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14080244
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10212 DUBON AVE CONTRACTOR: CHUEN YANG YANG PERMIT NO: 14080244 CONSTRUCTION CO OWNER'S NAME: DESHPANDE JEETENDRA K AND ANJALI J 15215 GALT ST DATE ISSUED: 07/07/2015 OWNER'S PHONE: 4083298548 SAN LEANDRO, CA 94579 PHONE NO: (510) 213-9981 LICENSED CONTRACTOR'S DECLAUATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ADDITION OF 1206 SQFT, ENLARGE EXISTING GARAGE, License Class Lic. # ADD BATHROOM(140SQFT), REMODEL DINING, ADD MASTER Contractor DateBED/BATH,KITCHEN(288SQFT). dterprovi*sionso.-Chapter9 FIRE SPRINKLERS WILL I hereby affirm that I am Leens u f BE (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $25000 erforrnance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 34214052.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agreecomply with all city and county ordinances and state laws relating WITBIN 180 Y T ISSUANCE OR ruction, and hereby authorize representatives of this city to enter to building construction, upon the above mentioned property for inspection purposes. (We) agree to save S�� 1 M LAST C LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulatio a Cupertino Municipal Code, Sectio 9.18. RE -ROOFS: Signature Date 1 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505,255'3Y, ad 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Dat permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, l become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14080244 10212 DUBON AVE CUPERTINO CA 95014 (342 14 052) (CHUEN YANG YANG ) SAN LEANDRO, CA 94579 OWNER'S NAME: DESHPANDE JEETENDRA K AND ANJALI J DATE ISSUED: 07/07/2015 OWNER'S PHONE: 4085157025 PHONE NO: 5102139981 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 11 Lic. #897965 Contractor (CHUEN YANG YANG ) Date 2/11/2016 — BLDG _ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — — — with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: ADDITION OF 1206 SQFT, ENLARGE EXISTING GARAGE, I hereby affirm under penalty of perjury one of the following two declarations: ADD BATHROOM(140SQFT), REMODEL DINING, ADD MASTER 1. I have and will maintain a certificate of consent to self-insure for Worker's BED/BATH,KITCHEN(288SQFT). FIRE SPRINKLERS WILL BE Compensation, as provided for by Section 3700 of the Labor Code, for the ADDED ASA DEFERRED SUBMITTAL performance of the work for which this permit is issued. z. I have and will maintain Worker's Compensation Insurance, as provided for Revision #1: Add cofferred ceiling to dining room. Issued 01/28/16. t ♦ by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. REVISION #2 - CHANGE LAYOUT OF THE COFFERED CEILING AT APPLICANT CERTIFICATION DINING ROOM - ISSUED 2/11/2016 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby Sq. Ft Floor Area: Valuation: $25000.00 authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and APN Number: Occupancy Type: expenses which may accrue against said City in consequence of the 342 14 052 granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR Signatur Date 2/11/2016 180 DAYS FROM LAST CALLED INSPECTION. OWNER-BUJIMERDECLARATION Issued by: PAUL O'SULLIVAN ( ' I hereby affirm that I am exempt from the Contractor's License Law for one of the �06AW Date' Z11/2016 following two reasons: 1. 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered RE-ROOFS: for sale (Sec.7044, Business & Professions Code) All roofs shall be inspected prior to any roofing material being installed. If a roof is 2. I, as owner of the property, am exclusively contracting with licensed installed without first obtaining an inspection, I agree to remove all new materials for contractors to construct the project(Sec.7044, Business & Professions Code). inspection. I hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant: 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Date: 2/11/2016 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER z. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE s. I certify that in the performance of the work for which this permit is issued, I I have read the hazardous materials requirements under Chapter 6.95 of the shall not employ any person in any manner so as to become subject to the California Health & Safety Code, Sections 25505, 25533, and 25534. I will Worker's Compensation laws of California. If, after making this certificate of maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous exemption, I become subject to the Worker's Compensation provisions of the material. Additionally, should I use equipment or devices which emit hazardous Labor Code, I must forthwith comply with such provisions or this permit shall air contaminants as defined by the Bay Area Air Quality Management District I be deemed revoked. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and APPLICANT CERTIFICATION the Health & Safety Code, SyPtions 25505, 25533, and 25534. 1 certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws Owner or authorized age relating to building construction, and hereby authorize representatives of this city Date: 2/11/2016 to enter upon the above mentioned property for inspection purposes. (We) agree CONSTRUCT ON LEAIN A to save indemnify and keep harmless the City of Cupertino against liabilities, I hereby affirm that there is a construction lending agency r t performance judgments, costs, and expenses which may accrue against said City in of work's for which this permit is issued (Sec. 3097, Civ C consequence of the granting of this permit. Additionally, the applicant Lender's Name understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Lender's Address ARCHITECT'S DECLARATION Signature Date 2/11/2016 1 understand my plans shall be used as public records. Pew" k CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCaD_cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED # 11408 0 2L �� IW#2 • ORIGINAL PERMIT # PROJECT ADDRESs 10 n ` -L `jam ` 1?�a jQ APN # OWNER NAME, PHONE G O � _5 d % E-MAIL �J STREET ADDRESS _ d 2 V - P CITY, STATE ZIP ���Q �.1 � bIL 1 � \ 1-0 FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX VTNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME C h� 1 LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP . 1� /1' ?) Q I PHONE ARCHITECT ENGINEER NAME (, h T LICENSE NUMBER 24 BUS. LIC # �`bo COivf(PC)yj NOAME * _ 1 E-1 FAX FA � �n STREETADDRESSL_a V_3r�y e� CITY( A�TE,ZIPCA Q k©ls� PHONE DESCRIPTION OF \\ ORKQ_V i �n �� n j t a� � � cwt \ j EXISTING U hhh PROPOSED USE CONSTR. TYPE �l v # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA �- (� NEW FLOOR AREA f�©/ DEMO AREA TOTAL NET AREA i.'J BATHROOM, KITCHEN OTHER REMODEL AREA 1111 REMODEL AREA REMODEL AREA PORCH AREA e.1 DECK AREA TOTAL DECKPORCH AREA GARAGE AREA: DETA 9DATTACH 2l G i❑'YES DWELLING UNITS: IS A SECOND UNIT E] YES SECOND STORY BEING ADDED? 