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15030081CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7475 DE LA FARGE DR CONTRACTOR: FRANOV PERMIT NO: 15030081 CONSTRUCTION OWN R'S NAME: SIVARAM SURYANARAYAN 627 SANTA SUSANA AVE DATE ISSUED: 08/27/2015 O ER'S PHONE: 4082572768 MILLBRAE, CA 94030 PHONE NO: (650) 255-5646 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION ADD 824 S.F TO ADD 1(N) BEDROOM & 2 (N) BATHS. q Lic. # 6 ! REMODEL & RECONFIGURE (E) KITCHEN 130 S.F., License Class REMODEL TWO (E) BATHS (123 S.F.) & OTHER REMODEL Contractor 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 Valuation: $150000 p rformance of the work for which this permit is issued. ' Sq. Ft Floor Area: 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: 35926018.00 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 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAYS F CALLED INSPECTION. upon the above mentioned properly 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 Z ss 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. &0-5RE-ROOFS: t o✓t/�! ► Date a 0 �/ All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature r / 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) HAZARDOUS MATERIALS DISCLOSURE I, as owner of the property, am exclusively contracting with licensed contractors to the (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the construct project 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 Health & Safety Code, Section 25532(a) should I store or handle hazardous declarations: 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 by the Bay Area Air Quality Management District I Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sec 'ons 25505, 25 33, and 25534. { Section 3700 of the Labor Code, for the performance of the work for which this �^� 17 Owner or authorized agent: !/o Date:ls 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, I 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 become subject to 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, may accrue against said City in consequence of the I understand my plans shall be used as public records. costs, and expenses which 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 -_ IIT APPLICATION '0 CONSTRUCTION ION PER COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(c)cu0ertin2. - \� CUPERTINO ❑ NEW CONSTRUCTION .- *�: ADDITION 2 ALTERATION / TI El .REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS S I �+� �}� -f-6LG�� 37R .� �%U\� 4tV APN IPHONE_C (I E-MAIL ^�V qG'i., �OL OWNERNAME SI J U �JI -��Yl ril Lc3J o rn' cyy . p CITY. STATE, ZIP. ��V' P 1 �i� 0 C_ A I FAX STREET ADDRESS 1 J, � S f(� RC � � S � 114 `i�( y� Q 4 Q _ �] CONTACT NAME CaVI�S PHONE. E -MAIL - a V$ ^ ! STREET ADDRESS i C N ^ , , CITY, STATE, ZIP" ❑ OWNER - ❑ OWNER-BUfLDER" - ❑ OWNERAGENT CONTRACTOR - ❑ CONTRACTORAGENT \P_,�RCHTTECT ENGII.EER.:,, ,.I] .DEVELOPER �,• TENAATf CONTRACTOR NAME LICENSE NUMBER TLICENSEn"PE BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE RCHITECT NGINEERNAME LICENSE NUMBER BUS. LIC E - FAX COMPANY NAME oti, ! Nr1 • vlCin ' CJ6 CITY, STATE, ZIP PHONE M STREET ADDRESS 6 -(C; Q DESCRIPTION OF'kVORK �y �i16`( C � AA:>p i vl®t o Owl L N �ol� Ns mit' ° E)GSTINGUSE PROPOSED USE CONSTR.TYPE S OSS USE TYPE OCC. I SQ.FT. VALUATION (S) EXISTGQ NEW FLOOR DEMO TOTAL AREA \ ®Q AREA AREA t NETAREPZ( Zt4 BATHROOM CHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA (1 iZ3. j7 PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA• DETACH `T ATTACH m D\VELLn.G UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES p BEING ADDED? O 1'�/�PNO ADDITION? "6a�4• lCOP_.. m�.� ..�. S..h•' TOTALATIOON'.F/ �/ PRE -APPLICATION ❑ YES IF YES, PROVIDE Y OF IS THE BLDG AN ❑ YES PLANNING APPL 0 PLANNBIGAPPROVALLETTER EICHLERHONIE? f7i O By my signature below, I certify to each of the following: I am the property owner or auth ori nt to ac th operty owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and veri ccurate. I agree to comply with all applicable local ordinances and state ]a -,vs relating t Ing construction. I authorize representatives of Cupertino ter the above -identified property for inspection purposes. Sia Iature of App]icanUAgent: a -\/r^ JA Date: 5; �nggg gymo SUPPLEMENTAL INFORMATION REQUIRED i An csEcx��mE r—o17%Ir;GSLTP; New SM or Multifamily dwellings: Apply for demolition permit forQ 0 ,Avr �� ULLD�GPL�41�RE`UE\Y }�F�f existing building(s). Demolition permit is required prior to issuance of buildings r 2� permit for new building. -0 EXPRESSOr PnI\�I11rGPL? 1kREyiEgj ' Kz Y� F1]4PUBLICIVOT.S� s _ gi Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. I�iiiGE i r �i>zEEPT R' _ Copy of Planning Approval Letter or Meeting with Planning prior to70RI a fl�y�ERnRIc submittal of Building Permit application..., r� �n.rENT TArr` } Bld,-App 201 Ldoc revised 06/21/11 rrry nip CTTPFRTINO MSCI,' Yes . No . PLUMB, I0URY7Y Yes - No , ELEC, HOURLY ®:Yes _QNo Meeh. Plan ('heck Phuub. Plan Check Elec, Plan Check Afee"11. Per mil Fee: Plumb. Permit Feer: Elee. Permit Fee: Other• ,ilec•h. lnsp. FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 7475 DE LA FARGE DR DATE: 03/12/2015 APN: 326 26 018 BP#: J C.� _� REVIEWED BY: MELISSA "`VALUATION: $150,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? Yes No OTC? O Yes �No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK SCOPE ADD 824 S.F TO ADD 1 N BEDROOM & 2 N BATHS. REMODEL & RECONFIGURE E KITCHEN 130 S.F., REMODEL TWO (E) BATHS (123 S.F.) & OTHER REMODEL AREA OF 172 S.F. 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 824 $2,654.00 1R3PLNCK $1,666.00 IR3INSP MISC ITEMS $2,654.00 130 s.£ Remodel, Kitchen (<=300 sf) Plan Check Fee: Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 $645.00 IREMRESKIT TOTALS: 824 $2,654.00 ;, $1,666 00 MSCI,' Yes . No . PLUMB, I0URY7Y Yes - No , ELEC, HOURLY ®:Yes _QNo Meeh. Plan ('heck Phuub. Plan Check Elec, Plan Check Afee"11. Per mil Fee: Plumb. Permit Feer: Elee. Permit Fee: Other• ,ilec•h. lnsp. I— ] Other Plumb Tn3p. u Oilier Elec. Insp. J Mesh. hnp..Fee: Plumb. Lisp. Fee: Public Works, Elec. Insp. re' Fire, Sanitary Sewer District, School NOTE. This estimate does not include fees due to other Departments Ae. Planning, information available and are onlyan estimate- Contact the Dept or addn'1 into. District, etc.).These fees are based on the relimina . FEE ITEMS (Fee Resolution 11-053 E 7� /1/13) FEE QTY/FEE MISC ITEMS $2,654.00 130 s.£ Remodel, Kitchen (<=300 sf) Plan Check Fee: Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 $645.00 IREMRESKIT PME Plan Check: $0.00 123 s.f. Remodel, Bath (<=300 sf) Permit Fee: $1,666.00 $645.00 IREMRESBAT Suppl. Insp. Fee -(F) Reg. Q OT 0,0 hrs $0.00 172 1 s.£ Remodel, Other PME Unit Fee: $0.00 $431.00 1REMRESOTH PME Permit Fee: $0.00 Construction Ten: 0 ,4diniriistrarive .�j�T 'oe: • G Work Without Permit? 0 Yes ie) No $0.00 Advanced Planning Fee: IPLLONGR $115.36 Select a Non -Residential Structure Building or Trcn-el Doctnnentutinn Fees: � Strong Motion Fee: IBSEISMICR $19.50 Select an Administrative Item Bldg Stds Commission Fee IBCBSC $6.00 TOTAL FSE $6,181. 86 f S7BTOTA>�5:` $4,460.86 $1,721.00 M4 Revised: 02/14/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030081 7475 DE LA FARGE DR CUPERTINO CA 95014 (359 26 018) 627 SANTA SUSANA AVE MILLBRAE, CA 94030 OWNER'S NAME: SIVARAM SURYANARAYAN I I DATE ISSUED: 08/27/2015 OWNER'S PHONE: I I PHONE NO: None License Class CONTRACTOR - GENERAL Lic. # Contractor Date 09/30/2016 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: t. I have and will maintain a certificate of consent to self -insure for Worker's BUILDING PERNUT INFO: BLDG —ELECT _ PLUMB MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: ADD 824 SY TO ADD 1 (1) BEDROOM & 2 (I) BATHS. REMODEL & RECONFIGURE (E) KITCHEN 130 S.F., REMODEL TWO (E) BATHS (123 S.F.) & OTHER REMODEL Compensation, as provided for by Section 3700 of the Labor Code, for the AREA OF 172 S.F. ( performance of the work for which this permit is issued. 4/5/16 - REVISE LOCATION & SIZE OF MAIN WATER LINE FROM z. I have and will maintain Worker's Compensation Insurance, as provided for by 3/4" TO 1 1/4" - ISSUED 4/5/16 :4 -- 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 regulatio ns per the Cupertino Municipal Code, Section 9.18. Signature Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) z. 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. 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. 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. 3. 