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13110076CUPERTINIO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Tone Avenue Cupertino, CA 95014 -3255 Telephone: 408- 777 -3228 Fax: 408 -777 -3333 JOB ADDRESS: Fj �(`�� �LiV� PERMIT # OWNER'S NAME: 544- VA V-tt NA14_ V Kp,1 -P ? PHONE # bg•'1 79 401DO GENERAL CONTRACTOR: MKb yle LUL.D�I2 BUSINESS LICENSE # S 03 ADDRESS: J b LVD '�- I Dd _ __. ,CITY /ZIPCODE: MD9 ` S rJ 1) *Our municipal 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 BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork -7 1-f-Z) 9 Cement Finishing Electrical jVl P-r C2FC-"t -21 C, ' 68-7 Excavation 6K`r -[�Iui✓ CA-r— RIoe, �p l Fencing Flooring / Carpeting (NPJA -C-L1� liA-P-fl Ir D()b Linoleum / Wood Glass / Glazing Heating Insulation We&-r COA-gT j I JS WAM O \/ -7 Landscaping Lathing Masonry Painting / Wallpaper MO-C-- ��(h(`� jv (� �f�1�'# 59616 Paving Plastering Plumbing n l N D (9 L-1-4 Roofing ILLS 'I/tl LTbV�( jeD4 I1�G1 -7 L3) Septic Tank Sheet Metal Sheet Rock. AJA-1-1- 3 (Q Tile T=0-4,vner / Contractor Signature Date 3h "1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING4MR5W g 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 „gg . CUPERTlNO - (408)..77 -3228 • FAX (408) 777 - 3333 • building CcDcmertinoRo QTE -' - - ❑ NEW_CONSTRU.CTION_ .❑ ADDITION ._. ❑ ALTERATION / TI ... REVISION / DEFERRED ORIGINAL PERMIT # 131140 Z6. PROJECT ADDRESS ' OWNER NAME PHONE E -MAI STREET ADDRESS 'CITY, STATE, ZIP FAX - .•- CONTACT NAME ­ 0 _ X0_ �A n',�as7v•✓ -- HONE E -MAI STREET ADDRESS'' CITY, STATE,, Z PAX., bnG4.v ❑ 01VNER ❑'OWNER: UILDER`- ❑ O N'ERAGENr . ' CONTRACTOR ❑'CONTRACTOR -AGENT - ❑ ARCHITECT ❑ ENGINEER ❑ .,DEVELOPER . EI TENANT CON7RACrORNAME LICEN E 4$$R LICENSETITE BUS. LIC ff � COMPANY NAME E -MAI Ca9� P Q m,.� FAX 6 '/ - ll 77k �OU STREET ADDRESS .Spy l UO CITY, STATE, ZIP PHONE "6), „ Lc.0 rG iv I�16— 6� (P000 ARCHITECTIENGA'EERNAME LICENSE NUMBER BUS. LIC 9 COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH E] ATTACH R DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? []NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF 1S THE BLDG AN ❑ YES RECEIVED B ,�. �'` ct °k'* ”' - TOTAL V TION• PLANNINGAPPL-� ❑NO PLANI.WG APPROVAL LETTER EICHLERHOAIE? 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 owner's behalf. I have read this application and the information I have dad is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local u'Id ordinances and state laws relating to bing cons ction. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date:, —2y SU?PLEMENTALAqFORMATION REQUIRED 1\ew SFD or Multifamily dwellings: A 1 for demolition permit for I Y Apply P existing building(s). Demolition permit is required prior to issuance of building 1 {i . TV; ER THE COUI�STER , r k BUU bvc rL �Nv� y Sri, '` permit for new building. " p ❑ ExPxESS `; �3 i7 PLATQI.INO`PLAhREVLEw�! Commercial Bldgs: Provide a completed Hazardous Materials Disclosure rAls❑ snAxn Pusircyvocs form if any Hazardous Materials are being used as part of this project. ;b des r,r"1 k �y l N L GEC t r z xk FIREAEPT n 5 _ Copy of Planning Approval Letter or Meeting with Planning prior to sa k tr ❑SA�IVTfr1RY submittal of Building Permit application. SE ERD STRICT B1dgRpp_2011.doc revised 06121111 CITY OF CUPERTINO IM-N, FEE ESTIMATOR — BUILDING DIVISION WdADDRESS: 10256 Clensoe Dr DATE: 02/26/2015 REVIEWED BY: Sean llealt. Permit Fee: APN: BP #: 13110076 'VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Phtmb. hTsp. Fee: PENTAMATION PERMIT TYPE: 1GENIRE WORK Revision #2: Structural clarifications. SCOPE Suppl. Insp. Fee: Reg. Q OT 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 based on the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 E . 701/13) Mech. Plan Check Plumb, Plan Check Flea Plan Check llealt. Permit Fee: Phnnb. Permit Fee: Elm, Permit Fce: Other ASech. Insp. Other Plumb lmp. Other F_ler.. htsp. Li Mech. Insp. Fee: Phtmb. hTsp. Fee: Ides. brsp. 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 based on the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 E . 701/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes (2) No $0.00 0 hours Plan Check, Hourly $286.00 ISTPLNCK Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: Q Work Without Permit? 0 Yes No $0.00 Advanced. Planning Fee. $0.00 Select a Non - Residential Q Building or Structure 0 Travel Documentation Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 s�- SUBTOTALS: $0.00 $286.00 ; TOTAL FEE: $286.00 Revised: 02/14/2015 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(G cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN # 0 OWNER NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E -1 IL n STREET ADDRESS CITY, STATE, ZIP FAX SS 2.