B-2016-3164 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B=2016-3164
10251 VICKSBURG DR CUPERTINO,CA 95014-3358(369 07 012) LYNSTAR
ENTERPRISES INC
SAN JOSE,CA 95112
OWNER'S NAME: DATE ISSUED:11/23/2016
OWNER'S PHONE: PHONE NO:(
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lic.#563773
Contractor LYNSTAR ENTERPRISES INC Date 04/30/2017 X BLDG _ELECT X PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing — — —
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
RELOCATE SEWER LINE CLEAN OUT
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
,-'performance of the work for which this permit is issued.
issued. Sq.Ft Floor Area: Valuation:$1500.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 07 012
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant unde nds and will comply with all non-point
source regula'ons per C pert' o Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION..
Signature, Date 11/23/2016 Issued by:AbbyAyende
Date: 11/23/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/23/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a);should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quail . anagement District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the C pertino Muni al CO.e,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, ' ctions 2 I,.,25533, nd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent' ._ �►
APPLICANT CERTIFICATION Date:11/23/2016
I certify that I have read this application and state that the above information is CONSTRUCTION
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 11/23/2016 Professional
CITY OF CUPERTINO BUILDING PERMIT
10251. VICKSBURG DR CUPERTINO, CA 95014-3358 (369 07 012)
CERPRISES INC.
SOUTH 15TH
tEET SAN JOSE, CA
12
B-2016-1146
OWNER'S NAME: SIGLER ROBERT D AND MARIA D I I DATE ISSUED: 02/05/2016
plifliffflUm
License Class )3 Lie. #553773
Contractor LYNSTAR ENTERPRISES INC. Date 2/5/2016
hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
ith Section 7000) of Division 3 of the Business & Professions Code and that my
tense is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
3. I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for
by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
hformation is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and hereby
uthorize representatives of this city to enter upon the above mentioned
roperty for inspection purposes. (We) agree to save indemnify and keep
armless the City of Cupertino against liabilities, judgments, costs, and
xpenses which may accrue against said City In consequence of the
ranting of this permit. Additionally, the applicant understands and will
omply with all rrt�on-paint source regulations per the Cupertino Municipal
de, ;oSection N8. ,, f
21512016
eby affirm that I am exempt from the Contractor's License Low for one of the
ving two reasons:
a. I, as owner of the properly, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Sce.7044, Business & Professions Code)
e. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the fallowing three declarations:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, w provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1. 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.
3. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
understands and will comply with all non -point source regulations per the
Cupertino Municipal Code, Section 9.18.
PHONE NO: 408-280-1848
PERMIT INFO:
BLDG —ELECT —PLUMB
MECH X RESIDENTIAL— COMMERCIAL
DESCRIPTION:
to master suite (198 SF); remodel to master suite (250 SF)
Ft Floor Area: I Valuation: $60000.00
APN Number: Occupancy Type:
369 07 Ol2 Deferred Submittal (11-3),Defencd Submittal (R-
3),Deferred Submittal (R-3),Deferred Submittal (R-
3),Deferred Submittal (R-3),Deferred Submittal (R-
3),Deferred Submittal (R-3),Deferred Submittal (R-
3),Defen'ed Submittal (R-3),Deferred Submittal (R-
3),Deferred Submittal (R-3)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
hs:1 8 i W ULU v.�,l '
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
2016
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I wild
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as deflned by the Bay Area Alr Quality Management District I
will maintain compliance with the Cupertino Municipa ode, Chapter 9.12 and
the Health & Safety Code, ctions 25 5, 5331arnd 25534,
)wner or authorized agent: VV
)ate: 21512016
hereby affirm that there Is a construction lending agency for the performance
f work's for which this permit is issued (Sec. 3097, Civ C.)
ender's Name
Address
CUPERTINO
CALGREEN RESIDENTIAL CHECKLIST - MANDATORY
ITEMS
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(fcupertino.org
PURPOSE: F I
The 2013 CalGreen Code applies to additions or alterations of existing res a bul 1I�g a the ddition
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: dt 4zt—y- Jr oC�1 V(, r2�
Project Address
Project Description: �t2vh jc C �ln c 1 Vritz�+2Y
Instructions:
` -n v (i e_U
6'"1
1. The Owner or the Owners 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
Reauirements
4.106.2 Storm water drainage and retention during construction. A plan is ❑
developed and implemented to manage storm water drainage during Ef
construction.
4.106.3 Grading and paving. The site shall be planned and developed to
keep surface water away from buildings. Construction plans shall indicate how
site grading or a drainage system will manage all surface water flows.
BY
Page 1 of 5 CalGreen_2014.doe revised 11104114
N4
NR-
P r
A4.2 ENERGY EFFICIENCY
s -
Gen�ra.�
4.201.1 Low-rise residential buildings shall meet or exceed the minimum
ti
standard design required by the California Energy Standards.