1JNO ADDITION? % (a NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES IVIED BY: TOTAL PLANNING APPL # ❑ NO PLAN'N'ING APPROVAL LETTER EICHLER HOME? Lel NO 6ATION: By my signature below, I certify to each of the following: I am the property owner or authori d aeent to act on the property owner's behalf. I 11ave read this application and the information I have provided is correct. I have read the Description of Work and Verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu. ng constructi n. I authorize representatives of Cupertino to enter the above -1 entrf d property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO TION UIRE PLAN CHECK TYPE ROUTING SLIP 1 �BUILnING New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building VER-THE-COU\TER PLAN REVIEW permit for new building. ❑ EXPRESS ❑ PL.ANNI_NG PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ ST.A.ND.ARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ ❑ LARGE FIRE DEPT _ Copy of Planning Approval Letter or Meeting \with Planning prior to y El MAJOR ❑ SANITARY SE\i ER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH Bldo 4pp_2011.doc revised 06121/11 0-- CITY OF CUPERTINO BUILDING PERMIT BUH.DING ADDRESS: CONTRACTOR: PERMIT NO: 14080244 10212 DUBON AVE CUPERTINO CA 95014 (342 14 052) (CHUEN YANG YANG ) SAN LEANDRO, CA 94579 OWNER'S NAME: DESHPANDE JEETENDRA K AND ANJALI J DATE ISSUED: 01/28/2016 OWNER'S PHONE: 408-515-7025 PHONE NO: 408-213-9981 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #897965 Contractor (CHUEN YANG YANG ) Date 01/28/2016 — BLDG _ELECT —PLUMB MECH RESIDENTLAI. COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — — — with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: ADDITION OF 1206 SQFT, ENLARGE EXISTING GARAGE, I hereby affirm under penalty of perjury one of the following two declarations: ADD BATHROOM(140SQFT), REMODEL DINING, ADD MASTER 2. I have and will maintain a certificate of consent to self -insure for Worker's BED/BATH,KITCHEN(288SQFT). FIRE SPRINKLERS WILL BE Compensation, as provided for by Section 3700 of the Labor Code, for the ADDED AS A DEFERRED SUBMITTAL performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for Revision #1: Add cofferred ceiling to dining room. Issued 01/28/16. by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above Sq. Ft Floor Area: Valuation: $25000.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned APN Number: Occupancy Type: property for inspection purposes. (We) agree to save indemnify and keep 342 14 052 harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will PERMIT EXPIRES IF WORK IS NOT STARTED comply with all non -point source regulations per the Cupertino Municipal WITHIN 180 DAYS OF PERMIT ISSUANCE OR Code, Section 9.1 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 01/28/2016 Issued by: -1 OWNER -BUILDER DECLARATION Date: 01/28/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: i. I, as owner of the property, or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed. If a roof is compensation, will do the work, and the structure is not intended or offered installed without first obtaining an inspection, I agree to remove all new materials for for sale (Sec.7044, Business & Professions Code) inspection. 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Signature of Applicant: Date: 01/28/2016 1 hereby affirm under penalty of perjury one of the following three declarations: t. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for HAZARDOUS MATERIALS DISCLOSURE by Section 3700 of the Labor Code, for the performance of the work for which I have read the hazardous materials requirements under Chapter 6.95 of the this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will 3. I certify that in the performance of the work for which this permit is issued, I maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the shall not employ any person in any manner so as to become subject to the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Sections 25505, 25533, and 25534. be deemed revoked. APPLICANT CERTIFICATION C C Owner or authorized agent: I certify that I have read this application and state that the above information ' Date: 01/28/2016 correct. I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY relating to building construction, and hereby authorize representatives of this city I hereby affirm that there is a construction lending agency for the performance to enter upon the above mentioned property for inspection purposes. (We) agree of work's for which this permit is issued (Sec. 3097, Civ C.) to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant Lender's Address understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date 01/28/2016 Licensed CONSTRUCTION PERMIT APPLICATICN C0l1h4UNITY DcVSLOPI%4EN T DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014.3255 (408) 777-3228 - FAX (408) 777-3333 buildinaf.cune -itino.org CUPERT[t10 ❑ NEW CONSTRUC710N u ADDI'T'ION I-] A.L T'EYLkTION / TI 0 REVISION / DEFIED GTUGINA r P_�Uvj'-, Ig PRGTiCf ADDPWss 0212 -� 086 N A/c -4 UE (OPG i�r-0 oke. NAI EEtC-OJ A 2�Pt ,>GSi-wWDE I P 401� r� I =.]� �� ,� Anao . c4q) ST1F._11 A.rjDR:SS to AZ -b'` o * cN )E . C;:�, _TE;r-, Zi? � CA 01 / �^upt5gi CO?,iACT 'tWl z I PHOT I=-1✓4?. STR,.:.cIf>DRSSS I C:iY.STATE, ZIP I FAx OktntR ❑.0lV?�'R-5LiD� ❑ OF'h=ZAC_TZ ❑ CO\TR.tCTOR ❑COhTr.�CTGP!GT7 ❑ f1c=--CT ❑ GSR ❑ D�1 Oz ❑ ic1�<h? 1 CONIACTORKAJV71^h"h y LICENSE xrB BUS.LicR COW°hh7 T;fa= I s•NAIL I FAA STREET ADD72'-SS i C174Y, STA,—_, Z:P �1�� �1� • ��� ~'. f3.C.-TC-7:?vOD3=r_:2NfJ!= %O I LIC�S_i-JTC=R � 13 BLS. LIC R co]�ANY Aict�c4 E 1dAgS$ GA(y) I rFx STP.EETaDP.Ess� '1 a I cl IY,�1AT--:, aqQ t D=SUZ-110N 0-r WORK PW RA � 6 ; j O(l � c%'►� ti� >?-t' _ '1=trJ c�,fT Wil. SDG c= F?OPOSED tJS CONS -17- TYP:STOP=S R —` VF I USS I Ttirfi OCC. I SQ.: T. IVAIUATi0\' ��STC ?7vvFLOOR D'c?.40 Y D TOTF3. 106 3AT7t00?✓i:uTCi'=.*I Cir ---i P,.c'1,10MLAREA (3 REMODEL ARRA f e i,=?,fODEL :,S.A, 2 I 0 �y 1# A TAC; ADW, 1DGlisPS: ISA 5ECO?QDuNrr ❑1"_s SECOND STORY 5 BEING ADDED? 77".0 I ADDITION? o?40 ??� :�?PLICA?70 4 ❑ : S = 1=S, PROVIDE COPi' OF I Is THE BLDG E) ❑ 1 S s I i PL4.'41,7?4GFP(J?4. PL4 0 PL�?.'T�.G<=PROV!LL=TER EICHLER::OmF? TOT. -.L \ �?>'0 .•.. '� ., . _- By -y si;nattre below, I ce-ify to each of the follo-,vi. I an the property ov,7-= or authorized agent to act o lthe prDpe, oa er's behalf. I have ea'd this application and the information I have provided is cc-ect. I have read the Description of '�% 0rk and veri Y it is accurate. I agree to aernply -N;lith all applicable local Or6inanCES and Sta"e laws relat?ng t0 y '.. �lr±g con5troction. I authorizze t0 eDier the at10\� 1C_77?'i'Ied �'Oi, �;iy f0i L'1SpeCt10:1 pxpC5e5. Si�,a:Lre CI A'?plicult/A Grit: Date: SUPPLE -MENTA, Q = > 6 u _ 1eW JtD Or Ml.,1tii�"l:ly d\%re1lin _r,: Apply for d::_'QZie-:'lii fOr � r•- ���' build;-Ic(s), T` -r i, t I tti,•A r' : i^� n itil vCi� COIF? 1 �"�.BL• IZ G a'R's •�ti':F*•, . _ De,.,olitioa e,__..t Z)enn.;t for n. e % v b it dine -a _ _ Co-..