14010012CITY OF CU P]E]E TINO BUILDING ING ]PLERMIT
BUILDING ADDRESS: 10557 GASCOIGNE DR
CONTRACTOR: GRAND NEST
PERMIT NO: 14010012
CONSTRUCTION
OWNER'S NAME: BEVIA HOLDING LLC
13428 CHRISTINE DR
DATE ISSUED: 03/17/2014
OWNER'S PHONE: 4083323887
SARATOGA, CA 95070
PHONE NO: (408) 891-8059
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
CONSTRUCT TWO STORY S]F1D (2082 SQ ]FT); ATTACHED
License Class Lic. # 7
GARAGE (421 SQ FT); ]FRONT PORCH (41 SQ FT); REAR
r
�f
COVERED PATIO (390 SQ FT); SECOND STORY BALCONYx��
Contractor���� _ ate
° ` D0
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.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $400000
rformance 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
APN Number: 37528007.00
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
ED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 JIDA� ��� ®�
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAY LAST CCALL SLPLECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
9
costs, and expenses which may accrue against said City in consequence of the
2
granting of this permit. Additionally, the applicant understands and will comply
by: Date: I
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
RE-ROOFS:
Signature Date C�
All roofs shall be inspec4prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection,
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
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(a) should I 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
Owner or authorized agent: I� Date:
permit is issued.
�'
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
{
CUPERTINO
606 R" N F M Ti 00N PES J N1AZ L C �.1 0NO
COMMUNITY DEVELOPMENT DEPARTMENT ° BUILDING DIVISION
10300 TORRE AVENUE ° CUPERTINO, CA 95014-3255
(408) 777-3228 ° FAX (408) 777-3333 ° building(cDcupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION /TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 1015719 —7
APN # 3 - S d I rg o
`Y7
OWNER NAME
PHONE q®sS-P�E-MAILLS0 I
(�0 ` Z® II
STREET ADDRESS clj ��
CITY, STATE, ZIP n«ya fl cpn ° cf a
s L 1
FAX
CONTACT NAME
PHONE d,_�
(wry �n��. nJl,r eO ,
E-MAILsna
STREET ADDRESS �on �® �� (�
l�
CITY, STATE, ZIP
,Z®C-4-N ual R9611 0
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT A ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME T °
l
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME w/n n S
[LICENSE NUMBER
BUS. LIC #
COMPANY NAME W �i 0QT
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
QF�
SFTL
V
v�
USE
TYPE
OCC.
SQ.FT.
VALUATION
EXISTG
0.�
AREA 104
NEW FLOOR
AREA -&S
DEMO
AREA a®�.�
TOTAL
NET AREA
BATHROOM
KITCHEN OTHER
REMODEL AREA
REMODEL AREA REMODEL
AREA
PORCH AREA
DEC AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
41
p �( �
tT u
S30
p 1 a ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SE"COON6Dr STORY S
BEING ADDED? RN
ADDITION? ❑ NO
PRE-APPLICATIONYES IF YES, PROVIDE COPY OF
fNO
IS THE BLDG AN [:]YES
-
TOTAL VALUATION:
PLANNING APPL# PLANNING APPROVAL LETTER
EICHLER HOME? 'IWO
By my signature below, l certify to each of the following: I am the property owner or authorized agen ct 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 to building corIstg1tiction. 1 autho representatives of Cupertino to enter the above- identifi/ed n----1 for inspection purposes.
Signature of Applicant/Agent: Date:
!!
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE ROUTING SLIP
❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS ❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE ❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_201 Ldoc revised 06/21/11
e-1Tr1r1R7 ?Trip e-1Tr Tlrl)Tr7Trbrn1TrT\.TAT
OCCUPANCY TYPE:
\l_ iL ll ll NJ/1P \1_ V lI 1L11V ll 111 N \U
FEE ESTIMATOR - B UMDING DffVffSff(DN
F1LR AREA
s.f
ADDRESS: 10557 GASC®OGNE 0)R DATE: 01/0212014 REVIEWED BY: MELISSA
FEE ID
APN: 375 28 007
1BP#: IWAD 19
*17AILUJATION: 1$400,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex
2nd Unit? Yes No
PENTAMATION
1R3SFDVU
USE:p
Permit Fee:
PERMIT TYPE:
WORD
CONSTRUCT N 2 STORY SFD (2,503 S.F.