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 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 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 Sq. Ft Floor Area: I Valuation: $150000.00 APN Number: Occupancy Type: 359 26 018 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FR T CALLED INSPECTION. Date:99iiiii�� $ lb 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: COVERINGS TO BE CLASS "A" OR 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, Sections 25505, 25533, and 25534. Owner or authorized agent: &�`s Date;, / _ i�CONSTRUCTION LENDING AGENCY 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 10 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building(Dcupert! no. org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI 9 REVISION / DEFERRED ORIGII.TAL PERMIT # ( �7 6 3 CO$ ( PROJECT ADDRESS <-7L4 4 —[ C DU LA �- APN R -14-AIL OWNER NAME5 1 V' ► , l I PHONE Jo< r -7 �-7—Z701 STREET ADDRESSC5 DL LA� CITY, � `' e IP tic) / FAX CONTACT NAME %%y71/1 � / PHONI rO STREET ADDRE1P / CITY, STATE �Zjy/ i ! �i ii 1c D rL %❑ FAa �R 13 ❑CONTRACTORAGENT E3 ❑ 11OH'NER-BUILDER 13 OWNER AGENT CONTRACTOR ARCHITECT ENGINEER DEVELOPER ❑ TEI<A.\T CON rp R/s� 0 LIC ET7 LICENSE TYPE ✓ BUS. LIC n Complyfv (�p A)5 -r 0- E -MAIL 'net FAX STREET ADDRESS/ o 7 �r, � Q J s-��A �LS (PEER' ✓ CITY, STATE, ZIP /t /� � �1� �i /�� , Z 7 PHOir �d �—� ARCHITECT,'EN NAME LICENSE NUMBER BUS... LIC n CONLPANY NAME � � f� j�+� 1 E-?��i. � _ FA.SC STREET ADDRESSC(F�f Y, STATE, ZIP NVa Cn is--IJ t PHONE � � —0 F ^ �I \ ' "l A I tQ 0 EXISTING USE PROPOSED USE CONSTR. nTE :STORIES USE TYPE OCC. SQ.FT. VALUATION (S) E)QSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOT.SL DECKTORCH AREA GARAGE AREA: LJ DETACH ❑ ATTACH DwELLiNG LNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION [:])TS IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ FES TOTAL VALUATION: PLANWING APPL R ❑ NO PLANNING APPROVAL LETTER EICHLER HONIE? ,s x g' �' By my signature below, I certify to each of the following: I am the property owner ora anent ` read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate gree to c \vitlm all applicable ]oca ordinances and state lasts relating to ding constivc uthoesentatites of Cupertino to enter the ab property. for inspection purposes. /(`S Date: Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED PJ,.AN C11ECI n PE ROUTING SLIP "LIE-COLSTI New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OA EI P. LC'ILDIVG FL.�\ FLS IEVt' permit for new building. F--rrLss PLANNING PLAN RFv :LW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure L-2SI�\D RD P' sLlc \\ ORRS To—nn if any Hazardous Materials are being used as part of this project. Lj ! L ,RGE FIRE DEPT. _ Copy of Planning Approval Letter or Meeting with Planning prior to V submittal of Building Permit application. L �I (J}` s -';I7 FAR] sE`\ ER 1):s7rICT ❑i3\\'1F0\1iE�TALi3F.".LTni Bldg 4pp_2011.doc revised 06/21/11 CUPERTINO 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: 7 q%.' OP 1-,4- 6;- PERMIT # 15rO 3008 OWNER'S NAME: ,51 VA9-" 54 YA/VA r�A-?lAc�-) PHONE # 65a zs� 5'(. tfL GENERAL CONTRACTOR: }1J ov BUSINESS LICENSE # 335Y -)g ADDRESS:tJrk 15�>l-M�4 A-vf l''lja&-A-6 c�k CITY/ZIPCODE: /`/(tO/L CA- i�4o1a *Our municipal code requires all businesses working in the city to have 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 V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork (=f7-A-/Jc;V C,, -S5 -r9 -0C -`Irl Of -� 7L II Cement Finishing A-IJOV -j 5'q- G Electrical 1--fLA-MV 60A,l TIZV CX7 0Af Excavation G X GL L �Ir&CSV I CCS 3 Fencing '-f!-kt7bV GQ,)STF-0GT7 b6) 77�j j I Flooring / Carpeting IVC7Al-F Linoleum / Wood t '( )tet'- 4-4f-bW6zn P -LA-' 3 13 Glass / Glazing A& Al E Heating A -u 9,(FkT g Z �. Insulation S L) ( l N 5 V 6-A-7'1 bk/ Ir ';0 2 Landscaping 0 W N C—PL� Lathing kA -&%O✓ C 0AJ5r)P-UG'T7D1Q 3 �1 3-4 Masonry N O h(C Painting / Wallpaper t<� 1 S 1 o N I p A tz IS 3 Paving O&f Plastering A- OV ' Plumbing f? -0 PLV M1-jr/)&- fr-)9-e /&x 40 Z 4-5- SRoofing Roofing 0-0,f/S - UC/170A/ -2,-77 j 4' Septic Tank OA6 Sheet Metal A-tc #&-A-7/A/' Sheet Rock r—/'Z-A-k(6v0' (V ti,5rlZ UCT? 01-1 3 Tile s 1' - Tt LC- j A447 --b WOW L- 33 Owner / Contractor Signature 4rZ—fes Date vp CALGREEN RESIDENTIAL CHECKLIST — MANDATORY ITEMS l� I COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino org PURPOSE: The 2013 CalGreen Code applies to all newly constructed hotels, motels, lodging houses, dwellings, dormitories, condominiums, shelters, 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 areo subj._the �requirements of CALGreen. 6 U [ i Project Name: Project Address: Sivaram 7475 De La Fame Dr., )n,c I Project Description: Home Add 4 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 Requirements 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 I of 5 CalGreen_2014.doc revised 01115/14 A4.2 General 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. I WATER AND • , • 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 01115/14 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. a ❑ ❑ 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 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, Disposaland 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 ® ❑ 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 Q ❑ shall be compliant with product weighted MIR Limits for ROC and other toxic compounds. Page 3 of 5 CalGreen_2014.doc revised 01115114 4.504.2.4 Verification. Documentation shall be provided to verify that VOC limit 0 ❑ compliant 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 ❑7 El 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 a ❑ 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 a ❑ 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. a ❑ 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 OR 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 ❑ ❑ 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 01115114 CALGREEN SIGNATURE DECLARATIONS Project Name: Sivaram Addition Project Address: 7475 De La Farge Dr. Project Description: Home Addition 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. Owner's Signature Date Owner's Name (Please Print) Design Professional's Signature Date A, i`--( I -- Design of ssional's Name (Please Print) 02!26!2015 Signature of License Professional responsible for CalGreen compliance Date Eric Kirk 408-806-9901 Name of License Professional responsible for CalGreen compliance (Please Print) Phone eric@builders-energy.net 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 Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen_2014.doc revised 01/15/14 CUPERTINO STATEMENT OF SPECIAL INSPECTIONS, 2013 CBC 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 oDcupertino.oro SITE (� ADDRESS `15 m e- �/ APN s . BP#t 5" 3 a a / 'r Owner .Ft.NA zi Yr. I . ............... ... Z..V..HT .. ...... Contractor....................................................................................................... Date: .... ................ -II Address... 1-.-�.6....ZF..../-:.r�........ FAR�.......J — f....... Address........................................................................................................... City/St...�LiQ; .. .T�.t�+.t%.Zip...:.! 5Q..1.t'f... Phone ..257 City/St..............................................n..� zip ...................Phon(e........................ Applicant......................................................................................................... Inspection Agenc / Inspector Nam/y YXI.-1400 e:WK ngine-e ArchGitect.../�'iA�,�7�i.-f.Pl!�I.. !0?y.. � �= ....��!.i'1 Address........................................................................................................... • Address...�...D..�R..../`l/..L �Ol�%......y. •. City/St............. ................................ Zip ........................... Phone ...................... City/St ..... S.._ -y.�.... Zi ... Phonj'(!{�)..�.1 PROJECT DESCRIPTION: Signature.................................................................................................................... This "STATEMENT OF SPECIAL INSPECTIONS" is submitted in fulfillment of the requirements of CBC Sections 1704 and 1705. This form is structured after and used by permission from the Structural Engineer Association of Northern California's (SEAONC) mode , L�al Inspections. Also, included with this form is the following: SPECIAL INSPECTION AGENCIES (page 2). A list of testing gencies and other special inspectors that will be retained to conduct the tests and inspections for this project HEDULE OF SPECIAL INSPECTION" (page 3--r-A)_.