-erC:al '3ldes: Provide a co-pleted _ua: dmis IM-erials Dlcz '111:e 7't•+� v"1,�, "�'• - �'q". '�' IOr'i :. _,y Hazardous 1\fa:erl?15 ae bei�a __ed r '� �E..� - �."�r �PLE� ''F O �i L+�j •�' � _y az- = as p -t G: this p, eject. Copy ^ n 'rla =DrOva / ina ..,:.ti Pt^ — eD�y GI P1a.Ilie 1 L tte, or �_eet _ _ �n�_n> prior to IMF 0 1 P-iff}� SL'b_T.iital 0f l�'Lild?r1g P..:-rlit cppllCauG'1._... . B1a'o R-)-2011,doc revised 06121/11 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 ; FAX (408) 777-3333 • building a(-cupertino.org ❑ NEW CONSTRUCTION M ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS i s 212 D ubo o Ave- AFN # ;31+2- A_ 2- 1 A - D 5 OWNER NAME J C�� ��� � PHONE�� } � n 'i r� EMAIL 6- STREET ADDRESS 10 2 1o21z �b�rl A �7 CITY, STATE, ZIP ® or FAX CONTACT NAME PHONE E. MAIL UM ZI u @)�Aa R Q John NaZ &a- Zba 40e O Y I I \ V` YC O - STREET ADDRESS`�� e�^p CITY, STATE, ZIP R — CA FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT )K ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT T �JPE CONTRACTOR NAME t2 /J/l ` LICENSE NUMBER _71 LICENSE TY BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAMEJ Dh1 LICENSE NUMBER n r BUS. LIC # c COMPANY NAME �r E-MAIL E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE V FkV4„ a aYi� D9 DESCRIPTION OF WORK _ Le- ffMn4iL4:1_d EXISTING USE PROPOSED USE CONSTA y� TYPE # STORIES I USE TYPE OCC. SQ.FT. VALUATION (S) � � {� A AREA � l NEW FLOOR AREA 1 / DEMO AREA TOTAL NET AREA G p BATHROOM KITCHEN OTHER REMODEL AREA o- REMODEL AREA REMODEL AREA D PORCH AREA _ DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH 0 ® ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? CRNO ADDrrION? gNO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REGEL D BY '-�''�' ter`.; TOTAL VALUATION: PLANNING APPL # [:]NO PLANNING APPROVAL LETTER EICHLER HOME? �NO 'a `+ By my signature below, I certify to each of the following: I am the property owner or authorized agen to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED rLnrrcHEccc�y. �:, ,r,�r.xo rrBv� sL� z .� .n;...:i New SFD or Multifamily dwellings: Apply for demolition permit for r OVER -"T, E[Ew.'06ft, BUH DING KLAN REW _ existing building(s). Demolition permit is required prior to issuance of buildingx permit for new building. EXPizEss ©LAIv?vlmG rAN REv>Ew r3 _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure0 sTANDARDx EUBLICWORKS '' form if any Hazardous Materials are being used as part of this project. 4,pgz _ Copy of Planning Approval Letter or Meeting with Planning prior to ivtA�oR K sAriTARY sEwmDisTlucT submittal of Building Permit application. BldgApp_201 Ldoc revised 06/21/11 In CITY OF CUPERTINO 7TTT TaTTA/f A TlIU 'UTTTT "PVC TI1V1C11l1N X. JLdX 1:l 1.J l itV AX TYPE OF CONSTR. FLR AREA s.f. PC FEES ADDRESS:/I 2- DATE: 08125/2014 BP FEE ID REVIEWED BY: larrys II-B,111-B,IV,V-B APN: APN: $2,715.89 IR3PLNCK VALUATION: $25,000 IBP4 *PERMIT TYPE: Building Permit PLAN CH CK TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? Yes C-9NoPENTAMATION 0 Yes E)No 1 R3SFDADD PERMIT TYPE: USE: OTC? WORK I addition of 1206 sq. feet enlarge existing arae add bathroom remodel dining, add master bed/bath SCOPE kitchen. Fire sprinklers will be added as a deffered submittal. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 1,206 $2,715.89 IR3PLNCK $1,887.73 IR3INSP Llerc. Irasp. Fee: l... 17- Qo imn j .CPWPr M.Wriet. School TOTALS: 1,206 $2,715.8911- $1,887.73 MECH, HOURLY 0 Yes ' Q No , PLUMB, HOURLY , 0Yes, No- ELEC, HOURLY 0. Yes Q' No ",ii.'c', ., . . 1'r2 ? t. . Tt'c.. (' lil'e'.rmir hetl. t'; ii±1E:%' �'18i'i't. hl. `,Y�. iii wr Ph;,,nu In'sl?. CI1hu :•teiL'. hap, Insp.T1/_ I'hlDttl,, h;.s}. F'c'e': Llerc. Irasp. Fee: l... 17- Qo imn j .CPWPr M.Wriet. School NOTE: This estimate does not mcluaejees aue to timer Lepureruerelj i..�.1 �•••••b, _ --�-- • • -• --_, _ __ District, etc . These fees are based on the prelimina information available and are only an estimate. Contact the Dept or addn'l info. FEE ITEMS (Fee Resolution 11-053 a.. 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,715.89 140 s.£ Remodel, Bath (<=300 sf) Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $645.00 IREMRESBAT PME Plan Check: $0.00 288 s.f. Remodel, Other Permit Fee: $1,887.73 $431.00 IREMRESOTH Suppl. Insp. Fee:Q Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: 1PLLONGR $168.84 Strong Motion Fee: 1BSEISMICR $3.25 Select an Administrative Item Blda Stds Commission Fee: IBCBSC $1.00 SUBTOTALS:. $4,776.711$1,076.001 TOTAL FEE: $5,852.71 Revised: 07/10/2014 0 Select allon-Residential -_1 Building or Structure 0 CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: t O L �— PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE. 'Our 'municipal code requires all businesses working -in the city to -have a City of Cupertino business license., NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL, CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not.usng any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass /Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date CUPERTINO PURPOSE UTILITY RELEASE REQUEST FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building acuoertino.org For residential single family or duplex construction, there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign -off of the building. INSTRUCTIONS 1. Download this form at: http://www.cupertino.org/index.aspx?page=297. 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3. Fax, E -Mail, Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Form 408-777-3228 office 10300 Torre Ave. 408-777-3333 fax Cupertino, CA 95014 building(a,cupertino.org 4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (#404). Please note, a Gas Test inspection (#506) is required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information): APN 05BLDG 70` PERMIT #: o DATE: 6 SITE g c�,�fn ADDRESS: )ova_ b oRoN t Iv EN UE � 1"�aTl)kPO OWNER'S NAME: ' 1 E -t go D D Tt7 1� PHONE M 409-51.S;-'70'25 FAX #: MAILING ADDRESS (if different from site address): CONTRACTOR: CS+ � G PHONE M slQ_ FAX #: 1 J ✓ CONTACT: PHONE M FAX # I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of I the building cannot move into the residence until they receive all of the required final sign -offs and the City has issued a certificate of occuoancv for the building. Owner: .............. Q�. ,..........................................Print:.% 1��5 }}PprN�� Date:.... .%... Cnntrartnr Jli n_/G.. l 1 ................... Print: �iA0 .1. r .......... .F.