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B-2016-1857CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1857 18836 LOREE AVE CUPERTINO, CA 95014-3635 (375 15 019) DIANLI CHEN CONSTRUCTION CUPERTINO, CA 95014 OWNER'S NAME: WANG JENNY JINLING DATE ISSUED: 08/17/2016 OWNER'S PHONE: 408-623-8225 PHONE NO: (408) 888-2898 LICENSED CONTRACTOR'S DECLARATION ARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #856154 Contractor DIANLI CHEN CONSTRUCTION Date 03/31/2017 X BLDG _ ELEC _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter`9 (commencing _ MECH X RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONSTRUCT N ONE STORY HOME 1990 SQ FT GARAGE 417 SQ I hereby affirm under penalty of perjury one of the following two declarations: FT, DECK 159 SQ Tre 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 REV #1 MOVE REAR LEFT BEDROOM 10 INCHES IN TO SATISFY 5 ,peiformance of the work for which this permit is issued. FT SETBACK; MO VE RIGHT REAR MASTER BEDROOM LEFT 2� % I have and will maintain Worker's Compensation Insurance, as provided for by WALL OUT Section 3700 of the Labor Code, for the performance of the work for which this 7INCHES ISSUED 9-15-2016 permit is issued, REV #2 - ADD GAI LAGE SKYLIGHT TO PLANS; REVISE ROOF APPLICANT CERTIFICATION PLANS -ISSUED 12/13/2016 1 certify that I have read this application and state that the above Sq. Ft Floor Area: 2406 Valuation: $260000.00 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 APN Number: Occupancy Type: inspection purposes. (We) agree tosave indemnify and keep harmless the 375 15 019 Deferred Submittal (R -3),R-3 (Custom),R-3 (Crstom),U City of Cupertino against liabilities, judgments, costs, and expenses which (Private Gar /Ag Bidg),U (Private Gar /Ag Bldg) 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 Mu' icipal Code, Section 9.18. %'? PERMIT E IBES IF WORK IS NOT STARTED ISSUANCE .Signature Date 12/13/2016 WITHIN 18 DAYS OF PERMIT OR y 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 AVENDE. following two reasons: Date: 08/17/2016 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 RF -ROOFS: sale (Scc.7044, Business & Professions Code) All roofs shall be insl ected prior to any roofing material being installed. Ifa roof is 2. I, as owner of the property, am exclusively contracting with licensed installed without first i btaining an inspection, I agree to remove all new materials for contractors to construct the project (Scc.7044, Business & Professions Code). inspection. I hereby affirm under penalty of perjury one of the following three declarations: s. I have and will maintain a Certificate of Consent to self -insure for Worker's Signature ofApplicant Compensation, as provided for by Section 3700 of the Labor Code, for the Dater 12/13/2016 performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by ALL ROO 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. ffAZARDOUS MATERIALS DISCLOSURE s. I 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. 1 will Worker's Compensation laws of California. If, after making this certificate of maintain complianct 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. Addition y, 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 Cupertino Municipal: Code, Chapter 9.12 and APPLICANT CERTIFICATION the Health & Safety Cod,, Sections 25 65, 25533, and 25534. 1 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 Oiivner or authorized agent: NJ relating to building construction, and hereby authorize representatives of this city < Date: 12/13/2016 to enter upon the above mentioned property for inspection purposes. (We) agree 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 12/13/2016 I understand my platis AR MUCT'S DECLARAJaON shall be used as public records. CONSTRUCTION PERMIT APPLICATI{ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DI 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building&cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION /-DEF PROJECT ADDRESS CTI Je OWNER NAME Es^ PHONE W6 -D STREET