08080228 CITY OF CUPERTINO t.:•. `* 's''
BUnArNG DIVISION PERMIT �.CONTRAACTOR INFURMATION�.`.
BUILDING ADD0.ES5: PERMfT NO.
2!.073 GRENOLA DR AIR QUALITY HEATING &, AIR 08080228
OWNER'S NAME: PERMIT ISSUE DAIS
N.A", I'SA ARTZA 720 NORTHRUP ST 08/28/2008
lip NE: (408) 293-7138 SANITARY NO. CONTROL NO.
ARCHITEC MNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
u p o LICENSED CONTRACTOR'S DECLARATION lob Description
m 1 h,rehr affirm wt I am Ikmnad under pmvitioaz of Chapter 9(commcnciM p
n with Semon 7IXe0 orDivialonlatw Badness aM Protesd=�ftanf mylicenxu MV FURNACE TO ATTIC & ADD A/C
N m full force and en 7 to
p Z Lt....Claza Lk,0
^p Dam Convector.
7WA CHr1ECTS DFLIARATI N
< I understand my pmous shall he used as public records
C(n Licensed Prof sst...I
5 OWNER-BUILDER DECLARATION
I barely aRm that I am uempt from the Contractor's License,Law for IIx
O 4 following mann.(Section 703 L5,Business and Profession Code:Any city.1..my
S$ which m9uim-s a Permit to construct,alter.improve,demolish,or repair any swctum
_Z< prior to its iasuam'e,alw rtquires wepplieanl for such permit m file a signed summers
ss
that he is Interact pumunt to w provisions of the Conmaamrs ucama Law(Chapna9 Sq.Ft. Floor AreaValuation
%52 (commencing with Section 70)0)of Division 3ofwBusinessand ProfesrsionCode)or - 10000
r3
that he u exempt threfrem and w basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for.permit subjects the applicant to a civil Penalty of
rotT more titan nor hundred dollars 32628005 .Number Occupancy Type
I,u awn.of the pmPvty,w mY employm with wages as win oak,ompewtion,
wiltdo wwork.and Ne stuctum u mtintendcd oroRerW far Ne(See.7044,Business
and Profestlans Code:The Contractors Liana Law does rat apply to an owner of �Required Inspections
Property who builds or impow thrrenn,and wbo does such wart himselfor through his
own employment,provided Nn such improvements art not imeMed aralfere0 forum If,
however.the building or improvement is sold within am year of completion,the owner-
builder will have the burden of proving that he did rot build Or improve for purpose of
sale.).
❑L as owner of the property,am exclusively contracting with licensed antraclom m
construct the project(Sc.7004,Business and Protection.Code:)The Canmcmri U. .
core Law does not apply m an mama of properly who builds or impowx wrcur,and
who contracts for such pmjeaa with a eom metur(s)Hemmed pursuant to w Convector's "
License law.
❑I aot exempt under Set .B&P C for this mason
Owns Dam
WORKER'S COMPENSATIONDEC ATLON
1 hereby afnm under penalty of perjury one of the following dulmadorm
1 haw am wilt maintain a Certificate of Cement to self-i.ure for Workers Compeo-
action,as provided for by Saber 3700 of w Labor Code,for the perrormarod of w
work for which this Permit is issued.
❑1 have snd will mainuln Worker's Campewtian humorous.as required by Section
37M.fw Labor Colo.fa the dormanaofw were frrwhlch this Amit is issued. '
My Workeh Compenuuon Lurane�.��am.crcrrrmd Policy num ram:
Cartier.n T 7PIiiN No.:
CEITfIFlG OF SATI NFRAN WORKERS
COMPENSATION INSURANCE '
(Teusectlon wed rot x completed Ifthe permit is foram,hundred dollars(5100)
or less)
1 antify Out in the performaae a the work for which this fourth is handed.l shall not
employ any person in any manner.as m bcame,object tow Workeri Cwnpensa0oo
Laws of California Date
Applicant
NOTICE TO APPLICANT:It.after making this Cenirta c of Exemption,you should
become subject to the Waters Compensation previsions of Ne Labor Cod,you most
.JO forthwith camP1Y with such proYmWo w this Permit shall barrook
Ito dared revolted.
z` CONSTRUCTION LENDING AGENCY
1hareb M.that ort isa.o.lrucdnm lending e•eeneY for the perrormana err
fri
the work for which this permit U issued(See.3097,Civ.C] ,
Q Lenders Name
z Ixrlders Address
U O I sonify that I have mad this application and rote the the above information is
IL comet 1 ague to comply with ill city and coumy ordinantm and mate laws relating m
C) Wilding construction.and hereby incentive repmacntatiws ofshis city to cocr uponw
gs1 ahow-me duarod property for inspection purpu¢s.
