14050045CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22430 CUPERTINO RD
CONTRACTOR: NEKO ELECTRIC
PERMIT NO: 14050045
OWNER'S NAME: ALI PAKNAHAL & MESBAHI MOTAHAREH
22430 CUPERTINO RD
DATE ISSUED: 03/27/2015
OWNER'S PHONE: 4084464141
CUPERTINO, CA 95014
PHONE NO: (408) 446-4141
?1181LICENSED CONTRACTOR'S DECLARATION
r�
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑
2 SQ FT ADDITION TO SFDWL, 200 SQ FT GARAGE AND
License Class Lic. # 3 -
REMODEL 825 SQ FT THROUGH OUT, 200 AMP PANEL
N y$' //L% C Date
UPGRADE
Contractor
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
mpensation, as provided for by Section 3700 of the Labor Code, for the
p ormance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $695675
ave and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32650070.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
SPECTION.
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
Issu Date:
granting of this permit. the applicant understands and will comply
with all n source regulations per Cupertino Municipal Code, Section
RE-ROOFS:
9Cature?
S Date 7- I J
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 -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
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 by the Bay Area Management District I
performance of the work for which this permit is issued.
will maintain compliance with t ertino Mal Counicipe, ter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, ions 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
—7
Owner or authorized a nt: : 3
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
CONSTRUCTION LENDING AGENCY
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
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
15
CONSTRUCTION PERMIT APPLICATION ��
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISIO �
10300 TORRE AVENUE - CUPERTINO, CA 86014.3266
I- (408) 777-3228 - FAX 408 777-3333 - buildin
CUPERTINO ( ) g0cuoertino.org
❑ NEW CONSTRUCTION ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS r/j���ryj^�j^
_ 7
APN # �U
^
OWNER NAM MOTNHAR1EPHONE
.'
E -M IL C
STRI;�14$$, 5 r''^
,STATE, ZIP _ _ -
FAX R ^ �
CONTACT NAME�l -
NE —
MAL
VG` r C"
1
STREET ADDRESS
CITY, STATE, ZIP_11AX Ti �) ^ O
72,
1
❑ OWNER ❑ OWNER -BUILDER V OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
,0,11611JINEER
DONE N�1A JU {
LICENSE NUMBER
BUS. LIC #
COMPANY NAE
LrN
E-MAIL
FAX
STS ADDRESS ��
CC ,STATE, ZIP S 1 �
PHONE ;
-
`J
DESCRIPTION OF WORK
00 (_
2-dc3 1 &A)QAQF_ AJ1Qe.J6-%AWGiuvqrtk 20AAp
EXISTING USE
,. su
PROPOSED USE CONSTR.
QE �,
TYPE
`'tZ,
v ✓TOTAL
# STORDiS
I
1
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG NEW FLOOR
AREA - �� AREA (� '
DEMO
AREA
NET AREA %7 /' _ I I
(flp `
t �{�
V LJ
f
��„� n
2B j U 7c,
BATHROOM
REMODEL AREA
�IEECKSl
KITCHEN
REMODEL AREA .4(5®
OTHER
REMODEL AREA
^
PORCH AREA
ISE)I(i✓
TOTAL DECK/PORCH AREA
N� �-j
GAR A::[IrDETTAACH
TTACH
# DWELLING UMTS:
IS A SECOND UNIT �❑ s
BEING ADDED?
SECOND STORY ❑ YES
ADDITION? �o
A'_
PRE -APPLICATION YES IF YES, PROVIDE CggPV OF
PLANNING APPL # ❑ NO PLANN IF LETTER
`e
IS THE BLDG AN ❑ YES
EICHLER HOME? �1pI�N0
RECEIVED BY:
TOTAL VALUATION:
� -79
By my signature below, I certify to e ch o following: I am the property owner or authorized agent to act on the property owner's behalf. I have lead this
application and the information I h e provided is correct. I have read the Description of Work and v ' - it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu* c nstr I authorizer entatly Ino to enter the above -identified property f r inspection purposes.
Signature of Applicant/Agent Date:
SUPPLENWNTAL INF01WATION 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
❑ 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
BldgApp 2011.doc revised 06/21/11
rr.�,�..--����:..����1 CITY OF CUPERTINO
Fia—m—l7l -92490VF.1W FCTI<MATnR — RITILDING DIVISION
PilADDRESS:
22*Wcuprtino rd
DATE: 05/06/2014
REVIEWED BY: MENDEZ
PC FEE ID
APN:
BP#:
"VALUATION:
$695,675
2,012
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
2nd Unit? 0 Yes No
OTC? 0 Yes No
PENTAMATION 1 R3SFDADD
PERMIT TYPE: i
WORK 11812
sq ft addition to sfdwl 200 sq ft garage and remodel 825 sq ft through out 200 amp panel
SCOPE I
upgrade
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
2,012
$2,797.33
IR3PLNCK
$2,406.25
IRMATSP
PME Plan Check:
$0.00200
amps
$47.00
Electrical
IBELEC2007 Services
Permit Fee:
$2,406.25
Suppl. Insp. Fee -0 Reg. Q OT
0.0
lirs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:$47.00
TOTALS:
2,012
$2,797.33
$2,406.25
MECH, HOURLY ® Yes E) No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY O Yes Q No
MISC ITEMS
Elec. Plan Check 0.0 1 hrs $0.00
$2,797.33
F-8257 s.f.
