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12120057CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20333 CLIFDEN WAY CONTRACTOR: ADVANCED HOME PERMIT NO: 12120057 IMPROVEMENT OWNER'S NAME: WILLIAM THROM 879 E HAMILTON AVE DATE ISSUED: 12/12/2012 OWNER'S PHONE: 4085590999 CAMPBELL, CA 95008 PHONE NO: (408) 559 -0999 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT F PLUMB License Class L' . # I S 3 b / - ;&q Contractor + 1 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. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, t applicant understands and will comply with all non -point source regulation er he Cupertino Municipal Code, Section 9.18. Signature Date ❑ 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) 1, 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 9.18. Signature Date MECH r- RESIDENTIAL COMMERCIAL r- JOB DESCRIPTION: KITCHEN REMODEL (208 SQFT) Sq. Ft Floor Area: I Valuation: $25000 APN Number: 36937004.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 D YS FROM „LAST CALLED INSPECTION. Issued by: / I- +% � L_ 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 Applicant: 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(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the CjLpertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Secti s 21505, 25533, and 25534. Date:-- �t�/`7� 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingCWcupertino.or4 c V1-bKr 1Nca r--I r—I M 1 1 -11�XT /TL`UUDDUT% nDMIATAI PFRAATT!!% LJ INLW - - -- 1. PROJECT ADS SS APN # -r � � _ 7, OWNERNAM E -MAIL e s q oIL-111 .' STREE DDRESS 21 CITY TAT , ZIP FAX �1 orvLi -0 , CONTACT NAME PRONE -1.5? 7 ?,,-5:- E -MAIL /� i w 7 STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICYF�y.B�BE LICE N TYPE BUS. LIC # V 2_ E�- MA�ILC� I- /,/ �Z3 STREET CIT T TE, ZI E �—�Q_ U Q 9 , r VDRE15 Jc ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOS D USE CO STR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA 2 v8' NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE - APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL # [:]NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO RECEIVED BY: TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I hprEyead the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construc . n. aut rize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP OVER- THE- C oUNTER ` ❑ 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 06/21/11 CITY OF CUPERTINO FrRMN FEE ESTIMATOR — BUILDING DIVISION [jiADDRESS: 20333 clifden way DATE: 12/12/2012 REVIEWED BY: (arty s I Wccll' r''�r„ �it Fc " APN: BP #: *VALUATION: 1$25,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex F'Iitnrb, liulz h'ef�: PENTAMATION 1 R3SFDREM USE: $0.00 PERMIT TYPE: WORK 208 sq ft kitchen remodel SCOPE Permit Fee: NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary sewer vistrict, School n;.s_; .. 7% ,o , f — "— hnaod nN tho nroliminany infarmatinn availahle and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11 -053 Eff. 711112) lkvh_ ('Ian C'h,cn 17wi h. I'Iccu C'hec /t 1_fu� I'lan Chc(k I Wccll' r''�r„ �it Fc " 1'o rnit Fcc: I rr !r r -mit V", - I 011wv ,11ec°h. Insp (lJher 1,11vinh 0 "" f I;le(. Insp. Li 11"(k hsp. Fae F'Iitnrb, liulz h'ef�: I ie� _ Insp. Fce: NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary sewer vistrict, School n;.s_; .. 7% ,o , f — "— hnaod nN tho nroliminany infarmatinn availahle and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11 -053 Eff. 711112) FEE QTY/FEE - MISC ITEMS Plan Check Fee: $0.00 208 s.f. F $600.00 Remodel, Kitchen (< =300 sf) 1REMRESKIT Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 t'orztruciorr T�r:�: 71 Adinthltsirwity Fee: E) Work Without Permit? Q Yes (F) No $0.00 Advanced Planning Fee. $0.00 Select a Non - Residential Building or Structure 0 0 71w cl FCCS. Strong Motion Fee: IBSEISMICR $2.