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12090127 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10397 PALO VISTA RD CONTRACTOR:CHANG GEORGE CHIA- PERMIT NO: 12090127 JUNG AND CHUNG SU OWNER'S NAME: CHANG GEORGE CHIA-JUNG AND CHUNG SU 10102 IMPERIAL AVE DATE ISSUED: 12/03/2012 OWNER'S PHONE: 2069104185 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALE] License Class Lie.# CONSTRUCT 2 STORY SFDWL,4,044 SQ FT WITH ATTACHED Contractor Date GARAGE 523 SQ FT,COVERED PORCH 437 SQ FT 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$450000 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35703027.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the /!� granting of this permit. Additionally,the applicant understands and will comply Issued �-- mate: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signal Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ' OWNER-BUILDER DECLARATION Signature of Applicant: Date: 1 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 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(n)should I store or handle hazardous I 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 C pertino M icipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 5505, 3,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorizedag Date: permit is issued. 1 certify that in the performance.ofthe 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 1 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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-poi n rce regul�s per the Cupertino Municipal Code,Section Licensed Professional 9.18. Z/- !3//2 s Signat Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVI ION \� CUPI+'RTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 v�(y`t° (408)777-3228•FAX(408)777-3333• building(a)cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/T1 ❑ REVISION/DEFERRED ORIGINAL PERMIT N PROJECT ADDRESSiO ?7 ?zo L/ -2w 1�2P ' APN N OWNERNAb1E L u\w �c� �_ PHONE r (0/ E-MAIL Lv STREET ADDRESS CITY, STATE,ZIPr, t(-VI'ot N- Z_t2d FAX CONTACT NAME PHONF 0 E-MAIL I STREET ADDRESS44CITY,STATE, ZIP FAX a� _ 33 / ❑ OWNER ❑ 0\VNER-BUB.DER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS,LIC B COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS,LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK / A17 14127 �ik EXIST 'G USE PROPOSP USE CONSTR.TYPE N STORIES I/rte USE TYPE OCC. SQ.FT. VALUATION($) EXISTG/ J NEW FLOOR / DEMO !/`„/TOTAL { �} AREA/6&e, REA J / Q AREA () AREA /�/ NET AREA RFMOD�ELBATHROOM AREA KITCHEN( ! v! OTHER d REMODEL AREA REMODEL AREA REMODEL AREA PCH AREA DECK AREA TOTAL DECK PORCH AREAGARAGE EA:ARDETACH � 7 � 3 ATTACH GGy d DWELLING UNITS: IS A SECOND UNIT ❑—/�R SECON STORY ❑Y / BEING ADDED? / ADDITION? PRE-APPLICATION YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED Y: TOTAL VALUATION: PLANNING APPL h ❑NO PANNING AP ROVAL LETTER EICHLER HOME? �o ,�- •„ / l L � By my signature below,I certify to each of the following: 1 am the�t ' er or authorized agent to act on the property owner's behalf, [have read this application and the information l have provided is corregt!Yhave repton of Work and verify it is accurate. I agree to comp{y with all applicable local ordinances and state laws relating to b tiding conslla ion. 1 authoatives of Cupertino to enter the above entified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE �y ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for 1-1OVER-THE-COUNTERY� BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building `!�-, permit for new building. ❑ EXPRESS I}St PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD PUBLIC WORKS I form if any Hazardous Materials are being used as part of this project. ❑ LARGE � FIRE DEPT _cOpy Of Planting Approval better Or Meeting with Planning prior t0 ❑ MAJOR SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONNIENTALHEALTH B1dgApp 2011.doc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST ' .TOB ADDRESS: 0Z 7 ^To c PERMIT# l 209 O 1 Z OWNER'S NAME: lt,rt c PHONE# 2�'6 1 'l o GENERAL CONTRACTOR. 0cA_-,n BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino busine License. NO BUILDING FINAL OR FINAL OCCUPANCY I SPECTION(S) WILL BE SCHEDULED NTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRA ORS HAVE OBTAINED A CITY OF C ERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: CV 441 D SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets_& Millwork `j Cab To b4 k © cam Q3 Cement Finishing a Electrical _ l !�' # �,000, 3 777 Excavation (':�S ry/ 2 7�2�K� o'fi >? CA 43 q Fencing 411A Flooring/Carpeting i Q Linoleum/Wood l Glass/Glazing • Heating Insulation Landscaping Lathing . Masonry Q �a Painting/Wallpaper Paving 9oL 0" Plastering Plumbing , Roofing F F E iGU, vC�S� Septic Tank Sheet Metal F 5 Sheet Rock Tile 1 i caner/ n actor Signature Date Building Department City OFCupertillo 10300 Ton-c Avenuc Cupertino, CA 95014-3)255 CUPERTINO Telephone: 408-777-3- � Fax: 408-777-333') CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# I ZO' U[2 OWNER'S NAME: PHONE # --�--E c /a GENERAL CONTRACTOR..j BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a Citv oI*Cupertino busincs�licensc. NO BUILDING FINAL OR FINAL OCCUPANCY 1�, SPECTION(S) WILL BE SCHI-DULED." NTIL THF GENERAL CONTRACTOR AND ALL SUBCONTRAC ORS HAVE OBTAINED A CITY OF CU,, ERT1\O BUSINESS LICENSE. 1 am not using any subcontractors: Signature Date Please check applicable subcontractors and cotnpletc the following infortnation: CQ .fin o V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENwo SE: # r Cabinets & Millwork j (� (�7.jj yl ��d o o. a3- Cement Finishing ElectricalNiCiYC �1G' C ti ���C�x'� 1z,# D0000 �3 Excavation Fencing VA Flooring/Carpeting Linoleum / Wood U� Glass /Glazing i • Heating 1 Insulation Landscaping ju Lath-ing Masonry o .S-R3 7 Painting/Wallpaper Paving �� 1� 1 0 00 0 Plastering o Plumbing Roofing — F gooEyaC wv Septic Tank � V A --{I Sheet Metal !