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B-2016-1329CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7525 NEWCASTLE DR CUPERTINO, CA 95014-5220 (36617 068) OWNER'S NAME: HUASONG CHEN OWNER'S PHONE: 408-805-0616 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor OWNER/BUILDER Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self -insure for worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.] 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 08/12/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: x. 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's CONTRACTOR: I PERMIT NO: B-2016-1329 DATE ISSUED: 04/28/2016 NO: BUILDING PERMIT INFO: X BLDG X ELECT X PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: Construct front and rear one story additions (I 110 sq ft); Front covered porch (66 sq ft); Interior remodel 989 sq ft); Kitchen remodel (170 sq ft); Remodel bathrooms (102 sq ft); Install (4) skylights; Install new furnace and water heater. REV # 1 -UPGRADE 100AMP PANEL TO 200AMP PANEL, SAME LOCATION - ISSUED 8/12/16 Sq. Ft Floor Area: 1176 1 Valuation: $200000.00 APN Number: Occupancy Type: 366 17 068 Deferred Submittal (R -3),R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM by: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 08/12/2016 Compensation, as provided for by Section 3700 of the Labor Code, for the ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. 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. Signature ° Date 08/12/2016 (/ HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent �L✓ Date: 08/12/2016 G CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed C U P E:R"TI N g ❑ NEW CONSTRUC PROJECT ADDRESS 0\VN'ERO NA ,ME 5,.�/s STREET Al2QRESS CONTACT NAME �] STREET ADDRESS , CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 16 U 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(dcupertino.org ❑ ADDITION ❑ ALTERATION / TI VISION / DEFERRED ORIGINAL PERMIT #B __Z0 l 27 rle. / APN# 3v16 21 Px/i _/_ 4, - _GrY PHONE y / _°y A E-MAIL CITY, STATE, ZIP t n - ❑ OWNER N OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL . FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Z Rr�'D f o Q/N�o 5 hV" G c.b -/-z a/2� FAX EXISTING USE PROPOSED. USE CONSTR. TYPE I # STORIES _ USE TYPE OCC. SQ.FT: VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA.. BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODELAREA ❑ ATTACH rDWELLING UNITS: IS A SECOND UNIT El YES SECOND STORY YES BEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION YES IF YES, PROVIDE COPY OF IS THE BLDG AN YES ;, - ❑ ❑ D8Y TOTAL VALUATION: PLAN'NINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO By my signature below, I certify to each of the following: I am the property owner or authorized o act on the property owner's behalf I have rea 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 construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: 1 /i > ,;4 Date: r I? I I SUPPLEMENTAL INFORMATIGN-REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure To—nn if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1329 7525 NEWCASTLE DR CUPERTINO, CA 95014-5220 (366 17 068) OWNER/BUILDER OWNER'S NAME: HUASONG CHEN DATE ISSUED: 04/28/2016 OWNER'S PHONE: 510-676-3689 PHONE NO: OWNER/BLDR LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor OWNER/BUILDER Date X BLDG _ELECT X PLUMB X MECH X RESIDENTIAL _ COMMERCIAL 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. JOB DESCRIPTION: Construct front and rear one story additions (1110 sq ft); Front covered I hereby affirm under penalty of perjury one of the following two declarations: porch (66 sq ft); Interior remodel 989 sq ft); Kitchen remodel (170 sq ft); 1. I have and will maintain a certificate of consent to self-insure for Worker's Remodel bathrooms (102 sq ft); Install (4) skylights; Install new furnace Compensation, as provided for by Section 3700 of the Labor Code, for the and water heater. 