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07080072 (2)CONTROL # PROJECT ADDRESSA APPLICANT PERMIT 4f DATE � �d 2 '+N. :�® Owl V l • �I JiOMM� m�-- ©mmm m■ mmm mmm ASSESSOR APN# l .0 RES. (LVNG) Z ( (GARAGE) -77 ,�— COMM. SQ. FT. (NEW) T.I. SQ.FT. RES. REMODEL CONTACT �Cs - k,,-(1 � PHONE# VALUATION .©G O RECEIPT # PLN. CHECK CONSTRUCTION TAX (Y) (I) SCHOOL FEES (Y) (I) HOUSING MITIGATION FEES (Y) (I) HEART OF THE CITY I (N) NOTES: ��� ,it d4lsCli ENERGY GRADING SOILS BLDG PMT SEISMIC ELECT PLBG MECH ISSUED B / T DATE ��`��� TOTAL FEES` �P CITY OF CUPERTINO BUILDING DIVISION PERNIIT e "'LDITgT6"E RE SCENT RD—LOT 4 KELLY GORDON DEVELOPMENT KELLY PERMIT OWNER'S NAME: - - - PERMTTLSSUEDATE KELLY GORDON DEVELOPMENT 12241 SARATOGA - SUNNYVALE 10/12/2007 PHONE: - D>1 SANITARY NO. CONTROL NO. (408)873-8774 ARCHITECT/ENGINEER: BUILDING PERMITINPO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 Job Description hereby affirm that I am licensed under provisions of Chapter 9 (commencing .with Section 700D) of Division 3 of the Btcdness and Professions Code, and my license is S FDWL 2 . STORY 3 , 8 2 8 ' /GARAGE 775 ' in full force and effect License Class Lie. N Date Contractor ARCHITECT'S DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason. (Section 703 M. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to is issuance, also requires the applicant for such permit to file a signed stale .,.,. he is licensed to the of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation that pursuant provisions $ 9 5 7 0 0 0 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - that he is exempt therefrom and the basis for the alleged exemption. Any violation of ep N Number 32617 09. 6 Occupancy p y T'pe Section 7031.5 by any applicant for a permit subjects the applicant to a civil penahy of net more than five hundred dollars (sso ❑ L as owner of the property, or my employers with wages as their sole compensation, Required Inspections will do the wort• and the structure is not intended or offered for sale (Sec.7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of Q property who builds or improves thereon, and who does such wort himself ar through his own employees, provided that such improvements are not intended or offered for sale If, however, the building or improvement is sold within one year of completion, the owner - builder will haw the burden of proving that he did not build or improve fur purpose of sale.). L as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec 7044. Business and Professions Code:) The Cootraeroes Li- ccnse Law does not apply to an owner of property who builds or improves thereon, and , who contracts for such pmjects with a contractor(s) licensed pursuant to the Comrawaors License Law. 0 1 am ex nder Sec- , B & P C for this reason Owns Date l ( 0 W RKER'S COMPENSATION DECLARATION I under penalty of perjury one of the following declarations ) hsve and will maintain a Certificate of Consent to self -insure for Workers Compen- salon, as provided for by Section 3700 of the Labor Code, for the performance of due work for which this permit is issued ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued ' My Workers Compensation Insunuxt carrier and Policy number are: Carrier; Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Phis section need not be completed if the permit is for one hundred dollars ($I00) orlcst) I certify chest le the once the work for which this pami issued, 1 steal not employ any person n manner asto beco bjec, orkcrs' Laws of California. Dam Applicant NOTICE TO APPLI . f, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must ' forthwith comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY I hereby alarm that there is a construction leading agency for the pertornunce of ' the work for which this permit is issued (See. 3097, Civ. C_) ' Lenders Name Lenders Address I certify that 1 have read this application and state that the above inform a ion is ' correct. I agree to comply with all city and county ordinances and state laws slating to building construction, and hereby authorize representatives of this city to enter upon the above-mcnuoned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against j liabilities, judgmens, cuss and expenses which may in any way accrue againstsaid City 7 in consequence oC dLe ranting of this permit. APPLIC uN ANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SO R ONS. / 1z) Re -roofs Type of Roof Signature of ApplianUCon�Bale US MATERIALS DISCLOSURE HAZARDOUS Will the applicant or future buildng occupant store or handle hazardous marcrial . as defined by fhe Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material*being installed. ❑ Yes No a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or d which emit hazardous air contaminants as defined by die Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes 1 have read the hazardous materials requirements under Chapter 6.95 of fhe Califor- nia Health & S Sections 25505, . l understand that irthe building does not ndy have tcnan4 chat ' my rrspo )icy to notify ehc oa t o! the rcqu' rncnswh;ch sax ri toiasm certifioetearfkcu Signature of Applicant Date 1 D All roof coverings to be Class "B" or better O au aecnl Dim CI F CUPEkTINO CITY OF CUPERTINO NEW SINGLE FAMILY DWELLING PERMIT APPLICATION APPLICATION FORM'7� r„ � 6 -7,08 (Z � 2, APN # r _ _ r 7 Date: /fir 7 Buildi Address: 0 1 Mailing Address (if different from building address): Owl �r>��: / Phone #: r0 3 Q 1400, Contractor'') ,( N C . License #: Conta c �( Phone: Jyo l Fax: e F77�Cupertino �73 gS�1 Bu nest ense#* d a Building Permit Info: Single Story ❑ Two -Story Three -Story ❑ Basement ❑ Sq.Ft. Floor Area:oLf,, ,0 SPac A 8 Z $/Sq.Ft.: Cost of Project: ��}}. ` S-7 DOCD Type of Construction: Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BCONSTAXR Constax - Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BI]WESTIGA Investigation fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric. Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING 1 of 3 MY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: C o 110 ves e�vL`�' v PERMIT # 022eEV7 2 OWNER'S NAME: z l( ca� 2JQ a ►"t HONE # qe)g B7 3 S7 7 GENERAL CONTRACTOR: e((V lvc, FAX # p 3 S8 1 I am not using any subcontractors: 7C 3 e/5 /0 — 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 Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile / Contractor Signature Date 12241 Saratoga -Sunnyvale Road Saratoga, CA 95070 Phone: (408) 873 — 8774 Fax: (408) 873 — 8819 Fax To: Sue Winslow Co: City of Cupertino Fax #: 777-3333 RE: Sue, From: Scott Kelly Pages: 5 CC: Date: March 25, 2009 Please call me when you have a minute. 690-5314. T k you, ott Kelly T'd 6T88EL880-1, quawdojanaQ uopJog RjjaN eTG:OT 60 Ga Jew 12241 Saratoga -Sunnyvale Road Saratoga, CA 95070 Phone: (408) 873 — 8774 Fax: (408) 873 — 8819 Fax To: Elizabeth Pettis Co: City of Cupertino Fax #: 777-3333 From: Scott Kelly Pages: CC: RE: Tree Covenant, Crescent Ct. Date: July 8, 2008 Elizabeth, I was able to get the attached recorded this afternoon. You will be receiving the original in the mail from the clerks' office. I would appreciate it if you could remove the planning hold so I don't get held up when I call for my final. Thank you for your help. Sincerely, ' Scott Kelly E'd 6TBBELBBO�, quawdoianaQ uopJ00 R119N eas:ol 60 Sz Jew • - Recording Requested By City of Cupertino When Recorded Return To: City of Cupertino Coinntwiity Development Department ] 0300 Torre Avenue Cupertino, CA 95014 not t, 0- ° f Doc#: 19912393 7/08/2008 3 15 Pm NOTICE OF CITY REQUIREMENT TO MAINTAIN TREE(S) The undersigned, being the owner(s) of the property shown in the Santa Clara County Assessor's Roll and identified as A.P.N 326-17-009 and addressed as 10110 Crescent Court, Lot 4 hereby agree(s) to plant and maintain one (1) Oak (Quercus) (60" box minimum), one (1) Cinamomum camphora (Camphor tree) (24" box minimum) along the northerly (front) property line; to plant and maintain six (6) Pittosporum eugenoides (15 gallon minimum), to retain as a specimen tree one (1) multi -trunk Redwood with a 15" trunk diameter along the westerly (right) property line; to retain as specimen trees three (3) Oaks (Quercus), with trunk diameters 12", 13" and 15" along the south/easterly (rear) property line as privacy protection trees to protect from views from second story windows. In the event that these plantings die, the owner(s) shall provide replacement plantings subject to approval of the City of Cupertino. This declaration is binding on successors and assigns of the owner(s). PRO RTY OWNER(): Owner's Sig re Brian Kelly, President of Kelly -Gordon Development Corp. Print Owner's Name 7/7/08 Date CITY AUTHORIZATION: Assistant Planner, Elizabeth Pettis Co -Owner's Signature Print Co -Owner's Name Date -%-- 3 'V Date b-al 6188CL880b zuawdojanaa UOPJ09 RjjaN eaG:01 60 Sa JeW CALIFORNIAALL-PURPOSE ACKNOWLEDGMENT State of California (j County of f j, L--C aL _, On �iUlt� ,2Gf�' before me, Ca'tc .1 • arrr.