� G / G� /O $ Coa Cv S �r o ,., ❑ OWNER ❑ .OWNER- BUILDER ❑ OWNER AGENT 111 COMRA TOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR ME n LICENSE NUMBER LICENS YPE BUS. LIC # / COMPANY NAME E -MAI . FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNAME / LICENSENUMBER BUS. LICP COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK pt EXISTING USE PROPOSED USE CONSTR TYPE STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDETACH ❑ ATTACH 9 DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? []NO PRE- APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED B -- 7 t, _ - TOTAL PLANMNGAPPL# ENO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO ..? 2 - By my my signature below, I certify to each of the following: I am the property owner or authorized agent t operty owner's behalf. I have read this application and the information I have provi orrect. 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 buildin ruction. I authorize representatives of Cupertino to enter the above- identified property for inspection purposes. Signature of Applicant/Agent: Date: / 0'— SUPPLEMENTAL 114FORMATION REQUIRED 01- �_ +zFiiouxriSc.sLLr .�.i�Pixc>cKTYrE_. .�;.�� , ❑ i z ❑ New SFD or Multifamily dwellings: Apply for demolition permit for OVER THECOUNTER v BUILDING PLAN REVIEVY r . existing buildings }, Demolition permit is required prior to issuance of building �r �P *, permit for new building. EXPRESS�`bt k G REVIEW ��, ?� ,, n ,❑'PIvs,NItiIIVGPLAN,- fr Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTArmaRD k ; ❑ Frv�LTCwoRxs _ form if any Hazardous Materials are being used as part ofthis project. F ' ❑ -) IRE AEPT r s v Copy of Planning Approval Letter or Meeting with Planning prior to ❑�>,IAaox t ❑ �� submittal of Building Permit application. e m r snIVITAxY sExDISTRTCr � t �:� � °'r r4 � '' � � `��°� .❑ ; ENYIROIVMEN`TAI HEALTA "z BldgApp_201 ].doe revised 06121111 I CITY OF CUPERTINO BUILDING PERMIT I 1 BUILDING ADDRESS: 10256 GLENCOE DR I BUILDERS INC R: MASON HAMMER I PERMIT NO: 13110076 I OWNER'S NAME: VENKATARAMAN SHIVAKUMAR AND ADIMO 1 18625 SUTTER BLVD STE 500 9 DATE ISSUED: 02/20/2014 1 'S PHONE: 4086549620 Ll LICENSED CONTRACTOR'S D ECLARATION � 'License Class 119 Lic.# 9/ �/ ! 7 Contractor � f— Date )6)--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 tw 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, foi 'performance of the work for which this permit is issued. 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, 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 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.I8. Date MORGAN HILL, CA 95037 j PHONE NO: (408) 778 -6060 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT 2 STORY SFDWL TO INCLUDE 1ST FLOOR, 2395, 2ND FLOOR 1877 SQ FT, BASEMENT 2273 SQ FT, ATTACHED GARAGE 618 SQ FT REVISION #1- RADIANT FLOOR AND DESIGN -ISSD OTC 10/9/2014 Sq. Ft Floor Area: I Valuation: $750000 APN Number: 32630029.00 1 Occupancy Type: I_ "_ I IT71 :�' I .� 19[�.Z�7:7 i�. [�yT.�l II:� -'EMI I -11 WITHIN 1 OF'PERMIT ISSUANCE OR 180 DA S FROM LAST CALLED INSPE Issued by: Date: 1 All r oofs 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 Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. 1 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. Q ' ufMor"iz agent: DateJo 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 Professional Testing Engineers, Inc. Quality Assurance Services Materials Consulting Since 1954 Regular Concrete Compression Test Report Project No.: 59160 Client: VEN008 Sample No.: 238867 Project Name: Report Date: 06/06/14 10256 Glencoe Drive RECEIVED Sample Date: 05/09/14 Cupertino, CA JUN 2 6 2014 Time Sampled: 1030AM Date Received: 05/14/14 Permit # 13110076 Inspector: N. C. Goard, TEI Supplier: Graniterock Mix: 671703 Ticket No.: 36149934 Location: 10" thick x 1 V -0" high basement foundation west & south perimeter walls (2nd lift). Spe&XeR&4aW -4UM C -31) : 5 Air Temperature (ASTM C -1064) : 67 deg F Mixture Temperature (ASTM C -1064) : 75 deg F Slump (ASTM C -143) : 4 inches I Date Tested 05/15/14 06/06/14 06106/14 06/06/14 HOLD ID Number 3A 313 3C 3D 3E Mark Sample Dimension, Inches Diameter 4 4 4 4 Length - 8 8 8 8 Area, sq. inches 12.57 12.57 12.57 12.57 Ultimate Load, Ibs 50000 76000 77000 78000 Ultimate Str., psi 3980 6050 6130 6210 Average, Str., psi 6130 Age Tested, Days 6 28 28 28 HOLD Fracture Type 1 1 1 1 Dry Unit Weight, pct Specified