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14050170CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10289 MENHART LN CONTRACTOR: ; � ` I PERMIT NO: 14050170 '3P ln OWNER'S NAME: DRAGOJEVIC MIROSLAV AND ZULEJKA I I DATE ISSUED: 11/05/2014 1 OWiXER'S PHONE: 4082573418 I , I PHONE NO: IV LICENSED CON'TRACTOR'S DECLARATION License Class Lic.tI 3W 7✓ Contractor _ ,L�" 1A G. Date A71,1 I hereby affirm thit 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. JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL CONSTRUCT A ONE STORY ADDITION (722 SQ FT); INTERIOR REMODEL (546 SQ FT); PANEL UPGRADE (200 AMP). 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 $ erformance of the work for which this permit is issued. Sq. Ft Floor Area: 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: 37515031.00 permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the i granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations er the Cupertino Municipal Code, Section 9.18. Signature Date ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self- insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date Valuation: $150000 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DA --P ERMIT ISSUANCE OR 180 D BAST CALLED INSPECTION. Date: RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25550055,, 2 -33, and 25534. Owner or authorized agent: / Date! S CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION„ 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255„ w" (408) 777 -3228 • FAX (408) 777 -3333 • buildina@cu ertinq.gLg 0 ❑ NEW CONSTRUCTION 0 ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAI�PERIMT # PROJECT ADDRESS APN # 1375-15-031-00 10289 Menhart Lane, Cupertino, CA 95014 OWNER NAME PHONE 1(408) E -MAIL Miroslav Dra o evic 257 -3418 mdragoje@pmail.com STREET ADDRESS CITY, STATE, ZIP FAX 19955 Pear Tree Lane Cupertino, CA 95014 CONTACT NAME HONE tom' E -MAI detour STREET ADDRESS CITY, STATE, ZIP FAX 12 OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHFFEiZ L5N ER NAW LICENSE NUMBER BUS. LIC # COMPANY NA E -MAIL FAX 17A U Y1 S STREET ADDRESS CrEY. STATE, Z1e�S� PHONE ( ,A _ -0 DESCRIPTION OF WORK amt, C/V+'� 1 �� n v � .. ..v EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) ?,e _ I EXISTO NEW FLOOR DEMO TOTAL AREA /,�.� 7! AREA AREA NET AREA {{ BATHROOM KrICHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH # DWELLING UNITS: IS A SECOND UNTO ❑YES SECOND STORY YES BEING ADDED? WO ADDITION? ®NO PRE-APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEI B r TOTAL VALUATION: PLANNING APPL # ®NO PLANNING APPROVAL LETTER EICHLER HOME? (.NO LL 7 Sb ov Q 1 By my signature below, I certify to each of th oilowing: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the info,)=oD I have p i is co 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 bui d' true I otize representatives of Cupertino to enter the above -iden operty for inspection purposes. � 70 -bb of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION kEQUIRED PLAN CHECK TYPE " ROUTING SLIP Q OVER - THE - COUNTER [ BUILDING PLAN RRVrIEw New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS f❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ PUBLIC WoRtcs form if any Hazardous Materials are being used as part of this project. Q LARGE ❑ kTRE DIEPf — of Planning Approval Letter or Meeting with Planning prior to of" 0 ❑ SEWER DISTRICT submittal of Building Permit application. MAJOR SANITARY ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06121111 C C,ell CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 CUPERTI 1 (408) 777- 3228 • FAX ( 408) 777 -3333 • buildiinngg(o �upertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI LJ VISI ©N EFERRED 1�4 ORIGINAL PERMIT 11 R PROJECT ADDRESS I 02M A je� q�} ( p r „ 9 r_ Ff PN N IV�[��VII��/ li{ /P�HOVIC�� OWNER NAME � I E- MAIL�j,/nn^�`{j -- l r (f V tF�AX(/JG STREET ADDRESS CITY, STATE, ZIP CONTACT NAME ! P ONE - - E -���L� r �� STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME l�L Svc ` L J LICENSE NUMBER LICENSE TYPE BUS. LIC k COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK r ON_`��, eA4 co EXISTING USE PROPOSED USE CONSTR. TYPE k STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEU' FLOOR DEMO TOTAL _.. AREA AREA AREA NET AREA ' A y ✓ , /(!1 -•V! ��� "m M'�� I/'�� ®�(d L/ BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJ DETACH ❑ ATTACH k DWELLING UNITS: IS SECOND UNIT ❑YES SECONDSTORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO r�-- PRE - APPLICATION [ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES ItEC,E1VEA H �, ;" ,,'. r �.�, T TAL V UA PLANNING APPL m ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO k ; I By my signature below, I certify to each o tht3 following: I ie rop rty owner or authorized agent to act on owner's beha f. I have read this application and the information I have vided is correct. I. ave. r d t e D scription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to I g construction, I a h ize sentatives of Cupertino to enter the -iden fled property for inspection purposes. /abovee Signature of Applicant/Agent: Date: / ���� SUPPLEMENTVL INF ATI N REQ IRED dFHF6'ICTYPFAicJUTTNC SPiP New SFD or Multifamily dwellings: Apply for demolition permit for ❑� OVEi2 TFLE COUNTER BTIIUDII�G PLAN REST \V existing building(s). Demolition permit is required prior to issuance of building rr rt i r' r permit for new building. L�PRLcc�i , i ANhTisG;P1 AN REVrr1V Bldgs: Provide Hazardous Materials Disclosure �' , ❑ °' Commercial a completed sT��Daizn 'Pill LlCtvphres _ form if any Hazardous Materials are being used as part of this project.l " xrRE r 1RCE . DTPT _ Copy of Planning Approval Letter or Meeting with Planning prior to 0 MatoR `' fSARrTARX�STRER'J7 submittal of Building Permit application. ' ❑ . F_NVIRONTLENTAI. I'EALIR