08090131 CITY OF CUPERTINOx .a -
BUILDING DIVISION PERMIT ,CONTRA-CTORgNF0RMAP0N*`i'*
w K ` Z"
BUILDING ADDRESS: PERMrr NO.
10139 N BLANEY AVE SAN JOSE PLUMBING INC 08090131
NER'S NAME: PERMIT ISSUE DATE
COX JAMES M SR 1732 HILLSDALE AVE 09/19/2008
PNONE: - SANITARY NO. CONTROL NO.
(408) 296-1820
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
boa LICENSED CONIRACr0WS DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
4 ' wiNsctionTglll)arDivi,ion3oldieBusinessaidProfewovGde,andmylicenseu * NO CONDITIONS
_ rn in full fora And effect
y taz License Clu, Liu.0
o s;,q Dam.Conlnewf
ee 7W ARCHRECrS DECLARATION
t 1 understand my plana awl W used a public records
�mmu
G:
Licensed professional
OWNER-BUILDER DECLARATION
dus RATION
.E 0 E 1 hereby,(firm that 1 1. exempt(rum ted fesnions Co Ueense taw for ted
E00 follwhich millions oacom(Satian 7U ostr Bwrtess am pronic.de im L Code:Any city m mm.
S$to whirh su a permit m pi n Set icer,impmw,demalta t m repair any sllemum
_iy prior heisHenancoursuategmen lhovisiosof die Consumeruofile.ceresLrcdstatemcm
E�a IwWuliccnsed pursuant 70th)provisions of theeBusinms and Frseadom Captm9 Sq.Ft.Floor Area Valuation
o commcncin
$ ( emitthesfinat andtheDivides sfr of the Business and Pro Any vi Cade)or 10000
-. that io ls exempt tMaefrom and the bats for the alleged exemption.Any violation of
Suction Ill. .by arty led doll for.001. mbjau the applicant m a ctvil penalty of Number Occupancy Type
not moo than five handled dollars($500). 31623042 . P Y YP
1,a owner of the property.or my employers with wages An their sole compensation,
will da the work and the anucttve Is not intended or offered for aide(Sec.TOM,Business
and Professions Code:The Canuxmrs License Law don Amt appy to an owner of Required Inspections
property who Wild,orimgow s timmosn,and who daes,uchworkhintalfor through his
awocmployen,provided Wt cash imprencmnots are not intended.oReod forsale It.
however,the building or improvement i,aid within arc year of eompleuoe die awar-
builder will have the burden of proving th,l he did wt Wild or improv far purposes of
uta).
❑1,An owner of the property am exclusively contracting with licensed contractors in .
construct the pmjal(Sec.1044.Baines and Professions Code)Ilia Conuxmr's U.
claim Law does n.apply he an ower of propcny who Wild,or imposes Neeson,am. .
who eontaM far Such pmfema with a eolaa or(s)licensed pmNant to the Committee,
Lica.Law.
❑I am exempt undeasea.O
.B k P C f.this reason
m r Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oro of the following declarations:
❑1h, andwillmaintainSC romwof Coventmself-inurefarWeher'aC=Wn-
ation,a provided fur by Seven 3700 of de tab.Code,far the pedorreane of are,
work for which Nin permit is issued.
1 haw And will maintain Worker's Compensation InsWane,As required by Section
37W of the Labor Coon.r.the perfaoure.of the wish fowich this pemtit in issued. '
Ca Worker' Ca ensation Insursnce CA ill and Polity
Grrier.�_Polity No. O n�(Y
CERTI•KATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thlssemloe need not W completed ifft Pcmtit is fare=hunNeduallars(SIM)
en lea)
I mnifv thal in the p.fmmaae of the wish fe,which this permit is bound,l awl not
employ any person in any manner so As in become subject to the Wormis Compensation
Law,of California.Date
Applinnt
NOTICE TO APPUCANP.If;after making Nu Cenificam or Exemption,you should
become subject m the Warkees Compla slide.po wisions of thm tabor Cede you mum
.J O moub-ith 10mpIY with such Pmvidmu.this permit shall W declinedre,okcd.
z CONSTRUCr10N LENDING AGENCY
(~ thereby affmu that Nem is A mommaction lendingageney far the perfmmanceef
!Yi
the sold,for which Nu permit u issued(Sec.3097,Civ.C.)
0.Q Lcndeea Name '
Z)z Iandees Address
U O 1 erify Nat 1 haw read this application am sum dun Ne above informWun u
C4comI atcomply with all city and county onfl and seem relatitom laws ng
D Ua Atom b .n Wilding construction.and hereby authorise opmseaauws of this City in nowupno the
417 ,Trove-menudgm properly for inspection es purposes
a (WO agree to Saw.indemnify and kap harmleu the City of Cupertino against
fI5 li,bilitin,judgmental.cases ani upcnu which may in any way A.atalnst said City
U z in comcguence ofdmg ting of thispermit.
