08040219W
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CITY OF CUPERTINO+^oa.�?a
BUILo1NCDtv(Slon PERMIT
RiII QRMATIp
BUILDING ADDRESS:
PERMIT NO.
20151 FOREST AVE
ECONOMY ROOFING
08040219
OWNER'S NAME:
PERMIT ISSUE DATE
MATSUKI ALFRED AND ATSUKO
825 CAMDEN AVE
04/30/2008
NE:
_
SANITARY NO. CONTROL NO.
(408)866-1800
ARCHTIECTYENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMBMECH
0 0 0 0
LICENSED CONTAACIOR'S DECLARATION
li¢raxed CnaPr 7
Job Description
l MabY aRirn wt I un mover ptaridaa rr (aammeMna
with section 7(kw) nroiAsin 3 ofw Business and Pmrusinm Code, and my license is
T/O T-1-11 SSIDE WL& REPAPR& INSTL NEW T-1-11
in full Loa and efr`3 2 Z
License Cln_L'm.g u
Dena
UNPRIMED
S(RCHITECrSDECI.WRATION
1 undemanJ mY Plans snail M tired u public records
,
Licensed Professional
OWNER -BUILDER DECLARATION
I hcrchy affirm that I am exempt from the Contractor's License Law for the
following meson. (Section 70313, Business and Pmfaasos Code: Any city or county
which requires • permit an cmwrmk slur. improve, demmlim. m repair any mucturc
Prior to its distance. aBU requires do, applieNl forpKh Permit W rile a signed sYlCment
Num is licensed mrsomllmthe pro,mmularme, Contacto'au<ns Law (Chapter v
Sq. Ft. Floor Area Valuation
(emnmendng with Suction 70M) n'Division 3 of Ne Business and Professions Code) or
$996
that he is exempt them. and w basis for the alleged eumpdon. Any violation of
saGi
aryl s(ilabjcwwapplicmttoarnl peu0y, a(man ..undred�(�
Occupancy Type
shautf
31633071.WNumber
❑ L u ower olLai property, a my aoployoa with wage u Ne'v mlemmpewLao,
wi0 do wwoa, and w manure is me, LiMed m Laware fm We (see. TOu, Buaimos
and ou Code: The centreeurs Law thou not apply m ,downer of
_ Required Inspections
ersylanebunNofimprowab it wh.
property h his
who aressohwokn aroffeed
own
awn em. impend
foam
uiprovided Law such imPsm not intended monnrnar roe sale B,
theid wheart
. w building o improvement u rola within au Wearer mm0leum, w mvecr-
Wilder
WaM will hese w btuden of goHnB wt lis did ml ddb o improv (o puryaxe of
Asia.).
❑ 1, u owner of w proPenY, am exclusively contracting with licensed contractors in
.1.1 w project (Sec. 70se, Business Ann Profassau Cade:) The Coumm'a U.
came Law arms m. apply N an owe of praimmy who builds or Improves wreon. and
wM eotruta lorsmh Mij ^• with a macmboss
ntrr(s) ed pmsuanl m the Co otsacmrs'
License Law.
❑ lamexemptuodasm. ,B&PCrmthmmjAM.
Owens Data:
WORKER'S COMPENSATION DECLARATION
1 barely agmen under parody of mdury nm of due following decleatiau:
1 haw and will maintain ACanifram ofcmuenl in self -inure for WoskefsCompen-
ration. As provided far by Section 7700 of One labor Code. for the Performance of w
work for which this permit is issmd.
t$.tttaw sod will maintain W WWS Compew0on Insurance, as; required by Sectio
Mores Labe Code, forty performmeeor w wart for which Nis permit is iumd.
'
MY Workela Compensatio Wasumceg ariv end Policy number am:
Cartier. _ i 1i�' �^"�M Policy No.: riii I �j�l .�--
CERTIFlCATEOFEXEMPTION FROM WO RS'
COMPENSATION INSURANCE
e
(This section rd ser M completed if ft permit is ren one haW nNdOOan (s100)
.
our less)
I terrify Nat in w purfonname of Lane work for which this permit is issued, I shall not
employ any person in My manner In As m become subject in the Workcrs' Compeuatim
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, after making Nu CeniBam of Examines, you should
berme subject to de WOlte(s Compensation provisions or die Labor Codc, you am
forthwith comply with such provisos or Nu permit shall M deemed mwkcd.
