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14030034 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20201 PATRIC CT CONTRACTOR: PQL fF(,/L PERMIT NO: 14030034 Cf��Ir 5,�2C>G,n vvv OWNER'S NAME: ZHIBIAO ZHAO DATE ISSUED:04/09/2014 OWNER'S PHONE: 4082061378 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL CONSTRUCT ONE STORY ADDITION(706 SQ FT); FRONT License Class Lic,# 1�_4572)0251 COVERED PORCH(50 SQ FT); INTERIOR REMODEL(300 S Contract (t� .� dG dlDate FT); PANEL UPGRADE (200 AMP). 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:$120000 �C 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:36935009.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 1 IT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agre LED INSPECTION. 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 comp sued by: Date: with all non- oint source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signal 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 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 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 I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 nd I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S ' ns 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized a nt•- Date:k/10 111'e, permit is issued. 1 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,1 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 1 certify that I have read this application and state that the above information is correct. 1 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 �O �A COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 r CUPERTINO (408) 777-3228• FAX (408)777-3333•building(5cupertino.org \ ❑NEW CONSTRUCTION ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS W--2-0 t C ` APN# �r O OWNERNAME ` .a PHONE 0 _2e,. E-MAIL a 0�, tom»'► STREET ADDRESS CITY,STATE,ZIP FAX r' e rt C CONTACT NAME CS �' L PHONE gg S v E-MAIL C MAILC ^ I STREET ADDRESS T ^ CITY,STATE, ZIPS FAX __71 ❑OWNER ❑ OR'NER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER y O BUS.LIC# COMPANY NAME E-MAIL C, FAX STREET ADDRESS �r n CITY,STATE,ZIP PHONE G{-7 l o DESCRIPTION OF WORK AGI EXISTING USE PROPOS USE CONSTR.Tot #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM C OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREATOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNrr ❑YES SECOND STORY E]YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YEs RECEIVE S r TPQTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property oHmer or Ized agent to ac the )Amer's beh If. I have read this application and the information I have provided is correct. I have read t escription bf Work and veri ate. I agree to co .th all applicable local ordinances and state laws relating to bu'Idin ction. I au ze re r entatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant)Agent: Date: :y �2-01 SUPPLEMEMffL INFORMAT ON REQUIRED tM €yROIJTI ..PLAN.CHECIC TYPE � New SFD or Multifamily dwellings: Apply for demolition permit for �CI�OVEATIiE.COIAHTER� �� 7)INGPTANREVIEW� ��} existing building(s). Demolition permit is required prior to issuance of building �� permit for new building. ] '_, INGPLANiiEVI1sW.�M Commercial Bldgs: Provide a completed Hazardous Materials Disclosure � sTAtvntD uH G orz s , fo_rm if any Hazardous Materials are being used as part of this project. a Y� _Copy of Planning Approval Letter or Meeting with Planning prior to "l 2 DI&TRICT submittal of Building Permit application. BldgApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20201 PATRIC CT DATE: 0310512014 REVIEWED BY: MELISSA APN: 369 35 009 BP#: 1 'VALUATION: 1$120,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY 2nd Unit' Yes • No PERMIT TYPE: PENTAMATION USE: SFD or Duplex OTC? ®Yes Q No 1R3SFDADD WORK ADDITION OF 681 S.F. TO CREATE 2 N BEDROOMS 2 N BATHS & 1 N UTILITY RM. SCOPE REMODEL 300 S.F OTHER INTERIOR AREA. UPGRADE 100 AMP PANEL TO 200 AMP, SAME 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 681 $2,577.00 IR3PLNCK $1,617.00 IR3INSP TOTALS: 681 $2,577.00 $1,617.00 MECH,HOURLY 0 Yes (j) No PLUMB,HOURLY 0 Yes Q No ELEC,HOURLY (:) Yes (2)No Flee.Plan Check 0.0 1 hrs $0.00 Elee.Permit Fee: IEPERMIT Other Elee.Insp. 0.0 hrs 1 $47.00 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 Detor addn'l info. FEE ITEMS (hee Resolution 11-033 E,ff 74 13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,577.00 = s.f. Remodel,Other Suppl. PC Fee: Q Reg. ® OT0.0 1 hrs $0.00 $418.00 /REMRESOTH PME Plan Check: $0.00 200 amps Electrical Permit Fee: $1,617.00 $47.001IBELEC200 Services Suppl. Insp. Fee:Q Reg. 0 OT F0.0 rhrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 0 Work Without Permit? ® Yes r'. No $0.00 E) Advanced Planning Fee: /PLLONGR $95.34 Select a Non-Residential G Travel Documentation Fee: ITIM VDOC $47.00 Building or Structure i Stronp,Motion Fee: /BSEISMICR $12.00 Select an Administrative Item Bldg Stds Commission Fee: /BCBSC $5.00 SUBTOTALS: $4,400.34 $465.00 TOTAL FEE: $4,865.34 Revised: 01/15/2014 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: Q PERMIT# m C?b OWNER'S NAME: A PHONE# /ff7 GENERAL CONTRACTORBUSINESS LIC'ENSf# ADDRESS: t I- a , _ 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 AN UBCONTRACTORS HAVE OBTAINED A CITY" OF CUPERTINO BUSINESS LICENSE. �. I am not using any subcontractor "V Signature Date Please check applicable subcontractors and complete the following information: j/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing rX Electrical Excavation Fencing ih Flooring/ Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature I} e FILE � -� _� I q_(t-t,,k �0 INSTALLATION CERTIFICATE CF-6R-ENV-01 Envelope—Insulation; oo ing; Fenestration (Page 1 of 3) Site Address; U� _r��—. _ V _ __ I Enforcement Agency:_ PermitNumber:_ Ge C- fvip If more than one person has responsibility for installation of the items on this certificate, each person shall prepare and sign a certificate applicable to the portion of construction for which they are responsible;alternatively, the person with chief responsibility for construction shall prepare and sign this certificate for the entire construction. All applicable Mandatory Measures with check boxes require to be checked to ensure the mandatory measures have been met. Description of Insulation 1. RAISED FLOOR o Material: Brand Name: Thickness (inches): Thermal Resistance (R-Value): ❑ §150(d):Minimum R-13 msulat n in raised wood-frame floor or equivalent U-factor. 