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14110002CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7998 WOODLARK WAY NONTRACTOR: RICH IE CONSTRUCTION PERMIT NO: 14110002 OWNER'S NAME: TT INVESTMENT PROPER TIES 1 1261 S ALMADEN I DATE ISSUED: 01/09/2015 1 OWNER'S PHONE: 4085091425 ❑ LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. #_ ContractorDate % 'l 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. 1 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 performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-pointations per the Cupertino Municipal Code, Section 9 I8.,�—� / r` C,- q,/ Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting ofthis permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date SAN JOSE, CA 95110 PHONE NO: (408) 531-7165 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL CONSTRUCT ONE STORY ADDITION (371 SQ FT); FRONT COVERED PORCH (34 SQ FT); INTERIOR REMODEL (900 SQ FT); RELOCATE (E) FURNACE; REPLACE WATER HEATER Sq. Ft Floor Area: I Valuation: $120000 APN Number: 36204034.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FRO AST CALLED INSPECTION, Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. if a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code 55 3, and 25534. Owner or authorized age Dater CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed V� CONSTRUCTION PERMIT APPLICATION O COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION \ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(o)cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT DRESS APN # 1� _ " t U� OWNER NAME PHONE E-MAIL !�:-r In L-,�6 t �v-> ol Sc Cl t2— STREETtDDRE CITY, STATE, ZIP --���� (/ FAX Lr '� > N l+J ° C S' l e 8 CO T NAME PHONE F MAIL STREET ADDRESS CITY, STATE, ZIP FAX C' �$ G> t.l `.�1�.� Lr L� L' C V ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO TRACTOR NAME LICENSE NU BER LICENSE TYPE BUS. LIC K COMPANY NAME "'� E-MAIL/ - FAX STREET ADDRESSCITY, STATE, IP 1 PHONE . ccldl c t,1 "�� t7 "cam ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA tr i AREA NET AREA BATHROOM (J KITCHEN I OTHER REMODEL AREA REMODEL AREA REMODEL AREA �OD PORCH A=A AREA TOTAL DECK/PORCH AREA i GARAGE AREA:: DETACH ❑ ATTACH --i—DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? []NO PRE-APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATION: PLANNTNGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLERHOME? C] 17 3y my signature below, I certify to each of the fallowing: I am the property owner or authorized e owner's behalf. I have read this application and the information I ha s correct. I have read the Description of W vets it is ac e. I agree to comply with all applicable local ordinances and state lay mg to bu struction. I authorize representatives of Cupertino to ent above-identified property for inspection purposes. Si-nature ofApp] ican r Date: ��- 2' L SUPPLEMENTAL INF CATION REQUIRED PLAN _cllEcxTrPE RovTuvcsLir New SFD or Multifamily dwellings: Apply for demolition permit for ' existing building(s). Demolition permit is required prior to issuance of building ©'' OVER-THEcoulvrER ❑ BUILDIhGPLANREVIEw permit for new building. SS❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑,; STANDARD ❑ PUBLIC vvoRxS, form if any Hazardous Materials are being used as part of this project. ❑, LARGE, ' ❑ FIRE DEFT _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal ofBuilding Permit application. ❑? MAJ0k:1 ❑ SA1\ITARY SEWER DISTRICT ❑. ENVIRON MENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO IM--ff FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 7998 WOODLARK WAY DATE: 11/03/2014 REVIEWED BY: MELISSA APN: 362 04 034 BP#: `VALUATION: 1$120,000 PERMIT TYPE: Building Permit R-3 (Custom) PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: $1,626.00 2nd Unit? Yes ) No OTC. 0 Yes Q No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK ADD 371 S.F. TO CREATE N DINING RM AREA & RELOCATE & ADD TO E KITCHEN & ADD 1 SCOPE (N) HALL BATH. REMODEL (E) 900 S.F. TO RECONFIGURE LIVING AREA INCLUDING 2 (N) 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 371 $1,626.00 IADDPLCK $1,323.00 IADDINSP $0.00 PME Plan Check: $0.00 2 # $431.00 Window / Sliding Glass Door 1WINREP Replacement Permit Fee: $1,323.00 Suppl. Insp. Feer Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 371 $1,626.00 $1,323.00 MECH, HOURLY 0 Yes E) No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info. FEE ITEMS Fce Resolution 11-053 Eff %iI%"L3) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,626.00 = s. f. $575.00 Remodel, Other IRENIRESOTH Suppl. PC Fee: Q Reg. Q OT 1 0.0 hrs $0.00 PME Plan Check: $0.00 2 # $431.00 Window / Sliding Glass Door 1WINREP Replacement Permit Fee: $1,323.00 Suppl. Insp. Feer Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 G Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: IPLLONGR $51.94 Select a Non -Residential Building or Structure E) 0 i Strom Motion Fee: IBSEISMICR $15.