15080104CITY OF CUPERTINO BUILDING, PERMIT i J
BUILDING ADDRESS:.
20525 MARIANI AVE CUPERTINO CA 95014 (326 56 001)
CONTRACTOR: I PERMIT NO:
OWNER'S NAME: 20525 MARIANI DRIVE LP DATE ISSUED 0////i
OWNER'S PHONE: PHONE NO:a
1_11 Lei 3103,51 =7N-VWr1M@ FOUTRIFIT1111 MM
License Class Lic. #
Contractor Date
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.
hereby affirm under penalty of perjury one of the following two declarations:
r. 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
��by
rmance of the work for which this permit is issued.
e and will maintain Worker's Compensation Insurance, as provided for
ction 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and hereby
authorize representatives of this city to enter upon the above mentioned
property for inspection purposes. (We) agree to save indemnify and keep
harmless the City of Cupertino against liabilities, judgments, costs, and
expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will
comply with all non- . sou regulations per the Cupertino Municipal
Code, c ion
Date
Signature
BUILDING PERMIT INFO:
—BLDG —ELECT _PLUMB
_ MECH _ RESIDENTIAL, _ C
JOB DESCRIPTION:
APPLE - T.I. FOR RECONFIGUP
FLR (WEST WING) LABS & OF
Sq. Ft Floor
APN Number:. Occupancy "1yp
326 56 001
PERMIT EXPIRES IF
WITHIN 180 DAYS OF
180 DAYS FR
Issued
Date:
I hereby affirm that I am exempt from the Contractor's License Law 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 offered
for sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for
by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
I certify that t have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
understands and will comply with all non -point source regulations per the
Cupertino Municipal Code, Section 9.18.
Signature Date
RE-]
All roofs shall be inspected prior to any
installed without first obtaining an inspet
Signature ofAppl
Date:
I have read the hazardous materials re4
California Health & Safety Code, Sect
maintain compliance with the Cupertino
Health & Safety Code, Section 25532(:
material. Additionally, should I use equi
air contaminants as defined by the Bay?
will maintain compliance with the Cope'
the Health & SafetxFlerSeel
Owner or authorized agent:
Date:
C-lt,"14� CONSTRUCTIONI
I hereby affirm; that there is a constructic
of work's for which this permit is issued
Lender's Name
Lender's Address
ARCHITECT'S
I understand my plans shall be used as
Licensed
IOVATE (E) GROUND
(6,265 S.F.)
IS NOT STARTED
IT ISSUANCE OR
.ED INSPECTION.
D
ig material being installed. If a roof is
I agree to remove all new materials for
"A" OR
iirements under Chapter 6.95 of the
ns 25505, 25533, and 25534. I will
Iunicipal Code, Chapter 9.12 and the
should I store or handle hazardous
nent or devices which emit hazardous
ea Air Quality Management District I
no Municipal Code, Chapter 9.12 and
nsA55eS.— M533, and 25534.
lending agency for the performance
ac. 3097, Civ C.)
records.
CONSTRUCTION PERMIT APPLICATION
Im COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingCa cupertino.org /57 o
6-0 ell C
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL
PERMIT #
PROTECTADDRESSa
Ne
APN# _Cy,'-(
0
y
OWNERNAME_
�r�� �
PRONE
E-MA®LLd
4h_.aCa,Co
f
STREET ADDRESS 4-I 6I ��"�'~' �� kin- ITY, STATE, ZIP r-(+��°
FAX
f -I I.
CONTACT NAME
PHONE
E-MAIL,
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGI
4EER ❑ DEVELOPER ❑ TENANT
CONTRALTO NAM ej� $
LICENSE NUMB R
LICENSE TYPE
BUS. LIC #
COMPANY E !
E-MAIL
FAX yob _D
�� ; !
TES
STREET ADDRESS ,
rl Vw_naMw)
CITY, STATE, ZIP
3� r Ca 01's
PHON
F
ARCHITECT/ENGINEER NAME
LICENSE NUMBERBUS.
