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15010145CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10779 BROOKWELL DR CONTRACTOR: BABEL CONSTRUCTION PERMIT NO: 15010145 OWNER'S NAME: LI-ERH WANG 3939 ARDEN FARMS PL DATE ISSUED: 04/06/2015 OWNER'S PHONE: 4084461886 SAN JOSE, CA 95111 PHONE NO: (408) 561-7041 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL [:] CONSTRUCT ONE STORY ADDITION (629 SQ IT); License Class_ Lic.# REPLACE �i_C1�T�`tV�) (E) SEWER LINE &INSTALL CLEANOUT. Contractor ('�) Qatie I hereby affirm that I am licensed under the provisions 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 Sq. Ft Floor Area: Valuation: $80000 erformance of the work for which this permit is issued. 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: 36921013.00 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 upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FR ED INSPE TIO . 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 ate: nt sou regulations per the Cupertino Municipal Code, Stio with all non-poiec 9.18. RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date: I certify that in the performance of the work for which this permit is issued, I shall /RUCTION 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 CON LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(oDcupertino.org _ iC71 I—I n crn�r itScrcoocri LJ iViwr LlJ1VJ11�V1-I I- - ------ - PROJECT ADDRESS I V77? 77Q -- -- - /7 /f APN # S !� o OWNER NAME I 'I ! Y ` Uja ' ^ (� Y l PHO /J 6 ¢ 1 `1-44 (`� 9j 6 E-MAIL r f'P Y� STREET ADDRESS CITY, STATEYZIPuJ �' i / FAX CONTACT NAME' 4 E-MAIL i YN S a--), C, V, co-II1A�/ CITY, STATF�, ZrIP 1� 1 / C� FAX STREET ADDRESS 1 Flynn OWNER 11 OWNER -BUILDER ElOWNER AGENT E3CONTRACTOR ElCONTRACTOR AGENT u ARCHII'EC7 El ENGINEER C3 DEVELOPER 1:1 TENANT CONTRACTOR NAME T S f LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT NGINEER NAME t / !� , LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL ;,�pL/p ��a�0v -y� FAX STREET ADDRESS 7� , . / CITY STATE,? C I PHONE J (I LI I DESCRIPTION OF WORK �/ %` I VV EXISTING USE PROPOSE SE CONSTR. TY�ELIASTORIESUSE TYPE OCC. SQ.FT. VALUATION (S) EXISTG / NEW FLOO AREA 9 DEMO AREA REI �� LAREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER ' L.12 REMODEL AREA Tr, r'e PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNTFS: IS A SECOND UNIT ❑ YES SECOND STORY LYES BEING ADDED? []NO ADDITION? ❑NO TAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ ' 6(]-V„ yv , PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES - �.we,-slr�thalo By my signature below, I certify to each of the following: I am the property owner or author n to act on the propI have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b ' ing construction. I authorize representati es of C Perrino to enter the above identifi property for inspection purposes. d Signature of ApplicanUAgent: Date: .� SUPPLEMENTAL INFORMATION REQUIRED PLAN CIECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS' _ form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 MI CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10779 BROOKWELL DR DATE: 01/26/2016 REVIEWED BY: MELISSA APN: 369 21 013 BP#:Zia 1 'VALUATION: $80,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY 2nd Unit? Yes No�PEN'AMATION 1R3SFDADD USE: SFD or Duplex OTC? © Yes NoRMIT TYPE: WORK ADD 629 S.F. TO FRONT OF PROPERTY TO CREATE N MASTER BEDROOM & N LIVING SCOPE ROOM. REPLACE (E) SEWER LINE & INSTALL CLEANOUT TYPE OF FLK AREA PC FEES PC FEE ID BP FEES BP FEE ID OCCUPANCY TYPE: CONSTR. s.f. R-3 (Custom) II-B,111-B,IV,V-B 629 $2,654.001 IR3PLNCK $1,666.00 1R31NSP TOTALS: 629 I $2,654.00 I $1,666.00I MECH, HOURLY O Yes (E) No PLUMB, HOURLY Q }'es Q No ELEC, HOURLY Q Yes Q No ..... ------ MISC ITEMS Plumb. Plan Check 0.0 hrs $0.00 Plan Check Fee: $2,654.00 Plumb. Permit Fee: IPPERMIT Plumbing IPRSEWER Sewer, Sanitary Other Plumb Insp. 0.0 �rs$48.00 0.0 hrs I'llimb I,7 E,. i ,. PME Plan Check: $0.00 M.L1.1. 