08080132 CITY OF CUPERTINO
BUILDING.9IVISION4 PE$MTT �RCO1�£L;RACTURINI$ ''aI2MATION.
BUILDING ADDRESS: PERMITNO.
225'/'/ POPPY DR JITENDRA KAVATHAKAR 08080132
OWNER'S NAME: PERMIT MUS DATE
JITEINDRA KAVATHAKAR 22577 POPPY DR 08/18/2008
NE SANITARY NO. CONTROL NO.
ARCHMOrflENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION IOM Description
4 1 hereby affirm deal 1 am licensed under provisions of Chapter 9(commencing
with Sachem 70M)of Division 3*(the Business ad Professiom Cade,soul my license is POOL DEMO & 'FILL'
? in full force and affect
C'g 3 License Class Lk.g
EF Dau Contractor
ARCHITECTS DECLARATION
e 1 undeawnd my Alam shill he used as public mcods
�6
Licensed Pmfc aimat .
bN OWNER-exempt ROE DECLARATION
i S 1 herohy.affirmc o n I am exempt from the Cm..Co License Law for the
p o following moon.(Seton 7031.5,Business in Profetum Code:Any eby err county
z 4 which mquire•permit no cnmweL aloe Impmw,do permit
I ere mpair cd structure
_i�, Prior u,is
sliaued intra re qui res theapplicantof for Code Peru's Li mon Lawdsuumenl
< Ihnhau�amed punanlmthe proviaiomofdte ConmcmrilJcemn Law(ChaPtes9 Sq.Ft.Floor Area Valuation
(common 0, wildostfrnlEadit udsfr afthe Budnevadon.Any violation
i Cade)or 4000
dm ha k 31.5 b therefrom and the bads far Ibe aikged ppikanm.Any l pen lty of
Seton bran l ve my red dollars
la(o a permit abjecu the appikal m a civil penally of Number Occupancy Type
at mart the 0w hundred thallus($y00). 34212007 !�
❑1,u ownso of the property,err my employee wild wage u theirsole ampmatme.
will da the wade,and duaromme is not Intended or offered for sale IDN,Bmircu Required Inspections
and Profeta-Code:The Communes License Law does our apply m er e ns se ownerr q P
properly who bullda or im proves dvsan,and w a does such wart himselfor through his
Own employee,provided dead such improvements tee nal intended or offered for ale ff.
downer.the building or improvement is veld within orc year of rompktion.dre owrcr-
builder will haw dw Maden of proving that K did ml build or Improve four purpose of
ale.).
❑I.as owner of W property.an exclusively contracting with Iiansed conmctan m
construct the pmjea(Sec.1004:Bminem sed Profession Code:).The Cmtramr;Li-
come Iso dues not cep ly u ano mu r of property who builds or Improves Merton,and
whoanmcufmauch jee with acanmcman.)Ikensed puna-w the CovtraaoYs
Lkman La
❑ rode sec prf W awes/
Owner1. Dan Dau �L5„IhT'1 I,
i WORKEMCOMWSATION DECLARATION
1 Mmby afRrm under Penury of perjury one of the fallowing declaetorm
I ha+e and will maintain a CadOate of Consent he selr4mum for WorkersCompa-
andm,a provided for by Secdm 770E of can,Labor Code,far On,pedama ce of the
work for which this Permit is issued.
❑I haw and will maintain Worked Compensation Insurance,as mquimd by Section
3700 of the lsbo Cade,for the performance of the work far which this permit is Wood. '
My Worker's Compensation Insurance artier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
( 1,asecdm need not be completed if m perch isteam hadmd dollen($100)
or leu)
1 certify !I 1 c perfarm a of the wort for which this permit B laved.I shall n
I cesoyany n minaym nnersou o become subject m the Worlited pensa n
cropi.ofCali am
ApPlianl inn4A CA
NOTICE TO ! .If.ter a t 1 Certificate of Etempdon, a ouul
become sub the Workers Compensation provisiom of the Laos Cade,you mon
.JO
P: forthwith comply with such provisions a this permit mail M deeed od.
mmvels'Z " CONSTRUCTION LENDING AGENCY
Ix`NlRb ra
" I hereby arm that them a construction lending agency for the Perfomof
Qi the wort for which Its peril is issued(sec 3197,Civ.C,)
Q Isndch Name
=z lenders Address;
U Ot 1 eenify the 1 have rad this applicatiand!auu Ur b
ion aathai above Watteau.
ted U cora l agree m=reply with all city ad county ordinances and sum Ise relating m
O building construction,and hmebyathodae mpresentaves of this city to enwr upon the
W ahmm-mentioned properly for inspection purposes.
