordance with the approved fire - resistance design and the approved manufacturer's — — wrttten instructions. ❑ Verify minimum ambient temperature before and after — X application, ❑ Verify ventilation of area during and atter application. -- X 2. ❑ Measure average thickness per ASTM E605 and1704 Section 1704.12.4. — — — 12 1 3. ❑ Verify density of material far conformance with the approved fire-resistant design and ASTM E605. (Ref. — — Section 1704.12.5) 4. ❑ Test cohesive/adhesive bond strength per Section 1704.12.6. — — 5. ❑ Condition of finished application. MISCELLANEOUS 1. Mastic and Intumescent Fire -Resistant Coating. — — — I 1704.13 2. Exterior Insulation and Finish Systems (EIFS), Water - resistive barrier coating when Installed over a sheathing — — — 1704.14 substrate. 3. Special Cases -- — __ 1704,15 4. Smoke Control System — — — 1704.16 5. Seismic Resistance ❑ Suspended ceiling systems and their anchorage. -- — — 1705.3 [4.31 Spec;alnspecXonForni_2011 doc reUfsed 09.06 12 VERIFICATION AND INSPECTION CP REFERENCED I IBC STANDARD REFERENCE 6. Wind Resistance ❑ Roof cladding and roof framing connections. — — — ❑ Wall connections to roof and floor diaphragms and framing. ❑ Roof and floor diaphragm systems, including collectors, drag struts and boundary elements. r — — ❑ Vertical wind•force-resisting systems, inducting braced frames, moment fames, and shear walls. _ — ❑ Wind -force -resisting system connections to the foundation. ❑ Fabrication and installation of systems or components required to meet the impact resistance requirements — — of Section 1609.12. SPECIAL INSPECTION FOR WIND REQUIREMENTS 1. Structural Wood ❑ Inspect field gluing operations of elements of the mein x — wind -force -resisting system. __ 1706.2 ❑ Inspect nailing, bolting, anchoring, and other fastening of components within the main windforce-resisting — x system, including wood shear walls, wood diaphragms, drag struts, braces and hold-downs. 2. Cold -Formed Steel Framing Welding of elements of the main wind -force -resisting system. — x inspection of screw attachments, bolting, anchoring, and other fastening of components within the main — 1705.3 wind -force -resisting system Including shear walls, — X braces, d;aphragms, collectors (drag struts) and hold- downs, 3. Wind -resisting components ❑ Roof claddng. — X -- 1706.4 ED Wall Gadding. — X SPECIAL INSPECTIONS FOR SEISMIC RESISTANCE 1. ❑ Special inspection for welding in accordance with the X — 1707.2 qual ty assurance plan requirements of AISC 341. 2. Structural Wood ❑ Inspect field gluing operations of elements of the X — seismic -force resisting system. ❑ Inspect nailing, bolting, anchoring, and other fastening of components within the seismic -force -resisting 1707.3 system, including woad shear walls, wood — X diaphragms, drag struts, braces, shear panels and hold-downs. 3. Cold -Formed steel light -frame construction Welding of elements of the seismic -farce -resisting — X 1 7G7.4 system. 5pecicrspe lion orn�_10!?.docrrv45ed09-0611 Inspection of screw attachments, bolting, anchoring, and other fastening of components within the seismic- — X force -resisting system including shear walls, braces, diaphragms, collectors (drag struts) and hold-downs. 