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15090121CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: 15090121 7518 LEEDS AVE CUPERTINO CA 95014 (366 16 021) GRIDLEY CONSTRUCTION INC CAMPBELL, CA 95008 OWNER'S NAME: HSU FREDERICK AND CHRISTINE E DATE ISSUED: 04/06/2016 OWNER'S PHONE: 408-673-5538 PHONE NO: (408) 374-0900 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class FLOORING AND FLOOR COVERING Lic. # 55QQf Contractor GRIDLEY CONSTRUCTION INC Date 08/31/2017 BLDG _ELECT PLUMB — — — I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH — RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONSTRUCT ONE STORY FRONT ADDITION (29 SQ FT); REAR I hereby affirm under penalty of perjury one of the following two declarations: ADDITION (207 SQ FT); REMODEL (E) RESIDENCE (1479 SQ FT); 1. I have and will maintain a certificate of consent to self-insure for Worker's UPGRADE ELECTRICAL PANEL (200 AMP); Compensation, as provided for by Section 3700 of the Labor Code, for the RELOCATE (E) FURNACE AND A/C TO ATTIC; IN STALL (I) WATER ' performance of the work for which this permit is issued.'_ HEATER. have ave and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this P REV #1 - STRUCTURAL CHANGES - ISSUED 7/1312016 permit is issued. Sq. Ft Floor Area: Valuation: $150000.00 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and Hereby authorize 366 16 021 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 PERMIT EXPIRES IF WORK ISN T STARTED'` may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 711312016Issued by ABBY AYENDE OWNER-BUILDER DECLARATION Date: 04/06/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the?­ROOFS: following two reasons: All roofs shall be inspected prior to , y roofing material be g installed. If a roof is 1. 1, as owner of the property, or my employees with wages as their sole installed without first obtaining an inE jection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for I Ispection. sale (Sec.7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Scc.7044, Business & Professions Code). Date: 7/13/2016 I hereby affirm under penalty of perjury one of the following three declarations: t. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS M kTERIALS DISCLOSURE 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materi its requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Cad , Sections 25505, 255 3, and 25534. 1 will permit is issued. maintain compliance with the Cup rdno Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25 532(a) should I store r handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I ust equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions ofthe will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall >the Health & Safety Cod, Sections 25505, 2553 3, and 25534. be deemed revoked. : Owner or authorized agent: + APPLICANT CERTIFICATION Date: 7/13/2016 1 certify that I have read this application and state that the aboveinformationis CONSTRUCTI DN LENDING A E Y correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a cons ruction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is is wed (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITS 'S DECLARATI Code, Section 9.18. 1 understand my plans shall be usi d as public records. Signature Date 7/13/2016 Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (4088)-777-3228 • FAX (408' 777-3333 - buildina(d)cuoertino.orra CUPERTINO ,.NEW CONSTRUCTION I ADDITION ALTERikTION / TI L��`J REVISION /.DEFERRED O GINAL PERMIT #/ 09,0 PROJECT ADDRESS AP1V # 7f/8 L c t OwNER NAME PHONE G GZL- E MAIL. cyrr.�,F►�—.zyasA-�a3. STREET ADDRESS 79 L CITY, STATE, ZIP FAX �'yT1d C' CONTACT NAME PHONE E-MAIL / 0 6 f -?'L JP 6:12SC v as Y®4=Jaz,3y STREET ADDRESS I CITY, STATE, ZIP FAX ❑ OWNER - ❑ OWNER -BUILDER ❑ OWNER AGENT 'r CONTRACTOR ❑- CONTRACTOR AGENT ❑ ARCHITECT ❑ E qGINEER ❑ DEVELO LR ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSETYPEBUS. LIC # COMPANY NAMEFAX '�}� y�� �,�/ '�7 �l /` ✓y� .�7 /7/M r. L -� s�� 4 7. 