08050106 BUILDING DIVISION PERNUT s CONTRACT$aR�INFORNySATIOIV
BUILDN ADDRESS: PERMIT NO.
� 20 DE PALMA LN TBD – TO BE DETERMINED 08050106
EWS NAME: PERMIT MUE DATE
ALEXANDER FERTELMEISTER 05/13/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
X00 LICENSED CONTRACTOR'S DECLARATION Job Description
m I hereby affirm Net 1 un liaisedCSCiIp
under provisions of Chapter 9(commercial
wIN$aYOn]BTIB)Of DIVILnrIJa(dY BYGI1eV and PN(CiSinN COdC.lad myllCeaS la WATER HEATER REPLACEMENT
_ N Ice full tome and effect-
v�Z Neeson Clue Tic.0
F Dam Contractor
g ARCHITECT'S DECLARATION
ZZ 1 undewnd my Plus Mall he used u public raor
gs
yGt; Licensed Professional
3 OWNER-BUILDER DECLARATION ...
E 1 hereby IT..that I m exempt from Ad Contractors Liana I-so,for the
C20 following moon.(Section]03 1.5,Business and Professions Cmk:Any city or County
which mr,.b ,•pmmit to cmuuuat aluc.unptow,dcmulitb.or repair any aware.
prior m its issuance.Msu mquids the applicant forsuch permit to Ek a signed summent
that he is uansedp roman in As,provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Areaz�$ $736 Valuation(commencing with Section 7DDD)of Division S of Oc Business and Professions Code)or
— Nat he is m mpt therefrom awed dee basis for the alleged esemplion.Any violation of
Section 7031.5 by any applicant for a permit mbjecu the ap IRCUL W a Civil penally of
nm mous pun five hundred dollars($50a 36932058q�Number Occupancy Type
❑Cuawrcr of the PropenY,mmy mployw wide wagesude'v role cmnpeaada,
will dethework,andtheaumumators I mawdo apply
to as,Hnerof
and ertywh ou Crede:The Contractors Livnm lace don not apply to rt Awrcr M Required Inspections
pmnmploycbuildsmimprovdemon,aMwumnauchworkhimfef wW his
awn ver.An a,pmvided improvement
year dWmicoon.fmaatel,
however,the building urimprovmatssold edid ut year of Completion,the purpose
of
builder will have,As buNa of pmvine that K did Out build m improve for purpnre of
isle.).
❑1,as mune,a Am propeny am exclusively conuamins with licensed contractors Is
construct the Project(Sec 7044,Business and Professions Code:)The Conuactets U.
Mase Law does not apply in an Owner of property who builds or impow Acuson.and.
who Contracts for such projects with a conuanm(H licensed pmausnt to the Contractors
Lice.Law.
.to under See �//� .B d PC for this name
r v �2W/�Dam r o
WORKERS COMPENSATION DECLARATION
I hereby stand under penalty of purjusy one,of dee following dedarsam ns:
❑thaw and will for by Session
of Consentrs Crash.
Waorm.mPa-
salon,r provided pe ed Section 3]00 0(de labor Code.for dee PeAomurcu of the
work for which this permit is lural
❑1 have and will maintain Workers Compeuauon Laurance,as required by Section
3](IOof dm labor Code.for the pmfmmarcc dldee work fmwhich this Pe.I,is issued. '
My Workers Compeuauon Iceman amid and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This scorns need not be compicmd lftle Permit is fords hundred dollars(5100)
or less) ..
1 Ccrtifv that In the perfosmaace of the work for which this permit Is issmd,l shall not
cunploy any person in any marcrm u to bccrme dbjeet to Ore Worked'Compensation
Laws of Calif arpiC Dis_47;
Applicant !J— �' _4 (1L1_,
NOTICE TO APPLICANT:IC after making this Certificate of Exemption,you shard
become subject m the Workeri Compensation provisions of dee tabor Code,you moa
.J O le nhwith comply with each provision ew this Permit shall be Commit reveled.
