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08030109 CITY OF CUPERTINO -'y'i.*x -BUILDINS DIVISION PERMITCONTNTRACTnR INFORMATION BUILDING ADDRESS: PERMrrNO. 934 BLAZINGWOOD AVE ERIC .S WU 08030109 OWNER'S NAME: PERMIT ISSUE DATE ERIC S WU 934 BLAZINGWOOD AVE 03/20/2008 ONE: SANITARY NO. CONTROL NO. ARCHITEC rENGINEER: BUILDING PERMIT INFO BLDG EMECH LECT PLUMB 0 0 0 0 3 am i; LICENSED CONTRACTOR'S DECLARATION 1 Mreby efilren WI 1 am Brood omen provisions of Chapmr 9(mmmcuing Job Description ma wiNSecdon701kBafOiviaianlofNeBudrwoandProfcssimnsCode,andmylicenu REPLACE EXTNG WATER PIPES j to in full farm and effeoL Z License Clan Lic.d Sa- Dam Contractor yyy ARCHITECTS DECLARATION iQ V I mUraund my plans shall be wed.,.bit,mcnrds tad Licensed Professional - ^ OWNER-BUILDER DECLARATION i i E 1 hereby affirm that I am exempt from the Contactors License Law far 0m K a C following memo.(Section 703 L5,Besi.0 and Pooneions Cede:Any city or county $ which requires a permit to cmewct alter,improv,demolish,or repair my muctum prior b its issumm.also requires the applicmt for such permit m Ole a signed statement < Nat he is licensed pursuant to the provisions of the Contractor's Limn Law(Chlmor 9 Sq.Ft. Floor Area Valuation 5$ (commencing with Section 7000)of Division 3 of the Business and Profeseimns Code)or $9000 Nat he is exempt therefrom and the basis for On alleged exemption.Any violation of Section 70313 by arty applicant fm a perrnh subjects the applicant An a civil penalty ofNumber Dcea not mom then Ren hundred dollars(S5W). 36917011 .UO Occupancy Type ❑I,As owner of Nc pmpmny,or my employee with wages As Neo sole eompendmn, wiltdo the work,and Ne swmure e,uniman led ea.oared forsalc(Sm.7044,Business and Professions Code:The Conmcwr's Limn Law dans not apply in an owner of Required Inspections property who builds or im proves therm.,and when dos such work himself ser through his own employes,provided Out inch improvements art not intended oroRered Image.if, however.the building or Improvement is sold within ow year of completion.the matter. builder will have Ne burden of proving Nat ho did of build or Improve for purpose of e owner of Ne property,am exclusively conuuYing with licensed onwmms W, construct Ne project(See.7044.Business and Pmfassiom Code:)The Cotrectore Lt. came law don not apply to an owns of property who builds or improves theman,and who convects for such pmjecm with amntractor(s)licenced pursuant to the Contractor's License Law. ❑Iameemptmearr Stns .BAl'C�farthismown Owner ( to kI Date fvLAV� r� WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declaration: - I haw and will maintain a Certifiam of Consent In UINnsum for Worker's Cropped. Iron,As provided for by Section 3700 of aha Ishan Code,nor On performenm of the work for which this permit is Issued. ❑I have and will maintain Worker's Compensation Insurance,As re uhad by Section 37W of the labor Code,for Ne pe formmce of the work for which this permit B Issued. My Workers Compensation Insurance camim and Policy number are: Carrier: Policy No.: - .... CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE mdse rection need not bo completed if the penal,is for one hundred dollen($100) m less) I certify,Nat in the