2. SLAB FLOOR/PERIMETER Material: Brand Name: Thickness (inches): Thermal Resistance(R-Value): Perimeter Insulation Depth(inches): ❑ §150(1):Water absorption rate for the insulation material alone without facings is no greater than 0.3%;water vapor permeance rate is no greater than 2.0 penn/inch and shall be protected from physical damage and UV light deterioration. 3. EXTERIOR WALL a. Insulation Type(e. . Batt;Loose Fill, Spray Foam) a.Thermal Resistance(R-Value): IR b. . Ins 1 tion Type(e.x.Batt,Loose Fill, Spray Foam) b. Thermal Resistance(R-Value): Brand: 11 0(-0 h vA-k" Spray/Loose 1) stalled Actual Thickness Spray/Loose fill) (inches): Contractor's min installed weight/ftz lb Manufactu r s inftled weight per square foot to achieve Thermal Resistance(R-Value) ❑ §150(c):Minimum R-13 insulation in wood-frame wall or equivalent U-factor. Exterior Foam Sheathing(rigid Insulation) Material: Brand Name: Thickness (inches) : Thermal Resistance (R-Value) 4. FOUNDATION WALL Material: Brand Name: Thickness(inches): Thermal Resistance (R-Value): 5. CEILING or Blanket Type: © Brand Name: '`1`l0y Loose Fill Type: Then-nal Resistance (R-Value): Spray Foam Type: Brand Name: Installed Actual Thickness (inches): `� Contractor's min installed weight/ft2 lb Manufacturer's installed weight per square foot to achieve Then-nal Resistance (R-Value): ❑ §150(a):Minimum R-19 insulation in wood-frame ceiling or equivalent U-factor. 6. ATTIC ROO IN ULATION AND/OR ATTIC RADIANT BARRIER Material: fccm k� Brand Name: Material: Brand Name: Thickness (inches): ' Thermal Resistance (R-Value): ❑ §118(a): Insulation installed meets Standards for Insulating Material. ❑ §150(g):Mandatory Vapor barrier installed in Climate Zones 14 or 16. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-ENV-01 Envelope — Insulation; Roofing; Fenestration (Page 2 of 3) Site Address;_, _ _ ct s C -- _C _ _ Enforcement_Agency: _ Permit Number: _ ug?of ` C9s ' C� ec��r•C' 1140100 _ Description of Roofing Products CRRC Product ID Manufacturer Product Roof Roof Product Initial Solar Aged Solar Thermal Number' Information Brand/Model Type Area Sloe Weight'' Reflectance Reflectance" Emittance �rvz= a5i �� din as d'n� /� g• �'' ❑3 1jJ. n 1 1 r"1 �� ❑3 ❑3 1.The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directoly at ww.coolroofs.org/products/search.php 2. The weight in lbs per square feet of the roofing product being installed. 3.Check box if the Aged Reflectance is a calculated value using the equation below,footnote 4. 4.If the aged reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the initial reflectance value from the directory and use the equation(0.2+0.7( ;,,;,;at—0.2)to obtain a calculated aged value. ✓OCHECK APPLICABLE BOX BELOW IF EXEMPT FROM THE ROOFING PRODUCT"COOL ROOF"REO_UIREMENT.• ❑ The roof area covered by building integrated photovoltaic panels and building integrated solar thermal panels are exempt from the above Cool Roof criteria. ❑ Roof constructions that have thermal mass over the roof membrane with a weight of at least 25 lb/ is exempted from the above Cool Roof criteria. To apply Liquid Field Applied Coatings,the coating must be applied with a tnininium dry mil thickness of 20 mils across the entire roof surface and meet minimum performance requirements listed in§118(1)3 and Table 118-C. Select the applicable coating ❑ Aluminum-Pigmented Asphalt Roof Coating ❑ Cement-Based Roof Coating ❑ Other ✓ ❑ CRRC-1 Label Attached to CF-6R (Note if no CRRC-1 label is available,this compliance method cannot be used and another method is required to meet compliance). FENESTRATION/GLAZING Product # Total Quantity Add.Exterior Comments/ Manufacturer/Brand Name U- Product of NFRC of Like Product Area Shading Dev. Location/Special Item (GROUP LIKE RODUCTS) factors SHGC' Panes Certifiedl 2 (Optional) ftZ or Overhang Features 1 2 3 4 6 T 8. 1. Use values,f•om a fenestration product's AFRCCertified Label Forfenestration products without an NFRC label, use the default values from Section 116, Table 116-,4 and 116-B of the 2008 Energy Efficiency Standards. 2.NFRC Label Certificates shall not be removed until the building inspector has verified the efficiency.Enter Yes or No. ❑ §116(a)l:Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. ❑ §116(a)2 and 3: Actual fenestration products installed are equivalent to or have a lower U-factor and/or a lower SHGC than that specified on the Certificate of Compliance(Form CF-1R). ❑§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 weather-stripped;all joints and penetrations caulked and sealed. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-ENV-01 -Envelope — Insulation; Roofing; Fenestration (Page 3 of 3) Site Address: _ Enforcement Agency: Permit Number: DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation)conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-1R)form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF-IR that apply to the installation have been met. • I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Compan Na e: (Installin Subco�tr�a_ctor or General Contractor or Builder/0-Avner) , �UC`1'�h ReSDongible Person's Name: Responsible Per . nature: 4m CS B License: Date igned: Position With Co any(Title): QIf 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-LTG-01 Residential Lighting (Pa e 1 of3) Site Address: Enforcement Agency: Permit Number: 1.Kitchen Lighting Does project include kitchen lighting? ❑Yes,complete section 1 ❑No,go on to section 2 ❑Yes §150(k)3:The wattage of permanently installed luminaires(lighting fixtures)has been determined asspecified by§130(d). ❑Yes ❑No §150(k)3:In the kitchen,are there electrical boxes finished with a blank cover or where no electrical equipment has been installed,and where the electrical box can be used for a luminaire or a surface mounted ceiling fan?If yes,the following row must also be yes: ❑Yes ❑NA Wattage has been calculated as 180 watts of low efficacy lighting er blank electrical box. §150(k)8 Kitchen Lighting must comply with either method(a), (b),or(c) below: (a)All high efficacy