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14040064
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20600 HOMESTEAD RD CONTRACTOR: SOUTH BAY PERMIT NO: 14040064 CONSTRUCTION, INC OWNER'S NAME: SOBRATO INTERESTS I ETAL 1711 DELL AVE DATE ISSUED: 06/19/2014 OWNER'S PHONE: 4084460700 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 �y9 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL �\ License Class 13 Lic.4t��N STEIN MART - T.I. TO BUILDOUT (E) SHELL (31,449 S. F.) 't et Contractor p� �lA �N� Date �41 Y V N REVISED WALL DEMENSIONS & NEW WALL DETAILS - ISSUED 1129/14 I hereby affirm that'll 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. 1 hereby affirm under penalty of perjury one of the following two declarations: 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 Sq. Ft Floor Area: Valuation: 5900000 erformance of the work for which this permit is issued. ve 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 APN Number: 32610066.20600 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF `YORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITIIIN 180 DAYS OF PESUANCE ®� to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FRO CALLED INSPECTION. 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 ue D te- with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. s -ROOFS: Signature DateAl� All roofs shall be inspect, 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should 1 store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized ager Date. 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 making this certificate of exemption, 1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. 1 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DEVISION [ , - iDRESS: 20600 HOMESTEAD RD DATE: 08/1212014 APN: 32610066.20600 BP#: 14040064 REVIEWED BY: MELISSA *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building iJS)E: s if'C;. J'�CY f+i 7? ".;c PENTAMATION PERMIT TYPE: WORK - REVISED WALL DEK/IENS10114S & NEW WALL DETAILS 18/12/14 SCOPE k'.'rw:b...ta;,;,, TW., y FEE 1,)1'v ?1). P/oi% (_'tic'^I" El"?(, P100 ("hecp.. Meek 1-ce: /.)7?w7h. ".)a qff! �":ii': s if'C;. J'�CY f+i 7? ".;c LI �.)rj7�,?. />rlfineb 17f i'j?. El {. f'`t7PY t.la'c.'Iyup. PME Plan Check: k'.'rw:b...ta;,;,, TW., Lsiet:. i;r.,•n rec: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FRE ITEMS (Fee Resolution 11-053 E,(f. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (D Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(2) Reg. Q OT Q Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Ll Work Without Permit? 0 Yes ) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 G, .i"t11'e/}r)C%(t ;111Ytiltt?7 �'�'f'4: Strong Motion Fee: $0.00 0 # Revisions $859.00 7REVC0MTi Tenant Improvement Bldg Stds Commission Fee: $0.00 SUBTOTALS:, $0.00 $859.00 TOTAL FEE: $859.00 Revised: 07/10/2014 cCUI;aEIR7IIM coNsIr RUC T110oN pERPM111T APPUC/°aTIOM COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISIO � (/ 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 /t�,� (408) 777-3228 ^ FAX (408) 777-3333 ^ bullding0cupertino.org �— ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI © REVISION / DEFERRED ORIGINAL PERMIT # PROIECTADDRESS 20600 HOMESTEAD ROAD APN# 326-10-066 OWNERNAME THE SOBRATO ORGANIZATION PHONE 408-446-0700 —7 E-MAIL RTRUEMPLER@SOBRATO.COM RICH TRUEMPLER STREET ADDRESS CITY, STATE,ZIP CUPERTINO, CA. 95014 FAX 408-866-6638 10600 N. DE ANZA BLVD. CONTACTNAME JEFF OPAROWSKI PHONE 408-496-0676 E-MAIL JOPAROWSKI@ARCTEC INC. COM STREET ADDRESS 99 ALMADEN BLVD., SUITE 840 CITY, STATE, ZIP SAN JOSE, CA 95113 T;;408-496-1121 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT El ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LARRY PATERSON LICENSE NUMBER B336974 LICENSE TYPE BUS. LIC# COMPANYNAME SOUTH BAY CONSTRUCTION E-MAIL LPATERSON@SBCI.COM FAX (408) 379-3256 STREETADDRESS 1711 DELL AVE. CtTY,STATE,ZIP CAMPBELL, CA 95008 PHONE (408) 379-5500 ARCHITECT/ENGHJEERNAME JEFF OPAROWSKI, AIA LICENSENUMBER C-21289 BUS. LIC# COMPANYNAME ARC TEC INC. E-MAIL JOPAROWSKI @ARCTEC INC. COM FAX 408-496-1121 STREET ADDRESS 99 ALMADEN BLVD. CITY, STATE, ZIP SAN JOSE, CA 95113 PHONE 408-496-0676 DESCRIPTION OF WORK WALL DIMENSIONS REVISED ON FLOOR PLAN, NEW WALL DETAILS ADDED. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES OFFICE USE ONLY NONE RETAIL II -B ONE OCC, E DESCRIPTION SOYI, V U T EXISTGNEW FLOOR DEMO TOTAL 3 1, 4 4 9 31,449 ''.. AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA; ❑ DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEINGADDED' ❑ NO ADDITION.' ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNER'S NAME: R ED �- VALUATION: PLANNING ADPL q ❑ NO PLANNING APPROVAL LETTER LTOTAL � By my signature below, I certify to each of the following: l am the property owner or authorized agent to act on the pmpe o er'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. a _tocomply with all applicable local ordinances and state laws relating to buildi corio,)l authorize re esentatives of Cupertino to enter the above ' tified property for inspection purposes. i Signature of Applicant/Agent:L41) Al Date: /1 SUPPLEMENT'ALIN TIO QUIRED PLANCHECKTYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ 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. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1-1STANDARD ElPUBLIC WORKS fo_rm 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 1:1SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH 2011.doe revised 03116111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20600 HOMESTEAD RD CONTRACTOR: SOUTH BAY PERMIT NO: 14040064 CONSTRUCTION, INC OWNER'S NAME: SOBRATO INTERESTS I ETAL 1711 DELL AVE DATE ISSUED: 06/19/2014 OWNER'S PHONE: 4084460700 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL STEIN MART' - T.I. TO BUILD OUT (E) SHELL (31,449 License Class_ Lic. q ��(p�1� S.F.) Contractor s Sy . Date W (I A j(q 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. 1 hereby affirm under penalty of perjury one of the following two declarations: 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 Sq. Ft Floor Area: Valuation: $900000 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 APN Number: 32610066.20600 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE ®I8 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save b LED IINSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of t granting of this permit. Additionally, the applicant understands and will com slued Date: with all non -point source regulations per the Cupertino Municipal Co ton 9.18. eq RE -ROOFS: Signature Date �y 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should 1 store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should t use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sceti 5509',A5 33, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 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 making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 1 certify that I have read this application and state that the above information is correct. 