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14050030CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7783 LILAC WAY CONTRACTOR: QUALITY GENERAL PERMIT NO: 14050030 CONSTRUCTION OWNER'S NAME: FENG LI-CHIEN AND ALICE A 138 NIAGARA AVE DATE ISSUED: 06/09/2014 OWNER'S PHONE: 4089730584 SAN FRANCISCO, CA 94112 PHONE NO: (415) 336-5657 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL q Q a CONSTRUCT A ONE STORY ADDITION (504 SQ FT); NEW License Class__ Lic. # ! + 2 FRONT PORCH (28 SQ FT); INTERIOR REMODEL (162 SQ ' Contractor ��I I Date FT). I hereby affirm that I am licensed under the provisions of Chapter (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $95000 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: 35904009.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXP WORD IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D OF PE T 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 LA ALLED INSPECTI N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ^J granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source re ulation r the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with the CupertitWMunicipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 550 , 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued, 1 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, [ 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 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 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7783 LILAC WAY CONTRACTOR: FENG LI-CHIEN AND PERMIT NO: 14050030 ALICE A OWNER'S NAME: FENG LI-CHIEN AND ALICE A 10815 E ESTATES DR DATE ISSUED: 06/09/2014 OWNER'S PHONE: 4089730584 CUPERTINO CA, 95014-4533 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] CONSTRUCT A ONE STORY ADDITION (504 SQ FT); NEW License Class Lic. # FRONT PORCH (28 SQ FT); INTERIOR REMODEL (162 SQ FT). Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $95000 performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 35904009.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMITIBES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating building hereby to WITHIN DAYS OF PERMIT ISSUANCE OR to construction, and authorize representatives of this city enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYXOM LAST CALLED INSP ION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ` / e granting of this permit. Additionally, the applicant understands and will comply Issued by: Date. r ' with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. OWNER -BUILDER DECLARATION 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 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 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this �`�— L �� Owner or authorized agent: y Date: permit is issued. W I certify that in the performance of the work for which this permit is issued, 1 shall of 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 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 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 ,+.:�C.�s'%� Date ����� CONSTRUCTION PERMIT APPLICATION [1 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ✓' CUPERTINO (408) 777-3228 •FAX (408) 777-3333 • building(aDcupertino.orq ❑ NEW CONSTRUCTION IN ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS WAY AC APPNN # 351_ D/72/iI OWNER NAME I— (C44 I �FE PHONEi� I3 —otQ E-MAIL STREET ADDRESS S �� p_ y = *Td1T�f 7]�v (/��C Y r CITY, STATE, ZIP ( M FAX CONTACT NAME r u f] rJ PHONE A J O E MAIL` AS G // bZ��� TTE, STREET ADDRESS + Q �e� ..T yT/yr . f� ,( j❑SCrONTRACTOR CITY, STA go— ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR AGENT ❑ ARCHITECT 111 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAH, FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME�� LICENSE NUMBER G •l > f i0i• BUS. LIC # COMPANY NAME L G � L[ t.y E MAILL ( q L/'y o /l . `� ! _`C /�,r _ (/ 'f��1 \/ I.—ia �Y�. FAX STREET ADDO �� rJw�T/1e,Ft T p qy CITY, STATE, l�cf-- I PV 3 --- 6 / DESCRIPTION OF WORK 67 12--e-vll r -D tZzvt� �6 f✓t� �E APD t,p — rN (,-Q �' cul 3, — �2cmu I1 rA 14 YIU't EXISTING USE PROPOSED USE FA-*4Sim T�-PlL s(OVEII ... `? i "D� �EM�O CONSTR. TYPE v. # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) AREA l ;^i(^� (aA NEW FLOOR AREA ty Q —1REMOKITCHENE AREA ,$ TOTAL NET AREA 2 BATHROOM REMODEL AREA � O ^ REMODEL AREA O REMODEL AREA REMODEL PORCH AREA DECK AREA TOTAL DECK/PORCH AREAI GARAGE DETACH 3 ATTACH #DWELLING UMTS: IS A SECOND UNIT YES SECOND STORY YES BEING ADDED? O ADDMON? RO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # PLANNING APPROVAL LETTER IS THE BLDG AN[]YES EICHLER HOME? NO RECEIVED BY: TOTAL V.�cjJil� 013:.. �NO 7�'\" By my signature below, I certify to each of the following: I am the property owner or authorized agent to nerty owner's behalf I have read this application and the information I have provided is corrcct. I have read the Description of Work and veri Is accurate. I agree to comply with all applicable local ordinanccs and state laws relating to buil ' g cons coon. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: — Date: SUPPLEMENTAL INFORMATION REQU D PLAN CHECK TYPE ROUTING SLIP ❑ OVF THE COUNTER ❑ BIJnnHVG 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. 0 EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1:3 STANDARD El PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FmE DEP'r _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVHtONMENTALHEALTH D/J_/___ -I1 J__ -I n1P11111 Z0'I*l '70 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 7783 Lilac Way DATE: 05/05/2014 REVIEWED BY: Sean PC FEE 1D APN: BP#: 14050030 `VALUATION: 1$95,000 `PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? Yes No OTC? 0 Yes ©No PENTAMATION PERMIT TYPE: 1 R3SFDADD � WORK Construct a one story addition 504 sqft, new front porch 28 sqft, Interior remodel 162 sqft SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE 1D BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 498 $1,579.00 1ADDPLCK $1,284.00 1ADDINSP $0.00 PME Plan Check: $0.00 Permit Fee: $1,284.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 498 $1,579.00 $1,284.00 MECH, HOURLY 0 Yes G No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No MISC ITEMS Plan Check 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff' 7'1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,579.001= s. f. $418.00 Remodel, Other IREMRESOTH Suppl. PC Fee: Q Reg. Q OT F0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,284.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 O (D Work Without Permit? O Yes No $0.00 Advanced Planninp, Fee: IPLLONGR $69.72 Select a Non -Residential Building or Structure (D O i Strong Motion Fee: 113SEISMICR $9.50 Select an Administrative Item BldgStds Commission Fee: IIiCl3SC $4.00 SUBTOTALS: $2,946.22 $418.00 TOTAL FEE: 1 $3,364.22 Revised: 04/01/2014 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: TJX L PERMIT # r 3U OWNER'S NAME: L1 t t PHONE # 4-1-' 33 GENERAL CONTRACTOR: '. )BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: e Cl* "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 SUBCONTRACT RS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. -- I am not using any subcontractors: ignature Efate Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c)cupet no.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS �I ry L / / + � APN BP# OWNERNAME� _` �iIri /1 `''J'T"� OWNER ADDRESS T DESCRIPTION OF WORK: �H/ lrA V� *" 17Tc*,/ L 11« fZ4rwM A"xi L44 W_ We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) . I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. / ns v — 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. `�3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. y_{�4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. !/z- 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. L.6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. /7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. /--t-18. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04114/10 I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. /iT 0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide /—by VII laws and requirements that govern Owner -Builders as well as employers. Zita-2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's drivers license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the orooerty owners siqnature Property Owner's Signature: w-�'�.�-� ;, --�.�c,.--P Date: b/ Zf 1 Lam- ----------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owners drivers license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 CALGREEN RESIDENTIAL CHECKLIST — MANDATORY :,. , ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUIL CUPERTINO f ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL E "cam 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buddingt�cupertmo.org PURPOSE: The 2013 CalGreen Code applies to all newly constructed hotels, motels, lodging houses, dwellings, dormitories, condominiums, shelters, congregate residences, employee housing, factory -built housing and 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: Project Address: ,7 °� ! r V Project Description: 6Ar749T.uC-T arm Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design professional shall initial 2 of this checklist, sign and date Section 1 -Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. SU MIT TL Suilding ti> ("")kSF'-OANCE � J 1 � 2014 L� Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Re uirements PLANNING AND DESIGN Planning and Design - Site Development 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during construction. 4.106.3 Grading and paving. The site shall be planned and d keep surf, 6 away from buildings. Construction plans sh A ;rmft 94 site grad ,., ainage systfe urface water flows. Suilding ti> ("")kSF'-OANCE � J 1 � 2014 L� A4.2 - 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 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following: 4.303.1.3.2 Water Closets. The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank-type water closets shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank-type Toilets. El"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 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. ❑ 4.303.1.3.2 Multiple Showerheads serving one shower. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Y-4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less than 0.8 gallons per minute at 20 psi. ❑ 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas (outside of dwellings or sleeping units) in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. ❑ 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. ❑ 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, rm and shall meet the applicable standards referenced in Table 1401.1 of the California Plumbing Code. -' Outdoor Water Use 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the time of final inspection shall be weather -based. ❑ 4.304.1.1 Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as weather conditions change. ® ❑ ❑ 4.304.1.2 Weather -based controllers without integral rain sensors orL communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. A4.4 MATERIAL. AND RESOURCE Enhanced Durability and Reduced Maintenance 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. Construction Waste Reduction, Disposal and 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. Building Maintenance and Operation 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. .. .5 ENVIRONMENTAL QUALITY Fps 4.503.1 General. Install only a direct -vent sealed -combustion gas or sealed ® ❑ wood -burning fireplace, or a sealed woodstove. 1 Pollutant Control 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 ®-- ❑ compliant with VOC limits. 4.504.2.3 Aerosol paints and coatings. Aerosol paints and other coatings shall be compliant with product weighted MIR Limits for ROC and other toxic ® ❑ compounds. 3 4.504.2.4 Verification. Documentation shall be provided to verify that 4.505.2 Concrete slab foundation. Required vapor retarders and capillary ® compliant VOC limit finish materials have been used. breaks are also required to comply with CalGreen Section 4.505.2.1. /� 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with ® ❑ VOC limits._,. materials used in wall and floor framing is checked before enclosure. 4.504.4 Resilient flooring systems. Eighty (80) percent of floor area Indoor Air Quality and Exhaust 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the receiving resilient flooring shall comply with the VOC-emission limits defined in building are provided in every bathroom. the Collaborative for High Performance Schools (CHPS) Low -emitting Environmental Comfort Materials List or be certified under the Resilient Floor Covering Institute (RCFI) using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or FloorScore program. 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) 4.504.5 Composite wood products. Particleboard, medium density INSTALLER AND SPECIAL INSPECTOR QUALIFICATIONS Qualifications fiberboard (MDF), and hardwood plywood used in interior finish systems shall ®*.— comply with low formaldehyde emission standards. d Interior Moisture Control 4.505.2 Concrete slab foundation. 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 ®i materials used in wall and floor framing is checked before enclosure. Indoor Air Quality and Exhaust 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the building are provided in every bathroom. Environmental Comfort 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. ®yam 2. Size duct systems according to ACCA 29-D (Manual D) or equivalent. 3. Select heating and cooling equipment according to ACCA 36-S (Manual S) or equivalent. INSTALLER AND SPECIAL INSPECTOR QUALIFICATIONS Qualifications 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. F' Verifications 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 ® El 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. CALGREEN SIGNATURE DECLARATIONS Project Name: 14— Project Address: y f Project Description rrl ?rx .-�.. rsl -�^� �' 1 -GC' "' � . rr„°— fir° ✓L a c P SECTION 1 - DESIGN VERIFICATION Complete all lines of Section 1 —"Design Verification” and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Owner's Signature Owner's Name (Please Print) Design Professional's Signature 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 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 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. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance CUPERTINO Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-.3228 • FAX ( /_ � M -e -WI FI�l FF, Address -779-3 2, 777-3333 - buildingAcupertino,org Iax S�(S. PERMIT CANNOT BE FINALED AND'COMPLETED UNTIL THIS CERTIFICATE Blease refer to the attached California Civil Code Sections 1101.1 -1101.8 which are part of this Certificatiq.r 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. 