08060061 CITY OF CUPERTINO ��s,�� .'ate"vena'F �?� `•n a' T"�ry�� n " ,g+^ " `�F �? -
BUILDING DIVISION PERMIT l�t>.�"�TQR�" �rYQnI01
BUllt IN ADORESS: PERMIT NO.
0/95 PROSPECT RD TBD — TO BE DETERMINED 08060061
OWNER'S NAME: PERMIT ISSUE DATE
SRIVIDHYA GOPALAN 06/25/2008
NE:
SANITARY NO, CONTROL NO.
ARCHTfECf/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
app LICENSED CONTRACTOR'S DECLARATION Job Description
ra F i hereby affirm Net I un liccnxd unJcr Provitiou o(CMpur Y(mmmcncing
`uf viNSecuonl0(Xl)ofDivivonlofJmBuSneesandProfusioruCode.antlmyliccnscia RMV EXSTNG FIRE PLACE. VELA PLASTERING PD FOR
^ N in full force and effect.
Brame Clue Lie.11 BUS
H Da¢ Contractor,
ARCHITECTS
jg� IunderstandmyplauabalneusedupuLIC 6/25/8
DECLARATION
5nU
g G In Licarsed Pro must
3 OWNER-BUILDER DECLARATION
a�<I I hereby alTrm that 1 an ar,ampt from the Conu etor's License Law for Btc
❑O following mason.(Section 9831.5,Business and Professions Code:Any city or county
8° which requiem a permit to concoct,after.toport demolish,or roPair my anmture
_Zta prim m its issuance,mw requires the applicant for such permit to file a signed stskment
thatneisrcemwdpu.nttothepm.isknoftheContrecmhli..Lawfchapmt9 Sq.Ft. Floor Area $ Valuation
x5l (cammcteing with Secom,7")Of Divkion Sof the Bass ..and Protan...Code)., 500
Nn M Is exempt therefrom and the buts for Ne alleged awrapuan.Any violation of
Section 1031.5 by airy applicant fm a Permit rubjects the applicant an a civil penalty ofNumber Occas
not mart thea Inco hundred dollars(S500). 3 6 615 05 3 . Occupancy Type
❑1.u owxr of tK property,m my mteployas with mga u tle'v wk comPensaJnn,
will do Ne work,and the mucmure isnot inmMed or a@red for sale(Sec.7W.Busiws
and Pmfessim s Code:The Commoner L'^^^law,don tut apply to w Owner of Required Inspections
preps ny who builds m impowa thertron,and who docs such wok hituclf or d amilb his
orate employee,provided dust such improwmants arc net intended OrORemd for sale.If,
howewr,the building or impm ement kwld within ore Sear Of emtepleuon,the Owner-
builder will bow the burdmt of proving that M did not build or imprew for purpose of
see.1.
®T.u Owner of she property,am escinively convecting wish Reamed conuutan in
communal the projca(Sec.10th.Buaincss and professional Cade)The Contracmr's U.
cease law does not apply in an owner of property who builds or improves thereon.and,
who can=%for etch projects with a conuaetnr(s)licnno d pmsam to the Contractor's
Beene law.
I.exempt undo c .B&PC for this won
Owner Dam O6 O
N 'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ore of the following Gclsratota:
1 ham and WII muntsm a Ceniftate of Consent to self-insure for Worker
u provided far by Section 3100 of the labor Code.for the performance of the
work fm whim this permit is issted.
❑1 haw and will maintain Worker's Compwtion Insurwm,as required by Section
3700ef the Labour Cade,for the pXmmwecofthe work for which this Permit is issued. '
My Warker'a Cempnauom Insurance artier and Polity number art:
Carom Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Oras section need not becomplced If the Permit Is fmano hundred dollar,($108)
or leu)
i certify t 'in the performanae of the woh fm which this Pernb u issued.l awl eat
empsPeumiramann WLol k .a�JJKcl�o the Wortca Compensation
sof CaliforniaData ,1,
Applicator_ gQr4
NOTICE TO APPLICANT-1f,Bier making this CcNfeae of Escmption.you should
become subject in the Worker's Compensation provisions of the lobar Cade,you man
.J O forthwith comply with such proviaimes m this Permit shall hmre
e deeed mked.
