08030151 CITY OF CUPERTINO
BUILDINGDIVISIbN PERMIT N= Ra�A#.�Ct'¢:,TOr€` N'St=El�Qn' }MOsNr '..::
BUiuIIDlG.n VESkOKES AVE ROMERO' S PLUMBING SERVICE '08090151 t
EROS 7NA.5MEE: PERMrr OUR DATE
POULSEN BEATRICE M 171 BRANHAM LN STE 10 03/26/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 224-2246
ARCHnEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION IU Description
r�u 1 hereby art=NmmOascrlP
at I are licensed under Provisions or Chapter 9(co
encing
with Section 700D)of Division 3 of the Business ofornmos Co .sad myliccnscu RPLACE 'SWER PIPE, INSTL PROP CLN-OUT, HOUSE CLN-OUT
o• in full form and offs ,
a�Z Uceme Cl a —�� Lk.is v
9g Date Canuactar
CH TEC'S DECLA ATION
o I uMenund my plus Nall he used an public record
6O
S Licensed Pmfnaional
OWNER-BUILDER DECLARATION ,
I I hereby oRm Not I am exempt Imre the Camnaofs License Law for the
i O O following muon.(Section 7D1.5.Business and Pmfeaiou Cade:Any city or county
S$V which require a Permit to etmumet.ally.impmw,demolish.or repair my structure
ZL^ prim to is issuance.ado requires themplicant(arsuch pemitu file aaigneJ sutemem
C Net W ie IkcnmJ Pumant m dm pmvisiaa Of the ConuuwrY Litxnau law(GaPn r 9 Sq.Ft. Floor Area $4000 Valuation
(mmmcaing with Semon 7000)of Division 5 of the Bminessmd Pmfmions Code)or
$
that be b exempt abominate and Ne bait for the alleged Contraption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a-civil penalty ofNumber Occupancy Type
.1 come Nm Eve hundred doll.(M). 3 2 6 4 8 0 0 4 Aff
❑1,..mer of the property,as my employees with wages as their sets compensation,
will do the work and the muaure is not intended or offered for sale 7044.Businaa Required Inspections
and Pmfesaioa Cade:The Communes License law dues not apply w e ns an owner of q p
properly who builds a improves thvmn,and who cines such wort himself ar through his
ownemployr provided Nusuchimpfovemenuamnotintendedaoffemd for We.IL
however,On,building a impmvemmt d wld within om year of mmplcdon.do wd er.
builder will have the burden of proving Nn he did cot build or Impmw for purpose of
sak.).
❑1,as..of the Property,am aeluiwly ccouacd.,with lictneed cenoae ons Onconstruc7ARY
whocont Ne pfor sit h pmjec4a,Bua cooess ani Prafasioa Codeb The the contrac LI- .yq`cove taw dna not apply w an away of property who builds or impmw thereon.and, / Y,wnoconLacu far auto pmjeN with•mnvactarta)Ikemeci pursuant w the Contranofs a-..lLkenu law.
amaempscodecS .Bk PCfa Nis muon
v Dau
WORKER'S COMPENSATION DECLARATION
1 herby affirm under penally of perjury arc of the following declarations:
I haw and will maintain•Certificate of Consent in self-Trion,fa Womer'sCompm-
aWon.as provided for by Section 3700 of the labor Code,for Na perfammen of One
work far which this Permit is issued.
❑I have and will maintain Wmkne.Compensation I..,u tryvircul by Section
37M.f the tabor Code,for the perturmunce of the work fawhich this Permit is Issued.
MyWarkp0,Cmailimmidualmomen,acande and Policy nu bream: r�(�[�y y
Grrkr. S m'ICY Na.: G �J✓ TVI ✓✓
E FICATE OF EXEMPTION FROM WORK S'
COMPENSATION INSURANCE
(This auction need not W completed if Ne permit is foronc hundred degas(5100)
or leu)
1 certify that in the performance of the work for which this permit is Issued.I shall ma
employ anypermn In my mmnerm an in become subject in the Worker'CompenaBan
Laws of California,Date
Applicant
NOTICE TO APPLICANT.Ir,arur making this ccrtiEate of Exemption,you should
became subject an the Worker's Compensated ed pmvisiuns of the labor Cede,you mat
O forthwith comply with such pmvisiou or Nm
is permit shall be deeed rooked.
