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09100154CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10200 MILLER AVE BLDG G CONTRACTOR: TBD - TO BE DETERMINED PERMIT NO: 09100154 OWNER'S NAME: RODNEY BERGMAN DATE ISSUED: 10/22/2009 OWNER'S PHONE: 8018152469 PHONE NO: L LICENSED CONTRACTOR'S DECLARATION j f—r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # MECH I- RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: CREATE AN 8SQFT SPACE FOR A (commencing with Section 7000) of Division 3 of the Business & Professions WASHER/DRYER IN AN Code and that my license is in full force and effect. EXISTING CLOSET 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $9600 I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 37503005.BLDGG Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs, and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Issued Datel' G Signature Date RE -ROOFS: OWNER -BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed. If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection, I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation, as provided for by Section 3700 of the Labor Code, for the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I have and will maintain Worker's Compensation Insurance, as provided for by Safety Code, Section 25532(a) should I store or handle hazardous material. Section 3700 of the Labor Code, for the performance of the work for which this Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued, I shall Health & Safety Code, Sections 25505, 25533, and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I Own",orjoed agent: become subject to the Worker's Compensation provisions of the Labor Code, I must Date: G �" forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued (Sec. 3097, Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities, judgments, Cr Ind expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION g g of this pe t. Additionally, the applicant understands and will comply with all non-poin so regulations per the Cupertino Municipal Code, Section I understand my plans shall be used as public records. 9.18. 7 Q� �/ Licensed Professional Signature Date CITY OF CUPERTINO CITY OF CUPERTINO ADDITION/REMODEL PERMIT APPLICATION FORM � i kD Q_ APN #3 A 6 L� G-- Gr � Date: � 0 Is a 2" unit being added? Yes [JNo If yes, please fill out the permit application for 2" unit. Building Address: l o? -0O 11 Mailing Address (if differe� from building address): 1✓ Owner's Name: Op N �,/ Fe�n�l rt/�/ Phoe # : _ V / v - --)- 1 Contractor: Phone #: ile ap ct _ / —d -;LZ Fax #: Contractor License Cupertino Business License #: Contact: �i sa Phone #: il-dk a-© 9— 1 Nl "s Fax #: Building Permit Info: Bldg. L_- Elect. Plumb. Mech. ❑-- Hillside ❑ Job Description: Addition -What is being added?(Be Specific): What is being remodeled (not including addition)? ORVI�' AfJ �5, (,; rprz 7k I vC -c� l K),er OwStT . Remodel Includes Re -Roof: Yes ❑ No If yes list number of squares Remodel Includes Structural: Yes ❑ No Do you have the pre -application planning approval? Yes ❑ No ❑ If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath Other Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/IIl/V-A ❑ IUIII B, IV -HT, V -B �L_3 Valuation: 1,(i00 Please check this box if the project is a second -story addition ❑ Project Size: Express M Standard ❑ Large ❑ Major ❑ Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, Green Building Points Achieved: include in plan set & the sheet index. ***For Office Use Only*** Over -the -Counter ❑ Revised 07/06/09 CITY Of CUPEkTINO CITY OF CUPERTINO ADDITION/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type ADDITIONS 1R3SFDADD 1 PLLONGRNGR Long Range Planning/Residential PL 1 R31NSP Dwellings Inspections B 1R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat Inspection B 1R3REPPLNC Dwellings Repeat Plan Check B 1 R3HINSP Dwellings Hillside ins ection B 1R3HPLNCK