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13060229 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10189 S FOOTHILL BLVD CONTRACTOR:SARATOGA PRIME LLC PERMIT NO: 13060229 OWNER'S NAME: SARATOGA PRIME LLC 10189 S FOOTHILL BLVD DATE ISSUED: 10/22/2013 OWNER'S PHONE: 4088296083 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG T_ ELECT F PLUMB ' License Class Lic.# ('"' F MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CONSTRUCT 2 STORY 3,492 SQ FT OF LIVING AREA,441 (commencing with Section 7000)of Division 3 of the Business&Professions SQ FT ATTACHED GARAGE 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$420000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:34214074.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued by: �4% f /�i� Date: /Gi •�p`�/� Signature Date l i OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGSTO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 1 certify that in the performance of the work for which this permit is issued,I shall health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or a rized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: a >ZL forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name_ to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address 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 ARCHITECT'S DECLARATION with all non-point sourc gulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. / 7 Licensed Professional Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION V� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 0U CUPERTINO (408)777-3228• FAX(408)777-3333 • building(a)cupertino.org \� ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS /I O /�� Muf(/_ZAPN# ^ — 14 - 074 1D OWNER NAME '/ f &A Lt e— PHONE O I Z 4.431 J 43 E-MAIL STREET ADDRESS�� CITY, STATE, P FAX O 0 0 CONTACT NAME PHONE E-MAI 7� N C� nEs� N e STREET ADDRESCITY,STATE, ZIP FAX 03 1?CIA)AJ $ q I—C, ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER 7 LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTRTYPE #STORIES 5, / ,Z USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NE FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEIT OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH 111 ✓38 45-7 I 6ii-ATTACH #DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY EYES BEING ADDED? E]NO ADDITION? []NO t/' PRE-APPLICATION ❑YES IFYES,PROVIDE COPY OF 1S THE BLDG AN E]YES , TOTAL VALUATION: PLANNINGAPPL# E]NO PLANNING APPROVAL LETTER EICHLER HOME? E]NO RECEI- .ki,. rJ f"G DOOM By my signature below,I certify to each of the following: I am the property owner or authori d age t ct on the property owner's behalf. I have read this application and the information I have provideA is correct. I have read the Description of Work and ify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin nstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. . Signature ofApplicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED r`iasic�cxTYPE,_, . xouTlivcsirP , New SFD or Multifamily dwellings: Apply for demolition permit for ovER T�coUtrTER nizc riANREVJi wr existing building(s). Demolition permit is required prior to issuance of building `r i permit for new building. ExrREss ra rLANNTn�ar ANxvIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTnNnARn UBiacwoRIcs' ��i form if any Hazardous Materials are being used as part of this project. r CD LARGE g e .FII2EDEPT 7 _Copy of Planning Approval Letter or Meeting with Planning prior to F submittal of Building Permit application. Q MAroR L�wSANrrtYSE�vERnTSTRTe�; -. ❑^ENVIF201V17EATALHEALTFI'`:�,. B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10189 S FOOTHILL BLVD DATE: 06/28/2013 REVIEWED BY: mendez APN: BP#: 36 'VALUATION: $420,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 2nd Unit? Yes No PENTAMATION 1 R3SFDW USE: PERMIT TYPE: WORK CONSTRUCT 2 STORY 3,492 SQ FT OF LIVING AREA 441 SQ FT ATTACHED GARAGE SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,111-B,IV,V-B 3,933 $3,043.40 IR3PLNCK $3,244.35 IR3INSP TOTALS: 3,933 $3,043.40 $3,244.35 F-1 Ir`t- Ll I Lj 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 prelimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E( 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,043.40 Select a Misc Bldg/Structure Suppl. PC Fee: 0 Reg. 0 OT O.07 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $3,244.35 Suppl. Insp. Fee:Q Reg. Q OT TO.07 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 #new Construction Tax: IBCONSTAXR 1 units $641.96 Work Without Permit? 0 Yes (F) No $0.00 0 Advanced PlanninL Fee: IPLLONGR $511.29 Select a Non-Residential 0 Building or Structure Strong Motion Fee: 1BSEISNIICR $42.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $17.00 SUBTOTALS $7,500.00 $0.00 TOTAL FEE: $7,500.00 Revised: 04/29/2013 Building Department City OfCupertino 10300 Torre Avenue Cupertino, CA 95014-3255 CUPERTINO Telephone: 408-777-3228 Fax: 408-777-3)33 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 'o ` '( , PERMIT# OWNER'S NAME: 0 > PHONE# Z c GENERAL CONTRACTOR: -/¢ L BUSINESS LICENSE# ADDRESS: 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. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting 1 Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank --TSheet Metal Sheet Rock Tile _l Ovil er/ Contractor Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax:408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: " ,' ;' - ? �� PERMIT# v� OWNER'S NAME: PHONE# GENERAL CONTRACTOR: 1 USINESS LICENSE# ADDRESS: r, , 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. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 i Owner/Contractor Signature Date OWNER-BUILDER NOTICE COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228-FAX(408)777-3333- buildinp(Dcupertino.ora Effective January, 1, 2009, Assembly Bill 2335 amends California Health and Safety Code, Section 19825, regarding disclosures and verifications required for all applicants seeking Owner- Builder construction permits. These new application requirements provide an enhanced level of consumer awareness and protection for property owners accepting the risks associated with Owner-Builder construction permits. "The Legislature hereby finds and declares that there is an urgent and statewide public interest in assuring that building contractors comply with the Contractors License Law...and provisions of law relating to Workers' Compensation Insurance for building construction, that property owners are informed about, and protected from, fraudulent representations, liability for worker's injuries, liability for material and labor costs unpaid by contractors, licensing requirements, and employer's tax liabilities when improving their property as owner-builders" Important information you need to know BEFORE pulling your permit! The term"Owner-Builder" can mean three different things: "Owner as Worker", "Owner as Contractor"or "Owner as Employer" Understand each has Benefits or Risk, and it is possible to combine them! Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the permit is not taken out in your name, you are not personally responsible for the construction and you are not an Owner-Builder. Instead,you become a"Customer" and California law provides you the benefit of protection from poor workmanship, failure to finish the job and financial risk due to worker injury. Benefit/Risk: Hi<Thest Benefits and the Least amount of Risk Owner-as-Worker is a type of Owner-Builder where you personally perforin the construction work, the permit is taken out in your name and you are personally responsible for the construction management, knowledge, workmanship, and completion of the job. You benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job successfully. Benefit/Risk: IF<=:z;il aex k>: E:i"`<t:with Low Financial Ris-k Owner-as-Contractor is a type of Owner-Builder where you personally act as your own General Contractor, the permit is taken out in your name and you hire California licensed sub-contractors to perform portions of the construction work. WARNING: The benefit of protection provided by law when you hire only California licensed sub-contractors can turn to serious financial risk if you hire unlicensed contractors to perform any of the work. Benefit/Risk: ''€?A and Significant Financial Risk Owner-as-Employer is a type of Owner-Builder where you pay any individual to perform any construction work valued at more than $500.00, the permit is taken out in your name and you are personally responsible for their employment requirements, supervision,performance,safety and welfare while on your property. WARNING: Cost savings benefit can turn to serious financial risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker. Benefit/Risk i, " ..",x;.= "g with Sianificaut Financial Risk Over 20,000 consumer complaints are filed each year. Many complaints relate to owner/builder projects and include workmanship and workers' compensation issues Homeowners suffer financial harm due to defective workmanship and injured employees. OwnerBuilder 2010.doc revised 06/08/10 Following are alarming examples of what has occurred with Owner-Builder permits: Example 1: Homeowner received insurance money to rebuild burned-down home. ■ Owner/Builder permit pulled to rebuild structure. ■ Unlicensed contractor built substandard structure— must be torn down and replaced. ■ Estimated financial injury is $225,000. ■ Additional financial injury - IRS threatened to tax insurance payout if house not completed by the end of the year. Example 2: Brother-in-law had active license but filed an exemption from Workers Comp. ■ Owner-Builder hires brother-in-law to install a new roof. ■ Employee falls and sustains multiple spinal and extremity fractures as well as a head injury and remains in a coma to this day. ■ "rhe Owner-Builder, who has sold the home, is now a defendant in a lawsuit for reimbursement for benefits paid to the injured worker. Example 3: Employee of contractor without Workers Comp is hired by Owner-Builder to install septic system and suffers injury that results in permanent disability. ■ "rhe Owner-Builder did not have a homeowner's insurance policy on the house against which to submit a claim. ■ The Owner-Builder is now a defendant in a lawsuit for reimbursement for benefits paid to the injured worker. Did you know— unlicensed persons frequently have the property owner obtain an "Owner- Builder" building permit which erroneously implies that the property owner is providing his or her own labor and material personally? Did you know—your homeowner's insurance may not provide coverage for injuries sustained on your property by an unlicensed contractor and his/her employees? Did you know— if you are considered an "employer" under state and federal law, you must register with the state and federal government, withhold payroll taxes, provide workers compensation and disability insurance and contribute to unemployment compensation for each "employee"? Did you know—that if you fail to abide by these laws you may be subjected to serious financial risk? OWNERS BEWARE AND CONS[DER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR YOUR CONSTRUCTION PERMIT OwneBuilder 2010.doe revised 04/12/10 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building aa-)cuPertino.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 r'^ APN BP# aya O N R NAME OWNER DDRES$ &4 n DESCRIPTION OF WORK: 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.) 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- ullder'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. 42. 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. jit:e3ct . I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. . I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. * I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the dal alue 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 eeral 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. * I understand under California Contractors' State License Law, an Owner-Builder who builds single-family rsidential 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. -fif 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for y financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. 