08070127z
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CITY OF C�UPERTINO
'
BUILDING DIVISION PERNUT
COAL, R1CT RI1 'bIiMATIO,N.,,,. �,
BUILDING ADDRESS:
PERMIT NO.
'7640 BERLAND CT
TOM & LYDIA HALCIN
08070127
OWNER'S NAME:
-
PERMIT ISSUE DATE
TOM & LYDIA HALCIN
7640 BERLAND CT
07/17/2008
NE:
SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby, aff m that I am licensed under provisions of Chapter 9 (commeicinj
with Section TOMB of Division 3 of Nd Buslnev and Proressiom Codd. and my license is
INSTL 1 ADDTL ELECTRCL OUTLT ON WALL ABV FIREPLC
in run force nod erten.
License Class Lk. g
Dale Contractor
ARCHDECI'S DECLARATION
1 t nMJsomi my plan shall be used As public records
Licensed Pmrcumnal
OWNER -BUILDER DECLARATION
I hereby eMm that I am exempt from the Cunuxctars License Law for IW
following reason. (Section 70313. Business And Profession Code: Any city or County
which squires A pctmit in construct, alter. Improve, demolish, or mpair my structure
prior W is issuance. Alan rtquims the applicant forsuch permit in file a signed statement
Nat he is licensed pumuant to the pmNaimu of the Conlmelora License Law (Chap¢r9
Sq. Ft. Floor Area$10 Valuation
(commencing with Section 7000) of Division 3 of the Business And Rofecsions Code) or
that he is eaempt therefrom And the bus for the Alleged eKmption Any violation of
Section 7031.3 by Any appimmt for a Permit subjects the applicant N A civil penally of
ppN Number
Oeeu ane T
lel mare tan lie treadmill dollars fiR)o3
36225039: VG'
P Y YPe
I,uowtter orthe propvty,ormy wploycu with wgesu Ne'v sole compensdon,
wise do Neworlc ande,-11. uusnotkU orAWdofor We(sec. 7014. Buainw
.lid cads Ilse Covuacmrs U. Taw ten oat apply m u oaora
Required Inspections
progenywhobuilds orionprovthereonadwhodoessuchwonthimself
who who is
Property his
dthrough
own employees, provided h improvements see not inledd mofremd for sale B.
aprove the
builder.Ilebaiting ur Mprocemvviinssold withinut )ear ofimrome
fo.
builder will have the When of proving that k did not build a improve far puryose of
m,of
Asia).
i. I oaacr M the Properly, w exclusively convexing with uchadid conuactam N
ns1the pmjen (Sec. 7044, Business ad Professlou Code:) The Conmcmrs U.
C. Law does not spply m An owner of property who Wilds or improv Oe.. And.
who com acle for such pmXN with a conYYbl(s) IknlYd inRWnt to the CCMYera
-
LKcnYLaw.
❑ lam uonsio"unnica See, B B P C far this uAsen
Owns
WOR�K�'S COMP dSATION DECIARATIO
1 hereby air= uder pemlty, of perjury one, of the following declArdone
i hare and will maintain • Cenifiute of Conant to tel( -insure rte Workers Comport.
sation, an provided for by Section 3700 of the Labor Code. for f porfamuaece of the
work for which this permit is issued.
❑ 1 have And will mainmk Workers Compensation Ins.. At resulted by Section
)RD M the Labor Cade. for f Knone. of du work Town kh Nis Permit s Issued.
MY Workers Compensation lnism. Cartier And Policy numbcr am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(nds section aced lmtbecomplemd Bthe Permit s forunehundrd dollars ($100)
or leu)
1 ecnify that in the pnformance of Nc wort for which this Permit is issued. l shall not
employ Any person in never seum subject la the Workem'Campewdm
'
Laws of Calif.
-
Applicam _
NOTICE TV APPLICANT: 1f, after making Nis Certificate of Exemption. you should
become subject An the Workers Canpeuntion provisions of the labor Coda you must
forthwith comply with such provision or this permit shall be doomed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby Afnmt that Neu it. cmmmcdon lending agency for the performance of
the work for which this permit Is mind (Sec. 3097, Civ. G)
Lenders Name
'
Lenders Address
I ceell that 1 have sad this appliudon ad stste than the Above Wm r adun 6
.
corms I aisce m comply with All city And county aNinances And sate lawn relating m
-
W ilding conswction, aM heubY --shines epusenstiv or Ns city to enter upon the
•sort-mcn6onrtd property, for ssspec. patches
(We) agree N LK. indemnify And kCp hanmlmes Be City of L'ui emna against
Cf pCnYGrivit. may in 811y way Kerne ag81N1IYd Dlly
incoiicarmjdgmCnla.CpNNd
A consequence of the &ranting of Ns permit.
