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15010119
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10290 STERLING BLVD CONTRACTOR: XIE CAIXING ET AL PERMIT NO: 15010119 OWNER'S NAME: XIE CAIXING ET AL 10290 STERLING BLVD DATE ISSUED: 04/10/2015 OWNER'S PHONE: 4082184090 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT 2 STORY SFD (1,923 SQ FT); ATTACHED License Class Lie. # GARAGE (437 SQ FT); ENTRY PORCH (51 SQ FT); REAR COVERED PORCH (295 SQ FT). Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 RdF�SI4lN�1:�TNC= OSEEYI�+ifIN(�aPATOYT�AD s(244 f]r +) OF (commencing with Section 7000) of Division 3 of the Business & Professions CONDITIIJP, ED SPAIN S TED 129/15 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 Sq. Ft Floor Area: Valuation: $350000 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 APN Number: 37524019.00 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 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 a �C�%h/ �� �'�� granting of this permit. Additionally, the applicant understands and will comply Issued by-, Date: / l/ 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 ❑ 17�V_ N rTSF3CL�=?�Rri�It7 inspection. 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) owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE 0 11as veonstruct the project (See.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, aRV5534. Section 3700 of the Labor Code, for the performance of the work for which this , {� •a= - vC p Owner or authorized agtents Date: - ccp�eermit is issued. 10 ertify 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 (See. 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 Cupertino Municipal Code, Section Licensed Professional '[ P Signatures Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10290 STERLING BLVD CONTRACTOR: XIE CAIXING ET AL PERMIT NO: 15010119 OWNER'S NAME: XIE CAIXING ET AL 10290 STERLING BLVD DATE ISSUED: 04/10/2015 OWNER'S PHONE: 4082184090 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT 2 STORY SFD (1,923 SQ FT); ATTACHED License Class Lic. # GARAGE (437 SQ FT); ENTRY PORCH (51 SQ FT); REAR COVERED PORCH (295 SQ FT). Contractor Date 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 Sq. Ft Floor Area: Valuation: $350000 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 APN Number: 37524019.00 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 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 INSPECT 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 �t7 granting of this permit. Additionally, the applicant understands and will comply / sued b Date: I with all non -point source regulations per the Cupertino Municipal Code, Section 9.18., RE- ROOFS: Signature Date All roofs shall be inspec a 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. 9 " OWNER- BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt. 0 the Contractor's License Law for one of the following two reasons: a%° ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or RI mployees 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, 25 33 and 25�534. % Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 rl� II II + " Owner or authorized agent: � Pry ' Date: 11 ertify 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. ' A '�6? Signature V! C Date If 9A) CUP RTINO NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildin-g(a)cupertino.orq ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS U, 0 si 1 f V1 I , V/ I APN # 3`75— o ^ OWNERNAME l �v�n PHONE E -MAIL `` STREET ADDRESS CITY, STATE, ZIP I FAX o CONTACT NAME PHONE %p -..,(, J /,,.�j E -MAIL r 1 � V / `� STREET ADDRESS CITY, STATE, ZIP v►a ysd�� FAX C ;--, OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME IrX P LICENSE NUMBER LICENSE TYPE BUS. LTC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME / c L YuRyl- LICENSE NUMBER BUS. LTC # COMPANY NAME E -MAIL as FAX L i� r STREET ADDRESS p CITY, STATE, ZIP PHONE [ f J DESCRIPTION OF WORK GJ l t �23liar 59 -s oV- EXISTING USE PROPOSED USE CONSTR TYPE #STORIES c USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA -a 5 AREA AREA NETAREA BATHROOM KIT N OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL D ORCH AREA GARAGE AREA: ❑DETACH W 3❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑NO ADDITION? ❑NO PRE- APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ C :- TOTAL VALUATIOV: PLANNING APPL # Fl NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ - i i t• 3 0 By my signature below, I certify to each of the following: I am the property owner or authorized agent to on the r owner's behalf —I have read this application and the information I have provided is correct. I have read the Description of Work and veri urate. I agree to comply with all applicable local ordinances and state laws relating to building construction.- orjze representatives Of Cupertino to enter the above- identifie property for inspection purposes. Signature of Applicant/Agent: ���� Date: �Z SUPPLEMENTAL INFORMATION REQUIRED PaiScllECIeTYPE .- . tiouTlxcsLlr ❑ ❑7� New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER THE- COI7NTER,� t BUII.DIIVG`PLAA REVIEW permit for new building. D EXPRESS ❑ :.PLANNING PLAN REVIEW f'A t' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTAxDARD ❑ `ruBLlcwoRlcs" form if any Hazardous Materials are being used as part of this project. S ❑ Copy of Planning Approval Letter or Meeting with Planning prior to K 0 LARGE 0 EFIRD DEPT; w ❑ _ submittal of Building Permit application. R MAJO = SANITARY SEWE RDISTRICT` ; - � "., ❑,Ii�ENV1I20NMENTAI:,IIEALTH ' ", ,,� , r3 -;, r BldgApp_201 ].doe revised 06121111 `i. , .4g t- CONSTRUCTION PERMIT APPLIC ION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDI I :ISION 10300TORRE AVENUE • CUPER- I -IN0, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building (cDcu pertino.org ❑ NEW CONSTRUCTION ❑ ADDITION . ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT 9 PRO7ECf ADDRESS i APN # � 5 'D I r O L OWNER NAME E -MAIL ` hatm&4 Lon STREET ADDRESS 0 L h n 61 CITY, S p4TE, ZIP 501 FAX to 2go S I CONTACT NAMi PHONE E -MAIL _A - 2 STREET ADDRESS CITY, STATE, ZIP C 1 FAX OWNER El OWNER- BUILDER ❑ OWNERAGENT. ❑ CONTRACTOR � ❑ CONTRACTORAGENT )R ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME L y LICENSE NUMBER c :iRor7 BUS. LIC # COMPANY NAME E- MAIL FAX Lobo J�� ����Il STREET ADDRESS a� f-1 e � Y ' CITY, STATE, ZIP � � � PHONE u DESCRIPTION OF WORK jC�r L-01 a1mroap nawath u!5�f. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (Sj EXISTG NEW FLOOR DEMO TOTAL AREA AREA G AREA NET AREA .- BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PO TC H -AR EA DECKAREA TOTAL DECK/PORCH AREA GARAGEAREA: L DETACH ❑ ATTACH # DWELLTNGUNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? ❑NO PRE APPLICATION ❑ YES D7 YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES "RFxCEIVED BY k r' 7 - TOT VALUATION: ' PLANNINGAPPL: E] NO PLANNING APPROVAL LETTER EICHL£RHOME? E] NO 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 relating to buildin construction. I aut or a representatives 'Of Cupertino to enter the above - identified property for inspection purposes. Si- nature of Applicant/Agent: Date: SUPPLEMEN AL ORMATION REQUIRED � {` MAE ��eANeieKT,PE = aovzzt:csi>P� = New SFD or Multifamily d%vellings:. Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building 3; OYEItTH)<COUhTER � BUH.DiNGPLANREVIEW x r for new building. fl,,EXPiss 5 P1AI`Nn.cpLArrlSr permit °0 ulEya Commercial Bldgs; Provide a completed Hazardous Materials Disclosure aF .naRD r uruBl lcvso�Ixs�� _ _ form if any Hazardous Materials are being used as part of this project. 2120 ti Copy of Planning Approval Letter or Meeting with Planning prior to "SA`StTTARR'ERbISTRICT,.y.. YSE sub_ mittal of Building Permit application. L x SAL � ` •` _ C�a E;NYSRONMENT HEALTH �r BldgApp_201 Ldoc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 1AADDRESS: 10290 STERLING BLVD DATE: 04/29/2015 REVIEWED BY: SEAN MISC ITEMS APN; BP #: 15010119 "VALUATION: 1$15,000 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: hrs PENTAMATION 1 GENRES PERMIT TYPE: WORK REVISION #1: ENCLOSE EXISTING PATIO TO ADD 204 SQ FT OF CONDITIONED SPACE. SCOPE NOTE: This estimate does not include fees due to other Departments (i.a Planning, Public Works, Fire, Sanitary Sewer District, School Aictrirt air ) 71 co foot nro hnced nn tho nrotiminani infnrmafins nvnitnhto and nro nnhv nn octimato_ Cnntnrt the AOnt fnr nddn'I info_ FEE ITEMS (Fee Resolution .1.1 -053 E,(f. 711113) FEE QTY /FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (D No $0.00 1 hours Plan Check, Hourly $143.00 1STPLNCK Suppl. PC Fee: (E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? Q Yes Q No $0.00 Suppl. Insp. FeelD Reg. 0 OT p,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 f "OnstruellI on Tax, Aeltninistralim fee: G Work Without Permit? 0 Yes (D No $0.00 Advanced Planning Fee: $0.00 hours Inspections $429.00 Ll STINSP Inspection, Hourly G nA Y'Vavel D ocumentation Fees: Strom Motion Fee: 1BSEISMICR $1.95 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS, . $2.95 $572.00 a T ®TAB :FE: : $574.95 Revised: 04/01/2015 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10290 STERLING BLVD TYPE OF CONSTR. DATE: 01/22/2015 REVIEWED BY: MELISSA APN: 375 24 019 BP #: G �r��0�1 VALUATION: 1$350,000 -PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY 2nd Unit? Yes ', No USE: SFD or Duplex PENTAMATION PERMIT TYPE: 1R3SFD WORK CONSTRUCT N 2 STORY SFD WITH 1,923 S.F. LIVING SPACE 437 S.F. ATTACHED GARAGE & SCOPE 346 S.F. PORCH AREAS $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Custom) II- B,III- B,IV,V -B 2,706 $3,025.83 IR3PLNCK $2,916.89 IR3INSP $0.00 PME Plan Check: $0.00 Permit Fee: $2,916.89 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 2,706 $3,025.83 $2,916.89 1 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 E {f. 711113) If"ch, Plan Check 11hin7b. Plan f:'hrc/ Eke. Plan Check .bleep. Pernlif Fee: Plumb. Pcrm ;t Fee: Elec. Permit Fey: • Ocher �1Tcrh. lres��. Ocher Plumb Iresn. Other l; CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: lo- 4 d. PERMIT # 1 570 / U OWNER'S NAME: ; l PHONE # L� 0 - GENERAL CONTRACTOR: �1� ,1� BUSINESS LICENSE # ADDRESS: Qo �, o CITY /ZIPCODE: 1Co *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing lot, q-,). v Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile r (OwnW/t8uti cto Si na re �� Date I - CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408- 777 -3333 JOB ADDRESS: V)- qo PERMIT # S o 0 OWNER'S NAME: PHONE # S'b -S' 57— 9j ff GE]VERAL CONTRACTO j�/, �� cu ,(� ` ��, BUSINESS LICENSE # O(S ADDRESS: CITY /ZIPCODE: v *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork V/ Cement Finishing L��'SdrS ��� `����� �12� �. �� o Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date r 3 CUPERTINO OWNER - BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 • building Qcupertino.org — 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,3. ��� C) % BP# / SOS Q 6 OWNER NAME ,' .., ,. ,OWNER ADDRESS. -• ' Gem ✓ Y DESCRIPTION OF WORK: /yew 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.) ,MLI. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - BuII'der" building permit that erroneously implies that the property owner is providing his or her own labor and material ponally. I, as an Owner - Builder, may be held liable and subject to serious financial risk for any injuries sustained by a unlicensed person and his or her employees while working on my property. My homeowner's insurance may not p ode coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. ?. I understand building permits are not required to be signed by property owners unless they are responsible for instruction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner- Builder" I am the responsible party of record on the permit. I understand that I may A myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her instead of my own. I. I understand Contractors are required by law to be licensed and bonded in California and to list their license ers on permits and contracts. i. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the falue of my construction is at least five hundred dollars ($500), including labor and materials, I may be Jered an "employer' understate and federal law, . I understand if I am considered an "employer" under state and federal law, I must register with the state and iI government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to )loyment compensation for each "employee." I also understand my failure to abide by these laws may subject serious financial risk. 7. I understand under California Contractors' State License Law, an Owner - Builder who builds single - family 4:,� 7 re idid`ential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is pF`e Iformed under contract with a licensed general building Contractor. 0 8. 1 understand as an Owner - Builder if I sell the property for which this permit is issued, I may be held liable for any 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 04114110 I 3. I understand I may obtain more information regarding my obligations as an "employer' from the Internal nue Service, the United States Small Business Administration, the California Department of Benefit Payments, ie California Division of Industrial Accidents. I also understand I may contact the California Contractors' State se Board (CSLB) at 1- 800 - 321 -CSLB (2752) or www.cslb.ca.gov for more information about licensed 10. 