08080081CITY OF CUPERTINO-
BUILDINF DIVISION PERMIT
�U1R'A�yQRII)�S.'iUY''.
e.� . �t .. L, F, v�.°MF
BUILDING ADDRESS:
PERMIT NO.
20823 STEVENS CREEK BLVD
DRAEGER CONSTRUCTION INC
08080081
OWNER'S NAME:
PERMIT ISSUE DATE
MATT ESON REALTY SERVICES INC.
605 COMMERCIAL ST
08/12/2008
NE:
SANITARY NO. CONTROL NO.
(408)536-0420
ARCHITECUENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 (�
LICENSED CONTRACTOR'S DECLARATION
Job Description
I baby affirm the 1 am Beamed under provisions of Chapter 9 (commencing
wash Suction 7000. Division 3 ofthe Businw and Prafcadmu Cads,md my licca is
RMV MANSARD RF SIDING& REPLC W/NEW JAMES HARDIE
in full forte and effmu.
ucenm Class Lt..{
SIERRA PANEL 8" O.C. 5, 500SQFT
Date 326EeadContractor
,
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 em exempt from tha Committees License Law for me
following mason. (Sudon 7(D 1.5, Bushman and Profestions Cork: Any city or county
which requires • permit to construct, altar, Impto m, demolish. or repair any structure
prior to its iasumm. alae requires the applicant for such permit to file a signed statement
Load he is licensed to site of the Conssctu's Lima Law (Chapter 9
Sq. Ft. Floor Area
Valuation
pursuant provisions
55 0 0 0
(commencing with Section 7000) of Division 3 of the Businusand Profusions Code) or
that he ]aexempt therefrom and the basis for the alleged assumption. Any violation of
Number
Occupancy
pane y Type
Section 7031.5 by airy applicant for a permit subject, the applicant to a civil penalty of
tet mom than rave hundred dollars (5500).
3 2 6 3 018 5 . [sIl(5
I, as owner of me pmperty, m my employees wire wages u ftEwle compeadon,
wi0do thewark and the swcmum is notkwnded moRercd fwssk(Sw.7044, Buaimos
Required Inspections
and Profession Code: The Conuacmea Lima Law dew tet apply to an want of
property who builds m improve thereon, and who does such work himself ar tluough his
own employees. ;sMided thus such impmssmenu art not intended ora@red tarsale If.
however, me building or improvements is said within ow year of eomPletion, the owner.
Wilder will have the burden of proving that M did ms build or improve far purpose of
,
vele.).
❑ I. or owner of the property, am cohesively contracting with Recorded contractors to
comsat the project (Su. 7044, Business and Profusions Coda:) The Comoacter's U.
cove Law dm not apply b an ownu of property who builds or improv thereon, ted.
who contracts for such projects with a comm ur(s) licensed pursuant to me Contractor's
Lkea Ism.
❑ l ore exempt under See. ,B&PC for thin mean
Owner Data
WORKER'S COMPENSATION DECLARATION
I history eDirm under penalty of perjury ore of the following declandens:
I have and will maintain a Cenifrwm of Caant to selbiaun for WaikatoCompen-
radon, an provided for by Section 3700 of dm Labor Code, for ma pefomurcs of site
- -
work for which suis permit is issued.
- -
❑ 1 haw and will maintain Warkerh Gmpellastion Insurance, a required by Section
3700 of the Labor Code, for the parf=wce ofthe wosk for which this permit is issued
-
MyWarkeesCom atian Insurance mmier andli nn saber
Cartier. /aj 41es 'W4`' Ii �W L / t
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This Section med notWcomplcmd lithe permit is foranchundred dollars ($100)
m lea)
1 terry that in the performance of the work for which this permit is issued. I shall am
employ any person in any man erso an m become subject to the Worafss' Compcmmon
Lswa of Calif nods, Dem
Applicant
NOTICE TO APPLICANT: If. after matin{ this CeniOcate of Exemption, you Mould
become Subject to the Worker's Compensation provisions of the Isom Cede. you mut,
forthwith comply with such provisions or this permit shall Ite deemed rmaked
CONSTRUCTION LENDING AGENCY
1 hambyaffirm mat then is• mmu ucirm lerldin{aRmY for Ne perrormancoof
the work for which this permit is issued (Sex, 3097, Civ. C.)
