08030024CITY OF CUPERTINO„
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_041R- " RJNFORMATION
BUILDING DIVISION PERMIT
ouILOINA A13DR...iEAR TREE CT
1'
AFFORDABLE WATER HEATERS &
NO.
PERMR 08030024
NERR's NAME:
PET1hI1T ISSUE DATE.
FW
MOORE RONALD
24707 SAN FERNANDO RD
03/06/2008
ALKONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
RPPLACE WATER HTR
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
LICENSED CONIRACIDRS DECLARATION
JOb Description
1 affirm Net I am under provisions of CTode. 9 (cm.mmming
f0m BL
with section ]IXIU) of Division ] of the Businev aM Prafeviav Code, and my license is
ion 7
in full force and of -
Lleense Class Lm. p
Dom Contractor
ARCHITECTS DECLARATION
1 understand my plans shall be used As public meomis
Licensed Pnfcsslonal
OWNER -BUILDER DECLARATION
1 heresy antero that I a.5 exempt from Ifni L'anllacl far BC
Any
Co :
inns Cade: Any city
$.Ii 5, BOSInnb and c ty o
mason. (Section
seaunty
in703
C.M Improve, do
which rcquirn a pcmnit m cnnxua4 alms', impmm, dcmnikh. m repair any soucmro
which
prior W its issuance. also mquias the applicann for such Permit o file&signed w¢menl
is licensed Law (Cbapen9
Sq. Ft. Floor Area
Valuation
that he pursuanttoNcprovisions ofNcContractor'Liensc
(commenefng wide Sado.7")of Division J of the Business and Professions Code) or
that he it aaempt therefrom and the that for the alleged eaempdan. Any NoWfm of
APN Number
Occupancy Type
Salon 7031.3 by any Applicant (or a permit subjew the aWficaeto a civil prnahy of
am more than five hurdmd dellen (SSW).
0 1, As owner of the property, or my employees wbh wages az their sole eompevadon,
Required Inspections
e ns
will do the work. and dm structure is not lnuMed or offered for sale(Sa. 7014, Business
an owner of
and Pmfemiom Cade: The Contractors License law donot apply W w
q P
property who buiIdamimproves damnn, and whodatessuch Werk himselforthrough his
awe amployres, provided that such imVrovemens art notinmMN reoffered forsale If.
however, the building or improvement Is sold within one year ofeempledoo, du ownes-
builder Ada haw Ne burden of proving that he did ICI build or improve fur purpose of
old.).
0 1, as Owner of the property, am exclusively contracting with licensed conlaxWn W
construct the project (Sec. 7W, Business and Profnsiov Cate:) The Contractors Li.
-
cove Law does out apply W An.wore of property who Wilda or improve deacon. and .
who.mracs for such projecs with a conuacmr(s) licensed pursuant W Ilse Contraerors
License La-
0lore nempt undo See .B&PC far Nis wan
weer Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury nos of the following declaratimse
0 1 haw and will mainum ACcrtifievuof Covent to self -insure far Workers Compen-
sWion, as provided for by Sation 37W of the Labor Code, for ave performance of de
work for which this permit is issued.
0 1 have and will maintain Workers Comperuadon Insurance, as KquirN by Section
37W of de Labor Code, for Ne performanceaf the work for which ni. permit is Word.
'
My Workers Compo ton Maumee camierand Policynumher am:
Carrier. Policy N, -Z0 (0 $7e 3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nut tecomplewd if the permh Is forov humanist aa0as(SIM)
'
it, lc..)
1 certify that in Ne performance of the work for which Lida permit u issued, l shall not
employ any person In Any mminer 5015 W became subject W the Workers'eampeN&ton
.
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, after making N0 CeniBme of Exemption. you should
became subjat W Ne Worker's Compevid.. pm,bhms Of the lana Code, you mus
forthwith COMPLY with such provision or this permit shall be deemed ermined.
CONSTRUCTION LENDING AGENCY
I hcroby a1Brm that NCK is A conslructinn lending agcnry for dm perfo..... f
the work for which Nis permit Is issued (Sec. 3797. Civ. C.)
Nurse
Lenders Addw
1 certify Nen 1 have read Nis ApPlie.d. and sou tut the above iNamatiun is
correct. 1 agree to comply with all city and county on inaao and sum laws relating W
building construction. and hemby authorim Kpmscnudvca Minis City m enter upon the
shove -rum tined pm,,ty for inspcninn pngwms.
