08030148 CITY 05 CUPERTINO uv :om
BUILDING DIVISION PERNIIT CQa3<l. V`TVA�yTO�Lyi� }O ��'.
r .,-. a F:..*.�Yux,� 4,-r• ee3nSd5pT�, .c; aa.
PERMIT NO.
au'LT6%ATTTREENLEAF DR JULI CHANG 08030148
R'S NAME: PERMIT L%UE DATE
JULI CHANG 20643 GREENLEAF DR 03/25/2008
PHONE: SANITARY NO. CONTROL NO,
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
30 o LICENSED CONTRACTOR'S DECLARATION Job Description
1 heebY.Rion that I am II¢ved under provision of Chapter 9(co ernme-g
with Section 7").f Division 3 of the Busima.and Pefent..Cade,and my ties.u SWIM POOL DEMO...
^ in full fora and cRnm r .
3 License Class Lk.0
D Dam Contractor
ee ARCHITECTS DECLARATION
i 1 understand my Ideas shall W hand u public records
yiilaCCC` Licensed professional
to OWNER-BUILDER DECLARATION
I hereby alfim mat I am cxcmPr from On Contractors License Law far One,
O following mean.(Section 703 1.5,Business and Prefessiom Coda:Any city or county
9 which raqul.a a Permit a cnnoum,alter,improve,demolish,m.pair any structure
�S^ Prior On its issuance.also requires six applicant for such permit in file a signed statement
< that he is named pursuant.the provision of the commemra Llueme Law(Claper9 Sq.Ft.Floor Area Valuation
51 (commend.,with Section 7000)of Division 3.17 the Business and Prafcaiom Cove)or $500
dust be u comp,tundfrom and the ban for the alleged aempdon.Any violation of
Section 7031.5 by say applicant fa a permit mbjecu the applicant to a civil panaity of �,t�I Number - Occupancy Type
ad am man five hundred dollars GkW) 32656002 .•7V'
01,mowuerofthepmpenymmywploymwithwagunthaireacompv don,
wiEdothewart,andthesbuau.urotintendedaranemdfmaale(Sa.9 .Bu muse
and Profession Cade:The Canuxees I lernse law dam rot apply to an awmr of Required Inspections
property who builds asimpawn chow nand who does such wort bivaelforthrough his
mvnemploym,provided mat such improvements am mat intended moReeni funnels.If. .
however,the Wilding or improvement Is old within on year of mmpledon,the mutter-
Wilda win have the Wrde^of proving that bo did rot Wild or improve for Wno=of
sats.),
❑1.as owner of the popery.am exclusively comtnint with licensed eonuamer to
mmuua the project(Sec.7044.Besimnn and Prefuaon Code:)The Combactnes IJ-
.law data at apply man owner of mealy who Wilds or improv thenars.and
who conuanu for such pmje, Nato rGllia punnnt m the ComracmYa
Litems law. `S/
❑Ism uempfbder See ,BA,PCfm th4n:cO.
Dam
WORKERS COMPENSATION DECLARATION
I thereby effort under penalty of perjury oat of the following decW Wont
❑1 hew and will maimain•CeNfnun of Conant to self-Mum for Wohcrs Coma"-
anon,as provided for by Station 3700 of the labor Can,Im the aRmmance of the ,
work fm which this permit is issued. - ....
❑i have aha will maims Workers Compensation Insuraus,a required by Sorin
3700 of the Lab.Coca.for tho pcdmmana ofthe work forwhleh this permit is instant. '
My Workers Compensation Instance unia and Policy number no:
Carrie Policy NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
l7h ssecdn rcsd an becanPleme ifine permit I.faroec hunthrddohan($1001
per len)
1 ceNfy the in tho Performa.y?of Out wpprkJJeerr Ich I. It is issued.I shall not
employ any arson//'E0soy at ass�bj It Wortcna
'Comnsation
Laws of GllfamlM.Oate •.I//�''Gs~f�w_//11 ,, .