Lender's Name
Leadees Add.
1 certify that 1 haw nod this application and smut Wt the above information Is
'
cortew 1 a{rte to comply with all city and county ordinamm and awe laws relating to
building construction, and hereby mtha se representatives of this city to enter upon the
shave -mandated property for inspection purposes
(We) agree to ave, indemnify and keep harmlm the City of Cupertino against
IiebiliBe, judgments. cam ad expands which may in any way acame against said City
in consuenc
of the
APPLICANTcUN ERSTANDSranting, of thn D WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
ShmommerAppliwm/Cm r Dem
HAZAA60US MATERIALS DISCLOSURE
Will the applicant at forum building uccupantnorc rehandle haaNaw material
U deBmd by the Cupertino Municipal Code. Chapter 9.1x, and the Health and Safety
Code, xss3x(a)7
CY. JNu
Ly
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
It❑Yes
Will the applicant or future building occupant a equipment or devices which
harsrdous air contaminants as defined by the Bay Aam Air Quality Management
all new materials for inspection.
icr7 ,
❑Yes )(Nu
I haw mal the hasardnw material, ne uiremmtsunderChapter6.95oftheCalirm-
nkHcalth&SalCLYCO,Sccdom25%5,M533usld25534.lundersmndthmifmc building
docs not monetHly have a tenant, the it h my nspoodidlisv to notify de awupant or the
nequlmmcds which mwm met priormi ante ar enificateafaman
9�
Signature of Applicant Date
All roof coverings to be Clrt» ' or better
g assRa
Owner onuthodv � em Dow
ow
"
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT
•
•
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32630185.MRS
DATE ISSUED.......: 08/12/2008
RECEIPT #.........: BS000005759
REFERENCE ID # ...: 08080081
SITE ADDRESS .....: 20823 STEVENS CREEK BLVD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ............:
MATTESON REALTY SERVICES INC.
ADDRESS ..........:
20823 STEVENS CREEK BLVD
CITY/STATE/ZIP ...:
CUPERTINO, CA 95014
RECEIVED FROM ....:
DRAEGER CONSTRUCTIO
CONTRACTOR .......:
DRAEGER,.JOHN EDWARD LIC # 21895
COMPANY ..........:
DRAEGER.CONSTRUCTION INC
ADDRESS ..........:
605 COMMERCIAL ST,
CITY/STATE/ZIP .
SAN JOSE, CA 95112
TELEPHONE ........:
(408)536-0420
FEE ID
UNIT QUANTITY
AMOUNT PD -TO -DT THIS REC
NEW BAL
---------------------------------
IBSEISMICR VALUATION 55,000.00
----------------------------------------
5.50 0.00 5.50
0.00
1SIDEOTHER SQ
FEET 5,500.00
2759.00 0.00 2759.00
0.00
TOTAL PERMIT
---------- ---------- ---------- ----------
2764.50 0.00 2764.50
0.00
METHOD OF PAYMENT AMOUNT
REFERENCE NUMBER
CHECK
-------------------
2,764.50
---------- --
#137494
TOTAL RECEIPT
---------------
2,764.50
i.
