Loading...
HomeMy WebLinkAbout12080002CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10139 BYRNE AVE I CONTRACTOR: ZICOVICH BUILDERS INC I PERMIT NO: 12080002 OWNER'S NAME: SMITH ROGER C AND GAIDIES-SMITH BRE I I75I0 FARLEY RD WEST I DATE ISSUED: 12/14/2012 OWNER'S PHONE: 4088020721 1 LOS GATOS, CA 95030 1 PHONE NO: (408) 399-0606 1 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor dv ( X14lDate i 1 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. BUILDING PERMIT INFO: BLDG r— ELECT PLUMB r— MECH �r RESIDENTIAL COMMERCIAL JOB DESCRIPTION: CONSTRUCT NEW TWO STORY SINGLE FAMILY DWELLING (4004 SQFT)WITH ATTACHED GARAGE(667 SQFT)&COVERED PORCHES(187 SQFT)&BASEMENT CELLAR(430 SQFT) I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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: 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. Addi tonally, th pplicant understands and will comply with all non o t so rce r g lations r t e Cupertino Municipal Code, Section 9.18. JZ G Signature Date ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date APN Number: 35711009.00 Valuation: $800000 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: L%N j�F%—G� Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertin unicipal Code, Chapter 9.12 and the Health S etyAde, Vons 255 2 33, and 25534. Owne ut it. c Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10139 BYRNE AVE CONTRACTOR: ZICOVICH BUILDERS PERMIT NO: 12080002 INC OWNER'S NAME: SMITH ROGER C AND GAIDIES-SMITH BRE 17510 FARLEY RD WEST DATE ISSUED: 12/14/2012 OWNER'S PHONE: 4088020721 LOS GATOS, CA 95030 PHONE NO: (408) 399-0606 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL License Class Lie. # 0700 CONSTRUCT NEW TWO STORY SINGLE FAMILY Contractor Date f fo (7j DWELLING (4004 SQFT)WITH ATTACHED GARAGE(667 I hereby affirm that I am licensed under the provisions of Chapter 9 SQFT)&COVERED (commencing with Section 7000) of Division 3 of the Business & Professions PORCHES(] 87 SQFT)& BASEMENT CELLAR(430 SQFT) Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: REVISIO #1- REVISE OPENING ON ENTRY DOOR FROM 36" TO I have and will maintain a certificate of consent to self -insure for Worker's �� - , ; TC -9/10/2013 Compensation, as provided for by Section 3700 of the Labor e loo ea: Valuation: $800000 performance of the work for which this permit is issued. l have and will maintain Worker's Compensation InsurQ APN Num► 5711009.00 Occupancy Type: Section 3700 of the Labor Code, for the performance o work for which this "t permit is issued. 00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY F OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may ac a against said City in consequence of the Additi ly, the app ' t understands and will comply grantinVpoit Issued by: Date: with alla reg ons per t pertino Municipal Code, Section 9.18. /O RE -ROOFS: Signatu Date t 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(a) should I store or handle hazardous 1 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 t uperti unit' al Code, Chapter 9.I2 and 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 the Health & Satety Code, Sec on 2 05 33, d 25534. Owner or authorized agent 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, 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI 0 REVISION /DEFERRED ORIGINAL PERMIT # ( N 6 tV0 2/ PROJECT ADDRESS 0 � � APN # OWNERNAME ( PHONE E-MAIL 5 ��j� STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ O�/WN��E/R/-BBUUILDER El OWNER AGENT 1:1 CONTRACTOR 1:1 CONTRACTOR AGENT 1:1 ARCHITECT El ENGINEER 1:1 DEVELOPER 1:1 TENANT CONTRACTOR NA7 `^' t ✓i 1 v 1 LICENSE NUMBER LICENSE TYPE BUS. LIC N COMPANY NAME E-MAIL FAX ( l 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 r 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 AREAESECOND DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH # DWELLING UNITS: ISUNIT ❑ YES SECOND STORY ❑ YES B? NO ADDITION? []NO Ilk PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REC ED Y * 5� o- TOTAL VAL N: PLANNING APPL S f-1NOPLANNING APPROVAL LETTER EICHLER HOME? ❑ NO �^ By my signature below, I certify to =hn of the fol wing: I the property caner or authorized agent to act on the property owner's behalf. I have read this application and the information I ve pr ided i correct. h e read the cription cf Work and verify it isacc ate. I agree to comply with all applicable local ordinances and state laws relating b it ng co truction I thorizf r