Dwellings Hillside plan check B 1R3HREINSP Dwellings Hillside Repeat Inspection B 1R3HREPLNC Dwellings Hillside Repeat Plan Check B 1R3ALTINSP Dwellings Alternate Materials Inspection B 1 R3ALTPLNC Dwellings Alternate Materials Plan Check B 1PCESS Cesspool P 1PPRSEWG Ea. Private Sewage Disposal System P 1 PRSEWER Sewers P 1BPSPRINK Lawn Sprinkler/Backflow P 1BPWSVCS Main Water Service P 1 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES I IBSEISMICRE SeismicResidential B 1RER00FRES Residential Re -roof Each 100 SF B CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1 REMRES2 Remodel Residential Greater than 1000 sq ft B 1REMRES3 Remodel Residential Greater than 2500 sq ft. B 1REROOFRES Residential Re -roof Each 100 SF B REMODEL PLNCK ISTPLNCK (1-3 for remodel) Standard Plan Check B NOT FOR OVER THE COUNTER PLAN CKS. WINDOW/SLIDING 1R3SFDREM GLASS DOOR 1 WINREP Replacement windows (ea 8 windows) B 1 WINNEWNSTR New Window (non- structural) B 1WINMEWSTR New Window (Structural Shear Wall/Masonry) B 1 WINBAYSTR Bay Window (Structural) B SKYLIGHTS 1R3SFDREM 1 SKYL<10 SF Skylight less than 10 sf B 1SKYL>10SF Skylight greater than 10 sf or structural B 1STAIRS Stairs -first flight/ea addt'l 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 CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft DECKS 1R3SFDADD OR 1R3SFDREM 1DECKWOOD Deck (Wood) -Each B (Each) 1 DECKRAIL Deck Railing -Each B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1 GARDTW<=1 K Wood Frame up to B 1,000 SF (each) 1 GARDTM<=1 K Masonry up to 1,000 SF B (each) 1BCONSTAXR Construction Tax Res (new detached garage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1 PATIOWOOD Wood Frame up to 300 B SF 1 PATIOMETAL Metal Frame up to 300 B SF 1PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1PATIOENCLW Enclosed Wood up to 300 B SF 1PATIOENCLM Enclosed Metal up to 300 B SF 1PATIOENCLO Other Enclosed Patio up B to 300 SF 1 COVPORCH Porch Covered -Each B (Each) REMODELS 1R3SFDREM 1REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check 1REMRESBAT Bath Remodel up to 300 B " SF 1REMREOTH Other Remodel up to 300 B c� SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1 MECPLNCK Stand Alone Mechanical Pln Ck (hourly M 1PLMPLNCK Stand Alone Plumbing Pln Ck (hourly) P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1TRAVD0C Travel & Documentation B 1BUSLIC Business License B Plan Review Process Work Book Page -12-Revised 3/25/08 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 i�.- .. �.. f:� -.. .,.. �•� ' :t45;'.IYi ��' ._. MR 'A.. .. I �45-4" YY'. . , J4: �. � � i Y.x ... 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 TOTAL POINTS 40 points Plan Review Process Work Book Page -12-Revised 3/25/08 f 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. 1. Recycle Job Site Construction & Demolition Waste 65 = 1 point: 75% = 2 points; 80% = 4 points 2. Salvage Reusable Building Materials 3. Remodel for Mixed Use, Adapbve Reuse, and Historic Preservation 4. Protect Native Soil 5. Minimize Disruption of Existing Plants & Trees 6. Implement Construction Site Stormwater Practices 7. Protect Water Quality with Landscape Design B. Design Resource -Efficient Landscapes and Gardens 9. Reuse Materials/Use Recycled Content Materials for Landscape Areas 10. Install High -Efficiency Irrigation Systems 11. Provide for On -Site Water Catchment / Retention 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 backfill 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 ]-Joists for Floors and Ceilings 4. Use Web Floor Trusses 5. Design Energy Heels on Trusses 6° or more 6. Use Finger -Jointed Studs for Vertical Applications 7. Use Engineered Studs for Vertical Applications B. Use Recycled Content Steel Studs for Interior Framing 9. Use Structural Insulated Panels (SIPS) a. Floors b. Wall c. Roof 10. Apply Advanced Framing Techniques 11. Use Reclaimed Lumber for Non Structural Applications 