BldgApp_201I.doe revised 06121111 M ''L/1 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etcJ. These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 1L-05_')L.'7/1,113 ADDRESS: 10289 menhart In DATE: 01/05/2015 REVIEWED BV: Mendez APN: BP #: `VALUATION: 1$20,000 YPERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION PERMIT TYPE: WORK convert patio area to bedroom 87 sq ft; revise bedroom and convert to bath 36 sq ft SCOPE PME Plan Check: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etcJ. These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 1L-05_')L.'7/1,113 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OTJ 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0 .0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 — - - c _F ; 0 E) Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure (F) 0 Strong Motion Fee: 1BSEISMICR $2.60 1 # $859.00 Revisions 1REVSFDWL SFDWL Bide Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $3.60 $859.00 TOTAL FEE; $862.60 Revised: 10/01/2014 Is M-11 I CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10289 menhart In DATE: 05/30/2014 APN: BP #: 0-5-0/70 REVIEWED BY: Mendez `VALUATION: 1$150,000 °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? Yes No OTC? 0 Yes Q No PENTAMATION 1 R3SFDADD PERMIT TYPE: � WORK 621 sq ft addition to front of sfdwl remodel through out 546 sq ft panel upgrade 200 am SCOPE IR3PLNCK OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Custom) II- B,111- B,IV,V -B 621 $2,577.00 IR3PLNCK $1,617.00 IR3INSP PME Plan Check: $0.00 200 amps $47.00 Electrical IBELEC200 Services Permit Fee: $1,617.00 Suppl. Insp. Fee :(F) Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 TOTALS: 621 $2,577.00 $1,617.00 Elec. Plan Check 10.0 1 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 0.0 1 hrs $47.00 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 haled on the nreliminary information availahle and are only an estimate_ Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 Eff: 711'13) FEE QTY /FEE MISC ITEMS Plan Check Fee: $2,577.00 546 s. f. $488.00 Remodel, Other IREMRESOTH Suppl. PC Fee: 0 Reg. C) OT 0.0 hrs $0.00 PME Plan Check: $0.00 200 amps $47.00 Electrical IBELEC200 Services Permit Fee: $1,617.00 Suppl. Insp. Fee :(F) Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 0 G Work Without Permit? 0 Yes E) No $0.00 Advanced Planning, Fee: IPLLONGR $86.94 Select a Non - Residential Building or Structure 0 i Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $15.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $6.00 SUBTOTALS: 1 $4,395,94 $535.00 TOTAL FEE.-T $4,930,94 Revised: 04/01/2014 I CITY OF CUPERTINO BUILDING PERMIT 1 BUILDING ADDRESS: 10289 MENHART LN I CONTRACTOR: 8 PLUS INC I PERMIT NO: 14050170 1 OWNER'S NAME: DRAGOJEVIC MIROSLAV AND ZULEJKA 1242 COMMERCIAL ST I DATE ISSUED: 11/05/2014 OWNER'S PHONE: 4082573418 f SUNNYVALE, CA 94085 1 PHONE NO: (408) 733 -8008 0 LICENSED CONTRACTOR'S DECLARATION License Class 1 Lic. 9 Contractor �? G Date d'� I hereby affirm tl at 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 I erformance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point sour ulati er the Cupertino Municipal Code, Section 9.18. Signature Date ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self - insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, 1 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ CONSTRUCT A ONE STORY ADDITION (722 SQ FT); INTERIOR REMODEL (546 SQ FT); PANEL UPGRADE (200 AMP). 1/5/15- REVISION 91 CONVERT PATIO AREA TO BEDROOM 87 SQ- FT; REVISE BEDROOM AND CONVERT TO BATH 36 SQ FT -ISSD 1/22/2015 Sq. Ft Floor Area: I Valuation: $150000 APN Number: 37515031.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WIT PERMIT ISSUANCE OR 180 D ZS O LA T CALLED INSPECTION. Issued by: Date: 4 a' RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cup t" o Mun' al Code, Chapter 9.12 and the Health & Safety Code, Sections 25" 53 , nd 25534. Owner or authorized agent: Date: /-/ V — —A�— CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional IW2 B CITY OF CUPERTINO BUILDING PERMIT V BUILDING ADDRESS: 10289 MENHAR,r LN I CONTRACTOR: 8 PLUS INC I PERMIT NO: 14050170 1 I OWNF,R'S NAME: DRAGOJEVIC MIROSLAV AND ZULEJKA 1 242 COMMERCIAL ST I DATE ISSUED: 11/05/2014 'S PHONE: 4082573418 `67 LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. # Contractor ef / Date 1 hereby affirm hat 1 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 Verformance of the work for which this permit is issued. and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source re tons W the Cupertino Municipal Code Section 9.18. SUNNYVALE, CA 94085 1 PHONE NO: (408) 733 -8008 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL 0 CONSTRUCT A ONE STORY ADDITION (722 SQ FT); INTERIOR REMODEL (546 SQ FT); PANEL UPGRADE (200 AM Jt - ELIMINATE 2 WINDOWS & CHANGE 2 OTHER WINDOWS MALLER, NO STRUCTURAL) & REVISE MASTER BATH - ISSUED 2/17/15 Sq. Ft Floor Area: I Valuation. $150000 APN Number: 37515031.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE- ROOFS: Signature Date � /A All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWN R- BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self - insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area . r Qu ty Management District I will maintain compliance with the Cupe 1% ' rpal Code, Chapter 9.12 and the Health & Safety Code, Sectio 2 5 ,and 25534. Owner or authorized agent: Dat CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed 110. It, NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI YL VISIO DEFERRED ORIGINAL PERMIT # r y o s " () 19 6 PROJECT ADDRESS V ®� ) y� �I� APN k V OWNERNAME PHONE i r p E -MAIL STREET ADDRESS r ` J L CITY, STATE, ZIP FAX CONTACT NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX OWNER ❑ OWNER - BUILDER ❑ OWNIER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHrTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME -. LICENSE 1a ,� ,� LICENSE T E BUS, LIC 4 COMPANY NAME "� E -MAIL ' �. �r �� n � ' � F c 3 ie 66 � STREET DRES , STATE, ZIP P ONE r i o X331 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC 4 COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE OF WORK (DESCRIPTION Cw- �''[C°.'