08080026 cJ 9UILOo CDp S;QNN0 PERMIT CONTnItACTOR IPTFORMATION
BUILDING ADDRESS: ( PERMITNO.
93 / BLAZINGWOOD AVE BLUE MOUNTAIN AIR 08080026
OWNER'S NAME: PERMIT'ISSUE DATE
DORCIIAK 9'ERRY R AND CAROLYN 707 ALDRIDGE RD STE B 08/04/2008
NE:
('707) 451-8111 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDGO EMECH
O PLO O
uaij LICENSED CONTRACTOR'S DECLARATION Job Description
�=C 1 herby IMM Nu 1 am li«nsW under pmvivom of chapter 9(Commencing
<tn with S«uon7")of Division 3 ofthe Business and Prornamst Com.and my license is RPLC FURNC 60K BTU 92% EFF
;q_ iluannaee ass « 2 C3bLk.ir3� 68
Conium
^� ARCHITECT'S DECLARATION
2 1 undcrsnnd my plata shall m used u Public mmvds
Dyu
g s.0� Licensed Professional
tl OWNER-BUILDER DECLARATION
1 hcrtby affirm that I am exempt from Um COnuIJemse law for thP
O O following mason.(Saito 703 13,Business am Pmfesffi.Dealt:
dc:Any city or county
which requires a permit rmit consumer,iter.imProve,demolish,or repair any structure '
–Z< plim m its i licensed
p mere to m the amlicmt far Cch permi'ro muco,Law(Ch emmt
i c m.tlmiau«tatdpar>vantmumpm.ieim..armeetnnaem�sueemnT,wfataf�m9 Sq.FC Floor Area $ Valuation
>:�$ (commencing with Section 7000)of Division 3 of the Business and Profeuinns Code)or 57389
Thu M is exempt therefrom and On basis for the alleged etempuon.My violation of
Section 7031.5 by am appfram rtes permit ab ew the appl,anl In a tivR penalty OfNumber Occupancy Type
not mar dons five hundred dollars(s300). 3 6 9 2 0 018 �(f
1,u owmr of tie pmpury.a my wpltyca with wags u Heir ak compensation,
wi8 m Lha work,and the smear amt ksemm m afkrtd faun(Sur.]DM,Businw
and pm(esdom Cade:The Cmuxmrs Litems,Law doss tet apply in an.1 of Required Inspections
property who builds orimpm en Heron,andwW doessuch wmk himself or through his
two mnployeex,provided that such improwen onts are Out imeMrd maRerM for can.IL
however.Ne building or improwerent is mid within one year of Completion,the owner- ,
builder will have the burden of Proving Nu he did Out build or improve for purpose of
uk.).
1,as owner of the property an enclusively con methit with licensed Comrusas to
Construct the project(Sec.7014,Business and profession,Cade:)The Comae er's Li-
cense Law does not apply to an mar r of property who Wiles err improv therton,arm
who Contracts for such projects with aConuacmr(s)Unnamed parmat to the Contractors
License Law.
❑I an exempt under See ,B A,PC far Nu reran
Owner Da,
WORKER'S COMPENSATION DECLARATION
I hereby+frim under peremy of petjarr one of Ise following declarulem:
1 ham and will maintain a Certificate ofConsenuo self-insure for WorkersCompcn-
uum,as provided for by section 3700 of dse Labs.Code.for d,perfmon.of On
work for which Nu permit is issued.
Khow and will maintain Workers Compensation u,q
ation h,utm, uited by Seeum
of u,Latour Code,for the performance often work for whim this pcmit is issued.
My Workers Campenuuam nouns««,ler and Policy number am:
Catrier.�^v Y1�-�v/'4l/xl1 Policy No.:W,-'z/Q�O6jy6 fJIrY
CE 11 Fl� M-ON MGM WORKERS'
COMPENSATION INSURANCE
(-f issevum need notbeeompled If Ne permit is furore hundred dollar(110a)
or loss)
1 cern(v that in the performance of the work for which this Permit is issued,I shall tet
employ any person in any mamera as in become abject to the Worimm'Compemadon
Laws of California ate
Applicant
NOTICE TO APPLICANT:If,after making this Cemificmc of Exemption,you should
become subject to On Workers Cmnpemkum provisions of the tartar Cmc,you most
.J z forthwith comply with s«h provisions m this Permit shall be deemed rtwkcd.
z"' CONSTRUCTION LENDING AGENCY
I herb air=dust usert is a Consuuttion lending a
F Y g ,tory for the Performance of
C' the work for which this permit Is Wood(Sec.3097,Civ.C.)