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 Sq. Ft Floor Area: 2352 Valuation: $200000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 366 17 068 Deferred Submittal (R-3),R-3 (Custom) 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 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 INSPECTION. sGrg-ri`aturew Date 4/28/2016 Issued by: Alex Vallelunea Date: 04/28/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 1. I, 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) F�I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: �' contractors to construct the project (Sec.7044, Business & Professions Code). Date: 4/28/2016 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous 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 Compensation 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. auorizeci,-AgMtc'M) Owner -.zorth APPLICANT CERTIFICATION Date: 4/28/2016~ - CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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, judgments, costs, and expenses which may accrue against said City in Lender's Address 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 Signa' Date 4/28/2016 Professional CONSTRUCTION PERMIT APPLICATION BX,b� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CLJPPR 0 ( (408) 7 7-3228 • FAX (408) 777-3333 • build ingfleupertino.org El NEW CONSTRUCTION ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS �� * I A ,Ca41 � P17 APN i{ I OWNERNAME "`via +� PHONE b0506� I_ B -MAIL J i4 aV-6Lq/}cboi)reed. ' STREET ADDRESS 110'7 -Or- O� a n CITY, STATE, ZIP s r��l `n o G� 1 FARC CONTACT NAME wvval � � i' o (' PHONE 6 to l�SCwJP 't 4 E-MAIL f � Gcav P � {, �� Qr, L / 1 STREET ADDRESS .-y ,� �� t FAX CITY, SQA �E, Zf Po �t �) V/ ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAIGGEENTT ❑ CONTRACTOR ❑(CCOOM,RACTORAGENT M ARCHITECT ❑ ENGINEER ❑ DBVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER FCENSETYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCIItTECT/ENGINEER NAME �� LICENSE NUMBER i L L� ate- BUS. LIC # likCOMPANYNAME r ` 11 -MAIL �� �rGdi �' top FAX retc�er, STREET ADDRESSCITY, �� STATE, ZIP r + iJ PHONE [ DESCRIPTION OF WORK ( j ,, �� / ow., 964/_ G d L 6�tw�`s �. o i vz�-arra rre Mo A, we I . W S<,YLTS EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES { 1 .- 09 Y I 1 USE TYPE OCC, SQ.Ff. VALUATION ($) EXISTG AREA I 5 NSW FLOOR AREA 11110 DEMO AREA ✓ TOTAL NET AREA ` r BATHROOM REMODEL AREA Loo KITCHEN REMODEL AREA (/A p� OTHER IMMODEL AREA r� PORCH AREA DECK AREA TOTAL DECK/PORCH ARBA GARAGE AREA: DLMACH TACH # DWELLING UNITS: IS A SECOND UNIT© F.S BEINGADDED? ROF SECOND STORY EITRS ADDITION? W10 PRF.APPLICANION MlfES IF YES. PROVIDE COPY OF PLANNINGAPPL# ❑NO PLANNING APP.ROVALLETTER IS TILE BLDG AN❑ Y_ES EICHLERHOME? 0 ` VED BY: TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act out the property owner's behalf. I have read this application and the information I have provided is correct. I vc re the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building constructio at orize 'epresentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: _.2 ZS// SUPPLEMENTAL INFORMATION REQ ED PLAN CHECK TYPE ROUTIPiG SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OvER-TAE-COUNTER BUILDING PLAN REVIEW ' existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS PLANNING. PLANREVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD PUBLIC WORKS form if any Hazardous Materials are being used as part of this project, ❑ LARGE FIRIr DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR sAruT�A2Y Dl�srlu submittal of Building Permit application. . st CT ❑ ENVIRONMENTAL -HEALTH Bldg ipp_2011.doc revised 06/21/11 COW) Dln CIT'' OF CUPERTINO f"SK FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 7525 NEWCASTLE DR DATE: 02109/2016 REVIEWED BY: PAUL BP FEES APN: 36617 068 BP#: *VALUATION: $200,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIlOi.ARY SFD or Duplex USE: 2nd Unit? Yes Q No OTC. 0 Yes (D No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORD Create N front and back addition (1,110 S.f. N Porch Area 66 S.f. • Remodel and reconfigure 1st SCOPE floor (1,261 S.f.) OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA _ (s.f.)- `" { { PC FEE ID BP FEES BP FEE ID R-3 (Custom) 11-B,111-BjV,V-B 1,176 $2,695.26 IR3PLNCK $1,813.82 IR3INSP ;.Qech 1nsp) Fee.- Alumb. Irish, f t'<: Elec. 11',q)- Fee' $1,813.82 Suppl. Insp. Fee::q .Reg. 0 OT 0 p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ("On.S1i•uellon TCzv: Lj TOTALS; 1,176$2,695.26- _- - - - - 8 82 $ 1 13. - - <UYIT�`..... � Yes No 1'1N3�fi,k' Yes N�zIIfJTi12%f�' = 3j 4'es 1} Ng ; .Aolech. Plan ('w21L Plumb. 111,w t:1&.'c1c Ahfc;..Phin (7r<:, i -Vech. Pevii! Fee: Phnh. Pcradi Fee --t- :.Orher.11umb ic'c., f'rrrrtir I e. beg). {F.1) El Ir:3t>)',OrYQi.'fCI ;.Qech 1nsp) Fee.