11/1-1", /:irn c,n;/.,r„ .cowor nharict. School NOTE: This estimate does not tnctuae,Iees aue /o umer "cpu.g,..o g— % ­ - •»•••••••a, - - - - - w� .../.� District, etc. . These fees are basea on the reutmna FEE ITEMS (Fee Resolution 11-053 Eff. 711113) /n or/nunon uvus&uMs FEE ........... QTY/FEE ..... ------ MISC ITEMS Plan Check Fee: $2,654.00 F1 # $25.00 Plumbing IPRSEWER Sewer, Sanitary Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,666.00 Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 0 Work Without Permit? © Yes (E) No $0.00 Advanced Planning Fee: IPLLONGR $88.06 Select a Non -Residential Building or Structure 0 Q A Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $10.40 Select an Administrative Item -----T7=:] Bldg Stds Commission Fee: I BCBSC $4.00 SUBTOTALS: $4,518.46 $25.00 TOTAL FEE: $4,543.46 Rt=vl Qu . v uvvI �� 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: PERMIT # J— OWNER'S NAME: PHONE # V0 GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 7'S� I am not using any subcontractors: l� ti Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date ., CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Joyce Wang Residence Calculation Description: Title 24 Analysis Calculation Date/time: 18:47, Tue, Jan 13, 2015 Input File Name: 15-008 Joyce Wang Residence.xml CF1R-PRF-01 Page 1 of 7 GENERAL INFORMATION 01 Project Name Joyce Wang Residence 01 Building Complies with Computer Performance 02 Calculation Description Title 24 Analysis 02 This building DOES NOT require HERS Verification 03 Project Location 10779 Brookwell Dr. 03 This building Incorporates one or more Special Features shown below 04 CA City Cupertino 05 Standards Version Compliance 2014 06 Zip code 95014 07 Compliance Manager Version BEMCmpMgr 2013-3 (651) 08 Climate Zone CZ4 09 Software Version EnergyPro 6.3 10 Building Type Single Family 11 Front Orientation (deg/Cardinal) 90 12 Project Scope Addition and/or Alteration 13 Number of Dwelling Units 1 14 Total Cond. Floor Area (FT2) 1805 15 Number of Zones 2 16 Slab Area (FT2) 1176 17 Number of Stories 1 18 Addition Cond. Floor Area 629 19 Natural Gas Available Yes 20 Addition Slab Area (FT2) 629 21 Glazing Percentage(%) 17.7% COMPLIANCE RESULTS IT1 01 Building Complies with Computer Performance %G fii.;. 02 This building DOES NOT require HERS Verification fD 03 This building Incorporates one or more Special Features shown below cD T, ENERGY USE SUMMARY r% 04 05 06 07 — Energy Use (kTDV/ft2-yr) Standard Design L AF Proposed Design Compliance Margin Pere larovement Space Heating 16.37 41111111111C16.52 -0.15 /o Space Cooling 14.23 14.70 -0.47 iy -9-/0 IAO Ventilation 0.00 0.00 0.00 Water Heating 15.69 14.31 1.38 % Photovoltaic Offset ---- 0.00 0.00 ---- 49 TOTAL 46.29 45.53 0.76 1.6% ti1� Reg istratiobe r: 215-A0017483A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2015-01-14 16:25:02 HERS Provider: CaICERTS inc. Report Version - CF1R-12122014-651 Report Generated at 2015-01-13 18:48:07 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Joyce Wang Residence Calculation Date/Time: 18:47, Tue, Jan 13, 2015 Calculation Description: Title 24 Analysis Input File Name: 15-008 Joyce Wang Residence.xml REQUIRED SPECIAL FEATURES The following are features that must be installed as condition for meeting the modeled energy performance for this computer analysis. • New ductwork added is less than 40 ft. In length CF1 R -PRF -01 Page 2 of 7 PROJECT HERS FEATURES The following are project -level features that must be field -verified as a condition for meeting the modeled energy performance for this computer analysis. These, plus any additional HERS features listed in the building components tables below, reclure field verification by a certified HERS Rater. Building -level Verifications: • -- None -- Cooling System Verifications: • -- None -- HVAC Distribution System Verifications: • -- None -- 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 (kTDVff2)* 97.83 97.07 0.76 0.8% includes calculated Appliances and Miscellaneous Energy Use (AMEU) BUILDING FEATURE INFORMATION 01 02 03 04 05 06 07 Project Name