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13050102
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10218 BRET AVE CONTRACTOR:D&D CONSTRUCTION PERMIT NO: 13050102 AND DEVELOPMENT OWNER'S NAME: LI'S CAPITAL LLC PO BOX 3565 DATE ISSUED: 10/03/2013 OWNER'S PHONE: 4087253692 FREMONT,CA 94539 PHONE NO:(510)579-2353 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL 11 License Class_ Lic.# ? ,6-2.,C." CONSTRUCT 2 STORY SFDWL,1ST FLOOR- 1,923.2ND FLOOR 1,524 SQ FTO INCLUDE(2)CAR GARAGES 712 SQ Contractor �r✓� X L& Date 10-3 - 1 FT,PORCH 101 SQ,PATIO 110 SQ FT I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$500000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:37511033.00 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 WITHIN0 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 DgYyFF M LAST CALLED INSPE TION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the (5 granting of this permit. Additionally,the applicant understands and will comply Issued by. Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 1 (9 All roofs shall be inspected prior to any roofing material being installed.if a roof is installed without first obtaining an inspection,l agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain aCertificate 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 I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio ry 2W,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this t c -) permit is issued. ,- Owner or authorized agent: Date: I certify that in the performance of the work for which this permit is issued,l 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,l CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,l must l hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save 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 CONSTRUCTION PERMIT APPLICATION 1�2' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIO 10300 TORRE.AVENUE•CUPERTINO, CA 95014-3255 (40:8).77773228• FAX(408)777-3333•building(@cupertino.org 1 CUPERTINOE NEW CONSTRUCTION C ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ✓T APN# S.� l t /�•� OWNERNAME u S Wk-m(,rHO E-MAIL acf�o 257 STREET ADDRESS. 75%Co CITY,STATE,ZIP e� � � „� - FAX CONTACT NAME D PHONE '1C) T 1 L L r EYEt Q, )A STREET ADDRESS' CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUIIAER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARctirmcT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME l 1 LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME 11 / 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 n -� �^ \ �F V\ VE4L1-477Vu i V i Nom- / ` AIL Z SE QA 1 }. EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES J C E yt" V(2> USE TYPE OCC. SQ.FT. VALUATION(S) EXLSTG 7 •`NEW FLOOR r'TDEMO TOTAL . AREA I 500 AREA ;44 AREA y s� NET AREA ` Y+7 BATHROOM KITCHEN 1 OTHER ' 1 REMODEL AREA Nor I - REMODEL AREA REMODEL AREA � - .PORCHAREA ff' DECK ARE�Ay TOTAL DECK/PORCH AREA G (A�RAGryE AREA: DETACH -11 2, ATTACH . #DWELLING UNITS:" IS A SECOND UNIT ❑YES SECOND STORY DYES . BEING ADDED? ANO ADDITION? J]'NO ]l PRE-APPLICATION IF YES,PROVIDE COPY OF 1S THE BLDG AN YESRECEIVED TOTAL VALUATION: PLANNING ADPL# NO PLANNING APPROVAL LETTER EICHLERHOME? XNO € 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 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 building construction. I uthorize representatives of Cupertino to enter the above-identified property for inspection purposes. 1141 Signature of Applicant/Agent: Date: J ! 1 4 1-LO 1 SUPPLEMENT Q INFORMATION REQUIRED s, ,P�CHECK�YT PE, ROiTfINGSLIP 96i, �hs - New SFD or Multifamily dwellings: Apply for demolition permit for 10-1i wt OYER TI3ECDU1Y7ER B PLANRE. € existing building(s)._.Demolition permit is required prior to issuance of building permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials DisclosuresTIvna�tD form if any Hazardous Materials are being used as part of this project. RC1 LARc _Copy of Planning Approval Letter or Meeting with Planning prior to �I submittal of Building Permit application. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10218 Bret ave DATE: 05/14/2013 REVIEWED BY: Mendez APN: BP#: 4_3 0n_21 D�;,_ `VALUATION: 1$500,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 2nd Unit? 0 Yes 0 No PENTAMATION 1R3.SFDW USE: PERMIT TYPE: WORK construct 2 story sfdwl 1 st floor- 1,923. 