13060067CUPERTINO
2010 CALGREEN RESIDENTIAL CHECKLIST -p�
MANDATORY ITEMS 'f�� Pb�b7
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL FILE
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building�a cupertino.org
PURPOSE:
The 2010 CalGreen Code applies to all newly constructed hotels, motels, lodging house dwellings,
dormitories, condominiums, shelters, congregate residences, employee housing, factory- uilt housing and
other types of swellings with sleeping accommodations and new accessory buildings associated with such
uses. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the
requirements of CALGreen.
Project Name: HSueh Residence (2nd unit)
Project Address: 1255 Poppy Way, Cupertino, CA
Project Description: New 2nd unit in the existing single family residence
Instructions:
1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2010 California
Green Building Standards Codes to verify and assure that all required work described herein is properly
planned and implemented in the project.
2. The licensed professional, in collaboration with the owner and the design professional shall initial Column
2 of this checklist, sign' and date Section, 1 - Design Verification at the end of this checklist and have the
checklist printed on the approved plans for the project.
3: Prior to final inspection by the'Building Department, the licensed professional shall complete Column 3
and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the
completed form to the Building Inspector.
Column 2 Column 3
MANDATORY FEATURE OR MEASURE Project Verification
Re uirements
A4.1 PLANNING AND DESIGN
Planning and Desig
4.104.1 A site plan and inventory of the site is developed and used to minimize
site disturbance in order preserve desirable existing natural resources and
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minimize future adverse effects on the proposed structure.
Planning and Deslg ;
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4.106.2 A plan is developed and implemented to.manage storm water
drainage during construction.
4.106.3 The site shall be planned and developed to keep surface water away
from buildings. Construction plans shall. indicate how site grading or a drainage
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system will manage all surface water flows.
Page 1 of 5 CalGreen 2010.doc revised 08127111
A4.2 -
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General
4.201.1 Low -rise residential buildings shall meet or exceed the minimum
standard design required by the California Energy Standards.
A4.3 WATER EFFICIENCY AND - .
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Indoor Water Use fs= f= : '
4.303.1 Indoor water use shall be reduced by at least 20 percent using one of
the follow methods.
❑ Water saving fixtures or flow restrictors shall be used per Table 4.303.2.
As of 7/01/2011
❑ A 20 percent reduction in baseline water use shall be demonstrated per
Table 4.303.1.
4.303.2 When using the calculation method specified in Section 4.303.1,
multiple showerheads shall not exceed maximum flow rates.
As of 7/01/2011
4.303.3 Plumbing fixtures (water closets and urinals) and fittings (faucets and
showerheads) shall comply with specified performance requirements.
As of 7/01/2011
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Outdoor Water Use.;:
4.304.1 Automatic irrigation systems installed at the time of final inspection
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shall be weather - based.
A4.4 MATERIAL CONSERVATION AND RESOURCE EFFICIENCY
Enhanced Durabili tied Ifwllaintenance�l4
4.406.1 Joints and openings. Annular spaces around pipes, electric cables,
conduits, or other openings in plates at exterior walls shall be protected
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against the passage of rodents by closing such openings with cement mortar,
concrete masonry or similar method acceptable to the enforcing agency.
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Construction Wastel r�oiposa� and Re�nycling
4.408.2 Where a local jurisdiction does not have a construction and demolition
waste management ordinance, a construction waste management plan shall
❑X
be submitted for approval to the enforcing agency.
Building Mainienan o"o x
4.410.1 An operation and maintenance manual shall be provided to the
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building occupant or owner.
Page 2 of 5 CalGreen 2010.doc revised 08/27/11
A4.5 -O
Fireplaces
4.503.1 Install only a direct -vent sealed - combustion gas or sealed wood -
burning fireplace, or a sealed woodstove. 14/ 4v `r mq 't,
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Pollutant Control
4.504.1 Duct openings and other related air distribution component openings
shall be covered during construction.
4.504.2.1 Adhesives, sealants and caulks shall be compliant with VOC and
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other toxic compound limits.
4.504.2.2 Paints, stains and other coatings shall be compliant with VOC limits.
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4.504.2.3 Aerosol paints and other coatings shall be compliant with product
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weighted MIR Limits for ROC and other toxic compounds.
4.504.2.4 Documentation shall be provided to verify that compliant VOC limit
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finish materials have been used.
4.504.3 Carpet and carpet systems shall be compliant with VOC limits.
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4.504.4 Fifty (50) percent of floor area receiving resilient flooring shall comply
with the VOC- emission limits defined in the Collaborative for High Performance
Schools (CHPS) Low - emitting Materials List or be certified under the Resilient
Floor Covering Institute (RCFI) FloorScore program.
4.504.5 Particleboard, medium density fiberboard (MDF), and hardwood
plywood used in interior finish systems shall comply with low formaldehyde
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emission standards.
