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B-2016-1356CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1356 7512 DE LA FARGE DR CUPERTINO, CA 95014-4361 (359 26 033) 1FRANOV OWNER'S NAME: PADMANABHAN SIVAKUMAR AND MANOHARAN UMA OWNER'S PHONE: 408-396-0958 LICENSED CONTRACTOR'S DECLARATION License Class 5 Lic. #BB2794 Contractor FRANOV CONSTRUCTION Date 12/31/2017 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 �R-Ze a . of the work for whieh this permit is issued. T_,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 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. Sign t rua e c tom' S Date 10/24/2016 hereby affirm that I am exempt from the Contractor's License Law for one of the' illowine two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (See.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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 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 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 10/24/2016 CA 94030 I ISSUED: 07/15/2016 PHONE NO: (650) 258-5646 BUILDING PERMIT INFO: X_ BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: ADDITION (954 SF); CONVERT 94 SF OF GARAGE TO LIVING SPACE; REMODEL ENTIRE HOUSE (1287 SF) REV #1 - REMOVING SKYLIGHT(1) & SMALL FDS;ED WINDOWS (2); MOVING BEDROOM WALL; ADDING TANKLESS WATER HEATER ISSUED 10/24/2016 Ft Floor Area: 954 I Valuation: $250000,00 APN Number: Occupancy Type: 359 26 033 Deferred Submittal (R-3),R-3;(Cust6m) PERMIT EXPIRES IF WORK IS NOTSTARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: KIM DUNI3 Date: 07/15/2016 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 ofAppli'cant: Date: 10/24/2016 COVERINGS TO BE CLASS "A" 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 255534. Owner or authorized age' nt: f S C — Date: 10/24/2016 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 ARC'HITECT'S DECLARATION I understand my plans shall be used as public records. Licensed .......... CUPER.ittita hT-\zt MTvCTRT i('TThT\i rw — CONS—1 RUCTION PERMIT APPLICAT [ON COMiMUNITY DEVELOPMENT DEPARTI\4ENT a BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 98014-3255 (408) 777-3228 • FAX (408) 777-3333 bulldlno(pDcuaerlino.org I I DDITIOI\ 17 AT_TERATTON TT C1RT(i\1LT PFpr.hrT - L W, ^735- PROTECTADDRESS X75-)2- 1:)F- I -F) FORaE DR, CLY ER'7)N79' fiPvr ` 9y coGIST )4 0V,,-ER-.1A;-i,t {Vj)KUMJL)R T f -).v mA?lfd')dFIA oJI PHO?�EE - �6 ��56I E't� k1L t M,5SI'VA@ ad, 00. to P} UMcif )TRA I STREETADDRESS ` 512 'E) F Lf-)- r1�)'RG P- .)R CITY, STATF,ZIP CUrEkTwo, C(-)/ 9501' y I FAX CCINTACTI AMIE ,:J W O K U m R R f M� U�� F) f� I 1-r.0\"E ( m J STREETADDRESS 7 jq !I)l= Lg PRR60- bg CITY: STATE, ZIP CU P2t'2`rimo, CR Q O 1�- FAX 11 m -\'ER. ❑ ORfiEt-BUTDER ❑ OV;'NERAGENT IK CO\ RACTOR ❑ COh�ACTORAGEI\'I ❑' AP-ChTtECT ❑ EI:GD\ttR ❑ DE\ -ELOPER ❑. TENANT COTT .4CTOP. A JE BC>R I_5 )2RO )!!Q V LICE SSE l L� BER O 6 9 '] R 1�o ( LICENSE TYPE BUS. Lic r COl4P-A YKUME FRk)rtoV CON57RUC-Mop, E-31L4_rL � Y'G'1nL9V s �.� I FAX STR=ET _ J)DRESS 6 2 7 c.%j-)N7'0 SUS 91\10 AVG I CITY, STATE, ZIP M 1 L -L )3RD g C)9 '?4 030 I PHONE �✓� ^ 2`�- �� zi6 .-^.RCHITFCTrNGINFER NA -','F Rp,\l C-)-) LICENSE I\1P, BER C- 6 S I S � DUS. LIC = COuP YNAh,E s E-IJi�IL �r)'� S �Z�t? QIl?�Q� �t?� I FAX STREET ADDRESS 15 3 2 t R HT A V e CITY, STATE, TIP (. L)1 C2- RT j N 0 , C0 - 95M11.I PHON:':' Ol e'a 712--3,946 DESCP,PTION OF )FORKnn N {j�� Remc)rinq JkLl11'p LNk6oryl % Ln RG t�2>yti n � (7 r�aa 1� CJ ,s' �-t t�2C 0-41 W e0 O)C) co'=a 0 K t' k 0 n_ _ 2 V v EXISTING L'SE - PROPOSED USE CONSUL n?E _ STORIES ( ( USE TYPE � OCC, � SQ.FT. VALt:gTiO?\' (S) EXISTG \rW FLOOR I DE?✓,O TOT Q,L AREA P3 A I! AREA NET AREA I -I BATl-ROOA4. - KITCHEN OTHER _ R.2\40DEL AREA I- REil40DEL AREA I REMWEL AREA PORCHLREA D CKAR-EA TOTALD_CKTORCHARi=A GARkGEARF : ❑DETACH I ❑ ATTACH DATLLL'\`G UNITS: IS A SECOND UNIT ❑ YES I SECOND STORY ❑ TE.S - BEING ADDED? ED NO . ADDITION? ElNO PRE. _p LICATIC'\ ❑7 cs. IF` ES PROVIDE COPY OF IS THE BLDG AN ❑ YES RSCE D E. TOTAL VALUATION: \ O "\LGP I .m N = By my si_ma—mre below, I cert i}= to each of the following: I am the property ormner or autho' zeda� t to z on the property owner's behalf._ I have read this application and t e.-Ymnmtion I have provided is correct. I have read he Desc iption of \fiork an verify it is accurate. I agree to comply with all applicable local crdm nces and state Ia\,,s relating to building const act?on. I authorize representatives of Cupertino to enter th above -identified property for inspection purposes. 