'Py CONSTRUCTION LENDING AGENCY
[—r .+ L hereby affirm Loss Ame a a corswNm lending agency,for dee pmicon.a
C the weak for which this Permit is issued(Sec.3097,Civ.CJ
Irl Q Lender's Name
Oz LemiCes Add.
U O 1 mtify that 1 haw teal W,application sad sum that Au above inform dem is
t-4 F coronet-I agree to comply wide all city and county ordinsmrs aM sae laws rerun/to
U beading Construction,and hereby ademia mpmaenutiws of One city to enerup a the
above-mentiorcd property for iapenian Amperes
F y (We)agree to cow,indemnify ad kap harmless the City of Cupertino against
fA liebiliUCsjWgmens.cosu and ups-...which may Aany way amre against said City
Uz A APPLICANT
oftheet TANdf this WIL -
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
souRfjERrut,AnyNsE���cc.2l0—
�'' ffRliianOCo Re-roofs
Signature at AppliaWConaanor pad
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicants m future building occupant Anne Or handle huardous namou l
Breed by the Cuper ire Municipal Code.Chapter 9.12,and the Health and Safety
Seen.255320)7 ) All roofs shall be inspected prior to any roofing material being installed.
❑Yet dNo
Will Ac Applicant or future building Occupant we If a roof is installed without first obtainingan inspection,I agree to remove
PP E P ea Air Qtt or Marta which Pe
emit hrradna air conuminsns u defined!by the Bay Area Air Quality Management all new materials IOC inspection.
District? P
0Ya Dd rvu
1 hew mal dee hamout
rr mrialsmquidmems un4r Chapmr6.95 of theGlifm-
nu Hnide hSafcty Code,Smram25505.25533 md25534.TunderAad densities building
does not currently ham a moat-that 11 is my responsibility to nobly dC Occupant of the
mquim uwhichmathemeL rtoiaana a Emmefocen Signature of Applicant Date
TZ"'Z�.��.7 734
Owner or athod=d agent D,m All roof coverings to be Class'%f{.a'or better
CITY OF CUPERTINO
• 4 ITEMS OF '4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36932058 . 00
DATE ISSUED. . . . . . . : 05/13/2008
RECEIPT # . . . . . . . . . : BS000004751
REFERENCE ID # . . . : 08050106
SITE ADDRESS . . . . . : 20020 DE , PALMA LN
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ALEXANDER FERTELMEISTER
ADDRESS . . . . . . . . . . : 20020 DE PALMA IN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3189
RECEIVED FROM . . . . : ALEXANDER -FERTELMEI
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 736 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1PRWHEATR 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 106 . 56 0 . 00 106 . 56 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 106 . 56 MC
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---- ---------------------------- --------
----------------------------
518 WATER HEATER
• uuR CITY OF CUPERTINO
WATER HEATER
CUPERTINO PERMIT APPLICATION FORM
APN# 2/ Date:
—C--
Building
-Building Address: Q /� /�
®G2 L A? l i�t cc 4 6�z � ��� 3-
Owner's Name: / Phone #:
/3 k Z
Contractor: Phone #: (L(0 (86 q y1(
JOcO�"( �ot(/� ✓Gtr Fax #:
Cupertino Business License Contractor State License #:
• Contact: A-el VL C�- Phone #: q0T Fj"/y(, g y(/
Fax #:
Building Permit Info:
Bldg Elect Plumb Mech
Residential Commercial ❑
Job Description:
"(4r ffe'jt4, k io—f
Strapped ff�—On Platform ❑ Bonded D— New Location a Replacement [�
Valuation:
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 achieved: Z�— --
-� CITY OF CUPERTINO
.' � WATER HEATER
•
CITY OF PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
IPCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BSEISMICOM Seismic Commercial B
/ 1PRWHEATR Residential Water B PRWHEATR
/ HeaterNent
/ 1BSEISMICRE Seismic Residential B
(� 1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel & B
Documentation
1BUSLIC . Business License B
CITY OF CUPERTINO
"-��� WATER HEATER
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
Owner's Name: Phone #:
Contractor: Phone #:
Fax M
Cupertino Business License M Contractor State License #:
Contact: Phone #:
Fax M
Building Permit Info:
Bldg ❑ Elect El Plumb ❑ Mech ❑
Residential ❑ Commercial ❑.
