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B-2016-1427
CITY OF &PERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1427 19700 VALLCO PKWY STE 100 CUPERTINO, CA 95014 (316 20 08) A C G CONSTRUCTION INC FOSTER CITY, CA 94404 OWNER'S NAME: KRISTEN LYNN DATE ISSUED: 06/16/2016 OWNER'S PHONE: 628-333-4836 PHONE NO: (650) 345-2082 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ]a Lie. #519466 Contractor A C G CONSTRUCTION INC Date 10/31/2017 X BLDG —ELECT —PLUMB — MECH RESIDENTL4L 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: FIT36 - T.I. (2,638 SQ FT) FOR A CROSS FIT FACILITY. I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self -ins re for Worker's REV #1 - T.I. - RELOCATED UTILITY ROOM TO THE FRONT Compensation, as provided for by Section 3700 of the Lablor Code, for the ISSUED: 06/22/2016 ,tom 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 Sq. Ft Floor Area: Valuation: $75000.00 permit is issued. I APPLICANT CERTIFICATION I certify that I have read this application and state that the abov information is correct. I agree to comply with all city and county lordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 31620 108 A (Tenant Improvements),B (Tenant Improvements) representatives of this city to enter upon the above mentioned �roperty for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of,this permit. WITHIN 180 DAYS OF PERMIT SSUANCE 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 LAST L INSPEC -ION. Signature a o Date 6/22/2016 Issued by: ALEX VALLELUNGA Date: 06/16/2016 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: II All roofs shall be inspected prior to any roofing material being installed. If a roof is m. I, as owner of the property, or my employees with wages a5 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 intlended or offered for inspection. sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting withlicensed Signature of Applicant: contractors to construct the project (Sec.7044, Business &rofessions Code). Date:6/22/2016 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 z. 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. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of 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 exemption, I become subject to the Worker's Compensatiop 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 revoked. I 0-02/1 Owner or authorized agent: 13 APPLICANT CERTIFICATION Date: 6/22/2016 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 6/2' 2/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION I 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUiPERTINO (408) 777-3228 • FAX (408) 777-3333 • build 1ng(a_)cupertino.org ,y� I ru P _ ❑ NEW CONSTRUCTION ❑ ADDITION' ❑ ALTERATION / TI REVISION/ DEFERRED ORIGINALL PERMIIT�(#C' PROJECT ADDRESS / 7� 4f ^ /1 APN # !� ® 68 a OWNER NAME 3.3 �E-MAIL STREET ADDRESS CITY, ATE, ZIP FAX CONTACT NAME/ ^ _ PHON�5O,p : ® E N�LZ AL _AaaL STREET ADDRESS /% - _ n — _% I I CITY, STATE, ZIP FAX • \ ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME JAY l CE LICENSE TYPE Q LD BUS. LIC # COMPANY NAME � 1/a /` EMAIL�/�J �1I ` ;J- /8® STREET ADDRESS tgC CITY, STV . PHO SD M Lj ,06 ARCHITECT/1 61 R L)1-6n LICENSE NUMBER BUS. LIC # COMPANYNAME5�`f.� F. -MAIL ---- FAX�F-010 ngs�B _3_1 �- STREET ADDRESS .31 CI STATE, ZIP C� C� w PH" K/ 2.�gL DESCRIPTION OF WORK. � 7� % y _ - 1 - ro- - . . A_ ..4 _n EXISTING USE PROPOSED USE CONSTR. TYP, ' # STORIES va 9 Ae /► pn P USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOG \ DEMO TOTAL ` AREA�?63F )i AREA 1�1` AREA BATHROOM '1 KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL REA PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA T GARAGE AREA: ❑ DETACH, ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? []NO a PRE -APPLICATION F1 YES IF YES, PROVIDE COPY OF IS THE BIl.DG AN ❑ YES RECENE ; -' TOTAL VALUATION: PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLE iHOME?. ❑NO &12 �-'"- By my signature below, I certify to each of the following: I am the property owner Or authorized ager o act ol the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is 2ccurate. I agree to comply with all applicable local ordinances and state laws relating to Q�ul� g ery�trucction.yII authorize representatives of Cupertino to enter the above -identified property/for inspection purposes. Signature of Applicant/Agent: ' (��.Xv �17 Date: SUPPLEMENTAL INFORMATION REQUI D PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ovER THE CouNTER BUILDING PLAN KEVIEW existing building(s). Demolition permit is required prior to is, of building permit for new building. PLANNWG,+PLANREVIEW _ Commercial Bldgs: Provide a completed Hazardous Ma erials Disclosure ❑' sTANri iRD ElP[ PUBLIC woxxs form if any Hazardous Materials are being used as part of this project:❑•, LARGE [RE DEPT' _ Copy of Planning Approval Letter. or Meeting with Planning prior to'M iaoR ❑ 'saivriAR SEN1ER DISTRICT submittal of Building Permit application. BldgApp_2011.doc revised 06121/11 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-1427 19700 VALLCO PKWY STE 100 CUPERTINO, CA 95014 (316 20 108) A C G OWNER'S NAME: KRISTEN LYNN OWNER'S PHONE: 628-333-4836 LICENSED CONTRACtORIS DECLARATION License Class 5 Lic. #519466 Contractor C G CONSTRUCTION INCDate 10/31/2017 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: i. 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 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 -point source -regulations per the Cupertino Municipal Code, Section 9.18. is Signature L,��J PU_L (—J Date 6/16/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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 (See.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. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manncr 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 ofthe 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 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 6/16/2016 CONSTRUCTION INC FOSTER CITY, CA 94404 ISSUED: 46/16/2016 NO: (650) 345-2082 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB — MECH _ RESIDENTIALX COMMERCIAL JOB DESCRIPTION: FIT36 - T.I. (2,638 SQ FT) FORA CROSS FIT FACILITY. Sq. Ft Floor Area: Valuation: $75000.00 APN Number: Occupancy Type: 316 20 108 A (Tenant Improvements),B (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby & ende Date: 06/16/2016" 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 ofApplicant: Date: 6/16/2016 ALL ROOF 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 agent: 0de1_C Date: 6/16/201 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 I I i NFW r0NgTRTT('TTr)1.T CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • building0cupertino.org 1 t A11 W- nXT %71 r `�-2otc�- ,. _ _ --------_,,. , . .. LJ ave v a-vav+[ ! >✓i:t-LL\14iL ViLLlrllVHl. t'.C.tV411I 7f PROJECT ADDRESS 19800 VALLCO PKWY, ST C-6 APN# ,. OWNER NAME * PHONE a�q. Q AC[G �1Ly R v STREETADDRESS ff vams 1 S TE, ZIP FAX CONTACT NAME�1 PHONE f �'/y� �%�j`xrti E-MAIL iIJ STREET ADDRESS- 'i"' aSTAT ❑ OWNER ❑ OWNER -BUILDER L OWNER AGENT CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER El DEVELOPER 0 TENANT CONTRACTORNAME�tal +r L7 I LIC SENUpb>d 14 r LICE TYPTi BUS. LIC N c/...., �' COMPANY NAME ✓ 1; G-YIAI� i V Y+� i i .t7.