09060022 CITY OF CUPERTINO '
BUILDING DIV1S10N PERMIT '���TF�.A��Q�;���������Nt `
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BUILDING ADDRESS: PERMIT NO.
880 E ESTATES DR ATLAS-`IRILLO '
OWNER'S NAME: PEItM1T LSSUE DATE
PHONE: A A �• CONTROL NO.
(408) 2�6-8931
ARCHI'IEC[7ENGINEER: BUiLDING PERMCC INFO
HLDG ELECT PLUMB MECH
0 0 0 0
�O p LICENSED CON'IRACCOR'S DECLARATION JOU D6SCTlPt10❑
;�v C I hcrcby aflirm�hat I am liccnscd undcr provisians af Chaptcr 9(commencing
_�W� witA SccGon 7000)of Division 3 of thc Busincss and Profcssiuns Codc.and my liccnsc is
��y infullforceandcff�t.�U ��- . 13}-- RMV/RPI�C PACK UNIT—SPLIT SYSTEM
j�Z Licensc Cla Lic.S
_t,p Datc ( �L Contracar � f L
� ARCH[TECl'S DECLARATION
��� l undctswnJ my plans s6a11 be uscd as pu6lic rccords
�yU
4 O y Liccnsed Pcufcuional
n y� OWNER-BUILDER DECLARATION
I hcrcby alYrm U�at 1 am czcmp�Crom thc Conuactors Licensc Law for thc
�p O following rcason.(Scctian 7b31.5,Busincss and Profacsions Cak:Any ci�y or county
t,�,Pi which requims a pertnit m consuuc4���.�provc,dcmolich,or�epuir any swcwm
�Z y prior to i�s iseuancc,alsu rcquires ihc applicant for such permit to filc a signcd su�cmcnt
_< that he is liccnsed pursuant to thc pmvisions of thc Conuactor's Licensc[�w(Chaptcr 9 Sq.Ft.Floor Area Valuation
yt—$ (commencing wilh Scction 7000)nf Division 3 af ihc Busincss and Profcssians Cadc)or 3 8 O 0
y�.. that he is exempt therefrom and t6e basis for t6e allegcd exemption.Any violaaon ot
Section 7031.5 by airy applicant for a permit subjecn U�e applicant to a civil penalty of APN Number Oeeupaney Type
rroc moro than fiw 6undred dollars(SS00). 3 6 9 2 4��7 . 0�
❑I,u owncr oC Ux pmperry,or my cmployces with wages u the'v wic compensadon,
will do thc work and Uu snucwce is not intended or otfered for sak(Sa.7044,Business
and Professions Code:77x Canuacar's License Law dces not apply m an owner of Required Inspections
property who 6uilds or improves thercon,and wha does such work himself or through his
owa emplayccs,provided that such improvemenu ue not in�ended or oReced for salc.IC,
however,the building or improvement ia sold wilhin ane year of wmpledon.Ihe owner-
builder will have the burden o(proving�Aat he did not build ar improve tor purpoae of
saleJ.
❑I,u awner of�he propeny,am exctusively conuacting wiih lianaed rnnvactors to
consuvct the projett(Sec.7044.Business and Pro[cssions Cade:)The Contraccols Li•
ccnse Law docs nat apply lo an owner of property who builds or improves iheieon,and,
who conmcts for such p�ojects with a conuactor(s)licensed pursuant w We Contrxtor's
License L.aw.
❑I am exempt under Sec. .B&P C for ihis rcaaon
Owner Date
WORKER'S COMPENSATiON DECLARAT[ON
reby aflirm under pendty o[perjury one of ihe following declaraGons:
� sve und will main�ein a CeniGcam of Consem to xlf-iesum for Warkcr's Compen-
.i n,as providcd for by Sectian 3700 at che[abor Code,far the performancc oC�hc
+vork for which�his permil is issucd.
��I ve and will mainlain Workcr's Compensation Insurancc,az�equircd by Scction
o the(aDor Code,Cor�he pert'armmce of�he woric for which this pern�i�is issued.
orkers_Cqmpens 'on l�;�u�c$n�ce c�aeri�/cj and Policy lu�/�G_ 7
Carrier. �� ''�`"YI"( Policy No.:� � —
CERTIFICATE OF EXEMP'['ION FROM WORKERS'
COMPENSATION lNSURANCE •
(This section necd not bc complcted if tlrc pecmit is for onc hundred doliaca(SI00)
or Icss) �
I cenify that in thc performancc of Ihc work for which U�is permi►is issced,I shall not
employ any person in any manncr so at W bccomc wbject a the Workcrs'Compensation
Laws of Califomia.Datc_
AppGcant -
NOTICE TO APPLICANT:1(,af�cr making this Cenifica�c of Excmp�ion,you should
become subject to the Woricer's Compensation provisions of�e Labor Code,you muu
,J O fonhwi�comply with such provisians or Nis pecmi�shall be deemed revoked.
