080502021
E�C
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z
CITY OF CUPERTINO
PERMIT
.z a„e,a. ,� a r 8 .a» r� a "
CONTRACTORsINFURMATIf1N
BUILDINGbIVIs1ON•
w,iP,#fi�"'TA'L.
Bu1l6ca-ADBETLIN AVE
SEARS HOME IMPROVEMENT
08050202
NER's NAME:
PER.UC T ISSUE DATE
LUCHAEL SKRZYPAK
1024 FLORIDA CENTRAL PKWY
05/27/2008
PHONE:
SANITARY NO. CONTROL NO.
(925)245-2000
ARC HITECTIENGINEER:
BUILDING PERMMNFO
BLDG ELECT' PLUMB MECH
0 0 0 0
LICENSED CONTRACT'OR'S DECLARATION
Chapter
lob Description
1 Mcby affirm that 1 m It...d umkr provision of 9 (rnmmeneing
withSection?XB)ofDivision3 of On Business and Professions; Cade.and mylicense is
RE—FC KTCHN CBNTS,RECONNCT NEW SNK&FCTS,ADD 5
in full face and ilea EWCl�
Liccnm Class t Lr..t%u O
OTLTS TO EXSTNG 'LINE,UPGRD 40UTLTS TO GFI(100SQ)
Dam_ T ��f— a11;'=--�� mal' CO.
ARCHITECTS DEC ION
I undersand my plans Mail IM used as puhlic ecorllt
Licensed Professional
OWNER -BUILDER DECI.URATION
I bcrtby aRm that 1 am cacmpt from the Contacim's Lkense Law for the
following maw n. (Smuon 103 1.5, Busiws and Profession Calc: My city or county
which mouses a permit as canlrwmt mmr, hnprow% dcmWish, or epar my structure
! prior to its issue¢. also mqu.m, ueapplicanl far such permit to fileasigttd sammco,
that he isliccowd pumanuo tie pmvismn of Ne Conuacmri Limne Law (Chapter 9
Sq. Ft. Floor Area$20354
Valuation
(commencing with Scotian 18X) of Division 3 of On Busincaamd Profession Cada) m
.
$ 2 0 3 5 4
Out Nhe u Tempt themrrom and the basis f« the alleged eampti.. My violation of
Number
Occas
Occupancy Type
section 7031.5 by try, applicant for a Fendt subjects roe applicant to a aril Penalty or
.I came Nan five hundred dallan(SSX).
36927025!
1, u awns of the property, ar my rmpbyces with wagesas Nc a solernmpenation,
Required Inspections
will do the vole and daavueturc O notinmMed oraRerd forsato ($m. T014, Badness
and Profession Cade: The Conmcmis U. law sums rot apply m m wnv M
9 P
ndw
ywWbuam«impuws thereat.andwW am sot
oroemdforedo his
can foredo.
ownemployees,dprovided intended
Mane
fmarmfemd
gori imsuchimprovementsamnot
busidar me building boderaof mals mid within oro Wild of.mPletion, &a Manor.
..
builder will law tbu bub. of poring Nat he did Out buiw or impmw for purpsm of
❑ 1, as; owner of the property am exclusively contracting with licensed cent ustam in
CONWct the pro)mY (See. 7Oa4. Business tad PnIGtLOn Cade:) The C.mewetafi U.
Cottle Lsw does sal apply m as owner of property who Wilds or improves therm., and,
who contracts for sucle project with a contracmr(s) licensed Fortune, as the Conbxm/s
Licetsm law.
❑ I am Tempt under See ,B&PC for this mason
nor Data
WORKERS COMPENSATION DECLARATION
1 hereby afam under penalty of perjury one of the following declaration:
❑ 1 hart and will mainain a Cenieesm ofCamenuo wlf-intim f« WmkettComp:n-
radon, u provided for by Section 31X of dte Labor Code. for the Perform. of tW
swrk for which this Permit is issued.
❑ 1 haw and will mainaln Wonch Compensation Inurmce, u movircd by Section
37X ofthe labor COM.f« Ne Polormance ofthe work forwbich Nis Permit u issued.