0ii,iieiBuildeiFo7-7ii2010.doc revised 04114110 I understand I may obtain more information regarding my obligations as an "employer"from the Internal evenue 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.csib.ca.gov for more information about licensed contractors. 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 Aabove. 11. 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. 2/ . I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the i ormation 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 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: -LZ,I ---------------- ----------------------------------------------------------------------------------------------------------------------- (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: Tel No Address of Authorized Agent: 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: OwnerBuilderForm 2010.doe revised 04/14/10 2010 CALGREEN RESIDENTIAL CHECKLIST — MANDATGRY ITEMS )30&0�� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 950143255 (408) 777-3228• FAX(408) 777-3333•buildingecupertino.oM PURPOSE: The 2010 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: �� R.,�s�To G�.�. JAI~ , Project Address: �O l Qol'i� 1 . �.•�� _ ,� t1_0�7_A.)Z:9 Project Description: uw -roa Instructions: 1. The Owner or the Owner's agent sh#Qploy a licensed professional experienced with the 2010 California Green Building Standards Codes to verik 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 Verific ion,�t tk eras of this checklist and have the checklist printed on the approved plans fo ° ' F. 3. Prior to final inspection by the Building D a li sed 'I�nal shall complete Column 3 and sign and date Section 2 -Implement V rif o t th end of this checklist and submit the completed form to the Building Inspector. Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Re uirements PLANNING AND DESIGN 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 QX 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, 13 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 ® 0 system will manage all surface water flows. Page I of 5 CalGreen_2010.doe revised 08'27111 A4.2 General 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards, A4.3 Indoor Water Use 4.303.1 Indoor water use shall be reduced by at least 20 percent using one of the follow methods. 0 ❑ Water saving fixtures or flow restrictors shall be used per Table 4.303.2. ❑ 11A 20 percent reduction in baseline water use shall be demonstrated per As of 7/01/2011 Table 4.303.1. 4.303.2 When using the calculation method specified in Section 4.303.1, multiple showerheads shall not exceed maximum flow rates. r] As of 7/01/2011 4.303.3 Plumbing fixtures(water closets and urinals) and fittings (faucets and 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. rXi MATERIAL CONSERVATION AND RESOURCE 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 0 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 building occupant or owner. Page 2 of 5 CalGreen_2010.doc revised 08127111 P A4.5 ENVIRONMENTAL QUALITY Fireplaces 4.503.1 Install only a direct-vent sealed-combustion gas or sealed wood- ® Cl burning fireplace, or a sealed woodstove. Pollutant Control 4.504.9 Duct openings and other related air distribution component openings ❑ shall be covered during construction. Ll 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. X ❑ 4.504.2.3 Aerosol paints and other coatings shall be compliant with product ® ❑ 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 a ❑ 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 ® ❑ emission standards. Interior Moisture Control 4.505.2 Vapor retarder and capillary break is installed at slab on grade foundations. ® ❑ 4.505.3 Moisture content of building materials used in wall and floor framing is checked before enclosure. Page 3 of 5 CalGreen_20)O.doc revised 08127/11 Indoor Air Quality and Exhaust 4.506.1 Exhaust fans which terminate outside the building are provided in every bathroom. Lai 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 ri 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, INSTALLER ► 1 SPECIAL INSPECTOR QUALIFICATIONS Qualifications 702.1 HVAC system installers are trained and certified in the proper installation of HVAC systems. El 702.2"rhe Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the discipline they inspect ® El 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 El Building Department after implementation of all required measures and prior to final inspection approval. Page 4 of 5 CulGreen_2010.doc revised 08/27/11 CALGREEN SIGNATURE DECLARATIONS Project Name: �RArOt �-I?n10 E �llL Project Address: p t , �j� 1?p"(" 1 641(". ,�{z.n t10 Project Description: N (fin � i�o hA-9- !ti L. R°c_.o+C-�� 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 2010 California Green Building Standards Code as adopted by the City of Cupertino. Owner's Signature Date Owner's Name (Please Print) Design Professional's Signature Date Design Professional's Name (Please Print) 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 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 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 Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen_2010.doc revised 08/17/11 CALGREEN SIGNATURE DECLARATIONS Project Name: -jAR--A;"o Zigme L,,1,., , Project Address: 10 161SP f-9 I�� __( P98—Xi tst? Project Description: t-� e O om O H* t .. 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 proje lens and will be implemented into the project in accordance with the requirements set forth in the 2010 California Building Standards Code as adopted by tie City of Cupe ino. �--- O Itk Owner's Signature ti Date Owner's Na (Please Print) L-Z-_ @ o Design Profe gn nai's S'l ature Date II�`a—' Styr: Design Professional's Name (Please Print) Signature of License Professional responsible for CalGreen complian ), �!4-, Date YAkA (/o -6'z/ -31 Name of License Professional responsible for CalGreen compliance(Please Print) Phone YA M ILA Vg- C 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 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 Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen 2010.doc revised 08127111