-
APPLICANT ERSTANDS AND WIL COM LY WITH ALL NON -POINT
SOUROER G A770N5.
Issued by: Date %—
�SRe-roofs
Sn6nuuu of AppinssHAZARle DaRDOUDOU
HAZARDOUS
S ALS DISCLOSURE
Type of Roof !/
tiny future building
batinge.
the
Chapmr 9AorAnd!teIuraAoud Safety u denxd
Cupertino ni
ata MunsipAl cads. Chapter 9.13, W the HW N and safety
ca11C. Section zss32(A)?
io 32(d)?
0y. {dao
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupantoccupanttau equipment or dcvim which
It
If a roof is installed without first obtaig an inspection, ection, I agree to remove
P
haeaNnos air conlamioancs u defined by the Bay AMA Air Quality Management
all new materials for inspection.
Disuic,?
O
❑yes
1 harm mad Neha»Nonsmamiaistequvemcnu under Clvpter6.95oflle Califor-
niaHealth ASefclyCotle, Sections 25505,25533 AW 25734. I understand! lhatifde Wilding
dam not curun0 ha •tenant dot it is my ibil' y b srotir de oecupanl Or the
--WA
mynim nvbemetpriar lir. mtearQxvpsery'
Signature of Applicant Date
All roof coverings to be Class '%¢" or better
Owns or mNori>rA agent Date ' '
• 3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36225039.00
DATE ISSUED.......: 07/17/2008
RECEIPT #.........: BS000005501
REFERENCE ID # ...: 08070127
SITE ADDRESS .....: 7640 BERLAND CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ............: TOM & LYDIA HALCIN
ADDRESS ..........: 7640 BERLAND CT
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5079
RECEIVED FROM ....: LYDIA HALCIN
CONTRACTOR .......: LIC # *OWNER*
COMPANY ..........: TOM & LYDIA HALCIN
ADDRESS ..........: 7640 BERLAND CT
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5079
TELEPHONE ........:
•
FEE ID UNIT
-----------------------
QUANTITY
----------
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
1BSEISMICR VALUATION
10.00
----------
.0.50
----------
0.00
----------
0.50
----------
0.00
1EPERMITFE FLAT RATE
1.00
40..79
0.00
40.79
0.00
ITRAVDOC 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
-----------------
CHECK
TOTAL RECEIPT :
n
LJ
AMOUNT
---------------
82.08
---------------
82.08
REFERENCE NUMBER
--------------------
#4991
•
•
•
CITY OF
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
APN #0
Date: _ 7 -Go4--
Building Address:
76 y 0 -Berle. nd CJ C ca per �I'FJ eI CA) c(SOI
Mailing Address (if different from building address):
Owner's Name:
Phone #:
)orrl
C) 'R
Contractor:
Phone:
(-,e 1?
Fax:
Contractor License #:
Cupertino Business License #:
Contact:
Phone:
Fax:
Residential Commercial IT
Job Description: 2n5+call one ele�4r-,c ed ooi je+
above �:re �Iwce .
Building Permit Info:
Bldg ❑ Elect [, Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ IL/ III/V-A ❑ IUIII B, IV -HT, V -B Z��
(L---1
Valuation: 4),0 Square Footage:
Project Size: Standard Large ❑ Major ❑
Revised 5/21/08
,CCS - CITY OF CUPERTINO
CUPER,TiNO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1GENCOM
1 BTEMPPER
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)
1 BBOILER2
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
'
1BBOILER4
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 .
1 BBOILER5
Install ation/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.
