08030118 CITY OF CUPERTINO .4 m �. k•ne s ac '-+ `fps tsl>` : -
BUILDINGDIVISION PERMIT .aCONTRACTORINFORMATION K
BUILDING ADDRESS: PERMIT NO.
10173 RIEDEL PL SANDIUM 08030118
OWNER'S NAME: PERMIT ISSUE DATE
BRUCE MORLEY 4223 VERDIGRIS CIR 03/20/2008
NE: SANITARY NO. CONTROL NO.
(408) 894-9072
7ARCHInCTfENGIN1EER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3a LICENSED CONTRACTOR'S DECLARATION1 Mreby"E mNal 1 am licensed under provisions of Chapter 9(commencing Job Description
Section?Q'(1)ofDivision 3Ofdw Business and Profetsiam Code.md my license r' REPLC FURNACE �. A/C ADD—ON
ll farceand.ffm nce Cleaa�/—`—�2y�_—Lie,p
Dom -y/pW"—Conlranor
e e a ABCHRECI-S DECLARATIO
e < I utMenlonJ my plans shall be used as public recnrda
J U
g G Licensed Professional
OWNER-BUILDER DECLARATION
ECC l I hereby.(Tion o that 11. exempt faro On Cssions o License:Anyc Law for On
following mmoa[section IIn construct,
Business and ws,dermal Code:Any city or county
$jei which rtquima•permit re mess On elven nnpmw,d permit,or e a sig any ttmdum
_Z y prior b its se licensed p tau requires the Ile applicant for such Permit to rile n signed mmmens
�<
that he(commencing
withSeclon(70th)ofDivions ision3 ftheBhe uiness nscomeLaw
onsCouw 9 Sq.Ft.Floor Area Valuation
$ Out he .exempt
thecticam and the Division r Od alleged
exe and Proreston.Any
Count)of $10300
`f
Out her'exempt Netefrom and the band for be cts the exemption.Any it Pention of
ad,...th LS by any applicant for a permit aubjttlo the applicmuo a civil penalty of ppm Number Occupancy e
oat mom aloe nw nunatea dolls.(ss0o} 31621058 .-OU� p yTyp
Cl 1,as owner of the property.Or my employees with ages as Noir sole compere radon,
will do the work.and the structure is not lmerded...brand foraale(Sm.T614,BmMmxs Required Inspections
arra Prefessloru Cade:The Cumselor,License taw aces not apply to owner
an of q p
property who buddsorimprows tharcon,and who aoessuch work himselforwougn his
own employers,provided Nat Ruth improvements art not intended oroQered for sale If,
however,the building or improvement it sold within one your of eamphnim.the owner-
builder wsB have Ne harden of proving that be did rot build or Improve for purpose of
sale.).
❑1,as Owner of the property,am exclusively contracting with licensed con(ramms in-
construct Ne project(Sec.?044.Buainas and Professors Code:)The Contractor's Li.
come law does not apply m an owner of pmpeny who build,or improves daemon,and
who comment for such projects with a cmuracmr(s)Incensed pursuant to the Contractors
License law.
❑I am exempt under Sec ,B A P C for this mason
Owner Dat
WORKER'S COMPENSATION DECLARATION }
1 hereby of tem under penalty of pedury one of the following decluxoWS:
1 have and will maintain a Ccnificam of Consent to self-daunt for Wulon',Compen-
ion,u provided for by Section 3700 of Ne Labor Code.for the performantt of the
work for which this Permit is issued.
❑1 have and will maintain Workers Compensation Inmv ..as required by Section
37M of On Ube,Code,for the performance of the work for which this permit is Issued. '
My WorkeCs Com nation Insurance tinier and Polk number are: `_
Canter. Policy No.:W If goo I Is 5So '
CERTIFICATED EX PrION FROM WORKERS'
COMPENSATION INSURANCE
CnOssection need nm Ee completed if the permit is for onehundmd doll.(SIM)
or lea)
I cenifv Out in the performance of the work for which this permit Is Wood,I shall not
employ any person in any manner an or in become subject o the Workers Compensation
Laws of Cehlmsa One
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject w Ne Workers Compensation provisions of the Labor Code,you most
.,z forthwith comply with such provisions Or this permit shall k deemed mvakad.
