08060091 (2) CITY OF CUPERTINO at•S; +eB�-fir 4 ' --
BUILDWGDIVISiON PER
JfMIT CW[RAG-TORJINFLUItMATIW r-
PERMIT NO
"U'll."b' 08060091
OWNERS NAME:
OAK WY SOUTH BAY PLUMBING
C - PERMRISUEDATE
PHOEBE WISE 441 N CENTRAL AVE STE 3A 06/11/2008
IF NE: (408) 370-3535 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION
in� 1 hereby affirm this mm
1 am licensed under provisions of Chapter 9 ommeing Job Description
wide Sation 700X0 of Divison 3 of den,Budnry and Professiev Code,and my license u RPLC WTR HTR SAME LOC
In full force and effect
j i License Class Lk.
ct-O Dao: Cmmmmr
"3 ARCHITECTS DECLARATION
UF 1 understand my plans shall be used u public mc-ds
DW
gc.
pN Licensed professional
3 OWNER-BUILDER DECLARATION
I hcmhy affirm that I am exempt from the Communes License Law for the
ti O Oyu fallowing won.(Sation 701.5.Butch.and Profession.Code:Any city or roomy
3$K which IequlrG a permit m construct,alter.Improve,dcmelLih,M repair my Mae.
_iZ~^ prior to its issuance,also requimn the applicant for such permiuo rile a signed awomem
< least heia licensed pmstontmthe pm.isimrsnfthe coWaaa'auansLaw Chapter 9 Sq.FL Floor Area Valuation
Y�C (commending with Station 700M of Division 3 of dee Busim. it pmfesam.Code)or $325
y that he u exempt tberefmm and the basis for the alleged assmpuon.Any violation of
Seaton 7031.5 by any applicant fa,permit subjects the appliances a civil penalty of Number Oecu ane-Type
net more vin five hundred dollars(150)). 34261001.W P Y YP
I,ssowner of the pmpmy.mmy cmployca wide wagesuHeir ink compewuon,
will de the wort and Neswnuo is notintended or oRaed formic(Sec.7044.Busndas
and Ptefessio s;Code:The Commemes License law,does rot apply be an owner of Required Inspections
propenywho Wild-orimsoves thercon,and who doessuch work himselforduoogh his
own employees,provided thin such improvements sumnot intended oroRered for els.If,
howevm,Ne building or impmmnent is mid within ere ycr of wmpkuon tlm owxr.
builder will have the burden of serving that tae did not Mid or improve for purpose of
sum.).
❑1.u owner of the proper•am velusvaly convicting with seemed mntrmws m
construct the project(Sec 70x4,Bvineas and Profasons Cade:)The Comaemfs U. .
cave law dura nut apply in an owner of property who builds or impmves thereon.and
who contracts for such projects with a conuacmr(s)licensed pursuant m use Comfectof-
Lies.law.
❑l am camepp{m ,B&P/C for this remainOwer I rl' a IM-(A�1�. o Dau(4-//-0Cf
WORKERS COMPENSATION DECLARATION
1 hereby aRmr under penalty of i mjury one of the following dcclamdov:
I his a and will maims.a Ceauf sof Co.,m self-ivumfor Workers Compen-
nation,an pmvidcd for by Sauon 3700 of the labor Code.far the Performance of Ne
work for which Its Permit is issued.
❑1 have sand will maintain Workers Compevuien Insurance,as required by Scit
37M of the labor Code,for the peRurmance of the wvrls for which our Peron u issued. '
My Wertrfn Campevation W..artier sed Policy number tee:
Caskr: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissecum reed net W completed lithe permit is forone hundred dd.(1100)
or I'm)
I anify Out in use perfamaac of the work fa which this Permit u indeed,1 sad(nm
ao
employ any pursue in my mnrmssmb - mbjafmthe Wm1mrs'CompmcMms
Laws of Califomia Date
APPliesum bb_ -
NOTICE TO APPLICANT!IL after ar dng this Certificate of P empGon,you�i i'W
become--hien m use Workers Compensation pmvi,ion,of the labor Code.yes crus
.J,Z feMwith comply with such Provisions or this permitshall be deemed muted.