�„'"l,'%... �- F Orr % "'''l/ ,! ''L ,e .,2 ✓L'°lj"' -,�,p E>3STT.NG USE PROPOSED USE CON R TYPE k STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH ARE GARAGE AREA: El DETACH [:]ATTACH I DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? NO ADDITION? ❑NO PRE - APPLICATION [:]YES IF YES, PROVIDE COPY OF 1S THE BLDG AN ❑ SB w '' seg 1'd ✓y ;,�,�, TOTAL V. PLANNING APPL9 ©NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ i �,� t�.- 019,11 .x,,..w � By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on thWfoperty owner's behalf. I have read this application and the information I have provided correct. I ha read the Description of Work and verify it is rate. I aeree to comply with all applicable local ordinances and state laws relating to buildin etion. I thorize representatives of Cupertino to enter the above -i ntified rope f inspection purposes. C, Signature of Applicant/Agent: SUPPLEMF>KA1 INF ATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for �" rah existing building(s). Demolition permit is required prior to issuance of building permit for new building. "curl s ✓% ,li I ,�� i( �"� /tl� �1�Y ❑rl �' %a�'l7d�AHY`fi W�iiYd�" i.r?!'7 4i 4 i Gs k�t��aiX A p��'tr?GrrtAN¢ Vtw "' x; �r' Commercial Bld s: Provide a completed Hazardous Materials Disclosure _ forth if any Hazardous Materials are being used as part of this project."+t���� ° x)rl� nti f��'{"��Zl �''1 "11�j'`ni'yy`�u ��{'tl7s �'� _ Copy of Planning Approval Letter or Meeting with Planning prior to Building Permit ,. m�"r!',�+/"i�i�4Ii�� ➢r sR- t`rsTca� U submittal of g application. Flo, �r11xt , Wl 1zO;'r BldgApp_201 1. doc revised 06121111 � CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 19 ADDRESS: 10289 MENHART LN DATE: 02/17/2015 REVIEWED BY: MELISSA MISC ITEMS APN: 37515 031 BP #: 14050170 *VALUATION: Iso .......... *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 0.0 PENTAMATION 1GENRES PERMIT TYPE: WORK REV # 2 -ELIMINATE 2 WINDOWS & CHANGE 2 OTHER WINDOWS SMALLER NO SCOPE STRUCTURAL) & REVISE MASTER BATH - ISSUED 2/17/15 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 Ef. 711113) FEE QTY /FEE MISC ITEMS Plan Check Fee: Hourly Only? (:) Yes (F) No $0.00 Li Suppl. PC Fee: E) Reg. () OT 0.0 hrs 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 Ef. 711113) FEE QTY /FEE MISC ITEMS Plan Check Fee: Hourly Only? (:) Yes (F) No $0.00 1 1 hours Plan Check, Hourly $143.00 1STPGNCK Suppl. PC Fee: E) Reg. () OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 1 hours Inspections $143.00 ISTINSP Inspection, Hourly 0 0 1 t"r ,.� t � � �F r �rer�r: €E 1. !��` �r��": Strong Motion Fee: $0.00 Select an Administrative Item 1 Bldg Stds Commission Fee: $0.001 SUBTOTALS:, $0.00 $286.00'` TOTAL FEE. $286.00 Revised: 02/14/2015 o Wa SAL R EN RE UDE wj "DIAL CHECKLIST— MANDATORY FTI I ITEMS i 4 CCiivi'r;llii\l7Y rE 'FLC`'Piv``IEN 3 DEF':AIPT AEM T ^ GU!L�!iNG DIVISiOi�! ALBERT SALVADOR. P c C_B.O., BUILCIi!G OFFICIAL 10300 TORRE AVENUE , CjUPER T INO, CA 95014 -3255 (408)777-3228- FAX (408)777-3333- buildings c.;.oait naam PURPOSE: The 2013 CalGreen Code applies to all newly constructed hotels. motels, lodging houses, dwellings; dormitories, condominiums, shelters, congregate residences, employee housing, factory-built housing and other types of swellings with sleeping accommodations and new accessory buildings associated with such uses. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: DRAGOJEVIC REMODEL Project Address: 10289 MENHART LADE Project Description: FRONT AND REAR ADDITION TO A SINGLE FAMILY RESIDENCE Instructions: _ Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Reauirements Planning and Design -Site Development 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during X❑ ❑ construction. 4.106.3 Grading and paving. The site shall be planned and developed to El surface water away from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. Page L of 5 CarGreen 2014.doc revised 01; 15 /l a General 4.201.1 Low -rise residential buildings shall meet or exceed the minimum I 0 standard design required by the California Energy Standards. Indoor Water Use 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 shalt be ® ❑ designed to allow only one shower outlet to be in operation at a time- 0 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. Q 4.3 (13.9.32 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. 0 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, 0 and shall meet the applicable standards referenced in Table 1401.1 of the California Plumbing Code. PaEe 2 ors CalGreent 2014.doe revised 01,115/14 7 Outdoor Water Use 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the time of final inspection shall be weather - based. ❑ 4.304.1.1 Controller 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 controllerls)_ Soil moistures -cased controllers are rat required to have rain sensor input. A4.4 a A • CONSERVATION 1 RESOURCE Enhanced Durability and Reduced Maintenance 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected © { El the passage of rodents by closing such openings with cement mortar, 4y concrete masonry or similar method acceptable to the enforcing agency_ ! Construction Waste Reduction, Disposal and Recycling 4.408.2 Construction waste management plan. Where a local jurisdiction doss spot have a construction and demolition waste management ordinance, a ❑ construction waste management plan shall be submitted for approval to the enforcing agency. Building Maintenance and Operation 4.410.1 Operation and maintenance manual. At the time of final inspection, © ❑ an operation and maintenance manual shall be provided to the building occupant or owner- A4.5 ENVIRONMENTAL QUALITY Fireplaces 4.503.1 General. Install only a direct -vent sealed- combustion gas or sealed ❑ ❑ wood - burning fireplace, or a sealed woodstove. Pollutant Control 4.504.1 Covering of duct openings and protection of mechanical X❑ ❑ equipment during construction. Duct openings and other related air distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks 1� L�J shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be 0 ❑ compliant with VOC limits. 