09050141CITY OF CUPEKI NO
BUILDING DIVISION PERMITS I�RIi'
....:..:..
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME:
ARCHITECTIENGINEER:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code. and my license is
in full force and effect.
License Class Lic• 8
Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used az public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance. also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
❑ 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
and Professions Code: The Contractor's License Law dotes not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. IL
however, the building or improvement is sold within one year of completion, the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
[11, aff'ii� ner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Cute:) The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt under Sec B & P C for this reason
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self -insure for Worker's Compcn-
an, as provided for by Section 3700 of the Labor Code, for the performanco of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as required by Section
5700 of the Labor Code, for the performance of the work for which this permit is issued.
Vly Workers Compensation Insurance carrier and Policy number are:
wrier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($ 100)
or less)
1 certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner to become subject to the Workers' Compens�Wn
Laws of California.
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
PERMIT ISSUE DATE
CONTROL NO.
BUILDING PERMIT INFO
ELECT PLUMB MECH
Job Description
INST ApBOR TRELLIS @MCCLELLAN RANCH
Sq. Ft. Floor Area
APN Number Occupancy Type
FMIG000C,000572 _
CONSTRUCTION LENDING AGENCY
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. C.)
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is
corecL 1 agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorise 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 in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS. _
S ---Z/ 2yfl
Signature of Applicant/Conuactor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
az defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes ❑NT_
Will the applicant or future building occupant use equipment or devices which
'L hazardous air contaminants az defined h the Bay Area Air Quality Management
rict?
❑ Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Cade, Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my responsibility to notify the occupant or the
requirements which must be met prior to issuance of a Certificate of Occupancy.
Owner of authorized
Date
7
l 'G
Issued bi
Re -roofs
Type of Roof
Required Inspections
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 rlaterials for inspection.
Signature of Applicant
All roof coverings to be Class "r'' or better
Date
-at -1
CITY OF
CUPEI�TINO
CITY OF CUPERTINO
GENERAI� BUILDING
PERMIT APPLICATION FORM
NOWN
I -/ -G) /I/
nqo,��
APN # _ kl(vC�C� �3 3670 C�
Date: 2 1 -- 2�dq
Building Address:` y 2 I �G C Q( a,�
��, � re '�M�� C Q
Mailing Address (if different from building address):
Owner's Name: C� C{ �� 1-A 41
Phone #:
HOA: (Exterior work only) Yes ❑ No ❑
If yes, provide letter from HOA
Contractor:
Phone:
Fax:
Contractor License #:
Cupertino Business License #:
Contact: D
Phone:
Fax:
Residential " Commercial
`r
Job Description: �f Fm a
c�,������ Fy��-
Building Pen -nit Info:
Bldg L/Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, I -B ❑ II/III/V-A ❑ 11/111 B, IV -HT, V- B
Cj/
V-- 3
Valuation: /00
Square Footage:
Project Size: Express [andard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
'oints Achieved:
For help, contact Build it Green at www.builditgreen.or
Revised 02/05/09
1. Use Low/No-VOC Paint
2. Use Low VOC, Water -Based Wood Finishes
3. Use Lowft VOC Adhesives
4. Use Salvaged Materials for Interior Finishes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
6. Use Exterior Grade Plywood for Interior Uses
7. Seal al Eosed t'A*Jaboard or MDF
6. Use FSC Certified Materials for Interior Finish
9. Use Finger -Jointed or Recycled -Content Trim
10. Install Whole House Vacuum System
N. Flooring
1. Select FSC Certified Wood Flooring