sentatives of Cupertino to enter thegab e -i miffed property for inspection purposes. Signature of Applicant/Agent: Date: + �� 3 SUPPLEMENTA FORMATIO REQUIRED ` �L cKrpE�; ,.' MaPi�,.; aioiicuvG"snip New SFD or Multifamily dwe ings: Apply for demolition permit for C� , existing building(s). Demolition permit is required prior to issuance of buildin OVER TAE COIIl�TER BT}ILDIPIGPLANREVIEW permit for new building. �, ExPRrss C3 PT ANNINGELfiNREVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑: STANDARD'S.' pt LcyvoRxs ' fo_rm if any Hazardous Materials are being used as part of this project.t2 ❑, �d " =f�.P - ti � . '� LARD$ x FIREDEPT E _ Copy of Planning Approval Letter or Meeting with Planning prior to rKnroli'i' s "` SANfrA�tl SEAR DISTRIC¢ submittal of Building Permit application. ! ❑ ,�� .=ENViROIVMENTAL HEAiTFt. B1dgApp 2011.doc revised 06/21/11 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(a1cupertino.org ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 1013cC_�4b-w_ Ave APN OWNER NAM . _ X / U ` E -MAI I� ellk• ajP �'T//�1 (,(/ STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAM/'� , ��%/� +07 ZZ E -MA[ STREET ADDRESS CITY, STATE, FAX OWNER ❑ OWNER -BUILDER ❑ O ER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME i LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP 3 PHONE ARCHITECT/ENGINEER NAMELICENSE NUMBER BUS. LIC # COMPA!!!BPZ E-MAIL , FAX �kac 1 STREET ADDRESS T STATE, 711 W-,352/ 4 Z DESCRIPTION OF WORK ,� /� A /� Dy EXISTING USE PROPOSED UV_ CO SV. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG ,AREA NEW FLO DEMO AREA �!� 7� AREA TOTAL NET AREA ���� ✓�`% `'(�/ . i �/ P-3 V /j :/ D W III BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA /� v ' ( v PORCH AREA DECK AREA TOTAL DECK/PORCII AREA GARAGE AREA: DETACH ATTACI I d DWELLING UMTS: f IS A SECOND UNIT YES SECOND STORY YES IBEING ADDED? O ADDITION? []NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF E BLDG AN ❑ YES RECE Y: TOTAL VALUATION: PLANNING APPLH []NO PLANNING APPROVAL LETTER E LER HOME? ❑ C -J By my signature below, I certify to each JNe folio g: I am the property o er o authorized agent to act on the property owner's behalf. I have read this application and the information I have ovi corzect. I have read the scrip' Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b Idin nstruction. I aut sen Iv of Cupertino to enter the above-ide' led propel for inspection purposes. Signature of Applicant/Agent: e: • y%, / SUPPLEMENTAL INF01 T N REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER BUILDINGPLAN REVIEW V New SFD or Multifamily dwellings: Ap y for demolition permit for existing building(s). Demolition permit is r Hired prior to issuance of building / permit for new building. EXPRESS PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ���❑(((''' t�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. MAJOR SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BddgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO Fm_� FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10139 Byrne Ave DATE: 08/01/2012 REVIEWED BY: Sean PC FEE ID APN: BP#: 'VALUATION: 1$1,000,000 ^'PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? Yes • No PENTAMATION 1 R3SFDW PERMIT TYPE: 14 WORK Construct new two story SFDWL 4004 sq ft with attached arae 667 sq ft and covered porches SCOPE (187 sq ft) and basement cellar (430). OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.L PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 4, $ 08.71 IR3PLNCK $3,754.94 IR3INSP $0.00 PME Plan Check: $0.00 Permit Fee: $3,754.94 Suppl. Insp. FeeiS Reg. © OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 4,858 $3,108.71 $3,754.94 1 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School 71.,.. d ..b. 1 71.....n Fn— ..rn A-11 — 11,n nonilnhlo and nro nnhr nn octimata. Cnntart tho Dant far addn'l U]rn_ FEE ITEMS (Fee Resolution 11-053 Eff 711/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,108.71 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,754.94 Suppl. Insp. FeeiS Reg. © OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR 1 # newunits $595.41 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: 1PLLONGR $631.54 Select a Non -Residential Building or Structure i Strong, Motion Fee: 1BSEISMICR $100.00 Select an Administrative Item t 134gStds Commission Fee: 1BCBSC $40.00 SUBTOTALS: $8,230.60 $0.00 TOTAL FEE: $$, 30.60 Revised:' 07/01/2012 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: 3L /' ; IIV-e PERMIT # /20 8(J Cj OWNER'S NAME: ='h i' PHONE # G' ;% GENERAL CONTRACTOR: V z;C L 'Z tett c .BUSINESS LICENSE # ADDRESS: >G S� L)� *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date Owder / Contractor Signature /�7 ' t Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owder / Contractor Signature /�7 ' t Date 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: / r l 1` ` i j =. PERMIT # OWNER'S NAME: Cabinets & Millwork PHONE # t ., GENERAL CONTRACTOR: V ' � ', ,r r.. BUSINESS LICE NSE �3 ADDRESS:' Electrical CITY/ZIPCODE: *Our municipal code requires alf businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE .# Cabinets & Millwork Cement Finishing YDllii 5::7- ::7- ✓ Electrical ' j G j23�jr� P4 ✓ Excavation Fencing Flooring / arpeting y i Linoleum Wood ✓ Glass / Glazingp�S 7 V 5V v Heating Si�et* al f �� ✓ Insulation Ins 4 �s Landscaping Lathing ,� A/,, 0l Cfkj I ,MVI 3 NS711frl Z Y-3 3 7J Masonry Painting / Wallpaper Paving m ✓ Plastering ✓ Plumbing I� k m inn Z 60q - ✓ Roofing i L Septic Tank ✓ Sheet Metal a �� �- Sheet Rock V h 0gi I ✓ Tile Owier / Contractor Signature 'Date INSTALLATION CERTIFICATE CF-611-MECII-04 Space Conditioning Systems, Ducts and Fans (( j j� y + Page 1 of 2) ��lt'1 G"j�" Y... Site Address:Enforcement gene Permit Number: Space Conditioning Systems Fleeting Equipment A� E(furcncy 1 Equip (AFF f Type � ARF i t: of esc )' � (package- ('FC Certified Mfr, Name Reference identical (>C•I.-I R heat pump) and Model Number ( Number z � Systems value)' i t-------- ------------ -- r— __---------- ---------- Cooling _ _Cooline; Equipment i)uct } '� Location (attic- i crawl- Nearing Heating space, Duct Lnad Capacity i etc.) R -value 1 (Btu/hr) (Btu hr) i Equip _ _ fSFE.R IL _ i ype 1. 10 pi ole( t is new ( onsirurtion, see r oomores to Nianclar•cis I ahie 1.)1-H and l ahte 15 l -C :Jnr duct ceiling alternative coiripliancc. 2. ARI Reference Number cart be found hr• entering the equipment model nuniher at hllp:11II iv m•idirectoii,.orgiar•if'ac.phpkt 3. Lisled effic•iencv on this page must be ,greater than or equal (>) to the valuc shown on the CF- iR,Iorin. 4. When ('F• -0R is rderence it is also applicable to the CF- l R. CF -1 R -AA or CF- IR -AL T A13.BOXES MUST BE CHECKED TO BE A VALiD FORM s� 10-9 1 13, HVAC equipment is certified by the California Energy Commission, 50(h); Heating and/or cooling loads calculated in accordance with ASHRAE. SMACNA, or ACOA. 500)- Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of § i 12(c). LJ §150(j)-') Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 2008 Residential Compliance Fornis August 2009 Fffiuenca Duct Equip I fSFE.R I Location i ype andFi.F:Ri (attic, 1 (package ', 4 of s crawl- ( ('Doling Cooling heat i CCC Cenified'Wr. Name ARI Reference f identical I r>( F -IR space, Duct Load I Capacity �iumPi and 'Model Number_ r� �( t tiI II L'.f;h/`t1'(`C1 vumb/Ier - � �L�k_ Systems value)'_ etc.) j�, t Iii R—value 4r, (Btu/hr) f 041u/hr) � t'7t11-� 1tiA _._ 41t � (' G ' i 2q 0 f I 1. 10 pi ole( t is new ( onsirurtion, see r oomores to Nianclar•cis I ahie 1.)1-H and l ahte 15 l -C :Jnr duct ceiling alternative coiripliancc. 2. ARI Reference Number cart be found hr• entering the equipment model nuniher at hllp:11II iv m•idirectoii,.orgiar•if'ac.phpkt 3. Lisled effic•iencv on this page must be ,greater than or equal (>) to the valuc shown on the CF- iR,Iorin. 4. When ('F• -0R is rderence it is also applicable to the CF- l R. CF -1 R -AA or CF- IR -AL T A13.BOXES MUST BE CHECKED TO BE A VALiD FORM s� 10-9 1 13, HVAC equipment is certified by the California Energy Commission, 50(h); Heating and/or cooling loads calculated in accordance with ASHRAE. SMACNA, or ACOA. 500)- Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of § i 12(c). LJ §150(j)-') Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 2008 Residential Compliance Fornis August 2009 iNSTALLAT'ION CERT'IFICAT'E CF-6R-MECII-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2 Site Address Enforcement Agency: Permit Number-. Ducts and Fans § I§ I - n): Duct and Fans L I. All air -distribution system ducts and plenums installed, seated and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5: supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be scaled with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181. U1, 181 A. or UT, 181 B or aerosol sealant that incets the requirements of UL 723. If mastic or tape is used to seal openings greater than 14 inch, the oration of mastic and either mesh or tape shall be used: and EI . Building cavities, support platfomis for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities anti support platforms shall not be compressed to c se reductions in the cross-sectional area of the ducts. 