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080600060 z Z Ver.) Q oz UO_ OF U C �z CITY OF CUPERTINO a c,. a.�:�:, �x ""` -'�:i° TOR AN - BUILDING DIVISION PERMIT WCON TRA BUILDING ADDRESS: FE Aal l NO. 1.8650 RUNO CT MORRIS MANDEL 08060006 OWNER'S NAME: PERMIT`ISSUE DATE MORRIS MANDEL 18650 RUNO CT 06/02/2008 NE: SANITARY NO. CONTROL NO. ARCHREC MNGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECN LICENSED CONTRACTOR'S DECLARATION l Job Description P 1 Wmby affirm Nal 1 am licensed under prawmas of Chapter 9 (commencing with Section 70)0) of Division 3 Afdm Busiasa and Proficestlov Code, and my license is INSTL NEW A/C UNIT in full farce and cffnet. License Clan Lic.It DAM Contractor ARCHITECTS DECLARATION I undersand my plans shal W used as public retards Liccmed Pmfcapansl OWNER -BUILDER DECLARATION 1 hereby affirm that i am eumpl from the Contractor's License law for Me following mourn, (Section 7031.5. Business and Pmfossiov Code: Any city or county which mquims A permit An conWnes, User. improw, dcmoiiah, At ml any swctum prior m its issuance. also Acquires the applicant for well permit o file a signed women, is licensed N the the Contactors U.. law(Chapter 9Sq. F1.Floor Area Valuation One W pursuant pmvlsinm of 2 0 0 0 (commencing with Section 7001)) of Division 3 of On BusineaaAnd Professions Code) or $ Oat he is exempt therefrom and Mon bus for the alleged ecempdon. My violation of Number Occupancy P Y Type Schon 7031.5 by airy applicant for a permit wbjccu the applicant An a civil penalty of trot more than Am hundred dmam(35001. 37525030. I, As owner of the pmpnmy, or my employes with wages As their sok compewdon, Required Inspections will do the work. and the swmum is not intended woffered for solo (Sm. 7014. Business And Plefesdau Code The CWmashoYs Lmohm Law dors trot apply in An ca nrr of .. Property who Wildaorimprovulhereon, andwho doessuchwork Mora lfm through his Own employers, provided that such improvements Am not intended Araffemd tarsale. if, howevv. Ne building or improvement a sWd within arc yev A(campktion. to. eowner- Wilder Guilder will have the burden of proving Nat be did not build or improve for purpose of sale.). 1. As owner of the property, am eaelusiwly convecting with licensed conlsseras N co otwel the pmjm (Sec. 7014. Bvinm AM Professions Code) The Commences Li. , term law does not apply to an owns of property who Wilds or improves thereon. and who cenvects for such projects with A contractortU licensed purmam m rite Consaetaes' License law. ❑l Am eaempl senders, ,B&PC for moan Owner ./ . �� Due r �. !O DECI.hRAT10N 1 hereby allow under penalty of perjury arc of the following derlaratiormp i have and will maintain Ceni37W of Covent fa Warrma Comite sation, u provided for a r Code, Section 3700 of the labor Code, for Ne Performance of the wart for which this permit is Issued. mi ❑ f have and will maintain Worker's Compensation Insurance, As mquinnI by Section 3700 of the labor Cade, for On performance of the work for which this permit is issued. My Worker's Compensation hswsance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EKEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need net becomplead if the Permit is foront, hundred dollars ($101) or toss.) I «nifv that in Ne N thirdureN work forwhich Nis pormit u issued. I "I nm employ any pmspninTny manner wttene b' tI. Warkeri Cmnpevation laws of ' omia. Dam Applicant NOTICE TO APPLICANT: IL after making NuCenifteau o minion, ou should become wbincn m On WortcrS CAmpcwtion p ' 'ons of the labor Coder, you coup forthwith comply with such provisions or this permit shell be dcemM mnkcd. CONSTRUCTION LENDING AGENCY 1 hereby since Nu them sea conaoselion londing agency for On performance Of