08050226CITY OF CUPERTINO _
+azw-•«+» a ,� , r �Y ems' 's �t +'�a
CQNTRACTOR INp'QRMATION '
BUILDING DIVISION PERMIT
Bu1LD11r�D.Es PORTAL AVE
STICKEL:ORVILLE L AND
PU�Rai5�+
99`6226 .
OWNER'S NAME:
PER.Mrr ISER E DATE
PS'PICKEL ORVILLE L AND PHYLLIS
10233 S PORTAL AVE
05/28/2008
ONE:
SANITARY NO. CONTROL NO.
ARCHn ECTfENGINEER:
BUILDING PERMITINFO
BLDG- ELECT PLUMB MECH
0 � 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 bectry grim that I am limned under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 ofdm antineas end prafeuions Code, and my license is
RMDL 2 BTHRMS,NON—STRUCTL(1 0SQ) & ELECT/PLMB
in full fume and erfAct.
Ua.so Class Lie.
Dow conVaMr
ARCHITECTS DECLARATION
1 undcrsund my puns mail be used as public mends
Liemsed Pmfcuimnal
OWNER -BUILDER DECLARATION
• I hereby alTim that 1 am acmpt from the COMaemrr Ucmm Law for tic
o following moon. (Sccum 1031.5, Business and professions Code: Any city Or county
which noires a permit to construct, about. improve, demolish, or repair any structure
! prior in its iuuarcc. risen requires the Appoint forsuch permit to rile a signed setamment
the Contractor's Limoc Law 9
Sq. Ft. Floor Area
Valuation
that w is licensed pursuant o provisional of the (Chapter
$1000
( (commencing with Section 700M of Division 3 or the Business and Professions Code)or
. did W u exempt themfmm and Use basis for the alleged exemption. Any violation of
3 6 9 0 9 0 04 � Number
Occupancy Type
Secdcn 1031.5 by any applicant for, permit subjects the applicant m A civil penalty or
nm fume doom five hundred dollars (S5W).
1, u owner of the goptatry Or my uopicyces with wages As theb sok compensation,
Required Inspections
will do doe work, and the svumum is rot intended As OOorAd for sale (Sec. RNs, Business
and Prolusions Code: The Cannes mes Lantra Law does Out apply in an owner Of
Dao W tY w'Ito builds or imgovu thceon, and who doessuch were, himself or duough his
own employees, provided that such improvements Me not intended mra0cmd for ate. Il,
horaMon, the building u impmwmem Is sold within one year of completion, the owner.
. .
Wilder will have the burden of proving that he did nor, wild or improve for propose of
f
iyn, u owner of the gopeny am exclusively contracting with licensed contractors An
C 1.1 the project (Sec. load. Business and pmf.,Aons Crede:) The Cmmrazmr, U.
,
cense law docs not apply as an Manu of property who builds or volumes theme. and,
who mnmcu for such projects with a contractor(s) licensed purc ant to the Contractors
License law.
❑Iron cue y6uEer ,B&PPccf r thio
rcr, Dat�L
WO ER'S COMPENSATION DECLARATIO
1 hubby alnm under penslty of perjury me of the following declaramor
❑ 1 haw and will maintain • Ceninate of Consent to self -inure for WorkersCompen-
suit., As pervldeA for by Section 3100 of the tabor Code. for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insursnm, as required by Section
3100 ofthe labor Cade. for dm performance Aldo, work for which this permit is issued
'
My Worker. Confirmed. t.. artier trod policy rcmber art:
Carrier. Policy No.:
CERTIFICATE OF ECEMMON FROM WORKERS
COMPENSATION INSURANCE
(Thu nectim need trot w cmmplemd RthA permit or forum hundred dollars ($100)
tor less.)
1 certify Net in Ne performance of me work for which mise permit is issued. )shall not
employ any person in any manic a 'Act m the Workers' COmpensasum
tonor CairoDue
'
Applicant _
NOTICE CAM. If, after making this Ceniliam of Exemption, you should
become subject in Ne Workers COmpenuuW provisions of the labor Cod, you mon
'
fonhwim comply with such provisions u this permit shall w dconcd muted.
1
CONSTRUCTION LENDING AGENCY
1 hcmby anima due dem A. con strucunn lending agency for de perfe marem of
!
Ne work for which this permit u issued (Su. 3091, Civ. C.)
lenders Name
Lenders Address
1 codify that 1 have mad W. applicaua. And sum this the show inmmoouon is
.
cmmci 1 Agree he comply with all city and county on it ces and sate laws heating to
-
building construction, and hcmby Authodre mpmsentarims of this city in enact upon do
aww-menuarcd propc for s.
purpowhich
1-pecuan
(We) agree to saw, indemnify and hoop harmless 0e City of Caperton agaiest
set A
may in ally wyazrncagalnsuaid City
L&gran
incoiues,juce Or Of this
APPLI guenm art the grantee of this permit
APPUCANTAN ILL MPLY WITH N�INT
ALL
SOURCE TI
Issued by: Date
Jai—//
D0
Re -roofs
aadd
Signature of ApplicanUC.Aunctor Dole
HAZARDOUS MATEIUAIS DISCLOSURE
Type of Roof
Will the applicant m None Wilding Occupans comm or baMu haardou material
As dcrmed by Ne Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
C. k
e, scevon 25532(,)T
❑ Yes011 a
All roofs shall be inspected prior to any roofing material being installed.
Will Me. liana or more wadi. mecu rt use, equipmentu JMana which
Pn g
If a roof is installed without first obtainingan inspection, I agree to remove
P
emu haordnes air contaminants u dcEncd by the Bay Area Air Quality Management
e
all new materials for inspection.
DinrictT
❑Yes Lynn
I have mal the harardens maeriabmquimmentsun4r Cheperh.95 of the Calirm-
nialloolthd: SaktYCudb, Secumns 2550,25533 and25534.1 undersand th dif de wilding
Jon fur c low a mrunc dot i 'troy reapnstbllity m notify do occupsom or do
mgmm w h ,a wEA.mmra p,. 8
Signature of Applicant Date
All roof coverings to be Class 'n" or better
toss uiyadagAn, Dow
• 3 ITEMS OF 3
•
40
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36909004.00
DATE ISSUED.......: 05/28/2008
RECEIPT #.........: BS000004919
REFERENCE ID # ...: 08050226
SITE ADDRESS .....: 10233 S PORTAL AVE
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OPERATOR; patg
COPY # : 1
TOTAL RECEIPT
---------------
551.50
OWNER ............:
STICKEL ORVILLE L AND PHYLLIS
ADDRESS ..........:
10233 S PORTAL AVE
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-3349
RECEIVED FROM ....:
ORVILLE L STICKEL
CONTRACTOR .......:
LIC # *OWNER*
COMPANY ...........:
STICKEL ORVILLE L AND PHYLLIS
ADDRESS ..........:
10233 S PORTAL AVE
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-3349
TELEPHONE ........:
FEE ID
-----------
UNIT QUANTITY
-----------------------
AMOUNT PD -TO -DT THIS REC
NEW BAL
1BSEISMICR
VALUATION 1,000.00
------------------------------
0.50 0.00 0.50
----------
0.00
1REMRESBAT
SQ FEET 1.00
429.00 0.00 429.00
0.00
1STPLNCK
HOURS 1.00
122.00 0.00 122.00
0.00
TOTAL PERMIT
---------- ---------- ----------
551.50 0.00 551.50
----------
0.00
METHOD OF PAYMENT AMOUNT
----------------- ---------------
REFERENCE NUMBER
CHECK
--------------------
551.50 #101
TOTAL RECEIPT
---------------
551.50
• 3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36909004.00
DATE ISSUED.......: 05/28/2008
RECEIPT #.........: BS000004919
REFERENCE ID # ...: 08050226
SITE ADDRESS .....: 10233 S PORTAL AVE
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ..........:.: STICKEL ORVILLE L AND PHYLLIS
ADDRESS ..........: 10233 S PORTAL AVE
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-3349
RECEIVED FROM ....: ORVILLE L STICKEL
CONTRACTOR .......: LIC # *OWNER*
COMPANY ..........: STICKEL ORVILLE L AND PHYLLIS
ADDRESS 10233 S PORTAL AVE
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-3349
TELEPHONE ........:
FEE ID UNIT
-----------------------
QUANTITY
----------
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
IBSEISMICR VALUATION
1,000.00
----------
0.50
----------
0.00
----------
0.50
----------
0.00
1REMRESBAT SQ FEET
1.00
429.00
0.00
429.00
0.00
1STPLNCK HOURS
1.00
122.00
----------
0.00
122.00
0.00
TOTAL PERMIT
551.50
----------
0.00
----------
551.50
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
551.50
---------------
551.50
REFERENCE NUMBER
--------------------
#101
Sum
CITY OF
CUPEkTINO
CITY OF CUPERTINO
ADDITION/REMODEL
PERMIT APPLICATION FORM
DS, az Z (o
J
Date: 7_8� Y
/"/•� D�
Building Address:
Mailing Address (if different from building address):
Owner's Nam/ / L ��/ c kEL
Phone # 2f Z 2�6 Z
J
Contractor:C�/23
Phone #:
Fax #:
Contractor License #:
Cupertino Business License #:
Contact:
Phone #:
Fax #:
Building Permit Info: Sid 8/Q7W P,ao,e-i rQesnan EG — /90�J — ST,2Uctdh2�
ldg. ❑ Elect. ❑ Plumb. Mech. ❑ Hillside ❑
Job Description:
Addition (adding sq footage):
Z BPr iEf 12�� wt S — �1 CNS S fes. z ,rc✓� ,
What is being remodeled?
Remodel Includes Re -Roof: Yes ❑ No If yes list number of squares
Remodel Includes Structural: Yes ❑ No
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
ZX &p0 F , 0ac- 11
Remodel: Kitchen Bath Other
Type of Construction (Usage Class):
Occupancy Type:
IA,1-,-'❑ 11,111,V -A ❑ 11,111,6IV-NT_V-B
Valuation: /�� D —
Please check this box if the project is a
second -story addition ❑
lease complete relevant portion of the Green Building
checklist & attach it to the application or if applicable,
Green Building Points Achieved:
include in plan set & the sheet index.
ror u111ce use unry^ ^ ^
Over -the -Counter ❑
5 -
CITY OF
CUPERTINO
CITY OF CUPERTINO
ADDITION/REMODEL
FEE SCHEDULE
0
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
Sq Ft
ADDITIONS
1R3SFDADD
PLLONGRNGR
Long Range
PL
Plannin esidential
1R3INSP
Dwellings Inspections
B
1 R3PLNCK
Dwellings plan check
B
1 R3REPINSP
Dwellings Repeat
B
Inspection
I R3REPPLNC
Dwellings Repeat Plan
B
Check
1R3HINSP
Dwellings Hillside
B
inspection
1R3HPLNCK
Dwellings Hillside plan
B
check
1R3HREINSP
Dwellings Hillside
B
R eat Ins ection
1R3HREPLNC
Dwellings Hillside
B
R eat Plan Check
1R3ALTINSP
Dwellings Alternate
B
Materials Inspection
1R3ALTPLNC
Dwellings Alternate
B
Materials Plan Check
1PCESS
Cesspool
P
IPPRSEWG
Ea. Private Sewage
P
Disposal System
1PRSEWER
Sewers
P
IBPSPRINK
Lawn Sprinkler/Backflow
P
1BPWSVCS
Main Water Service
P
I BSEISMICRE
SeismicResidential
B
DECKS
1R3SFDADD OR
IR3SFDREM
1DECKWOOD
Deck ood)-Each
(W
B
(Each
1 DECKRAIL
Deck Railing -Each
B
(Each)
•
I
L
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity
Sq Ft
Fee ID
Fee Description
Fee Group
Permit Type
GARAGES
1R3SFDADD OR
1R3SFDREM
1GARDTW<=1K
Wood Frame up to
1,000 SF
B
1GARDTM<=1K
Masonry up to 1,000 SF
B
BCONSTAXR
Construction Tax Res
(new detached garage)
PATIO'S OPEN
1R3SFDADD OR
1R3SFDREM
1 PATIOWOOD
Wood Frame up to 300
SF
B
1 PATIOMETAL
Metal Frame up to 300
SF
B
1PATIOOTHER
Other Frame up to 300 SF
B.
PATIO'S CLOSED
1R3SFDADD OR
1R3SFDREM
1PATIOENCLW
Enclosed Wood up to 300
SF
B
1PATIOENCLM
Enclosed Metal up to 300
SF
B
1 PATIOENCLO
Other Enclosed Patio up
to 300 SF
B
1 COVPORCH .
Each)
Porch Covered -Each
B
1REROOFRES
Residential Re -roof Each
100 SF
B
REMODELS
1R3SFDREM
IREMRESKIT
Kitchen Remodel up to
300 SF
13
(Deduct "$"for ea plan
check
/
1 REMRESBAT
Bath Remodel up to 300
SF
B
1REMREOTH
Other Remodel up to 300
SF
B
REMODEL PLNCK
I STPLNCK (1-3 for
remodel)
Standard Plan Check
B
NOT FOR OVER THE
COUNTER PLAN CKS.
3 of 3
CITY OF CUPERTINO
ADDITON/REMODEL
FEESCHEDULE
0
Quantity
Sq Ft
Fee ID
Fee Description
Fee Group
Permit Type
WINDOW/SLIDING
IR3SFDREM
GLASS DOOR
1 WINREP
Replacement windows
(ea 8 windows)
B
1 WINNEWNSTR
New Window (non-
structural
B
1WINMEWSTR
New Window (Structural
Shear Wall/Masonry)
B
1 WINBAYSTR
Bay Window (Structural)
B
SKYLIGHTS
IR3SFDREM
1 SKYL<10 SF
Skylight less than 10 sf
B
1 SKYL>10SF
Skylight greater than 10
sf or structural
B
1STAIRS
Stairs -first flight/ea addt'l
B
IEPERMITFEE
Electrical Permit Fee
E
1 MPERMITFEE
Mechanical Permit Fee
M
1PPERMITFEE
Plumbing Permit Fee
P
1 ELCPLNCK
Stand Alone Electric Pln
Ck (hourly)
E
1MECPLNCK
Stand Alone Mechanical
Pln Ck hourl
M
1PLMPLNCK
Stand Alone Plumbing
Pln Ck (hourly)
P
tITRIBSEISMICRE
Seismic Residential
B
AVDOC
Travel & Documentation
B
SLIC
Business License
B
4 of 3
TCITY'OF
UPEkTINO
Community Development
10300 Torre Avenue'
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
All Cupertino building permits must meet certain conditions related to maintaining
environmental quality and public peace and safety. The two most common
conditions are described below.
STORMWATER POLLUTION CONTROL
State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and
the Santa Clara Valley Water District control stormwater pollution. Educating local
residents and businesses and enforcing stormwater pollution control laws are key parts
of the City's compliance efforts.
Stormwater pollution prevention: It's up to us
In northern Santa Clara Valley, storm drains flow directly to local creeks and San
Francisco Bay, with no treatment. Stormwater pollution is a serious problem for wildlife
dependent on our waterways, for people living near streams and baylands, and for the
local water supply. Common sources of stormwater pollution include:
• Dripped oil, fuel, and antifreeze from vehicles and heavy equipment;
• Construction debris, including dirt, concrete and paint;
• Landscaping runoff containing pesticides or weed killers; and
• Any material dumped or spilled into streets or storm drains
•
The property owner and the contractor share ultimate responsibility for activities
occurring at a construction site and will be held responsible for any environmental
damage caused by subcontractors or employees.
For more information on construction -related stormwater requirements, see the
Stormwater Quality Regulations section of the City of Cupertino web site at:
httlp://www.cupertino.org/city government/departments and offices/
environmental services
COMMUNITY NOISE CONTROL
The basic noise control requirements for construction sites are as follows:
• Typical construction work hours are:
- Weekdays - 7 a.m. to 8 p.m.
- Weekends - 9 a.m. to 6 p.m.
• Construction other than street construction is prohibited on holidays.