luminaires ❑ Yes,complies because only high efficacy luminaires have been installed in the kitchen. ❑ No,complies with method(b)or(c). (b)>50%watts used by high efficacy luminaires �l Yes,complies because at least 50%of the installed watts are from permanently installed high efficacy luminaires as demonstrated in the table below:Total A>Total B. ❑ No,complies with method(a)or(c). Fill out the following table if complying with either method(b)or(c). Table(b Efficacy Luminaire Type High Low Watts x Quantity = High Efficacy Watts or Low Efficacy Watts ❑ ❑ x = or ❑ ❑ x = or ❑ ❑ x = or ❑ ❑ x = or ❑ ❑ x = or Complies with method(b)if A>B Total: A: > B: (c)Additional Kitchen Low Efficacy Lighting ❑ Yes,complies because the kitchen lighting qualifies for additional low efficacy lighting and as demonstrated in table in(b)(above)and the table in(c)(below)that(A+C)>B ❑ No,complies with method(a)or(b). Additional kitchen low efficacy lighting is available only if all of the following are true: ❑ Yes. All low efficacy luminaires in the kitchen are controlled by a vacancy sensor Dimmer energy management controls stem(EMCS)or a multi-scene programmable controls stem. ❑ Yes. Permanently installed luminaires in garages laundry rooms closets greater than 70 square feet and utility rooms are high efficacy luminaires AND are controlled by a vacancy sensor. Table c Use 50 W for dwelling units<2,500 ftz From the Table in(b) Use 100 W for dwelling units>2,500 ftz Add Yes/No? A B C A+C Is(A+C)>_B? 2.Lighting Internal to Cabinets Does project includes lighting internal to cabinets? ❑Yes, complete section 2 ❑No,go on to section 3 ❑Yes,§150(k)9:Permanently installed lighting internal to cabinets uses:S 20 watts of power per linear foot of illuminated cabinet. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-LTG-01 Residential Lighting (Page 2 of 3) Site Address: Enforcement Agency: Permit Number: 3.Installed Devices and Components Have Been Certified to the Energy Commission Does the project include any of the devices or components listed below?❑Yes,complete section 3 ❑No,go on to section 4 GY_Yes §119 and§150(k)7(F):Any of the following devices and components which have been installed have been certified to the Energy Commission according to the applicable provisions of§119:All LED lighting systems that are classified as high efficacy,ballasts used in recessed luminaires, vacancy sensors(automatic off/manual on occupant sensors),dimmers,track lighting integral current limiters,and outdoor motion sensors. 4.Lighting Controls Complete section 4 Yes ❑ NA §150(k)7A:Permanently installed low efficacy luminaires are controlled by switches separate from those controlling high efficacy luminaires. Yes ❑ NA §150(k)7B:Exhaust fans with integral lighting systems are switched separately from lighting systems,OR have a lighting system that can be manually turned on and off while allowing the fan to continue to operate for an extended period of time. J� Yes ❑ NA §150(k)7C:All permanently installed luminaires are switched with readily accessible controls that permit the luminaires to be manually switched on and off. Yes ❑ NA §150(k)7D:All lighting controls have been installed in accordance with the manufacturer's instructions. [ Yes ❑ NA §150(k)7E:All lighting circuits that are controlled by more than one switch,where a dimmer or vacancy sensor has been installed to comply with§150(k),no controls bypass the dimmer or vacancy sensor functions. 5.Luminaires(Lighting Fixtures) Does the prQject include the installation of any luminaires(indoor or outdoor)? ❑Yes,complete section 5 ❑No,go on to section 6 Yes,high efficacy luminaire classification has been determined according to§150(k)1,and low efficacy luminaire classification has been determined according to§150(k)2. ❑ Yes NA §150(k)4:Fluorescent lamps rated 13 watts or greater have an electronic ballasts having an output frequency no less than 20 kHz. ❑ Yes NA §150(k)5:Permanently installed night lights,and night lights integral to permanently installed luminaires or exhaust fans, contain only high efficacy lamps meeting the minimum efficacies contained in Table 150-C and do not contain a line-voltage socket or line voltage lamp holder,OR the night light is rated to consume no more than 5 watts of power and does not contain a medium screw-base socket. ❑ Yes 1A NA §150(k)6: Lighting integral to exhaust fans,in rooms other than kitchens,meet the applicable requirements of§150(k). ❑ Yes A NA Any electrical box finished with a blank cover or where no electrical equipment has been installed,and where the electrical box can be used for a luminaire or a surface mounted ceiling fan,has been treated as low efficacy luminaires for compliance with§150(k). Does the project include any luminaires that are recessed into insulated ceilings? ❑ Yes,complete the rest of section 5 ONo,go on to section 6 ❑ Yes,§150(k)12: Luminaires that are recessed into insulated ceilings meet all of the following conditions: ❑ Yes,are listed,as defined in§101,for zero clearance insulation contact(IC)by UL or other nationally recognized testing/rating laboratory,and ❑ Yes,have labels that certify the luminaires are airtight with air leakage less than 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283(Exhaust fan housings are not required to be certified airtight),and ❑ Yes,are sealed with a gasket or caulk between luminaire housings and the ceiling,and all air leak paths between conditioned and unconditioned spaces have been sealed with a gasket or caulk.(including all exhaust fan housings),and ❑ Yes,allows ballast maintenance and replacement to be readily accessible to building occupants from below the ceiling without requiring the cutting of holes in the ceiling. 6. Indoor Lighting(any indoor room that is not a kitchen) Does the prQject include permanently installed luminaires in any room that is not a kitchen? ❑Yes,complete section 6 ❑No,go on to section 7 Yes 13 NA §150(k)10:Permanently installed luminaires in bathrooms,garages,laundry rooms,closets>70 ftp,and utility rooms are high efficacy luminaires OR are controlled by a vacancy sensor. Yes ❑ NA §150(k)ll:Permanently installed luminaires located in rooms or areas other than in kitchens,bathrooms,garages,laundry rooms,closets,and utility rooms are high efficacy luminaires,OR are controlled by a dimmer switch OR are controlled by a vacancy sensor. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-LTG-01 Residential Lighting (Page 3 of 3) Site Address:�,�A�{ `a \C Enforcem t Agency: Permit Number: ` - - CV C� � ev _C�pper�� tl�®3003 7. Outdoor Lighting Does the project include any permanently installed outdoor lighting? Yes,complete section 7 ❑No,go on to section 8 Yes ❑ NA §150(k)13:Luminaires providing outdoor lighting,including outdoor lighting for private patios on low-rise residential buildings with four or more dwelling units,entrances,balconies,and porches,and which are permanently mounted to a residential building or to other buildings on the same lot are high efficacy luminaires OR are controlled by a manual on/off switch,plus a motion sensor not having an override or bypass switch that disables the motion sensor,plus one of the following three additional control methods: a. A photocontrol that does not have an override or bypass switch that disables the photocontrol;or b. An astronomical time clock not having an override or bypass switch that disables the astronomical time clock; or C. Energy management controls systems(EMCS)not having an override or bypass switch that allows the luminaire to be always on. ❑ YesNA Exception 2: Low efficacy outdoor luminaires used to comply with Exception 1 to§150(k)13 are controlled by anoverride switch which temporarily bypasses the motion sensing function,and the motion sensor is automatically reactivated within six hours.The luminaire is controlled by a photocontrol,astronomical time clock,or EMCS as required by Exception 1 to §150(k)13. ❑ Yes NA Exception 3: There are permanently installed luminaires in or around swimming pools,water features,or other locations subject to Article 680 of the California Electric Code which do not need to be high efficacy luminaires. ❑ Yes NA §150(k)14: Internally illuminated address signs comply with§148,OR do not contain a screw-base socket and consume no more than 5 watts of power as determined according to§130(d). ❑Yes WA §150(k)15 Lighting for parking lots and carports with a total of 8 or more vehicles per site have lighting that complies with §130,132, 134, and 147.Lighting for parking garages for 8 or more vehicles comply with§130, 131,134,and 146. If yes,the Nonresidential compliance forms must be submitted 8. Common areas of low-rise residential buildings Does the project include the installation of any luminaires in common areas of low-rise residential buildings? ❑Yes,complete section 8 No,go on to section 9 ❑ Yes,§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 OR are controlled by occupant sensor(s)certified to comply with§1 19(d). DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation)conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-1R)form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF-1R that apply to the installation have been met. • I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. ompany e• (Installing Subcontr for or General Contractor or Builder/Owner) ©wG ponsible Person's Name: Responsible Person's Signatu Y� CSLB Licens Date Signed: Position With Company(Title . 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-01 Domestic Hot Water(DHW) (Pae 1 of 2) Site Address: E force ent Agency: Permit Number: - - - -4w1 - clic �T - J� OTC�9 � ; 1 1. WATER HEATING SYSTEMS: Distribution Rated CEC Type If #of Input(kW Tank Standby Heater Certified Mfr Name&Model (Std,Point-of- Recirculation, Identical or Volume Efficiency Loss Ty e Number Use,etc) Control Type Systems Btu/hr)� (gallons) (EF,RE) 1 (%)� Note 1:For small gas storage(rated input less than or equal to 75,000 Btu/hr),electric resistance and heat pump water heaters, list Energy Factor(EF).For large gas storage water heaters(rated input of greater than 75,000 Btulhr), list Recovery Efficiency(RE), Thermal Efficiency,Standby Loss and Rated Input. For instantaneous gas water heaters, list the Thermal Efficiency and Rated Input. 2. Mandatory Measures TO COMPLY-ALL BOXES MUST BE CHECKED K§110-§113: Water heaters,showerhead and faucets are certified by the California Energy Commission. §1500):Water System Pipe and Tank Insulation.And Cooling Line Insulation 1. Storage tank insulation 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;and B. Unfired storage tanks 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. 2. Water piping and cooling system line insulation thickness and conductivity 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; and Pipe insulation for steam hydronic heating systems or hot water systems>15 psi,meets the requirements of Standards Table 123-A. Insulation is protected from damage,including that due to sunlight;moisture,equipment maintenance,and wind. §151(08D:If indicated on the CF-1R,all hot water piping that runs from the hot water source to the kitchen fixtures is insulated per Standards Table 150-13. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-01 Domestic Hot Water(DHW) -(Page 2 of 2) Site Address- a Enforcement Agency: Permit Number: t_`�- Ike, -�� - - baro 3. Central Water Heating in Buildings with Multiple Dwelling Units(required for prescriptive) TO COMPLY-ALL BOXES MUST BE CHECKED All hot water piping in main circulating loop is insulated to requirements of§1500) Central hot water systems serving six or fewer dwelling units which have(1)less than 25' of distribution piping outdoors;(2)zero distribution piping underground;(3)no recirculation pump;and(4)insulation on distribution piping that meets the requirements of Section 1500) 1� Central hot water systems serving more than 6 dwelling units-presence of either a time control or a time/temperature control DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • 1 reviewed a copy of the Certificate of Compliance(CF-1R)form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF-1R that apply to the installation have been met. • I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company e: (I stalling Subcontractor or General Contractor or Builder/Owner) b W U r,-sA- 4 9 h erson's Name: Responsible Person's Si to CSL License: Date ign Position Withptle): 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems,Ducts and Fans (Pae 1 of 2) Site Address:�?