(We)agree to saw,indemnify and keep harmless w City of Cupertino against
y liabilities,judgments.them and expenses which mry in any way accrue against said City
U Z Iso camegeewe of the grading of this permit. _ C
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N-POINT Issued by: Date �C-0 d F
�SOURC REGULA NS.
p�)/o. 4/2B log Re-roofs
Sngnu of ppincanuCrnuanw �� pate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will w applicant or lot=building eceupantsmm or handle hataNaos materiil
as defined by the Cupertino Municipal Cade,Chapter 9.11,and w Health and Safety
cases Sectionzssy2(a)?Yu All roofs shall be inspected prior to any roofing material being installed,
Will w applicant a tum building occupant use equipment ordavi e,which If a roof is installed without first obtaining an inspection,I agree to remove
.n WYmWua air canumi.nts as defiwd by w Bay Ama Air Quality Management all new materials for inspection.
District? �.- p
❑Yesw h nu
I have mal the haen' mo data noNiremao mulrr Chapmr693ofwcaller-
nuHeslth&SafctyColo.Sad=15505.25533x.125534.1un8.iva ifdxbuilding
docs mol cumntiy have u mount that it u my mapmenbility,to netify w 0aupant of the -
rogairemanuwldch ostlxmet primunissanaofaCcmreamoroccupancy, Signature of Applicant Date
owner ora ,gens Dam All roof coverings to be Class'%L"or better
CITY OF CUPERTINO
• 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32628005 . 00
DATE ISSUED. . . . . . . : 08/28/2008
RECEIPT # . . . . . . . . . : BS000005935
REFERENCE ID # . . . : 08080228
SITE ADDRESS . . . . . : 21073 GRENOLA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : NAGISA ARIZA
ADDRESS . . . . . . . . . . : 21073 GRENOLA DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : MATTHEW T FARBER
CONTRACTOR . . . . . . . : 'MATTHEW FARBER LIC # 22791
COMPANY . . . . . . . . . . : AIR QUALITY HEATING & AIR
ADDRESS . . . . . . . . . . : 720 NORTHRUP ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95126
TELEPHONE . . . . . . . . : (408) 293-7138
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
----- ------ --------- -- -- --- - ---------- ----------
IBREMAIRHA NO.UNITS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00
IBSEISM.I.CR VALUATION 10, 000 . 00 1 : 00 0 . 00 1 . 00 0 . 00
I.EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
I.MPERMITFE 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
ITRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
=------- ---------- ---------- ----------
TOTAL PERMIT 286 . 54 0 . 00 286 . 54 0 . 00
ME'T'HOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------- --------------- --------------------
CREDIT CARD 286 . 54 MC
---------------
TOTAL RECEIPT 286 . 54
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
g(me, FURNACE/AC
•CUPEI�TINO PERMIT APPLICATION FORM
APN# (O a s U v v Date: D�
Building Address: 0
-Z-1073 r v-
Owner's N714154 2-,4Phone #: /
Contractor: Phone #:
Fax #: ff
Contractor License#: Cupertino Business License#:
Contact: / Phone #:
f Fax #: V
Building Permit Info:
Elect �� Plumb Mech ❑'
Residential M Commercial
Sob Description:
ForResid ntial 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):
LD 09 U JG
Strapped On Platform Er Bonded New Location Er Replacement
Project Size: Express RR�- 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
c �. FURNACE/AC
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.
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.
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or •
floor mounted unit heater.
IPGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more er outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit. _
1BSEISMICO Commercial Seismic B
1MRRAA Residential 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.
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 lD Fee Description Fee Permit Type
CITY OF CUPERTINO
ifs FURNACE/AC
•FUPE�TiNO 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.