performance of the work for which this permit le towed,I"I not crnployany person in my manncrm As to become subject kis W9 r'cTpensaim Iowa of C.lif.mi..Date Applicant —� NOTICE TO APPLICANT:IL after making this Cenifica a of Exemption,you should become subject m the Workers Compensation pmvisions of the Labor Code,you most .J z forthwith comply with soh provisions w Nu permit shall be deemed revoked. , E'n CONSTRUCTION LENDING AGENCY [-t�+ Ihmmhy affirm Out Nem I,a mustmetinn lending agency fur Ne perf.rmarm of tiNe work for which this permit Is issued(See.3097,Civ.C.) A Lenders Name z fenders Md. U Q I certify that I have read Nie a"Headon and slow Na,the show information is U, t-" cortex 1 agree N comply with all city and county ordinances and sue laws relating in 0 SU' building construction.and hereby eutharix mpreunutivw of this city to enter upon the [17 above-mentioned property for Inspection purposes. 11 (Wc)agree to avis indemnify and keep hermless the Cry of Cupertino against rA liabilities.judgment,cuts and expense which may N my my accrue against mid City V Z in consix moce of the Swung of this permit F-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULA ONS. 1'�-4Q.V )b' _ Re-roofs _. Signature of Appitun ontrwtor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof WHI the applicant or future building occupant store At handle havudow material as defined by the Cupertino Municipal Coda.Chapter 9.11.and the Health and Safety Code,section 15531(4)? ❑Yen a All roofs shall be inspected prior to any roofing material being installed. .Will the applicant or future building occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove h i mardow air canuminwts As de0rmd by the Bay Area Air Quality Management all new materials for inspection. MeO ❑Yee Ihawmay Nehvardsmsma M5. requirements34.1.hapmrd.95ofthe building nu Hulth&safety Code. Ant,sled,iti my responsibility understand Nmcup Wilding dos not currently how a mnwL lmo it l nu rco onsihility II notify tic amupant of Ne rtgwirtmcnts when Mmm pdorm ivueno o(a Ccrdfi Areupwey. Signature of Applicant Date env-w-v Ft- Ownerormthoridagent DateAll roof coverings to be Class"B"or better CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36917011. 00 DATE ISSUED. . . . . . . : 03/20/2008 RECEIPT #. . . . . . . . . : BS000004209 REFERENCE ID # . . . : 08030109 SITE ADDRESS . . . . . : 934 BLAZINGWOOD AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER ERIC S WU ADDRESS . . . . . . . . . . : . 934 BLAZINGWOOD AVE CITY/STATE/ZIP . . CUPERTINO CA, 95014-4619 RECEIVED FROM . . ERIC WU CONTRACTOR . . . . . . . . LIC # *OWNER* COMPANY . . . . . . . . . . : ERIC S WU ADDRESS . . . . . . . . . . : 934 BLAZINGWOOD AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4619 TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BPWATER UNIT 1. 00 40 .79 0. 00 40.79 0 . 00 1BSEISMICR VALUATION 9, 000. 00 0 .90 0. 00 0.90 0. 00 1PPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00 1TRAVDOC FLAT RATE 1 . 00 40.79 0. 00 40 .79 ,0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 123 .27 0. 