O. (We)agree to ow,indemnify ad trop humkas the Chy of Cuyenino agaimt
M liabilitie,judgments.eou ad upcmu which may in any way acme agsimtaid Ciq G
into hme of the ung of this perk.
APPLI Nr UND ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date o
SOU0. EGULA NS,
si{nu I, o two V $o'-�I — Re-roofs
HAZARDOUS MA RIALS DISCLOSURE Type of Roof
Will the ipplieat or future building acupmetstoe orhandle huAdom material
u denned by he Cupertino Mudclpa Code.Chapter 9.12.ad the Health ad Safety
Cade,Seton 2s5]2(.Y.r All roofs shall be inspected nor to an roofing material beim Installed.
❑res o P P Y g 8 •
Will the applicant or future building caupant um equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
n hav Blair cmuminaU a Timd by the Bay Arta Air Quality Management all new materials for inspection.
claim?
❑Yes Nu
Ihavemalth us adommaurWrtquiremenuun@rChaPwr5 if buildio-
niaHalthhSafay Savo 25341,235]]am125g]d.luuadewuad lhalifahe buiWin{
doemtms.hi ave•ten Lthu�ne iryt'u,my1mpofabilll ll maty pal of
requi nuwhic muube t fll ar,cmlrw.war a Signature of Applicant Date
owner amarwAagcnt ave All roof coverings to be Class'%W'or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34212007 . 00
DATE ISSUED. . . . . . . : 08/18/2008
RECEIPT #. . . . . . . . . : BS000005818
REFERENCE ID # . . . : 08080132
SITE ADDRESS . . . . . : 22577 POPPY DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JITENDRA KAVATHAKAR
ADDRESS . . . . . . . . . . : 22577 POPPY DR
CITY/STATE/ZIP CUPERTINO, CA 95014
RECEIVED FROM . . . . : SKENDER KRAJA
CONTRACTOR . . . . . . . : LTC # *OWNER*
COMPANY . . . . . . . . . . : JITENDRA KAVATHAKAR
ADDRESS . . . . . . . . . . : 22577 POPPY DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1.BSEISMICR VALUATION 4, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
IDEMOPRE SQUARE 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
------------ --------------- --------------------
CREDIT CARD 490 . 50 AMEX
---------------
TOTAL RECEIPT 490. 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---------- ---------- -------- -------------------------
704 DEMO DEMO
•
Ole �-�< CbLtv�d(L
CITY OF CUPERTINO vSC1S 0130Z
DEMO
•CUPERTINO PERMIT APPLICATION FORM mP
APN# J , -�/ O 0 7, 0 () Date: 1 , 1 0
Building Address: 2-2-5-71
P0 17Q. u er+-ir.IaCR g5ol
Mailing Address (if different from buildin address):
Owner's Name: Phone:
i �-eND�A Kava a aR dog 924 -164
Contractor: Phone :
ow n,E71L Fax: 45o.0 �
Contractor License #: aI
k
Cupertino Business License 9#:
Contact: Phone: (,oS5—"N7
gIC61.1DE{Z KVQ 0. Fax:
Residential ❑ Sq Footage Commercial ❑ Sq Footage
Job Description:
Valuation:
Project Size: Express ❑ StandardV Large ❑ Major ❑
Please complete relevant portions of the Green Building Checklist & attach it to the application
or if applicable, include on the plan set & the sheet index.