2D. Joints art(] scams of duct systems and their components shall not be scaled with cloth back rubber adhesive du apes unless such tape is used in combination with mastic and draw hands. 7. Exhaust fan systems have back draft or automatic dampers. 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually oper cd dampers. Er 9. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall he protected as above or painted with a coating that is wa r retardant and provides shielding from solar radiation that can cause degradation of the material. 10. Flexible ducts cannot have porous inner cores. DECLARATION STATEMENT • i certify under penalty of perjury, tinder the laws of the State of California, the information provided on this form is true and correct, • 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction. or an authorized representative of the person responsible for construction (responsible person). • 1 certify that die installed features, materials, components. or manufactured devices identified on this certificate (the installation) contorins to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • 1 reviewed a copy of the Certificate of Compliance (CF -1 R) form approved by the enforcement agency that identifies the specific requirements for the installation. 1 certifv that the requirements detailed on the CF -IR that apply to the installation have been met. • I wiil ensure that a completed, signed copy of this installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to he included with the documentation the builder provides to the building owner at occupancy. Company iNamc. ( Installing Subcontractor or General Contractor or Bullder/owner) _ Re onsible Person's Name:I Responsible Person's Signature: qq CSLB License: 2008 Rectclenhal Compliance Forms Date i J on With Company (Title): { p r r L-- C:k ) August 2009 A'. CUPERTINO 2010 CALGREEN RESIDENTIAL CHECKLIST — MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 9501 5 (408) 777-3228 - FAX (408) 777-3333 - buddin AA PURPOSE: I r Nov 5 2012 The 2010 CalGreen Code applies to all newly constructed hotels, mo s, lag rouses,'dwellings, dormitories, condominiums, shelters, congregate residences, employee housing, factory- ul nd other types of swellings with sleeping accommodations and new accessory buildings associated with such uses. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: Gaidies-Smith Residence Project Address: 10139 Byrne Avenue Project Description:, New Two -Story, Single Familv Residence Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2010 California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design -professional shall)hAa"'IiCal irict 2 of this checklist, sign and date Section 1 - Design Verification .at the end of this checit checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional Shan compLeto Column 3 and sign and date Section 2 - Implementation Verification at the end of thischecklist and- submit the completed form to the Building Inspector. Column 2 o umn 3 MANDATORY FEATURE OR MEASURE Project Verification Re uirements ., .1 PLANNING AND DESIGN Planning and Design - Site Preservation 4.104.1 A site plan and inventory of the site is developed and used to minimize site disturbance in order preserve desirable existing natural resources and ® ❑ minimize future adverse effects on the proposed structure. Planning and Design - Site Development 4.106.2 A plan is developed and implemented to manage storm water El drainage during construction. 4.106.3 The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. Page 1 of 5 CalGreen 2010.doe revised 08/27/11 I .2 ENERGY EFFICIENCY General 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. A4.3 WATERAND CONSERVATION Indoor Water Use 4.303.1 Indoor water use shall be reduced by at least 20 percent using one of the follow methods. ® Water saving fixtures or flow restrictors shall be used per Table 4.303.2. ❑ A 20 percent reduction in baseline water use shall be demonstrated per As of 7/01/2011 Table 4.303.1. 