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14120033-DP 2 / CITY OF CUPERTINO BUILDING PERMIT / BUILDING ADDRESS: 834 MILLER AVE CONTRACTOR:LIM LUCIA TRUSTEE PERMIT NO: 14120033 / OWNER'S NAME: LIM LUCIA TRUSTEE 1490 DARTSHIRE CT DATE ISSUED:05/22/2015 OWNER'S PHONE: 8087808386 SUNNYVALE,CA 94087-3634 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ INFILL/COVER WITH SKYLIGHT 348 S.F.OF ATRIUM TO License Class Lic.# CREATE(N)FAMILY ROOM.REMODEL(E)KITCHEN (2315.F.),BATHROOMS(77 S.F.),RE-ROOF(E)22SQ'S Contractor Date I herebyaffirm 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 fullforce and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$40000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:37542002.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by:�iyr //4/G Date: �� with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date _ All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. o j •ER-BAIL•DER DE(315AKAT ON Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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, iiiusiness&Professions Code) as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by a Health&Safety Code,Sections 505 25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this wner�o^r au hor ed a n lx ' 1 a• .- y .ermit is issued. J 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-poin source r lations per the Cupertino Municipal Code;Section Licensed Professional 9.18. ug�a . s '�- w a ''. te:; . CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 834 MILLER AVE CONTRACTOR:JK BAKER PERMIT NO: 14120033 CONSTRUCTION INC OWNER'S NAME: LIM LUCIA TRUSTEE 226 MCEVOY ST DATE ISSUED:05/22/2015 OWNER'S PHONE: 8087808386 SAN JOSE,CA 95126 PHONE NO:(408)882-0199 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL `� �3' INFILL/COVER WITH SKYLIGHT 348 S.F.OF ATRIUM TO License Class Lic.# e, '" CREATE(N)FAMILY ROOM.REMODEL(E)KITCHEN \ �d � .� {, (231S.F.),BATHROOMS(77 S.F.),RE-ROOF(E)22SQ'S Contractor LI e f� cTet��.tv.`is`,•i', , n.,Date ka I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$40000 '/I have and will maintain Worker's Compensation Insurance,asprovided for �, P by -IISection 3700 of the Labor Code,for the performance of the work for which this APN Number:37542002.00 Occupancy Type: 'ii permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSP CT ON. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: Vf I—il✓ ll k/�1(('`/< l % Date: g 96 °-°/.7- 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. -5411r- All RE-ROOFS: Signature << __ '' ' Date Lr4 All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,2553,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this . fia � fie`.�•' u permit is issued. Owner or authorized agent: T°` .. �+' Date: " 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name • APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 834 MILLER AVE CONTRACTOR:JK BAKER PERMIT NO:14120033 • CONSTRUCTION INC OWNER'S NAME: LIM LUCIA TRUSTEE 226 MCEVOY ST DATE ISSUED:05/22/2015 OWNER'S PHONE: 8087808386 SAN JOSE,CA 95126 PHONE NO:(408)882-0199 113fLICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL D COMMERCIAL 0 =a� INFILL/COVER WITH SKYLIGHT 348 S.F.OF ATRIUM TO License Class r „ Lie.#_� E Gl '£ CREATE(N)FAMILY ROOM.REMODEL(E)KITCHEN Contracto, r'e ''" F ?*: ;r` h., Date _ 4 (231S.F.),BATHROOMS(77 S.F.),RE-ROOF(E)22SQ''SS I hereby affirm that I am licensed under the provisions of Chapter 9 evts�oat# pg ( )-100 Amp.;In I to )200 Ar r pitknelLISSUI•D}-sk (commencing with Section 7000)of Division 3 of the Business&Professions d/20 206 Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$40000 4lI have and will maintain Worker's Compensation Insurance,as provided for by ( ection 3700 of the Labor Code,for the performance of the work for which this � APN Number:37542002.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITIIIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSP CTI N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, / costs,and expenses which may accrue against said City in consequence of the /9O granting of this permit. Additionally,the applicant understands and will comply Issued by: A(.4-V Ul.f Le.l U�i1�� Date: with all non-point source regulations per the Cu.-rtino Municipal Code,Section 9.18. ., -';; � _, RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: , '-'°.4.7k." Date: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and,state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO y l ' FEE ESTIMATOR-BUILDING DIVISION 07' , .0' ADDRESS: 834 Miller Ave DATE: 08/20/2015 REVIEWED BY: Paul ' °'`° APN: 375 42 002 BP#: 14120033 *VALUATION: $1,800 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 REAP i WORK Revision#1 - Upgrade (E) 100 Amp panel to (N) 200 Amp Panel SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES / Services 1 ERT<200 200 Amps $48 ` TOTALS: $48.00 Vali Plan c rrg..,,L ,➢..I;.t;. Plan Cheek Elec.Plan Check 0.0 hrs $0.00 vzch 1e Ti �e,. Plumb. Per h s. Elec.Pemit Fee: 1EPERMIT Oshkn Mech..In p. n (ir,aer.Plumb imp. n Other Elec.Insp. F.C1 hrs $148.00 eclt, Imp in' Pit?7il'..Imp.l'e'e: E„r'C:. lnsp. Fee: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Cheek Fee: I S'uppl. PC Fee L PME Plan Check: $0.00 Permit Fee: Suppi. Imp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 (:,on.siruction I cix: Administrative Fee: 1ADMIN $45.00 7 Work Without Permit? 0 Yes € No $0.00 Advanced Planning Fees: Travel Documentation Fee: 1TRAVDOC $48.00 / A Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commissio-,,,,, ,_,,,„n Fee: 1BCBSC $1.00 . „ 'SUBTOTALS` '. $190.50 $0.00 TOTAL FEE 'I , 1', ” Revised: 07/02/2015 w.,, GENERAL PERMIT APPLICATION M -$ � {f COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION X '4 r,''- 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 ,,,,,kNi'k M 1 S C (408)777-3228• FAX(408)777-3333•buildinq(a�cupertino.orq CUPERTINO ❑PLUMBING ❑MECHANICAL E<ECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS �c� /,� r /( .,/i 4 AIN# C� 4, C� • OWNER NAME - � .t (/ j'1L� PHONE cJ E-IMAJILL LvC,\ G. Iwo. — I-f051-d'0S- '-fZ7-X 4eroLIz?, 0-l-mmf'I. C STREET ADDRESS ( j O CIT , STATE,ZIP FAX `1 �G�r s 6� t� CSI'. v,y�T y-c�I e, �t 57�I y CONTACT NAMEPH NE E-MAIL Usti.. L<r� C)�' �rYv� r�'3 � STREET ADDRESSCITY,STATE,ZIP FAX LosqA-6„6,c,„1 CUsi.erh�D CA 4SDI� ❑ OWNER 0 OWNER-BUILDER Eigl OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER '❑ DEVELOPER ❑ TENANT CONTRACTOR NAME C\��1L i / LICENSE NUMBER 63( / LICENSE TYPE BUS.LIC# �6 7 k (+ COMPANY NAME 1, K Bask� 5 ,..4 , E-MAIL - d LICS.. eIk -e_dx t-A,c s-,_`�( STREETADDRESS PHONE nc AA,_ecly 3 _ CITY, TcSvrJ lE,ZIP I 26 Cl/6N ��.pt-0(99 ARCHITECT/ENGINEER NAME )4, �"-�`�yy -j_ LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS /4;5 L -4 i �tIATKill 1 C 9 6/36 Q PHONE USE OF ,L SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑YES BUILDING: 0 COMMERCIAL URBAN INTERFACE AREA , 1i1.. NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO' DESCRIPTION OF WORK �c Uwef u f jrade ' a k /vo/- 1b Zoo/4 l .5( ic.e rI f 5- e_ 3c,..-1,-,vi� _ Asc /'6-11 • I �� — § aiFt x'114'''. 74-2..W.'''',.':, TOTAL VALUATION: 1, / - 4 �RECEVD Btii, 4< r N i ? �S4 .44asatg By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relat' .