08050068 •
•
CITY OF CUPERTINO ' s.,**iYE` '' k..M..% :4
BUILDING DIVIGION PERMIT CONTRACTOR INFORMATIO1V
pax r ifP# 'a5srda4 4AN yap .s-'z, ' k'u
BUILDING ADDRESS: PERMIT NO.
1119 KENTWOOD AVE LETELIER PATRICIO A AND 08050068 .
M
OWNER'S NAME: RK IA _, PERMIT ISSUE DATE
LETELIER PATRICIO A AND MARIA 1119 KENTWOOD' AVE 05/07/2008
�NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
• O C O O
u o 0 LICENSED CONTRACTOR'S DECLARATION Job Description
i U E I hereby affirm that I am licensed under provisions of Chapter 9(commencingP
nz2 ch m hSec 7Gtll force and )rofDivision 3ofteBusneuand Professions Code.and mylicenmu REPLC KTCHN PLMBNG FXTRS;NO ELEC, NO LIGHTNG & NO
t.
yqz License Class Ilc.a MECHNCL
n1-A Date Contractor
q 7th ARCHITECTS DECLARATION
U I understand my plans shall be used as public records
s
yu. Licensed Professional
42n OWNER-BUILDER DECLARATION
E I hereby affirm that I am exempt from ther Contractor's License Law for the .
-0 o following reason.(Section 7031.5.Business and Professions Code:Any city or county
m is which requires a permit to construct,alter,improve,demolish•or repair any structure
'i
zi prior to its issuance-also requires the applicant for such permit to file a signed statement .
< that he is licensed pursuant to the pmvuinm or the Budcmra ticensesLaw(Chapter 9 Sq.Ft. Floor Area Valuation
Y�C (commencing with Section 1000)of Division 3 of the Business and Professions Code)or $500
t`<g that he is exempt therefrom and the basis for the alleged mempUon.Any violation of
Section 10315 by any applicant for a permit subjects the applicant o a civil penalty of Occupancy Type more than five hundred dollars(5503). 35931007 .1Number
❑I.as owner of the property.or my employees with wages as their solecompensadon,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Connctor's License Law does not apply to an owner of Required Inspections
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 she burden of proving that he did not b ild or improve for purpose of
sale.).
❑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 contractor(%)licensed pursuant to the Contractor's
License Law.
❑I am exempt node{Sec I a/ i - .Ba PC for thisreasonwon ,
Owner %. tamttt' Date 5-/- 0-
t. a.S'COMPENS ON a- LARATION
0I here. afflrio cHr penalty of perjury one of the following declarations:
I haw and will maintain a Certifrsateof Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
1 have and will maintain Worker's 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 Compensation Insurance carrier and Policy number are:
Carver. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
•
(11a section need not be completed if the permit is for one hundred dollen($100)
or less.)
I certify that in the performance of the work for which this permit is issued I shall not
employ any person in any manner '. tobecom•IV,:tWorkers'Compensation '
Laws of Calify�mnia.Date /- - . I .1 i
Applicant R ," %//// t - - •
NOTICE TO PLCANT•sr afterS making' u Cenifiuic of Exemption,you should
become subject _grant Compensation provisions of the Labor Code,you must
.J Z forthwith comply with such provisions or this permit shall be deemed revoked.
z " CONSTRUCTION LENDING AGENCY
[-t I hereby eRrm thatthereuaed(construction097.lending.agency for the performance of
C> the work for which this permit is iuned(Su.3097.Civ.C.)
W 0 Lender's Adore
Cid
0 Z Lender's Address
C.)0 I certify that I have reed this application and sate that the above information is
pry Hcorrin I agree to comply with all city and county ordinances and sate laws relating to `
V
.O building eruabustion,and hereby authorire representatives of this city to enter upon the -
HW above-mentioned property for inspection purposes
en (We)agree to save indemnify and keep harmless the City of Cupertino against /
Iiabilitiucru
judgments.costs and expenses which may in any wayace against said City _)
0 Z in consequence of the granting of this permit.
•'^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: v- 111,A111U Date 7,GA.