Quantity Fee ID Fee Description Fee Group Permit Type
1DEMORES Demo-Residential B 1SFDWL-DEM
` IDEMOPRES Pool.Demo Residential B 1SFPOOL-DEM
/ 1BSEISMICRE Seismic Residential B
Revised 6/16/08
CITY OF CUPERTINO
DEMO
CUPEkTINO PERMIT APPLICATION FORM •
Quantity Fee ID Fee Description Fee Group Permit Type
1DEMOCOM Demo-Commercial B 1COMML-DEM
1DEMOPCOM Pool Demo Commercial B 1CPOOL-DEM
1BSEISMICOM Seismic Commercial B
1BUSLIC Business License B
Revised 6/16/08
r
Single Family GreenPoint Checklist date: \ B jld ft GCen
The GraenPdnt ChecUist Is rased on Na various green features Incorporated into the home and is the
heals ler 019 GreenPoint Rand pmgrem.A home can Be colMidered green 111 IulfiSs the prerequisites,
same at least 50 points,and meats No minimum points per category:Energy(30),Indoor Air Guelllyl
Hea0h(5),Responses(6),and Water(9).Please contact Build It Green for a Sat 01 quelled GreenPoint
Rana II you em interested in pursuing Ihlrdpady,verification.
T!;P green huflUng praclices lista below are described in the New Home ConsUudion Green Building
fiuvlelinen available aomw.huiNifmaan nm yE .� yy ,
ENTER PROJECT NAME
� S
A.SITE . :77777 t - - PerMeiisuita--F:'. '
1.Protect Topsoil entl Menai.Disruption d EMting Plante A Tr..
■ e.Pnnst Tsui from E=bn and Reuse star Construction 0
■ b.Line and Oaswte CwuNmAbn Foutpesfor Maximum proledon
■ L Deven.trud Inq..d of D.0shing E tftn Buildings On Sib 0 I 3 1
L Recycle Job Sta Conseudnn Wab Including Grsn Wate)
■ e.Mhlmurn 50%Wml.OAennn by Welphl(Rocydby oris..)47aglud 0 !
■ b.MhJmum 65%Diversioneon by Weight(RANor Reuae) p — ~`2 J..—...
_— .�..�.._�_.T_.._..
■ c.Mnteam 00%Diversion by Ws62h1(RxyWq.Rase) y0 2
A Use R.,,i Content Aggngeb(Mlnlmum 25%)
■ e.walkwayand DNnxay 0 1 1
■ b.Radewy San 0
1 i
Total Poteb Available M Sea•1 0
B.FOUNDATION. •.: - _
_ .___ ..,. ; ..• .., ". .'. ,�.','.'-' ` 'i` .'i..c r:^.' " :Poidti AveSable Per Mes%ird:'J:JL.
1.R.pb.Portland C.m.m In Concrete was Recycled Fty.h or$We
■ 0.Winton 23%Flyuh.Sip 0 I 1 1
■ b.Madison 25%FTyuh.alp D I I 1
■ LUs.Fre.W.Racld Shauow Founcation In Cold Ara.(C.EC.Cgess,las la) 0 i 3
■ 1 U.Radon Rnntant Construction On AbRsk Loutlon i Duly) 0 1
• ♦cast,and sold Structural Not control.
■ e.Insist TemYS ShiWS S Saunas Al EMM Wov6b4uvab CpmMM.by 1bW>RWk FallenervDMMsn 0 1 1
b..Now Rab Naw Trunk.Bass,or Stem Loci N Leal 361nctas hon Foundation
Total PWnb Aalblle b Foundation•S 0
C LANDSCAPING- Pei M6e5litd': -
u h.
1.CasWct R.wvawEMebm Landsaae,
■ a.M lmmM Soder Lai by CWPC M Rani
■ b.No Plan Space;We Require Hedging 0
■ c.75%ofRans va OmghHManit CeSAAnb NaIM.,Medltemnan,or otherAppmpMS Soda. 3...
■ L U.Fl,lSM land.apsg Technlqun 0
1 Mlnrntra Tud Area In Lendsap Uusled by aides,
■ e.AB Turf We Hare a Water RauremeM lass than a Equal n Td Fana.$)A pan fail.) p r 2
■ b.Tuff SMI Not Be sMMd m Sbpe.Emdllg l0%.In Nae,Len than l Feta WIG
■
C.Tud 03%of Lndusi Anallbtal 2 pastel —O
■ d.Tud hi W Lan.acad Na lwl a portal o—'—J._�..._.....F__..',._.