1 am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I die party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide Il applicable laws and requirements that govern Owner - Builders as well as employers. irrM12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the orr ation],have provided on-this form. Licensed contractors are regulated by_.laws designed to.protect.the_public. If . you contract with-someone who does not have .a license, the Contractors' State License Board maybe 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. If 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 maybe 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 verifv the nrooerty owner's sianafure. n _ , Property Owner's Signature: ------------------------------------------------------------------------------------------------------------------------------------------- (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: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the ad .r .aMlrsSedM176,Zexan, d I personally filled out the above information and certify its accuracy. Note: A copy of th ropert r r+ne nt�orm notarization, or other verification acceptable to the city may be required to be presented when the permit is issu I t verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04114110 .w BUILDING ENERGY ANALYSIS REPORT PROJECT: Sterling Blvd. Residence 10290 Sterling Blvd. Cupertino, CA 95014 Project Designer: Globe Architecture 96 Eleanor Ave. Los Altos, CA 94022 (650) 796 -4328 Report Prepared by: IMCEIV MAR 26 2015 I ` BY: Timothy Carstairs, CEA, HERS, GPR Carstairs Energy Calculations PO Box 4736 San Luis Obispo, CA 93403 (805) 904 -9048 0 - CUPERTINO Job Number: =1' Building oepartrmn* n ....,9 15 -01213 .r A 0 1 2015 REVIEWED F-OR G"DDE COMPLIANCE Date: Revlewea 8y Jl--Wl h4-441 1/21/2015 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. IThis program developed by EnergySoft, LLC — www.energysoft.com. EnergyPro 6.4 by EnergySoft User Number.- 6249 /D: 15 -01213 q 3 TABLE OF CONTENTS Cover Page Table of Contents Form CF -1 R- PRF -01 -E Certificate of Compliance Form RMS -1 Residential Measures Summary Form MF -1 R Mandatory Measures Summary EnergyPro 6.4 by EnergySoft Job Number: ID: 15 -01213 User Number: 6249 1 2 3 11 12 T- 00 Q H••• NLL O IL a� LL a 0 LO Q N ,-: X N ai Co c U c a) (7 2� r m d � E N H � � am �o c Z r m LO U. 3 r V 7 LO n• U) T m c Q c v O N f9 C � O Q. a) L fY N (D E M C Z r V y 3 •O � L LO a c) U C F w W U U v O a tn Of W 2 N N N 0 L6 CD N a1 E F— c O Y N v E z c 0 Y Oc a) cr LO LD m .i N C) O N 0 N v N c aL U O CL a) d' 01 lD N 0 N 3 ai CD O U C 0 J L O CL cu d d• O � m (+J O O N v c N m 2 a E CD O d C CL E C U U W m 0) W O N N N �-) o N N O .L al y C O .` y c O •i y y Ic c 'C V 0 5 0 0 N 0 y •O a 0 Q \ N c co a) 7 p N O O 6 � o c m tc al c d 3 G d ° E o y a E A (7 m a (+J O t0 VJ c N C c O a Z M Z 10 Z J m E co E m O E z p al O () C O LL O CL LO O I, O M O r r M r LO r n r 0 r r N CL 0) .� m •T m tT C T m U ` m c -p Qc N 2 Ln O N o c j d N m LL N o U T N Q Q � H rn U (n Z O Z Z a) LEo C 0 p C 0 R U 0 v 0 U 0 c p N 0 a F� 0 a 0 N F LL N F LL m Q N F LL Z d y 0 J tc N .d. 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C Z 0 d —O O A LL v t9 w n E V E w U °• Z Q c J � IL O U o w E U w Z C O E LL 0: zO w a o Q 0 U W co in N N 2to :1 a� W cu w C N C 0) Q W c I a) W V v N vi Q CO L E Cy a cu U CD Q = LL CO) U CL o y v a w w d 0 a E LL co J V M O G c Q u. ? a W o w V N w o Lu a� a U F- I z N a CO m ri N O Ln O N N (U N v c CU C7 0 C1 v w a 01 Ln c-I O N O LL U c O > 0 O CL w N c c (U v f9 a) CD c 2 Ef 0 > 'v -o O m o rn ui v .N T c d y fD C LU t9 .8 T > > d a aU. m E T d U 21 wo m c C C �o wcu m c cuU rna) C � E 7 y d L1 T QI m •� CU C c � CU M (U N 'O o9 O E O U cu a) w m c CD C c c cu E 0 C O In C O 'v L c T pc U O cu N cu E au co U io coU d C_ LO E Q w O w �. � c 2 p.. U.. 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U ar E y Z c+ O C h O cu 12 cu y I Ln ,° N V C6 M r-i N N c4 O N O N M -v ar v c al U 0 O CL v V 01 Lf 0 N V O LL LL V c 0 N > 0 O a v RESIDENTIAL MEASURES SUMMARY RMS -1 Project Name Sterling Blvd. Residence Building Type m Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition /Alteration Date 112112015 Project Address 10290 Sterling Blvd. Cupertino California Energy Climate Zone CA Climate Zone 04 Total Cond. Floor Area 1,923 Addition n/a # of Units 1 INSULATION Construction Type Area Cavity (ft) Special Features Status Floor Wood Framed w /Crawl Space R 19 1,203 New Wall Wood Framed R 19 1,791 New Door Opaque Door - no insulation 21 New Roof Wood Framed Attic R30 1,288 New FENESTRATION I Total Area: 523 Glazing Percentage: 27.2%1 New /Altered Average U- Factor: 0.32 Orientation Area(ft2) U -Fac SHGC Overhang Sidefins Exterior Shades Status Front (149 57.8 0.320 0.25 none none Bug Screen New Front (Vl9 48.0 0.320 0.25 none none Bug Screen New Left (N) 117.0 0.320 0.25 none none Bug Screen New Rear (E) 103.8 0.320 0.25 none none Bug Screen New Rear (E) 48.0 0.320 0.25 none none Bug Screen New Right (S) 148.2 0.320 0.25 none none Bug Screen New HVAC SYSTEMS Qty. Heating Min. Eff Cooling Min. Eff Thermostat Status 1 Central Furnace 80% AFUE Split Air Conditioner 13.0 SEER Setback New HVAC DISTRIBUTION Location Heating Duct Cooling Duct Location R -Value Status HVAC System Ducted Ducted Attic 6.0 New WATER HEATING Qty. Type Gallons Min. Eff Distribution Status 1 Small Instantaneous Gas 0 0.94 Standard New EnerqvPro 6.4 by EnerqySoft User Number: 6249 RunCode: 2015 -01 -21 T11:39:28 ID: 15 -01213 Pa e 11 of 15 2013 Love -Rise Residential Mandatory Measures Summary NOTE: Low -rise residential buildings subject to the Standards must comply with all applicable mandatory measures listed, regardless of the compliance approach used. Exceptions rnav apvly. Review the respective code section for more information. Building Envelope Measures: § 110.6(a)i: Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage. § 110.6(a)5: 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 -1 1 1 (a). § 110.7: Exterior doors and windows are weatherstripped; all joints and penetrations are caulked and sealed. § 1 10.8(a): Insulation specified or installed meets Standards for Insulating Material. Indicate type and include on the CF2R. §110.8(1): The thermal emittance and aged solar reflectance values of the cool roofmg material meets the requirements of § 110.8(i) when the installation of a cool roof is specified on the CF 1 R. § 110.80): A radiant barrier shall have an emittance of 0.05 or less when the installation of a radiant barrier is specified on the CF 1 R. Minimum R -30 insulation in wood -frame ceiling; or the weighted average U- factor shall not exceed 0.031. Minimum R -19 in a § I50.0(a): rafter roof alteration. Attic access doors shall have permanently attached insulation using adhesive or mechanical fasteners. The attic access shall be gasketed to prevent air leakage. § 150.0(6): Loose fill insulation shall conform with manufacturer's installed design labeled R- value. § 150.0(c): Minimum R -13 insulation in 2x4 inch wood framing wall or have a U- factor of 0.102 or less (R -19 in 2x6 or 0.074 maximum U- factor). § 150.0(d): Minimum R -19 insulation in raised wood -frame floor or 0.037 maximum U- factor. In Climate Zones 14 and 16 a Class II vapor retarder shall be installed on the conditioned space side of all insulation in all exterior § 150.0(g) 1: walls, vented attics and unvented attics with air-permeable insulation. In Climate Zones 1 -16 with unvented crawl spaces the earth floor of the crawl space shall be covered with a Class I or Class II § 150.0(g)2: vapor retarder. In a building having a control led ventilation crawl space, a Class l or Class II vapor retarder shall be placed over the earth floor of § 150.0(g)3: the crawl space to reduce moisture entry and protect insulation from condensation, as specified in the exception to Section 150.0(d). § 150.0(1): Slab edge insulation shall: have a water absorption rate, for the insulation material alone without facings, no greater than 0.3 %; have water vapor permeance rate is no greater than 2.0 perm/inch, be protected from physical damage and UV light deterioration; and when installed as part of a heated slab floor meets the requirements of § 110.8( ). 150.0 (q)' Fenestration, including skylights, separating conditioned space from unconditioned space or outdoors shall have a maximum U- factor of 0.58; or the weighted average U- factor of all fenestration shall not exceed 0.58. Fireplaces, Decorative Gas Appliances and Gas Log Measures: § 150.0(e) IA: Masonry or factory -built fireplaces have a closable metal or glass door covering the entire opening of the firebox. § 150.0(e) I B: 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 readily accessible, operable, and tight-fitting damper or a combustion -air control device. § l 50.0(e) I C: Masonry or factory -built fireplaces have a flue damper with a readily accessible control. § 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: § 1 10.0 -§ 110.3: HVAC equipment, water heaters, showerheads, faucets and all other regulated appliances are certified to the Energy Commission. § 110.3(c)5: Water heating recirculation loops serving multiple dwelling units meet the air release valve, backflow prevention, pump isolation valve, and recirculation loop connection requirements of § 110.3(c)5. Continuously burning pilot lights are prohibited for natural gas: fan -type central furnaces, household cooking appliances (appli- § 110.5: ances without 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)l: Heating and /or cooling loads are calculated in accordance with ASHRAE, SMACNA or ACCA using design conditions specified in §150.0(h)2. § 150.0(h)3A: Installed air conditioner and heat pump outdoor condensing units shall have a clearance of at least five feet from the outlet of any dryer vent. § 150.0(i): Heating systems are equipped with thermostats that meet the setback requirements of § l 10.2(c). § 150.00)1A: Storage gas water heaters with an energy factor equal to or less than the federal minimum standards shall be externally wrapped with insulation having an installed thermal resistance of R -12 or greater. § 150.00) 1 B: Unfired hot water tanks, such as storage tanks and backup storage tanks for solar water - heating systems, have R -12 external insulation or R -16 internal insulation where the internal insulation R -value is indicated on the exterior of the tank. For domestic hot water system piping, whether buried or unburied: the first 5 feet of hot and cold water pipes from the storage tank, all piping with a nominal diameter of 3/4 inch or larger, all piping associated with a domestic hot water recirculation system § 150.00)2A: regardless of the pipe diameter, piping from the heating source to storage tank or between tanks, piping buried below grade, and all hot water pipes from the heating source to kitchen fixtures must be insulated according to the requirements of TABLE 120.3 - A. § 150.00)2B: All domestic hot water pipes that are buried below grade must be installed in a water proof and non - crushable casing or sleeve that allows for installation, removal, and replacement of the enclosed pipe and insulation. 2013 Low -Rise Residential Mandatory Measures Summary § 150.00)2C: Pipe for cooling system lines shall be insulated as specified in § 150.0(j)2A. Piping insulation for steam and hydronic heating systems or hot waters stems with pressure > 15 psig shall meet the requirements in TABLE 120.3 -A. § 150.00)3: Insulation is protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Insulation exposed to weather shall either be rated for outdoor use or installed with a cover suitable for outdoor service. For § 150.0(j)3A: example, protected by aluminum, sheet metal, painted canvas, or plastic cover. Cellular foam insulation protected as specified or painted with coating that is water retardant and provides shielding from solar radiation that degrades the material. Insulation covering chilled water piping and refrigerant suction piping located outside the conditioned space shall have a Class I §150.0(j)3B: or Class II vapor retarding facing, or the insulation shall be installed at the thickness that qualifies as a Class I or Class II vapor retarder. Systems using gas or propane water heaters to serve individual dwelling units shall include: a 120V electrical receptacle within 3 feet of the water heater; a Category III or IV vent, or a Type B vent with straight pipe between the outside termination and the § 150.0(n)1: space where the water heater is installed; 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 assistance; and a gas supply line with a capacity of at least 200,000 Btu /hr. § 150.0(n)2: Recirculating loops serving multiple dwelling units shall meet the requirements of § 110.3(c)5. § 150.0(n)3: Solar water - heating systems and collectors shall be certified and rated by the Solar Rating and Certification Corporation (SRCC) or by a testing agency approved by the Executive Director. Ducts and Fans Measures: All air - distribution system ducts and plenums installed are sealed and insulated to meet the requirements of CMC §601.0, §602.0, §603.0, §604.0, §605.0 and ANSI /SMACNA- 006 -2006 HVAC Duct Construction Standards Metal and Flexible 3rd Edition. Supply -air and return -air ducts and plenums are insulated to a minimum installed level of R -6.0 (or higher if required by CMC §605.0) or enclosed entirely in directly conditioned space as confirmed through field verification and diagnostic testing (RA3.1.4.3.8). Connections of metal ducts and inner core of flexible ducts are mechanically fastened. Openings shall be sealed § 150.0(m)1: with mastic, tape, or other duct - closure system that meets the applicable requirements of UL 181, UL 181 A, or UL 181 B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than'/ inch, the combination of mastic and either mesh or tape shall be used. 