2nd floor 1,524 sq fto include 2 car garages 712 sq ft porch SCOPE 101 sq, patio 110 sq ft OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,111-B,IV,V-B 4,370 $3,072.76 IR3PLNCK $3,471.64 IR3INSP TOTALS: 4,370 $3,072.76 $3,471.64 oih. Ll NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 11-053 Elf' 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,072.76 Select a Misc Bldg/Structure Suppl. PC Fee: E) Reg. 0 OT FO.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $3,471.64 Suppl.Insp. Feer Reg. © OT T0.01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 # Construction Tax: 1BCONSTAXR 1 unitnews $641.96 `u2lrtsslF'ctrFcc' Work Without Permit? 0 Yes (F) No $0.00 0 Advanced Planning Fee: 1PLLONGR $568.10 Select a Non-Residential Building or Structure , _i Strong Motion Fee: 1BSEISMICR $50.00 Select an Administrative Item Bldg;Stds Commission Fee: IBCBSC $20.00 S>CTBTOTALSs��. $7,824.46 $0.00 TOTAL FEE�:. $7,824.46 Revised: 04/29/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 16 9rte. PERMIT# 13 CSD L02 OWNER'S NAME: U'/, 0�-Q+-�-�� , I�.C� PHONE# b - -Z GENERAL CONTRACTOR: 1P �Z) Cah.'f'-"'C;k BUSINESS LICENSE# ADDRESS: v. vv',01A4,531 CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical C 30`7- CSS Excavation M �,G �, �, Q4 4-6 t- t,,6-1Z 3 3V'1 Fencing Flooring /Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering tee n C- r w aAl 5 f7 3 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date r� 2010 CALGREEN RESIDENTIAL CHECKLIST — MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO ALBERT SALVADOR.P-E.,C B O..BUILDING OFFICIAL '0300 TORRE AVENUE•CUPERTINO.CA 95014-3255 ;408}777-3228-FAX(408)777-3333•b1til c1Qr nin,g_grg PURPOSE: 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 CAL Green. Project Name, IST CAPITAL RESTDENCE. Project Address: 102.18 BRET AVE. ProjectDescriptien NEW 4, 1.59SF WO STORIES HOME -- `— 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 property 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 Re uirements A4.t PLANNING AND DESIGN Planning and Deslgri-Slte"Preseniatiori 4.104.1 A see plan and inventory of the site is developed and used to minimize site disturbance In order preserve desirable existing natural resources and QX 0 minimize future adverse effects on the proposed structure. Planning and Design -Site Development 4.106.2 A plan Is developed and Implemented to marage storm water drainage during construction L1 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 XD s Q system will manage all surface water flows Page 1 00 CaIGrcrd 2 0!0.d K r"ije 1 0&?7.!1 A4.2 ENERGY EFFICIENCY General 4.201.1 low-rise residential buildings shall meet or exceed the minimum standard design required by the Califomia Energy Standards. A4.3 WATER EFFICIENCY AND CONSERVATION Indoor Water Use ' 4.307.1 Indoor water use shall be reduced by at least 20 percent using ore of the follow methods_ !� ❑ Water saving fixtures or flow restnctors shall be used per Table 4.303 2. E X Q A3 of 7101/2011 ❑ A 20 percent reduction in baseline water use shall be demonstrated per II Table 4.303.1- ! 4.303.2 When using the calculation method specified in Section 4.303.1, i a ❑ multiple showerheads shall not exceed max;mum now rates ? r As of 7101/2011 4.303.3 Plumbing fixtures(water closets and urinals)and fittings(faucets and shcwerheads)shall comply with specified performance requtremerts, Q As of 7/0112 011 Outdoor Water Use 4.304.1 Automatic irrigation systems installed at the time of final inspection j a a snail be weather-based. MATERIAL • ` • Enhanced Durability and Reduced Maintenance 4.406.1 Joints and openings.Annular spaces around pipes,elec;nc cables, condu;ts,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. f I Construction Waste Reduction,Disposal and Recycling ? 4.408.2 Where a local jurisdiction does not have a construction and demolition waste management ordinance,a construction waste management plan shall ® Q be submitted for approval to the enforcing agency. 1 Building Maintenance and Operation -------_._.._-._..._.__.__-.. E 4.410.1 An operation and maintenance manual small be provided to the f r� budding occupant or owner. •^-3 El Page 2 o!'S Calrrern ?O R Stix•remed qi;,i'-1l ENVIRONMENTAL QUALITY Fireplaces 4.507,1 Install only a direct-vent sealed-combustion gas or sealed wood- 1 burning(replace,or a sealed woodstove. Pollutant Control i 4.504.1 Duct openings and other related air distribution component openings j shall be covered during construction. a ❑ 4.504.2.1 Adhesives,sealants and caulks shall be compliant with VOC ar.d other toxic compound limits. 