4.504.2.3 Aerosol paints and coatings. Aerosol paints and other coatings for ROC toxic QX ❑ shall be compliant with product weighted NII R Limits and other compounds. Page 3 oF5 1.L11Vl eery sV� +.uw .�.•.•�••..• 4.504.2.4 Verification. Documentation shall be provided to verify that ® ❑ compliant VOC limit finish materials have been used. are also required to comply with CalGreen Section 4.505.2.1. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with 4.505.3 Moisture content of building materials. Moisture content of building ❑ VOG limits. materials used in wall and floor framing is checked before enclosure_ 4.504.4 Resilient flooring systems. Eighty (80) percent of floor area Indoor Air Quality and Exhaust 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the receiving resilient flooring shall comply with the VOC- emission limits defined in ❑ building are provided in every bathroom. the Collaborative for High Performance Schools (CHPS) Low - emitting l.! ❑ Materials List or be certified under the Resilient Floor Covering Institute (RCFI) using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or FloorScore program. 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) 4.504.5 Composite wood products. Particleboard, medium density ® v ® s �m . a Lei immmimmili Qualifications fiberboard (MDF), and hardwood plywood used in interior finish systems shall N/ ❑ comply with low formaldehyde emission standards. Interior Mo store Gontroi 4.505.2 Concrete slab foundation. Required vapor retarders and capillary © El are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture content of building n L_l ❑ materials used in wall and floor framing is checked before enclosure_ Indoor Air Quality and Exhaust 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the Q ❑ building are provided in every bathroom. Environmental Comfort 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. ❑X ❑ 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. ® v ® s �m . a Lei immmimmili Qualifications 702.1 Installer training. HVAC system installers are trained and certifted in !ice L1 the proper installation of HVAC systems. 702.2 Special inspection. The Licensed Professional responsible to verify in the CALGreen compliance is qualified and able to demonstrate competence discipline they inspect and verify. -:Verifications 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 a ❑ agency 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. CalGreenl_20I4.doc revised 01115114 Page 4 of 5 CALGREEN SIGNATURE DECLARATIONS Project Name: DRAGOJEVIC REMODEL Project Address: 10289 MENHART LANE Project Description: FRONT AND REAR ADDITION TO A SINGLE FAMILY RESIDENCE 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 ordance with the r wire nts set forth in the 2013 California Green Building Standards Code as adopts the City of Cuper Mo T 11V 08/0212014 Own ' Signatu Date MISHA DRAGOJEVIC w 0810212014 Desi n Professional' Signature Date DEBRA COX Design io I's N e Please P int) 08/02/2014 �7gilnt' 2 v� _ewrTSC 'r "viE.aa 0s,'ZWP rtr58a '&Tor r- 211 -`arr is CC i 'aS 'dS^^ v2 }2 FRANK E. CUTHBERT 5101235 -2200 Name of License Professional responsible for CalGreen compliance (Please Print) Phone title24andgreenpoint @gmail.com Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together w4h 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 Rofessiona! responsible for CalGreen compliance 'Please Print) Phone ail Address for License Professional responsible for CalGreen compliance Paoz 5 of Ca!Crers7 20! i.doc rer e l �J;'! ? 7J fi �s, T BUILDING ENERGY ANALYSIS REPORT PROJECT: DRAGOJEVIC RES. ADDITION REVISED 10289 Menhart Lane Cupertino, Ca. Project Designer: Bluelines Designs 1271 Lennon Way San Jose, Ca. 95125 650- 598 -0868 Report Prepared by: Frank Cuthbert - CEPE Bay Area Energy Compliance 1826 Alfreda Blvd. Cl San Pablo, Ca. 94806 1 0/235 -2200 17fEi nrxir; N)PY �E ✓i m�u AN Job Nurnber: 204 -14 Date: 12/22/2014 �a The EnergyF' '6Ter"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 2008 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC — www.energysoft.com. Ener ypro 5.1 by EnergySoft User Number: 5443 Run Code: 2014- 12- 22T20:50 :40 ID: 204 -14 PERFORMANCE CERTIFICATE: Residential Part 1 of 5 CF -1 R Project Name DRAGOJEVIC RES. ADDITION REVISED Building Type m Single Family ❑ Addition Alone ❑ Multi Family m Existing+ Addition /Alteration Date 1212212014 Project Address 10289 Menhart Lane Cupertino California Energy Climate Zone CA Climate Zone 04 Total Cond. Floor Area 1,574 Addition 742 # of Stories 1 FIELD INSPECTION ENERGY CHECKLIST ❑ Yes ❑ No HERS Measures -- If Yes, A CF -4R must be provided per Part 2 of 5 of this form. ❑ Yes ❑ No Special Features -- If Yes, see Part 2 of 5 of this form for details. INSULATION Construction Type Area Special Cavity (ft`) Features see Part 2 of 5 Status Wall Wood Framed None 269 Existing Roof Wood Framed Attic R -11 824 Existing Slab Unheated Slab -on -Grade None 832 Perim = 35' Existing Wall Wood Framed R -13 883 New Door Opaque Door None 20 New Roof Wood Framed Attic R -30 220 New Roof Wood Framed