�. The Schedule f d ns �ni arizes the Special NZ l�hi« i� sections and tests required. Special Inspectors iviA�r fed o #4 ap)ftoWd pians and specifications for detailed special inspection requirements. Any additional tests an&rt tioi rgquuired/)�yAh��pr;Df,,e .p s a �s{ M)qJ J sge� 1 0 be performed. <s ff��C �JUB AT ALL TIMES �V �Ji 13Y Spec al nsT� p� ec ions and Testing will be performed in accordance with the ap ro e�%�'kc. 01ah�71d specitigations, this s a eft5'eht`LkG Sections 1704, 1705, 170 1707, and 1708. Interim reports will be submitted to the Building Official and the Registered Design Professional in Responsible Charge in accordance with CBC Section 1704.1.2. A Final Report of Special Inspections documenting required Special Inspections, testing and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy (Section 1704.1.2). The Final Report will document: • Required special inspections. • Correction of discrepancies noted in inspections. l" The Owner recognizes his or her obligation to ensure that the construction complies with the approved permit documents and to implement this program of special inspections. In partial fulfillment of these obligations, the Owner will retain andI ay for the Special Inspections as required in CBC Section 1704.1. 90A A /� This plan has been developed with the understanding that the Building Official will: I I TTA L • Review and approve the qualifications of the Special Inspectors who will perform the inspections. • Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are perfo their duties as called for in this Statement of Special Inspection. • Review submitted inspection reports. • Perform inspections as required by the local building code. I have read and aaree to comoly with the terms and conditions of this statement Prepared By: Project Engineer ❑ Architect ��j �..... Registered D s n Professional in Charge Si nature .. ...... ...............!........ Lic.# `�.. .. Date: .... ................ Owner Name: fkm-y Owner's Authorization Si nature.................................................................................................................. Date:...... .. ......... Inspection Agenc / Inspector Nam/y YXI.-1400 e:WK A • Si natur ............... .. ....... ..... Lic.#....................................... Date .^.................... Building Officia or designee: Signature.................................................................................................................... Date:.......................... SpecialnspectionForm 2012.doc revised 09/06/12 LIST OF SPECIAL INSPECTION AGENCIES APPROVAL OF SPECIAL INSPECTORS: Each special inspection agency, testing facility, and special inspector shall be recognized by the Building Official prior to performing any duties. Special Inspection agency's listed on this form must be pre -approved and listed on Cupertino's approved Special Inspector's list. Special inspectors shall carry approved identification when performing the functions of a special inspector. Identification cards shall follow the criteria set by the California Council of Testing and Inspection Agencies. No personnel changes shall be made without first obtaining the approval of the Building Official. Any unauthorized personnel changes may result in a "Stop Work Order" and possible permit revocation. To be pre- approved by the City of Cupertino, refer to the SPECIAL INSPECTION CRITERIA handout. Please allow two weeks to complete the application process. The tollowing are the testing ands ectal inspection agencies tnat will oe retainea to conauct tests ana inspection on tnis projecu EXPERTISE FIRM / INSPECTOR INFORMATION * 1. Special Inspection (except for Firm.....................................................................Addr......................................................................................... geotechnical) City.......................................................................................................... State .......................Zip ...................... Telephone...................................... Fax ............................................ Email......................................................... 2. Material Testing Firm.....................................................................Addr......................................................................................... City_ ---- .................................................................................................. State .......................Zip ...................... Telephone.......................................Fax............................................ Email......................................................... 3. Geotechnical Inspections Firm.....................................................................Addr......................................................................................... City.......................................................................................................... State .......................Zip ...................... Telephone...................................... Fax............................................ Email......................................................... 4. Other: Firm.....................................................................Addr......................................................................................... City.......................................................................................................... State .......................Zip ...................... Telephone...................................... Fax ............................................ Email......................................................... *All agencies specified on this form must be SEISMIC REQUIREMENTS (Section 1705.3.6) on the City of Cupertino's Approved Special I Description of seismic -force -resisting system and designated seismic systems subject to special inspections as per Section 1705.3: The extent of the seismic -force -resisting system is defined in more detail in the construction documents. I w.4. -i Description of main wind -force -resisting system and designated wind resisting components subject to special inspections in accordance with Section 1705.4.2: The extent of the main wind -force -resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionForm 2012.doc revised 09/06/12 SCHEDULE OF SPECIAL INSPECTION SITE APN BP# ADDRESS PROJECT DESCRIPTION: Notation Used in Table: Column headers: C Indicates continuous inspection is required. P Indicates periodic inspections are required. The notes and/or contract documents should clarify. Box entries: X Is placed in the appropriate column to denote either "C" continuous or "P" periodic inspections. --- Denotes an activity that is either a one-time activity or one whose frequency is defined in some other manner. Additional detail regarding inspections and tests are provided in the project specifications or notes on the drawings. VERIFICATION AND INSPECTIONC P REFERENCED IBC REFERENCE STANDARD INSPECTION OF FABRICATORS 1. ❑ Inspect fabricator's fabrication and quality control 1704.3 procedures. INSPECTION OF STEEL 1. Material verification of high-strength bolts, nuts and washers. ❑ Identification marking to conform to ASTM stds AISC 360, specified in the approved construction documents. --- X Section A3.3 and applicable ASTM material standards ❑ Inspect fabricator's fabrication and quality control procedures. 2. Inspection of high-strength bolting: ❑ Snug -tight joints. --- X ❑ Pretensioned and slip -critical joints using turn -of -nut with matchmarking, twist -off bolt or direct tension --- X AISC 360, indicator methods of installation. Section M2.5 1704.3.3 ❑ Pretensioned and slip -critical joints using turn -of -nut without matchmarking or calibrated wrench methods X --- of installation. 3. Material verification of structural steel and cold -formed steel deck. ❑ For structural steel, identification markings to conform X AISC 360, to AISC 360. Section M2.5 ❑ For other steel, identification markings to conform to Applicable ASTM ASTM standards specified in the approved --- X material standards construction documents. ❑ Manufacturer's certified test reports. --- X SpecialnspectionForm 2012.doc revised 09/06/12 VERIFICATION AND INSPECTIONC C p REFERENCED STANDARD IBC REFERENCE 4. Material verification of weld filler materials: ❑ Identification marking to conform to AWS specification in the approved construction documents. --- X AISC 360, Section A3.5 and applicable AWS A5 documents --- ❑ Manufacturer's certificate of compliance required. --- X --- --- 5. Inspection of welding: a. Structural steel and cold -formed steel deck: ❑ Complete and partial joint penetration groove welds. X --- AWS D1.1 1704.3.1 ❑ Multipass fillet welds. X --- ❑ Single -pass fillet welds > 5/16" X --- ❑ Plug and slot welds. X --- ❑ Single -pass fillet welds <= 5/16" --- X ❑ Floor and roof deck welds. --- X AWS D1.3 b. Reinforcing steel: ❑ Verification of weldability of reinforcing steel other than ASTM A 706. X AWS D1.4 ACI 318: Section 3.5.2 ❑ Reinforcing steel resisting flexural and axial forces in intermediate and special moment frames, and boundary elements of special structural walls of concrete and shear reinforcement. X ___ ❑ Shear reinforcement. X --- ❑ Other reinforcing steel. --- X 6. Inspection of steel frame joints details for compliance: ❑ Details such as bracing and stiffening. --- X --- 1704.3.2 ❑ Member locations. --- X ❑ Application of joint details at each connection. --- X VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE INSPECTION OF WELDING 1. ❑ Welded studs when used for structural diaphragms. --- X --- 1704.3 2. ❑ Welding of cold -formed steel framing members. --- X r3. ❑ Welding of stairs and railing systems. --- X SpecialnspectionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTIONC p REFERENCED STANDARD IBC REFERENCE INSPECTION OF CONCRETE 1. ❑ Inspection of reinforcing steel, including prestressing --- X ACI 318: 3.5, 7.1-7.7 1913.4 tendons and placement. 