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15060172CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15060172 10197 ADRIANAAVE CUPERTINO CA 95014 (326 20 022) POWFUL CONSTRUCTION SAN JOSE, CA 95116 OWNER'S NAME: SHEN TIAN AND YU LI TRUSTEE DATE ISSUED: 01/28/2016 OWNER'S PHONE: 408-391-5246 PHONE NO: (408) 687-7607 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #853051 Contractor POWFUL CONSTRUCTION Date 01/31/2017 BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing. — MECI3 — 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: ADD 865 S.F. TO CREATE N BEDROOM,DINN ROOM,FAMILY I hereby affirm under penalty of perjury one of the following two declarations: ROOM,LAUNDRY ROOM & 1/2 BATKADD 63 S. (N)FRONT ENTRY. r. I have and will maintain a certificate of consent to self -insure for Worker's REVISION #1 - ADD 109 S.F. TO EXPAND MASTER BEDROOM TO Compensation, as provided for by Section 3700 of the Labor Code, for the ORIGINAL SCOPE OF WORK OF A 845 S.F. ADDITION (TOTAL 974 performance of the work for which this permit is issued. S.F.) z. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this REV #2 - ADD POWDER ROOM, CHANGE BEDRC IOM TO DEN, permit is issued. UPGRADE 100 AMP TO 200 AND. - ISSUED 6/28/2016 APPLICANT CERTIFICATION certify that I have read this application and state that the above - Sq. Ft Floor Area: Valuation: $125000.00 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 APN Number: Occupancy Type: City of Cupertino against liabilities, judgments, costs, and expenses which 326 20 022 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. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR sig atur ate 6/28/2016 180 DAYS FROM LAST CALLED EiSPECTION. OAR -BUILDER DECLARATION Issued by: LeggeX I hereby affirm that I am exempt from the Contractor's License Law for one of the Date: 01/28/2016 following two reasons: L 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 RE -ROOFS: sale (Sec.7044, Business & Professions Code) All roofs shall be inspected prior to any roofing material be' ag installed. If a roof is 2. I, as owner of the property, am exclusively contracting with licensed installed without first obtaining an inspection, I agree to remove all new materials for contractors to construct the project (Sec.7044, Business & Professions Code). inspection. I hereby affirm under penalty of perjury one of the following three declarations: Signature ofApplicant: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Date: 6/28/2016 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ALL ROOF COVERINGS TO BE CLASS"A" DR BETTER 2. 1 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. HAZARDOUS MATERIALS DISCI -011 RE s. I certify that in the performance of the work for which this permit is issued, I I have read the hazardous materials requirements undi r Chapter 6.95 of the shall not employ any person in any manner so as to become subject to the California Health & Safety Code, Sections 25505,255 3, and 25534. I will maintain compliance with the Cupertino Municipal Cod , Chapter 9.12 and the Worker's Compensation laws of California. If, after making this certificate of Health & Safety Code, Section 25532(a) should I store r handle hazardous exemption, I become subject to the Worker's Compensation provisions of the material. Additionally, should I use equipment or device which emit hazardous Labor Code, I must forthwith comply with such provisions or this permit shall air contaminants as defined by the Bay Area Air Quality Management District I be deemed revoked. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code Sections 25505, 2553 3, and 25534. APPLICANT CERTIFICATION I certify that] 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 CJ Owner or authorizedge relating to building construction, and hereby authorize representatives of this city Date: 6/28/2016 to enter upon the above mentioned property for inspection purposes. (We) agree CONSTRUCTION LENDE4GAGENCY to save indemnify and keep harmless the City of Cupertino against liabilities, I hereby affirm that there is a construction lending agency for the performance judgments, costs, and expenses which may accrue against said City in of work's for which this permit is issued (Sec. 3097, Civ C.) consequence of the granting of this permit. Additionally, the applicant understands Lender's Name and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Lender's Address ARCHITECT'SLARA Signature Date 6/28/2016 1 understand my plans shall be used as public records. BZdgApp_20I1.doc r�vised 06'21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: 10197 ADRIANA AVE CUPERTINO CA 95014 (326 20 022) �POWFUL CONSTRUCTION SAN JOSE, CA 95116 PERMIT NO: 15060172 OWNER'S NAME: SHEN TIAN AND YU LI TRUSTEE I(DATE ISSUED: 01/28/2016 OWNER'S PHONE: 650-796-6696 LICENSED CONTRACTOR'S DECLARATION License Class GENERAL BUILDING CONTRACTOR Lic. #Ua051 Contractor POWFUL CONSTRUCTION Date 01/31/2017 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 j license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1. 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: . % 1 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 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signatu 2-2 fi�0 _ -✓` Date Z OWNER -BUILDER DECLARATION 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 (Sec.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: 1. 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. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked.; APPLICANT CERTIFICATION, I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above.mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. NO: (408) 687-7607 BUILDING PERMIT INFO: BLDG _ ELECT _ PLUMB MECH _ RESIDENTIAL — COMMERCIAL JOB DESCRIPTION: ADD 865 S.F. TO CREATE (N) BEDROOM,DINNING ROOM,FAMILY ROOM,LAUNDRY ROOM & 1/2 BATH.ADD 63 S.F.