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14040049CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10370 PALO VISTA RD CONTRACTOR: NEW WORLD BUILDER PERMIT NO: 14040049 OWNER'S NAME: GERARD PALLIPURAM 1196 BRANDYBOOD WAY DATE ISSUED: 07/[5/2014 OWNER'S PHONE: 4087778275 SAN JOSE, CA 95121 PHONE NO: (408) 472 -3692 LICENSED CON'TRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ ADD 491 S.F. (INCLUDING GARAGE CONVERSION 54 S.F.) License Classil7 Lic. # 3 TO ENLARGE (E) KITCHEN AND CREATE (N) MASTER �� / BDRM. Contractor [REMODEL & RECONFIGURE (E) 868 S.F. ADD 82 S.F OF I I hereby affirm that 1 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. 1 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: $160000 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: 35702051.00 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 1 RMIT 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 CALLED INSPECTION. indemnify and keep harmless the City of Cupertino ino a ty ainst liabilities, Judgments costs, and expenses which may accrue a g ainst said City in conse q uence of the _ this Permit. Additionally, applicant understands and will co ue __Rate.: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date �I RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. ❑ OWNER- BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of ..._...._ .............._........_._..... the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(x) should I store or handle hazardous I have and will maintain a Certificate of Consent to self - insure for Worker's material. Additionally, should 1 use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Dat _ 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. I(. 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 _ CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building Qcupertino.org tCUPERTIN – � O � I NFW C`nN:STRI IC'TT(1 \IY I N Ah1lTTTnN F AT TFR ATICIN /TT I I RFVTSTCIN /IIFFFRRFII ORVIUNIA1 PFRMITB P jJ DDRESS , APN 3j• k r — O )–_ TER NAME F � N M' PHON 409 82 E -MAIL G' NKBe! _L.1 l!rA -'LAY rbd STREET ADD CITY, STA. ZIP FAX CO ACT NAME HON�r E -MAIL STRE ADDRESS CITY, S ATE, IP FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC k COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGMEER NANTE CENSE NUMBER BUS. LIC k , COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK % t-4- COT-1 A/�7 V4. Abi*�, -C&O a EXIM14G USE PROPOSIED USE C NSTR TYPq d STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL //II W � AREA AREA AREA NET AREA BATHROOM K1TC OTHER REMODEL AREA REMOD L AREA ( REMODEL AREA ' PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH []ATTACH kDWE ING UNITS: ISASECONDUTAT Y ES SECOND TORY E] YES BEING ADDED? RNO ADDITION? wo PRE- APPLICATION ❑ 1'ES IF YES, PROVIDE COPY OF IS THE BLDG ANES RECEIVED BY / TOTAL VALUATION: PLANNING APPL k ❑ NO PLANTING APPROVAL LETTER EICHLER HOME? 1'0 / ° ' b17- 0 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating it 'ng construction. uthorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature ofApplicandAgent Date: V SUPPLEMENTAL INFORMATIO REQUIRED PL K,,T PE ,,,ROUTINC�`SI:IP C7 C�] Buu.DtNGPLAN vcEw New SFD Or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building oYER TH�c�,uN�ER o permit for new building. ❑ /Ea�Ra ss / ; �/' Q /PiANNXNPL'RkvIEW % / ; Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Q " TAlvnnxn �' f d PUBIIG yvaRKS key /�� form if any Hazardous Materials are being used as part of this project. ��, ° ❑ LARGE / 3, C FIRE DEPT/ Copy of Planning Approval Letter or Meeting with Planning prior to '; /� /yl 1 ( f �% l /� � rI / �, r, � � /��ty 11 /�% {I %O /y�Mf�✓� �lP +�� l/ / � �� U �s ❑ ,�YIAJbR ' I� SNITRYSE1PEf2D1STRICTr/ l submittal of Building Permit application. ° "'� / /'' "` `lvrnd>irn�ETA4'r'l�� B1dgApp_2011.doc revised 06/21/11 rew" % /1.Sj.i A CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10370 PALO VISTA RD DATE: 04/08/2014 REVIEWED BY: MELISSA PC FEE ID APN: 357 02 051 BP #: 0 'VALUATION: 1$160,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? • Yes No OTC? 0 Yes (F)No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK ADD 491 S.F. INCLUDING GARAGE CONVERSION 54 S.F. TO ENLARGE E KITCHEN AND SCOPE CREATE (N) MASTER BDRM. REMODEL & RECONFIGURE (E) 868 S.F. ADD 82 S.F OF PORCH OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Custom) II- B,111- B,IV,V -B 608 $2,577.00 IR3PLNCK $1,617.00 IR3INSP $0.00 PME Plan Check: $0.00 200 amps $47.00 Electrical IBELEC200 Services Permit Fee: $1,617.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 = s.f. Re -roof $160.00 IREROOFRES PME Unit Fee: $0.00 PME Permit Fee: $47.00 TOTALS: 608 $2,577.00 1 $1,617.00 MECH, HOURLY ®' Yes E) No PLUMB, HOURLY ® Yes E) No ELEC, HOURLY 0 Yes (F) No MISC ITEMS Elec. Plan Check 0.0 hrs $0.00 $2,577.00 FEIec. Permit Fee: IEPERMIT Remodel, Other IREMRESOTfl Other Elec. Insp. 0.0 hrs $47.00 NOTE: This estimate does not include fees clue to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolulion 11 -053 Eff 711!13) FEE QTY /FEE MISC ITEMS Plan Check Fee: $2,577.00 868 s.f. $558.00 Remodel, Other IREMRESOTfl Suppl. PC Fee: Q Reg. ®OT 0.0 hrs $0.00 PME Plan Check: $0.00 200 amps $47.00 Electrical IBELEC200 Services Permit Fee: $1,617.