08010083 (2) CITY OF CUPERTINO
BuaDINC DIVISION PERNIIT �I 3�TIQN
3S 'a�'
euaq"� "'kIRWIN LN VALLEY HEATING & COOLING P
b 08010083
OWNER'S NAME: PERMIT ISUBDATE
MARSHALL CHARLSIE M 1171 N 4 TH ST 01/14/2008
NE (408) 294-6290 SANITARY NO. CONTROL NO.
ARCHITECT/fINGINEER: BUILDING PERMIT INFO
BLDG MECH
D E 0 0
30 p LICENSED CONTRACTORS DECLARATION
u� I beoubY affirm that l.Hamed under provision of CCapter 9 licansing Job DCSCriptlOn
Z1 withSeomnandIULl Division 3oflM Badness and Prh(etdhm Co /alW�r-y licert¢ia REPLACE FURNACE
Lfull Tema and`f(m
License Cluc Lk.N
Oaa Contractor
e ARCHITECTS DECLAR N
y 1 undersand my plans OWI be used as Public records
5�
Licensed Professional
y OWNER-BUILDER DECLARATION
I hcrelry alRrm that I em exempt from the Contractors License Law far the
O o following mason.(Section 7131.5,Business and Professions Code:Any city or county
2 ftii which requires a peamh to construct titer.Improa,dcmnUnh,or¢pair any structure
Z y prior in its issuance,also oxiUkes Ust applium fafsuch permit to file a signed summcm
< tial heis licensed puuuantithe p.akmsafJus CammcmrsI...Law(CNPar9 Sq.Ft. Floor Area Valuation
�sh (commencing with Section 7e00)af Division 3oftic Business and Professkn Code)., $6046
`d 9 dust he is asempl therefrmo and the buts for the alleged caempd.My HouLf.of
Section 7031.5 by my appliesnl fur a permit subjeca the applicant to a civil Mostly of �y 7q�p Number OGGD
ant mom than fisc hundred dollars(IM 3592 3 013:'l7 V Occupancy Type
I,asownu of Ula Propeny,umY wplay,es with waeuu NeiroulecompenscUan,
will do Um work.and the anaetum is notlnanded or offered foruk(Se..IDH,Business Required Inspections
and Professions Cade:The Contracmh License law done not apply to an owner e of q P
property who Wilds or i mproaa Nuean,and who does such work himself or through his
own employes,Provided that such Imprmemenu.not intended uoaud Ines•le If.
however,Ne building or improvement Isanld wham arc year of compkten.the awrcr-
builder .will haw ones WNan of pouring that be did an,build or imprmc for purpose of
CI
1,as owner of to property-am excluinly contracting with licensed contractors to
anwm dbe poujm(Sec.7044.Business and Professions Cade:)The Commuters U.
Comes law doss not apply a an owner of property who Wilds or improvse Norton,and
who centres fusuch poujem with a cownsu t(s)Ikenand parseam to the Comanches
Liccua law.
❑I are esempt under Be- ,B h PC fu this new.
Owner Data
WORKER'S COMPENSATION DECLARATION
1 busby aDism under penalty of perjury oast or the following dech stions:
I baa and will malmd.a Certificate of Covet,to self-inmm for Warkees Core,.-
on,u provided for by Section 3700 of da,Labor Code%fu the pufmmane of the
work for much this permit is issued
❑1 have and will maintain Workers Compensation Insurance,u ouquired by Section
37W of the labor Code.for Ne performance of Ne wuk fuwmch this Permit is issued, '
My Werime Mention In d na carrier and Polity n h r.:
Cartier. y Policy No.: =
CERTIFICATE OF EXEMPTION FRO OI ERS'
COMPENSA71ON INSURANCE
(IUs ucdu need out W completed If Ne parmit Is forum hundrd doll.(SIM)
or k es)
I certify Not in the performance of the work for which this permit is Issued,l shall not
employ any person In any meaner an as to become subject to Ne Workeri Compensatim
Laws of California Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensidon provision of sic taper Codc,you meet
.J O forthwith comply with inch previsions or this Permit shall be decreed rooked.