3-0 Owner' Signature: `-- V_NDate: o Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Sign below and skip the rest of the form. g Owner Si nature: Date: Q60 Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply, Sign below and skip the rest of the form. Owner' Date; p L"! Go to No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. E Owner' Signature: Date: OtIlYes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101A through 1101.8 apply. Refer to the attached. y property is a single family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-compliant plumbing fixtures shall be replaced with water-consciving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ Mypropertyis a multifamily residential real property, See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or unprovements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-cornpliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ Myproperty is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. SB407 2014.doc revised 03/18114 On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I/We, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures have been replaced with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply Wlth the requirements as indicated in the table below. Owner's (or Owner Agent's) Signature: _ ,___z Date: //C /j Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2014, doc revised 03/18/14 Non -Compliant Water -Conserving Plumbing Fixture -Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 (Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets -- Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets - Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2014, doc revised 03/18/14 CALIFORNIA CIVIL CODE SECTIONS 1101.1-1101.8 Civil Code Division 2. Property Part 4. Acquisition of Property Title 4. Transfer Chapter 2. Transfer of Real Property Article 1.4. Installation of Water Use Efficiency Improvements ........ 1101.1 — 1101.8 1101.1. The Legislature finds and declares all of the following: (a) Adequate water supply reliability for all uses is essential to the future economic and environmental health of California. (b) Environmentally sound strategies to meet future water supply and wastewater treatment needs are key to protecting and restoring aquatic resources in California. (c) There is a pressing need to address water supply reliability issues raised by growing urban areas. (d) Economic analysis by urban water agencies has identified urban water conservation as a cost-effective approach to addressing water supply needs. (e) There are many water conservation practices that produce significant energy and other resource savings that should be encouraged as a matter of state policy. (f) Since the 1991 signing of the "Memorandum of Understanding Regarding Urban Water Conservation in California," many urban water and wastewater treatment agencies have gained valuable experience that can be applied to produce significant statewide savings of water, energy, and associated infrastructure costs. This experience indicates a need to regularly revise and update water conservation methodologies and practices. (g) To address these concerns, it is the intent of the Legislature to require that residential and commercial real property built and available for use or occupancy on or before January 1, 1994, be equipped with water -conserving plumbing fixtures. (h) It is further the intent of the Legislature that retail water suppliers are encouraged to provide incentives, financing mechanisms, and funding to assist property owners with these retrofit obligations. 1101.2. Except as provided in Section 1101.7, this article shall apply to residential and commercial real property built and available for use on or before January 1, 1994, 1101.3. For the purposes of this article: (a) "Commercial real property" means any real property that is improved with, or consisting of, a building that is intended for commercial use, including hotels and motels, that is not a single-family residential real property or a multifamily residential real property. (b) "Multifamily residential real property" means any real property that is improved with, or consisting of, a building containing inore than one unit that is intended for human habitation, or any mixed residential-coinmercial buildings or portions thereof that are intended for human habitation. Multifamily residential real property includes residential hotels but does not include hotels and motels that are not residential hotels. (c) "Noncompliant plumbing fixture" means any of the following: (1) Any toilet manufactured to use more than 1.6 gallons of water per flush. (2) Any urinal manufactured to use more than one gallon of water per flush. (3) Any showerbead manufactured to have a flow capacity of more than 2.5 gallons of water per minute. (4) Any interior faucet that emits more than 2.2 gallons of water per minute. (d) "Single-family residential real property" means any real property that is improved with, or consisting of, a building containing not more than one unit that is intended for human habitation. (e) "Water -conserving plumbing fixture" means any fixture that is in compliance with current building standards applicable to a newly constructed real property of the same type. (i) "Sale or transfer" means the sale or transfer of an entire real property estate or the fee interest in that real property estate and does not include the sale or transfer of a partial interest, including a leasehold. 