07110160 CITzI OF CUPERTINO
BUILDING VIVISION pERMIT ,���TF.t��'��:�����T���
. : _ .: ... _ ...
. ::: :,:.. .
BUILDING DDRESS: PERMIT NO.
10�70 CORDOVA RD PERFORPIANCE AIR SERVICE 07110160 .
NER'S NAME: PERMIT LSSUE D'4TE
WEST DENNIS L AND BARBARA J 1805 L==TTLE ORCHARD ST � 11/28/2007
PHONE: SANITARY NO. CONTROL NO.
(408) 9:'0-6170
ARCHITECT/ENGINEER: BU(LD1NG PERMIT INFO
BLDG ELECT PLUMB MECH
� 0 0 �
u O p LICENSED CONTRACTOR'S DECLARATION JOU DBSCTIpU0I1
v� I hcrcby aflirm that I am licenscd unJcr provisions of Chapicr 9(commencing
�z� w�ihSccGon7000)ofDivivon3ofthcBusincssandProCcssionsCode,andmyliccnscis HEATIN(J & AIR CONDITIONING REPL FOR ENERGY EFF.
"� y in full Coree and effec�
i � Z Licensc Class L�. x
•• Da� Conuaclar
� � � ARCHITECCS DECLARATION
�� I undcrstand my plans shall be used az public rccorde
�yU
4 O y Liccnsed Rufcssional
n y � OWNER-BUII,DER DECLARATION
I hcrcby a�rm tt�at I am ucmpt ftim thc Canuactor's Licensc Law for �hc
� q o following reuon. (Scction 7U31.5, Business and Profcssiont Codc: Any cily or county
�� Pi which requi�cs a permit to consuuc4 aUet impmve. dcmolish. or �cpair any swcw�c
y Z y priar �o i�s issuancc, also rcquims ihc applicant for such pertnit to filc a signcd sta�emcnt
�= 0 that hc is liccnscd pucsuanl to lhc provisions oC ihc Conuactor's liccnsc Law (Chaptcr 9 Sq. Ft. Floor Area Valuation
� F- $ (wmmcncing wi�h Scction 7000) of Division 3 of Ihc Busincss and Profcscions Codc) or $1019 6
y �.. that Ae ia exempt theeefrom and ihe buia Cor the alleged exempdon. Any violation of
Secdon 7031.5 by airy applicant [or a permit subjecu ihe applicant to a civil penalty of 3 4 217 0! i 3� Number Oeeupancy Type
not more than fivc hundred dollars (5500�
❑ 1, u owner o[ tlie pmpecty, or my employces with wage.s u the'v sole wmpensation,
will do Ihe wark �nd ihe stcucwm is not intended or ofiered for sale (Sec. 7044. Businesa Re uired Ins ections
end Pmfessiona Code: 'I�e Conuactor's License Law does not apply in an owner of Q p
property who builda or improves thereon, and w6o does sixh work himself or through hia
own employca, provided ihat such improvemenls are not imm�ded ar olfercd tor sale. If,
howevu, U�e building or improvement ia sold within one year of compleGon, ihe ownu-
buil wiR have tMe burden oC proring Ihat he did nol 6uild or improvc for purpose of
ule
I, u owner of the propeny, am eaeUusivdy conuacting wi�h ticenaed rnnvact�s w
rnnstmct the project (Sec. 7044. Business and Professians Code:)'ILe Conuacwr's Li-
ccnse Law docs ool apply w an ownu of propeny w6o builds or improves Ihemon, �nd .
who conuscis far sucd projects wiih a coniractor(s) licensed pursuant to We Convacror's
License Law.
' I am exempi ndu Sec. . B& P C(or this rcaso
..wnet Date � `��� fi
KERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fo0awing declaralions:
❑ I hs.�e and will mainuin a CeniGcate of Consent to self-insure [w Workera Compen-
sation, u providcd for by Sectian 3700 of the Labor Code, for the performanx of the
waic for which this permit is issucd.
