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B-2016-1939
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1939 19025 PENDERGAST AVE CUPERTINO, CA 95014-3516 (375 37 043) D W K CONSTRUCTION CUPERTINO, CA 95014 OWNER'S NAME: XIE, YUCHEN SEPARATE PROPERTY TR I1/16/12 DATE ISSUED: 08/31/2016 OWNER'S PHONE: 858-228-0906 PHONE NO: (408) 424-8503 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #B20D27 Contractor D W K CONSTRUCTION Date 05/31/2017 X BLDG _ELECT _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 2 STORY SFD (2,257 S.F.), ATTACHED GARAGE (429 I hereby affirm under penalty of perjury one of the following two declarations: S.F.) &PORCHES (327 S.F.) 1. 1 have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 370.0 of the Labor Code, for the performance of the work for which this permit is issued. 2, I,have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: 2686 Valuation: $400000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above - a information is correct. I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 375 37 043 R-3 (Custom),R-3 (Custom),U (Private Gar /Ag Bldg),U representatives of this city to enter upon the above mentioned property for (Private Gar /Ag Bldg) inspection purposes. (We) agree to save indemnify land 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. PERMIT EXPIRES IF WORK IS NOT STARTED Additionally, the applicant understands and will comply with all noir-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. y > - Signature ,G �+ C- Date 08/31/2016 ,- Issued by: MELI S bate: 08/31/2 6 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 inspection, I agree to remove all new materials for sale (Sec.7044, Business & Professions Code)'i inspection. 2. 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: 08/31/2016 I hereby affirm under penalty of perjuryone of the following three declarations: s. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Section 3700 of the Labor Code, for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will a. I certify that in the performance of the work for which thispermit is issued, I maintain compliance with the Cupertino 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 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If after making this certificate of air contaminants as defined by the 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 Code, Sections 25505, 25533, and 25534. be deemed revoked. y GY� APPLICANT CERTIFICATION Owner or authorized agent: �- I certify that I have read this application and state that the above information is Date: 08/31/2016 correct. I agree to comply with all city and county ordinances and state lawsT relating to building construction, and hereby authorize representatives of this city U 1 hereby affirm that there is a construction lending agency for the performance to enter upon the above mentioned property for inspection purposes. (We) agree 7 Civ C. of works for which this permit is issued (Sec. 3097, ) 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 ARCHITECT'S DECLARATION Code, Section 9.18. understand my plans shall be used as public records. Signature Date 08/31/2016 Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUP ERT I NO (408) 777-3228 • PAX (408) 777-3333 • bulldina cx cuoertiric ora NEW CONTRUCTIQN ❑AUDITION ❑ ALTERATION I TI ❑ REVISION t D�FERRBU t?RtGTNAL PERIvIiT #1 P ROJECT7ADD7S- RNAME ate" r e�lde ast five. APN# � �S- 3 6 Ile-_. I. ; u �y FC-ITY� O E-MATL Ac 1Aeh l� C.j TRBET ADDRIIS Y� �. !t !S �� II, z �1 f+��I� dj FAX rCONTACT 'EMAIL�d 77J M Q � ♦ /�,J� n l fr{� !"I 1C�7�t !/V*► E,ZIPJ ` j JG�j ft -11 ^ PAX �jy��j( ff/ rCOWANY OHN'C KCONTRACTOR l3CONTRACTOR AGENT © ARCHrrRCT 12 ENGINEER�DHVLLOPERTENANTMC�BR BUII.,UEIt �] OWNERAGS LICENSEN(TMBt�R BUS. LIC E-MAIL E/ I/lN C.i7fYu tl G3/V GPC F S7RERTADDRESS /34 (i- 6ww,,-q i (J �J1` CITY, srA7•G, ZIP PIroNE �r,vs p , S7r NAMP ?ICiiNSENUMF3IiR / ��' � t] � f �;Z HUS. LIC # F -7 f1 I F-MATL 4 `bar e' nem ► C -h 6 c.R - C. eegM FAX TREHTAI]DRESS 1TY, STATE, ZIP' • Y"`'"y" ji P �rT �" - V � . PHONE DESCRiPTiONVI` WORK rsXISTTNG USE - PROPOSED USE CO NSIR. TYIE # STORIES - - - - 1,PG}7 EXISTG NEWI7:OOA lisp TYPE OCC. SQ.FT. VALUATION{$} - AREA /a/�{� ARP.A Z;S AREA TOTAL I i0 DATI. OM KITCHEN�C.