1 ELECINSP
Other Electrical Inspections (per hour)
E
1 MECHNSP
Other Mechanical Inspections (per
M
hour)
PLMBINSP
'PLM
Other Plumbing & Gas Inspections
P
er hour)
1MEETINGIHR
Application Meeting
B
•
CITY OF
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
,Group
Permit Type
1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW
SFDWL/DuplexNew
B
IACOUSRESAD
SFDWL/Duplex-Addition/Alteration
B
IACOUSCOM
Multi-Family/Commercial
B
CHIMNEY'S
1CHIMNEY
Chimney
B
1CHIMNEYR
Chimney Repair
B
FENCES
1 FENCE>6FT
Non -masonry, over 6 ft in height
B
I FENCEMAS>6
Masonry, over 6 ft in height
B
FIREPLACES
1FIREPLMAS
Fireplace Masonry
B
1 FIREPLFAB
Fireplace Pre-Fabricated/Metal
B
1 FLAGPOL>20
Flag pole (over 20 ft in height)
B
1MODUSTRU
Modular Structures
B
FOUNDATIONS
1FOUNDREP
Foundation Repair
B
1 PILECAST
Pile Foundation Cast in place concrete
B
1 PILEDRIV
-
Pile Foundation DrivenE (steel, pre-
stressed concrete)
B
3 of 5
1
CITY OF
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE 0
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY)
1 RETSTN
Standard (up to 50 ft)
B
IRETSP310
Special Design, 3-10' high (up to 50 `)
B
1RETSPI0
Special Design, over 10' high (up to
50')
B
1 RETCRB<
Gravity/Crib Wall, 0-1O'high (up to
50 ft)
B
1RETCRB>
Gravity/Crib Wall over 10' high (up to
50 ft)
B
SIDING
1SIDEST/BK
Siding, Stone & Brick Veneer
(interior/exterior)
B
1SIDEOTHER
Siding all other
B
SKYLIGHTS
1 SKYL<10 SF
Skylight less than 10 sf
B
1 SKYL>1 OSF
Skylight greater than 10 sf or
structural
B
1STAIRS
Stairs -first flight/ea addt'l
B
STORAGE RACKS
1 SRACKS<=8
Storage Racks 0-8' high (up to 100 sf)
B
1 SRACKS>8
Storage Racks over 8' high (up to 100
st)
B
1STUCOAP
Stucco Applications (up to 400 sf)
additional stucco application
B
4of5
•
F_
L
CITY or
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
1 WINREP
Replacement windows/sliding glass
door (ea 8 windows)
B
1 WINMEWSTR
New Window -structural shear
wall/masonry (includes plan ck fee)
B
I
1 EPERMITFEE
Electrical Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
1PPERMITFEE
Plumbing Permit Fee
P
1 ELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1MECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
1 PLMBLNCK
Stand Alone Plumbing Pln Ck (hrly)
P
1 STPLNCK-(3 Hr Min
when not over counter)
Standard Plan Check (when no E/M/P)
hourly -stand alone
B
/
/
1BSEISMICR
Seismic Residential
B
1BSEISMICO
Seismic Commercial
B
1TRAVDOC
Travel & Documentation
B
1BUSLIC
Business License
B
•
5of5
•
Plan Review Process Work Book Page -12-Revised 3/25/08
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
2 points
11.
Permeable Paving, Note
L-1
2 points
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 points
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.
Energy Star Refrigerator, (Note/Spec.)
A-3
1 tint
P.
Other
1.
List Green Features on Plans
A-1
1 paint
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.
[L2.
Recycle Job Site Construction & Demolition Waste ll
5%— 1 point; 75%= 2 points; BO%= 4 points
Salvage Reusable Building Materials
3. Remodel for Mixed Use, Adaptive Reuse, and
Historic Preservation
4. Protect Native Soil
5. Minimize Disruption of Existing Plants & Trees
6. Implement Construction Site Stonnwater Practices
7. Protect Water Quality with Landscape Design
iB: Design Resource -Efficient Landscapes and Gardens
9. Reuse MateriaVUse Recycled Content Materials
for Landscape Areas
10. Install High -Efficiency Irrigation Systems
11. Provide for On -Site Water Catchment / Retention
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
2. Use Recycled Content Aggregate
3. Insulate FoundadoniSlab before backfill
C. Structural Frame
1. Substitute Solid Sawn Lumber with Engineered Lumber J
2. Use FSC Certified Wood for framing
(For every 10% of FSC lumber used = 2 points, up to 10)
3. Use Wood ]-Joists for Floors and Ceilings
4. Use Web Floor Trusses
up to 4 Resource pts
4 Resource pts
y --yes
4 Resource pts
y --yes
2 Resource pts
y=yes
1 Resource pt
y=yes
2 Resource pts
y=yes
2 Resource pts
y=yes
4 Resource pts
y=yes
2 Resource pts y_—yes
2 Resource pts y --yes
2 Resource pts y=yes
up to 5 Resource
2 Resource pts y=
3 Enerav ots v=
3 Resource pts y=ye
up to 10 Resource pt
2 Resource pts y=ye
2 Resource pts y=ye,
5. Design Energy Heels on Trusses 6' or more
2 Energy pts
y=ya
6. Use Finger -Jointed Studs for Vertical Applications
2 Resource pts
y --ye!
7. Use Engineered Studs for Vertical Applications
2 Resource pts
y=ye!
S. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts
y --ye!
