02060030TY OF CUPERTHNO 0
Ctu� 7YOF FERMET APP LEC ATEON I�®I�I�YI1
0�'I,rj60030
APN #
Fee Description
Date ®, 05 A2—
APTFEE
Building Addre
� q U 64
LG AVE, CUPEkTlrvo 1 CA
9s -v �
Owner's Name:
PADAlA �U AC �
Phone #�
o - Z S 3— 21
S
Contractor '
BAPPLOTHER
License #:
MECHANICAL
Contact: K
Construction Tax
Phone #:
BCONSTAX
Applicant/Contraptor�
BUILDING
Fax #:
Con. Tax for BQ Zone
"Buil. ' g Permit Info:
'
Hotel and Motel
Bld Elec
Pl Mech
Constax — Resi/Mobile
J1Descriptio
Residential:
ornmercial:
Elec 600V <=1000A
Sq.Ft. Floor Area:
BELEC 1001
$/Sq.Ft.:
ELECTRICAL
Architect/Engineer:
Elec Svcs 600V <= 200A
Valuation:
HlEN ERGY
Energy
BUILDING,
BENERGYADD
EnergyAddMulti
Type of Construction:
BINVESTIGA
Occupancy Gr up
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
BMITIGATR
Quantity Fee HD
Fee Description
Fee Group
APTFEE
EACH STORY OVER 3
HOTELFEE
EACH STORY OVER 3
OFFICEFEE
EACH STORY OVER 3
BAPPLOTHER
Other Appliances
MECHANICAL
BCONSTAX
Construction Tax
BUILDING
BCONSTAX
Ind/Off/Comm/Quasi
BUILDING
BCONSTAXBQ
Con. Tax for BQ Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax — Resi/Mobile
BUILDING
BELEC 1000
Elec 600V <=1000A
ELECTRICAL
BELEC 1001
Elec 600V > 1000A
ELECTRICAL
FZ� BELEC200 .
Elec Svcs 600V <= 200A
ELECTRICAL
HlEN ERGY
Energy
BUILDING,
BENERGYADD
EnergyAddMulti
BUILDING
BINVESTIGA
Investigation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
BMITIGATR
Res. Housing Mit Fee
BUILDING
BMNEWMULTI
New Multi -Family Res
MECHANICAL
BNEWMULTI
New Multi -family Res
ELECTRICAL
1 of 3 �L—� D� C�iZ.e/L 7/S.00
DadZ
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CITE' OF CUPEj[tTIN®
BUILDING DIVISIONPE
�7
C®NTACTOR INFO
BUIL1)I8(8A9D1Es9fUGGLE AVE
PERMIT NfO 210004 5
OwgAMMHANDRAN , PADMA/ NATARAJ
APPLICATI1L�If��17Y 2 0 O 2
�� //
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affifm that I am licensed under provisions of Chapter 9 (commencing
T+y�T.�s
REV I S I ON — — I N !1V U JCr>'.��' ONLY
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
ORIG.
402060030, ADD 574 SQ.FT.
License Class Lic. p
Dale Contractor
ARCFIFTECT-S DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License law for the
following reason. (Section 7031.5, Business and Professions Cale: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
$70000
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Calc) or
37533062.00
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number Occupancy T
p y yl�
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than titre hundred dollars ($soo).
101 —
FOUNDATION
❑ 1, 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 We (Sec. 7044, Business
Professions Code: The Contractor's License Law does not apply
82 —
Required Inspections
and to an owner of10
3 —
UFER
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
104 —
REBAR
however, the building or improvement is sold within one year of completion, the owner -
builder
builder will have the burden of proving that he did not build or improve for purpose of
105 —
ANCHOR BOLTS
sa1o.).
106 -
SEWER & WATER
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
202 -
UNDERFLOOR PLUMBING
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon, and .
203 -
UNDERFLOOR MECHANICAL
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
204 -
UNDERFLOOR FRAME
❑ I am exempt under Sec , B & P C for this reason
205 -
UNDERFLOOR INSULATION
Owner Date
301 -
ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 —
TUB & OR SHOWER
I hereby affirm under penalty of perjury one of the following declarations:
303 —
ROUGH MECHANICAL
❑Ihave and will maintain aCertificate ofConsent toself-insure for WorkersCompen-
cation, as provided for by Section 3700 of the Labor Code, for the performance of the
3O4 —
ROUGH ELECTRICAL
work for which this permit is issued.
