08090041 CITY OF CUPERTINO w� >#�,+,kTra � '� �, -
BUILDYNGDIVIS4oN PERMITkC,ONTRAGTQR,. INFO,ItMATION, ,
BUILt�1yyG,ppp¢¢RFSS: PERMIT NO.
LUt5U3 ALVES DRTBD — TO BE DETERMINED 08090041
OWNER'S NAME: PERMITISSUEDATE
YOUNG MEN S CHRISTIAN ASSOC 09/09/2008
+NE=' SANTTARY NO, CONTROL NO.
ARCHTEC(ENGINEER: BUILDING PERMIT INFO
BLDGPLUMB MECH
0 t 0 0
u o o EIEC!
LICENSED CONTRACTOR'S DECLARATION Job Description
1 Mreby affirm that 1 w licomed under proviuom DSCiI of Chapter 9(commencing P
with Scedon70(10)of Division 3 of the Budaeu anal Pmfeadom Code.and my license is RUNNING A 110 CIRCT 'FM PANEL TO CEILING FAN PER
n'a a in full force and eRrce
o e.Clm ... 2007 CEC
an.Contractor
ARCHITECT'S DECLARATION
I uMerasnd my pW ss"I M used a public reeordr
k0
e tuo Licensed Professional
OWNER-BUILDER DECLARATION
I hereby slam that 1 am exempt from the Contractors License Law for the
Z 2 C following mason.(Section 7031.5.Bus.and Pmfeaium Code:Any city or county
which 1e9NR3 a Permit b enmNCL sher.MIpmN:.demolish,or repair my alrueWm
S=i prior or its issuance,alsu rtquim theapplieant forauch Permit o file a signed statemcm
�othatWislicensedpursuanttoftprovisiomorNeContractor'sLice. aw(Ch.'e,9 Sq.Ft.Floor Aread- Valuation
(eommercing with Sender 7ooD)of Division 3.1'the Busineumd Prefessiom Code)m y 3 0 o o
$ Nat he is exempt therefrom and the Want for the alleged eamplion.Any violation of
Section 70313 byany applicant for.permitsub)eetaNe,Miie.,N,arilpm.ltyor AigN Number Occu e
nm Dame than love hashed,hashed,Wdan,('%M 32632039 .`ff ane T Occupancy YP
❑i.u hwnm of the Prose antme 6 employees with wages a Neb tele compensation,
and Prthe amts and thehe Coma tbtended Lawrafforcel
bpply(See in
B.,
of
and prtywin,m Code:The canherarr dw1to law ansa mit apply lf an owrcr M Required Inspections
property who builds id mpmwa Ihuean,and who mesauch vwrkhWselfmthrough his
hmon owever.
miProgded Nalsuch imProwmanta anent in,, or offered for ale Ir,
however,the Wilding or impovemmt is cold within one year or comove for pu owner,
Wilder will have the Writes of pnwin6 Na ha did tet Wild m improve for PUTose of
aide.).
0 1,as owner of the Pmpeny,am exclusively consocdng with licensed contractor on
comuuct the project(Sec 7044,Bond.and pretensions Code:)The Co ora mrs Li-
me Law does not apply to an owner of property who Wilds or improves thereon.and
who contracts for sent;projects with a eonhanor(s)licensed punuanl b than Conuaetor, ,
Lireme law. .
❑lam aemp,undm ee
O .BdPCrm Nis mum
wner
WORK• 5 COMPENSATION DECLARATION -
1 barely-Bone under pemlty or perjury arc of tie fallowing dmWmWac
:Tum ondwillrommaina Cud!mofConttnt to self-imamfmWorkersCompan-
mion,u provided for by Section 3M of the tCade,for the perfomco anof the
wart fm which this permit is issued.
❑1 have and will maintain Workers Compensation Insurmm,as enquired by Section
17W.f the tabor Code.for the peRarmsoea of the work for,which Nis permit a Waned.
MY Worker,Compensulon 4uunna artier and Policy marWr art:
Caller: Policy No.:
CERIIFICAATE OF EXEMFDON FROM WORKERS
COMPENSATION INSURANCE '
rrhuacnlmi recd not W careploted if de pcmh is fame hendrm clothes($I.M .
rebs.)
I cenify W,in the performance of the wee,for whbh this permit u issued,l mall rat
em ploy my person in any asmrcrmu obctarne subjects Ne\or mpemadon
taw,ofcalifoma Dau —
NOTICE TO APPLIC :IL of ,bodeng Nu anSiEuaExemption,yej mWb
become mbjeel to the Worker,Cmnponardon provision of the talar Cede.you most
.J O forthwith comply with such provitlm aor this permit shall x detentes s te _
'ti M CONSIRUCr10N LENDING AGENCY
F IWmbY-Moss than Nen nta consuacdon lending agency for the Pollmm.rce of
Ix > the worst for whim this Penh is W ued(Sea.3097,Civ.C.)