On, work for which this Permit is intend (Sec. 3097, Civ. C.) Lender's Name - Undoes Address I ratify Nal I have read this application and sum Nu the abaw infoimmun is cadent I agree An empty with illd All city and county chimanem aM main I. misting m Wilding construction. and hereby mthadae mrsommativel of Nis city An emer upon On slmvo-mcMoued progeny for i.,Md W perm em, (We) agree no save, indemnify and keep harmless the City of Cupertino against liabilities. JMgmena, costs and espevu which may in any way acme against said City in comic uenoo of the growing of Nis permit APPLICAtDF-UNKRSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE1OU 5. Re-roofs A Signuure of Applian ontnctor Dan, HAZARDOUS MATERIALS DISCLOSURE Type of Roof Win the applicant or fumm Wilding acepaot nom or handle hasasdov material As defined by the Cupertino Municipal Code. Chapter 9.13, and On Health and Safety Cale. oY. 35513(x)? / All roofs shall be inspected prior to any roofing material being installed. Will thea applicant or future Wilding Accu ant u nt or devices which pP 6 p ren If a roof is installed without first obtainingan inspection, I agree to remove P gr cmil harardoua All conuminanu�uAil by Ne Bay Ama Air Quality Man agcmcnt all new materials for inspection. /ticfinctl David? ❑Yes G.4+rO 1 have mad the hvatdau materials requirements under Chapur6.95 oftW Califor- nlaHealM& Safety Cade. Sections 35505.25533 Ail I undersand Nnif the Wilding Jou nel cumpi" L dal it a in esihility notify do Ac .Mt of On mqui whichmuphe priarmiss of ¢ser 0, pancy. (J �y Signature of Applicant Date Q All roof coverings to be Class 'W' or better Ownclerauthontedagent 1, Dam • 6 ITEMS OF 6 r 1 L I • CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37525030.00 DATE ISSUED.......: 06/02/2008 RECEIPT #.........: BS000004961 REFERENCE ID # ...: 08060006 SITE ADDRESS .....: 18650 RUNO CT SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: MORRIS MANDEL ADDRESS ..........: 18650 RUNO CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: MORRIS D MANDEL CONTRACTOR .......: LIC # *OWNER* COMPANY ..........: MORRIS MANDEL ADDRESS 18650RUNO-CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 TELEPHONE ........: OPERATOR: patg COPY # : 1 FEE ID ---------- UNIT ------------- QUANTITY ---------- AMOUNT PD -TO -DT THIS REC NEW BAL 1BSEISMICR VALUATION 2,000.00 ---------- 0.50 ---------- 0.00 ---------- 0.50 ---------- 0.00 1EPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 IMPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1MRRAA UNITS 1.00 61.19 0.00 61.19 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 224.85 ---------- 0.00 ---------- 224.85 ---------- 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 224.85 --------------- 224.85 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- FINAL PLUMBING oslo(o 000(0 CITY OF CUPERTINO FURNACE/AC OF •CUPEkTINO PERMIT APPLICATION FORM APN #& 5-;,� 0 3 0 cSZ� Date: Building Address: /-06 ro /QvNc 95 o�y Owner's Name: Phone #: �/orz Fzir /t7,4 Al D EL Flo g- 2s -s --s g o 5 - Contractor: Phone #: Fax #: Contractor License #: Cupertino Business License #: MIA -- Contact: Phone #: Fax #: Building Permit Info: Elect B' Plumb ❑- Mech -E Residential Commercial Job Description: For Residential Installattiions: Attic ❑ I" floor 2"d floor ❑ Adhere to minimum setback requirement For Commercial Installations: / q Replacement �/ same weight ❑ / C Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: TypeofConstruction (Usage Class): Strapped On Platform LJ Bonded New LocationE Replacement 1 Valuation: 72-000 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. CITY OF CUPERTINO 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. I 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. 