08030184 CITY OF CUPERTINO �± �¢ "CT
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BmLDirvcorvlstoN PERMIT CONTR�AGKTORINFURMATYp�PI
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Bu1LgiT11TESNERKSHIRE CT WATER HEATERS ONLY "'08030184
OWNER'S NAME: PERMIT ISSUE DATE
DEVANG VASAVADA 970 E MAIN ST 03/31/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHI'IEC(ENGINEER: BUILDING PERMIT INFO
REPLC WATER HEATER 75 GAL BLDG ELECT PLUM a MECH
O O O O
.in IacENInCONIRACOR'SDEcuRATION IobDescrinon
e 1 Maeby affirm WI iun licensed under provisions of Chapter 9(commencing p
tz with Section 7010)of Division S of Ne Business and Professions Code,and my license is
u in full forte and effem C'p/ (Is7
519 Llcenu C . ✓V Lk.N
' Dau CTS DEu
ARCHITECT'S DECLARATION
I understand my plans shall W used As public=soma
�yU
yo Licensed Professional
y OWNER-BUIIDER DECLARATION
COS hereby.(Sero that 1 1. exempt from the Caths Co License Law for the
COO o following reason.Permit
Constr Business and Pm, oli demolish.an:Any tiny of roame -
z3� which itsisu•promo accnnswctalar.impmc,hpettanmind,a sig edswmen:
_Z� prior In its issume.also fequima the Applicant for such permit mfikaaiBneJ settlement
a that he is licensed purmanttothe provisions ofthe Contractor'sLicenseLaw(Chapter 9Sq.F FFloorArea Valuation
21 (mmmendng with Section 7000)of Division 3 of the Business end Protraction.Cook)or
that he in exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant not a civil penalty of APN Number Occupancy Type
Am m..dean five hundred dollen(S5M
o
I,uowmw of IIIc pmperty,omy wploym with wgnuthek sole rompeu+don.
and prthCP9rk,CdNC he Cor enalini menserawdo(Wut in M.BYLKoI
=d pretensions,n.code:The venBaLmra and
Law dear Out apply lf an owner,of Required Inspections
am
who W tea m improve,that s ch Improvements
ved ets arcaaoch Arctic dhiroffe ed Wougb rets
awn ver,me Wilding
that such Improvements art w1 intended matted rhe sale If.
however,Ne Wed ie orimPm proving
ts sold within ane year of Completion.for the case of
builds MO lure the WNm of mvNn{Wt he did Out build or Improve for purpose of
❑I,as my=r of me property.Am exclusively commuting with licensed contract..to
construct the pmjem(Sec.7064,Business and Profusions Code:)The C.ntrcur's Li.
cents law dos not apply in an Owner of property who Wilds or improm themur,and
who contracts far such projects with a mouseom(s)licensed purmam to the Contravenes
Licmm law.
lamuemp,undrSee .BdPC for Nis reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 battery arm under peully of perjury ane of the following declantimu:
❑1 haw and will maintain a CatiOuleof Conant to self-i=um for Worker's Camper
utian,As provided for by Section 3700 of the Labor Code,for the perfomunce of the
rk for which this P rmft is issued.
ave and=FICATE
r's Compensation Inmranre,u required by Section
f the taormance of the work for which this permit is issued.Work Cm umim and Poliryn bur are:Policy Na.: �3`EXEMFTION FROM WORKERS'
COMPENSATION INSURANCE
(Dmtssecdur need rot W committed If the pemeR is future hundred dollies($100)
onus)
I«reify the,in the performance of the work for which this permit is Issued,I shall not
employ any person in any maricrso as to become subject IO the Workeri Compenudon
Laws of California.Dau
Application
NOTICE TO APPLICANT:If,afar making this Certificate of Exemption,you should
become subject to the Worketa Compeosidon provisions of the tabor Code,you muss
Q Q forthwith Comply with such pmviamW m thin permit Shall W cooed armored.