A4.3 WATER EFFICIENCY AND • •
IridOOY 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:
th
IJ 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
pecifications for Tank -type Toilets.
4.303.1.3.2 Urinals. The effective flush volume of urinals shall not
exceed 0.5 gallons per flush.
IR/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
ecification 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
_/
❑
to allow only one shower outlet to be in operation at a time.
/designed
I 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.
)Y,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,
ram'
u
and shall meet the applicable standards referenced in Table 1401.1 of the
California Plumbing Code.
Page 2 of 5
CalGreen 2014.doc revised 11104114
4.304.1 Irrigation controllers. Automatic irrigation systems installed at the
time of final inspection shall be weather -based.
Lvl 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. ❑
t,PI 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.
4.406.1 Rodent proofing. Annular spaces around pipes, electric cables,
conduits, or other openings in plates at exterior walls shall be protected ❑
against the passage of rodents by closing such openings with cement mortar,
concrete masonry or similar method acceptable to the enforcing agency.
4.408.2 Construction waste management plan. Where a local jurisdiction /
does not have a construction and demolition waste management ordinance, a 1-7� ❑
construction waste management plan shall be submitted for approval to the u
enforcing agency.
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. N A
4.503.1 General. Install only a direct -vent sealed -combustion gas or sealed
wood -burning fireplace, or a sealed woodstove. lop ❑
4.504.1 Covering of duct openings and protection of mechanical / El
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 n( ❑
shall be compliant with VOC and other toxic compound limits. uu
4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be ❑
compliant with VOC limits. ff
4.504.2.3 Aerosol paints and coatings. Aerosol paints and other coatings ❑
shall be compliant with product weighted MIR Limits for ROC and other toxic
compounds.
Page 3 of 5 CalGreen_2014.doc revised 11104114
4.504.2.4 Verification. Documentation shall be provided to verify that r�(
compliant VOC limit finish materials have been used. E
4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with t7(
VOC limits.
4.504.4 Resilient flooring systems. Eighty (80) percent of floor area
receiving resilient flooring shall comply with the VOC-emission limits defined in ❑
the Collaborative for High Performance Schools (CHPS) Low -emitting
Materials List or be certified under the Resilient Floor Covering Institute (RCFI)
FloorScore program.
4.504.5 Composite wood products. Particleboard, medium density / ❑
fiberboard (MDF), and hardwood plywood used in interior finish systems shall �y
comply with low formaldehyde emission standards.
4.505.2 Concrete slab foundation. Required vapor retarders and capillary { r
breaks are also required to comply with CalGreen Section 4.505.2.1. E
4.505.3 Moisture content of building materials. Moisture content of building �j
materials used in wall and floor framing is checked before enclosure, uu
4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the r-r�
building are provided in every bathroom. IJ
4.507.2. Duct systems are sized and designed and equipment is selected
using the following methods:
1. Establish heat loss and heat gain values according to ACCA Manual J or
equivalent.
2. Size duct systems according to ACCA 29-D (Manual D) or equivalent.
3. Select heating and cooling equipment according to ACCA 36-S (Manual S)
or equivalent.
702.1 Installer training. HVAC system installers are trained and certified in
the proper installation of HVAC systems.
702.2 Special inspection. The Licensed Professional responsible to verify ❑
CALGreen compliance is qualified and able to demonstrate competence in the
discipline they inspect and verify.
703.1 Documentation. Verification of compliance with CALGreen may
include construction documents, plans, specifications, builder or installer
certification, inspection reports, or other methods acceptable to the enforcing
agency which show substantial conformance. Implementation verification shall
be submitted to the Building Department after implementation of all required
measures and prior to final inspection approval.
Page 4 of 5 CalGreen_2014.doe revised 11104/14
CALGREEN SIGNATURE DECLARATIONS
Project Name:
Project Address
Project Description:
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
adop by the City of Cu no.
6 l� 1lP
Owner's SS'nnature Da e
l�vlra, J2-v- S> t e r-
Owner's Name (Please Print)
Design Professional's Signature Date
l"A6 O LcOVnjopw e
Design Prnfeaci—"c hi---
5
Signature o License rofess' a responsible for CalGreen compliance Date
S ^S
Name license (�rofessi I responsible for CalGreen compliance (Please Print) Phone
`lam A Oki
Email Address for License P e ional resp nsible for CaIGr en compliance
�..
2 — IMPLEMENTATION VERIFICATION
Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section
2 to the Building Department prior to Building Department final inspection.
I have inspected the work and have received sufficient documentation to verify and certify that the project identified
above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of
the 2013 California Green Building Standards Code as adopted by the City of Cupertino.
Signature of License Professional responsible for CalGreen compliance Date
Name of License Professional responsible for CalGreen compliance (Please Print) Phone
Page 5 of 5 CalGreen_2014.doe revised 11104114