1 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION of COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �� ` (408) 777-3228 • FAX (408) 777-3333 • build ingPcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECTADDRESS 20600 HOMESTEAD ROAD APN# 326-10-066 , -,060d OWNER NAME THE SOBRATO ORGANIZATION PHONE 408-446-0700 E-MAIL RTRUEMPLER@SOBRATO.COM RICH TRUEMPLER STREET ADDRESS CITY, STATE, ZIP CUPERTINO, CA. 95014 FAX 408-866-6638 10600 N. DE ANZA BLVD. CONTACTNAME JEFF OPAROWSKI PHONE 408-496-0676 E-MAILJOPAROWSKI®ARCTECINC.COM STREET ADDRESS 99 ALMADEN BLVD., SUITE 840 CITY,STATE, ZIP SAN JOSE, CA 95113 FAX 408-496-1121 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT M ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LARRY PATERSON LICENSENUMBER B336974 LICENSE TYPE BUS. LIC# COMPANY NAME SOUTH BAY CONSTRUCTION E-MAIL LPATERSON@SBCI. COM FAX (408) 379-3256 STREETADDRESS 1711 DELL AVE. CITY,STATE,ZIP CAMPBELL, CA 95008 PHONE (408)379-5500 ARCHITECT/ENGINEERNAME JEFF OPAROWSKI, AIA LICENSENUMBER C-21289 BUS. LIC# COMPANY NAME ARC TEC INC. E-MAIL JOPAROWSKIGARCTEC INC. COM FAX 408-496-1121 STREET ADDRESS 99 ALMADEN BLVD. CITY, STATE, ZIP SAN JOSE, CA 95113 PHONE 408-496-0676 DESCRIPTION OF WORK NEW TENANT IMPROVEMENTS FOR STEIN MART IN AN EXISITNG RETAIL SHELL BUILDING. EXISTING USE PROPOSED USE CONSTR TYPE # STORIES OFFICE USE ONLY NONE RETAIL II -B ONE occ TYPE DESCRIPTION VALUATION EXISTG NEW FLOOR DEMO TOTAL 31,449 31,449 AREA AREA AREA NET AREA BATHROOM KITCHEN I OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH ❑ ATTACH p DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNER'S NAME: RECCEIYSP:!! i�f_ TOTAL VALUATION: PLANNING APPL# ❑ NO PLANNING APPROVAL LETTER [—DDO By my signature below, I certify to each of the foIIowing: I am the property owner or au agent to act on the property owner's behalf. I have read this application and the information I have provided is c ect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil . cons ion. I authorize representatives of Cupertino to enter the above Iden ' ed property for inspection purposes. A. Signature of Applicant/Agent: Date: SUPPLEMEN FORMA ON REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ 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. ❑ EXPRESS ❑ PLANNING PLAN 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_201 1. doc revised 03/16/11 e-11T1rr"Rl `/TTM f-ITI TTMTf, _n1Tr'1TT1TAT OCCUPANCY TYPE: \k11L ll ll FEE ESTIMATOR \1Y11` 111.. U 1L lull'&IL ILLI *q \LY - ]SUR LIDR `1II DIVISION PC FEES ADDRESS: 20600 HOMESTEAD RD DATE: 04/11/2014 REVIEWED BY: MELISSA BP FEE ID APN: 32610066.20600 BP#: 31,449 'VALUATION: 1$900,000 YPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building :r»f' 1 L.C. $12,051.90 PENTAMATION IM TMJ USE: $0.00 PME Unit Fee: PERMIT TYPE: PME Permit Fee: $0.00 WORK STEIN MART - T.I. TO BUILD OUT E SHELL (31,449 S.F. SCOPE O 0 Work Without Permit? C) Yes E) No OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.Q PC FEES PC FEE ID BP FEES BP FEE ID M (Tenant Improvements) 11-8,111-B,IV,V-B 31,449 $4,769.10 IMTIPLNCK $12,051.90 1MTIINSP :r»f' 1 L.C. $12,051.90 Suppl. Insp. Fee:Q Reg. t) OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ('orstru(tion K?X. Adiniffisfral ,e J`ec: O 0 Work Without Permit? C) Yes E) No $0.00 Advanced Planning_F'ee: $0.00 Select a Non -Residential E) Building or Structure O d• TOTALS: 31,449 1 $4,769.10 $189.00 $12,051.90 BldgStds Commission Fee: 1BCBSC M1EC>H, HOURLY O Yes E) No PLUMB, lHO><Jlfl;]LY ® Yes Q No IEILIEC, HOURLY O Yes (D No li;(h Flan ('hcrtc PhwlO 1'Inrc ('I-ir<l f ler F11111 Permil Fee: Phcirrh. /Permit Fec, /J( r;,n+i, (hirer.liceh. InslrLl 0iher Plomb 1rup.E17- Ur;,.. liicc 'ml, El 11cc•h. lr,clz Pee: plumb Ingr. :r»f' 1 L.C. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eft 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $4,769.10 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: E) Reg. O OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $12,051.90 Suppl. Insp. Fee:Q Reg. t) OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ('orstru(tion K?X. Adiniffisfral ,e J`ec: O 0 Work Without Permit? C) Yes E) No $0.00 Advanced Planning_F'ee: $0.00 Select a Non -Residential E) Building or Structure O d• Tr vel Dortimcntotion lees: Strong; Motion Fee: IBSEISMICo $189.00 Select an Administrative Item BldgStds Commission Fee: 1BCBSC $36.00 SUBTOTALS: 17,046.00 $0.00 TOTAL FEE: $17,046.00 Revised: 04/01/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 t D �� l ® Telephone: 408-777-3228 Fax: 408-777-3333 cC® ACTMUSUBCON 'RAcCT(DR UST JOB ADDRESS: 20590 Homestead Road PERMIT # 14040064 OWNER'S NAME:Sobrato Organization PHONE # GENERAL CONTRACTOR: South Bay Construction BUSINESS LICENSE #5655 ADDRESS: 1711 Dell Ave _ CITY/ZIPCODE: Campbell, CA 95008 *Our municipal code requires all businesses wm irking 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 SIMCONTRACTORS HAVE ORTA-IN ED A CITY OF CUPIERTI NO BUSINESS LICENSE. I am not using any subcontractors: . Signature Please cheek applicable subcontractors and complete the following information: Date d SUBCONTRACTOR BUSINESS ESS NAMlE BUSINESS ESS ILICIENSIE # Cabinets & Millwork NA NA Cement Finishing Noah Concrete Corporation 29578 Electrical Capital Valley Electric 34273 Excavation Blue Top Construction 35161 Fencing Pacific-SeGuMy-Geneing wee-recei{at.#� Flooring / Carpeting McGinness Flooring 34750 Linoleum /Wood McGinness Flooring 34750 Glass / Glazing USA All Glass Sof— Heating The Trillo Company 29816 Insulation Central California Insulation 557 Landscaping Jim Roberts Company 28615 Lathing Ageless Plastering 35164 Masonry IVlcCurley and Day 35159 Painting / Wallpaper NJ Kann Painting 35160 Paving Blue Top Construction 35161 Plastering Ageless Plastering 35164 Plumbing ]Master Craft Plumbing 35162 Roofing Statewide Roofing 23509 Septic Tank NA NA Sheet Metal The Trillo Company 29816 Sheet Rock South Bay Interiors 25499 Tile Fischer Tile and Stone 35157 10/9/14 Owner / Contractor Signature Date CALGREEN SIGNATURE DECLARATIONS Project Dame: STEIN MART '� Project Address: 20600 HOMESTEAD ROAD, CUPERTNO, CA 96014 Project Description: RETAIL TENANT IMPROVEMENT SECTION 1 ® DESIGN VERIFICATION Complete all lines of Section 1—'Design Verification' and submit the owrcpioted charklm QCT umas U and 2) rAth tha plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Siandards have favised the plans ®fad certify, that the items checked above are hereby Incorporated Into the project plans and will bla Implemented Into the project in accordanoe with the requiremmrits set forth in the 2013 California Green Building Standards Code Es adopted by the City of Cupertino. owners signature Ds" owners N?"( ease Print) Design PrWWonarl We CRAIG LMELEH Design Prof.9&4 Nam (PI e ' t) Signature AIG A MELEH 6ibiet�Calt3reenoornpRanm ��� 49d0676 Name of License Professional res bie to Cal mg0ance (masra Prinq Pi=0 CRAIGA ARC TECINC.0ooM Email Address for Lkense Pref weloxnal responsible For Ce113ran comp&arwo SECTION 2 — IMPLEMENTATION VERIFICATION Complete, sign and submit the competed cheddlsL including column 3, toather WM all wf&ml stnetss on Salm 2 to the Bulldtng Department prior to Building DepaMnent final inspection. I have inspected the work and have received sufficient documentation to verify and cuartify thei the project ldantMed above was constricted In accordance with lids Green Building Checklist and in accardarm with the raqutmments of the 2013 C do is Green SpIlding.Sta�ards Code as adopted by tine City of Ctaper iUrna. Signatures responslble for CaalGresn cornua= Nerve of License Professional respons[Ne For CalGreen compliance (Pleas Print) CRAIGA aBARCTECINC.COM Address compliance rhino Page 9 or9 CalGr¢an Nin-RPr CAeek►isedor rev&ed 0112JI14 Associates Date: August 19, 2014 To: Sylvia Mendez City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 syIviam(a-cu pertino.org (via email) Cc: Melissa Names melissanOcupertino.org (via email) RE: Plan Review for: Stein Mart — I'l (Revision) Project Address: 20600 Homestead Rd. Agency App. No.: 14040064 TRB+ Project No.: 14.014.106 R1.1 The following documents were received for review: Plans: (1 set) Sheet undated: Coversheet Agency: City of Cupertino TRB+ Project Number. 14.014.106 R1.1 Final Plan Review Page 1 of 1 Sheets dated 06/23/14: A2.11, A2.21, A3.21, A3.22, A5.01, A5.02, A8.01, A8.11, A8.31 Plans have been reviewed for compliance with the Building Department requirements contained in 2013 CBC, 2013 CPC, 2013 CMC, 2013 CEC, 2013 CRC, 2013 Green Building Standards Code, 2010 Energy_ Code, and City of Cupertino Ordinances. There are no further comments. Sincerely, TRB ¢ ASSOCIATES, INC. Jess Villar, ME Senior Plan Review Engineer TRB + Associates, Inc BUILDING SOLUTIONS 3180 Crow Canyon Place + Suite 216 + San Ramon, CA 94583 for MUNICIPALITIES T 925 866.2633 F 925 790.0011 www.TRBp/us.com —L,o c 4A M vl 'S.. 