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12070082I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20620 HOMESTEAD RD CONTRACTOR: SOUTH BAY PERMIT NO: 12070082 CONSTRUCTION, INC OWNER'S NAME: THE SOBRATO ORGANIZATION 1711 DELL AVE DATE ISSUED: 03/06/2013 OWNER'S PHONE: 4084460700 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class '� Lic. #_,Z.LgrO 22 � SAFEWAY- CONSTRUCT 54,964 SQ FT COLD SHELL RETAIL Contractor Date BUILDING I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additi y, the applicant understands and will comply with all non -point source ons per the Cupertino Municipal Code, Section 9.A Signature ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.I8. Date Sq. Ft Floor Area: I Valuation: $5080000 APN Number: 32610060.20620 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 80 DAYS OF PERMIT ISSUANCE OR 180 DAY F OM LAST CALLED INSP CTION. Issued by: Date RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cuunicipal Code, Chapter 9.12 and the Health & Safety Code, Sectio e25533, and 25534. Owner or CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20620 HOMESTEAD RD CONTRACTOR: SOUTH BAY PERMIT NO: 12070082 CONSTRUCTION, INC OWNER'S NAME: THE SOBRATO ORGANIZATION 1711 DELL AVE DATE ISSUED: 03/06/2013 OWNER'S PHONE: 4084460700 CAMPBELL, CA 95008 PHONE NO: (408)379-5500 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL -y y License ClassV_j __ Lie. # ��o� j'1 SAFEWAY- CONSTRUCT 54,964 SQ FT COLD SHELL RETAIL Contractor'�Ojrt� CA---,h&r Date :a BUILDING I hereby affirm that I am licensed under the provisions of Chapter 9 k*3-DEFERRED #1 -TRUSS CALCS- ISSD 3/14/2014 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two deetp I have and will maintain a certificate of consent to self -insure for W Compensation, as provided for by Section 3700 of the Labor r the Sq. Ft Floor Area: Valuation: $5080000 performance of the work for which this permit is issued. 10� 1 have and will maintain Worker's Compensation Insurance, as Rvided for by ection 3700 of the Labor Code, for the performance of the work for which this APN Number: 32610060.20620 Occupancy Type: It is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPI F WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHI AYS O ERMIT ISSUANCE OR 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 DA OM LAST 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 �16f granting of this permit. Additionally, the applicant understands and will comply Issued by: Date:/��jj with all non -point source regulations per the Cupertino Municipal Code, Section ac _109elf 9.18. RE -ROOFS: 64 m Signature ` w_-----' "� Date S 5 1 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 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sce.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I 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 I 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 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, Sections 2550, 25 , 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 I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 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 BUILDING PERMIT BUILDING.ADDRESS: 20620 HOMESTEAD RD CONTRACTOR:SOUTH BAY PERMIT NO: 12070082 CONSTRUCTION,INC OWNER'S NAME: THE SOBRATO ORGANIZATION 1711 DELL AVE DATE ISSUED:03/06/2013 OWNER'S PHONE: 4084460700 CAMPBELL,CA 95008 PHONE NO:(408)379-5500 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL F-] COMMERCIAL E] SAFEWAY-CONSTRUCT 54,964 SQ FT COLD SHELL License Class_ Lic.# g 3 (o y 7 ( RETAIL BUILDING Contractor+ 6,u5J/ 4ha+J Date 3/19/14- REVISION#1- RFI'S#'S 165, 169, 174,177&202- I hereby affirm that I am licensed under the provisions of Chapter 9 ISSUED 4/15/2014 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Pe)mpensation,as provided for by Section 3700 of the Labor Code,for the formance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5080000 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:32610060.20620 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 OR 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 DAYSOM LAS ECTION. 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. Ad to Ily,the applicant understands and will comply Issued te: with all non- source u i ns per the Cupertino Municipal Code,Section 9.18. r q RE-ROOFS: Signature Date S ZO/ All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,1 agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I 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 I 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 Are it Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupert' o unicipal ,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,_Seettbil 5 25534. Section 3700 of the Labor Code,for the performance of the work for which this �S Owner or authorized agent: Date: permit is issued. 1 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 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the l 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. Date CONSTRUCTION PERMIT APPLICATION Is COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq(cikupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/'TIK❑ REVISION/DEFERRED ORIGINAL PERMIT#12070082 PROJECT ADDRESS 20620 Homestead Road APN H OWNER NAME The Sobrato Organization PHONE 408-446-0700 E-MAIL STREET ADDRESS 10600 De Anza Blvd CITY, STATE,ZIP Cupertino,CA 95014 FAX CONTACT NAME Kristina Kleven PHONE 40&8742297 E-MA1L kkleven@sbci.com STREET ADDRESS 1711 Dell Ave CITY,STATE, ZIP Campbell,CA 95008 FAX 408-379-3256 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Kristina Kleven LICENSE NUMBER 336974 LICENSE TYPE B BUS.LIC H COMPANY NAME South Bay Construction E-MAIL kkleven@sbci.com FAX 408-379-3256 STREET ADDRESS 1711 Dell Ave CrrY,STATE,ZIP Campbell,CA 95008 PHONE 408-8742297 ARCHITECT•ENGINEER NAME Craig Almeleh LICENSE NUMBER BUS.LIC H COMPANY NAME ArcTec,Inc. E-MAIL joparowski@arctecinc.com FAX STREET ADDRESS 99 Almaden Blvd#840 CITY,STATE,ZIP San Jose,CA 95113 PHONE 408-496-0676 DESCRIPTION OF WORK Deferred Truss drawings and calculation EXISTING USE PROPOSED USE CONSTR TYPE H STORIES 11-B 1 USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOMKITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREAT TAL DECKIPORCH AREA GARAGE AREA. LJDETACH ❑ATTACH H DWELLING UMTS: IS A SECOND uNrr ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN 0 YES TOTAL VALUATION: PLANNING APPL H ❑NO PLANNING APPROVAL LEITER EICHLER HOME? []NO l By my signature below,I certify to each of the following: I am the property owner or authorized nt t on the property owner's behalf. I have read this application and the information I havrovided correct. I have read the Description of Work and veri it is accurate. I agree to comply with all applicable local ordinances and state laws relV,,, wilding c ction. I authorize representatives ofCupertino to enter the above-identified property for inspection purposes. Signature ofApplicant/AgenDate: SUPPLE INFO -H QUIRED PLANIC'BFA3.-TTM New SFD or Multifamily dwellings: Apply for demolition permit for D +Qs�tt�tit;vlXa.� -� N existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ * ❑ MANM NG Pt.4-x>REV'O14' _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure s�.n�sxasea ❑ et=ACWORKS form if any Hazardous Materials are being used as part of this project. ❑ L.MWF ❑ a ism DLn _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. MAJOR © sx*IrrAxi s�rEx laesrl�c r �. BldgApp_201 Ldoe revised 06/21/11 .4 08 CONSTRUCTION PERMIT APPLICATION 'LL [is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIOfY 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255C� (408)777-3228•FAX(408)777-3333•build ingcupertino.org CUPERTINO [_1NEW CONSTRUCTION ElADDITION [_1ALTERATION/TI REVISION/DEFERRED ORIGINAL PERMIT# k2— l�l7l� PROJECT ADDRESS 2-ID(_- C � 4`` ATN# OWNER NAME J JPHONE E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX ov F Lgn+.