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $5.00 SUBTOTALS: $3,021.541$1,006.00 TOTAL FEE: $4,027.54 Revised: 1010112014 W o � N.... 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O N > C io u w 0L O C Y C m mom u C L _ N u a c 0Eo Y > o m a V u m C Y C O O a m 0 E a v Y e v .� a .7. w D 0 C � L U C a1 � U U LI _ o u Y 4T LE o w -' O -0 N 7 U C Y L tCU c fC ++ um a) m a a) 0 u o a, -o c E -0 >- `^ : c 3 :o u U 0 a) O -m0 O O a ." > O o 3 c a U> oc 0 0 aO . 0) a Y OL oq ° U E m c w y" m Gi O C m C m f9 0c) C 0 m a) a v m a.+ ' ho Y '^ Y ar > v c V1 y 01 o E a N. C O IA m -0 �� o E v u� c '! d 4+ (A 7 m a N E 0 .�%. '6 v +� fL6 4- C W Ql .0 m u y 0 ._ °1 E a Y .L U O0 yo Y Y 0 -0 y w ami 0` m d 0 C 7 0 Y Q�y� vii G C' -0 a)- AO+ 0 u m O O U (3 C Y 7 u IA 4-V s?+ -0,, am+ 0 a) O -E O1 mv E > o c c E c O m a c OJ U m ` A v' E 5a c E oo ° CL m z ' 7 to E N C v m a) v o c `o a a c o c c n v > Q i 2 H- u IA c m v V v u o m Y- - + - C O }'j 7m E v v O O._a)__ �.: .... C: - m O if1 O L U d c o .°D o •^ a m 3_o c m L C7 c Y Q� Ln ' Q Q Q L c O�c = _° w E E Y a v a o O y +� U O aH4 p Q Q a Q ° H `_° $ m H - 3 m 7 °a N O O a 0 C ` m> L D.1 v Y F- m z E O Fj Z O v 0 c L v; Ln m p O w '^ Z c U U E Z OL N fn Vl �' Y `� N m C vj 0 Q CL C v 00 m N W O a E'- oN>c OJ a2E- orn Ma uU a°�° uvf6i °C - wx u� a0n''uU Q K LU Ln D a) v_ 0 0 - LA K W 2 lit m N N n vi co ri O ul O N al aiai c C v CD t 0 CL a) o' M Ln O a 0 N C 0 0 CL a) K CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: TT INV Woodlark Enforcement Agency: Cupertino Building Department Permit Number: 141-1002 Dwelling Address: 7998 Woodlark Wy City: Zip Code: 95014 A. System Information 01 Space Conditioning System Identification or Name System 1 02 Space Conditioning System Location or Area Served whole house 03 Building Type from CF -1R Single family 04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from CF1R? No, credit is not taken 05 Verified Low Leakage Air Handling Unit (VLLAHU) Credit from CF1R? No, credit is not taken 06 Duct System Compliance Category Replacement MCH -20d - Complete Replacement or Altered Duct System B. Duct Leakag6olagnc 1, '%st 01 Condenser Nominal Cooling Capacity (ton) Mierav RatersAssociation 02 Heating Capacity (kBtu/h) 58.00 03 Conditioned Floor Area served by this HVAC system (ft2) 1561 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor .06 07 Air Handling Unit Airflow (AHUAirflow) Determination Method Heating system method 08 Measured AHUAirflow 0 09 Calculated Target Allowable Duct Leakage (cfm) 75 10 Actual duct leakage rate from leakage test measurement (cfm) 48 1 1 Compliance Statement: System passes leakage test Registration Number: 315-A1009191A-M20004264A-0000 Registration Date/Time: 2015-07-13 15:18:35 HERS Provider: USERA CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-07-13 15:19:11 2013 Residential Compliance Schema Version: 0.51SDD CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3 ) C. Additional Requirements for Compliance 01 System was tested in its normal operation condition. No temporary taping allowed. Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage 02 testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. 03 All supply and return register boots were sealed to the drywall. 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All connection points between the air handler and the supply and return plenums are completely sealed. If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements 07 of Reference Residential Appendix RA3.1.4.3.6. Systems that comply using smoke test shall not be included in sample groups for HERS verification compliance. The responsible persons signature on this compliance document affirms that all applicable requirements in this table have been met. W0,13. Energy Raters Associatioll Registration Number: 315-A1009191A-M20004264A-0000 Registration Date/Time: 2015-07-13 15:18:35 HERS Provider: USERA CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-07-13 15:19:11 2013 Residential Compliance Schema Version: 0.51SDD CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Joe Novelo Signature Date:- " Company: California Air Duct Testers 2015-07-13 Address: CEA/ HERS Certification Identification (if applicable): 1823 Sheri Ann Circle 410231432 City/State/Zip: Phone: 1408-824-0740 San Jose CA 95131 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Installation is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforrps to all applicablewcodeS and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4. 