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13060072
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1154 S STELLING RD CONTRACTOR: LNB CONSTRUCTION, PERMIT NO: 13060072 INC OWNER'S NAME: YING MOY 861 SEQUOIA AVE DATE ISSUED: 09/09/2013 OWNER'S PHONE: 4082525864 MILLBRAE, CA 94030 PHONE NO: (415)585-3884 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L1 COMMERCIAL License ClassLic. # C) 06 CONSTRUCT A 951 SQ FT ONE STORY ADDITION TO (E) C, � l Contractor N`J pul ate L SFDWL; INTERIOR REMODEL (1132 SQ FT) 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: $150000 performance of the work for which this permit is issued. Ibave 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: 36226001.00 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 DAY IT 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 DA ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses w icIt may accrue against said City in consequence of the granting of this perm' . Additi ly, the applicant understands and will comply sued by: Date: with all non -point s reg at ns per the Cupertino MunicipalSection 9.I8. 111 Signature / Date t 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. ❑ OWNER -B I ER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exe pt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(x) 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 byte ay Ar Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with t e uper n Municipal Code, Chapter 9.12 and 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 the Health & Safety Code, Sec on 25 0, , 533, and 25534. permit is issued. Owner or authorized agent: Date: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building4cu-pertino.oro ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI a REVISION / DEFERRED ORIGINAL PERMIT #/ _3&; ' oU% a— PROJECT ADDRESS 117 S"�LL.1 �p • �7 APN # n 0. - �(p - OO' J OWNER NAME PHONF, qIN * ,paut� i E +71- 433-uni E-MAIL oo , to STREET ADDRESS lls� S.ST£11►►J6� Rn.omwo CITY, STATE,ZIP FAX I CA 9.501 CONTACT NAME (beoup PHONE � E-MAIL ', L%JIba dt74-B(� -05 QaC&A STREET ADDRESS'w� �N/ C! Y, STATE, ZIP II 504 FAx ,��/ ❑ OWNER ❑OWNER -BUILDER 'I/ OWNER AGENT ❑ CONTRACTOR ❑ C'ONTRACTOR AGENT 2Q ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 1� P%Aer -14 LICENSE NUMBER LICENSE TYPE BUS, LlC # COMPANY NAME E-MAIL rk.4- FAX b loix�•we�r STREET ADDRESS NJ CITY, STATE, ZIP PHONE ARCHITECT/ENG[NEER NAME LICENSE NUMBER 1 BUS. LIC # PAosAN C41J COMPANY NAM-MAILc f YU& J6 FAX STREET ADDRESS n CITY, STATE, ZIP PHONE 'l DESCRIPTION OF WORK 'SSN C4 LQ 1 P M I-c4L 1 po . 'i'RAN1 1�E ?6 *IP , AJD CAL.SCIP -GAqAf Roo PING EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES r-�r61M/Q p�`l VB USE TYPE OCC. SQ.FT. VALUATION ($) EXISTGr NEW FLOOR DEMO TOTAL AREA25q T AREA.0 AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA 953 } PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA.DETACH 453 ATTACH # DWELLING UNITS' IS A SECOND UNIT [I YES SECOND STORY ❑ YES IBEING ADDED? IQL.NO ADDITION? [%NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESRECEIVED B . / TOTAL V T[ON: PLANNING APPL # Q NO PLANNING APPROVAL LETTER EICHLER HOME? R NO N By my signature below, 1 certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf 1 have read this application and the information 1 have provided is correct. 1 have reaAffie Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. 1 e representatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApplicant/Agent_ Date: 6 I/2g� L4 SUPPLEMENTAL INF REQUIRED PLAN CHECK TYPE ROUTING SLIP OVER-THE-COUNTER BUILDING PLAN REVIEW 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 tttTTT gyri PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD /❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY ,OF CUPERTINO FEW FEE ESTIMATOR - BUILDING DIVISION 1AADDRESS: 1154 s stelling rd DATE: 01/28/2014 REVIEWED BY: Sean MISC ITEMS APN: BP#: "VALUATION: Iso "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 0.07 PENTAMATION 1GENRES PERMIT TYPE: WORK revision #1- revise garage roof from gable to hip and raised garage roof top plate SCOPE 14 .1' r 1 r NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nietrirt_ otr_ )_ Thoca foot ara hacod an tho nraliminnry infarmadmn availahle and are nnlv an e.etimato_ C antart the Dont Far addn'I info. FEE ITEMS (Fee Resolution 11-053 Eft' 711'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Cl Yes Q No $0.00 2 hours Plan Check, Hourly $278.00 ISTPLNCK Suppl. PC Fee: Q Reg. 0 OTJ 0.07 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes Q No $0.00 Suppl. Insp. Fee -0 Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0.00 hours $0.00 Inspections Inspection, Hourly Strong Motion Fee: $0.00 F-0-1 # Revisions $0.00 IREVSFDWL SFDWL Bldu Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $278.00 TOTAL FEE. ` $278.00 Revised: 01/15/2014 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinge-cupertino.org ❑ NEW CONSTRUCTION & ADDITION © ALTERATION I TI ❑ REVISION 1 DEFERRED c19- V'61 W ORIGINAL PERMIT # PROJECT ADDRESS IISy S. 5�I_t-►IJ61 RoAD APN # 3Coal� 0o) OWNEROWNER NAME i PHONP P-MAII �UUsE Y10C M6 ' 40 rd-SaS.ICI a��C�cL�16o. STREET ADDRESS CITY, STATE, ZIP FAX 1154. S•,5TCu.t-Y� F-A&,O CupE-TIN o CA g501q CONTACT NAME C-�izpUP PHONE fO$ � -O �J -1 -1 M L. +RC 02 S V S LNN SC. D E.51 G^I T T C C C- sr -de S r1 t(O .CA M STREET ADDRESS 0 6„..,>J Cir v�NE#13q CITY, STATE, ZIP C31`fKTI,,,6, CA 95o1q FAX ❑ OWNER ❑ OWNER -BUB -DER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS LIC # 13.19. COMPANY NAME E-MAIL FAX STREET ADDRESS CITY. STATE, ZIP PHONE ARCffiTECT ENGiNEE.R NAME LICENSE NUMBER BUS. LIC # CAAE-j c -a.81 G COMPANY NAME E-MAIL ' CJO m FAX U 1 1A f_ C'. S C.de.S STREET ADORE o� owlu CL---Cf_>� 13°1 , ZIP 6w> _.e.-rl,.lo,rA 01Soly1,407-,g(,5-05-7+ PHONE DESCRIPTION OF WORK 1 ` 51N S R kPP111 b%3 TLS A E t3 i 1N t-6SEs 1::r_0,1 C =I 'H,'% ECS AffKCW)N- Fo,¢ A %l Wo r_ RZ510e,-T/XL FVAf_ (APPL-lCA-r1oW RM-do13- 01)1=aR A REAV- YkAo A m Irl aN -N S 13 EXISTING USE PROPOSED USE CONSTR TYPE k STORIES MS11Dl_N,T1rL IZESiliE`���1 \J6 1 I USE TYPE OCC. SQ.FT, VALUATIONtS) EXISTRE A NEW FLOOR AREA C(S DEMO AREA TOTAL NET AREA {ZESIQEA70Al. 1/6 Q_3i `pSl.i(e V 150,00c)150,00c)BATHROOM I REMODEL AREA I n K TCREN REM90EL AREA 2�0 OTHER REMODEL AREA r PORCH AREA I DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA DETACH 3� 1'l 7.F TTACH # DWELLING UNITS. 1S A SECOND UNIT 1] YES SECOND STORY -[]YES BEING ADDED? WO ADDITION? MO PRE -APPLICATION aYFS IF YES, PROVIDE COPY OF IS THE BLDG AN 0 YES REC ED TOTAL VALUATION: PLANNING APPL4 []NO PLANNING APPROVAL LETTER EICHLER HOME? MNO Jct so, wo By my signature below, I certify to each of the following: I am the property owner or authonz gent to act on the property owner's behalf. T have read this application and the information 1 have provided is correct. I have read the Description of Work verify it is accurate. I agree to comply with all applicable local ordinances and stare laws relating to it ng construction. I authorize representatives of Cupertino to enter the above -I ntified property for inspection purposes. Signature of Applicant/Agent. Date: SUPPLEMENT71 INFORMATION REQUIRED PLAN CHECkTYPE ROUTINGSLIP ❑ OVER-THE-COUNTER -Ef-n-t26r,,a PLAN REVIEW _ 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 PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD PUBLIC WORKS fo_rm if any Hazardous Materials are being used as part of this project, ❑ LARGE FIRE DEP'i _ Copy of Planning Approval Letter or Meeting with Planning prior to C1 MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 I. doc revised 06121:`11 CITY OF CUPERTINO FM_7 FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 1154 S STELLING RD DATE: 06/10/2013 REVIEWED BY: MENDEZ 1101 APN: BP#: 5aaoo � `VALUATION: 1$150,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: I 2nd Unit? 0 Yes G No OTC. 0 Yes O No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK ADD 951 SQ FT TO E SFDWL REMODEL 1,132 SQ FT THROUGHOUT SFDWL SCOPE 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 951 $2,468.00 IR3PLNCK $1,549.00 IR3INSP $0.00 PME Plan Check: $0.00 120 1 s.f. $600.00 Remodel, Kitchen (<=300 sf) 1 IREMRESKIT Permit Fee: $1,549.00 Suppl. Insp. Fee -0 Reg. ( OT 0,0 hrs $0.00 = s.f. Remodel, Bath (<=300 sf) $600.00 IREMRESBAT PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 951 $2,468.00 $1,549.00 NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer District, School Metriet ate 1 Thoco fooe aro haeod nn tho nro/iminary informatian avai/ahlo and are nn1v an intimate_ 4-nntart the Dent for addn'l info_ FEE ITEMS (Fee Resolution 11-053 Eft 711!121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,468.00 892 s.f. $534.00 Remodel, Other IREMRESOTx Suppl. PC Fee: (!)Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 120 1 s.f. $600.00 Remodel, Kitchen (<=300 sf) 1 IREMRESKIT Permit Fee: $1,549.00 Suppl. Insp. Fee -0 Reg. ( OT 0,0 hrs $0.00 = s.f. Remodel, Bath (<=300 sf) $600.00 IREMRESBAT PME Unit Fee: $0.00 PME Permit Fee: $0.00 E) Work Without Permit? Yes No $0.00 Advanced Plannin& Fee: IPLLONGR $123.63 Select a Non -Residential Building or Structure Irtr�c> l)t,�',=1t, tttcrdaari F,es_ Strong Motion Fee: IBSEISMICR $15.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $6.00 SUtT6TALS:, $4,161.63 $1,734.00J TOTAL FEE: $5,895.63 Revised: 04/29/2013 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: S 5 , S;LK PERMIT # 27 UL eJ -12— 1ZOWNER'S OWNER'SNAME: li.