12. Use OSB a. Subfloors b. Sheathing up to 4 Resource pts 4 Resource pts y=yes 4 Resource pts y=yes 2 Resource pts y=yes 1 Resource pt y=yes 2 Resource pts y=yes 2 Resource pts y=yes 4 Resource pts y=yes 2 Resource pts y=yes 2 Resource pts y=yes 2 Resource pts y=yes up to 5 Resource pts 2 Resource pts y=yes 3 Energy pts y=yes 3 Resource pts y=yes up to 10 Resource pts. 2 Resource pts y=yes 2 Resource pts y --yes 2 Energy pts y=yes 2 Resource pts y=yes 2 Resource pts y=yes 2 Resource pts y=yes 3 Energy pts y=yes 3 Energy pts y=yes 3 Energy pts y=yes 4 Resource pts y=yes 3 Resource pts y=yes 1 Resource pt y=yes 1 Resource pt y=yes E 0 D I IN 4111:4 1513.1 is I M INPUT Resources Energy IAWHealth 1. Use Sustainable Decking Materials 1 Energy pt y=yes 2. Insulate Hot and Cold Water Pipes a. Recycled content 3 Resource pts y=y1 b. FSC Certified Wood 3 Resource pts y=y( 2. Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health pt y=y( 3. Install House Wrap under Siding 1 IAQ/Health pt y=y( 4. Use Fiber -Cement Siding Materials 1 Resource pt y --yes E. Plumbing 1. Install Water Heater Jacket 1 Energy pt y=yes 2. Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 3. Retrofit all Faucets and Showerheads with Flow Reducers 5 points) 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 4. Install High Efficiency Ceiling Fans with CFLs (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 1. Install Energy Star Dishwasher (2 points each, up to 4 points) Up to 4 IAQ/Health pts. B. Install On -Demand Hot Water Circulation Pump 4 Resource pts y --yes r. tiecrncai 1. Install Compact Fluorescent Light Bulbs (CFLs) (6 bulbs=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 0 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. G. Appliances 1. Install Energy Star Dishwasher 1 Energy pt y=yes 2. Install Washing Machine with Water and Energy Conservation Features 1 Energy pt y=yes 3.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 b. Ceilings 2 Energy pts y=yes 2. Install Floor Insulation over Crawl Space 4 Energy pts y=yes 3. Install Recycled -Content, Fiberglass Insulation with No Added Formaldehyde 3 IAQ/Health pts y=yes 4. Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 5. Use Cellulose Insulation a. Walls 4 Resource pts y=yes b. Ceilings 4 Resource pts y=yes 6. Alternative Insulation Products (Cotton, spray -foam) a. Walls 4 Resource pts y=yes o. Ueilings 4 Resource pts y=yes C � 0 0 C o Q � C r 1. Install Energy -Efficient VYindows 2 Energy pts a. Double -Paned 1 Energy pt y=yes b. Low -Emissivity (Low -E) 2 Energy pts y=yes c. Low. Conductivity Frames 2 Energy pts y=yes 2. Install Low Heat Transmission Glazing 1 Energy pt y=yes J. Heating Ventilation and Air Conditioning 2 Energy pts y=yes 1. Use Duct Mastic on All Duct 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 3 IAQ/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 a. Install EPA certified wood stoves/inserts 1 IAQ/Health pt y=yes b. Install/Replace 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) 5 IAQ/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 18 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 4 Resource 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 Particleboard 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 8 Resource pts y=yes 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 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 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes Total Points Available: Total Points Project Received: 1401 1301 57 b0 00 v0 °9 G:datalprogslgreenbuildnoguidelineslremodelerslgreenpointsfinal2.12.D4protected.xls - CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: P -OD E PHONE # WWL-- e�4-,/P GENERAL CONTRACTOR: FAX # -R3 -V I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 2, 2 ?lo Owner/ Contractor Signature Date 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 4. 2, 2 ?lo Owner/ Contractor Signature Date