08080039 CITY OF CUPERTINO
BUILDING'mwslON • PERNIITCONTRACTOR,INFORMATIO,N
x as,+� "<u+r' ,'xzV, aP lo'2t .a-C?Aa
BUIL gINT DRESS: PERMIT NO.
/�g CLIFFORD. DR CUPERTINO PLUMBING 08080039
OWNER'S NAME: - PERMIT ISSUE DATE
B kOESCH GLENN L AND RITA L 1300 DELL AVE STE C 08/05/2008
NE: SANrfARY NO. CONTROL NO.
(408) 253-0618
7ARCHrrECUENG[NEER: BUILDING PERMIT INFO
BLDG EPLUMB MECH
u 0 LICENSED CONTRACTORS DECLARATIONIOb D05CTI UOn
1 hcmby of inn Nal 1 am licensed umkr provisions of Chapter 9(commencing PSection7OBE)ofDivision3ofWeBudrcvWProfcssi``on1sCode.an!mylicenscu COPPER REPIPE/WTR MAIN/WTR HTR
ll forte arldeRat. ZT 9 cense a __ Lm.a
=p Date Camunor -- o
7W7W ARCHITECTS DECLARATION
r < 1 understand my plan shall be used as public records
g 0.t; Liconed Proftool
OWNER-BUILDER DECLARATION
1 borthy vlErm Nat I am exempt from Ne Conoanor's License Law for me
C o O following mason.(Scedon 7031.5.Business and Profession Cods:Any city or county
2 f., which mqui.a Permit W conatroc6 allu.improve.demolish,or repro,My swcom
=j, prior to in issuance,also mqumn me applicant forsuch Permit a rile a signed onemenr
< that he is licensed puu
rsuanoWeprovisionofWeConuzctorsUnmealaw(Chapter9 Sq.Ft. Floor Area Valuation
o
e52 (commencing with Section 7000)of Division 3ofWeBusiness anal profession Code)or $4000
that he u exempt thraerrom and We basis for We 41cpd exemption.Any violation of
Section 9031.5 by any applicant for a permit subjects We applicant in a Civil penally Of �,pN ccu ane
not mom Onto live hundred dollars(SM 3 6 9 2 7 0 41 .)ff Number OP Y T'Pe
❑I,..of the property.a my employees with wag.as their role compewtion,
will d0 me work.and Iheounum is not intended or m2red for sale(Sec.7044,Business
and Profession Code:The Com uses License Law da.Out apply m an Owner of Required Inspections
property who Wilda lir improves thereon,tib who do.,.h wart himself or through his
Own employees,provided that such improvements scent intended unfitted for alp if.
however.the building or improvement is sold within one year of completion.We owner-
Wilder will lure the burden of proving that he did not mold or improve for peT.e of
sale.).
❑L as owner of the property,am exclusively comenoing with licensed Contractors N
construct the project(Sec.7044,Business and Profession Code:)The Contractor's Li-
«lie law does net apply to an owner of property who Wiltla or unproven Warton,andt.
who conmacts for such projects with arnnuscbRs)licensed Fortune,to We Centimeters
Lieenm Law.
❑lameaemptunderSee, ,Bk PCIOrinism.on
Own. Date
WORKER'S COMPENSATION DECLARATION
I hereby a(Tum under penalty,of perjury mw of the following dalarmion:
I ham and will maintain aCudlicete of Co..,m self-ilium for Worku'sCooper-
.tion,u Provided for by SuMm 3700 of the Lather Code,for We performance of the
work for which dun Permit is issued. \
gj- end will maintain Workch Compensation Insurance,.required by Section
3700 aNe Labor Code.for the Pufurn.of We work for which this permit u issce4
My Wori¢(a Compensation W.rartce carrier and Policy number am:
Cartier:�, 7' jfn(Poliry No.: IS 53- y-�VI
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu min need rot lacompleted ifdw permit I.for enc Wedmddollars(SIOM)
or less)
I arufy dust in We puromaac Of We wort for which this permit is cement.l shall ON
employ any person in any manner.as N become object to We Wosen'Compensation ,
Laws Of California.Date
Applicant
NOTICE TO APPLICANT:IL after msking this Certificate of Exemption,you should
become subject On the Worrier's Compensation provisions of We Labor Codes,you most ..
.,O forthwith comply with such provision of Nu pupil be dcemeA numbed.
