08030064 CITY OF CUPERTINO
.BUILDINS DIVISION PERMIT `"zCdITRt1CT�QR)Il ,QR1VIAI01V
BUILDING ADDRESS: PERMIT NO.
21210 RAINBOW DR . ALL VALLEY PLUMBING 08030064
OWNER'S NAME: PERMIT ISSUE DATE
YOUNG NANCY AND MICHAEL 3345 SELDON CT 03/12/2008
ONE: SANITARY NO. CONTROL NO.
(510) 376-4816
ARCHRELT/ENGINEER: BUILDING PERMIT INFO
BLDG EO O MECH
O
300 LICENSED CONTRACT'OR'S DECLARATION 7b Description
r� I bunchy afarm that 1 am Boosted under provisions of ChpupCSCrIP
r 9(commencing
with Section 7MM))ofDivlsion 7 ofho Business and Profoaiom Code.was my license is WATER HEATER REPLACEMENT
a� in fall farm and effm
Z Lkcnx Clam Lie
9 Dam U7 Cr
ARCHITECTS
,DECDECLARATION
II 1 understand my plane shall be mad u public records
J
g8 Licnmad Protean..I .
5 OWNER-BUILDER DECLARATION
"lliem emNe
i 1 hereby arm the,I expt from CanuaLicensethe
s License Law for
D o following morn.(suction RD L5,Business and Proremium Case:Any city or county
3 2 which requires a pamB m construct,slier.improve,demolah,or repair any smuctua
ZC reform iuiauanec.alw requires Nc applicant fofauch Mrmitmfile adgnndsummm,
< that he mlicemad pumun,mma provisiomofue Cmoacdr'e License law(Chapmr9 Sq.Ft.Floor Area Valuation
5m (commemini with Bastin]000)nf Divulon Sof Jr'Budnmand Rofalav Cnde)a 750
r'3$ rut M m.....pt therefrom and the bass fa de alleged exemption,Any vlolNn of
Sections 7031.5 by any applicant fa a permit subjects the applicant to a civil penalty ofNumber Occupancy
Out mice than five hundred dollars($5011L 36652005 :•V6' Penc y Type
❑I,uownerof'tipmpny,amymoploymwithwg uthirwlecompemadon,
will do Newark,and theswcma4notimm�dW oroRerM farsale(Sec.7044,11udms Required Inspections
and ProfW
eom Code:The Commodes Liceme m mm e ns Law d ,apply an owner of q P
praputy who Wilds oaireptovu Nmnn,nd who doessuch wit blaualfa Nroagh his
awn emplOyen,prodded Nat ouch improwmnu art not intended aoMres easier If.
however,Ne Wilding ar(mprovemant i,alt did
not
yecmnpmtin,Ne ower
Wilds will haw the Wrdn of proving Nm hea did ,build a improve for purpose of
said.).
❑1,u owes of the property.me achadvely cammming with licensed com errs to
comtmct Ne project(Sec.]Om,Basins,ant Prefesdou Code)The Guarantees U.
dna Law dm nm apply at an aware of property who Wills or improves thereon.and,
who nnmacu for such projects wim a.=Or(,)licensed pmsusnl d de Grammes
Lic"m Law.
❑Tameaemp,under See .B&PCferlhismuon
Dam
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury aha of the following declanilmss
❑IlaveandwlllmainWnaCeWRauofCanan,dalf-(uumfor Woeces Compen-
station,at provided for by Section 3700 of tae Labor Cade,for the performance of the
work for which this permit is Wood.
❑1 haw and will main am Water's Compensation Imdance,at mgalad by Sutton
3RDof Jr'Labor Cade.fm de perfananeeaf Ne wars fa which than permit is lamed. '
My Worker's Compensation Insurance nrtW and Policy number am:
Cartier: ZPa p'Q' I Policy No.; a66 X t
CERTIFICATE OF EXEMPTION FROM WORK S'
COMPENSATION INSURANCE
(Ibamoctlm need an,becmnpmad Hthe Permit a faonchundrW do0us(5100)
or lea)
1 canary that in the performance of the wars for which this permit is Woad.I Wall not
employ try person in my monnera at m became abject d the Worlere'Compensation
Laws of Califumia.Dau
Appliaea
NOTICE TO APPtICANr:If,after making this Certificate of Eemp k n.you should
xecam subject in Na Workdea Compcnutien proviuou of the labor Cedc,you am
.J O forthwith comply with such padslou a Nu Permit shall W deemed awaked.