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N M f� a u ` t �• C as 1 n c !� n�a W ' F � � 4 ? 1 SS 2 x 0 ityq o 00 H1 ° s '1 $ n C wn i V 1 1 I t I i 1 T No �d 6 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-LTG-2A (Revised 08109) CALIFORNIA ENERGY COMMISSIC?i CER'TMCA'TE OF ACCEPTANCE L'FG-2A ' Lighting �ontrofl �cecptanee Document (Page t of �) Project Name/Address: System Name or Identification/Tag; System Location or Area Served: Enforcement Agency: Permit Number: �( Note: Submit one Certificate of Acceptance for each system that Enforcement Agency Use: Checked by/Date must demonstrate carnplionce. FIELD TECHNICIAN'S DECLARATION STATEMENT 0 t certify under penalty of periury. under the la+4s of the State of Califitrnia, the information pm ided on this loom is true and correct. o I am the person who performed the acceptance requirements Verification reported on this Certificate of Acceptance (f=ield Fechnician). 0 t certify that the construction/installation identified on this fomt complies with the nceeptance requirements indicated in the plans and specifications approved by the enforcement agency. and conforms to the applicable acceptance requiremerrs and procedures specified in Retcrence Nonresidential .appendix NAT 0 1 have confirmed that the Installation Certificat`(s) Ser the constrttctirnt`installation identified on die fern has been completed mid is posted or made ;available with the building pentit(s) issued for the building. Company Name: j (Meld Technicians Name: Field Technician's S;Tmantre:— — - - — RESPONSIBLE PERSON'S DECLARATION STATEMENT 0 1 certify under penalty of perjlivy. under the laws of the State of('alifbrnia, that I ant the Field `fcchnician. or the Field Technician `s acting on my behalfas my employee or my agent anti i have reviewed Lhe information prof ided on this form. 0 I atn a licensed contractor, architect, or engineer., who is eligible under Division 3 of the Ldusiness and professions Code, in the applicable classification. to take responsibility for the scope of work specified on this document and attest to the declarations in this statement (responsible person). 0 1 certil"y that the information provided on this form substmitiates that the cons lructiorthn,lallation identified on this form 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. 0 1 have confirmed that the Installation Certificate(s) ler the constructionlinstatlation identified on this form has been completed and is posted or made available with the building permit(s) issued for the building - 0 1 will ensure that a completed. signed copy of this Certificate of Acceptance shall he posted, or made aN ailable with the building pennit( s) issued cur lite building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy oft?tis Certificate ill Acceptance is required to be included with the documentalian the builder provides to the building, oW.ner at occupancy. Company Name: Phone: Pff0(RAE tlWc-. "'Q*��-0oG^`L3U,7'� Responsible Person's Name: Responsible Person's Sisnaturvl Licence: Date Signed: Position With Company i Tittt ): --� CA OT(5 510 Occu attt Sensor, Manual Da�ligrhtipg Control, and Automatic 7'itne Switch Control Intent., Lights are turned off when not needed per Section 119(d) &c i:+I(d). Construction inspection ImsttlIII ell tation to perfonn test includes.. but not limited to: a. _ 1 Hand-held amperage and voltage meter 2008 Aoni-esicit'nhal:leceptcriic-e Fornis . litgust 20119 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CEG-LTG-2A'Revised 08/0J) CALIFORNIA FNFRQY CtiMNAF.RAICIN CERTIFICATE OF ACCEPTANCE LTC -2A � Li=hting Control Acceptance Document (Page 2 of 4) Project Name/Address: STelPJAAAV"b Z System Name or Identification,/Tag: LI &MYtia, C.0,,JTV_"8l_g System Location or Area Served: b. :.Power metes- _ continued on next lame Occupancy Sensor Construction Inspectio-- --- - — __.. _ Inspection l Occupancy sensor has been located to minimize false signals -- -- - - Light meter ❑ i Ultrasonic occupancy sensors do not emit audible sound (i 19a) 5 feet from source — 3 Manual Daylighting Controls Construction inspection If dimming ballasts are specifier] for light Futures within the dayht arca, make sure they meet all the Standards requirements, including "reduced flicker operation" for mutual dlmmtna_!;ointrol L Automatic TiTtle S%vitch Controls Corstiuc.(ion Inspection d ^� a. Automatic time Switch control is programmed for (check all)` _--- - --R_—T -_ Weekdays Weekend Holidays ! Document for -the ovvner automatic time switch prouranimina (check all), D Weekdays settings - ( --- b. f ❑ Weekend seftinJs---- - ---------- -___T_ __—�_ } ❑ { Iloliday's settings 1-7 ' Set-up settings Preference program sertinb —�— - -- -- _ __-.-- — Verify the correct time and date is properly set in the time switch Verify the battery is installed and energized ❑ ❑ Oven-ide time limit is no more than 2 hours i Uccupant Sensors and Automatic Time Switch Controls have been certified to the Energy Commission in accordance with the applicable provision in Section 119 of the Standards, and model numbers for all such controls are listed on the Commission database as Certified A2pliance and Control Devices A. Select Acceptauce Test (indicate lighting control systems NamesiDesignations by the applicable tests below) I ❑ 1 Occupancy Scnsor ❑ 2 Manual Daylighting Controls 7 t] ; Automatic Time Switch Controls i B. Equipment Testing Requirements Applicable lighting I Check andverif.- those items applicable to selected system: i Control Systems Occupancy= Sensor - Step 1: Simulate an unoccupied condition 1 l 2 _, a.V Lights controlled by occupancy sensors turn off within a maximum of 30 minutes from start of an unoccupied condition per Standard Section t i S(d) 1' � Y/'N YIN b The occupant sensor does not trigger a false "on" froth movement in an area adjacent ro the controlled s ace or front HV.AC operation N Y / N Y 'N C. Si -nal sensitivity is adequate to achieve desired control -� 1' N -Z' % N Occupant Sensor - Step 2: Simulate an occupied condition 2�1p$1Vcnr1 twcirfa?Ittitrl ftceeplralrc:E roans :4u ust 2009 STATE OF CALIFORNIA LiGHTING CONTROL ACCEPTANCE DOCUMENT ; CEC-LTG-<A (Reused 08,W) CALIFORNIA FN1=Rev rr�+ta,�i�SirN CLRT:CFICATE Or ACClii'.PTANCE 1,TG-2A Lighting Control Acceptance Document ('age 3 of 4) Project Name/Address: System Name or Identification/Tag; W el t -4F 1 W Qa C—®A�7MV,=V System Location or Area Served: a, Status indicator or anniuncimor operates correctly e:-� N YIN Y 1 N b' Lights controlled by occupancy sensors turn on �+hen immediately upon an occupied condition OR (this requirement is mutual) exCinSiVe with Step 2.c.) � N Y / N Y i N c, I Sensor indicates space is "occupied" and lialits turn on manually Y ! N Y i N Y /N continued on next page Occupant Sensor - Step 3: System returned to initial operating conditions 'N Y i N Y i N Occupant Sensor - Step 4 - Sensor is also a multi -Level Occupant Sensor used to qualify Fora Power Adjustment f -actor in Section 146(a)2D of the Standards. If yes. duct `a.