08090176 CITY OF CUT'ERTINO
BUILDING DLVISICN PERMIT �,CONTR4GTORI,1VI'ORMA.
c-
BuIL.QIFjQpgO,ttEs ESTATES DR TBD — TO BE DETERMINED PERMIT 08090176
OWNERS NAME: PERMIT ISSUE DATE
SCHAEFER THOMAS J 09/26/2008
NE: SANITARY NO. CONTROL NO.
ARCHtT rEi4GINEEB: BUILDING PERMIT INFO
BLDG EIRCT PLUMB MECH
G
Z
LICENSED CONTRACTOR'S DECLARATION O O O
m 1 hereby affirm that I am Notated under pmvisiom of Chapter 9(commencing Job Description
i`uf with Section7IXp)ofDivWon3oftheBusincatandProfessionsCode,andmylicenses FURNACE REPLCMNT
^<din full form aM effm
,Eqb License Cleat�Lie.• NOTE: BAYHILL HEAT & AIR PD FOR BUS LIC 9/26/8
7W CI'S D ECI.SRATIO i
U 1 aMmsunJ my plans"I
atolI be uteA as public rtmrda .
a Licensed Pmfmaimul
i5 OWNER-BUILDER DECLARATION
y I hereby affirm Not I am exempt from the Contractor's Licensa Law for the
c pro O following mason.(Section 701.5.Busim em and Profadom Cade:Any city m county
�m which natuir m a permit an..L alcor.improve.damollah,or repair any structure
zy prior m its issuance.alto requires the applicant formch permit to file a signed stammcnt
'xo IWO M is licensed prevent to the Provisions of the Commuctar's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
1-s (commencing with Section 700MofDivuion3oftinBusiness and Pot, OmCade)a $3500
.- Net M s evmpt therefrom and Ne bass for to alleged exemption.Any viohd'on of
Section 70313 by any applicant for a permit subjects the applicmt m a civil penalty of Occu ane Typenet mom than five hundred dalm(SM 36925022 ,V� umber
0 I,as owner of IM property.or my employers with wages an their sale compensation,
will On Newark and the structure s not Intended or offered for sans(Sm.7(114.Budaev
and Ptolemaic.Code:The Convector.Lk.law does for apply m an owner of Required Inspections
property who buildsorimpmvea demean,and whodoeasuchworkhim elfarthrough hu
awe employes,provided On such improvements tie notimantra utolfored fmsale.If.
however,the building or improvement scold widdn one year of c umpleuoa.the ownv-
builder will have IM burden of proving that M did not build or improve for puryCsa of
sale.).
0 I,u Owner of the property,.m aetumm,convening with Borated emntratoc s an
onnttma the project.(Sec.7064,Bwinm and Professions Code:)The Convaamrs U. .
come law dose oat apply In an owmrofproery,wbu Mims of impmm Norton.and
who mnmcta for such projects with a eonuacmr(s)licensed purmaat no IM Contrmto's
Licensee Law.
❑lamexcmptuudm See ,BRPCrm Obs amn
Owner Data
WORKER'S COMPENSATION DECLARATION
I Mneby+Rive under penalty of perjury are,of the following dectatatiom:
1 ham and will maintain a Ccnificamof Cement to telt-imum fur Werner.Compen-
aadm,as provided for by section 3700 of the tabor code,for IM Fortune.of rM
wort for whim this permit is issued.
Q 1 have and will maintain Workers Crmpeauation I...aa retrained by Section
37M Crum tabor Code,for NC Performance ofdm wutk for which this permit isnamed. '
My Workers Coml!p--e.m�-w_ou'tt II�emma carrier and Policy number art: /S
Gmdv�"^'v^v�� Policy No.:'rl� —170-1 Y'
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cnrs tendon nerd Out W eenpkted lithe permit is future hunNeddoOan(5100)
or less)
I ceatif.that in the Performaree of Ne work fm which Nis Permit u svcd.1 shall net
employ any pmmn in my mmmrm m On become subject to the Workers'Compeoadon
Laura of c.lifamia,Dam
Applicant
NOTICE TO APPLICANT:IL after making this Ccainam of Eaempuno.you about;
become subject to On Workers CorrN anion previsions of the labor Code,you mum
.J ,'Z forthwith comply with such previuoru or this permit shall M dame4 revoked.
'Z O CONSTRUCTION LENDING AGENCY
r
(-+ hereby which rte that Nem iWcommucli30 ten ding agenry for tiro perfutmame of
a. L
the worn for which the maallil u Wood(Sec.3(57,Civ.C)
Ifs Q Lender.Name
7 z lsndef.Address
U0 I certify than I have mad this application seed sum Lha Nc above informant.is
{Ta correct.1 agree m comply with all city and county Ordinances and state laws mining to
building canmucuon,and hereby auNodre pC meentauvea of this city to comm upon the
{17 above-maudgm property Tut Cape.
ape on purpwhich
(We)agrm to can.indemnify and keep harmlma the City of Cupentro al aims
H incouauence fthecaaumdof ads ewllich may to any way mare agalmt vial City
V'z AePLICANTe oftheRSTAN ofadsDWiL
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date r'
SOURCE REGUI�ISR4S/ �°��p - 9 � a
` (/� Re roofs
SigmemeApplicaudl7boUnact., 1 Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant m famre wilding—Parat Cort m hwm havrdoas mamriil
as defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safety .
