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CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10414 S FOOTHILL BLVD I CONTRACTOR: KENNETH M LEE PERMIT NO: 13070090 I OWNER'S NAME: KENNETH M LEE I 1 DATE ISSUED: 09/04/2013 1 OWNER'S PHONE: 4088323073 CUPERTINO, 95014 1PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F_ ELECT r PLUMB r License Class Lic. # Contractor Date 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 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. t have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, 13usincss & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.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 perlbrmanee of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, 1 become subject to the Worker's Compensation provisions of the Labor Code, I must Forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter Upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. / Signature , Q Date���� MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: REBUILD AND ADD TO EXISTING RESIDENCE (815 SQ FT) REV # I - REVISE SCOPE TO BUILD (N) SFD (1589 Sq. Ft Floor Area: I Valuation: $120000 APN Number: 35703072.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LST 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 Appl 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 1 store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or a ri d a e 1 ��t / Date: / F—.� 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION J COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingC@cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI � yISIO DEFERRED ORIGINAL PERMIT # 3 046 chi � PROJECT ADDRESS #fdt0vC,4vz(-3 5; �y —O 3( —: A OWNER NAME CN ? o C_ E-MIL`j%/7 0 C l C() STREET ADDRESS CITY, ATE ZIP FAX CONTACT NAME?m (S / _ , IU 9 3 L - ) J? � E-MAIL �LJ� - ) ( STREET ADDRESS CITY, STATE, ZIP FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEi J,') 9= " LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX IN W v✓ad' f STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # i COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 4,0 EXISTING USE PROPOSED USE CONSTR TYPE /yam V�i # STORIES USE TYPE OCC. SQ.FT. VALUATIONEXIST($) !y� AREA✓G /n �7 / NEW FLOOR/EMO AREA/ jr l� DAREA /^ �7 CCC!lIJJJ✓ TOTAL NET'4R.F�A/'� X23 j BATHROOM KrrcHEiq OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKPORCH AREA GARAGE AREA: LJDETACH / g.2 -ATTACH # D WELLING UNITS: F IS A SECOND UNIT ❑ YES SECOND STORY []YES 101 BEING ADDED? ;a�110 ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN I] YES RECEIVED BY- TOTAL VALUATION: PLANNWG APPL # ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO Y -✓1y �� By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I hav read this application and the infonnation I have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building4 authorize representatives of Cupertino to enter the above-idenjtified property for inspection purposes. ,onktructionn. Signature of Applicant/Agent:-���/'�-�`-"� Date: (/ (-j 3 I 2P SUPPLEMENTAL INFO TION REQUIRED PLAN CHECK TYPE ROUTING SLIP, ❑ OVER-TIDE-COUNITER 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- pennit for new building. ❑ ,EXPRESS „ , PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure�( STANDARD PUBLIC woxK$ 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 ❑ submittal of Building Permit application. rIAJoR " sANrrARY SEER DISTRICT , �` ❑ ENVIRONi13ENTALHEALTH B1dgApp_2011.doc revised 06/21/11 K) O CONS'CRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPEF2TIN0 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org \• ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS / 0 ' i rJ FCC 7 , J Z Z 01 I / � `f / Q APN {! ?S -7 O -O 7;?-_ 610 O PHONE OWNERNAME I �f� �Y/ 01 �VFJ`1cLJ/7 y o,� J3a 3a7� ' E-MAII6 i7�✓LF[ STREET ADDRESS pJJ r / C CITY, STATE, ZIP0 Uflo C}� �� _ /� 1 �� FAX CONTACT NAME PHONE �E-MAIL�/J�C�C'I;L �V �� STREET ADDRESS -79fPCIJyt.,9a Cltl 7 �y�� 2J�Q/ y❑ FAX AD OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR, ❑ CONrRACT'O['RAGENT ❑ ARCHITECT ENGINTER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME/�. LICENSE NUMBER LICENSE TYPE �/ BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHiTECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # %okylelly COMPANY NAME of E-MAIL om e� YJ�cJG FAX ¢off- 997- z73S STREET ADDRESS rAWIJDO,d 0/'? CITY, STATE, ZIP s�/v </OS G� 951 ZD PHONE 1-6oS'S33 DESCRIPTION OF WORK n/9W Rm" D X17e& � ron0 6Z 16' s: F 1111V41h*, ,BA Ne6lj V A jyf K g d0A,1 , Mgh E L EXISTING USE PROPOSED USE CONSTR TYPE 4 STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXLSTG NEW FLOOR DEMO TOTAL AREA e 5"4 AREA z / 6 AREA cs J NET AREA C� /5- /Z BATHROOM REMODEL AREA KITCHEN OTHER REMODEL AREA REMODEL AREA � PORCH AREA DECK AREA TOTAL DECK/PO AREA GARAGE AREA DETACH Z 27 1 ❑ ATTACH 4VDR'ELLINGUHITS: IS A SECOND UNIT ❑ YES SECOND STORY [:]YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF TES, PROVIDE COPY OF IS THE BLDG AN [] YES Bl TOTAL VALUATION: PLA.NTNING.APPL# ANO PLANNIN G APPROVAL LEITER EICHLERHOME? ❑NO ` `V By my signature below, I certify to each of the following: I am the property owner or authd rized ag on the property owner's behalf. I have read this application and the information I have rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b �. �utho ' e representatives of Cupertino to enter the above_ identified property for inspection purposes. . Date: Signature of AppliczndAgent: SUPPLEMENTAL INFORMATION REQUIRED PLNc1ci�YPE w'Y '. .z,iouTiliGSLIr , s k } D New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVERTH1rCOII�TER BUILDII\GPLANREVIEW i permit for new building. EXPI2ES9 pq Commercial Bldgs: Provide a completed Hazardous Materials Disclosures STANDARD ., L� PUBLteS}ORIZS _ form if any Hazardous Materials are being used as part of this project. D LARG$ a e t FIRE REPT 3 _Copy of Planning Approval Letter or Meeting with Planning prior to�I MA30R r ft ❑ '.- SAIITARY SER ER DISTRIC F submittal of Building Permit application. fi m F , T� D EIN iROJ�^+ZENTAZ`IIEALTH'- BldgApp_2011.doc revised 06/21/:1 CITY OF CUPERTINO rm--7 FEE ESTIMATOR - BUILDING DIVISION NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711!13) ADDRESS: 10414 S FOOTHILL BLVD DATE: 10/31/2013 REVIEWED BY: MELISSA MISC ITEMS APN: 357 03 072 BP#: 13070090 'VALUATION: 1$70,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 0.0 PENTAMATION 1GENRES PERMIT TYPE: WORK - REVISE SCOPE TO BUILD N SFD 1589 S.F. W/ATTACHED GARAGE 413S.F [REY_" SCOPE NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711!13) Vut :i' QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No rF-1 El Li Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711!13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 4 1 hours Plan Check, Hourly $556.00 ISTPLNCK Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. Q OT 0 0 I hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 # units new $650.84 lc/s ar'srr. tr::,rv: Fcc . 0 Work Without Permit? 0 Yes ie) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Strong Motion Fee: IBSEISMICR $7.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $660.84 $556.001 TOTAL FEE: 1 $1,216.84 Revised: 10/01/2013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10414 S FOOTHILL BLVD CONTRACTOR: KENNETH M LEE PERMIT NO: 13070090 OWNER'S NAME: KENNETH M LEE 10414 S FOOTHILL BLVD DATE ISSUED: 09/04/2013 OWNER'S PHONE: 4088323073 CUPERTINO, CA 95014 PHONE NO: El LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL �� REBUILD AND ADD TO EXISTING RESIDENCE (815 SQ FT) License Class Lie. # REV # 2 - ADD 2 (N) WINDOWS IN KITCHEN, ADD (N) -�— Contractor c � 61 C>Y`j Date/ I cy> —14 c REV # 2 - ADD 2 (N) WINDOWS IN KITCHEN, ADD (N) I hereby affirm that I am licensed under the provisions of Chapter 9 ELECTRIC FP IN FAMILY RM & INSTALL 1 (N) TUBULAR (commencing with Section 7000) of Division 3 of the Business & Professions SKYLIGHT IN BATHROOMS 2 & 3 (2 SITYLIGHT TOTAL) - Code and that my license is in full force and effect. ISSUED 3/26/14 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 Sq. Ft Floor Area: Valuation: $120000 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 APN Number: 35703072.