S � Panders Name
M z Larders Addresev
V Q 1 certify than I Mare read this application and main duet the shave information is
Ll, Coma I agree In Comply with all city am cowry ami..am stare lows retain,he
building mmruction.am hereby authorise mprexentauvm of this city to now upon tie
fJJ ahme-mentiamd property for hapection purports.
'IY (We)agree to Save.Indemnify Nd F«p loormlem use,City of Cupertino against
rn in COiaer.lmgmenheem,ing and Of enwmit. may kany way,ce,r.,tinter said City
UZ inconsayumcea(IM,smrin,Of Oil pormik
^� APPLICYC`T)UNDERSTANQ)s AND WILL COMPLY WITH ALL NON-POINT Issued by:S Dale
sou uunoN .(Act
lu-n r on CC�'aY Ud' Re-roofs /
Signuum afApplicanUC�DOUS MATERIAL ISCLOSURE Dam Type of Roof
Will use,aPpli.1 tar future building«cuPat=.or kindle harzmons material
as m0md by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cone,Section 25532(x? F"'" All roofs shall be inspected prior to any roofing material being installed.
Dyes
If a roof is installed without first obtaininginspection,I agree to remove
Will the applicant or future building a«vpant ata equipment or devices which an iection
P g
dl havmom err contaminants as mftucd by the Bay Ara Air Quality Managmcm all new materials for inspection.
.let?
0Yes Nb
I have rte due Itaramommamriab mlryimmelns under CttaPser G95 of the Cali(ary
Tie HcnithhSafetyCme,S«uom255U5.25533am 25534.1 understand thatif the Wilding
does m rely ham a Item duel n In my rap mmliry m scoff On OYUPW L of Ilse Y Cl
OuNi which mtmm pear iumanceofa Ceruficaseof Oecpancy.
9 Signature of pl4 ant Date
Owner oraudborbs gcnf Date All roof c erings to be Class'W'or better
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36920018 . 00
DATE ISSUED. . . . . . . : 08/04/2008
RECEIPT # . . . . . . . . . : BS000005682
REFERENCE ID # . . . : 08080026
SITE ADDRESS . . . . . : 937 BLAZINGWOOD AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DORCHAK TERRY R AND CAROLYN
ADDRESS . . . . . . . . . . : 937 BLAZINGWOOD AVE
CITY/STATE/ZIP . . . : CUPERTINO_ CA, 95014-4618
RECEIVED FROM . . . . : EDWARD A GREGORY
CONTRACTOR . . . . . . . : GREGORY S . OWEN LIC # 29600
COMPANY BLUE MOUNTAIN AIR
ADDRESS . . . . . . . . . . : 707 ALDRIDGE RD STE B
CITY/STATE/ZIP . . . : VACAVILLE, CA 95688
TELEPHONE . . . . . . . . : (707) 451-8111
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 5, 389 . 00 0 . 60 0 . 00 0 . 60 0 . 00
I.EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
IMPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
I.MRRAA UNITS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00
IPPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 _ 0 . 00
1.TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 224 . 95 0 . 00 224 . 95 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 224 . 95 MC
---------------
TOTAL
-------------TOTAL RECEIPT 224 . 95
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- --------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
�0 Ugv�Z�
�1 CITY OF CUPERTINO
'' FURNACE/AC
OF
• CUPERTINO PERMIT APPLICATION FORM
APN # �9a 0 b � U Date: $ _ y_ O
Building Address:
9V -B/q z i•1 9 CUvd d 4 vp--
Owner's Name: Phone#:
Contractor: Phone#:
Ir7 tit-�4a <` Fax #:
Contractor License #: Cupertino Business License#:
a ,9 j-66 r -7Y6co
Contact: l� e ccc� Phone#: 7d7- 5"X1- J?//////:e �
Fax#:
Building Permit/Info:
Elect Plumb ❑� Mech
Residential Commercial
Job Description:
%Ze `J/;re
"'t
For Residential Installations:
Attic ❑ I" floor 2"d floor ❑
Adhere to minimum setback requirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction (Usage Class):
Strapped El On Platform LJ Bonded 0 New Location Replacement
Valuation: 2;_3 PQ
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.