CONSTRUCTION LENDINOAGENCY
I--i .�.., 1 hereby arfirm Out dent,be cmetructinn lending agency for On perfurnmon of
a M
the work for which this permit N issued(Sec.309'1,Civ.C.)
Q Landers Name ,
z Landers Address
U Q 1 ttnify that 1 haw mad this application and sum that the show information is
ty H cancer 1 agree to comply with all city and cowry ordinances and slow laws minting to
DU building construction,and hereby authodm representatives ofthis city to come upon the
W move-mentioned pmpeny for inspection purposes.
�v a (We)aS..to saw,indemnify and keep harmluo the City of Cupertino against
y
liabilities judgments,cote and expenses which may in any way.ccrue against said City
U Z in consequence of the grandng of this Permit.
o-a APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE R ATIONS./ 9 �
, 4 1 Re-roofs
Si{nuuof Bca
AppnaContrnctor
re �^
04
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will theapplinm or Futuro building oecupant.om arlundle haardous mamrind '
as de0md by On Cupertino Municipal Code.Chapter 9.13,and dw Health and Safety
Cod.,Sectionv53a(a)? A' All roofs shall be inspected prior to any roofing material being installed.
r]Yes Ad
Will the applicant or future building Occupant tree equip mutt or derscas which If a roof is installed without first obtaining an inspection,I agree to remove
It hanrdntu it contaminants ar dcBned by On Bay Area Air Quality Management all new materials for inspection.
S u in?
❑Yea )yNu .
1 haw mad!the hags ide smateriad o nu'mments under Chapter6.95 Of the ceifor-
meHeald&safsty Code.Sectiom25505,25533 md25534.I underseand ha(ifthe Wilding
does net cumen0y bow a mnank thm it is my mspomihility to notify the ocoupmt of Ne
mqm n.wnienmaR'`�`pnartoisxuxnmoraccnlrmaworOc Signature of Applicant Date
" Z '— All roof coverings to be Class"B" or better
Owner err autharisca agent Dam' '
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31621058 . 00
DATE ISSUED. . . . . . . : 03/20/2008
RECEIPT #. . . . . . . . . : BS000004220
REFERENCE ID # . . . : 08030118
SITE ADDRESS . . . . . : 10173 RIEDEL PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BRUCE MORLEY
ADDRESS . . . . . . . . . . : 10173 RIEDEL PL
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : YIU-HANG LEE
CONTRACTOR . . . . . . . : MICHAEL LEE LIC # 28867
COMPANY SANDIUM
ADDRESS . . . . . . . . . . : 4223.VERDIGRIS CIR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95134
TELEPHONE . . . . . . . . : (408) 894-9072
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 10, 300. 00 1. 10 0. 00 1 .10 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
1TRAVD0C FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 225 .45 0. 00 225 .45 0. 00
METHOD OF PAYMENT ----AMOUNT REFERENCE NUMBER
----------------- ------ ---------
CREDIT CARD 225 .45 VISA
---------------
TOTAL RECEIPT 225 .45
VOICE ID DESCRIPTION 'VOICE ID DESCRIPTION
-------- --------------------------- --------
505 FINAL ELECTRICAL .507 FINAL PLUMBING
508 FINAL MECHANICAL
O� b � oll �
CITY OF CUPERTINO
FURNACE/AC
• CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
Owner's Name: Phone#:
jr,�� rle Lig ZoS S1b3
Contractor: Phone#:
Fax #:
Contractor License#: Cupertino Business License#:
888119 as9(o7
Contact: Phone#:
� L1o� ✓�4�F go7z
Fax #:
Building Permit Info:
Elect ® Plumb ❑ Mech
Residential Commercial
Job Description:
�aw rnacc. AC cold o�
For Residential Installations:
Attic ❑ 1" floor 19 2"d 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 Ap roval Required ❑
Cost of Project: Type of Construction (Usage Class):
I $lo3pa
Strapped On Platform LJ Bonded El New Location Replacement
Valuation:
Green Building: Must attach Green Building Check list to this application
CITY OF CUPERTINO
FURNACE/AC
CUPEIZTINO 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.
