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12070164 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10171 STERN AVE CONTRACTOR:DWK CONSTRUCTION PERMIT NO: 12070164 OWNER'S NAME: KEN LIN 18665 LOREE AVE DATE ISSUED:01/07/2013 OWNER'S PHONE: 4089306892 CUPERTINO,CA 95014 PHONE NO:(408)996-1186 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class b Lic.# co 21 CONSTRUCT SFDWL-2,244 LIVING SPACE,20 SQ FT DECK,444 SQ FT ATTACHED GARAGE. SANITARY IS IN Contractor ;t/11C' CW, Date f SUNNYVALE'S JURISDICTION I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$250000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:37511064.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAV ROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued b Date: granting of this permit. Additionally,the applicant understands and will comply r with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date b% �"/3 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, wil I do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which thisJAV'—G permit is issued. . Owner or authorized agent: Date: i 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 Califomia. 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 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 GUPERTINO (408) 777-3228• FAX (408) 777-3333• building(cDcupertino.orq KNEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFE D ORIGINAL PERMIT# PROJECT ADDRESS /017 6 TE-RAI I+VE APN I C OWNER NAMEI/&�� / PHON �� E-MAIL STREET ADDRESS k_7 171 !M_ A 4� C CITY, STATE,ZIP CUP�P� &y-,, �jpX CONTACT NAME I !� �V� PHONE /I/[/ E-MAIL LCL y 4V4 STREET ADDRESS i pl,� CITY,STATE, ZIP ,/ FAX ❑ OWNER ❑ OWNER-BUILDERt/ ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER '-{❑ DEVELOPER ❑ TENANT CONTRACTOR NAM 0AJ604,P „ Jp_ LICENSE NUMB ERDQ , LICENSE TYPE BUS.LIC 4 COMPANY NAME EMAIL / / FAX n Q y/_/4VkCOn� - _h� 141kC�Sc � STREET ADDRESS 966J - CITY,STATE,ZIP PH70,Y -3U , /am ARCHITECT/ENGINEER NAME `� I1 LICENSE NUMBER I I BUS.LIC# COMPANY NAME b # 1 E-MAI F 'kl , S`c�tl- C�bot�I'. Com- STREET ADDRESS # CITY,STATE,ZIP 2 NE l DESCRIPTION OF WO WK AlLfV E- MKIY S/A/ L E- EXISTING USE PROPOSED USE CONSTR.TYPE 1 #STORIES PUSE TYPE OCC. SQ.FT. VALUATION(S) EXIST G NEW FLOOR DEMO TOTAL AREA/1C.n 4 1 AREA` 2 rj AREA ��' ., NET ARE$ (tl�� P� BATHROOM KITCHEN OTHE I `! REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: DETACH u _ 4'/1/ ' PATTACH #DWELLING L14ITS ISA SECOND UNIT ❑YES SECONDSTORY YES P' BEING ADDED? NO ADDITION? RNO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL# ANO PLANNING APPROVAL LETTER EICHLER HOME? NO By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: <- -� Date: 7 2�i��f 2— SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPEtt77 ROUTING SLIP 9 _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THErCOUNTER -gUI1.DING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 9 ST`\NDARD ❑' Puu c WORKS form if any Hazardous Materials are being used as part of this project. 11 LARGE ❑ SIRE DEPT _Copy of Planning Approval Letter or Meeting with.Planning prior to ❑ MAJOR El/SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION 4 ADDRESS: 10171 stern ave. DATE: 07/20/2012 REVIEWED BY: bobs. ' APN: BP#: � 7Q VALUATION: 1$250,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 2nd Unit? Yes No PENTAMATION 'I R3SFDW USE: PERMIT TYPE: WORK I construct new 1 story sfd. SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,111-B,IV,V-B 2,708 $2,813.48 IR3PLNCK $2,712.87 IRMNSP TOTALS: 2,708 $2,813.48 $2,712.87 E17- I-- NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Thesefees are based on the prelimina information available and are on an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/1I� FEE QTYIFEE MISC ITEMS Plan Check Fee: $2,813.48 Select a Misc Bldg/Structure Suppl. PC Fee: (!) Reg. () OT0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $2,712.87 Suppl. Insp.Feer Reg. Q OT T0,0Thrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 t!new Construction Tax: IBCONSTAXR 1 Tn $595.41 Aciminisfralitie f". . 0 Work Without Permit? Yes (F) No $0.00 0 Advanced Planning Fee: IPLLONGR $352.04 Select a Non-Residential Q Iicxv 11)n<zrxizrurxfiorf /'ei t, Building or Structure 0 i Strong Motion Fee. IBSEISMICR $25.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $10.00 SUBTOTALS: $6,508.80 $0.00 TOTAL FEE: $6,508.80 Revised: 07/01/2012 Building Del City Of'ot 10300 Torr&% Cupertino, CA 95015 C U P E RT I N O Telephone: 408-777- Fax: 408-777 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 5`�elit 14ve PERMIT# OWNER'S NAME: br ` PHONE# C -1196 GENERAL CONTRACTOR: G��r f BUSINESS LICENSE# ADDRESS: E t,- CP- fAlb , CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: - Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor qgnature Date 01/28/2014 13:15 14089961186 JULIE L HE PAGE 01/01 Building Department City Of Cupertino 10300 Torre Avenue cCupertino,CA 95014-3255 Telephone:408-777,3228 C.0 P ERTI NO Fax:408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: 141zi ye _ - PERMIT#_ Z O O/ OWNER.'S NAM.F: - _ _ PHONE# GENERAL CONTRACTOR: +3 b Yl BUSINESS LICENSE t? ADDRESS' - __ - __ C.1'I'Y/Z,IPCOD.E: E / "Our munlctpal code requires all businesses worktng In the city to)baNe a City of Cupertino business license, NO BUILDING FINAL OR FINAL OCCUPANCY iNSPECTION(S) WILL OF SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS FIAVF OBTAI,'YLD A CITY or CUPERTINO BUSINESS LICENSE. I I am not using any subcontractors: �•... --- _-._ Signature Date Please check applicable subcontractors and complete the following information: ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets &Millwork Cement Finishing` Electrical Excavation Fencing ----- — --- Flooring/Carpeting Linoleum!Wood Glass!Glazing -.