4. Storage racks and access floors ❑ Anchorage of storage racks 8 feet or greater in height X and access floors. — 1707.5 5, Architectural components ❑ Inspect erection and fastening of exterior cladding weighing more then 5 psf and higher than 30 feet — X above grade or walking surface. O Inspect erection and fastening of veneerweighing more than 5 psf.and higher than 30 feet above grade — X or walking surface. — 17o7.s ❑ Inspect erection and fastening of all exterior non- bearing walls higher than 30 feet above grade or — X walking surface. ❑ Inspect erection and fastening of all interior non- bearing walls weighing more than 15 psf and higher — X than 30 feet above grade or walking surface. S. Mechanical and Electrical Components ❑ inspect anchorage of electrical equipment for — X emergency or stand-by power systems. ❑ Inspect anchorage of non -emergency electrical — X equipment. ❑ Inspect instailation of piping systems and associated mechanical units carrying flammable, combustible, or — X — 1707.7 highly toxic contents. ❑ Inspect InsWadcn of HVAC ductwork that contains — X hazardous materials. ❑ Inspect installation of vibration isolation systems — X vtie'e required by Section 1707.7. 7. ❑ Verify that the equipment label and anchorage or mounting conforms to the certificate of compliance when mechanical and electrical equipment must be — — — 1707.8 seismically qualified. B. ❑ Seismic isolation system, Inspection of isolation X system per ASCE 7 - Section 172.4.8 — 1707.9 9. ❑ Obtain mid certificates for reinforcing steel, verify compliance with approved construction documents, — — — 17062 and verify steel supplied corresponds to certificate. 10. ❑ Structural Steel: Invoke the QAP Quality Assurance requirements in RISC 341. — 1708.3 11. ❑ Obtain certificate that equipment has been seismically qualified. — _ 1708.4 12. ❑ Obtain system tests as required by ASCE 7 Section 17.8. -' — — 1708.5 Spec9a(fv."c]ian orai_2012'bc revised 09,06-12 rt V CONSOLIDATED ENGINEERING L A B O R A T O R I E S 6/4/2015 City of Cupertino Albert Salvador 10300 Torre Avenue Cupertino, CA 95014 RE: Main Street Cupertino - Retail Shop 4 Stevens Creek and Finch Cupertino, CA 95014 Permit# 12110089 CEL#: 1028288C FINAL REPORT FOR SPECIAL INSPECTION AND MATERIALS TESTING SERVICES (Effective Through 04/02/15) RECEIVED JUN 2 9 2015;I 6Y�^/ In accordance with Section 1704 of the California Building Code, Consolidated Engineering Laboratories has provided the requested special inspection and testing on the subject project as listed below: 1. Reinforcing steel placement 2. Anchor bolts/holddowns installed in concrete 3. Installation of epoxied anchors 4. Concrete placement and testing 5. Structural steel shop and field welding, including non-destructive testing (UT & MT) and material ID 6. High-strength bolting 7. Grout placement and testing (base plates) 8. Proofload testing of all -thread anchors These inspections were performed by personnel under the general supervision of a Registered Civil Engineer in the State of California. Details of our work on this project are contained in our testing and inspection reports, issued during the course of construction. Based solely upon the inspections and tests performed and upon our substantiating reports, it is our professional judgment that the inspected work was performed substantially in conformance with the approved plans and specifications, approvals by the Engineer of Record and the applicable workmanship provisions of the California Building Code. 2001 Crow Canyon Road, Suite 100 • San Ramon, CA 94583 • TEL (925) 314-7100 • FAX (925) 855-7140 cw� CONSOLIDATED ENGINEERING L A B O R A T O R I E S Special inspection and materials testing is the observation of construction for general conformance with the approved design drawings and specifications. It should not be relied upon by others as acceptance or as a guarantee of work, nor should it in any manner relieve any contractor, or any other party, from their obligations and responsibilities