z ''' CONSTRUCTION LENDING AGENCY
(�� I hcreAy alTirtn Ihat thcre is�consuuctinn Icnding agcncy for thc perfurmancc u(
ai� �he work for which�his permit is issued(Scc.3097,Civ,C.) �
W�A Lendcr's Namc •
a� Lende�s Address
V Q I cectify�ha�1 have rcad this applieation and s�atc ihat�hc above infortnativa is
w� cortcc�I agcce w comply with all city and counry ordinances and�uk laws reladng to
�U building conswction,snd hereby authorim representaUves ol'ihis ci�y to cnicr upon ttic
�a abovc-mcntio�rd properry for inspccUon purposes
(We)agrce to save,indcmnify and kecp humless�he City of Cupertino against
�� liabiliues,judgmcnLt,costs and expenses which may in any way accruc against said City
V z in consequcnce oC�e ranting of�his permit. � � Q y
� APPLICANT U TANDS AND WILL COMPLY WITH ALL NON-POINT Issued b��: Date
SOURCE R ONS--"'--`"' �
� G Re-roofs /z�
Signuurc of Applicant/Convactor � a�c `
HAZARDOUS MA7'ERIALS DISCLOSURE Type of l Zoof
Will�he applicant w futurc building occupant storc or handlc ha•rardous matcrial
az dcfincd by thc Cupenina Munici al Cadc.Ct�aplcr 9.12,and�he Heal�h and Safety
c�,Scction 25532(a)? � f All roofs shall be inspected prior to any roofing material being installed.
❑Ycs p�
�ll�he applicant or Culurc building occupant use cyuipmcnt or dcvices which If a roof is installed without first obtaining an inspeetion,I agree to remove
•mit hazardous air conuminants as cicfincd by the Bay Arca Air Quality Managcmcnt a]1 peW�18teI'Ia1S fOi lIISpeCrIOII.
:suici? �
❑Ycs No �
1 havc roaJ the ha�ardous mamrials requircmcn�s undcr Chap�cr 6.95 of I�c Califot- , K
nia Hcalth&Saf ,Scctions 25505,25533 and?5534.t undcrstand ihu iC ilu huilding �
docs not cu ly h �enan4Aha[i�is my responsibility w noufy thc occupant of thc "�--- '�
wrcmon�s wh mus�bc met rior u>> of a Ccnificaic o( cu c �---.._
'�`+ � , P.=��'�"`� � � ° �� Signature of Applicant ---- Date
0 ori,.�a as��� � p„� All roof coverings to be Class';�}.``or better
o��� � o �
s ..
CITY O:F CUPERTINO
FUR]vACE/AC
CUPE�TINO PERMIT APPLICATION FORM
APN # �{I Q � , I' � 0�, O v Date: �, �--� �
c��-e ! y
Building Ad r ss:
, t� ��f��- �sf '17l� ,
Owner's ame: Phone#: �/
� " .�-SZ ' `Z �� �
Contractor: Phone#:
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� �� � Fax#: ' Gf ~ GS( �
Contractor License#: Cupertino Business License#:
(� �' � 1 ��.
Contact: Phone#:
T� v`� �
J � G��t C�-�r%t Fax #:
Building Permit Info:
Elect ❑ Plumb [�--- Mech��
Residential Commercial
Job Description:
��r�- �'��� - �v�-� -�
For Residential Installations:
Attic ❑ lst floor [] 2°d floor ❑
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installatior. ❑
New installation Planning Approval Required ❑
Cost of Project: Type of C'onstruction (Usage Class):
��� � �.t?
Strapped ❑ On Platform ❑ Bond ed New Location Replacement
Project Size: Express ❑ Standard ❑ Lar e �] Major ❑
Valuation:
Green Building: Please complete relevant portio n of the Green Building Checklist & attach it to the
application or if applicable, include in plan set& the sheet index. �
Revised O l/07/09
=�, CITY OF C UPERTINO
� �;�,, '
FURN��CE/AC
CUPE(�TINO FEE SCJ3EDULE
Quantity Fee ID Fee Descriptior� Fee Permit Type
Group
FURNACE FURN/AC
1 MCRAA Commercial-Rep�ir/Alteration/Add to M
ea heating applia�ice,refrigeration unit,
cooling unit,abso-ption unit,or ea
heating,cooling,a�sorption or
evaporative cooli ng system,incl
installation of coiitrols regulated by this
code.
1MCREPALT Commercial for the repair of alt/add to M
ea heating applia�ice,refrigeration
unit,cooling unit,VAV boxes,
absorption unit o:-ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Commercial Inst��ll/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted un it heater.
