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15060054CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11530 UPLAND WAY CUPERTINO CA 95014 51 CONTRACTOR: PERMIT NO 15060054 (366 005) R J HEATING & AIR CONDITIONING FREMONT, CA 94538 OWNER'S NAME: Mr & Mrs JOHN R AND WENDY L BUSCH i DATE ISSUED: 04/07/2016 OWNER'S PHONE: 408-257-3610 PHONE NO: (510) 821-4162 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lie. #619678 Contractor .R.J HEATING &AIR CONDITIONING pate 05/31/2017. —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: I hereby affirm under penalty of perjury one of the following two declarations: MASTER BATHROOM ADDITION (214 S.F.), BATHROOM REMODEL (152 S.F), INSTALL NEW FURNACE AND NEW r. I have and will maintain a certificate of consent to self -insure for Worker's TANKLESS WATER HEATER IN ATTIC, INSTALL NEW A/C Compensation, as provided for by Section 3700 of the Labor Code, for the CONDENSING UNIT ON NORTH EXTERIOR OF GARAGE performance of the work for which this permit is issued. F} 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. Sq, Ft Floor Area: Valuation: $150000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 366 51 005 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 IS NOT STARTED may accrue against said City in consequence of the granting this permit. Additionally, the applicant understands and will comply with all ll 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 4/7/16 Issued by: SEAN HATCH Date: 04/07/2016li✓ G OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is t. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the strueture`is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 4/7/16 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 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 MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials 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 Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino 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 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. ,. Owner or authorized agent: APPLICANT CERTIFICATION Date: 4/7/16 l certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (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 ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 4/7/16 Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 [ • TIN (408) 777-3228 • FAX (408) 777-3333 + b as€q ca�ticl. � ❑ NEW CONSTRUCTION 15? Al nM(—)N n er Tru a Irmo rr 1-1 -- roTr.,.r , PROJECT ADDRESS 1 IS3 APN# 3 b 6 -- S -1-v0 S- d OWNER NAME _- V IJ&,V Sc PHONE • , 36 v E -MAH W610—LIW P Norp ` STREET ADDRESS itS36 CITY, ST 1$ZIP FAX G� � r zr d � . 3 to CONTACT NAME 1 /V„ �� U \ p- Z PHONE j V�` �J 7�` EMAE.j. �6 a`Y J , STREET ADDRESS � l a - C1TY, STATE, ZIP • Q - /l � � � VI6 FAX � /' o � F l{X J o OWNER ❑ OWNER -BUILDER ❑ OWNER AOENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑. ARCHITECT El ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAyM�E :['. ' f� LICENSENUMBER �� LICENSE TYPF�'^ f.� BUS. LIC # l� COMPANY NAMEI1� r E MAH FAX - -__ _ STREET ADDRES - -_` CITY, ST" ."'.- PHONE - i'�j ARCHrT,ECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME 50 - s EMAIL FAX STREET ADDRESS Z �y CTI'Y ATE, k _ !z PHONE .. yid'• o-z�? DESCRIPTION OF WORK GD AWWSI(AA117. EXISTINGUSE 4 1 -L PROPOSED USE � ' CONSTR / i TYPE v # STORIlsS - - USE TYPE OCC. SQFT. VALUATION ($) J f 1 1 i EXISTG AREA WFLOOR -. AREA '1 DEMOr- AREA. TOTAL NET AREA - - - BATHROOM �+IUTCHFN REMODELAREAZ w REMODELAREA OTHER- REMODELAREA PORCH AREA. ECKAREA TOTALDECKIPORCHAREA GARAGEAREA: ODETACH - - ❑ATTACH I #DWELLINGUNIPS: ISASECONDUNIT AYES SECOND STORY - OYES -- - - - BEINGADDED? .ONO ADDITION? ONO PRE -APPLICATION YES IF YES,PROVIDE COPY OF PLANNINGAPPL# ONO PLANNINGAPPROVALLETTER IS THEBLDG AN O YES EICHLERHOME? KNO EIVED BY: r 1v, ,_.�- TOTAL�ATION: c.�_ By my signature below, I certify to each of the following: I am the property owner or autho • 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 relating to building PN4gt1uctIOn. I authorize restsentatives of Cupertino to enter the above -identified property �br inspection purposes. Signature of AppIicant/Agent: Date: &Z F-1 SUPPLEMENTAL INFORMATION D PLAN'CHECKTYPE ROUTING SLIP ❑ OVERXHF.COUNTER C7 Bun.DINGPLANREVIEw 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. N EXPRESS .. E PLANNING PL AN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD D PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. 