Awunm 11LL 11 4�P
NOTICE TO ct ,i ommaking mp Cc oro of of Labor oq.y u ould
a m
become subject y the Worker.COmawtian emvuion of the labor Cade,you roue
�Q forthwith comply vim such pmrWem or this permit shell be decmW evoked.
r" CONSTRUCTION LENDING AGENCY
[—rte l booby alnrm that mem is a conmucubm lending agency fm the perrorreamx of
a> the work for which this permit 4 issued(Sec.3097.Civ.C.)
tiQ lander.Nan
z Lender'.Address
t)(7 I stratify that I haw most this application and state dust the show Information Is
U, conal.I aims in comply with all city and county ordinances and sale laws elating he
0 SV-: Wilding comWWan,and hereby mmarim epmenudvn of this city in cmur upon the
[t7 above-mentioned Property for inspection purposes
G (We)agree to aw,indemnify and keep harmless Oe City of Cupe Lina$&an[
rA liabilities judgments.cents and dopenosw ichmaymanyny, staimtaid Chy
(„) in c.ueguenee of the{noun{of this t. i�
APPLICANT U ERSTANDS A 1 PL31QL NON-POINT Issued by: Date
SOURCERE U 77 LLL
Re-roofs C�
Sigossure of ApplidnUConrsanm Dan
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future building oaupant note Or handle haardam material
dWnd by the Cupertino Municipal Cade,Chapter 9.17.and mo Health and Safety
.SeWo"155324)+ All roofs shall be inspected prior to any roofing material being installed.
13 yes, ON.
Will the applicant Or future Wilding Occupant WC woipmem a Jenna which If 8 roof IS installed without firs[obtaining an inspection,I agree IO remove
emit haardmw air comaminams as defined by the Bay Atha Air Quality Management all new materials for inspection.
District?
❑Yn ONO
I have real the ha,srsiw,m.terial,.quiementa under Onperh.95 ofde Calder-
nu Hnlm&Safctycodc.Sced.15505,15533 and 25534.1 urdctnM thnifde building
does act currently have.tenon
orems neeItratihilbmnce
nquimmcnuwhkhm move Un asupern,of the
Signature of Applicant Date
own rNte
,te All roof coverings to be Class'%?."or better
• CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32656002 . 00
DATE ISSUED. . . . . . . : 03/25/2008
RECEIPT #. . . . . . . . . : BS000004267
REFERENCE ID # . . 08030148
SITE ADDRESS . . . . . : 20643 GREENLEAF DR
SUBDIVISION . . ... . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JULI CHANG
ADDRESS . . . . . . . . . . : 20643 GREENLEAF DR
CITY/STATE/ZIP . . . : CUPERTINO CA, . 95014-1907
RECEIVED FROM . . . . : JULI CHANG
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : JULI CHANG
ADDRESS . . . . . . . . . . : 20643 GREENLEAF DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1907
• TELEPHONE : . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 500. 00 0. 50 0. 00 0 .50 0. 00
1DEMORES SQ FEET 0. 00 490. 00 0. 00 490. 00 0. 00
----------- ---------- ---------- ----------
TOTAL PERMIT 490 . 50 0. 00 490. 50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CASH 490. 50
---------------
TOTAL RECEIPT 490 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
704 DEMO
•
4D-� C)
CITY OF CUPERTINO
bM DEMO
•CUPERTINO PERMIT APPLICATION FORM
APN# (PC) C>,;? , Date:
Building Address:
CTreQ ,� oQ r GPS q��l
Mailing Address (if different from building address):
Owner's Name: Phone:
Contractor: Phone
l Fax:
Contractor License #:
Cupertino Business License #:
Contact: Phone:
Fax:
Residential Sq Footage Commercial ❑ Sq Footage
Job Description:
W o
Valuation:
Attach Green Building Checklist to demo plans.
Quantity Fee ID Fee Description Fee Group Permit Type
�( 1DEMORES Demo-Residential B 1SFDWL-DEM
I IBSEISMICRE Seismic Residential B
1DEMOCOM Demo-Commercial B 1COMML-DEM
1BSEISMICOM Seismic Commercial B
1BUSLIC Business License B
OWNER-BUILDER VERIFICATION
• 1. (Check one) I ormy 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
.....................................................................................................................................................................................
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 Signature: ` Date: `J" �'Qt
Job Address: Permit#
C+J�
® Any changes to theinfo nation provided on his form shall be submitted to the City of Cupertino Build
Department.
afill
City of Cupertino Building Department.
CITY OF 10300 Torre Avenue
C U P E IST I N O Phone: (408)777-3228
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, e
City of Cupertino
Printed on Recycled Paper
Sin gle Family GreenPoint Checklist date: Build ItGreeri
The GreenPoint Checklist Is based on the various green features moorpo sled Into the home and is the Smart Solutions From The Ground Up
basis for the GreenPoint Rated program.A home can be considered green If 11 fulfills the prerequisAes,
• Hams at least 50 paints,and meets the minimum points per category:Energy Indoor Air
Health(5),Resources(6),and Water(9).Please contact Build It Green for a listst ityl
of of qualified GresreenPoint
Raters if you are Interested in pursuing third-parry verification.
