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08050094 CITY OF CUPERTINO �`* s��r��r�..pp♦♦z ��. p � BUILDING DIVISION PERMIT tP�l(]%1�1�t4CTQtw�-1`�., ,^' BUII.DN ADDS: PERMIT NO. 483 MC CLELLAN RD AAA FURNACE & AIR 08050094 R'S NAME: l—UNDI'lPERMIT ISSUE DATE GOLDSTEIN ROBERT H ET AL 1712 STONE AVE 05/12/2008 PHONE: SANITARY NO. CONTROL NO. (408) 293-4717 ARCHrrEC7fENGIN1i BUILDING PERMIT INFO BLDG ELECT PLUMBMECH 0 0 0 0 O p LICENSED CONTRACTORS DECLARATION Job Description e W F 1 hereby afBnn IMt 1 em licensed umkr P.,Wbm of Chapxr 9(commcncin6 p wt Secdan]")ofDivision 3 of du Business and Prohasimu Code,and my lice�is ADD A/C e s in full Tonic and Rc L n Z License Cls_ v _ `Z� LY.• k- Dem Gonummr ARCHITECT'S DEC OI o�U I undasunJ my plans slWl k tied u public rceordt 7/L( a kaG Licensed Professional 5 OWNER-BUILDER exempt OE0.DECLARATION 0 0 L krtby uSec ter 1 I.S.exempt from oho ConraetCo t:Any Law for to y O C folldwin t won.(Section Toncon I. Busimt and nese.de iofi Cale:Any rite m ounce $ which its ism a Permit ne consumer.,lira impmve,demolW,fi e awg anY munero _zy prim b is iererce,rmantM ma toviSio,ofcaml mesonhpermirmnmatiLaclstamment man W s< (commencing ctt wits alon7 )ofDi4oion3ofWBussmr'ania�lAw(Chapter 9ode)or Sq.Ft. Floor Area Valuation tat wit ScNon]OW)of Division J ofineeged exeandon.Anynvi Code)or $4340 Q Net io u exmmpt merefrom applicant and dee bus for be alleged exemption.Any violation of .1Section one won five my dont for a pumit subjects to applicant m a civil penalty of Number � Occupancy Type rot more man now hundred dolun(SM 3 5 7 0 5 0 5 0�wV 1,u awnror of de property,a my aoployers wvh wags u tens otic onmpeuWon. will do duwah and meswnme u smmxnded oreffened for ask(Sec.R)M,Buunw and Pmfeniou Code:The Comomm's L:..•..Law don not appy m an owner of Required Inspections property who Wilds or improver meron,and whodoessuchworkhimselfor trough his own employes,provided to such improvements art not intended oraRertd formic.If, hwever.me Wilding or improvement is mid whims ane year of oompldWn.me wnv- Wilda will haw to burden of proving mat M did rot Wild or improv for purpose of ❑1.as maser of the property.w exclusively contracting wide licensed com arms he costumer to project(Sec.7014,Business and Professiam Cade:)The Conmestofs Li- cense law does sat apply m an owner of property who Wilds or improws Berton.and. who contracts;for such projects wit a contractor(a)licensed pursuant m dee Conceits License law. ❑I am enam under Sec ,B k P C far this reason Dam WORKERS COMPENSATION DECLARATION 1 hereby Linton under penally of perjury one of me following dec'IwUoose ❑1 ham,nd will maintain vCenifiom of Coesenuo self-luurt far Workers Campen- sedon,u provided for by Solon 3700 of de labor Code.for me performance of to wort for which mit permit is issued. . ❑1 have and will outmadn Wohefa Compensation I...as em,m l by Section 3700 of Jon labor Code,fer the pcAarmance of the wort for which mis Permit is issued. ' My Workers C mreultI.I..nce easier and poli,number am: Cartier.F Poli,No:� E FlGTE OF EXEMPTION FRO V CER COMPENSATION INSURANCE (ITismeme n¢d metwoampicted if to permit is forane hooded dollars,($100) or less.) -.. . 