ADDRESS 10C& ( Fn CITY, STATE, ZIP --Qi10 CONTACT NAME p 1 I PHONE STREET ADDRESS, F^ E i✓d CITY STATF(�71P r a FAX FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ Al CHITECT ❑ ENGIlVEER ❑ DEVELOPER ❑ TENANT CONTRACTORN � kffam7 LICENSE TYPE �g BUS. LIC # l >� & dda COMPANY NAME E MA1T9 da f j� l P FAX STREET ADDRESS CITY, STATE ZSP PHONE aVF ARCHITECT/ENG EE Nf_ LICENSENUMBER BUS. LIC# 666 COMPANY NAME. E-MAIL FAX STREET ADDRESS43-7 C � C, 66 t, D CIT S�ATE��, GRIP Ag _ PHONE DESCRIPTION F l y(,�'S� i7 ,� t -✓AJ`� oc qcweaf, m -t w at ice Gyle 1.5 1`4 USE TYPE I OCC. I SQXT. I VALUATION ($) EXLSTG : NEW FLOOR - DEMO TOTAL -- AREA AREA AREA NET AREA _ BATHROOM - - KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA ❑ ATTACH #DWELLING UNITS: - IS ASECOND UNIT ❑YES SECONDSTORY OYES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES 'RECEIVED BY:.' , TOTAL VALUATION: PLANNING APPL # ❑.NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO TAL Ld By my signature below, I certify to each of the following: I am the property owner orauthorized agent t act or 1he 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 a curate. I agree to comply with all applicable local ordinances and state laws relating to buil mg o structi n. I authorize representatives of Cupertino to enter the bove-identified pro erty for inspection purposes. Signature of ApplicantlAgent; _ Date: t/,) ---a —g 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 form -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.doe revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: I CONTRACTOR: PERMIT NO: B-2016-1857 18836 LOREE AVE CUPERTINO, CA 9 014=3635 (375 15 019) DIANLI CHEN CONSTRUCTION CUPERTINO, CA 95014 OWNER'S NAME: WANG JENNY JINLING I I DATE ISSUED: 08/17/2016 OWNER'S PHONE: 408-623-8225 License Class B Lie. #856154 Contractor DIANLI CHEN N TR T � N Date 03/31/2017 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of theusiness & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perju ry one of the following two declarations: 2. I have and will maintain a cer ificate 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 N ihich�:this permit is issued. z. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Co le, for the performance of the work for which this permit is issued. certify that I have read this applicati n 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 u f}on the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, ju Jgm6nts, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understanc s and will comply with all non -point source regulations per the Cupertino Mur�cipal Code, Section 9.18. Date 9/15/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, oil my employees with wages as their sole compensation, will do the wo%k, and the structure is not intended or offered for sale (Sec.7044, Business &ofessions Code) 2. I, as owner of the property,4poject exclusively contracting with licensed contractors to constructthe (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 1 have and will maintain a Ce0fic4te 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 Ccjde, for the performance of the work for which this permit is issued. 3. I certify that in the performance of"the work for which this permit is issued, I shall not employ any person in any, manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. I certify that I have read this applicat on 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 whi rh 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 9/15/2016 PHONE NO: (408) 888-2898 BUILDING PERMIT INFO: X BLDG — ELECT _ PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: CONSTRUCT (N) ONE STORY HOME 1990 SQ FT, GARAGE 417 SQ FT, DECK 159 SQ Fire REV #1 MOVE REAR LEFT BEDROOM 10 INCHES IN TO SATISFY 5 FT SETBACK; MOVE RIGHT REAR MASTER BEDROOM LEFT WALL OUT 7 INCHES ISSUED 9-15-2016 Sq. Ft Floor Area: 2406 1 Valuation: $260000.00 APN Number: Occupancy Type: 375 15 019 Deferred Submittal (R -3),R-3 (Custom),R-3 (Custom),U (Private Gar / Ag Bldg),U (Private Gar / Ag Bldg) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued 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:/19 5/2016 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95of 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,�ectig�ns 255 255330, and 25534. Owner or authorized agent: 1! \` Date: 9/15/2016 CONS RUCTION 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 i CONSTRUCTION PERMIT APPLICATION OMS UNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION " 110300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (?108) 777-3228 FAX (408) 777-3333 buiidinclta)ouoertino.orr C:UPERTINO r—� i 5 I I NPXV r011JRTRT1CTinv i F7 $r� T)nv"nw 1 [ A T TPP AIrini i 1'i'r rv/n1711TCWNM rnVrVDD=n ORIGINAL PERMIT # -' ;'P r'9 7 PROJECT ADDRESSI 9P4, i'CAVE7APN n 7". I S W 01 OWNER NAME "TA PHONE E-h4AIL f {� y y� S iiLEETADDRESS` (( Z i (% CITY, STATE, ZIP CONTACT NAMEr - , PHONE / /�1y+ o E MA1Le� STREETADDRESS �f S` CITY, STATE, ZIP -,�/ FAX ©. OWNER ❑ OWNER -BUILDER.-. ❑ OWNERAOLKIT IeI CON'TRACT'OR ❑CONTRACTORAGENT 0 ARCHTIECT IN 5-aiNEER 1:1 DEVELOPER ❑ TENAmr CONTRACTORNAME LICENSENUMEER LICENSE TYPE BUS,LIC� COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCH[TECTlENGINEER NAIvIF LICENSE NUMBER BUS, LIC # COMPANY NAM[F E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE _ j i t } j UA r seLDHSCRIPTION OF §rORK u� _ f A" ^ 'A 41&9- . r• `ice 44& Q " &M ""it '!,y % IJ ✓'i '%t 1e# 41AII EXISTING USE PROPOSED USE CONSTR.TYPB # STORIES - - U E 1'YP% OCC. SQ.FT, VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA ARL -A 1dET AREA - -BATHROOM - KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA -DECK AREA TOTALDECKIPORCH AREA GARAGE AREA: DETACH C] ATTACH 9DWELLINGUNITS: ISASP.COrNDONIT []YES SECONDSTORY E]YES BEINGADDED? C1NO ADDITION? [JNO PRE -APPLICATION []YES IFIYESPROVjDECOPYOF ISTHRISLDCAN E] YES RE&.WFErB&Y TOTALVALUATION: PLANNINGAPPL# ONO PLANhINGAPPROVALLETTER EICI3LERIOME? ElNO By my signature below, I certify to each of the following: l am the property owner or autlr rized agent to act on the property owner's behalf. T have read this application and the information I have provided is collect. I have read the Description of Work and verify it is accurate, I a ee to comply with all applicable local ordinances and state laws relating to building const ucti n. Iauthorize representatives of Cupertino to enter the abov -ident ed property for inspection purposes. –SignatweofApplicant/Agent �i--Date:f�� —1 SUPPLEMENTAL INFORMATION RE UIiiED Q rz;�.NcxEG[t.rir - , Izaua'In�sLIP`>•:��:;''`---,= O� Ei2 TiiE;COIJIYTER 'D :'13UILIIIIvG _ New SFD or Multifamily dwellings: Apply for demolition permit for existing buildiD s . Demoliti n ermit is required prior to issuance of buildin permit for new building. �aPRr ss I� PII\nING PI ? R RL+� IEtti '. Colnnlereial BId-S: Provide a.eompleted Hazardous Materials Disclosure ^ D STAiND�RD. ;.:' _:: ` D pUBLIc itiolitcs ^. tori if any Hazardous Materials are being Used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to " Q, sAATTAI;1 s> ti� ERDISTRICT: submittal of Building Permit application.i�doR ^, ,: -- -' � Ri�'VIRONhI6INTt1li FIEi1.r;Tx — BldgAppj011.doc revised 06121111 ;Aq tuG�� CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18836 LOREE AVE CUPERTINO, CA 95014-3635(375 15 019) CONTRACTOR: DIANLI CHEM PERM NO: B-2016-1857 CONSTRUCTION CUPERTINO, CA 95014 OWNER'S NAME: WANG JENNY JINLING DATEISSUED: 08/17/2016 OWNER'S PHONE: 408-623-8225 PHONE O: (408) 888-2898 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #856154 Contractor DIANLI CHEN CONSTRUCTION Date 03/31/2017 X BLDG _ ELECT PLUM B I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X RESIDENTIAL COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: CONSTRUCT (N) ONE STOR HOME 1989 SQ FT, GARAGE 41.7 SQ 1. I have and will maintain a certificate of consent to self -insure for Worker's FT, DECK 1:59 SQ FT ' 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. Sq. Ft Floor Area: 2406 Valuation: $260000.00 APPLICANT NT RTIFI ATION certify that I have read this application and state that the above APN Number: Occupain cy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 375 15 019 / Deferred Submittal (R -3),R-3 (Custom),R-3 (Custom),U representatives of this city to enter upon the above mentioned property for (Private Gar /Ag Bldg),U (Private Gar /Ag Bldg) inspectionpur oses.