(N)FRONT ENTRY, REVISION #1 - ADD 109 S.F. TO EXPAND MASTER BEDROOM TO ORIGINAL SCOPE OF WORK OF A 845 S.F. ADDITION (TOTAL 974 S.F.) Sq. Ft Floor Area: I Valuation: $125000.00 APN Number: Occupancy Type: 326 20 022 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ABBY AYENDE Date: 01/28/2016 RE -ROOFS:. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code Sections 25505, 25533, and 25534. Owrier or authorized age t: = Date: CON STION 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 understand my plans shall be used as public records. Licensed Signature Date Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255F` �'��°+� ,jEa t40a) 777-3228 - FAX (408) 777-3333 • b,M6nq(c@cugert r4o. m / O! T!' F-1 nni VrTfVKT M ATTFRdTTnVJTT R-P.V1g10N)1)7T1^F.RU,D DIC GINA1'NICIVll 1, L Q& Fi t I lN.LVY I..Vl\J litVV11V1v `� ru+✓ii ivi. u +++tea.-.. .�.�...... -� eu -- _____.. _ - PROJECT ADDRESS f_. Ii(c7 APN n F Vr a( O\\TIER NAME �I/) I PH a 3 j ` L % E �J �S �J� l'4 STREET ADDRESSONE CITY, STATE, ZIP /-� �y CA �o FAX o r a Q " P 1 CONTACT NAME f� , /j ergs PHO � —a3,7— 4 0 b � U V' 4 ` E � �i STREET ADDRESS g -t CITY, STATE, ZIP FAX f �. �-�(`f ❑. OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑' DEVELOPER ❑ TENANT CONTRACTOR NAME C O JA 7 y+r 7 c4ic ij LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME. LICENSE NUMBER BUS. LIC 4 COMPANY NAME r T�1a11�.--.4'Sc'C3In�� i..S��=' E -EMAIL FAX STREET ADDRESS t 6 2.6 ('�v,�((� � so-, (G 2 CITY, STATE, ZIP l � -�✓� c � v Cas � S�� PHON ����� —7 vEscRrnTloN oFWORK i`�'= Ci �—y\% rrJY r f vAJ �7?''' x1 D --ROPOSED EXISTING USE CONSTR. TYPE T STORIES TYPE. OCC. SQ.FT. - VALUATION (.�)EXISTG �USE !f4 LOOR DEMO TOTAL AREA AREA NET AREA BATHROOM KITCHEN OTHER - REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK(PORCH AREA GARAGE AREA: ODETACH - . ❑ ATTACH ;t DWELLING UNITS: ISASECOND UNIT ❑YES SECOND STORY OYES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES. PROVIDE COPY OF IS THE BLDG AN ❑ FESIVED BY �` TOTAL VALUATION: PLANNING APPLY ❑NO PLANTING APPROVAL LETTER EICHLER HOME? ❑ NO"':�'. �'.�-' By my signature below, I certify to each of the following: I am the property owner or author zed agent to act on the property owner's behalf. 1 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 rela to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. y Signature ofApplicant/Ag . Date: SUPPLEMENT INTFORMATIO UIRED L�I�.CHECI TI,PE�^„�.,_. _ .�� .. �:? . � ROUTI LEP New SFD or Multifamily dwellings: Apply for demolition permit for ,� x a. � �. ovERTxE cali\TEx BIIILDIG PLARE\ _ existing building s). Demolition permit is required prior to issuance of building o� L� EGRESS PLA\ �L� PI aI.A IE% permit for new building. Bldgs: Provide a completed Hazardous Materials Disclosure sTANn ls _Commercial form if any Hazardous Materials are being used as part of this project. �rzcE ❑FIRE DEPT; Ma x Letter Meeting with Planning prior to Cl Copy of Planning Approval or Q > �2AJOR s�'IT�R� sE\� ExDisTxzcT _ submittal of Building Permit application. y. .. I], E'NVIRO\MENTA�IiEALfH ., Bldg4pp_2011.doc revised 06121/11 REVISION .O y. CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10197 ADRIANA AVEDATE: 02/19/2016 REVIEWED BY: PAUL AP 326 20 002 BP#: "VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? Yes •- No OTC? 0 Yes No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK I REVSION #1 - ADD 109 S.F. TO ORIGINAL SCOPE OF WORK OF A 865 S.F. ADDITION SCOPE - ____ _$.0:00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. P FEE ID BP FEES BP FEE ID R-3 (Custom) 11-B,111-B,IV,V-B __-,-109 $1,091.00 IA DPLCK $1,057.00 1ADDINSP - ____ _$.0:00 PME Plan Check: Permit Fee: ,( $1,057.00 Suppl. Insp, Fee:Q Reg. Q OT 0.0 hrs� '--­­7z_$0-.00- =—_- $0.00 PME Unit Fee: PME $0.00 PME Permit Fee: $0.00 TOTALS: 109 $1,091.00 .° $1,057.00111.1 11 { r S3 3 F-1 I E3 E3 h, J -npFee: C, NOTE. This estimate does not include -fees clue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School 71, 4_.,.s -4- 1 T7 ., ., f ., ., h..n.,A nn. fl n �.r'.nliz.,iz.n.n� itiFnvrrrnlins, nvni/nhlo nm`I nva nta/if nn acfisrinta. ('nsifnrf 1ho Want fnr nd�/n'I infin_ FEE ITEMS (Fee Resolution 11-053 Eff.' 711,113) _FEE, \QTY/FEE MISC ITEMS Plan Check Fee: $1,091.00 ' Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. Q OT 0.0 hrs1 - ____ _$.0:00 PME Plan Check: Permit Fee: ,( $1,057.00 Suppl. Insp, Fee:Q Reg. Q OT 0.0 hrs� '--­­7z_$0-.00- =—_- $0.00 PME Unit Fee: PME $0.00 PME Permit Fee: $0.00 0 Work Without Permit? C) Yes No $0.00 Advanced Planni7ie: IPLLONGR ;' $15.26 Select a Non -Residential Building or Structure g Strong Motion Pee: 1BSEISMICR $1.95 { Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 .SioTAL $2,166.21 $0.00 .. _ . TOTAL FEE: '` $2,166.21 Revised: 01/01/2016 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • building(j5-)cupertino.orgCUPERTINO BIdgApp 2011.doc revised 03116111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15060172 10197 ADRLANAAVE CUPERTINO CA 95014 (326 20 022) S P 8 CONSTRUCTION 295 E WASHINGTON AVE OWNER'S NAME: SHEN TIAN AND YU LI TRUSTEE DATE ISSUED: 01/28/2016 OWNER'S PHONE: PHONE NO: 650-6694188 LICENSED CONTRACTOR'S DECLARATION BUILDING PERNIIT INFO: License Class B Lie. #996622 Contractor S_ P 8 CONSTRUCTION Date 01/28/2016 —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: ADD 865 S.F. TO CREATE (N) BEDROOM, DINNING ROOM, I hereby affirm under penalty of perjury one of the following two declarations: FAMILY ROOM, LAUNDRY ROOM & 1/2 BATH. ADD 63 S.F. 1. I have and will maintain a certificate of consent to self -insure for Worker's (N) FRONT ENTRY. Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT NT RTIFI ATION PERMIT APP EXT - 3/22/16 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county Sq. Ft Floor Area: Valuation: $125000.00 ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned APN Number: Occupancy Type; property for inspection purposes. (We) agree to save indemnify and keep 326 20 022 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 PERMIT EXPIRES IF WORK IS NOT STARTED Code, section 9.18. WITHIN 180 DAYS OF PERMIT CE OR 180 DAYS FROM LAS_ ED I CTION. Signature- Date 01/28/2016 Pso Issued by. MELISSAN - OWN E E TI N Date: 01/28/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: F i. I, as owner of the property, or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed If a roof is compensation, will do the work, and the structure is not intended or offered installed without first obtaining an inspection, I agree to remove all new materials for for sale (See.7044, Business & Professions Code) inspection. 2. i, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). Signature of Applicant: I hereby affirm under penalty of perjury one of the following three declarations: Date: 01/28/2016 1. 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for HAZARDOUS MATERIALS DISCLOSURE by Section 3700 of the Labor Code, for the performance of the work for which I have read the hazardous materials requirements under Chapter 6.95 of the this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will 3. I certify that in the performance of the work for which this permit is issued, I maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the shall not employ any person in any manner so as to become subject to the Health & Safety Code, Section 25532(a) should I store or handle hazardous Worker's Compensation laws of California. If, atter making this certificate of material. Additionally, should I use equipment or devices which emit hazardous exemption, I become subject to the Worker's Compensation provisions of the air contaminants as defined by the Bay Area Air Quality Management District Labor Code, I must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino Municipal Code, r 9.12 and be deemed revoked, the Health &Safety Code, Sections 2 , - 533 d 25 4. APPLICANT CERTIFICATION Owner authorized agent. I certify that I have read this application and state that the above information is Date: 011// 28/2016 correct. I agree to comply with all city and county ordinances and state laws N EN relating to building construction, and hereby authorize representatives of this city I hereby affirm that there c ruction lending agency for the performance to enter upon the above mentioned property for inspection purposes. (We) agree of work's for which this per permit is issued (Sec. 3097, Civ C.) to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant Lender's Address understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date 01/28/2016 Licensed d • CUPERTIN No 1=17 •VY! CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-32550 (408) 777-3223 - FAX (408) 777-3333 • building Qcuoertino.ora /5 G f MV ill IT1T1T9` 111T F7 I T 11 A T-11 r err F7 Bld,aApp_201I.doc revised 06121111 PROJECT ADDRESS APN r zc)---022 OWNER NANM � ) PHOA'E/ ) V E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE EMAIL �2)-tCP STREET ADDRESS / pp A3 CITY, STATE, ZIP V i !n Zj et (FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ Y'ENp.NI' CONTRACTORNAME r� p LICENSENUMBER LICENSE TYPE BUS. LIC -1 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP I PHONE ARCHITECT/ENGI-NNEFRNAME y-� LICENSE NUNIBER BUS. LIC Iu c J�tig`, CA c COMPANYNAIYfEE-M.AIL ` ��C r� T C S S � rn C �1-- e S ,-i v\ --� - A . a � h @ 15 Vs1 Ck J r Ce9 (yj + FAX STREET ADDRESS ; ' y e s R 63 CITY, STATE, ZIP PHONE DESCRIPTION OF WORK- ORK i '� /...NrFva--+�'lT'4'T�" .r,�� 2 i • � �`� � t (n to t'[n � 5!'�6 Gvt •� �ct Ori "� � Yo3i'Vt Yn Y-,7 7' �) r15� 6CsC/ir Y cEvl lrlV� tT-b6ry2 /� ?ADL{ rr lr c v� U 12- r.- P ZOC) li0 'S�t/ ED,asnTiGtZE. _ "�-{— PROPOsBr5 USE COMM, TYPE STORIES - - -5 `9_USE I TYPE ( OCC. - ?1 Gyy SQ.FT. VALUATION (S) EXISTG NEW FLOOR- DEMO TOTAL ARE A66F.¢�Z AREA AREAS NET AREA BATHROOM. KITCHEN.- OTHER. REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA - >, DECK AREA TOTAL DECKROR.CH AREA 1 GARAGE AREA: 0 DETACH - - ATTACH. . + �y�. DWELLING UNITS: IS -A SECOND UNrr ❑ YES - SECOND STORY - []YES - -- 1 BEING ADDED? RNO I ADDITION? iI�NO l PRE -APPLICATION ❑ YES IF YES,. PROVIDE COPY OF PLANNING APPL r `RlqO' PLANNING APPROVAL LETTER IS THE BLDG AN $1,Y r - VALUATION: EICHLERHOME? By my simature below. I certify to each of the follol�dng: I am the property owner or authorized aeent to act oe pro o -mer's behalf. I have read this application and the information I ha , rovided is correct. I have read the Description of Work and verify it is e. I agree to comply with all applicable local. ordinances and state laws relating to b a construct authorize representatives of Cupertino to enter the above-identined properly for inspection purposes. S ignature of Applicant/Agel—Date: G.> --t 5 "— t SUPPLEMENTAL INFORMATION REQ _- 5 X0.53 LTi — - ---- hT�R - rm a M INN BUILMIiGPLAPLEYI�W New SFD Or Multifamily dvveilings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building `— permit for new building. mss _ —kms mow-- p P -._-'L.AI�TiTIitG-"P�NBE�'�F9. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure _ sTaND4Rns ❑ PZIBIawoRrrc 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. bQ sAnlAzR�Ts Rre_ _ ��`� 2-'��-..r�'S a-_�..—.- • �.I+vILY.Hi,OI�'MI�IZ'S+I'ZZJ-I3EA�.T,.H Bld,aApp_201I.