9. Use Structural Insulated Panels (SIPS)
a. Floors
3 Ener is
9Y P
Y=Ye`•
b. Wall
3 Energy pts
y=ye<
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=yas
!12.Use0SB --`"---- --- -)
a. Subfloors f
1 Resource pt
y=Yes
• b. Sheathing
1 Resource pt
y=yes
r
r
r
r
r
r
r
0
r
0,
0
_—
it. Use Sustainable Decking Materials
a. Recycled content
3 Resource pts
b. FSC Certified Wood
3 Resource pts
2. Use Treated Wood That Does Not Contain Chromium/Arsenic i
1 IAQ/Health pt
3. Install House Wrap under Siring
1 IAO/Health pt
4. Use Fiber -Cement Siding Materials i ;
1 Resource pt
E. Plumbing
1. Install Water Heater Jacket _ �__ J
1 Energy pt y=yes
2. Insulate Hot and Cold Water Pipes_
2 Energy pts Y --yes
3. Retrofit all Faucets and hea
ShoWerds with Flow Reducers 1
Up to 4 Energy pts.
a. Faucets (1 point each, up to 2 points)
Up to 2 Resource pts.
b. Showerheads (1 point each, up to 2 points) f
Up to 2 Resource pts.
4. Replace TcAest with Ultra -Low Flush Toilets
Up to 4 Energy pts.
(1 point each, up to 3 points) _ ' _�
Up to 3 Resource pts.
5. Install Chlorine Filter on Showerhead
1 IAO/Health pt y --yes
6. Convert Gas to Tankless Water Heater
4 Energy pts y=yes
7. Install Water Filtration Units at Faucets
3 IAQ/Health pts
(2 points each, up to 4 points)
Up to 41AQ/Health pts.
8. Install On -Demand Hol Water Circulation Pump
4 Resource pts y=yes
r. tlectncal
1 Energy pt
1. Install Compact Fluorescent Light Bulbs (CFLs)
(1.
Install Washing Machine with Water and Energy
(6 bulbs=2 points, 10 bulbs =3 points, 12 bulbs = 4 points)
Up to 4 Energy pts.
2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to
13.Install Energy Star Refrigerator
5 points)
Up to 5 Energy pts.
3. Install Lighting Controls (1 point per fixture, up to 4 points)
Up to 4 Energy pts.
4. Install High Efficiency Ceiling Fans with CFL;
4 Energy pts
(1 point each, up to 4 points)
Up to 4 Energy pts.
G. Appliances
_ J
1 Energy pt
Install Energy Star Dishwasher
(1.
Install Washing Machine with Water and Energy
IConservalion Features
1 Energy pt
13.Install Energy Star Refrigerator
1 Energy pt
14. Install Built -In Recycling Center
3 Resource pts
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Walls
2 Energy pts
y=yes
b. Ceilings
2 Energy pts
y=yes
2. Install Floor Insulation over Crawl Space
4 Energy pts
y=yes
14. Insfall Recyclad-Coniant, Fiberglass Insulation with
IND Added Formaldehyde _
3 IAQ/Health pts
y=yes
4. Use Advanced Infiltration Reduction Practices
2 Energy pts
y=yes
5. Use Cellulose Insulation
a. Walls
4 Resource pts
y=yes
b. Ceilings
4 Resource pis
y=yes
6. Alternative Insulation Products (Cotton, spray -foam)
a. Walls
4 Resource pts
y=yes
o. Cailings
4 Resource pts
y=yes
•
•
J. Heating Ventilation and Air Conditioning
r. Use Duct Mastic on All Duct Joints ___�
1 2 Energy pts
2. Install Ductwork within Conditioned Space
I. Windows
3. Vent Range Hood to the Outside
1 IAQ/Health pt
4. Clean all Ducts Before Occupancy
2 IAO/Health pts
5. Install Solar Attic Fan
2 Energy pts
h. Install Energy -Efficient! Wndovrs
1 Energy pt
7. Install Whole House Fan
4 Energy pts
a. Double -Paned
{ 1 Energy pt
y=yes
3 IAQ/Health pts
b. Water Heaters
b. Low -Emissivity (Low -E)
2 Energy pts
y=yes
Through -the -Wall Heal Pumps
c. Low. Conductivity Frames
2 Energy pts
y=yes
11. Install AC with Non -HCFC Refrigerants - ,
2. Ins(ell Low Heat Transmission Glazing
1 Energy pt
y=yes
J. Heating Ventilation and Air Conditioning
r. Use Duct Mastic on All Duct Joints ___�
1 2 Energy pts
2. Install Ductwork within Conditioned Space
3 Energy pts
3. Vent Range Hood to the Outside
1 IAQ/Health pt
4. Clean all Ducts Before Occupancy
2 IAO/Health pts
5. Install Solar Attic Fan
2 Energy pts
6. Install Attic Ventilation Systems
1 Energy pt
7. Install Whole House Fan
4 Energy pts
S. Install Sealed Combustion Units
14. Install Zoned, Hydronic Radiant Heating
a. Furnaces
3 IAQ/Health pts
b. Water Heaters
3 IAQ/Health pts
9. Replace Wall -Mounted Electric and Gas Heaters with
