08040155 CITY OF CUPERTINO �:
BUILDING DIVISION PERNIIT �je'o �TI2A t 0RMATT0N F%
BUI IT! DRESS: PERMIT NO.
�. � DERBYSHIRE DR VALLEY HEATING & COOLING 08040155
OWNER'S NAME: PERMIT ISSUE DAM
ANNE KHECHFE 1171 N 4 TH ST 04/22/2008
NE: SANITARY NO. CONTROL NO.
(408) 294-6290
ARCHITEC(ENGINEER: BUILDING PERMITINFO
-BLDG ELECT PLUMB MECH
Sop LICENSED CONTRACTOR'S DECLARATION Job Descriptionrd F 1 hereby office,Nn 1 am IRxnxd under provisions of Chapter 9(commencing
}f with Section 7")ofDivialon3ofdwDam.and I'micsaiu..C'm!e,andmylicenscis RELOCATE FURNACE TO ATTIC
in full face sad eR L ��Y G
License
anCl a 1 Lk.Is
Cmmcar .
ARCHITECTS DECLARATION
1 turnaround!my Plans Mall he used as Public records
s ta Licensed Profcnional
50 OWNER-attemp ER m Ce Conlr ON
y I hereby maim Inn 1am 1. .sumps from the Cemons Co :Anse Lew for the
O O fallowing muoa.(Section nonstr Business and rood,de oro Calc:Any oily or county
$ which its con a Permit on construct,the alar.WPaw,demolish,11 repair any nrunuro
Primaitsiuusnce.abo ro be the
the ofcant the Con Permit loestrum aw(Cha mens
< (Ind.he commescronsedPunuamaNeprovisionsoftheComncaraLiecmciow(ChaPIm9 Sq'.Ft. Floor Area $ Valuation
mF0
(commencing Secformandthe basisfon roftimBedexteand
on.AnyamCnde)of 3900
$ Nat he b eampl rhemfmm and the basis for bj 3s the esamant M Any violation of
Suction it=lbyairyapplicantfm•pemitobjectsNeapplteantmacivilpenaltyof Number Occupancy Type
not mom Ilan five hundred dollen(SSW). 3 6221027��
❑L as howm of Ne pmpmq,m my ernployces Or offered
ago u Neh m. W.Between
will Pr Newmk atM tie he Co e b ear's Lanes Or o s,de n not apply 0 an Business
and property
ease:The canhwasr,License Los,dee,not apply lf et awmr ter Required Inspections
pan eny srW nt,proAded Lawn thereon ommaca s we not in wart hWself ar through his
own employes,pmrided Nnsuch(mprowmsts we not ear o(c melfarrd(roses.If.
however,Ne building or Wpmvemantgchat withinet ildacompletion,tieawmr-
builder NB low the tarda of proving Nat he did ant Wild m impaw for pulpae of
saeJ.
❑1,as mum of No property,am enelu,iwly contracting with limmu d commusens to
construct the project.(Sec.7044.Business sed Pafssiens Cade:)The Contreemrs W-
onsm Law does not apply a an owner of property who Wilds or improve Nmeon,and,
who contracts for such pmjeets with a contractor(s)licensed pursuant to the Contractors
License low.
❑Iamuemplunder See .Ba PCfor Nipmnon
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hemby aBhm under Wnmty or perjuryoro of Na felewing dwlandom:
1 ham and will maintain,Certifpsts orCoapent to self-intim far Workers Co mpem
sation,as provided for by Suction 37W of Ne lobo Cade.for tite performance of No
work for which this Permit is issued. .
❑I hats and will maintain Workers Compensation Inewana,m required by Section
3700.fft Mbar Came.far the panic...of Ne weak for which this permit is basad. '
My Wo s Compensation Inom.me srnm add Pat be
G r
Carrier, Policy No.; 2 «16513
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
crab section reed set he completed if tin permit Is fmomehundmddaBan(SIM)
or leu)
I modify that In the performance of the work for which Nis permit is issued.I mail net
employ any person in my manncrm n in become abject to the Werkers'Comperuaden
Laws of Califamb,Doc
Applicant
NOTICE TO APPIJCANT:If,aMr making this Cortiante of Exemption,you should
become abject be No Workers Compensation previsions of the Labor Code,you most
.JQthwi
forth comply with such werism m Nb W
aPermit shall domed rowleed.
ZCONSTRUCTION LENDING AGENCY
[-+�+ Ihereby&Mm that Nen is a conwuction lending agency fm the Performance of -
fk
the work far which this Permit Is issued(Sec.309.7,Civ,Q
W Q IenM s Nate ,
r7 z Leaders Address
V Q 1 annify that I haw nod this application and sum Nat the above information is -
Dr aanosm 1 agree a comply with all city and county eminences and sue laws mlatrng in
Q Wilding construction,arm hereby anNorias mpmmma0vea of this city to enter upon tin
W +hove-mentioned property for inspection purp=L
(We)agree u save,indemnify and keep harmless the City of Cupertino against
wap rjj Ilabilidaa,Judgments.costs and sp cams which may in my my ancrow agarutsaid City
in camequmcm of the grunting of this Perot
I'+ APPLICANT UNDERSTANDS AND WILL COMPLY WIALL NON-POINT Issued by: Date
TH
S�UjR�secam EGU},ATIO S.
g�—`~fA 4n agar >V G� Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will the applicant or future building occupantatom orhande hanAots material
u dented by Ne Copetine Municipal Cede.Chapter 9.12,and the Health and Suety
code.section sss32(,)7 All roofs shall be inspected nor to an roofing material beim installed.