Z ^ CONSTRUCTION LENDING AGENCY
[ti► I hereby affirm Wt men In amnuructiur lending agency for me performance of
lY i the work for which this permit a fussed(Sm.3097,CN.C) '
[[7 Q tender's Name
Lender.Adm=,
V Q I certify that 1 have read this applion lon and scale un.the+Wm Information is
Com et.I agree in comply with all city and county ordinances and sure laws relating in
Wilding Conswetion,and hereby autharire rtpmxnmiw of mu City to color upon ace
Lel .hove-mentioned property,Tor Inspection pmposes
py (We)Agree in seam.indemnify and trop humlms the City of Cupertino 884=1
habi1111U,judgme.LL.Ceiu and LxpCllW which may in Any my aceme against said Cly I
fJ Z in co=eq L granting of thin paonil.
APPLICA ERSTANDS A W OMPLY WITH ALL NON-POINT Issued by: Date
SOURCE TIONS.
3=T[ r�P Re-roofs
Si{nun..of ApplicanUContncmr Oale
HAZARDOUS MATERIALS nIsC019PE Type of Roof
Will the pplicaratCupertino
future Commpaptrareof handle Health and
u de.Sed by ace CupLnlnO215
Code.Gaper 9.13,and tine Hc4N and 54e,y
Code.semen zss3z(+)7 All roofs shall be inspected prior to any roofing material being installed.
[3 Y.
Will the appli.n,orWilding occupant tau equipment or JcNms Mich If a roof is installed without first obtaining an inspection,I agree to remove
emit hmallou urcanumimytitrfk�JeMetf by ace Bay Am�Air Ou4ity Management all new materials for inspection.
District? Vt/Ja[y�'
❑You o -
I have mal the huamems mauri4s mquiremcm under Chapter 6.95 of the Califor-
Huith&SafenyCede,Semens,23M5.25533 And 25534.1 understood thin Ifthe Wilding
A not n,ly hew a amen,us,I,is my mapoadbility to mdfy the accuPant of the
tore hkhmuatW Ipmary,..of.Certficateorampm Signature of Applicant Date
3-3(
Owner or mthavcd ager All roof coverings to be Class'p'or better
Dau'
CITY OF CUPERTINO
4 ITEMS OF 16 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34212105.00
DATE ISSUED. . . . . ... : 03/31/2008
RECEIPT # . . . . . . . . . : BS000004316
REFERENCE ID # . . . : 08030184 -
SITE ADDRESS . . . . . : 10113 BERKSHIRE CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DEVANG VASAVADA
ADDRESS . . . . . . . . . . : 10113 BERKSHIRE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : EDWARD A GREGORY
CONTRACTOR . . . . . . . : MCGEE, PAT LIC # 18986
COMPANY . . . . . . . . . . : WATER HEATERS ONLY
ADDRESS . . . . . . . . . . : 970 E MAIN ST
CITY/STATE/ZIP . . . : GRASS VALLEY, CA 95945
TELEPHONE . . . . . . . . : (800) 835-5946
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 1, 400. 00 0 .50 0. 00 0. 50 0. 00
. 1PPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 _ 0. 00
IPRWHEATR 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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
•
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
PERMIT INVOICE OPERATOR: patg
Sec: Twp: Rng: Sub: Blk: Lot:
APN 34212105 . 00
INVOICE DATE. . . . . . : 03/31/2008
REFERENCE ID # . . . : 08030184 ..
SITE ADDRESS . . . . . : 10113 BERKSHIRE CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DEVANG VASAVADA
ADDRESS . . . . . . . . . . : 10113 BERKSHIRE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
CONTRACTOR . . . . . . . : MCGEE, PAT LIC # 18986
COMPANY . . . . . . . . . . : WATER HEATERS ONLY
ADDRESS . . . . . . . . . . : 970 E MAIN ST
CITY/STATE/ZIP . . . : GRASS VALLEY, CA 95945
TELEPHONE . . . . . . . . : (800) 835-5946
FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE
--------------------------- ---------------- ---------- ---------- ----------
SEISMIC RESIDENTIAL PRINTING PERMIT 0 .50 0. 00 0 .50
PLUMBNG PERMIT ISSUE PRINTING PERMIT 40 .79 0. 00 40 .79
RESIDENTIAL WATER HEATER/VE PRINTING PERMIT 24 . 48 0. 00 24 .48
TRAVEL & DOCUMENTATION FEE PRINTING- PER MIT 40.79 0. 00 40.79
® ----------
106 . 56 0. 00 106.56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
o�o�
CITY OF CUPERTINO
ZWATER HEATER
CUPERTnNO PERMIT APPLICATION FORM
APN # y C? Off— v v Date3
:
Building Address:
/0 ll3 ffe� �t s� � te
Owner's Name: Phone #:
� vaLti� US S9 U c�
41-&00 SIY6- Y �
Contractor: Phone #:;Jo_a7y-3�3/,czd3
ftp a �eG �e�s l c
y Fax 7
Cupertino Business License #: Contractor State License #:
Contact:7 Y Phone #:S3o- �7y- 3✓�j�r
^LL
Fax #:
Building Permit Info:
SIBIdg Elect ❑ Plumb Mech ❑
Residential Commercial ❑
Job Description: �� F 6s'
e-WQ/0/.i,c
Strapped L, On Platform Bonded U New Location ❑ Replacement
Valuation: /V
Green Building Check must be completed and attached to this application.