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS CALLED INS ECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, 7ST costs, and expenses which may accrue against said City in consequence of the '7 / Issued granting of this permit. Additionally, the applicant understands and will comply by: Da I with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Z� /1 RE -ROOFS: Signature / — Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for 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 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 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. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipaf Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: O Date: 3 _ c permit is issued. I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, 1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, l 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. 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATIWS10 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DbW ;]i'�� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 i� (408) 777-3228 • FAX (408) 777-3333 • building ancupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT # G �V C�Jo PROJECT ADDRESS / / \ APN # OWNERNAME 'D�a �l / PHONE -7 E-MAIL C� 14� STREET ADDRESS / / l-� l /, , L f/ PTY1 STATE, ZIP FAX '\ (J CONTACT NAME . „ /J n �(���NE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME. LICENSE NUMBER LICENSE TYPE BUS LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 4V del, cI/ EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH ARE GARAGE .AREA LJ 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 C] YES RECEIVED BY'- TOTAL VA TION: PLANNINGAPPL# [:]NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO�+�✓ By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided isVve read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and State laws relating to building consth.ri'ze representatives Cupertino to enter the above -identified property fo inspection purposes. ti > Il Signature of Applicant/Agent: Date: C.� SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE-COUNTER BUILDING PLAN REVIEW 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 ❑ STANDARDPUBLIC WORKS ?_c 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_201l.doc revised 0621/11 CITY OF CUPERTINO Iwo FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10141 S Foothill Blvd DATE: 08/21/2013 REVIEWED BY: Sean PC FEE ID APN: BP#: "VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes . No OTC. ® Yes (F) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK Revised Scope: Rebuild and add to existing residence (815 sq ft). 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 815 $2,577.00 1R3PLNCK $1,617.00 1R31.VSP $0.00 PME Plan Check: $0.00 Pen -nit Fee: $1,617.00 Suppl. Insp. Feer Reg. OT T 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 815 $2,577.00 1 $1,617.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt ,tr- )_ Thoco fooe aro hncod an tho nroliminary infnrniatinn availahlo and are nnly an oetimate_ Contact tho Dont far addn'I info_ FEE ITEMS (Fee Resolution 11-053 Ef{' 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,577.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: ) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Pen -nit Fee: $1,617.00 Suppl. Insp. Feer Reg. OT T 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes Q) No $0.00 Advanced Planning Fee. IPLLONGR $114.10 Select a Non -Residential Building or Structure 0 A Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $4,308.101 $0.00 TOTAL FEE: $4,308.10 Revised: 07/01/2013 CITY OF CUPERTINO Im FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 10414 S FOOTHILL BLVD DATE: 07/15/2013 REVIEWED BY: MELISSA PC FEE ID APN: 357 03 072 BP#: j yid o 'VALUATION: 1$120,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes .0 No OTC. ® Yes (E) No PENTAMATION 1R3SFDADD PERMIT TYPE: WORK 216 S.F. ADDITION TO ADD N BEDROOM DINING RM & KITCHEN. DEMO & REMOVE 55 S.F.OF SCOPE LIVING SPACE. REMODEL (E) LIVING RM, 2 (E) BATHS & (E) LAUNDRY RM (470 S.F.) 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 216 $1,035.00 IADDPLCK $983.00 IADDINSP $0.00 PME Plan Check: $0.00 Permit Fee: $983.00 Suppl. Insp. Fee -.0 Reg. Q OT 0,0 hrs $0.00 1(0 57 $0.00 PME Permit Fee: TOTALS: 216 $1,035.00 $983.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ ota )_ Thoco foot aro ha.cod an tho nreliminary infarmatian availahlo and are anly an o.wimato. Cantart tho Dont for addn'I info_ FEE ITEMS (Fee Resolution 11-053 Eff 7,1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,035.00 470 s.f. $488.00 Remodel, Other IREMRESOTx Suppl. PC Fee: E) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $983.00 Suppl. Insp. Fee -.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? ® Yes (E) No $0.00 /Advanced Planning Fee: 1PLLONGR $30.24 Select a Non -Residential Building or Structure � i Strong Motion Fee: 1BSEISMICR $12.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $5.00 SUBTOTALS:'- $2,065.24 $488.001 TOTAL FEE: $2,553.24 Revised: 07/01/2013 CITY OF CUPERTINO N M-7 FEE ESTIMATOR - BUILDING DIVISION iaADDRESS: 10414 S FOOTHILL BLVD DATE: 03/25/2014 REVIEWED BY: APN: 357 03 072 BP#: 13070090 'VALUATION: Iso xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PENTAMATION 1GENRE % USE: PERMIT TYPE: WORK REV # 2 - ADD 2 N WINDOWS IN KITCHEN ADD N ELECTRIC FP IN FAMILY RM & INSTALL 1 SCOPE (N) TUBULAR SKYLIGHT IN BATHROOMS 2 & 3 (2 SITYLIGHT TOTAL) - ISSUED 3/26/14 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 preliminar > information available and are only an estimate. Contact the Dept for addh 7 info. FEE ITEMS FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes E) No $0.00 2 hours Plan Check, Hourly $278.00 ISTPLNCK Suppl. PC Fee: 0 Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 A Strom Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.001 $278.00 TOTAL FEE: 1 $278.00 Revised: 01/15/2014 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: C) w c 1( ( PERMIT # 13o1700go OWNER'S NAME: Ot[rSZA— (,t,C.G Ste( PHONE # v —3 '-)- ZGENERAL GENERALCONTRACTOR: S J BUSINESS LICENSE # 3 U ADDRESS: I I �� 6 r A n d q to i t CL WLW SJ CITY/ZIPCODE: (:�3 Cr s- I -)-- *Our *Our municipal code requires all busir%sses working in die 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 s/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Ins ion (i a c � Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile R/Z%/2-o/y Owner/ eoWractor Signature Date 537 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS a - t /, fu`4 r� I r� n `� N/ A N BP# OWNER NAME S _ I ISUL OWNER ADDRESS v� G Cw9sv DESCRIPTION OF WORK: (� ' We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) y 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- uilder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. �9_ 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 13. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. by -5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer' under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work i erformed under contract with a licensed general building Contractor. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. O rnerBuilderForm 2010.doc revised 04114,110 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed 5tors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 0-1-11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to. assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: -------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's drivers license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: aMerBuilderForm 2010.doc revised 04/14/10 BUILDING ENERGY ANALYSIS REPORT PROJECT: Daisy Lee's Residence 10414 S. Foothill Blvd. Cupertino, CA 95014 Project Designer: David Wong Home Deign and Consultant 958 Meadowood Drive San Jose, CA 95120 408-997-2735 Report Prepared by: Mark Chu & Associates 1141 S. Stelling Rd. Cupertino, CA 95014 (408) 255-4804 Job Number: 050113 Date: 10/21/2013 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2008 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC — www.energysoft.com. 3 PERFORMANCE CERTIFICATE: Residential Part 1 of 5 CF -1 R Project Name Daisy Lee's Residence Building Type 0 Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition/Alteration Date 10/21/2013 Project Address 10414 S. Foothill Blvd. Cupertino California Energy Climate Zone CA Climate Zone 04 Total Cond. Floor Area 1,589 Addition n/a # of Stories 1 FIELD INSPECTION ENERGY CHECKLIST ❑ Yes El No HERS Measures -- If Yes, A CF -413 must be provided per Part 2 of 5 of this form. El Yes ❑ No Special Features -- If Yes, see Part 2 of 5 of this form for details. INSULATION Area Special Construction Type Cavity Et -9) Features see Part 2 of 5 Status Wall Wood Framed R-13 1,193 New Door Opaque Door None 38 New Roof Wood Framed Attic R-30 1,589 Radiant Barrier New Floor Wood Framed w/Crawl Space R-19 1,589 New FENESTRATION U- Exterior Orientation Area(ft) Factor SHGC Overhang Sidefins Shades Status Front (W 12.0 0.370 0.32 none none Roll -down Blind or Slats New Left (N) 24.0 0.370 0.32 none none Roll -down Blind or Slats New Rear (E) 155.0 0.370 0.32 none none Roll -down Blind or Slats New Right (S) 38.5 0.370 0.32 none none Roll -down Blind or Slats New HVAC SYSTEMS Ot . Heating Min. Eff Cooling Min. Eff Thermostat Status 1 Central Furnace 94% AFUE Split Air Conditioner 13.0 SEER Setback New HVAC DISTRIBUTION Duct Location Heating Cooling Duct Location R -Value Status Res HVAC Ducted Ducted Attic, Ceiling Ins, vented 6.0 New WATER HEATING Ot . Type Gallons Min. Eff Distribution Status 1 Small Gas 50 0.61 No Pipe Insulation New EnergyPro 5.1 by Ener Soft User Number. • 4970 RunCode: 2013-10-21T07:38:06 10:050113 Page 2 of 10 PERFORMANCE CERTIFICATE: Residential (Part 2 of 5) CF -1 R Project Name Daisy Lee's Residence Building Type 0 Single Family 13 Addition Alone ❑ Multi Family ❑ Existing+ Addition/Alteration Date 11012112013 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. The Roof R-30 Roof Attic with Radiant Barrier includes credit for a Radiant Barrier that is Continuous meeting eligibility and installation criteria as specified in Residential Appendix RA4.2.2. HERS REQUIRED VERIFICATION Items in this section require field testing and/or verification by a certified HERS Rater. The inspector must receive a completed CF -4R form for each of the measures listed below for final to be given. Ener Pro 5.1 by EnemySoft User Number. 4970 RunCode: 2013-10-21T07:38:06 ID: 050113 Pa e 3 of 10 PERFORMANCE CERTIFICATE: Residential (Part 3 of 5) CF -1 R Project Name Building Type © Single Family ❑ Addition Alone Date Daisy Lee's Residence ❑ Multi Family ❑ Existing+ Addition/Alteration 10/211201 ANNUAL ENERGY USE SUMMARY Standard Proposed Margin TDV (kgtu/ft2- r) Space Heating 21.80 24.10 -2.30 Space Cooling 6.22 2.21 4.01 Fans 4.68 4.37 0.31 Domestic Hot Water 21.37 20.48 0.89 Pumps 0.00 0.00 0.00 Totals 54.07 51.17 2.90 Percent Better Than Standard: 5.4% 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) 374 12 Fuel Available at Site: Natural Gas (N) 356 24 Raised Floor Area: 1,589 (E) 374 155 Slab on Grade Area: 0 (S) 356 39 Average Ceiling Height: 8.0 Roof 1,589 0 Fenestration Average U -Factor: 0.37 TOTAL: 230 Average SHGC: 0.32 Fenestration/CFA Ratio: 14.4% REMARKS STATEMENT OF COMPLIANCE This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 the Administrative Regulations and Part 6 the Efficiency Standards of the California Code of Regulations. The documentation author hereby certifies that the documentation is accurate and complete. Documentation Author Company Mark Chu & Associates 10/21/2013 Address 1141 S. Stelling Rd. Name City/State/ZipCity/State/Zip Cupertino, CA 95014 Phone (408) 255-4804 Signed Date The individual with overall design responsibility hereby certifies that the proposed building design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application, and recognizes that compliance using duct design, duct sealing, verification of refrigerant charge, insulation installation quality, and building envelope sealing require installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) Company David Wong Home Deign and Consultant Address 958 Meadowood Drive Name David Wong /O - 21 - !3 City/State/Zip San Jose, CA 95120 Phone 408-997-2735 Signed Li ens, # Date Ener Pro 5.1 by Ener Soft User Number. • 4970 RunCode: 2013-10-21T07:38:06 /D: 050113 Page 4 of 10 CERTIFICATE OF COMPLIANCE: Residential (Part 4 of 5) CF -1 R Project Name Daisy Lee's Residence Building Type ® Single Family ❑ Addition Alone Date 11 Multi Family ❑ Existing+ Addition/Alteration 0/21/201 OPAQUE SURFACE DETAILS Surface U- Insulation Joint Appendix -Type Area Factor Cavity Exterior Frame Interior Frame Azm Tilt Status 4 Location/Comments Wall 342 0.102 R-13 270 90 New 4.3.1-A3 1st Floor Zone Door 20 0.500 None 270 90 New 4.5.1-A4 1st Floor Zone Wall 314 0.102 R-13 0 90 New 4.3.1-A3 1st Floor Zone Door 18 0.500 None 0 90 New 4.5.1-A4 1st Floor Zone Wall 219 0.102 R-13 90 90 New 4.3.1-A3 1st Floor Zone Wall 3161 0.102 R-13 180 90 New 4.3.1-A3 1st Floor Zone Roof 1,589 0.031 R-30 0 22 New 4.2.1-A20 1st Floor Zone Floor 1,589 0.037 R-19 0 180 New 4.4.1-A4 1st Floor Zone FENESTRATION SURFACE DETAILS ID Type Area U -Factor SHGC Azm Status Glazing Type Location/Comments 1 Window 6.0 0.370 NFRC 0.32 NFRC 270 New IWC 5300 VinyULow-E 1st Floor Zone 2 Window 6.0 0.370 NFRC 0.32 NFRC 270 New IWC 5300 VinyULow-E 1st Floor Zone 3 Window 24.0 0.370 NFRC 0.32 NFRC 0 New IWC 5300 Vin Ulow-E 1st Floor Zone 4 Window 14.0 0.370 NFRC 0.32 NFRC 90 New IWC 5300 VinyULow-E 1st Floor Zone 5 Window 7.0 0.370 NFRC 0.32 NFRC 90 New IWC 5300 Vinyl/Low-E 1st Floor Zone 6 Window 20.0 0.370 NFRC 0.32 NFRC 90 New IWC 5300 VinyULow-E 1st Floor Zone 7 Window 7.0 0.370 NFRC 0.32 NFRC 90 New IWC 5300 VinyULow-E 1st Floor Zone 8 Window 53.5 0.370 NFRC 0.32 NFRC 90 New IWC 5300 Vinyl/Low-E 1st Floor Zone 9 Window 53.5 0.370 NFRC 0.32 NFRC 90 New IWC 5300 VinyYLow-E 1st Floor Zone 10 Window 12.5 0.370 NFRC 0.32 NFRC 180 New IWC 5300 VinyULow-E 1st Floor Zone 11 Window 6.0 0.370 NFRC 0.32 NFRC 180 New IWC 5300 VinyULow-E 1st Floor Zone 12 Window 20.0 0.370 NFRC 0.32 NFRC 180 New IWC 5300 VinyULow-E 1st Floor Zone (1) U -Factor Type: 116-A = Default Table from Standards, NFRC = Labeled Value 2 SHGC Type: 116-B = Default Table from Standards, NFRC = Labeled Value EXTERIOR SHADING DETAILS ID Window Exterior Shade Type SHGC H t Wd Ove hang Left Fin Right Fin Len H t LEA RExt Dist Len H t Dist Len H t 1 Roll -down Blind or Slats 0.13 2 Roll -down Blind or Slats 0.13 3 Roll -down Blind or Slats 0.13 4 Roll -down Blind or Slats 0.13 5 Roll -down Blind or Slats 0.13 6 Roll -down Blind or Slats 0.13 7 Roll -down Blind or Slats 0.13 8 Roll -down Blind or Slats 0.13 9 Roll -down Blind or Slats 0.13 10 Roll -down Blind or Slats 0.13 11 Roll -down Blind or Slats 0.13 12 Roll -down Blind or Slats 0.13 Ener Pro 5.1 by Ener Soft User Number: 4970 RunCode_ 2013-10-21 T07:38:06 ID: 050113 Pae 5 of 10 CERTIFICATE OF COMPLIANCE: Residential (Part 5 of 5) CF -1 R Project Name Building Type ® Single Family ❑ Addition Alone Date Daisy Lee's Residence ❑ Multi Family ❑ Existing+ Addition/Alteration 1101211201i BUILDING ZONE INFORMATION Floor Area System Name Zone Name New Existing Altered Removed Volume Year Built Res HVAC I 1st Floor 1,589 12,712 Totals 1,5891 01 01 01 1 HVAC SYSTEMS System Name Qty. I Heating Type I Min. Eff. Cooling Type Min. Eff. Thermostat Type Status Res HVAC 1 1 Central Furnace 94% AFUE I Split Air Conditioner 13.0 SEER Setback New S stem Name IHeating Goo Res HVAC I Ducted Ducted WATER HEATING SYSTEMS S stem Name RHEEM 44V50 MULTI-FAMIL 1 I Small Gas No Pipe Insulation Y WATER HEATING DETAILS Hot Water Piping Length ft o a � FQty. HP Plenum Outside Buried Q c Duct Location Duct R -Value Ducts Tested? Status oiling Ins, vented 6.0 ❑ New Rated Tank Input Cap. Btuh al Energy Factor or RE Standby Loss or Pilot Ext. Tank Insul. R- Value Status 40,000 50 0.61 rVa rVa New HYDRONIC HEATING SYSTEM PIPING Pipe I Pipe Insul. Name Lenqth Diameter I Thick. EnergyPro 5.1 by EnergySoR User Number. • 4970 RunCode: 2013-10-21707:38:06 ID: 050113 Page 6 of 10 1 MANDATORY MEASURES SUMMARY: Residential Pae 1 of 3 MF -1 R Project Name Daisy Lee's Residence Date 10/21/2013 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 listed on the Certificate of Compliance (CF -1 R, CF -1 R -ADD, or CF - 1 R -ALT Form) shall supersede the items marked with an asterisk (*) below. This Mandatory Measures Summary shall be incorporated into the permit documents, and the applicable features shall be considered by all parties as minimum component performance specifications whether they are shown elsewhere in the documents or in this summary. Submit all applicable sections of the MF -1 R Form with plans. Building Envelope Measures: 116 (a)1: Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage. §116(a)4: Fenestration products (except field -fabricated windows) have a label listing the certified U -Factor, certified Solar Heat Gain Coefficient SHGC , and infiltration that meets the requirements of 10-111 (a). 