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13050212 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10181 EMPIRE AVE CONTRACTOR:DIANLI CHEN PERMIT NO: 13050212 OWNER'S NAME: DIANLI CHEN 10181 EMPIRE AVE DATE ISSUED:08/13/2013 OWNER'S PHONE: 4088882848 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class Lic.# CONSTRUCT 2 STORY SFDWL TO INCLUDE IST FLOOR 1,939,2ND FLOOR 1263 ATTACHED GARAGE 426 SQ FT, Contractor Date DECK AND PORCH 691 SQ FT 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. Sq.Ft Floor Area: Valuation:$350000 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 APN Number:32624049.00 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 DAYS FROM LAST CALLED IN SPE TION. 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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 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 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(x)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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: w Date permit is issued. ertify 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,1 must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 1 certify that I have read this application and state that the above information is correct.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. (2; Signature Date v �� CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (40:8).777-3228• FAX(408)777-3333•building(a)cupertino.org CUFtATINO ®NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS I L{�' ✓� APN# -)Z 6 OWNER NAME PHONE 14006 igtrsZ S E-MAIL D 1 aA U s UA,90 STREET ADDRESS. �0 v 1. 'r4e xa� e- CITY, STATE,ZIP ��� � 0O/� FAX CONTACT NAME +/.�[�VC PHONE �q1 SDIC E-MAIL STREET ADDRESS_ '�7 I.I 0 � aT��Ok ASI CITY,STATE, ZIP I FAX "T S oCfA CA gX0"10 ❑ OWNER .�OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACI'ORNAME t_0 '_`V•'1`'` [ (b e (-• 1p LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME � �T E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCI-IITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORKUALd N5 STa E t N n EXISTING USE PROPOSED USE CONSTR TYPE k STORIES USE TYPE OCC. SQ.FT. VALUATION(S). EXISTG NEW FLOOR pb. DEMO TOTAL / �/ / /�AREA AREA 1 .1 S AREA .3 6Z p AREA ���4 5 NET AREA 3X02 0 sIOr y V _F-1 61 U" BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA .PORCH AREA ' DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH t SF Slk.Z 6�?1 ATTACH #DWELLING UNITS: IS A SECOND UNrr ❑YES SECOND STORY []YES t BEING ADDED? NO _ ADDITION? 04NO PRE-APPLICATIONYES IF YES,PROVIDE COPY OF. IS THE BLDG AN YES PLANNING APPL# CINO P }(/cL LETTER EICHLER HOME? ONO � � - �. TOTAL VALUATION: 1'-.::,< f7'� By my signature below,I certto ear of the following: 1 am the property owner or authorized a nt to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work an verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Age nt: Date: 5 ' I ZO SUPPLEMENTAL INFORMATION REQUIRED ,„ PI;ANCHECK.TYPE ` Pt , ��,a� 120LITAGSLIP �+�It�.+�,,,- New SFD or Multifamily dwellings: Apply for demolition permit for � _ �- fl ovER �coixx�Rzt ❑ Bu1iDIxGe ANRE _ ih a + � existing building(s): emolition permit is required prior to issuance of building � ..D permit for new building. C7 I xPiuvss{ I3 �I]� �cgi itE is _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure I];sTAaRD � C7�usLlcvoRxs form if any Hazardous Materials are being used as part of this project. sDLA$GERIM ,� � CIF1ItED _Copy of Planning Approval Letter or Meeting with Planning prior to � a sM r I] MA70R q CiSANTTAitY EWERDIS7RICT ` submittal of Building Permit application. Sea ,, _20�apq I EENViR(ANXENTALAIEALTH:6. . BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10181 EMPIRE AVE DATE: 05/31/2013 REVIEWED BY: MENDEZ APN: BP#: 'VALUATION: 1$350,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 2nd Unit? Yes • No PENTAMATION 1 R3SFDW USE: PERMIT TYPE: WORK I CONSTRUCT 2 STORY SFDWL TO INCLUDE 1ST FLOOR 1 939 2ND FLOOR 1263 ATTACHED SCOPE GARAGE 426 SQ FT, DECK AND PORCH 691 SQ FT OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,111-B,IV,V-B 4,319 $3,072.76 IR3PLNCK $3,471.64 IR3INSP TOTALS: 4,319 $3,072.76 $3,471.64 ;d.