� ( E force�qgnt A en Permit Number: Space Conditioning Systems Heating Equipment Duct Efficiency Location Equip (AFUE, (attic, Type ARI #of etc.)"' crawl- Heating Heating (package- CEC Certified Mfr.Name Reference Identical (>_CF-1R space, Duct Load Capacity heat um ) and Model Number Number Z Systems value)4 etc.) R-value (Btu/hr) (Btu/hr) Cooling Equipment Efficiency Duct Equip (SEER Location Type and EER) (attic, (package #of 1'3 crawl- Cooling Cooling heat CEC Certified Mfr.Name ARI Reference Identical (>_CF-1R space, Duct Load Capacity um ) and Model Number Number' Systems value)4 etc.) R-value (Btu/hr) (Btu/hr) 1. Ifproject is new construction, see Footnotes to Standards Table 151-B and Table 151-Cfor duct ceiling alternative compliance. 2.ARI Reference Number can be found by entering the equipment nsodel number at http:111v3vtiv,aridirectory.org/ari/ac.php# 3. Listed efficiency on this page must be greater than or equal(>_)to the value shown on the CF-1 R form. 4. When CF-IR is reference it is also applicable to the CF-IR, CF-1R-AA or CF-IR-ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM §110-§113:HVAC equipment is certified by the California Energy Commission. ,0'§150(h):Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA,or ACCA. ,�$140(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of§112(c). §1500)2:Pipe insulation for cooling system refrigerant suction,chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems,Ducts and Fans (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: Ducts and Fans §L1520( �Duct and Fans 1.All air-distribution system ducts and plenums installed,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 181A,or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch,the coom nation of mastic and either mesh or tape shall be used;and ,e 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. 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. E7.Exhaust fan systems have back draft or automatic dampers. ❑ 8.Gravity ventilating systems serving conditioned space have either automatic or readily accessible,manually opera a-dampers. SCJ 9.Protection of Insulation.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 rctardant and provides shielding from solar radiation that can cause degradation of the material. 10.Flexible ducts cannot have porous inner cores. DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-1R)form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF-IR that apply to the installation have been met. • I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Inst ing Subcontractor or Gener 1 Contractor or Builder/Owner) ��1- U yl Responsi er n's Name: Responsible Person's Si r CSLB License: Date Signe : Position With Compan (T'le): 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-05 Indoor Air Quality and Mechanical Ventilation (Page 1 of 5) Site Address: u - Enforcement Agency: Permit Number: Ventilation for Indoor Air Quality(L4Q): All dwelling units shall meet the requirements of ANSIIASHRAE standard 62.2. Ref. Title 24 Part 6 Section 150(0). Equation and table numbering on this CF-6R corresponds to the numbering for that information in the publishedASHRAE Standard 62.2. WHOLE-BUILDING VENTILATION Ventilation Rate: A mechanical supply system,exhaust system,or combination thereof shall provide whole-building ventilation with outdoor air each hour at no less than the rate in equation 4.1 a. For dwelling occupant densities known to be greater than(Nb,+ 1),the rate shall be increased by 7.5 cfm for each additional person. Where: Enter Eq 4.1a Calculation: . a .OlA . ( br ) Afloor=conditioned floor area,ftp Afloor= (Eq.41 ) Qfa,,——Ofloor+75N + 1Nbr=number of bedrooms:not to be less than one Nbr= Qfa =ventilation air requirement=fan flow rate,(cfm) Qfa = Delivered Ventilation: The effective ventilation rate of an intermittent system is the combination of its delivered capacity,its fractional on-time,cycle time,and the ventilation effectiveness from Table 4.2. This calculation only applies to intermittent systems. Where: Enter Eq 4.2 Calculation Qr=ventilation air requirement from Eq.4.1 a(above) (if applicable). (Eq.4.2) Qf=Qr 1(sf) f=daily fractional on-time,(%) Qr e=ventilation effectiveness(from Table 4.2) f Qf=fan flow rate during the on-cycle(cfm) E Qf= Table 4.2—Ventilation Effectiveness for Intermittent Fans Whole-Building Ventilation Rate Summary Select the method used to provide Whole- Daily Fractional On-Time,f Ventilation effectiveness,E Building Ventilation and enter the required fan f<35% 0.33 flow rate(cfm). Select one: 35%<f<60% 0.50 ❑ Continuous fan flow(cfm)= 60%<f<80% 0.75 n Intermittent fan flow(cfm)= Use the fan flow rate from this summary for 80%<f 1.0 selection of the whole-building ventilation fan and for the duct design for the whole-building Fan runs at least once every 1.0 ventilation system. Provide the system design three hours information in applicable sections below. LOCAL VENTILATION EXHAUST Local mechanical exhaust fans shall be installed in each kitchen and bathroom. The minimum airflow rates shall be at least the amount indicated in tables 5.1 and 5.2. Table 5.1 Table 5.2 Intermittent Local Ventilation Exhaust Airflow Rates Continuous Local Ventilation Exhaust Airflow Rates Application Airflow Notes Application Airflow Notes Vented range hood Based on Kitchen Kitchen 100 cfm required-if exhaust fan Kitchen 5 ACH Volume flow is less than 5 ACH Bathroom 50 cfm Bathroom 20 cfin 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-05 Indoor Air Quality and Mechanical Ventilation (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: VENTILATION SYSTEM DESIGN—Fan selection and duct design criteria for compliance The airflow rates required refer to the delivered airflow of the system as installed and tested using a flow hood,flow grid,or other airflow measuring device. Alternatively, the airflow rating at a pressure of 0.25 in.w.c. of a certified fan may be used to demonstrate compliance without testing of the airflow of the installed system,provided the system duct sizing meets the prescriptive requirements of Table 7.1, or manufacturer's design criteria. Other methods may be used to provide the required ventilation rates when approved by a licensed design professional,subject