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13100196 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10625 S FOOTHILL BLVD CONTRACTOR:VETTE INVESTMENT& PERMIT NO: 13100196 CONSTRUCTION OWNER'S NAME: BECKSTROM GORDON AND NELLIE 2175 DE LA CRUZ BLVD STE C DATE ISSUED:12/05/2013 OWNER'S PHONE: 4082349061 SANTA CLARA,CA 95050 PHONE NO:(408)234-9061 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL C TENANT IMPROVEMENT: CUPERTINO BIKE SHOP; License Class 13 Lic.# q3 O 7- O 51 SHOWROOM Contractor l"GKsh>�a�fic 2 311 I (1779 SQ FT); STORAGE AND REPAIR(611 SQ FT); OFFICE(170 SQ FT). I hereby affirm that I am licensed under the provisions of Chapter 9 REV#1-REPLACE 1(E)WALL,INSULATE&SHEETROCK.INSULATE (commencing with Section 7000)of Division 3 of the Business&Professions 2ND WALL&SHEETROCK-ISSUED 1/23/14 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 j� Compensation,as provided for by Section 3700 of the Labor Code,for the t performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$40000 have and will maintain Worker's Compensation Insurance,as provided for by V Section 3700 of the Labor Code,for the performance of the work for which this APN Number:34216087.10625 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 t comply with all city and county ordinances and state laws relating WITHIN�180D MEDSUANCE OR to building construction,and hereby authorize representatives of this city to enterupon the above mentioned property for inspection purposes. (We)agree to save 180 DM L indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 12,3 1 granting of this permit, Additionally,the applicant understands and will comply issued b Date: with all non-point source regilatns per the Cupertino Municipal Code,Section 9.18. J, / RE-ROOFS: Signature /4,/' '/ Date r 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 1 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. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous 1 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 C pertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 5505,2553 `and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date: — I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 1 certify that 1 have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228• FAX(408)777-3333•building(a)cupertino.orq ❑NEW CONSTRUCTION ❑ A(((DDITION ❑ AI TERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS \ \ 1 vV f I / 12 / ( APN# OWNERNAME // PHONE 77MAIL STREET ADDRESS CITY,STATE,ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK O I a-21 I-6 /� r EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: ODETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES – '--�--" BEING ADDED? ❑NO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIV r 7�N 5 TOTAL,VALVA PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each ofjthe following: I th property owner or authorized agent to act on the property owner's behalf. I ha read this application and the information I have pr ided is correct. I ve ad the Description of Work and verify it is accurate. I agree comply with all applicable Local ordinances and state laws relating to b it ing construction. aunt r'ze representatives of Cupertino to enter the abaap-id�94 e r perty for inspection purposes. Signature of Applicant/Agent: % Date: ✓/—[/ cJ PLANCHEC$TYPE RpIl�INGSLIP,s ,i-+ SUPPLEMENTAL INFORMATION REQ U1RED _New SFD or Multifamily dwellings: Apply for demolition permit for © OVER THE-COIINTER existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ �xPREss ��„�- ��t�� s�,�i,� �i� , rte nvG�� xrvt>.w� 4 � fi, Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTnNnaxn � r �ZisLlcwoiucs r 2r , for-m if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to k'" 5 AISTWCTr submittal of Building Permit application. Li ENVII20NMENTH s=;r_ B1dgApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ILI ADDRESS: 10625 S Foothill Blvd DATE: 02/03/2014 REVIEWED BY: Mendez APN: BP,#: 13050177 `VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 10EAP2 USE: PERMIT TYPE: WORK revision #2- sub ane/ upgrade 60 amp, revise mechanical platfrom SCOPE Elec. Plan Check 0.0 hrs $0.00 Elec. Permit Fee: IEPERMIT LlOther Elec. Insp. 0.0 hrs $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. . Thesefees are based on the relimina information available and are onl an estimate. Contact the De t or addn'l in o. FEE ITEMS (Fee Resolution 11-053 Eff 7:1,13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 60 amps Electrical Suppl. PC Fee: (D Reg. Q OT 0,0 hrs $0.00 $47.00 IBELEC200 Services PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Administrative Fee: (ADMIN $44.00 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure 0 i Strom Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $138,001 $47.00 TOTAL FEE: $185.00 Revised: 01/15/2014 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10625 FOOTHILL BLVD DATE: 01/23/2014 REVIEWED BY: MELISSA APN: 342 16 087 BP#: 13100196 *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION USE: PERMIT TYPE: WORK REV# 1 - REPLACE 1 E WALL INSULATE & SHEETROCK. INSULATE 2ND WALL & SCOPE SHEETROCK- ISSUED 1/23/14 z._.:-,rw Li `1st Li NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the prelimina information available and are onjV an estimate. Contact the De t or addn 7 info. FEE ITEMS (Fee Resolution 11-053 Eff7/1113FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl. PC Fee: Q Reg. 0 OT0.0 Fhrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: Hourly Only? Q Yes Q No $0.00 Suppl. Insp.Fee:Q Reg. Q OT 1070 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Co sn( Icfion TOA"' F71 FcC.' 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Tin,�,i DocruncntutiCn; l��rea_ Building or Structure 0 Strom;Motion Fee: $0.00 F-2--07 hrs Inspections Bldg Stds Commission Fee: $0,00 $278.00 1STINSP Inspection,Hourly SUBTOTALS: $0.00 $278.00 TOTAL FEE: $278.00 Revised: 01/15/2014 CONSTRUCTION PERMIT APPLICATION 1 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building(ftupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS r r' (( L� APN# —4 f --o OWNERNAME r-J( U / PHONE E-MAIL � : � e.u.ILJ�cI� STREET ADDRESS CTT 'ST TE,ZIP FAX CONTACT NAME �. r JG I� PHONE (0]) `U E-MAIL STREET ADDRESS CITY,STATE,IZIP s FAX f c;9(13 S. �� .� �,c�S�, Cu')u k cry Gr;:� ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCRrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME 2 LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHON&ws ARCHTTECT/ENGINEER NAME C LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX GA HO STREET ADDRESS CITY,ST TE,ZIP P Q kU 3 Fr-cite- J(k, c DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH ❑ATTACH #DWELLING UNrrS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ONO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES ; TOTAL VALUATION: PLANNINGAPPL# ONO PLANNING APPROVAL LEITER EICHLER HOME? moi • iE qy -a By By my signature below,I certify to each of the follo*i : I am the property o er or authorized agent to act o operty owner's behalf. I have read this application and the information I e provided is c r ct. I have read the Description of Work and verify it is accur e. I agree to comply with all applicable local ordinances and state laws relatin building cons c on. I authorize representatives of Cupertino to enter the ab e-identif d pro erty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO RMA ON REQUIRED �PIAN iccKJR csIP �� _ <<�� _New SFD or Multifamily dwellings: Apply for demolition Permit for existing building(s). Demolition permit is required prior to issuance of building fM permit for new building. ❑ Exrx�ss c L V[>iv „aA _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ©:STANbARDy* l W a i w form if any Hazardous Materials are being used as part of this project. r rpt �d 9 r ❑�1i Grp � � fi, �u �� xlRr ri a �� .� �� G _Copy of Planning Approval Letter or Meeting with Planning prior to I submittal of Building Permit application. CJ^� ONb7BNTAL BldgApp_2011.doc revised 06/21/11 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: 22 . PERMIT# 11 3 100 OWNER'S NAME: L. .vv PHONE# GENERAL CONTRACTOR: Q BUSINESS LICENSE# ADDRESS: 1 �-g -4- NJ Li % CITY/ZIPCODE: S Gk✓u Q,9-0 *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 # C mets & Millwork Cement Finishing O Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood ass /Glazing Heating Insulation Landscaping Lathing sonry Painting/Wallpaper Paving Plastering Plumbing C V Roofing Septic Tank eet Metal Sheet Rock Tile �J� f Owner/Contractof Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10625 S FOOTHILL BLVD CONTRACTOR:VETTE INVESTMENT& PERMIT NO: 13100196 CONSTRUCTION OWNER'S NAME: BECKSTROM GORDON AND NELLIE 2175 DE LA CRUZ BLVD STE C DATE ISSUED: 12/05/2013 OWNER'S PHONE: 4082349061 SANTA CLARA,CA 95050 PHONE NO:(408)234-9061 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL License Class Lic.Il ` C5 �6 TENANT IMPROVEMENT: CUPERTINO BIKE SHOP; SHOWROOM Contractorr! <tl Date '�' (1779 SQ FT);STORAGE AND REPAIR(611 SQ FT); I hereby affirm that I am licensed under the provisions of Chapter 9 OFFICE(170 SQ FT). (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:$40000 I have and will maintain Worker's Compensation Insurance,as provided for by 3700 of the Labor Code,for the performance of the work for which this APN Number:34216087.10625 Occupancy Type: rt 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.