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B-2016-2391CITY OF CUPERTI_ NO BUILDING PERMIT BUILDINGADDRESS: 20558 STEVENS CREEK BLVD CUPERTINO, CA 95014-2130 (359 08 018) CONTRACTOR: ART GAUTREAU INC PERMIT NO: 13-2016-2391 STANTON, CA 90680 OWNER'S NAME: MARDESICH COMPANY CROSSROADS LLC DATE ISSUED: 04/26/2017 OWNER'S PHONE: 480-385-2361 PHONE NO: (714) 934-8066 LICENSED CONTRACTOR'S DECLARATIQN BUILDING PERMIT INFO: License Class 5 Lic. #370609 Contractor ART GA-UTREAU INC Date 03/31/2019 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH — RESIDENTIAL X COMMERCL4 , with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm wader penalty of perjury one of the following two declarations: T.I.; (N) TRASH ENCLOSURE BEHIND BUILDING - SPROUTS �. 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. 5q. Ft Floor Area: Valuation: $125000.00 APPLICANT CERTIFICATION I 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 ordinances and state laws relating to building construction, and hereby authorize 359 08 018 A (Tenant Improvements),M (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 WORD IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point WITHIN ISO DAYS OF PERMIT ISSUANCE OR source rwhat ons per the Cupertino Municipal Code, Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION. - f Signature ", at 04/26/2017 Issued by: PAUL O'SULLIVAN Date: 04/26/2017 I hereby affirm at 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 1. L 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) z. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 04/26/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A°' OR BETTER x. 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. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. 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 & Safe Code, Sections 25505,25-533, and 25534. Labor Code, I must forthwith comply_ with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 04126!2017 I certify that I have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and state laws CON I hereby affirm that there is a cons ion len ency 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 �� F T' D . RATION l understand my plans shall be used as public records. Code, Section 9.18. Licensed SiSignature Date 04/26/2017 g Professional CONSTRUCTION PERMIT APPLICATION 2 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE ® CUPERTINO, CA 95014-8255 C:UPERTINO (408) 777-3228 • FAX (408) 777-3333 ! buildina a0cupertino.org ❑NEWCONSTRUCTION ® ADDITION ' ® ALTERATION/TI F-1 REVISION I DFFF.RRF.D nRTC;INAV'PV.PMITA PROJECTADDRESS 20558 Stevens Creek Blvd. APN# 351-7 —OS -77 OwNERNAME Sprouts E'arme s M rke Steve Ha en Ow 0. PHONE 480-385-2361 E- AIL s evenhagen@sprouts.com STREET ADDRESS 545 5 . 111 CITY, STATE Oe Z 85054 FAX /tic 1 CONTACTNAME Rick Redpath PHONE 480-998-4200 E-MAIL irick.redDath@fitch.com STREETADDRESS 16435 N. Scottsdale R . Suite 195 CITY. STATE, FAX 480_998_7223 6cottsdale, AZ 85254 ® OWNER ® OWNER. -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ® CONTRACTORAGENT M ARCHITECT ❑ BNmEBR ® DEVELOPER ❑ TENANT NTRACTOR NAME Jim Eckes LICENSE NUMBER 37069 LICENSE TYPE BA BUS. LIC # MPANYNAMEAGI General Contracting FcOST,RMTA,DREss E•MAiLjim.eckes@agigc.com FAx714-934-8067 8210 Katella Ave. Suite No. 1 CITY,STATE,ZIP Stanton, CA 90680 PHONE 714-412-148 . ARcIETECTIENGINBERNAME Blair Leach LICENSE NUMBER C 2 5 7 8 8 BUS. LIC # COMPANYNAME AAD:FXTCH,Inc. &MAIL blair.leach@f itch..com FAX 480-998-7223 STREBTADDRESS 16435 N. Scotts a e R . Suite 195 CITY. STATE,ZI Scottsdale, AZ 85254 PHONE4SO-998-4200 DESCRIPTION OF WORK Neter trash enclosure on rear of existing building. EXISTING USE PROPOSED USE CONSTRTYRB #STORIES Mercantile Mercantile VB-Sprk 1 USE TYPE OCC. SQ,FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA 2 0, 9 8 6 AREA9R SF AREA I NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL ARRA PORCEAREA DECK AREA TOTALDECYRORCHARBA GARAGEAREA:DETACH I ATTACH I 9DWELLINGUNITS! ISASECONDUNIT OYES SBCONDSTORY OYES BMWGADDEDP ONO ADDITION? ONO PRE -APPLICATION' YES IF YES, PROVIDE COPY OF IS TIIE BLDG AN ❑ TOTAL VALUATION: PLANNINGAPPL# NO PLANNMAPPROVALLETTER EICHLERHOME7 " I 4" 000 By my signature below, I certify to each of the following; I am the property owner or authorize gent to act on the prope owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work d verify it is accurate. I agree to comply with all applicable local ordinances and state laws relat' ildin construe ' . I aut orize representatives of Cupertino to enter the above-identifiedd property for inspection purposes. Signature ofApplicantz Date: SUPPLEMENTAL. INFORMATION il IItED PLAN CHECK TYPE ROUTING SLIP ElOVER.