CONSTRUCTION LENDING LENDING AGENCY
(ti I Wreby affirm Nat thea In construction landingagecy for Jr'performenee of
the vert fa which this permit a mond(Sec.3097.Civ.C.)
Q Lourdes Name
]z Lender's Addy•
V Q I aNfy,Nm 1 have road NB application and sum dust the aWw information is
V.U amact.I agree In comply with all city and cony ordinances and sum laws mladn{d
Q Wilding construction,and hereby moloria mpaaenoulm of this city to most upon tae
fy ahow-mndmd property far inspection purpoet
fY (Wc)@gree to saw.indemnify and Iuep barrettes the City of Cupertino against
r l liabiliuea judgments.cam and eapemn which may In anyway mo or'against said City
t.) In cmueti.M.of the granting of this Namit.
APPLICANT QUQEU1hNDS AND WILL COMPLY WITH ALL NON-POINT Issued by: . Date
SOUR LATION .
13
natan n a Data
Re-roofs
CS1
Sigp v�
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant a future Wal Co aaupant sda or hands hrarros mamdal
� u render by tie Cupertino Municipal Code.Chapter 9.13,and tae HnIN and Safety '
Section 25533(+)7 All roofs shall be inspected prior to any roofing material being installed.❑tin 2W.6
.
Will the applicant or future Wilding Occupant use equipment or Imdur which If a roof is installed without first obtaining an inspection,I agree to remove
until IWAWO=air cenumin ms u defined by Ne Bay Aad Air Quality Mangemem all new materials for inspection.
District?
❑tics ❑Nu
I law sad the huardns dammquimmmuum rChapmr6.95 ofthe Califon
Na HmlN&Safcty Care.Scaimn505.25533and25l34.IwW m W llutifNc briding
Jana rot cmand It is my aeopmiNlity to mory Jr'occupant of the
agmim len mutt be met prior srmuuac of a certificate Owner a anDam at 2;7.1
Signature of Applicant Date
n3)I All roof coverings to be Class'p."or better
m
• CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36652005 . 00
DATE ISSUED. . . . . . . : 03/12/2008
RECEIPT #. . . . . . . . . : BS000004147
REFERENCE ID # . . . : 08030064
SITE ADDRESS . . . . . : 21210 RAINBOW DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : YOUNG NANCY AND MICHAEL
ADDRESS . . . . . . . . . . : 21210 RAINBOW DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4978
RECEIVED FROM . . . . : ALL VALLEY PLUMBING
CONTRACTOR . . . . . . . : MARY SANDBRINK LIC # 23015
COMPANY . . . . . . . . . . : ALL VALLEY PLUMBING
ADDRESS . . . . . . . . . . : 3345 SELDON CT
CITY/STATE/ZIP . . . : FREMONT, CA 94539
• TELEPHONE . . . . . . . . : (510) 376-4816
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 750. 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
1TRAVD0C FLAT RATE 1 . 00 40:79 0. 00 40 .79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 106 . 56 0. 00 106 . 56 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 106 . 56 #1064
---------------
TOTAL RECEIPT 106 .56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- -------------------------- -------- ----------------------------
518 WATER HEATER
r
CITY OF CUPERTINO O0D5 D(-) (Dq
.SL
WATER HEATER
CITY OFN FORM
Oct-iPEkTINO PERMIT APPLICA'T'ION
1 Date:
A P
Addre,-,;-
phune
phone 6
omnactor:
Contra: or -,rare License
Cupertino Business License :
Phone ;30
C'ontac-t:
/Z I(Y 14 �
Buildin lit
Info:
E�ldPlumb
7 Eic!q2
Commercial
—_7
Residential
Job Description.:
...........