� 0"r PHONE # GENERAL CONTRACTOR: 0, JV �ZEJ Ic5/\f • t INESS LICENSE # ADDRESS: UO l ii'� CITY/ZIPCOD— 1 (��,n') � , CA 4 b *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 il Owner / Cont actor ig atur Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing 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 il Owner / Cont actor ig atur Date CUPERTINO April 25, 2013 Susan Chen OFFICE OF COMMUNITY DEVELOPMENT CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3308 • FAX (408) 777-3333 • plan n ing (a -)cu pertino.org SC Design Group 20370 Town Center Lane #139 Cupertino, CA 95014 SUBJECT: MINOR RESIDENTIAL PERMIT ACTION LETTER — Application RM -2013-07: This letter confirms the decision of the Director of Community Development, given on April 24, 2013, approving a Minor Residential Permit to allow a portion of a 951 square foot addition to encroach 10 feet into the required 20 foot rear yard setback, located at 1154 South Stelling Road, with the following conditions: 1. APPROVED PROTECT This approval is based on a plan set entitled, "Moy Residence, 1154 S. Stelling Road, Cupertino, CA 95014" consisting of six sheets labeled "A0.0, A1.0, A2.0, A3.0, A4.0, and A4.1", received March 5, 2013, except as may be amended by conditions in this resolution. 2. ANNOTATION OF THE CONDITIONS OF APPROVAL The conditions of approval set forth shall be incorporated into and annotated on the building plans. 3. ACCURACY OF THE PROTECT PLANS The applicant/property owner is responsible to verify all pertinent property data including but not limited to property boundary locations, building setbacks, property size, building square footage, any relevant easements and/or construction records. Any misrepresentation of any property data may invalidate this approval and may require additional review. 4. CONSULTATION WITH OTHER DEPARTMENTS The applicant is responsible to consult with other departments and/or agencies with regard to the proposed project for additional conditions and requirements. Any misrepresentation of any submitted data may invalidate an approval by the Community Development Department. Minor Residential Permit Action Letter RM -2013-07 Page 2 5. MODIFICATION OF THE PROPOSED DECK LOCATION In accordance with the agreement between the property owner of 1154 S. Stelling Road and property owners of 1157 Hollyhead Lane, the proposed deck location shall be revised to generally follow the existing deck location with the exception that a deck extension be allowed by the door on the north side of the addition within the rear yard setback. This requirement may be waived or modified to a less restrictive requirement in writing by the affected property owner. 6. FENCE EXTENSION In accordance with the agreement between the property owner of 1154 S. Stelling Road and property owners of 1157 Hollyhead Lane, a one -foot semi -transparent lattice extension of the existing six-foot (approximate) high fence shall be allowed by the property owner of 1154 S. Stelling Rd. This requirement may be waived or modified to a less restrictive requirement in writing by the affected property owner. 7. COMPLIANCE WITH PUBLIC WORKS CONFIRMATION FORM The project shall comply with the requirements indicated on the Public Works Confirmation form dated 10/9/2012, including, but not limited to, dedications, easements, off-site improvements, undergrounding of utilities, all necessary agreements, and utility installations/relocations as deemed necessary by the Director of Public Works and required for public health and safety. The Public Works Confirmation is a preliminary review, and is not an exhaustive review of the subject development. Additional requirements may be established and implemented during the construction permitting process. The project construction plans shall address these requirements with the construction permit submittal, and all required improvements shall be completed to the satisfaction of the Director of Public Works prior to final occupancy. 8. EXTERIOR BUILDING MATERIALS/TREATMENTS Final building exterior treatment plan (including but not limited to details on exterior color, material, architectural treatments and/or embellishments) shall be reviewed and approved by the Director of Community Development prior to issuance of building permits. The final building exterior plan shall closely resemble the details shown on the original approved plans. Any exterior changes determined to be substantial by the Director of Community Development shall require a minor modification approval with neighborhood input. 9. INDEMNIFICATION To the extent permitted by law, the Applicant shall indemnify and hold harmless the City, its City Council, its officers, employees and agents (the "indemnified parties") from and against any claim, action, or proceeding brought by a third party against the indemnified parties and the applicant to attack, set aside, or void this ordinance or any permit or approval authorized hereby for the project, including (without limitation) reimbursing Minor Residential Permit Action Letter RM -2013-07 Page 3 the City its actual attorneys' fees and costs incurred in defense of the litigation. The City may, in its sole discretion, elect to defend any such action with attorneys of its choice. 10. NOTICE OF FEES, DEDICATIONS, RESERVATIONS OR OTHER EXACTIONS The Conditions of Project Approval set forth herein may include certain fees, dedication requirements, reservation requirements, and other exactions. Pursuant to Government Code Section 66020(d) (1), these Conditions constitute written notice of a statement of the amount of such fees, and a description of the dedications, reservations, and other exactions. You are hereby further notified that the 90 -day approval period in which you may protest these fees, dedications, reservations, and other exactions, pursuant to Government Code Section 66020(a), has begun. If you fail to file a protest within this 90 - day period complying with all of the requirements of Section 66020, you will be legally barred from later challenging such exactions. Please note that if this permit is not vested within a year, it shall expire on April 24, 2014. Staff received a comment from a neighboring property owner during the public comment period. The neighboring owner had privacy concerns on the proposed addition into the rear yard setback due to the grade differential between the two lots (project property owner's lot is higher in elevation) and the windows proposed on the rear elevation. The neighboring property owner did not object to the addition into the rear setback, but did request that the project property owner allow them to install a one -foot semi -transparent lattice extension on the existing rear fence. Additionally, the neighboring property owner requested that the proposed deck generally follow the existing location and height (with allowance for a small extension out to the proposed sliding door on the north side of the addition) and that the rear windows on the proposed addition be raised in height in order to reduce privacy impacts. The project property owner agreed to the above-mentioned one -foot fence extension and agreed to keep the deck in the same general location with a small extension out to the new door. These agreements have been reflected in the conditions of approval. Staff has made all the findings that are required for approval a Minor Residential Permit as required by the of Cupertino's Municipal Code, Chapter 19.28.140 (A). Also, please note that an appeal of this decision can be made within 14 calendar days from the date of this letter. If this happens, you will be notified of a public hearing, which will be scheduled before the Planning Commission. Sincerely, eorge Schroeder Assistant Planner City of Cupertino Minor Residential Permit Action Letter RM -2013-07 408-777-7601 georges@cupertino.org Enclosures: Approved Plan Set cc: Yin Kin and Pauline Moy, 1154 South Stelling Road, Cupertino, CA 95014 Janice Rucks and Anthony Maran, 1157 Hollyhead Lane, Cupertino, CA 95014 G: \Planning \Minor Residential \RM, R&RM Approvals \2013 \RM -2013-07 Actionletter.doc Page 4 CUPERTINO CONTRACTOR/,S LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: "j_ 5 '`f' PERMIT # '0 O Z OWNER'S NAME: PHONE # Cabinets & Millwork GENERAL CONTRACTOR: ),J5 ;Z-O&per. I SINESS LICENSE # ADDRESS:1 " 1 CITY/ZIPCODE: 1 tt l5 Zig . *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUP GENERAL CONTRACTOR AND ALL SUB( BUSINESS LICENSE. I am not using any subcontractors: S INSPECTION(S) WILL BE SCHEDULED UNTIL THE AC, RS HAVE OBTAINED A CITY OF CUPERTINO ;natu a Date Please check applicable subcontractors and compl f to t�e following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINE NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing 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 STATEMENT OF COMPLIANCECABEC LThis certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 the Administrative Regulations and Part 6 the Ca'ft^o'ss°``atimoffB k4N' .E.�YC«m,ka°a Efficiency Standards of the California Code of Regulations.Tbn,M � ! R".210 The documentation author hereby certifies that the documentation is accurate and complete. Documentation Author Company Carstairs Energy Calculations Address P.O. Box 4736 Name Timothy Carstairs, CEA, CEPS 6/4/2013 Cit S ate2ip San Luis Obispo, CA 93403 _Phone (805) 904-9048 - — --- — -- Sipe 1---- ---- 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 building envelope sealing require installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) Company SC Design Group Address 20370 Town Center Lane Suite 139 Name - CO/State/Zip Cupertino, CA 95014 Phone (408) 421-5920 Sign License # Date I(sq S- Suri+" -7 2, PERFORMANCE CERTIFICATE: Residential Part 3 of 5) CF -1 R Project Name Moy Addition Building Type 0 Single Family 0 Addition Alone Date ❑ Multi Family 2 Existing+ Addition/Alteration 6/4/2Q13 ANNUAL ENERGY USE SUMMARY Standard TDV Proposed Margin (kBtu/ft2 yr Space Heating 57.26 41.46 15.80 Space Cooling 17.89 17.75 0.14 Fans 11.25 9.77 1. FILE3 Domestic Hot Water 18.86 18.86 o.00 oo Pumps 0.00 0.00 0.00 Totals 105.27 87.85 17.42 Percent Better Than Standard: 16.5 BUILDING COMPLIES - NO HERS VERIFICATION REQUIRED Building Front Orientation: (149 270 degFenestration Ext. Walls/Roof Wall Area Area Number of Dwelling Units: 1.00 (W) 352 Fuel Available at Site: !Natural Gas (N) 572 45 Raised Floor Area: 2,083 (E) 352 88 Slab on Grade Area: 0 (S) 572 89 Average Ceiling Height: 8.0 Roof 2,083 99 2 Fenestration Average U -Factor: 0.39 TOTAL: 324 REMARKS Average SHGC: 0.45 Fenestration/CFA Ratio: 15.5 % STATEMENT OF COMPLIANCECABEC LThis certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 the Administrative Regulations and Part 6 the Ca'ft^o'ss°``atimoffB k4N' .E.