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15010168 (2)CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20080 STEVENS CREEK BLVD CONTRACTOR: TERRA NOVA PERMIT NO: 15010168 INDUSTRIES OWNER'S NAME: PREG BILTMORE 1607 TICE VALLEY BLVD DATE ISSUED: 05/27/1.015 OWNER'S PHONE: 6506548900 WALNUT CREEK, CA 94595 PHONE NO: (925)934-6133 tU� LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] /^ SUITE 100-THE COUNTER BURGER; COMM T.I OF AN License Class_ Lic. # !%� EXISTING EMPTY SHELL RESTAURANT 3400 SQ FT. j( Contractorr%ey �RiG1G Date �% I hereby affirm that I am licensed under the provisions of hapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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: $350000 rformance 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: 36903009.20080 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 ISO DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses whi may accrue against said City in consequence of th �� granting of this it. d itionally, the applicant understands and w y Issued by: with all non -po t our r g ations per the Cupertino Municipal Code, Section 9.18. 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 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) 1, 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(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 eq6ipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by 94BapA yeoAir Quality Management District I performance of the work for which this permit is issued. will maintain compliance with C er i 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 performance of the work for which this the Health & Safety Code, Se 50 , 533, and 25534. Owner or authorized agent: Date: 7 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, 1 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 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 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 G CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20080 STEVENS CREEK BLVD CONTRACTOR: TERRA NOVA PERMIT NO: 15010168 INDUSTRIES OWNER'S NAME: PREG BILTMORE 1607 TICE VALLEY BLVD DATE ISSUED: 05/27/2015 ER'S PHONE: 6506548900 WALNUT CREEK, CA 94595 PHONE NO: (925)934-6133 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ f / 14(eir—)-5 SUITE 100-THE COUNTER BURGER; COMM T.I OF AN License Class Lic. # EXISTING EMPTY SHELL RESTAURANT 3400 SQ FT. Contractor Date !, JGyb REV # 1 - REVISION TO GAS PIPE SIZING, LOAD t'YY+A . SCHEDULES, WASTE CONNECTION & ELECTRICAL I hereby affirm that I am licensed under the provisions ofc4ter 9 LOADS - ISSUED 7/9/15 (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: 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: $350000 rformance of the work for which this permit is issued. e 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: 36903009.20080 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 IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mention property for inspection purposes. (We) agree to save 1 ROM LA ED INSPEC ION indemnify and keep h ess the gity of Cupertino against liabilities, judgments, costs, and expenses w i may a e gainst said City in consequence granting of this per Additio applicant understands anwimply f1s5ue e: with all non -points r e regul i r the Cupertino Municipal Code, Section 9.18. 1 VI / 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 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 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to 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 255#(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 u equi en or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by t ay it Quality Management District I performance of the work for which this permit is issued. will maintain compliance with t upe ti unicipal Code, Chapter 9.12 an I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, 'tis 55 3, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this W permit is issued. Owner or authorized agent: Date: 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, 1 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. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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: 20080 STEVENS CREEK BLVD CONTRACTOR: TERRA NOVA PERMIT NO: 15010168 INDUSTRIES OWNER'S NAME: PREG BILTMORE 1607 TICE VALLEY BLVD DATE ISSUED: 05/27/2015 OWNER'S PHONE: 6506548900 WALNUT CREEK, CA 94595 PHONE NO: (925)934-6133 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ SUITE 100 -THE COUNTER BURGER; COMM T.I OF AN License Class Lic. # Sv EXISTING EMPTY SHELL RESTAURANT 3400 SQ FT. -- � Q REV # 2 - UPDATE LOUVER VENT DETAIL A-4.1 - ISSUED " Contractor d,`n�t Date 8/6/15 I hereby affirm that I am licensed under the provisions o Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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: $350000 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: 36903009.20080 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 DAYS FROM LAST CALLED INSPECTION. indemnify and keep h mless the City of Cupertino against liabilities, judgments, costs, and exp ses which ay accrue against said City in consequence of the granting of is erm itionally, the applicant understands and will comply Issued by: Date: with all on p nt s r g ations per the Cupertino Municipal Code, Section 9.18. 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 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 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to 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 ) s uld I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I us ui ment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by th ay a Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance wit th upe i icipal 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 performance of the work for which this the Health & Safety Code, S 55 5 and 25534. b Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued, l 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 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20030 scb TYPE OF CONSTR. DATE: 01/28/2015 REVIEWED BY: Mendez APN: BP#: BP FEE ID `VALUATION: 1$350,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building IATIPLNCK $1,856.13 PENTAMATION PERMIT TYPE: 1A T� WORK the counter burger; comm t.i of an existing empyt shell restaurant 3400 sq ft. SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID A (Tenant Improvements) II-B,III-B,IV,V-B 3,400 $2,601.81 v IATIPLNCK $1,856.13 ]ATHNSP $0.00 PME Plan Check: $0.00 Permit Fee: $1,856.13 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 3,400 $2,601.81 $1,856.13 il MECH, HOURLY 0 Yes E) No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No Ll NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS(Fee Resolution 11-0-5_7 E': 7;7.13 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,601.81 0 s.f. $0.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Supp/. PC Fee: Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,856.13 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ) Work Without Permit? 