?► CONSTRUCTION LENDING AGENCY
[r I hereby affirm this Neta is a construction lending agency for Ne Performance of
ori > the wish for which Nd permit U issued(Sec.3097.Civ.C.)
uj 0lenders
0 z lender's Address
U O I ratify that 1 haw rem this appliatim and mute Nu the above Information is
Ly^. corm.l agree It,comply with all city and county chimmas and suit laws retailing to
SV^ building construction.and hereby mdhOirz Mpmunudw of Nte city to enter upon the
{27 shove-mentioned property fa inspection puryores.
(We)agree to use.indemnify ad keep harmless site City Of Cupertino against
tiy Iiabiliden,judgmens.coss and expeant which may in anyway accme against sold City
Uz in conxqucnaONDES
ngaf miL
PLICA ND WILCCOMPLY WITH A L NO POINT Issued by: Date J- 2-L
S RCE C ft"d �Q
��ff Re-roofs
sts.yfidcof Ilun✓Contmc r eta
HAZ or
MATE RIALS DISCLOSURE Type of Roof
Wi o Cul en ser forum Wilding aodemupanuwm 2,add Health
mucrisi
de nc by Ne Cupertino Municipal Code,Chapter 9.13,cosi the Health aJ Safety
.Scctinn 15532(07 All roofs shall be inspected prior to any roofing material being installed.
❑Ya No
Will dm applicant or future Wilding azupam um equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove
emit houndnus air contaminants an de00eJ by f Bay Area Air Quality Mansgemem all new materials for inspection.
Disuict7
QYa �U
IhawmWNeh sumawdsismquimmcntsunder Chapmr6.95oftheGlifer-
nuHcalN&sarctyc 'oanX , 533anJ15534.1undnvandthnifdn building
does nLcumnll t 4 ymspomibilkyumUr Ne Pat of the -
mqul e au m P" u afacarti0ate spy Signature of Applicant Date
' S
ownm nr antheriacd agent Date All roof coverings to be Class'%¢"or better
• - CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32648004 . 00
DATE ISSUED. . . . . . . : 03/26/2008
RECEIPT # . . . . . . . . . : BS000004273
REFERENCE ID # . . . : 08030151
SITE ADDRESS . . . . . : 10530 STOKES AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . ... : POULSEN BEATRICE M
ADDRESS . . . . . . . . . . : 10530 STOKES AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1235
RECEIVED FROM . . . . : FREDDIE NOEL ROMER
CONTRACTOR . . . . . . . : FRED ROMERO LIC # 27500
COMPANY . . . . . . . . . . : ROMERO'S PLUMBING SERVICE
ADDRESS . . . . . . . . . . : 171 BRANHAM LN STE 10
CITY/STATE/ZIP . . . : SAN JOSE, CA 95136
• TELEPHONE . . . . . . . . : (408) 224-2246
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------ ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 4, 000. 00 0 .50 0. 00 0.50 0. 00
1PPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
IPRSEWER UNITS 1. 00 20 .40 0 . 00 20 .40 0. 00
1TRAVD0C FLAT RATE 1. 00 40 .79 0 . 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 102 .48 0. 00 102 .48 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 102 .48 #1889
---------------
TOTAL RECEIPT 102 .48. .' -"
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
r
b� CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
• CUPEIiiTINO PERMIT APPLICATION FORM
APN# CP "' D- Date:
Building Address: 7 Q U �LCo
105- s
Or's Name: Phone#:
Contr tor: Phone q:�
GI I`V410 d A/ kA 064r Fax #:
Contact: Phone#:
Fax #:
Contractor License#: F07/e-3
Cupertino Business License#: -7 5Z�
Job Desch 'on:
C- /0
Residential Commercial ❑
Valuation:
Green Building Check list must be completed and attached to this application.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial P
1BSEISMICR Seismic Residential P
/ 1PRSEWER Residential building P 1RPSS
1
sewer/sanitary sewer
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEIi,TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS Gas Piping System 5+Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1 PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
/ 1TRAVDOC Travel &Documentation Fee B
1BUSLIC Business License B
Single'Family GreenPoint Checklist dam: Build It Cvfeeri
The GreenPoint Chackfial Is based on the various green features Incorporated into the home and Is the Sher Solutions From The Ground Up
• basis for the GreenPoint Rated program.A home can be considered green If It fulfills the prerequisites,
Game at leas[50 points,and meets the minimum points par category,Energy(30),Indoor Air Quality/
Health(5),Resources(6),end Water(9).Please contact Build It Green for a list of qualified GreenPoint
Raters If you are interested In pursuing third-party verification.