'
My Warkcfa Compcnatiae haunt,¢ carric tory number ma:
.ASF 9rtccsru&/ 1tryNJLV`F6Cs737
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mus seed. ted rolbccompiced Voice permit ts Ina. hundred thed. ($100)
M total
1 mnify that in Ne Imfomanee of On wan for which Nis .it u issued. 1 shall not
employ any Fenn in my manrer w a m become subject m de WorFu3' Compensation
Laws of CalifMan. Dae
Applicant
NOTICE TO APPLICANT: If. after making thin Certificate of Exemption, you should
became subject to the WoneYa Campcnilion proratan of the lab« Cad,, you must
forthwith comply with such provision or this Pe a shall W dcemcd oewked.
CONSTRUCTION LENDING AGENCY
1 touchy affirm that Nem I.. conttuctint lending agency for On performance or
dm wort for which this Permit Is isaed (see 389?, Cir. C.)
and es Name
Landee. Mdtett
I easily Nat I haw mad Nis application and all Nat Ne thaw infam actin it
comm 1 agree m.mPly wiN,ll city and county, adimnams and rate laws mladng in
.. .
building conswction, and hemhy aub areae epewnadv,n of Nu city in comes upon the
above-m.tio.d propmny for inpccuun purpa et
(We) ague to saw, indemnify and lueep hamlet the City of Cupertino agarol
Eabilium Judgmcnts.costa and espers,n which may in any way accroo again, said Cary
in Consequence of Ne granting of this email
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.[�
S -o8
Re -roofs
stgnate car Apphemt/Co r'Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will enc applicant m room building oceupanlnoe or handle haeNon material
an dcMed by de Cupnime Municipal Cdc. Chapter 9.12, and de Health and Safety
. Section 25532(.)?
❑Yea' A"a
All roofs shall be inspected prior to any roofing material being installed.
Will Ne appficanl or future building occupant one egmpmmd no demeod which
If a roof is installed without first obtaining an inspection, I agree to remove
emit ha'rardois, air c.amsnanu a defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Y,n �No
I than, road the haraNms mamriatseoviremcnts undc-Cluti er6.95oftheCmifor-
nix Health& SdetyCada Smdms 25505.25533 and 25534.1 mderstad thdifthe building
dart net cemndy haw a Imam Nd It is my mtpotaitt lily to 0otiry NC C¢upmt or NC
eouiemc whkIt mustbc s rias issu aft Ccnifipm afOttvpmry.
0
Signature of Applicant Date
All roof coverings to be Class '%" or better
Owner Mhomcdagent Dam
• 3 ITEMS OF 3
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub:. Blk: Lot:
APN ........: 36927025.00
DATE ISSUED.......: 05/27/2008
RECEIPT #.........: BS000004897
REFERENCE ID # ...: 08050202.
SITE ADDRESS .....: 863 BETLIN AVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
553.10
---------------
553.10
REFERENCE NUMBER
----------------
#1634
OWNER ............:
LUCHAEL SKRZYPAK
ADDRESS ..........:
863 BETLIN AVE
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-4546
RECEIVED FROM ....:
TOWN & COUNTRY PERM
CONTRACTOR .......:
MARK C GOOD LIC # 23097
COMPANY ..........:
SEARS HOME IMPROVEMENT
ADDRESS ..........:
1024 FLORIDA CENTRAL PKWY
CITY/STATE/ZIP ...:
LONGWOOD, FL 32750
TELEPHONE ........:
(925)245-2000
FEE ID
UNIT QUANTITY
-------------
AMOUNT PD -TO -DT THIS REC
NEW BAL
1BSEISMICR
----------
VALUATION 20,354.00
-------------------------
2.10 0.00 2.10
----------
0.00
1REMRESKIT
SQ FEET 1.00
., 429..00 0.00 429.00
0.00
1STPLNCK
HOURS 1.00
.122.00 0.00 122.00
----------
0.00
TOTAL PERMIT
---------- ----------
553.10 0.00 553.10
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
553.10
---------------
553.10
REFERENCE NUMBER
----------------
#1634
I
L
GeO,!37 0,�2 0 ,;�
CITY OF CUPERTINO
I ADDITION/REMODEL
cuPEkTiNO PERMIT APPLICATION FORM
APN #
86 - a?- ()
Date:
Building Address:
86 —AE—'Tl—r4AVE-, Cv F —,vo 6
Mailing Address (if different from building address):
Owner's Name:
-
Phone #
a,sa -
Contractor:
Phone #: 9oZS XV3,- p1000
S1EAA51qLrtAG066
Fax #:
Contractor License #: r7,? -(37 9
Cupertino Business License #:
Contact: N l C 6 -
Phone
Fax #:
Building Permit Info:
Bldg. Nf Elect. Plumb. Mech. Hillside ❑
Job Description: 'TE_- FAr-F PTC -He -AJ �°ALi/niCT/
Addition K RFCa ,✓ -✓EST
(adding sq footage):
/Alp+ VZACUt�7-3/i9DD S6UnCM -1-0 X'-L/nIE/ (J?G240C
601 L- T0— 7 a G F I/
What is being remodeled?