The green building pracbces listed below are described in the New Home Construction Green Building
Guidelines,available at www.buitdltOreen.om. n n n n
ENTER PROJECT NAMEc
U �
A.BITEPofnls Availaola Per Measure
1.Protect Topsoil and Mlnimim Dlsmptio of Edsfing Plants B Tracts
❑ a.Protect Topscll tmm Erosion and Reuse after Conduction 0 1 1 I 1
❑ b.Limit and Delineate Cautruction Footprim for Maximum protection 0 I I 1
2.Dennsbuct Instead of Demolishing Existing Buildings On Site 0 1 3 1
0.Recycle Job Site Construction Webb Precluding Green Waste)
❑ e.Minimum 50%Waste Diversion by WeigM(Recycling or Reuse)-Requiatl p
❑ b.Minimum a5%Diversion by Weight(Recycling a Rouse) I I R 1
0 2
❑ c.Minimum 80%Diversion by Weigh(Recycling or Reuse) 0 I 2
4.Use Recycled Content Aggregate(Minimum 25%)
❑ a.Walkway and Driveway - 0 I 1
❑ b.Roadway Base 0
Total Points Available In Site 12 0
El.FOUNDATION Points Available Per Measure
1.Replan Portland Camara in Concrete with Recycled Ftyash or Slog
❑ a.Minimum 20%Ftyash or Slag 0 r I 1
❑ b.Minimum 25%Flyash or Slag 0 I 1
2 Use Frost-Protected Shallow Foundation in Cold Areas O.E.C.Climate Zone 16 0 I 3
❑ 3.Use Radon Resistant Construction On Al-Risk Locations Only) 0
4.Design and Build Structural Pest Controls
❑ a.Install Termite ave6 Separate All Exterior Wed toCmcmte Connections Meld a Plastic FestenerMDNitlere 0
Fj bHave I -ti 1 Ir
.All Now Planta ee Trunk,Base,or Stem Located At Le0 ——— ' I 1 —
TotalPointsAvaflebleinFoundation=B 0
C.LANDSCAPING Points Available Per Measure
• 1.Construct Resource-EMclent Landscapes
❑ a.No Invasive Species Listed by CaHPC Are Planted
❑ b.No Plant Spaclas Will Require Hedging 0 1
0 1
❑
C.75%of Plants Are DroupMideaht California Natives,Mediterranean,or Other Appropriate Spades 0 I IF 3
2Un Phi Landscaping Techniques 0 1 I
3.Minimize Turf Areas in Landscape Installed by Builder
❑ a.All Turf Will Heve a Water Requirement Less than or Equal to Tell Fescue(50.8 plant fader) 0 I 2
❑ b.Tud Shall Not Be Installed on Slopas Exceeding 1D%or in Areas Lou than B Fast Wide 0 i 2
❑ c.Turf Is SM of Landscaped Area(tetel2 points) g
❑ J.Turf Is 510%of Landscaped Area(told 4 points) p 2
2
4.Plant Shade Tron 0 I 3
5.Group Plants by Water Needs(Hydrozoning) 0 I 2
E.Install High-Efficiency Irrigation Systems
❑ a.System Uses Only Law-Flcw Ord,Bubblers,a Low-flow Sprinklers 02
❑ b.System Has Smart controllers 0
3
—71n= orete Two Inches of Compost in me Top 6 to 12Inches of Sell 0 I I 3
e.Mulch Ali Planting Beds to the Greater of 2 Inches or Local Water Ordinance Requirement 0 I I I 2
9.Ues 50%Salva atl or Recycled-Content Materials/or 50%of Non-Plant Landscape Elements 0 1 1 I
ID.Retlucs Light Pollution by Shlaldin Enures anther Directing Light Downward 0 1 I
Told Points Available in Landsoddin =31 0
D.STRUCTURAL FRAME&BUMMING ENVELOPE Points Available Per Measure
1.Apply Optimal Value Engineering
❑ a.Place Refers and Studs at 24-Inch On Center Framing 0 1
❑ b.Size Door and Window Headers for Lead 0 1
❑ c.Use Only Jack and Grippe Studs Required for Load 0 1 I
2 Use Engineered Lumber
❑ e.Beams and Headers 0 I 1
❑
to.Insulated Engineered Headers 0 1 I
❑ c.Wood WoiSs a Web Tmsses for Fleas 0 1
❑ d.Wood IJdsts for Roof Peters 0 ' 1
❑ e.Engineered or Flngo ihted Studs for Vertical Applications 0 1
