08090008 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,CONiTR".11 TQR I1�{FgQ, MATA,,O, N'�n,.
eUIID1NG O FSS: PERMITNO.
J2��.� W ESTATES DR AAA FURNACE & AIR 08090008'
OW NER'S NAME: PERMIT ISSUE DATE
DAWN Kl1AN 1712 STONE AVE 09/03/2008
NE (408) 293-4717 SANITARY NO. CONTROL NO.
ARCHITELTrENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 O
LICENSED CONTRACTOR'S DECLARATION O O O
8 1 hereby amore dust 1 am Iimued under provisions of Chapter 9(commencing Job Description
ire sceuon 701knofDimiumi 3arthe Budnessarrd Pm@sdmu code.and my Beets REPLC WATER HEATER
n'�a
, f ronx and Jen
ueense IAsa Lte.d —
��� Date 4 Contractor
pp ARCHITECTS DECLARATI I
C i 1 undersand my plans shall W used as public rectrds
Dgu
g C t; Licatad Professional!
5 OWNER-BUILDER DECLARATION
E 1 hereby anion that I am excmps form use Contractor's License Law for arc
E no following meson.(Section 7031.5,Bud a Ptofesdou Cade:My city.munty
3
SO! which requires a permit m commueL alter.Wpmve,demolish.or repair my muclum
_Zw prior to is esurence.em,requites the applicant forfuch permit in file a signed statement
�o
due he a licensed founincent to ft Provisions of the Coronation's Licerm Law(Chapter 9 Sq.Ft. Floor Area Valuation
$ (commencing with Secon701ofDivision 3ofthe Business and Professions Code)or $1168
�.- that he I.exempt theref om and then basis for th alleged exemption.Any violation of
Section 7031.5 by nary applicant for a permit mbjecu the applicant an a dwl penalty ofNumber Occupancy T
ret more than fsw hundred dollars(S500) 36923037 . Pane Y YPe
❑1,u owner of she mom'rtY,a reY.oployeea wW red.u Ne'v sole compewtion,
win do the work.and roe stmrmure is net intended or uncured fords(Sec.70th.Becomes
and Porferadons Code The Conocu's License,law dens not apply an an own.of .- Required Inspections
Property who builds.i exons thereon,surd who docssuclr work himm3!m though his
own employer,PmWded that such impmsereerns are not imnoded or onret for ale R.
however,the Wilding or Improvement is sold within one rev of completion.the owner.
a deer NB law du buNm of porting that M did not Wild or immose for purpoa of
au.).
0 1,an owner of tins Pormrty,am cxdudwly connecting with licensed eontreeun in
construct the pmjea(See.7044.Business and Pmressiou Cade,)The Cmvacmr's U.
cease Law does not apply in an owner or property who Wilda ear improv.Neeson.ad
who contracts for such projects with a eomaclan(s)licensed persons in the Contractor's
Lk.ue law.
0 lamuempsunde See ,BdPCforthumasoo
owner Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of tie following declarations,
I haw and will reainain a Ceninote ofComent N self-ivme for Workers Canter.
.it.,as provided for by Section 3700 of the Labor Code.for the performance of use
were for which this permit is iaued. _
0 1luw and will maintain Worker's Compensation Insurance,as inquired by Section
37fI0of the Labar Code.for the pcuformance of da work for which this permit is issued.
My Wolan's Compen"donI/u-u�rana carrier and Policy number arc:
Cartier. fe LEI/lf Policy No.n �. _
T�'11 I&TEE�O X�MMON FRO ORP. RS'
COMPENSATION INSURANCE
(ThHacNo reed mthecamputed Ron Permit isformu hundred dollars($100)
or ka)
I certify that in Nc mrf.m.of Ne work for which she perms is bound,I Met nm
employ any peran in any manncr so as to Income subject in NC Wmkrn'Componsatio
Laws of Califom as.Date
Applicant
NOTICE TO APPLICANT:If,after making this CcniEeste of Exemption.you Nnuld
Wean--him in NC WorkCrs Campenultiun foursome,of Ne L abw Cadi%you re1W
.J Z faMwith comply with such provisions or this remit shall W deemed kraoked.
P O CONSTRUCTION LENDING AGENCY _
[-+ Iherebyanon Nat thre iso crermuctimm lending.,ocy for the P onmanceof
Ci the work for which esus permit u bund(Sec.3097,Cl,C.)
W 0 Lenm:
Lender's Name
'
O z Lenders Address
U O I mtify that 1 haw read this applicadon and sou the the show hdomatim I,
com=1 agree in comply with all city and county ominwaxs and sum laws relating to
.O U Wilding construction,and hereby mNorim representatives of this city in enter upon tic
V1 aWw-mc Judgments.
dgmpmpertyst for inspeao purpova
1„r P. (We,)aZ.to saw.indemnify ad kap bureau an Csy of Cupertino against
fA in
Jues.ofh,gisid,expnu.which may In any way anweagdna said City
U z in consequence of the dranunB of this permit,
'--' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date U {'-,
SO CE REGULATIONS.