Cam,Suction 25533(.)?
yea 04- All roofs shall be inspected prior to any roofing material being installed.
Will the applicant Of future building Occupant Lisa equipment a devices which If a roof is installed without first obtaining an inspection,I agree to remove
,t hvardnm air conumim uM v defired by the Bay Area Air Quality Mangemcnt all new materials for inspection.
PLO
0Ya myths
I hive real Ne hvu0vrsmamdila nequireoew underCMpher6.95ofthe Califar.
out Heal"SafetyCede,seclionain 15.35533 d235M.I undcrstsnE dooddm wilding
dam net curve tidy Mve a sena t,dui It u my netpmorbilily to hairy,the amupanl of de
requimrllew tl M vel(star to lasualLC ori L'pmfClm Of f3CNPan .
Signature of Applicant Date
owne wmNadrrAsgem Dam All roof coverings to be Class'4a'or better
CITY OF CUPERTINO
• 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36925022 . 00
DATE ISSUED. . . . . . . : 09/26/2008
RECEIPT # . . . . . . . . . : BS000006200
REFERENCE ID # . . . : 08090176
SITE ADDRESS . . . . . : 10610 E ESTATES DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : SCHAEFER THOMAS J
ADDRESS . . . . . . . . . . : 10610 E ESTATES
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4509
RECEIVED FROM . . . . :
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 3 , 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1. 00 110 . 00 0. 00 110 . 00 0 . 00
IEPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40.79 0 . 00 40 . 79 0. 00
1MRRAA UNITS 1. 00 61 . 19 0. 00 61 . 19 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 334 . 85 0 . 00 334 . 85 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 110 . 00 MC
CREDIT CARD 224 . 85 CTI MC
------------
TOTAL RECEIPT 334 . 85
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 'FINAL MECHANICAL
•
06C-0(901 -7(�,
CITY OF CUPERTINO
FURNACE/AC
r'
Nl OF
:CUPEkTINO PERMIT APPLICATION FORM
APN# Q Date0 + � / OQ
Building Address: 1
Ow s Name: Phone#:
�-3y
Contractor: Phone
Fax #:(-AV
Contractor License#: Cupertino Business License #:
Contact: I ' Phon(�!:
V Fax #:
Building Permit Info:
Elect Plumb - Mech
Residential Commercial
Job Descriptio
For Residential Installations:
Attic ❑ Is` floor 2nd 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):
3 --si2 V G
Strapped ❑ On Platform LJ Bonded ❑ New Location Replacement
Project Size: Express E' - Standard ❑ Large ❑ Major ❑
Valuation:
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.
Revised 6/16/08
CITY OF CUPERTINO ,
'nO�NFURNACE/AC
OF
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
IMCRAA 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.
1MCREPALT 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.
IMCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or •
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit.
IBSEISMICO Commercial Seismic B
IMRRAA Residential Repair/Alteration/Add to M
C
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.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1MRAPPVNT Residential for the install/relocate/or M •
replacement of ea appliance vent
install ¬ incl in an a 1 permit'
Quantity Fee ID Fee Description Fee Permit Type
Crnlln
CITY OF CUPERTINO
\� =�'' FURNACE/AC
t
CUPERTINO FEE SCHEDULE
Group
FURNACE FURN/AC
1PGASRES Residential for ea gas piping system of P
1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
a 1BSEISMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
1MFR=<I00 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/buiner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
lEPERMITFEE Electric Permit Fee E
/ 1MPERMITFEE Mechanical Permit Fee M
/ 1PPERMTTFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
I1BUSLIC Business License B
uantity Fee ID Fee Description I Fee I Permit Type
CITY OF CUPERTINO ;
d'' FURNACE/AC 1
CUPERTINO FEE SCHEDULE
Grou
AIR FURN/AC
CONDITIONING
1BCAIRHAN Commercial A/C Units <= l0k CFM B
IMCRAA Commercial Mech Repair/alt/add M
IBSEISMICO Seismic Commercial B
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. CommlResid
1BREMAIRHAN Residential A/C units <= l0k CFM B
1MRRAA Residential Mech Repair/alt/add M
1BSEISMICR Seismic Residential B
•
1 EPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
IBUSLIC Business License B
•
Green Building Plan Check
Index of Green Building Points/Categories
A Category Example of an Index or Table of Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
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
__Lpoints
D. Structural 3. Uses Wood IJoist, (See Spec.) S-2 2 points
5: Use Truss with heels, (detail) S-2 2 points
6. B. OSS Sheathing, detail S-2 2 oints
E. Ext. Finish 1. Composite Decking, (Note/Spec.) AJ 2 points
4. B. Fiber Cement Siding, (Note/Spec.) A32 pints
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 ants
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 __Lpoints .