CITY OF CUPERTINO
S FURNACE/AC
OF
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code. •
1MCSUSHTR Commercial Install/Relocate-ea -M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1 PGASCOM Commerical for ea gas piping System P
1-4 outlets
1 BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ca appliance vent
installed & not incl in an appliance
permit.
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
t cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,inel
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed.wall hit, or
floor mounted unit heater. •
1MRAPPVNT Residential for the install/relocate/ or M
replacement of ea appliance vent
install & not incl in an appl permit.
CITY OF CUPERTINO
FURNACE/AC
al or
•CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1 PGASRES Residential for ea gas piping system of P
1-4 Outlets
IBPGAS For each gas piping system of 5 or P
more per outlet.
1BSEISMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
1MFR=<100 Furnace Syst<=100k BTU install or M
relocate ea forced-air/gravity type
fumace/burner, incl ducts/vents
• attached to such appliance up to and
include 100,000 Btu/h
1MFRN>100 Furnace Syst> 100k BTU install or M
relocate ea forced-air/gravity type
fumace/bumer, incl ducts/vents
attached to such appliance over
100,000 Btu/h
1EPERMITFEE Electric Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit P
/ 1TRAVDOC Travel Documentation B
1 1BUSLIC Business License B
•
CITY OF CUPERTINO
FURNACE/AC
CITY OF
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
1 BCAIRHAN Commercial A/C Units<= lOk CFM B
1MCRAA Commercial Mech Repair/alt/add M
IBSEISMICO Seismic Commercial B
IPGASCOM Commerical for ea gas piping System P
1-4 outlets
1 PGASRES Residential for ea gas piping system P
of 1-4 Outlets
IBPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
1 BREMAIRHAN Residential A/C units <= I Ok CFM B
IMRRAA Residential Mech Repair/alt/add M
iBSEISMICR Seismic Residential B •
IEPERMITFEE Electric Permit E
IMPERMITFEE Mechanical Permit M
IPPERMITFEE Plumbing Permit P
1TRAVD0C Travel Documentation B
IBUSLIC Business License B
`13,7 4uc.
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
a
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 1-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 oints
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
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.
INPUT ReSDurces Energy IADIHeafth
A.Site
F1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;BD%=4 points up to 4 Resource pts D
12.Salvage Reusable Building Materials 4 Resource pts y=yes D
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 Stormwater Practices. 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
16.Design Resource-EHicient Landscapes and Gardens _ 4 Resource pts y=yes 0
9.Reuse Materials/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes D
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 D
1 1 1
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 up to 5 Resource pts 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate FoundatioNSlab before backfill 3 Energy pts y=yes 0
1 1 1
C.Structural Frame
.Substitute Solid Sawn Lumber with Engineered Lumber 3 Resource pts y=yes 0
(1
2.Use FSC Ca ifed Wood for framing l
(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 Heals 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
B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a.Floors 3 Energy pts y=yes 0
b.Wall 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 0S8 --
a.Subfloors
1 Resource pt y=yes 0
• b.Sheathing
1 Resource pt y--yes 0
1 1
rtenor mrs
INPUT ReSDurces Energy IAO/Health
1.Use Sustainable Decking Materials .
