08050040 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT -ONTRAC�TOR!INFORMATION
PERMIT NO.
BulTYWr MBRTAYW00D DR CUPERTINO PLUMBING 08050040
� OWNER'SNAME: PERMIT ISSUE DATE
16� HOM HARRY D AND ALICE N 1300 DELL AVE STE C 05/02/2008
)NE! SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
COPPER RE-PIPE/ WATER MAIN BLDG ELECT mum MECH
300 LICENSED CONTRACTOR'S DECLARATIONO O O
vd C 1 hereby affirm Nat I un licensed under provisions of Chapter 9(commencing Job Description
w with Section 7003)of Division 3 of the Business and Professions Code.and my licenser
in full farce and ciffat
Licavc ` 3
Cl � Lt.Y G 4505
e F p Dab Comte m PPs �
ARCHITECTS DECIARA OTI N v
1 ondenund my rims shall W used u puhlic record,
JyU
y o
Licensed professional
5 OWNER-BUILDER mDECLARATIONtit
C 0 0 1 hereby.Inco that 1 1. cumpt from Ne Commutes a:My c taw for the
O O following reason.(Section
](131.3,Business and .,do ov Code:Any city or county
S$'o which its issuance.
a permit re construct,Mealter.improve,do permit
t care a sig any structure
_b< prior inMet hili taic=dptaaonLua Meres lWvision of farsucMe Cohremi'm0ancre Ladsubment
ss NatWuliccvedpunuamblkpmvisiovo(theConus,mSLinemelaw(CMrter9 Sq.FL Floor Area Valuation
iF$ (eommeneing with Scction]000)of Division 3ofde Business and Prefeu ns Code)m
Q Nit he is eumpt Nemfsem and Ne bins for the alleged eumption.Any violation of
Section 7031.3 by any applicant for a permit subjects Ne applicut to•coil penalty of APN Number Occupancy Type
an,more Nan .ded da
fn bellart ass). Pane Y YP.
❑1.u owner of Ne property.m my employm with wage u Neb sole campensstion,
and do the wort and the she Conies ones Li dN ar Law
Mas
.1,(See.]ON,Budnm
and property
obu Cade:The C.bscmr, ndwho IoW does rot apply b rt owner of Required Inspections
ow.son who Wildaorirepbt suchat imn,andwho does such ime de or.05 adthrough his
ownemployees,provided Natumimpm mid
semnot ear ofcmpletioA ferule Owner.
Wilderr.Ne Wilding un imPrvvem inti said within one Wild ofcompletion,the poseof
Wilder will how the Wrdcn of proving Nat k did Out build n improve for Purpose of
sale.).
❑1.u mvrcr of the property am eulusiWIY contracting with Memse l mnuactan to
construct the project(Sec.70s4,Business and professions Code:)The Combiners U.
cc=law does not apply b an owner of progeny who Wilds Or improves d¢mon,and
wh tcomraces for such Projects with acomrscbr(s)licensed pursuant b the Conbacbh
Lin.low.
❑I am exempt under See ,a&P C for this rescan
Owner Data
WORKER'S COMPENSATONDECIARATON
1 hereby affirm under penalty of perjury On:of the fallowing declarations:
1 Niro and will maintain a Certificate of Covent to self-inure fm Women.Comyem
rather,an provided for by Section 3700 of Ne labor Code,for Ne performance of the
wortfor which this pamit is issued.
❑1 have and will mtimab WorkeYs Compensation Insurance,u saqumed by Section
370().f the lane
bor Code,for Ne perfomse of the wort forwhtch this permit is issued. '
My Wortee. promotion Itt cc cirri.and Policy number dc:
Gorier. 1�`^•r-`�.l�Policy No.:A 40,3 244 2—0
CERTIFICATE OF EXEMPTION FROMWO ERS'
COMPENSATION INSURANCE
Ins sad.lard mthe completed if Ne permit late.hundred dollars;(SIOO)
or loss)
I mrtify Not in the imlomanee of the wells fm which this permit is issued.I Mail not
employ any person in any manner an as b become subject in,the Worlbrs'Compensation
Laws of Califomia.Data
Applicant
NOTICE TO APPUCANT:If,after making this Certificate of Exemption.you sh.W
become subject le the Wohch Compensation provision,of de latter Code,you most
.J.Z forthwith comply with such providnv or this permit shall W deemed mated.