•� (/ �j REMODF,LAREA OTHER DELAREA REMODEL AREA PORCHAREA DECKARBA TOTALDECKIP RCH AREA GARA-ZAREA:.. AETACIi TTACH #DwELLIN ISA SECOND UNIT OYES 54+CONDSTOY - BEINGADDUb! )IVO ADDITXOW. ©NO S I - PRE -APPLICATION R YRS, PROVIDE COPY OF 15 THE ELD G AN YES - RECE r PLANNRIGAPPL tf NO PLANNING APPROVAL LL•TTLIt t1CHLER IIOME7 Ai, V Oa application my tii n and t below, I certify to each of the following; I am the property owner or authorized agent lv act on t!x appliaiion and the information t have provider! is correct. I have read the Description of Work and verify it is ac rate, I agree oecotnply with have applicable local ordinances and state laws reiatulg to building construction. I authorize representatives of Cupertino to enter the above -identified roperty for inspection purposes. Signature of Applicant/Agent, Date: SUPPLEMENTACII+7FORMATION RE(I77RED PLAN CFIECK TYPE ROUTBQG SLIP New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building °-THEBI TII brnic PI ArTxEVI1 w _ permit for now building. W. EXPRESS © PLANNINGPI._ANREVIEW; Commercial Bldgs: Provide a completed Hazardous Materials Disclosure E7 .sTAND,IRD form if any Iazardous Materials are beingused as part of this project © PURI is woluzs i _ l] I nllczr D Fuze DnPT Copy of Planning Approval Leiter- or Meeting with Planning prioi:'to submittal of Building l'ermitapplication. ©MAJOR Q SAT?7ARXSEwERDIs77i1cT . . .. � . Q .ENVIRONMENTALHF,AI,T11 .:,. BldgApp 2011.doc l evised 06121111 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino I 0300 Torre Avenue Cupertino, CA 95014-3255 Teleplaotie• 408-777-3228 Fax,. 408-777-3333 JOB ADDRESS- /!?D. e RS �Fi/C _ PERMIT # i OWNER'S NAME -Gr P y PHONE # GENERAL CONTRACTOR. jT1W 9f7U4171�D 13 USINESS LICENSE ADDRESS D A-ftiR14- d tvfi , CITYMPCODE. 54A/j0;&_G�9 .Sr/l -vur naunActpat code requWes ail businesses working in the city: to have a Cfry 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: Owner / Contractor Signature a Z:>_ 1 D to s Vj 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 iPlumbin Roofing a,n ��f'/ Septic Tank _ f Sheet Metal Sheet Rock Tile Owner / Contractor Signature a Z:>_ 1 D to s Vj CALGREEN RESIDENTIAL CHECKLIST — MANDATORY (' yi 1...0 El ITEMS cEP*t COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL 106o cl 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building@cupertino.org PURPOSE: The 2013 CalGreen Code applies to additions or alterations of existing residential buildings where the addition or alteration increases the building's conditioned area, volume, or size and also applies to all new low-rise residential buildings, high-rise residential buildings, or both. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: Xie's Residence Project Address: 19025 Pendergast Ave, Cupertino, CA 95014 Project Description: New Two-story Single Family Home Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 -Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification'at the end of this checklist and submit the completed form to the Building Inspector. Column 2. Column 3 MANDATORY FEATURE OR MEASURE Project Verification Requirements A4.1 PLANNING AND DESIGN Planning and Design -Site Development 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during 0 0 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 ® 0 site grading or a drainage system will manage all surface water flows. CUPERTINO Building Department „ _ x REVIEWED FOR CODE COMPLIANCE Page 1 of 5 Reviewed By:Phuong Devries CalGreen_2014.doc revised 11/04/14 Date: 08/05/16 A4.2 ENERGY EFFICIENCY ,,General. 4.201.1 Low-rise residential buildings shall meet or exceed the minimum 0 ❑ standard design required by the California Energy Standards. A4.3 WATER EFFICIENCY AND CONSERVATION Indoor Water Use 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals)and fittings(faucets and showerheads)shall comply with the following: ❑ 4.303.1.3.2 Water Closets.The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank-type water closets shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank-type Toilets. ❑ 4.303.1.3.2, Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. ❑ 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. ❑ 4.303.1.3.2 Multiple Showerheads serving one shower. When a shower is served by more than one showerhead,the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons:per minute at 80 psi, or the shower shall be 12I 0 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, El and shall meet the applicable standards r in Table 1401.1 of the California Plumbing Code. CUPERTINO Building Department REVIEWED FOR CODE COMPLIANCE Reviewed By:PhuongDevriesPage 2 of 5 CalGreen_2014.doc revised 11/04/14 Date: 08/05/16 .