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12120108CITY OF CUPERTINO BUILDING PERMIT BUILDIlNG ADDRESS: 7852 BELKNAP DR CONTRACTOR: AVA CONSTRUCTION PERMIT NO: 12120108 OWNER'S NAME: SUBAGIO PUTU H AND MAR BRENDA M TRU 21060 HOMESTEAD RD APT 216 DATE ISSUED: 02/25/2013 OWNER'S PHONE: 4083156168 CUPERTINO, CA 95014 PHONE NO: (408) 387-0999 ❑ LIC + SED CONTRAC OR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lie. #� --� CONSTRUCTION OF TWO(2)STORY RESIDENCE (2739 ��„�d Contractor t/t.,� ��Date SQFT); GARAGE (420 SQFT);FRONT COVERED PORCH (56 SQFT) I hereby affirm that 1 am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions\ DEFERRED #1- TRUSS CALLS- ISSD OTC 3/14/2013 Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the folio I have and will maintain a certificate of consent to self-in�er'sCompensation, as provided for by Section 3700 of the Labor Code, for theperformance 4.FtFloorArea: of the work for which this permit is issued. Valuation: $500000 1 have and will maintain Worker's Compensation Insurance, 1 4-for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 36210042.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the2 Issued by: _1W Date: -:P-/,/ "� 7 granting of this permit. Additionally, the applicant understands and will comply with all non-point regulations per the Cupertino Municipal Code, Section 9.18. l / RE-ROOFS: Signature Date ` All roofs shall be inspected prior to any roofing material being installed. if a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (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 l 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 Cu lino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Section 550 , 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Date: Owner or authorized agent:' #*3 permit is issued. !� 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, 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. w'ork'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, ARCH ITECT'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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 •FAX (408) 777-3333 • building (:D ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI A3,REVISION /DEFERRED ORIGINAL PERMIT # 2-0 PROJECT ADDRESS APN # J 1 O (�J �E-MAIL l/ OWNERNAME \, PHONE STREET ADDRESS S CITY, STATE, ZIP FAX CONTACT NAME PHONE STREET ADDRESS CITY, STATE, ZIP �r^"T� r r FAX Q V— � S� '0 f ((ARCHITECT 4❑f ❑ OWNER ❑ OWNER-BuiLDER ❑ OWNER AGENT ❑ CONTRACTOR 1-1CONTRACTORAGENT ❑`` ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME p�� LICENSE NUMBER ` 0 „ LICENSE TYPE 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 ✓ 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 REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: 0 DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VALUATION: PLANNINGAP.PL# ❑NO PLANNING APPROVAL LETTER EICHLERHOME? ONO By my signature below, I certify to each of the wing: 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 co ct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ' roperty for inspection purposes. ordinances and stale laws relating to boding constru 'on. I authorize representatives of Cupertino to enter the above-entifi Signature of Applieant/Agent: / : Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SL[P ❑ 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 El STANDARD El PUBLIC WORKS To—nn 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_2011.doc revised 06/21/11 � t tC"Yy CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7852 BELKNAP DR CONTRACTOR: AVA CONSTRUCTION PERMIT NO: 12120108 OWN'ER'S NAME: SUBAGIO PUTU H AND MAR BRENDA M TRU 21060 HOMESTEAD RD APT 216 DATE ISSUED: 02/25/2013 OWNER'S PHONE: .4083156168 CUPERTINO, CA 95014 PHONE NO: (408) 387-0999 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class Lie. 9 C 1 � eloe.w CONSTRUCTION OF TWO(2)STORY RESIDENCE (2739 c _ Contractor SQFT); e / GARAGE (420 SQFT);FRONT COVERED PORCH (56 SQFT) 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 Sq. Ft Floor Area: Valuation: $500000 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: 36210042.00 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 0 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: p regulations per the Cupertino Municipal Code, Section a non -point n . RE -ROOFS: source,,, 9.18. � 'h 9. f ) v f.°"_„w Signature "° "T Date All 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. _r ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A” OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner ofthe property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (See.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. 