Z" CONsn UcnON LENDING AGENCY
[-�� Ilorehyen.Wt there is.contraction lendingagenry far she efornanceof
C> the work far whim this Permit Is traded(Sec.3097.Civ.C.)
G0 Lenders Name
.7 z Undoes Addw -
U Q 1 certify that I haw rad this application and r,um she she show information is
D. F conecL I agree Or comply with til rimy and county oNin mess;and sok laws rehting in
0 V Wilding concoction,and hereby authority represcrumm of this city to enter upon me
[31 above-mantimmd property for iupcuen Purposes
4L (We)agree mo uw,indcmmfy and kelp harmless the City of CuPenino gairs,
y
liabilities.judgments.costs and exPemas whim may in any way accrue almost said City
V Z in consequence of the treating of this permit..
APPLICANT UNDERST4NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 6 C�J�VC
SOURCE REGULATION$t,s�
i�ff�f rrrl 0 4�)a(— Re-roofs
Silnuurt of Applian n err <' Peak
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tie a Cupertino
o(Mum building Co caupapt more m handle hmudon materim
u de. ed by she Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Cale,Section 255334)?
❑yes BNa All roofs shall be inspected prior to any roofing material being installed.
Will the.,]i. ,or future Wilding occupant use cquipmcm or skvima which If a roof is installed without first obtaining an inspection,I agree to remove
mit harm ou air conuminwts as defined by Ne Bay Area Air Quality Management all new materials for inspection.
lurid?
El Yes [)No
I haw read the materials requirements under Chapter 6.95 ethe Califon
nk Health&Smmy Cade,Seetlots 25505.35533 ala 35534.1 unceramad that if the Wilding
does aat cutendy hvw. .thus Ire u my teapondiality m mdfy the aceawt of the
requirements whkh tun _ rto iuouce ora Cenifeak of Oce m� Signature of Applicant Date
j�DD All roof coverings to be Class'W'or better
0wner ur sothoriced n Date'
CITY OF CUPERTINO
• ITEM 1 OF 1 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36615053 . 00
DATE ISSUED. . . . . . . : 06/25/2008
RECEIPT # . . . . . . . . . : BS000005219
REFERENCE ID # . . . : 08060061
SITE ADDRESS . . . . . : 7495 PROSPECT RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SRIVIDHYA GOPALAN
ADDRESS . . . . . . . . . . : 7495 PROSPECT RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : HEMANTHARAJU SUBBAN
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 500 . 00 0 . 50 0 . 50 0 . 00 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 . 00 110 . 00 0 . 00 0 . 00
1DEMORES SQ FEET 24 . 00 490 . 00 0 . 00 490 . 00 0 . 00
---------- ----------• ---------- ----------
TOTAL PERMIT 600 . 50 110 . 50 490 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 490 . 00 AMEX
---------------
TOTAL RECEIPT 490 . 00
•
CITY OF CUPERTINO
' DEMO
CITY OF
CUPEI�T
• INO PERMIT APPLICATION FORM
APN# 366 / SO 5 S . n Date: 6
Building Address: P
S Y-6A P %Q 2� CuQ civ C 4 2L9 � (4
Mailing Address (if different from building address):
Owner's Name: Phone:
S'cf`J t'�-cQA ce o - 5 4 - q6 E�-E-r-
Contractor: I Phone
OWn1 2 L3UILOEp�
Fax:
Contractor License #: i
Cupertino Business License #:
Contact: Phone:
QW rzr-
Fax:
Residential Sq Footage Commercial ❑ Sq Footage
Job Description: -T� /
c) VC, �Y, l j 1-1
Valuation: LAS 4" S 6-0
Project Size: Express Q--�Standard ❑ Large ❑ Major ❑
Please complete relevant portions of the Green Building Checklist & attach it to the application
or if applicable, include on the plan set & the sheet index.