❑ f.Oriented Stand Board for Subi 0 1 I
❑ g.Oriented Stud Board for Wall and Roof Sheathing 0 I 1
• ].a. F Dimensional
Lu Wood
❑ a.Dimensional Lumber,Studs and Timber Minimum 40% g
❑ b.Dimensional Lumber,Studs and Timber.Minimum 70% g
❑ c.Panel Products:Minimum 40% D =, 1
❑ J.Panel Products:Minimum 70% D 1 I
0 2D07 Build It Green Single Family GreenPoint Checklist 2007 Version Pagel of 4
p§ 5 y1
ENTER PROJECT NAME
A.Ute Solid Well Systems(Includes SIPS,ICF%6 Any Non-Sack Frame Assembly)
❑ a.Floors D 2 _ 2 —
❑ b.Were 0 2 2 _
❑ C.Roof 0 2 2
5.Reduce Pollution Entering the Home from the Garage
❑ a.Tightly Seal the Air Border between Garage and Living Area _
❑ b.Install Garage Exhaust Fan OR Build a Detached Garage 0 r
8.Dost n Energy Heels on Truau(75%of Ates Insularism Height at Outside Edge of Estedor Well 0 1
❑ 7.Design Roof Tmu to Accommodate Ductwork 0 _ 1
B.Use RecycledContonl Steel Studs for 90%01 Interior WeII Framing 0 1
2,1 mod Mees Wells:S0-Inch Drywall on All Interior Walls or Wells Weighing more Man 4D IblcuJL 0 1
Ii. it Overhangs and Cutlers
❑ e.Minimum 164rch Overhangs and Gutlae 0 ----
It.
__,h.Minimum 244nch Overhangs and GuIlms 0 1
Total Points Available In Structural Building Frame and Envelope•38 D
E.EXTERIOR P'DRSH Points Avallehle Per Measure
1.Uee R cledConknl o Virgin Plutic or FSCCei Wood Decking 0 2
2.Install a Rain Sewn Well System 0 2 �
9.lgae Durable and Noncombustible Siding Materiels 0 1 1
1.Soled Durable and Noncombustible Roofing Materials 0 - 2
ToW Prints Avaflable In Errariur Finishes 7 0
F.INSOLATION Points Available Par Measure
1.Install Insulation with 75%Recycled Content
❑ a.Walls angor Floors 0
b.Catlins 0 1
2.Install Insulation that IS Low-Emitting(Cerefled Section 01350)
❑ a.Wells andlor Place o
❑ b.Cellin s
3.Inspect Quality of Insulation Insulation before Applying Drywall 0 1
Total Points Available in Insulation=5 0
O.PLUMBING Points Available Per Measure
1.Distribute Dom laic Hot Water Elgcienfly(Ma nnum 7 Points)
❑ a.Insulate Hot Water Pipes from Water Heater to noon
U
❑ b.Insulate All HM Water Pipes 0
❑ c.Use Engineerad Pamllel Piping
❑ L Use Engineered Parallel Piping with Demand Controlled Circulator Loop
❑ e.Use Se and Plumbing with Demand Controlled Circulation Loop _ 0 �._1 T_ _ - _ 2
❑ L Use Central Core Plumbing 0 1 1 2
Ej 2.Imtall Onl HI h EfficienCyTollets(DuakFluthor5125gpO 0 ! 4
Total Points Avallable In Plumbing=Tope 12 0
H.R"TINO VENTILATION&AIR CONDITIONING Points Available Per Measures
1.Design and Install HVAC System to ACCA Manual J,D,and S Reeommendstbns 0 4
2.Install Sealed Combustion Units
❑ a.Fumacea 0 _ r 2
❑
It.Water Heaps 0 2
3.Insull Zoned,Hydrond Radiant Holding with Slab Edge Inwletion 0 1 1
4.Install High Elfidency Air Condlrioning with Environmenplly Responsible Refrigerants 0 1
It.Design and Install Effective Ductwork
❑ e.Install HVAC Unit end Ductwork will Conditioned Space o
❑ b.Use Duct Mastic on All Dud Joints and seems
❑ c.Install Duchvofx under Attic Insulation(Buried Duds) _ IT
❑ d,Pressure Balance the DuCOvDfk System U _ 1 L
❑ a.Protect Duct during Constriction and Clean NI Duda before Occupancy 0 1 1
6.1r 11 High Efircifing HVAC Filter ERV&) 0 1
❑ 7.Don't Install Flreplece or Install Sealed Get Fireplaces with Efficiency Raring Not Leu Than 60% 1
using CSA Stendertlt 0