`C'i -�:��t� _f,_ l✓, (' OI. _ _,'carLi rrria ,,: -,.Ii�:. arc_lta.�, i:. 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 only an estimate. Contact the Dept/or addh 7 info. FEE ITEMS (Fee Resolution //-053 Eff' 71/i/2) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,072.76 Select a Misc Bldg/Structure Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $3,471.64 Suppl. Insp. Fee.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR "e-1 units $641.96 ,Idntini,sIrativc 1"'C %, 0 Work Without Permit? Q Yes (F) No $0.00 0 Advanced Planning IPLLONGR $561.47 Select a Non-Residential 0 Building or Structure 0 Tru;rer Dn'c;rtYtc,ttuti0'i F(I<',4`: � Strong Motion Fee: IBSEISMICR $35.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $14.00 SUBTOTALS: $7,796.83 $0.00 TOTAL FEE: 1 $7,796.83 Revised: 04/29/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P ERTI N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: � PERMIT# 130 na z OWNER'S NAME: ( j PHONE# 4t-00 w GENERAL CONTRACTOR: FJlcutjAe4, U• BUSINESS LICENSE# ?-- ADDRESS: 0t 46j A%-t_ CITY/ZIPCODE: mal Sc *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 HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors an complete the following information: V 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 ner/Contractor Signature Date OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildingO)cupertino.ora Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS )D 6 6 , �j1� _)1re I✓t APN � �j ��l;� BP# J � OWNER NAME D j a,/ CA en ,t OWNER ADDRESS Lolyz 'j Avg— DESCRIPTION OF WORK: zb W We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) ICLW4-1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. I understand building permits are not required to be signed by property owners unless they are responsible for 04"construction and are not hiring a licensed Contractor to assume this responsibility. I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may rotect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the tal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and ederal government, withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �Z. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performe under contract with a licensed general building Contractor. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 understand I may obtain more information regarding my obligations as an "employer"from the Internal venue Service, the United States Small Business Administration,the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB)at 1-800-321-CSLB(2752)or www.cslb.ca.gov for more information about licensed contractors. X2�"'I'Q. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that 1 yam the party legally and financially responsible for proposed construction activity at the site address listed above. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide ijf all applicable laws and requirements that govern Owner-Builders as well as employers. _ . . v gree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the iri rmation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's si nature. Property Owner's Signature: Date: ------------------------------------------ ---------------------------------------------------------------------------------------- (NOTE: The following Authorization�Ormlii required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 t� CAL®REEN BIGINATURE DECLARATIONS Lei,l� �rts)ed Nftnt: CHI'S RE$IDF'ICE :'Ir^,jW A41drom 10181 fiIRE AVENUE �re;$d C.brstt ii0lt MW 3,.528SF TWO STORIES HOUSE SECTION I —DEMN VERIFICATMN i Colrlp"of km d Owbm,—'L'fOW v rnk;10on'WW subrnh tht CWWWW dwdcbt(C0lumv 1 w4 2)wNh tdt oie ns and 0AW4 pwnd appkxjbm b tNt Bugling Dgadmor t. "n c w1ar tea demo rwomm"rttp"bk for oompwm we c&Kw to fStt ww*have named va pmns ane �rs�ry tAtt�11tn�t d+ttAttd aeovs to ht�rtby