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14100144CITE' OF CUP ERTINO BUILDING PERMIT BUILDING ADDRESS: 10777 FARALLONE DR CONTRACTOR: ALVARADO PERMIT NO: 14100144 CONSTRUCTION OWNER'S NAME: ROHIT & MEGHA GURTU 1001 JACKSON ST DATE ISSUED: 12/09/2014 OWNER'S PHONE: 8143215838 SAN JOSE, CA 95112 PHONE NO: (408) 799 -9918 LICENSED CONTRACTOR'S DECLARATION' JOB DESCRIPTION: RESIDENTIAL COMMERCIAL g� CONSTRUCT ONE STORY ADDITION (684 SQ FT); FRONT License Class � Lic. 4 59 9 U C ^T -�� COVERED PORCH (28 SQ FT); REMODEL HALL BATH (86 Contractor O Date SQ FT); RELOCATE FURNACE TO ATTIC AND ADD A /C; I hereby affirm that 1 am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self - insure for Worker's CoInpensation, as provided for by Section 3700 ofthe Labor Code, for the Sq. Ft Floor Area: Valuation: $70000 of the work for which this permit is issued. W aante nd will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance ofthe work for which this APN Number: 36935023.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 ISO DAYS OF PERMIT ISSUANCE ®� to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 HAYS FROM INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, "— costs, and expenses which may accrue against said City in consequence of the Date: `✓ / granting of this permit. Additionally, the plicant understands and will compl with all non -point irce egulatio er t Cupe ' o Municipal Code, Secti Signature I 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. F1 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(x) should I store or handle hazardous I have and will maintain a Certificate of Consent to self - insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cuper 'no Mu ipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 255 d 2553 Section 3700 ofthe Labor Code, for the performance ofthe work for which this /n Owner or authorized agent: Date: G permit is issued. I certify that in the performance ofthe 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 ofexemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions ofthe Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence ofthe I understand my plans shall be used as public records. granting ofthis 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 cCUPERTIN0 COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 • building(cDcupertino.orq 61A B a�u 1 F NEW CONSTRUCTION n ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10 77 7 F^k a to 01 o APN # 3,61— 3 57 ,O (� 3 b OWNER NAME Qo R( l qv R.T V rr1N ,1 PHON g /t 3 2' _ S O S R E -MAIL } J 6 C �oHtr6'vRTV �YA-J400, co.lN STREET ADDRESS /7 ! �� 6 CITY, STATE, ZIP Cv T/w CA 1�!� FAX CONTACT NAME f� PRONE E -MAIL C� ✓SD STREET ADDRESS �%'� 1 CITY, STATE, ZIP n qq 6 `�r d. ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENUMBER LICENSETYPE BUS. LIC# COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT /FNGINEERNAME� �I�mP @l? LICENSE NUMBER BUS. LIC# COMPANY NAME i ® a E -MAIL �� `(� A14 A N STREET ADDRESS CITY, STATE, ZIP ��/ PHONE br 3 S 3,(' DESCRIPTIONWO K I &Ch u® ®� lfa JF gMd f Ch S �t �dU C F. • f 4 N4 ly . �� c 11 � EXISTING USE �de4 PROPOSED USE CONSTR. TYPE 1d t V8 #STORIES A. USE TYPE OCC SQ.FT. VALUATION ($) t� U y ��J ''.. EXISTG AREA 3 J NEW FLOOR AREA 68J1 DEMO AREA TOTAL NETAREA BATHROOM✓ KITCHEN OTHER REMODEL AREA 6 REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH 2,Q CCJJ 'ATTACH # DWELLING UNITS: IS ASECOND UNIT (]YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? PdNO PRE - APPLICATION DYES IF YES, PROVIDE COPY OF ISTHE BLDG AN ❑ YES RECEIVED BY: AL VALUATIO TOT AL PLANNING APPL # O PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO v ,u O Z }- 70 By my signature below, I certify to each of the following: 1 am the property owner or authorized a nt to act on the propkty owner's behalf. II have read this application and the information I have provided is correct. I have read the Description of Work and verl agree to comply with all applicable