�YC«m,ka°a Efficiency Standards of the California Code of Regulations.Tbn,M � ! R".210 The documentation author hereby certifies that the documentation is accurate and complete. Documentation Author Company Carstairs Energy Calculations Address P.O. Box 4736 Name Timothy Carstairs, CEA, CEPS 6/4/2013 Cit S ate2ip San Luis Obispo, CA 93403 _Phone (805) 904-9048 - — --- — -- Sipe 1---- ---- 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 building envelope sealing require installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) Company SC Design Group Address 20370 Town Center Lane Suite 139 Name - CO/State/Zip Cupertino, CA 95014 Phone (408) 421-5920 Sign License # Date CUPERTINO Owner Name / /*,` /110 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(W-cupertino.oro INE M 0 Address //4 %%l/?f'r 'r�'_ ;roti <) C'fj 9 -,/ 00�0(90?z", PERRIIT CANNOT BE FINALED ANS C011I1"LETED TTlNTIL THIS CERTIFICATE I -I S BEEN SIGNED AND RETtTR.NED TO THE BUILDING DIVISION Please refer to the attached California Civil Code Sections 1101.1-1101.8 which are part of this Certification fo rm. L E 1. Is your real property a registered historical site? l" ❑ Yes Civil Code Sections 1101.1 through 1101.8 do n t apply. Sign below and skip the rest of the form. Owner Si atur Date: ® No Go to Question 2. / 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Sign below and skip the rest of the form. Owner' Signatur� Date: No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 dogot apply. Sign klow and skip the rest of the form. Owner' Signatur . <L2��^-tel Date: Q 9 No Go to Question Ilk estion 4. / 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do no apply. Sign below and skip the rest of the form. Owner' Signaturc�� `�� �1 Date: N Yes My real property is Zand available for u e or occupancy on onuary 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. ® My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. SB40 7 2014.doc revised 03/18/14 r On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I/We, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures have been replaced with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing -fixtures comply with the requirerAents as indicated in the table below. Owner's (or Owner Agent's) Signate, Date: Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2014.doc revised 03/18/14 Non -Compliant Water -Conserving Plumbing Fixture f " Plumbin Fixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate ix Type Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, 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 @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets — Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2014.doc revised 03/18/14 CALIFORNIA CIVIL CODE SECTIONS 1101.1-1101.8 Civil Code Division 2. Property Part 4. Acquisition of Property Title 4. Transfer Chapter 2. Transfer of Real Property Article 1.4. I nstal I ati on of Water Use Efficiency Improvements ........ 1101.1 —1101.8 1101.1. The Legislature finds and declares all of the following: (a) Adequate water supply reliability for all uses is essential to the future economic and environmental health of California. (b) Environmentally sound strategies to meet future water supply and wastewater treatment needs are key to protecting and restoring aquatic resources in California. (c) There is a pressing need to address water supply reliability issues raised by growing urban areas. (d) Economic analysis by urban water agencies has identified urban water conservation as a cost-effective approach to addressing water supply needs. (e) There are many water conservation practices that produce significant energy and other resource savings that should be encouraged as a matter of state policy. (f) Since the 1991 signing of the "Memorandum of Understanding Regarding Urban Water Conservation in California," many urban water and wastewater treatment agencies have gained valuable experience that can be applied to produce significant statewide savings of water, energy, and associated infrastructure costs. This experience indicates a need to regularly revise and update water conservation methodologies and practices. (g) To address these concerns, it is the intent of the Legislature to require that residential and commercial real property built and available for use or occupancy on or before January 1, 1994, be equipped with water -conserving plumbing fixtures. (h) It is further the intent of the Legislature that retail water suppliers are encouraged to provide incentives, financing mechanisms, and funding to assist property owners with these retrofit obligations. 1101.2. Except as provided in Section 1101.7, this article shall apply to residential and commercial real property built and available for use on or before January 1, 1994. 1101.3. For the purposes of this article: (a) "Commercial real property" means any real property that is improved with, or consisting of, a building that is intended for commercial use, including hotels and motels, that is not a single-family residential real property or a multifamily residential real property. (b) "Multifamily residential real property" means any real property that is improved with, or consisting of, a building containing more than one unit that is intended for human habitation, or any mixed residential -commercial buildings or portions thereof that are intended for human habitation. Multifamily residential real property includes residential hotels but does not include hotels and motels that are not residential hotels. (c) "Noncompliant plumbing fixture" means any of the following: (1) Any toilet manufactured to use more than 1.6 gallons of water per flush. (2) Any urinal manufactured to use more than one gallon of water per flush. (3) Any showerhead manufactured to have a flow capacity of more than 2.5 gallons of water per minute. (4) Any interior faucet that emits more than 2.2 gallons of water per minute. (d) "Single-family residential real property" means any real property that is improved with, or consisting of, a building containing not more than one unit that is intended for human habitation. (e) "Water -conserving plumbing fixture" means any fixture that is in compliance with current building standards applicable to a newly constructed real property of the same type. (f) "Sale or transfer" means the sale or transfer of an entire real property estate or the fee interest in that real property estate and does not include the sale or transfer of a partial interest, including a leasehold. 1101.4. (a) On and after January 1, 2014, for all building alterations or improvements to single-family residential real property, as a condition for issuance of a certificate of final completion and occupancy or final permit approval by the local building department, the permit applicant shall replace all noncompliant plumbing fixtures with water - conserving plumbing fixtures. (b) On or before January 1, 2017, noncompliant plumbing fixtures in any single-family residential real property shall be replaced by the property owner with water -conserving plumbing fixtures. (c) On and after January 1, 2017, a seller or transferor of single-family residential real property shall disclose in writing to the prospective purchaser or transferee the requirements of subdivision (b) and whether the real property includes any noncompliant plumbing fixtures. 1101.5. (a) On or before January 1, 2019, all noncompliant plumbing fixtures in any multifamily residential real property and in any commercial real property shall be replaced with water -conserving plumbing fixtures. (b) An owner or the owner's agent may enter the owner's property for the purpose of installing, repairing, testing, and maintaining water -conserving plumbing fixtures required by this section, consistent with notice requirements of Section 1954. (c) On and after January 1, 2019, the water -conserving plumbing fixtures required by this section shall be operating at the manufacturer's rated water consumption at the time that the tenant takes possession. A tenant shall be responsible for notifying the owner or owner's agent if the tenant becomes aware that a water -conserving plumbing fixture within his or her unit is not operating at the manufacturer's rated water consumption. The owner or owner's agent shall correct an inoperability in a water -conserving plumbing fixture upon notice by the tenant or if detected by the owner or the owner's agent. (d) (1) On and after January 1, 2014, all noncompliant plumbing fixtures in any multifamily residential real property and any commercial real property shall be replaced with water -conserving plumbing fixtures in the following circumstances: (A) For building additions in which the sum of concurrent building permits by the same permit applicant would increase the floor area of the space in a building by more than 10 percent, the building permit applicant shall replace all noncompliant plumbing fixtures in the building. (B) For building alterations or improvements in which the total construction cost estimated in the building permit is greater than one hundred fifty thousand dollars ($150,000), the building permit applicant shall replace all noncompliant plumbing fixtures that service the specific area of the improvement. (C) Notwithstanding subparagraph (A) or (B), for any alterations or improvements to a room in a building that require a building permit and that room contains any noncompliant plumbing fixtures, the building permit applicant shall replace all noncompliant plumbing fixtures in that room. (2) Replacement of all noncompliant plumbing fixtures with water -conserving plumbing fixtures, as described in paragraph (1), shall be a condition for issuance of a certificate of final completion and occupancy or final permit approval by the local building department. (e) On and after January 1, 2019, a seller or transferor of multifamily residential real property or of commercial real property shall disclose to the prospective purchaser or transferee, in writing, the requirements of subdivision (a) and whether the property includes any noncompliant plumbing fixtures. This disclosure may be included in other transactional documents. 