• Residential daytime noise levels from complaint site - 60 dBA
• Nonresidential daytime noise levels from complaint site - 65 dBA
For more information on noise control, please see Chapter 10.48 of the Cupertino
Municipal Code, which can be accessed at htto://www amlegal com/cuoertino ca/
Greg Casteel
Building Official
CM
MENSIM
Kie�eeksethr!�smmurray WILSONART
Fresno • Sacramento I N T E R N A T l p N A L
• 559-292-5751 800-533-0533 FAX 559-346-6140 www.chariesmcmurray.com
APPROVED
IN ACCORDANCE WITH THE Cf �F
GUPERTINO CODES AND ORDIN
S �fiC GU S
SHO LITC
)ATE '
31GNEDP
This set of plans an n 7,--rE�,4
Oe kept on the job at all times a d it is
lawful to make any changes or alterat ou
on same without written permi
me building Dept., City of Cupe•:`"�
The stamping of this plan and slff
iHALL NOT be held to permitspproval of the violation o` amUrn
I anv City Il o nanrE ^,
v✓o
�BhTE�RfX�
t��y�R..4w7� HaWE2
Guess ,c¢�W�R. D RS ,
BA7rN B
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P�Fs�vE �011
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'- stio SOL u 6+ s/
U -)T �e 5l sfia' h
Fi,<fures ►�1
'Showers
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AF-TEIZ
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/b ti 3 3 S 30 -ACA 1 -4L --e
Plan Review Process Work Book Page -l2-Revised 3/25/08
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
11.
Permeable Paving,Note
L-1
C.
Foundation
1.
Use 15 % Flyash Concrete, (note)
S-1
7points
D.
Structural
3.
Uses Wood I-Joist, (See Spec.)
S-2
5.
Use Truss with heels, (detail)
S-2
6.
B. OSB Sheathin detail
S-2
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 12int
P.
Other
1.
List Green Features on Plans
A-1
1 point
TOTAL POINTS1
40 points
0
/b ti 3 3 S 30 -ACA 1 -4L --e
Plan Review Process Work Book Page -l2-Revised 3/25/08
Green Points Rating System for Remodeling Projects
e 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 or 'greening' your project.
A. Sde
Recycle Job Site Construction & Demolition Waste
_ :�i 3 Resource pts
y=ye
�1.
65%=1 point; 75%= 2 points; 80%= 4 points
up to 4 Resource pts
2. Salvage Reusable Building Materials _I
4 Resource pts
y=yes
3. Remodel for Mixed Use, Adaptive Reuse, and
2 Resource pts
y=ye
Historic Preservation
4 Resource pts
y -yes
4. Protect Native Soil
2 Resource pts
y --yes
5. Minimize Disruption of Existing Plants & Trees
1 Resource of
Y --yes
6. Implement Construction Site Stormwaler Practices
2 Resource pts
y=yes
7. Protect Water Quality with Landscape Design
2 Resource pts
y=yes
(8. Design Resource -Efficient Landscapes and Gardens _
4 Resource pts
y=yes
9. Reuse Materials/Use Recycled Content Materials
3 Energy pts
y=yes
for Landscape Areas
2 Resource pts
y=yes
10. Install High -Efficiency Irrigation Systems
2 Resource pts
y=yes
11. Provide for On -Site Water Catchment / Retention
2 Resource ots
v_wes
B. Foundation
1. Incorporate Recycled Flyash in Concrete
25% Recycled Flyash = 2 points; Add 1 point for every 0%
increase of flyash, up to 5 points
2. Use Recycled Content Aggregate
3, Insulate Foundation/Slab before backfill
C. Structural Frame
1. Substitute Solid Sawn Lumber with Engineered Lumber
_ :�i 3 Resource pts
y=ye
2. Use FSC Certified Wood for framing
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10 Resource pts
3. Use Wood I -Joists for Floors and Ceilings
2 Resource pts
y=ye
4. Use Web Floor Trusses
2 Resource pts
y=ye!
5. Design Energy Heels on Trusses 6" or more
2 Energy pts
y=ye;
B. Use Finger -Jointed Studs for vertical Applications
2 Resource pts
y=yes
7. Use Engineered Studs for Vertical Applications
2 Resource pts
y=ye:
B. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts
y=ye!
9. Use Structural Insulated Panels (SIPS)
a. Floors
3 Energy pts
y=yes
b. Wall
3 Energy pts
y=yes
C. Roof
3 Energy pts
y=yes
10. Apply Advanced Framing Techniques
4 Resource pts
y=yes
11. Use Reclaimed Lumber for Non Structural Applications
_.
