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B-2016-3326CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3326 19419 STEVENS CREEK BLVD STE 110 CUPERTINO, CA 95014 (316 20 112) ALEGIS CONSTRUCTION INC PORTLAND, OR 97223 OWNER'S NAME: MAIN STREET CUPERTINO DATE ISSUED: 04/05/2017 OWNER'S PHONE: PHONE NO: (206) 724-0385 LICENSED CONTRACTOR'S DECLARATION j BUILDING PERMIT INFO: i License Class GENERAL BUILDING CONTRACTOR Lic. #977691 Contractor ALEGIS CONSTRUCTION INC Date 10/31/2018 X BLDG —ELECT —PLUMB MECH RESIDENTIAL X COMMERCIAL I hereby affirm that 1 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: SUITE I10 PRESSED JUICERY;TENANT IMPROVEMENT (665 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. 2. 1 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: $92000.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 31620 112 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 WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT 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 LAST CALLED INSPECTION. Signature Date Issued by: Abby Ayende Date: 04/05/2017 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 t. 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 (See.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed I Signature of Applicant: contractors to construct the project (See.7044, Business & Professions Code). Date: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1 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 j. 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 revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: I 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 Ito save indemnify and keep harmless the City of Cupertino against liabilities, Iludgments, 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. Signature Date Licensed Professional CONSTRUCTION PERMIT APDL i ATION COMMUNITY DEVELOPMENT DEPARTMENT - Bk),- )ING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-,t?55 (408) 777-322EI - FAX (408) 777-3333 - buiICingrd_cugertin2.gLg CUPERTINO NPWCONSTRUCTION AITPRATrn-c -r 7 izPviqrnv s r)Prt:r'4;:n nRInINAT PPPMTTii PROIECT ADDRESS tj q -2 'kS NPN�- OWNER NAME PHONE fres" J"il�m (I, C' 3 /0 -71-7 ISIRU'l-ADDUSS 16.5D 11g S CITY, SIATE.Z1 10111T 1 EIIAII -q eA C' P'"Sdl STREET ADI)PfSS Cln"S(AIL' ZIP FAX I C A 0 owNER 0 owNEa-surLDER i ow -mm AaENT CONTRACTOR OCO'117RACTORAGENT 6ARCInTELT OENGWEER 0 DEVELOPER AENANT CONTRACTORNAlIf7 —1 LICENSE NUMBER LICENSE TYPE al -'s- LIC COMPANY NAME E-NIAIL FAX STREET ADDRESS 0FIN, STME, ZIP PHONE, ARMTECI F%GINFFRNw, 110",SENt, 4181 R BE'S LTC - COMPANY N AM r. FA:X — VIL" %1 KEE] ADDREsS0 CI;k,SI,%TE,1JP PHONE CA 10,410I.J 7'� DESCRIPTION OF WORK FAISTING USE UPON)SEDUSE CONSTR TYHF-T SrORAAI A AA ESP TYPE OCC sQ,rT. j VALUATION($) 5XI to NEW FLOCIO DEMOTOT At AREA AREA %REA117% 1 NUAREA P BATHROOM %J LHLNOTHER REMODEL AREA RFAIODH, AREA RLNIC'�DEL AREA ATTACU L # DtViLLENG UNffS- I IS A SECOND UNIT ........ . ... . ....................... BEI' NG ADDED? ONO 1 ADDITION? Cl NO .. ............ ...... ..... -------- PRE-APPLICATION 0 YES IF YES, PROVIDE COPY OF ISTHE BLDG X% -ES TLU V ATION: PLANNING APPE. # ONO PLANNING APPROVAL LETTER EICIMERIJOArt? ONO r By MY Signature below, I certify 10 each Of the following: I am the property owner or authorized agent to act on the property owner's behalf. thave read this application and the information I have pro yjis cane read the Description oflh'ork and verify it is accurate. I agree to comply with all applicable local ordmances and state laAS wating to g constniquin. I Oonze representatives of Cupertino to enter the above-identi4ed property for inspection purposes. Signature ofApplicant'Agent: Date: SUPPLEMENTAI. INFORMATION REQUIRED PLAIN CHECK TYPE ROUTING SLIP 0 OVER-THE-COUNTER 8139 °N P'"N REVIEW New SFD or Multifamily dtiellings: Apply for demolition permit for71 e*%istingbuilding(s-). Demolition permit is required prior to issuance of building permit for now building, 0 EXPRESS FL4XN1NG P L,% N RE VIEW Commercial Wdgs. Provide a completed Hazardous Materials Disclosure 1/3- STANDARD PuMLIC AVRKS form if any Hazardous Materials are being used as part ofthis project. LARGE "IT Mn Cfleeting of Planning Approval Letter or ecting withPlanning prior to q% submittal of Building Permit apphication. '%%JOR S.VNITARY STEM DISTRICT VrRONIAENTALHEALTH K _I SldgApp,,201 tdoc revised 0811;'11 LIGHTING CONTROL ACCEPTANCE DOCUMENT Automatic Shut-off Controls: Automatic Time Switch Control and Occupant Sensor} Intent: Lights are turned off or set to a lower level when not needed per Section 110.9(a) & 130.1(c). QnPN I A. Construction Inspection Fill out Section A to