2. Use Rapidly Renewable flooring Materials
3. Use Recycled Content Ceramic Tiles
4. Install Natural Linoleum in Place of Vinyl
5. Use Exposed Concrete as Finished Floor
6. Install Recycled Content Carpet with Low VOCs
1 IAQ/Health pts
y=yes
21AQ/Health pts
y=yes
31AQ/Health pts
y=yes
3 Resource pts
y=yes
6IAQ/Health pts
y=yes
1 IAQ/Health pts
y=yes
41AQ/Health pts
y=yes
4 Resource pts
y=yes
1 Resource pts
y=yes
3 IAQ/Health pts
y=yes
B Resource pts
y=yes
. Resource pts
y=yes
4 Resource pts
y=yes
5 IAQ/Health pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y=yes
Total Points Available: // �t f 1 1401 1301 57
Total Points Project Received: S _ 2� 01 01 0
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Siddarth Kadlyala
Eagle Scout Leadership Service Project Proposal
Scout's name:
Address:
Telephone No.:
E-mail:
Unit No.:
District:
Local council:
Unit Leader's Name:
Address:
Siddarth Kadiyala
21103 Grenola Drive, Cupertino, CA 95014
(408) 253-6012 ,as nOlde I NUN JU au1�+ uru,u „4
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sidman123C�gmail.corUE�II �!w,ad 01 Ploy
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wr:1.,: "„��� uo adI
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Polaris _:!d )0
Santa Clara County
Ed Snyder
;30Nb1110?10 (INb S3400 ONS
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A
2298 Elkhorn Court, San Jose, CA 95125
Telephone No.: (408) 265-7232
Unit Advancement Committee person's name:
Court, Cupertino, CA 95014
10110 Adelheid Cour
Address:
27-
Telephone No.: (408) 255-7506 t
OF Fk,,, 0 J
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By. 20
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3
Siddarth Kadiyala
Project Description
1. Project Description
• Building and Installation of an arbor trE-llis
• Making an Orchard Mason Bee House
• Designing and building a park bench
I intend to do work on building an arbor trellis, and two other projects on the side. This will be in
McClellan Ranch Park, a small nature preserve owned and managed by the City of Cupertino, located at
22221 McClellan Rd, Cupertino, CA. As part of this :)rofect, I will build and install an arbor trellis near the
visitor center of McClellan Kt nch. We will grow wild grape and the Clematis flower along the trellis,
which will attract birds, and some'butterflies. I also, intend to build a park bench, which will be
strategically located underneath ihe�trellis, so birdwatchers will have somewhere to sit while enjoying
the nature. I also will make An Orchard Mason Bee house. This can be placed anywhere throughout the
park, and we will choose the location later. All these projects will enhance the habitat of the animals
nearby, and nature.
In front of the Visitor center, Nhere the trellis will be constructed
2
Siddarth Kadiyala
possibic area for bench
CD
1) Ueneflflng Gre-UP
The organization benefiting from this project is:
institution, school, or commur ity; McClellan Ranch Park
N
Name of religious
Telephone No.: (408) 777-3149
Rd.
Street Address: 22221 McClellan
City: Cupertino
State: CA
Zip Code: 95014
3
Siddarth Kadiyala
There are three main groups that benefit from this project.
The first one is the City of Cupertino, which is trying to add structures with grape vines that will
attract birds.
The second group that benefits is the publ c who can once again see and enjoy the birds in the
area, while being able to sit on a bench.
The third group that benefits is the birds a -id butterflies that like wild grapes, and the Orchard
Mason bees. They now have a place to rest on top of the trellis. They are attracted to wild
grapes, and the bees like Clematis. The Ori:hard Mason Bees will benefit, because they have a
place to stay.
This concept was discussed with my unit leade r on (Date): April 18, 2009
The project concept was discussed with the following representative of the group that will benefit
from the project. `
Representative's name:
Representative's Title:
Phone No.:
Date of Meeting:
4
Barbara Banfield
Naturalisi, City of Cupertino
(408) 777-3149
April 14, 2009
Siddarth Kadiyala
3. Project Details
The area under construction is about Sft. by 14 ft. The area is right in front of the visitor center and is on
4.6- �^, +h Dido ra rho nark_ near the entrance as shown in the picture here.