- - .uilding cons.. .'ion. authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: = <_ Date: / .6/ ( 5 SUPPLEMENTAL,INFCRI�ATION REQUIRED s NL 410 _ �., , ?F,FSGE USE ONAY ,yz+tii o. `OVER4HE e0: TER' , M,1'i 0�EXPRESS >Dam . �a , ka 41t.. MAJOR. '',s.t.) , C-C • MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO ,....,:;\ 4,,,,,f r , MI FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 834 MILLER AVE DATE: 12/05/2014 REVIEWED BY: MELISSA , , l`'dltAPN: 375 42 002 BP#: I 6633 *VALUATION: $40,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY 2nd Unit? • Yes ®No PENTAMATION SFD or Duplex USE: OTC., Q Yes 0 No PERMIT TYPE: 1 R3SFDA©D WORK INFILL/COVER WITH SKYLIGHT 348 S.F. OF ATRIUM TO CREATE N FAMILY ROOM. REMODEL SCOPE (E) KITCHEN (231S.F.), BATHROOMS (77 S.F.), RE-ROOF (E) 22SQ'S & REPLACE 10 WINDOWS b TYPE OF FLR AREA OCCUPANCY TYPE: CONSTR. _ (s.f.) PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) 1 II-B,III-B,IV,V-B 348 $1,626.00 IADDPLCK $1,323.00 IADDINSP . TOTALS: 348 $1,626.00 $1,323.00 MECH,HOURLY sQ Yes'' ® No PLUMB,HOURLY,'. Q Yes.�® No. ELECHOURLY © Yes -0N o 4vch, Pian Check I l plumb Plan Cheek I 1 - Ll,.e. Nan Check n L1ech. Permit Fee: Plurnii, Perini; 01P2 ,.,.r CONSTRUCTION PERMIT APPLICATION ' {� COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 4' 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 v CUPERTINO (408)777-3228• FAX(408)777-3333•building a(�,cupertino.org. \ ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# ' PROJECT ADDRESS 834 MILLER NE. • APN# '39.'-S - cti2 — O O Z OWNER NAME Lut1A LINT PHONE .04 s VAI. •rl C$o8)780G/ p o4384, E-MAIL 0.po 7/ U,MT€I4E114AIL Ca M +1�F90 imams that Cz ) l � STREET ADDRESS CITY, STATE,ZIP W! .j foal FAX (4o%)g .D 3 4, CONTACT NAME Llys `IM PHONE(Sb>�c)r89.8386 E-MAIL LT PRtiiMiM7en.o 11"u►LLa1 STREET ADDRESS iII 0 17 ,C CIA W CITY,STATE,ZIP ® FAX 4 .RA `1 Gup1 +MCJS T0. ♦rut r OWNER 0 OWNER-BUILDER ❑OWNER AGENT 0 CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER ElDEVELOPER ❑TENANT 1 CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# tDt f Ni & el. . COMPANY NAMEw E-MAIL FAX ! STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# Ido A1ttufTtt71•S vl COMPANY NAME E-MAIL FAX 17CriNt Its 14 STREET ADDRESS CITY,STATE,ZIP -PHONE DESCRIPTION OF WORK Amu Or) SL40 R7of 114 FILL V S(-Y I C -r . (Peg —/4./..)— ./7,4-.-„1/4,—/2,,91,A,-/- 2)--- �Gt -4_(331 0)) errL(09 i3- � e,e-P'/'s ( G =i�� aaa� -e 'ii (iv� r,�f c. 7 5 Cad �«,g5 . EXISTING USE PROPOSED US CONSTR.TYPE #STORIES I'Sraell SPMG& r NIL7 + A0��y Ket. ' USE TYPE OCC. SQ.FT. VALUATION(,S) EXISTG NEW FLOOR DEMO TOTAL 1--__AREA 8 ss AREA 3+a AREA NET AREA 12.04 Y-a vs-3 22.10. A goy 000 BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH ?ATTACH #DWELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORYC_YES I BEING ADDED? ?O ADDITION? O , PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN £YESRECE .�e B`Y TOTAL VALUATION: PLANNING APPL# 0 NO PLANNING APPROVAL LETTER EICHLER HOME? 0N -^ -, ' 4s;,', AD get 000 By thy signature below,I certify to each of the following: I am the property owner or ihonzed agent to act on,,. .ropert'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 i accurate. I agree to comply with all applicable local ordinances and state laws relatin uilding co ction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: .---e___'—'^�. Date: air/14} SUPPLEMENTAL INFORMATION REQUIRED M $ "r a Ys � s U r r: :.a �: PL,A�,CHECIC,'�'YPE m .. ._ :,.Ri�UTI1�GSLIE,v` _c,�: VSs.. New SFD or Multifamily dwellings: Apply for demolition permit for ` ,'lw ski. tPIREI!TMEEE w;" cd,8#4-2, 0. 0.titet F `BliDIIYGPIANRoli xu V existing building(s). Demolition permit is required prior to issuance of building ', °: g4 x t' e 41ss T ,a, c IJ x s w "�,K ,,e permit for new building. : L ExPREIaPLANNTNGPlAN REvtEw x }} yt $ i _ nV# c t t � � Commercial Bldgs: Provide a completed Hazardous Materials Disclosure : ;STAND`ARD , 4D PUBucwoRKst F _ ` ' 4€ ` 'form if any Hazardous Materials are being used as part of this project. ' " - -11y,1 l * *` 'r- AR&gO Z ztR MiZIE ' q r sRO Copy ofPlanning Approval Letter or Meeting with Planning prior to . i � 3 > _ w; IOR W r+ tzQ'SATARY SEWRDISTa sa submittal of Building Permit application. - � ' t tom, -T ' „ n � . x .ail'i.IRoON7a, ALTA_sYk BldgApp_2011.doc revised 06/21/11 '\.e. , Building:Departme�i t Cit -Of Cupertino. : 10300 Torre Avenue Cupertino,CA 95014-3255 .. Telephone:408-777-328 :: .. ..CUPERTINO- Fax:408-777-3333 : :: CONTRACTOR/SUBCONTRACTOR LIST Lr�l;� `}d8�.s Toy JOB ADDRESS:834 Miller Ave.,Cupertino, CA : PERMIT#14120063 • • OWNER'S NAME:Lim Lucia Trustee PHONE:#408-882-0199 , • GENERAL CONTRACTOR: JKBaker Construction : :BUSINESS LICENSE#. 23677 :: ADDRESS: 226.McEvoy St. CITY/ZIP.CODE::::San Jose 95126 1 *Our municipal Code requiresall businesses working in the city to have a City:of Cupertino business license. : NO BUILDING FINAL OR.:FINAL. . . . . .INSPECTION(S) .WILL BE ED UNTIL THE : GENERAL CONTRA TOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO l BUSINESS LICENSE: I am not using any subcontractors: , Signature . . Date Please check applicable subcontractors and complete the:following information: V SUBCONI'RACI'OR: BUSINESS NAME : BUSINESS LICENSE#. : X Cabinets&Millwork JK Baker.Construction, Inc. : 23677. Cement Finishing : : . X Electrical JK Baker:Construction, Inc: 23677. -- Excavation 1 = 1 - . Fencing Flooring/.Carpeting .. . .Linoleum/Wood. .. . . .. . ... ... .. .... . . X . .Glass/GlazingJK.Baker Construction, Inc. : :. 23677 X Heating • Calvey Heating &Air 32390 X: •Insulation KIK Baker Construction, Inc. 23677 .. . . .Landscaping:. :: .. . . . Lathing .:. . . :. .: .. Masonry X Painting/Wallpaper : JK Baker Construction, Inc. .. 23677 • Paving .. Plastering : :: • .X Plumbing: Michael Venostat plumbing 3566:1 . X ROOfing Statewide Roofing - 23509 Septic Tank. .. Sheet Metal X Sheet Rockn JK Baker Construction_, Inc.. 23677 X Tile • JK Baker Construction, Inc. 23677 9:,-: : Owner/Contractor Signature : : Date . i i i' (A33 ADDITION TO MILLER AVE RESIDENCE 834 MILLER AVENUE CUPERTINO, CA 95014 RECEIVED 9Y. CUPERTINO DEC 0 5 2014 ` �? Building Department :. • I BY ` DEC 115 2014 REVIEWED FOR (CD8 COMPLIANCE Reviewed By: TITLE 24 ENERGY REPORT IRI ENERGY CONSULTANTS, LLC TITLE 24 ENERGY CONSULTANTS 21 N. HARRISON AVE. CAMPBELL, CA. 95008 408-866-1620 FAX: 408-866-6832 EMAIL: info@friconsulting.com BUILDING ENERGY ANALYSIS REPORT PROJECT: Miller Ave Residence 834 Miller Avenue Cupertino, CA 95014 Project Designer: Ko Architects, Inc. 900 High Street, Suite 1 Palo Alto, CA 94304 650-853-1908 Report Prepared by: Deborah San Luis R08-12-2133 FRI Energy Consultants, LLC 21 N. Harrison Avenue, Suite 210 Campbell, CA 95008 408-866-1620 Job Number: 0140860 Date: 12/3/2014 The EnergyPro computer program has been used to perform the calculations•summarized in this compliance report.This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2013 Building Energy Efficiency Standards. This program developed by EnergySoft,LLC—www.energysoft.com. EnergyPro 63 by EnergySoft User Number.1315 ID:0140860 TABLE OF CONTENTS Cover Page 1 1 Table of Contents 2 Form RMS-1 Residential Measures Summary 3 I Form MF-1R Mandatory Measures Summary 4 I HVAC System Heating and Cooling Loads Summary 7 3 ! � I EnergyPro 6.3 by EnergySoft Job Number: ID:0140650 User Number:1315 CERTIFICATE OF COMPLIANCE-RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1 R-PRF-01 Project Name:Residential Building Calculation DatelTime:09:13,Wed,Dec 03,2014 Page 1 of 7 - Calculation Description:Title 24 Analysis Input Fite Name:0140860 Miller Ave Residence.xml GENERAL INFORMATION 01 Project Name Residential Building 02 Calculation Description Title 24 Analysis 03 Project Location 834 Miller Avenue 04 CA City Cupertino 05 Standards Version Compliance 2015 06 Zip code 95014 07 Compliance Manager Version BEMCmpMgr2013-3(651) 08 4 Climate Zone CZ4 09 Software Version EnergyPro 6.3 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) 2206 15 Number of Zones 2 16 Slab Area(FT2) 1858 17 Number of Stories 1 18 Addition Cond.Floor Area 348 19 Natural Gas Available Yes 20 Addition Slab Area(FT2) 348 21 Glazing Percentage(%) 18.2% COMPLIANCE RESULTS 01 Building Complies witlf.Oomiiiiter Perfojar e . ,y `� ' . 