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B-2016-1507 { CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1507 934 HYDE AVE CUPERTINO,CA 95014-4663(375 39 003)', IRAVANI FARSHID 934 HYDE AVE CUPERTINO,CA 95014-4663 1 OWNER'S NAME: IRAVANI FARSHID DATE ISSUED:03/14/2016 OWNER'S PHONE:408-835-5164 PHONE NO:408-835-5164 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor IRAVANI FARSHID Date X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing _ MECH X RESIDENTIAL COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONSTRUCT(N)KITCHEN ADDITION(97 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent toself-insure for Worker's Compensation,as provided for by Section 3700 ofthe Labor Code,for the performance of the work for which this permit is issued. z. 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. Sq.Ft Floor Area:97 Valuation:$20000.00 APPLICANT CERTIFICATION i 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 75 Number: Occupancy Type: 37539003 and state laws relating to building construction,and hereby authorize 375 39 003 R-3(Custom) 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INS CTION. Signature Date 03/14/2016 Issued by:ALEX VALLELUNGA Date:03/14/2016 OWNER-BUILDER DECLARATION i I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) ` I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: v contractors to construct the project(Sec.7044,Business&Professions Code). Date:03/14/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 34. of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections Municipal 25533,and ter 9.1 I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section 25532(a)should I store or handle hazardous y I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous f shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Cotiipensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534, Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized a ent:7 APPLICANT CERTIFICATION Date:03/14/2016 I certify,that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. Licensed /Signature�� pate 03/14/2016 professional CONSTRUCTION PERMIT APPLICATION K COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408) 771-3228• FAX(408)777-3333•building(a.cupertino.org tt� CUPERTINO ❑NEW CONSTRUCTION ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS ® 5 ^ e- ( APN n 3�715 00 OWN ERNAME TC 4 ��1���� ��!?V A f") I PHOI�TF+'i/e)fJ ��� �P E-MAIL VYI y-(�d b Lam- � l `� !�� it STREET ADDRESS 0�7 C ` r�yp(� CITY, STATE,ZIP �� �� { y FAX /-A i -03,U16- 7 �{ CONTACT NAME r� ,d ! Irq'VCI vl\ I PHONE i f v E-MAIL Y clt I- -3 1Gt Ade ggy STREET ADDRESS � � � � a CITY,STATE, ZAP �U nA � � FAX tQOV NER ❑ OWNER-BUILDER OWNER AGENT ❑ CONTRACTOR ❑CONTRA•:CTO•RAGENT 1:1 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENUMBER LICENSE TYPE BUS.LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT,'ENGLNEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK c?V SL t,d✓�L.L � . ®Vl Y ^e 1 EXISTING USE- PROPOSED USE CONSTR.TYPE n STORIES c, l�e S t A1-4USE TYPE OCC. SQ.FT. VALUATION($) res EXISTG NEW FLOOR � DEMO TOTAL AREA AREA .. AREA NET AREA BATHROOM I KITCHEN OTHER - REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECKAREA TOT_SL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH DWELLTNG LN-S- IS A SECOND UNIT ❑YES SECOND STORY ❑YES BENGADDED? NO ADDITION? IZN'O PRF-.APPLICA710N ❑YES ff YES:PROVIDE COPY OtF�' IS THE BLDG.AN YES t RECEIVED BY -- ; - TOTAL VALUATION: PLA ❑NO PLANNING APPROVAL LETTER EICHLERHOME? 'O By nay signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct, I have read the Description of Work,and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building conshv tion• I authorize representatives of Cupertino to enter the above-identified property,for inspection purposes. —�' Signature of Applicant/Agent: Date: �� d�g SUPPLEMENTAL INFORMATIOTREQUIRED yy�PL �cHEc> 7arE..._ F n, <Rourant=sLlr55 New SFD or Multifamily dwellings: Apply for demolition permit foro1ER TxE cov.TERsUILDI\GPLA�REI existing building(s). Demolition permit is required prior to issuance of building27 { permit for new building. IDERI ss ��-���G _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure LIc«oRl.s form if any Hazardous Materials are being used asart of this project. ` II p � _Copy of Planning Approval Letter or Meeting with Planning prior to fl nzAaox <� b` ❑�sANIT4R]sE«ER DISTRICT submittal of Building Permit application. ti > flhE\BIRO\�ZENTALHEALTH.,, ,..,' Bldo 4pp_2011.doc revised 06121/11 I CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: "VALUATION: 1$20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY 2nd Unit? 0 Yes No PENTAMATION USE: SFD or Duplex OTC? 0Yes E)No PERMIT TYPE: 1R3SFDADD WORK I CONSTRUCT N KITCHEN ADDITION 97 S.F. SCOPE TYPE OF FLR AREA OCCUPANCY TYPE; CONSTR. s.f.' PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 97 $1,091.00 IADDPLCK $1,057.00 IADDINSP TOTALS: 97 $1,091.00 $1,057.00 11 MECH,HOURLY Q Yes ;Q No PLUMB,HOURLY 0"Yes, No ELEC HCIURLY 01 Yes 6F)No ? -T zin".r Feta 3.