08050096 CITY OF CUPERTINO ��s,L� ezr'ra.>F'
BUILDING DIVISION' PERMIT COI�FTRt�-46RIN OI TIQNW�'
.6'esFs "% .„ �_c•1 u�_$,& s+Frs�' s��tx%^ _
BUI G DRESS: PERMIT NO.L�� WOODLARK WAY SAM PLUMBING CONSTRUCTION 08050096
ER'S NAME: ISSUE UE DATE
CROSBY RAYMOND W AND NANCY L 915 GREENWICH AVE 05/12/2008
PHONE. SANITARY NO. CONTROL NO.
(408) 396-8184
ARCH=/ENGINEER: BUILDING PERMIT INFO
BLDG EIFCT PLUMB MECH
wo0 LICENSEDCONfRACTORS DECLARATION Jpb Description
U a1 thereby of mon Nu 1 Am Ile mused under Provisions of Chapw 9(comImencing P
^Uwit Sd.7")of Division l ofte Budnw and Prokmiotu Code.and my license a CHG WATER HEATER
N in Nll forte and ettmry 3
G�Z license Clw _Cnd
^ Dec Ge
e
ARCHITECTS DECLARATION
t 1 underoanJ my Pev dull W used as public records
DyUF.
kpN
Licensed Professional
OWNER-BUILDER m Co Contractor's
ON
Z O y I erobY affires Nat 1 1. esompt from Ne sionsC L eenx law for the
ZOO following m.=m(Salon 701.5.Buaiass and Professions Cafe:MY city m county
$ which its acquires a promo re restful.
em.alar.tmpmw,demolh permit t or repair my swctam
z i Prior a its concede,also ro to tho tW applicant for such permit m 0k asigmrd suuumt
�0
(deal commencing
Srmu.nt tato of Division
of teConuacmrsnd Profsson(Ch-Pum 9ode)or Sq.Ft. Floor Area Valuation
than a is exa wit Smuon 10nd of Dtveiof 1 th Al ege lass vM Prafwi vi Cade)or $450
'd 9 Sec io u ese5 b Any RPpII and da:bur for the alleged PPIkepon.Any riotsuon of
Section 1Dns by am•vplicmut ism a permit=bjeets tc.Pplkmut he a assn penalty Of
nm orae dufve hundred dolWs(5500). 36203027At Occupancy TyPeumer
❑I,u awwor of Je property,or mY moploycu wit wage u Less=le cmnpewJm,
and Prodors Code:
he Comforts Lice.
coot
to An BYLnw
and Rty he u Code:The Conmmors Liwve Isw does et appy f tower of Required Inspections
Propertywhobuilds i ireprosesch improvement
who Areasuchwokhimselfnd through he
awn employers,provided Wtsahimps Wdwitimns eu:MedmoOemd the manor.
haaewr,to Are to or improvementproving sold a did et Yar of completion,themanor.
of
Ask.). will haw Ju burden of pursing tat a did ret build or improve for purpose of
ark.).
❑1.u aware a tc Property,w esclusively conuaming wit licteued mnu smarm as
co muct the pmjecm(Sec.1044.Business and Professions Code:)The Contractor's U.
cause Law does not apply to An awes of Property who Wilds or bnpvws Lemon.me
who contracts for such projects wit a mnusctor(s)licensed punumut us to Contractors
License Law.
❑Iameaemptuntler Sec ,Bh PCfortismason
Dam
WORKER'S COMPENSATION DECLARATION
1 barely aware under peaky of Perjury,arm of to following declwioner
I have and will maintain a CcrJOwle of Covent to self-Insert fm Workers Compere
smi as provided for by Section 3700 or to Labor Code,for to perfor mss of the
wars for which tis permit is ivad. -
yf 1 have,and will maintain Workers Compensator Insurance,as required by Savo^
11o0of dte Labor Code,for to performance ofte work for which this Permit is issued. '
My Workers Compowmn Luumce wrrica and Policy number ere:
Cartier. Poll,No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(The scnion wood rot W complead time pemir a faaa humle ddoll.(SIM)
or Mss.)
1 cu ify that in to performance of to wank for which tis Permit is issued.I shall nm
employ my person in any manner=As at become subject to dm Worker'CompenvJm
Laws Of California.QLu • ilk
NOTICE TOct C NP.1, ismaking ''
llninwte of P emp0an,you should
.,Oassume subject it Workers Compcukhis Provisions of to need Codeyou=tut
forthwith comply with such Provisions or to pevntl shall W Mcmed mated.