Green Building Points.achieved:
CITY OF CUPERTINO
WATER HEATER
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BSEISMICOM Seismic Commercial B
1PRWHEATR Residential Water B PRWHEATR
HeaterNent
1BSEISMICRE Seismic Residential B
1PPERMITFEE Plumbing Permit P
/ 1TRAVDOC Travel & B
Documentation
1BUSLIC Business License B
Single Family GreenPoint Checklist date: 3 zw Y Build It Greed
The GreenPoint Checklist is based on the various green features incorporated Into the home and Is the Smart Solutions From me Ground Up
basis for the GreenPoint Rated program.A home can be considered green if it fulfills the prerequisites,
Hams a(5), st Resources
ices(6a,and Watets r
( ).Please
coints ntact er Build It ore Energy list
of Indoor Air Gually
arrPoi �I
Health(5),Resources(6),entl Water(g).Pleese contact Build It Green for a Ilst of qualified GreenPoint
Raters If you are interested In pursuing third-parry verification.
The green building prectices listed below are described in the New Home Construction Green Building
Guidelines,available at www.bullditareen ora,
ENTER PROJECT 4 m F�
B rn Ci w ;
® n a U W Q ¢
A 61TE- Points Available Par Measure
1.Protect Topsoil and Minimize DismpGon of Existing Plants&Tree
❑ a.PMect Topsoil from Erosion and Reuse after Conshohan D 3 7
❑ b.Limit and Delineate Construction Footprint for Maximum ProteaGon0 1
2.Deconstruct Instead of Demolishing Ezisdn Buildings On site 0 - 3
S.Renoir*Job Site Construction Waste(Including Green Waste)
❑ AMinimum 50%Waste Diversion by Weighl(Recycling oRouse)-Required 0 R
❑ h.Minimum 65%Diversion by Weight(Recycling or Rouse) D
- —
❑ c.Minimum BO%Diversion by Weight(Recycling or Reuse) 0 --—'---'-'—• "2
4.Use Recycled Content Aggregate(Minimum 25%)
❑ a.Walkway and Driveway 0 1
E] b.Roadway Boo _ "'-- ---'-----' _. --
i
Total Points Available in site=12 0
B.FOUNDATION Paints Available Par Measure
1.Replace Portland Cement in Concrete with Recycled Flyash or Slag
❑ aMinimum 20%Fil or Slag 0 I 7
❑ b.Mlnimum 25%Fl ash ce Slag 0 !