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. Factory- Fabricated Duct Systems shall comply with specified requirements for duct construction, connections, and closures; joints § 150.0(m)2: 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)3 -6: Field- Fabricated Duct Systems shall comply with requirements for: pressure - sensitive tapes, mastics, sealants, and other requirements specified for duct construction; duct insulation R -value ratings; duct insulation thickness; and duct labeling. § 150.0(m)7: All fan systems that exchange air between the conditioned space and the outside of the building must have backdraft or automatic dampers. § 150.0(rn)8: Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers except combustion inlet and outlet air openings and elevator shaft vents. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind but not § 150.0(m)9: limited to the following: insulation exposed to weather shall be suitable for outdoor service. For example, 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 shielding from solar radiation. § 150.0(m) 10: Flexible ducts cannot have porous inner cores. When space conditioning systems use forced air duct systems to supply conditioned air to an occupiable space, the ducts shall be § 150.0(m)11: sealed and duct leakage tested, as confirmed through field verification and diagnostic testing, in accordance with Reference Residential Appendix RA3. Mechanical systems that supply air to an occupiable space through ductwork exceeding 10 feet in length and through a thermal § 150.0(m)12: conditioning component, except evaporative coolers, shall be provided with air filter devices that meet the requirements of §150.0(m)12. Space conditioning systems that utilize forced air ducts to supply cooling to an occupiable space shall have a hole for the placement of a static pressure probe (HSPP), or a permanently installed static pressure probe (PSPP) in the supply plenum. The §I50.0(m)13: space conditioning system must also demonstrate airflow >_ 350 CFM per ton of nominal cooling capacity through the return grilles, and an air - handling unit fan efficacy :5 0.58 W /CFM as confirmed by field verification and diagnostic testing, in accordance with Reference Residential Appendix RA3. Zonally controlled central forced air cooling systems shall be capable of simultaneously delivering, in every zonal control mode, § I50.0(m)15: an airflow from the dwelling, through the air handler fan and delivered to the dwelling, of >_ 350 CFM per ton of nominal cooling capacity, and operating at an air - handling unit fan efficacy of -< 0.58 W /CFM as confirmed by field verification and diagnostic testing, in accordance with Reference Residential Appendix RA3. All dwelling units shall meet the requirements of ASHRAE Standard 62.2. Neither window operation nor continuous operation of § 150.0(0): central forced air system air handlers used in central fan integrated ventilation systems are permissible methods of providing the Whole Building Ventilation. § 150.0(0) IA: Whole Building Ventilation airflow shall be confirmed through field verification and diagnostic testing, in accordance with Reference Residential Appendix RA3. Pool and Spa Heating Systems and Equipment Measures: Any pool or spa heating system shall be certified to have: a thermal efficiency that complies with the Appliance Efficiency § 110.4(a): Regulations; an on -of switch mounted outside of the heater that allows shutting off the heater without adjusting the thermostat setting; a permanent weatherproof plate or card with operating instructions; and shall not use electric resistance heating. i 2013 Low -Rise Residential Mandatory Measures Summary § 110.4(b)1: Any pool or spa heating equipment shall be installed with at least 36 inches 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 pro- grammed to run only during off-peak electric demand periods. § 110.5: Natural gas pool and spa heaters shall not have a continuous burning pilot light. §150.0(p): Residential pool systems or equipment shall meet specified pump sizing, flow rate, piping, filters, and valve requirements. Lighting Measures: § 110.9: All lighting control devices and systems, ballasts, and luminaires shall meet the applicable requirements of § 110.9. § 150.0(k)IA: Installed luminaires shall be classified as high - efficacy or low- efficacy for compliance with § 150.0(k) in accordance with TABLE 150.0 -A or TABLE 150.0 -B, as applicable. § 150.0(k)1B: When a high efficacy and low efficacy lighting system are combined in a single luminaire, each system shall separately comply with the applicable provisions of § 150.0(k). The wattage and classification of permanently installed luminaires in residential kitchens shall be determined in accordance with § 150.0(k) I C: § 130.0(c). In residential kitchens, the wattage of electrical boxes finished with a blank cover or where no electrical equipment has been installed, and where the electrical box can be used for a luminaire or a surface mounted ceiling fan, shall be calculated as 180 watts of low efficacy lighting er electrical box. § 150.0(k) I D: Ballasts for fluorescent lamps rated 13 watts or greater shall be electronic and shall have an output frequency no less than 20 kHz. Permanently installed night lights and night lights integral to installed luminaires or exhaust fans shall be rated to consume no § 150.0(k)1 E: more than 5 watts of power per luminaire or exhaust fan as determined in accordance with § 130.0(c). Night lights do not need to be controlled by vacancy sensors. § 150.0(k) IF: Lighting integral to exhaust fans (except when installed by the manufacturer in kitchen exhaust hoods) shall meet the applicable requirements of § 150.0(k). § 150.0(k)2A: High efficacy luminaires must be switched separately from low efficacy luminaires. § I50.0(k)2B: Exhaust fans shall be switched separately from lighting systems. § 150.0(k)2C: Luminaires shall be switched with readily accessible controls that permit the luminaires to be manually switched ON and OFF. § 150.0(k)2D: Controls and equipment are installed in accordance with manufacturer's instructions. § 150.0(k)2E: No control shall bypass a dimmer or vacancy sensor function if the control is installed to comply with § l 50.0(k). § 150.0(k)2F: Lighting controls comply with applicable requirements of § 110.9. An Energy Management Control System (EMCS) may be used to comply with dimmer requirements if: it functions as a dimmer § 150.0(k)2G: according to § 110.9; meets Installation Certificate requirements of § 130.4; the EMCS requirements of § 130.5; and all other requirements in § 150.0(k)2. An Energy Management Control System (EMCS) may be used to comply with vacancy sensor requirements of § 150.0(k) if. it § 150.0(k)2H: functions as a vacancy sensor according to § 110.9; meets Installation Certificate requirements of § 130.4; the EMCS requirements of § 130.5; and all other requirements in § 150.0(k)2. § I50.0(k)2I: A multiscene programmable controller may be used to comply with dimmer requirements of this section if it provides the functionality of a dimmer according to § 110.9, and complies with all other applicable requirements in § 150.0(k)2. § 150.0(k)3A: A minimum of 50 percent of the total rated wattage of permanently installed lighting in kitchens shall be high efficacy. Kitchen lighting includes all permanently installed lighting in the kitchen except internal lighting in cabinets that illuminate only § I50.0(k)3B: the inside of the cabinets. Lighting in areas adjacent to the kitchen, including but not limited to dining and nook areas, are considered kitchen lighting if they are not separately switched from kitchen lighting. § I50.0(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. § I50.0(k)5: A minimum of one high efficacy luminaire shall be installed in each bathroom; and 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. Luminaires recessed into ceilings shall: be listed for zero clearance insulation contact (IC) by Underwriters Laboratories or other nationally recognized testing /rating laboratory; have a label that certifies that the luminaire is airtight with air leakage less than 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283; be sealed with a gasket or caulk between the luminaire housing § I50.0(k)8: and ceiling, and shall have all air leak paths between conditioned and unconditioned spaces sealed with a gasket or caulk; and allow ballast maintenance and replacement without requiring cutting holes in the ceiling. For recessed compact fluorescent luminaries with ballasts to qualify as high efficacy for compliance with § 150.0(k), the ballasts shal i be certified to the Energy Commission to comply with the applicable requirements in § 110.9. For single - family residential buildings, outdoor lighting pernianently 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 § 150.0(k)9A: 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; and iii. Controlled by one of the following methods: 2013 Low -Rise Residential Mandatory Measures Summary 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 § 110.9; meets the Installation Certification requirements in §130.4; meets the requirements for an EMCS in § 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. For low -rise multifamily 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 § 150.0(k)9B: following requirements: i. Shall comply with § 150.0(k)9A; or ii. Shall comply with the applicable requirements in § 110.9, § 130.0, § 130.2, § 130.4, § 140.7 and § 141.0. § 150.0(k)9C: For low -rise residential buildings with four or more dwelling units, outdoor lighting not regulated by § 150.0(k)9B or 150.0(k)9D shall comply with the applicable requirements in § 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 § 110.9, § 130.0, § 130.2, § 130.4, § 140.7 and § 141.0. § 150.0(k) 10: Internally illuminated address signs shall comply with § 140.8; or shall consume no more than 5 watts of power as determined according to § 130.0(c). § 150.0(k) 11: Lighting for residential parking garages for eight or more vehicles shall comply with the applicable requirements for nonresidential garages in § 110.9, § 130.0, § 130. 1, § 130.4, § 140.6, and § 141.0. In a low -rise multifamily residential building where the total interior common area in a single building equals 20 percent or less of § 150.0(k) I2A: 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. In a low -rise multifamily 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: § 150.0(k)12B: i. Comply with the applicable requirements in § 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. Solar Ready Buildings: Single family residences located in subdivisions with ten or more single family residences and where the application for a § 110.10(a)1: tentative subdivision map for the residences has been deemed complete, by the enforcement agency, on or after January 1, 2014, shall comply with the requirements of § 1 10.10 (b) through §I 10.10(e ). § 110.10(a)2: Low -rise multi - family buildings shall comply with the requirements of § 110.10(b) through § 110.10(d). The solar zone shall have a minimum total area as described below. The solar zone shall comply with access, pathway, smoke ventilation, and spacing requirements as specified in Title 24, Part 9 or other Parts of Title 24 or in any requirements adopted by a local jurisdiction. The solar zone total area shall be comprised of areas that have no dimension less than 5 feet and are no less than 80 square feet each for buildings with roof areas less than or equal to 10,000 square feet or no less than 160 square feet each for § 110.10(b)1: buildings with roof areas greater than 10,000 square feet. For single family residences the solar zone shall be located on the roof or overhang of the building and have a total area no less than 250 square feet. For low -rise multi - family buildings the solar zone shall be located on the roof or overhang of the building or on the roof or overhang of another structure located within 250 feet of the building or on covered parking installed with the building project and have a total area no less than 15 percent of the total roof area of the building excluding any skylight area. § 110.10(b)2: All sections of the solar zone located on steep- sloped roofs shall be oriented between 110 degrees and 270 degrees of true north. § 110.10(b)3A: No obstructions, including but not limited to, vents, chimneys, architectural features, and roof mounted equipment, shall be located in the solar zone. Any obstruction, located on the roof or any other part of the building that projects above a solar zone shall be