0 LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR L7 SANITARY SEWERDISTRICT submittal of Building Permit application. 11:. ENVn20NMENTALHEALTH BldgApp 2011. doe revised 06/21/11 CITY OF CUPERTINO FFF ESTIMATOR — BUILDING DIVISION ADDRESS: 11530 Upland Way DATE: 06/08/2015 REVIEWED BY: PAUL APN: 36651005 BP#: `' *VALUATION: $150,000- PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: - 2nd Unit? Yes '' No OTC? 0 Yes E) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK Master bathroom addition 214 S.f. Bathroom remodel 152 S. Install new furnace and new tankless SCOPE I water heater in attic, Install new A/C condensing unit on north exterior of garage OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP' FEE ID CONSTR. s.L R-3 (Custom) II-B,111-B,IV,V-B 214 $1,091.00 IADDPLCK $1,057.00 IADDINSP I TOTALS: 214 I $1,091.00 II $4,057.00 Mech. Plan Check 10.0 1 hrs $0.00 Plumb. Plan Check 10.0 1 hrs Mech. Permit Fee: IMPERMIT Plumb. Permit Fee Other Mech. Insp. 0:0 hrs $48.00 Other Plumb Insp. 0.0 hrs Ween, ltzs t. Fee: Ph ,ab. h p. Fee.- NOTE. ete. NOTE: This estimate does not include fees due to other Departments (Le. Plant $0.00 Elea. Plan Check i 1PPERMIT /'le:c. Permit Fee $48.00 Oihef, Elec. Imp. FT Islcc. Fee., rg, Public Works, Fire, Sanitary Sewer Disi School District, etc.). Thesefees are based on the preliminary information available and are only an estimate, Contact the Dept -for aaan't info. FEE ITEMS (Fee Resolution 11-053 Eff.� 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,091.00 152 1 s.£ Remodel, Bath (<=300 st) Suppl. PC Fee: (F) Reg. 0 OT 0.0 lits $0.00 $645.00 1REMRESBAT PME Plan Check: $0.00 L—L—J # Mechanical Permit Fee: $1,057.00 $143.00 1 IMFR=<100 Furnace, Forced -Air Suppl. Insp. Fee -(E) Reg. 0 OT 1070 hrs $0.00 =1 # Plumbing PME Unit Fee: $0.00 $29.00 IPRWHEATR Water Heater PME Permit Fee: $96.00 � 1 # Mechanical Inst c°ticn Tax: $72.00 IBREM41R A/C Units (<=10K cfm) Administrative Fee: Work Without Permit? ® Yes (F) No $0.00 G Advanced Planning Fee: IPLLONGR $29.96 Select a Non -Residential G Travel Documentation Fee: ITRA VDOC $48.00 Building or Structure i Strom Motion. Fee: 1BSEISMICR $19.50 / Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $6.00 SUBTOTALS: $2,347.46 $889.00 $3,236.46 Revised: 05/07/2015 Building Department City Of Cupertino V/ 10300 Torre Avenue V/ Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS:/ !�/,q.( �' N PERMIT # % S 6 ODS OWNER'S NAME: 01114&� *- K)eA,11) Aj.�C# PHONE # S/ / GENERAL CONTRACTOR: C C0A4r1 L& BUSINESS LICENSE # v2 ADDRESS:SY$S- CITY/ZIPCODE:/n/I *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Aou 2© U/6 ignatu Date Please check applicable subcontractors and complete the following information: AiJl--1 26 11-1// Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical GL o& / / &C-9 FCS I C Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering P mbing MC IY06 0 9 Roofing C e-,r-T>n. 0 :2- S -70/ Septic Tank Sheet Metal Sheet Rock Tile AiJl--1 26 11-1// Date CUPERTINO PURPOSE: CALGREEN RESIDENTIAL CHECKLIST — MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinga�.cupertino.org The 2013 CalGreen Code applies to additions or alterations of existing residential buildings where the addition or alteration increases the building's conditioned area, volume, or size and also applies to all new low-rise residential buildings, high-rise residential buildings, or both. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name Project Address: BUSCH Nt�_Zz,-WOML— A_01) 10'/,J I� Project Description: (J _ Z- N&G.J f3tl�tt+R vbWl D! -T b/J Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional. experienced with the Califomia Green Building Standards Codes to verify and assure'tl­�at all r�quired:w l described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and -TRklesign 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. Page 1 of 5 CalGreen_2014.doc revised 11104114 Column 2 Column 3 MANDAT 1EA RE OR MEASURE Project Verification Re uirements A4.1 PLANNING Planning and Design - Site Development 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage stor �ii�ag Ding I construction. 