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) AJ 1 point
3. Energy Star Refrigerator, (Note/Spec.) A3 1c
int
P. Other 1. List Green Features on Plans A-1 1 paint
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 Rewurces Energy IA011-leatth
A.Sde
1.Recycle Job Site Construction&Demolition Waste
65°%=1 point;75%= 2 points;BO%=4 points up to 4 Resource pts 0
12.Salvage Reusable Building Materials _ 4 Resource pts y--yes 0
3.Remodel for Mixed e,Ad
Usaptive Reuse,and
Historic Preservation 4 Resource pts y--yes O
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
Ie.Design Resource-Efficient Landscapes and Gardens 4 Resource pts y=yes 0
9.Reuse Materials/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes 0
10.Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts y=yes p
1
B.Foundation - ENO
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 Foundation/Slab before backfill 3 Energy pts y=yesFJ 0
1 1 !
C.Structural Frame
i 1.Substitute Solid Sawn Lumber with Engineered Lumber _ 3 Resource pts y--yes p
2.Use FSC Certified Wood for framing
(For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0
3.Use Wood I-Joists for Floors and Ceilings 2 Resource pts y=yes 0
4.Use Web Floor Trusses 2 Resource pts y=yes 0
5.Design Energy Heels on Trusses 6'or more 2 Energy pts y=yes 0
B.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 Ener is
b.Wall 9Y P Y=Yes 0
3 Energy pts y=yes 0
c.Roof 3 Energy pts y--yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0
12.Use OSB
a.Subfloors 1 Resource pt y=yes p
• b.Sheathing 1 Resource pt y=yes 0
1 1 f
INPUT Resources Energy 1ADIHeafth
.ExterlOr rmsh
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 1 IAQ/Health pt y--yes 0
3.Install House Wrap under Siding 1 IAQ/Health pt y=yes 0
4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
E.Plumbing
I1.Install Water Heater Jacket 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
,3.Retrofit all Faucets and Showerheads with Flow Reducers
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0
4.Replace Toilest with Ultra-Low Flush Toilets
i(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filteron Showerhead 1 IAQ/Health pt y=yes 0
6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0
S.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
r.eiecmcai
It.Install Compact Fluorescent Light Bulbs(CFLs)
1(6 bulbs=2 points, 10 bulbs=3 points,12 bulbs=4 points) 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
I 1 1
G.Appliances
1.Install Energy Star Dishwasher 1 Energy pt y=yes 0
i2.Install Washing Machine with Water and Energy
Conservation Features IEnergy pt y=yes 0
j3.lnstall Energy Star Refrigerator 1 Energy of 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 p
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 with
INo Added Formaldehyde 31AQ/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes D
5.Use Cellulose Insulation
a,Walls 4 Resource pts y=yas 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.callings
4 Resource pts y=yes p
0 1 1
INPUT Resources Energy JADIHeafth
1.Windows
1.Install Energy-Efficient Windows
• _ a.Double-Paned 1 Energy pt y=yes 0
b.Low-Emissivity,(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy of y=yes D
1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on All Duct Joints _ 2 Energy pts y=yes D
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAQ/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 7
0
5.Install Solar Attic Fan 2 Energy pts y=yes D
S. Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts y=yes 0
B.Install Sealed Combustion Units
a.Furnaces 31AQ/Health pts y=yes 0
b.Water Heaters 31AQ/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.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stovesrnserts 1 IAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 41AQ/Hea1th pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 31AQ/Health pts y=yes 0
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energypts y=yes 0
2.Install Solar Water Heating System 10 Energy pts y=yes 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=1 B )oints) Up to 18 Energy pts p
�6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pts yges 0
1 1
L.Natural Heating and Goofing 1
1.Incorporate Passive Solar Heating 5 Energy pts y=yes p
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes p
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
1 1 1
INPUT ReSDUTMS Energy 1ADIHealth
M.In oor Air Quality and F1ms es
1.Use LowMo-VOC-Paint 1 IAQ/Health pts y=yes 0
• 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
,3.Use LowMo VOC Adhesives _ 3 IAQ/Health 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 61AQ/Health pts y--yes 0
6,Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal a l Exposed Padicleboard cr MDF 4 IAQ/Health pts y=yes 0
B.Use FSC Certified Materials for Interior Finish _ 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
1 1 !
N.Flooring
1.Select FSC Certified Wood Flooring _ 8 Resource pts y=yes 0
L2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/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 0
1 1
Total Points Av 1 1401 130-r---77
• Total Points Project Received: 01 01 0
Gaa;arprogs/greenbulldngg delineslremotlelers/greeny:nlsfina12.12.04protededxls
•
Community Development
' F' 10300 Torre Avenue
,, 'yr- Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
o e . ` -ST• fir? 6
OWNER'S NAME:3'Af-?zit-t Sc — PHONE # IFOS 2 _77 3 ete
GENERAL CONTRACTOR FAX#
I am not using any subcontractors: c� o
Signature Date
Please check applicable subcontractors and complete the followin 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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
•
Owner/Contractor Signature Date