■
4.Plant Shade Tans 0 t 3
■ S Group Plan%by Water xnG(Hrdnnning) 0 I I 1 2
G.te.ml Hlgh. fflww y Waalte.sywa
■ a.System Use,Only Lgwf Ddp,Bubbten.or Lar0yw SprhUeb 0 1 1 ! 2
____ ._._.l-. ........F_........._.._.
■ 6.9abm Me smart controls. I I 3 '
■ 7.Innrycab Two Inch.d Compo.t In M.Top k n 12 Inch..if poll 0 3
■ a Mulch At Pending east b she Gaon,d 21ncMa or Lod Water Orders Mqubvisnt p j ( 2
■ e.U.SO%SWapd ar McyaldJ;oMmt Masrtes or 50%of H.eP dLanst.pe Biomass 1
■ 10.Rdus DDM PaIIWanp Shteking Futures ano,Dindnp DpM downward 0 1 i I
Tole!Pains Available In Landwee;•31 0
D.STRUCTURAL FRAME&BUILDING ENVELOPE ;r � C.- :+ �;.r„':t-*. -',:r:;°�;ui`' -,1-�"rwfX':?:,.Yrs .'� .�PdInIS Av511stile Per MeesuNr:'..•
1.Apply optimal Value Engiosdp
■ s.Pea Reba entl SNst at 2L1mh On Cami Films; 0 ' 1 1 1
■ le.Side Dmf nMWlndnwHaustus l.Udall
• ■
__1_._'__.
c.Use only JerA end copies Poured fordr le
1 Us,Engineered!Lumber !1
■ a.Boma and Holden D I 1
■
le.Insulted Epireei Hessen 0
■ e.Wsai Wosb.WaoTan Wb D _—
■
02007 Build It Green Single Femlly GreenPoint Chectdnt 2007 Verson Page t of 7
ENTER PROJECTs
u s a
4.Wood Waeta bPOW M fWm
a.FspYaMad u iinovld^Id Sbtla Im VOW aleauecrM 0 7
I.OnanMd Seed Soanlb Sm 0
g.Odmled Seal SOW MWal and RWISW Dhlno 0 1 i
I U.FSC•CanilMd W.d
..DkMWIWu .Blue and Tmber-MbMWn.mc D Z _
b.Dlm.nsonal lunW,SW and TMbar.WAnW 70% 0
c.Pants PW":MInMMm 40%
d.P.W Pmduda:NWum 70% 1 D
0 2007 Build It Green Single Femlry GreenPdnt CheUdlet 2007 Varian Page 2 017
ENTER PROJECT s
V S 6
• K.Uas eoW W4 Systama pndudss SIP,.ICFs,f My Ron-Stick FMna NxlnbM
■ a.Flora
b.Wate
.. ---
2 2 -}`_-_._.
S Radium PoUJon EnWdng the Herm from the Gump
■ ATlphy Seat tie Ak Se",belaaen Gang,and LM+Ig Am 0 I
■ e.InsW Ganq FJaxl Fan DR BUW a Dehtlptl Garage p
■ 1.DWgn Emmpy Haste on Tnusx(75%ef Ants Insuhtlon Height d Outside Edge W Elate,WIN) 0 1 1 I !
■ 1.0adpn Real Tmses b Mconrwele Oudenum D t 1 !
■ 0.Ux R.gch."onlbd Steal SWtla for Po%of lntsdar Well Fnminp p 1
■ 0.Thamad 1teu All.:fill Drywais on AS lead.Wdta or Wall.W.1,1n,mon nun 101Wcu.fL D 1
10.natal Overhangs and Ou len
■
I.MWMM If Inch Overmalp and Guam p
■ b.MWmum 24nM Orarbige and Guh,n
TdM Pahb Available M Sh ml Building File.; Embge•X 0
E.EXTERIOR FINLSH..(.av "' .<..... .i 1�. § 'a ,.; ., " i+
+ � ' T„'.+..:.. + ' - �”.; '. 5 .,-.•`Pomata AveOaDIR Per
■ 1.Uaa RaryW6Conbnt(N.Will.Plante)ar FSC-Cadlned Wood Decking 0 2
■ i IMteil a RW Soman Wall Spun 0 2
■ 1 Ues Duvebte and Nwconmu rt hh Sldhp IYterhte 0 I
■ ,.StlM Ourabie and llwcvmbxtibla Roofing Matenats 0 1 2
TcW Points A.W.h EMadm Fhhh• 0
F:[NS[7LATION r' .. Rt.-.i+- ,`'! �r.:`-S,'w ` t'a'i--::�"ti>vi'v's 4S!'1=`:c`�-,:87�''4'"''fr'�>"4.dti i':K•5 r:ra %3: ';P.DInte AvegebldPecMOeture'i',ti.