tnoorpOtaAtd hlo Ma projtOR plant at►a wf�ba fnnpMtrtwMtd Y+laO tttb orc�vot to sawdom wth on P*Wn wft w forth in Ow 3044 Cwt Gnan&Aft UwWsrft 000 M acoow by ow Chyy d cuoulne. www-.or's&We%" Dols :-AN LI CH83�t Rdmow%swamm Ddb FF-MK LIMN HO 5.27.2013 4+p, d#1eMrto ntptnbbtal for 0orrlpiitnct Ddb FRANK LnM NO 408.892 .5020 ,Na-*of Loans+P+aftttWW nbspbnsfkt far Catlram com0l&mw(Pleb►P" Phorlb F RANKLWDYABOO.C. M Sm of Addron Mr Probodonal nbpord bbl br Co)Sr w+affirm SECTION 2—VWLEMENTATION VERIFICATION ttcsp�bthe��plcontr Bu anw,llp��bftwr wlsh tap ori�rri s!p>aturaa an N oes naw+nspwytd tf It wwh and hwAt raotlwbyd auft t aoawntngrtton t0 vwlfy and that the pmj d ldaraWill abvw wet wftuftd in aomftva wlh t a Qmm Bul ft Chsd tt Intl kr a+000+drmicb wOh the ntquintntnb of t?re 20JO CarlbM t 0nr n 0 BttnO r t"Mopltd by Me Cllr d Cuptrt a. � 6 Zvi 89reim d Lkwm Prdno66 a+bfblb for c4ofw tram bow tsdb �M Mms of 1, '1M probastrad m pOr ,"for coo"to awnpkm P% M Prim Plrbr» i t"EmeW AWr"aM 'w CSOMM MrOWWO A4.2 .� 4,201,1 Low-rise residential buildings shall meet or exceed the minimum ! standard design required by the Catifomia Energy Standards. WATERi CONSERVATION indoor Wtelr`Use 4.303.1 indoor water use shalt be reduced by at least 20 percent using one of the follow methods. ❑ Water saving fixtures or flow restnctrNs shalt be used per Table 4.303.2 As of 7101/2011 ❑ 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)shaft comply with specified performance requirements. As of 7101/2011 t Outdoor Water Use 4.304.1 Automatic irrigation systems installed at the time of final inspection shall be weather-based. A4.4 MATERIAL CONSERVATION AND RESOURCE EFFICIENCY ,4 Enhanced,i5urab111ty and Reduced Maintenance 4ANA Joints and openings.Annular spaces around pipes,electric cables, conduits,or other openings in plates at exterior waft 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 TM 4.408.2 Where a local jurisdiction does not have a construction and demolition waste management ordinance,a construction waste management plan shall be submitted for approval to the enforcing agency. i Building Maintenance and Operation 4.410.1 An operation and maintenance manual shall be provided to the Ph building occupant or owner. (J� rx° • �kpf Sg. y!{3 yY L f A5 it 14 r k 3 d 2040 CALGiREEN RESIDENTIAL CHECKLIST— ar MANDATORY ITEMS COiWA Nn Y DML'OPMlW 0a A n ENT-BUlLOINw3 DIVISION CUP# INO I ALBERT ULVA "!R.PAL,CBA.,B%AU)IW OFFICAL I OM TORRE AVM*•C11PEWfW,CA OWIA-32M � (408)7774=-FAX t4o 777 $8,1 ¢n, Time 2010 C40w Code oppk%to all rnvey WWhMW hotf*rt" b*V houses,dweNW, k dormitoriec wxWNrdurne,atm,eta Meidsnon,WnWoyse houeft,fadwy-built hataft and other tAm of swelkr4p W h a«aq*V soo>7mmodatlon and row accessory butldkV*noodalW with such :..' uses. ExhbV aft and len impr+oasrrrarrta that ars not othruwiss dftebod are not etrbjsot to the roqultsmenis of CALGreert, pig o CHEM'S RESIDENCE ' Projsrtt Addrgs 10181 EMPIRE AVENUE { . NEW 3,6283F TWO STORIES HOME lnaouotiow�. 1. The Owrw or the hr's spent"I employ a il'Irereaed prai colonel soarlencsd wkh On 2010 Catlfterniie Green Buldrig 8buiderds Coda to ve*and 88;X9 VW all rbgukW work ftewbed hetet is proper peened awl titaad in tttie p 2. The 3csnsed profeeelorial,In oot*bon*ion wBh the owner and to design prohniona l shall bW Column 2 of ft cho*Ist,&Vn and data Season i -Destpn V"eWlestion at the and of ttrtt Ott and have the dw4dd printed on the oppwed pier»for the project, 3. Prior to inal bapecklm by the BUWbV Departrleertt,the li on erd final el�a I oompleee Column 3 and so and dabs Section 2-tmpkawift4on Vein at the end of 8ds ahe*JW end submit the completed'torm to the Buldrq Iretpewltar. ,R Column 3 1 +C unm 3 MANDATORY FEATURE OR MEAStM I Prol"'t vorMlcatton Al 4.1"1 A oft plan vW inventory Y ttw aft is Jov*W ed and motto ndnWfto tae dteurbertot In order pnaarw des hate eadadrwp natural reeowsn and minwinfe Alun atwom eftol *(,Via pmp000d struchn. Pietelllnp aru!tAsstl2n•i1Da i3eveNrarprrarat 4.106.2 A plan Is deaebW end implamao d w menage storm water is dr~durS aWMWUCW. + 4.104.3 The ate 001 be pleMed and devetag�W to keep tea%M water sway *an buBdin ,Conelruficn plant fish indicate now ske Dnp or a dt hwas ® a system WIN mWApar an surbae wow flows. Pace 1 agff'f Astra 3A1la,darrv�seai��7�1, t A j A4,5 ENVIRONMENTAL Flrep#acss 4.503 1 t only a direct-vent sealed-combustion gas or sealed wood- © V bum- e,or a sealed woodstove Potlutud Control 4.504.1 openings and other related air distribution component openings a shall to covered during construction. 