❑Yon NO P P Y g 8
Will tite aPPfiaant or revere building aectrp,m me whhPmm4t ar dcriaon wmeh If a roof is installed without first obtaining an inspection,I agree to remove
colt hasallom air cmmommeu an defined by Ne Bay Area Air Quality Management all new materials for inspection.
District?
❑Yon PO
1 haw nand the huarthw materials oniubmmcmts user Chapter 6.95 of Ne Cahifor-
nbHomthaSafetyCotleS.d.ns r13.25533md25534.1mdcmand Nnirft building
dean sale...dy haw a eJmn4 that it is my responsibility a notify we Occupant of On,
/aAaimme wma an{K//WLJ//y�amtpdorauwtecofpCenfuMofOcup 3y. Signature of Applicant Date
FO/wnerunwhmmcdagcnt� Da All roof coverings to be Class'W'or better
Community Development
s
10300 Torre Avenue
It
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME. •e •k e&[14 E PHONE # W 2 d
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: _ aZ
Si ature 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36221027 . 00
DATE ISSUED. . . . . . . : 04/22/2008
RECEIPT #. . . . . . . . . : BS000004547
REFERENCE ID # . . . : 08040155
SITE ADDRESS . . . . . : 1142 DERBYSHIRE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ANNE KHECHFE
ADDRESS . . . . . . . . . . : 1142 DERBYSHIRE DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5072
RECEIVED FROM . . . . : VALLEY HEATING & CO
CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141
COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING
ADDRESS . . . . . . . . . . : 1171 N 4 - TH ST
CITY/STATE/ZIP . . . : SAN JOSE,- CA 95112
TELEPHONE . . . . . . . . : (408) 294-6290
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 3, 900. 00 0. 50 0. 00 0. 50 0. 00
lEPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
1MFR=<100 UNITS 1. 00 122 .38 0. 00 122 .38 0. 00
1MPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40 .79 0. 00
1PPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00
1TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00
---------- ---------- --- ----------
TOTAL PERMIT 286 . 04 0. 00 286 . 04 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 286 . 04 #17475
---------------
TOTAL RECEIPT 286 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL -
•
X/ i h
• - e w , 4 �y E u � � 6
S
4.US,Solid Well Systems(Includes SIPS,ICFS,6 Any Non-Stick Frame Assembly)
• ❑ e.Flansb.Walls
❑ c Poufs Dc 7 i 2
S.Reduce Pollution Entering the Home from the Garage
❑ a Tightly Seal the Air Barrer between Giage and Living Area
❑ b.Install Gate Exhaust Fan OR Build a Detached Garage 0 1 i i
E
Design Energy Heels on Trusses 75%of Attic Insulation Haight at Outside Edge of Exterior Well 0 1
7.Design Roof Trusses to Accommodate Dueaverk D 1
B.Use Recycled-Content Steel Studs for BO%of Interior Well Furracp D 1
B.Thermal Ms.Walls:51&Inch Drywall on All Interior Wells or Walls Weighing more than 40lbleu.fL 0 1
10:Install Overhangs and Gutters
.___. —. ..
-El- -.a:Minimum t&Inch Overhangs and Gutters . . . _ .. ._. _ _ _.. __.__. . _... g ___.._. i�- 1 1
❑ b.Minimum 24-Inch Cverhan s and Gutlers D 1
Total Pomv;Available In Sa Md W Building Ftame and Envelope c 361 D
E.EXTERIOR FINISH Points Available Per Measure
LJ 1.Use Recycled-Commnl(No Virgin Plastic)or FSC.CaMad Wood Decking 0 2
LJ 2 install a Raln Screen Well System 0 2
J.Use Durable and Noncombustible Siding Materiels D 1
4.Select Durable and Noncombustible Addling Materials 0 2
Total Points Available In Exterior Finish=7 0
F.INSULATION - Points Available Per Maasure I
1.Install Insulation with 75%Recycled Content
❑ a.Walls endfor Floors 0 I 1 I
—0—b..Callings 0 —'--i I—I---
2.Install Insulation that is Low-Emlding(Certified Section 0135D)
❑ .a.Wells andfcr Floors D
❑ b,Callings 0 1
J.Inspect Quality of Insulation Insufflation before Applying Drywall I 0 11
Total Points Available In Insulation 51 0
G.PLUMBING Points Available Per Measure
1.Distribute Domestic Hot Water Efficiently(Maximum 7 Points), I
❑ a Insulate Hat Water Pipes from Water Healer to Ochen 0
❑ b.Insulate All HN Water Pipes 0
• ❑ c.Use Engineered Parallel Piping
ED by
Use EngineeredeaEngineeredd Parallel Piping with Demand ControSad Caculation Loot '0 1