.Zi 7 CONSTRUCTION LENDING AGENCY
[-n.�. 1 hereby am.to Cert is A construction lendingfar Jte
orthis Agency, performance of
to wt for which
permit a iuwod(Sec.]097,Civ.C.) ,
WM Q Lsnderl Name
�,Z f<ndeh Addmu .
U O 1 Conry t.t I have rand this application and sate to to above inramamim I. -
D.;" reran 1 Agra t comply wit all city and county mJlnan¢s and sou laws relating eb
O SV-: building convection,and Wmby mutation rtprumtatives oftu city t mer upon to
,here-mcntiowod property for inspection purpams
(We)Agree to saw.indemnify,and kmp homlw the City of Cupertino against
r/f Ilabilities,JWgmcou.cnu
And eaPews which may in any way Amro altuaRsaid City
U Z in.muctiucow of to grating or ti.permlL ! r-
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATION /
'1l 4yi-s-/Oc� -Re-roofs /Q�r
gesture of HwHAZAItDOU S MATERIALS DISCLOSURE Dau
Type Of ROOF
Will Ne applicant or(mum holding Co e,Chapter
arae mend t hmrdan material
dellad by the Cupertino Municipal Code.ChaPrcr 9.13,and to Health and Safety
.
Sec ..zss12(a)7 a No All roofs shall be inspected prior to any roofing material being installed.
Will to applicant or foram Wilding occupant use equipmcnt at device.which If a roof is installed without first obtaining an inspection,I agree to remove
arni ha Tvdnv air cmumem=ta u dcrnod by to Bay Area Air Quality M=ACcom.l all new materials for inspection.
DiAtri ❑Yw C]No
I have read to hecardau materiae mquimmcnu under Chapter 695 of tc Califor.
rte Halt StSafaYCudc,Savoy 25505.25511 ara1255XI untested to tfuse Wilding f7 L
donrose
dons Out currently heA rrwmeo dit a my maporoubtty=entry the nommen=of tc �-
mquiremoms which most be met prior t issuance of a ConlOcam 01 o Pavy. Signature gApplicant Date
Owner or...bmi.d.gwm Date All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT' OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . : 36203027 . 00
DATE ISSUED. . . . . . . : 05/12/2008
RECEIPT # . . . . . . . . . : BS000004737
REFERENCE ID # . . . : 08050096-
SITE ADDRESS . . . . . : 7989 WOODLARK WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER CROSBY RAYMOND W AND NANCY L T
ADDRESS . . . . . . . . . . : 7989 WOODLARK WY
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4936
RECEIVED FROM . . . . : EUNG SAM SEOK
CONTRACTOR . . . . . . . : EUNG SAM SEOK LIC # 23680
COMPANY SAM PLUMBING CONSTRUCTION
ADDRESS . . . . . . . . . . : 915 GREENWICH AVE
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94087
• TELEPHONE . . . . . . . . : (408) 396-8184
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 450 . 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
ITRAVDOC 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
---------------- --------------- --------------------
CASH 106. 56
---------------
TOTAL RECEIPT 106. 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
CITY OF CUPERTINO
!Sul - WATER HEATER
Of
CUPERTINO PERMIT APPLICATION FORM
APN # U Date:
Building Address:
7yS 9 wood ,Lakk wmy C,k eY,+Wo CA . %s-o / zl-
Owner's Name: Phone #:
C )-OSL, nanc
Contractor: m P I U>�b i n es Phone #: (� oQ)—,W-0S
,E,117t�AYYI Sl:G k 1 Fax #:
Cupertino 8usiness License #: Contractor State License #:
Contact: Phone #:
Fax #:
Building Permit Info:
Bldg ❑ Elect P�� Plumb Mech
Residential M Commercial ❑
Job Description:
'77 a k 2A�
Strapped ❑ On Platform E� Bonded New Location ❑ Replacement [�
Valuation:
b , iw
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.