RepjaCernU-M L
Strapped On Platform Banded oc3ti(
Valuanom
completed and attached to this application
(.,reen
Building Check must be
Green Building Points achieved-
CITY OF CUPERTINO
WATER HEATER
�UPEPTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Grou
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BSEISMICOM Seismic Commercial B
1PRWHEATR Residential Water B PRWHEATR
HeaterNent
j 1BSEISMICRE Seismic Residential B
I 1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel & B
Documentation
IBUSLIC Business License B
PROJECT NAME _
L RENEWABLE ENMGY / Points Available Pat Measure
1.Pre-Plumb her Solm Hire Water Hearin 0 4
• _77 2.Install Solar Water Healing Season 0 10
Lj 3.total Wiring Conduh NO Future PhDIDVDI ie lnstalta0om&Provide 200 if of Sour-FacingRoof 0 2
I.ln&W Photo iftaic(PV)Panels
❑ &3D%d electric neetla DR 12 kW(tatal a points) 0 R
(tdel l2 points) _____.... .... __
El h.X96 d eleddc needs DR 2.4kW D 5
❑
C.D0%of Distinct need OR 3.6 kW( 1111 points) " ' '-
0 E
Total Available Points in Remvrable Enarpy=2& 0
J.BIIII.DING PERFORMANCE Points Available Per Measure
1.Diagnoc4c Evsh016DU
❑ &House Passu;Blower Door Test 0
Daae Process,Combustion Sably BacktlrattTried 0 I
2.Design and BuDd High Perfommme Homes-%above Tme24-minimum l5%Required 0 t30
❑ 3.House Obtain ENERGY STAB with Indoor Air Package Certification-Pilo Measure(rental 45 pointe,read comment) 0 5 2
Toll AvaOada Pdmss Build Pedamarme=3e 0
H.FINISA89 Points Avdllable Per Measure
1.DeeRn Entryways to Reduce Tracked In Conraminswes
0 1
2 Use Lqv-VOC or Zero-VOC Paint(AEedmum 9 Points) -
❑ a Law-VDC Interior WeIOCeNng Pains(c50 WI VOCs(Flap and<150 go VOCs(Non Rall o
7
❑ h.7amVOC:Interim We10Lal0n Pains(d VOCs(Flap) ._p - .. . 3
❑ 3.use Low VOC,Wekr-Based Wood Fetiches(Q50 gpl VDCs)
D
❑ 4.Um Low-VDC Caulk and Construction Adhesives(c70 gpI VOCs)for All Adhesives 0 2 2
❑
S.Use Recytled-Contam Palm -
0 1
G.U) Emironmantally Preferable Motorists for Interior Finish:A)FSC-Certified Wood,B)Reclaimed,CJ Rapidly Ranmvable,0)RecytlatlLoment
o
or E)flngm,laintatl
❑ &Cabinets(50%Minimum)
El 4sr'pr 1nTran(50%Minimum) 0mum)
❑ ' c.ShaNing(50%Minimum)
❑ d.Doore(So%Minimum) a_
❑ e.CouOta (50%Minimum) --
].Reduce Formaldehyde in Imemor Finish(CA Section 01350) '
• ❑ a.SMrOoa&Stair Treads laws minimum)
b. o
❑ Cabinets Caumwtops(50%k mhMm) _0 'T
❑ c.Interior Tnm(50%Minimum)
❑ tl.ShaNin (50%Mlninum) 0 -
&titter InctalWon of Retches,Test of Indoor Ah Shows Formaldehyde Level;i b 0 3
Toll Available PmM Fmishea=21 D
L.FLOORING Points Available Per Ideasure
1.Use Environmentally Preferable Flooring:A)FSC-CaNfied Wood,B)Reclaimed or Rafinisheq C)Rapidly Renewable,Di Regd d-ConW%
Espoused Comment&Flooring Adhesives Must Haw<50gpl VDC&
❑ &MiNmum 15%d now Area
L
El b.Minimum 30%at DFloa Area _ 0.__ .. _.. __. .. '. . ..
F-1 c.Minimum 50%of Floor Area
0
❑ d.Mnimum Ta%dFloa Area —_
0 1
❑ 2 Themml Mass Floorr.Roof Covering Ocher than Carpet on 50%m More of Concrete Floors p 1
❑ 3.Fluorin Mees Section 01350 or CRI Green Label Plus Requirements(50%Mini mum 1 0 I Z
' ' Toll Availabgai Fluorin =7 0
M.APPLIANCES AND LIGHTING Points Available Per M&asura
1.nation Water and Enamels Effident Dishwasher
❑ a.ENERGY STAR(toll t pearl
❑
_ .._l.. .. . . .1 ... .. _ ..-.b.Dishwasher Uses No More Men 6.5 GenonsrC cls letal2 Dints �.0 i
2.Install ENERGY STAR Clothes Washing Machine with Water Factor of 6 or Lem
❑ &Meeh Energy Sem wM CFE Tw2 requirements(mod5ad energy lacta 2.q Weiss Fads 6.p)(mal3 points) 0 II�
❑ b.Mesh Energy Star and CEE Tar 3 requiremens(medfUld energy factor 22,Water Factor 4S a less) _ _.�.. _..-.1 p
- "' 2
PW 5points) p
3.Install ENERGY STAR Refrigerator
❑
A.ENERGY STAR Qualified&.25 Cubic Fast Capacity _0._.l_ I .
