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CITY OF CUPERTINO
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I.t.�l�!k'C?TiMATION
BUILDING DIVISION PERMIT
CONTA.GTQYT•yd "
BUILDING ADDRESS:
PERMIT NO.
:?0-1.6S FOREST AVE
TBD — TO BE DETERMINED
08080212
NAME:
FERMTr ISSUE DATE
VNEWS
ZACHARJAH CHERIAN & MANJU
08/27/2008
PHONE;) I p A I I A M
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
PULL GAS LINE TO GAS COOKING
BLDG ELECT PLUMBMEC"
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
lob Description
1 Worthy amen that 1 am Bmnwa un ict provisions of aalvr 9 (commencing
with Section 70(1()) of Division 3 of the Business and Professions Code. and my license is
in full mree and.nm
License Class Lk. g
Dale
DECLARATION
DECLARATION As
shallE muco
1 undenuaol my plans dull be used As public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby aliren asl I am exempt from the Contractor's License Law for the
following mason. (Section 1031.5, Business and Pmfcniom Cade: Any chy or rnunty
which requ(rns a permit in ctmsmeL aher. Impmwe, demnitsh, or ¢pair any slmmmc
prior to its issuance. also Icquires tho applicant fursuch pemnitto Ole a signed statement
that k u licensed pursuant to the proaisiam of the contractor's Uenea Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 700M of Division 3 of the Business and Profession Crude) or
Nat lis is exempt therefrom and ale basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
P y
Schon 70315 by Any applicant f« a permil subjects the applicant th a civil penalty, of
then Ow hundred dollars (SMYP
rat moss then
❑ 1, As awxr of the property, or my employees with wages As their sok campemadon,
Required Inspections
will do the work, and the structure u not intended o aRcrtd for sale (Sec. 711 Business
and Prefessiom Code: The Contractor's License Law does rot apply to An owner of
pvpenywhobuilds«ireProwsthermr Anaens aovsuch w«k himself«0waglt his
awncm.the es,ofcmoeertd f«sale if.
-
iprovidedthatsuchimpmvemenuarenot
howevv. the Wilding or impmvemmt 4 old within one year of mmpwcfar the rawer
builder will hen the Wrdcv of proving that k did not ddk «improve f« purpose of
sale.).
rsnsenu se. to
owr of the property, Am exclusively mmuseeling with Ildi m
As e
As
F the, project (Sec. 70x4. Bnsi. and Professions Code:) The Conuulots U.
.
cove Law dors not apply to An owner of pmpety who builds or improver th mon. and
who contracts for such projects with a cantraoor(s) licensed puremant he the Conlrulofs
_
Lkxnu law.
I Am exempt under See . B & PPC�for 11,11..a
Dau'
P. WORKER'S COMPTSATION DECLARATION
I hereby ARM under penalty of perjury We of the following declarations
❑ 1 have and WII mainuin • Ccnifiamof Cmnum m self -loam I« WarkNACompen-
now. as provided for by Section 3700 of the Labor Code, for the Performance of Ne
were for which Nis permit is issued.
I norm a1( will common Worker, Compensation Wur . As nexiuired by Schon
3700 of am lab« Code. for the performance of the work f«which this permit is issued.
'
My WafkeYs Compensation Nunn. carrier and Policy number art:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu satire need not M complexed if be permit Is Faxon hundred dollen (SIM)
or less)
I certify Out in the pvf«mence of the work for which this permit is issued. l shall n«
amploy,,nT mnnm mannerp�jpbcp zubject mths Workers' Compensation
Calif ice. D KK ��y(� O!!SS
laws oECA
Appliant
NOTICE TO A ANT: If, afar making this Ccr male of Exemption, you should
bcome aub' m th Worker's Cmepenfaaan provisions of Ore lab« Cade, you muss
forthwith comply wi such provisions or this p«mil AM Is, domed nevmkcd.
CONSTRUCTION LENDING AGENCY
I hcmby Afrum dol there u. consonsam. lending agency far the Perform. of
-
Nc wish for which this permit is issued (Sec. 309], Civ. C.)
LcoaeYs Nuns
-
Lender's Adamss
1 anify Nat I A. mad this application and scale this the shove information u
cis eo. I Aires As comply with all city and county orainances and soca lava misting to
building construction. and hereby authadm rap eecnutiva of this city w cnwr upon the
shove -mentioned for inspection puryous
(We) agree to HYc, Indemnify and kep hamnlen dK City of Gupenlna Against
ros..a
Soso and expevnsmnit. may in any wayaara agdnst.uid City
in
AcPLICANT of the granting of Nis
D WILL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
g12,6f#
Re -roofs
Signature of ApplicanUConlraclor
HAZARDOus MA AIS DISCLOSURE
Type of Roof
Will Om applicant «future btilding «apart same «handle hanNous msmrud
A, defined by the Cupertino Municipal Cade. aapler 9.13. and the Health and safe,,
section 25532(,)7
❑Yen JZ/N,.