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 = s.f. Re -roof $160.00 IREROOFRES PME Unit Fee: $0.00 PME Permit Fee: $47.00 .. C G Work Without Permit? 0 Yes (j) No $0.00 Advanced Plannin& Fee: IPLLONGR $85.12 Select a Non - Residential Building or Structure G 0 i Travel Documentation Fee: ITRAVD0C $47.00 Strong Motion Fee: IBSEISMICR $16.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $7.00 SUBTOTALS: $4,396.12 $765.00 TOTAL FEE: $5,161.12 Revised: 04/01/2014 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408- 777 -3333 JOB ADDRESS: ,, � � �°� � # �� S NAME: �� OWNER'S PHONE # GENERAL CONTRACT BUSINESS L CENSE ADDRESS: ` 1" yo CITYIZIPCODE:5� � � ,H 1 *Our municipal code requires alTl�usinesses working4n the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signatutp,` Date Please check applicable subcontractors and cam following information: V ISUBCONTRACTOR BU E AME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation� Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile / Contractor Signature Date CUPE'RTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: PC4 Vt- ' PERMIT # V p U OWNER'S NAME: 9 C0 PHONE # '.O GENERAL CONTRACTOR: Q BUSINESS LICENSE # ADDRESS: 1196 404' w A ITY /ZIPCODE: *Our municipal code requires all- fsinesses working-M the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner rcontractor Signature rT (-- 2 - Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10370 PALO VISTA RD CONTRACTOR: NEW WORLD BUILDER PERMIT NO: 14040049 OWNER'S NAME: GERARD PALLIPURAM 1196 BRANDYBOOD WAY DATE ISSUED: 07/15/2014 OW ER'S PHONE: 4087778275 SAN JOSE, CA 95121 PHONE NO: (408) 472 -3692 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDEIN'TIAL COMMERCIAL ❑ ADD 491 S.F. (INCLUDING GARAGE CONVERSION 54 S.F.) License Class �Lic. TO ENLARGE (E) KITCHEN AND CREATE (N) MASTER Contractor} (; to Z1 BDRM. REMODEL & RECONFIGURE (E) 868 S.F. ADD 82 S.F OF I hereby affirm that I am licensed under the provisions of Chapter 9 REV # 1 - RELOCATE WATER HEATER & DOOR FROM GARAGE TO (commencing with Section 7000) of Division 3 of the Business & Professions DWELLING - ISSUED 10/15/14 Code and that my license is in full force and effect. 1 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: $160000 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: 35702051.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree comply with alla and county ordinances and stale to relating to building hereby authorize to WITHIN 180 DAYSfWTE"IT ISSUANCE OR construction, and representatives of this city on construction, enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS_ -ROM LAST — GALLED INSPECTION. 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 [Izis permit. Additionally, the applicant understands and will comply ued by n ""mow" � Dam with all non -point source regulations per the Cupertino Municipal Code, Section . � RE- ROOFS: Signature Date 2,41 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER - BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(x) should 1 store or handle hazardous 1 have and will maintain a Certificate of Consent to self - insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this - - / / Cy7l� 1% Date: permit is issued. Owner or authorized agent: C 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, f 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. CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building okupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROD J ' AL f (.+ APN N / 'T v cis ,•ADDRESS Y) )e OWNERNAME p I fLiPU PHONE Wig) r �j2 � E -MAIL /� ? !R a /#i ov, C� STREET ADDRESS CITY, STATE, ZIP FAX f O � :k) Cuairz' o CONTACT NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LI NS LICENS 1'PE BUS. LIC C? COMPANY NAME E -MAIL � FAX }�p {nom ( STREET D ESS CITY, STATLZIP� � P ONE 11 �/ , ARCHITECT/ENGTNEER NAME LICENSE NUMBER BUS. LIC R COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE CRIPTION OF WORK ;. A2 exa� / yLCZX, C�Wr t Pi rkAd y E PROPOSED USE CONSTR TYPE k 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 GARAGE AREA: DETACH ❑ ATTACH DWELLING AMTS: IS A SECOND UNIT ❑ YES SECOND STORY ]YES BEING.ADDED? NO ADDITION? ❑NO PRE - APPLICATION ❑ YES IF YES, PROVmE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY; A A ION' PLANTING APPL h ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO r% By my signature below, I certify to each of the following: I am the property owner or authorized agent to act property owner's behal . ve read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all app ordinance id state laws relating to uilding construction. I autiorize representatives of Cupertino to enntt the above - identified p opyerty for in eCtion purposes. G Signature of Applicant/Agent: Dath SUPPLEMENT INFORMATION RE UIRED Q "�AN CHECK TYPE ^ : t QTJTING`S IP ❑ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildi a ER THF- 4G01iNtER ; BL7LLDING PLAN REVIEW r permit for new building. rXPRESS ❑ PI,,NINCfPL RkVii Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ `' SrAa`DnIiD rr rrr r ❑ Prase IC Woxxs _ form if any Hazardous Materials are being used as part of this project. 