- ---__---- --� He.atin6 --- Jnstitation .Landscaping -------.._ ...�..-•---- Lathing r(D� ��JkAfd�r J� .Masonry - Painting/Wallpaper --- -- -- ----'---- raving - Plastering rV Plumbing Ab "s C )i-7 oee-Atvco elo' Roofing clensfIl4effo 1 22 5(p G Septic Tank - - Sheet Metal— . . ,-..� ------ -----'._--- --. .. Sheet Rock P 3 Tile . . ... .......... . . ro -.... .._�(ct�� -- --�-��-�^- ---'---'--- ---- ..---'-L--' Owner/Cont &tor Signature Date CALGR`E/EN SIGNATURE DECLARATIONS 1a070 (� Project Name: kLr�v Project Address: Project Description: 4 Or Lo 1 61 SECTION 1 - DESIGN VERIFICATION Complete all lines of Section 1 —"Design Verification"and submit the completed checklist(Columns 1 and 2)with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2010 California Green Building Standards Code as adopted by thCity of Cupertino. /0 Z Owner's gnature Date v �, =:�cl Lln/ Owner's Name (Please Print) r —o "—%Z Design Professional's ignature Date l Oso Design Professional's Name (Please Print) Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for lalGreen compliance(Please Print) Phone Email Address for License Professional responsible for CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2010 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Profession sponsible for CalGreen compliance Name of License Professional responsible for CalGreen compliance(Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen_2010.doc revised 08/27/11 INSTALLATION CERTIFICATE (Pagel of 12) CF-6R Site Address Permit Number i otl 4-arn Ave• 1207,01 e q Installation certificates(CF-6R)are required for each and every dwelling unit.When the installation of measures that require field verification and diagnostic testing is complete,the builder or the builder's subcontractor shall complete diagnostic testing and the procedures specified in this section.When the installation is complete,the builder or the builder's subcontractor shall complete the CF-6R(Installation Certificate),and keep it at the building site for review by the building department.The builder also shall provide a copy of the Installation Certificate to the HERS rater for any measures requiring field verification and diagnostic testing,per Section 10-103(a). C 17 116 No WATER HEATING SYSTEMS: -1`h q2 Distribution CEC Certified Type If #of Rated Input External Heater Mfr Name& (Std,Point- Recirculation, Identical (kW or Tank Volume Efficiency Standby Insulation T e Mo el Number of-Use,etc) Control Type Systems Btu/br)' (gallons (EF,RE)z Loss(%)z R-value T 1 For small gas storage(rated input of less than or equal to 75,000 Btu/hr),electric resistance and heat pump water beaters,list Energy Factor(EF).For large gas storage water heaters(rated input of greater than 75,000 Btu/hr), list Recovery(RE),Thermal Efficiency,Standby Loss and Rated Input. For instantaneous gas water heaters, list Thermal Efficiency and Rated Input. 2. R-12 external insulation is mandatory for storage water heaters with an energy factor of less than 0.58. Kitchen Piping: If indicated on the CF-1R,all hot water piping>3/4 inches in diameter that runs from the hot water source to the kitchen fixtures is insulated. Faucets&Shower Heads: All faucets and showerheads installed are certified to the Energy Commission,pursuant to Title 24,Part 6,Section 111. Central Water Heating in Buildings with Multiple Dwelling Units(required for prescriptive) ❑All hot water piping in main circulating loop is insulated to requirements of§1506) ❑Central hot water systems serving six or fewer dwelling units which have(1)less than 25' of distribution piping outdoors;(2)zero distribution piping underground;(3)no recirculation pump;and(4)insulation on distribution piping that meets the requirements of Section 1500) ❑Central hot water systems serving more than 6 dwelling units-presence of either a time control or a time/temperature control ✓ ❑ I, the undersigned, verify that equipment listed above my signature is: 1) the actual equipment installed; 2) equivalent to or more efficient than that specified in the certificate of cc npliance(Form CF-1R)submitted for compliance with the Energy Efficiency Standards for residential buildings; and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices(from the Appliance Efficiency Regulations or Part 6),where applicable. Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner DkVK � CStrG�-�� Signature: G Date: th �] 14, G � '1 Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY Residential Compliance Forms September 2005 INSTALLATION CERTIFICATE (Page 2 of 12) CF-6R Site Address Permit Number /of 7 i 5 ern. el+ko, } l 12 00 C/ An installation certificate is required to be posted at the Suilding site or made available for all appropriate inspections. (The information provided on this form is required)After completion of final inspection,a copy must be provided to the building department(upon request)and the building owner at occupancy,per Section 10-103(a). FENESTRATION/GLAZING: ManufacturerBrand Name Total t t Quantity of Area Exterior (GROUP LME Product U-factor Product SHGC #of Like Product Square Shading Device Comments/Location/ Item ROD CTS) (<_CF-1R value)_ (SCF-M value)_ Panes O nonan Feet or Overhang Special Features 1. t d. , O. 3 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. t> Use values from a fenestration product's NFRC label.For fenestration products without an NFRC label,use the default values from Section 116 of the Energy Efficiency Standards. _) Installed U-factor must be less than or equal to values from CF-IR.Installed SHGC must be less than or equal to values from CF-1R,ora shading device(exterior or overhang)is installed as specified on the CF-1R. Alternatively,installed weighted average U-factors for the total fenestration area are less than or equal to values from CF-1R.If using default table SHGC values from§116 identify whether tinted or not. ✓ ❑ I, the undersigned, verify that.the fenestration/glazing listed above my signature: 1) is the actual fenestration product installed; 2) is equivalent to or has a lower U-factor and lower SHGC than that specified in the certificate of compliance(Form CF-1R)submitted for compliance with the Energy Efficiency Standards for residential buildings; and 3)the product meets or exceeds the appropriate requirements for manufactured devices(from Part 6),where applicable. Item#s Signature Date Installing Subcontractor(Co.Name)OR (if applicable) [ �g / / General Contractor(Co.Name)OR Owner OR Window Distributor -P11I1\ Galt St7i� Item#s Signature Date Installing Subcontractor(Co.Name)OR (if applicable) General Contractor(Co.Name)OR Owner OR Window Distributor Item#s Signature Date Installing Subcontractor(Co.Name)OR (if applicable) General Contractor(Co.Name)OR Owner OR Window Distributor Copies to:Building Department,HERS Rater(if applicable)Building Owner at Occupancy Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 3 of 12) CF-6R Site Address Permit Number l ol7 l Am , Salo t 2 o 701 b4 An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required)After completion of final inspection,a copy must be provided to the building department(upon request)and the building owner at occupancy,per Section 10-103(a). HVAC SYSTEMS: Heating Equipment CEC Certified Mfr. #of Efficiency � Duct Duct or Heating Heating Equip Type Name and Model Identical (AFUE.etc.) Location Piping Load Capacity (pkg.heat um Numbcr S stems >_CF-1 R value) attic,etc. R-value (BW/hr) uAr :rj%y 1 ala. C&n . 141e SA o Cooling Equipment CEC Certified Mfr. #of Efficiencyi Duct Cooling Cooling Equip Type Name and Model Identical (SEER or EER) Location Duct Load Capacity k .heat um Number Systems ?CF-IRvalue) attic,etc. R-value (Btu/hr) (Btu/hr � - ti /3 tic Stites�-�3bK� . 1. >symbol reads greater than or equal to what is indicated on the CF-1R value. Include both SEER and EER if compliance credit for high EER air conditioner is claimed. ✓ ❑I I,the undersigned,verify that equipment listed above is: 1)is the actual equipment installed,2)equivalent to or more efficient than that specified in the certificate of compliance (Form CF-1R) submitted for compliance with the Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices(from the Appliance Efficiency Regulations or Part 6),where applicable. Installing Subcontractor(Co.Name)OR General TAX Contractor(Co.Name)OR Owner Signature: Date: �i L Copies to:BUILDING DEPARTMENT,FIERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 4 of 12) CF-6R Site Address / x^14 PermitNumber tD/6 2 4 INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT The building was: ✓ UTested at Final ✓❑ Tested at Rough-in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE FOR NEW DUCTS: ❑ Remove at least one supply and one return register,and verify that the spaces between the register boot and the interior finishing wall are properly sealed. ❑ If the house rough-in duct leakage test was conducted without an air handler installed,inspect the connection points between the air handler and the supply and return plenums to verify that the connection points are properly sealed. ❑Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used on new ducts. ✓❑ DUCT LEAKAGE REDUCTION Procedures or reld verification and diagnostic testing of air distribution systems are available in RACM,Appendix RC4.3 NEW CONSTRUCTION: Duct Pressurization Test Results(CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM: Fan Flow:Calculated(Nominal: ✓❑Cooling✓❑Heating)or✓❑Measured 2 If Fan Flow is Calculated as 400 cfn/ton x number of tons or as 21.7 cfin/(kBtu/hr)x Heating ✓ ✓ Capacity in Thousands of Btu/hr,enter total calculated or measured fan flow in CFM here: 3 Pass if Leakage Percentage< 6%for Final or<4%at Rough-in without air handle: fPass❑Fail 100 x Line# 1 / Line#2 ALTERATIONS: Duct System and/or HVAC Equipment Change-Out 4 Enter Tested Leakage Flow in CFM from Pre-Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change-Out. Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct 5 S stem for Duct System Alteration and/or Equipment Change-Out. Enter Reduction in Leakage for Altered Duct System 6 Line#4 Minus Line#5 – (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside(Only if Applicable) ✓/ ✓ Entire New Duct System-Pass if Leakage Percentage <6%for Final. (a Pass ❑ Fail 8 100 x ine#5 / Line#2'I TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change- ✓ ✓ Out Use one of the following four Test or Verification Standards for compliance: 9 Pass if Leakage Percentage< 15% [100 x[ (Line#5)/ (Line#2)]] Pass ❑ Fail 10 Pass if Leakage to Outside Percentage< 10%[100 x r(Line#7)/ (Line#2)11 Pass ❑ Fail Pass if Leakage Reduction Percentage>60%[100 x[-(Line#6)/ (Line#4)1] [ ass ❑ Fail 11 and Verification by Smoke Test and Visual Inspection 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Ins ection _ ass ❑ Fail Pass if One of Lines#9 throw h#12 pass Pass ❑ Fail ✓ 1:11,the undersigned,verify that the above diagnostic test results were performed in conformance with the requirements for compliance credit.I,the undersigned,also certify that the newly installed or retrofit Air-Distribution System Ducts,Plenums and Fans comply with Mandatory requirements specified in Section 150(m)of the 2005 Building Energy Efficiency standards. Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner pGdL— G6-N S Signature: Date: 2A 04 Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY Residential Compliance Forms December 2005 INSTALLATION CERTIFICATE (Page 5 of 12) CF-6R Site AddressPermit Number 0/ l S" Ale, �c(1, c-4 �!4 2070 ,64 ✓ ❑ THERMOSTATIC EXPANSION VALVE(TXV) Procedures for field verification of thermostatic expansion valves are available in RACM,Appendix RI. Access is provided for inspection.The procedure shat l consist of visual verification that the TXV is installed on ✓ ❑Yes ❑No the system and installation of the specific equipment ❑ ❑ shall be verified. Yes is a pass I Pass I Fail ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without Thermostatic Expansion Valves Outdoor Unit Serial# Location Outdoor Unit Make Outdoor Unit Model Cooling Capacity Btu/hr Date of Verification Date of Refrigerant Gauge Calibration (must be checked monthly) Date of Thermocouple Calibration (must be checked monthly) Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above): Procedures for Determining Refrigerant Charge using the Standard Method are available in RA CM,Appendix RD2. Note:The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures Supply(evaporator leaving)air dry-bulb temperature(Tsupply,db) °F Return(evaporator entering)air dry-bulb temperature(Tretorn,db) OF Return(evaporator entering)air wet-bulb temperature(Tretorn,wb) °F Evaporator saturation temperature(Tevaporator,sat) °F Suction line temperature(Tsuction,db) OF Condenser(entering)air dry-bulb temperature(Tcondenser,db) OF Superheat Charge Method Calculations for Refrigerant Charge Actual Superheat =Tsuction,db—Tevaporator,sat °F Target Superheat(from Table RD-2) °F Actual Superheat—Target Superheat (System passes if between-5 and+5°F) OF Temperature Split Method Calculations for Adequate Airflow S lit Method Calculation is not necessary i Ade uate Airflow credit is taken Actual Temperature Split =T return,db Tsupply,db OF Target Temperature Split(from Table RD3) OF Actual Temperature Split Target Temperature Split (System passes if between- OF 3°F and+3°F or,upon remeasurement,if between -3°F and-100°F Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 6 of 12) CF-6R Site Address Permit Number W71 ,54-9& 41C Xu., .0014 tzoot64 Standard Charge Measurement Summary: System shall pass both refrigerant charge and adequate airflow calculation criteria from the same measurements.If corrective actions were taken,both criteria must be remeasured and recalculated. ✓ 10 Yes I ❑No I System Passes Alternate Charge Measurement Procedure(outdoor air dry-bulb below 55°F) Note:The system should be installed and charged in accordance with the manufacturer's specifications and installer verification shall be documented on CF-6R before starting this procedure. If outdoor air dry-bulb is 55°F or above,installer shall use the Standard Charge Measure Procedure: Procedures for Determining Refrigerant Charge using the Alternate Method are available in RA CM,Appendix RD3. Wei h-In Charging Method for Refrigerant Charge Actual liquid line length: ft Manufacturer's Standard liquid line length: ft Difference(Actual—Standard): ft Manufacturer's correction(ounces per foot) x difference in length = ounces (+=add)(-=remove) Measured Airflow Method for Adequate Airflow Verification available in RACM,Appendix RD2.6 Calculated Airflow:Cooling Capacity(Btu/hr) X 0.033(cfmBtu-br)= CFM Measured Airflow is CFM(Measured airflow must be greater than the calculated airflow). Alternate Charge Measurement Summary: System shall