02 This.building DOESNC7f require HRSVe ciitiort �wfr , lit 03 This building incorp`oOes ar#iit6Tmotr Spec ai,Featur�s�shownn below al' ENERGY USE SUMMARY 04 05 06 07 08 Energy Use(kTDV/ft2-yr) Standard Design Proposed Design Compliance Margin Percent Improvement Space Heating 31.23 21.30 9.93 31.8% Space Cooling 6.98 11.23 -4.25 -60.9% IAQ Ventilation 0.00 0.00 0.00 0.0% Water Heating 12,88 12.40 0.48 3.7% Photovoltaic Offset -- 0.00 0.00 ---- TOTAL 51.09 44.93 6.16 12.1% Registration Number: 214-A0151252A-000000000-0000 Registration Date/Time: 2014-12-03 10:10:44 HERS Provider: Ca10ERTS inc. CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version-CF1R-10172014-651 Report Generated at 2014-12=03 09:15:21 CERTIFICATE OF COMPLIANCE-RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1R-PRF-01 Project Name:Residential Building Calculation Date/Time:09:13,Wed,Dec 03,2014 Page 2 of 7 Calculation Description:Title 24 Analysis Input File Name:0140860 Miller Ave Residence.xmi REQUIRED SPECIAL FEATURES The following are features that must be installed as condition for meeting the modeled energy performance for this computer analysis. • Cathedral Ceiling • No cooling system Included PROJECT HERS FEATURES The following are project-level features that must be field-verified as a condition for meeting the modeled energy performance for this computer analysis. These,plus any additional HERS features listed in the building components tables below,requre field verification by a certified HERS Rater. Building-level Verifications: • —None -- Cooling System Verifications: • —None— HVAC Distribution System Verifications: • —None— Domestic Hot Water System Verifications: • —None-- ENERGY DESIGN RATING This is the sum of the annual TDV energy consumption for energy use ci mpoYientS inducted itltthe'Pbrforman a campltanCB,approach for the Standard Design Building(Energy Budget)and the annual TDV energy consumption for lighting and coThponents not reguiated Title 24 Pa 6 such as do estic a lianceS and consumer electronics)and accountingfor the annual TDV energyoffset byan �,w �y_ � (such �.� FPb W on-site renewable energy system. °' �`'� gy, 9Y Desr n Ratip ti �r � �eference.Ener fse -Ener g g z� � Margin Percent Improvement Total Energy(kTOVlf2)• 38.83 =92 67 - 6.16 6.2% includes calculated Appliances and Miscellaneous Energy Use(AMEU) BUILDING FEATURE INFORMATION 01 02 03 04 05 06 07 Number of Dwelling Number of Number of Water Project Name Conditioned Floor Area(sft) Units Number of Bedrooms Number of Zones Ventilation Cooling Systems Heating Systems Residential Building 2206 1 4 2 0 1 ZONE INFORMATION 01 02 03 04 05 06 07 Zone Floor Area Avg.Ceiling Zone Name Zone Type HVAC System Name (ft2) Height Water Heating System 1 Water Heating System 2 1ST Floor Conditioned HVAC Systeml 1858 8 DHW Sys 1 1ST Floor Addition Conditioned HVAC Systeml 348 8 DHW Sys 1 Registration Number: 214-A0151252A-000000000-0000 Registration Date/Time: 2014-12-03 10:10:44 HERS Provider: CaiCERTS inc. CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version-CF1R-10172014-651 Report Generated at 2014-12-03 09:15:21 CERTIFICATE OF COMPLIANCE-RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1 R-PRF-01 Project Name:Residential Building Calculation Date/Time:09:13,Wed,Dec 03,2014 Page 3 of 7 - Calculation Description:Title 24 Analysis Input File Name:0140860 Miller Ave Residence.xml OPAQUE SURFACES 01 02 03 04 05 06 07 08 09 10 Verified Window and Door Tilt(deg Existing Name Zone Construction Azimuth Orientation Gross Area(ft2) Area(ft2) ) Status Condition Front Wall 1ST Floor R-0 Wall 270 Front 192 77.3 90 Existing No Left Wall 1ST Floor R-0 Wall 0 Left 356 48 90 Existing No Rear Wall 1ST Floor R-0 Wall 90 Back 404 187.9 90 Existing No Right Wall 1ST Floor R-0 Wail 180 Right 320 33 90 Existing No Front Wall 2 1ST Floor Addition R-19 Wall 270 Front 34 20 90 New N/A Front Wall 3 1ST Floor Addition R-19 Wall 270 Front 34 90 New N/A Front Wall 4 1ST Floor Addition R-19 Wall 270 Front 34 90 New N/A OPAQUE SURFACES—Cathedral Ceilings 01 02 03 04 05 06 07 08 09 10 11 12 13 r.--T r Roof Roof Framin Verified g i,, Orientatiot s litea a *;Skylight `Roof Rise `Roof Roof Reflectan Emmittan g Statu Existing Name Zone--- ''Type / , n ids. ,,(ft2) F Area{ft2* (x fri'd ,, Pitch Tilt(deg) ce ce Factor s Condition R 19 Roof s pecif 1858 0 4 ~ ..9 33 „18.43 0.1 0.85 0.1 'vtdere N/A Roof Altered 1ST Flood • A� p {Y R-19 Roof Roof 1ST Floor AdditionCathedra# specify- 348 36 4 0.33 18.43 0.1 0.85 0.1 New NIA Registration Number: 214-A0151252A-000000000-0000 Registration Date/Time: 2014-12-03 10:10:44 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version-CF1R-10172014-651 Report Generated at 2014-12-03 09:15:21 i CERTIFICATE OF COMPLIANCE-RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1 R-PRF-01 Project Name:Residential Building Calculation Date/me:09:13.Wed,Dec 03,2014 Page 4 of 7 - Calculation Description:Title 24 Analysis Input File Name:0140860 Miller Ave Residence.xmi • WINDOWS 01 02 03 04 05 06 07 08 09 10 11 Verified Width(ft Height Multiplie Existing Name Side of Building ) (ft) r Area(ft2) U-factor SHGC Exterior Shading Status Condition Window New Front Wall -- --- 1 33.0 0.32 0.25 Insect Screen(default) New N/A Window New 2 Front Wall -- --- 1 19.5 0.32 0.25 Insect Screen(default) New N/A Window New 3 Front Wall --- ---- 1 8.3 0.32 0.25 Insect Screen(default) New N/A Window New 4 Front Wall --- -- 1 16.5 0.32 0.25 Insect Screen(default) New N/A Window New 5 Left Wall -- -- 1 33.0 0.32 025 Insect Screen(default) New N/A Window New 6 Left Wall -- 1 15.0 . 0.32 0.25 Insect Screen(default) New N/A Window New 7 Rear Wall -- -- 1 21.0 0.32 0.25 Insect Screen(default) New N/A Window New 8 Rear Wall -- -- 1 42.0 0.32 0.25 Insect Screen(default) New N/A Window New 9 Rear Wall -- --- 1 24.5 0.32 0.25 Insect Screen(default) New N/A Window New 10 Rear Wall ---- ---- 1 36.9 0.32 0.25 Insect Screen(default) New N/A Window New 11 a Rear Wall ,. "1"7."4,--'7,7-'17,10 ` 18 0 -11032 025 Insect Screen(default) New N/A Sliding Glass Door New C5,7;`; Rear Wax hum y ---A 1 .m-',45,51, 0.32 029 Insect Screen(default) New N/A Window New 12 R1g0tali' ,j -4V, 1 1-',,,,,i,33.0, 032,:;,.it 0.25 Insect Screen(default) New N/A French Door '-'= ;-- Frai(Wait2�M e =;s -- '''r'1'''''-'''= + 20.0''F'. y 0-B2' '''Q29 Insect Screen(default) New N/A Skylight ,Roof 1 36.0 0.32 0.27 New N/A DOORS 01 02 03 04 05 06 Name Side of Building Area(ft2) U-factor Status Verified Existing Condition Door New Front Wall 20.0 0.50 New No Registration Number: 214-A0151252A-000000000-0000 Registration Date/Time: 2014-12-03 10:10:44 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version-CF1R-10172014-651 Report Generated at 2014-12-03 09:15:21 CERTIFICATE OF COMPLIANCE-RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1R-PRF-01 Project Name:Residential Building Calculation Date/Time:09:13,Wed,Dec 03,2014 Page 5 of 7 - Calculation Description:Title 24 Analysis Input File Name:0140860 Miller Ave Residence.xml OPAQUE SURFACE CONSTRUCTIONS 01 02 03 04 05 Construction Name Surface Type Framing Total Cavity R-value Assembly Layers • Inside Finish:Gypsum Board R-0 Wall Exterior Walls 2x4 @ 16 in.O.C. -no insulation(vertical)- • Cavity/Frame:no insuL/2x4 • Exterior Finish:Wood Siding/sheathing/decking • Inside Finish:Gypsum Board R-19 Roof Cathedral Cathedral Ceilings 2x8 @ 16 in.O.C. R 19 ' Cavity/Frame:R-19/2x8 • Roof Deck:Wood Siding/sheathing/decking • Roofing:Light Roof(Asphalt Shingle) • Inside Finish:Gypsum Board R-19 Wall Exterior Walls 2x6 @ 16 in.O.C. R 19 • Cavity/Frame:R-19/2x0 • Exterior Finish:Wood Siding/sheathing/decking SLAB FLOORS 01 02 03 04 05 06 07 08 09 Verified #M ,Perimeter, ;. r --= Carpeted Existing Name l Zoner Area(ft1) (ft) ``• I' Edge tesul.R-value Fraction Heated Status Condition . Slab-on-Grade `' AST-Floar, p` ,1#58 • v " 16'9 , ., none- _ 0.8 No Existing No Slab-on-Grade2 q' i ST IoorAddltlon $ :3"348! 