The URL can be used to link to this page

14110024CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22354 RIVERSIDE DR CUPERTINO, CA 95014-3982 (356 02 012) CONTRACTOR: (ALMO PERMITN- L CONSTRUCTION INC) REDWOOD CITY, CA _ OWNER'S NAME: Tehram 94063 Saied Trustee & Et Al DATE ISSUED: 01/12/2016 OWNER'S PHONE: PHONE NO: IrPdSED nNT1oarrmrr'gDirr .TrraN BUILDING PERMIT INFO: License Class Lie. # '9 Contractor {_A_ LMO CONSTR irTlrlN INC) Date X BLDG —ELECT — PLLTMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: i hereby affirm under penalty of perjury one of the following two declarations: CONSTRUCT ONE STORYADDITION 734 SQFT;REBUILD ATTACHED GARAGE 483 SQFT INTERIOR REMODEL 1887 r. 1 have and will maintain a certificate of consent to self -insure for Worker's SQFT. Compensation, as provided for by Section 3700 of the Labor Code, for the Performance of the work for which this permit is issued. REVISION #2: Provide additional details for bay window and garage x. I have and will maintain Worker's Compensation Insurance, as provided for framing; Change vvood beam to steel beam in living room. by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq, Ft Floor Area: Valuation: $0.00 AT'I'LICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: - Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby 356 02 012 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 PERMIT EXPIRES IF WORD IS NOT STARTED expenses which may accrue against said pity in consequenceof the granting of this permit. Additionally, the applicant understands and will WITHIN 180 DAYS OF PERMIT ISSUANCE OR comply with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED IiNSPECTION. Code, Section .18. Issued by: 1445 Signature Date Date: RE -110091 OWNER-BUII DER DE LARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for r. 1, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: r.. I, as owner of the property, am exclusively contracting with licensed Date: contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the fallowing three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. 1 have and will maintain Worker's Compensation Insurance,. as provided for California health & Safety Code, Sections 25505, 25533, and 25534. 1 will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of Califomia. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sectio 505, 25533, and 25534. exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall Owner or authorized agent: be deemed revoked. Date: APPLICANT CERTMCATION CONSTRUCTION LENDING ADENV I certify that 1 have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. t agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (See. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (Vve) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in of the granting of this permit. Additionally, the applicant ARCHITECT'S DECLARATION understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9.18. Licensed Signature Date Professional CONSTRUCTION PERMIT APPLICATION _ CONhliUNIi i'I',EVcCOPI;1ii=NT'DTP,t,Ri'hliENT ; BUILDING DIVISION' i 0300 i ORRE AVENUE • CUPER 11NO, CA 95011-3255 CUPERTINO (408)777-322B-Fr.X(408) 777-3333 buildino .cune;<in0.0T0 (: NEW G01i5UCTlON (7T TSIO Dart. _ OP -Tc --1 eT pER?r�7 � ?RD:r.CiADD?FSS21 - ?i3n q :.+:al.r.:i't2�.t7r• V:. rrUY,fi i� i :td 6 5 A J.nPl l n J— 1 a -L DDI. i K i, !J t i 1 /'9f Ylt bvA, & L m,,i ;11' E�G57�Gi3SE 1 r'?0?OS.'ct7t3•-_ ( Oii%?:aRldAl✓� �f, t��.�--�--' , I ,I.I�_ �� . Y I✓.?� . ST? •t F�7P� SS u Y, STAi--, ZIP .TAX COIv7ACT N,� vE j Q j PHONE £ ` 2.6 E STRcit J.ZDRSS C.'+TY,STAT�_ ZIP 'rAn q OT+?wB. Q..:011'!ti.R-9L'7�£t; ❑ Dit:k=i2hCR°t Q CO?v7":�{CTOR ❑ GO?\fi.6C?Oi2AT -❑ ?2C-.-7BCYE COIvTPJ C70R7 Ah£ LI Cr� Si?vIA.3- (� LICENSE i Y'rn .'„?Gir`.-__^_,�, © L1L0? G '-• � BvS. LIC r V?.LUATIO*i ;S) c1', _tG J ?vnNr OAR FAX srR r ADDS Ss (ctIY, Srh *B� Z:._ Pxclm C--N.SB BUSLIC AR.cR I{ i Yl tC)�� B3si{} 5 '' CS SLPi'cTADDRPS$ /' i t'1'TCA� c;Y,>t� =.zl i gaor q :.+:al.r.:i't2�.t7r• V:. rrUY,fi i� i :td 6 5 A J.nPl l n J— 1 a -L DDI. i K i, !J t i 1 /'9f Ylt bvA, & L m,,i ;11' E�G57�Gi3SE 1 r'?0?OS.'ct7t3•-_ ( CG?.'S'tn.i1?£ ( :'STORIES j USE I T P OCC. i iii SQ.iT V?.LUATIO*i ;S) c1', _tG J ?vnNr OAR DI7.40 iGi?y AR.cR I{ ��.2h A.� � l�yThP`A � � �L'4i0D5L - ?GRCd a=_A DECK Awl.{ ++ TOTALD-Ci;..r.'CRC3 � i ❑ATiAC:3 �. ISA S£CONDUTNErr IDY=S- SBCONDSTOPY ©Y_s SUNG ADDED r_J":"*0 ADDITION 1 Quo PP L n +CAT,ON (]S S a=FA9tT,1G?=rL ,: []IoLl.?c'7ti�G?°?RO\?T i YS PROt 7 CDPYO? TTia2 Uin BLDG A t r?Cr.Lu230hiE. ❑ =5 QIaA tTs ,O Its: TOT. =i Vs7 -+ - - F - F` Y i ut c at t elect. -tECTA tO a" OR :fie p OD TEY OV;'Der'S behalf. j. have ad this applicztion ---I)d 'th ipso , a on I hF Drop Ided is � +iidir.� co.:sem p.,ocoply=happlIc_e, irz ,ces and state l ,s r l_.e local D a _= d o -o qct j or msvec.fan purposes. D?te: - — --_1i sU??i.-k Nl EN MAL -11NIFOISiATIONREQU RED Ne�� SFD c; Nnl ifzr�i?y &,veLinp: Apply i0r dernolition per -±it -er eh st;Dg lc n s . Ders-olition e—m- t =s -ee= ctrl 41 Q i) i prior o i-su�c o; b=.z_d•-.� perp. it for naw bpildiDg. _Gori,-tercGi �le;s: Provide z corr<DlEied '__zea; eotls Naze, {als Disc?Asure. TAr.n i any 12Z_ G'us R:e�e-ials J:e vein.- usad as part of thi's roject. Copy ofPlan i nd Approval Letter or-lvj�eelmlg with al-nzi=g prior to sLl�_}ettzl OI BLrldLig 11' en -wit, apDlic8 iOIl, C3? a �a_2©Il.uoo revised 06121/11 0 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22354 RIVERSIDE DR CONTRACTOR: ALMO CONSTRUCTION PERMIT NO: 14110024 OWNER'S NAME: TEHRANI SAIED TRUSTEE & ET AL 370 CONVENTION WY 312 DATE ISSUED: 05/01/2015 OWNER'S PHONE: 4802969186 REDWOOD CITY, CA 94063 PHONE NO: (650) 610-9300 fo LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ License Class C 6��, CONSTRUCT ONE STORY ADDITION 734 SQFT;REBUILD c. # ATTACHED GARAGE 483 SQFT-INTERIOR REMODEL 1887 _ Z _ l Contractor ` ' Date SQFT. I hereby affirm that I am licensed under the provisions of Chapter 9 REVISION #1 • REPLACE EXISTING FLOOR FRAMING (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. THROUGHOUT; REVISE THE LAYOUT IN TWO BATHROOMS; REVISE TYPE OF SLIDING DOOR IN I hereby affirm under penalty of perjury one of the following two declarations: LIVING ROOM.- ISSUED 8/24/15 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: $465000 performance 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 permit is issued. APN Number: 35602012.00 Occupancy Type: 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 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSP CT JON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of theC r �6 granting of this permit. Additionally, the applicant understands and will comply Issued by:?naa) `"'��v� `r Date: with all non -pointe ourc r ulations per the Cupertino Municipal Code, Section 9.18. s �S RE -ROOFS: Signature Date 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 . I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) I, 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, Sectior 55055533, and 25534. T Section 3700 of the Labor Code, for the performance of the work for which this k Owner or authorized agent: Date:y l _ is 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CONSTRUCTION PERMIT APPLICATION COMIJiUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 9501�C(c(�} CUPERTfNO (408) 777-3228 - FAX (408) 777-3333 • building a( cu' p"ertino ❑ 1,TFW COWS-TRTTCTTnN n a rmrrrnl l F-1 ATT=D A TTIIT i— f;ZT - - - +yam t G1�1Y111 PROJECT ADDRESS 17,3'! _ APN R � a� 0�' d 1-2 OWNER NAME •® - PHO E-MAIL STREET ADDRESS CITY, STATE, ZIP I FAX CONTACT NAME C) PHONIE E-MAIL 9 STREET ADDRESS;, GDj r CITY, 5TATE, IIP� FAX OR'NER ❑. OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGElTf R<C=CT ❑ ENGINLT cR ❑ DEVELOPER ❑ TENANT CONTRACTOR NAI IE LICEI SE NIJ11BER I LICENSE -TYPE BUS. LIC O am C 01,2AN-Y NAME E-MAIL I FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE DUMBER AW IA ®MA _� BUS. LIC R COMPANYNAb e � 9pq ,To WA��Oe'dd� F.