15060036CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10315 STONYDALE DR CONTRACTOR: JANAKIRAMAN PERMIT NO: 15060036
RAMAPRABHU AND CHEN SHI
OWNER'S NAME: JANAKIRAMAN RAMAPRABHU AND CHEN SHI
OWNER'S PHONE: 4085059549
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor
Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
2. 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.
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
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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)
ner of the property, am exclusively contracting with licensed contractors to
nstruct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. 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.
3. I certify that in the performance of the work for which this permit is issued, I shall
not mploy 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 C % t3 ual-,
10315 STONYDALE DR J DATE ISSUED: 09/03/2015
CUPERTINO, CA 95014 j PHONE NO:
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
CONSTRUCT AN UNCONDITIONED PARTIAL BASEMENT -156
SQFT REMODEL PANTRY AREA (110 SQ FT).
Sq. Ft Floor Area: I Valuation: $21500
APN Number: 32637013.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: J.q +��L�/ Date: Ile"
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 Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owe t o
.. Date: 1
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
10
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildinq[a.cupertino.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 �
ry � ,�.� �'�' ,
APN
BP#o
OWNER NAME>� ki
1�i �JOWNER
ADDRESS i-0-3 n U� C\CAkt
DESCRIPTION OF WORK:
� L ^' QN C L I , ���-� 1-0 WV AC\'4�
i IN A I tM06-6
^ D
PA
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.)
?-1. 1 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.
2. I 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.
I 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.
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
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.
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.
. aI understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
inncial 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 04/14/10
9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
VR!evenue 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.
r"10. 1 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.
11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
y all applicable laws and requirements that govern Owner -Builders as well as employers.
agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
formation 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 driver's 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 owner's si natur .
%Property Owner's Signature: Date: �Lff
---------------------------------------------------------------------------------------------------------------------------------------------
(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 owner's driver's 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 owner's
signature.
Property Owner's Signature:
Date:
OwnerBuilderForm 2010.doc revised 04/14/10
LEBEC, Inc
A/B/C27 LIC. NO. 930961
October 12, 2015
City of Cupertino
Community Development Department
Building Division
10300 Torre Avenue
Cupertino, CA 95014-3255
Re: Removal of Contractor on Record for Permit Number 15060036
@ 10315 Stonydale Drive, Cupertino
To Whom It May Concern:
Please accept this letter as confirmation that LEBEC, Inc. is no longer contracted
to do any work at 10315 Stonydale Drive for permit number 15060036 as of
Tuesday, October 6, 2015.
The homeowner will be taking over as an owner -builder and has been forwarded
the Owner Builder Policy form to complete and drop off at the City offices.
Please feel free to contact our office with any questions.
Respectfully submitted,
Robyn L. B ockman
Office Manager
To Whom It May Concern:
Robyn Brockman has our authorization to act and sign any documents pertaining
to this permit on behalf of LEBEC, Inc.
Respectfully submitted,
JV41A�b
Edward P. Machado
Vice President
3041 WALNUT BLVD, BRENTWOOD, CA 94513 • P.O. BOX 1178, BRENTWOOD, CA 94513
925.634.4177 • 925.634.7831 (FAX) • VWNW.LEBECINC.COM
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10315 STONYDALE DR ' CONTRACTOR: ' Laa,
ilfl //' PERMIT NO: 15060036
OWNER'S NAME: JANAKIRAMAN RAMAPRABHU AND CHEN SIU
DATE ISSUED: 09/03/2015
OWNER'S PHONE: 4085059549 1 kh1(l_W(Y'XY "1 A�,-Z1 A I PHONE NO.Q14'i PI'OV W A
ju LICENSED CONTRACTOR'S DECLARATION
License Class A'ZC27 Lic. # 5���- (10 { +
Contractor � b EC I C N C' Date CA D� ` 5
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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
l performance of the work for which this permit is issued.
2,%►'t Fjave 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.
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. G,
Signature
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
i. 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)
2. I, 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:
t. 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.
2. 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.