APPLIC NDE AND WILL COMPLY WITH ALL NON-POINT Issued by: di Date
SJJ ULA 5.s
Re-roofs
gnamrt of Appli ntranor
Data G
HAZIRDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding oc,tipantaero or handle haardons material
As defined by the Cupertino Municipal Code.Chapter 9.11,and the Health And safety
.smmuonzss3zp)+ L All roofs shall be inspected prior to any roofing material being installed.
❑Tn /l�Na
Will the Applicant or fame Wilding am, If a roof is installed without first obtaining an inspection,I agree to remove
IW g pant tic equipment.dMana which g
Districts n air contaminants ss defined by IW Bay Area Air Quality Management all new materials for inspection.
QYo ;M No
I haw mal Lhe herandous materials requirements underChapmr 6.95 of the Calif.-
nia Health h Safety Code.Seedmts 155115,25533 am 15534.1 andemarROm
Not
Jan rot currendy hew ten ilu my rnaaihllitY m notify whkhm ted priormissuane ofa Cc stenSignature of Applicant Date
rte tnWimn, gen, All roof coverings to be Class';W'or better
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31623042 . 00
DATE ISSUED. . . . . . . : 09/19/2008
RECEIPT # . . . . . . . . . : BS000006137
REFERENCE ID # . . . : 08090131
SITE ADDRESS . . . . . : 10139 N BLANEY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : COX JAMES M SR
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2329
RECEIVED FROM . . . . : DAVID PLEMON
CONTRACTOR . . . . . . . : GARZA, KEVIN N LIC # 14200
COMPANY . . . . . . . . . . : SAN JOSE PLUMBING INC
ADDRESS . . . . . . . . . . : 1732 HILLSDALE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
• TELEPHONE . . . . . . . . : (408) 296-1820
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BPWSVCS WATER SERVICE 1 . 00 20 .40 0 . 00 20 . 40 0 . 00
1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
IPPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1PRREPIPE NO OF FIXTURE 12 . 00 122 . 40 0 . 00 122 . 40 0 . 00
1TRAVDOC. FLAT RATE 1 . 00 40. 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 225 . 38 0 . 00 225 . 38 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 225 . 38 visa
---------------
TOTAL RECEIPT 225 .38
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- --------- -I
ROUGH PLUMBING 507 FINAL PLUMBING
•
a1 Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
UPEkTOF INO Fax(408)777-3333
Building De artment
JOB ADDRESS: PERMIT #
6CP0 (O( �S
OWNER'S N . ; PHONE # 27
'
GENERAL CONTRACTOR: FAX #
I am not using any subcontract rs: w � v
Signature bate
Please check applicable subcontractors and complete the following information:
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
Owner/Contractor Signature Date
CITY OF CUPERTINO O* 01
REPIPE/SEWER/MAIN SERVICE
ITY OF
CUPERTINO PERMIT APPLICATION FORM
APN# Date: n a3 b�-12 7
Building Address:
Owner's Name: Phone #:
Contractor: Phone#: ( DOS 9 / 7 z4
Fax #: G
Contact: tefPhone#:
/ Yoh �F/ �
�i ✓' ( Fax #:
C tractor License #:
Cupertino Business License#: 4
Job Description: / l
Residential Commercial ❑
Valuation:
00.0
Project Size: Exp ss LJ Standard Large ❑ Major
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set& the sheet index.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
-
Group
IPCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System p
1-4 Outlets
1BSEISMICOM Seismic Commercial p
1BSEISMICR Seismic Residential p
1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
CITY OF CUPERTINO
GQ ' REPIPE/SEWER/MAIN SERVICE
CUPErRTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
IPCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P •
1PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel &Documentation Fee B
IBUSLIC Business License B
Revised 6-16-08
•
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 Pavin , Note L-1 2 points
C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 -__Lpoints
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 Sheathing, detail S-2 2 oints
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A3 2 points
4. B. Fiber Cement Siding, (Note/Spec.) A-4 --LE ints 2 points
F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P•1
5. Tankless W.H., (Note/Spec.) A-1 2 points
11.A 2500 Gal.Tank, (Note/Spec) L-1 10 tints
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 _Lpaints
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A3 1 point
3. Energ Star Refrigerator, (Note/Spec. A-3
___Lpoint
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 40 points
•
•
Plan Review Prot=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.