1 certify dont in me perfo urnmea of to work for which this Permit is issued,I shall not employ any person in my summerso as m become subject to W Worker,'Comp roadon Laws of C.1ifornis.Dam Applicem NOTICE TO APPLICANT:IL after making to Ceruftote a Emotions,you touch Reome mbjm m tc Wasters C.'rhad..pmvw"of to labor Code,you must .JO foMwit comply wit such Providou amu Permit"I W domed revoked. ,'�.�ti CONSTRUCTION LENDING AGENCY r+r 1 hereby salon mal more it a convection� [ending a far me i tits g .) performance of to work for which permit u isswd(Sa.309w,Civ.C.) Z) A Lenders Nene . Z) z larders Addw V C) I certify mat 1 haw mad mit application end also Jut the show information is I,pr^ cortca I Is=m comply wit all city and county oNimnco and sum laws relating to 0 Wilding construction.and hereby autonre repmaeasmdvea of ibis city to enter upon me pro W shove-mentioned oM one for inspection purposes V"^t'J VJG/1./ LL (We)agree m n..indemnify and kop hvrmkm date City of Caperton against Z Iiabintsequ WLmcnts,cnmeM eepeun which may in my my an*ve against laid City C..>Z APPLI ANTUerace UNDERthe STANDS of des permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU CE 0.EGUTATIO ZP -91' Re-roofs iywurta App tonYCan Dam HAZARDOUS �- MATERIALS DISCLOSURE Type of Roof Will me applicant or funic Wilding occupant sort or handle ha ardau mammal defined by the Cupertino Municipal Code,Cbh1W 9.12,and de Hat and Wet, . "Mon"' {{{��' All roofs shall be inspected prior to any roofing material being installed. Will to pplicant or future Willing aecuWnt use equipment or devices which g an pe ❑Yes JIN. /mak• If a roof is installed without first obtaining inspection,I agree to remove a emit harardnu air contaminants as defined by the Bay Am Air Quality Management all new materials for inspection. Distna? ❑Yo qNu Tho reall S9CLYC material 2553 requirements munJorCermand toifte Calding ties ollt eumerudyhowamctiou 33303,Z5533 and! un notify eoccuosorte Jots not curtendy how a terrane Jut h u my responsibility m notify de arupant of de mats' maims. ebmtmkoom pri.,to Wu.of.Ccur.mof Oce Signature of Applicant Date wearaaaman.=dagent Da All roof coverings to be Class'R"or better os do9LI CITY OF CUPERTINO FURNACE/AC C1 OF •CUPERTINO PERMIT APPLICATION FORM APN# " 6106 050 00 Date: DS-/L -oy Building Address: Owner's Name: Phone#: ,Gxl,ut Contractor: Phone#:,s/��, 93 1911fv C�/✓Ci C Fax #: Contractor License#: Cupertino Business License#: VU 71 Contact: Phone #: Fax #: Building Permit Info: Elect [- Plumb [`]— Mech Residential Commercial ❑. Job Description: A d" I X /G For Residential Installations: Attic ❑ I" floor ❑ 2"d floor ❑ Adhere to minimum setback requirement ,r For Commercial Installations: Replacement same weight ❑ Additional weight (structural talcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): y 3 1/P, C(> �--�3 Strapped -- On Platform ❑ Bonded ❑ New Location Replacement ❑ Valuation: i Green Building: Must attach Green Building Check list to this application CITY OF CUPERTINO bm' FURNACE/AC COF 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. 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 &not incl in an appliance ermit. 