08080236 CITY OF CUPERTINO
BUILDINI:4HVISIOry PERMIT a aaC��..O� AP�WTRACTGTR INI` A.TIf)1V,,.+
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BUILDING.�aqqµES PERMIT NO.
G i..S b.l kELFORD DR TBD — TO BE DETERMINED 08080236
OWNER'S NAME: PERMITISSUEDATE
KNN,: FINN 08/29/2008
NE: SANITARY NO. CONTROL NO.
ARCHnECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Z 0 0 0
30p LICENSED CONTRACTORS DECLARATION MJb Description .
fd 0 1 barely affirm that 1 an licensed under provisions of Chapter 9(commencing O0SCr1P
mencing
M who Section 70Xf)ofDlviaam3aftkBusinauahaPralcuionsCade.and mylicense I. INSTL NEW GS LINE FRM FRNCTO FIREPLC, OUTFIT
^< in full forte and effem
Z Wcenso Clau Lk.N EXTNG
3g�
Data_ unnetor
ARCHITECTS ECLARATIONMASNRY FP W/GAS INSRT, GAS LINE, NEW FRM FOR
1 unm
doand my pima shall M used as public mcmd,
TV& ELECTRCL& INSTL NEW GAS DECORTVE OPENING FOR
g LL Licensed Professional
yN OWNER.BUILDER DECLARATION
i f 1 Washy affirm that 1 am exempt from the Conuac ofs License Law for the
p O following mason.(Secdon 7 W 1.7,Buslncss and Professions Cale:Any city at county
$2 which re ulms a permit to emsouct,sbm,improw,demulish,at Spahr my Structure
iy prior in its issuance.also requires the applicant far such permit to file a signed statement
< that be is Removal Portman,to the provision;of the Comment's Licanm Law(chapter 9 Sq.Ft. Floor Area Valuation
�S (commencing with Section 70D0)of Division 3 of the Business and Professions Cade)or $2560
Nat he is exempt thosefeam and the basis for the alleged emmpuon.Any vichdon of
Section 703 by Ory applicant for a permit Subjects the appinmt to a civil penalty ofNumber Occupancy Type
001 mom atm nem hundred dollars(gam), 3 2 6 41101 .
0 Las owner of the property,army employees with wagam tlnksolecempewdon,
will do thewoskmd the structure Is mtinundedaraffased forsale(Sec.7014,BuaIMu Required Inspections
and Profeulons Coda roe The Contravenes License law does t apply to in Owner of q p
property who Wilds orimpows thveemand whodoes such work hlmaJforthrough his
own employees.pmsided that Such impovements tic not Intended orOffereal foraale.If.
however,the Wilding or Improwm ret IS mid within am year of oomph um.the Owner.
Wilder will haw the WNen of proving that M did not Wild or improve for purpose of
axle.).
04:'"ow.of We Property.am aelaiwly emuaning with licensed mnuanata to
construct the project(Sec.7044.Business and Profarnv Code)The Contractor's Li-
ansa law dans nm apply to So owner of property who Wilds or improves thereon,and
who contracts for Such projects with a conuactor(s)Reasoned pharum,to the cmacul s
Licmhm law.
❑Iannempt undaSee ,BBPCfml,
Owns, LaAk fnCn, Data
MPENSATION DECLARATION
1 hemby afam under poky of pedury ane of the following dMlandons:
ham and will maintain•Cenifhamof Consent to self-Ivum far Warkees Coolant.Ian.u provided for by Section 3700 of the Labor Code.for tau Performance of the
work for Mach this permit Is issued
❑1 haw and will munuin Workees COmpen t don Insurance,as m9uired by Section
7700 ofthe Labor Coda.for the prfmmmce of the work for which this permit is Issued '
My Worker's Compensation Insurance carrier and Policy number rue:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This SeNon heed Out W corepknd i(the permit Is two=hundred dollar($100)
M less.)