located at least twice §1 10.10(b)3B: the distance, measured in the horizontal plane, of the height difference between the highest point of the obstruction and the horizontal projection of the nearest point of the solar zone, measured in the vertical plane. § 110.10(b)4: For areas of the roof designated as solar zone, the structural design loads for roof dead load and roof live load shall be clearly indicated on the construction documents. The construction documents shall indicate: a location for inverters and metering equipment and a pathway for routing of conduit § I I OA 0(c): from the solar zone to the point of interconnection with the electrical service (for single family residences the point of interconnection will be the main service panel); a pathway for routing of plumbing from the solar zone to the water - heating system. § 110.10(d): A copy of the construction documents or a comparable document indicating the information from § 110.10(b) through § 110.10(c) shall be provided to the occupant. § 110.10(e)1: The main electrical service panel shall have a minimum busbar rating of 200 amps. The main electrical service panel shall have a reserved space to allow for the installation of a double pole circuit breaker for a § 110.10(e)2: future solar electric installation. The reserved space shall be: positioned at the opposite (load) end from the input feeder location or main circuit location, and permanently marked as "For Future Solar Electric'. \ 4 A. CALGREEN RESIDENTIAL CHECKLIST - MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING,. IV st CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL; G 0 pyll : , 4 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildin4(akuaertino.or4 PURPOSE: The 2013 CalGreen Code applies to all newly constructed hotels, motels, lodging hog esi- T dormitories, condominiums, shelters, congregate residences, employee housing, fa*fP), „ i In other types of swellings with sleeping accommodations and new accessory buildings associat ith such uses. Existing site and landscaping improvements that are not otherwise disturbed are not s Q to the requirements of CALGreen. Project Name: LPIA1 P14,4G[,P0±1 aL J02 q0 I`eV /► (Vt = . Project Address: CA0 jr�i t Project Description: 7,35F tafgL tiivl rlU A; laud 01560,0= IziffiL amnflh 2 -lava 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 i n professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verificati end of this eWlis d have the checklist printed on the approved plans for the project. INO 3. Prior to final inspection by the Building Department, the licens Sfi ional shall com9etPOV�mW 3 and sign and date Section 2 - Implementation Verification * ptj of Mpph6c� 11g and submit the completed form to the Building Inspector. 2615 RE1�iEVV�U FOR t;UDE C _ Keviewea By. `.� Il1IP�I,q�C� f,/ Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Requirements 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during 0 El 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 ® El ,site grading or a drainage system will manage all surface water flows. Page 1 of 5 /so /oi /9 CalGreen 2014.doc revised 01115114 A4.2 ENERGY EFFICIENCY R �M6 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. A4.3 WATER EFFICIENCY AND CONSERVATION 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following: ❑ 4.303.1.3.2 Water Closets. The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank-type water closets shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank-type Toilets. ❑ 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. ❑ 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 Specification for showerheads. ❑ 4.303.1.3.2 Multiple Showerheads serving one shower. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. ❑ 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less than 0.8 gallons per minute at 20 psi. ❑ 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas (outside of dwellings or sleeping units) in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. ❑ 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. ❑ 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, and shall meet the applicable standards referenced in Table 1401.1 of the California Plumbing Code. Page 2 of 5 CalGreen-2014.doc revised 01115114 Page 3 of 5 CalGreen_2014.doc revised 01115114 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the time of final inspection shall be weather - based. ❑ 4.304.1.1 Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as weather conditions change. ❑ 4.304.1.2 Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. A4.4 MATERIAL CONSERVATION AND RESOURCE EFFICIENCY 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. "nstructionp,Waste gf l Co Reduction; Disposal andiRecycl�ng � rr, n c eyp 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall be submitted for approval to the enforcing agency. 4 �i p.v'±^Y...+i �rl. +� i .�}' �' . „.'r „�5 .yY«,.t �: VA pi 4� F' G, f 4 ?. i �. .l.�Sf �. .��.:}s ss. ��,5 _�: :� „j.1 �;xix��n.v;"$nu' Sx r_ vri'dl l'��F �'y�: ✓��I,l��^w„1 y.6� Fr��1 ': , 4Ytk�£I??M1 4.410.1 Operation and maintenance manual. At the time of final inspection, an operation and maintenance manual shall be provided to the building 0 occupant or owner. A4.5 ENVIRONMENTAL QUALITY-. 4.503.1 General. Install only a direct -vent sealed- combustion gas or sealed wood - burning fireplace, or a sealed woodstove. wx Lt,<.. Yi .i3. ..Y.,•. .Aro hu T.Vi .�v .d.n_F:P,i. 4.504.1 Covering of duct openings and protection of mechanical equipment during construction. Duct openings and other related air ❑X distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be compliant with VOC limits. 4.504.2.3 Aerosol paints and coatings. Aerosol paints'and other coatings shall be compliant with product weighted MIR Limits for ROC and other toxic ❑X compounds. Page 3 of 5 CalGreen_2014.doc revised 01115114 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 ❑X ❑ Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Composite wood products. Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall ❑X ❑ comply with low formaldehyde emission standards. Interior Moisture Control ' � ti � � � x � h � r, 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. m Indoor'Air Quality andExhaust �3 r# b v },. n,9 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the ❑ building are provided in every bathroom. Y.,� t Y Y `�, .y h ,ae^P ?aJ EnvironmentaltComfort ,i x ai:-�, ...': �. S .i J, .- 2�..tx.� V 1 _. .::.w�.A< ,s_'iFV ,y� S� ! f�'+,v:. Z v Jt-0 t '� �• .: "Y N'4 :.-.5 r_ } M1 {,� -.e, 1v, �Y:' 4.507.2. Duct systems are sized and designed and equipment is selected using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or equivalent. ❑ 2. Size duct systems according to ACCA 29 -D (Manual D) or equivalent. 3. Select heating and cooling equipment according to ACCA 36 -S (Manual S) or equivalent. NSTALLER AND SPECIALINSP E: ® - OUALIFICATIONS yy cJk fi +i Fx atw,**F' ,^� } Qualifications f r Jt , Tf y4 Y 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 CALGreen compliance is qualified and able to demonstrate competence in the ❑X ❑ discipline they inspect and verify. L 703.1 Documentation. Verification of compliance with CALGreen may include construction documents; plans, specifications,. builder or installer certification, inspection reports, or other methods acceptable to the enforcing El which show substantial conformance. Implementation verification shall be submitted to the Building Department after implementation of all required measures and prior to final inspection approval. Page 4 of 5 . CalGreen_2014.doc revised 01115114 Project Name: Project Address: Project Description: CALGREEN SIGNATURE DECLARATIONS 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. �l 77,Z ignature Date 'ri'm x Owner's Name (Please Design Professional's Signature Date t-6(\ Yuiqyl- Design Professional's Name (Please Print) ,l icense Professionai'responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone aua ki &01 ma ( � crm Email Address for L ense Profession'd responsible for CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION a Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen_2014.doc revised 01115114 U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE EMERGENCY MANAGEMENT AGENCY Natioaai Flood lum=c Program IMPORTANT: Follow the instructions on pages 1 -9. OMB No. 1660 -0008 Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION FOR INSURANCE. COMPANY USE Al. Building Owner's Name Caixing Xie and Di Wei Policy Number: A2. Building Street Address Lincluding Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. Comparry NAIC Number: 10290 Sterlin4 Boulevard City Cupertino State CA ZIP Code 95014 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 254 of Tract No. 1183 recorded in book 44 of Maps at page 13 of Santa Clara County of Official Records - APN 375-24 -019 A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc,) Residential A5. Latitude /Longitude: Lat. '17'19'07 78" Long. 121 °59'46.86" Horizontal Datum: ® NAD 1927 ❑ NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number R A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 1203 sq ft a) Square footage of attached garage 437 sq ft b) Number of permanent flood openings in the crawlspace 15 b) Number of permanentlflood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b 1204 sq in c) Total net area of flood openings in A9.b 438 sq in d) Engineered flood openings? ❑ Yes N No d) Engineered flood openings? ❑ Yes N No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NAP Community Name & Community Number B2. County Name ec t e measuremen used. 0 N feet ❑ meters B3. State City of Cupertino 060339 Santa Clara County I CA B4. Map /Panel Number 85. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ B8. Flood Zone(s) B9. Base Flood Elevation(s) (Zone ❑ meters e). Lowest elevation of machinery or equipment servicing the building 177 Revised Date ❑meters AO, use base flood depth) 0228 H 05/18/2009 05!18/2009 A 175.90 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69: ❑ AS Profile ❑ FIRM ❑ Community Determined ® Other /Source: BFE Calculated using HEC -.RAS Bll. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other /Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date: / / ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: N Construction Drawings* ❑ Building Under Construction* ❑ Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR /A, AR /AE, AR /A1 -A30, AR /AH, AR /A0. Complete Items C2.a -h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: Santa Clara Water District BM ID #/166 Vertical Datum: 202.78 feet Indicate elevation datum used for the elevations in items a) through h). below. ❑ NGVD 1929 ® NAVD 1988 ❑ Other /Source: Datum used for building elevations must be the same as that used for the BFE. Ch k h t a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 176 ec t e measuremen used. 0 N feet ❑ meters b) Top of the next higher floor 178.8 N feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) n/a . N feet ❑ meters d) Attached garage (top of slab) 177 6 N feet ❑ meters e). Lowest elevation of machinery or equipment servicing the building 177 0 ®feet ❑meters :. (Describe type of equipment and location in Comments) f)-: t w'V adjacent (finished) grade next to building (LAG) 177 _ 0 N feet ❑ meters g): Higbftf ?adjacent (finished) grade next to building (HAG) 177. 1 N feet ❑ meters h) Lowe ,adi4ent grade at lowest elevation of deck or stairs, including 177.0 ®feet ❑meters structural - support SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to 15e signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. M Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? N Yes ❑ No Certifier's Name License Number Porfirio Oscar Osuna I PLS 8921 Title Company Name President GreenBluEarth, Inc. 117 Berr Signature San Jose CA Date Telephone 04/07/2015 (408) 772 -4381 ZIP Code 95119 Ni- LAND S� PORF11310 OSCAR '4 � i'6sk1N�°o � N`flF$:�21 it \un Exp' \T� OF C AO () FEMA Form'086-0-33 (Revised 7/12) See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, !page 2 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. Policy Number: 10290 Sterling Boulevard City State ZIP Code Company NAIC Number: Cupertino CA 95014 SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments 1) Property is Located in Zone A (without BFE in FIRM); However the BFE used is 175.90 feet, as calculated using HEC -RAS modeling. s cu a I ns will a sutimitted to City of upe ino Public WoMs Department Condenser Unit on concrete slab. Signature �j�f , / Date 0410712015 SECTIOWE — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete items E1 -E5. If the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, Band C. For Items El -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure). is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and /or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. ES. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and /or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? E] Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA- issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 -G10. In Puerto Rico only, enter meters. G1_ ❑ The Information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA- issued or community - issued BFE) or Zone A0. G3. ❑ The following information (Items G4 -G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance /Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10-Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments. FEMA Form 086-0 -33 (Revised 7/12) Replaces all previous editions. BUILDING ENERGY ANALYSIS REPORT V-,- J-7 PROJECT: Sterling Blvd. Residence 10290 Sterling Blvd. Cupertino, CA 95014 Project Designer: Globe Architecture 96 Eleanor Ave. R-M 0FF1t;E Los Altos, CA 94022 a (650) 796 -4328 p,ECEIVE, APR 2,9 2015 BY Report Prepare ;b t�ul�dmJ DBP�`- }ent Timothy Carstairs, CEA, = GPI V 20� Carstairs Energy Cal' s PL�A�c� PO Box 4736 v c09F � San Luis Obispo, CA�.343 Y (805) 904 -9048 Reviewed p D Job Number: 15 -04288 Date: 4/28/2015 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. 6.5 TABLE OF CONTENTS I Cover Page Table of Contents Form CF -1 R- PRF -01 -E Certificate of Compliance Form RMS -1 Residential Measures Summary Form MF -1 R Mandatory Measures Summary EnergyPro 6.5 by EnergySoft Job Number: ID: 15 -04288 User Number: 6249 2 3 11 12 l 00 jL o W T a a, m U a U E x O w LAO Q O 0 N d 00 a) N U a c Q o U) I- M � [0 T C E `m �1 m E 0 C Z o m LL V 3 m Q. U 5 D W 2' V) QL w S .t U N Q m J @ a � c p U ) Q U. O �+ LU d D Q E C U Z r Li +. m � � V W m U a U U _c F- Q.' w U U v v 'o a w w x N C) rn N 0 !9 N Ul E p v C 0 fa .m a) v a E Z c 0 m v s N 6ir-I 00 N O Uf �i N d v c v C7 t O CL ar w O �-i n Ln 0 N N N N O U c O t 0 tL a) w `d O 'O •� M w c co 0. N d c N o 0 n o co CD ` I 0. O O N c L-° N a E U') co ° a W d O a pJ C? O L U rn = o E E o U l W M m c W o N �- N y i°' - N N • o N 'O Lo c c 0 > m c La c 0 -L" y ° c 'E U c c d w C tm ,6 o o 6 a E m o O d a E-0 ' z m $ 'L•• O - d 5 Z m a Q N m 0 ' Z o rn c .. a c m (' 0 E O z CL CL U O O LL U M P Im r M M P 01 r O O O r r r r r N C v y j m O U 6 m m c d N T � c Q N d .-. f- — w? U O N rn O c a r U V rn U E, LL d v, C fA 2 C U > 3 Z N N o Q Z Q Z z O z V o a` 0• .0 •E 0 CS c v U -0 o o J 0 P a C� o U 0, O N d E U P Cl m O N 0 a` F- - m ►d• Q o ° LL p w LL m ►d• Q a m Q `o O Li o p U o Q U m ►d• Q a to c w Q Q N 2 d w CL , O Ll •E � cq °o °r° °o a°fo U) LL O m O N O In O N Z QJ a W Z W r O N O M O I't O f0 O 00 O O r I,- r �t r fa r 00 r O N U U _c F- Q.' w U U v v 'o a w w x N C) rn N 0 !9 N Ul E p v C 0 fa .m a) v a E Z c 0 m v s N 6ir-I 00 N O Uf �i N d v c v C7 t O CL ar w O �-i n Ln 0 N N N N O U c O t 0 tL a) w `d 'O •� � w c 0. N d c N o 0 n o co CD ` I 0. O 00 W d O a pJ C? O M P = E ° d 0 CL CL O U w U O c 0 N d CL , Ll •E � cq °o °r° °o a°fo U) O m O N O In O N W r 'O --- d N Of O O W N O 01 0.- N 00 C6 aND M a �w w 't O r3 W z '•4 c : � w v- H d_ ? pl N r O O e0 0 1 _0 d LH .- O r- 4 c6 cS ` M c_ 4. of COL O 0'ti 0 U 4; w 3 0 a m L 0 w F°- E d L= C C 0 C O c 'o p Lo O d a c c 7 et O IM > S U c 2 : e w U) N N O d d c> d > 0 V C Y m G C LO m F- f) _Q � L a w a E od U W U Z Q o 0 J a 2 O U U _c F- Q.' w U U v v 'o a w w x N C) rn N 0 !9 N Ul E p v C 0 fa .m a) v a E Z c 0 m v s N 6ir-I 00 N O Uf �i N d v c v C7 t O CL ar w O �-i n Ln 0 N N N N O U c O t 0 tL a) w T- Q) C O LL W N a m LL a U E X w LO Q O 0 N d 00 N N CL Q Oo a� U) H � Vl M '' T W m c CM m 41 '` al CL t cn E U r d LO E Mn p � w C Z p 0 o 0 L ca C w —° co E d � V C w a) U T Z Q a) J c 0 m N V o w E U 0 E LL o W IL o Q c WN Lo p 0 W T m cc C N W Q c p V N W LU E I— J ip W a :p N 0 W In N 0 p Q w `7 W .O U. 0 � .N V Q W G1 p CL LL Q M O 0 c Q U LL iaZ U a v W CL ru N &i e-I 00 N v 0 11 0 N co -a aj c v c� O CL a1 K O a--I n Ln 0 N In N N 0 z U C O O a 5 l: A cu �a m d N C 0 Q Q T N° ui .N � T M L9 C E L9 U m a) l0 d y CL E 0 U y w Mn T a 2 f9 N U ° C l9 W tc9 rn0 c w U m CL rn 0 (D C m 0 01 7y a) W ap N a) 0 0 y 0 O E � d wL.+ 0I C 2 c9 - E z= C c co O c 0 �o .Y C U) nl E a) Lo N l9 w U O '` w w 2 C d a on :3 w co y C a) U LO O CU, '. _ C -' p d �- a`,cu T mE W 75 w v C.' a d a N E 3 O N > .c 10 �! ai cn u) d O y C C 0 0 m C y I O O C CD LH ` d wL+ O O n W w O > d Q c O cu O W LL d 0 -OIL N In j ca m> 0 O O N :3 ++ C W.- T 7 .►. a' m 'AE'00B: Q C C > i LL 0 �- d N 7 lE y d V d C E tA_E Z; N Q� t; O :53Sc L) �z � y o `on Q O LL Q p E 2. 2 H M V.. . 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N C o o O N N �>� O C) C ° C C w N O U O °o O °o 0 O V m rn CQ G to O O o LL Z m Z L6 U) E N � z 7 �0 Z 0 d E m W ° d Q Z E LL 'p C -00 0-• p 0 LT 7 c7 a a O J o 0 W Z N m N N &i e-I 00 N v 0 11 0 N co -a aj c v c� O CL a1 K O a--I n Ln 0 N In N N 0 z U C O O a 5 l: T.- CO C LL 0 - M M CL m LL d U E x W LO Q O N Q C N U CL Q v H � M -6 d: in m d C U) LO E c o Z :N � LL V 3 CL U c G An W T cu C o) Q W C ". U -o N Q m :—E- m c CL o O :o c O N F d Q E C U Z O LL w M LUV 0 0 IL U C F- w w U U N O CL` w W Z N bi M 6i 0 N It 0 !9 N 41 E N m C O bD v v E 7 Z c O IT s N M N v 0 Ln O N m 41 N v C N 0 0 a 41 K O a--1 n N a--I O N N N N O K U- U C O O a v Of c Z Z O U d m w 'O O O O O O O O O } O O O O 'O u p C E O C LO O LO O W o 0 O c u c Q w v W d O y O 0 0 t0 � - 00 f� M N O co M M d0' ,t N o O C) 0 0 O �o co 'O N c O y c Q O o m V C N O w N J m L`0 0 ca U U Q Q t0 m M to O 10 d' N N co O 0 co L0 co m r� O Q O N m N —t d' N m N N m N f- 0 N f- �. O N O N O N O N M d' y Q Q U a O 1 t f C o m `Y' v� o �� _- `ca a� c y o LL J c m Q o LL ai J ca c m _rn Q LL e Ji c 'm= Q' - L - 7 cl O 0 CD 00 CD O m 0 O CD O '� tiN O N N N LO * C U U 0 U u cu O y m m m m r m m m m Q Q O 9 O t0 M M c m c m m m ca m m 2 c 2 c 2 c m c 2 c m m m �, ,m Q Q Q Q Q Q Q Q Q Q Q 0 ,� im N O C o m m m m m m m m m m m (m0 c Co c ,L�,• co N c c c c c c c c c c c J J J J J J J J J J J — N N N N `p co co co CO U (p ?) 0 N O 0 LL -0 — i0 _ �p �j — (0 — LC CO O {QL C to Z O N N m O - N 61 Q wo N y m Q LL J Q Q J Q Q o O LL J Q Q rn W 7 a a O U C F- w w U U N O CL` w W Z N bi M 6i 0 N It 0 !9 N 41 E N m C O bD v v E 7 Z c O IT s N M N v 0 Ln O N m 41 N v C N 0 0 a 41 K O a--1 n N a--I O N N N N O K U- U C O O a v O c Z Z O U d m h m O y CD c Z } LO 'O u C E O E LO O LO O W o 0 O u c w v W d O y O O Q' O m o O C) 0 0 �o co N c O y c Q O o m V C N O w N J m L`0 0 ca U U Q Q L6 m Q 0 Q7 c O M '> Z v J Q Q U a U C F- w w U U N O CL` w W Z N bi M 6i 0 N It 0 !9 N 41 E N m C O bD v v E 7 Z c O IT s N M N v 0 Ln O N m 41 N v C N 0 0 a 41 K O a--1 n N a--I O N N N N O K U- U C O O a v V- CD y. 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U a{ p o• ' cfl. cu - -=N ❑ U z D r co a o m a a m- i X' m E `o - M U O — U) w C i C O N C. O O - CL 0 N �: m :s ai id CL m - - a o �v U `- E •- m N y O _.__ 'p co O w N yy •� N C N N C a) p`I 32 ti r U Co L- m vL- E N 16 U p N N Z c F (D � N 3r. CL co W °- 0 Z W m-vm �c C C C m y O wt..• Co m C ._ CD U H C L p U p (n > E a > Q m _ ~ U Z O_ m �O N g'a 0-'b au)) ou W o CO) o M g C') w m p.m �a O � O N U o + N M U W 5? CD vi c.N >1 m e fY y y W CL w ID U E N U O vv CD mU m N Z N CO y w c m c w rn U W Q O L'7 �' 3 'rn w O p 0 •N L. Q U Q c m O V w d' O J � y m� w❑ CD t ~ tm_, co N X N m o E y O N `Y' O C Q C N W '�' C i >' (9 0 Co •� Z wt..• U �--' 3 N C w\O.• O E a" f/1 i RESIDENTIAL MEASURES SUMMARY RMS -1 Project Name Sterling Blvd. Residence Building Type m Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition /Alteration Date 412812015 Project Address 10290 Sterling Blvd. Cupertino California Energy Climate Zone CA Climate Zone 04 Total Cond. Floor Area 2,127 Addition n/a # of Units 1 INSULATION Construction Type Area Cavity (ft) Special Features Status Floor Wood Framed w /Crawl Space R 19 1,407 New Wall Wood Framed R 19 2,074 New Roof Wood Framed Attic R 30 1,398 New FENESTRATION Total Area: 579 Glazing Percentage: 27.2 % Orientation Area ft2 U -Fac SHGC Overhang Sidefins New /Altered Average U- Factor: 0.32 Exterior Shades Status Front (M 57.8 0.320 0.25 none none Bug Screen New Front (Kq 66.5 0.320 0.25 none none Bug Screen New Left (N) 92.7 0.320 0.25 none none Bug Screen New Rear (E) 144.3 0.320 0.25 none none Bug Screen New Rear (E) 66.5 0.320 0.25 none none Bug Screen New Right (S) 121.2 0.320 0.25 none none Bug Screen New Right (S) 30.1 0.320 0.25 none none Bug Screen New HVAC SYSTEMS Qty. Heating Min. Eff Cooling Min. Eff Thermostat Status 1 Central Furnace 80% AFUE Split Air Conditioner 13.0 SEER Setback New HVAC DISTRIBUTION Location Heating Cooling Duct Location Duct R -Value Status HVAC System Ducted Ducted Attic 6.0 New WATER HEATING Qty. Type Gallons Min. Eff Distribution Status 1 Small Instantaneous Gas 0 0.94 Standard New EnerqvPro 6.5 by EnerqySoft User Number: 6249 RunCode: 2015- 04 -28T15 :45:39 ID: 15 -04288 Pa a 11 of 15 2013 Low -Rise Residential Mandatory Measures Summary NOTE: Low -rise residential buildings subject to the Standards must comply with all applicable mandatory measures listed, regardless of the compliance approach used. Exceptions may apply. Review the respective code section for more information. Building Envelope Measures: § 110.6(a)1: Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage. § 110.6(a)5: 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 weatherstripped; 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 the CF2R. § 110.8(i): The thermal emittance and aged 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 1 R. § 110.80): A radiant barrier shall have an emittance of 0.05 or less when the installation of a radiant barrier is specified on the CF1R. Minimum R -30 insulation in wood -frame ceiling; or the weighted average U- factor shall not exceed 0.031. Minimum R -19 in a § 150.0(a): rafter roof alteration. Attic access doors shall have permanently attached insulation using adhesive or mechanical fasteners. The attic access shall be gasketed to prevent air leakage. §`150.0(b): Loose fill insulation shall conform with. manufacturer's installed design labeled R- value. §150.0(c): Minimum R -13 insulation in 2x4 inch wood framing wall or have a U- factor of 0.102 or less (R -19 in 2x6 or 0.074 maximum U- factor). §150.0(d): Minimum R -19 insulation in raised wood -frame floor or 0.037 maximum U- factor. In Climate Zones 14 and. 16 a Class II vapor retarder shall be installed on the conditioned space side of all insulation in all exterior §150.0(g)l: walls, vented attics and unvented attics with air-permeable insulation. In Climate Zones 1 -16 with unvented crawl spaces the earth floor of the crawl space shall be covered with a Class I or Class II §150.0(g)2: vapor retarder. In a building having a controlled ventilation crawl space, a Class I or Class 11 vapor retarder shall be placed over the earth floor of §150.0(g)3: the crawl space to reduce moisture entry and protect insulation from condensation, as specified in the exception to Section 150.0(d). §150.0(1): Slab edge insulation shall: have a water absorption rate, for the insulation material alone without facings, no greater than 0.3 %; have water vapor permeance rate is no greater than 2.0 perm/inch, be protected from physical damage and UV light deterioration; and when installed as part of a heated slab floor meets the requirements of § 110.8 § 150.0(q): Fenestration, including skylights, separating conditioned space from unconditioned space or outdoors shall have a maximum U- factor of 0.58; or the weighted average U- factor of all fenestration shall not exceed 0.58. Fireplaces, Decorative Gas Appliances and Gas Log Measures: §150.0(e)lA: Masonry or factory-built fireplaces have a closable metal or glass door covering the entire opening of the firebox. § 150.0(e)1B: 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 readily accessible, operable, and tight-fitting damper or a combustion -air control device. §150.0(e)1C: Masonry or factory-built fireplaces have a flue damper with a readily accessible control. § 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 to the Energy Commission. §110.3(c)5: Water heating recirculation loops serving multiple dwelling units meet the air release valve, backflow prevention, pump isolation valve, and recirculation loop connection requirements of § 110.3(c)5. Continuously burning pilot lights are prohibited for natural gas: fan-type central furnaces, household cooking appliances (appli- §110.5: ances without an electrical supply voltage connection with pilot lights that consume less than 150 Btu/hr are exempt), and pool ands a heaters. § 150.0(h)1: Heating and /or cooling loads are calculated in accordance with ASHRAE, SMACNA or ACCA using design conditions specified in §150.0 2. § 150.0(h)3A: Installed air conditioner and heat pump outdoor condensing units shall have a clearance of at least five feet from the outlet of any dryer vent. §150.0(i): Heating systems are equipped with thermostats that meet the setback requirements of § 110.2(c). §150.06)lA: Storage gas water heaters with an energy factor equal to or less than the federal minimum standards shall be externally wrapped with insulation having an installed thermal resistance of R -12 or greater. § 150.00)1B: Unfired hot water tanks, such as storage tanks and backup storage tanks for solar water- heating systems, have R -12 external insulation or R -16 internal insulation where the internal insulation R -value is indicated on the exterior of the tank. For domestic hot water system piping, whether buried or unburied: the first 5 feet of hot and cold water pipes from the storage tank, all piping with a nominal diameter of 3/4 inch or larger, all piping associated with a domestic hot water recirculation system § 150.00)2A: regardless of the pipe diameter, piping from the heating source to storage tank or between tanks, piping buried below grade, and all hot water pipes from the heating source to kitchen fixtures must be insulated according to the requirements of TABLE 120.3 - A. §150.00)2B: All domestic hot water pipes that are buried below grade must be installed in a water proof and non - crushable casing or sleeve that allows for installation, removal, and replacement of the enclosed pipe and insulation. 