4.303.2 When using the calculation method specified in Section 4.303.1, multiple showerheads shall not exceed maximum flow rates. As of 7/01/2011 4.303.3 Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with specified performance requirements. As of 7/01/2011 Outdoor Water Use 4.304.1 Automatic irrigation systems installed at the time of final inspection shall be weather -based. A4.4 MATERIAL Enhanced Durability and Reduced Maintenance 4.406.1 Joints and openings. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.408.2 Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall be submitted for approval to the enforcing agency. Building Maintenance and Operation 4.410.1 An operation and maintenance manual shall be provided to the building occupant or owner. Page 2 of 5 CadGreen_2010.doc revised 08/27/11 Fireplaces 4.503.1 Install only a direct -vent sealed -combustion gas or sealed wood- ® ❑ burning fireplace, or a sealed woodstove. Pollutant Control 4.504.1 Duct openings and other related air distribution component openings ❑ shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks shall be compliant with VOC and ® ❑ other toxic compound limits. 4.504.2.2 Paints, stains and other coatings shall be compliant with VOC limits. ® ❑ 4.504.2.3 Aerosol paints and other coatings shall be compliant with product ® ❑ weighted MIR Limits for ROC and other toxic compounds. 4.504.2.4 Documentation shall be provided to verify that compliant VOC limit ® ❑ finish materials have been used. 4.504.3 Carpet and carpet systems shall be compliant with VOC limits. ® ❑ 4.504.4 Fifty (50) percent of floor area receiving resilient flooring shall comply with the VOC-emission limits defined in the Collaborative for High Performance ® ❑ Schools (CHPS) Low -emitting Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall comply with low formaldehyde ® ❑ emission standards. Interior Moisture Control 4.505.2 Vapor retarder and capillary break is installed at slab on grade foundations. ® ❑ 4.505.3 Moisture content of building materials used in wall and floor framing is ® ❑ checked before enclosure. Page 3 of 5 CalGreen_2010.doc revised 08/27/11 Indoor Air Quality and Exhaust 4.506.1 Exhaust fans which terminate outside the building are provided in ® ❑ every bathroom. Environmental Comfort 4.507.1 Whole house exhaust fans shall have insulated louvers or covers which close when the fan is off. Covers or louvers shall have a minimum ❑ ❑ insulation value of R-4.2. 4.507.2. Duct systems are sized and designed and equipment is selected using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or ® ❑ 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 OQUALIFICATIONS Qualifications 702.1 HVAC system installers are trained and certified in the proper installation ® ❑ of HVAC systems. 702.2 "rhe Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the discipline they inspect ® ❑ and verify. Verifications 703.1 Verification of compliance with CALGreen may include construction documents, plans, specifications, builder or installer certification, inspection reports, or other methods acceptable to the enforcing agency which show ® ❑ substantial conformance. Implementation verification shall be submitted to the Building Department after implementation of all required measures and prior to final inspection approval. Page 4 of 5 CalGreen_2010.doe revised 08/27/11 Project Name: Project Address: Project Description: CALGREEN SIGNATURE DECLARATIONS Gaidies-Smith Residence 10139 Byrne Avenue New Two -Story, Single Family Residence SECTION 1 — DESIGN VERIFICATION Complete all lines of Section 1 —"Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2010 California Green Building Standards Code as adopted*y the City of Cupertino. 1_ - I .J Owners��{�(-t Owner's Name (Please Print) Design Professional's Signature Michael Rowe (Britt -Rowe) Design Professional's Name (Please Print) Signature of License Professional responsible for CalGreen compliance Name of License Professional responsible for CalGreen compliance (Please Print) Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION 9 . I zY Date Date Date Phone 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 iosmicted thew rl a YwasoT3tru ed20rnr S' re f License es Name of License Professior received sufficient documentation to verify and certify that the project identified ce with this Green Building Checklist and in accordance with the requirements of Standards Code as adopted by the City of Cupertino. ----------- &/�/ rq responsible for CalGreen compliance I responsible for CalGreen compliance (Please Print) I crams CL . C' o-v+x Phone Page 5 of 5 CalGreen_2010.doc revised 08/27/11