-?S">� r .z€ �._, l�Vj El NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the Dept.(—or addn'l info. FEE ITEMS(Fee Resolution 11-053 E,ff 711,113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,091.00 Select a Misc Bldg/Structure Suppl.PC Fee: (F) Reg. Q OT 0.0hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,057.00 Suppl.Insp.Fee:E) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 ((PME Permit Fee: $0.00 . .t .L. .... , . £,*s. Work Without Permit? 0 Yes No $0.00 Advanced PlanniDg Fee: IPLLONGR $13.58 Select a Non-Residential E) Building or Structure Strong Motion Fee: IBSEISMICR $2.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC 1 $1.00 SUBT&T S: $2,165.18 $0.00 . TOTAL,F'EE: $2,165.18 Revised: 0.1/01/2016 ' OWNER-BUILDER DISCLOSURE FORM . G COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228 FAX(408)777-3333•building(5cupertino.org — CUPERTINO 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 APIC.. BP# 375 -�q_9 3� _.__.. .. OWNER ADDRESS- OWNER NAME NAME Rs141,0 e c� e. na ni y _ DESCRIPTION OF WORK: 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 informafion.) Ff 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. 1, 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. l am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. _Fv'2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. _kL3.I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that 1 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. ell, 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. ,L 5. 1 understand if I employ or otherwise engage any persons,other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500),including labor and materials, I may be considered an"employer"under state and federal law, L 6. I understand if I am considered an"employer" under state and federal law,1 must register with the state and IV—,,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. I 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. 8, I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. ' OwnerBuilderForm 2010.doc revised 04/14/10 A t'. ^` 9. 1 understand I may obtain more information regarding my obligations as an"employer" from the Internal Revenue Service,the United States Small Business Administration,the California Department of Benefit Payments, and the California Division of Industrial Accidents. l also understand l may contact the California Contractors' State License Board(CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors: 10. i am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that 1 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 ey all applicable laws and requirements that govern Owner-Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information-I have-provided on this form. Licensed contractors are regulated bylaws 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 maybe in civil court. Itlls 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: IVA Lender Address: /Yid' 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 propefty owner's si nature. Property Owner's Signature:,. �/ Date. :3 Y//4 ---- ------------------------ --------------- ------- ------------------------------------------------------------------------------------- (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: Tel No Address of Authorized-Agent: I declare under penalty of perjury that I am the property owner for the address listed above and l personally filled out the above information and certify its accuracy.Note:A copy of the property owner's drivers license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 0wnerBui1de2- br n 2010.doc revised 0?/14/10 CALGREEN RESIDENTIAL CHECKLIST— MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION € O ALBERT SALVADOR, P_E., C.B.O,, BUILDING OFFICIAL CUPERT 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228 FAX(408)777-3333•- ulldin r curkincs.or PURPOSE: 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: a4>� ,�i/�� � �/1s/ Project Address: % ��, r✓ 1�� 1ri gra Project Description: J�i�I® MAR R 4 2 S, Instructions: BY 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the California Green Building Standards Codes to verify and assure that all required work described herein-is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design professional shall initial 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 plementation Verification at