�fr\. f`?� J (/y� � j'1 fes'•, � � FAX/% 2 5"_ L� tJ STREET ADDRESS f 05 C Y6540', ATiEs .IP /j _ 1 L �" PHO�NjE„�j ARCHrrECTlENG1NEER NAME DANIEL K MULLIN LICENSE NUMBER C24 05 BUS, CTC# COMPANY NAME EMAIL daniel@dkmullin.com FAX 303-362-7361 STREET ADDRESS 517 S MAIN ST CITY STATE.ZIP MOSCOW, ID 83843 PHONE 303-257-6029 DESCRIPTION OF WORK TENAN FINISH FOR RETAIL CROSS -FIT FACILITY - T %k bu- tuika (,—(p EXISTING USE - PROPOSED USE- - CONSTIL TYPL 9 STORIES - - - - - N/A A-3 I -A ra USE TYPE OCC. SQ.FT, VALUATION ($) EXISTG AREA NEW FLOOR AREA 2638 DEMO AREA 'rOTAL NET AREA 2638 - - - BATHROOM KITCHEN OTHER REMODEL.AREA REMODELAREA REMODELAREA PORCH AREA. DECK AREA TOTALDECIUPORCH AREA GARAGE AREA: - DETACH - ATTACH It DWELLING UNITS: ISA SECOND UNIT YES SECOND STORY [] YES - - - BMC ADDED? ZNO ADDITION? '�NO PRE -APPLICATION AYES IF YES, PROVIDE COPY OF PLANNINGAPPL$ KNO PLANNING APPROVALLETTER. ISTIIEBLDGAN ❑YES ..RECEIVED LICIILCRHOML? X,NO X ; _ TOTAL VALUATION: - - By my signature below, T certify to each of the following: I aril the property owner or authorized agent to act on the pr perty owner's behalf. I 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 colhply with all applicable Iocal ordinances and state laws relating to building construction.authorize representatives of Cupertino to enter the above-id�enttiifiedprroperty for inspection purposes. ..I Signature oi'Applicant/Agent: JS31 .- Crr Date: _ dC[^�t" L 60 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TAPE ROUTING SLTR ❑ : ovI it ri co[INz> R �BCJILDING P..Ar REVIE�y 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. YA Commercial Bldgs: Provide a completed Hazardous Materials Disclosure❑ . STANDARD � PTJI3LIC \VO$KS �I1Ut1(IY({i 't _ orrn if any Hazardous Ivlatcrials are being used as part of this project. CI.LARGE I7REDEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to p Ild submittal of Building Permit application. I4rAJOR sANITr1RY SEw$RDISTRICT BldgApp 2011.doc revised 06/21/11 r, lu OSHPD No: Service Code(s): 2501: INSPECTION OF BLOCK, REINFORCING STEEL Permit No: Re -inspection: NO Show Up: Other: Job -site Contact: Roger Other 2: ❑ Inspected placement of block/brick units at (list locations below): ❑ Approximately square feet were placed. RY IN$PECTION a FIT36 TENANT IMPROVEMENT 19700 VALLCO PARKWAY, STE. 10 0 Work was performed by 1 masons and 1 hod carriers. ❑ Cast 2" x4" cylinders representing mortar placement for ❑ the above locations ❑ the following Jobsite mix was: ❑ Type S with a specified strength of 1,500 psi for 2" x 4" cylinders (or 1,800 psi for 2" x 2" cubes) El Type M with a specified strength of 2,100 psi for 2" x 4" cylinders (or 2,500 psi for 2" x 2" cubes) 0 Inspected placement of reinforcing steel at ❑ the above listed locations 0 the following locations: 1 st level, medicine ball wall at grid lines C.2 -C.5/20.6 (1 st lift). 0 Inspected grout placement of 2 cubic yards from and 'ticket # 58621 at above listed location 0 Cast 4 0 4" x 4" x 8" grout prisms ❑ masonry prisms representing grout placemet for: (Dimensions) 0 the above locations Elthe following locations: Star Ready Mix with mix #: (Supplier) Any Non -Compliance Reports? NO Any attachments to this report? NO Person notified of inspection results? Copy sent to the following email addresses: I verify that the work observed/performed applicable building codes. Roger 0 does ❑ does not (check one) comply with the approved drawings, specifications, and the Dispatch ID: 175974 Inspector: MEGEVAND, �9* Date: 06/29/2016 Inspector Signature Copy of inspector's/technician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI inspectors. Official reporting of such daily reports will be submitted to the approved distribution, in a timely manner, after review / edit / clarification by ISI managers and/or professional engineers. This procedure may not be followed to its full extent if a representative is not available. y FILE 1798 University Ave, Berkeley, CA 94703 510.900.2100 main 51 0.90G.21 01 fax Inspector: MEGEVAND, ANTOINE ISI Project No. Date: 06/29/2016, WEDNESDAY ISI Project N r Hours Worked: ST: 4.00 Address: OSHPD No: Service Code(s): 2501: INSPECTION OF BLOCK, REINFORCING STEEL Permit No: Re -inspection: NO Show Up: Other: Job -site Contact: Roger Other 2: ❑ Inspected placement of block/brick units at (list locations below): ❑ Approximately square feet were placed. RY IN$PECTION a FIT36 TENANT IMPROVEMENT 19700 VALLCO PARKWAY, STE. 10 0 Work was performed by 1 masons and 1 hod carriers. ❑ Cast 2" x4" cylinders representing mortar placement for ❑ the above locations ❑ the following Jobsite mix was: ❑ Type S with a specified strength of 1,500 psi for 2" x 4" cylinders (or 1,800 psi for 2" x 2" cubes) El Type M with a specified strength of 2,100 psi for 2" x 4" cylinders (or 2,500 psi for 2" x 2" cubes) 0 Inspected placement of reinforcing steel at ❑ the above listed locations 0 the following locations: 1 st level, medicine ball wall at grid lines C.2 -C.5/20.6 (1 st lift). 0 Inspected grout placement of 2 cubic yards from and 'ticket # 58621 at above listed location 0 Cast 4 0 4" x 4" x 8" grout prisms ❑ masonry prisms representing grout placemet for: (Dimensions) 0 the above locations Elthe following locations: Star Ready Mix with mix #: (Supplier) Any Non -Compliance Reports? NO Any attachments to this report? NO Person notified of inspection results? Copy sent to the following email addresses: I verify that the work observed/performed applicable building codes. Roger 0 does ❑ does not (check one) comply with the approved drawings, specifications, and the Dispatch ID: 175974 Inspector: MEGEVAND, �9* Date: 06/29/2016 Inspector Signature Copy of inspector's/technician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI inspectors. Official reporting of such daily reports will be submitted to the approved distribution, in a timely manner, after review / edit / clarification by ISI managers and/or professional engineers. This procedure may not be followed to its full extent if a representative is not available. 