--� CONTACT NAMP �r PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX I� � A C�}>"1 C q, �� i'S ❑OWNER ❑ OWNER-BUILDER ❑ OW'NERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME `,1 LICENSE 1S'21::R� ` E-MAILLICENSE TYPE BUS LIC# COMPANY NAME FAX STREET ADDRESS CITY,STATE,ZIP PHONE I' AVS CAL 0I ARCMTECT/ENGINEER NAREJ E CT��KA LICENSE NUMBER BUS.LIC# COMPANY NAME `v1 E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE C) Ste, DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH.AREA GARAGE AREA DETACH ❑ATTACH #DWELLING UMTS. IS A SECOND UNIT ❑YES SECOND STORY [:]YES BEING ADDED? [3 NOS ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES t OT VALUATIO PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or authorized agent to a 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 I agree to comply with all applicable local ordinances and state laws relating y buil ing construct' n. I authorize representatives of Cupertino to enter the above-i enti led pro erty for inspection purposes. Signature of Applicant/Agent: F� Date: SUPPLEMENTA INFORMA ON REQUIRED 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. 0 Nuaw 0Its Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 ST' ❑ form if any Hazardous Materials are being used as part of this project. 0 LAW= 011 Copy of Planning Approval Letter or Meeting with Planning prior to 0 > � submittal of Building Permit application. BldgApp 2011.doc revised 06/21/11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVIS N 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building(o)_cupertino.orcl ®NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Tl REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 20620 HOMESTEAD ROAD APN# 326-10-Q1,060, 3 OWNERNAME THE SOBRATO ORGANIZATION PHONE408-446-0700 E-MAIL RTRUEMPLER@SOBRATO.COM RICH TRUEMPLER STREET ADDRESS 10600 N. DE ANZA BLVD- CITY, STATE,ZIP CUPERTINO, CA. 95014 FAX 408-866-6638 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 FAX 408-496-1121 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ® CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEERNAME JEFF OPAROWSKI, AIA LICENSENUMBER C-21289 X BUS.LIC# JOPAROWSKI@ARCTECINC.COM 408-496-1121 COMPANY NAME ARC TEC INC. E-MAIL FAX STREET ADDRESS 99 ALMADEN BLVD. CITY.STATE,ZIP SAN JOSE, CA 95113 PHONE 408-496-0676 DESCRIPTION OF WORK CONSTRUCTION OF A NEW 54,964 SF COLD SHELL RETAIL BUILDING FOR SAFEWAY EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES OFFICE USE NLY NONE RETAIL III-B ONE OCC. TYPE DU=noN SO.Fr. VALUATION(S) EXISTG NEW FLOORDEMO TOTAL AREA AREA 54,964 AREA NET AREA 54,964AN BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA:❑ DETACH ❑ ATTACH DWELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑ YES IF YES,PRCVIDE COPY OF PLANNER'S NAA4'. RECEIVEDBY: TOTAL VALUATION: PLANNING APPI,F ❑ NO PLANNING APPROVAL,LETTER 5, 080, 000 By my signature below,1 certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to build co ction. I uthorize repr sentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 71 1(`) 2, Fig SUPPLEMENTAL IN TION QUIRED PLAN CHECK TYPE ✓ ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ElOVER-THE-COUNTERLJ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building �..-- permit for new building. El EXPRESS E PLANNING PLAN REVIEW L1Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0-STANDARD _PUBLIC WORKS fo_rm if any Hazardous Materials are being used as part of this project. ❑ LARGE �9IRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ElMAJOR L I SANITARY SEWER DISTRICT submittal of Building Permit application. 2-ENVIRONMENTAL HEALTH BldgApp_201 Woe revised 03/16111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20620 Homestead Rd. DATE: 07/11/2012 REVIEWED BY: A. Salvador APN: BP#: `VALUATION: 1$5,080,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY Civil/Religious activities PENTAMATION USE Commercial Building ;n BQ zone? 1 SHELLBLDG Yes E)No PERMIT TYPE: WORK New Retail Shell Building (54,964 s.f. SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. Shell Bldgs II-B,III-B,IV,V-B 54,964 $13,606.00 IOSPLNCK $25,262.50 IOSINS TOTALS: 54,964 $13,606.00 $25,262.50 F-1 7- Li NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelimina information available and are on an estimate. Contact the Dept fior addn'1 in o. FEE ITEMS(Fee Resolution 11-053 L.(t: 7'1/11) FEE QTY/FEE M1SC ITEMS Plan Check Fee: $13,606.00 Select a Misc Bldg/Structure Suppl. PC Fee: (j) Reg. ® OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $25,262.50 Suppl. Insp. Fee:Q Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction If,ax: 1BCONSTAXC $141,257.48 0 Work Without Permit? Q Yes Q) No $0.00 Advanced Planning Fee: 1PLLONGC $14,290.64 Select a Non-Residential Q Building or Structure Strong Motion Fee: 1BSEISMICO $1,066.80 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $204.00 SUBTOTALS 95,687.42 $0.00 TOTAL FEE: $195,687.42 Revised: 07/01/2012 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20620 homestead rd DATE: 11/15/2013 REVIEWED BY: Mendez APN: BP#: I *VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY Civil/Religious activities PENTAMATION USE: Commercial Building in B zone? 1GENCOM Q � Yes Q No PERMIT TYPE: WORK safewa -truss calcs SCOPE Ll L_ Ll �7r.t"tr, 2 r i"o' 11 r c tS l' 1`(T. NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc . Theseees are based on the prelimina information available and are only an estimate. Contact the Dept/or addn'l info. FEE ITEMS Thee Resolution 11-053 EA: 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Deferred Submittal Suppl. PC Fee: Q Reg. OT 0.0 hrs $0.00 $278.00 IDEFSUBM PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 Work Without Permit? Cl Yes e) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential Q Building or Structure Strong Motion Fee: $0.00 Select an Administrative Item Bldg�Stds Commission Fee: $0.00 SUU'I`4TALSt $0.00 $278.00 TOTAL FEE: $278.00 Revised: 10/01/2013 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20620 HOMESTEAD RD DATE: 03/19/2014 REVIEWED BY: MELISSA APN: 32610060.20620 BP#: 12070082 ''VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY Commercial Building PENTAMATION 1GENCOM USE: PERMIT TYPE: WORK 3/19/14 REV# 1 - RFI'S#'S 165, 169, 174, 177 & 202 SCOPE El Ll Ll NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on tl:e prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 hours Plan Check,Hourly Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $278.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 � . .. . . . Work Without Permit? 0 Yes (D No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structure Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $278.00 TOTAL FEES 1 $278.00 Revised: 01/15/2014 /2-07 008; 2- 2010 CALGREEN NON-RESIDENTIAL CHECKLIST — MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 0 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• building(ci)-cupertino.org PURPOSE: ��. '�✓, The non-residential provisions of the 2010 CalGreen Code outline planning, design and development methods that include environmentally responsible site selection, building design, building siting and development to protect, restore and enhance the environmental quality of the site and respect the integrity of adjacent properties; establishes the means of conserving water used indoors, outdoors and in wastewater conveyance; outlines means of achieving material conservation and resource efficiency; and outlines means of reducing the quantity of air contaminants. Project Name: SAFEWAY STORE NO. 3251 Project Address. 20620 HOMESTEAD ROAD Project Description: NEW RETAIL SHELL BUILDING Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2010 California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 fir: and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Requirements NONRESIDENTIALD . O- General Requirements The project meets all the requirements of Divisions 5.1 through 5.5. 0 ❑ DivisionPLANNING Planning and Design - Site Development 5.106.1 Storm water pollution prevention plan. For projects of one acre or less, develop a Storm Water Pollution Prevention Plan(SWPPP)that has been designed, specific to its site, conforming to the State Storm water NPDES ❑ Construction Permit or local ordinance,whichever is stricter, as is required for projects over one acre. The plan should cover prevention of soil loss by storm water run-off and/or wind erosion, of sedimentation and/or of dust/particulate matter air pollution. err Page 1 of 9 CalGreen Non-Res Checklist.doc revised 08/27/11 t 5.106.4 Bicycle parking and changing rooms. Comply with Sections El 5.106.4.1 and 5.106.4.2; or meet local ordinance,whichever is stricter. 