❑ 2.Use Frost-Prolscted Shallow Foundation in Cold Arses(C.E.C.Climate Zone 15) 0 3 I
❑ 3.Use Radon Resistant Construction on At-Risk
Locations Only) 0 1
4.Design and Build Structural Past Controls
❑ a.Install Termite Shields&Separate All Exterior Wood-loConcrete Connections by Metal or Plastic Fasteners/Dividers 0 7
b.All New Plants Have Trunk,Base,or Stem Located At Least 36 Inches from Foundation 0 1
Total Points Available In Foundation=B 0
C.LANDSCAPING Paints Available Per Measure
1.Construct Resource-Efficient Landscapes
❑ a.No Invasive Species Listed by Cal-IPC Are Planted D 3
E] b.No Plant Species Will Require Hedging —0 — — — --
El c.75%ol Plants Are brought-tolerant California Natives,Mediterranean,or Other Appropriate Species 0 3
❑ 2.Use Flm-Safe Landscaping Techniques 0 1
3.Minimize Turf Arses in Landscape Installed by Builder
❑ a.All Turf Will Have a Water Requirement Less than or Equal to Tall Fescue(50.8 plain factor) 0 7
® ❑ b.Tud Shall Not Be installed on Slopes Exceeding l D%or in Areas Less than B Feet Wide _ 0_ -- l_—i_- T__i=Z_
❑ c.Turf Is 533%of Landscaped Area(total2 points) 0 1 d
Eld.Turfls510%of Landscaped Area(lotal4polnts) 0 2
❑ 4,Plant Shade Trees
D1 3
❑ S.Group Plants by Water Needs(Hydmmning) 0 1 2
5.install High-Efficiency Irrigation Systema
❑ a.System Uses Only Low-Flow Drip,Bubblers,or Low-flow Sprinklers D
❑ b.System Has Smart Controllers 0 3
❑ 7.Incorporate Two Inches of Compost in the Top 6 to 12 Inches of Soil 0 3
❑ 8.Mulch All Planfing Beds to the Greater of 2 Inches or Local Water Ordinance Requirement 0 2
TT 9,Use 5D%Salvaged or RecyciedCi,mant Materials for 50%of Non-Plant Landscape Elements 0 1
❑ 10.Reduce Light Pollution by Shielding Fixtures and/or Directing Light Downward 0 1 I 1 )
Total Points Avallablein Landacapin =31 0
D.STRUCTURAL FRAME h BUDDING ENVELOPE Points Available Per Measure
1.Apply Optimal Value Engineering
❑ a.Place Rafters and Studs at 24-Inch On Center Framing D
❑ b.Size Door and Window Headers for Lead '---
❑ c.Use Only Jack and Cripple Studs Required for Load
2.Use Engineered Lumber
❑ a.Beams and Headers
❑ It.Insulated Engineered Headers
❑ c.Wood Woes or Web Trusses for Floors D --"--�'�---E] d.d.WOOd I-Joists for Roof Radars
r
❑ e.Engineered or RngervJointetl SNtls for Vertical Applications 0
❑ f.Oriented Strand Board for Subtlow --
❑ g,Oriented Strand Board for Wall and RDol Sheelhing —
I'0"--"---- "---- —_'_r
T
3.Use FSC-Certi6ad Wood
❑ a.Dimensional Lumber,Studs and Timber.Minimum 40% 0 2
❑ b.Dimensional Lumbar,Studs and Timber.Minimum 70% —0--
E]
--❑
c.Panel PoolMinimum 40% ___f.
❑ d.Panel Products:Minimum 70%
0 1
02D07 Build It Green Single Family GreenPoint Checklist 2007 Version Page 1 of 4
ENTER PROJECT s } r$Ypg
a
4.Use Solid Wall Systems Position Sloe,ICFs,6 Any Non-Stick Frems Assembly)
❑ s.FIDDM 07 _ 2
E:1b.Wells ._D_ .. 2_... . _
❑
C.Rosh !0 2 2
S.Reduce Pollution Entering the Home from the Garage
❑ a.Tightly Seal the Air Barrer between Garage and LNing Area _ 0
❑ b.trend Garage Exhaust Fan OR Build a Detached Garage 0 1
6.Dul n Eneroof Try ls on Trusses(75%of Abic Insulation Height at Outside Edge of Exterior Well) 0 1
7.Dui n RueHeedse to Accommodate Dorsa k 0 1
Lj B.Use Re clod- onbnrt Steel Studs for DD%of Interior Wall Framing 0 1
S.Thermal Meds Walls:516-Inch Drywall on All Interior Wells or Wella Weighing mora than 40 Rudloff. 0 1
1 D.Install Overhangs and Quotas
❑ a.Minimum 1Bunch Overhangs and Gulf am 0 _ 1 _
[:1b.Minimum 2Llnch Overhangs and Suffers D 1
Total Points Available In SbucWial Building Freme and Envelope=38 0
E.EXTERIOR FINISH Points Available Per Measure
1.Use Re died-Content(No Virgin Plastic)or FSC-0eNOed Wood Disking 0 2
2.Install a Rain Screen Wall System o - 2
3.Use Durable and Noncombustible Siding Materials. 0 1
ED 1.Select Durable and Noncombustible RDGfing Materials 0 2
Total Points Available In Exiedor Finish=7 0
P.INSULATION Points Avollable Par Measure
1.Install Insulation with 75%Recycled Content
❑ e Wells andhe Floor 0 __ _ 7 _
❑ b.Collings 0 1
2.Install Insulation that Is Low-Emlttlng(CaNfied Section D1350)
❑ .A Wells ancVor Room0 7 !