The green building practices listed below ere described in the New Home Construction Green Building
Guidelines,available at www.Duiltlitaraen.oro. - - - - -
ENTER PROJECT
• , 1 9 C
s
A SITEPoints Available Per Id995ure
1.Protect Top m inimim Disruption o1Existing Pients 6 Tress
❑ a.Protect Topso3 from Emslon and Reuse after Construction p
❑ b.Umlt and Delineate Constriction Footprint fa Maximum Protection
.0
77 2 DbmnatructInstead of Demorrshin Existing Suldin s On Bib 0 3
3.Recycle Job Site Construction Waste(including Green Waste)
❑ asifin m50%Waste Contract;by Welght(Raryymg a Rees-Removed R
❑ b.Minimum SS%Diversion by Weight(Recycling or Rouse) -p-' - ---- 2 _----
❑ c.Minimum 80%Diversion by Weight(Recycling a Reuse) p --
4.Use Recycled Content Aggregate(Minimum 25%)
❑ a.Walkway and Dhveway p
❑ b.Roadway Ran D 1 I
Tinel Points Available in Site 12 0
B.FOUNDATION Points Arallable Per Measure
1.Replan Portland Cement in Concrete with Recycled Flynn or Slag
❑ a Minimum 20%Flyash or Slag 0 t 1 !
❑ b.Minimum 25%Nash or Sia
p- ---t---, 1 I —
❑ 2 Use Froa[-Protected Shallow Foundation in Cold Aram(C.EC.Climate Zone 15) 0 I i 3
El 3.Use Ration Assistant Construction On Al-Risk Locations Only) 0 1 I
4.Design and Build Structural Past CDntrols
❑ a.Install Tennfts Shields 3 Separate All Exterior Wood-to-Conaste Connections by Mata;or Plastic Faslsners/DNlders
b.All New Plants Have Trunk,Base,or Sam Located At Least 36 Inches from Foundation _ 0 1
Toto Points Available In Foundation=B 0
C.LANDSCAPING Points Available Per Measure
• 1.Construct Resourm-Efficient Landscapes; _
❑ e.No IWill Snolas Used by Cal-IPC As Planted
E] b.No Plain Species Nil Require Hedging �-
❑ c.75%M Plants Are Drought-lolaremlifomria CaNatures,Mediterranean,or Other Apprrpiiale Species 0 t
2.Use Five,Side Landscaping Techniques 0 1 '!