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR—RTIIT.n><1V(:' nw—FoTnN x ADDRESS: 10197 ADRIANA AVE FEE DATE: 06/25/2015 REVIEWED BY: MELISSA APN: 326 20 022. BP#: 200 amps Electrical $48.00 IBELECzoo Services *VALUATION: j$1H,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? OTC? Yes No 0 Yes (E) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK ADD 865 S.F. TO CREATE N BEDROOM DINNING ROOM FAMILY ROOM LAUNDRY ROOM & SCOPE 1/2 BATH. ADD 63 S.F. (N) FRONT ENTRY. UPGRADE (E) 100 AMP PANEL TO 200 AMP, SAME TYPE OF FLR AREA OCCUPANCY TYPE: CONSTR. s.f. PC FEES PC' FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 928 $2,654.00 1R3PLNCK $1,666.00 IR3INSP ;tlech. flan Check :-1ech. Pe Trait Fee: Other AIech.Insp. NOTE: This estimate does not TOTALS: 928 I $2,654.00 _ $1,666.00 Pl wib. Plan Check I IElec. Plan Check 10.0 1 hrs $0.00 P-1111tr. Peen?it Fee: Elec. Permit Fee: 1EPERMIT £)t/?et I'itttt2h Imp.Other Elec. Insp. 0.0 hrs $48,00 Phuiib. Insp. Fee: I %c. Imp. Fee: due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Listrict, etc.). lhese_/ees are based on the preliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,654.00 200 amps Electrical $48.00 IBELECzoo Services Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,666,00 Suppl. Insp.. Fee:E) Reg. 0 OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Construction, Tax.` T-1 Administrative 1''ee: 0 E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: IPLLONGR $129.92 Select a Non -Residential E Building or Structure i Travel Documentation Fee: 1TRAVD0C $48.00 Strong Motion Fee: IBSEISMICR $16.25 Select an Administrative Item Bldy Stds Commission Fee: IBCBSC $5.00 S $4,67.17 { TOT HI= $4,615.17T3T Revised: 05/07/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15060172 10197 ADRIANAAVE CUPERTINO CA 95014 (326 20 022) POWFUL CONSTRUCTION SAN JOSE, CA 95116 I;OWNER'S NAME: SHEN TIAN AND YU LI TRUSTEE I (DATE ISSUED: 01/28/2016 I I OWNER'S PHONE: 408-391-5246 I I PHONE NO: (408) 687-7607 I 111 Lei cm 01 1XV-11k1k License Class B Lic. #$53051 Contractor POWFUL CONSTRUCTION Date 01/31/2017 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. I hereby affirm under penalty of perjury one of the following two declarations: 1. 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 Y� /performance of the work for which this permit is issued. z. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this / permit is issued. APPLICANT CERTIFICATION certify that Ihave 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 rp@d-aTio—q per the Cupertino Municipal Code, Section 9.16. Signatu%f 'S, Date/8 23/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner ofthe property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). PERMIT INFO; —BLDG —ELECT _ PLUMB _ MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: ADD 865 S.F. TO CREATE (I) BEDROOM,DINNING ROOM,FAMILY ROOM,LAUNDRY ROOM & 1/2 BATH.ADD 63 S.F.(I)FRONT ENTRY. REVISION #1 - ADD 109 S.F. TO EXPAND MASTER BEDROOM TO ORIGINAL SCOPE OF WORK OF A 845 S.F. ADDITION (TOTAL 974 S.F.) - ISSUED 5/16/16 REV # 3 - RE -ROOF; TEAR OFF; INSTALL 1/2" OSB; INSTALL TILE (W/STRUCTURAL - 7.2 PSF)(35 SQ'S) ISSUED 8/23/2016 REV #2 - ADD POWDER ROOM, CHANGE BEDROOM TO DEN, UPGRADE 100 AMP TO 200 AMP. ISSUED 6/28/2016 Sq. Ft Floor Area: Valuation: $125000.00 APN Number: Occupancy Type: 326 20 022 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ABBY AYENDE Date: 01/28/2016 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. hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Signature of Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for,the performance of the work for which this permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in - consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 8/23/2016 "Alt 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 zm= Owner or authorize " Date: 8/23/2016 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 AR.C1HTECT'S DECLARATION understand my plans shall be used as public records. GQNSTRU"GTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DiVIS 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a�cupertino.org N11 OF +GtSPERTiN0 � NEW CONSTRUCTION ❑ ADDITION ❑ ®, ALTERATION / TIREVIS / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS OWNER NAMEPHONE �( CZ N E-MAIL � STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-I%ikIL STREET ADDRESS (o z6 cf Ie PY. '(b� CITY, STATE, ZIP FAX J C ,��1`� ��o, cwt amt El OWNER ❑ oV,UILDER OWNER AGENT 0 CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGLNTEER ❑ DEVELOPER El TENANT CONTRACTOR NAME LICENSE NUMBER LICENTSE TYPE BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC» COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 'PLO Z-21 � o v �. a �a EXISTAG USE - PROPOSED USE - NSTR. TIE - - - - -"STORIES " USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL - AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER - REMODELAREA RB40DELAREA REMODELAREA PORCH AREA DECK AREA. TOTAL DECK,?ORCH AREA GARAGE AREA: ❑ DETACH - E] ATTACH a DVA'ELLLNG UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES - - C,A - BEINGADDED? NO ADDITION? IS THE BLDG AN ❑CEIVED $- TO TION: PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNLN'G APPL r - TO PLANNING APPROVAL LETTER EICHLER HOt+4EI z By my signature below, I certify to each of the following: I am the property owner or authorize 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 Rork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building consttplrction. I authorize representatives of Cupertino to�enter the above -identified property for inspection purposes. l Signature of Applicant/Agent: - \ Date: SUPPLEMENT INTFORMAT%O REQUIR \ K AX CHECKTZPE ROUTING SLIP x � New SFD or Multifamily dwellings: Apply for demolition pernl-t for o) hR THE couNTER � L7 BUTI vmc Pi4I� uE�zE« existing building s). Demolition permit is required prior to issuance of building � ermit for new buildin p g �• EXPRESS PLAi�I�InGPLAIS REA IE13 Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1D sT�I.nRDk ❑�LTBLicioxxs fonm if any Hazardous Materials are being used as part of this project. "FIREDEPI z _ Copy of Planning Approval Letter or Meeting with Planning prior to I�?AJOR ❑,:SAnTTARYSE��ERDISTRICT submittal of Building Permit application. .�,'� ,v� ..'�:..w': ; �' :Q.'EI�'VIR01�71IE'STAI;HEAL'I'H ;�.�.