The area is near the entrance, on the left side of -:he cement path to the visitor center. It will be a Sft. by
14ft. area. There will also be another small area aff to the side where another group of scouts will be
making the Orchard Mason Bee House. The following Is a picture of the area, labeled with dimensions.
''3
6W
_.
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CO
�
_.A y'. V"
''3
6W
Dirnen->ions of area
The posts are 8ft. high and the distance between them is 6.5ft.
I plan to make a free standing arbor trellis. It will oe made
with three 4"x4" x 8' posts and different small thin pieces of
wood at the top. It will be made of pressure treated redwood.
All the brackets used will be galvanized steel. The cement will
go 18" deep into the ground. To the right is a diagram that
shows the plans for this trellis.
-T-
IF
r
1 -j—
�- -- 6.5' --+-- 6.5'
Trellis plans
I also intend to make an orchard Mason bee house it is simple and will
require only a few scouts to drill 5/16"holes in a 4"K4" piece of wood in a
predetermined pattern. orchard Mason bees are s nall, so they can fit in a
small hole. To the right is a picture of how an Orchard Mason bee house
will look like.
I also intend to make a bench. A simple design
is by assembling two 4"x4"x2' as bases, and a
plank on the top.
Siddarth Kadiyala
i
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orchard Mason bee house
Wood Costs ...;
At Home Depot, these are the prices for pressure treated redwoods: P ,.
size Unit price si of pieces 'Age
2"x 4"x 16' $9.97 (x1) .)9.97
4"x 4"x8' $10.97 (x4) 443.88
Wx 1r6"x 12' S6.35-- (x4) 25.40
Total Cost: $79'25
7
b. Implementation Plan
People
Hours
I propose this to be a two day project.
Install arbor trellis
6
On day 1, 1 propose to do the following:
12
Install bench
• Cut wood for trellis and bench
2
4
• Build bee house
2
1
• Build bench
trellis
• Set cement base (with brackets) for posts
of arbor trellis and bench and level
• Build top of trellis
4
0.5
On day 2, 1 propose to do the following:
Total:
14
• Install arbor trellis
20
• Install bench
• Move birdfeeders to the trellis
• Clean up
c. An estimate of the total man-hours it Nill take to complete the project.
Day 1
Task People
Hours
Total
Make Orchard Mason 3
2
6
Bee House
Cut wood 4
2
8
Build bench 4
4
16
Build trellis 4
6
24
Dig holes, Pour 8
4
32
cement, Set brackets
Total: 23
18
86
Day 2
Task
People
Hours
Total
Install arbor trellis
6
2
12
Install bench
2
2
4
Move birdfeeders to
2
1
2
trellis
Clean up
4
0.5
2
Total:
14
5.5
20
Equipment and Materials Needed
We need gloves, goggles, circular saws, power dr IIs, power screwdrivers, sanders, ladder, and shovels.
E1
Siddarth Kadiyala
Safety Equipment and Procedures
There will be a first aid kit at the check in area. There will be scoutmasters and scouts that are trained in
first aid. I will post up directions to the nearest hospital, and other safety procedures. You must wear
goggles, when cutting wood and gloves all the tirnft. l will give the scouts a safety talk prior to working,
and they would have signed a medical release and consent form, that they would be (carrying with them
at the project. 7-7
The directions that 1 will post to the two main hospitals, Kaiser Permanente and El Camino HospitalCrg
as follows:
Directions to Kaiser' Perman me Hospital '
Directions to Kaise r Permanente Santa Clara Medical Center
Goole Kaiser Or, Santa Clara, GA 95051
Maps. 7.5 mi — about 13 mins
Save trees. Go green!
22221 McClellan Rd, Cupertino, CA 95014
1. Head northwest on McClellan Rd toward Club House Ln 90 0.2 mi
total 0.2 mi
412-
Turn left to stay on McClellan Rd
t o 00. mi
toia! OA mi
1* 3.
Turn right at S Foothill Blvd
t o 1.4 mi
tctafl.3 mi
o 3mi
4.