❑ b.Callings _0 1
❑ 3.Inspect Duality of Insulation Installation before Applying Drywall 0 1
Total Points Available in Insulation=5 0
G.PLUMBING Points Available Per Measure
1.Distribute Domestic Hot Water Efficiently(Madmum 7 Points)
❑ a.Insulate HM Water Pipes from Water Heater to Kitchen 0
❑ In.Insulate All Hot Water Pipes 0
❑ c.Use Engineered Pal Piping 0 __ __ 1
❑ d.Use Engineered needed Piping with Demand Controlled Cimulatlon Loop 0
❑ e.Use Structured Plumbing with Demand Controlled Circulator Loop _0
❑
I.Use Central Dore Plumbing0 7 1 2
❑ 2.Install Only High Efficiency TD110%IDual-Flush or 51.288 Q 0 4
Total Points Available In PIumbin =Total 12 0
H.HEATING VENTILATION R AIR CONDITIONING Points Available Per Measure
❑ 1.Design and Install HVAC System to ACCA Manual J,0,and 5 Recommendations 0 4
2.install Sealed Combustion Units
❑ a.Forl 0 2 1
❑ b.Water Heaters 0
3.Install Zoned,Hytlronle fldslent Hinting with Slab Edge Insulation 0 1 1
1,Install High Efficiency Air Conditioning with Environmentally Responsible Refrigerants 0 1
5,Design end Install Effective Ductwork
❑ a.Install HVAC Unit and DDohVDik within Conditioned Space 0 _ 3
❑ b.Use Duct Mudd on All Duct Joints and Seams 0 _ 1
❑ c.Install Ductwork under Attic Insulation(Boded Ducts) _ 0
E] d.Pressure Balance the Ductwork System __0 _ _ y 7
❑ e.Protect Duma during Construction and Clean All Ducts before Occupancy 0 1
6.Install High Efficiency HVAC Filter MERV 6. D 1
❑ 7.Don't Install Fireplace or Instll Staled Gas Fireplaces with Efficiency Rating Not Lasa Than 60% 0 1
using CSA Standards
B.Install Effective Exhaust Systems In Beihrooms and Kitchens
❑ a.Install ENERGY STAR Bathroom Fens Vented to the Outside 0
❑ b.All Bathroom Fans Are on Timer or Humid!atal 0
❑ c.Install Kitchen Range Hood Vented to the Outside 0 - 1
6.Install Mechanical Vengietlon System for Cooling(Maximum 4 Points)
❑ a.Install ENERGY STAR Calling Fans 6 Light Kits In Living Areae a Bedrooms 0
❑ to.Instal Whole House Fan with Variable Speeds _ 0
❑ c.Automatically Controlled Integrated System _ 0 _2
❑ d.Automatically Controlled Integrated System with Variable Speed Control D 3 —
1D.Install Mechanical Fresh Air Ventilation System(Mdsimum 3 Points)
❑ a.Any Whole House Venfilation System That Masts ASHRAE 02.2 0_ _I 2 _
❑ b.Install AiMo-Air Heal Exchanger that mats ASHRAE 62.2 0 7 2 r
11.Install Carbon Monoxide Alarms) 0 1
Total Points Avallable In Heafin,Ventilation and Air Conditioning 301 0
O
C 2007 Build It Green Single Family GreanP0lnt Checklist 2D07 Version Page 2 of 4
ENTER PROJECT
w • = a
n Q V a
I.RENEWABLE ENERGY - Points Available Per Ideasure
1.Pre-Plumb for Soler Hot Water Heading 0 4
77—Z Install Solar Water Heading System 0 10
3.Install Wiring Conduit for Future Photovoltaic Installation&Provide 200 to of South-Facing Roof D 2
4,Install Pholin olmic(PV)Panels
❑ a.30%of closed needs OR 1.2 kW(total 6 points) 0 6
—_T—...�..—
®
El b.60%of electric neatly DR 2.4MN(fo(bassl2 points) _0__ _____6__El c.BD%of 61801,11C need OR 3.6 kW Intel 16 paints) 0 6
Total Available Points In Renewable Energy=23 0
J.BUD,D[NG PERFORMANCE Points Available Per Measure
1.Diagnostic EMILHIllons
❑ a.House Passes Blower Door Test 0 ]