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSP CTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may_ggqu&against said City in consequence of the 2 granting of this er ditionally,the app is erstands and will comply Issued by: Date: with al n-poi source the Cupertin nicipal Code,Section 9.18. _� RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION 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 I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 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(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants asde ued b Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain com �xlr Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Co 3,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this f� Owner or authorized a Date: permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date D� CONSTRUCTION PERMIT APPLICATION ` COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ig 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq(a1cupertino.org \ ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Tl ❑ REVISION/DEFERRED \ORIGINAL PERMIT# PROJECT ADDRESS i' ,a, --y I I APN# OWNER NAME V 1 a PHONE E-MA / / IL r brei ,cecu STREET ADDRESS .-� CITYTAT ,Z.IP F ss/ S Ari- y �- �' e/ s CONTACT NAME }_ N �q., C_ ©C`-t� ', d.�� U C C� PY Zit M��. c /3•C041 STREET)P�tES -� CIT STAT ,ZIP FAX CJ !v a o, � � , Il I ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER XIENANT CONTRACTOR NAME LICENSE NUM (� LICEN YPE BUS.LIC# C MAN AM E-MAIL FAX STRE).�DV_I (U�, �. CITY,S ,ZI A ,�5 PHO ARCHITECT/ENGINEER NAM /i Z LICENSE N BER �j�.J J BUS.LIC# COMPANY 1� �� E MA�„ t I FAX c�✓fir it£ STREE Aa CIT<, ATE, ' y 31 DESCRIPTION OF WORK EXIST G USE PR(l OOSSED USE CO TR.TYP ft STORIES 6 f1 VT W USE TYPE OCC. SQ.FT. VALUATION($) EXISTG �T NEW FLOOR li DEMO VV "TOTAL GJ AREA ZO AREA AREA NET AREA E' BATHROOM KITCHEN OTHER G•- REMODELAREA /� 1 REMODELAREA REMODELAREA t PORCH AREA DECK AREA TOTAL I]�CK/PORCH AREA GARAGE AREAA: DETACH J.�/{ ATTACH H DWELLING UNITS: ISA SECOND UNIT �,❑.,�Y`EES SECOND STORY ❑YES BEING ADDED? -a_l ADDITION? �'BpiO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF "\ IS THE BLDG ANC]YES RECEIVED BY: TOTAL VALUATION: G PLANNINAPPL H [:]NO PLANNING APPROVAL LETTER EICHLER HOME? SPO S` L/O'O O0 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. 1 hhave read this application and the information I have IS ea Ie ri_pfici�f Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to uilding construc i n. n6 >C ertmo to enter the above-identified property for inspection purposes. Signature of ApplicanUAgent: _ Date:��(/'� �3� - SUPPLEMENTAL INFORMATION REQ PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ PIRE DET[, Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MA7ost ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10625 S FOOTHILL BLVD DATE: 10/29/2013 REVIEWED BY: MELISSA APN: 342 16 087 BP#: � �G'J jj *VALUATION: 1$40,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial BuildingT PENTAMATION 1 M TI USE: PERMIT TYPE: WORK To Clear Code Enforcement Case: T.I. TO CREATE N M OCCUPANCY FOR BIKE SHOP. 2000 SCOPE S.F) INCLUDING M.E.P.'S OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. M (Tenant Improvements) II-B,111-B,IV,V-B 2,000 $2,975.30 1MTIPLNCK $1,716.95 1MTIINSP TOTALS: 2,000 $2,975.30 $1,716.95 MECH,HOURLY O Yes Q No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes E)No Vcc NOTE. This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelimiina information available and are only an estimate Contact the De t or addn 7 info. FEE ITEMS (Fee Resolution 11-053 Eff, 7/1!133 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,975.30 Select a Misc Bldg/Structure Suppl. PC Fee: Q Reg. () OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,716.95 Suppl. Insp. Fee-.0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? E) Yes No $4,692.25 Advanced Planning Fee. $0.00 Select a Non-Residential Building or Structure 1rk .'e'( i)��z?itiac'P'tlailc�:�F"c'c,E; � Stronp_Motion Fee: IBSEISMICO $8.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.001 1 SUBTOTALS: $9,394.90 $0.00 TOTAL FEE;` $9,394.90 Revised: 10/01/2013 AM : P(RMIT NUMBER ISSUED BY DAl[ APPLICATION FOR BUILDING PERMIT 9�� RRTIFICATIO OF SIGNIFIES COMPLIANCE IS NCJ WITH At IfSU LIrA OF CFRN CIAJI OT OCCUPANCY DEPT,OF PUBLIC WORKS SANTA CLARA COUNTY wuli LINDIR DEPARTMENTAL PU VIEW. TN AN Arn1UeL[SANTA CEARA COUNA ORD. 13UILDING INSPECTION DIVISION 1555 BERGER DRIVE SAN JOSE,CA.95112 TEL.299-2351 INS SPACE PON lnfrfaoRsusEONLY ADDRESS ENGI♦NEERING SERVICES DIV. ' LAND DAT! �.u,/ Div. /�� L.L.-. 06 V-r —dW WG. �_ G474.¢ COMP. RY Ill[NO. rARCII NG^�+ /� f-1 INSPECTION RECORD NEAREST CROSS STREET �'(,r y. all REDuIRID OY.. ❑No RIR-NI. [I Too Df. ❑Ne I.fOVNDAIION n "'yAPPROACH [3 """RT DATI IORMS rosyoFrlcEtam �/N �S7fJ U. D/ - co"sr. INfP. ROAD MMP ❑/_ INSP DY DATE 7•FONMS OWNER Pasy'1 019�( CofLnllf f0 A.L, qN0❑ l.,J ✓ D L PNONF DATE POUR HOCONCRTTE UNTIL THE ABOVE HAS TEEN SIGNED MA41N0 S ,,u APPROVED SY 7.G'xHEAlm O ADDR[Sf clmF 0.1! t a,CONTORT alY C•v pER T„N a G q ,,, ' HEALTH DEPT. CooIING OR CFO noC ser TR rERaVT No. APPROVAL �/�. S.W RDfRf ) jWHIT Cl PHONE .Sp++.IS�" REQUIRED? HID1NlPR DO NOT COVER FLOORS UNTIL THE ADM NAS IEE"SIGNED R COIITIIARORSELF ,/(�_,,J/ p ^['• tir-ho. (LASS CERTIFICATION OF COMTy1ANCE DATE 7,ROUGH PLIG. ('L Ill MAILING PARTIAL . 10-1W (� L ADDRESS PNONI FIRE MARSHAL DEPTP CIT' lipAPg . B'COWMMtIFTi�' F I RE BUILDING INSPECTION DIV. NiSEWER fvLR wT TZAR PLAN CNSCR NO. APPROVED IT S`per !Bfl�/1ISfO2C�/-.1 'D•I�REssuRE flock A.P.N. CE.IIFIU710N Oi O ANC[ 11,ROUGH ROp TYPE Of I MPROVEAMENT PLANNING DEPT. FRAMF FLUIS EUILD PiMODEI ADD TO REPAIR MOV! CONVERT DEMOtIlN SET FRONT IIROM[EN1ER SID! .[A0. SOME DO NOT WIRE UNTIL TNI A.0V[.1.I1N SIGNED 10.FT. Me.d Ne,d .ACRS LINE OF N WJ slit IAWII[s STORKS FEE! CG..- 17.ROVON EI[( Y W RING REKNIT NUMIERUSF OT VARIANCE OR Div Rio COMP 3866S1.URURE/)�sy � � SPE(RIO. DL'I (,,. DA7( COVER NO WALLS UNTIL Ili[MOVE FW FEIN/IONTO 1/J/ ARCH.illi / b A=I'DY: • IS.slucco WISE O.LATH 6 1 a,an[R v r1 t /2 Root 13. N/LL IF;Ilan) �• o o E: v Is.GAs APPLIANCES �'./G7 C• /'�•Y_YS •C• iR1ALIH.Irn) EP"If�7G APPROVED" APPROVED SIT: ID.COMPLETE C[RTGI 1 F COMILANCE DAII CERTIFICATION OF(OMRIMC( OATS NO Ullllll[3 WIU ti CLEARED uN14"BUIlpNO(OMR[I[""AS REEK 3NFN[D NOTE.TOTAL IEIV SRaUDIIAPPLMARL[ ELICI.ICAL.PlUMSIND. 3—Y111M.IlOmin. VALUATION TOTAL Itt$ AND MECHANICAL PERMIT f i t4. SEPTIC TANK Illi Iff ANC!I � M11RfHAlI �`90 nAN ReRV.Ib fer-lf nd.er pd)n%—I.In IMT peid I.aN be ned.h M.WIdln/ellNlal In (�� CHlcK rlilirp in t.nlwarorN.risk epp111able. Ianf,)al Ih.Sonia Clala C—Ar O.dIMKa Cad.. J IOVM SiJ/77 PE.MiI �-a(.��°• / `'• AUS-Z4-76 3 4 014 9P o23666 W— A 1 n nn c:+"%':: G. y JU UL THIS APPLICATION IS A VALID PERMIT WHEN PROPERLY FILLED OUT,SIGNED.AND MACHINE VALIDATED IN THE SPACE PROVIDED. PERMISSION IS THEREFORE GRANTED TO DO THE WORK INDICATED IN ACCORDANCE WITH ALL APPLICABLE ORDINANCES;LAWS AND REGULATIONS. PERMIT IS SUBJECT TO ALL APPLICABLE SECTIONS OF SANTA CLARA COUNTY ORDINANCE CODE. THIS PERMIT SHALL EXPIRE BY LIMITATION AND BECOME NULL AND VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS. "REFUND:WHERE NO PORTION OF THE WORK OR CONSTRUCTION COVERED BY THIS PERMIT HAS BEEN COMMENCED BEFORE THE EX- PIRATION DATE HEREOF,REQUESTS FOR REFUNDS MUST BE MADE IN WRITING TO THE DIRECTOR OF THE BUILDING INSPECTION DIVISION ON OR BEFORE SEVENTY-FIVE(75)DAYS FROM THE DATE OF ISSUANCE OF THIS PERMIT." GRADE LINES AS SHOWN ON DRAWING ACCOMPANYING THIS APPLICATION ARE ASSUMED TO BE CORRECT.IF ACTUAL GRADE LINES ARE NOT THE SAME AS SHOWN,REVISED DRAWINGS SHOWING CORRECT GRADE LINES,CUTS AND FILLS,TOGETHER WITH COMPLETE DETAILS OF RETAINING WALLS AND WALL FOOTINGS REQUIRED,MUST BE RESUBMITTED TO THIS DIVISION FOR APPROVAL. INSPECTOR MUST BE GIVEN 24 HOURS NOTICE FOR EACH INSPECTION. IN CONFORMITY WITH THE PROVISIONS OF,SECTION 7031.5 OF THE BUSINESS AND PROFESSIONS CODE AND SECTION 3800 OF THE LABOR CODE OF THE STATE OF CALIFORNIA;APPLICANT SHALL FILE WITH THE BUILDING INSPECTOR THE CERTIFICATES DESIGNATED IN 1 ° (1)AND(2)BELOW AND/OR SHALL INDICATE ITEM(3).(A),(5)OR(6)WHICHEVER 15 APPLICABLE. (1) CERTIFICATE OF CONSENT OF SELF-INSURED ISSUED BY THE DIRECTOR OF INDUSTRIAL RELATIONS. - (2) CERTIFICATE(OR EXACT DUPLICATE COPY)OF WORKMEN'S COMPENSATION INSURANCE ISSUED BY AN ADMITTED INSURER. (3) THE COST OF THE WORK TO BE PERFORMED IS$100 OR LESS. (4) 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SAALL)�0T EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKMEN'S COMPENSATION LAWS OF CALIFORNIA.LI (5) DIVES ON 3 OF THE RTIFY THAT B SIINESSANT IS LICENSED UNDER THE AND PROFESSIONS CODE AND SAID AION�OF PPPLICAN S CAPLIFORNIA STATE CONTRACTOR'SNCING-AT OLICEP45E NOF CLASS IS IN FULL FORCE AND EFFECT, (6) AP CONNT IS EXEM 5 LICENSE LT FROM (ABOVE UNDER STATE BASIS FOR APPLICABLEEXEMPTIONPROVISIONS OF SECTION 7040 THROUGH SECTION 7053 OF APPLICANT S SIGNATURE PHONE APPLICANT'S ADDRESS ZIP CODE AGENT'S SIGNATURE DECLARATION OF CONSTRUCTION LENDER PURSUANT TO SECTION 1193 OF THE CODE OF CML PROCEDURES,AN APPLICANT IS REOUIREO TO INDICATE THE FOLLOWING. 1)NAME OF CDNSTRUCTION LENDER BRANCH DESIGNATION_ ADDRESS ZIP CODE 2) THERE IS NO CONSTRUCTION LENDER. APPLICANT'S SIGNATURE / DATE ITEM EAO, NO. Ffls 1Ny frKl IOe nYfCIOFi Yft APPLICATION FOR PLUMBING PERMIT ISSUANCE IEE 2.20 2.9a SANTA CLARA COUNTY ENVIRONMENTAL MANAGEMENT AGENCY SUWV FEE INL/fl9 ft. la- BUILDING INSPECTION DIVISION 70 W.HERDING ST.,SAN JOSE,CA 95110•TEL 299.2351 la p1uw0lp+Ytvr•.Irap.••1 a+i.t«r•.wa 1.70 IraP,IM•dlnp.alar.mpinppa pbrp pntl he0.Ilaw prTotllm+hpm« ADDRESS I—Wlldlna ww..«ImI4,pari • Np..e{n xpY.• 1,.00 ronorncua 27i1v was w c rtxo. wo[A To el EOG wtw M.I.wd/«.en 1.29 .vnmwnw OS f[t t6 oax[n L•Pr�swo� ruOa O[1——) wn uf[w SnucruA Tw1 W•Y[OVFMFR fe0,am••M I.TO p FAN AfIDBxO OwIIE omMOWI 0e1rME �alN:a A NIE {edr pm OTinp•T•I•n d w•+o Iiw«dYy 1.10 �7v EWON OS ImONKYEI) All IO.Fl. xO.Oi O.O. MA —SS IMEI[S Eorh Pm PION 4+10:.d It.«apry, /7 FINK ON IiIGMAN[[) w1E ys/�J pYll01 .9 �/ xwME«DANE[ � ItgNf 9 IaOt .Pk '«M Iwm•yp•m lar• {/ Id.p.lr•a O O {IEsnr ns wn FO.ED pNtm6 w00[IEf � w W /�� S.Sa lml� GT n oc to ysue nswr wn or ysuE art Ea and iN Apel•p d"IF, Im«Sept«. "(L plrn xo. wn k1kh.irq xi+rap wd.