00 123 .27 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 123 .27 AMEX --------------- TOTAL RECEIPT 123 .27 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING • NoCITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE • CUPE INO PERMIT APPLICATION FORM APN 11 v v Date: „ n Building Address: Ivy 7- q Ave Owner's Name: Phone#: 6 Contractor: Phone#: Q W V\Jp— Fax #: Contact: Phone#: Fax #: Contractor License#: Cupertino Business License#: Job Description: Residential ®� Commercial ❑ Valuation: Green Building Check hist must be completed and attached to this application. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BSEISMICOM Seismic Commercial P 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P / 1BPWATER Install/alter Water Pipe P 1BPFIXTURE Plumbing Fixture P I PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P IPLMBLNCK Plumbing Plan Check P IPLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel &Documentation Fee B IBUSLIC Business License B OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: � • A. = All the work authorized by this permit B. _ A portion of the work C. _ None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. _ A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to be performed 3. I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be erformed AR , leg ................................ .................................................. I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner's Signatures: Job Address: C 3 / ��Z hs c ��d f1c r Permit# Anychanges to the information provided on this form shall be submitted to the City of Cupertino Build Department. • City of Cupertino Building Department CITY Of 10300 Torre Avenue • Phone: (408) 777-3228 C U P E IST I N O Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensation • contributions. There may be financial risks for you if you do not carry out these obligations,and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor,only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street,Sacramento,California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino • Printed on Recycled Paper Single Family GreenPoint Checklist date: 3" Build ItGreed The GreenPoint Cheddist Is based on the various green features Incorporated into the home and is the SmartSafutiore Film The Ground Up basis for the GreenPoint Rated program.A home can be considered!green It It fulfills the prerequisites, Dams at least 5D come,and meets the minimum points per category.Energy(30),Indoor Alr Quality/ Hawh(5),Resources(6),and Winer(9).Please contact Build It Green for a list of qualified GredrPoirs - n • Raters d you are interested in pursuing third-party vedficabim. L The green building practicas listed below are described In the New Home Construction Green Building Guidelines,available at tnnmlldrtoreen.om. - - - - ENTER PROJECT NAME U s A.6I1'E s A Points Avellahla or assure 1.Protect Topsoll en mrinewsDimplion of Existing Plants d T ❑ a.ProredTopsoll from Erosion and Reuse after Construction 0 , , ❑ b.Limit and Delineate Consmsctiin Footprint for Maximum Pme don 0 I i 1 2 Deconstruct Instead of Demolishing Existing Buildings On Site 0 3 0.Recycle Job Site Construction Waste pncluding Green Waste) ' ❑ a.Minimum 50%Wmfe Ohwrim by Weight(RecycMg or Reass)-Required p R ❑ b.Minimum 65%Diversion by Weight(Recycling or Reuse) - ❑ c.Minimum BD%Diversion by