under either the construction contract or generally accepted industry custom/practice. We appreciate the opportunity of working with you. If you have any questions or require additional information, please feel free to contact us at your convenience. REVIEWING ENGINEER: CHRIS KAVALARIS, R.C.E. CC: Main Street Aggregator LLC (E) JD2 Inc. (E) South Bay Construction (E) South Bay Construction (E) Sand Hill Construction Management, LLC. (E) All reports are submitted as the confidential property of clients. Publicatic Main Street Aggregator LLC (E) Inspection & Valuation International, Inc. (E) South Bay Construction (E) Sand Hill Construction Management, LLC. (E) South Bay Construction (E) 2001 Crow Canyon Road, Suite 100 • San Ramon, CA 94583 • TEL (925) 314-7100 • FAX (925) 855-7140 CONSOLIDATED ENGINEERING L A B O R A T O R 1 E S 4/24/2015 City of Cupertino Albert Salvador 10300 Torre Avenue Cupertino, CA 95014 RE: Main Street Cupertino - Retail Shop 4 Inspection Date: Stevens Creek and Fineh Location: Cupertino, CA 95014 Inspector: Report #: Permit# 12110089 CEL#: 1028288C FIELD WELDING INSPECTION REPORT On the above date, our representative inspected the referenced project. RECEIVED APR 2 9 W5 13Y -24)-- 03/18/15 Y - 03/18/15 Jobsite W. Marlik 0320FieldA Please refer to the attached reports for details and locations of our inspection services for the above noted date. Note 1: Welding is in progress. Work inspected was in compliance with approved plans and specifications, as noted. REVIEWING ENGINEER: GREG LeROY, R.C.E. CC: Main Street Aggregator LLC (E) JD2 Inc. (E) South Bay Construction (E) South Bay Construction (E) Sand Hill Construction Management, LLC. (E) Enclosures (3) pPpD. FESS/O\ CO C-13 No. C73002 * Exp. 12/31/16 Main Street Aggregator LLC (E) Inspection & Valuation Intemational, Inc. CIVI\- South Bay Construction (E) TFOF CA1-�F�e''° Sand Hill Construction Management, LLC. (E) South Bay Construction (E) All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. 2001 Crow Canyon Road, Suite 100 - San Ramon, CA 94583 - TEL (925) 314-7100 - FAX (925) 855-7140 Form ID 017 Rev.0 CONSOLIDATED ENGINEERING L A 8 O R A T O A 1 E S Structural Steel Welding Project Name Main Street Cupertino - Retail Shop 4 DSA File # CEL Project # 1028288C - DSA Appl # Project Location Stevens Creek and Finch, Cupertino, CA 95014 LEA # Contractor JD -2 � OSHPD # Date ,03/18/2015 Day (Wednesday IR # Permit/Appl # 12110089 Drawing No. X52.3 -S4 Detail No. S7.1 Other Work at: ❑ Shop ® Jobsite Type of work: ® Structural Steel For shop inspections: Shop Name: Reported to (Name): ,John McGowan Address: Company: South Bay const. ❑ Collected ❑ Checked mill certificates Sampled: Verified: ® Welder qualification ® Procedure qualification ❑ Weld procedure specification 0 Visually inspected the: ® In progress Welding performed by: , 3 -welders v - r ❑ Completed Qualified welders using: NR -232-7010 e -_0a SMAW ® Filler Metal Type(s) E ( 7010 _ SAW ❑ Filler Metal Type(s) E , A FLAW ® Filler Metal Type(s) E (71T-8 j GMAW ❑ Filler Metal Type(s) E , r ca 2 Other ❑ Fillet Metal Type(s) E Verified proper electrode storage. Preheat temperature maintained ❑ at ( ❑ Maintained per WPS requirements ❑ Maintained per AWS D1.1 ❑ Groove welds ❑ Complete penetration ❑ Partial penetration ❑ Flare -bevel p Fillet welds: ® single -pass Elmulti-passElDirect ElIndirect butt splice on reinforcing steel M — - - - �; ❑ Other = For: ❑ Baseplate ❑ Gusset plate ❑ Connection plate ❑ Moment plate ❑ Plate -to -plate Splices 0 ❑ Stiffener plate ❑ Reinforcing steel ❑ Brackets ❑ Bent plate ❑ Beam to column connections