—e.YpNnp �I+A•Y+IDa praaw mlawapl«t INMiwlnf wttnwclpE lin m ,.lo THIS APPLICATION IS A VALID PERMIT aus tic xe. rNOXI TO INSTALL PLUMBING WORK AND/OR FIXTURES AS LISTED, Etltl,rpinwrr ery.nt_pn Noln 2.20 AT THE JOB ADDRESS INDICATED HEREON, ONLY WHEN PROPERLY INITIALED AND MACHINE VALIDATED W THE SPACE PROVIDED BELOW. AWA21 AJ—iw m r•(Kir d veYr piping«water 1.20 N mNNMn wiM t••pr•grlr•d fMb 1pll.i d N.Mbr W 0.gWr•4ee InYellniw Ir•a1Np•Quipm•nl. W iMlen ilm d M I•e•r Ce••d M trY q bIErW.ypkM.x.11 NI•.la M I„ne.w.el:+n...Y In Ya re:tl:w•1 b.wb b te•0.:MYp d1nl•1 b rpyWlnp InlFoar A MIOMw.aew:w•t•d b IIl N 131 MI.O•„a/s WII WN•N INn p Iw w.ls.eo ytN•plieYw ogY.W d rN•Sea Oen Grq 0.d'mn•Toe•. (1)IeN4rMikq�eN 4nr�un I f l'wM iawe N 0.OnYsr q b6enlm Ylml y Irl Cr��l�.MpW.•wR1 d WwY:wm'•Sa.ywe.t sn nw••a uM ti r' Alt•rmlen m n• d dnirwp•«wnl piping 1.20 IQ DI Ilse rM d M.ri b a pero.e'v f 100..x.. SUB TOTAL : 'r r-• �mtAr Ew Y N.p8rws..q w.4 wNan qh WM I.bW A. Nr:`a r~..�[:.a>Via:eu•b owr rWiM CPI Ad). ±% rgl [•unlawn rprintbr P on- .I mlh 2.20 Q 121 I•sner rxw w.w.topnmq b Ibwe.e I..lr a•pe.Ws.q PoFw• i Wdlnp pori Ilow y0lmnw E•.ly Ih.nlw. laww•wLne m be:e.rpC�r q.bi•n a d m•iuirm wV nd.eryw C•a wK N•, o®tl,mll•.b I.fl�i�v.ne.nM. DII,.r MI. D QMI apron I•n•rp N..Udyee,• •.aw�A—.p«kbq q V—mn bwe5or•«b—new prm•dr•dnlm 'm TOTE 0.rgxM w Iw.0—aaw on IpnW.•me,o...m br iglalbliw w•n —ICA-1 plvmbitp li.brse TOTAL FEES SIONATIfII[ a b lie• 2.20 [ON ON ltNOie SEE 11a .(,P. Wer lhO,eprh oddi,l—1 30 ells SMCF rOt MwCXiNi YMtwTN2X OKY ""['i' Swimming Fo b.prirmo I I.00 t •Z -79 6 ri z d •P • • W-8 7 O AORI31. _ pohlk 2240 UNo,oaw: R: SUB Toru s pl NPp calm !w ti j 1wf srwq rot INfrfRoi's Rft APPLICATION FOR ELECTRICAL PERMIT ITEM EACH NO. FEES 1BSUAXCt FEE ) 5.30 1.30 SANTA CLARA COUNTY ENVIRONMENTAL VISION EN7 AGENCY BUILDING INSPECTIONA96110IDN Wdl.�r°mpN..e.wN.t. •IlAo pr�pn. 70 W.NEDDING ST.,SAN JOSE,CA 96110 TEL 299$551 An rs.N.r min etrlr I I.so r rr ADDRESS / LIGHT OURETS I I-to(MINIMUM FEE) 5.30 RECEPTACLI BWTCHES I °`�10 •50 w. rOst OrrKt 1 �0 LIGHT FIXTURES 1;10 _..e1.10(MINM FE) 2.50 OVER D .30.0 . AmKAlcx NEATER(PER MI I .30 /ARTMIwWtt `'� t31MUCiw RA.."OVEN/DWER/WATER NEATER I.ID Uft IN INURU i TYri Oi VY40ViMINT p{AMBY ItuOix[l O Wllp pILNpOtI pRt.AD flDIxS4 PANEL/PANEL BOARD/SWITCHBOARD 1.10 pyOx OL lycxATYREI DAtF �_ T. NOOr FIRE OAMAC;R INSPECTION II.Op 36 i .OI NO. f0:1 i4UtlO^ fTOM[s SERVICE MANGE 11aD _ SURVEY-I MR(1110)MIN. 10.00 t1U LwAL O4flwxANlt1 OM[ TEMFORAIY METER SET 4.00 nAN[Of OwNit�• MOWD IN ROUSE(MINIMUM t11.00) I IAO So MOTORS•1/5 NP OR LESS Ao FD r.L.4w O O uRrxm Wt Mll Ntcp MAnwO Apw[M 1.10 ccuoxtDs.ROR �uc xD, rNOx1 so .10 ^ I[RMR xOn M/lVrt OF."Fut Ut .TY 7S TTOO 6!NNPP 130 Yo AIS T53 W 40 SSOSaTOIO W a.a0 D NNP 11.ao THIS APPLICATION IS A VALD PERMIT OVER 100 NP .00 TO INSTALL ELECTRICAL WORK ANDJOR FIXTURES AS LISTED. AT THE JOB ADDRESS INDICATED HEREON. ONLY WHEN TRANSFOEMERB 1/5 RVA OR 1E55 ,m PROPERLY INITIALED AND MACHINE VALIDATED IN THE AO0ttf3 1/5 TO 3 KVA 1.10 SPACE PROVIDED BELOW. M mr•INM wee Nw wrh:•m r aMk•iOlrJ r rM wnwr rs Nrwiw 0.•. 3 To f KVA 1.10 M S.er]100 d rr bYY AI•d Or ur.d(eI]rr•.Vtlkmn uen l0.rrx M STD IS RVA S,Sp we r rr•.6 r•A•rw...e N r.Ytr r n Ielgh ONk M iaIpm1 wrP.Dr m.mmllrolw awP.re a III•w i>t rw rr(/r.erl wsm..INw. .�.irw mdr.rr.au aw.rrl...nr,jq r w I..a O.m 4wp Oafwo Ems. ).NI.OI r 11,wnkM.r,N gNimy., 1 B TO]!KVA 3.30 (1) [Milk.N d 4m.r d NY.wwW 4 ra.Rr.m r Yri•b W Iasxmr_ 711 70>D RVA aA0 P) T•ruiear.Ir n•a evN;ml.mvrl s wmtw.•:[wn.uu:..Imrw m..a 4 .r•ewlmi tn.rr. 50 TO IN KVA E.80 d•w.•n w M pMrwN b 1100 r Ir. OVER IN KYA 11.00 SUB TOTAL ��1 s1iIT Orr k Y Prlr.xwm d 0r al Em.Olm M prwY h Wm0 nmN rlrtY4AN 1rrnrlM.1 prtr•r w!wo-mw r m m 4w.+1e SIGNS 3.]0 'Ten.mar len d L.Mr.ls. VI Atlj. !L Q 131 I rr1Kr rxr 0..prlmr b I:aer rb.a mrelrx d Owpv. SIGN TRANSFORMERS Ap IwNwrl•I r f.Oln 7000)d b•bl•.]d Or Wem••0 Admr:.r leo.m9 Mk yXlm.h WYrOk Imb frw•tlr\purr. Ya -ewR:mlN•�Ie I.0 Irn rd.nmr. FESTOON LIGHTING 100 LAMPS OR L[SS 5.50 O1hNr Adl. O IH BYdrw h.]..•T uw pl rrm.r.r AN epfweu•r••hlw d 101 TO 300 LAMPS be.M 0 Ma T ]dd//,•�.[m•atV:l Is.Elms OVER IN LAM03 A.A0 (�• fIONANt[ .wl A' •�0.� SPEOAL ORCUITS 3.20 TOTAL FEES tONSTR o-'s"MRrISFE 1103 C..r TRAILER SPACES I.I. .•T5T L 4 C1RN arA�rat AnCxl�l vAyµ��plq ,_y,•!I� yEr� xAM1. ELECTRIC WEIBER fPER WAI .60. E77 U CE W U. W AD04TIIa MERCURY VAPOR LAMP 1.10 sHFAo N: IN; SUB TOTAL IF ml rORMr0.1T , U[M FA" NO. FEES THIS q/.O sot lNPriCTDlY us{ •` APPLICATION FOR PLUMBING PERMIT ISSUANCE Fit lfo f.» DEPT.OF PUBLIC WORKS SANTA CLARA COUNTY fUNFY FEE 1 NA./SIO MIN. 10.00 BUILDING INSPECTION DIVISION 1655 BERGER DRIVE SAN JOSE,CA.95112 TET.299.2951 I—plaeibl I�. .vew.N a ti.l".. ew I j.% 1, rep.rsl"dirp watt.aroirop piping b.Et Ilrw wweEli.n Ibwdw I ^�•y ADDRESS }}�/ EPN bulld..E wrr w 1roIW p-w.ar 3.50 FREE M .. b T 5 Qd ,L� I—VQ V-. A1a..a b Owns 13..00 MRO+ WAmXO rtiwT NO. w RA TOY E.N wear 6eaar PM/w wr 1.70 ArRIUTION 101 g0S1 IIFInNCE Q NEE rARNK oa(E ATmEj wu rAnw au W 1RYCIUt1 M!01 wnovttl[Nr EPN om"a1d 1.70 AOTIIItY ttl10[NC OtPW r@Ftyppp OY°Alt 00111Ii ErrN per pplrq t7rew d Ore b liw evH.M1 1)o � tDUOM Ot(ipiNANEE) pAll ii'iT' i�ln uouu ��?D I-lb Om OWN.1.—dl la w mwa.par IMAI Et%pnNATWFI PATI o w Jo MA4E 01 owNEEV>+ECLQR L/ D)h rdNonelm— �•� EaN repwr w bwellwi. d waver. lU.radwt O® IRwA4 x1 PATI SNlP A4RNG APDIItl Sa S .J np• MiL wwla.oM wN tMfam !,)0 ox G U / IwtlladilcMiM1 trap ww wrmr.."wv�ew GF $//Y!r ><ttrwn STP.P..aw Imwvw.n 1"n6enirq GONrtACTO! m Ilrwe NPPt I.IO wtl '1 No. rlloxe THIS APPLICATION IS A VALID PERMIT Q .3 �J G EPN rPle.aer eTelemt_pw drPlP 1 At INSTALL PLUMBING WORK ANDIOII PEON. AS LISTED.N AT THEALIO ADDRESS INDICATED HEREON, ONLY WHEN PROPERLY INITIALED AND MACHINE VALIDATED IN THE SPACE PROVIDED BELOW. Apptw �t � FQ s •T/v-5 AO,raian r.Pwr d.alw PtpinP w wIw 1.70 b melnulb.Ye~rrerd.m r S.tlbe>mt.!r M Wiwr..r Mwiau Eei Ir.bllwlm ft-.m'eWlpaer. eM fEdw PSW dw ldv Cale d M far a(rP.111a wNlrol.OeP IM.m as sl Nlaap I.pW la mrllNOIM.u.11.mM N 111 W(E)MIe..W w W I IMlmle Mn Mll�q w.f— mill rave rM mN mtl rrlla{q d mr 1®a Owe Gwry 116C�°aw 4a.• DI.1.1.fw W ala...r,N roN+mw. 11t E.nmNr.r rwe.N d Een+m.�d N...d 4 P1.wr.da.d Iro.sam Ylwl.a. � I (7� aN�rw 3.w..re emd.l.woul d n.te.e.tm.arien 1�wb Irw M ew Ilad Iwer. Albwl.n w rapPu d d.aioo°.w wr Pipip 1.70 Y s �,,�O P Q D) N.rW d r1r vwb a M reN...t w 3..a �Z SUB TOIAt Res I WNI eve rn.lw M vel..b w.waver a m a Mow ablest ala W.Awa.Y Gw pwwlw...d EMW Na [PN 3.q 'ti IM ro�[leal A IirmM eirer a..aeNMm d Oarlrr E -I.M., we 7.20 Pc f Cri Adj. t It InPledi0 Di IIm pwai. tlplu N Imr+rbq.�S.d Oa01 d r.Wu�a r w eW®o.d Ared.a �e p l Ce6,od.rlatlpdaair.4msr.taa Eminaa'e I'n�.w. /� G/ aMr Adj. O lal AsN4si Y r�.rW Iwe tl1�� W rwwN .b+r vwwin 1-4.n w 1—Ibw 1—d.+irp t.e1s�law w^wa)mt d Irwy.l lPtlw.sea. sn TanS,a va11,VR..w 1.Inm IWL-en uo- a ArnICANri wavered plvnlBirp Ilulwel S10NANt1 ene Ie IIw 7,20 TOTAL FEES CI>MSxOCTgNLFNwt SEE 1199 C.C.P. wet live.ewh Pddflw l ,Sp INd IrAq FOImAOPNI VAUWNNI Owx NANO S.IwnbN peeM1,pi.aa Il.lp APpttlt rNaNpn N: "b'b 76 3403.6 •P 62:266 M--A 12.4 SUB TOTAL OF rpwman. rNls arAa iDR manaDR•a uu ' APPLICATION FOR ELECTRICAL PERMIT ITEM EACH NO. FLEE DEPT.OF PUBLIC WORKS SANTA CLARA COUNTY ISSUANCE FEE 1.30 7.70 BUILDING INSPECTION DIVISION 1555 BERGER DRIVE SAN JOSE,CA.95112 TEL.299.2351 Ml aErn m WI s.,b 1.50 ADDRESS TEMPORARY POLF 7.w /1 LIGHT OUTLETS 1.10(MIwMUM FEE) 1.70 O anlN xuMua 06 y. �.,L �.j/j� RICERAQts p D �•G f1 SwITaEs IWRr Io .m30 w raft ONKE IAT {L LIGHT FIRNRES 1.10(MINIMUM FEF) 1. KjT 70 /1 IMn Ot WRrwlc rFlMIr KO. u OVER 10 . . 'O Z0 _4"ON iq gDyy IUSRNU DOE([n OWN= HEATER(PLR KW) .30 ruNU Oa UIONAwaq Olil NO0• GNGE/OVEN/ORTER/WATER NEATER 1.10 �3r UM Or STRUCTU[a M[q nIM PANEL/PANEL BOARD/SWICHBORpDr ,ErWx1.EDAftROuax ORIIMxAfURU 1 IMn ixu FERE DAMAGE INSPECTION (IAO ND.a P.a 3N1 I-I.ts D -ITS / SERVICE CHANGE N' 7.703130 SURVEY•i NR(5101 MIN. 10.00 iMM O[IMGNAwRI at{ 954--pYH-H TEMPORARY METER SFT S.a xArt OY OWNn GD DAN 'B�c,4%5T ./•/V>xWf�sV �� MOVED IN HOUSE EMINIMUM 511.001 .1.00 c� MOTORS•I12 HP OR LESS .60 SIS,eA.beR O a ala mxr RI IN.n rnaREB _D*-I.. (T S V Al DF 1/7107 W LAD 1TO 5 W 1.70 p OF�ro Nsus NNM Wn or Dw[ !!%(! /ND i20 s rol:sHHP 7.30 GtY Y•' 7 GTe> Gf S H��N ]5 TO 30 KP f.a0 So mxnA[roa / F TO I HP [.So THIS APPLICATION IS A VALID PERMIT cosy •• uc xo. rKoa[ OVER Im N9 Il.m TO INSTALL ELECTRICAL WORK AND/OR FIXTURES AS LISTED, I>' 3r> �� OG AT THE JOB ADDRESS IMDICATED HEREON. ONLY WHEN V INITIALED TRANSFORMERS•1/3 RVA OR LESS .60 $SPACERLY PROVIDED BELOW.D MACHINE VALIDATED IN THE AEmRess /lob. ////➢'In UE 4 s e-,# O S 1/1 TO 7 KVA 1.10 M rdrwlr.Nn a me,IEI..d Holm)OaIJ d mr q.b.,,nF P.d.abn Cea 7 TO 5 KVA 1.70 WnVs,mm mm r r telex tre d Me flew d[OlKpnir,arel,�I,I,rl Ib,.Im a S TO IS KVA 1.70 aee+e,r rI w W,r ro Impr,r w erNllmlel.Marna M E11 r/Dl Nlew Mr/w,bll M(imr irr 1,x tir,x eRl+aax,er M bn. a YIWs wm.l b Ial.f I nil.xkMwr.4 mMbab. 15 TO 75 K VA 1.70 ,rH4r le mdarevr�Im eaRnmre rmWV r a yxmr asR Iexlb ortmw foga II 4nRlmn r Gm,wV d(MMw.N ia,ea q M Hnvw d wR.mriel R,b.I 75 TO SO RVA 4.,M)If 4nPlrre W noel ewllmn mrrl d Wahwr i CMgmml�r-1.IvvK N r•/""��•'- 50 TO 100 KVA SlSO Q lal iN mn d nr r,u r M Pr,sm,e b Ulm m Ir. OVER Im RVA I I.m /1/e' SUB TOTAL R{(� ��G _ .WY ew rnr b uw mm.,.,r m b 6.mir anAE_ SIGNS 1.70 1 1 ee PIPb Ne su,�•Co,q.wlim I..e d mwwnb, �,I CM Ael. ±i IN a {p4vm b IMemM eWr Ilr wembr d(xwe.a 51GM TRANSFORMERS .00 Im,,.nena�Emgr�InpOi d 4lxpnb ire,n F d Y YVnw ena rrd,Wm, T eP �•• C%Ol I� SmN tarmbr',Llw• A,,�IIII Orl'YartmbblAltwMd,q• FESTOON IIGHIINO 100 LAMPS OR LES f 1.70 l y OIM Adj. Q ls1 Ap{IlaOr L.e....q xa,D) 101 TO 300 LAMPS 7.30 Frm�m..TOaO r.m9a>(Da d ey frWCw1 Ibnw lw.jam,amb OVER 700 IAAIPs KAD -[ j 4 Ari,nt L/ y SPECIAL OECNTS 1.70 TOTAL Fln `i, snurnOx NNINRSEE 11 P3 GCP.1 TRAILER SPACES 1.10 rxnlFA0 E0a rutrlxt vxlwn0x omv ELE"I"'WELDER(PER KVA) Ac A00Nas' MERCURY YAPOR LAMP 1.10 IINKNOWx, a.: AUG•24 3 4 o I s EP .23866 0--A SUE TOTAL -------------- IAI O ml MRM TDS7] ITEM ll M NO. F E ixf!srAp iDF IMueDOF1m ISSUANCE FEE s APPLICATION FOR MECKANICALFERMIT DEPT.Of PUBLIC WORKS SANTA CLARA COUNTY SURVEY FEE 1 NR./{10 AU N. 10.00 5.1/ fj BUILDING INSPECTION DIVISION 'vhf_ lwurdalr w pr mllr/rpF IVrmr wr Nvnwr, ' 15155 BERGER DRIVE SAN JOSE,C.A.45112 T&.299.2351 � ;,.t„a;,y ano.and wnN Fnmra!