08090145CITY OF CUPERTINO
sz a•ai �w>, ��'�'ta +:'
BUILD NQ Dh fSION PERMIT
` C��NLfRACT®R IAT.PORMAT�ON
BUILI DRESS:
PERMIT NO.
T 1 DE ANZA BLVD
TBD - TO BE DETERMINED
08090145
OWNER'S NAME:
PERMIT ISSUE DATE '
JOHN TONG
09/23/2008
)NE:
SANITARY NO. CONTROL NO.
ARCHIECnENGINEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
CONTIACTOR'S DECLARATION
Chapter 9
Jtion
Job Description
p
I hcroby grim that l am licensed under provision of (commencing
with Section 71)(0) ofDbidon 3 offt Business and profession Code. and my l&encu
RPLCE WTR MN- JMB PLUMBING & CONST PD FOR BSL
in full farce end .(tact.
uemota Class Lie..
9/22/8
Dam Contractor
ARCHITECTS DECLARATION
1 m oho sand my pads Mall W used u public recorda;
Licensed Pmfassianal
OWNER-BUILI)ER DECLARATION
I hereby o?tm that I am exempt from the, Contractors License Law for the
following reason. (Section 703 1.5, Business and Profession Code: Any city or county
which requite a permit m construct. alter. improv. demWtN. or repair any ormame
'
! prior to its issuance. Am requires the applicant forsuch permit to file a signed statement
that he is licensed to the of tad Contractor's License Law (Chapter 9
Sq. FL Floor Area
Valuation
pursuant provision
(eom.. iCods)or
meneingwithSection7000)ofDivuion3oftheSm andProfesson
$5200
Ithis he is exempt Ihwfrom and the bssu for the alleged eatmption My violation of
Number3YPe
Section 7031.3 by my poll., fora penoth subjects the applicant to a coil pe..try ofOccupancy
trot mom then 0w hundred dollars (SM
35917003.E
(] I, as owmr of Ute popery, a my wployces with wags u the'v ulc mmpewdon,
will do the work and the structure is not intended or offered for sale rime. YON. Bad.
and Profession Cade: The Comactoes License law does not apply as an mater of
Required Inspections
proWtywho Wildsorimproveslhercon and whodoeasuch wart himalfor through his
ownwployees,pr ded Uutsuchimpmvemenuartnotintended naRcred for sola B.
-
howmer. Ne building or improvement Is sold within ou year of completion, the owner -
builder will have the Waken of proNng that he did mat Wild or improw for purpose of
sok.).
1. as owner Of the Property. am exelnelvely committing with licensed cmuscmR to
contact the project (Ste. 7W. Business; alit professional Cede:) The Cor mYme's Li.
.
t roe law does not apply or an owner a property who Wilds or impmws daemon, and.
who conusca for soh projects with a canmudor(.) licensed pursuant as the Contractors
Licene Law.
El Iamexempdunden Set .B&PCfnthismase.
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hemby aQam under penalty of rcdmrrc aof t e following declaration:
1 Wa a and will maintain sCeniftom of Canx m, as self -inure fm WmI crs Compete
When, as provided for by Sedan 3100 of the Labor Code. for the performance of the
work for which then pvmh is issued.
1 haw and will maintain Warhol Compensation IMIIaN0.'. as regVlRd by Section
37M.f the Labor Cade. for the peRormance of the work for which Otis permit i. issmd
My Workers Compeassom lnsunna arien nai Policy number ate.
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section aced notbe completed If the Permit is for one hundred dollar ($IW)
or less)
I certify that in Ute part.. rce or the work for which this permit is issued. I Mall am
'
employ any Krone in any manner so u to become subject w the Worker' Compensation
Laws of Caliram a. Dam
Applicant
NOTICE TO APPLICAM: If, after making Nu Ceniftna of Exemption, you Mould
become subject to the Worker's Compensation provisions of the Labor Cade, you menu
forthwith comply with such provision or this permit shall W doomed rewked.
.
CONSfRUCnON LENDING AGENCY
1 Wreby aRtm that IICrt i.. conuroednn koding agency 0, Ne terforoance of
the work fm which this permit is issued (Sec. 3097, Civ. C.)
lenders Name
Lenders Add.