9 Date: bL I,& .re•�g _ 1fr lid a i (Q SignatrofApplicantent: SUPPI.ElMENTA L INFORMATION REQUIRED Q > ' ` ` PLS\ CFIECh TIPS .,:. ,, 1.ROLTING SLIP.n �e,ay SFD or A u1 1V. =aniily d-wellincs Apply for de ;tolition p reit for _.. - IOID� DerT Irt I- to ISs 'ance,ofbllilding �x E O\ ER TI- COL -'\T 'RDL.iL � e sic D� b= t5�. olltlOn p ,, cOL i p:IOt der I,t Ter ne\\y building. E�PRE�sPL \ s \L G i . \ E COInme-cial Bldzs: Provide a completed Hazardous 3\4aterials Disclosure D sr.6 _ Sol ilI if any razardouS 1\4aterials are being used as pa,i of fla:S p oj st. ❑ 7 iRGE 3 F FIP DEPT Copy of Planning 5.pp.o\yaI Letter or l\feetmQ -with PlanninQ prior to ❑ L�JOR � S�iIT9R1 SE\\ERDIcTRICT f submittal of BuildlnQ Pernnt application. x 5. -TAL = HE.4LT$ BTdgA'pp_2011.doc revised. 06121/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1356 7512 DE LA FARGE DR CUPERTINO, CA 95014-4361 (359 26 033) FRANOV CONSTRUCTION MILLBRAE, CA 94030 OWNER'S NAME: PADMANABHAN SIVAKUMARAND MANOHARAN UMA DATE ISSUED: 07/15/2016 OWNER'S PHONE: 408-396-0958 PHONE NO: (650) 258-5646 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. # 6 7 4 Contractor FRANOV CONSTRUCTION Date 12/31/2017 X BLDG ._ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X 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: ADDITION (954 SF); CONVERT 94 SF OF GARAGE TO LIVING I hereby affirm under penalty of perjury one of the following two declarations: SPACE; REMODEL ENTIRE HOUSE (1287 SF) i. 1 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. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area; 954 Valuation: $250006.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances' and state laws relating to building construction, and hereby authorize 359 26 033 Deferred Submittal (R -3),R-3 (Custom) representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence the granting this permit. Additionally, the applicant understands and willl comply with all ll non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. �5 ` Signature " Date 07/15/2016 Issued by: PAUL O'SULLIVAN Ll t -Jt u, va ✓ Date: 07/15/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. 1, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all. new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 07/15/2016 I hereby affirm under penalty of perjury one of the following three declarations: 1. 1 have and will maintain a Certificate of Consent to self insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall;not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Sections 25505, 255 , and 25534. )r be deemed revoked. �j �j /8��, VV S11 Owner or authorized agent: _ ; " APPLICANT CERTIFICATION Date: 07/15/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 07/15/2016 Licensed Professional �yT.39sr.,. CONSTRUCTION PERMIT APPL[CATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building cDcupertino.org NEW CONSTRUCTION X ADDITION X ALTERATION / I'I ❑ REVISION /DEFERRED ORTGINAr. PERMIT # PROJECT ADDRESS r� APN # OWNERNAME f PRONE E-MAIL STREET ADDRESS ,., CITY, STATE, ZIP �yy gAX CONTACT NAME AAV Gtl4c PHONE f f . % Z � E-MAIL p G"o� S STREET ADDRESS CITY, STATE, !3FAX ❑ OWNER ❑ .OWNER -BUILDER 11 OWNERAGENT ❑ CONTRACTOR 11 CONTRACTOR AGENT ❑' ARCHITECT ENGFNEER 11 DEVELOPER O TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUs.LIC .4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT(NGINEERN ACENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF 1VORK ISE) EXISTING USE - PROPOSED USE. CONSTR. TYPE N STORIES - n _ 1' Y I USE TYPE OCC. SQ.FT. VALUATIONS) EXISTO AREA NEW FLOOR AREA DEMO TOTAL AREA NET AREA F - BATHROOM KITCHEN - OTHER 'REdiODELAREA REMODEL AREA co REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGB AREA: EIDETACH Ir TACH I +10 is DWELLING UNITS: ISA SECOND UXI T. (D YES SECOND STORY QYES. - - - - BEINGADDED? NO ADDITION? ANO PRE -APPLICATION RYES IF YES, PROVIDE COPY OF PLANNING APPL # PLANNING IS THE BLDG AN © I'ESRECE[ B - = TOTAL VALUATION: UNO APPROVAL LETTER EICHLER HOBTE? RNO ,� 611 By my Signatole below, I certify to each of the following: I anti file property wv;Ier or auth a ge to ct on the property owner's behalf. I have read this application and the information I have provided is correct, uetread the Description of Nark and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construe ' authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 2 I3 SUPPLEMENTAL INFORMATION REQUIRED Q rPL 41� CHECF._'I'YPE .