rrr.a
Remodel Includes Re -Roof: Yes ❑ No LW If yes list number of squares
Remodel Includes Structural: Yes ❑ No bg
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Oa Bath Other
Type of Construction (Usage Class):
Occupancy Type:
1 FR, I IFR ❑ 11, 111, V -IHR ❑ 11, 111, 1V V -N ❑
S 1<R
Valuation:
Please check this box if the project is a
second -story addition ❑ -
Green Buildi g Check list must be completed and
attached to the plans.
Green Building Points Achieved:
rvl voice use "My
Over -the -Counter ❑
CITY OF
CUPERTINO
CITY OF CUPERTINO
ADDITION/REMODEL
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
Sq Ft
ADDITIONS
1R3SFDADD
PLLONGRNGR
Long Range
PL
Planning/Residential
lR3INSP .
Dwellings Inspections
B
1R3PLNCK
Dwellings plan check
B
1R3REPINSP
Dwellings Repeat
B
Inspection
1R3REPPLNC
Dwellings Repeat Plan
B
Check
1R3HINSP
Dwellings Hillside
B
inspection
1R3HPLNCK
Dwellings Hillside
B
plan check
1R3HREINSP
Dwellings Hillside
B
Repeat Inspection
1R3HREPLNC
Dwellings Hillside..
B
Repeat Plan Check
1R3ALTINSP
Dwellings Alternate
B
Materials Inspection
IR3ALTPLNC
Dwellings Alternate
B
Materials Plan Check
IPCESS
Cesspool
P
IPPRSEWG
Ea. Private Sewage
P
Disposal System
1PRSEWER
Sewers
P
1BPSPRINK
Lawn
P
Sprinkler/Backflow
1BPWSVCS
Main Water Service
P
1BSEISMICRE
SeismicResidential
B
DECKS
1R3SFDADD OR
1R3SFDREM
IDECKWOOD
Deck (Wood) -Each
B
(Each)
IDECKRAIL
Deck Railing -Each
B
(Each
u
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
Sq Ft
GARAGES
1R3SFDADD OR
1R3SFDREM
1 GARDTW<=1K
Wood Frame up to
B
1,000 SF
1GARDTM<=1K
Masonry up to 1,000
B
SF
BCONSTAXR
Construction Tax Res
(new detached gazage)
PATIO'S OPEN
1R3SFDADD OR
1R3SFDREM
1PATIOWOOD
Wood Frame up to 300
B
SF
1PATIOMETAL
Metal Frame up to 300
B
SF
1PATIOOTHER
Other Frame up to 300
B
SF
PATIO'S CLOSED
1R3SFDADD OR
1R3SFDREM
1PATIOENCLW
Enclosed Wood up to
B
300 SF
1PATIOENCLM
Enclosed Metal up to
B
300 SF
1PATIOENCLO
Other Enclosed Patio
B
up to 300 SF
1COVPORCH
Porch Covered -Each
5 -
(Each)
1REROOFRES
Residential Re -roof
B
Each 100 SF
REMODELS
1R3SFDREM
1REMRESKIT
Kitchen Remodel up to
B
(Deduct "$"for ea plan
/
300 SF
check
1REMRESBAT
Bath Remodel up to
B
«
300 SF
IREMREOTH
Other Remodel up to
B
«
300 SF
REMODEL PLNCK
r
ISTPLNCK (1-3 for
Standard Plan Check
B
NOT FOR OVER THE
remodel)
COUNTER PLAN CKS.