z O CONSTRUCTION LENDING AGENCY
r
[-+ I herebywhich
this Nene uaed(Secunn kndingsageayfnr the srfwm,necof
6i La work for which cites permit V issued(Sec.309'T,Civ.CJ
4 Q Lendues Name -
z Lenders Addw
U Q 1 cosily that 1 have mad Ibis application and sum Nu the shove inf essamon u
D. F cOMM I agree m Comply with in City and Cowry ONirtaae,and stat Was missing an
OV Midingconsvucuon,and hereby museum,repmaenuuuesof Nis city menterupnn Nt
H ,i above-menu llnu Property for inspection puryssea
6, (Wc)agree to save.indemnify and Yap hmseless the City of Contuse against
2 incoi...jndgmc thecvtsand eapevcnmit. may in any way accrue against said City
nc APPLICANT
olthe UNDERSTANDS
Nis permit
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 6i Date G
SOURCE RE?rTION - ,
Srgnuum ser AppVCe fur pate Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tie-Pli icant or furme building—Pan4m.or Lundie haurdess material
u L=Oned by the Cupertino Municipal Code.Chapter 9.11.and tis Health and Safety
Code.Salim 35533(a)?
❑Yon 93N. All roofs shall be inspected prior to any roofing material being installed.
Will NC apprtam or future b-ddlag mcup,m me equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t hrraednns air conuminanu u dc0ned by the Bay A.Air Quality Management all new materials for inspection.
vise
CL?
QYa �Nu.
I have read the ha sommsmaterials requiremcns under Clupkr6.95 of bm Califor-
nia He.IN&Safety Cede,Secuwu25ML 35533 and 25534.1 undersand belifthc Wilding
dues net currently have a tenant,this,it in my responsibility in notify,de encomium or de
mquirementsZ mus hester pior ss,07 of:Cvufcsa¢of Ocmpancy.
'�A--^�/l/Ati- A/// g � _�I _pe Signature of Applicant Date
owoera,-therasd ag=nt D,te' All roof coverings to be Class'As*or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34261001 . PW
DATE ISSUED. . . . . . . : 06/11/2008
RECEIPT # . . . . . . . . . : BS000005084
REFERENCE ID # . . . : 080'00091
SITE ADDRESS . . . . . : 21070 CANYON OAK WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PHOEBE WISE
ADDRESS . . . . . . . . . . : 21070 CANYON OAK WAY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : PHOEBE WISE
CONTRACTOR . . . . . . . : RICK PERKINS LIC # 22605
COMPANY SOUTH BAY PLUMBING
ADDRESS . . . . . . . . . . : 441 N CENTRAL AVE STE 3A
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE (408) 370-3535
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 325 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00.- : 40 . 79 . 0 . 00 40 . 79 0 . 00
IPRWHEATR UNITS 1 . 00 24 . 48 0 . 00 24 . 48 0 . 00
1TRAVDOC 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
----------------- --------------- --------------------
CREDIT CARD 106 . 56 MC
---------------
TOTAL RECEIPT 106 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
•
ao(p 0011
CITY OF CUPERTINO
t,�-�n WATER HEATER
CITY OF
CUPEkTINO PERMIT APPLICATION FORM
APN #
Building Address:
501 --
Owner's Name:n4 V
2 Phone #: 33 S/
Contractor:
¢� ��y pPhone #: ►L6$ 3 0 3S- 3S
r4(f tA �i6oFax #:
Cupertino Business License #: Contractor State License #:
a 6 0 5 813 7 .31
Contact: toa tr �- it �-- Phone #: �0.9 370 T53 .5
Fax #: 00,31 72,-9 ��•`��
Building Permit Info:
Bldg D Elect Plumb [� Mech ❑'"
Residential [I f Commercial ❑
Job Description:
Strapped [�— On Platform ['Bonded Ej-� New Location ❑ Replacement Q
Valuation: 2 2 S
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:
511-2
CITY 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
1PRWHEATR 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
B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 72points
11. Permeable Paving, Note L-1
C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1
D. Structural 3. Uses Wood 1-Joist, (See Spec.) S-2
5. Use Truss with heels, (detail) S-2
6. B. OSB Sheathing, detail S-2
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 I A-1 1 point
TOTAL POINTS1 40 points
•
•
Plan Review Process Work Book Page A2-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 IAQ1Hea10E
A. rte
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;80%=4 points up l0 4 Resource pts 0