❑ I havc and will maintain Worker's CompensaUon ]nsurana, as �cquired by Scction
3700 of �he Labor Codc. Cw thc performance of the work for which �his permit is issued.
My Worket's Compenaation Insurance carticr and Poliry number aze:
�u; Policy No.:
CER7'1FICA7'E OF EXEMP'1'fON FROM WORKERS'
COMPENSATION INSURANCE '
(This section necd not bc complcted if ihe permit is for anc hundred dallara (S I00)
or Icss) '
I cenify �hat in t6c performan e of thc w rk for which ihis permit is issucd. t shall not
employ any person in any m jec� o the Wo ' Com nsauon
Laws of Califomia. Duc �
Applicant
N077CE 7'O APPLICANT: If attcr making Ihis Ccnifics�c of Excmption, you should
become subjcct w thc Worlccr'a Compensation provisions of thc Lalwr Codc, you muu
� O foMwith comply with such provisions or this permit shail bc decmed mrokcd.
z '"'' CONSfRUGT10N LENDING AGENCY
F r � 1 he�eby atfirtn ihat there is a conswcGnn Icnding agcncy (or thc perCortnancc u[
p; � Uu work for which this permit is issued (Scc. 3097, Civ. CJ
W� Q Lendcts Namc '
� z Lender's Address
V � I certify �hat 1 have resd this application snd sute iAU the above informatiun is
w�"' cortect. I agrce w rnmply with �II city and counq oniine�xes and sute Iaws relating w
� U building consuuction, and he�eby authoria represcntativcs of ihis ciiy to cmcr upon �hc
� a ahovc-mentio�d p�uperty for inspcnion purpcuea
(Wc) agree to save, indcmnify and keep harmlesc ihe City of Cupertino against
H � liabiliuu, judgmcn�s, cosu and expenscs which may in any way accruc agains� said City
V z in consequence oC thc granting of this permiG � j. ��'G 7
�"" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PO1NT Issued b��: Date �
SOD U TIO S. � �
� Re-roofs
f Applicam/ConuacWr Da1c �
HAZARDOUSMATER[ALSDISCLOSURE T}�]� Of .ZOOf G "�
�11 the applicant or futut+e building oceupant store or handlc ha•raMous matcrial
dcfincd by Ihe Cupertina Mun" �pal Cadc. Chaplcr 9.12. and ihc Hcalih and Safcty
_«k. s�;o� zss3zce�� All roof:; shall be inspected prior to any roofing material being instailed.
❑ Ya No
Will thc applicant or futurc building occupant use equipmcnt ar devices which If a roof is installed without first obtaining an inspection, I agree to remove
cmit haiardnus air conwninan�dcfincd by thc Bay Arca Air Quality Managcmcm all new � naterials for inspection.
a:����
Q Ycs No
1 havc rcaA Uu hasardau ma�crials requircmcn�s undcr Ctupicr 6.95 of �hc Califor-
nia Hcalth dc Safcry Code, Scctions 25505, 25533 ancl 25534. I undcrsmnd �hat if Uu building
docs no� curtcnAy havc a tenan4 �hat it is my responsibiliry to noaty �hc occupant nf Ne
�swh' hmus� «�;o�w�u��arec�a��ora���. Signatur�; ofApplicant Date
Ow r au or'v�d agcm p„� All roof coverings to be Class ��B" or better
� CITY O F CUPERTINO
; �_ �
FURITACE/AC
CuPE�T�NO PERMIT APPLICATION FORM
C� ? �/ ��
APN# T Dat��
D5 . ��
Building Address:
/Olv1 o Ca2 �ov� RD, Cu�GR]'in�o, c./� '�s��� .