LIC #
A4_4
COMPANY NAME, p[� _c
..
E-MAIL
�'V el
FAX e 9 l -1 I r2 L)
g^K°-eD �6\G"yM ■�60.6.rLi'�1" }
STREET ADDRESS
CITY, STATE, ZIP
9q I di
O. W
PHCA
DESCRIPTION OF
12 C -J)
EXISTING USE PRO POSED USE CONSTR- TYPE #STORIES USE TYPE OCC.
SQ.FT. VALUATION ($)
g
IL
LXISTGNEWFLOOR
ae DEMO TOTAL
AREA(r`a _ AREA J AREA NET ARE
BATHRO M TCHEN OTHER
REMODELAREA REMODELAREA REMODEL AREA
PORCH AREA CKAREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑ATTACH
# DWELLING ITS: IS A SECOND UNIT❑YES SECOND STORY ❑YES
BEING ADDED? ZNO ADDITION? I-i1'NO
J`�
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN 11 YES -
LETTER EICHLER ROME? No
TOTAL VALUATION:
UA®r J
PLANNING APPL #NO PLANNING APPROVAL
4
By my signature below, I certify to each of the following: I am the property o r aut orized agen ct 0 e prope is behalf. I have read this
' to comply with all applicable local
application and the information I have provided is correct. I have read the Description of Work an verify Is ae . agree
I of Cupertino to enter the above -identified p perty for inspection purposes.
ordinances and state laws relating to building construction. authorize representatives
Signature of Applicant/Agent: Date
SUPPLEMENTAL IXPORMATION REQUIRED
tsa IEr T h z A
New SFD or Multifamily dwellings: Apply for demolition permit for]
;y�RtiltitG�LA>��r��
existing building(s). Demolition permit is required prior to issuance of building
y
permit for new building.
;
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
vAAr
form if any Hazardous Materials are being used as part of this project.rP'p
_ Copy of Planning Approval Letter or Meeting with Planning prior toMy
f
:,� s r iAIsrAxs DsTRICT
submittal of Building Permit application.
IROItIT�1zI As .....
u,.
I
B1 ARP_2011.docrevised 06/21/11
R
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 15080104
20525 MARIAM AVE CUPERTINO CA 95014 (326 56 001)
Devcon Construction
690 Gibraltar Dr. Milpitas,
CA 95035
OWNER'S NAME: 20525 MARIAM DRIVE LP
DATE ISSUED: 01/12/2016
OWNER'S PHONE: 4084721275
PHONE NO: 4086090716
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class" Lic. #399163
Contractor Devcon Construction Date 2/25/2016
—BLDG —ELECT —PLUMB
MECII RESIDENTIAL _ 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:
APPLE - T.I. FOR RECONFIGURE/RENOVATE (E) GROUND
I hereby affirm under penalty of perjury one of the following two declarations:
FLR (WEST WING) LABS & OFFICES (6,265 S.F.)
1. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
REV # 1 - REVISE PLUMBING LAYOUT - ISSUED 2/25/2016
performance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as provided for
by Section 3700 of the Labor Code, for the performance of the work for which
Sq. Ft Floor Area:
Valuation: $250000.00
this permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county
326
32656 001
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
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply all n-py w' urc ulations per the Cupertino Municipal
180 DAYS FROM LAST CALLED INSPECTION.
Code ection 9 8`
Issued by: PAUL O'SULLIVAN
Signature ate 2/25/2016
Date: 2/25/2016
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
t. 1, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 2/25/2016
contractors to construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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, for the
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
z. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
this permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, sh equipment or devices which emit hazardous
air contaminants as de red by the B ity Management District I
shall not employ any person in any manner so as to become subject to the
will maintain complian with th Cup to o Municipa ode, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Co , Se ions 25505 553 an 25534.
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
Owner or authorized agent:
be deemed revoked.
