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B-2016-2151CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-20'16-2151 19449 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112) MAIN STREET CUPERTINO AGGREGATOR LLC 2882 SAND BILL RD STE 241 MENLO PARK CA 94025-7057 OWNER'S NAME: MAIN STREET CUPERTINO AGGREGATOR LLC OWNER'S PHONE: 650-344-1500 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor MAIN STREET CUPERTINO AGGREGATOR LL 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. 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 -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. 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 10.14.16 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 (Sec.7044, Business &Professions Code) (/�/ ✓/,�J 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: 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. 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 manner so as to become subject to the Worker's Compensation laws of California. If, after waking this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state 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 all non -point source regulations per the Cupertino Municipal Code, Secti 9.1 1 _--- In 1 <u //_ ISSUED: 10/14/2016 PHONE NO: Owner Builder BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: CONSTRUCT PARK NEXT TO SHOP 8 FOR MAIN STREET Sq. Ft Floor Area: I Valuation: $200000.00 "N Number: Occupancy Type: 316 20112 PERMIT EXPIRES IF WORK IS NOT STARTED WITIIIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: SEAN HATCH Date: 10/14/2016 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: 10.14.16 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the "Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Cod s 505, 25533, and 25534. Owner or authorized agent: Date: 10.14.16 CONSTRUCTION LENDING AGENCY 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 understand my plans shall be used as public records. CUPERTINO, KNEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • building(Woupertino.orp 6'�al� ADDITION D ALTERATION I TI I ^ I RRVTST(iN I T)-RRRRRRTI 0RTC:TN[AT 'tPRRTRTT if PROJECT ADDRESS OWNERNAMEyg � '• b2 "D-34Lir V;010 g-MAjj� 'lj5m6gbe sr S crnctC,co STREET S Z _ItC!2 1 CITY T qTE,ua ZIP 4vZ I`-�`3-tS2. CONTACT ME PH VtE.a2r7 + "t9- t "7 S1 1= S C99 STRF_.ET�I�RES C Y,STAT ZIP ® /S^-� At— F ❑[j-OWNEEROWNER-BUILDER OWNERAGENT ❑ CONTRACTOR '❑ CONTRACTORAGENT ❑ARci-nrECT .1 l ENGINEER 11 DEVELOPER Cl TENANT CONTRACI'ORNAME ' LICENSENUMBER TLICENSETYPE BUS, LIC# COMPANYNANIE - _ E-MAIL FAX ST RVET ADDRESS CITY, STATE, 7IP PRONE ARCEITECTIENGINEER NAME LICENSE NUMBER BUS. I,IC # COMPANY NAME F, -MAIL FAX STREETADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF -WO ( �� �?'j`� `r �r�.t-i=As-I-r�' EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. 5t2.CT. VALUATION ($) EXS.STG NEW FLOOR DEMO. TOTAL AREA AREA AREA. NETAREA BATHROOM KITCHEN OTHER KEMODEL.AREA REMODELAREA REMODELAREA - PORCHAREA DECK AREA TOTAL DECKIPORCII AREA GARAGE AREA: D DETACI3 []ATTACH #DWELLING UNITS: � IS,A SECOND UNIT ©YES SECOND STORY []YES EIiINVADDED? FlNO ADDITION? .ONO PRE -APPLICATION []YES IFYES,PROVIDECOPY Or ISTIIEELDCAN ©YES RECI;IV TALVA.LUATION: PLANNINGAPPL# []NO PLANNINGAPPROVALLETTER EICHLERHOME? NO ;"?:-:'- ',Lp z�, By my signature below, I certify to eaclt of be foliowing; i am thepropertyowner or authorized aged to 04 41 the pr erty vner's behalf. I have read this application and the infarnration I 1 Innvi -ect. I haveTead the Description of Work and verity it is accurate. I agree to comply with all applicable local ordinances and state laws rel ' g to buil ' o ruction. I authorize representatives of Cupertino to enterthe alloy -Iden 'fled property for inspection purposes. Signature ofApplictatt � Date: GB SUPPLEMENTA FORMATION REQUIRED PLAjNCHECK TYPE, ❑ ov R TiIE cour,TER Isvn Dti.c P xE IE�v ' New SPD or Multifamily dwellings: Apply for demolition permit for existing buildil g(s). Demolition permit is required prior to issuance of building permit for new building. [�'zxrleEss :":;:=: YLAn INGPIAYREVIktV Commercial Bldgs: Provide a. completed Hazardous Materials Disclosure ^% ` STANDARD i PUBLIC 1i OT3i£S _ form if any Hazardous Materials are being used as part of this project. '.0 LARGE ... .; TTRE DEPT ' _ Copy of Planning Approval Letter or Meeting with Planning prior to I. �".:;tiLtSOR•. D SAE�IT LRY SE�i`ER DISTRTC�' submittal of Building Permit application. _..._ ...,-.:.._ ........ =:,;- ., :._...'.. _.._ ❑ :ENVIEOI3i\TENTALIIEALTPC __:-- BldgApp__2011.doc i-evised.06/21111 2001 Crow Canyon Road, Suite 100 San Ramon, CA 94583-5387 CONSOUDATED ENGINEEF 1NG Tel. 925 314-7100 Fax. 925 855-7140 L A 0. 0 R A T O R t t Swww.ce-lab .com INSPECTION/TESTING REPORT Date Of Issue: 7/20/2017 RE: Main Street Cupertino -Park Rpt City of Cupertino To: 10300 Torre Avenue Cupertino, CA 95014 Attn: Building Department Inspection Date(s): 7/12/2017 Location: Jobsite Report # 170714Field, Inspector(s): Leeberth Sedacy-Rowe IV4k sr,b On the above date, our representative inspected the referenced project. Permit 2016-2151 CEL# 1032088 Please refer to the attached reports for details and locations of our testing and inspection services for the above noted date. Work inspected was in compliance with approved plans and specifications. RECEIVED JUL 24 2017 BY _J_"JAJ CC: Enclosures (2) Reviewing Engineer: Leann Armbrust, EIT DCI Engineers(ER)DCI Engineers (ER) TGP.(ER) City of Cupertino (P) Sand Hill CM (ER) All reports are submitted as the confidential properly of our.clients. Publications of statements, conclusions, or extracts is revised pending written approval. CONSOLIDATED ENGINEERING Proofload Testing Project Name Main Street Cu ertino-Park CEL Project # 7032088 Project Location 19449 Stevens Creek Boulevard, Cupertino,' CA 95014 Contractor .SHCM Date 07/12/2017 J Day Wednesday IR# Reported to: Gabriel Sanchez Performed proofload tests on: Wed a Anchors Installed at: North side Parking Garage Form ID 011 Rev.0 DSA File#-� DSA Appl #—� LEA # OSHPD # Permit/Appl # 2016-2151 ® See the attached data sheet(s) for location and quantity of anchors/dowels and the specified applied loads and results. 100.00 % of the total installed were tested. Total Installed: 12 Quantity Tested: 12 ® Loads were applied in direct tension by using a calibrated hydraulic ram Ram size/No. 2x5 #23 RED Gauge No. CAL59OAK#23RGI Calibrated (date) 5/4/2017 Each anchor/dowel tested was individually proofload tested to the specified load of 3161 pounds. ❑ Loads were applied by use of a torque wrench. ® All anchors/dowels tested were found to be satisfactory with no visible evidence of distress or failure. ❑ exceptias noted Each anchor/dowel tested was individually checked for proper installation by applying a specified torque of ft. -lbs. Notes/ Comments: plans print out not provided. This Work as INSPECTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE IN APPROVED DOCUMENTS The Work Inspected Oet THE REQUIREMENTS OF THE ITY APPROVED DOCUMENTS Material Sampling /A PERFORMED IN ACCORDANCE WITH THE /A APPROVED DOCUMENTS Signature of Special Inspector Date 7/12/2017 Print NamefTitle Leeberth Sedacy Certification #: CON$ )LIDATED ENGINEERING Proofload Testing Summary Project Name Main Street Cupertino -Park CEL Project # 1032088 Project Location 19449 Stevens Creek Boulevard, Cupertino, CA 95014 Contractor SHCM Date 07/12/2017 Day ednesda IR # Load Test Performed on © Rebar FO� Shotpinwire Assembly Anchors Method: Anchors were proof loaded to the specified load using the following apparatus: ❑Q Dynamometer R❑ Torque Wrench Q Hydraulic Jack Svstem n Srala Installed in Concrete 0 FF -11 , 4k_ Form ID 012 Rev.1 DSA File # DSA Appl # LEA # OSHPD # Permit/Appl # 2016-2151 Installed in Masonry o❑ Test # Test Location Dowel/Anchor Type/Size Total Installed Total Tested Quantity Tested Quantity Retested Applied Load lbs. tension or ft.-Ibs. torque 3161 Pass Fail Pass Fail 1 North Side Garage Parking Signage Hilt! KB TZ 5/8 12 12 12 0 Remarks: The Work Inspected (Was The Material Tested et -) SAMPLED AND TESTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE ITY APPROVED DOCUMENTS THE REQUIREMENTS OF THE ITY APPROVED DOCUMENTS Signature of Special Inspector Date 7/12/2017 Print Name/Title - Leeberth Sedacy - Certification #: