09060076 CITE'OF CUPERTINO
BUILDING DIVISION PERMITTiR IO1MTI�N«
PERMIT NO.
BUILDING ADDRESS:
20304 NORTHGLEN SQ BLUE MCUNTATN ATR
PERMIT ISSUE DATE
OWNER'S NAME:
SA CONTROL NO.
r0
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
REMOVE & REPLACE FURNACE 60
u ad c a LICENSED CONTRACT'OR'S DECLARATION K BTU c 3% EFF AC Z T%b Description
V)= I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of the Business and ProfcfN' �ody�nd my license is
y in full force an _jnZ License lass LicCon
ARCHITECTS D RATI
tt -t I understand my plans shall be used as public records
jyU
W H Licensed Professional
n y-1 OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
p o following reason.(Section 7031.5,Business and Professions Code:Any city or county
3.e m V which requires a permit to construct alter.improve•demolish,or repair any structure
y H prior to its issuance,also requires the applicant for such permit to file a signed statement ,. Valuation
-Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 >q.Ft.Floor Area
YF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number
not more than five hundred dollars($500).
❑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 Required Inspections
and Professions Code:The Contractor's License Taw 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 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 the burden of proving that he did not build 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-
ccnse Law does 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.
❑I am exempt under Sec. B&P C for this mason
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 Workces Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued
My Workeeess�Compensation Insurance carrier and Policy number ate: s�
Carrier./'ICI C Policy No.:
RTIFICATE OF EXEMPTION FROM ORKEITS'
COMPENSATION
S'
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 manncr 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
O forthwith comply with such provisions or this permit shall be deemed revoked.
Z, CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
(x the work for which this permit is issued(Sec.3097.Civ.C.)
W QLender's Name
0Z
Lender's Address
V C) I certify that I have read this application and state that the above information is
;Z~H correct.I agree to comply with all city and county ordinances and state laws relating to
O V building construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
E (We)agree to save,indemnify and keep harmless the City of Cupertino against
r�r tM liabilities,judgments,costs and expenses which may in any way accrue against said City n
V Z in consequence of the granting of this permit. Date
►-t APP NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SO REGULA NS.
��J-J� Re-roofs
Signature of ApplicanVConuactor Date
HAZARDOUS MA LOSURE Type of Roof
will the applicant or future building occupant store or handle hazardous material
as deft by the Cupertino ipa1 Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(7)? All roofs shall be inspected prior to any roofing mater 1 being installed.
❑Y� No
Will the applic or future building occupant use equipment or devices which
If a roof I's installed without first obtaining an inspec Iegree-to remove
emit hazardous air co taminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes o
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs rcntly have a tenant,that it is my responsibility to notify the occupant of the
re ts which m t be r to issuance of a iu fl of Occu ancy. Signature of Applicant Date
` Z All roof coverings to be Class rte"or better
Owner or authorized agent Date
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
uCITY OF Fax(408)777-3333
v V PES\! 'NO
Buildin De artment
JOB ADDRESS: PERMIT #
-z 0.30Y x/0 r f 1�� 61)4,a 7.6
OWNER'S NAME: u i-f osL,4 PHONE #yo,'- Vi i'&
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: -/Z-
Si;natur 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 C)z 2 bCJt�
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
0 /Z' 2 6y y'
Owner/Con ctor S' ature Date
CITY OF CUPERTINO
FURNACEAC
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
62 0 �'
Owner's Name: Phone#:
Contractor: Phone#: 70 7_- �
—B j t)e 4 4 c c`r 1 Fax #:
Contractor License#: Cupertino Business License#:
&--)
Z q &620
Contact: // Phone#: 70;7- eal
Fax#: 707-- y-I&- 70 Z L—
Building Permit Info:
Elect ❑ Plumb ❑ Mech
Residential Commercial
Job Description:-/j 471 c5�v p `0 K 13 (l Y J t L2 '
A c, Z ;o� , s c<� -�,b K s
For Residential Installations:
Attic ElI" floor 2°d floor El
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: 5-3 cyo Type of Construction (Usage Class):
Strapped On Platform ❑ Bonded New Location Replacement
Valuation. S3(�
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. /0
CITY OF CIUPERTINO
FURNACEAC
Of
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FUP N/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,at sorption or
evaporative coolir,g system,incl
installation of controls regulated by this
code.
I MCREPALT Commercial for the repair of alt/add to M
ea heating appliar ce,refrigeration
unit,cooling unit,`IAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Commercial InstalURelocate ea M
suspended heater,recessed wall htr, or
floor mounted un,t heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1 BPGAS For each gas pipi:lg system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of e,,L appliance vent
installed ¬ incl in an appliance
permit.
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliaace,refrigeration unit,
cooling unit,abscrption unit,or ea
heating,cooling,z.bsorption or
evaporative cool:ng system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed.wall htr, or
floor mounted ujiit heater.
1MRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install ¬ inc: in an applpermit.
CITY OF 4.UPERTINO
FURNACE/AC
cloof
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1PGASRES Residential for :,a gas piping system of P
1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet,
1BSEISMICR Residential Sel3mlc B
1MECPLNCK Mechanical Plan Check M
I 1MFR=<1 00 Furnace Syst<=100k BTU install or M
relocate ea forced-air/gravity type
furnace burner, incl ducts/vents
attached to such appliance up to and
include 100,000 Btu/h
1MFRN>100 Furnace Syst> 100k BTU install or M
relocate ea fore;ed-air/gravity type
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
1 EPERMITFEE Electric Permi:Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Pennit P
1 TRAVDOC Travel Docurr.entation B
1BUSLIC Business Lice ase B
M
CITY OF CUPERTINO
" FURNACE/AC
CUPEi�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Grou
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A/C Units <= l Ok CFM B
1MCRAA Commercial Mech Repair/alt/add M
1BSEISMICO Seismic Commer6al B
IPGASCOM Commerical for ea gas piping System P
1-4 outlets
1PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piling system of 5 or P
more per outlet. C;omm/Resid
1BREMAIRHAN Residential A/C louts<= 1O CFM B
1 MRRAA Residential Mecr Repair/alt/add M
1BSEISMICR Seismic Residential B
IEPERMITFEE Electric Permit E
1 MPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License " B
o3LoV- /V
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, (no-e) 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/Spey:.) A-3 2 points
4. B. Fiber Cement Siding, Note/:' ec. 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'S ec. A-3 1 point
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 40 points
lo '��s
Plan Review Process Work Book. Page-12-Revised 3/25/08
INPUT Resources Energy A!
I.Windows
1.Install Energy-Efficient Windows
a.Double-Paned 1 Energy pt Y=YeS 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yeq1 0
c.Low.Conductivity Frames 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 01 1
. 1 1 i
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
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts y=yes 0
8.Install Sealed Combustion Units
e-- a.Furnaces 3 IAQ/Health pts y=yes 3 0
b.Water Heaters 3 IAQ/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 3 0
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes z 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 'Z 0
13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stoves/inserts 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 D
15.Install High Efficiency Filter 4 IAQ/Health pts y=yes D
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yesl 0
' 1 1 1
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 Materials 1 Resource pt yges0
7.Install Radiant Barrier 3 Energy pts y=yes 0
' 1 1 1
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 • IAQ/Health
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2*IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health 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 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0
B.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 IAQ/Health pts y--yes I0
. 1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 1 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 1 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health 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
1 1 1
Total Points Available: dq 74 140 1301 - 57
Total Points
Project Received: 01 0 0
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