SCOPE
$0.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
F1LR AREA
s.f
PC (FEESPC
FEE ID
B? FEES
]BP FEE ID
R-3 (Custom)
II-13,111-B,WN-B
2,503
$2,897.01
IR3PLNCK
$2,739.24
IR3INSP
Permit Fee:
$2,739.24
Suppl. Insp. Fee -0 Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
1
# new
units
$650.84
Administrative .Fee:
0
a
Work Without Permit? 0,Yes E) No
$0.00
TOTALS:
2,503
$2,897.01
Travel Documentation Fees:
$2,739.24
Strong Motion Fee: 1BSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13)
:Lfeclr. Plan Check
Plumb. Plan Check
Elec. Plan Check
;vfech. Permit Fee:
Plumb. Permit Fee:
Elee. Permit Fee:
Other Alecrh. Insp.
Other Plumb Ins). ED
Other Elec. Imp. C
.11ech. Insp. Fee:
Plumb. lasp. Fee:
Elcc. Insp. fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13)
FEE
(QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,897.01
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (j) Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,739.24
Suppl. Insp. Fee -0 Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
1
# new
units
$650.84
Administrative .Fee:
0
a
Work Without Permit? 0,Yes E) No
$0.00
Advanced Planning Fee: 1PLLONGR
$350.42
Select a Non -Residential 0
Building.or Structure 0
Travel Documentation Fees:
Strong Motion Fee: 1BSEISMICR
$40.00
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$16.00
SUBTOTALS:
$6,693.51
$0.00
TOTAL FEE:
$6,693.51
Revised: 10/01/2013
GUPER TIING
CONTRACTOR / SUBCONTRACTOR LEST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: ` O SC,i Y� Y
PERMIT # d ® ®®P
OWNER'S NAME:
PHONE # 8
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS: u
CITY/ZIPCODE: -r
*Oani- municipal code requires all businesses working in the city to have a City of Cunpertino Nosiness license.
NO BURLICDING FINAL OR ]FILIAL OCCUPANCY INSPECTION(S) WRLL BE SCHEDULED UNTR L THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTA1<N ED A CIITY OF CUP]ERTENO
l($US1<N ESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following inffoirumadon:
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
/ Contractor Signature
7,1137/14
D Ito
CUP EfBt79HO
CONTRACTOR / SUBCONTRACTOR LRET
Building I<Depairtment
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: �'
PERMIT # O
OWNER'S NAME:)'
PHONE #
GENERAL CONTRACTOR: Ca_BUSINESS
LICENSE #
ADDRESS:
CITY/ZIPCODE:
*Our municipal conte 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 CUPIERTINO
BUSINESS LICENSE.
I am not unsung any subcontractors: i
Signature )(Date
Please check applicable sunlbcontract®irs and complete the following information:
V
SUBCONTRACTOR R
BUSffN ESS NAME
BUMN ESS 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
CALGREEN RESIDENTIAL CHECKLIST — MANDATORY
ITEMS
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION
CUPERTINO ALBERT SALVADOR, P.E., C.B.Q., BUILDING OFFICIAL {,�I
10300 TORRE AVENUE • CUPERTINO, CA 950143255
(408) 777-3228 • FAX (408) 777-3333 • building( cupertino.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: JUANG'S*RESIDENCE
Project Address: 10557 GASCOIGNE DR.
Project Description: NEW 2 STORIES WITH 4 BEDROOMS & 3.5 BATHROOMS
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 9 - Design Verification at the end of this checklist and have the
checklist printed on the approved plans for the project.
3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3
and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the
completed form to the Building Inspector.
Page 1 of 5 CalGreen_2014.doc revised 01115114
Column 2
Column 3
MANDATORY FEATURE OR MEASURE
Project
Verification
Requirements
ac
Planning and Design Site Ae�reloprnentd E ,_ C
,.-
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<�.' mF ., t, . k
4.106.2 Storm water drainage and retention during construction. A plan is
developed and implemented to manage storm water drainage during
�X
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.
Page 1 of 5 CalGreen_2014.doc revised 01115114
Page 2 of 5 CalGreen_2014.doc revised 01/1/14
General"
4.201.1 Low-rise residential buildings shall meet or exceed the minimum
standard design required by the California Energy Standards.
Indo6KWater Use
3 X y� s- F zits s ss'i nx i �+• ` }• i \ 7 %"` "'F 1 -i.
..T`r }' n:3Y.'k"f..}...
