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15080024i CITY OF CUPERTINO BUILDIiNG PERMIT BUILDING ADDRESS: 10110 PENINSULA AVE CONTRACTOR: TBD - TO BE PERMIT NO: 15080024 DETERMINED OWNER'S NAME: DOREEN ROVETTI DATE ISSUED: 10/21/2015 OWNER'S PHONE: 4089100807 PHONE NO: RESIDENTIAL ❑ COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIP'T'ION: (, License Class Lic. # %� CONSTRUCT 0111E GARAGE (436 S(FT). STORY ADDITION (224 SQFT)& DETACHED Contractorn).SENc ,Dade 7 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: Sq. Ft Floor Area: Valuation: $115000 �. 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 Fherformance of the work for which this APN Number: 3 Z624028.00 Type: permit is issued.Occupancy ave 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. PERMI EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITMN 180 DAYS OF PERMIT ISSUANCE OR 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 laws 180 DAYS LAST CALLED INSPECTION. and state relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection (C) purposes. (We) agree to save Issued by: Date: indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which ma crue against said City in consequence of the granting of ' pe it. Ad . onal the applicant understands and will comply with all non -p nt sours gu tions p the Cupertino Municipal Code, ectio ® 9.18. RE -ROOFS: All roofs shall be �nspected prior to any roofing material being installed. If a roof is Signatur Date �� / installed withoutfirst obtaining an inspection, I agree to remove all new materials for inspection. Signature of App, cant: Date: ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for HAZARDOUS MATERIALS DISCLOSURE sale (Sec.7044, Business & Professions Code) I have read the h izardous materials requirements under Chapter 6.95 of the 2. I, as owner of the property, am exclusively contracting with licensed contractors to California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain construct the project (Sec.7044, Business & Professions Code). compliance with he Cupertino Municipal Code; Chapter 9.12 and the Health & Safety Code, Seri 'on 25532(a) should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally, sho Ad I use equipment or devices which emit hazardous air t: I have and will maintain a Certificate of Consent to self -insure for Worker's contaminants as efrned by the Bay Area Air Quality Management District I will Compensation, as provided for by Section 3700 of the Labor Code, for the maintain compli nce 'th the Cupertind Municipal Code, Chapter 9.12 and 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 Healt Safety w e, ections 25505, 25533, and 25534. agent: Section 3700 of the Labor Code, for the performance of the work for which this D a te -.J b ? permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I shall CONSTRUCTION LENDING AGENCY 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 I hereby affirm th � t there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, I for which this perm it is issued (Sec. 3097, Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Addres$ APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I .understand my p ams shall be used as public records. 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 Licensed Professi nal 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 -- CONSTRUCTION PERMIT APPLICATION COA4h/UNITY DEVELOPMENT DEPARTMENT • BUI;LDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPirRTiri1® (408) 777-3228 • FAX (408) 777-3333 • buildinc cup,eriin0 orcl I ❑ NEW CONSTRUCTION YADDITION ❑ ALTERATION / Ti ❑ REVIII$ION / DEFERRED C PRnTF!'r AnT)Dccc -I I :mak Bldk4pp_2011.doc revised 0612Ili I ! OWNERIIAME PH NE 1 �� G2 E-MSTL I � (fit'✓ %C7 `; STREETADDRESS CITY NATE, ZIP /� % " 'e FAX `fit ✓cJ [3 l �d � . T CONTACT N. PHONE_ / E hiiAIL I STREET ADDRESS C%(!J� fc�'fdf CSS S r'F�Js � CITY, STATE, ZIP FAX OWNER ❑. OWNER -BUILDER COy R0.CTOR ❑ COMRA-CTORAGEt r ARCHITECT ❑ `EE EZ\GL�cR ❑ DF VtLOPER ❑ TENANr CONTRACTOR NA1vIE LICENSE NUMBER LICENSE TYPE BUS. LIC m COMPAivY NA ,S E-MAIL FAX STREET ADDRESS CrIY, STATE, ZT" ! PHONE a ARCHITECT /ENGINEER NAME LICENSE AUMBEF BUS, LTC COMPANY NAS r'r FAX E M : i STREET ADDRESS ` CrfY,STATE. ZIP PHONE DESCRIPTION OF WORK C��j E30STINGUSE PROPOSED USE ASTR TYTE ~STORIES USE TYPE I OCC. I SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEM�3' TOTAL - AREA - AREA Ar NET AREA wy r BATI-RO Ir KITCHEN OT'H'ER / REMODEL AREA P.Eb30DEL 0.RE/ - REh,ODEL AREA PORCH AREA DECK AREA TOT A✓i; 'CK/PORCH AXF-A GARAGE AREA: LIDETACH i ❑ ATTACH ( n MAULING UNITS: IS A SE - ND UNrr ❑ YES SECOND STO RY ❑ YES BEING DDED? NO ADDITION? ❑No I I PRE APPLICATION ❑ YES IF 1?.s�(PROVIDE COPY OF PLAN'hTNG42PLR ❑NO PL TINGAPPROVALLETIER IS TH£ BLDG AN YES I EICHLERHOAiE? ❑NO j �. CEI - '�'EI -"� ` - / TOT• LVALUATIO