to confirmation of delivered ventilation airflow of the installed system. Central Fan Integrated (CFI)ventilation systems shall demonstrate compliance by field testing of the delivered ventilation airflow of the installed system. WHOLE-BUILDING VENTILATION SYSTEM DESIGN-Identify the ventilation system design criteria (select one criteria from this column) Requirements for installer to demonstrate compliance with Airflow Test code Required? Enter the installed ventilation air-moving equipment information and the installed ventilation duct system ❑Prescriptive design(Table 7.1) information in the tables below,and certify on the CF-6R that no the installed system conforms to the Table 7.1 prescriptive design criteria. Central forced air system fans used in Central Fan Integrated ventilation systems shall demonstrate,in air distribution mode, ❑ Central Fan Integrated(CFI) a watt draw less than 0.58 W/CFM per Standards §15l(f)l 1. yes Submit a CF-6R-MECH-22-HERS form for each forced air unit used for a CFI system. HERS verification is required. Enter the installed ventilation air-moving equipment information and the installed ventilation duct system ❑Engineered Design information in the tables below,and certify on the CF-6R that yes the installed system conforms to the engineered ventilation system design approved by the enforcement agency. Enter the installed ventilation air-moving equipment information and the installed ventilation duct system ❑Manufacturer's design criteria information in the tables below,and certify on the CF-6R that no the installed system conforms to the manufacturer's ventilation system duct design criteria. LOCAL VENTILATION SYSTEM DESIGN-Identify the ventilation system design criteria (select one criteria from this column) Requirements for installer to demonstrate compliance with Airflow Test code Required. Enter the installed ventilation air-moving equipment information and the installed ventilation duct system ❑Prescriptive design(Table 7.1) information in the tables below,and certify on the CF-6R that no the installed system conforms to the Table 7.1 prescriptive design criteria. Enter the installed ventilation air-moving equipment information and the installed ventilation duct system ❑Engineered Design information in the tables below,and certify on the CF-6R that yes the installed system conforms to the engineered ventilation system design approved by the enforcement agency. Enter the installed ventilation air-moving equipment information and the installed ventilation duct system ❑Manufacturer's design criteria information in the tables below,and certify on the CF-6R that no the installed system conforms to the manufacturer's ventilation system duct design criteria. 2008 Residential Compliance Forrns August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-05 Indoor Air Quality and Mechanical Ventilation (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: Table 7.1 Prescriptive Duct Sizing Requirements Diameter,(in) Flex Duct Smooth Duct Fan Rating cfrn 0.25 in.w.g. 50 80 100 125 50 80 100 125 Maximum Allowable Duct Length(ft) Diameter,(in) Flex Duct Smooth Duct 3 X X X X 5 X X X 4 70 3 X X 105 35 5 X 5 NL 70 35 20 NL 135 85 55 6 NL NL, 125 95 NL NL NL 145 7 and above NL NL NL NL NL NL NL NL This table assumes no elbows. Deduct 15 ft of allowable duct length for each turn,elbow,or fitting. Interpolation and extrapolation in Table 7.1 is not allowed. For airflow values not listed,use the next higher value. This table is not applicable for airflow>125 cfm. NL,=no limit on duct length of this size. X=not allowed,any length of duct of this size with assumed turns,elbows,fittings will exceed the rated pressure drop. INSTALLED VENTILATION AIR-MOVING EQUIPMENT INFORMATION Ventilation devices and equipment shall be tested and rated by HVI proceduresfor airflow and sound. Sound rating maximum is 1.0 sone for all continuous duty fans; 1.0 sone for intennittent duty whole-building fans;and 3.0 sone for intermittent duty local exhaust fans. Refer to the Residential Compliance Manual section 4.6for information about exclusions to these sound rating requirements. In the table below, list the fan e ui ment installed that meets the re uirement or whole uilding ventilation and local ventilation exhaust. Fan or System Fan Power System Type' Required Fan Certified Sound Ratio Name or (WBV Airflow3 Manufacturer Fan Airflow Rating Fan (Watt per Location' or LVE) (CFM) Name' Model Numbers (CFM) (Sone) Watts' CFM)' 1)Enter the Fan or System Identification Name or Location Name or System Identifier(e.g. "Bath02"'MastBath", 'Kitchen0l'). 2)What type of ventilation requirement is the fan specified to meet? WBV(whole-building ventilation)or LVE(local ventilation exhaust). 3)Enter the required ventilation aifow values determined by the calculations or tables in the WHOLE-BUILDING VENTILATION and/or LOCAL VENTILA TION EXHA UST sections at the beginning of this Installation Certificate(CFM). At least one fan must be designated for use for compliance with the"Whole-Building Ventilation"requirement. 4)Enter the fan manufacture's name. 5)Enter the fan model number or series number. 6)Enter the fan's Certified Airflow rating at 0.25 inch w.c. (CFM). Fans rated at less than 0.25 inch w.c. (e.g. 0.]inch w.c.)cannot be used to comply with the ventilation requirements using the prescriptive design criteria in Table 7.1. This certified airflow rating value must be equal to or greater than the required airflow from column 3 of this table when demonstrating compliance using Table 7.1. 