1 understand that a HERS rater will chkk the installat)on to verify compliance, and that if such checking identifies defects; I am required to take corrective action at my expense. I udder ,Oqd that Energy Commission and HERS Provider representatives will also perform quality assurance checking of installatipps, including these approved as part Sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality'assurapce checking, the',required corrective action and additional checking/testing of other installations in that HERS sample group will be perrforMed at my expense. S. I reviewed a'cppytrf ihe:Certificate of Gatxtpltatiti?aoproved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured hat the requirements that apply to the construction or installation have been met.0. Enve,�rg� ers Association 6. 1 will ensure that a registered copy of this Certificate of Installation shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Installation is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: KIM AN TRUONG Company Name: (Installing Subcontractor or General Contractor or Position With Company (Title): k/]y, am rx foy Builder/owner) Owner kim an truong (Jul 13, , TT Inestment Address: CSLB License: 7998 WOODLARK WAY n/a City/State/Zip: Phone: Date Signed: CUPERTINO CA 95014 4085091425 2015-07-13 Third Party Quality Control Program (TPQCP) Status: Name of TPQCP (if applicable): v>' TM -This digital signatifte is provided in order to serum the content of this registered document, and i? no way implies Registration ;ar�vider responsibility A the accumry of the information Registration Number: 315-A1009191A-M20004264A-0000 Registration Date/Time: 2015-07-13 15:18:35 HERS Provider: USERA CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-07-13 15:19:11 2013 Residential Compliance Schema Version: 0.51SDD k W ^ M N M ei O 4. 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E Ln v 2 O °� °0 �° 0- 3 E Q Q C _ f+ z ~ u {A C m N W C bD vi N O E C C m O Ln O ++ L U U L d 1] N 0 C °CD o E°°° C7 Y Q1 41 m °C O Ln d :cD v 3 c v L `o—° v u v bD Q Q 41 cQ ° Q a U o m a`6 u 3 c_ o v Q a 0 GO) !a Ql N M N E IV Z E -mc > > C L v� C Z .. > N � F 7 dl u W 0 Z m `p 2 '^ Ln v m 0 O cL w ti v Q m al v'^i io UJ C u a) a E = -° N \— c 'n 4 m -n a 2 a c E v 00 n. CO t --Ln m` 0 ri 0 0 uu <H a' w Y P, o Q s LA D L: O CL s LLJ2 a N V1 m r -I n O vi O ai E N fa C O w v cc Q1 m r -I Lf1 m 0 0 vi O N UJ Y Q! c N (D C O a cr m m 0 v 0 N O i t O a v s CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: TT INV Woodlark Enforcement Agency: Cupertino Building Department Permit Number: 141-1002 Dwelling Address: 7998 Woodlark Wy City: Zip Code: 95014 A. System Information 01 Space Conditioning System Identification or Name System 1 02 Space Conditioning System Location or Area Served whole house 03 Building Type from CF -1R Single family 04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from CF1R? No, credit is not taken 05 Verified Low Leakage Air Handling Unit Credit from CF1R? No, credit is not taken 06 Duct System Compliance Category Replacement MCH -20d - Complete Replacement or Altered Duct System B. Duct Leakage PlagnosticTest 01 Condenser Nominal Cooling Capacity (ton) Merav Raters Association 02 Heating Capacity (kBtu/h) 58 03 Conditioned Floor Area served by this HVAC system (ft2) 1561 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor .06 07 Air Handling Unit Airflow (AHUAirflow) Determination Method Heating system method 08 Measured AHUAirflow 0 09 Calculated Target Allowable Duct Leakage Rate (cfm) 76 10 Actual duct leakage rate from leakage test measurement (cfm) 48 11 Compliance Statement: System passes leakage test 12 Notes: Registration Number: 315-A1009191A-M20003270A-M20A Registration Date/Time: 2015-07-13 16:43:52 HERS Provider: USERA CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-07-13 16:44:29 2013 Residential Compliance Schema Version: 0.51SDD CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3 ) C. Additional Requirements for Compliance 01 System was tested in its normal operation condition. No temporary taping allowed. 02 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. 03 All supply and return register boots were sealed to the drywall. 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All connection points between the air handler and the supply and return plenums are completely sealed. 07 If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements of Reference Residential Appendix RA3.1.4.3.6. Systems that comply using smoke test shall not be included in sample groups for HERS verification compliance. 