-MP.IL "" - ,4 - eA, fle@ � FAX STREET ADDRESS �. CITY, STATE, ZIP -- PHONE DESCRIPTION OF WORK ®j4 Ex15 G SE PROPOSED USE CON'S TR TYPE r S ORIES USE I TYPE OCC. SQ.FT. LVALUATION (S) E50STG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA —_— — BATHROOM 1 KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH ?.ILA GARAGE AREA: DETACH A -I rACH I ,". DWELLING UNITS: IS A SECOND UNrf ❑ YES SECOND STORY ❑YES - BEING ADDED? EjNo ADDITION? E]NO I PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YE53C$IVE,,p - ` _.1 - -_.A TOTAL V ' PLANNINTGAPPLR ❑NO PLANNING APPROVAL LETTER EICHLERHOME? E] NO - - _ ' By my signature below, I certity to ea of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information 11, e provide is correct. Ihave re the Description of V7ork and verify it is accurate. I agree to comply with all applicable local ordinances and state lays relating o building nstruction thorize repre atives'of Cupertino to enter the above -identified for inspection property purposes. Signature of Appl icant/Agent: Date: SUPPLEMENTAL INFORMAT N QUIRED =� - _� OBER THEECOTJhTER — New SFD or Multifamily d;vellings: Apply for demolition permit for existing building(s). Demolition is to issuance building -Mm BUIL )LNGPiNREV.TEF T� permit required prior of permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used this ssp�DaRD _-- puB c Olzuc as part of project. L iAR�5 .FRtEDEET _ Copy of Planning Approval Letter or Meeting with Planning17 rior to 0 submittal of Building Permit application. � �] M++70R h,,, _� . r iI-� "!A3vTPA.RY SE;'iRiDT57'RTCT`J 'S B1dgf4pp_2011.doc revised 06121.11 N -kr CITE' OF CUPERTINO FMM�E__ FEE ESTIMATOR - BUILDING DIVISION "WFADDRESS: 22354 Riverside Drive DATE: 08/04/2015 REVIEWED BY: Sean ,i•lech. Permit Fee: APN: BP#: 'VALUATION: $0 PERMIT TYPE: Building Permit PLAN CHECK T E: Alteration / Repair PRIMARY SFD or Duplex lace. Insp. Pec:: PENTAMATION USE: $0.00 PERMIT TYPE: 1 GENRE i WORK SCOPE $0.00 NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminary infnrmntinn availably ns,d nra .,Hi„ my t;"!.,io FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13 j11eck Plan Check Phimb. Plan Oieck Elee. Plan Check ,i•lech. Permit Fee: Plumb. Permir Fee:l_lec. Pen�rit Fee: Other 1 Leek h?SP• Other Plumb hap. Orh<er Klee. lisp. Li I il9ech. hap. Fee: Phimb. Insp. Fee: lace. Insp. Pec:: NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminary infnrmntinn availably ns,d nra .,Hi„ my t;"!.,io FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (F) No $0.00 hours $286.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: (E) Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp-. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tux: A(Infrrns/ratn'e Fee: 0 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 Travel Doclnneniation fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 - SUBTOTALS = $0.00 $286.00 $286.00 Revised: 07/02/2015 it L CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 22354 RIVERSIDE DR I CONTRACTOR: ALMO CONSTRUCTION I PERMIT NO: 14110024 OWNER'S NAME: TEHRANI SAIED TRUSTEE & ET AL OWNER'S PHONE: 4802969186 IF LICENSED CONTRACTOR'S DECLARATION License Class C. Lic. # 6 (P ` 25 4 -1 Contractor A lv% o C Oq S+ry ch 0'n Date 6-? l -) S 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. 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 performance 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 permit is issued. APPLICANT CERTIFICATION 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 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 regulations per the Cupertino Municipal Code, Section 9.18. Signature Date (O .Z 2 ^ 1S ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons:' 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 performance 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 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 Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 370 CONVENTION WAY I DATE ISSUED: 05/01/2015 REDWOOD CITY, CA I PHONE NO: 650-610-9300 BUILDING PERMIT INFO: BLDG ELECT PLUMB r— MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: CONSTRUCT ONE STORY ADDITION 734 SQFT;REBUILD ATTACHED GARAGE 483 SQFT-INTERIOR REMODEL 1887 SQFT. Sq. Ft Floor Area: , I Valuation: $465000 APN Number: 35602012.00 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 W7M LAST CALLED INSPE TIO . Issued by: �- Date. RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sectiygs 2550 ",55339 and 25534. Owner or authorized agent: L Date: G -7-2 -1 S CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTIPt0 I (408)8) 728 •FAX (407-3333 • building(a�cupertino.org ❑ NEW CONSTRUCTION ADDITION ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS j � � "4' P—� W iv, � e �� APN # OWNERNAMEv� �--T PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NA MEAW i PH O^E E-MAIL o� STREET ADDRESS CITY, STATEZIP FAX , ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �- • LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAILFAX STREET ADDRESS CITY; STATE, ZIP PHONE. DESCRIPTION OF WORK � F -7-3 (j le"✓ &I /' d O EXISVNG USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE ;12 OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL NET AREA is AREA AREA q- 3 q AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA 7 PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH pti3rATTACH I #DWELLING UMTS: IS ASECOND UNIT ❑YES SECONDSTORY ❑YES BEING ADDED? ❑ NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPR LbF`TiER IS THE BLDG AN [:]YES EICHLER HOME? ❑ NO D - TOTAL VALUATION: By my signature below, I certify to e ch of the following: I am the property o er or o Iced ac the property owner's b alf I have read this application and the information I h e provided is c ect. I have r escription 0 ork and vers it is accurate. I agree to comply with all applicable local ordinances and state laws relating o buildin const etion. Orize represen 'ves of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATI D `- PLANCHECx TYPE ROUTING SLIP - p' 0 "R -THE COUNTER ❑ •BUILDiNGPLANREVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. 0 EXPRESS ❑ PLANNING PLAN:REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure TANDARD ❑ -rtiBl rcwolixs . _ form if any Hazardous Materials are being used as part of this project. r ' 1-i LtiRGE '.