A.Site INPUT Resources Energy D
[1.Recycle Job Site Construction&Demolition Waste -
65%=1 point;75%= 2 points;B0%=4 points up to 4 Resource pts D
2 Salvage Reusable Building Materials 4 Resource pts y--yes D
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 D
6.Design Resource-Efficient Landscapes and Gardens _ 4 Resource pts y=yes D
9.Reuse Materials/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
2596 Recycled Flyash=2 points;Add 1 point for every 10%
increase of flyash,up to 5 points up to 5 Resource ptsFOO 2.Use Recycled Content Aggregate 2 Resource pts y=yes
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes 0
1 1 i
C.Structural Frame
T.Substitute Solid Sawn Lumber wth Engineered Lumber J 3 Resource pts y--yes D
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--yes 0
5.Design Energy Heels on Trusses 6"or more 2 Energy pts y=yes D
S.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes D
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes p
B. Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes p
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y=yes D
b.Wall 3 Energy pts y=yes D
C,Roof 3 Energy pts y=yes D
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications
12.Use OSB 3 Resource pts y=yes D
— - -
• a.Subfloors 1 Resource pt Y=Yes D
b.Sheathing
1 Resource of y=yes 0
1 1 1
INPUT Resources Energy [AWHealth n
xtenor Finish
1.Use Sustainable Decking Materials
a.Recycled content 3_Resource pts y=yes 0
b.FSC Certified Wood 3 Resource pts y--yes 0
2.Use Treated Wood That Does Not Contain ChromiunUArsenic 1 IAL/Health pt y=yes 0
13.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
E.Plumbing
�1.Install Water Heater Jacket - 1 Energy pt Y--yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
3.Retro61 all Faucets and Showerheads with Flow Reducers
I a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0
4.Replace Toilest with Ultra-Low Flush Toilets
I(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlonne Filter on Showerhead 1 IAQ/Health pt y=yes 0
6.Convert Gas to Tankless Water Heater 4 Energy pts Y--yes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0
8,Install On-Demand Hot Water Circulation Pump 4 Resource pts y--yes 0
1 1 1
r.riectncai
It.Install Compact Fluorescent Light Bulbs(CFLs) •
Lbulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) Up to 4 Energy pts. 0
2.Install IC-AT Recessed Fixtures with CFLs(1 point each,up to
5 points) Up to 5 Energy pts. 0
3.Install Lighting Controls(1 point per fixture,up to 4 points) Up to 4 Energy pts. 0
4.Install High Efficiency Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. 0
1 1 1
G.Appliances
+1.Install Energy Star Dishwasher 1 Energy pt y=yas 0
:2.Install Washing Machine with Water and Energy
IConservation Features 1 Energy pt y=yes 0
l3.lnstall Energy Star Refrigerator 1 Energy pt y=yes 0
4.Install Built-In Recycling Center 3 Resource pts y=yes 0
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls 2 Energy pts y=yes 0
b.Ceilings 2 Energy pts y=yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
3.Install Recycled-Content,Fiberglass Insulation with
No Added Formaldehyde 31AQ/Health pts y=yes 0
�4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5.Use Cellulose Insulation
a.Walls 4 Resource pts y--yes 0 •
b.Ceilings 4 Resource pts y=yes 0
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
o.uewngs 4 Resource pts y--yes I 0
I 1 1
I.Windows INPUT Resources Energy [AD/Healith
1.Install Energy-Efficient-Windows
a.Double-Paned 1 Energy of y=yes 0
It.Low-Emissivity(Low-E) 2 Energy pts Y--yes 0
c.Low.Conductivity Frames 2 Energy pts y=yes 0
2.iristall Low Heat Transmission Glazing 1 Energy of y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
r1.Use Dud Mastic on All Duct Joints `v_ _ _ 2 Energy pts y=yes 0
2.Install Ductwork within Conditioned Space 3 Energy pts Y_—Yes 0
3.Vent Range Hood to the Outside 1 IAQ/Health of 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
B.Install Sealed Combustion Units
a.Furnaces 31AQ/Health pts y=yes 0
It.Water Heaters 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 D
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes D
13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stoves/inserts 1 IAQ/Health of y=yes 0
b. Install/Replace Dampers 1 Energy of y=yes 0
c.Install Airtight Doors 1 Energy of y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 4 IAQ/Health pts y--yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 0
1 1 1
K.Renewable Energy and Roofing
1,Pre-Plumb for Solar Water Heating 4 Energy pts y=yes D
2.Install Solar Water Heating System 10 Energy pis 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=1B points) Up to 18 Energy pts 0
6.Select Safe and Durable Roofing Materials _ 1 Resource of y=yes 0
7.Install Radiant Barrier 3 Energy pts y=yes 0
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 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes p
• 1 1 1
INPUT Resources Energy 1AD/Health
. n oor tr Quality and Finishes
1.Use LowMo-VOC Paint - 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes 0
3 Use LowMo VOC Adhes ves 3 IAQ/Health pts y--yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Ezpoaed Particleboard or MDF _ 4 IAQ/Health pts y--yes D
6.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y--yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0
1 1
N.Flooring
1.Select FSC Certified Wood Flooring 6 Resource pts y--yes 0
12.Use Rapidly Renewable Flooring Materials _ 4 Resource pts Y--yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y--yes 0
5.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes D
1 1
Total Points 1 1401 1301 57
Total Points Project Received: ( , 1 01 01 0
G:daiarprogsrgmenbuildneguidelinesln modelersigreenpolntsfinal21204proletad.xls
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