Date: 2/25/2016
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
AGENCY
CONSTRUC ON LENDING Cy
I hereby affirm that there is a construction lending agency for the pe rmance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
ARCHITECT'S DECLARATION
understands and will comply with all non-point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date 2/25/2016
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPfRT[NO
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org
CC
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT 02510 1
PROSECT ADDRESS 1 t APN # 3a V
OWNER NAME d \ PHONE MAIL
-k a�l
STREET ADDRESS CITY STATE, ZIP FAX
1
CONTACT NAME PHON — E-MAIL 1�
STREET ADDRESS PTY, STATE, ZIP _ !. J _^ FAX 1
❑ OWNER ❑ OWNIER-BUILDER ❑ OWNERAGENT ,XCONTR4CTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE Tl'P
BUS. LIC
l
1
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CI TY, STATE, ZIP
PHONE
EXISTG
NEW FLOOR
DEMO
LICENSE NUMBER
ARC1ITECT111qW
BUS. LIC #
SS d
COMPANY NAME
E-ILAIL
-ax
FAX 5_ g 2 l
k 1 J 1
OC
a c
c�
STREET ADDRESS
C;TY, S�TE, ZIP C
PHONE
,
CC�_
IDES IQ39 CjF G (2_r l S l 6 ifs
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
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK,PORCH AREA
GARAGE AREA: DDETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? []NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN S' REC BY: ION:
PLAN'NTING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME
By my signature below, I certify to each of the following: I am the pro? rty owner or authorized agent to act -6h the property owner's behalf. 1 have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating t buildin const uctron. I au�thoorriize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: � � `/� fel Date: ? fZ,�3 /I (Q
SUPPLEMENTAL ENTFORMATION REQUIRED PLAN CHLCK TYPE ROUTING SLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COU\TER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIENY
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to ElI%tUOR 1-1 SANITARY SENYER DISTRICT
submittal of Building Permit application. V
❑ ENVIRONMENTAL HEALTH
B1d&4pp_2011.doc revised 06/21/11
,
CITY OF CUPERTINO
TTT T.c1rF'W1%N ♦ rgld-%" DTTTT "INT!'' "7F%T11QTn1V
'-
1' Al L' JLJ" 1 XI V JL 1 1 vim
— — -
—
PC FEE ID BP FEES
ADDRESS: 20525 MARIANNI AVE
B (Tenant Improvements)
REVIE;ED BY: MELISSA
6,265
7DATE:08/13/2015
APN: 326 56 001 BP#:
*VALUION: $250,000PERMIT
TYPE: Building Permit PLAN YPE, Tenant
ImpromentPRIMARY
Commercial Buildin gPERMIYPE:
PENTATION1B TI
A
USE:
Mer! Irl DIJ. 1` eE;:
WORK
I APPLE - T.I. FOR RECONFIGURE/RENOVATE E GROUND FLR
WESTWING) LABS & OFFICES
SCOPE
(6,265 S.F.)
QTY/FEE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.L
PC FEES
PC FEE ID BP FEES
BP FEE ID
B (Tenant Improvements)
II-A,111-A,V-A
6,265
$3,127.34
IBTIPLNCK $6,481.07
IBTIINSP
0[heP:�'l('ch. Ird.Sti.
%3iide3' 1's tt.17?iJ fPt3ir).
Mer! Irl DIJ. 1` eE;:
1'f7!tt t i+. lwvp. Fee:
NOTE: This estimate does not include fees due to other Departments 0.e. Planning, I
District, etc). Theseees are based on the pretiminarY information available and are
FEE ITEMS (Fee Resolution 11-053 Eff.
711/13) FEE
QTY/FEE
Plan Check Fee:
$3,127.34
TOTALS:
6,265
$3,127.34
$6,481:07
PME Plan Check:
lYiEG1GI,HOiRLY Yes : ,1S7o
: PLUMB, HOURLY ®ryes ..
?wcil. Plan ('heck
1'11,w;7b..Plan CFtC:2'
1e& 1'eni t Fee:
1'Ia m%. 1'2i 27 Fec::
0[heP:�'l('ch. Ird.Sti.
