CITY OF PALO ALTO GREEN BUILDING INSPECTIONS
SCHEDULE
Prior to issuance of a building permit, the Ow ner, on the advice of the Architect or Project Designer,
shall complete, sign and submit this form to the Building Official.
_______________________________________________ _______________________________________________
Project Name Permit Number
_______________________________________________ _______________________________________________
Project Address Special Inspection Agency name
_______________________________________________ _______________________________________________
Owner’s Name Owner’s Signature
I hereby certify that the Special Inspection Agency named above has been engaged to perform green building plan
review and on-site inspections during construction, as checked below, to satisfy all applicable portions of the Green
Building Code.
Prior to issuance of a building permit, the special inspection agency shall submit a statement on a permit plan sheet
entitled “GB-1” stating that all items applicable green building requirements have been included within the
construction documents.
Prior to green building final approval, the special inspection agency shall submit a statement verifying that all green
building requirements shown on the permit plans were executed in the field.
Whenever any designated items on this list are ready for plan review or inspection, it shall be the responsibility of
the Contractor to give timely notice to the Special Inspection Agency so that the required services may be
performed.
PRE-PERMIT APPLICATION
THIRD-PARTY DESIGN REVIEW
X Verify Green Building Triggers.
Confirm that the applicant has appropriately selected
triggers from the Green Building Verification Form
based on the scope of work.
X Verify Minimum Compliance in Contract
Documents.
Confirm that the applicant has appropriately
designated the “Y”, “O”, and “N” elements on the GB-
1 based on the scope of work.
CALGreen Mandatory Plus Tier 1
CALGreen Mandatory Plus Tier 2
X Verify Minimum Compliance in Contract
Documents.
Confirm that the applicant has shown design &
construction elements in the contract documents
when designated as “Y” elements on the GB-1 sheet
in compliance with the Standard Green Building
Conditions.
INSPECTION PHASE
THIRD-PARTY INSPECTION REVIEW
X Pre-Construction Meeting. Conduct a Green
Building Pre-Construction Meeting in accordance with
the Residential Green Building Inspection Guidelines.
X Incremental Green Building Verification.
Conduct an incremental green building verification in
accordance with the Residential Green Building
Inspection Guidelines.
X Final Green Building Verification. Conduct final
green building verification in accordance with the
Residential Green Building Inspection Guidelines.
X Submit Final Green Building Verification
Documents. Submit final green building verification
documentation to the building department in
accordance with the Residential Green Building
Inspection Guidelines.
SELECT APPLICABLE PROJECT REQUIREMENTS
__ CALGreen Mandatory Plus Tier 1
__ CALGreen Mandatory Plus Tier 2
click to sign
signature
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