08080176 CITY OF CUPERTINO
BUILDING DIVISION PERMIT aCONTRACTt1R NFURMATICIN .
sA F ILA.
A :b34,bx a"ia. 3>st:
BUILDING ADDRESS: PERMITNO.
21.39/ KRZICH PL GREAT AMERICAN PLUMBING CO 08080176
ER'S NAME: INU PERMIT ISSUE DATE
RAVI NALLURI P 0 BOX 26942 08/22/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHIECTIENGINEER: BUILDING PERMIT INFO
INSTALL .BACKFLOW DEVICE BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
inI bamby sfftrm that i sumllcetvcd under provisions ar Clupmr 9(mmmercing - ---^ ^- ^--- ^--- Job Description
wiOSm
ZZ am7088)of Div on Softhe BusimowdProfcasWmCole.a mylkc is
infull for¢en 3 .
>�� License Clss �� fY.R
c f O Dao: GoninECL
wwy ARCHITECTS OECLa r N
v < 1 understood mo
and my plans shall W used public or
y G w Licensed Professional
OWNER-BUILDER DECLARATION
iE I hcmhy alarm that I am exempt(mm the Contractors Liecnsa Law for the
00 following mason.(Section 7831.5,Business and Pro(minm Code:Any city car County
<$V which rtquir.a pcomil to eomanuM al¢r,improve,demnli h.or mpalr any vmcoma
°Z< prior to its issuance.also ta,dres the applicantfor each Permit to Bk a signed statement
EEO that h islicensed pursuant to the provisions of the Contractorsse la
Lkchw(Chapter 9 Sq.Ft. Floor Area Valuation
tl- (Commencing with Section 700M of Division 3 of duce Business and Pmfcamam Cadc)w
y 3 that W Is eacmpt therefrom and the basis for the alleged ercmpdon.Day violation of
Section 70313 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
trot mote tons five hundred dollars(5500} P Y YP
0 1,as mvwc of the propusy,or my wplay.with wag.as their tok mmpewtion.
will do the work,and that structure at on,intended or offered for skill($..7016,Buda"•
aad Prefeoiom Code:The Canuanors Lacrosse Law dors trot apply 0 an own.of Required Inspections
property who buildaoimprowas thmmn,and whodocssuch warkhimself or through his
own employes,provided dist such improvements are not intended wagered forsale.B.
however,the Wilding or improvement is;told within ane year of eompleuan,the owner-
builder will ham the burden of proving that he did not Wild or improve for purpose of
sale.).
❑1,an aww,r of the property,am.clmively cmtraming with licensed mammon to
mo
construct the project(Sec.7006,Business and Pmf.siam Code:)The Connectors U.
canto law do. or apply m.owner of property who Wilds.,ini m,aa thereon.and
who...mets far tach Projects witha canuanor(s)licensed potential W the Contractors
Liceme law.
l un.empt undo See ,lid PC fm this woo
our Due
WORKERS COMPENSATION DECLARAMON
1 hereby aRim under pevalty of perjury ow,of ted following declensions,
Ih&mandwillmvnuin&Certif mofComenuaulf-insumfor Work sCompen.
action.m provided for by Section 3700 of the labor Cade,for the performance of the
work for which this Permit is bound.
❑1 have and will maintain Workers Compensation Insurance,as tcquired by Section
37W.f the Labor Code.far the perform...e of the work far which this permit is Wood. '
My Workers Compemadon lanamna artiw and Polity n W �O I
Gricr, LKC�AIriy�diry No.: g Y
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('Otisse mneedrotWmmpicv Bthepermit Isfoawhunme0do8an(SIO
wW e)
I cerdfy mal in the perform.of ted walk fes which this Permit ls issued.I scall nes
employ any person in any manner to at W become subject to th Workcre Compenetim,
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
Wcome subject to the Workers Campcmentma pmviaiom of the Labor Cod..you muu
�z forthwith comply with such Provisions or this permir shall to decreed rovoked.
zO CONSTRUCTION LENDING AGENCY
0
[-+ IWmbyalrimthan emit lss ed(S...3097.die. agency for the Performance of
a the work fes which this permit u issued(Sec.7(19'1,Civ.C.)
