08080075 (2) CITY OF CUPERTINO
BUILIJI�G DIVI''MON PERNUT ` t1f'iITR �TQRI t?Rl�'.IA.TIE'1 .� '
BUILDING ADDRESS: PERMIT NO.
711.09 MANITA CT S BAY BATHROOM 08080075
OWNER'S NAME: PERMIT ISSUE DATE
S11ROF HOSHANG D AND VERA H 1468 FERGUSON WAY 08/11/2008
NE: SANITARY NO, CONTROL NO.
(408) 865-0381
ARCHIT iENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p
�1o0 CONTRACTOWS DECLARATION Job Description
eA� 1 hereby alarm that 1 em Ikenso under Pmvwiom of Chapter 9(commencing ... p
With socdon]ales)oronwon3orthe Business adProfessions cam,ad my license is SHOWR STL RPLCMNT LIKE4LIKE 36"X60" CULT. STONE
n In mu race and affect.
Licensecl�a MTRL; NO LIGHTNG,NO ELCTRCL,NO MECHNCL
aa- Dau Canuuar r .w
ARCHITECTS DECLARATI BSL RENEWED &NAME CHG TO BAY BATHROOM (26625)
1 undcrsund my plana shall W used as public records
`yU
yud Licensed Pnowesional -
y Oat I Me s oarept p orDECLARATION
ai 1 Wrohy reason.(Ern thus 11. uempl from Ne Canuanah :Any c Law sof Nc
I O O following onceI(Section]031.3,Business and improve,
demolish,
Cale:Any city or county
$lei which wquima a permit a cmmmL alar.Wprove,de ermit t or mpcle cd NNmere
prior wslicensedpalso mquirte lW applicant for such ContranrilwakaeLaw(uumat
F� wman isingwit pursuant in the of Division
ar thehe Busucwr'flJwms,law(Chapwr9 Sq.F[. Floor Area $ Valuation
$ (cam he
ixem it therefore
adtfDiviaior3 the
exempton.Any
Code)nor1(]225
.+
that io u exempt b Bwrerrom and the buts it Ns,alleged gumption.Any l penalty
of
Scotian then five
airy red dons refs permit objects the applicant u a civil penalty of Number Occupancy Type
not mom Nan five hundred dmWs(5500). 3 6 2 2 3 0 4 6 .�
0 1.a owner of the properly,or my employees with wagon as their sale compensation,
will do Nework,and thsamown m Is estinuMed or offered foraaw(San.7W,Buemem
and Profnalou Cadc:The Conuacurs License Law does at apply to an owner of Required Inspections
property who bu ilds or im proves dn:rwn,and who does such work himmif or through his
own employees,provided thaauch improvements em nm enhanced aro@red forsane If.
however,the Wilding or improvement is mid within am year of completion,she owner-
builder will have the books of proving that k did ml Wild or improve fa purpom of
saes.).
❑1,as owner of the properly,am exclusively contracting wish licensed contractors to
constmcl the proJka(Sem.70<4,Busiewu and Proreaeiou Code:)M Conmcmw's U.
ounce Law does not apply ban owner of property who Wilde or improves thereon,sad.
who contracts for such projects with a cons actors)Iimued Formal w the Camractor's
Litems,Lew.
❑I an eeemptunder See. ,B B PC for this rtsson
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby same under penalty of perjury was of the fallowing conclusions:
1 ham end will maintain a Cutiacam ofConaem he ulf mare for Waiter'sCamper-
ution,We provided for by Section 3100 of the Labor Cade,far to peRormame of the -
work for which this permit is Wood. .,..
&I I haw ad will maintain Worker's Compensation luunna,as required by Section
of the Labor Cocks,for Ne performance of the work for which Nis permit Is Issued.
My Worker's Compensation Insures cartiv ad Policy number art:
Grtier. w><t �a/�� Polley No.: go 263?21App
CERTIFICATE OF EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
new motion need wt We mplewd Umk permit is form=hundred dellen(5100)
nruu) ,
I certify that In the performance of the work for which this persalt is issued,I Nall not
employ any persan in any mannersa an an became subject to dem Wortrss'Computation
Tawe of Califamia.Dew
Applicat
NOTICE TO APPLICANT:If,a0cr making thin Certificate of Excmpllon,you should
become subject to the Worker's Compensation provisions of the Law,Code.you most
.JO forthwith comply with such provisoes or Nu permit Nall W deemed revoked.