1 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 Section 3700 of the Labor Code, for the perf6rmance of the work for which this the Health & Safety Code, Sections 5, 5533, and 25534. Owner or authorized agent: s - w°'°'° °' """ Date: permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, 1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must 1 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address _ 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city .and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO TEMPORARY CERTIFICATE OF OCCUPANCY FORM COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • building(a)cupertino.org APN BP #: , �j�, Ci. DATj PROJECT VALUATION: $ SITEj ADDRESS: % L1 Z I �Yl G� �� v e� `I^ C T 5Q � OWNER'S NAME: PHONE #: ❑ APPROVED WITH CONDITIONS` Signature .... ..... .. .......(.I.. FAX #: u or, s Signature: ........................... MAILING ADDRESS (if different from site address): .. R APPROVED WITH CONDITIONS" t er: S cam- CA -Cl`- d ❑APPROVED APPROVED WITH CONDITIONS` Signature: ......................................................... CO RACTOR: pp V X C ©''1 �� G 1' t (9 "•'\ PHONE #: FAX #: Cf6 C1 -14 C� -f C, CONTACT: PHONE #: 6F- FAX #: `T o q 5 Jr 5 I �\,, TFMPORARY CERTIFICATE OF OCCUPANCY INFORMATION BOND TYPE: ❑ SURETY BOND AMOUNT (1 % VALUATIONCODE [I CHECK F-1CASHBOND OF BOND: 5K min -10K max Sk � - (BLDBONDS] EDITION: TCO EXPIRATION FEE: $286.00/1110 TOTAL FEE: $ [1TEMPOCC] DATE (6 MONTHS MAX): USE TYPE OF CONSTR FLOOR AREA OCC LOAD LEVEL COMMENT 4Sinature:......... ire 0PPROVED Date:.. ❑ APPROVED WITH CONDITIONS` Signature .... ..... .. .......(.I.. u or, s Signature: ........................... Date:..4....e.. is ❑ APPROVED APPROVED WITH CONDITIONS" t er: ❑APPROVED APPROVED WITH CONDITIONS` r%TU=0 nP91ART1IM& i AGENCY APPRnVALS: /1 anningll PPROVED ❑ APPROVED WITH CONDITIONS` ..'.. ... ...... ..................... Date:..................... 4Sinature:......... ire 0PPROVED Date:.. ❑ APPROVED WITH CONDITIONS` Signature .... ..... .. .......(.I.. u or, s Signature: ........................... Date:..4....e.. is ❑ APPROVED APPROVED WITH CONDITIONS" t er: ❑APPROVED APPROVED WITH CONDITIONS` Signature: ......................................................... Date:...................... *CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property stating the list of items required to be completed for each individual Department before final occupancy can be granted. Include approximate completion dates for each item. The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or buildings complete and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration date specified. If this Temporary Certificate of Occupancy expires, the total amount of the bond may be forfeited and the non-compliance may result in an enforcement action. re:. Date: ........................ Signa:.............................................1V. Date:...................... This temporary certificate ensures that all fire protection an ife safety systems have been complet d, insp to ccessfuI[ tested and approved for the specific area of the building speci ve to provide a reasonable degree of saf t thT T--,,,' u nts from a and similar emergencies. Iuilding Official: ...................................1..................................Print:� �............ DEPARTMENT ACTION: After dete n, copies to: 1) applicant, 2)1 Tem Occ orm_2013.doc revised 717114 V, <I CUPERTINO NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(ftugertino.org El ADDITION ❑ ALTERATION / Ti Q REVISION / DEFERRED ORIGINAL PERMIT a PROJECT ADDRESS 7 _7 7"N a ^° WNER NAME P NE 9 a: "' E-MAIL STREET ADDRESS. . � , c�, CITY, STAT P / r / , ,°r ,I FAX CONTACT NAMEPHON MAIL v;r.11,1_1 Cam STREET ADDRESS,„ CITY, ST TF,ZIFk) FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER�� LICENSE TYPE �� BUS. LIC a ;40 COMPANY NAMEY C,. us'o t �pp o f CG z�) U �'g ( L. FAX STREET � CI STATE ZIP " `� PHONE �, /R�S / ARCHITECT/ENGINEER NA. ICE BUS. LIC a COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK — �7j IV, �� ��� r �'��s .✓� '.. EXISTING USE - PROPOSED USE 17) CONSTR. TYPE 11115 a STO S USES TYPE OCC. SQ.FT. VALUATION (S) EXISAT/ f�..._. �A LGG R �O/ �! 9 TOTAL VV ..J! �✓ V �I ,� 3 a 9 BATHROOM .-_............. REMODEL AREA / KITCHEN REMODEL AREA �/ OTHER REMODEL AREA v PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH J/_ ' VO [3A TTACH DWELLING UNITS IS A SECOND UNIT YES SECOND STORY BEINCADDED? ❑NO ADDITION? []NO IF YES, PRO VU:)F OPY PMAPPLICATIPLANNING © IS THE BLDG AN ElYES 7,, �`��1r`j���rffgr'��✓,��/j/,TOTAL VALUAT N. ETTER...... AL LOF APPLOa O PLANNING APPROVYES EICHLER HOME? + 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 Is fo : I authorize representatives of Cupertino to enter the above-identiliederty for inspection purposes. Signature of Applicant/Agent: --- — Date: SUPPLEMENTAL INFORMATION REQUIRED r,„,,�i,/,,�!