I cavity than in the performance of the workfarwhich this permit is issued,l Mall not '
employ any person In mem R/�4la mbJecI In he Wmkeri Compewthm
Law of Cali(omia. f f f� /4
Applicant
NOTICE To APPLICANT:If,after pensng this Genome of Labor an,you should
becomehcompto it Worker's Compensationthisprovisions of thearhor Code,you mot
0 foMwith comply with such provitiav or Nu Amit shall ho domed mucked.
z'rA CONSTRUCTION LENDING AGENCY
F 1 homby atom Ilan dorm is a conmocunn lending agonry far the performance of
GS > the wash fur which this Permit is issued(Sec.3097,Civ.C.)
OW. A Landes Name
= z Lender Address
V Q I caddy that 1 haw meal thus application and sun this the Show information is
coma I agree n comply with all city and county ordinances and sum laws re1Nng to
C) WildingWilding cmuvucdan,and hereby mNadm MIcaenuuws of this City to enter upon Nc
W atom-mentioned properly for inspection purposes.
fy nm)agree to ave,indemnify and keep harmless the City of Cupertino agaiat
ti Vs. Ilabllifa.IudgmenWcvu and expenses which may In my way amme agaivtald City
O z APPLICANT UNDERSTANDS ANDnsequence of da.graming,of WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCctEREG��`��/ArIIONS, ` ��/
Signature of ApplicenY EUC uecllarr t�/a� Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(mart Wilding occupant Som orhanalk hazardous material
as deMad by the CupNm Municipal Code.Chapter 9.13,vex the Health and Safety
Code,Section 25372(a)7
❑Ya 9*- All roofs shall be inspected prior to any roofing material being installed.
Will the applicant Or future Wilding aaopnt ma rgdpment W doiea which If a roof is installed without first obtaining an inspection,I agree to remove
I hoaramm air canummants a donned by the Bay Am.Air Quality Management all new materials for inspection.
inct7
❑Yes
1 haw read tie hvardau materials mpiremen s under Chapter 693 of f Califor.
IS
Halthk Safety code.Smio.25307,25537 ami 25534.1 undorrund noir the Wilding
daa not curmndy haw•unmk t1a It is my responsibility m notify this occupant of the
mgtow 6 trabemetpiorto __ .C.Cmufeanof Signature of Applicant Date
ownetormthariredagent D n' All roof coverings to be Class'J{"or better
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32641101 . 00
DATE ISSUED. . . . . . . : 08/29/2008
RECEIPT # . . . . . . . . . : BS000005946
REFERENCE ID # . . . : 08080236
SITE ADDRESS . . . . . : 21361 MILFORD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
•OWNER . . . . . . . . . . . . : KATE FINN
ADDRESS . . . . . . . . . . : 21361 MILFORD DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1327
RECEIVED FROM ' . . . . : KATHLEEN E FINN
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS
CITY/STATE/ZIP . . . . '
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- -- ------------- ---------- ---------- ---------- ---------- ----------
IBSE.I.SMICR VALUATION 2, 560 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1MECHINSP HOUR 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
].PGASRES OUTLETS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00
IPPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
7.PRREPIPE NO OF FIXTURE 1. 00 10 . 20 0 . 00 10 . 20 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- --- ---
TOTAL PERMIT 275 . 85 0 . 00 275 . 85 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 275 . 85 VISA
---------------
TOTAL RECEIPT 275 . 85
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 507 FINAL PLUMBING
CITY OF CUPERTINO5"
REPIPE/SEWER/MAIN SERVICE 01P 00?-3('10
• CUPERTINO PERMIT APPLICATION FORM
APN# 342 (o Ll I/ O / .
