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09050059 CITY OF CUPERTINO BUILDING DIVISION PERMIT C1�'�TR�CTQZ PERMIT NO. IJ►l ;. BUILDING ADDRESS: 22065 M AR PERMIT ISSUE DATE OWNER'S NAME: FE7 SA PHOik- CONTROL NO. BUILDING PERMIT INFO 'HITECC/BNGINEER: BLDG ELECT PLUMB MECH RMV/RPL2 1 WINDOW IN KTCHN D D O D �',p c LICENSED CONTRACTOR'S DECLARATION RETRO FIT VINYL Job Description UC I hereby affirm that I am licensed under provisions of Chapter 9(commencing to with Section 7000)of Division 3 of the Business and Professions Code,and my license is ^T^^ ^T^^ o y in full fora and / 3 j vn Z License Class Lle•N 3 cpy Datc d Con 3 ARCH TECT'S DECLA ON a I understand my plans shall be used as public records �yU l'O H Licensed Professional OWNER-BUILDER DECLARATION Je x 1 hereby affirm that 1 am exempt from the Contractor's License Law for the in o following reason.(Section 7031.5,Business and Professions Code:Any city or county .Le m 9 which requires a permit to construct.alter.improve,demolish,or repair any structum y - prior to its issuance,also requires the applicant for such permit to file a signed statement aFt.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q YH (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number not more than five hundred dollars(MS 0 I,as owner of the property,or my employees with wages as their sole compensation, will do the work.and the structure is not intended or offered for sale(See.7044.Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees.Provided that such improvements are not intended or offered for sale.If. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(:)licensed pursuant to the Contractor's License Law. 0 1 am exempt under Sec. B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code.for the performance of due it for which this permit is issued. J I have and will maintain Workefs Compensation insurance,as required by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. My Worke/���Com scion Insurance carrier and Policy number are: Carrier. �J� //Jyri 'Grp Policy No..-LJ(a C4,2. 179a CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:if,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY Fr►�-. I hereby affirm that there is a construction lending agency for the performance of pC> the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name CIO Lender's Address U 0 1 certify that I have read this application and state that the above information is V.H correct.l agree to comply with all city and county ordinances and state laws relating to O V building construction,and hereby authorise representatives of this city to enter upon the Lta above-mentioned property for inspection purposes a (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,toss and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. APPLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: -� SOU EGDate IO S.ULAT _S"' -v`= Re-roofs Signature of Applicant/Contractor DateT of R sof HAZARDOUS MATERIALS DI CLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(x)? All roofs:;hall be inspected prior to any roofing material being installed. 0 Yes If a roof i:;installed without first obtaining an inspection,I agree to remove Will the applicant o future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes I have read the hazardmaterials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building —— `Z,iU S does not currently have a tenant,that it is my responsibility to notify da occupant of the 3+: requi c which must be mel 'or to issuance of a Certirtcate of Occupancy. $ignature of Applicantp � Date All roof coverings to be Class'J ``or better Owner or authorize gcn Datc CITY OF CUPERTINO CUPE�ANO GENERAL BUILDING PERMIT APPLICATION FORM APN# d2 5 . Date: +� C) Building Address: 'Z, Z0 /14 cCeX Mailing Address (if different from building address;: Owner's Name: Phone#: Cie b&, t1v e- 77-_�;--3 G S-6C-3 Contractor: �z7t,,e;c,�•�c.. Phone: ���_ (f 3 j.- 3 Se-Q�r X10 �� �-- Fax: Vv -7— S".rl- 3v7— Contractor License#: 7_0137j Cupertino Business License#: Contact: r 9<6— Z S� 6 S 6 0 Phone: Fax: Residential Commercial • Job Description: � � � / ��•f���� �� �`-���� Building Permit Info: Bldg Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: S/c7`? 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, 17-B (2- Valuation: Valuation:!�J ( Square Footage: Project Size: Express ❑ Standard Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.buil!jijtzreen.org Revised 7/01/08 CITY OF C UPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEI�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1 GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional >tucco application 1 WINREP ReplacemEnt windows/sliding glass B door (ea 8 windows) IW INMEWSTR New Winc ow-structural shear B wall/maso:zry(includes lan ck�fee) 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alcne Electric Pln Ck (hourly) E 1 M .CP LNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMBLNCK 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-st ind alone IBS EISMICR Seismic Itesidential B 1BSEISMICO Seismic fommercial B 1TRAVDOC Travel &:Documentation B 1 BUSLIC Business; License B 5 of 5 � S 7- 6filCC' l8,t144 d Green Building Plan Check Index of Green Building Points/Categories A. Category Example of an Index or Table of G'een Plan Sheet or Page Points Building Points Categories that must be shown and referenced on the Pro.ect 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, (nota) 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, (Nate/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/33 ec. A-3 1 oint P. Other 1. List Green Features on Plans A-1 1 point TOTAL :)INTS 40 points a Plan Review Process Work Book Page-12-Revised 3/25/08 I.Windows 1.Install Energy-Efficient Windows a.Double-Paned 1 Energy pt y=yes ( 0 b.Low-Emissivity(Low-E) i 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 AU Duct Joints 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 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 stoves/inserts 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 0 16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 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 1 B Energy pts 0 6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0 7.Install Radiant Barrier 3 Energy pts y=yes 0 1 1 1 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 1 1 1 INPUT Resourzes Energy iAQ/Health M.Indoor Air Quality and Finishes 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 pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. 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 IAQ/Health pts y=yes 0 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 i mid Total Points Available: 1 1401 1301 57 Total Points Project Received1 01 01 0 — C2 2OL G:data/progs/g eenbuildngg�delines/remodelerslgreenpointsfinal2.12.04pmtected xis Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPERTINO Building Department OB ADDRESS:, �► PERM # OWNER'S NAME: �-FQ �',�,� t=' PHONE #Yp,?-16-3 -6,510 GENERAL CONTRACTOR: 'e-q1-:.s 0 c4 FAX# yo _ I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing rs Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ContActor e Date