Interior Moisture Cortttol k
4.505.2 Vapor retarder and capillary break is installed at slab on grade
foundations.
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4.505.3 Moisture content of building materials used in wall and floor framing is
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checked before enclosure.
Page 3 of 5 CalGreen 2010.doc revised 08/27/11
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Indoor Air Quality art
4.506.1 Exhaust fans which terminate outside the building are provided in
every bathroom.
Environmental Comfor'.
4.507.1 Whole house exhaust fans shall have insulated louvers or covers
which close when the fan is off. Covers or louvers shall have a minimum
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insulation value of R-4.2.
4.507.2. Duct systems are sized and designed and equipment is selected
using the following methods:
1. Establish heat loss and heat gain values according to ACCA Manual J or
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equivalent.
2. Size duct systems according to ACCA 29 -D (Manual D) or equivalent.
3. Select heating and cooling equipment according to ACCA 36 -S (Manual S)
or equivalent.
INSTALLER AND SPECIAL INSPECTOR QUALIFICATIONS
Qualifications
702.1 HVAC system installers are trained and certified in the proper installation
of HVAC systems.
702.2 The Licensed Professional responsible to verify CALGreen compliance
is qualified and able to demonstrate competence in the discipline they inspect
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and verify.
Verifications r
703.1 Verification of compliance with CALGreen may include construction
documents, plans, specifications, builder or installer certification, inspection
reports, or other methods acceptable to the enforcing agency which show(
substantial conformance. Implementation verification shall be submitted to the
Building Department after implementation of all required measures and prior to
final inspection approval.
Page 4 of 5 CalGreen_2010.doe revised 08127111
CALGREEN SIGNATURE DECLARATIONS
Project Name: Hsueh Residence (2nd unit)
Project address: 1255 Poppy Way, Cupertino, CA
Project Description: New 2nd unit in the existing single family residence
SECTION 1 — DESIGN VERIFICATION
Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the
plans and building permit application to the Building Department.
The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and
certify that the items checked above are hereby incorporated into the project plans and will be implemented into the
project in accordance with the requirements set forth in the 2010 California Green Building Standards Code as
adopted by the City of Cupertino.
Owner's Signature "
Wen -Chung Hsueh
Owner's Na leap Print
Design P ofessional's Signatu e
Eric Keng
Design Pr ional's [fa--m-
a Print)
Signatuorof ficense P ofessional r nsible for CalGreen compliance
Eric Keng
Name of License Professional responsible for CalGreen compliance (Please Print)
erickeng @elhome.com
Email Address for License Professional responsible for CalGreen compliance
SECTION 2 — IMPLEMENTATION VERIFICATION
06/25/2013
Date
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Date
&A,77113
Date
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Phone
Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section
2 to the Building Department prior to Building Department final inspection.
I have inspected the work and have received sufficient documentation to verify and certify that the project identified
above was consY40ed in accord ith this Green Building Checklist and in accordance with the requirements of
the 2010 Cali is GreenfiuiI4rds Code as adopted by the City of Cupertino.
Of
compliance
Eric Keng
Name of License Professional responsible for CalGreen compliance (Please Print)
erickeng @elhome.com
12/17/2013
Date
(650) 321 -2808
Phone
Page 5 of 5 CalGreen 2010.doc revised 08127111
LE
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INSTALLATION CERTIFICATE CF -6R- LTG -01
Residential Lighting (Page 1 of 3
Site Address: Enforcement Agency: Permit Number:
Tri 13o60062
1. Kin'I:igA gD
Does nroiect include kitchen liehtin¢?
Yes, complete section 1 ❑ No, go on to section 2
Yes §150(k)3: The wattage of permanently installed luminaires (lighting fixtures has been determined as specified by §130(d).
Yes ❑ No § 150(k)3: In the kitchen, are there electrical boxes finished with a blank cover or where no electrical equipment has been
installed, and where the electrical box can be used for a luminaire or a surface mounted ceiling fan? If yes, the following row must also be es:
es ❑ NA Wattage has been calculated as 180 watts of low efficacy lighting r blank electrical box.
§150(k)8 Kitchen Lighting must comply with either method (a), (b), or (c) below:
(a) All high efficacy luminaires
Yes, complies because only high efficacy luminaires have been installed in the kitchen.
❑ No, complies with method or (c).
(b) >_ 50% watts used by hiah efficacv luminaires
Yes, complies because at least 501/6 of the installed watts are from permanently installed high efficacy luminaires
as demonstrated in the table below: Total A >_ Total B.
❑ No, complies with method a or (c).
Fill out the following table if complying with either method (b) or (c).