I.Inatali lnsutetim ut,75%Ra Wd COW,W _
■ a.Wald andV Fban 0 I 1
i
■ D.CaIbO, p t ,
2.I.Wi InsulNon that Is Low6nlNnp(Coifed Section 01150)
■ a.Wage andlm Flom 0 t
b.Gtllig. _
6-
I
1
• Mutetlm teshltetion babas II 0 1 ..
G.PLUMBING
Quality al l :. AppMnp Orywa
:. -+'Points Av`agabla PerfADeaure:;;
- oma vete AWhtlamlreuhtlon• 0
1.Dl WOUW Domestic Not Water ESlchnlly(MxMum T Panne)
■ a hINNh Hct Wam Ptees horn WWr Hasler an gWan 0
■ e.IMYteIeNHof Water Pipes
■ c.UP,Enpbeend Pan"Nphp p '
■ d.U.EngwW Pan!!Poll rots Damns Cabxed CO uedw Imp
■ ,.UesSbuxraO PbaMYq ons 0.nuN CaMaitM CbadaAm loop D —__'i�_.__.;r..__'..2
■ L U.Conal Con Pbmbbq - 7 -` - '--r-i—'.._-i._.1
..1._2
L Install Dny High EOlcWnq TWlab(Dual4luah wI1Z gpB 0
+ I 4
Total Ponts AWgeW,h%nbbO•Total 1 0
H.HEATING;VENTILATION&AIR CONDITIONHHC• n7 tl,Ix ,r76ilr y.,J,C,„Q s,,,v i",c, sTi�'vr ' '.'y.'., ..;POlnb li�elleble Pa.Abaeuie 3,kc
■ 1.Design and Install HVAC System b ACCA Wnml J,0,and S Rommmanda0ons. 0 4
L Instep Bwled Combesibn Unite
■ a 0
■ b.Water Haalen
■ 1.Inatall Zoned,Hydronlc Redeem Heading anti She Edge lnsuato
■ I,Instill High Ef henry Nr CondeUenirp wM EMlramvnta0,Responsible RdH"M 0 1 1 I
S.Design and IMWI ESacIM Ducbo t
■ a.In"WAC Unit ale Ducleot wWln CondDo0ad Spam 0 1 3
L .......
cIMN dKhntauWrAtlk pulbti,n leuledmml .-..O_. _- + L_..—...
■ d.Presaun Balance be OadavdlByslWn p ', t
■ a.PWW DUW dudtp CanemcBon and ClesnN Duds babas OcmWnaY ...o_
■ 0.1MWl High ESldeney WAG Rear RXERV H) D + I
■
7.Owl instill Finplim m]name Sasled Ox Flnptems utih EfOclansy RAW Not lass Tan 00%
wing CSA Standards +
i 1
0.needy EB,cOn EWwt Systema In 0aNroaM and KIWans
• ■ S Install ENERGY SEAR Bateman Fans Vend b Ou Outside ..._i..___+ t
■ b.N Salam.Fans An on Tbnsr or Humbtatat .p
■ c.Instal Kitchen Range Hootl Venal b tit DIWde -.0
1.autan W WNmI V,+datlon System ter Cooling(Huhum 4 PahW)
■
A.Irelea ENERGY STM Calling Feu S LigW Kb In tlbg Anes L Sadnare 0 f T
■ b.lnatep Whd,Hour Fan with VadaeN SPeetla __D_ _. t 1_ +
ea
020177 Build It Green Singh Fahy GxenPdnl ChecidW 2007 Vemon Page 3 of 7
V S ¢
cENTER PROJECT NAME
*,b,%*e/CwOaod lnpnma Simon 0 2 I •
d.k"TAUaaF Conbdod lneOahid BpWn Wln Verhibhi SPwd Coma _ 0 i 3 I I