�...... � � ... �....... �.............. Date:. !. 114 UtilityReleaseForm_2011.doc revised 08109111 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: MR. DESHPANDE RESIDENCE Calculation Date/Time: 16:15, Fri, Mar 27, 2015 d Calculation Description: Title 24 Analysis Input File Name: 1405 Deshpande Residence.xml CF1 R -PRF -01 Page 1 of 7 GENERAL INFORMATION 01 Project Name MR. DESHPANDE RESIDENCE 02 Calculation Description Title 24 Analysis 03 This building incorporates one or more Special Features shown below 03 Project Location 10212 DUBON AVE This Certificate of Compliance is for permit applications made BEFORE October 13, 2014 04 CA City CUPERTINO 05 Standards Version Compliance 2014 06 Zip code 95014 07 Compliance Manager Version BEMCmpMgr 2013-2 (595c) 08 Climate Zone CZ4 09 Software Version EnergyPro 6.2 10 Building Type Single Family 11 Front Orientation (deg/Cardinal) 90 12 Project Scope Addition and/or Alteration 13 Number of Dwelling Units 1 14 Total Cond. Floor Area (FT2) 2328 15 Number of Zones 1 16 Slab Area (FT2) 0 17 Number of Stories 1 18 Addition Cond. Floor Area 0 19 Natural Gas Available Yes 20 Addition Slab Area (FT2) 0 21 Glazing Percentage (%) 113.5% COMPLIANCE RESULTS 01 Building Complies with Computer PerfoiLanc# 02 This building incorporates features that L,e uire field testing and/or verification by a certified HERS rater under the supervision of a CECapproved HERS provider. 03 This building incorporates one or more Special Features shown below This Certificate of Compliance is for permit applications made BEFORE October 13, 2014 ENERGY USE SUMMARY 04 05 06 07 08 Energy Use (kTDV/ftZ-yr) Standard Design Proposed Design Compliance Margin Percent Improvement Space Heating 21.03 18.65 2.38 11.3% .:_ Space Cooling 11.55 9.81 1.74 15.1% IAQ Ventilation 0.00 0.00 0.00 0.0% Water Heating rk12.26 8.39 3.87 31.6% Photo is Offset ---- 0.00 0.00 ---- ►e L 44.84 36.85 7.99 17.8% V ivamons Registration Number: 214-A0075584B-000000000-0000 Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08012014-595c HERS Provider: CaICERTS inc. Report Generated at 2015-03-27T16:17:56 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: MR. DESHPANDE RESIDENCE Calculation Date/Time: 16:15, Fri, Mar 27, 2015 Calculation Description: Title 24 Analysis Input File Name: 1405 Deshpande Residence.xml REQUIRED SPECIAL FEATURES The following are features that must be installed as condition for meeting the modeled energy performance for this computer analysis. • Ducts with high level of insulation • Non-standard roof reflectance • Window overhangs and/or fins CF 1 R -PRF -01 Page 2 of 7 PROJECT HERS FEATURES The following are project -level features that must be field -verified as a condition for meeting the modeled energy performance for this computer analysis. These, plus any additional HERS features listed in the building components tables below requre field verification by a certified HERS Rater. Check the individual building component sections below for any required HERS verification requirements. BUILDING FEATURE INFORMATION 01 02 03 04 05 06 07 Project Name Conditioned Floor Area (sft) Number of Dwelling Units Number of Bedrooms Number of Zones Number of Ventilation Cooling Systems Number of Water Heating Systems MR. DESHPANDE RESIDENCE 2328 1 4 1 1 1 ZONE INFORMATION 01 02 03 04 05 06 07 Zone Name Zone Type HVAC System Name Zone Floor Area (ft2) Avg. Ceiling Height Water Heating System 1 Water Heating System 2 House Conditioned Living spacel 2328 9 DHW Sys 1 Front Wall OPAQUE SURFACES 01 02 03 04 05 06 07 08 09 10 Name Zone Construction Azimuth Orientation Gross Area (ft2) Window or Door Area (ft2 ) Tilt(deg) Status Verified Existing Condition Front Wall House R-13 Wall 90 Front 395 55.008 90 New N/A Rear Wall House R-13 Wall 270 Back 700 79.992 90 Altered N/A Left wall House R-13 Wall 180 Left 804 73.992 90 Altered N/A Right Wall House R-13 Wali 0 Right 606 106.008 90 Altered N/A Roof House R-30 Roof 2328 Altered N/A Raised Floor House R-19 Floor (F19.2x8.16) 2328 Altered N/A Registration Number: 214-A00755848-000000000-0000 Registration Date/Time: HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08012014-595c Report Generated at 2015-03-27T16:17:56 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: MR. DESHPANDE RESIDENCE Calculation Date/Time: 16:15, Fri, Mar 27, 2015 Calculation Description: Title 24 Analysis Input File Name: 1405 Deshpande Residence.xml CF1 R -PRF -01 Page 3 of 7 ATTIC 01 02 03 04 05 06 09 10 11 Name Construction Roof Rise Roof Reflectance Roof Emittance Radiant Barrier Cool Roof Status Verified Existing Condifion Attic Attic Roof Cons 5 0.1 0.85 No No Existing No WINDOWS 01 02 03 04 05 06 07 08 09 10 11 Name Side of Building Width(ft ) Height (ft) Multiplie r Area (ft2) U -factor SHGC Exterior Shading Status Verified Existing Condition New Window Front Wall 6.0 4.0 2.292 55.0 0.35 0.32 0 New N/A New Window 2 Rear Wall 6.0 4.0 3.333 80.0 0.35 0.32 0 New N/A New Window 3 Left wall 6.0 4.0 1.75 42.0 0.35 0.32 0 New N/A Existing Window Left wall 6.0 4.0 1.333 32.0 0.35 0.32 0 Altered N/A New Window 4 Right Wall 6.0 4.0 4.417 106.0 0.35 0.32 New N/A DOORS 01 02 03 `' 04 05 06 Name Side of Building Area (ft2) U -factor Status Verified Existing Condition New Door Front Wall 42.0 0.60 New No OVERHANGS AND FINS 01 02 03 04 05 06 07 08 09 10 11 12 13 14 Overhang Left Fin Right Fin Window Depth Left Dist Up Extent Right Extent Flap Ht. Depth Top Up DistL Bot Up Depth Top Up Dist R Bot Up New Window 2 0.1 2 2 0 0 0 0 0 0 0 0 0 New Window 2 2 G.1 2 2 0 0 0 0 0 0 0 0 0 New Window 3 0 0 0 0 0 0 0 0 0 0 0 0 0 Existing Window 2 0.1 2 2 0 0 0 0 0 0 0 0 0 New Window 4 2 0.1 2 2 0 0 0 0 0 0 0 0 0 Registration Number: 214-A0075584B-000000000-0000 Registration Date/Time: HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08012014-595c Report Generated at 2015-03-27T16:17:56 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: MR. DESHPANDE RESIDENCE Calculation Date/Time: 16:15, Fri, Mar 27, 2015 Calculation Description: Title 24 Analysis Input File Name: 1405 Deshpande Residence.xml CF1 R -PRF -01 Page 4 of 7 OPAQUE SURFACE CONSTRUCTIONS 01 02 03 04 05 Construction Name Surface Type Framing Total Cavity R -value Assembly Layers Number of Heaters Solar Fraction (%) Ststus Verified Existing Condition Roofing: Light Roof (Asphalt Shingle) (HERS req'd) Pipe Insulation, All Lines 1 2x4 Top Chord of Roof Altered Above Deck Insulation - no insulation - Attic Roof Cons Attic Roofs Truss @ 24 in. O.C. no insulation - Roof Deck: Wood Siding/sheathing/decking Cavity: - no insulation - Inside Finish: - select inside finish - Attic Floor: - no attic floor - R-30 Roof Ceilings (below attic) 2x4 @ 24 in. O.C. R 30 Cavity: R 30 Sheathinglnsulation - no sheafhinghnsul. - Inside Finish: Gypsum Board Inside Finish: Gypsum Board Sheathing/Insulation: - no sheathingfinsul. - R-13 Wall Exterior Walls 2x4 @ 16 in. O.C. R 13 Cavity: R 13 Sheathing/Insulation: - no sheathinghnsul. - Exterior Finish: Wood Siding/sheathing/decking Floor Surface: Carpeted Concrete Fill: - no concrete fill - R-19 Floor (F.19.2x8.16) Floors Over Crawispace 2x6 @ 16 in. O.G. R 13 Floor Deck. Wood Siding/sheathing/decking Cavity: R 13 • Sheathing/Insulation: - no sheathinglnsul. - Exterior Finish: - select finish - WATER HEATING SYSTEMS 01 02 01 02 03 04 05 06 Name Distribution Type Number of Heaters Solar Fraction (%) Ststus Verified Existing Condition DHW Sys 1 (HERS req'd) Pipe Insulation, All Lines 1 Annual Altered No WATER HEATERS 01 02 03 04 05 06 07 08 Name Heater Element Type Tank Type Tank Volume (gal) Energy Factor or Efficiency Input Rating Tank Exterior Insulation R -value Standby Loss (Fraction) DHW Sys 1 Natural Gas Small Instantaneous 0.2 0.84 EF 199000-Btu/hr 0 0 Registration Number: 214-A0075584B-000000000-0000 Registration Date/Time: HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08012014-595c Report Generated at 2015-03-27T16:17:56 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: MR. DESHPANDE RESIDENCE Calculation Date/Time: 16:15, Fri, Mar 27, 2015 Calculation Description: Title 24 Analysis Input File Name: 1405 Deshpande Residence.xml CF1 R -PRF -01 Page 5 of 7 WATER HEATING - HERS VERIFICATION 01 02 03 04 05 06 07 Name Pipe Insulation Parallel Piping Compact Distribution Point -of Use Recirculation with Manual Control Recirculation with Sensor Control DHW Sys 1 Pipe Insulation, All Lines n/a n/a n/a n/a n/a HVAC SYSTEMS 01 02 01 02 03 04 05 06 07 08 09 Verified Refrigerant Charge Name Heating System Cooling System Zonally Controlled Compressor HERS Verification Living space l -cool SplitAirCond - Split air conditioning 11 3 13 No No Distribution Fan Floor Area Verified Existing Name System Type Name Ducted Name Ducted System System Served Status Condition Living spacel Other Heating and Heating Yes Living Yes Air Distribution HVAC Fan 2328 Altered No Cooling System Component 1 spacel-cool System 1 1 HVAC - HEATING SYSTEMS 01 02 03 Name Type Efficiency Heating Component 1 CntrlFurnace - Fuel -fired central furnace 93.1 AFUE HVAC -COOLING SYSTEMS 01 02 03 04 05 06 07 Name Verified Airflow Efficiency Verified EER Multi -speed Verified Refrigerant Charge Name System Type EER SEER Zonally Controlled Compressor HERS Verification Living space l -cool SplitAirCond - Split air conditioning 11 3 13 No No Living system space l -cool -hers -cool HVAC COOLING - HERS VERIFICATION 01 02 03 04 05 06 Name Verified Airflow Airflow Target Verified EER Verified SEER Verified Refrigerant Charge Living space l -cool -hers -cool Required 350 Required Not Required Required Registration Number: 214-A0075584B-000000000-0000 Registration Date/Time: HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08012014-595c Report Generated at 2015-03-27716:17:56 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: MR. DESHPANDE RESIDENCE Calculation Date/Time: 16:15, Fri, Mar 27, 2015 Calculation Description: Title 24 Analysis Input File Name: 1405 Deshpande Residence.xml CF1 R -PRF -01 Page 6 of 7 HVAC - DISTRIBUTION SYSTEMS 01 02 03 01 02 03 04 05 06 07 08 09 08 --- -- -- Insulation Supply Duct Return Duct Verify Existing HERS Name Type Duct Leakage R -value Location Location Bypass Duct Status Condition Verification Air Distribution Air Distribution Ducts located in Sealed and tested 8 Attic Attic None New No System System 1 unconditioned attic I I I I I I I I 1 -hers -dist HVAC DISTRIBUTION - HERS VERIFICATION 01 02 03 04 05 06 Name Duct Leakage Verification Duct Leakage Target (%) Verified Duct Location Verified Duct Design Return Supply Air Distribution System 1 -hers -dist Required 6.0 --- -- -- HVAC - FAN SYSTEMS & HERS VERIFICATION 01 02 03 04 Name Type Fan Power (Watts/CFM) HERS Verification HVAC Fan 1 Single Speed PSG Furnace Fan 0.58 Required COOLING VENTILATION 01 02 03 04 05 Name Cooling Vent CFM Cooling Vent Watts/CFM Number of Fans HERS Verification WH Fan 1 90 0.555556 1 Registration Number: 214-A0075584B-000000000-0000 Registration Date/Time: HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08012014-595c Report Generated at 2015-03-27T16:17:56 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: MR. DESHPANDE RESIDENCE Calculation Date/Time: 16:15, Fri, Mar 27, 2015 Calculation Description: Title 24 Analysis Input File Name: 1405 Deshpande Residence.xml CF1 R -PRF -01 Page 7 of 7 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: 494WAV�re - Helen Nguyen Company: Signature Date: IDA, inc. Address: CEA/HERS Certification Identification (If applicable): 510 Lawrence Expressway, #105 City/State/Zip: Phone: Sunnyvale, CA 94085 408-245-0991 RESPONSIBLE PERSON'S DECLARATION STATEMENT 1 certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. 2. 1 certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 3. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Responsible Designer Name: ResponsibleDesigner Signature: - Helen Nguyen Company: Date Signed: IDA, inc. Address: License: 510 Lawrence Expressway, #105 C-26137 City/State/Zip: Phone: Sunnyvale, CA 94085 408-245-0991 Digitally signed by CaiCERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 214-A0075584B-000000000-0000 Registration Date/Time: HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF111-08012014-595c Report Generated at 2015-03-27T16:17:56 SCUP RTINO PROJECT DATA - RESIDENTIAL COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingO)cupertino.org PROJECT ADDRESS t t 2 9 tkb o n Ave- APN # ?42„ 0 OWNER NAME I oe,twtA� �es `J n� PHONE D 3 �� � E-MAIL STREET ADDRESS 102(2 bubon �e CITY, STATE, ZIP e� ' FAX APPLICANT NAME John PHONE 99l E-MAIL ung u a,8 9. STREET ADDRESS CITY, STATE, ZIP D FAX ❑ OWNER ❑ OWNER -BUILDER 1:1 OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT p� A( ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT DESCRIPTION OF WORK To n K. :2 66 SE TV &E S tL EXISTING USE(S): C U f ZP5 � d 7PROPOSED r�ctr'a l USE(S): ( � OCCUPANCY(S): TYPE OF CONSTRUCTION: PARCELILJ //[[ AREA: a. /A vii.p E7 FIRE Y N SPRINKLERS: WUI AREA: Y FLOOD AREA: Y SIESMIC AREA: D N )In Existin Proposed Floor Area: First Floor: s.f. (, I v t I Q� S. f. = �' Second Floor: Q S.f. 0 s.f. V1P_ji 6AAj- 1'5 > Garage (� s.f. I,-T2' s.f. f, �� Af-f TOTAL: 5 — s.f. 1120 IM s.f. Are there at least two 10 feet by 20 feet clear spaces inside the garage? © N Is privacy protection planting required for the project? Y Governing Codes: 201fCalifornia Building Code (based on the 2009 International Building Code) 2011 California Residential Code (based on the 2009 International Residential Code) 201 California Plumbing Code (based on the 2009 Uniform Plumbing Code) 201$ California Mechanical Code (based on the 2009 Uniform Mechanical Code) 2011 California Electrical Code (based on the 2009 International Electrical Code) 2011 California Energy Code 2015 California Green Building Standards Code Cupertino Municipal Code ProjectData-ResidentiaLdoc revised 03/09/11 CALGREEN RESIDENTIAL CHECKLIST — MANDATORY ITEMS fI ffik MMUNITEVELOPMENT DEPARTMENT • BUILpI(�1G DIVISION GUi' O E1VfT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 AU6 201408) 777-3228 - FAX (408) 777-3333 • buildinaa_cupertirtq org PURPOSE: i by i The 201 de applies to all newly constructed hotels, motels, lodging houses, dwellings, dormitories, condominiumlters, congregate residences, employee housing, factory -built 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 Project Address: Deshpande Residence Addition 10212 Dubon Ave Project Description: To add approximately 1270 SF to existing single family house. Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 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. MANDATORY FEATURE OR MEASURE Column 2 Column 3 Project Verification Reauirements Planning and Design - Site Development 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during ❑X ❑ construction. 4.106.3 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how ® ❑ site grading or a drainage system will manage all surface water flows. Page 1 of 5 CalGreen_2014.doe revised 01/15/14 Outdoor Water Use 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the time of final inspection shall be weather -based. ❑ 4.304.1.1 Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as weather conditions change. ❑ ❑ 4.304.1.2 Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. A4.4 MATERIAL• •RESOURCE EFFICIENCY Enhanced Durability and Reduced Maintenance 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected ❑ against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a ❑ ❑ construction waste management plan shall be submitted for approval to the enforcing agency. Building Maintenance and Operation 4.410.1 Operation and maintenance manual. At the time of final inspection, an operation and maintenance manual shall be provided to the building ® ❑ occupant or owner. A4.5 ENVIRONMENTALQUALITY Fireplaces 4.503.1 General. Install only a direct -vent sealed -combustion gas or sealed ❑ wood -burning fireplace, or a sealed woodstove. Pollutant Control 4.504.1 Covering of duct openings and protection of mechanical equipment during construction. Duct openings and other related air ❑X ❑ distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks ❑ shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be ❑ compliant with VOC limits. 4.504.2.3 Aerosol paints and coatings. Aerosol paints and other coatings shall be compliant with product weighted MIR Limits for ROC and other toxic ❑X ❑ compounds. Page 3 of 5 CalGreen_2014.doc revised 01/15/14 A4.2 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 CONSERVATION Indoor Water Use 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following: ❑ 4.303.1.3.2 Water Closets. The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank -type water closets shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank -type Toilets. ❑ 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. ❑ 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. ❑ 4.303.1.3.2 Multiple Showerheads serving one shower. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be ® ❑ designed to allow only one shower outlet to be in operation at a time. ❑ 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less than 0.8 gallons per minute at 20 psi. ❑ 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas (outside of dwellings or sleeping units) in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. ❑ 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. ❑ 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, © ❑ and shall meet the applicable standards referenced in Table 1401.1 of the California Plumbing Code. Page 2 of 5 CalGreen_2014.doc revised 01/15/14 4.504.2.4 Verification. Documentation shall be provided to verify that © ❑ compliant VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with ❑ ❑ VOC limits. 4.504.4 Resilient flooring systems. Eighty (80) 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 ❑X ❑ Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Composite wood products. Particleboard, medium density ❑ fiberboard (MDF), and hardwood plywood used in interior finish systems shall ❑X comply with low formaldehyde emission standards. Interior Moisture Control 4.505.2 Concrete slab foundation. Required vapor retarders and capillary ❑ ❑ breaks are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture content of building ❑ ❑ materials used in wall and floor framing is checked before enclosure. Indoor Air Quality and Exhaust 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the ❑ ❑ building are provided in every bathroom. Environmental Comfort 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 equivalent. ❑X ❑ 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 Installer training. HVAC system installers are trained and certified in ❑ ❑ the proper installation of HVAC systems. 702.2 Special inspection. The Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the ❑X ❑ discipline they inspect and verify. Verifications 703.1 Documentation. Verification of compliance with CALGreen may include construction documents, plans, specifications, builder or installer certification, inspection reports, or other methods acceptable to the enforcing a ❑ 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_2014.doc revised 01/15/14 Project Name: Project Address: Project Description: CALGREEN SIGNATURE DECLARATIONS Deshpande Residence Addition 10212 Dubon Ave To add approximately 1270 SF to existing single family house. 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 2013 California Green Building Standards Code as adopted by tha-City of Cupertino. Owner's Signature I `r Jeetendra Deshpande Owner's Name (Please Print) Signature Design Print) for CalGreen compliance Name of License Professional responsible for CalGreen compliance (Please Print) t,6(0- & E ail Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION 06/23/2014 Date Date Date 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 constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen_2014.doc revised 01/15/14 CALGREEN RESIDENTIAL CHECKLIST MANDATORY E COM NITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 12-z� IDD Gu I Ttc O�OOT ORRE ORADVEENUEECU ERTINO, CA 951 '5rte � b- (408) 777-3228 • FAX (408) 777-3? bcildrngbOcOp&Ll'n( olg_I E�� /" 3` PURPOSE '_ . G d0i �u a�u A NG The 2013 CalGreen Code applies to all newly constructed hotels pt- PQc c i� � us�"�"esPA,kellings, dormitories, condominiums, shelters, congregate resdences,�Cem�plo ee hola�Iiigactory-wilt 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 :_3-Deshpande Residence Addition Project Address: "--\.l 0212 Dubon Ave -5. Project Description: To add -approximately 1270 SF to existing single family house. Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 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 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during OX construction. 4.106.3 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how El site grading or a drainage system will manage all surface water flows. Page 1 of 5 CaZCrreen 2014.doc revised 01115114 Page 2 of 5 CaICTreen_2014.doe revised 01115114 '5_ Is - 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 CONSERVATION , MW 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following: ❑ 4.303.1.3.2 Water Closets. The effective -flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank -type water closets shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank -type Toilets. El 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. ❑ 4.303.1.3.2 Multiple Showerheads; serving one shower. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. ❑ 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less than 0.8 gallons per minute at 20 psi. El 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas (outside of dwellings or sleeping units) in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. El 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. El 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California, Plumbing Code, and shall meet the applicable standards referenced in Table 1401.1 of the California Plumbing Code. Page 2 of 5 CaICTreen_2014.doe revised 01115114 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the X❑ time of finalr inspection shall be weather -based. ❑ 4.304.1.1 Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as weather conditions change. ❑ ❑ 4.304.1.2 Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the controller(s),. Soil moisture -based controllers are not required to have rain U sensor input. .. .4 MATERIAL CONSERVATION AND RESOURCE EFFICIENCY 4.406.1 Rodent proofing. Annular spaces around pipes electric cables, conduits, or other openings in plates at exterior walls shall be protected 0 against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a E construction waste management plan shall be submitted for approval to the enforcing agency. 4.410.1 Operation and maintenance manual. At the time of final inspection, an operation and maintenance manual shall be provided to the building OX occupant or owner. 4.503.1 General. Install only a direct -vent sealed -combustion gas or sealednX wood -burning fireplace, ora sealed woodstove. 4.504.1 Covering of duct openings and protection of mechanical X❑ equipment during construction. Duct openings and other related air distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be compliant with VOC limits. 4.504.2.3 Aerosol paints and coatings. Aerosol paints and other coatings shall be compliant with product weighted MIR Limits for ROC and other toxic U compounds. Page 3 of 5 CaZGreen 2014.doc revised 01/15/14 4.504.2.4 Verification. Documentation shall be provided to verify that compliant VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with VOC limits. - 4.504.4 Resilient flooring systems. Eighty (80) percent of floor area receiving resilient flooring shall comply with the VOC-emission limits defined in the Collaborative for High Performance Schools (GNPs) Low -emitting 0 Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Composite wood products. Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall ❑X comply with low formaldehyde emission standards.. 4.505.2 Concrete slab foundation. Required vapor retarders and capillary I l breaks are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture content of building materials used in wall and floor framing is checked before enclosure. 4.506.4 Bathroom exhaust fans. Exhaust fans which terminate outside the building are provided in every bathroom. 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 ACOA Manual J or equivalent. Ell 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. 702.1 Installer training. HVAC system installers are trained and certified in ©, the proper installation of HVAC systems. 702.2 Special inspection. The Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the QX discipline they inspect and verify. 703.1 Documentation. 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 2014.doc revised 01115/14 CALGREEN SIGNATURE DECLARATIONS Project Name: Deshpande Residence Addition Project address: 10212 Dubon Ave Project Description: To add approximately 1270 SF to existing single family house. 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 2013 California Green Building Standards Code as adopted by the -City of Cupertino. WQ 06/23/2014 Owner's Signature Date Jeetendra Deshpande Owner's Name CPe Print)o Design Professional's Signature Date Design Profession ' am%,.(=P ase Print) 7-f 2,0 1 atureflfdLicense-Prrofessio , Er4onsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Enl6il Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION 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. have inspected the work and have received s claPt d5fation to verify and certify that the project identified above was constructed in accordan'.,,_this'--_n-Building Checklist and in accordance with the requirements of the 2013 California Green ids r s Code as adopted by the City of Cupertino. ` f Sig for CaPGTseD Name of License Professional responsible for CalGreen compliance (Please Print) for License Professional responsible for CalGreen compliance Page 5 of 5 Date / Phone CalGreen 2014.doc revised 01115114 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: leetendra Deshpande Enforcement Agency: City of Permit Number: C� 14080244 Building Type from CF -111 Cupertino 04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from CF1R? Dwelling. Address:;�1021�2.iD.ubam Atienue City: Cupertino Zip Code: 95014. 