local ordinances and state laws relating to b ing constr . I thorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQ IRED 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 ANDARD 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. MAJOR SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BtdgApp_2011.doc revised 06121111 RUM] cCRTY OF SCUP EI[ TNNO OCCUPANCY TYPE: ADDRESS: 10777 farallone dr /DATE: 10/3312014 REVIEWED BY: Mendez PC FEE IID BP FEES APN: BP #: wo, /_/ "VALUATION: 1$70,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? Yes No ®No OTC? 0 Yes D PENTAMATION 1R3SFDADD PERMIT TYPE: a WORK addition to 1 st floor 684 sq ft)' 28 sq ft to porch; remodel hall bath 86 sq ft); relocate furnace to attic; SCOPE add a/c unit; skylight in bedroom 1 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE IID BP FEES BP FEE ID R -3 (Custom) II- B,111- B,IV,V -B 712 $2,654.00 IR3PLNCK $1,666.00 IR3INSP Phapih. lire). Fee: 1.,3ee. Insp. Fee: = # $143.00 Mechanical 1MFR = <I00 Furnace, Forced -Air Permit Fee: $1,666.00 Suppl. Insp. Fee:Q Reg. () OT Q Q hrs $0.00 = # Mechanical $72.00 IBREMAIR A/C Units ( < =10K cfm) PME Unit Fee: $0.00 PME Permit Fee: $48.00 # $431.00 Window / Sliding Glass Door I9,TVREP Replacement f'OX TOTALS: 712 $2,654.00 $1,666.00 MECH, HOURLY 0 Yes G No ]PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No Mech, Plan Check 0.0 hrs $0.00 Plunth. P!un Ch,:r -11mb. L *1, -tr, Plain Cheel( Mech. Permit Fee: IMPERMIT P Permit Fee. _L_ F,lec Permir Fee IF----I Other Mech. Insp. 0.0 hrs $48.00 oawr Plumb Insp (Jthc>r l_1cc. Ins *:. Li I if"(", 1.1_.1: P ,r. Phapih. lire). Fee: 1.,3ee. Insp. Fee: 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 Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -033 Eff' 7/1!13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,654.00 86 s.f. $645.00 Remodel, Bath (< =300 sf) IREMRESBAT Suppl. PC Fee: Q Reg. 0 OT Q.Q I hrs $0.00 PME Plan Check: $0.00 = # $143.00 Mechanical 1MFR = <I00 Furnace, Forced -Air Permit Fee: $1,666.00 Suppl. Insp. Fee:Q Reg. () OT Q Q hrs $0.00 = # Mechanical $72.00 IBREMAIR A/C Units ( < =10K cfm) PME Unit Fee: $0.00 PME Permit Fee: $48.00 # $431.00 Window / Sliding Glass Door I9,TVREP Replacement f'OX I {!! ?iilrillClil4L F"c— 0 Work Without Permit? C) Yes ) No $0.00 Advanced Planning Fee: IPLLONCR $99.68 Select a Non- Residential Building or Structure 0 4 Travel Documentation Fee: ITRAVDOC $48.00 Strom Motion Fee: IBSEISMICR $9.10 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $4,527.78 $1,291.00 TOTAL FEE: $5,818.78 Revised: 08/20/2014 CITY OF CUP E][RTRNO M_ FEE IES TRMATO[R - BUIL®] N G I[ IVESION NOTE: This estimate floes 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 nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. IEEE ITEMS (Fee Resolution 11 -053 Eff 711113) 7� rd. P10 Chh cr, Plrunh. Plo7 Chc( F Elec. Plan Che=ck ADDRESS: 90777 Farallone Dr DATE: 09/22/2095 REVIEWEID BY: Sean Flee. Permit Fe": APN: BP #: 'VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES� USE: Suppl. Insp. Fee:Q Reg. COT Q p PERMIT TYPE: WORK{ Revision #1: Revise the layouts of hallway and master bathrooms. SCOPE $0.00 NOTE: This estimate floes 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 nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. IEEE ITEMS (Fee Resolution 11 -053 Eff 711113) 7� rd. P10 Chh cr, Plrunh. Plo7 Chc( F Elec. Plan Che=ck tr; gat. Pr, -n�ir i'cr: PI?(mh. Permit Fee: Flee. Permit Fe": 0"orr 7o" h. Insp. ( fIwr Phinib Insy, Oflier Ele(. Insp. Ll i /•c/i /n,p I., P/arnh.hw).Pce. Elec. Insp. Foe: NOTE: This estimate floes 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 nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. IEEE ITEMS (Fee Resolution 11 -053 Eff 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: hourly Only? Yes Q No $0.00 L__I_j hours Plan Check, Hourly $143.00 ISTPLNCK Suppl. PC Fee: () Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Penn it Fee: $0.00 Suppl. Insp. Fee:Q Reg. COT Q p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 J1 IH-!J17lsff. rte, r? FCC O Work Without Permit? ® Yes No $0.00 Advanced Planning Fee. $0.00 Select a Non - Residential Building or Structure Q d 7i-ur.' f)t�.