•.ah •FPIi•^m,xP b..ambdip 100,000 E.T.U.'r a,fD w...IOOAw 0.i.U.'. 530 / F '7 ADDRESS // OOInaYN by balr•mw 55a lnflr nllNs[F � ��1/ �/�� Canunrw:al w I Wi.pl bv.IIMn•rmO. t].10 Z FI—lurn¢F ir•tlWiap.ad 1,10 �! s j N{i drlClID11'1 ® C� �y• 1.0 4fl'O mU1nAON IIWMG FIFY0 M0. 1 pp IAtMtwllIONAIW[I OAIt �i VT EA/f1 f lkNCt w x{FYFF Dr l 1•mmty all a lmn[.11 Inn•IIFtl '/KC) �pAn� ad nm II•dud•d In m evp11°M.pFnnll ].]0 us!of F e me a urnevunxr 0 4pror d,Olbrm Nw r,or Fddhl..tF FON /AYE7.OImH6 O tmlp gTl{N L OFE.wn 0—a. bmNp appllmnm,rmlrlp•Miw VnN, .OVGx W(H--) Wl[ /� mNar1 cmlln{unll,dnvpKm.nN, li, x0,m Of m FaN indm h—m 9,[eellnp.Fm.mplim, Ilii {AMN[!f D• flOtlt! r FmPO I"cwwh'np SO—imi.dbq hmr011atim dmnlraN a,a0 iWK Oa(HpxAT1nE1 L41t �� rll� Im101brim w rFl%arien d aoN eeilw w nun a alwrn VVV mmprFro ' Tomd hpI -7 hp. aJo IN r.aaVwd a® Inm11N 7t5 WTk reEO mAnIN0 A0D.ts: �, L�d rn O aw.5 hplI.dwli i al�°ry a0 hl. I�.W 0—30 hp and indudt 50 hp. 10.50 Oc TD n5ni ri.lm wit m tnw Dr IbMWbn q—_ T.IM r[FYn mOy n EF w t OrT l.duw.r 100.000 m mtl mdwdlp IOUD BAA:. F.aD O` Dbp SMODO e.a0 / oF..Eoo.oDa re mna mdntlbp I.00D,000 Ir.w mxAAC/Os f1rFr 1,000.000 re Ord Intludlnp 1,7'J0.000 IeJU awu lK INMI (nlrip.rmim—p•Ffuw—SO hp mr THIS APPLICATION IS A VALID PERMtT obwplim a IFm—1,750,000 B.T.U.'. ° 7130 TO INSTALL MECHANICAL WORK AND/OR FUErURE3 AS LISTED, AT THE JOB ADDRESS INDICATED HEREON, ONLY WHEN wmdrndtl•q xdr ra.wd In[Intllnp 10,am alw. PROPERLY INITIALED AND MACHINE VALIDATED IN THE In[Ivtllnp eum anmtlra/brda 5.70 SPACE PROVIDED BELOW. AOmos bwa Y s.aw,7 MbllmIWm wNpi•tdOwD rw'i�WlF�INmuF,aNM Idpwmy.F I°(1...rDl ml,al>e•da.•rewlwr•fndl 14braM fIetrar NOTE hl.IFF m •° H,1dbNku41.11. pIf.P .1 e IMmwry ah•henMatlimnd pll— WYo —1inp Fawn y rrw6 w•a�•rnum N Ir peW wr M w•a.n w•MlMlbq WIWI N YnN,awWOrmF. wltlp In mrar°wx wm gprlmer.•.nla•hl r[r Fanl.Owv ferr OdNaw CW. g�(F7�)w lfl rvm.wr.N.ppplWa 0eebr w p0wp/im unit Iw MIN O prmN b IOmN r Cmrr r 3•MLxwFa' In M Wear d NdrxY tlr4 wbba rmpdrmd FbmvhFn. 1 Pn i..±X•e.l�mom•°°NN°'°rvr(a w«.�w.:/.+o..•xr Ir,w eF w" Al's—Iliw—It ewr WOOD u.m. l.50 cQ IFI iM m+d m.ww.+•a wxwiwa h I'M.r Nw. Ev[mmdin—4,albr%m Ww IF 1lpF ].]0� SUB TOTAL NE'•) Ib•wµr��N a.rwlw....r ON.°n Ir.tJdr uN sw.11 N Iowa wrw e+r rww•N em•xmnw r s N OamnF rWlrrr vwm len rMreEFd b O Ynpl•tlw ],]° wmewY(wrwawW land Wxwda O lFl N fly rMr w wFOmY h xmad waw m.pwdw d O,°pr,r 1 VFnlilatipn s7nwF wh•[I•N nel o panlm d OI bl' f IS ( k.elr 10001 r aNhN•a d IM msw.nc ndslw an7 bathe w dr mnONNwllp wnFm Deda ano wld wNbA•edlbYa slwr•fsnwa°:• . ae+--i—by rr0.50 W. Ovnxbllr 6 N W1 1w Iwm ra rl.a. InrFllmlwn d FaN hood whkh NrrvFa by 0Nw A4.O Tel AWI—N..wp1 frm D)arw.waw W wplbMa Pr —d medwnlml axbuv,lwI,dlrlp d!:7 W I—J. a,]. 010 >Db Y ur nadw i lbr•Law.I/NN hwN Apgimr5.ar Plr...1 .11 r•m deNsd In ArM1CANTf dhw.fplam i.n[e mtapwim,m Is.him we TOTAL FEES fmMATYtl athw IFF i.Ilnsd. 7.]0 iXn NKf ICF IMpI W f VNIMil0x OxIT dOx1111ucilOX liNm. (SEF 1170 CGI. Vad 7.]a MA n: A—al: EON Ilw wat Iliad eea» 76 's G a z b HP 023866 �0—A � + m 6.60 sue TDrAL ®L roFNFtan. UNREASONABLE HARDSHIP EXEMPTION FORM [1 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR,P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• buildin cu ertino.or `.` For Tenant Improvements where the Cost of Construction does not ed $136,060.0 SITE ADDRESS _ O�t"l� tJ(W APj�I� OS 100176 CITY Cd r ILzip � ..TOTAL CONSTRUCTION COST A $...... qr 0UO. V 0.............. DESCRIPTION OF WORK: toot ruye 44 e4l IS The following is a list of costs to provide access features in order to comply 100%with the current State Title-24 Disable Access Standards.(AII costs to be documented by actual bids or other information accepted by the Bui ding Official. Accessible Features Complies with If not,list required upgrades in order for Cost to make feature current standards? features to fully com I ? —fully accessible? 1.Path of travel to accessible entrance. ,' 2.Cost of providing a primary entrance. (Including but not limited to,thresholds,landings,door hardware, I $ max.door pull,etc.) (% ,U✓�� ^G G�Jt�:' ��,a� G�Kwn t J �,U 3.Cost of providing the primary path of travel to the specific area of alteration,structural repair,or $ addition. 4.Cost of providing accessible restroom facilities. $ ��h�, � • ,� CSC) 5.Cost of providing an accessible drinking fountain. (If $ required or if a drinking fountain is provided.) 6.Cost of providing accessible public telephones(if $ provided) Al A 7.Cost of providing other accessible features,including f $ but not limited to,parking,storage,alars m TOTAL COST OF ACCESS FEATURES(B): $ 2 J�V Has the same tenant performed work in the �1J same tenants ace within the last three ears? K0 Calculate(B/A)x 100% (( Description of access features to be ovided: r �J/� fG1 Wn�L c'V=� �ct�i� C1;� �C�� TOTAL COST OF !!^^ PERCENTAGE (20%minimum C� ° PROPOSED UPGRADE $ L W expenditure is required) /° ARCHITECT OR ENGINEER OF RECORD INFORMATION: I c a e noted information is true and correct. Name(print):�� c'.f?_ a�ir�� Ac� Signatu Date: /� Firm address: U I r r J Tit Phone: c�� F _ FOR DEPARTMENT US&&LY� `❑ The above named project has been denied an unreasonableC r8P fJN()nder 2010 CBC Section 1134B.2.1. ^� The above named project has be~ n unreasona a v+ i Qpm the requirements of the State of California CCR Title 24 �,hff"ice (Regulation for the Accommodati bled)pursuant to 2010 CBC Section 11348.2.1. � E; Y f�1 COMMENTS: �...,.�._... � _ ., rpt l/aNCE REVIETu.�_+ ; Kevi�:�t'c try / Building Official Designee(print): �� GDa /V A/ � Signature: te: 1/ '�7'1-3 _/ — —W - / L.14c� HardshipExemptionForm_2012.doe revised 06/25/12 CUPERTINO BIKE SHOP 10625 S. FOOTHILL BLVD. CUPERTINO, CA 95014 TITLE 24 ENERGY REPORT BUILDING ENVELOPE ,LIGHTING & MECHANICAL SUBMITTAL ##2 FRI ENERGY CONSULTANTS, LLC TITLE 24 ENERGY CONSULTANTS 21 N. HARRISON AVE. CAMPBELL, CA. 95008 408-866-1620 FAX: 408-866-6832 EMAIL: info@friconsulting.c OFFICE Cr"'upy BUILDING ENERGY ANALYSIS REPORT PROJECT: Cupertino Bike Shop 10625 S. Foothill Blvd. Cupertino, CA 95014 Project Designer: Steve Benzing, Architect 12405 Fredericksburg Saratoga, CA 408-867-6910 Report Prepared by: Nicholas L Bignardi NR08-12-3847 FRI Energy Consultants, LLC 21 N. Harrison Ave Suite 210 Campbell, CA 95008 408-866-1620 Job Number: 0130615 Date: 11/4/2013 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report.This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2008 Building Energy Efficiency Standards, This program developed by EnergySoft, LLC—www.energysoft.com. En Pro 5.1 by Ener Soft User Number:1315 RunCode:2013-11-04T09:40:10 !D:0130515 TABLE OF CONTENTS Cover Page 1 Table of Contents 2 Nonresidential Performance Title 24 Forms 3 Form ENV-MM Envelope Mandatory Measures 21 Form LTG-MM Lighting Mandatory Measures 22 Form MECH-MM Mechanical Mandatory Measures 23 Energy Pro 5.1 by EnergySoR Job Number: ID:0130615 User Number:1315 PERFORMANCE CERTIFICATE OF COMPLIANCE (Part 1 of 3) PERFAC Project Name Date Cupertino Bike Shop 11/4/2013 Project Address Climate Zme Total Ccnd Floor Area Addition Floor Area 10625 S. Foothill Blvd. Cupertino CA Climate Zone 04 2,802 2,802 GENERAL INFORMATION Building Type: m Nonresidential ❑ High-Rise Residential ❑ Hotel/Motel Guest Room ❑ Relocatable- indicate ❑ specific climate zone ❑ all climates Phase of Construction ❑ New Construction ❑ Addition m Alteration STATEMENT OF COMPLIANCE This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations. This certificate applies only to a Building using the performance compliance approach. The documentation author hereby certifies that the documentation is accurate and completes. Documentation Author NameSignature —' NicJtofas L&gnardt NR08.12.384 T Company FRI Energy Consultants. LLC ate 7 7,1412013 Address 21 N.Harrison Ave Suite 210 Phone 408.866.1620 CityState Zjp Csmpbelr CA 95008 The Principal Designer hereby certifies that the proposed building design represented in this set of construction documents is consistent with the other compliance corms and worksheets. with the specifications, and with any other calculations submitted with this permit application. The proposed building has been designed to meet the energy efficiency requirements contained in sections I M 116 through 118, and 140 through 149 of Title 24, Part 6 Please check one ENV. LTG. MECH. I hereby affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code to ❑ ❑ ❑ sign this document as the person responsible for its preparation,and that I am licensed in the State of California as a civil engineer mechanical engineer: electrical engineer or I am a licensed architect i attirm that I am eligible under the provisions of Division 3 of the Business and Professions Code by section ❑ ❑ ❑ 5537.2 or 6737.3 to sign this document as the person responsible for its preparation,and that I am a licensed contractor performing this work. I affirm that I am eligible under Division 3 of the Business and Professions Code to sign this document ❑ ❑ ❑ because h pertains to a structure or type of work described as exempt pursuant to Business and Professions _Code Sections 5537 5538 and 6737 1 Principal Envelope Designer Name Stere Bening Sicta Company Steve Senting Archtect Address 12405 Fredericksburg License 0 " Sara foga, CA hon 408-867-6910 Principal Mechanical � ��.�. Name Stere Benzrng Signature Company Steve 8enztrg Architect ate Address 12405Fredencksburg Ucense+� CitYState`2'ip Saratage,CA P 408.867-6910 Principal Lighting Designer Nara® Steve eenzmg Signariir. Company Steve Bening. Archltecr li Address 12405Fredencksburg ti`one 0 ity,-State'Zip Saratoga, CA Phorsa 408.867.6910 INSTAUCTIONS TO APPLICANTCOMPLIANCE&WQ SH EYS(check box if worksheets are induded) ® ENV-1C Certificate of Compliance.Required on pians ® MECH•1C Certificate of Compliance Recuifedonplans ® LTG-1C Cenificate of Compliance. Required on plans m MECH-2C Air Water Sid .'Swvice Hot Water 8 Pool Requirements. ❑ LTG 2C Lighting Controls Credit Worksheet. 