1101.6. The duty of an owner or building permit applicant to comply with the requirements of this article shall be postponed for one year from the date of issuance of a demolition permit for the building. If the building is demolished within the one-year postponement, the requirements of this article shall not apply. If the building is not demolished after the expiration of one year, the provisions of this article shall apply, subject to appeal to the local building department, even though the demolition permit is still in effect or a new demolition permit has been issued. 1101.7. This article shall not apply to any of the following: (a) Registered historical sites. (b) Real property for which a licensed plumber certifies that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible. (c) A building for which water service is permanently disconnected. 1101.8. A city, county, or city and county, or a retail water supplier may do either of the following: (a) Enact local ordinances or establish policies that promote compliance with this article. (b) Enact local ordinances or establish policies that will result in a greater amount of water savings than those provided for in this article. I BUILDING ENERGY ANALYSIS REPORT I T I N 0 PROJECT: is Moy Addition 1154 S. Stelling Rd. NCCupertino, CA 95014 V - Project Designer: SC Design Group 20370 Town Center Lane Suite 139 Cupertino, CA 95014 (408) 421-5920 Date: 1) Co AOMM*& 6/4/2013 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This 0"i bas approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2008 Building 49wVy Efficiency Standards. This program developed by EnergySoft, LLC - www.energysoft.com. Report Prepared by: 7- Timothy Carstairs, CEA, CEPE Carstairs Energy Calculations P.O. Box 4736 San Luis Obispo, CA 93403 (805) 904-9048 ISI Job Number: 13-0604 Date: 1) Co AOMM*& 6/4/2013 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This 0"i bas approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2008 Building 49wVy Efficiency Standards. This program developed by EnergySoft, LLC - www.energysoft.com. I TABLE OF CONTENTS I Cover Page Table of Contents Form CF -1 R Certificate of Compliance Form MF -1 R Mandatory Measures Summary 2 3 9 I EnergyPro 5.1 by EnergySoft Job Number: ID: 13-0604 '� User Number: 6249 _ j PERFORMANCE CERTIFICATE: Residential Part 1 of 5 CF -1 R Project Name Moy Addition Building Type ® Single Family 0 Addition Alone ❑ Multi Family ® Existing+ Addition/Alteration Date 6/4/2013 Project Address 1154 S. Stelling Rd. Cupertino California Energy Climate Zone CA Climate Zone 04 Total Cond. Floor Area 2,083 Addition 951 # of Stones 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 El No Special Features -- If Yes, see Part 2 of 5 of this form for details. INSULATION Construction Type Area Special Cavi Features see Part 2 of 5 Status Floor Wood Framed w/Crawl Space None 1,132 Existing Wall Wood Framed None 494 Existing Roof Wood Framed Attic R-11 1,131 Existing Floor Wood Framed w7Crawl Space R-19 951 New Wall Wood Framed R-13 981 New Door Opaque Door None 51 New Roof Wood Framed Attic R-30 950 New FENESTRATION U- Exterior Orientation Area( Factor SHGC Overhang Sidefins Shades Status Left (N) 55.0 0.390 0.45 none none Bug Screen New Rear (E) 36.0 0.390 0.45 none none Bug Screen New Rear (E) 53.3 0.390 0.45 none none Bug Screen New Skylight 1.0 0.840 0.67 none none None New Front (Kq 45.0 0.390 0.45 none none Bug Screen New Left (N) 33.3 0.390 0.45 none none Bug Screen New Right (S) 99.0 0.390 0.45 none none Bug Screen New Skylight 1.0 0.840 0.67 none none None New HVAC SYSTEMS Ot . 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, Ceiling Ins, vented 4.2 Existing WATER HEATING Ot . Type Gallons Min. Eff Distribution Status EnergyPro 5.1 by Erre Soft User Number. 6249 RunCode: 2013-08.04T07.-25:53 ID: 13-0604 Page 3 of 11 PERFORMANCE CERTIFICATE: Residential Part 2 of 5 CF -1 R Project Name Moy Addition Building Type ®Single Family 0 Addition Alone ❑ Multi Family ® Existing+ Addition/Alteration Date 6/4/2013 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. EnergyPro 5.1 by EnergySoft User Number. 6249 RunCode: 2013.06-04T07:25:53 ID: 13-0604 Peoe 4 of 11 PERFORMANCE CERTIFICATE: Residential Part 3 of 5 CF-1 R Project Name Building Type m Single Family 17 Addition Alone Date Moy Addition 0 Multi Family DJ Existing+ Addition/Alteration 6/4/2013 ANNUAL ENERGY USE SUMMARY Standard Proposed Margin TDV kgtu/ftz- r Space Heating 57.26 41.46 15.80 Space Cooling 17.89 17.75 0.14 Fans 11.25 9.77 1.47 Domestic Hot Water 18.86 18.86 0.00 Pumps 0.00 0.00 0.00 Totals 105.27 87.85 17.42 Percent Better Than Standard: 16.5 % BUILDING COMPLIES - NO HERS VERIFICATION REQUIRED Fenestration Building Front Orientation: (M 270 deg Ext. Walls/Roof Wall Area Area Number of Dwelling Units: 1.00 (w) 352 45 Fuel Available at Site: Natural Gas (N) 572 88 Raised Floor Area: 21083 (E) 352 89 Slab on Grade Area: 0 (S) 572 99 Average Ceiling Height: 8.0 Roof 2,083 2 Fenestration Average U-Factor: 0,39 TOTAL: 324 Average SHGC: 0.45 Fenestration/CFA Ratio: 15.5% REMARKS STATEMENT OF COMPLIANCE This certificate of compliance lists the building features and specifications needed CABS to comply with Title 24, Parts 1 the Administrative Regulations and Part 6 the MaZ22121MIAMOM'"'�ei�n 73 Efficiency Standards of the California Code of Regulations.*1m0"prsulR ,o The documentation author hereby certifies that the documentation is accurate and complete. Documentation Author Company Carstairs Energy Calculations 6/48013 P.O. Box 4736 Timothy Carstairs, CEA, CEPE Address Name y City/State/ZipCity/State/Zip San Luis Obispo, CA 93403 Phone (805) 904-9048 Si ne 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 building envelope sealing require installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) Company SC Design Group Address 20370 Town Center Lane Suite 139 Name City/State/Zip Cupertino, CA 95014 Phone (408) 421-5920 igned License # Date EnerayPro 5.1 by EnefgySoft User Number. 6249 RunCode: 2013.06-04T07:25:53 ID: 13-0604 Page 5 of 11 CERTIFICATE OF COMPLIANCE: Residential (Part 4 of 5) CF -1 R Project Name Moy Addition Building Type m Single Family ❑ Addition Alone 1 ❑ Multi Family ® Existing+ Addition/Alteration Date 6/412013 OPAQUE SURFACE DETAILS Surface Type Area U- insulation Joint Appendix Factor Cavity Exterior Frame Interiorl Frame I Azm Tilt Status 4 Location/Comments Floor 1,132 0.097 None 0 180 Existing 4.4.1-A1 Existing 1st Floor Wall 152 0.356 None 270 90 Existing 4.3,1-A1 Existing ist Floor Door 18 0.500 None 270 90 Rernom 4.5.1-A4 Existing 1st Floor Wall 175 0.356 None 0 90 Exish 4.3.1-A1 Existing 1st Floor Wall 167 0,356 None 90 90 Existing 4,3.1-A1 Existing 1st Floor Roof 1 131 0.079 R-11 0 0 Existin 4.2.1-A2 Existing 1st Floor Wall 168 0.356 None 270 90 Removec 4.3.1-A I Existi 1st Floor Wall 40 0.356 None 0 90 Rema 4.3.1-A 1 Existing 1st Floor Wall 80 0.356 None 90 90 Removvc4.3.14l Existing 1st Floor Wall 252 0.358 None 180 90 Renmve 4.3.1-A 1 Existing 1st Floor Floor 951 0.037 R-19 0 180 Now 4.4.1 A4 1st Floor Addition Wall 122 0.102 R-13 270 90 New 4.3.1-A3 1st Floor Addition Door 33 0.500 None 270 90 New 4.5.1-A4 istFloor Afthon Wall 291 0.102 R-13 0 90 New 4.3.1-A3 1st Floor Addition Door 1 181 0.500 None 0 90 1 New 4.5.1-A4 1st Floor Addition Wall 1 961 0.102 R-13 901 90 1 Now 14.3,1-A3 ist Floor Addition FENESTRATION SURFACE DETAILS ID Type Area U -Factor SHGC Azm Status Glazing Type Location/Comments 1 Window 200 0.390 NFRC 0.45 NFRC 0 New Double Non Metal Clear Existing 1st Floor 2 Window 5.0 0.390 NFRC 0.45 NFRC 0 New Double Non Metal Clear Existing 1st Floor 3 Window 20.0 0.390 NFRC 0.45 NFRC 0 New Double Non Metal Clear Existing 1st Floor 4 Whdow 20.0 0.390 NFRC 0.45 NFRC 90 New Double Non Metal Clear Existing 1st Floor 5 Window 53.3 0.390 NFRC 0.45 NFRC 90 New Sliding Glass Door Existing 1st Floor 6 Skylight 1 1.0 0.840 Defauff 0,67 Default 0 New Skylight Existing 1st Floor 7 Window 22.5 0.390 NFRC 0.45 NFRC 270 New Double Non Metal Clear 1st Floor Addition 6 Window 22.5 0.390 NFRC 0.45 NFRC 270 New Double Non Metal Clear 1st Floor Additlon 9 Window 10.0 0.390 NFRC 0.45 NFRC 0 New Double Non Metal Gear 1st Floor Addition 10 Window 33.3 0.390 NFRC 0.45 NFRC 0 New Sliding Glass Door 1st Floor Addition 11 Window 8.0 0.390 NFRC 0.45 NFRC 90 New Double Non Metal Clear 1st Floor Addition 12 Window 8.0 0.390 NFRC 0.45 NFRC 90 New Double Non Metal Clear 1st Floor Addition 13 Window 8.0 0.390 NFRC 0.45 NFRC 180 New Double Non Metal Clear 1st Floor Addition 14 Window 8.0 0.390 NFRC 0.45 NFRC 180 New Double Non Metal Clear 1st Floor Addition 15 Window5.0 0,390 NFRC 0.45 NFRC 180 New Double Non Metal Clear 1st F1oorAddiffon 16 Window 12.0 0.390 NFRC 0.45 NFRC 180 New Double Non Metal Clear 1st Floor Addition (1) U -Factor Type: 116-A = Default Table from Standards, NFRC - Labeled Value 2 SHGC T 116-B = Default Table from Standards NFRC = Labeled Value EXTERIOR SHADING DETAILS ID Exterior Shade Type SHGC Window Hot Wd Ove ang Left Fin Len Hot LExt RExt Dist Len I Right Fin Hot Dist Len Hot 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 None 1.00 7 Bug Screen 0,76 8 Bug Screen 0.76 9 Bug Screen 0.76 10 Bug Screen 0.76 11 Bug Screen 0.76 12 Bug Screen 0.76 13 Bug Screen 0.76 14 Bug Screen 0.76 15 [Bug Screen 0.76 16 JBuq Screen 0.76 EnergyPro 5.1 by EnergySoft User Number. • 6249 RunCode: 2013-06#T07:25:53 ID: 13-0604 Page 6 of 1 i CERTIFICATE OF COMPLIANCE: Residential (Part 4 of 5) CF -1 R Project Name Moy Addition Building Type m Single Family ❑ Addition Alone ❑ Multi Family ® Existing+ Addition/Alteration Date 614/2013 OPAQUE SURFACE DETAILS Surface U- Insulation Joint Appendix Type Area Factor Cavity Exterior Frame Interior Frame Azm Tilt Status 4 Location/Comments wall 473 0.102 R-13 180 90 New 4.3,1-A3 1st Floor Addition Roof 950 0.031 R-30 0 0 New 4.2.1-A20 1st Floor Addition FENESTRATION SURFACE DETAILS ID Type Area U -Factor SHGC Azm Status Glazing Type Location/Comments 17 Window 21,0 0.390 NFRC 0.45 NFRC 180 New Double Non Metal Clear 1st Floor Addition 18 Window 25.0 0.390 NFRC 0.45 NFRC 180 New Double Non Metal pear 1st Floor Addition 19 window 10.0 0.390 NFRC 0.45 NFRC 180 New Double Non Metal Clear 1st FloorAddition 20 Window 10.0 0.390 NFRC 0.45 NFRC 180 New Double Non Metal Clear 1st FloorAddition 21 Skylight 1,0 0.840 Default 0.67 Default 0 New Skylight 1st Floor Addition (1) U -Factor Type: 116-A - Default Table from Standards, NFRC = Labeled Value 2 SHGC T 1 i 6-B = Default Table from Standards, NFRC - Labeled Value EXTERIOR SHADING DETAILS Window ID Exterior Shade Type SHGC H t Wd Ove hang Left Fin Right Fin Len H t LExt REA Dist Len Hgt Dist Len H t 17 Bug Screen 0.76 18 Bug Screen 0.76 19 Bug Screen 0.76 20 Bug Screen 0.76 21 None 1.00 EnergyPro 5.1 by EnergySoft User Number. 