08070127 (2) •
CITY OF C.UPERTINO 4 gxx zrar a+ „ ?:S,r uA -0' t/M " z ' .
BUILDING DIVISION PERMIT CONRACTOR$ 04ATION:
, T
BUILDING ADDRESS: PERMIT NO.
7640 BERLAND CT TOM & LYDIA HALCIN 08070127 -
OWNER'S NAME: - • - ' ' PERMIT ISSUE DATE
TOM & LYDIA HALCIN 7640 BERLAND CT 07/17/2008
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
x00 LICENSED CONTRACTOR'S DECLARATION O O O C
mi1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
< withSection7C00)ofDivision3oftheBusinessandProfessionsCode,andmylicenseis INSTL 1 ADDTL ELECTRCL OUTLT ON WALL ABV FIREPLC
< in fun force and effect.
n.
j y',33, License Class Lie.a
n F, Date Contractor
Q ARCHITECTS DECLARATION
WV I understand my plans shall be used as public records
t.6.• Licensed Professional .
`a3 OWNER-BUILDER DECLARATION
<I I hereby affirm that I am exempt from the Contractors License Law for the
-o o following mason(Section 70313.Business and Professions Code:Any city or county
2 M which requires a permit to construct.alter,improve,demolish.or repair any suumum .
_i y prior to its issuance.alsorequires the applicant for such permit to file a signed statement
▪�,1 Section that he is licensed pursuant to the provisions of the Contractors License Law(Chapter9 Sq.Ft. Floor Area $10 Valuation
(commencing with 7000)of Division 3 of the Business and Professions Code)or
$ that he is exempt therefrom and the basis for the alleged exemption Any violation of
Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of Number Occupancy mom Na five hundred dollars(1500). 36225039 :Meg' Pane Y T yPe
Las owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure Is not mended of offered forale(Sec.7044.Business .
and Professions Code:The Contractors License Law does not apply to an owner of . Required Inspections
property who builds or improves thereon,and who ekes such work himself or through his
own employees-provided that such improvements are not intended or offered for sale IL .
however,the building or improvement is sold within one year of cmnpledoo.the owors-
builder will have the burden of proving that he did not build or improve for purpose of
ale.). •
cl I.as owner of the property,w excuactmto
lusively contracting with licensed cons
nsbuct the project(Sec.7044,Business and Professions Code:)The Contractors Li.
cense Law does not apply man owner of property who builds or improves thereon,and
who contracts for such projects with a conuacmris)licensed pursuant to the Contractors
License Law.
❑lam exempt un Sec. � ,B 8 PPCC for this reason
Owner U/ '�" .tb'[/ Dae Jf-1 7-0[T -
WORKER'S COMPENSATION DECLARATIO
busby affirm under penalty of perjury one of the following declarations
wi I have and will maintain a Certificate of Consent to self-insure for WorkersCompen.
salon,as provided for by Section 37W of the Labor Code,for the performance of the .
work for which this omen is issued.
❑I have and will maintain Worker's Compensation Insurance.as required by Section
37W of the Labor Code.for the performaoce of the work for which this permit is issued. • '
My Workers Compensation Insurance carrier and Policy number ver: .
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE
•
rads section need not be completed If the permit Is for one hundred dollars(3100)
or lest)
I certify that in the performance of the work for which this permit is issued.I shall no
employ any person in an ryannum as to•-„. subject to the Workers'Compensation
Laws of Califo
Applicant da
e ... -/in.
NOTICE TO APPLICANT:If.after making this Cenificate of minion,you should -
become subject to the Workers Compensation provisions of the Labor Codeyou must
.J Z forthwith comply with such provisions or this permit shall he deemed revoked.
'z pct CONSTRUCTION LENDING AGENCY
[-tI herebyaffirm N
at there is a construction lending agency for the performs=of
IN•mthe work fur which this permit Is issued(Sec.3097.CM C.)
W Q Lenders Name
7Z Lenders Address .
U O I certify that I have read this application and state that the above infomution is .
D. (, correct,I agree to comply with all city and county ordinances and state laws gelating to -
O ndsebuildin�d�tiro,end hereby [tion p representatives sof this city to cater upon the
W a property for empmNan purposes.
gy (lder)agree to assts indemnify and keep harmless the City accrue
agairuna againstCity ��
y in coisequneofh,granting cahnxesm itch may in any way acrnesgaimtsud City
U z incoaegmercerfthe granting of A permit,
v. APPLICANT ERSTANDS AND WIL COMELY WITH ALL NON-POINT Issued by: o- Ice 4119) Date'7-f 7 -" >
SOUROER G ATIONS. Ly % /-/7-0
Signature of ApplicanuConeesctor - Dale Re-roofs 41. —/
HAZARDOUS MATERIALS DISCLOSURE Type of Roof v
Will the applicant or future building occupant store or handle braid=material .
as defined by the Cupenino Municipal Code,Chapter 9.12,and the Health and Safety
Cade.Section 25532(a)7
❑Yos {dAo All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaininginspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which an p
II hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes .
1 have read the haardasmaterials requirements under CTapter6.95 of the Califor.
nia Health 8 SafctyCode,Sections 25505,25533 and 25534.I undcrosnd that if the building
does not cunendy ha •tenant.that it is my ihif y m notify the occupant of the
require wh'Kh uwbemet prior of Trate offaapancy. Signature of Applicant Date
Owner or authorized agent Date�� / /� ��' ' . All roof coverings to be Class nit'or better
•
•
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN • 36225039 . 00
DATE ISSUED • 07/17/2008
RECEIPT # • BS000005501
REFERENCE ID # . . . : 08070127
SITE ADDRESS • 7640 BERLAND CT
SUBDIVISION
CITY • CUPERTINO
IMPACT AREA
OWNER • TOM & LYDIA HALCIN
ADDRESS • 7640 BERLAND CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5079
RECEIVED FROM • LYDIA HALCIN
CONTRACTOR LIC # *OWNER*
COMPANY • TOM & LYDIA HALCIN
ADDRESS • 7640 BERLAND CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5079
TELEPHONE
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
1BSEISMICR VALUATION 10 . 00 . 0 . 50 0 . 00 0 . 50 0 . 00
lEPERMITFE 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 : 82 . 08 0 . 00 82 . 08 0. 00
METHOD OF. PAYMENT AMOUNT REFERENCE NUMBER
CHECK 82 . 08 #4991
TOTAL RECEIPT : 82 . 08
•
Q107 v /c7
CITY OF CUPERTINO
CITY 5F
• CUPEVINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # (4, 02 oC 5U 5 / , v o Date: 7 GS"
Building Address:
76 y 0 Ber-/c nd Ci C u p&r s'�, d , C %ol d
Mailing Address (if different from building address):
Owner's Name: Phone#:
) orn 4 L9 diet_ [laic ;r7 / o ;TS3 3fCQ
Contractor: Phone:
(se I?) Fax:
Contractor License#:
Cupertino Business License#:
• Contact: Phone:
Fax:
Residential 17 Commercial ❑ •
Job Description: Ens+all one c-c&:-f;'onal eJec c-I ooff e+ o,- w4
above V:re rIwce .
Building Permit Info:
Bldg 0 Elect lEr Plumb 0 Mech 0
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B
Valuation: 4 ISquare Footage:
/ b
Project Size: Standar Large ❑ Major ❑
•
Revised 5/21/08
CITY OF CUPERTINO
CUPEKTINO GENERAL BUILDING •
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 BTEMPPER Temporary Building Permit (good for B
30 days) _
1BBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw) _
1 BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
IBBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to •
& incl 1,000,000 Btu/h _
1BBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h _
1 BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption'sys over
1,750,000 Btu/h _
1 BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP Other Electrical Inspections (per hour) E
1 MECHINSP Other Mechanical Inspections (per - M
hour)
•
IP LMBINSP Other Plumbing & Gas Inspections - P •
(per hour) _
IMEETINGIHR Application Meeting B
•
CITY OF CUPERTINO
CITY OF
CU GENERAL BUILDING APPLICATION
.
FEE SCHEDULE
Quantity/Sf • Fee ID Fee Description , Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
I ACOUSFDW SFDWL/Duplex New B
I ACOUSRESAD SFDWL/Duplex-Addition/Alteration B
I ACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIMNEY Chimney B
I CHIMNEYR Chimney Repair B
FENCES
• 1 FENCE>6FT Non-masonry, over 6 ft in height B
1 FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1 FIREPLFAB Fireplace Pre-Fabricated/Metal B
1 FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1 FOUNDREP Foundation Repair B
1 PILECAST Pile Foundation Cast in place concrete B
• 1 PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete)
3 of5
CITY OF CUPERTINO
CUPEf�T
TY of INO GENERAL BUILDING APPLICATION
FEE SCHEDULE •
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY)
1 RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B •
1RETSPIO Special Design, over 10' high (up to B
50')
1 RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft)
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft)
SIDING
1SIDEST/BK Siding, Stone & Brick Veneer B •
(interior/exterior)
1SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
• STORAGE RACKS •
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st)
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
•
4 of 5
4(G • CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CIJIWINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
t 1GENCOM
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1 WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
• 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
/ 1 BSEISMICR Seismic Residential B
( IBSEISMICO Seismic Commercial B
I TRAVDOC Travel & Documentation B
1BUSLIC Business License B
• •
5 of 5
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
#IPlans See below
�.3 1'3ii:h4' ✓ .. ..`..� .l.':3 }W usgaggsgwasiggneggssmitams
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
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 IAO/Health
A. Ito
1.Recycle Job Site Construction&Demolition Waste I
65%=1 point;75%= 2 points;B0%=4 points I up to 4 Resource pts 0
12.Salvage Reusable Building Materials _} 4 Resource pts Hes . 0
3.Remodel for Mixed Use,Adaptive Reuse,and
l
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 Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
tB: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
0 0 0
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 2 Resource pts y=yes— 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes— 0
0 0 0
C.Structural Frame
1.Substitute Solid Sawn Lumber with Engineered Lumber J 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
8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energypts
Hess 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
•
0 0, 0
INPUT Resources Energy IACIReatth '
D.Exterior mrs
j1.Use Sustainable Decking Materials
a.Recycled content 3 Resource pts y=yes- 0 •
b.FSC Certified Wood 1 3 Resource pts y=yes_ 0
2.Use Treated Wood That Does Not Contain Chromium/Arsenic t 1 IAQ/Health pt y=yes 0
3.Install House Wrap under Siding I 1 IAD/Health pt y=yes_ 0
4.Use Fiber-Cement Siding Materials _ i 1 Resource pt y=yes D
0 0 0
E.Plumbing
1.Install Water Heater Jacket _ J 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes Energy pts y=yes 0
3.Retrofit all Faucets and Showerheads_with Flow Reducers 1
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
b.Showe heads(1 point each,up to 2 points) f Up to 2 Resource pts. 0
4.Replace Toilest with Ultra-Low Rush Toilets I
(1 point each,up to 3 points) ______JUp 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 IAD/Health pts. 0
8.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0 .