06 Duct System Compliance Category "" . - Alteration 07 A. System Information 01 Space Conditioning System Identification or Name System 1 02 Space Conditioning System Location or Area Served Whole house 03 Building Type from CF -111 Single family 04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from CF1R? No, credit is not taken 05 Verified Low Leakage Air Handling Unit (VLLAHU) Credit from CF1R? No, credit is not taken 06 Duct System Compliance Category "" . - Alteration MCH -20d,- Complete Replacement or Altered Duct System.. s B. Duct Leakage DiagnosticTest _ - 777 01 Condenser Nominal Cooling Capacity (ton) 0 02 Heating Capacity(kBtu/h) 95 03 Conditioned Floor Area served by this HVAC system (ft2) 2300 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.15 07 Air Handling Unit Airflow (AHUAirflow) Determination Method Heating system method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage (dm) 309 10 Actual duct leakage rate from leakage test measurement (cfm) 105 = 11 Compliance Statement System passes leakage test Registration Number: 216-A0410378A-M2000002B-0000 Registration Date/Time: 2016-11-17 22:23:50 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-11-15 18:22:21 2013 Residential Compliance Schema Version: 2013.1.007 ri CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3 C. Additional Requirements for Compliance 01 System wastested in its normal operation condition. No temporary taping allowed. Outside air (OA) duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage 02 testing. OA ducts used for Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan Ventilation Cooling Systems, that utilize dampers that open only when OA is required and automatically close when OA is not required, may configure the OA damper to the closed position during duct leakage testing. 03 If a complete replacement, all supply and return register boots were sealed to the drywallr. 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All connection points between the air handier and the supply and return plenums are completely sealed. If the system compliesusing the Smoke Test method, the smoke test was conducted in accordance with the requirements 07 of Reference ResidentialAppenclix RA3.1.4.3.6. Systems that comply using smoke test shall not be included in sample groups for HERS verification compliance. The responsible pers6nssignature on -this co 'm'pl!6n'ce.docuf6erit,-affinhs:that ail applicable requirements in thistable have been met. Registration Number: 216-A0410378A-M2000002B-M CA Building Energy Efficiency Standards 2013 Residential Compliance Registration Date/Time: 201641-1722:23:50 HERS Provider: CaICERTS Report Version: 2013 Rev 1.008 Report Generated: 2016-11-15 18:22:21 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3 ) Documentation Author's Declaration Statement 1. I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: or Justin Myers Company: signature Date: 2016-11-15 18:21,50 Innovative Energy Solutions Address: CEA/ HERS Certification Identification (if applicable): 24 Timber Cove Dr CC2006657 City/State/Zip: Phone: Campbell CA 95008 408-856-5250 Responsible Person's' Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Installation is true and correct. 2. 1 am eligible under Division, 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to ail applicable codes and regulations,; and the installation conforms to the requirements given onlhe plans and specifications approved by the enforcement agency r�: 4. I understand that a HERS rater will, check the rnstailatron to vQnfy c. pliance, an i that rfsuch checking idenxif�es defects; I am required ta'iake" corrective action at.my expense: 16nderstand`that Energy Commission and HERS Provider representatives will b so perform quality assurance checking of installations, indudmg those approved as pa'- a sample group but checked by'a.HERS rater, end if those mstallatinns fail to meet thq; , requirements of such quality 'ass prance checking, the required corrective action and additional checking/testing of other installations in that HERS] sample group will be performed at my expense.--- ti 5. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of installation, and I have ensured that the requirements that apply to the construction or installation have been met. 6. 1 will ensure that a registered copy of this Certificate of installation 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 registered copy of this Certificate of Installation is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Builder/installer Name: Responsible Builder/Installer Signature: Louis Aranda Company Name: (installing Subcontractor or General Contractor or Position With Company (Title): Builder/Owner) Owner BAY AREA HEATING & AIR CONDITIONING Address: CSLB License: 1805 LITTLE ORCHARD ST #137 931855 City/State/Zip: Phone: Date Signed: SAN JOSE CA 95173 4008-674-6845 2016-11-17 22:23:50 Third Party Quality Control Program (TPQCP) Status: Name of TPCtCP (if applicable): Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in no way"impiies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0410378A-M2000002B-0000 Registration Date/rime: 2016-11-17 22:23:50 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-11-15 18:22:21 2013 Residential Compliance Schema Version: 2013.1.007 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION Ct)PERTIN0 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aOcupertino.org zt Q f X02- 1 k) 12� r � � o ar is Qke Cafhaii-Mouoxide• PERMIT CANNOT HE F, INALED AND COMPLETED UNTHs THIS CERTIFICATE INGD.1 tN PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required u1 dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access. by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s), referenced above has/have been installed in accordance with the manufacturer`s instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. T Smoke and. CO fornz.do.c revised 63'/L8/I4, WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • _buildingCED-cupertino.orq Owner Name 4 � � P,A Kr b ca Permit No Imo) 0 90 2-� Address % t b °)— p ii ( als d l l -I 1. Is your real property a registered historical site? El Yes ' Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Z- No Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. 2 No Go to Question 3, 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 1�i No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, ,1994? ❑ No My real property is built and available for use or occupancy after January 1,1994. Civil � Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. .1 C�Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: Z' My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non- compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). El My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). 1, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. ?� . , (1 P % ns,p � _., , 4 , Owner or Owner Agent's S Unon mmnletinv and ciuning this Certificate_ nlease return ,it to the Building Division in order to final vour building nermit SB407 2015.doc revised 08126115 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shovel, it is not required to be upgraded. SB4072015.doc revised 08/26/15 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div, 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets — Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shovel, it is not required to be upgraded. SB4072015.doc revised 08/26/15