0 CONSTRUCTION LENDING AGENCY
[-w Ihemhy affirm Nat siert is chnshmetion lending agency for lbe performance of
> No work for which this permit is issued(Sec.3097,Civ.C.)
W 0 Lenders Name ,
z Landers Mddes,
U O I adfy that 1 baa mad this application ad two dust the ahoa information Is
4,E Correct.1ggae to comply with dl city and county adinames and low Ism misting In
-0 Wilding conswedhn,and hcmby authtdm mPresenatinas of this city to enter upon Uc
W above-mentuned property for inspection Pugdoans
gy (We)agree to an.indemnify and Cup bamhless the City of Cupertho•gdnsl
y liabilities,judgmems,cow and calamms which may in anyway scene,sinks said City
U Z in convquena of the lf. of Nis h.
APPLICANT UNDERSTANpS- D PLY WITH y
ALL NON-POINT Issued b Date
SOURCEREGULATIO / _
Re-roofs /
Signature OfAKi9"l?C.~ Data
l t um ATERIidingMALSL=MosuaE Type of Roof
WIII appll to utwm u116ing ucupanlatom or handle hasadov material -
as daMad tic Copeatinh Munta I Code.Chapter 9.1x.and Ne Hulthstd Safety
code, hn zss3x(a)7 All roofs shall be inspected prior to any roofing material being installed.
Ycs o
Will the applicant or future imiding=Open(o2 equipment or&A.which If a roof is installed without first obtaining an inspection,,I agree to remove
haoadnu air conuminanu ncd by sic Bay Area Air Quality Management all new materials for inspection.
It
said?
❑Yes
I baa reW the huadau materials requimmenu underCMpo06.93ofdueCalifor-
nhH.1"StddyCoda,Schou 23505,25533 and x5534.1 unes nand theadthe Wilding
docs at Currently Mae a u Thu It u my 'Why to awtfly the occupant of tst
mquimmenu which m las ofa Cortifcateof Signature of Applicant Date
Om ter a ori, t Dow. All roof coverings to be Class"B"or better
0809 oc)�3
CITY OF CUPERTINO
FURNACE/AC
licUP kTINO PERMIT APPLICATION FORM
APN#
Building Address:
Owner's Nan., Phone #:
Contractor: Phone #:
(t' Fax #:
Contractor License#: Cupertino Business License#:
Contact: q Phone #:
Building ermit Info: Fax #:
Elect 1911� Plumb Mech
Residential Commercial ❑.
Job Description:
For Residential Installations:
Attic ❑ 1"floor 2nd floor ❑
Adhere to minimum setback requirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural talcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: ZO Type of Construction (Usage Class):
601 V--3
Strapped ❑ On Platform Bonded New Location ❑ Replacement
Valuation:
Green Building: Must attach Green Building Check list to this application _/
y� IT
C Y OF CUPERTINO
Q" FURNACE/AC
CITY OF
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteratio»/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Cormnercial Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1PGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed & not incl in an appliance
permit.
iBSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
IMRAPPVNT Residential for the install/relocate/ or M
replacement of ea appliance vent
install & not incl in an appl permit.
.� CITY OF CUPERTINO
t FURNACE/AC
CITY OF
®CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
-IPGASRES -Residential-for ea—gas of P--
1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet.
