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14060127CITY OF CUPERTINO ;UILDING ADDRESS: 10391 MENHART LN IWNEWS NAME: YINGHE AND YUGEN HU CONTRACTOR: YINGHE AND YUGEN HU I PERMIT NO: 14060127 10391 MENHART LN DATE ISSUED: 10/20/2014 )WNER'S PHONE: 4082093308 CUPERTINO, CA '195014 PHONE NO: LICENSED CONTRACTOR'S DECLARATION ,icense Class Lic. contractor Date 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. 1 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. 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) 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: �. 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 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 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. JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT (N)1; STORY SFD (1805 S.F.) WITH ATTACHED GARAGE (343 S.F.) DEF #1 -TRUSS CRUS - ISSUED 10/22/15 Sq. Ft Floor Area: APN Number: 37: PERMIT WITHIP 180 DAY Issuedby: All roofs shall be installed without i inspection. Signature of Appl ALL I have read the h California Healtl compliance with Safety Code, Sec Additionally, sh( contaminants as maintain compii Health & Safety Owner or Valuation: $200000 Occupancy Type: EXPIRES IF WORK IS NOT STARTED 180 DAYS OF PERMIT ISSUANCE OR 4FRZLAST CALLED INSPECTION. lfl Date: RE -ROOFS: ected prior to any roofing material being installed. If a roof is obtaining an inspection, I agree to remove all new materials for Date: COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE ardous materials requirements under Chapter 6.95 of the it Safety Code, Sections 25505, 25533, and 25534. I will maintain e Cupertino Municipal Code, Chapter 9.12 and the Health & n 25532(a) should I store or handle hazardous material. d I use equipment or devices which emit hazardous air :fined by the Bay Area Air Quality Management District I will ce with the Cupertino Municipal Code, Chapter 9.12 and the ode; Sections 25505, 25533, and 25534. -Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating I understand my to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Licensed Profe indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ARCHITECT'S DECLARATION shall be used as public records. CONSTRUCTION PERMIT APPI COMMUNITY DEVELOPMENT DEPARTMENT • B 10300 TORRE AVENUE • CUPERTINO, CA 95014 (408) 777-3228 • FAX (408) 777-3333 • buidn [71 ADDITION ALTERATION FI PROJECT ADDRESS I �• APN 1,07 OR$ ERNAA PHONE F-) AII r STREET ADDRESS - I CITY, STATE, ZIP J FAX CONTACT NAME I PHONE E-MAIL 1 e3 STREET ADDRESS � - CITY, STATE, ZIP FAX . Gd3'NER ❑. OWNER -BUILDER - ❑ OWNER.AAGENr ❑ CONTRACTOR ❑ CONTRACTOR AGENI ARCHITECT 13 ENGINEER 13 DEVELOPER ❑ TENANT CONTRACTORNAME( LICENSENUA B ` LICENSE a II Us. _ GOIvIPANY N a FAX 1 a STREET ADDRESS e r d 22 CITY, STATE; ZIP `�" �, b ( PHONE ARCHITECDBNGINEERNA.ME ' LICENSENIVIBER BUS.LICR pg� COMPANY NA7 f E-MAIL a FAX B STREET """ESS CITY. STATE; ZIP y i PHONE j �-2 r DESCRIPTION OF WORK44 - EXISTIIJGUSE - I PROPOSED USE CONSTR, TYPE 4 STORIES usE � I TYPE _i. OCC. III ( SQ.FT. VALUATION (S) F:XISTG NEW FLOOR DEMO TOTAL AREA AREA AREA .. NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REASODEL AREA REMODEL AREA i _ POR.CHAREA DECK AREA TOTAL DECh/PORCH:a.REA GARAGE AREA:. DETACH ATTACH I I - u 9 DVIELLIIsG UNITS: IS A SECOND UNIT YES SECOND STORY YES BEING ADDED? No ADDITION? []NOI — PRE -APPLICATION ❑YES ff YES, PROVIDE COPY OF Is THE BLDG AN ❑ YE5 �C I��D.BY .