7®92 STREET ADDRESS CITY, STATE; ZIP PHONE ezz 9 e�/.� e ; tee _ e,4 ysaa spa q V. A 9 ARCHITECT/PNt;INF ERN Q LICE'_ ISH NUMBER BUS. LIC # C�31,�a� COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE S $'76 Ae 7`z12A i&7— ,0/ 0 -7 9 -,(I '3 a DESCRIPTION OF'kVORK f( USE TYPE I 04;d' SQ.FT. I vALUATION($) EXISTG I NEW FLOOR �.. DEMO _ TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA PORCH AREA -- DECK AREA .. TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH _ # DWELLING UNIT'S: ISASECONDUNIT ❑YES 'SECOND STORY ❑YES -- BEING ADDED? ® NO ADDITION? ❑ NO , PRE-APPISCATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES RECTCV,ED $Y TOTAL VAL ATION: PLANNiNO APPL # ❑NO PLANNING APPROVAL LETTER EiCHLER E[OIYiE?' ❑ NO L Z _ ✓ a By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on th properly oi mer's behalf. I have re d this application and the information I have providedis correct. l have read the Description of Work and verify it is accurate. I agree to comply with all app I.icable local ordinances and state laws relatingep,bilding con ction. I authorize representatives of Cupertino to enter the above-identifiec property for inspection purposes. Signature of Applicant/Agent: _ Date: ate/ SUPPLEMENTAL INFORMATION REQUIRED QPLAN.CHECK TYPE ". ROfrft SQP , Q OYER 2z C4trNTER ® BUILDiNGk� v1]EW 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. L7 ExPR> sS`. ' '' ❑ , P CANNING r REl IE`h Commercial Bldgs: Provide a completed Hazardous Materials Disclosure X., ❑.; STANDARD ❑ I uBLrc�Gzxs _ form if any Hazardous Materials are being used as part of this project. ❑' ARGE : ❑ T ixEDEPT ; Copy of Planning Approval Letter or Meeting with Planning prior to �AaoR ❑ RVISTRICT submittal of Building Permit application. "` SANITAI£YS 2011.doc re ised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15090121 7518 LEEDS AVE CUPERTINO CA 95014 (366 16 02 1) GRIDLEY CONSTRUCTION INC CAMPBELL, CA 95008 OWNER'S NAME; HSU FREDERICK AND CHRISTINE E OWNER'S PHONE: 5106735538 LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #575006 Contractor GRIDLEY CONSTRUCTION INC Date 08/31/2017 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. hereby affirm under penalty of perjury one of the following two 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. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulation r the Cupertino Municipal Code, Section 9.18. Signature Date 04/06/2016; I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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 (See.7044, Business & Professions Code) 2. 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. 2. 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. a.. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California, If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (VI/e) 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 04/0612016 ISSUED: 04/06/2016 PHONE NO: (408) 374-0900 BUILDING PERMIT INFO: —BLDG —ELECT _ PLUMB _ MECH _ RESIDENTIAL COMMERCIAL JOB DESCRIPTION: CONSTRUCT ONE STORY FRONT ADDITION (292 SQ FT); REAR ADDITION (207 SQ FT); REMODEL (E) RESIDENCE (1479 SQ FT); UPGRADE ELECTRICAL PANEL (200 AMP); RELOCATE (E) FURNACE AND A/C TO ATTIC; INSTALL (N) WATER Sq. Ft Floor Area: Valuation: $150000.00 APN Numbers Occupancy Type: 366 16 021 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: PAULO' SULLIVAN RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant; Date: 04/06/2016 "A" OR HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code;�Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 04/06/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 buildin (ecu rf CCUPERTINO I � ^ x-74 ue mo.orp 1 NEW r_0N..;-rRTI�`.