Quantity Fee ID Fee Description Fee Group Permit Type
/ 1DEMORES Demo-Residential B 1SFDWL-DEM
1DEMOPRES Pool Demo Residential B 1SFPOOL-DEM
/ 1BSEISMICRE Seismic Residential B
Revised 6/16/08
CITY OF CUPERTINO
SUM DEMO
OF
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1DEMOCOM Demo-Commercial B 1COMML-DEM
IDEMOPCOM Pool Demo Commercial B 1CPOOL-DEM
1BSEISMICOM Seismic Commercial B
1BUSLIC Business License B
•
•
Revised 6/16/08
a'
Single Family GreenPoint Checklist dab: Budd K lGrW
i�:..
eJ#"f:YSIFSYi%iP:'�4'ufw,
The GreenPoint Checklist M basad on Me various green lectures Incorporated Into Me home and u the - W
basis for the GreenPoint Rated Program.A hone can be considered green if R hll6ps 0re prerequisites,
• same at least 50 points,and meets the minimum points Per category:Energy(30),Indoor Air Quietly
Health(5),Resources(6),and Water(9).Please contact Bull It Green for a bel of qualified GmenPolnt
Raters d you are Interested In pursuing third-party':edficatun.
T::w green huildino pradli il5lac below are.described in the New Home Construction Green Building
Gu+]efinae aQlbble atwww.holldifereen.on)
PROJECTENTER
V S
A.SITE 1 ? ,� r -�s�. " ? PUlntsAvailable Per Measnie'=;�'*f
1.Prang Topnn and Mlnimlae Disruption of Esbtinp Manor d Tran
a.Protea Tome hom Erosion and Raun sbr Conagoton
b.Link and Delimata Wnludbn Footprint for MnNNm Pmtatlbn 0 1
iDamntrud lmlmda0amolbhlnp Eslatinp BMIONW On SIb 0 1 I 3 1
3.Rai Job into construction Wmla(Including own Wnb)
s.MYunan 50%Wash oiareicn by W'41 org ol,or Reused Aiming p j R !
__ _y__.�.._....
b.MWmum 65%0lnrsbn Cywelpnl lRaydkgw Boreal 01
r c Uranium In ONasbn by Wall m Rveg _...o_ _........._
U �...�...._...
Rf I j
e.Un Reryaad Contnt Apprepaa gllMmum 25%)
e.Walkway and Orbweay 0 --—----
� C.Iw.d,Wy aan B I I 3
Tool PokN Available F She=1 0
B.FOUNDATION - - 'r'; ", Pom(cAvvl. . ..,
_,_.�_ •'..., ,- zble Per Measure._::;1�.
' 1.Rei Portland temm In Conant walk atoll Flyash or slap
s.Mlnbum 20%Flynh or Sip 0 3 r
■ b.Minimum 25%Flesh or slaA
Sake, _ _..___._.I__.,.�._.._._1__1.............
Z Un frorWrotacbd Shallow Foundation In Cold kem(GEC.Chub Zon 15) 0 ]
3.Use Radon Rmbtant construction 0n At-Risk lauaons Onty) 0 ] ;
d.DeMpn antl Build Struaunl Peat Combols
• elnbO Temtlta SAiebsSSepaMa NEIeM WaodbCmcreb tnnediaa by MeW or PluOCFnbrorWMtlen 0 1 r p
C.N Now Plena Hare Tmnk,sag.ar Sign lmWkLeast 36 Inches hon Fwltlalbn
Total Pot Arable,in FouMabn=a 0
0.I:AND$GAPING. e, r,a..;.j'tJ i1._-. „ ¢, 'POldli'Adaildbk Per Meagre t-t;i:
. - ..: . _ _
I.construct RnnrwEmWnt landampas
e.No lnvaln speaker Used or GaHPC he Ranted p j
b.No Rang Spades M Require Hedplrp
75%of Rants AreD -_..O � r3...