❑ b.House Passes Combustion Safety Backdratl Test 0 7
2.Design and Build High Performance Homes-%above Title 24-minimum 15%Required 0 >_30
❑ 3.House Obtains ENERGY STAR with Indoor Air Package Certification-Pilot Meesure(Total 45 points;read comment) 0 5 2
Total Available Points In Building Performance 39 0
K.FINISHES Points Available Per Manure
❑ 1.Design Entryways to Reduce Tracked in Contaminants 0 F1
2 Use Low-VOC or Zero-VOC Paint(Madman 3 Points)
❑ a.Low-VOC Interior Wa lf0ellfng Paints(d0 go VOCs(Flan and<150 gpl VOCs(Non-Flal)) 0 __ 1
❑ b.ZemVOC:Interior WaIVCaliin Paints(d 90 VOCs(Flan)
0 3
❑ 3.Use Low VOC,Water-Based Wood Finishes(450 gpi VOCs) 0 2 1
--7—[-4.Use Low.VOC Caulk and Construction Adhesives(d3 go VDCs)for All Adhesives 0 7
❑ 5.Use Recycled-Content Paint 0 1
6.Use Environmentally Preferable Materials for Interior Finish:A)FSC-Certified Wootl,B)Reclaimed,C)Rapidly Renewable,0)Recysied-Conant
or E)FinginJointed
❑ a.Cal(50%Minimum) 0 _ _ 1__ _
❑ b.Interior Trim(5C%Minimum) D
-❑ c.Shelving(50%Minimum) 0 ]
❑ d.Doors(50%Minimum) 0 ^ 1
❑ e.Ccuntartops(50%Minimum) 0 1
7.Reduce Formaldehyde In Interior Finish(CA SBetion 01350)
❑ e.Sul&Stair Treads(5D%Minimum) 0
❑ b.Cabinets&Counterspy(50%Minimum) 0__ ____ _
❑
C.Interior Trim(50%Minimum) 0 1 1
❑ J.Shelving(50%Minimum) 0 1 ,
❑ 6.Afar Installation of Finishes,Test of Indoor Air Shows Formaldehyde Level 47ppb 0 3
Total Avalable Points in Finishes 21 0
L.FLOORING Points Available Per Measure
® 1.Use Environmentally Preferable Flooring;A)FSC-Certified Wood,B)Reclaimed or Refinished,C)Rapidly Renewable,D)Recycled-Content,E)
Exposed Concrete.Flooring Adhesives Must Have<50 Suit VOCs
❑ a.Minimum 15%of Floor Area - 0 _
❑ b.Minimum 30%of Floor Area 0 1 I 1
❑ c.Minimum 50%of Floor Area
❑ d.Minimum 75%of Floor Area 0 —� ]
❑ 2 Thermal Mass Floors:Floor Covering Other Nan Ca et on 50%or More of Concrete Floors 0 1
❑ 3.Flooring Meats Section 01350 or CRI Green Label Plus Requirements(50%Minimum) 0 1 2 I
Total Available Points in Flooring=7 0
M.APPLIANCES AND LIGHTING Points Available Per Measure
1.Install Water and Energy Efficient Dishwasher
❑ a.ENERGY STAR(total l point) 0
❑ b.Dishwasher Uses No More than 55 GallonslCycle(maltpoints) 0 1
2.Install ENERGY STAR Clothes Washing Machine with Water Factor of 6 or Less
❑ e.Meets Energy Star and CEE Tier 2 requirements(modified energy factor 2.0,Water Factor Ell)(total 3 points) _0
❑ b.Meets Energy Star and CEE Tior 3 requirements(modified energy factor 2.2,Water Factor 4.5 or less) 2
totalsPoints) 0
3.Install ENERGY STAR Refrigerator
❑ a.ENERGY STAR Qualified&<25 Cubic Feet Capacity _ 0
❑ h.ENERGY STAR Ouallfietl&<20 Cubic Feat Capacity 0 1 I � I
4.install Built-In fleryding Center 0
❑ a.Built-in Recycling Center 0 7
❑ b.Built-In Composting Center 0 1
Total Available Points in Appliances and Lighting=12 0
N.OTHER Points Available Per Measure
❑ 1.Incorporate GraenPofnt Rated Checklist in Blueprints-Required - 0 R
❑ 2.Develop Homeowner Manual of Green FesturesSianeffa 0 1 1 1
3.Community Design Measures&Locat Priorities:See the Community Planning&Design section In Chapter 4 M the New Home Guidelines for
measures.Maximum of 20 points for suggested measures.Local requirements may also be listed here.