1275 i nnne-- '' 0.8 No New No BUILDING ENVELOPE-HERS VERIFICATION i 01 02 03 04 Quality Insulation Installation(Qll) 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 Verified Existing Name Distribution Type Number of Heaters Solar Fraction(%) Status Condition DHW Sys 1 Pipe Insulation,All Lines 1 Annual Altered No i Registration Number: 214-A0151252A-000000000-0000 Registration Date/Time: 2014-12-03 10:10:44 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version-CF1R-10172014-651 Report Generated at 2014-12-03 09:15:21 CERTIFICATE OF COMPLIANCE-RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1 R-PRF-01 Project Name:Residential Building Calculation Date/rime:09:13,Wed,Dec 03,2014 Page 6 of 7 Calculation Description:Title 24 Analysis Input File Name:0140860 Miller Ave Residence,xml 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) DHW Heater 1 Natural Gas Small Storage 50 0.62 EF 37000-Btu/Iv 0 0 WATER HEATING-HERS VERIFICATION 01 02 03 04 05 06 07 Recirculation with Recirculation with Name Pipe Insulation Parallel Piping Compact Distribution Point-of Use Manual Control Sensor Control DHW Sys 1 n/a n/a n/a n/a n/a n/a HVAC SYSTEMS — 01 02 03 04 05 06 07 08 09 Heating System Cooling System Distribution Fan Floor Area Verified Existing " n Name System Type Name Ducted�r`,,, »Name 4a^DuctetY ¢ System System Served Status Condition Other Healingand `, ` Heahn O� �� HVAC y "' � HVAC se HVAC Systeml � g No -. Yep 2206 Existing No Cooling System Com unenttn- ,,. 4 Systetnl-0.0.1 1 yske 141st n '.:i.1m, ' n F `:b < % € `^SLS zY�. € 7 ,.," s "" >,1 C. . � , .,v '^��=a;.a fir_ ."'�.�.. . � .. HVAC-HEATING SYSTEMS ' 01 02 03 Name Type Efficiency Heating Component 1 CntrlFurnace-Fuel-fired central furnace 80 AFUE HVAC-COOLING SYSTEMS 01 02 03 04 05 06 07 Efficiency Multi-speed Name System Type EER SEER Zonally Controlled Compressor HERS Verification HVAC Systeml-cool NoCooling-No cooling equipment 11.7 NoI No N/A Registration Number: 214-A0151252A-000000000-0000 Registration Date/Time: 2014-12-03 10:10:44 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version-CF1R-10172014-651 Report Generated at 2014-12-03 09:15:21 CERTIFICATE OF COMPLIANCE-RESIDENTIAL PERFORMANCE COMPLIANCE METHOD CF1R-PRF-01 Project Name:Residential Building Calculation Date/Time:09:13,Wed.Dec 03,2014 Page 7 of 7 Calculation Description:Title 24 Analysis Input File Name:0140860 Miller Ave Residence.xml DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1.I certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: p�D • Nicholas Bignardi apn Company: Signature Date: FRI Energy Consultants, LLC. 2014-12-03 09:35:35 Address: CEA/HERS Certification Identification(If applicable): 21 N. Harrison Ave,Suite 210 City/State/Zip: Phone: Campbell, CA 95008 408-866-1620 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury,under the laws of the State of California: 1. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. 2. I certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the California Code of Regulations. 3. The building design features or system desigrp features identified on this;Certiflcate of�Compliance pre consistent with the information provided on other applicable compliance documents. worksheets,calculations,plans and_specifications submitted to the enforcement agen fo"approva1with thin building permit application. Responsible Designer Name: '- IRespcttisible Designer Signature ,. `�C, Z Peter Ko,AIA Y t % f = ,. 4.;,;1.., L eler c o �-� Company: DateSigned: Ko Architects, Inc. 2014-12-03 10:10:44 Address: License: 900 High Street, Ste 1 C24487 City/State/Zip: Phone: Palo Alto, CA 94301 650-853-1908 Digitally signed by Ca/CERTS 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: 214-A0151252A-000000000-0000 Registration Date/Time: 2014-12-03 10:10:44 HERS Provider: CaICERTS inc. CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version-CF1R-10172014-651 Report Generated at 2014-12-03 09:15:21 RESIDENTIAL MEASURES SUMMARY RMS-1 Project Name Building Type 0 Single Family 0 Addition Alone Date Miller Ave Residence 0 Multi Family ®Existing+Addition/Alteration 12/3/2014 Project Address California Energy Climate ZoneTotal Cond.Floor Area Addition #of Units 834 Miller Avenue Cupertino CA Climate Zone 04 1 2,206 348 1 INSULATION Area Construction Type Cavity (ft) Special Features Status Wall Wood Framed -no Insulation 906 Existing Door Opaque Door -no insulation 20 New Roof Wood Framed Rafter R 19 1,858 Altered Slab Unheated Slab-on-Grade -no insulation 1,858 Perim=159' Existing Wall Wood Framed R 19 82 New Roof Wood Framed Rafter R 19 312 New Demising Wood Framed R 13 40 New Slab Unheated Slab-on-Grade -no insulation 348 Perim=13' New FENESTRATION Total Area: 402 Glazing Percentage: 18.2% t'ew/Altered Average U-Factor. 0.32 Orientation Area(ft2) U-Fac SHGC Overhang Sidefins Exterior Shades Status Front(VV) 77.3 0.320 0.25 none none Bug Screen New Left(N) 48.0 0.320 0,25 none none Bug Screen New Rear(E) 142.4 0.320 0.25 none none Bug Screen New Rear(E) 45.5 0.320 0.29 none none Bug Screen New Right(S) 33.0 0.320 0.25 none none Bug Screen New Front(IN) 20.0 0.320 0.29 none none Bug Screen New Skylight 36.0 0.320 0.27 none none None New HVAC SYSTEMS Qty. Heating Min. Eff Cooling Min. Eff Thermostat Status 1 Hot Water n/a No Cooling 13.0 SEER Setback Existing HVAC DISTRIBUTION Duct Location Heating Cooling Duct Location R-Value Status HVAC System Radiant Floor Ductless n/a n/a Existing WATER HEATING Qty. Type Gallons Min. Eff Distribution Status 1 Small Storage Gas 50 0.62 All Pipes Ins Altered EnergyPro 6.3 by EnergySoft User Number:1315 RunCode:2014-12-03T09:33:27 ID:0140860 Page 3 of 7 MANDATORY MEASURES SUMMARY: Residential (Page 1 of 3) MF-1R Project Name Date Miller Ave Residence 12/3/2014 NOTE: Low-rise residential buildings subject to the Standards must comply with all applicable mandatory measures listed,regardless of the compliance approach used.More stringent energy measures listed on the Certificate of Compliance(CF-1R,CF-IR-ADD,or CF- 1R-ALT Form)shall supersede the items marked with an asterisk(")below.This Mandatory Measures Summary shall be incorporated into the permit documents,and the applicable features shall be considered by all parties as minimum component performance specifications whether they are shown elsewhere in the documents or in this summary.Submit all applicable sections of the MF-1R Form with plans. Building Envelope Measures: §110.6(a)1:Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage. §110.6(a)4:Fenestration products(except field-fabricated windows)have a label listing the certified U-Factor,certified Solar Heat Gain Coefficient(SHGC),and infiltration that meets the requirements of§10-111(a). §110.7: Exterior doors and windows are weather-stripped;all joints and penetrations are caulked and sealed. §110.8(a): Insulation specified or installed meets Standards for Insulating Material.Indicate type and include on CF-2R Form. §110.8(i):The thermal emittance and solar reflectance values of the cool roofing material meets the requirements of§110.8(i)when the installation of a Cool Roof is specified on the CF-1R Form. *§150.0(a): Minimum R-30(R-19 for Alterations)insulation in wood-frame ceiling or equivalent U-factor. §150.0(b): Loose fill insulation shall conform with manufacturer's installed design labeled R-Value. 