mgNXpbraM Camanta WOWS,Matllbmman,a00ar Approaiale Spades
Z Use FIroSaM Landscaping TacMlqun 0 ] I I
3.MlnMbe Tud Mu M bntlampe Installed by BUlldar
Is.Nl Turf WB Ha"a Water Requsamorl Less Nan or Enol is Tek Fgooll Wl fvla) 0 '
i_..__,..?,_,.
C.Tud Sha3 Na Be lmtalad on Sbpas EarsadhB l0%mNArees len than Feer Wide
c Tud al of tandarped Area notal2 bye __.._.
d.Tud hill omMsmped km(W 4 polyds) _p..__ ..r— a__..,! ._.
e.Plant SMda Tram
0 i i 3
S Group Plants by Water Nntls(Hydmmning)
0 2
6.Install XIph-EMclenry Irtlyeon Systema
s.System Uan only lowilow Odp,ButaMn.alPiwaki sainken. 0
.. 2
Is,Sporn Has Smart Con oil .t_,_.-.J'
__...
3
T.Innroon4 Two Inches a compoq In Ne Top e b 121ncMa a$oil 0 3
S.Yutah NI PlaMnp sada to Na Gregg of 2lnaaa or Laml Water Ordlmxe Iii,= amnl 0
9.Us.50%Salnped or Rerycladtontent MabMb for 50%a NomPlnt landsmps Elemmb 0 3
10,Radii Ught PPIIWPn by Shlaldlnp Final infor Dmicting Ught Dnwnwnd 0 ] f
Tag Points Anbble F Wgrzapinp•31 0
D.STRUCTURAL FRAME&BUILDING ENVELOPE.: -
- .. :: 'POInt2Avzllzble Per Meesdror2:,.
t.Appty optimal Valva Enpinndp
e.Rem Rahn and studs at 2alrch On Canter Fra lrq
0
b.S.Doo ant WPNow Hagen,In trod '
• c.Use 0*Jed and Cripple Starts Raoul for load ._.Q- ..___•._--i.____! �__..
2.Us.Enpinnnd full ]
a.Boone antl Hearten
r—i
C. autetad Enpineeledlwrtwacl,baWWood bbbTruun tarFoon
02007 Build It Green Single Famly GmenPDint Checklist 2007 Versloo Page 1 of 7
ENTER PROJECT
s m1 8 & _
5 s"
ME
/.Uu SOIM Wall Syatams"..ludas SIP.,ILFs,{My NamSU.a Fnma Aaumby) - •
■ e.Fbas 0 2 2
■ b.Web ..___..._...- _.--___--_:___.
p
■ ROW 0 2 2
S Reduce Pollution EntaHt,Us Home from tha Camp
■
a.Tightly Seel lie M Earner Woman Garage all LMng Area
■ b.Instatl Garage Exhaust Fm OR Bold.Oebtlnd Camp
■ 6.DAN,Emig,Heels on Trusses(75%WAM InaWBon Height at OW Ide Edge of Exterior Walp 0 j I
■ 7.Daalgn Roof Tnasaa b AaammoNb Ducbor4 0 1 I I
■ I.Use Regco d ontanl Sleel Surds for 90%of Inti Wall Framing 0 ]
■ 9.Themul Was Walls:Wnch Drywall on NI IMador Walls or Walls Walghing mon than W bwA 0 1 i
10.Install OraHunp all G Ware
■ a.Wdmum 16-IMh Onrhaa,s all Guam. D ]
■
A.MmbNm 244ah OsaMvgs and Gugen 0 j
Total Points Avah*b Structural Bolding Fnme AM Ehveloie 3f 0
E.EXTERIOR FINISH - .. `* ..+.�. . ..