2013 Low -Rise Residential Mandatory Measures Summary § 150.00)2C: Pipe for cooling system lines shall be insulated as specified in § 150.00)2A. Piping insulation for steam and hydronic heating systems or hot waters stems with pressure > 15 psig shall meet the requirements in TABLE 120.3 -A. § 150.00)3: Insulation is protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Insulation exposed to weather shall either be rated for outdoor use or installed with a cover suitable for outdoor service. For §150.00)3A: example, protected by aluminum, sheet metal, painted canvas, or plastic cover. Cellular foam insulation protected as specified or painted with coating that is water retardant and provides shielding from solar radiation that degrades the material. Insulation covering chilled water piping and refrigerant suction piping located outside the conditioned space shall have a Class I § 150.00)3B: or Class II vapor retarding facing, or the insulation shall be installed at the thickness that qualifies as a Class I or Class II vapor retarder. Systems using gas or propane water heaters to serve individual dwelling units shall include: a 120V electrical receptacle within 3 feet of the water heater; a Category III or IV vent, or a Type B vent with straight pipe between the outside termination and the §150.0(n)l: space where the water heater is installed; 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 assistance; and a gas supply line with a capacity of at least 200,000 Btu/hr. §150.0(n)2: Recirculating loops serving multiple dwelling units shall meet the requirements of § 110.3(c)5. § 150.0(n)3: Solar water - heating systems and collectors shall be certified and rated by the Solar Rating and Certification Corporation (SRCC) or by a testing agency approved by the Executive Director. Ducts and Fans Measures: All air - distribution system ducts and plenums installed are sealed and insulated to meet the requirements of CMC §601.0, §602.0, §603.0, §604.0, §605.0 and ANSI /SMACNA- 006 -2006 HVAC Duct Construction Standards Metal and Flexible 3rd Edition. Supply -air and return-air ducts and plenums are insulated to a minimum installed level of R -6.0 (or higher if required by CMC §605.0) or enclosed entirely in directly conditioned space as confirmed through field verification and diagnostic testing (RA3.1.4.3.8). Connections of metal ducts and inner core of flexible ducts are mechanically fastened. Openings shall be sealed § 150.0(m)l: 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. 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. Factory- Fabricated Duct Systems shall comply with specified requirements for duct construction, connections, and closures; joints §150.0(m)2: 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)3-6: Field- Fabricated Duct Systems shall comply with requirements for: pressure- sensitive tapes, mastics, sealants, and other requirements specified for duct construction; duct insulation R -value ratings; duct insulation thickness; and duct labeling. § 150.0(m)7: All fan systems that exchange air between the conditioned space and the outside of the building must have backdraft or automatic dampers. § 150.0(m)8: Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers except combustion inlet and outlet air openings and elevator shaft vents. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind but not § 150.0(m)9: limited to the following: insulation exposed to weather shall be suitable for outdoor service. For example, 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 shielding from solar radiation. §150.0(m)10: Flexible ducts cannot have porous inner cores. When space conditioning systems use forced air duct systems to supply conditioned air to an occupiable space, the ducts shall be § 150.0(m)11: sealed and duct leakage tested, as confirmed through field verification and diagnostic testing, in accordance with Reference Residential Appendix RA3. Mechanical systems that supply air to an occupiable space through ductwork exceeding 10 feet in length and through a thermal §150.0(m)12: conditioning component, except evaporative coolers, shall be provided with air filter devices that meet the requirements of §150.0(m)12. Space conditioning systems that utilize forced air ducts to supply cooling to an occupiable space shall have a hole for the placement of a static pressure probe (HSPP), or a permanently installed static pressure probe (PSPP) in the supply plenum. The §150.0(m)13: space conditioning system must also demonstrate airflow > 350 CFM per ton of nominal cooling capacity through the return grilles, and an air - handling unit fan efficacy :5 0.58 W /CFM as confirmed by field verification and diagnostic testing, in accordance with Reference Residential Appendix RA3. Zonally controlled central forced air cooling systems shall be capable of simultaneously delivering, in every zonal control mode, §150.0(m)15 an airflow from the dwelling, through the air handler fan and delivered to the dwelling, of> 350 CFM per ton of nominal cooling capacity, and operating at an air - handling unit fan efficacy of < 0.58 W /CFM as confirmed by field verification and diagnostic testing, in accordance with Reference Residential Appendix RA3. All dwelling units shall meet the requirements of ASHRAE Standard 62.2. Neither window operation nor continuous operation of §150.0(o): central forced air system air handlers used in central fan integrated ventilation systems are permissible methods of providing the Whole Building Ventilation. § 150.0(o)lA: Whole Building Ventilation airflow shall be confirmed through field verification and diagnostic testing, in accordance with Reference Residential Ap2endix RA3. Pool and Spa Heating Systems and Equipment Measures: Any pool or spa heating system shall be certified to have: a thermal efficiency that complies with the Appliance Efficiency § 110.4(a): Regulations; an on -off switch mounted outside of the heater that allows shutting off the heater without adjusting the thermostat setting; a permanent weatherproof plate or card with operating instructions; and shall not use electric resistance heating. . 2013 Low -Rise Residential Mandatory Measures Summary § 110.4(b)1: Any pool or spa heating equipment shall be installed with at least 36 inches 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 pro- grammed to run only during off -peak electric demand periods. § 110.5: Natural gas pool and spa heaters shall not have a continuous burning pilot light. §150.0(p): Residential pool systems or equipment shall meet specified pump sizing, flow rate, piping, filters, and valve requirements. Lighting Measures: § 110.9: All lighting control devices and systems, ballasts, and luminaires shall meet the applicable requirements of § 110.9. §150.0(k)IA: Installed luminaires shall be classified as high - efficacy or low- efficacy for compliance with § 150.0(k) in accordance with TABLE 150.0 -A or TABLE 150.0 -13, as applicable. §150.0(k)1B: When a high efficacy and low efficacy lighting system are combined in a single luminaire, each system shall separately comply with the applicable provisions of § 150.0(k). The wattage and classification of permanently installed luminaires in residential kitchens shall be determined in accordance with § 150.0(k)l C: § 130.0(c). In residential kitchens, the wattage of electrical boxes finished with a blank cover or where no electrical equipment has been installed, and where the electrical box can be used for a luminaire or a surface mounted ceiling fan, shall be calculated as 180 watts of low efficacy lighting er electrical box. §150.0(k)1D: Ballasts for fluorescent lamps rated 13 watts Or greater shall be electronic and shall have an output frequency no less than 20 kHz. Permanently installed night lights and night lights integral to installed luminaires or exhaust fans shall be rated to consume no § 150.0(k) l E: more than 5 watts of power per luminaire or exhaust fan as determined in accordance with § 130.0(c). Night lights do not need to be controlled by vacancy sensors. §150.0(k)1F: Lighting integral to exhaust fans (except when installed by the manufacturer in kitchen exhaust hoods) shall meet the applicable requirements of § 150.0(k). §150.0(k)2A: High efficacy luminaires must be switched separately from low efficacy luminaires. §150.0(k)2B: Exhaust fans shall be switched separately from lighting systems. § 150.0(k)2C: Luminaires shall be switched with readily accessible controls that permit the luminaires to be manually switched ON and OFF. §150.0(k)2D: Controls and equipment are installed in accordance with manufacturer's instructions. § 150.0(k)2E: No control shall bypass a dimmer or vacancy sensor function if the control is installed to comply with § 150.0(k). § 150.0(k)2F: Lighting controls comply with applicable requirements of § 110.9. An Energy Management Control System (EMCS) may be used to comply with dimmer requirements if. it functions as a dimmer § 150.0(k)2G: according to § 110.9; meets Installation Certificate requirements of § 130.4; the EMCS requirements of § 130.5; and all other requirements in §150.0(k)2. An Energy Management Control System (EMCS) may be used to comply with vacancy sensor requirements of § 150.0(k) if: it § 150.0(k)2H: functions as a vacancy sensor according to § 110.9; meets Installation Certificate requirements of § 130.4; the EMCS requirements of § 130.5; and all other requirements in § 150.0(k)2. § 150.0(k)2I: A multiscene programmable controller may be used to comply with dimmer requirements of this section if it provides the functionality of a dimmer according to §110.9, and complies with all other applicable requirements in §150.0 (k)2. § 150.0(k)3A: A minimum of 50 percent of the total rated wattage of permanently installed lighting in kitchens shall be high efficacy. Kitchen lighting includes all permanently installed lighting in the kitchen except internal lighting in cabinets that illuminate only § 150.0(k)3B: the inside of the cabinets. Lighting in areas adjacent to the kitchen, including but not limited to dining and nook areas, are considered kitchen lighting if they are not separately switched from kitchen lighting. § 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: A minimum of one high efficacy luminaire shall be installed in each bathroom; and 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. Luminaires recessed into ceilings shall: be listed for zero clearance insulation contact (IC) by Underwriters Laboratories or other nationally recognized testing/rating laboratory; have a label that certifies that the luminaire is airtight with air leakage less than 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283; be sealed with a gasket or caulk between the luminaire housing §150.0(k)8: and ceiling, and shall have all air leak paths between conditioned and unconditioned spaces sealed with a gasket or caulk; and allow ballast maintenance and replacement without requiring cutting holes in the ceiling. For recessed compact fluorescent luminaries with ballasts to qualify as high efficacy for compliance with § 150.0(k), the ballasts shall be certified to the Energy Commission to comply with the applicable requirements in § 110.9. 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 § 150.0(k)9A: 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; and iii. Controlled by one of the following methods: . 