S.Install Effective Exhaust Systems in Bathrooms and Kitchens
❑ a.Install ENERGY STAR Bathroom Fars Vented to the Outside 0
❑
It.All Bathroom Fans Are on Timer or Humiciialat 0Y--
❑ c.Install Kitchen Range Hood Vented to the Ouside 0 1— 1
9.Install Mechanical Ventilation System for Cooling(Maximum 4 Points)
❑ a.Install ENERGY STAR Calling Fans a light IQs In Living Areas 5 Bedrooma U _ 1 —
❑ b.Install Whole House Fan with Variable Speeds _0 1 _ __ +
❑ c.Automatically Controlled Integrated System T 2 _
_
❑
it.Automatically Contolled Integrated System with Variable Speed Carl 0 — 3
10.Install Mechanical Freah Air Ventilation System(Maximum 3 Paints) -
❑ a.Any Nide Houle Venlike n System That Meats ASHRAE 62.2 _
Elb.Install Air-m-Air Heat Exchanger that meets ASHRAE 62.2 0 1 2
11.Install Carbon Monoxide Alarm(a) 0 1
Total Points Avallable in Hearing,Ventilation and Ar Conditioning=30 0
02007 Build It Green Single Family GmenPolnt ChecMIs12007 Version Page 2 of 4
EN • •ROJECT
NAM E o 3
U 4 �
• L RENEWABLE ENERGY Points Available Per Measure
LJ 1.Pro-Plumb for Solar Hot Water Hearing 0 1 4 1 1 1
2.Install solar water Healling System 0 10 1 1 1
3 Install Wln Condull for Future Photovoltaic Installation B Provide 2DD M of SimurthrFecing Roof 0 I 2 I
4.Install Photovoltaic(PV)Panel
❑ a.30%m electric needs OR 1.2 IN(inial 6 points) D I 6 I I
❑ b.60%of electric needs OR 2.41N(total 12 points)
❑ c.90%01 electric need OR 3.6 kW f coal 16 points) D 1 6 I
Total Available Points in Renewable Energy=2B 0
J.BUHAING PERFORMANCE Points Available Per Measure
1.Diagnostic Einluahons
❑ a.House Passes Blower Door Test 0 1 I I
b.House Passes Combustion Safety Backdtaft Test 0 I I 1
2.Design and Build High Performance Homes-%above Title 24-minimum 15%Required 0 >_30
❑ 3.House Obtains ENERGY STAR with Indoor Air Package Certification-Picot Mmsum(Total 45 paints;rmtl comment) D I I 6 2
Total Available Points In Building Performance 39 0
B.FINISHES Points Available Per Measure
❑ 1.Design Enfryways to Rai Tracked in Contaminants 0 I 1
2.Use Low-VOC or Zwc.VGC Paint(Maximum 3 Points)
❑ a.Low-VOC Interior WalUCelling Pelnts(60 gpl VOCs(Flap and<150 wI VOCs(Non-Flaq) 0 I I 1 1
❑ b.Zsm-VOC:Interior Waili Paints(<5 gotVOCs Flat 0 3
❑
—3U..Low VOC,Winer-Based Wood Finishes(Q50 pipt VOCs) 0 2
❑ 4.Use Low-VOC Caulk and Construction Adhesives(40 opt VOCs)for All Adhesives 0 2 1
❑ S.Use RerydedContem Paint 0 1 I I 1 1
S.Use Environmentally Preferable Matmiala for Interior Finish:A)FSCCaNfied Wood,B)Reclaimed,C)Rapidly Renewable,D)Recycled-Content
or E)Finger-Jointed
❑ a.Cabinets(50%Minimum) 0 1 1
❑ d.Interior Two(50%Minimum) 0 1 1
❑ c.Shelving(50%Minimum) 0 _ 1
❑ J.DDDM(50%Minimum) 0. 1
❑ e.Countertops(50%Minimum) 0 1 I 1
7,Reduce Formaldehyde in Interior Finish(CA Section 01350)
❑ a.Subi 6 Stair Treads(50%Minimum) 0
.' ❑ b.Cabinets A Countem ps(50%Minimum) 0 1 1
❑ C.Interior Tdm(50%Minimum) 0 1
❑ d.ShaMn (50%Minimum) D 1
❑ B.Aber InstelMtion of Finichm,Test of Intloor Air Shows Formusidehyda Level a7ppb 0 1 3
Total Available Points In Finishes=21 0
L.FLOORING Forms Available Per Measure
1.Use Environmentally Preferable Flooring:A)FSCCerfified Wood,B)Reclaimed or Refinished,C)Rapidly Renewable,D)ReryctedComany E)
Exposed Concrete.Flooring Adhesives Most Rave c50 got VOCs.