Gj Lender,Name '
,J z leader.Actions
UC) 1 cerdfy that 1 have mad this applicadon and state than ftshots mon a
w!'� CanKL I as=to comply with all city and conmy aNinson a sad state lawn Rladng he
.0 tr,^ Wilding construction,and Wreby masorisa reprasenladw.of this city or enter upon the
Ht27 show-mentioned.ts,C for inspection which ea
g1 (We)agree to ave,indemnify and tap hamlet the City of Cupertino against
fn
in
or thecrata.,expi.ms farm. may in my w'+y.erneagalnst said City
U z A PLICA consequence or the UNDERSTANDS
NaD WILL
/y�. y' iC
APPLICANT UNDERSTANDS nAND WILL C PLY WITH ALL NON-POINT Issued by:S Date / CIG,
SOURCE REGULATIONS; n " —1
HAZARDOUS
X � -y Re-roofs
Stgnuure a/AppltanUCanr�r 'T Bate <Y
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIIIy finom�Wilding..Chapter 9.12.
arias HaAam material
a defined io Ne 32(.)?mi Munidpal Code.Chapter 9.12,and Ne HeilN and,Safety
Code,Section 25532(0?
❑Yes ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future building oacapaat one equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Atiecomdoua air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
❑Ya ONO
I haw mad the hvallousmucriil,mquiremena under Qupter6.95of he califm-
ni.Haldt 1SafclYCade,Scedon,255D5,25533 and 25534.1 undersand denif the Wilding
doc4 not cummly have a tenant dant it' my biliry m aoury de occupant or do
mgaimaen muahe tp�a, m,e ,cc-iTe,teara paaey. Signature of Applicant Date
_ IV/ „� 7"9-hap'
Gana or antheri,cd ages Date All roof coverings to be Class';qa'or better
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32632039 . 00
DATE ISSUED. . . . . . . : 09/09/2008
RECEIPT #. . . . . . . . . : BS000006030
REFERENCE ID # . . . : 08090041
SITE ADDRESS . . . . . : 20,803 ALVES DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : YOUNG MEN S CHRISTIAN ASSOC OF
ADDRESS . . . . . . . . . . : 20803 ALVES DR
CITY/STATE/ZIP . . . : CUPERTINO, 95126-1704
RECEIVED FROM . . . . : MIKE LUSK
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . .
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
lBSEISMICO VALUATION 3 , 000 . 00 0 . 63 0 . 00 0 . 63 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 ' 40 .79 0 . 00 40 . 79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 82 . 21 0 . 00 82 . 21 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CASH 82 . 21
---------------
TOTAL RECEIPT 82 . 21
•
L �l
CITY OF CUPERTI
CIN OF N O
• CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN � )—,& 3 2,_0 o c� Date:
Building Address:
av46 � JLS
Mailing Address (if different from building address):
Owner's Name: C 1 Lkr
Phone
Contractor: �/ � Phone: o — L-16 S— �3 Po
V l l ec+ tl[, Fax:
Contractor License#i l C 'J 2)/ v 9_�0 —
Cupertino Business License#: ��" 4z 0 /sr
Contact: Phone:--t4 U _
• [`Q Fax:
Residential Lj Commercial
Job Description: RU t ) yU el-uu rc,,�v I
C i\�JI , �G N , - 260-7 CFzc
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B KI II/III/V-A ❑ II/III B, IV-HT, V-B ❑
Valuation: ge
Square Foota :
UU
Project Size: Ex ress ❑ Standard Large ❑ Major ❑
i
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set& the sheet index.