(We) acme to save, indemnify and keep harmless Lie City of Cupertino against
liabilities. pilgreeits. cossandeapenacs which may in any way seem againtsaid Ch,
in Co..,.. of the granting of this pc.i,.
'7
APPLICANT UND RSSSfffANDS AND WILL, CO PLY WITH AUU7 NON -POINT
Issued by: Date
SOUR=.„,f / /G
Re -roofs
�✓ a� ! /mm
SignatumO ApplicanUConuacmr
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will to applicant M future building occupants. orhandk hound.. mtum.1
a defined by she Cupertino Muni 'pal Code, Chapter 9.12, and the Health arid Safely
ode, Semon 25532(x)]
All roofs shall be inspected prior to any roofing material being installed.
❑Yrs No
If a roof is installed without first obtaining an inspection, I agree to remove -
Will thc applicant or fUMM building occupant use equipment or devices which
emit hazardous air cmhmminans az Bncd by Ne Bay AKA Air Quality ManAgcmenl
all new materials for inspection.
Disuia]
[3 Yes Na
I have read the havrdousmamriaH rtquimmcns under ChaPmr6.95.(tire Calif..
nix Health&Safety COM,Savas25 25573 mW 255Ja.1uodcrsund son fdve building
does not.nenty ho mel. t k m m hilip W mdfy the occupant of the
Kyuimmcnts t� x print aaanaaracmddnWaf7«/cyp�atey.
ham`. /D
Signature of Applicant Date
s
All roof coverings to be Class "B” or better
owner roam-n.dagent ,
• 4 ITEMS OF 32
•
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31630085.00
DATE ISSUED.......: 03/06/2008
RECEIPT #.........: BS000004096
REFERENCE ID # ...: 08030024
SITE ADDRESS .....: 19967 PEAR TREE CT
SUBDIVISION .......
CITY .............: CUPERTINO'
IMPACT AREA .......
OWNER ............: MOORE RONALD
ADDRESS ..........: 19967 PEAR TREE CT
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: EDDIE D NALLEY
CONTRACTOR .......: LEONCE ROUX LIC # 26850
COMPANY ..........: AFFORDABLE WATER HEATERS &
ADDRESS ..........: 24707 SAN FERNANDO RD
CITY/STATE/ZIP ...: NEWHALL, CA 91321
TELEPHONE ........: (661)259-7131
FEE ID
UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
IBSEISMICR
-------------
VALUATION
----------
1,400.00
----------
0.50
----------
0.00
----------
0.50
----------
0.00
1PPERMITFE
FLAT RATE
1.00
40.79
0.00
40.79
0.00
1PRWHEATR
UNITS
1.00
24.48
0.00
24.48
0.00
1TRAVDOC
FLAT RATE
1.00
40.79
0.00
----------
40.79
0.00
TOTAL PERMIT
----------
106.56
0.00
----------
106.56
----------
0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
I OF
• CUPEkTINO
4
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
APN #
Date: 31616 K
1 , 6-1)
/
Building Address:
CA 6-7
Owner's Name:
Phone #:
uo,- �.�3— 119`7
`cam
Rpn1�\" 00Y c�
Contractor:
Phone #: W i - 2-5-5 - -7/ 3/
b�-ovOA(31� WA�r-
Fax#: 106- zS 5-�iSlL
Cupertino Business License #:
Contractor State License #:
6z-2 36
Contact:
Phone #: (o6(- zsy
Fax#: 66/- z5y _5351
Building Permit Info:
Bldg Elect [� Plumb
2111�
Mech
Residential
Commercial ❑
Job Description:
Strapped []� On Platform ❑ Bonded ['
New Location ❑ Replacement [�
Valuation:
t40a
Green Building Check must be completed and attached to this application.