117: Exterior doors and windows are weather-stripped; all joints and penetrations are caulked and sealed. 118(a): Insulationspecified or installed meets Standards for Insulating Material. Indicate type and include on CF -6R Form. §118(1): The thermal emittance and solar reflectance values of the cool roofing material meets the requirements of §118(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 orequivalent U -factor. 1 50 b : Loose fill insulation shall conform with manufacturer's installed design labeled R -Value. *§1 50 c : Minimum R-13 insulation in wood -frame wall orequivalent U -factor. *§1 50 d : Minimum R-13 insulation in raised wood -frame floor orequivalent U -factor. 150(f): Air retarding wrap is tested, labeled, and installed according to ASTM E1677-95(2000) when specified on the CF -1 R Form. 150 : Mandatory Vapor barrier installed in Climate Zones 14 or 16. §150(1): Water absorption rate for slab edge insulation material alone without facings is no greater than 0.3%; water vapor permeance rate is no qreater than 2.0perm/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 burning pilot lights and the use of indoor air for cooling a firebox jacket, when that indoor air is vented to the outside of the building, are prohibited. Space Conditioning, Water Heating and Plumbing System Measures: §110-§113: HVAC equipment, water heaters, showerheads, faucets and all other regulated appliances are certified by the Energy Commission. §113(c)5: Water heating recirculation loops serving multiple dwelling units and High -Rise residential occupancies meet the air release valve, backflow prevention, pump isolation valve, and recirculation loop connection requirements of §113(c)5. §115: Continuously burning pilot lights are prohibited for natural gas: fan -type central furnaces, household cooking appliances (appliances with an electrical supply voltage connection with pilot lights that consume less than 150 Btulhr are exempt), and pool and spa heaters. 150(h): Heating and/or cooling loads are calculated in accordance with ASHRAE, SMACNA or ACCA. 150(i): Heating systems are equipped with thermostats that meet the setback requirements of Section 112(c). §1506)1 A: Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are externally wrapped with insulation having an installed thermal resistance of R-12 or greater. §1500)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. §1500)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 150-13. §1500)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. §1500)2: Pipe insulation for steam hydronic heating systems or hot water systems >15 psi, meets the requirements of Standards Table 123-A. 150(j)3A: Insulation is protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. §150@3A: Insulation for chilled water piping and refrigerant suction lines includes a vapor retardant or is enclosed entirely in conditioned space. 150 4: Solar water -heating systems and/or collectors are certified by the Solar Rating and Certification Corporation. EnergyPro 5.1 by EnergySoff User Number. 4970 RunCode: 2013-10-21 T07:38.06 /D: 050113 Page 7 of 10 MANDATORY MEASURES SUMMARY: Residential Pae 2 of 3 MF -1 R Project Name Date Daisy Lee's Residence 10/21/2013 §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 openings reater 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)1: Any pool or spa heating equipment shall be installed with at least 36" of pipe between filter and heater, or dedicated suction and return lines, or built-up connections for future solar heating. 114(b)2: Outdoor pools ors as that have a heat pump or gas heater shall have a cover. §114(b)3: Pools shall have directional inlets that adequately mix the pool water, and a time switch that will allow all pumps to be set or programmed to run only during off-peak electric demand periods. 150 : Residential pool systems orequipment meet the pump sizing, flow rate, piping, filters, and valve requirements of §150 Residential Lighting Measures: §150(k)1: High efficacy luminaires or LED Light Engine with Integral Heat Sink has an efficacy that is no lower than the efficacies contained in Table 150-C and is not a low efficacy luminaire as specified by §150(k)2. 150(k)3: The wattage of permanently installed luminaires shall be determined asspecified by §130(d). §150(k)4: Ballasts for fluorescent lamps rated 13 Watts or greater shall be electronic and shall have an output frequency no less than 20 kHz. §150(k)5: Permanently installed night lights and night lights integral to a permanently installed luminaire or exhaust fan shall contain only high efficacy lamps meeting the minimum efficacies contained in Table 150-C and shall not contain a line -voltage socket or line - voltage lamp holder; OR shall be rated to consume no more than five watts of power as determined by §130(d), and shall not contain a medium screw -base socket. 150(k)6: Lighting integral to exhaust fans in rooms other than kitchens, shall meet the applicable requirements of §150(k). 1 50 k 7: All switching 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 2,500 112 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 EnergySofr User Number. 4970 RunCode: 2013-10-21 T07:38:06 /D: 050113 Page 8 of 10 MANDATORY MEASURES SUMMARY: Residential (Page 3 of 3 MF -1 R Project Name Date Daisy Lee's Residence 10/21/2013 §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)l 1: 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 listed for zero clearance insulation contact (IC) by Underwriters Laboratories or other nationally recognized testing/rating laboratory; and have a label that certifies the lumiunaire is airtight with air leakage less then 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283; and be sealed with a gasket or caulk between the luminaire housing and ceiling. §150(k)13: Luminaires providing outdoor lighting, including lighting for private patios in low-rise residential buildings with four or more dwelling units, entrances, balconies, and porches, which are permanently mounted to a residential building or to other buildings on the same lot shall be high efficacy. EXCEPTION 1: Permanently installed outdoor low efficacy luminaires shall be allowed provided that they are controlled by a manual on/off switch, a motion sensor not having an override or bypass switch that disables the motion sensor, and one of the following controls: a photocontrol not having an override or bypass switch that disables the photocontrol; OR an astronomical time clock not having an override or bypass switch that disables the astronomical time clock; OR an energy management control system (EMCS) not having an override or bypass switch that allows the luminaire to be always on EXCEPTION 2: Outdoor luminaires used to comply with Exceptionl to §150(k)13 may be controlled by a temporary override switch which bypasses the motion sensing function provided that the motion sensor is automatically reactivated within six hours. EXCEPTION 3: Permanently installed luminaires in or around swimming pool, water features, or other location subject to Article 680 of the California Electric Code need not be high efficacy luminaires. §150(k)14: Internally