1 MCREPALT 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 InstalI/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
permit.
1BSEISMICO Commercial Seismic B
IMRRAA 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 InstalI/Relocate ea M
suspended heater,recessed wall htr, or •
floor mounted unit heater.
1 MRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install ¬ incl in an appl permit.
CITY OF CUPERTINO
Z
FURNACE/AC
• CUPEVINO 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/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
furnace/burner, incl ducts/vents
attached to such appliance over
100,000 Btu/h
IEPERMITFEE Electric Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
CITY OF CUPERTINO
FURNACE/AC
CUPEI�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Grou
AIR FURN/AC
CONDITIONING
1BCAIRHAN Commercial A/C Units <= l0k 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. Comm/Resid
1BREMAIRHAN Residential A/C units <= l0k CFM B
IMRRAA Residential Mech Repair/alt/add M
1BSEISMICR Seismic Residential B
IEPERMITFEE Electric Permit E
/ 1MPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
Single Family GreenPoint Checklist date: I-J Build It Green
The GreenPoint Checklist is based on the various green features Incorporated Into the home and is the Smart Solutions Fmm The Ground Up
s basis for the GreenPoint Rated program.A home can be considered green If It fulfills the prerequisites, {--)
cams at(least 50(Ices,and meets the minimum pante par category:Energy et of Indoor d Quaill
nPoi I I I I
Health(5),Resources(6),and Water(9).Please contetl Build It Green for a]let of qualified GreenPoint L JI I JI
• Raters If you are interested In pursuing thrid-parry verification.
The green building practices listed below are described in the New Home Construction Green Building
Guidelines,available at www.bullditoraen.ore.
' S
ENTER PROJECT NAME c E
A BIT& .,o' Poirds Avallahla Par Measure
1.Protect Topsail and MI m Disruptiono 7=,Ing reef^
❑ a.Protect Topsoil him Erosion and Reuse alter Construction D
❑ b.LhnO and Delineate Construction Footprint for Maximum Protection 0 I 1
2.Deconstruct Instead of Demolishing Existing euiltlingt On Site 0 i 3 1
3.Recycle Job Site Construction Waste(Including Green Waste)
❑ aMinimum 50%Waste Diversion by Weight(Recycling or Reuse-Required
❑ b.Minimum 65%Diversion by Weight(Recycling or Reuse)
❑ c.Minimum 80%Diversion by Weight(Recycling or Reuse) 0 I 2
4.Use Recycled COMM Aggregate(Minimum 25%)
❑ a.Walkway and Driveway 0i
_ ]'
❑ b.Roadway Base 0 i 1
Total Pomo;Available in Site 12 0
B.FOUNDATION - Points Available Per Measure
1.Replace Portland Cement in Concrete with Recycled Flyash or Slag
Mmrmum 20%FlynsM1 as Slag 0
❑ b.Minimum 25%Flyash a Slag 0 1 1
77 2.Use Frost-Protected Shallow Foundation In Cold Areas(C.E.C.Climate Zone 16) 0 1 3 1
Lj 3.Use Radon Resistant Continuation On At-Risk Locations Daily) 0 I 1 t
4.Design and Build SWclural Past Controls
❑ a.Install Termite Shields a Separate All Exterior Wood-to-Comate Connections by Metal or Plastic FaetimerslDNMars 0
b.All New Plants Have Tmnk,Base,or Stam Located At Lent 36 Inches fmm Fountletion
Total Points Avagede in Pod _=B 0:6 n
C.LANDSCAPING ,.7-Points' Per Measure
1.Construct Rescurce-Efhdenl Landscapes V y
❑ a.No Ii Species Used by Cal-IPC Are Planted
• ❑ b.No Plant Species Will Require Hedging _ I
❑ c.75%of Plants Ara Drought-tolerant Celgomis Natives,Medd.nmean,a Dill Appropriate Species D j — 3
ET 2 Use FlreSah Landscaping Techniques D I I
3.Minimize Tud Areas In Landscape Invented by Builder
❑ a.All Tud Will Have a Water Requirement Less than or Equal to Tell Fescue(500 plant factor) 0 2
❑ b.Tud Shall Not Be Installed on Slopes Fxceeclng 10%or In Areas Less than B Fact Wide D _ 2
❑ c.Tud Is S33%of Landscaped Area(tom 2 points) 0 I 2
❑ d.Tud Is 510%of Landscaped Ares(total4 points) 0
4.Plein Shad.Trees "0 1 3
S.Grou Plaon by Water Needs dmzonin ) 0 I I 2
6.Install High-Efficiency Irrigation Systems '
❑ a.System Uses Only LmwRow Dip,Bubblers,a Low-Aow Sprinklers 0 2
❑ b.System Has Smart Commoners - 0 3
❑ 7.