5.106.4.1 Short-Term bicycle parking. If the project is anticipated to generate visitor traffic, provide permanently anchored bicycle racks within KX 200 feet of the visitors' entrance, readily visible to passers-by,for 5 percentX❑ of visitor motorized vehicle parking capacity,with a minimum of one two- bike capacity rack. 5.106.4.2 Long-Term bicycle parking. For buildings with over 10 tenant- ❑ occupants, provide secure bicycle parking for 5 percent of tenant-occupied motorized vehicle parking capacity,with a minimum of one space. 5.106.5.2 Designated parking. Provide designated parking for any combination of low-emitting,fuel-efficient and carpool/van pool vehicles as ❑X shown in Table 5.106.6.2. 5.106.8 Light pollution reduction. Comply with lighting power requirements in the California Energy Code and design interior and exterior lighting such that zero direct-beam illumination leaves the building site. Meet or exceed exterior light levels and uniformity ratios for lighting zones 1 —4 as defined in Chapter 10 of the California Administrative Code, using the following strategies: ��tt 1. Shield all exterior luminaires or use cutoff luminaires. ❑X U3 2. Contain interior lighting within each source. ❑X 01 3. Allow no more than .01 horizontal foot candle 15 ft beyond the site. 10 4. Contain all exterior lighting within property boundaries. Exception: See Part 2, Chapter 12, Section 1205.6 for campus lighting requirements for parking facilities and walkways. 5.106.10 Grading and paving. The site shall be planned and developed to keep surface water away from buildings.Construction plans shall indicate how X❑ site grading or a drainage system will manage all surface water flows. Division Performance Requirements 5.201.1 Scope. The California Energy Commission will continue to adopt mandatory building standards.' Division ' AND • • Indoor Water Use 5.303.1 Meters. Separate meters shall be installed for the uses described in Sections 503.1.1 through 503.1.3. 5.303.1.1 Buildings in excess of 50,000 square feet. Separate X❑ submeters shall be installed as follows: 1. For each individual leased, rented or other tenant space within the building projected to consume more than 100 gal/day. Page 2 of 9 CalGreen Non-Res Check-list.doc revised 08127111 2. For spaces used for laundry or cleaners, restaurant or food service, medical or dental office, laboratory or beauty salon or barber shop ❑ projected to consume more than 100 gal/day. 5.303.1.2 Excess consumption.Any building within a project or space err within a building that is projected to consume more than 1,000 gal/day. 5.303.2 20 percent savings.A schedule of plumbing fixtures and fixture ❑ ❑ fittings that will reduce the overall use of potable water within the building by 20 percent shall be provided. (Calculate savings by Water Use Worksheets) 5.303.2.1 Multiple showerheads serving one shower.When single shower fixtures are served by more than one showerhead, the combined flow rate of all the showerheads shall not exceed the maximum flow rates 0 ❑ specified in the 20 percent reduction column contained in Table 5.303.2.3 or the shower shall be designed to only allow one showerhead to be in operation at a time. 5.303.4 Wastewater reduction. Each building shall reduce the generation of wastewater by one of the following methods: As applicable 1. The installation of water-conserving fixtures or 0 ❑ 2. Utilizing non-potable water systems. Lai 5.303.6 Plumbing fixtures and fittings. Plumbing fixtures(water closets and urinals) and fittings(faucets and showerheads)shall comply with the requirements listed for each type in Items listed in Table 5.303.6. As applicable 1. Water closets (toilets)—flushometer type 0 ❑ 2. Water closets (toilets)—tank type 0 ❑ 3. Urinals 0 ❑ 4. Public lavatory faucets 0 ❑ 5. Public metering self-closing faucets 0 ❑ 6. Residential bathroom lavatory sink faucet 0 ❑ 7. Residential kitchen faucets 0 ❑ 8. Residential shower heads 0 ❑ 9. Single shower fixtures served by more than one showerhead 0 ❑ Outdoor Water Use 5.304.1 Water budget.A water budget shall be developed for landscape ❑ ❑ irrigation use. 5.304.2 Outdoor potable water use. For new water service, separate meters or submeters shall be installed for indoor and outdoor potable water use for 0 ❑ landscaped areas between 1,000 square feet and 5,000 square feet. 5.304.3 Irrigation design. In new nonresidential projects with between 1,000 As applicable and 2,500 square feet of landscaped area (the level at which the MLO applies), install irrigation controllers and sensors which include the following 0 criteria and meet manufacturer's recommendations. Kiri+` Page 3 of 9 CalGreen Non-Res Checklist.doc revised 08/27/11 5.304.3.1 Irrigation controllers.Automatic irrigation system controllers installed at the time of final inspection shall comply with the following: 1. Controllers shall be weather-or soil moisture-based controllers that automatically adjust irrigation in response to changes in plants' needs as QX weather conditions change. 2. Weather-based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicates with the controller(s). Soil moisture-based controllers are not required to have rain sensor input. Weather Resistance and Moisture Management 5.407.1 Weather protection. Provide a weather-resistant exterior wall and foundation envelope as required by California Building Code Section 1403.2 id1 and California Energy Code Section 150, manufacturer's installation ISI instructions or local ordinance,whichever is more stringent.' 5.407.2 Moisture control. Employ moisture control measures by the following methods; 5.407.2.1 Sprinklers. Prevent irrigation spray on structures. QX 5.407.2.2 Entries and openings. Design exterior entries and openings to prevent water intrusion into buildings. Construction Waste Reduction, Disposal and Recycling 5.408.1 Construction waste diversion. Establish a construction waste management plan or meet local ordinance, whichever is more stringent. �r 5.408.2 Construction waste management plan. Submit plan per this section to enforcement authority. 5.408.2.1 Documentation. Provide documentation of the waste management plan that meets the requirements listed in Section 5.408.2 Items 1 thru 4 and the plan is accessible to the enforcement authority. 5.408.2.2 Isolated jobsites. The enforcing agency may make exceptions to the requirements of this section when jobsites are located in areas 0 beyond the haul boundaries of the diversion facility. 5.408.3 Construction waste. Recycle and/or salvage for reuse a minimum of 50 percent of nonhazardous construction and demolition debris or meet local ordinance, whichever is more stringent. Exceptions: 1. Excavated soil and land-clearing debris. 2. Alternate waste reduction methods developed by working with local agencies if diversion or recycle facilities capable of compliance with this item do not exist. 5.408.4 Excavated soil and land clearing debris. 100 percent of trees, stumps, rocks and associated vegetation and soils resulting primarily from land ❑X clearing shall be reused or recycled. Page 4 of 9 CalGreen Non-Res Checklist.doc revised 08/27/11 Building Maintenance and Operation 5.410.1 Recycling by occupants. Provide readily accessible areas that serve the entire building and are identified for the depositing, storage and collection X❑ ❑ of nonhazardous materials for recycling.' 5.410.2 Commissioning. For new buildings 10,000 square feet and over, building commissioning for all building systems covered by T24, Part 6, process systems and renewable energy systems shall be included in the 0 ❑ design and construction processes of the building project. Commissioning requirements shall include items listed in Section 5.410.2. 5.410.2.1 Owner's Project Requirements (OPR). Documented before the design phase of the project begins the OPR shall include items listed in ❑ ❑ Section 5.410.4. 5.410.2.2 Basis of Design (BOD).A written explanation of how the design of the building systems meets the OPR shall be completed at the design phase of the building project and updated periodically to cover the systems 0 ❑ listed in Section 5.410.2.2. 5.410.2.3 Commissioning plan.A commissioning plan describing how the project will be commissioned shall be started during the design phase of ❑ ❑ the building project and shall include items listed in Section 5.410.2.3. 5.410.2.4 Functional performance testing shall demonstrate the correct installation and operation of each component, system and system-to- ❑ ❑ system interface in accordance with the approved plans and specifications. 