- Alumb. Irish, f t'<: Elec. 11',q)- Fee' NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These.fees are Gassed on the prelinunary information available and are only an estimate. Contact the Dept.foraddn'l info, FEE ITEMS (Fee. Resolution.11-0531ff7111131 FEE QTY/FEET MISC ITEMS Plan Check Fee: $2,695.26 1,261 s,f. Remodel, Other $4,604.00 1REMRES2 Suppl. PC Fee: (@ Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,813.82 Suppl. Insp. Fee::q .Reg. 0 OT 0 p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ("On.S1i•uellon TCzv: Lj 0 E) Work Without Permit? (0 Yes G) No $0.00 Advanced Planniqg_Fee: IPLLOA[GR $164.64 Select allon-Residential 0 Building or Structure 0 :t-i•cxv4:f Do<:zrtiae?rtr?livri ��•c�c�s; Strom Motion Fee: IBSEISMICR $26.00 Select an Administrative Item Bldg Stds Commission :Fee: IBCBSC $8.00 .............._........................ _ .........._......._._..._._._.. _.....__....._..._._.. :._; ::SUFI TAL -:_ 5,... 4,707.72 ...........:....:.:........... __ .:: -::. ;' `:, ::.:::: >:TQTAI�::F $4,604.00 ,.:..: ::::::::.:...::.::::.......::.::.:..: _ $9,311.72 Revise : 01 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 a FAX (408) 777-3333 • buildinala cugertino.ora Dear Property Owner(s): An application for a building permit has been submitted in your name lisi-ing yourself as the builder of the property improvements specified at: - SITE ADDRESS OWNER NAME_ , . _ _'. OWNER ADDRESS- CAI rn4E 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.) 1(�4-. t understand a frequent practice of unlicensed per is to have the property owner obtain an "Owner- ilder" building permit that erroneously implies that the property owner is providing his or her own labor and material rsonally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by unlicensed person and his or her employees while working on my property. My homeowner's insurance may not wide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my urance coverage for injuries to workers on my property. ; I understand building permits are not required to be signed by property owners unless they are responsible for construction and are not hiring a licensed Contractor to assume this responsibility. �, I understand as an "Owner -Builder" I am the responsible party of record on the permit, I understand that I may ect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her ie instead of my own. . I understand Contractors are required by law to be licensed and bonded in California and to list their license ;rs on permits and contracts. LL -5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the al value of my construction is at least five hundred dollars ($500), including labor and materials, I may be nsidered an "employer" under state and federal law. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and �deral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to nemployment compensation for each "employee," I also understand my failure to abide by these laws may subject ie to serious financial risk. L U. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family -esidential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by icensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work s performed under contract with a licensed general building Contractor. W. 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. O i;iierBuilderFo7'm 2010, doc rel,,'sed O4ll4/10 t,--•-9. I 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, tf and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State Ro License Board (CSLB) at 1-800-321-CSLB (2752) or wvw.csib.ca.gov for more information about licensed contractors. .=,Ik U o. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity of the site address listed above. - Li . 11. I agree that, as the partly legally and financially responsible for this proposed construction activity, I will abide 4' by all applicable laws and requirements that govern Owner -Builders as well as employers. Je(f ,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 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. If 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 otethose 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, orm 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. --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The folloiv✓ing Authorization Form is required to be completed by the properly 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 AuthOd ed 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 cer Liy its accuracy. Note: A copy of the property ov✓ner'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: Ox-rerBuilderForm ?OIO.doc revised 04-17"110 \ / - Building Department City Of Cupertino 10300 Torre Avenue 51./9„. _ Cupertino,CA 95014-3255 CUPERTINO Telephone:408=777-3228 Fax:408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST =`JOB ADDRESS: ye-vs/06T DMZ PERMIT# 2-016 '13 OWNER'S NAME: -- PHONE# 610 67.