Incorporate Two Inches of Compost In the Top 6 to 12 Inches of 5011 D C 3
❑ B.MUlch All Plandn Bas to the Greeter of 2 Inches or Local Water Ordinance Requirement 0 2
9.Uses
etl or R..rycled-Content Materials for 50%DI Non-Plant Landscape Elements 0 1 1
1 a Reduce Light Pollution by Shielding Fixtures anclor Directing Light Downward 0 1 I I
Tonal Points Available In Landscaping=31 0
D.STRUCTURAL FRAME$BlUrLDTNQ ENVELOPE ins Available Pet Measure
1.Apply Optimal Valu.Engineering
❑ a.Place Fallen;and Studs at 24-Inch On Center Framing ( 1
❑ b.Size Door and Window Headers for Load 0 7
❑ c.Use Only Jack and Crops Surds Required for Load s I 1
2-Use Engineered Lumber
❑ a.Beams and Headers
❑ b.Insulated Engineered Headers
❑ c.Wood I-Joists or Web Twines for Floors 1 I
❑ d.Wood-Joists for Rool Racers E So
❑ e.Engineered or Fmgar-Jolnted SNtls for Vertical Applications 0
C-] L Oriented Strand Board fa Suolloor
E] g.Oriented Simard Board for Well and Pool Sheathing 07-
1
3.Use FSC-Cedigad Wood
❑ a.Dimensional Lumber,Studs and Tracer Minimum 4D% 0 _ I_ 2
• ❑ b.Dimensional Lumber,Studs and Timber.Minimum 70% —0_ 1 _ I 2
E]` c.Panel Products:Minimum 40% 0 �_ 1
❑ d.Panel Products:Minimum 70% 0
02D07 Build It Green Single Family GreanPoint Checklist 2007 Version Page I of 4
z i
_ ffi
ENTER
PROJECT
w , A
@H
1.Use Solid WWI Systeme(Includu SIPs,ICF@,A Any Non•Stick Frarn Assembly) r
❑
A.Floor D 2
❑ e,wells D -z— 2 _
❑
C.Roots 0 2 2
5.Reduce Polludon Forming the Home from the Garage
❑ e.Tightly Seal the Air Berner between Garage and Living Area
E] b.Install Game Exhaust Fan OR Solid a Detached Garage 0 1
6 Design Energy Healon Trustee %of Adds Insulation Height At Outside Edge of EYrdOr Wal Q 0 1
❑ 7.Design Roof Tmnn W Av ommodele DucMoh 0 1
B Use RerycledLontem Steel Studs for 90%of Interior Wall Foaming 0 ! 1
e.Thermal Mau Walls.SO4nch Drywall on All Interior Wells or Walls Weighing more than 401MauAL D 1
10.Install Overhangs and GUM
❑ e.Minimum 16-Inch Overhangs and Guiana 0
❑ 0.Minimum 244mch Overhangs and Guun D 1
Totet Pomo Avalable in Sbuctuidl Building Frame and ErwelcM, JB D
B.RXTSRIOR FIINISH Points Available Per Measure
LJ 7.Use Reryclatl•Comenl(No Virgin Plastic)or FSFCahfied Wood Deckles D 2 .