3 Resource pts
y=yes
r... ---- ------------..
Use_ 0SB
(12.
a. Subfloors
I
b. Sheathing
1 Resource pt
5
Y=Yes
• — -- _ __ _ - _—_ _ - --
1 Resource or
y=yes
r
r
r
r
r
r
r
r
r
r
0.
r
r
r
r
U
,0'
_—
. h
1. Use Sustainable backing Materials
I a. Recycled content i
3. Resource pts
y=yi
1 b. FSC Certified Wood
3 Resource pts
y=yi
�2. Use Treated Wood That Does Not Contain Chromium/Arsenic ;
7 IAQ/Health pt
y=y
�3. Install House Wrap under Siding
1 IAQ/Health pt
y=yi
4. Use Fiber -Cement Siding Materials
1 Resource pt
y --yes
E. Plumbing
1. Install Water Heater Jackal —
_ -- J 1 Energy Pt Y=Ye`-
2. Insulate Hot and Cold Water Pipes
2 Energy pts y=yes
3. Retrofit all Faucets and Showerheeds with Flow Reducers
Up to 4 Energy pts.
a. Faucets (1 point each, up to 2 points)
Up to 2 Resource pts,
b. Showerheads (1 point each, up to 2 points)
Up to 2 Resource pts,
4. Replace Toilest wit Ultra -Low Flush Toilets
Up to 4 Energy pts.
(1 point each, up 163 pints) _ _ J
Up to 3 Resource pts,
5. Install Chlorine Filter on Showerhead
1 IAQ/Health pt y --yes
6. Convert Gas to Tankless Water Heater
4 Energy pts y=yes
7. Install Water Filtration Units at Faucets
y=yes
(2 points each, up to 4 points)
Up to 4 IAQ/Hsalth pts
S. Install On -Demand Hot Water Circulation Pump
4 Resource pts y=yeE
r. eiecmcai
1. Install Compact Fluorescent Light Bulbs (CFLs)
r
0
(6 bulbs=2 points, 10 bulbs =3 points, 12 bulbs = 4 points)_
Up to 4 Energy pts.
2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to
y=yes
5 points)
Up to 5 Energy pts.
3. Install Lighting Controls (1 point per fixture, up to 4 points)
Up to 4 Energy pts.
4. Install High Efficiency Ceiling Fans with CFLs
y=yes
(1 point each, up to 4 points)
Up to 4 Energy pts,
G. Appliances
r
0
0
r
0
1 Energy pt
y=yes
2. Install Washing Machine with Water and Energy
i
!_
1 Energy pt
y=yes
3.lnstall Energy Star Refrigerator
G. Appliances
r
r
-0
r
r
0_
1. Install Energy Star Dishwasher
1 Energy pt
y=yes
2. Install Washing Machine with Water and Energy
i
Conservation Features
1 Energy pt
y=yes
3.lnstall Energy Star Refrigerator
1 Energy pt
y=yes
4. Install Built -In Recycling Center J
J 3 Resource pts
y=yes
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Walls
2 Energy pis
y=yes
b. Ceilings
2 Energy pts
y=ye=-
2. Install Floor Insulation over Crawl Space
4 Energy pts
y=yes
Rcled-Content, Fiberglass Insulation with
3. Installecy
rNo
j
Added Formaldehyde
j 3 IAQ/Health pts
y=yes
4. Use Advanced Infiltration Reduction Practices
2 Energy pts
y=ye<
5. Use Cellulose Insulation
a. Walls
4 Resource pts
y=yes
b. Ceilings
4 Resource pts
y=ye;
6. Alternative Insulation Products (Cotton, spray -foam)
a. Walls
4 Resource pis
y=ye
b. Cenings
4 Resource pts
y=ye,
•
E
•
r
r
-0
r
r
0_
r'
0.
