15060056 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21861 MCCLELLAN RD CONTRACTOR:UNITED FIELD PERMIT NO: 15060056
REMODELING DBA
OWNER'S NAME: LUCAS MICHAEL E AND SHERRY S 17855 VANOWEN ST DATE ISSUED:06/08/2015
ONV ER'S PHONE: 6506447674 RESEDA,CA 91335 PHONE NO:(818)402-5656
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COh1Iv1ERCIAL
KITCHEN ADDITION& REMODEL(311 S.F.),BATHROOM
License Class Lic. _1 J REMODEL(50 S.F),OTHER REMODEL AREA(200 S-F),
I CONSTRUCT NEW FRONT ENTRANCE,REPLACE(8)
Contractor r I`r1�� r,[I �t.n a d�•pat / "p— EXISTING
1 hereby affirm that 1 am licensed under the In sions of Chapter 9
(commencing with Section 7000)of Division 3 oj},,e 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 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
e ormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$40000
" t 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:35714005 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPE TON.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, (! O ��'
costs,and expenses which may accrue against said City in consequence of the : L`l`^ ®ate:
granting of this permit. Additionally,the applicant understands and will comply (J
Issued by
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature D / All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,l agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION Date:
Signature of Applicant:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
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 tite 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 Owner or authorized agent a e•
permit is issued.
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 CONSTRUCTION LENDING AGENCY
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 1 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
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 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
CONSTRUCTION PERMIT APPLICATION
[a COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 IS06/�5
(408)777-3228• FAX(408)777-3333•building(a)cupertino.org �J (0
CUPERTINO
[:1NEW CONSTRUCTION [3/
ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS ^ t o G I ^^ CCI N n APN#
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OWNER NAME rf•1 G'�.l f"l (� PHONE 6 y L/ E-MAIL
STREET ADDRESS 21.$61 11 `C C(e- le, N 2 CITY, STATE,ZIP e ( ,1 v FAX
CONTACT NAME I ®. s PHONE �Dc6 Z v�e7��� E-MAIL �l)�l✓I S�{a71-c
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STREET ADDRESS n D S l.(I N (�►T(��C✓ -�,f CITY,STATE, ZIP C,h P/ FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT W C'OINTRA[["CTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMELIYENS$NUMBER � LICENSETYPE BUS.LIC N
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COMPANY NAME E-MAIL FAX
STREET ADDRESS 1 CG-.5 ,(Q Q S CITY,STATE,ZIP � PHONE Z� b v� }. 'Y A, S
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ARCMXCT/ENGINEER NAME ' LICENSE NUMBER BUS.LIC N
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COMPANY NAME E-MAIL FAX
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STREET ADDRESS t .�-C� CITY,STATE,ZIP C-� b�I j PHONE �6 C[ !g r 9 },
DESCRIPTION OF WORK
EXISTING USE PROPOSED USE CONSTR TYPE HSTORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL t'
ARE AREA
BATHROOM KITC '� ? O
REMODEL AREA 5 DEL AREAS MODEL AREA
POR A DECK AREA TOTAL DECK/PORCH AREA A: El DETACH
❑ATTACH
d DWELLING UNITS: IS A SECOND UNIT []YES SECONDSTORY [I YES
BEING ADDED? []NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES �� �,Y+3s _ro f2 is of} ` 1; TOTAL VALUATION:
PLANNING APPL W ❑NO PLANMNG APPROVAL LETTER EICHLER HOME? NO
By my signature below,I certify to each of the following: I am the property owner or authorized agent t ct the property owner's behalf. I have read this
application and the information 1 have provided is correct. I hav read the Description of Work and veri Is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. la t orize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Dat
U�
SUPPLEMENTAL INFORMATION REQUIRED `cctcTYPE,ry °,Us ;1„t.tKRotir>tics >PztN w a
New SFD or Multifamilydwellings: Apply for demolition permit for „�4' 'x s``MSA`
a z sut+
g PP Y P C!VERT1 Y�BUII,DINGPLANREVIEW3 > '
existing building(s). Demolition permit is required prior to issuance of buildingnv �'€� yl4�ttri }r1�” yna�,� reg
r` r
permit for new building. k®{{SE s ' ” �D LVA
FT
existing
' {
Ia�ylcc4h' 1 a .�trnY.rs ti�I,+r S�k.Y w.#`3 ,¢tPj 4Erfi#yC'�
z,.'+ ate y`'_3"` 3fi # % fa -F�''YYa'c P.� II-+'.,, ,,�
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 6 Ar+%MWISD`A'RD `IGIT�,�, O� BlJcwoxxs
Y g P project.
r w� �V YY {y�TF � ry7hiyF� �� s{z "3r� �t
form if an Hazardous Materials are being used as art of this
vi11�3f ii�H'jiYi �.u'�Y'tx 7 �5 }' ,,.fir{lUi�'{` ���SyMfY`vl �ks.ti�T' v:.