- ❑ ..FIRE DEPT. _ _ Copy Of Planning Approval Letter Or Meeting with Planning prior t0 Q� MAJOR;'. - - El "SANITARY SEWERDTSTRICT submittal of Building Permit application. ❑' "ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION SS: 22354 Riverside Drive FAPN: DATE: 11/04/2014 REVIEWED BY: Sean PC FEES BP#:p? *VALUATION: $465,000 PERMIT TYPE: Building Permit R-3 (Custom) PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: IR3PLNCK 2nd Unit? Yes E) No OTC? 0 Yes No PENTAMATION 1 R3SFDADD PERMIT TYPE: i WORK Construct one story additions 734 sq ft); Rebuild attached arae 483 sq ft); Interior remodel 1887 s SCOPE I ft). $1,290.00 1U1INSP OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 734 $2,654.00 IR3PLNCK $1,666.00 1R3INSP U (Private Gar/Ag Bldg) II-B,III-B,IV,V-B 483 $0.00 IUIPLNCK $1,290.00 1U1INSP Permit Fee: $2,956.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 1,217 $2,654.00 _ $2,956.00 MECH,`HOURLY 0 Yes : ) No PLUMB, HOURLY . 0 Yes E) No.' ELEC, HOURLY 0 Yes Q No irrelr. Ere% tfrJ;11. 1,f%NeCf 1`;i? °..'k%PTt; >.7ztck Ak,J1. 7i 1- Plumb. EE s.f. $5,172.00 Remodel, Other IREMRES2 : ,Irk;` i •at)t.., r,'sn. El r.. 0.0 rhiliti', 1:7`,','7_ Fee: 1:iciC. insp. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, fire, Sanitaryfewer -uturacq L—nuut A J w il.o oroliw.iL/nr,i i., fnr,a,n/inn nvni/nhln and arP_ only an estimate. Contact the Dept for addn'l info. LLJL/LVL, u=. 1/L 1J 111 w/a: //wJc.w vLr r.ra. ...rr•. rr.rw. FEE ITEMS (Fee Resolution 11-053 Ef . 7f /1/13) ... ...-..---.-•- _--------- FEE ------ --- - QTY/FEE - MISC ITEMS Plan Check Fee: $2,654.00 EE s.f. $5,172.00 Remodel, Other IREMRES2 Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,956.00 Suppl. Insp. Fee:Q Reg. Q 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: IPLLONGR $170.38 _ Select a Non -Residential Building or. Structure Strong Motion Fee: IBSEISMICR $60.45 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $19.00 SUBTOTALS: $5,859.83 $5,172.00 TOTAL FEE: $11,031.83 Revised: 10/01/2014 I U. �.uptzluno aun❑tng vepL. rage /- or / Lu] 1-Ul -21 .zs:1 zau (UIVI 1) r-rom: an moghaooam / .. .. .s Ir 9 . t . 1"J' rI Z'4 1 1 4 i,! 'I-... .. .. . .. :. ._.. .. .,.. ..., .. _ ._.._ .. '. .. ... .. � ... UA..�i tti. ) y . - -y...t { yay.�r a , A 1 »,1.¢-v4i �rC y .� S�[ I ,; .,, C�y^t!J[� » E}W,�} , fF"'t {5, qy�� f y# m}" .y� � "��$ g fi Y ' - ' . .. .. ... . L j ar, e � 'i` -_ ` .. .... _._ ( _ } F �x iYt.�E} !tea 1 i- i tk� <Y�� d , yt o y tJ }51ppa r * 1.,1t.! Fr 6� 'Ps -. -- Pa t W 1 �3{ii. K< .i`7 }' ! S 1 t'ti / I )�%i d .}4 r : i "K.' .- �"".� .t ' % k. 4i i r !t c.., .1 " , i � ly E - � 7 t. 1 f l E ` /(/"% .,'e/��/ I— k - i. C,. : j S I� 5 )� k C t rf 1E t4 s`' p r a i x br$i F.3 a i t .�.�L. •-,6,ii"�...1 .r` 1� 4 i. i-, I.E ��ya !}, .� 1� Y2P�k _�y, 'j t ff, r pp p .E I'�i$ 4YY(Cr7 l.ifi..1 '.0 t •!,'xfC. ...z.k C } -, �4 A 44 9:at,`.�ffl .�e.s q ; F.f$3.j fv 5.� k j�-'+:2 .� Ski .fit'' CF. ' fil P. ', ')i rY "J' YSi �r.;, 'tt �b .�. 4.A .r' ' ' , lE" TY -r!cpyy y�i�pp "t:" 3., y.YY.r'.T.1^-%t-2- -� r,�-Y y...$ Y 5 .h, S.4:s�. 2:'."t'S F3- ti1. i -:}t ._ t ..k. P'v..% ."ti.i M1 �_ '_1.3. .:1. 3'.� S`J J.Y`P- W.I o r tt�k. ,: t, •, f 'f ti.�.�P3 )e t p ff� �, 3.r' _ kh3. .,'E .tL.. .. _. .r. 2 -F�. .T _ -. yy.Y- . ...- v`::.X S� S'i4 -F ',A. i.�d //]'.SSS 3 .kx%. j'J,. r' :^ i S 3 5' 9 i 2 .k £ 'YI :.5 '-.7 liF3£ y y' ' ^ Q ;i.3.1 5. F� �,,1j $�w G...: ti. 4 .-iT.t - �d..F1 % !� �...f g. .f1 S 1. 1..,'§, Z"K,.}.,` -. ..._ 3 . 0. -. _ .. ,-r. - _ % 1 . ; '.. -.. .. ... .. .. .. .. �' [" �ryS l (C t y, tt,, --aay y pp vy-� Y, p �� ( y a^ } /, y 'yF c1 t1 y i Y�si.st. f�m a- C ..,Rt'A'dlY tiSS 3.."}Y.to `f r yY � �'i pp S.. F' SO SS x'1'19 }�_.'t4 io t�fi��"a i� L Y �i .iS�S.Gi.R .L :`Y. -p' .=R at'y - ^ 5 t'3fi�� .;. 3 i��1 t)R-$� $. to,_ ;,'SSS t _'4 -- t'. `` v, E . .. T -- i @i f, — I'�,Gp fit_ F:*}F E i.i.r a 9r,i JN r/yj jr 1) .. "l�.r �. :.1 �.,, ��' �- t ..F � _— _ :'_II ,. . ; ! 9'! Ysf I !. �. .- .. 4:. U �." §_` i _k. .' ¢y.i.. : .. td� :-, ... _'..:-.-__....-.__.___—_,_�._.----<-------__ •Fa----'----'---..-,_...-_.___-__.—_-.__.-.___�__—_.___.__ c.. t ...... .. . . .. . .i; -- - -- — - - - _ . .. ... , ... - i .. . f-- _. ._,_- — — -. .. — — ! 8- <i .' t f£... 1 X7151{yctE};.' if a k t -__ _._- _-- _ _ W ^' %_� . ... :: YEl4.; _k )�,AK o . . ... . .. ;. -,. .. .. •.' ,. �- —___ _ .--- - -- -- — - - - - -- - - — -- - - . ,='has^ fir. I - - . _ _ L-._ . _— _ _. _ ..a f I } k: ;. .. '�<inF1. ^ _. _ — - -- - - - c — — .. s , _ __ _ _ _ _ _. ---- . . :.. ,. -.. - ". . .. S % -Y t -- - :_ _._ _..._ __..-.___ - _ .. Qom/..✓ '" ) I ,5. 6�IIC11�::1.5 7..... ,i 7_'i.A 'b ..}..] t—'t("t F+„' i� �. E .. ., _ I �'Lt r- I IG. e a s )� �� P i t >�{.� t1.% — # . L. -r . .., " a - -. 1 { d,. t 'i4 1.E I _. -.__ - - I: }I�er`I?) . F•- , .. . I. . _ �-,_ "!I ... .. , ..: t ti`.. f' ' �. — I I .� i p ., .3 33 - t jam ( ..ik . -.._1. '-..... .; _.. ...r S g 1 ... . .. .. . - ... .. ... ... ." -. .. .. .. .. .. .. .. .. '. �.'.'. -_.. .. _ .. ... _. .. '.. '.. '. ... .. :.. .... J T - .. LL Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U PE RTI N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 2-'L3) . 't K I vt RJ I OE PERMIT # Z OWNER'S NAME: PHONE # c 0 0 GENERAL CONTRACTOR: h L 0; a C c ¢ V c 7 i 4 N BUSINESS LICENSE # ADDRESS: 3-io OoNvrNV I -oro Nikj Jk3{j . "i C TY/ZIPCODE: f-EOVV4eb C It• *Our municipal code requires all businesses working in Me city to bane a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date 1 Owner / Contractor Signature 1/2011 Date 63 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Vo o ry j vo N SLA 1 k. Co Electrical R 7- iN V) LE G T f& 1 L Excavation Fencing E,X P iz >~ S 'F a N( E Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating A 1N Insulation N O)z' i N'0L fA T I Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing t�� S k o o r i N" Septic Tank Sheet Metal Sheet Rock Tile 1 Owner / Contractor Signature 1/2011 Date 63 A CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22354 RIVERSIDE DR CONTRACTOR: TEHRANI SAIED PERMIT NO: 14110024 TRUSTEE & ET AL OWNER'S NAME: TEHRANI SAIED TRUSTEE & ET AL 22354 RIVERSIDE DR DATE ISSUED: 05/01/2015 OWNER'S PHONE: 4802969186 CUPERTINO, CA 95014- 9 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTI : RESIDENTIAL COMMERCIAL CONSTRUfA ONE STORY ADDITION 734 SQFT;REBUILD License Class Lic. # ATTAC D GARAGE 483 SQFT-INTERIOR REMODEL 1887 SQF Contractor Date 1 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. 