08060233 CITY OF CUPERTINO -
BUILnINGDLV1540N PE G`ONTI2ACTORINIORMATION
BUIL 1 GA DRESS: PERMIT NO.
511 1 FINCH AVE GOLDEN ROOFING CO 08060233
OWNER'S NAME: PERMIT ISSUE DATE
B,'THEL LUTHERAN CHURCH 828 WILLOW ST 106/26/2008
ONE:
SANITARY NO. CONTROL NO.
(650) 298-9393
ARCHRECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONfRACOWS DECLARATION
4 hi 1 hereby affirm that 1 sm 0aruedi under provisions,of Chapter 9(commencing Job Description
with Section 7")of Division 30fdm ButincvvM Protestav Code,and my liceng,is RE—RF COMM'L CLS A 50SQ; RMV EXT CAPSHT RF DWN TO
^or°n in fu[Ifome Nd Off ,
pgjz Ucenm lass — Ls.0 5 EXTNNG PLYWD& INSTL 1 LYR FBRGLS BSSHT&NAIL
;rc Dam ARCHITECTSDDEc AnoN INPLACE; INSTL 2 LYRS MDFDBITUMN TRCH ON RF
£ 1 undemmad my plans send be nuc ,
as public record'
g
Wok Licensed Professional
OWNER-BUILDER DECLARATION
iF 1 herehy aRrm that I am escmpt from the Conameme,Licence Law for the
00 fallowing raamn.(Salon 7(D 1.5.Business and profession,Code:Any city Or county
5 S ff which requires a permit to construct altar,improve,demolish,Or minor any structure
—Z j, prior to its announce,slap squires the applicant for such permit to rile a signed aummcn,
< land heiammuan,edpursuant tothe pm.i,ionsofthe Gmractar,U,<nreLaw(Chapter 9 Sq.Ft. Floor Area Valuation
x5j (coencing with Section 7000)of Divskon 3 M the But.and Professums Code)., $26000
a. Nat he is exempt therefrom and the bass for the alleged exemption.My violation of
Section 7031.5 by any applicant fa a permit subjem he applicant in a civil penalty,of Number Occupancy Type
ria more dem fres hundred dollar,(5500). 3 7 5 0 3 0 2 2 .
❑1.u Owner Of the progeny a my ermployeu wish wags ss theirmle es
compeadon,
will do the workan
, d tangents.s
csnotinu ded or Offered focus(Sec.7016,Biomass
arm Pmfudes ocode:The commemes License law does WE apply m an owner of Required Inspections
,impart who wild.Orimpmvea thereon.to dwhodocasuch wart himselforthrough his
own amplaycs,provided hs,such improvements are notinsMed oraffered for sake If,
however.Ne building or improvement is mid within one year of completion.the owner-
builder will have the msdrs Of proving that he did not wild tar improve for purpose Of
us.).
❑1.as owner of the property,am uclmively...=I.,with licensed Imassohim in
wusrua the project(Sec.7016.Bminm and Pmfsssimu Code:)M Contractors Li-
cape law does not apply in an owner of propery,who wilds or Improves daemon.and.
who contracts for such project with a eonsm,Or(s)limnsed pumumt to the Comaacio',
I.ksnae L.W.
❑lomeacmptundersec. .BAPCforthsmamn
Owner Dam
WORKERS COMPENSATION DECLARATION
I herey a
by under pcna ly of perjury oro oNe r following decluatiou:
❑1 hiveand WII maintain aCenibns Of Comer m Ylf--imam fc WorkersCompcn-
ration,u pmvidcd far by Section 37M of the Labor Code.for the performance of the
work for which this Permit Is slued.
❑1 have and will drainhin Workers Comperwtion Insurance,in inquired by Section
3700 offs Labor Crede,for the performance offs work for which this permit is issued.
My Wortrr�ec N 0.0.J P.amu and PoRry nvmwr are:
Grier. TGG �TY£`✓2z Polity No.:e?OOZSII�—Zro�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE Oq
(This safes dead rot becompksd'f hie permit is rams hundred dollars(SI W)
or less)
1 certify the,in the performance Of he work for which this permit is issued.I shall Out
employ anypermn in mY m,nrerm as m become mbjal to the Workers'Compensation --
Laws of California.Dam ,
Applicant
NOTICE TO APPLICANT:If,after making this Cci iEus of Exemption,yen should
become Subject as the Workers Compensation provisions of the Lahar Code you most
,J Qforthwith forthwith comply with such provisions;Or this permit shall he deemed revoked.
Z'C7 CONSTRUCTION LENDING AGENCY ,
[—i I hereby affirm thus them is.conruuction lending ill far the serfrman.of
IY'
re work far which this Permit is issued(Sec.3097,Civ,C.)