Z CONSTRUCTION LENDING AGENCY
[—� hereby which
than Vert iWood(uuctim7,Clending agency for Ne perfannanw of
CL 2�.s Lu week for which them permit H wsmd(Sec.3(197,Civ.C.)
ZD A Lendeh Name
� z Lendeh Add.
U Q 1 certify Nm I have read We application and sum Nu the show informadon Is
ly H canon I agree in comply with all city ad county ordinances and mw awe reining w
U building convection,ad hereby•utharlm representatives or this city uawr upon the
aw.-mkntiomd property for wspentian purposes
(we)agree to saw,indemnify and keep humwaf 0w City of Cupertino against
liabilities,judgments.cath ad expects which may in my way aeemk al and City
U APPIICANTeof the grating of this UNDERSTANDS AN/DWILLy CO LY WITH ALL NON-POINT Issued by: Date -
SOURCE REG ATIONS.
Re-roofs
Signature aliApplicaniCtsounctor Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will du applicant ar futures Wilding occupatatart or handle haaa w,materml
as leaned by the Cupertino Municipal Code.Chapur 9.13,ad dem Health ad Safely
Cole.Section 33373(a)T
❑Yes ONO All roofs shall be inspected prior to any roofing material being installed.
VIII the applicant or future Wilding acupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it Wvaonus air cone emanty u defined by dw Bay Arta Air Quality Management all new materials for inspection.
Nlet7
❑Yes ON.
1 have read the hosaoaus mawriW requirements under LTapurb.95 ofdte Califor-
niaHealth&SafetyCode,Secdom 25505,25533 am125534.l understood thwifam Wilding
Jou sat,wrcnlly have•venom.and it k my me mihility w 0oufy the¢typal or am
requirements wh' un W mel prior w' f Ona of Occupwxy
w fit/—off Signature of Applicant Date
Owner of autharixed aggro Dam' '
All roof coverings to be Class'A"or better
CITY OF CUPERTINO
• 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36223046 .00
DATE ISSUED. . . . . . . : 08/11/2008
RECEIPT # . . . . . . . . . : BS000005750
REFERENCE ID # . . . : 08080075
SITE ADDRESS . . . . . : 21109 MANITA CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SHROFF HOSHANG D AND VERA H
ADDRESS . . . . . . . . . . : 21109 MANITA CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5074
RECEIVED FROM . . . . : BAY BATHROOMS INC
CONTRACTOR . . . . . . . : TOM TODD LIC # 26625
COMPANY . . . . . . . . . . : S BAY BATHROOM
ADDRESS . . . . . . . . . . : 1468 FERGUSON WAY
CITY/STATE/ZIP . . . : SAN JOSE, CA 95129
TELEPHONE . . . . . . . . : (408) 865-0381
FEE ID UNIT QUANTITY AMOUNT, PD-TO-DT THIS REC NEW BAL
--- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 10, 225 . 00 1 . 10 0 . 00 1 . 10 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00
lINSPREIFE HOURS 1 . 00 122 . 00 0 . 00 122 . 00 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 314 . 68 � 0 . 00 314 . 68 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
---------- --------------- --------------------
CREDIT CARD 314. 68 MC
---------------
TOTAL RECEIPT 314 . 68
•
aloCITY OF CUPERTINO
• CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # � oZ a� � Date:
Building Address:
0 //09 Me,ni �a G �
Mailing Address (if different from building address):
Owner's Name: Phone#:
,-, i Ito 6 25-7 —o 116
Contractor. ,,/ o e A 2g-N Aar ihone: lgog 6123 . 4Sfr o
S 1` fJfl7/� ax:
Contractor License#: C6.2 3 5-6
Cupertino Business License#: 02
Contact: Phone: L/,v s, 6 A 3 -4 s sr
Fax: lfo'R� 3,3 -//-A7
• Residential DQ Commercial
Job Description: S h,o ,.P-. 5 /, //// Nt/J/4Oe. -6• L -.
L., k--t- . "
AA.,,, �. . 4 l — no i:�K+� vlu e_\,a coo nn.