� 1 Sheet Rock Tile *—� i can ractor Signature Date OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 C U P E RTI N O (408)777-3228•FAX (408)777-3333- building(o3cuoertino.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 `0 D /�� APN 3�7 0 ,3 o 27 BP# OWNER NAME f ,/OWNER ADDRESS J 6 6-0 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.) C 1. 1 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. 4 i 2. 1 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. 4 ( 3. 1 understand as an "Owner-Builder' I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. t 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. Cq(— 5. 1 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. 1 C 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal 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. L 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. OwnerBuilderForm 2010.doc revised 04/14/10 t 4- 9. 1 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.cslb.ca.gov for more information about licensed contractors. S(_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. 4C 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. {x(12. 1 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 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: ao - ------------------------- ------------------------------------------------------------------------------------------------------------------- (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: 0YvnerBuilderForm 2010.doc revised 04114110 LANDSCAPE WATER-EFFIC r C HECKLIST Lommundy Deaeloprnent Departmuni 0385,x10300 Torre Avenue M 408.777.3333: Cupertino, CA 95024 planning@cupertino.org CUPERTINO http://cupertino.org/planni Applicant Name: G �Cjl(-6& Email: Project Site Address: l D -7 q{b Phone: Total Landscape Landscape area: All the planting areas, turf areas, and water Area (square feet : 4, b L{ 2- `� features in a landscape installation.The landscape area does not include footprints of buildings or structures, sidewalks, ! driveways,parking lots,decks,patios,gravel or stone walks, Turf Area: s other pervious or non-pervious hardscapes, and other non- irrigated areas designated for non-development (e.g., open spaces and existing wildland vegetation). Non-Turf Plant Area. 7;t 76 Turf: A ground cover surface consisting of non-native grass species that is customarily mowed. Annual bluegrass, !U n Kentucky bluegrass, perennial rvegrass, red fescue, and tall Special Landscape Area: ! fescue are examples of cool-season turf grasses. Bermuda Water Feature Wet Surface Area: �J f} grass,kikuyu grass,seashore paspalum,St. Augustine grass, zoysia grass,and buffalo grass are warm-season turf grasses. If>10%of landscaped area,water budget c cu- See reverse side for other definitions. tation required with landscape project submittal. NOTE: if landscape area exceeds 2,500 sq.ft.,a landscape project submitt:a shall be required, it no landscaping is proposed,enter "0"above and proceed directly to the signature block at the bottom of this form. Landscape Parameter Requirements Project Compliance Turf Total turf area shall not exceed 25%of the landscape 1 Yes 0 No area,or 1,250 square feet,whichever is lesser in area. (If no,I'Vater budget calculation required with landscape project submittal] All portions of turf areas shall be wider than eight(8)feet. Yes Turf(if utilized)is limited to slopes not exceeding 15%. Yes Non-Turf At least 80%of non-turf area shall consist of native or Yes \o low water use plants. lit no,Water budget cakulaliun require with landscape project submittal] Hydrozones Plants with similar water needs shall be grouped within Yes ❑ No hydrozones. Each hydrozone shall be controlled by a [Plants can be grouped per separate valve. Table 14.15.050(C)] Irrigation System Systems shall be designed and maintained to minimize Yes ❑ No i water waste(e.g.,runoff,low head drainage,overspray). Low-volume irrigation shall be utilized in non-turf areas. Irrigation shall only occur between the hours of 8:00 pm [if no,Provide explanation on bark( and 10:00 am. Soil A minimum of eight(8)inches of non-compacted topsoil Yes ❑ No shall be available in planted areas. [It no,Provide explanation cin h: Soil amendments,such as compost or fertilizer,shall be appropriately added according to the soil conditions at Yes No the project site and based on what is appropriate for the [I(no,Provide explanation on bark] selected plants. Mulch A minimum two(2)-inch layer of mulch shall be applied Yes No on all exposed soil surfaces of planting areas,except in areas of direct seeding application(e.g.hvdro-seed). [If no,Provide explanation on back] 1 am aware of available informational resources regarding native and low water use plants,irrigation efficiency,and other aspects of water-efficient landscaping. I certify that the information provided on this checklist is correct,and the installed landscape complies with the requirements of Chapter 14.15.I also understand that any changes to the project will necessitate a new checklist. i a IA"LAa Arl.dwk-tt) r ;2 Si ature of ro rty owner or authorized representative _r Date Page o f 9(t )y ] " `�� . } This checklist implements the requirements of Chapter 14.15,Landscape Ordinance,of the Cupertino Municipal Code. The responses provided will be evaluated to determine whether the proposed landscape is generally consistent with the ordinance's