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets I BPGAS For each gas piping system of 5 or P more per outlet. IMCAPPVNT Commercial for the install/relocate/ or M replacement of ea appliance vent installed & not incl in an appliance permit_ IBSEISMICO 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. IMRAPPVNT Residential for the install/relocate/ or M replacement of ea appliance vent install &not incl in an appl permit. • 1J CITY OF CUPERTINO C.. FURNACE/AC CITY40CUPEI�TINO FEE SCHEDULE 41 E Quantity Fee ID Fee Description Fee Group Permit Type FURNACE TURN/AC 1 PGASRES Residential for ea gas piping system of 1-4 Outlets P 1BPGAS For each gas piping system of 5 or more per outlet. P 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst <=100k BTU install or relocate ea forced-air/gravity type fumace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h M 1MFRN>100 Furnace Syst> 100k BTU install or relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h M 1 EPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business License B S CITY Or CUPERTINO CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type AIR CONDITIONING FURN/AC 1 BCAIRHAN Commercial A/C Units <= l Ok CFM B 1MCRAA Commercial Mech Repair/alt/add M 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System 1-4 outlets P 1 PGASRES Residential for ea gas piping system of 1-4 Outlets P 1BPGAS For each gas piping system of 5 or more per outlet. Comm/Resid P 1BREMAIRHAN Residential A/C units <= IOk CFM B 1MRRAA Residential Mech Repair/alt/add M 113SEISMICR Seismic Residential B I IEPERMITFEE Electric Permit E / 1MPERMITFEE Mechanical Permit M 1PPERMITFEE Plumbing Permit P I 1TRAVD0C Travel Documentation B 1BUSLIC Business License B • 0 0 • C Plan Review Process Work Book Page -12-Revised 3/25/08 t~M 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 2 points 11. Permeable Paving, Note L-1 2 points C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points D. Structural 3. Uses Wood I -Joist, (See Spec.) S-2 2 points 5. Use Truss with heels, (detail) S-2 2 points 6. B. OSB Sheathing, detail S-2 2 points 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/S ec. A-3 1 point P. Other 1. List Green Features on Plans A-1 1 point TOTAL POINTS1 40 points C Plan Review Process Work Book Page -12-Revised 3/25/08 t~M 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. 1. Recycle Job Site Construction & Demolition Waste 65%= 1 point; 75%= 2 points; 80%= 4 points - I2. Salvage Reusable Building Materials 3. Remodel for Mixed Use, Adaptive Reuse, and Historic Preservation 4. Protect Native Soil 5. Minimize Disruption of Existing Plants & Trees 6. Implement Construction Site Stormwater Practices 7. Protect Water Quality with Landscape Design 8. Design Resource -Efficient Landscapes and Gardens —� J 9, Reuse Matenals[Use Recycled Content Materials for Landscape Areas 10. Install High -Efficiency Inigation Systems 11. Provide for On -Site Water Catchment / Retention B. Foundation 1. Incorporate Recycled Flyash in Concrete • 25% Recycled Flyash = 2 points; Add 1 point for every 10% increase of flyash, up to 5 points 2. Use Recycled Content Aggregate 3. Insulate Foundation/Slab before backfill C. Structural Frame [Substitute Solid Sawn Lumber with Engineered Lumber 2. Use FSC Certified Wood for framing (For every 10% of FSC lumber used = 2 points, up to 10) 3. Use Wood I -Joists for Floors and Ceilings 4, Use Web Floor Trusses 5. Design Energy Heels on Trusses 6° or more 6. Use Finger -Jointed Studs for Vertical Applications 7. Use Engineered Studs for Vertical Applications B. Use Recycled Content Steel Studs for Interior Framing 9. Use Structural Insulated Panels (SIPS) a. Floors b. Wall c. Root 10. Apply