�„s ' _ � ROUTI{\G.SLIPp. New SFII or Multifamily dwellings: Apply for demolition permit for i 7 O existing building s). Demolition permit is required prior to issuance of building ���� T� cou�TER € r BUILnI�GrL�i RE�7s5i P ellnit for new buiIding• i. EXPRESS _ "``:` - x ❑ PLAL"\:rl\G PLzI.i� REI I):R - __ Commercial Bldgs: Provide a Completed Hazardous Materials Disclosure 0 ST�D4RD ffg ❑ PUBLiC�iORhS fori i if any Hazardous Materials are being used as part of this project, � �! nEPr LARG> FIRE _ Copy of Planning Approval troval Letter or Meeting with Planninprior to s. P L7 nsaaox 5A�ITAR] sE11 ER submittal of Building Pernmit application. - IlISTRICT yIE\�IR01A4ENT4LiIEAI.TH _ :.:. BldlaXpp 2011.doc revIsed 0612 1/11 kr Building, Department, ON"Of"Cuperfino 10300 Tom Ave. Cupertino, CA'95I Proposed Addition midRemiodefing at 7512 . , La Farge Cupertino. t FOOTING EXCAVATION (GRALDE REAMS & SPREAD FOS MN PREPARATION OBSE RVATION RFTORT Dear Six A E S EVG—LW .INC., has pro-vided hispection sei vict fog f o hi"ion and prMaration, Fooft depthwidth wm excavated. ata . in accordance with approved foundation plan, and s4veifications. ` ycm il conditions ofemeavated foundation are beyouddesign bearing capacity, and acceptable. Any questions, please call our OfficeouT convemence., CAPEX ENIGINEEP 6 NC.. rr u . m1-3sy AP XEN IN V PO BOX 14199, rR:iT, CA 9539' TO,; ('510) 668-18115 m (,5j0)490-8;690 Cietob 5 0)490 - too r 19, 2,016 Building Department PrqJect No. 10277 city, Cupertino 10310 Torre Ave. Cuper no, `A95114 Subject-- Proposed Addition and Remicde Dear Sir: CAPEXENGINEERING; PVC, has provided observaidan service or site d r ol t ong primate and final grading of InWding pad.. On the basisof our olnervation mid testing W concluded bi ire pad, mpaw a operation. was performedin general ordanc i1 recommendation � f sell r po� and compacted to a "Immurn Of 90% relative mpti you haveany tt s-to & plea contact our office at your conventence, Sincerely, s Principat -2& i,& - 1""J5"." FILE -Date: 01 /06117 . , � __.- t 7 To: Community Development Department >F City of Cupertino 10300 Torre Avenue Cupertino CA 95014 From: Ray Chen 384 Stowell,.Ave., Sunnyvale Ca. 94085 Subject: Special Inspection-ep Xy anchors Project Address: City Building Inspector Per specification of the Plan, the project engineer performed a field inspection to verify the epoxy anchors, holdown locations and epoxy connection process. 1, The special,.inspecti.pA pxovided was only far_boldown anchors on,.the existing. concrete -foundation. "based -on walk-through observation, the 8 epoXy anchorage assemblies were installed per the recommendations of the manufacturer. Their embedment was more than 13" specified on the approved plans. Anchorage epoxy assemblies for anchor bolts were completed before this inspection. If you have any questions or concerns, please contact me at 408.524.5488. Sincerely iay Chen i' t�SS � yjr Building Department City Of Cupertino 10300 �'orre ����u� _ Cupertino, CA 95014-3255 I Telephone: 408-777-3229 I Fax: 408-777-3333 ICUPERTINQ CONTRACTOR f SUBCONTRACTOR LIST PERMIT # JOB ADDr— PHONE # & - OWNER' S NAME: CONTRACT l��"i\6� _ �'Tl�� BUSINESS LICENSE # GENERAL CO CITY/ZIPCODE:! a ADDRESS:' ,A- *Our municipal code requires all businesses working in the city to have a CityWILL BE elicense. SCHEDULED UNTIL THE NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) iVI GEN CONTRACTOR AND AL URAL 'L SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO - BUSINESS LICENSE. I I am not using any subcontractors: Date Signature applicable subcontractors and complete the followfn information: p g Please check app ' BUSINESS INCENSE # BUSINESS NAME t/ SUBCONTRACTOR�- �ka� Cabinets & Millwork � /lji�d�� 1 Cement Finishing - a5' M7 f Electrical V/ Q � -1 4 Excavation Fencing Flooring / Carpeting I Linoleum / Wood Glass / Glazing Heating Insulation St) (f % �` "T j '� / /JC 0 Y 6 Landscaping Lathing k,`A P6- tO d Masonry Painting / Wallpapers ^�1 Paving Plastering t)0f A- &A572-7 �tf&— 6 Plumbing X Roofing Septic Tank Sheet Metal Sheet Rock Tile �5 %l- 17 b do Owner / Contractor Signature M N q63 Z7 you 3 8 4iz-y y 17 Date C elL CALGREEN RESIDENTIAL CHECKLIST — MANDATORY '1,....11)451: • ITEMS ,a0110-13CC° COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINo ALBERT SALVADOR, P.E.; C.B.O.,BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAx(408)777-3333•buiidinqacupertiino.orq PURPOSE: The 2013 CalGreen Code applies to additions or alterations of existing residential buildings where the addition or alteration increases the building's conditioned area, volume, or size arid also applies to all new low-rise residential buildings, high-rise residential buildings, or both. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: Si VA e i T/A f-- REi(702') / . i 7�.c' Project Address: 7j""/2 2e7 L.A f ' r Project Description: Q.2) L l A7).)- 7.70,.; Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional'experienced with the California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project 2. The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 -Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2-Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Re•uirements A4.1 PLANNING AND DESIGN Ft 1 .yq• v-f'p !t y'1` '(R +.4•,``i- a....tr'S.-. x.�:P tt 1M h 4 S d Y'- L r'T ..SC Ctk 1 E kX?p.-f"r L .r ° �, 7y.�s, SY ar tiF; ra s AW =04 ;i .aa „-",✓.) rc "tv >� F,...�.°t,.: ! _r.,;rv. t,.,:?�.`r"?r .a.p..' ^7i,. :lw.s.::�T`.c'.S�`+'s4y' s'c'"y �:'���' 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during construction: 4.106.3 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. ` CUPERTINO Building Department REVIEWED FOR CODE COMPLIANCE r Page 1 of 5 Reviewed By:Phuong Devries CalGreen_2014.doc revised 11/04/14 Date: 07/05/16 A4.2 ENERGY EFFICIENCY Yii 4. sxi < 0-v : 4t--,-A- -4 -.4,..6,6,„-',,,re",;, .,r.*L'�.• 3 } nr r �j t' `-N VErk r � y'r1 ,-A , "t4 / . -., =ti .Rytg,t4g4: ti - � i 'twwiilr W 'R, Ze r4w. � 0.l � r : if,*4 4 h : �£ in5� .: g3 ,, - Kt1a. 4201.1 Low-rise residential buildings shall meet or exceed the minimumI standard design required by the California Energy Standards. D A4.3 WATER EFFICIENCY AND CONSERVATION s:„.:, ,ti ,- S P'.--' t/$ 1vip. ” •kL"3VAC-P` s''fir y� }ai i-arT'�41tit cc 2"'� krk 1�F`xs _l' i k } Asa 'z'�ti- n f:Ls• 'S 1 s Li'�..v� P• `� ,k 4.s '�i g -f 9�T. _7•},.- rl,tf, F''4'y 4 9 c n .:-1 7 7¢ ¢ x,054'' a -tirvYK ^(.� �R J S fry s.P Y ;tit 4.4-= k4 1 Ql 5 ,s - z.F*',1- iV t'e.�- °rC.f a_. t`i'. .;7^'.�'t :.Ai..,.a Y..c. .9..� rt cJ 3- .Vii".. krry.-aesF.s`i, fY .+s +g_,r :,4 s�vr ,. y s _sr> +:"t' ,�, k''e y,.,t' -. i r t?i. $` -.?; 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings(faucets and showerheads)shall comply with t e following: 4.303.1.3.2 Water Closets.The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank-type water closet's shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank-type Toilets. 0 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. Ici 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the,performance criteria of the U.S. EPA WaterSense ,., ecocation for showerheads. lid'4.303.1.3.2 Multiple Showerheads serving one shower, When a shower is served by more than one showerhead,the combined flow rate of - t77 all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute at 80 psi,or the shower shall berii designed to allow only one shower outlet to be in operation at a time. 14 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less t n 0.8 gallons per minute at 20 psi. 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas(outside of dwellings or sleeping units) in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. ❑ 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. tO4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets i shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, and shall meet the applicable standards remoras] in Table 1401.1 of the IP 9/ California Plumbing Code. .` :": , Building Department REVIEWED FOR CODE COMPLIANCE Page 2 of 5 Reviewed By:Phuong Devries CalGreen72014.doc revised 11/04/14 Date: 07/05/16 p�`� .;J n" i�t3}v 't"'q.i= S ):VkiV. -�,} *§t 'u,, 24't 4*,'£v.. �'�s^:;- 24 kr 5 PtA'jg.' Wtt� 9`�V'��A'ft f 4 z,.rx`a y ;i -4 rps Etn y'r' r -. m.n�Y - 4s-,' cl^.aoA,„V .,.'�6+'�:�.r lY' ' -'. 3''i Yir. {� - t, R:x.}, -z. .0 r, n"S. -F gtt r3 - h eas c s avv S 4� tk y adh 2 , ` � , 4' a 4. '34- -. 45 a l z� . 4 'tvy r`4-", i' Ntz q sfz` %��yb x c 5+ s ! n e 'may y.4}. -' ,r ' .n#;+:a 3?hxr ii ,��+h.'t-m=t„��'.r���.fiF=- �!"�"�;:��.;Y .�r;:a�,..�..�.,zx�, X„-*�.�”.- r'�f ,e�s��.'�. .kh _ .�:i�k ,��• •,. ,.� ->w �:r'��' .. 