By my signature below, I certiy to eachof the follo��ing: I am the proper y o�,ner or authorized agent to act on the property owner's behalf. I ha e read this application and the information I have provided is correct. I have read the Description of �TJork and erify it is accurate. I agree to comply with all applicable local ordinances and state laws re lat Q building construction. I authorize repr��es--en--ta--ti'of Cupertino to enter the above -identified property for inspection purposes. SipatureofApplicant/ Date: SUPPLEMENTAL INFORMATION REQUIRED i y - - New SFD or Multifamily dvvellings: Apply for demolition� permit for building � � O�iER TfiD•COL'NTER— %�L�DL\GPLA^ZE4Y, existing (s). Demolition permit is required prior to issuance of building permit for new building.EMUMri Commercial BIdgs: Provide a completed Hazardous Materials Disclosure �� i' EL"B..SCS�oRhs �-�` form if any H2zardous Materials are being used as part of this project. " k r� _ Co of Planning Approval Letter or Meeting with Planning prior to PY PP i submittal ofBuilding Permit application. ... £�YSR01'YSE'tF�iliAl2sE . Bldk4pp_2011.doc revised 0612Ili I CITY OF CUPER EEE ESTIMATOR - BUILD ADDRESS: 10112) APN: ^PERMIT TYPE: Building Permit PRIMARY SFD or Duplex USE: P WORK SCOPE DATE: BP#: PLAN CHECK T 2nd Unit? Yes OTC? 0 Yes O T DIVISION REVIEWED BY: *VALUATION: Addition Q9 No PENTAMATION ONo PERMIT TVPF.- 115,000 1R3SFDADD OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f.) i PC iPEES I PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 224 $1,091.00 IADDPLCK $1,057.00 IADDINSP U (Private Gar/Ag Bldg) II-B,iII-B,IV,V-B 436 1 $0.00 IUIPLNCK $1,290.00 1UIINSP Cl OT p,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: i TOTALS: 660 $1,991.00 T '; $2,347.00 I .. .1:.1 NOTE: This estimate does not include fees due to other Departments (Le. Planninj, Public Works, Fire, Sanitary Sewer District, School Di.Qt[irt Ptr_)_ FEE ITEMS (Fee Resolution 11-033 E . 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,091.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q) Reg. 0 OTO,Q hrs $0,00 PME Plan Check: $0.00 j Pen -nit Fee: $2,347.00 Suppl. Insp. Fee:(F) Reg. Cl OT p,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 / 0 Work Without Permit? 0 Yes ) No $0.00 Advanced Planning Fee: IPLLONGR $92.40 Select a Non -Residential Building or Structure E) 0 on, 1114enhi17 1 f t:'t.','; Strong Motion Fee: IBSEISMCR $14.95 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $5.00 n, SUBTOTALSi>' $3,550.35 $0.00 TOTAL FEE,: $3,550.35 Revised: 07/02/2015 CUPERTINO i - CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c1cupertino.org NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINA PERMIT T PROIECfADDRESS P ATN, 2 / G O \�y J V Ia OWNERNAME PH NE E-MgiL STREET ADDRES CITY STATE, ZIP FAX A�'V��e TI AJ 0 CA CONTACT N. PHONE E-MAIL S wu 3 t -SZ�I — C yru <u vGc�s STREET ADDRESS CITY, STATE, ZIP FAX ^ y\__ C— ❑ MXWER ❑ OWNER-B=DER ❑ OWNER AGENT ❑ CONTRACTOR ❑ co,,7RACTORAGENT ❑ ARCHITECT ❑ ENGLNEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER I LICENSE TYPE BUS. LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZI PHONE ARCHITECTM4GINtER NA.MP LICENSE NUMBS BUS. LIC COMPANY NAME E-M FAX STREET ADDRESS C STATE, ZIP I PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CO STK TYPE A STORIES I USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA ` f v /r Y ✓ - BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTALDE ' ORCH AAAA GARAGE AREA: 0 DETACH --"- I I ❑ ATTACH I �— DWELLINGUNTrS: ISASECOND Mitr E] YES SECOND STORY ❑YES BEING ADDED+ [3 NO ADDITION? E] NO PRE -APPLICATION []YES IF YES, PRW E COPY OF IS THE BLDG AN ❑ YES TOTTA4L YA.LUATION: PLANNING APPL 0 Ll NO PLANNIN PROYAL LETTER I EICHLER HOME? ❑ NO J. (/,J ✓�j O�O By my signature below, I certify to ach 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 ve 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 rela ' building construction. I authorize representatives Df Cupertino to enter the above -identified property for inspection purposes. S i gpature of Applicant/ t: Date: SUPPLENtNTAL INTFORMATION REQ UIRED PL'�CHECKr1PE= _ .. r�_. u�OUTL�G SLIP New SFD or Multifamily d-wellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building ❑ OVER THE COUNTER 4BUIIDL�GPL�NREVIE�v i t o it for new buildino a• permAii PLAI� REVLFW i ss _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure L-KEI E11111111111- sraN7D Rn ❑ PUBI c �o _ , form if any Hazardous Materials are being used as part of this project. zzGE _ _ ❑ FSE> Pr —REP _ Copy of Planning Approval Letter or Meeting with Planning prior to _ ❑M470R -'❑ = submittal of Building Permit application. = SANITARER"ERDISTP CT _ YS _ - � ry� s;n��oNMEn>=.u, riEAiTa B1d&4pp_2011.doc revised 06121/11 r • % r CITY OF CUPERTINO I: FEE ESTIMATOR - BUILDING