3.Minimim Tud Aram In Landscape Installed by Builds
❑ a All Tud Will Have a Water Requirement Leas than a Equal to Tall Fescue(Soul plant labor) 0 i�I 2_
❑ h.Tuff Shall Not Be Installed on Slopes Exeazmng 10%or In ken Less than B Feet Wide 0 t ! 2
❑ c.Turf is 533%of Landscaped Area(total 2 points) 0 Z
❑ d.Tud is 510%of Landscaped Area(total 4 poirns)
4.Plant Shade Treat - D 3
5.Group Plante b Water Needs Hydrozoning) 0 ! 2
S.Install High-Efficiency lnig3ben Systems
❑ a.System Uses Only Low-Flow Drip,Bubbles,or Low-Oow Sprinklers 02
El In.System Has Smad CorNollas 0 _r — 3
❑ 7.In- Dbb Two Inches of Compost In be To 6 b 12 Inches of Soil 0 3
3.Muish All Planang Beds to the Greater of 2Inches or Local Water Ordinance Requirement 0 2
9.Use 50%Salvegad or ReryeledConbnt Maadais for 50%of Non-Plant Landscape Elements 0 I 1 I
10.Retluce Li hl Pollullonb Shieltlin Ffaunas and/or Direcifing Light Downward 0 1 ! I
Total Points Available in Landscaping=31 0
D.STRUCTURAL FRAME A BUILDING ENVELOPE Points Available Per Measure
1.Apply Optimal Value Engineering
❑ a.Place Rafters and Studs at 24-Inch On Center caning 0
❑ b.Size Door and Window Header for Load "-
D
❑ c.Use Only Jack end Cripple Surds Required for Load
2.Use Engineered Lumber
❑ a Saws and Header, 0 _ 1
❑ b.Insolent Engineered Headers p----- i
El c.Wood I,loisa or Web Trusses la Floes - - 1 o
----'-'
❑ tl.Wood l-Joists for Rom Ratter D
❑ a.Engineered or Finger-Joinatl Studs for Vertical Applications D _
❑ (.Oriented Stand Board for SubBoor p —
❑ g.Oriented Strand Board for Weal and Roof Sheathing 0 ! 1
3.Use FSCCedlfled Wood
❑ a.Dimensional Lumber,Suds and Timber.Minimum 40% 0 2
Elb.Dimensional Lumber,Studs and Timboc Minimum 70%
El C.Panel Products:Minimum 40%
Eld.Panel Products Minimum 70% D ! 1 !
02007 Build It Green Single Family GreenPolnt Checklist 2007 Version Page 1 of 4
ENTER PROJECT , manna L Un Solid Well Systems(IncludesSIPS,ICF4 6 Any NomStick Frame Assembly)
❑ a Floors __0
❑ b.Welt 0 2 __ 2
El c Roofs U _ 2
5.Reduce Pollution Entering the Home from the Geroge
❑ a.Tightly Seal the Air Border between Garage and Living Area 0
❑ b.Install Garage Exhaust Fen OR Suit a Detached Gamile 0 1
El S.Design Energy Heels on Tnrsses(75%of Attic Insulation Height at Outride Edge of Exterior Well) 0 1
El 1.Design pool Trust to A=mmodae Ducl rork D 1
e.Use R cled-Cmtem Steel Studs for Do%of Interior Wall Flaming 0 1
LJ 0.Thema Ness Walls 544nch Drywall on All Interior Wells or Wells Weighing mora then ID IbhoJL 0 1
10.install Overhangs and Gutters
❑ e.Minimum 16dnch Overhangs and Buffers U
❑ b.Minimum 244nch Overhangs and Gutters D 1
Total Points Avalmle In Structural Building Frame and Envelope=36 D
B.RETMOR FINISH Points Available Per Measure
1.Un Reryded'Content(No Virgin Plastic)or FSCGemfied Wood Docking 0 2
2lnstll a Reln Serest Wall System 0 2
Lj d.Use Durable and NonoombuNble Siding Materiels 0 1
1.Select Durable and Ncnoombusdble Roofing Mistrals D 2
Total Point Avallaola in Exterior Finish•7 0
F.INSULATION Points Available Per Measure
1.Install insulation With 75%Reryde11 Concert
❑ e.Walls endrin Fioore _0_ _ _. _
❑ b.Callings 0 1
2 Install insulation that is Low•Emisfing(Cerified Section D1350)
❑ .a.Welt anaor Floors D ]
❑ b.Collins 0 1
a.