illuminated address signs shall comply with Section 148; OR not contain a screw -base socket, and consume no more than five watts of power as determined according to §130(d). §150(k)15: Lighting for parking lots and carports with a total of for 8 or more vehicles per site shall comply with the applicable requirements in Sections 130, 132, 134, and 147. Lighting for parking garages for 8 or more vehicles shall comply with the applicable requirements of Sections 130, 131, 134, and 146. §150(k)16: Permanently installed lighting in the enclosed, non -dwelling spaces of low-rise residential buildings with four or more dwelling units shall be high efficacy luminaires. EXCEPTION: Permanently installed low efficacy luminaires shall be allowed provided that they are controlled by an occupant sensors certified to comply with the applicable requirements of 119. EnergyPro 5.1 by EnergySoff User Number: 4970 RunCode: 2013-10-21T07:38:08 /D: 050113 Page 9 of 10 HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY Project Name Daisy Lee's Residence Date 10/21/2013 System Name Res HVAC Floor Area 1,589 ENGINEERING CHECKS SYSTEM LOAD Number of Systems 1 COIL COOLING CFM Sensible Total Room Loads 416 8,806 Return Vented Lighting 0 Return Air Ducts 399 Return Fan 0 Ventilation 0 0 Supply Fan 0 Supply Air Ducts 399 TOTAL SYSTEM LOAD 9,605 PEAK COIL HTG. PEAK Heating System Latent CFM Sensible Output perSystem 75,000 1,059 383 18,174 Total Output (Btuh) 75,000 Output Btuhi ft 47.2 1,009 Cooling System 0 Output perSystem 33,600 0 0 0 Total Output (Btuh) 33,600 1,0591'20,193 0 Total Output (Tons) 2.8 1,009 Total Output (Stuh/sgft) 21.1 Total Output s ftfTon 567.5 Air System CFM perSystem 1,050 HVAC EQUIPMENT SELECTION Airflow cfm 1,050 Carrier58MVB80-14 CNP 38HD 3 T 29,494 2,408 75,000 Airflow (cfm/s ft) 0.66 Airflow cfm/Ton 375.0 Outside Air °k) 0.0% Total Adjusted System Output 29,494 (Adjusted for Peak Design conditions) I TIME OF SYSTEM PEAK 2,408 75,000 Aug 3 PM Jan 1 AM Outside Air (cfm/ft 0.00 Note: values above given at ARI conditions HEATING SYSTEM PSYCHROMETRICS Airstream Tem ratures at Time of Heating Peak 281F 690F Outside Air Av- 0 cfm Supply Fan 1,050 cfm 69 OF 69 °F 115 IF Heating Coil r i 114 IF -- ROOMa 70 °F COOLING SYSTEM PSYCHROMETICS Airstream Temperatures at Time of Cooling Peak 88/68°F 75/62°F 75/62°F 55/54°F Outside Air 0 cfm Supply Fan Cooling Coil 55 / 54 IF 1,050 cfm 46.5% ROOM 75 / 62 OF 75/ 621F I EnergyPro 5.1 by EnergySoft User Number: 4970 RunCode: 2013-10-21T07:38:06 fD: 050113 Page 10 of 10 32E '"We" Landscaping Ordinance Appendix A APPENDIX A - LANDSCAPE WATER EFFICIENCY C (C , KLFF_RiINO 2010 S-25 LANDSCAPE WATER -EFFICIENCY CHECKLIST Community Development Department 10300 Torre Avenue 408.777.3308/Fax 408.777.3333 Cupertino, CA 95014 planning@cupertino.org CU PERTI NO http://cupertino.org/planrLini Applicant Name: i Email ' l f 0 0, 77cp vT Project Site Address: i Phone: Total Landscape _ y Landscape area: All the planting areas, turf areas, and water features in landscape installation. The landscape does Area (square feet): - 5 a area not include footprints of buildings or structures, sidewalks, driveways, parking lots, decks, patios, gravel or stone walks, Turf Area: { — Turf other pervious or non -pervious hardscapes, and other non - irrigated areas designated for non -development (e.g., open spaces and existing wildland vegetation). Non -Turf Plant Area: N A Turf: A ground cover surface consisting of non-native grass species that is customarily mowed. Annual bluegrass, Special Landscape Area P p 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 Wet Surface Area: If > 10% of landscaped area, water budget ©]cu- 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 "T above and proceed directly to the signature block at the bottom of this form Landscape Parameter 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 [If no, Water budget calculation required with landscape project submittal] All portions of turf areas shall be wider than eight (8) feet. @� Yes Turf (if utilized) is limited to slopes not exceeding 15%. [/Yes Non -Turf At least 80% of non -turf area shall consist of native or Yes ❑ No low water use plants. [If no, Water budget calculation require with landscape project submittal] Hydrazones Plants with similar water needs shall be grouped within [Yes ❑ No hydrazones. Each hydrozone shall be controlled by a [Plants can be grouped per separate valve. Table 14.15.050(C)] Irrigation System Systems shall be designed and maintained to minimize dYes ❑ 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 [lf no, Provide explanation on back] and 10:00 am Soil A minimum of eight (8) inches of non -compacted topsoil Ey Yes ❑ No shall be available in planted areas. [If no, Provide explanation on back] Soil amendments, such as compost or fertilizer, shall be Yes ❑ No appropriately added according to the soil conditions at the project site and based on what is appropriate for the [If no, Provide explanation on back] selected plants. Mulch A minimum two (2) -inch layer of mulch shall be applied 01/yes ❑ No on all exposed soil surfaces of planting areas, except in areas of direct seeding application (e.g. hydro -seed). [If no, Provide explanation on back] I am aware of available informational resources regarding native and low water use plants, irrigation efficiency, and other aspects o water -efficient landscaping. I certify that the information provided on this checklist is correct, and the installed landscape complies with the requirements of Chapter 14.15. I also understand that any changes to the project will necessitate a new checklist. -3 Signature of property owner or authorized representative Date 2010 S-25 BUILDING ENERGY ANALYSIS REPORT CUPERTINAML) Bdd;ng D e PROD REVIEWED FOR E COMPLIPtNCE Daisy Lee's Res'dence wed By. 10414 S. Foothi[,(bi,eVd. Cupertino, CA 95014 Project Designer: David Wong Home Deign and Consultant 958 Meadowood Drive San Jose, CA 95120 408-997-2735 C� Report Prepared by: Mark Chu & Associates 1141 S. Stelling Rd. Cupertino, CA 95014 (408) 255-4804 F J, lee Job Numbe 050113 i CUP RTINO i14, i idir)a 17elt?artnenl ) ip pV13 Date. fit. YV C�,! by 1L1iiiY �' 8/24/2013 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2008 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC — www.energysoft.com. EnergyPro 5.1 by EnergySoft User Number. • 4970 RunCode: 2013-08-24T09:55:49 /D: 050113 1 PERFORMANCE CERTIFICATE: Residential Part 1 of 5 CF-1 R Project Name Daisy Lee's Residence Building Type 0 Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition/Alteration Date 8/24/2013 Project Address 10414 S. Foothill Blvd. Cupertino California Energy Climate Zone CA Climate Zone 04 Total Cond. Floor Area 815 Addition n/a # of Stories 1 FIELD INSPECTION ENERGY CHECKLIST ❑ Yes El No HERS Measures -- If Yes, A CF-4R must be provided per Part 2 of 5 of this form. El Yes ❑ No Special Features -- If Yes, see Part 2 of 5 of this form for details. INSULATION Area Special Construction Type Cavity ( Features see Part 2 of 5 Status Wall Wood Framed R-13 936 New Door Opaque Door None 20 New Floor Wood Framed wlCrawl Space R-19 815 New Roof Wood Framed Attic R-30 815 Radiant Barrier New FENESTRATION U- Exterior Orientation Area(fie) Factor SHGC Overhang Sidef ins Shades Status Front (W) 24.0 0.370 0,32 none none Roll-down Blind or Slats New Front (W) 40.0 0.510 0.61 none none Roll-down Blind or Slats Existing Left (N) 14.0 0.370 0.32 none none Roll-down Blind or Slats New Rear (E) 103.0 0.370 0.32 none none Roll-down Blind or Slats New Right (S) 20.5 0.510 0.61 none none Roll-down Blind or Slats Existing Right (S) 6.0 0.370 0.32 none none Roll-down Blind or Slats New HVAC SYSTEMS Ot . Heating Min. Eff Cooling Min. Eff Thermostat Status 1 Central Furnace 97% AFUE Split Air Conditioner 13.0 SEER Setback New HVAC DISTRIBUTION Duct Location Heating Cooling Duct Location R-Value Status Res HVAC Ducted Ducted Attic, Ceiling Ins, vented 6.0 New WATER HEATING Ot - Type Gallons Min. Eff Distribution Status 1 Small Gas 50 0.61 No Pipe Insulation New EnergyPro 5.1 by EnargySoft User Number: 4970 RunCode: 2013-08-24T09:55:49 ID: 050113 Pae 2 of 11 PERFORMANCE CERTIFICATE: Residential Part 2 of 5) CF -1 R Project Name Daisy Lee's Residence Building Type ® Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition/Alteration Date 8/24/2013 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. The Roof R-30 Roof Attic with Radiant Barrier includes credit for a Radiant Barrier that is Continuous meeting eligibility and installation criteria as specified in Residential Appendix RA4.2.2. 