Strength, psi 2500 2,500 2500 SPECIMENS NOT SCHEDULED FOR TESTING WILL BE DISCARDED AFTER 28 DAYS OLD The Material if WAS WAS NOT The Material Tested If MET DID NOT MEET THE SAMPLED AND TESTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS. REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS. Remarks: Samples Tested in General Conformance with ASTM C -39 1 cc. City of Cupertino 1 cc. Mason Hammer Builders, Inc. Revie 1 cc. Shivakumar Venkataraman Robert GWSUDperviSOr Concret Corporate Office - 2811 Teagarden Street, San Leandro, California 94577 - (510) 835 -3142 - Fax (510) 834 -3777 Amik c TESTING ENGINEERS, INC. 2 2811 Teagarden St. 510 - 835 -3142 &p 510 - 834 -3777 fax San Leandro, CA 94577 800 - 660 -3142 San Leandro • San Jose • Marhn\ INSPECTION REPORT Week Ending: 5/9/14 PROJECT # 59160 TYPE OF INSPECTION: y Concrete Placement PROJECT: PLACE OF INSPECTION: 10256 Glencoe Drive Jobsite Cupertino, CA �) / Permit # 13110076 DATE HOURS 5/9/14 INSPECTOR N. C. Goard Reported to JT Matarangas of Mason Hammer Builders at the jobsite as requested. Monitored loads arriving at the jobsite for correct mix and proper slump. Inspected placement operations and vibrating procedures. Performed 1 slump test (4 ") and cast 1 set of compression test specimens (5 each) Sample # 238867, for Concrete Mix # 671703 from Graniterock (specified strength 2500 psi, slump 4 ") for concrete placed at 10" thick x 11' -0" high basement foundation retaining wall. Total cubic yards placed: 81. Inspected the placement of reinforcing steel for the above. The preceding work was, to the best of my knowledge, in compliance with approved plans and specifications, including revisions by engineer, and Drawing S-1, Details on S-5, STD -1, Revision 2, dated 1/3/14. Reviewe David Xjppero Sp Inspection Division Manager 1cc: Shivakumar Venkataraman Mason Hammer Builders, Inc. / JT Matarangas City of Cupertino /Bldg. Inspection Dept. This report can be reproduced only in its entirety unless written permission from TEI is obtained. Page 1 of 1 AOL IjTESTING ENGINEERS, INC. 2811 Teagarden St. 510 - 835-3142 San Leandro, CA 94577 800 - 660 -3142 PROJECT # 59160 PROJECT: 10256 Glencoe Drive Cupertino, CA Permit # 13110076 4/18/14 HOURS 8 INSPECTOR C. Wilson JUN 2.6 2014 510 - 834 -3777 fax BY San Leandro • San Jose • Martinez INSPECTION REPORT Week Ending: 4/18/14 Reported to Mason Hammer Builders at the jobsite as requested. TYPE OF INSPECTION: Concrete Placement PLACE OF INSPECTION: jobsite Monitored loads arriving at the jobsite for correct mix and proper slump. Inspected placement operations and vibrating procedures. Performed 2 slump tests (4 ", 4 ") and cast 2 sets of compression test specimens (5 each) Sample #s 240137, 240138, for Concrete Mix # 671703 from Graniterock (specified strength 2500 psi, slump 4") for concrete placed at mat slab at basement. Total cubic yards placed: 126. Inspected the placement of reinforcing steel for the above. The preceding work was, to the best of my knowledge, in compliance with approved plans and specifications, including revisions by engineer, dated 2/20/14. by: 1cc: Shivakumar Venkataraman Mason Hammer Builders, Inc. / JT Matarangas City of Cupertino /Bldg. Inspection Dept. Chippero M I Inspection Division Manager This report can be reproduced only in its entirety unless written permission from TEI is obtained. Page 1 of 1 Testing Engineers, Inc. Quality Assurance Services Materials Consulting Since 1954 Regular Concrete Compression Test Report Project No.: 59160 Client: VEN008 Sample No.: 240137 Project Name: Report Date: 05/15/14 10256 Glencoe Drive Sample Date: 04/18/14 Cupertino, CA JUN 2 6 2014 Time Sampled: 0900AM Date Received: 04/21/14 Permit # 13110076 Inspector: C. Wilson, TEI Supplier: Graniterock Mix: 671703 Ticket No.: 49117 Location: i Northwest corner of basement mat sla L Specimens Cast (ASTM C -31) : 5 Air Temperature (ASTM C -1064) : 61 deg F Mixture Temperature (ASTM C -1064) : 72 deg F Slump (ASTM C -143) : 4 inches Date Tested 04/15/14 4 5/14 It 05/15/14 05/15/14 HOLD ID Number 1A 1 C 1 D 1 E Mark Sample Dimension, Inches Diameter_ 4 4 4 4 Length 8 8 8 8 Area, sq. inches 12.57 12.57 12.57 12.57 Ultimate Load, Ibs 49000 71000 74000 74000 Ultimate Str., psi 3900 5650 5890 5890 Average, Str., psi Age Tested, Days 7 27 27 27 HOLD Fracture Type 1 1 1 1 Dry Unit Weight, pcf Specified Strength, psi 2500 2500 2500 SPECIMENS NOT SCHEDULED FOR TESTING WILL BE DISCARQED AFTER 28 DAYS OLD The Material V WAS WAS NOT The Material Tested _� MET DID NOT MEET THE SAMPLED AND TESTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS. REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS. Remarks: Samples Tested in General Conformance with ASTM C -39 1 cc. City of Cupertino 1 cc. Mason Hammer Builders, Inc. 1 cc. Shivakumar Venkataraman Corporate Office - 2811 Teagarden Street, San Leandro, California 94577 - (510) 835 -3142 - Fax (510) 834 -3777 Testing 'Engineers, Inc. Quality Assurance Services Materials Consulting Since 1954 Regular Concrete Compression Test Report Project No.: 59160 Client: VEN008 RECMET) Sample No.: 240138 Project Name: Report Date: 05/15/14 10256 Glencoe Drive JUN B 6 2014 Sample Date: 04/18/14 Cupertino, CA Time Sampled: 120OPM Date Received: 04/21/14 Permit # 13110076 BY Inspector: C. Wilson, TEI Supplier: Graniterock Mix: 671703 Ticket No.:. 49133 Location: North east corner of mat slab in basement. Specimens Cast (ASTM C -31) : 5 Air Temperature (ASTM C -1064) : 69 deg F Mixture Temperature (ASTM C -1064) : 79 deg F Slump (ASTM C -143) : 4 inches A' `/ Date Tested 04/25/14 05/ 5/14 05/15/14 05/15/14 HOLD ID Number 2A 213 2C 2D 2E Mark Sample Dimension, inches Diameter 4 4 4 4 Length 8 8 8 8 Area, sq. inches 12.57 12.57 12.57 12.57 Ultimate Load, ibs 45000 68000 71000 71000 Ultimate Str., psi 3580 5410 5650 5650 Average, Str., psi Age Tested, Days 7 27 27 27 HOLD Fracture Type 1 1 1 1 Dry Unit Weight, pct Specified Strength, psi 2500 2500 2500 SPECIMENS NOT SCHEDULED FOR TESTING WILL BE DISCARDED AFTER 28 DAYS OLD The Material WAS WAS NOT The Material Tested MET DID NOT MEET THE SAMPLED AND TESTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS. REQUIREMENTS OF THE BLDG. DEPT. OR DSA APPROVED DOCUMENTS. Remarks: Samples Tested in General Conformance with ASTM C -39 1 cc. City of Cupertino 1 cc. Mason Hammer Builders, Inc. 1 cc. Shivakumar Venkataraman Corporate Office - 2811 Teagarden Street, San Leandro, California 94577 - (510) 835 -3142 - Fax (510) 834 -3777 DAILY PROGRESS REPORT Project Name V 2Y1 LoAo x Project Address `c, 2 S 6 A rim Purpose of Site Visit nA - C_-,-ra1_ Project Activity Today Sigg k Project No. 213 i - V Page 1 of Report Sequence No. Day/Date o , C11&114 Weather (���^^ � ox — a*'J 7 circ1(a -r eaccs�l ;may reo,x ya,,,rd J l_ 5 �it%r�i�� ab �Ydw Fra�re. �oca�:ons Ao � i was PS ir. GiY� -3 �1^��c�ewa� �as� bwSPnmri� Wal� bGkF: `� CL> �acCa�c�cn �� Lomp6AR _ For re-ow Aav; )S k Eros T ev n' gene. iLd , per D(-,Ya Next Visit(s) 6A G cal'_' v cv� S� �+• ��� ra9-� �� sec Goncne.� pd "Cwva�tom I a'CQ, C.o���e J NOTE: PLEASE NOTIFY rUS 48 HOURS IN ADVANCE OF ANY EARTHWORK AND FOUNDATION CONSTRUCTION TO BE OBSERVED Equipment in Use �yc►� lot t labor Client ors Contact Contractor Contact 9\ -am* r.� 0, s:ka.} G AsJ . V Copy to Report by U 1� d`i� � T) t:� ;� 9o) R O M I G ENGINEERS, INC. 1390 El Camino Real, Second Floor, San Carlos, California 94070 GEOTECHNICAL & ENVIRONMENTAL SERVICES (650) 591 -5224 Fax (650) 591 -5251 I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10256 GLENCOE DR CONTRACTORe77lV -' F&-BE PERMIT NO: 13110076 OWNER'S NAME: VENKATARAMAN SHIVAKUMAR AND ADIMO I k ^n < < _ a�- - — I DATE ISSUED: 02/20/2014 1 I OWNER'S PHONE: 4086549620 I .FZ., , t J" T..,.,_ I PHONE NO: I LICENSED CONTRACTOR'S DECLARATION cerise Class____ Lic. # � 1- ( _ Contractor MASOO AM M LZe� Date ' - ao I hereby affirm that I am lice r end u de"r 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: Ihave 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 comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. /I1 - -11 / n Date ❑ OWNER- BUILDER DECLARATION 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) 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: 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. 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. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, l 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. 1 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. JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL CONSTRUCT 2 STORY SFDWL TO INCLUDE 1ST FLOOR, 2395, 2ND FLOOR 1877 SQ FT, BASEMENT 2273 SQ FT, ATTACHED GARAGE 618 SQ FT Sq. Ft F1oorArea: I Valuation: $750000 APN Number: 32630029.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DA +RO T CALLED INSPECTION. Issued by: Date: �.