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B-2016-1301CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1301 19419 STEVENS CREEK BLVD STE 100 CUPERTINO, CA 95014 (316 20 112) MIDGLEN STUDIO ASSOCIATES WOODSIDE, CA 94062 OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LLC DATE ISSUED: 05/05/2016 OWNER'S PHONE: 408-777-3081 PHONE NO: (650) 366-0314 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #531113 Contractor MIDGLEN STUDIO ASSOCIATES Date 05/31/2018 X BLDG —ELECT —PLUMB MECH RESIDENTIAL X_ COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: Restaurant Tenant Improvement (Oren's Hummus Shop) (3038 sq ft) I hereby affirm under penalty of perjury one of the following two declarations: t. I have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 the Labor Code, for the of the work for which this of performance permit is issued. Sq. Ft Floor Area: Valuation: $130000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 316 316 20 112 A (Tenant Improvements) representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PFrR1VIIT ISSUANCE OR Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM L SPECTION. Signature Date 05/05/2016 Issued by: N Date: 05/05/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is r. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 05/05/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the a. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revolted. Owner or authorized age APPLICANT CERTIFICATION Date: 05/05/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 05/05/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 40300 TORRE AVENUE • CUPERTINO, CA 86014.3255 (408) 777-3228 • FAX (408) 777-3333 4 buildin oU ertlno.br ' Zo / .. { a CUPERTI!NO r� r}�I�"r� U n MOW OMW-Q'r'DFIPTIAM 1 { AnrsITMV I/V AT TFR AT,,). / TI M RRVISTON /DFARRRP_D ORIGINAL PERMIT 0 PROJECT ADDRESS `f 11 �sVPHONE APN V�/yyArLY [�r �r��iir OWNBRNAMA �} t� A /•J vLJ Cg P3 ?�r7D NCa Irr1W ', STRE$7 ADDRES$� M ITY,f0 A�V/1►J�. - "2 �ZA FAX CONTACT NAME % rte 0 STREET ADDRESS CITY, STATE, ZIP pAX ❑ OW)MR. ❑ OWM-BUE,DER MAOHNT ❑ CONTRACTOR ❑MNTRACTORAODNT © AROIIITRCr LI WWII= ❑ DEVELOPER ❑ TDNANr CONTRACTOR NAME ` I'lell ENUMD Je 2�l L1CHN5>; TN BUS. LIC ® COMPANY /•yt t - ti J (••4111 �� Y H-MAILk a ` /;m C1 F )I / [ 46 s,mPxrADDnP.ss �%vC)�I JAL CITY.�I�ji Non - Px �T7/,St'JQ�U ARCHP[TlCT/HNORdHRRNA ei P/ �f // � 1��+,t L[CDNSRNIJM(D�ER/'`/ ff�/"" C.�I L 'J BUS. LIC N C ���[y/L"1 �6� yy^ / C l/�)�"�"C@jL�4ZJ(J42`i�J ME, L� • CQ 1rA / P G (! V 0/0' /^11 p SrHBET DjtjiSB S%f/ ` �.Y,J �/y�^� /l / C1TYG �+ cz �! 17:� U / 7 /� PIi09% 1 V d/00 U=ldP`TION 0V WORtC C.fC1/Y►I t G t ` ^Z2 G! Iid EXIST USE PR S USE 1 ON 'R. TYPE 171 13 #STORMS USP, TYPR bCl;. SQ.FT, ($) VALUATIONtrANt. EXI970 AREA 77) NEW I%OOR DEMO AREA AREA TOTAL NBT AREA BATHROOM REMODnLARBA KITCHEN I MOAELAREA 01135R REMODELARRA - 31ORCHARM DECKAREA TOTALDECWPORCHAREA OARAOEARAA: El DEPACH ❑ ATTACH NDWELLINGUNITS:ISASBCONDiWr-r ❑YFS 1HUNGADDED? QNO smowisToky [3YEs ADDITION? []NO PRE -APPLICATION QYES WYSS,PROVIDECOPYOP PLANNING ADPL# ❑NO PLANNING APPROVALLMTBR ISTRUBLDOAN []YES E[CRLER Whig? L7 NO© EI TALVALUATION: OT 6 By my signature below, I certify to each of tho fbllowhig: I dm the property owner or authorized agent to on the property owner's WhalE 1 have lvadCtlllls ad