Rafter R -19 518 New Slab Unheated Slab -on -Grade None 742 Perim = 102' New FENESTRATION U- Orientation Area(ft) Factor Exterior SHGC Overhang Sidefins Shades Status Front (S) 7.5 1.190 0.83 none none Bug Screen Removed Left (W) 24.0 0.340 0.35 none none Bug Screen Altered Left (W) 61.0 0.340 0.35 none none Bug Screen New Rear (N) 80.0 1.190 0.83 none none Bug Screen Removed Right (E) 24.0 0.340 0.35 none none Bug Screen Altered Right (E) 77.0 1.190 0.83 none none Bug Screen Removed Skylight 8.0 0.500 0.30 none none None New Front (S) 58.0 0.340 0.35 none none Bug Screen New Rear (N) 130.8 0.340 0.35 none none Bug Screen New Right (E) 24.0 0.340 0.35 none none Bug Screen New Skylight 4.0 0.500 0.30 none none None New HVAC SYSTEMS Qty. Heating Min. Eff Cooling Min. Eff Thermostat Status 1 Central Furnace 90% AFUE Split Air Conditioner 13.0 SEER Setback Altered HVAC DISTRIBUTION Location Heating Duct Cooling Duct Location R -Value Status HVAC System Ducted Ducted Attic, Ceiling Ins, vented 6.0 Altered WATER HEATING Qty. Type Gallons Min. Eff Distribution Status 1 Small Gas 50 0.58 No Pipe Insulation Altered EnergyPro 5.1 by EnergySoft User Number. 5443 RunCode: 2014- 12 -22T20 :50:40 ID: 204 -14 Page 3 of 11 PERFORMANCE CERTIFICATE: Residential Part 2 of 5) CF -1 R Project Name DRAGOJEVIC RES. ADDITION REVISED Building Type m Single Family ❑ Addition Alone ❑ Multi Family 0 Existing+ Addition /Alteration Date 12/22/2014 SPECIAL FEATURES INSPECTION CHECKLIST The enforcement agency should pay special attention to the items specified in this checklist. These items require special written justification and documentation, and special verification to be used with the performance approach. The enforcement agency determines the adequacy of the justification, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. HERS REQUIRED VERIFICATION Items in this section require field testing and /or verification by a certified HERS Rater. The inspector must receive a completed CF -4R form for each of the measures listed below for final to be given. Ener Pro 5.1 by EnerqySoft User Number: 5443 RunCode: 2014 -12- 22720:50:40 ID: 204-14 Pa e 4 of 11 PERFORMANCE CERTIFICATE: Residential (Part 3 of 5) CF -1 R Project Name Building Type m Single Family ❑ Addition Alone Date DRAGOJEVIC RES. ADDITION REVISED ❑ Multi Family [0 Existing+ Addition /Alteration 121221201 ANNUAL ENERGY USE SUMMARY Standard Proposed Margin TDV (kBtu /ft2- r Space Heating 68.56 29.29 39.27 Space Cooling 30.59 11.67 18.93 Fans 13.42 7.43 5.99 Domestic Hot Water 24.29 21.95 2.34 Pumps 0.00 0.00 0.00 Totals 136.86 70.33 66.53 Percent Better Than Standard: 46.6% BUILDING COMPLIES - NO HERS VERIFICATION REQUIRED Fenestration Building Front Orientation: (S) 170 deg Ext. Walls /Roof Wall Area Area Number of Dwelling Units: 1.00 (S) 174 58 Fuel Available at Site: Natural Gas (W) 609 85 Raised Floor Area: 0 (N) 287 131 Slab on Grade Area: 1,574 (E) 424 48 Average Ceiling Height: 8.7 Roof 1,574 12 Fenestration Average U- Factor: 0.34 TOTAL: 334 Average SHGC: 0.35 Fenestration /CFA Ratio: 21.2 REMARKS THE INFORMATION IN THIS REPORT IS FOR PERMIT DOCUMENTATION ONLY BAYAREA ENERGY COMPLIANCE MAKES NO GUARANTEE OF COMFORT OR PERFORMANCE OF THE BUILDING IN THIS REPORT. THE CONTRACTOR SHALL INDEPENDENTLY VERIFY HVAC SYSTEM SIZING. STATEMENT OF COMPLIANCE This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 the Administrative Regulations and Part 6 the Efficiency Standards of the California Code of Regulations. The documentation author hereby certifies that the documentation is accurate and complete. Documentation Author Company Bay Area Energy Compliance 12/22/2014 Address 1826 Alfreda Blvd. Name Frank Cuthbert - CEPE Cit /State /Z, San Pablo Ca. 94806 Phone 5101235 -2200 Signed Date The individual with overall design responsibility hereby certifies that the proposed building design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application, and recognizes that compliance using duct design, duct sealing, verification of refrigerant charge, insulation installation quality, and buildin envelope sealing require installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) Company Bluelines Designs Address 1271 Lennon Way Name Debra Cox City /State/Zip San Jose, Ca. 95125 Phone 650 - 598 -0868 Signed License I Date EnerqyPro 5.1 by EnenqySoft User Number., 5443 RunCode: 2014- 12- 22T20:50:40 ID: 204 -14 Page 5 of 11 CERTIFICATE OF COMPLIANCE: Residential (Part 4 of 5) CF -1 R Project Name DRAGOJEVIC RES. ADDITION REVISED Building Type m Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition /Alteration Date 1212212014 OPAQUE SURFACE DETAILS Surface Typ e Area U- Factor Insulation Azm Tilt Status Joint Appendix 4 Location /Comments Cavity Exterior Frame Interior Frame Wall 18 0.356 None 170 90 Existing 4.3.1 -A1 Existing Wall 206 0.356 None 170 90 Remove 4.3.1 -A1 Existing Door 20 0.500 None 170 90 RemoveG 4.5.1 -A4 Existing Wall 150 0.356 None 260 90 Existing 4.3.1 -A1 Existing Wall 21 0.356 None 3501 90 Existing 4.3.1 -A1 Existing Wall 194 0.356 None 350 90 Removea 4.3.1 -A1 Existing Wall 80 0.356 None 80 90 Existing 4.3.1 -A1 Existing Wall 23 0.356 None 80 90 Removec 4.3.1 -A1 Existing Roof 824 0.079 R -11 0 0 Existing 4.2.1 -A2 Existing Slab 832 0.730 None 0 180 Existing 4.4.7 -A1 Existing Wall 78 0.102 R -13 170 90 New 4.3.1 -A3 Addition Door 20 0.500 None 170 90 New 4.5.1 -A4 Addition Well 374 0.102 R -13 260 90 New 4.3.1 -A3 Addition Wall 135 0.102 R -13 350 90 New 4.3.1 -A3 Addition Wall 296 0.102 R -13 80 90 New 4.3.1 -A3 Addition Roof 1 2201 0.031 R- 1 0 0 New 4.2.1 -A20 Addition FENESTRATION SURFACE DETAILS ID Type Area U- Factor SHGC2 Azm Status Glazing Type Location /Comments 1 Window 7.5 1.190 Default 0.83 Default 170 Removed Single Metal Clear Existing 2 Window 24.0 0.340 NFRC 0.35 NFRC 260 Altered