•
•
D
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
0r U k d UPJ-✓
APN # p
I 6D-3 6 �o rn i -S
Date: $-12-orb
Building Address:
TOM-,$ epqGd"ep c�tE��l_ �IJrJ
Mailing Address (if different from building address):
Owner's Name:
Phone#: tGo Rolot62-
as - of SIT-( 5%savia Id6•
1. (9rio_g(g2-1t7�
Contractor:
Phone: 4 n 6. -ria (P-O'+zo
12Atgbl��z CpVSI'7.v�0^t L,
Fax: x+06-S3fo-0425
Contractor License #: 1 1 p
Cupertino Business License #: 7101S
Contact: L. oo "jet _ Z A jo iro L
Phone: q os - zo q _ q (o q 4
Fax: `f 0B - c33 fo - 0 Lt 2
Residential to Commercial
Job Description: 21ew4oJtF_ r►q,tsqv_o R+oor_ ;�thtJ`r AJ7 9ZW-P14LCr—_ Wir-}{
�C-vl 0-.ahtEs Haa.niC- gir�-'Z24 Pa4JtEL 3" O•C
Building Permit Info:
Bldg 19 Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ IUIII/V-A ❑ IUIII B, IV -HT, V -B [.]--
2
Valuation: ,yySquare Footage:
Oct> !,;C; 00
Project Size: Express ❑ Standard Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgreen.org
Revised 7/01/08
CUPEI,TINO
4W
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
IGENCOM
1 BBOILERI
For the installation,or relocation of ea
M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h 29,3kw
1 BBOILER2
Installation /relocation'of ea
M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1 BBOILER3
Installation/relocation of ea
M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea ,
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1BBOILER4
Installation/relocation of ea
M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5
Installation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH
For ea appliance or piece of equip
M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code,
1ELECINSP
Other Electrical Inspections (per hour)
E
I MECHINSP
Other Mechanical Inspections (per
M
hour)
1PLMBINSP
Other Plumbing & Gas Inspections
P
(per hour
1MEETINGIHR
Application Meeting
B
40
•
•
CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPEkTINO
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW
SFDWL/Duplex New
B
IACOUSRESAD
SFDWL/Duplex-Addition/Alteration
B
1ACOUSCOM
Multi-Family/Commercial
B
CHIMNEY'S
1 CHIMNEY
Chimney
B
1 CHIMNEYR
Chimney Repair
B
FENCES
' 1FENCE>6FT
Non -masonry, over 6 ft in height
B
1 FENCEMAS>6
Masonry, over 6 ft in height
B
FIREPLACES
1FIREPLMAS
Fireplace Masonry
B
1FIREPLFAB
Fireplace Pre-Fabricated/Metal
B
1FLAGPOL>20
Flag pole (over 20 ft in height)
B
1MODUSTRU
Modular Structures
B
FOUNDATIONS
1FOUNDREP
Foundation Repair
B
1PILECAST
Pile Foundation Cast in place concrete
B
1 PILEDRIV
Pile Foundation Driven (steel, pre-
stressed concrete
B
3 of 5
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
RETAINING
WALUCONCRETE
OR MASONRY
1RETSTN
Standard (up to 50 ft)
B
1RETSP310
Special Design, 3-10' high (up to 50 `)
B
1RETSPI0
Special Design, over 10' high (up to
50'
B
1RETCRB<
Gravity/Crib Wall, 0-1O'high (up to
50 ft
B
1RETCRB>
Gravity/Crib Wall over 10' high (up to
50 R
B
SHED -(EACH)
Shed Over 120 sq ft
B
SIDING
1 SIDESTBK
Siding, Stone & Brick Veneer
interior/exterior
B
SS.6 O /3
1 SIDEOTHER
Siding all other
B
SKYLIGHTS
1 SKYL<10 SF
Skylight less than 10 sf
B
1 SKYL>t OSF
Skylight greater than 10 sf or
structural
B
1STAIRS
Stairs -first flight/ea addt'l
B
STORAGE RACKS
1 SRACKS<=8
Storage Racks 0-8' high (up to 100 sf)
B
1 SRACKS>8
Storage Racks over 8' high (up to 100
st
B
4 of 5
46
•
�:....'- CITY OF CUPERTINO
CITY F GENERAL BUILDING APPLICATION
CUPERTINO
FEESCHEDULE
4
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
]GENRES or
1GENCOM
1STUCOAP
Stucco Applications (up to 400 sfl
additional stucco application
B
1 WINREP
Replacement windows/sliding glass
door (ea 8 windows
B
1WINMEWSTR
New Window -structural shear
wall/masonry includes plan ck fee
B
1 EPERMITFEE
Electrical Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
1 PPERMITFEE
Plumbing Permit Fee
P
1 ELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1 MECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
1 PLMBLNCK
Stand Alone Plumbing Pln Ck (hrly)
P
1 STPLNCK-(3 Hr Min
when not over counter)
Standard Plan Check (when no E/M/P)
hourly -stand alone
B
/
1BSEISMICR
Seismic Residential
B
1BSEISMICO
Seismic Commercial
B
1TRAVDOC
Travel & Documentation
B
1BUSLIC
Business License
B
5 of 5
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.