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. Ene Pro 5.1 by Ener Soft User Number. • 4970 RunCode: 2013-08-24709:55:49 /D: 050113 Pa e 3 of 11 PERFORMANCE CERTIFICATE: Residential (Part 3 of 5) CF -1 R Project Name Building Type 0 Single Family ❑ Addition Alone Date Daisy Lee's Residence ❑ Multi Family ❑ Existing+ Addition/Alteration 8/24/2013 ANNUAL ENERGY USE SUMMARY Standard Proposed Margin TDV kBtu/ft2- r Space Heating 27.09 29.07 -1.99 Space Cooling 12.97 6.50 6.47 Fans 7.45 6.66 0.79 Domestic Hot Water 33.64 31.60 2.04 Pumps 0.00 0.00 0.00 Totals 81.16 73.84 7.32 Percent Better Than Standard: 9.0% BUILDING COMPLIES - NO HERS VERIFICATION REQUIRED Fenestration Building Front Orientation: (149 270 deg Ext. Walls/Roof Wall Area Area Number of Dwelling Units: 1.00 (w) 311 64 Fuel Available at Site: Natural Gas (N) 230 14 Raised Floor Area: 815 (E) 311 103 Slab on Grade Area: 0 (S) 311 27 Average Ceiling Height: 8.0 Roof 815 0 Fenestration Average U -Factor: 0.41 TOTAL: 208 Average SHGC: 0.40 Fenestration/CFA Ratio: 25.5 REMARKS STATEMENT OF COMPLIANCE This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 the Administrative Regulations and Part 6 the Efficiency Standards of the California Code of Regulations. The documentation author hereby certifies that the documentation is accurate and complete. Documentation Authores Company �C4�� ^�Y+�- 1141 S. Stelling Rd. 8!24/2013 Address Name City/State/ZipCity/State/Zip Cupertino, CA 95014 Phone (408) 255-4804 Signed Date The individual with overall design responsibility hereby certifies that the proposed building design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application, and recognizes that compliance using duct design, duct sealing, verification of refrigerant charge, insulation installation quality, and building envelope sealing require installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) Company David Wong Home Deign and Consultant / �1 � J -Z 13 958 Meadowood Drive David Won , ! Address Name g City/State/Zip San Jose, CA 95120 Phone 408-997-2735 Signed License # Date Ener Pro 5.1 by Ene Soft User Number. 4970 RunCode: 2013-08-24T09:55:49 ID: 050113 Page 4 of 11 CERTIFICATE OF COMPLIANCE: Residential (Part 4 of 5) CF -1 R Project Name Daisy Lee's Residence Building Type R1 Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition/Alteration Date 1812412013 OPAQUE SURFACE DETAILS Surface U- Insulation Joint Appendix Type Area Factor Cavity Exterior Frame Interiorl Frame Azm Tilt Status 4 Location/Comments Wall 227 0.102 R-13 270 90 New 4.3.1-A3 1st Floor Zone Door 20 0.500 None 270 90 New 4.5.1-A4 1st Floor Zone Wall 216 0.102 R-13 0 90 New 4.3.1-A3 1st Floor Zone Wall 208 0.102 R-13 90 90 New 4.3.1-A3 1st Floor Zone Floor 815 0.037 R-19 0 180 New 4.4.1-A4 1st Floor Zone Wall 285 0.102 1 R-13 180 90 New 4.3.1-A3 1st Floor Zone Roof 815 0.031 R-30 0 22 New 4.2.1-A20 1st Floor Zone FENESTRATION SURFACE DETAILS ID Type Area U -Factor SHGC Azm Status Glazing Type Location/Comments 1 Window 5.0 0.370 NFRC 0.32 NFRC 270 New IWC 5300 VinyULow-E 1st Floor Zone 2 Window 7.0 0.370 NFRC 0.32 NFRC 270 New IWC 5300 VinyULow-E 1st Floor Zone 3 Window 6.0 0.370 NFRC 0.32 NFRC 270 New IWC 5300 Vin 1/Low-E 1st Floor Zone 4 Window 20.0 0.510 NFRC 0.61 NFRC 270 Existing IWC 5300 Vinyl/Clear 1st Floor Zone 5 Window 6.0 0.370 NFRC 0.32 NFRC 270 New I /WC 5300 Vinyl/Low-E 1st Floor Zone 6 Window 20.0 0.510 NFRC 0.61 NFRC 270 Existing I IWC 5300 VinyUClear 1 st Floor Zone 7 1 Window 14.01 0.370 NFRC 0.32 NFRC 0 New IWC 5300 VinyULow-E 1st Floor Zone 8 Window 7.0 0.370 NFRC 0.32 NFRC 90 New IWC 5300 VinyULow-E 1st Floor Zone 9 Window 20.0 0.370 NFRC 0.32 NFRC 90 New IWC 5300 VinyULow-E 1 st Floor Zone 10 Window 7.0 0.370 NFRC 0.32 NFRC 90 New IWC 5300 VinyULow-E 1 st Floor Zone 11 Window 40.0 0.370 NFRC 0.32 NFRC 90 New IWC 5300 VinyULow-E 1st Floor Zone 12 Window 7.0 0.370 NFRC 0.32 NFRC 90 New IWC 5300 Vinyl/Low-E 1st Floor Zone 13 Window 15.0 0.370 NFRC 0.32 NFRC 90 New IWC 5300 VinyULow-E 1st Floor Zone 14 Window 7.0 0.370 NFRC 0.32 NFRC 90 New IWC 5300 VinyULow-E 1st Floor Zone 15 Window 20.5 0.510 NFRC 0.61 NFRC 180 Existing IWC 5300 VinyUClear 1st Floor Zone 16 Window 3.0 0.370 NFRC 0.32 NFRC 180 New IWC 5300 VinyULow-E 1st Floor Zone (1) U -Factor Type: 116-A = Default Table from Standards, NFRC = Labeled Value 2 SHGC Type: 116-B = Default Table from Standards, NFRC = Labeled Value EXTERIOR SHADING DETAILS ID Exterior Shade Type SHGC Window H t Wd Ove hanq Left Fin Right Fin Len H t LExt RExt Dist Len H t Dist Len H t 1 Roll -down Blind or Slats 0.13 2 Roll -down Blind or Slats 0.13 3 Roll -down Blind or Slats 0.13 4 Roll -down Blind or Slats 0.13 5 Roll -down Blind or Slats 0.13 6 Roll -down Blind or Slats 0.13 7 Roll -down Blind or Slats 0.13 8 Roll -down Blind or Slats 0.13 9 Roll -down Blind or Slats 0.13 10 Roll -down Blind or Slats 0.13 11 Roll -down Blind or Slats 0.13 12 Roll -down Blind or Slats 0.13 13 Roll -down Blind or Slats 0.13 14 Roll -down Blind or Slats 0.13 15 Roll -down Blind or Slats 0.13 16 Roll -down Blind or Slats 0.13 EhergyPro 5.1 by EnergySoft User Number: 4970 RunCode: 2013-08-24T09:55:49 0: 050113 Page 5 of 11 CERTIFICATE OF COMPLIANCE: Residential (Part 4 of 5) CF -1 R Project Name Daisy Lee's Residence Building Type 2 Single Family ❑ Multi Family ❑ Addition Alone ❑ Existing+ Addition/Alteration Date 8124/2013 OPAQUE SURFACE DETAILS Surface U- Insulation Type Area FactorCavit Exterior Frame Interior Frame Azm Tilt Status Joint Appendix 4 Location/Comments FENESTRATION SURFACE DETAILS ID Type Area U -Factor SHGG2 Azm Status Glazing Type Location/Comments 17 Window 3.0 0.370 NFRC 0.32 NFRC 180 New IWC 5300 Vinyl/Low-E 1st Floor Zone (1) U -Factor Type: 116-A = Default Table from Standards, NFRC = Labeled Value 2 SHGC Type: 116-B = Default Table from Standards, NFRC = Labeled Value EXTERIOR SHADING DETAILS Window Overhang ID Exterior Shade Type SHGC H t Wd Len H t LExt RExt Left Fin Right Fin Dist Len H t Dist Len H t 17 Roll -down Blind or Slats 0.13 EnergyPro 5.1 by EnergySoft User Number. 4970 RunCode: 2013-08-24T09:55:49 ID: 050113 Page 6 of 11 CERTIFICATE OF COMPLIANCE: Residential (Part 5 of 5) CF -1 R Project Name Daisy Lee's Residence Building Type ® Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition/Alteration Date 8/24/2013 BUILDING ZONE INFORMATION System Name Zone Name Floor Area ft New Existin Altered Removed Volume Year Built Res HVAC 1st Floor 815 6,520 Totals 815 0 0 0 HVAC SYSTEMS System Name Qty. Heating Type Min. Eff. Cooling Type Min. Eff. Thermostat Type Status Res HVAC 1 Central Furnace 97% AFUE Split Air Conditioner 13.0 SEER Setback New HVAC DISTRIBUTION System Name Heating Coolin Duct Location Duct R -Value Ducts Tested? Status Res HVAC Ducted Ducted Attic, Ceiling Ins, vented 6.0 ❑ New 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 RHEEM 44V50 1 Small Gas No Pipe Insulation 40,000 50 0.61 n/a n/a New MULTI -FAMILY WATER HEATING DETAILS HYDRONIC HEATING SYSTEM PIPING Control Hot Water Piping Length ft 0 _ o m — System Name Pipe Length Pipe Diameter Insul. Thick. Qty. HP Plenum Outside Buried EnergyPro 5.1 by EnergySoft User Number. 4970 RunCode: 2013-08-24T09:55:49 /D: 050113 Pae 7 of 11 MANDATORY MEASURES SUMMARY: Residential Pae 1 of 3 MF -'1 R Project Name Daisy Lee's Residence Date 8/24/2013 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 listed on the Certificate of Compliance (CF -1 R, CF -1 R -ADD, or CF - 1 R -ALT Form) shall supersede the items marked with an asterisk (*) below. This Mandatory Measures Summary shall be incorporated into the permit documents, and the applicable features shall be considered by all parties as minimum component performance specifications whether they are shown elsewhere in the documents or in this summary. Submit all applicable sections of the MF -1 R Form with plans. Building Envelope Measures: 116(a)1: Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage. §116(a)4: Fenestration products (except field -fabricated windows) have a label listing the certified U -Factor, certified Solar Heat Gain Coefficient SHGC , and infiltration that meets the requirements of 10-111 (a). 