•". ------ B1dgApp_2011.doc revised 06121111 CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: t PERMIT # OWNER'S NAME: - ' PHONE # A-1 _'76 0 GENERAL CONTRACTOR: •. ", cot - 'u k oc "Myl BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: e) L *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 subcontractor': Signature Date Please check applicable subcontractors and complete the following information: `/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / `Carpeting - Linoleum / Wood Glass / Glazing Insulation Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature date Tian Shen and Li Yu Trustee 10197 Adriana Ave Cupertino, CA 95014 November 17, 2015 Community Development Department — building Division 10300 Torre Avenue Cupertino, CA 95014-3255 Subject: Building permit extension Site Address: 10197 Adriana Ave Permit Number: 15060172 Permit Expiration Date: 12/22/2015 To Whom It May Concern: I am writing you to apply for an extension of the building permit, that's expiring on 12/22/2015. 1 had originally planned to start the remodeling work in early August. But due to the delay in getting the permit, and the super EI Nino that is going to hit California this winter, I have to postpone the starting of remodeling to next year. Because of the summer vacation that's already planned (when we thought we would start this year and finish by early 2016), we won't be starting the project until August. As such, we would like to apply for an extension to the building permit. Thank you, Tian Shen / ol"; - / �? "? , - /V /S -! � 7� May 16, 2016 Li Yu 10197 Adriana Ave, Cupertino, CA 95014 To Cupertino City Building Dept, I am the owner of property located at 10197 Adriana Ave, Cupertino, CA 95014. 1 have made the decision to hire Pedro Camacho, DBA Powfull Construction (State Lic: 853051) as general contractor for my home addition/modification project per plan approved by Cupertino Planning / Building Dept. This letter is to authorize the release of approved plan to Pedro Camacho so he can start working on the project asap. Should you have any questions, please contact me at (650)796- 6696. Thanks, Regards, Li Yu PVC OR v TO MAIN =--- EXISTING LA S=2% (M CUPER TIlel0 SA NI TA R Y DISTRICT aj OR APPROVED EQUAL (TYP) SEE DETAIL -7 V V�vv V~V NOTE: 1. ALL NEW PIPING SHALL BE PVC SDR 26, OR APPROVED EQUAL UNLESS OTHERWISE NOTED. 2. ALL CLEAN-OUT BOXES SHALL BE CHRISTY CONCRETE PRODUCTS MANUFACTURED BY OLDCASTLE PRECAST, INC. WITH THE FOLLOWING MODEL NUMBERS: 4" RISER 6" RISER NON -TRAFFIC TRAFFIC NON -TRAFFIC TRAFFIC BOX F08 G05T F08 G08T LID F08C G05CT F08C G05CT 3. LIDS SHALL BE MARKED "SEWER" 4. STAMP OR GRIND FACE OF CURB WITH "S" WHERE LATERAL PASSES UNDER CURB, IF NOT PRESENT. 5. 1/8 BEND MAY BE PART OF 45° WYE IF APPROVED BY CITY. FIE NO. SEWER LATERAL CLEAN-OUT INSTALLATION ON EXISTING SEWER LATERAL !DETAIL 9 SP -DR. BY: DATE: CK. BY: DATE: TN 06/01/14 JC 06/03/14 APPROVED. BY: DATE: 06/04/14 (s) CUPER TI lel 0 SA loll TA R Y DISTRICT PUBLIC R/WI PRIVATE PROPERTY EXTENDABLE BACKFLOW VALVE ACCESS CAP FLOW �— 4' TYPICAL, UNLESS 6" MIN FOR BEDDING OTHERWISE APPROVED MATERIAL, SEE DETAIL 7 NOTES: 1. A BACKFLOW PREVENTER DEVICE IS REQUIRED WHEN THE ELEVATION OF THE LOWEST FINISHED FLOOR WITH PLUMBING IS LESS THAN 12" ABOVE THE NEAREST UPSTREAM MANHOLE OR FLUSHING INLET. 2. ALL CLEANOUTS AND BACKFLOW DEVICES ARE TO BE MAINTAINED BY PROPERTY OWNER. 3. ALL BACKFLOW DEVICES ARE TO BE ACCESSIBLE FOR LATERAL SEWER MAINTENANCE. 4. PLACARD SHALL BE PLACED IN THE UPSTREAM CLEANOUT BOX CLOSEST TO THE HOUSE WARNING THE PLUMBER OF THE EXTENDABLE BACKWATER VALVE. FILE N0. SID STANDARD BACKFLOW PREVENTER DEVICE INSTALLATION DETAIL 10 12 DR. BY: DATE: CK. BY: DATE: TN 06/01/14 JC 06/03/14 APPROVED. BY: DATE: 06/04/14 FINISH GRADE z VALVE AND CLEANOUT J ACCESS BOX SHALL BE CHRISTY G5 TRAFFIC VALVE wl ACCESS BOX BOX 10-3/8" I.D. X 12" _ _ SEE NOTE 2 WITH G5C LID LABELED AND BRICK "SEWER" OR APPROVED SEE DETAIL 7 LAYOUT ON DETAIL 9 EQUAL AND 9 FOR CLEAN—OUT -- EXTENDABLE DETAIL bBACKFLOW 6.� MIN VALVE FLOW �— 4' TYPICAL, UNLESS 6" MIN FOR BEDDING OTHERWISE APPROVED MATERIAL, SEE DETAIL 7 NOTES: 1. A BACKFLOW PREVENTER DEVICE IS REQUIRED WHEN THE ELEVATION OF THE LOWEST FINISHED FLOOR WITH PLUMBING IS LESS THAN 12" ABOVE THE NEAREST UPSTREAM MANHOLE OR FLUSHING INLET. 2. ALL CLEANOUTS AND BACKFLOW DEVICES ARE TO BE MAINTAINED BY PROPERTY OWNER. 3. ALL BACKFLOW DEVICES ARE TO BE ACCESSIBLE FOR LATERAL SEWER MAINTENANCE. 4. PLACARD SHALL BE PLACED IN THE UPSTREAM CLEANOUT BOX CLOSEST TO THE HOUSE WARNING THE PLUMBER OF THE EXTENDABLE BACKWATER VALVE. FILE N0. SID STANDARD BACKFLOW PREVENTER DEVICE INSTALLATION DETAIL 10 12 DR. BY: DATE: CK. BY: DATE: TN 06/01/14 JC 06/03/14 APPROVED. BY: DATE: 06/04/14 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD ` (S O 4L b 1-7 Z_ Project Name: PD515-YU Calculation Date/Time: 08:34, Thu, Feb 18, 2016 Calculation Description: Yu's addition Input File Name: PD515-YU.ribd CF1 R -PRF -01 Page 1 of 8 GENERAL INFORMATION 01 Building Complies with Computer Performance 01 Project Name PD515-YU 03 This building incorporates one or more Special Features shown below 02 Calculation Description addition 865 08 - 03 Project Location 10197 ADRIANA AVE. Compliance Margin Percent Improvement 04City CUPERTINO CA. 05 E _tan rds erslon Compliance 2015 06 Zip Code 95014 07 Compliance Manager Version BEMCmpMgr 2013-4 (744) 08 Climate Zone CZ4 09 Software Version CBECC-Res 2013-4 (744) 10 Building Type Single Family 11 Front Orientation (deg/Cardinal) 90 12 Project Scope Addition and/or Alteration 13 Number of Dwelling Units 1 14 Total Cond. Floor Area (ftZ) 2980 15 Number of Zones 2 16 Slab Area (ftZ) 0 17 Number of Stories 1 18 Addition Cond. Floor Are 974 19 Natural Gas Available Yes 20 Addition Slab Area (ft) 0 21 Glazing Percentage (%) 10.8% 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 1 