1 "' Js. .'Pailnb AvdaDla PeiMeaslire.
■ 1.Ues Racycp nbM(No W„b PI g,)or FSOC.N Wood DML, 0 1 2 j
■ 2.1.1AR.Rain Sawn Wall Bystam 0 2
■ O.U..D.rable ud NhnoombuWbla Siding Materials 0 1
■ e.Salact Dunbls antl Nonwmb.Ubk Reefing Wbdals 0 2
Total Palm A.Iabe in EWMr Arish• 0
F:INSVI:ATI0N° _!.,.-: a s'„�.:.? ��;. 1 .u..5::$� t - `?;..� x ?10..,.5r..+,1 ya... f"::',$mats AvWable'Pei.Maesara S s`.
1.IAAW1InaWbon With 75%RaryckA Conten
■ a.WabeWbr Floor
■ b,temps 0 1
Z InaWI Wuls0on that Is low Iftfn,(C.M.d Sadon 01550)
e.Wa6s wvM Fbhra
b.Ceti,s 0
0.In.padCodify M lnwb0on Installattan intra Applying Drywall 0
Tour PdMS AWbbe m lnuraC 0 •
C.PLOhIDING,', +''"Points Avellable Per Measure.r'+
1.Dl.tdbaa DWnaah Hol Wader Eftivity(W.I..7 P.Inh)
■
A.hmiMe HM Watar Pipe than Welea Heater b(Iden 0 1 I ]
■ b,ImulstaMHoIWM,%pee
c.Jam EnpeeeaW Partial Ppb, 0
■ d.um,EApAW j PmeOal Pipl,Aral OemeM ContMed Clmdetbn Lap
■ e.Use SbudaW Plumbt,Ath Car"Conboled Gaola0a Lpap 0 ._._...j.__z__.
■ f.use Cental awe Phndd,
Z lm,tall Only High EfBcl ncy TWleta(B."i ah omi.L pg 0 1 4
Towl POMts Anal"In Pkml*g=Tour 1 0
H.HEATING;VEL7TILATI0N&AIR CONDITIONING , �', .`.T'� `. y; ", .f r,:„'iv `' '..:..f� ;'.:id 'I POInts A4ilahie Pei MeasuretV'+'`
■ 1.peal,.aM Writ HVAC SOW.b ACGA W.ul J,D.and S Rusemandaeons 0 j 4
Z.Install III Combustion Unlb
■ b.Wale,Heats 0 2
■ f.Install Zonad,Hydnnk WOisM Hering Arils Slab Ed,lnwtaeen 0
■ 1.Instillf High Eclenc,Nr Conditioning wsh EnWnnmentaly Responsible RatAgemnb 0 1 )
I.Oeslgn and Ivtall Eflsdes DucWOM1
a.hood HVAC Ung all Oust MWn Cpollbnd Spare 0 i 3 1
■ b.U.Dud WMIco,M Dud JOIMs AM Brims
■ c.lmai 0uatxmk under A9X twblon(BudW oud.) 0
■ A.Pn. m Balance be Docbhh BYWAY .-.. (___..-,... ...._-.p. .._._....
■ e.PMM Duds duds,Com,WdnneM tbanM Duds balaeOmpaary
0
■ s Install High Efftde cy WAG RAW IMERV N) 0 1
■ 7.Don't Im,b1I Flnplsce or Install Sa led Gas Flnplsces with Efficiency Rating Not lass Than 60% 0 1 1
Wil,cu standards t
1.Wult ERaoM Exhaust S"Wor.In SMhomm,all(totem,
■ e.Install ENERGY STAR Bath.Fam,Vended to Cs OUISMe 0 __ a 1_• •
■ b.M Balham Fans Am an Thee,s HumYOslsl
■ c.Insall Clori Wage HOM Vented bee Coma 0 ( 1 1
9.Iulall Wohanlnl Vedsdan System h,OWN,(Wabnum 1 Points)
■ ..Instal ENERGY STAR Coling Frs I Light N9s N Lwag Ames d W. _��.
