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14090148CITY OF CUPERTINO BUILDING PERMIT BU LDING ADDRESS: CONTRACTOR:. PERMIT NO: 14090148 10159 S BLANEY AVE (369 03 008) BYLDAN CORP 412 OLIVE AVE PALO ALTO, CA 94306 OWNER'S NAME: LAKE BILTMORE APARTMENTS DATE ISSUED: 05/05/2015 OWNER'S PHONE: (408) 255-8787 PHONE NO: 650-322-7069 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CONTRACTOR - GENERAL Lic. #Z10-42_BLDG Contractor BYLDAN CORP Date 03/31/2016 _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH _ RESIDENTIAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: TCO GOOD THRU 9/29/2016 I hereby affirm under penalty of perjury one of the following two declarations: CONSTRUCT TWO STORY CLUBHOUSE WITH FITNESS CENTER 1. I have and will maintain a certificate of consent to self -insure for Worker's (1107 SQ FT); CLUBROOM/KITCHEN (1845 SQ FT); Compensation, as provided for by Section 3700 of the Labor Code, for the LEASING OFFICE (1797 SQ FT); (7) STUDIO UNITS performance of the work for which this permit is issued, 'I have and will maintain Worker's Compensation Insurance, as provided for by (UNIT 1F - 791 SQ FT)/(lA - 807 SQ FT)/(lB - 793 REV Section 3700 of the Labor Code, for the performance of the work for which this SQ FT)/(1B1 -.783 SQ FT)/(1C - 754 SQ FT)/(1D permit is issued. 754 SQ FT)/(IE - 810 SQ FT), CONSTRUCT POOL APPLICANT CERTIFICATION HOUSE/STORAGE (281 SQ FT) WITH TRELLIS (280 SQ certify that I have read this application and state that the above FT); REMODEL POOL DECK AREA AND CONSTRUCT NEW SPA information is correct. I agree to comply with all city and county ordinances (100 SQ FT); INSTALL NEW PLAY STRUCTURE. and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for REV #6 - GROUND FLOOR EXITING - ISSUED 10/13/2016 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, REV #5 -CHANGE GRATE ON ROOF TO GUARD RAIL- ISSUED Additionally, the applicant understands and will comply with all non -point 8/23/16 source regulations per the Cupertino Municipal Code, Section 9.18. DEF #2 - (8/12/16) TRUSS CALCS FOR CARPORT(S) - ISSUED 8/23/16 Signaturedg& Date 10/13/2016 REV # 3 - REVISE STRUCTURAL, MEP'S & LANDSCAPE -ISSUED 1/22/16 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the REV #4 -STEEL STAIR CHANGE -ISSUED 7/7/16 following two reasons: 1. 1, as owner of the property, or my employees with wages as their sole DEF # 1 - TRUSS CALC'S - ISSUED 9/8/15 compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) REV #2 -REVISE NORTH SIDE OF DRIVE AISLE TO ADD 2. 1, as owner of the property, am exclusively contracting with licensed CURB TO SIDEWALK -ISSUED 6/30/15 contractors to construct the project(Sec.7044, Business & Professions Code). REV # 1 -CHANGE (E) NORTHWEST WALL I hereby affirm under penalty of perjury one of the following three declarations: WINDOW FROM 2 WINDOWS TO 8 WINDOWS, ISSUED 1. I have and will maintain a Certificate of Consent to self -insure for Worker's 5/27/15. Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. 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. Sq. Ft Floor Area: Valuation: $2940000.00 s. 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, I become subject to the Worker's Compensation provisions of the APN Number: Occupancy Type: Labor Code, I must forthwith comply with such provisions or this permit shall 36903 008 be deemed revoked. APPLICANT CERTIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED certify that I have read this application and state that the above information is WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: ABBY AYENDE consequence of the granting of this permit. Additionally, the applicant understands Date: 05/05/2015 and will comply with all non -point source regulations per the Cupertino Municipal - Code, Section 9.18. RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature Date 10/13/2016 installed without first obtaining an inspection, I agree to remove all new materials for inspection. ture of Applicant: ' 10/13/2016 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 10/13/2016 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 understand my plans shall be used as public records. Licensed -= CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14090148 10159 S BLANEYAVE (369 03 008) 412 OLIVE AVE PALO ALTO, CA 94306 OWNER'S NAME: L BILTMORE APARTMENTS DATE ISSUED: 05/05/2015 OWNER'S PHONE: 65045-9394 PHONE NO: 650-322-7069 LICENSED CONTRA 7OR'S DECLARATIONBUILDING PERMIT INFO; License Class B Lic. #:719142 Contractor Date 1 2016 —BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL I hereby affirm that I a licensed under the provisions of Chapter 9 (commencing _ _ _ with Section 7000) of Di 'sion 3 of the Business & Professions Code and that my license is in full force an effect. JOB DESCRIPTION: CONSTRUCT TWO STORY CLUBHOUSE WITH FITNESS CENTER I hereby affirm under penalty of perjury one of the following two declarations: (1107 SQ FT); CLUBROOM/KITCHEN (1845 SQ FT); 1. I have and will maintain a certificate of consent to self -insure for Worker's LEASING OFFICE (1797 SQ FT); (7) STUDIO UNITS Compensation as provided for by Section 3700 of the Labor Code, for the (UNIT 1F - 791 SQ FT)/(IA- 807 SQ FT)/(1B - 793 ie�rmance o the work for which this permit is issued. SQ FT)/(1B1 - 783 SQ FT)/(1C - 754 SQ FT)/(1D - %I have and will maintain Worker's Compensation Insurance, as provided for by 754 SQ FT)/(lE - 810 SQ FT). CONSTRUCT POOL Section 3700 of the Labor Code, for the performance of the work for which this HOUSE/STORAGE (281 SQ FT) WITH TRELLIS (280 SQ permit is issued. FT); REMODEL POOL DECK AREA AND CONSTRUCT NEW SPA APPLICANT CERTIFICATION (100 SQ FT); INSTALL NEW PLAY STRUCTURE. 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 REV #5 - CHANGE GRATE ON ROOF TO GUARD RAIL- ISSUED and state laws relating to building construction, and hereby authorize 8/23/16 representatives of this city to enter upon the above mentioned property for inspection purposes. e) agree to save indemnify and keep harmless the - : DEF #2 - (8/12/16) TRUSS CALCS FOR CARPORT(S) - ISSUED 8/23/16 City of Cupertino again t liabilities, judgments, costs, and expenses which may accrue against saii Additionally, the applicant City in consequence of the granting of this permit. understands and will comply with all non -point REV # 3 -REVISE STRUCTURAL, MEP'S & source regulations pe the Cupertino Municipal Code, Section 9.18. LANDSCAPE -ISSUED 1/22/16 _ REV #4 - STEEL STAIR CHANGE - ISSUED 7/7/16 Signature : -� Date 08/23/2016 t: DEF # i - TRUSS CALC'S - ISSUED 9/8/15 OWNER -BUILDER DECLARATION exempt from the Contractor's License Law for one of the REV #2 -REVISE NORTH SIDE OF DRIVE AISLE TO ADD I hereby affirm that I a following two reasons: CURB TO SIDEWALK -ISSUED 6/30/15 1. 1, as owner ofihe property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for REV # 1 - CHANGE (E) NORTHWEST WALL sale (Sec.7044 Business & Professions Code) WINDOW FROM 2 WINDOWS TO 8 WINDOWS. ISSUED 2. I, as owner of; he property, am exclusively contracting with licensed 5/27/15. contractors to Ivonstruct the project (Sec.7044, Business & Professions Code). I hereby affirm under p�nalty of perjury one of the following three declarations: 1. I have and wi maintain a Certificate of Consent to self -insure for Worker's Compensahon� as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $2940000.00 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by - Section 3700 cif the Labor Code, for the performance of the work for which this permit is issued. APN Number: Occupancy Type; a. 1 certify that in the performance of the work for which this permit is issued, I 369 03 008 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 PERMIT EXPIRES IF WORK IS NOT STARTED 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR be deemed re oked. 180 DAYS FTION. I certify that I have rea( APPLICANT CERTIFICATION this application and state that the above information is b correct. I agree to comply with all city and county ordinances and state laws sued Date: 05/05/2015 23 b relating to building construction, and hereby authorize representatives of this city to enter upon the abov mentioned property for inspection purposes. (We) agree to save indemnify andeep harmless the City of Cupertino against liabilities, RE -ROOFS: judgments, costs, and xpenses which may accrue against said City in All roofs shall be inspected prior to any roofing material being installed. If a roof is consequence of the gr�nting of this permit. Additionally, the applicant understands installed without first obtaining an inspection, I agree to remove all new materials for and will comply with all non -point source regulations per the Cupertino Municipal inspection. Code, Section 9.18. Signature of Applicant: Signature Date 08/23/2016 Date: 08/23/2016 ALL ROOF COVERINGS TO BE CLASS "A" OR HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 255339 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sectlon5r25505,25533 Z— Owner and 25534. or authorized agent'' c Date: 08/23/2016 ` 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 understand my plans shall be used as public records. Licensed CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 !CUPERTIN (408) 777-3228 FAX (408) 777-3333 • buildin cu ino.or ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION 4EFtRRED ORIGINAL PERMIT 9 �J PROJECT ADDRESS >( STREETADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHO STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑. O TER-BDHDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER '❑ TENANT CONTRACTOR N LICENSE NUMBER LICEJT E TYPE BUS. LIC # I/� COMPANY NAME s E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEE NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK e ,i-f,P1- USE I CO; USE I TYPE I OCC. I SQ.FT. I VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELAREA PORCH AREA I DEgK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: ❑ DETACH ❑ ATTACH #DWELLING UNITS:IS A SECOND UNIT ❑YES SECOND STORY ❑ YES BEING ADDED? FIND ADDITION? [-]NO PRE -APPLICATION ❑ $ES IF YES, PROVIDE COPY OF IS THE BLDG AN L VALUATION: PLANNING ADPL# ❑ATO PLANNING APPROVAL LETTER EICHLER HOME? x ;; By my signature below, I certify to each of the following: I am the property owner or authorized ,ent to a the property owner's behalf I have read this application and the information I have provided is correct. I have read the Description of Vork aftd-ve-nTy it is accurate. I agree to comply with all applicable local ordinances and state aws relating to b,u lldd�g cons on. I authorize representatives of Cupertino to enter the above-iidennt fled property for inspection purposes. Signature of Applic it/Agent: /1�L1� 0 � �{rJ Date �O / / 2-// SUPLEMENTAL INFORMATION 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. _ Commercial E ldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. —Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Buildi g Permit application. BIdgApp_2011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS CONTRACTOR: PERMIT NO: 14090148 10159 S BLANEYAVE 369 03 008) 412 OLIVE AVE PALO ALTO, CA 94306 OWNER'S NAME: L BILTMORE APARTMENTS DATE ISSUED: 05/05/2015 OWNER'S PHONE: 650-245-9394 PHONE NO: 650-322-7069 LICENSED CONTRACTOR' D A ATION BUILDING PERMIT INFO: License Class -a Lie. #h1 142 Contractor Date 1 2016 —BLDG _ELECT _PLUMB I hereby affirm that I a licensed under the provisions of Chapter 9 (commencing — MECH _ RESIDENTIAL — COMMERCIAL with Section 7000) of DiiAsion 3 of the Business & Professions Code and that my license is in full force an effect. JOB DESCRIPTION: I hereby affirmmeunndder penalty of perjury one of the following two declarations: CONSTRUCT TWO STORY CLUBHOUSE WITH FITNESS CENTER (1107 SQ FT); CLUBROOM/KITCHEN (1845 SQ FT); 1. 1 will maintain a certificate of consent to self-insure for Worker's LEASING OFFICE (1797 SQ FT); (7) STUDIO UNITS Compensatio I as provided for by Section 3700 of the Labor Code, for the (UNIT 1F - 791 SQ FT)/(lA - 807 SQ FT)/(1B - 793 erformance the work for which this permit is issued. SQ FT)/(1B1 - 783 SQ FT)/(1C - 754 SQ FT)/(1D - -"I have and wi maintain Worker's Compensation Insurance, as provided for by 754 SQ FT)/(IE - 810 SQ FT). CONSTRUCT POOL Section 3700 Of the Labor Code, for the performance of the work for which this HOUSE/STORAGE (281 SQ FT) WITH TRELLIS (280 SQ permit is issued. FT); REMODEL POOL DECK AREAAND CONSTRUCT NEW SPA APPLICANT CERTIFICATION (100 SQ FT); INSTALL NEW PLAY STRUCTURE. 