1 0, Y.AR(rD ❑yFIRE.DEPT Copy of Planning Approval Letter or Meeting with Planning prior to , ❑ ❑ submittal of Building Permit application. , SAlv17A$Y S):WER` DIStRt�� e ❑,�NVIRONfiIEN1ALIIEAI,TH „<;�,; BldgApp_201 Ldoc revised 06121111 CALGREEN RESIDENTIAL CHECKLIST — MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION a - ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building Dcuperiino.org PURPOSE: The 2013 CalGreen Code applies to all newly constructed hotels, motels, lodging houses, dwellings, dormitories, condominiums, shelters, congregate residences, employee housing, factory-built housing and other types of swellings with sleeping accommodations and new accessory buildings associated with such uses. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: _ Iy 1V ITA 41:751 W Project Address: [0 10 1>A L 0 91I57A Tel-7-) CCAPEWTIV10 CA 95C(4 Project Description: _4ppmo4J 354 4 + CON (St' i�j—r Mj' L(J1(VV&( sy s1-44. Instructions: The Owner or the Owner's agent shall employ a licensed professional experienced with the California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. Prior to final inspection by the Bu;1,' ; ^^ =submit Co.iurnn 3 and sign and date Section 2 - Irr the completed form to the Building In A MANDATORY FEAT 4.106.2 Storm water drainage and ret( developed and implemented to manage construction, 4.106.3 Grading and paving. The site! _... __ r. ,,,,,,u U „u ucvatUpru to keep surface water away from buildings. Construction plans shall indicate I site grading or a drainage system will manage all surface water flows. Pagc I orS C016)-eca 2014.dnc'reii.%cd 01 ;.$'/” 4.201.1 Low -rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following: ❑ 4.303.1.3.2 Water Closets. The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank -type water closets shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank -type Toilets. ❑ 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. ❑ 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. ❑ 4.303.1.3.2 Multiple Showerheads serving one shower. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and /or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be ❑X designed to allow only one shower outlet to be in operation at a time. ❑ 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less than 0.8 gallons per minute at 20 psi. ❑ 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas (outside of dwellings or sleeping units) in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. ❑ 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. ❑ 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, and shall meet the applicable standards referenced in Table 1401.1 of the California Plumbing Code. Page 2 of CalGreen_20 14.doc remised 0l /15, 1'14 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the time of final inspection shall be weather-.based. ❑ 4.304.1.1 Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as weather conditions change. ❑ 4.304.1.2 Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. 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, El 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 construction waste management plan shall be submitted for approval to the 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. 4.503.1 General. Install only a direct -vent sealed- combustion gas or sealed wood - burning fireplace, or a sealed woodstove. ED I El 4.504.1 Covering of duct openings and protection of mechanical equipment during construction. Duct openings and other related air ❑X distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks ❑ shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be compliant with VOC limits. 11 ED 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 �X compounds. Page 3 of 5 CalGreen_2014.doc revised 01115;74 4.504.2.4 Verification. Documentation shall be provided to verify that ❑ El VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with ❑ El 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 ❑X ❑ 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 ❑X ❑ comply with low formaldehyde emission standards. 4.505.2 Concrete slab foundation. Required vapor retarders and capillary ❑ ❑ breaks are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture content of building ❑ El used in wall and floor framing is checked before enclosure. 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the ❑ ❑ building are provided in every bathroom. 4.507.2. Duct systems are sized and designed and equipment is selected using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or equivalent. 0 ❑ 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 ❑X ❑ 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 CalGreerr_2014.doc revised 01 15/14 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 adopted by the City of Cupertino. /xv14 Owner's Signature Date fNrt,Ll Owner's Name (Please Print) M. A (3 LC crz, L� Design Professional' nature Date Design Professional's ease Print) Signature of License Professional responsible for CalGreen compliance Date _ SLASAyt 04-e^--- Name of License Professi al responsible for CalGreen compliance (Please Print) Phone X ,sZ—MS/a ►JGch,UUP_ Cow^--- Email Address for License Professional responsible for CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 Ca1Gl'een_2014.doc revised 01 115/14