pass both refrigerant charge and adequate airflow calculation criteria from the same measurements.If corrective actions were taken,both criteria must be remeasured and recalculated. ✓ ❑ Yes I []No stem Passes Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner > e e ws Signature: Date: l Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 7 of 12) CF-6R Site Address Permit Number 10171 5f-- �, 'ko, t,4 s t4 /2 o7o r64 MISCELLANEOUS CREDITS ✓ ❑ DIAGNOSTIC SUPPLY DUCT LOCATION,SURFACE AREA AND R-VALUE Procedures for field verification and diagnostic lesling for this group compliance credits are available in RACM,Appendix RC,RE&RH. ✓ ❑ LESS THAN 12 LINEAL FEET OF SUPPLY DUCT OUTSIDE OF CONDITIONED SPACE COMPLIANCE CREDIT ✓ []Yes I ❑No I Less than 12 lineal feet of supply duct outside of conditioned space. Yes to this compliance credit is a pass ✓ ❑ Pass ✓ ❑ Fail ✓ ❑ SUPPLY DUCTS LOCATED IN CONDITIONED SPACE COMPLIANCE CREDIT F;7-E1:1 Yes ❑No I Ducts are located within the conditioned volume of building. Yes to this compliance credit is a pass ✓ ❑ Pass ✓ ❑ Fail Duct System Design verification is required for a compliance credit for the following: 1. Supply duct surface area reduction 2. Buried supply ducts on the ceiling 3. Deeply buried supply ducts ✓ ❑ DUCT SYSTEM DESIGN VERIFICATION ✓ ❑ Yes ❑No Adequate airflow verified ✓ ❑ Yes ❑No The duct system design plan meets the requirements specified in RACM,Appendix RE,Section RE.4.2 ✓ ❑ Yes ❑No The duct system design plan exists on building plans ✓ ❑ Yes ❑No Duct sizes,duct system layout and locations of supply&return registers match the duct system design plan Yes to all is a pass ✓ ❑Pass ✓ ❑Fail ✓ ❑ SUPPLY DUCTS SURFACE AREA REDUCTION COMPLIANCE CREDIT R-4.2 R-6.0 R-8.0 Crawl Deeply Duct Surface Surface Surface Attic Space Basement Covered Covered Other Diameter Area Area Area ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Total Surface Area for Each R-Value= ✓ ❑ Yes I ❑ No tches Performance's CF-1R? ✓ ✓ Yes to all is a pass ❑ Pass ❑ Fail ✓ ❑BURIED DUCTS ON THE CEILING COMPLIANCE CREDIT ❑Yes ❑No Buried Ducts on the Ceiling ❑Yes ❑No Verified High Insulation Installation Quality ✓ ✓ Yes to ducts stem design,supply duct surface area reduction and this compliance credit is a pass ❑ Pass ❑Fail ✓ ❑DEEPLY BURIED DUCTS COMPLIANCE CREDIT ✓ ❑Yes ❑No Deeply Buried Ducts ✓ ❑Yes ❑No Verified High Insulation Installation Quality ✓ ✓ Yes to ducts stem design,supply duct surface area reduction and this compliance credit is a ass ❑Pass TO Fail Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 8 of 12) CF-6R Site Address Permit Number fo►71 574rn 1hV . ,thio, O ,A 1 X14 12070 1,64 ✓❑ FAN WATT DRAW Procedures for measuring the air handler wait draw are available in RACM,Appendiz RE3.2. ✓Method For Fan Watt Draw Measurement ❑ RE3.2.1 Portable Watt Meter Measurement ❑ RE3.2.2 Utility Revenue Meter Measurement Measured Fan Watt Draw Watts Measured Fan Flow enter total cfn from airflow verification cfm Enter results of Watts/cfm Watts/cfm ✓ ❑ Yes ❑No Measured fan watt/cfrn draw is equal to or lower than the fan watt/cfm draw documented in CF-1 R ❑ ❑ Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION Procedures or measuring the airflow are available in RACM,Appendix RE3.1. ✓Method For Airflow Measurement ❑ RE4.1.1 Diagnostic Fan Flow Using Flow Capture Hood ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement ❑Yes ❑No Duct design exists on glans Measured Airflow: Total cfm Rated Tons cfm/ton cfm/ton ✓ ❑ Yes ❑No Measured airflow is greater than the criteria in Table RE-2 ✓ ✓ Yes is a pass Pass Fail ✓ ❑ MAXIMUM COOLING CAPACITY Procedures or det rmining maximum cooling load capacity are available in RACM,Appendix RF3. 1 ✓ ❑Yes ❑No Adequate airflow verified(see adequate airflow credit) 2 ✓ ❑ Yes ❑No Refrigerant charge or TXV 3 ✓ ❑ Yes ❑No Duct leakage reduction credit verified 4 ✓ ❑ Yes ❑No Cooling capacities of installed systems are 5 to maximum cooling capacity indicated on the Performance's CF-1 R and RF-3. If the cooling capacities of installed systems are>than maximum ✓ ✓ 5 ✓ ❑ Yes ❑No cooling capacity in the CF-1R,then the electrical input for the El systems must be 5 to electrical input in the CF-1R. Yes to 1,2,and 3;and Yes to either 4 or 5 is a pass Pass Fail ✓❑ HIGH EER AIR CONDITIONER Procedures or ver'rcation are available in RACM Appendix RI. 1 ✓ ❑ Yes ❑No EER values of installed systems match the CF-IR 2 ✓ ❑ Yes ❑No Fors lit system,indoor coil is matched to outdoor coil ✓ ✓ 3 ✓ ❑ Yes ❑No Time Delay Relay Verified(If Required) ❑ Yes to 1 and 2;and 3 f Required)is a pass Pass Fail Installing Subcontractor(Co.Name)OR General '�''/ Contractor(Co.Name)OR Owner .IV A,-: 6,rns Signature: - Date: (12-q 1114 Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 9 of 12) CF-6R Site Address Permit Number o� / sle rl k4, G,4 9. 