Green Building Points achieved:
aI'CF
CUPEkTINO
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
1PCWHEATR
Commercial Water
HeaterNent
B
PCWHEATR
1BSEISMICOM
Seismic Commercial
B
t
1PRWHEATR
Residential Water
HeaterNent
B
PRWHEATR
1BSEISMICRE
Seismic Residential
B
1PPERMITFEE
Plumbing Permit
P
1TRAVDOC
Travel &
Documentation
B
1BUSLIC
Business License
B
0
E
•
Single Family GreenPoint Checklist date: 3A(
The GreenPoint Checklist is based on the various green features Incorporated Into the home and is the
basis for the GmDnPolnl Rated program. A home can be considered green If it fulfills the prerequisites,
eams at least SO points, no meets the minimum points per Category. Energy (3D), Indoor Air OuallW
Health (S), Resources (6), and Water (9). Please contact Build It Green for a list of qualified GmenPolni
Raters P you are Interested In pursuing third -party verification.
The green building practices listed below are described in the New Home Construction Green Building
Guidelines, available at www.buildltamen.om.
Build It Greeri
Smart Solutions From The Ground Up
H. FOUNDATION
Points Avaliable Per Measure
❑
❑
1. Replace Portland Cement in Concrete with Recycled Fyash or Slag
a. Minimum 20% RI w Slag
b. Minimum 25% FI ash or Slap0
f. Apply Optimal Value Engineering
0
1 I
o
2. Use Froal-Protected Shallow Foundation In Cold Ames(C.E.C. Climate Zone 16)
0
3 '
0
a. Use Radon Resistant Construction on At -Risk Locations Only)
0
1
❑
4, Design and Build Structural Past Controls
a. Install Tormfla Shields & Se arate All Exterior Wood -to -Comate Connections by Metal or Plastic FeslenarsrDNidars
p
-
0
0
1
b. All Now Plants Have Trunk, Base, or Stem Located At Least 36 Inches from Foundation
C. LANDSCAPING
Points Available Per Masi
❑
❑
El
1. Construe Resource-EJfcient Landscepn
a. No Invasive Species Listed by CaHPC Are Flamed
b. No Plant Spades Will ught Hedging
C. 75% m Plants Are Drougnt-meant California Natives, Meditananean, a Other Appropriate Spades
f. Apply Optimal Value Engineering
0
—_n
]
o
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3
❑
❑
❑
2 Use FlrsSefe Landacapin Techniques
0
I
❑
❑
❑
❑
❑
s. Minimize Turf Areas in Landscape Instilled by Builder
a. All Turf WV Have a Water Requirement Less than or Equal to Tall Fescue (50.6 plant factor)
b. TurfShall Not Be Installed on Slopes Exceeding 10% or In Areas Less than 6 Feet Wide
c. Tud Is 573% of Landscaped Area (total 2 point)
d.Turf Is 510% of Landscaped Area(Wal 4 points)
4. Plant Shade Treat
0
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❑
❑
❑
❑
❑
❑
❑
2
0
0
2
_T 2
3
S. Group Plants by Wetter Needs (Nydmzonin
0
2
❑
Elb.
6. Install High -Efficiency Irrigation Systems
a. System Uses Only Low -Flow Drid, Bubblers, a Low -flow Sprinklers
System Has Smart Controllers _ \
3. Use FSC-Cenifiod Wood
2_
—r--T-�
0
3
El
7. Incorporate Two Inches of Compost In the Top 6 to 12 inches of Soil �„�
0
3
ro
B, Mulch All Planting Beds to Na Greater of 2Inches or Local Water Ordinance Requirement
. 0
2
9. Use 5D% Salvagod or Rocycled-Content Materials for 60%of Non-Plard Landscape Elam b�
0
( 1
10. Retluee Light Poilutlon by Shielding Pictures andlor Directing Light Downward4.1
0
1 I I
D. STRUCTURAL FRAME & BUILDING ENVELOPE
1-
Prime Available Per Measure
f. Apply Optimal Value Engineering
❑
❑
❑
a Place Rafter and Studs at 24 -Inch On Cantor Framing
b. Size Door and Window Haddam for Load
c. Use Only Jack and Cripple Studs Required for Load
/
y
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l
0
0
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❑
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2. Use engineered Lumber
a Beams and Header
b. Insulated Engineered Header
C. Wood IJoists or Web Trusses for Floor
J. Wood sls for Rom Ratter
4Joi
e. Engineered or Finger -Jointed Studs for VaNcal Applications
I. Oriented Strand Board for Subfias
g. Oriented Strand Board for Well and Roof Sheathing
r
i
oI
D
0
0
0
r1
3. Use FSC-Cenifiod Wood
❑
[I
a. 01mensional Lumber, Studs and Timber: Minimum 40%
b. Dimensional Lumber, Studs and Timber. Minimum 7D% c. Panel Produce: Minimum 40% -
Panel Products: Minimum 70%
ro
2
"—'—T-- _"-�d.