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the . time of final inspection shall be weather-based. 0 4.304.1.1. Controllers shall be weather-or soil moisture-based controllers that automatically adjust irrigation in response to changes in plants'needs .. as weather conditions change. A ry� • in 4.304.1.2 Weather-based controllers without integral rain sensors or J"'" communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the controller(s). Soil moisture-based controllers are not required to have rain sensor input. • A4.4 MATERIAL CONSERVATION AND RESOURCE EFFICIENCY & o-zw?,, ,,„ r,, . " .'',,." .i. r ,, ,`,x ': 0... wzo, ',i.44 _ate ` Q C s ..a,y ° r ; ,,T ,41, 4.. -01 s 4 n s 3 'S P r kier4. f x 4�irt-Z- e{ .^ l'3 "`r NAci ,li i',e b ` 'd 1i +�y ,. y5.r t_t r :. a,.'vk 'N• YaT 4-T i n $ r, 3.ro.:..;E 4-'r,',.,: ...."-.`7t.�?,:_ -.. jt-M,. :' o- i. ..F �,..tit �s. .,�.. . .FR -�.t'.. ��,: 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, . conduits, or other openings in plates at exterior walls shall be protected against the passage of rodents by closing such openings with cement mortar, Jam! concrete masonry or similar method acceptable to the enforcing agency. ''" :fa, 4,g - ..„n*-t .-gTa tr. 3. rS'#?'l' a..11.v ,max.;.. ,_ .+,, g -t.'w i� 4 f t.y,:,. X`s '.cSSrts. 4,�A gi l i x'4',vr a ,k `i Y`r<7 4 ia. y; Mt' r .�-� ifY r �4-a .r-�.fi�'St���S#'•,,.» s+. ,t"�h� �.:?3� r - y_ ,r.k ° -ti+. '� c.fi a3:`+ 1 K 'n ,� �.. ."a�j, f .YY ky jz4 5x-"_ FCJx q 'g Yy`„1„,„„ < E Sa 61�.: �5; u 2 1Y n,•%.✓ r r:5�- �A,:4.1, ..,.3 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance,a ❑ tiri construction waste:management plan shall be submitted for approval to the enforcing agency. , h ,{t t''Y.r r ,, 'u.c:.• aZ mt,, yt.`+•rt''4,g.!t,- ¢ E' ui ° r'�+,v' ,„e 3N,k,tt>'k?t-.;}F. "�"t... .,`. ,]F.a .� Ye„s's-,` '"y. .3 . dt + m'7''31 ?}«.t :.J. n”, n:t,`'h Y �Z-S a�ri y� ,r 4-t 3t f,r aa'• :. '(; b .:>3 i Ott a-- ;y��w[ " s 4-a»W £.71-‘,4,-, `' t� +, ;c'y,,:s.J `r'.Ait.,'r'd-, t..,A1-,,,k^x t �era'rJ ea,1-,,�*o- t,' eo,, , :i t:�2:, p war�,<..,;Tr :,, x_ ." '.�..5..4WM: a ,,.:mfr.'s' 3 iI Y, YFr1. _,;,,Ve l.,a 3%Y E.v',` ,><l14 - ..a: -'�Y?R_. ... 5,..,� F# iJ ,;.J,;c 5,:� 'moi . I 4.410.1 Operation and maintenance manual. At the time of final inspection, an operation and maintenance manual shall be provided to the building rit II occupant or owner. i , 'i A4.5 ENVIRONMENTAL QUALITY x E++. C. k w ; 9,t w.<g2 x y.,�cdW , .r° s +fix &Y+ • �' 7, t.•VI +� rg t'k',�*J, ,. , ,4-.t Q:q°+1. }t X .w.,,,. .,...,..:.; ' 4. J'�r" y�,�}�. �t���}�., `� '�� c'rf7 Fr-s�+�w,. �J�}.�c�a�`�.� i aF z.�� s e�y-4"°"0 � J�xr't' o-„��,��E����-. o-'�w,6+."�'. 1 kis �R.,r3 zi' ti +'4.,% H 3 ( .1 t!V" 7'k1<+.' '.l Y`59.v. }r r; t g r>. moi#'` 44-4 a i �Y 4.F+..+�rr.. i'•ro +:M `'q 7. S ,4- 'r• . t ialY`:',"e.• `r* ,7 r4-�`<M'`t 9cc'1 +7s�n`,547-`i rah,."5 k't- }o„�'«WAN-Wse '''`'S yP'''aZ .S--cr<�xa,,t,K 'k Mss `c Y"4400i;„� IWV M yj "t`::4!,00,%, .� 1 K T �v. .'r �'a a.'�4...- ,i ,H.+��iGY .1r✓' /Y. 14.503.7 General. Install only a direct-vent sealed-combustion gas or sealed �j wood-buming fireplace,or a sealed woodstove. �+ ' . .s•,z ,V'',0'Y41 4 ti� t- ✓ir -t, r �5r� M. p : ay ) 4§4,70n -q, 04-ri , ' , ;0-. , - 7 4 L� a"yyd �siiS,,A4.- Ley&AOV4 4M a iWxAg, kte , 07f ., , ku ?' J -v -'Px � } . t' a,A- : . (Rik;.+iirfZ :: . ;.`Yt ; , i , AL r` ,-.4a.j 4.504.1 Covering,ofduct openings and protection of mechanical I equipment during construction. Duct openings and other related air distribution component openings shall be covered during construction. ,10/ 6 4.504.2.1 Adhesives, sealants and caulks. AdFiesives,sealants and caulks shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints,stains and other coatings shall be6, . In compliant with VOC limits. j r: T}� q 4.504.2.3 Aerosol a .ints and coatings. -.7� . .40t ir�in shall be compliant with product weighted ' ', . s or e n otEei xi compounds. Page 3 of 5 Reviewed By:Phuong Devries Cal Green 2014.doc revised 11/04/14 Date: 07/05/16 j • 4.504.2.4 Verification. Documentation shall be provided to verify that compliant VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with ❑ »,/ VOC limits. 4.504.4 Resilient flooring systems. Eighty(80)percent of floor area receiving resilient flooring shall comply with the VOC-emission limits defined in the Collaborative for High Performance Schools(CHPS) Low-emitting 0 Materials List or be certified under the.Resilient Floor Covering Institute(RCFI) FloorScore program. 