(Wl)getsavienifyandpsshCity of no agaliabilities, judgments, expenses c may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES WORK IS NOT STARTED Additionally; the applicant understands and will comply with all non.point source regulations per the Cupertino Municipal Code, Section 9.18. WITHIN 180 DAYS F PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Signature , , �o Date 08/17/2016 Issued by: Kim Dunbar OWNER -B TTL D R DECLARATION Date: 08/17/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: 1. I, as owner of the property, or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed. If a roof is compensation, will do the work, and the structure is not intended or offered for installed without first obtaining an it spection, I agree to remove all new materials for sale (Sec.7044, Business & Professions Code) inspection. z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Signature of Applicant Date: 08/17/2016 1 hereby affirm under penalty of perjury one of the following three declarations: i. 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by HAZARDOUS ft ATERIALS DISCLOSURE Section 3700 of the Labor Code, for the performance of the work for which this I have read the hazardous materr als requirements under Chapter 6.95 of the permit is issued. California Health & Safe Co Safety e, Sections 25505, 25533, and 25534. I will 3. I certify that in the performance of the work for which this permit is issued, I maintain compliance with the Cul ertino Municipal Code, Chapter 9.12 and the shall not employ any person in any manner so as to become subject to the Health & Safety Code, Section 5532(a) should I store or handle hazardous Worker's Compensation laws of California. If, after making this certificate of material. Additionally, should I use air contaminants as defined by the equipment or devices which emit hazardous Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Cod,-, Sections 25505, 25533, and 25534. be deemed revoked. APPLICANT CERTIFICATION - f ' Owner or authorized agent: s'I ' certify that I have read this application and state that the above information is Date: 08/17/2016 correct. I agree to comply with all city and county ordinances and state laws N ON LENDING AGENCY relating to building construction, and hereby authorize representatives of this city i hereby affirm that there is a cons truction lending agency for the performance to enter upon the above mentioned property for inspection purposes.. (We) agree of work's for which this permit is is sued (Sec. 3097, Civ C.) to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands Lender's Address and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be us d as public records. Signature Date 08/17/2016 Licensed Professional cuil 11II hTFII7 i'f1'it'CTRTi["1'TCIiS CONSTRUCTION PERMIT APPLICAT[O COMMUNITY DEVELOPMENT DEPARTMIENT • BUILDING M\,, 10300 TORRE AVENUE • CUPERTINO, CA 85014-3255' -(408) 777-3228 . FAX (408) 777-3333 - building ftuDertlno, org M&nT)TrTC)%7 I I A.T TCT) A TTn'kT I TT I7 nct rrnr-111 - PROJECT ADDRESS 4 j • + AP NT # DANER I.AmE PHONE E_h C 6y $yy" STREETADDRESS CITY, STATE, ZIP ito Ave r COT1T'ACT NAMEMf �y1,s• ,,. �� Pte' • r PITGh'E!'�l ¢�7 �J p � 'E-Rifl+TL ` _ J3�G>*�~��dSTREETADDRESS CITY, STATE,ZIP Ff gA ❑ OR'I@ER '011''ER-BUILDER )] OB'h'ER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT IQ ARCHITECT i LG ENGM'EER © DEVELOPER ❑ TENANT CONTRACTOR NAME •, % e.. LICENSE?