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15010098CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10240 STERN AVE CONTRACTOR;. PERMIT NO: 15010098 Tt'K�RftED OWNER'S NAME: RUIZ, GINO DATE ISSUED: 04/08/2015 OWNER'S PHONE: 4086611971 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT ONE STORY ADDITION (197 SQ FT); License Class_A_�:: Lic. # 3 6ST— REMODEL s,B, �or157721l�7� Date EXISTING MASTER BEDROOM (225 5Q FT); REMOVE Contractor WALL I hereby affirm that I am licensed under the provisions of Chapter 9 FURNACES AND INSTALL NEW FAU IN ATTIC; BUILD 3' (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's )Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $30000 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 APN Number: 37512042.00 Occupancy �1 >'pe: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS O PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FRO T ALLED INSPE TI N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non-poi ource regulations per the Cupertino Municipal Code, Section 9.18. � j RE-ROOFS: Signature Date? `-' 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous CAipensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with the upertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectio 255055, 25533, and 25534. r Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: a4A-A7Date: �J 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall he deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date I� CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10240 STERN AVE CONTRACTOR: S B CONSTRUCTION PERMIT NO: 15010098 OWNER'S NAME: RUIZ, GINO 1263 ALMA CT DATE ISSUED: 04/08/2015 OWNER'S PHONE: 4086611971 SAN JOSE, CA 95112 PHONE NO: (408) 661-1971 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ Fc/3 License Class Lic. # 0 c/3 CONSTRUCT ONE STORY ADDITION (197 SQ FT); REMODEL /5 EXISTING MASTER BEDROOM (225 SQ FT); REMOVE Contractor ate WALL I hereby a rrm t at I1'_a_mQenT,,Rd and t e provisions of Chapter 9 FURNACES AND INSTALL NEW FAU IN ATTIC; BUILD 3' (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. REVISION #1 - REMOVE LAUNDRY ROOM FROM SCOPE OF WORK I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $30000 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 APN Number: 37512042.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 D S FROM LAST CALLED INSP CTI N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -poi source regulations per the Cupertino Municipal Code, Section 9.18. 6 C� Signature /t^ CJ Date �" ` � anyRE- 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(x) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should 1 use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the of the work for which this the Health & Safety Code, Sectio 25505, 2553, and 25534. performance Owner or authorized agent: . 11 t 492"4'''7 Date: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address _ 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15010098 10240 STERN AVE CUPERTINO CA 95014 (375 12 042) S B CONSTRUCTION 1263 ALMA CT SAN JOSE, CA 95112 OWNER'S NAME: GINO RUIZ DATE ISSUED: 04/08/2015 OWNER'S PHONE: 650-248-4203 PHONE NO: 408-661-1971 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CONTRACTOR - GENERAL Lic. #843655 Contractor S B CONSTRUCTION Date 04/30/2016 —BLDG —ELECT _ PLUMB COMMERCIAL MECH RESIDENTIAL 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 ONE STORY ADDITION (197 SQ FT); REMODEL I hereby affirm under penalty of perjury one of the following two declarations: EXISTING MASTER BEDROOM (225 SQ FT); REMOVE WALL 1. I have and will maintain a certificate of consent to self -insure for Worker's FURNACES AND INSTALL NEW FAU IN ATTIC; BUILD 3' Compensation, as provided for by Section 3700 of the Labor Code, for the EXTERIOR FENCE AROUND PROPERTY. i performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by REV #2 - REMOVE FURNACE FROM SCOPE OF WORK - ISSUED Section 3700 of the Labor Code, for the performance of the work for which this 6/23/2016 permit is issued. APPLICANT CERTIFICATION REVISION #1 - REMOVE LAUNDRY ROOM FROM SCOPE OF I certify that I have read this application and state that the above WORK - ISSUED 6/24/2015 information is correct. I agree to comply with all city and county ordinances Sq. Ft Floor Area: Valuation: $30000.00 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for APN Number: Occupancy Type: inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which 375 12 042 