1� I hereby affirm under penalty of perjury one of the following two de c rations: I have and will maintain a certificate of consent to self -insure for Wor is l I Compensation, as provided for by Section 3700 of the Labor Code or the Sq. Ft Floor Area: Valuation: $465000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance provided for by Section 3700 of the Labor Code, for the performance of work for which this APN Number: 35602012.00 Occupancy Type: permit is issued. APPLICANT CERTIFI ATION I certify that I have read this application and sta that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and co ty ordinances and state laws relating WITHIN 180 DAYS OF PE ISSUANCE OR to building construction, and hereby author' representatives of this city to enter upon the above mentioned property for in ection purposes. (We) agree to save 180 DAYS F INSPEC ON. indemnify and keep harmless the City o upertino against liabilities, judgments, costs, and expenses which may accrue ainst said City in consequence of the Is - granting of this permit. Additionally the applicant understands and will comply with all non -point source regulatio per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date 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, usiness & Professions Code) I, 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(x) 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, 25V3, and 25534. „ Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 46 permit is issued. C3 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY 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. / re / tr �S SignatuDate CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingQ)cupertino.org — Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: f - SITE ADDRESS 2-23L1 IVey-s `� —I APN v o2_ l BP# /L O a2J OWNER NAME— e ie I7_ rletr� OWNEADDRESS Y DESCRIPTION OF WORK: 5 V We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) iu 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- lder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowners insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. �2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. t 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. -514. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. l 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. �6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. t2_t& I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuildeYForm 2010. doe revised 04/14/10 rr CALGREEN RESIDENTIAL CHECKLIST - MANDATORY ITEMS I �0 I COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL ITTAL 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 U+ BM (408) 777-3228 - FAX (408) 777-3333 - hu'ding9Dcupertino.ora PURPOSE: The 2013 CalGreen Code applies to additions or alterations of existing residential buildings where the addition or alteration increases the building's conditioned area, volume, or size and also applies to all new low-rise residential buildings, high-rise residential buildings, or both. Existing site and landscaping improve} t are not otherwise disturbed are not subject to the requirements of CALGreen. MAR 3 O 2015 Project Name: Project Address: 223 5 fZtv�17 S Project Description: 1,j r; �,� ��, l� , 6 j jZ, p�� C; L(k,.l�- c, $7= r—_ X i �T oN� sToczY �-}nus` 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. PriQr-to final inspection by the Building Department, the licensed professional shall complete Column 3 aq&M' art Zihd date Sec&.ORE:ntation Verification at the end of this checklist and submit the pform to thsgWlg�@),lYie°nt APR 0 1 2015 - u r01-� l:uDE i,c)fuiPt_IANCE Column 2 Column 3 Rew Q�TO��FEA�R E pR MEASURE Project Verification Re uirements ., .1 PLANNING AND DESIGN 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 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 I of' i CalGreen 2014.doc revised 11/04114 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 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 Califomia 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 rewsed 11104114 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 controllers). Soil moisture -based controllers are not required to have rain sensor input. .. .4 MATERIAL CONSERVATION AND 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 ENVIRONMENTAL Fireplaces 4.503.1 General. Install only a direct -vent sealed -combustion gas or sealed ❑ El 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 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 compounds. Page 3 o CalGreen 2014. doe revised 11104114 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 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 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. 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. SPECIAL INSPECTOR INSTALLER AND QUALIFICATIONS Qualifications 702.1 Installer training. HVAC system installers are trained and certified in 13the 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 [] 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 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 11104/14 CALGREEN SIGNATURE DECLARATIONS Project Name: :VT-,- [ZA&j I 12 f TD—r-- C' I - Project Address: z -2- -A 5 ,r. �j1%�(�Sj C21 j�t21 ULA Project Description: AEx: tM *„q�L�el,. e,- ,r— t;:: --X ttE Ohl c-- 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 re irements set forth in the 2013 California Green Building Standards Code as adopted by the City pf Cupeono/ Owner's Signature Date Owner's Name (Please Print) Design Professional's Signature Date Design Professional's Name (Please Print) , S Signature of License Professional responsible for CalGreen compliance Date oa/n65 �rf2aj'��.` 010.4e.I (Itag)5-q Name of License Professional responsible for CalGreen compliance (Please Print) Phone �nlc�a�o_ C--0-Vf c 6� loco Coo0'I Email 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. 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 Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen 2014. doc revised 11;'04;14 op��' Ic P ADDITION TO TEHRANI RESIDENCE 22354 RIVERSIDE DRIVE CUPERTINO, CA 95014 C't PERTINO Building Dpportrnent APP 0 1 2015 REVIEWED FOR CODE COMPLIANCE Reviewea By: -% TITLE 24 ENERGY REPORT FRI ENERGY CONSULTANTS, LLC TITLE 24 ENERGY CONSULTANTS 21 N. HARRISON AVE. CAMPBELL, CA. 95008 408-866-1620 FAX: 408-866-6832 EMAIL: info@friconsulting.com y BUILDING ENERGY ANALYSIS REPORT PROJECT: Tehrani Residence 22354 Riverside Drive Cupertino, CA 95014 Project Designer: Joma Studio Architects 200 Industrial Rd, Suite 150 San Carlos, CA 94070 650-532-8200 Report Prepared by: Deborah San Luis R08-12-2133 FRI Energy Consultants, LLC 21 N. Harrison Avenue, Suite 210 Campbell, CA 95008 408-866-1620 Job Number: 0140751 Date: 10/27/2014 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2013 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC — vvww.energysoft.com. EnergyPro 6.3 by EnergySoft User Number. 1315 !D. 0140751 I TABLE OF CONTENTS I Cover Page Table of Contents Form RMS -1 Residential Measures Summary 3 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Residential Building Calculation Date/Time: 10:35, Mon, Oct 27, 2014 Calculation Description. Title 24 Analysis Input File Name: 0140751 Tehrani Residence.xml CF1 R -PRF -01 Page 1 of 7 GENERAL INFORMATION 01 Project Name Residential Building 02 Calculation Description Title 24 Analysis 03 Project Location 22354 Riverside Drive 04 CA City Cupertino 05 Standards Version Compliance 2014 06 Zip code 95014 07 Compliance Manager Version BEMCmpMgr 2013-3 (651) 08 Climate Zone CZ4 09 Software Version EnergyPro 6.3 10 Building Type Single Family 11 Front Orientation (dog/Cardinal) 0 12 Project Scope Addition and/or Alteration 13 Number of Dwelling Units 1 14 Total Cond. Floor Area (FT2) 2621 15 Number of Zones 2 16 Slab Area (FT2) 0 17 Number of Stories 1 18 Addition Cond. Floor Area 734 19 Natural Gas Available Yes 20 Addition Slab Area (FT2) 0 21 Glazing Percentage (%) 28.4% COMPLIANCE RESULTS 01 Building Complies with Computer Performance 02 This building incorporates features that require field testing and/or verification