y d ❑ Other: E at: ❑ Wide flange columns ❑ Wide flange beams ❑ Tube steel columns ® Tube steel beams ❑ Embeds ❑ Beam to column ❑ Girder to column ❑ Column to column splice ❑ Chord bar splices ❑ Diagonal brace to ❑ Angle to ❑ Studs to ❑ Other Inspected on metal decking 3 y® Arc spot welds ❑ Stitch welds ❑ Shear studs ❑ Button punch G CONSOLIDATED ENGINEERING L A B O R A T O R 1 E S Structural Steel Welding Form ID 017 Rev.0 Refer to the attached: ® Field Inspection Record ❑ Member Completion Record ❑ Material Identification Record Work inspected was: ❑ Completed ® In progress ❑ Pending approval ❑ W.I.P. punch list E E ❑ Non-compliance report was left with contractor 3 to ❑ Items were reinspected and ❑ Accepted ❑ Remain in progress 0See the attached ElPunch list ElNon-complianceItem # CLd Issues/Problems? ,CAes *No Notified: ( Company Name: This Work Was _ INSPECTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE CITY APPROVED DOCUMENTS The Work Inspected (Met THE REQUIREMENTS OF THE CITY APPROVED DOCUMENTS Material Sampling 1 PERFORMED IN ACCORDANCE WITH THE APPROVED DOCUMENTS CC: Project Architect Signature of Special Inspector i%%/�// Date 3/18/2015 Structural Engineer Project Inspector DSA Regional Office Print Name/Title William Marlik School District Certification #: 1085171-85 G CONSOLIDATED ENGINEERING L A B O R A T O R 1 E S Field Inspection Record Project Name Main Street Cupertino - Retail Shop 4 DSA File # CEL Project # 9028288C DSA Appl # Project Location ,Stevens Creek and Finch, Cupertino, CA 95014 LEA # Form ID 020 Rev.0 Contractor JD -2 OSHPD # Date 03/18/2015 Day Wednesda IR # Permit/Appl # I12110089 ® Field Inspection Note: Use seperate line for each rejected weld. ---------------------- Weld/Connection Type ; ; Pe aetrat Gr°n e,d HSB H h h SC Bolt ; ;urnn Cppg tr bon e Y� g gIR n`i 48 Ff I Groove We BG 8 c(c ou F,le IIw¢Y g ge ttgg ------------ Ile fo +mt g ��S }pg�4 Member/Joint T e n Im 55e t I to B m S par S li e V u�e Teel (°exp t �f to tom am L`sa�re<ebe�r u<e I}p t e� �}.yI} t et ube Steel sset to Column S ect bar Spice N.D.E. V sual kr Tern t rti��gTesting r e�e+grant t song Upon if is list r A c teeltl ;� gg t Co{umn D9 a nSSStu De°c to am RT�adioon to 66 aMDeck TTT ehac Testing TTT �r� pn reinspection, weld rejected, weld as a P P 1 fIPW fAIPr`tPrt Walri SSSS Sieel d C°��e<tion: MSF/D M¢WI SNd Framing/OfYWaIl r Q° g -- _ - Level `Held/ Member/ Locations Visual NDE Accept/ Repaired/ Status Remarks Connection Type Joint Tye Type Re'ect Reinspected Roof AS DD,DB E.5/4.5 to 5, E.5/4.5 to 4 Notes/ Comments: This Work Was INSPECTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE CITY APPROVED DOCUMENTS The Work Inspected Met THE REQUIREMENTS OF THE �C ITY APPROVED DOCUMENTS CC: Project Architect Structural Engineer Signature of Special Inspector Project Inspector DSA Regional Office Print Name/Title ,William Marlik School District Certification #: 1085171-85 Date X3/18/2015 - G" 534 23rd Avenue Oakland, CA 94606-5307 CONSOLIDATED ENGINEERING (510)436-7626 L A B O R A T O R 1 E S COMPRESaO T PORT DATE OF ISSUE: 10/8/2014 RPT TO: City of Cupertino RE: Main Street Cupertino - Retail Shop 4 10300 Torre Avenue Stevens Creek and Finch Cupertino, CA 95014 Cupertino, CA 95014 ATTN: Albert Salvador Permit#: 12110089 A1bertS(ncupertino.org Additional#: CEL #: 1028288C Lab #: 011234 PLACEMENT DATA Placement #: 3 Admixture type: POLY 997 ADMIX Placement date: 09/10/2014 Mix Number 6034FP Sample date: 09/10/2014 Strength Spec: 3000 psi @ 28 days Total sets: 2 Agg. Size/Src: 1" / star Material type: Concrete Compression Cyl. ASTM C 39 Cement factor: 6.00 