1PGASCOM Commerical for e;a gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of e<<appliance vent
installed ¬ ir.cl in an appliance
permit.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,abscrption unit,or ea
� heating,cooling,absorption or
evaporative cooli ng system,incl
installation of co Ztrols regulated by
this code.
1MRSUSHTR Residential Insta.URelocate ea M
suspended heatet,recessed wall htr, or
floor mounted ur.it heater.
CITY OF C'UPERTINO
�I .,.'��` FURN��CE/AC
CUPEI�TINO FEE SC:HEDULE
Quantity Fee ID Fee Descriptio�i Fee Permit Type
Grou
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A/C Units <= l Ok CFM B
1 MCRA.A Commercial Mec h Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Seismic Commeicial B
1 PGASCOM Commerical for f:a gas piping System P
1-4 outlets
1PGASRES Residential for e��gas piping system P
of 1-4 Outlets
1BPGAS For each gas pi��ing system of 5 or P
more per outlet. 1�omm/Resid
1BREMAIRHAN Residential A/C�znits<= lOk CFM B
� 1MRRAA Residential Mecr�Repair/alt/add M
/' 1BCBSC Cal Bldg StandaYds Commission Fee B ALL PERMIT
� TYPES
,
/ 1BSEISMICR Seismic Residenlial B
r 1 EPERMITFEE Electric Permit E
(
I 1MPERMITFEE Mechanical Perrr�it M
� 1PPERMITFEE Plumbing Permit P
1TR.AVDOC Travel Documen:ation B
1BUSLIC Business License B
� • ' � ��
(.WI� OWS
1.Install Energy-Efficient Windows
a.Double-Paned � ' Energy pt y=yes 0
b.Low-Emissivity(Low-E) ��Energy pts y=yes 0
c.Low.Conductivity Frames ��Energy pts y=yes .0
2.Install Low Heat Transmission Glazing ' Energy pt y=yes 0
■ 1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duct Mas4ic on All Duct Joints ;!Energy pts y=yes 0
2.Install Ductwork within Conditioned Space :3 Energy pts y=yes D
3.Vent Range Hood to the Outside ' IAQ/Health pt y=yes 0
4.Clean all Ducts Before Occupancy ;�IAQ/Health pts y=yes 0
5.install Solar Attic Fan ;?Energy pts y=yes 0
6.Install Attic Ventilati�n Systems � Energy pt y=yes 0
7.Install Whole House Fan •1 Energy pts y=yes 0
B.Install Sealed Combustion Units
a.Fumaces :i 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 � Resource pts y=yes � 0
12.Install 90%Annual Fuel Utilizaiion Efficiency(AFUE)Furnace �Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
a.Install EPA certified w�od stoves�nserts i IAQ/Health pt y=yes • 0
b. InstalUReplace 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 �IAQ/Health pts y=yes D
16.Install Heat Recovery Ventilation Unit(HRV) i IAQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 0
. i 1 1
K.Renewable Energy and Roafing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0
2.Install Solar Water Heating System 1�Energy pts y=yes 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(12 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 i !
L.Natural Heating and Coofing
1.Incorporate Passive Solar Heating E Energy pts y=yes 0
2.Install Overhangs or Awnings over South Facing Windows � Energy pts y=yes 0
3.Plant Deciduous Trees on the West and South Sides � Energy pts y=yes 0
. 1 1 1
. a�
M.Indoor Air Quality and Finishes
1.Use LowMo-VOC Paint 1 IAQ/Health pts y=yes p
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes p
3,Use LowMo VOC Adhesives 3 IAQ/Health pts y=yes p
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 IAQ1Health pts y=yes p '
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 Sysfem 3 IAQMealth pts y=yes 0
, 1 ! i
N.Fiooring
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 p
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
, I 1 1
Total Points Available: � 140 130 57
Total Points Pra'ect Received: 0 0 0
1 � ��-�
. G:datalprogs�gre�nbuildngguidelines/remodelers/greenpointsfinal212.�4protected.xls
�� . Community Development
�" � 10300 Torre Avenue
�' ;�;t-- Cupertino CA 95014
Telephone(408)777-3228
ClTY OF Fax(408)777-3333
��UPEI�TINO
Buildin De artment
JOB ADDRESS• PERMIT #
- - � . ��a6�� 2-2
OWNER'S NAME: PHONE # ,Z� - �� � �
GENERAL CONTRACTOR: �f��'c r- yl� /�� �1��4 L FAX #
� � U �
I am not using any subcontractors: �---.___
Si�nature Date
Please check a licable subcontractors and com��lete the followin information:
SUBCONTRACTOR BUSIl'JESS NAME SUSINESS LICENSE #
Cabinets &Millwork
Cement Fini.shing
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
Til
_ . ---' _ ��` � G
�f_
Owner/Contractor Signature ate