& —3'6 GENERAL CONTRACTOR: 5p1 eaS'S LICENSE# 0 ADDRESS: tor? i' p,-t c, a Oi 'TY/ZIPCODE: Our municip$l"code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL.BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO etii< BUSINESS LICENSE. I am not using any subcontractors: %glir-772-.1---- 441/47 Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets&Millwork *a-7E4Y r exL cotvIT Cement Finishing Electrical • Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating J� Insulation Landscaping Jl Lathing / Masonry Painting/Wallpaper - Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock.. Tile 1 AMP 31 ,j/ ( 7 Owner/Con; .c r Signature Dat CALGREEN RESIDENTIAL CHECKLIST - MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildlna cupertlno.org 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: 7525 Newcastle Dr Addition/Remodel Project Address: 7525 Newcastle Dr, Cupertino, CA Project Description: To add 1,110 sf to the front and back of one-story house. 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 professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Reauirements 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. dei°iilldhi g Ilgelpar°timent I3IEVH.: Wl..D I::OU CODs _ COI iIIIII.JANCI Page 1 of 5 Rev dew d By13'e&�, i I"""""Ia�tdh CalGreen_2014.doc revised 11/04/14 Datr„P n4./'I >f'It 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. in 1:1 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 r in Table 1401.1 of the California Plumbing Code.CU!"IER"T"INO Page 2 of 5 DatE„P 4./'�5/'� CalGreen_2014.doc revised 11104114 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 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 El 1:1 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 Fireplaces 4.503.1 General. Install only a direct-vent sealed-combustion gas or sealed El 1:1 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 compliant with VOC limits. 4.504.2.3 Aerosol paints and coatings.�I shall be compliant with product weighted for ROC and other toxic compounds. FiEV l'..I. ll:..D FU) COD OM[IlJANCI Page 3 of 5 Revle ed By,13'e&n I"""""I atdh CalGreen_2014.doc revised 11/04/14 V )a tE„ n4./'l )f'l 6 4.504.2.4 Verification. Documentation shall be provided to verify that compliant VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with VOC limits. 4.504.4 Resilient flooring systems. Eighty (80) percent of floor area receiving resilient flooring shall comply with the VOC-emission limits defined in the Collaborative for High Performance Schools (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 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 com fiance with CALGreen may include construction documents, plans, s ns, m t I P p p r p ing certification, inspection reports, or other m o cce t .. agency which show substantial conforms nllni°°ul�lafuiu „qui u II be submitted to the Building Department mentation of all required measures and prior to final inspection app"l�.11wI�'::Ui CONCOWI[JANCE Page 4 of 5 Rev dew d � Y°'13'eaI,i I"""""Iatdh CalGreen_2014.doc revised 11/04/14 V )a tE„ n4./'I )f'I 6 CALGREEN SIGNATURE DECLARATIONS Project Name: 7525 Newcastle Dr Addition/Remodel Project address: 7525 Newcastle Dr, Cupertino, CA Project Description: To add 1,110 sf to the front and back of one-story house. 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 ertino. k0 Owner's Signature Regina Kao Owner's Name (Please Print) I Design Professional's Signature Huiwen Hsiao I Signature of License Professional responsible for CalGreen compliance Huiwen Hsiao I Name of License Professional responsible for CalGreen compliance (Please Print) hhsiao(darchirender. corn Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION 03/30/2016 Date 03/30/2016 Date 03/30/2016 Date 510-5856445 Phone 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. 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