$558.00
Elec. Permit Fee: IEPERMIT
Suppl. PC Fee: Q Rcg. Q 01'
Other Elec. Insp. 0.0 �rs$47.00
hrs
$0.00
PME Plan Check:
$0.00200
amps
$47.00
Electrical
IBELEC2007 Services
NOTE: This estimate does not include fees due to other Departments (i.e. Manning, ruouc rvorKs, mere, ouRuury serve. Lwu�u, �a .. w.
bd #1.l' ina in ormation available and are onl an estimate. Contact the De t or addn'l in o.
Dtstrict, eta . These ees are as on a re tm
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,797.33
F-8257 s.f.
$558.00
Remodel, Other
1REMRESOTH
Suppl. PC Fee: Q Rcg. Q 01'
0.0
hrs
$0.00
PME Plan Check:
$0.00200
amps
$47.00
Electrical
IBELEC2007 Services
Permit Fee:
$2,406.25
Suppl. Insp. Fee -0 Reg. Q OT
0.0
lirs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:$47.00
7"71'."
F
O
0
Work Without Permit? Yes 0 No
$0.00
Advanced Planning Fee: IPLLONGR
$281.68
Select a Non -Residential
Building or Structure
Q
Travel Documentation Fee: 1TRAVDOC
$47.00
Strong Motion Fee: 1BSEISMICR
$69.57
Select an Administrative Item
Bldp, Stds Commission Fee: IBCBSC
$28.00
SUBTOTALS:
$5,676.83
$605.00
TOTAL FEE:
$6,281.83
Revised: 04/01/2014
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: ,'L 3 v C a e r
LTJ b PERMIT # 1 D 5 D
OWNER'S NAME: L.c, rAk A,,-*,4j0r-,4
PHONE # d 3
GENERAL CONTRACTOR: U w`t't %
v0'V tiBUSINESS LICENSE #
ADDRESS: 2 o LSC er i),7 O
kd CUP-erf4l;�o CITY/ZIPCODE: 5 D L
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Z De 5/1 27 Co ry� . ru L�� o yj
1 D v 1°17
Cement Finishing
Electrical
/4/V S l y1 G NJ d e C
L C <5 3 TtE 3 �((p
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
(,( r G L 5-9
C—! 7- 6 3 3 8
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
C L (,L')yl b 1' r»
Ll C . q335 15
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
9r/
Owner / Contractor Signature Date
1o'
Mev
J
11
RECEIVED
COPY Ci
SEP 0 9 2014
CALIFORNIA ENERGY COMIVII SII
TITLE 24 CALCULATIONS AND DOC NTAMN- 4
/`fo500y�
�AHAL RESIDENCE
�UPERTINO ROAD
ERTINQ CALIFORNIA
CUPERTINO
aBuilding Department
DEC 05 2014
PEVIEVAIEU rUR COUE COMPLIANCE
r-<UV1dYVe ] tiy•
Prepared by
Yarmila Kennett & Associates
Certified Energy Analyst
Certified Energy Plans Examiner
Certified GreenPoint Advisor & Rater
Build It Green Professional
15231 Perry Lane, Morgan Hill, CA 95037
armi 1 avera&netscape. net
.408-521-3740
TABLE OF CONTENTS
1. CERTIFICATION OF COMPLIANCE: RESIDENTIAL -
FORM CF -1R
2. HVAC SIZING -FORM HVAC
3. MANDATORY MEASURE CHECKLIST: RESIDENTIAL -
FORM MF -1 R
CERTIFICATE OF COMPLIANCE: RESIDENTIAL COMPUTER
METHOD
CF -1R Page 1
Project Title..........
Paknahal Residence
Design
----------
Date..07/31/14 16:18:19
Project Address........
22438 Cupertino Road
******
---------------------
9.6%
Cupertino, California
*v8.1*
I I
Documentation Author...
Yarmila Kennett
******
I Building Permit # I
0.0%
Yarmila Kennett & Associates
I I
0.20
15231 Perry Lane
--------
43.60
I Plan Check/ Date I
--------
3.77
Morgan Hill, CA 95037
(408) 621-3740
I Field Check/ Date
Climate Zone...........
04
---------------------
Compliance Method......