-s. Mo4z�r4 PUbh L Date Here Insert Name anoT a o1 the Officer personally appeared IET� I z-& b_-4' Pc --A s DOME J. tfIARR" Commission # 17S44A3 Notary Publlc - Cailfomia Santa Clara County Cantu. Jul 29 ?Dl t who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/herAheir signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature Place Notary Seal Above QL10albre of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document fG' Title or Type of Document: ` N cc D f�4c UI !'C me I�t ► Ifl Document Date: a ��0Number of Pages Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) l Z r t S ner's Name: ►K J f Individual W ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact El Trustee Top of thumb here ❑ Guardian or Conservator ❑ Other: Signer Is Representing: GIB A D¢' u i n--zzi. n T✓ees Signer's Name: E. Individual ❑ Corporate Off icer--Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing 1 •>� RIGHTTHUM13PRINT OF SIGNER Top of thumb hefe ® 2007 Nationaf Notary Association- 9350 De Soto Ave., P.O.Box 2402 -Chatsworth, CA 91313-2402-,w NationalNatary.org`Item 45907 Reorder: Call Tall -Free 1-800-676-6827 S'd 6188EL880b '4uawdoiana0 uopJoS F;IIaN ezS=OT 60 SZ Jew State of California County of Santa Clara On 7th day of July, 2008 before me, G. Jarnagan a Notary Public, personally appeared Brian J. Kelly, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. G,JARNAGAN wITNESS my hand and official seal. /$ Comm. # 1578906 u) Urfa ,� NotARyFUBLIc•cALIFORNIA ' Santa cloro counly .. Signatur I`' 6 SIP—r'� i Aty Comm. EKplies June 12, 2009 Name: G. Jarnagan --j (typed or printed) (Seal) GJ/gj 9'd 61886L880� quawdojaAaa uopJog RIJaN e2s:01 60 SZ Jew 12241 Saratoga -Sunnyvale Road Saratoga, CA 95070 Phone: (408) 873 — 8774 Fax: (408) 873 — 8819 Fax To: Sue Winslow From: Scott Kelly co: City of Cupertino Pages: l/ Fax #: 777-3333 CC: RE: Date: March 25, 2009 Sue, Please call me when you have a minute. 690-5314. 5T k you, ott Kelly T'd BTBBSLBBOb 4uaWJ0janaQ uopJQq RjjaN eBS:01 60 SZ JeW e a" OF CUPERTII`i0 UI L.DING DIVISION PERMIT -�` sys k*�r ZRI ... ..V ILODvG ADCRESS: 10110 CRESCENT RD—LOT 4 KE.LLY GORDON DEVELOPMENT PERMIT Na 07080072 OWNERS NAME: KELLY GORDON DEVELOPMENT uuhp 12241 SARATOGA — SUNNYVALE !' i rrSUEDATE 10 12 2 7 PHONE: RT) SANITARY NO. C.ONrROLNQ AACHR'ECT/FNG[NE—ER: PHONErt SFDWL 2 STORY 3, 828' /GARAGE 775' rriNm BLDG BE= PERhP1LUbgg MECH 0 0 0 K x...vA.H'a. rt.5 ^�•''" „Ctr �... _,. i Ss&ii ,'1s , . ..'JI av t :`D J ;.'•: TO ARRANGE INSPECTION Call 777-3228 between 7:30 a.m. and 3:30 p.m., nday through Friday, at least 24 hours before Pquired inspection. Job address and Permit Number are needed when requfsting an inspectio Ol'�6aWGa On/ I-2-65 6G— rCRCIAOTHER JOB DESCRnrnON RGSTf1$NTTAT -- Cl SF17WL ❑ IQT173EN ttPMOI]E= ❑ ADDITION ❑ PLUMBING RiE.?IPE ❑ MULTI -UNIT ❑ STRUCTURAL MODEFICAnCH D ❑ IN7EMOR °ALR IMPROVEMENT ❑ SWRAMWG POOLS ❑ BATH REMODEL'REP.SIR ❑ DEMOLITION ❑ OTHER .y2. FOUNDATION/PCERS/N-D.S. Q UFER GROUND y PAD/SET BACK-CERT —2 GARAGE SLABS/PRF,GUNTTE • O ors HAZARDOUS FIRE 4RE.A Q YES If yet • I and —•sand UU, a Class A rnaf aaunbly is Mquir; d. Q NO miliu LCa.O. a F.Y s-nNG RMECOVERr-N_G -- -- _- - Number of=mUne corvine, To be removed To be ruained UNDERGROUND/SLAB o` UNDERGROUND PLUMBING Z- t7 $ UNDERGROUND ELECTRICAL C)NrW B CIAT: ❑ NrrV/ B1.DG/ADDrrION ❑ DEMOLITION ❑ TENANT ❑ r-o0D SERVICE IMPROVEMENT ❑ arHu UNDERFLOOR PLUMBING ' UNDERFLOOR MECHANICAL UNDERFLOOR ELECTRICAL UNDERFLOOR FRAMING VENTS UNDERFLOOR INSULATION TYPE OF ROOF COVERING EXISTING; PROPOSED, Built -Up Roof ❑Built -Up Roof ❑ Asphalt Shingtes ❑ Asphalt Shingles ❑ Wood Shah= ❑ Wood Shakes ❑Woad Shingle [j ,Y✓aod Shingle ❑ Other(Spedfy) ❑ (Scher (Specify) NO FINAL. INSPECTIONS Provide I.C.B.D. Report Na UMIL ALL REQUIRED BUSINESS Mfgr- Insallaoon Specs. ROOF SHEATH/DIAPHRAGM .O PLUMBING TUBS &SHOWER PAN • MECHAMCAL ELECTR.ICALJPOOL BOND FRAMING/STAIRS/E. EGRESS INSULAAION/VENTILATION 1 r ' fiiCTERIOR SI-E R/HOLD DOWN 6 INTERJOR SHEAR/HOLD DOWN • , INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP SHEETROCKrSHEETROCK SHEAR U EXTERIOR LATWW-SCR= i S SHOWER LATH • L'L•� SCRATC AT V. 5 A r 7, -0 cMPO RYAPPROVALS �LK.c[ _ OCCUPANCY (I�/)+��+-/� CUPERTINO SANITARY DIS RICT Closed circuit video Inspection of property Ilne cleanout, point of connection and street lateral required prior to passing FINAL CITY PLUMBING Call the District (408-2S3-7071) for an appointment. IMPORTANT When a permit has expired, a charge totaling one-half the fees to obtain a new permit must be paid to reactivate the permit. If a permit has been expired for more than one year, a charge totaling the full fees to obtain a new permit must be paid to reactivate the p ermit. PLANNING 777-33719 > GAS TEST -� GRADE (P.W. 777-INSPECTION. O FIRE - CALL (408) HANDICAP - wELECT RicAL p, PLUMBING Z MECHANICAL ENERGY - VISUAL FINAL ONLY VISUA BUILDMG �, t2h�'I"I�>a3�i�3tG��.I�s2t�ELili�� �� F• Y •t a�c bra CERTIFICATE OF OCCUPANCY ❑ PRE-(NS?ECTION: INSP. TEAR OFr INSPECTION: PLYWOOD: DATE INSP. RATTENS: IN -PROGRESS: INSP. FINAL DATE rNSP. DAT= INSP. DATE INSP. DATE NOTE: OSHA APPROVED ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION Z'd GIBBELBBOtr 4uawdojanaQ uopuo0 911aA eTS=01 GO SZ Jew CITY OF CUPERTINO 10300 Torre Avenue Telephone 777-3228 INSPECTION NOTICE BUILDING DIVISION l JOB `' DATE ADDRESS i; '!', c` ,ter 61'77 TIME DAILY REPORT ❑ CORRECTION NOTICE' VIOLATION ❑ TYPE INSP.: BLDG. U ELEC. ❑ PLBG. ❑ MECH. ❑ STOP WORK U REINSPECTION FEE f 'r i ,dam._ •..