Advanced Framing Techniques 11. Use Reclaimed Lumber for Non Structural Applications !12.Use0SB------------------1 I a. Subtloors . b. Sheathing up to 4 Resource 4 Resource pts y= 4 Resource pts y=yes 2 Resource pts y=yes 1 Resource pt y=yes 2 Resource pts y=yes 2 Resource pts y=yes 4 Resource pts y=yes 2 Resource pts 2 Resource pts 2 Resource pts up to 5 Resource 2 Resource pts y- 3 Energy pts y 3 Resource pts y=yes up to 10 Resource pts. 2 Resource pts y=yes 2 Resource pts y=yes 2 Energy pts y=yes 2 Resource pts y=yes 2 Resource pts y=yes 2 Resource pts y=yes 3 Energy pts 3 Energy pts 3 Energy pts 4 Resource pts 3 Resource pts 1 Resource pt y=yes 1 Resource pt y=yes it. Use Susiaineble Decking Materials 1. Install Water Heater Jacket _ __ 1 Energy of y=yes 2. Insulate Hot and Cold Water Pipes 2 Energy pts y=yes a. Recycled content j 3. Resource pts y --yes 0 b. Showerheads (1 point each, up to 2 points) 1 • b. FSC Certified Wood 3 Resource pts y --yes 0 5. Install Chlorine Filter on Showerhead 1 IAQMealth pt y=yes 2. Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health pt y=yes 0 Up to 4 IAQ/Heallh pts, 3. Install House Wrap under Siding 1 AQ/Health pt y=yes 0 4. Use Fiber -Cement Siding Materials 1 Resource pt y --yes 0 0 E. Plumbing 1. Install Water Heater Jacket _ __ 1 Energy of y=yes 2. Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 3. Retrofit all Faucets and Showerheads with Flow Reducers Up to 5 Energy pts. 0 a. Faucets (1 point each, up to 2 points) I Up to 2 Resource pts. b. Showerheads (1 point each, up to 2 points) 1 Up to 2 Resource pts. 4. Replace Toilest with Ultra -Low Flush Toilets ` Up to 4 Energy pts. 0 (1 point each, up to 3 points) _ _ _� Up to 3 Resource pts. 5. Install Chlorine Filter on Showerhead 1 IAQMealth pt y=yes 6. Convert Gas to Tankless Water Heater 4 Energy pts y=yes 7. Install Water Filtration Units at Faucets (2 points each, up to 4 points) Up to 4 IAQ/Heallh pts, B. Install On -Demand Hol Water Circulation Pump 4 Resource pts y=yes r. oecmcai 1. Install Compact Fluorescent Light Bulbs (CFLs) 1. Install Energy Star Dishwasher (6 bulbs=2 points, 10 bulbs =3 points, 12 bulbs = 4 points) J 2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to Up to 4 Energy pts. 0 • 5 points) Up to 5 Energy pts. 0 3. Install Lighting Controls (1 point per fixture, up to 4 points) Up to 4 Energy pts. 0 4. Install High Efficiency Ceiling.Fans with CFLs y=yes (1 point each, up to 4 points) Up to 4 Energy pts. 0 G. Appliances 1. Install Energy Star Dishwasher 1 Energy pt y=yes 2. Install Washing Machine with Water and Energy a. Walls 2 Energy pts y=yes Conservation Features 1 Energy pt y=yes �3.Install Energy Star Refrigerator 1 Energy pt i y=yes 4. Install Built -In Recycling Center 3 Resource pts y=yes H. Insulation 1. Upgrade Insulation to Exceed Title 24 Requirements a. Walls 2 Energy pts y=yes 0 b. Ceilings 2 Energy pts y=yes 0 2. Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0 13 Install Recycled,Content, Fiberglass Insulation with —j Lo Added Fomraldehyde J 31AQ/Health pts y=yes 0 _ 4, Use Anced Infiltration Reduction Practices 2 Energy pts y=yes dva 0 5, Use Cellulose Insulation a. Walls 4 Resource pts y=yes 4 b. Ceilings 4 Resource pts y=yes 0 • 6. Alternative Insulation Products (Cotton, spray -foam) a. Walls 4 Resource pts y=yes 0 b. Cemngs 4 Resource pts y=yes 4 • 1. Install Energy -Efficient Windows a. Double -Paned 1 Energy pt b. Low -Emissivity (Low -E) (1. Use Ducn MMastic on All Duct Joints 2 Energy pts c. Low. Conductivity Frames 2 Install Ductwork within Conditioned Space 2 Energy pts 2. Install Low Heat Transmission Glazing 1 Enerov of (h eating Ventilation and Air Conditioning 2 Energy pts y=yes (1. Use Ducn MMastic on All Duct Joints I 2 Energy pts y=yes 2 Install Ductwork within Conditioned Space 3 Energy pts y --yes 3. Vent Range Hood to the Outside 1 IAO/Health pt y=yes 4. Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 5. Install Solar Attic Fan 2 Energy pts Y --yes 6. Install Attic Ventilation Systems 1 Energy pt y=yes 7. Install Whole House Fan 4 Energy pts y=yes 8. Install Sealed Combustion Units a. Furnaces .3 IAQ/Health pts y=yes b. Water Heaters 3 IAQ/Health pts y=yes 9. Replace Wall -Mounted Electric and Gas Heaters with Through -the -Wall Heat Pumps 3 Energy pts y=yes 10. Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes ✓ 11. Install AC with Non -HCFC Refrigerants 2 Resource pts y=yes 12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace 2 Energy pts y=yes • 13. Retrofit Wood Burning Fireplaces a. Install EPA certified wood stoveslnserts ' 1 IAQ/Health pt y=yes b. Install/Replace Dampers 1 Energy pt y=yes c. Install Airtight Doors 1 Energy pt y=yes 14. Install Zoned, Hydronic Radiant Heating 3 Energy pis y=yes ✓ 15. Install High Efficiency Filter 4 IAQ/Health pts y=yes 16. Install Heat Recovery Ventilation Unit (HRV) 51AQ/Health pts y=yes 17. Install Separate Garage Exhaust Fan 3 IAQ/Health pts v=ves K. Renewable Energy and Roofing 1. Pre -Plumb for Solar Water Heating 4 Energy pts 2. Install Solar Water Heating System 10 Energy pts 3. Pre -Wire for Future Photovoltaic (PV) Installation 4 Energy pts 41nstalhPhoovol5iy PV) ysem " --I,- (1 .2 - (1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw =18 points) Up to 18 Energy pts f6_. -Selects afe and Durablele Roofng Materials -- " -- 1 Resource pt y=yes 7.Install Radiant Barrier 3 Energy pts y=yes L. Natural Heating and Cooling 1. Incorporate Passive Solar Heating 5 Energy pts y=yes 2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes 3. Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes �1_ Use Low/No_VOC Paint ___ -_ __ _ _ j 1 IAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes Lse Low/NoVOC Adhesives . 3 IAQ/Health pts y=yes 4. Use Salvaged Materials for Interio.r Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for interior Uses 1 IAQ/Health pts y=yes 7. Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 0 0 1. Select FSC Certified Wood Flooring 0 0 0 0 0 0 • 2. Use Rapidly Renewable Flooring Materia -1-s' 4 Resource pts y=yes 3: Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts 0 N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y=yes 2. Use Rapidly Renewable Flooring Materia -1-s' 4 Resource pts y=yes 3: Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y --yes Total Points AValla e: 1 1401 1301 57 Total Points Project Received: 1 01 0 0 • G:datalprogsrgreenbuildingguidelines remodelerslgreenpointsfinal2.12.04pmtected.xls 1r u .. OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: • A.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 v ✓ - G C � • 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 (revers Property Owner's Signature: Date: Job Address: Permit # Any hanges to the information provided on this form shall be submitted to the City of Cupertino Build • Department. s ' City of Cupertino Building Department• @ CITY OF 10300 Torre Avenue C U P E n J I N ® 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 LJ 1 , Community Development e 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 ISUPEkTINO Building Department ,1* I am not using any subcontractors: 4% 2 -4V� Signature Date Please check applicable subcontractors and complete the following information: JOB ADDRESS: �s6Co iz,no cl,�- PERMIT # 00600 BUSINESS LICENSE # OWNER'S NAME: 4 4 PHONE # 2s"l" _,r?O-F GENERAL CONTRACTOR: � FAX # ,1* I am not using any subcontractors: 4% 2 -4V� 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