08010170 CTTY OF
CUP
ERTINOt'i,
BUILDING DIVISION PERMIT CUNGRAC"^TQIrINk',U,RMA"CI(31,
L 1 PERMITNO.
BUI
g�VRTTIBISCUS DR VALLEY HEATING & COOLING 08010170
ER'S NAME: PERMIT ISSUE DATE
JIM LEONARD 1171 N 4 TH ST 01/31/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 294-6290
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
• _ BLDG ELECT PLUMB MWN
0 0
Doo LICENSED CONTRACrOR'S DECLARATION Job D0SCr1 uOn
u� 1 lercby affirm that 1 am licensed muter P.,W.ns of Chapter 9(commencing RE PLC FURNACE/ ,SME LOC p
with Suction 7(1110)ofDivialon 3 of the BusinwarW Formation,Codbimal my licew is
am in full fame and eR 1`, -- b s
Z_ Licenan Clans. J Lk.N
Date Cmmumr
tl ARCiDECLARATION
tl'ol I understand my Pons Null ll bbe e=it u Public mrnrtla
36
k W LkcnuJ Pmfcadonal
Sm OWNER-BUILDER DECLARATION
Contractors
ON
Si I hereby.affirmSu mat 1 I. exempt Item the Cnnianofs License Law for than
p o following reason. oult a 703 Construct,
Business and Professions Code:Any city or county
which requlae a PemJt W cmnsWeL alter Carl
for such
demolish,or repair any omcWm
_zy priarmits issusnce.alm require the appliculfar such permiuo Ole aaign,J satement
that de ialiccnseJ pursumtmlhcpmvisilimoftite Cony w'&Lkcnw Law(ChapWr9 Sq.Ft.Floor Area $4900 Valuation
$ (commencingwithS dm7DW)ofDivision3ofthe Businwand PmfceaiomC )or
..
that he in exempt lhceftem and the basis for the alleged exemption.Any violation of
Bandon 70313 by any applicant far a permit Subjects the applicant le a civil penalty Of 3 2 6 0 2 0 3 4 . Number Occupancy Type
pmt mom than 111"hundred dollms WOOL
❑1.u mm of die pmpmy,or my emplayeu with wage u d eirmk compewdon,
will do mework,and theasrumum is mut imendedor offered foraak(Sec.Mol,Business Required Inspections
and Professions Cade:The Conveners License Law doe net apply m an owner of q 13
intensity who builds or impmvni daemon.and who does each work himaelf teduough his
mvnemPloycu,pmvldedthatsuchimpmwmenU=nollmmaded oro@mdite We.If.
however,One building or improvement is sold within one year of eampleuon.the owner-
builder will taw the burden of pmving Out he did nal build or improve for purpose of
sale.).
❑1.as owner of do property,am exclusively contracting with Iicensed Contraction In
CoWtract the project(Sec.70x0.Business and Prefassions Code:)Tim Contractor's U.
sew Law does misapply in u owns of property who builds art imp n.the...and,
who Contracts for such pmjeca with a ccoon'vu m(s)licamoued pursuant m me Contractors
0Ive Law. GO TL�I�ar �I ,B&PCfar thuruvan
❑1 am Laerm7pl under Sec
40 -
rcr Dane
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arc of the following daneamtians:
❑I have and provided!
a dam 33em of Covent to s ode.for tfar Woher nce of one wor le f r phich ifA far by Section 3700 0!the Labor Code.for W performance of than
work for which Nis permit is leased.
1 have and will maintain Workers Compe dmon Insurance,u required by Section
370D of the Labor Code,for the performance of Ne work for which mis permit is issued.
My Workers Compensation Wuruee Cartier and Policy number me;
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Thissemlon need not M completed IrtK permit is furrow handed dolive(SIM)
ter leis.)
1 o nify that in the Performance of me work for which this permit is bound,l shall not
employ any parson in any mannerSu an in become subject n the Worimm'Compensa h m
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.IL apor making this Cedificae of Exemption,you should
Ontario Subject in the Worker!Compensation provisions of the Labor Code,you muse
wJ O fuMwim comply with Such pterlsons or this permit shall be danmcd mwked.
Z CONSTRUCTION LENDING AGENCY
(~ I hereby alfore that them its construction loading gene,for me Performance of
a > the work for which ihis permit is issued(Sec.3097.Civ.C.)
