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09050148CITY OF CUPERTINO BUILDING DIVISION PERMIT�� BUILDING ADDRESS: 10387 A OWNER'S NAME: foo �U 'may 3tU3 r. U 7: W F Z0` qAqy� ia0 Kmr� yza FFC' LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business anqgrofessions Code, and Jmy license is in full force and effect. f/ (_Ir [ License ClLic• M Date Contrsctor ARCHITECTS DEC 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm drat I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements arc not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 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- ccnse Law docs not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 0 I am exempt under Sec B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self -insure for Workees Compen- on, as provided for by Section 3700 of the Labor Code, for the performance of the ..ork for which this permit is issued. 0 I 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 arc: Cartier. S o► f W e 14 ! t4 4Z _ Policy No.: � � � � � 2 CERTIFICATE OF EXEMP71ON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($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 so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: if, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must `%, forthwith comply with such provisions or this permit shall be deemed revoked. O z� Qr Q Z)z UO LT. E, OV a U CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct 1 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 upon the above-mentioned property for inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgmen costs and expenses which may in anyway accrue against said City in consequence of ranting of this permit. APPLICANT U D RSTANDS AND WIL OMPLY WITH ALL NON -POINT SOURCE REGU ONS. 2 .01 rz Signature pplicant/Contractor Eale T HAZARDOUS MA ALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code. Section 25532(a)? 0 Yes KNo Will the applicant or future building occupant use equipment or devices which shit hazardous air contaminants as defined by the Bay Area Air Quality Management strict? 0 Yes NO 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safcty , Sections 25505.25533 and 25534.1 undcrsaml that if the building does not currently a tenant, that it is myptTopnsibility to notify the occupant of the requirements whi must be met prior to isspn5,bf a Certificate of Occu cy. 15722 6/0 Owner or Job Description WINDOWES & DOORS REPLCMNT Sq. Ft. Floor Area 3424504 0.00 Issued b: Re -roofs Type of goof Number Required Inspections Valuation Occupancy "Type All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new lnaterials for inspection. Signaturs of Applicant All roof coverings to be Class','jg•'' or better Date NO. D 090r)01 4RPERMIT PERMIT ISSUE DATE S A CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description WINDOWES & DOORS REPLCMNT Sq. Ft. Floor Area 3424504 0.00 Issued b: Re -roofs Type of goof Number Required Inspections Valuation Occupancy "Type All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new lnaterials for inspection. Signaturs of Applicant All roof coverings to be Class','jg•'' or better Date 7-17 �: CUPETIN CITY OF CUPERTINO GENERAI� BUILDING PERMIT APPLICATION FORM (-po's �r APN #�� [55ia�t�e:260 I? Building Address: /03-94 ALle"ICI , LP1- Mailing Address (if different from building address): Owner's Name: Jo V1 'S h Q 11 Phone #: Lr p $ 2S — 6 p y HOA: (Exterior work only) Yes ❑ No W If yes, provide letter from HOA Phone: s239-0011 Contractor: UU11 W. COUSifUCi(oVi Fax: CSO F39-00(0 Contractor License #: 6 p /-1 Gr / Cupertino Business License #: Contact: m S rn d Phone: g S U Fax: Residential Commercial El Job Description: ...� �e�'�ac.ev4e►� l� 1'Wow s qual c�loo(� Building Permit Info: Bld Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B II/III/V-A F1 II/VI B, IV -HT, V -B , 7 Valuation: /4 Square Footage: ( i V V Project Size: Ex ressdard Lar c Ma or 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.buildit reen.or Revised 02/05/09 CITY OF CUPEkTINO CITY OF (�UPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1 STUCOAP Stucco Applications (up to 400 sf) additional stucco application B 1 WINREP Replacerr. ent windows/sliding glass door (ea 3 windows) B 1WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B 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 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M I PLMBLNCK Stand Al ane Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -sl and alone B % / 1 BCBSC Cal BWE Standards Commission Fee B ALL PERMIT TYPES I BSEISMICR Seismic Residential B IBSEISMICO Seismic Commercial B I TRAVDOC Travel & Documentation B 1 BUSLIC Busines ; License B 5 of 5 1. Install Energy-Effiderit Windows a. Dm bie-Paned I Energy pt y=yes b. Lma*s** (LM -E) ? Energy pts y=yes c. Low. Gouty Far+nes 2 Energy pts y=yes 2. Install Low Heat Transmission Glazing 1 Energy pt y=yes J. Heating Ventilation and Air Conditioning 1. Use toot Mastic on AM fit Joints 2 Energy pts Y=Yes 2. Install Ductwork within Conditioned Space 3 Energy pts y=yes 3. Vent Range Hood to the Outside 1 IAQ/Health pt y=yes 4. Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 5. Install Solar Attic Fan 2 Energy pts y=yes 6. Install Attic Ventilation Systems 1 Energy pt y=yes 7. Install Whole House Fan 4 Energy pts y=yes'. 8. Install Sealed Combustion Units 51AQ/Health pts y=yes a. Furnaces 3 IAQ/Health pts y=yes b. Water Heaters 3 IAQ/Health pts y=yes 9. Replace Wall -Mounted Electric and Gas Heaters with 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 10 Energy pts y=yes a. Install EPA certified wood stoves/inserts 1 IAQ/Health pt y=yes b. InstaIVReplace Dampers 1 Energy 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 4 IAQ/Health pts y=yes 16. Install Heat Recovery Ventilation Unit (HRV) 51AQ/Health pts y=yes 17. Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 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 -Wire for Future Photovoltaic (PV) Installation 4 Energy pts y=yes 4. Install Photovoltaic (PV) System (1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw = 18 points) Up to 1 B Energy pts 6. 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 y=yes 2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes 3. Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 1. Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes 3. Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea 5 IAQ/Health pts y=yes Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7. Seal all Exposed Parbcleboard or MDF 4 IAQ/Health. pts y=yes 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y=yes N. Flooring 1. Select FSC Certified Wood Flooring 3 Resource pts y=yes 2. Use Rapidly Renewable Flooring Materials I Resource pts y=yes 3. Use Recycled Content Ceramic Tiles t Resource pts y=yes 4, Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 1 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 1 Resource pts y=yes Total Points Available: Total Points Project Received: X 1401 130 57 1 S 01 0 0 G:data/progs/greE:nbuildingguidelines/remodelers/greenpointsfina12.12.04protected.xls 2 CITY OF DUH TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # ©�oSv/�( � OWNER'S NAME: n4 �"_ '' G Q vt PHONE # d .So 9? - 3 r 0 Y GENERAL CONTRACTOR: q? L4 2 { j w _ Co k 5 t r , FAX # K I am not using any subcontractors: 12 G `© g Signature Date anti onm n1Pte the following information: ,- S aC � - Z_4�Owner/ Contractor Signature Date SUBCONTRACTOR BUSI14ESS 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 ,- S aC � - Z_4�Owner/ Contractor Signature Date 2..Pw 2g�1� X21S�a 2 3, P� Pw LY r kA 1 2 1 t -t o(ok/ I 11 1 y�•t K d� C 00. for Ch�lu�C �, )c LID ► � x� S �'($ / C) t ID Ll Py xLOO �$ L'/k x �6 ��$ -t 1�. pw 28% x 5212-1 U �� ting e --4 2 3 1-�2 ►-- �_ 6• �'� 6' � G . of �1uo(ow5 3 a'ooTS Tep(acxwreu )166 -� o ' ( K -e'- �0 V EL4( (YO GIt- /Y 13 PT 'CUA ;16N' an ted it is ur' i S Put) v hageP C? u'jtOn �. 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