sack Material Supplier: STAR Slump spec: 4.00 in SET DATA Set number: 2 of 2 Slump: 5.00 in ASTM C143 Sample time: 10:05 Air temp: 61 deg F Sampled by: Robert Barron Mix temp: 77 deg F ASTM C1064 Ticket/Truck : 3503841785 / 89 Mold type: CYL Placement Location Slab on grade 5" shop 4 between H -B/1-8, 4 -5/A -B.5 Sample Location: Approx 3/G.5 Comments: Cylinder Test Test Cure Dimensions (in) Area Max Load Corr Strength Fracture # Age Date Type Diameter X Height (int) (lb) Factor (psi) Type 011234A 7 09/17/14 Lab 4.00 X 8.00 12.57 46,410 1.00 3,690 Side fracture at end 011234B 28 10/08/14 Lab 4.00 X 8.00 12.57 63,070 1.00 5,020 Side fracture at end 011234C 28 10/08/14 Lab 4.00 X 8.00 12.57 65,600 1.00 5,220 Columnar 011234D 28 10/08/14 Lab 4.00 X 8.00 12.57 62,130 1.00 4,940 Side fracture at end 011234E H Lab 4.00 X 8.00 12.57 0 1.00 0 Samples MEET specified 28 DAY strength requirement at 28 DAYS. Avg=5060 Unless otherwise noted, samples tested in accordance with ASTM C39 RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER CC:City of Cupertino - Albert Salvador City of Cupertino - Albert Salvador E -Reports placeholder - RFC TVED OCT 14 2014 f r ' All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. CONSOLIDATED ENGINEERING L A B O R A T O R 1 E S Co DATE OF ISSUE: 10/8/2014 534 23rd Avenue Oakland, CA 94606-5307 (510)436-7626 RPT TO: City of Cupertino RE: Main Street Cupertino - Retail Shop 4 ;,i 10300 Torre Avenue �� Stevens Creek and Finch Cupertino, CA 95014 Cupertino, CA 95014 ATTN: Albert Salvador Permit#: 12110089 AlbertS(ucupertino.org / Additional#: f CEL #: 1028288C Lab #: 011233 DATA Placement #: 3 Admixture type: POLY 997 ADMIX Placement date: 09/10/2014 Mix Number 6034FP Sample date: 09/10/2014 Strength Spec: 3000 psi @ 28 days Total sets: 2 Agg. Size/Src: 1" / star Material type: Concrete Compression Cyl. ASTM C 39 Cement factor: 6.00 sack Material Supplier: STAR Slump spec: 4.00 in 4.00 X 8.00 12.57 SET DATA 1.00 4,340 Side fracture at end Set number: 1 of 2 Slump: 5.00 in ASTM C143 Sample time: 08:25 Air temp: 57 deg F Sampled by: Robert Barron Mix temp: 76 deg F ASTM C 1064 Ticket/Truck : 196567417 / 85 12.57 63,820 Mold type: CYL 011233D 28 Placement Location Slab on grade 5" shop 4 between H -B/1-8, 4 -5/A -B.5 4.00 X 8.00 12.57 Sample Location: Approx 6.9/C 5,690 Side fracture at end 011233E Comments: Lab 4.00 X 8.00 Cylinder Test Test Cure Dimensions (in)Area Max Load Corr Strength Fracture # Age Date Type Diameter X Height (int) (lb) Factor (psi) Type 011233A 7 09/17/14 Lab 4.00 X 8.00 12.57 54,510 1.00 4,340 Side fracture at end 011233B 28 10/08/14 Lab 4.00 X 8100 12.57 68,810 1.00 5,470 Columnar 011233C 28 10/08/14 Lab 4.00 X 8.00 12.57 63,820 1.00 5,080 Side fracture at end 011233D 28 10/08/14 Lab 4.00 X 8.00 12.57 71,490 1.00 5,690 Side fracture at end 011233E H Lab 4.00 X 8.00 12.57 0 1.00 0 Samples MEET specified 28 DAY strength requirement at 28 DAYS. Avg=5410 Unless otherwise noted, samples tested in accordance with ASTM C39 RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER CC:City of Cupertino - Albert Salvador City of Cupertino - Albert Salvador E -Reports placeholder - RECEI' OCT 14 2014 fly All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. CONSOLIDATED ENGINEERING L A B O R A T 0 R 1 E S 10 /.3•!Y COMPRESSION TEST REPORT 534 23rd Avenue Oakland, CA 94606-5307 (510) 436-7626 DATE OF ISSUE: 10/7/2014 RPT TO: City of Cupertino RE: Main Street Cupertino - Retail Shop 4 10300 Torre Avenue Stevens Creek and Finch Cupertino, CA 95014 Cupertino, CA 95014 ATTN: Albert Salvador Permit#: 12110089 A1bertSnacupertino.org