•
E
•
• 1. InstaO Enorgy-Efficient Windows
a. Double-Paned
1 Energy pt
b. Low-Emissivity (Low-E)
2 Energy pts
c. Low. Conductivity Frames
2 Energy pts
_
2. Install Low Heat TTraemission Glazing
1 Enerov of
J. Heating Ventilation and Air Conditioning
I. Use Duce Mastic on All Duct Joints
2. Install Ductwork within Conditioned Space
3. Vent Range Hood to the Outside
4. Clean all Ducts Before Occupancy
5. Install Solar Attic Fan
5. Install Attic Ventilation Systems
7. Install Whole House Fan
6. Install Sealed Combustion Units
a. Furnaces
b. Water Heaters
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
10. Install 13 SEER/11 EER or higher AC with a TXV
11. Install AC with Non -HCFC Refrigerants '
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
• 13. Retrofit Wood Burning Fireplaces
a. Install EPA certified wood stoveshnserts
b. Install/Replace Dampers
c. Install Airtight Doors
14. Install Zoned, Hydronic Radiant Heating
15, Install High Efficiency Filter
16. Install Heat Recovery Ventilation Unit (HRV)
17. Install Separate Garage Exhaust Fan
K. Renewable Energy and Rooting
1. Pre -Plumb for Solar Water Heating
2. Install Solar Water Heating System
3. Pre -Wire for Future Photovoltaic (PV) Installation
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw =16 points)
r- - - --'----- -- ---..
�6. Select Saie and Durable Roofing Materials �
--- —_.
7. Install Radiant Barrier - ---' -' --'
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating
2. Install Overhangs or Awnings over South Facing Windows
3. Plant Deciduous Trees on the West and South Sides
0
2 Energy pts
3 Energy pts
1 IAQ/Health pt
21AQ/Health pts
2 Energy pts
1 Energy pt
4 Energy pts
31AQ/Health pts
3IAQ/Health pts
3 Energy pts
3 Energy pts
2 Resource pts
2 Energy pts
1 IAQ/Health pt
y=yes
1 Energy pt
Y --yes
1 Energy pt
y=yes
3 Energy pts
y=yes
41AQ/Health pts
y=yes
5 IAQ/Health pts
y=yes
3IAQ/Health ots
v=ves
4 Energy pts
10 Energy pts
4 Energy pts
Up to 16 Energy
1 Resource pt y=
3 Enerav ots v=
5 Energy pts
3 Energy pts
3 Energy pts
y=Yes
1. Use Low/No-VOC Paint
2. Use Low VOC, Water -Based Wood Finishes
I3. Use LowMo VOC Adhesives
4. Use Salvaged Materials for Interior Finishes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
6. Use Exterior Grade Plywood for Interior Uses
7. Seal all Exposed Padicleboard'or to1DF
S. Use FSC Certified Materials for Interior Finish
9. Use Finger -Jointed or Recycled -Content Trim
10. Install Whole House Vacuum System
N. Flooring
1. Select FSC Certified Wood Flooring
2. Use Rapidly Renewable Flooring Materials,
3. Use Recycled Content Ceramic Tiles
4. Install Natural Linoleum in Place of Vinyl
5. Use Exposed Concrete as Finished Floor
6. Install Recycled Content Carpet with Low VOCs
Total Points Available:
Total Points Project Received:
1 IAQ/Health pts
21AQ/Health pts
31AQ/Health pts
3 Resource pts
61AQ/Health pts
1 IAQ/Health pts
41AQ/Health. pts
4 Resource pts
1 Resource pts
3 IA0/1-lealth pts
B Resource pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y=yes
5 IAQ/Health pts
y --yes
4 Resource pts
y=yes
4 Resource pts
y=yes
•
1401 130 57 .
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• 559-292-5751 800-533-0533 FAX 559-346-6140 www.charlesmcmurray.com
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OWNER -BUILDER VERIFICATION
(Check one) I or my immediate family (parent, spouse or child) will perform:
• A. _V-� 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.
Phone Number I Type of work to be
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner -Builder Information (revers e).
Property Owner's Signature: /fes Date: O
Job Address:./e e Permit #
Any changes to the information provided on this form shall be submitted to the City of Cuvertino Build
0
Department.
City of Cupertino Building Department.
CITY Of 10300 Torre Avenue
C U P S Ur'�' I 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
w�J
CITY OF
�UPERTINO
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOBa14. P,33 S- 702T� �v�
PERMIT#��Go5 O�2�p
OWNER'S NAME:
PHONE # .2�Z-
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/Contractor Signature
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