4.504.5 Composite wood products. Particleboard, medium density 0 fiberboard(MDF),and hardwood plywood used in interior finish systems shall 112/ comply with low fomialdehyde emission standards. _� J�. �� ..ii AYE.s k ,, .•sifY fy S" W'�L� .,+) i,¢">.{ -fid(Ss`E'e}� � 7 Y F � i'3'4'.. tr t Iv j9i:` {,�F'�i' aLL 'f dt 'lvy.t s jy v� ✓els. s �F f s a a sjyS ' j F atFY s y^._ i �� µF Y gg ,�ia✓ c;Ft:.�. �j�`�,7`,,,.at.ayat �-.'-�r��,.i":(I .: 4.505.2 Concrete slab foundation. Required vapor retarders and capillary ❑ . breaks are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture'content of building materials used in wall and floor framing is checked before enclosure 1x' _f z,O - . tis ? " -�0,10151�3. R a 2-„r.: .W , :a � - R a .c Y a�`'�'�,r'[� .a'`� t`}�'N0.F c t`�t�aa >* �,�”S .� a �f 40d 'y ustrr r r ti w.r# ,r ,.#,� 5 tel. y4 5.,. k o^r s x s'k�i ,�,.v.` �1' �R.S 5 a"Y•. Ass"'°»,� .L t �- rs.'-ht7�N ,�'k h,q�1�4 ��.1�^'A '�� t.'���{a ay,e. �f� � ', f. :r .n.k4`:='t i `�._..;•� +f• !n 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the building are provided in every bathroom. ",y .tk1 x , f , •a u a f�C fi- 3sf t i�` �t . ,� �. w� ; LSF .l$ '�. r`".i J7 �'Fi '.r"i `" r SP a rs . r�r . � A i .•_:-; , y' ::+. u S,'a. ,.r,F xr psi. riMt^emil',4 :K,z r^$ i` __rlrl i n as,`�`-astA,V7 ' �<a S ;.. • P�. �4� $ �'ix.z a � f .: `+ � fid• ''``�-I� � y�� � '`'.sC Y: a.r Ax +�r-Yr.. �c � 3 448 Y � �� 4 +.� •�- }y � } k 'i,- �' ka'mv � ^h, ;rza.„., '''x.'n':.Yc.,s�x'r:-�ls. 4 a 4.507.2. Duct systems are sized and designed and equipment is selected using the following methods: 1. Establish heat loss and,heat gain values according to ACCA Manual J or equivalent. fa/ 2. Size duct systems according to ACCA 29-D(Manual D)or equivalent. 3. Select heating and cooling equipment according to ACCA 36-S(Manual 6) or equivalent. INSTALLER AND SPECIAL INSPECTOR QUALIFICATIONS �' 'Zdr.1'f.",�F '*.t ,!t3F� ''w � ?, ,•S-p+:r .-t -.iafr� �4R;;-t ,� s, 4��- •'x,;`a 2fhryx,.en -s'.: r ,� y k.K- ra�s -�;�:. 702.1 Installer training. HVAC system installers are trained and certified in ❑ the proper installation of HVAC systems. 702.2 Special inspection. The Licensed Professional responsible to verify git/ CALGreen compliance is'qualified and able to demonstrate competence in the discipline they inspect and verify �7 d F -, .rs "",1'i t, a"J }ti*'Y.vt i 1,8,N YCz+%. t tt'"4�-i���h M_ 'r r.. f�a.S/i`”`is�,-X.W,%f it ,s.ra :}-4 x x's'-r s�� ,Wla-ts.[t,^W. 4rd ::i-� t��'f '"c li..r � -}�,. x I��i '�� �� r"�c F"C. a3 5 � �;L p �:p�:r �s�s ��'i��.�nC�ss�^iv�"�*..,= ii�.+tryfi� �; ttt # Itt `.r?``"ot s s 2 a^# U�y75 f 'L i+'IPS �5�. 741,5 xs .14 .t x-'3 y y . "fF'1 i1 rs a; :� � tit N r � �-�' '�✓ ^�' t y b ".f - 5�C - ;..� k. s �^�, ! �' .�'� +4 �rR •� y'� 703.1 Documentation. Verification of compliance with CALGreen may include construction documents, plans s• 14 .ns builder or installer certification, inspection reports,or other -j: *1 emcee ffi, _ °ingra/ agency which show substantial conforma rt en ianrificafon shell be submitted'to the Building,Departments= � „ measures and prior to final',inspection ap• REVIEW CO-B-E CO l* CE Page 4 of 5 Reviewed By:Phuong Devries CalGreen 2014.doc revised 11/94/14 Date: 07/05/16 CALGREEN SIGNATURE DECLARATIONS • Project Name: ; '/ zsr-r y, Roe,w- Jr Project Address: ZP/2 t- - Project Description: �ri�1� .. fr ���-r�F�ht r.� liktP•SrRe r1.T'e- SECTION 1 —DESIGN VERIFICATION Complete all lines of Section 1—"Design Verification"and submit the completed checklist(Columns 1 and 2)with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green.Building Standards Code as adopted by the City of Cupertino. Owner's Signature Date cii ignro tf R)N Owner's Name (Pleas int) .21/ //.4 Design.Professional's Signature Date y CA/EA/ Design Professional's N (Please Print) '°79 ‘ Signature of License Professional responsible f CalGreen compliance Date / Poesy � e �f Name of License Professional responsi le for CalGreen compliance(Please Print) Phone r License Professional responsible for CalGreen compliance Email Address fo SECTION 2— IMPLEMENTATION VERIFICATION Complete,sign and submit the competed checklist, including column 3,together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. t have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building _ = - as adopted by the City of Cupertino, Signature of