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10050199 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22646 SILVER OAK WAY CONTRACTOR:TBD-TO BE PERMIT NO: 10050199 C ETERMINED VNER'S NAME: JEFF PAGE DATE ISSUED:05/26/2010 OWNER'S PHONE: 4089963648 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic.# INSTALL GAS DECORATIVE APPLIANCE AT V JOODBURNING Contractor Date FIREPLACE ARE TO BE ALTERED I hereby affirm that I 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. I 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. Sc.Ft Floor Area: Valuation:$5000 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. APN Number:34212060.22646 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. 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 Iss ued by: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ;nature Date RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is ins ailed without first obtaining an inspection,I agree to remove all new materials for OWNER-BUILDER DECLARATION ins section. I(hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I h:ve read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three declarations: maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Hef Ith&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air -ontaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this _ permit is issued. Owner or authorized ent• Date 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 CONSTRUCT N LENDING AAGEVNCIV become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 building construction,and hereby authorize representatives of this city to enter )n the above mentioned property for inspection purposes.(We)agree to save „idemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point sourcerjegulations per the Cupertino Municipal Code,Section 9.18. Licer sed Professional Sign ture i�� Date��� �� Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIST l � JOB ADDRESS: �-} L� L r 0�1 PERMIT OWNER'S NAME: � . PHONE# b GENERAL CONTRACTOR:G ' � rc �4 � BUSINESS LICENSE# �t ADDRESS: I �) CITY/ ADDRESS: municipal code requires all buss esses working in the city to have a City of Cupertino business license. *OurTHE NO BUILDING FINAL OR FINAL OCCUPANCY AC'IORSION(S) WILL BE HAVE OBTAINED AHCITY OF CUPERTINO GENERAL CONTRACTOR AND ALL SUBCONT BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: ESS LICENSE # SUBCONTRACTOR BUSINESS NAMEBUSIN Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile j /.� leo► Date wner/Con r for Signature CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lct: APN 34212060 .22646 DATE ISSUED. . . . . . . : 05/26/2010 RECEIPT # . . . . . . . . . BS000010497 REFERENCE ID # 100501S9 SITE ADDRESS 22646 SILVER OAK WAY SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JEFF PAGE ADDRESS 22646 :SILVER OAK WAY CITY/STATE/ZIP . . . : CUPERT:NO CA, CA 95014-5622 RECEIVED FROM GAYLA :?AGE CONTRACTOR TBD - 'CO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 000 . 00 1. 00 0 . 00 1. 00 0. 00 1BSEISMICR VALUATION 5, 000 . 00 0 .50 0 . 00 0 .50 0 .00 1FIREPLFAB EACH 1 . 00 443 . 00 0 . 00 443 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 444 . 50 0 .00 444 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 889 . 00 VISA --------------- TOTAL RECEIPT 889. 00 CITY OF CUPERTINO CITY OF CUPEI�TINO GENERAL BUILDING PERMIT APPLICATION FORM APN # Date: �,P 1 2 � -C� r O Building Address: as (P � 511 qC 00A,,-0" ,C 01.,-0 ,C C 4 Mailing Address (if different from building address): Owner's Name: j e ecC-11 3 40 HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA Contractor:Ca 0 pj F\. 4(-C_) o r-� Phone: rCL ses `; -_ ; Fax: gog — Contractor License#:� Cupertino Business License#: Contact: ,a Phone: :J "L Fax: Residential Commercial El Job Description: CC ��.c�� csL.J p / Building Permit Info: Bldg [?