1798 University Ave, Berkeley, CA 94703 510.900.2100 main 510.900.2101 fax Inspector: STOCKE, JACOB ISI Project No.: Date: 07/01/2016, FRIDAY ISI Project Name: Hours Worked: ST: 4.00 Address: OSHPD No: Service Code(s): 2501:_ INSPECTION OF BLOCK, REINFORCING STEEL Permit No: Re -inspection: NO Show Up: Other: Job -site Contact: Roger Other 2: ❑ Inspected placement of block/brick units at (list locations below): ❑ Approximately square feet were placed. MASONRY INSPECTION' 2810-001.0 FIT36 19700 VALLCO PARKWAY. STE. I od ❑ Work was performed by masons and hod carriers. ❑ Cast 2" x4" cylinders representing mortar placement for ❑ the above locations ❑ the following Jobsite mix was: ❑ Type S with a specified strength of 1,500 psi for 2" x 4" cylinders (or 1,800 psi for 2" x 2" cubes) Type M with a specified strength of 2,100 psi for 2" x 4" cylinders (or 2,500 psi for 2" x 2" cubes) R1 Inspected placement of reinforcing steel at ❑ the above listed locations R1 the following locations: 12" Non-bearing CMU Wall - 2nd Lift © Inspected grout placement of 1.5 cubic yards from and ticket # 58629523641 at ❑ Cast ❑ 4" x 4" x 8" grout prisms ❑ the above locations ❑ the following locations: Any Non -Compliance Reports? NO Any attachments to this report? NO Person notified of inspection results? Copy sent to the following email addresses: I verify that the work observed/performed applicable building codes. mix #: (Supplier) ❑ masonry prisms representing grout placemen for: (Dimensions) Q does ❑ does not (check one) comply with the approved drawings, specifications, Dispatch ID: 175975 Inspector: STOCKE, JACOB Date: 07/0112016 Inspector Signature Copy of inspector's/technician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI inspectors. Official reporting ofsuch daily reports will be submitted to the approved distribution, in a timely manner, after review /edit/ clarification by ISI managers and/or professional engineers. This procedure may not be followed to its full extent if a representative is not available. J the 1798 University Ave, Berkeley, CA 94703 510.900.2100 main 510.900.2101 fax Inspector: ALAKBAROV, HEYDAR ISI Project No.: Date: 07/02/2016, SATURDAY ISI Project Name: Hours Worked: OT: 3.00 Address: FIELD STUC7URAL STEELIWELDIN REPORT 2810-001.0 FIT36 TENANT IMPROVEMENT 19700 VALLCO PARKWAY, STE. 106 Inspection Report Inc. Performed visual inspection of welding connections of HSS 10"x4"x1/4" beam to two HSS 4"x4"x1/4" columns as per detail 4 of drawing Column location: lines B.6/21.2 and B.6/22 ( reference drawing S-1). For all welds: VT -OK. Performed after the fact visual inspection of previously welded basement plates to HSS 4"x4"x1/4" columns as per detail 5 of drawing S - For all welds: VT -OK. ❑ Completed O Incomplete RIWelding to continue after this date ❑ Mill test reports attached ❑ Field Inspection ❑ Welding Procedure Specification (WPS) attached ❑ Non Conformation 'Report Attached: Job Status ❑ Exceptions Noted. Final acceptance pending Engineer approval or corrective action: 0 All welding completed and in progress comply with approved plans, specifications, approved changes AWS, CBC, AISC, and/or Any Non -Compliance Reports? NO Any attachments to this report? NO Person notified of inspection results? AI Graves Copy sent to the following email addresses: BigAI@acg1_.com I verify that the work observed/performed Q does ❑ does not (check one) comply with the approved drawings, specifications, ad the applicable building codes. Inspector Signature Dispatch ID: 176427 Inspector: ALAKBAROV, Date: 07/05/2016 Copy of inspector's/technician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI inspectors. Official reporting of such daily reports will be submitted to the approved distribution, in a timely manner, after review/ edit/ clarification by ISI managers and/or professional engineers. This procedure may not be followed to its full extent if a representative is not available. Attached OSHPD No: Service Code(s): 2601: FIELD INSPECTION OF STRUCTURAL STEEL A Permit No: _ Re -inspection: NO Show Up: Other: Job -site Contact: AI Graves Other 2: _ Erector: Silicon Valley Iron Work Contractor: ACG C Type of inspection 0 Continuous ❑ Periodic 0 After -the -Fact (check): ❑ Re -inspection ❑ High -Strength Bolting ❑ Other: Inspection Report Inc. Performed visual inspection of welding connections of HSS 10"x4"x1/4" beam to two HSS 4"x4"x1/4" columns as per detail 4 of drawing Column location: lines B.6/21.2 and B.6/22 ( reference drawing S-1). For all welds: VT -OK. Performed after the fact visual inspection of previously welded basement plates to HSS 4"x4"x1/4" columns as per detail 5 of drawing S - For all welds: VT -OK. ❑ Completed O Incomplete RIWelding to continue after this date ❑ Mill test reports attached ❑ Field Inspection ❑ Welding Procedure Specification (WPS) attached ❑ Non Conformation 'Report Attached: Job Status ❑ Exceptions Noted. Final acceptance pending Engineer approval or corrective action: 0 All welding completed and in progress comply with approved plans, specifications, approved changes AWS, CBC, AISC, and/or Any Non -Compliance Reports? NO Any attachments to this report? NO Person notified of inspection results? AI Graves Copy sent to the following email addresses: BigAI@acg1_.com I verify that the work observed/performed Q does ❑ does not (check one) comply with the approved drawings, specifications, ad the applicable building codes. Inspector Signature Dispatch ID: 176427 Inspector: ALAKBAROV, Date: 07/05/2016 Copy of inspector's/technician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI inspectors. Official reporting of such daily reports will be submitted to the approved distribution, in a timely manner, after review/ edit/ clarification by ISI managers and/or professional engineers. This procedure may not be followed to its full extent if a representative is not available. Attached Field Structural Steel/Welding Report (page 2) C (Complete) I (Incomplete) Copy of inspector'sitechnician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI inspectors. Official reporting of such daily reports will be submitted to the approved distribution, in a timely manner, after review / edit / clarification by ISI managers and/or professional engineers. This procedure may not be followed to its full extent if a representative is not available. 