Additional#: CEL #: 1028288C Lab #: 010050 PLACEMENT DATA Placement #: 1 Admixture type: Pozz 322N Placement date: 08/20/2014 Mix Number 5534FWR50 Sample date: 08/20/2014 Strength Spec: 3000 psi @ 28 days Total sets: 3 Agg. Size/Src: 1 "X#4 / Material type: Concrete Compression Cyl. ASTM C 39 Cement factor: 5.50 sack Material Supplier: STAR Slump spec: 4.00 in SET DATA Set number: 1 of 3 Slump: 5.00 in ASTM C143 Sample time: 13:20 Air temp: 80 deg F Sampled by: John Blaylock Mix tem p: 84 deg F ASTM C 1064 Ticket/Truck : 663545/049 Mold type: CYL Placement Location Foundation A -H/1-8 Sample Location: 8/C -C.5 Comments: Cylinder Test Test Cure Dimensions (in) Area Max Load Corr Strength Fracture # Age Date Type Diameter X Height (in (lb) (lb) Factor (psi) Type 010050A 7 08/27/14 Lab 4.00 X 8.00 12.57 40,270 1.00 3,200 Side fracture at end 010050B 28 09/17/14 Lab 4.00 X 8.00 12.57 54,840 1.00 4,360 Side fracture at end 010050C 28 09/17/14 Lab 4.00 X 8.00 12.57 56,390 1.00 4,490 Columnar 010050D 28 09/17/14 Lab 4.00 X 8.00 12.57 58,360 1.00 4,640 Side fracture at end 010050E H Lab 4.00 X 8.00 12.57 0 1.00 0 Samples MEET specified 28 DAY strength requirement at 28 DAYS. Avg=4500 Unless otherwise noted, samples tested in accordance with ASTM C39 RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER CC:City of Cupertino - Albert Salvador City of Cupertino - Albert Salvador E -Reports placeholder - RECEIVED BY_ ------ All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. FI 534 23rd Avenue Oakland, CA 94606-5307 CONSOLIDATED ENGINEERING (510)436-7626 L A B O R A T O R I E S COMPRESSION TEST REPORT DATE OF ISSUE: 10/7/2014 RPT TO: City of Cupertino RE: Main Street Cupertino - Retail Shop 4 10300 Torre Avenue Stevens Creek and Finch Cupertino, CA 95014 Cupertino, CA 95014 ATTN: Albert Salvador Permit#: 12110089 AlbertSp,cupertino.org Additional#: CEL #: 1028288C Lab #: 010051 PLACEMENT DATA Placement #: 1 Admixture type: Pozz 322N Placement date: 08/20/2014 Mix Number 5534FWR50 Sample date: 08/20/2014 Strength Spec: 3000 psi @ 28 days Total sets: 3 Agg. Size/Src: 1 "X#4 / Material type: Concrete Compression Cyl. ASTM C 39 Cement factor: 5.50 sack Material Supplier: STAR Slump spec: 4.00 in SET DATA Set number: 2 of 3 Slump: 5.00 in ASTM C143 Sample time: 14:35 Air temp: 83 deg F Sampled by: John Blaylock Mix temp: 84 deg F ASTM C1064 Ticket/Truck : 663565/049 Mold type: CYL Placement Location Foundation A -H/1-8 Sample Location: 4/E -F Comments: Cylinder Test Test Cure Dimensions (in) Area Max Load Corr Strength Fracture # Age Date Type Diameter X Height (int) (lb) Factor (psi) Type 010051A 7 08/27/14 Lab 4.00 X 8.00 12.57 37,800 1.00 3,010 Side fracture at end 010051B 28 09/17/14 Lab 4.00 X 8.00 12.57 57,730 1.00 4,590 Side fracture at end 010051C 28 09/17/14 Lab 4.00 X 8.00 12.57 51,780 1.00 4,120 Diagonal fracture 010051D 28 09/17/14 Lab 4.00 X 8.00 12.57 56,020 1.00 4,460 Side fracture at end 010051E H Lab 4.00 X 8.00 12.57 0 1.00 0 Samples MEET specified 28 DAY strength requirement at 28 DAYS. Avg=4390 Unless otherwise noted, samples tested in accordance with ASTM C39 RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER CC:City of Cupertino - Albert Salvador City of Cupertino - Albert Salvador E -Reports placeholder - BY ----- A I I Y All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. REC EJ? OCT 0 9 2014 BY All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. F®L534 23rd Avenue Oakland, CA 94606-5307 CONSOLIDATED ENGINEERING (510)436-7626 L A B O R A T O R I E S COMPRESSION TEST REPORT DATE OF ISSUE: 10/7/2014 RPT TO: City of Cupertino RE: Main