08090044 CITY Ot'CUPERTINO
BUILDING DIVIAON PERMIT ,,,,CO 1 R "CTOR4N.�OR�MATIQN,
aaul�gti'YT'B'ENISON AVE NATIONAL ROOTER 0809Ug
044 '
OWNERS NAME: PERMIT ISSUE DATE
PHILIP BOHANNON & EMILY 2911 MONROE ST. 09/09/2008
O ^ SANITARY NO, CONTROL N0.
(408) 241-0887 _ —
ARCHITECnENGINEER: BUILDING PERMIT INTO
BLDG ELECTPLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION O O O O
1 hR
hereby ann Nat 1 am licensed under provisions of Chapter 9(commencing Job Description
U
_U with section 70Ml)ofDivision3of&BudeemmlProfessionsCudc.sedmyBecome u INSTL 40 GAL WATER HEATER
a.
ro„ in full Toro W erc�LO:.g 7�r'I.?O f)
�qz p.naeCl CO .
NOTE: NATIONAL ROOTER BSL RENWD 9/9/8 '
eepp RCHRECTS DECLARATION
Y W O 1 understand used nd my Plana shall ed a public records
ono Licensed Professional
OWNER-BUILDER DECLARATION
F 1 hereby aM m that I am exempt from the Contractor's License Law for do
00 following mason.(Seedon 7031.5,Business and Professions Codc:Any city or county
$t'i which requires a permit in construct,a]Am.improve,demul W,nr repair any structure
_t< prior An its iauaxe.sign ret,ines thcapplicust farsuch Permit in Bic a signed suament
FF that heis licensed rotational tothe psovimunifthe Conlowl's Licares,Law(Chapur9 Sq.Ft. Floor Area Valuation
y�0 (commencing with Section TWD)of Division 3 of the Busnnsa
sd Prof'ons Code)or $1025
that he b exempt thnefrms and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of
.imam Win five hundred dollara(lmx0Number Occupancy
. 31628022 .EType
❑I,as owner clubs proptaty,or my employees with wage a their sole compensation,
will do the work,and the sWmme is Out imundcd oraRertd for sale(Sec.7016,Business
atW Pnfcssoes Cade:760 CO,Oc s License Law don not apply in An awnar of Required Inspections
property who builds or improses thsrton,and who does suchwark himself orthrougb his
awn cmplayen,provided that such improvements Are not intended oroffued f rsale.B.
however,the building or Improvement is mid within ane year of mmpletio n.the owner-
builder will have the When of proving that he did not build or improve for purpose of
❑1,as Owner of the property am exclusively contracting with licensed convectors to
construct the project(Sec.7064,Business and Professions Cade:)The Canuscmh U.
conic Taw does not Apply in An owner of property who Wilds or improves Merton,and '
who contracts for such projects with aconracwr(s)licensed pursuant As the Contractor's
License law.
❑Tamaunptumersec. .Bapcimtuamaon _.
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby a0irn under penalty of perjury one of fallowing dnclantimm,.
1 haw and will maintain a Cudfiauof Consenuo self-insert for Worker'sCompton-
ation,As provided far by Section 3700 of do Labor Code,far the pcdo..of de
Zfor which Nis pewit is issued.
have and will maintain W erase.Compensation Insurance,As required by Section
1
of the Labor Cade,far the peRormuRn of the wort for which this permit is Wood
My Worker's Compensation Insurance aria and Polityn saber are �f
Carrier: A�-KYJU/Y�I Policy No.: a r/ CrsZ
�® wifn Fl 1E F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(lhumcdm need ambecomple¢d UIk permit is for.hundred dollars(SIM)
or leu)
1«nify duo in the performance of IW work for which this Permit is issued.l shall cot
employ any permn in my manner an As b become subject to do Waloori Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,ager making Nu Cenificem of EumptIon,you should
become subject in the Worker's Compensation provisions of do L bar Code,you harts
.J O forthwith comply with such Provisions ar,this permit me]W dcemed n voted.
z N
CONSTRUCTION LENDING AGENCY
[—� I hereby alGrm that Vert is a constriction lending agency for die perfarmana of
the wish for which this permit Is issued(Sec.3097,Civ.C.)
W Q Lender's Name
Z) z Undoes Address
fJ Q 1 codify wt 1 have and thia application and .in that th<Above infmmauun is
U,5 ews eI agree b comply with sill city and cowry ordinances and sou laws relating to
.C) Wilding Wilding consrvction,And hereby athodx upmsanutives of this city to cote,upon the 6azz
•hove-mcnudgm property an ex enies puryoms �/`i/V
�" fY (We)agree to ave,indemnify and keep harmless the City of Cupertino against
h in Criueajudg Of
and expenses which may in ay way xmoagsirtstsaid City
t.)z inconsequence of the granting of Nis D WILL
^ SOURCAM UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date U
SOURCEtE6jIlAT10NS� �����
w', E' Re-roofs
signer �.17Alicausucimusuctor
HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant or future Wilding occupatso n or handle haarduns mawnal
As darrmd by do Cupertino Municipal Cade.Chapter 9.12,and the Health and Wally
Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yos �ro
pplicant of future Wilding Occupant use equipment or devices which g p
If a roof is installed without first obtaining an inspection,I agree to remove
Will the a
it harWnus air conumhunts As deflated by the Bay Ansa Air Quaky Magcment all new materials for inspection.