❑ a.Minimum 15%of Floor Area 0 1 1
❑ b.Minimum 3D%of For Area 0 1
❑ c.Minimum 50%of Floor Area 0 1
❑ 1.Minimum 75%of Floor A,aa 0 1 1
❑ 2 Thermal Mem Flooro:Floor Covering Other than Carpet on 50%at More of Concrete Floors 0 1
❑ 3.Flooring Meats Section 01350 or CRI Green label Plus Requirements(50%Minimum) 0 1 2 1 1
Total Available Points In Flooring=7 0
M.APPLIANCES AND LIGHTING Points Available Per Measure
1,Instill Water and Energy Efficient Dishwasher
❑ e.ENERGY STAR pmol 1 point) 0 1 Ir
❑ b.Dishwasher Uses No More than 6.5 GellonslC le lotel2 Dints 0 —�—I
2.Instill ENERGY STAR Clothes Washing Machine with Water Factor of 6 or Lem
❑ a.Meats Energy Star and CEE Tier 2 requirements(modified energy factor 2.0,Water Factor 6.0)(total 3 points) 0 1 1 2
❑ b.Meets Energy Sian and CEE Ter 3 requirements(modified energy factor 2.2,Water Factor 4.5 or less) 0 I I 7
iotal5 Dints
3.Install ENERGY STAR Refrigerator
❑ a.ENERGY STAR Oualifiod I<25 Cubic Feet Capacity 0
❑ b.ENERGY STAR Qualified 6<20 Cubic Feet Capacity 0 1
4.Install Built-in Recycling Center 0
❑ a.Bulli-In Recycling Center 0 2
❑ 'b.Bullbin Compcsfing Center 0 1
Total Available Points In Appliances and Lightlig=12 0
N.OTHER Points Available Per Measure
❑ 1.Incorporate GrmnPulntRated Checklist inBlueprints.Required 0 R
• ❑ 2.Develop Homeowner Manual of Green FaaWresrBenefits 0 1 1 1 1 I 1
3.Community Design Measures 8 Local Priorities:See the Community Planning&Design section in Chapter 4 of the New Home Guidelines for
measures.Maximum of 20 penis for suggested measures.Loral requirements may also be listed here.
0 2007 Build It Green Single Family Greer int Checklist 2007 Version Page 3 of 4 .
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4.Innovation:List Innovative measures that meet the Breen building objectives of the Guidelines.Enter up to a Build It Green Checklists entl
maximum combined total of 20 pis.See Innovation Checklist for suggested measures,using the link to the right. __ _Guidelines_ _ to_
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Total Available Points In Specific Categories' I + I 96+ 42+ 66+ 43+
Minimum Points Required In Specific Categories 0 30 5 6 9
Total Points Achieved r r r r r r
Project has not yet mot the following recommended minimum requiromontsr
-Total Project Score of At Least 50 Points
-Required measures:
-A3a: 50% waste diversion by weight
-32: 15%above Title 24
-NI:Incorporate GreenPoint Rated Checklist into blueprints
-Minimum points in specific categories:
-Energy(30 points)
-IAQ/Health(5 points)
-Resources(6 points)
-(Nater(9 points)
0 2007 Build It Green Single Family GreenPoint Checklist 2007 Vemlon Page 4 of 4
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEPTINO
Building Department
JOB AD112_ 6:Y3 1pcP PERMIT # � CIL
�U 30 L .
OWNER'S NAME: Sal PHONE #
GENERAL CONTRACTOR: ( FAX #
I am not using any subcontractors: \ 3 XI;- 1) S
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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