305 -
FRAME
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3 O 6 —
HOEDOWNS
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Polity number are:
307 —
INSULATION
Carrier. Policy No.:
308 -
SHEETROCK
CERTIFICATEO WORKERS'
COMPENSATION INSURANCE
309 -
EXTERIOR LATH
(This section need not be completed ifthe permit is for one hundred dollars (SI00)
310 —
INTERIOR LATH
or less')
311 —
SCRATCH COAT
I certify that in the performance of the work for which this permit is issued, 1 shall not
313 -
ROOF NAIL
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
501 -
502 -
FINAL ELECTRICAL ENERGY
F I NAL PLUMBING ENERGY
Applicant
NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Latex Code, you must
forthwith comply with such provisions or this permit shall he deemed revoked.
503 —
FINAL MECHANICAL ENERGY
504 -
F I NAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
505 -
FINAL ELECTRICAL
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
506 —
507 -
GAS TEST
F I NAL PLUMBING
Lenders Address
1 certify that I have read this application and state that the above information is
508 -
F I NAL ME CHAN I CAL
correct. 1 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
5
F I NAL GRADE
above-mentioned property for inspection purposes
10
FIN I G
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities,judgments, costs and expenses which may in any way accrue against said City
5
N LI WORKS
in consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:
Date
SOURCE REGULATIONS.
Re -roofs
Type of Roof
Signature of ApplicanUContractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Cafe, Chapter 9.12, and the Health and Safety
Calc, Section 25532(a)?
❑Yes [3 No
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection, I agree to remove
P g
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes ❑ No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a Certificate of Occupancy.
Signature of Applicant
Date
All roof coverings to be Class "B" or better
Owner or authorized agent Da1C
CITY OF
cCUPER:1IING
CRTY (�) I C I" ER I \ (�)
III.�� I I •� I" I" I I( AI I (I) \ IF(I) i". 1
b
62-L)��3��
APN #
s �'
Date: tt 2
BAPPLOTHER
Other Appliances
-
Building
Building Address:
Construction Tax
BUILDING
18 e-3 7-UC7
Cof EC7f-rvo s o
Owner's Name:
BCONSTAXBQ
Phone #:
MS R
BCONSTAXH
4,Z3 P- - -2-
2Contractor:
Contractor:
BCONSTAXR
License #:
Contact:
BELEC 1000
Phone #:
Ap c Contra` tor:
BELEC 1001
Fax #:
Buil ' gP rmit Info:
BELEC200
Elec Svcs 600V <= 200A
Bldg Elect
Plumb
Mech
scription:
BENERGYADD
Energy Add Multi
Residential: �%
BI VESTIGA
ercial:
Sq.Ft. Floor Area:
BMITIGATC
$/Sq.Ft.:
Architect/Engineer:
BMITIGATR
Valuation:
Type of Construction:
BMNEWMULTI
Occupancy Group:
Quantity Fee RD
Fee llDesciri tion
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BCONSTAX
Construction Tax
BUILDING
BCONSTAX
Ind/Off/Comm/Quasi
BUILDING
BCONSTAXBQ
Con. Tax for BQ Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax - Resi/Mobile
BUILDING
BELEC 1000
Elec 600V <=1000A
ELECTRICAL
BELEC 1001
Elec 600V > 1000A
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
B ENIERGY
Eneirgy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BI VESTIGA
Investigation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
BMITIGATR
Res. Housing Mit Fee
BUILDING
BMNEWMULTI
New Multi -Family Res
MECHANICAL
BNEWMULTI
New Multi -family Res
ELECTRICAL
BNUCOMME
New Comm Electric
ELECTRICAL
BNUCOMMM
New Comm Mechanical
MECHANICAL
BNUCOMMP
New Comm Plumb
PL NG
1 of
BUILDING DIVISION
PER MET J(t �t� ll a A� tui �+ 411jt�Cl�YjiES\ Il �tul�
BUILDING ADDRESS:
18891 TUGGLE AVE
OWNER'S NAME:
RAMACHANDRAN, PADMA/NATARAJAN
PHONE:
aO O_ ARCHITECTIENGINEER;
F U
i 6 0.