-; TOTAL VALUATION: T PLANNING APDL m []NO PLANNING APPROVAL LETTER I EICHLER HO ME? n NO = _ By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property o A per'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 for inspection ordinances and state laws relating to building cons` ction. I authorize representatives -of Cupertino to enter the above -identified property purposes. / Date Signature of Applicant/Aeent: SUPPLEMENTALIDRI�dATION REQUIRED i _ CDECKE I oiJxLncsT1E New SFD or Multifamily d\vellings: Apply for demolition permit for fl 0 g Tg COLhTER $IIILDLnGPL iNStE«� existing building(s). Demolition permit is required prior to issuance of building ©PL`�n� s --E E)TxESs permit for new building. Hazardous Materials Disclosure . s� Ll rvBLz�oRxs Commercial Bldgs: Provide a completed _ _ form if any Hazardous Materials are being used as part of this project. �� ��RG� Copy of Planning Approval Letteror Meeting with Planning prior to EMO �oR���;RSEz�i�Isalxrca _ submittal of Building Permit application. � AE�AI;2'A - � ,ate -�. E,=�."`�.§... ?�•-�� E�'F'iR'OTi'MEI1T-.43. � �_.: BldgAlpp_2011. dog revised 06121111 i CITY OF CUPERTINO 'Off TT,i T.I rel rVTM r ♦ rim ll7l 1DTT7T-TiTWPi-nTxIT.P.-tn T .__. 1'1J'L' L'"i 11Ti Xvi_. Fee: NOTE: This estimate does not include fees due to other Departments 0-e. Planning { ADDRESS: 10391 Menhart Ln DATE: 09/36/2015 REVIEWED BY: PAUL $0.00. 1 APN: 37515 048 BP#: 14060127 *V ALUATION: $0 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: :Addition PME Plan Check: PRIMARY SFD or Qu lex p Permit Fee: PENTAMATION 1 GENRES USE: $0.00 PME Unit Fee: PERMIT TYPE: WORK Deferred #1 - Truss Calculations 1...oP"L.StT'ucti.fin Ta.,,: :1.chnini`frative Fee: SCOPE $0.00 Advanced Planning Fee: f .. __ } � ,' Lt 1't<;r•, (.Its c t .1,1ech, Plan Check r Itrrtte. 1'lu,I _ r,c:tk " .. Ir Plumb. nP Permit sit_: [s <c 1 e"rrn;T P�'e: erwi! Fee {llt e'r. t'Iec'dJ, i?'t,5j7. i}lf3_'rPI7/f71 f} Inv). L—j L t Jc ia. ,tzsi f r'e: T hin d?. hiss Fee: NOTE: This estimate does not include fees due to other Departments 0-e. Planning District, etaThese ees are based on the Preliminaryinformation available and a FEE ITEMS (Fee Resolution 11-053 Ef. 711113) FEE QTY/FE] Plan Check Fee: $0.00. 1 Suppl.'PC Fee: Reg. 0 OT 0.0 hrs $0.00 $286.( PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 1...oP"L.StT'ucti.fin Ta.,,: :1.chnini`frative Fee: Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 7'ro el Doe LtJnt'72uvion Fees: Strom Motion Fee: $0.00 Bldg Stds Commission Fee: $0.00 Si7BTOTALSi $0.00 $286 Dec. tttra, ,' ,t - Public IVorks, Fire, Sanitary Sewer District, Sc only an estimate. Contact the Dept -for addn'l MISC ITEMS Deferred Submittal IDEFSUBM 09 I Select a Non -Residential — I Building or Structure Select an Administrative Item TOTAL FFjE $286.00 Revised: 07/02/2015 CITY OF CUPERTINO BUILDING ADDRESS: 10391 MENHART LN OWNER'S NAME: YINGHE AND YUGEN HU CONTRACTOR:YINGHE AND YUGEN HU 9 PERMIT NO: 14060127 10391 MENHART DATE ISSUED: 10/20/2014 OWNER'S PHONE: 4082093308 CUPERTINO, CA 195014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT, (N) 1 STORY SFD (1805 S.F.) WITH License Class Lie. # ATTACKEDGARAGE (343 'S.F.) 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: 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. 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 co I with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date OWNER -BUILDER DECLARATION Sq. Ft Floor APN Number: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, 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: 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. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 oft f the Labor Code, for the performance of the work for which this permit i issued. i I 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 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, .4 Signature DA All roofs shall be installed without inspection. Signature of Apl ALL Valuation: $200000 Occupancy Type: !S iF WO S NOT STARTED DAYS OFnRMIT ISSUANCE OR . ` ALLED INSPECTION. S Date: RE -ROOFS: ected prior to any roofing material being installed. If a roof is obtaining an inspection, I agree to remove. all new materials for Date: COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the Hazardous materials requirements under Chapter 6.95 of the California Healt� & Safety Code, Sections 25505, 25533, and 25534. I will maintain compli ncc 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 255 5, 25533, and 25534. Date: ,f Owner or authorized agent: 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 - i Lender's Address ARCHITECT'S DECLARATION I understand mylplans shall be used as public records. Licensed CUPERTINO ❑ NEW CONSTRUCTIC PROJECT ADDRESS® OWNERNAME •� a STREET,ADDRESS—s ,923��--� a CONTACT NAME STREETADDRESS CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building C_cupertinb.org ❑ ADDITION ❑ ALTERATION / TI ❑V1SI0� ESD APN # T 15 vx PHONE E-MAIL -3va v CITY, STATE, ZIP PHONE ` I E-MAIL .� (,3 s GITY> STATES ZIP ` A 9 FAX FAX y, y�OV�T'ER El ❑ CONTRACTOR ❑ CONTRACTOR AGENT j ❑ ARCHITECr ❑ ENGINEER 11 DEVELOPER TENANT ❑ ORTIER-BUILDER. OWNER AGENT OCG. SQ -FT 3XISTING USE 6 CONTRACTOR NAMES 9 LICENSE NUMBER p LIC SE TYPE BUS. LIC 1L Signature of Applicant/Agent: TFORMATION REQUIRED e� COMPANY NAI,lE E-MAIL FAX A ! ° CITY, STATE, ZIP "" PHONE� IVe r STREET ADDRES i C ARE � fi b e BUS. LIC # BAT KITCHEN LICENSE NUMBER a g ARCHITECT/ENGINEER NAME REMODEL AREA REMODEL.AREA I �} REMODEL AREA FAX COMPANY NAME E-MAIL , _. CITY, STATE; PHONE STREET ADDRESS - - DESCRIPTION OF W/REI ,DWELLINGUNITS: "�"""",•" "..."- � BEING ADDED? O ADDITION? USE CONSTR. TYPE # STORIES us, TYPE 9I OCG. SQ -FT 3XISTING USE application and the information I have provided is correct. 1 rize representatives of Cupertino V, V, `90 ordinances and state laws relating to building co ction. Date: Signature of Applicant/Agent: TFORMATION REQUIRED e� - Multifamily dwellings: Apply for demolition permit for EXIST W FLOOR' DEMO TOTAL NET I. i C ARE � ARE AREA �� e form if any to BAT KITCHEN OTHER a g . REMODEL AREA REMODEL.AREA I �} REMODEL AREA - ,DWELLINGUNITS: "�"""",•" "..."- � BEING ADDED? O ADDITION? YES g YES, PROVIDE COPY OF IS THE BLDG AN ❑PES EICHLERHOME? PRE -APPLICATION ❑ I PLANNING APPL:' ❑NO PLAA'NINGAPPROVALLETrER By my signature below, I certify to each of the following: I am the property owner or onze o act I have read the Description of W and vIe r i application and the information I have provided is correct. 1 rize representatives of Cupertino enter to enter t! ordinances and state laws relating to building co ction. Date: Signature of Applicant/Agent: TFORMATION REQUIRED RLa i c> SUPPLEMENTAL Multifamily dwellings: Apply for demolition permit for Q o�R:TFIE New SFD or existing building(s). Demolition permit is required prior to issuance of building `E�Plurss , permit for new building. Materials Disclosure s7`ATDAR% Bldgs: Provide a completed Hazardous _Commercial Hazardous Materials are being used as part Of this project.. form if any to Planning Approval Letter or Meeting with Planning prior ilZA7QR _Copy of submittal of Building Permit application. VALUATION (S) 71-1,1 0 owner's behalf. I have read this I agree to comply with all applicable local ntifiad Droperty for inspection purposes. BldgAPP_20l Ldoc revised 06121/11 CITY OF CUPERTIN11 FEE ESTIMATOR — BUILDING DIVISION KESS 10391 MENHART LN I DATE: 06/18V2014 REVIEWED BY: MELISSA APN: 375 15 048 BP#: f�0/,,?7VALUATION: $200,000 'PERMIT TYPE: Building Permit PC FEE ID PLAN CHECK TYPE; New Construction PRIMARY USE: SFD or Duplex 2nd Unit? „_; Yes '' No MATION 1'R3SFDW �IVERMITTYPE: WORK SCOPE CONSTRUCT N 1 STORY SFD 1805 S.F.).WITH ATTACHED GARAGE 343 S.F. 1NSP IHINSP OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f.) PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) 11-B,111-B,IV,V-B 1,805 $2,707.27 IR3PLNCK $2,262.75 1NSP IHINSP 11-B,111-B,IV,V-B 434 $0.00 1 UIPLNCK $1,252.00 I U (Private Gar/Ag