/ IBSEISMICR Residential Seismic B
1MECPLNCK Mechanical Plan Check M
1 MFR=<100 Furnace Syst<=100k BTU install or M
/ relocate ea forced-air/gravity type
rfarnace/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
l EPERMITFEE Electric Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit P
/ 1TRAVD0C Travel Documentation B
1BUSLIC Business License B
r
CITY OF CUPERTINO
FURNACE/AC
:'CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
- --
l -- --mm- -- - - -
BCAII2HAN— —Co- AIC Units <= lOk CFMB
1 MCRAA 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
1BREIVIAIR IAN Residential A/C units <= l0k CFM B
1MRRAA 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
CITY OF CUPERTINO
® 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35923013 ;-00
DATE ISSUED. . . . . . . : 01/14/2008
RECEIPT # . . . . . . . . . : BS000003688
REFERENCE ID # . . . : 08010083
SITE ADDRESS . . . . . : 20564 KIRWIN IN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MARSHALL CHARLSIE M
ADDRESS . . . . . . . . . . : 20564 KIRWIN LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : VALLEY HEATING & CO
CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141
COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING
ADDRESS . . . . . . . . . . : 1171 N 4 TH ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 294-6290
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --------.- ----------- ---------- ----------
1BSEISMICR VALUATION 6, 048. 00 0.70 0. 00 0 .70 0. 00
1EPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40 .79 0. 00
1MFR=<100 UNITS 1. 00 122 .38 0. 00 122 .38 0. 00
1MPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40 .79 0. 00
1PPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40 .79 0. 00
1TRAVDOC FLAT RATE 1 . 00 40 .79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 286 .24 0. 00 286 .24 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 286 .24 #17205
---------------
TOTAL RECEIPT 286 .24
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------ -------------- -------- ----- ------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
r
Single Family GreenPoint Checklist Build ItGreeri
The GreenPoint Checklist Is based on the various green features inodmDrated Into the home and Is the Smart Solutions From The Ground Up
basis for the GreenPoint Rated program.A home can be considered green If It tullills the prerequisites,
Hams at(least SD points,and meets the minimum points per category:Energy(30),manor d OuallQuality/HearthHearth(5),Resources(6),and Water(S).Plane contaq Build it Green for a Its;of qualified GreenPoint
Raters it you are interested in pursuing third-party verification.
. The green building practices listed below are described in the Now Home Construction Green Building
Guidelines,available at www.buildfween oro. FF
ENTER PROJECT NAME
U A. fiI18- - POrn(5 Available Per Meets u B
1.Protect Topsoil and Minimize Disruption of Extending Plants 6 Trees
❑ a.Protect Topsoil from Erosion and Reuse after Confusion
D 1
❑—tiLimN antl Delineate ConsWdion Foodiridt for Mexlmum Protad'mn 0 I I 1
2.Deconstruct Insimtl.IDemolishing Extctrng Buildings On Bite 0 3
3.Reryde Job Site ConaWCtlDn Waste(Including Green Waste)
❑ a.Mimmurl Waste Diversionby Weight fRe_cychinga•Reurn.Required 0 R
❑ to.Minimum 65%Diversion by Weight(Recycling or Reuse) 0 2
❑ c.Minimum 8D%Diversion by Weight(Recycling or Reuse) 0 --- — 2
4.Use Recycled Content Aggregate(Minimum 25%l
❑ e.Walkway and Driveway
0 __ I
❑ b.Roadway 8xse
Total Points Avaiable in Site 12 0
B.FOUNDATION Points Avalmddle Per Measure
1.Replace Portland Cement in Concrete with Recycled Flynh or Slag
—[]—R Minlmum20%FyashmSlag 0 —
❑ b.Minimum 25%Flash or Slag 0 --- 1
❑ I Use Fros4Pretacted Shallow Foundation in Cold Arses(C.00.Climate Zone 16) 0 3
El 3.Use Radion Resistant Construction On At-Risk Longoria Only) 0 1
4.Design and Build Structural Past Controls
❑ a.Install Tel Shields a Separate All Evil Wood4D-Connate Connections by Metal or Plastic Fasteners/Dividers 0
b.All New Plants Have Trunk,Base,or Stem Looand At Least 36 Inches from Foundation 0 1
Total Points Available In Foundation=6 D
C.LANDSCAPING Points Available Per Measures
