08070004CITY OF CUPERTINO
Buit.mNcDkyrstoN PERMIT
CONTRAC£ORjNFORMATIOI
BUIL LNG DRESS:
p21.3�5
PERMITNO.
BENETTI CT
A-1 ELECTRIC
08070004
OWNER'S NAME:
PERMIT ISSUE DATE
FiOSLUND JIM
421 E HEDDING ST
07/01/2008
ONE:
SANITARY NO. CONTROL NO.
(408)975-9171
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
1 hereby afford that 1 aw licensed under provis ic, of Chapter 9 (commencing
Job Description
p
aim Section 7") of Dlvonso 3 of Ne Bull.. and Professions Cade. and my lkcn. is
UPGRD SVC & REPLC 100AMP FOR 125 AMP
in full force and effect, -1
Lln clu ^act Lk.g 4iol
come
3—acv canmacmr l;-� a t+;�
ARCHITECTS DECLARATION
I urdcrstan ! my plans shall be used u public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 bcmby 41firm that I am memo[ from the Contractor's License Law for de
following moan. (Section ?031.3, Business and Profeumm Code: Any city or county
which mquirm a permit as momme, alcor, improve. domolich, or .pair any Mo..
prior m its issuance. also requires We applicanl for such permit to file a signed statement
thw he Is famed to tie of tho contractor, Llama law(C'hapw 9
Sq. Ft. Floor Area
Valuation
pwment provisions
(com.eming with Sector, 7") of Division 3 of do Business wit Professions Code) at
$18 00
• that he is esempt therefrom and the hub for the alleged esemption. Any violation of
Section 7031.3 by any applicant for a pem it subjects the applicant an a civil penalty ofNumber
OGDU
Occupancy Type
nolo. than five hundred dollars ($5=.
3 2 6 4 9 0 3 0.
L, m owner of use property. or my c sployas with wad m in dcir sole compensation,
will dodo work, amd the structure is not intended or offered forsale (Sec. TON, Busmen
areal Prof ..I.. code: The Cantacmrs License Law dam trot apply m ,n owner of
Required Inspections
propertywho builds o improves theroon, and whodoassuch werkhimxlfothmugh his
'
own cmployam. provided Nu such improvements am not intended arofferW for sales If.
'
however, the building or improvement Is sold within ane yew of completion. the owner.
buildw will have the burden of proving that he did net build or improve for purpose of
sale.).
❑ 1, u ower of the popery, am eulusvcly cnnuusing with licensed mnmamom as
corumum the project (Sec. 7W. Business add profeuimns Code:) The Contractors U.
.
Cense law does nal apply . N mare( of p(Opemr who builds or brown S dleRan, and
who contracts far such p.jeeta with a eanuatto,4) licensed pursuant in We Comminutes
I.Iceme Law.
❑ l am mcmpt under See . B B P C for this reason
Owe Data
WORKERS COMPENSATION DECLARATION
I hereby aliir. under penally of perjary, arc of the fallowing decbrWom:
❑ 1 ham and will maintain a Cemifimm of Conwm to self -Inst. for Wotreh Campen-
aul.n, u provided far by Section 3700 of the labor Code, for the perforrdma of the
work for which this permit is Want
have and will maintain Workees CO.pematlon insurance, as required by $a40n
700 of the labor Code, far the performance of the work far which Nb permit is Issued.
'
My Worker C.unparompon Lnvuams carrier std Policy number art:
Cartier.Policy No:4ptie%1o41 (4'1 i
FOPPON FROM WORKERS'
COMPENSATION INSURANCE
(This orlon need not bu completed lines permit is forone hundred dollars ($100)
or lora)
I certify unit th the perfomaxe of the work fw which this Permit 4 issued, l NJI trot
employ amy' perm. in say master. u m biome mbj.t to the Woken Compensation
lass of California. Data
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemplium, you should
become subject m the WoduYs Compensation previsions of the labor Cads, you most
forthwith comply with such Parwhoom o this permit shall k deemed rooked.
CONSTRUCTION LENDING AGENCY
I hereby afro died there b a construction lording agancy for the perrarmm ec of
dne work far which this permit is issued (Sec. 3097, Civ, C.)
Lenders Name
Latrines Address
I Cavity that T have mad this application and soon that the above information is
cpmXL L agmL . comply with all city Nd county oNinwKea nib alae laws elating to
Wilding construction, and hereby wthodue reponsenuuvm or this city. coerupnn the
above -me property for purpowhich ma
(We) agree to save, Indemnify and keep hwmlass the City of Cupertino agaiML
expenses
In judgmontundents. whhch may in eny wy accrue against mid Cily
andexpensesthis
Cmitieajodg of the permit.
in coLICANT of the gradmRSTAN of thisDWI`
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: 1V O Y
CE REGUIgAS.