Table (b)
(c) Additional Kitchen Low Efficacy Lighting
es, complies because the kitchen lighting qualifies for additional low efficacy lighting
Ad as demonstrated in table in above and the table in c below that A + C > B
❑ No, complies with method a or
Additional kitchen low efficacy lighting is available only if all of the following are true:
Yes. All low efficacy luminaires in the kitchen are controlled by a vacancy sensor
Dimmer energy management control system CS or a multi -scene programmable control system.
❑ Yes. Permanently installed luminaires in garages laundry rooms closets greater than 70 square feet and utility rooms are high efficacy
luminaires AND are controlled by a vacancy sensor.
Table (c)
From the Table in
Efficacy
Add
Yes/No ?
A
B
C
A +C
Is (A +Q >B?
Type
High Low
Watts
x
Quantity
High Efficacy Watts
or
Low Efficacy Watts
rrLuminaire
LQ.
..
❑
x
=
or
❑ ❑
x
=
or
❑ ❑
x
=
or
❑ ❑
x
=
or
° °
x
=
or
Complies with method (b) if A >_ B Total: A: > B:
(c) Additional Kitchen Low Efficacy Lighting
es, complies because the kitchen lighting qualifies for additional low efficacy lighting
Ad as demonstrated in table in above and the table in c below that A + C > B
❑ No, complies with method a or
Additional kitchen low efficacy lighting is available only if all of the following are true:
Yes. All low efficacy luminaires in the kitchen are controlled by a vacancy sensor
Dimmer energy management control system CS or a multi -scene programmable control system.
❑ Yes. Permanently installed luminaires in garages laundry rooms closets greater than 70 square feet and utility rooms are high efficacy
luminaires AND are controlled by a vacancy sensor.
Table (c)
From the Table in
Use 50 W for dwelling units :5 2,500 fC
Use 100 W for dwelling units > 2,500 ft'
Add
Yes/No ?
A
B
C
A +C
Is (A +Q >B?
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2. Lighting Internal to Cabinets
&es project includes lighting_ internal to cabinets?
JS Yes, complete section 2 ❑ No, so on to section 3
2008 Residential Compliance Forms
August 2009
INSTALLATION CER
Residential Lighting
Site Address: 13 6
3. Ins a led I7evi'Ce§ Od"
Enforcement Agency:
Been Certified to the Energy Commission
CF -6R- LTG -01
(Pane 2 of 31
Permit Number:
D es the project include any of the devices or components listed below? ❑ Yes, complete section 3 ❑ No, go on to section 4
Yes
§ 19 and § 150(k)7(F): Any of the following devices and components which have been installed have been certified to the Energy Commission
according to the applicable provisions of §119: All LED lighting systems that are classified as high efficacy, ballasts used in recessed luminaires,
vacancy sensors (automatic off/manual on occupant sensors), dimmers, track lighting integral current limiters, and outdoor motion sensors.
4_ i.iuhtinu Controls Comnlete section 4
Yes ❑ NA
§ 150(k)7A: Permanently installed low efficacy luminaires are controlled by switches separate from those controlling high
efficacy luminaires.
Yes ❑ NA
§150(k)7B: Exhaust fans with integral lighting systems are switched separately from lighting systems, OR have a lighting
system that can be manually turned on and off while allowing the fan to continue to operate for an extended period of time.
EV*Ves ❑ NA
§150(k)7C: All permanently installed luminaires are switched with readily accessible controls that permit the luminaires to be
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manually switched on and off.
Yes ❑ NA
§150(k)7D: All lighting controls have been installed in accordance with the manufacturer's instructions.
C Yes ❑ NA
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§ 150(k)7E: All lighting circuits that are controlled by more than one switch, where a dimmer or vacancy sensor has been
installed to comply with § 150(k), no controls bypass the dimmer or vacancy sensor functions.
5. Luminaires (Lighting Fixtures)
does the nrnient inchide the inctallstinn of anv luminaires tindonr or nutdnnrl?
Yes, complete section 5 ❑ No, go on to section 6
es, high efficacy luminaire classification has been determined according to § 150(k) 1, and low efficacy luminaire classification has been
determined according to § 150(k)2.
Yes ❑ NA § 150(k)4: Fluorescent lamps rated 13 watts or greater have an electronic ballasts having an output frequency no less than 20
kHz.
Yes ❑ NA § 150(k)5: Permanently installed night lights, and night lights integral to permanently installed luminaires or exhaust fans,
contain only high efficacy lamps meeting the minimum efficacies contained in Table 150 -C and do not contain a line - voltage
socket or line voltage lamp holder, OR the night light is rated to consume no more than 5 watts of power and does not contain
a medium screw -base socket.
Yes ❑ NA §150(k)6: Lighting integral to exhaust fans, in rooms other than kitchens, meet the applicable requirements of §150(k).
C� Yes ❑ NA Any electrical box finished with a blank cover or where no electrical equipment has been installed, and where the electrical
box can be used for a luminaire or a surface mounted ceiling fan, has been treated as low efficacy luminaires for compliance
with §150(k).