• / 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: ALL ROOF COVERINGS TO BE CLASS "A" OR LETTER 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, Sect' ors 2550 , 2 533 and 25534. Date: OzedgeFt t 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional ICITY OF CUPERTINO � FEE ESTIMATOR — BUILDING DIVISION 19 ADDRESS: 10256 glencoe dr DATE: 1111212013 REVIEWED BY: MENDEZ PC FEE ID APN: BP #: 31 0 7 *VALUATION: 1$750,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: p •, 2nd Unit? Yes No PENTAMATION PERMIT TYPE: 1 R3SFD A WORK I construct 2 story sfdwl to include 1 st floor, 2395 2nd floor 1877 sq ft basement 2273 sq ft attached SCOPE garage 618 sq ft OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA sS. PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Custom) II- B,111- B,IV,V -B 7,164 $3;960 1R3PLNCK $5,276.32 1R31NSP $0.00 PME Plan Check: $0.00 Permit Fee: $5,276.32 Suppl. Insp. Fee :(D Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 7,164 $3,958.60 Construction Tax: 1BCONSTAXR $5,276.32 # new units NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the areliminary information available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 U 711113) Mech. Plan Check Phrmb, Plan Check Elec. Plan Check 1Ner. h. Pertnit Fee: Ph mh. Permit Fee: l lec. Permit Fee., Other blech. Insp. Other Plurnb Insp. 071rer Elec. Insp. Li ,1:lec•h. Insp. Fee: Plumb. Insp. Fee: Llec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the areliminary information available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 U 711113) FEE QTY /FEE MISC ITEMS Plan Check Fee: $3,958.60 Select a Misc Bldg /Structure or Element of a Building Suppl: PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $5,276.32 Suppl. Insp. Fee :(D Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR 1 . # new units $650.84 Administrative Fee: Q E) Work Without Permit? ® Yes (2) No $0.00 Advanced Planning Fee: 1PLLONGR $1,002.96 Select a Non - Residential Building or Structure E) 0 i Ti avel Documentation Fees: Strong Motion Fee: 1BSEISMICR $75.00 Select an Administrative Item Bldg; Stds Commission Fee: 1BCBSC $30.00 SUBTOTALS:. 10,993.72 $0.00 TOTAL FEE: t:41;V ,72 Revised: 10/01/2013 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 B'�� c l RTI[IYC3 (408) 777 -3228 • FAX (408) 777 -3333 • building(?7cupertino.org 1 W CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROTECT ADDRESS APN /i v ( I• G OVV'NERNAME VC-A11011 PHONE TF- ";,H v "!Jrf T O AV' d STREET �ADDRESS� A 0 CITY, TATS, Z/1P j FAX IN CON,JA T WAME A "tn-M,1x1 PHONE o 50 - 3 2© —7 -Z EL E- IL �� � �' o 0 0 STRE TAD RESS CITY STATE, IP F el<0 . ❑ OwNER-B DER ❑ 0 ENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME , e� LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE �g L--,AJ ARCHITECT GINEERNAME fq Al LICENSE NUMBER `v BUS. LIC # COMPANY NAME E -MAIL �Y�)LI T �� Lr >S D,� r Al F STREET ADDRESS f,5 (O r _l r� 1 p CITY, STA ,ZIP � �' ` rn �! \ r/ PHONE 2 l 9 ^ 1 6 L7 DESCRIPTION OF WORK r EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG UWI i . - DEMO TOTAL AREA A`R -E'A AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: LJDETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEINGADDED? ❑NO ADDITION? ❑NO PRE - APPLICATION []YES IF YES, PROVIDE COPY OF 1S THE BLDG AN ❑ YES RECE B �.; '�� ��'' '`''„ �' OTAiz ALUATION: PLAA7VING - RL d.O.w,�,�'ELiN.NING: R YAL,L EICHLERHOME? NO s�' •"' �, Grn x, - N- By my signature below, I certify to each of the following: I am the property owner or autho Ad ent o act on the property owner's be alf. I have read this application and the information I have provided is correct. I have read the Description of Work affd verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building con tion. I authorize °prey sentatives of Cupertino to enter the above - identified roperty for ' pection purposes. Signature of Applicant/Agent: G`— Date: l SUPPLEMENTAL INFORMATION REQUIRED PLAl�CAECKTIPE xROUTING;SIIP New SFD or Multifamily dWellirigs: Apply for demolition permit for 1 A existing building(s). Demolition permit is required prior to issuance of building OVER THECOUNTBR v' K iLDII�GPLANREVIEW permit for new building. , ❑IiESS� r'IIGPiANiiEVrw °" Commercial Bldgs: Provide a completed Hazardous Materials Disclosure TA71`�DARD a PUBLICUCiRKS form if any Hazardous Materials are being used as part of this projects _ Copy of Planning Approval Letter or Meeting With Planning prior to Planning a a - *'F TTAR'SEWERDISTRICT, ' submittal of Building Permit application. �y B1d.App_2011.doc revised 06121111 f� J Page T of 2 -101')> LANDSCAPE WATER - EFFICIENCY CHECKLIST ELI Community Development Department 10300 Torre Avenue 408.777.3308/ Fax 408.777.3333 Cupertino, CA 95014 planning ®cupertino.org U P S RT I NO C http://cupertino.org/planninE Applicant Name: Email:�J r i v. a C ff o Project Site Address: i. Phone: 'ttb — 