LICENSED CONTRACT'OR'S DECJ,ARATION
OZ z - i he§eby affirm that ham licensed under provisions of Chapter9 (commencing
QN F to avith'SteegqGn7,q fl) of D[vision 3 of the Business and Professions Code, and my license
Y 1 :3i$Jir ftlTTpft>etniaitrieffect.
eC C 6 License Class Lie. #
CLa UO Date " Contractor
O
N ARCHITECT'S DECLARATION
F — m I understated my plans shall be used as public records
"rut.,' p O Licensed Professional
OWNER -BUILDER DECLARATION
Z} I hereby affirm that I am exempt from the Contractor's License Law for the
_ following reason. (Section 7031.5, Business and Professions Code: Any city or county'
i Y n which requires a permit to construct, alter, improve, demolish, or repair any structure
LU prior to its issuance, also requires the applicant for such permit to fele aligned statement
3 — that he Issticensed pursuhnt to the provisions of the Contractors License Law (Chapter 9
(commencing with Sectio0000)of Division 3 of the Bu;mess and Professions Code)
or that he is exempt theiefrom and the basis for the all exemptigp. Any violation
of Section 7031.5 by. my applicant for a permit -subjects the applicant to a civil penalty
of not -more than five hundred dollars (5500).
❑ 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 and Professions Code: The Contractor's License Law does not apply to an
owner of property Who builds or improves thereon, and who does such work himself
or through his own employees. provided that such improvements are not intended or
offe7red for sale. If, however, the building of iinprovement is sold within one year of
completion, the owner -builder will have the burden of proving that he did not build or
improve for purpose of sale.).
at owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's
License Law does not apply to an owner of property who builds or improves thereon,
and who contrdcts_for such projetts with a contractors) licensed pursuant.to the
Contractors License Law.
❑ f am ex t under Sec - r B & P C for this reason
Dt� 0 �.AG3fo�
WOR'KER'S COMPENSAt07O1 DEC R ATfON i
®Z
Z
b
DZ
U®
y
b C4]
I hereby affirm under penalty,of perjury ode of the following declarations:
❑ I have and win 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 required by Section
3700 of the Labor Code, for the performance of the work for 'which this permit is
issued.' My Workers Compensanon Insurance carrier and Policy number are:
Carfier. ` ! Policy No.:
CERTIFiC 1:1 N OF EXEMPTION FROM WORKERS' .
COMPENSATION INSURANCE -
(This section need not be completed if the permit is for one hundred dollars
($100) or less.)
I certify, that'in the petfo ofthework for which is pe 't is issued, I
shall not employ an Berson in an' wooer so as tocp�e bje§t f the,avorkers'
Compensation FCalile"' ate "E
Applic t
NO APPLICANT: If, after making this' ertificate of Exemptipn, you should
hec Subject to the Workei s Compensation #bvisions of the Labor Code, you must
forthwith cothp(y with such provisions or this permit shall be deemed revoked.
-'CONSTRUCTION LENDING AGENCY
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. C.)
Lender's Name
Lender's Address
I cenlfy- that[ have read this application and state that the.above information is
SdiTe6o I agiee:to.cofriply 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 rposes.
(We) agree to save, indemnify and keepup harmless the City of Cuperiino against
liabilities, judgments, costs and expenses which may in any way accrue against said
Ci t consequence the granting of this permit.
A��F ICANT STANDS AND WILEVOMPLY. WITH ALL YQ'pOIVT
59LRC R ATIGNS.
01? u O Z�
Sign re ofApplicant/Comractor Date
HAZARDOUS MATERIALS DISCLOS RE
Will the applicant or futuie building occupant store or handle hazardous material
as defined by the Cupertino unit' Code. Chapter 9.12. and the Health and Safety
Code, Section 75532(a)?
0 Yes o
Will the appticant or tore building occupant use equipment or devices which
emit hazardous air coniami ants as ed by the Bay Area Air Quality Management
District?
D Yes No
I have ad the hazardous materials requirements under Chapter 6.95 of the
Cahfore
mia Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that
if the building does not currently have a tenant that it is mysponsibility to notify the
oc€upant of th quirements which must be met prior to (ss no of a Certificate of
Occupancy. /
or authorized agent
PERMIT NO.
02060030
APPLICATION SUB DATE
06/05/2002
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L_7 LJ L_-3 1_-1
Job Description
ADDITION AND UPGRADE/REMODEL
37�3�,TTr'.fea. .. ,�.`'. .
