08080149 CITY OF CUPERTINO
BUILDING nIVISION . PERMIT 90NTRSC+TQRjNFrO�t1VIACION
BUI 1 GAD S: PERMIT NO.
�5a58 RESL�OCKWOOD DR UNIT A & AAA FURNACE & AIR 08080149
OWNER' =EP PERMIT ISSUE DATE
UAV1'.1) CAYTON 1712 STONE AVE 08/20/2008
NE: (408) 293-4717 SANITARY NO. CONTROL NO.
ARCH=MNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
pop LICENSED CONTRACTOR'S DECLARATION Job Description
mF 1 Macey affirm that 1 am licensed under provisions of Chapter 9(commencing p
imy with SectionAllll/)ofDivialon3ofN Burin proru mCode.andmylke—u; RPLC FURNACE 60, OOOBTU IN BOTH UNITS, A&B
in full fusee and E
D Ll Z Licanm Clan - ` W Inc.N 7
Da. Conuxwr
AR ItECrS DECD
9 i l 1 understand my plans shall W used as public records 4trl
JyU
g C� Licensed Professknsl
3 OWNER-BUILDER DECLARATION
.�<z I hereby alirm Wit I am exempt from the Cre uutoes license Law for We
02 following moron.(Section 7031.5,Business and Professinm Cade:Any city or county
$(Li which roquiren a Main ten construaL alum,improv,demullah.or¢pair any sUalle m
prior to its issuance,also requires the applicant for such permit to rile a signed statement
< that he is licensed pursuant m the mroishi.of We Cortices Beene Law(Chapter 9 Sq.Ft.Floor Area Valuation
y�$ (commencing wide Semon 70007 of Division 3n17 um Business and Pmfessions Code)or $3100
that M Is exempt therefrom and tie basis for the alleged exemption Any violation of
Senior 703M by any applicant for a Permit subjects the applicant in a civil penalty of
nut more Wan fiat hundred dollars($3007. 3422901 .�12 Number Occupancy TYPe
❑1,a owner offt property,or my employee wide wage m their sole compensation,
Will do We work and dw structure It notlmendrA mrRerrd forsak(See.7041.Busimas
and Pmftesioes Cade:The Contractors Lt.Law dam Out apply m.owner of Required Inspections
propeny who bui Ids or im prows thereon,and who doea such work hinesel f m through his
own cmploycon.provided that such impsotemcnts aro not intended molfered fm sale If.
however,We building Or improvement is sold within am year of trmpleeon,We owner-
Wilder the b
will haw udrn ro
Of pving O
that he did rot amid m improve far puryme of
sale.).
❑1,a owner of the property.am exclusi%mly contracting wide licensed canuamon in
romtrutt die projen(Sec.7044.Business and professions Code:)The CootraMr's U.
come law does ant apply to an owner of property who Wilds or improves demon and,
who concocts fm such projects with a conwctar(s)licensed Pursuant in the cmamesara
Lkeme law.
❑I ane exempt under Sm ,B k PC fm this meson
Owner Data
'WORKER'S COMPENSATION DECLARATION
I Mmby affirm under penally of perjury one of the following declaradons:
1 haw and will maintain a Certificate of Consent in self-insure for Wmkeh Camper
indent,as provided fee by Section 37M of de Labor Cade.for the Performance of the
want,for which this Permit is issued. _
❑1 dew and will maintain Wmkerl Comp.ution Importance.as regoircd by Section
3700 ofti.labor Cade,fm the Mfunc...1'the work forwhich this permit is issued. '
My Workers Comparessetion Insurance carrier and Policy number are:
Carrier.S Q Policy No.lz�J G w�
CERTI•G ^OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
flhu need.need rot k completed if the Perron is foram huntheddoBan($IBM
or less)
I.oily that in die performance of the work fee which this Permit u issued.l shall nm
employ say Peron in any manner an u.become subject to the Workers'Compensadoet
Laws of California Dare
Applicant
NOTICE TO APPLICANT:.If.after making this Certifies.of Exemption.you shank
become mbjeet m the Workers Compensation provisions of the labor Code.you muse -
.,O forthwith comply with such Provisions m this permit shall W dremW rowked.
z '-" CONSTRUCTION LENDING AGENCY
[-. .�. I hereby,affirm that then is a.arommninn knding agency for die Performance of
lYi the work for which this permit u Wood(Sec.](W,Civ.Cd
ALanders Namc
z Lenders Address
U O 1 cen;fy chat 1 Mw road this appliedcho and satw died de show information is
u,F" colonel.lag=b.mply with all city and county amimnce and media laws reseal in
D V building construed.,and hereby auWmim reprvmeduwa ofthis city in ever noun the
F yshove-menuancd PscPc for Inspection purposes.
