08060117 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORI I1T.,,' �2NTATN
PERMIT N0.
BU'".r5V?R'UbINTERNO CT DAHL PLUMBING CO, JOHN F 08060117
OWNER'S NAME: PERMIT ISSUE DATE
DAVE LEIBOWITZ P 0 BOX 450 06/17/2008
NE: SANITARY NO. CONTROL NO.
(650) 321-5500
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
.00 LICENSED CONTRACTORS DECLARATION Ib Description
as O 1 hereby affirm Nal I am licensed antler OaSCrIP
er provisions of Chapter 9(commencing
1<E with Section 7")ofDivision 3of the Busimssand ProfeuiuuCode.and mylicense e INSTL FURNACE & A/C
in fun forge and erten. C. O
i License Class Lk.R
Dab 'R1�Conlranar
eARCHI ECI-S DECLARATION
y I mehosc nd my plus shall he iced as public Iaards
a
y'LL y IJtCnxd PNfCi{InNI
y03 OWNER-BUILDER DECLARATION
.�<E I istaby atnrm that I ten exempt from Ne Contactors License city
a for the
00 following moon.(Baden 8131.5, 4 a]l r u0 Rafcoiue Cook:Any oily m teeny
$� which require a permit b mnraroct sumac Improv,demoltsb,ter epee icy s,mctum '
pmor is li cnwdpuantto p.,i.plkantfarsahpermitmfileasigleds,atement
EES<
(commencing
com incingwithSe antmNepmviviouaflMConuumranianxlaw(Chapmr9 Sq.Ft. Floor Area Valuation
YF9 (codas I,ngwith Sedan7000)the
basis far
of Neagei exemption.
MyoehtWc)of 12100
r3—
that he u 1.5 b dtemfrom and Ile baba for Ne Weged exmpnt to Any l imam or
Sedannot.. man by any ed dont for•permit subjects Ute applicant a civil penalty of �AN Number Occupancy Type
tent more Nan fisc hundred dollen(57W). 3 5709071 .'lTtf' P Y YP
I,uowner of Ne pmpmry.or my wplayee wlN wgeulheir sees eompenuden,
will do lesions me Ne suunumunotamndedoraReacL a act a(Ste.8N4, of
and erty who be Cove:The Canhermon, liU.d who law dam at apply m rt awugh is Required Inspections
propertywhobuildsor edprowech and who daessuintwank himselforNmugn lits
awe emploe buiprovidedIpm manot intended terk6on.for sales,
said., iR buildingorimpmmnentuxk did arcyw ori improve wiB nave the wmdm of proving that Ile did ml build a improve Lor purposes of
ices.).
❑1,as owner of the pmpenY am eachremly contracting wish licensed contacted to
couwct the project(Sec.1044,Business and Profrsvoa Coda:)8c Coutrxmrs U.
acres Law doe oro apply as an owner of property who builds or improwa thereon.and,
who concocts for such projects with a connctor(s)licensed puraam to Ne Conersetors
Licdue Law.
❑1 oro acrepu under Sec .B d P C for Nis reason
Owner Dae
WORKERS COMPENSATION DECLARATION
1 hereby afflon under penalty of perjury,arc of Ire following dee arualts,
1 have and will mainuin.Certificate of Consent to elf-iaurt for WorkersComped-
sadon,as provided far by Sedan 3100 of the Inbar Code.fa the pmfomatra of do
wort for whim this permit is immM
I bane and will murrain Workers Compensation huurance,as taloned by Section
later de labor Code.for tie arrarmmceofthe work far which this permit is brand. '
My Wor a Compenaalm 1 nett carrier and Polity number art: II``11 __
Carrier.� `��Policy No.: N 0 \`_\UL
CERDFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
most seetim Iced rot w completed if ft Permit isfaanchundxd dollar($1011)
or less)
1 unify that in the performaae of de work for which this permit Is boned,I shall not
employ any person in any mmarso at in become subject in the Worked Compensation
Laws of CaBromia Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cenifiob of Exemption,you should
became subject in Ne Worker,Compensation Inmate.of the Labor Cade you mus,
.J z fardswith comply with race provision or Nis permit shall w deemed masked,
z O CONSTRUCTION LENDING AGENCY
r
(—I I herewhich the that Ncd is concentration lending saner far the performua of
Le wort for which INs pemlil ts bred(Sic.]09'i,civ.CI
Q Lenders Nene
z Landers Address
U O 1 certify that 1 have acted this applicalom end sue con the above iefmn Tice is
LL co a=1 ague to comply with all city and county oNinaae and sues laws dialing to
O booking coatuction,and hemby uUanes representatives of this city to enter open the
r 4 show-mmdmed property rte iapenion pugroxs
(We)agree in sane,indemnify and kap harmluo the City of Cupertino against
F+VI liabilhim judgments.costs andFAIINZLIL
which may is any way a arae againnoid Cry
U z in maegllenen f the granting=in' RSTAN COMPLY LTH ALL NON-P INT Issued by: Date ? -'�SOU N5. ,^A " 7 I�' �jJI V✓ 6� by:
Signa mfA li o RDO DataD. �-
AZARDOUSMATERIALSDISCI.OSURE Type afRoof
WIII Ne applicant or(mud Municipal
Cg amputsbrt .and the
humdsan material
u definetl by the Cupenim Municipal Cade.Chapter 9.12,rots Ne HnIN uJ Safety
Code,sedan 25532(x)+ All roofs shall be inspected prior to any roofing material being installed.