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
rz
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
Califomia Plumbing Code.
Page 2 of 5 CalGreen_2014.doc revised 01/1/14
Page 3 of 5 CalGreen_20N.doc revised 0//15/14
Outdoor Water Use
3.4 1-
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.
Y(�, rk+sn'y�° •'Y �1^V �IS �i Y §Y ... uT�
r
Durahinty-laid. ducedxhfNiaEntenance
rEnhAiced
htfi
i Sa _ V: >.s s•w �. _Aaxso _y';'rz. ' .Nk z >6 ^ �' �•:i _ ...a ar; . `Y'.
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.
..`'`x
r '
Constriction 1f aste�Reduot�oa, Dis osafl�antl Rec city � ti �t rrF ��n_x
P. x g� �.
�. t � ,Y F
'v mH-
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.
Y � -'i{ � F� d. � Y� sb �rt�• ; 4r 7-,.,:,, °' 7' �'S..'t w J r zy ^e. > 5 .f ._.'
'Ildin,
B �Mamt`enarice�and peratwn'
'A t i,
• ... , k 3 {{..��� 9 AFT,
Q.�in..v ..Y .e'rv") } f. ,,,79, y �W rl k^'[ .0, 3vN ;R.4-
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.
pR Sq,
�,.�`5+,1� e� `�•}#F &y �utc.w�P4^iF^n' s �� ��v.vv �Y � Y��ryL�"`�'����yY(� wq �E °'A� {C �'� ' q J .' ey .� � �� f ", -y��
f=irelplaces� x
sn
Y � � i• l"'i
� ,G` , x.., w! ��a.. �4�:�.°(`' i h'- � 6" . t � r. ;«'�i.. �-h 4. 4. `8:'. ,1 9�.a • moi,` _
4.503.1 General. Install only a direct -vent sealed -combustion gas or sealed
r
�J
wood -burning fireplace, or a sealed woodstove.
ar y° .. r iY°'v 4 `.a r',� ,ed'.Y F�.y, r'y'a e s ^o'�,C '�,,. °..-i "1'¢ �✓ w'. b�-,
Pollutant Controls; r § r
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
®
�p
!�
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.
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_20N.doc revised 0//15/14
4.504.2.4 Verification. Documentation shall be provided to verify that
compliant VOC limit finish materials have been used.
4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with
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
®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.
.,e W (`. .S is '4-' Si � 'f i 2+• `4 ,r i'4 }.
lnterror Mo�stUr2 ConfraF %
kg
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
floorframing
materials used in wall andis checked before enclosure.
r
k'»�'.e`
4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the
building are provided in every bathroom.
L7"
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 29-0 (Manual D) or equivalent.
3. Select heating and cooling equipment according to ACCA 36-S (Manual S)
or equivalent.
Nn
s`"�
3a rc5 a,
bh airs :x"�'e A'e �� ri EL
S i arA�+C € xrt a 1
`
QUaCificairons a 4 hA
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v
4$ 3<!`"Yk
U!"
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.
��,$.^ .. �. � �-
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$ Verrfrcations �, � �- � t,. °� x x ';� �, z_ �.� ' •. �' r � r � =
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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
MIA
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.doc revised 01/15/14
CALGREEN SIGNATURE DECLARATIONS
Project Name: JUANG'S RESIDENCE
Project Address: 10557 GASCOIGNE DR.
Project Description:
NEW 2 STORIES WITH 4 BEDROOMS & 3.5 BATHROOMS
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
adoptee City of Cupertino.
q—zCf._G5—
Date
JUANG
Ownel'<Name (Please Print)
Des6n Professional's Signature Date
FRANK LINH HO
Design ofess' I's Name (Please Print) �� n
Sign ture of License Professional responsible for CalGreen compliance Date 1/
FRANK LINH HO C wa)
Name of License Professional responsible for CalGreen compliance (Please Print) Phone
FPOO — L -Mg YlA -LOA
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 Licen$e Professional responsible for CalGreen compliance Date
kMF,_ L o
Name of License Professional responsible for CalGreen compliance (Please Print) Phone
` Q-A-Qtc_t� �kv@ %�A wzmo Lom
Email Address for License Professional responsible for CalGreen compliance
Page 5 of 5 CalGreen_2014.doc revised 01/15114