'Z y CONSTRUCTION LENDING AGENCY
[-+ 1 Wmby affirm NU Were is a mnruction lending agency for We performance of
G' > Nes were for which Nis permit It issued(Sec 3097,Civ,C)
W 0 lattices Nene
Dz landefa Addre.
U O I cutify that 1 have red this application arch sure the We above iNoroutico u
{7.E cortat 1 agree In Comply with all city sem county ordinances and some laws misting N
O Wilding convection,and Wmby auho ee representatives of Nu city to enter upon We
shove-rocnuened property for is pecuen purposes
y (We)agree to nM indemnify sed keep herculean me City of Cupertino against
fI1 Iia consequence ftheStartingOfyeneswhish may In my way accrue againt.id City
U z in consequence Of the granting of this permit
" APPLICANT UND ANDy71N ��L CO PLY WITH ALL NON-POINT Issued by:
Re-roofs
Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Neapplicant or(mum Wilding .Chaptnom OrhandleHealth Mod
C de.So by dm CupeNno Municipal Codes.Chapter 9.13.,lid We H.Im amf Safety
Code.s Cl Y.
zss3zU)7 All roofs shall be inspected nor to an roofing material being❑res e� P P � Y g g installed.
Will We applicant or future molding occupant lie equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hCarre.air coo.mirunts ss defircA by We Bay Atha Air Quilty Management all new materials for inspection.
wsoiu7 P
❑Y. t
I hem mal We bvaNaam,uual,mtNircmems underCNpter 6.9sofine Caliror-
nia Heal"Safety Cade,Section 25505,25533 and 25514.1 understand Waif de building
dna not�fly Lsews' ' my mapornihility o ma�=p=t Neeg tf.CerdrteawSignature of Applicant Date
oG JAll roof coverings to be Class'J�."or better
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36927041 . 00
DATE ISSUED. . . . . . . : 08/05/2008
RECEIPT #. . . . . . . . . : BS000005695
REFERENCE ID # . . . : 08080039
SITE ADDRESS . . . . . : 6716 CLIFFORD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BLOESCH GLENN L AND RITA L
ADDRESS . . . . . . . . . . : 6716 CLIFFORD DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4558
RECEIVED FROM . . . . : CUPERTINO PLUMBING
CONTRACTOR . . . . . . . : CARDIA, FRANK L LIC # 612
COMPANY . . . . . . . . . . : CUPERTINO PLUMBING
ADDRESS . . . . . . . . . . : 1300 DELL AVE STE C
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 253-0618
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------ -- ----- ---------- ---------- ---------- ---------- ----------
1BPWATER UNIT 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1.13PWSVCS WATER SERVICE 1. 00 20 .40 0 .00 20 . 40 0 . 00
IPPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1PRREPIPE NO OF FIXTURE 1 . 00 10 . 20 0 . 00 10 . 20 0 . 00
113RWHEATR UNITS 1 . 00 24 . 48 0 . 00 24 . 48 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT . 177 .45 0 . 00 177 . 45 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
- --------------- --------------------
CREDIT CARD 177 . 45 VISA
---------------
TOTAL RECEIPT 177 . 45
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 301 ROUGH PLUMBING
507 FINAL PLUMBING
•
0 �9
CITY OF CUPERTINO
5 REPIPE/SEWER/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # 99? -20
vl, Date: 8 5 O 8
Build in Address:
Owner's Name: Phone#:
Contractor: Phone#: 25 3 -Or�. t £3
Fax #:
Contact: Phone#: '
�(G n Fax #:
Contractor License#: 1�2 e4,
(�
Cupertino Business License#:
Job Description:
Ccs, f2e ff— lWaA-c-e- M r\ l\W,+�
4IResidential ❑_�_ Commercial ❑
Valuation:
Project Size: Express Standard 0 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 Descriptio-n7 Fee Permit Type
Group
1PCSEWER 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
r
CITY OF CUPERTINO
Q' REPIPE/SEWER/MAIN SERVICE
CUPERT`INO 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
1PCESS Cesspool P
1BPWATER Install/after Water Pipe P
1BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS Gas Piping System 5+ Outlets P
IPPERMITFEE Plumbing Permit Fee Issuance P
1PLMBLNCK Plumbing Plan Check P •
1PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel & Documentation Fee B
/ 1BUSLIC 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 7points 11. Permeable Pavin Note L-1 C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 5. Use Truss with heels, (detail) S-2 6. B. OSB Sheathin detail S-2
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 point
P. Other 1 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 40 points
•
•
Plan Review Process Work Book Page-I2-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 Res=es Energy ]ADII-leafth
f 7 Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;B0%=4 points up to 4 Resource pts 0
12.Salvage Reusable Building Materials 4 Resource pts y--yes 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 of 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
IS.Design Aesource-Efficient Landscapes and Gardens 4 Resource pts y=yes 0
9.Reuse Matenals/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=yas 0
1
C.Structural Frame I !