1)t& ... - Total Landscape Landscape area: All the planting areas, 'turf. areas, and water Area feet): �CO features in a landscape -insfallation. The landscape area does (square _ not include footprints of--buildings or structures, sidewalks, driveways, paikmg lots, decks, patios, -gravel or stone walks, Turf Area: other pervious or .non- pervious hardscapes, and other non - irrigated .areas designated for .non - development (e.g., open spaces.and existing wildland vegetation). Ai_ Non -Turf Plant Area: Zi , 1 Turf: A ground cover surface consisting of rton= native grass species that is customarily mowed. Annual 'bluegrass, �� Special Landscape Area: Kentucky bluegrass, perennial ryegrass,:red fescue, and tall fescue are examples of cool - season turf grasses. ,Bermuda grass, likuyu grass, seashore paspalum, St. Augustine grass, zoysia grass, and 'buffalo s are warm - season turf grasses. Water Feature Wet Surface Area: If 10% of landscaped area, water budget calcu= lation required with landscape project submittal: See reverse side for other definitions.. NOTE: If landscape, area exceeds 2,500 sq. ft., a landscape project submittal shall be required: If no landscaping.is proposed, enter " 0" •above and ,proceed directly to the signature.block at. the bottom of this form Landscape Parameter Requirements Project Compliance Turf Total turf area shall not exceed 25% of the landscape ❑ Yes 5 . No area, or 1,250 square feet, whichever is lesser in area. [If. no, Water budget calculation required I Mkb landscape project submittal] i All portions of turf areas shall be wider than eight (8) feet. Yes [Turf (if utilized) is limited to.slopes not exceeding T5- Yes Non -Turf At least 80% of non -turf area shall consist of native or 1 , Yes ❑ No low water use plants. ![if no, Water budget calculation required 4 witli landscape project submittal] Hydrozones Plants with similar water needs shall be grouped within yes ❑ No hydrozones. Each hydrozone shall be controlled by a [Plants can be grouped per separate valve. Table 7.4.15.050(0)], Irrigation System Systems shall be designed and maintained to minimize Yes ❑ No water waste (e.g., runoff, low head drainage, overspray). Low irrigation be in - volume shall utilized non -turf areas. i Irrigation shall only occur between the hours ofROO pm IMOD [If no, Provide explanation on back] and am. Soil A minimum of eight (8) inches of non- compacted topsoil .� Yes ❑ No shall be available in planted areas. [It no, Provide explanation on back] Soil amendments, such as compost or fertilizer, shall be j R� Yes D No appropriately added according to the soil conditions at the project site and based on what is appropriate for the selected plants. J1 no, Provide explanation on back] Mulch A minimum two (2) -inch layer of mulch shall be applied Yes Cl No on all exposed soil surfaces of planting areas, except in areas of direct seeding application (e.g. hydro- seed). [If no, Provide explanation on back] I am aware of available informational resources regarding native and low water use plants, irrigation efficiency, and other aspects of water - efficient landscaping. I certify that the information provided on this checklist is correct, and the installed landscape complies with the requirements of Chapter 14.15. I also understand that any changes to the project will necessitate new checklist. as ri )�� 7 Signature of property owner or atMorized representative to Page T of 2 -101')> f This checklist implements the requirements of Chapter 14.15, Landscape Ordinance, of the Cupertino Municipal Code. The responses provided will be evaluated to determine whether the proposed landscape is generally consistent with the ordinance's water - efficiency goals. Applicant Comments Ussv additional Lahr it necessary / Staff Evaluation Staff Comments 1-1' Approved [] Not Approved Signature Select Definitions Date Hydrozone: A portion of the landscaped area having plants with similar water needs. A hydrozone may be irrigated or non- irrigated. Low - volume irrigation: The application .of Irrigation water through a system, of tubing or lateral lines and low- volume emitters such as drip and bubblers. Certain rotary emitters designed for highly efficient water distribution, and- situated to irrigate low water use plants, may also be included in this definition at the discretion of the Planning Office. Low water use plant A plant species whose demonstrated eater needs are compatible with local climate an soil conditions such that regular supplemental irrigation is not required to sustain :the plant after it has be- come established. Any