Street Cupertino - Retail Shop 4 10300 Torre Avenue Stevens Creek and Finch Cupertino, CA 95014 Cupertino, CA 95014 ATTN: Albert Salvador Permit#: 12110089 A1bertSp,cupertino.org Additional#: CEL #: 1028288C Lab #: 010052 PLACEMENT DATA Placement #: 1 Admixture type: Pozz 322N Placement date: 08/20/2014 Mix Number 5534FWR50 Sample date: 08/20/2014 Strength Spec: 3000 psi @ 28 days Total sets: 3 Agg. Size/Src: 1 "X#4 / Material type: Concrete Compression Cyl. ASTM C 39 Cement factor: 5.50 sack Material Supplier: STAR Slump spec: 4.00 in SET DATA Set number : 3 of 3 Slump: 5.00 in ASTM C143 Sample time: 15:45 Air temp: 83 deg F Sampled by: John Blaylock Mix temp: 84 deg F ASTM C 1064 Ticket/Truck : 663581/049 Mold type: CYL Placement Location Foundation A -H/1-8 Sample Location: B/1.8-2 ( F10 footing) Comments: Cylinder Test Test Cure Dimensions (in) Area Max Load Corr Strength Fracture # Age Date Type Diameter X Height (int) (lb) Factor (psi) Type 010052A 7 08/27/14 Lab 4.00 X 8.00 12.57 40,990 1.00 3,260 Columnar 010052B 28 09/17/14 Lab 4.00 X 8.00 12.57 70,230 1.00 5,590 Diagonal fracture 010052C 28 09/17/14 Lab 4.00 X 8.00 12.57 54,280 1.00 4,320 Side fracture at end 010052D 28 09/17/14 Lab 4.00 X 8.00 12.57 63,840 1.00 5,080 Side fracture at end 010052E H Lab 4.00 X 8.00 12.57 0 1.00 0 Samples MEET specified 28 DAY strength requirement at 28 DAYS. Avg=5000 Unless otherwise noted, samples tested in accordance with ASTM C39 RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER CC:City of Cupertino - Albert Salvador City of Cupertino - Albert Salvador E -Reports placeholder - REC EJ? OCT 0 9 2014 BY All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. CONSOLIDATED ENGINEERING L A B O R A T O R I E S flm�le COMPRESSION TEST REPORT 534 23rd Avenue Oakland, CA 94606-5307 (510) 436-7626 DATE OF ISSUE: 10/7/2014 Test Test RPT TO: City of Cupertino RE: Main Street Cupertino - Retail Shop 4 10300 Torre Avenue Stevens Creek and Finch Cupertino, CA 95014 Cupertino, CA 95014 ATTN: Albert Salvador Permit#: 12110089 AlbertS(ub,cupertino.org Additional#: (ill') (lb) CEL #: 1028288C Type Lab #: 010933 10/01/14 PLACEMENT DATA 2.01 X 2.01 X 2.02 Placement #: 2 30,235 1.00 Placement date: 09/03/2014 Mix Number 28 Sample date: 09/03/2014 Strength Spec: 7500 psi @ 28 days Total sets: 1 30,445 1.00 Material type: Hydr. Cement / Non Shrink ASTM C 109 28 Material Supplier: SPEC Slump Spec: 2.01 X 2.01 X 2.01 4.04 SET DATA 1.00 Set number: 1 of 1 Sample time: 08:44 Air temp: 65 deg F Sampled by: Antonio Uscanga Mix temp: 71 deg F ASTM C 1064 Mold type: CUBE Placement Location Columns baseplates A -C/1-3 Sample Location: B/3 Comments: Cylinder Test Test Cure Dimensions (in) Area Max Load Corr Strength Fracture # Age Date Type Width X Length X Height (ill') (lb) Factor (psi) Type 010933A 28 10/01/14 Lab 2.01 X 2.01 X 2.02 4.04 30,235 1.00 7,480 Cones both ends 010933B 28 10/01/14 Lab 2.02 X 2.00 X 2.01 4.04 30,445 1.00 7,540 Cones both ends 010933C 28 10/01/14 Lab 2.01 X 2.01 X 2.01 4.04 31,237 1.00 7,730 Cones both ends Samples MEET specified 28 DAY strength requirement at 28 DAYS. Avg=7580 Unless otherwise noted, samples tested in accordance with ASTM C 1107 RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER CC:City of Cupertino - Albert Salvador City of Cupertino - Albert Salvador E -Reports placeholder - RECMTFP OCT 0 9 2014 BY________ All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. RECEIVED OCT 0 9 2014 RN All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. j'-E534 23rd Avenue Oakland, CA 94606-5307 CONSOLIDATED ENGINEERING (510)436-7626 L A B O R A T O R 1 E S