1.Construct Resourn-Efficient Landscapers
❑ a.No Invasbe Species Listed by CaHPC Are Planted
0
❑ b.NO Plaza Species Will Require Kedging D® ___ ; �_ 1 i❑ C.75%of Plants Are Drought-tolaranl Calilomia Natives, or Other Appropriate SpDoies D 1 3
❑ 2,Use Fire-Safe Landscaping Techniques 0 1 1
3,Minimize Turf Areae In Landscape Installed by Builder
❑ a Al TO Will Have a Water Requirement Less than or Equal to Tan Fescue(50.6 plant factor) 0
❑ b.Tud Shall Not Be Installed on Slopes Exceeding 1D%Cr in ken Less than 6 Feet Wide 0 I I ' 2
❑ C.Turf Is 43%of Landscaped Area(total 2 points) – -'—� I
❑ o.Turf is 510%of Landscaped Area(total 4 points) ' D_—r__--� 2
4.Plant Shade Trees D 3
❑ 5.Group Plants b Water Needs(Hdronnin ) 0 2
S.Install High-Efficiency Irrigation Systems
❑ a.System Uses Only Low+low Drip,Buboes,Or Low-flow Sprinklers 0
❑ b.System Has Sman Controllers r 2
❑ 7Jn.,2,2R to Two Inches of Compost In the To D 3
6 to 12 inches of Soil 0 3
e.Mulch All Pi rm Beds to the Greater of 2 Inches or Local Water Ordinance Requirement 0 2
LJ B.Use 5D%Salvaged or Anycled-Content Materials for 5D%of Non-Plant Landscape Elements 0 1
❑ 1 D.Reduce Light Pollution by Shielding Fixtures and/or Directing Light Downward 0 1 1 I
Total Points Available in Landscaping=31 0
D.STRUCTURAL FRAME&BUILDING ENVELOPE Porins Available Par Measure
1.Apply Optimal Value Engineering
❑ a.Place Rafters and Studs at 24-Inch On Center Framing 0 1
❑ b.Size Dow and Window Headers for Load
0 1
❑ c.Use Only Jack and Cripple Studs Required for Load 0 1
2.Use Engineered Lumber
❑ a.Beams and Headers - 0
Elb.Insulated Engineered Headers 0
❑
C.Wood 6Joisis or Wed Trusses im Floors 0 1
E:1d.Wood 6Joists for Roof Rafters _0 --
❑ e.Engineered or Finger-Jolmik!Studs for Vertical Applications 0 1
❑ (.Oriented Strand Board Its Subfloor —'
❑ g.Oriented Smi Board for Wall and fillSheathing p — 1 --
3.Use FSCCertified Wood 1
❑ a.Dimensional Lumbar,Studs and Titter.Minimum 40% 0 1 2
Elb.Dimensional Lumber,Studs antl Tinder.Minimum 70% 0 - –' --- 2 --
• ❑ c.Panel Products:Minimum 40% 0
❑ d.Panel Produce:Minimum 70%
0
02D07 Build It Green Single Family GreenPoint CheckJisi 2007 Verden Page 1 of 4
EUTER OROJECT NAME
4.Uas SDlitl Walt thrown,(Includes SIP41CFe,A Any Non-Stick Pretax Assembly)
❑
is.Floors 0. 2 1 2 i
❑ b.Walls 0 2 - —_
• ❑ C.Roofs D z_—_i 2 1
5.Reduce Pollution Entering the Home from the Garage
❑ a.Tightly Seal the Air Bader between Garage and Living Area 0 r 1
❑ b.Initial Gane Exhaust Fan OR Build a Detached Garage D 1
LJ E.Design Energy Heels on Trusses V5%of Attic Insulation Haight at Dural Edge of Exterior Well) 0 1
❑ 7.Design Roof Trustees W Aroommotlate Ductwork 0-77 1
B.Use Racyclad-Doman Steel Surds Mr 90%of Interior Well Framing 0 1
LJ B.Thermal Mass Walls:5l&Inch Drywall on All Interior Walls or Wells Weighing more than 40 Iblou.tL 0 1
10.Install Dvarhangs and Gutters
-- --- - --a.Minimum 15-Inch Overhangs and Gutters - - - -- - - ---- — p --!---!-- - - 1
❑ b.Minimum 24-Inch Overhangs and Sutlers 0 1
Total Points Available In Structural Building Frame and Envelope.38 0
E.EXTERIOR FINISH - - - Points Avallable Per Me sure
LJ 7.Use Recycled-Convent(No Virgin Plastic)or FSC-Certified Wood Decking t 2
1 Install a Rein Screen Wall System 0 2
3.Use Durable and Noncombustible Siding MaterialsD i 1
LJ 1.Select Durable and Noncombhux ble Roofing Materials 0 2 i
Total Forms Available in Exterior Finish=7 0
F.INSULATION' - Points Available Per Measure
t.Install Insulation with 75%Recycled Content
❑ a.Wells endlor Floors .p .1
—❑ b.Ceilings 0 --- —1— --
2.install Insulation that is Low-Emitting(Cerflfed 5ection 01350)
❑ e.Walls antlror Floors 0 ]
❑
to.Ceilings 0 1 1
❑ 3.Inspect Duality of Insulation Installation before Apptying Drywall 0 ]
Tour Points Available in Insulation 5 0
G.PLUMBING - Points Available Par Measure
1.Distribute Domestic Hot Water Efficiently(Maximum 7 Points)
❑ a.Insulate Hol Water Pipes from Water Heater to Kitchen 0
❑ b.Insulate All Hol Water Pipes p 1 ! ]
❑ c.Use Engineered Parallel Piping 0
❑ d.Use Engineered Parallel Piping with Demand Controlled Circulation Loop 0 -T
_ 1
• ❑ Use Bouchard! Demand Controlled Circulation Loop
f.