Date
Re-roofs
�• _2'I
Si6nmuof ApplmmnUC
m onmacoor Dadw
a
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or Indiana building accupsmstere or handle hmardom mabdal
u dcfned by the Cupertino Municipal Cade. Chapter 9.13, and the Health and Safely
cepa. Second m533(.)?
❑ Ym
All roofs shall be inspected prior to any roofing material being installed.
rego
Will the applicant or future Wilding oCaupanl um equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit havafdnis air contsmimnts u defined by Ne Bay Amo Air Quality Managemem
all new materials for inspection.
District?
C] Yet Nu
Ihave mad thehuardous materials
macdabrequimmenbuCltapmr6.95 oftic Cables.
riaHnSaetyCoda 3n.Inirc Wild
.&dot'monCtuncnu
lowlmasmt cansitigna,espomandily mmmtil'ytheetplmsae
^O
mcnuwhichm tpdarmimmnaaraCertificate ofOceupocy.
Signature of Applicant Date
`I^l otc
All roof coverings to be Class's" or better
Ownerorauthoriacd age. D,m'
L�
•
•
C
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
APN #�
Drlate:\�o
Building Address: A
21 35
Mailing Address (if different from building address):
Owner's Name:
Phone #:
—s"\ .
16-1
Contractor:
Phone: c� rlS9
VV—k�L\ `Q
�C
Fax:
Contractor License #: LI-bL> I L+
Cupertino Business License #:
Contact:
Phone: tieg
,i�3o�V)
Fax:
Residential Commercial
Job Description:
gLR-V 1 tt` �ae9_e.c�_ (pc7 ,rte e P09--kLS,
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ IUIII/V-A ❑ IUIII B, TV -HT, V -B [q--
12--�]
Valuation: Square Footage:
vo
Project Size: Express EC Standard ❑ Large ❑ • Major ❑
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.builditQreen m•
Revised 6/16/08
W
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1 GENCOM
1BTEMPPER
Temporary Building Permit (good for
B
30 days
1BBOILERI
For the installation or relocation of ea
M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw
11313OILER2
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
11313OILER4
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
11313OILER5
Installation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH
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
1MECHINSP
Other Mechanical Inspections (per
M
hour)
IPLMBINSP
Other Plumbing & Gas Inspections
P
(per hour
1MEETINGIHR
Application Meeting
B
•
affix
CITY of
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW
SFDWL/Duplex New
B
IACOUSRESAD
SFDWL/Duplex-Addition/Alteration
B
1ACOUSCOM
Multi-Family/Commercial
B
CHIMNEY'S
1 CHIMNEY
Chimney
B
1CHIMNEYR
Chimney Repair
B
FENCES
1 FENCE>6FT
Non -masonry, over 6 ft in height
B
1FENCEMAS>6
Masonry, over 6 ft in height
B
FIREPLACES
1FIREPLMAS
Fireplace Masonry
B
1FIREPLFAB
Fireplace Pre-Fabricated/Metal
B
1FLAGPOL>20
Flag pole (over 20 ft in height)
B
IMODUSTRU
Modular Structures
B
FOUNDATIONS
1FOUNDREP
Foundation Repair
B
-7-
1PILECAST
Pile Foundation Cast in place concrete
B
1PILE5RIV
1
Pile Foundation Driven (steel, pre-
stressed concrete)
B
3 of 5
�� OF
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY)
1RETSTN
Standard (up to 50 ft)
B
1RETSP310
Special Design, 3-10' high (up to 50 `)
B
1RETSP10
Special Design, over 10' high (up to
50'
B
1RETCRB<
Gravity/Crib Wall, 0-10'high (up to
50 ft
B
1RETCRB>
Gravity/Crib Wall over 10' high (up to
50 ft
B
SIDING
1SIDESTBK
Siding, Stone & Brick Veneer
(interior/exterior)
B
1SIDEOTHER
Siding all other
B
SKYLIGHTS
1SKYL<10 SF
Skylight less than 10 sf
B
1 SKYL>I OSF
Skylight greater than 10 sf or
structural
B
1STAIRS
Stairs -first flight/ea addt'1
B
STORAGE RACKS
1 SRACKS<=8
Storage Racks 0-8' high (up to 100 sf)
B
1SRACKS>8
Storage Racks over 8' high (up to 100
St
B
1STUCOAP
Stucco Applications (up to 400 sf)
additional stucco application
B
4of5
LJ
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6 SO
CITY OF
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
I WINREP
Replacement windows/sliding glass
door ea 8 windows)
B
IWINMEWSTR
New Window -structural shear
wall/masonry (includes plan ck fee
B
IEPERMITFEE
Electrical Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
1PPERMITFEE
Plumbing Permit Fee
P
Ilk
IELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
IMECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
IPLMBLNCK
Stand Alone Plumbing Pln Ck (hrly)
P
1 STPLNCK-(3 Hr in
when not over counter)
Standard Plan Check (when no E/M/P)
hourly -stand alone
B
1BSEISMICR
Seismic Residential
B
1BSEISMICO
Seismic Commercial
B
/
I
1TRAVDOC
Travel & Documentation
B
IBUSLIC
Business License
B
•
5 of 5
•
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Plan Review Process Work Book Page -12-Revised 325/08
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
OREM
2 points
11.