Inspect Quality of Insulation installation before Applying Drywall 0 1
Total Pointe Avaltble in Insulation•5 0
G.PLUMBING Points Available Per Measure
1.Distribute Domestic Hot Watt Efficantly(Maximum 7 Points).
❑ a.Insulate Hot Water Pipes from Water Heater to Kitchen _0
❑
D.Insulate As Hot Warm Pipes
❑ c.Use Engineered Parallel Piping _0
❑ d.Use Engincared Parallel Piping with Demand Controlled Circulation Loop _ 0
❑ e.Use Structured Plumbing with Demand Controlled Circulation Loop _ 0 _ 1 __ _ 2
❑ I.Uca Carmel Core Plumbing 0 1 1 2
❑ 2.Install Only High Efficiency Toltb(Dual-Flush or 512a l) 0 4
Total Point A41able In Plumbing-Toted 12 0
H.KEATING VENTMA71ON k AIR CONDITIONING Point Available Per Manure
1.Design and Install HVAC System to RCCA Manual J,D,end 5 Recommendation& 0 4
2.Install Soled Combustion Unit
❑ A Furnaces D 2
❑ b.Water Heat e 0 2
a.Install Zoned,Hydronic Racism Hearing With Stab Edge Insulation 0
4.Install High Efficiency Air Conditioning With Environmentally Responsible Refrigerant 0 1 1
S.Design and Install EOacOve Ductwork
❑ e.Install HVAC Unit and Ductwork WDhin Conditioned Space _ 0
❑ b.Use Duct Mastic on All Duct Joime and Seems 0
❑ c.Install DWWod under Attic Insulation(Buried Ducts) _ 0
❑ d.Pressure Balance the Ductwork System
❑ e.Prated Duct during Ccnsbucha l and Geer AH Duct pointe Occupancy D 1
Ll 6.Install High Efficiency HVAC Filter(MERV 6a) 0 1
❑ 7.Don't Install Fireplace or Install Sealed Gas Fireplaces with Efficiency Rating Not Less Then 50% 0 1
using CSA Standards
B.hoped Effective Exhaust Systems In Bathroom and Kitchen
❑ a Install ENERGY STAR Bammom Fens Valned t the Outside _0
❑ b.All Bathroom Fens Are on Timer or Humldistt -
❑ c.Ins&II Kitchen Range Hood Vented to the Outside 0 1
0.Install Mechanical Ventilation System for Cooling(Maximum 4 Point)
❑ a Install ENERGY STAR Calling Fane 6 Lipa Kits In Wing Areas 6 Bedrooms 0_
❑ b.Instatl Whole House Fen with Variable Speeds _ 0--.
❑ c.Automatically Controlled Integrated System _ 0 Z
❑ d.Automatically Controlled Integrated System wth Variable Speed Control 0 3
10.Install MeohanlcW Fresh Air Ven0letion System(Msximum J Point)
❑ e.Aay Whole House ventttion System net M9eb ASHRAE 622 0 2 _
❑ b.Install Alf-*Air Heat Exchanger met mast ASHRAE 622 0 1 2
Lj 11.Instal Carbon Monoxide Alarms) 0 1
Tota Points Avallebie In Haetn,Ventilation and Air Condllionln •30 D
0 2007 Build 11 Green Single Family BreenPolnt Chnkllsl 2007 Version Page 2 of 4
Jj
• EN • PRO
• • 4 E s $ $ m
cccYYY
• I.RENEWABLE EN=GV Points Available Par Measure
LJ 1.PwPlumb for Solar Hot Weer Hosting 0 q
Ll 2 Install Solar Water Hanting System 0 10
3.Instill Winfing Conduit for Future Photovoltaic Installation 6 Provide 200 k of South-Felin Roof 0 1 2-
4.Install Phobvoleic(PV)Panels
❑ e.30%of eladdc needs OR 12 kW Metal 6 points) 0 ' 6
❑ b.60%of alechk needs 08 2-4kW(low 12 points) 0
❑ c.90%of satiric need OR 3.6 kW(total 1 B points) 0 —6-7
TOM Available Points In Renewable Ener =26 0
J.BUII,DING.PBRPORMANCE .Points Available Per Measure
1.Diagnostic Evaluedoru
❑ a House Passes Blmva Door Test _0
❑ h.House Passes Combustion Safety BackoraltTest 0 1