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 regulati ns per the Cupertino Municipal Code, Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED gC00-' Date 6/23/2016 WITHIN 180 DAYS OF PERMIT ISSUANCE OR Signature 180 DAYS FROM LAST CALLED INSPECTION. OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by: ABBY AYENDE following two reasons: Date: 04/08/2015 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 RE -ROOFS: sale (Scc.7044, Business & Professions Code) All roofs shall be inspected prior to any roofing material being installed. If a roof is 2. I, as owner of the property, am exclusively contracting with licensed installed without first obtaining an inspection, I agree to remove all new materials for contractors to construct the project (Sec.7044, Business & Professions Code). inspection. I 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 Signature of Applicant: Compensation, as provided for by Section 3700 of the Labor Code, for the Date: 6/23/2016 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 3. 1 certify that in the performance of the work for which this permit is issued, I I have read the hazardous materials requirements under Chapter 6.95 of the shall not employ any person in any manner so as to become subject to the California Health & Safety Code, Sections 25505, 25533, and 25534. I will Worker's Compensation laws of California. If, after making this certificate of maintain compliance with the Cupertino Municipal. Code, Chapter 9.12 and the exemption, I become subject to the Worker's Compensation provisions of the Health & Safety Code, Section 25532(a) should I store or handle hazardous Labor Code, I must forthwith comply with such provisions or this permit shall material. Additionally, should I use equipment or devices which emit hazardous be deemed revoked. air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cu erd Municipal Code, Chapter 9.12 and APPLICANT CERTIFICATION the Health & Safety Code, ections 25505, 25533, and 25534. 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 Owner or authorized agent: relating to building construction, and hereby authorize representatives of this city Date: 6/23/2016 to enter upon the above mentioned property for inspection purposes. (We) agree CONSTRUCTION LENDING AGENCY to save indemnify and keep harmless the City of Cupertino against liabilities, I hereby affirm that there is a construction lending agency for the performance judgments, costs, and expenses which may accrue against said City in of work's for which this permit is issued (Sec. 3097, Civ C.) consequence of the granting of this permit. Additionally, the applicant understands Lender's Name and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Lender's Address Signature Date 6/23/2016 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building cunertino.ora ❑ NEW CONSTRUCTION t ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED D� ORIGINAL PERMIT # PROJECT ADDRESS ' J� 2./ O /�e _` , A n J 1 rN APN # ^ 12 r Oq ,1r D' VVI OWNER NAME _564 ►orf" WNl PHONE U �G �� E i Zgro`"' k Co(1 STREET ADDRESS h 2 r i 0 �' Q L CITY, STATE, Z T OA i� FAX CONTACT NAME l� PHONE OSS ;7 IZ E-MAIL STREET ADDRESS V ;2q S /- j, r� CITY, STATE, ZIP: p (q6)1, FAX ❑ OWNER ❑ OWNER-BumDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME "l -C �^ �- D LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME EMAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME I LICENSE NUMBER BUS. LIC # COMPANY NAM" pp, ` 1M E -MAIL J) ` I (J_IMv� FAX STREET ADDRESS Qn9 5, -pin s►�1 Go 7 X 112I� CITY, STATE, Zi If 3 PHONE G-q-ZxxJ DESCRHMON OF WORK MaA ravrn l�cn An -1 IA QW( ►J VJ ` WO ftnelM EXISTING U$E �rCCJJ PROPOSED USE CONSTR. TYPE �1/� # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR DEMO AREA AREA TOTAL NET AREA BATHROOM KITCIPIEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH # DWELLING UMTS: IS A SECOND UNIT [YES I SECOND STORY ❑YES BEING ADDED? [:]NO ADDITION? []NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES ON: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ N N " W(000 By my signature below, I certify to each of the following: I am the property owner or authoriz agent to a e property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building consctio . I authorize representatives of Cupertino to enter the abov -identified property for inspection purposes. Signature of Applicant/Agent: Date: �— I (� � ( S SUPPLEMENTAL INFO ION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ 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. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ 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 ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVH2ONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 C." CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingO)cupertino.org I �� F-1 VFW CONSM rCTtION I—I Ar)DITION n ALTERATION / TI 3I REVISION/ DEFERRED ORIGINAL PERMIT # Pet) -1�Z. RE PROH``AVE- IiA APN # �V OD O(( OWNERNAME/II, p G0 //ILo3 E-MAIL MAIL STREET ADDRESS/,,, O CITY. SZTG/erL, /;VR l ` of FAX CONTACT NAME �a ,`+� 1 r, ! Z_ '•v �I PII N�r� zl( L/�y b 7 (_ E-MAIL STREET ADDRESS O �Oi CITY�ST ATfy' y I /%3 QC Ol FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �� (1,e4 eC j��.) PPP LICEN SER/ LICEN TYPE BUS. LIC # COMPANY NAME si , �h E ��/ K4 M - F STREET ADDRESS ,AME CITY, $WIP y _ v i PH r�6ll o ARCIBTE N� EQRN /� alt _— LICENSE NUMBER BUS. LIC # COMPANY NAME esroTe�ol�e 5 P>�ZSi �e,+,.' �gAna.1 Com• .75Z C -oS�. P STREET AD RESS �% �/1TE /r, ^Y o (/ J.;-? i J///��� .2 DESCRIPTION OF WORK C -e )1Q40/ ► Q �t �_ A ��i e / a ♦ - - EXISTING USE PROPOSED USE CONSTR. TYPE # STORffS USE TYPE OCC. SQ.FT. VALUATION ($; EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES BEING ADDED? []NO SECOND STORY []YES ADDITION? []NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES RF(CF1VFD 3Y: TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pro rty owner's behalf. I have read this application and the information I have rovided 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.I ing constructi n. I a prize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApplicanUAgent: A- 6G��rt � _ Date: 3 — 1Y SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ 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. I ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1:1 STANDARD El PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT —Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ElSANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 W ��,..����� CITY OF CUPERTINO -Wo FEE ESTIMATOR - BUILDING DIVISION t ADDRESS: 10240 Stern Ave DATE: 02/02/2015 REVIEWED BY: Sean PC FEE ID APN: BP#: /,50/ *VALUATION: 1$30,000 °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du leX USE: P 2nd Unit? Yes No OTC? 0 Yes (F) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK I CONSTRUCT ONE STORY ADDITION 197 SQ FT • REMODEL EXISTING MASTER BEDROOM SCOPE (225 SQ FT); BUILD T EXTERIOR FENCE AROUND PROPERTY. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 197 $1,091.00 IADDPLCK $1,057.00 IADDINSP lYcc. hISp. Fee: $1,057.00 Suppl. Insp. Fee:O Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tea: Acltntnisirtith,e P'ee-: 0 0 Work Without Permit? Yes 0 No $0.00 TOTALS: 197 1 $1,091.00 Trarel Documentation Fees: 1 $1,057.00 Strong Motion Fee: IBSEISMICR MECH, HOURLY © Yes 0 No PLUMB, HOURLY ® Yes 0 No ELEC, HOURLY 0 Yes 0 No Aech. Plan Checi: Plan Check Fee: Elec. Plus c hec: 6 11ech, Permit I ec • 'hunh. Permit Fee: it F'c-r- Other Afech. InsprF-1 I $0.00 Other Elec. Imp. 14cch. Irrslr. Ice: lYcc. hISp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Hire, Sanitary Sewer District, School n;....;, t .1, Thowo rove aro hncod nn tho nroliminary informatinn available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eli:' TT"13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,091.00 225 s.£ Remodel, Other $431.00 1REMRESOTx Suppl. PC Fee: 0 Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,057.00 Suppl. Insp. Fee:O Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tea: Acltntnisirtith,e P'ee-: 0 0 Work Without Permit? Yes 0 No $0.00 Advanced Planning Fee. 1PLLONGR $27.58 Select a Non -Residential 0 Building or Structure i Trarel Documentation Fees: Strong Motion Fee: IBSEISMICR $3.90 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $2,181.48 $431.00 TOTAL FEE: 1 $2,612.48 Revised: 01/06/2015 Fm_I CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 61' ADDRESS: 10240 Stern Ave DATE: 06/22/2015 REVIEWED BY: Paul Afeclr. P<rrrttit F'r: ------- APN: 375 12 042 BP#: 15010098 'VALUATION: Iso *PERMIT TYPE: Building Permit 1 PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: ;' z.., , r .._, PENTAMATION 1GENRES PERMIT TYPE: WORK Revision #1 - Remove laundry room from scope of work SCOPE 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 preliminary information available and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resolution 