Permeable Paving,Note
L-1
2 pints
C.
Foundation
1.
Use 15 % Flyash Concrete, (note)
S-1
5 points
D.
Structural
3.
Uses Wood IJoist, (See Spec.)
S-2
2 points
5.
Use Truss with heels, (detail)
S-2
2 points
6.
B. OSB Sheathin detail
S-2
2 points
E.
Ext. Finish
1.
Composite Decking, (Note/Spec.)
A3
2 points
4.
B. Fiber Cement Siding,(Note/Spec.)
A-4
F.
Plumbing
1.
Insulate all H.W. pipes, (Note/Spec.)
P-1
__Z_points
2 points
5.
Tankless W.H., (Note/Spec.)
A-2
2 points
11.
A 2500 Gal. Tank, (Note/Spec)
L-1
10 points
G.
Electrical
4.
E. Ceiling Fans, (Note/Spec.)
A-3
4points
H.
Appliances
1.
Energy Star Dishwasher, (Note/Spec.)
A3
1 point
3.
Enerov Star Refrigerator, Note/S ec.
A3
1 point
P.
Other
1.
List Green Features on Plans
A-1
1 point
TOTAL POINTS
40 points
•
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Plan Review Process Work Book Page -12-Revised 325/08
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.
1. Recycle Job Site Construction &Demolition Waste
3 Energy pts
y=yes
65%=1 point; 75%= 2 points; 80%= 4 points ,
up to 4 Resource pts
2. Salvage Reusable Building Materials _
J' 4 Resource pts
y --yes
3. Remodel for Mixed Use, Adaptive Reuse, and
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10 Resource
Historic Preservation
4 Resourceis
p
y�e
4. Protect Native Soil
2 Resource pts
y=yes
5. Minimize Disruption of Existing Plants & Trees
1 Resource pt
Y --yes
6. Implement Construction Site Stonnwater Practices
2 Resource pts
y=yes
7. Protect Water Quality with Landscape Design
2 Resource pts
y=yes
B. Design Resource -Efficient Landscapes and Gardens
4 Resource
2 Resource pts
_
pts
y=yes
9. Reuse Matedals/Use Recycled Content Materials
for Landscape Areas
2 Resource pts
y=yes
10. Install High -Efficiency hdgation Systems
2 Resource pts
y=yes
11. Provide for On -Site Water Catchment / Retention
2 Resource pts
y --yes
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
2. Use Recycled Content Aggregate 2 Resource pts y=
3. Insulate Foundation/Slab before backfill , ❑,,,,,,,,,
C. Structural Frame
3 Energy pts
y=yes
`. Substit teu(So'i al d S wn Lumber with Engineered Lumber
J 3 Resource pts
y=yes
2. Use FSC Certified Wood for framing
3 Energy pts
y=yes
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10 Resource
pts.
