08080008 CITY OF CUPERTINO
BUILDINGDIVISION PERMITCONTRACTQRI1kORMATI :
BUI11MINGA DRESS: PERMIT NO.
] 65 LA PALOMA DR AAA FURNACE & AIR 08080008
OWNER'S NAME: PERMIT ISSUE DATE
ST1.C,I.,MAN IGEN AND GEORGIANNA TR 1712 STONE AVE 08/01/2008
'ONE: SANITARY NO. CONTROL NO,
ARCHn ECrfENGINEER: BUILDING PERMIT INFO
RPLC FURNACE & ADD A/C e o ELECTO PLUMB
MSCH
0
u o o LICENSED CONTRACTOR'S DECLARATION -
I hereby a(Rrm Cat 1 atn limed ander provisions of Chapter 9(commencing Job Description
with Sation 7000)of Division 3 of the Business and Professions Code,and my license is
_ in full In an ffqt,
�� Licemc Cl.. L/ Q Lic.g s
t;,q Dam i CSDECr
q7W Call be
DECLARATION
DW U 1 undewnJ my plate shall de used u public mmrds
a C� Limosed Pmfcuional
aN5OWNER-BUILDER DECLARATION
<� 1 hereby aRnn
that 1 am exempt from the Conuamor'a Licence Taw for dte
o O following reason.(Section IID 1.5.Business and Prefesuum Code:Any city or county
$ which requites a permit to camneL alter.improve,demolish,w repair any structure
_zy prior on its luuatee.alw acquires twApplicam forsuch permit m Trlcasi,.d swemem
sye du he is licensed purwamtothe pmvisiomofthe cantmcmrsuconreLaw(Chapter 9 Sq.Ft.Floor Area Valuation
yF$ (cammencingwid S.U.7000)of Divuion3ofde Burin..dPmfessinm Code)or
East he u aempt dmcf.uW the baso for Ne aBcSW uempdon.My violation of
Section 7031.5 by airy applicant fat a permit subjccu the applicant to a civil penalty of APN Number Oe
Mt mem wan Eve hundred dollars(5500). Occupancy Y EYP
❑1.u owes of the WoperAY,w my employer wid cages u thc'u tele compewtion,
will do Newark,and theswcture is not intended or offered foraale(Sec. 40,Business
and Pmressiom Cower The Connacmam a 90
es LiLaw does set apply an owner of Required Inspections
property who wild+w ire prows thmmn.aM who does such work himself ewthrough his
awn employer,provided dusuch improvements are not intended oroffered for We.If,
however,we building or improvement is mid within One Year of completion.de owner-
wider will nava ths anderr of proving wt he did net wiw or improve for PorPote of
sale.).
0 1.as ower of the property so exclusively Woraming with licensed conuacmn m
comnaLt the project eac.7OM.Business and RafeSVOm Calc:)The ContraCbYs LF
came Law does not apply to son motor of property,who wilds or improves thereon,and,
who cnnaacts for Such projects With a eonaYbr(a)Iimmed pmaW nt m we Contractor's
limn¢LAW.
0 lamcaemptundmsee ,Bk PCforCtumamn
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby AErm under penalty of perjury ane of the following declantiom:
N14.e and will manwn a Co ifieseofC..at to self-insure for Worin'sCompen-
ot,as provided for by Section 37M of the Inbar Cade,for the perfmman a of the,
work for which this permit is issued.
0 I have and will maintain Worker's Cmnpenss6on Imurse¢,as required by Section
3700.f the Labor Code,for we pcfEmmseceof d,west for which this permit is issmd. '
My Worker's Cm/ pcnsamm Wanes terrier and Policy'�num�5be.r�ar�,�'� ��
Cartier: //L� ,a.,0 Policy Na1k0;
fi a �_�
1 TIONINSURANCE PERP
COMPENSATION INSURANCE
amu section nxd oat w completed lithe permit is Forma hundred Collin(SIM)
or leu)
I cuddy,that in the performance of the wart far which this permit is issued.I shall=I
employ any person in any manner m as to become subject to the Warkeri Compemulon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject In the workers Compensation previsions of the Tabor Code,You most
.,O forthwith comply with such Po rim an m this permit shall be dceW m
mrokcd.
'Z y CONSTRUCTION LENDING AGENCY
[-+ Iwreby Kinn this there u a mmtmction lending Money far to Pufonmrce of
IX i the walk for which this Permit H issued(Sec.3099,Civ.C.)
4 Q Tenders Name
=z Landers Addre;
U O I modify that 1 have read this application and also,dot de show information It
ty Ecooag
ccL 1 ree m comply with A[city and county ordinances and some laws relating to
wildingearcuuuion,and hereby sedan.epnsenuuvese this city Or amerupon the
hove-mcnuogm pmPcnt for impenies which ms
H G a (We)agree to ave,indemnify and keep harmless de City of Cupertino against
Z in consequence
of th.cmuand of this expenses which may in any wayurneagamt aid City
C.3 z in eoruegmn¢of de granting of this permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:s4ta� Date ('-4 G
SOU REGULATIONS.
S atumo,�canuConuxmr�' ��o )C Re-roofs
me
HAZARDOUS MATERIALS DISCLOSURE Type of Roof loe'
Will Ce applicant or future wilding excupant rem rehandle haasrdom material
u de0md by the Cupertino Municipal Code,Chapter 9.13.W the Health and Safety
Code.0y.men 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
Ten
Will the applicant o fulumo wilding occupant use equipment w dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
1 head air conamimnu as defined by we Bay Area Air Quality Management all new materials for inspection.