1 Total number of welders this date 1 New Welders Previously Identified Welder's Name: Identification: Carlos Loarca 1327641 Certified Welders: ❑ SMAW ❑ SAW Welding Process (identify ❑ FCAW E71T-11, diameter 0.035" ❑ ESW electrode and diameter) ❑ GMAW ❑ Same as previous date: ❑ Single Pass Fillet 0 Multi -Pass Fillet ❑ Complete Penetration ❑ Partial Penetration Type of welding ❑ Arc Spot Plug ❑ Flare Groove ❑ Seam ❑ Shear Stud performed Rebar to Structural Steel ❑ Rebar to rebar O Other: GRADE: ❑ A325 ❑ A490 ❑ Verified torque with bolt tension calibrator High Strength SAMPLED: ❑ Yes ❑ No (If yes, please see attached sampling report.) Bolts (HSB's) Location of HSB's: FIELD INSPECTION SUMMARY Use 8" x 19.5" 'Field Inspection Summary" sheet if all work identified cannot fit on this page (do not use both). Floor I Plan Grid Lines I Col. Size I Bm. Size I Other I I C I Description/Remarks/DWS, Details ❑ ❑ C (Complete) I (Incomplete) Copy of inspector'sitechnician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI inspectors. Official reporting of such daily reports will be submitted to the approved distribution, in a timely manner, after review / edit / clarification by ISI managers and/or professional engineers. This procedure may not be followed to its full extent if a representative is not available. 1798 University Ave, Berkeley, CA 94703 510.900.2100 main 510.900.2101 fax Inspector: ALAKBAROV, HEYDAR Date: 07/02/2016, SATURDAY Hours Worked: OT: 1.00 GENERAL INSPECTION REPORT IS] Project No.: 2810-001.0 ISI Project Name: FIT36 TENANT IMPROVEMENT Address: 19700 VALLCO PARKWAY. STE. 1 OSHPD No: Service Code(s): 2903: INSPECTION OF ANCHOR/DOWEL INSTALLATI Permit No: Re -inspection: NO Show Up: NO Other: Job -site Contact: Al Graves Other 2: Witness of installation of: 1. Four screw anchors ( Tapson, 3/8"x4") as per detail 3B of drawing S-2 2. Two expansion anchors (HILTI KB -TZ, 1/2"x3-3/4") as per detail 5 of drawing S-2. Column location: line B.6/22. All installation performed in accordance with the Project Specification and manufactor recommendations. Any Non -Compliance Reports? NO Any attachments to this report? NO Person notified of inspection results? Copy sent to the following email addresses: I verify that the work observed/performed applicable building codes. Representative Signature BiqAICcDacq1.com Q does ❑ does not (check one) comply with the approved drawings, specifications, nd the Dispatch ID: 176591 Inspector: ALAKBAROV; HEYDAR Z5;;;4 Date: 07/05/2016 Inspector Signature Copy of inspector's/technician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI Official reporting of such daily reports will be submitted to the approved distribution, in a timely manner, after review /edit/ clarification by ISI managers and/or professional This procedure may not be followed to its full extent if a representative is not available. 1798 University Ave, Berkeley, CA 94703 510.900.2100 main 510.900.2101 fax ANCHOR / DOWEL INSTALLATION Inspector: PATTERSON, RODGER ISI Project No.: 2810-001.0 Date: 06/27/2016, MONDAY ISI Project Name: FIT36 TENANT IMPROVEMENT Hours Worked: ST: 4.00 Address: 19700 VALLCO PARKWAY, STE. 1 OSHPD No: Service Code(s): 2903: INSPECTION OF ANCHOR/DOWEL INSTALLATI- Permit No: Re -inspection: NO Show Up: Other: Job -site Contact: Roger Other 2: Type of Anchor System (check one): ❑ Sleeve/Wedge/Expansion ❑ Epoxied All -thread Anchor (for Holddown: RI Epoxied Rebar Dowel ❑ Other (describe): Material into which anchors are/will be installed (check one): Q Concrete ❑ Masonry ❑ Other (describe): Remarks: Any Non -Compliance Reports? NO Any attachments to this report? NO Person notified of inspection results? Copy sent to the following email addresses: I verify that the work observed/performed applicable building codes. Q does ❑ does not (check one) comply with the approved drawings, specifications, I and the Dispatch ID: 175972 Inspector: PATTERSON, R DGER Date: 06/28/2016 Inspector Signature Copy of inspector's/technician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI Official reporting of such daily reports will be submitted to the approved distribution, in a timely manner, after review / edit / clarification by ISI managers and/or professional This procedure may not be followed to its full extent if a representative is not available. Holes blown Location(s) in Structure a 75 > Depth dust Nfreeof Verified and debris NStructure (Please note floorlevel,structural o E Ca L c Epoxy Used Exp. Date element [slab, wall, footing, etc]and N Z J_- C �=. grid lines from plans and anchor cLi m a Q v o o system Le_ plumbing, electrical, Q p O E aNi Z 4Ni } Z HVAC, fire sprinWer, structural, etc) m W Medicine Ball Wall 5/8" 17ebar 3" min. X X 18 Hilti Hit RE -500 ID 03/01/17 Remarks: Any Non -Compliance Reports? NO Any attachments to this report? NO Person notified of inspection results? Copy sent to the following email addresses: I verify that the work observed/performed applicable building codes. Q does ❑ does not (check one) comply with the approved drawings, specifications, I and the Dispatch ID: 175972 Inspector: PATTERSON, R DGER Date: 06/28/2016 Inspector Signature Copy of inspector's/technician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI Official reporting of such daily reports will be submitted to the approved distribution, in a timely manner, after review / edit / clarification by ISI managers and/or professional This procedure may not be followed to its full extent if a representative is not available. COMMENTS/NOTES TIFIED MATERIAL TEST RE] CUSTOMER BILL TO ADELPHIA METALS LLC 411 MAIN ST E NEW PRAGUE,MN 56071-2237 USA CUSTOMER MATERIAL Na DATE 07/27/2015 Vr 0 1 GRADE CUSTOMERSHIPTO E SEP ADELPHIA METALS LLC 12459B ARROW RTE LENGTH RANCHO CUCAMONGA,CA US -ML -RANCHO CUCAMON 91739-9601 12459-B B ARROW RTE_ USA RANCHO CUCAMONGA, CA 91739 SALES ORDER 2529754[000020 USA CUSTOMER PURCHASE ORDER NUMBER BILL OF LADING 815026 1338-0000033403 CHEMICAL COMPOSITION I5 �j% Fi % u % %o Q 0.41 1.08 0.012 0.037 0.28 0.23 CHEMICAL COMPOSITION CEq O6 0 0.61 MECHANICAL PROPERTIES UTS A MYISI PSl 69000 476 107000 MECHANICAL PROPERTIES BendTest OK COMMENTS/NOTES TIFIED MATERIAL TEST RE] CUSTOMER BILL TO ADELPHIA METALS LLC 411 MAIN ST E NEW PRAGUE,MN 56071-2237 USA CUSTOMER MATERIAL Na DATE 07/27/2015 Vr 0 1 GRADE SHAPE/ 60 (420) Rebar ! # LENGTH r48 2000° SPECIFTCAON / DATE or REVISION ASTM A615/ 615M-14 G/L El?g Inc a The above figures are certified chemical and physical test records as contained in the permanent records of company. We certify thai these data are correct and in specified requirements. This material, including the billets, was melted and manufactured in the USA. CMTR complies with EN 102 04 3.1. Mtcx aFi ^�/ saAsxAx YA1 Ahu+xcxn t )UC«i (% 2 jy&"'� v2, ! QUALITY QUALYF Y DWECrOR COMMENTS/NOTES The above figures are certified chemical and physical test records as contained in the permanent