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08090023 CITY OF CUPERTINO 4~' BUILDINGOIVISIOr,- PERMITpRC01�ITRA.GT,QR,ANFORM ATI. N 11 BUILDI PD ESB: _ PERMRNO. 7P� i3 I>I,;oBI,E PE, SANDIUM 08090023 OWNER'S NAME: PERMIT LgUEDATE GROVER JILL E AND GAYLEN T 4223 VERDIGRIS CIR 09/04/2008 NF-1" (408) 894-9072 SANrfARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG EIE-Cr PLUMB MECH 30p LICENSED CONfRACTOWS DECLARATION O O O O ur 1 bemby afrom tha 1 are Ifxnsed under Provisions of Chapter 9(commencing Job Description ,t� withSectionnand, fDiviaon3o(dmBusneu,ndProfesn iCa andmyliccwcu ADD A/C & FURNACE O h in full force aha a et J Lk.e 8 '' n0Z License J^q Da¢ Customer 7W ARCHITECTS DECLARATION e U 1 undersand my platy Nal W used as public records s s0� LicenseLicensed Professionalaha OWNER-BUIMER DECLARATION E I hcmby aflum that I con nmroyt from the Contractors License Law for ft COO - i O O following mason.(section 703 1.5,Business and Prefemiom Code:Any city or county $ which requdms a Permit to comtmm,alter,impmw,demolish.or mpair my structure prior tu is issuance.also requires the applicant(orsuch permit to file a signed statement wt hes licemed pursuant to the provisions of the Cuntracmr'a Licemc law(Chapaw 9 Sq.Ft.Floor Area Valuation Y�O (commencing with Section]110o)of DivisionJof Ne Bud«ssand Rafessiam Cade)« $7000 9 the ha u exenp,therefrom and the basis f«me,alleged exemption.Any violation of Section 7071.5 by airy applicant for a permit subjects the applleanl m a snail penalty OfNumber Occupancy rot room moa RK hundreddollar,(SS 32643049 '�(jT'Pe I,uae wok and prop ucur mY mnploycu wire (Sac.70". Bui. will do Newark,ands: Cominaes LMcdoraw dororule(sec.70aa,Boanev and Profetiom Code:The Cantraebra License Law dam nos apply at an owner of _ Required Inspections property who Wilds i irepmtesthvron,and w W scam nouchwmrk oreff oe We�ge his man employee,provided poweamimpmvemmtsin not iearWa uroReml f«saleer, hamomWitter,the an the«imam pomrinant u cold with arc year of wprom for me owe of Wieder will law me huNen of pvving that k did rot Wild or improve f«purpose of alk.). ❑I.as owner of that property.am exclusively contracting with licensed conga roes Is conavuct the project(Sec.706d.Business end Proruaom Cola:)TM Comuxmr's U. . cane Law does not apply b an owner M property who Wilds or improves themon,and who contracts for such projects with a contracmn(a Seemed purandam to the Contractors Lien n m Law. Iamaeroplundersec. ,BkPCferthummw Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affimt under penalty of perjury,one of the following declwtions: l law and will munuin a Cmtificaus orc..nt to self-iwurt for W«kchComprn- =Sam u mvidsd foe by Beeson 37M of the Labor Cade—for me performance of the wwk f ich oris permit u jaunt naw and will mountain Workers Compaumma I.,u required by Section ]00 of In Lather Cedc,for the performance of the work for which mu permit is issued ' MY WortrrsCmmpewtio�nla��eecann Poldry Ns.:ntenIx all3 of Cuaer.TTGGMMPIPI...•a�n'ss CERTIFICATE OFEXEMPION FROM WORKERS' COMPENSATION INSURANCE (Thu section seed Out W completed if the permit is I.man hundred do0am t$IW) . oe terra) 1 certify that in me perfum ace,of me work for which suis Permit In Weed,d Nal not employ my person in my meant,m u as become subject to the Wmim"'Compoo ation Laws of Califurom Dam Applicant NOTICE TO APPLICANT:If.after making this Certificate of Emmption,yon NouW become subject W tht Worker's Cmnpeuation pro Bradt of the Ise«Code-you most .,O forthwith comply with such proviaow«Nu permit Nut W doom<mwked - z y CONsmucnON LENDING AGENCY (—r Ihereby,Rrtn the dart is a eommundon lending agency for the performance or C the work for which this permit is Wood(Sec.3097,Civ,C.) 1 0 Lenders Name z Leaders Address U O 1 certify that I haw read This appilevion W sac this the above joy.fieo is Ls. cormcl.I agree to comply with all city and county oNinac ces and some laws raising to 0 building construction.and hemby author=reprommums ofthm city to enter upon aro W liaowtmenuuned Property for salmon puryosea G (We)agree to caw,indemnify and keep harmless the City or Cupertino against Vy Iiacomancence fth,comms uRs permiththey in my my access,agilmlasCity z in cansequeme of the granun6 Of this prnnll '--' APPLIC UNDERSTANDS AND WILL COMPLY WITH AIL NON-POINT Issued by: 1(70Date SOU EGUTATIO B/nay• , ' G� 1t /NRe-roofs Signature of ApplrcanVContramor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Willtheappliamorfuture Wildingamupmtsomorhan, havNow matarial as deBncd by tie Cupertino Municipal Cock.Chapter 9.13,and the Health and Safety code.Bccuon 25532(,)± ❑Tru XJ No. All roofs shall be inspected prior to any roofing material being installed. Will the, licant or future siding nccu nt nm If a roof is installed without first obtaining an inspection,I agree to remove Pp g W equipment it Mara which g Dit4r�carsNnw air cmtvninants u OncO by the Bay Area Air Quality Management all new materials for inspection. ❑Yon Nu I have read dm Warden materials mquiremmts uolerchaptar6.95ofthe Califur- nis Head!"SfelyCede,Secures25505.25533 and25534.f urNersand dutiftim Wilding does trot carmtiy haw•mmnL thur it u my maponahility m ratify the=oPmt of the coq . ntswnknm be tpnarmWnmceah for/n Signature of Applicant Date owner«aa,n nt XP6M Dow All roof coverings to be Class'%?"or better CITY OF CUPERTINO • 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32643049 . 