11-053 Eff 7%1%731 Afech. Alan Check Plmrob. Plan Check l'lec. Plan ('heck Afeclr. P<rrrttit F'r: ------- Plumb. Permit kee 1 << thher A4ech. InspEl , lrirer Phimi) /rup. ;her Dec. Insp. Lj ilech. Insp. Fee: ;' z.., , r .._, h'. " /..._ 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 preliminary information available and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resolution 11-053 Eff 7%1%731 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? O Yes Q No $0.00 2 1 hours Plan Check, Hourly $286.00 ISTPLNCK Suppl. PC Fee: (F) Reg. Q OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tcrr:TT 1dininistrative Fee: 1 1 0 Work Without Permit? © Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i Travel Documenlation FC(IN Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $286.00 TOTAL FEE: F $286.00 Revised: 05/07/2015 CALGREEN RESIDENTIAL CHECKLIST - MANDATORY ;a ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINIO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 PURPOSE: (408) 777-3228 - FAX (408) 777-3333 - buildin9@cupertino.org I MAR 31 2015 The 2013 CalGreen Code applies to additions or alterations of existing residential buildings where the addfiion'�_A 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: h I� �} - SUBMITTAL Project Address: a) EV Project Description:_ ��-1 N ;ii 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. MANDATORY FEATURE OR MEASURE Column 2 Column 3 Project Verification Requirements .. .1 PLANNING AND DESIGN � �, F1an1 ,==QrmMW__.1vW1MPR 7- 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during construction. 4.106.3 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. Page 1 of 5 CalGreen_2014.doc revised 11/04/14 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. V. 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.doe 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 MATERIAL Enhanced Durability and Reduced Ma6 l `.9.sr�.2'.A24+ hy�+'`F r?,rR .sC+'�'2t�k ,;� _Y*i .�+�3.%U?k>. roe.A..: �'�•4'r4?'` 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected L� ❑ 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 waste management plan shall be submitted for approval to the enforcing agency. Building Maintenance and Operation 4.410.1 Operation and maintenance manual. At the time of final inspection, an operation and maintenance manual shall be provided to the building ❑ ❑ occupant or owner. A4.5 ENVIRONMENTAL Fireplaces a .. , +. 3, -v�'a`:.. Kv37 x :1':'fis`�..�t ..+.. :ANN b '� �i£r. a.. .ni � a . �"v�^`�lhl't7i .``". iF 'n•-•�••. { � •la :�.. i ,� � _ 4.503.1 General. Install only a direct -vent sealed -combustion gas or sealed ❑ ❑ wood -burning fireplace, or a sealed woodstove. RIB PQ'1��;S,�,. a.0 ... i .. z 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 �/ u ❑ 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 11104114 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 l 4.505.2 Concrete slab foundation. Required vapor retarders and capillary breaks Eli❑ 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. ❑ n�3 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the T building are provided in every bathroom. ❑ Enviroimet�fail 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 RCCA 36-S (Manual S) or equivalent. INSTALLERO- 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 and able to demonstrate qualified competence in the ❑ discipline they inspect and verify. 'Ma� w '" Verl�C`at�i $` t a 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 which show substantial conformance. Implementation verification shall El be submitted to the Building Department after implementation of all required measures and prior to final inspection approval. Page 4 of 5 CalGreen 2014.doe revised 11104114 CALGREEN SIGNATURE DECLARATIONS Project Name: tyj Project Address: Project Description:]--Ar�y't� T 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 7 Gado tedbheCit of Cuertino, foa reen Building Standards Code as Name (Please Print) Professional's Design Professional's Name (Please Print) Sign r nse Profession responsible for CalGreen compliance Name of License Professional responsible for CalGreen compliance (Please Print) Email Address for License Professional responsible for CalGreen compliance 5 331 .5e 3 1f— Phone 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 r onsible for CalGreen compliance (Please Print) Phone Email Address far License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen 2014.doe revised 11/04/14