W� Lender's Name
i7. Address,
Addre
C)Q I Cavity that I haw mad this application and Sum that dre then irdomtstion is
IS, ;"! coarom I agree to comply with all city and county ordinances and lute laws reading to
Q rV" building convection,and hereby authors represemativu of this city to enter upon the
W above-mentioned properly for inspection purposes.
(We)agee W saw,indemnify and kanp tensions the City of Cupertino against /
y liabilities,judgments,coati and expenses which may in any way earn,against mid City
t)7 in conesquenee of me granling of this PermlL /� O
a APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON PDINT Issued by: Date
SOURCF,RGULATIONS.q
1 i; GY /131 � e Re-roofs f
Signmue IicanU nor �m _
H RDOUS MATERIALS DISCLOSURE Ty�Of ROOF
Will the appikant or fume building ocContents.Or handle husmous ru a,ul
defloed by tie Cupeni.Municipalan
Code.Chapter 9.11, d the Realm and Safely
Sedan 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
F
❑Ye
Will the applicant or future bas' ing occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
C1114 h®erdous air Conaminants efned by the Bay Area Air Quality Mansgcmcm all new materials for inspection.
District?
❑Yes No
I ban and the hnsNmns materials mquiemenu us&,Charter 6.95 of the Caeifor.
as Halm@Safctycom,Sceuons 8505,25533 and 25534.1 undersand thuif Oe building
Jaen no Oily In •arrant,that it is my responsibility in mealy da accumen Of dte
regmadm,vb whiCI.m�priarWiasenaafacerdn,aeaf�ea3//O- Signature of Applicant Date
1�Yo_�/s.4, All roof coverings to be Class"B"or better
Owncr a.iuitarir�em Dam. _
CITY OF CUPERTINO
FURNACE/AC
COF
• CUPERTINO PERMIT APPLICATION FORM
APN# n 02,0 -3 L4 ,
60
Date:
Building Address:
Owner's Name: Phone#:
ICY) 4D2> - '7 3 $ Q
Contractor: Phone #: ^ 00-t4c)
3 Fax 4: 6eR-y(—"f
Contracto cense#: Cupertino Business License#:
2aS�_5 Lem I q-)
Contact: Phone#: _ a4 y� H v-9 B
Z� C_��
. V,a-5'cd6\ Fax #:
• Building Permit Info:
Elect ❑ Plumb ❑ Mech [�
Residential Commercial
Job Description:
- F wr 2,
For Resi eVatial Installations:
Attic 1" floor ❑ 2'6 floor ❑
Adhere to minimum setback requirement [V]�
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage Class):
S� �q &--�
Strapped ❑ On Platform Bonded New Location Replacement 52,
Valuation:
Green Building: Must attach Green Building Check list to this application
CITY OF CUPERTINO
-Y or FURNACE/AC CUPE or FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
_ Group _
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
• absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,rec.essed wall htr, or
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed &riot incl in an appliance
permit.
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1MRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install ¬ incl in an appl permit.
a
CITY OF CUPERTINO
® - FURNACE/AC
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
-IPGASRES -Residential-or ea gas pipingsystem of P
1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1BSEISMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst<=100k BTU install or M
relocate ea forced-air/gravity type ( u� L
® fumace/bumer, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1MFRN>I00 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
lEPERMITFEE Electric Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITF.EE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
=� CITY OF CUPERTINO
j � ' FURNACE/AC
Y... !
® CUPERTiNO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Q tY P YP
Group
AIR FURN/AC
CONDITIONING
1BCAlR14AN Commercial A/C Units<= l0k CFM B
1MCRAA Commercial Mech Repair/alt/add M
1BSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. Conun/Resid
1BREMAIRHAN Residential A/C units <= 1Ok CFM B
® IMRRAA Residential Mech Repair/alt/add M
1BSEISMICR Seismic Residential B
1EPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
ITRAVDOC Travel Documentation B
IBUSLIC Business License B
® CITY OF CUPERTINO
6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32602034 . 0.0.