Conditioned Floor Area (sft) Number of Dwelling Units Number of Bedrooms Number of Zones Number of Ventilation Cooling Systems Number of Water Heating Systems Joyce Wang Residence 1805 1 4 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 Joyce Wang Residence New Conditioned Split Systeml 629 9 DHW Sys 1 Joyce Wang Residence Exis Conditioned Split Systeml 1176 9 DHW Sys 1 Registration Number: 215-A0017483A-000000000-0000 Registration Date/Time: 2015.01-14 16:25:02 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-12122014-651 Report Generated at 2015-01-13 18:48:07 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1 R -PRF -01 Project Name: Joyce Wang Residence Calculation Date/Time: 18:47, Tue, Jan 13, 2015 Page 3 of 7 Calculation Description: Title 24 Analysis Input File Name: 15-008 Joyce Wang Residence.xml OPAQUE SURFACES 01 02 03 04 05 06 07 08 09 10 Name Zone Construction Azimuth Orientation Gross Area (ft2) Window and Door Area (ft2) Tilt(deg ) Status Verified Existing Condition Exterior Wall N Joyce Wang Residence New R-19 Wall 0 Right 205 18.3 90 New N/A Exterior Wall E Joyce Wang Residence New R-19 Wall 90 Front 250 61.3 90 New N/A Exterior Wall NE Joyce Wang Residence New R-19 Wall 45 315 40 12 90 New N/A Exterior Wall SE Joyce Wang Residence New R-19 Wall 135 45 40 12 90 New N/A Roof Joyce Wang Residence New R-30 Roof Attic 629 New N/A Exterior Wall W Joyce Wang Residence Exis R-19 Wall 270 Back 492.5 132 90 Existing No Exterior Wall N 2 Joyce Wang Residence Exis R-19 Wall 0 Right 242 54.3 90 Existing No Exterior Wall S Joyce Wang Residence Exis R-19 Wall 180 Left 240 30.3 90 Existing No Roof 2 Joyce Wang Residence Exis R-30 Roof Attic 1176 Existing No Exterior Wall E 2 Garage Garage Ext Wall 90 Front 200 90 Existing No Exterior Wall S 2 Garage Garage Ext Wall 180 Left 210 90 Existing No Interior Surface 3 Garage R-0 Wall 200 Existing No Interior Surface 4 Garage R-0 Wall 210 Existing No Interior Surface 5 Garage»Joyce Wang Residence Exis R-0 Wall 210 Existing No Interior Surface 6 Garage»Joyce Wang Residence New R-0 Wall 200 New N/A Roof 3 Garage R-30 Roof Attic I 1 1 468 1 Existing No ATTIC 01 02 03 04 05 06 09 10 11 Name Construction Roof Rise Roof Reflectance Roof Emittance Radiant Barrier Cool Roof Status Verified Existing Condifion Attic Attic Roof Cons 4 0.1 0.85 No No Existing No Registration Number: 215-A0017483A-000000000-0000 Registration Date/Time: 2015-01-14 16:25:02 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-12122014-651 Report Generated at 2015-01-13 18:48:07 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Joyce Wang Residence Calculation DatelTime: 18:47, Tue, Jan 13, 2015 Calculation Description: Title 24 Analysis Input File Name: 15-008 Joyce Wang Residence.xml CF1 R -PRF -01 Page 4 of 7 WINDOWS 01 02 03 04 05 06 07 08 09 10 11 Name Side of Building Width(ft ) Height (ft) Multiplie r Area (ft2) U -factor SHGC Exterior Shading Status Verified Existing Condition Sliding Window Exterior Wall N ---- ---- 1 3.0 0.32 0.30 Insect Screen (default) New N/A DH Window Exterior Wall N ---- ---- 1 15.3 0.32 0.30 Insect Screen (default) New N/A SH Window Exterior Wall E ---- ---- 1 24.0 0.32 0.30 Insect Screen (default) New N/A Sliding Window 2 Exterior Wall E ---- ---- 1 37.3 0.32 0.30 Insect Screen (default) New N/A SH Window 2 Exterior Wall NE ---- ---- 1 12.0 0.32 0.30 Insect Screen (default) New N/A SH Window 3 Exterior Wall SE ---- ---- 1 12.0 0.32 0.30 Insect Screen (default) New N/A Existing Window Exterior Wall W ---- ---- 1 113.0 0.60 0.60 Insect Screen (default) Existing No Bay Window Exterior Wall W ---- ---- 1 19.0 0.32 0.30 Insect Screen (default) New N/A Existing Window 2 Exterior Wall N 2 1 48.0 0.60 0.60 Insect Screen (default) Existing No Bay Window 2 Exterior Wall N 2 ---- 1 6.3 0.32 0.30 Insect Screen (default) New N/A Existing Window 3 Exterior Wall S ---- 1 24.0 0.60 0.60 Insect Screen (default) Existing No Bay Window 3 Exterior Wall S 1 6.3 0.32 0.30 Insect Screen (default) New N/A OPAQUE SURFACE CONSTRUCTIONS 01 02 03 04 05 Construction