101ApN N5ftATION
103
104
105
_106
202
203
204
205
301
302
303
304
305
306
307
30$'
3.0.9
'310
311
'313-,
501
502 "
503
504
505
506 _
507
508
509
510
514
$70000
- UFER Required Inspections
.-. _ REBA R
- ANCHOR BOLTS
- SEWER & WATER
- UNDERFLOOR PLUMBING
- UNDERFLOOR MECHANICAL'
=- UNDERFLOOR •FRAME
- UNDERFLOOR'INSULATION
- ROUGH PLUMBING
- TUB & OR SHOWER
- ROUGH MECHANICAL
- ROUGH ELECTRICAL
- FRAME
- HOLDOWNS
- INSULATION
SIJEETROCK
EXTERIOR LATH'
SCRATCH COAT
-'ROOF NAIL
- FINAL ELECTRICAL ENERGY
- FINAL PLUMBING ENERGY-
- FINAL MECHANICAL ENERGY
FINAL BUILDING ENERGY
FINAL ELECTRICAL
7. GAS TEST ;
FINAL PLUMBING
- FINAL MECHANICAL
- FINAL GRADE
- FINAL PLANNING it
- F INAL ,,PUB161 C WORKS /
Issued by: Date
Re -roofs
Type of Roof .
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 iemove
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.
0 ?/
Signature of Applicant Date
All roof coverings to be Class "B" or better
OFFICE
(CIEIIg'ICI+'II(CA'ITE OF CC(GM? LL4N CIE-. R ESM EDTTEAL (Page 1 of 3) CIF -IR
I^ OE ala �� 2
Project Title Date
/Jwf/ ro6416- *,Ef 1,ferllvg f ' 4w®i�
- Projec�s Address Building Ferrol[ �
Fri UlrC t9 � ✓_/ 99 ' 0 49 '
Documentation Author Telephone Plan Check / Date
er. /Z — Iftorfl,014 4110AC d Field Check / Date
Compliance Method (Package or Computer) Climate Zone LniorccrncntAgencv sc v
cGIEN ERAIL IMYO IBMA7MN /
Total Conditioned Floor Area 1S2!5_ft' Average Ceiling Height: & ft
Conditioned Slab Floor Area e5V W
Building Type: Single Family j/ Addition
(check one or more) Multi -Family Existing -Plus -Addition
�I
Front Orientation: � North ou East / West / All Orientations �il (�J;
(input front orientation in degrees from True North and circle one) I '� goop
Number of Stories !i �
Number of Dwelling Units:
Floor Construction Type: _ (-a Raised Floor (circle one or both)
RAllD1IANT BAIL8IIU ER (required in climate Required for this submittal �es no
BUI LIIDffNG IENV EILGIM UiSUILA'> HON
Component
Type
Frame Type
wd = wood
stl = steel
Cavity
Insulation
R -Value
Sheathing Total R- Assembly
Insulation Value' U -Factor'
R -Value
Location/Comments
(attic, garage, typical, etc.)
Wall
z i4gtegs-
.0
N9 -A
Lw Wks
war OI?�
Fenestration
U -Factor
Fenestration
SHGC
n •
W
Roof
Roof
Front
`
Floor
Left
Floor
Slab Edge
Left
'For prescriptive compliance, Total R -Value and Assembly U -Factor are not required for a wood -framed wall that meets cavity R -value
insulation requirements for fire Prescriptive Package.
FENESTRATION
ASO. ALl.80e4. 'a�f S� K �. `7� i Pr r�t�uG—ca CLAI,S
cto C,
Compliance Forms August 2001
z.}M,5 —i- k -t ?.,'' 'trr
P? 'S,l"_
A-2
anaaln
z i4gtegs-
Fenestration
#/T os.