�'+�+J"'1i+ki�`Ct�? I"�'��f1/�r�i� t����4�,� �, n”'a/,,RbII�'L(!itx,'S�+I,I'✓r�✓�r'%fill✓,%,rhl��!!` M3 li7,/.sr°ai"/G�r''r/j �����'fjtfi������;'`yN+ %!r fir!✓,! '�fi:f/! ..-. L�f/�7/fl f%/f��,//f/i� �%i i %r, 1 ifi' • ,/'Fi'rM 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. P g kr l } ,r , ,i flak i& a „,G h yr��° G i�(t�ft,,r�l/• Ff 1`1��r5,ri`P' 1/,,��+�, �� �f��/ /,. ! , F 1, ; ,•J ,�/ N++' i� � ���s�xr�k,�r' �; � � )9wlt �ru1�� ��/I� �'�! � ,�,r„ — Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sT Af +/ , /+ , 7irItBLIc}y7,ilD+ rf rr�y lrfl +✓% i�✓,ijJj+/ir' farm if any, Hazardous Materials are being used as pari of this project J r?!yy/ari�rf Fll, fr/Pi/ 6 xry r/WVr i ❑�aI:�,ItGE;+l,��r� /✓ r1K fli ^* d 1srl ❑� 1 �%� _ Copy of Planning Approval Letter or Meeting with Planning prior to i, r , �� �i� l� l �, /� f/l�flfr'//i�ONY ���/ l /f�FA 'i, tl , ' /// Pr ❑ MAJgR "?%y �ut��rFrz'�, ���f,1�y��r,�'1 ' 3� � ,�,�rd/J4 ''f 7A�uJ fi /r„ rr, S>w> submittal of Building Permit application. ly f jt fr1+r ' i�%i"�i/ � /i`` 1 /fi / ,/?Alalxax baSl�'y`4 �' // " +a�r,i�,r'G i, Y�yU'71�r��l:r��f����/�✓; ll�rr / /�, , ;i.; ❑ , ENVIRONA7E}�TAI>,IiEALTH"�� !'/f/, („ B1dgApp_201 Ldoc revised 06/21/11 L. , : CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 1AADDRESS: 7852 Belknap Dr DATE: 12/20/2012 REVIEWED BY: Sean APN: BP#: *VALUATION: 1$500,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes G No PENTAMATION 1 R3SFDW PERMIT TYPE: WORK. Construction of two story residence 2739 sq ft); Garage 420 sq ft); Front covered porch 56 sq ft). SCOPE $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.t; PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 3,215 $2,909.28 IR3PLNCK $2,934.32 IR3INSP $0.00 PME Plan Check: $0.00 Permit Fee: $2,934.32 Suppl. Insp. FeeQ Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 3,215 $2,909.28 Construction Tax: IBCONSTAXR $2,934.32 # newunits 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7-1/12,) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,909.28 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (D Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,934.32 Suppl. Insp. FeeQ Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 7 # newunits $629.29 c i"cc Work Without Permit? ® Yes C) No $0.00 Advanced Planning Fee: IPLLONCR $417.95 Select a Non -Residential Building or Structure i ,)'' 1,; Strong Motion. Fee: IBSEISAIICR $50.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $20.00 SUBTOTALS:; $6,960.84 $0.00 TOTAL FEEF $6,960.84 Revised: 10/01/2012 32E Landscaping Ordinance Appendix A APPENDIX A - LANDSCAPE WATER EFFICIENCY CHECKLIST 2010 S-25 IV< I k CC-D&A LANDSCAPE WATER -EFFICIENCY CHECKLIST Community Development Department 10300 Torre Avenue 408.777.3308/Fax 408.777.3333 Cupertino, CA 95014 planning@cupertino.org CUPERTINO http://cupertino.org/planrLin We �� ' — C�tlS� Applicant Name:Email: C —(W Project Site Address: kAce_ Phone: Total Landscape Landscape area: All the planting areas, turf areas, and water Area (square feet): features in a landscape installation. The landscape area does not include footprints of buildings or structures, sidewalks, driveways, parking lots, decks, patios, gravel or stone walks, Turf Area: 44 other pervious or non -pervious hardscapes, and other non- irrigated areas designated for non -development (e.g., open spaces and existing wildland vegetation). '-' Non -Turf Plant Are Turf: A ground cover surface consisting of non-native grass species that is customarily mowed. Annual bluegrass, Kentucky bluegrass, perennial ryegrass, red fescue, and tall Special Landscape Area: fescue are examples of cool -season turf grasses. Bermuda grass, kikuyu grass, seashore paspalum, St. Augustine grass, zoysia grass, and buffalo grass are warm -season turf grasses. Water Feature Wet Surface Area: If > 10% of landscaped area, water budget calcu- lation required with landscape project submittal. See reverse side for other definitions. NOTE: If landscape area exceeds 2,500 sq. ft., a landscape project submittal shall be required. If no landscaping is proposed, enter "0" above and proceed directly to the signature block at the bottom of this form. Landscape Parameter Requirements Project Compliance Turf Total turf area shall not exceed 25% of the landscape Yes ❑ No area, or 1,250 square feet, whichever is lesser in area o, Water budget calculation required with landscape project submittal] I Yes All portions of turf areas shall be wider than eight (8) feet. Turf (if utilized) is limited to slopes not exceeding 15%. Yes Non -Turf At least 80% of non -turf