0 Yes ) No $0.00 Advanced Planning, Fee: $0.00 Select a Non -Residential Building or Structure E) 0 Strong Motion Fee: IBSEISMICO $98.00 Select an Administrative Item Bld. Stds Commission Fee: IBCBSC $14.00 SUBTOTALS: $4,569.94 $0.00 TOTAL FEE: 1 $4,569.94 Revised: 01/06/2015 CITY OF CUPERTINO rm_� FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictript pir ). Thovo %PPC aro ha Cod an tho nrolimi ary infnrmatlnn availahlo and arP ank an P.QtimatP_ rantart tho vont Far addn'l inFn_ FEE ITEMS (Fee Resolution 11-053 Uf..' 71'Y13) ADDRESS: 20080 Stevens Creek Blvd DATE: 06/18/2015 REVIEWED BY: Paul APN: 369 03 009 BP#: 15010168 *VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: Suppl. PC Fee: (E) Reg. ©OT PENTAMATION PERMIT TYPE: WORK Revision #1 - MEP SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nictript pir ). Thovo %PPC aro ha Cod an tho nrolimi ary infnrmatlnn availahlo and arP ank an P.QtimatP_ rantart tho vont Far addn'l inFn_ FEE ITEMS (Fee Resolution 11-053 Uf..' 71'Y13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (E) Reg. ©OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.(F) Reg. Q OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes E) No $0.00 Advanced Planning_Fee: $0.00 Select a Non -Residential Building or Structure Strong Motion Fee: $0.00 F-1-1 # $859.00 Revisions 1REVCOMTI Tenant Improvement Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $859.00 TOTALFEE-F $859.00 Revised: 05/07/2015 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 20080 STEVENS CREEK BLVD DATE: 0810612015 REVIEWED BY: MELISSA MISC ITEMS APN: 369 03 009 BP#: *VALUATION: $0 °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: 0.0 PENTAMATION 1GENCOM PERMIT TYPE: WORK REV # 2 - UPDATE LOUVER VENT DETAIL A-4.1 - ISSUED 8/6/15 SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District- Pte ). These fees are hated an the preliminary infnrmatinn available and are only an estimate. Cnntact the Dent fnr addn'1 info. FEE ITEMS (Fee Resolution 11-053 Et': 7/1/13, FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Yes 0 No $0.00 F-77 hours Plan Check, Hourly $143.00 1STPLNCK Suppl. PC Fee: Q Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. Q OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i E) Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 A Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALST $0.00 $143.00 TOTAL FEE: $143.00 Revised: 07/02/2015 CONSTRUCTION PERMIT APPLICATION ' COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildin cue' PION ❑ ADDITION [:1 ALTERATION 7/:'ALTERATION / TI EERRED ORIGINAL PEI # PROTECT ADDRESS OU _O —00 / OWNER NAM 1 PHONFj� t5 / I1 -I E-MAIL er–L r 1 (OtjU (�J STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHO E Q � E-MAIL �&Vt'/ STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME . LI N BR LIC YPE BUS. LIC # qv V COMPANY NAME ,i– E-MAILf ' ` FAX STREET ADDRESS CITY, ST/kTE,, ZI PHONE r (Ale ';'V ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Je vwr vrk4 Aa4a A - EXISTING USE PROPOSED USE CONSTR. TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA G�GE:ETACH TTACH #DWELLING UNITS: IS A SECOND 17NIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION [] YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ Y RECEIVED BY: TOTAL VALUATION: PLANNING APPL # n NO PLANNING APPROVAL LETTER EICHLER HOME? By my signature below, I certify to ea of e ollowing: I am the property owner or au onze perty owners behalf__1 have read this application and the information I hav prov de is orrect. I have read the Description of Wort d veri s accurate. 1 a ree to comply with all applicable local ordinances and state laws relatin to uild' o tion. I authorize representatives of C ertino nter thcab ov 'den feed ofor inspection purposes. roSignature of Applicant/Agent: Date: SUPPLEMENTAL INFO MATION REQUIRED PLANCHECKTYPE 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 El El Submittal Of Building Permit application. MAJOR .SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06/21/11 CUPERTIINO F-1 NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408C� ) 777-3228 • FAX ((408) 777-3333 • buildingcupertino.om 8) I I ADDITION M ALTERATION/T1 F1 REVISION/ DEFERRED ORIGINAL PERMIT # 15010168 PROJECT ADDRESS 20080 Stevens Creek Blvd. Suite 100 APN# 36 G O 3 Q O ` OWNERNAME Peter Katz l r `t31(�-y►��re- PHONE 650-654-8900 E-MAIL pkatz@thecounterburger.co STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME I I he Counter, LLC U/U bolden Propert PHONE 916-316-0005 E-MAIL Mike@goldenpd.com Develo ment LLC Attn: Mike Ramirez STREET ADDRESS 10 S. Grant St. CITY, STATE, ZIP Roseville, CA 95678 FAX ❑ OWNER ❑ OWNER -BUILDER IM OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Bob Dugan LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME Terra Nova Industries E-MAIL bobd@terranova-ind.com FAX STREET ADDRESS 1607 Tice Valley Blvd CITY, STATE, ZIP Walnut Creek, CA 94595 PHONE ARCHITECT/ENGINEERNAME Josh Cool LICENSE NUMBER BUS. LIC# COMPANY NAME Innovation & Design E-MAIL jcool@idaexperience.com FAX STREET ADDRESS CITY, STATE, ZIP PHONE 562-206-7720 DESCRIPTION OF WORK Revise gas pip sizing, remove gas pressure reg., revise make-up air unit, revise MAU-1 sequence of operation to include evaporative cooler, revise gas load schedule, add waste connection, revise electrical load. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL 3 400 AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: EIDETACH N/A ❑ATTACH #DWELLING UNITS: IS A SECOND UNITr� YES SECOND STORY O YES BEING ADDED? R NO ADDITION? ®NO PRE -APPLICATION O YES IF YES, PROVIDE COPY OF Is THE BLDG AN YE RECEIV TOTAL VALUATION: PLANNING APPL # QgNO PLANNING APPROVAL LETTER EICHLER HOME? By my signature below, 1 certify to each of the following: I am the property owner or authorized agV1iT_tV6ct on the property owner's_bgh9T I have read I application and the information I have provided is correct. I have read the Description of Work and veriis ao comply with all applicable local ordinances and state laws relating to building construction. I a orize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: ^Z Date: 6/17/2015 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. ❑ EXPRESS ❑ PLANNING PLAN REVIEW X 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. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doe revised 06121111 it CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building a-cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECTADDRESS 20000 Stevens Creek Blvd. Cupertino, CA 95041 APN# lO f240 �4 r OWNER NAME Peter Katz PHONE 650-654-89001 E-MAIL pkatz@thecounterburger.c zTl STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME he counter, Golden Proper V PHONE 916-666-2423 E-MAIL Jeremy@goldenpd.com Development LLC Attn: JeremV La ton STREETADDRESS 10 S. Grant St. CITY, STATE, ZIP Roseville, CA 95678 FAX ❑ OWNER ❑ OWNER -BUILDER IN OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME TBD LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME Josh Cool LICENSE NUMBER BUS. LIC # COMPANY NAME Innovation 8t Design E-MAIL jcool@idaexperience.com FAX STREET ADDRESS CITY, STATE, ZIP PHONF 562-206-7720 DESCRIPTION OFWORK Project consists of T.I. alternation level 2 of an existing empty shell building for a new restaurant space "The Counter Burger". Work shall include interior improvements, new kitchen and bar, mechanical, electrical, and plumbing, exterior modifications and patio with cover. EXISTING USE PROPOSED USE CONSTR. TYPE N STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL 400 AREA AREA AREA NETAREA !v' BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCII AREA DECK .AREA TOTAL