6249 RunCode: 2013-06-04T07:25:53 ID: 13-0604 Pae 7 of 11 CERTIFICATE OF COMPLIANCE: Residential Part 5 of 5 CF -1 R Project Name MoyAddition Building Type ® Single Family ❑ Addition Alone ❑ Mufti Family ® Existing+Addition/Afteration Date 6/4/2013 BUILDING ZONE INFORMATION System Name Zone Name Floor Area New Existing Altered Removed Volume Year Built HVAC System, Existing 1st Floor 1,132 9,056 1961 ist Floor Addition 951 7,608 Totals 951 1,132 01 0 HVAC SYSTEMS System Name Q Heati Type Min. Eff. Cooling Type Min. Eff. Thermostat Type Status HVAC System i Central Furnace 80% AFUE Split Air Conditioner 13.0 SEER Setback New HVAC DISTRIBUTION System Name Heating Duct Coolina Duct Location R -Value Ducts Tested? Status HVAC System Ducted Ducted Attic, Ceiling Ins, vented 4.2 ❑ EkWin ❑ WATER HEATING SYSTEMS S stem Name Qty. 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 i Small Gas No Pipe Insulation 40,000 50 0.58 n/a n/a Existing MULTI -FAMILY WATER HEATING DETAILS HYDRONIC HEATING SYSTEM PIPING Control Hot Water Piping Length ft 9 c� -. y o ¢ System Name Pipe Length Pipe Diameter Insul. Thick. Qty. HP Plenum Outside Buried L 13 13 EnergyPro 5.1 by EnergySoft User Number. 6249 RunCode: 2013.06-04TO7:25:53 ID: 13-0604 Page 8 of 11 MANDATORY MEASURES SUMMARY: Residential Pae 1 of 3 MF -IR Project Name Moy Addition Date 6/4/2013 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 fisted 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): Insulation specified 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(i) when the installation of a Cool Roof is specified on the CF -1 R Form. * §150(a): Minimum R-19 insulation in wood -frame ceiling or equivalent 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 or equivalent U -factor. *§150(d): Minimum R-13 insulation in raised wood -frame floor or equivalent 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 greater than 2.0perm/inch and shall be protected from physical damage and UV light deterioration. Fireplaces, Decorative Gas Appliances and Gas Log Measures: 150 e 1 A: Masonry or factory -built fireplaces have a closable metal or glass door covering the entire opening of the firebox. §150(e)l 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 buming 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 §113(c)5. §115: Continuously burning pilot lights are prohibited for natural gas: tan -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). §1500)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. §150(j)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. §150(j)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. §150(j)2: Pipe insulation for steam hydronic heating systems or hot water systems >15 psi, meets the requirements of Standards Table 123-A. 150 3A: Insulation is protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. §1 500)3A: Insulation for chilled water piping and refrigerant suction lines includes a vapor retardant or is enclosed entirely in conditioned space. §1500)4. Solar water -heating systems and/or collectors are certified by the Solar Rating and Certification Corporation. EnergyPro 5.1 by EnergySoft User Number. 6249 RunCode: 2013-0604T07.25.53 ID: 13-0604 Page 9 of ?? MANDATORY MEASURES SUMMARY: Residential Page 2 of 3 MF -1R Project Name Date Moy Addition 6/4/2013 §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 openinas greater than 1/4 inch the combination of mastic and either mesh or tape shall be used §150(m)1: Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. §150(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 ora pilot light. §114(b)l : 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 or spas 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 or equipment meet the pump sizing, flow rate, piping, filters, and valve requirements of §150 . Residential Lighting Measures: §150(k)l : 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 ass cified by §150(k)2. §150(k)3: The wattage of permanently installed luminaires shall be determined as specified 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(4), and shall not contain a medium screw -base socket. 150(k)6: Lighting integral to exhaust fans, in rooms other than kitchens, shall meet the applicable requirements of §150(k). 150(k)7: All switchigg devices and controls shall meet the requirements of §150(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. 6249 RunCode: 2013-MMT07:25:53 ID: 13-0604 Page 10 of 11 MANDATORY MEASURES SUMMARY: Residential Pae 3 of 3 MF -1 R Project Name Date Moy Addition 1 61412013 §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 iuimnaires. 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 §150 k 11. §150(k)i 2: 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 compty with Exception 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 recluirements 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. EnergyPm 5.1 by EnergySolt User Number: 6249 RunCode: 2013-06-04T07:25:53 /D: 13-0604 Page 11 of 11 10300 T Amnut CJW- rtma CW*Mia 95"4 TeWww-- (408) 7774348 FAX (408) 777-3333 COMMIMM DEVELOPAENT FENCE "PROVAL msmw_ Addrom Page 1 of 2 LANDSCAPE WATER -EFFICIENCY CHECKLIST Community Development Department 10300 Torre Avenue 408.777.3308/ Fax 408.777.3333 Cupertino, CA 95014 planning@cupertino.org CUPERTINO http://cupertino.org/plannin t `` Applicant Name: a e? ��oeo�1� Email:: er c roc C' CA - Ac t Project Site Address: �.`5 e�1c oc�e5 Phone: '-101 - V—CUA Total Landscape ,� no pC5'C� �J Landscape area: All the planting areas, turf areas, and water features in a landscape installation. The landscape area does Area feet of ; t 4q • 5�u c3S s ware : not include footprints of buildings or structures, sidewalks, driveways, parking lots, decks, patios, gravel or stone walks, Turf Area: 1,143 `l F• other pervious or non -pervious hardscappes, and other non- • S. irrigated areas designated for non-developinent (e.g., open spaces and existing wildland vegetation). ( Non -Turf Plant Area: �1$ S. 5- S, * ' Turf: A ground cover surface consisting of non-native grass species that is customarily mowed. Annual bluegrass, S eCial Landscape Area: Kentucky bluegrass, perennial rvegrass, red fescue, and tall fescue are examples of cool -season turf grasses. Bermuda grass, kikuyu grass, seashore paspalum., St. Augustine grass, zoysia grass, and buffalo grass are warm -season turf grasses. Water Feature Wet Surface Area: tJ. A . ( 0) If > 10% of landscaped area, water budget calcu- lation required with landscape project submittal. See reverse side for other definitions. NOTE: If landscape area exceeds 2,500 sq. ft., a landscape project submittal shall be required. If no landscaping is proposed, enter "0" above and proceed directly to the signature block at the bottom of this form. Landscape Parameter i Requirements ! Project Compliance Turf Total turf area shall not exceed 25% of the landscape ❑ Yes ❑ No area, or 1,250 square feet, whichever is lesser in area. i(Lf no, Water budget calculation required With landscape project submittal] All portions of turf areas shall be wider than eight (8) feet. LJ Yes _ ------------- Turf (if utilized) is limited to slopes not exceeding 15%. i ❑ Yes Non -Turf At least 80% of non -turf area shall consist of native or ❑ Yes ❑ No low water use plants. Jlfno, Water budget calculation required E with landscape project submittal] Hydrozones ` Plants with similar water needs shall be grouped within ❑ Yes ❑ No hydrozones. Each hydrozone shall be controlled by a [Plants can be grouped per separate valve. Table 14.15.0:50(C)] Irrigation System Systems shall be designed and maintained to minimize ❑Yes ❑ No water waste (e.g., runoff, low head drainage, overspray). Low-volume irrigation shall be utilized in non -turf areas. Irrigation shall only occur between the hours of 8:00 pm [If no, Provide explanation on back] and 10:00 am. Soil A minimum of eight (8) inches of non -compacted topsoil ❑ Yes ❑ No I shall be available in planted areas. [If no, Provide explanation on back] Soil amendments, such as compost or fertilizer, shall be appropriately added according to the soil conditions at ❑ Yes ❑ No Jthe project site and based on what is appropriate for the selected plants. a [11 no, Provide explanation on back] E Mulch A minimum two (2) -inch layer of mulch shall be applied r ❑Yes ❑ No on all exposed soil surfaces of planting areas, except in areas of direct seeding application (e.g. hydro -seed). Jlf no, Provide explanation