MICROPAS8 v8.1 for 2008
CEC Standards (r03)
MICROPAS8 v8.1 File-PAKNAHAL Wth-CTZ04S08
User#-MP1217 User-Yarmila Kennett & Associa Run-Paknahal Residence
--------------------------------------------------------------------
= MICROPAS8 ENERGY USE SUMMARY =
_---------------------------- _
= Energy Use
_ (kTDV/sf-yr)
-----------------------
Space Heating..........
Space Cooling..........
Ventilation Fans.......
Water Heating..........
Total
Standard
Proposed
Compliance
Percent
Design
----------
Design
----------
Margin
----------
Improvement
-----------
19.99
18.06
1.93
9.6%
11.33
9.69
1.64
14.5%
0.56
0.56
0.00
0.0%
11.72
11.52
0.20
1.7%
--------
43.60
--------
39.83
--------
3.77
--------
8.6%
_ *** Building complies with Computer Performance
GENERAL INFORMATION
HERS Verification.......... Not Required
Conditioned Floor Area..... 3589 sf
Building Type .............. Single Family Detached
Construction Type ......... New
Natural Gas at Site ....... Yes
Building Front Orientation. Front Facing 0 deg (N)
Number of Dwelling Units... 1
Number of Building Stories. 1
Weather Data Type.......... FullYear
Floor Construction Type....
Number of Building Zones...
Conditioned Volume.........
Slab -On -Grade Area.........
Glazing Percentage.........
Average Glazing U -factor...
Average Glazing SHGC.......
Average Ceiling Height.....
Raised Floor
1
38874 cf
0 sf
17 % of floor area
0.3 Btu/hr-sf-F
0.35
10.8 ft
CERTIFICATE OF COMPLIANCE: RESIDENTIAL COMPUTER METHOD CF -1R Page 2
Project Title.......... Paknahal Residence Date..07/31/14 16:18:19
I MICROPAS8 v8.1 File-PAKNAHAL Wth-CTZ04S08
User#-MP1217 User-Yarmila Kennett & Associa Run-Paknahal Residence
--------------------------------------------------------------------------------
BUILDING ZONE INFORMATION
Floor # of # of Cond- Thermo- Vent Vent Verified
Area Volume Dwell Peop- it- stat Height Area Leakage or
Zone Type (sf) (cf) Units le ioned Type (ft) (sf) Housewrap
-------------- ----- ------ ----- -•---- ------------- ----- ------- ----------
Residence 3589 38874 1.00 4.0 Yes Setback 2.0 Standard No
Surface
1
Wall
2
Wall
3
Wall
4
Wall
5
Wall
6
Wall
7
Wall
8
Door
9
Roof Rad
10
Floor
11
FloorExt
Frame Area
Type (sf)
Wood 351
Wood 391
Wood 554
Wood 28
Wood 550
Wood 166
Wood 189
Wood 19
Wood 3589
Wood 3439
Wood 150
U-
fact -
or
0.102
0.102
0.102
0.102
0.102
0.102
0.102
0.500
0.032
0.037
0.048
OPAQUE SURFACES
---------------
Sheath- Solar Appendix
Cavity ing Act Gains JA4
R-val R-val Azm Tilt Reference
13
0
0
90
Yes
13
0
90
90
Yes
13
0
180
90
Yes
13
0
135
90
Yes
13
0
270
90
Yes
13
0
0
90
No
13
0
90
90
No
0
0
0
90
No
30
0
n/a
0
Yes
19
0
n/a
0
No
19
0
n/a
0
No
4.3.1 A3
4.3.1 A3
4.3.1 A3
4.3.1 A3
4.3.1 A3
4.3.1 A3
4.3.1 A3
4.5.1 A4
4.2.1 A8
4.4.1 A4
4.4.2 A4
Location/
Comments
Typical
Typical
Typical
Typical
Typical
To Garage
To Garage
To Garage
Typical
Typical
0/Basement
FENESTRATION SURFACES
----------------------
Exterior
Area U- Act Shade
Orientation (sf) factor SHGC; Azm Tilt Type Location/Comments
------------------ ----- ----- ------ --- ------------ ------------------------
1 Wind Front (N) 78.0 0.300 0.350 0 90 Standard Vinyl/Wood Operable Low
2 Door Front (N) 60.0 0.300 0.350 0 90 Standard Vinyl/Wood Patio Door Lo
3 Wind Left (E) 51.0 0.300 0.350 90 90 Standard Vinyl/Wood Operable Low
4 Wind Back (S) 155.5 0.300 0.350 180 90 Standard Vinyl/Wood Operable Low
5 Wind Left (SE) 32.5 0.300 0.350 135 90 Standard Vinyl/Wood Operable Low
6 Door Back (S) 72.0 0..300 0.350 180 90 Standard Vinyl/Wood Patio Door Lo
7 Wind Right (W) 40.8 0.300 0.350 270 90 Standard Vinyl/Wood Operable Low
8 Door Right (W) 120.0 0.300 0.350 270 90 Standard Vinyl/Wood Patio Door Lo
CERTIFICATE OF COMPLIANCE: RESIDENTIAL COMPUTER METHOD CF -1R Page 3
Project Title.......... Paknahal Residence Date..07/31/14 16:18:19
MICROPAS8 v8.1 File-PAKNAHAL Wth-CTZ04S08
User#-MP1217 User-Yarmila Kennett & Associa Run-Paknahal Residence