4.106.3 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. Page 1 of 5 CalGreen_2014.doc revised 11104114 A&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 WATERAND 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. 34.303.1.3.1 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 11/04114 Outd.bor 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. .. .4 MATERIAL CONSERVATION AND RESOURCE EFFICIENCY Enhanced Durability and Reduced Maintenance 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall be submitted for approval to the enforcing agency. Building Maintenance and Operation 4.410.1 Operation and maintenance manual. At the time of final inspection, an operation and maintenance manual shall be provided to the building occupant or owner. .. .5 ENVIRONMENTAL QUALITY 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 shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be r,7f �t 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_2014.doc revised 11104114 4.50F2.4 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 L 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 El 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 INSPECTOR QUALIFICATIONS Qualifications 702.1 Installer training. HVAC system installers are trained and certified in ri 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 �( til 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 11104114 CALGREEN SIGNATURE DECLARATIONS Project Name: —Db —J10/k-2 Project Address: Project Description: N ew *tt e0dy l e�-,pDI-T10iJ SECTION 1 - DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Owner's Signature' JAZ �A/D S C Owner's Name (Please Print) Design Professionbl's Signature Design Professional's Name (Please Print) of License Professional responsible for CalGreen compliance Name of License Pr6fessional responsible for CalGreen compliance (Please Print) P-09 ZS IST LOVE �r Email Address for License Professional responsible for CalGreen compliance IZ013411`Lov&LYiAS' 6M4I • 6,2 In SECTION 2 — IMPLEMENTATION VERIFICATION Date Date Date Nr.ZFAWA= Phone Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen_2014.doc revised 11104114 kREIVED JUN 082015 k $Y OFFIct (;upv k:, SUBMITTAL CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHODi CF1R-PRF-01 Project Name: Madson - Busch Add Calculation Date/Time: 14:48, Fri,W(P05, 2015 Page 1 of 10 Calculation Description: Title 24 Analysis Input File Name: MadsonBuschAdd2.xml GENERAL INFORMATION Ot Project Name Madson - Busch Add 02 Calculation Description Title 24 Analysis 03 This building incorporates one or more Special Features shown below 03 Project Location 11530 Upland Way 04 City Cupertino 05 Standards Version Compliance 2015 06 Zip Code 95014 07 Compliance Manager Version BEMCmpMgr 2013-3c (710) 08 Climate Zone CZ4 09 Software Version EnergyPro 6.5 10 Building Type Single Family 11 Front Orientation (deg/Cardinal) 270 12 Project Scope Addition and/or Alteration 13 Number of Dwelling Units 1 14 Total Cond. Floor Area (FT2) 2438 15 Number of Zones 2 16 Slab Area (FT2) 2438 17 Number of Stories 1 18 Addition Cond. Floor Area 214 19 Natural Gas Available Yes 20 Addition Slab Area (FT2) 214 21 Glazing Percentage (%) 20.0 COMPLIANCE RESULTS 01 Building Complies with Computer Performance 02 This building incorporates features that require field testing and/or verification by a certified HERS rater under the supervision of a CEC-approved HERS provider. 03 This building incorporates one or more Special Features shown below ENERGY USE SUMMARY 04 05 06 07 08 Energy Use Standard (kTDV/ft2-yr) Design Proposed Design Compliance Margin Percent Improvement Space Heating 25.17 19.48 5.69 22.6% Space Cooling 12.74 14.47 -1.73 -13.6% IAQ Ventilation 0.00 0.00 0.00 0.0 Water Heating 16.46 12.96 3.50 21.3 Photovoltaic Offset ---- 0.00 0.00 --- Compliance Energy Total 54.37 46.91 7.46 13.71/6 Registration Number: 215-AO1294918-000000000-0000 Registration Date/Time: 2015-06-05 15:57:59 HERS Provider: CaICERTS inc CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015-06-05 14:50:57 CUP pRpartmOnt Building JAN 14 2016 REVIEWED FOR CODE COMPLIANCE Reviewed By: 0"e,�� CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Madson - Busch Add Calculation Datefrime: 14:48, Fri, Jun 05, 2015 Calculation Description: Title 24 Analysis Input File Name: MadsonBuschAdd2.xml REQUIRED SPECIAL FEATURES The following are features that must be installed as condition for meeting the modeled energy performance for this computer analysis. • Cathedral Ceiling CFI R -PRF -01 Page 2 of 10 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: • Minimum Airflow • Fan Efficacy Watts/CFM HVAC Distribution System Verifications: • Dud Sealing Domestic Hot Water System Verifications: • --None — ENERGY DESIGN RATING This is the sum of the annual TDV energy consumption for energy use components included in the performance compliance approach for the Standard Design Building (Energy Budget) and the annual TOV 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. 