5.410.2.5 Documentation and training.A Systems manual and systems operations training are required. 0 ❑ 5.410.2.5.1 Systems manual. The systems manual shall be delivered to the building owner or representative and facilities operator and shall ® ❑ include the items listed in Section 5.410.2.5.1. 5.410.2.5.2 Systems operations training.The training of the appropriate maintenance staff for each equipment type and/or system ❑ ❑ shall include items listed in Section 5.410.2.5.2. 5.410.2.6 Commissioning report.A complete report of commissioning process activities undertaken through the design, construction and reporting recommendations for post-construction phases of the building 0 ❑ project shall be completed and provided to the owner or representative. 5.410.4 Testing and adjusting. Testing and adjusting of systems shall be required for buildings less than 10,000 square feet. 5.410.4.2 Systems. Develop a written plan of procedures for testing and adjusting systems. Systems to be included for testing and adjusting shall include, as applicable to the project,the systems listed in Section 0 ❑ 5.410.3.2. 5.410.4.3 Procedures. Perform testing and adjusting procedures in accordance with industry best practices and applicable national standards ❑ ❑ on each system. 5.410.4.3.1 HVAC balancing. Before a new space-conditioning system serving a building or space is operated for normal use, the system ❑ ❑ should be balanced in accordance with the procedures defined by national standards listed in Section 5.410.3.3.1. Page 5 of 9 CalGreen Non-Res Checklist.doc revised 08127111 5.410.4.4 Reporting.After completion of testing, adjusting and balancing, provide a final report of testing signed by the individual responsible for performing these services. 5.410.4.5 Operation and maintenance manual. Provide the building owner with detailed operating and maintenance instructions and copies of X guaranties/warranties for each system prior to final inspection. 5.410.4.5.1 Inspections and reports. Include a copy of all inspection verifications and reports required by the enforcing agency. 0 Fireplaces 5.503.1 Install only a direct-vent sealed-combustion gas or sealed wood- burning fireplace or a sealed woodstove and refer to residential requirements in the California Energy Code, Title 24, Part 6, Subchapter 7, Section 150. 5.503.1.1 Woodstoves.Woodstoves shall comply with US EPA Phase II emission limits. Pollutant Control 5.504.3 Covering of duct openings and protection of mechanical equipment during construction.At the time of rough installation or during storage on the construction site and until final startup of the heating and cooling equipment, all duct and other related air distribution component 0 openings shall be covered with tape, plastic, sheet metal or other methods acceptable to the enforcing agency to reduce the amount of dust or debris which may collect in the system. 5.504.4 Finish material pollutant control. Finish materials shall comply with Sections 5.504.4.1 through 5.504.4.4. 5.504.4.1 Adhesives, sealants, caulks.Adhesives and sealants used on the project shall meet the requirements of the following standards. 1. Adhesives, adhesive bonding primers, adhesive primers, sealants, sealant primers and caulks shall comply with local or regional air pollution control or air quality management district rules where applicable or SCAQMD Rule 1168 VOC limits, as shown in Tables 5.504.4.1 and 5.504.4.2. 2. Aerosol adhesives and smaller unit sizes of adhesives and sealant or caulking compounds(in units of product, less packaging,which do not weigh more than one pound and do not consist of more than 16 fluid ounces)shall comply with statewide VOC standards and other 0 LA requirements, including prohibitions on use of certain toxic compounds, of California Code of Regulations, Title 17, commencing with Section 94507. 5.504.4.3 Paints and coatings.Architectural paints and coatings shall comply with Table 5.504.4.3 unless more stringent local limits apply. OX 5.504.4.3.1 Aerosol paints and coatings.Aerosol paints and coatings shall meet the Product-Weighted MIR Limits for ROC in Section 94522(a)(3) and other requirements, including prohibitions on use of Iq certain toxic compounds and ozone depleting substances (CCR, Title 17, �! Section 94520 et seq). Page 6 of 9 CalGreen Non-Res Checklist.doc revised 08/27/11 5.504.4.3.2 Verification.Verification of compliance with this section shall be provided at the request of the enforcing agency. QX 5.504.4.4 Carpet systems.All carpet installed in the building interior shall meet the testing and product requirements of one of the standards listed in Section 5.504.4.4. 5.504.4.4.1 Carpet cushion.All carpet cushion installed in the building interior shall meet the requirements of the Carpet and Rug Institute Green Label program. 5.504.4.4.2 Carpet adhesive.All carpet adhesive shall meet the requirements of Table 804.4.1. QX 5.504.4.5 Composite wood products. Hardwood plywood, particleboard and medium density fiberboard composite wood products used on the interior or exterior of the building shall meet the requirements for QX formaldehyde as specified in Table 5.504.4. 5.504.4.5.2 Documentation.Verification of compliance with this section shall be provided as requested by the enforcing agency. Documentation shall include at least one of the following: As applicable 1. Product certifications and specifications QX 2. Chain of custody certifications QX 3. Other methods acceptable to the enforcing agency QX 5.504.4.6 Resilient flooring systems. Comply with the VOC-emission limits defined in the 2009 CHPS criteria and listed on its Low-emitting Materials List(or Product Registry)or certified under the FloorScore program of the Resilient Floor Covering Institute. 5.504.5.3 Filters. In mechanically ventilated buildings, provide regularly occupied areas of the building with air filtration media for outside and return air prior to occupancy that provides at least a MERV of 8. 5.504.7 Environmental tobacco smoke(ETS)control. Prohibit smoking within 25 feet of building entries, outdoor air intakes and operable windows where outdoor areas are provided for smoking and in buildings; or as enforced by ordinances, regulations or policies of any city, county, city and county, QX California Community College, campus of the California State University or campus of the University of California, whichever are more stringent. Indoor Moisture and Radon Control 5.505.1 Indoor moisture control. Buildings shall meet or exceed the provisions of California Building Code, CCR, Title 24, Part 2, Sections 1203 XQ and Chapter 14.1. ' Air Quality and Exhaust 5.506.1 Outside air delivery. For mechanically or naturally ventilated spaces in buildings, meet the minimum requirements of Section 121 of the California Energy Code, CCR, Title 24, Part 6 and Chapter 4 of CCR, Title 8 or the applicable local code, whichever is more stringent.' Page 7 of 9 CalGreen Non-Res Cheeklist.doe revised 08127111 5.506.2 Carbon dioxide(CO2) monitoring. For buildings equipped with demand control ventilation, CO2 sensors and ventilation controls shall be specified and installed in accordance with the requirements of the latest edition of the California Energy Code, CCR, Title 24, Part 6, Section 121(c).' Environmental Comfort 5.507.4 Acoustical control. Employ building assemblies and components with STC values determined in accordance with ASTM E 90 and ASTM E 413. 5.507.4.1 Exterior noise transmission. Wall and floor-ceiling assemblies making up the building envelope shall have an STC of at least 50 and exterior windows shall have a minimum STC of 30 for any of the building 0 locations listed in Items 1 through 3 in Section 5.507.5.1. 5.507.4.2 Interior sound.Wall and floor-ceiling assemblies separating tenant spaces and tenant spaces and public places shall have an STC of at least 40. Outdoor Air Quality 5.508.1 Ozone depletion and global warming reductions. Installations of HVAC, refrigeration and fire suppression equipment shall comply with Sections 5.508.1.1 and 5.508.1.2. As applicable 5.508.1.1 CFCs. Install HVAC and refrigeration equipment that does not contain CFCs.' 5.508.1.2 Halons. Install fire suppression equipment that does not contain Halons. 