the end of this checklist and submit the completed form to the Buildig In PFICE Qr Py Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Requirements A4.1 PLANNING AND DESIGN -77 Plannirigand f)esign4 S>tte©evelo men t R 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 I- construction iPL RWnJ how Q site grading or a drainage syste a age all surf# Ijf�eDf�Otment REVIEWED FOR CODE COMPLIANCE Reviewed By- Page 1 of 5 CalGreen 2014.doc revised 11104/14 Gene1'al� '� 33� A4.2 ENERGY EFFICIENCY 1,n 7777T77— q, E - 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. . . .3 WATER EFFICIENCY AND CONSERVATION NORIt htdoo d ate C)se , � €� 4.303.1Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads)shall comply with the following: El4.303.1.3.2 Water Closets.The effective flushwolu'me'of'allvater closets' shall not exceed 1.28 gallons per flush. Tank-type water-closets shall bei,: certified to the performance criteria of the U.S.-EPA'WaterSense Specifications for Tank-type Toilets, r7k, ❑ 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. El 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. El 4.303.1.4.1 Residential lavatoryfaucets The maximum flood rate of residential lavatory faucets`shall noi-exceed'1.5 gallons,permiinute 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.doe revised 11/04/14 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 El Collaborative for High Performance Schools (CHPS) 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(MDF), and hardwood plywood used in interior finish systems shall comply with low formaldehyde emission standards. E Interior Moist` r`e C�rttrol ES E W. 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 ED/ Elmaterials used in wall and floor framing is checked before enclosure. u � � 411 door Air Qahty and Exaus 3 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the building are provided in every bathroom. 77777-7777777, Aj �Eiauironmentaorf�ort ' .S w• j;. I EY E X 1 X E 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 ACOA 29-D(Manual D) or equivalent. 3. Select heating and cooling equipment according to ACCA 36-S(Manual S) or equivalent. INSTALLER AND SPECIAL • ` QUALIFICATIONS 40uallfltlOn F 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 GALGreen compliance is qualified and.able to demonstrate competence in the ❑ discipline they inspect and verify. errfica#cons T� I' 703.1 Documentation. Verification of'compliance with GALGreen 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 11104114 i 4' x 1 � 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. El El ❑ 4.304.1.2 Weather-basedcontrollers 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 c6ntrollers are not required to have rain sensor input. ',ss A4.4 , > nnced Dur`a��l>ty and Reduce; Ma�r►tenarice' v.. V 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. c nstr"u'Cito" Waste Reduc6oh , sposal and R`"' Cl 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. Built ung Mamtenarlceand UparatjC t �t F v� 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. ENVIRONMENTAL QUALITY I Fireplaces, «� 4.503.1 General. Install only a direct-vent sealed-combustion gas or sealed ❑ wood-burning fireplace, or a sealed woodstove. Pollutant`�on ;a R 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 B 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 11/04/14 CALGREEN SIGNATURE DECLARATIONS Project Name: �A)2S/y-/ /& ✓ I Project Address: 9 4 H y dt b n a C G— Project Description: a-7 S- I.,eLd Lt 64- U N Jgt!, ne.1 SECTION 1 — DESIGN VERIFICATION Complete all lines of Section 1 —"Design Verification" and submit the completed checklist(Columns 1 and 2)with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the City of Cupertino. //lo 7-7 Owner's Signature Date r-14-a-.5 !f lj;> /2-/A '��"� J Owner's Name (Please Print) Design Professional's Signature Date Design Professional's Name (Please Print) Signature of License Professional responsible for CalGreen compliance Date ✓1-S/ i v A. N I Name of License Professional responsible for CalGreen compliance(Please Print) Phone Y)l r-15'(Ca aCA Lb o c o 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. q p4 Signature of License Professional responsible for CalGreen compliance Date r� dol -9 3 Name of License Professional responsible for CalGreen compliance(Please Print) Phone 114 Email Address for License Professional Yesp6nsiblefor Ca Green 6ompliance Page 5 of 5 ', CalGreen 2014.doc revised 11/04/14 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE FILE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333• building(d)cupertino.org Permit � Address— `� �}Y Cµ ►�a C ##ofd s Smo e l ,Carbon Mo oxide`:? PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICAT AAS.BEEN