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 Residentia=Install/Relocate Msuspended htr, orfloor moun 1MRAPPVNT Residential for the install/relocate/ or M replacement of ea appliance vent install &not incl in an a 1 ermit. CITY OF CUPERTINO ` FURNACE/AC cl�CUPEiZTiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type 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 1MFR=<100 Furnace Syst <=100k BTU install or M relocate ea forced-air/gravity type furnace/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 furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h 1 EPERMITFEE Electric Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit P 1TRAVD0C Travel Documentation B 1BUSLIC Business License B • CITY OF CUPERTINO ad FURNACE/AC OF CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units <= l Ok 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 IBPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid 1BREMAIRHAN Residential A/C units <= lOk CFM B / 1MRRAA Residential Mech Repair/alt/add M ! 1BSEISMICR Seismic Residential B r IEPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M / 1PPERMITFEE Plumbing Permit P 1TRAV50C Travel Documentation B 1BUSLIC Business License B CITY OF CUPERTINO • 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35705050 . 00 DATE ISSUED. . . . . . . : 05/12/2008 RECEIPT # . . . . . . . . . : BS0.00004733 REFERENCE ID # . . . : 08050094 SITE ADDRESS . . . . . : 22483 MC CLELLAN RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GOLDSTEIN ROBERT H ET AL ADDRESS . . . . . . . . . . : 22483 MCCLELLAN RD CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2767 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 4, 340 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1EPERMITFE 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 224 . 85 0 . 00 224 . 85 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 224 . 85 VISA --------------- TOTAL RECEIPT 224 . 85 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • Single Family GreenPoint Checklist date:S/eZ bg n Build It Green The GreenPoint Checklist is based on the various green features incorporated into the home and is the Smarr Solutions From The Ground Up basis for the GreenPoint Rated program.A home can be considered green if it fulfills the prerequisites, n Hams al least SD points,and meets the minimum points per category.Energy(30),Indoor Air Qualiasty/Health(5),Resources(6),antl Water(S).Plee contact Builtl It Green for a list of qualifetl GreenPoint Raters If you are interested In pursuing third-parry verification. The green building practices listed below are described in the New Horns Constriction Green Building Guidelines,available at www.buildit0reeaom, IfT ENTER PROJECT NAME n' a n n_ E is E w tl A SITE C' U Points Available Per Measure 1.Protect opeol And inimize Disruption ol 'ting Plants 8 Tracer ❑ a.Protect Topsoil from Erosion and Reuse after Construction 0 1 1 1 1 ❑ b.Limit and Delineate Construction FDD1q int for Maximum Protection 0 1 2.Deconsauq Instead of Demolishing Existing Buildings On Site 0 3 I 3.Recycle Job Site Construction Wasle(Including Green Waste) ❑ a.Minimum 50%Waste Diversion by Weight(Recycling or Reuse)-Required 0 R ❑ b.Minimum 65%Diversion by Weight(Recycling or Reuse) 0 2 ❑ c.Minimum 60%Diversion by Weight(Recycling or Reuse) 0 2 4.Use Recycled Content Aggregate(Minimum 25%) ❑ a.Walkway B Driveway 0 E] b.Roadway Base 1 b 1 Total Points Available in Site=12 0 B.FOUNDATION Points Available Per Measure 1.Replace Portland Cement in Concrete with Recycled