1. Recycle Job Site Construction & Demolition Waste
'
'
'
'
'
'
'
0
'
0
=1 point; 75%= 2 points; 80%= 4 points
L.
t4t
up to 4 Resource pts
Salvage Reusable Building Materials
4 Resource pts
y=yes
3. Remodel for Mixed Use, Adaptive Reuse, and
(For every 10% of FSC lumber used= 2 points, up to 10)
up to 10 Resource pts
Historic Preservation
4 Resource pts
y=yes
4. Protect Native Soil
2 Resource pts
y=yes
5. Minimize Disruption of Existing Plants & Trees
1 Resource pt
y=yes
6. Implement Construction Site Stormwater Practices
2 Resource pts
y=yes
7. Protect Water Quality with Landscape Design
2 Resource pts
y=yes
8. Design Resource•Efficient Landscapes and Gardens
4 Resource pts
y=yes
9. Reuse Materials/Use Recycled Content Materials
,
for Landscape Areas
2 Resource pts
y=yes
10. Install High -Efficiency Irrigation Systems
2 Resource pts
y=yes
11. Provide for On -Site Water Catchment / Retention
2 Resource pts
y=yes
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
2. Use Recycled Content Aggregate 2 Resource pts y=
3. Insulate Foundation/Slab before backfill 3 Energy pts Y=
C. Structural Frame
'
'
'
'
'
'
'
0
'
0
1. Substitute Solid Sawn Lumber with Engineered Lumber
J 3 Resource pts
2. Use FSC Certified Wood for framing
y=ye:
(For every 10% of FSC lumber used= 2 points, up to 10)
up to 10 Resource pts
3. Use Wood I -Joists for Floors and Ceilings
2 Resource pts
y=ye;
4. Use Web Floor Trusses
2 Resource pts
y=ye.
5. Design Energy Heels on Trusses 6" or more
2 Energy pts
y=yes
6. Use Finger -Jointed Studs for Vertical Applications
2 Resource pts
y=yes
7. Use Engineered Studs for Vertical Applications
2 Resource pts
y=yes
8. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts
y=yes
9. Use Structural Insulated Panels (SIPs)
a. Floors
3 Energy pts
y=yes
b. Wall
3 Ener is
9Y P
y=yes
c. Roof
3 Energy pts
y=yes
10. Apply Advanced Framing Techniques
4 Resource pts
y=yes
11. Use Reclaimed Lumber for Non Structural Applications
3 Resource pts
y=yes
12. Use OSB
a. Subfloors
1 Resource pt
y=yes
. b. sheathing '^
1 Resource pt
y=yes
'
'
'
'
'
'
'
0
'
0
0
llllllii�
1. Use Sustainable Decking Materials
1 Energy of y=yes
2. Insulate Hot and Cold Water Pipes
a. Recycled content
3 Resource pts
y=ye
b. FSC Certified Wood
3 Resource pts
y=ye
2. Use Treated Wood That Does Not Contain ChromiumlArsenic
1 IAO/Health pt
y=ye
3. Install House Wrap under Siding
1 IAQ/Health pt
y=ya
4. Use Fiber -Cement Siding Materials
1 Resource pt
Y_ -Yes
E. Plumbing
1. Install Water Heater Jacket
1 Energy of y=yes
2. Insulate Hot and Cold Water Pipes
2 Energy pts y=yes