�'[I] iEER LICENSE TYPF' `% BUS. LTC COMPAh1 NA IE co E i,?AIL �!"dil/vl � .77 FAX �"a f Gi� `moi q4Go qe STREETADDRESq y �1 g I I Y CITY, STATE, ZIP/n- Uv W: PHOIE, 4 .r ` ARCHITECT.'EIvCiL\TEER NAMH _ � �,� LICENSE NUMBER � BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS � e� CITY, STATE, ZIp -1�� J �� rESCRIPT70N OF \4'OR11- ` t C.. EMUSE fROPO$I,USE CO4N� TYPE 'STQRIES ` Y 1 ' USE { TYPE - - OCC. i SQ,Ff. ! VAiL aTION (S) EXISTG IIMPFLO�OyR DMMO TOTAL P.ItEfs AREA („I � ' AREA - hIE7 AREA i BA ROOM KITCHEN ..OTHER REMODELAREA RWODELAREA REMODELAREA PORCdiARE.A IECE.4 - TOT.ALDECKIfORCHP.REA Gra Ai DETACH R:dTTACH - VT n DELLiN'G UNITS: IS A SECO\D U\IT YESSEGOI;6 STORY ❑1`ES"'- - - BEI\GADDED NO ADDITION2 ❑NO PILE -APPLICATION ❑ YES IF YES, PRO VIDE COPY OF PLANW,M-G APPL- ❑h0 PLANNING APPROVAL LETTER IS THE BLDG AN ❑ 1 ES I EICHLER HOME? A NO RE C tD..$1 �_r � � t TOTAL N ALUATION: �, r 'r .F:nh ?' x,,, iti ry M V 0 v 13y nay signature Wow, I certify to each of tale following, I am the property Owner or autliOrized agent to act on he prop er o«ner'S behalf. I hay e read this application and the information I have provided is correct. I have read the Description of 1ATork and verify it is accurate. I iagree to Comply Yxdth all applicable local ordinances and stale laws relating to buildine construction I autborize r resentativeS Of Cupertino to enter the ab ov id . 'fie ropeYy. for inspection purposes. Si -nature of AppiicantlAgent: �1 ~ Date: SbPPLEMENTAL INFORI�MATI _ T REQUIREI? �..PLA�CHECi Ti PE, _ *. s_,� i iLIILTl+G�LIP ❑�Oi � i��5L'TiDI\G} 2\7ew SFD or Multlfan111y dv,-ellings: Appy for demolition pexalit for existing building{s). Demolition permit is re ired prior to issuance of building ER TYE COULTER � a TrA\ itEliEYi +� perinit fat• new building: t� � ❑ E�r�ss'� > � t � � s,.7 ` � � ❑ �L3L\L\G PLAN REt IER . Commercial Provide a completed Hazardous Materials 17isclosule❑� a sT�\DaRD Uy -p( SZiCSiORTt�45 _ us .Lot= if any Hazardous :M1hatesi2lS are being used as part ofthis project. ' � - `� � i T ❑ £iREDEPT. ` _ Copy of Fiallnillg Approval Letter or Meeting Yi itll Planning prior to M'❑LAFGE s� - - .. I submittal of Building Pe1TI•Tit 2pplicatian. )`fAJOR ��. � , � � ❑ 3I2.] SEtiIERDI�T.RICT + S4\IT._ a�1 �.:a:, �_. �: `':`� ..❑t E\�"iRO\. SE'.T.�L IIE.4LTH .� t y 7 2 • Bldg.4pp_2011.docrevised 06/21111 5 01 +GUP RTINO I 0 NFNV CONSTRUCTION PROJECT ADDRESS s OWNER NAME "--1CP N 1% STREET ADDRESS /1 D CONSTRUCTIONPERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 1.0300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildingp_cupertino.org ❑ ADDITION Q ALTERATION / TI VREVISION /DEFERRED ORIC / 11 ,^,PG _ V _ APN # 5 — 15- Of v V�.V►GI PHONE SA fl �Y 7q . EMAIL CITY, STATE, ZIP(f FAX ARCHITECT/ENGINEERNAME CONTACT NAME J PHONE CCly� t� E-MAIL Ccl , 1? sl iZiG�e!* STREET ADDRESS S y� / J 6 CITY, STATE, ZIP COMPANY NAME ❑ OWNER ❑ OWNER -BUILDER. ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT El ARCHITECT ARCHITECTL-r' ENGINEER ❑ DEVELOPER ❑ TENANTS CONTRACTORNAME LICENSENUMBER 7LIC ENSE TYPE BUS. LIC# COMPANY NAME E-MAIL FAX PHONE STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNAME LICENSENIB4BER . BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK. 1Z 121 e4:L 6doo-v KA 4m ISTING USE I PROPOSED USEI CONSTR. TYPE # STORIES U E TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM - KITCHEN - OTHER _ REMODEL AREA REMODELAREA REMODELAREA PORC9AREA1 DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: n DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑.YES SECOND STORY ❑ YES T7 BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION: PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? NO a 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 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: r Date: SUPPLEMENTAL INFORMATION 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 form 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 Perinit application. B1dgApp_2011.doC revised 06/21/11 CUPERTINO CONTRACTOR-/ SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE #�' GENERAL CONTRACTOR: WANE 1, C� BUSINESS LICENSE # ADDRESS: f 01F'j CITY/ZTPCODE: �/ , *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 I am not using_ any subcontractors:•&AA '_ Signature D to Please check applicable subcontractors and complete the following information: `/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date CUPERTINO PURPOSE: 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 - buildincna.cupertino.org 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 Project Address: Project Description: Instructions: W%N 6t h r 0��J Gy - 11NIF 5 - t v t'L� 'tTO LA Yr 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. 