❑ L Use Central Core Plumbing0
❑ 2lnstall Only High EthclencyToilets(Dual+lush or 5128 gp0 D 4
Total Points AvallaMe in Plumbin =Treat 121 0
H.HZATMG,VENTILATION&Alit CONDITIONING
Points Available Per Measure
❑ 1.Design and install HVAC System to RCCA Manual J,D,and 5 Recommendations 0 I 4 �
2.Install Sealed Combustion Units
a.Furnaces 02 1
b.Walter Heaters 01 2 1 I
3,Install Zoned,Hydronic Radiant Healing with Slab Edge Insulation 0 ! 1 1
4.Install High Etncienry Air Conditioning with Environmentally Responsible Refrigerants 0 1
5.Design and install Effective Ductwork
❑ a Install HVAC Wit and Ductwork within Conditioned Space 0 I 3_ I
❑ b.Use Duct Mastic on All Duct Join and Seams 0 1 i
❑ c.Install Ductwork under Attic Insulation(Boded Ducts) D
❑ d.Pressure Balance the Ductwork System 0 1
❑ e.Protect Ducts during Construction and Clean All Ducts before Occupancy D 1 --
LJ fi.Install High Efficiency HVAC Filter(MERV W) D 1
❑ 7.Don't Install Fireplace or Install Sealed Gas Fireplaces with Efficiency Rating Not Less Than 60% 1I
using CSA Standards 0
a.Install Effective Exhaust System in Bathrooms and Kitchens
❑ a.Install ENERGY STAR Bathroom Fans Vented to the Outside 0 1
❑ b.All Bathroom Fans Are on Timer or Humidistat - 0
❑ c.Install Kitchen Range Hood Vented to the Outside 0 1
9,Install Mechanical Ventilation System for Cooling(Mazimum 4 Points)
❑ a.Install ENERGY STAR Ceiling Fans 8 Light Kits In Living Arses 8 Bedrooms D 1
❑ b.Install Whole House Fan with Variable Speeds D I ] .L—� —
❑ c.Automatically Controlled Integrated System p 2
❑ d.Automatically Controlled Integrated System with Variable Speed Control
10,1ns1all Mechanical Fresh AIr Ventilation System(Maximum 3 Points)
❑ a.Any Whole House Ventilation System That Masts ASHRAE 62.2 D
2
❑ b.Install Air-Io-Nr Heel Exchanger that meats ASHRAE 622 D 1 ! 2 I
71.Install Carbon Monoxide Alarms( p ( ]
• Total Points Available In Heating,Ventilation and As Conditioning=30 0
0 2007 Build It Green Single Family Grear Poid Chill 207 Version Page 2 of 4
ENTER 9ROJECT NAME
C
LRENEWABLE ENERGY' Pound Available Par Measure
LJ 1.Pre-Plumb for Solar Hot Water Heading 0 4
LJ 2.Install Soler Watar funding System 0 1 i 10
• _TT 3.Insall Wiring Conduit for Future Photovoltaic Installation 6 Provide 2DO to of South-FacingRoof D 2 i
4.Install Photovoltaic(PV)Panels
❑ e.30%of elecbic needs OR 12 kW(tmal a points) 0 1 6
❑ b.60%of electric needs OR 2.41X(tonal 12 pants) 0 6 _
❑ c.90%of electric need OR 3.5 kW(total 1 B points) 0 6
Total Available Points in Renewable Energy=20 0
J.ISIMMING PERFORMANCE - - Pointe Available Per Measure
1.Diagnostic Evaluations
❑ a.House Passes Blower Dom Test p 7
----- 2 - b:House Passes Combustion Safety Ba.kdrd Test -— - — D
2.Design and Build High Performance Homes-%above Title 24-minimum lSX Required 0 >_30
❑ 3.House Obtains ENERGY STAR with Indoor Air Package Certification-Pilot Measure(Total 45 pointe;read comment) D 5 2.