714 12-07,016 C� An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required)After completion of final inspection,a copy must be provided to the building department(upon request)and the building owner at occupancy,per Section 10-103(a). BUILDING ENVELOPE LEAKAGE DIAGNOSTICS ✓ ❑ ENVELOPE SEALING INFILTRATION REDUCTION Procedures for field verification and diagnostic testing of envelope leakage are available in RACM,Appendix RC. Diagnostic Testing Results ✓ ✓ Building Envelope Leakage(CFM @ 50 Pa)as measured by Rater: 1 ❑ ❑ Measured envelope leakage less than or equal to the required level from Yes No CF-1R? 2. ❑ ❑ Is Mechanical Ventilation shown as required on the CF-1R? Yes No El El If Mechanical Ventilation is required on the CF-1R(`Yes'in line 2),has it 2a. Yes No been installed? Check this box`yes' if mechanical ventilation is required(`Yes'in line 2) 2b. ❑ ❑ and ventilation fan watts are no greater than shown on CF-IR. Yes No Measured Watts= Check this box`yes"if measured building infiltration(CFM @ 50 Pa)is 3. El ElCheck than the CFM @ 50 values shown for an SLA of 1.5 on CF-1R Yes No If this box is checked no,mechanical ventilation is required.) Check this box"yes"if measured building infiltration(CFM @ 50 Pa)is 4 ❑ ❑ less than the CFM @ 50 values shown for an SLA of 1.5 on CF-1R, Yes No mechanical ventilation is installed and house pressure is greater than minus 5 Pascal with all exhaust fans operating. Pass if: a.Yes in line 1 and line 3,or ✓ ✓ b.Yes in line I and line2,2a,and 2b,or c.Yes in line 1 and Yes in line 4. ❑ ❑ Otherwise fail. Pass Fail ✓ ❑ I,the undersigned,verify that the building envelope leakage meets the requirements claimed for building leakage reduction below default assumptions as used for compliance on the CF-1R. This is to certify that the above diagnostic test results and the work I performed associated with the test(s)is in conformance with the requirements for compliance credit. (The builder shall provide the HERS provider a copy of the CF-6R signed by the builder employees or subcontractors certifying that diagnostic testing and installation meet the requirements for compliance credit.) Test Performed Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner Signature: sem-_- Date: lo Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 10 of 12) CF-6R Site Address � . �cM , P��N lof7l St� Insulation Installation Quality Certificate ✓ ❑ Description of Insulation,(CF-611,formerly IC-1)signed by the installer stating: insulation manufacturer's name, material identification,installed R-values,and for loose-fill insulation: minimum weight per square foot and minimum inches ✓ ❑ Installation meets all applicable requirements as specified in the High Quality Insulation Installation Procedures (ACM,Appendix RH) ✓ FLOOR ❑ ❑ ❑ All floor joist cavity insulation installed to uniformly fit the cavity side-to-side and end-to-end Yes No NA ❑ ❑ ❑ Insulation in contact with the subfloor or rim joists insulated Yes No NA ❑ ❑ ❑ Insulation properly supported to avoid gaps,voids,and compression Yes I No NA ✓WALLS ❑ ❑ ❑ Wall stud cavities caulked or foamed to provide an air tight envelope Yes No NA ❑ ❑ ❑ Wall stud cavity insulation uniformly fills the cavity side-to-side,top-to-bottom,and front-to-back Yes No NA ❑ ❑ ❑ No gaps Yes No NA ❑ ❑ ❑ No voids over 3/4"deep or more than 10%of the batt surface area. Yes No NA ❑ ❑ ❑ Hard to access wall stud cavities such as;comer channels,wall intersections,and behind Yes No NA tub/shower enclosures insulated to proper R-Value ❑ ❑ ❑ Small spaces filled Yes No NA ❑ ❑ ❑ Rim joists insulated Yes No NA ❑ ❑ ❑ Loose fill wall insulation meets or exceeds manufacturer's minimum weight-per-square-foot Yes I No NA I requirement ✓ ROOF/CEILING PREPARATION ❑ ❑ ❑ All draft stops in place to form a continuous ceiling and wall air barrier Yes No NA ❑ ❑ ❑ All drops covered with hard covers Yes No NA ❑ ❑ ❑ All draft stops and hard covers caulked or foamed to provide an air tight envelope Yes No NA ❑ ❑ ❑ All recessed light fixtures IC and air tight(AT)rated and sealed with a gasket or caulk between the Yes No NA housing and the ceiling ❑ ❑ ❑ Floor cavities on multiple-story buildings have air tight draft stops to all adjoining attics Yes No NA ❑ ❑ ❑ Eave vents prepared for blown insulation-maintain net free-ventilation area Yes No NA ❑ ❑ ❑ Knee walls insulated or prepared for blown insulation Yes No NA ❑ ❑ ❑ Area under equipment platforms and cat-walks insulated or accessible for blown insulation Yes No NA ❑ ❑ ❑ Attic rulers installed Yes No NA Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 11 of 12) CF-6R Site Address Permit Number C>171 S4evn AW, "/ GA .S-V14 izo 7P4 ✓ ROOF/CEILING BATTS Yes No NA No gaps Yes No NA No voids over 1/4 in.deep or more than 10%of the batt surface area. Yes No I NA Insulation in contact with the air-barrier Yes No NA Recessed light fixtures covered ❑ ❑ ❑ Nel free-ventilation area maintained at eave vents Yes No NA ✓ ROOF/CEILING LOOSE-FILL Yes No NA Insulation uniformly covers the entire ceiling(or roof)area from the outside of all exterior walls. Yes No NA Baffles installed at eaves vents or soffit vents-maintain net free-ventilation area of eave vent Yes No NA Attic access insulated Yes No NA Recessed light fixtures covered ❑ ❑ ❑ Yes No NA Insulation at proper depth—insulation rulers visible and indicating proper depth and R-value ❑ ❑ ❑ Loose fill insulation meets or exceeds manufacturer's minimum weight and thickness requirements Yes No NA for the target R-value. Target R-value .Manufacturer's minimum required weigh!for the target R-value (pounds-per-square-fool).Manufacturer's minimum required thickness at time of installation . Manufacturer's minimum required settled thickness .Note: To receive compliance credit the HERS rater shall verb that the manufacturer's minimum weight and thickness has been achieved for the target R-value. (CF-61?only) DECLARATION ✓ ❑ I hereby certify that the installation meets all applicable requirements as specified in the Insulation Installation Procedures. Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner -!)fi✓k 4m 5taq Jfm Signature: ,,,,,,,f,F, - ,-Z5 Date: tr Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 12 of 12) CF-6R Site Address PermiINumberQ r6 County Subdivision '] 7 Lot Number Description of Insulation (Formerly IC-1 Form) 1. RAISED FLOOR Material Fo,kie-' <��JM Brand Name Thickness (inches) L9 Thermal Resistance(R-Value) 2. SLAB FLOOR/PERIMETER Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Perimeter Insulation Depth (inches) 3. EXTERIOR WALL Frame Type pbe,, CVIA" 2xQ A. Cavity Insulation Material Fll b,,- Brand Name Thickness(inches) Thermal Resistance(R-Value) B . Exterior Foam Sheathing Material Brand Name Thickness(inches) Thermal Resistance(R-Value) 4. FOUNDATION WALL Material Brand Name Thickness (inches) Thermal Resistance(R-Value) 5. CEILING Batt or Blanket Type F;Ler C*4VA Brand Name Thickness(inches) R30 Thermal Resistance (R-Value) Loose Fill Type Brand Contractor's min installed weight/ft2 lb Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance(R-Value) 6. ROOF Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Declaration ✓ ❑ I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Energy Efficiency Standards for residential buildings(Title 24,Part 6,California Code of Regulations)as indicated on the Certificate of Compliance,where applicable. Item#s Signature Date Installing Subcontractor(Co.Name)OR (if applicable) General Contractor(Co.Name)OR Owner 112-4114 OR Window Distributor Item#s Signature Date Installing Subcontractor(Co.Name)OR (if applicable) General Contractor(Co.Name)OR Owner OR Window Distributor Item#s Signature Date Installing Subcontractor(Co.Name)OR (if applicable) General Contractor(Co.Name)OR Owner OR Window Distributor Residential Compliance Forms April 2005 August 05, 2013 4070l0 Mr. Thomas Chung DWK Construction 101 7 1 STERN AVENUE Cupertino, CA J 5ubject: Structural framing Observation Dear Mr. Chung : At your request, we have made a structural framing walk for the project mentioned above on 8/05/2013. To the best of our knowledge and based on our observations through accessible areas, the framing work for the lot mentioned above , include shear wall nailing, hold-downs and shear transfer paths were in general conformance with the city approved plan dated on 8/30/201 2. The two openings at the rear wall of the Nook and family Room, were changed and there is no structural impact on the vertical and lateral load transfer path. This review is conceptual and qualitative. It is intended to verify the presence of major Structural connections and to identify major deficiencies. Accuracy of dimensions, number and location of fasteners, type and grading of materials and similar features of the work were not checked in detail. The above information constitutes the professional opinions of C1150TTI Engineering, Inc. in accordance with generally accepted engineering principles and presented above are based on a limited reconnaissance. No physical testing examine areas not readily accessible. We do not undertake the guarantee of the construction, nor do we relieve the contractor from his responslbility to produce a completed project conforming to the plans. Should you have any questions regarding this matter, please feel free to call. Engineer of Record: Scott Cibotti P.E., CEE 12935 Alcosta 61vd, #2025 off° San Ramon, Ca. 94583 c1 bus (925) 829-0920 cm fax (925) 829-092 1 of Scott@cibotti.com 8-05-2013 2010 CALGREEN RESIDENTIAL CHECKLIST- ' MANDATORY ITEMS 0701(iq COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO ALBERT SALVADOR P.E. C.B.O. BUILDING OFFICIAL 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333-building(a)cupertino.org PURPOSE: The 2010 CalGreen Code applies to onstructed ht t houses, dwellings, dormitories, condominiums, shelters, a residences;aq� o �e , factory-built housing and other types of swellings with sleepin dations and new awes%iq ings associated with such uses. Existing site and landscaping nts that are not otherwise disturbed are not subject to the requirements of CALGreen. REV E ED FOR COD LIANCE Project Name: E/V Project Address: 4/ ! 5'7_EkJ_7 Ufa Project Description: A/&c) 4172 Y 1�t4 le h�rcc Instructions: 1. The Owner or the Owner's agent shall employ a licensed pf&ssional explenced with the 2010 California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2- Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Requirements A4.1 PLANNING AND DESIGN Planning and Design -Site Preservation 4.104.1 A site plan and inventory of the site is developed and used to minimize site disturbance in order preserve desirable existing natural resources and OX minimize future adverse effects on the proposed structure. Planning and Design - Site Development 4.106.2 A plan is developed and implemented to manage storm water drainage during construction. 