1 wary that I haw read aria application now seam then the aWw Womudw is
coney I agree to comply with all city and county oNinances and sok laws renting at
building construction, and herby mducien mpreumuisra of this city m enter upnn the
aWw-mentioned.repast fm in purposes
(We) ages to ssw, iMcmnify and keep harmless the City of Cupertino sign.
'
Krems
esrcnc.watch may In anY war •cc^u aguntsaid City
IiaMliuepaxonc
orthecoatiand
of thegranting or this Formal.
A
APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
WILL
Issued by: Date
SOURCE REGULATIONS. ,
Re -roofs
Sgnuurt of ApplacanUComrw:mr pate
HAZARDOUS MATERIALS DISCLOSURE
Type Of ROOF
Willy m handle
icon tar fmure Wilpal
Cg e. Chaptuore
u defined the Cupertino Smalous sh and Sterid
Ue Munid WI Cade. Chapter 9.12. and Use FIca1N and Sa(cly
Cade, 0Yen 25332(ap
om 32(.)7
❑Yes ON.
All roofs shall be inspected prior to any roofing material being installed.
Win the applicant m future bdiding occupant enc equipment m devicm which
If a roof is installed without first obtaining an ins ection, I agree to remove
g P
.1 bxnkon an conamitanss as defined by the Bay Aro Air Quality Management
all new materials for inspection.
❑Yes 0 N
I haw read the hvakous materials re lemements under Chapter 6.93 of the Califon
-
meHealth &Safely Cade, Section 25303.25533 and 25534.1tmahe end that doe Wilding
docs not currently haw a enant and, it u my nammmii ialy to Mary the am Ixem of the
miuiomenmWhich ambemepoor toutumlroofacmBfeamafacepoemy.
Signature of Applicant Date
All roof coverings to be Class 'W or better
Owner m authsrbed agent Date
CITY OF CUPERTINO
• 5 ITEMS OF 5 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35917003.00
DATE ISSUED.......: 09/22/2008
RECEIPT #.........: BS000006152
REFERENCE ID # ...: 08090145
SITE ADDRESS .....: 10311 DE ANZA BLVD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: JOHN TONG
ADDRESS ..........: 10311 S DE ANZA BLVD
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: JMB PLUMBING & CONS
CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096
COMPANY TBD - TO BE DETERMINED
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
is FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
1BPWATER
UNIT
1.00
40.79
0.00
40.79
0.00
1BPWSVCS
WATER SERVICE
1.00
20.40
0.00
20.40
0.00
lBSEISMICO
VALUATION
5,200.00
1.26
0.00
1.26
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
----------
144.03
----------
0.00
----------
144.03
0.00
METHOD OF PAYMENT
-----------------
CASH
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
1.26
142.77
---------------
144.03
VOICE ID DESCRIPTION
-------- ----------------------------
103 UFER
507 FINAL PLUMBING
REFERENCE NUMBER
--------------------
#4870
VOICE ID DESCRIPTION
-------- ----------------------------
106 SEWER & WATER
ZITYOF'
CUPEkTINO
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
PERMIT APPLICATION FORM
De?o10/c
APN # —3511-7 OO, 0 0
Fee ID
Da
2
Building Address:
Permit Type
6
1PCSEWER
Owner's Name:
ZZ k-1 1<, ^ 7�1, P W
P
Phorw#:
Y9 4�
Contractor:
1BPREPIPE
Phone#:yob
fw & 1v `-G
1CPRP
Fax #: 'e* Ef 3 /— o /
Contact:
Commercial Gas Piping System
1-4 Outlets
Phone #:
�5i 1-33?