DECKIPORCH AREA GARAGE AREA: UDETACH N/A ❑'ATTACH H DWELLING UNITS IS A SECOND UNIT ❑YES SECOND STORY OYES BEING ADDED? INNO ADDITION? agNO PRE -APPLICATION O YES IF YES, PROVIDE COPY OF IS THE BLDG AN [] YES I';,E"1,`EIVED TOTAL VILUATION: PLANNING APPL 4 NO PLANNING APPROVAL LETTER EICHLER HOME" NO G C By my signature below, I certify to each of the following: I am the property owner or authorized agent to act property owner's behalf. I have read this application and the information l have provide 4is correct. I have read the Description of Work and verify it is accurate. l agree to comply with all applicable local ordinances and state laws relating to bui g nstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 1/27/2015 SUPPLEME FORMATION REQUIRED PLAN'CMCKTYPE WUMGSLIP New SFD or Multifamily dwellings: Apply for demolition permit for © OVER TxE COUNTER J9t1 IDINGPLANREI ' existing building(s). Demolition permit is required prior to issuance of building permit for new building. © EMPRESS PLANNING PLAN REVIEW X Commercial Bldgs: Provide a completed Hazardous Materials Disclosure srAxnacRn' PURLIGWORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE Copy of Planning Approval Letter or Meeting with Planning prior to submitt 1 of Building Permit application. iwtu�at�It �CT Q ENVIRONMENTAL REALTU B1dgApp 2011.doc revised 06/21/11 cov-pod CUPERTINO TEMPORARY CERTIFICATE OF OCCUPANCY FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build ingacupertino.orq APDL, 3,� BP #' DA FE: � PROJECT /� �,r VALUATION: $ �'S�� 60 O LEVEL COMMENT vl9/ OVED K APPROVED WITH CONDITIONS' SITE.r- ADDRESS: -f y ✓t✓ r Gi !VE S NAME: Signature: ...... ..... . ................................... Date:...................... FAX #: MAILING ADDRESS (if different from site address): APPROVED CONT CTOR: PHONE #: 2,5"- 1?3471-- / 33 Y'A„ �Ui� FAX #: CO CT:/ p e PHONE #: Ut e(' {' -V W FAX #: TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION BOND TYPE: ❑ SURETY BOND AMOUNT (1% VALUATION $ 56oa �'� CODE ❑ CHECK ❑ CASH BOND OF BOND: 5Km1n-10Kmax (BLDBONDSJ EDITION: TCO EXPIRATION DATE (6 MONTHS MAX): FEE: $286.00/m0 TOTAL FEE: $ S ��� . c_ [1TEMPOCC] l USE TYPE OF CONSTR FLOOR AREA OCC LOAD LEVEL COMMENT vl9/ OVED K APPROVED WITH CONDITIONS' Public Works ❑ APPROVED ❑ APPROVED WITH CONDITIONS - Signature: ...... ..... . ................................... Date:...................... t Fer: APPROVED C3 APPROVED WITH CONDITIONS - Signature: ......................................................... Date:...................... OTHER DEPARTMENT I AGENCY APPROVALS: Planning Signature: ............................................. .. Date:........................ ❑APPROVED El APPROVED WITH CONDITIONS* Fire �.�'>�� G��r,r�'E � Signature: .................................. ..... vl9/ OVED K APPROVED WITH CONDITIONS' Public Works ❑ APPROVED ❑ APPROVED WITH CONDITIONS - Signature: ...... ..... . ................................... Date:...................... t Fer: APPROVED C3 APPROVED WITH CONDITIONS - Signature: ......................................................... Date:...................... "CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property stating the list of items required to be completed for each individual Department before final occupancy can be granted. Include approximate completion dates for each item. The undersigned covenant and agree as a condition to the approval of the above request fnr to porary occupancy to have the building or buildings con)plete and in compliance with all building codes, ordinances and regulation nd r ady for inspection prior to the expiration date specifed�lf this T mporary Certificate of Occupancy expires, the total amount of bo be forfeited and the non-compliance may result in enfa ent action. Owner Contractor Sign ture:............... .. .. ..................... Date:......:.. ...... Signature: 4:•:.. .:.............................. Date:../.. 1.... This temporary certifica n res t a fir protection and life safety systems have been completed, inspected, successfully tested and approved for the spec' c r of th i in specified above to provide a reasonable degree of safety to the occupants from fire and similar emer encies. Building Offci I : ....... 12,.......................Print:.......!. .............. .......................................... Date:...........�� .......... DEPARTMENT A : After edF@rminalion, copies to: 1) applicant, 2) permit file TempOccForm_2011 doc revised 717114 CALGREEN NON-RESIDENTIAL CHECKLIST - MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BU SION CVPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 X� (408) 777-3228 • FAX (408) 777-3333 • build inn )cupertino.arg Z PURPOSE: The non-residential provisions of the 2013 CalGreen Code outline planning, design dI that include environmentally responsible site selection, building design, building siting a d E protect, restore and enhance the environmental quality of the site and respect the integrit properties; establishes the means of conserving water used indoors, outdoors and in waste outlines means of achieving material conservation and resource efficiency; and outlines means quantity of air contaminants. Project Name: Tfl e Couw rz mt methods ment to Project Address: oa o i£Y A1S cRe K i34 -VD,_ f_v_mori vo, GA g5a, Project Description: /NrF_A102 7- 1 . Poa *4W A5rr4Ul21-;..yr W/ 04a r PArio ce; the Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2013 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. Page 1 of 9 CalGreen Aron -Res Checklist.doc revised 01123/14 Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Re uirements 1 1 ! 1 .- MEASURES CHAPTER NONRESIDENTIAL General Requirements The project meets all the requirements of Divisions 5.101 through 5.508. Q ❑ Division PLANNING AND DESIGN Planning and Design -Site Development 5.106.1 Storm water pollution prevention. For projects of one acre or less, develop a Storm Water Pollution Prevention Plan (SWPPP) that has been designed, specific to its site, conforming to the State Storm water NPDES Construction Permit or local ordinance, whichever is stricter, as is required for 0 projects over one acre. The plan should cover prevention of soil loss by storm water run-off and/or wind erosion, of sedimentation and/or of dust/particulate matter air pollution. Page 1 of 9 CalGreen Aron -Res Checklist.doc revised 01123/14 5.106.4 Bicycle parking. Comply with Sections 5.106.4.1 and 5,106.4,2; or local is Q ❑ meet ordinance, whichever stricter. 5.106.4.1.1 Short -Term bicycle parking. If the qualified project is anticipated to generate visitor traffic, provide permanently anchored bicycle racks within 200 feet of the visitors' entrance, readily visible to passers-by, Q ❑ for 5 percent of visitor motorized vehicle parking spaces being added, with a minimum of one two -bike capacity rack. 5.106.4.1.2 Long -Term bicycle parking. For qualified buildings with over ❑ ❑ 10 tenant -occupants, provide secure bicycle parking for 5 percent of tenant vehicle parking spaces being added, with a minimum of one space. 5,106.5.2 Designated parking. Provide designated parking for any combination of low -emitting, fuel-efficient and carpool/van pool vehicles as ® ❑ shown in Table 5.106.5.2. 