• Points Achieved:
For help, contact Build it Green at www.buildit reen.or
Revised „J'i& g
7- CITY OF CUPERTINO
c
Ty of
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 BBOILERI For the installation or relocation of ea M
boiler/compressor to &including 3
horsepower, or ca absorption sys to &
incl 100,000 Btu/h (29.3kw)
IBBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1BBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1 BBOILER4 Installation/relocation of ea M •
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
IELECINSP Other Electrical Inspections (per hour) E
1 MECHINSP Other Mechanical Inspections (per M
hour)
1 PLMBINSP Other Plumbing & Gas Inspections P
(per hour •
1MEETINGIHR Application Meeting B
i av_'
CITY OF CUPERTINO
CITY of GENERAL BUILDING APPLICATION
CUPEIZTINO
0 FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL1Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
1ACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIMNEY Chimney B
1CHIMNEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
1 FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1 FIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
IFOUNDREP Foundation Repair B
1 PILECAST Pile Foundation Cast in place concrete B
1 PILEDRN Pile Foundation Driven (steel, pre- B
stressed concrete
3 of 5
CITY OF CUPERTINO
CIT F GENERAL BUILDING APPLICATION
CUPER,TINO
FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONR
1RETSTN Standard (up to 50 ft) B
IRETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSPI0 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SHED-(EACH) Shed Over 120 sq ft B
SIDING
1 SIDESTBK Siding, Stone & Brick Veneer B
(interior/exterior
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYUl OSF Skylight greater than 10 sfor B
structural E - .-
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sO B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st) �
4of5
CITY OF CUPERTINO
CITY Of GENERAL BUILDING APPLICATION
CUPERTINO
• FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door ea 8 windows)
IWINMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee
/ 1 EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1BSEISMICR Seismic Residential B
/ 1BSEISMICO Seismic Commercial B
/ ITRAVDOC Travel & Documentation B
IBUSLIC Business License B
5 of 5
Green Building Plan Check
Index of Green Building Points/Categories
A. Category Example of an Index or Table of Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 2 points
11. Permeable Paving, Note L-1 2 oints
C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points
5. Use Truss with heels, (detail) S-2 2 points
6. B. OSB Sheathing, detail S-2 2 points
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec.) A-4 2 points
F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points
5. Tankless W.H., (Note/Spec.) A-2 2 points
11.A 2500 Gal. Tank, (Note/Spec L-1 10 oints
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point
3. Ener Star Refrigerator, (Note/Spec. A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS 40 points,
•
•
Plan Review Process Work Book Page-12-Revised 3/25/08
Green Points Rating System for Remodeling Projects
Due to the diversity of remodeling project types,assigning a'total points'value to a project to be considered environmentally friendly is
not feasible. However,25 measures have been highlighted to signify that every effort should be made to incorporate them into your •
projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with
ease of implementation and relative low cost. These measures can be used as a starting point for'greening'your project.
INPUT Resources Energy IAO/Health
A.Site
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0
2.Salvage Reusable Building Materials 4 Resource pts yeses 0
3.Remodel for Mixed Use,Adaptive Reuse,and
Historic Preservation 4 Resource pts y=yes 0
4.Protect Native Soil 2 Resource pts y--yes 0
5.Minimize Disruption of Existing Plants&Trees 1 Resource pt y=yes 0
6.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y--yes 0
B.Design Resource-Efficient Landscapes and Gardens 4 Resource pts y--yes 0
9.Reuse Maledals/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y--yes 0
10.Install High-Efficiency Irrigation Systems 2 Resource pts y--yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts y--yes 0
1 1 1
B.Foundation
1.Incorporate Recycled Flyash in Concrete
25%Recycled Flyash=2 points;Add 1 point for every 10% •
increase of flyash,up to 5 points up to 5 Resource pts 0
2.Use Recycled Content Aggregate 2 Resource pts y--yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y--yes 0
1 1 1
C.Structural Frame
1.Substitute Solid Sawn Lumber with Engineered Lumber 3 Resource pts y=yes 0
2.Use FSC Certified Wood for framing
(For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0
3.Use Wood I-Joists for Floors and Ceilings 2 Resource pts y--yes 0
4.Use Web Floor Trusses 2 Resource pts y=yas 0
5.Design Energy Heels on Trusses 6'or more 2 Energy pts yryes 0
6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y--yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource pts y--yes 0
B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y--yes 0
9.Use Structural Insulated Panels(SIPs)
a.Floors 3 Energy pts Y--Yes 0
b.Wall 3 Energy pts y=yes 0
C.Roof 3 Energy pts Y--yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y--yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y--yes 0
12.Use OSB
a.Subfloors 1 Resource pt y=yes 0
b.Sheathing 1 Resource pt Y_-Yes 0 •
1 1 1
INPUT Resources Energy 1AWHealth
.Windows
1.Install Energy-Efficient Windows
• a.Double-Paned 1 Energy pt Y--yes 0
b.Low-Emissivity(Low-E) . 2 Energy pts y=yes 0
C.Low.Conductivity Frames 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
1 1 t
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on All Duct Joints 2 Energy pts yeses 0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAQ/Heafth pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 7
0
5.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts y=yes 0
8.Install Sealed Combustion Units
a.Furnaces 31A0/Heafth pts y=yes 0
b.Water Healers 3 IAQ/Health pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes 0
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stovesfinsens 1 IAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 41AQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAO/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 0
I 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0
2.Install Solar Water Heating System 10 Energy pts y=yes 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts p
6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes p
7.Install Radiant Barrier 3 Energy pts y=yes 0
I 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy.pts y=yes p
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes p
3.Plant Deciduous Trees on the West and South Sides 3 Enema pts y7es 0
1 1 1
•
Community Development
e 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
16UPEf�TINO
Building Department
JOB ADDRES • PERMIT #
03 es c� C)8C)q 00q l
OWNER'S NAME: C C PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
nop
• — _
Owner/Contractor Signature Date