3. Retrofit all Faucets and Showerheads with Flow Reducers
1 Energy pt
a. Faucets (1 point each, up to 2 points)
Up to 2 Resource pts,
b. Showerheads (1 point each, up to 2 points)
Up to 2 Resource pts,
14. Replace Toilest with Ultra -Low Flush Toilets
(1 point each, up to 3 points)
Up to 3 Resource pts
5. Install Chlorine Filter on Showerhead
1 IAQ/Health pt y=yes
6. Convert Gas to Tankless Water Heater
4 Energy pts y=yes
7. Install Water Filtration Units at Faucets
(2 points each, up to 4 points)
Up to 4 IAQ/Health pis
B. Install On -Demand Hot Water Circulation Pump
4 Resource pts y=yea
r. uecmcai
4 Resource pts
1. Install Compact Fluorescent Light Bulbs (CFLs)
6. Alternative Insulation Products (Cotton, spray -foam)
(6 bulbs=2 points, 10 bulbs =3 points, 12 bulbs = 4 points)
Up to 4 Energy pts
2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to
4 Resource pts
5 points)
Up to 5 Energy pts
3. Install Lighting Controls (1 point per fixture, up to 4 points)
Up to 4 Energy pts
4. Install High Efficiency Ceiling Fans with CFLs
(1 point each, up to 4 points)
Up to 4 Energy pts
G. Appliances
1, Install Energy Star Dishwasher
1 Energy pt
12. Install Washing Machine with Water and Energy
b. Ceilings
-Conservation Features
1 Energy pt
3.Install Energy Star Refrigerator
1 Energy pt
4. Install Built -In Recycling Center
3 Resource pts
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Walls
s
s
s
b. Ceilings
2 Energy pts
y --yes
2. Install Floor Insulation over Crawl Space
4 Energy pts
y=yes
3. Install Recycled -Content, Fiberglass Insulation with
No Added Formaldehyde
a. Walls
2 Energy pts
y=yes
b. Ceilings
2 Energy pts
y --yes
2. Install Floor Insulation over Crawl Space
4 Energy pts
y=yes
3. Install Recycled -Content, Fiberglass Insulation with
No Added Formaldehyde
3 IAQ/Health pts
y=yes
4. Use Advanced Infiltration Reduction Practices
2 Energy pts
y=yes
5. Use Cellulose Insulation
a. Walls
4 Resource pts
y=yes
b. Ceilings
4 Resource pts
y=yes
6. Alternative Insulation Products (Cotton, spray -foam)
a. Walls
4 Resource pts
y=yea
o. uaiiings
4 Resource pts
y=yes
•
•
r
L
J. Heating Ventilation and Air Conditioning
I1 Use Duct Mastic on All Duct Joints
1. Install Energy -Efficient Windows u
�.
2. Install Ductwork within Conditioned Space
a. Double -Paned
b. Low -Emissivity (Low -E)
c. Low. ConductivityFrames
i 1 Energy pt y=yes
2 Energy pts y=yes
±
2 Energy pts y=yes
1 Energy pt y=yes
2. Install Low Heat Transmission Glazing
J. Heating Ventilation and Air Conditioning
I1 Use Duct Mastic on All Duct Joints
4 2 Energy pts
y=ye:
2. Install Ductwork within Conditioned Space
3 Energy pts
y=yes
3. Vent Range Hood to the Outside
1 IAQ/Health pt
y=yes
4. Clean all Ducts Before Occupancy
2 IAO/Health pts
y=yes
5. Install Solar Attic Fan
2 Energy pts
y=yes
6. Install Attic Ventilation Systems
1 Energy pt
y=yes
7. Install Whole House Fan
4 Energy pts
y=yes
B. Install Sealed Combustion Units
5 IAQ/Health pts
y=yes
a. Furnaces
31AQ/Health lits
y=yes
b. Water Heaters
3 IAQ/Health pts
y=yes
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
3 Energy pts
y=yes
10. Install 13 SEER/11 EER or higher AC with a TXV
3 Energy pts
y=yes
11. Install AC with Non -HCFC Refrigerants
2 Resource pts
y=yes
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pts
y=yes
13. Retrofit Wood Burning Fireplaces
4 Energy pts.
y=yes
• a. Install EPA certified wood stoveslnserts
1 IAQ/Health pt
y --yes
b. Install/Replace Dampers
1 Energy pt
y=yes
c. Install Airtight Doors
1 Energy pt
y=yes
14. Install Zoned, Hydronic Radiant Heating
3 Energy pts
y=yes
15. Install High Efficiency Filter
41AO/Health pts
y=yes
16. Install Heat Recovery Ventilation Unit (HRV)
5 IAQ/Health pts
y=yes
17. Install Separate Garage Exhaust Fan
3 IAQ/Health pts
y=yes
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
4 Energy pts.
y=yes
2. Install Solar Water Heating System
10 Energy pts
y=yes
3. Pre -Wire for Future Photovoltaic (PV) Installation
4 Energy pts
y=yes
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2A kw =12 points, 3.6 kw = 18 points)
Up to 16 Energy pts
�6. Select Safe and Durable Roofing Matedals--'�
1 Resource pt
y=yes
7. Install Radiant Barrier
3 Enerav, ots
v=ves
L, Natural Heating and Cooling
1. Incorporate Passive Solar Heating 5 Energy pts
2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts
3. Plant Deciduous Trees on the West and South Sides 3 Energy pts
0
1. Use Low/No-VOC Paint 1 IAQ/Health pts y=yes
2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes
3. Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes
4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes
5, Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes
6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7. Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y --Yes
8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes
9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes
10. Install Whole House Vacuum System 3 IAQ/Health pts y=yes
0
0
0
1. Select FSC Certified Wood Flooring
u
0
0
0
0
0
y=yes
2. Use Rapidly Renewable Flooring Materials
4 Resource pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resource pts
y --yes
4. Install Natural Linoleum in Place of Vinyl
Ej
V --yes
5. Use Exposed Concrete as Finished Floor
4 Resource pts
0
N. Flooring
1. Select FSC Certified Wood Flooring
8 Resource pts
y=yes
2. Use Rapidly Renewable Flooring Materials
4 Resource pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resource pts
y --yes
4. Install Natural Linoleum in Place of Vinyl
51AQ/Health pts
V --yes
5. Use Exposed Concrete as Finished Floor
4 Resource pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
y=yes
Total olntsvela e: 1 1401 130 57
Total Points Project Received: 1 01 01 0 •
G:datalprogsrgreenbuildingguidelineslremodelerslgresnpolntsfina12.12.e4protected.xls
A
Green Building Plan Check
Index of Green Building Points/Categories
Example of an Index or Table of GreenPlan Sheet or Page
Building Points Categories that must be
shown and referenced on the Project
Site 9. Install H.E. Irrigation, (details/spec)-
unaailon
1.
Use 15 % Flyash Concrete, (note)
uctural
3.
Uses Wood Waist, (See Spec.)
S.
Use Truss with heels, (detail)
6.
B. OSB Sheathing, detail
. Finish
I.
Composite Decking, (Note/Spec.)
4.
B. Fiber Cement Siding, ec.
tubing
1.
Insulate all H.W. pipes, (Note/Spec.)
5.
Tankless W.H., (Note/Spec.)
11. A 2500 Gal. Tank, (Note/Spec)
ctrlcal
4.
E. Ceiling Fens, (Note/Spec.)
rliances
1.
Energy Star Dishwasher, (Note/Spec.)
3.
Ene gy Star Refrigerator, (Note/Spec.
er
1.
List Green Features on Plans
PIZZA= Process Work Book Page -12-Revised 325/08
L-1
S-1
S-2
S-2
S-2
A-3
A-4
P-1
A-2
A3
A3
A-1
Points
2 points
5 points
2 points
2 points
2 oints
2 points
2 points
2 points
2 points
1 p=4:oint
1
taint
1 point
40 points
CITY OF
�UPEkTINO
i
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
20 FZ3 s ev n r Greeff �
PERMIT #
v o U v �/
OWNER'S NAME:
PHONE #
GENERAL CONTRACTORS
FAX #
I am not using any subcontractors: /z"lle, ��� /Z
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/Contractor Signature
Date
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