%3iide3' 1's tt.17?iJ fPt3ir).
Mer! Irl DIJ. 1` eE;:
1'f7!tt t i+. lwvp. Fee:
NOTE: This estimate does not include fees due to other Departments 0.e. Planning, I
District, etc). Theseees are based on the pretiminarY information available and are
FEE ITEMS (Fee Resolution 11-053 Eff.
711/13) FEE
QTY/FEE
Plan Check Fee:
$3,127.34
Suppl. PC Fee: 0 Reg. Q OT 17a
ii: $0.00
PME Plan Check:
$0.00
Permit Fee:
$6,481.07
Suppl. Insp. Fee -.(j) Reg. 0 OT
0.0
hrs $0.00
PME Unit Fee:
$0.00
PME Permit Fee:Via
i ()J ZSITUCt O}t 1 TV:
Administrative Fee:
Work Without Permit?
Advanced Planning Fee'1"ravel
Daeuine rllali0r, Fees:
Strong Motion Fee: 1BSEISMICO .
Bldg Commission Fee:
IBCBSC $10.00
UIITOTAhS`": $9,688.41
$0.0
i'..1 lan C .eck I '
( Elec. Iiie.:C. ICY. rI`rl iT 1'E'r"
r>tec. Imp. 1 -
Works, Fire, S nitary Sewer District, School
an estimate Cj Fitact the De t or addn'l
°ISC ITEMS
Select a Mis Bldg/Structure
-� r Element of a Building
X
Select a lon-Residential G
Building or Structure 0
Select Administrative Item
T fiAL FEE:4 $9,688.41
Revised: 07/02/2015
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department 1
City Of Cupertino 1s I
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: Q, M5 �A
PERMIT # 1-5- (0)0 t (�
OWNER'S NAME: PW&L – :l
PHONE #
GENERAL CONTRAC OR:
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE:
*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 THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: —
Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
rA
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
m(nka-VU)CA
0,6LR
Cement Finishing
(� I
Electrical
8�a3
Excavation
Fencing
`
7jg
Flooring/ Carpeting
a 3
Linoleum / Wood
Glass / Glazing
Heating
—
a)
Insulation
r
(�1 Z�j2(
Landscaping
Lathing
Masonry
Painting /Wallpaper
Y
Paving
Plastering
Plumbing
i.
v 2 a
Roofing
U j
039 a.(o 35(;6
Septic Tank
Sheet Metal
R
Sheet Rock
0(0 j17444
ce� � I yl
Owner / Contractor Signature
Date
rA
CUPERTINO
PURPOSE
HAZARDOUS MATERIALS CHECKLIST
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ing(Dcupertino.orq
To minimize possible delays that would result for the Fire Department plan review, please complete the
following checklist to determine if an additional level of Hazardous Materials plan review will be
required.
MARK `YES' IF THE PROPOSED SCOPE OF WORK INCLUDE ANY OF THE FOLLOWING?
PLEASE MARK YOUR ANSWER WITH AN `X' IN THE YES OR NO BOX ON THE SIDE
BELOW.
YES
NO
1. Use, dispensing, mixing or storage of flammable or combustible liquids or gases,
hazardous materials, etc.
2. Battery back-up rooms or racks.
3. Propane tanks.
4. Gasoline stations with underground tanks.
5. Installation or replacement above ground or underground storage of liquid petroleum
products, liquefied petroleum gases, compressed natural gas, explosives or other
regulated hazardous materials.
6. Gas rooms for dentist, doctors or veterinarians.
7. Generators with back-up diesel or other fuels.
8. Large refrigeration systems.
9. Fuel cell systems.
10. Commercial pool systems.
11. Chemical Storage areas.
12. Flammable liquid storage.
13. Compressed Gases.
14. Dry cleaners.
15. Print Shops.
16. Auto Repair and Auto Body Shops.
17. Research and Development.
For any additional information regarding this checklist, please contact Hazardous Materials Specialist, Santa
Clara County Fire Department, at (408) 378-4010.