Weight(Recycling or Reuse) -- 4.USe Resided Content Aggregate(Minimum 25%) - ❑ a Walkway and Dithmay 0 1 ❑ to.Roac ay Base -----_ ---.T-- 0 1 Total Points Avaslos in Site=1 0 B.FOUNDATION Points Available Per Measure 1.Replace Portland cement in Concrete with Resided Ryesh or Slag ❑ a.Minimum 20%Flyashor Slag 0 l 1 _ ❑ b.Minimum 25%Riyash or Slag D 1 2.Use Frost-Prole ed Shallow Foundation in Cold Aram(C.EC.Climate Zone 16) 0 3 a.Use fledon Resislant Construction(tn AI-Risk Locations Only) 0 4,Design and Build Struof ref Pest Controls ❑ e.Install Temdte Shields&Separate All Ermuior WWdAOCon xele Connections by Mete)or Plastic FastanamUMdom 0 7 b.All New Plants Have Trunk,Base,or Stem Located At Lead 36 Inches from Foundation 0 ^1 Total Pairs;Avallable in Foundation 11 0 C.LANDSCAPING Points Available Per Measurer 1.Construct Resource-Ef ruent Landscapes ❑ a.No Imasbe Spades Listed by Cel-IPC Are Plamad _D • ❑ b.No Plant SpDcles Will Require Hedging Elc.75%d Plants Are Drought-tdanant Califomla Natives,Modtam mean,or Other Apprpriats Species 0 l 3 2 Use FlreSefe LaniMcinpint Techniques 0 1 9.Minimize Turf Areae In Landscape Installed by Builder ❑ a All Turf Will Have a Water.Requirement Less than or Equal to Tall Fescue(50.8 plant factor) 0 ❑ to.Turf Shelf Not Be Installed on Slopes Eeceedng 10%of in Aram Less than B Feat Wide 0 -'� ( 2 ❑ c.Tud Is 533%of landscaped Area(total 2 points) -0 -_-7---------7-- ❑ d.Tud is 510%of Landscaped Area(total4 points) ❑ 2 4.Plant 5hede TracerD _ 13 S.Group Plants M Water Neetls tlrozonin ) 0 2 6.Imtell High-Elfldanry Irripetlon systems ❑ a System Uses Only Lo/-Row Ddp,Bubblers,or Lox-Oox Sprinklers 0 ) ___ 2 El b.System Has Smart Conal �D�—�- ( 3 ❑ 7.Incur orate Two Inches of Com ost In the Top 6 to 12 Inches of Soil 0 3 B.Muleh MI Plardn Beds to the Greater of 2Inches or Local Water Ordinance Re uirement _-0- I 1 I 2 LJ g.Use 5D%Selvaged or ReryCed-Content Me@rials for 5D%of Non-Plant Landscape Elements D I 1 10.Reduce Light Pollution by Shielding Flxtuma andior Directing Li ht Downward Total Points Available In Landscaping=3 ---:D=:N I D.STRUCTURAL FRAME R BUILDING ENVELOPE oats Available Per Measure 1,Apply Optimal Value Engineering ❑ a.Piece Ratters anti Sbds at 244nch On Center Fanning p , ❑ to.Size Door and Window Headers for Load f E] c.Use Only Jack and Cripple Sods Required fir Load I / 1 2 Use Engineered Lumber i ❑ a Seems and Headers E] q.Insulated Engineered Headers MAR 2 01008 _0 ❑ c.Wood Idoists or Web Trusses fa Floors _0 E] d.Wood Waste fix Rod Rafters —�_— 0 [:] e.Engineered or FlnpsrJointetl Studs for Vesical Application Y - I"��^ 0 ❑ f.Oriented Brand Board to Subiloor 0 —" --f —' ❑ g.Oriented Brand Board for Wag and Rod Sheathing p —'- s.Use PSCLerti ed wood ❑ a.Dimensional Lumber,Studs and Timber.Minimum 40% ❑ b.Dimensional Lumber,Studs and Timber.Minimum 70% ❑ c.Panel Products:Minimum 40% d.Penal Products:Minimum 70% 0 T 1 0 2DD7 Build It 0reen Single Family GreenPoint Checklist 2007 Version Page 1 of 4 ENTER 4.Un Solid Wall SYRUM(Includes SIP4[CFR 8 AM Non-Stick Forme Assembly) ❑ R.Floor —0 2 I _2 . ❑ b.Wells ❑ a Ronda D 2 2 5.Reduce Pollution Entering Me Home from the Campo ❑ a.Tightly Seal the Air Bander between Camps and Living Area D ❑ In.Install Gare a Exhaust Fan OR Build a Detached Game D 1 Lj B.DesignEmergyHeation Truces %of Aide Insulation Height at Dumids Edge of Extmior Wale 0 1 ❑ 7.DeW n Roof Tmnn m Acmmmodau Ductwork ' 0 1 B.Use Rs cled-Conlent Steel Studs for 00%of Interior Well Framing 0 1 s.Thermal Mesa Walls Sl6dnch Drywall on All Intel Walls or Wald Weighing more than 40IWcult. 