4.504.2.1 Adhesives,sealants and caulks shall be compliant with VOC and ® fbf other to»compound limits.. rQ►I 4.504.2.2 Paints, stains and other coatings shall be compliant with VOC f rnits. 1 4.504.2.3 Aerosol paints and other coatings shall be compliant with product weightec MIR Limits for ROC and other toxic compounds i 4.504.2,4 Documentation shall be provided tc verify that compliant VOC limit finis)rlaterials have been used. 4.504.3 Carpet and carpet systems shall be compliant with VOC limits Q 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(CHIPS)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 emission standards. Interior Moisture Control 4.505.2 Vapor retarder and capillary break is installed at slab on grade fount ations. 4.505.3 Moisture content of building materials used in wall and floor framing is checked before enclosure. L� Page 3 of 5 lCirPeH 201044x•revised Ox T!! B �1 S Indoor Air quality and Exhaust 4.508.1 Exhaust fans which terminate oufsidls the building are provided in ® k > every bathroom. .. Environmental Comfort 4.507.1 Whole house exhaust fans shah have insulated louvers or covers ~ which close when the fan is off.Covers or lowers shall have a minimum ® ; insulation value of R-2. 4.507.2,Dud systems are sized and designed and equipment is selected using the following methods: �, �%v ` I? to X 1, Establish heat loss and heat gain values according to ACCA Manual J or equivalent. ' 2. Size duct systems according to ACCA 2"(Manual b)or equivalent, 3. Select heating and cooling equipment socording to ACCA 36-S(Manual S) s i or equivalent. INSTALLER AND •E w QUALIFICATIONS Dualifleations 702.1 HVAC system installers are trained and certified in the proper installation ® ,; of HVAC systems. '� ds 702.2 The Licensed Professional responsible to verify CALGreen compliance rVL is qualified and able to demonstrate competence in the disapline they inspect and verify, :; Verificatioria _ �_ 703.1 Verification of compliance with CALGreen may include construction 's documents,plans,specifications,builder or installer certification,inspection ? reports,or other methods acceptable to the enforcing agency which show F substantial conformance.Implementation vernccation shah be submitted to the Building Department after implementation of all required measures and prior to final inspection approval. Page 4 of 5 �. �� ('alGrarR IOl o,dac rrviaed al 74 1 UTILITY RELEASE REQUEST FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(a�cupertino.org PURPOSE For residential single family or duplex construction, there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign-off of the building. INSTRUCTIONS 1. Download this form at: http://www.Cupertino.orgy/inclex.aspx`:?pagc=297. 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3. Fax, E-Mail, Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Form 408-777-3228 office 10300 Torre Ave. 408-777-3333 fax Cupertino, CA 95014 buildl])L'(i uucrtin0.0r'2 4. Schedule a Gas Meter Release inspection (#403)and/or Electric Meter Release inspection (#404). Please note, a Gas Test inspection (#506) is required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information): APN all [/ , 9 BLDG PERMIT#: d 24 Z DATE: SITE �` ADDRESS: Cola'/ -6kL re .4-ve QQ OWNER'S NAME: nl�Cr G t FADE FAX MAILING ADDRESS (if different from site address): to&/ CONTRACTOR: / PHONE#: Q l oculi c!! uct FAX#: 4403 CONTACT: L � PHONE#: 5 etc le C,LL1e%'4 FAX#: I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of the building cannot move into the residence until they receive all of the required final sign-offs and the City has issued a certificate of occupancy for the building. Owner:.................... .... . ......................................................Print:........ ,. ..' a n.........................Date:....f... . ... ..X. Contractor:............ .. .............. Print:....... .. e..� .......................Date:...1 -2-4. . (. UtilityReleaseForm_2011.doc revised 08109/11 '3' e-'S- 02l ' - STATE OF CALIFORNIA FILIJ RESIDENTIAL LIGHTING CEC-CF-6R-LTG-01 Revised 08109 4�— CALIFORNIA ENERGY COMMISSION INSTALLATION CERTIFICATE CF-6R-LTG01 Residential Lighting (Page 1 of 6 Site Addres : Enforcement Agency: Permit Number: F © / ✓ /tr fq ✓ 1:301-024 1.Kitchen Lighting Does project include kitchen lighting? Pq Yes,complete section 1 ❑No,go on to section 2 ❑Yes §150(k)3:The wattage of permanently installed luminaires(lighting fixtures has been determined as specified by§130(d). ❑Yes ❑No §150(k)3:In the kitchen,are there electrical boxes finished with a blank cover or where no electrical equipment has been installed,and where the electrical box can he used for a luminaire or a surface mounted ceiling fan?If yes,the following row must also be es: ❑Yes ❑NA Wattage has been calculated as ISO watts of low efficacy lighting r blank electrical box. §150(k)S Kitchen Lighting must comply with either method (a),(b),or(c)below: (a)All high efficacy luminaires FW—yes,complies because only high efficacy luminaires have been installed in the kitchen. ❑ No,complies with method b or(c). (b)>50%watts used by high efficacy luminaires Yes,complies because at least 50016 of the installed watts are from permanently installed high efficacy luminaires as demonstrated in the table below:Total A>Total B. ❑ No,complies with method(a)or(c). Fill out the following table if complying with either method(b)or(c). Table b Efficacy Luminaire Type Hio Low Watts x Quantity = High Efficacy Watts or Low Efficacy.Watts LD ❑ x = or ❑ ❑ x = or ❑ Cl x = or ❑ ❑ x = or ❑ Cl x = or Complies with method(b)if A>B Total: A: > B: (c)Additional Kitchen Low Efficacy Lighting ❑ Yes,complies because the kitchen lighting qualifies for additional low efficacy lighting and as demonstrated in table in b above and the table in c below that A+C)>B ❑ No,complies with method a or(b). Additional kitchen low efficacy lighting is available on if all of the following are true: ❑ Yes. All low efficacy luminaires in the kitchen are controlled by a vacancy sensor Dimmer energy management control system EMCS or a multi-scene programmable controls stem. ❑ Yes. Permanently installed luminaires in garages laundry rooms closets greater than 70 square feet and utility rooms are high efficacy luminaires AND are controlled by a vacancy sensor. Table c Use 50 W for dwelling units<2,500 f 2 From the Table in b Use 100 W for dwelling units>2,500 flz Add Yes/No? A B C A+C is(A+C)>B? 2.Lighting Internal to Cabinets Does project includes lighting internal to cabinets? 2008 Residential Compliance Forms August 2009 STATE OF CALIFORNIA RESIDENTIAL LIGHTING x CEC-CF-6R-LTG-01 Revised 081091 CALIFORNIA ENERGY COMMISSION INSTALLATION CERTIFICATE CF-6R-LTG-01 Residential Lighting (Page 2 of 6 Site Address: Enforcement Agency: Permit Number: 'we D ❑Yes complete section 2 ❑No,go on to section 3 ❑Yes,§150(k)9-Permanently installed lighting internal to cabinets uses<20 watts of power per linear foot of illuminated cabinet. 2008 Residential Compliance Forms Augn-,t 9009 STATE OF CALIFORNIA RESIDENTIAL LIGHTING =j CEC-CF-6R-LTG-01 Revised 08/09 CALIFORNIA ENERGY COMMISSION INSTALLATION CERTIFICATE CF-6R-LTG-01 Residential Lighting (Page 3 of b Site Address: Enforcement Agency: Permit Number: 3.Installed Devices and Components Have Been Certified to the Energy Commission Does the project include any of the devices or components listed below?