i Inman a Rein Screen Well strover, 0 2
J.Usa Durable and Noncombustible Siding Materials 0 1
/.Select Durable anti Noncombustible Roofing Metedals - 0 2
Total Pbmb Available In Exterior Finish.7 0
F.INSULATION Points Avallable Per Measure
1.Install Insulation with 75%Recycled Content
❑ e.Walls mayor Floor
--S—b.Coffingif2L Install Insulation that is Low-EmlNng(CeNfied Section 0135D)
❑
A.Walla nncVor Floor 0
❑ b.Comings D 1
❑ J.Inspect Quality of Insulation Installation before Applying Drywall 0 1
Total Points Available In Insulation 5 0
G.PLUMBING Points Available Per Measure
1.Disbibure Domestic Hot Water EKcientiy,(MAXIMUM 7 Palms)
❑ a.Insulate Hot Water Pipes torn Wa1er Heater to Kronor 0
❑ b.Insulate AD HN Water Pipes
❑ c.Use Engineered Pari lrl Piping
❑ J.Use Engineered Parallel Piping with Demand Contmllad Clmula4on Loop _0 y
E3 a. with e.Use SbuCred Plumbing Demand Controlled Circulation Loop D —
❑ f.Use Central Cora Plumbing 0
❑ 2.Install Only High Efficiency Toilets(Dual-Flush or 51.2E fpj 0 4
Tonal Points Available in Plumbing.Total 12 0
H.DATING VBNTLI ATION R AIR CONDITIONING Poinls Available Per Measure
t.Design and install HVAC System to ACCA Manual J,D,and S Recommendations 0 4 !
2.Install Sealed Combustion Units
❑ a.Furnaces U �_ _.t 2 _
❑ b.Water Neaten 0 1 2 1 1
J.InaMll Zoned,Hydmnla Radiant Healing with Slab Edge Insulation D 1 1 !
/.install Hiph EMclury Air Conditioning whin Environmentally Responsible Refrigerants D 1 1
5.Design and Install Effective Ductwork
❑ a.Install HVAC Ung ap(I,}lunwork within Conditioned Space _0 _ 1. 3
❑ b.Use Duct Mastic on All Dun Joints and Seems
❑ c.Install Duclwuk under All¢Insulali0n(Buried Ducts)
❑
J.Pressure Balance the Ductwork System 0
T_
❑
A.Protect Ducts during Constmcdon and Clean All Duels trains Occupancy D + 1 i ~
El e.Install High EfficienHVAC Filter MERV 6+ 0 1 1
❑ T.Don't Install Fireplace or Install Sealed Gas Fireplaces with Efficiency Rating Not Lees Than 60% 0 1
using CSA Standard.
B.Install Effective Exhaust Systeme In Bathrooms and Kitchens
❑ e.Install ENERGY STAR Bathmom Feng Vented to the Outside 10 _ __
❑ b.All Bathroom Fang Are on Timer or Humidlstal __ T —T _
❑ c.Install Kitchen Range Hood Varied o Me Outside 0 1 T— 1
9.Install Mechanical Ventilation System for Cooling(Meximam I Points)
❑ a.Install ENERGY STAR Ceiling Fane a Light Kir In living Areas 5 Bedrooms D
❑ b.Install Whole House Fan with Variable Speeds 0
❑ c.Automatically Controlled Integrated System
❑ d.Automatically Controlled integrated System with Variable Speed Control
10.Install Mechanical Fresh Air Vonthetion System(MAXIMUM J Points)
❑ e Any Whole House Ventilation System That Meals ASHRAE
0 2
❑ b.install A MUM Hen Exchanger that moats ASHRAE 622 0 1 2 t !