WQ Lenders Name
M
=z fenders Address
U Q 1 a hol"that 1 have read this application and sus thu the above infmm'don s
u,Pcorrect.I agcy u comply with all city and county on ironces and sus laws resting to
C) U wilding cmwmctian.and herebyauthosi,s representatives ofthis city in cnscrupma lap
W above-mcnd...d propcny fu impcaion pucpama
(~ gy (We)agree to save,indemnify and kap hVn11N the City of Coperhm apshch
rr h Ikabilitiu,judgment,ensu and uperues which may in my way,cave against said City
(„)Z in consequence of the granting of this Permit.
^' APPLICANT UNDERSTANDS AND ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGULAMONS.
Hu7.41]
,orApphanUCon ) mob Re-roofs
AZARDOUS MATERIAL ISCLOSURE Type of Roof
lllill////// WIIl the applicant or future wilding oecupnt sore,handle hanmoasmamrfal
its defined by he Cupertino Municipal Code.Chapter 9.13,and his Hcalth and Safety
Code,section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes boll dae applicmtINO
re buil ' Occupant use equip rman a devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hovamnus air cmuas ncd by Iw Bay Area Air Quality Man,....t all new materials for inspection.
Dsttrict?
❑Yu
I have mel he harutlousmasria0 requwmebls underChapW 6.95ofhcCalifmr-
meIltO,hhkSarcty cede,Safwo25M5.25533 md25534.1 understand hsirfs wilding
does mm Carmody have..4 wtittmy mimutymaofrr the aemPmt nr the
rcquimm nu which mus wmet 'Ortel o or Ocapanic,.
z.c,m8 Si erre of ApplicantDate
OfnLpdr authoraedagcnt Idem All roof coverings to be Class'%¢."or better
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 37503022 . 00
DATE ISSUED. . . . . . . : 06/26/2008
RECEIPT # . . . . . . . . . : BS000005236
REFERENCE ID # . . . : 08060233
SITE ADDRESS . . . . . : 10181 FINCH AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER BETHEL LUTHERAN CHURCH
ADDRESS . . . . . . . . . . : 10181 FINCH AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3410
RECEIVED FROM . . . . : GOLDEN ROOFING CO
CONTRACTOR . . . . . . . : GOLDEN ROOFING LIC # 23265
COMPANY . . . . . . . . . . : GOLDEN ROOFING CO
ADDRESS . . . . . . . . . . : 828 WILLOW ST
CITY/STATE/ZIP . . . : REDWOOD CITY, CA 94063-4229
TELEPHONE . . . . . . . . : (650) 298-9393
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICO VALUATION 26, 000 . 00 5 . 46 0 . 00 5 . 46 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00
1REROOFCOM SQUARES 50 . 00 337 . 00 0 . 00 337 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 452 . 46 0 . 00 452 . 46 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 452 . 46 #13854
---------------
TOTAL RECEIPT 452 . 46
i
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
CITY OF CUPERTINO
REROOF
CITY OF
*CUPERTINO PERMIT APPLICATION
APN # .7 t v 3 0 e2 a v Date: Z G J
Building Addr ss:
c 11e - Q
Owner's Name: Phone #:
e e
Contractor: Phone #: 650 a 98 /3 i3
(90 c/e ®msr I - ,C/ / IPeW( ed .Fax #: 4. 0 .91 98 f_�Z"g41
Cupertino Business License #: Contractor License #:
/0
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings Z- ❑ Provide I.C.B.O. Report #
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: -Move e s iw� Lqe ,btep4 100.E v/*\, I-c2 -ekfs};,
o4 ti �('bCrj/&5_' base Spec-� . t+H� /Iccc°11k [
(MS4c� Lrr(- �Wo la_1 "S W�octfF�'e� b i`�v�eUt �ovet�
Sur TC Ge m Q.0 r"o1e,,- Fr"nes6t ,
Residential I Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the there are any restrictions: ❑
application or if applicable, include in plan
gi set & the sheet index. "
Valuation. GP-c"-
• 1 Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
S' ature
CITY OF CUPERTINO
REROOF
�CUPEI�TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
IREROOFRES Re-roof Residential B 1SFDWLROOF
IBSEISMICRE Seismic Residential B
1RER00FMRES Re-roofMulti-FamilyB 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
•
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
• 5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be Raid before another inspection can be scheduled
IMPORTANT:
1. Flat roofs must have a minimum of 1/4"per foot slope and demonstrate
that there is no ponding.
2. An-I:C;B:O-r6p rrfis.re uuiiedao lie.on tlio:job—site.at the-time on.inspection7
I understand and will comply/o/with the above stated policy on re-roofing.