License" ofessional responsible for CaiGreen compliance Date >ic '4.K y'0P-,66 ^ 7705/ Name of License Professional responsible for CaiGreen compliance(Please Print) Phone Email Addre or License Professional responsi, iir IGr r -' 'MO L uUaing Department REVIEWED FOR CODE COMPLIANCE Page 5 of 5 Reviewed Sy:Phuong Devries CalGreen 2014.doc revised 11104114 Date: 07/05/16 P2cip 91 CERTIFICATE OF VERIFICATION • CF3R-MCF1=20-H Duct Leakage Diagnostic Test (page).of 3) Project Name: Padmanabhan Addition Enforcement Agency: City of Permit Number: Cupertino . _ . Dwelling Address: 7512 De La Farge Dr. City: Cupertino Zip Code: 95014 A.System Information 01 Space Conditioning System Identification or Name System one , 02 •Space Conditioning:System Location or Area Served Whole House 03 Building Type from CF-1R .Single family 04 Verified Low Leakage Ducts in Conditioned Space No,credit is not taken (VLLDCS)Credit from CF1R? 05 Verified Low Leakage Air-qandling Unit(VLLAHU)Credit No,credit is not taken from CF1R? II 1, ! ' 06 Duct System Compliance Category I New A 1' ..,' MCH-20a-CompletelyNew,DuerSysteM 6•574;) ' /le k 3 n - • - - - _ B.Duct Leakage Diagnostic Test 4:—)1 01 Condenser Nominal Cooling Capacity(ton) 02 Heating Capacity(kBtu/h) 78 03 Conditioned Floor Area served by this HVAC system(ft2) '2335 04 Duct Leakage Test Condition : Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor. — „ • 0.06 07 Air Handling Unit Airflow(AHUAirflow)Determination Heating system method- „ . -Method i 08 Measured AHUAirflow This field or section is not applicable: . 09 Calculated Target Allowable Duct Leakage(cfm) 1102 Actual,duct leakage,rate from leakage test measurement !94 10 (cfm) 11 Compliance Statement System passes leakage test Registration Number:217-A0337441A-M2000001A-M2OA Registrationpate/Time: 2017,09-29 12:38:19 HERS Provider:CaICERTS CA Building Energy Efficiency Standards. Report Version:2013 Rev 1.008 Report Generated:2017-09-29 12:37:53 2013 Residential Compliance Schema Version:2013.1.007 - I CERTIFICATE OF VERIFICATION CF3Ft-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 31 B.Duct Leakage Diagnostic Test ` 12. Notes C.Additional Requirements for Compliance -- - - -- - - • , 01 System was tested in its normal operation condition.No temporary taping allowed. Outside air(OA)duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage 02 testing.OA ducts used for Central Fan Integrated(CFI)Indoor Air Quality ventilation systems,or Central Fan Ventilation ' Cooling Systems,that utilize dampers that open only when OA is required and automatically close when OA is not required, may configure the OA damper to the closed position during duct leakage testing. , 03 All supply and return register boots'were sealed to the drywall. tc 04 Building cavities were/notused asplenums or platform returns in lieu of ducts. - 05 If cloth backed tapelwasused it was covered with Mastic and draw bands. , • 06 All connection,points between the airhandler and the supply and return plenums are completely sealed. , w.. rrt -- r• .� '1 t ...`- ' -_ .i P Visual Inspection at Final Construction Stage(apphcableif system was tested at rough in) :, . --..7::- After installing the interior fimshingwall and verifying that the above rough in tests was completed;ithe following procedure must be performed r -t ; ;- " ... 5 , __ ` r i- --rt J-, Y l 1 ' .J' `.,,,.:1 ri I ' S`;.,,t4 nf�h �r-' 3y d 1.4e "' 1,1 151..1. ,, .. 07 For all supply and return registers,verify that the-spaces between the'register boot•and theinterior finishing-wall are properly.sealed. ,' ,i If the house rough-in duct leakage test was conducted-without an air handler installed,,,inspectthe connection points 08 between the air handler and the supply and return plenums to verify that the connection pointsare properly sealed. 