Take the ramp onto 1-280 S
t !.ctal `.`_ mi
'iUt -' "11115
o 0.mi
5.
Take the exit toward Lawrence Expy
total `.. 8 mi
t
6.
Merge onto Calvert Or
go 59 R
total E.3 mi
i1 7.
Turn left at Stevens Creek Blvd
t o 0 6. mi
fetal 0.1 mi
a;mltI nin
8. Turn left to merge onto County Rte-G21Lr�wrence Expy 901.0 mi
g � feta! 7.0 mi
r* 9. Turn right at Homestead Rd total ' 7 o o. mi
fmi
Destination will be on the left
�:�out t tin
Kaiser Permanente Santa Clara Medical Centar
12%
Kaiser Dr, Santa Clara, CA 95051
- a sI la `r +I r a�.; I r I.1 hr irll _a !,
t I Y::Al I I
J.
evews mai cauS, Jrl III II ` 11 In h
Il1LIS` all stork 0'
[.ii taa I Tele A -las
x.
Ki.
LU
F—
Gousle
Maps
Directions to EI Camino Hospital
Directions to Grant & EI Camino Hospital
2500 Grant Rd, Mountair View, CA 94040 - (650) 940-7000
4.9 mi — about 12 mins
Sage trees. Go green!
4 22221 McClellan Rd, Cupertino, CA 95014
1. Head northwest on McClellan Rd toward Club House Ln
i1 2_ Tum left to stay on McClellan Rd
3. Turn right at S Foothill Blvd
4. Continue on Foothill Expy
1 5. Slight left to stay on Foothill Expy
ri 6_ Turn right at Grant Rd
�1 7. Turn left at Eunice Ave/North Dr
Continue to follow North Dr
r ul t r!ilia
1% 8. North Dr turns slightly left and becomes Hospital Dr
Destination ;rill be lin the IFR
Grant & EI Camino Hospital
Y
2500 Grant Rd, Mountain View, CA 94040 - (650) 940-7000
go 0.2 mi
..131 . _
go 0.2 mi
go 1.4 mi
tela! 1 _ ...
go 0.2 mi
go 0.8 mi
?L.'31 _._ ....
go 1.7 mi
1Ct31 4.5 rr
go 0.2 Ml
,Cia , rn
go 0.1 mi
Tht— 1i `'jlllj c
'U,
_:1.1 1111.. (.—� �jll :U_l (.;; ,I i .11,.
Both these directions will be posted up at the work area, so in case someone gets injured severely, the
driver will know where to drive them. This is because there is a risk of injury, as they are working with
power tools. However, I will address this safety cc ncern by ensuring that the scouts working with power
tools are well supervised by adult leaders, as well as me.
Conclusion
I am excited about this project, and am looking fcrward to doing it as an opportunity to give something
back to the city and community I have been partof throughout my life.
all
Approval Signatures for Project Plan
Project plans were reviewed and approved by:
Religious Institution, school, or community representative:
Scoutmaster/Coach/Advisor:
Unit Committee Member:
Cown�jl or pisi rjct Advancement Committee Member:
Date:
Date: -
Date: -
Date: -
Siddarth Kadiyala
11
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Name of owner. C NA -q a -V cqm kiho
Project address. 22 .2A MG C �P U U,YI lAZ� Aim) CR
Contact person. -Mxk m wrn�ieU Phone.
Far..
Net square footage of lot.
Existing
Proposed
Square footage: First floor:
Second floor:
Garage: - -
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces in,,ide the garage? Y -'-,,<—N
�. privacy protection planting required for the project? --N
On what floor(s) is work being done? N/A
Brief description of work.S��lt���y1
Code editions: 2008 CBC dy;'N)2008 CFC
2008 CPC (Y -1)2008 NEC
Effective 1/1/08
Plan Review Process Work Book Page -B-Revised 1/1/08
(Y- N)