cover spaces 1 through 3 that are functionally tested under Section B. Instruments needed to perform tests include, but are not limited to: hand-held amperage meter, power meter, or light meter 1: Automatic Time Switch Controls Construction Inspection—confirm for all listed in Section S a. All automatic time switch controls are programmed for (check all): Pe Weekdays P Weekend r Holidays b. Document for the owner automatic time switch programming (check all): a fJ Weekday settings 17 Weekend settings r Holidays settings r Set-up settings r Preference program setting r Verify the correct time an6 date is. properly set in the time switch M t,,.. -:c., t4.o i ni+o.,, is incrauafi Rnri Pnerai7ed Override time limit is no more than 2 hours We Occupant Sensors and Automatic Time Switch Controls have been certified to the Energy Commission in accordance with the applicable provision in Section 110.9 of the Standards, and model numbers for all such controls are listed on the Commission database as Certified Appliance and Control Devices 2. occupancy Sensor Construction Inspection—confirm for all listed in Section S 17 Occupancy sensors are not located within four feet of any HVAC diffuser F Ultrasonic occupancy sensors do not emit audible sound 5 feet from source �� ��CallfomiaAdvanced LigMing Controls Training Program This is page I of I - OF ACCEPTANCE d Juicey 19419 Stevens Creek Suite 130 19 Stcwau Creek Blvd Unit 130 rccenwnt Agency CITY OF CUFERTINO OJPmtw B2016.3326 B. Functional Testing of Lighting Controls For every space in the building, conduct functional tests 1 through 5 below if applicable. If there are several geometrically similar spaces that use the same lighting controls, test only one space and list in the cells below which 'untested spaces" are represented by that tested space. EXCEPTION: For buildings with up to seven (7) occupancy sensors, all occupancy sensors shall be tested. (NA7.6.2.3) Representative Spaces Selected Tested/space/room name: restroom Space Type (office, corridor, etc) restroom Untested areas/rooms 1. Automatic Time Switch Controls Step 1: Simulate occupied condition a. All lights can be turned on and off by their respective area control switch r b. Verify the switch only operates lighting in the ceiling -height partitioned area in which the switch is located. r Step 2: Simulate unoccupied condition a. All lighting, including emergency and egress lighting, turns off. Exempt lighting may remain on per Section 130.1(c)1 and 130.1(a)1, r b. Manual override switch allows only the lights in the selected ceiling height partitioned space where the override switch is located and remain on no longer than 2 hours (unless serving public areas and override switch is captive key type). r Step 3: System returned to initial operating conditions r 2. Occupancy Sensors Step 1: Simulate an unoccupied condition a. Lights controlled by occupancy sensors turn off within a maximum of 30 minutes from start of an unoccupied condition per Standard Section 110.9(b) r b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation 1711 ,step 2: Simulate unoccupied condition a. Status indicator or annunciator operates correctly r b. Lights controlled by occupancy sensors turn on immediately upon an occupied condition OR sensor indicates space is 'occupied' and lights may be turned on manually Stec, 3: System returned to initial operating conditions 1 1711 E:California Advanced LightingcALI �` Controls Training Program This is page 2 of 11 3. Partial Off Occupancy Sensor Step 1: Simulate an unoccupied condition a. Lights go to partial off state within a maximum of 30 minutes from start of an unoccupied condition per Standard Section 110.9(a) r b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. For library book stacks or warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in the aisle or stack. f c. In thepartial off state, lighting shall consume no more than 50% of installed lighting power, or: No more than 60% of installed lighting power for metal halide or high pressure sodium lighting in warehouses. No more than 60% of installed lighting power for corridors and stairwells in which the installed lighting power is 80 percent or less of the value allowed under the Area Category Method. Light level may be r used as a proxy for lighting power when measurements are taken Step 2: Simulate an occupied condition The occupant sensing controls shall turn lights fully ON in each separately controlled areas, Immediately upon an occupied condition f Step 1. _Simulate an occupied condition. Verify partial on operation. a. Immediately upon an occupied condition, the first stage activates between 30 to 70% of the lighting automatically. !