0 MECH 3C Mechanical Ventilation and Reheat. ❑ LTG-3C Indoor Ughting Power Allowance. m MECH-5C Machainical Equipment Details EnergyFro 5 1 by Ener Soft User Number. 1315 RunCode:2013-11-04 r09:40:10 10 01.30615 Page 3 of 23 PERFORMANCE CERTIFICATE OF COMPLIANCE Part 2 of 3 PERF-1C Project Name Date Cupertino Bike Shop 11/4/2013 ANNUAL TDV ENERGY USE SUMMARY kBtu! ft- r Standard Proposed Compliance Energy Component Design Design Mar in Space Heating 2.94 10.02 -708 Heating Space Cooling 147.64 108.38 39.27 Cooling Indoor Fans 62.07 50.40 11,66 Fans Heat Rejection 0.00 0.00 0.00 Heat Rej Pumps &Misc. 0.00 0.00 Goo Pumps Domestic Hot Water 0.00 0.00 Goo DHW Lighting 122.71 39.26 83.45 Lighting Receptacle 61.15 61.15 Goo Receptacle Process 0.00 0.00 Goo Process Process Lighting 0.00 0.00 Goo Process Ltg TOTALS 396.51 269.21 12730 Percent better than Standard 32.1% 32.1%excluding process) BUILDING COMPLIES GENERAL INFORMATION Building Orientation (E)90 deg Conditioned Floor Area 2,802 sqft. Number of Stories 1 Unconditioned Floor Area 0 sqft. Number of Systems 1 Conditioned Footprint Area 2,802 sqft. Number of Zones 5 Natural Gas Available On Site yes Orientation Gross Area Glazing Area Glazing Ratio Front Elevation (E) 918 sqft. 275 sqft. 29.9% Left Elevation (S) 726 sqft. o sqft. 0.0% Rear Elevation (w) 921 sgft, o sqft. 0.0% Right Elevation (N) 72o sqft. o sqft. 0.0% Total 3,285 sqft. 275 sqft. 8.4 Roof 2802 sqft. o sqft. 0.0% Standard Proposed Prescriptive Values for Prescriptive Lighting Power Density 1.323 W/sqft. 0.495 W/sgft. Comparison only. See Prescriptive Envelope TDV Energy 55,832 92,304 LTG-1C for allowed LPD. Remarks: Energ yPro 5.1 by Ener Soft User Number:1315 RunCode:2013-11-04T09:40:f0 ID:0130615 Pa e 4 of 23 PERFORMANCE CERTIFICATE OF COMPLIANCE (Part 3 of 3) PERF-1C Project Name Date Cupertino Bike Shop 11/4/2013 ZONE INFORMATION Floor Inst. Ctrl. Allowed LPD Proc. Area LPD Credits Area Tailored Loads System Name Zone Name Occupancy Type s ft. /sf ' (W/SW` W/sf s W/sf ` W/sf Day&Night NA36OAKC Showroom Retail Sales, Wholesale 1,779 0.334 Storage Commercial,industrial Stora 611 0.802 Office Office<=250 sqft 170 0.194 Rear Entry Lobby,Main Entry 180 1.167 Restroom Corridor/Restroom/Support 62 0.971 Notes:1.See LTG-iC 2.See LTG-2C 3.See LTG-3C 4.See LTG-4C Items above require special documentation items marked with asterisk,see LTG-1-C by others) (by others EXCEPTIONAL CONDITIONS COMPLIANCE CHECKLIST The local enforcement agency should pay special attention to the Items specified in this checklist.These Items require special written justification and documentation,and special verification to be used with the performance approach.The local enforcement agency determines the adequacy of the justifications,and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. The Roof Roof has been designated as an alteration,however the Roof Sunace is NOT being replaced. The Roof Roof has been designated as an alteration,however the Roof Sunace is NOT being replaced. The Roof Roof has been designs ted as an alteration,however the Roof Sunace is NOT being replaced. The Roof Roof has been designated as an alteration,however the Roof Surface is NOT being replaced. The Roof Roof has been designated as an alteration,however the Roof Surface is NOT being replaced. The exceptional features listed In this performance approach application have specifically been reviewed.Adequate written justification and documentation for their use have been provided by the applicant. Authorized Signature or Stamp Ener Pro 5.1 by Ener Soft User Number:1315 RunCode:2013-11-04T09:40:10 ID:0130615 Page 5 of 23 CERTIFICATE OF COMPLIANCE (Part 1 of 3) ENV-1 C AND FIELD INSPEC'T'ION ENERGY CHECKLIST Project Name Date Cupertino Bike Shop 11/4/2013 Project Address Climate Zone Total Cond. Floor Area Addition Floor Area 10625 S. Foothill Blvd. Cupertino 4 2,802 2,802 GENERAL INFORMATION Building Type: ® Nonresidential ❑ High-Rise Residential ❑ Hotel/Motel Guest Room ❑ Schools(Public School) ❑ gledlocatable g. Public School m Conditioned Spaces ❑ Unconditioned Spaces ❑ Skylight Area for Large Enclosed Space z 8000 ft2 (If checked include the ENV-4C with submittal) Phase of Construction: ❑ New Construction ❑ Addition ® Alteration Approach of Compliance: ❑ Component ® Overall Envelope ❑ Unconditioned(file affidavit) Front Orientation:N, E,S,W or in Degrees: I90 deg FIELD INSPECTION ENERGY CHECKLIST OPAQUE SURFACE DETAILS I INSULATION c v _o$ ®m ¢ N b 7 O O IM V N LL N 7 k N k 7 y y Q• O a N Ta IID AssemblyType a 0 z 0¢ w> w a 5> S LL "au v m n U- I Stab 1,779 (N) 0.730 Nonel 4.4.7-A1 Existing ❑ ❑ 2 Watt 343 (E) 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 3 Watt 12 (S) 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 4 Watt 456 N 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 5 Watt 432 (M 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 6 Roof 1,779 (M 0.041 R-25 4.2.2-A15 Altered ❑ ❑ 7 Stab 611 (M 1 0.730 None 4.4.7-A1 Existing ❑ ❑ 8 Wall 300 (E) 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 9 Wall 360 (S) 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 10 Walt 150 (lM 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 1.See Instructions in the Nonresidential Compliance Manual,page 3-96. 2. If Fail,then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. A fail does not meet compliance. FENESTRATION SURFACE DETAILS 03 v rn c raCn Fenestration V) °� X V) o' 0 to a a Tag/ID Typo 1 Window 20 (17 1.250 Default 0.800 Default ❑ 1 Existing ❑ 1 ❑ 2 Window 255 (q 1.280 Default 0.800 Default ❑ Existing ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1.See Instructions in the Nonresidential Compliance Manual,page 3-96. 2. If Fail then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. EnergyPro 5.1 by EnergySoft User Number:1315 RunCode:2013-11-04709:411:10 0:0130615 Page 6 of 23 CERTIFICATE OF COMPLIANCE (Part 1 of 3) ENV-1 C AND FIELD INSPECTION ENERGY CHECKLIST Project Name Date Cupertino Bike Shop 1 11/4/2013 Project Address Climate Zone Total Cond. Floor Area Addition Floor Area 10625 S. Foothill Blvd- Cupertino 4 2,802 2,802 GENERAL INFORMATION Building Type: ® Nonresidential ❑ High-Rise Residential ❑ Hotel/Motel Guest Room ❑ Schools(Public School) ❑ BRledlocatable Public School m Conditioned Spaces 13Unconditioned Spaces ❑ Skylight Area for Large Enclosed Space a 8000 ft`(If checked include the ENV-4C with submittal) Phase of Construction: ❑ New Construction ❑ Addition ® Alteration Approach of Compliance: ❑ Component ® Overall Envelope ❑ Unconditioned (file affidavit) Front Orientation: N, E,S,W or in Degrees: 190 deg FIELD INSPECTION ENERGY CHECKLIST OPAQUE SURFACE DETAILS INSULATION cx o ?3 a °C v CD A A > � Am `W 4 K C N Ta /ID AssemblyType a 0 z n ¢ w a w LL 0 U va _ ii 11 1 Roof 611 (N) 0.041 R-251 14.2.2-A15 Altered ❑ ❑ 12 Slab 170 (N) 0.730 None 4.4.7-A1 Existing ❑ ❑ 13 Wall 180 (S) 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 14 Wall 156 (w) 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 15 Wall 180 (N) 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 16 Roof 170 (N) 1 0.041 R-25 4.2.2-A 15 Altered ❑ M 17 Slab 180 (N) 1 0.730 Nonel 4.4.7-A1 Existing ❑ ❑ 18 Wall 66 (S) 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 19 Wall 52 (tv) 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 20 Door 20 (tv) 0.700 None 4.5.1-A2 Existing ❑ ❑ 1.See Instructions in the Nonresidential Compliance Manual,page 3-96. 2.If Fail,then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. A fail does not meet compliance. FENESTRATION SURFACE DETAILS o�Is. 0v Crn o U 5 U = (J U 9 q Fenestration ' ' ' A OZSo' Tag/ID Type > m U)1% O U m A a. LL ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 13 ❑ ❑ ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1.See Instructions in the Nonresidential Compliance Manual,page 3-96. 2.If Fail then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. EnergyPro 5.1 by EnergySoft User Number:1315 RunCode:2013-11-04T09:40.10 ID:0130615 Page 7 of 23 CERTIFICATE OF COMPLIANCE (Part 1 of 3) ENV-1 C AND FIELD INSPECTION ENERGY CHECKLIST Project Name Date Cupertino Bike Shop 1 11/4/2013 Project Address Climate Zone Total Cond. Floor Area Addition Floor Area 10625 S. Foothill Blvd. Cupertino 4 2,802 2,802 GENERAL INFORMATION Building Type: ® Nonresidential ❑ High-Rise Residential ❑ Hotel/Motel Guest Room ❑ Schools(Public School) ❑ BRledlocatable Public School m Conditioned Spaces ❑ Unconditioned Spaces ❑ Skylight Area for Large Enclosed Space>_8000 ft2 (If checked include the ENV-4C with submittal) Phase of Construction: ❑ New Construction ❑ Addition ® Alteration Approach of Compliance: ❑ Component m Overall Envelope ❑ Unconditioned(file affidavit) Front Orientation: N, E, S,W or in Degrees: 190 deg FIELD INSPECTION ENERGY CHECKLIST OPAQUE SURFACE DETAILS INSULATION c v 03 ¢ ¢ 2 3N g Z�—' $ o 8 om oc v � m ui ii a> 2 2 2 5 Ta IID AssemblyType Q O z v cc w> w ii > 5 ti v N a� Li 21 Roof 180 (N) 0.041 R-251 4.2.2-A 15 Altered ❑ ❑ 22 Slab 62 (N) 0.730 None 4.4.7-A1 Existing ❑ ❑ 23 Wall 108 (S) 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 24 wall 87 (W 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 25 wall 108 (N) 0.102 R-13 4.3.1-A3 Altered ❑ ❑ 26 Roof 62 (N) 0.041 R-25 4.2.2-A 15 Altered ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1.See Instructions in the Nonresidential Compliance Manual,page 3-96. 2. It Fail,then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. A fail does not meet compliance. FENESTRATION SURFACE DETAILS vi S S m 0 U m _ ,a ui x = v m Fenestration i�LL a o '�^ z oo > co A Tag/1D T a o Z �> > m �°5 N N o v N r a ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1.See Instructions in the Nonresidential Compliance Manual,page 3-96. 