H.Insult Carbon Monoxide Alamtls 0 1
Tort Points Avallsole In Haafi Ventilation and Air Con fidonin .301 0
02007 Build 11 Green Single Family GreenPoird Checl is12007 Version Page 2 of 4
• � 5 M
PROJECT n C E 7 =
ENTER NAME
` 1.RENMARLE ENERGY Poinic Availabie Per MeaSum
1.Pre-Plumb for Solar Hot Water Heating D . 4 . I
• LJ I transit Solar Water Hotel System 0 11 O
S Initial fisfirfing Corel for Future Photwordal lnatsllelien 6 Provide 2110 M of South-Facing Root 0 1 2 1 I
4.Install Photovoltaic(PV)Panels
❑ a 30%of electric needs OR 12 kW(total 6 points) D ! 6
❑ b.ill of electric needs OR 2.4kyy(tool 12 poims) 0 6 _
❑ c.go%of electric need OR 3.6 kW(loW 18 points) 0 6
Total Available Points In Renewable Energy=23 0
J.HUELDING PEERPORY&MCE Points Available Per Measure
1.Diagnostic Evaluations
❑ e.House Peaces Blower Door Test _0 1 i
b.House Passes Combustion Se Backdrafl Teri
2.Design and Build High Performance Homes-%above Title 24-minimum 15%Required 0 I >_30 i i I
❑ 3.House Obtains ENERGY STAR with Indoor Air Package Cardfical-Pool Measure(Total 45 points;read comment) 0 S 2
I
Total Avallable Points in Building Performance 39 0
H.PI EHES Points Available Per Measure
I.Design Entryways to Reduce Tracked In Contaminants 0 1
2.Use Low-VOC or Zero-VDC Paint(Maximum 3 Points)
❑ a.Low-VOC Interior WeIVCelling Paints(d0 go VOCs(Flap and d50 gpl VOCs Mori lap) 0
❑ to.Zeal Interior WelfiC 1110 Palms d qrs VOCs Flat) 0
T-
-0-3.Use Low VDC,Weter-Besed Wood Finishes(Q50 p)VOCs) D I 2 I i
—0-4.UseLow.VOC-Caulk and Communion nion Adhesives(c7)gpI VOCs)dot.All Adhesives 0 —;—
❑ S.Use Recycied-Content Point 0 1-
6.Use Environmentally Preferable Materials lot Interior Finish:A)FSC-Certified Wood,B)Redefined,C)Rapidly Renewable,D)Recycled-Cmunit
or E)FingerJoinmd
❑ e Cabinets(50%Minimum) 0
❑ b.Interior Tom(50%Minimum) 0 I 1 -
❑ c.Shelving(50%Minimum) 0
❑ J.Doom;(50%Minimum) 0 —� ]
❑
S.Coutes a 50%Minimum) - 0 1
7,Reduce Formaldehyde in Interior Finish(DA Section 01350)
❑ a Subiloor s Slab Treads(50%Minimum) 0
• ❑ b.Cabinets 5 Cornterhps(50%Minimum) 0 —
❑ c.Interior Trim(50%Minimum) 0
❑
it.Shelving(50%Minimum) 0 ) 1
❑ 8.After Installation of Finishes,Ted of Indoor Air Shows Formaldehyde Leval d7ppb 0 3 1
Total Available Points In Finishes=21 0
L.FLOORING - Prints Available Per Measure
1.Use Environmentally Preferable Flooring:A)FSCCertl6ed Wood,B)Reclaimed or Refinished,C)Rapidly Renewable,D)Recyelad-Content,E)
Exposed Concrete Flooring Adhesins Must Have c50 gPl VDCs.