- Tn Jf47 AT)nTTT=D 1 1 ET =D h. TTn KT /PT I I DMIT TILT tnrrrnnrr� PROJECT ADDRESSy APN 4K � 11 v OWNER NAME PHONE f All--'=� 6a / a7 -11Y E 63 - `2 E-MAIL STREET ADDRESS CITjyr STpJj7 E�ZIP. FFAX CONTACT NAME i� P$OA en 195E_ II eC�` +�1 e� 5�QL�e-�r r'yc' STREET ADDRESS CITYr3 STATE, ZIP /"A� - +' l� d'" FAX 7 Y p� 01[1 ✓ % t ' it 7 OWNER ❑. OWNER -BUILDER ❑ OWNER AGENT � CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑"ENGATEER ❑ DEVELOPER ❑ TENANT. CONT° " ^ ,rte LICENSE LICENS; TYPE BUS. LIC ff COMP NAME G�f3'6eM, q- Z � VAX () ?,) ] ^ ® STREET ADDRESS /;Z2�1TjsrZir�i2�/t CITY, STATE ZIP �i �✓ PHONE e_-497-"� - Y4P�— ARCHITECT/ENGINEFR NAME ,f LICENSE NUMBER BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP L PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE _ CONSTR TYPE $STORIES USE TYPE OCC. SQ.FT. VALUATION (S) FJC.STG NEW FLOOR DEMO. TOTAL _ AREA �: AREA per' AREA NET AREA /,gCQ 7 '- BATHROOM .. KITCHEN OTHER REMODEL AREA/`l REMODEL AREA REMODEL 7. PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE A:. DETACH - - -- ^� - AQ ^G RATTACH -.. A DV,'ELLINGUNI'TS: IS A SECOND UNIT ❑ YES SECOND STORY [],YES BEING ADDED? PNO ADDITION? JINO PRE APPLICATION ❑.YES IF YES, PROVIDE COPY OF iS THE BLDG AN El EIVED,:BY �- .�- � TOTAL VALUATION: PLANNINTTGAPPL# RNO PLANI.'INGAPPROVAL .LETTER EICHLERHOME? qN0 � •4 � 'OM = � By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information 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 relatin&t�yildingcX ion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: /i , Date: 911 SUPPLEMENTAL�/`INTFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for I� 0VERTHI<CO[32tTER�IBUIIDII�GPL4NS2EVZEW t existing building(s). Demolition permit is required prior to issuance of building permit for new building. E mssI LAI�ALV p iylEv v _ Commercial Bldgs: Provide a completed Hazardous Materials DisclosuresTar,DARD std ruBra of xs form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to _ submittal of Building Permit application.AW rox 4 �`;TsExD�ze EI�'ViRO,NMENTiI�HEALTH¢ BldgApp M1. doe revised 06121111 CITY OF CUPERTINO w FEE ESTIMATOR BUILDING DIVISION 7518 Leeds Ave DATE: 1 011 3/201 5 REVIEWED BY: Sean JimADDRESS: APN: BP#: *VALUATION: 1$150,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? - Yes '- No OTC? Yes E O No PENTAMATION PERMIT TYPE: 1 R3SFDADD WORK CONSTRUCT ONE STORY FRONT ADDITION 292 SQ FT); REAR ADDITION 207 SQ FT); SCOPE REMODEL (E) RESIDENCE (1479 SQ FT); UPGRADE ELECTRICAL PANEL (200 AMP); RELOCATFa OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA. (s.f.) PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 499 $1,626.00 IADDPLCK $1,323.00 1ADDINSP Permit Fee: $1,323.00 Suppl. Insp. Feer Reg. 0 OT 070 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 0 G Work Without Permit? 0 Yes No $0.00 TOTALS: 499 1 $1,626.001'' u ' $1,323.00 , Mech. Plan Check Plumb. Plan Check Elec. Plan Check Mech. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee.: Other Mech. Insp. Other Plumb Insp. Other Elec. Insp. -Ea-1 Mech. Insp. Fee: Plumb. Insp. Fee: Elea Insp. Feer NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept.for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,626.00 1,479 s.f. Remodel, Other $4,888.001 IREMRES2 Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,323.00 Suppl. Insp. Feer Reg. 0 OT 070 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 0 G Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: 1PLLOIVGR $69.86 Select a Non -Residential 0 Building or Structure j Travel Documentation Fees: Strom Motion Fee: 1BSEISMICR $19.50 Select an Administrative Item $6.00 NOTAL FRE $7,932.36 $3,044.36 $4,888.00 ffl Revised: 10/01/2015 Bldg Stds Commission Fee: 1BCBSC r SIIBOTAL;* R. .v.. A..