Building Permit Info:
Bldg 2' Elect ❑ Plumb p� Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ 11/111 B, IV-HT, V-Bz�l
Valuation: /o"2 1
O21 5, d „ Square Footage:
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 hel , contact Build it Green at www.buildit reen.or
Revised 7/01/08
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BBOILERI 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 sys over 100,000 Btu/h
1 BBOILER3 Instal lation/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 Instal I ation/rel ocation 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 Install ation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH 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.
1 ELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing & Gas Inspections P
(per hour
iMEET1NGIHR Application Meeting B •
sm CITY OF CUPERTINO
CITY Of GENERAL BUILDING APPLICATION
CUPERTINO
• FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1 CHIMNEY Chimney B
1CHIMNEYR Chimney Repair B
FENCES
lip 1 FENCE>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
1 FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1 PILECAST Pile Foundation Cast in place concrete B
1PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete
3 of 5
Stn CITY OF CUPERTINO ;
CITY OF GENERAL BUILDING APPLICATION
CUPEIi,TINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
IRETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSPI O Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SHED-(EACH) Shed Over 120 sq ft B e
SIDING
1 SIDEST/BK Siding, Stone & Brick Veneer B
interior/exterior
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>1 OSF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 so B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
4of5
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING APPLICATION
• FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee
IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel & Documentation B
/ ( 1BUSLIC Business License B
5of5
Green Building Plan Check
Index of Green Building Points/Categories
Category Example of an Index or Table of Green Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
B. Site 9. Install H.E. Irrigation, (details/spec)• L-1 2 points
11. Permeable Paving, Note L-1 2 points
C. Foundation 1. Use 15% Flyash Concrete, (note) S-1 5 points
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points
5. Use Truss with heels, (detail) S-2 2 points
B. B. OSB Sheathing, detail S-2 2 oints
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points
4. B. Fiber Cement Siding, (Note/Spec.) A-4 2 Points
F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points
5. Tankless W.H., (Note/Spec.) A-2 2 points
11. A 2500 Gal.Tank, (Note/Spec) L-1 10 points
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point
3. Energy Star Refrigerator, (Note/Spec.) A-3 1 Doint
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS 40 points
Plan Review Process Work Hook Page-12-Revised 3/25/08
i
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.
INPUT Resources EnDTM' 1ALIHenhh
rte
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;60%=4 points j up to 4 Resource pts 0
12.Salvage Reusable Building Materials _ _ i 4 Resource pts y=yes 0
3.Remodel for Mixed Use,Adaptive Reuse,and
Historic Preservation 4 Resource pts y=yes 0
4.Protect Native Soil 2 Resource pts y--yes 0
5.Minimize Disruption of Existing Plants 8 Trees 1 Resource pt y--yes 0
6.Implement Construction Site Stonnwater Practices 2 Resource pts yryes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y--yes 0
B.Design Resource-Efficient Landscapes
-ind Gardena 4 Resource pts y=yes 0
9.Reuse MateriaW[Jse Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes , 0
10.Install High-Efficiency Irrigation Systems 2 Resource pts Y--yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts y=yes 0
1 I 1
B.Foundation
1.Incorporate Recycled Flyashin Concrete
• 25%Recycled Flyash=2 points;Add 1 point for every 10%
increase of flyash,up to 5 points up to 5 Resource pts 0
2.Use Recycled Content Aggregate 2 Resource pts yryes 0
3.Insulate FoundatiordSlab before backfill 3 Energy pts y=yes 0
1 1 1
C.Structural Frame
1.Substitute Solid Sewr Lumber with Engineered Lumber 3 Resource pts y=yes 0
2.Use FSC Certified Wood for framing
(For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0
3.Use Wood I•Joists for Floors and Ceilings 2 Resource pts y--yes 0
4.Use Web Floor Trusses 2 Resource pts y=yes 0
5.Design Energy Heels on Trusses 6'or more 2 Energy pts Y--yes 0
6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0
6.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPS)
a. Floors 3 Energy pts y=yes 0
b.Wall 3 Energy pts y=yes 0
c.Roof 3 Energy pts Y--yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0
12.Use OSB
a.Subfloors
� � 1 Resource pt y=yes D
• I b.Sheathing _ _ 1 Resource pt yryes 0
1 1 1
r