7)Enter the fan's certified sound rating(Sone) 8)Enter the fan watt draw 9)Divide the Watt value front column 8 by the Certified Airflow value(CFM)fi-om column 6. For dwellings utilizing the peifonnance energy compliance method,for standalone whole-building ventilation systems(does not apply to local ventilation exhaust fans),the an power ratio must be less than orequal to theJan power ratio value reported on the Per ornance CF-1R. 2008 Residential Compliance Forums March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-05 Indoor Air Quality and Mechanical Ventilation (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: INSTALLED VENTILATION DUCT SYSTEM INFORMATION Airflows required by the standard refer to delivered airflow of the installed system as determined by testing with a flow hood,flow grid, or other measuring device. Alternatively,the installed equipment's HVI airflow rating at a pressure of 0.25 inch w.c.may be used, provided the system can be inspected to confirm the duct sizing meets the prescriptive requirements of Table 7.1,or manufacturer's duct design criteria. Fan or Compliance Required Airflow Number of Actual Allowable Pass System Name Method Airflow3 Test' Elbows and Duct Length? Duct Length8 or or Location' (T;P,or M) (CFM) (CFM) Duct Type 5 FittinQs6 (ft) (ft) Fail9 1. Enter the Fan or System Identification Name,or Location Name,or System Identifier. T)zese should be the same identifiers as shown in the INSTALLED VENTILA TION AIR-MO VING EQUIPMENT INFORMATION table column 1 above. 2. Enter the method for demonstrating compliance with the ventilation airflow requirements. Enter"T"for Tested;"P"for Prescriptive Table 7.1 design criteria(inspection); "M"for Manufacturer's duct design criteria(inspection). Note:the building official may require submittal of manufacturer's published design criteria documentation if compliance is to be demonstrated by inspection of the installation for conformance to manufacturer's design criteria. 3. Enter the required ventilation airflow values determined by the calculations or tables in the WHOLE-BUILDING VENTILATION and/or LOCAL VENTILATIONEXHAUST sections at the beginning of this Installation Certificate(CFM). These should be the same airflow values that were entered for each corresponding fan in column 3 of the INSTALLED VENTILATIONAIR-MOVING EQUIPMENT INFORMATION table above. 4. If complying by a method that requires an Airflow Test of the installed system,enter the result fnonn the Airflow Test for the installed system(CF*. 5. Enter duct type for the installed system. Choices are "Flex"or"Smooth"if using Table 7.1 for compliance. 6. Enter total number of elbows or fittings or abrupt turns in the ventilation duct for the installed system. 7. Enter the installed system's actual total duct length(ft). 8. If complying by use of the prescriptive design criteria or manufacturer's design criteria,enter the Maxinn an Allowable Duct Length (ft)for the system as determined by Table 7.1 or manufacturer's duct design criteria. 9. If complying by airflow test, the system passes if the Tested Airflow°equals or exceeds the Required Air flow3. If complying by demonstrating conformance to prescriptive design criteria or manufacturer's design criteria, the system passes if actual total duct len th rom column 7 is less than the maximum allowed len th from column 8. Enter: Pass or Fail 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-05 Indoor Air Quality and Mechanical Ventilation (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: OTHER REQUIREMENTS The items listed below(6.1 through 6.8)correspond to the information given in ASHRAE 62.2 Section 6"Other Requirements". Refer also to Chapter 4.6 of the Residential Compliance Manual(Section 4.6.5)for information describing these "Other Requirements". 771e signature of the Responsible Person in the declaration statement below certifies that the building complies with these requirements specified in ASHRAE 62.2 Section 6.1 through 6.8 if applicable. ❑ 6.1 Transfer Air ❑ 6.2 Instructions and Labeling ❑ 6.3 Cloths Dryers ❑ 6.4 Combustion and solid-fuel burning appliances ❑ 6.5 Garages ❑ 6.6 Ventilation Opening Area ❑ 6.7 Minimum filtration ❑ 6.8 Air Inlets ❑ Prescriptive Designs: For ventilation systems that utilize prescriptive design criteria,the signature of the Responsible Person in the declaration statement below certifies that the installed system conforms to the prescriptive ventilation system design criteria from Table 7.1 of Standard 62.2 and manufacturer's installation specifications. ❑ Engineered Designs: For ventilation systems that utilize engineered design criteria,the signature of the Responsible Person in the declaration statement below certifies that the installed system conforms to the engineered ventilation system design documentation approved by the enforcement agency. ❑ Manufacturer's design criteria: For ventilation systems that utilize manufacturer's design criteria,the signature of the Responsible Person in the declaration statement below certifies that the installed system conforms to the manufacturer's published duct system design criteria and installation specifications. DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-1R)form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF-1R that apply to the installation have been met. • I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: stalling S 10co tractor or General Contractor or Builder/Owner) V ThLI<4 uoV . Respo 1 P rson's Name. q Responsible Person's Signatu �y& VSO CSLB License: p. Date Sign d: Position With Company-ml e %� 2008 Residential Compliance Forms August 2009 CALGREEN RESIDENTIAL CHECKLIST — MANDATORY ITEMS �� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL APR �o+a 1 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 r o 9 1 (408)777-3228•FAX (408)777-3333-build inaacupertino.orq PURPOSE: IAX The 2013 CalGreen Code applies to all newly constructed hotels, motels, lodging ouses, dwellings, dormitories, condominiums, shelters, congregate residences, employee housing, ctory-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: Zhao Residence Addition & Remodel Project Address: 20201 Patric Court, Cupertino, CA95014-4424 Project Description: 706.1 SQ. FT addition including two new bedrooms, two bath rooms,utiIity room_ Instructions.- 1. nstructions:1. The Owner or the Owner's agent shall employ a licensed professional experienced with the California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the ofessiona1 I �p 2 of this checklist, sign and date Section 1 - Design Verification of this ch checklist printed on the roved plans for theproject. lti Ifli P PP P _r 3. Prior to final inspection by the Building Department, the licensed 1 shall com ,e olumn 3 and sign and date Section 2 -Implementation Verification at th is ctA. n mit the completed form to the Building Inspector. REv;tvVED FOR CODE COMPLIANCE Kevieweci i3v. ,��^r �TRT� Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Re uirements PLANNING Planning and Design -Site Development 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during Q construction. 