08 Verification Status: Pass - all applicable requirements are met 09 ' Correction Nctes for this table:Al The responsible per5dnssign2iture on thtscompliake document affirms that all applicable requirements in this table have been met unless othervivfse'hoted in the Vfication Status and the Corrections Notes in this table. D. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 01 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: 315-Al009191A-M2000327OA-M20A Registration Date/Time: 2015-07-13 16:43:52 HERS Provider: USERA CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-07-13 16:44:29 2013 Residential Compliance Schema Version: 0.51SDD CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Joe Novelo Date Signed: Company: California Air Duct Testers 2015-07-13 Address: CEA/ HERS Certification Identification (if applicable): 1823 Sheri Ann Circle 410231432 City/State/Zip: Phone: San Jose CA 95131 408-824-0740 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The installed features, materials, components, manufactured devices, or system performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements specified on the Certificate of Compliance for the building approved by the enforcement agency. 4. The infoltmat on reported'on applicable Sectionsof the,Certificate(s) of Installation (CF2R) signed and submitted by the person(s) responsible for the construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (CF1R) approved by the enforcement agency. 5. 1 will ensure that a registered Copy ofthls Certificate bf Verification shall be posted, or made available with the building permit(s) issued for the building, and trade available to the enforceinent agency for all applicable inspections. I understand that a registered copy of this Certificate of Verification,is required to be'fncluded with the documentation the builder provides to the building owner at occupancy. Builder Or Installer Infor 66 b` n A ShovWn Oa -The Certificate Of Installation Company Name (installing Subcontractor, General Contractor, or Builder +, y titers Association TT Inestment Responsible Builder or Installer Name: CSLB License: KIM AN TRUCING n/a HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status in Sample Group (if applicable) 315-5368 Tested HERS Rater Information HERS Rater Company Name: California Air Duct Testers Responsible Rater Name: Responsible Rater Signature: 7ce Joe Novelo oe Nov/el�o' .1 13 2015) Responsible Rater Certification Number w/ this HERS Provider: Date Signed: 410231432 2015-07-13 A i' �' 1his digital signature is provided lay order to secure(...f � tine content of this registerod doctrrrk>:rn€, arrcl rr .no way implies Rerglsfr��tiorr Prrrviderres�nsib�"!r`ty for the acc urecy of the r>!Vormation. Registration Number: 315-A1009191A-M20003270A-M20A Registration Date/Time: 2015-07-13 16:43:52 HERS Provider: USERA CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-07-13 16:44:29 2013 Residential Compliance Schema Version: 0.51SDD rJ CALGREEN RESIDENTIAL CHECKLIST - MANDATORY ITEMS ISI COMMUNITY DEVELOPMENT DEPARTMENT • BUILDIN"'T �:� CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building (a)cupertino.orla PURPOSE: 0. i1aThe 2013 CalGreen Code applies to additions or alterations of existin I I e ie addii or alteration increases the building's conditioned area, volume, or size " n s a to all new low-rise residential buildings, high-rise residential buildings, or both. Existing si landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: Project Address: Project Description: Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. t i jA4 Page I of 5 CalGreen_2014.doc revised 11104114 Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Requirements .. .1 PLANNING AND DESIGN Planning and Design - Site Development 4.106.2 Storm water drainage and retention during construction. A plan is and implemented to manage storm water drainage during El construction. 4.106.3 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. t i jA4 Page I of 5 CalGreen_2014.doc revised 11104114 A4.2 ENERGY EFFICIENCY General. - 4.201.1 Low-rise residential buildings shall meet or exceed the minimum n/ 44�� standard design required by the California Energy Standards. A4.3 Indoor Water"Use 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following: IJ[I 4.303.1.3.2 Water Closets. The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank -type water closets shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank -type Toilets. ❑ 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not 0.5 gallons per flush. ��exceed t�J 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. ❑ 4.303.1.3.2 Multiple Showerheads serving one shower. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve / shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be ❑ designed to allow only one shower outlet to be in operation at a time. �, 6d 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less than 0.8 gallons per minute at 20 psi. ❑ 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas (outside of dwellings or sleeping units) in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. ❑ 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, and shall meet the applicable standards referenced in Table 1401.1 of the California Plumbing Code. Page 2 of 5 CalGreen 2014.doc revised 11104114 AW 0- oor`Water Use.:' 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the time of final inspection shall be weather -based. ❑ 4.304.1.1 Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as weather conditions change. ❑ 4.304.1.2 Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. ��EEFN :... ..Y , r Enhanced Durability and Reduced Maintenance 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected against the passage of rodents by closing such openings with cement mortar, El concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall be submitted for approval to the enforcing agency. Buiiding Maintenance and,Operation 4.410.1 Operation and maintenance manual. At the time of final inspection, ❑ an operation and maintenance manual shall be provided to the building occupant or owner. 4.504.1 Covering of duct openings and protection of mechanical ❑ equipment during construction. Duct openings and other related air distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be ❑ compliant with VOC limits. 4.504.2.3 Aerosol paints and coatings. Aerosol paints and other. coatings El be compliant with product weighted MIR Limits for ROC and other toxic compounds. Page 3 of 5 CalGreen 2014.doe revised 11104114 Aft 4.504.2.4 Verification. Documentation shall be provided to verify that compliant VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with VOC limits. 4.504.4 Resilient flooring systems. Eighty (80) percent of floor area receiving resilient flooring shall comply with the VOC-emission limits defined in Collaborative for High Performance Schools (CHPS) Low -emitting El Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Composite wood products. Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall ❑ comply with low formaldehyde emission standards. Interior Moisture'Control 4.505.2 Concrete slab foundation. Required vapor retarders and capillary El 11 breaks are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture content of building materials used in wall and floor framing is checked before enclosure. Indoor Air Quality and Exhaust / 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the NNNJJJ building are provided in every bathroom. Environmental Comfort' 4.507.2. Duct systems are sized and designed and equipment is selected using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or equivalent. 2. Size duct systems according to ACCA 29-D (Manual D) or equivalent. 3. Select heating and cooling equipment according to ACCA 36-S (Manual S) or equivalent. INSTALLER AND SPECIAL INSPECTOR QUALIFICATIONS Qualifications` 702.1 Installer training. HVAC system installers are trained and certified in ^ , yJv/ ❑ the proper installation of HVAC systems. 702.2 Special inspection. The Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the discipline they inspect and verify. Verifications 703.1 Documentation. Verification of compliance with CALGreen may include construction documents, plans, specifications, builder or installer / certification, inspection reports, or other methods acceptable to the enforcing uuu El agency which show substantial conformance. Implementation verification shall be submitted to the Building Department after implementation of all required measures and prior to final inspection approval. Page 4 of 5 CalGreen 2014.doc revised 11104114 Project Name: Project Address: Project Description: CALGREEN SIGNATURE DECLARATIONS SECTION 1 - DESIGN VERIFICATION Complete all lines of Section 1 - "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Owner's Signat a Date _TZ tQ � F-0 f:p- Owner's Name (Please Print) T 3n -k ti to [ h, W S' 1 Professional's Signature Date D*siJtT7 ofessio I's ame (Please Print) Signature of License Professional responsible for CalGreen compliance 1Date Name of ILdnsl ,Proffessional responsible for CalGreen compliance (Please Print) hone 1r1" L1 l ,A t C t 0 no � (� 9 t L LG,•� � -. C-C-IA/1 Email Address -Mr License Professional responsiblEVfor CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Nrotessronal responsiole for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 9 of 9 CalGreen Non -Res Checklist.doc revised 01%23/14