I 1
02007 Build It Green Single Family GreenPoint Checklist 2DD7 Version Page 1 of 4
6. PLIIMBING
Palms Avallabia Par Measure
1. Distribute Domestic Hot Water Efficiently (Matlmum 7 Points)
0_
1_ 1
I
❑ a Insulms Hot Wow Plpes from Water Healer to Kitchen
❑
b. Insulins All Hot Water Pipes
0
❑
c. Use Engineered Parallel Piping
0
❑
d. Use Engineered Parallel Piping Win Demand Controlled Circulation Loop
0
❑
e. Use Stu -heed Plumbing Mth Demand Cormbils f Ciwulallon Loop
_
❑
L Use Central Core Plumbing
-0
0
1 1
2
[T-2.
Install Ontir High Efficlancy Toilets (Dual -Flush or 51.48
0
4
0 2007 Build It Green Single Famlty GreenP0lra Checklist 2007 Version Page 2 of 4
0
•
J. BUILDING PERFORMANCE
Points Available Per Measure
1. Diagnostic Evaluations
❑ a. House Passes Blavar Door Test
b. House Pa66a9 Combustion Safety Backtlretl Test
❑
0 ]
0 7
0
2.Dmipn and Build High Performance Homas-Y. above Title 2l -minimum 15% Required
0 >_30 !.
❑ 3. House Obtalus ENERGY STAR with Indoor Air Package Certification - Pilot Measure (Total0 points; read comment)
0 5 2
Tom Awilehln Pefmc in R„Irinn Pxrm,inee a eel n 1
H. FINISHES
Points Available Pel Measure
❑
1. Design bVyways In Ratio. Treated in Contaminants
0
1
0
❑
❑
2. Use Low-VOC or Zino-VOC Paint (Maximum 3 Points)
a. Low-VOC Interior WeIVCelling Paints (dO go VOCs (Fla) and d50 gpI VOCs (Non -Flat))
b. Zsro-VOC: Interior WalliODI in Paints (c5 0 VOCs (Fla
1
o
i
0
2. Thermal Mass Floors: Floor Covering Omer than Carpet on So% or More of Concrete Floors
p g
1
❑
3. Use Low VOC, Water -Based Wood Finishes (a5a Spit VOCs)
0
2
'
❑
d. Use Low-VOC Caulk and Construction AdhesNn (a0 gpI VOCs) for All Adhesives
0
2
I ]
1
[7-5
Use Reryded-Content Paint
p
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]
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El
6. Use Environmentally Preferable Materials for Interior Finish: A) FSCCergfied Wood, B) Reclaimed, C) Rapidly Renewable, D) Recycled con ant
or E) Finger -Jointed
a. Cahinen(50%Minimum)
b. Interior Trial (50% Minimum)
c. Shelving (50% Minimum)
J. Doors (50% Minimum)
e. e. Countorts so%mimmum)
p
D
1
0
0
0
p -
p
]
1
❑
❑
❑
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7. Reduce Formaldehyde in Interior Finish (CA Seetlon 01350)
A, Subiloor 6 Slab Treads (50% Minimum)
b. Cabinets A Coumadops (50% Minimum)
c. Interior Trim (50% Minimum)
d. Shelving (50% Minimum)
0 ]
p
p ]
D 1
- {
❑
6. Atter Installation of Finished, Teat of Indoor Air Shows Formaldehyde Level a7ppb
0
•3
Finishes a 21 a
L. FLOORING -
Points Available Pet Measure
❑
❑
❑
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1. Use Environmentally Preferable Flooring: A) FSC -Certified Wood, B) Reclaimed or Refinished, C) Rapidly Renswabia, D) ReryeledConleny E)
Exposed Concrete. Flooring Adhesives Must Have dO gpl VOCs
a. Minimum 15% of Floor Area
h. Minimum 30% of Floor Area
c. Minimum 50% of Flow Area
J. Minimum 75% of Floor Area
0
]
0
1
o
i
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2. Thermal Mass Floors: Floor Covering Omer than Carpet on So% or More of Concrete Floors
0
1
❑
3. Roaring Meed, Section 01350 or CRI Green Label Plus Requirements (50% Minimum)
0
2
M. APPLIANCES AND LIGHTING
Points Available Pat Measure
❑
❑
1. Install Water and Energy Efficient Dishwasher
a. ENERGY STAR (total 1 point)
h. Dishwasher Uses No More than 6.5 Gefion cls(toed 2points)