SO 'CE REGULATI0 '
A.r__ L 0 7 Re-roofs ��,
g -Mir,. ." Date
Sr u p 'HAZARDOUSMATERIALSDISCLOSURE Type of Roof
Will the applicant or future building occupant nom or handle hazardous material .
as defined by die Cupertino Municipal Code.e.Chapter 9.12.and the Health and Safety
Code.Section 25532(a)? //
•
Dyes All roofs shall be inspected prior to any roofing material being installed.
j$Na
an inspection,I a
Will the applicant or future building occupant use equipment or devices which gg
ree to remove
13trice? If a roof is installed without first obtainin dna,air contaminants asdefined by the Bay Arta Air Quality Management all new materials for inspection.
•
0Yes t
I have real the Wardens materials requirements under Chapter 6.95ofthe Califor-
nia Health&SafetyCode.Sections 25505,25533 and 25534.f urd:mend their the building
does not currently hast a that it ism �i/i'ility to notify the occupant of the
requirements which m 1pnor to' a.' ;tCertiftcae of Occupancy' Signature of Applicant Date
/gym. 4, S -04
Ow rorauthorizedagent Date All roof coverings to be Class'fl"or better
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN • 35931007 . 00
DATE ISSUED • 05/07/2008. ..
RECEIPT # • BS000004687
REFERENCE ID # . . . : 08050068
SITE ADDRESS • 1119 KENTWOOD AVE
SUBDIVISION
CITY • CUPERTINO
IMPACT AREA
. OWNER • LETELIER PATRICIO A AND MARIA
ADDRESS • 1119 KENTWOOD AVE
CITY/STATE/ZIP . . . : CUPERTINO •CA, 95014-5807
RECEIVED FROM • MARIA ELENA M LETEL
CONTRACTOR LIC # *OWNER*
COMPANY • LETELIER PATRICIO A AND MARIA
ADDRESS • 1119 KENTWOOD AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5807
TELEPHONE
• FEE ID • UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
1BSEISMICR VALUATION 500 . 00 . ' 0 : 50. 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40:79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0. 00
TOTAL PERMIT : 82 . 08 0 . 00 82 . 08 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
CREDIT CARD 82 . 08 MC
TOTAL RECEIPT : 82 . 08
o?o s 90(08
CITY OF CUPERTINO
• CUPER INO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date:
u 5' 3 /op -7 . 00
Building Address:
/2 /7 /(EArrA aec( 6 dG G rcrr( Na c/, 7c-0 1y
Mailing Address (if different from building address):
•
Owner's Name: Phone#:
Ve8 -273 —? oZ7
Contractor: Phone:
Fax:
Contractor License#:
Cupertino Business License#:
• Contact: Phone:
Fax:
Residential ❑ Commercial ❑
Job Description: ,Pe- [?C-8 C t om, C G a �i A, 6 ric Tors (L-,�c.
Vatn
no ems; h� �:5���� tv.o rv,ecken,
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No EV
Building Permit Info:
Bldg lir •Elect 0 Plumb Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 11-B ❑ 11, 111, V-A ❑ 11, 11I, 1VV-B ❑� Fy �[ r c c2C—Sij7E ce
Valuation: Square Footage:
(Coo 2 /ft 71--
Project
1'Project Size: 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.builditgreen.org
CITY OF CUPERTINO
CITY OF
CUPERJINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 BTEMPPER Temporary Building Permit (good for B
30 days)
1 BBOILER1 For the installation or relocation of ea M
boiler/compressor to &including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
1BBOILER2 Installation/relocation of ea • M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to •
•
& incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILERS Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP Other Electrical Inspections (per hour) E
1 MECHINSP Other Mechanical Inspections (per M
hour)
IPLMBINSP Other Plumbing& Gas Inspections P .