02 Reference Energy Use Energy Design Rating Margin Percent Improvement Total Energy (kTDV/f2-yr)' 100.63 93.17 7.46 7.4% includes calculated Appliances and Miscellaneous Energy Use (AMEU) BUILDING - FEATURES INFORMATION 01 02 03 04 05 06 07 Project Name Conditioned Floor Area (11:2) Number of Dwelling Units Number of Bedrooms Number of Zones Number of Ventilation Cooling Systems Number of Water Heating Systems Madson - Busch Add 2438 1 6 2 0 2 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 Main Floor (E) Zone Conditioned (N) 4ton Split Gas/Electl 2224 9 DHW Sys 1 Main Floor Add Zone Conditioned (N) Mon Split Gas/Elect2 214 9 DHW Sys 3 Registration Number: 215-AO12949IB-000000000-0000 Registration Date/Time: 2015-06-0515:57:59 HERS Provider: Ca10ERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015.06-05 14:50:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Madson - Busch Add Calculation Date/Time: 14:48, Fri, Jun 05, 2015 Calculation Description: Tide 24 Analysis Input File Name: MadsonBuschAdd2.xml CF1R-PRF-01 Page 3 of 10 OPAQUE SURFACES 01 02 03 04 05 06 07 08 01 02 03 04 05 06 07 08 09 10 Name Zone Construction Azimuth Orientation Gross Area (ft) Window & Door Area (ft) Tilt (deg) Status Verified Existing Condition Front Wall Main Floor (E) Zone Default Wall 1978 to 1991 270 Front 585 2152 90 Existing No Right Wall Main Floor (E) Zone Default Wall 1978 to 1991 180 Right 112.5 90 Existing No Left Wall Main Floor (E) Zone Default Wall 1978 to 1991 0 Left 301.5 63.2 90 Existing No Rear Wall Main Floor (E) Zone Default Wall 1978 to 1991 90 Back 549 158.3 90 Existing No Roof 2 Main Floor (E) Zone Default Roof 1978 to Pres 2224 Existing No Interior Surface to Garag Main Floor (E) Zone»_Garage_ R-11 Wall to Garage 220.5 Existing No Front Wall 2 Main Floor Add Zone R-13 Wall 270 Front 117 6.6 90 New N/A Right Wall 2 Main Floor Add Zone R-13 Wall 180 Right 373.5 61.9 90 New N/A Rear Wail 2 Main Floor Add Zone R-13 Wall 90 Back 154.4 15 90 New N/A Roof 3 Main Floor Add Zone R-30 Roof Attic 207.7 New N/A Front Wall 3 _Garage_ R-0 Wall 270 Front 252 168 90 Existing No Left Wall 2 _Garage_ R-0 Wall 0 Left 180 90 Existing No Rear Wall 3 _Garage_ R-0 Wall 90 Bads 306 90 Existing No Roof 4 Garage_ R-0 Roof Attic 615 Existing No OPAQUE SURFACES — Cathedral Ceilings 01 02 03 04 05 06 07 08 09 10 11 12 13 Name Zone Type Onentatlo n Area (ft) Skylight Area (112) Roof Rise (x in 12) Roof Pitch Roof Tllt(deg) Roof Reflectan ce Roof Emittance Framin g Factor Statu 6 Verified Existing Condiflon Roof Main Floor Add Zone R-30 Roof Attict Left 6.4 6.3 5 0.42 22.62 0.1 0.85 0.07 New N/A Registration Number: 215-A0129491B-000000000-0000 Registration Date/Time: 20154)6-05 15:57:59 HERS Provider: CaICERTS Inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015-06-05 14:50:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Madson - Busch Add Calculation DatefTime: 14:48, Fri, Jun 05, 2015 Calculation Description: Title 24 Analysis Input File Name: MadsonBuschAdd2.xml CF1R-PRF-01 Page 4 of 10 ATTIC 01 02 03 04 05 06 07 06 09 10 Name Construction Type Roof Rise Roof Reflectance Roof Emiltance Radiant Barrier Cool Roof Statu a Verified Existing Condition Attic Garage Attic Garage Roof Cons Ventilated 5 0.1 0.85 No No Enrgsti No Attic Main Floor (E) Zone Attic RoofMain Floor (E) Zone Ventilated 5 0.1 0.85 No No Eng h No Attic Main Floor Add Zone I Attic RoofMain Floor Add Zone I Ventilated 1 5 1 0.1 1 0.85 1 No No New No WINDOWS 01 02 03 04 05 06 07 08 09 10 11 Name Surface (Orientation4imimuth) Width(ft) Multiplie Height (ft) r Area (W) U -factor SHGC Exterior Shading Status Verified Existing Condition (E) Front Windows Front Wall (Front -270) - - 1 175.2 0.40 0.40 Insect Screen (default) Existing No (E) Left Windows Left Wail (Left -0) - -- 1 29.8 0.40 0.40 Insect Screen (default) Existing No (N) Window 5-0x6-8 Left Wall (Left -0) - - 1 33.4 0.40 0.40 Insect Screen (default) New N/A (E) Rear Windows Rear Wall (Back -90) - - 1 151.6 0.40 0.40 Insect Screen (default) Existing No (N) Window 3-8x1-10 Rear Wall (Back -90) -- - 1 6.7 0.32 0.28 Insect Screen (default) New N/A (N) 2-10x1-2 Front Wall 2 (Front -270) --- -- 1 3.3 0.32 0.38 Insect Screen (default) New N/A (N) 2-10x1-2 2 Front Wall 2 (Front -270) -- -- 1 3.3 0.32 0.38 Insect Screen (default) New N/A (N) 3-8x1-10 Right Wall 2 (Right -180) - - 1 6.8 0.34 0.32 Insect Screen (defauft) New N/A (N) 2-4x3-6 Right Wall 2 (Right -180) - - 1 8.2 0.34 0.32 Insect Screen (default) New N/A (N) 2-4x3-6 2 Right Wall 2 (Right -180) - -- 1 8.2 0.34 0.32 Insect Screen (default) New N/A (N) 2-0x1-10 Right Wall 2 (Right -180) - -- 1 3.7 0.32 0.38 Insect Screen (default) New N/A (E) 4-0x5-0 Right Wall 2 (Right -180) -- - 1 20.0 0.58 0.65 Insect Screen (default) New N/A (N) 3-8x1-10 2 Right Wall 2 (Right -180) - -- 1 6.8 0.34 0.32 Insect Screen (default) New N/A (N) 24x3-6 3 Right Wall 2 (Right -180) - -- 1 8.2 0.34 0.32 Insect Screen (default) New N/A (N) 3-80-10 3 Rear Wall 2 (Back -90) -- - 1 6.8 0.34 0.32 Insect Screen (defau8) New N/A (N) 2-03.6 4 Rear Wall 2 (Back -90) - -- 1 8.2 1 0.34 0.32 Insect Screen (default) New N/A (N) 30 x30 Skylight Roof (Left -0) -- -- 1 6.3 1 0.39 029 None New N/A Registration Number: 215-AO129491B-000000000-0000 Registration Date/Time: 2015406-05 15:57:59 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CFiR-04012015-710 Report Generated at: 2015-06-05 14:50:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Madson - Busch Add Calculation Date/Time: 14:48, Fri, Jun 05, 2015 Calculation Description: Title 24 Analysis Input File Name: MadsonBuschAdd2.xml CF1 R -PRF -01 Page 5 of 10 DOORS 01 02 03 04 05 06 Name Side of Building Area (ft2) U -factor Status Verified Existing Condition (E) Entry Door Front Wall 40.0 0.50 Existing No Registration Number: 215-Ao129491&000000000-0000 Registration Date/Time: 2015-06-0515:57:59 HERS Provider: CeICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CFiR-04012015-710 Report Generated at: 2015-06-05 14:50:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Madson - Busch Add Calculation DatefTime: 14:48, Fri, Jun 05, 2015 Calculation Description: Title 24 Analysis Input File Name: MadsonBuschAdd2.xml CFI R -PRF -01 Page 6 of 10 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 Inside Finish: Gypsum Board Cavity / Fume: no insul. / 2x4 • Exterior Finish: Wood R-0 Wall Exterior Walls Wood Framed Wall 20 @ 16 in. O.C. none 0.302 Siding/sheathing/docking Ceilings (below Inside Finish: Gypsum Board R-0 Roof Attic attic) Wood Framed Ceiling 20 @ 24 in. O.C. none 0.481 Cavity/ Frame: no insul. / 2x4 Cavity/ Frame: no insul. / 2x4 Top Chrd • Roof Deck: Wood Sidfngrsheathingrdecking 2x4 Top Chord of Roof Truss @ 24 Trlo Gap: present Attic Garage Roof Cons Attic Roofs Wood Framed Ceiling in. O.C. none 0.400 Roofing: 10 PSF (Roof ile) Cavity/ Frame: no insul. /2x4 Top Chrd Roof Deck: Wood Sidirpsheathing/decking 2x4 Top Chord of Roof Truss @ 24 Tile Gap: present Attic RoofMain Floor (E) Zone Attic Roofs Wood Framed Ceiling in. O.C. none 0.400 Roofing: 10 PSF (Rooffilo) • Inside Finish: Gypsum Board • Cavity / Frame: R-11 / 2x4 Exterior Finish: Wood Default Wall 1978 to 1991 Exterior Walls Wood Framed Wall 2x4 @ 16 in. O.C. R11 0.103 Siding/sheathing/decking Inside Finish: Gypsum Board Ceilings (below Cavity / Frame: R-9.1 / 2x4 Default Roof 1978 to Pres attic) Wood Framed Ceiling 2x4 @ 16 in. O.C. R19 0.049 Over Floor Joists: R-9.9 insul. Inside Finish: Gypsum Board • Cavity / Frame: R- 11 / 2x4 R-11 Wall to Garage Interior -Walls Wood Framed Wall 2x4 @ 16 in. O.C. R11 0.099 Other Side Finish: Gypsum Board Cavity / Frame: no insul. / 2x4 Top Chid • Roof Deck: Wood Skfingvsheathing/decking 2x4 Top Chord of Roof Truss @ 24 Tile Gap: present Attic RootMain Floor Add Zone Attic Roofs Wood Framed Ceiling in. O.C. none 0.400 Roofing. 