HasA1al 2011.doc revised 0107111
engineered systems
1133 Aladdin Avenue
San Leandro, CA 94577
Tel: (510) 346-4300
Fax: (510) 347-1331
Contractors Lic#120696
TEST AND BALANCE ANALYSIS REPORT
Job Name: Apple NIA01 ETFA Lab
20525 Mariani Ave., Phase 2
Cupertino, CA ,
ACCO Job #: 621032
Contractor: Devcon Construction
Engineer: acco engineered systems
AIR DISTRIBUTION SYSTEM HAS BEEN COMPLETELY BALANCED
AS PER REQUIREMENTS OF SPECIFICATIONS AND RESULTS OF
TESTS HEREIN LISTED.
Date: May 9, 2016
Technician: Bryan Tate
Approved By: Amber Ryman
(::A:CCODengineered systems
Air Balance Symbols
(;FM
Cubic Feet Per Minute
FPM
Feet Per Minute
Ak
Free Area Factors
CSD
Ceiling Supply Diffuser
CSG
Ceiling Supply Grille
CRR
Ceiling Return Register
EAG
Exhaust Air Grille
SWG
Sidewall Grille
EAG
Exhaust Air Grille
LT
Light Troffer
LSD
Linear Slot Diffuser
VAV
Variable Air Volume Box
AHU-1
Air Handling Unit #1
EF -1
Exhaust Fan #1
SF -1
Supply Fan #1
T -stat
Thermostat
D.A.
Direct Acting
R.A.
Reverse Acting
DDC
Direct Digital Control
N.I.
Not Installed
N/L
Not Listed
N/A
Not Applicable
DNA
Data Not Available
FLA
Full Load AMPS
V
Volts
A
Amperage
PH
Phase
HP
Horsepower
BHP
Brake Horsepower
RPM
Revolutions Per Minute
SP
Static Pressure
TSP
Total Static Pressure
TES
Total External Static Pressure
VP
Velocity Pressure
OSA
Outside Air
RA
Return Air
MAT
Mixed Air Temperature
EAT
Entering Air Temperature
LAT
Leaving Air Temperature
AT
Differential Temperature
AP
Differential Pressure
W.C.
Inches of Water Column
N/T
Not Taken
r engineered systems
1133 Aladdin Avenue San Leandro, CA 94577-4311
(510) 346-4300 9 (510) 347-1331 • License # 120696
AIR OUTLET TEST REPORT
DATE: 04/27/16
PAGE: 1
PROJECT Apple MA01 ETFA Lab
SYSTEM NO. Existing Supply TEST APPARATUS Alnor Flowhood EBT721 91201041
AREA SERVED ETFA Lab OUTLET MANUFACTURER Titus
SUB -SYSTEM
OUTLETFLOW
GAIN
DESIGN
(CFM)
PRELIMS
FINAL
IDENTIFIER
N0. TYPE SIZE
COOL HEAT
COOL HEAT
COOL
HEAT
(N) RH 1-B
1
SWG
12"x8"
365
-
348
209
2
SWG
12"x8"
365
-
373
189
3
SWG
12"x8"
365
-
382
182
Total
-
-
-
2.901
1095
550
0
0
1103
580
(E) RH 1-D
1
CD
2412
245
-
268
268
2
CD
2412
245
-
242
242
3
CD
2412
245
-
225
225
4
CD
2412
245
-
269
269
5
CD
2412
245
-
238
238
Total
-
-
-
2.413
1225
1225
0
0
1242
1242
(E) RH 101A
1
CD
2410
365
-
368
174
Total
-
-
-
2.551
365
180
0
0
368
174
(E) RH 122A
1
SWG 10"x10'
140
-
145
81
2
SWG
12"x8"
200
-
205
114
Total
-
-
-
4.475
340
180
0
0
350
195
(E) RH 125A
1
CD
2412
450