water-efficiency goals. Applicant Comments JW paper if rre�essam Staff Evaluation Staff Comments JApproved Not Approved Signature Date Select Definitions Hydrozone: A portion of the landscaped area having plants with similar water needs. A hydrozone may be irrigated or non-irrigated. Low-volume irrigation: The application of irri ation water through a system of tubing or lateral lines and low-volume emitters such as drip and bubblers. Certain rotary emitters designed for highly efficient water distribution,and situated to irrigate low water use plants,may also be included in this definition at the discretion of the Planning Office. Low water use plant: A plant species whose demonstrated water needs are compatible with local climate and soil conditions such that regular supplemental irrigation is not required to sustain the plant after it has be- come established. Any species classified as"very low water use"and"low water use" by WUCOLS,having a regionally adjusted plant factor of 0.0 through 0.3,shall be categorically deemed a low water use plant. Native plant: A plant indigenous to a specific area of consideration. For the purpose of this division,the term will refer to plants indigenous to the coastal ranges of Central and Northern California,and more specifical- ly to such plants that are suited to the ecology of the present or historic natural community of the project's vicinity. Special landscape area: An area of the landscape dedicated solely to edible plants,areas irrigated with re- cycled water,water features using recycled water and areas dedicated to active play such as parks,sports fields,golf courses,and where turf provides a playing surface. Turf: A ground cover surface consisting of non-native grass species that is customarily mowed. Annual blue- grass,Kentucky bluegrass,perennial ryegrass,red fescue,and tall fescue are examples of cool-season turf grasses. Bermuda grass,kikuyu grass,seashore paspalum,St.Augustine grass,zoysia grass,and buffalo grass are warm-season turf grasses. Water feature: A landscape design element where open water performs an aesthetic or recreational function. Water features include ponds,fountains,waterfalls and artificial streams. Also includes spas and swim- ming pools that are ancillary to single-family,two-family and multi-family residential uses. Wet surface area: The surface area of that portion of a water feature that functions to contain water,such as the water surface of a swimming pool,spa,or garden pond. For a fountain or other feature with flowing water, wet surface area shall be measured as a two dimensional plane bounded by the perimeter of the area where water has been designed to flow. s 2010 CALGREEN RESIDENTIAL CHECKLIST -00 Igo] MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVIitylvens Cv�CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255 (408)777-3228-FAX(408)777-3333-building0cuperfing.oW PURPOSE: j - The 2010 CalGreen Code applies to all newly constructed hotels, mote s, o inLjjF, 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: ✓LL'' (�-05, c6",t a- Project Address: i V-y peov Project Description: Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2010 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 Re uirements A4.1 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 ❑X ❑ 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 I of 5 CalGreen_2010.doc revised 08/27/11 A4.2 ENERGY EFFICIENCY -- ---------- General 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. El A4.3 WATER EFFICIENCY AND CONSERVATION Indoor Water Use 4.303.1 Indoor water use shall be reduced by at least 20 percent using one of the follow methods. ❑ Water saving fixtures or flow restrictors shall be used per Table 4.303.2. a ElA 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. 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 0 shall be weather-based. CONSERVATIONA4.4 MATERIAL 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 X❑ 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 Ca[Green_2010.doc revised 08/27/11 A4.5 -O Fireplaces 4.503.1 Install only a direct-vent sealed-combustion gas or sealed wood- ❑ ❑ 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. Q ❑ 4.504.2.3 Aerosol paints and other coatings shall be compliant with product 0 ❑ 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. ❑X ❑ 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 ❑X ❑ emission standards. Interior Moisture Control 4.505.2 Vapor retarder and capillary break is installed at slab on grade foundations. ❑X ❑ 4.505.3 Moisture content of building materials used in wall and floor framing is ❑ ❑ checked before enclosure. Page 3 of 5 CalGreen_2010.doc revised 08127111 Indoor Air Quality and Exhaust 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 0 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. nX 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 • SPECIAL INSPECTOR QUALIFICATIONS 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 0 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. Page 4 of 5 CalGreen_2010.doc revised 08/27/11 ,� �CALGREEN SIGNATURE DECLARATIONS Project Name: (�l�.av 5 G 1 Project Address: ( c1, z . CA ( M j- Project Description: -j- Famw Iq 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 CTS e- Gly Owner'same (PleaPrin Design Professional's Si a-@r& Date —ff/Q fA-0 Desi n Professional' Name (Please Print) G -7o Signature of License Profes i nal responsible for CalGreen compliance Date 1-1 Ate- 0_11�J& L I A70 A Name of License Professional responsible for CalGreen compliance(Please Print) Phone Email Address foWcense 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 08/27/11