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 - REV #5 - CHANGE GRATE ON ROOF TO GUARD RAIL- ISSUED and state laws relating o building construction, and hereby authorize 8/23/16 representatives of this city to enter upon the above mentioned property for inspection purposes, e) agree to save indemnify and keep harmless the City of Cupertino again t liabilities, judgments, costs, and expenses which DEF #2 - (8/12/16) TRUSS CALCS FOR CARPORT(S) = ISSUED 8/23/16 may accrue against sai J City in consequence of the granting of this permit. Additionally, the applic nt understands and will comply with all non-point REV # 3 -REVISE STRUCTURAL, MEP'S & source regulations per he Cupertino Municipal Code, Section 9.18. LANDSCAPE-ISSUED 1/22/16 Signature's,ii% ( "� Date 08/23/2016 REV #4 - STEEL STAIR CHANGE - ISSUED 7/7/16 DEF # 1 = TRUSS CALC'S - ISSUED 9/8/15 OWNER-BUILDER DFJCLAR ATION I affirm that I am from the Contractor's License Law for one of the REV #2-REVISE NORTH SIDE OF DRIVE AISLE TO ADD here m following two reasons: CURB TO SIDEWALK-ISSUED 6/30/15 1. I, as owner of he property, or my employees with wages as their sole compensation, lwill do the work, and the structure is not intended or offered for REV # 1 - CHANGE (E) NORTHWEST WALL sale (Sec.7044y Business & Professions Code) WINDOW FROM 2 WINDOWS TO 8 WINDOWS. ISSUED 2. I, as owner of k e property, am exclusively contracting with licensed 5/27/15. contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and ' maintain a Certificate of Consent to self-insure for Worker's Compensationas provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $2940000.00 performance o the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 df the Labor Code, for the performance of the work for which this APN Number: Occupancy Type: permit is issued. 3. I certify that performance of the work for which this permit is issued, l 36903108 mthe shall not empl y 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 b�come subject to the Worker's Compensation provisions of the PERMIT EXPIRES IF WORK IS NOT STARTED Labor Code, I must forthwith comply with such provisions or this permit shall WITHIN 180 DAYS OF PERMIT ISSUANCE OR be deemed rev ked. 180 DAYS FROM LA INSPECTION. APPLICANT CERTIFICATION I certifythat I have read this application and state that the above information is correct. I agree to coml ily with all city and county ordinances and state laws !D!,t!,�0105/2015 �j Z 3 relating to building con truction, 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, RE-ROOFS judgments, costs, and expenses which may accrue against said City in All roofs shall be inspected prior to any roofing material being installed. If a roof is consequence of the granting of this permit. Additionally, the applicant understanfttinstalled without first obtaining an inspection, I agree to remove all newmaterials for and will comply with all inon-point source regulations per the Cupertino Municipal inspection. Code, Section 9.18. Signature of Applicant: Signature Date 08/23/2016 Date: 08/23/2016 ALL ROOF COVERINGS TO BE CLASS "A" 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25 34. Owner or authorized agent:,= Date: 08/23/2016 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'SARCHITECT9S DFCLARATTON I understand my plans shall be used as public records. Licensed Professional 19 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 c� (408) 777-3228 • FAX (408) 777-3333 • building(akupertino.orq o ❑ NEW CONST UCTION ❑ ADDITION ❑ ALTERATION / TI REVISION /DEFERRED OR PROJECT ADDRESS 7N# -kA f OWNER NAME i 1s'-4. PHONE E-MAIL STREET ADDRESS ®�S /-� 61 j J CITY, LZP --7' CONTACT NAME I� < </ _ {�r-�--- PHONE STREET ADDRESS CITY, STATE, ZIP 0 OWNER ❑ OWNER -BUILDER ❑. OWNERAGENT 0 CONTRACTOR CONTRACTOR NAME C /amu C s eau. LICENSL COMPANY NAME [ (� E STREET ADDRESS NAME COMPANYNAME STREET ADDRESS DESCRIPTION OF'i .. _,. LICENSE NUMBER E-MAIL CITY, STATE, ZIP k FAX W S FAX ENT ❑ ARCHITECT E ENGINEER 0 DEVELOPER 0 TENANT LICENSTYPE BUS. LIC # J�J FAX PHONE BUS. LIC # FAX PHONE USE TYPE I OCC. SQ.FT. I VALUATION ($) ERISTG I NEW FLOOR DEMO TOTAL AREA I .AREA AREA NET AREA q BATHROOM KITCHEN OTHER REMODEL.AREA. REMODEL AREA REMODEL AREA PORCH AREA DEC AREA TOTAL DECKIPORCH AREA GARAGE AREA: LJDETACH Q ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY El YES BEING ADDED? ONO ADDITION? ❑ NO PRE -APPLICATION [] PLANNINGAPPL# ❑NO YES IF YES, PROVIDE COPY OF PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? REC gD may". s ve r T ❑NO 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 provi ed 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 1�ws relating to b g co n. I au ize epresentatives of Cupertino to enter the above-ide tilled property for inspection purposes. $� Signature ofApplicadt/Agent: __ %J Date: l SUPPLEMENTAL INFORMATION REQUIRED PLAN`CHECI{TYPE ,' zloUTI Nc.sLIP OVER-THE-COUNTER,❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings:. Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new buil Ing. C`�xPREss , D P�NNINPLANREVIESY Commercial Bldgs: Provide a completed hazardous Materials Disclosure ❑ - STANDARD ; ' � ~ � .0 PABLIC.'WORKS form if an Hazard m s Materials are being used as of this " =" y part project. LARGE i ©. FiRIsDEPT Co ann'.-: Copy of Pl ung Approval Letter or Meeting with Planning prior to ', ❑ SEwERDISTRICT" submittal of Buildin Permit application. MAJOR SANITARY BldgApp_2011.doc revised 06/21/11 _`1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14090148 10159 S BLANEY AVE (369 03 008) CLARUM 412 OLIVE AVE PALO ALTO, CA 94306 OWNER'S NAME: LAKE BILTMORE APARTMENTS DATE ISSUED: 05/05/2015 OWNER'S PHONE: PHONE NO. 650-722-7069 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CONTRACTOR- GENERAL Lic. #36813 Contractor CLARUM Date 03/31120.16 _ BLDG —ELECT _ PLUMB I hereby affirm. that I am licensed under the provisions of Chapter 9 (commencing T COMMERCIAL — MECH — RESIDENIAL — with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONSTRUCT TWO STORY CLUBHOUSE WITH F SS CENTER I hereby affirm under penalty of perjury one of the following two declarations: (1107 SQ FT); CLUBROOM/KITCHEN (1845 SQ Fr,; 1. I have and will maintain a certificate of consent to self -insure for Worker's LEASING OFFICE (1797 SQ FT); (7) STUDIO UNIT Compensation, as provided for by Section 3700 of the Labor Code, for the (UNIT 1F - 791 SQ FT)/(lA - 807 SQ FT)/(1B - 793 performance of the work for which this permit is issued. SQ FT)/(1B1 - 783 SQ FT)/(IC - 754 SQ FT)/(1D - have and will maintain Worker's Compensation Insurance, as provided for by 754 SQ FT)/(IE - 810 SQ FT). CONSTRUCT POOL Section 3700 of the Labor Code, for the performance of the work for which this HOUSE/STORAGE (281 SQ FT) WITH TRELLIS (28 SQ permit is issued. FT); REMODEL POOL DECK AREA AND CONSTR JCT NEW SPA APPLICANT CERTIFICATION (100 SQ FT); INSTALL NEW PLAY STRUCTURE. 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 REV # 3 - REVISE STRUCTURAL, MEP'S & and state laws relating to building construction, and hereby authorize LANDSCAPE -ISSUED 1/22/16 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the REV #4 -STEEL STAIR CHANGE -ISSUED 7/7/16 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 DEF # 1 -TRUSS CALC'S - ISSUED 9/8/15 source regulations per theCupertino Municipal Code, Section 9.18. REV #2 -REVISE NORTH SIDE OF DRIVE AISLE T ADD CURB TO SIDEWALK -ISSUED 6/30/15 Signature v f ate 07/07/2016 5/14/15 - REV # 1 - CHANGE (E) NORTHWEST WALL OWNER-BUILDERDECLARANION WINDOW FROM 2 WINDOWS TO 8 WINDOWS. ISSUED I hereby affirm that I am exempt from the Contractor's License Law for one of the 5/27/15. following two reasons: r. I, as owner of the property, or my employees with wages as their sole REV #5 - CHANGE GRATE ON ROOF TO GUARD I AIL compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Sq. Ft Floor Area: Valuation: $2940000.00 I hereby affirm under penalty of perjury one of the following three declarations: r. 1 have and will maintain a Certificate of Consent to self -insure for Worker's APN Number: Occupancy Type: Compensation, as provided for by Section 3700 of the Labor Code, for the 369 03 008 performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this PERMIT EMPIRES IF WORK ISN T STARTED permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR 3. I certify that in the performance of the work for which this permit is issued, i 180 DAYS FRO CALLED INSPECTION. 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 Issued by: Labor Code, I must forthwith comply with such provisions or this permit shall Date: 05/05/2015 be deemed revoked. APPLICANT CERTIFICATION RE -ROOFS: I certify that I have read this application and state that the above information is All roofs shall be inspected prior to any roofing material be' g installed. If a roof is correct. I agree to comply with all city and county ordinances and state laws installed without first obtaining an inspection, I agree to remo ie all new materials for relating to building construction, and hereby authorize representatives of this city inspection. to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Signature of Applicant: ' judgments, costs, and expenses which may accrue against said City in Date: 07/07/2016 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. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Signature Date 07/07/2016 HAZARDOUS MATERIALS DISCLOS RE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25531, and 25534. I will maintain compliance with the Cupertino Municipal Co le, 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 Cupertino Municipal. Code, Chapter 9.12 and the Health & Safety Code, Sec ' ns 25505, 25 33, and 25534. Owner or authorized agent: /0 Date: 07/07/2016 CO TR I0N LENDING A N Y 1 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, ON C.) Lender's Name Lender's Address I understand my plans shall be used as public Licensed CONSTRUCTION PERMIT APPLICATION' COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTIN'0 I (408) 777-3228 •FAX (408) 777-3333 • buildin cupertlao.org. ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED PROJECT ADDRESS fJ /ems I APN n OWNER NAME � PHONE E-MAILW STREET ADDRESS CITY, ;ATE, ZIP 054 FAX CONTACT NAME PHONE e/ E-MAIL C✓ cam! ds -9 *3l J!S" STREETADDRESS CITY, STATE, ZIP FAX ,z� -••s'' ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR L7 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUI,4BER LICENSE TYPE BUS. LIC # Q� COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENIGLNTEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAM- O E-?`4AIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK • / EXISTING USE PROPOSED USE CONSTR. TI PE4 STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXiSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM - KITCHEN OTHER - REMODELAREA REMODELAREA REMODEL AREA - PORCH AREA DECK AREA TOTAL DELI: -PORCH AREA GARAGE AREA: LJ DETACH - { l ATTACH I r DWELLTNG UTIITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEI-NG?DDED? El NO ADDITION? FINO PRE -APPLICATION F1 YES IF YES: PROVIDE COPY OF IS THE BLDG AN ❑. YESRECEIVED BY r 3 xa _ ' - TOTAL ik VALUATION: PLANNING APPL r ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ ri0 .� 7 t ? & : , - l 4221., . ;;;, , Y .x• 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 h ve read this application and the inforniation I have provided 's 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 to buil ' onstruction. I authorize repyesentatives of Cupertino to enter the above-' entified property. for inspection proposes. V Y'°" r Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED © BUlin �G LAS REZ IEi�% INrew SFD or Multifamily d- ellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building of Ex THE cou1TER F � for new building. EaPREss PLA��ING PL�Ia ItE�zE«. permit K Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C tsrA�D�RD I] Puslic« RI.s form if any Hazardous Materials are being used as part of this project. - g4 i] FIREDEPT LARGE a x with Planning prior to Co ofPlanning Approval ing A l LettMeeting w Copy pp Letter or �\,{ I] NLA7OR ❑ SA\ITARI EST ERDISTRICT _ . submittal of Building Permit applicationkP ,.r , I] .E\VIRO\4 ENTAL HEALTH Bldg 4pp_2011. oOC ?-evised 06/21/11 "IV I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10159 S BLANEY AVE I CONTRACTOR: BYLDAN CORPORATION I PERMIT NO: 14090148 l OWNER'S NAME: LAKE BILTMORE APARTMENTS I PO BOX 60970 1 DATE ISSUED: 05/05/2015 OWNER'S PHONE: 6509313457 1 PALO ALTO, CA 94306 I PHONE NO: (650) 614-1149 I NJ' LICENSED CONTRACTOR'S DECLARATION '7 License Class 2 / Lic.# L Contractor J li /t/ Date 5 I hereby affirm that I am licensed under the provisions of Cii.pter 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: t. I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the rformance 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 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 wi all non -point source a latio s r the Cupert' o Municipal Code, cti n 9.18. Signature Z L- vl Date �S ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. 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: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. 