r� i pc
p
Fax #:
Contractor License #: C� Q
IBSEISMICR
Cupertino Business License #:
p
Job Description:
IPRSEWER Residential building
sewer/sanitary sewer
eaJ,
1RPSS
Residential ❑ Commercial
Valuation:
`L
Project Size: Express Standard LJ Large LJ 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:
Quantity
Fee ID
Fee Description
Fee
Grou
Permit Type
1PCSEWER
Commercial building
sewer/sanitary sewer
P
1CPSS
1BPREPIPE
Commercial re -pipe per fixture
P
1CPRP
1PGASCOM
Commercial Gas Piping System
1-4 Outlets
P
1BSEISMICOM
Seismic Commercial
p
IBSEISMICR
Seismic Residential
p
IPRSEWER Residential building
sewer/sanitary sewer
P
1RPSS
r 1
CITY OF CUPERTINO
d' REPIPE/SEWER/MAIN SERVICE
CUPERT`INO FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
IPRREPIPE
Residential re -pipe per fixture
P
1RPRP
1BPWSVCS
Water Service
P
1CPWS or
1RPWS
1PPRSEWG
Private Sewage Disposal System
P
1PCESS
Cesspool
P
1BPWATER
Install/alter Water Pipe
P
1BPFIXTURE
Plumbing Fixture
P
1PGASRES
Residential Gas Piping System
1-4 Outlets
P
IBPGAS
Gas Piping. System 5+ Outlets
P
IPPERMITFEE
Plumbing Permit Fee Issuance
P
1PLMBLNCK
Plumbing Plan Check
P
1 PLMBINSP
Other Plumbing/gas Insp.
P
1TRAVDOC
Travel & Documentation Fee
B
1BUSLIC
Business License
B
Revised 6-16-08
•
0
C-
•
•
Plan Review Process Work Book Page -12-Revised 3/2.5/08
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 paints
11. Permeable Paving, Note
L•1
2 Dints
C.
Foundation
1.
Use 15 % Flyash Concrete, (note)
S-1
D.
Structural
3.
Uses Wood I -Joist, (See Spec.)
S-2
5 points
S.
Use Truss with heels, (detail)
S-2
2 points
2 points
6.
B. OSB Sheathing. detail
S-2
2 amts
E.
Ext. Finish
1.
Composite Decking, (Note/Spec.)
AJ
2 points
4.
B. Fiber Cement Siding, (Note/Spec.)
A-4
2 oinLs
F.
Plumbing
1.
Insulate all H.W. pipes, (Note/Spec.)
P-1
2 points
S.
Tankless W.H., (Note/Spec.)
A-2
2 points
11. A 2500 Gal. Tank, (Note/Spec)
L-1
10 Dints
G.
Electrical
4.
E. Ceiling Fans, (Note/Spec.)
A-3
4 points
H.
Appliances
1.
Energy Star Dishwasher, (Note/Spec.)
A-3
1 paint
3.
Enemy Star Refrigerator,(No te/S ec.
A-3
1 Dint
P.
Other 1
1.
List Green Features on Plans
A-1
1 paint
TOTAL POINTS
40 paints
•
•
Plan Review Process Work Book Page -12-Revised 3/2.5/08
Green Points Rating System for Remodeling Projects
Due to the diversify 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.
!1. Recycle Job Site Construction & Demolition Waste
2 Energy pts
Y --yes
65%=1 point; 75% = 2 points; 60%= 4 points
up to 4 Resource pts
2. Salvage Reusable Building Materials _ _ V _
_ 4 Resource pts
y --yes
3. Remodel for Mixed Use, Adaptive Reuse, and
B. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts
Historic Preservation
4 Resource pts
y=yes
4. Protect Native Soil
2 Resourceis
P
y --yes
5. Minimize Disruption of Existing Plants & Trees
1 Resource of
y=yes
6. Implement Construction Site Stormwater Practices
2 Resource pts