---' Elect ©�- Plur-ib E'— Meche Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B ❑� ``�—� Valuation: y .J Square Footage: Project Size: Express Ca_--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.buddit2reen.or Revised 02/05/09 : - CITY OF CUPERTINO Cin Of GENERAL BUILDING APPLICATION CUPEI�TINO FEE SCHEDULE Quantity/Sf Fee ID Fec Description Fee Permit Type Group 1GENRES or 1GENCOM ACOUSTICAL REVIEW lACOUSFDW SFDWL/Duplex New B IACOUSRESAD SFDWL/Duplex-Addition/Alteration B 1 ACOUSCOM Multi-Family/Commercial B CHIMNEY'S 1 CHIMNEY Chimney B 1 CHIMNEYR Chimney Repair B FENCES 1 FENCE>6FT Non-masonry over 6 ft in height B 1 FENCEMAS>6 Masonry, over 6 ft in height B FIREPLACES 1FIREPLMAS Fireplace Ma,onry B 1FIREPLFAB Fireplace Pre-Fabricated/Metal B 1FLAGPOL>20 Flag pole (over 20 ft in height) B 1 MODUSTRU Modular Structures B FOUNDATIONS 1 FOUNDREP Foundation R,,-pair B 1 PILECAST Pile Foundation Cast in place concrete B 1 PILEDRIV Pile Foundation Driven (steel,pre- B stressed concrete) 3 of f 4(tt� CITY OF CUPERTINO CU CITY OF O GENERAL BUILDIN13 APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 STUCOAP Stucco Applicz.tions (up to 400 sf) B additional stuc;o application 1 WINREP Replacement windows/sliding glass B door (ea 8 wir.dows) IWINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee) 1 EPERMITFEE Electrical Perniit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Perriit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P I STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES / l BSEISMICR Seismic Residential B IBSEISMICO Seismic Commercial B ITRAVDOC Travel &Docimentation B 1BUSLIC Business License B 5 of_` Breen Paints Rating System, for Remodeling Projects Due to the diversity of remodeling project types,assigning a"total poi its"value to a project to be considered environmentally friendly is not feasible. However,25 measures have been highlighted to signify chat 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 ba used as a starting point for"greening'your project. A.Site £5%=1 Qoir$75%= 2 polft80%=4 points u)to 4 Resource pts 0 2.Salvage RWs;OeBjldhglJf erials - 4 Resource pts y=yes D 3.Remodel for Mixed Use,Adaptive Reuse,and Historic Preservation 4 Resource pts y=yes 0 4.Protect Native Soil 2 Resource pts y=yes D 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 Rmurce-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 Resr�urce 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 pts 0 2.Use Recycled Content Aggregate 2 Resource pts y=yes 0 3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes I 0 1 1 1 C.Structural Frame 1•daft Siffid Sam Lumber with egnasred Lmmber 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 1:)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 Ene-gy pts y=yes 0 6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes D 7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0 B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0 9.Use Structural Insulated Panels(SIPS) a.Floors 3 Eno-gy pts y=yes 0 b.Wall 3 Ene-gy pts y=yes 0 c.Roof 3 Ene gy pts y=yes 0 10.Apply Advanced Framing Techniques 4 Resc urce pts y=yes 0 11.Use Reclaimed Lumber for Non Structural Applications 3 Resc urce pts y=yes 0 12.Use OSB a.Subfloors 1 Rescurce pt y=yes D b.Sheathing 1 Rescurce pt y=yes 0 t 1 [ I.Windows 1.Install Energy-Efficiant Windows a.Double-PanBd 1 Energy pt y=yes 0 b.L-ow-ETnissivity(Low-E) 2 Energy pts y=yes 0 c.Low.Conducfi►nty ernes 2 Energy pts y=yes 0 2.Install Low Heat Transmission Glazing 1 Energy pt y—yes 0 1 1 W J.pleating Ventilation and Air Conditioning MkM 1.Use Duct Mastic on AN Duct Joints 2 Energy pts y=yes 0 2.Install Ductwork within Conditioned Space 3 EnE rgy 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 Ene ray 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-!Nall Heat Pumps 3 EnE rgy pts y=yes 0 10.Install 13 SEERM 1 EER or higher AC with a TXV 3 En rgy pts y=yes 0 11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0 vw\&_�,.� Ie-cP14 *, / 12.Install 90%Annual Fuel LYtilization Efficiency(AFU Furnace 2 EnE rgy P is Y=Y es 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 EnE rgy 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 i 1 K.Renewable Energy and Roofing 1.Pre-Plumb for Solar Water Heating 4 Enc rgy pts y=yes D 2.Install Solar Water Heating System 10 EnE rgy pts y=yes 0 3.Pre-Mire 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 ktv=18 points) IJp to 18 Energy pts 0 6.Select Safe and Durable Roofing Matarials_ 1 Rescurce pt y=yes 0 7.Install Radiant Barrier 3 EnE rgy pts Y=yes 0 1 1 1 L.Natural Heating and Cooling 1.Incorporate Passive Solar Heating 5 Ener jy pts y=yes 0 2.Install Overhangs or Awnings over South Facing Windows 3 Ener jy pts y=yes 0 3.Plant Deciduous Trees on the West and South Sides 3 Ener 3Y pts y=yes 0 1 1 E