•y / Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: 7,fle g jewns PERMIT# / OWNER'S NAME: /72e- #-50 PHONE# GENERAL CONTRACTOR: 6/21rxe----y r BUSINESS LICENSE# /75:43- ADDRESS: /?Z erc,41/17-e. elry,A0e, erfpfee,eeze,c4 CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City ofCupertisiness license NO BUILDING FINAL OR FINAL OCCUPANCY INSPECT-40,NIVii-L BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND MI SUBCONTRA-CtORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontraebirs: Signature Date Please check applicable subcontractors and complete the following information: I/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# X Cabinets &Millwork 6-21p4eF/ 6 /7 57g75-- 1,(/ Cement Finishing p71/ ,j v/ Electrical 47afpcey 7S -57s— ‘,7 Excavation i7?ciff4-7-t /974.P So-VS /95- Fencing V" Flooring/Carpeting 6.4/e-Per'r 30629 /*Linoleum/Wood awre-72, g 7Glass/Glazing -77,4 4--P 6,F 17/6 FAO V Heating V Insulation c 4-770-", ;2.2 6c/7 Landscaping vr Lathing exo 25i93.2 Masonry /Painting/Wallpaper (7-"P_79-70v Ke>"Pfli- -Z-571(9S- Paving Plastering V Plumbing /7 SSTS— V Roofing „1- Pe,*c- lei 7 I SOfSe0.‹.- Septic Tank ,e--Sheet Metal Sheet Rock /74-7z/974. Lz, 66. v/Tile 3/6/57 1-4,66"-- O /4wner/Contractor Signature Date CALGREEN RESIDENTIAL CHECKLIST — MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION SUBMITTAL CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building acupertino.om # 3 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 are not subject to the requirements of CALGreen. Project Name: Hsu Addition Project address: 7518 Leeds Ave. Cupertino, CA 95014 Project Description: Home Addition J""W Avow Instructions: 0 i- 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 Re uirements ,. .1 PLANNING AND DESIGN Plan nn - -, $ite, Developnne.� ,;, r ,? _� i g.�nit! Del ign nlr " ., �'` ; S� ,1 i ; ff,, � r� � .J I 4.106.2 Storm water drainage and retention during construction. A plan is 1 developed and implemented to manage storm water drainage during []X construction. 4.106.3 Grading and paving. The site shall tie 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. ! Pagelof5 (•alGreen X01d.&wrevised01/15,14 • I t rr f, .' .-},, ismer!' Ji ii �1 7'j>'Ir rr'ba i - ,_ •.:. T.�j a r:..:. J.L. Genera •..Zc .• •t f ' 4.201.1 Low-rise residential buildings shall meet or exceed the minimum © ❑ standard design required by the Califomia Energy Standards. A4.3 WATER EFFICIENCY AND • r _ r :lrid 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 �X 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 201 a.doc revised 0/ 15 14 — ...... ..h yyy �t wcu t ~L., i...,;� 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 i 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 Enhahce > i�jap�llfy anal Reduced 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. on Waste Reduction, Disposal Construpfiand Rec�C�ing 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a ® El waste management plan shall be submitted for approval to the enforcing agency. 8u1ldir}gfainteitan6"e and Operation t 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. .. .5 ENVIRONMENTAL QUALITY •, ' y• Fireplace � Susi, h I � Y , , � 9i � sL, , 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 a ❑ shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be ❑ compliant with VOC limits. 4.504.2.3 Aerosol paints and coatings. Aerosol paints and other coatings shall be compliant with product weighted MIR Limits for ROC and other toxic © [] compounds. Page 3 of 5 CalGreen 20l4 slur reused 0I 15 14 4.504.2.4 Verification. Documentation shall be provided to verify that compliant VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with VOC limits. 4.504.4 Resilient flooring systems. Eighty (80) percent of floor area receiving resilient flooring shall comply with the VOC-emission limits defined in the Collaborative for High Performance Schools (CHPS) Low-emitting 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 QX �] comply with low formaldehyde emission standards. _� °; �j i Iri�e r soakI . p(J 4.605.2 Concrete slab foundation. Required vapor retarders and capillary a 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. ai>y-tit E ...... 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the building are provided in every bathroom. w . Y '� 1 x; MEs� 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 OR QUALIFICATIONS v ' z;.r::: , I+ a tJaU., 9"i't t 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. 