by a certified HERS rater under the supervision of a CEC-approved HERS provider. ENERGY USE SUMMARY 04 05 06 07 08 Energy Use (kTDVlftz-yr) Standard Design Proposed Design Compliance Margin Percent Improvement Space Heating 20.62 14.71 5.91 28.7% Space Cooling 10.75 15.58 -4.83 -44.9% IAQ Ventilation 0.00 0.00 0.00 0.0% Water Heating 12.15 12.15 0.00 0.0% Photovoltaic Offset ---- 0.00 0.00 ---- TOTAL 43.52 42.44 1.06 2.5% Registration Number: 214-A0126456A-000000000-0000 Registration Date/Time: 2014-10-28 11:26:45 HERS Provider: Ca10ERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-10172014-651 Report Generated at 2014-10-27 10:37:16 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Residential Building Calculation DatelTime: 10:35, Mon, Oct 27, 2014 Calculation Description: Title 24 Analysis Input File Name: 0140751 Tehrani 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. NO SPECIAL FEATURES REQUIRED PROJECT HERS FEATURES CFI R -PRF -01 Page 2 of 7 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. Building -level Verifications: - None -- Cooling System Verifications: • Fan Efficacy Watts/CFM HVAC Distribution System Verifications: • Duct Sealing Domestic Hot Water System Verifications: --None ENERGY DESIGN RATING This is the sum of the annual TDV energy consumption for energy use components included in the performance compliance approach for the Standard Design Building (Energy Budget) and the annual TDV energy consumption for lighting and components not regulated by Title 24, Part 6 (such as domestic appliances and consumer electronics) and accounting for the annual TDV energy offset by an on-site renewable energy system. Reference Energy Use Energy Design Rating Margin Percent Improvement Total Energy (kTDV/f2)` 88.71 87.63 1.08 1.2% ` includes calculated Appliances and Miscellaneous Energy Use (AMEU) 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 Residential Building 2621 1 6 2 0 1 ZONE INFORMATION 01 02 03 04 05 06 07 Zone Name Zone Type HVAC System Name Zone Floor Area (ft) Avg. Ceiling Height Water Heating System 1 Water Heating System 2 1st Floor Conditioned HVAC Systeml 1887 8 DHW Sys 1 1st Floor Addition Conditioned HVAC Systeml 734 B DHW Sys 1 Registration Number: 214-A0126456A-000000000-0000 Registration Date/Time: 2014-10-26 11:26:45 HERS Provider: CalCERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-10172014-651 Report Generated at 2014-10-27 10:37:16 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Residential Building Calculation Date/Time: 10:35, Mon, Oct 27, 2014 Calculation Description: Title 24 Analysis Input File Name: 0140751 Tehrani Residence.xml CF1R-PRF-01 Page 3 of 7 OPAQUE SURFACES 01 02 03 04 05 06 09 10 11 01 02 03 04 05 06 07 08 09 10 Name Zone Construction Azimuth Orientation Gross Area (ft) Window and Door Area (ft2) Tilt(deg } Status Verified Existing Condition Front Wall list Floor R-19 Wall 0 Front 103.5 40 90 Altered N/A Left Wall 1st Floor R-19 Wall 90 Left 319.5 81 90 Altered N/A Right Wall 1st Floor R-19 Wall 270 Right 54 6 90 Altered NIA Roof 1st Floor R-30 Roof Attic 1887 Altered N/A Raised Floor 1st Floor R-0 Floor Crawlspace 1887 Existing No Front Wall 2 1st Floor Addition R-19 Wall 0 Front 270 62.5 90 New N/A Left Wall 2 1st Floor Addition R-19 Wall 90 Left 216 29 90 New NIA Rear Wall 1st Floor Addition R-19 Wall 180 Back 585 429 90 New N/A Right Wall 2 1st Floor Addition R-19 Wall 270 Right 517.5 96 90 New N/A Roof 2 1st Floor Addition R-30 Roof Attic 734 New N/A Raised Floor 2 1st Floor Addition R-19 Floor Crawlspace 734 New N/A 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 4 0.1 0.85 Yes No Existing No Registration Number: 214-A0126456A-000000000-0000 Registration Date/Time: 2014-10-28 11:26:45 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-10172014-651 Report Generated at 2014-10-27 10:37:16 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Residential Building Calculation Date/Time: 10:35, Mon, Oct 27, 2014 Calculation Description: Title 24 Analysis Input File Name: 0140751 Tehrani Residence.xml CF 1 R -PRF -01 Page 4 of 7 WINDOWS 01 02 03 04 05 Construction Name Surface Type Framing Total Cavity R -value Assembly Layers 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 Glass Door new Front Wall ---- ---- 1 40.0 0.29 0.29 Insect Screen (default) New N/A Window New Left Wall ---- ---- 1 41.0 0.28 0.25 Insect Screen (default) New N/A Glass Door new 2 Left Wall ---- ---- 1 40.0 0.29 0.29 Insect Screen (default) New N/A Window New 2 Right Wall ---- ---- 1 6.0 0.28 0.25 Insect Screen (default) New NiA Window Front Wall 2 ---- ---- 1 62.5 0.28 0.25 Insect Screen (default) New N/A Window 2 Left Wall 2 1 29.0 0.28 0.25 Insect Screen (default) New N/A Window 3 Rear Wall ---- ---- 1 189.0 0.28 0.25 Insect Screen (default) New N/A Glass Door new 3 Rear Wall ---- ---- 1 144.0 0.29 0.29 Insect Screen (default) New N/A Glass Door new 4 Rear Wall ---- ---- 1 48.0 0.29 0.29 Insect Screen (default) New N/A Glass Door new 5 Rear Wall ---- ---- 1 48.0 0.29 0.29 Insect Screen (default) New N/A Window 4 Right Wall 2 ---- I ---- 1 96.0 0.28 0.25 Insect Screen (default) New N/A OPAQUE SURFACE CONSTRUCTIONS 01 02 03 04 05 Construction Name Surface Type Framing Total Cavity R -value Assembly Layers Cavity / Frame: no insul. / 2x4 Top Chrd Attic Roof Cons Attic Roofs 2x4 Top Chord of Roof Truss @ 24 in. O.C. no insulation - Roof Deck: Wood Siding/sheathing/decking • Roofing: Light Roof (Asphalt Shingle) • Floor Surface. Carpeted R-0 Floor Crawlspace Floors Over Crawlspace 202 @ 16 in. O.0 no insulation - Floor Deck Wood Siding/sheathing/decking Cavity / Frame: no insul. / 2x 12 • inside Finish: Gypsum Board R-19 Wall Exterior Walls 2x6 @ 16 in O C. R 19 Cavity/Frame: R -19/2x6 • Exterior Finish. Wood Siding/sheathing/decking • inside Finish: Gypsum Board R-30 Roof Attic Ceilings (below attic) 2x4 @ 24 in. O.0 R 30 Cavity / Frame: R-9.1 / 2x4 Over Floor Joists: R-20.9 insul. Floor Surface: Carpeted R-19 Floor Crawlspace Floors Over Crawtspace 2x6 @ 16 in. O C R 19 Floor Deck. Wood Siding/sheathing/decking • Cavity / Frame R-19 / 2x6 Registration Number: 214-A0126456A-000000000-0000 Registration Date/Time: 2014-10-28 11:26:45 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-10172014-651 Report Generated at 2014-10-27 10:37:16 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Residential Building Calculation Date/Time: 10:35, Mon, Oct 27, 2014 Calculation Description: Title 24 Analysis Input File Name: 0140751 Tehrani Residence.xml CFIR-PRF-01 Page 5 of 7 WATER HEATING SYSTEMS 01 02 01 02 03 04 05 06 Name Distribution Type Number of Heaters Solar Fraction (%) Status Verified Existing Condition DHW Sys 1 Standard 1 Annual Existing 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 Heater 1 Natural Gas Small Storage 50 0.575 EF 40000-Btu/hr 0 0 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 n/a n/a n/a n/a n/a n/a HVAC SYSTEMS 01 02 03 04 05 06 07 08 09 Heating System Cooling System Distribution Fan Floor Area Verified Existing Name System Type Name Ducted Name Ducted System System Served Status Condition HVAC Systeml Other Heating and Heating Yes Cooling Yes Air Distribution HVAC Fan 2621 Altered No Cooling System Component 1 Component 1 System 1 1 HVAC - HEATING SYSTEMS 01 02 03 Name Type Efficiency Heating Component 1 CntriFurnace - Fuel -fired central furnace 80 AFUE Registration Number: 214-A0126456A-000000000-0000 Registration Date/Time: 2014-10-28 11:26:45 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CFiR-10172014-651 Report Generated at 2014-10-27 10:37:16 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Residential Building Calculation Date/Time: 10:35, Mon, Oct 27, 2014 Calculation Description: Title 24 Analysis Input File Name: 0140751 Tehrani Residencexml CF1R-PRF-01 Page 6 of 7 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 Cooling Component 1 SplitAirCond -Split air conditioning 11.3 13 No No Cooling Component Duct Leakage system Location Location Bypass Duct Status 1 -hers -cool HVAC COOLING - HERS VERIFICATION 01 02 03 04 05 06 Name Verified Airflow Airflow Target Verified EER Verified SEER Verified Refrigerant Charge Cooling Component 1 -hers -cool Required 350 Not Required Not Required Not Required 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 attic Sealed and tested 6 Attic Attic None New No System System 1 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 PSC Furnace Fan 0.58 Required Registration Number: 214-A0126456A-000000000-0000 Registration Date/Time: 2014-10-28 11:26:45 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-10172014-651 Report Generated at 2014-10-27 10:37:16 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Residential Building Calculation Date/Time: 10:35, Mon, Oct 27, 2014 Calculation Description: Title 24 Analysis Input File Name: 0140751 Tehrani Residence.xml CF 1 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: Nicholas Bignardi Company. Signature Date FRI Energy Consultants, LLC. 2014-10-27 10:40:45 Address: CEA/HERS Certification Identification (If applicable): 21 N. Harrison Ave, Suite 210 City/State/Zip Phone: Campbell, CA 95008 408-866-1620 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. I 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: Responsible Designer Signature: },�,,,' (] cSr" v" Cl�rruz Antony Joma rT Company Date Signed: Joma Studio Architects 2014-10-28 11:26:45 Address. License: 545 Palmer Lane N/A City/State/Zip: Phone: Menlo Park, CA 94025 650-532-8200 Digitally signed by CatCERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number: 214-AO126456A-000000000-0000 Registration Date/Time: 2014-10-28 11:26:45 HERS Provider: CaICERTS inc CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-10172014-651 Report Generated at 2014-10-27 10:37:16 RESIDENTIAL MEASURES SUMMARY RMS -1 Project Name Tehrani Residence Building Type m Single Family ❑ Addition Alone ❑ Multi Family m Existing+ Addition/Alteration Date 10/27/2014 Project Address 22354 Riverside Drive Cupertino California Energy Climate Zone CA Climate Zone 04 I Total Cond. Floor Area 2,621 Addition 734 A of Units 2 INSULATION Construction Type Area Cavi(ft) Special Features Status Floor Wood Framed w/Crawl Space - no insulation 1,887 Existing Wall Wood Framed R 19 350 Altered Roof Wood Framed Attic R 30 1.887 Altered Floor Wood Framed w/Crawl Space R 19 734 New Wall Wood Framed R 19 972 New Roof Wood Framed Attic R 30 734 New Demising Wood Framed - no insulation 540 _ Existing FENESTRATION Total Area ig Percentage: 28.4 % New/Altered Average U -Factor 018 Orientation Area(ft) U -Fac SHGC Overhang Sidefins Exterior Shades Status Front (N) 40.0 0.290 0.29 none none Bug Screen New Left (E) 70.0 0.280 0.25 none none Bug Screen New Left (E) 40.0 0.290 0.29 none none Bug Screen New Right (W) 102.0 0.280 0.25 none none Bug Screen New Front (N) 62.5 0.280 0.25 none none Bug Screen New Rear (S) 189.0 0.280 0.25 none none Bug Screen New Rear (S) 240.0 0.290 0.29 none none Bug Screen New HVAC SYSTEMS Qty. Heating Min. Eff Cooling Min. Eff Thermostat Status 1 Central Furnace 80% AFUE Split Air Conditioner 13.0 SEER Setback Altered HVAC DISTRIBUTION Location Heating Duct Cooling Duct Location R -Value Status HVAC System Ducted Ducted Attic 6.0 Altered WATER HEATING Qty. Type Gallons Min. Eff Distribution Status Ene Pro 6.3 b Ene Soft User Number. 1315 RunCode: 201410-27T10:37:51 ID. 0140751 Pa e 3 of 7 MANDATORY MEASURES SUMMARY: Residential Pae 1 of 3 MF -1 R Project Name Date Tehrani Residence 10/27/2014 NOTE: Low-rise residential buildings subject to the Standards must comply with all applicable mandatory measures listed. regardless of the compliance approach used. More stringent energy measures listed on the Certificate of Compliance (CF -1 R, CF -IR -ADD, or CF - 1 R -ALT Form) shall supersede the items marked with an asterisk (") below. This Mandatory Measures Summary shall be incorporated into the permit documents, and the applicable features shall be considered by all parties as minimum component performance specifications whether they are shown elsewhere in the documents or in this summary. Submit all applicable sections of the MF -1 R Form with plans. Building Envelope Measures: 110.6(a)l: Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage. §110.6(a)4: Fenestration products (except field -fabricated windows) have a label listing the certified U -Factor certified Solar Heat Gain Coefficient SHGC , and infiltration that meets the requirements of 10-111 La).,. 110.7: Exterior doors and windows are weather-stripped: all joints and penetrations are caulked and sealed. 1 10.8 a : Insulation specified or installed meets Standards for Insulating Material. Indicate type and include on CF -2R Form. §110.8(1): The thermal emittance and solar reflectance values of the cool roofina material meets the requirements of §110.8(i) when the installation of a Cool Roof is specified on the CF -1 R Form. *§1 50.0 a : Minimum R-30 R-19 for Additions/Alterations insulation in wood -frame ceiling orequivalent U -factor. 1 50.0 b : Loose fill insulation shall conform with manufacturer's installed design labeled R -Value. 150.0 c Minimum R-13 insulation in 2x4 wood -frame wall R-19 in 2x6 orequivalent U -factor. *§1 50.0 d : Minimum R-19 insulation in raised wood -frame floor orequivalent U -factor. 150.0 : Air retarding wra is tested, labeled, and installed according to ASTM E1677-95(2000) when specified on the CF -1 R Form. §150.0(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16. §150.0(1): Water absorption rate for slab edge insulation material alone without facings is no greater than 0.3%; water vapor permeance rate is no greater than 2.0 permlinch and shall be protected from physical damage and UV light deterioration. §150.0(q) Fenestration Products. Fenestration separating conditioned space from unconditioned space or outdoors shall meet the requirements of either Item 1 or 2 below: 1. Fenestration, including skylight products, must have a maximum U -factor of 0.58. 