2. ❑ Inspection of reinforcing steel welding in accordance AWS D1.4 ACI 318: with Table 1704.3 Item 5b. ___ ___ 3.5.2 --- 3. ❑ Inspection of bolts to be installed in concrete prior to and during placement of concrete where allowable X ___ ACI 318: 8.1.3, 1911.5, 1912.1 loads have been increased or where strength design 21.2.8 is used. 4. Inspection of anchors installed in hardene5 wrete. --- X ACI 318: 1912.1 5. ❑"Verifying use of required design mix. X ACI 318: 1904.2.2,1913.2, 1913.3 6. ❑ At time fresh concrete is sampled to fabricate ASTM C 172 specimens for strength tests, perform slump and air X --- ASTM C 31 1913.10 content tests and determine the temperature of the concrete. ACI 318: 5.6, 5.8 7. ❑ Inspection of concrete and shotcrete placement for X --- ACI 318: 5.9, 5.10 1913.6, 1913.7, proper application techniques. 1913.8 8. ❑ Inspection for maintenance of specified curing X ACI 318: 5.11-5.13 1913.9 temperature and techniques. 9. Inspection of prestressed concrete: ❑ Application of prestressing forces. X --- ACI 318:18.20 ❑ Grouting of bonded prestressing tendons in the X --- ACI 318: 18.18.4 seismic force-resisting system. 10. ❑ Erection of precast concrete members. --- X ACI 318: Ch. 16 --- 11. ❑ Verification of in-situ concrete strength, prior to stressing of tendons in posttensioned concrete and ___ X ACI 318: 6.2 --- prior to removal of shores and forms from beams and structural slabs. 12. ❑ Inspect formwork for shape, location, and dimensions ___ X ACI 318: 6.6.1 --- of the concrete member being formed. 13. ❑ Bolts Installed in Existing Masonry or Concrete ❑ Direct tension testing of existing anchors. --- X See ICC ES Reports form special inspection requirements for proprietary ❑ Direct tension testing of new bolts. --- X ❑ Torque testing of new bolts. _-- X products ❑ Prequalification test for bolts and other types of ___ X anchors. 14. ❑ Other: ArJ d A3- t_V "9-,4t (, )eA#41 C->0 0P-✓A / ( '� �' 0, SpecialnspectionForm 2012.doc revised 09/06/12 SpecialnspectionForm_2012.doc revised 09/06/12 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION 530/ASCE 5 530/ASCE 6 INSPECTION OF LEVEL 1 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved --- X --- --- Art. 1.5 submittals shall be verified. 2. ❑ Verification of fmand faac prior to construction --- X -__ ___ Art. 1.413 except where specifically exempted by this code. 3. ❑ Verification of slump flow and VSI as delivered to X --- _-- --- Art. 1.5B.1.b.3 the site for self consolidating grout. 4. As masonry construction begins, the following shall be verified to ensure compliance: ❑ Proportions of site -prepared mortar. --- X --- --- Art. 2.6A ❑ Construction of mortar joints. --- X --- --- Art.3.313 ❑ Location of reinforcement, connectors, --- X --- --_ Art. 3.4, 3.6A prestressing tendons, and anchorages. ❑ Prestressing technique. --- X --- --- Art. 3.61B ❑ Grade and size of prestressing tendons and ___X --- Art. 2.413, 2AH anchorages. 5. During construction the inspection program shall verify: ❑ Size and location of structural elements. --- X --- --- Art. 3.3F ❑ Type, size, and location of anchors, including Sec. 1.2.2(e), other details of anchorage of masonry to --- X --- 1.16.1 ___ structural members, frames or other construction. ❑ Specified size, grade, and type of reinforcement, anchor bolts, prestressing tendons and --- X --- Sec. 1.15 Art. 2.4, 3.4 anchorages. ❑ Welding of reinforcing bars. X --- --- --- ❑ Preparation, construction and protection of masonry during cold weather (temperature below ___ X Sec. 2104.3, ___ Art. 1.8C, 1.8D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressingX Art. 3.6B force. 6. Prior to grouting the following shall be verified to ensure compliance: ❑ Grout space is clean. --- X --- --- Art. 3.2D ❑ Placement of reinforcement and connectors and --- X --- Sec. 1.3 Art. 3.4 prestressing tendons and anchorages. ❑ Proportions of site -prepared grout and -_- X ___ --- Art. 2.6B prestressing grout for bonded tendons. ❑ Construction of mortar joints. --- X --- --- Art. 3.31B 7. Grout placement: ❑ Grout placement shall be verified ensure X --- Art. 3.5 compliance. ❑ Observe grouting of prestressing bonded X --_ ___ --- Art 3.6C tendons. SpecialnspectionForm_2012.doc revised 09/06/12 SpecialnspectionForm_2012.doc revised 09/06/12 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION 530/ASCE 5 530/ASCE 6 8. ❑ Preparation of any required grout specimens, Sec. mortar specimens, and/or prisms shall be --- X 2105.2.2, --- Art. 1.4 observed. 2105.3 INSPECTION OF LEVEL 2 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved --- X --- --- Art. 1.5 submittals. 2. ❑ Verification of fm and fAAc prior to construction and for every 5,000 square feet during --- X --- --- Art. 1.46 construction. 3. ❑ Verification of proportions of materials in premixed or preblended mortar and grout as --- X --- --- Art. 1.5B delivered to the site. 4. ❑ Verification of slump flow and VSI as delivered to X -__ --_ ___ Art. 1.513.1.b.3 the site for self consolidating rout. 5. The following shall be verified to ensure compliance: ❑ Proportions of site -prepared mortar, grout, and -__ X -_- ___ Art. 2.6A prestressing grout for bonded tendons. ❑ Placement of masonry units and construction of _-- X --- ___ Art. 3.313 mortar joints. ❑ Placement of reinforcement, connectors and --- X --- Sec. 1.15 Art. 3.4, 3.6A prestressing tendons and anchorages. ❑ Grout space prior to grouting. X --- --- --- Art. 3.2D ❑ Placement of grout. X --- --- --- Art. 3.5 ❑ Placement of prestressing grout. X --- --- --- Art. 3.6C ❑ Size and location of structural elements. --- X --- --- Art. 3.3F ❑ Type, size, and location of anchors, including other details of anchorage of masonry to X -_- ___ Sec.1.2.2(e) -- structural members, frames and other construction. ❑ Specified size, grade, and type of reinforcement, anchor bolts, prestressing tendons and --- X --- Sec. 1.15 Art. 2.4, 3.4 anchorages. ❑ Welding of reinforcing bars. X--- --- Sec. 2.1.9.7.2, --- 3.3.3.4 (b) ❑ Preparation, construction, and protection of masonry during cold weather (temperature below ___ X Sec. 2104.3, -__ Art. 1.8C, 1.8D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing X --- _-- ___ Art. 3.6B force. 6. ❑ Preparation of any required grout specimens, Sec. mortar specimens, and/or prisms shall be X --- 2105.2.2, --- Art. 1.4 observed. 2105.3 SpecialnspectionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTIONC p REFERENCED STANDARD IBC REFERENCE INSPECTION OF WOOD 1. ❑ Inspect prefabricated wood structural elements and assemblies in accordance with Section 1704.2. --- --- -__ 1704.6 2. ❑ Inspect site built assemblies. --- 3. Inspect high -load diaphragms: ❑ Verify grade and thickness of sheathing. --- --- ❑ Verify nominal size of framing members at adjoining panel edges. --- --_ --- 1704.6.1 ❑ Verify nail or staple diameter and length, --- --- ❑ Verify number of fastener lines, --- --- ❑ Verify spacing between fasteners in each line and at --- edge margins. -_ 4. ❑ Metal -plate -connected wood trusses spanning 60 feet or greater: Verify temporary installation restraint/bracing and the permanent individual truss --- X --- 1704.6.2 member bracing are installed in accordance with the approved truss submittal package. REQUIRED VERIFICATION AND INSPECTION OF SOIL 1. ❑ Verify materials below footings are adequate to X achieve the desired bearing capacity. --- 2. ❑ Verify excavations are extended to proper depth and __- X have reached proper material. 3. ❑ Perform classification and testing of compacted fill X materials. ___ --- Table 1704.7 4. ❑ Verify use of proper materials, densities and lift thicknesses during placement and compaction of X --- compacted fill. 5. ❑ Prior to placement of compacted fill, observe subgrade -_ I X and verify that site has been prepared properly. REQUIRED VERIFICATION AND INSPECTION OF DEEP DRIVEN FOUNDATION ELEMENTS 1. ❑ Verify element materials, sizes and lengths comply X --- with the requirements. 2. ❑ Determine capacities of test elements and conduct X _- additional load tests, as required. 3. ❑ Observe driving operations and maintain complete X --- and accurate records for each element. 4. ❑ Verify locations of piles and their plumbness, confirm type and size of hammer, record number of blows per --- Table 1704.8 foot of penetration, determine required penetrations to X --- achieve design capacity, record tip and butt elevations and document any damage to foundation element. 