_Copy of Planning Approval Letter or Meeting with Planning prior tofo
}Int MAOR 'Lrt 2, Eb} § ti v` IT 13th SEWDISTRICP
submittal of Building Permit application.
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 21861 MC CLELLAN RD DATE: 06!08!2015 REVIEWED BY: PAUL
APN: 357 14 005 BP::, ! ._1 'VALUATION: $40,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY2nd Unit? •,Yes No PENTAMATION 1 R3SFDADD
USE: . SFD or Duplex OTC? 0 Yes QNo PERMIT TYPE: e
WORK Kitchen addition & remodel 311 S.f.), Bathroom Remodel 50 S. Other remodel area 200 S.
SCOPE Construct new front entrance, Replace (8) existing window, Install (2) new windows in living room
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. (s.Q
R-3 (Custom) II-B,111-B,IV,V-B 311 $1,626.0 IADDPLCK $1,323.00 IADDINSP
TOTALS: 311 $1,626.00 7f;`F°', 'hF2'k';Ss $1,323.00 F
5 �Io >PLUMB;HOURT.Y es'a Q o>, C,,$ URLY; No
MECHx HO'U4-RLY �3Yes O r 1' t EL
t «F
llc rlr. Plan i In:ck
Ph/111h, Plorl("hcN, file('. I'I(7n C Irt':ac
,, Nlurrrll. Pcr-nur Fri:: l;h:c• PL(rnrir 1�Lr'
Lj
!J;ltrr 1lrch, ,rr,c;:
ofhcr Phmab hasp. Uihc r face. l rs/.>.
rec: Phwil). hrsp. Pet,
NOTE: This estimate does not include fees due to other Departments(Le.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 Efl.' 711113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,626.00 = s.f. Remodel,Bath(<=300 sf)
Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $645.00 IREMRESBAT
PME Plan Check: $0.00 200 I s.f. Remodel, Other
Permit Fee: $1,323.00 $431.00 1REMRESOTH /
Suppl. Insp. Fee-.(F) Reg. 0 OT 0,0 hrs $0.00 = # Window l Sliding Glass Door
PME Unit Fee: $0.00 $574.00 IWINREP Replacement
PME Permit Fee: $0.00
t urrstruclion 7'1?.\"
[clllir;)i.1/r(rt;L•L�1'Lre:
C
Work Without Permit? 0 Yes E) No $0.00 E)
Advanced Planning Fee: IPLLONGR $43.54 / Select a Non-Residential 0
Building or Structure 0
7:1-4/v,l Dnr.'r.ttrwnluliorr 1''c'us: A
Strong Motion Fee: IBSEISMICR $5.20 l Select an Administrative Item
Bldg;Stds Commission Fee: IBCBEC $2.00
r°,; " SUBTOTALS $2,999.741$1,65 0.00 ` r TOTA°L FEE $4,649.74
Revised: 05/07/2015
Q !
CALGREEN RESIDENTIAL CHECKLIST - MANDATORY
ITEMS
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION C
CUPERTINO ALBERT SALVADOR, P.E,C:B:O., BUILDING OFFICIAL
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333- Q1IdJn.MAjM5uinm o
PURPOSE: WFIm COPY
The 2013 CalGreen Code applies to additions or alterations of existing residential buildings where the addition
or alteration increases the building's conditioned area, volume, or size and also applies to all new low-rise
residential buildings, high-rise residential buildings, or both. Existing site and landscaping improvements that
are not otherwise disturbed are not subject to the requirements of CALGreen.
Project Name: PROPOSED ADDITION
Project Address: 21861 MCCLELLAN RD
Project Description: NEW 311-SF ADDITION. XV_U5
092015
Instructions:
1. The Owner or the Owner's agent shall employ a licensed professional expene ed 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 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.
Column 2 Column 3
MANDATORY FEATURE OR MEASURE Project Verification
Re uirements
A4.1 PLANNING AND DESIGN
ry
Plann�ng 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 developed to
keep surface water away from buildings. Construction plans shall indicate how ❑
site grading or a drainage system will manage all surface water flows.
Page 1 of 5 CalGreen 2014.doc revised 11/04/14
A4.2 ENERGY
4.201.1 Low-rise residential buildings shall meet or exceed the minimum ■
standard design required by the California Energy Standards.
