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B-2016-2636CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2636 21890 MEADOWVIEW IN CUPERTINO, CA 95014-1143 (326 45 025) NORTH VALLEY BUILDERS INC GILROY, CA 95020 OWNER'S NAME: AHMADI SASSAN AND AZIZI SHAHRNAZ TRUSTEE OWNER'S PHONE: 408-439-0193 LICENSED CONTRACTOR'S DECLARATION License Class a Lic. #925966 Contractor NORTH VALLEY BUILDERS INC Date 12/31/2016 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 cense is in full force and effect. 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. zyi 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 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. Date 9/28/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. 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 following three 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. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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. Signature Date 9/28/2016 ISSUED: 09/28/2016 NO: (408) 687-0464 PERMIT INFO: BLDG —ELECT X_ PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: (I) LAUNDRY ROOM (88 SF); (N) COVERED FRONT PORCH; (1) GAS FIRE PLACE; (N) GAS LINE; (I) WINDOWS (6); (I) FRENCH DOOR (1); REMODEL (750 SF) - (REFER TO PERMIT# B-2016-2562 FOR KITCHEN REMODEL) Sq. Ft Floor Area: I Valuation: $50000.00 APN Number: Occupancy Type: 326 45 025 R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: AbbyAyende 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. Signature of Applicant Date: 9/28/2016 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 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 25505,d and 25534. Owner or authorized agent - Date: 9/28/2016 CONSTRU&IN LENDING AGENCY I hereby affirm that there is a co truction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed 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?cugertlno.org / TI ORIGINAL-PEPMIT PROJECT ADDRESS v U 70 +�" C Gi-"V V1 �lAl. I P >7 { - I �—o Gr G• C� iE-MAIL OWNERNM4E , SS /}� % PRONE 9 6 f� r� �!� STREET ADDRESSq i Cj 4� ! titu CITY, STATE, ZIP r FAX �] - l J p CON'TAC'T NAME Ir2 PHONE E-MAIL _._ STREET ADDRESS CITY, ,TATE ZIP x j ---- � �e��oD1lO_� �U i'� FAX ri OWNER 11 C'A%TEE:BU1LDER ❑ OWN.ERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT -❑ ENGINEFR ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSENUMDER LICENSE TYPE Bus. LIC 4 COMPANTYNAME E-tvlfilT FAX — STREET ADDRESS CITY, STATE, ZIP PHONE ARCWFCT/ENGINE-FR NAME LICENSE NTUhMER BUS. LIC # COMPANYNAME E-MAIL FAX -- - STAEET'.ADDRF.SS CITY,. STATE, ZIP PHONE - ��� _ - —__ � _ `IIESCRIPTiONOF R �� � tea t�� t t 0.ti-J(.._;�+:-c�i�'�_ - -1 V� !✓ I\f �';�, fJ [ �. r i to I A4% t 7 �n1 LA_r EXISTING USE PROPOSED USECDNSTR.'IYPr- F STORIES USE TYPE OCC. SQ,FT. VALUATION ($) EXISTG NEWFLOQIt DEMO TOTAL AREA AREA AREA NET AREA BATHROOM IUTCHEN - OTHER - - RF-IvIODELAREA REMODEL AREA REMODELAREA POItCHAREA DECK AREA TOTALDECK'PORCHAREA GARAGE AREA: LJ DETACH ❑ ATTACH fDWELLRNOUNITS: ISASECONDUNIT ❑YES SCCOND STORY ❑YTS BEINGADDED? ❑NO :ADDITIO[N? ❑NO PRE -APPLICATION ©YES >xYES, PROVIDE COP YI)F 'ISTHEBLDiGAIN ❑YES ?REGEIVED73Y TOTAL VALUATION., PLANI\RNGAPPI.I". ❑NO PLANI;RNG APPROVAL LETTER MCYILERHOME? NO 0 By my signature below, I certify to each of the followiva: I am the property owner or authorized agent to act on the property owner's behalf. I have read.this application and the'infonnation I have provided is correct. I have read the Description of'Alork and verify it is accurate. I agree to comply wide all applicable local ordinances and state laws rela' Lildmigconstruclion. I authorize representatives of Cupertino to enter the above --id nti ed property for inspection pm'poses. Signature of Applicant/Agent � Date; l 1` SUPPLEMENTAL I TF MATION REQUIRED f'PL.4.'tCHFCI��'CIPE,, � _ _.-cROF77'INGSLIP_.