3 oI 3
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity
Sq Ft
Fee ID
Fee Description
Fee Group
Permit Type
WINDOW/SLIDING
1R3SFDREM
GLASS DOOR
1WINREP
Replacement windows
ea 8 windows
B
1WI2,TNEWNSTR
New Window (non-
structural
B
1WINMEWSTR
New Window
(Structural Shear
Wall/Masonry
B
IWINBAYSTR
Bay Window
(Structural)
B
SKYLIGHTS
1R3SFDREM
1 SKYL<l0 SF
Skylight less than 10 sf
B
1 SKYL>10SF
Skylight greater than
10 sf or structural
B.
1STAIRS
Stairs -first flight/ea
addt'1
B
1BUSLIC
Business License.
B
•
4of3
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; 60%=4 points
Salvage Reusable Building Materials
3. Remodel for Mixed Use, Adaptive 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
18. Design Resource -Efficient Landscapes and Gardens
9. Reuse Matehals/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
f 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 I -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
8. Use Recycled Conterit 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 OEB - --
a. Subfloors
• b. Sheathing
up to 4 Resource
4 Resource pts y=
4 Resource pts y=ye
2 Resource pts y=yes
1 Resource of 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
2 Resource pts y=
3 Energy pts y=
3 Resource pts
up to 10 Resource pts.
2 Resource pts
y=yas
2 Resource pts
y=yes
2 Energy pts
y=yes
2 Resource pis
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
1 Resource pt
I
1. Use Sustainable Decking Materials
1 Energy pt Y --yes
2. Insulate Hot and Cold Water Pipes
a. Recycled content
3 Resource pts
y=yes
b. FSC Certified Wood 1
3 Resource pts
y --yes
'2. Use Treated Wood That Does Not Contain Chromium/Arsenic
1 IAQ/Health pt
y --yes
;3. Install House Wrap under Siding {
1 IAQ/Health pt
y --yes
'4. Use Fiber -Cement Siding Materials _
1 Resource pt
y=yes
E. Plumbing
f 1. Install Water Heater Jacket _
1 Energy pt Y --yes
2. Insulate Hot and Cold Water Pipes
2 Energy pts y=yes
l3. Retrofit all Faucets and Showefieads with FI6W Reducers
Up to 4 Energy pts.
Faucets (1 point each, up to 2 points)
Up to 2 Resource pts.
1a.
It. Showerheads (1 point each, up to 2 points)
Up to 2 Resource pts.
4.Replace Toilest with Ultra -Low Flush Toilets
Up to 4 Energy pts,
I(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
(2 points each, up to 4 points)
Up to 4 IAQ/Health pts.