1150.0(c):Minimum R-13 insulation in 2x4 wood-frame wall(R-19 in 2x6)or equivalent U-factor. *§150.0(d): Minimum R-19 insulation in raised wood frame floor or equivalent U-factor. §150.0(f):Air retarding wrap is tested,labeled,and installed according to ASTM E1677-95(2000)when specified on the CF-1R Form. §150.0(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16. §150.0(l):Water absorption rate for slab edge insulation material alone without facings is no greater than 0.3%;water vapor permeance rate is no greater than 2.0 perm/inch and shall be protected from physical damage and UV light deterioration. §150.0(q)Fenestration Products. Fenestration separating conditioned space from unconditioned space or outdoors shall meet the requirements of either Item 1 or 2 below: 1.Fenestration,including skylight products,must have a maximum U-factor of 0.58. 2.The weighted average U-factor of all fenestration,including skylight products,shall not exceed 0.58. EXCEPTION to Section 150.0(q)1: Up to 10 square feet of fenestration area or 0.5 percent of the Conditioned Floor Area,whichever is greater,is exempt from the maximum U-factor requirement. §150.0(r)Solar Ready Buildings. Shall meet the requirements of Section 110.10 applicable to the building project. Fireplaces, Decorative Gas Appliances and Gas Log Measures: §150.0(e)1A:Masonry or factory-built fireplaces have a closable metal or glass door covering the entire opening of the firebox, §150.0(e)18:Masonry or factory-built fireplaces have a combustion outside air intake,which is at least six square inches in area and is equipped with a with a readily accessible,operable,and tight-fitting damper and or a combustion-air control device. §150.0(e)2:Continuous burning pilot lights and the use of indoor air for cooling a firebox jacket,when that indoor air is vented to the outside of the building,are prohibited. Space Conditioning,Water Heating and Plumbing System Measures: §110.0-§110.3:HVAC equipment,water heaters,showerheads,faucets and all other regulated appliances are certified by the Energy Commission. §110.3(c)5:Water heating recirculation loops serving multiple dwelling units and High-Rise residential occupancies meet the air release valve,backflow prevention,pump isolation valve, and recirculation loop connection requirements of§110.3(c)5. §110.5:Continuously burning pilot lights are prohibited for natural gas:fan-type central furnaces,household cooking appliances (appliances with an electrical supply voltage connection with pilot lights that consume less than 150 Btu/hr are exempt),and pool and spa heaters. §150.0(h): Heating and/or cooling loads are calculated in accordance with ASHRAE,SMACNA or ACCA. §150.0(i):Heating systems are equipped with thermostats that meet the setback requirements of Section 110.2(c). §150.0(j)1A:Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are externally wrapped with insulation having an installed thermal resistance of R-12 or greater. §150.0(j)18:Unfired storage tanks,such as storage tanks or backup tanks for solar water-heating system,or other indirect hot water tanks have R-12 external Insulation or R-16 internal insulation where the internal insulation R-value is indicated on the exterior of the tank. EnergyPro 6.3 by EnergySoft User Number: 1315 ID:0140860 Page 4 of 7 MANDATORY MEASURES SUMMARY: Residential (Page 2 of 3) MF-1 R Project Name Date Miller Ave Residence 12/3/2014 §150.0(j)2A: All domestic hot water system piping conditions listed below,whether buried or unburied,must be insulated per TABLE 120.3-A. i.The first 5 feet(1.5 meters)of hot and cold water pipes from the storage tank. ii.All piping with a nominal diameter of 3/4 inch(19 millimeter)or larger. All piping associated with a domestic hot water recirculation system regardless of the pipe diameter. iv. Piping from the heating source to storage tank or between tanks. v. Piping buried below grade. vi.All hot water pipes from the heating source to the kitchen fixtures. §150.0(j)2:Pipe insulation for steam hydronic heating systems or hot water systems>15 psi,meets the requirements of Standards Table 120.3-A. §150.0(j)3A:Insulation is protected from damage, including that due to sunlight, moisture,equipment maintenance,and wind. §150.0(j)4:Solar water-heating systems and/or collectors are certified by the Solar Rating and Certification Corporation. §150.0(m)1:All air-distribution system ducts and plenums installed,are sealed and insulated to meet the requirements of CMC Sections 601,602,603,604,605 and Standard 6-5;supply-air and return-air ducts and plenums are insulated to a minimum installed level of R-6 or enclosed entirely in conditioned space.Openings shall be sealed with mastic,tape or other duct-closure system that meets the applicable requirements of UL 181,UL 181A,or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch,the combination of mastic and either mesh or tape shall be used §150.0(m)1:Building cavities,support platforms for air handlers,and plenums defined or constructed with materials other than sealed sheet metal,duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. §150.0(m)2D:Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. §150.0(m)7:Exhaust fan systems have back draft or automatic dampers. §I50.0(m)8:Gravity ventilating systems serving conditioned space have either automatic or readily accessible,manually operated dampers. §150.0(m)9:Insulation shall be protected from damage,including that due to sunlight,moisture,equipment maintenance,and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. §150.0(m)10: Flexible ducts cannot have porous inner cores. §150.0(n)1: Systems using gas or propane water heaters,whether tank or on-demand,to serve individual dwelling units shall include all the following components A. A 120V electrical receptacle that is within 3 feet from the water heater and accessible to the water heater with no obstructions; B. A Category III or IV vent,or a Type B vent with straight pipe between the outside termination and the space where the water heater is installed; C. A condensate drain that is no more than 2 inches higher than the base of the installed water heater, and allows natural draining without pump assist, D. A gas supply line with a capacity of at least 200,000 Btu/hr. §150.0(o):All dwelling units shall meet the requirements of ANSI/ASHRAE Standard 62.2 Ventilation and Acceptable Indoor Air Quality in Low-Rise Residential Buildings.Window operation is not a permissible method of providing the Whole Building Ventilation required in Section 4 of that Standard, Pool and Spa Heating Systems and Equipment Measures: §110.4(a):Any pool or spa heating system shall be certified to have:a thermal efficiency that complies with the Appliance Efficiency Regulations;an on-off switch mounted outside of the heater;a permanent weatherproof plate or card with operating instructions;and shall not use electric resistance heating or a pilot light. §110.4(b)1:Any pool or spa heating equipment shall be installed with at least 36"of pipe between filter and heater,or dedicated suction and return lines,or built-up connections for future solar heating. §110.4(b)2:Outdoor pools or spas that have a heat pump or gas heater shall have a cover. §110.4(b)3: Pools shall have directional inlets that adequately mix the pool water,and a time switch that will allow all pumps to be set or programmed to run only during off-peak electric demand periods. §150.0(p): Residential pool systems or equipment meet the pump sizing,flow rate,piping,filters, and valve requirements of§150.0(p). Residential Lighting Measures: §150.0(k)1A:Installed luminaires shall be classified as high-efficacy or low-efficacy for compliance with Section 150.0(k)in accordance with TABLE 150.0-A or TABLE 150.0-B,as applicable. §150.0(k)1C:The wattage of permanently installed luminaires shall be determined as specified by§130.0(c). §150.0(k)1 D: Ballasts for fluorescent lamps rated 13 Watts or greater shall be electronic and shall have an output frequency <=20 kHz. §150.0(k)1E: Permanently installed night lights and night lights integral to installed luminaires or exhaust fans shall be rated to consume no more than five watts of power per luminaire or exhaust fan as determined in accordance with Section 130.0(c). Night lights shall not be required to be controlled by vacancy sensors. EnergyPro 6.3 by EnergySoft User Number. 