-. New SFD or Multlfanuly duTelllmas: Apply for -demolition permit for p opeltix> COtJnT7It' ❑ autLDiticP5 AT REiTE�i - existingbuildings). Demolition permit is required prior to issuance of bui]dln¢ ' pt-,rinit for new building. __- Commercial Bldgs: Provide a completed Hazardous Materials Disclosure s'[7 sT4T+•D4Rn: - ❑ rv�Llc.i4oRl s form ifany Hazardous Materials are being used as part o£this project. _Copy Df Planning Approval Letter or Mectrng with Planning prior to Q �r241DIt Mir s tnlrAxl sEjiExnlsTluCr ^ - submittal of Building Pennit application. =` . - f s r _ ❑-:EIS'\'IRO�'•17EI�TAi:HEAi.3'H_. r B1daApp 2011.doc revised 06/21/17 C43PERTINO. PURPOSE: 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 • buildin cu erbno.ar 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: Azizi Residence Project Address: 21890 Meadowview Lane Project Description: Addition/Remodel Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Reauirements 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during ❑ ❑ 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. L IIII°°) L FII 11140 I'I°tWilldi°iing II)ei artirnein't Pago 1 of 5 FO HI:��°. IED FOR CO [ - COM [I IL.J O N C E CalGreen 20.14. doc revised 01/I5/.l4 Revuewed By:! !:!!:'II,Wrc::ii-i II°:)yM iile Cala: 09/� )7/ H3 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 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. lim—N-19" j iI3uuliilllrt ingI13ellluartuineet 0 IM 701 Page 2 of 5 [iEVHl.Wi.D VOR CCSD,-. C:O p [I II.. V N C 11.- C'a]Greerr 2014. doc revised 01115114 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, 10 F1 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 10❑ wood -burning fireplace, or a sealed woodstove. 4.504.1 Covering of duct openings and protection of mechanical equipment during construction. Duct openings and other related air ❑ ❑ distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks ® 1:1shall 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. 4.504.2.3 Aerosol paints and coatings. am s shall be compliant with product weighed s�IliiIlP �� ptui�it ❑ ❑ compounds. Page 3 of 5 Fi EV H E F U" CODE U U°I II J A N CIE CalGreen_2014. doc revised 01115114 Revew d l ydIl::'"Iluuollri II°:)evl e 4.504.2.4 Verification. Documentation shall be provided to verify that ❑ 11compliant VOC limit finish materials have been used. j 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with ❑ j j ❑ I 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 CO Elcomply 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 ® 11 I materials 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. ❑ ❑ 2. Size duct systems according to ACCA 29-D (Manual D) or equivalent. 3. Select heating and coling equipment according to ACCA 36-5 (Manual S) or equivalent. 702.1 Installer training. HVAC system installers are trained and certified in ❑ 1:1the 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, s ecifications, builder or installer ingtinspection p n f mi, shall show conform ❑ ❑ be submitted to the Building Department i eiiPgn�tdjqiA measures and prior to final inspection ap Page 4 of 5 Ii III U; D U U" COM.. U [I II..V N - CcadGreen_2014.doe revised 01115/14 Revvew d u ydIl::'"Iluualri II°:)yM IIle DatE' 09/� Uhf°I3 CALGREEN SIGNATURE DECLARATIONS Project Name, Azizi Residence _.....,..._,_�__ Project Address: 21 890 Meadowview Lane Project description: Addition I Remodel SECTION 1 -- DESIGN VERIFICATION Complete all lines of Section 1 Q "resign Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. Theowner 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 Cade as adopted by the City of Cupertino. >r a . �. &--- i bwnerssignature t� Date 'VI fawner' Nar. (Please Print) Design Prnfessionp s Signature Date Rick Reyn s e ' fessi. 's Name apse Print) 9/27/2016 _............____ Signature of icense Professional responsible for CalGreen compliance Gate Miles Hancock .....w_.....__...._.....__........-................._......................_..___.. (650) 8049063_____ Name of license Professional responsible for CalGreen compliance (Please Print) Phone energy@pacbell.net Email Address for License Professional responslbie for GalGreen 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 Gate Name of License Professional responsible for CalGreen compliance (Please Print) Phony; n corn i3EVH MED FOR CODE fwMA[II[JAN - Reviewed 1 ydll::�h ualri C°:)yM IIle tt tE` 09/t M H3 ColGiv n- 2014. d?x- �-evfsed 01-15,74