1.These measures are currently required elsewhere in statute or in regulation. Page 8 of 9 CalGreen Non-Res Checklist.doc revised 08127111 CALGREEN SIGNATURE DECLARATIONS Project Name: SAFEWAY STORE NO. 3251 Project Address: 20620 HOMESTEAD ROAD Project Description: NEW RETAIL SHELL BUILDING SECTION 1 — DESIGN VERIFICATION Complete all lines of Section 1 —"Design Verification"and submit the completed checklist(Columns 1 and 2)with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2010 California Green Building Standards Code as ad ,77 of Cupertino. 03/04/2014 Own a Date RICH -rRUEMPLER Owner's Nt I', A ,,— ame (Please Print) 03/04/2014 Design Prof sional s ig ature Date CRAIG ALMELEH Design Professional'sme (Please Print) 03/04/2014 Signature of icens rofessionaI responsible for CalGreen compliance Date CRAIG ALMELEH 408-496-0676 Name of License Professional responsible for CalGreen compliance(Please Print) Phone CRAIGA@ARCTECINC.COM Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3,together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2010 CaliforniaG en Building Standards Code as adopted by the City of Cupertino. AA 03/04/2014 Signature of icense Professional responsible for CalGreen compliance Date CRAIG ALMELEH 408-496-0676 Name of License Professional responsible for CalGreen compliance(Please Print) Phone CRAIGA@ARCTECINC.COM Email Address for License Professional responsible for CalGreen compliance Page 9 of 9 CalGreen Non-Res Checklist.doe revised 08/27/11 -- Zo? o o 8 2-- STATE OF CALIFORNIA FENESTRATION ACCEPTANCE CERTIFICATE CEC-ENV-2A Revised 08/09 CA�11ORNIAOMMISSION CERTIFICATE OF ACCEPTANCE ENV-2A Fenestration Acceptance Certificate (Page 1 of 2) Project Name.Address: Homestead Square 10640-20680 Homestead Rd,Cupertino,CA 95014 System Name or Identification/Tag: 1/4"Solarban 60, 1/2" Air,1/4" System Location or Area Served: Clear" Note: A maximum q1'4 NFRC Product Listings for tntorcement Agency Use: Checked by'Date each Certificate of'Acce tance. Note: The Enforcenncia Agency mai•choose to verify the Fenestration Certified Products Directory,munber that matches the CPD-ID number at htt :;ic d.nfre.or /search/search c dnum.as x. BUILDING INFORMATION Date of Permit: Building Permit# Label Certificate Issuance Date: Climate Zone: BUILDINGTYPE: X NONRESIDENTIAL COMMERCIAL SC HOO L ❑HIGH RISE RESIDENTIAL ❑HOTELMOTELGUEST ROOM PHASE OF CONSTRUCTION: X NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑NFRC CMA LABEL CERTIFICATE X NA7 or CEC Default Values ❑ CEC Default Values LABEL ID# (Attach an NFRC Label Use FC-I/FC-2 10,000 ftp Usc FC-I/FC-2_ 10.000 ft' CERTIFICATE: Certificate for each product listing and enter the (Attach FC-1/FC-2 and Enter (Attach FC-I/FC-2 and Enter Label Certificate/D in each colunur below) information in Row/through 4) information in Rowlthrough 4) STATEMENT OF ACCEPTANCE This Certificate ofAcceptance strnhmarires the restos of the Acceptance test related to building fenestration requirements as per Title 24, Part 6. Verify that each fentesn atiort product meets the Reference Plonresidential Appendix, NAT 4. In accordance with Sections 10-103(a)3B, 10-1/1. 116(x)5 of the Energv Standards. SUMiVIARY OF FENESTRATION VERIFICATIONAND INSPECTION BY RESPONSIBLE PARTY The Responsible Parm shall verify the thcrnm/perform (U ance -fcncCor andSHGC)of'each specified fenestration product being installed matches the fenestration label certl icate,energy compliance documentation and building plans. I 2 3 4 NFRC Label Certificate ID# CEC Default Fenestration Information: Manufactured 1i4" Solorban 60 Fenestration (61nm)Blue, 1/2"Air, 1 Description 1/4" Clear (i.e. Blucgreen/ air,'clear-61nm) Manufactured 2 Product ]D# 3 Glazing Layers 7-1SingleX Double ❑ Single ❑ Double ElSingle ❑ Double ❑ Single ElDouble ❑ Other ❑ Other ❑ Other ❑ Other ❑ Delivery Receipt(s) ❑Delivery Receipts) ❑ Delivery Rcceipt(s) ❑ Delivery Receipt(s) Verification(Verify ❑ Purchase Order or ❑ Purchase Order or ❑ Purchase Order or ❑ Purchase Order or 4 each product Frith...) ❑ Detailed Receipt ❑ Detailed Receipt ❑ Detailed Receipt ❑ Detailed Receipt X Cross Reference and ❑Cross Reference and ❑ Cross Reference and ❑Cross Reference and Matches Building Plans Matches Building Plans Matches Building Plans Matches Building Plans �irrY 2008 Nonresidential Acccptutce Forms August 2009 STATE OF CALIFORNIA FENESTRATION ACCEPTANCE CERTIFICATE CEC-ENV-2A Revised 08109 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE ENV-2A Fenestration Acceptance Certificate (Page 2 of 2) Project Name Address: Homestead Square 10640-20680 Homestead Rd,Cupertino,CA 95014 �Irr� System Name or Identification!Tag: Solorban 60 System Location or Area Served:All Exterior FIELD TECHNICIAN'S DECLARATION STATEMENT 1 certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • 1 am the person who performed the acceptance requirements verification reported on this Certificate of Acceptance(Field Technician). [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. I have confirmed that the Installation Certificate(s)for the construction/installation identified on this form has been completed nd is posted or made available with the building pennit(s)issued for the building. Company Name: USA All Glass Field Technician's Name:Joe Waldherr Field Technician's Signature: Date Signed:3/4/14 Position With Company Title):Senior Project Manager RESPONSIBLE PERSON'S DECLARATION STATEMENT • 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. 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). • 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 confornms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. • I have confirmed that the Installation Certificate(s)for the construction!instal[ation identified on this form has been completed and is posted or made available with the building permit(s)issued for the building. • I will ensure that a completed,signed copy of this Certificate of Acceptance shall be posted,or made available with the building pen-nit(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 bu]ding owner at occupancy. Company Name: USA All Glass Phone:916-564-6806 // Responsible Person's Name:Joe Waldherr Res n ' le Per ' Sign . License:796707 Date Signed:3/4/14 sition With Com any(Title):Senior Project Manager �1rr' 2008 Nonresidential Acce,)hrnce Farms August 2009 SOIARBAN®60 6a��aS�a'Pe SOLAR CONTROL LOW-E GLASS Glass•Coatings• Paint Solarban®60 solar control, low-e glass by PPG was engineered to control solar heat gain,which is essential to minimizing cooling costs. In a standard one-inch insulatingglass unit(IGU), Solarhan 60 glass offers an exterior appearance similar to clear, uncoated glass. With a very good Solar Heat Gain Coefficient(SHGC)of 0.38, - Solarban 60 glass blocks 67 percent of the total solar energy ° - while allowing 70 percent of the visible light to pass through. This combination produces an excellent Light to Solar Gain (LSG) ratio of 1.85,along with exceptional insulating performance, as evidenced by its 0.29 winter nighttime U-value. } Aesthetic Options Solarban 60 glass can be coated on Starphire®glass and paired with Starphire glass to produce an IGU with exceptional clarity and solar control characteristics. For even more color and performance options, it can be coated on the second (#2)surface of most r40, ' Oceans of Coli and Earth&Sky performance tints, or combined 1= ude,itial C nteY in an IGU with any PPG tinted glass, Solarcoor reflective glass or Location:Newark, NJ Vistacii subtly reflective, color-enhanced glass(see performance Product:Solarban 60 Glass data on back page). Architect.Morris Adjmi Architects Glass Contractor.Josloff Glass Solarban 60 Glass and Sustainable Design Glass Fabricator.J.E.Berkowitz,LP An energy modeling study conducted by an independent energy design and consulting firm showed that architects and building owners can potentially save millions of dollars during a building's lifetime by specifying Solarban 60 glass instead of less advanced " - architectural glazings. For instance,the study showed that, by substituting Solarhan 60 glass in place of dual-pane tinted glass,the owners of a typical glass-walled, eight-story office building in Boston could lower their initial HVAC equipment costs by nearly$350,000 while realizing annual energy savings of more than $80,000. Corresponding carbon emissions from the same building were also reduced by more than 300 tons per year, which eclipses the total carbon emissions generated by 31,000 gallons of gasoline. In addition to making products that support