Owner's Name: Phone #: (S(0 Y )
�Gu�v�S ¢ �✓�t3�r2R W �sT �55-z o 7 7
Contractor: Phone #: �D $� ZO -(v 170 IC � 1
��R�o2�l�WC��� SEKy, c�s I�vC • F� #: yo8- �za-(�i��
Contractor License #: Cupertino Business License #:
�(o I 33 ! '� rj C.0 �S
Contact: �eOW�er . ,�h�']1S (�p.S� Phone #: �.p$ �SS-2077 h)
� -9 8� -o So � Cc )
Fax #: p .. _�
Building Permit Info:
Elect 0� Plumb �� Mech [}�
Job Description:
6� !�r-AT�u6 4� ��2cdNDrT,o�1�NG �EF�4cEMduT Fo�C ��2.Gy �Ff[C��lcy
Residential Commercial
For Residential Installations:
Attic ❑ l or [�� 2 floor ❑
Adhere to minimum setback re uirement
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):
�1D,�91��`�b �,,.
Strapped On Platform Bonc ed New Location Replacement
Valuation:
� �o< <9���fv
Green Building: Must attach Green Building Check list to this application
; �-. CITY OF C'UPERTINO
��: � :: : , FURN��CE/AC
��n oF
CuPE�,T�NO � FEE SC:KEDULE
FURNACE :
Qty. if
Ap licable Fee ID : Fee Descri tion Fee Grou Permit T e
' MCRAA . Furnace M F�TRN/AC
MCREPALT Commercial Mech Repair/alt/add M
MCSUSHTR� Commercial Sus��end Wall/floor M'
Heater
PGASCOM New Gas Piping System 1-4 Outlets P
Commercial �`
BSEI�MICO . 5eismic Commercial B
MRRAA Residential MecY� Repair/altJadd M
MRSUSHTR Residential Susp�;nd WalUfloor M
Heater
j� BSEISMICRE Seismic Residenlial B
(
MFLRFURN Install/relocate'F.00r Furrrace � M � ' � '
MECPLNCK Mechanical Plan Check M
MFR=<100 Furnace Syst <1(�Ok BTU M
MFRN>100 Furnace Syst > 1 �Ok BTU M
MRAIRHAN Comm/Res < 10Ok BTLT M
� EPERMITFEE Electric Permit Fee E
/ MPERMITFEE Mechanical Perrriit Fee M
BREMRECEPT Electric Receptacles E
PGASRES New Gas Piping System 1-4 Outlets P
Residential
BPGAS Gas Piping System 5+ Per Outlet P
� TRAVDOC Travel Documentation B
BUSLIC Business License. B
.
CITY OF CUPERTINO
�� � � FURlJACE/AC
CUPEI�TINO FEE S�CHEDULE
AIR CONDITIONER:
Qty. if
A licable Fee ID Fee Descri tion Fee Grou Permit T e
BCAIRHAN Commercial ?JC Units <= lOk CFM B FURN/AG
MCRAA Commercial l�iech Repair/alt/add M
SEISMICOM Seismic Comrlercial B
% BREMAIRHAN Residential A/C units <= lOk CFM B
MRRAA Residential M;,ch Repair/alt/add M
BSEISMICRE Seismic Residential B
EPERMITFEE Electric Permit E
MPERMITFEE Mechanical P�:rmit M
/ PPERMITFEE Plumbing Pennit P
BREMRECEPT Electric Rece��tacles E
PGASCOM New Gas Pipi 1g System Commercial P
1-4 Outlets
PGASRES New Gas Pipi 1g System Residential P
1-4 Outlets
BPGAS Gas Piping Sy stem 5+ Per Outlet P
TRAVDOC Travel Docur��entation B
BUSLIC Business License B
� �
� � � m: -
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• ■ � , � � ° E m S � m
a c E w � '�° �
a � a �
4. Use Solid WaII Systems pnciudes SIPs, ICFs, & Any Non-5tick Frame Assembly)
❑ a. Floors 0 2 2
_ _ _ __
❑ b. Walls 0 2 �
❑ _ _.
c. Roofs 0 2 2
5. Reduce Pollution Entering the Home from the Garage
❑ a. Tightly 5eai the Air Bartier between Garage and Living Area 0 ; _1 _�_ °_
❑ b. Install Garage Exhaust Fan OR Build a Detached Garage 0 ' 1;
6. Design Energy Heels on Trusses (75% of ACic Insulation Height at Outside Edge of Exte ior Wali) 0 1
❑ 7. Design Roof Trvsses to Accommodate Ductwork 0 1
❑ 8. Use Recycled-Content Steel Studs for 90Y. of Intariw Wall Framing 0 1 �
9. Thertnal Mass Walls: 518-lnch Drywall on Ail Interior Walis or Walis Weighing more ffian 40 IWcu.R 0 1
10. Instail Overhangs and Gutters
❑ a. Minimum 16-Inch Overhangs and Gutters 0 ._,_ ; 1:
_ _ .. _ . _ _ . .,.. _.._..