5.106.8 Light pollution reduction. Outdoor lighting systems shall be ❑ ❑ designed and installed to comply with the following; 1. The minimum requirements in the California Energy Code for lighting zones 0 1 — 4 as defined in Chapter 10 of the California Administrative Code; and 2. Backlight, Uptight and Glare (BUG) ratings as defined in IES TM -15-11; and ❑ ❑ 3. Allowable BUG rating not exceeding those shown in Table 5.106.8, or ❑ ❑ Comply with a local ordinance lawfully enacted pursuant to Section 101.7, whichever is more stringent. 5.106.10 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. Division Performance Requirements 5.201.1 Scope. The California Energy Commission will continue to adopt © ❑ mandatory building standards. Division+TER EFFICIENCY AND CONSERVATIO Indoor Water Use 5.303.1 Meters. Separate meters shall be installed for the uses described in Sections 503.1.1 and 503.1.2. 5.303.1.1 New building or additions in excess of 50,000 square feet. ❑ Separate submeters shall be installed as follows: 1. For each individual leased, rented or other tenant space within the ❑ ❑ building projected to consume more than 100 gal/day. 2. Where separate submeters are unfeasible, for water supplied to the following systems: a. Makeup water for cooling towers where flow through is greater ❑ ❑ than 500 gpm. b. Makeup water for evaporative coolers greater than 6 gpm. c. Steam and hot-water boilers with energy input > 500,000 Btu/h. Page 2 of 9 CalGreen A'on-Res Checklist doe revised 01/2M 5.303.1.2 Excess consumption. A separate submeter shall be provided for any tenant within a new building or within an addition that is projected © ❑ to consume > 1,000 gaVday. 5.303.2 Water reduction. Plumbing fixtures shall meet the maximum flow rate Q ❑ values shown in Table 5.303.2.3, Exception: Building that demonstrate 20 -percent overall water use reduction. 5.303.2,1 Areas of addition or alteration. For those occupancies within the authority of the California Building Standards Commission, as specified in Section 103, the provisions of Section 5.303.2 and Section 5.303,3 shall Q ❑ apply to new fixtures in additions or areas of alterations to the buildings. 5.303.4 Wastewater reduction. Each building shall reduce by 20 percent wastewater by one of the following methods: 1, The installation of water -conserving fixtures or X❑ ❑ 2. Utilizing non -potable water systems. ❑ 5.303.6 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code MX El(CPC), and shall meet the applicable standards referenced in CPC Table 1401.1 and CalGreen Chapter 6. Outdoor Water Use 5.304.1 Water budget. A water budget shall be developed for landscape ❑ ❑ irrigation use. 5.304.2 Outdoor potable water use. For new water service or for addition or alteration requiring upgraded water service for landscaped areas of at least MX 131,000 sq.ft. but not more than 5,000 sq.ft,, separate submeters or metering devices shall be installed for outdoor potable water use, 5.304.3 Irrigation design. In new nonresidential construction or building addition or alteration with at least 1,000 but not more than 2,500 sq.ft. of cumulative landscaped area, install irrigation controllers and sensors which MX ❑ include the following criteria, and meet manufacturer's recommendations. 5.304.3.1 Irrigation controllers. Automatic irrigation system controllers installed at the time of final inspection shall comply with the following: 1. Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as ❑X ❑ weather conditions change. 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 communicates Q ❑ with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. Weather Resistance and Moisture Management 5.407.1 Weather protection. Provide a weather -resistant exterior wall and foundation envelope as required by California Building Code Section 1403.2 Eland California Energy Code Section 150, manufacturer's installation instructions or local ordinance, whichever is more stringent.' Page 3 of 9 CalGreen A'on-Res Checklisi.doc revised 01/23/74 5.407.2 Moisture control. Employ moisture control measures by the following methods; 5.407.2.1 Sprinklers. Prevent irrigation spray on structures. [X] ❑ 5.407.2.2 Entries and openings. Design exterior entries and/or openings ❑ ❑ to prevent water intrusion into buildings. 5.407.2.2.1 Exterior door protection. Primary exterior entries shall be covered to prevent water intrusion by using nonabsorbent floor and ❑ wall finishes within at least 2 ft around and perpendicular to such openings plus at least one of the following: 1. An installed awning at least 4 ft in depth. 2. The door is protected by a roof overhang at least 4 ft in depth. 3. The door is recessed at least 4 ft. 4. Other methods which provide equivalent protection. 5,407.2.2.2 Flashing. Install flashings integrated with a drainage Elplane. Construction Waste Reduction, Disposal and Recycling 5.408.1 Construction waste management. Recycle and/or salvage for reuse a minimum of 50 percent of the nonhazardous construction and demolition waste in accordance with Section 5.408.1.1, 5.408.1.2, or 5.408.1.3; or meet a © ❑ local construction and demolition waste management ordinance, whichever is more stringent. 5.408.1.1 Construction waste management plan. Submit plan per this ❑ ❑ section to enforcement authority. 5.406.1.2 Waste management company. Utilize a waste management company that can provide verifiable documentation that the percentage of 0 ❑ construction and demolition waste material diverted from the landfill complies with CalGreen Section 5.408. 5.408.1.3 Waste stream reduction alternative. The combined weight of new construction disposal that does not exceed two pounds per square ❑ El of building area may be deemed to meet the 50 percent minimum requirement as approved by the enforcing agency. 5.408.1.4 Documentation. Provide documentation of the waste Q Elmanagement plan that meets the requirements listed in Section 5.408.1.1 through 5.408.1.3. 5.408.3 Excavated soil and land clearing debris. 100 percent of trees, stumps, rocks and associated vegetation and soils resulting primarily from land ❑X ❑ clearing shall be reused or recycled. Building Maintenance and Operation 5.410.1 Recycling by occupants. Provide readily accessible areas that serve the entire building and are identified for the depositing, storage and collection ❑X ❑ of nonhazardous materials for recycling. 5.410.2 Commissioning. For new buildings 10,000 square feet and over, building commissioning for all building systems covered by T24, Part 6, process systems and renewable energy systems shall be included in the Eldesign and construction processes of the building project. Commissioning requirements shall include items listed in Section 5.410.2. Page 4 of 9 CalGreen A'on-Res Checkllst.doc revised 01/23/14 Fireplaces 5,503.1 Install only a direct -vent sealed -combustion gas or sealed wood - burning fireplace or a sealed woodstove and refer to residential requirements 0 ❑ in the California Energy Code, Title 24, Part 6, Subchapter 7, Section 150. 5.503.1.1 Woodstoves. Woodstoves shall comply with US EPA Phase II emission limits. Q ❑ Pollutant Control. 5.504.3 Covering of duct openings and protection of mechanical equipment during construction. At the time of rough installation or during storage on the construction site and until final startup of the heating and cooling equipment, all duct and other related air distribution component 0 ❑ openings shall be covered with tape, plastic, sheet metal or other methods acceptable to the enforcing agency to reduce the amount of dust or debris which may collect in the system. 