` `b,' Y 6 ` Y 1 N Y ;N and 'c' must also be res. The first stage activates 151�tiveen 30 te, 70% of the lighting eithermanually or � autounatically. A reasonably uniform level of illuminance is achieved by dimming of all latttps or b. luminaires; or by switching alternate'lamps in luminaire;, alternate luminaires, or Y_ p> 1' / N Y : N altemate rows of luminaires. After the aur si. sea:*e occurs, manual switches have been provided to activate the c, alternate set of lights. arti,,ate 100% of the lightiutg po,ver, and man ualIy deactivate all 4'�N' of the li��hts.. Nil anual Dor figl►t►►t- Cotntrols - Step I : kfnnuai switching control a. At least 50% of lighting power in dayl it areas is separately controlled from other lights VIN Y / N" Y i N b. The amount of light delivered to the space is uniformly reduced YIN YIN V 1 N Manual Daylighti.ng Controls - Step 2: System returnee] to initial operating con_dilions Y 1 N Y i N V? N Automatic Time Switch Controls - Step 1: Simulate occupied condition a. All lights can be tented on and off by thein respective area control switch �� �I Y i N Y I N b Verity the switch only operates lighting in the. ceiling -height partitioned area in which � r N Y : N the switch is located Automatic Time Snitch Controls - Step ?: Simulate unoccupied condition a. All non-exempt lighting turn off per Section 131(d)1 (J�? N Y IN Y! N Manual override swritch allows only the lighis in the selected ceiling height partitioned , '/ b. space where the override switch is located, to turn on or remain on until the next N Y /N Y ! N scheduled shut offoccurs c. All non-exempt lighting turns off N YIN Y + N Automatic Time Switch Controls - Step 3: System returned to initial operating conditions YIN Y ! N Y % N :Vote: Shaded areas do Trot apply for partieular lest precedure C. ] SS 1 FAIL Evaluation (check one): PASS: All applicable Construction Iuspectiou responses are complete and all applicable Equipment Testing Requirements responses at•e positive (Y - yes) FAiL: A.ny applicable Construction Inspection responses are incomplete OR there is onQ or more negative (N - no) responses in any applicable Equipment Testing Requirements section. Provide explanation belo.v. Use and attach additional ages if necessa . _j 1 i 2008 Nonresidential Acceptoace rorins Aijgv r 2009 STATE OF CALIFORNIA pti LIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-LTG•ZA (Revised 06109) CALIFORNIA ENERGY CtjMMUSSION CERTIFICATE OF ACCEPTANCE 1,'6TG-2A Liffliting Control Acce tante Document (Page 4 of 4) Project Name/Address: System Nacre or Identification/Tag: L.9Cb@p—0parQ-0 System Location or Area Served: 2103Forms Aiqu. t 2009 4t+04-0-064- 1200 RIVERPLACE BOULEVARD o JACKSONVILLE, FL 32207-1809 0 (904) 346-1500 June 18, 2004 George Schroeder City of Cupertino, Planning Department 10300 Torre Avenue Cupertino, CA 95014 RE: Stein Mart #384 Dear George: Homestead Square S/C Cupertino, California It is our understanding that you would like us to replace spandrel glass on the storefront with transparent glass. For your convenience, I have enclosed a fixture plan for the proposed Cupertino Stein Mart store and the floor plan from our prototypical plan set which shows our store fixtures set against the exterior windows. The layout for Stein Mart stores consist of a sales area with a variety of free standing fixtures and wall mounted display areas on all perimeter walls. The front wall of our store is designed with spandrel glass in front of display walls so that we can maximize sales floor utilization while providing an esthetically pleasing store front. We do not utilize display windows in the front of the store as maintaining these is costly, labor intensive and robs the store, of valuable interior merchandising space. By maximizing sales floor utilization we are able to bring value to our customers. Kindly reconsider your request to replace the spandrel glass with transparent glass. Sincerely, Mart Inc. ry Incollingo !ctor of Store n & Constr ion HVAC Contras Proied: Stein AC #1 lTAHo Companoes 1Inc 20600 Hol4estead Rd., Cupertino, CA (�Oi m 1 AREA CD1 T -Bar 8" 100 Design Prelim Sales Fina( Airflow 8" 100 No. TYPE SIZE Airflow Airflow 250 250 of Design SERVICED CD1 T -Bar 14" 675 675 100% Sales (CF(CFM)% 14" 675 675 100% Sales (CFM) (CFM) 675 675 100% Sales CD1 T -Bar 8" 100 100 100% Sales CD1 T -Bar 8" 100 100 100% Sales. CD1 T -Bar 8" 250 250 100% Sales CD1 T -Bar 14" 675 675 100% Sales CD1 T -Bar 14" 675 675 100% Sales CD1 T -Bar 14" 675 675 100% Sales CD1 T -Bar 14" 675 675 100% Sales CD1 T -Bar 14" 675 675 100% Sales CD1 T -Bar 14" 675 675 100% Sales CD1 T -Bar 10" 250 250 100% Sales CD1 T -Bar 10" 250 250 100% Readings By: Abel Navarro Test Date: 10/20/2014 HVAC Cont adorn The Trffi® Compa es Mc Project: Stein Mart 20600 Homestead Rd., Cupertino, CA SySte : AC #2 AREA CD1 T -Bar 14" Design Prelim 100% Final Airflow CD1 SERVICED NO. TYPE SIZE Airflow Airflow CD1 (CFM) % of Design 750 750 100% Sales (CFM) (CFM) 14" 750 750 Sales CD1 T -Bar 14" 750 750 100% Sales CD1 T -Bar 14" 750 750 100% Sales CD1 T -Bar 14" 750 750 100% Sales CD1 T -Bar 14" 750 750 100% Sales CD1 T -Bar 14" 750 750 100% Sales CD1 T -Bar 14" 750 750 100% Sales CD1 T -Bar 10" 200 200 100% Sales CD1 T -Bar 10" 200 200 100% Readings By: Abel Navarro Test Date: 10/20/2014 HYAC Contractor: The Ism Ho C ompaMes lint Project: Stein mart 20600 Homestead Rd., Cupertino, CA System: AC #3 Sales CD1 T -Bar 14" Design Prelim 100% Sales CD1 AREA No. TYPE SIZE Airflow Airflow CD1 Final Airflow % of Design SERVICED 625 100% Sales CD1 T -Bar 14" (CFM) 625 100% Sales CD1 T -Bar (CFM) (CFM) 625 100% Sales Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Readings By: Abel Navarro Test Date: 10/20/2014 HVAC Contractor: The TrUllo Companies �nc ftjed: Stein Mart 20600 Homestead Rd., Cupertino, CA System: : AC #4 AREA CD1 T -Bar 14" 625 Design Prelim CD1 Final Airflow 14" 625 625 100% N0. TYPE SIZE Airflow Airflow Sales CD1 % of Design SERVICED 625 100% Sales CD1 T -Bar 14" 625 625 100% (CFM) CD1 T -Bar 14" 625 625 100% Sales (CFI) (CFM) 14" 625 625 100% Sales Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Readings By: Abel Navarro Test Date: 10/20/2014 HVAC Contractor: The TrUb C ompaMes In PF(Dj8d: Stein Mart 20600 Homestead Rd., Cupertino, CA System: AC #5 AREA CD1 T -Bar 14" Design Prelim 100% Final Airflow CD1 T -Bar NO. TYPE SIZE Airflow Airflow CD1 T -Bar % of Design SERVICED 625 100% Sales CD1 T -Bar 14" (CFM) 625 100% Sales CD1 T -Bar (CFM) (CFM) 625 100% Sales Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Sales CD1 T -Bar 14" 625 625 100% Readings By: Abel Navarro Test Date: 10/20/2014 PrOje : Stein Mari: 20600 Homestead Rd., Cupertino, CA SyStW: AC #6 AREA CD1 T -Bar 12" DesignPrelim 550 100% Final Airflow CD1 SERVICED NO. TYPE SIZE Airflow Airflow CD1 (CFftq) "/o of Design 550 550 100% Sales (CFM) (CFM) 12" 550 550 Sales CD1 T -Bar 12" 550 550 100% Sales CD1 T -Bar 12" 550 550 100% Sales CD1 T -Bar 12" 550 550 100% Sales CD1 T -Bar 12" 550 550 100% Sales CD1 T -Bar 12" 550 550 100% Sales CD1 T -Bar 12" 550 550 100% Sales CD1 T -Bar 12" 550 550 100% Sales CD1 T -Bar 12" 550 550 100% Sales CD1 T -Bar 12" 550 550 100% Readings By: Abel Navarro Test Date: 10/20/2014 TAC Contractor: The Trnlll® Compan[iez Ilnc project: Stein Mart 20600 Homestead Rd., Cupertino, CA system: AC #7 AREA SERVICED N0. TYPE SIZE Design Prelim 450 Final Airflow "�" of Design CD1 T -Bar 12" Airflow (CFM) Airflow (CFM) 100% (CFM) Sales CD1 T -Bar 12" 450 450 100% Sales CD1 T -Bar 12" 450 450 100% Sales CD1 T -Bar 12" 450 450 100% Sales CD1 T -Bar 12" 450 450 100% Sales CD1 T -Bar 12" 450 450 100% Sales CD1 T -Bar 12" 450 450 100% Sales CD1 T -Bar 12" 450 450 100% Changing Room 8" 200 200 100% Changing Room 8" 200 200 100% Changing Room 8" 200 200 100% Changing Room 8" 200 200 100% Changing Room 8" 200 200 100% Changing Room 8" 200 200 100% Readings By: Abel Navarro Test Date: 10/20/2014 HVAC Contractor: The TvNl® Companies enc Project: Stein Mart 20600 Homestead Rd., Cupertino, CA System: AC #8 Warehouse CD2 T -Bar 14' Design Prelim 100% Final Airflow CD3 AREA SERVICED NO. TYPE SIZE 100% CD4 T -Bar % of Design 800 800 100% Airflow (CFM) Airflow (CFM) 14' (CFM) 800 Warehouse CD2 T -Bar 14' 800 800 100% CD3 T -Bar 14' 800 800 100% CD4 T -Bar 14' 800 800 100% CD5 T -Bar 14' 800 800 100% CD6 T -Bar 14' 800 800 100% Office CD1 T -Bar 8' 120 120 100% CD1 T -Bar 8' 120 1 120 100% Restroom CD1 T -Bar 8' 120 120 100% Restroom CD1 T -Bar 8' 120 120 100% Restroom CD1 T -Bar 8' 120 120 100% Restroom CD1 T -Bar 8' 120 120 100% Restroom CD1 T -Bar 8' 120 120 100% Readings By: Abel Navarro Test Date: 10/20/2014 STATE OF CALIFORNIA ENVELOPE COMPONENT APPROACH CEC-MECH-1C (Revised n3/1 01 PAI IF(IIT IA =K1[:0GV C(nAhA1QC1'-�1 CERTIFICATE OF COMPLIANCE and - lF]IIEILI(D INSPECTION ENERGY CIEIIIECIKILI(ST eu— o z' a 0 age I of 5) M E(CH-1(C Project Name: S !