Does the project include any luminaires that are recessed into insulated ceilin s?
Yes, complete the rest of section 5 ❑ No, go on to section 6
❑ Yes, §150(k)12: Luminaires that are recessed into insulated ceilings meet all of the following conditions:
Yes, are listed, as defined in § 101, for zero clearance insulation contact (IC) by UL or other nationally recognized testing/rating
laboratory, and
Yes, have labels that certify the luminaires are airtight with air leakage less than 2.0 CFM at 75 Pascals when tested in accordance
with ASTM E283 (Exhaust fan housings are not required to be certified airtight), and
Yes, are sealed with a gasket or caulk between luminaire housings and the ceiling, and all air leak paths between conditioned and
unconditioned spaces have been sealed with a gasket or caulk. (including all exhaust fan housings), and
Yes, allows ballast maintenance and replacement to be readily accessible to building occupants from below the ceiling without
requiring the cutting of holes in the ceiling.
6. Indoor Lighting (any indoor room that is not a kitchen)
Does the project include permanently installed luminaires in any room mat is not a Kitchen'!
Yes, complete section 6 ❑ No, go onto section 7
Yes ❑ NA §150(k)10: Permanently installed luminaires in bathrooms, garages, laundry rooms, closets > 70 ft2, and utility rooms are high
efficacy luminaires OR are controlled by a vacancy sensor.
,KT Yes ❑ NA §150(k)l l: Permanently installed luminaires located in rooms or areas other than in kitchens, bathrooms, garages, laundry
` \ rooms, closets, and utility rooms are high efficacy luminaires, OR are controlled by a dimmer switch OR are controlled by
a vacancy sensor.
2008 Residential Compliance Forms August 2009
1 y
INSTALLATION CERTIFICATE CF -6R- LTG -01
Residential Lighting (Page 3 of 3
Site Addre Enforcement Agency: Permit Number:
C k W TY*Oi " (A
7. Outdoor Lighting
Does the project include any permanently installed outdoor lighting?
Yes, complete section 7 ❑ No, go on to section 8
Yes ❑ NA
§150(k)13: Luminaires providing outdoor lighting, including outdoor lighting for private patios on low -rise residential buildings
C�1J�.
with four or more dwelling units, entrances, balconies, and porches, and which are permanently mounted to a residential
Responsible Person
building or to other buildings on the same lot are high efficacy luminaires OR are controlled by a manual on/off switch, plus a
motion sensor not having an override or bypass switch that disables the motion sensor, plus one of the following three
CSLB License:
additional control methods:
Position With Company (Title):
a. A photocontrol that does not have an override or bypass switch that disables the photocontrol; or
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b. An astronomical time clock not having an override or bypass switch that disables the astronomical time clock;
or
C. Energy management controls systems (EMCS) not having an override or bypass switch that allows the
luminaire to be always on.
Yes ❑ NA
Exception 2: Low efficacy outdoor luminaires used to comply with Exception 1 to § 150(k) 13 are controlled by an override
switch which temporarily bypasses the motion sensing function, and the motion sensor is automatically reactivated within six
hours. The luminaire is controlled by a photocontrol, astronomical time clock, or EMCS as required by Exception 1 to
§150(k)13.
Yes ❑ NA
Exception 3: There are permanently installed luminaires in or around swimming pools, water features, or other locations
subject to Article 680 of the California Electric Code which do not need to be high efficacy luminaires.
Yes ❑ NA
§150(k)14: Internally illuminated address signs comply with §148, OR do not contain a screw -base socket and consume no
more than 5 watts of power as determined according to § 130(d).
Yes ❑ NA
§150(k)15 Lighting for parking lots and carports with a total of 8 or more vehicles per site have lighting that complies with
§ 130,132, 134, and 147. Lighting for parking garages for 8 or more vehicles comply with § 130, 131, 134, and 146.
If yes, the Nonresidential compliance forms must be submitted
8. Common areas of low -rise residential buildings
oes the project include the installation of any luminaires in common areas of low -rise residential buildings?
Yes, complete section 8 ❑ No, go on to section 9
Yes, § I50(k)l6: Permanently installed lighting in the enclosed, non - dwelling spaces of low -rise residential buildings with four or more
dwelling units shall be high efficacy luminaires OR are controlled by occupant sensor(s) certified to comply with § 119(d).
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative
of the person responsible for construction (responsible person).
• I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms
to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement
agency.
• I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building
permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a
signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building
owner at occupancy.
Company Nam0 (jngtallih Subcontractor orGeneral Contractor or
uilyde O� er)
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VReesp'onsible
Responsible Person
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Person's Si at
CSLB License:
Date Si ed:
Position With Company (Title):
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d
2008 Residential Compliance Forms August 2009