2. If Fail then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. Verity building pians if necessary. EnergyPro 5.1 by Ener ySoft User Number:1315 RunCode:2013-11-04T09:40:10 1D:0130615 Page 8 of 23 CERTIFICATE OF COMPLIANCE (Part 2 of 3) ENV-1 C AND FIELD INSPECTION ENERGY CHECKLIST Project Name Date Cupertino Bike Shop 11/4/2013 ROOFING PRODUCT COOL ROOFS (Note if the roofing product is not CRRC certified,this compliance approach cannot be used). Go to Overall Envelope Approach or Performance Approach. CHECK APPLICABLE BOX BELOW IF EXEMPT FROM THE ROOFING PRODUCT"COOL ROOF"REQUIREMENTS: Pass Fail' N/A ❑ Roofing compliance not required in Climate Zones 1 and 16 with a Low-Sloped. 2:12 pitch or less. ❑ ❑ ❑ ❑ Roofing compliance not required in Climate Zone 1 with a Steep-Sloped with less than 5 Ib/ft2.Greater than 2:12 pitch. ❑ ❑ ❑ Low-sloped Wood framed roofs in Climate Zones 3 and 5 are exempted,solar reflectance and thermal emittance or ❑ SRI that have a U-factor of 0.039 or lower.See Opaque Surface Details roof assembly,Column H of ENV-2C. ❑ ❑ ❑ Low-sloped Metal building roofs in Climate Zone 3 and 5 are exempted,solar relectance and thermal emittance or SRI [3 that have a U-factor of 0.048 or lower.See Opaque Surface Details roof assemblybelow,Column H of ENV-2C. ❑ ❑ 13 ❑ The roof area covered by building integrated photovoltaic panels and building integrated solar thermal panels are ❑ ❑ ❑ exempted. Solar reflectance and thermal emittance or SRI,see spreadsheet calculator at en r .ca. ov/title24/ Roof constructions that have thermal mass over the roof membrane with a weight of at least 25 Ib/t are exempt from ❑ the Cool Roof criteria below. Cl C1 13 ❑ High-rise residential buildings and hotels and motels with low-sloped roofs in Climate Zones 1 through 9, 12 and 16 are ❑ ❑ ❑ exempted from the low-sloped roofing criteria. 1. If Fail then describe on this page of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. CRRC Product ID Roof Slope Product Weight Product Aged Solar Thermal Number' < 2:12 >2:12 < 5lb/ft2 >_ 51b/fl T ype2 Reflectance' Emmitance SRI' Pass Fail" ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑ ❑ ❑4 ❑ ❑ 1.The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolroofs.orcUarod ucts/search.aho 2. Indicate the type of product is being used for the roof top,i.e.single-ply roof,asphalt roof,metal roof,etc. 3. 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 same directory and use the equation(0.2+0.7(pi miai—0.2)to obtain a calculated aged value. Where p is the Initial Solar Reflectance from the Cool Roof Rating Council's Rated Product Directory. 4.Check box if the Aged Reflectance is a calculated value using the equation above. 5.The SRI value needs to be calculated from a spreadsheet calculator at httpYtwww.eneray.ca.aov/dte24/ 6.If Fail then describe on this page of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. To apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in§118@4. Select the applicable coating: ❑Aluminum-Pigmented Asphalt Roof Coating ❑Cement-Based Roof Coating ❑Other Discrepancies: En Pro 5.1 by Ener Soft User Number.1315 RunCode:2013-11-04709:40:10 ID:0130615 PaQe 9 of 23 CERTIFICATE OF COMPLIANCE (Part 3 of 3) ENVA C AND FIELD INSPECTION ENERGY CHECKLIST Project Name Date Cupertino Bike Shop 99/4/2093 Required Acceptance Tests Designer: This form is to be used by the designer and attached to the plans. Listed below is the acceptance test for Envelope Fenestrations system.The designer is required to check the acceptance tests and list all the fenestration products that require an acceptance test. If all the site-built fenestration of a certain type requires a test, list the different fenestration products and the number of systems. The NA7 Section in the Appendix of the Nonresidential Reference Appendices Manual describes the test. Since this form will be part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropriately. Enforcement Agency: Systems Acceptance. Before Occupancy Permit is granted for a newly constructed building or space or whenever new fenestration is installed in the building or space shall be certified as meeting the Acceptance Requirements. The ENV-2A form is not considered a complete form and is not to be accepted by the enforcement agency unless the boxes are checked and/or filled and signed. In addition, a Certificate of Acceptance forms shall be submitted to the enforcement agency that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of§10-103(b) of Title 24 Part 6.The field inspector must receive the properly filled out and signed forms before the building can receive final occupancy. A copy of the ENV-2A for each different fenestration product line must be provided to the owner of the building for their records. Test Description ENV-2A Test Performed By: Fenestration Products Name or ID Area of like Building Envelope Requiring Testing or Verification Products Acceptance Test 13 13 11 13 11 13 13 13 13 13 13 11 13 13 11 13 13 11 13 11 Ener Pro 5.1 by Ener Soft User Number:1315 RunCode:2013-11-04T09:40:10 ID:0130615 Page 10 of 23 CERTIFICATE OF COMPLIANCE (Part 1 of 3) LTG-1 C Project Name Date Cupertino Bike Shop 11/4/2013 INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST Installation Certificate,LTG-1-INST(Retain a copy and verity form is completed and signed.) Field Inspector ❑ Certificate of Acceptance, LTG-2A and LTG-3A(Retain a copy and verify form is completed and signed.) Field Inspector ❑ A separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces Installed Lighting Power listed on this Lighting Schedule is only for: ® CONDITIONED SPACE ❑ UNCONDITIONED SPACE ® The actual indoor lighting power listed below includes all installed permanent and portable lighting systems in accordance with§146(a). Only for offices: Up to the first 0.2 watts per square foot of portable lighting shall not be required to be included in the ® calculation of actual indoor lighting power density in accordance with the Exception to§146(a).All portable lighting in excess of 0.2 watts per square foot is totaled below. Luminaire(Type,Lamps, Ballasts Installed Watts A B C D E F G H How wattage field Was determined Ins ctor2 O 11 N X None CEC .03 m m o or Complete Luminaire Description' vE Default 0 w, E E `0 Item (Le,3lampfluaescenttroffer, `0 :3From o o :3 :3 Tag F32T8 one dmmable electronic ballasts -J NA8 Q~ Z-J — rl u_ 60w Incandescent 60.0 0 ❑ 1 60 13 13 11wLED 11.0 ® ❑ 38 418 ❑ ❑ (2)4 ft Fluorescent T8 Rapid Start 70.0 ® ❑ 13 910 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ Installed Watts Pae Total: 1,388 Installed Watts Building Total Building total number of pages: Sum of all pages) Enter into LTG-1C Pae 4 of 4 1.388 1.Wattage shall be determined according to Section 130(d and e).Wattage shall be rating of light fixture,not rating of bulb. 2.If Fail then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct.Verify building plans if necessary. Ener Pro 5.1 by Ener Soft User Number:1315 RunCode:2013-11-04T09:40:10 ID:0130615 Page 11 of 23 CERTIFICATE OF COMPLIANCE Part 2 of 3 LTG-1C Project Name Date Cupertino Bike Shop 11/4/2013 INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST Fill in controls for all spaces:a)area controls, b)multi-level controls,c)manual daylighting controls for daylit areas> 250 ft2, automatic daylighting controls for daylit areas>2,500 ftp,d)shut-off controls, e)display lighting controls,f)tailored lighting controls— general lighting controlled separately from display,ornamental and display case lighting and g)demand responsive automatic controls for retail stores>50,000 ft`, in accordance with Section 131. MANDATORY LIGHTING CONTROLS-FIELD INSPECTION ENERGY CHECKLIST Field Inspector Number Special Type/Description of Units Location in Building Features Pass Fail ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ SPECIAL FEATURES INSPECTION CHECKLIST See Page 2 of 4 of LTG-IC) The local enforcement agency should pay special attention to the items specified in this checklist.These items require special written justification and documentation,and special verification. The local enforcement agency determines the adequacy of the justification, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. Feld Inspector's Notes or Discrepancies: En Pro 5.1 by En Soft User!Number:1315 RunCode:2013-11-04709:40:10 /D:0130615 Pae 12 of 23 CERTIFICATE OF COMPLIANCE Part 3 of 3 LTG-1C Project Name Date Cupertino Bike Shop 11/4/2013 CONDITIONED AND UNCONDITIONED SPACE LIGHTING MUST NOT BE COMBINED FOR COMPLIANCE Indoor Lighting Power for Conditioned S aces Indoor Lighting Power for Unconditioned Spaces Watts Watts Installed Lighting 1,388 Installed Lighting 0 from Conditioned LTG-1C,Page 2) (from Unconditioned LTG-1C,Page 2 Lighting Control Credit 0 Lighting Control Credit 0 Conditioned Spaces from LTG-2C Unconditioned Spaces(from LTG-2C) Adjusted Installed 1,388 Adjusted Installed = 0 Lighting Power Lighting Power Complies if Installed:5 Allowed Complies if Installed 5 Allowed Allowed Lighting Power 1,388 Allowed Lighting Power 0 Conditioned Spaces from LTG-3C or PERF-1) Unconditioned S aces from LTG 3C Required Acceptance Tests Designer: This form is to be used by the designer and attached to the plans. Listed below is the acceptance test for the Lighting system, LTG-2A and LTG-3A.The designer is required to check the acceptance tests and list all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance. If all the lighting system or control of a certain type requires a test,list the different lighting and the number of systems. The NA7 Section in the Appendix of the Nonresidential Reference Appendices Manual describes the test.Since this form will be part of the plans,completion of this section will allowthe responsible party to budget for the scope of work appropriately. Forms can be grouped by type of Luminaire controlled. Enforcement Agency: Systems Acceptance. Before Occupancy Permit is granted for a newly constructed building