-
480
480
2
CD
2412
450
-
445
445
3
CD
2412
450
-
450
450
Total
-
-
-
2.747
1350
1350
0
0
1375
1375
REMARKS:
BALANCE TECH: Bryan Tate
I engineered systems
1133 Aladdin Avenue San Leandro, CA 94577-4311
(510) 346-4300 • (510) 347-1331 • License # 120696
AIR OUTLET TEST REPORT
DATE: 04/27/16
PAGE: 2
PROJECT Apple MA01 ETFA Lab
SYSTEM NO. Existing Supply TEST APPARATUS Alnor Flowhood EBT721 91201041
AREA SERVED ETFA Lab OUTLET MANUFACTURER Titus
S M
GAIN
(
FINALHEAT
IDENTIFIER
N0. TYPE SIZE
COOL HEAT
COOL HEAT
EAT
COOL
(N) RH 126.1
1
LSD
4'
300
-
285
149
2
LSD
4'
300
-
286
136
Total
-
-
-
2.473
600
300
0
0
571
285
(N) RH 126.2
1
LSD
4'
300
-
288
148
2
LSD
4'
300
-
300
158
3
CD
2408
150
-
158
156
Total
-
-
-
2.345
750
450
0
0
746
462
(N) RH 126A
1
CD
2412
450
-
470
470
2
CD
2412
450
-
433
433
Total
-
-
-
2.462
900
900
0
0
903
903
(E) RH 127A
1
CD
2414
365
-
361
361
2
CD
2414
365
-
366
366
3
CD
2414
365
-
371
371
Total
-
-
-
3.122
1095
1095
0
0
1098
1098
(E) RH 128A
1
CD
2408
80
-
80
52
2
CD
2412
240
-
264
145
3
CD
2412
240
-
230
174
Total
-
-
-
5.453
560
390
0
0
574
371
T:::A
REMARKS:
BALANCE TECH: Bryan Tate
engineered systems
1133 Aladdin Avenue San Leandro, CA 94577-4311
(510) 346-4300 • (510) 347-1331 • License # 120696
AIR OUTLET TEST REPORT
DATE: 04/27/16
PAGE: 3
PROJECT Apple MA01 ETFA Lab
SYSTEM NO. Existing Supply TEST APPARATUS Alnor Flowhood EBT721 912Q1041
AREA SERVED ETFA Lab OUTLET MANUFACTURER Titus
REMARKS:
BALANCE TECH: Bryan Tate
•
•
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■
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imm
■Emm
REMARKS:
BALANCE TECH: Bryan Tate
engineered systems
1133 Aladdin Avenue San Leandro, CA 94577-4311
(510) 346-4300 9 (510) 347-1331 • License # 120696
AIR OUTLET TEST REPORT
DATE: 04/27/16
PAGE: 4
PROJECT Apple MA01 ETFA Lab
SYSTEM NO. Existing Supply TEST APPARATUS Alnor Flowhood EBT721 91201041
AREA SERVED ETFA Lab OUTLET MANUFACTURER Titus
S M
GAIN
(CM
IDENTIFIER
D NTIFIER
N0. TY ELE SIZE
N)
MAX
MAXRELIM MIN
MAXFINAL
MIN
(E) CO 130A
1
CD 2416
500
-
528
131
2
SWG 12"x12'
200
-
186
38
Total
-
- -
2.664
700
165
0
0
714
169
(E) CO 133A
1
CD 2412
330
-
315
63
2
CD 2412
330
-
301
77
3
CD 2412
330
-
305
41
Total
-
- -
3.029
990
190
0
0
921
181
(E) CO 134A
1
CD 2412
300
-
308
60
2
CD 2414
700
-
630
116
Total
-
- -
1.592
1000
190
0
0
938
176
(E) CO 135A
1
CD 2412
300
-
1
310
54
2
CD 2412
300
-
295
10
Total
-
- -
2.441
600
65
0
0
605
64
(E)1 -G
1
CD 2412
330
-