the Description of Work and verify it is accurate. I agr o to reply with all applicable local application and file htti iontion I have provided is co at0121ho ordinances and state laws relnting t coD ru oze representatives of Cupertino to enter the above-idetlti ed .perry for inspection purposes. / SigrrdureofApplicant/Agmt: Date; SUPPLEMFNTAi. INFORMATION REQUIRED rI�AtY liaoK imE ; ... -R*Vr.nI G SLir p b�x� THL+.e'6 Ijgkk ❑ --B* UI .DING Pr Ail REVIEW New SPD or Multifamily dwellings: Apply for demolition permit for olcisting building(s). Demolition permit is required prior to Issuance of building ❑ k permit for new building, CJ EXPIISS PLANNING PL4t.f g�V _ Cotmneroial Bldgs: Provide a completed hazardous Materials Disclosure El STANDARD LO - PUBLIG �YOitK3 form if any Hazardous Materials no being used as part of this project. d TvaxcE Lp •irttsl; DEPT _ Copy ofPlatuung Approval Lotter or Meeting With Plai"tig prior to .�] i1rAJax Q BAN(TAItY SMVURDISTAI. ' submittal of $uildnlg Perinit application. . : ; CI HtiNlRtit�L4lEl�i7�'e1i�'�tEalt�l�li: <:;: . BidgApp 2011,doc revised 06/21/11 t, f uilding Department ^ City .Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255; Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR ! SUBCONTRACTOR LIST JOB ADDRESS: 19 41-4 5+o-Ve 1: ,,e -k. PERMIT # ZO lb — [' �l OWNER'S NAME: �' �-. e^ PHONE # dA -sT38 GENERAL CONTRACTOR: • y a Q �tL o sem" BUSINESS LICENSE # ZO' - _ l a cr> CITY/ZIPCODE: Mo- q�067 ADDRESS: *Our municipal code requires all businesses working in the eity to have a City of Cupertino NO BUILDING FINAL OR FINAL OCCUPANCY �SPECTION(S), WILL BE__SCHI GENERAL CONTRACTOR AND ALL SUBCONTRACTORS_ IIAVU OBTAINED A C BUSINESS LICENSE. I am not using any subcontractors: -y Signature �r Please 'check applicable sumac tractors and -complete the following information: siness license. ULED UNTIL THE Y OF CUPERTINO r Date V SUBCONTRACTOR-- BUSINESS NAME - BUS NESS LICENSE # Cabinets & Millwork a ' Cement Finishing ft Electrical " V1 � • Excavation Fencing. Flooring /Carpeting v^ cav►5 r - Linoleum / Wood! _ jV Glass / Glazing(,=:/1 j Heating Insulation Cs�i C3 Landscaping - Lathing Masonry ! fainting / Wallpaper i Com ' Paving Plastering , Plumbingvt VW fl 5`41 ZOO Roofing s t Septic Tank Sheet Metala r _ ` Sheet Rock F io 011 Tile ', �� %; �� � � � 1 `1�, L,�ve� i t�./�EA102 : » :��i � Owner /'Contractor Signature Date RECEIVED OCT 0'3 2016 qw�; TESTING ENGINEERS, INC. BY _'_Z1W 2811 Teagarden St. 510-835-3142 510-834-3777 fax San Leandro, CA 94577 800-660-3142 San Leandro • San Jose • Martinez INSPECTION REPORT Week Ending: 6/10/16 PROJECT # 63689 TYPE OF INSP ON: Vis Welding PROJECT:.. _v_ _ --PLACE-'.- 19419 PLACE Q19419 Stevens Creek Blvd. Ste. 100 obsite Orer's Hummus ' Cupertino, CA jO Permit # B2016-1301 DATE HOURS 6/10/16 4 INSPECTOR D. Knight Reported to Jim of Global Steel at the jobsite as requested. Performed visual inspection of welding previously completed without special inspection. Weldments consist of fillet welds joining HSS 31/2' x 3-1/2" x 5/16" brace to 3/8" gusset plate at top and bottom for assemblies marked BRI, BR2, BR3 and BR4 (complete); puddle and seal welds joining steel deck to W beams (complete); and stud welds joining composite deck to W members (in -progress). NOTE: Inspection was limited to weld