44 .., TI aN4 r 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 nX agency which show substantial conformance. Implementation verification shall be submitted to the Building Department after implementation of all required measures and prior to final inspection approval. Page 4 of 5 CalGreen 2014.doc revised 01115/14 Project Name: Project Address: Project Description: CALGREEN SIGNATURE DECLARATIONS Hsu Addition 7518 Leeds Ave. Cupertino, CA 95014 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. Owners Signature Date Owners Name (Please Print) Design PPrrofessionOss Signature Date Desig f al's Slame (Please Print) 09/15/15 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 Email Address for License Professional resp6n-iible 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 responsible for CalGreen Page 5 of CalGreen 2014.doc revised 01115/14 Project Name: Project Address: Project Description: CALGREEN SIGNATURE DECLARATIONS Hsu Addition 7518 Leeds Ave. Cupertino, CA 95014 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 94y of Cupertino. 1 A4) I1, Signature Data Owners Name (Please Print) Design Professional's Signature Date Desig f al's ame (Please Print) 09/16/15 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 Email Address for License Professional resp nsinie for CalGreen compliance 5EG li iuN z — ipAr ENTATIC. N 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 Bantling 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 Name of License ro essi CalGreen ?014.daac revised 0/17-144 Page 5 of 5 I BUILDING ENERGY ANALYSIS REPORT I CJPER iNO P lding DOP rt-nEnt � JAN 1 1 201s; REVIEWED F(JR (;CJJE COMPLIANCE Reviewed By. PROJECT: Hsu Addition 7518 Leeds Avenue Cupertino, CA 95014 Project Designer: Stewart Design 850 Revere Drive Sunnyvale, CA 94087 650-520-9215 Report Prepared by: Heather Clark Builders' Energy Services 1478 Bird Avenue San Jose, CA 95125 408-202-9075 1 rF BUILDER'S ENERGY SERVICES Job Number: 06466 Date: 9/15/2015 °U8�3TTA( OPP lcF co The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2013 Building Energy Efficiency Standards. IThis program developed by EnergySoft, LLC — www.energysoft.com. I EnerovPro 6.7 by EneravSoft User Number: 1234 ID: 06466 I TABLE OF CONTENTS I Cover Page Table of Contents Form CF -1 R -PRF -01-E Certificate of Compliance Form MF -1 R Mandatory Measures Summary EnergyPro 6.7 by EnergySoft Job Number. ID: 06466 User Number: 1234 2 3 11 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Hsu Addition Calculation Date/Time: 13:35, Tue, Sep 15, 2015 Calculation Description: Title 24 Analysis Input File Name: 06466.xml CF1 R -PRF -01 Page 1 of 8 GENERAL INFORMATION 01 Project Name Hsu Addition 02 Calculation Description Title 24 Analysis 03 Project Location 7518 Leeds Avenue 04 City Cupertino 05 Standards Version Compliance 2015 06 Zip Code 95014 07 Compliance Manager Version BEMCmpMgr 2013-4 (744) 08 Climate Zone CZ4 09 Software Version EnergyPro 6.6 10 Building Type Single Family 11 Front Orientation (deg/Cardinal) 0 12 Project Scope Addition and/or Alteration 13 Number of Dwelling Units 1 14 Total Cond. Floor Area (ft) 1994 15 Number of Zones 2 16 Slab Area (ft2) 0 17 Number of Stories 1 18 Addition Cond. Floor Area 493 19 Natural Gas Available Yes 20 Addition Slab Area (ft) 0 21 Glazing Percentage (%) 12.5% COMPLIANCE RESULTS 01 Building Complies with Computer Performance 02 This building DOES NOT require HERS Verification 03 This building incorporates one or more Special Features shown below Registration Number: Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 HERS Provider: Report Generated at: 2015-09-15 13:35:57 ENERGY USE SUMMARY 04 05 06 07 08 Energy Use (kTDV/ft2-yr) Standard Design Proposed Design Compliance Margin Percent Improvement Space Heating 30.93 28.24 2.69 8.7% Space Cooling 19.80 20.44 -0.64 -3.2% IAQ Ventilation 0.00 0.00 0.00 0.0% Water Heating 13.96 9.99 3.97 28.4% Photovoltaic Offset ---- 0.00 0.00 ---- Compliance Energy Total 64.69 58.67 6.02 9.3% Registration Number: Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 HERS