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. 3 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. Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT TWO STORY CLUBHOUSE WITH FITNESS CENTER (1107 SQ FT); CLUBROOM/KITCHEN (1845 SQ FT), LEASING OFFICE (1797 SQ FT); (7) STUDIO UNITS DEF # 1 - TRUSS CALC'S - ISSUED 9/8/15 Sq. Ft Floor Area: Valuation: $2940000 APN Number: 36903008.10159 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS ED INSPECT ON 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: 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. 1 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 complW�nnce with the Cupertino Municipal Code, Chapter 9.12 and the Health & SafeWCode, Sections 25505, 25533, and 25534. Owner i izercut: Date: �c5 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 Of CUPERTINO I (408) 777-3228 • FAX (408) 777-3333 • build in c ertino. Ong oil � ❑ NEW CONSTRUCTION [71ADDITION ❑ ALTERATION /TI REVISIO EFERREDRIGINAL PERMIT # /Vo �ov Y? PROJECT ADDRESS O ` / —77 # -00k f J l� OWNERNAME N]y PHOs v $ s E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME �— �-- PHONE E -MA STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR a1-.1 RACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME� / l LIC EN LICENSETg BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK LD4� fit/ moi% 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 UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? []NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES - TOT N: PLANNING APPL # []NO PLANNING APPROVAL LETTER O EICHLER HOME? ❑ 51", - _ By my signature below, I certify to each of the following: I am the property owner or authoriz nt to act property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and veri accurate. I agree to comply with all applicable local ordinances and state laws relating tobul di const c� tion. I autt representatives of Cupertino to enter the above -id ti ie property for 'nspec`tion purposes. Signature of Applicant/Agent: �.� ��1Cr.>~-6�1i ) Date: f] c/ SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE , ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE. ❑ ,FIRE DEPT . Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION LMADDRESS: 10159 S BLANEY AVE DATE: 08/20/2015 REVIEWED BY: MELISSA imN APN: 369 03 008 BP#: -VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: Civil / Religious activities in BQ zone. 0 Yes 0 No PENTAMATION 1 GENCOM PERMIT TYPE: WORK DEF # 1 FOR TRUSS CALC'S SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the areliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef. 711/13) Weclr. Plug ('heck P/1w,;,h I�ae_. Ch,-clr t.feclr. Permit Fire' I'r LIC( Prr l l << Other ri9c<h. lrtslrE]__L_ i;?rer 1'i„n.rL I; s;E3 (Ji%�' /Je'c I�rsI, 1�n? p. l'i'('.: Phl7 o/,. hiss. I"("t f:lc;(.'. l/l if7. l'l'.: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the areliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef. 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# $286.00 Deferred Submittal 1DEFSUBM Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXC $0.00 ?(ltrairrisirativ(� Fc,'c: 1 1 E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure O 0 1'1',Ivel lUoc U)11� 11(11ior F(T.S. Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0,001 $286.001 TOTAL FEE: $286.00 Revised: 07/02/2015 I r/ CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10159 S BLANEY AVE CONTRACTOR: BYLDAN CORPORATION PERMIT NO: 14090148 OWNER'S NAME: LAKE BILTMORE APARTMENTS PO BOX 60970 DATE ISSUED: 05/05/2015 OWNER'S PHONE: 6509313457 PALO ALTO, CA 94306 PHONE NO: (650) 614-1149 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] CONSTRUCT TWO STORY CLUBHOUSE WITH FITNESS License Class Lic. # CENTER(1107 SQ FT); CLUBROOMAUTCHEN (1845 SQ FT); LEASING OFFICE (1797 SQ FT); (7) STUDIO UNITS Contractor /3Date d j Z5— I hereby affirm that I am licensed under the provisions of Chapter 9 5/14/15 - REV # 1 - CHANGE (E) NORTHWEST WALL WINDOW FROM 2 (commencing with Section 7000) of Division 3 of the Business & Professions WINDOWS TO 8 WINDOWS. ISSUED 5/27/15. 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 rflorjnance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $2940000 I ave 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: 36903008.10159 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 180 DAYS FROM LAST CALLED INSPECTION. 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 b^� �� Date: granting of this permit. Additionally, the applicant understands and will comply Issued Y with all non -point sour regulations per the Cupertino Municipal Code, Section 9.18. Signature <, .��< p' Date v 2 ? �S— 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. ❑ 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 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 Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliancewith the Cu ertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 505,;5533, and 255 4. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: �t✓t Date: S L T 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 CONSTRUCTION LENDING AGENCY 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 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 ;ger the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO n *raVv OnXIC MI r!'TtnA w CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org 8) R I 1 A nnnu rTrF-1 A A i TPR TInN / Ti n RFVNION /DEFERRED ORIGINAL PERMIT # ` r �/ O t " PROJECT ADDRESS 10159 South Blaney Avenue APN# 369-03-008 OWNER NAME take Biltmore Apartments, a California limited partnership PHONE 650 931-3457 E-MAIL mducote@prometheusreg.com STREET ADDRESS 1900 South Norfolk Street, Suite 150 CITY, STATE, ZIP San Mateo, CA 94403 —7 FAx 650 931-3657 CONTACT NAME Michael Ducote PHONE 650 931-3457 E-MAIL mducote@prometheusreg.com STREET ADDRESS 1900 South Norfolk Street, Suite 150 CITY, STATE, zip San Mateo, CA 94403 FAx 650 931-3657 ❑ OWNER ❑OWNER-BUII DER OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT 11ENGINEER ElDEVELOPER 11TENANT CONTRACTOR NAME Michael Kaizoii LICENSE NUMBER 719142 LICENSE TYPE B BUS. LIC # COMPANY NAME Clarum Communities E-MAIL michael@clarum.com FAX 650 681-9521 STREET ADDRESS 412 Olive Avenue CITY, STATE, ZIP Palo Alto, CA 94306 PHONE 650 322-7069 ARCHITECT/ENGINEER NAME Ray Welter LICENSE NUMBER On file BUS. LIC # On file COMPANY NAME Studio T -SQ., Inc. E-MAIL (welter@studiot-sq.com FAx 510 451-2850 STREET ADDRESS 304 12th Street, Suite 2A CITY, STATE, zip Oakland, CA 94607 EHO510 2860 DESCRIPTION OF WORK Revised plan submittal��j(%E�� EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA 5,000 DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH []ATTACH # DWELLING UNITS: 7 IS A SECOND UNIT YES SECOND STORY ❑ YES BEING ADDED" NO ADDITION' ®NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN Q YES HOME? TOTAL VALUATION: $100,000.00 PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER EICHLER By my signature below, I certify to each of the following: I am the property owner or authoriod ent to act on the property owner's behalf. I have read this I to comply with all applicable local application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. agree the above -identified property for inspection purposes. ordinances and state laws relating to buildi stru ion. I authorize repr sentatives of Cupertino to enter Date: Signature of Applicant/Agent:r^ / SUPPLEMENTAL INFORMATION REQUIRED PLAN;CRECK TYPE R UTiNGSLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ existing building(s). Demolition permit is required prior to issuance of buildingElPLANNING PLAN REVIEW permit for new building. ElExPREss 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 IMALTH BldgApp_201 1. doc revised 06/21/11 /W `� U/ 41 12 ��-�� CITY OF CUPERTINO 1 ME FFF FATIMATOR - BUILDING DIVISION 69 ADDRESS: 10159 S BLANEY AVE DATE: 05/14/2015 REVIEWED BY: MELISSA Foc i, Permit Fee• APN: 369 03 008 BP#: 14090148 "VALUATION: $100,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial BuildingPENTAMATION USE: PERMIT TYPE: WORK 5/14/15 - REV # 1 - CHANGE E NORTHWEST WALL WINDOW FROM 2 WINDOWS TO 8 SCOPE WINDOWS NOTE: This estimate does not include fees due to other Departments (Le. Manning, Public works, fire, Sanitary .3cwc, 1,1511wy •.•._ _ t'_ c_ _.J 1L.. ..,: -1r _fins. nv H"%io and aro ank an estimate. Contact the Dent for addn'1 info. District, etc.. ......... FEE ITEMS (Fee Resolution 11-053 Eff. 7/11131 alech. Nan Check Phill!b. PIc117 ( hCek P3CL'. Ptal. Check Foc i, Permit Fee• Numb. Powlit [� ,C� 1-1��c Perrt;it Fce -I_Other Alerh. InsP. Other Plumb Ins). Urlrer l.;lec. Insp. Wech. Insp. Fee. P111111b. hlsp. Vee: 7: cc. Insp, FCC' hrs $0.00 PME Plan Check: NOTE: This estimate does not include fees due to other Departments (Le. Manning, Public works, fire, Sanitary .3cwc, 1,1511wy •.•._ _ t'_ c_ _.J 1L.. ..,: -1r _fins. nv H"%io and aro ank an estimate. Contact the Dent for addn'1 info. District, etc.. ......... FEE ITEMS (Fee Resolution 11-053 Eff. 7/11131 FEE - QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 1_0_,01 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee,0 Reg. Q OTO,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 7_71 Con'sfruction Tax: Achni ntslrative Fee.* E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) � 1'rlatiel I�ncarrn<r�atatir,n Fe�cs: Strong Motion Fee: IBSEISMICO $28.00 F 1-1 # $859.00 Revisions IREVCOMTI I Tenant Improvement Bldg Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $32.00 $859.00 TOTAL FEE: $891.00 Revised: 05/07/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10159 S BLANEY AVE CONTRACTOR: BYLDAN CORPORATION PERMIT NO: 14090148 OWNER'S NAME: LAKE BILTMORE APARTMENTS PO BOX 60970 DATE ISSUED: 05/05/2015 OWNER'S PHONE: 6509313457 PALO ALTO, CA 94306 PHONE NO: (650) 614-1149 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] �J 7, �� CONSTRUCT TWO STORY CLUBHOUSE WITH FITNESS License Class Lie.# 2 CENTER Contractor 14�v 3� i Date (1107 SQ FT); CLUBROOM/KITCHEN (1845 SQ FT); LEASING OFFICE (1797 SQ FT); (7) STUDIO UNITS I hereby affirm that I am licensed under the provisions of Chapter 9 REV # 2 - REVISE NORTH SIDE OF DRIVE AISLE TO ADD CURB TO (commencing with Section 7000) of Division 3 of the Business & Professions SIDEWALK - ISSUED 6/30/15 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 Sq. Ft Floor Area: Valuation: $2940000 ,performance of the work for which this permit is issued. ave 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. APN Number: 36903008.10159 Occupancy Type: 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FRO ALLED 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 r. granting of this permit. Additionally, the applicant understands and will comply Y� i /= Date (O U t! �� with all non -point so ce regulations per the Cupertino Municipal Code, Section 9.18. / > Signature %� `/L'l/j�( Date (� 3 © 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. ❑ 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: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(x) should I store or handle hazardous 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 1 performance of the work for which this permit is issued. will maintain compliance with the Cuper 'no Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections , 2W3 , 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: _ b /rieand Date: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, 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 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 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 *W, _. CONSTRUCTION PERMIT APPLICATION 12 COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • builclinaacuneLfino.ora ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ TI REVISIO DEFERRED ORIGINAL PERMIT # /T09D! �O PROJECT ADDRESS 10159 South Blaney Avenue 369-03-008 OWNER NAME Lake Biltmore Apartments, a California limited partnership PHONE 650 931-3457 E-MAIL mducote@prometheusreg.com STREET ADDRESS 1900 South Norfolk Street, Suite 150 CITY, STATE, ZIP San Mateo, CA 94403 FAX 650 931-3657 CONTACT NAME Michael Ducote PHONE 650 931-3457 E-MAIL mducote@prometheusreg.com STREET ADDRESS 1900 South Norfolk Street, Suite 150 CITY, STATE, zip San Mateo, CA 94403 FAx 650 931-3657 ❑ OWNER ❑ OWNER -BUILDER OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Michael Kaizoji _7 LICENSE NUMBER 719142 LICENSE TYPE B BUS LIC # COMPANY NAME Clarum Communities E-MAIL mlchael@clarum.com FAX 650 681-9521 STREET ADDRESS 412 Olive Avenue CITY, STATE, ZIP Palo Alto, CA 94306 PHONE 650 322-7069 ARCHITECT/ENGINEER NAME Ray Welter LICENSE NUMBER On file BUS. LIC # On file COMPANY NAME Studio T -SQ., Inc. E-MAIL (welter@studiot-sq.com FAX 510 451-2850 STREET ADDRESS 304 12th Street, Suite 2A CITY, STATE, ZIP Oakland, CA 94607 PHONE 510 2860 DESCRIPTION OF WORK Revision to drive aisle to add a curb to the sidewalk. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) F.XISTG AREA NEW FLOOR AREA 5,000 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 UNITS7 IS A SECOND UNIT YES BEING ADDED? NO SECOND STORY ❑ YES ADDITION' ®NO PRE --APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN YESgY: EICHLER HOMEY N5 F -"R �F AL VALUATION: $0 wing: I am the property owner or authorized age act property owners behalf. I have read this application and the information I horrect. I have read the Description of Work tt is accurate I agree to comply with all applicable local ordinances and state laws relating tuction. 1 authorize representatives of Cup rtino to enter the above -identified property for inspection purposes. By my signature below, I certify to4FTION Signature ofApplicant/, Date: �' ✓ �� SUPPLEMENTREQUIRED _ 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. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ EXPRESS ❑ STANDARD ❑ LARGE ❑ MAJOR ❑ BUILDING PLAN REVIEW ❑ PLANNING PLAN REVIEW ❑ PUBLIC WORKS ❑ FIRE DEPT ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 go CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION im,ADDRESS: 10159 S BLANEY AVE DATE: 06/05/2015 REVIEWED BY: MELISSA tfcch. 1'ernrii l=ce APN: 36903008 BP#: 14090148 "VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Commercial Building Civil / Religious activities in BQ zone?Yes • � No PENTAMATION PERMIT TYPE: � WORK 6/5/15 - REV # 2 - REVISE NORTH SIDE OF DRIVE AISLE TO ADD CURB TO SIDEWALK SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary sewer District, acnool TGn r- oro Ann„d ns A. nrolissisnnf ;"Fnrmatinn availahlo and are nnly an estimate. Contact the Dept for addn'1 info. FEE ITEMS fFee Resolution 11-053 Ef. 7.%1/13) Afech. flan Check Phuub. Plur-i Check Llec. Plan Check tfcch. 1'ernrii l=ce Plumb. Permit I"re: Flec Permit 1'c� Other Mcch. Insp. Outer Plumb lnsp. Ocher Llcc. Insp'. Li Mech. Insp. Fee. Plumb. lilsp. Fee: Lie(. Insp, Fec. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary sewer District, acnool TGn r- oro Ann„d ns A. nrolissisnnf ;"Fnrmatinn availahlo and are nnly an estimate. Contact the Dept for addn'1 info. FEE ITEMS fFee Resolution 11-053 Ef. 7.%1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Supp/. 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 Construction Tax: IBCONSTAXC $0.00 "Llrniffistrative P-ee: 0 G Work Without Permit? 0 Yes (E)No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 Tr aivl Documentation If"Ce . Strong Motion Fee: $0.00 F 1 # $859.00 Revisions IPEVCOMTI I Tenant Improvement Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $859.00 TOTAL FEE. $859.00 Revised: 05/07/2015 I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10159 S BLANEY AVE CONTRACTOR: BYLDAN CORPORATION I PERMIT NO: 14090148 OWNER'S NAME: LAKE BILTMORE APARTMENTS I PO BOX 60970 1 DATE ISSUED: 05/05/2015 1 OWNER'S PHONE: 6509313457 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic.# Contractor /3y Date cS~ l 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 aerfoor Bance 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. V__ 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. Additionally, the applicant understands and will comply with all non -point sou7 regulations per the Cupertino Municipal Code, Section 9 18. Signature /A1__1Z.G�Ir7 �—' DateS 2? �s— ❑ OWNER -BUILDER DECLARATION I hereby affirm that 1 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. 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. 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, l become subject to the Worker's Compensation provisions of the Labor Code, 1 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 PALO ALTO, CA 94306 1 PHONE NO: (650) 614-1149 1 JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL CONSTRUCT TWO STORY CLUBHOUSE WITH FITNESS CENTER(1107 SQ FT); CLUBROOM/KITCHEN (1845 SQ FT); LEASING OFFICE (1797 SQ FT); (7) STUDIO UNITS 5/14/15 - REV # 1 - CHANGE (E) NORTHWEST WALL WINDOW FROM 2 WINDOWS TO 8 WINDOWS. ISSUED 5/27/15. Sq. Ft Floor Area: Valuation: $2940000 APN Number: 36903008.10159 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTTION. Issued by: �� /✓ /yI Date: �-,,27/7f 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections500533, and 255 4. Owner or authorized agent: leDate:S 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1 (408) 777-3228 ^ FAX (408) 777-3333 • building (a).cupertino.org CUPERTINO L� q R 1 RI NFW rYINSTRI ICTT(1N F-1Ar)r)ITI(-)N Q ALTERATION / Ti I- 1 REVISION /DEFERRED ORIGINAL PERMIT # t 1' D PROJECT ADDRESS 10159 South Blaney Avenue APN# 369-03-008 —7E-AlLmducote@proMetheusreg.com OWNER NAME Lake Biltmore Apartments, a California limited partnership PHONE 650 931-3457 STREET ADDRESS 1900 South Norfolk Street, Suite 150 CITY, STATE, ZIP San Mateo, CA 94403 FAX 650 931-3657 CONTACT NAME Michael Ducote PHONE 650 931-3457 E-MAIL mducote@prometheusreg.com STREET ADDRESS 1900 South Norfolk Street, Suite 150 CITY, STATE, ZIP San Mateo, CA 94403 FAX 650 931-3657 ❑ OWNER ❑ OWNER -BUILDER 6 OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Michael Kaizoii LICENSE NUMBER 719142 LICENSE TYPE B BUS. LIC # COMPANY NAME Clarum CommunitiesE-MAIL Michael@clarum.com FAX 650 681-9521 STREET ADDRESS 412 Olive Avenue CITY, STATE, ZIP Palo Alto, CA 94306 PHONE 650 322-7069 ARCHITECT/ENGTNEER NAME Ray Welter LICENSE NUMBER On file BUS. LIC # On file COMPANY NAME Studio T -SQ., Inc. E-MAIL rwelter@studiot-sq.com FAX 510 451-2850 STREET ADDRESS 304 12th Street, Suite 2A CITY, STATE, ZIP Oakland, CA 94607 PHONE 510 2860 DESCRIPTION OF WORK Revised plan submittal — EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA 5,000 DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKMORCH AREA GARAGE AREA: LJ DETACH I []ATTACH I #DWELLINGUNITs: 7 IS ASECOND UNIT SECONDSTORY ❑YES DYES BEING ADDED? NO ADDITION? ONO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF PLANNING APPL # []NO PLANNING APPROVAL LETTER IS THE BLDG AN YES '� d- -` I EICHLER HOME? [� + ;.' TOTAL VALUATION: $100,000.00 ' By my signature below, I certify to each of the following: I am the property owner or authori ent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildiligg stru ion.I authorize repr sentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED R„ UTiNG SLTP`. ©':;OYER THVCOUNTER © BUJLDING PLANREVIEW i New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. 0' ExPREsg Q PLA1�N[NGYLAN REYtEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �` STANDp$D © PUBL'IC Wo, i. _ form if any Hazardous Materials are being used as part of this project. L7;' LARCE ❑ I >iREDEPT . Copy of Planning Approval Letter or Meeting with Planning prior to �` MAJ4lt O a SANTTARYISEW$tt D[STRIGi _ submittal of Building Permit application. ' Ix ❑ NYIRONMENTAUHEALTH B1dgApp_2011.doc revised 06/21/11 ,��,�...,�.��11 CITY OF CUPERTINO WWW I 'F'F-F 1V QTTM A Tn12 _ RI TII ,DING DIVISION 121 ADDRESS: 10159 S BLANEY AVE DATE: 05/14/2015 REVIEWED BY: MELISSA Elec. Non l_`f7ec/t APN: 369 03 008 BP#: 14090148 *VALUATION: j$100,000 *PERMIT TYPE: Building Permit 111un7h. pernzil Fec: PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building lhher Plum1! In,gp, El Other Efeu. 1!rcp. PENTAMATION PERMIT TYPE: i USE: l,lef.`. 117-sp. Vee: Permit Fee: WORK 5/14/15 - REV # 1 - CHANGE E NORTHWEST WALL WINDOW FROM 2 WINDOWS TO 8 SCOPE IWINDOWS $0.00 t �'� 9 y" Mu Id jb!.✓"' 4 it '1 M.4 -{. {x' >t3 ^: m,, 1:c�''x �,�"��h A�ir,r n.,'�•iti�. .fz4f fit y�.<3 .r..f�� 9v7+�,. te.,.��.. ft'!_E`i4 ti {i. ..�i+`e), .. 3.. IY Y-. -.Yi :l—' T" MEICII. PL07 ('heck 1'11w h. 1'11:!) O wr.!k Elec. Non l_`f7ec/t Plan Check Fee: $0.00 L1c<;h. llerlWl Fee: 111un7h. pernzil Fec: Isiec. NrwiT F r _E]F_1_ fhhcr .FI¢:rt7. Ins/.,.ED lhher Plum1! In,gp, El Other Efeu. 1!rcp. Wech. Maj). Vee: Phuill'. lisp. Fee: l,lef.`. 117-sp. Vee: Permit Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, fire, SanitarySewer tstrict, c too Contact the Dent for addn'l info. District, etc. . mese ices ure anseu v„ WE FEE ITEMS (Fee Resolution 11-053 E{: 7/f 1/13) FEE QTY/FEE - MISC ITEMS Plan Check Fee: $0.00 Select a Mise Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 1 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. Q OT E0j hrs $0.00 PME Unit Fee: $0.00 .PME Permit Fee: $0.00 : thninistralNe Fee: Work Without Permit? Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure A l /lavel T)(7cume'',niewfon Tees: Strong Motion Fee: IBSEISMICO $28.00 F1-1 # Revisions $859.00 IREVCOMTI Tenant Improvement ✓' Aix ��t 7�:^�ReeRq tpy 'J Ai } �f�- i+T i, A# �A' Y/�1 ✓ALy }7 t} 4 A 1� $891.00 $859.00 Blde Stds Commission Fee: IBCBSC 1 Y " ✓i a^ (i1 i'} � � � A� 1 hi�� $k T �AA 1 k El4 ?>\ Y 7 �� L«Sii�3TOxA)GS $4.00 , $32.00 Revised: 05/07/20'15 I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10159 S BLANEY AVE CONTRACTOR: BYLDAN CORPORATION PERMIT NO: 14090148 OWNER'S NAME: LAKE BILTMORE APARTMENTS PO BOX 60970 DATE ISSUED: 05/05/2015 OWNER'S PHONE: 6509313457 PALO ALTO, CA 94306 PHONE NO: (650) 614-1149 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL F] 76 CONSTRUCT TWO STORY CLUBHOUSE WITH FITNESS License Class/ Lic. # 7 /q ` lL— CENTER l,4 S S� / 1 J (1107 SQ FT); CLUBROOM/KITCHEN (1845 SQ FT); Contractor f Date LEASING OFFICE (1797 SQ FT); (7) STUDIO UNITS I hereby affirm that 1 am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 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 Sq. Ft Floor Area: Valuation: $2940000 -performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 36903008,10159 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 ERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agreeto save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 T CALLED INSPEC ION costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will co Issued Date: with all non -point sou a regulations per the Cupertino Municipal Cod , ection 918. S RE -ROOFS: Signature 11 Date r/ / 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 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 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 5,2 3, and 25534, Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: 1 � L - 9 Date: S S /5 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 CONSTRUCTION PERMIT APPLICATION a� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 0 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(okupertino.org \ © NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / Tl ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10159 South Blaney Avenue APN # 369-03-008 OWNER NAME Lake Biltmore Apartments, a California Limited Partnership PHONE 650 931-3457 E-MAIL mducote@prometheusreg.com STREET ADDRESS 1900 South Norfolk Street, Suite 150CITY, STATE. ZIP San Mateo, CA 94403 FAx 650 931-3657 CONTACT NAME Michael Ducote PHONE 650 931-3457 E-MAIL mducote@prometheusreg.com STREET ADDRESS 1900 South Norfolk Street, Suite 150 CITY, STATE, ZIP San Mateo, CA 94403 FAX 650 931-3657 ❑ OWNER ❑ OWNER -BUILDER LJ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME TBD LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME Ray Welter LICENSE NUMBER BUS. LIC # COMPANY NAME Studio T -SQ, Inc. E-MAIL rwelter@studiot-sq.com FAX 510 451-2860 STREETADDRESs 304 12th Street, Suite 2A CITY, STATE, ZIP Oakland, CA 94607 PHONE 510 451-2850 DESCRIPTION OF WORK Demolition of the existing walkway leading up to the clubhouse, clubhouse, pool deck and play structure. Construction of a new clubhouse, 7 new studio units, new drive aisle with parking, new play area and renovated pool/spa and decking. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) 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: LJ DETACH []ATTACH I d DWELLING UMTS: IS A SECOND UNIT ❑YES SECONDSTORV E]YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES R_ECEIVED BY l' TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? []NO $2,940,000.00 By my signature below, I certify tdeaco the following: I am the property owner or authorized to act on thepr rty owner's behalf. I have read this application and the information ]ro ided is correct. I have read the Description of Wo urate. I agree to comply with all applicable local ordinances and state laws relatingd n construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature Applicant/Agent 011 ' h t of Date: • SUPPLEMENTAL FO ATION REQUIRED P,LAN,CH$CK,,TyI'E ,ROUTING SLIP,_,:, _ New SFD or Multifamily dwellings: Apply for demolition permit for OVER THE COUNTER ❑ $UILDING.PLAN existing building(s). Demolition permit is required prior to issuance of building - REVIEW permit for new building. Ca EXPRESS ❑. PLANNING PLAN REVIEW . _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ IPUBLIC 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 ANITARYSEWER DISTRICT submittal of Building Pcrmit application. ❑ 'ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FF,F FSTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10159 South Blaney Ave DATE: 09/23/2014 REVIEWED BY: Sylvia PC FEE ID APN: BP#: I *VALUATION: 1$2,940,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: Commercial Building Civil / Religious activities in BQ zone? Q Yes (F)No PENTAMATION PERMIT TYPE: 1RA WORK Construct two story clubhouse with Fitness Center 1107 sq ft • Clubroom/Kitchen 1845 sq ft • Leasing SCOPE Office (1797 sq ft); (7) Studio Units (Unit 1 F - 791 sq ft)/(1 A - 807 sq ft)/(1 B - 793 sq ft)/(1 B1 - 783 sq 13 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-2 (Apartment) II-B,III-B,NN-B 5,492 $6,065.90 IR2PLNCK $3,393.95 1R21NSP A-3 II-B,111-B,IV,V-B 2,952 $5,465.20 IA3PLANCK $2,568.40 IA3INSP B (Offices) II-B,111-B,IV,V-B 1,797 $6,015.08 1BOPLNCK $2,332.72 IBOINSP PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 10,241 $17,546.18 ';n $8,295.07 r NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pire, sanitarysewer Vtsirtct, scttoot mss,. i Th fn— nrn hnced n tho nroltinmary :nfarnialmn availahle and are nnly an estimate. Contact the Dent for addn'1 into. FEE ITEMS (Fee Resolution 11-053 E f. 711113) FEE ....._,.., Plan C'Iwc. LPFc1;. f <>rit7lt f=rte. E'i't<trai':. x>':'tc'. Per's:iz Fee., (.tii;E•r �vf<'i:ei. f;iS,i3, 0!her l}i;tiil> it"sp, (.,ti?tP}' ',!'ti', 1};.s..?, 'AfcohFee: pilonb, biyp' Fee: Elec. h'tsjp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pire, sanitarysewer Vtsirtct, scttoot mss,. i Th fn— nrn hnced n tho nroltinmary :nfarnialmn availahle and are nnly an estimate. Contact the Dent for addn'1 into. FEE ITEMS (Fee Resolution 11-053 E f. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (D No $17,546.18 100 1 s.f. $1,574.00 Swimming Pool IPOOLGUNIT I Gunite Suppl. PC Fee: (E) Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 280 s.f. $716.00 Patio Cover / Sun Room IPATIOWOOD Wood Pen -nit Fee: Hourly Only? C)Yes (E)No $8,295.07 Suppl. Insp. Fee:Q Reg. OOT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR 7 # new units $18,398.02 ,. ,h?t/r:iszraih,,e 1''r:c,' 4 hours $572.00 Plan Check, Hourly 1 ISTPLNCK 1 G 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: IPLLONGC $2,969.89 ® hours $572.00 Inspections ISTINSP Inspection, Hourly G O� r..rrt�ria:irSe;f177c:rt�(;tf!?}i .I<'ce.s: Strong Motion Fee: IBSEISMICO $823.20 Select an Administrative Item B1d2 Stds Commission Fee: IBCBSC $118.00 1 '11 4 I i 31 SUBTOTALS Y $48,150.36 $3,434.00; TOTAL FEE $51,584.36 Revised: 08/20/2014 I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10159 S BLANEY AVE CONTRACTOR: BYLDAN CORPORATION PERMIT NO: 14090148 OWNER'S NAME: LAKE BILTMORE APARTMENTS PO BOX 60970 DATE ISSUED: 05/05/2015 OWNER'S PHONE: 6509313457 PALO ALTO, CA 94306 PHONE NO: (650) 614-1149 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL F] 76 CONSTRUCT TWO STORY CLUBHOUSE WITH FITNESS License Class/ Lic. # 7 /q ` lL— CENTER l,4 S S� / 1 J (1107 SQ FT); CLUBROOM/KITCHEN (1845 SQ FT); Contractor f Date LEASING OFFICE (1797 SQ FT); (7) STUDIO UNITS I hereby affirm that 1 am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 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 Sq. Ft Floor Area: Valuation: $2940000 -performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 36903008,10159 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 ERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agreeto save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 T CALLED INSPEC ION costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will co Issued Date: with all non -point sou a regulations per the Cupertino Municipal Cod , ection 918. S RE -ROOFS: Signature 11 Date r/ / 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 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 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 5,2 3, and 25534, Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: 1 � L - 9 Date: S S /5 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 CONSTRUCTION PERMIT APPLICATION a� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 0 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(okupertino.org \ © NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / Tl ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10159 South Blaney Avenue APN # 369-03-008 OWNER NAME Lake Biltmore Apartments, a California Limited Partnership PHONE 650 931-3457 E-MAIL mducote@prometheusreg.com STREET ADDRESS 1900 South Norfolk Street, Suite 150CITY, STATE. ZIP San Mateo, CA 94403 FAx 650 931-3657 CONTACT NAME Michael Ducote PHONE 650 931-3457 E-MAIL mducote@prometheusreg.com STREET ADDRESS 1900 South Norfolk Street, Suite 150 CITY, STATE, ZIP San Mateo, CA 94403 FAX 650 931-3657 ❑ OWNER ❑ OWNER -BUILDER LJ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME TBD LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME Ray Welter LICENSE NUMBER BUS. LIC # COMPANY NAME Studio T -SQ, Inc. E-MAIL rwelter@studiot-sq.com FAX 510 451-2860 STREETADDRESs 304 12th Street, Suite 2A CITY, STATE, ZIP Oakland, CA 94607 PHONE 510 451-2850 DESCRIPTION OF WORK Demolition of the existing walkway leading up to the clubhouse, clubhouse, pool deck and play structure. Construction of a new clubhouse, 7 new studio units, new drive aisle with parking, new play area and renovated pool/spa and decking. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) 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: LJ DETACH []ATTACH I d DWELLING UMTS: IS A SECOND UNIT ❑YES SECONDSTORV E]YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES R_ECEIVED BY l' TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? []NO $2,940,000.00 By my signature below, I certify tdeaco the following: I am the property owner or authorized to act on thepr rty owner's behalf. I have read this application and the information ]ro ided is correct. I have read the Description of Wo urate. I agree to comply with all applicable local ordinances and state laws relatingd n construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature Applicant/Agent 011 ' h t of Date: • SUPPLEMENTAL FO ATION REQUIRED P,LAN,CH$CK,,TyI'E ,ROUTING SLIP,_,:, _ New SFD or Multifamily dwellings: Apply for demolition permit for OVER THE COUNTER ❑ $UILDING.PLAN existing building(s). Demolition permit is required prior to issuance of building - REVIEW permit for new building. Ca EXPRESS ❑. PLANNING PLAN REVIEW . _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ IPUBLIC 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 ANITARYSEWER DISTRICT submittal of Building Pcrmit application. ❑ 'ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FF,F FSTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10159 South Blaney Ave DATE: 09/23/2014 REVIEWED BY: Sylvia PC FEE ID APN: BP#: I *VALUATION: 1$2,940,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: Commercial Building Civil / Religious activities in BQ zone? Q Yes (F)No PENTAMATION PERMIT TYPE: 1RA WORK Construct two story clubhouse with Fitness Center 1107 sq ft • Clubroom/Kitchen 1845 sq ft • Leasing SCOPE Office (1797 sq ft); (7) Studio Units (Unit 1 F - 791 sq ft)/(1 A - 807 sq ft)/(1 B - 793 sq ft)/(1 B1 - 783 sq 13 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-2 (Apartment) II-B,III-B,NN-B 5,492 $6,065.90 IR2PLNCK $3,393.95 1R21NSP A-3 II-B,111-B,IV,V-B 2,952 $5,465.20 IA3PLANCK $2,568.40 IA3INSP B (Offices) II-B,111-B,IV,V-B 1,797 $6,015.08 1BOPLNCK $2,332.72 IBOINSP PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 10,241 $17,546.18 ';n $8,295.07 r NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pire, sanitarysewer Vtsirtct, scttoot mss,. i Th fn— nrn hnced n tho nroltinmary :nfarnialmn availahle and are nnly an estimate. Contact the Dent for addn'1 into. FEE ITEMS (Fee Resolution 11-053 E f. 711113) FEE ....._,.., Plan C'Iwc. LPFc1;. f <>rit7lt f=rte. E'i't<trai':. x>':'tc'. Per's:iz Fee., (.tii;E•r �vf<'i:ei. f;iS,i3, 0!her l}i;tiil> it"sp, (.,ti?tP}' ',!'ti', 1};.s..?, 'AfcohFee: pilonb, biyp' Fee: Elec. h'tsjp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pire, sanitarysewer Vtsirtct, scttoot mss,. i Th fn— nrn hnced n tho nroltinmary :nfarnialmn availahle and are nnly an estimate. Contact the Dent for addn'1 into. FEE ITEMS (Fee Resolution 11-053 E f. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (D No $17,546.18 100 1 s.f. $1,574.00 Swimming Pool IPOOLGUNIT I Gunite Suppl. PC Fee: (E) Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 280 s.f. $716.00 Patio Cover / Sun Room IPATIOWOOD Wood Pen -nit Fee: Hourly Only? C)Yes (E)No $8,295.07 Suppl. Insp. Fee:Q Reg. OOT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR 7 # new units $18,398.02 ,. ,h?t/r:iszraih,,e 1''r:c,' 4 hours $572.00 Plan Check, Hourly 1 ISTPLNCK 1 G 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: IPLLONGC $2,969.89 ® hours $572.00 Inspections ISTINSP Inspection, Hourly G O� r..rrt�ria:irSe;f177c:rt�(;tf!?}i .I<'ce.s: Strong Motion Fee: IBSEISMICO $823.20 Select an Administrative Item B1d2 Stds Commission Fee: IBCBSC $118.00 1 '11 4 I i 31 SUBTOTALS Y $48,150.36 $3,434.00; TOTAL FEE $51,584.36 Revised: 08/20/2014 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, school n.* ., :nn Th— f— oro hn d nn tho nroliminary information available and are onlv an estimate Contact the Dept for addn't info. FEE ITEMS (Fee Resolution 11-053 Eff. 7%1.73) DDRESS: 10159 S BLANEY AVE DATE: 06/05/2015 REVIEWED BY: MELISSA WPERTY PN: 36903008 BP#: 14090148 VALUATION: $0 PE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: Civil / Religious activities I in BQ zone. 0 Yes o No PENTAMATION PERMIT TYPE: WORK 6/5/15 - REV # 2 - REVISE NORTH SIDE OF DRIVE AISLE TO ADD CURB TO SIDEWALK SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, school n.* ., :nn Th— f— oro hn d nn tho nroliminary information available and are onlv an estimate Contact the Dept for addn't info. FEE ITEMS (Fee Resolution 11-053 Eff. 7%1.73) rltech. Plan Check /'lunih. Plan Cheek Elec. Plan Check :ttech. Perwit Fere Plumb. Permit Fee: Fit Other Mech. /nsp Wier Plumh trup her Elect. Inst>. Suppl. PC Fee: Q Reg. trJ' OT 0.0 hr's NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, school n.* ., :nn Th— f— oro hn d nn tho nroliminary information available and are onlv an estimate Contact the Dept for addn't info. FEE ITEMS (Fee Resolution 11-053 Eff. 7%1.73) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. trJ' OT 0.0 hr's $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 Construction Tax: IBCONSTAXC $0.00 Administrative Fe i Work Without Permit? Yes 1E) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure Q �'A Trcn,el 1 oewnentaticm Fees Strong Motion Fee: $0.00 1 # $859.00 Revisions IPEVCOMTI I Tenant Improvement Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $859.00 TOTAL FEE: 1 $859.00 Revised: 05/07/2015 CITY OF CUPERTINO &M FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the preliminar information available and are only an estimate. Contact the De t or addn7 info, FEE ITEMS (Fee Resolution I1-053 EN 711113) ADDRESS: 10159 S BLANEY AVE DATE: 10/13/2015 REVIEWED BY: MELISSA R-1ech. Permit Fee: APN: 369 03 008 BP#: *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: Civil / Religious activities in BQ zone. ® Yes ® No PENTAMATION PERMIT TYPE: WORK REV # 3 - VARIOUS CHANGES TO STRUCTURAL M E P'S & LANDSCAPE SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the preliminar information available and are only an estimate. Contact the De t or addn7 info, FEE ITEMS (Fee Resolution I1-053 EN 711113) :Rech. Plcni Check /'Iamb. Plan Cluck FT Bice. Plan (Beck R-1ech. Permit Fee: Plumb. Permit Fee: IYec. Permit Fee Othar 14cch. Insp. her Plumb Insp. Other klee. Ir>; „r. Insp_ i NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the preliminar information available and are only an estimate. Contact the De t or addn7 info, FEE ITEMS (Fee Resolution I1-053 EN 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. ® OT 0.0 I hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. O OT TO.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXCF-1 $0.00 _a(hministrative Fee: 0 E) Work Without Permit? © Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 A 1ieivel Documentation Fees: Strong Motion Fee: $0.00 1 # $859.00 Revisions IREI'COMTI Tenant Improvement Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $859.00 TOTAL FEE: 1 $859.001 Revised: 10/01/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14090148 10159 S BLANEYAVE CUPERTINO CA 95014 (369 03 008) OWNER'S NAME: LAKE BILTMORE APARTMENTS DATE ISSUED: 05/05/2015 OWNER'S PHONE: PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. #% 1(f !