5.504.4 Finish material pollutant control. Finish materials shall comply with Sections 5.504.4.1 through 5.504.4.4. 5.504.4.1 Adhesives, sealants, caulks. Adhesives and sealants used on the project shall meet the requirements of the following standards. 1. Adhesives, adhesive bonding primers, adhesive primers, sealants, sealant primers and caulks shall comply with local or regional air pollution control or air quality management district rules where applicable or ❑ SCAQMD Rule 1168 VOC limits, as shown in Tables 5.504.4.1 and 5.504.4.2. 2. Aerosol adhesives and smaller unit sizes of adhesives and sealant or caulking compounds (in units of product, less packaging, which do not weigh more than one pound and do not consist of more than 16 fluid ounces) shall comply with statewide VOC standards and other © ❑ requirements, including prohibitions on use of certain toxic compounds, of California Code of Regulations, Title 17, commencing with Section 94547. 5.504.4.3 Paints and coatings. Architectural paints and coatings shall comply with Table 5.504.4.3 unless more stringent local limits apply. ❑-7 ❑ 5.504.4.3.1 Aerosol paints and coatings, Aerosol paints and coatings shall meet the Product -Weighted MIR Limits for ROC in Section 94522(a)(3) and other requirements, including prohibitions on use of ❑ ❑ certain toxic compounds and ozone depleting substances (CCR, Title 17, Section 94520 et seq). 5.504.4.3.2 Verification. Verification of compliance with this section shall be provided at the request of the enforcing agency. Q ❑ 5.504.4.4 Carpet systems. All carpet installed in the building interior shall meet the testing and product requirements of at least one of the standards ❑ ❑ listed in Section 5.504.4.4. 5.504.4.4.1 Carpet cushion. All carpet cushion installed in the building interior shall meet the requirements of the Carpet and Rug Institute ❑ ❑ Green Label program. 5.504.4.4.2 Carpet adhesive. All carpet adhesive shall meet the requirements of Table 5.504.4.1. 0 ❑ Page 6 of 9 CalGreen Non -Res Checklistdoc revised 01123114 5.504.4.5 Composite wood products. Hardwood plywood, particleboard and medium density fiberboard composite wood products used on the interior or exterior of the building shall meet the requirements for QX ❑ formaldehyde as specified in Table 5,504.4.5. 5.504.4.5.3 Documentation. Verification of compliance with this section ❑ ❑ shall be provided as requested by the enforcing agency. Documentation shall include at least one of the following standards listed in Section 5.504.5.3. 5.504.4.6 Resilient flooring systems. For 80 percent of floor area receiving resilient flooring, installed resilient flooring shall meet at least one ❑ ❑ of the following standards listed in Section 5.504.4,6. 5.504.5.3 Filters. In mechanically ventilated buildings, provide regularly occupied areas of the building with air filtration media for outside and ❑ ❑ return air prior to occupancy that provides at least a MERV of 8. 5.504.7 Environmental tobacco smoke (ETS) control. Prohibit smoking within 25 feet of building entries, outdoor air intakes and operable windows where outdoor areas are provided for smoking and in buildings; or as enforced 0 ❑ by ordinances, regulations or policies of any city, county, city and county, California Community College, campus of the California State University or campus of the University of California, whichever are more stringent. Indoor Moisture and Radon Contro( 5.505.1 Indoor moisture control. Buildings shall meet or exceed the provisions of California Building Code, CCR, Title 24, Part 2, Sections 1203 and Chapter 14.1. Air Quality and Exhaust 5.506.1 Outside air delivery. For mechanically or naturally ventilated spaces in buildings, meet the minimum requirements of Section 121 of the California ❑ ❑ Energy Code, CCR, Title 24, Part 6 and Chapter 4 of CCR, Title 8 or the applicable local code, whichever is more stringent.' 5.506.2 Carbon dioxide (CO2) monitoring. For buildings equipped with demand control ventilation, CO2 sensors and ventilation controls shall be ❑ ❑ specified and installed in accordance with the requirements of the latest edition of the California Energy Code, CCR, Title 24, Part 6, Section 121(c).' Environmental Comfort 5.507.4 Acoustical control. Employ building assemblies and components 0 ❑ with STC values determined in accordance with ASTM E 90 and ASTM E 413. 5.507.4.1 Exterior noise transmission. Wall and floor -ceiling assemblies making up the building envelope shall have an STC of at least 50 and exterior windows shall have a minimum STC of 30 for any of the building ❑X ❑ locations listed in Items 1 through 3 in Section 5.507.5.1. 5.507.4.2 Interior sound. Wall and floor -ceiling assemblies separating tenant spaces and tenant spaces and public places shall have an STC of ❑ ❑ at least 40. page 7 of 9 CalGreen Non-lZes Checklist.doc revised 01/23/14 5.410.2.1 Owner's Project Requirements (OPR). Documented before the design phase of the project begins the OPR shall include items listed in © ❑ Section 5.410.4. 5.410.2.2 Basis of Design (SOD), A written explanation of how the design of the building systems meets the OPR shall be completed at the design phase of the building project and updated periodically to cover the systems ❑X ❑ listed in Section 5.410.2.2. 5.410.2.3 Commissioning plan. A commissioning plan describing how the project will be commissioned shall be started during the design phase of ❑ the building project and shall include items listed in Section 5.410.2.3. 5.410.2.4 Functional performance testing. Functional performance testing shall demonstrate the correct installation and operation of each component, system and system -to -system interface in accordance with the ❑X ❑ approved plans and specifications. 5.410.2.5 Documentation and training. A Systems manual and systems operations training are required. 0 ❑ 5.410.2.5.1 Systems manual. The systems manual shall be delivered to the building owner or representative and facilities operator and shall ❑X ❑ include the items listed in Section 5.410.2.5.1. 5.410.2.5.2 Systems operations training. The training of the appropriate maintenance staff for each equipment type andlor system ❑ ❑ shall include items listed in Section 5.410.2.5.2. 5.410.2.6 Commissioning report. A complete report of commissioning process activities undertaken through the design, construction and El recommendations for post -construction phases of the building project shall be completed and provided to the owner or representative. 5.410.4 Testing and adjusting. Testing and adjusting of systems shall be required for buildings less than 10,000 square feet or new systems to serve an addition or alteration subject to Section 303.1. 5.410.4.2 Systems. Develop a written plan of procedures for testing and adjusting systems. Systems to be included for testing and adjusting shall include, as applicable to the project, the systems listed in Section © ❑ 5.410.3.2. 5.410.4.3 Procedures. Perform testing and adjusting procedures in accordance with industry best practices and applicable national standards El El each system. 5.410.4.3.1 HVAC balancing. Before a new space -conditioning system serving a building or space is operated for normal use, the system should be balanced in accordance with the procedures defined by 0 ❑ national standards listed in Section 5.410.3.3.1. 