08080140 (2) CITY OF CUPERTINO �'
BUILDING DIVISION PERMIT CCINTRACTQRsIA1F'URMATIQN
BUILDING ADDRESS: PERMrI NO.
10485 MERRIMAN RD BLUE MOUNTAIN AIR 08080140
OWNER'S NAME: PERMITISSUEDATE
HONG 'PONY N AND YVONNE 707 ALDRIDGE RD STE B 08/19/2008
446 r ry m fro SANITARY NO. CONTROL NO.
(707) 451-8111
ARCHITEC IENGiNUER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MUCH
3oa LICENSED CONTRACTOR'S DECLARATION O O O
uFF 1 hereby affirm WI 1 am lixnecd under previsions of Chapter 9(mmm acing Job Description
{ wiLbScctim7 ofDivision]oftheBusirmssat .f.WmCaM,andmylicanuVa RPLC FURNC 80K BTU 92%EFF& A/C TO EXTNG SYS 4 CON
tofr`iiL:
full fora on f
ME I msec 06 Uk, 3 (7(7 SEER 13
_ Con
ARrHm C`TS DE N
1 understand my plana Mall be used u public records
3�
a
yloo�a Licewed Pmfimat ..I
5 OWNER-BUILDER DECLARATION
iE I Imrtlry a?rm that I am exempt from the Convactars license Law rot 0e
C O o following reuon.(Suction 7071.5,Business and Professions Code:Any city or munry
$ which nomr.a Permit to codon L alter.improve.demmlm.nr repsir any atronurt
prior to its issout aim requires the applicant for such permit to filo a signed statement
�< that he is licensed pursuant to the provisions ofthe Communes license Law(Chapter 9 Sq.Ft. Floor Area Valuation
�E 9 (commencing with Section 70W)of Division)of the B usiness and Profeslons Code)or $6350
S — that be b exempt therefrom and the bub fm the alleged aemp0on.Any eldlati0n of
Section 7071.5 by any applicant for a Permit ubjects the applicant to a civil penalty of ppN Number Occupancy Type
not mom wan 0w hundred dollars(SSW} 34229056 OU'
0 i,as ownerufthe property,ormyemployces with wagesuthebsolecomperesation,
will do tbewark,nd theswcmm Ismt Imm.dcd moRertd faraale(Sm.70a4,Basimust
w Pmre esinm Coder The Commcmrl Lipme Law does ret apply m «an ownor Required Inspections
perty
prowho Wlldsorlmproam thereon,andwhodoessuchwork himselfor through his
awe employees,provided that such improvemmte are not InmadW oraRarM rorssie If.
however,Ibe building or Improvement is sold within ore year of cmopletion,Ibe manner-
builder will haw rte burden of proving that be did on,Mid or improve for purpose of
sale.).
❑1,as owner of the pmperq,am exclusively contracting with licensed mntncbrs he
mnstmn the project(Sec.7044,Bwlnm send Profession Cade:)The CmlrmmA u-
awe Law does not apply he an owner of property who Wilds or impmvu thereon,and
who mnmanu for such pmjcm with a commettor(s)licensed posses to tie Contractors
Licenm law.
0 lameumptundm5ee ,B&PCrorthbrtuon
Owner Dam
WORKERS COMPENSATIONDECI RADON
1 bereby affirm under penalty of perjury am of Ibe fallowing dmlaatiom:
I haw sond w01 maintain•Catiftata ofConm a m self-ma.for WorkeraCompen-
lion,,u provided for by seNm 7700 of Ibe Labor Cade,for tbe performance or the
work for which this permit is Wheat. '
0 1 have and will maintain Workers Compo crul"Insurance,as required by Smite
37Waf the laborCode.for the performance of the work For which this permit is luued. '
My Warkker',cmepelnuuon handsome curies and Policy number am: �5
carder: b'Ity�vval PolicyNo.: (y 6 Q
FlGTE OF 6EMPrION FROM WORKERS'
COMPENSATION INSURANCE
(This see0on reed ret W completed ff the permit laforame hundred dollars(SIM)
or Imus)
I cartry,that in the performance of Lha work for which this Permit is Issued,l shall not
employ any person in my manoeran as lo hemme subject in the Woetui CompernWan
Laws of Csiifomia.Date
Applicant
NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you should
become mbject he the Warkcrs Compewtion provisions of the labor Cade you muse
O forthwith comply with m
such provisions or this permit shall W deeed revoked.
CONSTRUCTION LENDING AGENCY
Ibereb a0hnn that them iso cmunectinn Imello ere for de Oe work ror whim tnb g .)" cI' hedarm.nec err
Permit b baoea(Set]09y,Civ.CI
dQ Lenders Name
7 la
z nder. mes
Aea
U O T caul,that I have rad this application and sum dead the aWw infomauoe It
CORmL I agree in Comply with all city and County ordinances and some lawn mlating to
.�rU^ Wilding con enter. ,and hereby suthadse miscamstinns of this city to color upon tie
W above-mentioned property for inspection purposes
py (We)agree to save,indemnify and kcep harmless the City of Caperton gaim,
fA Iiabilitim judgmenu,core and expemu which may in my way accrue again,said City
U?a- in consequence of the granting of this Permit.
APANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S R REGULAT10y!
signaamwD, ` aD.sa� Date ' Re-roofs �_.
HAZARDOUS MA AIS DISCLOSURE Type of Roof
Will the applicant or future building acupmutore orhandle Waterloo material
as donned by the Cupertino Municipal Code.Chapter 9.11,and rte Health and Safety
code, en 23532(.)7
0Yp All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding ocevpant site equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t hmardnw air comarninanb as donned by the Bay Area Air Quality Manage mot all new materials for inspection.
strict]
0Yp ICN.
I have mad the Into smamisis requiremenu under Clupter6.95ofthe Cdifor-
.is Health k Safctycade,Sections 25305,25513 and 25574.1 utndemmb dor iftho Wilding
t conenlly hew a mmL that It is my mvponslbllity m rotary the necupml of the
u nuwhich m met prior to.me.of ftatearacupancy. Signature of Applicant Date
ownermmthA . cCzm Date All roof coverings to be Class'A:s'or better
CITY OF CUPERTINO
• 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34229056 . 00
DATE ISSUED. . . . . . . : 08/19/2008
RECEIPT # . . . . . . . . . : BS000005826
REFERENCE ID # . . . : 08080140
SITE ADDRESS . . . . . : 10485 MERRIMAN RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER HONG TONY N AND YVONNE TRUSTEE
ADDRESS . . . . . . . . . . : 10485 MERRIMAN RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2680
RECEIVED FROM . . . . : EDWARD A GREGORY
CONTRACTOR . . . . . . . : GREGORY S. OWEN LIC # 29600
COMPANY . . . . . . . . . . : BLUE MOUNTAIN AIR
ADDRESS . . . . . . . . . . : 707 ALDRIDGE RD STE B
CITY/STATE/ZIP . . . : VACAVILLE, CA 95688
TELEPHONE . . . . . . . . : (707) 451-8111
• FEE ID UNIT QUANTITY, AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 6, 350 . 00 0 . 70 0 . 00 0 . 70 0 . 00
IEPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
IMPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1MRRAA UNITS 2 . 00 122 . 38 0 . 00 122 . 38 0 . 00
IPPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
ITRAVDOC 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
----------------- --------------- --------------------
CREDIT CARD 286 . 24 MC
---------------
TOTAL RECEIPT 286 . 24
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FURNACE/AC
•CUPEkTINO PERMIT APPLICATION FORM
APN # ,J Date:
0 —
Building Address:
/0 / �S�/e�f,,�-��K 7z
Owner's Name: Phone#:
oA �K J 01- 607
Contractor: Phone#: 79
7/b e- lkladw4gf,A 41"-
Fax #: 707 - S/y6— 70 z 6
Contractor License#: Cupertino Business License#:
Contact: Phone#:
� // 70 7- f's�
2h�C�4 Fax #: 70 7 W6 7D Z 6
Building Permit Info:
Elect k Plumb Mech
Resid ntial Commer ial
Job Description: f��ncce g'D /c 67-v q?Z :557q
—
A
rJ /� / /
� dcJ TTG GF,s- i, s aysle L(SGUr� /3
For Residential Installations:
Attic ❑ I" floor 2"d 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: 63 &70 Type of Construction (Usage Class):
U G
Strapped On Platform Bonded New LocationEl Replacement
Valuation: /
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set& the sheet index. _.__
4 �
CITY OF CUPERTINO
FURNACE/AC
CUPERTINO FEE SCHEDULE S
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1 MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by this
code.
1 MCREPALT Commercial for the repair of alt/add to M
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code. e
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1 PGASCOM Commerical for ea gas piping System P
1-4 outlets
1 BPGAS For each gas piping system of 5 or P
more per outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed & not incl in an appliance
permit.
1BSEISMICO Commercial Seismic B
1 MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
C heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocateea M
suspended heater,recessed.wall htr, or
floor mounted unit heater.
1 MRAPPVNT Residential for the install/relocate/or M
replacement of ea appliance vent
install ¬ incl in an appl permit.
i
CITY OF CUPERTINO
FURNACE/AC
OCUPER°T`iNO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1 PGASRES Residential for ea gas piping system of P
1-4 Outlets
IBPGAS For each gas piping system .of 5 or P
more per outlet.
IBSEISMICR Residential Seismic B
IMECPLNCK Mechanical Plan Check M
1 MFR=<100 Furnace Syst<=100k BTU install or M
relocate ea forced-air/gravity type
fumace/burner, 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
fumace/bumer, incl ducts/vents
attached to such appliance over
100,000 Btu/h
I EPERMITFEE Electric Permit Fee E
I MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit P
ITRAVDOC Travel Documentation B
1BUSLIC Business License j B
•
CITY OF CUPERTINO
7 FURNACE/AC
CUPEI, TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
AIR FURN/AC
CONDITIONING
IBCAIRHAN Commercial A/C Units <= l0k CFM B
I MCRAA Commercial Mech Repair/alt/add M
1BSEISMICO Seismic Commercial B
1 PGASCOM Commerical for ca gas piping System P
I-4 outlets
1 PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
1BREMAIRHAN Residential A/C units <= l0k CFM B
I MRRAA Residential Mech Repair/alt/add M
/ 1BSEISMICR Seismic Residential B
n 1 EPERMITFEE Electric Permit E
1MPERMITFEE Mechanical Permit M
1 PPERMITFEE Plumbing Permit P
q 1TRAVDOC Travel Documentation B
1BUSLIC Business License B
•
�b r vo�
Green Building Plan Check /o
Index of Green Building Points/Categories g -p�_
A. 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
.a.