DATE ISSUED. . . : . . . : 01/31/2008
RECEIPT #. . . . . . . . . : BS000003815
REFERENCE .ID # . . . : 08010170
SITE ADDRESS . . . . . : 22042 HIBISCUS DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER JIM LEONARD
ADDRESS 22042 HIBISCUS DR
CITY/STATE/ZIP . . . : CUPERTINO, CA '95014
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 4, 900. 00 0.50 0. 00 0. 50 0. 00
1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00
1MPERMITFE- FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
IMRRAA UNITS 1. 00 61 .19 0. 00 - 61.19 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 224 . 85 0. 00 224 .85 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
ENTER PROJECT NAME,
® 4.Use Solltl Wall Systems(Indutls SIPs,ICFs,B Any Non-Stick Frame Assembly)
❑ a Floors
Elb.Walls
D % 2
S.Reduce Pollution Entering the Home from the Garage
❑ e.rightly Seal the Nr Barrier batwoo Garage and Living Area - 0 _ 1
❑ b.Install Garage Exhaust Fan OR Solid a Detached Swags 0 1
6,Design Energy Herts on Trusses(75%of Attic Insulation Height at Outside Edge of Exterior Well) 0 1
❑ 7.Design poor Trvss N Accommodate Ductwork D 1
LJ B.Use Reryclad-Conteh Steel Stade lor 90%of Interior Wall Framing p 1
LJ S.Thermal Mace Wells SIB-Inch Drywall on All Interior Walls or Wells Weighing more than 4D @Icu.tL 0 1
10.Install Overhangs and Gutters
.--. —. .. .{-�. . -a.Minimum 15-Inch Dvarholis and Gutters _ _ .. .._ _ . ... __._.. —. p
❑ le.Minimum 24-Inch Overhangs and Guests 0 1
Total Points Available In Structural Building Frame and Envelops=361 D
E.E:=RIOR FMSH Points.Availar l=Per lv5asure
LJ 1.Use Racysled-Content(No Virgin Plesfic)or FSC-Cartified Wood Decking p 2
2Inte ll a Rein Susan Wall System p 2
LJ 9.Use Durable and Noncombustble Siding Materiel¢ p 1 1
77 4.Select Durable and Noncombustible Roofing Materials p 2
Total Points Available in Bderior Finish=7 0
F.INSULATION
Points AvallahL=Par idaasure
1,Install Insulation with 75%Recycled Content
❑ 9.Walls and/or FIooR
—O—hrGellings
1—
L Install Insulation that Is Low-Emitting(Cenibed Section 01350)
❑ a.Walls and/or Floors 0 1 1
❑
D.Ceigncs 0 1
❑ 3,Inspect Duality of Insulation Installation before Applying Drywall 0 1
Teal Points Available in lnsulafion a 51 0
G.PLUMBING Points Available Per Measure
1.Distribute Domestic HM Water Efficiently(Msxlmum7 Points)
El a.a.Insulate Hot Water Pipes fmm Water Heater ED Kitchen 0 1 1
❑ b.Insulate All Hot Witter Pipes 0 --1 —_-- 1
❑ c.Use Engineered Parallel Piping
❑ d Use Engineered Parallel Piping with Demand Controlled Cimulation Loop 0 - 1
❑ e.Use Structured Plumbing with Demand Controlled Circulation Loop 0 _ 1_ 2 _
❑ 1.Use Central Core Plumbing 0 1 1
❑ L Install Only High Efficiency Toilets(Dual-Flush or 5125 gpy p 4
Total Poims Available In Plumbing=Teal 121 0 1
H;HE-4TING,VENTUATION&AIIi CONDITIONING - Paints Avallable Par Measure
❑ 1.Design and Install HVAC System to ACCA Manual J.D,and S Recommendations 0 1 G 1
L Install Sealed Combustion Units
I Furnaces
❑ h.Water Heaters0 2 I 1_
D 2 1
3.I-stall Zoned,Hydrenig Radiant Heating with Slab Edge Insulation D '='y -1
4.Install High Efficiency Air Conditioning with Environmentally Responsible Refrigerants r=D 5.Design end Install Effective DuctworkE) a.Install HVAC Unli and Ductwork within Conditioned Space Elh,Use Duct Iaesfic on All Duct Joints and Seams Elc.Insall Ductwork under Attic lnsulafion(Buried Ducts) 1
Eld.Pressure Balance the Dualevork System --
❑ E.Protect Ducts dung Construction and Clean All Ducts before OocupanDy
S.Install High Efficiency HVAC Filter(MERV 6+) D