>1 T+ �'�� D U14 Climate Z ne: Project Address: 1 - i W� Conditioned Floor Area: General Information Building Type: Nonresidential ❑ High -Rise Residential ❑ Hotel/Motel Guest Room ❑ Schools (Public School) ❑ Relocatable Public School Bldg. P Conditioned Spaces ❑ Unconditioned Spaces Phase of Construction: ❑ New Construction ❑ Addition ❑ Alteration Approach of Compliance: ❑ Component ❑ Unconditioned (file affidavit) Front Orientation: N, E, S, W or in Degrees: HVAC SYSTEM DETAILS FIELD INSPECTION ENERGY CHECKLIST ]Equipment Inspection Criteria []Meets Criteria or Requirements ]Pass ]Fail - Describe ]Reason Item or System Tags (i.e. AC -1, RTU -1, HP -1) 4f 13 Equipment T e3: ❑ No of Systems Max Allowed Heating Capacity1 ❑ Minimum Heating Efficiency 1 ❑ Max Allowed Cooling Ca aci 1 ❑ Cooling Efficiency' ❑ Duct Location/ R -Value ❑ When duct testing is required, submit M[ECH-4A & Ml1ECH-4-HEIRS Economizer 13 Thermostat ❑ Fan Control ❑ Equipment Inspection Criteria FIELD INSPECTION ENERGY CHECKLIST ]Pass ]Fail - Describe 1Reason2 Item or System 'fags (i.e. AC -1, RTU -1, HP -1) 13 13 Equipment T e3: ❑ ❑ No of Systems ❑ ❑ Max Allowed Heating Capacity' ❑ ❑ Minimum Heating Efficiency' ❑ ❑ Max Allowed Cooling Capacity1 ❑ ❑ Cooling Efficiency 1 ❑ ❑ Duct Location/ R -Value ❑ ❑ When duct testing is required, submit MECH-4A & M[ECH-4-HERS ❑ Economizer ❑ ❑ Thermostat ❑ ❑ Fan Control ❑ 1. If the Actual installed equipment performance efficiency and capacity is less than the Proposed (from the energy compliance submittal or from the building plans) the responsible party shall resubmit energy compliance to include the new changes. 2. For additional detailed discrepancy use Page 2 of the Inspection Checklist Form. Compliance fails if a Fail box is checked. 3. Indicate Equipment Type: Gas(Pkg or, Split), VAV, HP (Pkg or split), Hydronic, PTAC, or other 2008 Nonresidential Compliance Forms March 2010 2008 Nonresidential Compliance Forms March 2010 Q Z K O LLJ Q U LL O N Q H U o O Oguuu000000 V � �; � � ti •o ofii � d A U V o U �� w 000000000 v i b o tl Zi V o U M � oa � cy ° � .� v ,s � � fi fi Q �•. a.. � 0001300000 tl m y O to O v IE W � fi 000000000 O O fi .� > � O C y fi ` z to < 000000000 W � e� ofii �S - y �� d o°�i bo tl• fi x + ~ U 130000000 w 'y � y� cfii fi �� o"i 'ts W U O� A g �� tl•o" v N 130 00000 ® o y vami W U c 4) N 'n ° U "3O fi . �. � o $ o ,,o ma v Q 0 0®0000000 � � � oii •� chi o � o y hl � •� W '" A cc fd � o o W o o� N 1313 131300 U tl tl y y q� cv O�c' O > d U 001200000 o� ® V fi v fi v y 4 CL V bow C y bo O V V C3 to,4-, �Q 'ZI d N '� bU O O d y tl b 43s 1 �� O �� i ~ W H 9L 9L o ®Cl) 0 a � � c Lu s O 4 ® U Q U _ O W r O Q g V N � U 0 0 N rr1 C1 4+ � O 0r � O Lir Q k� W) W v r� 1D ® ® ® ® o ® ® ® ® ® ® ® ® ® ® o ® ® ® ® ® ® ® ® ® ®........ U z ¢ v 00 ® UA 00000000000000000000000000 00000000000000000000000000 N x � O G x ® ® ® ® ® L 1 1 ® ® ® ® ® ® ® ® ® O [a Q w w Tj O I G It u C N r®Q K •V � r- � � 7 a � w w 0 0 N STATE OF CALIFORNIA ENVELOPE COMPONENT APPROACH CEC-MECH-1C (Revised 03/10) CALIFnRNIA FNFRGY rOMMMAI �—=� CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (]Part 5 of 5) MIECI -1 c Project Name: Date: >(D®cumentation Author's )]Declaration Statement o I certify that this Certificate of Compliance documentation is accurate and complete. Name: Signature: Company: Date: Address: If Applicable CEA # CEPE # City/State/Zip Phone: Principal Mechanical Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the mechanical design. • This Certificate of Compliance identifies the mechanical features and performance specifications required for compliance with Title 24, Parts 1 and 6 of the California Code of Regulations. • The design features represented on this Certificate of Compliance are consistent with the information provided to document this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Name: Signature: Company Name: Date: Address: License # City/State/Zip Phone: Mandator y Measures Indicate location on building plans of Note Block for MandatoEy Measures MECHANICAL COMPLIANCE FORMS & WORKSHEETS(check box if worksheet is included For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, refer to the 2008 Nonresidential Manual Note: The En rcementAgency may require all,forms to be incorporated onto the building plans. ❑ MECH-1 C Certificate of Compliance. Required on plans for all submittals. ❑ MECH-2C Mechanical Equipment Summa is required for all submittals. ❑ MECH-3C Mechanical Ventilation and Reheat is required for all submittals with mechanical ventilation. 1 ❑ 1 MECH-4C I Fan Power Consumption is required when for all prescriptive submittals. 11 2008 Nonresidential Compliance Forms March 2010 STATE OF CALIFORNIA ~ AOR, WATER 500 SYSTEM, SERVICE HOT WATER & POOL REQUiREMEHTS t "f CEC-MECH-2C (Revised 08/09) CALIFORNIA ENERGY COMMISSION AIR SYSTEM REQUIREMENTS ff a rit I of 3) IYlIIECI -2c PROJECT NAME: DATE: Item or System Tags (i.e. AC -1, RTU -1, HP -1) Indicate Air Systems Type (Central, Single Zone, Package, VA or etc...) `� q -� T, g 0 , 0 U V No. of Systems MANDATORY MEASURES Heating Equipment Efficiency Cooling Equipment Efficiency HVAC or Heat Pump Thermostats Furnace Controls/Thermostat Natural Ventilation Mechanical Ventilation VAV Minimum Position Control Demand Control Ventilation Time Control Setback and Setup Control Outdoor Damper Control Isolation Zones Pipe Insulation Duct Insulation PRESCRIPTIVE MEASURES Calculated Design Heating Load Calculated Design Cooling Load Fan Control DP Sensor Location Supply Pressure Reset (DDC only) Simultaneous Heat/Cool Economizer Heat and Cool Air Supply Reset Electric Resistance Heating' Heat Rejection System Air Cooled Chiller Limitation Duct Leakage Sealing. If Yes, a M[ECH-4-A must be submitted Indicate Page Reference on the Plans or Schedule list or list in ormation Below T-24 Sections 112(a) 112(a) 112(b), 112(c) 112(c), 115(a) 121(b) 121(b) 121(c) 121(c) 122(e) 122(e) 122(f) 122(g) 123 124 144(a & b) 144(a & b) 144(c) 144(c) 144(c) 144(d) 144(e) 144(f) 144(g) §144 (h) §144 (i) 144(k) 1. Total installed capacity (MBtu/hr) of all electric heat on this project exclusive of electric auxiliary heat for heat pumps. If electric heat is used explain which exceptton(s) to ys744(Q) apply. 2008 Nonresidential Compliance Forms August 2009 Z O co co O U } K W M o Mo, LLI :1 U W IL m X ,W,+ W U) 0 .G/ U E i Y -�D 4. O # � y Q `ty L v r fi s 4 O Q O � � •OU! N O � CQi y i C U Q OI Vj � y L O \ V � Q 5 `i � Q fi • U O i 4 its r p Iv � y L � Q N U ns Y U �\ Y/I Y h ti y o � 4 ,U �co i'� 4 � N � cOC O ~ O � � � � ^v � U o o _ � H to Y y ..Y• W p U U> U U E _Q Z O LL J Q U LL O Lu F- (1) y 2 O U V) O U } C7 w LU tu Z O t a L U Lu tu 0x tu Ji O O N i E e fi 00 ® � o � h R b d t o � � o d A h K o a' � o y � o � Chi d C h Q U ~ c � i ~ � r t3 _n y g o 0 M ° " R ts cm cd cpo cpo c°o coo coo W cOo cOo coo coo o g � o q ^ _ c U � � •V N w d �a B ^o O U G O c°iti >1Q G C G O E d O Q 'n y cd v) v� cncz o �Sa �z cl S4� �• a O O O O co C63 'a" a a° a°. a°, a°, V) a N O O N z W 0 LL � d y fi F i m •,n O E .�y OA � fi y q a� � O g\ m U ° Y q0. O `Q• o UU V vai�N� U E C q ,o o fi o � h fi Lifi 0 chi Q o o o „YV ,i W=1 � h vn Wn Wn Wn to W) Wn v) v) kn vn W) m o o b a4 .� O y +�., fi Q ti r, 1� F U C14 Y fi 4 � W � O N 4S o e Q' •y 06, i1 ® O O fi CL U a 1 @ q O ifi. fi •O Y � fi c„Q� p � h O Y q :8 Q O N 07 fi S fi14) U wu O O O N STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE CEC-MECH-2A (Revised 08/09) CALIFORNIA ENERGY COMMISSION -- CERTIFICATE OF ACCEPTANCE MECH-2A NA7.5.1 Outdoor Air Acce tante (Page 1 of 3 Proj Name/Address: System Name or Identification/Tag: System Location or Area Served: Enforcement Agency: Permit Number: Note: Submit one Certificate of Acceptance for each system that must demonstrate compliance. Enforcement Agency Use: Checked by/Date FIELD TECHNICIAN'S DECLARATION STATEMENT o I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. I am the person who performed the acceptance requirements verification reported on this Certificate of Acceptance (Field Technician). o I certify that the construction/installation identified on this form 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. 