2013 Low -Rise Residential Mandatory Measures Summary 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 § 110.9; meets the Installation Certification requirements in § 130.4; meets the requirements for an EMCS in § 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. For low -rise multifamily 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 §150.0(k)9B: following requirements: i. Shall comply with § 150.0(k)9A; or ii. Shall comply with the applicable requirements in § 110.9, § 130.0, § 130.2, § 130.4, § 140.7 and § 141.0. § 150.0(k)9C: For low -rise residential buildings with four or more dwelling units, outdoor lighting not regulated by § 150.0(k)9B or 150.0(k)9D shall comply with the applicable requirements in § 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 § 110.9, § 130.0, § 130.2, § 130.4, § 140.7 and § 141.0. §150.1)(k)10: Internally illuminated address signs shall comply with § 140.8; or shall consume no more than 5 watts of power as determined according to § 130.0(c). § 150.0(k) l l : Lighting for residential parking garages for eight or more vehicles shall comply with the applicable requirements for nonresidential garages in § 110.9, § 130.0, § 130.1, § 130.4, § 140.6, and § 141.0. In a low -rise multifamily residential building where the total interior common area in a single building equals 20 percent or less of § 150.0(k)12A: 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. In a low -rise multifamily 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: § 150.0(k)12B: i. Comply with the applicable requirements in § 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. Solar Ready Buildings: Single family residences located in subdivisions with ten or more single family residences and where the application for a § 110.10(a)1: tentative subdivision map for the residences has been deemed complete, by the enforcement agency, on or after January 1, 2014, shall comply with the requirements of § 110.10 through § 110.10(e). § 110.10(a)2: Low -rise multi - family buildings shall comply with the requirements of § 110.10(b) through § 110.10(d). The solar zone shall have a minimum total area as described below. The solar zone shall comply with access, pathway, smoke ventilation, and spacing requirements as specified in Title 24, Part 9 or other Parts of Title 24 or in any requirements adopted by a local jurisdiction. The solar zone total area shall be comprised of areas that have no dimension less than 5 feet and are no less than 80 square feet each for buildings with roof areas less than or equal to 10,000 square feet or no less than 160 square feet each for § 110.10(b)1: buildings with roof areas greater than 10,000 square feet. For single family residences the solar zone shall be located on the roof or overhang of the building and have a total area no less than 250 square feet. For low -rise multi - family buildings the solar zone shall be located on the roof or overhang of the building or on the roof or overhang of another structure located within 250 feet of the building or on covered parking installed with the building project and have a total area no less than 15 percent of the total roof area of the building excluding any skylight area. § 110.10(b)2: All sections of the solar zone located on steep - sloped roofs shall be oriented between 110 degrees and 270 degrees of true north. § 110.10(b)3A: No obstructions, including but not limited to, vents, chimneys, architectural features, and roof mounted equipment, shall be located in the solar zone. Any obstruction, located on the roof or any other part of the building that projects above a solar zone shall be located at least twice § 110.10(b)3B: the distance, measured in the horizontal plane, of the height difference between the highest point of the obstruction and the horizontal projection of the nearest point of the solar zone, measured in the vertical plane. § 110.10(b)4: For areas of the roof designated as solar zone, the structural design loads for roof dead load and roof live load shall be clearly indicated on the construction documents. The construction documents shall indicate: a location for inverters and metering equipment and a pathway for routing of conduit § 110.10(c): from the solar zone to the point of interconnection with the electrical service (for single family residences the point of interconnection will be the main service panel); a pathway for routing of plumbing from the solar zone to the water - heating s stem. §110.10(d): A copy of the construction documents or a comparable document indicating the information from §110.10(b) through §110.10(c) shall be provided to the occupant. § 110.10(e)1: The main electrical service panel shall have a minimum busbar rating of 200 amps. The main electrical service panel shall have a reserved space to allow for the installation of a double pole circuit breaker for a § 110.10(e)2: future solar electric installation. The reserved space shall be: positioned at the opposite (load) end from the input feeder location or main circuit location, and permanently marked as "For Future Solar Electric'. CERTIFICATE OF VERIFICATION CF3R- MCH -27 -H Indoor Air Quality and Mechanical Ventilation (Page 1 of 3 ) Project Name: Sterling Blvd. Residence Enforcement Agency: City of Cupertino Permit Number: B812620 / Dwelling Address: / 10290 Sterling Blvd City: Cupertino Zip Code: 95014 Title 24, Part 6, Section 150.0(o), entilatio ndoor Air Quality. All dwelling units shall meet the requirements of ANSI /ASHRAE Standard 62.2. Ventilation and Acceptable Indoor Air Quality in Low -Rise Residential Buildings. Equation and table numbering on this form corresponds to the numbering for that information in the published ANSI /SHRAE Standard 62.2 -2010. A. Dwelling Mechanical Ventilation - General Information 01 Dwelling unit name Sterling Blvd. Residence 02 Building Type Single family 03 Project scope Addition greater than 1,000 ft2 04 Total Conditioned Floor Area of Dwelling Unit (For addition projects the conditioned floor area equals existing area plus addition area.) 2127 05 Number of bedrooms in dwelling unit (For addition projects the number of bedrooms equals the existing bedrooms•plus addition bedrooms) _ 4 - 06 Ventilation Operation Schedule Continuous 07 Whole- Building Ventilation Rate Calculation Method Fan Ventilation Rate Method (4.1.1) 08 Whole Building Ventilation System Type Standalone - Exhaust MCH -27a - Continuous Ventilation Airflow - Fan Vent Rate Method B. Whole- Building Continuous Ventilation - Fan Ventilation Rate Method 01 Required Continuous Whole- Building Ventilation Rate 59 02 Installed Continuous Whole- Building Ventilation Rate 70 C. Compliance Statement 01 Building passes continuous whole - building ventilation rate test Registration Number: 215- N0023697B- M2700001A -M27A Registration Date/Time: 2016 -04 -05 14:53:05 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -04 -05 14:52:28 2013 Residential Compliance Schema Version: 2013.1.006 CERTIFICAfE OF VERIFICATION CF3R- MCH -27 -H Indoor Air Quality and Mechanical Ventilation (Page 2 of 3 ) D. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 01 Complies: All specified verification protocol requirements on this document are met. Registration Number: 215- N0023697B- M2700003A -M27A Registration Date/Time: 2016 -04 -05 14:53:05 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -04 -05 14:52:28 2013 Residential Compliance Schema Version: 2013.1.006 o i CERTIFICATE OF VERIFICATION CF3R- MCH -27 -H Indoor Air Quality and Mechanical Ventilation (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: �GdZI�Lf!/Sli Minxuan Liu Company: Date Signed: Bay Area Energy Consultants 2016 -04 -05 14:53:05 Address: CEA/ HERS certification Identification (if applicable): 1181 Sundown Ln San Jose / CA / 95127 City /State /Zip: Phone: San Jose CA 95127 408 - 883 -3865 Responsible Person's Declaration statement I certify the following under penalty- fperjury, under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. 1 am the certified HERS Rate_D1who performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The installed features, mat&ials, components, manufactured devices, or system performance diagnostic results that require HERS verification identified on.this Certificate'of- Verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements specified- on`.the Certificate of Compliance for the building approved by the enforcement agency. - ..j �r 4. The information Deported on applicable sections?of-the Certificates) of Installation_(CF2R)-signedrghd submitted:by the person(s) responsible for the construction or installation.conforms to the requirements specified on the Certificates) of Compliance (C 1R) approved by the enforcementragency. S. I will ensure that a registered copyof this Certificate of Verification (shall be posted; or made available with the building permit(s){ issued f6i the building, and made available to the,_enforcemeht,agency for all applicable inspections I understand that a registered;copy of thisRCer4cate.of .. ' ;�� Verification is: required to be 'included with theSclbcumentation the builder provides to the building owner at occupancy. r.,�P� � 15.�s�°' �'� P � t�.... . � •Td � #'sw�• fi Builder Or Installer Information As � " Shown On The Certificate °Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder /Owner): WELKIN INTERNATIONAL INDUSTRIAL INC Responsible Builder or Installer Name: CSLB License:, Xin Lu 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: Bay Area Energy Consultants Responsible Rater Name: Responsible Rater Signature: �G1fl�pfifi Minxuan Liu Responsible Rater Certification Number w /this HERS Provider: Date Signed: CC2006550 2016 -04 -05 14:53:05 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215- NO023697B- M2700001A -M27A Registration Date/Time: 2016 -04 -05 14:53:05 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -04 -05 14:52:28 2013 Residential Compliance Schema Version: 2013.1.006 s: I soj na Y CERTIFICATE OF VERIFICATION CF3R- MCH -23 -H Space Conditioning System Airflow Rate (Page 1 of 4 ) Project Name: St I1* Blvd. Resit a Enforcement Agency: Cupertino City of Permit Number: B812620 Dwelling Address: 10290 Sterling Blvd City: Cupertino Zip Code: 95014 A. Ducted Cooling System 1 �rmation 01 System Identification or Name System 1 02 System Location or Area Served Location 03 System Installation Type New 04 Nominal Cooling Capacity (tons). of Condenser 4 05 Condenser Speed Type `• Single Speed 06 Cooling System Zonal °Control Type Not Zonal 07 Central Fan Integrated (CFI)-Ventilation.System Status Not a CFI system 08 System Bypass Duct Status - ' No Bypass Duct 09 Date of System Airflow`Rate Measurement ' ` S 2016 -04 -04 10 Airflow Rate Protocol utilized 'F—, r_ f,RA3.3 rocedures fo airflowtrateameasurement B. Hole for the placement of a Static Pressure Probe (HSPP), and Permanently installed Static Pressure Probe (PSPP) in the supply plenum. Procedures for installing HSPP or PSPP are specified in RA3.3.1.1. 01 I Method used to demonstrate compliance with the I HSPP installed and labeled consistent with Figure RA3.3 -1 HSPP /PSPP requirement C. Airflow Rate Measurement Apparatus and Procedure Information Instrument Specifications are given in RA3.3.1.1, and system airflow, rate measurement apparatus information is given in RA3.3.2. 01 Airflow Rate Measurement Type used for this airflow rate Traditional Flow Capture Hood according to procedure in verification. RA3.3.3.1.4 02 Manufacturer of Airflow Measurement Apparatus Alnor 03 Model number of Airflow Measurement Apparatus 634 - 513 -044 Certification Status of the Airflow Measurement Apparatus Certified by Manufacturer and listed on CEC Website at 04 Accuracy http: / /www. energy. ca. gov /title24 /equipment _ cert/ama_fas /index.html Registration Number: 215- N0023697B- M2300002A -M23A Registration Date/Time: 2016 -04 -05 08:37:48 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -04 -05 08:36:34 2013 Residential Compliance Schema Version: 0.555SDD i CERTIFICATE OF VERIFICATION CF3R- MCH -23 -H Space Conditioning System Airflow Rate (Page 2 of 4 ) MCH -23a Forced Air System Airflow Rate Measurement - Newly Installed Non -Zoned Systems or Zoned Multi -Speed Compressor D. Forced Air System Airflow Rate Measurement The procedures for System Airflow Rate Verification are specified in Reference Residential Appendix RA3.3. 01 Required Minimum System Airflow Rate (cfm/ton) 350 02 Required Minimum System Airflow Target (cfm) 1400 03 Actual System Airflow Rate Measurement (cfm) 1400 04 Compliance Statement: System airflow rate complies E. Additional Requirements: Air filters thatmeet the applicable requirements of Standards Section 150.0(m)12 or 150.0(m)13 were properly installed in 01 the system•diiring system air flow rate measurement identified on this Certificate of Verification. The airflow rate measurement. apparatus used to-perform the airf low ,rat6 measurement identified on this Certificate•of 02 Verification was calibrated in'accordance with the apparatus manufacturer's specifications and conforms:to the instrumentatioii`specifications given in RA3:3.1'. - .. A visual inspection shall confirm that bypass duct's -that ;.� deliverconditioned supply air - directly to the space conditioning system return duct airflow are not used on newly constructed zonally controlled systems unless the Performance Certificate 03 of Compliance indicates an allowance for use of a bypass duct. When a bypass duct is accounted for on the Performance Certificate of Compliance, the airflow rate shall conform to the specifications listed on the Certificate of Compliance. 04 All registers were fully open during the diagnostic test. 05 System fan was set at maximum speed during the diagnostic test. 06 If fresh air duct is part of the HVAC system it was not closed during the diagnostic test. 07 Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value. Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm /ton) and fan 08 efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air handler fan speed. 09 Verification Status Pass - all applicable requirements are met 10 Correction Notes The responsible person's 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. Registration Number: 215- N0023697B- M2300002A -M23A Registration Date/Time: 2016 -04 -05 08:37:48 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -04 -05 08:36:34 2013 Residential Compliance Schema Version: 0.555SDD } _ A CERTIFICATE OF VERIFICATION CF3R- MCH -23 -H Space Conditioning System Airflow Rate (Page 3 of 4 ) F. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 01 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: 215- N0023697B- M2300002A -M23A Registration Date/Time: 2016 -04 -05 08:37:48 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -04 -05 08:36:34 2013 Residential Compliance Schema Version: 0.555SDD . CERTIFICATE OF VERIFICATION CF3R- MCH -23 -H Space Conditioning System Airflow Rate (Page 4 of 4 ) Documentation Author's Declaration Statement 1.1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: *GtM!lQlfie� Minxuan Liu Company: Date Signed: Bay Area Energy Consultants 2016 -04 -05 08:37:48 Address: CEA/ HERS Certification Identification (if applicable): 1181 Sundown Ln CC2006550 City /State /Zip: Phone: San Jose CA 95127 408 - 883 -3865 Responsible Person's Declaration statement I certify the following under penalty of. perjury, under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. 1 am the certified HERS Rate�,who performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The installed features, materials, components, manufactured devices, or system performance diagnostic results that require HERS verification identifiedrori.il is Certificate &\We Ifieation comply_withShe:applicable requirements in Reference Appendices RA2, RA3, and the requirements specified'ori the Certificate of Compliance- fbeJ.he -building approved by the enforcement agency. 4. The informatiWi. eported on applicable sections of the Certificate(s),of Installati6n (CF2R)3igned and submitfed`by the persons) responsible for the construction or installation-conforms to the.fequirements'specified or the Certificate(s)£of Compliance (CF1R) approved bythe enforcement:agency. =_3 e, S. I will ensure that a registered copyof this Certificate of Verification shall be posted or made available with the ;building permit(s) issued f6ir the r building, and made available to the enforcement agency for,; ii applicable inspections I understand that a registere ropy of this "Certificate,ofs Verification isf required to b6nclu &d with the dotumentation the buiider`provides' to the building owner at occupancy. Builder Or Installer Information As Shown'On "Thd`Certifkate Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder /Owner): WELKIN INTERNATIONAL INDUSTRIAL INC Responsible Builder or Installer Name: CSLB License: Xin Lu 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: Bay Area Energy Consultants Responsible Rater Name: Responsible Rater Signature: Minxuan Liu Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006550 2016 -04 -05 08:37:48 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215- N0023697B- M2300002A -M23A Registration Date/Time: 2016 -04 -05 08:37:48 HERS Provider: CaICERTS CA Building Energy.Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -04 -05 08:36:34 2013 Residential Compliance Schema Version: 0.555SDD r. no 10 a 7 CERTIFICATE OF VERIFICATION CF3R- MCH -22 -H Space Conditioning System Fan.Efficacy (Page 1 of 3 ) Project Name: Sterling Blvd. Residence Enforcement Agency: Cupertino City of Permit Number: B812620 Dwelling Address: 10290 Sterling Blvd City: Cupertino Zip Code: 95014 A. Ducted Cooling System Information 01 System Identification or Name System 1 02 System Location or Area Served Location 03 System Installation Type New 04 Nominal Cooling Capacity (tons) of Condenser 4 05 Condenser Speed Type ', Single Speed 06 Cooling System Zonal Control Type Not Zonal 07 Central Fan Integrated (CFI) Verftilation System Status Not a CFI system 08 System Bypass Duct Status I ,� ' No ,Bypass-'DucL 09 Date of System Airflow Rate Measurement ' e, s �! 2016-04-04 4 1. 10 Airflow Rate Protocol utilized' " ;,- j.'-v "_ RA3.3 proced es fo airflow;rate measurement in B. Fan Watt Measurement Apparatus and Procedure Information Instrument Specifications are given in RA3.3.1, and system fan watt measurement apparatus information is given in RA3.3.2.2. 01 1 Fan Watt Verification Device Used. Portable watt meter MCH -22a Forced Air System Fan Efficacy Measurement - 'Newly Installed Non -Zoned Systems or Zoned Multi -Speed Compressor C. Forced Air System/Fan Efficacy Measurement The procedures for System Fan Watt Verification are specified in Reference Residential Appendix RA3.3. 01 Actual Tested Watts 805 02 Actual Tested Airflow from MCH -23 (cfm) 1400 03 Required Fan Efficacy (watts /cfm) 0.58 04 Actual Fan Efficacy (watts /cfm) 0.57 05 Compliance Statement: System fan efficacy complies Registration Number: 215- N0023697B- M2200002A -M22A Registration Date/Time: 2016 -04 -05 08:37:48 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -04 -05 08:37:18 2013 Residential Compliance Schema Version: 0.51SDD CERTIFICATE OF VERIFICATION CF3R- MCH -22 -H Space Conditioning System Fan Efficacy (Page 2 of 3 ) D. Additional Requirements 01 All registers were fully open during the diagnostic test. 02 System fan was set at maximum speed during the diagnostic test. 03 If fresh air duct is part of the HVAC system it was not closed during the diagnostic test. 04 Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value. 05 Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm /ton) and fan efficacy (Watt /cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air handler fan speed. 06 Zoned cooling air distribution systems with single speed compressors shall meet both the airflow (cfm /ton) and fan efficacy (Watt /cfm) criteria in every zonal control mode. 07 Verification Status Pass - all applicable requirements are met 08 Correction Notes - 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. E. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification pr.'otocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 1 01 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: 215- N0023697B- M2200002A -M22A Registration Date/Time: 2016 -04 -05 08:37:48 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -04 -05 08:37:18 2013 Residential Compliance Schema Version: 0.51SDD CERTIFICATE OF VERIFICATION CF3R- MCH -22 -H Space Conditioning System Fan Efficacy (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: �GffeLlL�f/!/ Minxuan Liu Company: Date Signed: Bay Area Energy Consultants 2016 -04 -05 08:37:48 Address: CEA/ HERS Certification Identification (if applicable): 1181 Sundown Ln City /State /Zip: Phone: San Jose CA 95127 408 - 883 -3865 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided-on this Certificate of Verification is true and correct. 2. 1 am the certified HERS Raterwho performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The installed features, materials, components, manufactured devices, or system performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements specified on the Certificate of Compliance for the building approved by the enforcement agency. 4. The information reported on applicable-sections of the Certificate(s) of Installation (CF2R) signed-and 'submitted by the person(s) responsible for the construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (MR) approved by the enforcement agency. S. I will ensure that a registered copy of this Certificate of Verification shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a; registered copy of, this.Certificate of Verification is:required to be included with the documentation the builder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder /Owner): WELKIN INTERNATIONAL INDUSTRIAL INC Responsible Builder or Installer Name: CSLB License: Xin Lu 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: Bay Area Energy Consultants Responsible Rater Name: Minxuan Liu Responsible Rater Signature: Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006550 2016 -04 -05 08:37:48 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215- NO023697B- M2200002A -M22A Registration Date/Time: 2016 -04 -05 08:37:48 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -04 -05 08:37:18 2013 Residential Compliance Schema Version: 0.51SDD FOLE CERTIFICATE OF VERIFICATION 01 CF3R- MCH -20 -H Duct Leakage Diagnostic Test 02 (Page 1 of 3 ) Project Name: Sterling Blvd. Residence Enforcement Agency: Cupertino City of Permit Number: B812620 Dwelling Address: 10290 Sterling Blvd C* Cupertino Zip Code: 95014 zz — A. System Information 01 Space Conditioning System Identification or Name System 1 02 Space Conditioning System Location or Area Served Location 03 Building Type from CF -1R Single family 04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from CF1R? No, credit is not taken 05 Verified Low Leakage Air Handling Unit (VLLAHU) Credit from CF1R? No, credit is not taken 06 Duct System Compliance Category. New MCH -20a - Completely New, Duct System B. Duct Leakage Diagnostic Test = 01 Condenser Nominal Cooling Capacity (ton) 4 02 Heating Capacity (kBtu /h) 78 03 Conditioned Floor Area served by this HVAC system (ft2) 2127 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 Method Heating system method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage (cfm) 102 10 Actual duct leakage rate from leakage test measurement (cfm) 63 11 Compliance Statement System passes leakage test Registration Number: 215- N0023697B- M2000002A -M20A Registration Date/Time: 2016 -04 -05 08:37:48 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -04 -05 08:35:06 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF VERIFICATION CF3R- MCH -20 -H Duct Leakage Diagnostic Test (Page 2 of 3 ) 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. 04 Building cavities were'not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape,was'used it was covered with Mastic and draw bands. 06 All connection points between the air handler and the supply and return plenums are completely sealed. Visual Inspection at Final Construction Stage ( applicablee` if system was tested atyrough -in) After installing the interior finishing4all and verifying that, the above rough in tests,ywas completed;`Ithefnllowing procedure must be performed 07 For all supply" and return registers, verify that the - spaces between the register boof =and the;intenor finishing -wall lase properly sealed. 08 If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points between the air handler and the supply and return plenums to verify that the connection points are properly sealed. 09 Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used. 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 verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 01 Complies: All specified verification protocol requirements on this document are met. Registration Number: 215- N0023697B- M2000002A -M20A Registration Date/Time: 2016 -04 -05 08:37:48 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -04 -05 08:35:06 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF VERIFICATION CF3R- MCH -20 -H Duct Leakage Diagnostic Test Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Liu Documentation Author Signature: M i nxuan /�l�Ifd'fldL:l/G Company: Date Signed: Bay Area Energy Consultants 2016 -04 -05 08:37:48 Address: CEA/ HERS Certification Identification (if applicable): 1181 Sundown Ln City /State /Zip: Phone: San Jose CA 95127 408 - 883 -3865 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. 1 am the certified HERS Rate- who performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The installed features, materials, components, manufactured devices, or system performance diagnostic results that require HERS verification identified'on this Certificate of Verification comply with the.applicable requirements in Reference Appendices RA2, RA3, and the requirements specified on the Certificate of Compliance for 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 person(s) responsible for the construction or installation conforms to the requi rem ents:specified 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 the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of . Verification is required to be included with the documentation the builderproJides to the building owner at"occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder /Owner): WELKIN INTERNATIONAL INDUSTRIAL INC Responsible Builder or Installer Name: CSLB License: Xin Lu 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: Bay Area Energy Consultants Responsible Rater Name: Minxuan Liu Responsible Rater Signature: A"x4 wodai/ Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006550 2016 -04 -05 08:37:48 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215- N0023697B- M2000002A -M20A Registration Date/Time: 2016 -04 -05 08:37:48 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -04 -05 08:35:06 2013 Residential Compliance Schema Version: 2013.1.007 SIGNATURE DECLARATIONS Project Name: Project Address: Project Descriptio 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 Cupertipo. Owner'91rignature Date Owner's Name (Please Print)-; Design Pr fessional's Signature Date Le,( Yuq)q- Design Professional's. Nam (Please Print) � 2GrrS Signat re f icense Professions responsible for CalGreen compliance Date _716V AAFC> 6f -cLru Ole, 6x ), 7q Name of License Professional responsible for CalGreen compliance (Please Print) Phone is,f�Wa�,& r� Mai (YCam Email Address for Llbense Professionlaf responsible for CalGreen compliance 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. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 Cal rnia Green Buildi� Standards Code as adopted by the City of Cupertino. Signature of`License Professional responsible for CalGreen compliance Date Ge i Yttan, Name of License Professional responsible for CalGreen compliance (Please Print) Phone _A9J ,1+111ayl tea' 1 e Cri Email Address fb, License Professibbal responsible for CalGreen compliance Pace 5 of 5 CalGreen_2014.doc revised 01115114