Double Non Metal Existing 3 Existing 1.190 Default 0.83 Default Single Metal Clear pre - altered for above 4 Window 6.0 0.340 NFRC 0.35 NFRC 260 New Double Non Metal Existing 5 Window 80.0 1.190 Default 0.83 Default 350 Removed Single Metal Clear Existing 6 Window 24.0 0.340 NFRC 0.35 NFRC 80 Altered Double Non Metal Existing 7 Existing 1.190 1 Default 0.83 Default I Single Metal Clear pre- altered for above 8 Window 24.0 1.190 Default 0.83 Default 80 Removed Single Metal Clear Existing 9 Window 53.0 1.190 Default 0.83 Default 80 Removed Single Metal Clear Existing 10 Skylight 8.0 0.500 NFRC 0.30 NFRC 0 New Skylight Existing 11 Window 58.0 0.340 NFRC 0.35 NFRC 170 New Double Non Metal Addition 12 Window 55.0 0.340 NFRC 0.35 NFRC 260 New Double Non Metal Addition 13 Window 130.8 0.340 NFRC 0.35 NFRC 350 New Double Non Metal Addition 14 Window 24.0 0.340 NFRC 0.35 NFRC 80 New Double Non Metal Addition 15 Skylight 4.0 0.500 NFRC 0.30 NFRC 0 New Skylight Addition (1) U- Factor Type: 116 -A = Default Table from Standards, NFRC = Labeled Value 2 SHGC Type: 116 -B = Default Table from Standards, NFRC = Labeled Value EXTERIOR SHADING DETAILS ID Exterior Shade Type SHGC Window Overhang Left Fin Right Fin HqqF Wd Len H t LExt RExt Dist Len H t Dist Len H t 1 Bug Screen 0.76 2 Bug Screen 0.76 3 Bug Screen 0.76 4 Bug Screen 0.76 5 Bug Screen 0.76 6 Bug Screen 0.76 7 Bug Screen 0.76 8 Bug Screen 0.76 9 Bu Screen 0.76 10 None 1.00 11 Bug Screen 0.76 12 Bug Screen 0.76 13 Bug Screen 0.76 14 Bug Screen 0.76 15 None 1.00 EnergyPro 5.1 by EnergySoft User Number: 5443 RunCode: 2014- 12- 22T20:50:40 ID: 204 -14 Page 6 of 11 CERTIFICATE OF COMPLIANCE: Residential (Part 4 of 5) CF -1 R Project Name DRAGOJEVIC RES. ADDITION REVISED Building Type m Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition /Alteration Date 212212014 OPAQUE SURFACE DETAILS Surface Type Area U- Factor Insulation Azm Tilt Status Joint Appendix 4 Location /Comments Cavity Exterior Frame Interior Frame Roof 518 0.051 R -19 0 0 New 4.2.2 -A 12 Addition Slab 742 0.730 None 0 180 New 4.4.7 -A 1 Addition FENESTRATION SURFACE DETAILS ID Type Area U- Factor SHGC2 Azm Status Glazing Type Location /Comments (1) U- Factor Type: 116 -A = Default Table from Standards, NFRC = Labeled Value 2 SHGC Type: 116 -B = Default Table from Standards, NFRC = Labeled Value EXTERIOR SHADING DETAILS ID Exterior Shade Type SHGC Window Overhang Left Fin Right Fin H t Wd Len H t LExt RExt Dist Len H t Dist Len H t EnergyPro 5.1 by EnergySoft User Number: 5443 RunCode: 2014- 12- 22T20:50:40 ID: 204 -14 Page 7 of 11 CERTIFICATE OF COMPLIANCE: Residential (Part 5 of 5) CF -1 R Project Name DRAGOJEVIC RES. ADDITION REVISED Building Type ❑ Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition /Alteration Date 12/22/201 BUILDING ZONE INFORMATION System Name Zone Name Floor Area ft Volume Year Built New Existing Altered Removed HVAC System Existing 832 6,656 1952 Addition 742 7,049 Totals 742 832 0 0 HVAC SYSTEMS System Name Qty. Heating Type Min. Eff. Cooling Type Min. Eff. Thermostat Type Status HVAC System 1 Central Furnace 90 %AFUE Split Air Conditioner 13.0 SEER Setback Altered pre- altered for above Gravity Wall Furnace 73% AFUE Split Air Conditioner 10.0 SEER Setback HVAC DISTRIBUTION System Name Heating Coolin Duct Location Duct R -Value Ducts Tested? Status HVAC System Ducted Ducted Attic, Ceiling Ins, vented 6.0 ❑ Altered pre- altered for above Ductless/ No Fan Ductless n/a n/a ❑ WATER HEATING SYSTEMS S stem Name Qt . Type Distribution Rated Input Btuh Tank Cap. al Energy Factor or RE Standby Loss or Pilot Ext. Tank Insul. R- Value Status Standard Gas 50 gal or Le 1 Small Gas No Pipe Insulation 40,000 50 0.58 n/a n/a Altered Default Gas Prior to 1999 1 Small Gas pre- altered for Above 28,000 50 0.53 n/a n/a MULTI - FAMILY WATER HEATING DETAILS HYDRONIC HEATING SYSTEM PIPING Control Hot Water Piping Length ft 0 ro a Q — S stem Name Pipe Len th Pipe Diameter lnsul. Thick. Qty, HP Plenum Outside Buried EnergyPro 5.1 by EnergySoft User Number: 5443 RunCode: 2014- 12- 22T20:50:40 ID: 204 -14 Page 8 of 11 MANDATORY MEASURES SUMMARY: Residential (Page 1 of 3 MF -1 R Project Name DRAGOJEVIC RES. ADDITION REVISED Date 1212212014 NOTE: Low -rise residential buildings subject to the Standards must comply with all applicable mandatory measures listed, regardless of the compliance approach used. More stringent energy measures listed on the Certificate of Compliance (CF -1 R, CF -1 R -ADD, or CF- 1 R -ALT Form) shall supersede the items marked with an asterisk ( *) below. This Mandatory Measures Summary shall be incorporated into the permit documents, and the applicable features shall be considered by all parties as minimum component performance specifications whether they are shown elsewhere in the documents or in this summary. Submit all applicable sections of the MF -1 R Form with plans. Building Envelope Measures: 116(a)l: Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage. §116(a)4: Fenestration products (except field- fabricated windows) have a label listing the certified U- Factor, certified Solar Heat Gain Coefficient SHGC , and infiltration that meets the requirements of 10 -111 (a). 117: Exterior doors and windows are weather-stripped; all joints and penetrations are caulked and sealed. 118(a): Insulationspecified or installed meets Standards for Insulating Material. Indicate type and include on CF -6R Form. §118(1): The thermal emittance and solar reflectance values of the cool roofing material meets the requirements of §118(1) when the installation of a Cool Roof is specified on the CF -1 R Form. *§1 50 a : Minimum R -19 insulation in wood -frame ceiling orequivalent U- factor. 150(b): Loose fill insulation shall conform with manufacturer's installed design labeled R- Value. *§1 50 c : Minimum R -13 insulation in wood -frame wall orequivalent U- factor. *§1 50 d : Minimum R -13 insulation in raised wood -frame floor orequivalent U- factor. 