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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 ­. 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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 _. �lL� ' 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 po a►!oP 'iQ ®PSP •sss�.o losPo• ols s!!•�A 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 f I ) w r - L LJ 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)