■ b.InsteO WNde Novae FanwM Vahada Spews _..�.
AW Pe 3017
02007 Build It Green Single Felly GmenPoint Cheddis12007 Version 9e
ENTER PROJECT NAME
Mongol
• L RENEWABLE ENERGY,
1.PhI for Solar Hot Water Hoating 0
4
1 Insall War Wan Heating Symorn 0 I lo
S.lodall Mdq Conduit for Fenno Photovoltaic Installation&Provide 200 it of South4scong Roe D 1 2-1
4.Inuall PhoWstalk,(PV)Pinvols
e.3D%of oloohic,mass OR 1.2 kW(WWI 6 none)
D 6
b.67%of SIR*maxis OR 2.41M(Inn 12 pWds)
c.90%of Wool Wood OR 3.6 kW(WW 18 points)
D 6
Toed Aabble Points In Renvoidele Emargy•H D
J.B UELDIN G PERFORMANCE
'PitntV Available Per WgsunaY
1.Diagninall,E.I.Inn.
e.Mouse Paimem Bownur 0.Tic 0 t Ii
b,House Pon...Ctnevid.Sandy Bacclail T.0
InIes.15W.,olma, 0 230 i
5 2
S.Hous,01rains ENERGY STAN afth Indoor Air Packnip ComflionfiDe-Pilot Mnson(roUl 45 points;mad c nrq 0
Tood Ameba Nims In UldVV Periennnenca•3E D
V-FINISHES ......
1.0ecpn Entryways W Rada.T..WNI In C.nb.inW
I U.Lam-WX.A VDC Point lassie.3 Points)
I.1.rVOC never WaftlCinding Porti 16010 VCCI"t) ndl<150 ppl V0Ca(Nm Q)
b.Zeno-VOC:Interior WaRCellh,Paris(6 go VWs(Flil)) G
3
3.U.I.Wo VDC.llhmimfhmial Wood Finislood,(QW ppI VOCs) D I 2
4.Us.Law-V0C Caulk and Cianst.clio.Auffmal.,(Q0 gel VOCs)I.,Ali Jolhown.
0 2
S.Uim Rencycla&Content Pah
6.Use EnArowarnall,Privionakow fthorals for Intaflar Findah:A)FSC{adftd Wood,8)RactsdrN,C)Rapidly RavarraimW,D)Ra.Yco6CorWnt w E)
FMW4aInWd
I.Ginnie,(�M..) 0
In.Intoner Trm(�Warman) --------
D
c.Sh&M%(50%Madmem)
d Gen.(5n Iffinneon.) __ i_.—_'___.._.-5--..
e.Couroameo;(50!,,Innanum)
0
7.Rod..Forrmidwhyde In Intoner Fiefth(CA S.W..013%)
a.Sold.A SWk Teat.(Sn Mirdroar) 0
b Canada&Causaire,[!0%Nlvmou�)
c Interior Tan 150%Mlnb nn)
d.Shishing 150%Minarman)
no.,Tut of Indoor 0 ShowFinneraidwhyde Larval Q7,b 0 3
9.After Inabbilm.1 Finds
Tota Avadase Ponts In FJnW.•2 0
L FLOORING
.Points Availeby Per Mee6Ur¢.ai'ri.'';`.
1.Use EnWhonerinitaly Plefthel.Roaring:A)FSC{wrdfflirdl Wood,III Rachih im!or hflnbh.d,C)Raakll,Nauprobi,D)RaoyuW".rU,,E)E,.m,
Whinern 15%of Fbor Ams, 0
b.MaInerarn 30%of l9om Arre
it Minimum 75%of l9cWr Area
Z Thormal Mu.Floors:Flaxor Comm,00Wr Sun Carpet on 50%w Mom,of Co."Fee.