3. Use Wood I -Joists for Floors and Ceilings
2 Resource pts
y=yes
4. Use Web Floor Trusses
2 Resource pts
y=yes
5. Design Energy Heels on Trusses 6' or more
2 Energy pts
y=yes
6. Use Finger -Jointed Studs for Vertical Applications
2 Resource pts
y=yes
7. Use Engineered Studs for Vertical Applications
2 Resource pts
y=yes,
B. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts
y=yes
9. Use Structural Insulated Panels (SIPS)
a. Floors
3 Energy pts
y=yes
b. Wall
3 Energy pts
y=yes
c. Roof
3 Energy pts
y=yes
10. Apply Advanced Framing Techniques
4 Resource pts
y=yes
11. Use Reclaimed Lumber for Non Structural Applications
3 Resource
pts
y=yes
• a. Subfloors
b. Sheathing
1 Resource pt
j
y=yes
— — --
1 Resource or
y=yes
It Use sustainable Decking Materials
I .a. Recycled content
I b. FSC Certified Wood
12. Use Treated Wood That Does Not Contain Chromium/Arsenic
3. Install House Wrap under Siding
4. Use Fiber -Cement siding Materials
E. Plumbing
1. Install ater H
Weater ket
Jac -_
2. Insulate Hot and CDld Water Pipes
3. Retrofit all Faucets ang Shovi rheads with Flow Reducers
i
a. Faucets (1 point each, up to 2 points) )
b. Showerheads (1 point each, up to 2 points)
4. Replace Toilest with Ultra -Low Flush Toilets
(1 point each, up to 3 points)
5. Install Chlorine Filter on Showerhead
6, Convert Gas to Tankless Water Heater
7. Install Water Filtration Units at Faucets
(2 points each, up to 4 points)
8. Install On -Demand Hot Water Circulation Pump
r. tiecrncai
I1, Install Compact Fluorescent Light Bulbs (CFLs) t
(6 bulbs=2 points, 10 bulbs � points, 12 bulbs = 4 points) _i
L --I — -----'
2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to
5 points)
3. Install Lighting Controls (1 point per fixture, up to 4 points)
4. Install High Efficiency Ceiling Fans with CFLs
(1 point each, up to 4 points)
G. Appliances
1. install Energy Sta -Dishwasher ?
2. install Washing Machine with Water and Energy i
Conservation Features
3.lnstall Energy Star Refrigerator
4. Install Built -In Recycling Center
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Walls
b. Ceilings
2. Install Floor Insulation over Crawl Space
N3.Iristall Recycled-Coo'terit, Fiberglass Insulation with
o Added Formaldehyde
4. Use—A& a;cedInfiltration Reduction Practices
5. Use Cellulose Insulation
a. Walls
b. Ceilings
6, Alternative Insulation Products (Cotton, spray -foam)
a. Walls
D.Cemngs
1 Energy pt
2 Energy pts
Up to 2 Resource
Up to 2 Resource
Up to 3 Resource
1 IAQ/Health pt y:
4 Energy pts y=
Up to 4 IAQ/Health pts.
4 Resource pts Y_ -Yes
Up to 4 Energy
Up to 5 Energy
Up to 4 Energy
to 4 Energy pts.
1 Energy of
1 Energy pt
1 Energy pt
3 Resource pts
2 Energy pts
2 Energy pts
4 Energy pts
31AQ/Health pts y=yes
2 Energy pts Y --yes
4 Resource pts
4 Resource pts
4 Resource pts y=yes
4 Resource pts y=yes
•
•
•
3 Resource pts y=yes
0
3 Resource pts y=yes
0
1 IAQ/Health pt y --yes
0
1 IAQ/Health of y=yes
0
1 Resource pt y=yes
0
1 Energy pt
2 Energy pts
Up to 2 Resource
Up to 2 Resource
Up to 3 Resource
1 IAQ/Health pt y:
4 Energy pts y=
Up to 4 IAQ/Health pts.
4 Resource pts Y_ -Yes
Up to 4 Energy
Up to 5 Energy
Up to 4 Energy
to 4 Energy pts.
