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14060034I CITY OF CUPERTINO BUILDING PERMIT I 1 BUILDING ADDRESS: 18601 STARRETT CT I CONTRACTOR: SAGE PROPERTY I PERMIT NO: 14060034 OWNER'S NAME: SAGE PROPERTY INVESTMENT LLC 1 19726 SAINT ANN CT I DATE ISSUED: 10/06/2014 1 OWNER'S PHONE: 4088212533 SARATOGA, CA 95070 1 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT (N) 2 STORY SFD (1877 S.F.) WITH License Class Lie. # ATTACHED GARAGE (416 S.F.) Contractor Date 1 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. 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 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 permit is issued. 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. Signature Date ld OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) j,.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 following three 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 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. d certify that in the performance of the work for which this permit is issued, 1 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, l 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. Signature Date 1 b I Sq. Ft Floor Area: I Valuation: 5340000 APN Number: 37526016.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS OM LAST CALLED INSPE TION. i Issued by: Date: 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. Signature of Appl Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25" 5, 25533, and 25534. / Owneror authorized agent: Date: �" 6 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Ad ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed Professional E CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildinq(c>cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS �� APN # .J^'? OWNER NAME l ZA ( 6TH J'7 L� E- MA�IL� STREET ADDRESS -!� C� CITY, STATE, ZIP �� FAX CONTACT NAME l� E 2 ,�r E -MAIL ��( / STREE�T /ADDRESS _ .{� CITY, STATE, ZIP FAX OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT XNGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME r LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS I CITY, STATE ZIP PHON DESCRIPTION OF WORK ^� V /7- EXISTING USE PROPOSED USE CONSTR. TYPE 4 STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL lq- AREA AREA 117-AW AREA NET ARE BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE A: DETACH ` ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT " YES SECONDS TORY E] YES BEING ADDED? E]NO ADDITION? []NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOT ,VALUATION: PLANNING APPL k ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO a�s ;:! By my signature below, I certify to each of the following: I am the property owner o uthorize ropy owner's behalf. I have read this application and the information I have provide is correct. I have read the Description of Work anccurate. gree to comply with all applicable local ordinances and state laws relating to bui in onstr tion. 1 auth e representatives of Cupertino to enter the abov//e- identi propyerty for inspection purposes. /fled Signature of Applicant /Agent: ` Date: C/ —NJ ' �LL SUPPLEMENTAL INFO RMA ON REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER - THE COUNTER ❑ BUILDING PLAN REVIEW 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 ❑ PUHLIC 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 DISTRicr submittal of Building Permit application. ENVIRONMENTAL HEALTH BldgApp_201 1. doc revised 06/21/11 1L,_ FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 18601 STARRETT CT TYPE OF CONSTR. DATE: 06/06/2014 REVIEWED BY: MELISSA APN: 375 26 016 BP #: GaO�j "VALUATION: $340,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? • Yes No PENTAMATION 1R3SFDW PERMIT TYPE: WORK CONSTRUCT N 2 STORY SFD 1877 S.F. WITH ATTACHED GARAGE 416 S.F. SCOPE $1,252.00 1 UIINSP Permit Fee: OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Custom) II- B,III- B,IV,V -B 1,877 $2,757.27 IR3PLNCK $2,262.75 IR3INSP U (Private Gar /Ag Bldg) II- B,III- B,IV,V -B 417 $0.00 I UIPLNCK $1,252.00 1 UIINSP Permit Fee: $3,514.75 Suppl. Insp. Fee:Q Reg. Q OT 1 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 2,294 $2,757.27 $3,514.75 1 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt etc ) Thew feet are hosed an the nrvliminary information availahle and are only an estimate_ Contact the Dent fnr addn 7 info_ FEE ITEMS (Fee Rcsolti Lion N -053 Ef . ,71 13' FEE QTY /FEE MISC ITEMS Plan Check Fee: $2,757.27 Select a Misc Bldg /Structure or Element of a Building Suppl. PC Fee: (j) Reg. 0 OT FO. p rhrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,514.75 Suppl. Insp. Fee:Q Reg. Q OT 1 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 # units new $659.99 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: IPLLONGR $321.16 Select a Non - Residential Building or Structure G 0 Strong Motion Fee. IBSEISMICR $34.00 Select an Administrative Item Bldg. Stds Commission Fee: IBCBSC $14.00 SUBTOTALS: $7,301.17 $0.00 TOTAL FEE: $7,301.17 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: t a( f c< y k (2 t C k PERMIT # p c) o OWNER'S NAME: O D in Mr Lk PHONE # GENERAL CONTRACTOR: j CG). BUSINESS LICENSE # ADDRESS: Electrical CITY /ZIPCODE: *Our municipal code requires all businesses working in 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. r _, I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date mi SUVA,. June 16, 2014 City of Cupertino Building Department 10300 Torre Avenue Cupertino, CA 95014 -3255 Subject: 18601 Starrett Court, Cupertino, CA 95014 To Whom It May Concern: Please be advised that the proposed building as referenced above will not have any adverse impact on the City of Sunnyvale's sewer system. Please call me if you have any questions at (408) 730 -7285. Very truly yours, Kent Steffens Director of Public Works Marjorie C. Estavillo r 2010 CALGREEN RESIDENTIAL CHECKLIST - MANDATCRY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION Q O CUPERTINO I ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE P� i� (408) 777 -3228 • FAX (4d8) 777 -3333 - buildin cu ert no.or PURPOSE: I� SEP 2 6 2014 ` i The 2010 CalGreen Code applies to all n6W[yc Bing houses, dwellings, dormitories, condominiums, shelters, congregate residences, e Ii housing, factory-built housing and other types of swellings with sleeping accommodations and new cessory 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: U 0, g'-3 ; to C Project Address: 1 0� d S7 rf7ZP rT i Project Description: rlj W - 2 --5 f`or'-y. :�; 4ao LL f �T Instructions: MAIN ON 1. The Owner --or the Owneris a ent- sh'ali'6l4 to�( Wall rofessional ex erienced with the 2010 California Building `Standards, Codes to �efi a►l Um required work described herein is properly %06 n ed arld mpI4g1 Ynte&id thei �ro)jeci:. e 2. T� tioertsled�professioi�af, ir� 01�1agrt the owner and the design professional shall initial Column 2 of this checl ig`Y e" 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 Planning and Design - Site Preservation 4.104.1 A site plan and inventory of the site is developed and used to minimize site disturbance in order preserve desirable existing natural resources and minimize future adverse effects on the proposed structure. Planning and Design - Site Development 4.106.2 A plan is developed and implemented to manage storm water drainage during construction. 4.106.3 The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage �X system will manage all surface water flows. Page 1 of 5 CalGreen 2010.doc revised 08/27/11 Page 2 of 5 CalGreen 2010.doe revised 08127/11 General 4.201.1 Low -rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. Indoor Water Use 4.303.1 Indoor water use shall be reduced by at least 20 percent using one of the follow methods. l^J ❑ Water saving fixtures or flow restrictors shall be used per Table 4.3032. ❑ A 20 percent reduction in baseline water use shall be demonstrated per As of 7101/2011 Table 4.303.1. 4.303.2 When using the calculation method specified in Section 4.303.1, LN multiple showerheads shall not exceed maximum now rates. As of 710112011 4.303.3 Plumbing fixtures (water closets and urinals) and fittings (faucets and Lai showerheads) shall comply with specified performance requirements. As of 7/01/2011 Outdoor Water Use 4.304.1 Automatic irrigation systems installed at the time of final inspection shall be weather- based. / Enhanced Durability and Reduced Maintenance 4.406.1 Joints and openings. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.408.2 Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall be submitted for approval to the enforcing agency. Building Maintenance and Operation 4.410.1 An operation and maintenance manual shall be provided to the L^� building occupant or owner. Page 2 of 5 CalGreen 2010.doe revised 08127/11 l f ° Noun Fireplaces 4.503.1 Install only a direct -vent sealed- combustion gas or sealed wood- ® Q burning fireplace, or a sealed woodstove. Pollutant Control 4.504.1 Duct openings and other related air distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints, stains and other coatings shall be compliant with VOC limits. 4.504.2.3 Aerosol paints and other coatings shall be compliant with product El weighted MIR Limits for ROC and other toxic compounds. 4.504.2.4 Documentation shall be provided to verify that compliant VOC limit finish materials have been used. 4.504.3 Carpet and carpet systems shall be compliant with VOC limits. 