10.Iwhig MCNnlal Fresh Air Valliant,ephim(Mvlmum 0 Pomhi)
. a.Any VAchi lbws Ventilation BpWnThl Mesh ASMIME B22 0 2
b.Muhl Alrvbae Hat ExftW that mwA ASHRAE 622 0 14 2 i 1-
11.Anthill Carbon Monoddo AWmld 0 1
TOW Pope Awabhi to thi ft Vordston AM 0 CuMllanry•W 0
•
•
02007 Build It Green Single Farnly GmenPolnl ChedJlat 20117 Vftm Page 4 N 7
PROJECT '
• LRENEWABLE ENERGY;, -.r,�;-." ` , jr..:; " ti. -.:;u"a,,:..,�f.;" �^r< i+::"„�,�..,:i- 2t- i<Pnln6'AileiahNiPet MBawieu ti'= '
1.PI ftanb for Bahr Not Waht Nu0ng 0 p
I lmhll Bohr Water NMlng Byshm 0 10 1
1 lmhllWWp ConduN M Fu ,Ph0lvval h lmtallatlon B ProYY►Mat Bouths.ing Roof 0 1 2 1
41nah11 Photevolhic(M Pamh
a.30%debWk mada OR 11 aW(WW a eolnb) 0 6_-�_.._ 1
b.SO%d eeddc meda OR 2.40N Rental 12*ft)
C.90%d als d need OR 7.6 MY lB pate)
6 j
TOW Avaltable Polda In Remrabh Energy 0
L BUILDING PERFORMANCE + ''"'w. xt, ".,hies t , s ;i'y.T R ,1'a,.9' "` i + <”'-` •I i"'''
..>,. .:Poln6 AJeBebb Per Meesure.;.�
1.01agnosllc Evalu a ors
. a.Hou.Paoam Bb rpoor Tad +
I_._._.
b.Hou.Panama Cw stbn Sealy Bacdrall Teal
I.palpn and BulN Nlph Wrbrmmw Mwna-%above Tlpa Sa•minlmum l5'gpulre0 0 1 230 I { I
S 2
3.Nam Obhi.ENERGY STM all IIWmr AU PacNpa CaNBmdon-Pilar W.,.(Taut a poiMa;nad mmm.0 0
i
Tote Avae,bh Poke,h Building Porlom.-3S D
KFINISRES y,"<i ,I 777777777 77 ..4:Polnt Ave05hle Per Mea6pre_?,
1.Oadgn Enbyraya W Redum Trak In COIhmWnte p
I 1 i i
I U.Lo VOC arA VOC Paint(Mubnum 7 Panda)
a.Lo VOC interior Wallte2bp Paints(40 ppi VOBs(FlgaW 410 gpI VOCa(NwnFX) D i 1
b.LmVOCanhlb WaaCeUnp Pdnb(<S gWVOG IFWI) -_a ___��_,__3__�_._�..___ .
1 UN Lw VOC,Water-Based Wood FhhbN(QU ppi VOCs) 0 ) 2 +
1U..Lor-VOC CNIY and Constu.Uen MauM•(<TO pi VOW)for Al Mheai.a 0 j ! 2
. 1 UN Ra""enhnt Paled 0 i1
B UN Eml.mnenlally PMerWh WhMb hr IntaMr FlnM:A)FSCXAM&d Wood,B)RedalmM,Q Rapidly ftm ,0)RacychdConted orE)
FlnpNJohted
• . a.Cabheb(50%MW.) 0 _. _t. 1 I.-`._...
b.In Tdm(5%Md+ ) _..0 •-- 4 —.._I 1 .(___...._
■
C.SIrMm(50%MlNmum) _O
. d.Goon(50%Mnlmim) _ _U —.. •j—__j.,.i'.__..
e.CmnhMN 150%MhhNn)
7.Reduce Fomuldehyda In Indo,Mlah(CA SetWn 01150)
a.Sub0om S Shk Tneda(50%Mlnhum) p J I_}__•_
b.Cabbleb S Countertops(M MMhaon) 0 _} 1 1
c.hhM TM1n(50%Menenuml -O. __.______.r_i I .