332
111
2
CD 2412
330
-
326
99
Total
-
- -
2.076
660
200
0
0
658
210
(N) CO -136
1
SWG 12"x12'
300
65
296
63
Total
-
- -
3.171
300
65
0
0
296
63
(N) CO -137
1
CD 12"x12'
300
65
308
67
Total
-
- -
3.501
300
65
0
0
308
67
REMARKS:
BALANCE TECH: Bryan Tate
)engineered systems
1133 Aladdin Avenue San Leandro, CA 94577-4311
(510) 346-4300 • (510) 347-1331 • License # 120696
AIR OUTLET TEST REPORT
DATE: 04/27/16
PAGE: 5
PROJECT Apple MA01 ETFA Lab
SYSTEM NO. EF 1 TEST APPARATUS Alnor Flowhood EBT721 91201041
AREA SERVED ETFA Lab
OUTLET MANUFACTURER Various
SUB -SYSTEM
OUTLET
DESIGN (CFM
PRELIMS
FINAL
IDENTIFIER
NO. TYPE SIZE Ak
EXHAUSTT
EXHAUST
EXHAUST
EF 1
1 RND 6"
50
50
2 RND 10"
250
270
3 RND 6"
400
180
4 00 62"x15"
735
N/1
5 H0063"x`13" 5.88
600
647
6 HOOE 62"x15"
735
651
7 RND 4"
100
26
Total
- - - -
2870
0
1824
REMARKS:
Inlet 3 has been chanaed to
a snorkel from a Drevious
reaister inlet. 180 CFM is the hiahest
attainable CFM.
Inlet 7 is attached to equipment that does not draw when not operating. Unable to verify
actual flow.
BALANCE TECH: Bryan Tate
(3)engineered systems
,133 Aladdin Avenue San Leandro, CA 94577-4311
(510) 346-4300 • (510) 347-1331 • License # 120696
AIR OUTLET TEST REPORT
DATE: 04/27/16
PAGE: 6
PROJECT Apple MA01 ETFA Lab
SYSTEM NO. EF 2 TEST APPARATUS Alnor Flowhood EBT721 91201041
AREA SERVED ETFA Lab OUTLET MANUFACTURER Various
SUB -SYSTEM
OUTLET
DESIGN (CFM
PRELIMS]F—
FINAL
IDENTIFIER
NO. TYPE SIZE Ak
EXHAUST
EXHAUST
EXHAUST
EF 2
1 100E 62"x15"
735
993
2 100E 62"x15"
735
1142
3 RNID 8"
211
202
4 RND 8"
50
55
5 RNID8"
380
NIC
Total
- - - -
2111
0
2392
FT� I
REMARKS:
Hood flow balanced for velocity
not total CFM.
Inlet 3 design CFM taken from equipment manufacturers IOM.
BALANCE TECH: Bryan Tate
Gengineered systems
1133 Aladdin Avenue San Leandro, CA 94577-4311
(510) 346-4300 • (510) 347-1331 • License # 120696
AIR OUTLET TEST REPORT
DATE: 04/27/16
PAGE: 7
PROJECT Apple MA01 ETFA Lab
SYSTEM NO. EF 3 TEST APPARATUS Alnor Flowhood EBT721 91201041
AREA SERVED ETFA Lab
OUTLET MANUFACTURER Various
SUB -SYSTEM
OUTLET
DESIGN (CFM)
PRELIMINARY
FINAL
IDENTIFIERN0.
TYPE SIZE Ak
EXHAUST
EXHAUST
EXHAUST
EF 3
1 00 62"x15"j
735
664
2 00 62"x15"
740
900
3 RND 2.25"
105
34
Total
- - - -
1580
0
1598
REMARKS:
Hood flow balanced for velocitv
not CFM.
Inlet #3 for digester is only 2.25" diameter. Highest velocity attained was 1200 FPM.
BALANCE TECH: Bryan Tate
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