Bldg) TOTALS:I 2,239 I $2,757.27 susToTaLs l $7,273.47' $0. $3;514.75 Works, Fire, Sanitary Sewer District, School an estimate Contact the Dept for addn'l info. MISC ITEMS Select a Misc Bldg/Structure —� or Element of a Building n L Select a Non -Residential —� Building or Structure 0 Select an Administrative Item EE� $7,273.47 Revised: 04/01/2014 1" a sib–h NOTE. This estimate does not include fees due to other Departments (i.e. Planning, District,'etc . These fees are based on the prelimin= in ormation available and ar FEE ITEMS (Fee Resolution 11-(}53 Eff. 7/1113) FEE QTY/FEF Plan Check Fee: $2,757.27 Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,514.75' Suppl. Insp. Fee:(D Reg. 0 OT 10.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR # new 1 units $659.99 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: IPLLONGR $313.46 Strong Motion Fee: IBSEISMICR $20.00 Bld.p Stds Commission Fee: 1BCBSC $8.00 susToTaLs l $7,273.47' $0. $3;514.75 Works, Fire, Sanitary Sewer District, School an estimate Contact the Dept for addn'l info. MISC ITEMS Select a Misc Bldg/Structure —� or Element of a Building n L Select a Non -Residential —� Building or Structure 0 Select an Administrative Item EE� $7,273.47 Revised: 04/01/2014 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building(c)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 ADDRESS24 APN BP# OWNER NAME _ OWNER ADDRESS 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 information.) *A . I 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. V2. 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. *.3. 1 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. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. �115. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the otal 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. 17. 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. JA8. 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. Ox,nerBuilderForrn 2010.doc revised 04114110 --0. 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. 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. tn//d 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I athe party legally and financially responsible for proposed construction activity at the site address listed above. L111applicable 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide )by laws and requirements that govern Owner -Builders as well as employers. 412. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the in rmation 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 verifv the aroaerty owner's sionature. Property Owner's Signature: Date: X/Zp -------------------------------------------------------------------------------------------------------------------------------------------- (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: OwnerBuilderFornT 2010.doc revised 04114110 CALGREEN RESIDENTIAL CHECKLIST — MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINO I ALBERT SALVADOR, P.E., C.B.O., BUILDIN ICTAL 10300 TORRE AVENUE • CUPERTINO, CA01 (408) 777-3228 • FAX (408) 777-3333 • buildin Wein P110%. PURPOSE: v� The 2013 CalGreen Code applies to all newly constructed hotels, motels, lodging housIli dormitories, condominiums, shelters, congregate residences, employee housing, factory -built k other types of swellings with sleeping accommodations and new accessory buildings associated with su uses. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: Hu Residence Project Address: 10391 Menhart Lane Cupertino, CA 95014 Project Description: Construct (N) one story SFD 1805 sq.ft. with garage (343 sq. ft.) Instructions: 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 profess%* I oiflK ir N*Column 2 of this checklist, sign and date Section 1 - Design Verification adthe end of tFrfs c klst n have the checklist printed on the approved plans for the project. Build nqeparr menT 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 qhd of this checklist and submit the completed form to the Building Inspector. -" REVIEWED FOR CODE COMPL I ANCE Reviewed By. Column 2Column 3 MANDATORY FEATURE OR MEASURE Project Verification Requirements Planning 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 CnlGreen 2014.dor revised 0145, 14 General 4.201.1 Low-rise residential buildings shall meet or exceed the minimum i ❑ standard design required by the California Energy Standards. .. .3 WATER EFFICIENCY AND CONSERVATION Indoor Water Use 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. 0 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. ❑x 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. 0 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 $ CalGreeni 2014.doc remised 0111 i/14 General 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. Indoor Water Use 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. 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. 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. 1 0 INK 0 Page 2 ol'S Cu Kireen-20J4,do( revised o///iil4 Page 3 of S CalGreen ?014.dor revised 011/5;14 Outdoor Water Use 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. EFFICIENCY A4..4 MATERIAL. • URCE Enhanced Durability and Reduced Maintenance 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, Disposal 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. Building Maintenance and Operation 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 QUALITY Fireplaces 4.503.1 General. Install only a direct -vent sealed -combustion gas or sealed 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 ❑ kaj distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks be compliant VOC K IJ with and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be compliant with VOC limits. ❑ UJ 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 Lai ❑ compounds. Page 3 of S CalGreen ?014.dor revised 011/5;14 4.504.2.4 Verification. Documentation shall be provided to verify that VOC limit finish © ❑ compliant 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 (CHPS) Low -emitting 0 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 Q comply with low formaldehyde emission standards. Interior Moisture Control 4.505.2 Concrete slab foundation. Required vapor retarders and capillary El are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture content of building in materials used wall and floor framing is checked before enclosure. Indoor Air Quality and Exhaust 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the X ❑ El are provided in every bathroom. Environmental Comfort 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 ASPECIAL ND INSPECTOR QUALIFICATIONS Qualifications 702.1 Installer training. HVAC system installers are trained and certified in the installation HVAC ❑ proper of systems. 702.2 Special inspection. The Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the 11 discipline they inspect and verify. / Verifications 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 Cul(»� eir ?014.t1n� revr.ce d W 11544 Project Name: Project Address: Project Description: CALGREEN SIGNATURE DECLARATIONS Hu Residence 10391 Menhart Lane Cupertino, CA 95014 Construct (N) one story SFD 1805 sq.ft. with garage (343 sq. ft.) 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. 9 Owner's Sign re Date Design Professional's Signature Date Joseph Xu Design Professional' a PI ase Print) Signature oittumne Professional responsible for CalGreen compliance Date Name of License Profes Tonal responsible for CalGreen compliance (Please Print) Phone X p mss. %A P_P� ��Kn Email Address for`ticense ProfesXbnaltresponsible 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 01115/14