Name Surface Type Framing Total Cavity R -value Assembly Layers 2x4 Top Chord of Roof Cavity/ Frame: no insul. /2x4 Top Chrd Attic Roof Cons Attic Roofs Truss @ 24 in. O.C. - no insulation - Roof Deck: Wood Siding/sheathing/decking Roofing: Light Roof (Asphalt Shingle) • Inside Finish: Gypsum Board R-19 Wall Exterior Walls 2x8 @ 16 in. O.C. R 19 Cavity/Frame: R -19/2x8 Exterior Finish: Wood Siding/sheathing/decking Inside Finish: Gypsum Board R-0 Wall Interior Walls 2x4 @ 16 in. O.C. no insulation (vertical) - Cavity/ Frame: no insul. /2x4 Other Side Finish: Gypsum Board Inside Finish: Gypsum Board R-30 Roof Attic Ceilings (below attic) 2x4 @ 24 in. O.C. R 30 Cavity/Frame: R-9.1 /2x4 Over Floor Joists: R-20.9 insul. Registration Number: 215-A0017483A-000000000-0000 Registration Date/Time: 2015-01-14 16:25:02 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-12122014-651 Report Generated at 2015-01-13 18:48:07 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Joyce Wang Residence Calculation Date/Time: 18:47, Tue, Jan 13, 2015 Calculation Description: Title 24 Analysis Input File Name: 15-008 Joyce Wang Residence.xml CF1 R -PRF -01 Page 5 of 7 SLAB FLOORS 01 02 03 04 05 06 07 08 09 Name Zone Area (ft) Perimeter (ft) Edge Insul. R -value Carpeted Fraction Heated Status Verified Existing Condition Slab -on -Grade Joyce Wang Residence New 629 53 none - 0.8 No New No Slab -on -Grade 2 Joyce Wang Residence Exis 1176 98 none - 0.8 No Existing No BUILDING ENVELOPE - HERS VERIFICATION 01 02 03 04 Quality Insulation Installation (011) Quality Installation of Spray Foam Insulation Building Envelope Air Leakage ACH @ 50 Pa Not Required Not Required Not Required --- WATER HEATING SYSTEMS 01 02 01 02 03 04 05 06 Name Distribution Type Number of Heaters Solar Fraction (%) Status Verified Existing Condition DHW Sys 1 Standard 1 Annual Altered No WATER HEATERS 01 02 03 04 05 06 07 08 Name Heater Element Type Tank Type Tank Volume (gal) Energy Factor or Efficiency Input Rating Tank Exterior Insulation R -value Standby Loss (Fraction) DHW Heater 1 Natural Gas Small Storage 50 0.62 EF 40000-Btu/hr 0 0 WATER HEATING - HERS VERIFICATION 01 02 03 04 05 06 07 Name Pipe Insulation Parallel Piping Compact Distribution Point -of Use Recirculation Central Recirculation DHW Sys 1 n/a n/a n/a n/a n/a n/a Registration Number: 215-A0017483A-000000000-0000 Registration Date/Time: 2015-01-14 16:25:02 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CFiR-12122014-651 Report Generated at 2015-01-13 18:48:07 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1 R -PRF -01 Project Name: Joyce Wang Residence Calculation Date/Time: 18:47, Tue, Jan 13, 2015 Page 6 of 7 Calculation Description: Title 24 Analysis Input File Name: 15-008 Joyce Wang Residence.xml HVAC SYSTEMS 01 02 01 02 03 04 05 06 07 08 09 09 Name Heating System Cooling System Zonally Controlled Compressor HERS Verification Cooling Component 1 SplitAirCond - Split air conditioning 11,3 13 No No Distribution Fan Floor Area Location Verified Existing Name System Type Name Ducted Name Ducted System System Served Status Condition Split Systema Other Heating and Heating Yes Cooling Yes Air Distribution HVAC Fan 1805 Existing 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 HVAC - COOLING SYSTEMS 01 02 03 04 05 06 07 04 05 Efficiency 07 Multi -speed 09 Name System Type EER SEER Zonally Controlled Compressor HERS Verification Cooling Component 1 SplitAirCond - Split air conditioning 11,3 13 No No N/A Duct Leakage system Location Location Bypass Duct Status Condition HVAC - DISTRIBUTION SYSTEMS 01 02 03 04 05 06 07 08 09 08 Insulation Supply Duct Return Duct Verify Existing HERS Name Type Duct Leakage R -value Location Location Bypass Duct Status Condition Verification Air Distribution Ducts located in attic Existing (not 6 Attic Attic None Existing + New No N/A System 1 specified) IAQ (Indoor Air Quality) FANS 01 02 03 04 05 Name IAQ CFM IAQ Fan Type IAQ Recovery Effectiveness(%) HERS Verification SFam IAOVentRpt 0 Default 0 Not Required Registration