1315 ID:0140860 Page 5 of 7 MANDATORY MEASURES SUMMARY: Residential (Page 3 of 3) MF-1R Project Name Date Miller Ave Residence 1213/2014 §150.0(k)1 F:Lighting integral to exhaust fans,in rooms other than kitchens,shall meet the applicable requirements of§150.0(k). §150.0(k)2:All switching devices and controls shall meet the requirements of§150.0(k)2. §150.0(k)3:A minimum of 50 percent of the total rated wattage of permanently installed lighting in kitchens shall be high efficacy. EXCEPTION: Up to 50 watts for dwelling units less than or equal to 2,500 ft2 or 100 watts for dwelling units larger than 2,500 ft2 may be exempt from the 50 percent high efficacy requirement when all lighting in the kitchen is controlled in accordance with the applicable provisions in Section 150.0(k)2, and is also controlled by vacancy sensors or dimmers, §150.0(k)4: Permanently installed lighting that is internal to cabinets shall use no more than 20 watts of power per linear foot of illuminated cabinet. §150.0(k)5:Lighting installed in bathrooms shall meet the following requirements: A.A minimum of one high efficacy luminaire shall be installed in each bathroom;and B.All other lighting installed in each bathroom shall be high efficacy or controlled by vacancy sensors. §150.0(k)6: Lighting installed in attached and detached garages, laundry rooms,and utility rooms shall be high efficacy luminaires and controlled by vacancy sensors. _ §150.0(k)7: Lighting installed in rooms or areas other than in kitchens,bathrooms,garages, laundry rooms,and utility rooms shall be high efficacy,or shall be controlled by either dimmers or vacancy sensors. EXCEPTION 1: Luminaires in closets less than 70 square feet. EXCEPTION 2:Lighting in detached storage building less than 1000 square feet located on a residential site. §150.0(k)8: Luminaires recessed into insulated ceilings shall be listed for zero clearance insulation contact(IC)by Underwriters Laboratories or other nationally recognized testing/rating laboratory;and have a label that certifies the luminaire is airtight with air leakage less than 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283;and be sealed with a gasket or caulk between the luminaire housing and ceiling. §150.0(k)9A: For single-family residential buildings,outdoor lighting permanently mounted to a residential building or other buildings on the same lot shall be high efficacy,or may be low efficacy if it meets all of the following requirements: i.Controlled by a manual ON and OFF switch that does not override to ON the automatic actions of items ii or iii below,and ii.Controlled by a motion sensor not having an override or bypass switch that disables the motion sensor, or controlled by a motion sensor having a temporary override switch which temporarily bypasses the motion sensing function and automatically reactivates the motion sensor within 6 hours iii.Controlled by one of the following methods: a.Photocontrol not having an override or bypass switch that disables the photocontrol;or b.Astronomical time clock not having an override or bypass switch that disables the astronomical time clock,and which is programmed to automatically turn the outdoor lighting OFF during daylight hours;or c. Energy management control system which meets all of the following requirements: At a minimum provides the functionality of an astronomical time clock in accordance with Section 110.9; meets the Installation Certification requirements in Section 130.4;meets the requirements for an EMCS in Section 130.5;does not have an override or bypass switch that allows the luminaire to be always ON;and, is programmed to automatically turn the outdoor lighting OFF during daylight hours, §150.0(k)9A:For low-rise multi-family residential buildings,outdoor lighting for private patios,entrances, balconies,and porches;and outdoor lighting for residential parking lots and residential carports with less than eight vehicles per site shall comply with one of the following requirements: i.Shall comply with Section 150.0(k)9A;or ii.Shall comply with the applicable requirements in Sections 110.9, 130.0, 130.2,130.4, 140.7,and 141.0. §150.0(k)9: For low-rise residential buildings with four or more dwelling units,outdoor lighting not regulated by Section 150.0(k)98 or Section 150.0(k)9D shall comply with the applicable requirements in Sections 110.9, 130.0, 130.2, 130.4, 140.7,and 141.0, §150.0(k)9D:Outdoor lighting for residential parking lots and residential carports with a total of eight or more vehicles per site shall comply with the applicable requirements in Sections 110.9, 130.0, 130,2, 130,4, 140.7,and 141,0. §150.0(k)10:Internally illuminated address signs shall comply with Section 140.8;OR not contain a screw-base socket,and consume no more than five watts of power as determined according to§130.0(d). §150.0(k)11:Lighting for residential parking garages for eight or more vehicles shall comply with the applicable requirements for nonresidential garages in Sections 110.9, 130,0, 130.1, 130.4, 140.6,and 141.0. §150.0(k)12A.In a low-rise multi-family residential building where the total interior common area in a single building equals 20 percent or less of the floor area,permanently installed lighting for the interior common areas in that building shall be high efficacy luminaires or controlled by an occupant sensor, §150.0(k)12B.In a low-rise multi-family residential building where the total interior common area in a single building equals more than 20 percent of the floor area,permanently installed lighting in that building shall: i.Comply with the applicable requirements in Sections 110.9, 130.0, 130.1, 140,6,and 141.0;and ii. Lighting installed in corridors and stairwells shall be controlled by occupant sensors that reduce the lighting power in each space by at least 50 percent,The occupant sensors shall be capable of turning the light fully On and Off from all designed paths of ingress and egress. EnergyPro 6.3 by EnergySoft User Number:1315 ID:0140860 Page 6 of 7 , HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY Project Name Date Miller Ave Residence 12/3/2014 System Name Floor Area HVAC System 2,206 ENGINEERING CHECKS SYSTEM LOAD Number of Systems 1 COIL COOLING PEAK COIL HTG.PEAK Heating System CFM Sensible Latent CFM Sensible Output per System 31,332 Total Room Loads 1,065 22,945 1,239 786 31,332 Total Output(Stub) 31232 Return Vented Lighting 0 Output(Btuhlsgtt) 14.2 Return Air Ducts 0 0 ; Cooling System Return Fan 0 0 Output per System 0 Ventilation 0 0 0 0 0 Total Output(Stub) 0 Supply Fan 0 0 Total Output(Tons) 0.0 Supply Air Ducts 0- 0 Total Output(Btuh/sgft) 0.0 Total Output(sgfttron) 0.0, TOTAL SYSTEM LOAD 22,945 1239 31,332 Air System CFM per System 0 HVAC EQUIPMENT SELECTION Airflow(dm) 0 Radiant Heat System 0 0 31,332 Airflow(cfm/sgft) 0.00 Airflow(cfm/Ton) 0.0 Outside Air(%) 0.0% Total Adjusted System Output 0, 0 31,332 Outside Air(cfm/sgft) 0.00 (Adjusted for Peak Design conditions) Note:values above given at ARI conditions TIME OF SYSTEM PEAK Aug 3 PM Jan 1 AM ,.HEATING SYSTEM PSYCHROMETRICS(Airstream Temperatures at Time of Heating Peak) 28°F 68°F 105°F P. Y illi i- Outside Air -- 0 cfm Heating Coil 105°F i ROOM 4",r4 68°F 68°F E _ l _ , 4 1 COOLING SYSTEM PSYCHROMETICS(Airstream Temperatures at Time of Cooling Peak) 88/68°F 75/61°F 55154°F aw Outside Air - - ' "c. 0 cfm Cooling Coil 55/54°F I ofc,-.1 46.7% ; ROOM 75/62°F 75/62°F .' I i, 4 EnergyPro 6.3 by EnergySoft User Number. 