Flyash or Slag —❑ a,Minimum2DsVRashor Slag 0 —� 1 ❑ b.Minimum 25%Ell or Slag0 �— ❑ 2Use Frost-Protocled Shallow Foundation in Cold Amas(CE C.Climate Zone 16) 0 ( 3 ❑ 3.Use Radon Resistant Construction(In At-Risk Locations Only) 0 ( 1 4.Design and Build Structural Past Controls ❑ a.Install Termite Shields&Separate All Exterior Wood-toConcreta Connections Metal a Plastic Fasteners/Dividers 0 1 b.All New Plants Have Trunk,Base,or Stem Located At Least 36 Inches from Foundation 0 1 Total Points Available in Foundation=B 0 C.LANDSCAPING Paints Available Per Measure • 1.Construct Re4DIRelEffrtlenl Landscapes ❑ a.No evasive Species Listed by Gal-IPC Are Planted 0 E] p.No Plant Species Will Require Hedging 1 0 � 1 ❑ c.75%of Plants Am Drought-lolerant California Natives,Mediterranean,or Other Appropriate Species 0 ( 3 2.Use Fre-Safe Landscaping Techniques 0 1 3.Minimize Turf Areae in Landscape Installed by Builder ❑ a.All Turf Will Have a Water Requirement Less than or Equal to Tall Fescue(50a plant factor) 0 2 ❑ b.Tud Shall Not Be Installed on Slopes Exceeding 10%or in Areas Less than 6 Feet Wide 0 2 ❑ c.Turf is 533%of Landscaped Area(total 2 points) -- ❑ d.Tullis 510%of Landscaped Area pD 2oral b point) � 0 2 El4,Plant Shade Trees D3 ❑ S.Group Plante by Water Needs(Hydrozoning) 0 1 1 2 S.Install High-Efficiency Irrigation Systems ❑ e.System Uses Only Low-Flaw Drip,Bubblers,or Low-flow Sprinklers 0 z ❑ b.System Has Small Con trollers 0 3 ❑ 7.Incorporate Two Inches of Compost in the Top 6 to 12 Inches of Soil 0 ( 1 1 1 3 ❑ B.Mulch All Planting Beds to the Greater of 2 Inches or Local Water Ordinance Requirement 0 ( 1 1 1 2 9.Use 50%Salvaged or Recycled-Content Materiels for 51 of Non-Plant Landscape Elements 0 1 1 1 1 10.Reduce Light Pollution by Shielding Fixtures ari Directing Light Downward 0 1 1 1 1 Total Points Available in Landscaping=31 0 D. STRUCTURAL FRAM R BUILDING ENVELOPE Points Available Per Measure 1.Apply Optimal Value Engineering ❑ a.Place Rafters and Studs at 24-Inch On Center Framing 0 1 El p.Size Door and Window Headers W Load 0 1 ❑ c.Use Onry Jack antl CntoIs Studs Required for Load 0 1 2 U5a Engineered Lumber ❑ a.Beams and Headers 0 ( 1 ❑ b.Insulated Engineered Headers ❑ C.Wood I-Joists a Web Trusses for Floors 0 1 ❑ J.Wood IJoists for Root Rafters 0 1 ❑ 1 e.Engineered our Finger-Jointed Studs IV Vertical Applications 0 1 ❑ I.Oriented Strand Board for Subflow E:1 — 1 _ g.OmniStrand Board for a Wall and Roof Sheathing � 0 1 3.Use FSC crtified el • ❑ a.Dimensional Lumber,Studs and Timoec Minimum 4D% ID b. 2 b.Dimensional Lumber,Studs and Timber.Minimum 70% 0 2 El c.Panel Products:Minimum 40% ❑ 0 1 _ d.Panel Products:Minimum 70% 0 1 02007 Build It Green Single Family GreenPoint Checklist 2007 Version Page 1 of 4 ENTER PROJECT w • a 4.Use Solid Well Systems(Includes SIPS,ICFs,&Any Non-Stick From Assembly) ❑ a.Floors 0 2 2 ❑ b.Walls 0 ! 