❑ 7.Dont Install Fireplace or Install Sealed Gas Fireplaces with Efficiency Rating Not Less Than 5D% - 1
using CBA Standards 0
8,install Effective Exhaust Systems in Bathrooms and Kitchens
❑ a.Install ENERGY STAR Bathroom Fans Vented to the Oulslde 0 1-
❑ h.All Bathroom Fans Are on Timer or Humidstat D
❑ c.Install Kitchen Range Hood Vented to the Outide
D
9.Install Machanicd Ventilation System for Cooling(Maximum 9 Points)
i1
❑ a.Insall EIJERGY STAR Calling Fens 8 Light Kits In Wing Areas&Bedrooms 0
❑ b._Install Whole House Fan with Variable Speeds 0 i —�-
❑ c.Automatically CDmrdlsd Integrated System p 2
El d Automatically Controlled Integrated System with Variable Speed Control 0 2
10.install Mechanical Fresh Air Ventilation System(Maximum 3 Points)
® ❑ aAny Whole House Vsnlllafnn System That Ideals ASHRAE'o22 - 0 2-
❑ b.install Air-*Air Heal Exchanger thal meets ASHRAE 622 D 1
LJ 11.Install Carbon Monoxide Alorm(s) 0 1 1
Tctal Points Available in Healing,Vanulation and Air GDnd[tuning 301 0
02D07 Build It Green Single Family Greal-Point Checklist 2DD7 Version Pees 2 Df 4
22 oYL i/3J SCvS ,%ter CEbiUr�2,j
Q U
I
❑ Enter deeod ion here n
® M a d enter oink available for msasure in appropriate categades tome right 0 D 0
---......-- — .----T__.—.___ ._—...____.
❑ Emar descdpim here,and emer points evallable for msasura in appropria2 camgodes b the right _ _ _ __ _ _ 0 _D
Enter tlasndplionhem,antl enter poin6 avaAable tm msasureln ap rP oPriat_celagonesfithe right __ _ __ _ _ - ______0 D__ _ _ _ D
❑ Enter darrmiptim here,and enter points available for measure In appropriate categories to the dgM
4.Innovation:List innovative measures that meet the green building objectives of the Guidelines.Enter up to a IS°Ild h Green Checl-fst_=a d
maadmum combined total of 20 pts.See Innovation Check9t5t for suggested measures,using the link to the right Guidelines
Innwa iw in Community:Emor besodption hem,and ener points available formessure in appropriate ca ones to the right _ 0 0 _o _ 0 D 0
—.
❑
Innovation in Energy:Emyr description hare,and enter points available for manure in appropriate cateoodes to the Fight 0 _D _ D_ _ D __ D D
❑ mnevafion in Mllaalth:Enter description hare,and enter point evallable for measure in eppropnate cafe Dries to the dght _0 _ 0 _ 0 _1 0 _D 0
❑ Innovation In Baourcer.Enter dasoription here,and enter points avallableior meazure in appropriate Delegates to the right D _0 0 {I 0 D _ 0
❑ Inn NEW m M r.Enter description hare,and enter points MIable for measure in appropri ile categories to the right. D 0 D _j D 0 D
_ __.__. .__ _. _.. .._ __.... ._...... _. _. . . FotelJsvallanlefoints-1mDthar=43 0
Total Available Points in Specific Categories' 4+ 96+ 42+ 66+ 43+
Minimum Points Required in Specific Categories 0 30 5 6 9
�L 'e L6WILM e
Project has not yet met the foltowfng recommended minimum requirements:
-Total Project Score of At Least 50 Points
-Requirad measures:
-A_,a: 50% iva5te diversion by.,ei,J,`ri
Jg: I_5?10-above 7itla-?4
-All:Incorporate Greenpoint Rated Cnecibist into blueprints
-
141nimum points in specific c5Lepories:
-Energy(30 points)
-IAO 1H= (5 points)
-Resources(5 points)
-Klater(9 points)
r
m 20D7 Build It Green Since Family GreanPDint Chavklieol 2007 Version
- _ __ Pace of
Community Development
10300 Torre Avenue
a, Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPERTINO
Building De artment
JOB ADDRESS: PERMI# O/ 7-�
22 412 r l SCu Q
OWNER'S NAME: G ,, - PHONE # — Z
GENERAL CONTRACTO : oL� FAX #
I am not using any subcontractors: ����
ignature 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