5. ❑ For steel elements, perform additional inspections in __- --- accordance with Section 1704.3. 6. ❑ For concrete elements and concrete filled elements, perform additional inspections in accordance with --- Section 1704.4. SpecialnspectionForm 2012. doe revised 09/06/12 VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE 7. ❑ For specialty piles, perform additional inspections as determined by the registered design professional in --- --- --- Table 1704.8 responsible charge. REQUIRED VERIFICATION AND INSPECTION OF CAST -IN-PLACE DEEP FOUNDATION ELEMENTS 1 ❑ Observe drilling operations and maintain complete and X --- accurate records for each element. 2. ❑ Verify placement locations and plumbness, confirm element diameters, bell diameters (if applicable), lengths, embedment into bedrock (if applicable), and X --- --- Table 1704.9 adequate end -bearing strata capacity. Record concrete or grout volumes. 3. ❑ For concrete elements, perform additional inspections in accordance with Section 1704.4. HELICAL PILE FOUNDATIONS 1. ❑ Record installation equipment used, pile dimensions, X 1704.10 tip elevations, final depth, final installation torque. SPRAYED FIRE-RESISTANT MATERIALS Physical and visual tests 1. Condition of substrates. ❑ Inspect surface for accordance with the approved fire - resistance design and the approved manufacturer's --- --- written instructions. ❑ Verify minimum ambient temperature before and after X application. --- 1704.12.1 ❑ Verify ventilation of area during and after application. --- X 2. ❑ Measure average thickness per ASTM E605 and Section 1704.12.4. S --- --- --- 3. ❑ Verify density of material for conformance with the approved fire-resistant design and ASTM E605. (Ref. --- --- Section 1704.12.5) 4. ❑ Test cohesive/adhesive bond strength per Section 1704.12.6. 5. ❑ Condition of finished application. MISCELLANEOUS 1. Mastic and Intumescent Fire -Resistant Coating. --- --- --- 1704.13 2. Exterior Insulation and Finish Systems (EIFS). Water - resistive barrier coating when installed over a sheathing --- --- --- 1704.14 substrate. 3. Special Cases --- --- --- 1704.15 _-T4. Smoke Control System --- --- --- 1704.16 5. Seismic Resistance ❑ Suspended ceiling systems and their anchorage. --- --- --- 1705.3 SpecialnspectionForm 2012.doc revised 09/06/12 VERIFICATION AND INSPECTION C P REFERENCED STANDARD IREFERENCE IBC 6. Wind Resistance ❑ Roof cladding and roof framing connections. --- --- • Wall connections to roof and floor diaphragms and framing. ❑ Roof and floor diaphragm systems, including collectors, drag struts and boundary elements. ❑ Vertical wind-force-resisting systems, including braced frames, moment frames, and shear walls. ❑ Wind-force-resisting system connections to the foundation. ❑ Fabrication and installation of systems or components required to meet the impact resistance requirements --- --- --- of Section 1609.1.2. SPECIAL INSPECTION FOR WIND REQUIREMENTS 1. Structural Wood ❑ Inspect field gluing operations of elements of the main X --- wind-force-resisting system. --- 1706.2 ❑ Inspect nailing, bolting, anchoring, and other fastening of components within the main windforce-resisting - X system, including wood shear walls, wood diaphragms, drag struts, braces and hold-downs. 2. Cold-Formed Steel Framing ❑ Welding of elements of the main wind-force-resisting --- X system. --- 1706.3 ❑ Inspection of screw attachments, bolting, anchoring, and other fastening of components within the main wind-force-resisting system including shear walls, --- X braces, diaphragms, collectors (drag struts) and hold- downs. 3. Wind-resisting components ❑ Roof cladding. --- X ___ 1706.4 ❑ Wall cladding. --- X SPECIAL INSPECTIONS FOR SEISMIC RESISTANCE 1. ❑ Special inspection for welding in accordance with the X 1707.2 quality assurance plan requirements of AISC 341. 2. Structural Wood ❑ Inspect field gluing operations of elements of the X --- seismic-force-resisting system. Inspect nailing, bolting, anchoring, and other fastening s ��j V\AA�' ' 1707.3 of components within the seismic-force-resisting X 4 -�' r Sly oL` system, including wood shear walls, wood --- diaphragms, drag struts, braces, shear panels and Lz , o, hold-downs. 3. Cold-Formed steel light-frame construction ❑ Welding of elements of the seismic-force-resisting X 1707.4 system. SpecialnspectionForm_2012.doc revised 09/06/12 ❑ Inspection of screw attachments, bolting, anchoring, and other fastening of components within the seismic- X force -resisting system including shear walls, braces, diaphragms, collectors (drag struts) and hold-downs. 4. Storage racks and access floors ❑ Anchorage of storage racks 8 feet or greater in height X 1707.5 and access floors. 5. Architectural components ❑ Inspect erection and fastening of exterior cladding weighing more than 5 psf and higher than 30 feet --- X above grade or walking surface. ❑ Inspect erection and fastening of veneer weighing more than 5 psf.and higher than 30 feet above grade --- X or walking surface. --- 1707.6 ❑ Inspect erection and fastening of all exterior non- bearing walls higher than 30 feet above grade or --- X walking surface. ❑ Inspect erection and fastening of all interior non- bearing walls weighing more than 15 psf and higher --- X than 30 feet above grade or walking surface. 6. Mechanical and Electrical Components ❑ Inspect anchorage of electrical equipment for X emergency or stand-by power systems. ❑ Inspect anchorage of non -emergency electrical X equipment. ___ ❑ Inspect installation of piping systems and associated mechanical units carrying flammable, combustible, or --- X --- 1707.7 highly toxic contents. ❑ Inspect installation of HVAC ductwork that contains X hazardous materials. --_ ❑ Inspect installation of vibration isolation systems X where required by Section 1707.7. --- 7. ❑ Verify that the equipment label and anchorage or mounting conforms to the certificate of compliance -__ 1707.8 when mechanical and electrical equipment must be seismically qualified. 8. ❑ Seismic isolation system: Inspection of isolation ___ X --_ 1707.9 system per ASCE 7 — Section 17.2.4.8 9. ❑ Obtain mill certificates for reinforcing steel, verify compliance with approved construction documents, --- --- --- 1708.2 and verify steel supplied corresponds to certificate. 10. ❑ Structural Steel: Invoke the QAP Quality Assurance 1708.3 requirements in AISC 341. --- 11. ❑ Obtain certificate that equipment has been seismically 1708.4 qualified. --_ 12. ❑ Obtain system tests as required by ASCE 7 Section--- --- __- 1708.5 17.8. SpecialnspectionForm 2012.doc revised 09/06/12 CUPERTINO RECOGNIZED SPECIAL INSPECTION AGENCY LIST 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 • buildingacupertino.org The following list of Special Inspection Agencies and their special inspectors are approved by the City of Cupertino to provide specific inspection in their respective field until the expiration date listed. Agency Name, Address and expiration date Special Inspectors RC PC Special Inspection Field SM SW HB FP S W CG Achievement Engineering Corp. 434 Camille Cir. #13 San Jose, CA 95134 Tel: (800) 653-1397 Fax: (408) 852-0331 Expires: 07/22/2015 Firouz'aei, Arash FP = Spray -Applied Fire roofin CG = CalGreen Code X X X X Hooshdar, Sina X X X X Khodadadi, Mohammad X Safaian, Farshad Applied Materials &Engineering, Inc. 980 4151 Street Oakland, CA 94608 Tel: (510) 420-8190 Fax: (510) 420-8186 Expires: 12/19/2014 Email: info .appmateng.com Aaron Hardy X X X AnthonyKlarich X X X X X Armen Ta'irian, P.E. X Bryan Jackson X X David Jackson X I X X X X Diego Bertolino X X X Harold Walrath X X X X Ken Maloney X X Michael Knowles X X X I X Oswaldo Dominguez X X X X Sean Guches X X X Bagg Engineers 847 West Maude Ave. Sunnyvale, CA 94085-2911 Tel: (650) 852-9133 Fax: (650) 852-9138 Expires: 7/16/2015 www.baggengineers.com Brown, Christian X X X X X Cole, Michael Hepper, John X X X Knudsen, Steven J. McManus, Alvin X X X Norris, David L. X X X X O'Driscoll, Alan Salceda, Francisco Sciortino, Brandon Smith, Louis Steinbrueck, Bryan Thai, Minh Umeki, Takashi RC = Reinforced Concrete SW = Steel & Welding S =Soils PC = Pre-stressed/Post-tensioned Concrete HB = High -Strength Bolding W = Wood SM = Structural Masonry FP = Spray -Applied Fire roofin CG = CalGreen Code Speciallnspectionbst.doc revised 02/01/14 Agency Name, Address and expiration date Special Inspectors RC PC Special Inspection Field SM sw HB FP s w CG Biggs Cardosa Associates, Inc. 865 The Alameda San Jose, CA 95126 Tel: (408) 296-5515 Fax: (408) 296-8114 Expires: 7/11/2014 www.biggscardosa.com Castro, Roberto FP = Spray -Applied Fire roofin CG = CalGreen Code Chan, David X X Ghorbani, Behrooz Lazzarini, Dan Rivas, Ricardo Rosales, Adolfo Rosellini, Daniel Sanchez, Adam To an, Claudiu X X Wooley, Mark X X X X Yamane, Robert BSK Associates Engineers & Laboratories 324 Earhart Way Livermore, CA 94551 Tel: (925) 315-3151 Fax: (925) 315-3152 Expires: 9/06/2014 www.bskassociates.com Auser, Jim X X X Bos ue, Jeff X X X Clary, Mike X X X X Evans, Keven X Minerales, Gilbert Ness, Dennis X X X Olsten, Ken X X Reeves, Ben Rodriguez, Tim X X X Schurman, Peter X Capex Engineering Inc. 571 Seville Place Fremont, CA 94539 Tel: (510) 668-1815 Fax: (510) 490-8690 Expires: 6/25/2014 Gary Hsu X X X X X Chow, Erwin 1105 Belmont Ave. Long Beach, CA 90804 Tel: (562) 449-7491 Expires: 4/24/2014 Erwin Chow X RC = Reinforced Concrete SW = Steel & Welding S =Soils PC = Pre-stressed/Post-tensioned Concrete HB = High -Strength Bolding W = Wood SM =Structural Masonry FP = Spray -Applied Fire roofin CG = CalGreen Code SpeciallnspectionList.doc revised 02/01/14 Agency Name, Address and expiration date Special Inspectors RC PC Special Inspection Field SM SW HB FP s w CG Consolidated Engineering Laboratories 2001 Crow Canyon Road, Suite 100 San Ramon, CA 94583 Tel: (925) 341-7100 Fax: (925) 855-7140 Expires: 6/25/2014 www.ce-labs.com Ahmed, Badaruddin FP = S ra -A lied Fireproofing CG = CalGreen Code Alexander, David X X X Andersen, Calvin X X Bartlett, Dennis X X Bobrovitsk , Edward X X X Bolen, Michael X X X Brooks, Brendan X X X X X Brown, Ronald X X X X X Buchmiller, Kenn Cottingham, Paul Currier, James X X Eschliman, Duaine Eschliman, Kevin Fuller, Mark X X Halloran, James X X X X X Harrington, Wayne X X Hassebrock, Scott X X X X X Healy, Michael X Heilmann, Mark X X X Hornyak, John X X X X Hyslop, John X X X X King, Phillip X X X X Kmitt, Stanley X I X Liebold, Jeffrey X X X X X Lozano, Alfonso Art Ma, Steven X Marlik, William X X McCutcheon, Thurmond X X McKenzie, Quinten McLaughlin, Lori X X Miner, Dwight X X Murphy, Don X Pastora, George X X X X Rodriguez, Sandra X X Si mon, Josephine Sisson, James X X X X Small, Michael X X Van Horn, Bradford X X X X Walters, Michael Zuerner, Robert X X I X RC = Reinforced Concrete SW = Steel & Welding S =Soils PC = Pre-stressed/Post-tensioned Concrete HB = High -Strength Bolding W = Wood SM = Structural Mason FP = S ra -A lied Fireproofing CG = CalGreen Code SpeciallnspectionList.doc revised 02101114 Agency Name, Address and expiration date Special Inspectors RC Pc Special Inspection Field SM sw Hs FP S W CG Construction Testing Services 2174 Rheem Dr., Ste. A Pleasanton, CA 94588 Tel: (925) 462-5151 Fax: (925) 462-5183 Expires: 6/26/2014 www.Cts-1.Com Brian Arnold X X X Edward Bindert X X X X X Jeremy Brown X X X James Brumley X Jared Byers X X Richard Collin X X X Robert Cortez X X X X X Robert Criswell X X X Mark Dornan X X X X Tom Edwards X X X X X Tim Farley X X X X X X Gary Fechner X X X Mike Gaunt X Ron Harr X X X X Neal Hoellwarth X Richard Jones X X X X Rick Mann X X Kevin McCurdyX X Kevin Meyers X Kevin Moore X X Craig Nagle David Puskarich X X X X William Radulovich Brian Ragan X X X X X John Rink X George Rockenstein X X Larry Rothey X Erin Salazar X X Robert Schulze X Donald ShirleyX X X Tom Shuster X X X X X Larry Slater X Daryl Spieker X X Gary Stapleton X X X Matt Swope X X Travis Taylor X X Vinny Vinavong X Shawn Vucenic X John White X X X X X Isidoro Za ien X I X I X RC = Reinforced Concrete SW = Steel & Welding S =Soils PC = Pre-stressed/Post-tensioned Concrete HB = High -Strength Bolding W = Wood SM = Structural Masonry FP = Spray -Applied Fire roofin CG = CalGreen Code SpeciallnspectionList.doc revised 02/01/14 Agency Name, Address and expiration date Special Inspectors RC Pc Special Inspection Field SM SW HB FP s w CG Earth Systems Pacific 446 S. Hillview Dr. Milpitas, CA 95035 Tel: (408) 934-9302 Fax: (831) 637-0510 Exp: 6/28/2014 www.earthsystems.com George Barnett FP = Spray -Applied Fire roofn X X Jeff Bryan X X Norman Engen X X X X Cal Hicks X X X X X Dennis Hurley X X rus Mejia ENGEO Incorporated 2010 Crow Canyon PI., Suite 250 San Ramon, CA 94583 Tel: (925) 866-9000 Fax: (888) 279-2698 Exp: 7/06/2014 www.engeo.com Tim Benton Greg Hudson X Mike Huener ardt X X X X Kevin Lecce James "Chip" Moore X X X Randy Mues X Jonathan Parker X X X X Rich Rose X X X H P Inspection, Inc. 690 Sunol ST, Building H San Jose, CA 95126 Tel: (408) 288-8460 Fax: (408) 271-0902 Expires: 11/15/2014 Larry Castrence Tony Cotta X X Mark Cotter Chuck Pinkham X X X X David Pinkham X X X X P. Scott Pinkham X X X Stafford X X X X X -Gary Jason Waugh X X X X X RC = Reinforced Concrete SW = Steel & Welding S =Soils PC = Pre-stressed/Post-tensioned Concrete HS = High -Strength Bolding W = Wood SM = Structural Masonry FP = Spray -Applied Fire roofn CG = CalGreen Code SpeciallnspectionList.doc revised 02/01/14 Agency Name, Address and expiration date Special Inspectors RC PC Special Inspection Field SM sw HB FP S W CG Inspection Services, Inc. 1798 University Ave. Berkeley, CA 94703 Tel: (510) 900-2100 Fax: (510) 900-2101 Expires: 03/21/2015 www.inspectionservices.net Alakbarov, Ha dar CG = Ca/Green Code X Amos III, Jessie X Baccus, Garrett X X Baek, Byung Gi X X X X X X Barone, Judith X X X Celik, Can X X X X X X X Colby, Paul X X Ehrsam, Gary X Falk, Andrew X X X X Flynn, Chris X X X X X X Gaut, Tobin X X X X Llames, Fernando X X X X Lon, Rand "Roy" X X X X X X Patterson, Rodger X X Putman, Edward X X X X X Sandoval, Carlos X X X X X X Shebesta, Todd X Simonton, Cy -Leon X Solis, Winnie X X Stafford, William X Stark, Douglas X X X X Toschi, Patrick X X X X X Wheeler, Steven X X X X X Kleinfelder 2601 Barrington Court Hayward, CA 94545 Tel: (925) 484-1700 Exp: 7/10/2014 www.kleinfelder.com Anderson, Tim X X X X X X Brewster, Steve X Burton, Nathan X X X Craig, Cliff X X X X X X Delabriandais, Gary X X X Eres, Mark X X X X X Foster, Stephen X X X X Hammon, Robert X X X X Johnson, Josh X Kesler, Timothy X Milla e, Leonard X X X X X Nicoletti, Johnathon I X X Oandason, Jose X X X X X X Rommel, Daniel X X Saber, Sam X X X Swank, Phillip X X X RC = Reinforced Concrete SW = Steel & Welding S =Soils PC = Pre-stressed/Post-tensioned Concrete HB = High -Strength Bolding W = Wood SM = Structural Masonry FP = Spray -Applied Fire roofin CG = Ca/Green Code SpeciallnspectlonList.doc revised 02/01/14 Agency Name, Address and expiration date p Special Inspectors RC PC Special Inspection Field SM SW HB FP S W CG Krazan &Associates, Inc. 6711 Sierra Court, Ste B Dublin, CA 94568 Tel: (925) 307-1160 Fax: (925) 307-1161 Exp: 2/6/2014 www,krazan.com James Allen X X X James Benefeito X X X Larry Borges X X X X Ron Chandler X Van DeMent X X Gregory Fernald Matthew Fernald Lewis Franklin X X X X X Ken Hafeli X X X Andy Morris X X X X Sidney Moss X X X X Matt Romero X Gregory Ruf MatriScope Engineering Laboratories, Inc. 4730 Contractors Common Livermore, CA 94551 Tel: (925) 606-7700 Fax: (925) 606-7702 Expires: 7/26/2014 www.matriscope.com D'Souza, Andrew Fannin, Dana X X X Ho elian, Joseph X X X X Keller, Don X X Kohls, Kristin Lake, Adam X X Mathis, Q. Shane X X X X X Nieser, Paul X Palmer, Scott Reese, Mark X Scoble, Kod Selvage, Kevin Shelton, James X X X X X X Sta ner, Jack X X X X X X Swartz, Jud Tadlock, K. Scott X X X X X X Tadlock, Robert X X X X X X Thomas, Chris X Varella, Joe RC = Reinforced Concrete SW = Steel & Welding S =Soils PC = Pre-stressed/Post-tensioned Concrete HB = High -Strength Bolding W = Wood SM = Structural Masonty FP = Spray4pplied Fireproofing CG = CalGreen Code SpeciallnspectionList.doc revised 02/01/14 Agency Name, Address and expiration date Special Inspectors RC Pc Special Inspection Field SM SW HB I FP S W CG Neil O. Anderson & Associates, Inc. 902 Industrial Way Lodi, CA 95240 Tel: (209) 367-3701 Fax: (209) 333-8303 Expires: 2/1/2016 www.noanderson.com Allen, Eric FP = Spray -Applied Fire roofin CG = CalGreen Code Cozad, Mike X X X X X Dickey, David X Erickson, Rick Gray, Dave X X X X X X Hall, Rollin Johnson, Carl X X X X King, Ryan X Kort, Jason X X X X Landess, Frank X X X Lenehan, Gerry Me'orado, Aaron X Merrell, Ryan X Morgan, Daniel O as, George Oszut, Gregory X X X X Roberts, Jason Westfall, Kimmis X X X X X Whiting, John Williams, Roger X X X PacificlnterWest Bldg Consultants, Inc. 1600 South Main St, Suite 380 Walnut Creek, CA 94596 Tel: (925) 939-5500 Fax: (925) 939-9561 Expires: 9/6/2013 www.gacificinterwest.com Cope,Doug X PSI, Inc. 365 Victor Street, Ste. C Salinas, CA 93907 Tel: (831) 757-3536 Fax: (831) 757-6265 Expires: 1/10/2015 www.psiusa.com Albert George X X X X X Deborah White X Michael Winter X X William Monger X X X X X Brand Burfield X Ezekiel Robles X Stephen Ramos X Darwin Zackary X RC = Reinforced Concrete SW = Steel & Welding S =Soils PC = Pre-stressed/Post-tensioned Concrete HB = High -Strength Bolding W = Wood SM = Structural Masonry FP = Spray -Applied Fire roofin CG = CalGreen Code Speciallnspectionbst.doc revised 02/01/14 Agency Name, Address and expiration date p Special Inspectors RC PC Special Inspection Field SM SW HB FP S W CG RMA Group of Northern California 6296 San