Wti Q Lentrls Nunc
7 z lend.(:Addw
U O I certify Out,I have read this wlicamm sed sum than ted above inforen,an is
it, F Cancra I agree m comply with all City and canary odinarnoes and Stam laws misting an
OU aWlvemmGotted oan,�farbuaby Cvonne mpresnatadvcs of mu city to cnwupan the
PmR Y a Purposes
(We)agree Wave,indemnify and keep harmleses the City of Cupertino agalmt
rte Iiabilidenjudgments.cwtsandexpmm m
ewhich may in yway accrue agalmtoid City
U z in consequence of the granting of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT sued by: Date
-LQjjRCE REGULATIONS
al Re-roofs
Bi urn afA c Canes v Chun
-
I OUS MATERIALS DISCLOSU RE Type of Roof
WII c applicant or future Wild' Eoccupanttamm arlundk hawdom motorial
deRned by ted Cupertino MunicipRWade.Chapter 9.13,and me Helm and Safety
.Sec Y.25532(k)7 All roofs shall be inspected prior to any roofing material being installed.
❑Y.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicantw Tatum Wildimg pmtLave aqui MQuor,Management
P $
omstrl` nes ale contaminants u der y UW Bry Amn Air Quality Managcmcnt all new materials for inspection.
❑Y. No
I have mal doe havardms mamri ilanati.mmcnuunder CTapler6.95 of ho Califon
Sia Health&SafenyCode,Sections 75585,15533 and 25530.I understand matifmc Wilding O
dors not currently oma a normae mal it a my r.p ocability m nadry me neaprnr of tiro y
cru wMch muu met brWissuance of•Certificeno afa Signa[ e0f EBflt-'�� D e
own umnam gc Z ono.d All roof coverings to be Class'pa'or better
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CU OF
C1
PERMIT APPLICATION FORM
G E-6 dol 7 tv
APN # Date:
P)Iaz 05- 037- o�
Building Address:
/
Owner's Name: Phone#:
kfi-V a //ole-i ,1r - moo- 7 02
Contractor: 1S S BW C e Gi ��l� Phone#:
Ave, S//v Fax #: Ya& 7 9 !e3
Contact: Phone#: '
Fax #:
Contractor License#:
Cupertino Business License#: 1?6
Job Description: Z'p5AR11 Ik BgGK Alo4d Aev1GY $Ani¢aiy SCwu t�
P,eoPeoj 41xjL e 1100A; -ouLL
IMF
Residential Commercial ❑
Valuation:
41,
Project Size: ExpressEJ Standard 0 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 ipdex.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial p
/ 1BSEISMICR Seismic Residential p
/ 1PRSEWER Residential building P 1RPSS
/ sewer/sanitary sewer
CITY OF CUPERTINO
Ga' REPIPE/SEWER/MAIN SERVICE
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
113PFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS Gas Piping System 5+ Outlets P .
1PPERMTTFEE Plumbing Permit Fee Issuance P •
I 1PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
/ 1TRAVDOC Travel &Documentation Fee B
1BUSLIC Business License B
Revised 6-16-08
•
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 oints
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 POINTS 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.
A.Site
�1 Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;60%=4 points up to 4 Resource pts 0
!2.Salvage Reusable Building Matedals 4 Resource pts Y_—Yes 0
3.Ramcdal 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
16.Design Resource-Efficient Landscapes and hardens 4 Resource pts y=yes 0
9.Reuse Materials/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes D
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
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 D
2.Use Recycled Content Aggregate 2 Resource pts y=yes D
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yesF:::: 0
! 1 I
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 D
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
B.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 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 or Y--yes p
1 ! 1
D.Exterior Finis
1.Use Sustainable backing Materials
a.Recycled content 3 Resource pts y--yes 0
b.FSC Certified Wood 3 Resource pts y--yes 0
2.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
,4.Use Fiber-Cement Siding Materials 1 Resource pt Y--yes 0
1 ! !