i
Total Available Points in Building Performance 39 D
IL FINISHES Polnts Available Per Measure
❑ 1.Design Entryways to Reduce Tracked in Contaminants 0 7
2 Use low-VOC or Zero-VOC Paint(Maximum 3 Points)
❑ a Low-VOC Interior Wall Paints(c50 Sol VOCs(Flap and 050 go VOCs Mon-Flap)
❑ b.Zao-VOC:Interior WBIIICelin Paints(d gpl VOCs Flat 0 1 3
❑ 3.Use Low VOC,Waler-Based Wood Finishes(050 gel VOCs) 0 2
—Q-4.Use Low.VOC.Caulk and Construction Actual(O0 OPI VOCs)tDrAll Adhesives 0
❑ 5.Use Recycle lZontent Paint 0 1
S.Use Environmentally Preferable Materiels for Interior Finish:A)FSCCenRed Wood,B)Reclaimed,C)Rapidly Renewable,D)Recycled-Content
or E)FingerJoimed
❑ a.Cabinets(50%Minimum) p 1
❑
In.Interior Trim(50%Minimum) p 1
❑
C.Shelving(5D%Minimum) 0
❑ d.Doors(50%Minimum) 0
❑ e.CounteMm(50%minimum) 0 1
7.Reduce Formaldehyde in Interior Finish(CA Section 01350) .
❑ e Subrom 6 Stair Term;(50%Minimum) p 1 1
❑ b.Cabinets 6 Countenance(50%Minimum)
❑ c,Interior Trip(50%Minimum)
❑
J.Shelving(50%Minimum) 0 1
❑ B.Aker Installation of Finishes,Test of Indoor AT Showa Formaldehyde Level d7ppb 0 3
Total Available Points in Finishes=21 0
L.FLOORING Points Avallable Per Measure
1.Use Environmentally Preferable Flooring:A)FSCCerfified Wood,B)Reclaimed or Refinished,C)Rapidly Renewable,D)Recycled-Content,E)
Exposed Concrete.Flooring Adhesives Must Have 60gp1 VOCs.
❑ a.Minimum 15%of Flom Area 0 1 1
❑ b.Minimum 30%of Flom Area _ 0
❑ c.Minimum 50%of Floor Area 0
❑ d.Minimum 75%of Floor Ansa' - 0 —� 1
❑ 2 Thermal Mass Moore:Floor Covering Other than Carpet on 50%or More of Comment Fioore 0 1
❑ 3.Flooring Meets Section 0135D or CRI Grain Label Plus Requirements(5D%Minimum) 0 2
Total Avaliable Points In Floorin =7 0
M.APPLIANCES AND LIGHTING I Paints Available Per Measure
1.Install Water and Energy Efficient Dishwasher
❑ a.ENERGY STAR(total 1 point) -
❑ b,Dishwasher Uses No More than 6.5 Gallons/Cycle(total2 pointed
L undid ENERGY STAR Clothes Washing Machine with Water Factor of 6 or Less
❑ a.Meats Energy Star and CEE Tier 2 requirements(modified energy fads 2.0,Water Faction 6.0)(total 3 pound) 0 1 i ( 2
❑ b.Meed Energy Star and CEE Tion 3 requirements(modified energy famm22,Water Fader 4.5 a less) - 2
totals 301111 0
3,Install ENERGY STAR Refrigerator
❑ a.ENERGY STAR Ouslified 6<25 Cubic Feet Capacity 0
❑ b.ENERGY STAR Qualified 5 e 20 Cubic Feat Capacity 0 1
4.Inctell Built-In Recycling Center 0
❑ a,Bulll-In Ra yDling Center 0 7 I
❑ b.Bum-In Composting Center 0 r 1 1
Total Available Points in Appliances and Lighting=12 0
N.OTHER I Points Available Per Measure
❑ 1.Incorporate GreenPoint Rated Checklist in Blueprints-Required 0 R
❑ 2 Develop Homeowner Manual of Gran FeatureslBenefite D 1 1 1 1
3.Community Design Measures a Local Priorities;Soo the Community Planning 8 Design section in Chapter 4 of the New Home Guidelines for
• manures.Maximum of 20 points for suggested measures.Local requirements may also be fatad here.