records of company. We certify tj jat these data: are correct and in specified requirements- This material, including the billets, was melted and manufactured in the USA. CMTR complies with EN 1 D204 3.1. NaCHAa �J BHASKAR YALAMANC M' [ cera_ /Z QUALMY paECTOR GRADE TOMER SHIP TO FAI2uD4,,B CUSTOMER BILL TO 60(420) ELPHIA lviETALSADELPHIA METALS LLC GERDAU ARROW RTE 411 MAIN ST E jP RANCHO CUCAMO ICA,CA NEW PRAG-UE,1ViN 56071-2237 LENGTH US ML-RAINCHO CUCAMON 91739-9601 USA 20' 00" 12459-B B ARROW RTE. USA CUSTOMER MATERIAL N° SPECIFICATION /DATE or REVISIOT RANCHO CUCAMONC3A, CA 91739 SALES ORDER ASTM A6 i 5j A615M-14 2529754/000050 USA CUSTOMER PURCHASE ORDER NUMBER BILL OF LADING DATE 815026 1338-0000033521 07/30/2015 CHEMICAL COMPOSITION % °Io % v % Ma %a % % 0.33 %1 %a 0.09 0.09 0.020 0.011 0.010 0.40 1.08 0:012 0.049 0.29 EI4n; MECHANICAL PROPERTIESa �.g G/L PSf 1ViPa PSI 684 .000 11.0 65000 448 100000 MECHANICAL PROPERTIES BendTest OK COMMENTS/NOTES The above figures are certified chemical and physical test records as contained in the permanent records of company. We certify tj jat these data: are correct and in specified requirements- This material, including the billets, was melted and manufactured in the USA. CMTR complies with EN 1 D204 3.1. NaCHAa �J BHASKAR YALAMANC M' [ cera_ /Z QUALMY paECTOR 07/09/15 ld-.05 AM va-usy iron inc via VSX—FAX page 1 of CL z51 Z:P,4 cr CD CA CL 0 'm (D CO Q. m G=W — :: 2 9. Z > M ca ;u 88zOz6z8OtL WW7�-rn mymlmmljm n--- 95416 A=M=:tL Z,5 (71 PeIS Od 869:2 94 90 Ef 'tnt to i A0, air 63 0 na 9L m at pYr OW cn Ol 88zOz6z8OtL WW7�-rn mymlmmljm n--- 95416 A=M=:tL Z,5 (71 PeIS Od 869:2 94 90 Ef -� A 081609:01a PD Steel C C C73 CD 0 0 CD cr to 5 Er—K a 0 CL CD tA io CA ID — 'ICACD m M6 0 cr, > M;= Im CLCD gi 14082920288 10 0 co A, 10 Cn to III cn 10 0 Z (p 0 In to w W co w co 00 N t0 C6 W N CD Ln IN Ich Ln co cn 04 ?R c-, > 0 co N 0 Z (p 0 w W co w co r -r OMER N t0 C6 i0 N Ich Ln co cn 04 ?R c-, w to I— Di —3 00 4:1 Ln CD w N cm m I--- co EQ C) w CD 0 C) 0 to to a LD m m C, ID C) C> 0a -3 Cl 00 t - Q CD C) VA ON CD Ln ZA tilCD J4 I., cla 0 b in o t- N w I-- to ri -1- 0% ko 4.1> ko 11 -4 t- Cil z z P 0 > 0 co N (p 0 w W co w co Aug.18.2016 3:2/NM ACG Construction CONTRACTOR / SUBCONTRACTOR LIST No. U94� N. 1 Building Department City Of Cupellino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 1 ax: 408-777-3333 70B ADDRESS- 19700 vALLCO PKWY SUITE 100 PERMIT #8-2016-1427 OWNER'S NAME:FIT36 PHONE #650-345-2082 GENERAL CONTRACTOR:ACO CONSTRUCTION INC BUSINESS LICENSE .#40506 ADDRESS: 1155 CHESS DR. #100 CITY/ZIPCOD E: POSTER CITY94404 -Our municipal code requires all businesses tivorking 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 CUPI RTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 8/18/16 Owner / Contractor Signature pate I SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSX # . X Cabinets & Millwork HAYWARD COMMERCIAL DOOR AND CONSTRUCTION 6213 Cement Finishing, X Electrical CAMPBELL ELECTRIC 36064/6217 Excavation X Life Safety BERGELECTRIC CORP 33918 X Mooring / Carpeting CRG 6216 4 Linoleum / Wood X Glass / Glazing CLASSIC GLASS 25840 X Heating C A MECHANICAL INC. 6214 X Insulation ACG CONSTRUCTION INC 40506 Landscaping Lathing X Masonry PT MASONRY 35846, X Painting / Wallpaper G & G PAINTING INC 34391 Paving Plastering X Plumbing A P S ROOTER 26535 Roofing Septic Tank X Sheet Metal C A MECHANICAL INC. 6214 X Sheet Rock ACG CONSTRUCTION INC 40506 X Tile PENNACHIO TILE INC 6215 8/18/16 Owner / Contractor Signature pate I i L E REPORT TO: City of Cupertino —Building Department August 17, 2016 1 mlii 10300 Torre Avenue ISI File No. 2810-001.0 Cupertino, CA 9501.4 ISI Lab No.: ' FV -59980 Oka PROJECT: Fit 36 Tenant Improvement 19700 Vallco Parkway, Ste. 100 Cupertino, CA 95014` C Application No. B-2016-1427 THIS IS I O CERTIFY that, as defined in Section 1704 of the California Building Code, we have provided special inspections of the following: • Masonry • Field welding Anchor/DowelInstallation These inspections were performed by personnel under the general supervision of the undersigned Registered Civil Engineer. Based upon the inspections performed, it is our professional judgment that the above listed work requiring special inspections was substantially in conformance with the approved plans and specifications and the applicable workmanship provisions of this Code. This report shall not be reproduced, except in full, without the written approval of ISI. y Submitted, )N SERVICES, INC. Somboon Sayawat, P.E. Senior Project Engineer cc: Tobin INSPECTION SERVICES, INC. a Berkeley, San Francisco, Oakland and Torrance s www.inspectionservices.net Mailing Address: 1798 University Ave., Berkeley, CA 94703-1514 a Phone 510-900-2100 a Fax 510-900-2101 1 1798 University Avel Berkeley, CA 94703 510.900.2100 main 510.900.2101 fax Inspector: PATTERSON, RODGI Date: 0,6/27/2016, MONDAY Hours Worked: ST: 4.00 Service Code(s): Re -inspection: Job -site Contact: Type of Anchor Material into which be installed (check NO Show Up: ger ANCHOR / DOWEL INSTALLATION ISI Project No.: 2810-001.0 ISI Project Name: FIT36 TENANT IMPROVEMENT Address: 19700 VALLCO PARKWAY, STE. 100 OSHPD No: TI Permit No: Other: o Other 2: �. Depth Verified (check one): ❑ Sleeve/Wedge/Expansion ❑ Epoxied All -thread Anchor (for Holddown: NIA) 0 Epoxied Rebar Dowel ❑ Other (describe): cors are/will 0 Concrete ❑ Masonry ❑ Other (describe): Location(s) in Structure CL — Holes blown Structure E o �. Depth Verified free of dust m m (Please note floor /e el, stmctural O _ E� and debris m element (slab, wall, fol ting, etc]and N Ca Z t CL Epoxy Used gritl Imes from plan and anchor E Li ca c v system i.e. plumbin HVAC, fie sprink/e� i, electrical, structural, etc) Q Q c Q o E Z Z .