� Z, /6 Contractor Date ¢,c/ f/22. —BLDG —ELECT — PLUMB Y MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: CONSTRUCT TWO STORY CLUBHOUSE WITH FITNESS CENTER I hereby affirm under penalty of perjury one of the following two declarations: (1107 SQ FT); CLUBROOM/KITCHEN (1845 SQ FT); 1. I have and will maintain a certificate of consent to self -insure for Worker's LEASING OFFICE (1797 SQ FT); (7) STUDIO UNITS Compensation, as provided for by Section 3700 of the Labor Code, for the (UNIT 1F - 791 SQ FT)/(IA - 807 SQ FT)/(1B - 793 performance of the work for which this permit is issued. SQ FT)/(1B1 - 783 SQ FT)/(1C - 754 SQ FT)/(1D - z. I have and will maintain Worker's Compensation Insurance, as provided for 754 SQ FT)/(IE - 810 SQ FT). CONSTRUCT POOL by Section 3700 of the Labor Code, for the performance of the work for which HOUSE/STORAGE (281 SQ FT) WITH TRELLIS (280 SQ this permit is issued. FT); REMODEL POOL DECK AREA AND CONSTRUCT NEW SPA APPLICANT CERTIFICATION (100 SQ FT); INSTALL NEW PLAY STRUCTURE. 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 REV # 3 - REVISE STRUCTURAL, MEP'S & ordinances and state laws relating to building construction, and hereby LANDSCAPF' authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep DEF # 1 - TRUSS CALC'S - ISSUED 9/8/15 harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the REV #2 -REVISE NORTH SIDE OF DRIVE AISLE TO ADD granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal CURB TO SIDEWALK -ISSUED 6/30/15 Code, Section 5/14/15 - REV # 1 - CHANGE (E) NORTHWEST WALL WINDOW FROM 2 WINDOWS TO 8 WINDOWS. ISSUED SignatureG Date l a !/ fG 5/27/15. Sq. Ft Floor Area: Valuation: $2940000.00 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: APN Number: Occupancy Type: m. I, as owner of the property, or my employees with wages as their sole 369 03 008 compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed PERMIT EXPIRES IF WORK IS NOT STARTED contractors to construct the project (Sec.7044, Business & Professions Code). WITHIN 180 DAYS OF PERMIT ISSUANCE OR I hereby affirm under penalty of perjury one of the following three declarations: 180 DAYS FROM LAST CALLED INSPECTION. 1. 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 is Issued by: performance of the work for which this permit issued. Date: d l z. 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. RR-ROOFS.- E-ROOFS:3. 3.I certify that in the performance of the work for which this permit is issued, I All roofs shall be inspected prior to any roofing material being installed. If a roof is shall not employ any person in any manner so as to become subject to the installed without first obtaining an inspection, I agree to remove all new materials for Worker's Compensation laws of California. If, after making this certificate of inspection. 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 Signature of Applicant: be deemed revoked. Date: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE to enter upon the above mentioned property for inspection purposes. (We) agree I have read the hazardous materials requirements under Chapter 6.95 of the to save indemnify and keep harmless the City of Cupertino against liabilities, California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will judgments, costs, and expenses which may accrue against said City in maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Consequence of the granting of this permit. Additionally, the applicant Health & Safety Code, Section 25532(x) should I store or handle hazardous understands and will comply with all non -point source regulations per the material. Additionally, should I use equipment or devices which emit hazardous Cupertino Municipal Code, Section 9.18. air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Signature Date t 1 & Safety Code, Sections, 25533, and 25534. CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingrgcupertino.orq a ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / Tl El REVISION /DEFERRED ORIGINAL PERMIT 4 I UI")vtV PROJECTADDRESS 10159 South Blaney Avenue APN# 369-03-008 OWNERNAME Lake Biltmore Apartments, a California PHONE 650 931-3457 E-MAILmducote@prometheusreg.com limited partnership STREET ADDRESS 1900 South Norfolk Street, Suite 150 CITY,STATE,ZIPSan Mateo, CA 94403 FAX 650 931-3657 CONTACT NAME Michael Ducote PHONE 650 931-3457 E-MAIL mducote@prometheusreg.com STREETADDRESS 1900 South Norfolk Street, Suite 150 CrrY,STATE, ZIP San Mateo, CA 94403 FAX 650 931-3657 ❑ OWNER ❑ OWNER -BUILDER LJ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME Mike Kaizoji LICENSE NUMBER 719142 LICENSE TYPE B BUS.LIC# On File COMPANYNAME Clarum Communities E-MAIL michael@clarum.com FAX 650 681-9521 STREETADDRESS 412 Olive Avenue Crry,STATE,zIP Palo Alto, CA 94306 PHONE 650 322-7069 ARCHITECT/ENGINEERNAME Ray Welter LICENSE NUMBER On File BUS.LIC# On File COMPANYNAME Studio T -SQ., Inc. E-MAIL rwelter@studio-sq.com FAX 510 451-2860 STREETADDRESS 304 12th Street, Suite 2A CITY,STATE,ZIP Oakland, CA 94607 PHONE 510 451-2850 DESCRIPTION OF WORK Revision to original permit set of plans.SGen-ZC�V / 6 EXISTING USE PROPOSED USE CONSTR. TYPE 11 STORIES USE TYPE OCC. SQ.FT. 1 VALUATION (i) 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 ARE GARAGE AREA: LJ DETACH ❑ ATTACH I # DWELLING UNITS: ISA SECOND UNIT Q YES SECOND STORY ❑ YES BEING ADDED? ®NO ADDITION? ®NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN LUATION: PLANNING APPL # ❑ NO PLANNING OVAL LEITER EICHLER HOME? $ O By my signature below, I certify tQQQQQQ ea o he following: I am the property owner or authorized agent to act o e prope s behalf. I have re application and the information I ve o 1 d is correct. I have read the Description of Work and verify ' e. I agree to comply with all applicable lora ordinances and state laws relating b g nstruction. I authorize representatives of Cupertino to enter the above -identified p1roperty for inspection purposes. IN Signature of Applicant/Agent: r-•: Date: �O r SUPPLEMENT F ATION REQUIRED PLAN CHECK TYPE ROUTING SLIP El OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to _ submittal of Building Permit application. El MAJOR El SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121/11 1 I CUPERT INO CONSTRUCTION PERMIT APPL[CAT[ON COMMUNITY DEVELOPIAENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(1cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ AL.TERATION / TIVISI /DEFERRED ORIGIN?AL PERMIT# /40'10146 PROJECT ADDRESS ` r O 15c--( S S r e l•/' r7u -,0-3 no 0 O'NNERNAME PHONE E-MAIL i7fz fi &6*0 31-3457 Mafc>P_jfie STREET.ADDRESSCITY, STATE, ZIP FAX h 412Aolk SaisD Ch 1VV0 I sa•4a . A06 swv sf- Sho ,s CONTACT NAME, PHONE65-O -'M- -9145 1 E M n e STREET ADDRESS( q G o �. 1 s • !6 CITY, .5.4ZIP 1!0 IN 0 &a FAX OWER ❑ ORR.ER-BUII.DER 0111TERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGEN'r ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL F.AX STREET ADDRESS CITY, STATE, ZIP PHONE .ARCHITECT/ENGINEER NAME LICENSE N AIBER BUS. LIC n COMPANY N.ADE E-MAIL FAX STREET ADDRESS CITY, STATE, 7IP PHONE DESCRIPTION OF WORK A.JA EXISTNIG USE PROPOSED USE CONSTR. TYPE STORIES USE TYPE OCC. SQ.FT. VALUATION (a) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECXPORCH AREA GARAGE AREA: 0 DETACH ❑ ATTACH D'AILLIN-G LNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEDQG ADDED? ❑ NO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES : . ;y TOTAL VALUATION: PL.P..\W1NGAPPL: ❑NO PL4]XNIN- GAPPROVALLETTER I EICHLERHOME? ❑NO 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 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. S i --nature of Applicant/Agent: SUPPLEMENTAL LNFORMATION REQUIRED pL�N cx c Ii'_'E i ROUTING SLIP New SFD or Multifamily ciNvellines: Apply for demolition pennit forEl existing building(s). Demolition pen -nit is required prior to issuance of building o ER -THF -COUNTER iT viNc I -n I:I Y i � permit for new building. ❑ Er'RESS ;cf LAN PEN Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ -TA '\D .ED ❑' r��uc «oi };S _ p form if any Hazardous Materials are being used as part of this project. ❑ ❑ I 1-3F:GE. FIRE DEFT _ Copy of Planning Approval Letter or Meeting with Planning prior toi submittal of Building Permit application. �❑ EN\"IRONV-ENT.ALHEALTH BldgApp_2011.doc revised 06/21111 jowl toftI To: 14087773333 From: 16506819525 Date: 10/10/16 Time: 10:47 AM Page: 02/02 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: j �- PERMIT # OWNER'S NAME:` sur �:�� s �: PHONE # L. to SG'� GENERAL CONTRACTOR: 'R�,,\r,.,n.sti C k--�_T ADDRESS: 61 USINESS LICENSE # �{'3 CITY/ZIPCODE: oe - *Our municipal code requires all busWWs 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 and complete the following information: s/ SUBCONTRACTOR BUSINESS NAME, BUSINESS LICENSE # v— Cabinets &i Millwork � �.� `a�� `21(0 S 1-\1� L,-- Cement Finishing V Electrical Excavation IX Fencing - Flooring / Carpeting _ . .k C -111 -u k' C- 11� S 1-1 Linolcum / Wood V-•- Glass / Glazing -> \ L V- IIeating 13 5 `I c ✓ Insulationi lr� l) C�'S Landscaping ` ij Lathing r \ �\ r5� C) D' Masonry 1- Painting /Wallpaper Paving Plastering „i Plumbing _. pi 363 S6 _ Roofing —' C_. .\ �o:. Z 1p �A 00 Septic Tank Sheet Metal a\\ �.c .. `c�ee:� e;\ra Sheet Rock � V Til � r •�u�c� �LJ�-\-c • `•(U�C,CC S ..,.�a�c.. �. �% r'{ �� O ner / o ctor Signature ate 20 January 2015 City of Cupertino 10300 Torre Avenue Cupertino, CA 95114 Attention: Building Department To Whom It May Concern: This letter is to confirm that if we have an individual that rents a unit at Biltmore Apartments then we will provide a two -in -one washer and dryer combination machine. The washer and dryer combination machine is front loading which will provide an individual in a wheelchair accessibility to it. The control knobs are also located in such a location to provide accessibility to an individual in a wheelchair. feel free to contact me should you have any questions. Development Manager E of:F1%.0 COPY I\ / CALGREEN RESIDENTIAL CHECKLIST - MANDATORY IV)/ ITEMS 1111103 1,11 �si.�9ss COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION rlr CUPERTINO ALBERT SALVADOR, RE., C.B.O., BUILDING OFFICIAL 4010146 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building(@cupertino.orq PURPOSE. The 2013 CalGreen Code applies to additions or alterations of existing residential buildings where the addition or alteration increases the building's conditioned area, volume, or size and also applies to all new low-rise residential buildings, high-rise residential buildings, or both Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen Project Name Biltmore Clubhouse Project Address 10159 S Blaney Avenue Project Description New 2 story clubhouse/ leasing office with 7 new studio apartments Instructions 1 The Owner or the Owner's agent shall employ a licensed professional experienced with the 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 AND DESIGN Planning and Design -Site Development 4106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during construction 4106.3 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how 1:8:1 1►� site grading or a drainage system will manage all surface water flows. Page 1 of 5 CalGreen 2014.doc revised 11/04/14 A4.2 ENERGY EFFICIENCY 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. A4.3 WATER EFFICIENCY AND CONSERVATION ® � ® 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads)shall comply with the following: l 4.303.1.3.2 Water Closets.The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank-type water closets shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank-type Toilets. 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. >=1 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. 4.303.1.3.2 Multiple Showerheads serving one shower. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. E4 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less than 0.8 gallons per minute at 20 psi. 12 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas (outside of dwellings or sleeping units)in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. In 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. ® 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, ®, and shall meet the applicable standards referenced in Table 1401.1 of the California Plumbing Code. Page 2 of 5 CalGreen 2014.doc revised 11/04/14 �.: ap; r=/ ••;-z �.,. y. v;.... / 25t ./�"Xe%Pre, 49,0 t e 0pr .0l� ,V—,46,17,1v",/71/ � l'0�0v ';` 's,t;41/1r5:. 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the time of final inspection shall be weather-based. ® 4.304.1.1 Controllers shall be weather-or soil moisture-based controllers that automatically adjust irrigation in response to changes in plants' needs as weather conditions change. ® 4.304.1.2 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 communicated with the controller(s). Soil moisture-based controllers are not required to have rain sensor input. A4.4 MATERIAL CONSERVATION AND RESOURCE EFFICIENCY :� i%";i .