or space or when ever new lighting system with controls is installed in the building or space shall be certified as meeting the Acceptance Requirements. The LTG-2A and LTG-3A forms are not considered complete forms and are not to be accepted by the enforcement agency unless the boxes are checked and/or filled and signed. In addition,a Certificate of Acceptance forms shall be submitted to the enforcement agency that certifies plans,specifications, installation certificates, and operating and maintenance information meet the requirements of§10-103(b)of Title 24 Part 6.The field inspector must receive the properly filled out and signed forms before the building can receive final occupancy. A copy of the LTG-2A and LTG-3A for each different lighting luminaire control(s) must be provided to the owner of the building for their records. LTG-2A and Luminaires Controlled LTG-3A Controls and Sensors and Number of Automatic Luminaires Daylighting Controls Equipment Requign Testin Description controlled Location Acceptance 13 13 13 13 13 13 13 13 13 Ener Pro 5.1 by En Soft User Number:1315 RunCode:2013-11-047179:40:t 0 1D:0130615 Page 13 of 23 CERTIFICATE OF COMPLIANCE and (Part 1 of 4) MECH-1 C FIELD INSPECTION ENERGY CHECKLIST Project Name Date Cupertino Bike Shop 11/4/2013 Project Address Climate Zone Total Cond. Floor Area Addition Floor Area 10625 S. Foothill Blvd. Cupertino 4 2,802 2,802 GENERAL INFORMATION Building Type: m Nonresidential ❑ High-Rise Residential ❑ Hotel/Motel Guest Room ❑ Schools(Public School) ❑ Relocatable Public School Bldg. ® Conditioned Spaces ❑ Unconditioned Spaces affidavit Phase of Construction: ❑ New Construction ❑ Addition ® Alteration Approach of Compliance: ❑ Component ❑ Overall Envelope TDV ❑ Unconditioned(file affidavit) Energy Front Orientation: N, E, S,W or in Degrees: 1 90 deg HVAC SYSTEM DETAILS FIELD INSPECTION ENERGY CHECKLIST Meets Criteria or Requirements E Ld ment2 Inspection Criteria Pass Fail—Describe Reason Item or System Tags ❑ ❑ i.e.AC-1,RTU-1 HP-1 Day&Night NA360AKC Equipment Type': Split DX ❑ ❑ Number of Systems 1 ❑ ❑ Max Allowed Heating Capacity' 120,000 Bttdhr ❑ ❑ Minimum Heating Efficiency' 80%AFUE ❑ ❑ Max Allowed Cooling Capacity' 57,000 Btu/hr ❑ ❑ Cooling Efficiency' 13.0 SEER/11.0 EER ❑ ❑ Duct Location/R-Value Attic, Ceiling fns, vented/8.0 ❑ ❑ When duct testing is required, submit ❑ ❑ MECH4A&MECH4-HERS No Economizer No Economizer ❑ ❑ Thermostat Setback Required ❑ ❑ Fan Control Constant Volume ❑ ❑ FIELD INSPECTION ENERGY CHECKLIST E ui ment2 Inspection Criteria Pass Fail—Describe Reason Item or System Tags i.e.AC-1,RTU-1 HP-1) [3 ❑ Equipment T pe': ❑ ❑ Number of Systems ❑ ❑ Max Allowed Heating Capacity' ❑ ❑ Minimum Healing Efficiency' ❑ ❑ Max Allowed Cooling Capacity' ❑ ❑ Cooling Efficiency' ❑ ❑ Duct Location/R-Value ❑ ❑ When duct testing is required,submit ❑ ❑ MECH4A&MECH4-HERS Economizer ❑ ❑ Thermostat ❑ ❑ Fan Control ❑ ❑ 1.If the Actual installed equipment performance efficiency and capacity is less than the Proposed(from the energy compliance submittal or from the building plans)the responsible party shall resubmit energy compliance to include the new changes. 2.For additional detailed discrepancy use Page 2 of the Inspection Checklist Form.Compliance fails if a Fail box is checked. 3. Indicate Equipment Type:Gas(Pkg or,Split),VAV,HP(Pkg or split),Hydronic, PTAC,or other. IEnergyPro5.1byEnergySoft User Number:1315 RunCode:2013-11-04709:40:10 JD:0130615 Page 14 of 23 CERTIFICATE OF COMPLIANCE and (Part 2 of 4) MECHAC FIELD INSPECTION ENERGY CHECKLIST Project Name Date Cupertino Bike Strop 11/4/2013 Discrepancies: Ener Pro 5.1 by Ener Soft User Number:1315 RunCode:2013-11-04T09:40:10 !D:0130615 Pa a i5 of23 CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST Part 3 of 4 MECH-1 C Project Name Date Cupertino Bike Shop 11/4/2013 Required Acceptance Tests Designer: This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for mechanical systems. The designer is required to check the applicable boxes by all acceptance tests that apply and listed all equipment that requires an acceptance test. If all equipment of a certain type requires a test, list the equipment description and the number of systems. The NA number designates the Section in the Appendix of the Nonresidential Reference Appendices Manual that describes the test. Since this form will be part of the plans,completion of this section will allow the responsible party to budget for the scope of work appropriately. Building Departments: Systems Acceptance:Before occupancy permit is granted for a newly constructed building or space, or a new space-conditioning system serving a building or space is operated for normal use,all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance. Systems Acceptance:Before occupancy permit is granted.All newly installed HVAC equipment must be tested using the Acceptance Requirements. The MECH-1C form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked.The equipment requiring testing, person performing the test(Example:HVAC installer, TAB contractor,controls contractor, PE in charge of project)and what Acceptance test must be conducted. The following checked-off forms are required for ALL newly installed equipment. In addition a Certificate of Acceptance forms shall be submitted to the building department that certifies plans, specifications, installation, certificates, and operating and maintenance information meet the requirements of§10-103(b)and Title-24 Part 6.The building inspector must receive the properly filled out and signed forms before the building can receive final occupancy. TEST DESCRIPTION MECH-2A MECH-3A MECH-4A MECH-5A MECH-6A MECH-7A MECH-8A MECH-9A MECH-10A MECH-11A Hydronic Outdoor Constant Demand Supply System Automatic Ventilation Volume& Air Control Supply Valve Water Variable Demand For Single-Zone Distribution Economizer Ventilation Fan Leakage Temp. Flow Shed Equipment R uirin Testing or Verification Qty. VAV&CAV Unitary Ducts Controls DCV VAV Test Reset Control Control Day&Night NA36OAKC 1 ® 1 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ ❑ ❑ ❑ 1 ❑ 1 ❑ 1 ❑ Ener Pro 5.1 by Ener Soft User Number:1315 RunCode:2013-11-04T09:40:10 0:0130615 Noe 16 of23 CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST Part 4 of 4 MECH-1 C Project Name Date Cupertino Bike Shop 11/4/2013 TEST DESCRIPTION MECH-12A MECH-13A MECH-14A MECH-15A Fault Automatic Fault Distributed Detection& Detection& Energy Storage Thermal Energy Diagnostics Diagnostics for DX AC Storage(TES) Equipment R uirin Testing for DX Units Air&Zone Systems Systems Test Performed By: Day&Night NA360AKC 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Ener Pro 5.1 by Ener Soft User Number:1315 RunCode:2013-11-04T09:40:10 ID:0130615 Page 17 of 23 AIR SYSTEM REQUIREMENTS (Part 1 of 2) MECH-2C Project Name Date Cupertino Bike Shop 1 11/4/2013 Item or System Tags Indicate Air Systems T Central,Sin le Zone,Package,VAV or etc... i.e.AC-1,RTU-1,HP-1 Day&Night NA36OAKC Number of Systems 1 Indicate Pae Reference on Plans or Schedule and indicate the applicable exception(s) MANDATORY MEASURES T-24 Sections Heating Equipment Efficiency 112(a) 80%AFUE Cooling Equipment Efficiency 112 a 13.0 SEER/11.0 EER HVAC Heat Pump Thermostat 112(b), 112(c) n/a Furnace Controls/Thermostat 112(c),115(a) Required Natural Ventilation 121 b No Mechanical Ventilation 121 598 cfm VAV Minimum Position Control .121(c) No Demand Control Ventilation 121 c No Time Control 122(e) Programmable Switch Setback and Setup Control 122(e) Setback Required Outdoor Damper Control 122(f) Auto Isolation Zones 122 n/a Pipe Insulation 123 Duct Location/R-value 124 Attic,Ceiling Ins, vented/8.0 PRESCRIPTIVE MEASURES Calculated Design Heating Load 144(a&b n/a Proposed Heating Capacity 144(a&b 120,000 Btuihr Calculated Design Cooling Load 144(a&b n/a Proposed Cooling Capacity 144(a&b 43,321 Btu/hr Fan Control 144(c) Constant Volume DP Sensor Location 144(c) Supply Pressure Reset(DDC only) 144(c) Yes Simultaneous Heat/Cool 144(d) No Economizer 144(e) No Economizer Heat Air Supply Reset 144(f) Constant Temp Cool Air Supply Reset 144(f) Constant Temp Electric Resistance Heating' 144(g) Air Cooled Chiller Limitation 144(i) Duct Leakage Sealing.If Yes,a MECH-4-A must be submitted 144(k) No 1. Total installed capacity(MBtu/hr)of all electric heat on this project exclusive of electric auxiliary heat for heat pumps.If electric heat is used explain which exception(s)to§144(g)apply. Ener Pro 5.1 by EnergySoft User Number:1315 RunCode:2013-11-04709.40.10 10:0130615 Page 18 of 23 MECHANICAL VENTILATION AND REHEAT MECH-3C Project Name Date Cupertino Bike Shop 11/4/2013 MECHANICAL VENTILATION 121 b 2 REHEAT LIMITATION(§144(d)) AREA BASIS OCCUPANCY BASIS VAV MINIMUM A B C D E F G H I J K L M N Min CFM REO'D Design 5096 of Max.of Design Condition CFM Min CFM Number CFM by V.A. Ventilation Design Zone Columns Minimum Area per By Area Of per Occupant Max of Air Supply B X0.4 H,J, K, Air Transfer Zone/System (ft2) ftz B X C People Person E X F D or G CFM CFM CFM/ft' 300 CFM Se int Air Showroom 1,779 0.25 445 445 445 Storage 611 0.15 92 92 92 Office 170 0.15 26 26 26 Rear Entry 180 0.15 27 27 27 Restroom 62 0.15 9 9 9 Day&Night NA36OAKC Tota! 598 598 Totals Column I Total Design Ventilation Air C Minimum ventilation rate per Section J121,Table 121-A E Based on fixed seat or the greater of the expected number of occupants and 500%of the CBC occupant load foregress purposes for spaces without fixed seating. H Required Ventilation Air REal)V.A. is the larger of the ventilation rates calculated on an AREA BASIS or OCCUPANCY BASIS Column D or G). I Must be greater than or equal to H or use Transfer Air column N to make up the difference. J Design fan supply CFM Fan CFM x 500%;or the design zone outdoor airflow rate per§121. K Condition area ft' x 0.4 CFM/hz;or L Maximum of Columns H,J,K,or 300 CFM M This must be less than or equal to Column L and greater than orequal to the sum of Columns H plus N. N