1315 RunCode:201442-03T09:33:27 ID:0140860 Page 7 of 7 ��ra CALGREEN RESIDENTIAL CHECKLIST— MANDAT ITEMS GENE. CGh>MLIN ITY DEVELOPMENT DEPARTMENT•BUILDING CiVl.S CSM �g GLIPERTINO ALBERT'SALVADOR,PE .C.B G .EuiLD NG GFFlC;.�.L MAY 2 2 201q 5 :OP.=-IE AVENUE•CQ PERT•NO,CAS_.c•:41a-:.2{5 (4Ca: 77-322 2FAX midi 171-1113•bo] -=,�L':'_'et-rt!no.:_a PURPOSE: Y The 2413 CalGreeh Code applies to additions or alterations of existing residential buildings where the addition or attcration increases the building's conditioned area, volume, or size and also applies lo all new law-rise residential buiId_rrgs,high-rise residential buildings, or both. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Pec Name: '{M I LLEFLA-VE. g(bE J C' QD Protect Address: 531-° 14t4AVE . CL1 41 N 0 Project Descriptran7 re) '�i:hoot e Q t 2r6s^,F,f. th µ Instructions: yj /W O ate_ �s ( / 033 1, The Owner or the Owners agent shall entproy a licensed professional experienced with the California Green Budding Standards Codes to verify and assure that all required work described Herein is properly planned and implemented in.the project 2. The licensed professional, in co Iaboration with the owner and the design gyr al shalt Initial Column 2 of this c iecktist, sign and date Section.I-Design Verification at the e,' OlfigltheckliSt and ra.JP TING checklist printed on the approved plans for the project , Building Department 3. Prior to final inspection by the Building Department,the licensed profess' `_,,,'a la,mplete Column 3 and sign and dale Section 2-Implen entation Verification at the end i. 'e, c.list a iii . completed dorm to tate: Building Inspector, " � REVIEWED FOR CODE COMPLIANCE Reviewed By. .5 Column.2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Re u(regi en is A4.1 PLANNING AND DESIGN Planning and Design-Site Development 4.106.2 Storm water drainage and retention during cGnstructlen, A plan is developed ane implemenlerl to manage sto4m water drainage during CGnsttuCtiC1. . 4.106,3 Grading and paw Ing.•The site shall be planneC and developed to keep surface w ter.away from buildings.Constructan plans snail indicate Now site grading or a drainage VYstem% it manage all surface water flows. NECEC I of ok"t' FF ;L C 1( (,'.i;Grrea_:i1�4�lk n.•lte�171 114 i1 . fid. i 4.2 ENERGY EFFICIENCY • General 4.201.1 Lots-nse residential buildings shall meet or exceed the mfr+imy standard design required ty the California Energy Standards. 1 A4.3 WATER EFFICIENCY AND CONSERVATION Indoor Water Use 4303.1 Water conserving plumbing fixtunas and fittings. Plumbing Fixtures (water closets and urinals)and fit-lungs(faucets and showerheads)shall comply ; . • with the fot.liw,ng. c1 i 14,303.1,3.2 Water Closets.The.effectve flush volume of all water Hotels 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 ' SpeciFicatons dor Tank-type Toilets. . ❑ 4.303.1.32 Urinals. The effective Malt volume of urinals"shall not ' exceed 0.5 gallons per flush. • a] �is� ii 4.303.1.3.1 Single Showerheads, Shcerheads shall hative a maximum 'Pow rate of not more than 2.0 gallons per minute at BO psi. Showertteads sha'I be certified to the performance criteria of the U S EPA WaterSense .. Specification for showerheads. . 0 4.303,1.3.2 Multiple Showerheads.serving ono shower. When a • - in"`,iftcfe'er is seree-d by more than one shxxwerhead,the combined r rw rale of all,showerheads ands:or other shower outlets controlled by a single valve '' ,"' ' ''6.shall not exceed 2.0 gallons per minute at 80 psi,of the shower shall be t 0 ,,,�,,(( designed to allow only one shower outlet to be in operation at a time. It 4.303.1.4,1 Residential lavatory faucets. 'The maximum£7w rale of ., :residenlial layato,ry,faucets shall nal exceed 1.5 gallons per minute a1660 - '``-!�'``` 'psi. They minimum flow rate of residential.lavatory faucets shall not be less :s than q.A gallons per minute at 20 psi. W4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common end put is use . areas(outside of dwellings or slerp.ng urL•1s)in residentiat buildings shall . not exceed 0 5 galcns per minute at 60 psi. O 4.303.1.4,3 hlcaterina faucota. Velering faucets men anstald in residential bu•Id:.ngs shall not delver more lha.n 0 25 gallons per cycle 4.303.1.4.4 Kitchen Faucets. The rnaxmum flow rate of kitchen faucets ' Shall not exceed I 8 gallons per minute at 60 psi. Kitchen faucets may r. temporarily increase the flc'w above the max mum rate,but not to exceed 2 2 gallons per minute at'0 psi:,and must default to a maxarum flow rate of 1 6 gallons per minute at 6f1 psi. ...tree... - w*.. _Y • 4.303,2 Standards for plumbing fixtures and fittings. P.umting fixtures and fittings she be Lnsta'ted in accordance with the Ca 1,fornia Plumbing Code: ,u,{ '. and shall meet the appl-,.able standards referenced in Table 140t.1 of the . • California Plumbing Cede • . I'a_a t isf ;. .' �_ c lr;r.v:.1 .:°131.1,,.1.0,7105,11,-,i1f x114.. • i. �,_� a ' d Outdoor Water Use 4.304A Irrigation controllers. Automatic irrigation systems Installed at the toe el final inspection shall be weal.erbased , E 4.305.1,1 Con_tro':lers shall be weather-or soil mo.s1ure-based controllers that automatica ly adult irrgaton i,n response to changes in plants'needs as weather eand:I ars ct arge. D 4.304.1,2 Weather-based controllers without integral rain sensors Of communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the Controperds) Sod mo.5ture-based control'ers are not required to have rain sensor input. A4.4 MATERIAL CONSERVATION AND RESOURCE EFFICIENCY Enhanced Durability and Reduced Maintenance 4.4015.1 Rodont proofing. Annular.spaces around pipes, aiectnc caoles, conduits,or other openings in plates at exterior wells shall be protected against the passage of rodents by closing such openings with cement morar, concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.40®.2 Construction waste management plan. Where a local;urisd!ction dill does not have a construcl.on and deme ition VMste management ordinance,a ® construction waste management plan shall be submitted for approval to the L1 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 lo the bu'din•g 0 0 occupant or owner A4.5 ENVIRONMENTAL QUALITY Fireplaces 4.50 .1 General install only a direct-vent sealed-combuston gas of seared wood.burning f.replace..or a seared woo,dstove. Pollutant Control 4.604.1 Covering of duct openings and protection of mechanical equlpreientduring construction. Duct openings and other related air 0 0 d5fr bution component openings shall be covered during construction. 4304/.1 Adhesives,sealants and caulks. Adhesives, sealants and cau.ks 121 DI shall be Compliant w in VOC and other toxic compound I.mits. 5.504.3-2 Paints and coatings. eamts,s,a.ns and olher cuatin9s snail oe compliant wth VOC li _its. tYJ 4,504.7.3 Aerosol paints end coatings. Aerosol paints and other coal•nys shall be comp:ant with product weighted M.1 Li-nits fur ROC and direr toxic compounds. Poet 3Id.. Ci;.nrLrn_;,�jiil,.�cLtt',Irj J.ri� 4.504.2A Verification. Dacvmentatron shalt be prowled to verify that �( ❑ compkant VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shalt be co ptrant with VOC linitis. 