❑Yes,complete section 3 ❑No,go on to section 4 ❑ Yes §119 and§150(k)7(F):Any of the following devices and components which have been installed have been certified to the Energy Commission according to the applicable provisions of§119:All LED lighting systems that are classified as high efficacy,ballasts used in recessed luminaires, vacancy sensors automatic off/manual on occupant sensors),dimmers,track lighting integral current limiters,and outdoor motion sensors. 4.Lighting Controls Complete section 4 ( Yes ❑ NA §150(k)7A:Permanently installed low efficacy luminaires are controlled by switches separate from those controlling high efficacy luminaires. ❑ Yes ❑ NA §150(k)7B:Exhaust fans with integral lighting systems are switched separately from lighting systems,OR have a lighting system that can be manually turned on and off while allowing the fan to continue to operate for an extended period of time. ❑ Yes ❑ NA §150(k)7C:All permanently installed luminaires are switched with readily accessible controls that permit the luminaires to be manually switched on and off. ❑ Yes ❑ NA §150(k)7D:All lighting controls have been installed in accordance with the manufacturer's instructions. ❑ Yes ❑ NA §150(k)M All lighting circuits that are controlled by more than one switch,where a dimmer or vacancy sensor has been installed to comply with§150(k),no controls bypass the dimmer or vacancy sensor functions. 5.Luminaires(Lighting Fixtures) Does the proiect include the installation of any luminaires indoor or outdoor)? Yes,complete section 5 ❑No,go on to section 6 Yes,high efficacy luminaire classification has been determined according to§150(k)l,and low efficacy luminaire classification has been determined according to§150(k)2. ❑ Yes ❑ NA §150(k)4:Fluorescent lamps rated 13 watts or greater have an electronic ballasts having an output frequency no less than 20 kHz. ❑ Yes ❑ NA §150(k)5:Permanently installed night lights,and night lights integral to permanently installed luminaires or exhaust fans, contain only high efficacy lamps meeting the minimum efficacies contained in Table 150-C and do not contain a line-voltage socket or line voltage lamp holder,OR the night light is rated to consume no more than 5 watts of power and does not contain a medium screw-base socket. ❑ Yes ❑ NA §150(k)6: Lighting integral to exhaust fans,in rooms other than kitchens,meet the applicable requirements of§150(k). ❑ Yes ❑ NA Any electrical box finished with a blank cover or where no electrical equipment has been installed,and where the electrical box can be used for a luminaire or a surface mounted ceiling fan,has been treated as low efficacy luminaires for compliance with§150(k). Does the project include any luminaires that are recessed into insulated ceilings? Yes,complete the rest of section 5 ❑No,go on to section 6 ❑ Yes,§150(k)12: Luminaires that are recessed into insulated ceilings meet all of the following conditions: ❑ Yes,are listed,as defined in§101,for zero clearance insulation contact(1C)by UL or other nationally recognized testing/rating laboratory,and ❑ Yes,have labels that certify the luminaires are airtight with air leakage less than 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283(Exhaust fan housings are not required to be certified airtight),and ❑ Yes,are sealed with a gasket or caulk between luminaire housings and the ceiling,and all air leak paths between conditioned and unconditioned spaces have been sealed with a gasket or caulk.(including all exhaust fan housings),and ❑ Yes,allows ballast maintenance and replacement to be readily accessible to building occupants from below the ceiling without requiring the cutting of holes in the ceiling. 6.Indoor Lighting(any indoor room that is not a kitchen) Does the project include permanently installed luminaires in any room that is not a kitchen? ❑Yes,complete section 6 ❑No,go on to section 7 ❑ Yes ❑ NA §150(k)10:Permanently installed luminaires in bathrooms,garages,laundry rooms,closets>70 ftz,and utility rooms are high efficacy luminaires OR are controlled by a vacancy sensor. 