area shall consist of native or Yes ❑ No low water use plants. [If o, Water budget calculation require with landscape project submittal] Hydrazones Plants with similar water needs shall be grouped within I Yes ❑ No hydrozones. Each hydrozone shall be controlled by a [Plants can be grouped per separate valve. Table 14.15.050(C)] Irrigation System Systems shall be designed and maintained to minimize Yes ❑ No water waste (e.g., runoff, low head drainage, overspray). Low-volume irrigation shall be utilized in non -turf areas. Irrigation shall only occur between the hours of 8:00 pm [If no, Provide explanation on back] and 10:00 am Soil A minimum of eight (8) inches of non -compacted topsoil kYes ❑ No shall be available in planted areas. [If no, Provide explanation on back] Soil amendments, such as compost or fertilizer, shall be Yes C1 No appropriately added according to the soil conditions at the project site and based on what is appropriate for the [If no, Provide explanation on back] selected plants. Mulch A minimum two (2) -inch layer of mulch shall be applied Yes ❑ No on all exposed soil surfaces of planting areas, except in areas of direct seeding application (e.g. hydro -seed). [If no, Provide explanation on back] I am aware of available informational resources regarding native and low water use plants, irrigation efficiency, and other aspects of water -efficient landscaping. I certify that the information provided on this checklist is correct, and the installed landscape complies with the r reme of Ater 14.15. I also understand that any changes to the project will necessitate a new checklist. oC15rmpe'rfy owner or authorized representative Date 2010 S-25 IV< I k CC-D&A Appendix A Cupertino - Streets, Sidewalks and Landscaping 32F This checklist implements the requirements of Chapter 14.15, Landscape Ordinance, of the Cupertino Municipal Code. The responses provided will be evaluated to determine whether the proposed landscape is generally consistent with the ordinance's water -efficiency goals. Applicant Comments Use additional paper if necessary Staff Evaluation Staff Comments - Approved Not Approved Signature Date Select Definitions Hydrazone: A portion of the landscaped area having plants with similar water needs. A hydrozone may be irrigated or non -irrigated.` Low-volume irrigation: The application of irrigation water through a system of tubing or lateral lines and low-volume emitters such as drip and bubblers. Certain rotary emitters designed for highly efficient water distribution, and situated to irrigate low water use plants, may also be included in this definition at the discretion of the Planning Office. Low water use plant: A plant species whose demonstrated water needs are compatible with local climate and soil conditions such that regular supplemental irri ation is not required to sustain the plant after it has be- come established. Any species classified as "very low water use" and "low water use' by WUCOLS, having a regionally adjusted plant factor of 0.0 through 0.3, shall be categorically deemed a low water use plant. Native plant A plant indigenous to a specific area of consideration. For the purpose of this division, the term will refer to plants indigenous to the coastal ranges of Central and Northern California, and more specifical- ly to such plants that are suited to the ecology of the present or historic natural community of the project's vicinity. Special landscape"area: Ari area of the landscape dedicated solely to edible plants, areas irrigated with're cycled water, water features using recycled water and areas dedicated to active play such as parks, sports fields, golf courses, and where turf provides a playing surface. Turf: A ground cover surface consisting of non-native grass species that is customarily mowed. Annual blue- grass, Kentucky bluegrass, perennial ryegrass, red fescue, and tall fescue are examples of cool -season turf grasses. Bermuda grass, kikuyu grass, seashore paspalum, St. Augustine grass, zoysia grass, and buffalo grass are warm -season turf; grasses. Water feature: A landscape design element where open water performs an aesthetic or recreational function. Water features include ponds, fountains, waterfalls and artificial streams. Also includes spas and swim- ming pools that are ancillary to single-family, two-family and multi -family residential uses. Wet surface area: The surface area of that portion of a water feature that functions to contain water, such as the water surface of a swimming pool, spa, or garden pond. For a fountain or other feature with flowing water, wet surface area shall be measured as a two dimensional plane bounded by the perimeter of the area where water has been designed to flow. 2010 S-25