16. Install Heat Recovery Ventilation Unit (HRV)
Through -the -Wall Heal Pumps
3 Energy pts
10. Install 13 SEER/11 EER or higher AC with a TXV
3 Energy pts
11. Install AC with Non -HCFC Refrigerants - ,
2 Resource pts
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pts
y=yes
13. Retrofit Wood Burning Fireplaces
10 Energy pis
y=
• a. Install EPA certified wood stovesrinserts
1 IAQ/Health pt
y=yes
b. Install/Replace Dampers
1 Energy pt
y=yes
c. Install Airtight Doors
1 Energy pt
y=yes
14. Install Zoned, Hydronic Radiant Heating
3 Energy pts
yryes
15. Install High Efficiency Filter
4 IAQ/Health pts
y=yes
16. Install Heat Recovery Ventilation Unit (HRV)
5 IAQ/Health pts
y=yes
17. Install Separate Garage Exhaust Fan
3 IAQ/Health pts
V_–Vas
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
4 Energy pts
y=
2. Install Solar Water Heating System
10 Energy pis
y=
3. Pre -Wire for Future Photovoltaic (PV) Installation
4 Energy pts
y=
4. Install Photovoltaic (PV) System
(t.2 kw = 6 points, 2A kw =12 points, 3.6 kw = 18 points)
Up to 1 B Energy
!6. Select Saie and Durable Roofirig Materials
1 Resource pt
y_
7. Install Radiant Harrier — _— _ __
_ 3 Enerav ots
v
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating 5 Energy pts
2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts
3. Plant Deciduous Trees on the West and South Sides 3 Energy pts
0
11. Use Lbw VOC Paint
— — — –
2. Use Low VOC, Water-based Wood Finishes
3. Use Low/No VOC Adhesives - -
4. Use Sa vaged Materials for Interior Finishes
5. Use Engineered Shaet Goods with no added Urea
Formaldehyde
6. Ose Exterior Grade Plywood for Interior Uses
7. Seal all Exposed Particleboard or MDF
8. Use FSC Ce of ed Materials for Interior Finish
9. Use Finger -Jointed or Recycied-Content Trim
10. Install Whole House Vacuum System
N. Flooring
1 IAQ/Health pts
y=yes
21AO/Health pts
y --yes
31AQ/Health pts
y --yes
3 Resource pts
y --yes
61AO/Health pts
y=yes
1 IAQ/Health pts
y --yes
41AQ/Health pts
y=yes
4 Resource pts
y=yes
1 Resource pts
y=yes
3 IAQ/Health ots
v=vas
1. Select FSC Certified Wood Flooring
6 Resource pts
2. Use Rapidly Renewable Flooring Materials _ _ _
_ JJ 4 Resource pts
3. Use Recycled Content Ceramic Tiles
4 Resource pts
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
5. Use Exposed Concrete as Finished Floor
4 Rasource pts
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
Total Points Available:
Total Points Project Received:
- - -.-- -1 - . -
is
1401 1301 57 •
01 0 0
G:daialprogslgmenbu7dnggtidelineshemodele,lgmenpointsfne121204prmecledAs
OWNER -BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A. All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked, complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City
Phone # State License # Type of work to
be performed
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner -Builder Information (reverse s'de).
Property Owner's
Signature: B1'%7.t
,'/Date: 7 z)-, o c�
job Address: �F� �� y�e� l!� �d C �_u pP ao j50/y Permit #
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
. • Department.
City of Cupertino Building Departmen
1 Cin ()f 46
10300 Torre Avenue
CO P E IST I N O Phone: (408) 777-3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner -builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself, you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer, you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law, contact the Internal Revenue
Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your
obligations under state law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees, without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department, •
City of Cupertino
Printed on Recycled Paper
0
Signature
Please check applicable subcontractors and complete the following information:
Date
r
Owner/ Contractor Signature
%- 1%'®l-
Date
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
r
Owner/ Contractor Signature
%- 1%'®l-
Date