— b. After the first stage occurs, manual switches allow an occupant to activate the alternate set of lights, activate 1000/6 of the lighting power, and manually 1" deactivate all of the lights. Step 2. Simulate an unoccupied condition a. Both stages (automatic on and manual on) lights turn off within a maximum of 30 minutes from start of an unoccupied condition per Standard Section 110.9(a) r b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation r GTP California Advanced Lighting cALControls Training Program This is page 3 of 11 S. Additional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger than 250 Square Feet, to Qualify for a Power Adjustment Factor (PAF) Step 0: First, complete Functional Test 2 (above ) for each controlled zone Step 1: Verify area served and compare actual PAF with claimed PAF. Refer to Functional Test 2. a. Area served by controlled lighting (square feet) b. Enter PAF corresponding to controlled area from line (a) above (<125sf for PAF=0.4, 126-250sf for PAF=0.3, 251-500sf for PAF=0.2). c. Enter PAF claimed for occupant sensor control in this space from the Certificate of Compliance d. The PAF corresponding to the controlled area (line b), is less than or equal to the PAF claimed in the compliance documentation (line c) i— e. Sensors shall not trigger in response to movement in adjacent walkways or workspaces r f. All steps are conducted in Functional Test 2 'Occupancy Sensor (On Off Control)' and all answers are Yes (Y) r cAL�� TP California Advanced Ughting I Controls Training Program This is page 4 of 11 IFICATE OF ACCEPTANCE s Carmol Nmne: Premed Juicery 19419 Stevens Creek Suite 130 Address: 19419 Stevens Cmek Blvd Unit 130 C. Testing Results r 1. Automatic Time Switch Controls (all answers must be Y). 2. Occupancy Sensor (On Off Control) (all answers must be Y). 3. Partial Off Occupancy Sensor (all answers must be Y). For warehouses, library book stacks, corridors, stairwells in nonresidential buildings must also be accompanied by r passing Test 1 or Test 2. 4. Partial On Occupant Sensor for PAF (all answers must be Y). r 5. Occupant Sensor serving small zones for PAF (all answers must be Y). Also must r pass Test 2 Type (office, corridor, etc) retail Untested areas/rooms 1. Automatic Time Switch Controls Step 1: Simulate occupied condition a. All lights can be turned on and off by their respective area control switch b. Verify the switch only operates lighting in the ceiling -height partitioned area in W, which the switch is located. imulate unoccupied condition a. All lighting, including emergency and egress lighting, turns off. Exempt lighting may remain on per Section 130.1(c)1 and 130.1(a)1. I r�_] b. Manual override switch allows only the lights in the selected ceiling height partitioned space where the override switch is located and remain on no longer than r 2 hours (unless serving public areas and override switch is captive key type). tep 3. System returned to initial operating conditions I 1W ipancy Seasons imulate an unoccupied condition a. Lights controlled by occupancy sensors turn off within a maximum of 30 minutes from start of an unoccupied condition per Standard Section 110.9(b) r e occupant sensor does not trigger a false 'on' from movement in an area California Advanced gt-GControls Training Program This is page 5 of I 1 19419 )419 Stevens Crede Blvd Unit 130 E adjacent to the controlled space or from HVAC operation Step 2: Simulate unoccupied condition CUPERTINO nit Nmnber. B2016.3326 Code 95014 11 a. Status indicator or annunciator operates correctly r b. Lights controlled by occupancy sensors turn on immediately upon an occupied condition OR sensor indicates space is 'occupied' and lights may be turned on r manually Step 3: System returned to initial operating conditions r 3. partial Off Occupancy Sensor Step 1: Simulate an unoccupied condition a. Lights go to partial off state within a maximum of 30 minutes from start of an unoccupied condition per Standard Section 110.9(a) r b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. For library book stacks or warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in the aisle or stack. r c. In the partial off state, lighting shall consume no more than 50% of installed lighting power, or: No more than 60% of installed lighting power for metal halide or high pressure sodium lighting in warehouses. No more than 60% of installed lighting power for corridors and stairwells in which the installed lighting power is 80 percent or less of the value allowed under the Area Category Method. Light level may be used as a proxy for lighting power when measurements are taken r Step 2: Simulate an occupied condition The