3. 1 certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
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
1 certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
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
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
CONSTRUCT AN UNCONDITIONED PARTIAL BASEMENT (156
SQ FT); REMODEL PANTRY AREA (I 10 SQ FT).
Sq. Ft Floor Area: I Valuation: $21500
APN Number: 32637013.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALL E INSP ��TI//ON.
Issued by: V� Date: 3;/
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 Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
onrlauth zed agent : WI , DOL
3
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228• FAX (408) 777-3333 • buildina(a)CuDertino.org
❑ NEW CONSTRUCTION R AT)T)TTTnN
17 AT TPP ATTr)V/TT I 1)=1rT0TnMir,
/S0 t/;, 00
BIdgApp_2011.doc revised 06/21/11
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PROJECf ADDRESS N qlVy
APN R 2-46 '"y @
OWNERNAME:fAy%CA R.�,ro^ C:p r1 V\ E-MAIL
STREET ADDRESS1 � s S ��
CITY, SATE. ZIP $ FAQ{
t
®_
CONTACT NAME f pH 7p� `f ®+y + E-MAIL
CFAX
❑ OWNER ❑ OWNER-BUIIAER ❑ O'ANERAGENT CONTRACTOR ❑COONNfRACTORAGENT ❑ ARCHITECT ❑ ENGA'EER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �S A
LICENSE NUMBER / iii \ LICENSE TYPE Ig
1
BUS. LIC k
COMPANY NAME ®�� ��l'�i�~��•� ���r
�E MAIL Q(�� h S'�' j � u • Vim"
FAX
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FAX
STR ADDRESS
CITY. STAT IP
D®E�SCRIPTION OF WORK
v�st, , `��\ �� , ®�w� �• \ _
�! �V�i�•
`M"��ii.�i.
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40s�i\ir' "
EXISTINGUSE PROPOSED USE CONSTR
TYPE 4 STORIES
USE
TYPE OCC.
SQ.FT.
VALUATION (S)
E>aSTG
AREA
NEW FLOOR.
AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM.
REMODEL AREA
KITCHEN.
REMODEL AREA
OTHER. �i
l -4
REMODEL AREA [/
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATrACH
m DWELLING UNITS:
IS A SECOND UNrr ❑ YES
SECOND STORY []YES
BEING ADDED? ❑NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLAhTTNG APPL E3 NO PL.4NI.TII�G APPROVAL LETTER
IS THE BLDG AN
ETCHLER HOME? :]NO "�-'"' �• rte,
L-
TOTAL VALUATION:
-,;q
1 ���
By my signature below, I certify to each of the folloNaring: I am the property owner or authorized on the property owner's behalf. I have read this
application and the information I have r*idoisco I have read the Description of Work an verify it iSaccurate. I agree to comply with all applicable local
ordinances and state lays relating to I tru on. I authorize representatives ofCupertino to enter the above -identified property for inspection purposes.
Signature ofApplicanUAgent: Date: CG --� — l
SUPPLEMENTAL INFORMATION RE RED
e =_drip
dial. crcx T��Eu_ z
zINIM-.:T
OFEI2THErCO'[IhTER -fl
BUII,DINGPLANREYIEW"';
g
New SFD or Multifamily d-,vellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
for new building.
_�
permit
nv�xpr,Ess moi- sg
nt,mc4Iz> NTM�
_ Commercial B1d9s: Provide a completed Hazardous Materials Disclosure
MIANDARD�Q
PUBLIcvEosj.;
form if any Hazardous Materials are being used as part of this project.
-Q
_ Copy ofPlanning Approval Letter or Meetin with Planning Prior to
submittal of Building Permit application.M�R�sAnTrxYsIsTluer
'��' ��,t-'s-A,, „� E,`r�`
,�� ���.•-�� � �5,,�
BIdgApp_2011.doc revised 06/21/11
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�,,��,,,,�,,,,,,��,��, CITY OF CUPERTINO
1�►1►'�y/�I FEF ESTIMATOR — BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10315 STONYDALE DR
DATE: 06/04/2015
REVIEWED BY: MELISSA
PC FEE ID
APN: 326 37 013
BP#:
`VALUATION:
$21,500
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
2nd Unit? • Yes No
OTC? 0 Yes Q No
PENTAMATION
PERMIT TYPE: 1 R3SFDADD
WORK
ADD 156 S.F. TO UNCONDITIONED PARTIAL BASEMENT & RECONFIGURE AND REMODEL E
SCOPE 1110
S.F. TO EXPAND PANTRY AND LAUNDRY AREAS
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
156
$1,091.00
1ADDPLCK
$1,057.00
IADDINSP
0,-x. hasp. Fee'..