00 DATE ISSUED. . . . . . . : 09/04/2008 RECEIPT # . . . . . . . . . : BS000005997 REFERENCE ID # . . . : 08090023 SITE ADDRESS . . . . . : 10673 PEBBLE PL SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GROVER JILL E AND GAYLEN T TRU ADDRESS . . . . . . . . . . : 10673 PEBBLE PL CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1333 RECEIVED FROM . . . . : YIU-HANG LEE CONTRACTOR . . . . . . . : MICHAEL LEE LIC # 28867 COMPANY . . . . . . . . . . : SANDIUM ADDRESS 4223 VERDIGRIS CIR CITY/STATE/ZIP . . . : SAN JOSE, CA 95134 TELEPHONE . . . . . . . . : (408) 894-9072 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---`------ ---------- ---------- IBSEISMICR VALUATION 7, 000 . 00 0 . 70 0 . 00 0 . 70 0 . 00 1EPERMITFE 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 1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TO'PAL PERMIT 286 . 24 0 . 00 286 . 24 0 . 00 METHOD OF PAYMENT AMOUNT . REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 286 . 24. VISA 'TOTAL RECEIPT ---------286 .24 VOICE ID DESCRIPTION VOICE ID DESCRIPTION `------- --------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL oio9 0o �3 CITY OF CUPERTINO ++ FURNACE/AC •CUPEI�TINO PERMIT APPLICATION FORM aR APN#,-�,z10 2 J O Do Date: 4 /og Building Address: . Ivb tebble I Owner's Name: Phone #: (3,�oveu. 4e>$ 73 g ZA7S Contractor: Phone #: 894- go7Z/ Fax #: Contractor License#: Cupertino Business License #: Contact: Phone#: Fax #: Building Permit Info: Elect ©/ Plumb ❑� Mech n/ Residential Commercial Job Description: A e 41CL ¢ - ��, •, , For Residential Installations: Attic ❑ 1St floor � 2"d floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction(Usage Class): +7voo �G Strapped On Platform Bonded New Location Replacement Project Size: Express R" Standard ❑ Laze ❑ Major ❑ 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. Revised 6/16/08 CITY OF CUPERTINO Q' ' FURNACE/AC CUPERTINO FEE SCHEDULE • ' Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1MCRAA 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. 1MCSUSHTR Commercial 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 113PGAS 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. 113SEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, I 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. 1 MRAPPVNT Residential for the install/relocate/ or M • replacement of ea appliance vent install &not incl in an a pl permit. Quantity Fee ID Fee Description �FePermit Type CITY OF CUPERTINO FURNACE/AC •CUPPEI,TINO FEE SCHEDULE Group FURNACE FURN/AC 1PGASRES Residential for ea gas piping system of P 1-4 Outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M 1MFR=<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 furnace/burner, incl ducts/vents attached to such appliance over, 100,000 Btu/h lEPERMITFEE Electric Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit ~P- 1TRAVDOC Travel Documentation B 1BUSLIC Business License B • Quantity Fee ID Fee Descri tion Fee Permit T e a,tot CITY OF CUPERTINO FURNACVAC CITY Of CUPERTINO FEE SCHEDULE • Group AIR FURN/AC CONDITIONING 1BCAIRHAN Commercial A/C Units <= lOk CFM B I 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 1 BREMAIRHAN Residential A/C units <= l Ok CFM B r IMRRAA Residential Mech Repair/alt/add M I, 1BSEISMICR Seismic Residential B • i IEPERMITFEE Electric Permit E IMPERMITFEE Mechanical Permit M I 1PPERMITFEE Plumbing Permit P 1 ITRAVDOC Travel Documentation B 1BUSLIC Business License B • j, 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 B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 2 points 11. Permeable Paving, Note L-1 2 -ot—s 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 oints E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points 4. B. Fiber Cement Siding, (Note/Spec. A-4 2 oints 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 aint P. Other 1. List Green Features on Plans A-1 1 point TOTAL POINTS 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. A.Site 1.Recycle Job Site Construction&Demolition Waste 65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0 j2.