,1_Substitute Solid Sawn Lumbar with Engineered Lumber - 3 Resource pts y=yes 0
2.Use FSC Certified Wood for iraming
(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 Ceilincs 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 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 p
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.She 1 Resource pt y=yes p
INPUT Resources Energy ]AWHealth
.Exterior Finis
1.Use Sustainable becking Materials
a.Recycled content 3 Resource pts y=yes D •
b.FSC Certified Wood 3 Resource pts y--yes0
'2.Use Treated Wood That Does Not Contain ChromiuMArsenic 1 IAO/Health pt y--yes 0
i3.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
14.Use Fiber-Cement Siding Materials 1 Resource pi y=yes 0
1 1 1
E.Plumbing
11.Install Water Heater Jacket _ 1 Energy of y--yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
i3.Retrofit all Faucets and Showerheads with Flow Reducers
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
ib.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0
14.Replace Toilest with Ultra-Low Flush Toilets
I(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAQ/Health pt y=yes 0
6.Convert Gas to Tanklass(Nater Heater 4 Enargy pts y--yes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pis. 0
S.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
r.eiecmcai
1.Install Compact Fluorescent Light Bulbs(CFLs)
1(6 bulbs=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
i i 1
G.Appliances
1.Fn—stall Energy Star Dishwasher 1 Energy pt y=yes 0
i
12.Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y=yes 0
13.lnstall Energy Star Refrigerator 1 Energy pt y=yes D
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=yas 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
3_.Install Recycled-Content,Fiberglass Insulation with -
No Added Formaldehyde _ 3 IAQ/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 D
b.Ceilings 4 Resource pts y=yes C •
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
o.Uenings 4 Resource pts y=yes D
1 1
. in ows INPUT Fesounces Energy IALYHealth
1.Install Energy-Efficient Windows
• a.Double-Paned 1 Energy pt y yes D
b.Low-Emissivity(Low-E) 2 Energy pts y=yes D
c.Low.Conductivity Frames 2 Energy pts y=yes 0
Z.Install Low Heat Transmission Glazing 1 Energy pt y=yesD
1 f 1
J.Heating Ventilation and Air Conditioning
,1.Use Duct Mastic on All Duct Joints 2 Energy pts y=yes D
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1.IA0/Health pt y=yes D
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y--yes 0
5.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y--yes D
7.Install Whole House Fan 4 Energy pts Y--yes 0
6,Install Sealed Combustion Units
a.Furnaces 31AQ/Health pts y=yes 0
b.Water Heaters 31AQ/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 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stovestinserts 1 IAQ/Health pt y--yes 0
b. Install/Replace Dampers 1 Energy pt 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 IAO/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y--yes p
1 i 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-Mra 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=16 points) Up to 15 Energy pts 0
6.Select Safe and Durable Roofing Materials _ _ 1 Resource pt y=yes 0
7.Install Radian t Barney 3 Energy pts y=yes 0
1
L.Natural Heating and Cooling 1 I
1.Incorporate Passive Solar Heating 5 Energypts 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 Energy pts y=yes p
1 1 1
•
.In oor Air Quality and Fmishes
1.Use Low[No-VOC Paint 1 IAO/Hsalth pts y--yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
j3.Use Low/No VOC Adhesives 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 D
t7_Ssal all Exposed Particleboard or MDF 41AQ/Health pts y=yes D
B.Use FSC Ce tifiad Materials for Interior Finish 4 Resource pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes D
10.Install Whole House Vacuum System 31AOIHealth pts y=yes 0
! f f
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
�2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycied Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAO/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yas 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yesN. 0
1 t 1
Total Points Available: 1 1401 1301 57
Total Points Project Received: //� � 01 01 0 •
G:datalpmgslgreenbuildingguidellneslremodelerslgreenpointsfinal2.12.04protemed.xls
•
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: G(e, ,n Q loe sal` PHONE # -2-5-2 2'7
GENERAL CONTRACTOR: c _�� FAX #
I am not using any subcontractors: (6- S-U8
Signature Date
Please check applicable subcontractors and complete the followin 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
�r/Coniraictor Signature Date
. . , �.
, .
' o
_ _ _ �, •
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