❑ e.Use SWeWred Plumbing with Demand Controlled Clmulation Loop 1C'•'a 0 1 _ 2 _
❑ f.Use CantRl Care Plumbing 0 1 1 2
2 Install Only High Efficiency Toilets(Dua-Fluch or 5128 gpf) - -0 ! 4
Total Points Avellahle in Plumbing=Total 12✓D^
H: TING,VENTILATION&AIR CONDITIONING - - i V 1� Points Available Per Measure
1.Design and beer HVAC System to ACCA Manual J,D,and B Recommendations 4
L Install Sealed Combustion Units
e.Furnaces 1 0 cs 7
❑ b.Water Heaters 0 2
3.Inslell Zoned,Hydrants Radiant Hearing with Slab Edge Insulation 0 1 1
Lj 1.Install High Effisfemcy Air Conditioning with Environmentally Responsible Refrigerants 0 . 111
S.Design and Install Effective Ductwork
❑ a.Install HVAC Unit and Ductwork within Com iffloned Space 0
['(7 b.Use Duct Mass:an All Duct Joints and Seams 0
❑ c.Install Ductwork under Ads lnsulation(Bumid Ducts)
❑ d.Pressure Balance the Ductwork System 0
❑ e.Protect Ducts during Commotion.and Clean All Ducts before Occupancy
S.Install High Efficiency HVAC Flair(MERV 6+)
❑ 7.Dahl Install Fireplace or Install Seead Gas Fireplaces with Efficiency Rating Not Less Than 50% 0
usingCSA Standards
B.Install Elki Exhaust Systems in Bathrooms and IOtchens "
❑ a.Install ENERGY STAR Bathroom Fans Vented to the Outside q 0
❑ b.All Bathroom Fens Are on Timer or Humimstat
❑ c.Install Kitchen Range Hood Vented to the Outside
B.Install Mechanical Ventilation System for Cooling(Maximum 4 Points)
❑ e.Install ENERGY STAR Ceiling Fans a tight Kits in Liking Areas d Bedrooms
❑
to.Install Whole House Fan with Varable Speeds
❑ c.AutomaOcally Controlled Integrated System _ 0 - - 2
❑ d.Automatically Controlled Integrated System with Variable Speed Control D 3
10.Install Mechanical Fresh Air Ventilation System(Maximum 3 Points)
❑ e Any Whole House Ventilation System Thal Nests ASHRAE 62.2 _ 0_ i_ 2
• ❑ b.install Aur-k-Am Heal Exchanger that meet ASHRAE 62.2 0 1 2
77 71.Insce Carbon Monoxide Alarm(s) D I I
Total Points Available in Heating Ventilagon and Air Conditioning 3DI 0
02DD7 Build It Green Single Family GreenPoirn Checklist 2007 Version Page 2 of A
5 .@ _
n Q U Q C
❑ - Enter tlescription here,anonto ontls available for measure in eppn rials cafe Dries to the ri ht - 0 0 0_ D
_._ _ � ._ .-A B__ __
❑ Erder tloecripflon here antl ardor poin6 evalla6le lm measure in appropna2 cafes to the ri911. _ __ 0 0 0__ 0 0_ 0 -
_ Enver doearptlon here antl ane;points ava0able for measure In appropnate cetegones to the nAht _ D 0 0 0 0
❑ Enter des=ptionhare antl entarpoilds eveilableformauure in appropnatecategones lathe right _ D 0 _ D_- 0
4.Innovation:List Innovative measures that meet the green building objacflves of the Guidelines.Enter up to aIBuiltl A eon hechl' t any
maximum Combined total of 20 pts.See Innovation Checklist for suggested measures,using the link to the ri ht. Guidelines
Li Innwafion in Community:Enter description here,and enter points available for measure In appropriate calx ones to the right 0 0 0 0 0 D
_______.__.
❑ Innovation in Energy:Ener description here,and enter Dints available for Measure in appropriate celegmixs to the right. 0 D 0 � 0 0 0
Innwafion In IAOMasIth:Enter description here,and enter Points available for measure in appropriate tate odes to the right _ 0 _0 _ 0 _ D__ _q__ 0
Innovation In Resources:Enter description hare,and enter points,available for measure in appropriate ofielionies to the right
Innovation in Wetac Enver description hare,antl enter poinR avallah19 fm meesum in appropriate categories to the tight _ 0 _ 0
- - - Total Available Points lnOmer=43 D
=TotalPoints in Specific Categories'equired in Specific Categories 0 30 5 6 9
[ e [ a e t
Protect has not yet met the following recommended minimum requirements;
-Total Project Score of At Least 50 Points
-Required measures:
-A3a:50% waste diversion by weight
-J�15P/o-aSor�e Title-24 __
-Ml:Incorporate Green Point Rated Checklist into blueprints
Minimum points in specific categories:
-Energy(30 points)
-1Aq/Health(5 points)
-Resources(5 points)
-Water(9 points)
i
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02007 Build It Green Single Family GreanPoiM Checklisl2007 Version. Pape 4 of 4