CONSTRUCTION LENDING AGENCY
1 Mmby affirm Nu than, is a agmamdM leading Agenry, ser the performs. of
the wart far which this permit is issued (Sec. 7077, Civ. C.)
Lsnder's Name
'
,
Lenders Address
I candy Out I hale mad thus application Mod sum Our the Mose offermadan is
correct. l agree m comply with sl city and county Mliarces and sum laws relating in
Wilding couwctio, god Mmby mNasu repremmutisus of this city as comropno use
aMw.motiomd property fm iupenian purposes
(We) agree to saw. indemnify and keep harmless the City of Ca icnino ageiut
liabilities, judgments, costs and expenses which may in any way vcmun agsm� aid City
in exasequeme of On granting of Nis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POTNT
URCE REGULA, ONS
�7
Issued by: Date J r�
�� r G�
\lam
Re -roofs
�—
srgnuum of App saarUCARDOU
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
WIII Lac applicant o larva Wilding a. score ofmamriai
u de. Chill AndhasidlefthauNou
by Ne Cupertino Municipal Cade. Chapmf 9.1; and Um Ha1N and Safety
Sect
Code. sem. 23532(a)7
[3 Yu [T Ne
All roofs shall be inspected prior to any roofing material being installed.
Will w Applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining inspection, I agree to remove
g an ins p
Ol IL hu mous air contaminants as dcrined by the Day Area Air Quality Management
all new materials for inspection.
❑Yrs C{
IhawreWwhvNaumamrialarequiremcotsunder Chapurd95afwWildi"-
niaHalN&oradyycm Wilding
2my.1,d2553d,1
A LMAIshan iti An Mar aNai(apa
Jou net currently how s mnu4 this It u my mspamibility b notify tM rampant of w
- \
re uimmcnu which now M met prior to Madame of a Cenifiau of Occapmry,�
Signature of Applicant Date
All roof coverings to be Class a'R" or hotter
Own& or mtha a ant Data
• 2 ITEMS OF 2
•
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31633071.00
DATE ISSUED.......: 04/30/2008
RECEIPT #.........: BS000004626
REFERENCE ID # ...: 08040219
SITE ADDRESS .....: 20151 FOREST AVE
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
122.50
---------------
122.50
REFERENCE NUMBER
--------------------
#2283
OWNER ............:
MATSUKI ALFRED AND
ATSUKO
ADDRESS ..........:
20151 FOREST AVE
CITY/STATE/ZIP ...:
CUPERTINO CA, CA 95014-2008
RECEIVED FROM ....:
ECONOMY ROOFING
CONTRACTOR .......:
HORSAGER, PAUL B
LIC # 19307
COMPANY ..........:
ECONOMY ROOFING
ADDRESS ..........:
825 CAMDEN AVE
CITY/STATE/ZIP ...:
CAMPBELL, CA 95008
TELEPHONE ........:
(408)866-1800
FEE ID
----------
UNIT QUANTITY
------------- ----------
AMOUNT PD -TO -DT
THIS REC
NEW BAL
1BSEISMICR
VALUATION 996.00
---------- ----------
0.50 0.00
------
0.50
-------
0.00
1INSPODD
HOUR 1.00
122.00 0.00
122.00
0.00
TOTAL PERMIT
---------- ----------
122.50 0.00
----------
122.50
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
122.50
---------------
122.50
REFERENCE NUMBER
--------------------
#2283
•
•
0
CITY OF
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
0g0� o 7-19
APN # 31 cP 33 0 —� 1, 0
Date:
Building Address: �o t 5-) I
L 1 1}y % V�
Mailing Address (if different from building address):
I
Owner's Name:
Phone #:
Contractor: No�
Phone: qog —
�
Fax:
Contractor License #: L-2(? Z 3
Cupertino Business License #: 2 3 1-f -�
Contact:
~�
Phone:
Fax:
Residential H Commercial
Job Description: ��f�/L USF / �� So S/o�> O� L,411
— p a/00 - t .