4.5044 Resilient flooring systems. Eighty t80)percent of floor area receiving resilient flooring,shall compty With the VOC-ernissio,limits defined in the Collaborative for High Performance Schools(CHIPS)Low-em:t5ng ❑ ❑ Materials List or be certified under the Resilient Floor Covering tnstitute(R CFI) FaoorScore program. ' 4.5043 Composite wood products. Particleboard,medium densrty fiberboard (MDF)_and harctfood Arwood used in interior finish systems shall Q 0 comply with lcnv formaldehyde emission standards: , Interior MOIsture Control 4.505.2 Concrete slab foundation.. Required vapor retarders,and capillary �( ❑ breaks are also required to comply with CelGree'n Section 4.505.2.1. IJ 4.505.3 Moisture content of building materiels. Moisture content of building : ❑ ❑ materials used In welt and floor framing Is checked before enclosure. Indoor Air Quality and Exhaust. 4.505.1 Bathroom exhaust fans. Exhaust fans which terminate outside the• g l2.l ❑ building are provided in every bathroom. Environmental Comfort • 4.507,2.Duct systems ere sized and designed and equipment is selected using the folrowing methods: 1.. Establish heat toss and heat gain values according to ACCA Manual J or equivalent • ❑ ❑ 2. Size duct systems according 10 ACCA 29•D(Manual D)or equivaent i 3. Sc act heating and cooling equipment according to ACCA 36•S(Mannar S) or equra'alent INSTALLER AND SPECIAL INSPECTOR QUALIFICATIONS Qualifications 702.1 Installer training. HVA^C,system insteOers are trained and certified in ❑ ❑ the proper installation of HVAC systems. 7022 Space!inspection. The Lensed Professional responsible to verify CALGreen compliance is qualified.and able to demonstrate competence In the ❑ 0 discipline they Inspect and vertfy 7 Verifications cat[ofbs} • 703.1 Documentation. Verification or compliance with CALGreen may include construction documents,pars, speciricatrons,bolder or installer certification,inspection reports, or other methods acceptable to the enforcing ❑ ❑ agency vitilch show Substantiae conformance.Implementation verification shall be submitted to the Building Deparinnner.,t afler implementation of all required measures and prior to final inspection approval. Pas ai7f5 • ro:Co:en ..Q,rJa:aeeiiled f1.1ait CALGREEN SIGNATURE DECLARATIONS Project Name: v34 M AOC • 1•Si13e C Project Address: B-34 r v l( �„(E{2- frcyGCS(- 4' O Project Description it • • I . l .. _ +h a S RD A w 114-€41Dr' t{Nrre v,e_wt,- SECTION 1 — DESIGN VERIFICATION Complete all tines of Section 1—*Design Verikatiord•and submit the completed checklist(Calumns t and 2)with the plans and twilling 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 nems checked above are hereby incorporated Into the protect plans and will be implemented into the project In accoedance with the requieetnenis set forth in the 2813 California Green Budding Standards Code as adopted by,he City of Cupertino. Owns Ssiure Date L (,c.:ck owns some unease Pr i:) LZlce t Oevign Prprossionars Signature Date �E•l dor ArI Pc LEED . Design Pro/essloner's Nome (Please Pratt) SAND #S t" 2.1( I9' Signature of License Professional raspoasible for CC:Green corriPiance as (C/ I:;') W53.-- I go8r Name of License Preless44 response for CaiGreen compliarr_e[Reale Printp Phone desig��+� arc,L► . co�vt Email Address for Liam s+s Professional responsible for CaIGwa corec4ance SECTION 2 —IMPLEMENTATION VERIFICATION Complete.sign and submit the competed checklist,including column 3.together vett"all original signatures on Secton 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 protect identified above was constrvfled in accordance with this Green Bui.•.ding Checklist and in accordance with the requirements of the 21113 California Green'Building Standards Code as adopted by the City of Cupertino]_ Signature of License Prn'esscnal responsible forCalGreen compliarce Date Name of t,cense Professional responsible for Ce.GYeen compliance;Please Pnni) Phone Erral Address for Icons°Prpfes*i*nl re-40tsrble rer CAIG(een compliance fade f n f S C ?Crean._:01 JIcic rn ued 11.64�l 7, -:--: \V - OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �ST,sa 10300 TORRE AVENUE•CUPERTINO;CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildinq(a�cupertino.orq -- Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property -.::'improvements specified-at: SITE ADDRESS .APN-:. BP# R' :.OWNER NAME , OWNER ADDRESS:: - ....,.. Lu..C.,�. 1 ,W ),HCtO Dir l-shim C Surro yve+lz C/1 €4jUr: ' DESCRIPTION OF WORK: V.411.C.(oSe- (A kr i'ir', rJGq.:c. \—1 i-114le '1 40..,1(ni 19 0-ti4.-t • •y' We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed,and - returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) )'1 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- :der" building permit that erroneously implies that the property owner is providing his or her own labor and material prsonally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an nlicensed person and his or her employees while working on my property. My homeowner's insurance may not 11,,,r, provide coverage for those injuries. I am willfully acting as an Owner-Builderand am aware of the limits of my insirance coverage for injuries to workers on my property.W2'4 2. I understand building permits are not required to be signed by property owners unless they are responsible for the;construction and are not hiring a licensed Contractor to assume this responsibility.A�Yy °1 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. . 1 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license nuitubers on permits and contracts. !IA� If 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the Vail value of my construction is at least five hundred dollars ($500), including labor and materials, I may be o_r) idered an "employer" under state and federal'law. 41 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and i.,- federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to ' unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject rule to serious financial risk. '"4 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family r s1' ential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by li•erased subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is 1rformed under contract with a licensed general building Contractor. 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for al 'y financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 7'W IIlir .-,,,'' 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal ReVenue Service, the United States Small Business Administration, the California Department of Benefit Payments, ;,,, P Y , andythe California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed Contractors. _ V:4 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I ,mthe party legally and financially responsible for proposed construction activity at the site address listed above. 1 ', 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide Yq all applicable laws and requirements that govern Owner-Builders as well as employers. '4,412. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the - in;or ation°I have provided on this form. Licensed contractors are regulated by_iaws designed to protect.the.public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint..-Your only remedy against unlicensed .. Contractors maybe in civil court. It is also important for you-to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you..obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not-- those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to yeti the .ro•ert owner's si•natuFe. Property Owner's Signature: s4" qt-27.7g000 Date ---'5/F2/ls (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: - Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 (.,UcA c& Lew" g \\-6v Ave-. CJS p.e,(k;r,v, C(sv Vhf-Ks-f'er -fi )2 /in I 2 0033 �, k X3 Csy,sfi-1,6„ 6--)-►r l o c a..\-z cA U k r3 11 or rs ve. G v 12,24-+irk), Gly ci S—c)l . 8'J 0-c) 15 RECEIVED AUG 2 O 2015