y=yes
7. Protect Water Quality with Landscape Design
2 Resource pts
y=yes
a Design Resource -Efficient, Landscapes and Gardens _
4 Resource pts
y=yes
9. Reuse Materials/Use Recycled Content Materials
12. Use OSB
for Landscape Areas
2 Resource pts
y=yes
10. Install High -Efficiency Irrigation Systems
2 Resource pts
y=yes
11. Provide for On -Site Water Catchment/ Retention
2 Resource pts
y --yes
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
2. Use Recycled Content Aggregate
3. Insulate Foundation/Slab before backfll
C. Structural Frame
.1. Substitute Solid Sawn Lumber with Engineered Lumber
2. Use FSC Certified Wood for framing
(For every 10% of FSC lumber used = 2 points, up to 10)
3. Use Wood I -Joists for Floors and Ceilings
4. Use Web Floor Trusses
3 Resource pts
up to 10 Resource
2 Resource pts y:
2 Resource pts y:
5. Design Energy Heels on Trusses 6' or more
2 Energy pts
Y --yes
B. Use Finger -Jointed Studs for Vertical Applications
2 Resource pts
y=yes
7. Use Engineered Studs for Vertical Applications
2 Resource pts
y=yes
B. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts
y=yes
9. Use Structural Insulated Panels (SIPS)
a. Floors
3 Energy pts
y=yes
b. Wall
3 Energy pts
y=yes
c. Roof
3 Energy pts
y=yes
10. Apply Advanced Framing Techniques
4 Resource pts
y=yes
11. Use Reclaimed Lumber for Non Structural Applications
3 Resource pts
12. Use OSB
y=yes
a. Subfe0(s
• b. Sheathing
1 Resource pt
1 Resource
y=yes
pt
y=yes
INPUT Resources Energy IAD/Heafth
xtenor Fins
1. Use Sustainable Decking Materials
a. Recycled content 3. Resource pts y=yes 0
b. FSC Cerfified 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 IAQ/Health pt y=yes 0
14. Use Fiber -Cement Siding Materials 1 Resource pt y=yes 0
E. Plumbing
j1. Install Water Heater Jacket
1 Energy pt Y --yes
2. Insulate Hot and Cold Water Pipes
2 Energy pts Y_—Yes
5. Retmfd all Faucets and Showerheads with Flow Reducers
a. Faucets (1 point each, up to 2 points)
Up to 2 Resource pts.
b. Showerheads (1 point each, up to 2 points)
Up to 2 Resource pts.
4. Replace Toilest with Ultra -Low Flush Toilets
1 Energy pt
(1 point each, up to 3 points)
Up to 3 Resource pts.
_ _ _ _ _ _
5. Install Chlorine Filter on Showerhead
1 IAQ/Health pt y=yes
6. Convert Gas to Tankless Water Heater
4 Energy pts y=yes
7. Install Water Filtration Units at Faucets
(2 points each, up to 4 points)
Up to 4 IAQ/Health pts.
8. Install On -Demand Hot Water Circulation Pump
4 Resource pis y=ye=-
r. eiecmcar
I1. Install Compact Fluorescent Light Bulbs (CFLs) .
L(6bulbs 2 points, 10 bulbs =3 points, 12 bulbs = 4 points) Up to 4 Energy pts.
2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to
5 points) Up to 5 Energy pts.
3. Install Lighting Controls (1 point per fixture, up to 4 points) Up to 4 Energy pts.
4. Install High Efficiency Ceiling Fans with CFLs
(1 point each, up to 4 points) Up to 4 Energy pts.