❑ b. Minimum 24-Inch Overhangs and Gutters 0 1
Total Points available in 5tructural Bulding Frame and Envelope = 36 0
E. EXTERIOR FINISH Points Available Per Measure
1. Use Recycled•Content (No Virgin Plastic) or FSGCertified Wood Decking 0 2
2 Install a Rain 5creen Wall System � Z :
3. Use Dura6le and Noncombustible Siding Materials 0 � 1 '
4. Select Durable and Noncombustible Rooting Materials 0 � 2
Total Points Available in Exterior Finish = 7 0
F_INSULATION Points Available Per Measure
1. Install Insulation with 75X Recycled Content
❑ a Walls andlor Floors � � � 1
- -_- -_ __...-----;--_,__,__.... __..
❑ b. Ceilings � 1
2. Install Insulation that is Low-Emitting (Certified Section 01350)
❑ a. Walls and/or Floors 0 1 i � -
__._ _ _, - -___ �_ __ . _.._...._._._! _.__.
❑ b. Celings _ 0 ; 1 -
❑ 3. Insped puality of Insulation Installation before Applying Drywall 0 1 �
Total Points Available in Insuiation = 5 0.
G: PLUMBING Points Available Per Measure .
1. Distribute Domestic Hot Water Efficiently (Maximum 7 Points)
❑ a. Insulate Hot Water Pipes from Water Heater to IGtchen _. _�. _. _ 1 _. __l._ . _ _._.._ i ...__..- -. :-- _1 . _.
❑ b. Insulate All Hot Water Pipes __ 0 _ ` 1 ;_ ; ; 1
❑ c. Use Engineered Parallel Piping � _,._ ' _. . i 1
❑ d. Use Engineered Parallel Piping wRh Demand Controlled Cirtailation Loop 0 � 1
-- -- - -- — ; '-- ----
❑ e. Use Structured Plumbing with Demand ConVolled Cir�ulation Loop _ _ � 1 i ; 2
__....__..—_._.__.._-- -----
❑ f. Use Central Core Plumbing 0 � 1 1! 2
❑ 2 Install Only High Efficiency Toiiets (Dual•Flush.or 9.28 gp� � 0 i ! ! 4
Total Points Available in Plumbing = Total 12 0
H. A1TNG VEIVTILATION & AIR CONDITiONING ` Points Available Per Measure
1. Design and Install HVAC System to ACCA Manual J, D, and S Recommendations ___ 0 4
� 2. Install Sealed Combustion Units
a. Fumaces ' '
0 2
❑ --- _. --,.. ____<_ _-----------. ..___-
b. Water Heaters _ � " ' 2
3. Install Zoned, Hydronic Radiant Heating with Slab Edge Insulatlon __` 0 � 1 1 ! �
4. Install High Efficiency Air Conditioning with Environmentally Responsible Refrigerents 0 1 !
� 5. Design and Install EffecUve Ductwork
,-�/ a. Install HVAC Unit and Ductwork within Conditioned 5pace 0 3' `
CJ _ �. _ _.._.