117: Exterior doors and windows are weather-stripped; all joints and penetrations are caulked and sealed. 118(a): Insulationspecified or installed meets Standards for Insulating Material. Indicate type and include on CF -6R Form. §118(1): The thermal emittance and solar reflectance values of the cool roofing material meets the requirements of §118(i) when the installation of a Cool Roof is specified on the CF -1 R Form. *§1 50 a : Minimum R-19 insulation in wood -frame ceiling orequivalent U -factor. 150(b): Loose fill insulation shall conform with manufacturer's installed design labeled R -Value. *§1 50 c : Minimum R-13 insulation in wood -frame wall orequivalent U -factor. *§1 50 d : Minimum R-13 insulation in raised wood -frame floor orequivalent U -factor. 150(f): Air retarding wrap is tested, labeled, and installed according to ASTM El 677-95(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 burning pilot lights and the use of indoor air for cooling a firebox jacket, when that indoor air is vented to the outside of the building, are prohibited. Space Conditioning, Water Heating and Plumbing System Measures: §110-§113: HVAC equipment, water heaters, showerheads, faucets and all other regulated appliances are certified by the Energy Commission. §113(c)5: Water heating recirculation loops serving multiple dwelling units and High -Rise residential occupancies meet the air release valve, backflow prevention, pump isolation valve, and recirculation loop connection requirements of §113(c)5. §115: Continuously burning pilot lights are prohibited for natural gas: fan -type central furnaces, household cooking appliances (appliances with an electrical supply voltage connection with pilot lights that consume less than 150 Btu/hr are exempt), and pool and spa heaters. 150(h): Heating and/or cooling loads are calculated in accordance with ASHRAE, SMACNA or ACOA. 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. §1500)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. §1500)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@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. i 50(j)3A: Insulation is protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. §1 506)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: 4970 RunCode: 2013-08-24T09:55:49 ID: 050113 Page 8 of 11 MANDATORY MEASURES SUMMARY: Residential (Page 2 of 3 MF -1 R Project Name Date Daisy Lee's Residence 8/24/2013 §150(m)l : All air -distribution system ducts and plenums installed, are sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R- 4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181 A, or UL 181 B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings reater than 1/4 inch, the combination of mastic and either mesh or tape shall be used §150(m)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)1: Any pool or spa heating equipment shall be installed with at least 36" of pipe between filter and heater, or dedicated suction and return lines, or built-up connections for future solar heating. 114(b)2: Outdoor pools ors as that have a heat pump or gas heater shall have a cover. §114(b)3: Pools shall have directional inlets that adequately mix the pool water, and a time switch that will allow all pumps to be set or programmed to run only during off-peak electric demand periods. 150 : Residential pool systems orequipment meet the pump sizing, flow rate, piping, filters, and valve requirements of §150 Residential Lighting Measures: §150(k)1: High efficacy luminaires or LED Light Engine with Integral Heat Sink has an efficacy that is no lower than the efficacies contained in Table 150-C and is not a low efficacy luminaire asspecified by §150(k)2. 150(k)3: The wattage of permanently installed luminaires shall be determined asspecified by §130(d). §150(k)4: Ballasts for fluorescent lamps rated 13 Watts or greater shall be electronic and shall have an output frequency no less than 20 kHz. §150(k)5: Permanently installed night lights and night lights integral to a permanently installed luminaire or exhaust fan shall contain only high efficacy lamps meeting the minimum efficacies contained in Table 150-C and shall not contain a line -voltage socket or line - voltage lamp holder; OR shall be rated to consume no more than five watts of power as determined by §130(d), and shall not contain a medium screw -base socket. 150(k)6: Lighting integral to exhaust fans, in rooms other than kitchens, shall meet the applicable requirements of §150(k). 150(k)7: All switching devices and controls shall meet the requirements of §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: 4970 Run Code: 2013-08-24T09:55:49 ID: 050113 Page 9 of 11 MANDATORY MEASURES SUMMARY: Residential (Page 3 of 3 MF -1 R Project Name Date Daisy Lee's Residence 8/24/2013 §150(k)10: Permanently installed luminaires in bathrooms, attached and detached garages, laundry rooms, closets and utility rooms shall be high efficacy. EXCEPTION 1: Permanently installed low efficacy luminaires shall be allowed provided that they are controlled by a manual -on occupant sensor certified to comply with the applicable requirements of §119. EXCEPTION 2: Permanently installed low efficacy luminaires in closets less than 70 square feet are not required to be controlled by a manual -on occupancy sensor. §150(k)11: Permanently installed luminaires located in rooms or areas other than in kitchens, bathrooms, garages, laundry rooms, closets, and utility rooms shall be high efficacy luimnaires. EXCEPTION 1: Permanently installed low efficacy luminaires shall be allowed provided they are controlled by either a dimmer switch that complies with the applicable requirements of §119, or by a manual - on occupant sensor that complies with the applicable requirements of §119. EXCEPTION 2: Lighting in detached storage building less than 1000 square feet located on a residential site is not required to comply with §150 k 11. §150(k)12: Luminaires recessed into insulated ceilings shall be listed for zero clearance insulation contact (IC) by Underwriters Laboratories or other nationally recognized testing/rating laboratory; and have a label that certifies the lumiunaire is airtight with air leakage less then 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283; and be sealed with a gasket or caulk between the luminaire housing and ceiling. §150(k)13: Luminaires providing outdoor lighting, including lighting for private patios in low-rise residential buildings with four or more dwelling units, entrances, balconies, and porches, which are permanently mounted to a residential building or to other buildings on the same lot shall be high efficacy. EXCEPTION 1: Permanently installed outdoor low efficacy luminaires shall be allowed provided that they are controlled by a manual on/off switch, a motion sensor not having an override or bypass switch that disables the motion sensor, and one of the following controls: a photocontrol not having an override or bypass switch that disables the photocontrol; OR an astronomical time clock not having an override or bypass switch that disables the astronomical time clock; OR an energy management control system (EMCS) not having an override or bypass switch that allows the luminaire to be always on EXCEPTION 2: Outdoor luminaires used to comply with Exceptions to §150(k)13 may be controlled by a temporary override switch which bypasses the motion sensing function provided that the motion sensor is automatically reactivated within six hours. EXCEPTION 3: Permanently installed luminaires in or around swimming pool, water features, or other location subject to Article 680 of the California Electric Code need not be high efficacy luminaires. §150(k)14: Internally illuminated address signs shall comply with Section 148; OR not contain a screw -base socket, and consume no more than five watts of power as determined according to §130(d). §150(k)15: Lighting for parking lots and carports with a total of for 8 or more vehicles per site shall comply with the applicable requirements in Sections 130, 132, 134, and 147. Lighting for parking garages for 8 or more vehicles shall comply with the applicable requirements of Sections 130,131, 134, and 146. §150(k)16: Permanently installed lighting in the enclosed, non -dwelling spaces of low-rise residential buildings with four or more dwelling units shall be high efficacy luminaires. EXCEPTION: Permanently installed low efficacy luminaires shall be allowed provided that they are controlled by an occupant sensors certified to comply with the applicable requirements of 119. EnergyPro 5.1 by EnergySoft User Number. 