(per hour)
1MEETINGIHR Application Meeting B
GGA`- CITY OF CUPERTINO
cukk°r GENERAL BUILDING APPLICATION
TINO
•
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
I ACOUSRESAD SFDWL/Duplex-Addition/Alteration B
1ACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIMNEY Chimney B
I CHIMNEYR Chimney Repair B
FENCES
• 1FENCE>6FT Non-masonry, over 6 ft in height B
•
1 FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>20 Flag pole (over 20 ft in height) B
1 MODUSTRU Modular Structures•
B
FOUNDATIONS
•
I FOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1 PILEDRIV Pile Foundation Driven (steel,pre- B
• stressed concrete)
3 of5
CITY OF CUPERTINO
•
CUPEI�TINO
J GENERAL BUILDING APPLICATION
FEE SCHEDULE •
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY)
1RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSP10 Special Design, over 10' high (up to B
50')
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft)
IRETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft)
SIDING
1 SIDESTBK Siding, Stone & Brick Veneer B •
(interior/exterior)
1 SIDEOTHER Siding all other B
SKYLIGHTS
1SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1SRACKS>8 Storage Racks over 8' high (up to 100 B
st)
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
•
4of5
• .;LC, CITY OF CUPERTINO
Y°r
GENERAL BUILDING APPLICATION
cuFTY TING
• •
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
• 1MECPLNCK Stand Alone Mechanical Pin Ck (hrly) M
1PLMPLNCK Stand Alone Plumbing Pln Ck (My) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone •
1BSEISMICR Seismic Residential B
IBSEISMICO Seismic Commercial B
1TRAVDOC Travel & Documentation B
1BUSLIC 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 Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below)
�`yy�
Iwo" .t k .t.Et,c..^�,qY � _ mb11FYz � t ..:i nXtit :41--. A"rt1%.0,::• r2 rhN: .2 r '4;; .^' iir,.
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, (note) 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, (Note/Spec.) A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
z.f, ,.3."��errs.;...,„r, ;_ 1,24,--17-4,0( TOTAL POINTS 40 points
um Ats-`
•
RE
MAY 0 01008
Sri
;rte .
o
Ce N \
0
0O
fr••
Plan Review Process Work Book Page-12-Revised 3/25/08
Green Points Rating System for Remodeling Projects
Due to the diversity of remodeling project types,assigning a"total points'value to a project to be considered environmentally friendly is
• not feasible. However,25 measures have been highlighted to signify that 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 be used as a starting point for"greening"your project.
INPUT Resources Energy IAO/Health
A.Site •
i1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;80%=4 points 1 up to 4 Resource pts 0
12.Salvage Reusable Building Materials I 4 Resource
is y=yes 0
P
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 0
5.Minimize Disruption of Existing Plants&Trees 1 Resource pt y=yes 0
6.Implement Construction Site Stormwater Practices 2 Resource pts i y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
[Design Resource-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 Resource pts y=yes 0
0 0 0
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 0
C.Structural Frame
0 0 0
1.Substitute Solid Sawn Lumber with Engineered Lumber 1 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 to 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 Energy pts y=yes 0
6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0
8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Ener
b.Wall Energy pts Y=Yes 0
3 Energy pts y=yes 0
c.Roof 3 Energy pts y=yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0
12.Use OSB 1
a.Subfloors 11 Resource pt y=yes 0
• b.Sheathing _ 1 Resource pt y=yes 0
0 0 0
I INPUT Resources Energy IAO/Health
I. -xtenor Inls
11.Use Sustainable Decking Materials , J -
' a.Recycled content 3.Resource pts y=yes_ 0 •
b.FSC Certified Wood 3 Resource pts y=yes- 0
2.Use Treated Wood That Does Not Contain Chromium/Arsenic ! 1 IAQ/Health pt y=yes 0
13.Install House Wrap under Siding 1 IAO/Health pt y=yes- 0
14.Use Fiber-Cement Siding Materials__ _ 1 Resource pt y=yes 0
• •
0 0 0
E.Plumbing
1.Install Water Heater Jacket _ J 1 Energy pt y=yes 0
2,Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
3.Retrofit all Faucets and Showerheads with Flow Reducers
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0
4.Replace Toilest with Ultra-Low Flush Toilets
1(1 point each,up to 3 points) Up to 3 Resource pts. - 0
5.Install Chlorine Filter on Showerhead 1 IAQ/Health pt y=yes 0
6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0
8.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
0 0 0
r.tlectrlcal .