species classified as "very low water use" and "low water use' by WUCOLS, having a regionally adjusted plant factor of 0.0 through 0.3, shall be rategorically deemed a low water use plant. Native plant A plant indigenous to a specific area of consideration. For the purpose of this division, the term will refer to plants indigenous to the coastal ranges of Central and Northern California, and more specifical- ly to such plants that are suited to the ecology of the present or historic natural community of the project's vicinity. Special landscape area: An area of the landscape dedicated solely to edible plants, areas irrigated with re- cycled water, water features using recycled water and areas dedicated to active play such as parks, sports fields, golf courses, and where turf provides .a playing surface. Turf: A ground cover surface consisting of non - native grass species that is customarily mowed. Annual blue- grass, Kentucky bluegrass, perennial ryegrass, red fescue, and. tall fescue are examples of cool - season turf grasses. Bermuda grass, kikuyu grass, seashore paspalum, St. Augustine grass, zoysia grass, and_ buffalo grass are warm - season turf grasses. Water feature: A landscape design element where open water performs an aesthetic or recreational function. Water features include ponds, fountains, waterfalls and artificial streams. Also includes spas and swim- ming pools that are ancillary to single - family, two- family and multi- family residential uses. Wet surface area: The surface area of that portion of a water feature that functions to contain water, such as the Water surface of a swimming pool, spa, or garden pond. For a fountain or other feature with flowing water, -wet surface area shall be measured as a two dimensional plane bounded by the perimeter of the area where water has been designed to flow. 2010 CALGREEN CHECKLIST — MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building ED-cupertino.ora PURPOSE: The 2010 CalGreen Code applies to all newly constructed hotels, motels, lodging houses, dwellings, dormitories, condominiums, shelters, congregate residences, employee housing, factory-built housing and other types of swellings with sleeping accommodations and new accessory buildings associated with such uses. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: CUSTOM RESIDENCE Project Address: 10256 GLENCOE DRIVE Project Description: SINGLE FAMILY NEW HOUSE Instructions: l C: J ; <. 1. The Owner or the Owner's agent shall employ a licens roiessioial�experienced'with Ph .� ©California s e' s.o Green Building Standards Codes to verify and assure t atla r qui�ed work described�h d s roperly planned and implemented in the project. i 2. The licensed professional, in collaboration with the owner and th6 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. MANDATORY FEATURE OR MEASURE 4.104.1 A site plan and inventory of site disturbance in order preserve d, minimize future adverse effects on t 4.106.2 A plan is developed and drainage during construction. 4.106.3 The site shall be planned and from buildings. Construction plans shi system will manage all surface water 1 Page 1 of 5 Javelo nd used to minimize istin nat I resources and Id structu Bd to keegi urface water away E12-1w s" ; rading or a drainage Column 2 Project hauirements p C Column 3 Verification MI GalGreen 2010.doc revised 02114114 - - 4 4.201.1 Low -rise residential buildings shall meet or exceed the minimum ❑ standard design required by the California Energy Standards. 4.303.1 Indoor water use shall be reduced by at least 20 percent using one of the follow methods. ❑X ® Water saving fixtures or flow restrictors shall be used per Table 4.303.2. ❑ El A 20 percent reduction in baseline water use shall be demonstrated per 7/01/2011 Table 4.303.1. 4.303.2 When using the calculation method specified in Section 4.303.1, multiple showerheads shall not exceed maximum flow rates. ❑ 7/01/2011 4.303.3 Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with specified performance requirements. ❑ 7/01/2011 Outdoor Water Use 4.304.1 Automatic irrigation systems installed at the time of final inspection ® 1:1 shall be weather- based. 4.406.1 Joints and openings. 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. Construart�+ar�:Waste 1Redulctebn: Daspos f and;Recycling 4.408.2 Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall ❑X ❑ be submitted for approval to the enforcing agency. 4.410.1 An operation and maintenance manual shall be provided to the 1:1 building occupant or owner. Page 2 of 5 CalGreen 2010.doe revised- 02114111 - - A4.5 -O r fiir� places z - ly k , 4.503.1 Install.'