-------------------------------------------------------------------------------
HVAC SYSTEMS
------------
Verified
Verified Verified Verified Verified Maximum
System Minimum Refrig Charge Adequate Fan Watt Cooling
Type Efficiency EER or CID Airflow Draw Capacity
---------------- ----------- ----- ------------- -------- -------- --------
Furnace 0.900 AFUE n/a n/a n/a n/a n/a
ACSplit 13.00 SEER No No No No No
HVAC SIZING
Verified
Total Sensible Design Maximum
Heating Cooling Cooling Cooling
System Load Load Capacity Capacity
Type (Btu/hr) (Btu/hr) (Btu/hr) (Btu/hr)
------------------------•-----------------------------
Furnace 55157 n/a n/a n/a
ACSplit n/a 28124 32230 n/a
Sizing Location............ CUPERTINO
Winter Outside Design...... 28 F
Winter Inside Design....... 70 F
Summer Outside Design...... 86 F
Summer Inside Design....... 75 F
Summer Range ............... 30 F
DUCT SYSTEMS
------------
Verified Verified
Verified
System
Duct
Duct Duct Surface
Buried
Type
-------------
Location
R• -value Leakage Area
Ducts
Furnace
-----------
Attic
-•-------------------------
R-6 No No
---------
No
ACSplit
Attic
R-6 No No
No
FAN SYSTEMS
------------
Flow Power
System Type
-----------------
(cfm) (W/cfm)
----------------
Standard
65.89 .25
CERTIFICATE OF COMPLIANCE: RESIDENTIAL COMPUTER METHOD CF -1R Page 4
------------
Project Title.......... Paknahal Residence Date..07/31/14 16:18:19
I MICROPAS8 v8.1 File-PAKNAHAL Wth-CTZ04S08
I User#-MP1217 User-Yarmila Kennett & Associa Run-Paknahal Residence
-------------------------------------------------------------------------•------
Heater
Tank Type Type
---------------- --------
1 Instantaneous Gas
WATER HEATING SYSTEMS
---------------------
Number
in
Distribution Type System
------------------- ------
Standard 1
Tank External
Energy Size Insulation
Factor (gal) R -value
-------- ------ ----------
.65 n/a R-n/a
SPECIAL FEATURES AND MODELING ASSUMPTIONS
-----------------------------------------
*** Items in this section should be documented on the plans, ***
*** installed to manufacturer and CEC specifications, and ***
*** verified during plan check and field inspection. ***
This building incorporates a Radiant Barrier.
This building incorporates a non-standard Water Heating System.
REMARKS
New Fenestration to be dual -pane, low -e typical.
See Calculations for max. U -value & SHGC,
CERTIFICATE OF COMPLIANCE: RESIDENTIAL COMPUTER METHOD CF -1R Page 5
Project Title.......... Paknahal Residence Date..07/31/14 16:18:19
I MICROPAS8 v8.1 File-•PAKNAHAL Wth-CTZ04S08
I User#-MP1217 User-Yarmila Kennett & Associa Run-Paknahal Residence
---------------------------------------•----------------------------------------
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance
specifications needed to comply with Title -24, Parts 1 and 6 of the
California Code of Regulations, and the administrative regulations to
implement them. s certificate has been signed by the individual with
overall desi res onsibility.
SIGN or OWNER DOCUMENTATION AUTHOR
Name.. t Zazueta Name.... Yarmila Kennett
Company. DZ Design Associates, Inc Company. Yarmila Kennett & Associates
Address. 17705 Hale Avenue, #H4 Address. 15231 Perry Lane
Morgan Hi 1, CA 95037 Morgan Hill, CA 95037
Phone... 408�y� 05 / Phone... (408) 621-3740
License. �j'A
-. /„"�4 =
(date)
ENFORCEMENT AGENCY
Name.... _
Title... _
Agency..
Phone... -
Signed.. _
(date)
Signed.. /, �,, ,I— 7`c�����%y
6-C (date)
ABOVE CODE REPORT: RESIDENTIAL COMPUTER METHOD ACR Page 1
Project Title.......... Paknahal Residence Date..07/31/14 16.18.19
I MICROPAS8 v8.1 File-PAKNAHAL Wth-CTZ04S08
I User#-MP1217 User-Yarmila Kennett & Associa Run-Paknahal Residence
-------------------------------------------------------------------------------
End Use
Space Heating...
Space Cooling...
Ventilation Fans
Water Heating...
Total
End Use
Space Heating...
Space Cooling...
Ventilation Fans
Water Heating...