Z O CONSTRUCTION LENDING AGENCY
[-r Ihereby afnm Nat dere is a comuunion lending,cucy,for Maperformancc of
Q! Ne work for which this permit is issued(Sec.3097,Civ.C.)
A Landers Nuns
Loaders Address
()Q 1 certify Nat I have read this application and sub that Ne above Information is
lL carmcs I agree or comply with all city send county ordinarcn and sate laws rcbting b
_Q Wilding conswction.md herebyauNods bpescosom of Nis city to enter upon the
H CaWve-mentioned progeny far impaction purposes
(We),grtt b save,indemnify and keep hum4ss tie City of Coombs.against
fA liabilities,jadgm.ts,costs andexpcmes which may in any way u.ea&m.,said City
U Z in consgucme of Ne granting of this permit 2i---
"-' APPLICANT UNTIE S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
Re-roofs /
Si fAppliosn RO Data rJ
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willthea applicantorforum Wilding ac hart stareorand handle Me Health
u de.Sed by the Cupertino Municipal Code.Chapter 9.11,inti tie Health and Safety -
cade.semieaus3z(.)] All roofs shall be inspected nor to an roofing material beim
[I Yea �— P P Y g g installed.
Will thea Brant or btu.building oxo nt sae If a roof is installed without first obtainingan inspection,I agree to remove
PP g W equipmentar Mara which P g
t hvardnu air canumimnts u defined by the Bay Area Air Quality Management all new materials for inspection.
W strict?
pYn [7 a1J--
I hats mal the hdard.smabdaa roquimmcnls under Chapter6.95ofNe Califor-
nia Healdt&SafnyCcde,Secures 25505.25533 and 25534.1 undcusnd Natifthe Wilding
does not cumndW hate a insert Nat it es re vihility b notify the occupant of de
(Cgbw/hleT LL4 mel name of IGb afQN
_aS Signature of Applicant Date
Owner ed,gem Dow. All roof coverings to be Class'%g."or better
CITY OF CUPERTINO
. 5 ITEMS OF 5 PERMIT RECEIPT - OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: B1k: Lot:
APN . . . . . . . . : 31631014 . 00
DATE ISSUED. . . . . . . : 05/02/2008
RECEIPT #. . . . . . . . . : BS000004654
REFERENCE ID # . . . : 08050040
SITE ADDRESS . . . . . : 19850 BAYWOOD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HOM HARRY D AND ALICE N
ADDRESS . . . . . . . . . . : 19850 BAYWOOD DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2316
RECEIVED FROM . . . . : FRANK CARDIA
CONTRACTOR . . . . . . . : CARDIA, FRANK L LIC # 612
COMPANY . . . . . . . . . . : CUPERTINO PLUMBING
ADDRESS . . . . . . . . . . : 1300 DELL AVE STE C
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 253-0618
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- ------------- - ------- ------ -- -
1BPWSVCS WATER SERVICE 1 . 00 20 .40 0. 00 20 .40 0. 00
1BSEISMICR VALUATION 4, 000 . 00 0 .50 0. 00 0.50 0. 00
1PPERMITFE FLAT RATE 1:00 40.79 0. 00 40.79 0. 00
1PRREPIPE NO OF FIXTURE 8. 00 81. 60 0. 00 81. 60 0. 00
ITRAVDOC FLAT RATE 1. 00 40.79 0 . 00 40.79 0. 00
TOTAL PERMIT 184 . 08 0. 00 184 . 08 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 184 . 08 VISA
---------------
TOTAL RECEIPT 184 . 08
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----- -------------------------- -------- ----------------------------
301 ROUGH PLUMBING 507 FINAL PLUMBING
CITY OF CUPERTINO
' REPIPE/SEWERIMAIN SERVICE
• CUPEkTINO PERMIT APPLICATION FORM
APN # ' d/ ' Date:
V S- 2 = Ufj
Building Address:
/ 9 (95<:) (3z,- woocc
Owner's Name: V Phone#:
Contractor. Phone#:
Fax #:
Contact: V Phone#: 307_3q q
Fax #:
Contractor License#: 6;2 y q O 5
Cupertino Business License #:
Job Description:
Residential Er-- Commercial Q
Valuatiog• 14000
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.