� .- ._ .-, -. , . �_ V WEATHER INSP. i CARD TO REMAIN ON JOB -SITE r c� I V,) U O z'd 6TSSELBSDj, '4u9wd0t9A9G UDPJ09 R119A eBS:01 6D Sz JeW A" 7 L-0TP;4--:;*-0X6W7a, CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 5) CF-1R Project Title Pro f �1 j C+/ZSC� Cr- . Date (1p f O BuildingPermit # Project Address 1 O C 4 ,e5 c -.vim C T u A i DC APlan Check / Date Documentation Author S c e, � �'`� Telephone + -% %-? Field Check 1 Date Co ance Method (Prescriptie) rv-) ca'E`— Climate Zone p . Enforcement Agency Use Ora ✓ ❑ Alternative Component Package Method: (check one) C D D (Alternative) Package C and Package D choices require HERS rater field verification and/or diagnostic testing (see CF-1R page 3) For Package D Alternative see Appendix B Table 151-C Footnotes 7-14 GENERAL INFORMATION Total Conditioned Floor Area (CFA) 33 Sp-, Average Ceiling Height: ft Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C ---- (5% X CFA) Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C----(20% X CFA) ft2 ft ✓ ❑ Building Type: (check one or more)y Single Family Multifamily Addition Alteration (If adding fenestration fill out WS-4R, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2 for Additions and 8.3.3 for Alterations.) Number of Stories: Z-- Number of Dwelling Units: Floor Construction Type: la ised Floor (circle one or both) Front Orientation: 31 �� ort South /East / es All Orientations (input front orientation in degrees from True North and circle one). ✓ ❑ RADIANT BARRIER (required in climate zones 2, 4, 8-15) OPAQUE SURFACES INCLUDING OPAQUE DOORS Component Type (Wall, Roof, Floor, Slab Edge, Doors) Frame Type (Wood or Metal) Cavity Insulation R-Value Continuous Insulation R-Value Assembly U- factor (for wood, metal frame and mass assemblies Joint Appendix IV Reference Roof Radiant Barrier Installed Yes or No Location Comments (attic, garage, typical, etc. L t L GCk.7 T . 1) See Joint Appendix IV in Section IV.2, IV.3 and IVA, which is the basis for the U-factor criterion. U-factors can not exceed prescriptive value to show equivalence to R-values. Residential Compliance Forms April 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 5) CF-1R Project Title ID It 0 C N e-5(-Z ,L -t- I Date FENESTRATION PRODUCTS — U-FACTOR AND SHGC ✓ ❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS-4R —must be included for New Construction, Additions and Alterations. Fenestration #/ Type/Pos. (Front, Left, Rear, Right, S li ht) Orien- tation, N, S, E, Wt Area ft U-factor2 U-factor Source' SHGC4 SHGC Sources Exterior Shading/Overhangs6•' ✓ box if WS-3R is included S ❑ .4 mE ❑ 1,J` vvo t0c,t 1 6715 S ❑ 2 ,o ❑ l ) Skylights are now included in West -facing fenestration area if the skylights are tilted to the west or tilted in any direction when the pitch is less than 1:12. See § 151(03C and in Section 3.2.3 of the Residential Manual 2) Enter values in this column are either NFRC Rated value or from Standards default Table 116A. 3) Indicate source either from NFRC or Table 116A, 4) Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from WS-3R. 5) Indicate source either from NFRC or Table 116B. 6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS-3R to calculate Exterior Shading devices. 7) See Section 3.2.4 in the Residential Manual. HVAC SYSTEMS Heating Equipment Type and Capacity fumace heat pump,boiler, etc. Minimum Efficiency AFUE or HSPF Distribution Type and Location ducts attic etc. Duct or Piping R-Value Thermostat Type Configuration (split or package) ,, v V%O- C, V Q 1 • F' Cooling Equipment Type and Capacity (A/C, heat pump, evap. cooling) Minimum Efficiency SEER or EER Duct Location attic, etc. Duct R-Value Thermostat Type._ Configuration (split or package) C c2 r s Ilk C iF ' dZ_ - Residential Compliance Forms April 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 5) CF-1R Project Title Date A signed CF-4R Form must be provided to the building department for each home for which the following. are re uired. Sealed Ducts all climate zones Installer testing and certification and HERS rater field verification required.) ❑ TXVs, readily accessible (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field verification required.) ❑ Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field verification required.) OR ❑ Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for Project Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14. OR For additions and alterations, duct systems that are not documented to have been previously ❑ sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D. WATER HEATING SYSTEMS 17-7 'Check box if system meets criteria of a "Standard" system. Standard system is one gas -fired water heater per dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is not allowed. ❑ Check box when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential Manual. No water heating calculations are required, and the system complies automatically. Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved ❑ Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the submittal. ❑ Check box to verify that a time control is required for a recirculating system pump for a system serving multiple units Systems serving single dwelling units Water Heater Type/Fuel Type Distribution Type Number in System Rated Input' (kW or B(gallons) Tank Capacity Energy Factor' or Thermal Efficient Standby Loss % Tank External Insulation R-Value System serving multiple dwelling units Water Heater Type Distribution Type Number in System Rated Input' (kW or Btu/hr) Tank Capacity (gallons) Energy Factor' or Thermal Efficient Standby Loss % Tank External Insulation R-Value l) For smal I gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water heaters, list Rated Input and Thermal Efficiencies. Pipe Insulation (kitchen lines > 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2 B. Residential Compliance Forms April 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 4 of 5) CF-1R Project Title Date SPECIAL FEATURES NOT REQUIRING HERS VERIFICATION (add extra sheets if necessary) Indicate which special features are part of this project. The list below represents special features relevant to the Prescriptive and Performance Method. ✓ Feature Required Forms if applicable) Description ❑ Metal Framed Walls CF-1R ❑ Radiant Barriers CF-1R ❑ Exterior Shades WS-4R N/A; Performance Calculation ❑ Cool Roof Required. Attach CRRC Label to Forms. ❑ Dedicated Hydronic Heating Performance Calculation System Required; Attach Run to Forms. ❑ Combined Hydronic System Performance Calculation Required; Attach Run to Forms. ❑ Gas Cooling N/A; Performance Calculation Required. ❑ Buried Ducts N/A; Indicate on building plans. ❑ Kitchen Pipe Insulation See Section 5.6.2 Distribution Systems in Residential Manual. Multiple Water Heaters Per See Table 5-13 or use ❑ Performance Calculation and Dwelling Unit attach Run to Forms. ❑ Central Water Heating System Performance Calculation and Serving Multiple Dwellings attach Run to Forms. ❑ Non-NAECA Large Water CF-1R Heater See Table 5-13 or use ❑ Indirect Water Heater Performance Calculation and attach Run to Forms See Table 5-13 or use ❑ Instantaneous Gas Water Heater Performance Calculation and attach Run to Forms See Table 5-13 or use ❑ Solar Water Heating System Performance Calculation and attach Run to Forms ❑ Wood Stove Boiler Performance Calculation and attach Run to Forms SPECIAL FEATURES REQUIRING HERS RATER VERIFICATION (add extra sheets if necessary) Indicate to the HERS Rater which credits are hart of this oroiect and need verification ✓ Feature Required Forms if applicable) Description ❑ Duct Sealing CF-6R part 4 of 12 ❑ Refri erant Charge CF-6R part 5 of 12 ❑ Thermostatic Expansion Valve CF-6R part 6 of 12 Residential Compliance Forms September 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 5 of 5) CF-1R Project Title Date l o l o 8 C✓�sc� Cr— y i o /0i COMPLIANCE STATEMENT 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, and the administrative regulations to implement them. This certificate has been signed by the individual with overall design responsibility. The undersigned recognizes that compliance using duct design, duct sealing, verification of refrigerant charge and TXVs, insulation installation quality, and building envelope sealing require installer testing and certification and field verification by an approved HERS rater. DesiLvIIer or Owner (oer Business and Professions Code) Documentation Author Name: Name: Title/Firm: Title/Firm: Address: Address: Telephone: S 7 O Telephone: �7`� V License #• n), q !D (signature) (signa (date) Enforcement Agency Name: Comments: Title Agency: Telephone: (si iure.l:sfam lei.. _.. Residential Compliance Forms 4pril 2005 7 7 CERTIFICATE OF COMPLIANCE: RESIDENTIAL COMPUTER METHOD CF-lR Page 2 Project Title.......... CRESCENT CT. LOT 4 Date..02/12/07 11:36:23 ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- I MICROPAS7 v7.20 File-KELLYG4 Wth-CTZ04S05 Program -FORM CF-lR I User#-MP0113 User -Monterey Energy Group Run-R-30R R-13W R-19F 2P GAS I ------------------------------------------------------------------------------- BUILDING ZONE INFORMATION ------------------------- Floor # of # of Cond- Thermo- Vent Vent Verified Area Volume Dwell Peop- it- stat Height Area Leakage or Zone Type (sf) (cf) Units le ioned Type (ft) (sf) Housewrap -------------- ----- ------ ----- ----- ------------- ----- ------- ---------- Residence 3788 34935 1.00 4.0 Yes Setback 8.0 Standard No OPAQUE SURFACES U- Sheath- Solar Appendix Frame Area fact- Cavity ing Act Gains IV Location/ Surface Type (sf) or R-val R-val Azm Tilt Reference Comments ------------ 1 Wall ----- Wood ---- 686 ----- 0.102 ----- 13 ----- 0 --- 318 ---- 90 --- Yes ----------------------- IV.9 A3 2 Wall Wood 882 0.102 13 0 48 90 Yes IV.9 A3 3 Wall Wood 636 0.102 13 0 138 90 Yes IV.9 A3 4 Wall Wood 941 0.102 13 0 228 90 Yes IV.9 A3 5 Roof Wood 2668 0.032 30 0 n/a 0 Yes IV.1 A7 6 Door None 48 0.330 0 0 318 90 Yes None 8 FloorExt Wood 301 0.048 19 0 n/a 0 No IV.20 A4 PERIMETER LOSSES Appendix Length F2 Insul Solar IV Location/ Surface (ft) Factor R-val Gains Reference Comments ------------ --------------------- -------------- ---------------------- 7 SlabEdge 242 0.730 R-0 No NONE FENESTRATION SURFACES --------------------- Exterior Area U- Act Shade Orientation (sf) factor SHGC Azm Tilt Type Location/Comments ------------------ ----- ----- ----- --- ------------ ------------------------ 1 Wind Front (NW) 135.0 0.400 0.450 318 90 Standard FGLASSI/Vinyl/Wood Opera 2 Wind Left (NE) 126.5 0.400 0.450 48 90 Standard LGLASSI/Vinyl/Wood Opera 3 Wind Back (SE) 233.5 0.400 0.450 138 90 Standard BGLASSI/Vinyl/Wood Opera 4 Wind Right (SW) 67.5 0.400 0.450 228 90 Standard RGLASSI/Vinyl/Wood Opera 5 Skyl Horz 20.0 0.400 0.350 318 0 None SKY CERTIFICATE OF COMPLIANCE: RESIDENTIAL COMPUTER METHOD CF-1R Page 3 Project Title.......... CRESCENT CT. LOT 4 Date..02/12/07 11:36:23 I MICROPAS7 v7.20 File-KELLYG4 Wth-CTZ04S05 Program -FORM CF-lR I I User#-MP0113 User -Monterey Energy Group Run-R-30R R-13W R-19F 2P GAS I ------------------------------------------------------------------------------- OVERHANGS Window--- ---- Overhang Area Left Right Surface ----------- (sf) ----- Width Height ------ Depth ----- Height ------ Extension --------- Extension --------- 1 Window 135.0 ----- n/a 6.7 2.5 1.2 n/a n/a 2 Window 126.5 n/a 6.8 2.5 1.2 n/a n/a 3 Window 233.5 n/a 6.5 3.0 1.6 n/a n/a 4 Window 67.5 n/a 7.1 2.0 1.5 n/a n/a SLAB SURFACES ------------- Area Slab Type (sf) ---------------- ------ Standard Slab 2367 HVAC.SYSTEMS ------------ Verified Number Verified Verified Verified Verified Maximum System of Minimum Refrig Charge Adequate Fan Watt Cooling Type Systems Efficiency EER or TXV Airflow Draw Capacity ------------ Furnace ------- 2 ----------- ----- 0.900 AFUE n/a ------------- n/a -------- n/a -------- n/a -------- n/a ACSplit 2 13.00 SEER No No No No No HVAC SIZING Verified Total Sensible Design Maximum Heating Cooling Cooling Cooling System Load Load Capacity Capacity Type ----------------------- (Btu/hr) (Btu/hr) ---------- (Btu/hr) ---------- (Btu/hr) ---------- Furnace 71174 n/a n/a n/a ACSplit n/a 36085 41353 n/a Sizing Location............ CUPERTINO Winter Outside Design...... 28 F Winter Inside Design....... 70 F Summer Outside Design...... 86 F Summer Inside Design....... 75 F Summer Range ............... 30 F CERTIFICATE OF COMPLIANCE: RESIDENTIAL COMPUTER METHOD CF-lR Page 4 Project Title.......... CRESCENT CT. LOT 4 Date..02/12/07 11:36:23 MICROPAS7 v7.20 File-KELLYG4 Wth-CTZ04S05 Program -FORM CF-lR I User#-MP0113 User -Monterey Energy Group Run-R-30R R-13W R-19F 2P GAS I ------------------------------------------------------------------------------- DUCT SYSTEMS F�------------ Verified Verified Verified System Duct Duct Duct Surface Buried Type Location R-value Leakage Area Ducts ------------------------------------------------------- Furnace Attic R-6 No No No ACSplit Attic R-6 No No No WATER HEATING SYSTEMS --------------------- Number Tank External Heater in Energy Size Insulation Tank Type Type Distribution Type System Factor (gal) R-value ------------------------------------------- -------------- ---------------- 1 Large Gas Standard 1 n/a 75 R-n/a WATER HEATING SYSTEMS DETAIL ---------------------------- Standby Internal Tank Recovery Rated Loss Insulation Pilot System Efficiency Input Fraction R-value Light -------------------------------------------------------------------- 1 Large 0.76 n/a 0.03 R- n/a n/a SPECIAL FEATURES AND MODELING ASSUMPTIONS ----------------------------------------- *** Items in this section should be documented on the