(We)agree W saw,indemnify and keep hatmless Oe City of Ctl cr inn agairm
h liebilitie.Judgmcracned,cass e andexpcnsu which may in any way attroe galnstsud City
V z to conscqueme of the lranunt of Wu permit
'^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ti
SO/UICjE REGULATIONS.
SiE�aro;f•A'oo� p Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE Type of Roof ! (/
Will the applicant Or future Wilding occupant acre orhandlc haardons res.riat
as der=.y.
ad by WI Cupenim Municipal Code.Chapter 9.13.and the Health and Safety
Code.�tian23532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Y.
kuWill the applicant or mum building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
M>aNnus air contamimmu sa defined by the Bay Area Air Quality Management all new materials for inspection.
tt7 P
❑Yea / 'Po
I haw mal the hvudws materials requirements under Chaps 6,95 of IM Califary
out Health k SafeyCade.Srctiau 75305,25533 and 75534.I undmnand den ifew Wilding
door not cermady haw a.nanL Wa It is my responsibility to notify use occupant of the
require .which mnst Is,met prior toWersetttnfacemnm.ofaYnypamT. Signature of Applicant Date
owner or auboupcd agent gQ Dote ro All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN 34229012 .AB
DATE ISSUED. . . . . . . : 08/20/2008
RECEIPT # . . . . . . . . . : BS000005843
REFERENCE ID # . . . : 08080149
SITE ADDRESS . . . . . : 10458 LOCKWOOD DR UNIT A & UNI
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . .. DAVID CAYTON
ADDRESS . . . . . . . . . . : 10458 LOCKWOOD DR UNIT A
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JIM RANDO
CONTRACTOR . . . . . . . : RANDO, JIM LIC # 8050
COMPANY . . . . . . . . . . : AAA FURNACE & AIR CONDITIONING
ADDRESS . . . . . . . . . . : 1712 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 293-4717
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- - -- - --- ----
IBSEISMICR VALUATION 3 , 100 . 00 0 . 50 0 . 00 0 . 50 0 . 00
IEPERMITFE 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
IMRRAA UNITS 2 . 00 122 . 38 0 . 00 122 . 38 0 . 00
IPPEIRMITFE 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 . 04 0 . 00 286 . 04 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 286 . 04 VISA
---------------
TOTAL RECEIPT 286. 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- -- ---- ---------- -------- --------------------- -
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
CITY OF CUPERTINO
' FURNACE/AC
•CUPEkTINO PERMIT APPLICATION FORM
APN #�qaag Date:
Building Address:
Owner's Name: Phone#:
" o d3I- DO
Contractor: Phone#:,/off X93 K;717
RC Fax #: %T
Contractor License#: Cupertino Business License #:
94�,fdp 7/ o 0
Contact: Phone#:
Z, Fax #:
Building Permit Info:
Elect ❑ Plumb ❑ Mech
Residential Commercial
Job Description: /C ,,/4cc
For Residential Installations:
Attic ❑ I" floor 2"a 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 H On Platform El Bonded New Location Replacement
Project Size: Express ❑ Standard ❑ Large ❑ Major❑
Valuation:
3/0,0, e2p
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
FURNACE/AC
a10F
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.
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
IBPGAS 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 & not incl in an appliance
permit.
IBSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,coolin'g,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.
IMRAPPVNT Residential for the install/relocate/or M •
replacement of ea appliance vent
install ¬ incl in an appl permit.