4.504.2.2 Paints,stairs and other coatings shall be compliant with VOC limits ❑X ❑ 4.504,2.3 Aerosol paints and other coatings shall be compliant with product weighted MIR Limits for ROC and other toxic compounds 4.504.2.4 Documentation shall be provided to venty that compliant VOC limit finish materials have been used. 4.504.3 Carpet and carpet systems shall be compliant with VOC limits. 4 Q , 4,504.4 Fifty(50)percent of floor area receiving resilient flooring shall comply I with the VOC-emission limits defined in the Collaborative for High Performance ` ❑ Schools(CHIPS)Low-emitting Materials List or be certified under the Resilient I Floor Covering Institute(RCFI)FloorScore program. 4.504.5 Particleboard,medium density fiberboard(MOF),and hardwood j plywood used in interior finish systems shall comply with low formaldehyde ; ❑X i Q emission standards Interior Moisture Control 4,505.2 Vapor retarder and capillary break is installed at stab an grade foundations X❑ ❑ 4.505.3 Moisture content of building materials used:n wall and flair training is ❑. checked before enclosure Nge 3 of 5 r"dklrerrn 10f1)Jnc"Vi,md 08x27 11 Indoor Alr'Quallty arid Exhaust 4.506.1 Exhaust fans which terminale outside the building are provided In Q every bathroom. Environmental Comfort 4.507,1 Whole house exhaust fans shall have insulated louvers or covers i which close when the fan is off.Covers or louvers shall have a minimum [X insulation value of R-4.2. 4.307.2.Duct systems are sized and designed and equipment is selected using the following methoos. 1 Establish heat loss and heat gain values according to ACCA Manual J or equ!valent. 2. Size duct systems according to ACOA 29-0(Manual D)or equivalent. } 3 Select healing and cooling equipment according to ACOA 36-5(Manual S) or equivalent INSTALLER AND SPECIAL INSPECTOR QUALIFICATIONS Qualifications ! 702.1 HVAC system instatiers are trained and certified in the proper installation of HVAC systems. FRI i 702.2 The Licensed Professional responsible to verity CALGreen compliance is qualified and able to demonstrate competence in the discipline they inspect - XX 0 and verity Verification's 703.1 Verification of compliance with CALGreen may include construction documents,plans,specifications,budder 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 inspect=on approval. l CALGREEN SIGNATURE DECLARATIONS Project Name: LI CAPITAL RESIDENCE Project Address: -0218 BRET AVE Project Description: NEW 4, 159SF TWO STORIES HOUSE SECTION f - DESIGN VERIFICATION Complete all lines of Section 1 —'Design Verification and submit the completed checklist(Columns 1 and 2)with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the Items checke"bove are hereby Incorporated into the project plans and will be implemented into the project in accordance w e requirements set forth in the 2010 California Green Building Standards Code as adopted by the Cit uberti o. 2-312-vi OwnOr!Synatuie _ Oate ——t — ANDY LI Owner's Name (Please Prat) I DesgnI Professionals Signature Date PRANK LINH HO Design Professicriaijs Name (Please Print) Signature of LLcense Professional responsible for CalGreen compliance Date FRANK LINH HO 408.992 .5020 Name of License Professional responsible for CalGreen compliance(Please Print) Phone FRANKLE04YAHOO.COM Email Addressor License Professional responsible for CalGreen compliance i SECTION 2 - IMPLEMENTATION VERIFICATION Complete,sign and submit the competed checklist,including column 3,together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2010 California Greeg,euilding Standards Code as adopted by the City of Cupertino Signature of License Professional responsible for CalGreen compliance _ Date — _- Name of License Professional responsible for Ca.Green cumpl;ance(Please P:nri) Phoae Email Address(or License Professional responsible for CalGreen compliance Page So(S Calcirr.en :0/ll dao nvivd i4Y.;?,'U L , INSTALLATION CERTIFICATE age 1 of 12) CF-6R Site Address Permit umber L2 t t-�T, - Installation certificates(CF-6R)are requir for each and every dwelling unit.When the installs'on of measures that require field verification and diagnostic testing is complete,the builder or the builder's subcontractor sh 1 complete diagnostic testing and the procedures