PME Plan Check:
$0.00
Permit Fee:
$1,057.00
Suppl. Insp. Fee:Q Reg.
0 OT
O,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
TOTALS:
156
$1,091.001
1 $1,057.00
T_T�
MECH, HOURLY Yes (F) No
PLUMB, HOURLY Q Yes (F) No
ELEC, HOURLY 0 Yes Q No
ecrr. Pt1.,�, C f,�r c„
PG�uah. Plan ('rig i�
!JCL'.
FT-,,�; 7 ,°rnr,'i 1 i�
-L-
Plumb. Pe!imi! Pipe:
(ih�c A' Amir
t ),�,. �. II. L ;;i -E3
[hl�cr t 1i ,1, ;t,,..,
Usher Elev. In r). Li
�E3
l r/I- Iil)p, h���::
a>>i ,. I;;;p. I c"
0,-x. hasp. Fee'..
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, mire, Sanitary Fewer Vistricy 3cnoo,
A;.f ... r.. 1 Th.— r— ,,.o h, d .. tbo nroliminan, infarmation availahle and are only an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (Fee Resolution 11-053 E f 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,091.00
110 s.f.
$431.00
Remodel, Other
IREMRESOTH
Suppl. PC Fee: Q Reg. 0 OT
F-0,01hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,057.00
Suppl. Insp. Fee:Q Reg.
0 OT
O,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
i OIISOl V(ItOYT 1OX.
T_T�
,4,hnh7i.%lre it v Fee:
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Plannipg Fee:
IPLLONGR
$21.84
Select a Non -Residential
Building or Structure
G
0
It"tlV2t �)(JCtlll'Ic'72ECd/It117 'L'('J':
Stronp, Motion Fee:
IBSEISMICR
$2.80
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2,173.641
$431.00
TOTAL FEE:
$2,604.64
Revised: 05/07/2015
PURPOSE:
CALGREEN RESIDENTIAL CHECKLIST -
MANDATORY ITEMS '
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIV
ALBERT- SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildingCc)-cupertino.org
F}a.r
The 2013 CalGreen Code applies to additions or alterations of existing residential buildings where the
addition or alteration increases the buildings conditioned area, volume, or size and also applies to all new
low -rise residential buildings, high -rise residential buildings, or both. Existing site and landsc ping
improvements that are not otherwise disturbed are not t o 're een,
Project Name: Janakiraman &Chen CDP
Project Address: 10315 Stonydale Drive, Cupertino
Project Description:, ([VSTRUCT AN UNCONDITIONED PARTIAL BASEMENT (156 SQ FT);
R� ANTRY AREA (110 SQ FT).
Instruction
1. The Owner or the Own ent shall employ a licensed professional experienced with the California Green
Building Standards Code-Tie.Xerify and assure that all required work described herein is properly
planned and implemented in the project.
2. The licensed professional, in collab6ration with the owner and the design professional shall initial
Column 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.
colcamn 2 rcolumn 3 �
MANDATORY FEATURE OR MEASURE
, � 1 4 Kequiremen�r 4:
y,
Planning and Design' S� #e`Developme_nt
= x< a
x;
o
4.106.2 Storm water drainage and retention during construction. A plan is
developed and implemented to'manage storm water drainage'during X O
construction.
4.106.3 Grading and paving. The site shall be planned and developed to
keep surface water away from buildings. Construction plans shall indicate how X
site grading or a drainage system will manage all surface water flows.