1101.4. (a) -On and after January 1, 2014, for all building alterations or improvements to single-family residential real property, as a condition for issuance of a certificate of final completion and occupancy or final permit approval by the local building department, the permit applicant shall replace all noncompliant plumbing fixtures with water - conserving plumbing fixtures. (b) On or before January 1, 2017, noncompliant plumbing fixtures in any single-family residential real property shall be replaced by the property owner with water -conserving plumbing fixtures. (c) On and after January 1, 2017, a seller or transferor of single-family residential real property shall disclose in writing to the prospective purchaser or transferee the requirements of subdivision (b) and whether the real property includes any noncompliant plumbing fixtures. 1101.5. (a) On or before January 1, 2019, all noncompliant plumbing fixtures in any multifamily residential real property and in any commercial real property shall be replaced with water -conserving plumbing fixtures. (b) An owner or the owner's agent may enter the owner's property for the purpose of installing, repairing, testing, and maintaining water -conserving plumbing fixtures required by this section, consistent with notice requirements of Section 1954. (c) On and after January 1, 2019, the water -conserving plumbing fixtures required by this section shall be operating at the manufacturer's rated water consumption at the time that the tenant takes possession. A tenant shall be responsible for notifying the owner or owner's agent if the tenant becomes aware that a water -conserving plumbing fixture within his or her unit is not operating at the manufacturer's rated water consumption. The owner or owner's agent shall correct an inoperability in a water -conserving plumbing fixture upon notice by the tenant or if detected by the owner or the owner's agent. (d) (1) On and after January 1, 2014, all noncompliant plumbing fixtures in any multifamily residential real property and any commercial real property shall be replaced with water -conserving plumbing fixtures in the following circumstances: (A) For building additions in which the sum of concurrent building permits by the same permit applicant would increase the floor area of the space in a building by more than 10 percent, the building permit applicant shall replace all noncompliant plumbing fixtures in the building. (B) For building alterations or improvements in which the total construction cost estimated in the building permit is greater than one hundred fifty thousand dollars ($150,000), the building permit applicant shall replace all noncompliant plumbing fixtures that service the specific area of the improvement. (C) Notwithstanding subparagraph (A) or (B), for any alterations or improvements to a room in a building that require a building permit and that room contains any noncompliant plumbing fixtures, the building permit applicant shall replace all noncompliant plumbing fixtures in that room. (2) Replacement of all noncompliant plumbing fixtures with water -conserving plumbing fixtures, as described in paragraph (1), shall be a condition for issuance of a certificate of final completion and occupancy or final permit approval by the local building department. (e) On and after January 1, 2019, a seller or transferor of multifamily residential real property or of commercial real property shall disclose to the prospective purchaser or transferee, in writing, the requirements of subdivision (a) and whether the property includes any noncompliant plumbing fixtures. This disclosure may be included in other transactional documents. 1101.6. The duty of an owner or building permit applicant to comply with the requirements of this article shall be postponed for one year from the date of issuance of a demolition permit for the building. if the building is demolished within the one-year postponement, the requirements of this article shall not apply. if the building is not demolished after the expiration of one year, the provisions of this article shall apply, subject to appeal to the local building department, even though the demolition poxnit is still in effect or a new demolition permit has been issued. 1101.7. This article shall not apply to any of the following: (a) Registered historical sites. (b) Real property for which a licensed plumber certifies that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible. (c) A building for which water service is permanently disconnected, 1101.8. A city, county, or city and county, or a retail water supplier may do either of the following: (a) Enact local ordinances or establish policies that promote compliance with this article. (b) Enact local ordinances or establish policies that will result in a greater amount of water savings than those provided for in this article.