0 I have confirmed that the Installation Certificate(s) for the construction/installation identified on this form has been completed and is posted or made available with the building permit(s) issued for the building. Company 'wDe; I rn Field Technician's Name: Field T cian's Signature: Lic ns O Date Signed: A Position With Company (Title): RESPONSIBLE PERSON'S DECLARATION STATEMENT 0 I certify under penalty of perjury, under the laws of the State of California, that 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 form: O I am a licensed contractor, architect, or engineer, who is eligible under Division 3 of the Business and Professions Code, in the applicable classification, to take responsibility for the scope of work specified on this document and attest to the declarations in this statement (responsible person). O I certify that the information provided on this form substantiates that the construction/installation identified on this form 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. O I have confirmed that the Installation Certificate(s) for the construction/installation identified on this form has been completed and is posted or made available with the building permit(s) issued for the building. O 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. Company Name: l Phone: Responsible Person's Name: Respon ible Person's Signature: Lic ns O Dfatt(eoSigned: Q, PositTon ith Company (Title): ill` �� ` 2008 Nonresidential Acceptance Forms August 2009 M STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE CEC-MECH-2A (Revised 08/09) CALIFORNIA ENERGY COMMISSION CERTIFICATE FICATE O1F ACCEPTANCE IWECH-2A NA7.5.1 Outdoor Air Acceptance (Page 2 of 3 Project Name/ ress: System Name or Identification/Tag: System Location or Area Served: Intent: Verb measured outside airflow reading is within f 10% of the total required outside airflow value found in the Standards Mechanical Plan (MECH-3C Column H or Column 1), per NA7.5.1. Construction 1 Instrumentation to perform test includes, but not limited to: a Watch b. Calibrated means to measure airflow 2 Check one of the following: ❑ Variable Air Volume (VAV) - Check as appropriate: a• Sensor used to control outdoor air flow must have calibration certificate or be field calibrated ❑ Calibration certificate (attach calibration certification) ❑ Field calibration (attach results) Constant Air Volume (CAV) - Check as appropriate: A System is designed to provide a fixed minimum OSA when the unit is on NA7.511 Outdoor Air Acceptance A. . Functional Testing (Check appropriate column) CAV VAV a. Verify unit is not in economizer mode during test - check appropriate column / Step 1: CAV and VAV testing at full supply airflow a. Adjust supply to achieve design airflow b. Measured outdoor airflow reading (cfm) C. Required outdoor airflow (cfm) (from MECH-3C, Column 1) d. Time for outside air damper to stabilize after VAV boxes open (minutes) e. Return to initial conditions (check) Step 2: VAV testing at reduced supply airflow a. Adjust supply airflow to either the sum of the minimum zone airflows or 30% of the total design airflow b. Measured outdogr airflow reading (cfm) C. Required outdoor airflow (cfm) (from MECH-3C, Column 1) d. Time for outside air damper to stabilize after VAV boxes open and minimum air flow achieved (minutes) e. Return to initial conditions (check) B. 'Testing Calculations & Results CAV VAV Percent OSA at full supply airflow (%OAFA for Step 1) a. %OAFA = Measured outside air reading /Required outside air (Steplb/Steplc) ' % % b. 90% < %OAFA < 110% N Y / N c. Outside air damper position stabilizes within 15 minutes (Step Id < 15 minutes) Y / N Y / N Percent OSA at reduced supply airflow (%OARA for Step 2) 'L k a. %OARA = Measured outside air reading /Required outside air (Step2b/Step2c) C l % % b. 90% < %OARA < 110% Y / N 2008 Nonresidential Acceptance Forms August 2009 .. N STATE OF CALIFORNIA , OUTDOOR AIR ACCEPTANCE CEC-MECH-2A (Revised 08/09) CALIFORNIA ENERGY COMMISSION r CIERTIIFICATIE OF ACCEPTANCE MIECII-2A NA7.5.1 Outdoor Air Acceptance (PaLe 3 of 3 Project N e/Address: System Name or Identiticationaag: System Location or Area Served: tai C. I Outside air damper position stabilizes within 15 minutes (Step 2d < 15 minutes) Y N Note: Shaded boxes do not apply for CA V systems C. PASS / FAIL ]Evaluation (check one): PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive (Y - yes) El FAIL: Any Construction Inspection responses are incomplete OR there is one or more negative (N - no) responses in Testing Calculations & Results section. Provide explanation below. Use and attach additional pages if necessary. 2008 Nonresidential Acceptance Forms August 2009 STATE OF CALIFORNIA CONSTANT VOLUME SINGLE ZONE UNITARY AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-MECH-3A (Revised OB/09) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE MlEC1HlI-3A NA7.5.2 Constant Volume Single Zone Unita Air Conditioner and Heat Pump Systems (Page I of 4 Project , ame/Address: T c 'cian's Signature: System Name or Identification/Tag: 19 -To 2- 1, a - Date Signed: System Location or Area Served: Enforcement Agency: Permit Number: Note: Submit one Certificate of Acceptance for each system that must demonstrate compliance. Enforcement Agency Use: Checked by/Date FIELD TECHNICIAN'S DECLARATION STATEMENT e I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. C I am the person who performed the acceptance requirements verification reported on this Certificate of Acceptance (Field Technician). e I certify that the construction/installation identified on this form 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. O I have confirmed that the Installation Certificate(s) for the construction/installation identified on this form has been completed and is posted or made available with the building permit(s) issued for the building. Company Name: C-0i?� Field Technici�s Name:C�"_ Fiel T c 'cian's Signature: License: Date Signed: Position With Company (Title): .: -C.J L�-4 Date Signed: -1 Position ' Companx(Title): RESPONSIBLE PERSON'S DECLARATION STATEMENT O I certify under penalty of perjury, under the laws of the State of California, that 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 form. O I am a licensed contractor, architect, or engineer, who is eligible under Division 3 of the Business and Professions Code, in the applicable classification, to take responsibility for the scope of work specified on this document and attest to the declarations in this statement (responsible person). O I certify that the information provided on this form substantiates that the construction/installation identified on this form 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 NAT O I have confirmed that the Installation Certificate(s) for the construction/installation identified on this form has been completed and is posted or made available with the building permit(s) issued for the building. O 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. Company Name: Phone: Responsible Person's Name: Re o sible Person's Signature:` pcJ- y�� 1.1 �� License: Date Signed: Position With Company (Title): -C.J L�-4 2008 Nonresidential Acceptance Forms August 2009 STATE OF CALIFORNIA CONSTANT VOLUME SINGLE ZONE UNITARY AIR CONDITIONER AND BEAT PUMP SYSTEMS CEC-MECH-3A (Revised 08/09) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NIECH-3A NA7.5.2 Constant Volume Single Zone Unitary Air Conditioner and Heat Pump Systems (Page 2 oI' D Project e/Address: System Name or Identification[Fag: -I AAU-v System Location or Area Served: Verify, the individual components of a constant volume, single -zone, unitary air conditioner and heat pump system function correctly, Intent: including: thermostat installation and programming, supply fan, heating, cooling, and damper operation per NA 7.5.2 Construction Inspection 1. Instrumentation to perform test includes, but not limited to: a. None required 2. Installation ,®'Thermostat is located within the space -conditioning zone that is served by the HVAC system. 