09120129CITY OF CUPERTII
BUILDING ADDRESS: 10192 PARK CL
OWNER'S NAME: TSAI WILLIAM H AND PATRICIA
NER'S PHONE: 6509689746
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # �7'/• J
ContractoDate
I hereby affirm that 1 am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
10 BUILDING PERMIT
CONTRACTOR: NEWPANECOM PERMIT NO: 09120129
340 INDUSTRIAL WAY STE T DATE ISSUED: 12/21/2009
DIXON, CA 95620 PHONE NO: (707)678-9970
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating;
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point s rce irgulations per the ertmo Municipal Code, Section
9.18.
Signatur aAv Date/,112_9/_e
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one cf
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensatiol 1,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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 Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I mu :t
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relatir g
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
',�mnify and keep harmless the City of Cupertino against liabilities, judgments,
., and expenses which may accrue against said City in consequence of the
g.anting of this permit. Additionally, the applicant understands and will comply
with all non -points rce regulations per the upertmo Municipal Code, Section
9.18.
SignaturDate�—
JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL
10192-10194, REPLACE 19 WINDOWS & 8 PATIO SLIDING
DOORS LIKE FOR LIKE
Sq. Ft Floor Area: I Valuation: $13433
APN Number: 32632007.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued bar'...— - Date: 12-
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cup rtino Municipal Code, Chapter 9.12 and
the Health & Safety Code, SerS9yon,05A05, 2V33, jp.4jW34.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF
-UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: �
1?v `
PERMIT # 2 0/ 2 T
'..moi
OWNER'S NAME: W, ',rcz < z� i
-
PHONE #
GENERAL CONTRACTOR: . -E E C ' _
AX # 70
I am not using any subcontractors:;
S:.gnature Date
Please check avvlicable subcontractors and complete the following information:
Owner/Contractor Signature Date
SUBCONTRACTOR
BUSI14ESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
inoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
'e
Owner/Contractor Signature Date
CITY OF
CITY OF CUPERTINO
..J GENERAL BUILDING
CUPERTINO PERMIT APPLICATION FORM
MIVNEq
APN # –�
Date:
Building Address:
Mailing Address (if different from building address):
l-) "Z 100-c- L os' /�l4ps' Gl `i O2-4
Are Hazardous Materials bei used as pareof thi i project? Yes ❑ No Jam,
HOA: Exterior work only) Yes ❑ No If yes, provide letter from HOA
Owner's N m :
W i�iTa �u� �S�t1
Phone #:
%Jd �g Ct7`�f;
Contractor:
Phone:
CU p6Ae. Coh.
Fax:
Contractor License #: -7 g 7-aJ -Z_
Cupertino Business License #:
Contact: l
K '
Phone: 70–) ycf7o
-2 '8
<Yi
Fax: 94 3
Residential ❑ Commercial
Job Description: Z
Building P rmit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ II/Ill/V-A ❑ II/III B, IV -HT, V-13
Valuation: — Square Footage:
Project Size: Express0,--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: 6
For help, contact Build it Green at www.builditgrcen.org
Revised 07/14/09
CITY OF
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
CUPERTINO FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
1STUCOAP
Stucco A )plications (up to 400 so
additiona stucco application
B
2
1 WINREP
Replacers ent windows/sliding glass
door ea 8 windows
B
I WINMEWSTR
New Window -structural shear
wall/masons includes plan ck fee
B
1 EPERMITFEE
Electrical Permit Fee
E
1 MPERMITFEE
Mechanical Permit Fee
M
1 PPERMITFEE
Plumbing Permit Fee
P
1 ELCPLNCK
Stand Alone Electric Pin Ck (hourly)
E
1 MECPLNCK
Stand Alone Mechanical Pin Ck (hrly)
M
1 PLMBLNCK
Stand Alone Plumbing Pin Ck (hrly)
P
1 STPLNCK-(3 Hr Min
when not over counter)
Standard Plan Check (when no E/M/P)
hourl -stand alone
B
1 BCBSC
Cal Bldg Standards Commission Fee
B
ALL PERMIT
TYPES
'
1 BSEISMICR
Seismic f:esidential
B
I BSEISMICO
Seismic Commercial
B
ITRAVDOC
Travel & Documentation
B
1 BUSLIC
Business License
B
5 of 5
1. Install Energy -Efficient Windows
a. Double -Paned 1 Energy pt y=yes
b. Low -Emissivity (Low -E) 2 Energy pts y=yes
c. Low. Conductivity Frames 2 Energy pts y=yes
2. Install Low Heat Transmission Glazing 1 Energy pt y=yes
J. Heating Ventilation and Air Conditioning
2 Energy pts
1. Use Duct Mastic on All Duct Joints
2 Energy pts
2. Install Ductwork within Conditioned Space
3 Energy pts
3. Vent Range Hood to the Outside
1 IAQ/Health pt
4. Clean all Ducts Before Occupancy
2 IAQ/Health pts
5. Install Solar Attic Fan
2 Energy pts
6. Install Attic Ventilation Systems
1 Energy pt
7. Install Whole House Fan
4 Energy pts
8. Install Sealed Combustion Units
y=yes
a. Furnaces
3 IAQ/Health pts
b. Water Heaters
3 IAQ/Health pts
9. Replace Wall -Mounted Electric and Gas Heaters with
y=yes
Through -the -Wall Heat Pumps
3 Energy pts
10. Install 13 SEER/11 EER or higher AC with a TXV
Energy pts
11. Install AC with Non -HCFC Refrigerants
2 Resource pts
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pts
y=yes
13. Retrofit Wood Burning Fireplaces
3. Pre -Wire for Future Photovoltaic (PV) Installation
Energy pts y=
a. Install EPA certified wood stoves/inserts
1 IAO/Health pt
y=yes
b. Install/Replace Dampers
1 Energy pt
y=yes
c. Install Airtight Doors
1 Energy pt
y=yes
14. Install Zoned, Hydronic Radiant Heating
: Energy pts
y=yes
15. Install High Efficiency Filter
4 IAQ/Health pts
y=yes
16. Install Heat Recovery Ventilation Unit (HRV)
F IAQ/Health pts
y=yes
17. Install Separate Garage Exhaust Fan
3 IAQ/Health pts
y=yes
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
I Energy pts y=
2. Install Solar Water Heating System
1( Energy pts y=
3. Pre -Wire for Future Photovoltaic (PV) Installation
Energy pts y=
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw = 18 points)
Up to 18 Energy
6. Select Safe and Durable Roofing Materials
1 Resource pt y=
7. Install Radiant Barrier
: Energy pts y=
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating 5 =nergy pts
2. Install Overhangs or Awnings over South Facing Windows 3 -nergy pts
3. Plant Deciduous Trees on the West and South Sides 3 =nergy pts
1. Use Low/No-VOC Paint
1 IAQ/Health pts
y=yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/Health pts
y=yes
3. Use Low/No VOC Adhesives
12 IAQ/Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
; Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
E IAQ/Health pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Health pts
y=yes
7. Seal all Exposed Particleboard or MDF
4 IAQ/Health pts
y=yes
8. Use FSC Certified Materials for Interior Finish
Resource pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
Resource pts
y=yes
10. Install Whole House Vacuum System
5 IAQ/Health pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
8 Resource pts
2. Use Rapidly Renewable Flooring Materials
4 Resource pts
3. Use Recycled Content Ceramic Tiles
4 Resource pts
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
5. Use Exposed Concrete as Finished Floor
4 Resource pts
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
Total Points Available:
Total Points Project Received:
0
0
0
1401 130 57
1 01 0 0
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