❑Yes
I have mad the Wardsw materials mquimmrnu under Chapter 6.95 of the Califon.
nia Health&SafelYCads.Sactiom 25505.75533wW 25534.1 understand dos ifdo Wilding
does not concndy have a¢none that it u my respansiNliry m ramify de orsuprm of de
mquire hichmanx car issuancearacerdroaoaraaPatmy. Signature of Applicant Date
own ar.athnrirrd.g rat _ Dam All roof coverings to be Class'f?"or better
CITY OF CUPERTINO
• 5 ITEMS OF 5 PERMIT RECEIPT. OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN 31628022 . 00
DATE ISSUED. . . . . . . : 09/09/2008
RECEIPT # . . . . . . . . . : BS000006033
REFERENCE ID # . . . : 08090044
SITE ADDRESS . . . . . : 10197 DENISON AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO '
IMPACT AREA . . . . . . .
OWNER PHILIP BOHANNON & EMILY UNDER
ADDRESS . . . . . . . . . . : 10197 DENISON AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2426
RECEIVED FROM . . . . : NATIONAL ROOTER i
CONTRACTOR . . . . . . . :RONALD J. PEREIRA LIC # 25124
COMPANY NATIONAL_ROOTER
ADDRESS 2911 MONROE. 'ST.
CITY/STATE/ZIP . . . : SANTA CALARA, CA 95051
TELEPHONE (408) 241-0887
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 1, 025 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 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
ITRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 216 . 56 0 . 00 216 . 56 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 216. 56 #4141
---------------
TOTAL RECEIPT 216. 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----- ---------------------------- -------- ----------------------------
518 WATER HEATER
•
409 ON 4
CITY OF CUPERTINO
WATER HEATER
CITY OF
• CUPERTINO PERMIT APPLICATION FORM
APN #
Building Address:
/ d / 1I7 � v<svu
Owner's Name: Phone #:
A/7i / S641- 7c993
Contractor: Phone #: z, //_p sw7
Fax #:
Cupertino Business License #: Contractor State License #:
1Z 7
Contact: Phone #:
ROIL) Fax #:
Building Permit Info:
Bldg ❑ Elect �/ PlumbR Mech
Residential Commercial ❑
Job Description:
O Via, Gofer` eGtQ�
Strapped ® On Platform ® Bonded ® New Location ❑ Replacement
Valuation (cost of project):
/UZS�
Project Size: Express ❑ 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 Buildin Points achieved: t`
Revised 6/16/08
CITY OF CUPERTINO
SUM
WATER HEATER
CITY OF
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BSEISMICOM Seismic Commercial B
IPRWHEATR Residential Water B PRWHEATR
HeaterNent
r 1BSEISMICRE Seismic Residential B
I PPERMITFEE Plumbing Permit P
1 TRAVDOC Travel & B
Documentation
M 1BUSLIC Business License B
p
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. Ener Star Refrigerator, (Note/Spec.) A-3 1 point
P. Other 1. List Green Features on Plans A.1 1 point
MOMAIMMERM TOTAL POINTS1 40 points
•
Plan Review Process Work Book Page A2-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 AG/HealT.,
A, de
1.Recycle Job Site Construction&Demolition Waste
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 Stormwater 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 p
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes 0
1
C.Structural Frame - 1 1
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
0
b.Wall 3 Energy pts `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
a.Subfloors 1 Resource pt y=yes 0
• b.Sheathing 1 Resource pt y=yes p
1
INPUT Resources Energy IA011-lealth
I.Windows -
1.Install Energy-Efficient Windows
a.Double-Paned 1 Energy pt Y--yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yes0 •
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
1.Use Duct Mastic on All Duct 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 21AQ/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 31A0/Health pts y--yes 0
b.Water Heaters 31AQ/Health pts y--yes 0
9.Replace Wall-Mounted Electric and Gas Healers with
Through-the-Wall Heat Pumps 3 Energy pts y=yes 0
10.Install 13 SEER/1 I 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 stovesfinsens 1 IAQIHealth pt y=yes 0 •
b. 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 IAQfHealth pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 AQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 31A0/Health pts y=yes 0
1 1 I
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=1 B points) Up to 1 B Energy pts 0
6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pts y=yes 0
1 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
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 1
Community Development
10300 Torre Avenue
It Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
*UPER,TINO
Building Department
JOB ADDRESS: PERMIT # CU I `I
101? 7 0 `t
OWNER'S NAME: PHONE # S6
GENERAL CONTRACTOR: 4 ,� ,� 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
fP
lastering
lumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
• 'i� Lam,.>�� 9-9z��
�er/Contractor Signature Date