5.410.4.4 Reporting. After completion of testing, adjusting and balancing, provide a final report of testing signed by the individual responsible foruX- ❑ performing these services. 5.410.4.5 Operation and maintenance manual. Provide the building owner with detailed operating and maintenance instructions and copies of ❑ guaranties/warranties for each system prior to final inspection. 5.410.4.5.1 Inspections and reports. Include a copy of all inspection ❑ verifications and reports required by the enforcing agency. Page 5 of 9 CalGreen Non -Res Checklist doc remised 01/23/14 Outdoor Air Quality 5.508.1 Ozone depletion and greenhouse gas reductions. Installations of HVAC, refrigeration and fire suppression equipment shall comply with Sections 5.508.1,1 and 5.508.1,2. 5.508.1.1 Chlorofluorocarbons (CFCs). Install HVAC and refrigeration equipment that does not contain CFCs, 5.508.1.2 Halons. Install fire suppression equipment that does not contain ❑ Halons. Page 8 0r9 CalGreen Afon-Res Checkllsf.docrevised 01/23/14 CALGREEN SIGNATURE DECLARATIONS Project Name: %ryE rou/-, 7— 2 Project Address: 200 30 g f'f yENS GREEK13Gt�4, i JPetz7-J V0 , GA 01501 y Project Description: INTEAtaR 7: f. Fox NfW RE;r,+r)24Nr wiry Raiz �- Pari© 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 adopt by the City pf Cupertino. Owner i„ ature � Date owner's a'� . me (P Print) ign Pr. e `oT--s Signa rs Date Design#' e,, ion ame (pie e Print) ,ell_ 5 - ZIL nahatr3 f w- rse P ?fession responsible for CalGreen compliance Date Narne of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION I Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 12 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 2093 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone r License Professional responsible for CalGreen compliance Page 9 of 9 CalGreen Nora -Res Checklist doc revised 01173114 CALGREEN NON-RESIDENTIAL CHECKLIST — MANDATORY ITEMS41U14' JO COMMUNITY DEVELOPMENT DEPAR G I l IONOpy13 C CVPERTINO ALBERT SALVADOR, P.E., C.B.O., BUF 10300 TORRE AVENUE - CUPERTINO, CA 9501 (408) 777-3228 - FAX (408) 777-3333 s buildinadcu41 PURPOSE: �''�'rt e� ��%f �/% The non-residential provisions of the 2013 CalGreen Code outline planning, design and ent meifiyC0 that include environmentally responsible site selection, building design, building siting and development to protect, restore and enhance the environmental quality of the site and respect the integrity of adjacent properties; establishes the means of conserving water used indoors, outdoors and in wastewater conveyance; outlines means of achieving material conservation and resource efficiency; and outlines means of reducing the quantity of air contaminants. Project Name: Project Address: Project Description: /Nr&AraA r For wow 9P6r40,Q,4,yr wf 43AA v- PATZQ Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2013 California Green Building Standards Codes to verify and assure that all required work described herein Is property 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. Page 1 of 9 11 V\ CalCreen Noir-Rar Checklist.doc revised 01,123114 4p, , Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Re utrements CHAPTER 5 — NONRESIDENTIAL MANDATORYMEASURES General Requirements The project meets ail the requirements of Divisions 5.101 through 5.508. Division • AND DESIGN Planning and Design - Site Development 5.106.4 Storm water pollution prevention. For projects of one acre or less, VIA develop a Storm Water Pollution Prevention Plan (SWPPP) that has been �/ designed, specific to its site, conforming to the State Storm water NPDES Construction Permit or local ordinance, whichever is stricter, as is required for XD projects over one acne. The plan should cover prevention of soil loss by storm water run-off and/or wind erosion, of sedimentation and/or of dust/particulate matter air pollution. Page 1 of 9 11 V\ CalCreen Noir-Rar Checklist.doc revised 01,123114 4p, , 5.106A Bicycle parking. Comply with Sections 5.106.4.1 and 5.106.4.2; or local is Q meet ordinance, whichever stricter. 5.106.4.1.1 Short -Tenn bicycle parking. If the qualified project is anticipated to generate visitor traffic, provide permanently anchored bicycle racks within 200 feet of the visitors' entrance, readily visible to passers-by, © for 5 percent of visitor motorized vehicle parking spaces being added, with a minimum of one two -bike capacity rack 5.106.4.1.2 Long Term bicycle parking. For qualified buildings with over !_ tdlQr I� 10 tenant -occupants, provide secure bicycle parking for 5 percent of tenant vehicle parking spaces being added, with a minimum of one space. 5.106.5.2 Designated parking. Provide designated parking for any combination of low -emitting, fuel-efficient and carpool/van pool vehicles as shown in Tape 5.106.5.2. 5.106.8 Light pollution reduction. Outdoor lighting systems shall be designed and installed to comply with the following: 1. The minimum requirements in the California Energy Code for fighting zones 1 — 4 as defined in Chapter 10 of the Califomie Administrable Code; and 2. Backlight, Uplight and Glare (BUG) ratings as defined in IES TM -15-11; and 3. Allowable BUG rating not exceeding those shown in Table 5.106.8, or �f Comply with a local ordinance lawfully enacted pursuant to Section 101.7, whichever is more stringent." 5.108.10 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how ❑X n4a site grading or a drainage system will manage all surface water flows. . Division Performance Requirements 5.201.1 Scope. The California Energy Commission will continue to adopt u mandatory building standards. Division` EFFICIENCY AND CONSERVATION lndorar Water Use 5.303.1 Meters. Separate meters shall be installed for the uses described in Sections 503.1.1 and 503.1.2. 6.303.1.1 New building or additions in excess of 50,000 square feet. Separate submeters shall be installed as follows: 1. For each individual leased, rented or other tenant space within the ®/ I building projected to consume more than 100 gal/day. 2. Where separate submeters are unfeasible, for water supplied to the following systems: a. Makeup water for cooling towers where flow through is greater than 500 gem. b. Makeup water for evaporative coolers greater than 6 9em. c. Steam and hot-water boilers with energy input > 500,000 Btulh. Page 2 of 9 CalGreen iVon-Res Cheeldisi.doc revised 01/23/14 J 5.303.1.2 Excess consumption. A separate submeter shall be provided for any tenant within a new building or within an addition that is projected ® �� to consume > 1,000 gal/day. 5.303.2 Water reduction. Plumbing fixtures shall meet the maximum flow rate OX values shown in Table 5.303.2.3. Exception: Building that demonstrate 20 -percent overall water use reduction. 5.803.2.1 Areas of addition or alteration. For those occupancies within the authority of the California Building Standards Commission, as specified in Section 103, the provisions of Section 5.303.2 and Section 5.303.3 shall ® LK apply to new fixtures in additions or areas of alterations to the buildings. 