150(f): Air retarding wrap is tested, labeled, and installed according to ASTM E1677 -95 2000 when specified on the CF -1 R Form. 150 : Mandatory Vapor barrier installed in Climate Zones 14 or 16. §150(1): Water absorption rate for slab edge insulation material alone without facings is no greater than 0.3 %; water vapor permeance rate is no qreater than 2.0 perm/inch and shall be protected from physical damage and UV light deterioration. Fireplaces, Decorative Gas Appliances and Gas Log Measures: 150 e 1A: Masonry or factory-built fireplaces have a closable metal or glass door covering the entire opening of the firebox. §150(e)1 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 with a readily accessible, operable, and tight-fitting damper and or a combustion -air control device. §150(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 - §113: HVAC equipment, water heaters, showerheads, faucets and all other regulated appliances are certified by the Energy Commission. §113(c)5: Water heating recirculation loops serving multiple dwelling units and High -Rise residential occupancies meet the air release valve, backflow prevention, pump isolation valve, and recirculation loop connection requirements of §1 13(c)5. §115: Continuously burning pilot lights are prohibited for natural gas: fan -type central furnaces, household cooking appliances (appliances with an electrical supply voltage connection with pilot lights that consume less than 150 Btu /hr are exempt), and pool and spa heaters. 150(h): Heating and /or cooling loads are calculated in accordance with ASHRAE, SMACNA or ACCA. 150(i): Heating systems are equipped with thermostats that meet the setback requirements of Section 112(c). §1506)1 A: Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are externally wrapped with insulation having an installed thermal resistance of R -12 or greater. §1506)1 B: Unfired storage tanks, such as storage tanks or backup tanks for solar water - heating system, or other indirect hot water tanks have R -12 external insulation or R -16 internal insulation where the internal insulation R -value is indicated on the exterior of the tank. §1506)2: First 5 feet of hot and cold water pipes closest to water heater tank, non - recirculating systems, and entire length of recirculating sections of hot water pipes are insulated per Standards Table 150 -B. §1506)2: Cooling system piping (suction, chilled water, or brine lines),and piping insulated between heating source and indirect hot water tank shall be insulated to Table 150 -B and Equation 150 -A. §1506)2: Pipe insulation for steam hydronic heating systems or hot water systems >15 psi, meets the requirements of Standards Table 123 -A. §150(i)3A: Insulation is protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. §150(j)3A: Insulation for chilled water piping and refrigerant suction lines includes a vapor retardant or is enclosed entirely in conditioned space. §150(')4: Solar water-heating systems and /or collectors are certified by the Solar Rating and Certification Corporation. EnergyPro 5.1 by EnergySoft User Number: 5443 RunCode: 2014- 12- 22T20:50:40 1D: 204 -14 Page 9 of 11 MANDATORY MEASURES SUMMARY: Residential (Page 2 of 3 MF -1 R Project Name Date DRAGOJEVIC RES. ADDITION REVISED 1212212014 §150(m)1: All air - distribution system ducts and plenums installed, are sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6 -5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R- 4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct - closure system that meets the applicable requirements of UL 181, UL 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 reater than 1/4 inch, the combination of mastic and either mesh or tape shall be used §150(m)l : Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross - sectional area of the ducts. §150(m)2D: Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. 150(m)7: Exhaust fans stems have back draft or automatic dampers. §150(m)8: Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. §150(m)9: Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. 150 m 10: Flexible ducts cannot have porous inner cores. §150(o): All dwelling units shall meet the requirements of ANSI /ASHRAE Standard 62.2 -2007 Ventilation and Acceptable Indoor Air Quality in Low -Rise Residential Buildings. Window operation is not a permissible method of providing the Whole Building Ventilation required in Section 4 of that Standard. Pool and Spa Heating Systems and Equipment Measures: §114(a): Any pool or spa heating system shall be certified to have: a thermal efficiency that complies with the Appliance Efficiency Regulations; an on -off switch mounted outside of the heater; a permanent weatherproof plate or card with operating instructions; and shall not use electric resistance heating or a pilot light. §114(b)1: Any pool or spa heating equipment shall be installed with at least 36" of pipe between filter and heater, or dedicated suction and return lines, or built-up connections for future solar heating. 114(b)2: Outdoor pools ors as that have a heat pump or gas heater shall have a cover. §114(b)3: Pools shall have directional inlets that adequately mix the pool water, and a time switch that will allow all pumps to be set or programmed to run only during off-peak electric demand periods. 150 : Residential pool systems orequipment meet the pump sizing, flow rate, piping, filters, and valve requirements of §1 50 Residential Lighting Measures: §150(k)1: High efficacy luminaires or LED Light Engine with Integral Heat Sink has an efficacy that is no lower than the efficacies contained in Table 150 -C and is not a low efficacy luminaire asspecified by 150(k)2. 