2008 Residential Compliance Forms August 2009 STATE OF CALIFORNIA RESIDENTIAL LIGHTING CEC-CF-6R-LTG-0t Revised=09 CALIFORNIA ENERGY COMMISSION INSTALLATION CERTIFICATE CF-6R-LTG01 Residential Lighting (Page 4 of 6 Site Address: Enforcement Agency: Permit Number: 4v❑ Yes ❑ NA §150(k)11:Permanently installed luminaires located in rooms or areas other than in kitchens,bathrooms,garages,laundry rooms,closets,and utility rooms are high efficacy luminaires,OR are controlled by a dimmer switch OR are controlled by a vacancy sensor. 2008 Residential Compliance Forms August 2009 STATE OF CALIFORNIA RESIDENTIAL LIGHTING ; CEC-CF-6R-LTG-01 Revised 08/09 CALIFORNIA ENERGY COMMISSION INSTALLATION CERTIFICATE CF-6R-LTG-01 Residential Lighting (Page 5 of 6 Site Address: Enforcement Agency: Permit Number: 7.Outdoor Lighting Does the project include any permanentlyinstalled outdoor lighting? Yes,complete section 7 ❑No,go on to section 8 ❑ Yes ❑ NA §150(k)13:Luminaires providing outdoor lighting,including outdoor lighting for private patios on low-rise residential buildings with four or more dwelling units,entrances,balconies,and porches,and which are permanently mounted to a residential building or to other buildings on the same lot are high efficacy luminaires OR are controlled by a manual on/off switch,plus a motion sensor not having an override or bypass switch that disables the motion sensor,plus one of the following three additional control methods: a. A photocontrol that does not have an override or bypass switch that disables the photocontrol;or b. An astronomical time clock not having an override or bypass switch that disables the astronomical time clock; or C. Energy management controls systems(EMCS)not having an override or bypass switch that allows the luminaire to be always on. ❑ Yes ❑ NA Exception 2: Low efficacy outdoor luminaires used to comply with Exception I to§150(k)13 are controlled by an override switch which temporarily bypasses the motion sensing function,and the motion sensor is automatically reactivated within six hours.The luminaire is controlled by a photocontrol,astronomical time clock,or EMCS as required by Exception 1 to §150(k)13. ❑ Yes ❑ NA Exception 3: There are permanently installed luminaires in or around swimming pools,water features,or other locations subject to Article 680 of the California Electric Code which do not need to be high efficacy luminaires. ❑ Yes❑NA §150(k)14: Internally illuminated address signs comply with§148,OR do not contain a screw-base socket and consume no more than 5 watts of power as determined according to§130(d). ❑Yes ❑NA §150(k)15 Lighting for parking lots and carports with a total of 8 or more vehicles per site have lighting that complies with §130,132, 134, and 147.Lighting for parking garages for 8 or more vehicles comply with§130, 131, 134,and 146. If yes,the Nonresidential compliance forms must be submitted 8.Common areas of low-rise residential buildings Does the project include the installation of any luminaires in common areas of low-rise residential buildings? ❑Yes,complete section 8 ❑No,go on to section 9 ❑ Yes,§150(k)16: Permanently installed lighting in the enclosed,non-dwelling spaces of low-rise residential buildings with four or more dwelling units shall be high efficacy luminaires OR are controlled by occupant sensor(s)certified to comply with§119(d). 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. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation)conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-1 R)form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF-1R that apply to the installation have been met. • I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) 2008 Residential Compliance Forms August 2009 STATE OF CAUFORIM RESIDENTIAL LIGHTING 1.�,,: CEC-CF-0R-LTG-01 Revised 08109 CALIFORNIA ENERGY COMMISSION INSTALLATION CERTIFICATE CF-6R-LTG01 Residential Lighting a e 6 of 6 Site Address: Enforcement Agency: Permit Number: l2Res *Lie, fo 2-/?