�1. Install Energy SarD-ishwashar j
1 Eneroy pt
•
12. Install Washing Machine with Water and Energy
0
D
D
0
Conservation Features
1 Energy pt
y=yes
13.lnstall Energy Star Refrigerator
G. Appliances
�1. Install Energy SarD-ishwashar j
1 Eneroy pt
y=yes
12. Install Washing Machine with Water and Energy
a. Walls 2 Energy pts y=yes
Conservation Features
1 Energy pt
y=yes
13.lnstall Energy Star Refrigerator
1 Energy pt
y=yes
4. Install Built -In Recycling Center
3 Resource pts
y --yes
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
No Added Formaldehyde 3 IAQ/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. Alternative Insulation Products (Cotton, spray -foam)
a. Walls 4 Resource pts y=yes
D
I). cemngs 4 Resource pts y=yes
C
0. Instail Energy -Efficient Windows
a. Double -Paned
b. Low -Emissivity (Low -E)
c. Low. Conductivity Frames
L install Low Heat Transmission Glazing
J. Heating Ventilation and Air Conditioning
i1. Use Dud Mastic on All Duct Joints
2. Install Ductwork within Conditioned Space
3. Vent Range Hood to the Outside
4. Clean all Ducts Before Occupancy
5, Install Solar Attic Fan
6. Install Attic Ventilation Systems
7. Install Whole House Fan
B. Install Sealed Combustion Units
a. Furnaces
b. Water Heaters
1 Energy pt
2 Energy pts
2 Energy pts
1 Energy pt
2 Energy pts
3 Energy pts
1 IAQ/Health pt
21AQ/Health pts
2 Energy pts
1 Energy pt
4 Energy pts
Y --yes
31AQ/Health pts y --yes
31AQ/Health pts y=yes
9. Replace Wall -Mounted Electric and Gas Heaters with
4 Energy pts
y=yes
Through -the -Wall Heat Pumps
3 Energy pts
y --yes
10. Install 13 SEER/11 EER or higher AC with a TXV
3 Energy pts
y=yes
11. Install AC with Non -HCFC Refrigerants
2 Resource pts
y=yes
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pts
Y_—Yes
13. Retrofit Wood Burning Fireplaces
1 Resource pt
y=yes
a. Install EPA certified wood stoves/inserts
•
1 IAQ/Health pt
y=yes
b. Install/Replace Dampers
1 Eneray pt
y=yes
c. Install Airtight Doors
1 Energy pt
y=yes
14. Install Zoned, Hydronic Radiant Heating
3 Energy pts
y=yes
15. Install High Efficiency Filter
41AQ/Health pts
y=yes
16. Install Heat Recovery Ventilation Unit (HRV)
5 IAQ/Health pts
yryes
17. Install Separate Garage Exhaust Fan
3 IAQ/Health pts
v=ves
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
4 Energy pts
y=yes
2. Install Solar Water Heating System
10 Energy pts
Y --yes
3. Pre-N9re for Future Photovoltaic (PV) Installation
4 Energy pts
y=yes
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2A kw =12 points, 3.6 kw =18 points)
Up to 1 B Energy
pts
8. Select Safe and Durable Roofing Materials
1 Resource pt
y=yes
7. Install Radiant Barrier
3 Energy pts
y=yes
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating 5 Energy pts
2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts
3. Plant Deciduous Trees on the West and South Sides 3 Energy pts
C1
J
;1. Usz LowMb-VOC Paint
Z Use Low VOC, Water -Based Wood Finishes
'3_ Use LowRJo VOC Adhesives
4. Use Salvaged Materials for Interior Finishes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
6. Use Exterior Grade Plywood for Interior Uses
,7. Seal all 6posad Frtidleboard or MDF -
6. Use FSC Certified Materials for Interior Finish
9. Use Finger -Jointed or Recycled -Content Trim
10. Install Whole House Vacuum System
N. Flooring
1. Select FSC Certified Wood Flooring
f2. Use Rapidly Renewable Flooring Materials -
3. Use Recycled i5ontent Ceramic Tiles
4. Install Natural Linoleum in Place of Vinyl
5. Use Exposed Concrete as Finished Floor
6. Install Recycled Content Carpet with Low VOCs
1 IAQ/Health pts
21AQ/Health pts
31AQ/Health pts
3 Resource pts
61AQ/Haalth pts
1 IAQ/Health pts
41AQ/Health pts
4 Resource pts
1 Resource pts
3 IAQ/Health pts
B Resource pts
y=yes
4 Resource pts
y --yes
4 Resource pts
y=yes
5 IAQ/Health pts
y=yes
4 Resource pts
y --yes
4 Resource ots
v=ves
Total Points Avails le:
Total Points Pro'ect Received:
0
1401 1301 57
01 01 0 •
�-.22-0&
3elersrgreenpointsfina12.12.e4pra1ected.z1s
0
E
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
631 „j -+
PERMIT #
009 C)
OWNER'S NAME: pLt--) o I k
PHONE # 96 -- 6
GENERAL CONTRACTOR l,.,i ,� _ 1
FAX # [ — b c,
\ Trwc-Ttp/J
I am not using any subcontractors:
i Date
Please check applicable subcontractois 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
Owner/ Contractor Signature
Date