Ignacio Ave., Suite A San Jose, CA 95119 Tel: (408) 362-4920 Fax: (408) 362-4926 Expires: 04/01/2012 www.rmacompanies.com Alley, Maurice X CG = CalGreen Code X Bosque,Jeff X X X Carr, Greg Cecconi, Joe X Chinn, Gordon X X X X Francis, Chris X X Geraghty, Rich X X X Gillespie, John X X X X X Gundersen, Al X X X Haff, Tiffany Hughes, Dottie X X X Sondrol, Jeff X X X X Stocke, Jacob X Swain, Pat X Tellesen, Mike X X Tonkovich, Bill X X X X Walters, Chris X X X X X X Zeiher, Adam X RC = Reinforced Concrete SW = Steel & Welding S =Soils PC = Pre-stressed/Post-tensioned Concrete HB = High -Strength Bolding W = Wood SM = Structural Masonry FP = Spray -Applied Fire roofin CG = CalGreen Code SpecialInspectionList.doc revised 02/01/14 Agency Name, Address and expiration date p Special Inspectors RC PC Special Inspection Field SM SW HB FP S W CG Smith -Emery Company Corporate Office: 781 E. Washington Blvd. Los Angeles, CA 90021 Testing Facilities: 1940 Oakdale Ave. P.O. Box 880550 San Francisco, CA 94124 Tel: (415) 642-7326 Expires: 4/09/2015 www.smithemervsf.com Allder, Scott FP = Spray -Applied Fire roofin CG = CalGreen Code Brunett, John X X X Caraisco, Thomas X X X X X X Chuong, Jason X Contreras, Roberto X X X X X Cross, Len Cunningham, Jim Daniels, Jodie X X Daquinag, Bonafacio Docena, Bernard Drake, Barry X X Joakimson, Robert X X X X X X Klopson, Paul X X X Mazuk, Ray X McCarron, Liam X X X Merino, Salvador X X X X X Miranda, Allen Murphy, Mike Nadler, Joel X X X Nickerson, Scott X X X X Ross, Jason X X Serrano, Ramon Sherwood, Tony X X X X X X Starkey, Raymond Stevenson, Wylie Viramontes, Keith X X X Stevens, Ferrone & Bailey 1600 Willow Pass Court Concord, CA 94520 Tel: (925) 688-1001 Fax: (925) 688-1005 Expires: 8/09/2014 www,sfandb.com Babione, Martin X X X Conner, Scott X X X X X X Fletcher, Brett X X X X X X X Minor, Matt X X X Quinn, Tom X XX X Thielges, Jon RC = Reinforced Concrete SIN = Steel & Welding S =Soils PC = Pre-stressed(Post-tensioned Concrete HB = High -Strength Bolding W = Wood SM = Structural Mason FP = Spray -Applied Fire roofin CG = CalGreen Code SpeciallnspectionList.doc revised 02101/14 Agency Name, Address and expiration date Special Inspectors RC PC Special Inspection Field SM SW HB FP S W CG Terracon Consultants, Inc. 3140 Gold Camp Drive, Suite 170 Rancho Cordova, CA 95670 Tel: (916) 858-1579 Fax: (916) 858-8277 Expires: 7/17/2015 www.terracon.com Houts, Walter X X X X X X Mears, Steven X X X X X X Testing Engineers, Inc. 2811 Teagarden Street San Leandro, CA 94577 Tel: (510) 835-3142 Fax: (510) 834-3777 Expires: 4/22/2015 testing -engineers. com Ardizonne, Mike X Dougherty, John X X X X Ganly, Jim Geraghty, Richard X X X X Grossman, Peter, P.E. X Gunderson, Al X X X X Hernandez, Frank X X X X X Mendosa, John X Muzika, Bruce X X Ronald, Seth X Souza, Jason X X Tellesen, Mike X X Thomas, Paul X X X X Watanabe, Dan X Williams, Brian X White, Walker X Yoka, John X X X Western Technologies, Inc. 3480 South Dodge Blvd. Tucson, AZ 85713 Tel: (520) 748-2262 Expires: 8/29/2014 www.wt-us.com Tiedemann, Thomas X RC = Reinforced Concrete SW = Steel 8 Welding S =Soils PC = Pre-stressed/Post-tensioned Concrete HB = High -Strength Bolding W = Wood SM = Structural Masonry FP = S ra -A lied Fire roo iin CG = Ca/Green Code SpeciallnspectionList.doc revised 02/01/14 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Sivaram Addition Calculation Description: Title 24 Analysis Calculation Date/Time: 11:32, Fri, Jun 26, 2015 Input File Name: 06163.PC1.xml CF1 R -PRF -01 Page 1 of 8 GENERAL INFORMATION 01 Project Name Sivaram Addition Ar a 02 Calculation Description Title 24 Analysis nd/or verification by a certified HERS rater under the supervision of a CEC-approved HERS provider. 03 This building incorporates one or more Special Features shown below 03 Project Location 7475 De La Farge Drive 04 City Cupertino 05 Standards Version Compliance 2015 06 Zip Code 95014 07 Compliance Manager Version BEMCmpMgr 2013-3c (710) 08 Climate Zone CZ4 09 Software Version EnergyPro 6.5 10 Building Type Single Family 11 Front Orientation (deg/Cardinal) 180 r 12 Project Scope Addition and/or Alteration 13 Number of Dwelling Units 1 14 Total Cond. Floor Area (FT2) 2124 15 Number of Zones 2 16 Slab Area (FT2) 0 17 Number of Stories 1 N 18 Addition Cond. Floor Area 824 19 Natural Gas Available Yes c n 20 Addition Slab Area (FT2) 0 21 Glazing Percentage (%) 17.8% COMPLIANCE RESULTS 01 Building Complies with Computer Performance Ar a 02 This building incorporates features that require field tesi f l nd/or verification by a certified HERS rater under the supervision of a CEC-approved HERS provider. 03 This building incorporates one or more Special Features shown below ENERGY USE SUMMARY 04 05 06 07 08 Energy Use (kTDV/ft2-yr) Standard Design Proposed Design Compliance ✓ Margin Percent Improvement Space Heating 42.11 37.97 4.14 9.8% Space Cooling 16.81 20.90 -4.09 -24.3% IAQ Ventilation 0.00 0.00 0.00 0.0% Water Heating 15.72 15.72ZAS 0.00 0.0% Photovoltaic Offset ---- 0.00 0.00 ---- Compliance Energy Total 74.64 74.59 0.05 0.1% Registration Number: 215-A0055176C-000000000-0000 Registration Date/Time: 2015-06-26 12:02:48 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015-06-26 11:33:34 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Sivaram Addition Calculation Date/Time: 11:32, Fri, Jun 26, 2015 Calculation Description: Title 24 Analysis Input File Name: 06163.PC1.xml REQUIRED SPECIAL FEATURES The following are features that must be installed as condition for meeting the modeled energy performance for this computer analysis. • Cathedral Ceiling • Ceiling has high level of insulation HERS FEATURE SUMMARY CF1 R -PRF -01 Page 2 of 8 The following is a summary of the features that must be field -verified by a certified HERS Rater as a condition for meeting the modeled energy performance for this computer analysis. Additional detail is provided in the building components tables below. Building -level Verifications: • High Quality Insulation Installation (QII) Cooling System Verifications: • --None -- 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-yr)* 123.03 122.98 0.05 0.0% * includes calculated Appliances and Miscellaneous Energy Use (AMEU) BUILDING - FEATURES INFORMATION 01 02 03 04 05 06 07 Project Name Conditioned Floor Area (ft2) Number of Dwelling Units Number of Bedrooms Number of Zones Number of Ventilation Cooling Systems Number of Water Heating Systems Sivaram Addition 2124 1 3 2 0 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 House1 1300 8 DHW Sys 1 Addition Conditioned House1 824 8.5 DHW Sys 1 Registration Number: 215-A0055176C-000000000-0000 Registration Date/Time: 2015-06-26 12:02:48 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015-06-26 11:33:34 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Sivaram Addition Calculation Date/Time: 11:32, Fri, Jun 26, 2015 Calculation Description: Title 24 Analysis Input File Name: 06163.PC1.xml CF1 R -PRF -01 Page 3 of 8 OPAQUE SURFACES 01 02 03 04 05 06 07 08 09 10 Name Zone Construction Azimuth Orientation Gross Area (ft2) Window & Door Area (ft) Tilt (deg) Status Verified Existing Condition Front Wall House Wall Prior to 1978 180 Front 197 No 90 Existing No Left Wall House Wall Prior to 1978 270 Left 265 34.9 90 Existing No Back Wall House Wall Prior to 1978 0 Back 359 71.5 90 Existing No Right Wall House Wall Prior to 1978 90 Right 265 28 90 Existing No Front Garage Wall House Garage Wall Prior to 1978 180 Front 162 90 Existing No Roof 3 House Roof Prior to 1978 Front 23 1277.1 0 0 Existing No Raised Floor House Floor Crawlspace Prior to No 1300 19781 Existing No Front Wall 2 Addition R-13 Wall 180 Front 255 105 90 New N/A Left Wall 2 Addition R-13 Wall1 270 Left 362 55 90 New N/A Back Wall 2 Addition R-13 Wall1 0 Back 119 40 90 New N/A Right Wall 2 Addition R-13 Wait 90 Right 163 35 90 New N/A Right Garage Wall Addition Garage Wall 90 Right 231 17.8 90 New N/A Roof 4 Addition R-38 Roof Attic 813.7 New N/A Raised Floor 2 Addition R-19 Floor Crawlspace 824 New N/A OPAQUE SURFACES — Cathedral Ceilings 01 02 03 04 05 06 06 07 08 09 10 11 12 13 Roof Reflectance Roof Emittance Radiant Barrier Cool Roof Statu s Verified Existing Condition Attic House Attic RoofHouse Ventilated Roof 0.1 Framin No Verified Existi ng No Attic Addition Orientatio Area Skylight Roof Rise Roof Roof Reflectan Roof g Statu Existing Name Zone Type n (ft) Area (ft2) (x in 12) Pitch Tilt(deg) ce Emittance Factor s Condifion Roof Prior to Existin Roof House Front 23 3 0 0 0 0.1 0.85 0.1 No 19781 g Roof 2 Addition R-38 Roof Attic1 Front 10.4 6.3 0 0 0 0.1 0.85 0.07 New N/A ATTIC 01 02 03 04 05 06 07 08 09 10 Name Construction Type Roof Rise Roof Reflectance Roof Emittance Radiant Barrier Cool Roof Statu s Verified Existing Condition Attic House Attic RoofHouse Ventilated 0 0.1 0.85 No No Existi ng No Attic Addition Attic RoofAddition Ventilated 