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
6. B. OSB Sheathing, detail S-2 2 points
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 point
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 40 points
•
0
Plan Review Process Work Book Page-12-Revised 3/25/08
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 with
ease of implementation and relative low cost. These measures can be used as a statng point for'greening.your project.
INPUT Resources Energy IAG/Heatth
de
1.Recycle Job Site Construction&Demolition Waste E
165%=1 point;75%= 2 points;60%=4 points up to 4 Resource pts 0
112 Salvage Reusable Building Materials _ 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&Trees 1 Resource pt y=yes 0
6.Implement Construction Site Stonmwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
Design Resource-Efficient Landscapes and Ga duns _ 4 Resource pts y=yes 0
9.Reuse Matedals/Use Recycled Content Matedals
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 1 1
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 pts 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes 0
1 1 1
C.Structural Frame
LSubs6tute Solid Sawn Lumber w th 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 0S8 — —
a.Subfloors ; 1 Resource pt y=yes 0
. b Sheathing _ _ 1 Resource pt es
1 1 1
r
INPUT Resources Energy JAO[Heallh
iter or n e
1.Use Sustainable Decking 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/Hsalth pt y--yes 0
3.Install House Wrap under Siding 1 IAQ/Health pt y--yes 0
4.Use Fiber-Cement Siding Materials 1 Resource pt Y--yes 0
1 1 1
E.Plumbing
1.Install Water Heater Jacket 1 Energy pt Y--yes D
2.Insulate Hol and Cold Water Pipes 2 Energy pts yryes 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 yryes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0
8.Install On-Demand Hot Water Circulation Pump 4 Resource pts y--yes D
P-.trecmcer 1
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 pts. 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
I 1 1
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.lnstall Energy Star Refrigerator 1 Energy pt Y--yes D
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 D
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 pis 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.Ueilings 4 Resource pts y=yes 0
n ows
i1.Install Energy-Efficient Windows _
e.Double-Paned1 Energy pt Y--yes
0
b.Low-Emissivity(Low-E) 2 Energy pts Y--yes 0
c.Low.Conductivity Frames 2 Energy pts Y--yes D
2.Init-i LOW Heat Transmission Glazing i 1 Energy pt y=yes 0
J.Heating Ventilation and Air Conditioning
f1.UseDuct MasticonAll DuctJoints 2 Energy pis77,
2.Install Ductwork within Conditioned Space 3 Energy pts0
3.Vent Range Hood to the Outside 1 IAQ/Health0
4.Clean all Ducts Before Occupancy 21AQMea t0
5.Install Solar Attic Fan 2 Energy pts yryes
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 31A0/Health pts y=yes IX0
b.Water Heaters 31ACVHealth pts y--yes D
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heal Pumps 3 Energy pts Y--yes 0
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes y 3 0
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes '2 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes Z 0
• 13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stovestinserts 1 IAQ/Health 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 41AQ/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 IAOMealth pts y--yes 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=16 points) Up to 16 Energy pts 0
6.Select Safe and Durable Roofing Meterials� .�f 1 Resource pt y=yes D
7.Install Radiant Barrier 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
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pis y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y--yes 0
1 1
•
. n oor r ue ty en n s es
1.Use Low/No-VOC Paint 1 IAQ/Hsalth pts y--Yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use LowMo VOC Adhesives 3 IAQ/Heaith pts y=yes 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/Health pts y--yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAO/Health pis y=yes 0
7.Seal all Exposed Particleboard or MDF 4 IAQMealth pts y--yes D
6.Use FSC Certified Materials for Interior Finish 4 Resource pts y--yes; 0
D.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts Y--yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0
1 1 I
N.Flooring
1.Select FSC Certified Wood Flooring 6 Resource pts y--yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pis y--yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Heallh pts y=yes 0
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--yes0
1 1 1
Total ointsval a e: 1 1401 1301 57
Total Points Project Recelved:1 1 01 51 Ole
G:datalpmgsrpreenbullCngguldallneslmmodelana greenp6iMsflnal2.12.D4pmteoled.ds
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
a� —sCITY OFFax(408)777-3333
� %�UPEI�TINO
Building De artment
JOB ADDRESS: 'FC, PE nea �0 4f e)
OWNER'S NAME: Oil PHONE # 70z,2s7-:)2 G JR
GENERAL CONTRACT /„e oo da, FAX #70 -kY6- 70 Z&
I am not using any subcontractors: g rIZ-�
Signa a Date
Please check applicable subcontractors and complete the followinginformation:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• Glass / Glazing
Heating P2 9 600
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
it
Owner/Contractor gn a Date