INPUT ReqDulces Energy 1ALTHealth
'Lrtxtenor File
1.Use Sustainable Docking Materials
a.Recycled content 3 Resource pts y=yes 0
b.FSC Certified Wood 3 Resource pts y--yes 0
2.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAQ/Health pt y--yes 0
3.Install House Wrap under Siding 1 IAQ/Health pt y--yes 0
4.Use Fiber-Cement Siding Materials i Resource pt y=yes 0
1 1 1
E.Plumbing
1.Install Water Heater Jacket 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts Y--yes 0
3.Retrofit all Faucets and Showerheads with Flow Reducers
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0
4.Replace Toilest with Ultra-Low Flush Toilets
(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAQ/Health pt y--yes 0
6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0
B.Install On-Demand Hol Water Circulation Pump 4 Resource pis y--yes 0
r.erectncai
1,Install Compact Fluorescent Light Bulbs(CFLs)
(6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) Up to 4 Energy pts. 0
2.Install IC-AT Recessed Fixtures with CFLs(1 point each,up to
5 points) Up to 5 Energy pis. 0
3.Install Lighting Controls(1 point per fixture,up to 4 points) Up to 4 Energy pts. 0
4.Install High Efficiency Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. 0
1 1 I
G.Appliances
1.Install Energy Star Dishwasher 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y_-Yes 0
3.Install Energy Star Refrigerator 1 Energy pt Y--yes 0
4.Install Built-In Recycling Center 3 Resource pts y=yes 0
1
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls 2 Energy pts y=yes 0
b.Ceilings 2 Energy pts y=yes 0
2.install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
3.Install Recycled-Content,Fiberglass Insulation with
No Added Formaldehyde 3 IAQ/Health pts y--yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5.Use Cellulose Insulation
a.Walls 4 Resource pts y--yes 0
b.Ceilings 4 Resource pts y--yes 0
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
D.Ceilings 4 Resource pts y=yes 0
1 1 1
INPUT Resources Ener_qy
m ows
1.lristall Energy-Efficient Windows
• a.Double-Paned - 1 Energy pt y--yes D
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames 2 Energy pts y=yas 0
2.InstaTLow Heat Transmission'Glai-ng 1 Energy pt y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duci Mastic on All Duct Joints 2 Energy pts Y--yes D
2.Install Ductwork within Conditioned Space 3 Energy pts y--yes D
3.Vent Range Hood to the Outside 1 IAQ/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0
5.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts Y--yes 0
B.Install Sealed Combustion Units
a.Furnaces 31AQ/Health pts y=yes 0
b.Water Heaters 3 IAQ/Hsalth pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes 0
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0
12.Install 9D%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes D
13.Retrofit Wood Burning Fireplaces
• a.Install EPA certified wood stoves/inserts 1 IAQ/Heallh pt y=yes 0
b. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y--yes 0
15.Install High Efficiency Filter 4 IAQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0
17,Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yesl 1 0
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts Y--yes 0
2.Install Solar Water Heating System 10 Energy pts Y--yes 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0
6.Select Safe and Durable Roofing Materials — 1 Resource pt y=yes 0
—7.Install Radiant Barrer - 3 Energy pts y=yes 0
1 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
0
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y--yes
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
1 1 1
•
. n oor r ua Iry en n s es
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes D
2.Use Low VOC.Water-Based Wood Finishes 2 IAQ/Health pts y=yes D •
3.Use Low/No VOC Adhesives 3 IAQ/Health pts yryes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Hsallh pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Exposed Particleboard or OF 4 IAQMealth pts y--yes 0
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes D
10,Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts yryes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes D
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAO/Health pts y--yes D
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
I 1 !
Total Points A 1 1401 130 57
Total Points Project R 1 01 01 019
G:data/pmgslgmanbuildngguidellneslremodelerslgreenpointsf na1212.D4pmlectedads
Community Development
10300 Torre Avenue
It
SLoO Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
*UPER,TINO
Building Department
JOB ADDRESS: II PERMIT #
x //09 MahItg G�- I Veo86o7f
OWNER'S NAME: Veiy No5-he,_,C, Slir644 PHONE # jog' 2 - 0116
GENERAL CONTRACTOR: (j> 4, ,,,, s FAX #
I am not using any subcontractors: Fs-
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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