10 PSF (RoolTile) Inside Finish: Gypsum Board Cavity/Frame: R -13/2x4 Exterior Finish: Wood R-13 Wall Exterior as Wood Framed Wall 2x4 @ 16 in. O.C. R 13 0.095 Siding/sheathing/dedking • 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: 215-A0129491B-000000000-0000 Registration Datefrime: 2015-06-05 15:57:59 HERS Provider: Ca10ERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015-06-05 14:50:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Madson - Busch Add Calculation Date/Time: 14:48, Fri, Jun 05, 2015 Calculation Description: Title 24 Analysis Input File Name: MadsonBuschAdd2.Xml CF1R-PRF-01 Page 7 of 10 SLAB FLOORS 01 02 03 04 05 Inside Finish: Gypsum Board 07 08 09 Name Zone Area (tt2) Cavity/ Frame: R-301 2x4 Edge Insul. R -value Carpeted Fraction Heated Status Verttled Existing Condition Slab Roof Dock., Wood Siding/sheathing/decking 2224 172 None 0.8 No Existing Tile Gap: present R-30 Roof Atticl Cathedral Ceilings Wood Framed Ceiling 2x4 @ 24 in. O.C. R 30 0.039 RoolkV 10 PSF (RoofTrki) SLAB FLOORS 01 02 03 04 05 06 07 08 09 Name Zone Area (tt2) Perimeter (ft) Edge Insul. R -value Carpeted Fraction Heated Status Verttled Existing Condition Slab Main Floor (E) Zone 2224 172 None 0.8 No Existing No Slab -on -Grade Main Floor Add Zone 214 71.5 None 0.8 No New No BUILDING ENVELOPE - HERS VERIFICATION 01 02 03 04 Quality Insulation Installation (QII) Quality Installation of Spray Foam Insulation Building Envelope Air Leakage ACH @ 50 Pa Not Required Not Required Not Required -- WATER HEATING SYSTEMS 01 02 03 04 05 06 07 08 Name System Type Distribution Type Water Heater Number of Heaters Solar Fraction (X) Status Verified Existing Condition DHW Sys 1 DHW Standard DHW Healer 1 1 Annual Existing No DHW Sys 3 DHW Standard DHW Heater 3 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 0.58 EF 40000-Btu/hr 0 0 DHW Heater 3 Natural Gas Small Instantaneous 0 0.81 EF 199000-Btu/hr 0 0 Registration Number: 215-A0129491&000000000-0000 Registration Date/Time; 2015-06-05 15:57:59 HERS Provider: CeICERTS Inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015-06-05 14:50:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Madson - Busch Add Calculation DatefTime: 14:48, Fri, Jun 05, 2015 Calculation Description: Title 24 Analysis Input File Name: MadsonBuschAdd2.xml CFI R -PRF -01 Page 8 of 10 WATER HEATING - HERS VERIFICATION 01 02 03 04 05 06 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 DHW Sys 3 n/a n/a n/a n/a n/a n/a SPACE CONDITIONING SYSTEMS 01 02 03 04 05 06 07 08 09 CntdFumace - Fuel -fired central furnace 95 AFUE Heating System Cooling System 95 AFUE EER SEER Zonally Controlled Compressor HERS Verification Cooling Component 1 Spl"rCond - Split air conditioning 11.7 14 Distribution Fan Floor Area Verified Existing Name System Type Name Ducted Name Ducted System System Served Status Condition (N) Con Split Other Heating and Heating Yes Cooling Yes Air Distribution HVAC Fan 2224 Altered No Gas/Eled1 Cooling System Component 1 Component 1 System 1 1 (N) Con Split Other Heating andHeating Yes Cooling Yes Air Distribution HVAC an 214 Altered No Gas/Elect2 Cooling System Component 2 Component 2 System 2 2 HVAC - HEATING SYSTEMS 01 02 01 02 03 Name Type Efficiency Heating Component 1 CntdFumace - Fuel -fired central furnace 95 AFUE Heating Component 2 CntrIFumace - Fuel -fired cental furnace 95 AFUE HVAC - COOLING SYSTEMS 01 02 03 04 05 06 07 Efficiency Multi -speed Name System Type EER SEER Zonally Controlled Compressor HERS Verification Cooling Component 1 Spl"rCond - Split air conditioning 11.7 14 No No Cooling Component system 1-herscool Cooling Component 2 Sp6tAirCond - Split as conditioning 11.7 14 No No Cooling Component system 2 -hers -cool Registration Number: 215-A0129491B-000000000.0000 Registration DateMme: 2015-06-05 15:57:59 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CFIR-04012015-710 Report Generated at: 2015-06-05 14:50:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Madson - Busch Add Calculation Date/Time: 14:48, Fri, Jun 05, 2015 Calculation Description: Title 24 Analysis Input File Name: MadsonBuschAdd2.xml CF1R-PRF-01 Page 9 of 10 HVAC COOLING - HERS VERIFICATION 01 02 03 04 05 01 02 03 04 05 06 Name Verified Airflow Airflow Target Verified EER Verified SEER Verified Refrigerant Charge Goofing Component 1 -hers -cool Required 350 Not Required Not Required Not Required Cooling Component 2 -hers -cool Required 350 Not Required Not Required Not Required HVAC - DISTRIBUTION SYSTEMS 01 02 03 04 05 06 07 08 09 10 Air Distribution System 1 -hers -dist Required 6.0 Insulation Supply Duct Return Dud Air Distribution System 2 -hers -dist Required Verified Existing HERS Name Type Dud Leakage R -value Location Location