Total
MICROPAS8 ENERGY USE SUMMARY
----------------------------
--------kTDV/ft2-yr--------
Stand. Prop. Percent
Design Design Margin Improve
19.99 18.06 1.93 9.6%
11.33 9.69 1.64 14.5%
0.56 0.56 0.00 0.0%
11.72 11.52 0.20 1.7%
43.60 39.83 3.77 8.6%
Therms
Stand.
Prop.
Percent
Design
------
Design
------
Margin
--------
Improve
------
417
373
45
10.8%
0
0
0
0.0%
0
0
0
0.0%
284
279
5
1.8%
701
651
50
7.1%
CPUC kW
Stand. Prop. Percent
Design Design Margin Improve
------------- ------
0.00 0.00 0.00 0.0%
4.30 3.84 0.46 10.7%
0.00 0.00 0.00 0.0%
0.00 0.00 0.00 0.0%
4.30 3.84 0.46 10.7%
-------- kWh --------
Stand. Prop. Percent
Design Design Margin Improve
------ ------------- ------
519 536 -18 -3.4%
1364 1192 172 12.6%
144 144 0 0.0%
0 0 0 0.0%
2026 1872 154 7.6%
Measures
Site
MF -IR
NOTE: Low-rise residential hwldmgs subject to the Stantiiards mast comply with all qpplicable mandatory measures listed
regardess of the compliance approach used More stringent energy measures listed on the CerWwate of Cong.*wlee (CF -11L
CF -IR -ADD, or CF -IR ALTForm) shall supersede the items marked with an asterisk (•) below. This Mandatory Measures
Summary shall be incorporated into the permit documents and the qpplicable features shall be considered by all parties as minimum
component performance specificadons whether they are shown elsewhere m the documents or in this summmy. Submit all
qpplicable sections ofthe MF -IR Form with plans, _
DESCRIPTION ~
Building Envelope Measures: --
11 a 1: Doors and windows between conditioned and uncond'itionr�t are m� to limit air
§116(a)4: Fenestration products (except field -fabricated windovas) have a label listing the oer ifred U-Footor, =ffiYed Solar Hees Cain Coefficient
(SHGQ, and infiltration that meets the requirements of §�t0.111(a).
§ 117: Exterior doors and windows are • all . kiwis sod. Penetrations are caulked and sealed
§118(a): Tnsuiahm or voslatled meets Standards for im-o atin;g Matariat lnd=ft type and include on CF-WForm.
§ 119(1): The thoracal ami ttance and solar mflactanee values of the coca] roofing material meets the miuirements of $i 18(i) whmi the installation &f
-
a Cool Roof is specified on the CF -IR Form _
*§l :Minimum R-19 insulation in wood -frame eei!!ngor eru�'w.ahatt U -factor.
110 (b): Doose fill insulation shall conform with mfr's instatted design labeled R Value.
*§150(c): M'mimum R 13 insulation in wood -frame wall ar equivalent U -factor.
*§1 d): Minimum R-13 insulation in raised wood -frame f nor or equivalead U -factor
§25 : Air reiar is toasted, labeled, and installed ace _a !Nr to ASTM E1677-"(2000) when specified on the CF -1R Form.
§150(g): Mandatory Vapor barrier installed in Climate Zones 14 or 1.6.
§1500: Wow absorption rate for slab edge insolation material adopt: without facings is no greater, than 034* waterr
than 20 h and shall be farm .tical damage and W light det>erioratioat. � P rate is ret
Fireplaces, Decorative Gas Appliances and Gas Log Memirtes:
§150(e)IA: Masonry or f6ctory4ndh fireplaces have a closable watEd or glass door covering the entire opening of%e firebox.
§ 150(e)1B: Masonry or factory -built fireplaces have a combustion outside air imake, which is at least six square inches in area and is equipped
with a with a and ti iitdng and or a combustioarak control device.
§l50(e)2: Continuous burning pilot lights and the use of indoor rdr for 4cooling a firebox jadm% wboo that indoor air is vented tO the outside of the
Wilding, are pmhMe&
Space Conditioning, Wager floating and Plumbing S tem M_feamres:
110- 113: HVAC water heaters, showerheads, lancets anal all other regulated appliances are notified W the PPOW Commission.
§113(c)5: Water heating rocirculation loops serving multiple dwrilhing imits and High -Rise residential occupancies meet the air release valve,
backflowirevenUm pump isolation valve, and rechrsxriatiort kto connection of ll c 5.
§115: Continuously burning pilot lights are prohe'bited for natural gaer fin typo central fi roace% household cooking 4plianow (appliances with an
electrical supply voltax connexion with pilot lights that imnsunw less #=150 BUYbr aro op"I and pool and sm heaters.
§150(h): and/or cootHng loads are calculated in accordance vitt ASERA14 SMACNA or ACCA.
150(1: Heating systems are eqqipped. with thermostats that meet the setback requirements of stiction l l2(c).