❑Yes
No
I haw real the hat oas materials nquimmcnu underC7apter6.95ofdteCwifor-
.is Health h Safmy Codc,Scniom 255,15,25533 and25534.I undcrsurw uwifthe wilding
docs not currently have•ICnanL du it u MY mipomibility to reufy the oecupmr of do
requi menu which Chau h met priw m issuaaa of a Cenifeaw of Ocnrpseey.
Signature of Applicant Date
E
nen or mud Sod g m Date- All roof coverings to be Class'W*Or better
CITY OF CUPERTINO
6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg
• COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35616038 . 00
DATE ISSUED. . . . . . . : 08/01/2008
RECEIPT # . . . . . . . . . : BS000005659
REFERENCE ID # . . . : 08080008
SITE ADDRESS . . . . . : 11165. LA PALOMA DR
SUBDIVISION . . . . . . . '
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : STILLMAN BEN AND GEORGIANNA TR
ADDRESS . . . . . . . . . . : 11165 LA PALOMA DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4772
RECEIVED FROM . . . . : JIM RANDO
CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050
COMPANY . . . . . . . . . . : AAA FURNACE & AIR CONDITIONING
ADDRESS . . . . . . . . . . : 1712 STONE AVE
CITY/STATE/ZIP . SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 293-4717
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- ------ ------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 7, 892 . 00 0 . 80 0 . 00 0 . 80 0 . 00
IEPERMITFE 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
1MRRAA UNITS 2 . 00 122 . 38 0 . 00 122 . 38 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40. 79 0 . 00
lTRAVDOC FLAT RATE 1 . 00 40 .79. 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 286 . 34 0 . 00 286 . 34 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 573 . 38 VISA
---------------
TOTAL RECEIPT 573 . 38
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL -ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
Stu- FURNACE/AC
CITY OF
•CUPEKTINO PERMIT APPLICATION FORM
APN # -3 (l (�O 03?, Uv Date:D��ol—�
Building Address:
L r9 �o i vE
Owner's Name: Ph on #:
of'olS3-3�/d'
Contractor: h Phone#: y,7/ ,
14141po /l U�� �C Fax #:
Contractor License#: Cupertino Business License#:
7lo�F ) IFpJ 0
Contact: Phone#: .9
4 wZ' Fax #: /
Building Pe it Info:
Elect Er-- Plumb [C / Mech ❑--
Residential Commercial ❑
Job Description:
l2 C
For Residential Installations:
Attic ❑ I" floor (� 2"d floor ❑
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage�Class)-
00
d.e�
Strapped I I On Platform Bonded ❑ New Location Replacement
Project Size: Express E�'Standard ❑ Large ❑ Major❑
Valuation:
7(P
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.
Revised 6/16/08
CITY OF CUPERTINO
FURNACE/AC
cl or
CUPEkTINO 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,recessed wall htr, or
floor mounted unit heater.
IPGASCOM 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 & not 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
I 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 & not incl in an —1 errnit.
CITY OF CUPERTINO
' FURNACE/AC
•cuPE� Tlrvo FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1PGASRES Residential for ea gas piping system 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
fumace/burner, incl ducts/vents
attached to such appliance up to and
• include 100,000 Btu/h
1MFRN>100 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
fumace/bumer, incl ducts/vents
attached to such appliance over
100,000 Btu/h
IEPERMITFEE Electric Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
•
CITY OF CUPERTINO
�r FURNACE/AC
CITY OF
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1BCAIRHAN Commercial A/C Units <= IOk CFM B
1MCRAA Commercial Mech Repair/alt/add M
IBSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1PGASRES Residential for ca gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
1BREMAIRHAN Residential A/C units <= I Ok CFM B
IMRRAA Residential Mech Repair/alt/add M
1BSEISMICR Seismic Residential B •
r 1EPERMITFEE Electric Permit E
/ IMPERMITFEE Mechanical Permit M
IPPERMITFEE Plumbing Permit P
1TRAVD0C Travel Documentation B
IBUSLIC Business License B
•
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 Sidin 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 y Star Refrigerator, (Note/Spec. A-3 1 oint
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.
INPUT ReSOUTCeS Energy IAQ/Health
A
A.Site // (6 S— A NG A / y �.l
1.Recycle Job Site Const uction&Demolition Waste
65%=1 point;75%= 2 points;60%=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 t Resource pt y=yes 0
6.Implement Construction Site Stormwater Practices 2 Resource pts y--ye0
7. Protect Water Quality with Landscape Design 2 Resource pts y--yes 0
6.Design Resource-Efficient Landscapes and Gardens 4 Resource pts y--yes 0
9.Reuse Matedals/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
OW
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 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yesF; 0
1 1 1
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 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
6.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 0 •
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=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 pts y=yes 0
3.Vent Range Hood to the Outside 1 IAQ/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 AQ/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 IAO/Health pts y=yes 0
b.Water Heaters 31AQ/Healfh pts 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 Efficiency(AFUE)Furnace 2 Energy pts Y--yes 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stoves/inserts 11AQ/Health 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 IAQ/Health pts y--yes g
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes g
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 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 g
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=16 points) Up to 16 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 p
1 1 1
L.Natural Heating and Cooling
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 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
1 1
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
S UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
i/ gas' C.v /,00 kIf-b6-V Cf--
OWNER'S NAME: S74; 1f1Ata.,j PHONE # -
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:�/�J=V/
Signature Date
Please check applicable subcontractors and complete the followinginformation
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