0 0 0
r.metrical
1.Install Compact Fluorescent Light Bulbs(CFLs)
I ` j
(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
0 0 0
G.Appliances
1.Install Energy Star Dishy=y
washer 1 Energy pt es_ 0
(.Install Washing Machine with Water and Energy _ J •
r
(Conservation Features 1 Energy pt y=yes 0
13.Install Energy Star Refrigerator 1 Energy pt y=yes 0
14.Install Built-In Recycling Center 4 3 Resource pts y=yes_ 0
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
G.Install'Recyclbd-Content,Fiberglass Insulation with 1
ilAdded Formaldehyde _ _ _ __ _ 3 IAQMealth 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 pis y=yes 0 •
6.Alternative Insulation Products(Cotton,spray-loam)
a.Walls 4 Resource pts y=yes 0
0.ceilings 4 Resource pts y=yes 0
0 . 0
•
INPUT Resources Energy IAOIHealth
I. widows
Fr Install Energy-Efficient Windows - •
a.Double-Paned { 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) , 2 Energy pts y=yes 0
j c.Low.Conductivity Frames _ j 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing1 Energy pt y=yes 0
• 0 0 0
J.Heating Ventilation and Air Conditioning
r.Use Duct Mastic on All Duct Joints _ _ 1 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 IAO/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAO/Health pts y=yes 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'AG/Health pts y=yes 0
•
b.Water Heaters 3 IAO 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)Fumace 2 Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stoves/inserts •
1 IAQ/tiealth 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 IAO/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAO/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAO/Health pts y=yes 0
0 0 0
K.Renewable Energy and Roofing -
1.Pre-Plumb for Solar Water Heating 4 Energypts y=yes 0
2.Install Solar Water Heating System 10 Energy pis 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
•
16.Select Sale and Durable Roofing Materials__ _ 7 1 Resource pt y=yes 0
7.Install Radiant Harrier - -- --_ 3 Energy pts y=yes 0
0 0 0
L.Natural Heating and Cooling -
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
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 0
0
0 0' 0
INPUT Resources Energy IAO/Health
M. n•oor •it Qua lty and Finishes •
11.Use Low/No-VOC Paint _ 1 IAO/Health pts y=yes 0
d
I
2.Use Low VOC,Water-Based Wood Finishes 2 IAQMealth pts y=yes 0 •
ail SeLow/No VOC Adhesives _ ptsy=yes 0
3 LAO/Health— -- -- —
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 •
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6IAOMealth pts y=yes • 0
6.Ilse Exterior Grade Plywood for Interior Uses 1 IAO/Health pts y=yes 0
17.Seal all Exposed Particleboard or MDF _ 4 lAO/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/Health pts y=yes 0
0 0 0
N.Flooring
•
1.Select FSC Certified Wood Flooring 6 Resource pts y=yes 0
ruse Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
-
J
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAO/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
0 0 0
Total Points Available: 1401 1301 57
Total Points Project Received: • 01 01 0 •
•
•
G:data/prma/greenbuil ngguidelineshemodele,Jgreenpaintstinal27204pratectedxls
•
•
•
o ff or7 c.)D7
OWNER-BUILDER VERIFICATION
oii1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A. )( All 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
• 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( .617172-6-7reverse s de).
Property Owner's Signature: c���
� Date: a /7 ato F
/ J
Job Address: 7 Y $erJo .0d1 64, Cu/ tarhic 50/y Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
. • Department.
CITY City of Cupertino Building Department`
10300 Torre Avenue
CU P E T I N 0 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
Panted on Recycled Paper •
Community Development
10300 Torre Avenue
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Cupertino CA lo95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
•UPEILTWO
Building Department
JOB ADDRESS: PERMIT # j1
7/ 90 Rer!4„ i ci. QO 0 -2 01027
OWNER'S NAME: To `--, H a_f c n PHONE # 90 g-- a53 -3 y o gGENERAL CONTRACTOR: FAX #
I am not using any subcontractors: �f 7 /` 4 r 7-)7- 01s-
Signature
-/7- OFfSignature Date
Please check applicable subcontractors and complete the following information:
0 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
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Owner/Contractor Signature Date