specified in this section.When the installation is complete,the buildei or the builder's subcontractor shall complete the CF-6R(Installation Certificate),and keep it at the building site or roview by the building department.The builder also shall provide a copy of the Installation Certificate to the HERS rat .for;any measures requiring field verification and diagnostic testing,per Section 10-103(a). WATER HEATING SYSTEMS: Distribution CEC Certified Type If #of Rated Input External Heater Mfr Name& (Std,Point- Recirculation, Identical (kW or Tank Volume Eff icierx y Standby Insulation _TypeModel Number of-Use,etc) Control Type S stems Btu/hr)I (gallons) (E ,REQ' Loss(%)' R-value' .l �.i 1 For small gas storage(rated input of less than or equal to 75,000 Btu/hr),electric resistant and,heat pump water heaters,list Energy Factor(EF).For large gas storage water heaters(rated input of greater than 75,000 Btu/hr),list Recovery(RE),Thermal Efficiency,Standby Loss and Rated Input. For instantaneous gas ategr h ters,list Thermal Efficiency and Rated Input. 2. R-12 external insulation is mandatory for storage water heaters with an energy factor of less an 10.58. Kitchen Piping: If indicated on the CF-1R,all hot water piping>3/4 inches in diameter that runs from the ho water source t the kitchen fixtures is insulated. Faucets&Shower Heads: All faucets and showerheads installed are certified to the Energy Commission,pursuant to Ti le 24,Part 6,Section 111. Central Water Heating in Buildings with Multiple Dwelling Units(required for prescriptive) []All hot water piping in main circulating loop is insulated to requirements of§1500) I� ❑Central hot water systems serving six or fewer dwelling units which have(1)less than 25 of distribution piping outdoors;(2)zero distribution piping underground;(3)no recirculation pump;and(4)insulal'on on distribution piping that meets the requirements of Section 1500) ❑Central hot water systems serving more than 6 dwelling units-presence of either a time control or a time/temperature control ✓ I, the undersigned, verify that equipment listed above my signature is: 1) the actual equipment installed; 2) equi alent to or more efficient than that specified in the certificate of compliance(Form CF-1 submitted for compliance with the Energy Efficiency Standards for residential buildings; and 3) equipment that meets Dr e:tceeds the appropriate requirements for manufactured devices(from the Appliance Efficiency Regulations or Part 6),v here applicable. Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner Signature: Date: Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER A r OCCUPANCY Residential Compliance Forms September 2005 INSTALLATION CERTIFICATE (Page 2 of 12) CF-t Site Address Permit Nuxixber f a2a� tc�Nc tLAti r� ��ID nZ An installation certificate is required to be posted at the building site or made available for all appropriate inspections.(The information provided on this form is required)After completion of final inspection,a copy mus be provided to the building department(upon request)and the building owner at occupancy,per Section 10-103(a). FENESTRATION/GLAZING: Manufacturer/Brand Name Total Product U-factors Product SHGC Quantity Area Exterior (GROUP LIKE #of Like Product Square ShadSng Device Camments/L.ocation/ Item RODUCTS z z (<_CF-1R value) (<_CF-1R value) Panes (optional) Feet or.Overhang Special Features 1. 2. to t 3. 4. t t3 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Use values from a fenestration product's NFRC label.For fenestration products without an N RC label,use the default values from Section 116 of the Energy Efficiency Standards. 2) Installed U-factor must be less than or equal to values from CF-1 R.Installed SHGC must be 1 ss than or equal to values from CF-1R,or a shading device(exterior or overhang)is installed as specified on the CF-1R Alternatively,installed weighted average U-factors for the total fenestration area are less than or equal to values from CF-1R.If using default table SHGC values from§116 identify whether tinted or not. ✓ bi 1, the undersigned, verify that the fenestration/glazing listed above my signature: 1 is the actual fenestration product installed; 2) is equivalent to or has a lower U-factor and lower SHGC than that srKcifted in the certificate of compliance(Form CF-1R)submitted for compliance with the Energy Efficiency Standards fo residential