2 Design and Build High Performance Homes-%above Tale 24-minimum 15%Required 0 >_30
❑ 3.House Obtains ENERGY STAR with Indoor Air Package Certification-Pilot Mastwre(Tool 45 points;reed oommenq 0 5 2
,
Total Available Points In Building Pedamance=39 0
E.FINISHES Points Available Pet Measure
1 Dassion Entryways to Reduce Tracked In Comteminant 0 ]
2 Use Low-VOC or Zero-VOC Palm(MAXIMUM 5 Points)
❑ a.Lini Interia WeIVCaIMg Paint(c50 go VDCs(Flag and c150 gpl VOCs(Ron+14) 0 _ i 1
❑ b.Zoro-VOC:Interior Wall Paints d porl VOCs(Flat) 0 T 3
❑ 3.Use Low VOC,Wafer-Based Wood Finishes(Q5D gp1 VOCs) 1 1 2 1
❑ 4.Use Low-VOC Caulk and Construefion Adhesives(OO g I VOCs)for All Adhesives p 2
—0-5.Use ReryeledConlent Paint 0 1
S.Use Environmentally Preferable Materials for Interior Finish:A)FSC-Certified Wood,B)Reclaimed,C)Rapidly Renewable,D)Recycled-Content
or E)Flinger-Minmed
❑ a Cabinets(5D%Minimum) p r 1
❑ b.Interim Trim(50%Minimum) 0 1
❑ a SheMing(5D%Minimum)
❑ 6.Doors(50%Minimum)
El 0.Counters a(5D%Minimum) 0 ]
• 7.Reduce Formaldehyde in Interior Finish(CA Section 0135D) 1 — —
❑ e.Subaoor 6 Stair Treads(50%Minimum) 0 1
❑ b.Cabinet a Counteracts(5D%Minimum) 0 —7--1 -1..I
❑ c.Interior Trim(50%Minimum) - 0
❑ d.Shslvin 50%Minimum) 0 1
❑ B.Atter Installation of Finishes,Ten of Indoor Air Shows Fnrmaldehyda Level,27ppb 0 3
Total Available Points In Finishes=21 0
L.P'I.00HING Points Available Per Measure
1.Use Environmamally Preferable Flooring:A)FSC.CeNfied Wood,B)Reclaimed or Refinished, C)Rapidly Renewable,D)RelyciedContanl,E)
Exposed Connote Flooring Adhesives Must Have 60gpl VOCs
❑ A.Minimum 15%of Floor Area 0 1
❑ b.Minimum 30%of Floor Area
❑ c.Minimum 50%of Floor Area 0
❑ 6,Minimum 75%of Floor Arab0 1
❑ 2.Thermal Mass Floors:Floor Covering Other than Carpet on 50%Or More of Concrete Floors 0 1 I
❑ 3.Flooring Meeh Section 0135D or CRI Green Label Plus Requirements(5D%Minimum) 0 1 2
TOW Available Points In Fioaln =7 0
M.APPLIANCES AND LIGATING Points Available Per Measure
1.Install Water and Energy Efficient Dishwasher
❑ a ENERGY STAR gotal 1 point) 0
❑ b.Dishwasher Uses No More than 6.5 Gallons/Cycle(roti 2 tints)
2.Install ENERGY STAR Clothes Washing Machine wit Water Factor of 6 or Less
❑ A Meet Energy Sher and CEE Tier requirements(modified energy faces 2.0,Water Factor 6.0)(oel3 points) 0 1 ' 1 2
b.Meet Energy Star and CEE Tier 3 requirements Modified energy error 2 Water Factor 4.5 a less
(told s Imo
' ].Install ENERGY STAR Refrigerator
❑ a ENERGY STAR Ouallfied 6 c 25 Cube Foot Capady 0
❑ b.ENERGY STAR Qualified 8 c 20 Luck Fen Capacity D 1
4.Install Built-in Recycling Center 0
.❑ a Bula4n Reycfmg Center 0 j 2
❑
It.Built-In Composting Center 0 1
Total Avefiable Point in Appliances and Lighting=12 0
N-OTHER Points Available Per Measure
❑ 1.Incorporate GreenPoint Rated Checklist in Blueprints-Required 0 I 1 R
• ❑ 2.Develop Homeowner Manual of Green FeewrsMBenefie 0 1 1 1
3.Community Design Measures 6 Local Priorities:See 0e Community Planning 5 Design section In Chapter 4 of the New Home Guidelines fa
measures.Maximum of20 points far suggested manures.Local requirement may also be fisted here.