❑ b.ENERGY STAfl Ouayr6ad&c 20 Cultic Feet 0 -
I.Install BuilHn Recyclin Centro
❑ &BaI&-In Recycling Center 0
❑ b.BuliHn Cwnposting Cadet -
D I
N.OT2IER Total Avasable Pours in Appliances end U 'ng=12 0
❑ 1.Incorporate GreanPoim Rated Checklist in Bluaprinta-RegwPoints Available Per Measurered 0
❑ 2 Develop Homeowner Manual of Green FamunduSenefis D 1 3
1 1 1
• 3.Community Design Measures&Leal Priorities:Seg the Community Planning&Design section in Chapter4 of tha New Horne Guidalines for
measures.Mairmum of 2D points fmsuggass0 measures.Local requirements may also be listed here.
0 2007 Build It Green Single Family GniumPoint Checklist 2007 Version Pane 1 of 4
i
ENTER PROJECT NAME
IN
U
iiiiiim Enrer tleacrplmn hereantl enter proms ava0abla io meazure in.oproprate categories to the nghL _ _ 0
❑ Biter tlasttption here ane enter pomp evn0eda is measure m epprcpale raagoJes to the right __ 0 o 0 D 0 D
• Enim tlmng4on nae antl emm pom!walreole Int measure m appmprate cmegones to the night 0 0 I 0 D 0 -
❑ Enter tlescnpaon here antl anter poems BvaliffiIB fa measure in appropriate calegooestome right 0 0 D 0 11 0
4.Innovation:List Innovative measures that meet the green building objectives of the Guidelines.Ester up to a IBwld tt Graen Checklists and
maximum combined total of 20 pis.Sea Innovation Chacklist for suggested measures,using the link to the right (Guidelines
Li Innovation in eommun :Enter oeso¢aion her.and enter pgms Vessels fm measure in apprDI Cale ones to the ri hL D_ 0 0 0 0 0
___. .._:.. __ . ___. ._.. _._
Innovation m Energy:Enter tlescr'rylion here,and enter points eva0ama for measure In appropriate tate vies to the right. _ D 0 D 0 0 0
Lj Innwatlon In IAgA4eelM Enter descriphun here,and enter points available to measure in appropriate categories to the right. 0 0 0 0 0 0
Innwehon in pesoores%Entor dehem. ----
scnPhon end enter rib avalreble to measure m nate to tl!ri 0 0 D 0 0 0
Iwar"mWatt/Enter de - "— — -
_._____, amlphM bare endemer PGtlls aVaadal Ver mBa5lae N IIPP era Ca gw!ElomP ngM
- _,.
Tore!Avabole Points in Other=_ ._0
Total Available Points In Specific Categories' 1 4+ 96+ 42+ 1 66+ 43+
Minimum Points Required in Specific Cetogories 0 30 5 6 9
c e e B e e
1P!!j..tas not yet met tba fo[iovvtng recommended minimum requirements:
Total Project Score of At Least 50 Points
-Required measures:
-A32: 500/o waste diversion by weight
-32: I5%above Title 24
-.411:Incorporate GfeenPoint Ra.ed Checklist into blueprints
-Minim"m Points in sPeci5c ce:epoxies:
-Energy(30 points)
-1AQ/Hea1th (5 points)
-Resources(6 points)
-141a.er(9 points)
• 0
02007 Build It Green Single Fernily GreanPoint Checklist 2007 Version Page 4 of 4
Community Development
10300 Torre Avenue
vt. Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OJPERTINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE
GENERAL CONTRACTOR `F'AX•#
I am not using any subcontractor .
Signature Date
Please check applicable subcontra rs and complete the following ' ormation:
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
Ah Tile
Owner/Contractor Signature Date