Green Building Points achieved:
SCITY OF CUPERTINO
WATER HEATER •
CUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BSEISMICOM Seismic Commercial B
1 PRWHEATR Residential Water B PRWHEATR
/ HeaterNent
/ 1BSEISMICRE Seismic Residential B
1PPERMITFEE Plumbing Permit P •
1TRAVDOC Travel & B
Documentation
1BUSLIC 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
a. r�
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/Spec. A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
WRIMIMM TOTAL POINTS1 40 points
0
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.Site
1.Recycle Job Site Construction&Demolition Waste i
65%=1 point;75%= 2 points;B0%=4 points up to 4 Resource pts 0
2.Salvage Reusable Building Materials 7 4 Resource pts y--yes V 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 Stonnwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
B.Design Resource-Ecient 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 D
1 1 I
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 up to 5 Resource pts 0
2.Use Recycled Content Aggregate "Energy
y=yes 0
3.Insulate Foundation Slab before backfill y=yes 0
1 1 1
C.Structural Frame
11.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 I-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
B.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.Use0S8 ----- ----`------
• a.Subfloors
1 Resource pt y=yes 0
b.Sheathing
1 Resource pt y=yes 0
INPUT ReSDurces Energy 1ADIHealth
Extenor mu;ki
,1.Use Sustainable Decking Materials •
a.Recycled content 3.Resource pts y--yes 0
lb.FSC Certified Wood 3 Resource pts y--yes 0
2.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health pt y=yes 0
3.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
1 1 1
E.Plumbing
F.Install Water Heater Jacket _ _� 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
f3.Retrofit all Faucets and Showerheads with Flow Reducers
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0
14.Replace Toilest with Ultra-Low Flush Toilets 1
I(1 point each,up to 3 points) _ 'J Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAQ/Health pt y=yes 0
6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0
B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
t-.tiecmcai
f 1.Install Compact Fluorescent Light Bulbs(CFLs) •
,(6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) Up to 4 Energy pts. 0
2.Install IC-AT Recessed Fixtures with CFLs(1 point each,up to
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
(1 point each,up to 4 points) Up to 4 Energy pts. 0
1 1 1
G.Appliances
(1.Install Energy Star Dishwasher 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy
Conservation Features I 1 Energy pt y=yes 0
13.lnstall Energy Star Refrigerator 1 Energy pt y=yes 0
4.Install Built-In Recycling Center � 3 Resource pts y=yes 0
1 1 1
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
3 Install Recycled-Content,Fiberglass ksulition with
No Added Formaldehyde 1 3 IAQ/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5.Use Cellulose Insulation
a.Walls 4 Resource pts y=yes 0 •
b.Ceilings 4 Resource pts y=yes 0
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
I).uenings 4 Resource pts y=yes 0
1 1
INPUT Resources Energy IAO/Healt"
I. rn ows
i1.Install Energy-Efficient Windows
a.Double-Paned 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
L c.Low.Conductivity Frames _ _ 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
ruse Duct Mastic on All Duct Joints - ;_J 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 2 IAQ/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 IAQ/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 Buming Fireplaces
a.Install EPA certified wood stoveslnserts 1 IAQ/Health pt y=yes 0
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.Install High Efficiency Filter 4 IAQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/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 0
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,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0
6.Select Safe and Durable Roofing Materials i—� 1 Resource
--— -- — — -- Pt Y=Yes ""I'7.Install Radiant Barrier 3 Energy pts Y='a'
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 0
• 1 1 1 '
— INPUT Resources Energy IAQ/Heat
indoor Au ua rty and Fnishes
1.Use-LOVIAN10-40C Paint _ i 1 IAOMealth pts y=yes 0 •
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives _ 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
j.Seal all Exposed Particleboard or MDF - _ J 4 IAO/Health pts y=yes 0
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 31AQ/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
C--2.Use Rapidly Renewable Flooring Materials 7 4 Resource pts y=yes 0
- ---
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes D
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5,Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpel with Low VOCs 4 Resource pts y=yes 0
1 1
Total Points Available: 6 140 130 57 •
Total Points Project Received: 1 01 01 0
G:datalprogs/greenbuildmgguidelineslremodelerslgreenpointsfinal2.12.04prolected.xls
•
L
a;,. Community Development
10300 Torre Avenue
A Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building De artment
JOB ADDRESS: CA �_O /If PERMIT #
OWNER'S NAME: c S n >7 C PHONE #
GENERAL CONTRACTOR: FFAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
RI 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 (J
Own Contractor Signature Date