08090175 •
CITY OF/SUPERf[NO ,, k .Aa+*r 11 «* a"''� •^ =
BUILDING DIVISION PERMIT a CONTRACtOR INFORMATION. '
PERMIT NO.
BmLpI�uAp�aEMIRA VISTA AVE BOB HENDRICKSON 08090175
OWNERS NAME:.SPERMITISSUEDATE
BOB HENDRICKSON 10535 MIRA VISTA AVE 09/26/2008
SNE SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 0 0 0
u O ocg, LICENSED CONTRACTOR'S DECLARATION Job Description
rd I hereby affirm that tam Santo!under provisions of Chapter 9(commencingP
V
°oH nmOforceaanddeeffect, an3ardeBaainessWPrafessiansUde.ndmyfianseis INSTL 2 SKYLIGHTS: 2 IN COVRD PRCH(FRNT) ;
o n z License Class Lie.♦ NON-STRUCRL
n t-q Date Contractor
'
'�W ARCHITECT'S DECLARATION
�W e I understand my plans shall be used as public records
6
k O licensed Professional
25 OWNER-BUILDER DECLARATION
9 2 0 1 hereby alum that I am exempt from the Contractors License Law far the
is 0 fallowing reason.ea (Section 7031.5.Business and Professions Code:Any city or county
•
_m C which inquires a permit to construct.alter,improve,demolish,or repair any structure
iy prior to its issuance,also requires the applicant for such permit to file a signed statement
r< that he is licensed penano heprovisions o the Convector's licenselaw(Chapter9 Sq.Ft,Floor Area Valuation
Ey s-.1 (commencing with Section 7000)of Division of the Business and Professions Code)or $1500
e 2— that he b exempt zany applicant
and the basis for the alleged exemption.Any violaaon of
Section 7031.5 by any dont fora permit subjects the applicant to a civil penalty of •Number Occupancy e
not more than rive hundred dollars(55C0). 35705040 . P Y�'P
❑las owner of the property,or my employees with wages as their sole compensation,
will do the;Mit andthestructuresnotintendedorofferedforsale(Sec.7w,,Busnes Required Inspections
and
Professions Cot he Contractors License Law does not apply to an owner of
property who builds or improves thereon.and who does such work hinuel f or though his
own employees,provided that such improvernenu are not intended or offered for sale.If. •
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or Improve for purpose of
sale.). •
O I.a owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Cootracmrs
cense Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a contraemr(s)licensed pursuant to the Contractors
License law. •
❑I am exempt un Se'c/ ,B&P C for this won
Owner /..s/ 4.-.ice. Date ,.r.!
WOK SdehWlet#I0N DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
• I have and will maintain a Certificate of Consent o self-Insure for Workers Compere
sation,as provided for by Section 3703 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued. • '
My Workers Compensation Insurance ant and Policy numbs are: -
Cartier. Policy No.: •
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE .
(Trissection need not be cempkud If the permit is for are hundred dollus(S 100) ,
or less)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any omen in any mail
nt r..as to=rim subject to the Workers Compensation
Laws of Califon' -
Applica .%) ' ,ate%' /
NOTICE TO :PLICA-NT: f,a'r i m.'Q n is Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
...Z forthwith comply with such provisions or this permit shall be daro
rned oked.
'� CONSTRUCTION LENDING AGENCY
[••tI hereby affirm that there is a construction lending agency for the performance of
ae> the work for which this permit is issued(Sec.3097,Civ.C.)
W a Lender's Name
5z Lenders Address
•
Q I certify that I have read this application and sate that the above information is
IL E correct.I agree to comply with all city and county ordinances and state laws relating to
Q building construction,and hereby authorize representatives of this city to enter upon the
r IT.1 above-mentioned property for inspection purposes /
F g� (We)agree to save,indemnify and keep harmless the City of Cupertino against
,-r Vlliabilities,judgments,costs and expenses which may N e any way accnagainst said City _I�
U z in consequence of the granting of this permit.
,•' APPLICA ••ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: re / 4,OOP) /^Date ' 2C 406'
sou. • t TIO
- r Re-roofs d
Sr Toa ••i-, �o-- .r Daw /J'
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle Keadous material •
as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Code,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes �m Na .