- — m Co W Ci Medicine Bali Wall ::::5�/8-ebar X 18 Hilti Hit RE -500 SD Remarks: Any Non -Compliance Reports? NO Any attachments to this report? NO Person notified of inspection results? Copy sent to the following email addresses: I verify that the work observed/performed Qes. El does ❑ does not (check one) comply with the approved drawings, specifications, and the applicable building Copy of inspector's/technician Official reporting ofsuch daily This procedure may not be fo Dispatch ID: 175972 Inspector: PATTERSON, RODGER Date: 06/28/2016 Inspector Signature s daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI inspectors. reports will be submitted to the approved distribution, in a timely manner, after review/ edit/ clarification by ISI managers and/or professional engineers. owed to its full extent if a representative is not available. Exp. Date 03/01/17 1798 University Ave, Berkeley, CA 94703 510.900.2100 main 5h 0.900.2101 fax Inspector: Date: Hours Worked: Service Code(s): Re -inspection: Job -site Contact: ip Inspected plat 0 Approximately 0 Work was ❑ Cast 06(29/2016, WEDNESDAY ST: 4.00 25)1: INSPECTION OF BLOCK REINFORCING STEEL INO Show Up: Roger ne,t of block/brick units at (list locations below): square feet were placed MASONRY INSPECTION ISI Project No.: 2810-001.0 ISI Project Name: FIT36 TENANT IMPROVEMENT Address: 19700 VALLCO PARKWAY, STE. 100 OSHPD No: Permit No: Other: Other 2: d by 1 masons and 1 hod carriers. _2" x4" cylinders representing mortar placement for ❑ the above locations ❑ the following locations: Jobsite mix was: ❑ Type S with a specified strength of 1,500 psi for 2" x 4" cylinders (or 1,800 psi for 2" x 2" cubes) ❑ Type M with a specified strength of 2,100 psi for 2" x 4" cylinders (or 2,500 psi for 2" x 2" cubes) 0 Inspected placement of reinforcing steel at ❑ the above listed locations 0 the following locations: 1st level,, medicine ball all at grid lines C.2 -C.5/20.6 (1st lift). 21 Inspected grout placement of 2 cubic yards from Star Ready Mix with mix #: S70MZ (Supplier). and ticket # 58621 at above listed location 0 Cast 4 1 0 4" x 4" x 8" grout prisms ❑ 0 the above locatil ns ❑ the following locations: Any Non -Compliance Reports? NO Any attachments to this report? NO Person notified of inspl ction results? Copy sent to the following email addresses: I verify that the work observed/performed applicable building codgI�S. {Dimensions} masonry prisms representing grout placement for: amegevand(a)inspection services. net Q does ❑ does not (check one) comply with the approved drawings, specifications, and the Dispatch ID: 175974 Inspector: MEGEVAND, ANTOINE Dater 06/29/2016 Inspector Signature Copy of inspector's/technician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI inspectors. Official reporting of such daily reports will 6e submitted to the approved distribution, in a timely manner, after review / edit / clarification by ISI managers and/or professional engineers. This procedure may not be followed to its full extent if a representative is not available. LS1 11M 1798 University Ave, Berkeley, CA 94703 510.900.2100 main 410.900.2101 fax Inspector: STOCKS, JACOB Date: 04/01/2016, FRIDAY Hours Worked: ST: 4.00 Service Code(s): Re -inspection: Job -site Contact: p Inspected plat ❑ Approximately ❑ Work was per Cast Jobsite mix was: ❑ 0 0 Inspected placeme 12" Non-bearing. CMU 0 Inspected grout and ticket # ❑ Cast ❑ the above I Any Non -Compliance Any attachments to tI Person notified of ins Copy sent to the follo I verify that the work o applicable building coc 31: INSPECTION OF BLOCK REII NO Show Up: of block/brick units at (list locations below): square feet were placed. MASONRY INSPECTION ISI Project No.: 2810-001.0 ISI Project Name: FIT36 TENANT IMPROVEMENT Address: 19700 VALLCO PARKWAY, STE. 100 OSHPD No: Permit No: Other: Other 2: by masons and hod carriers. _2" x4" cylinders representing mortar placement for ❑ the above locations ❑ the following locations: Type S with a specified strength of 1,500 psi for 2" x 4" cylinders (or 1,800 psi for 2" x 2" cubes) Type M with a specified strength of 2,100 psi for 2" x 4" cylinders (or 2,500 psi for 2" x 2" cubes) it of reinforcing steel at ❑ the above listed locations Q the following locations: Nall - 2nd Lift of 1.5 cubic yards from Star with mix #: 570MG (supplier) 23641 at ❑ 4" x 4" x 8" grout prisms ❑ masonry prisms representing grout placement for: (Dimensions) ❑ the following locations: ports? NO report? NO cion results? Roger ig email addresses: �rved/performed E does 0 does not (check one) comply with the approved drawings, specifications, and the Dispatch ID: 175975 Inspector: STOCKS, JACOB Date: 07/01/2016 Inspector Signature Copy of inspector's/technician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI inspectors. Official reporting of such daily reports will IIbe submitted to the approved distribution, in a timely manner, after review / edit / clarification by ISI managers and/or professional engineers. This procedure may not be followed to its full extent if a representative is not available. 1798 University Ave, Berkeley; CA 94703 510.900.2100 main 510.900.2101 fax Inspector: ALAKBAF Date: 07%2/20' Hours Worked: OT: 3.00 Service Code(s): Re -inspection: Job -site Contact: Erector: Silicc Type of inspection (check): Inspection Report Performed visual inspe Column location: lines I For all welds: VT -OK. Performed after the fac For all welds: VT -OK. 11 Completec ❑ Welding Pi Job Status 0 Exceptions R1 All welding Any Non -Compliance F Any attachments to thi: Person notified of insp Copy sent to the follow I verify that the work applicable building c Y Show Up: Iron Work Continuous ❑ Periodic Re -inspection ❑ High -Strength Bolting FIELD STRUCTURAL STEELIWELDING REPORT ISI Project No.: 2810-001.0 ISI Project Name: FIT36 TENANT IMPROVEMENT Address: 19700 VALLCO PARKWAY, STE. 100 OSHPD No: Permit No: Other: Other 2: Contractor: ACG Construction Inc. El After -the -Fact ❑ Other: tion of welding connections of HSS 10"x4"x1/4" beam to two HSS 4"x4"x1/4" columns as per detail 4 of drawing S-2. .6/21.2 and B.6/22 ( reference drawing S-1). visual inspection of previously welded basement plates to HSS 4"x4"x1/4" columns as per detail 5 of drawing S-2. 0Incomplete OWelding to continue after this date ❑ Mill test reports attached ❑ Field Inspection Summary Attached e Specification (WPS) attached ❑ Non Conformation Report Attached: Noted. Final acceptance pending Engineer approval or corrective action: completed and in progress comply with approved plans, specifications, approved changes AWS, CBC, AISC, and/or NO report? NO cion results? Al Graves ig email addresses: BigAh7a.acg1.com �rved/performed Q does ❑ does not (check one) comply with the approved drawings, specifications, and the Inspector Signature Dispatch ID: 176427 Inspector: ALAKBAROV, HEYDAR Date: 07/05/2016 Copy of inspector's/technician's d'ily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI inspectors. Official reporting of such daily reports will a submitted to the approved distribution, in a timely manner, after review / edit /clarycation by ISI managers and/or professional engineers. This procedure may not be followed to its full exte t if a representative is not available. aW Field Structural C (Complete) I lelding Report (page 2) Total number of welders this date 's Name: Loarca 1 New Welders Identification: 1327641 Previously identified vv ❑ SAW Al E71T-11, diameter 0.035" ❑ ESW W ❑ Same as previous date: e Pass Fillet RI Multi -Pass Fillet ❑ Complete Penetration ❑ Partial Penetration ;pot Plug ❑ Flare Groove ❑ Seam ❑ Shear Stud r to Structural Steel ❑ Rebar to rebar ❑ Other: 11 A325 ❑ A490 ❑ Verified torque with bolt tension calibrator D: ❑ Yes ❑ No (If yes, please see attached sampling report.) of HSB's: )n Summarysheet if all work identified cannot fit on this page (do not use both). Col. Size I Bm. Size I Other I I C I Description/Remarks/DWS, Details Copy of inspector's/technician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI inspectors. Official reporting of such daily reports will �e submitted to the approved distribution, in a timely manner, after review / edit/ clarification by ISI managers and/or professional engineers. This procedure may not be followed to its full extent if a representative is not available. Weld( Carlo: Certified Welders: ❑ SP Welding Process (identify 0 F( electrode and diameter) ❑ Gf El Sir Type of welding ❑ Art performed ❑ Re GRAD High Strength SAMP Bolts (HSB's) Locati( FIELD INSPECTION St Use 8"x 11.5" 'Field li Floor I Plan Grid Lines C (Complete) I lelding Report (page 2) Total number of welders this date 's Name: Loarca 1 New Welders Identification: 1327641 Previously identified vv ❑ SAW Al E71T-11, diameter 0.035" ❑ ESW W ❑ Same as previous date: e Pass Fillet RI Multi -Pass Fillet ❑ Complete Penetration ❑ Partial Penetration ;pot Plug ❑ Flare Groove ❑ Seam ❑ Shear Stud r to Structural Steel ❑ Rebar to rebar ❑ Other: 11 A325 ❑ A490 ❑ Verified torque with bolt tension calibrator D: ❑ Yes ❑ No (If yes, please see attached sampling report.) of HSB's: )n Summarysheet if all work identified cannot fit on this page (do not use both). Col. Size I Bm. Size I Other I I C I Description/Remarks/DWS, Details Copy of inspector's/technician's daily reports are emailed to the jobsite (or shop) representative as a convenience to the contractor, owner's representative and/or other ISI inspectors. Official reporting of such daily reports will �e submitted to the approved distribution, in a timely manner, after review / edit/ clarification by ISI managers and/or professional engineers. This procedure may not be followed to its full extent if a representative is not available. i 1798 University Ave, Berkeley, CA 94703 GENERAL INSPECTION REPORT 510.900.2100 main 510.900,2101 fax Inspector: A, AKBAROV, HEYDAR ISI Project No.: 2810-001.0 Date: 07/02/2016, SATURDAY ISI Project Name: FIT36 TENANT IMPROVEMENT Hours Worked: OT: 1.00 Address: 19700 VALLCO PARKWAY, STE. 100 OSHPD No: Service Code(s): 2903: INSPECTION OF ANCHOR/DOWEL INSTALLATI Permit No: Re -inspection: NO Show Up: NO Other: Job -site Contact: Graves Other 2: Witness of installatior1 of. 1. Four screw anchors ( Tapson, 3/8"x4") as per detail 3B of drawing S-2 2. Two expansion anchors (HILTI KB -TZ, 1/2"x3-3/4") as per detail 5 of drawing S-2. Column location: line .6/22. All installation performed in accordance with the Project Specification and manufactor recommendations. Any Non-ComplianceReports? NO Any attachments to this report? NO Person notified of inspection results? Copy sent to the follo�jving email addresses: BIgAI@acg1.com I verify that the work observed/performed R1 does ❑ does not (check one) comply with the approved drawings, specifications, and the applicable building codes. Dispatch ID: 176591 Inspector: ALAKBAROV, HEYDAR Date: 07/05/2016 Representative Signature Inspector Signature Copy of inspector's/technician's daily reports are emailed to thejobsite (or shop) representative as a convenience to the contractor, owner's representative and/orother ISI inspectors. Official reporting of such daily reports will be submitted to the approved distribution, in a timely manner, after review/ edit/ clarification by ISI managers and/or professional engineers. This procedure may not be followed to its full extent if a representative is not available. 13 INSPECTION SERVICES INC. Project Name: Client Name: FIT36 TENANT IMPROVEMENT FIT36 SILICON VALLEY COMPRESSION TEST REPORT Lab ID No,: 71935 Set# 1 of 1 ISI File No.: 2810-001.0 Approval Date: Material Type: GROUT Sampled By: ANTOINE MEGEVAND Supplier: STAR READY MIX Mix No.: S70MG Date/Time Sampled: Wed, 06/29/16 11:25 AM Truck No. /Ticket No: 53 / 58621 No. of Samples: 4 Location in Structure: 1ST LEVEL, MEDICINE BALL WALL AT Slump [in.]: 8.50 (C143) GRIDLINES: C.2 -C.5/20.6, 1ST LIFT Fresh Unit Weight [pct: NIR (C138) Air Temp [F]: 74 Air Content [%]: N/R (C173/C231) Mix Temp [F]: 80 (C1064) Comments: SAMPLE SIZE: 4X4X8 Average Measured Ultimate Corr Ultimate ID AGE Date Tested Diameter (in) Area Load (Ibs) Factor Stress (psi) Failure Type A 7 07/06/2016 4.08 x 7.71 x 3.85 15.71 46,670 1.00 2,970 4 - Diagonal B 28 07/27/2016 3.98 x 7.67 x 3.92 15.60 74,940 1.00 4,800 3 - Columnar C 28 07/27/2016 4.09 x 7.73 x 4.01 16.40 76,350 1.00 4,660 3 - Columna) D 28 07/22.7/2016 4.03 x 7.64 x 3.85 15.52 73,400 1.00 4,730 4 - Diagonal RESULTS Avg. Ultimate Compressive Strength at 28 days: 4,730 psi Specified strength: 2,000 psi PASS SAMPLED AND TESTED 1N ACCORDANCE WITH ASTM C140 AND UBC 21-18 SAMPLES NOT SCHEDULED FOR TESTING WILL BE DISCARDED AFTER 28 DAYS. THIS REPORT SHALL NOT BE REPRODUCED, EXCEPT IN FULL, WITHOUT THE WRITTEN APPROVAL OF ISI. Reviewed by: INSPECTION SERVICES, INC. Gabriel S. Hernandez, P.E. Laboratory Manager cc: FIT36 SILICON VALLEY (K LYN), ACG CONSTRUCTION INC (M TAYLOR) PECTION SERVICES, INC. ■ Berkeley, San Francisco, Oakland and Torrance ■ www.inspectionservices.net iling Address: 1798 University Ave. Berkeley, CA 94703-1514 0 Phone 510.900.2100 0 Fax 510.900.2101 CALGREEN SIGNATURE DECLARATIONS Project Name: Fit30 Project Address.- 19700 Vallco Pkwy, Suite 1001, Cupertino, CA Project Description: Tenant Finish for Crossfit Facility SECTION 'I — DESIGN VERIFICATION Complete al lines of Section 1 — "Design Verification" and submit the completed checklist (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 adopted by the City of Cupertino. r " I 5/10/16 — Owner's Signature---"- Kristen Date Lyn (Please Print) Owner's Name 05102/2016 Signature Design Professionai's Daniel K tate Mullin Name (Pl e Print) Design Professional's cense Professio al responsible for CalGreen compliance pate —we i Signature of L L05102/2016 5 to ccAS � I C- 208-892-8433 ponns�i/bllee(f1orrCalGreen compliance (Please Print) Professiex Name License (onal (ooff lre �Phone License Professional responsible for CalGreen compliance Email Addresslfor SECTION, 2 — IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Build ng Department prior to Building Department final inspection. 1 have inspec ed the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 Callfornia Green Building Standards Code as adopted by the City of Cupertino. -CQ 3. 