6150(1)1A: Storage gas water heaters rated with an FneW Factor none greater than the federal minimal s�are ext�y wrtWed vin&
insulation baying an installed thermal resistance: of R-12 or greater.
§150()1B: Unfired storage tanks, such as storage tanks or backti p tanks for solar water -heating system, or othex indirect hotwftw tanks have R-12
external insulation or R 16 internal insulation what the internal insulattion R valw is indicated on the exterior of the tank.
§1506)2: First 5 feet of hot and cold water pipes closest to wator hwwr tank, non -recirculating systems, and entim length of recircadating sections
of hot water pipes ane insulated per Standards Table 1!",
§1 S0(1(j)2: Cooling system piping (mwchilled water, or brine linesland piping kmilated between lxalimg source and indirect hot water tank
shall be insulated to Table 150-B and 150-A. _
§150(D2: Pipe insulation: for steam hydmnic hooting systems or bot wafer systems >15 psi, meets tree retguremenb of Standards Table 123-A.
§150Q)3A: Instilation.is protected from damage, including that due to sunlight; moisture, equipment mainteoaooe, and wind.
§150(1')3A. Insulation for chilled wafer piping and refrigerant suction lines includes a vapor retardant or is endowed entirely m eonditlogod space.
2008 Restderttial Compliance Forms August 2009
Mandatory Measures Summa
_ MT -1R
Residential
Site Add. as.(Pat of
Enforcement Agency: p ate:
1 X150()4. Solar water -heating systems and/or collectors are cerlifed by the Solar Raibm and Certification Cntmw�inn -- �
�r
Ducts and Fans Measurer.
§150(m)l: All air -distribution system ducts and plenums installed we sealed and inmlateci to meet the requirements of CMC Suctions 601,662—,
603, 604, 605 and Standard 6-5; supply -air and retun4r ducts and plemmns are insulated to a minimum installed level of R-4.2 or
enclosed entirely in conditioned space. Openings shall to .sealed with mastic, tape or other duct -closure System thag meets the applicable
requirements of UL 181, UL ISM or UL 18113 or aerosol sealant that meats the requirements of UL 723. if mastic or tape is used to
seal opennigs greater dm 1/4 inA the combination ofnmainc and either mesh or tape shall be used
§150(m)l: Building cavities, support platforms for air handlers, and p8mums defined or oohed with materials otter than sealed sheet metal,
duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support pladbnw may coda ducts.
Duds installed in cavities and support plWfornis shall} wt be compressed to cause reductions in the moss-sectiwtsl m+ea of the ducts.
§150(m)2D: Joints and seams of flux systnns and their compcm;ents; shall not be sealed with cloth back rubber adhesive duct
tapes unless such tape
is used in combination with mastic and draw bards. _
§150(m)7: Exhaust fan systems have back draft or autnma tic dammers..
1 m)$: Crravi conditioned spue heave: either automatic or readily accessi§*pwanually operaterl
§ 150(m)9: Insulation shall be protected from damage, including thin: due to sunlight, moisture, equipment maintenance, and wind. Cellular foam
insulation shall be protected as above or painted wits► a costing that is water retardant and provides shielding from solar radiation that
can cause on of the material.
§ 15 m 10: Fleta'bie ducts cannot have porous inner cores.
§150(0): All dwelling units shall meet the requirements of ANSUASHRAE Standard 62.2-2007 Venfileflon and A le Indoor Air
oaalttab Qua}ity in
Low -Rise Residential Buildings. Window operation is not a permissible method ofproviding the Whole Budding Ventilation required in
Section 4 ofthat Standard.
Pool and Spa Beating ftstenis and Equipment Menswres:
1114(a): Any pool or spa heating system shall be certified to have: 111 thermal of iciemcy that complies with the Appliance Efficiency Regulations;
an on-off switch mounted outside of the heater, a permanent weeflun goof plate or card with operating instructions; s; and shalt not use
electric resistance beating ora pflat light
§114(b)l: Any pool or spa heating equipment shell be installed with st least 36" ofpipe between filter and ie_ , or dedicated suction and return
lines,or built-up connections for future solarbeatin
11 )2: Outdoor p22ls or spas than have a heat pump or Vs hem shall }rave a cover.
§1 14(b)3.- Pools shall have directional inlets that adequately mit rte pool water, and a time switch that will allow all pumps to be set or
programmed to ruin 92!y during off- electric demand j!niods.
_§150(p),Residential pool system or equipment meet the EM siziict�, flow rate, filters, and valve ents of 15
ReAdeathdMeasures:
§150(k)l: High efficacy luminaires or LED Light Engine with Intgxal Heat Sink has an efficacy that is no lower them the efiiewies contained in
Table 150-C and is not a low efficacy luminaire as ocified by §150(k)2.
§I 3: The wattap ofpcimanently installed luminaires shall be detumined as speciSed by 9130(4).