.only a direct -vent sealed- combustion gas or sealed wood- ❑ burning fireplace, or a sealed woodstove. ��4tu#ant Coritroll ' k >r X 4.504.1 Duct openings and other related air distribution component openings ❑ shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks shall be compliant with VOC and © ❑ other toxic compound limits. 4.504.2.2 Paints, stains and other coatings shall be compliant with VOC limits. X❑ ❑ 4.504.2.3 Aerosol paints and other coatings shall be compliant with product © ❑ weighted M I R Limits for ROC and other toxic compounds. 4.504.2.4 Documentation shall be provided to verify that compliant VOC limit © ❑ finish materials have been used. 4.504.3 Carpet and carpet systems shall be compliant with VOC limits. ❑X ❑ 4.504.4 Fifty (50) 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 Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall comply with low formaldehyde © ❑ emission standards. Irtenar�VlO�sture Cantroi =' 4 i e 4.505.2 Vapor retarder and capillary break is installed at slab on grade foundations. ® ❑ 4.505.3 Moisture content of building materials used in wall and floor framing is © ❑ checked before enclosure. - -Page 3 of 5 - - - — - CalGreen_2010.doc revised 02114111 1 4.506.1 Exhaust fans which terminate outside the building are provided in j every bathroom. 4.507.1 Whole house exhaust fans shall have insulated louvers or covers which close when the fan is off. Covers or louvers shall have a minimum insulation value of R -4.2. 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. °Qual�ffcafians , 702.1 HVAC system installers are trained and certified in the proper installation of HVAC systems. 702.2 The Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the discipline they inspect and verify. 703.1 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. p 0 0 IN AN ❑ E A L- - - Pape -4 of 5 - - - - -- -- - CalGreen_2010.doc revised 0211411-1— - - -- -- - �l Project Name: Project Address: CALGREEN SIGNATURE DECLARATIONS CUSTOM RESIDENCE 10256 GLENCOE DRIVE Project Description: SINGLE FAMILY NEW 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 2010 California Green Building Standards Code as adopted by the City of Cupertino. Owners Signature Owners Name (Please Print) Design Professional's Signature Signature 6f Lielen`se'Professional responsTO for CalGreen compliance Miles Hancock Name of License Professional responsible for CalGreen compliance (Please Print) energy @pacbell.net Email Address for License Professional responsible for CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION Date Date 09/04/2013 Date (650) 424 -1189 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 2010 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 compliance - - - - -Page 5 of 5, CalGreen 2010.doc revised 021-14111 CUPERTINO PURPOSE UTILITY RELEASE REQUEST FORM 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 • building(a)cupertino.org For residential single family or duplex construction, there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign -off of the building. INSTRUCTIONS 1. Download this form at: http : / /www.cupei-tino.org /index.aspx ?page =297. 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3. Fax, E -Mail, Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Form 408 - 777 -3228 office 10300 Torre Ave. 408 - 777 -3333 fax Cupertino, CA 95014 building(a)cupertino.org 4. Schedule a Gas Meter Release inspection ( #403) and /or Electric Meter Release inspection ( #404). Please note, a Gas Test inspection ( #506) is required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information): APN h y 3 O Q� BLDG PERMIT #: I I� y� / V W DATE: SITE ii ADDRESS:a`t DoZ.Fj l0 C� L II Dy OWNER'S NAME: S1 { ( AutNla>) _ w PHONE #: (( (� C��I �5J^•3�}D• 1 IU ✓ V�__K ZT/k 'l-W FAX #: -V MAILING ADDSd1erent from site �d�ress : I i - ,t CONTRACTOR: _ A I�1C- PHONE #: ) FAX #: ` 08 -1 1q. biD 6 0V 1-7 ,Db • CONTACT: Pis f vl ISM IZ'I PHONE #: FAX #: i'-I i '. -t O . S J ps . j —I 7 I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of the building cannot move into the residence until they receive all of the required final sign -offs and the City has issued a certificate of occupancy for the building. Owner:.......... C ........... ............................... Print: l liWlt .. t °1 ................ Date:.. j. J.... /....... Contractor:.......... ..... .............. .............. ....... ... Print:..R 9kp�.7.... PM IS .................... Date :.............................. UtilityReleaseForm_2011.doc revised 08109, /1