p
0
1
❑
❑
I Install ENERGY STAR Clothes Washing Machine with Water Factor of 6 or Less
a. Meats Energy Star and CEE Tier 2 requirements (modified energy factor 2.0, Water Factor 6.0) (total 3 Points)
b. Meats Energy Star and CEE Tier 3 requirements (To dried energy factor 2.2, Water Farrar 4.5 or less)
total$points)
0
_
p
I - --2 -
❑
❑
3. Install ENERGY STAR Refrigerator
a. ENERGY STAR Qualified A <a Cubic Feet Capacity
b. ENERGY STAR Qualified A <20 Cubic Feat Capectly
'
0
0
I ]
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4. Install Built -In Recycling Center
p
❑
❑
a. Built -In RecyGing Center
b. Bulli -In Composting Center
p
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1
• 3. Community Design Measures A Local Prioddes: See the Community Planning A Design section In Chapter 4 of the New Home Guidelines for
measures. Maximum of 20 points for suggested measures. Local requirements may visa be listed hare.
02007 Build It Green Single Family GreenPoint Chu iist 2007 Version Page 3 of
ENTER
_Enter damn lon hen, and aaer polls ovelleble for metal in appropriate celegodu dome dghL
0
D
0 0 00
Enter deschpbon has, and enter pone available fn measure In appropdele celegodes to the right.
0
0
D 0 0 0
Enter description nen, and enter pointe ever for measure M appropriate calegores to the right.
0
0
0 0 0'
❑ Ener deeodplMn here, and war pWas available hermeasure In epleapdae tampons to the right.
0
0
0 0 0 D
4. Innovetlon: List Innovative measures that meet the green building objectives of the Guidelines. Enter up to a
Build h
Guld
Green Checklists and
maldmum combined total of 20 pts. See Innovation Checklist for suggested measures, using the link to the right.
alln_
0
0
0
0
0_
es
0 0 0 0
0 0 0 0
0 0 _ D 0
0 0 0 0
0_ 0 0 0
Li Innovation M Commun . Emer dimoripton hen, and ehta prime aveaeth for manure M apopmulate cOgWa to the rigot. 0
Innc+adon M En . Enter de 'on hen, and ala nit evallable in moral M tae Dale oln to the L 0
Irmwaten In IAOMalth: Enter description here, and area polim, available for amesum in appropriame categories to the right. 0
Innovation In Raouroa: Erder de tion here, and enter PDIM emilable to measure In dale cat oder to the right. 0
Innovation In Water. Enter deemlpllan here, and ems pont{ walehla for measure In appropriaor calepoda to the right 0 _
Total Available Ponds in Other.
D
Total Available Points In Specific Categories''4+
96+ 42+ 66+ 43
Minimum Points Re uimd In Specific Categodes
O
30 5 6 9
Dial Points•
1
e
1 e 1 1
Project hits not yet mat the following recommended minimum requirements{
- Total Project Score of At Least 50 Points
- Required measures:
-A3a: 50% waste diversion by weight
-J2: 15% above Title 24
-N3: Incorporate GreenPoint Rated Checklist into blueprints
- Minimum points In specific categories:
-Energy (30 points)
-!AQ/Health (5 points)
-Resources (6 points)
-iNater (9 points)
02007 Build It Green Single Fanlly GreenPoint Checidsl 2007 Version Pape 4 of 4
II
CITY OF
OUPEkTINO
•
I't
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS: C�
I �q b7 ?ec, t+ ��
PERMIT
OWNER'S NAME: .Flo ev oor�
PHONE # q o* - z33 - ! 19
GENERAL CONTRACTOR: pf�ro,o"i< W/4 J 6od1-/
FAX #
I am not using any subcontractors: -2s 4, 16,> -
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
Date
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