DIVISION I OCCUPANCY TYPE: ADDRESS: 10110 Peninsula Ave DATE: 08/04/2015 REVIEWED BY: Sean PC FEE ID APN: BP#: O '`VALUATION: 1$90,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPAddition PRIMARY SFD or Duplex USE: 2nd Unit? Yes No OTC. O Yes E) No PE AMATION 1 R3SFDADD RMIT TYPE: WORK Construct one story addition 224 sq ft). SCOPE Suppl. Insp. Fee:Q Reg. ©O I OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FE S PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 224 $,1/491.00 IADDPLCK $1,057.00 1ADDINSP Insp 1 $1,057.00 Suppl. Insp. Fee:Q Reg. ©O 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: ,4(lministrative Fee: E) Work Without Permit? © Yes (F) No $0.00 TOTALS: 224 $1,091.00 Travel Documentation .Fees: $1,057.00 Strong Motion Fee: IBSEISMICR MECH, HOURLY 0 Yes 0 No PLUMB, HO LY ® Yes 0 No ELEC, HOURLY Q Yes Q No .Tech. Plan Check rttmb. Plan C`/. h>e. flan Cheek Mech. 1'ermlt 1 'eco: Plum/' I' �. Efec. Parrnit Fee: Other il4ech. lrisp. Other 1'1 nb la.;'Ll I Other Elec. hist.. Piech. Insp. Fee; ;, hxsp. li. Insp 1 .NOTE: This estimate does not include fees due tother Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preli nary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS Fee Resolution 11-053 E : 7/ /13 FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,091.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: E) Reg. © OT 00 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,057.00 Suppl. Insp. Fee:Q Reg. ©O 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: ,4(lministrative Fee: E) Work Without Permit? © Yes (F) No $0.00 Advanced Planning Fee: IPLLONGR $31.36 Select a Non -Residential E) Building or Structure O i Travel Documentation .Fees: Strong Motion Fee: IBSEISMICR $11.70 Select an Administrative Item 1 Bldg Stds Commission Fee: IBCBSC $4.001 SUBTOTALS: $2,195.06 $0.00 TOTAL FEE: $2,195.06 Revised: 07/02/2015 r CITY OF CUPERTINO FM -7, FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10110 Peninsula Ave DATE: 08/04/2015 REVIEWED BY: Seanim , PC E ID APN: BP#: *VALUATION: 1$25, 0 °PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Cons ction PRIMARY SFD or Duplex USE: 2nd Unit? Yes No PENTAMATI 1U1 PERMIT TY : WORK Construct one story detached garage 436 sq ft). SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.i PC FEES PC E ID BP FEES BP FEE ID U (Private Gar/Ag Bldg) II-B,111-B,IV,V-B 436 $0.00 IUIPLNCK $1,290.00 1UIINSP $0.00 PME Plan Check: $0.00 Permit Fee: $1,290.00 Suppl. Insp. Fee.0 Reg. Q OTS 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 436 $0.00 Construction Tax: IBCONSTAXR $1,290.00 # new units NOTE: This estimate does not include fees due to of er Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the preliminjiry information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS Fee Resolution 11-053 E . 7111Y3) Alech..Pkan (:heck /'Iamb. flan Check Elec. flan Check A9eeh. Permit Fee: P/ mb. Perinit lee Elec. Perrnit Fee: flier :Llech.Insp. OtherPhcmh respLj I OiherElec. hisp. ',wch. Insp. Fee: Plumb. / p. / ite: 11ec. Insp. Fee: NOTE: This estimate does not include fees due to of er Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the preliminjiry information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS Fee Resolution 11-053 E . 7111Y3) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. O OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,290.00 Suppl. Insp. Fee.0 Reg. Q OTS 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 0 # new units $0.00 .-ic%ninistrative Fee: E) Work Without Permit? © Yes (E) No $0.00 Advanced Planning Fee: IPLLONGR $61.04 Select a Non -Residential Building or Structure E) 7rcn-,cll)ocnrnentution Fees: Strong Motion Fee: /BSEISMICR $3.25 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1,355.291 $0.001 TOTAL FEE: $1,355.291 Revised: 07/02/2015 CALGREEN RESIDENTIAL CHECKLIST - MANDATn� r' ITEMS ITTAL COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION #2 CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 RE (408) 777-3228 • FAX (408) 777-3333 • buildingna cupertino.orp ��� 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 r*,�v low-rise residential buildings, high-rise residential buildings, or both. Existing site and landscaping improvem%wAs are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: i6lld fl(j,6� Project Address: /D//U FtlA(I 15k_A A()V_� C—uPF _rIuo t cA 9S`6(N Project Description: <�l`Tt,4--_t&H660k467r -� 46aS�-- AM17706V Instructions: 1. The Owner or the Owner's agent shall employ a licensed professioJQ&r(ef)tPhd California Green Building Standards Codes to verify and assur,lad planned and implemented in the project. 1 1 ;. 1 _ L_. 1 2. The licensed professional, in collaboration with th a f 2 of this checklist, sign and date Section 1 - Desi rf rific lti n his e s%a Ma et e G checklist printed on the approved plans for the project. i?'