2 2 ❑ c.Roots 0 2 i 2 5.Reduce Pollution Entering Ne Home horn the Garage ❑ a.Tightly Seal the Air Barber between Garage and Living Area 0 1 ❑ to Install Garage Exhaust Fen 08 Build a Detached Garage 0 I 1 I 6.Design Energy Heels on Trusses(75%of Attic Insulation Height M Outside Edge of Exterior Well) 0 I 1 I I I ❑ 7.Design Roof Trusses to Accommodate Ductwork 0 I 1 I 8.Use Recycled-Content Steel Scads for 90%of Immor Wall Framing 0 I 1 I 9.Thermal Mau Walls:S S4nch Drywall on All Interior Walls or Walls Weighing more than 401btcu.fL D I 1 I I 10.Install Overhangs and Guners ❑ a.Minimum 16-Inch Overhangs and Gutters 0 I ! I 1 I ❑ b.Minimum 24-Inch Overhangs and Gutters 0 ) 1 I Total Points Avallable in Struchlral Building Frame and Envelope 36 0 E.EXTERIOR FINISH Points Available Per Measure 1,Use RerycledContent(No Virgin Plastic)or FSC-Certfed Wood Decking 0 2 2.Install a Rain Screen Wall System 0 2 3.Use Durable and Noncombustible Siding Materials 0 1 4.Select Durable and Noncombustible Roofing Materials 0 2 Total Paints Available in Exterior Finish=7 0 F.INSULATION Points Available Per Measure 1.Install Insulation with 75%Recycled Content ❑ a.Walls and/or Floors 0 1 ——❑ b:Cellin s 0 —- —1— 2.Install Insulation Walls Low-Emitting(Certified Section OU50) ❑ a.Walls and/or Floors 0 ( 1 ❑ b.Ceilings 0 1 I ❑ 3.Inspect Quality of Insulation Installation before Applying Drywall 0 I 1 Total Points Available in Insulation=5 0 G.PLUMBING Points Available Per Measure 1.Distribute Domestic Hot Water Efficiently(Maximum 7 Points). ❑ a.Insulate HM Water Pipes from Water Heater to Khhen 0 I 1 1 ❑ b.Insulate All HM Water Pipes 0 1 1 ❑ c.Use Engineered Parallel Piping 0 ! 1 [:1d.Use Engineered Parallel Piping with Demand Controlled Circulation Loop 0 1 ❑ e.Use Structured Plumbing with Demand Cmtrolled Ciroulation Loop 0 1 2 1:1I.Use Central Core Plumbing 0 1 1 2 ❑ 2.Install Only High Efficiency Toilet(Dual-Flush or 9.210 gpg 0 I I I -4 Total Pants Available in Plumbing=Total 121 0 H.HEATING,VENTILATION 6 AIR CONDITIONING Points Available Per Measure ❑ 1.Design and Install HVAC System to ACCA Manual J,D,and S Recommendations 0 1 4 I I 2.Install Sealed Combustion Units ❑ a.Furnaces 0 2 ❑ b.Water Healers 0 2 77 3.Install Zoned,Hydronic Radiant Heating with Slab Edge Insulation 0 7 I 1 I 4.Install High Efficiency Air Conditioning with Environmentally Responsible Refrigerants 0 1 5.Design and Install Effective Ductwork ❑ a.Install HVAC Unit and Ductwork within Conditioned Space 0 3 I ❑ b.Use Duct Mastic on All Dud Joints and Seams 0 1 ❑ c.Install Ductwork under All lludittion(Buried Ducts) 0 1 ❑ J.Pressure Balance the Ductwork System 0 11 ❑ e.Protect Ducts during Construction and Clean All Duds before Occupancy 0 t Lj fi.Install High Efficiency HVAC Filter(MERV 6.) 0 I 1 I ❑ 7.Don't Install Fireplace or Install Sealed Gas Fireplaces with Efficiency Rating Not Less Than 60% 0 I 1 using CSA Standards 8.Install Effective Exhaust Systems in Bathroom and Kitchens ❑ a.Install ENERGY STAR Bathroom Fans Vented to the Outside 0 1 ❑ b.All Bathroom Fans Are on Timer or Humitl:stat 0 1 ❑ c.Install Kitchen Range Hood Vented to the Outside 0 I I 1 9.Install Mechanical Ventilation System for Cooling(Maximum 4 Points) ❑ a.Install ENERGY STAR Ceiling Fans 8 Light Kits in Living Areas&Bedrooms , 0 1 ❑ b.Install Whole House Fan with Variable Speeds 0 1 ❑ c.AutomaOcaRy Controlled Integrated System 0 2 ❑ d.Automatically Controlled Integrated System with Venable Speed Control 0 1 3 1 I 10.Install Mechanical Fresh Air Ventilation System(Maximum 3 Points) F_1 a.Any Whole House Ventilation System That Meets ASHRAE 622 0 2 El b.install AliHeat Exchanger that meets ASHRAE 62.2 0 1 1 2 11.Install Carbon Monoxide Alerm(s) 0 1 1 