1( Signature of License Professional responsible for CalGreen compliance Date �� 0,pzpwas6 Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for Page 9 cif 9 1CalGreen Non -Res Checklist.doc z eidsed 01123114 : INDEPENDENT AIR BALANCE �— i St Walsh Ave. an Santa Clara, 050 • ([ (f TEL: 408-327-7- 8400 • EMAIL: main@independentairbalance.com THE RESULTS OF OUR TESTS ARE ENCLOSED. CERTIFICATION NO: RT CERTIFICATION DATE: AND APPROVED BY: 26289 August 22, 2016 dent Air GENE TIRADO CERTIFICATION 3203 GENE D. TIRADO / Certified NE -RB Professional INDEPENDENT AIR BALANCE AIR SOUND HYDRONIC PROFESSIONALS TEL: 408-327-8400 TABLE OF CONTENTS FIT36 19700 VALLCO PARKWAY; STE 100, CUPERTINO, CA. AHU FAN APPARATUS SHEET PAGE: 1 *** �Hu AIR DISTRIBUTION SHEET PAGE: 2, 3 * * * FLOOR PLAN SHEET xxx COMPANY INFORMATION / CERTIFICATES ------ NEBB CERTIFICATIONS ------ CALIFORNIA STATE LICENSE ------ ABBREVIATION SHEET INDEPENDENT AIR BALANCE AIR SOUND HYDRONIC PROFESSIONALS 1134 Walsh Ave., Santa Clara, CA 95050 TEL: 408-327-8400 FAN SHEET PROJECT:1 FIT36 - 19700 VALLCO PKWY, STE 100, CUPERTINO PAGE: 1 SUCTION $.P. ------ 0.42" ----- 0.41" DISCHARGE S.P. ------ 0.23" ------ 0.25" E.S.P. i 0.60" 0.65" 0.60" 0,66" MOTOR MANUF THONI THON MOTOR HF 2.4 bhp 2.4 bhp 2.4 bhp 2.4 bhp MOTOR VOLTAGE 480 488 480 488 MOTOR PHASE 3 3 3 3 MOTOR AMPS 2.8 1.8 2.8 1.8 SERVICE FACTOR 1.15 1.15 1.15 1.15 MOTOR RPM 1725 1725 1725 1725 MOTOR SHEAVE 1VP50 x 5/8" 1VP50 x 5/8" SHEAVE % OPEN 90% 90% FAN SHEA VE AK94 x 1 AK94 x 1 FAN RPM DNL 801 DNL 808 BELT SIZENO OF A41/1 A41/1 NOTES: *1 *2 *3 INDEPENDENT AIR BALANCE AIR SOUND HYDRONIC PROFESSIONALS 1134 Walsh Ave., Santa Clara, CA 95050 TEL: 408-327-8400 AIR DISTRIBUTION ': FIT36 - 19700 VALLCO PKWY, STE 100, CUPERTINO PAGE: 2 AIR DISTRIBUTION DESIGN PRELIM FINAL NOTE 1D#� TYPE SIZE AK CFM CFM CFM AH -1 1 CD 6110 FH 50 40 55 2 , CD 811 0 FH 100 70 90 3 {, CD 8"0 FH 100 50 90 4 '', SWS 24 x 6 0.65 250 210 230 5 SWS 24 x 6 0.65 250 280 240 6 SWS 24 x 6 0.65 250 290 230 7 SWS 24x6 0.65 200 150 210 8 SWS 24 x 6 0.65 200 170 220 9 SWS 24 x 6 0.65 200 140 210 101 SWS 24 x 6 0.65 200 180 220 III SWS 24 x 6 0.65 200 140 180 121 SWS 24 x 6 0.65 200 145 190 131 SWS 24 x 6 0.65 200 240 220 2400 2385 OSA INTAKE 221t0 2.63 480 0 515 i I i i NOTES: INDEPENDENT AIR BALANCE AIR SOUND HYDRONIC PROFESSIONALS 1134 Walsh Ave., Santa Clara, CA 95050 TEL: 408-327-8400 AIR DISTRIBUTION FIT36 - 19700 VALLCO PKWY, STE 100, CUPERTINO PAGE: 3 ® . 1 • 11 1 .1 ® ' . 1 . 11 .® •1 1 ® . 1 • 11 •i ii ' ® ' • 1 . 11 1 G11 • ® ' • 1 • 11 � 11 •1- ®®® ' • 1 . 11 • 1 • t• 1 1 • 1 1 -- 1_1,� - —r___. -i� _� 1 — s8EG . s C+ { 3 € 1:50t/'-`\ ice( r -� IS CDSpi 1 IR 0 r k " it ,r I 5i tit 'M— 24K4IR 24§WR - QC 2sROFM I II E , 0 CD i OSA cFln.i�'J 22 0 , I; 3' g is .( { 5.BFTURnTJR C supRt� 6,0 CD jj V w s lz r101-2dX6 W% i ( jAnu yy, �E. aiu SOCy .f ,. 250CFM 1 IS F IX I n5 Y W n _. a ; I 9i#it ; Mfe € t N R[TURN — t RETURN RETURN% t .E :..' t ......»w._«_.........-- ] I� _ 24X6 €1JR y' ' S 2004 10 ;tet Ir! Too r ;moi 1 1, = f1 t ,.° z12 i I _ IXH i I t t , i OW SOOC t 824x6 i r CUF 4X6 WR;24X61 R 3 f ..;000FM' f I 9 200CF 7 tits T �� ! ,r - ' !fit .y � i•- 1 � f n � LF 4X6 WR t 200CFM 3 j/ } C$ ` 1 0200(.it F i 1 03 € 4X6 W� 24X6 WR; t j IR { I 2DOCFM .4 I j ! ! 1 1200 I F fOOCFM 1 G. 4X6 WRR I 1 2 I j, DOCFM S i. 200 F - 7 8 , 9 24X6 WR 24X6,WR 1 24X6 WR E I 24X6 WR 24X6 WR i 24X6 1JR + 200CFM 200CFAA -TM-) CIA l 200EF.'N ,1 �'2,OOCFn 200CFM 1 am Mom MENEM MaNNIONEamo �.W gm MMOL Ma; HY HP 2 MECHANICAL PLAN Project M1.0 � SCALE: 1/4' = 1'-0" North MIS is TO CEPdW-DW Indeyendmi. Air Balance m San Jose, CA HAS MET AU THE NEBB REQUIREMENTS To Cea lotm nd3ia"e TESTING AND BALANCING,* MD AGREES TO CONFORM TO NEBB PROCEDURES AND STANDARDS FOR Jtil and Sydtooic & i vtwnme n ntalSystems 'FOR THE BOARD OF DIRECTORS: Inde-yendent Air BaCancelCA Pres NO -3203 President -Elect THWISTO.-CIERTInTIMT erre. Tirado with Indefiendent Air- V,Cance m.San jose,* CA HAS NWT ALL THE NI*EB'B: REQUUWvMNTS FOR NEBCEMFIED PROFESRPNAL SIMSIN .: e6 . � .�lOntC UnVttonMenta"s�errt.� a F IRECTORS: Inde, Air BaCanceICA NO. 3203 NEB I% Cert. No, President-Sect Paul Schifino Board Chair -&- ro Pursuant to Chapter 9 of Division 3 of the Business and Professions Code and the Rules and Regulations of the Contractors State License Board, the Registrar of Contractors does hereby issue this license to: INDEPE INC to engage in th'0'UUsi66ss;- r act j,,th capacity;"f a contractor -fn ih-64"'f6flo C20 - WARM -AIR HEAVING, b AIR-CONDITIONING Witness my hand and seal this day, March 4, 2013 Issued March 1,,2013 This license is the property of the Registrar of Contractors, is not transferrable, and shall be returned to the Registrar upon demand when suspended, revoked, or invalidated for any reason. It becomes void if not renewed. Stephen P. Sands Registrar of Contractors 13L-24 (REV. 12.07) fM OSP 07 105.460 AUDITNO:6$1990 INDEPENDENT AIR BALANCE 1134 Walsh Ave Santa Clara, CA 95051 AIR SOUND HYDRONIC PROFESSIONALS TEL: 408-327-8400 ABBREVIATIONS ACT - ACTUAL AK FREE AREA FACTOR R.A. D - CEILING DIFFUSER RtQ ER - CEILING EXHAUST REGISTER aFM - CUBIC FEET per MINUTE S ' CENTER LINE CL _ RR CEILING RETURN REGISTER E.B. - DRY BULB E.D. - DIRECT DRIVE DNA - DATA NOT ACCESSIBLE D L - DATA NOT LISTED ETT - ENTERING ESP - EXTERNAL STATIC PRESSURE FP - FLOWHOOD (MEASURES CFM DIRECTLY SO FPM AND AK I FACTORS ARE NOT REQUIRED). FPM - FEET PER MINUTE FLA - FULL LOAD AMPS F L RR - FLOOR RETURN REGISTER FLSR - FLOOR SUPPLY REGISTER GM - GALLONS PER MINUTE HPA - HIGH EFFICIENCY PARTICULATE AIR FILTER H1 'P - HORSEPOWER L"G - LEAVING NA - NOT APPLICABLE Nj - NOT INSTALLED N - NOT MEASURED LA - LACK OF ACCESS NVL - NO VALID LOCATION O S.A. - OUTSIDE AIR WI.B. - WET BULB W.G. - WATER GAUGE PRESSURE DROP P_ - PITOT TRAVERSE R.A. - RETURN AIR RtQ - REQUIRED RPM - REVOLUTIONS PER MINUTE WI.B. - WET BULB W.G. - WATER GAUGE ROUND DIFFUSER S. A. - SUPPLY AIR S.F. - SERVICE FACTOR S. . - STATIC PRESSURE S S - SIDE WALL SUPPLY S ' R - SIDE WALL RETURN T. .H. - TOTAL DEAD HEAD WI.B. - WET BULB W.G. - WATER GAUGE INDEPENDENT AIR BALANCE 1134 Walsh Ave., Santa Clara, Ca 95050 AIR SOUND HYDRONIC PROFESSIONALS TEL: 408-327-8400 Tool Calibration ool Model Number N — — M12737 —07/16/2016 to 07/15/2017 — 93710033 — 07/16/2016 to 07/15/2017 32 — 89130969 — 07/16/2016 to 07/15/2017 is Manometer HM670 — 70741061 — 07/16/2016 to 07/15/2017 — Al 370067R — 07/16/2016 to 07/15/2017 / Hydrometer 200-6510526 — 07/16/2016 to 07/15/2017 Type K Temp Probe— NSN — 07/16/2016 to 07/15/2017 uke Type K Surface Probe— NSN — 07/16/2016 to 07/15/2017