1 N(k)4. Ballasts for fluorescentlamps rated 13 Watts or or shall be electronic and shall have an output frequency no km than 20 kHz,
§150(k)5- Pexmaneattly installed night lights and night lights integral to a peraw nemdy inshiiled huuimtire or exhadest fan shall attain only high
efficacy lamps meeting tits minimum efficacies conitdneei 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 faro watts of power as determined by §130(4), mrd shall not contain a medium
screw -base socket _
§15900: Li integrW to exhaust fans, in rooms other than kitcherm, shell meet the kop#mble requirements of
§150(k)7: All switching devices and controls shall meet the tirennems of 1150(k)7.
§150(k)S: A minimum of 50 percent of the trial rated wattage of pelmaanently installed lighting in kitchens shall be high esfflcacy.
EXCEPTION: Up to 50 watts for dwelling units less than or equal to 2,500 fl or 100 walls for dwelling units larger• than 2,500 fe may be exempt
from the 50% high efficacy requitement when: all love t0cacy luminaires in the kitchen are controlled by a manual on occupant
sensor, dimmer, energy management system (EMCS), or a multi -some programmable control system; and all Permanently installed
luminaries in garages laundry rooms, closets greaser ihim 70 square feet, and utility rooms are high efficacy and cxmtmlled by a
manual -on oompant seutsor.
§150(k)9. Permanently installed lighting that is internal to cabinets saladl use no more than 20 watts of power per linear foot of illuninsted
cabinet.
§150(k)10: Permanondy installed luminaires in bathrooms, attached a r d detached garages, laundry rooms, closer and utility rooms shall be high
efficacy,
zuuef xesmenuat c.ompuannce ro►ms August 2009
Mandatory Measures Summa MF -1R
Residential ...._ (Page 3 of 3
Site Address: Enforcement Agency: Date;
EXCEMON 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 occypant sensor.
§150(k)11: Permanently installed luminaires located in rooms or areas other than in kitchens, bathrooms, garages, laundry rooms, closets, and utility
rooms shall be high efficacy luimnaires.
EXCEPTION 1: Permanently installed low efficacy luminaires shall be allowed provided they are controlled by either a dimmer switch
that complies with the applicable requirements of §119, or by a manual -on occupant sensor that complies with the
applicable requirements of §119.
EXCEPTION 2: Lighting in detached storage building less than 1000 square feet located on a residential site is not required to comply
with § 150(k) 11.
§150(k)12: Luminaires recessed into insulated ceilings shall be lisled': 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 fighting 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 air override or bypass switch that disables the astronomical time clock; OR an
energy management control system (EM(CS) not having an override or bypass switch that allows the luminaire to be
always on
EXCEPTION 2: Outdoor Iuminaires used to comply with Exceptionl to §150(k)13 may be controlled by a temporary override switch
which bypasses the motion sensing function provided that the motion sensor is automatically reactivated within six
hours.
EXCEPTION 3: Permanently installed luminaires in or imwnd 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 comume no more than five
watts of power as determined according to §130
§150(k)15: Lighting for parking lots and carports with a total at for 8 or more vehicles per site shall comply with the applicable requirements in
Sections 130, 132, 134, and 147. Lighting for parking ganges for 8 or more vehicles shall comply with the applicable requirements of
Sections 130, 131, 134, and 146
§150(k)16: Permanently installed lighting in the enclosed, non-dwelliag 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 sensor(s)
certified to comply with the applicable requirements of §119.
2008 Residential Compliance Forrrrs August 2009
CUPERTIINO
PURPOSE:
CALGREEN RESIDENTIAL CHECKLIST - MANDATORY
ITEMS
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 or
The 2013 CalGreen Code applies to all newly constructed hotels, motels, lodging houses, dwellings,
dormitories, condominiums, shelters, congregate residences, employee housing, factory -built housing and
other types of swellings with sleeping accommodations and new accessory buildings associated with such
uses. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the
requirements of CALGreen.
Project
Project
Project
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.
MANDATORY FEATURE OR MEASURE
Planning and Design - Site Development
Column 2 Column 3
Project Verification
muirements
4.106.2 Storm water drainage and retention during construction. A plan is P
UI-
developed and implemented to manage storm water drainage during QX
construction. A / —7-(;z ,;2 rfl
4.106.3 Grading and paving. The site shall be planned and developed to OI
keep surface water away from buildings. Construction plans shall indicate how
site grading or a drainage system will manage all surface water flows. T
Page 1 of 5 CalGreen_2014.doc revised 01115114
A4.2
General
4.201.1 Low-rise residential buildings shall meet or exceed the minimum
standard design required by the California Energy Standards.
A4.3 WATERAND CONSERVATION
Indoor Water Use
4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures
(water closets and urinals) and fittings (faucets and showerheads) shall comply
with the following:
❑ 4.303.1.3.2 Water Closets. The effective flush volume of all water closets
shall not exceed 1.28 gallons per flush. Tank -type water closets shall be
certified to the performance criteria of the U.S. EPA WaterSense
Specifications for Tank -type Toilets.