7
Homeowner's Name: (�_7lI ./q- I r ixl ter-4,4 �hVYr_A Cava s c�ioa/
Job Site Address: 101Ri FI,,4 ,h X V-C _
Roofing Company Name: /�Cn h
Applicant's Signature: Date: ir r Z G-o
• Greg Casteel
Building Official
Revised 11/2/04
Green Building Plan Check
Index of Green Building Points/Categories
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
f' 7 72points
B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 11. Permeable Pavin Note L-1C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 5. Use Truss with heels, (detail) S-2 6. B. OSB Sheathin detail S-2
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. Energ Star Refrigerator, (Note/Spec. A-3 1oint
P. Other 1. List Green Features on Plans A-1 1 point
TOTAL POINTS1 CL 40 points
•
•
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 coordination with
ease of implementation and relative low cost. These measures can be used as a starting point for'greening'your project
INPUT Remurces Ener
A. rte
1.Recycle Job Site Const uction 6 Demolition Waste yt
�65%=1 point;75%= 2 points;60%=4 points I up to 4 Resource pts 0
2.Salvage Reusable Building Materials } 4 Resource pts y=yes D
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
B.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes - 0
a B.Design Resource-Efficient Landscapes and Gardens
P 4 Resource pts y=yes 0
9.Reuse MaterialsfUse 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 D
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 ptsD
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
1.Substitute Solid Sawn 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
B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y--yas 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
rr---— —— -- --
I12.Use OSB -—`
• a.Subfloors — --- 1 Resource pt y=yes 0
Lb.Sheathing II 1 Resource pt y=yes 0
IrPUT Resources Energy 1ADIHealth
D.fxtein finis
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/Health pt y--yes 0
3.Install House Wrap under Siding I 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 —i 1 Energy pt y--yes
D
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 Hot Water Circulation Pump 4 Resource pts y--yes D
1 1 !
r.trecmcai
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
1 1 1
G.Appliances
11..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=yas 0
1 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
ff3.Install Recycled-Content,Fiberglass Insulation with -�
No Added Formaldehyde ' 3 IAQ/Health pts y=yes D
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.Uewngs 4 Resource pts y=yes 0
1 1
c
IMPUT Resources Energy IA01heatth
Windows
1.Install Energy-Efficient Windows j
a.Double-Paned 1 Energy pt y=yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y--yes0
c.Low.Conductivity Frames 1 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt Y--yes D
1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Dud Mastic on All Duct Joints _ 2 Energy pts y=yes 0
2.Install Ductwork within Conditioned Space 3 Energy pis y=yes 0
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 7 D
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 3IAQ/Health pis y--yes 0
b.Water Heaters 3 IAQ/Health 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 p
11.Install AC with Non-HCFC Refrigerants 2 Resource pts yeses 0
12,Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts Y--yes 0
• 13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stoves/inserts 1 IAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt Y--yes o
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(HPV) 51AQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y_—yes p
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
LSelect Safe and Durable Roofmg Matenals 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pts y=yes 0
1 1
L.Natural Heating and Cooling 1
1.Incorporate Passive Solar Heating 5 Energy pts y=yes p
2.Install Overhangs or Awnings over South Facing V�fndows 3 Energy pts y=yes p
3.Plant Deciduous Trees on the West and South Sides 3 Energy pis y=yes p
M. ndoor Air Qua ity and F nishes
.Use Low%No-VOC Paint 1 IAD/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2IAQ/Health pts y=yes 0
I.U'se LowMo VOC Adhesives i 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pis 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 [AD/Health pts y=yes D
7.Seal all Exposed Particleboard or MDF_ —_� 41AQ/Health. pts y=yes D
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
9.Use Finger-Jointed or Racycled-Content Trim 1 Resource pis y--yes D
10.Install Whole House Vacuum System 31AQ/Health pts y--yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pis y=yes D
[Fuse 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 IAQMealth pts y--yes D
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
S.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes D
1 1 1
Total Points Available: 1 1401 130T---5-71 •
Total Points Project Received: 1 01 0 0
G:da;alprogs<greenbuildngguidellneyremodelers�greenpointsfina1272.D4proteMed.zls
•
Community Development
10300 Torre Avenue
11 Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPEI,TINO
Building Department
JOB ADDRESS: PERMIT# 6 0233 650,
OWNER'S NAME: ej " a„d PHONE #
GENERAL CONTRACTOR: vl'p e _ FAX # 02 rP'
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
Roofing oa�n
Septic Tank
Sheet Metal
Sheet Rock
• Tile
Owner/Contractor Sie Date