Total Points Available in Hearing,Ventilation and Air Conditioning 3DI 0 zd 02007 Build It Green Single Family GreenPoint Checklist 2007 Version - Page 2 of 4 -MononaENTER PROJtCT NAME • 1.RENEWABLE ENERGY Points Available Per Measure 1.Pre-Plumb for Solar Hot Water Heating 0 1 4 1 1 1 LJ 2.Install Solar Weter Heating System 0 1 10 1 3.Install Wiring Conduit for Future PhWovoRaic Installation 6 Provide 2001P of South-Facing Roof 0 1 2 1 1I 4.Install Photovohaic(PV)Panels ❑ a.3D%of electric needs OR 12 kW(total6 point) 0 6 I ❑ b.60%of electric needs OR 2.4kW(tolal 12 points) _ _R 6 Elc.9D%of electric need OR 3.6 kW(total 18 points) 0 6 ! Total Available Point in Renewable Energy=2B 0 J.BUILDING PERFORMANCE Points Available Per Measure 1.Diagnostic Evaluations ❑ a.House Prices Blower Door Test 0 1 ❑ Is.House Passes Combustion Safety Backdrafl Ten 0 I 2.Design and Build High Performance Homes-%soon Title 24-minimum 15%Requited 0 I no ❑ 3.House Obtains ENERGY STAR with Indoor Air Package Cerllfication-Pifor Measure(Total 45 points;read comment) 0 5 I 2 Total Available Points In Building Performance 39 0 R.FIMSHFS Points Available Per Measure 1.Design Entryways to Reduce Tracked in Contaminant 0 1 2 Use Low-VOC or Zero-VOC Paint(Maximum 3 Point) ❑ a.Lox-VOC Intent WaIVCeiling Paints(c60 gPl VOCs(Flat)and<150 gpi VOCs(Non-Flap) 0 1 ❑ b.Zera-VOC:IMmier WaIVCeIIin Paints(6 gal VOCs(Flat)) 0 3 ❑ 3.Use Low VOC,Water-Based Wood Finishes(¢50 girl VOCs) 0 2 —Q-4.Use Low-VOC Caulk and Construction Adhesives(<70g l VOCs)for.All Adhesives 0 —1-1 _2-1 —! — ❑ 5.Use Recycled-Content Paint 0 1 6.Use Environmentally Preferable Materials for Interior Finish:A)FSCCemfied Wood,B)Reclaimed,C)Rapidly Renewable,D)Recycled-Content or E)FingerJoinbrd ❑ a.Cabinet(50%Minimum) 0 7 I ❑ b.Intent Trim(50%Minimum) 0 ❑ c.Shelving(50%Minimum) I ❑ U d.Doors(50%Minimum) — 1 0 E) a.Counettops(50%Minimum) -- D I • 7. a.Sab Fo&Star ydoTreads Interior Finish Finish(CA Section 11 110) - ❑ a.Subeooe Stair Treads(50%Minimum) D 1 ❑ b.Cabinet A Counterfeits(50%Minimum) g ❑ u Interim Trim(50%Minimum) I 0 j ❑ d.Shelving(50%Minimum) 0 1 ❑ 8.Affair lnstallat7on of Finishes,Test of Indoor Air Shows Formaldehyde Level 47pple 0 1 1 3 Total Available Points in Finishes=21 0 L.FLOORING Points Available Per Measure 1.Use Environmentally Preferable Flooring:A)FSC-Cerci Wood,B)Reclaimed or Refinished,C)Rapidly Renewable,D)Recycled-Content,E) Exposed Concretes Flooring Adhesives Must Have d0 girl VOCs ❑ a.Minimum 15%DI Floor Area D I 1 1 1 ❑ b.Minimum 30%of Floor Area ❑ 0 c.Minimum 50%of Floor Area 1 ❑ d.Minimum 75%of Floor Area 0 1 0 ❑ 2.Thermal Mass Floors:Floor Covering Other than Carpet on50%orMore ofConcrete Floors 0 1 ❑ 3.Flooring Meet Section 01350 or CRI Green Label Plus Requirements(50%Minimum) 0 1 2 1 1 Total Avai Points in Floorin =7 0 M.APPLIANCES AND LIGHTING Paint Available Per Measure 1.Install Water and Energy Efficient Dishwasher ❑ a.ENERGY STAR(total 1 point) 0 El b.Dishwasher Uses NO Maine than 6.5 G¢Ilons/C le(total2 rots) D � 1 2.InstMl ENERGY STAR Clothes Washing Machine with Water Factor of 6 or Less ❑ a.Meets Energy Star and GEE Tier 2 requirement(modified energy factor 2.0,Water Factor 5.0)(total 3 points) 0 1 2 ❑ b.Meets Energy Star and CEE Tier 3 requirements(modified energy factor 2.2,Water Factor 4.5 