8. Install On -Demand Hot Water Cirulation Pump
4 Resource pts y=yes
r-, riecrricar
1 Energy pt
11. Install Compact Fluorescent Light Bulbs (CFLs)
r
r
0
L(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
1 Energy pt
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
I2. Install Washing Machine with Water and Energy
r
r
0
!Conservation Features
1 Energy of
3.Install Energy Star Refrigerator
1 Energy pt
4. Install Built -In Recycling Center
3 Resource pts
E
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 vuitIh
INo 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
D. Uemngs 4 Resource pts y=yes
r
r
r
0
r
r
r
r
0
•
0
0
0
0
0
0
0
0
D
I-
E
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 vuitIh
INo 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
D. Uemngs 4 Resource pts y=yes
0
r
r
r
11
0
0
•
0
0
0
0
E
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 vuitIh
INo 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
D. Uemngs 4 Resource pts y=yes
•
0
0
0
0
0
0
0
0
D
1. Install Energy -Efficient Windows
_ a. Double -Paned '
b. Low -Emissivity (Low -E)
c.'Low. Conductivity Frames
2. Install Low Heat Transmission Glazing
J. Heating Ventilation and Air Conditioning
7l'Use Duct Mastic on All Duct Joints
2. Install Ductwork within Conditioned Space
3. Vent Range Hood to the Outside
4. Clean all Ducts Before Occupancy
5. Install Solar Attic Fan
6. Install Attic Ventilation Systems
7. Install Whole House Fan
6. Install Sealed Combustion Units
a. Furnaces
b. Water Heater
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
10. Install 13 SEER/11 EER or higher AC with a TXV
11. Install AC with Non -HCFC Refrigerants
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
• 13. Retrofit Wood Burning Fireplaces
a. Install EPA certified wood stovesrnserts
b. Install/Replace Dampers
c. Install Airtight Doors
14. Install Zoned, Hydronic Radiant Heating
15. Install High Efficiency Filter
16. Install Heat Recovery Ventilation Unit (HRV)
17. Install Separate Garage Exhaust Fan
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
2. Install Solar Water Heating System
3. Pre -Wire for Future Photovoltaic (PV) Installation
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw = 12 points, 3.6 kw = 1 B points)
:6. Select Safe and Durable Roofing Materials
7. Install Radiant Barrier
L. Natural Heating and Cooling
1. Incorporate Passive Solar Heating
2. Install Overhangs or Awnings over South Facing Windows
3. Plant Deciduous Trees on the West and South Sides
0
1 Energy pt
y=yes
2 Energy pts
y=yes
2 Energy pts
y=yes
1 Energy pt
Y --yes
2 Energy pts
Y --yes
3 Energy pts
y=yes
1 IAQ/Health pt
y=yes
21AQ/Health pts
y=yes
2 Energy pts
y=yes
1 Energy pt
y=yas
4 Energy pts
y=yes
3IA0/Health pts
31A0/Health pts
3 Energy pts
3 Energy pts
2 Resource pts
2 Energy pts
1 IAQ/Health pt
y=yes
1 Energy pt
y=yas
1 Energy pt
y=yes
3 Energy pts
y=yes
41AQ/Health pts
y=yes
5 IAQ/Health pts
y=yes
31AQ/Health ots
v=ves
4 Energy pts
10 Energy pts
4 Energy pts
Up to 18 Energy pts
1 Resource pt y=yes
3 Energy pts y=yes
5 Energy pts y=yes
3 Energy pts y=yes
3 Energy pts y=yes
1. Use LowMo-VOC Pa n
2. Use Low VOC, Water -Based Wood Finishes
i9. Use Low/No VOC Adhesives
4. Use Salvaged Materials for Interior Finishes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
B. Use Exterior Grade Plywood for Interior Uses
t7. Seal all Exposed Particleboard or MDF
B. Use FSC Certified Materials for Intedor Finish
9. Use Finger -Jointed or Recycled -Content Trim
10. Install Whole House Vacuum System
N. Flooring
1. Select FSC Certified Wood Flooring
2. Use Rapidly Aenewable Flooring Materials
3. Use Recycled Content Ceramic Tiles
4. Install Natural Linoleum in Place of Vinyl
5. Use Exposed Concrete as Finished Floor
6. Install Recycled Content Carpet with Low VOCs
Total Points Available:
Total Points Project Received:
1 IAO/Health pts y --yes
2IA0/Health pts y=yes
31A0/Health pts y=yes
3 Resource pts y=yes
y=yes
0
y=yes
0
0
p
so
5 [AD/Health pts
' y=yes
4 Resource pts
6IAO/Health pis
1 IAO/Health pts
41A0/Health pts
4 Resource pts
1 Resource pts
3 IAQ/Health pts
B Resource pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y=yes
5 [AD/Health pts
' y=yes
4 Resource pts
y=yes
4 Resource pts
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
3 9F7 -[.(AJ 14 C1
PERMIT #
OWNER'S NAME: L U C EL k
PHONE #
GENERAL CONTRACTOR
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
E4
OwnerfContractor 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
E4
OwnerfContractor Signature Date