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District P
Gales XNo
•
I have read the haardas maleriab requirementsunder Chapter 6.95 of the Califoo
nia Health&SafetyCode,Sections 25505.25533 and 25534.1undvsund that if the building
does not currently hnt.dist It is my responsibility to notify the occupant of the '
requireeff me __„rtgt.met.,:orto issuance ofaCertificate of(ken.114 G' Signature of Applicant Dateowner errauthorized neem All roof coverings to be Class a%¢"
Dam' g or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: 'Rng: Sub: Blk: Lot:
APN • 35705040 . 00
DATE ISSUED • 09/26/2008
RECEIPT # • BS000006199
REFERENCE ID # . . . : 08090175
SITE ADDRESS • 10535 MIRA VISTA AVE
SUBDIVISION
CITY • CUPERTINO
IMPACT AREA
OWNER • BOB HENDRICKSON
ADDRESS • 10535 MIRA VISTA AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM • ROBERT MM HENDRICKS
CONTRACTOR • LIC # *OWNER*
COMPANY • BOB HENDRICKSON
ADDRESS • 10535 MIRA VISTA AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
1BSEISMICR VALUATION 1, 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1SKYL<10SF EACH 1 . 00 367 . 00 0 . 00 367 . 00 0 . 00
TOTAL PERMIT : 367 . 50 0 . 00 367 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
CHECK 367 . 50 #4958
TOTAL RECEIPT : 367 . 50
•
o ?0 O/7,i
CITY OF CUPERTINO
CITY OF
• CUPERJINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN
Date: ^/f l) a o b t
Building Address: C�
/ DS 3 / ira LI/ sict 6u-e_ •
Mailing Address (if different from building address):
Ow s Name: Phone#: //
KmlLWeTd Her)thri Ict- er) dr1CPSC/0 g4/4 94/y3
Contractor: Phone:
Hoye LQJneR -<Cc' Fax:
Contractor License #:
Cupertino Business License#:
Contact:l'� /" Phone: /� ///_
• /&er-r J--/er)cJYIC n Fax: 1710
Residential �f Commercials
Job Description:
ar')sl'ell 42,N hi h,s o2- ►n Cc re ) Prcil (cioni)
NON trUCTVQ (— •
Building Permit Info:
Bldg E Elect 0 Plumb 0 Mech ❑
Type of Construction (Usage Class): Occupancyn� Type:
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B 7
Valuation: Square Footage:
/J 4niat
Project Size: Express .Standard ❑ Large ❑ . Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set& the sheet index.
Points Achieved:
•
For help, contact Build it Green at www.builditgreen.org
Revised 7/01/08
•
`^ t CITY OF CUPERTINO
CITY OF
CUPERINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 BBOILER1 For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
1 BBOILER2 Installation /relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
I BBOILER4 Installation/relocation of ea• M •
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1•,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing & Gas Inspections P
(per hour)
IMEETING1HR Application Meeting B •
•
• • ; d, • CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING APPLICATION
• FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
1ACOUSFDW SFDWL/Duplex New B
1 ACOUSRESAD SFDWL/Duplex-Addition/Alteration B
1ACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIMNEY Chimney B
1 CHIMNEYR Chimney Repair B
FENCES
• 1 FENCE>6FT Non-masonry, over 6ft in height B
1 FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1 FIREPLMAS . Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1 FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1 PILEDRIV Pile Foundation Driven (steel, pre- B
• stressed concrete)
3of5
CITY OF CUPERTINO •
CUPEf�T
�� RJiNO GENERAL BUILDING APPLICATION
FEE SCHEDULE •
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group .1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
IRETSPI0 Special Design, over 10' high(up to B
50')
1RETCRB< Gravity/Crib Wall; 0-10'high (up to B
50 ft)
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft)
SHED-(EACH) Shed Over 120 sq ft B •
SIDING
I SIDEST/BK Siding, Stone & Brick Veneer B
(interior/exterior)
1 SIDEOTHER Siding all other • B
SKYLIGHTS
/ 1SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 sf or B
structural
'STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
• 1 SRACKS<=8 Storage Racks 0-8' high (up to 100 se B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st) •
•
4of5
•
CITY OF CUPERTINO
CITiOF GENERAL BUILDING APPLICATION
, cugkcTINO
• FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sO B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee)
1EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
•
1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
IMECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
/ 1BSEISMICR , Seismic Residential B
1BSEISMICO Seismic Commercial B
•
ITRAVDOC Travel & Documentation B
• 1BUSLIC Business License B
5 of 5
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)
:,Mi,";j ' . ;+,tw`+'guz.i t'7r., '4r,:,y4.N v .Y , '4'r.S: ;:k-,v':a ur t jY, w i .•!;k. aN.,'1;,.4c6--ti
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) 5.2 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
vj•`M'91'43•C : ''; . 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- Resources Energy IAD/Health •
A.Site
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;80%=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 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
IB.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 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
0 0' O
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=yes 0
0 - 0 .' 0
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
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 y=yes 0
b.Wall
c.Roof 3 Energy pts y=yes 0
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 OSS
a.Subfloors 1 Resource pt y=yes 0
• b.Sheathing •
- 1 Resource pt y=yes 0
Q. Q _ 0
INPUT Resources Energy IAO/Health
B.Exterior Finish
1.Use Sustainable Decking Materials
a.Recycled content 3 Resource pts y=yes- 0 •
b.FSC Certified Wood 3 Resource pts y=yes- 0
12.Use Treated Wood That Does Not Contain ChromiumlArsenic ; 1 IAD/Health pt y=yes 0
I3.Install House Wrap under Siding 1 IAO/Health pt y=yes- 0
4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
0 0 0
E.Plumbing
1-.I.Install Water Heater Jacket _ 1 Energy pt y=yes 0
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
4.Replace Toilest with Ultra-Low Flush Toilets
(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead - 1 IAO/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 IAOJHealth pts. 0
B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0 •
•
0 0 - 0
r.necmcar
1.Install Compact Fluorescent Light Bulbs(CFLs)
1(6 bulbs=2 points,10 bulbs=3 points, 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. 0 •
•
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. 0
0 0 0
G.Appliances
I1.Install Energy Star Dishwasher 1 Energy pt y=yes- 0
12.Install Washing Machine with Water and Energy
'Conservation Features 1 Energy pt y=yes- 0
3.Install Energy Star Refrigerator 1 Energy pt y=yes i 0
14.Install Built-In Recycling Center 3 Resource pts y=yes_ 0
. 0 0 0
H.Insulation •
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls2 Energy pts y=yes 0
b.Ceilings . 2 Energy pts y=yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
• iS:Install Recycled-Content,Fiberglass Insulation with
'No Added Formaldehyde 3 lAO/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5.Use Cellulose Insulation .