/ 1BSEISMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
IMFR=<100 Furnace Syst <=100k BTU install or M
relocate ea forced-air/gravity type
f imace/bumer, 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
r IEPERMITFEE Electric Permit Fee E
II 1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit '-p-
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
•
Quantity Fee ID Fee Description Fee I Permit T e
-a CITY OF CUPERTINO
4
FURNACE/AC
C11 OF
CUPEkTINO FEE SCHEDULE
Group
AIR FURN/AC
CONDITIONING
1BCAIRHAN Commercial A/C Units <= IOk CFM B
1MCRAA Commercial Mech Repair/alt/add M
1BSEISMICO 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. CommfResid
1BREMAIRHAN Residential A/C units <= l Ok CFM B
r 1MRRAA Residential Mech Repair/alt/add M
1BSEISMICR Seismic Residential B •
1EPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
IPPERMITFEE Plumbing Permit P
1TRAVD0C Travel Documentation B
1BUSLIC 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 Dints
C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points
D. Structural 3. Uses Wood Moist, (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. A4 2 Dints
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, (Nate/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. Energ Star Refrigerator, (Note/Spec. A-3 1 aint
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS 40 points
Plan Review Prwrm Work Hook 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.
A.Site
I Fl.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0
�2.Salvage Reusable Building Materials 4 Resource pis y=yes 0
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 Duality with Landscape Design 2 Resource pts y=yes 0
B.bes—ign 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 Inigation Systems 2 Resource pts y=yes 0
11.Provide for On-Site Water Catchment!Retention 2 Resource pts y=yes 0
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 Foundation/Slab before backfill 3 Energy pts y=yesl;;F 0
1 1
C.Structural Frame I
1.Substitute Solid Sawn Lumber with Engineered Lumber_ J 3 Resource pts y=yes 0
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
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
8.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.Root 3 Energy pts y=yes p
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 0
• b.Sheathing 1 Resource pt y=yes p
f 1 i
INPUT Resources Energy IAD/Health
D.Exterior rmsh
1.,Use Sustainable Decking Materials
a.Recycled content 3 Resource pts y yes 0 •
b.FSC Ce tfed Wood 3 Resource pts y--yes 0
i2.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
14_Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
E.Plumbing
�L Install Water Heater Jacket 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
I3.Retrofit all Faucets and showerheads with Flow Reducers ,
Ia.Faucets(i 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 Toiled 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
5.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
B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
r.tiecmcar
11.Install Compact Fluorescent Light Bulbs(CFLs)
I(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
1 1 1
G.Appliances
i1.Install Energy Star Dishwasher - - - ` 1 Energy of y=yes 0
2.Install Washing Machine with Water and Energy
!Conservation Features ` 1 Energy pt y=yes 0
13.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-yYes 0
b.Ceilings 2 Energy pts y=yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
13.Install Recycled-Content,Fiberglass Insulation with
jNoAdded.Formaldehyde 31AQ/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 C •
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
I).uemngs 4 Resource pts y=yes D
1 1 1
I.Windows
1.Install Energy-Efficient Windows
• a.Double-Paned 1 Energy pt y=yas D
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames 2 Energy pts y=yes D
2.Instal(Low Heat Transmission Glazing 1 Energy pt y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
�1.Use Duct Mastic on All Duct Joints_ 2 Energy pts y=yes - 0
2.Install Ductwork vdthin Conditioned Space J 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAO/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0
5.Install Solar Attic Fan 2 Energy pis y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes D
7.Install Whole House Fan 4 Energy pts y=yes 0
8.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Health pts y=yes 0
J.Water Heaters 3 IAO/Health pis 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=yas 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stoveshnserts 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 4 IAQ/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 D
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes p
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 - D
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0
6.-Select Safe and-Durable Roofing Materials _ ' 1 Resource pt y=yes 0
7.Install Radiant Barrer 3 Energy pts y=yes p
11
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 p
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes p
1 1 1
•
INPUT Resourms Energy IAD/Hmfth
M.Indoor AW Quality and Finishes
1.Use Low%ND-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 •
13.Use Low/No 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 Intader.Uses 1 IAQ/Health pts y--yes 0
i7.Seal all 1iWs d Particleboard or MDF 4 IAQ/Health pts y=yes 0
8.Use FSC Ce tified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts yeses 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0
1 I 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
(2.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 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 0
1 1 1
Total Points Available: 1 1401 130 57
Total Points Project R 1 0 0 0
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPERTINO
Building Department
JOB ADDRESS: PERMIT #
7-) 0+3 Gt&A)ocA Dry I eo'
OWNER'S NAME: gA&j S A IZA-,L-J4 PHONE # Qy( —gyp
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: k
SignatureUDate
Please check applicable subcontractors and complete the following 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
all Tile
Owner/Contractor Signature Date