All roofs shall be inspected prior to any roofing material being installed.
Will th. appliantorfuture Wilding occupant use equipmentordcv which
If a roof is installed without first obtaining an inspection, I agree to remove
.mit harardnus air conumim nts as de0vd by the Bay Ana Air Qvlity Management
all new materials for inspection.
P
Di,WeL7
oyer Ja Nu
I have road the bxsandoo mAurials.quim.,m under C%ApW &95 aline C bror.
nu HWth&SAfcty Cade,Seaoca2550.5.25533a 25534.1uMcrnandthmifthe building
dao rot mene. y have xenav Nat it is my naponsibilily to notify, ac occupant of am
Ziremems whichcomet rto issuvmc of. Certificate of Occu
Signature of Applicant Date
All roof coverings to be Class';}" or better
owm.r or aatharixeaa Dim
r
L.
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CITY OF
CU
PEkTINO
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
PERMIT APPLICATION FORM
oe6e6212
APN #Date:
5I (p 33 l�'26o
Fee ID
s Z6 16 9
Building Address
20 (b5 8 � (� � C bt. ¢� + c a
C A Qr Si) l
IPCSEWER
Owner's Name: //
P
Phone #: 7 c_
Contractor:
1BPREPIPE
Phone #:
-T-6p
1CPRP
Fax #:
Contact:
Commercial Gas Piping System
1-4 Outlets
Phone #:
N/A
1BSEISMICOM
Seismic Commercial
P
Fax #:
Contractor License #:
1BSEISMICR
Cupertino Business License #:
P
Job Description:
1PRSEWER
Residential building
sewer/sanitary sewer
Residential Commercial
❑
Valuation: �j
Project Size: Express J ' Standard Large ❑ Major F-1
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
Grou
Permit Type
IPCSEWER
Commercial building
sewer/sanitary sewer
P
1CPSS
1BPREPIPE
Commercial re -pipe per fixture
P
1CPRP
IPGASCOM
Commercial Gas Piping System
1-4 Outlets
P
1BSEISMICOM
Seismic Commercial
P
/
1BSEISMICR
Seismic Residential
P
1PRSEWER
Residential building
sewer/sanitary sewer
P
1RPSS
CITY OF CUPERTINO
` REPIPE/SEWER/MAIN SERVICE
CUPEkTiNO FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
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
1-4 Outlets
P
1BPGAS
Gas Piping System 5+ Outlets
P
1PPERMITFEE
Plumbing Permit Fee Issuance
P
1PLMBLNCK
Plumbing Plan Check
P
1 PLMBINSP
Other Plumbing/gas Insp.
P
1 TRAVDOC
Travel & Documentation Fee
B
1BUSLIC
Business License
B
Revised 6-16-08
is
•
0
E
•
•
Plan Review Process Work Book Page -12-Revised 3/25/08
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 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.
Energy Star Refrigerator, (Note/Spec.
A-3
1 point
P.
Other
1.
List Green Features on Plans
A-1
1 point
TOTAL POINTS1
L7
40 points
•
•
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.
1. Recycle Job Site Cohstruction & Demolition Waste
65%=1 point; 75%= 2 points; BO%= 4 points
up to 4 Resource
2. Salvage Reusable Building Materials '
4 Resource pts y=
3. Remodel for Mixed Use, Adaptive Reuse, and
•
Historic Preservation
4 Resource pts y=
4. Protect Native Soil
2 Resource pts y=
5. Minimize Disruption of Existing Plants & Trees
1 Resource pt y==
6. Implement Construction Site Stormwater Practices
2 Resource pts y=
7. Protect Water Quality with Landscape Design
2 Resource pts yq
8. Design Resource -Efficient Landscapes and Gardens
4 Resource pts y=,
9. Reuse Materials/Use Recycled Content Materials
for Landscape Areas
2 Resource pts y=,
10. Install High -Efficiency Irrigation Systems
2 Resource pts y=,
11. Provide for On -Site Water Catchment / Retention
2 Resource pts y—
B. Foundation
1. Incorporate Recycled Flyash in Concrete •
25% Recycled Flyash = 2 points; Add 1 point for every 10%
increase of flyssh, 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 Enerov ots v=ves 0
C. Structural Frame
1. Substitute Solid Sawn Lumber with Engineered Lumber 3 Resource pts y=yes
2. Use FSC Certified Wood for framing
(For every 10% of FSC lumber used = 2 points, up to 10) up to 10 Resource pts.