09 Inspect all joints to ensure that no eloth'backed rubber adhesive duct tape is used. i' . ,;II 10- Verification Status Pass . = 11 Correction Notes for this table ,': ' . , The responsible persons signature on this compliance document affirms that all applicable requirements in this table have, ,, been met unless otherwise noted in the.Verification Status and the Corrections Notes in this table. D.Determination of HERS Verification Compliance , All applicable sections of this document shall indicate compliance with the specified verificatidn protocol requirements in order for this Certificate of Verification as a whole'•to be determined to be in compliance. ' ' - - 1 - 01 Complies:All specified verification protocol requirements on this document are met: '` .I • I • i! , r Registration Number:217-A0337441A-M2000001A-M20A Registration Date/Time: 2017-09-29 12:38:19 HERS Provider:Ca10ERTS CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-09-29'12:37:53 2013 Residential Compliance Schema Version:2013.1.007 • ;41 14,Joi2 IL W2. CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3) Documentation Author's Declaration Statement 1.I certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: �`Z �Er� Darrel Kelly Company: Date Signed: Builders'Energy Services,Inc. 2017-09-29 12:38:19 Address: CEA/HERS Certification Identification(if applicable): 1478 Bird Avenue City/State/Zip: Phone: San Jose CA 95125 408-202-9075 Responsible Person's Declaration statement I certify the following under penalty(perjury,under the laws of the State of California: 1. The information provid'edon this Certificate of Verification is true and,correct 2. 1am the certified HERSeRateriwho performed the verification identified and reported on this Certificate of Verification(responsible rater). 3. The installed features,jmatrials,-components,manufactured devices,or system performance diagnostic results that require HERS verification identified on this Certificate'of Verificationcomply with.the:applicable requirements in Reference Appendices RA2,RA3,and the requirements specified'ori'the Certificate of Compliance:fo[the'building approved by the enforcement agency. 4. The information.reported on applicable Sections`ofthe Certificate(s)of Installation"(CF2R)signed and:submitted by the persons)responsible for the construction or installation conforms to the,requirementssspecified on the Certificate(s)'of Compliance(CF1R)approved by the enforcement'agency. 5. I will ensure that a registered copy,of this Certificate of Verification shall be posted`or made available with thebuilding peimrt(s)issued for the building,and made'available to the;enforcement agency for all applicable inspections Iunderstand:that a registered;copy of this Certificate of Verification isrequired to be included with the documentation the builder provides`to the building owner atoccupancy '' Builder Or Installer Information As Shown On The Certificate Of Installation" Company Name(Installing Subcontractor,General Contractor,or Builder/Owner): N/A-Consumer Certificate Responsible Builder or Installer Name: CSLB License: N/A-Consumer Certificate N/A-Consumer Certificate HERS Provider Data Registry Information Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable) Tested HERS Rater Information HERS Rater Company Name: Builders'Energy Services,Inc. Responsible Rater Name: Responsible Rater Signature: I�� _ Darrel Kelly �`Z e®Q Responsible Rater Certification Number w/this HERS Provider: Date Signed: CC2005655 2017-09-29 12:38:19 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:217-A0337441A-M2000001A-M20A Registration Date/Time: 2017-09-29 12:38:19 HERS Provider:Ca10ERTS CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-09-29 12:37:53 2013 Residential Compliance Schema Version:2013.1.007 BUILDER'S: ENER`afy SERVICES_ September 5, 2017 City of Cupertino Building Division 10300 Torre Avenue Cupertino, CA 95014 Project Name: Padmanabhan Addition Project Address: 7512 De La Farge Dr. Cupertino, CA Please be advised that the above identified home meets and/or exceeds the minimum green point rating for the City of Cupertino. Documentation has been compiled throughout the construction process. This residence has completed all of the Green Building mandatory measures meeting or exceeding the minimum requirements. As required by the City of Cupertino, I,Eric Kirk, a licensed Green Point Rater and the General Contractor, Franov Construction, have verified that the residence has been constructed in accordance to the Green Building mandatory measures. If requested, they can show documentation supporting this. Any questions please call Eric Kirk at 408-806-9901. Sincerely, Eric Kirk Eric Kirk Builders' Energy Services, Inc. Green Point Rater# 14293 Corporate Offices 1478 Bird Avenue Sacramento San Jose,California 95125 Santa Cruz (408)718-1908 San Jose (408)273-6303 Fax Gilroy E-Mail:energy@builders-energy.net Phuong Devries 07/05/16 Phuong Devries 07/05/16 Phuong Devries 07/05/16 Phuong Devries 07/05/16 Phuong Devries 07/05/16