150(k)3: The wattage of permanently installed luminaires shall be determined asspecified by 130(d). §150(k)4: Ballasts for fluorescent lamps rated 13 Watts or greater shall be electronic and shall have an output frequency no less than 20 kHz, §150(k)5: Permanently installed night lights and night lights integral to a permanently installed luminaire or exhaust fan shall contain only high efficacy lamps meeting the minimum efficacies contained in Table 150 -C and shall not contain a line- voltage socket or line - voltage lamp holder; OR shall be rated to consume no more than five watts of power as determined by §130(d), and shall not contain a medium screw -base socket. §150(k)6: Lighting inte ral to exhaust fans, in rooms other than kitchens, shall meet the applicable requirements of §150(k). 150(k)7: All switching devices and controls shall meet the requirements of §1 50(k)7. §150(k)8: A minimum of 50 percent of the total rated wattage of permanently installed lighting in kitchens shall be high efficacy. EXCEPTION: Up to 50 watts for dwelling units less than or equal to 2,500 ft2 or 100 watts for dwelling units larger than 2,500 ft2 may be exempt from the 50% high efficacy requirement when: all low efficacy luminaires in the kitchen are controlled by a manual on occupant sensor, dimmer, energy management system (EMCS), or a multi -scene programmable control system; and all permanently installed luminaries in garages, laundry rooms, closets greater than 70 square feet, and utility rooms are high efficacy and controlled by a manual -on occupant sensor. §150(k)9: Permanently installed lighting that is internal to cabinets shall use no more than 20 watts of power per linear foot of illuminated cabinet. EnergyPro 5.1 by EnergySoft User Number., 5443 RunCode: 2014- 12- 22T20:50:40 ID: 204 -14 Page 10 of 11 MANDATORY MEASURES SUMMARY: Residential (Page 3 of 3 MF -1 R Project Name Date DRAGOJEVIC RES. ADDITION REVISED 1212212014 §150(k)10: Permanently installed luminaires in bathrooms, attached and detached garages, laundry rooms, closets and utility rooms shall be high efficacy. EXCEPTION 1: Permanently installed low efficacy luminaires shall be allowed provided that they are controlled by a manual -on occupant sensor certified to comply with the applicable requirements of §119. EXCEPTION 2: Permanently installed low efficacy luminaires in closets less than 70 square feet are not required to be controlled by a manual -on occupancy sensor. §150(k)11: Permanently installed luminaires located in rooms or areas other than in kitchens, bathrooms, garages, laundry rooms, closets, and utility rooms shall be high efficacy luimnaires. EXCEPTION 1: Permanently installed low efficacy luminaires shall be allowed provided they are controlled by either a dimmer switch that complies with the applicable requirements of §119, or by a manual - on occupant sensor that complies with the applicable requirements of §119. EXCEPTION 2: Lighting in detached storage building less than 1000 square feet located on a residential site is not required to comply with §1 50 k 11. §150(k)12: Luminaires recessed into insulated ceilings shall be listed for zero clearance insulation contact (IC) by Underwriters Laboratories or other nationally recognized testing /rating laboratory; and have a label that certifies the lumiunaire is airtight with air leakage less then 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283; and be sealed with a gasket or caulk between the luminaire housing and ceiling. §150(k)13: Luminaires providing outdoor lighting, including lighting for private patios in low -rise residential buildings with four or more dwelling units, entrances, balconies, and porches, which are permanently mounted to a residential building or to other buildings on the same lot shall be high efficacy. EXCEPTION 1: Permanently installed outdoor low efficacy luminaires shall be allowed provided that they are controlled by a manual on /off switch, a motion sensor not having an override or bypass switch that disables the motion sensor, and one of the following controls: a photocontrol not having an override or bypass switch that disables the photocontrol; OR an astronomical time clock not having an override or bypass switch that disables the astronomical time clock; OR an energy management control system (EMCS) not having an override or bypass switch that allows the luminaire to be always on EXCEPTION 2: Outdoor luminaires used to comply with Exceptionl to §150(k)13 may be controlled by a temporary override switch which bypasses the motion sensing function provided that the motion sensor is automatically reactivated within six hours. EXCEPTION 3: Permanently installed luminaires in or around swimming pool, water features, or other location subject to Article 680 of the California Electric Code need not be high efficacy luminaires. §150(k)14: Internally illuminated address signs shall comply with Section 148; OR not contain a screw -base socket, and consume no more than five watts of power as determined according to §130(d). §150(k)15: Lighting for parking lots and carports with a total of for 8 or more vehicles per site shall comply with the applicable requirements in Sections 130, 132, 134, and 147. Lighting for parking garages for 8 or more vehicles shall comply with the applicable requirements of Sections 130, 131, 134, and 146. §150(k)16: Permanently installed lighting in the enclosed, non - dwelling spaces of low -rise residential buildings with four or more dwelling units shall be high efficacy luminaires. EXCEPTION: Permanently installed low efficacy luminaires shall be allowed provided that they are controlled by an occupant sensors certified to comply with the applicable requirements of 119. EnergyPro 5.1 by EnergySoff User Number: 5443 RunCode: 2014- 12- 22T20:50:40 ID: 204 -14 Page 11 of 11