0
3.Floor,Manots section 01350 or CRI Grain WWI Pin Roquinueen(50%Allinimer) —------
0 2.7
TURN T.Wp ;Phas W—Fl.rW —0
M.APPLIANCES AND LIGHTING 7777— Points Avzltebla
1.Instal Water and Earp,Md..t 01.1mashor
a.ENERGY STAR(WIN!I pae) D
to Dsomaurar Umm No Mom Seen 6.5 GalonsinCycle(Waid 2 donti)
0
Z install ENERGY STAR Coftm Woohlin;linhim union Vailan factor 0 6 or I.am
a Me EmwSter"CEETbr2raulmmt(mo MemNy4 r2.0,WftFe rS.0)(bsl3pw I
b 2
Was PW`W) a 2
3.Wing ENERGY STAR Rdrigarintor
8.ENERGY STAR Quoted&<25 Cubic Fact Capacity
b.ENERGY STAR Cinelfiae&<20 Gone Feel C.,eacky
A.Install R.Ift4n Raytung Carter
e.Bulain Racychn,;Carter
—0
02007 Build It Green Single Family GmenPoint Checklist 2007 Venda Page 5 of 7
2:1
INTER PROJECT NAME
ftwesoperi mrsaminner poem wome for mi In wrimmilIt W;xias W he 62hL 0 0 D 0 •
E MIN I
+67 7�'
Ener ui�hsm'.�exte",poise mulaIxe for numsurn In mme"'�;Oumu to be rNIni. 0, 0a
0, D 0
dis 8 Ipwi%Mn and rnia,whbmah Wf;".m._aPx*Prms M ing.1 0 th a digh L 0 0
4.Innovation:List innovative measures that meet the groan building objectives of the Guidelines.En 8 Build It Green Checklist.,and
Guidelines
'"up up
maximum combined total of 20 pts.See Innovation Checklist for suggested measures,using the link to the right.
InCommuiriltr.lines,des.0im Mn,W inift,Pairs smiltme fix.In aImmepalsmin u,ft qlirL 0 0
� �
Inn w
: rdpMm,,WenWrbBnbWobrmnumhappmpAaW"orb �
sWthL 0 0 0 0
0 0
ruxuaton iiRmumm:Enne dimalpfien hem,and entst poine milable for seems 0 appiaii cim9ores W N NX 0
nuxineor in WI Ener diumpurn Ain,an!anur prime rialletli,tur immune h atimulate Cargoes to IM fight. 0 0 0
Toll-A-.
Summary
•
Total Available Points In Specific Categories* 1 4+ 66+ 43+
�T+
9
Minimum Points Required in Specific Categories 0 1 30 1 5 1 6 9
Total Poi..nts Achieved 1 01 0 i 0 i 0 1 0 i 0
Project has not yet met the following recommended minimum requirements:
Total Project Score of At Least 50 Points
Required measures:
-A3a: 50% waste diversion by weight
-12: 15%above Title 24
-NI:Incorporate Green Point Rated Checklist into blueprints
Minimum points in specific categories:
-Energy(30 points)
-IAQIHealth(5 points) •
-Resources(6 points)
-Water(9 points)
•
0 2007 Build It Green Single family GmenPoint Checdat 2007 Version Page T of 7
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. 7L, 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
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse si e).
Property Owner's Signature: Date:
Job Address: 'I t C enc n 6,( T Nh-13 Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
• Department.
,
CITY OF City of Cupertino Building Department
10300 Torre Avenue
CUPS TIN 0 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
_ Community Development
f e 10300 Torre Avenue
- Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRES : ",-J-qT f-rotPCc6 12d PERMIT �O 6 06-11 X4 0 - 2T-- (
4 1 OWNER'SNAME: ivi aa HONE # .y 1" T�v 46gs'
GENERAL CONTRACTOR: a FAX #
I am not using any subcontractors: &I 2, oG a g ,
ignature Date
Please check applicable subcontractors and complete the followin 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
Own p ontractor Signature Date