plans, *** *** installed to manufacturer and CEC specifications, and *** *** verified during plan check and field inspection. *** This building incorporates a non-standard Water Heating System. REMARKS THE BUILDER/CONTRATOR TO PROVIDE THE OWNER AND THE COUNTY BUILDING DEPARTMENT WITH A COPY OF THE CF-6R INSTALLATION CERTIFICATE AT THE TIME OF FINAL INSPECTION. Mr. CERTIFICATE OF COMPLIANCE: RESIDENTIAL COMPUTER METHOD CF-1R Page 5 Project Title.......... CRESCENT CT. LOT 4 Date..02/12/07 11:36:23 I MICROPAS7 v7.20 File-KELLYG4 Wth-CTZ04S05 Program -FORM CF-lR I I User#-MP0113 User -Monterey Energy Group Run-R-30R R-13W R-19F 2P GAS I ------------------------------------------------------------------------------- COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specifications needed to comply with Title-24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall design responsibility. DESIGNER or OWNER Name.... Company. KELLY GORDON DEVP. Address. 12241 SARATOGA-SUNNYVALE SARATOGA, CA. 95070 Phone... (408) 873-8774 License. Signed.. ENFORCEMENT AGENCY Name.... Title... Agency.. Phone... (date) Signed. (date) DOCUMENTATION AUTHOR Name.... DAVID W. KNIGHT Company. Monterey Energy Group Address. 227 Forest Ave., Suite 5 Pacific Grove, CA 93950 Phone... 831-372-8328 Signed.. —00'� 02/12/07 (date) INSPECTIONS, Inc. EP . CONSTRUCTION INSPECTION SPECIALISTS March 6, 2008 HPI Project No.: KGDC-1 Permit No: 07-080072 City of Cupertino Building Department 10300 Torre Avenue Cupertino, CA 95014 Subject: Final Project Affidavit Special Inspection Services and Materials Testing Lot 4, Crescent Court Dear Sirs: J b 110 C' rz�sCe,"-4 all - This Project Affidavit is submitted in accordance with the requirements of CBC Section 1701.3 and certifies that HP Inspections has provided special inspection services for the following work at the above -referenced project: Periodic field welding inspection of all required structural steel connections. Based on our observations and to the best of our knowledge, the work observed was performed in accordance with the approved project plans, specifications and with the applicable workmanship provisions of the California Building Code. Scott Pinkham, cc: Kelly Gordon Development Corp. 690 SUNOL STREET, BUILDING H 0 SAN .LOSE, CA 95126 • (408) 288-8460 • FAX: (408) 271-0902 } 0 110 Grin<s � 4 to' ¢ MS Engineering & Associates, Inc. Consulting Structural Engineering Services (408) 377-6504 (408) 377-6518 (Fax) 2105 S. BASCOMA VE. SUITE 260 CAMPBELL, CA 95008 DA TE. Apri118, 2008 SUBJECT. Framing walk through inspection PROJECT ADDESS: Crescent Court Lot 4 Cupertino, Ca OWNER: Kelly Gordon Developers As requested by the developer, our office performed a walk through framing inspection with the project superintendent and the framer on April 10, 2008 and April 14, 2008. At the time of our framing inspection, the roofing material was in place and exterior wall covering had been installed. Our inspection was limited only to the readily accessible areas and did not include the concealed spaces. In our initial inspection, we prepared a list of comment and corrections. We verified compliance to all of our comments and corrections in our follow up April 14, 2008 inspection. The construction is in general conformance with the approved plans. Please call me if you have any questions. MAHMOUD SANA KHANI, PE MS Engineering & Associates, Inc. QPpFESSIp�\� p SA/V�9T� z ti 2 w No.48545 z m EXP. 06/30/0� X sT CIVIL `P OF Cgl,\FQP NOTE: The above framing inspection was based on a visual walk through observation as defined in UBC 1702 and 220. Structural observation does not waive the responsibility of the contractor for full compliance with approved plans and revisions, with the exceptions of approved changes specifically addressed in writing by this engineer. Geotechnical Environmental Special Inspections Material Testing �j•,&$4 [ _RR SHAPCI /NC. San lose. Livermore - Sacramento • Oakland . Fresno Date: — DSA File No.: Pro'ect No.: / -J� , S App. No.: Pro ect Name: 1 [ Permit.No.: !S 62� Location:,4 %j C? ,'��_IW{/OWeather / Temp: 1�C Concrete, Reinforcing Steel and Post -Tensioning Inspection Report [ PerformeAccontinuous ❑ periodic inspection of the placement of reinforcing steel;, tendons; [>/AB's;P(HD's; ❑ tie downs lI at the foll wing locations: (� ❑ Performed continuous inspection of stressing operations and recorded elongations for the following location(s): ❑ Stressing record attached. ❑ Performed ❑ continuous ❑ periodic inspection of batch plant operations at: ❑ Performed continuous inspection of the placement of ❑ sample only ❑ concrete; Q shotcrete; ❑ gunite; ❑ non -shrink grout at the following location(s): ❑ Cast set(s) of test samples representing total yards of mix no. supplied by Test Specimen type: ❑ Performed slump and temperature test(s), air entrainment test(s), and unit weight test(s). ❑ All non-compliance items were brought to the attention of at job site. ❑ Final acceptance is pending written approval or corrective action as noted. ❑ See attached notes. Notes:/�% 1i�t']Fr� t'�'�E e'?