4V44 I/ ZCl/
w Re-roofs
ienaare afApp ican cta Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
MU did"ficaut fuace Wadinge.occureart ptsawmandth hazardous material
u ut.denoulSec by th Cupertino Municipal Code.Chapter 9.11.and the HcaIN and Safely
Cade,Section 23532(x)? '
❑Yes No All roofs shall be inspected prior to any roofing material being installed.
�C
Will Ne,applicant or farere lding occupant use equipment or dcvlmts which If a roof is installed without first obtaining an inspection,I agree to remove
bui
District?huardoo dr conaminsnu as dinned by tie Bay Area Air Quality Management, all new materials for inspection.
0Yu
I haw mad ftha sdourials requirements todm Chapmti.95 ofthe Califer.
nice HealNk SafctyCadc,lectons 25505,25533 and 23534.1 undersand Nntifthe Wilding
does not currently how a uonL caw It Is my responsibility to naufy tic aceupant of th
.qui u which mmol W met prior m iavana of a caur=u of cx a ..
Signature of Applicant Date
oilrnermauth., All roof coverings to be Class npa,or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # . 1
Sec : Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 36923037 . 00
DATE ISSUED. . . . . . . : 09/03/2008
RECEIPT # . . . . . . . . . : BS000005974
REFERENCE ID # . . . : 08090008
SITE ADDRESS . . . . . : 10833 W ESTATES DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER DAWN KUAN
ADDRESS . . . . . . . . . . : 10833 W ESTATES DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4537
RECEIVED FROM . . . . : JIM RANDO
CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050
COMPANY AAA FURNACE & AIR CONDITIONING
ADDRESS . . . . . . . . . . : 1712 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 293-4717
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- --- - ---------- ----------
li3SEISMICR VALUATION 1, 168 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
].PRWHEATR UNITS 1 . 00 24 . 48 0 . 00 24 .48 0 . 00
1TRAVDOC 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
agog ooc4
CITY OF CUPERTINO
WATER HEATER
OF
•CUPERTINO PERMIT APPLICATION FORM
APN # 3 / n a �� -� J J Date:
Building Address: _
104'33 /f/, �Yi9Ttr �r IUL
Owner's Name: Phone #: a /
Contractor: Phone #:
!/ C Fax #:
Cupertino Business License #: Contractor State License #:
Contact: Phone #: o
-� t` d'
Z e6 Fax #:
Buildin Permit Info:
Bldg Elect [ -- Plum] Mech [71�--
Residential Commercial ❑
Job Description:
lefil/eZG-?
Strapped Q On Platform ❑ Bonded L/ ---New Location ❑ Replacement ❑'
Valuation (cost of project):
lo' .Ply
P oject 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 o
d' WATER HEATER
COF
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
IBSEISMICOM Seismic Commercial B
IPRWHEATR Residential Water B PRWHEATR
HeaterNent
1BSEISMICRE Seismic Residential B
IPPERMITFEE Plumbing Permit P
l
r 1TRAVDOC Travel & B
1 Documentation
1BUSLIC Business License B
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
.z.
B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 72points
11. Permeable Paving, Note L-1 C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 5. Use Truss with heels, (detail) S-2 6. B. OSB Sheathin detail S-2
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 oint
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 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.
n
INPUT Resources Energy AG/Health
A.Srte � .Sl�q
1.Recycle Job Site,Constiuction&Demolition Waste .
65%=1 point;75%= 2 points;80%=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 Stormwaler 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 I 1
B.Foundation
1.Incorporate Recycled Flyash in Concrete
• 25%Recycled Flyash=2 points;Add 1 point for every 10%
increase of fiyash,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=yesF F 0
1 1 1
C.Structural Frame
1.Substitute Solid Sawn 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 Resource pts 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
8.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Ener
b.Wall 9Y Pts Y=Yes 0
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.Subfloors 1 Resource pt y=yes 0
• b.Sheathing 1 Resource pt yges 0
-- INPUT Resources Energy M011realth
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=yes 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 7
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
a.Furnaces 3 IAQ/Health pts y=yes 0
b.Water Heaters 3 IAQ/Health pts y=yes 0
9.Replace Wall-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 a 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.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stoveslnserts 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/Heaith pts y=yes 0
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=yes 0
1 1E
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=15 points) Up to 18 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
10300 Torre Avenue
Cupertino CA 95014
f
Telephone(408)777-3228
CITY OF Fax(408)777-3333
`UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
/o is e vE 0F0 ?7000do--
OWNER'S NAME: ,v 4v PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: O f
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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