on bacl<J 1 am aware of available informational resources regarding native and low water use plants, irrigation efficiency, and other aspects of water -efficient landscaping. I certify that the information provided on this checklist is correct, and the installed landscape complies with there uiremen o C a ter 14.15. I also understand that any changes to the project will necessitate a new checklist. Sin e o ro owner or authorized representative D e Page 1 of 2 This checklist implements the requirements of Chapter 14.15, Landscape Ordinance, of the Cupertino Municipal Code. The responses provided will be evaluated to determine whether the proposed landscape is generally consistent with the ordinance's water -efficiency goals. Applicant Comments Use additi.ouat paper if necessary. Staff Evaluation Staff Comments Ii Approved JNot Approved Signature Select Definitions Date Hydrozone: A portion of the landscaped area having plants with similar water needs. A hydrozone may be irrigated or non -irrigated. Low-volume irrigation: The application of irrigation water through a system of tubing or lateral lines and low-volume emitters such as drip and bubblers. Certain rotary emitters designed for highly efficient water distribution, and situated to irrigate low water use plants, may also be included in this definition at the discretion of the Planning Office. Low water use plant: A plant species whose demonstrated water needs are compatible with local climate and soil conditions such that regular supplemental irrigation is not required to sustain the plant after it has be- come established. Any species classified as "very low water use" and "low water use' by WUCOLS, having a regionally adjusted plant factor of 0.0 through 0.3, shall be categorically deemed a low water use plant. Native plant: A plant indigenous to a specific area of consideration. For the purpose of this division, the term will refer to plants indigenous to the coastal ranges of Central and Northern California, and more specifical- ly to such plants that are suited to the ecology of the present or historic natural community of the project's vicinity. Special landscape area: An area of the Landscape dedicated solely to edible plants, areas .irrigated with re- cycled water, water features using recycled water and areas dedicated to active play such as parks, sports . fields, golf courses, and where turf provides a playing surface. Turf: A ground cover surface consisting of non-native grass species that is customarily mowed. Annual blue- grass, Kentucky bluegrass, perennial ryegrass, red fescue, and tall fescue are examples of cool -season turf grasses. Bermuda grass, kikuyu grass, seashore paspalum, St. Augustine grass, zoysia grass, and buffalo grass are warm -season turf grasses. Water feature: A landscape design element where open water perforins an aesthetic or recreational function. Water features include ponds, fountains, waterfalls and artificial streams. Also includes spas and swim- ming pools that are ancillary to single-family, two-family and multi -family residential uses. Wet surface area: The surface area of that portion of a water feature that functions to contain water, such as the water surface of a swimming pool, spa, or garden pond. For a fountain or other feature with flowing water, wet surface area shall be measured as a two dimensional plane bounded by the perimeter of the area where water has been designed. to flow. �z INSTALLATION CERTIFICATE (Page l of 12) CF -6R Site Address Permit Number It J�v CjW. jyk-rob, [ 4 a6 c-9 0 7 !,�-+ -A), 1jhW1\4' Installation certificates (CF R) are required for each and every Uwelling unit. When the installation of measures that require field verification and diagnostic testing is complete, the builder or the builder's subcontractor shall complete diagnostic testing and the procedures specified in this section. When the installation is complete, the builder or the builder's subcontractor shall complete the CF -6R (Installation Certificate), and keep it at the building site for review by the building department. The builder also shall provide a copy of the Installation Certificate to the HERS rater for any measures requiring field verification and diagnostic testing, per Section 10-103(a). WATER HEATING SYSTEMS: CEC Certified Heater Mfr Name & Model Number Distribution Type (Std, Point- Use, etc If # of Rated Input Recirculation, Identical (kw or Tank Vol nine Control T Systems Btu/1tr) lions) Extcnlal Efficiency Standby Insulation (EF, RE)' Loss °io z R_,,,.,.,:2 .� c 1 For small gas storage (rated input of less than or equal to 75,000 Btu/hr), electric resistance and heat pump water heaters, list Energy Factor (EF)_ For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Recovery (RE), Thermal Efficiency, Standby Loss and Rated Input. For instantaneous gas water heaters, list Thermal Efficiency and Rated Input. 2. R-12 external insulation is mandatory for storage water heaters with an energy factor of less than 0.58. Kitchen Piping: If indicated on the CF -1R, all hot water piping > 3/4 inches in diameter that runs from the hot water source to the kitchen fixtures is insulated. Faucets & Shower Heads: All faucets and showerheads installed are certified to the Energy Commission, pursuant to Title 24, Part 6, Section 111. Central Water Heating in Buildings with Multiple Dwelling Units (required for prescriptive ❑All hot water piping m main circulating loop is insulated to requirements of § 1500) ❑Central hot water systems serving six or fewer dwelling units which have (1) less than 25 outdoors; (2) zero distribution piping underground; (3) no recirculation pump; and (4) insula that meets the requirements of Section 1506) ❑ Central hot water systems serving more than 6 dwelling units - presence of either a time t con*..,. dnsmbutt Q. on ptFjpILE o dis utiottn ppng or a time/te pe Cure ✓ I, the undersigned, verify that equipment listed above my signature is: 1) the actual equipment installed; 2) eqw aient to or more efficient than that specified in the certificate of compliance (Form CF -1 R) submitted for compliance urith the Energy Efficiency Standard for residential buildings; and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable. Installing Sucontract r (Co. Name) OR General Contractor ( e R Owner C)�l� \dam ;moi '� l 1 j Signature: Date: 1 \ I Copies to: BUILDING DEPAI TMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms September 2005 INSTALLATION CERTIFICATE (Page 2 of 12) CF -6R Site Address Permit Number An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required) After completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at occupancy, per Section 10-103(a). FENESTRATION/GLAZING: Item Manufacturer/Brand Name (GROUP LIKE RODUCTS) Total i Quantity of Area Exterior Product U -factor I Product SHGC # of Like Product Square Shading Device (<_ CF -1R value) 2 (<–CF- IR value)2 Panes (Opfi-4 Feet or Overhang Comments/Location/ Spccial Features 1. Installing Subcontractor (Co. Name) OR (if applicable) 2. OR Window Distributor 3. Signature Date Installing Subcontractor (Co. Name) OR (if applicable) 4. General Contractor (Co. Name) OR Owner 5. 6. 7. 8. 9. 10. H. 12. 13. 14. 15. i> Use values from a fenestration product's NFRC label. For fenestration products without an NFRC label, use the default values from Section 116 of the Energy Efficiency Standards. 2) Installed U -factor must be less than or equal to values from CF -I R. Installed SHGC must be less than or equal to values from CF -1R, or a shading device (exterior or overhang) is installed as specified on the CF -IR. Alternatively, installed weighted average U -factors for the total fenestration area are less than or equal to values from CF -1R If using default table SHGC values from § 116 identify whether tinted or not_ ✓ ❑ I, the undersigned, verify that the fenestration/glazing listed above my signature_ 1) is the actual fenestration product installed; 2) is equivalent to or has a lower U -factor and lower SHGC than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the Energy Efficiency Standards for residential buildings; and 3) the product meets or exceeds the appropriate requirements for manufactured devices (from Part 6), where applicable. Item #s (if applicable) Signature Date Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner OR Window Distributor Item #s Signature Date Installing Subcontractor (Co. Name) OR (if applicable) General Contractor (Co. Name) OR Owner OR Window Distributor Item #s Signature Date Installing Subcontractor (Co. Name) OR (if applicable) General Contractor (Co. Name) OR Owner OR Window Distributor Copies to: Building Department, HERS Rater (if applicable) Building Owner at Occupancy Residential Compliance Forms April 2005 I INSTALLATION CERTIFICATE (Page 3 of 12) CF -6R Site Address Permit Number An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required) After completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at occupancy, per Section 10-103(a). HVAC SYSTEMS: Heating Equoment Equip Type (pkg. heat um CEC Certified Mfr. Name and Model Number # of Identical Systems Efficiencyt (AFUE, etc.) >CF -1 slue) Duct Location attic, etc. Duct or Piping R -value Heating Load Btulltr Heating Capacity Btu/hr r. -1�i ��lt- -C 'Af0 Cooling Equipment Equip Type (pkg. heat CEC Certified Mfr. Name and Model Number # of Identical Systems Efficiency. � (SEER or EER) (>_CF -IR value) Duct Location attic, etc. Duct R -value Cooling Load Btu/hr) Cooling Capacity Btu/hr) 1. > symbol reads greater than or equal to what is indicated on the CF -IR value. YI de both SEER and EER if compliance credit for high EER air conditioner is claimed. V', the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or more efficient than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the EnergT Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices (from the Appliance Ellicien y Regulations or Part 6), where applicable. Installing Subcontract (Co. Name) OR General Contractor o. am R O.4 L&-)- y:z 4VA� , tkx Signature: Date: Copies to: BUILDING DEP, TMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R Site Address Permit Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT The building was: ✓ ❑Tested at Final ✓ ❑ Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE FOR NEW DUCTS: ❑ Remove at least one supply and one return register, and verify that the spaces between the register boot and the interior finishing wall are properly sealed. ❑ 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. ❑ Inspect al l joints to ensure that no cloth backed rubber adhesive duct tape is used on new ducts. ✓ 0 DUCT LEAKAGE REDUCTION Procedures for field verification and diarnostir lestin,- of air distribution systems are available in RA CM. Appendix RC4.3 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM: Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cftnAon x number of tons or as 21.7 cfm/(kBtu/hr) x Heating Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here: ✓ ✓ 3 Pass if Leakage Percentage < 6% for Final or < 4% at Rough -in without air handle: ❑ Pass ❑ Fail [100x Line # 1 / Line # 2 ALTERATIONS: Duct System and/or HVAC Equipment Change -Out Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct 4 System Alteration and/or Equipment Change -Out. Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct 5 System for Duct System Alteration and/or Equipment Change -Out. Enter Reduction in Leakage for Altered Duct System 6 Line # 4 Minus me # 5 -(Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage < 6% for Final. ❑ Pass ❑ Fail 8 100 x Line # 5 / Line # 2)11 TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change- ✓ ✓ Out Use one of the following four Test or Verification Standards for compliance: 9 Pass if Leakage Percentage < 15% [100 x [ (Line # 5) / (Line # 2)11 ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage < 10% [100 x �— (Line # 7) / (Line # 2)11 ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage > 60% [ 100 x L(Line # 6) / (Line # 4)11 ❑ Pass ❑ Fail 11 and Verification by Smoke Test and Visual Inspection 12 Pass if Seating of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail Pass if One of Lines # 9 throw h # 12 pass ❑ Pass ❑ Fail ✓ ❑I, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for compliance credit. I, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply with Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency standards. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Signature: Date: Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms December 2005 INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R Site Address Pemnt Number --10 THERMOSTATIC EXPANSION VALVE (TXV) Procedures for field verification of thermostatic expansion valves are availahle in RA CM Appendix R1 ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without Thermostatic Expansion Valves Outdoor Unit Serial # Location Access is provided for inspection. The procedure shall Outdoor Unit Make OF Outdoor Unit Model consist of visual verification that the TXV is installed on ✓ ❑ Yes ❑ No the system and installation of the specific equipment ❑ ❑ Date of Refrigerant Gauge Calibration (must be checked monthly) Date of Thermocouple Calibration shall be verified. OF Yes is a pass I Pass I Fail ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without Thermostatic Expansion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Tretum, db) Outdoor Unit Make OF Outdoor Unit Model Cooling Capacity Btu/hr Date of Verification OF Date of Refrigerant Gauge Calibration (must be checked monthly) Date of Thermocouple Calibration (must be checked monthly) Standard Charee Measurement Procedure (outdoor air dry-bulb 55T and above): Procedures for Determining Refrigerant Charge using the Standard Method are availahle in RA CM, Appendix RD2. Note_ The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db) OF Return (evaporator entering) air dry-bulb temperature (Tretum, db) OF Return (evaporator entering) air wet -bulb temperature (Tretum, wb) OF Evaporator saturation temperature (Tevaporator, sat) OF Suction line temperature (Tsuction, db) OF Condenser (entering) air dry-bulb temperature (Tcondenser, db) OF Superheat Charge Method Calculations for Refrigerant Charge Actual Superheat — Tsuction, db — Tevaporator, sat °F Target Superheat (from Table RD -2) °F Actual Superheat — Target Superheat (System passes if between -5 and +5°F) °F Temperature Split Method Calculations for Adequate Airflow Split .Method Calculation is not necessary if Adequate Airflow credit is taken Actual Temperature Split = T return, db Tsupply, db F Target Temperature Split (from Table RD3) °F Actual Temperature Split Target Temperature Split (System passes if between - 3°F and +3°F or, upon remeasurement if between -3°F and -100°F) T Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 6 of l 2) CF -6R Site Address Permit Number Standard Charge Measurement Summary: System shall pass both refrigerant charge and adequate airflow calculation criteria from the same measurements. If corrective actions were taken, both criteria must be remeasured and recalculated. ✓ ❑ Yes ❑ No I System Passes Alternate Charge Measurement Procedure (outdoor air dry-bulb below 55 °F) Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer verification shall be documented on CF -6R before starting this procedure. If outdoor air dry-bulb is 55 OF or above, installer shall use the Standard Charge Measure Procedure: Procedures for Determining Refrigerant Charge using the Alternate Method are available in RAC -4d, Appendix RD3. Weigh -In Charging Method for Refrigerant Charge Actual liquid line length: ft Manufacturer's Standard liquid line length: ft Difference (Actual — Standard): ft Manufacturer's correction (ounces per foot) x difference in length = ounces I (+ = add) (- = remove) leasured Airflow Method for Adequate Airflow Verification available in RAC.>Vf, Appendix RD2.6 Calculated Airflow: Cooling Capacity (Btu/hr) X 0.033 (efm/Btu-hr) = CFM Measured Airflow is CFM (Measured airflow must be greater than the calculated airflow). Alternate Charge Measurement Summary: System shall pass both refrigerant charge and adequate airflow calculation criteria from the same measurements. If corrective actions were taken, both criteria must be remeasured and recalculated. ✓ 10 Yes I ❑ No I System Passes Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Signature: Date: Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 7 of 12) CF -6R Site Address Permit Number MISCELLANEOUS CREDITS ✓ ❑ DIAGNOSTIC SUPPLY DUCT LOCATION, SURFACE AREA AND It -VALUE Procedures for field veilJication and diagnostic testing for this group compliance credits are available in RACM, Appendix RC, RE & RH. ✓ ❑ LESS THAN 12 LINEAL FEET OF SUPPLY DUCT OUTSIDE OF CONDITIONED SPACE COMPLIANCE CREDIT ✓ []Yes I ❑No I Less than 12 lineal feet of supply duct outside of conditioned space. Yes to this compliance credit is a pass ✓ ❑Pass ✓ ❑ Fail ✓ ❑ SUPPLY DUCTS LOCATED IN CONDITIONED SPACE COMPLIANCE CREDIT ✓ ❑ Yes ❑ No I Ducts are located within the conditioned volume of building. Yes to this compliance credit is a pass ✓ ❑ Pass ✓ ❑ Fail L..�...� �..........,..yam....•....-......... W ..,.i........ _... _ �.....�......._..-......_ ........., �...........b. 1. Supply duct surface area reduction 2. Buried supply ducts on the ceiling 3. Deeply buried supply ducts ✓ ❑ DUCT SYSTEM DESIGN VERIFICATION ✓ ❑ Yes ❑ No Adequate airflow verified ✓ ❑ Yes ❑ No The duct system design plan meets the requirements specified in RACM, Appendix RE, Section RE.42 ✓ ❑ Yes ❑ No The duct system design plan exists on building plans ✓ ❑ Yes ❑ No Duct sizes, duct system layout and locations of supply & return registers match the duct system design plan Yes to all is a pass ✓ ❑ Pass ✓ ❑Fail ✓ 0 SUPPLY DUCTS SURFACE AREA REDUCTION COMPLIANCE CREDIT Attic Crawl Space Basement R4.2 Deeply Duct Surface Covered Covered Other Diameter Area R-6.0 Surface Area R-9.0 Surface Area ❑ ❑ ❑ ❑ ❑ ❑ ❑ Pass ❑ Fail ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ II II II II II II ❑ ❑ ❑ ❑ ❑ ❑ Total Surface Area for Each R -Value = ✓ ❑ Yes C No tches Performance's CF -1R? ✓ ✓ Yes to all is a pass L Pass _j Fail ✓ n RiTRiF.D DiTCTS ON THF. CFiLiNG r0MPLIANCF. CRFDiT ✓ n DFFPi.Y RiTRiVII i ITCTC rOMPi.iANCF. CRFDiT ✓ ❑ Yes ❑ No Buried Ducts on the Ceiling ✓ ❑ Yes ❑ No Verified High Insulation Installation Quality ✓ ✓ Yes to ducts stem design, supply duct surface area reduction and this compliance credit is a pass ❑ Pass ❑ Fail ✓ n DFFPi.Y RiTRiVII i ITCTC rOMPi.iANCF. CRFDiT ✓ ❑ Yes []No Deeply Buried Ducts ✓ ❑ Yes ❑ No I Verified High Insulation Installation Quality ✓ ✓ 1 Yes to ducts stem design, supply duct surface area reduction and this compliance credit is a pass ❑Pass ❑ Fail Copies to: BUILDING DEPARTMENT, HERS RATER (iF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page S of 12) CF -6R Site Address Permit Number ✓❑ FAN WATT DRAW Procedures for measuring the air handler watt draw are available in RACM,, Append' RE3.2. ✓ Method For Fan Watt Draw Measurement ❑ RE3.2.1 Portable Watt Meter Measurement ❑ RE3.22 Utility Revenue Meter Measurement Measured Fan Watt Draw ✓ ❑ Yes Measured Fan Flow enter total cfin from airflow verification ❑ RE4.1 A Enter results of Watts/cfm Flow Capture Hood ❑ No 3 ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ✓ ❑ Yes ❑ No Measured fan watUcfrn draw is equal to or lower than the fan watt/cfm draw documented in CF -1R ❑ ❑ Flow Grid Measurement ✓ Yes is a ass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION Praredurpv fnr menvurinv 1he airllnw are availahle in PA( -'If Annendix RF_ 3.1. ✓ Method For Airflow Measurement ✓ ❑ Yes ❑ No ❑ RE4.1 A Diagnostic Fan Flow Using Flow Capture Hood ❑ No 3 ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching 4 ✓ ❑ RE4.13 Diagnostic Fan Flow Using Flow Grid Measurement ✓ ❑ Yes ❑ Yes ❑ No Duct design exists on plans If the cooling capacities of installed systems are > than maximum ✓ ✓ cooling capacity in the CF -1R, then the electrical input for the installed systems must be <_ to electrical input in the CFA R. ❑ ❑ Measured Airflow: Fail Rated Tons cfm/ton ✓ ❑ Yes ❑ No Measured airflow is greater than the criteria in 'fable R E-2 ✓ ✓ Yes is a pass Pass I Fail ✓ ❑ MAXIMUM COOLING CAPACITY PrnrMurNc Mr determining maximum rnnlinu lnad canarity are availahle in RACM. Annendix RF3_ Watts cfm Watts/cfm Total cfm cfm/ton 1 ✓ ❑ Yes ❑ No Adequate airflow verified (see adequate airflow credit) Refrigerant charge or TXV 2 ✓ ❑ Yes ❑ No 3 ✓ ❑ Yes ❑ No Duct leakage reduction credit verified 4 ✓ ❑ Yes ❑ No Cooling capacities of installed systems are <_ to maximum cooling capacity indicated on the Performance's CF -IR and RF -3. 