0 2007 Build It Green Single Family GreenPofnt Checklist 2DD7 Version Page 3 of 4
ENTER PROJECT NAME
4ennui
_Entar de"IT hare,and Inner primp avaleGe for manna In OpP03111116 calegoriea to the right.
Enter dewrit flown hem,and anter points available its measure In appropriate categories to the tight. 0 0 0 0 0 0
Enter deacdplion nam,and enter prime available for measure In appropriate Categories to the right 0 0 0 0 D
❑ Enter description hem,and mar prima availabe for measum in appropriate neporles to the right. 0 0 0 0 0 0
4.Innovation:List Innovative measures that meet the green building objectives of the Guidelines.Enter up to a Bulltl H Green Checklists antl
maximum combined total of 20 pts.Sae Innovation Checklist for suggested measures,using the link to the right, _ Guidelin_ es _
Innwation In Community:Enter description here,and enter 'ma avalmoe for measure in r m ate Wdee to the right D 0 D 0 _ 0 0
Innwetl0"In=Enter Enter dean tion hem,and enter 'ne mailable for manure In appropriate cat Mal to the right, 0 0 0 D 0
innwelin m IAOMwIN:Etta deem 'on hen,and soler Dine ovellabls fa measure in date tate oris to The tl . D 0 D D _0 0
Innwation In Resources:Enter des ion here,and snow points available her measure in appropriate categories to the right. _ D 0 0 0 0 0
Innwetin In Waler,Entor daa dplion nae,and ante points available for measure In"Hem neporiu to me tight _ 0 _ 0 0 D D 0
Total Available Points In C1her=43 0
Summary
Total Available Points In Specific Catagodes` 4+ 96+ 42+ 66+ 43+
Minimum Points Re ulretl in Specific Categories G 30 5 6 9
Total 0 1 1 1 1 1
Project has not yet met the following recommended minlmum requirements:
- Total Project Score of At Least 50 Points
-Required measures:
-A3a:50% waste diversion by weight
-32: 15%above Title 24
-NI:Incorporate Green Point Rated Checklist into blueprints
-Minimum points in specific categorles:
-Energy(30 points)
-IAQIHealth (5 points)
-Resources(6 points)
-(Nater(9 points)
C2007 Build It Green Single Family GrearrP0lnt Checklist 2007 Version Page 4 of 4
Community Development
1 Avenue
It
Torre
J Cupertino
95014
S" ,. Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building De artment
-JOB ADDRESS: -7� (J3 D
ID//3 VC�t�Cg�r'r� PERMIT #v8 07
OWNER'S NAME: �el/ct" S va C(5 PHONE # YOB yr/
GENERAL CONTRACTOR: a,�w!�/F///(eaa ,
je,,c u( �,� FAX # Sao- Z7Y-306 Y
I am not using any subcontractors: -I Q- 3 3/-o e
Signature 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
• Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing ecl�err l9 R6
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
3 31�D�
Owner/Contractor Sia a Date