/
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ NO ❑
Building Permit Info: S—FD va pr1-r
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 11-B ❑ 11, 111, V-A ❑ 11, 111, 1 V V -B [Q�
Valuation,Square Footage•
OC s
M•or ❑ Q-�
Size: Standard are Ela
Vee 0'
GBuilding: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgreen.org
710S
Ii CITY OF CUPERTINO
CUPER,TINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1GENCOM
1BTEMPPER
Temporary Building Permit (good for
B
30 days)
1 BBOILERI
For the installation or relocation of ca
M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw),
1 BBOILER2
Installation /relocation of ea
M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1 BBOILER3
Installation/relocation of ea
M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1 BBOILER4
Installation/relocation of ea
M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5
Installation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btwb
1 BAPPLOTH
For ea appliance or piece of equip
M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP
Other Electrical Inspections (per hour)
E
1MECHINSP
OtherMechanical Inspections (per
M
hour)
1PLMBINSP
Other Plumbing & Gas Inspections
P
er hour
1MEETINGIHR
Application Meeting
B
CITY OF CUPERTINO
S
CUPCITY EYOF GENERAL BUILDING APPLICATION
• FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW
SFDWL/DuplexNew
B
IACOUSRESAD
SFDWL/Duplex-Addition/Alteration
B
1ACOUSCOM
Multi-Family/Commercial
B
CHIMNEY'S
1CHIMNEY
Chimney
B
1 CHIMNEYR
Chimney Repair
B
FENCES
1 FENCE>6FT
Non -masonry, over 6 ft in height
B
1FENCEMAS>6
Masonry, over 6 ft in height
B
FIREPLACES
1FIREPLMAS
Fireplace Masonry
B
1FIREPLFAB
Fireplace Pre-Fabricated/Metal
B
1 FLAGPOL>20
Flag pole (over 20 ft in height)
B
1MODUSTRU
Modular Structures
B
FOUNDATIONS
1FOUNDREP
Foundation Repair
B
1PILECAST
Pile Foundation Cast in place concrete
B
1PILEDRIV
Pile Foundation Driven (steel, pre-
stressed concrete) .
B
3 of 5
Sa,z
CITU OF
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEESCHEDULE
0
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN
Standard (up to 50 ft)
B
IRETSP310
Special Design, 3-10' high (up to 50 `)
B
1RETSPI0
Special Design, over 10' high (up to
50'
B
1RETCRB<
Gravity/Crib Wall, 0-10'high (up to
50 ft
B
1RETCRB>
Gravity/Crib Wall over 10' high (up to
50 ft
B
SIDING
1SIDESTBK
Siding, Stone & Brick Veneer
(interior/exterior
B
:]
I
`
/
1 SIDEOTHER
Siding all other
B
SKYLIGHTS
ISKYL<10 SF
Skylight less than 10 sf
B
1 SKYL>1 OSF
Skylight greater than 10 sf or
structural
B
1STAIRS
Stairs -first flight/ea addt'1
B
STORAGE RACKS
1 SRACKS<=8
Storage Racks 0-8' high (up to 100 sf)
B
1 SRACKS>8
Storage Racks over 8' high (up to 100
st)
B
1STUCOAP
Stucco Applications (up to 400 sf)
additional stucco application
B
4of5
Jet
CITY OF
• CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
1 WINREP
Replacement windows/sliding glass
door (ea 8 windows)
B
1WINMEWSTR
New Window -structural shear
wall/masonry (includes plan ck fee
B
IEPERMITFEE
Electrical Permit Fee
E
IMPERMITFEE
Mechanical Permit Fee
M
I PPERMITFEE
Plumbing Permit Fee
P
IELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1 MECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
1 PLMPLNCK
Stand Alone Plumbing Pln Ck (hrly)
P
1 STPLNCK-(3 Hr Min
when not over counter)
Standard Plan Check (when no E/M/P)
hourly -stand alone
B
/
1BSEISMICR
Seismic Residential
B
IBSEISMICO
Seismic Commercial
B
1TRAVDOC
Travel & Documentation
B
1BUSLIC
Business License
B
5 of 5
0
Plan Review Process Work Book Page -12-Revised 3/25/08
�u
0
'
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
11.