4970 RunCode: 2013-08-24T09:55:49 ID: 050113 Page 10 of 11 HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY Project Name Daisy Lee's Residence Date 8/24/2013 System Name Res HVAC Floor Area 815 ENGINEERING CHECKS SYSTEM LOAD Number of Systems 1 COIL CFM Total Room Loads 335 Return Vented Lighting Return Air Ducts Return Fan Ventilation 0 Supply Fan Supply Air Ducts TOTAL SYSTEM LOAD COOLING PEAK COIL HTG. PEAK Heating System Sensible Latent CFM Sensible Output per System 38,000 7,056 933 263 12,471 Total Output (Btuh) 38,000 0 Output Btuh/s ft 46.6 320 693 Cooling System o 0 Output per System 23,700 0 0 0 0 Total Output (Stun) 23,700 0 933 0 Total Output (Tons) 2.0 320 693 Total Output Btuh/s ft) 29.1 Total Output s ft/Ton 412.7 7,697 13,856 Air System CFM per System 700 HVAC EQUIPMENT SELECTION Airflow cfm) 700 Carrier 58MVB40-14 CNP 38HD 2 T 20,915 1,634 38,000 Airfiow cfm/s ft 0.86 Airflow (cfm/Ton) 354.4 Outside Air %) 0.0% Total Adjusted System Output (Adjusted for Peak Design conditions) TIME OF SYSTEM PEAKAug 20,915 1,634 38,000 Jan 1 AM Outside Air cfm/S ft 0.00 Note: values above given at ARI conditions 3 PM HEATING SYSTEM PSYCHROMETRICS (Airstream Temperatures at Time of Heating Peak 28 OF 69 IF Outside Air 0 cfm Supply Fan 700 cfm 69 OF 69 OF 115 OF Heating Coil I 114 OF ROOM 70 OF COOLING SYSTEM PSYCHROMETICS Airstream Temperatures at Time of Cooling Peak 88/68°F 75/62°F 75/62°F 55/54°F Outside Air 0 cfm Supply Fan Cooling Coil 700 cfm 75 / 62 OF i 55 / 54 OF 46.9% ROOM li 75 / 62 OF EnergyPro 5.1 by EnergySoff User Number. 4970 RunCode: 2013-08-24T09:55:49 ID: 050113 Page 11 of 11 Project Name: Project Address: Project Descriptiom CALGREEN SIGNATURE D] (,'UP ERT IN 0 JIM!$ uePart�-Ifnnt I.SECTION I - DESIGN VERIFICATION Complete all lines of Se --tion 1 - "Design Venfication- and submit 0h ed checkfist lColumns 1 and 2) with the plans and building Permit ap-.)licat"or, to ti -le Suiidino DepartmenO. -ke owner and design professional responsltle for compdance. vvith Standan4s have revised tne Onns and certl'�y that the items checked above are hereby incorporated into the project plans and will be impiernerited into the project ir accotance with, the requirements set forth in. the 201 D Cal l"alli-een 6kiding Standards Code as adopted by the C=ty cf Cuoe-tino. . ......... r 'iMamma Dasign Proless'onal's Na"ne Lzr;e7-s,P,o'esso;, a'-espa"'s t,e 'or -o ona. -.--e P,m- Lice P ons�"ie !or Ca,G,ee compi�ance! Pie- 0 w" - - — - - - - - ------------ . . .... ..... . MaM F*121 F-Mity, 1 -31:1 if, 13211 NUNN, 10721.113 ram Cn-,=;ele. sion, 3,nd s�,brif 'he Cornpe"Lad ,---he6d,st� �nc>:,ding 3, together w�th -i" coriginal signatu;--as or S-,,-,Iicn -men' -,al inspectic�n. 2 O *�Ine 6it D"� 1-tirg PaMTert p, ioi- to Suiichng Depa, ., fl,! I have inspected "ne ,Vorlk and have ieceived suffiecient 0 veffY an -1 certfy thatthe �--rojec� idenfifled aho%/e `vias cor's,"Lic"ed N - accordance s fh�s, Green Builarng Id in acc�orda r—en's of t' e 201�,-) Ca�Jc.mia Gr C U CtAfRTNO" �:)deasadcpted � of Lce-ise Da Name ro"Lcer P, r . . � U F- ),ersiona� re's-o'ns'u, e fi�- Cai3re-am G(`(A:P'HuAN(>, or Ca:Gee, 5 CUPERTtNO PURPOSE: 2010 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 • build inQ(ailcupertino.or4 The 2010 CalGreen Code applies to all newly constructed hotels, motels, lodging houses, dwellings, dormitories, condominiums, shelters, congregate residences, employee housing, factory -built housing and other types of swellings with sleeping accommodations and new accessory buildings associated with such uses. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: Project Address: 0 � SO o f I'l , a Ca TlJ T Project Description: Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2010 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. Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Requirements 4.104.1 A site plan and inventory of the site is developed and used to minimize site disturbance in order preserve desirable existing natural resources and ❑X ❑ minimize future adverse effects on the proposed structure. 4.106.2 A plan is developed and implemented to manage storm water MX drainage during construction, 4.106.3 The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage X❑ ❑ system will manage all surface water flows. Page 1 of 5 CalGreen_2010.doc revised 08127111 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. ED 0 4.303.1 Indoor water use shall be reduced by at least 20 percent using one of the follow methods. ❑ Water saving fixtures or flow restrictors shall be used per Table 4.303.2. 0 ❑ ❑ A 20 percent reduction in baseline water use shall be demonstrated per As of 7/0112011 Table 4.303.1. 4.303.2 When using the calculation method specified in Section 4.303.1, 0 multiple showerheads shall not exceed maximum flow rates. ❑ As of 7/01/2011 4.303.3 Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with specified performance requirements. As of 7/01/2011 4.304.1 Automatic irrigation systems installed at the time of final inspection I 0 shall be weather -based. f 4.406.1 Joints and openings. 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. 4.408.2 Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall QX be submitted for approval to the enforcing agency. 4.410.1 An operation and maintenance manual shall be provided to the building occupant or owner. Page 2 of 5 CalGYeen_2010.doc revised 08/27%11 A4.5 - ifi$j9�aCos 4.503.1 Install only a direct -vent sealed -combustion gas or sealed wood- ❑ ❑ burning fireplace, or a sealed woodstove. NPol utant ntroi 4.504.1 Duct openings and other related air distribution component openings MX shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks shall be compliant with VOC and ❑ ❑ other toxic compound limits. 4.504.2.2 Paints, stains and other coatings shall be compliant with VOC limits. X❑ ❑ 4.504.2.3 Aerosol paints and other coatings shall be compliant with product ❑X ❑ weighted MIR Limits for ROC and other toxic compounds. 4.504.2.4 Documentation shall be provided to verify that compliant VOC limit ❑ ❑ finish materials have been used. 4.504.3 Carpet and carpet systems shall be compliant with VOC limits. ❑X ❑ 4.504.4 Fifty (50) 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 Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall comply with low formaldehyde ❑X ❑ emission standards. {ntedbr Moisture Control 4.505.2 Vapor retarder and capillary break is installed at slab on grade foundations. ❑X ❑ 4.505.3 Moisture content of building materials used in wall and floor framing is ❑ ❑ checked before enclosure. Page 3 of 5 CalGreen_2010.doc revised 08127111 4.506.1 Exhaust fans which terminate outside the building are provided in 13every bathroom. 4,507.1 Whole house exhaust fans shall have insulated louvers or covers which close when the fan is off. Covers or louvers shall have a minimum insulation value of R-4.2. 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. 702.1 HVAC system installers are trained and certified in the proper installation of HVAC systems. 702.2 The Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the discipline they inspect and verify. 703.1 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. 0 0 'Ml 0 0 AN] L -J 0J Page 4 of 5 CalCreen_2010.doe revised 08127111