0 Date:
Building Address:
a13(/ 1/ .fi o CA R56/
Owner's Name: Phone#:
)4a)gJ1een 'lien S'�' oz5s —lsa'/l
Contractor: e �rp�/QCT � `2 f Phone #: 5D
/ to /q3b'-a6oa
Fax#: 650 &q- /Pd
Contact: Phone#: '
SaMiR
P Yt�r Fax #:
Contractor License#: a 3 5 6
Cupertino Business License#:
Job Description: ri15in'lP /IeGJ q�5 1 n C �fdvVt fiyrnctGe. fz� �r�p/Qce
D fi+ eXishn� se17/I� VF/� JJ/ �as i.'7Se-r-4 , dc4S l�'ne; YyJpc.l ,
Ffa m i n �'IN" TV v �-EC '�i Ccu s �-y� '�'c-l.1 �...�2c.... �•1' (�.2c,•rwl�C
41
Residential Commercial ❑ � �c
Valuation: da 660
Project Size: Express Standard El 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 index.
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 IRPSS
sewer/sanitary sewer
II
I
CITY OF CUPERTINO
11 ao REPIPE/SEWER/MAIN SERVICE
CUPERTiNO FEE SCHEDULE
Quantity Fee ID Fee Description ..Fee Permit Type
Group
I 1PRREPIPE Residential re-pipe per fixture P IRPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
IPCESS Cesspool P
IBPWATER Install/alter Water Pipe P
IBPFIXTURE Plumbing Fixture P
IPGASRES Residential Gas Piping System P
I 1-4 Outlets
IBPGAS Gas Piping System 5+ Outlets P
r IPPERMITFEE Plumbing Permit Fee Issuance P
1PLMBLNCK Plumbing Plan Check P e
1PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel &Documentation Fee B
IBUSLIC Business License B
Revised 6-16-08
e
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 POINTS E 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 Resnives Energy AWHealth
to
21,Recycle Job Site Construction&Demolition Waste
421>=1 point;75%= 2 poi s;80%=4 in � 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
Histodc Preservation 4 Resource pts y=yes 0
4.Protect Native Soil 2 Resource pts y--yes D
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
B.Design Resource-Efficient Landscapes and Gardens 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 pis y--yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts y=yes D
1 MEMO
B.Foundetlon
1.Incorporate Recycled Flyash in Concrete
25%Recycled Flyash=2 points;Add 1 point for every 10%
increase of fiyash,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=yesk_�:: 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 1-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 pis y=yes 0
8.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 yryes 0
b.Weil 3 Energy pts y=yes 0
c.Root 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 pis y--yes 0
12.Use OSB
a.Subfloors 1 Resource pt y=yps 0
b.Sheathing t Resource pt y--yes 0 •
mLOWS INPUT ReSOUTCeS EnETqY IAD/Health
1.Install Energy-Efficient Windows
• e.Double-Paned 1 Energy pt y=yes p
b.Low-Emissivity(Low-,E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames 2 Energy pts y--yes0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes p
1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on All Duct Joints 2 Energy pts y=yesp
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 p
4.Clean all Ducts Before Occupancy 2 IAO/Health pts y=yes p
5.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes p
7.Install Whole House Fan 4 Energy pts y=yes p
B.Install Sealed Combustion Units
a.Furnaces 31AQ/Health pts y=yes p
b.Water Heaters 3 IAQ/Health pts y=yes p
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes p
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes p
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
1 etrofit Wood Burning Fireplaces
nstall EPA certified wood stovesfinserts 1 IAQ/Health pt y=yes p
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 41A0/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 31AQ/Health pts y=yes p
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes p
2.Install Solar Water Heating System 10 Energy pts y=yes p
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=18 points) Up to 18 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
DL Iatural Heating and Cooling NOW
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 pts y=yes p
I 1
Community Development
130 Torre Avenue
ST00 Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
` �UPEkTINO
Building De artment
JOB ADDRESS: ,213 61 /!7i rd b r PERMIT #
er+frlo . CA 96o1 oeo Z-623 6
OWNER'S NAME: Kdl+.(een E. ern r PHONE # C a5 - 68 11
GENERAL CONTRACTOR:'Tke 5;w late Slemc d FAX #
I am not using any subcontractors: Z.Lq O Y
Signature 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
e19 O
Owner/Contractor Signature Date