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial P
1BSEISMICR Seismic Residential P
1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
[j 1PRREPIPE Residential re-pipe per fixture P 1RPRP
CIS 1BPWSVCS Water Service P 1CPWS or
l 1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS Gas Piping System 5+ Outlets P
1PPERMITTEE Plumbing Permit Fee Issuance P
1 PLMBLNCK Plumbing Plan Check P •
1PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel & Documentation Fee B
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
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
/� ( P
TOTAL POINTS 40 points
• O
P r19?
9
D
CD
G.O)
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;, IAO/Heafth
A.Site
1.Recycle Job Site Construction 8 Demolition Waste
65%=1 point;75%= 2 points;80%=4 points ' up to 4 Resource pts 0
12.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 8 Trees 1 Resource pt y=yes 0
6.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
B.Design Resou ce-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 1 1
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 pts0
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3,Insulate Foundation/Slab before backfill 3 Energy pts y=yes 0
EM 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 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.Use OSB — ----
a.Subfloors I 1 Resource pt y=yes 0
• b.Sheathing 1 Resource pt Y=Ye
s 0
1 1 1
xterwr rms
1.Use Sustainable Decking Materials
a.Recycled content 3 Resource pts y=yesF 0 •
b.FSC Certified Wood 3 Resource pts y=yes 0
2.Use Treated Wood That Does Not Contain Chromiurn/Arsenic 1 IAO/Health pt y=yes 0
3.Install House Wrap under Siding 1 IAO/Health pt y=yes 0
4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
1 1 1
E.Plumbing
1.Install Water Heater Jacket 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts y--yes 0
3.Retroft 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
4.Replace Toilest with Ultra-Low Flush T610
(1 point each,up to 3 pants) 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 IAO/Health pts. 0
8.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1
r-.trecurl
1.Install Compact Fluorescent Light Bulbs(CFCs)
(6 bulbs=2 points,10 bulbs=3 pants,12 bulbs=4 pants) 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 CFCs
(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 1 Energy pt y=yes 0
3.install Energy Star Refrigerator 1 Energy pt y=yes 0
4.Install Buil Recycling Center 3 Resource pts y=yes 0
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 Insulation with
No Added Formaldehyde 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).Ueiungs 4 Resource pts y=yes 0
1 1 1
INPUT Resources Energy; IAQIHIItP
Windows
1.Install Energy-Efficient Windows .I
. 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 0
1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on All Duct Joints _ _ --f 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
B.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 Burning Fireplaces .
• a.Install EPA certified wood stovesfinserts 1 IAQ/Health of 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 0
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 IS Energy pts 0
r_ __ 9 _ —� 1 Resource pt y=yes 0
6.Select Safe and Durable Roofin Materials
7 Install Radiant Barrier ----- 3 Energy pts y=yes p
I 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 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes p
1 1
. n oor a ua rty en 1ms es
1.Use Low/No-VOC Paint 1 IAQ/Health 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
7.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y=yes 0
8.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 3 IAO/He filth pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
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 Carpet with Low VOCs 4 Resource pts y=yes 0
1 1 1
Total Points Avalla e: - 140 130 57
Total Points Project R 1 0 0 0 •
G:datarprogslgmenbuildingguidelineshemodelersrgreenpointsfinal2.12.04pm1amedxis
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
*UPERTINO
Building Department
JOB ADDRESS: PERMIT #
wain fir .
OWNER'S NAME: PHONE # y[/G — 95-
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
'5�---'sign6ure, Date
Please check applicable subcontractors and complete 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