Orien-
tation
Area
ftZ
Fenestration
U -Factor
Fenestration
SHGC
Exterior
Shading Att.
a s
Fins
Front
Front
Left
Left
Re Wt
NtrYQ
3
0.3
0^
(
bYIYMk�
Rear(Dow
11
Q
0.ll
, 9
STAN19 A)tQV
Nh
Right(ON064
Right
Skylight
Skylight
ASO. ALl.80e4. 'a�f S� K �. `7� i Pr r�t�uG—ca CLAI,S
cto C,
Compliance Forms August 2001
z.}M,5 —i- k -t ?.,'' 'trr
P? 'S,l"_
A-2
' (CIEII TII1FE CAT E OF (C®M1?ILL4N CIE-. R ESIDD Eh`TTII�1i IL (]Page 2/of 3)
(CIF -IR
Project Title
Date
' HVAC SYSTEMS
Note: Input hydronic or combined hydropic data under Water Heating Systems,
except Design Heating Load
Distribution
Heating Equipment
Minimum Type and
Duct or
Heat Pump
Type (furnace, heat
Efficiency Location
Piping
Thermostat
Configuration
pump, etc.)
(AFUE or HSPF) (ducts, attic, etc.)
R -Value
Type
(split or package)
D'79 LiAtiS
l4-1&
SG'(W
Cooling Equipment
Minimum Duct
Heat Pump
Type (air conditioner,
Efficiency Location
Duct
Thermostat
Configuration
heat pump, evap. cooling)
(SEER) (attic, etc_)
R -Value
Type
(split or package)
SEALED DUCTS and TXVs for Alternative Measures)
U Sealed Ducts (all climate zones)
(Installer testing and certification and HERS rater field verification required)
U TXVs, readily accessible (climate zones 2 and 8-15 only)
(Installer testing and certification and HERS Rater or field verification required)
U Refrigerant Charge/Air :Flow (climate zones 2 and 8-15 only)
(Installer testing and certification and HERS Rater or field verification required)
OR
U Alternative to Sealed Ducts and TXVs (see Package C or D Alternative Package Features for Project Climate Zone)
Climate Zone Window SHGC Window U -Factor SEER Heating
WATER HEATING SYSTEMS
Energy' External
Rated' Tank Factor or Tank
Water Heater Distribution Number Input (kw Capacity Recovery Standby' Insulation
1. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy
Factor. For large gas storage water heaters (rated input of greater than 75,400 Btuihr), list Rated Input, Recovery Efficiency and Standby Loss.
For instantaneous gas water heaters, list rated input and recovery efficiencies.
SPECIAL IFIEATURIES (add extra sheets if necessary). (Package C and D: TXVs, Sealed Duets, radiant
Barriers (see installation requirements for radiant barriers in Section 8.13 of the 2001Residential Manual).
(Package C: thermal mass (thermal mass type, covering, thickness, and description).
Yiv0- by ;n.(fir,tied IP t`ov9,,Al v 4I4lr evid EVrJ!E G 4 a,�#%,tlo V,(-'11*e^1"
v RCeS .'h 4)e --,-Nis a, -id VeGPft,lei"JJP) crt*7-+=i",t. pw tt:
Compliance Forms August 2001 A-3
CCIEIIR'IL'1[I RCCA1<'IE OF (COMP LIIAN CIE: I[BIERID Eh` TM L (Page 3 of 3) (CIF -IR
�! Project Title Date
COMIP I.IT4NC E STATEMENT
This certificate of compliance lists the building features and performance specifications needed to comply with
Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement
them. This certificate has been signed by the individual with overall design responsibility. When this certificate
of compliance is submitted for a single building plan to be built in multiple orientations, any shading feature that
is varied is indicated in the Special Features/Remarks section. The undersigned recognize that compliance using
duct sealing and TXVs requires installer testing and certification and field verification by an approved HERS
rater.
IlDe5igner or Owner (per Business and Professions Code)
Title/Firm: ,(%y19M
Address: f 6q t���
Telephone: <10? • 7,5_3 • zq 15-1;
Lic- 4-.
/o Z-
(srpature) (date)
lk
EnfoTcemela
Title:
Agency:
Telephone:
(signature/ stamp)
I(Doe uunneun>tntion Author
Name: 6C-14ri C-fi td6
Title/Firm: CYC CA"Ai $ "VC
Address: -3� 3 (or rxv Bic a2
PW40W 0-1+ 4055r
Telephone: 511 • 36 `F - 6,901
(sign (date)
Compliance Forms August 2001 A-4
MANDATORY MIEASURIES CIEIIIECKILI ST: R ESMIEN'l RAIL (Page 1 of 2) MF -IR
b Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used.
Items marked with an asterisk (*) may be superseded by more stringent compliance requirements Listed on the Certificate of
Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as
minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents
or on this checklist only.