�+� ` �� ! �'; T i C) N 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. Page I of 5 CalGreen 2014.doc revised 11104114 Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Requirements .. .1 PLANNING AND DESIGN 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 I of 5 CalGreen 2014.doc revised 11104114 A4.2 General 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 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. ❑ 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 11/04114 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. A4.4 MATERIAL CONSERVATIONRESOURCE 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 n{ ILJJ ❑ 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 ENVIRONMENTALQUALITY 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 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 �( LJ 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 11/04114 4.504.2.4 Verification. Documentation shall be provided to verify that E( 1:1 compliant VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with E]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 ❑ 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. Interior Moisture Control 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. Indoor Air Quality and Exhaust 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the building ❑ ❑ 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 AND SPECIAL INSPECTOR QUALIFICATIONS Qualifications 702.1 Installer training. HVAC system installers are trained and certified in r-�( LLJJ ❑ 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. 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 !__I u ❑ 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 CALGREEN SIGNATURE DECLARATIONS Project Name: /f) //b IAC-1015utLA A Project Address: W 5a 4-11 RUQ / GLt/fit c-4 Project Description: 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. Owner's Signature Date ^-J L Owner's Name (Please jj��Print) Design Pr�ional's Signature Date Design Professional's Name Tease Print) Signature of License Professional responsible for CalGreen compliance Date f Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Prof ssional 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 ColGreen_2014.doc revised 11104114 r CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildinola.cuoertino.oro 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: ..:....APN.. BP# SITE ADDRES4�, . Ut i OWNER NAME _ OWNER ADDRESS- v P4JLZ "'L' (,4 c-� -0 It i S0 V NA A vii _ O DESCRIPTION OF WORK: E 44 o vt- - �� a ✓ot-D /Z-C- e? 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.) (,�/�—•t. 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. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for inj0ries to workers on my property. 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. L'&=3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. L� 1 understand Contractors are required by law to be licensed and bonded in California and to list their license Tumbers on permits and contracts. i�_IueI understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the 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. A: I 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. 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. PI understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for ny financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OivnerBuilderForrn 2010.doc revised 04/14/10 Keven 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal e 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. fI am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I party legally and financially responsible for proposed construction activity at the site address listed above. 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide y all applicable laws and requirements that govern Owner -Builders as well as employers. V)L--f2. I 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 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 maybe in civil court. itis also important for you -to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you'obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's si natur . Property Owner's Signature: - Date: (NOTE: The following Authorization Form is required to be completed by the propertyowner 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. eG...0vf_ - /U '-*/I G i_!a-t 4 w„NHt so 4d„,4 �},pQr-tiow Scope of Construction Project (or Description of Work): 5n nGLs , Project Location or Address: t0 t (.0 PC_"%VJSUL_V; Ay4-- C,,., P<_t,-n vu0 CA GLS 01 L4 Name of Authorized Agent: 7L>sloo�Jt S L u NtJ Tel No 831 'GZA Z�sE3 Address of Authorized Agent: LO titer ?c_"tvysut,tA A"iL • Cu Q4grr�wo . CA. °►Sola I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10