Transfer Air must be provided where the Required Ventilation Air(Column H)is greater than the Design Minimum Air(Column M).Where required,transfer air must be greater than or ual to the difference between the Required Ventilation Air Column H and the Design Minimum Air Column M Column H minus M. Ener Pro 5.1 by Ener Soft User Number:1315 RunCode:2013-11-04709.40:10 /D:0130615 Pa 19 of 23 MECHANICAL EQUIPMENT DETAILS Part 1 of 2 MECH-5C Project Name Date Cupertino Bike Shop 11/4/2013 CHILLER AND TOWER SUMMARY PUMPS Pump Equipment Name Type City, Eff Iclency Tons City, GPM BHP Control DHW/BOILER SUMMARY Vol. Energy Factor Standby Loss Tank Ext. System Name Type Distribution City, Rated Input (Gals). or RE or Pilot R-Value Status MULTI-FAMILY CENTRAL WATER HEATING DETAILS Hot Water Pump Hot Water PI in Len th ft Control city. HP Type In Plenum Outside I Burled Add lis"Insulation CENTRAL SYSTEM RATINGS HEATING COOLING System Name Type City. output Aux.kW Eff Iclancy Output Eff 1clency Status Day&Night NA36OAKC Split DX 1 120.000 0.0 80%AFUE 57,000 13.0 SEER/11.0 EER New CENTRAL SYSTEM FAN SUMMARY SUPPLY FAN RETURN FAN System Name Fan Type Economizer Type CFM BHP CFM BHP Day&Night NA36OAKC Constant Volume No Economizer 2,000 0.75 none En Pro 5.1 by Ener Soft User Number:1315 RunCode:2013-11-04T09:40:10 ID:0130615 Paw 20 of 23 ENVELOPE MANDATORY MEASURES: NONRESIDENTIAL ENV-MM Project Name Date Cupertino Bike Shop 11/4/2013 DESCRIPTION Building Envelope Measures: §118(a): Installed insulating material shall have been certified by the manufacturer to comply with the California Quality Standards for insulating material,Title 20 Chapter 4, Article 3. §118(c): All Insulating Materials shall be installed in compliance with the flame spread rating and smoke density requirements of Sections 2602 and 707 of Title 24, Part 2. §118(f). The opaque portions of framed demising walls in nonresidential buildings shall have insulation with an installed R-value of no less than R-13 between framing members. §117(a): All Exterior Joints and openings in the building that are observable sources of air leakage shall be caulked,gasketed, weatherstripped or otherwise sealed. Manufactured fenestration products and exterior doors shall have air infiltration rates not exceeding 0.3 cfm/ft.2 of §116(a) 1: window area, 0.3 cfm4t.2 of door area for residential doors, 0.3 cfm/ft.2 of door area for nonresidential single doors (swinging and sliding),and 1.0 cfm/ft.2 for nonresidential double doors(swinging). §116(a)2: Fenestration U-factor shall be rated in accordance with NFRC 100, or the applicable default U-factor. §116(a)3: Fenestration SHGC shall be rated in accordance with NFRC 200, or NFRC 100 for site-built fenestration,or the applicable default SHGC. §116(b): Site Constructed Doors,Windows and Skylights shall be caulked between the unit and the building, and shall be weatherstripped (except for unframed glass doors and fire doors). Ener Pro 5.1 by Ener Soft User Number:1315 Run Code:2013-11-04T09:40:10 /D:0130615 Pa a 21 of 23 LIGHTING MANDATORY MEASURES: NONRESIDENTIAL LTG-MM Project Name Date Cupertino Bike Shop 11/4/2013 Indoor Lighting Measures: §131(d): Shut-off Controls For every floor,all interior lighting systems shall be equipped with a separate automatic control to shut off the lighting. 1. This automatic control shall meet the requirements of Section 119 and may be an occupancy sensor,automatic time switch or other device capable of automatically shutting off the lighting. 2 Override for Building Lighting Shut-off: The automatic building shut-off system is provided with a manual,accessible override switch in sight of the lights. The area of override is not to exceed 5 D00 square feet. §l 19(h): Automatic Control Devices Certified: All automatic control devices specified are certified, all alternate equipment shall be certified and installed as directed by the manufacturer. §111: Fluorescent Ballast and Luminaires Certified: All fluorescent fixtures specified for the project are certified and listed in the Directory.All installed fixtures shall be certified. §131(a): Individual Room/Area Controls: Each room and area in this building is equipped with a separate switch or occupancy sensor device for each area with floor-to-ceiling walls. Uniform Reduction for Individual Rooms: All rooms and areas greater than 100 square feet and more than 0.8 watts §131(b): per square foot of lighting load shall be controlled with bi-level switching for uniform reduction of lighting within the room. Daylight Area Control: All rooms with windows and skylights that are greater than 250 square feet and that allow for 131 c the effective use of daylight in the area shall have 50%of the lamps in each daylit area controlled by a separate switch; § ( ) or the effective use of daylight cannot be accomplished because the windows are continuously shaded by a building on the adjacent lot. Diagram of shading during different times of the year is included on plans. §131(c): Display Lighting. Display lighting shall be separately switched on circuits that are 20 amps or less.6. Outdoor Lighting Measures: §130(c)1: Mandatory lighting power determination for medium base sockets without permanently installed ballasts §132(a): Al permanently are Installed I b in ares with lamps am s rated over 100 Watts either have a lamp efficacy of at least 60 lumens per Watt 1 32 b All Luminaires with lamps rated greater than 175 Watts in hardscape area, including parking lots, building entrances, § ( ) canopies, and all outdoor sales areas meet the Cutoff Requirements. §132(c)l: All permanently installed outdoor lighting meets the control requirements listed. §132(c): Building facades, parking lots,garages, canopies, and outdoor sales areas meet the Multi-Level Lighting Requirements listed. Ener Pro 5.1 by Ener Soft User Number:1315 RunCode:2013-11-04T09:40:10 ID:0130615 Page 22 of 23 i MECHANICAL MANDATORY MEASURES: NONRESIDENTIAL MECH-MM Project Name Date Cupertino Bike Shop 11/4/2013 Equipment and System Efficiencies §111: Any appliance for which there is a California standard established in the Appliance Efficiency Regulations will comply with the applicable standard. §115(a): Fan type central furnaces shall not have a pilot light. §123: Piping, except that conveying fluids at temperatures between 60 and 105 degrees Fahrenheit, or within HVAC equipment,shall be insulated in accordance with Standards Section 123. §124: Air handling duct systems shall be installed and insulated in compliance with Sections 601, 602, 603, 604, and 605 of the CMC Standards. Controls §122(e): Each space conditioning system shall be installed with one of the following: 1A. Each space conditioning system serving building types such as offices and manufacturing facilities (and all others not explicitly exempt from the requirements of Section 112(d))shall be installed with an automatic time switch with an accessible manual override that allows operation of the system during off-hours for up to 4 hours. The time switch shall be capable of programming different schedules for weekdays and weekends and have program backup capabilities that prevent the loss of the device's program and time setting for at least 10 hours if power is interrupted-,or 1 B. An occupancy sensor to control the operating period of the system;or 1C, A 4-hour timer that can be manually operated to control the operating period of the system. 2 Each space conditioning system shall be installed with controls that temporarily restart and temporarily operate the system as required to maintain a setback heating and/or a setup cooling thermostat setpoint. Each space conditioning system serving multiple zones with a combined conditioned floor area more than 25,000 §122(g): square feet shall be provided with isolation zones. Each zone: shall not exceed 25,000 square feet;shall be provided with isolation devices, such as valves or dampers that allow the supply of heating or cooling to be setback or shut off independently of other isolation areas;and shall be controlled by a time control device as described above. §122(c): Thermostats shall have numeric setpoints in degrees Fahrenheit(F)and adjustable setpoint stops accessible only to authorized personnel. §122(b): Heat pumps shall be installed with controls to prevent electric resistance supplementary heater operation when the heating load can be met by the heat pump alone Each space conditioning system shall be controlled by an individual thermostat that responds to temperature within the zone. Where used to control heating,the control shall be adjustable down to 55 degrees F or lower. For cooling,the §122(a&b): control shall be adjustable up to 85 degrees F or higher. Where used for both heating and cooling,the control shall be capable of providing a deadband of at least 5 degrees F within which the supply of heating and cooling is shut off or reduced to a minimum. Ventilation §121(e): Controls shall be provided to allow outside air dampers or devices to be operated at the ventilation rates as specified on these plans. §122(f): All gravity ventilating systems shall be provided with automatic or readily accessible manually operated dampers in all openings to the outside, except for combustion air openings. Ventilation System Acceptance. Before an occupancy permit is granted for a newly constructed building or space,or a §121(f): new ventilating system serving a building or space is operated for normal use,all ventilation systems serving the building ors ace shall be certified as meeting the Acceptance Requirements for Code Compliance Service Water Heating Systems §113(c) Installation 3. Temperature controls for public lavatories. The controls shall limit the outlet Temperature to 110°F. 2 Circulating service water-heating systems shall have a control capable of automatically turning off the circulating pump when hot water is not required. Ener Pro 5.1 Py Ener Soft User Number:1315 RunCode:2013-11.04T09:40:10 10:0130615 Page 23 of 23