Number: 215-A0017483A-000000000-0000 Registration Date/Time: 2015-01-14 16:25:02 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CFiR-12122014-651 Report Generated at 2015-01-13 18:48:07 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Joyce Wang Residence Calculation Description: Title 24 Analysis Calculation Date/Time: 18:47, Tue, Jan 13, 2015 Input File Name: 15-008 Joyce Wang Residence.xml CF1 R -PRF -01 Page 7 of 7 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Gary Zhou" Company: Signature Date: GMEP Engineering 2015-01-14 10:56:48 Address: CEA/HERS Certification Identification (If applicable): 4400 Campus Dr City/State/Zip: Phone: Newport Beach, CA 92660 949 232 1919 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. I 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: er,�, - � li-erh Wang Company: Date Signed: Home Owner - Installer 2015-01-14 16:25:02 Address: License: 10779 brookwell dr N/A City/State/Zip: Phone: cupertino, CA 95014 4084461886 Digitally signed by Ca10ERTS. 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-A0017483A-000000000-0000 Registration Date/Time: 2015-01-14 16:25:02 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-12122014-651 Report Generated at 2015-01-13 18:48:07 CALGREEN RESIDENTIAL CHECKLIST - MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINO I ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinaRr=a org CUPERTINO PURPOSE: , %f,i gug(11N 04psRment a� The 2013 CalGreen Code applies to additions or alterations , i�g residential buildings where the addition or alteration increases the building's conditioned area, volu ize and also applies to all new low-rise residential buildings, high-rise residential buildings, or both. �ciAtggNtEa W(Iandscapindirbog4ments that are not otherwise disturbed are not subject to the requirements of CALGreen.;� Reviewed ray _ Project Name Project Address: WANG RESIDENCE 10779 BROOKWELL DR, CUPERTINO, CA95014 Project Description: BUILDING FRONT ADDITION OF 629 SF. MMMMMMMM REPLACE 4" SEWER LINE AND INSTALL CLEAN OUT. REPLACE (E) WATER LINE. Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experience## LC� ifornia Green Building Standards Codes to verify and assure that all required a i'Ierein is roperly planned and implemented in the project. 1p15 �� 2. The licensed professional, in collaboration with the owner and the desig pro o I shall initi41 Column 2 of this checklist, sign and date Section 1 -Design Verification at the nd of this checklist altd have the checklist printed on the approved plans for the project. $Y 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. MANDATORY FEATURE OR MEASURE 14.1 PLANNING AND DESIGN Planning and Design - Site Development Column 2 Column 3 Project Verification Re uirements 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during ® ❑ construction. 4.106.3 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how ® ❑ site grading or a drainage system will manage all surface water flows. Page] of 5 CalGreen_2014.doc revised 11/04/14 A4.2 General 4.201.1 Low-rise residential buildings shall meet or exceed the minimum ® ❑ standard design required by the California Energy Standards. A4.3 WATER EFFICIENCY AND CONSERVATION Indoor Water Use 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following: ❑ 4.303.1.3.2 Water Closets. The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank -type water closets shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank -type Toilets. ❑ 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. ❑ 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. ❑ 4.303.1.3.2 Multiple Showerheads serving one shower. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be ® ❑ designed to allow only one shower outlet to be in operation at a time. ❑ 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less than 0.8 gallons per minute at 20 psi. ❑ 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas (outside of dwellings or sleeping units) in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. ❑ 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. ❑ 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, ® ❑ and shall meet the applicable standards referenced in Table 1401.1 of the California Plumbing Code. Page 2 of 5 CalGreen_2014.doc revised 11/04/14 Outdoor Water Use 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the time of final inspection shall be weather-based. ❑ 4.304.1.1 Controllers shall be weather- or soil moisture-based controllers that automatically adjust irrigation in response to changes in plants' needs as weather conditions change. ® ❑ ❑ 4.304.1.2 Weather-based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the controller(s). Soil moisture-based controllers are not required to have rain sensor input. A4.4 MATERIAL- RESOURCE Enhanced Durability and Reduced Maintenance 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected ® ❑ against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a ® ❑ construction waste management plan shall be submitted for approval to the enforcing agency. Building Maintenance and Operation 4.410.1 Operation and maintenance manual. At the time of final inspection, building ® ❑ an operation and maintenance manual shall be provided to the 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 distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks In kal 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 toxic ® ❑ shall be compliant with product weighted MIR Limits for ROC and other compounds. Page 3 of 5 CalGreen_2014.doc revised 11104/14 4.504.2.4 Verification. Documentation shall be provided to verify that ® ❑ compliant VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with ® ❑ VOC limits. 4.504.4 Resilient flooring systems. Eighty (80) percent of floor area receiving resilient flooring shall comply with the VOC-emission limits defined in the Collaborative for High Performance Schools (CHPS) Low -emitting ❑ ❑ Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Composite wood products. Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall ® ❑ comply with low formaldehyde emission standards. Interior Moisture Control 4.505.2 Concrete slab foundation. Required vapor retarders and capillary ❑ ❑ breaks are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture content of building ® ❑ materials used in wall and floor framing is checked before enclosure. Indoor Air Quality and Exhaust 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the ® ❑ building are provided in every bathroom. Environmental Comfort 4.507.2. Duct systems are sized and designed and equipment is selected using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or equivalent. ® ❑ 2. Size duct systems according to ACCA 29-D (Manual D) or equivalent. 3. Select heating and cooling equipment according to ACCA 36-S (Manual S) or equivalent. - INSTALLER AND SPECIAL- OQUALIFICATIONS 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 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 ® El 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 11/04/14 UALUKLLN SIGMA I UKL ULULAHA II IUN5 Project Name: Project Address: Project Description: 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. q5& , 4'a Owner's Signature Date - e -f 1 r1 Owner's Name (Please Print) YIN SU r Design Professional's Signature Date Name (Please Print) Signature,of License Professional responsible for CalGreen compliance Date License Professional responsible for CalGreen compliance (Please Print) Phone 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 STATENIFENTOF SPECIAL INS 2013 CBCUPERTINO AJBr.-R, PIE- ", kz,Q. 4LVl)0TC-RRf. A VF,*4!JF -flAIPERY INC, CA t;,5014.E l CUPERTINO i . 40F 7 -�'k 22A - r AX a4 Cki� 7 MAR, 2015 TE—mos '17-,79 BROOKVVELA, OR APH �tFWVE D HoR G iA-,GRflVVANG 10 71) RReviewea By. —�k— n0-OWAIT:71 i 2,V (';UPCRTJNCj ....... . ... 'im LI E.RHJvV0iG C3, P. . IIRT,Ip_.lil41.`5,Q11.9, c.Gfai Clitv/.S! ps7wp,cy ov.zcpjpnoN. BUILDYNG FR(' --N i ADN, 110N OF 629 5V REPIAGE. 11 t AND IN,M. TAU Ci,t-,PN OW' REPLACE tE.) lljA'VL-.R UNF, I Ns'STATE-41,FNIT 'IF IM5PE(,TIONS' if !tgjjmrnl, 4,,hp, CS( , Sk+dk)ns 1704 �kwl ':705 TI%;k,.