09050147 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � � ► � � T�� �
BUILDING ADDRESS: PERMIT NO.
10165 SCENIC BLVD CUSTOM EXTERIORS INC. 09050147
OWNER'S NAME: PERMIT ISSUE DATE
ONE: S AR N CONTROL NO.
(925) 2.19-2280
ARCHrrECT/ENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u0c LICENSED CONTRACTOR'S DECLARATION Job Description
v
p I hereby affirm that I am licensed under provisions of Chapter 9(commencing
,Zcu with Section 7000)of Division 3 of the Business and Professions Code,and my license is RMV&R P�C 31 W I NDOW S r 2 8 RETRO FIT 3 NAIL FINE;5
n y in full force and fect� /�� 3&
D v�Z License Class Lle.�► DOOR—3 3 PD & 2 ENTRY
3 Date ,�-7- - y Contracto
gg ARCHi7ECTS DEC TION
g d< I understand my plans shall he used as public records
DyU
L CH Licensed Professional
ti 11 OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
t,$Pi which requires a permit to concoct,alter,improve,demolish,or repair any structure
—" prior to its issuance,also requires the applicant for such permit to file a signed statement
=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
yF$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 2 6 0 6 4
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than fire hundred dollars(:tsar). 35709034 . 00
Q I,as owner of the property,or my employees with wages as their solo compensation,
will do the work and the structure isnot intended oroffered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of q P
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.).
Q 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 contractors)licensed pursuant to the Contractor's
License law.
Q 1 am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
non,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
lave and will maintain Workces Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's ampensation Insurance carrier and Policy number are:
' /_ 1y Z
Carrier. J CUr-��3 ��`.'olicy No.:, l 7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in tk performance of the work for which this permit' issued,I shall not
employ any pc n any man as o bject to the Wo Compensation
Laws of Calif tic
Applicant
NOTICE TO APPLICANT:If,after making this iGcatc of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
7--, forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
[-r ham. I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lendcfs Name
z Lender's Address
U O 1 certify that I have read this application and state that the above information is
LL -' cortcct.I agree to comply with all city and county ordinances and stale laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless ft 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. Date
t"h APP ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SO EGULATI �S.
Re-roofs
Signature of ApplicanUContractorData Type of Roof
HAZARDOUS MATERI 0SURE yP
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(a)7 All roof 3 shall be inspected prior to any roofing material being installed.
Q Yes ,
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
tat hazardous air contaminants as defined by the Bay Area Air Quality Management all new 'materials for inspection.
stricl7 /
Q Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
re ens which ust be met prior to issu of a certificate of occupancy. Signatuf a of Applicant Date
2-2— 3f,
All roof coverings to be Classor better
Owner or authoriz agent Date
` CITY OFCUPERTINO
CITY Of
CUPEI,TINO GENEWLL BUILDING
PERMIT APPLICATION FORM
APN# Date:
Building Address:
/d /6Cs- S � ��� c
Mailing Address (if different from building addre:,$):
Own is Name: / Phone#:
M
Contractor:I Phone: y_�_7--
�U S Fax: yQ`- �
Contractor License#: 7P .S 3 6
Cupertino Business License#: 'Z 3 7 q
Contact: / Phone:
Fax:
ResidentialCommercial
Job Description: 3 �` u,S
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Building Permit Info: �t s —� ; r ' '^
0 -IP7 74
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type: S i
1-A, 1-B ❑ IUIII/V-A ❑ IUIII B, IV-HT. V-B
Valuation: 611 1 Square Footage:
Project Size: Express ❑ Standard e 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.builditgreen.org
Revised 7/01/08
I-, �CITY OF CUPERTINO
nOF GENERAL BUILDING APPLICATION
CUPERTINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additionz.l stucco application
1 WINREP Replacer.ient 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 Mechani;,al Permit Fee M
1 PPERMITFEE Plumbin;;Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK 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-si and alone
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel &: Documentation B
1 BUSLIC 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 3reen Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Pioject
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, (nate) 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, (Not e/Spec.) A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS 40 points
L
Plan Review Process Work Book Page A2-Revised 3/25/08
INPUT Resources Energ� AO'Health
I.Windows
1.Install Energy-Eff+cierit Windows
a.Double-Paned 1 Energy pt y=yes L D
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames 2 Energy pts y=yes `Z 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on All 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
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 Burning 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 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 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 Rescurces Energy IA01HEafth
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 6IAQ/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/HeaJth. pts y=yes D
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
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
Total Points Available: 1 1401 1301 57
Total Points Project Received: 3/0 01 0 Q
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4 Community Development
10300 Torre Avenue
s Cupertino CA 95014
Telephone(408)777-3228
CIT1f OF Fax(408)777-3333
%KkTINO
Building Department
JOB ADDRESS: PERMIT #
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OWNER'S NAME: r dtJ Mu, - J PHONE # `Io -g T-? 7 f l-z
GENERAL CONTRACTOR: A. FAX #
I am not using any subcontractors:
Signature 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
00
Owner ontracto e Date