5.303,4 !Wastewater reduction. Each building shall reduce by 20 percent wastewater by one of the following methods: 1. The installation of water -conserving fixtures or Utilizing non -potable water systems. ® V/52. Q4;./A- 5.303.6 .303.6 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed In accordance with the California Plumbing Code (CPC), and shall meet the applicable standards referenced in CPC Table 1401.1 and CalGreen Chapter 6. Outdoor Water Use 5.304.1 Water budget. A water budget shall be developed for landscape irrigation use. 5.304.2 Outdoor potable water use. For new water service or for addition or alteration requiring upgraded water service for landscaped areas of at least 1,000 sq.ft. but not more than 5,000 sq.ft., separate submeters or metering devices shall be installed for outdoor potable water use. / v 5.314.3 Irrigation design. In new nonresidential construction or building addition or alteration with at least 1,000 but not more than 2,500 sq.ft, of cumulative landscaped area, install irrigation controllers and sensors which include the following criteria, and meet manufacturer's recommendations. 5.304.3.1 Irrigation controllers. Automatic irrigation system controllers installed at the time of final inspection shall comply with the following: 1. Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as QX weather conditions change. J �� 2. Weather -based controllers without integral rain sensors or \,K y communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicates YYY with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. Weather Resistance and Moisture Management 5.407.1 Weather protection. Provide a weather -resistant exterior wall and foundation envelope as required by Califomia Building Code Section 1403.2 and California Energy Code section 150, manufacturer's installation instructions or local ordinance, whichever is more stringent' Page 3 of 9 CalGiven A'on Res Ckceklist.doc revised 01/2.3/14 M laalw� ".1 5.407.2 Moisture control. Employ moisture control measures by the following methods; 5.407.2.1 Sprinklers. Prevent irrigation spray on structures. ® }� 5.407.2.2 Entries and openings. Design exterior entries and/or openings to prevent water Intrusion Into buildings. 5.407.2.2.9 Exterior door protection. Primary exterior entries shall be covered to prevent water intrusion by using nonabsorbent floor and n j' wall finishes within at least 2 ft around and perpendicular to such openings plus at least one of the following: j 1. An installed awning at least 4 ft in depth. 2. The door is protected by a roof overhang at least 4 ft in depth. 3. The door is recessed at least 4 ft. 4. Other methods which provide equivalent protection. 5.407.2.2.2 Flashing. Install flashings integrated with a drainage ® ' d plane, Construction Waste Reduction, Disposal and Recycling 6.408.1 Construction waste management. Recycle and/or salvage for reuse a minimum of 50 percent of the nonhazardous construction and demolition �/ waste in accordance with Section 5.408.1.1, 5.408.1.2, or 5.408.1.3; or meet a ® local construction and demolition waste management ordinance, whichever is more stringent. 5.406.1.1 Construction waste management plan. Submit plan per this% section to enforcement authority. 5.406.1.2 Waste management company. Utilize a waste management company that can provide verifiable documentation that the percentage of construction and demolition waste material diverted from the landfill [L complies with CalGreen Section 5.408. 5.408.1.3 Waste stream reduction alternative. The combined weight of new construction disposal that does not exceed two pounds per square l+� foot of building area may be deemed to meet the 50 percent minimum requirement as approved by the enforcing agency. 5.408.1.4 Documentation. Provide documentation of the waste management plan that meets the requirements listed in Section 5.408.1.1 through 5.408.1.3. 5.408.3 Excavation gnil and land clearing debris. 100 percent of trees, stumps, rocks and associated vegetation and soils resulting primarily from land ® m-'/44 clearing shall be reused or recycled. Building Maintenance and Operation 5.410.1 Recycling by occupants. Provide readily accessible areas that serve the entire building and are Identified for the depositing, storage and collection of nonhazardous materials for recycling, 5.410.2 Commissioning. For new buildings 10,000 square feet and over, 1 building commissioning for all building systems covered by T24, Part 6, process systems and renewable energy systems shall be included in the design and construction processes of the building project. Commissioning requirements shall include items listed in Section 5.410.2. Page 4 of 9 CalCreen Aeon -Res Ckecklkrdoc revised 01123114 VA f�. P&J, i'%I K- 9 5.410.2.1 Owner's Project Requirements (OPR). Documented before the design phase of the project begins the OPR shall include items listed in Section 5.410.4. 5.410.2.2 Basis of Design (SOD). A written explanation of how the design of the building systems meets the OPR shall be completed at the design phase of the building project and updated periodically to cover the systems fisted in Section 5.410.2.2. 5.410.23 Commissioning plan. A commissioning plan describing how the projext will be commissioned shall be started during the design phase of the building project and shall include items listed in Section 5.410.2.3, 5.410.2.4 Functional performance testing. Functional performance testing shall demonstrate the correct installation and operation of each component, system and system -to -system interface in accordance with the approved pians and specifications. 5.410.2.5 Documentation and training. A Systems manual and systems operations training are required. 5.410.2.6.1 Systems manual. The systems manual shall be delivered to the building owner or representative and facilities operator and shall include the items listed in Section 5.410.2.5.1. 5.410.2.5.2 Systems operations training. The training of the appropriate maintenance staff for each equipment type and/or system shall include items listed in Section 5.410.2.5.2. 5.410.2.6 Commissioning report. A complete report of commissioning process activities undertaken through the design, construction and reporting recommendations for post -construction phases of the building project shall be completed and provided to the owner or representative. 5.410.4 Testing and adjusting. Testing and adjusting of systems shall be required for buildings less than 10,000 square feet or new systems to serve an addition or alteration subject to Section 303.1. 5.410.42 Systems. Develop a written plan of procedures for testing and adjusting systems. Systems to be Included for testing and adjusting shall include, as applicable to the project, the systems listed in Section 5.410.3.2. 5.410.4.3 Procedures. Perform testing and adjusting procedures in accordance with industry best practices and applicable national standards on each system. 5.410.4.3.1 HVAC balancing. Before a new space -conditioning system serving a building or space is operated for normal use, the system should be balanced in accordance with the procedures defined by national standards listed in Section 5.410.3.3.1. 5.410.4.4 Reporting. After completion of testing, adjusting and balancing, provide a final report of testing signed by the individual responsible for performing these services. 5.410.4.5 Operation and maintenance manual. Provide the building owner with detailed operating and maintenance instructions and copies of guarantlesiwarranties for each system prior to final inspection. 5.410.4.5.1 Inspections and reports. Include a copy of all inspection verifications and reports required by the enforcing agency. E 0 A 0 0 6 23 7M 70, L l n Page 5 of 9 CalGrcen Non -Res Checklisl.doc revised 01/23114 Fireplaces 6.603.1 Install only a direct -vent sealed -combustion gas or sealed wood- buming fireplace or a sealed woodstove and refer to residential requirements in the California Energy Code, Title 24, Part 6, Subchapter 7, Section 150. 