Permeable Paving,Note
L-1
C.
Foundation
1.
Use 15 % Flyash Concrete, (note)
S-1
7points
D.
Structural
3.
Uses Wood I -Joist, (See Spec.)
S-2
5.
Use Truss with heels, (detail)
S-2
6.
B. OSB Sheathing,detail
S-2
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 points
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
I 1 point
P.
Other
1.
List Green Features on Plans
A-1
1 point
IMMMMM
TOTAL POINTS1
1 40 points
0
Plan Review Process Work Book Page -12-Revised 3/25/08
�u
0
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.
1Recycle Job Site Construction 8 Demolition Waste
65% =1 point; 75%= 2 points; 80%=4 points
up to 4 Resource
2. Salvage Reusable Building Materials_
J 4 Resource pts y=
3. Remodel for Mixed Use, Adaptive Reuse, and
Historic Preservation
4 Resource pts y=
4. Protect Native Soil
2 Resource pts y=
5. Minimize Disruption of Existing Plants 8 Trees
1 Resource pt y=
6. Implement Construction Site Stormwater Practices
2 Resource pts y=
7. Protect Water Quality with Landscape Design
2 Resource pts y=
8. Design Resource -Efficient Landscapes and Gardens _
_ i 4 Resource pts y=
9. Reuse Materials/Use Recycled Content Materials
2 Resource pts
for Landscape Areas
2 Resource pts y=
10. Install High -Efficiency Irrigation Systems
2 Resource pts y=
11. Provide for On -Site Water Catchment / Retention
2 Resource pts y=
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
2. Use Recycled Content Aggregate 2 Resource pts y=yes
3. Insulate Foundation/Slab before backfill 3 Energy pts y=yes
C. Structural Frame
1. substitute Solid Sawn Lumber with Engineered Lumber
J 3 Resource pts
2. Use FSC Certified Wood for framing
y=ye:
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10 Resource pts
3. Use Wood kJoists for Floors and Ceilings
2 Resource pts
y=yes
4. Use Web Floor Trusses
2 Resource pts
y=yes
5. Design Energy Heels on Trusses 6" or more
2 Energy pts
y=yes
6. Use Finger -Jointed Studs for Vertical Applications
2 Resource pts
y=yes
7. Use Engineered Studs for Vertical Applications
2 Resource pts
y=yes
S. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts
y=yes
9. Use Structural Insulated Panels (SIPS)
a. Floors
3 Ener 9Y pts
y=yes
b. Wall
3 Energy pts
y=yes
c. Roof
3 Energy pts
y=yes
10. Apply Advanced Framing Techniques
4 Resource pts
y=yes
11. Use Reclaimed Lumber for Non Structural Applications
I1Us e OSB — --
3 Resource pts
y=yes
a. Subfloors
b. Sheathing
I 1 Resource pt
y=yes
. L
1 Resource pt
y=yes
1. Use Sustainable Decking Materials ___1
a. Recycled content
b. FSC Certified Wood
2. Use Treated Wood That Does Not Contain Chromium/Arsenic 1
13. Install House Wrap under Siding
i4. Use Fiber -Cement Siding Materials
E. Plumbing
F. Install Water Heater Jacket
2. Insulate Hot and Cold Water Pipes
3. Retrofit all Faucets and Showerheads with Flow
Reducers
a. Faucets (1 point each, up to 2 points)
b. Showerheads (1 point each, up to 2 points)
4. Replace Toilest with Ultra -Low Flush Toilets
(1 point each, up to 3 points)
5. Install Chlorine Filter on Showerhead
6. Convert Gas to Tankiess Water Heater
7. Install Water Filtration Units at Faucets
(2 points each, up to 4 points)
3. Install On -Demand Hot Water Circulation Pump
r. ciecmcai
11. Install Compact Fluorescent Light Bulbs (CFLs)
(6 bulbs=2 points, 10 bulbs =3 points, 12 bulbs = 4 points)
2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to
5 points)
3. Install Lighting Controls (1 point per fixture, up to 4 points)
4. Install High Efficiency Ceiling Fans with CFLs
(1 point each, up to 4 points)
G. Appliances
rt. Install Energy Star Dishwasher
I2. Install Washing Machine with Water and Energy I
Conservation Features
3.Install Energy Star Refrigerator j
4. Install Built -In Recycling Center
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Walls
b. Ceilings
2. Install Floor Insulation over Crawl Space
3. InstallRecycledConte t, Fiberglass Insulation with
L o Added Formaldehyde J
4. Use Advanced Infiltration Reduction Practices
5. Use Cellulose Insulation
a. Walls
b. Ceilings
6. Alternative Insulation Products (Cotton, spray -foam)
a. Walls
o. callings
3. Resource pts y=yes 0 •
3 Resource pts y=yes 0
1 IAQ/Health pt y=yes 0
1 IAQ/Health pt y=yes 0
1 Resource pt y=yes 0
1 Energy pt
2 Energy pts
Up to 2 Resource
Up to 2 Resource
Up to 3 Resource pts.