a.Walls 4 Resource pts y=yes 0
b.Ceilings - 4 Resource pts y=yes 0 •
•
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
D.uenings 4 Resource pts y=yes 0
0 0► 0
INPUT Resources Energy IAQtHeatth
•
I. endows
1.Install Energy-Efficient Windows •
D
• a.Double-Paned 1 Energy pt y=yes
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
0 0
J.Heating Ventilation and Air Conditioning -
'1.Use Duct Mastic on Au 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 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
8.Install Sealed Combustion Units
a.Furnaces 3IAQMealth pts y=yes 0
b.Water Heaters 3 IAQMealth 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 Efficiency(AFUE)Furnace 2 Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stoves/inserts 1 IAQ/Health pt y=yes 0
b. InstalVReplace 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 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAO/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 0
Q 0 Q.
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 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 Sate and Durable Roofing Materials _ 1 Resource pt y=yes 0
•
7.Install Radiant Barrier - 3 Energy pts y=yes 0
•
00 . 0
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
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
0: 0 0
•
INPUT Resources Energy IAQfHeatth '
M.Indoor Air Qua ity and Finishes
1.Use Low/No-VOC Paint 1 IAQMealth pts y=yes 0 , •
2.Use Low VOC,Water-Based Wood Finishes 2 IAQMealth pts y=yes 0 • •
I3.Use Low/No-Vet Adhesives 3 IAO/Health pts 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 6lAQMealth pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQMealth pts y=yes 0
.7.Seal all Exposed Particletward or MDF 4 IAQ/Health pts y=yes 0
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim • 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAO/Health pts y=yes 0 .
•
o o 0
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Floonng 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 Low VOCs 4 Resource pts y=yes 0
0 0 0
Total Points Available:) ' 1401 1301 571
, Total Points Project Received:) 2 01 01 0 •
•
•
9faiel2ac
•
3:data/progsrgreenbuildngguidelineshemodelersrgreenpdntsf nal2.12.O4protectedxis
•
tln ACCOAPPR®�EDS Oi
��� ERTINO CODES AND ORDINANCES
Gip
a ___
OWNER: rnR, & MRS HENDERSON� �N®
10535 MIRA VISTA RU, pis ;on t — r
le 8elliSI
CUPERTIN❑ CA 95014 t° m `'� �
� of?rt ssaame i:•.,
use DOilnr , • i pt-.1)Stamdi • • no.
SHALL Pmt r r,
NOT t rc , . ; 4..ratbm
+DP oe& of tt vicb., a , -• hP ar
(E) 2X6 "AFTERS c' 24' O.C. • any rit<, o• „r•^ „ `r� !"— ..f) .
a+ t: ,
AV NEW 4X4
Ail / E) 2X6 'AFTERS
ATTACI PER /./ @ 24'
ATTACHED SKYLIGHT
DETAIL gIARcy_
(N) ='X2' SKY_IGHT �� NEW 4X4 ;' ti?1� _: 4tPfr, T'CIl
A,�'
OPENING (TYP ) —J
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OWNER-BUILDER VERIFICATION
• 1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A. All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked, complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
• A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
RJ-wrr J—k-ndrirlrcgtq fny35' Ahiethc& j, 4oe,y46-y493 Performed $tytiT'
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature: et- A.., _ / _ Date: dpJ_Q?/ / zpr
Job Address: /05-3 C th P4 UK—4 ft/a_ Permit# 4-0 9 O / 7s-
Any
SAny changes to the information provided on this form shall be submitted to the City of Cupertino Build
• Department.
CITY City of Cupertino Building Department
I 10300 Torre Avenue
C U P S T'N O Phone: (408)777-3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as
contractors or subcontractors,then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation•
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish, the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department, •
City of Cupertino
Printed on Recycled Paper