-THWCOUNTER I q nr BUILDING PLAN REVIEW _ 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. El ERPREss r-� VPLANNINGPLAN REVIEW _ 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 ® MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ENVIRONMENTAL HEALTH BldgApp 2011. do revised 06121111 16435 NORTH SCOTTSDALE ROAD T + 1 480 998 4200 SUITE 195 F + 1 480 998 7223 SCOTTSDALE, ARIZONA 85254 USA AAD:FITOH, Inc. WW W.FlTCH.COM April. 7, 2017 City of Cupertino Building Department Attn: Albert Salvador, Building Official 10300 Torre Avenue Cupertino, CA 95014-3202 408-777-3228 RIE: CITY OF CuPERTINO BUILDING DEPARTMENT - PERMIT #B-2016-2391 (20558 STEVENS CREEK BLVD) Dear Mr. Salvador, FITCH Per my recent communication with Abby Ayende, we are respectf iUy requesting a one-time 3 - month extension for the above referenced project, which is a new recycle trash enclosure in the rear drive of the existing Sprouts Farmers Market. i Although we've been notified the project has been approved by e Building Department, Abby let us know the application was submitted July 27, 2016 and expired January 27, 2017 and we needed to provide this extension request letter. A check in the amount of $296.00 is included with this letter for the extension fee. Thank you in advance for your approval of this extension, and please let me know if you have any questions or need additional information. Sincerely, Rick Redpath, AIA, LEED AP Managing Director Transmittal V' Geotechnical and Environmental Sciences Consultants .. _ . Oakland, Webster Street, Suite 400 Oakl1 F I LN and, California 94612 Phone: 510/ 343-3000 Fax: 510/ 343-300 ^ I ,7 1�� J TO: Mr. Jeremy Nelson DATE: 7/21/17. AGI General Contracting PROJECT NUMBER: 40309200t 8210 Katella Avenue, Suite 1 PROJECT -NAME: AGI/ Sprouts Trash Stanton, California 90680 Enclosure We are, sending ,you -the following via: ® E -Mail: Jeremy. nelsonQagigc.com Copies Description 1 Testing and Inspection Reports Through 7-21-17 REMARKS: Transmittal Al/naO&AAsOre FIELD TECHNICIAN'S DAILY REPORT -T v e - 2149 O'Toole Avenue, Suite 30, San Jose, CA 95131 1 Report Date: duly 06, 2017, Thursday Project Name: AGI SPROUTS NEW TRASH ENCLOSURE Project No: 403032001 Jurisdiction: CITY OF CUPERTINO .. Permit No.: 20558 Stevens Creek Boulevard Plan File No.: Project Street Address: Cupertino, CA 95014 ..Contractor; Approved Documents: CODE DESCRIPTIONS OF WORK PERFORMED, SAMPLES TAKEN, WORK REJECTED,.JOB PROBLEMS, PROGRESS, REMARKS, ETC. S18 I arrived on site in the a.m. I performed inspection of the footing for the new trash enclosure that was located at the rear of the sprouts building. I observed the'bottom of the footing.,The footing was approximately 12" deep 3' feet wide and, 22;.long.. Probing of this area indicated very dense and compact soil conditions. The contractor was not. on site during the observation. The weather was warm with'overcast skies and a light breeze. Weather:, Attachments: Pt Cloudy STAFF START ',, STOP REG. O.T. # OPTEST DUSTIN BELTRAN TIME TIME HOURS HOURS SPECIMENS Name of Field Technician' 11 c 2 3' P ' U� 2CLit' CODE: RW = Rework NIC = Not ImContract ST = Standby WC =Work Cancelled '; Code- (No. of hours) Signature of Field Technician THE WORK ® was.., ❑ was not;tested in accordance with 7/6/2017 the approved documents. Date Certification Number THE WORK TESTED'. 0 imet O did not meet the . OBSIPECONTACTISASKWTOSr.NTOVERIFYMSPECnONHOURSONLY.THECONTMTOF requirements Of the approved documents. THISREPORTANDFEECHARGESMEn ERESPONSBUNOFOrHERS. MATERIAL SAMPLING ❑ was El was not ® N/A Signature: Field Technician's Daily Report 2013 v,1.2 Page 1 of 2 ii } /`j.VVQQrQ FIELD TECHNICIAN'S DAILY REPORT 2149 O'Toole Avenue, Suite 30, San Jose, GA 95131 Report Date: 7uly 06, 2017; Thursday Project Name: AGI SPROUTS NEW TRASH ENCLOSURE Project No: 403092001 CODE DESCRIPTIONS OF WORK INSPECTED, TEST,SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC. performed in accordance with the approved documents. Owner -Authorized Job Site Contact erfo Page 2 of 2