❑ 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not
exceed 0.5 gallons per flush.
❑ 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum.
flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads
shall be certified to the performance criteria of the U.S. EPA WaterSense
Specification for showerheads.
❑ 4.303.1.3.2 Multiple Showerheads serving one shower. When a
shower is served by more than one showerhead, the combined flow rate of
all showerheads and/or other shower outlets controlled by a single valve
shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be
designed to allow only one shower outlet to be in operation at a time.
❑ 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of
residential lavatory faucets shall not exceed 1.5 gallons per minute at 60
psi. The minimum flow rate of residential lavatory faucets shall not be less
than 0.8 gallons per minute at 20 psi.
❑ 4.303.1.3.2 Lavatory faucets in common and public use areas. The
maximum flow rate of lavatory faucets installed in common and public use
areas (outside of dwellings or sleeping units) in residential buildings shall
not exceed 0.5 gallons per minute at 60 psi.
❑ 4.303.1.4.3 Metering faucets. Metering faucets when installed in
residential buildings shall not deliver more than 0.25 gallons per cycle.
❑ 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets
shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may
temporarily increase the flow above the maximum rate, but not to exceed
2.2 gallons per minute at 60 psi, and must default to a maximum flow rate
of 1.8 gallons per minute at 60 psi.
4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures
and fittings shall be installed in accordance with the California Plumbing Code,
and shall meet the applicable standards referenced in Table 1401.1 of the
California Plumbing Code.
Page 2 of 5 CalGreen_2014.doc revised 01/15/14
Outdoor Water Use
4.304.1 Irrigation controllers. Automatic irrigation systems installed at the
time of final inspection shall be weather -based.
❑ 4.304.1.1 Controllers shall be weather- or soil moisture -based controllers
that automatically adjust irrigation in response to changes in plants' needs
as weather conditions change.
❑ 4.304.1.2 Weather -based controllers without integral rain sensors or
communication systems that account for local rainfall shall have a separate
wired or wireless rain sensor which connects or communicated with the
controller(s). Soil moisture -based controllers are not required to have rain
sensor input.
A4.4 MATERIAL
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,
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.
Building Maintenance and Operation
4.410.1 Operation and maintenance manual. At the time of final inspection,
an operation and maintenance manual shall be provided to the building
occupant or owner.
A4.5 ENVIRONMENTAL
Fireplaces
4.503.1 General. Install only a direct -vent sealed -combustion gas or sealed
wood -burning fireplace, or a sealed woodstove.
Pollutant Control
4.504.1 Covering of duct openings and protection of mechanical
equipment during construction. Duct openings and other related air
❑X
distribution component openings shall be covered during construction.
4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks
shall be compliant with VOC and other toxic compound limits.
4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be
El
compliant with VOC limits.
4.504.2.3 Aerosol paints and coatings. Aerosol paints and other coatings
shall be compliant with product weighted MIR Limits for ROC and other toxic
❑X
compounds.
Page 3 of 5 CalGreen_2014.doc revised 01115,114
4.504.2.4 Verification. Documentation shall be provided to verify that
compliant VOC limit finish materials have been used.
4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with
VOC limits.
4.504.4 Resilient flooring systems. Eighty (80) percent of floor area
receiving resilient flooring shall comply with the VOC-emission limits defined in
the Collaborative for High Performance Schools (CHPS) Low -emitting
❑X
Materials List or be certified under the Resilient Floor Covering Institute (RCFI)
FloorScore program.
4.504.5 Composite wood products. Particleboard, medium density
fiberboard (MDF), and hardwood plywood used in interior finish systems shall
❑X
comply with low formaldehyde emission standards.
Interior Moisture Control
4.505.2 Concrete slab foundation. Required vapor retarders and capillary
breaks are also required to comply with CalGreen Section 4.505.2.1.
4.505.3 Moisture content of building materials. Moisture content of building
materials used in wall and floor framing is checked before enclosure.
Indoor Air Quality and Exhaust
4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the
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
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
QX
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
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 005114
Project Name:
Project Address:
Project Description
�iT W-ciN74-M-ireiki/TddII N :291*i4W±1-TA drel 0�
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
pro'e cordance with the re ments set forth in the 2013 California Green Building Standards Code as
-aod pted by the City of Cupertino.
Owner's Signature A I Date
Owner's Name
n P—wossionars Signature Date
Design Professional's Name (Please
Sign ure of License Professional responsible for CalGreen compliance Date
1c &7WAdM y0,f 42/-97y6r
Name of License Professional responsible for CalGreen compliance (Please Print) Phone
Email Address for License Professional responsible for CalGreen compliance eli-# Z0 0 p- 2 L1
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 Professional responsible for CalGreen compliance (Please Print) Phone
Email Address for License Professional responsible for CalGreen compliance
Page 5 of 5 CalGreen 2014.doc revised 01/15/14