2. The weighted average U -factor of all fenestration, including skylight products, shall not exceed 0.58. EXCEPTION to Section 150.0(q)l Up to 10 square feet of fenestration area or 0.5 percent of the Conditioned Floor Area, whichever is greater, is exempt from the maximum U -factor requirement - e uirement.150.0 r Solar Ready Buildings. Shall meet the requirements of Section 110.10 applicable to the building project. §150.0(r) Fireplaces, Decorative Gas Appliances and Gas Log Measures: 150.0 a 1A: Masonry or factory -built fireplaces have a closable metal or glass door covering the entire opening of the firebox. §150.0(e)l B: Masonry or factory -built fireplaces have a combustion outside air intake, which is at least six square inches in area and is equipped with a with a readily accessible. operable, and fight-fifting fight-fittingdamper and or a combustion -air control device. §150.0(e)2: Continuous burning pilot lights and the use of indoor air for cooling a firebox jacket, when that indoor air is vented to the outside of the building, are prohibited. Space Conditioning, Water Heatin2 and Plumbing System Measures: §110.0-§110.3: HVAC equipment, water heaters, showerheads, faucets and all other regulated appliances are certified by the Energy Commission. §110.3(c)5: Water heating recirculation loops serving multiple dwelling units and High -Rise residential occupancies meet the air release valve, backflow prevention, pump isolation valve, and recirculation loop connection requirements of §110.3(c)5. §110.5: Continuously burning pilot lights are prohibited for natural gas: fan -type central furnaces, household cooking appliances (appliances with an electrical supply voltage connection with pilot lights that consume less than 150 Btu/hr are exempt), and pool and spa heaters. §150.0(h): Heating and/or cooling loads are calculated in accordance with ASHRAE. SMACNA or ACCA. 150.0 i : Heating systems are eq ui ed with thermostats that meet the setback requirements of Section 11 0.2 c . §150.0(j)1A. Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are externally wrapped with insulation having an installed thermal resistance of R-12 or greater. §150.06)1B: Unfired storage tanks, such as storage tanks or backup tanks for solar water -heating system. or other indirect hot water tanks have R-12 external insulation or R-16 internal insulation where the intemal insulation R -value is indicated on the exterior of the tank. EnergyPro 6.3 by EnergySoft User Number. 1315 ID: 0140751 Page 4 of 7 MANDATORY MEASURES SUMMARY: Residential (Page 2 of 3)_ MF-1 R Project Name Date 110127120141 Tehrani Residence §1%00)2A: All domestic hot water system piping conditions listed below, whether buried or unburied, must be insulated per TABLE 120.3-A. i. The first 5 feet (1.5 meters) of hot and cold water pipes from the storage tank. ii. All piping with a nominal diameter of 3/4 inch (19 millimeter) or larger. iii. All piping associated with a domestic hot water recirculation system regardless of the pipe diameter. iv. Piping from the heating source to storage tank or between tanks. v. Piping buried below grade. vi. All hot water pipes from the heating source to the kitchen fixtures. §150.00)2: Pipe insulation for steam hydronic heating systems or hot water systems >15 psi, meets the requirements of Standards Table 120.3-A. 150.0 3A'. Insulation is protected from damage, i cluding that due to sunlight, moisture, equipment maintenance, and wind. §150.00)4: Solar water-heating systems and/or collectors are certified by the Solar Rating and Certification Corporation. §150.0(m)1 All air-distribution system ducts and plenums installed, are sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply-air and return-air ducts and plenums are insulated to a minimum installed level of R-6 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct-closure system that meets the applicable requirements of UL 181, UL 181A, or UL 181 B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings reater than 1/4 inch, the combination of mastic and either mesh or tape shall be used §150.0(m)1: Building cavities. support platforms for air handlers. and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. §150.0(m)2D Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tae is used in combination with mastic and draw bands. §150,0(m)7i Exhaust fans stems have back draft or automatic dampers. §150.0(m)8: Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. §150.0(m)9: Insulation shall be protected from damage. including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. 150.0(m)10: Flexible ducts cannot have porous inner cores. §150.0(n)1: Systems using gas or propane water heaters, whether tank or on-demand, to serve individual dwelling units shall include all the following components A. A 120V electrical receptacle that is within 3 feet from the water heater and accessible to the water heater with no obstructions, B. A Category III or IV vent, or a Type B vent with straight pipe between the outside termination and the space where the water heater is installed; C. A condensate drain that is no more than 2 inches higher than the base of the installed water heater, and allows natural draining without pump assist. D. A gas supply line with a capacity of at least 200;000 Btu/hr. §150.0(0): All dwelling units shall meet the requirements of ANSI/ASHRAE Standard 62.2 Ventilation and Acceptable Indoor Air Quality in Low-.Rise Residential Buildings. Window operation is not a permissible method of providing the Whole Building Ventilation required in Section 4 of that Standard. Pool and Spa_ Heating Systems and Equipment Measures: §110.4(a) Any pool or spa heating system shall be certified to have a thermal efficiency that complies with the Appliance Efficiency Regulations, an on-off switch mounted outside of the heater: a permanent weatherproof plate or card with operating instructions, and shall not use electric resistance heating ora pilot light, §110.4(b)1: Any pool or spa heating equipment shall be installed with at least 36" of pipe between filter and heater, or dedicated suction and return lines, or built-up connections for future solar heating. 110.4(b)2: Outdoor pools ors as that have a heat pump or gas heater shall have a cover. §110.4(b)3: Pools shall have directional inlets that adequately mix the pool water, and a time switch that will allow all pumps to be set or programmed to run only during off-peak electric demand periods. 150.0 Residential pool systems orequipment meet the pump sizing, flow rate, piping, filters, and valve requirements of §150.0 Residential Lighting Measures: §150.0(k)1A: Installed luminaires shall be classified as high-efficacy or low-efficacy for compliance with Section 150.0(k) in accordance with TABLE 150.0-A or TABLE 150.0-8, as applicable. 150.0 k 1C: The wattage of permanently installed luminaires shall be determined as s ecified by §130.0(c). 150.0 k 1 D: Ballasts for fluorescent lam s rated 13 Watts or greater shall be electronic and shall have an output frequency - 20 kHz. §150.0(k)1 E: Permanently installed night lights and night lights integral to installed luminaires or exhaust fans shall be rated to consume no more than five watts of power per luminaire or exhaust fan as determined in accordance with Section 130.0(c). Night lights shall not be required to be controlled_ by vacancy sensors. EnergyPro 6.3 by EnergySoft User Number. 1315 ID 0140751 Page 5 of 7 MANDATORY MEASURES SUMMARY: Residential (Page 3 of 3 MF -1 R Project Name Date Tehrani Residence 11012712014 1 50.0 k 1 F: Lighting integral to exhaust fans, in rooms other than kitchens, shall meet the applicable requirements of §150.0(k). 