3. Programming (check all of the following): ❑�T ermostat meets the temperature adjustment and dead band requirements of 122(b) Occupied, unoccupied, and holiday schedules have been programmed per the facility's schedule. ❑ Pre -occupancy purge has been programmed to meet the requirements of Standards Section 121(c)2. A. Functional Testing Requirements Operating Modes Cooling load during unoccupied condition Cooling load during occupied condition Manual override No-load during unoccupied condition Heating load during unoccupied condition No-load during occupied condition Heating load during occupied condition Step 1: Check and verify the following for each simulation mode required A B C D E F G a• Supply fan operates continually Er b - Supply fan turns off C. Supply fan cycles on and off d• System reverts to "occupied" mode to satisfy any condition e System turns off when manual override time period expires .� f Gas-fired furnace, heat pump, or electric heater stages on „a 9. Neither heating or cooling is provided by the unit J2 - h. No heating is provided by the unit i No cooling is provided by the unit j Compressor stages on k. Outside air damper is open to minimum position l Outside air damper closes completely M. System returned to initial operating conditions after all tests have been completed: Y / N B. Testing Results A B CID1 CIDE F C Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter ? 2008 Nonresidential Acceptance Forms August 2009 STATE OF CALIFORNIA CONSTANT !VOLUME SINGLE ZONE UNITARY AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-MECH-3A (Revised 08/09) CALIFORNIA ENERGY COMMISSION - CERTIFICATE OF ACCEPTANCE MECH-3A NA7.5.2 Constant Volume Single Zone Unita Air Conditioner and heat Pump Systems (Page 3 of 4 Project e/Address::�� ` System Name or [dentification[Fag: System Location or Area Served: 2008 Nonresidential Acceptance Forms August 2009 STATE OF CALIFORNIA CONSTANT VOLUME SINGLE ZONE UNITARY AIR CONDITIONER AND CHEAT PUMP SYSTEMS CEC-MECH-3A (Revised 08/09) CALIFORNIA ENERGY COMMISSION C1ERTIFfCAT E OF ACCEPTANCE MlECH-3A NA7.5.2 Constant Volume Single Zone Unitag Air Conditioner and Heat Pump Systems (Page 4 of 4 Project a/Address: V., 0�A System Name or Identification/Tag: System Location or Area Served: C. PASS / FAILS Evaluation (check one): PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P) 0 FAIL: Any Construction Inspection responses are incomplete OR there is one or more "Fail" (F) responses in Testing Results section. Provide explanation below. Use and attach additional pages if necessary. 2008 Nonresidential Acceptance Forms August 2009 STATE OF CALIFORNIA AIR ECONOMIZER CONTROLS ACCEPTANCE CEC-1VIECH-5A (Revised 08/09) CALIFORNIA ENERGY COMMISSION �___ % CERTIFICATE OF ACCEPTANCE M ECH-5A NA7.5.4 Air Economizer Controls Acceptance � e 1 off �} Pro'ect Name/AddE�r�guh System eN,ame or Identification/Tag: —fV — I rV ID e System Location or Area Served: Enforcement Agency: Permit Number: Note: Submit one Certificate of Acceptance for each system that must demonstrate compliance. Enforcement Agency Use: Checked by/Date FIELD TECHNICIAN'S DECLARATION STATEMENT 0 I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. 0 I am the person who performed the acceptance requirements verification reported on this Certificate of Acceptance (Field Technician). 0 I certify that the construction/installation identified on this form 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 NAT 0 I have confirmed that the Installation Certificate(s) for the construction/installation identified on this form has been completed and is patted or made available with the building permit(s) issued for the building Comp��Name: 0,-A LLD "n •k Field Technician's Name: Fi>< ech ician's Signature: Date Signed: Posh-iolffV@th Company (Title): I V 'aO ' t'191 CP_ �,CIA VA bGaCVY-% RESPONSIBLE PERSON'S DECLARATION STATEMENT 0 I certify under penalty of perjury, under the laws of the State of California, that I am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and 1 have reviewed the information provided on this form. 0 1 am a licensed contractor, architect, or engineer, who is eligible under Division 3 of the Business and Professions Code, in the applicable classification, to take responsibility for the scope of work specified on this document and attest to the declarations in this statement (responsible person). 0 1 certify that the information provided on this form substantiates that the construction/installation identified on this form 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. 0 I have confirmed that the Installation Certificate(s) for the construction/installation identified on this form has been completed and is posted or made available with the building permit(s) issued for the building. o 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. Company Name: Phone: Responsible Perso 's Name: Res oible rson's Signature: 6 L License: Date Signed: Positio With Company (Title): 2008 Nonresidential Acceptance Forms August 2009 rl STATE OF CALIFORNIA AIR ECONOMIZER CONTROLS ACCEPTANCE CEC-MECH-5A (Revised 08109) ,.. CALIFORNIA ENERGY COMMISSION \ J CERTIFICATE OF ACCEPTANCE MECH-5A NA7.5.4 Air Economizer Controls Acceptance (Page 2 of 4 Project Name/Address: YA System Name or Identification/Tag: _ _�Ve QJ U I System Location or Area Served: Intent: Verify that airside economizers function properly Construction Inspection 1 Instrumentation to perform test includes, but not limited to: a. Hand-held temperature probes Calibration Date: (9— i (must be within last year) b. Multi -meter capable of measuring ohms and milliamps 2 Test method (check one of the following): F1 Economizer comes from HVAC system manufacturer installed by and has been factory calibrated and tested. Attach documentation and complete certification statement. No Functional Testing required. Economizer field installed and field tested or factory installed and field tested. 3 nstallation (check all of the following first level boxes) .iff-- Economizer lockout setpoint complies with Table 144-C per Standards Section 144(e)3. ,Rr— Economizer lockout control sensor is located to prevent false readings. System is designed to provide up to 100% outside air without over -pressurizing the building. For systems with DDC controls lockout sensor(s) are either factory calibrated or field calibrated. ,E�l For systems with non -DDC controls, manufacturer's startup and testing procedures have been applied A. Functional Step 1: Disable demand control ventilation systems (if applicable) Step 2: Enable the economizer and simulate a cooling demand large enough to drive the economizer fully open (check and verify the following) 1,2 Economizer damper modulates 100% open Return air damper modulates 100% closed. �-- For systems that meet the criteria of 144(e)I, verify that the economizer remains 100% open when the cooling demand can no longer be met by the economizer alone. g All applicable fans and dampers operate as intended to maintain building pressure. The unit heating is disabled Step 3: Simulate a cooling load and disable the economizer (check and verify the following) �- Economizer damper closes to its minimum position. ,�p All applicable fans and dampers operate as intended to maintain building pressure. The unit heating is disabled Step 4: Simulate a heating demand and enable the economizer (check and verify the following) Economizer damper closes to its minimum position. Step 5: System returned to initial operating conditions �' N B. Testing Results PASS / FAR L Step 1: Simulate cooling load and enable the economizer (all check boxes are complete) Step 2: Simulate cooling load and disable the economizer (all check boxes are complete) 2008 Nonresidential Acceptance Forms August 2009 STATE OF CALIFORNIA AIR ECONOMIZER CONTROLS ACCEPTANCE CEC-MECH-5A (Revised 08/09) } V CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE MIECH-5A NA7.5.4 Air ]Economizer Controls Acceptance OT4)1 Project a/Address• V�aA (�, System Name or Identification/Tag: System Location or Area Served: 11 Step 3: Simulate heating demand and enable the economizer (all check boxes are complete) I I 2008 Nonresidential Acceptance Forms August 2009 STATE OF CALIFORNIA AIR ECONOMIZER CONTROLS ACCEPTANCE CEC-MECH-5A (Revised 08/09) ( CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE MIECH-5A NA7.5.4 Air Economizer Controls Acceptance (Page 4 of 4 Project Name/Ad System Name or Identification/Tag: POU D -k System Location or Area Served: C� PASS / 1FAIlL ]Evaluation (check one): PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass" FALL: Any Construction Inspection responses are incomplete OR there is one or more "Fail" responses in 'Testing Results section. Provide explanation below. Use and attach additional pages if necessary. 