06 BY Registration Number: 216-A0120325A-000000000-0000 Registration Date/Time: 2016-03-31 09:52:54 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 Report Generated at: 2016-02-18 08:35:48 ENERGY USE SUMMARY 04 05 1 06 07 08 Energy Use (kTDV/ftZ-yr) Standard Design Proposed Design Compliance Margin Percent Improvement Space Heating 34.56 30.30 4.26 12.3% Space Cooling 11.61 13.20 -1.59 -13 7% IAQ Ventilation 1.22 122 0.00 0.0% Water Heating 10.19 10.58 -3.8% Photovoltaic Offset ---- 0.00 ---- Compliance Energy Total 57.58 55.30 2,28 4.0% BY Registration Number: 216-A0120325A-000000000-0000 Registration Date/Time: 2016-03-31 09:52:54 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 Report Generated at: 2016-02-18 08:35:48 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: PD515-YU Calculation Date/Time: 08:34, Thu, Feb 18, 2016 Calculation Description: Yu's addition Input File Name: PD515-YU.ribd CF1R-PRF-01 Page 2 of 8 includes calculated Appliances and Miscellaneous Energy Use (AMEU) BUILDING - FEATURES INFOR :"ATION 01 02 03 04 05 na 07 Number of Dwellina �r �f :r�nti!atio �, �bcr catcr Project Name Conditioned Floor Area (ft2) Units Number of Bedrooms Number of Zones I Cooling Systems I Heating Systems PD515 YU 2980 1 5 2 1 1 ZONE INFORMATION 01 02 03 04 05 Zone Name Zone Type HVAC System Name Zone Floor Area (ft2) Avg. Ceiling Height house Conditioned HVAC System 2 2006 8 addition Conditioned HVAC System 2 974 10.1 Registration Number: 216-A0120325A-000000000-0000 Registration Date/Time: 2016-03-31 09:52:54 CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 06 1 07 1 Water Heating System 1 I Water Heating System 2 DHW System 1 HERS Provider: CaICERTS inc. Report Generated at: 2016-02-18 08:35:48 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: PD515-YU Calculation Date/Time: 08:34, Thu, Feb 18, 2016 Calculation Description: Yu's addition Input File Name: PD515-YU.ribd n on nlly c _. CF1 R -PRF -01 Page 3 of 8 OPAQUE SURFACES — Cathedral Ceilings 01 02 03 04 05 06 07 08 09 10 Name Zone Construction Azimuth Orientation Gross Area (ft2) 05r8i(ft2) Window 8 Door Area (ft2) Tilt (deg) 90 Status Existing Verified Existing Condition No E -Ext -Wall -L house E -Wall 180 Left 448 6 E -Ext -Wall -R hou— E \Nall 0 —g1 .y.. 3400 29 90Existing Roof Pitch IVU E -Ext -Wall -B house Ext -Wall -int 270 Back 152 14 90 Existing No E -Ext -Wall -F house E -Wall 90 Front 342 56 0.33 90 Existing No Ceiling -E house E Ceiling 0.85 2006 New N/A Existing No Existing Floor Over Crawlspace house E -fir 4.2 4 2006 4 0.33 18.43 0.1 0.85 Existing No N -Ext -Wall -L addition N -Wall 180 Left 216 64 133 90 New N/A N -Ext -Wall -B addition N -Wall 270 Back 384 90 New N/A N-Ext-Wall-Raddition N -Wall 0 Right 267 26 90 New N/A Ceiling -N addition N -Ceiling -R30 08 09 974 Name New N/A N -Floor Over Crawlspace addition N-Flr Roof Reflectance Roof Emittance 974 Cool Roof Statu s Verified Existing Condition Attic New N/A OPAQUE SURFACES — Cathedral Ceilings 01 02 03 04 05r8i(ft2) 06 07 08 09 10 11 12 13 Name Zone Type Orientatio n AreaRoof (ft2) Rise (x in 12) Roof Pitch Roof Tilt(deg) Roof Reflectan ce Roof Emittance Framin g Factor Status Verified Existing Condifion Cathedral Ceiling 1 house E -Ceiling Back 8.44 0.33 18.43 0.1 0.85 0.1 New N/A Cathedral Ceiling 2 house E -Ceiling Left 4.2 4 4 0.33 18.43 0.1 0.85 0.1 New N/A ATTIC 01 02 03 04 05 06 07 08 09 10 Name Construction Type Roof Rise Roof Reflectance Roof Emittance Radiant Barrier Cool Roof Statu s Verified Existing Condition Attic Asphalt Shingle Roof Ventilated 4 0.1 0.85 Yes No New No Registration Number: 216-A0120325A-000000000-0000 Registration Date/Time: 2016-03-31 09:52:54 HERS Provider: CalCERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CFIR-08252015-744 Report Generated at: 2016-02-18 08:35:48 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: PD515-YU Calculation Date/Time: 08:34, Thu, Feb 18, 2016 Calculation Description: Yu's addition Input File Name: PD515-YU.ribd CF1R-PRF-01 Page 4 of 8 WINDOWS 01 02 03 04 05 06 07--70-87 Area (ft) 09 10 11 Name Surface (Orientation -Azimuth) Width(ft) Height (ft) Multiplie r Area (ft) 11.11 -factor SHGC Exterior Shading Status Verified Existing Condition E -Win -L E -Ext -Wall -L (Left -180) ---- — 1 6.0 0.40 0.40 Insect Screen (default) Existing No E -Win -R F-Fvt-1A/all-R !Right -0) _... ..`�.. .. �. ..y�.. � ____ 1 2g.. ^. Q,4Q inacu Screen �uciow�/ !nsect Screen (def..- lt) r..:......._ uia.n iy ��� E -WIN -B E -Ext -Wall -B (Back -270) ---- ---- 1 14.0 0.40 0.40 Insect Screen (default) New N/A E -WIN -F E -Ext -Wall -F (Front -90) ---- ---- 1 56.0 0.40 0.40 Insect Screen (default) Existing No Skylight 1 Cathedral Ceiling 1 (Back -270) ---- 1 8.0 0.44 0.35 None New N/A Skylight 2 Cathedral Ceiling 2 (Left -180) ---- 1 4.0 0.44 0.35 None New N/A N -win -L N -Ext -Wall -L (Left -180) ----1 64.0 0.30 0.25 Insect Screen (default) New NIA N -Win -B N -Ext -Wall -B (Back -270) --- ---- 1 115.0 0.30 0.25 Insect Screen (default) New N/A N -Win -R N -Ext -Wall -R (Right -0) ---- 1 26.0 0.30 0.25 Insert Screen (default) New N/A DOORS 01 02 03 04 05 06 Name Side of Building Area (ft) U -factor Status Verified Existing Condition InputDoor 1 N -Ext -Wall -B 18.0 0.50 New No Registration Number: 216-A0120325A-000000000-0000 Registration Date/Time: 2016-03-31 09:52:54 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF111-08252015-744 Report Generated at: 2016-02-18 08:35:48 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: PD515-YU Calculation Date/Time: 08:34, Thu, Feb 18, 2016 Calculation Description: Yu's addition MDAnl IC C"n-= r Input File Name: PD515-YU.ribd CF1R-PRF-01 Page 5 of 8 ...•a..� vv•.