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. 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 Reaulrements Planning and Design` Sjte ©evelgpmnt= -_ - 4.106.2 Storm water drainage and retention during construction. A plan is Eldeveloped and implemented to manage storm water drainage during construction. 4.106.3 Grading and paving. The site shall be planned and developed to El surface water away from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. CUPERTINO Building Department REVIEWED FOR CODE COMPLIANCE Reviewed By: Phuong Devries CnlGreen_2014.doc revised 11104114 Page 1 of 5 Date: 08/16/16 General 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. LE -_ indoor -,Water Use 4.3031 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 re in Table 1401.1 of the California Plumbing Code. CUPERTINO Page 2 of 5 REVIEWED FOR CODE COMPLIANCE Reviewed By: Phuong Devries Date.. 08/16/16 u CalGree7J 2014.doc revised 11104114 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. Enhanced Durabtirty-and Reduced Malrttenahcean 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; f7isposat and Recycling 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall be submitted for approval to the enforcing agency. Building Main enanc�ttorl —--=-__— 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. 0 Fireplaces 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 rq compliant with VOC limits. LJ RERT 4.504.2.3 Aerosol paints and coatings.1Elbfla h®e tint shall be compliant with product weighted M for ROC and other toxic compounds. REVIEWED FOR CODE COMPLIANCE Page 3 of Reviewed By: Phuong Devries CalGreen_2014. doc revised 11104114 Date: 08/16/16 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 El 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 (CHIPS) Low-emitting Ef ❑ 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. Inter�or_Moistur.;e Control__ = - 4.505.2 Concrete stab 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 n1 u building are provided in every bathroom. Env�ronmentai Com#ort - _ 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. rLvJf ❑ 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. MR, 3A e ► a A . . e 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 compliance with CALGreen may include construction documents, plans, spe , builder or installer inspection reports, or other me eptEUiRFbRTrkNQ1g certification, agency which show substantial conforman \ t jjd oeb i ojl be submitted to the Building Department of en anon f a equire measures and prior to final inspection approva�. iF�niFn FnR rnnF rnnn Wage 4 of 5 Reviewed By: Phuong Devries CulGreen_2014.doc revised 11104/14 Date: 08/16/16 Project Name: Project Address: Project Description: CALGREEN SIGNATURE DECLARATIONS SECTION 1 - DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Owner's Signature Date r N VJ,4r Oviner's Name (Please Print) Q k� rlacinn Prnfaccinnal'c RinnnturP Date Design Professional's Name (Please Print) _ ( Signature of Lice a Professional responsible for CalGreen compliance Data/ Name of License Professional responsible for CalGreen compliance (Please Print) Phone �t Ct�wf 0 C,ee4 Email Address for License Professional responsible for CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Name of License Professional responsible for CalGreen compliance (Please Print) Email Address for License Professional Date Phone REVIEWED FOR CODE COMPLIANCE Page 5 of 5 Reviewed By: Phuong Devries CalGreen_2014.dcc revised 11/04114 Date: 08/16/16