0 1 10.Im mil Onrial and Bunten ❑ a.Minimum 16-Inch Overhangs and GuOeu 0 ❑ It.Minimum 24-Inch Overhangs and Guuela 0 1 Toted Poled Available in Structural Building Frame and Fmlaiops a 36 0 E.EXTERIOR FINISH Points Avallable Per Measure 1.Ues Reryeled-Contem(No Virgin Plastic or FSC-CeNfied Wood Decking D 2 2l:M1 a Rein Screen Well System D 2 Lj 3.Use Durable and NonoombusOble Siding Materiels 0 1 4.Select Durable and Noncombustible Rol Malariale 0 2 Total Poiret Avallable In Exmrile Finish 0 F.INSULATION Points Avatlotr a Per Measure t.Install Insulation with 75%Raeycied Coned ❑ e.Wells anis Floes _ 0 _ _ 1 _ ❑ b.Casings 0 1 2.Install Insulation that is Low-EmlNng(Cerin Section 01360) ❑ e Walla smile Floors ❑ b.Callings 0 1 _ 3. Impact Duality of lnculadon Installation before Applying Drywall 0 1 Total Points Ansable In Imulabon.5 0 O PLUMBING Points Available Per Measure 1.Distribute Domestic Hot Water EOiclesdy(Maximum 7 Pointe) ❑ a.Insulate Hot Water Pipes from Water Heater to Kien _0 ❑ b.[mutate AO Hol Water Pipes ❑ c.Use Engineered Parallel Piping _ 0 ❑ d.Use Engineered Palatial Piping with Demand Controlled Clmulal Loop ❑ a.Use Structured Plumbing with Demand Corbelled Circulation Loop 0 _ 1 __ t_ __2 ❑ I.Use Cenral Core Plumbing 0 ] 1 2 ❑ 2.Install Only High Effelannot,Tollete(Dual-Flush or<_1.21 gpq 0 4 Tocol Points Available In Plumbing=Tocol 12 D H.HEATING VENTILATION At AIR CONDITIONING Points Available Per Measure 1.Design and Install HVAC System to ACOA Manual J,D,and 5 RMInnumdations 0 4 2.Install Salad Combustion Units ❑ A Furnaces 0 _ r _ 2 1 t ❑ b.Water Heamla 0 2 _r - 3.Insall Zoned,Hydronlc Radiant Heating with Slab Edge Insulation 0 1 1 4.Imsmll fOph Efficiency Air Conditioning with Environmentally Responsible Refrigerant 0 1 5.Design and Insall EOestin Ducal ❑ e.Insall HVAC Unit and Ductwork within Conditioned Space _ 0 _ 3 1 ❑ b.Use Duct Metric on All Duct Joints and Seams ❑ c.Install Ductwork under Attic lmudtion(Budatl Ducts) ❑ d.Pressure Balance the Ductwork System ❑ a.Protect Ducts during Consumption and Coen As Duca before Occupancy 0 1 8.Install High Efficiency HVAC Filter MERV fie 0 _ 1 7.Dont Install Flmplace or Install Sealed Gas Fireplaces with Efficiency Rating Not Lasa Than 60% 0 1 ❑ using CSA Standeroe B.Inches EHDctin Exhaust Systems In BNAPDem and IOtehens ' ❑ a Install ENERGY STAR Bathroom Fans Vented to the Oudde 0 ❑ b.As Bathroom Fans An on Time or Humidistal _0 ❑ c.Install Kitchen Range Hood Vemad to the Outside 0 7 g.Insall Mechanical Vandlafion System for Cooling(Maximum 4 Points) ❑ A metal ENERGY STAR Caning Fan 6 Upm Kits In Living Areas 6 Badmorm _0 ❑ to.Install Whole House Fan with Variable Speeds 0 ❑ C.Automatically Controlled Integrated System 0 ❑ d.Automatically Controlled Integrated System with Variable Speed Control I 10.Install Mechanical Fresh Air Ventilation System(Maximum 3 Points) ❑ a.Any Whole House Ventilation System That Meets ASHRAE 622 _0 _ 2 ❑ b.install AlntoAir Heat Exchanger that meets ASHRAE 62.2 0 ] 2 71.Instill Carbon Monoxide Aortas D 1 Taal Points Avalaba In Hoofing,Ventilation and Ah Conciliating.30 0 02507 Build 11 Green Single Family Grear let Checklist 2D07 Version Page 2 of 4 'ENTER PROJECT NAME c s c r' c no I.RENEWABLE ENERGY I Points Available Per Maasure LJ 1.Pre-Plumb for Solar Her Water Hushing 0 I 4 2.Install Solar Water floating System In3 10 77 ].Inelall Winn Conduit for Future Photovoltaic Installation 6 Provide 200 In of South-Facia. Roof 2 4.Install Photovoltaic(Py)Panels Ela.30%m electric needs DR 12 kW(total 6 Pont) E ❑ b.60%of electric needs OR 2.4kAr(road 12 perms) ❑ c.90%de1&:nrcneed OR3.6kW(ttai 16port) 6 Toil AveOable Point In Renewable Ena =26 BUILDINGM J.BUILDING PERFORMANCE Points Available Per Measure 1.Diagnostic Evaluations El House Prance Blower Door Test _ ' 1_ Q House Passes Combustion Be"Backdrafl Test 0 1 —T i 2Deeign and Bulitl High Pedormancs [areas-%above Tale 24.minlmum15%Required 0 >_30 ❑ 3.House Obtains ENERGY STAR with Indoor Air PbCbga Certification-PAW Measure(Total 45 points;head comment) 0 5 2 Trial Available Palms in Building Performance 0 E.FINISHES Points Available Pat Measure 1.Design Entryways to Reduce Tracked in Contminenls 0 1 2.Use Low-VOC or Zwo-VOC Paint(Maximum 3 Points) ❑ a.Low-VOC Interior WaIVCaIMg Palms(60 gpI VOCs(Fla)and 050 gpI VOCs(Non-Flap) 0 ❑ It.2aro-VOC:Interior WarXelling Palm, s.5 VOCs Fla 0 3 ❑ ].Use Low VOC,Wads-Based Wood Finishes(450 ppi VOCs) 0 2 ! ❑ 4.Use Low-VOC Caulk and Construction Adhesives(40 gpi VDCa)for All Adhesives 0 2 ❑ 5.Use Recycled-Cement Palm 0 1 1 I 6.Use,Environmentally Preferable Materials for Interior Finish;A)FSGCertlfied Wood,B)Reclaimed,C)Rapidly Renewable,D)Reryded-Content or E)Flnger,lolntsd ❑ a.CabinWs(SD%Minimum) 0 ] ❑ b.Interior Trim(50%Minimum) El _ c.Shelving(50%Minimum) 0 j ] ❑ d.DDas(SD%Minimum) ❑ e.Countdo a 50%INK nimum) p I ] 7.Reduce Formaldehyde in Indoor Finish(CA Section 0135D) ❑ a.SubSoa&Star Trends(50%Mlntmum) 0 ] - • ❑ b.DBerirT&L50%Mini um) Minimum) 0 ❑ c.InteCabin s&Co0%Minimum) ❑ d.Shelving(50%Minimum) 0 1 ❑ I.ANar Installation of Flniahm,Test of Indoor Air Shows Formaldehyde Leval 17ppb 0 3 Trial Available Palms In Finishes=21 0 L.FLOORING Points Available Per Measure 1.Use Environmentally Preferable Flooring:A)FSC-Certified Wood,Bj Reclaimed or Refinished, C)Rapidly Renewable,D)Rerycled-cDmant,E) Exposed Carolina.Flooring Adhashws Must Neve<0 gpf VOCs. ❑ a.Minimum 15%od Flew Area - 0 ] ❑ b.Minimum 3D%d Flax Area 0 __ 1 ❑ c.Minimum 50%W Flag Area 0 j ] ❑ d.Minimum 75%m Floor Area 0 1 ❑ 2.Thermal Mass Floors:Floor Covering Other then Carpet on 50%or More of Concrete Floors 0 ] j. ❑ 3. Flooring Maet Section of 350 or CRI Green Label Plus Requirements SD%Minimum) 0 I 2 I Toted Available Ports in Flooring=7 0 M.APPLIANCES AND LIGHTING Points Available Per Measure 1.Install Water and Energy Efficient Dishwasher ❑ e.ENERGY STAR(tolls poinp 0 ❑ b.Dishwasher Uses No More than 6.5 Gallon cls total2 tint 0 — I 1 2.insist ENERGY STAR Clothes Washing Machine with Water Fetor of 6 or Len ❑ L Mast Ensrgy Star and DEE Tier2 requirements(modified energy factor 2.0,Water Factor 6.0)(total3 point) 0 j 7 ! _2 ❑ b.Mast Energy Star and DEE Tier 3 raquiramams(moolmd energy factor 22,Water Factor 4.5 a less) 2 (total olds D 3.Install ENERGY STAR Refrigerator ❑ a.ENERGY STAR Qualified&e 25 Cubic Feet Capacity 0 _ 1 ❑ b.ENERGY STAR Qualified&c 20 Guide Feel Capacity 0 1 ! 