5 ✓ ❑ Yes ❑ No If the cooling capacities of installed systems are > than maximum ✓ ✓ cooling capacity in the CF -1R, then the electrical input for the installed systems must be <_ to electrical input in the CFA R. ❑ ❑ Yes to 1, 2 and 3; and Yes to either 4 or 5 is a pass Pass Fail ✓❑ HIGH EER AIR CONDITIONER Procedures for veri kation are available in RACM, .4ppendix Rl. 1 ✓ 1 ❑ Yes ❑ No I EER values of installed systems match the CF -1R 2✓ ❑Yes 11 No Fors lits stem, indoor coil is matched to outdoor coil 3 ✓ ❑Yes ❑ No Time Delay Relay Verified (If Required) Yes to 1 and 2: and 3 (1f Reauire Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Signature: Date: Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 ✓ I ✓ ❑ ❑ I is a Dass Pass Fail Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 9 of 12) CF - Site Address I Permit Number An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required) After completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at occupancy, per Section 10-103(a). BUILDING ENVELOPE LEAKAGE DIAGNOSTICS ✓ ❑ ENVELOPE SEALING INFILTRATION REDUCTION Procedures for field verification and diagnostic testing of envelope leakage are available in RACM, Appendix RC. Diagnostic Testing Results ✓ ✓ Building Envelope Leakage (CFM @ 50 Pa) as measured by Rater: ❑ ❑ Measured envelope leakage less than or equal to the required level from 1 Yes No CF -1 R? ❑ ❑ 2. Is Mechanical Ventilation shown as required on the CF -1R? Yes No ❑ ❑ if Mechanical Ventilation is required on the CF -1 R (`Yes' in line 2), has it 2a Yes No been installed? ❑ Check this box 'yes' if mechanical ventilation is required (`Yes' in line 2) 2b. and ventilation fan watts are no greater than shown on CF -1R. Yes No Measured Watts = ❑ ❑ Check this box `yes" if measured building infiltration (CFM @ 50 Pa) is 3. greater than the CFM @ 50 values shown for an SLA of 1.5 on CF -1R Yes No (If this box is checked no, mechanical ventilation is required.) Check this box `fres" if measured building infiltration (CFM @ 50 Pa) is ❑ ❑ less than the CFM @ 50 values shove for an SLA of 1.5 on CF -1R, 4 Yes No mechanical ventilation is installed and house pressure is greater than minus 5 Pascal with all exhaust fans operating. Pass if: a. Yes in line 1 and line 3, or ✓ ✓ b. Yes in line 1 and line2, 2a, and 2b, or c. Yes in line 1 and Yes in line 4. ❑ ❑ Otherwise fail_ Pass I Fail ✓ ❑ I, the undersigned, verify that the building envelope leakage meets the requirements claimed for building leakage reduction below default assumptions as used for compliance on the CF -1R. This is to certify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance with the requirements for compliance credit. (The builder shall provide the HERS provider a copy of the CF -611 signed by the builder employees or subcontractors certifying that diagnostic testing and installation meet the requirements for compliance credit.) Test Performed Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Signature: Date: Copies to: BUII DING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 M INSTALLATION CERTIFICATE (Page 10 of 12) CF -6 Site Address / I� Pe t Number Insulation Installation Quality Certificate ✓ ❑ Description of Insulation, (CF -6R, formerly IC -1) signed by the installer stating: insulation manufacturer's name, material identification, installed R -values, and for loose -fill insulation: minimum weight per square foot and minimum inches ✓ ❑ Installation meets all applicable requirements as specified in the High Quality Insulation Installation Procedures (ACM, Appendix RH) ✓FLOOR Ye ❑ No ❑ NA All floor joist cavity insulation installed to uniformly fit the cavity side-to-side and end-to-end V ❑ No ❑ NA Insulation in contact with the subfloor or rim joists insulated XYes ❑ No ❑ Insulation properly supported to avoid gaps, voids, and compression es NA ✓ 'WALLS ❑ ❑ Wall stud cavities caulked or foamed to provide an air tight envelope Y No NA ❑ Ye No ❑ NA Wall stud cavity insulation uniformly fills the cavity side-to-side, top -to -bottom, and front -to -back V ❑ 'No ❑ No gaps Yes NA Zes❑ ❑ NA No voids over 3/4" deep or more than 10% of the bau surface area. No ❑ ❑ Hard to access wall stud cavities such as; comer channels, wall intersections, and behind Ye No NA tub/shower enclosures insulated to proper R -Value ❑ Ye No ❑ NA Small spaces filled 1e❑ s No ❑ NA Rim joists insulated EX ❑ ❑ 1 Loose fill wall insulation meets or exceeds manufacturer's minimum weight -per -square -foot Yes No NA requirement ✓ $OOF/CEILING PREPARATION Yes ❑ No ❑ NA All draft stops in place to form a continuous ceiling and wall air barrier Zes 1All drops covered with hard covers NZ NA ❑ ❑ All draft stops and hard covers caulked or foamed to provide an air tight envelope es . No NA Y's, ❑ ❑ All recessed light fixtures IC and air tight (AT) rated and sealed with a gasket or caulk between the .I No NA I housing and the ceiling Er Yes 1 ❑ . No ❑ NA Floor cavities on multiple -story buildings have air tight draft stops to all adjoining attics Yes © No ❑ I NA Dave vents prepared for blown insulation - maintain net free -ventilation area ❑ ❑ Knee walls insulated or prepared for blown insulation es No NA Ives ❑ No ❑ NA Area under a entlatforms and cat -walks insulated or accessible for blown insulation p es I❑ No ❑ NA Attic rulers installed Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 11 of 12) CF -6R Site Address -7 Permit Number ✓ ROO,F/CEILING BATTS DECLARATION ✓ ❑ I hereby certify that the installation meets all applicable requirements as specified in the Insulation Installation Procedures. Installing Subctractor (Co. Name) OR General Contractor (Co. ) caner Signature: Date: Yes No NA No gaps ❑ ❑ YesK No NA No voids over'/. in. deep or more than 10% of the batt surface area. ❑ ❑ Ye No NA Insulation in contact with the air -barrier ❑ ❑ Ye,R No NA Recessed light fixtures covered ❑ ❑ Net free -ventilation area maintained at eave vents Yes No NA ✓ ROOF/CEILING LOOSE -FILL ❑ ❑ ❑ Yes No NA Insulation uniformly covers the entire ceiling (or roof) area from the outside of all exterior walls. ❑ ❑ ❑ Yes No NA Baffles instal led at eaves vents or soffit vents - maintain net free -ventilation area of eave vent ❑ ❑ ❑ Yes No NA Attic access insulated ❑ ❑ ❑ Yes No NA Recessed light fixtures covered ❑ ❑ ❑ Yes No NA Insulation at proper depth — insulation rulers visible and indicating proper depth and R -value ❑ ❑ ❑ Loose -fill insulation meets or exceeds manufacturer's minimum weight and thickness requirements Yes No NA jor the target R -value. Target R -value . Manufacturer's minimum required weight for the target R -value (pounds -per -square -fool). Manufacturer's minimum required thickness at time of installation . Manufacttoer's minimum required settled thickness . Note: To receive compliance credit the HERS rater shall verify that the manufacturer's minimum weight and thickness has been achieved for the target R -value. CF -6R only DECLARATION ✓ ❑ I hereby certify that the installation meets all applicable requirements as specified in the Insulation Installation Procedures. Installing Subctractor (Co. Name) OR General Contractor (Co. ) caner Signature: Date: `t L Copies to: BUILDING DEPART ENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 12 of 12) CF -6R Site Address Installing Subcontractor (Co. Name) OR Contractor (Co. Name) OR Owner OR Window Distributors'","' Permit Number ti 1�-q S t>u� r2 �.�-1� o County Subdivision Lot Number Description of Insulation (Formerly IC -1 Form) 1. RAISED FLOOR S w� l ,tiir Material 6!Z1, CdA4- Brand Name t%W� Thickness (inches)a" Thermal Resistance (R -Value) 2 �1 2. SLAB FLOOR/PERiMETER Material Brand Name Thickness (inches) Thermal Resistance (R -Value) Perimeter Insulation Depth (inches) 3. EXTERIOR WALL Frame Type VY&UN) A. Cavity Insulation rr��/►U�� Material Brand Name 0 1N -qw S G Thickness (inches) Thermal Resistance (R -Value) B . Exterior Foam Sheathing Material Brand Name Thickness (inches) Thermal Resistance (R -Value) 4. FOUNDATION WALL Material Brand Name Thickness (inches) Thermal Resistance (R -Value) 5. CEILING y - Batt or Blanket Type �1z�fiI�UN�i'� Brand Name 0 v"G� I� ��J Thickness (inches) Thermal Resistance (R -Value) Loose Fill Type Brand Contractor's min installed weight/W lb Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) 6. ROOF Material Thickness (inches) Brand Name Thermal Resistance (R -Value) Declaration ✓ ❑ I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Energy Efficiency Standards for residential buildings (Title 24, Part 6, California Code of Regulations) as indicated on the Certificate of Compliance, where applicable. Item #s (if applicable)General Signa a Date �'i` W4 Installing Subcontractor (Co. Name) OR Contractor (Co. Name) OR Owner OR Window Distributors'","' Item #s Signature V Date Installing Subcontractor (Co. Name) OR (if applicable) General Contractor (Co. Name) OR Owner OR Window Distributor Item #s Signature Date Installing Subcontractor (Co. Name) OR (if applicable) General Contractor (Co. Name) OR Owner OR Window Distributor Residential Compliance Forms April 2005