buildings;and 3)the product meets or exceeds the appropriate requirements for manufactured devices(from P an 6),where applicable. Item#s Signature Date Installing Subcontractor(Co.Naj Ine)OR _ (if applicable) General Contractor(Co.Name)OR Owner 4 OR Window Distributor Item#s Signature Date Installing Subcontractor(Co.Nai ne)OR (if applicable) General Contractor(Co.Name)C R Owner OR Window Distributor Item#s Signature Date Installing Subcontractor(Co.Name)OR (if applicable) General Contractor(Co.Name) R Owner OR Window Distributor Copies to:Building Department,HERS Rater(if applicable)Building Owner at Occupant Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE Page 3 of 12) CF-6R Site Address Permit Number An installation certificate is required to be posted at the building site or made available for all appropriate inspections.(The information provided on this form is required)After completion of final inspection,a copy mus be provided to the building department(upon request)and the building owner at occupancy,per Section 10-103(a). HVAC SYSTEMS: Heating Equipment Efficiency, CEC Certified Mfr. #of Duct Duct oi Heating Heating Equip Type Name and Model Identical (APUE,etc.) Location Piping Load Capacity (pkg.heatum g YY Number Systems >_CF-llRgvalue) attic,etc. R-valu tulbr tuthr 1b19 E5t-T;Yt ' i kJ kw�' 80,ywa;Cr I S L1' uS t7,5ll Cooling Equipment CEC Certified Mfr. #of Efficiency � Duct Cooling Cooling Equip Type Name and Model Identical (SEER or EER) Location Duct Load Capacity (pkg.heat tun Number Systems (>CF-I R value) attic,etc. R-value Btu/br ►�P� � i`�41 `A / 4-4ec- Ate; o 7 4c, Is V A 05 VN 1. >symbol reads greater than or equal to what is indicated on the CF-IR value. Include both SEER and EER if compliance credit for high EER air conditioner is claimed. ✓ ISI I,the undersigned,verify that equipment listed above is: 1)is the actual equipment installed,2)equivalent to or more fficient than that specified in the certificate of compliance (Form CF-1R) submitted for compliance with the Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices(from the Appliance Efficiency Regulations or Part 6) where applicable. Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner Signature: Date: 1 r Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER A T OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 10 of 12) CF-6R Site Address it Number to-2-vi 13t 5 e A o Z Insulation Installation Quality Certificate ✓ Description of Insulation,(CF-6R,formerly IC-1)signed by the installer stating:insulat ion manufacturer's name, material identification,installed R-values,and for loose-fill insulation:minimum weight per square foot and-minimum inches ✓ 0 Installation meets all applicable requirements as specified in the High Quality Insulatioi t Installation Procedures (ACM,Appendix RH) ✓FLOOR ❑ ❑ All floor joist cavity insulation installed to uniformly fit the cavity Sid -to-side and end-to-end es No NA ❑ ❑ Insulation in contact with the subfloor or rim joists insulated es No NA ❑ ❑ Insulation properly supported to avoid gaps,voids,and compression es No NA ✓WALLS l ❑ ❑ Wall stud cavities caulked or foamed to provide an air tight envelope es No NA ❑ ❑ Wall stud cavity insulation uniformly fills the cavity side-to-side,top- -b6 and front-to-back es No NA ❑ ❑ No gaps es I No NA ❑ ❑ No voids over 314"deep or more than 10%of the batt surface area. es No NA ❑ Hard to access wall stud cavities such as;comer channels,wall inters tiobls,and behind Zs N❑o NA tub/shower enclosures insulated to proper R-Value es No ❑ NA❑ Small spaces filled ❑ ❑ Rim-joists insulated es No NA ❑ 1 ❑ ❑ Loose fill wall insulation meets or exceeds manufacturer's minimum 1N eight-per-square-foot Yes No NA requirement ✓ ROOF/CEILING PREPARATION A ❑ All draft stops in place to form a continuous ceiling and wall air barri0e es N ❑ ❑ ❑ All drops covered with hard covers Yes No NA ❑ ❑ ❑ All draft stops and hard covers caulked or foamed to provide an air ti t envelope Yes No NA _ ❑ 13 All recessed light fixtures IC and air tight(AT)rated and sealed with a gasket or caulk between the e No NA housing and the ceiling ❑ ❑ ❑ Floor cavities on multiple-story buildings have air tight draft stops to a I adjoining attics Yes No NA ❑ ❑ ❑ Eave vents prepared for blown insulation-maintain net free-ventilatio area Yes No NA ❑ ❑ ❑ Knee walls insulated or prepared for blown insulation Yes No NA ❑ ❑ ❑ Area under equipment platforms and cat-walks insulated or accessible I br blown insulation Yes No NA ❑ ❑ ❑ Attic rulers installed Yes No NA Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE Page 11 of 12) CF-6R Site Address Perau'l Number_ ✓ ROOF/CEILING BATTS 11 13 Y s No NA No gaps Yes No NA No voids over 1/4 in.deep or more than 10%of the batt surface area. 11 El s No NA Insulation in contact with the air-barrier ❑ ❑ No NA Recessed light fixtures covered ❑ Cl Net free-ventilation area maintained at eave vents Y s No NA ✓ ROOF/CEILING LOOSE-FILL ❑ ❑ ❑ Yes No NA Insulation uniformly covers the entire ceiling(or roof)area from the o atside of all exterior walls. ❑ ❑ ❑ Yes No NA Baffles installed at eaves vents or soffit vents-maintain net free-venti 4tion area of eave vent ❑ ❑ ❑ Yes No NA Attic access insulated ❑ ❑ ❑ Yes No NA Recessed light fixtures covered ❑ ❑ ❑ Yes No NA Insulation at proper depth—insulation rulers visible and indicating prc per depth and R-value ❑ ❑ ❑ Loose-fill insulation meets or exceeds manufacturer's minimum weigh and thickness requirements Yes No NA for the target R-value. Target R-value .Manuf cturer's minimum required weight for the target R-value (pounds per-sqare-foot). Manufacturer's minimum required thickness at time of installation Mavtufacturer's minimum required settled thickness .Note: To receive compl once credit the HERS rater shall verb that the manufacturer's minimum weight and thickness has been achieved for the target R-value. CF-6R only) DE ARATION ✓ I hereby certify that the installation meets all applicable requirements as specified in the nsulation Installation Pro edures. Installing Subcontractor(Co.Name,)OR General Contractor(Co.Name)OR Owner' Signature: Date: Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE), BUILDING OWNER kT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE Page 12 of 12) CF-6R Site Address Pemri Number County Subdivision Lot N unber Description of Insulation(Formerly IC-1 Form) 1. RAISED FLOOR Material T,A-At �7 Brand Name ` r Thickness(inches)' Thermal Resistance(R-Valu ) 2. SLAB FLOORIPERIlv1ETER Material Brand Name Thickness(inches) Thermal Resistance(R-Valu,) Perimeter Insulation Depth(inches) 3. EXTERIOR WALL Frame Type Z 7C `'`'e,1A j7m-%o aA A. Cavity Insulation , Material tj Brand Name Thickness(inches) 3 t Thermal Resistance(R-Valu ) Q,—r B . Exterior Foam Sheathing Material Brand Name Thickness(inches) Thermal Resistance(R-Valu ) 4. FOUNDATION WALL Material Brand Name Thickness(inches) Thermal Resistance(R-Value) 5, CEILING Batt or Blanket Type ') Brand Name 15 a Thickness(inches) IV Thermal Resistance(R-Valu ) Loose Fill Type Brand Contractor's min installed weight/ft' lb Minimum thickness chis Manufacturer's installed weight per square foot to achieve Thermal Resistance(R- alue) 6. ROOF Material Brand Name Thickness(inches) Thermal Resistance(R-Valuc) Declaration ✓M I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Energy Efficiency Standards for residential buildings(Title 24,Part 6,California Code c f Regulations)as indicated on the Certificate of Compliance,where applicable. Item#s Signature Date Installing Subcontractor(Co.P lame)OR (if applicable) General Contractor(Co.Nam OR Owner 10-2--11+ OR Window Distributor Item#s Signature Date Installing Subcontractor(Co.1,ame)OR (if applicable) General Contractor(Co.Name i OR Owner OR Window Distributor Item#s Signature Date Installing Subcontractor(Co.Is ame)OR (if applicable) General Contractor(Co.Name 1 OX,Owner OR Window Distributor Residential Compliance Forms April 2005 LV Nord»m Climate - zone • Nom Central Climate .. lie -. ;.�• - South Central CIImeEe , Zone Southern imate • zone NAorA'Fenestra> RebrgCouna70 ENERGY PERFORMANCE RATINGS U-Factor(U CJI-P) Solar Heat.Gain Coefficient ADDITIONAL PERFORMANCE RATINGS Visible,Transmittance Manufacture►stlpolates that these ratings eoalotm to applicable NFRC procedures for determining whole product performance.NFRC ratings oro determined for a flied ad of eavirenmetdal conditions and a speeitic product M. NFRC done not recommend any product and does not warrant the mitabilNy of any product for any specific moo.Commit manufacturers IHeraturs for other product performance Information. www.nh.org Ea enestration product has been certified by the manufacturer to t the air infiltration requirements of Section 111i(a)1.,1992 California Energy Standards