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS; $3.50 $600-001 TOTAL FEE: $603.50 Revised: 10/01/2012 CUPERTINO PURPOSE: 2010 CALGREEN RESIDENTIAL CHEC.KLT — MANDATORY ITEMS s COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING q/IS(01t. f ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL V OF : � � �0� V0�++�4 fir 01, TORRE AVENUE • CUPERTINO, CA 95014 3255 ( 77 - cu ertino.or - : "", ` The 2010 CalGreen Code'applids'tb all newly constructed hotels, motels, lodging houses, dwellings, dormitories, condominiums, shelters, congregate residences, employee housing, factory-built housing and other types of swellings with sleeping accommodations and new accessory buildings associated with such uses. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: Project Address: R Project Description: (L� �.� �� --o') E-1— Instructions: 11111!111154111L_2 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 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 Re uirements A4.1 PLANNING Planning and Design - Site Preservation 4.104.1 A site plan and inventory of the site is developed and used to minimize ❑X ❑ site disturbance in order preserve desirable existing natural resources and minimize future adverse effects on the proposed structure. Planning and Design - Site Development 4.106.2 A plan is developed and implemented to manage storm water ❑ ❑ drainage during construction. 4.106.3 The site shall be planned and developed to keep surface water away ❑X ❑ from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. Page 1 of 5 CalGreen_2010.doc revised 08127111 General 4.201.1 Low -rise residential buildings shall meet or exceed the minimum Lai ❑ standard design required by the California Energy Standards. A4.3 WATER EFFICIENCY AND CONSERVATION Indoor Water Use 4.303.1 Indoor water use shall be reduced by at least 20 percent using one of the follow methods. ❑X ❑ Water saving fixtures or flow restrictors shall be used per Table 4.303.2. ❑ As of 7/01/2011 ❑ A 20 percent reduction in baseline water use shall be demonstrated per Table 4.303.1. 4.303.2 When using the calculation method specified in Section 4.303.1, ❑ ❑ multiple showerheads shall not exceed maximum flow rates. As of 7/01/2011 4.303.3 Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with specified performance requirements. ❑ As of 7/01/2011 Outdoor Water Use 4.304.1 Automatic irrigation systems installed at the time of final inspection ❑ ❑ shall be weather - based. A4.4 MATERIAL • - • RESOURCE EFFICIENCY Enhanced Durability and Reduced Maintenance 4.406.1 Joints and openings. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected ❑ ❑ against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.408.2 Where a local jurisdiction does not have a construction and demolition ❑X ❑ waste management ordinance, a construction waste management plan shall be submitted for approval to the enforcing agency. Building Maintenance and Operation 4.410.1 An operation and maintenance manual shall be provided to the ❑ ❑ building occupant or owner. Page 2 of 5 CalGreen 2010.doc revised 08127111 Fireplaces 4.503.1 Install only a direct -vent sealed- combustion gas or sealed wood- ❑ ❑ burning fireplace, or a sealed woodstove. Pollutant Control 4.504.1 Duct openings and other related air distribution component openings ❑ ❑ shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks shall be compliant with VOC and ❑ ❑ other toxic compound limits. 4.504.2.2 Paints, stains and other coatings shall be compliant with VOC limits. ❑X ❑ 4.504.2.3 Aerosol paints and other coatings shall be compliant with product ❑X ❑ weighted MIR Limits for ROC and other toxic compounds. 4.504.2.4 Documentation shall be provided to verify that compliant VOC limit ❑ ❑ finish materials have been used. 4.504.3 Carpet and carpet systems shall be compliant with VOC limits. ❑X ❑ 4.504.4 Fifty (50) percent of floor area receiving resilient flooring shall comply with the VOC- emission limits defined in the Collaborative for High Performance ❑ ❑ Schools (CHPS) Low - emitting Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall comply with low formaldehyde ❑X ❑ emission standards. Interior Moisture Control 4.505.2 Vapor retarder and capillary break is installed at slab on grade foundations. 