2008 Nonresidential Acceptance Forms August 2009 P STATE OF CALIFORNIA DEMAND CONTROL VENTILATION SYSTEMS ACCEPTANCE CEC-MECH-6A (Revised 08/09) CALIFORNIA ENERGY COMMISSION tt Ir CERTIFICATE OF ACCEPTANCE MECH-6A NA7.5.5 Demand Control Ventilation Systems Acce tante (Page I of 3 Project N\ame/Address: C �r ,i System Name or Identification/Tag: System ocation or Area Served: Enforcement Agency: Permit Number: Note: Submit one Certificate of Acceptance for each system that must demonstrate compliance. Enforcement Agency Use: Checked bv/Date FIELD TECHNICIAN'S DECLARATION STATEMENT o I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. o I am the person who performed the acceptance requirements verification reported on this Certificate of Acceptance (Field Technician). o I certify that the construction/installation identified on this form 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. o I have confirmed that the Installation Certificate(s) for the construction/installation identified on this form has been completed and is posted or made available with the building permit(s) issued for the building. A Company Field Tec ician's Name: Fi Technician's Signature: S� Date Signed: POS MO With Company (Title): "�?,C)' RESPONSIBLE PERSON'S DECLARATION STATEMENT G I certify under penalty of perjury, under the laws of the State of California, that 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 form. O I am a licensed contractor, architect, or engineer, who is eligible under Division 3 of the Business and Professions Code, in the applicable classification, to take responsibility for the scope of work specified on this document and attest to the declarations in this statement (responsible person). a I certify that the information provided on this form substantiates that the construction/installation identified on this form 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 NAT O I have confirmed that the Installation Certificate(s) for the construction/installation identified on this form has been completed and is posted or made available with the building permit(s) issued for the building. O 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. Comp an N{e: Phone: Com,` X31 1� Z � I Responsible Person's Name: I Responsible Person's Signature: Lice Date Signed: Position With Company (Title): 2008 Nonresidential Acceptance Forms August 2009 STATE OF CALIFORNIA DEMAND CONTROL VENTILATION SYSTEMS ACCEPTANCE Ell CEC-MECH-6A (Revised 08/09) CALIFORNIA ENERGY COMMISSION i CERTIFICATE OF ACCEPTANCE MECII-6A NA7.5.5 Demand Control Ventilation. stems Acceptance (Page 2 of 3 Pr' ame/Addre� System Name or Identification/Tag: System Location or Area Served: Intent: Verify that systems required to employ demand Controlled ventilation (refer to §121(c)3) can vary outside ventilation flow rates based on maintaining interior carbon dioxide (CO,) concentration setpoints Construction Enspect➢on 1 Instrumentation to perform test includes, but not limited to: a. Calibrated hand-held CO2 analyzer b. Manufacturer's calibration kit c. Calibrated CO2 /air mixtures 2 Installation. The sensor is located in the high density space between 3ft and 6 ft above the floor or at the anticipated level of the occupants' heads. 3 Documentation of all carbon dioxide control sensors includes (check one of the following): a. Calibration method Victory -calibration certificate •� calibration cert must be attached ❑ Field calibrated b. Sens ccuracy Certified by manufacturer to be no more than +/- 75 ppm calibration cert must be attached A. Functional 'Testing Results a. Disable economizer controls b. Outside air CO2 concentration (select one of the following) Measured dynamically using CO2 sensor ppm c. Interior CO2 concentration setpoint (Outside CO2 concentration + 600 ppm) Lo ppm Step 1: Simulate a signal at or slightly above the C02 setpoint or follow manufacturers recommended testing procedures. For single zone units, outdoor air damper modulates opens to satisfy the total ventilation air called for in the Certificate of Compliance. For multiple zone units, either outdoor air damper or zone damper modulate open to satisfy the zone ventilation J� requirements. Step 2: Simulate signal well below the CO2 setpoint or follow manufacturers recommended procedures. gr�For single zone units, outdoor air damper modulates to the design minimum value. 9i For multiple zone units, either outdoor air damper or zone damper modulate to satisfy the reduced zone ventilation requirements. Ste 3: System returned to initial operating conditions Y N B. 'Testing Results IFAIIL Step 1: Simulate a high CO2 load (check box complete) Step 2: Simulate a low CO2 load (check box complete) 2008 Nonresidential Acceptance Forms August 2009 Mn F CALIFORNIA ND CONTROL VENTILATION SYSTEMS ACCEPTANCE" I R IGH -6A (Revised 08109) CALIFORNIA ENERGY COMMISSION , IJ � -WI FICA')<'IE OF ACCEPTANCE MlEC1H[-6A � - 5.5 ][Demand Control Ventilation Systems Acceptance (Page 3 of 3 N /Address: Name or1Ide�nytification/Taag: - System Location or Area Served: 4 PASS l FAIL Evaluation (check one): ,..:..Inspection "Pass" Construction reonses are and allTestin Results are a, .']~AIL: Any Construction Inspection r ponses are incomplete OR there is one or more "Fail" responses in 'Testing Results Section. Provide explanation below. Use and attach additional a es if necessa r , , Rr; ib 4 r v PJXonresidential Acceptance Forms August 2009 Ir Zt 4- 'A 'A R » © y� }� ! 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A O O r N N N M M I- O It 00 � �-- LL LL 0 m d E �V M � a C o c A M N N N N 7> 44•• P \ Y P \ V � o w N cc0 EH®• M �m yN 6 Vo'Oupiadno 069oz Is 0890Z ISMON peou pw cl IN om 33V1dl3)lVVWQv3ls3woH w souinn 11M PlOO OBIOU Z PUIR 4 JD!T!W MIN 2 OF cli aI ell Q tD 4 r �00 co Building Department CITY OF CUPERTINO 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3228 - FAX: (408) 777-7606 OFFICIAL NOTIFICATION O F NEW/ADDRESS CHANGE TO: All Agencies FROM: City of Cupertino DATE: March 26„ 2014 RE: New/Change of Address APN #326-10-066 Please note the following address correction (letter dated 3/18/14): APN #326-10-066 (Homestead Sq Retail Center) at.Homestead Rd & De Anza Blvd, 20580 Homestead was assigned to 2 different buildings in error. 20580 Homestead Rd (ultra on map) will remain. See attached map & see below for the changes: Pad 2 will become 20574 Homestead Rd (formerly 20576) Pad 3. will become 20576 Homestead Rd (formerly 20578) Pad 3 the 2nd unit will become 20578 Homestead Rd. The new.address .will take effect 30 days from the date of this letter. Please update your records accordingly. if you have any questions, please call ane at (408) 777-3246. Sincerely, Susan Winslow Administrative Clerk Cupertino Building Dept 408-777-3246 or suew@cupertino.org 3]A7lB7MZNV3aH1MON 10 11111 I) T-11 l 11-1111 r b