08080213 CITY OF CUPERTINO
y BUILDING DIVISION PERIVIIT ;@aNTRACT,QI2INFORMATTaNN
BUILTDRESS: PERMITNO.
?0��8 SHELLY DR JS MILLER 08080213
NET'S NAME: PERMIT ISSUE DATE
ANNY CH.CU 87 WESTMONT DR 08/27/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHf1ECDENGINEER: BUILDING PERMIT INFO
REPLACE 40 GALLON GAS WATER I
O O PLUMS UM O
h�o0 HEATHER
LICENSED CONTRACTOR'S DECLARATION
v6 I hereby affirm but I am licensed under provisions of Chapter 9(commencing Job Description
with Section 7000 of Division Sof the Business and PrCcdc.md Ilcowi+
^ in full force end ettett Gl' '
0Z LkenSu Clua Llo.w
Dau Condra
tk56s+ A Hf1ECf3 DECI.aRA 1
I undenunJ my pins Mall he u+W u public men
k ted
Licensed Professional
ire Oat I me cUILDER DECLARATION
.�a 5 1 Woutry mature.
alarm Nn I am eumpt from the Cssione o License:Anyc taw for the
p o following uires a(Sect t 7W IJ,Business and remove,
demolish,
Cade:Any city m county
$� which requite a Permit m canurucd,alter,improve,demolW,or mpdr any+drunum '
Z prior w its issuanea,dm requires to aPPli<ant(attach permit w file•Signed mumenl
�< that he is licensed puutent m the provisions of the Consacwr's License Law(Chamer 9 Sq.Ft. Floor Area Valuation
$ (commencing with Section TODD)of Division 3 of the Business and Professions Code)or
dMt he in aumpt Closer.and the bub for the alleged escmPdon.Any violation of
Section 7031.5 by any appllum for a Perini,subjects the applicant to a civil penalty of APN Number Occupancy Type '
not come dhan five hundred dollars(1509).
L u owner ortha property,w my=ploycw with mm u dub rob mmpewdm.
and do the work end c The Comb non LMed,Lau,W(mule(Sec.usae,H neer of
and mywincons Cade The coma em.Lw-»law dam rot apply lf m owner of Required Inspections
moperty l.mes.Pro erimpmwa thvmo.and wind doesoneh wwrk himrlfer brought his
owaver.the
pr such improvements and not earf.mo@ced(rodeIf,
homers the len ft er improvement b sold did au ynsr or coupled^n,be cm:Wilder wW haw Bin harden of Proving that ha did rod build er improve for Purpaa of
tele.).
❑1, a owner of the property.am=elusively contracting with licensed commemen in
construct the project(Sec.you,Business aM Professions Code:)The Centimeter's U.
«w law does not apply he an owner or property who builds or improves berso.and,
who contracts for such projects with a co manors)licensed pnnaam w to Conusuch's
Circum law.
Cl l em asempt under Sec .B R P C rm dhi+reamn
fln= Date
WORKERS COMPENSATION DECLARATION
1 hereby d n m under penalty of perjury,one of the following declantou;
I ham and will maintains CeNOnwof Consent to self-insure for WorFeY+Compen-
nation,as provided for by Secion 37M of the Isbor Code,For the Performance of du .
work for which this Permit is issued
❑1 ban and will maintain Worker's Compensation Insurance,u mquirod by Sc=ion
3700 of the labor Code.for the performance of that wart forwhich WMned
s Permit�6na
My Worker ComPens 'm Wme 'm
urand PoliCf numbe1 l/ /S�T
Carder: Policy Nur
Flue OF EXEMPTION FROM W RK
COMPENSATION INSURANCE
(This avian need not uncompleted BWe permit Is imam hunmW dollar($109)
or leu)
I Unify,thin In the Performance of the work fer which this Permit Is issued,I shall not
employ any meson in my mamerm u or become subject to the Worker'Compcwdon
Laws of California.Date
Applicant
NOTICE TO APPLICANT.IL star making this Certificate of Eaempton,you shouw
become Subject w thin WarkeYa Compensation provisions of the Jaber Code,you most
0 O forthwith comply with Such Pmvisimu On Nb Permit Mail be rimmed mated. .
zy CONSTRUCTION LENDING AGENCY
[—r Ilrerohyair.that wort be omasuctwn lending spoey nor the performance of
CLi i to work for which this meront b issued(Sec 3097,Civ.C)
A f.eMen Name
z landau Address
U 0 I certify that I have read this application and Sum that the%bow information is
Uy !'. correct.)agree in=reply with all city and county ordinances and awe lam relating to
0 rV^ Wilding conWucton,and hereby authoda rtpmenutws ofthis city he inter upon the
til .hove-mendoned Property for Wp^niou purposes
G (Wu)agree to nw,indemnify and kap homeless the City of Cupertino against
CA Ilabilhimjudgments.mom and=penece which may in my my accrue against tail City
U Z in conuquercc of the granting of this Permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH LL NONivOINT Issued by: Date
SOURCE RE ONS. n /U�
l� Re-roofs
Signuurt or Appli a tncl0r Dow
ROD
Us A JA
DISCLOSURE Type of Roof
Will the appli erfmwa Idl amupanwwmmhaMle haudaw maudal
Fdonned by the Cupertino ted IF ode.Chapter 9.12.and the Health and Safely
l
s yes 2ss3x(.)± All roofs shall be inspected prior to any roofing material being installed.
❑Yn o
VAR the applicant er future 'Iding occupant urs equlpmet dr devices which If a roof is installed without first obtaining an inspection,I agree to remove
cult luudnw dr conuminana u dcOned by the Bay Area Air Quality M...gemem all new materials for inspection.