4.106.3 The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. e Page 1 of 5 CalGreen_2010.doe revised 08127111 I .2 ENERGY EFFICIENCY General 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. . . .3 WATER EFFICIENCY AND CONSERVATION Indoor Water Use 4.303.1 Indoor water use shall be reduced by at least 20 percent using one of the follow methods. ❑X ❑ Water saving fixtures or flow restrictors shall be used per Table 4.303.2. E:1A 20 percent reduction in baseline water use shall be demonstrated per As of 7/01/2011 Table 4.303.1. 4.303.2 When using the calculation method specified in Section 4.303.1, multiple showerheads shall not exceed maximum flow rates. As of 7/01/2011 4.303.3 Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads)shall comply with specified performance requirements. ❑ As of 7/01/2011 Outdoor Water Use 4.304.1 Automatic irrigation systems installed at the time of final inspection shall be weather-based. A4.4 MATERIAL CONSERVATION AND RESOURCE EFFICIENCY Enhanced Durability and Reduced Maintenance 4.406.1 Joints and openings. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected • against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.408.2 Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall ❑X be submitted for approval to the enforcing agency. Building Maintenance and Operation 4.410.1 An operation and maintenance manual shall be provided to the building occupant or owner. Page 2 of 5 CalGreen_2010.doe revised 08/27111 A4.5 Fireplaces 4.503.1 Install only a direct-vent sealed-combustion gas or sealed wood- burning fireplace, or a sealed woodstove. Pollutant Control 4.504.1 Duct openings and other related air distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints, stains and other coatings shall be compliant with VOC limits. OX 4.504.2.3 Aerosol paints and other coatings shall be compliant with product ❑X weighted MIR Limits for ROC and other toxic compounds. 4.504.2.4 Documentation shall be provided to verify that compliant VOC limit finish materials have been used. 4.504.3 Carpet and carpet systems shall be compliant with VOC limits. ❑X 4.504.4 Fifty(50) percent of floor area receiving resilient flooring shall comply with the VOC-emission limits defined in the Collaborative for High Performance Schools (CHPS) Low-emitting Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall comply with low formaldehyde OX emission standards. Interior Moisture Control 4.505.2 Vapor retarder and capillary break is installed at slab on grade foundations. OX 4.505.3 Moisture content of building materials used in wall and floor framing is checked before enclosure. Page 3 of 5 CalGreen_2010.doc revised 08/27/11 Indoor Air Quality and Exhaust 4.506.1 Exhaust fans which terminate outside the building are provided in ❑ every bathroom. Environmental Comfort 4.507.1 Whole house exhaust fans shall have insulated louvers or covers which close when the fan is off. Covers or louvers shall have a minimum OX insulation value of R-4.2. 4.507.2. Duct systems are sized and designed and equipment is selected using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or equivalent. 2. Size duct systems according to ACCA 29-D (Manual D) or equivalent. 3. Select heating and cooling equipment according to ACCA 36-S (Manual S) or equivalent. INSTALLER AND SPECIAL INSPECTOR QUALIFICATIONS Qualifications 702.1 HVAC system installers are trained and certified in the proper installation of HVAC systems. 702.2"rhe Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the discipline they inspect QX and verify. Verifications 703.1 Verification of compliance with CALGreen may include construction documents, plans, specifications, builder or installer certification, inspection reports,or other methods acceptable to the enforcing agency which show substantial conformance. Implementation verification shall be submitted to the Building Department after implementation of all required measures and prior to final inspection approval. f Page 4 of 5 CalGreen_2010.doc revised 08/27/11 CALGR�E/EN SIGNATURE DECLARATIONS Project Name: Kt-/V L/A/ Project Address: / r7 / e- I 114e l:��Uflo • C� 1 `�� r7e SSDProject Description: Ma— A.,se e -J J SECTION 1 — DESIGN VERIFICATION Complete all lines of Section 1 —"Design Verification'and submit the completed checklist(Columns 1 and 2)with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2010 California Green Building Standards Code as adopted by t City of Cupertino. Owner's Signature Date LC-fll LIn/ Owner's Name (Please Print) Z Design Professional's ignature Date !el Design Professional's Name (Please Print) Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance(Please Print) Phone Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2010 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance(Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen_2010.doc revised 08/27/11