3. Use Wood IJoists for Floors and Ceilings 2 Resource pts y --yes
4. Use Web Floor Trusses 2 Resource pts y=yes
5, Design Energy Heels on Trusses 6' or more 2 Energy pts y=yes
6. Use Finger -Jointed Studs for vertical Applications 2 Resource pts y=yes
7. Use Engineered Studs for Vertical Applications 2 Resource pts y=yes
8. Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes
9. Use Structural Insulated Panels (SIPS)
a. Floors 3 Energy pts y=yes
b. Wall 3 Energy pts y=yes
c. Roof 3 Energy pts y=yes
10. Apply Advanced Framing Techniques 4 Resource pts y=yes
11. Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes
12. Use OSB
a. Subfloors 1 Resource pt y=yes
b. Sheathing 1 Resource pt y --yes
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
•
• 1. Install Energy -Efficient Windows
a. Double -Paned
b. Low -Emissivity (Low -E)
c. Low. Conductivity Frames
2. Install Low Heat Transmission Glazing .
J. Heating Ventilation and Air Conditioning
1. Use Duct Mastic on All Duct Joints
2. Install Ductwork within Conditioned Space
3. Vent Range Hood to the Outside
4. Clean all Ducts Before Occupancy
5. Install Solar Attic Fan
6. Install Attic Ventilation Systems
7. Install Whole House Fan
6. Install Sealed Combustion Units
a. Furnaces -
b. Water Heaters
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
10. Install 13 SEER/11 EER or higher AC with a TXV
11. Install AC with Non -HCFC Refrigerants
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
• 13. Retrofit Wood Burning Fireplaces
a. Install EPA certified wood stoves/inserts
J. Install/Replace Dampers
c. Install Airtight Doors
14. Install Zoned, Hydronic Radiant Heating
15. Install High Efficiency Filter
16. Install Heat Recovery Ventilation Unit (HRV)
17. Install Separate Garage Exhaust Fan
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
2. Install Solar Water Heating System
3. Pre -Wire for Future Photovoltaic (PV) Installation
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw =18 points)
6. Select Safe and Durable Roofing Materials
7. Install Radiant Banter
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating
2. Install Overhangs or Awnings over South Facing Windows
3. Plant Deciduous Trees on the West and South Sides
0
1 Energy pt
2 Energy pts
2 Energy pts
1 Enerov of
2 Energy pts y=yes
3 Energy pts y=yes
1 IAQ/Health pt y --yes
21AtQ/Hsalth pts y=yes
2 Energy pts y --yes
1 Energy pt y=yes
4 Energy pts y=yes
31AQ/Health pts y --yes
31AQ/Health pts y --yes
3 Energy pts
3 Energy pts
2 Resource pts
2 Energy pts
1 IAQ/Health pt
1 Energy pt
1 Energy pt
3 Energy pts
41A0/Health pts
5 IAQ/Health pts
31AQ/Health pts
4 Energy pts
10 Energy pts
4 Energy pts
Up to 18 Energy
1 Resource pt y=
3 Energy pts y=
5 Energy pts y=yes
3 Energy pts y=yes
3 EnereV ots v=ves
CITY OF
stUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: 20(65, F6 p E ST =
CCA PC- RT (NC), C 99-b)4
PERMIT #
0? -0 2 l L
OWNER'S NAME: 4Acti AR(AH f+>c21 AnI
.PHONE # Dg-213i;--OE-4--
$-2ss-OGENERAL
GENERALCONTRACTOR: T6 n
FAX #
I"
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following' ormation:
•
ki
Owner/Contract 5i nature
Date
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
•
ki
Owner/Contract 5i nature
Date
!INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• PERMIT INVOICE OPERATOR: SylviaM
Sec: Twp: Rng: Sub: Blk: Lot:
APN .......... 31633072.00
INVOICE DATE......: 08/27/2008
REFERENCE ID # ...: 08080212
SITE ADDRESS .....: 20165 FOREST AVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: ZACHARIAH CHERIAN & MANJU ABRAHAM
ADDRESS ..........: 20165 FOREST AVE
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096
COMPANY ..........: TBD - TO BE DETERMINED
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
:.-EE DESCRIPTION
- _,
•
DUE FOR
------
AMOUNT DUE
PAID
BALANCE
SL.I.SMIC RESIDENTIAL
PRINTING
--
PERMIT
----------
0.50
--------------------
0.50
0.00
RESIDENTIAL GAS PIPING SYS
PRINTING
PERMIT
61.19
61.19
0.00
PLUMBNG PERMIT ISSUE
PRINTING
PERMIT
40.79
40.79
0.00
TRAVEL & DOCUMENTATION FEE
PRINTING
PERMIT
40.79
40.79
0.00
--
--
143.27
---------- ----------
143.27
0.00
VOICE ID DESCRIPTION
- ----
VOICE
ID
DESCRIPTION
------------------
202 UNDERFLOOR PLUMBING
------
301
-------------------------
ROUGH
PLUMBING
506 GAS TEST
507
FINAL
PLUMBING