Provider: Report Generated at: 2015-09-15 13:35:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1R-PRF-01 Project Name: Hsu Addition Calculation Date/Time: 13:35, Tue, Sep 15, 2015 Page 2 of 8 Calculation Description: Title 24 Analysis Input File Name: 06466.xmi 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 • New ductwork added is less than 40 ft. in length HERS FEATURE SUMMARY 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: • --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 (kTDV/f2-yr)* 114.24 108.22 6.02 5.3% * 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 Hsu Addition 1994 1 4 2 0 1 ZONE INFORMATION 01 02 03 04 05 06 07 Zone Name Zone Type HVAC System Name Zone Floor Area (ft) Avg. Ceiling Height Water Heating System 1 Water Heating System 2 Existing Conditioned Housel 1501 8 DHW Sys 1 Addition Conditioned Housel 493 8 DHW Sys 1 Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 Report Generated at: 2015-09-15 13:35:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Hsu Addition Calculation Date/Time: 13:35, Tue, Sep 15, 2015 Calculation Description: Title 24 Analysis Input File Name: 06466.xmi 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 (ft) Window & Door Area (ft2) Tilt (deg) Status Verified Existing Condition Left Wall Existing Wall Prior to 1978 90 Left 280 No 90 Existing No Back Wall Existing Wall Prior to 1978 180 Back 231 55.6 90 Existing No Right Wall Existing Wall Prior to 1978 270 Right 241 75 90 Existing No Front Garage Wall Existing Default Garage Wall Prior 0 Front 169 16.8 90 Existing No Roof 2 Existing Roof Prior to 1978 0.42 22.62 1494 0.85 0.1 Existing No Raised Floor Existing Default Floor Crawlspace 1501 Existing No Front Wall Addition R-13 Wall 0 Front 230 68 90 New N/A Left Wall 2 Addition R-13 Wall 90 Left 198 40 90 New N/A Back Wall 2 Addition R-13 Wall 180 Back 168 24 90 New N/A Right Wall 2 Addition R-13 Wall 270 Right 197 90 New N/A Roof 3 Addition R-30 Roof Attic 493 New N/A Raised Floor 2 Addition R-19 Floor Crawlspace 493 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 Existing Attic RoofExisting Ventilated Roof 0.1 Framin No Verified Existi ng No Attic Addition Orientatio Area Skylight Roof Rise Roof Roof Reflectan Roof g Existing Name Zone Type n (ft) Area (ft2) (x in 12) Pitch Tilt(deg) ce Emittance Factor Status Condifion Roof Existing Roof Prior to Front 7.1 7 5 0.42 22.62 0.1 0.85 0.1 Existing No 19781 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 Existing Attic RoofExisting Ventilated 5 0.1 0.85 No No Existi ng No Attic Addition Attic RoofAddition Ventilated 5 0.1 0.85 Yes No New No Registration Number: Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CFiR-08252015-744 HERS Provider: Report Generated at: 2015-09-15 13:35:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Hsu Addition Calculation Date/Time: 13:35, Tue, Sep 15, 2015 Calculation Description: Title 24 Analysis Input File Name: 06466.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 (ft) U -factor SHGC Exterior Shading Status Verified Existing Condition 8040 Window Back Wall (Back -180) ---- --- 1 32.0 0.35 0.27 Insect Screen (default) New N/A 19366 Window Back Wall (Back -180) ---- ---- 1 6.1 0.35 0.27 Insect Screen (default) New N/A 5036 Window Back Wall (Back -180) ---- ---- 1 17.5 0.35 0.27 Insect Screen (default) New N/A 10040 Window Right Wall (Right -270) ---- ---- 1 40.0 0.35 0.27 Insect Screen (default) New N/A 5036 Window 2 Right Wall (Right -270) ---- ---- 1 17.5 0.35 0.27 Insect Screen (default) New N/A 5036 Window 3 Right Wall (Right -270) ---- ---- 1 17.5 0.35 0.27 Insect Screen (default) New N/A Skylight Roof (Front -0) ---- ---- 1 7.0 0.35 0.27 None New N/A 2040 Window Front Wall (Front -0) ---- ---- 1 8.0 0.35 0.27 Insect Screen (default) New N/A 2040 Window 2 Front Wall (Front -0) ---- ---- 1 8.0 0.35 0.27 Insect Screen (default) New N/A 8040 Window 2 Front Wall (Front -0) ---- ---- 1 32.0 0.35 0.27 Insect Screen (default) New N/A 6068 Door Left Wall 2 (Left -90) ---- ---- 1 40.0 0.35 0.27 Insect Screen (default) New N/A 6040 Window Back Wall 2 (Back -180) ---- ---- 1 24.0 0.35 0.27 Insect Screen (default) New N/A DOORS 01 02 03 04 05 06 Name Side of Building Area (ft) U -factor Status Verified Existing Condition Door Front Garage Wall 16.8 0.50 New No Door 2 Front Wall 20.0 0.50 New No Registration Number: Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 HERS Provider: Report Generated at: 2015-09-15 13:35:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Hsu Addition Calculation Date/Time: 13:35, Tue, Sep 15, 2015 Calculation Description: Title 24 Analysis Input File Name: 06466.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 RoofExisting 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 • Cavity/ Frame: no insul. / 2x4 • Exterior Finish: Wood Default Garage Wall Prior Exterior Walls Wood Framed Wall 2x4 @ 16 in. O.C. none 0.302 Siding/sheathing/decking • Floor Surface: Carpeted Floors Over Floor Deck: Wood Siding/sheathing/decking Default Floor Crawlspace Crawlspace Wood Framed Floor 2x6 @ 16 in. O.C. R 13 0.062 Cavity/Frame: R -13/2x6 • 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. R 11 0.088 Roofing: Light Roof (Asphalt Shingle) • Cavity/ Frame: no insul. / 2x4 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 Wall1 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-30 Roof Attic attic) Wood Framed Ceiling 2x4 @ 24 in. O.C. R 30 0.032 Over Floor Joists: R-20.9 insul. Registration Number: Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 HERS Provider: Report Generated at: 2015-09-15 13:35:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Hsu Addition Calculation Date/Time: 13:35, Tue, Sep 15, 2015 Calculation Description: Title 24 Analysis Input File Name: 06466.xml CF1 R -PRF -01 Page 6 of 8 WATER HEATING SYSTEMS 01 02 03 04 05 06 07 08 Name System Type Distribution Type Water Heater Number of Heaters Solar Fraction N Status Verified Existing Condition DHW Sys 1 DHW Standard DHW Heater 1 1 Annual New 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 0.8 EF 40000-Btu/hr 0 0 WATER HEATING - HERS VERIFICATION 01 02 03 04 05 06 07 Name Pipe Insulation Parallel Piping Compact Distribution Point -of Use Recirculation with Manual Control Recirculation with Sensor Control DHW Sys 1 n/a n/a n/a n/a n/a n/a 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 Housel Other Heating and Heating Yes Cooling No Air Distribution HVAC Fan 1994 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 Registration Number: Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 HERS Provider: Report Generated at: 2015-09-15 13:35:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Hsu Addition Calculation Date/Time: 13:35, Tue, Sep 15, 2015 Calculation Description: Title 24 Analysis Input File Name: 06466.xmi CF1 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 N/A 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 Ducts located in attic Existing (not 6.0 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 IAQVentRpt 0 Default 0 Not Required Registration Number: Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 HERS Provider: Report Generated at: 2015-09-15 13:35:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Hsu Addition Calculation Date/Time: 13:35, Tue, Sep 15, 2015 Calculation Description: Title 24 Analysis Input File Name: 06466.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: Heather Clark Company: Signature Date: CEPE # Builders' Energy Services 9/15/2015 R-oB-Ot-MO CEA/HERS Certification Identification (If applicable): ABEC Address: 1478 Bird Avenue Heather Clark City/Stateban Jose, CA 95125 Phone: 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: Responsibl Design r Signature: Fredric Gould 6 ,,a ( 6 �- Company: Date Signe Stewart Design Address: License: 850 Revere Drive City/State/Zip: Phone: Sunnyvale, CA 94087 650-520-9215 Registration Number: Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 HERS Provider: Report Generated at: 2015-09-15 13:35:57