�G}•�%.�h�� D.S.�7 ❑ Show -up; ❑ Stand-by time; ❑ Job Cancelled; ❑ Job Delayed; ❑ Re -inspection; Time: The work ❑ was ❑ was not inspected in accordance with the Building Department or DSA approved documents. The work inspecteI(Awas t ❑ did7nt et the requirements of the Building Department or DSA approved documents, ❑ except as noted above. Material samplin ❑ was /A performed in accordance with the Building Department or DSA approved documents. fAle Inspector: %� Date: C� Received by: Date: Copies To: U • City of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: (408) 777-3228 FAX: (408) 777-3333 BUILDING DEPARTMENT TO: Brian Kelly, Inc. FROM: City of Cupertino DATE: 11 / 1 / 07 RE: Address: 10110 Crescent Ct, Lot 4 Permit: 07080072 With the length of time it takes for PG & E to provide gas and electric to a project we are allowing both utilities to be released prior to finals. This is allowed only if the inspector agrees and feels it is safe to do so. The owner and contractor need to sign this form stating that they understand they can- not move into the residence until they have received all of the required finals and the City has given a certificate of occupancy. If both do not sign this form, the inspections will be incomplete and the utilities not released until we have a signed form. Printed on Recycled Paper Cupertino Union School District N2 89910 10301 Vista Drive, Cupertino, CA 95014 Tel (408) 252-3000 • Fax (408) 865-0326 Check Number: 1� Developer Impact Fee Compliance The Cupertino Union School District has adopted Resolution Nos. 1403 and 1404, imposing developer impact fee pursuant to Government Code 53080. Building permit Request The City of f t' WN Cd has received a request for a Building Permit described as follows: Residential Development Project Commercial/Industrial Development Project Name of Developer: K4W—l\- "�-- (S cw-j°fN Project Address: It-) I I ,g Ci-42Tarm CT r u-(` Ll Description: -� 'L S-0 C`�--- - dr IV Square Footage: 2--� Lot/Parcel #::K Permit M Date: D- If f -o % By. City Authorized Representative Square footage will be verified by the city prior to issuance of a building permit; fees may be adjusted accordingly. Important Notice: Cupertino Union School District gives no credit for total demolition of existing square footage area, which makes way for new construction as mandated in the Government Code Sections 53080, 53080.6 and 65995. SCHOOL DISTRICT DEVELO ACT FEE CERTIFICATE OF COCj#B E The authorized representative of the Cupertind ion Schoo �D strict has reviewed the City of G Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District ' Developer Impact Fee requirements. Dated: By: f Authorized 1trdentative1F Cupertino Union School District Ce,gifrcate not valid without District Seal, Initial, and Date Fee: S 6 4 Facilities Planning - White City - Yellow Requestor - Pink Accounting - Gold FREMONT UNION HIGH SCHOOL DISTRICT 589 WEST FREMONT AVENUE SUNNYVALE, CALIFORNIA 94087 408-522-2200 Developer Impact Fee Compliance Building permits will not be issued without a completed Certificate of Compliance Building Permit Application The City off -",r` O has received a request for a Building Permit described as follows: ((=,-New Residential Development Name of Owner / Developer: Residential Addition (501) sq. ft. or more _ Commercial Development L� .A __ C -� C*� Project Address: 1�/'�� C f-ei CQ A [ r -T- + fi Lot/Parcel Square Footage: �ls���..� Description: (. 0� Permit / Plan Check # Date: /D - //-a I By:C�—�r� City Building Inspector Square footage verified by the city prior to issuance of a building permit; fees may ted accordingly. Feeder Elementary District �+ O`T .........................C.............................................. ,t�.. . �Od> SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OF COMPLIANCE The authorized representative of the Fremont Un n High School District has reviewed the City of Y Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requiirrements of the District's Developer ImpactFeerequirements. Dated: y remont Union High School District Authorized Representative Certificate not valid without District Seal, Initial, and Date ..., qtn. q 0 Distribution: Facilities Planning -White City - Yellow Requestor - Pink Accounting - Gold Dev. Impact Fee Compliance (Rev. 11/22/05) [11/05 - 1000]