- Responsible ponsible Person's Name: Responsible Person's Signator 0t" OkIeAA CSLB License: Date Signe : Position With Company( e): a3 IV11-15- 6 3 2008 Residential Compliance Forms August 2009 STATE OF CALIFORNIA DOMESTIC HOT WATER (DHW) CEC-CF-6R-MECH-01 Revised 09/08 CAUFORNIA ENERGY COMMISSION INSTALLATION CERTIFICATE CF-6R-MECH-01 Domestic Hot Water HW (Page 1 of 3 Site Ad_dress: Enforcement Agency: Permit Number: 0 [0 f re ky>- 130 S'-o 2-f2- 1. WATER HEATING SYSTEMS: Distribution Rated CEC Type If #of Input(kw Tank Standby Heater Certified Mfr Name&Model (Std,Point-of- Recirculation, Identical or Volume Efficiency Loss Type Number Use,etc) Control Type Systems Btulhr)� (gallons) (EF,RE)t low 5aum - �(,(-�� -moo ! Note 1:For small gas storage(rated input less than or equal to 75,000 Btulhr), electric resistance and heat punW water heaters,list Energy Factor(EF).For large gas storage water heaters(rated input ofgreater than 75,000 Btu/hr), list Recovery Efficiency(RE), Thermal Efficiency,Standby Loss and Rated Input. For instantaneous gas water heaters, list the Thermal Efficiency and Rated Input. 2. Mandatory Measures TO COMPLY-ALL BOXES MUST BE CHECKED ❑ §110-§113: Water heaters,showerhead and faucets are certified by the California Energy Commission. §1500):Water System Pipe and Tank Insulation.And Cooling Line Insulation 1. Storage tank insulation A. Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are externally wrapped with insulation having an installed thermal resistance of R-12 or greater;and ❑ B. Unfired storage tanks or other indirect hot water tanks have R-12 external insulation or R-16 internal insulation where the internal insulation R-value is indicated on the exterior of the tank. 2. Water piping and cooling system line insulation thickness and conductivity ❑ First 5 feet of hot and cold water pipes closest to water heater tank,non-recirculating systems,and entire length of recirculating sections of hot water pipes are insulated per Standards Table 150-13;and ❑ Pipe insulation for steam hydronic heating systems or hot water systems>15 psi,meets the requirements of Standards Table 123-A. ❑ Insulation is protected from damage,including that due to sunlight,moisture,equipment maintenance,and wind. 2008 Residential Compliance Forms August 2009 STATE OF CALIFORNIA DOMESTIC HOT WATER (DHW) >, r CEC-CF-6R-MECH-01 Revised 08108 CALIFORNIA ENERGY COMMISSION INSTALLATION CERTIFICATE CF-6R-MECH-01 Domestic Hot Water HW e 2 of 3 Site Address: Enforcement Agency: Permit Number: ❑ §151(f)8D:If indicated on the CF-IR,all hot water piping that runs from the hot water source to the kitchen fixtures is insulated per Standards Table 150-13. 3. Central Water Heating in Buildings with Multiple Dwelling Units(required for prescriptive) TO COMPLY-ALL BOXES MUST BE CHECKED All hot water piping in main circulating loop is insulated to requirements of§1500) IS Central hot water systems serving six or fewer dwelling units which have(1)less than 25'of distribution piping outdoors;(2)zero distribution piping underground;(3)no recirculation pump;and(4)insulation on distribution piping that meets the requirements of Section 1500) Central hot water systems serving more than 6 dwelling units-presence of either a time control or a time/temperature control DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-IR)form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF-JR that apply to the installation have been met. • 1 will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. 1 understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. 2008 Residential Compliance Forms August 2009 STATE OF CALIFORNIA DOMESTIC HOT WATER (DHW) CEC-CF-6R-MECH-01 Revised M09 CALIFORNIA ENERGY COMMISSION INSTALLATION CERTIFICATE CF-6R-MECH-01 Domestic Hot Water HW (Page 3 of 3 Site Address: ` Enforcement Agency: Permit Number: E 1 �e kve, Company Name: (In ling Subcontractor or General Contractor or Builder/Owner) q Ldvi1 U(= Cmat yolct(6 Responsible Person's Name: �� Responsible Person's Signature: 7 17�c+ (-c CSLB License: Date Signed: Position With Company(Title): 6C 2008 Residential Compliance Forms August 2009