4.106.3 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. ]'age I o1'5 n `.•'r ('al6reen_2nilduc reiv,w 101 15 14 f A4.2 ENERGY EFFICIENCY General 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. WATER / CONSERVATION Indoor Water Use 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings(faucets and showerheads) shall comply with the following: ❑ 4.303.1.3.2 Water Closets.The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank-type water closets shall be certified to the performance criteria of the U.S- EPA WaterSense Specifications for Tank-type Toilets. ❑ 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. j ❑ 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. ❑ 4.303.1.3.2 Multiple Showerheads serving one shower. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. ❑ 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 ' psi. The minimum flow rate of residential lavatory faucets shalt not be less than 0.8 gallons per minute at 20 psi. ❑ 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas(outside of dwellings or sleeping units)in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. ❑ 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. ❑ 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, and shall meet the applicable standards referenced in Table 1401.1 of the MX California Plumbing Code. — Parc 2 of 5 CalGreen 2011.doc revised 0,' 15 14 f Outdoor Water Use 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the time of final inspection shall be weather-based. ❑ 4.304.1.1 Controllers shall be weather-or soil moisture-based controllers that automatically adjust irrigation in response to changes in plants' needs as weather conditions change. ❑ 4.304.1.2 Weather-based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the controller(s). Soil moisture-based controllers are not required to have rain sensor input. A4.4 MATERIAL CONSERVATION A / RESOURCE Enhanced Durability and Reduced Maintenance 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall be submitted for approval to the enforcing agency. Building Maintenance and Operation 4.410.1 Operation and maintenance manual. At the time of final inspection, an operation and maintenance manual shall be provided to the building Q occupant or owner. A4.5 ENVIRONM ENTAL QUALITY Fireplaces 4.503.1 General. Install only a direct-vent sealed-cornbustion gas or sealed wood-burning fireplace, or a sealed woodstove. Pollutant Control 4.504.1 Covering of duct openings and protection of mechanical equipment during construction. Duct openings and other related air QX distribution component openings shall be covered during construction. 4.504.2.1 Adhesives,sealants and caulks. Adhesives, sealants and caulks shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be compliant with VOC limits. MX i 4.504.2.3 Aerosol paints and coatings. Aerosol paints and other coatings shall be compliant with product weighted MIR Limits for ROC and other toxic OX compounds. Page 3 of 5 CalGreen 10/4_doc rerised 01 Li 14 4.504.2.4 Verification. Documentation shall be provided to verify that compliant VOC limit finish materials have been used. F7 El 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with VOC limits. 4.504.4 Resilient flooring systems. Eighty(80) percent of floor area receiving resilient flooring shall comply with the VOC-emission limits defined in the Collaborative for High Performance Schools (CHPS) Low-emitting QX Materials List or be certified under the Resilient Floor Covering Institute(RCFI) FloorScore program. -------------- 4.504.5 Composite wood products. Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall OXEl comply with low formaldehyde emission standards. Interior Moisture Control 4.505.2 Concrete slab foundation. Required vapor retarders and capillary breaks are also required to comply with CalGreen Section 4.505.2.1. 0 j 4.505.3 Moisture content of building materials. Moisture content of building materials used in wall and floor framing is checked before enclosure. El Indoor Air Quality and Exhaust 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the j E ' building are provided in every bathroom. Environmental Comfort 4.507.2. Duct systems are sized and designed and equipment is selected using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or equivalent. 2. Size duct systems according to RCCA 29-D(Manual D) or equivalent. 3. Select heating and cooling equipment according to ACCA 36-S(Manual S) or equivalent. INSTALLER AND SPECIAL OQUALIFICATIONS - Qualifications 702.1 Installer training. HVAC system installers are trained and certified in the proper installation of HVAC systems. 702.2 Special inspection. -rhe Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the QX discipline they inspect and verify. Verifications 703.1 Documentation. Verification of compliance with CALGreen may _T 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 El be submitted to the Building Department after implementation of all required measures and prior to final inspection approval. Page 4 of 5 Caff;reen 2011 doc revised 01 1? 14 CALGREEN SIGNATURE DECLARATIONS Project Name: Zhao Residence Addition & Remodel Project Address. 20201 Patric Court, Cupertino, CA95014-4424 Project Description: 706.1 SQ. FT addition including two new bedrooms, two bathrooms,utility room. SECTION 1 — DESIGN VERIFICATION Complete all lines of Section 1 -"Design Verification"and submit the completed checklist(Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the require is set forth in the 2013 California Green Building Standards Code as adopted by the.�ity of Cupe wners Signature Date of Owner's Name (Pleas Print) 04/09/2014 Design Professional's Snature Date Chia-Ching Lin D gn fessional's Name (Please Print) tur f License Professional responsible for CalGreen compliance Date — —� Na6e of License Professional responsible for CalGreen compliance(Please Print) Phone Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance(Please Print) Phone -- - ---- -._.........._._...— Email Address for License Professional responsible for CalGreen compliance Page 5 of i C(VGreer, 014.c oc.,vv cd W l? l d