•rmcr�NUlirlr� Fcrs. Strong; Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $143.001 TOTAL FEE: $143.00 Revised: 01/0612015 I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10777 FARALLONE DR CONSTRUCT ONALVARADO I PERMIT NO: 14100144 OWN'ER'S NAME: ROHIT & MEGHA GURTU OWNER'S PHONE: 8143215838 ❑ LICENSED CONTRACTOR'S DECLARATION License License Class Lic. # 19 C, qSj p Contractor JG - 0 C-013 Date Q/ — 2 - L5 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: 1 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 p rmance of the work for which this permit is issued. 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 with all non -point regulations pe upert' Municipal Code, Section 9.18. Signatu G Date ❑ OWNER - BUILDER DECLARATION 1 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. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 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 source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 1001 JACKSON ST I DATE ISSUED: 12/09/2014 SAN JOSE, CA 95112 j PHONE NO: (408) 799 -9918 .rOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ CONSTRUCT ONE STORY ADDITION (684 SQ FT); FRONT COVERED PORCH (28 SQ FT); REMODEL HALL BATH (86 SQ FT); RELOCATE FURNACE TO ATTIC AND ADD A /C; REVISION #1: REVISE THE LAYOUT OF THE HALLWAY AND MASTER BATHROOMS. ISSUED 1.22.15 Sq. Ft Floor Area: Valuation: 570000 APN Number: 36935023.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: J'rAN A' re_ <7 Date: /• as -,"5 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 Appli 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. 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 compliance with the Cupertino Mumc* al Code, Chapter 9.12 and the Health & Safety Code, Secti 55 , 255 , an 2553q J Owner or authorized a Date:() /- M- / CONSTRUCTION LENDING AGENCY 1 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 Profess {CUPERTINO C®NS7RUC71ON PERM17 APPLICA71ON{� I COMMUNITY DEVELOPMENT DEPARTMENT - B19R_ @ffi INS 10300 TORRE AVENUE o CUPERTINO, CA 95014 - - -- (408) 777 -3228 ° FAX (408) 777 -3333 e buildings acupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION []ALTERATION / TI V REVISION/ DEFERRED ORIGINAL PERMIT # l D(/( PROJECTADDRESS O6-7 I '7 '"'4mRA NF, ®p 'APN# ,, p , 1 - pnli�.. OWNERNAME %P %41 C�L)R- `V PHONE 40S^-A1 7�;88 E -MAIL STREET ADDRESS CITY, STATE, ZIP C o/� to ER-77/ b FAX _C /T / I �y CONTACT NAME / 1 � Pf � L)Py(,7 0 PHONE 7E-MAIL /� STREET ADDRESS 1 O 77 / LLOME �% CITY, STATE, ZIP CA ofckT r No ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM ^ !\• LICENSE NUMBER LICENSE TYPE 13 BUS. LIC # COMPANY NAME I E -MAIL FAX Q STREET ADDRESS 00 e so CITY, STATE, ZIP ` 1 k_)�05C ^ ^ j- (V V �BUS. PHONE 4&_997 a ARCHITECT /ENGINEER NAME LICENSE NUMBER LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTK 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 DECKlPORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT E] YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE- APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY` '` - TOTAL VAL TION: PLANNING APPL # [:]NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I e property wrier or authorized agent to act on the property owner's behalf. I have read this application and the information I have I distort I hav ead scription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating uildi cons ction. I or' r resentatives of Cupertino to enter the above- identified property for inspection purposes. Signature of Applicant/Agent: Date: all— ?I— — / S SUPPLEMENTAL INFORMATION REQUIRED FLAN CHECK TYPE', 'RQITING SLIP OVER +THE COUNTER I,�C PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building _ ,BUH.DING [[[ permit for new building. -� =❑ EXPRESS ..t PLANNINGfPLt1N 12EVIEW - _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑•'STANDARD ❑'.;PUBLIC WORKS . form if any Hazardous Materials are being used as part of this project. LnRGE ❑+`FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR ❑ sANITARxsEH EHDisTRICI submittal of Building Permit application. ❑. ENVIRONMFNTALHEALTit'! BldgApp_201 1. doc Devised 06121111 °lN CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408- 777 -3228 Fax: 408- 777 -3333 JOB ADDRESS: li PERMIT # OWNER'S NAME: PHONE # 69 - '?'' GENERAL CONTRACTOR: Mucv -tt� Cavi54 , BUSINESS LICENSE # ADDRESS: k 00 � TACv SOS .1- CITY /ZIPCODE: S40 05G C4- 1 /e- *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) 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 Please check applicable subcontractors and complete the following information: Date ner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE ## Cabinets & Millwork P4A�J C-Ab 1�%T Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood lass / Glazing _ C—t 1 eA 3 - 41F -4� Heating ( t M Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ner / Contractor Signature Date -11 1l CALOREEN RESIDENTIAL CHECKLIST ® MANDATORY ITEM r.� � CUPERTINO COMMUN TY DEVELOPMENT DEPARTMENT ^ BUILDING DIJ48IOR!' i Buildi CG�aEiLa'9r�1® ALBERT LVADOR, P.E., C.B.O., BUILDING OFFICIAL Building Department I, r, - ' 10300 TO RE AVENUE ^ CUPERTINO, CA 95014 -3255 i E. t DEC 0 5 20A (408) 777 -II228 o FAX (408) 777 -3333 o building(a)cuoertina.ora PURPOSE* REVIFWrED t-UR CODE COMPLIANCE The 2013 CalGreen Code applies to additions or alterations of existing residentialil�a+it#irlip wh. khe ad 6"/ or alteration increases the b ilding's conditioned area, volume, or size and also applies to all new low -rise residential buildings, high -ris residential buildings, or both. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: ate � llct °d>►C Project Address: o Project Description: & Instructions: 9 . The Owner or the Owns Green Building Standai planned and implement 2. The licensed professior 2 of this checklist, sign!, checklist printed on the 3. Prior to final inspection; and sign and date Sect completed form to the E Z U, �1 shall imploy a licensed professional experienced with the California !Comi,to, verify and assure.that all required work described herein is property in the project. , in collaboration with the owner and the design professional shall initial Column d date Section 1 - Design Verification at the end of this checklist and have the ?proved plans for the project. the Building Department, the licensed professional shall complete Column 3 n 2 - Implementation Verification at the end of this checklist and submit the Iding Inspector. FEATURE OR MEASURE 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented tol manage storm water drainage during construction. 6.106.3 Grading and paving. 'The site shall be planned and developed to keep surface water away fromuildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. 3 +e + w I r .i y rw Column 2 Column 3 Project Verification �auirements Page I of 5 1 CalGreen 2014.doc revised 11104114 A 6 4.201.1 Low -rise residential buildings shall meet or exceed the minimum standard design required by the CaBfomia Energy Standards. 4.303.1 Water conserving plymbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following: j ® 4.303.1.3.2 Water Closete. 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. ® 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than i0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerhea ds. • 4.303.1.3.2 Multiple Show' erheads 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 gallon' per minute at 80 psi, or the shower shall be designed to allow only one !shower outlet to be in operation at a time. • 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucetsshall 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. ® 4.303.1.3.2 Lavatory faucIeta 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. ® 4.303.1.4.3 Metering fauck ets. Metering faucets when installed in residential buildings shall n' t deliver more than 0.25 gallons per cycle. ® 4.303.1.4.4 Kitchen Faucli ts. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallon per minute at 60 psi. Kitchen faucets may temporarily increase the floI 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 ati60 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 sndards referenced in Table 1401.1 of the California Plumbing Code. la 0 `bi ❑ IN Page 2 of 5 1 CalGreen 2014. doc revised 11104114 a C. 4.304.1 Irrigation controllers: Automatic irrigation systems installed at the time of final inspection shall be weather- based. a i ® 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 6ntrollers 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. 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. C(� astei�liuctron Disposal a'nd' Recycling 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall be submitted for approval to the enforcing agency. j 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. 01 4.503.1 General. Install only, a direct -vent sealed - combustion gas or sealed wood - burning fireplace, or a sealed woodstove. m r OWN 4.504.1 Covering of duct openings and protection of mechanical equipment during construction. Duct openings and other related air 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 K compliant with VOC limits. 4.504.2.3 Aerosol paints and 'coatings. Aerosol paints and other coatings shall be compliant with product1weighted MIR Limits for ROC and other toxic compounds. Page 3 of 5 r CalGreen 2014.doc revised !1104/14 Q 4.504.2.4 Verification. Documentation shall be provided to verify that ❑ compliant VOC limit finish materials have been used. 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 ❑ Materials list or be certified udder the Resilient Floor Covering Institute (RCFI) FloorScore program. i 4.504.5 Composite wood pro {ducts. Particleboard, medium density fiberboard (MDF), and hardwo6d plywood used in interior finish systems shall ❑ ❑ comply with low formaldehyde emission standards. m 4.505.2 Concrete slab found#tion. Required vapor retarders and capillary ❑ ❑ 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 ❑ ❑ materials used in wall and floof framing is checked before enclosure. j L - Int�1liw�l ' s Q�i PJ$� �'iaus r W7 . M 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the ❑ building are provided in every bathroom. 4 I lll5 'n 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. a 3. Select heating and cooling equipment according to ACCA 36 -5 (Manual S) or equivalent. INSTALLER AND SPECIAL INSPECTOR QUALIFICATIONS Nk (� *F fil cad,,.mq"s^. V w 702.1 Installer training. HVAC system installers are trained and certified in ❑ ❑ 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 ❑ ❑ discipline they inspect and verify. , 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 ❑ Implementation agency which show substantial I conformance, verification shall be submitted to the Building Department after Implementation of all required measures and prior to final inspection approval. Page 4 of 5 i ' CalGreen 2014.doc revised 11104114 Project name: Project Address: Project Description: REEK SIGNATURE DECLARATIONS Nnw AIMA1'nn t. "Afim4a] fir; i SECTION I ® DESIGN VERIFICATION I 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 e f Cupertino. net's Signature Date 9,0HIT Gv(z.T U Owner's a (Please P ' 2i / -/ 11)6igh'Professio ignature Date Design Professional's flame (Please Print) A Signature of License Professio responsible Rd CalGreen compliance Date ame o License Professional responsible for CalGreen compliance (Please Print) Phone i 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 2013 California Green Building Standards Code as adopted by the City of Cupertino. i Signature of License Professional responsible for CalGreen compliance Date I Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen 2014.doc revised 11104114