a.Recycled content 3.Resource pts Y_—Yes 0 •
b.FSC Certified Wood 3 Resource pts y=yes 0
2.Use Treated Wood That Does Not Contain Chromium/Arsenic j 1 IAQ/Health pt y=yes 0
13.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
14.Use Fiber-Cement Siding Materials 1 Resource pt Y--yes 0
' 1 1 1
E.Plumbing
[1 Install Water Heater Jacket 1 Energy pt Y--yes 0
2.Insulate Hot and Coid Water Pipes 2 Energy pts y=yes 0
r3.Retroft all Faucets and Showerheads with Flow Reducers j
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. D
b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0
14.Replace Toilest with Ultra-Low Flush Toilets )
I(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAQ/Health pt y--yes 0
6.Coned Gas to Tankless Water Heater4 Energy pts y=yes 0
7.Install Water Filtration Units at Faucets
(2 points each;up to 4 points) Up to 4 AQ/Healthpts. 0
B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
r.trecumcar
I1 Install Compact Fluorescent Light Bulbs(CFLs)
L6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) 1 Up to 4 Energy pts. 0 •
2.Install IC-AT Recessed Fixtures with CFLs(1 point each,up to
5 points) Up to 5 Energy pts. 0
3.Install Lighting Controls(1 point Per fixture,up to 4 points) Up to 4 Energy pts. 0
4.Install High Efficiency Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. 0
1 1 1
G.Appliances
11.Install Energy Star Dishwasher 1 Eneroy pt .y=yes 0
I2.Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y=yes 0
�3.Install Energy Star Refrigerator `� 1 Energy pt Y--yes 0
�4.Install Built-In Recycling Center + 3 Resource pts y--yes 0
1 1 1
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls 2 Energy pts y--yes 0
b.Ceilings 2 Energy pts Y_—Yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts Y--yes 0
3,Install Recycled-Content,Fiberglass Insulation witfi
!.No Added Formaldehyde 3 IAQ/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts Y_—Yes 0
5.Use Cellulose Insulation
a.Walls 4 Resource pts y=yes 0
b.Ceilings 4 Resource pts y--yes 0 •
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
o.Ceoings 4 Resource pts y=yes 0
1 1 t
INPUT Resources Energy IA011-leal
I.Windows
1.Install Energy-Efficient Windows
• a.Double-Paned 1 Energy pt y=yes D
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames 2 Energy pts Y--yes;
D
2.Install Cow Heat Transmission Giavng 1 Energy pt y=yes D
1 1 1
J.Heating Ventilation and Air Conditioning
,1.-Use Duct Idasfic on All Duct Joints ___ --� 2 Energy pts y=yes - 0
ll D
2.Instauctwrk wi
othin Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAQ/Health of 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
6.Install Sealed Combustion Units
fumaces 31AQ/Health pts y--yes 3 0
b.Water Heaters 3 IAQ/Health pts y--yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat 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. stall 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes Z 0
3.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stoves/inserts 1 IAQ/Health of 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 41AQ/Health 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 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yas 0
2.install Solar Water Heating System 10 Energy pts y=yas 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4,Install Photovoltaic(PV)System
(1.2kw=6points,2Akw,=12points,3.6kw=IB points) Up to I B Energy pts D
6.Select Safe and Durable Roofing Materials _ 1 1 Resource of y=yes 0
7.Install Radiant Barrier 3 Energy pts y=yes 0
1 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts 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 I
. n oor a Qua ny an niscies INPUT Resources Energy [AD/Heafth -
,1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes D .
3 Use Low/No VOC Adhesives 3 IAQlHealth pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQfHealth pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Exposed Pa ticleboard or MDF 4 IAQ/Health pts y=yes D
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycied-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring _ 8 Resource pts y--yes D
LUse Rapidly Renee-wable Flooring Materials 4 Resource pts y=yes D
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAO/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor .4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes D
1 1
Total Points Availab e: 1 1401 130 57
Total Points Project Received: �— 01 0 0
G:datarprogsrgreenbuildinggi idelinesJmmodelerrgreenpointsfna212.D4prmeded.ds
•
Community Development
', 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
g�UPEkJINO
Building Department
JOB ADDRESS: (�? els
Z!et Gk.,b A ve. PERMIT # OGD pUv
OWNER'S �rTr DC�RC1-[ /H- PHONE # y6 Y- OOZi"�c-,-JL9;'
GENERAL CONTRACTOR/3t (`//1/1;10 ,, ,,� - AX #
I am not using any subcontractors:
SignatuPe Date
Please check applicable subcontractors and complete the following information:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• Glass/ Glazing
Heating ��v wFa�. 41'1- �DJ
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contra or Si tune Date