sustainable design, PPG has pioneered innovative technologies that reduce energy �1 consumption during the glass-making process. PPG promotes environmentally responsible manufacturing by recovering and Location:Chicago,rr, reusing virtually all of its glass manufacturing byproducts and by Product.Solarban 60 Glass shipping its materials on reusable steel racks. PPG also facilitates Architect.Solomon C„rdwellBuenzand Associates Owner/Developer.Golub and Companv regional sourcing through its nationwide network of certified glass Glass Fabricator:Northwestern Industries, Inc. fabricators and laminators. Glazing Contractor.Custom Windows and Je%DErectors With Solarban 60 glass, sustainable design and LEED credit opportunities are provided according to the following criteria: LEED/Green Design Category Feature Benefit Optimizing Energy Performance Excellent SHGC,U-value,and Tvis performance Enhance energy performance of building design Daylight&Views High visible light transmittance Connectivity to natural lighting and the outdoors Innovation in Design MBDC Cradle to Cradle Certification Selection of environmentally-focused product evaluation ' SOIARBAN®60 SOLAR CONTROL LOW-E GLASS Fahrication and Availability .A* Additional Resources Solarban 60 glass can be (L ,)-PPG Certified Solarban 60 glass is just one of many �'1 Ological heat-strengthened,tempered 1``'- FABRICATOR® NETWORK Ecological Solutions from PPGTm. For and laminated, and is readily available as a standard product. more information, or to obtain samples of this product, call Like other high-performance PPG architectural glasses, n , r � '_)z_ 7 '41339,,339)_or visits Solarban 60 glass is available through more than 65 locations of the PPG Certified Fabricator®Network. PPG Certified All PPG architectural glass is Cradle to Cradle® Certified. Fabricators can meet tight construction deadlines and accelerate the delivery of replacement glass before, during PPG ldeaScapeC Integrated products,people and services to and after construction. inspire your design and color vision. Solarban®60 Glass Performance-Commercial Insulating Glass Unit Comparisons Using 1/4" (6mm) Glass Insulating Vision Unit Performance r , r. two 1/4-inch(6mm)lites;as shown below Transmittance Reflectance U-Value(Imperial) Salar Heat Light to Glass Type Total Total European Shading Gain Solar YP Ultra- Visible Winter Summer U-Value Coefficient Gain Visible Solar Solar violet Light Night- Day, CoeNicient En�ogy g En�ogy time Time (LSG) / .1 Solar Control SOLARBAN 60(2)STARPHIRE" 25 74 38 11 43 0.29 0.27 1.55 0.46 0.40 1.85 SOLARBAN 60(2)Clear+Clear 19 70 33 11 29 0.29 0.27 1.55 0.44 0.38 1.85 SOLEXIAT'^+SOLARBAN 60(3)Clear 10 61 25 11 11 0.29 0.27 1.55 0.42 0.36 1.70 ATLANTICATM+SOLARBAN 60(3)Clear 5 53 20 9 7 0.29 0.27 1.55 0.35 0.30 1.78 CARIBW+SOLARBAN 60(3)Clear 8 54 20 9 7 0.29 0.27 1.55 0.35 0.31 1.74 AZURIAT"+SOLARBAN 60(3)Clear 13 54 21 9 7 0.29 0.27 1.55 0.36 0.31 1.75 PACIFICA-+SOLARBAN 60(3)Clear 5 1 34 15 6 7 0.29 0.27 1.55 0.29 0.25 1.36 SOLARBLUE"+SOLARBAN 6G(3)Clear 10 45 21 8 13 0.29 0.27 1.55 0.37 0.32 1.39 SOLARBRONZE®+SOLARBAN 60(3)Clear 8 42 20 7 17 0.29 0.27 1.55 0.36 0.31 1.36 SOLARGRAY®+SOLARBAN 60(3)Clear 8 35 17 7 13 0.29 0.27 1.55 0.32 0.28 1.26 GRAYLITEg II+SOLARBAN 60(3)Clear 1 7 4 4 5 0.29 0.27 1.55 0.14 0.12 0.58 SOLARBAN 60(2)SOLEXIA+Clear 10 61 25 10 11 0.29 0.27 1.55 0.36 0.32 1.92 SOLARBAN 60(2)ATLANTICA+Clear 5 1 54 20 8 7 0.29 0.27 1.55 0.31 0.27 1.98 SOLARBAN 60(2)AZURIA+Clear 13 54 21 8 7 0.29 0.27 1.55 0.32 0.28 1.93 SOLARBAN 60(2)PACIFICA+Clear 5 34 15 6 7 0.29 0.27 1.55 0.26 0.22 1.52 SOLARBAN60(2)SOLARBLUE+Clear 10 45 21 7 13 0.29 0.27 1.55 0.32 0.28 1.60 SOLARBAN 60(2)SOLARBRONZE+Clear 8 42 20 7 16 0.29 0.27 1.55 0.31 0.27 1.56 cOL.A.RBA,N 60(2)SOLA.P.GRA.Y �C!ear 8 35 17 6 12 0_29 0.27 1.55 0,28 0,29 1.97 II I � .1 r r Mr vfSTACOOL(2)AZURIA+Low-E 11 42 16 20 11 0.29 0.27 1.55 0.30 0.26 1.61 VISTACOOL(2)PACIFICA+Low-E 4 26 12 11 9 0.29 0.27 1.55 0.24 0.21 1.23 VlSTACOOL(2)SOLARGRAY+Low-E 7 27 14 11 15 0.29 0.27 1.55 0.28 0.24 1.13 I II I1111111=121111 SOLARCOOL(2)SOLEXIA-Low-E 3 24 10 24 15 0.29 0.27 1.55 0.22 0.19 1.26 SOLARCOOL(2)AZURIA+Low-E 4 21 8 19 10 0.29 0.27 1.55 0.19 0.16 1.31 SOLARCOOL(2)PACIFIALow-E2 13 6 10 8 0.29 0.27 1.55 0.17 0.15 0.89 SOLARCOOL(2)SOLAR3 17 9 14 15 0.29 0.27 1.55 0.21 0.18 0.97 SOLARCOOL(2)SOLARB3 17 9 14 18 0.29 0.27 1.55 0.21 0.18 0.92 SOLARCOOL(2)SOLAR2 14 7 11 14 0.29 0.27 1.55 0.19 0.16 0.86 SOLARCOOL(2)GRAYL <1 3 2 5 5 0.29 0.27 1.55 0.12 0.10 1 Data based on using Starphire glass for both interior and exterior kites. All performance data calculated using LBNL Window 5.2 software,except European U-value,which is calculated using W1nDat version 3.0.1 software.For detailed information on the methodologies used to calculate the aesthetic and performance values in this table,please visit www.ppgideascapes.com or request our Architectural Glass Catalog. O 2012 PPG Industries,Inc.All rights reserved.Atlantica,Azuria,Azurlite,Caribia,Graylite,ideaScapes,oceans of Color Pacifica,Solarban,Solarblue,Solarbronze,Solarcool,Solargray, Solexia,Starphire,Sungate,rstacool,PPG,the PPG logo,the PPG Certified Fabricator Network logo and the Ecological Solutions from PPG logo are trademarks of PPG Industries Ohio.Inc. Cradle to Cradle is a registered trademark of MBDC,LLC. /� Printed in U.S.A. aJ�GCl�JIoSM '**W 7071 02/12 10M Glass•Coatings• Paint PPG Industries,Inc. Glass Business&Discovery 400 Guys Run •r.r Cheswick,PA 15024I Ire 1- .1• r j zo7oo 8 PERFORMANCE CERTIFICATE OF COMPL (Part 1 of 3) PERF-1C Project Name ' 7 Date Safeway-Homestead Square 7 5242012 Project Address Climate ZoneTotal Cond.Floor Area Addition Floor Area 20620 Homestead Road Cupertino CA Climate Zone 04 54,928 n/a GENERAL INFORMATION Building Type: ® Nonresidential 0 High-Rise Residential 0 Hotel/Motel Guest Room 0 Relocatable-indicate 0 specific climate zone 0 all climates Phase of Construction: 0 New Construction ❑ Addition 0 Alteration STATEMENT OF COMPLIANCE This certificate of compliance lists the building features and specifications needed to CA BEC comply with Title 24, Parts 1 and 6 of the California Code of Regulations.This certificate applies only to a Building using the performance compliance approach. The documentation author hereby certifies that the documentation is accurate and com ete. Documentation Author Name Energy Compliance Systemg Inc./Ken Miller Signature A Company Energy Compliance Systems, Inc Date 51412012 Address 1190 Coleman Avenue, Suite 140 hone 408-988-2252 City/State(Lp San Jose,CA 95110-1141 The Principal Designer hereby certifies that the proposed building design represented in this set of construction documents is consistent with the other compliance forms and worksheets,with the specifications,and with any other calculations submitted with this permit application. The proposed building has been designed to meet the energy efficiency requirements contained in sections 110, 116 through 118, and 140 through 149 of Title 24, Part 6. Please check one: ENV. LTG. MECH. I hereby affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code to ❑ ❑ sign this document as the person responsible for its preparation;and that I am licensed in the State of California as a civil engineer,mechanical engineer,electrical engineer,or I am a licensed architect. I affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code by section 0 ❑ 0 5537.2 or 6737.3 to sign this document as the person responsible for its preparation;and that I am a licensed contractor performing this work I affirm that I am eligible under Division 3 of the Business and Professions Code to sign this document 0 ❑ ❑ because it pertains to a structure or type of work described as exempt pursuant to Business and Professions Code Sections 5537,5538 and 6737.1. Principal Envelope Designer Name Signature Y CompanyDat Arc Tec Address 99 Almaden Blvd., Suite 840 License# - V City/State)Zip Sen Jose, CA 95113 Phone 408496-0676 Principal Mechanical Designer Name Signature Company Mechanical Compliance Not In the Scope Of This Submittal Date Address License# City/State/Zip I hone Principal Lighting Designer Name Signature Company Lighting Compliance Not in The Scope Of This Submittal Date Address License# City/State2p Phone INSTRUCTIONS TO APPLICANT COMPLIANCE&WORKSHEETS check box If worksheets are included) 0 ENV-1C Certificate of Compliance.Required on plans. 