� b. Use Duct Mastic on All Duct Joints and Seams 0 1
_. _ ... _ . .. ._ _ _ _--
� a Install Ductwork underAttic Insuiation (Buried Ducts) 0 1 _ _
d. Pr�sure Balance the Ductwork 5ystem 0 1"
� e. Protect Ducis during ConsUucGon and Ciean All Ducts before Ocxupancy ___ 0 1
6. Install High EFficiency HVAC Fitar (MERV 6+) U 1
7. DonY Install Fireplace or Install Sealed Gas Flreplaces with Efficiency Rating Not Less 1 han 60% 0 ( 1,
us ing CSA 5tandards __ �_ `_ �
B. Install Effective Exhaust Systems in Bathrooms and Kitchens
❑ a. Instan ENERGY STAR Bathroom Fans Vented t� the Outside 0 ' 1
_ . - ----._. _.._ ... _.
❑ b. All Bathroom Fans Are on Timer or Humidistat 0 1
❑ c. instali Kitchen Range Hood Vented to the Outside 0 1
9. Install Mechanical Ventilation System for Cooling (Maximum 4 Points)
❑ a. Install ENERGY STAR Ceiling Fans & Light Kits in Living A2as 8 Bedrooms 0 1
_ .. , __
❑ b. install Whole House Fan with Variable Speeds 0 1
❑ c. Automatiqlly Controlled Integrated System 0 2 I
_.. _, _ ., _.,
❑ d. Automaticaliy Con Uoiled Integrated S ystem with Variable Speed Con trol ^ __, ___ __ 0 ' '
10. Install Mechanical Fresh Air Ventilation System (Maximum 3 Points)
❑ a. Any Whole House Ventilation System That Meets ASHRAE 622 D� 1 2 �
❑ b. install Air to-Air Heat Exchanger that meets ASHRAE 62.2 `_ Z �
11. Install Carbon Monoxide Alartn(s) � i
Total Points ,�vailable in Heating, VentilaGon and Air Condi6oning = 30� 0
� 2007 Build It Green Single Family GreenPc int Checklist 2007 Version Page 2 of 4
CITY OF' CUPERTINO
7 ITEMS OF 7 PERM]T RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: B]k: Lot:
APN ......... 3�217053.00
DATE ISSUED.......: 1]/28/2007
RECEIPT #.......... B:;000003349
REFERENCE ID # ...: 0;110160
SITE ADDRESS .....: 1(�670 CORDOVA RD
SUBDIVISION .......
CITY .............. CL�PERTINO
IMPACT AREA .......
OWNER ............: WE:ST DENNIS L AND BARBAR.A J
ADDRESS .. ........: 1(�670 CORDOVA RD
CITY/STATE/ZIP ...: CLfpERTINO, CA 95014
RECEIVED FROM ....: B WEST
CONTRACTOR .......: T7:M STANFORD LIC # 27768
COMPANY ..........: PF:RFORMANCE AIR SERVICE
ADDRESS ..........: 1f�05 LITTLE ORCHARD ST
CITY/STATE/ZIP ...: S�N JOSE, CA 95125
TELEPHONE ........: (4:08)920
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1MCRAA UNITS 1.00 122.38 0.00 122.38 0.00
1MRAIRHAN LTNITS 1.00 122.38 0.00 122.38 0.00
BSEISMICRE VALUATION 10,196.00 1.10 0.00 1.10 0.00
EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
PPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00
TR.AVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00
-�--------- ---------- ---------- ----------
TOTAL PERMIT : 409.02 0.00 409.02 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 409.02 #7657
---------------
TOTAL RECEIPT : 409.02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------- -------- ----------------------------
113 SLAB 301 ROUGH PLUMBING
303 ROUGH MECHANICAL � 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
Community Development
�`` � " 10300 Torre Avenue
�� ' , +�;�.- Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
CUPEI�TINO
Build:in De artment
JOB ADDRESS: PERMIT #
lO(o70 CdI��OIIf� /el�' CU�C/ZTJIVO qsn! � `� ((.l� t� lJ
OWNER'S NAME: �')t_-'�V/V W ES r PHONE # ZSS-2� 7 7
GENERAL CONTRACTOR: � ' � FAX # �if0$ 7
I am not using any subcontractors:
5 ignature Date
Please check a licable subcontractors and con� lete the followin information:
SUBCONTRACTOR BUSI�TESS 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
� z� v
er/ Date