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 Stormwater Practices 2 Resource pts y=yes 0 7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0 �8.Design Resource-Efficient Landscapes and Gardens _ 4 Resource pts y--yes 0 9.Reuse Materials/Use Recycled Content Materiais 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 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 y=yes 0 3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes p 1 { 1 C.Structural Frame r-- -- �1.Substitute—Solid Sawn Lumber with Engineered Lumber J 3 Resource :pts y=yes p 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 FngerJointed Studs for Vertical Applications 2 Resource pts y--yes 0 7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0 S.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 J.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.Use0SB -- -" -- - a.Subfloors 1 Resource pt y=yes 0 Sb.Sheathing 1 Resource of y=yes 0 1 1 1 D.Exterior Fmis INPUT RESDUMBS Energy AD/Health 1.Use Sustainable Decking Materials a.Recycled content 3 Resource pts y—ryes 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 1 Resource pt y=yes 0 t 1 i E.Plumbing FLinstall Water Heater Jacket _ 1 Energy of y=yes 0 2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0 13.Retrofit all Faucets and Showerheads with Flow Reducers i a.Faucets1 int each,u ( Po P to 2 points)) Up to 2 Resource pts. 0 b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0 I4.Replace Toilest with Ultra-Low Flush Toilets 01 point,each,up to3 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 Enercy 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 0 1 1 1 t-.uecmcai I1.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 f 1 G.Appliances 11.Install Energy Star Dishwasher f 1 Energy pt y=yes 0 12.Install Washing Machine with Water and Energy Conservation Features 1 Energy pt y=yes 0 13.Install Energy Star Refrigerator 1 Energy pt y=yes 0 4.Install Built-In Recycling Center 3 Resource pts y=yes 0 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 Wo 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 b.oenings 4 Resource pts y=yes 0 INPUT RMDurces Energy 1AGAlealth I.Widows • -1.Install Energy-Efficient Windows • a.Double-Paned 1 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 0 2.Install Low Heat Transmission Glazing 1 Energy pt y--yes D 1 1 1 J.Heating Ventilation and Air Conditioning 1.Use Duct Mastic on All Duct Joints Jj 2 Energy pts y=yes D 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 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 3 IAQ/Health pts y=yes 0 b.Water Heaters 3 IAQ/Health pis 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 y=yes 0 12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pis "Mes 0 13.Retrofit Wood Burning Fireplaces • a.Install EPA certified wood stoveshnserts 1 IAQfHealth pt y=yes 0 b. Install/Replace Dampers 1 Energy pt y=yes 0 c.Install Airtight Doors 1 Energy or y=yes 0 14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes0 15.Install High Efficiency Filter 4 IAQ/Health pis 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=yes 0 1 1 1 K.Renewable Energy and Roofing 1.Pro-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 16 Energy pts 0 8.Select Safe and durable Roofing Materials _ _ 1 Resource pt y=yes 0 7.Install Radiant Barner - 3 Energy pts y=yes 0 1 1 1 L.Natural Heating and Cooling 1.Incorporate Passive Solar Heating 5 Energy pts y=yes p 2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes p 3. Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes p 1 1 1 INPUT Resources Energy [AD/Heafth M.Indoor Air Quality and Finishes '. rl.Use Low/No-VOC Pelt 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood is 2 IAO/Health pts y=yes 0 • '3.Use Law/No VOC Adhesives 3 IAQMealth 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/Hsa1th pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yas 0 .7.Seal all Exposed Particleboard or MDP _ _ 4[AD/Health pts y--yes 0 6.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 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooding 8 Resource pts y=yes 0 L Use Rapidly Renewable Flooring Materials_. _ _ 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4. Install Natural Linoleum in Place of Vinyl 51AQ/Health 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--yes 0 1 1 Total Points A 1 1401. 130 57 Total Points Project Received:1 1 01 ni 0 • G:daWprogslgreenbuildinoguidellneslmmodelerslgreenpointsfina12.12.04prolected.xls • Community Development 10300 Torre Avenue Gam` r Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 *UPEkTINO Building Department JOB ADDRESS: 1003 Po61k fl • PERMIT # o (�D g O OWNER'S NAME: ro VP.K- PHONE # 40 6 $ o7Z GENERAL CONTRACTOR FAX # So 644- o S o S I am not using any subcontractors: 74w, q A o Signature Date Please check applicable subcontractors and complete the followin 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 Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date