Quantity Fee ID Fee Description Fee Permit Type
Groton
CITY OF CUPERTINO
FURNACE/AC
•CUPEkTINO FEE SCHEDULE
Group
FURNACE FURN/AC
1 PGASRES 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
1MFR=<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
IEPERMITFEE Electric Permit Fee E
I 1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit P
ITRAVDOC Travel Documentation B
1BUSLIC Business License B
•
Quantity Fee ID Fee Description Fee Permit Type
CITY OF CUPERTINO
N)- FURNACE/AC
ITY OF
CUPERTINO FEE SCHEDULE
Group
AIR FURN/AC
CONDITIONING
1BCAIRHAN Commercial A/C Units <= lOk 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. Commaesid
1BREMAIRHAN Residential A/C units<= IOk CFM . B
1MRRAA Residential Mech Repair/alt/add M
1BSEISMICR Seismic Residential B •
IEPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
ITRAVDOC 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, (detaiWspec)' L-1 2 points
11. Permeable Paving, Nota L-1 2 oints
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. OSB Sheathing, detail S-2 2 cints
E. Ext. Finish 1. Composite Decking, (Note/Spec.) AJ 2 points
4. B. Fiber Cement Siding, (Note/Spec. A-4 2 ints
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/S ec -L-1 cints
G. Electrical 4. E. Ceiling Fans, Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A3 1 point
3. Energy Star Refrt erator, (Note/Spec. A3 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
r
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 Resources Energy IAO/Health
�// _
A.Srte 0 4 /446 ,v
1.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 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
[8—besign Resource-Efficient Y
is =Yes
Landscapes and Gardens 4 Resource P
— -- -- - -- —-- 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 Catchmant/Retention 2 Resource pts Y=Yasl 1 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=yesF;F 0
1
C.Structural Frame I 1
ESL Solid Sawn Lumber with Engineered Lumber __1 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
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 p
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
i12.Use OSB -
a.Subfloors 1 Resource pt y=yes 0
. j b.Sheathing 1 Resource pt y=yes p
1 1 1
__ INPUT Resources Energy IAO/Health
D.Extenor Fnish -
F1 Use Sustainable Decking Materials
i 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 IAO/Health pt y=yes 0
3.Install House Wrap under Siding 1 IAWiealth pt y=yes 0
4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
E.Plumbing
1.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 Showe heads w th 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) I Up to 2 Resource pts. 0
4.Replace Toilest with Ultra-Low Flush Toilets
(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhsad 1 IAO/Health pt y=yes 0
6.Convect 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 IAO/Health pts. 0
8,Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 1
r,.tiecmca,
I Install Compact Fluorescent Light Bulbs(CFCs)
t!3l s=22 points,10 bulbs=3 points,12 bulbs=4 points) I Up to 4 Energy pts. 0
2.Install IC-AT Recessed Fixtures with CFCs(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
1.Install Energy Star Dishwasher— 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy
Conservation FeaturesI Energy pt y=yes 0
3.lnstall Energy Star Refrigerator I 1 Energy pt y=yes 0
4.Install Built-In Recycling Center 3 Resource pts y=yes 0
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 sulation with
No Added Formaldehyde _ 3 IAO/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.uenings 4 Resource pts y=yes 0
r '
INPUT Resources Energy
lHealth
Windows
1.Install Energy-Efficient Windows
• a.Double•Panad 1 Energy of y=yes 0
It.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 pt y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
J.Use buct'Mastic on All Duct Joints _y 2 Energy pts y=yes 0
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 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
8.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Health pts y--yes 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.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood sloveshnserts 1 IAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy of y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 41A0/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=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=18 points) __ Up to 1 B Energy pts p
l6.Select Sale and Durable Roofing Watenals 1 Resource pt y=yes 0
7.Install Radiant flamer 3 Energy pts y=yes 0
1
L.Natural Heating and Cooling 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 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
1 1 1
•
M.Indoor Air Qua ity and Finishes INPUT Resources Energy IAQ/Heafth
ll Use Low/No-VOC Paint 1 IAQfHealth is es
L —– --- —-- — P Y=Y 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes D •
3.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 Interior Uses 1 IAQ/Health pts y=yes 0
L7.Sea!all Exposed Particleboard or MDF_ - 4 IAQ/Health is es
-__--- - --- P Y=Y 0
6.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 IAO/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 6 Resource pts y=yes0
2.Use Rapidlynew
Reable Flooring Materials _J 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 A 1 1401 130 57
Total Points Project 1 0 0 0 •
G:daia/progsrgreenbuildngguidelineshemodelerVgreenpdntsfina12.12.o4protected.xis
r, Community Development
r 10300 Torre Avenue
rH+ f` Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
D Co C o 6
OWNER'S NAME: PHONE # cejl_7 po
GENERAL CONTRACTOR -c,,ri FAX #
I am not using any Subcontractors: rF -,�/-e
Sigrfature Date
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 J
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date