1 0 1 0.1 0.85 Yes No New No Registration Number: 215-A0055176C-000000000-0000 Registration Date/Time: 2015-06-26 12:02:48 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015-06-26 11:33:34 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Sivaram Addition Calculation Date/Time: 11:32, Fri, Jun 26, 2015 Calculation Description: Title 24 Analysis Input File Name: 06163.PC1.xml CF1 R -PRF -01 Page 4 of 8 WINDOWS 01 02 03 04 05 06 07 08 09 10 11 Name Surface (Orientation -Azimuth) Width(ft) Height (ft) Multiplie r Area (ft2) U -factor SHGC Exterior Shading Status Verified Existing Condition New W6 Left Wall (Left -270) ---- ---- 1 25.6 0.35 0.27 Insect Screen (default) New N/A New W5 Left Wall (Left -270) ---- ---- 1 9.3 0.35 0.27 Insect Screen (default) New N/A 5832 Window Back Wall (Back -0) ---- ---- 1 17.5 1.19 0.83 Insect Screen (default) Existing No 8068 Door Back Wall (Back -0) ---- ---- 1 54.0 1.25 0.80 Insect Screen (default) Existing No 7838 Window Right Wall (Right -90) ---- ---- 1 28.0 1.19 0.83 Insect Screen (default) Existing No Existing 2016 Skylight Roof (Front -180) ---- ---- 1 3.0 1.98 0.83 None Existing No New Skylight 1 Roof (Front -180) ---- ---- 1 6.3 0.35 0.27 None New N/A New Skylight 1 2 Roof (Front -180) ---- ---- 1 6.3 0.35 0.27 None New N/A New Skylight 1 3 Roof (Front -180) ---- ---- 1 6.3 0.35 0.27 None New N/A New Sun Tunnel 1 Roof (Front -180) ---- ---- 1 1.0 0.35 0.27 None Existing No New 2080 Sidelight Front Wall 2 (Front -180) ---- ---- 1 16.0 0.35 0.27 Insect Screen (default) New N/A New W4 Front Wall 2 (Front -180) ---- ---- 1 35.0 0.35 0.27 Insect Screen (default) New N/A New W3 Front Wall 2 (Front -180) ---- ---- 1 30.0 0.35 0.27 Insect Screen (default) New N/A New W2 Left Wall 2 (Left -270) ---- ---- 1 20.0 0.35 0.27 Insect Screen (default) New N/A New W1 Left Wall 2 (Left -270) ---- ---- 1 35.0 0.35 0.27 Insect Screen (default) New N/A New 5080 Door Back Wall 2 (Back -0) ---- ---- 1 40.0 0.35 0.28 Insect Screen (default) New N/A New W1 2 Right Wall 2 (Right -90) ---- ---- 1 35.0 0.35 0.27 Insect Screen (default) New N/A New Skylight 1 4 Roof 2 (Front -180) ---- ---- 1 6.3 0.35 0.27 None New N/A New Skylight 2 Roof 2 (Front -180) ---- ---- 1 4.0 0.35 0.27 None New N/A DOORS 01 02 03 04 05 06 Name Side of Building Area (ft2) U -factor Status Verified Existing Condition Door Front Wall 2 24.0 0.50 New No Door 2 Right Garage Wall 17.8 0.50 New No Registration Number: 215-A0055176C-000000000-0000 Registration Date/Time: 2015-06-26 12:02:48 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015-06-26 11:33:34 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Sivaram Addition Calculation Date/Time: 11:32, Fri, Jun 26, 2015 Calculation Description: Title 24 Analysis Input File Name: 06163.PC1.xml CF1 R -PRF -01 Page 5 of 8 OPAQUE SURFACE CONSTRUCTIONS 01 02 03 04 05 06 07 Total Cavity Winter Design Construction Name Surface Type Construction Type Framing R -value U -value Assembly Layers • Cavity/Frame: no insul. /2x4 Top Chrd 2x4 Top Chord of Roof Truss @ 24 Roof Deck: Wood Siding/sheathing/decking Attic RoofHouse Attic Roofs Wood Framed Ceiling in. O.C. none 0.644 Roofing: Light Roof (Asphalt Shingle) • Inside Finish: Gypsum Board • Cavity/ Frame: no insul. / 2x4 • Exterior Finish: Wood Wall Prior to 1978 Exterior Walls Wood Framed Wall 2x4 @ 16 in. O.C. none 0.302 Siding/sheathing/decking • Inside Finish: Gypsum Board Ceilings (below Cavity/Frame: R-9.1 /2x4 Roof Prior to 1978 attic) Wood Framed Ceiling 2x4 @ 16 in. O.C. R 11 0.083 Over Floor Joists: R-1.9 insul. • Inside Finish: Gypsum Board • Cavity / Frame: R-11 / 2x4 • Roof Deck: Wood Siding/sheathing/decking Roof Prior to 19781 Cathedral Ceilings Wood Framed Ceiling 2x4 @ 16 in. O.C. R11 0.088 Roofing: Light Roof (Asphalt Shingle) • Floor Surface: Carpeted Floors Over Floor Deck: Wood Siding/sheathing/decking Floor Crawlspace Prior to Crawlspace Wood Framed Floor 2x12 @ 16 in. O.C. none 0.216 Cavity/Frame: no insul. /2x12 • Inside Finish: Gypsum Board • Cavity/ Frame: no insul. / 2x4 • Exterior Finish: Wood Garage Wall Prior to 1978 Exterior Walls Wood Framed Wall 2x4 @ 16 in. O.C. none 0.302 Siding/sheathing/decking • Cavity / Frame: no insul. 12x4 Top Chrd 2x4 Top Chord of Roof Truss @ 24 Roof Deck: Wood Siding/sheathing/decking Attic RoofAddition Attic Roofs Wood Framed Ceiling in. O.C. none 0.644 Roofing: Light Roof (Asphalt Shingle) • Inside Finish: Gypsum Board • Cavity / Frame: R-13 / 2x4 • Exterior Finish: Wood R-13 Wall Exterior Walls Wood Framed Wall 2x4 @ 16 in. O.C. R 13 0.095 Siding/sheathing/decking • Floor Surface: Carpeted Floors Over Floor Deck: Wood Siding/sheathing/decking R-19 Floor Crawlspace Crawlspace Wood Framed Floor 2x6 @ 16 in. O.C. R 19 0.049 Cavity/Frame: R -19/2x6 • Inside Finish: Gypsum Board Ceilings (below Cavity/Frame: R-9.1 /2x4 R-38 Roof Attic attic) Wood Framed Ceiling 2x4 @ 24 in. O.C. R 38 0.025 Over Floor Joists: R-28.9 insul. • Inside Finish: Gypsum Board • Cavity / Frame: R-38 / 2x4 • Roof Deck: Wood Siding/sheathing/decking R-38 Roof Atticl Cathedral Ceilings Wood Framed Ceiling 2x4 @ 24 in. O.C. R 38 0.036 Roofing: Light Roof (Asphalt Shingle) Registration Number: 215-A0055176C-000000000-0000 Registration Date/Time: 2015-06-26 12:02:48 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015-06-26 11:33:34 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Sivaram Addition Calculation Date/Time: 11:32, Fri, Jun 26, 2015 Calculation Description: Title 24 Analysis Input File Name: 06163.PC1.xml CFI R -PRF -01 Page 6 of 8 WATER HEATING SYSTEMS 01 02 03 04 05 • Inside Finish: Gypsum Board 07 08 Name System Type Distribution Type Water Heater • Cavity/ Frame: R-13 / 2x4 Solar Fraction M Status Verified Existing Condition DHW Sys 1 DHW Standard • Sheathing / Insulation: R5 Sheathing 1 Annual Existing No Floor Area • Exterior Finish: Wood Garage Wall Exterior Walls Wood Framed Wall 2x4 @ 16 in. O.C. R 13 0.061 Siding/sheathing/decking WATER HEATING SYSTEMS 01 02 03 04 05 06 07 08 Name System Type Distribution Type Water Heater Number of Heaters Solar Fraction M Status Verified Existing Condition DHW Sys 1 DHW Standard DHW Heater 1 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 0.525 EF 28000-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 SPACE CONDITIONING 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 House1 Other Heating and Heating Yes Cooling NO Air Distribution HVAC Fan 2124 New No Cooling System Component 1 Component 1 System 1 1 HVAC - HEATING SYSTEMS 01 02 03 Name Type Efficiency Heating Component 1 CntrlFurnace - Fuel -fired central furnace 80 AFUE Registration Number: 215-A0055176C-000000000-0000 Registration Date/Time: 2015-06-26 12:02:48 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015-06-26 11:33:34 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Sivaram Addition Calculation Description: Title 24 Analysis Calculation Date/Time: 11:32, Fri, Jun 26, 2015 Input File Name: 06163.PC1.xml CFI R -PRF -01 Page 7 of 8 HVAC - COOLING SYSTEMS 01 02 03 04 05 06 07 Name System Type Efficiency EER SEER Zonally Controlled Multi -speed Compressor HERS Verification Cooling Component 1 NoCooling - No cooling equipment N/A N/A No No HVAC - DISTRIBUTION SYSTEMS 01 02 03 04 05 06 07 08 09 10 Insulation Supply Duct Return Duct Verified Existing HERS Name Type Duct Leakage R -value Location Location Bypass Duct Status Condition Verification Air Distribution Air Distribution System 1 Ducts located in attic Sealed and tested 6.0 Attic Attic None Existing + New No System 1 -hers -dist 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 --- IAQ (Indoor Air Quality) FANS 01 02 03 04 05 Name IAQ CFM IAQ Fan Type IAQ Recovery Effectiveness(%) HERS Verification SFam IAQVentRpt 0 Default 0 Not Required Registration Number: 215-A0055176C-000000000-0000 Registration Date/Time: 2015-06-26 12:02:48 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015-06-26 11:33:34 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Sivaram Addition Calculation Date/Time: 11:32, Fri, Jun 26, 2015 Calculation Description: Title 24 Analysis Input File Name: 06163.PC1.xml CF1 R -PRF -01 Page 8 of 8 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: p 4v O1aiX Heather Clark Company: Signature Date: Builders' Energy Services, Inc. 2015-06-26 12:00:16 Address: CEA/HERS Certification Identification (If applicable): 1478 Bird Avenue n/a City/State/Zip: Phone: San Jose, CA 95125 (408) 202-9075 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: Seema Mittal Company: Date Signed: Perspectives Design, Inc. 2015-06-26 12:02:48 Address: License: 21949 Lindy Lane n/a City/State/Zip: Phone: Cupertino, CA 94014 408-334-0827 Digitally signed by CaICERTS. 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: 215-A0055176C-000000000-0000 Registration Date/Time: 2015-06-26 12:02:48 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015-06-26 11:33:34