1 IAO/Health pt y=yes
4 Energy pts y=yes
Up to 4 IAQ/Health pts.
4 Resource pts y=yes
Up to 4 Energy pts. 0
Up to 5 Energy pts. 0 •
Up to 4 Energy pts. 0
Up to 4 Energy pts.
1 Energy pt
1 Energy pt y=yes
1 Energy pt y=yes
3 Resource pts y=yes
2 Energy pts y=yes
2 Energy pts y=yes
4 Energy pts y=yes
31AQ/Health pts
2 Energy pts
4 Resource pts y=yes u
4 Resource pts y=yes0 •
4 Resource pts y=yes 0
4 Resource pts y=yes 0
i1. Install Energy -Efficient Windows
• a. Double -Paned
b. Low -Emissivity (Low -E)
L–c. Low Conductivity Frames
—
2. Install Low Heat Transmission Glazing
J. Heating Ventilation and Air Conditioning
rt. Use Duct Mastic on AO butt 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
8. Install Sealed Combustion Units
a. Furnaces
b. Water Heaters
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
10. Install 13 SEERM 1 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 stovesrinseds
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 =18 points)
16. Select Safe and Durable Roofing Materials
7.InstallRadiantBarrier--�--"–
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
1 Energy Pt
2 Energy pts
2 Energy pts
1 Enerov Dt
2 Energy pts
3 Energy pts
1 IAQMealth pt
21AQ/Health pts
2 Energy pts
1 Energy pt
4 Energy pts
Y --yes
31AQ/Health pts
y=yes
31AQ/Health pts
y=yes
3 Energy pts
y=yes
3 Energy pts
y=yes
2 Resource pts
y=yes
2 Energy pts y=yes
1 IAQ/Health pt
1 Energy pt
1 Energy pt
3 Energy pts
41AQ/Health pts
5 IAQ/Health pts
31AQ/Health pts
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
3 Energy pts
3 Energy pts
L1. Use Low/No-VOC Paint
1 IAD/Health pis
y=yes
2. Use Low VOM, Water -Based Wood Finishes
2 IAQ/Health pts
y=yes
i3. Use Low/No VOC Adhesives _
_ 3 IAQ/Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
4 Resource pts
Formaldehyde
61AQ/Health pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAO/Health pts
y=yes
17. Seal all Exposed Particleboard or MDF_
41AO/Health pts
y=yes
8. Use FSC Certified Materials for Interior Finish
4 Resource pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Resource pts
y=yes
10. Install Whole House Vacuum System
3 IAQ/Health pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
8 Resource pts
22.. Use Rapidly Renewable Flooring Materials
4 Resource pts
3. Use Recycled Content Ceramic Tiles
4 Resource pts
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
5. Use Exposed Concrete as Finished Floor
4 Resource pis
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
Total Points Available:
Total Points Project Received:
0
1401 1301 57
01 01 0 is
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CITY OF
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS: (SIS -
PERMIT #
OWNER'S NAME:
PHONE # (o
GENERAL CONTRACTOR:
FAX #
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I am not using any subcontractors:
—� Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
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