2.Salvage Reusable Building Materials I 4 Resource pts y=yes 0
3.Remodel for Mixed Use,Adaptive Reuse,and
Histodc 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
8.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
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 ptsFO
2.Use Recycled Content Aggregate 2 Resource pts y=yes
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes 0
11
C.Structural Frame I I 1
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
8.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 C
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 _ _ —
I 1 Resource pt y=yes p
1 1
INPUT ReSDUrces Energy 1ACIIHealth
xteriorFn ii
r.Use Sustainable Decking Materials i
a.Recycled content 1 3.Resource pts y=yes 0 •
b.FSC Certified Wood 3 Resource pts y=yes 0
l
2.Use Treated Wood That Does Not Contain Chromium/Arsenic I 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 e=yes 0
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
13.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
4.Replace Toilest with Ultra-Low Flush Toilets
(1 point each,up to 3 points) _ Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAQ/Health of 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 41AQ/Health pts. 0
S.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 I 1
r.trecmcar
11.lull Compact Fluorescent Light Bulbs(CFLs) 1
(6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) _ I 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
12.Install Washing Machine with Water and Energy
lConservation Features 1 Energy pt y=yes 0
3.lnstall Energy Star Refrigerator I 1 Energy pt y=yes 0
4.Install Built-In Recycling Center _ — 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
13.Install Recycled-Conlent,Fiberglass Insulati6ri7wfilli
'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 C •
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
o.Uenings 4 Resource pts y=yes 0
1 1
INPUT Resources Energy IAO/Heai
1.Wmdows
1.Install Energy-Efficient Windows
a.Double-Paned 1 Energy of y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames 2 Ener t
- Energy pis y=yes 0
2.Install- -Low Heal 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 2 Ener is
9Y P 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 of 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 31AQ/Health pts y=yes 0
b.Water Heaters 31AQ/Health pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heal 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 11AQ/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 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 18 Energy pts 0
6.Select Safe and Durable Roofing Matenals _� 1 Resource pt y=yes 0
7.Install Radiant Ba ner- - - � -- ---- 3 Energy pts y=yes 0
1
L.Natural Heating and Cooling 1 1
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 pis y=yes 0
1 1 1
•
M. n oor Air ftality and Finishes INPUT Resources Energy �AQ/Healt"
r1.Use LowMo-VOC Paint 1 IAQ/Health is es 0
_ P Y=Y
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
ff3.Use Low/No VOC Adhesives 3 IAQ/Health is es 0
l`—� -- — ._-_--- - P y=y
Z.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes D
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
Y.Seal all Exposed Particleboard or fv1DF __ __J 4 IAQ/Health pts y=yes 0
8.UseFSC Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Tim 1 Resource pts y=yes0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes D
1 1 1
N.Flooring
1.Select FSC Certified Wood Floodng 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
Total Points A 1 1401 1301 57
Total Points Project Received: 0 0 0 •
G:datalprogsrgreenbuilNngguidelineslremodelersrgreenpointsf nal2.12.04protected.xls
•
Community Development
�N„ 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
`WUPERTINO
Building Department
JOB ADDRESS: ,z/ 0' 6 C u�s D cP� GUa PERMTT #
dj-z 6 �l�
OWNER'S NAME: Plic e d V r S e PHONE # I'So 6 9 43 3 y
GENERAL CONTRACTOR:So c M I3 vk ti FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
ADGlass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
nTile
^ / I
Owner/Contractor Signature Date