0 ❑ 4.505.3 Moisture content of building materials used in wall and floor framing is ❑ ❑ checked before enclosure. Page 3 of 5 CalGreen_2010.doc revised 08127111 Indoor Air Quality and Exhaust 4.506.1 Exhaust fans which terminate outside the building are provided in ❑ ❑ every bathroom. Environmental Comfort 4.507.1 Whole house exhaust fans shall have insulated louvers or covers ❑X ❑ which close when the fan is off. Covers or louvers shall have a minimum insulation value of R -4.2. 4.507.2. Duct systems are sized and designed and equipment is selected using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or M-71 ❑ equivalent. 2. Size duct systems according to ACCA 29 -D (Manual D) or equivalent. 3. Select heating and cooling equipment according to ACCA 36 -S (Manual S) or equivalent. INSTALLER AND SPECIAL INSPECTOR QUALIFICATIONS Qualifications 702.1 HVAC system installers are trained and certified in the proper installation ❑ ❑ of HVAC systems. 702.2 The Licensed Professional responsible to verify CALGreen compliance ❑X ❑ is qualified and able to demonstrate competence in the discipline they inspect and verify. Verifications 703.1 Verification of compliance with CALGreen may include construction documents, plans, specifications, builder or installer certification, inspection reports, or other methods acceptable to the enforcing agency which show ❑ ❑ substantial conformance. Implementation verification shall be submitted to the Building Department after implementation of all required measures and prior to final inspection approval. Page 4 of 5 CalGreen_2010.doc revised 08127111 Project Name: Project Address Project Description: CALGREEN SIGNATURE DECLARATIONS %ffa,9'I 00333 � W 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 adopted by the City of Cupertino. Owner's Signature Date Owner's ame (P Print) I F: L Des n Pro essional's Signature Date Design Professional's Name (Please Print) /Z /2. Si na re of License Pr fe io I r nsib for CalGreen compliance Date 9 7- 57 73 Name of License Professional responsible for CalGreen compliance (Please Print) Phone E ail Address for License fession I res risible for CalGreen compliance v,e � e-0 -'ZI 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 ac ace with this Green Building Checklist and in accordance with the requirements of the 2010 California Green KildinA Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date 4 7 Name of License Professional responsible /for CalGreen compliance (Please Print) Phone S �J C//1 i ,Core( Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen_2010.doc revised 08127111 Material Doors/Top /Bottorn...... se- End Panel Drawers c- c Finish � Counters l Floor WoodJ Edge Detail �' M ^ I Entry /Crown r - 1Z Z11k <. -' DEC `t 2012 T-1-V The �tarnpin( i ._�t +f,i p Or of S.i iY E3 GVi`.: i:;t1S of a j Lli f L IFi 1G`� of BY iAA- ) 101 -f ow 70.,"1 d •-&I 026'33 C� W rj 5`f OFFICE COP`! Q W O� = Qc (7 00 Z c) N J - 7f-tcc.k — 5�' g6c fsss> - /fD o� L 51 N y* - f l r l 1 t �! _.. 4 1Ye. ;4 i 1 This sit of nhT- and G' L S J r l C l 7 r r a t +Iy i_ N '. f rt 101 -f ow 70.,"1 d •-&I 026'33 C� W rj 5`f OFFICE COP`! Q W O� = Qc (7 00 Z c) N J - 7f-tcc.k — 5�' g6c fsss> - /fD o� L 51 N y* CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: Zo 3 33 t EN �,,� PERMIT # 7 --I �' OWNER'S NAME: Wlykvjj N row PHONE # GENERAL CONTRACTOR: f}pv Lip „, BUSINESS LICENSE # ZS) ADDRESS:g—/q E iL -�r ,¢,. CITY /ZIPCODE: *Our municipal code requires all businesses working 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 SUBCONTRACTORS A E OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature /1� /22�zZ.— Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature /1� /22�zZ.— Date