•. -.vim vvi�v �a�V I IVIVJ - -- 01 02 03 04 05 06 07 Construction Name Surface Type Construction Type Framing Total Cavity R -value Winter Design U -value Assembly Layers Status Verified Existing Condition DHW System 1 DHW Standard Water Heater -n 1 none - New No • Cavity/ Frame: no insul. / 2x4 Top Chrd Asphalt Shingle Roof Attic Roofs Wood Framed Ceiling 2x4 Top Chord of Roof Truss @ 24 in. O.C. Roof Deck: Wood Siding/sheathing/decking none 0.644 Roofing: Light Roof (Asphalt Shingle) Floor Surface: Carpeted Floor Deck: Wood Siding/sheathing/decking Floors Over Cavity/ Frame: no insul. /2x6 E -fir Crawispace Wood Framed Floor 2x6 @ 16 in. O.C. none 0.190 Exterior Finish: Wood Siding/sheathing/decking E -Wall Exterior Walls !hood Framed Wall 2x4 @ 16 in. O.C. none 0.387 Inside Finish: Gypsum Board Cavity/ Frame: no insul. / 2x4 Inside Finish: Gypsum Board Cavity/Frame: R-11 /2x4 E -Ceiling Cathedral Ceilings Wood Framed Ceiling 2x4 @ 16 in. O.C. R 11 0.088 Roof Deck: Wood Siding/sheathing/decking Roofing: Light Roof (Asphalt Shingle) Floor Surface: Carpeted Floor Deck: Wood Siding/sheathing/decking Floors Over Cavity/Frame: R -19/2x6 N -Fir Crawlspace Wood Framed Floor 2x6 @ 16 in. O.C. R 19 0.047 Exterior Finish: Wood Sidinq/sheathing/decking N -Wall Exterior Walls Wood Framed Wall 2x4 @ 16 in. O.C. R 13 0.104 Inside Finish: Gypsum Board Cavity/ Frame: R -13/2x4 Ext -Wall -int Exterior Walls Wood Framed Wall 2x4 @ 16 in. O.C. none 0.387 Inside Finish: Gypsum Board Cavity/ Frame: no insul. /2x4 Ceilings (below Inside Finish: Gypsum Board N -Ceiling -R30 attic) Wood Framed Ceiling 2x6 @ 16 in. O.C. R 30 0.032 Cavity/ Frame: R -14.3/2x6 Over Floor Joists: R-15.7 insul. Ceilings (below Inside Finish: Gypsum Board E Ceiling I attic) I Wood Framed Ceiling ! 2x4 @ 16 in. O.C. I R 11 I 0.083 ! Cavity/ Frame: R-9. 1 /2x4 • Over Floor Joists: R-1.9 insuf. WATER HEATING SYSTEMS 01 02 03 04 05 06 07 08 Name System Type Distribution Type Water Heater Number of Heaters Solar Fraction (%) Status Verified Existing Condition DHW System 1 DHW Standard Water Heater -n 1 none - New No Registration Number: 216-A0120325A-000000000-0000 Registration Date/Time: 2016-03-31 09:52:54 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 Report Generated at: 2016-02-18 08:35:48 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1R-PRF-01 Project Name: PD515-YU Calculation Date/Time: 08:34, Thu, Feb 18, 2016 Page 6 of 8 Calculation Description: Yu's addition Input File Name: PD515-YU.ribd WATER HEATERS 01 02 03 04 05 06 07 08 Tank Volume Energy Factor or Tank Exterior Standby Loss Name Heater Element Type Tank Type (gal) Efficiency Input Rating Insulation R -value (Fraction) Water Heater -n Natural Gas Small Storage 50 0.58 EF 40000-Btu/hr 0 0 SPACE CONDITIONING SYSTEMS 01 02 03 04 OS 06 07 Heating System Name System Type Name Ducted HVAC System 2 Other Heating and Heating System Cooling System 2 Yes HVAC - HEATING SYSTEMS 01 Name Heating System 2 HVAC - COOLING SYSTEMS 01 02 Name System Type Cooling PkgAirCond - Central packaged A/C system (< 65 kBtuh) Cooling System 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 System 1 n/a n/a n/a n/a n/a n/a SPACE CONDITIONING SYSTEMS 01 02 03 04 OS 06 07 Heating System Name System Type Name Ducted HVAC System 2 Other Heating and Heating System Cooling System 2 Yes HVAC - HEATING SYSTEMS 01 Name Heating System 2 HVAC - COOLING SYSTEMS 01 02 Name System Type Cooling PkgAirCond - Central packaged A/C system (< 65 kBtuh) Cooling System Name Ducted Distribution System Fan System Floor Area Served Cooling Yes attic HVAC Fan System 1 2980 02 Type CntrlFurnace - Fuel -fired central furnace 08 09 Verified Existing Status Condition New No 03 Efficiency 92 AFUE 03I 04 I 05 i 06 07 Efficiency Multi -speed EER SEER Zonally Controlled Compressor HERS Verification 11 14 No No Cooling -hers-cool Registration Number: 216-Ao120325A-000000000-0000 Registration Date/Time: 2016-03-31 09:52:54 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 Report Generated at: 2016-02-18 08:35:48 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: PD515-YU Calculation Date/Time: 08:34, Thu, Feb 18, 2016 Calculation Description: Yu's addition Input File Name: PD515-YU.ribd HVAC CO LIN CF1R-PRF-01 Page 7 of 8 O G - HERS VERIFICATION 01 02 03 04 05 06 NameVerified Verified Airflow Airflow Target Verified EER Verified SEER Refrigerant Charge Cooling -hers-cool Required 350 Not Required Not Required Not Required HVAC - DISTRIBUTION SYSTEMS 01 02 03 04 05 06 07 08 09 10 Name Type Insulation Duct Leakage R -value Supply Duct Location Return Duct Verified Existing HERS Location Bypass Duct Status Condition Verification attic Ducts located in attic Sealed and tested 6.0 Attic Attic None New No attic -hers-dist HVAC - FAN SYSTEMS & HERS VERIFICATION 01 02 03 04 Name Type Fan Power Watts/CFM ( ) HERS Verification HVAC Fan Systeml Single Speed PSC Furnace Fan 0.58 Required IAQ (Indoor Air Quality) FANS 01 02 03 04 Name IAQ CFM IAQ Fan Type IAQ Recovery Effectiveness(°/ ) SFam IAQVentRpt 1-1 78 Exhaust 0 COOLING VENTILATION 01 02 03 Name Cooling Vent CFM Cooling Vent Watts/CFM Whole House Fan 0 0.1 05 HERS Verification Not Required 04 Number of Fans 1 Registration Number: 216-A0120325A-000000000-0000 Registration Date/Time: 2016-03-31 09:52:54 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 Report Generated at: 2016-02-18 08:35:48 CERTIFICATE OF COMPLIANCE - RESIDENTIAL PERFORMANCE COMPLIANCE METHOD Project Name: PD515-YU Calculation Date/Time: 08:34, Thu, Feb 18, 2016 Calculation Description: Yu's addition Input File Name: PD515-YU.ribd DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: David Perng Company: Professional Design Address: 10268 Bandley Dr. #102 City/State/Zip: Cupertino, CA 95014 RESPONSIBLE PERSON'S DECLARATION, STATEMENT Documentation Author Signature: Signature Date: 2016-03-31 09:52:54 CEA/HERS Certification Identification (If applicable): c21376 Phone: 408-996-7988 CF1R-PRF-01 Page 8 of 8 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: David Perng -., Company: Date Signed: Professional Design 2016-03-31 09:52:54 Address: License: 10268 Bandley Dr. #102 c21376 City/State/Zip: r408-996-7988 one: Cupertino, CA 95014 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0120325A-000000000-0000 Registration Date/Time: 2016-03-31 09:52:54 HERS Provider: CaICERTS ine. CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version - CF1R-08252015-744 Report Generated at: 2016-02-18 08:35:48 Department of Public Works �I Encroachment Permit Application CUPERTINO PERMIT # 10300 Torre Ave Cupertino, CA 95014-3255 PH: (408) 777-3354 Revised 11/2009 FX: (408) 777-3333 Location of Work Building Permit # Type of Work: check all that apply F- Sidewalk rDriveway Approach F- Curb & Gutter F- Street Light [— Curb Ramp r Paving F- Utility Trench r Monitoring Well F- Pool r' Fiber Cable r News Rack F- Other: PERMITTEE: Name: Address: Phone: Start Date: # of Working days: CONTRACTOR: Name: Address: 24 hr. Contact: 24 hr. Phone - Contractor's Lic. No. City Business Lic. No.: ATTACH THE FOLLOWING TO APPLICATION: 1) Written Description of Work 2) Engineer's Cost Estimate 3) Detailed Traffic Control Plan including plan of existing pavement delineation (traffic stripes, pavement markings, and pavement markers) and signs 4) Project Plans and Specifications 5) Contractors Insurance Certificate (Insurance requirements listed on reverse) Permittee Signature: Date: (CITY USE ONLY) Permit Fee $ Bond $ Rereint #- Bond Retention Schedule 4pproved By: Inspected By: Expiration Date: Type of Bond: I— Cash I— Paper I— Certificate of Deposit Date: Date: SEE REVERSE FOR PERMIT CONDITIONS SPECIAL CONDITIONS F_ Work hours limited to Monday - Friday: r', 7:00 a.m. 8:00 a.m. to (�' 4:30 p.m r 6:00 p.m. Work hours in pavement limited to: r', 8:00 a.m. (', 9:00 a.m. to r', 3:30 p.m. (� 4:30 p.m. rj Any violation of working hours shall result in "STOP WORK" notice Two lanes of traffic to be maintained at all times Permanent paving must be installed WITHIN 5 WORKING DAYS after completion Pavement delineation or signs damaged during construction shall be replaced in kind r' Pavment section shall match existing F_ Slurry Seal is required to match existing pavement All Trenching shall be backfilled to a minimum of 95% relative compaction Trench plates in the travel way shall be traffic rated, properly secured and shall be recessed upon request (— If trench is Tor less from Lip of Gutter, contractor shall repave to Lip of Gutter. F_ Jobsite shall be properly posted. Barricades must bear the name and phone number (24 hour number) of the contractor or utility performing work. All signs attached to barricades must show the days and dates when work will be performed. Parking may not be restricted on Saturday or Sunday. F_ BMP Sheet Attached ri Potholes and bore pits shall be filled to grade with cutback at end of each work day: Other General Conditions 1) The Public Works Inspector of the City of Cupertino, (408) 777-3104, shall be notified at least 48 hours prior to beginning work in the public Right -of -Way or requesting inspection of work. After the work is completed, notify the Public Works Inspector to schedule a final inspection. 2) A copy of this permit must be kept on the job site. 3) The applicant shall notify County Communications, (408) 299-2501, at least 24 hours prior to any work in the traveled way section of a street. 4) Permittee shall employ construction best management practices which will prevent pollutants such as mud, silt, chemical residue, and washings from concrete saw -cutting from entering storm drains. Brochures are available at the Public Works counter. 5) The applicant agrees that if the encroachment for which this permit is issued which shall at any time in the future interfere with the use, repair, improvement, widening, or change of grade of any street, roadway, highway, sidewalk, curb, drain, or Right -of -Way, applicant or his successor or assigns, shall within 14 days after receipt of written notice from the Director of Public Works to do so, at its own expense either remove such encroachment subject to approval from the Director, or relocate to a site which may be designated by the Director. Any encroachment removed by the City will not be replaced. 6) It is further agreed that, commencing with the performance of the Work by the Permittee or his contractor and continuing until the completion of the maintenance of the Work, the Permittee shall indemnify, hold harmless and defend the City from and against any or all loss, cost, expense, damage or liability, or claim therof, occasioned by or in any way whatsoever arising out of the performance or nonperformance of the Work or the negligences or willful misconduct of the Permittee or the Permittee's agents, employees and independent contractors, except to the extent any of the foregoing is caused by the sole negligence or willfull misconduct of the City or the City's agents, employees and independent contractors. 7) Should the Permittee provide services which are subject to the City's Franchise ordinance, Permittee agrees to pay any applicable City franchise fee. 8) This encroachment permit shall be terminable at the sole discretion of the City upon 30 days written notice to the Permittee. 9) The applicant's contractor shall carry at all times commercial general liability insurance with a combined single limit of $1.0 million per occurrence; $2.0 million aggregate; and provide a Certificate of Insurance and Endorsement naming the City as Additional Insured. Insurers must be licensed to do business within the State of California and have a current Best's Guide Rating of A, Class VII or better or that is otherwise acceptable to the City. 10) All work within the public Right of Way must be completed by a contractor who holds a current Class A or appropriate Class C license and a current City of Cupertino business license.