0 2007 Sul Id 11 Groan Single Family GreenPoim Checklist 2007 Version Page 3 of 4
R PROJECT NAMEf
Einar deserel here,and able points eveuuWe to manure in Appea leu ntepodas to the ri ft. D D 0 0 D 0
Einer despigim here,end anti poem ova We fo moaner inepgoprlate ulegofin to me dgh. 0 o D 0 0 0
Ener dacorlpllon hare,and enter points avelleWe to measure In appropriate whagodes to the right. D 0 D 0 D
❑ Enter deamphon hen,and anter points avaEeWe fo mewne M appropriate Wagoner to me righ. _ 0 0 0 D 0 0
4.Innovation:List Innovative measures that most the green building objectives of the Guidelines.Enter up to a Bulltl It Green Checklists end
maximum combined total of 20 pts.See Innovation Checklist for suggested measures,using the link to the right _ GuidelinesLi -1Innovation in Community:Enter deet' Ion here,and onto o rd;available for manse In appropriate wt as to the ri . 0 0 0 0 0 0
Imuovetion in En .Enter de �on hers,end show Vess is Its mmsum h Panel to meright. 0 D 0 0 0 0
Innwellon In 14QHael"V Enter description hon,end enter points amuses for measure in appDoam categories 10 the d M 0 0 0 0 D 0
Inrv�ueaon In Resourwe:Einer dimemeon hen,and enter points nallabts he muoas in ApoWearludl Callerills to 11111 69M 0 0 0 a D 0
unovelion In Waterr:Enter de"on hare,and ants,ponds endears Int m_Boors in eppupiate rutsgorias n the right _ 0 D_ 0 D D 0
Total Available Points in Other.43 0
Total Available Points in Specific Categories' 4+ 96+ 42+ 66+ 43+
Minimum Points Required in Specific Categories 0 30 B B g
Total Points Aclueved I e e e e e
Project hats not yet met the following recommended minimum requirements:
- Total Project Score of At Least 50 Points
-Required measures:
-A3a: 50% waste diversion by weight -
-12: 15%above Title 24
-N1:Incorporate Green Point Rated Checklist Into blueprints
-Minimum points In specific categories:
-Energy(30 points)
-IAQ/Health(5 points)
-Resources(6 points)
-(Nater(9 points)
•
02007 Build It Green Single Family GreartPolnt Checklist 2007 Version Page 4 of 4
l Community Development
10300 Torre Avenue
j _�i� Cupertino CA 95014
Telephone(408)777-3228
PCil OF Ek �NQ Fax(408)777-3333
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rG I�1 Building De artment
JOB �j DpR_E,�S: PERMIT #
CU` m`�� P. O �rd3ac C /
OWNER'S NAME: 0PHONE oZ-6 SS
GENERAL CONTRACTOR: o r)/XZgf I I 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 /yLQ/n0 GL C:;L- 5
Roofing
Septic Tank
Sheet Metal
Shee ock
• ' e
3/a 6 d
Owner/Contractor Signature Date