✓u x!O%///� ESi. y/r%%1// „�: ,ay:r /r/re /'� /J/�fx,;:�l/fir' ' C f /,0*. ec • '�„' ,/- n: e i'''�'.zr'£`j!ig'/. y ;'Y. ` ` �j ,iced Dura d ed ced Marn na ce �/ / -'*Y/ ,/; FN • ./,la; '%�//,,... /i /,..rr J'.' ,�1n-h✓ %,�rr, ,;_;;',/%/r�l;`r�r." .Y`?"'»-:{r, /�rla'?>_ ....,�r.:� Ya �i/r, ,,_>'`;,F+' / � fs3/' '"o`�'' /. # - �`r;; � �.+�` sH .'i; 4.406.1 Rodent proofing. 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. / !:;ya "::x � G/ h. xt // • 1"2/..'mss4:17'; Yom(€ .r. .✓ •1.J. % .,'!T 4..tc 3''"�.Jrf....:;..//.. �i. �,"� ri �"`! 1.✓,s Jf' � • 4i o S :(.(c (O aster,,.e v ttion"Dispos•1 .n o Recyo :g 2//,Or w�y/ i" /r„y / � 4. . ,. yy,¢ r//•;/ ra'/i/ /r d/<:,t ,,.1' % y ,...%s%a,Qz. r,s::;::f av•'-3-v j 4 �_ ':. .,m „ �:fir.'"�/ ii �'t/.04,4.,,',y✓ j 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a ® F construction waste management plan shall be submitted for approval to the enforcing agency. p�n : 4 , a.: "✓.6,ensr/rn�?'fyc •nar.' “ '• " frl V,L,yx- ry� /q'i/ k/✓/%l�a»c;yjFz'. ;t i. r, 3,0474'. .�` ✓ a /t1 �� '404:2r . 4.410.1 Operation and maintenance manual. At the time of final inspection, an operation and maintenance manual shall be provided to the building occupant or owner. A4.5 ENVIRONMENTAL QUALITY 4/74, /7.4 , 0,/,/ i ,A;„ „///G•Si,c�yrr,:i. /'` !�Y/�' :»r ii,,.y.,s �i .•:.: �.^ C..sµ r , - / O ` u yJ / � ; 1 11`”��ry, J,� ,,, ftea ac / S �4/�/� % 1. x,+- 4,14 ✓ 'a/47a l�ru 4/'; /4'4/. ,�i''�r/�i/ 4`t %,�ir 4.503.1 General. Install only a direct-vent sealed-combustion gas or sealed wood-burning fireplace, or a sealed woodstove. %.:'o'l/isa/'/.'�,,.r.✓;/r v�yw,,r/.�.%j t�i`//9'v G -j / d 0 "" / :24J000 V/, 0 ,• Q • t ^,-04.6.6,g4` 7/ i � st � m,x1`.14.4"1:1", ,✓ /" . 4'�';'1%,‘7"' �.r.✓` xi. 4.5O4.1 Covering of duct openings and protection of mechanical equipment during construction. Duct openings and other related air IXI distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks ® shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be compliant with VOC limits. 4.504.2.3 Aerosol paints and coatings. Aerosol paints and other coatings shall be compliant with product weighted MIR Limits for ROC and other toxic compounds. Page 3 of 5 CalGreen_2014.doc revised 11/04/14 4.504.2.4 Verification. Documentation shall be provided to verify that compliant VOC limit finish materials have been used. LSI 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with ® .® VOC limits. 4.504.4 Resilient flooring systems. Eighty(80) 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 ® [21 Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. • 4.504.5 Composite wood products. Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall 1 comply with low formaldehyde emission standards. ,(44/2 v3>r -� G /# .r4 , Wiy4dP 'i o1/1# e tociltti 6 ecO / / ix ' r z // 9<'r/'"�,r✓r/%iq';<r;i%yt.' .'r1ras,'yei: 4.505.2 Concrete slab foundation. Required vapor retarders and capillary ® M breaks are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture content of building ® rsR materials used in wall and floor framing is checked before enclosure. L� x//z.G,y,� A W`� . {m/, "s!». ,�I y r,:*.:� - y$tp y� .rf G«•y"' % /%Ir"7J= < :,' <r ''° 'Y�?" ,: / 's :vr 6l r4° . n ,4r. rl`el/4,9G r/r/, . k ��. .s/ri.k. '/ ��/,Gy 1; d ,O. AtC Qu � :li CrS. v.z „ � t ;.:,l/ D/ /' : /I ; ri � • • r��a�.�...��`�. .*z*�Fi.�ri�4i��.,>i .</<�' .,�'"./<a ;r�w'�/�� //� �� , �'�ly' �-./ ��s fir,•d:d:.��a�''`t'a,�./,r��,�.�r`y%/'r... 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the building are provided in every bathroom. rSJ rlor .>yq//�';r //i%•' ,g*' '.7 „'; ;�.,r ...... am, <,✓' i ray ��s,...�<r .r..,: �f '1. ?1Ireg,4,;.Ari. �i<� �k �<� �'37r I'f�:� Fs a� :�/r � 3� '#si�� `sZ � 1"�yf� r �"� rrr%�^'��/r/r� r r�. '�6�' rr`o�,,.r �. /%� � �' / / / `.�J � ry�./- G�,?�• ",✓>�ylrs"'`�% nta cx'�/��ii�' r /'� 3 � 6 ��" r Earn� entaF omfo fyr / / may ff �� ' r � / � / �//r/ 'yr� �/�� t /: r;`- i %h?'. �/�y',�r �.%Gr,,/ � ��i �,j. I�.. s' �•r�, .0<v!G.�!l ;.�';. <..'� „ ��.: ,.. �s�.../.�� .r. .., �L'.;✓s.�€'_' ,Y•'- .q;..E 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 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 ..,�Y �.i,.A: ti, �k�i .�Parfrc it) r �, 00 ysl %.. 0 % t '�,4/£s 7,':!;`,4077,1i* �x• ,e14-../ ��' 5 <,w 4/ ,ff4 {y3 • yr /'/ . > ��i,•//�% ✓..aia/,;�;, 702.1 Installer training. HVAC system installers are trained and certified in ,121 the proper installation of HVAC systems. 702.2 Special inspection. The Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the ® l discipline they inspect and verify. ;.r'.. 4. �/ 4 r ...r ; ... ",a„ X%•. : r/% ay 'K �, aut0 ��;;1'� sy r✓lr"' 7 � M Y / sa YyS f4 . t, . .. 703.1 Documentation. 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_2014.doc revised 11/04/14 z :„.-6.t "6.y f,, CALGREEN SIGNATURE DECLARATIONS "Project Name: Biltmore Clubhouse Project Address: 10159 S. Blaney Avenue Project Description: New 2 story clubhouse/ leasing office with 7 new studio apartments 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 2013 California Green Building Standards Code as adopted by the City of Cupertino. 2 December 2014 Owner's Signature Date Michael Ducote/ Prometheus Real Estate Group Owner's Name (Plea rin 2 December 2014 Design Prof ssi al's Signature Date Chris Roberts, AIA - Design Professiona'. ,9 (� ) ?le se Pnnt Signature of Lic:1 = Professional responsible for CalGreen compliance Date c6 -J e� .F 'J Pa -4•51-76-Qs 4•y /-26- Name of License Professional responsible for CalGreen compliance(Please Print) 0 Zd151Pln- (9 -U r/1, 7-..5gi..4=7A 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 2alifornia Green Building Standards Code as adopted by the City of Cupertino. ,,,,r 1130/ It Signature of License Professional responsible for CalGreen compliance Date �c ehe\ �C iric 1,�. €to—t43(-1195 Name of License Pressional responsible for CalGreen compliance(Please Print) Phone Email Address for License Professionial responsible for CalGreen compliance Page 5 of 5 CalGreen_2014.doc revised 11/04/14 I 1 r a 1 CALGREEN NON-RESIDENTIAL CHECKLIST- ttP4 MANDATORY ITEMS - fl b 1.19 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO ALBERT SALVADOR,RE.,C.B.O., BUILDING OFFICIAL i � I 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 1 46- (408)777-3228•FAX(408)777-3333•buildinq{ cupertino.org PURPOSE: The non-residential provisions of the 2013 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: Biltmore Clubhouse Project Address: 10159 S. Blaney Avenue Project Description: New 2 story clubhouse/leasing office w/7, new studio apartments Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2013 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 I Column 3 MANDATORY FEATURE OR MEASURE Project Verification Re•uirements CHAPTER 5 - NONRESIDENTIAL MANDATORY MEASURES s,l4.0- .+',�:✓ y 7 � e a 9U enf fi ,#,/ N`�rJ / ` 4�� A e " ! .'y. The project meets all the requirements of Divisions 5.101 through 5.508. Division 5.1 PLANNING AND DESIGN fi y / e✓ , f�� b riestgt . 1.4 5.106.1 Storm water pollution prevention. 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. CalGreen Non-Res Checklist.doc revised 01/23/14 Page lof9 5106.4 Bicycle parking. Comply with Sections 5.106.4.1 and 5.106.4.2;or meet local ordinance,whichever is stricter. 5.106.4.1.1 Short-Term bicycle parking. If the qualified project is anticipated to generate visitor traffic,provide permanently anchored bicycle racks within 200 feet of the visitors' entrance, readily visible to passers-by, 0 0 for 5 percent of visitor motorized vehicle parking spaces being added,with a minimum of one two-bike capacity rack. 5.106.4.1.2 Long-Term bicycle parking. For qualified buildings with over 10 tenant-occupants, provide secure bicycle parking for 5 percent of tenant vehicle parking spaces being added,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 ❑ f1 shown in Table 5.106.5.2. 5.106.8 Light pollution reduction.Outdoor lighting systems shall be 0 designed and installed to comply with the following: 1. The minimum requirements in the California Energy Code for lighting zones ❑ r j 1 4 as defined in Chapter 10 of the California Administrative Code; and 2. Backlight, Uptight and Glare(BUG)ratings as defined in IES TM-15-11; and 3. Allowable BUG rating not exceeding those shown in Table 5.106.8,or0 Comply with a local ordinance lawfully enacted pursuant to Section 101.7, whichever is more stringent. 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 0 site grading or a drainage system will manage all surface water flows. Division 5.2 ENERGY EFFICIENCY f /,,/�s"2 �ye' grow._.>�v ,u- 'iJ47�..0rf°, ` r ? y' e;s�f 0 / - 0', ' 0,0:: 0 // 9044444404440-004;4;444w000400044,40044':_ ;;;044444,0440-4 emd/ eRequire n ssr0.fs /,r ,� 40100,00� , r0000,44444/4,0440040444,44044 94444�%� „004r:i4-fw0 „ 0 ,4s,/te h, , te/G , f� /� , � G- _ 4/ ;0404 5.201.1 Scope.The California Energy Commission will continue to adopt ❑ ❑' mandatory building standards. Division 5.3 WATER EFFICIENCY AND CONSERVATION : 1447 ; ��! fi7, 74 777797" r� J 7774474 �' ' � sr . .«M ,%4se„/ r �/ 0�01 „r0 ,� � �s �0 ,4 ,, � 0 /�� ,� ; 4/;r rl�J 04444404-444440004040444040404,4 „ � rAl„ ��%�� 00 � 5.303.1 Meters.Separate meters shall be installed for the uses described in Sections 503.1.1 and 503.1.2. 5.303.1.1 New building or additions in excess of 50,000 square feet. Separate submeters shall be installed as follows: 1.For each individual leased,rented or other tenant space within the 0 building projected to consume more than 100 gal/day. 2.Where separate submeters are unfeasible,for water supplied to the following systems: a. Makeup water for cooling towers where flow through is greater E3 than 500 gpm. b. Makeup water for evaporative coolers greater than 6 gpm. c. Steam and hot-water boilers with energy input>500,000 Btu/h. Page 2 of 9 CalGreen Non-Res Checklist.doc revised 01/23/14 ;'i 5303.1.2 Excess consumption.A separate submeter shall be provided ❑ for any tenant within a new building or within an addition that is projected to consume> 1,000 gal/day. 5.303.2 Water reduction.Plumbing fixtures shall meet the maximum flow rate 0 values shown.in Table 5.303.2.3. Exception: Building that demonstrate 20-percent overall water use reduction. 5.303.2.1 Areas of addition or alteration. For those occupancies within the authority of the California Building Standards Commission, as specified in Section 103,the provisions of Section 5.303.2 and Section 5.303.3 shall apply to new fixtures in additions or areas of alterations to the buildings. 5.303.4 Wastewater reduction. Each building shall reduce by 20 percent wastewater by one of the following methods: . 1. ❑ 1.The installation of water-conserving fixtures or 2. Utilizing non-potable water systems. 0 5.303.6 Standards for plumbing fixtures and fittings.Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code 0 (CPC), and shall meet the applicable standards referenced in CPC Table 1401.1 and CalGreen Chapter 6. %✓ ,._ rr. // 0-0.0://,0,000,00.,..r,w.;". r 000-00-0- rr ,. .. ; . _00 . 'f, , .400,00 r/--*-4,00'„00000,0.0,-.0,00 „00,0„00,4,.//9r / ;fi ;r0000.000.0000- v0 rf/f .; ' !"/0,0000004000,00000000000,00 OutdoorWaterU es /,/,',1crrr rr: r,�, %% ,r,• rtJrfir�r / Gsffirr /fr,:'0-0rr ��ff�rsr;f ''� reM J %IWrrr,r /e;..... . `rr� rr , "4 ::,--.74-04,/,:).,:,4;44-1...;;01/000'' „frr /, ),:4; /4✓ r1/0ri rfr,,%r;;r /,/ ;rrrr f; /. 5.304.1 Water budget.A water budget shall be developed for landscapeEl ei irrigation use. 5.304.2 Outdoor potable water use. For new water service or for addition or ❑ ❑ alteration requiring upgraded water service for landscaped areas of at least 1,000 sq.ft. but not more than 5,000 sq.ft.,separate submeters or metering devices shall be installed for outdoor potable water use. 5.304.3 Irrigation design. In new nonresidential construction or building addition or alteration with at least 1,000 but not more than 2,500 sq.ft.of cumulative landscaped area, install irrigation controllers and sensors which include the following criteria, and meet manufacturer's recommendations. 0 1E1 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 0 weather conditions change. 2.Weather-based controllers without integral rain sensors or communication systems that account for local rainfall shall have a 0 separate wired or wireless rain sensor which connects or communicates 13 with the controller(s). Soil moisture-based controllers are not required to have rain sensor input. .. r✓:rr / r • ,/- * -,000.r, 0<,, 0000. / , f/ rr0r✓r!.•Fr ,, ,Lo e" ;" n trrarrr1,-, rl!r ! / � WO% l ,r ,,,� % ,rG,W%/re,y 17,7,409/4*,' , �u; r; ,y�;;; f4)�{,er Res „e- � �a. . pr, /M�!gemer1rrr � ,,�;� r;r .r,r - . ie. %rr'r , 4;`r� J/ � r� 0�/ �r/ ,, , f, '4r,-, .r` rr � ��, rl,,. r/r / .r.rrr�!,r/r .