Pagel of 5 CalGreen 2014.doc revised 11104114
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:
o 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.
o 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not
exceed 0.5 gallons per flush.
o 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.
o 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 N/A
/A Q
designed to allow only one shower outlet to be in operation at a time.
o 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.
o 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.
o 4.303.1.4.3 Metering faucets. Metering faucets when installed in
residential buildings shall not deliver more than 0.25 gallons per cycle.
o 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 O
Code, and shall meet the applicable standards referenced in Table 1401.1 of
the California Plumbing, Code.
Page 2 of 5 CalGreen 2014.doc revised 11104114
Quttloor Water,Use � h, � � a
4.304.1 Irrigation controllers. Automatic irrigation systems installed at
the time of final inspection shall be weather - based.
0 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. N/A
. N/A
0 4.304.1.2 Weather -based controllers without integral rain sensors or
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 CONSERVATION AND RESOURCE EFFICIENCY
4.406.1 Rodent proofing. Annular spaces around pipes, electric cables,
conduits, or other openings in plates at exterior walls shall be protected
X
O
against the passage of rodents by closing such openings with cement mortar,
concrete masonry or similar method acceptable to the enforcing agency.
"1Naste and rc
Construction Reductfon,?DisposaI Recycling
r r:
4.408.2 Construction waste management plan. Where a local jurisdiction
does not have a construction and demolition waste management ordinance,
N/A
O
a construction waste management plan shall be submitted for approval to the
enforcing agency.
Bull ldmgJMaintenance and Operation °'
y
e ad e a
4.503.1 General. Install only a direct -vent sealed- combustion gas or sealed.
N/A O
wood - burning fireplace, or a sealed woodstove.
Pollutant Control
4.504.1 Covering of duct openings and protection of mechanical
equipment during construction. Duct openings and other related air
X
O
distribution component openings shall be covered during construction.
4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks
X
O
shall be compliant with VOC and other toxic compound limits.
4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be
X
O
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
X
O
toxic compounds.
Page 4 of 5 CalGreen 2014.doc revised 11104114
4.504,2.4 Verification. Documentation shall be provided to verify that
X
O
compliant VOC limit finish materials have been used.
4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with
N/A
O
VOC limits.
4.504.4 Resilient flooring systems. Eighty (80) 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
N/A
O
Materials List or be certified under the Resilient Floor Covering Institute
(RCFI) FloorScore program.
4.504.5 Composite wood products. Particleboard, medium density
fiberboard (MDF), and hardwood plywood used in interiorfinish.systems
X
Q
shall comply with low formaldehyde emission standards.
lnted or Moisture Control a
4.505.2 Concrete slab foundation. Required vapor retarders and capillary
X
O
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
X
O
materials used in wall and floor framing is checked before enclosure.
Indoor Air Quall�iy antl Eztaust
4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the
N/A
O
building are provided in every bathroom.
OM 6 0 " t
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. X O
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
X
O
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
X
O
the discipline they inspect and verify.
Verrlf�cat<ons #' �
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
X
O
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.
CALGREEN SIGNATURE DECLARATIONS
Janakiraman & Chen
Project Name:
10315 Stonydale Drive, Cupertino
Project Address:
Project Description: CONSTRUCT AN UNCONDITIONED PARTIAL BASEMENT (156 SQ FT);
REMODEL PANTRY AREA (110 SQ FT).
SEGTIUN 1 — DESIGN VERIFIGATIUN
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 th6t 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 %::! erti no.
i
Owner's Signature -Date
JfAof
�ItIR
Owner's Name (Please Print)
• �� lA95
esign Professional's ignature Date
Design rofessional's ame (Please Print)
UUILMMID
Signature oidicense P ofessional responsible for CalGreen compliance Date
Pb EC 1 A C__ 012C:DL103L4LA 1 -11
Name of Lice a Professional responsible for CalGreen compliance (Please Print) Phone
c.M
Email Add ss for License Professional responsible for CalGreen compliance
SEG 1 IUN 1— INIF'LENIEN I A I IUN VtKll-IGA I IUN
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
Page 5 of 5 CalGreen 2014.doc revised 11104114