1.Install Compact Fluorescent Light Bulbs(CFLs)
(6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) Up to 4 Energy pts. 0
2.Install IC-AT Recessed Fixtures with CFLs(1 point each,up to •
5 points) Up to 5 Energy pts.- 0
3.Install Lighting Controls(1 point per fixture,up to 4 points) Up to 4 Energy pts._ 0
4.Install High Efficiency Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. 0
0 0 0
G.Appliances
1.Install Energy Star Dishwasher 1 Energy pt y=yes- 0
2.Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y=yes 0
3.Install Energy Star Refrigerator 1 Energy pt y=yes- 0
4.Install Built-In Recycling Center 3 Resource pts y=yes_ 0
0 0 0
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls 2 Energy pts y=yes 0
b.Ceilings 2 Energy pts y=yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
(3.Install Recycled-Content,Fiberglass Insulation with y
No Added Formaldehyde J 3 IAD/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5.Use Cellulose Insulation _ •
a.Walls 4 Resource pts y=yes 0
b.Ceilings 4 Resource pts y=yes 0 •
6.Altemative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
b.tleiungs 4 Resource pts y=yes 0
0 0 0
r
•
INPUT Resources Energy IAO/Health
Windows
it.Install Energy-Efficient Windows 1
• i a.Double-Paned 1 Energy pt y=yes 0
I b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
L c.Low.Conductivity Frames � 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
0 0 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 IAO/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
B.Install Sealed Combustion Units
a.Furnaces 31AO/Health pts y=yes • 0
b.Water Heaters 3 IAO/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 stoves/inserts1 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 IAO/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAO/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 0
0 0 0
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 Materials1 Resourcept
_ 1 y=yes 0
7 Install Radiant Baffler 3 Energy pts y=yes 0
0 0 0
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
0 0 0
•
INPUT Resources Energy IAO/Health
1. n•oor •it Quality and Finishes
,1.Use LowMo-VOC Paint 1 IAQMealth pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQMealth pts y=yes 0 •
13.Use Low/No VOC Adhesives r 3 IAQMealth 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 6lAQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQMealth pts y=yes 0
7.Seal all Exposed Particleboard or MDF 4 IAQMealth 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 System 3 IAQMealth pts y=yes 0
0 0 0
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
12.Use Rapidly Renewable Flooring Materials _J 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 IAQMealth 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
0 0 0
•
I Total Points Available:) 1401 1301 57
Total Points Project Received: 01 01 0 •
G:datatprogs/greenbuildingguidelineshemodelers/greenpdnisrmal2.12.04prolected.xls
110
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
• A. .r All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked, complete 2 or 3 below.
2. A state licensed contractor will be hired to do: .
A. _ All of the work
A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
3. I will utilize unlicensed person(s) other than my immediate family to perform all or
•
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
/
Property Owner's Signature: 0---u t/"////
'x¢ Date: s— 7'2
Job Address: /7/7 /`ENT oo `/ /Fac Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
•
•
City of Cupertino Building Department
CITY OF 10300 Torre Avenue.
C lJ P E�T I N® Phone: (408) 777-3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself, you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs, andunemployment compensation.
contributions.
There may be financial risks for you if you do not carry out these obligations,and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S. Small Business Administration). For more specific information about your
obligations under state law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their ownemployees,without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino •
Printed on Recycled Paper
- Community Development
F
10300 Tone Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY Of Fax(408)777-3333
•UPERJINO
Building Department
JOB ADDRESS: PERMIT #
///S it-e-xiTw o yer o
OWNER'S /yj,
NAME: «p j A ere-en)", `T
r /4 rrcio GeedeHONE # Y°) 9 73- S 02 7
GENERAL CONTRACTOR: O Q FAX #
I am not using any subcontractors: t �� 5=7- o
e Date
Please check applicable subcontractors and complete the following information:
El 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 Q
• 1tree- _ • 5- 7 - ° 8
er/Contractor Signature Date