❑ aMinimum 15%of Floor Area 0 11 I
❑ b.Minimum 30%of Floor Area —1 7 L=
❑ c.Minimum 50%of Flow Area
❑ d.Minimum 75%d Floor Area 0 ( 1
❑ 2.Thermal Masa Floors:Floor Covering Other than Carpet on SD%or Mora of Concrete Floors 0 1
❑ 3.Flooring Meets Section 01350 or CRI Green Label Plus Requireme0ts 5D%Minimum) 0 I I 2 I
Total AvallaMa Points In Flooding=7 0
M.APPLIANCES AND LIGHTING Points Available Per Msasure
t.Install Water and Energy Efficient Dishwasher
❑ a.ENERGY STAR(total l point)
❑ b.Dishwasher Uses No More than 6.5 Gallons/Cycle total2points) 0 1 1
L Instsll ENERGY STAR Clothes Washing Machine with Water Factor of 6 or Less
❑ a.Meets Energy Star and CEE Tier 2 requirements(modified energy factor 2.0.Water Factor 6.0)(Intel 3 Points) 0 1 2
❑ b.Meeh Energy Star and CEE Ter 3 requirements(modified energy factor 22,Water Factor 4.5 or less) 0 �� 2
(tea 5points)
3.Inatsll ENERGY STAR Rehigaretor
❑ e.ENERGY STAR Ouelifietl 6 c 25 Cubic Fest Capacity 0
❑ b.ENERGY STAR OualiSed 6'c 20 Cubic Feel Capacity0 1 r
4.Install Bufll-in Recycling Center 0
❑ a.Built-in Rarycling Comer
❑ to Bull Competing Center 0 �— ]
Total Avagabla Points in liances and LI hgn =12 0
N.OTHER Points Available Par Measure
❑ 1.Incorporate GreanPoint Rated Checklist In Blueprints-Required 0 I R
❑ 2.Develop Homeowner Manual of Groan FaetureadBanefits 0 1 1 ! 1
• 3.Community Design Measures A Loot Priorities:See the Cornmunly,Planning Is Design section In Chapter 4 of the New Home Guidelines for
measures.Maximum M 20 points for suggested measures.Local requirements may also be Fisted here.
02007 Build It Green Single Famfly GreenPolnt Checklist 2DD7 Version Page 3 014
n
3
;ENTER PROJECT NAME
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Enter tlumlptlon here,entl ntxpdme ave1U 11 fee meeaure U yiprapAate nleporiw I0 the right. D 0 0 0 D D_
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4.Innovation:Ust Innovative measures that most the green building objectives of the Guidellnes.Enter up to a t3ulltl H Green Checklists end
maximum combined total of 20 p1s.See innovation Checklist for suggested measures using the link to the right. _ _Guidel s __ _ _
Innovation In Commun :Emal deco on hen,and Omer points awllede tarneuun In U categories W the n 0 _ 0 g D 0 D_
Innwallan U En .Enter 'm Iles end emm aerath to meneure U e cel to the _ _o a - 0 0 0 0
Innwdlon)n IROMUIN:Ener dew ion hare,end 601x. ns walkhb fe meaeure in nU oriel to Ina d D 0 0 0 0 0
Li Innwadon In anoonae:Erne de onhem,end onto points eve for memun In a rate ite to the d . _ D 0 0 0 0 D
Innovation m Weer.Entx tlaat¢4in Am,entl mx pohm rv�iq meeeura U'84'�e°ne�01181 ro tte ripn. _ 11 0 _L_ 0 _ o 0
ToW AvW jIe PdnU In Other.4 0
iSummary
Total Available Points In SpeclFlc Catepodes' 4+ 96+ 42+ 66+ 43+
Minimum Points Required In Specific Categories 0 30 6 6 9
Total Pcilinis Achieved e e e e e e
Project hex not yet met the Collo ing recommended minimum requirements
-Total Project Score of At Least 50 Points
-Required measures:
-A3a: 50% waste diversion by weight
J2T13D/a-ab o ve_TitIe-24
-NI: Incorporate GreenPoint Rated Checklist Into blueprints
(din%TOT points in specific categor(es:
-Energy(30 points)
-IAQ/Health (5 points)
-Resources(6 points)
-(Nater(9 points)
0 2007 Sulld It Green Single Famlly GreenPDint Chsckiist 2DD7 Version Page 4 of 4
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
e? 3 re—z"02 p�030Cl
OWNER'S NAME: S;a54 r,l Lzz,_ ` cru PHONE # e 4 C< — 0'?Z
GENERAL CONTRACTOR S ,Z� 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