Job Description:
Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement ❑
Valuation:
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 achieved:
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
,lPlans See below ri
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. Ener Star Refrigerator, (Note/Spec.) A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
Vc... 'IM TOTAL POINTS1 40 points
• 64Xate
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 A01Health
A.Site
1.Recycle Job Site Construction&Demolition Waste 1
65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0
2.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 pt y=yes 0
6.Implement Construction Site Stormwarer Practices 2 Resource pts , y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
8.Design Resource-Efficient Landscapes and Gardens _ 4 Resource pts y=yes 0
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
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
I I 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=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
8.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 p
b.Wall 3 Ener is
9Y P 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 ------- '-
• ra.Subfloors I 1 Resource pt y=yes 0
b.Sheathing
1 Resource pt y=yes 0
IN
1 I 1
.Extenor Finis
INPUT ReSDurces Energy AQ[Heafth
,.-Use Sustainable Decking Materials .
a.Recycled content 3.Resource pts y=yes 0
b.FSC Certified Wood 3 Resource pis y=yes 0
12.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health pt y=yes 0
3.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
14,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.Retrofit all Faucets and Showerheads with Flow Reducers
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2 points) I Up to 2 Resource pts. 0
4.Replace Toiled with Ultra-Low Flush Toilets
!(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 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.tiecmcar
1.Install Compact Fluorescent Light Bulbs(CFCs)
,(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
1 1 1
G.Appliances
i1.Install Energy Star Dishwasher - i 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy
IConservation Features I 1 Energy pt y=yes 0
3.Inslall 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 pis y=yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
[3Install Recycled-Content,Fiberglass Insulation
I^I with
Added Formaldehyde _ _ _ 3 IAO Health pis y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5.Use Cellulose Insulation
a.Walls 4 Resource pis 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.ueilings 4 Resource pts y=yes 0
I. endows
• INPUT Resources Energy IA011-lealth
i 1.Install Energy-Efficient Windows
a.Double-Paned 1 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) i 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 1
J.Heating Ventilation and Air Conditioning
E 1.Use Duct Mastic on All Dud Joints _ 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 pt y=yes 0
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 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
b.Water Heaters 3IAQ/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 stovesfinseds 1 IAQ/Health pt y=yes 0
J. 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 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 0
1 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
0
I6 Select Safe and Durable Roofing Materials l 1 Resource pt y=yes 0
7___ __
7.Install Radiant Barrier ' 3 Energy pts y=yes p
L.Natural Heating and Cooling 1 1 1
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 0
• 1 1 I
INPUT ReSOUTces Energy Mfflealth_
. n oor Au uality and Finishes
'1.Use LOW/NO VOC Paint 1 IAQ/Health pts y=yes 0 •
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
I3 Use Low/No VOC Adhesives 31AQMealth pts y=yes 0
- — -- -- - -- - - - -----'
4.—Use Salvaged— Materi—als 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 IAO/Health pts y=yes 0
17.Seal all Exposed Particleboard or MDF — 4 IAQ/Health pts y=yes 0
8.Use FSC Certified Matenals 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 31AQ/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
12.Use Rapidly Renewable Flooring Matenals __� 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
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
1 1
Total Points Availablel 1 1401 1301 57 •
Total Points Project Received: 1 01 01 0
G:dam/progs/greenbuildngguidelineshemodelerslgreenpantsfina!2.12.04prrnec.tedx!s
•
Community Development
f 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
'ItUPEkTINO Fax(408)777-3333
Building Department
JOB ADDRESS• /� PERMIT #
Wo 20 D /ia cod,
OWNER'S NAME: AVPHONE # yob (, (/
GENERAL CONTRACTOR: , c)Ll FAX #
I am not using any subcontractors:
Signature Date
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
S /3 0
Owner/Contractor Signature Date