❑Yu B{a
Will the p,licm,or fubm wilding manpml sax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I havamme it conominano at&tied by dm Bay Area Air finally Management all new materia for inspection.
crt
❑ye alA
I haw mad elunmdlusmuen rtqumentensunder ,Chaper6.95dthcCalifor-
nialicalNhSalet de,Soceou25 533md25534.1underwndthnifthebuil ng
w tenant,Nal' m esmnaleililY bIptifY do t
n ateepemetea te.5, Signature of Applicant Date
uW!
owmerar.mhmir d.e 1 Dad I All roof coverings to be Class's"or better
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 35709071 . 00
DATE ISSUED. . . . . . . : 06/17/2008
RECEIPT # . . . . . . . . . : BS000005133
REFERENCE ID # . . . : 08060117
SITE ADDRESS . . . . . : 22207 QUINTERNO .CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DAVE LEIBOWITZ
ADDRESS . . . . . . . . . . : 22207. QUINTERO CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2749
RECEIVED FROM . . . . : JOHN F DAHL PLUMBIN
CONTRACTOR . . . . . . . : GARY CAVAGNARO LIC # 5573
COMPANY . . . . . . . . . . : DAHL PLUMBING CO, JOHN F
ADDRESS . . . . . . . . . . : P 0 BOX 450
CITY/STATE/ZIP . . . : PALO ALTO, CA 94301
TELEPHONE . . . . . . . . : (650) 321-5500
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 12 , 100 . 00 1 . 30 0 . 00 1 . 30 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
1MRRAA UNITS 2 . 00 122 . 38 0 . 00 122 . 38 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 286 . 84 0 . 00 286 . 84 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 286 . 84. #34230
---------------
TOTAL RECEIPT 286 . 84
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
o�vc� ai � 7
CITY OF CUPERTINO
FURNACE/AC
•CUPEIOTINO PERMIT APPLICATION FORM
APN # 3 5,70 I D- / o Date:
O�
Building Address:
22,2p`1 Q ve�� e
Owner's Name: Phone :
Contractor:` ` p Phone#: \j o_
Fax #: &36-2\�
Contractor License#: a Cupertino Business License#:
LOA 5 9 `3
Contact: Phone#: lflS�
Fax #: �« 3
Building Permit Info:
Elect ❑ Plumb ❑ Mech _
Residentia�a Commercial
Job Description:
For Residential Installations:
Attic ❑ I" floor ❑ 2"d floor ❑
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage Class):
Z 00 , oca (L - 3
Strapped r On Platform ❑ Bonded LJ New Location Replacement D--
Project Size: Express 9'—Standard ❑ Laz e ❑ Major ❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set& the sheet index.
Revised 6/16/08
CITY OF CUPERTINO
'SO FURNACE/AC
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration .
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code. •
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
IPGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit.
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or •
floor mounted unit heater.
1MRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install & not incl in an —1 ermit.
CITY OF CUPERTINO
FURNACE/AC
•CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1PGASRES Residential for ea gas piping system of P
1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1BSEISMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
1MER=<100 Furnace Syst <=100k BTU install or M
relocate ea forced-air/gravity type
furnace/bumer, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1 MFRN>100 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
furnace/bumer, incl ducts/vents
attached to such appliance over
100,000 Btu/h
1EPERMITFEE Electric Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
IPPERMITFEE Plumbing Permit P
ITRAVDOC Travel Documentation B
1BUSLIC Business License B
CITY OF CUPERTINO
FURNACE/AC
CITY OF
CUPERTINO FEE SCHEDULE
Quantity Fee ID . Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1BCAIRHAN Commercial A/C Units<= l0k CFM B
1MCRAA Commercial Mech Repair/alt/add M
1BSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
IBREMAIRHAN Residential A/C units <= 10k CFM B
/ 1MRRAA Residential Mech Repair/alt/add M
IBSEISMICR Seismic Residential B •
IEPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
/ IPPERMITFEE Plumbing Permit P
/ 1TRAVD0C Travel Documentation B
IBUSLIC Business License B
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 72points
11. Permeable Paving, Note L-1 C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 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 oint
P. Other 1. List Green Features on Plans A-1 1 point
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 IAQIHealth
A.Srte
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;80%=4 points r 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 Stoonwater Practices 2 Resource pts y=yes 0
7,Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
8.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
1
memo
B.Foundation
1.Incorporate Recycled Flyash in Concrete
25%Recycled Flyash=2 points;Add 1 point for every 1 D% •
increase of fiyash,up to 5 points up to 5 Resource pts 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yesF 0
1 1 1
C.Structural Frame
1.Substitute Solid Sawn Lumber with Engineered Lumber 3 Resource pts y=yes 0
2.Use FSC Certified Wood for framing
(For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0
3.Use Wood(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 3 Energy pts y=yes 0
c.Roof 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 OSB
a.Subfloors 1 Resource pt y=yes 0
b.Sheathing 1 Resource pt Y--yes 0 •
INPUT ReSOUTces Energy A0111ealth
I.Windows
1.Install Energy-Efficient Windows
• a.Double-Paned 1 Energy pt y=yes 0
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 D
1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on All 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 21AQ/Health pts y=yes 7 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 3 IAO/Health pts y=yes 0
b.Water Heaters 3 IAQ/Health pts 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 p
b. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Instal;High Efficiency Filter 4 IAQ/Health pts y--yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes p
17.Install Separate Garage Exhaust Fan 31AQ/Health pts y=yes p
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes p
2.Install Solar Water Heating System 10 Energy pts y=yes 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,2A kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0
6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pts , y=yes .p
1 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes p
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes p
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes p
1 1 1
•
Community Development
sum.. 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4UPERTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: ' ' W, Z PHONE # l O
GENERAL CONTRACTOR: PAFAX # , %- Tjrc i4
I am not using any subcontractors: 1p _
Signature Date
Please check applicable subcontractors and cbm2lete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
•
Owner/Contractor Signature Date