1 50.0 k 2: All switching devices and controls shall meet the requirements of §150.0(k)2. §150.0(k)3: A minimum of 50 percent of the total rated wattage of permanently installed lighting in kitchens shall be high efficacy. EXCEPTION: Up to 50 watts for dwelling units less than or equal to 2,500 ft2 or 100 watts for dwelling units larger than 2,500 ft2 may be exempt from the 50 percent high efficacy requirement when all lighting in the kitchen is controlled in accordance with the applicable provisions in Section 150.0(k)2, and is also controlled by vacancy sensors or dimmers. §150.0(k)4: Permanently installed lighting that is internal to cabinets shall use no more than 20 watts of power per linear foot of illuminated cabinet. §150.0(k)5: Lighting installed in bathrooms shall meet the following requirements. A. A minimum of one high efficacy luminaire shall be installed in each bathroom, and B. All other lighting installed in each bathroom shall be high efficacy or controlled by vacancy sensors. §150.0(k)6: Lighting installed in attached and detached garages, laundry rooms, and utility rooms shall be high efficacy luminaires and controlled by vacancy sensors. §150.0(k)7: Lighting installed in rooms or areas other than in kitchens, bathrooms, garages, laundry rooms. and utility rooms shall be high efficacy, or shall be controlled by either dimmers or vacancy sensors. EXCEPTION 1: Luminaires in closets less than 70 square feet. EXCEPTION 2: Lighting in detached storage building less than 1000 square feet located on a residential site. §150.0(k)8: Luminaires recessed into insulated ceilings shall be listed for zero clearance insulation contact (IC) by Underwriters Laboratories or other nationally recognized testing/rating laboratory, and have a label that certifies the luminaire is airtight with air leakage less than 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283; and be sealed with a gasket or caulk between the luminaire housing and ceiling. §150.0(k)9A: For single-family residential buildings, outdoor lighting permanently mounted to a residential building or other buildings on the same lot shall be high efficacy, or may be low efficacy if it meets all of the following requirements i. Controlled by a manual ON and OFF switch that does not override to ON the automatic actions of items ii or iii below; and ii. Controlled by a motion sensor not having an override or bypass switch that disables the motion sensor, or controlled by a motion sensor having a temporary override switch which temporarily bypasses the motion sensing function and automatically reactivates the motion sensor within 6 hours iii. Controlled by one of the following methods a. Photocontrol not having an override or bypass switch that disables the photocontrol: or b. Astronomical time clock not having an override or bypass switch that disables the astronomical time clock, and which is programmed to automatically turn the outdoor lighting OFF during daylight hours, or c. Energy management control system which meets all of the following requirements: At a minimum provides the functionality of an astronomical time clock in accordance with Section 110.9; meets the Installation Certification requirements in Section 130.4, meets the requirements for an EMCS in Section 130.5: does not have an override or bypass switch that allows the luminaire to be always ON; and. is programmed to automatically turn the outdoor lighting OFF during daylight hours. §150.0(k)9A: For low-rise multi -family residential buildings. outdoor lighting for private patios. entrances, balconies, and porches, and outdoor lighting for residential parking lots and residential carports with less than eight vehicles per site shall comply with one of the following requirements i. Shall comply with Section 150.0(k)9A: or ii. Shall comply with the applicable requirements in Sections 110.9, 130.0, 130.2, 130.4. 140.7, and 141.0. §150.0(k)9: For low-rise residential buildings with four or more dwelling units, outdoor lighting not regulated by Section 150.0(k)9B or Section 150.0(k)9D shall comply with the applicable requirements in Sections 110.9, 130.0, 130.2, 130.4, 140.7, and 141.0. §150.0(k)91]i: Outdoor lighting for residential parking lots and residential carports with a total of eight or more vehicles per site shall compl_y with the applicable requirements in Sections 110.9, 130.0. 130.2, 130.4, 140.7, and 141.0. §150.0(k)10: Internally illuminated address signs shall comply with Section 140.8; OR not contain a screw -base socket, and consume no more than five watts of power as determined according to 130.0 d . §150.0(k)11: Lighting for residential parking garages for eight or more vehicles shall comply with the applicable requirements for nonresidential garages in Sections 110.9, 130.0, 130.1, 130.4, 140.6, and 141.0. §150.0(k)12A. In a low-rise multi -family residential building where the total interior common area in a single building equals 20 percent or less of the floor area. permanently installed lighting for the interior common areas in that building shall be high efficacy luminaires or controlled by an occupant sensor. §150.0(k)12B. In a low-rise multi -family residential building where the total intenor common area in a single building equals more than 20 percent of the floor area, permanently installed lighting in that building shall: i. Comply with the applicable requirements in Sections 110.9. 130.0, 130.1, 140.6.. and 141.0; and ii. Lighting installed in corridors and stairwells shall be controlled by occupant sensors that reduce the lighting power in each space by at least 50 percent. The occupant sensors shall be capable of turning the light fully On and Off from all designed paths of ingress and egress. EnergyPro 6.3 by Energy5oft User Number. 1315 !D. 0140751 Page 6 of 7 HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY Project Name Tehrani Residence Date 10/27/2014 System Name HVAC System Floor Area 2,621 ENGINEERING CHECKS SYSTEM LOAD Number of Systems 1 COIL CFM Total Room Loads 1,218 Return Vented Lighting Return Air Ducts Return Fan Ventilation 0 Supply Fan Supply Air Ducts TOTAL SYSTEM LOAD COOLING PEAK COIL HTG. PEAK Heating System Sensible Latent CFM Sensible Output per System 30.920 25,181 1,472 719 27.829 Total Output Btuh 30.920 0 Output Stuh/ tt 11.8 1,142 1,546 Cooling System 0 0 Output per System 30,000 0 0 0 0 Total Output Btuh) 30.000 0 1.472 0 Total Output (Tons) 2.5 1,142 1.546 Total Output Btuh/s ft 11.4 Total Output s ttlTon 1.048-4 27,466 30,920 Air System CFM per System 0 HVAC EQUIPMENT SELECTION Airtlow cfm 0 80% AFUE (13 SEER) 28,558 0 30.920 Airflow cfm! ft 0.00 Airflow cfm/Ton 0.0 Outside Air % 00% Total Adjusted System Output (Adjusted for Peak Design conditions) TIME OF SYSTEM PEAK 28,558 0 Aug 3 PM 30.920 Jan 1 AM Outside Air cfm/s ft 0,00 Note: values above given at ARI conditions HEATING SYSTEM PSYCHROMETRICS Airstream Temperatures at Time of Heating Peak 28 IF Outside Air 0 cfm 67 IF 67 OF 1 Heating Coil 104 OF ROOM 68 IF COOLING SYSTEM PSYCHROMETICS Airstream Temperatures at Time of Cooling Peak 88 / 68 IF Outside Air 0 cfm 76 !62 IF 76 / 62 IF 55 154 IF Cooling Coil 56 54 0 46.6 % RO �A 75 ! 62 IF EnergyPro 6.3 by EnergySoft User Number 1315 RunCode: 2014-10-27i10r37:51 ID. 0140751 Page 7 of 7