A4.3 WATER EFFICIENCY AND CONSERVATION
# a #1
p (, y r c r '" .:r `4 e ,,� ',�3 j .s 'x
�I IMod Watt/rUJ.SPi d �e i1 f t w $t kPr g 3v d 4 d 7° Q' h F$
m 1 s ' x s 3'
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.
❑ 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.
❑ 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, ■
and shall meet the applicable standards referenced in Table 1401.1 of the
California Plumbing Code.
Page 2 of 5 CalGreen 2014.doc revised 11/04/14
r
,...r 2 w _,r
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 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 MATE RIALCONS ERVATI ON AND RESOURCE
n '�Enhk` ayC r V r N' ,S G. N•..f t *4 sro; afi.f �r i .�anced Durability and Reduced Ma�rltenance
fl
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,;®isposal 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.
Bu�Idmg flfla�ntenance andOpetat�on � w �F
4xi `:h tut nF ,4t., >l a •,k.v h e e,.:CN �,.
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.
A4.5 ENVIRONMENTAL
Fireplaces r " fl '?
n x i
. a
4.503.1 General. Install only a direct-vent sealed-combustion gas or sealed ■
wood-burning fireplace, or a sealed woodstove.
Pgllutant 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.
Page 3 of 5 CalGreen 2014.doc revised 11104114
-(A 4
4.504.2.4 Verification. Documentation shall be provided to verify that ■ ❑
compliant VOC limit finish materials have been used.
4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with ❑
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(CHIPS) Low-emitting ❑ ❑
Materials List or be certified under the Resilient Floor Covering Institute(RCFI)
FloorScore program.
4.504.5 Composite wood products. Particleboard, medium density
fiberboard (M DF), and hardwood plywood used in interior finish systems shall ❑
comply with low formaldehyde emission standards.
lntenor Moisture Control }
'151-Y-
4.505.2
,
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 ❑
materials used in wall and floor framing is checked before enclosure.
f 3ry'; +c.,F i ::t , g,4
f�4 p,
Indoor Air, uaIi}{/ ,; ,N4 a ,. z»dx t,.,,. � ; ku ;� �
m7 ry �7rf� u �, i "t Sv S x Yk 3 t u n 3d",�'xY 3+�u K S� ''�v,.y ass fat
F,ei.! x,c +r. �aS` d�y„„4
4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the ❑ ❑
building are provided in every bathroom.
t s a �v e `�r,+` 3 . s x t:� ,r' � y
Environmental Comfort
f,.
}. �s
4.507.2. Duct systems are sized and designed and equipment is selected
using the following methods:
1. Establish heat loss and heat gain values according to ACCA Manual J or
equivalent. ■ ❑
2. Size duct systems according to ACCA 29-D (Manual D) or equivalent.
3. Select heating and cooling equipment according to ACCA 36-S (Manual S)
or equivalent.
INSTALLER AND SPECIAL OR QUALIFICATIONS
f s ” 's tz fist 9 Katiit
,w
Qualkftcat onss� � ,
r <
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.
' rµ ,* +y h„�, ..� i"' Ktrs;x n E *,{,P .•.Sty rcE- t ° �'' 3 "� aF p '' ”&tx 3 6 8.a +!"sok F�A f ,tY Y ;d
i
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 ■ ❑
agency which show substantial conformance. Implementation verification shall
be submitted to the Building Department after implementation of all required
measures and prior to final inspection approval.
Page 4 of 5 CalGreen 2014.doc revised 11/04/14
CALGREEN SIGNATURE DECLARATIONS
Project Name: PROPOSED ADDITION -
_ Project Address: A,&--TANTAWA B-; X(Z 6 i♦ Ntc G 1e,(r v vt-Rol --
Project Description: NEW 2W-SF wrILYfefcR- DDITION.
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 a 2013 Californi Green Building Standards Code as
adopted by the City of Cupertino.
&—Wn"
e7r's]ptgwiarke ®ate
4 /-t t c�
*u ,ter' Name
42
(ASS 1 Yo,Gt ✓ G Lt it wrwlos hJ ro S i
Design Professional's Signature C )--s- ti- Date
Design Professi a (Please Print)
Va>)r2,> o —�
Signature of License Professional responsible for CalGreen compliance Date
OSx- %:-tvL
Name of License Professional responsible for CalGreen compliance (Please Print) Phone
Email Address for License Professional responsible for CalGreen compliance
SECTION 2 — IMPLEMENTATION VERIFICATION
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 11/04/14