1 Energy of
1 Energy pt
1 Energy pt
3 Resource pts
2 Energy pts
2 Energy pts
4 Energy pts
31AQ/Health pts y=yes
2 Energy pts Y --yes
4 Resource pts
4 Resource pts
4 Resource pts y=yes
4 Resource pts y=yes
•
•
• Fl. Install Energy-Efficiern Windows
a. Double -Paned 1 Ener t
Energy P
b. Low -Emissivity, (Low -E) t 2 Energy pts
c. Low. Conductive Frames
� _ ----_ry ___--- ___ ___ _-' 1 Energy pts
2. Install Low Heat Transmission Glazing � 1 Enerw of
J. Heating Ventilation and Air Conditioning
11. Use Dud Mastic on All Duct Joints __
2. Install Ductwork within Conditioned Space
3. Vent Range Hood to the Outside
4. Clean all Ducts Before Occupancy
5. Install Solar Attic Fan
6. Install Attic Ventilation Systems
7. Install Whole House Fan
S. Install Sealed Combustion Units -
a. Furnaces
b. Water Heaters
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
10. Install 13 SEER/11 EER or higher AC with a TXV
11. Install AC with Non -HCFC Refrigerants
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
• 13. Retrofit Wood Burning Fireplaces
a. Install EPA certified wood stoveslnserts
b. Install/Replace Dampers
c. Install Airtight Doors
14. Install Zoned, Hydronic Radiant Heating
15. Install High Efficiency Filter
16. Install Heat Recovery Ventilation Unit (HRV)
17. Install Separate Garage Exhaust Fan
IC Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
2, Install Solar Water Heating System
3. Pre -Wire for Future Photovoltaic (PV) Installation
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw = 1 B points)
(6. Select Safe and burable Roo—ting Materials - - l
7. Install Rediani Barrer - - "- - - ` "
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating
2. Install Overhangs or Awnings over South Facing Windows
3. Plant Deciduous Trees on the West and South Sides
is
2 Energy pts
3 Energy pts
1 IAQ/Health pt
21AQ/Health pts
2 Energy pts
1 Energy pt
4 Energy pts
31AQ/Heaith pts
31AQ/Haalth pts
3 Energy pts
3 Energy pts
2 Resource pts
2 Energy pts y=yes
1 IAQ/Health pt
y=yes
1 Energy pt
Y --yes
1 Energy pt
Y=Yes
3 Energy pts
y=Yes
41AQ/Health pts
y=yes
5 IAQ/Health pts
y=yes
31AQ/Health ots
v=vas
4 Energy pts
10 Energy pts
4 Energy pts
Up to 18 Energy pts
1 Resource pt y=yes
3 Enerov ots v=ves
5 Energy pts
3 Energy pts
3 Energy pts
Y=yes
F1. Use LowMo-VOC Paint
2. Use Low VCC, Water -Based Wood Finishes
, 3. Use Low/No VOC Adhesives
4. Use Salvaged Materials for Interior Finishes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
6. Use Exterior Grade Plywood for Interior Uses
17. Seal all Exposed.Particcleboard or MDF
B. Use FSC Certified Materials for Interior Finish
9. Use Finger -Jointed or Recycled -Content Trim
10. Install Whole House Vacuum Systen
N. Flooring
1. Select FSC Certified Wood Flooring
2. Use Rapidly Renewable Flosring Matenals _r
3. Use Recycled Content Ceramic Tiles
4. Install Natural Linoleum in Place of Vinyl
5. Use Exposed Concrete as Finished Floor
6. Install Recycled Content Carpel with Low VOCs
Total Points Available:
Total Points Project Received:
ed.
IAQ/Health pts y=yes D •
21AQ/Health pts y=yes D
31AQ/Health pts y=yes D
3 Resource pts y --yes 0
1 1
61AQ/Health pts
1 IAQ/Health pts
41AQ/Health pts
4 Resource pts
1 Resource pts
3 IAO/Health pts
B Resource pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y=yes
5 IAQ/Health pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y=yes
1401 1301 57 •
01 01 0
C::atarpmgs/greenboilrLngguidelineshemodelersrpaenpoin:sfnal212.e4prme:ted.ds
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CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32649030.00
DATE ISSUED.......: 07/01/2008
RECEIPT #.........: BS000005309
REFERENCE ID # ...: 08070004
SITE ADDRESS .....: 21835 BENETTI CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER .............. ROSLUND JIM
ADDRESS ..........: 21835 BENETTI
CITY/STATE/ZIP ...: CUPERTINO CA,
OPERATOR:pdtg
COPY # : 1
95014-1221
RECEIVED FROM ....:
A-1 ELECTRIC
CONTRACTOR .......:
ROBERT LAMANTA LIC #
27061
COMPANY ..........:
A-1 ELECTRIC
ADDRESS ..........:
421 E HEDDING ST
CITY/STATE/ZIP ...:
SAN JOSE, CA 95112
TELEPHONE ........:
(408)975-9171
FEE ID UNIT QUANTITY
-----------------------
AMOUNT PD -TO -DT
THIS REC
NEW BAL
----------
1BSEISMICR VALUATION 1,800.00
--------------------
'0:50 0.00
----------
0.50
----------
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
----------
82.08 0.00
------
82.08
------
0.00
METHOD OF PAYMENT AMOUNT
----------------- ---------------
REFERENCE NUMBER
CHECK 82.08
--------------------
#10564
---------------
TOTAL RECEIPT 82,08
CITY OF
SCUPERTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
PERMIT #
2l 3�
0 V 070
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors: --1—o X
Signature Date
Please check applicable subcontractors and complete the follnwinv;nfnrmaf9nn•
Owner/ Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
1�_t
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
nI,
Tile
Owner/ Contractor Signature
Date