�„r.. r. rr„4 . r.,.0„;,r/1..,,, .? 5.407.1 Weather protection. Provide a weather-resistant exterior wall and foundation envelope as required by California Building Code Section 1403.2El 0 and California Energy Code Section 150, manufacturer's installation instructions or local ordinance,whichever is more stringent. CalGreen Non-Res Checklist.doc revised 01/23/14 Page 3 of 9 i 5.407.2 Moisture control. Employ moisture control measures by the following methods; 5.407.2.1 Sprinklers.Prevent irrigation spray on structures. 0 E3 5.407.2.2 Entries and openings. Design exterior entries and/or openings CI 0 to prevent water intrusion into buildings. 5.407.2.2.1 Exterior door protection. Primary exterior entries shall be covered to prevent water intrusion by using nonabsorbent floor and 0 M wall finishes within at least 2 ft around and perpendicular to such openings plus at least one of the following: 1.An installed awning at least 4 ft in depth. 2.The door is protected by a roof overhang at least 4 ft in depth. II 3.The door is recessed at least 4 ft. 4. Other methods which provide equivalent protection. 5.407.2.2.2 Flashing.install flashings integrated with a drainage 0 plane. :Fr ,;,r r r:r, rrr y.t'.'rrr r, / /,rr rr }v,;-..:/ rr^'rmr 7:,,,,,,z.;.rrr , /,f r'rr,,,Ar.ir 'rrr 07., rr,./5 ', f� 4 ,,:. / •jr rt0tr �o , t R ,� . tQnr •s "aa. rY lngy/f,/ /7i'�%, !j1!� fy 'i. ; r ,' '�!; , r �'t�i , „R r! .- ,,r,% rrr fr � rrff .. .r !'<07,0 /7'rr %�, f ,�rfi/ r ,,,,r?*0: r .rk„rt :r,r,o,.. ,rrr ,r '1/ ;r✓� , „� 5.408.1 Construction waste management. Recycle and/or salvage for reuse a minimum of 50 percent of the nonhazardous construction and demolition waste in accordance with Section 5.408.1.1, 5.408.1.2, or 5.408.1.3; or meet a Q local construction and demolition waste management ordinance,whichever is more stringent. 5.408.1.1 Construction waste management plan.Submit plan per this 0 1 section to enforcement authority. 5.408.1.2 Waste management company. Utilize a waste management X company that can provide verifiable documentation that the percentage of ❑ 12 construction and demolition waste material diverted from the landfill complies with CalGreeni Section 5.408. 5.408.1.3 Waste stream reduction alternative.The combined weight of new construction disposal that does not exceed two pounds per square El 1 foot of building area may be deemed to meet the 50 percent minimum requirement as approved by the enforcing agency. 5.408.1.4 Documentation. Provide documentation of the waste 0 management plan that meets the requirements listed in Section 5.408.1.1 through 5.408.1.3. 5.408.3 Excavated soil and land clearing debris. 100 percent of trees, stumps, rocks and associated vegetation and soils resulting primarily from land 0 clearing shall be reused or recycled. .. .. %�m..�r6,”.rirrf r„'.:rfArf�/ :rTJr7' rr `r.„.'.r',FrJ' r' / isv, r.,„' f rr ?! ',lr/rrrrt:;-:. - , „r'f, '': ri?%, � f.r%r1f /;fra r° ''''r/ fr.rrr ,r ,,r1�;;f`r' ,-,F rr� r ,R f '}mo; *,/„ � / r�;.•f r"rrfi ; u �1Cnf r�ena �aanrd'O0-ertonP , ' rlrrztr--” r-- /, ir . *6re-✓' r.044� ,tfrf/r, r , � e� ` r.07~fr�ffrrrrrF' r n:oi %trrrf/ ;,,f /0rsr<rr a,srr , ? . A�� /r�r. ..,,, ' 5.410.1 Recycling by occupants.Provide readily accessible areas that serve the entire building and are identified for the depositing,storage and collection 1:1 Er 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, 0 0 I process systems and renewable energy systems shall be included in the design and construction processes of the building project. Commissioning requirements shall include items listed in Section 5.410.2. I CalGreen Non-Res Checklist.doc revised 01/23/14 Page 4 of 9 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 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.Functional performance testing shall demonstrate the correct installation and operation of each component, system and system-to-system interface in accordance with the 0 n 45.1 approved plans and specifications. 5.410.2.5 Documentation and training.A Systems manual and systems operations training are required. 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 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 or new systems to serve an addition or alteration subject to Section 303.1. 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 0 ❑ include,as applicable to the project,the systems listed in Section 5.410 3.2. 5.410.4.3 Procedures. Perform testing and adjusting procedures in accordance with industry best practices and applicable national standards El El 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 0' national standards listed in Section 5.410.3.3.1. 5.410.4.4 Reporting.After completion of testing, adjusting and balancing, 0 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 y, 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. CalGreen Non Res Checklist.doc revised 01/23/14 Page 5of9 4 r , r.u ,rrc r rr „w r „,,,,/, . ;j/ ,, rrr rrrrrrr f //f,1,,,,,f' "''' f rr rry rr' r% 0o t/tl,, ,' /rrr rf "' yr , ,r- r ,rr . rr„ r. rrr '',,,,,W, ,;// t ./f/erf r„ifsr',,n, r ' jfr''''r''' Fireplaces � 7ff40frrr r , " F � / mfrr ,./.7,,,„/ r,% ,r i .rrfr/ „:„,,,,,,,,,--,w,"7,,,,,, ,, �9 �r�rf� ,,,ifl�,rr. ,,0,04/I,�JlL�rlz-. ,r' bE�r . . / 0044,0,'//, r . +irf ,,,rr 044 r , 5.503.1 Install only a direct-vent sealed-combustion gas or sealed wood- 0 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:. 0 0 r% rr,, r �:rrf 9rrrr rr' ri% 'rr �r/, ?rrr'rrrr''rrrr,�/-,'a r :;;F r frr -% fe,f,r//f..'., ,:/ r/f. . :,, rF/rr /i'.,e„ �.!r ri r r'/!r' -r ..r ;;,r�r% �-h:rrr- ,;:,r r;, /^'.rrf - �,r%r`:,r„✓rt ,r,.. ,. „rte r/rfrr .<� ,,:„',eft.�r,�r rfjriJ'f,..,rr, .r„/r/%rr''. rrr,r ,, ;� ,r/;r,..,�f rfl,:�' 1 /> ' 5 r o). rrr$0 r,, r; r ''7-- /f n/F<'i ''r:4V/7 ;, r rrr0f'' ,1/, e %'f%''f rr r�rrrrr� �r� r;�,�r, f/,lf�rrf`''': 1 �rr%�` r, rrrr:f , ` ,r rir'r�G .x, rr %r';,�rf ,� -,r � / /r't Gy i.,fff ff / f1 r , 1lla to f ./,/rff r rrr r%'% r,70:lrr ,60 r rare'f r f .f/I ry /,'r /*4;:r , r,'rrrr' ';j >.ie�'di*frit ��fl� n� ��, � � firm;,.;;/r��.:. a;r.:�i,:`: r r,sf3rf:,// r//rrr'r',:lr, �' /„ fff� ,�irru, r�oi ��,rri'r`r ,.,,rr .� 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 Et 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 0 b 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 El 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. 0 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 X El certain toxic compounds and ozone depleting substances(CCR,Title 17, Section 94520 et seq). 5.504.4.3.2 Verification.Verification of compliance with this section shall be provided at the request of the enforcing agency. 5.504.4.4 Carpet systems.All carpet installed in the building interior shall meet the testing and product requirements of at least one of the standards 0❑ /a1J 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 X 51 Green Label program. 5.504.4.4.2 Carpet adhesive.All carpet adhesive shall meet the 0 0requirements of Table 5.504.4.1. CalGreen Non-Res Checklist.doc revised 01/23/14 Page 6 of 9 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 1:1 El formaldehyde as specified in Table 5.504.4.5. 5.504.4.5.3 Documentation.Verification of compliance with this section X shall be provided as requested by the enforcing agency. Documentation shall include at least one of the following standards listed in Section 5.504.5.3. 5.504.4.6 Resilient flooring systems. For 80 percent of floor area ❑ receiving resilient flooring, installed resilient flooring shall meet at least one X of the following standards listed in Section 5.504.4.6. 5.504.5.3 Filters. In mechanically ventilated buildings, provide regularly occupied areas of the building with air filtration media for outside and ® CI 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, El 125 California Community College, campus of the California State University or campus of the University of California,whichever are more stringent r rr"-rr r'- rr• :Yrrrr rf,r,r ✓ r ,� frrrrr.r"r,,'rrr r Fr,, , ,,:, frl7f,+,,%�•'%'^'%f.%•; e , 1.•� „rrrr Yr f t ri% ,rs.••,',/ J,r r '"', fir r --4A-47-4/,,,,,7 ,/' ` r s r f.,^Y..="�',;,, / r r ' ✓ " / ;,rrr/r . rfi,.:,,., " ✓jr , ,Y .;'l./r4Aff;fF �',, f, ', / r',rl-%r/n.^ t { ,r 'r" S; fr'' ''''''.„,4'./ 1.;>',/,,,,,,rf //rf' r,'r.,r/o yrr,i rr..'^yr� • Cont of✓� r'r' rr;r,� ri%rr.: r `, r.r r -1n Il o(S1RAW,**d,14ClQrl %. , 0/4"r jr t% •-r,r„ ''-le /Jr r<.40,,rf%'/ .„, ;. r,r f f,,,,, Jr/,Afir. ,, �;y`',��frrrr"f��i:�%r�"r�%r�'r r /��,�- r,��, 5.505.1 Indoor moisture control. Buildings shall meet or exceed the provisions of California Building Code,CCR,Title 24,Part 2, Sections 1203 El E and Chapter 14.1. ,- ;r� r ,,✓,'!...;.fr,, r Vii %-r'"`. ,,�,f r”' r",%r s r'�l y Y' ,'"�-,rf'r ,frrrlrr�✓r`'' y r �r rr -^�rrr:-rz,y„`ir / r r,' ,,,! /f v - fr r.'r/'i,: ,r r1;r'r'g,,r A,:rr'/r�',',r�%'„'rr ✓'rr.� ,✓r,w,,r %` fry f rr;,;f ,, .' sr '''�,'.".rr'1' r''�,rr'�r/•'`r�,,°;� r/"y��.%.,"_/ � � /ff ,%,'rr" ;fr%Gr`i' '� f` ',r' ''f`/ �'r',%'/� 'r'� �, %, /'r`rr y ,'/r'r,�rr��/r"Y r,r,',f rr,%rs ! f ., ,, ,/%' ,srr ,r,"' 1 i/, r, r: ; n'!7.';',.;.,/,,A .r/ '6`.04.0;',"71,00X:444,4f0 ' ! / r '//:',/,,,47 . fj r r!r', r� r r ✓ r'r ,f „! f �/,-r•�i,�i'r '�r� ,"��,��,:/rrrr:r� rk,f!• �rrr,r„rrr,:' ,,� rr,,. rr,,r ,,,,ir�✓r/rf. �„rs t „r , ,'%r/lir%r<,. 5.506.1 Outside air delivery. For mechanically or naturally ventilated spaces Elin buildings, meet the minimum requirements of Section 121 of the California 12 Energy Code, CCR,Title 24, Part 6 and Chapter 4 of CCR,Title 8 or the applicable local code,whichever is more stringent.' 5.506.2 Carbon dioxide(CO2) monitoring. For buildings equipped with 1:1demand control ventilation, CO2 sensors and ventilation controls shall be Ig 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).1 ?,%sr, „/ ,fir,r'�- ,, t ,,,,%,,'/Vrfr;' i r�ir ,,,z r ,: .r✓ .-ytrsr",.%,✓b rrra'f":r r/-'.+1'„%4.,rrr :,;;rj,r r%,',/r ,'��/,•�%ry'-` /r'/.''s r �/rrf-�rr,�' 'r ,.r�, ,^%�„ !�:; ,�1,�r� .�r'f /!%rr� ,./f.%Y/rr/rrrr%/.%r,'r,r Y! ,,,f� lr",f ;%%�r�rri,.Y:' � ;f,. r//,r„r,r,Tpr penetritalf„'r i f ,a.,��,,,;„-:/srrx r,,,,,,,o,' rr f .!f w r `2, , r rr.; ,r ` 's'. ',,'/*-4 4/ r<ir i //,--- '4'--<';,„;, af,,' jrd-'%✓r rJr rfr /r. �( �p n1e' I omfort r r” r i / : 'r r 'f. • t%r arm•rl/r/%r;,o=r oe. :r,rrr � .s r rrr .�' .''l,� rs/r'r'r/.!l"�r^'r r ,,,,s^l/,:/f�frrrfi,,1/Li, ;., ..., .r. �� /,%r..r'�'.,``//r,r',,�r.. r-`�,�`.9sr,rr,r,r r� ,.,rr, ;,,,, ,,,,,f0;24"'''.rrrl 5.507.4 Acoustical control. Employ building assemblies and components �' k. 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 X exterior windows shall have a minimum STC of 30 for any of the building 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 0 at least 40. I CalGreen Non-Res Checklist doe revised 01/23/14 Page 7 of 9 "! •l • ; Y., � r' r ;///,-l/r rrrr / / ',/ ��1,:. ;�; sr , r r r r r % f• uf�f•,rr/�i¢ . „/ o ali r4r -fr i ,�/�l% %rrrf�r� ,1 <� it/ ' -r .t .. r, ,� � r/ r%!7r/A / 44/%�, 6.% 4f! ^'r. ir/ ! / ,olr 5.508.1 Ozone depletion and greenhouse gas reductions. Installations of HVAC,refrigeration and fire suppression equipment shall comply with Sections 5.508.1.1 and 5.508.1.2. 5.508.1.1 Chlorofluorocarbons (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. Page 8 of 9 CalGreen Non-Res Checklist.doc revised 01/23/14 CALGREEN SIGNATURE DECLARATIONS Project Name: Biltmore Clubhouse Project address: 10159 S. Blaney Avenue Project Description: New 2 story clubhouse/leasing office w/ 7 new studio apartments 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 2013 California Green Building Standards Code as adopted by the City of Cupertino. Owner's Signature Date Owner's Name (Ple0e ip OA:4. 1 Design Pr �ofe ss al's Signature Date - Design Professio I's a (P ase Print) / v' 7 Signature of License essional responsible for CalGreen compliance i Date. -1 t L 51Pho4 Name of License Professional responsible for CalGreen compliance(Please Print) C r 3r 0 i 1 y--6a . com Email Address for License Professional responsible for CalGreen compliance I SECTION 2 — IMPLEMENTATION VERIFICATION 1 1 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 20 . ifornia Green Building Standards Code as adopted by the City of Cupertino. k/ C-)/ II Signature of License Professional responsible for CalGreen compliance Date 3 ,\ tr eati [o -1-131 -1746 Name of License Professional responsible for CalGreen compliance(Please Print) Phone l ra Email Address for License Professi al responsible for CalGreen compliance Page 9 of 9 CalGreen Non-Res Checklist.doc revised 01/23/14 .,1 , : . . 8 ! leicilocina a pi 1-, g p g 1 . . . , . . , • _ IN M 1 t!,,, 2 4-ii-.',.. T E '. . . "13 & al l , ,.... et, r II , - . , . , . . . a 3 . 0 • , . ' 32 0 . . I aa 1., •a . 2. ., . : ti. 0) - ., ' 74 w — a – , a ' - . 1. . .. .: '. 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