4.Ios dl Built-In Recyeting Center 0 ❑ a.Burt-in Recycling Center p ❑ In.Bush-In Composting Center 0 i Total Available Points in Appliances and 0 Min =12 0 N.OTHER Pants Available Per Measure ❑ 1.Incorporate GroomPoint Rated Checklist in Blueprints-Required 0 ❑ 2.Develop Homeowner Manual of Green FeaturearBenefits 0 I 1 1 1 • 3.Community Design Measures 6 Local Priorities:Soo the Community Planning Is Design section in Chapter 4 of the Now Home Guidelines for measures,Maximum of 20 points far suggested measures.Local requirements may also be fisted here. 0 20D7 Build It Green Single Family GraerrPoim Checklist 2007 Version Page 3 of 4 ENTER PROJECT NAME a Enter demiplim hen,and mut pDnb fordable IN manure in eppnprtes cetepehs to the tgo, 0 0 0 o D o Ends,dascripdan hen,am order prime eveleb4 fe measure In App apdete ralepodn to the right 0 0 0 0 0 0 Enter,deecr"m hen,and ends,points notable for measure In gernprlau ceregeln to he rigid. 0 D 0 0 0 Eraser description hen,end ants,puns avapena for monun h appropriate catspei-to he rlpn. 0 D D 0 _ 0 0 4.Innovation:List Innovative measures that meet the green building objectives of the Guidelines.Enter up to a Build It Green Checklists entl maximum combined total of 20 pts.Seo Innovation Checklist for suggested measures,using the link to the right. _ Guidelines _ Innova0m in Communi .Eme adsorption hen,and enter iten avee he amount,In a cat 'n to dhe d 0 0 D D 00 EJ Innovation In Energy,Enter de lion Mn,and soon points notable fe mann In eta cos as to the right _ p 0 D 0 p D Innovatlm In MOMan h:Eraser ru Int hare,and outer ns nail ons for measure in rine odle odn ID heNa. 0 0 D 0 0 _ 0 E03InnovafM la RUDur est Enter description here,and enter ns evallable le mwure n ase cos 'e to he d t 0 0 0 0 0 D Imerretion h Wnn:Em_r draw"tine,and emm pdrds eveOatY_a fa manure n oppmprlele cosporbs to the right_ D p_ 0_ 0 D 0 Total Available Pduds In Other=4 D Summary Total Available Points in Specific Categories' 4+ 96+ 42+ 66+ 43+ Minimum Points Requiretl in Specific Categories 0 30 6 6 9 Total Points Achieved e e e e e e Project hats not yet mol the following recommended minimum roquiromantss - Total Project Score of At Least 50 Points -Required measures: -A3a:50% waste diversion by weight -11:15D/o above Title 14 -NI:Incorporate GreenPoint Rated Checklist Into blueprints -Minimum points In specific categories: -Energy(30 points) -IAQ/Health,(5 points) -Resources(6 points) -11rater(9 points) 0 2007 Build It Green Single Family GrDDnP01nl Checidlisl 2D07 version Page 4 of 4 Community Development 10300 Torre Avenue �. Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 #UPERTINO Building De artment JOB ADDRESS: PERMIT # O I OWNER'S NAME: S_ W PHONE # 4 b 9--63 GENERAL CONTRACTOR: a(n1QV v FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information RI 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 t — Mnv, - - � Owner/Contractor Signature Date