4.504.4 Fifty (50) 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 Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall comply with low formaldehyde LX emission standards. Interior Moisture Control 4.505.2 Vapor retarder and capillary break is installed at slab on grade foundations. i 4.505.3 Moisture content of building materials used in wall and floor framing is X checked before enclosure. Page 3 of CalGreen_2010_doc revised 08/27/11 I Indoor Air Quality and Exhaust I 4.506.1 Exhaust fans which terminate outside the building are provided in every bathroom. Environmental Comfort 4.507.1 Whole house exhaust fans shall have insulated louvers or covers which close when the fan is off. Covers or louvers shall have a minimum insulation value of R -4.2. 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. Qualifications 702.1 HVAC system installers are trained and certified in the proper installation of HVAC systems. 702.2 The Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the discipline they inspect and verify. Verifications 703.1 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. Vol ❑W- WWI u L0i FE-1 LEI 1❑ In— I E] FOW Page 4 of 5 CalGreen 2010.doc revised 08,'27,111 CALGREEN SIGNATURE DECLARATIONS Project Name: k-5 i .6-� (%o Project Address: i' P, C 1 s - 0, 77- (! - t C-,! Project Description: rk2& -W -1-D aY C-0 k'� SECTION 'I - 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 2010 California Green Building Standards Code as adopted by the City of Cup 'no. Owner's 3Wr9ure Date %G Owner's Name (PA,ease Print) Design Professional's,Signature Design Professional's Name (Please Print) Signatkfre 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 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 2010 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 ress for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen ?010.doc revised 081,1711 l CUPERTINO OWNER- BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingacupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS APN -7 BP# OWNER NAME L% OWN ADDRESS o WORK: DESCRIPTION' OF p A We are providing you with an Owner - Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner - Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) L' I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner - Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. . I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an "Owner- Builder" I am the responsible party of record on the permit. I understand that I may p otect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. -L4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. -�v. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. I understand if I am considered an "employer" under state and federal law, I must register with the state and le'd_erl government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. IA,7. 1 understand under California Contractors' State License Law, an Owner - Builder who builds single - family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. "�- 8. 1 understand as an Owner - Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OivneiBuilderForm 2010.doc revised 04114110 c-9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800 - 321 -CSLB (2752) or www.esib.ca.gov for more information about licensed contractors. `t�k 10. 1 am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. :Jk41. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner - Builders as well as employers. by/ ` VkZ I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner - Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable t the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: Jj --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner - Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner - Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuildeYForn? 2010. doe revised 04114110 LGREEN SIGNATURE DECLARATIONS Project Name: XU RE I NCE Project Address: 18601 STAR ETT COURT, CUPERTINO CA 95014 Project Descriptio New 2 st0r' s building with 1,876.94sf living and 416.78sf garage. SECTION 1 — DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Owner's Signature Date ELISABETH XU Owner's Name (PI se Print) / VA ( I Design Professional's Signature Date TRI HONG Design Professional's Name (Please Print) Sig(iature of License Professional responsible for CalGreen compliance Date FRANK L. HO - ARCHITECT - C29889 Name of License Professional responsible for CalGreen compliance (Please Print) Phone FRAN KLHO @YAHOO.COM Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. g 5(sot5 Signatufe of License Professional responsible for CalGreen compliance Date FRANK L. HO - ARCHITECT - C29889 (4-0s) w --5010 Name of License Professional responsible for CalGreen compliance (Please Print) Phone FRANKLHO@YAHOO.COM Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen_2014.doc revised 01/15114