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. 0 ❑ 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 CONSERVATION AND RESOURCE EFFICIENCY Enhanced Durability and Reduced Maintenance 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected El 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 construction waste'management plan shall be submitted for approval to the enforcing agency. Building Maintenance and Operation • 4.410.1 Operation and maintenance manual. At the time of final inspection, an operation and maintenance manual shall be provided to the building occupant or,owner. , A4.5 ENVIRONMENTAL QUALITY Fireplaces 4.503.1 General. Install only a direct-vent sealed-combustion gas or sealed wood-burning fireplace, or a sealed woodstove. Pollutant Control 4.504.1 Covering Of duct openings and protection of mechanical equipment during construction. Duct openings and other related air distribution component openings shall be covered during construction. 4.504.2.1 Adhesives,sealants and caulks. Adhesives, sealants and caulks 121 0 shall be compliant with,VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be 121 0 compliant with VOC limits. \� C P TI NO 4.504.2.3 Aerosoli'paints and coatings. �_t_ Dattiidintogr4186tittrayit shall be compliant with product weighted `' ►. for ROC and other toxic 0 compounds. REVIEWED FOR,CODE COMPLIANCE Page 3 of 5 Reviewed By:Phuong Devries CalGreen_2014.doc revised 11/04/14 Date: 08/05/16 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 0 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 El 0 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 ❑ 0 comply with low formaldehyde emission standards. Interior Moisture Control „ ` 4.505.2 Concrete slab foundation. Required vapor retarders and capillary 10 El ibreaks are also required to comply with CalGreen Section 4.505.2.1. S' 4.505.3 Moisture content of building materials. Moisture content of building 0 El materials used in wall and floor framing is checked before enclosure. indoor Air Quality and Exhaust • 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the ® ❑ building are provided in every bathroom. Environmental Comfort I 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. 0 0 2. Size duct systems according to ACCA 29-D (Manual D)or equivalent. 3. Select heating and cooling equipment according to ACCA 36-S (Manual S) or equivalent. INSTALLER AND SPECIAL INSPECTOR QUALIFICATIONS Qualifications • 702.1 Installer training. HVAC system installers are trained and certified in El El 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 0 0 discipline they inspect and verify. Verifications 703.1 Documentation. Verification of corn.liance with CALGreen may include construction documents, plans, spt \Lir.ins, �u r. - certification, inspection reports, or other m C ccep t. - o ing agency which show substantial conforms r-� ,;,•••ri uPc.io'rgae a ll ® ❑ be submitted to the Building Department LLL\ mentation of all required measures and prior to final inspection appgivaL FOR CODE COMPLIANCE Page 4 of 5 Reviewed By:Phuong Devries CalGreen_2014.doc revised 11/04/14 Date: 08/05/16 • CALGREEN SIGNATURE DECLARATIONS Project Name: Xie's Residence Project Address: 19025 Pendergast Ave. Cupertino Project Description: New Two-story Single Family Home 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. 5/11/2016 Owner's Signature. Date Yuchen Xie Owner's Name (Please Print) gez& Y y L 5/12/2016 rtgsign Professional's Signature Date Julie L He Design Professional's Name (Please Print) �ln.42d, C`air 5/12/2016 Signature of License Professional responsible for CalGreen compliance Date Thomas Chung 5/12/2016 Name of License Professional responsible for CalGreen compliance(Please Print) Phone dwkconstruction@yahoo.com 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. 8/ 7/7 Signature of License Professional responsible for CalGreen compliance Date — o /- G- � � ( As9307— Name of License Professional responsible for CalGreen compliance(Please Print) Phone dwkcGI3 Solt-i)71® 1 hoe'.c rnii \\ Email Address for License Professional respons Hy'aIGre= ' . • - _ B ildin. s e.a �Stly� REVIEWED FOR CODE COMPLIANCE Page 5 of 5 Reviewed By:. Phuong Devries CalGreen_2014.doc revised 11/04/14 Date: 08/05/16