E.Plumbing
f1.lnstalIWaterHeaferJacket 1Energy pt y--yes D
2.Insulate Hot and Cold Water Pipes 2 Energy pts y--yes 0
r3.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) Up to 2 Resource pts. 0 14*.Replace Toilest with Ultra-Low Flush Toilets
I(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Instal Ghlonne Filter on Showerhead 1 IAC/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
B. Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
V.electrical
1.Install Compact Fluorescent Light Bulbs(CFLs) •
,(6 bulb =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. D
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. D
f 1 f
G.Appliances
J.Install Energy Star Dishwasher 1 Energy pt y=yes 0
;2.Install Washing Machine with Water and Energy '
Conservation Features 1 Energy pt y=yes 0
13.Install 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
'3.Install Recycled-Content,Fiberglass Insulation with
;No Added Formaldehyde 31AQ/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Enargy pts y=yes D
5.Use Cellulose Insulation •
a.Walls - 4 Resource pts y=yes D
b.Ceilings 4 Resource pts y=yes 0
5.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pis y=yes D
o.oenings 4 Resource pts y=yes D
1 i 1
I.Windows .
1.Install Energy-Efficient Windows
a.Double-Paned 1 Energy pt Y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pis 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
�1.Use Duct Mastic on All Duct Joints - 2 Energy pts y=yes 0
2.Install Ductwork within Conditioned Space 3 Energy pis Y--yes 0
3,Vent Range Hood to the Outside 1.IAQ/Health pt y--yes 0
4.Clean all Ducts Beiore 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 3 IAQ/Health pts y--yes 0
b.Water Heaters 31AQ/Healffi pis 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 Eificiancy(AFUE)Furnace 2 Energy pts Y7'as 0
13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stovesrnsarts 1 IAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt y=yas 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15,Install High Efficiency Filter 41AQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/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 yryes p
2.Install Solar Water Heating System 10 Energy pts y--yesH 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 13 Energy pts 0
6.Select Safe and Durable Roofing Materials 1 Resource pt Y=Yes p .
T.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 p
3.Plant Deciduous Trees on the West and South Sides 3 Energy pis yryes p
• 1 1 1
M.In oor Air Quality and mishes
1.Use LOwMo-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health PIS y=yes 0
4.Use Salvaged Materials 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 IAQ/Health pts y=yes 0
.7.Seal all Exposed Pai1boleboard or MDF 4 IAO/Health.pts y=yes - D
6.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finoar-Jointed or Recycled-Content Trim 1 Resource pts y--yes D
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
! f !
N.Flooring
1,Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
t2.Use Rapidly Renewable Flooring Materials 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 Law VOCs 4 Resource pts y=yes 0
1 t f
Total Points A 1 1401 130 57 •
Total Points Project Received: 1 01 01 0
G:data/progs/greenbuildinrrpguidelines�remodelers<greenpointsfnal212.04prolectedx!s
•
Community Development
4 10300 Torre Avenue
fs � Cupertino CA 95014
Telephone(408)777-3228
OC PCITY OF
EkTINO Fax(408)777-3333
IJfC 1IV Building Department
JOB ADDRESS: /3 9 7 /-,e z /e A, PERMIT#
e UPPltPA'o (7 q
OWNER'S NAME: Rv/ PHONE # ClOr !'5�- Cs y0
GENERAL CONTRACTOR: 4 /S Sew u^ Z D f A+' FAX # Vogl ? -29 - l e,?7
I am not using any subcontractors: 7
8 ZZ W",
ignature Date
Please check applicable subcontractors and complete the following information:
66 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 ZZ e)g'
ontractor Signature Date
• CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36205037 . 00
DATE ISSUED. . . . . . . : 08/22/2008
RECEIPT # . . . . . . . . . : BS000005868
REFERENCE ID # . . . : 08080176
SITE ADDRESS . . . . . : 21397 KRZICH PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RAVI NALLURI
ADDRESS . . . . . . . . . . : 21397 KIRZICH PL
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4942
RECEIVED FROM . . . . : THE GREAT AMERICAN
CONTRACTOR . . . . . . . : CORPORATION LIC # 18061
COMPANY . . . . . . . . . . : GREAT AMERICAN PLUMBING CO INC
ADDRESS . . . . . . . . . . : P 0 BOX 26942
CITY/STATE/ZIP . . . : SAN JOSE, CA 95159
• TELEPHONE . . . . . . . . : (408) 279-1515
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- ------- --------- ---------- ----------
I.PLMBINSP HOURS 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
I.PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
I.TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---- ---- ---------- ----------
TOTAL PERMIT 203 . 96 0 . 00 203 . 96 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
------- --------------- --------------------
CHECK 203 . 96 107146
---------------
TOTAL RECEIPT 203 . 96
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- --- ------------ -------- ----------------------------
106 SEWER & WATER . . 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•