sizes, lengths, profiles and surface quality. Cannot verify proper welding procedures, welder qualification, fit -up, etc. NOTE: Request for information: The following items are not in compliance with the approved job plans and specifications. These items need to either be corrected or approved in writing by the responsible engineer before the work can be accepted and a final report can be issued. > Eighteen (18±) studs to be rewelded; all stud welds to be cleaned for reinspection. The preceding work, as noted, was to the best of my knowledge, in compliance with approved plans and specifications, including revisions by engineer, and Drawings S1, S2.2 and S3.2. Reviewed by: -- "David Chippero Special Inspection Division Manager 1cc: Midglen Studio Associates / S. Patrick Masoud Salamat, S. E. Tecta Associates / A. Mohazab City of Cupertino / Bldg. Inspection Dept. The results presented in this report relate only to the item(s) tested/inspected and can be reproduced only in its entirety unless written permission from TEI is obtained. i CALGREEN SIGNATURE DECLARATIONSJ Project Name: Oren's Hummus Main Street 19419 Stevens _u. Project Address; _ Creek Blvd, Fier 1, Cupertino,. CA 95014 Project Description: Interior Tenant Improvement for A Restaurant. N1— TION Complete all lines of Section 1 — "Design verification" and submit the completedchecklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building:Standards Code as dootedaih0 City of Cupertino. Owner's Signature David qbhoi Owners game, mise Plio t Design Ptoleii5nsi"s Signature Ahmad Date 4 v Signature Lice ..a Professional responsible for CalGreen compliance date Ahmad Mo 415.362.5857 Name of License Professional responsible for CalGreen compliance (Please Print) Phone ahmad@tecta.com Email Address for License Professional responsible for CalGreen compliance ON .2 -- IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was c tructed " accordance with this Green Building Checklist and in accordance with the requirements of the 2 Cwal rnia Gr r Bu/i� Standards Code as adopted by the City of Cupertino. 10 G Signature of Licensrofessional responsible for CalGreen compliance Ahmad Mohazab Name of License Professional responsible for CalGreen compliance (Please Print) ahmad@tecta.com Email Address for License Professional respons IGre UIN( REVIEWED FOR CODE COMPLIANCE Page 9 of 9 Reviewed BY: Phuong Devries CalGreen Non -Res nntw 05/04/16 Date 415.362.5857 doc vised 01123;1=/ STATE OF CALIFORNIA REQUIRED ACCEPTANCE TESTS CEC-NRCC-MCH-04-E Revised 05/15 CALIFORNIA ENERGY COMMISSION — CERTIFICATE OF COMPLIANCE NRCC-MCH-04-E Required Acceptance Tests (Page 3 of 3) Project Name: OREN'S HUMMUS arePrepared: 1/11/2016 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: 4 Company: Mars Engineering Group, Inc. signature Date: 1/11/2016 Address: CEA/ HERS Certification Identification (if applicable): City/State/Zip: Phone: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer), 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. ResponsibleDesignerName: MAJID AMIRI RAZAVIAN Responsible Designer Signature: Company: MARS ENGINEERING GROUP Date Signed: o 1 Address: 22715 VICTORY BLVD. License; M31452 City/state/zip: WEST HILLS, CA 99307 Phone: 818-593-8999 CA Building Energy fff(ciency15tandards 2013 Nonresidential Compliance May 2015