or less) I 2 tolal5 'nes D 3.Install ENERGY STAR Refrigerator ❑ a.ENERGY STAR Qualified 8<25 Cubic Feel Capacity' 0 1 El b.ENERGY STAR Qualified d<20 Cubic Feet C city 0 1 4.Install Built-In Recycling Center 0 ❑ a.Built-In Recycling Center 0 2 ❑ b.Bulli-In Composting Center — 0 j Total Available Point in Appliances and Lighting 12 0 N.OTHER Points Available Per Measure • ❑ 1.IncorporateIncorporateGreenPoint Rated Checklist in Blu¢print-Required � 0 I I R❑ 2 Develop Homeowner Manual of Green FeatureYJenefits 0 I 1 1 1 1 1 3.Community Design Measures 6 Local Priorities:See the Community Planning 8 Design section in Chapter 4 of Ne New Home Guidelines for measures.Maximum of 20 point for suggested measures.Local requirement may also be listed here. 02007 Build It Green Single Family Greer int Checklist 2007 Version Page 3 of 4 ENTER appropdale ca • oJECT • • ri a W F14: ' ❑ Ener description here,and enter pbln,available tar mas eure in appioryiete categories tome high.___ ________ _ __ _ 0 _ 0_ 0 _ 0d _0 _0_ ❑ Enter description here,and enter Roan,evallable for measure in tegories to the right. _ __ _ _ 0 D __ LJ1 Enter description here,and enter ppn,avmlable for measure in appLammecategori Ne es to right _ 0 0 _ _ _ 0 _ _00 ❑ I Enter description here,and enter points available for measure m appropriate calegones to the right 0 D D_ 0 0 0 4.Innovation:List innovative measures that meet the green building objectives of the Guidelines.Enter up to a Build li Green Checklists antl maximum combined total of 20 pts.See Innovation Checklist for suggested measures,usingthe link to the right. Guidelines Innwatim in Community.Enter deecripton here,and enter points avellable for measure in appropriate ca 'es to the right iOm 0 DInnovation in Energy:Enter description here,antl enter points available fa measure in appropriate cats ones to the nght. _ _0_ 0 ❑ mranation In IAOMealth:Enter desim ion here,antl enter gents avallable for measure in appropriate Cate ories to the right. 0__ 0❑ I Innwation in Resources:Enter description here,and enter points avallatee for measure in appropriate cats ories to the n hl. __ _-0_ 0 ❑ Innwaticn in Water:Einer tlesmptim here,antl enter points available fu measure in apprcpnata categories to the right 0TOW Available Points in Omer=4 Total Available Points in Specific Categories' 4+ 96+ 42+ 66+ 43+ Minimum Points Required in Specific Categories 0 30 5 6 9 t • t • • t Project has not yet met the following recommended minimum requirements: Total Points Achieved -Total Project Score of At Least 50 Points -Required measures: -A3a: 50% waste diversion by weight -J2:-15%.above-Title-24 - - -Ni:Incorporate Green Point Rated Checklist into blueprints -Minimum points in specific categories: -Energy(30 points) -IAQ/Health(5 points) -Resources(6 points) -Water(9 points) • 02007 Build It Green Single Family GreenPoint Checklist 2007 Version Page 4 of 4 r Community Development 10300 Torre Avenue itCupertino CA 95014 Telephone(408)777-3228 ��PCITY OF EI �N� Fax(408)777-3333 fC Building Department JOB ADDRESS: PERMIT # „7,7, y,r 3 /`/ G C? /-, //,q OWNER'S NAME: o s /r PHONE # GENERAL CONTRACTOR / ae — FAX # I am not using any subcontractors: Signature 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 Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date