Instructions: Check or initial applicable boxes when completed or enter N/A if not applicable.
DESCRIPTION
DESIGNER
ENFORCEMENT
Building Envelope Measures:
° §150(a): Minimum R-19 ceiling insulation.
§ 150(b): Loose fill insulation manufacturer's labeled R -Value.
° § 150(c): Minimum R-13 wall insulation in wood framed walls or equivalent U -Factor in metal frame walls
/
does not apply to exterior mass walls).
V
° § 150(d): Minimum R-13 raised floor insulation in framed floors.
§ 1500) : Slab edge insulation - water absorption rate no greater than 0.3%, water vapor transmission rate no
eater than 2.0 pernitinch.
§118: Insulation specified or installed meets insulation quality standards. Indicate type and form.
§ 116-17: Fenestration Products, Exterior Doors, and Infiltration/Exfiltration Controls
1. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage.
2. Fenestration products (except field -fabricated) have label with certified U -Factor, certified Solar Heat
Gain Coefficient (SHGC), and infiltration certification.
3. Exterior doors and windows weatherstripped; all joints and penetrations caulked and sealed.
§ 150(g): Vapor barriers mandatory in Climate Zones 14 and 16 only.
§ 150(f): Special infiltration battier installed to comply with § 151 meets Commission quality standards.
tv A
§ 150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs.
1. Masonry and factory -built fireplaces have:
a. Closeable metal or glass door
b. Outside intake damper
I
air with and control
c. Flue damper and control
2. No continuous burning gas pilot lights allowed.
Space Conditioning, Water Heating and ]Plumbing System Measures:
§110-§113: HVAC equipment, water heaters, showerheads and faucets certified by the Commission.
§150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA or ACCA.
1
§150(i): Setback thermostat on all applicable heating and/or cooling systems.
W
§1500): Pipe and tank insulation
L Storage gas water heaters rated with an Energy Factor less than 0.58 must be externally wrapped with
insulation having an installed thermal resistance of R-12 or greater.
2. First 5 feet of pipes closest to water heater tank, non -recirculating systems, insulated (R4 or greater)
^ I�
` V
3. Back-up tanks for solar system, unfired storage tanks, or other indirect hot water tanks have R-12
external insulation or R-16 combined internal/external insulation.
4. All buried or exposed piping insulated in recirculating sections of hot water systems.
5. Cooling system piping below 55° F insulated.
6. Piping insulated between heating source and indirect hot water tank.
Compliance Forms August 2001 A-5
MANDATORY DA's ORYY lyll IEASUR ES (CIHIIE(CK LIIS T: R ESR DIEN7RA-L (Page 2 of 2) MF -IR
Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used.
Items marked with an asterisk (°) may be superseded by more stringent compliance requirements listed on the Certificate of
Compliance. When this checklist is incorporated into the permit documents, the features noted shall be consideredby all parties as
minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents
or on this checklist only.
Instructions: Check or initial applicable boxes when completed or enter N/A if not applicable.
DESCRIPTION
DESIGNER
ENFORCEMENT
Space Conditioning, dater Heating and Plumbing System Measures: (continued)
° § I50(m): Ducts and Fans
/V
I. All ducts and plenums installed, sealed and insulated to meet the requirement of the 1998 CMC Sections 601,
603, 604, and Standard 6-3; ducts insulated to a minimum installed level of R4.2 or enclosed entirely in
conditioned space. Openings shall be sealed with mastic, tape, aerosol sealant, or other duct -closure system
that meets the applicable requirements of UL 181, UL 181 A, or UL 181 B. If mastic or tape is used to seal
openings greater than 1/4 inch, the combination ofmastic and either mesh or tape shall be used. Building
cavities shall not be used for conveying conditioned air. Joints and seams of duct systems and their
components shall not be sealed with cloth back tubber adhesive duct tapes unless such tape is used in
combination with mastic and drawbands.
2. 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.
3. Joints and seams of duct systems and their components shall not be sealed with cloth back tubber
adhesive duct tapes unless such tape is used in combination with mastic and drawbands.
4. Exhaust fan systems have back draft or automatic dampers.
5. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
manually operated dampers.
6. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight,
moisture, equipment maintenance, and wind but not limited to the following: Insulation exposed to
weather shall be suitable for outdoor service e.g., protected by aluminum, sheet metal, painted canvas,
or plastic cover. Cellular foam insulation shall be protected as above or painted with a coating that is
water retardant and provides shieldin& from solar radiation that can cause de adation of the material.
§ 114: Pool and Spa Heating Systems and Equipment.
I. System is certified with 78% thermal efficiency, on-off switch, weatherproof operating instructions, no
electric resistance heating and no pilot light.
2. System is installed with:
a. At least 36 of pipe between filter and heater for future solar heating.
b. Cover for outdoor pools or outdoor spas.
3. Pool system has directional inlets and a circulation pump time switch.
§ 115: Gas fired central furnaces, pool heaters, spa heaters or household cooking appliances have no
9a
continuously burning pilot light. (Exception: Non -electrical cooking appliances with pilot < 150 Btu/hr)
§118(0: Cool Roof material meet specified criteria
2002
Lighting Measures:
§150(k)l.: Luminaires for general lighting in kitchens shall have lamps with an efficacy of 40 lumens/wan
or greater for general lighting in kitchens. This general lighting shall be controlled by a switch on a readily
IIIA
accessible lighting control panel at an entrance to the kitchen.
§ 150(k)2.: Rooms with a shower or bathtub must have either at least one luminaire with lamps with an
efficacy of 40 lumens/watt or greater switched at the entrance to the room or one of the alternatives to this
requirement allowed in § 150(k)2.; and incandescent recessed ceiling fixtures are IC (insulation cover)
approved.
Compliance Forms August 2001 A-6
vva SIGN
^_ sun nate DIVISION CONTRACTOR INFORMATION:
BUILDING ADDRESS: .. _ PERMITNO.
NAME:
W
z O.Ri s LICENSED CONTRACTOR '$ DECLARATION
OZ rhandily affirm that fam ficaused under provistious of Chaper,9trommenting
,., Cp i nh ge �qq)90W
ofDnti,nW 7- flie Bu -nen and professions Coda, and my license
°• O y'U _
License Class Lic. 0
3 a-
Data - ..Contractor
ARCHITECT'S DECLARATION
i > g ,°'..I undetamnd my plans shall be used m public rccoNs
til 6 O O Licensed Professional
OWNER -BUILDER DECLARATION,
I hereby ef5do that 1 nm a con,, from she Cmpmnor s License Law for the
F < fallowing reamn. (Section 70I.S. Business and Professions Code: Any city .r county
Z G , which requires a permit to constrdcCalmr, improve, demolish, or .,it nay stmctum
C r prior toitsissuance,aim acquimtheapplicant forsuch prmiuofile asigned^tnemern
d 3 — . .,: h. n n.Ina. i ............ ,...••�:..•......nn. r•...........�. t ._... � .... 11—.—
Lot not more than five hundred dollars
0 L' as owner of the property. or my employees with wages as their sale compensation,
will do'the 'vo rk: andthe-stmcture is not Intended' or offered for auto ISec: 7044,
^'Busirieinand Professions Code: The Contractor's License Law does not apply to an
oner of property Who Wilds or improves thereon, and who does such work himself
or through his own employees. provided Nat such improvements ere not intended or
-`offered for sok: Ir; hw
oever, the Wilding or impldm
veem is sold' within' one year of
Completion
, the owner -Wilder will have the burden of proving that he did not build or
improve for pumase of sale.).
..f �ICz��t as rte t Ili .pan, t o Itis sly c (ng wah I'Lelmed contractors m
r 4oristruct the pro,ecl (Sat 70 ,'Hti,mmsiand Prokvier, Cade I The Contractors
License Law,dues m apply to an owner of property who builds or improves thereon,
and who, com icts,for, such. profess witha. contmnor(s) licensed pursmnt,to the
CalculationsLicense La
Ola - funder Secj — - ° B&P C for thisrcmn
0.7'
1"4W0` WORKER'S COMPENS710N DEC ARATION
Ihereby affirm under penalty,of perury tui, fine f II ing dedhotoin sry
0 1 have "ond'will t ni n'u Cao name of Cnnsem to If insure for Workers
Compensation, us, provided far by Section 3700 of the Labor Code, for the
- _ - pertonnance df the work for which mis.permil is issued. .