5.503.1.1 Woodstoves. Woodstoves shall comply with US EPA Phase II emission limits. Pollutant Control 5.504.3 Covering of duct openings and protection of mechanical equipment during construction. At the time of rough installation or during storage on the construction site and until final startup of the heating and cooling equipment, all duct and other related air distribution component �X openings shall be covered with tape, plastic, sheet metal or other methods w j acceptable to the enforcing agency to reduce the amount of dust or debris �_rj�'j•�/ which may collect in the system. 5.504.4 Finish material pollutant control. Finish materials shall comply with Sections 5.504.4.1 through 5.504.4.4. 6.604.4.1 Adhesives, sealants, caulks. Adhesives and sealants used on the project shall meet the requirements of the following standards. 1. Adhesives, adhesive bonding primers, adhesive primers, sealants, sealant primers and caulks shall comply with local or regional air pollution control or air quality management district rules where applicable or SCAQMD Rule 1168 VOC limits, as shown in Tables 5.504.4.1 and 5.604.4.2. � 2. Aerosol adhesives and smaller unit sizes of adhesives and sealant or caulking compounds (in units of product, less packaging, which do not weigh more than one pound and do not consist of more than 16 fluid ounces) shall comply with statewide VOC standards and other requirements, including prohibitions on use of certain toxic compounds, of California Code of Regufations, Title 17, commencing with Section 94507. ��✓ 5.504.4.3 Paints and coatings. Architectural paints and coatings shall comply with Table 5.504.4.3 unless more stringent local limits apply. rX 5,504.4.3.1 Aerosol paints and coatings. Aerosol paints and coatings shall meet the Product -Weighted MIR Limits for ROC in Section 94522(a)(3) and other requirements, including prohibitions on use of certain toxic compounds and ozone depleting substances (CCR, Title 17, Section 94520 et seq). 6.604.4.3.2 Verification. Verification of compliance with this section shall be provided at the request of the enforcing agency. [X] [� 5.504.4.4 Carpet systems. All carpet installed in the building interior shall meet the testing and product requirements of at least one of the standards listed in Section 5.504.4.4. 5.504.4.4.1 Carpet cushion. All carpet cushion installed in the building interior shall meet the requirements of the Carpet and Rug Institute Green Label program. 5.504.4.4.2 Carpet adhesive. All carpet adhesive shall meet the requirements of Table 5.504.4.1. C7X Page 6 of 9 C&Green li=on -Res Checklis[.doc revised 01/23/14 5.604.4.6 Composite wood products. Hardwood plywood, particleboard and medium density fiberboard composite wood products used on the interior or exterior of the building shall meet the requirements for 19 formaldehyde as specified in Table 5.504.4.5. 5.504.4.6.3 Documentation. Verification of compliance with this section rry U641shell be provided as requested by the enforcing agency. Documentation shall include at least one of the following standards listed in Section 5.504.5.3. 5.504.4.6 Resilient flooring systems. For 80 percent of floor area receiving resilient flooring, installed resilient flooring shall meet at least one X of the following standards listed in Section 5.504.4.6. 5.504.5.3 Filters. In mechanically ventilated buildings, provide regularly occupied areas of the building with air filtration media for outside and return air prior to occupancy that provides at least a MERV of 8. ddd 5.504.7 Environmental tobacco smoke (ETS) control. Prohibit smoking within 26 feet of building entries, outdoor air intakes and operable windows where outdoor areas are provided for smoking and in buildings; or as enforced by ordinances, regulations or policies of any city, county, city and county, California Community College, campus of the California State University or campus of the University of California, whichever are more stringent. Indoor Moisture and Radon Control 5.505.9 Indoor moisture control. Buildings shall meet or exceed the provisions of Califomia Building Code, CCR, Title 24, Part 2, Sections 1203 and Chapter 14.1. Air Quality and Exhaust 5.506.9 Outside air delivery. For mechanically or naturally ventilated spaces in buildings, meet the minimum requirements of Section 121 of the Califomia ® �/ Energy Code, CCR, Title 24, Part 6 and Chapter 4 of CCR, Title B or the applicable local code, whichever is more stringent,' 5.506.2 Carbon dioxide (CO2) monitoring. For buildings equipped with demand control ventilation, CO2 sensors and ventilation controls shall be specified and installed in accordance with the requirements of the latest edition of the Califomia Enefgy Code, CCR, Title 24, Part 6, Section 121(c).' Environmental Comfort 5.507A Acoustical control. Employ building assemblies and components ❑ with STC values determined in accordance with ASTM E 90 and ASTM E 413. 5.507.4.1 Exterior noise transmission_ Wall and floor-ceiling assemblies making up the building envelope shall have an STC of at least 50 and exterior windows shall have a minimum STC of 30 for any of the building locations listed in Items 1 through 3 in Section 5.507.5.1. 5.507.4.2 Interior sound. Wall and floor-ceiling assemblies separating tenant spaces and tenant spaces and public places shall have an STC of at least 40. Page 7 of 9 Cn1Grcon Non -Res Checkfistdoc revised 01/23/14 Outdoor Air Quality 5.508.1 Ozone depletion and greenhouse gas reductions. Installations of HVAC, refrigeration and fire suppression equipment shall comply with Sections 5.508.1.1 and 5.508.1.2. 5.508.1.1 Chlorofluorocarbons (CFCs). Install HVAC and refrigeration ®/ equipment that does not contain CFCs. 5.508.1.2 Halons. install fire suppression equipment that does not contain Halons. X ❑ Ail r4,m5 lh��)i4,cy,/ zv� `fn` `r' ajr'&-,d p,�,s anal 4..K h,,, %4tnnueln 5p� qwt, C446, we '0� Paw - ZA//-5- <�.'4 "7 Z�"AVe2 xre Page 8 of 9 Ca1Green Non -Res Check(ikdoc revised 01123114 CALGREEN SIGNATURE DECLARATIONS Project Name: THE Gault+ M 2 Project Address: 20030 sri'VENS COABEK BLVD. Cdh'tRTi/vo, CA 95014 Project Description: 11MAJOA 1' . 1. Fog NEW 9ES6+002 FNT woW J1,14 0' P r/a SECTION i — DESIGN VERIFICATION Complete all lines of Section 1— "Design Verification" and submit the completed eheeldist (Colurrms 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 projec in acoordance with the requirements set forth in the 2013 California Green Building Standards Code as adopt by the City pf Cupertino. t , Date ase Print) Data Design ion ams (Pl?-4de Print) !` ter':=` _ --- S - _ZI • .0 5 signature ale Ptofess ondl responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone _w---- Ernail 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 wa structed in accordance with this Green building Checklist and in accordance with the requirements of the 2 alif 1 Gree ing Standards Code as adopted by the City of Cupertino. q +gnat nse Proles anal responsible for CalGreen compliance Date SC2- 20C. ;tp2o Name of Llcense Professional responsible for CalGreen compliance (Please Print) Phone Email itUldress for IJcons'a Professional reeponslble for CalGreen compliance Page 9 or 9 CalGreen Non -Res ChecWxt.doc mrixed 01113/14