0 MECH-1C Certificate of Compliance. Required on plans. ❑ LTG-iC Certificate of Compliance.Required on plans. ❑ MECH-20 AirMater Side/Service Hot Water&Pool Requirements. 0 LTG-2C Lighting Controls Credit Worksheet. ❑ MECH-3C Mechanical Ventilation and Reheat 0 LTG-3C Indoor Lighting Power Allowance 0 MECH-5C Mechanical Equipment Details. Vowe EnefgyPro 5.1 by EnefqySoft User Number 1308 A RunCode:2012-05-24723:33:17 1D: 12069 Page 1 of 8 PERFORMANCE CERTIFICATE OF COMPLIANCE Part 2 of 3) PERF-1C Project Name Date Safeway-Homestead Square 5/2412012 ANNUAL TDV ENERGY USE SUMMARY kBtu/ ft- r Standard Proposed Compliance Energy Component Design Design Margin � Space Heating 2780 3041 -260 Heating Space Cooling 3104 4587 5.16' Cooling Indoor Fans 32.10 29.97 2.12 Fans Heat Rejection 0.00 0.00 0.00 Heat Rej Pumps&Misc. 0.00 0.00 0.00 Pumps Domestic Hot Water 0.00 0.0a 0.00 DHW Lighting 62.29 62.29 0.00 Lighting Receptacle 56.95 56.95 0.00 Receptacle Process 0.00 0.00 0,00 Process Process Lighting 0.00 0.00 0.00 Process Ltg TOTALS 230.18 225.49 4.68 Percent better than Standard 2 0% 2.0%excluding process) BUILDING COMPLIES GENERAL INFORMATION Building Orientation (N)0 deg Conditioned Floor Area 54,928 sqft. Number of Stories 1 Unconditioned Floor Area 0 sqft. Number of Systems 1 Conditioned Footprint Area 54,928 sqft. Number of Zones 3 Natural Gas Available On Site res �r►y Orientation Gross Area Glazing Area Glazing Ratio Front Elevation (N) 6,644 sqft. 2,195 sqft 33.0% Left Elevation (E) 747 sqft. o sqft 0.0% Rear Elevation (s) 5,445 sqft. 0 sq ft 0.0% Right Elevation (tv) 722 sqft. o sqft 0.0% Total 13,558 sqft. Z 195 sqft 16.2% Roof 54,938 sqft. o sqft 0.0% Standard Proposed Prescriptive Values for Prescriptive Lighting Power Density 1.000 W/sgft. 1.000 W/sgft. Comparison only. See Prescriptive Envelope TDV Energy 652,966 547,178 LTG-1 C for allowed LPD. Remarks: -This report is for T24 permIt documentation purposes only, and it oufd not be relied upon for design,spec ication,or any other purpose. NOW I EnergyPro57YEnemysoft User Number. 1308 A RunCode:2012-05-24T23:33.17 ID: 12069 Paoe 2 of 8 PERFORMANCE CERTIFICATE OF COMPLIANCE (Part 3 of 3) PERF-1 C Project Name Date Safeway- Homestead Square 5124/2012 ZONE INFORMATION Floor Inst. Ctrl. Allowed LPD Proc. \tws Area LPD Credits Area Tailored Loads System Name Zone Name Occupancy Type s ft. W/sf ' /Sf a /sf s /sf a W/sf Safeway B5 B5-Front Comp Bldg Ind Work,Low B 3,336 "1.000 B5-Back Comp Bldg Ind Work,Low 8 8,316 "1.000 B5-Core Comp Bldg Ind Work, Low B 43,276 '1.000 Ilf� Notes:1.See LTG-1C 2.See LTG-2C 3.See LTG-30 4.See LTG4C Items above require special documertation items marked with asterisk see LTG-1-C by others) (by others EXCEPTIONAL CONDITIONS COMPLIANCE CHECKLIST The local enforcement agency should pay special attention to the items specified in this checklist.These items require special written justification and documentation,and special verification to be used with the performance approach.The local enforcement agency determines the adequacy of the justifications,and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. The Roof R-24.2 Metal Deck Roof or similar Reflectance=0.58,Emittance=0.84 shall berated and labeled by the Cool Roof Rating Council in accordant The exceptional features listed In this performance approach application have specifically been reviewed.Adequate written justlflcation and documentation for their use have been provided by the applicant. Authorized Signature or Stamp Ener Pro 5.1 by Ener ySoft User Number:1308 A RunCode:2012-05-24723:33:17 ID:12069 Page 3 of 8 CERTIFICATE OF COMPLIANCE (Part 1 of 3) ENV-1 C AND FIELD INSPECTION ENERGY CHECKLIST Project Name Date Safeway-Homestead Square 1 5/24/2012 Project Address Climate Zone Total Cond. Floor Area I Addition Floor Area 20620 Homestead Road Cupertino 4 54,928 n/a GENERAL INFORMATION Building Type: ® Nonresidential 13 High-Rise Residential ❑ Hotel/Motel Guest Room ❑ Schools(Public School) p Relocatable Public School ® Conditioned Spaces ❑ Unconditioned Spaces Bldg. ❑ Skylight Area for Large Enclosed Space>_8040 ftz (If checked include the ENV-4C with submittal) Phase of Construction: ® New Construction ❑ Addition ❑ Alteration Approach of Compliance: E3 Component ® Overall Envelope ❑ Unconditioned (file affidavit) Front Orientation:N, E, S,W or in Degrees: 10 deg FIELD INSPECTION ENERGY CHECKLIST OPAQUE SURFACE DETAILS INSULATION ro- c � U. T ID Assembly Type oL z 6 v cc U1> U1 LL'. 5> 5 ri CERTIFICATE OF COMPLIANCE (Part 1 of 3) ENV-1 C AND FIELD INSPECTION ENERGY CHECKLIST Project Name Date Safeway-Homestead Square 1 6/24/2012 Project Address Climate Zone Total Cond.Floor Area Addition Floor Area 20620 Homestead Road Cupertino 4 54,928 n/a GENERAL INFORMATION Building Type: ® Nonresidential D High-Rise Residential ❑ Hotel/Motel Guest Room ❑ Schools(Public School) ❑ RR`locatable Public School ® Conditioned Spaces 13Unconditioned Spaces D Skylight Area for Large Enclosed Space>_8000 ft2(If checked include the ENV-4C with submittal) Phase of Construction: ® New Construction ❑ Addition D Alteration Approach of Compliance: ❑ Component ® Overall Envelope ❑ Unconditioned (file affidavit) Front Orientation: N, E, S,W or in Degrees: 0deq FIELD INSPECTION ENERGY CHECKLIST OPAQUE SURFACE DETAILS INSULATION c v m ui LL �' g` 7 g` 7 c 9 a r- 10 E37 � A � 7 O �� A N T ID AssemblyT O"2F :iU 1 m a0 m LL _=a =a ro o_ a 11 Wall 658 (W)1 0.049 None 19.0 Nonel 4.3.5-A10 New ❑ ❑ 12 Door 21 (W) 0.700 None 4.5.1-A2 New ❑ D 13 Door 43 (W} 1.450 None 4.5.1-A6 New ❑ ❑ 14 Wall 211 (17 0.049 Nonel 19.0 None 4.3.5-A10 New ❑ D 15 Wall 1,762 (S) 0.049 None 19.0 None 4.3.5-A10 New ❑ ❑ 16 Wall 408 (E) 1 0.049 None 19.0 None 4.3.5-A10 New ❑ D 17 Door 64 (E) 1.450 None 4.5.1-A6 New ❑ ❑ 18 Door 64 (E) 1.450 None 4.5.1-A6 New ❑ ❑ 19 Roof 43,284 (N) 0.038 None 24.2 None 4.2.6-A5 New D D 20 Slab 43,276 (N) 0.730 None 4.4.7-A1 I New ❑ ❑ 1.See Instructions in the Nonresidential Compliance Manual,page 3-96. 2.It Fail,then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. A fail does not meet compliance. FENESTRATION SURFACE DETAILS `3 zz ui 20 '� 5 w LL LL = N C7 70 Fenestration z o '�^ x o a O 0 A � Tag/ID T 026 2> > W N N O a N o_ a D ❑ ❑ D D D ❑ ❑ ❑ D D D ❑ ❑ ❑ D D D D D D ❑ ❑ ❑ D ❑ ❑ ❑ ❑ ❑ 1.See Instructions in the Nonresidential Compliance Manual,page 3-96. 2. If Fal then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. ;,+ EnergyPro 5.1 by EnergySoff User Number:1308 A RunCode:2012-05-24T23:33:17 ID:12069 Page 5 of 8 CERTIFICATE OF COMPLIANCE (Part 2 of 3) ENVA C AND FIELD INSPECTION ENERGY CHECKLIST Project Narne Date Safeway- Homestead Square 5124/2012 ROOFING PRODUCT COOL ROOFS �rrr° (Note if the roofing product is not CRRC certified,this compliance approach cannot be used). Go to Overall Envelope Approach or Performance Approach, CHECK APPUCABLE BOX BELOW IF EXEMPT FROM THE ROOFING PRODUCT"COOL ROOF"REQUIREMENTS: Pass Fall' WA ❑ Roofing compliance not required in Climate Zones 1 and 16 with a Low-Sloped. 2:12 pitch or less. ❑ ❑ ❑ ❑ Roofing compliance not required in Climate Zone 1 with a Steep-Sloped with less than 5 Ib(ft2.Greater than 2:12 pitch. ❑ ❑ ❑ ❑ Low-sloped Wood framed roofs in Climate Zones 3 and 5 are exempted,solar reflectance and thermal emittance or ❑ ❑ ❑ SRI that have a U-factor of 0.039 or lower.See Opaque Surface Details roof assembly,Column H of ENV-2C. ❑ Low-sloped Metal building roofs in Climate Zone 3 and 5 are exempted,solar relectance and thermal emittance or SRI ❑ ❑ ❑ that have a U-factor of 0.048 or lower.See Opaque Surface Details roof assembly below,Column H of ENV-2C. ❑ The roof area covered by building integrated photovoltaic panels and building integrated solar thermal panels are ❑ ❑ ❑ exempted. Solar reflectance and thermal emittance or SRI,see spreadsheet calculator at www.ener .ca. ov/titie24/ [3 Roof constructions that have thermal mass over the roof membrane with a weight of at least 25 Ib/ft are exempt from ❑ ❑ ❑ the Cool Roof criteria below. ❑ High-rise residential buildings and hotels and motels with low-stoped roofs in Climate Zones 1 through 9, 12 and 16 are ❑ 13 [3exem ed from the low-sloped roofingcriteria. 