01 have'and will maintiin Woikei E Compeb'seilnn'Insumncc, as required by genion
37W of Ne labor Code, for the peHomtence of the work for which this p4mout is
iss ed My W k Y Compenset on 1 uller and Policy n mbe no:
Carts r ' S 0i ' I 1 'i Policy NAL
il, CFKlI11CATIONOPE' EMPTION FROM WORKERS
n ,
I COMPENSATION INSURANCE—
trisection nceL m� be compleieJ if the permit is for one hundred dollars
„ (SlWlmor less.) ;
y with such previsions or this permit &hall be deemed revoked.
` I CONSTRUCTION LENDING AGENCY ` t ILL
of nii that there is'. construction lending agency for the perfnmsdnce'
which this permit is loved (Sar'3097, Civ. C.)
r' r,:tl.,Lt.-f.1 t:':,..,
that I h e read th"s appl nt nd. sate that the above Informal ion is
tit -comply th', olfeity.a it countyordinances d stare laws relating
tinction,and hereby twtipnze mIniammmives ofthtvcity center upon
Lined property for inspection purposes.,,,
ee m save, indemnify and keep harmless the City of Copeninb'against
scnts, costs and expenses which may in any w� accrue crue against said
tie dhb: ol.niino nh6:...:6.n � •
atY PP n 9 t - t fillt -u't
t WII th appl cA]\RUOre b'\Iding tµANlurt hoPS n le hazardoust tn'I
ps Jef ed by th C peryn9 Code Ch pmr91 dth Healthu ISafety
Cede SOecm 25573( 1, I , s1
W II th yes
. am or mrt Wilding ac p nt use eq ipmcn, or device which
emit hazard omaml ants a od by theB y Area Ail Qml ty Management
D t n /jNa—C"Tn�'
t 1 M1 e Health
& Se hex dons mann Is req 25533 a under 4, pt understand
f the
C hf m a H Ith & $ fety Code Sections 25505 I I and 25534 Fundenu d that
tf th bddmg tloesnt trendy haveet ria tthmiW my spices bltymnoufy the
ac pant of th qu.ements wh¢h musnbe ren p or ro t n of a Cenificarc of
r •.
01 Y''
,PPLICATION SUB DATE
06/05/2002
BLDG ELECT PLUMB MECH
Job Description _• .
ADDITION AND-UUPGRADDE•/REMODEL'-
FINAL ED
FEB 2 7 2003
El ING, '..' $70000
F6�,A�f Valw r S'3+3t ., j`r
101" V8ftATION Occupt
103 - UFER Required Inspections"
-----'---__----_---------------------
105 - ANCHOR BOLTS
106 - SEWER & WAT_ER
202 UNDERFLOOR PLUMBING ,' c
203 - UNDERFLOOR MECHANICAL` '
.-2047--- UNDERFLOOR'_- FRAME_-
205 UNDERFLOOR'INSULATION-
301 ROUGH --PLUMBING•``
302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL'
304 - ROUGH ELECTRICAL
305 - FRAME
306 - HOLDOWNS
307, - INSULATION,
'` I 30'9 ` "EXTERIORO-'LATH'
31'0:;'=•. INTERIOR 'LATH , ;, :'k: , . + ,:•
311 - SCRATCH COAT
313,.,_.:.ROOFNAI=L-a„+..•:.•:.:„:,n
501 - FINAL ELECTRICAli'ENERGY
502- --FINAL
503 FINAL MECHANICAL'ENERGY
..
_.._......504- __F.INAL-BUILDING-ENERGY..-----.__.._.___-.....__...._..
505 - FINAL ELECTRICAL,.,,
506,=, -,GAS TEST ....._ _.....__...._.._.... _... -- -..._.
507 - FINAL PLUMBING,,r,t.,,,.,
508 - FINAL MECHANICAL,,,
509 - FINAL GRADE
510 - FINAL PLANNING
514 n FINAL U C WORKS J
Issued by: Date
Re -roofs Y, •
-T'pe of Roof. _..� _.,..,_.
All roofs shall be Inspected poor to any-rooffng,matenal being installed.__
If a roof Is installed without first obtaining an inspection I'agree toremove
allnew materials for inspection Applicant understands and will comply with ,.._.
511 non -point source`[egulahons
h Signature of Applicant Date
All roof coverin s to be Class `rB" or better
.agent j.,L f, Date l 9
a I.
OFFICE'.__ ..., ..:_... ..__.... ....