02D07 Build It Green Single Family GreenPoint Checklist 2007 Version Page 3 of 4
PhOJECT —
NAME
_ c E c `u
e w o R i
6 Q w Q
❑ - Enter tlescnplio bore,entl emaz prints available for measure in epPopnee ceteponei to Ne right_- - _-_ _ 0 a _ _0_ _0__ _0 _ 0_
Enter dow iption hare,entl enter pdms avatable Io measure in appmpriah tato ones to Ne nghL 0 0 0 0 0 0
El _ Enter desorption here,and emur d�avallffile for measure in nrpnah catepI fo the ri D 0 0 0 0
�—..___a --._ —___ _—_
Enter tlescnption here,
and enter points evallable for measure in appropriate catepwies to Ne right - - -_ _ 0-_0_ 0_ -D_
4.Innovation:List innovative measures that meet the green building objectives of the Guidelines.Enter up to a Build It Green Checklists and
maximum combined total of 2D pts.See Innovation Checklist for suggested measures,using the link to the right. Guidelines
Innovation in Community:Enter description here,and anter points available for measure in appy nate categories to the ri M _ 0the 0 D _ 0__ 0 D _
❑ innonitim in Eno ' '
Energy:Enter des an here,and enter points avallaNe for instant,in categories to then _ ____L 0 0 __ 0____ _T__
_0 _ 0 _ D _
❑ Innovation In IADIHasith:Enter description here,and enter points wettable for measure in eppmpnate categories to the n ht _ 0_ 0 D _ 0 _ __D 0
❑ Innwaeon in Resources:Enter des ideflon here,and enter points available to measure In appropriate categonea to the right D 0 0 0 D ___ 0
❑ innovation In Waur.Enter deacnpW here,and Omer points available in measure in appropriate categories to r _
ight_ 0 0 D D D 0
'----- --- -- --- - - ----- - - -- --- -- - - - - - Total Available Points in Other 431 0 -
MIR
Total Available Points in Specific Categories* 4+ 96+ 42+ 66+ 43+
Minimum Points Required in Specific Categories 0 30 5 6 9
Total Points Achieved e 0 s r e
Project has not yet met the following recommended minimum requirements:
-Total Project Score of At Least 50 Points
-Required measures:
-A3a: 50% iaaste diversion by weight
32�15"/o-above Tltle 24 _
-NI:Incorporate Green Point Rated Checklist into blueprints
-Minimum points in specific Categories:
-Energy(30 points)
-IAQ/Health(5 points)
-Resources(6 points)
-Vda:er(9 points)
•
02D07 Build It Green Single Family GreenPoint Checidist 2DD7 Version. Page 4 of 4
Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�CUPEkTINO
Building De artment
JOB ADDRESS: ?65'6,c1 frw,°N C/J PERMIT #
04foL 0
OWNER'S NAME: gel-
GENERAL
c -GENERAL CONTRACTOR
I am not using any subcontractors:
ignature Date
Please check applicable subcontr t rs and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
® lass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Omamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
//O�g(e4do-ntractor Signature Date