1.If Fail then describe on this page of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. CRRC Product ID Roof Slope Product Weight Product Aged Solar Thermal Number' s 2:12 >2:12 < sib/te >- 51blie TYPW Reflectance3 Emmitance SR16 Pass Fails R-24.2 Metal Deck R ® ❑ m ❑ ❑4 0.58 0.84 ❑ ❑ ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ 1 ❑ ❑ c3 ❑ ❑ ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑ ❑ c3 ❑ ❑ ❑ ❑ ❑ ❑ ❑4 ❑ ❑ 1.The CRRC Product I D Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolroofs.orgt2[oducts/search.pho 2. Indicate the type of product is being used for the roof top,i.e.single-ply roof,asphalt roof,metal roof,etc. 3. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same directory and use the equation(0.2+0.7(p nal d—0.2)to obtain a calculated aged value. Where p is the Initial Solar Reflectance from the Cool Roof Rating Council's Rated Product Directory. 4.Check box if the Aged Reflectance is a calculated value using the equation above. 5.The SRI value needs to be calculated from a spreadsheet calculator at htto)hwww.eneray.ca.aov/dle24/ S.If Fail then describe on this page of the Inspection Checklist Form and take appropriate action to correct. Verity building plans if necessary. To apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in§118@4. Select the applicable coating: ❑Aluminum-Pigmented Asphalt Roof Coating ❑Cement-Based Roof Coating ❑ Other Discrepancies: EneravPro 5.1 bv En Soft User Number:1308 A RunCode:2012-05-24T23:33:17 ID:12069 Pac ie 6 of 8 CERTIFICATE OF COMPLIANCE (Part 3 of 3) ENV-1 C AND FIELD INSPECTION ENERGY CHECKLIST Project Name Date Safeway-Homestead Square 5/24/2012 Required Acceptance Tests Designer: This form is to be used by the designer and attached to the plans. Listed below is the acceptance test for Envelope Fenestrations system.The designer is required to check the acceptance tests and list all the fenestration products that require an acceptance test. If all the site-built fenestration of a certain type requires a test, list the different fenestration products and the number of systems. The NA7 Section in the Appendix of the Nonresidential Reference Appendices Manual describes the test. Since this form will be part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropriately. Enforcement Agency: Systems Acceptance. Before Occupancy Permit is granted for a newly constructed building or space or whenever new fenestration is installed in the building or space shall be certified as meeting the Acceptance Requirements. The ENV-2A form is not considered a complete form and is not to be accepted by the enforcement agency unless the boxes are checked and/or filled and signed. In addition, a Certificate of Acceptance forms shall be submitted to the enforcement agency that certifies plans,specifications, installation certificates, and operating and maintenance information meet the requirements of§10-103(b)of Title 24 Part 6.The field inspector must receive the properly filled out and signed forms before the building can receive final occupancy. A copy of the ENV-2A for each different fenestration product line must be provided to the owner of the building for their records. Test Description ENV-2A Test Performed By: Fenestration Products Name or ID Area of like Building Envelope Requiring Testing or Verification Products Acceptance Test Dual w/rrmz.SHGCcog 0.38 1,980 Door Single Metal Clear 215 0 11 13❑ 13 11 13 13 13 13 13 13 13 11 ❑ Ener Pro 5.1 b Ener Soft User Number:1308 A RunCode:2012-05.24723:33:0 ID:12069 Page 7 of 8 ENVELOPE MANDATORY MEASURES: NONRESIDENTIAL ENV-MM Project Name Date Safeway-Homestead Square 5/24/2012 DESCRIPTION Building Envelope Measures: Installed insulating material shall have been certified by the manufacturer to comply with the California Quality §118(a). Standards for insulating material, Title 20 Chapter 4,Article 3. § 1 18 c All Insulating Materials shall be installed in compliance with the flame spread rating and smoke density requirements of( )' Sections 2602 and 707 of Title 24, Part 2. The opaque portions of framed demising walls in nonresidential buildings shall have insulation with an installed R-value of no less than R-13 between framing members. 17 a All Exterior Joints and openings in the building that are observable sources of air leakage shall be caulked,gasketed, §1 ( )' weatherstripped or otherwise sealed. Manufactured fenestration products and exterior doors shall have air infiltration rates not exceeding 0.3 Cfm/ft.2 of §116(a) 1: window area, 0.3 cfm/ft.2 of door area for residential doors, 0.3 cfm/ft.2 of door area for nonresidential single doors (swinging and slidingand 1.0 cfm/ft.2 for nonresidential double doors wingin §116(a)2: Fenestration U-factor shall be rated in accordance with NFRC 100, or the applicable default U-factor. §116(a)3: Fenestration SHGC shall be rated in accordance with NFRC 200, or NFRC 100 for site-built fenestration,or the applicable default SHGC. §116(b): Site Constructed Doors,Windows and Skylights shall be caulked between the unit and the building,and shall be weatherstripped (except for unframed glass doors and fire doors). En Pro 5.1 7y Ener Soft User Number:1308 A RunCode:2012-05-24T23:33:17 !D:12069 Page 8 of 8 /"70o � STATE OF CALIFORNIA DEFAULT U-FACTOR AND SHGC LABEL CERTIFICATE CEC-FC-1/FC-2(Revised 08/09) CALIFOe A E' R COMMISSION U-FACTOR AND SHGC FENESTRATION CERTIFICATE LABEL FC-1/FC-2 PRO.IF.CT INFORMATION Farm 1 of 2 PROJECT NAME: Homestead Square DATE: 3/4/14 PROJECT ADDRESS: 10640-20680 Homestead Rd.,Cupertino, CA 95014 CLIMATE ZONE:3 Option 1:For"buildings with less than 1 o,000 1r of,site-built%nestratiorr mar optionally use either CEC Default Tables 116-.4 and 116-B, Wethod 1,or the Alternative Calculation Nonresidential Reference Appendix X.46, Afethod 2, Option 2:For buildings with greater 10,000.ff of site-hailt fenestration only one option is available;use CEC Default Tables 116-A and 116-B. Use Method 1 onh•. A separate(FC-/IFC-2)Label Cer-tlrcate Forth is requir-ed.for each different fertcstrtrtiarr product line. Unlaheled manufactured _fenestration products including skj"lights and exterior doors shall meet the air infiltration requirements ol'>>116(a)1 of the 2008 California Energy Efficiency Standards applicable to Residential and Nonresidential Buildings. Enter the U-factor,and SHGC,in the following boxes after completing Method 1 or 2 below. U-factort SHGCt =.28 =.38 PRODUCT LINE INFORMATION(Complete a separate Label Certificate for each fenestration product line is required) Total Number of units for the same product line: 616 Total square footage of this product line: 6336 Schedule location on the building plans- N,A Total Fenestration Area(ft`)on project: 6336 Reference page: Location(s)on building:S.N.E,W S,N,E,W Coo Method 1 For fenestration either less than or greater than or equal to 10,000 8z) U-FACTOR INFORMATION FROM DEFAULT See TABLE 116-A: Frame Type e Metal Metal With Thermal Break Nonmetal Product Type Operable Fixed Greenhouse/Garden Window Doors Skylights Glazing Type V Single Pane r Double Pane Glass Block Insert value in the default U-factor gray box above SOLAR HEAT GAIN INFORMATION FROM DEFAULT See TABLE 116-B: Product Type Operable Fixed Glazing: Clear a Tinted Insert value in the default SHGC,gray box above 1-bo Method 2 For fenestration less than 10,000 ft)Reference Nonresidential Appendix NA6 2008 Nonresidential Conrpliance Forms .august 2009 STATE OF CALIFORNIA DEFAULT U-FACTOR AND SHGC LABEL CERTIFICATE l ; CEC-FC-1/FC-2 Revised 08/09 CALIFORNIA ENERGY COMMISSION GLAZING INFORMATION:Alternative Calculation<less than 10,000 fe STEP 1:Determine U-Facto Enter U-factor from Equation NA6-l above in the gray box next to ti-factor STEP 2:Detarntinte SFIGC,: Use Center of Glass.SHGCc.in the equation below to determine the solar heat gain coefficient with frame ' Enter Center of Glass.COG,from Manufacturer's Documentation.SHGCc .38 Insert Center of Glass%alue here Calculate the new SHGC,of the frame. SHGC,=0.08+(0.86 x SHGCc)_ •41 Insert calculated result value here and in above gra}'box next to SHGC, STEP 3: ATTACHED MANUFACTURER'S LITERATURE: Mmtafacturer's lileraten-e must he attached showing the Prochret Tape,frame Type,Glazing.Center Of Glass(COG) C'-(actor,curd SHGC infornmtion needed to determine the Default U-tactor,and SHGC,. PARTY TAKING RESPONSIBILITY]FOR FENESTRATION COMPLIANCE: CONTACT PERSON: Joe Waldherr COMPANY NAME and ADDRESS: USA All Glass, 705 Del Paso Rd,Sacramento, CA 95834 PHONE: 916-564-68?0 FAX: 916-564-6801 SIGNATUR LICENSE# (if Applicable) 796707 2008 Nonresidential Compliance Forms August 2009