occupant sensing controls shall turn lights fully ON in each separately controlled areas, Immediately upon an occupied condition r 4. Partial On Occupancy Sensors Step 1. -Simulate an occupied condition. verify partial on operation. a. Immediately upon an occupied condition, the first stage activates between 30 to 70% of the lighting automatically. r b. After the first stage occurs, manual switches allow an occupant to activate the alternate set of lights, activate 100% of the lighting power, and manually deactivate all of the lights. r Step 2. simulate an unoccupied condition a. Both stages (automatic on and manual on) lights turn off within a maximum of 30 minutes from start of an unoccupied condition per Standard Section 110.9(a) r b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation f1 r-`� w, Tn California Advanced Lighting (� (! Controls Training Program This is page 6 of 11 ATE OF ACCEPTANCE d Pressed Juicery 19419 Stevens Crede Suite 130 s: 19419 Stevens Credo Blvd. Unit 130 California Advanced LightingcAL vTP Controls Training Program B2016-3326 This is page 7 of 11 5. Additional test for Occupancy Sensors Serving 5malf cones In viiiLc alsaxa.c�vG— &,.v.. 250 Square Feet, to Qualify for a Power Adjustment Factor (PAF) Step 0: First, complete Functional Test 2 (above ) for each controlled zone Step 1: verify area served and compare actual PAF with claimed PAF. Refer to Functional Test 2. a. Area served by controlled lighting (square feet) b. Enter PAF corresponding to controlled area from line (a) above (<125sf for PAF=0.4, 126-250sf for PAF=0.3, 251-500sf for PAF=0.2). c. Enter PAF claimed for occupant sensor control in this space from the Certificate of Compliance d. The PAF corresponding to the controlled area (line b), is less than or equal to the PAF claimed in the compliance documentation (line c) e. Sensors shall not trigger in response to movement in adjacent walkways or workspaces f. All steps are conducted in Functional Test 2 'Occupancy Sensor (On Off Control)' and all answers are Yes (Y) CriTLightingCAL , Tr GontrotsTrainingProgr2 r r 1 This is page 8 of 11 TRCATE OF ACCEPTANCE 1 Control Name: Pressed Juicery 19419 Stevens Creels S Address 19419 Stevens Crede Blvd Unit 130 C. Testing Results B2016-3326 r 1. Automatic Time Switch Controls (all answers must be Y). 2. Occupancy Sensor (On Off Control) (all answers must be Y). r 3. Partial Off Occupancy Sensor (all answers must be Y). For warehouses, library book stacks, corridors, stairwells in nonresidential buildings must also be accompanied by r passing Test 1 or Test 2. r 4. Partial On Occupant Sensor for PAF (all answers must be Y). 5. Occupant Sensor serving small zones for PAF (all answers must be Y). Also must r pass Test 2 D. Evaluation : F7 PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing Requirements responses are positive (Y - yes) California TLightingCAL&TP Controls TrainingProgra This is page 9 of I i OF essed Juicery 19419 Stevens Creek Suite 130 19419 Stevens Crede Blvd Unit 130 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Paul Smith Company Name Name Address City 4410 Casa Madeira Lane Zip Code 95127 Phone CEA/ATT Certification Author Signature Identification (if TC -A813999 applicable) Date of Signature: 05/25/2017 1 Acceptance Testing San lose (408)748-9000 nit Number. B2016-3326 Code: 95014 FIELD TECHNICIAN'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 Acceptance is true and correct. 2. I am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. I have confirmed that the Certificate(s) of installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name Company Name Paul Smith 1 Acceptance Testing Address: 4410 Casa Madeira Lane City San Jose Zip Code 95127 Phone (408)748-9000 ATT Certification Position with Company Identification TC -A83999 (Title) President Field Technician Signat� Date of Signature: 05/25/2017 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the lays of the State of California: 1. i am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3of the tSusiness and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. I have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or 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 signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Company Name 1 Acceptance Testing Person Name Paul Smith Address: City San lose 4410 Casa Madeira Lane Zip Code 95127 Phone (408)748-9000 CSL8 License Position with Company President Ci0-707269 (Title) Responsible Acceptanc Signature Date of Signature: 05/25/2017 California Advanced lightingQGTP Controls TrainingPrgrm This is page 10 of 11 Cmia Advanced Lighting C r Controls Raining Program This is page 11 of 11