COMPRESSION TEST REPORT DATE OF ISSUE: 10/7/2014 RPT TO: City of Cupertino RE: Main Street Cupertino - Retail Shop 4 10300 Torre Avenue Stevens Creek and Finch Cupertino, CA 95014 Cupertino, CA 95014 ATTN: Albert Salvador Permit#: 12110089 A1bertS(acupertino.org Additional#: CEL #: 1028288C Lab #: 011233 PLACEMENT DATA Placement #: 3 Admixture type: POLY 997 ADMIX Placement date: 09/10/2014 Mix Number 6034FP Sample date: 09/10/2014 Strength Spec: 3000 psi @ 28 days Total sets: 2 Agg. Size/Src: 1" / star Material type: Concrete Compression Cyl. ASTM C 39 Cement factor: 6.00 sack Material Supplier: STAR Slump spec: 4.00 in SET DATA Set number: 1 of 2 Slump: 5.00 in ASTM C143 Sample time: 08:25 Air temp: 57 deg F Sampled by: Robert Barron Mix temp: 76 deg F ASTM C1064 Ticket/Truck : 196567417 / 85 Mold type: CYL Placement Location Slab on grade 5" shop 4 between H-B/1-8, 4-5/A-B.5 Sample Location: Approx 6.9/C Comments: Cylinderl Test I Test Cure Dimensions (in) Area Max Load Corr Strength Fracture # Age I Date Type Diameter X Height (int) (Ib) Factor (psi) Type 011233A 7 09/17/14 Lab 4.00 X 8.00 12.57 54,510 1.00 4,340 Side fracture at end 011233B 28 10/08/14 Lab 4.00 X 8.00 12.57 0 1.00 0 011233C 28 10/08/14 Lab 4.00 X 8.00 12.57 0 1.00 0 011233D 28 10/08/14 Lab 4.00 X 8.00 12.57 0 1.00 0 011233E H Lab 4.00 X 8.00 12.57 0 1.00 0 Unless otherwise noted, samples tested in accordance with ASTM C39 RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER CC:City of Cupertino - Albert Salvador City of Cupertino - Albert Salvador E-Reports placeholder - RECEIVED OCT 0 9 2014 RN All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. DECEIVED OCT 09 2014 BY All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval. 534 23rd Avenue --. Oakland, CA 94606-5307 CONSOLIDATED ENGINEERING (510) 436-7626 L A B O R A T O R 1 E S COMPRESSION TEST REPORT DATE OF ISSUE: 10/7/2014 RPT TO: City of Cupertino RE: Main Street Cupertino - Retail Shop 4 10300 Torre Avenue Stevens Creek and Finch Cupertino, CA 95014 Cupertino, CA 95014 ATTN: Albert Salvador Permit#: 12110089 AlbertSnacupertino.org Additional#: CEL #: 1028288C Lab #: 011234 PLACEMENT DATA Placement #: 3 Admixture type: POLY 997 ADMIX Placement date: 09/10/2014 Mix Number 6034FP Sample date: 09/10/2014 Strength Spec: 3000 psi @ 28 days Total sets: 2 Agg. Size/Src: 1" / star Material type: Concrete Compression Cyl. ASTM C 39 Cement factor: 6.00 sack Material Supplier: STAR Slump spec: 4.00 in SET DATA Set number : 2 of 2 Slump: 5.00 in ASTM C143 Sample time: 10:05 Air temp: 61 deg F Sampled by: Robert Barron Mix temp: 77 deg F ASTM C1064 Ticket/Truck : 3503841785 / 89 Mold type: CYL Placement Location Slab on grade 5" shop 4 between H -B/1-8, 4 -5/A -B.5 Sample Location: Approx 3/G.5 Comments: Cylinder Test Test Cure Dimensions (in) Area Max Load Corr Strength Fracture # Age Date Type Diameter X Height (int) (lb) Factor (psi) Type 011234A 7 09/17/14 Lab 4.00 X 8.00 12.57 46,410 1.00 3,690 Side fracture at end 011234B 28 10/08/14 Lab 4.00 X 8.00 12.57 0 1.00 0 011234C 28 10/08/14 Lab 4.00 X 8.00 12.57 0 1.00 0 011234D 28 10/08/14 Lab 4.00 X 8.00 12.57 0 1.00 0 011234E H Lab 4.00 X 8.00 12.57 0 1.00 0 Unless otherwise noted, samples tested in accordance with ASTM C39 RESPECTFULLY SUBMITTED: Consolidated Engineering, Greg D. LeRoy, PE, LAB MANAGER CC:City of Cupertino - Albert Salvador City of Cupertino - Albert Salvador E -Reports placeholder - DECEIVED OCT 09 2014 BY All reports are submitted as the confidential property of our clients. Publication of statements, conclusions, or extracts is reserved pending our written approval.