� 9(tiv awl used by pwllmtmor from ffvn luyM w1l" 1 #;c. VST OF SPFCIAL ipAop i). A Sw of ubs!inq .,Owes AM sqmzxlal ln.swolon iha* s rotawnm tri Ilii-W4o'( thr. �x lhi,: protFnt Of CPF C "T SCHFOWT Mt. iNF, r, im. m tA ped'o-nod, !'iN, .^-al aric Timing V..lf tif, ppef"flned tnolw;r% ar-4 4, So tux* 1704 11706, 17,00, t"?07- aod 170e ux"ll, Z" 1711�.li " Arid we flogtn'trip'd lf-I- Jr., r 1, vv p."lloo Of por*ll 11 mr, flomt) S oc-c"i q -w rl. Mq r(.Wi u Sp ;,.i! I, Wt , g . tik—lr,pei,V,om ;4hie totirmMAJ onow io)w;!x4rcc M,A of 7ni)Efi,PjNl? 10's orl"j-(Tim of iq.w. 4 4*NRN)erl 6iANIC, Clf!uml A*0: IA- :car spec-Lsi trisp9oinn ArliqitfieF, Im ltw leb ide to assure ltu4 0h, Sjwj'41 4zqppr;l;,x, r,,,jhw, a,; iwifid far in Vils of Iflo,=k lrmj3Wxlfl- am repimd t -,y 11w lacal twiklipp ��mlv !rod and aglym w o�tvyl:y Wfli, fbfr w(r)"'.WXY Of �-cwp'Ir"r, Ny 1 Dam., W—W tile; T I Dalk, 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 tarty approved identification when performing the functions of a special inspector. Identification cards shall follow the criteria sort by the +> .?_;,... No personnel changes shall be made without first obtaining the approval of the Budding 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 rnflowinn arra the testinn and spacial insnaction anancias that will be retained to conduct tests and inspection on this project, EXPERTISE FIRM ! INSPECTOR INFORMATION t. Special Inspection (except for Firm ` t Add, �,✓f�.f_ _ .".! .. P4 -- geotechnical) City_ Telephone.l rj ✓ 1 �. o- -, 0 - State Email Zip 2, Material Testing firm ...... ................. __... ....... _. ........ Addr............. ..... .................. ... 1.11-1-11. 11 . ,,....... City_ 1111.. .. _...,........ _ 1111... .. State _ _. _ Zip ..................... Telephone _ ....... __.. ........ Fax .............. _ _..__.._..Email. 111 1. _ .....111.. 3 Geotechnical Inspections Firm ... ................................... ......... ................ ._....Addr.............. ......... _......... .......... ....... ,..................... 111. City..... .......... ............................ ....... ........ .................................. ..._,... • State ...,...._-1111.-._.....Zip ..-..-......,,,.... Telephone ....................... ....Fax............_.__............. ......... Email ..... ........_., ...,...,...,...,.. ...,.....,..... 4 Oafer Firm....................................................................Addy.. . _ .......... .......... .........................I......... City _............... __ _. .. --stale ........... Telephone _ Fax.. _ Email _. -- 'All agencies specified on this form must be pre -approved and listed on the City of Cupertino s Approved Spectal inspectors List. SEISMIC REQUIREMENTS (Section 1705.3.6) Description of seismic -force -resisting system and designated seismic systems subject to special inspections as per Suction 1705.3. ANCHOR BOLTS (EPDXY) INTO EXISTING CONCRETE The extent of the seismic -force resisting system is defined in more detail in the construction documents tRl°ilifl Description of main wind force -resisting system and designated wind resisting components subject to special inspections in accordance with Section 1/0542 The extent of the main wind-force-resisling system and wind resisting components is defined in more detail in the construction documents '4vcirdnspecffon1-orm 201240c revised 09,(4'12 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 _ _ I 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 _— X 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 INSPECTION C p REFERENCED STANDARD I 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 1704.3 ❑ 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 INSPECTIONC p REFERENCED STANDARD IBC IREFERENCE INSPECTION OF WELDING 1. ❑ Welded studs when used for structural diaphragms. --- X --- 1704.3 2. ❑ Welding of cold -formed steel framing members. --- X 3. ❑ Welding of stairs and railing systems. --- X SpecialnspectionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTION C P REFERENCED STANDARD IREFERENCE IBC INSPECTION OF CONCRETE 1. ❑ Inspection of reinforcing steel, including prestressing tendons and placement. X ACI 318: 3.5, 7.1-7.7 1913.4 2. ❑ Inspection of reinforcing steel welding in accordance with Table 1704.3 Item 5b. -� --- AWS D1.4 ACI 318: 3.5.2 __- 3. ❑ Inspection of bolts to be installed in concrete prior to and during placement of concrete where allowable loads have been increased or where strength design is used. X _-- ACI 318: 8.1.3, 21.2.8 1911.5, 1912.1 4. ❑ Inspection of anchors installed in hardened concrete. --- 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 specimens for strength tests, perform slump and air content tests and determine the temperature of the concrete. X __ ASTM C 172 ASTM C 31 ACI 318: 5.6, 5.8 1913.10 7. ❑ Inspection of concrete and shotcrete placement for proper application techniques. X ___ ACI 318: 5.9, 5.10 1913.6, 1913.7, 1913.8 8. ❑ Inspection for maintenance of specified curing temperature and techniques. X ACI 318: 5.11-5.13 1913.9 9. Inspection of prestressed concrete: ❑ Application of prestressing forces. X --- ACI 318: 18.20 ❑ Grouting of bonded prestressing tendons in the seismic force -resisting system. X _-- ACI 318: 18.18.4 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 prior to removal of shores and forms from beams and structural slabs. _-_ X ACI 318: 6.2 --- 12. ❑ Inspect formwork for shape, location, and dimensions of the concrete member being formed. X ACI 318: 6.6.1 --- 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 products ❑ Direct tension testing of new bolts. --- X ❑ Torque testing of new bolts. ___ X ❑ Prequalification test for bolts and other types of anchors. _-_ X 14. ❑ Other: 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 f m and f A„c prior to construction _-- X --- --- Art. 1.46 except where specifically exempted by this code. 3. ❑ Verification of slump flow and VSI as delivered to X ___ ___ --- Art. 1.513.1.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. 3.66 ❑ Grade and size of prestressing tendons and ___ X ___ ___ Art. 2.413, 2.4H 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 prestressing X i __ --_ ___ Art. 3.66 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. 2.613 prestressing grout for bonded tendons. ❑ Construction of mortar joints. -- X --- --- Art. 3.313 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. I 1 1 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 f m and f AAc 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. 1.513 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. 3.21D ❑ 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. 3.613 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 INSPECTION C P REFERENCED STANDARD IBC IREFERENCE 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 _ 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.doc 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,--- 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. 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 4. Smoke Control System --- --- --- 1704.16 5. Seismic Resistance ❑ Suspended ceiling systems and their anchorage. -- --- --- 1705.3 [4.3] SpecialnspectionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTION CP REFERENCED STANDARD IBC REFERENCE 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 1707.3 of components within the seismic -force -resisting system, including wood shear walls, wood --- X diaphragms, drag struts, braces, shear panels and 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 09/06112 ❑ 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 ,o F e:10779 Brookwell,,rbof eave FILE !2� To whom it may concern, Cement plaster underside of the roof projection which provide 1 hr rating is acceptable for roof projection with fire separation distance more than 2 feet, but less than 5 feet without fire sprinklers per CRC R302.1(1). Architect Yin Su y nsu2002@gmail.com 0 AR�y�T vG ,(IN SU Rc r * 281 R OF CAI�EOQ'