DistderT
❑Y= Nu
I hew mad the hmadnu�d t.onytementsunde,Chapter 6.95ofthe Calilm.
ni.lica"Sdcty Cade,5ce6=M5W 533em125534.Imdctaundthalfoo,building
does not currently hew that u our 'lily du Ucu ant of the
require nuw mug ue 'o Who. In awor Signature of Applicant Date
OwnererSuthbds age h Dow I I All roof coverings to be Class'}W'or better
CITY OF CUPERTINO
WATER HEATER
a of
CUPERTINO PERMIT APPLICATION FORM
APN # s C1 i p Date:
d-
Building Address: 2 o F,pg s"'Iffl.t-1-1 VfL
Owner's Name: Phone #:
1144� (40 - ) 5D-84S-4
Contractor: Phone #: y n._bey--L 3 o 6
Fax #:
Cupertino Business License #: . Contractor State License #:
Contact: sJ Phone #:
Fax #:
Building Permit Info:
Bldg ❑ Elect LJ Plumbr, Mech
Residential Commercial ❑
Job Description: n ,V\vz� LAOS �AS w ,H
Strapped On Platform ❑ Bonded ❑ New Location ❑ Replacement
Valuation (cost of project): 7
M
Project Size: Express Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to
the application or if applicable, include in plan set & the sheet index.
Green Building Points achieved:
Revised 6/16/08
CITY OF CUPERTINO *.
41 WATER HEATER
CUPEI,TINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BSEISMICOM , Seismic Commercial B
1PRWHEATR Residential Water B PRWHEATR
HeaterNent
1BSEISMICRE Seismic Residential B
1PPERMITFEE Plumbing Permit P
0
r 1TRAVDOC Travel & B
Documentation
1BUSLIC Business License B
f 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
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. A4 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 1oint
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS 40 points
•
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 IAG/Health
to
1.Recycle Job Site Construction,&'DembliHon Waste:
65%=1 point;75%p= 2 points;B0%=4 points up to 4 Resource pts 0
2.Salvage Reusable Building Materials` 4 Resource pts y--yes 0
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 Stonnwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y--yes 0
8.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
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 0
1 1 1
C.Structural Frame
1:Substitute Solid Sewn Lumber with Engineered Lumber '' 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 Resourceis
p 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
B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y=yes 0
b.Well 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
• a.Subfioors 1 Resource pt y=yes 0
b.Sheathing 1 Resource pt Y--yes0
1 1
114PUT Resources Energy AG/Heafth
n ows
1.Install Energy-Efficient Windows •
e.Double-Paned 1 Energy pt yryes 0
b.Low-Emissivity(Low•E) 2 Energy yryes 0
c.Low.Conductivity Frames 2 Energy pts Y--yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt Y--yes 0
1 1 1
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 IAQ/Health pts y=yes 0
5.Install Solar Attic Fan 2 Energy pts Y--yes 0
S.Install Attic Ventilation Systems i Energy pt Y--yes 0
7.Install Whole House Fan 4 Energy pts y--yes 0
B.Install Sealed Combustion Units
a.Furnaces 31AQ/Health pts y=yes 0
b.Water Heaters 31AQ/Heallh pts y=yes 0
9.Replace Well-Mounted Electric and Gas Heaters with
Through-the-Wall Heal Pumps 3 Energy pts y--yes 0
10.Install 13 SEER/11 EER or higher AC with e 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.Relrolil Wood Burning Fireplaces .
a.Install EPA certified wood stovesrnserts 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 Energy 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 31AQ/Health pts y--yes 0
I 1 1
IG 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 yryes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=1B points) Up to 1 B 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
I 1 I
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pis 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
1 1 1 •
Community Development
Cupertino CA 95014
0 Torre Avenue
Telephone(408)777-3228
CITY OF-to Fax(408)777-3333
�UPEI,TINO
Building Department
JOB ADDRESS: 7 0&V OL L P% OdteeCY2 (
OWNER'S NAME: PSK3 LQ (��W PHONE # 3A ct-74
GENERAL CONTRACTOR: t_C) FAX # /
I am not using any subcontractors: d f2)
S ature 0 Date
Please check applicable subcontractors and complete the following information
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
vp
Owner/Contractor Signature Date
• CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEI-PT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35915010 . 00
DATE ISSUED. . . . . . . : 08/27/2008
RECEIPT # . . . . . . . . . : BS000005916
REFERENCE ID # . . . : 08080213
SITE ADDRESS . . . . . : 20608 SHELLY DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . . -
OWNER . . . . . . . . . . . . : ANNY CHIU
ADDRESS . . . . . . . . . . : 20608 SHELLY DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2924,
RECEIVED FROM . . . . : JASON MILLER
t CONTRACTOR . . . . . . . : JASON MILLER LIC # 30014
COMPANY . . . . . . . . . . : JS MILLER
ADDRESS 87 WESTMONT DR
CITY/STATE/ZIP . . . : DALY CITY, CA 94015
TELEPHONE . . . . . . . . : (408) 674-2306
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---- ------------- ---------- ---------- ---------- ---------- ----------
IBSEISMICR VALUATION VALUATION 750 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 .79 0. 00 40 . 79 0 . 00
IPRWHEATR UNITS 1 . 00 24 . 48 0 . 00 24 . 48 0 . 00
ITRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 106 . 56 0 . 00 106 . 56 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 106 . 56 visa
---------------
TOTAL RECEIPT 106. 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--------------------------- -------- ---------------
518 WATER HEATER
•