Bypass Dud Status Condition Verification Air Distribution Air Distribution Ducts located in attic Sealed and tested 6.0 Attic Attic None Existing + New No System System 1 1 -hers -dist Air Distribution Air Distribution Ducts located in attic Sealed and tested 6.0 Attic Attic None Existing + New No System System 2 2 -hers -dist HVAC DISTRIBUTION - HERS VERIFICATION 01 02 03 04 05 06 Name Dud Leakage Verification Dud Leakage Target (%) Verified Dud Location Verified Dud Design Return Supply Air Distribution System 1 -hers -dist Required 6.0 — — — Air Distribution System 2 -hers -dist Required 6.0 - — - HVAC - FAN SYSTEMS S HERS VERIFICATION 01 02 03 04 Name Type Fan Power (Watts/CFM) HERS Verification HVAC Fan 1 Single Speed PSC Furnace Fan 0.58 Required HVAC Fan 2 Single Speed PSC Furnace Fan 0.58 Required IAQ (Indoor Air Quality) FANS 01 02 03 04 05 Name IAQ CFM IAQ Fan Type IAQ Recovery Effectiveness(%) HERS Verification SFam IAQVentRpt 0 Default 0 Not Required Registration Number: 215-A0129491B-000000000-0000 Registration Date/Time: 2015-06-05 15:57:59 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CFSR-04012015-710 Report Generated at: 2015-06-0S 14:50:57 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: Madson - Busch Add Calculation DatefTime: 14:48, Fri, Jun 05, 2015 Calculation Description: Title 24 Analysis Input File Name: MadsonBuschAdd2.xml C F1 R -PRF -01 Page 10 of 10 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Jeffery Burkard Company: Signature Date: California Energy Design 2015-06-05 15:33:50 A- Address: CE:A/HERS Certification Identfication (if applicable): jr. -. - =- � a +. c 7475 Texas Canyon Rd. (No US mail) R13-09-10005 / CC2005632 City/State/Zip: Phone: Placerville, CA 95667 530-626-1386 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. 2. 1 certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 3. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Responsible Designer Name: Responsible Designer Signature: James Madson Company: Date Signed: Madson Design 2015-06-05 15:57:59 Address: License: 528 Myra Way N/A City/State/Zip: Phone: San Francisco, CA 94127 415-890-2884 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215-A0129491B-000000000-0000 Registration Date/Time: 2015-06-05 15.57:59 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-04012015-710 Report Generated at: 2015 -06 -OS 14:50:57 PUBLIC WORKS CONFIRMATION FORM Public Works Department 10300 Torre Avenue (408) 777-3354 / Fax (408) 777-3333 Cupertino, CA 95014 publicworksOccupertino.org C U P S RT t N 0 http.//www.cupertino.org/publicworks A Public Works confirmation form, if required, must be completed prior to project submittal to the Planning Department. The fee for the confirmation is $282.00. If a Building Permit Application is submitted within one year of the sign -off date at the bottom, the confirmation fee will be applied towards the Public Works Building Permit fee. The purpose of this confirmation is to identify preliminary Public Works issues, which may adversely affect the application. Please submit this form, the fee, and a copy of the site plan to the Public Works Department for review. The Public Works Department can be reached at (408) 777-3354. ,y Project Address: j 3UC,64idEmail Address•u�••+�ll Applicant Name: Phone No: 00 r Z. 36 10 *� * For Public Works Department Use Only "** PW Confirmation Required ($282)__ _ RECEIVED /; Addition: �/ Single Family Dwelling 2160 Requirements: ❑ Dedicate Right-of-way (road): BY ❑ Easement (streetlight): Offsite improvements req circled): sidewalk, curb and gutter, curb ramp, driveway, pavement, street light,treet tre 4-- Cr- y +cn 514 - ❑ Registered civil engineer required to design grading plans or improvement plans ® Clearly show all utility lines from the house/ project site to the street (electric, electric panel, gas, water, sewer). Indicate as new (N) or existing (E) ❑ Underground all overhead utility service to new house or new electric panel ® Show onsite drainage on site plan with direction and slope percentage. Roof down spouts to direct storm water to landscaped areas. Include relevant City Standard notes and Details on plans ❑ Encroachment permit or Development Agreement ❑ Strearnside Permit Soils letter/report r r Master Storm Area fees ® Submit preliminary title report and Quitclaim underground water rights Parkland Dedication In -lieu Fees $ Comments: ) %feA -TaxeQ. X46 , sv\ �`-(�, Ptow, Sinai locoATaK cad a �f, `Evesz -�o lop— lute by -l-V.R- C&� . IN z W�IMAce, P T' 41 -?