___.j
d.SNMng(50%Mlnimum) ----0
1Aft,InstalteGan d Mhhes,Teat of lndom Ale Shoo FonuMe"Laval Q7ppb 0 3 ! I
Tye Avatehe Parch In FhuMre•2 0
L FLOORING ; ., ... ' r . s , . :# . • , ., . Meenure
1.U.EYWronmantally Prehrable Flooding:A)FBCCaNOad Wood,B)RFchlmed ar f ftnI.Nd,C)Rapidly Rann.W.,0)RerydadLo.%K E)Eapoaed
Cu W.Romhp AdheeMN Must Nan<10 getWW.
a.MYdmum 15%d Fbar NN
D.Mhlmum 70%dFbm A.a ...0.._ � 1
cMnhsm SD%dFew Nee
d.Mnkmm75%dFbar ArN 0
IThermal III n.Floors:Floor C.wing Other than Carpel an 60%or Mom at Centrale Flears 0 1 + I
1 Fborinp MNb Millon 01750 or CRI Gmm label PIN Rpuimmnh 150%Mlnboum) 0 2
Total A.W.Paha In Peering0
M.APPLIANCES AND LIGATING is + .IL"" + o n'4
{ 5
8 y s
u S a
ENTER PROJECT NAME
e.Bum h Con amung Umar 0 I I L •
TOW Awd•ele Palm In Apphmm and tithing 12 0
MOTHER.,,:.
�';, - . •': r:::. -._"r _ ',. F L-- +,_,:�.. '= .:iPoirim AJeOebhPer Measure. .
J.teaeiporate(ImnPolnl Bated ChecYIW In BlwpdMe-Baeulmd 0 R
10wdap He..,Mmwl el Bran PaatemlBampte 0 I 1 1 1
e.Cw uhltYO ignMUMlUcd"o ;BMee Cmunn*PWnVBOcynuetbnNChaptersolftB Nome GddO.WIwewY.
Madmunof2a Pintelmtuaaeeadmn .Leminmeamema may ON W Beed Mn.
02007 Build It Green Single Family GmenPolnt Chocift 2007 Version Page 6 W 7
.......... -------- ......
ENTER PROJECT NAME
• Enor dwotWboan lare,not sVerporIs avalable forrnatme hap wdips orageres title ript
de-It— 0 �0.t _11 IC a
Enter desolater,lara,eal near paint,available her nianeve In gerapdaft,oneepia,In he NL� 6, 0 1 0
D
... .......... _0 0 0
Build It(:mann rheckiNt.,and
4.Innovation:List innovative measures that meet the green building objectives of the Guidelines.Enter up to a Miid,llra=
maximum combined total of 20 pts.See Innovation Checklist for suggested measures,using the link to Na right.
haerankin In Conounhy Enter deKdW hav,aral arear poria antexplai to interior,In appropriate,o9egarlen,M the 0gh —0 -a a
Inionelon In Energy:Entardantrater,hare,im anter pors,marble for nxiona Inappropriate magarle,Is un,NK a 0 0 0
Invandenin Entordineal;fianhane,anserserpona andspie rorramun,hap prippratia casperso to Via Mile.
0 D ID,
capagarkewtherght.
0 .0 o 0 1 w 0
ImmtmhWWr:EiAerbftghl.. a a 0 a' D
TaflallnelndafthulnOfthsr,,I0
Summary
Total Available Points in Specific Categories' 4+ 96+ 42+ 66+ 43+
Minimum Points Required In
Total Points Achieved 01 0 0 0 0 0
Project has not yet met the following recommended minimum requirements:
- Total Project Score of At Least 50 Points
-Required measures:
-A3a: 50%waste diversion by weight
-_)2: 15%above Title 24
-NI;Incorporate GreenPoint Rated Checklist into blueprints
-Minimum points In specific categories:
-Energy(30 points)
• -IAQIHealth(5 points)
-Resources(6 points)
-Water(9 points)
C 2007 Build It Green Single Family GmenPoint Checklist 2007 Version Page 7 of 7
I- Community Development
10300 Torre Avenue
Cupertino CA 95014
. Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPERTINO
Building Department
JOB ADDRESS: 2257? Poppy DI _ Pe9:Mtoo e,+ 95014 PERMIT �013Z,
4
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR:N FAX #
I am not using any subcontractors:
Signatur 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