S AND RETURNEIi TO.THE BUMI)ING PWISToN PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxid Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interioi access.for inspections are required. GENERAL INFORMATION Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations,or repairs to existing dwelling ur its exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM C 0 ALARM Outside of each separate sleeping area in,the immediate vicinity of the X X bedroom(s) On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings wl-dch do not contain fuel-burning appli -ices and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms'shall co ply with CBC Section 420.6 and shall-be approved by the Office of the State Fire Marshal. Power Supply:In dwelling units with no commercial power supply, alarm(s)may be solely battei y operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basem ant or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is equired for alarms which must be connected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above ha /have been installed in accordance with the manufacturer's instructions and in compliance with the Californi a Building and California Residential Codes.The alarms have been tested and are operational, as of the date signed below. 1 have read and agree to comply with the terms and conditions of this statement Owner(o�Owner A enfs)Name:_�' Q T _ J Si gnature........; -!"`---"-..............................................................`ote3l� (Ag... - 0r1tw00r Name: rSinature ............................. Lrc ......,...........................;Dafe` .................. Smoke and CO formal c revised 03118114 WATER-CONSERVING PLUMBING FIXTURES :LE OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 1030b TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333-building Dcupertino.org Owner Name — t 7 A 4 V/9 /V / Permit Noll) B�a Address g 4 C .�`►j1 u o l y 1. Is your real property a registered historical site? Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of :onn. C"No Go to Question 2. 2. Does your real property have a licensed plumber certifying that;due to the age or configuration of the property or its plumbing,installation of water-conserving plumbing fixtures is not technically feasible? Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. EJ-No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1.through 1101.8 do not apply. Skip the rest of the form and sign bottom of orm. L1 @ No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom ofform. uD'Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements andsign ign bottom of form.. 5. Please check ONE of the following: My property is a single-family residential real property. See Civil Code Section 1101.4., On and after January 1, 2014,building alterations or improvements shall require,all non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). El My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether propertyundergoes alterations or improvements). El My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019, all non-compliant`plumbing fixtures shall be replaced with water- cons ruing plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improveme-its). 1,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indice ted in the table on the following page. Owner or Owner Agent's Signature r ; �_ Date:w J Y Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB4072015.doe evised 08126115 UUILDING,PERMIT CANNOT BE,FINALED AND COMPLETED UNTIL THIS. CE TFiCATE HAS BEEN TO THE BUILI33NGDPVISY±��Y Non-Compliant Water-Conserving Plumbing Fixture Plumbins Fixture (Fixture Complying with Current Code Applicable to New Construction) Fixture Type Maximum Water Usage/Flow Rate Water Usage 2013 CPC Ch. 4 2013 CPC Ch.4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div: 4.3 2013 CALGreen Div.4.3 2013 CALGreeh Div. 5.3 Single-Family Multi-Family Comme cial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume(the composite, Urinals Exceed 1.0 average flush volume of two reduced flushes and one full flus Gallons/flush 0.5 gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criter of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower,the combined flow rate o all showerheads and/or other shower outlets controlled by a single valve s II not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designel to allow only one shower outlet to be in operation at a time. Faucets— Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per in rlute @ 60 Lavatory per minute minute @ 60 psi;minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets— Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown,it is not required to be ipgraded. SB4072015.cioc)evised 08126/15