(( S sizer 11 qf11 RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: 34 b —S I 'Do Y Name of owner. –1,1 &V PY g u s ctf Project address. 3 0 6 eb Contact person. ! I y U S l�P`I Phone. W q o () 3'r / Fax. 4k k - �,S �7� 7,,[ �n Net square footage of lot. 4 l 6CO) Existing Square footage: First floor: Zz Second floor: Garage: C S TOTAL: 3 Q Proposed 2L d Are there at least two 10 foot by 20 foot clear spaces inside the garage? (,V N Is privacy protection planting required for the project? Y On what floor(s) is work being done? ILT P&O Y- [trief description of • iii i 6MEM .4. 01a Code editions: 2010 CBC (Y - N)2010 CFC (Y - N)2010 CMC (Y- N) 2010 CPC (Y - N)2010 NEC (Y - N) California Green Building Standards Code 2010 Effective 1 /01 / 11 t P3, qW y COMMUNITY MANAGEMENT SERVICES, INCORPORATED March 4, 2015 DD 1� cErD John Busch Wendy Busch 'JUN 0 8 2015 11530 Upland Way Cupertino, CA 95014-5104 BY Re: SEVEN SPRINGS OWNERS ASSOCIATIONS 11530 Upland Way Dear Homeowners: Enclosed you will find a copy of your Architecture Application for the addition to your home, with the conditional approval from the Board of Directors and recommendations from the association's architect. The architect has recommended that you obtain and submit a permit from the City of Cupertino Building Department for the additional building. This letter is to signify you have complied with the initial step in the approval process. The association will publish a general notice to the membership for a period of 60 days as required by the association's rules and regulations. You may move forward with obtaining permits and procuring your contractors. Please keep in mind that any deviation from your approved application will require you to resubmit your application for review. If you utilize an unapproved material you will be required to remove and replace the material with an approved selection. The approval of your project's architectural compatibility with the Seven Springs Owners' Association's complex does not constitute or imply, that the Architectural Committee and/or the Association Board of Directors deem your project as meeting City of Cupertino /County of Santa Clara codes. The approval is given contingent upon you and /or your contractor(s) obtaining the required construction permits and meeting all code requirements, if any. Sincerely, Communis nagement Services, Inc. Kslredia �Sessociatinn Manager, CCAM SEVEN SPRINGS OWNERS ASSOCIATIONS cc: Board of Directors File #4 & # 16 1935 Dry Creek Road, Suite 203 • Campbell CA 9 95008-3631 9 voice (408) 559-1977 • fax (408) 559-1970 Seven Springs Owners Association Page 1 of 2 Application For Approval of "Category B" Architectural Change/Addition Categoy B - Modifications are exterior changes to the original building structure. This includes changes to exterior walls, roof lines or the original floor plan, and grading, or re -grading. All exterior room additions fall into this category. NOTE: This application may only be submitted when all requirements listed on page 2 have been completed and/or submitted with this application To: Architectural Control Committee Subject: Application for Approval of Proposed "Category B" Architectural Change PLEASE PRINT THE FOLLOWING INFORMATION Name: � N I�� _ �iU S C 1�1 Address: _ t i S 3 iu 1 t,•' j i,� T� /� (tit ' i` { tsTl L rte— l � rrl , Home Phone: V; Z � 1.3 Work Phone: ! f i�_&' ��� General Description of Proposed Change/Addition: __ tr thyk4Ehlin ti V' l --1 ►iC.k % .?12 1 _7c �.'�1 _.. is'� LQ-E_T _4_1 4 )0-fh 4 16 NT o v&C hi'tST &K. rH '``�'� �- ' s t��,�.t•1 �t-�-- �4 ������z �-i,��.?:C _�' - 1_f� � . �-Ii E----�. +-#�i�.Lz� �� �. � Ff-i C �% I agree to submit this form along with all items listed on page 2 of this form. I understand that all items listed on page 2 of this form must be submitted and processing must be completed in order for this application to be formally submitted for final considcra ' in by the Board of Directors. Homeowner's Signature: _ -_Date: 1✓ i ARCHITECTURAL CONTROL COMMITTEE/BOARD ACTION f , Approved - Approved Pending V J f T, ' . Cf (. ✓� c' _ ( c "4 Denied Denied Pending Architectural Control Committee Comments: Atrhiteehiml ('nntrnL('ntrnnrittw.,'Rnarrl Citrnafiuwc-