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14010122
CITY OF CUPERTINO BUILDING PERMIT I 1 BUILDING ADDRESS: 6370 BLACKWOOD DR I CONTRACT OR: ELITE HOME I PERMIT NO: 14010122 OWNER'S NAME: SHIXI QIU 12787 MOORPARK AVE 1 DATE ISSUED: 06/19/2014 1 OWNER'S PHONE: 4086566570 1 SAN JOSE, CA 95128 1 PHONE NO: (408) 848 -8370 LICENSED CONTRACTOR'S DECLARATION License Class__,,, Liic.. #�� 1 Contractor E'j &� 0 t A I hereby affirm that 1 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. 1 hereby affirm under penalty of perjury one of the following two declarations: 1 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. 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 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9. l 8. Signature Date ❑ OWNER - BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three 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. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence ofthe granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] CONSTRUCT A ONE STORY ADDITION (632 SQ FT); INTERIOR REMODEL (496 SQ FT); BATHROOM REMODEL (56 SQ FT). Sq. Ft Floor Area: I Valuation: $110000 APN Number: 36917050.00 1 Occupancy Type: IF WORK IS NOT STARTED WIT 180 DAYS OF PERMIT ISSUANCE OR 180 DA FR CALLED INSPECTION. Issued by: Date: RE- ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections % /25505, 25533, and 25534. Owner or authorized agent: " Date: /914 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Profess CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 C V PERTINO (408) 777-3228 • FAX (408) 777 -3333 • buildinng(cDcupertino.org rINFWCnNSTRii(-TInN 11 Ar)r)rTrr1N Ar.TFRAT1N /Tr RFVISInN /T)FFFRRFn v l� �0 �O ORI(;INAI. PFRMTT!! PROJECT ADDRESS f 3 7 O Q L, P,� W 0C b 9 p \ YJ L�� � e�� �v o, � �� APN # 3 eat 1-7 n 5 0 OWNER NAME i X 1 `� 1 PHONE 406 _ G � - � JC Jd E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME µtNEW1 �a � PHONE r 5o �S'%) oil E -MAIL Mph p l y� ��fy2 �7/ylu!/ ` STREET ADDRESS 3 -705 rwe So��P_ 0 CITY, STATE, ZIP Memo pkf-K L� quc��.i FAX ❑ OWNER ❑ OWNER- BUILDER Ial OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT YS! ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 7C D LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME Jim, �1 C u E P .1 �� r, 1 LICENSE NUMBER C :Z 1 p J BUS. LIC # COMPANY NAME (2` G U 5� E -MAIL FAX STREET ADDRESS z coo C O� Lc l) iZ y n R / s O F� CITY, STATE, ZIP Sew J Gy / ` A el (3 I PHONE L4 D'b - q Z DESCRIPTION OF WORK p1,0on i}Dpl7,o•, r6osV1 OFF (3L.t Ia.n )W6. 6c04E1f-S7kdf* QT OLC 60DK00r, —10 iMn)ICY -13�rTN ` L✓1�l.jG— j!v G(.u7� �t2cvfl,�� (�l� ►cvlErzlv�c artyrVDl�`/ �vo+� R�w�ip^ o� C�II�IZ�C,bs pDO►z � f�i2tvEwk�(. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES pe,i DC-t--TA L PX51 l)t k4 I, ✓kt J Y y„ f 1 USE TYPE OCC. SQTT. VALUATION ($) EXISTG AREA NEW FLOOR 1 AREA DEMO AREA TOTAL NET O� �'7 �j BATHROOM REMODELAREA C A fi KITCHEN REMODELAREA OTHER REMODEL AREA s(A F1 PORCH AREA DECK AREA TOTAL DECK/PORCH AREE GARAGE AREA: DETACH �y� '# ATTACH I DWELLING UNITS: IS A SECOND UNTT YES SECOND STORY YES BEING ADDED? MNO ADDITION? aNO PRE - APPLICATION ® YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REC BY: TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? I D NO I 1 O/ 0 d n (l By my signature below, I certify to each of the following: I am the property owner or authorized agent to act operty owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. �onssttrruction. 1-711—IV Signature of ApplicantlAgent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER- THE - COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ PUBLIC WORKS _ For—in if any Hazardous Materials are being used as part of this project. !!!❑ ❑ LARGE FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121111 Cp•+A FM__7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 1A ADDRESS: 6370 BLACKWOOD DR DATE: 01/21/2014 REVIEWED BY: MELISSA PC FEE ID APN; 369 17 050 BP #: 'VALUATION: 1$110,000 *PERMIT TYPE: Building Permit I PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes Q No OTC. QYes QNo PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK ADD 633 S.F. TO FRONT OF SFD TO CREATE N BEDROOM. REMODEL E 134S.F. TO SCOPE RECONFIGURE (E) LAYOUT, INCLUDING CREATE MASTERBED /BATH OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Custom) II- B,111- B,IV,V -B 633 $2,577.00 IR3PLNCK $1,617.00 IRMNSP 56 1 s.f. $626.00 Remodel, Bath (< =300 sf) IREMRESBAT Permit Fee: $1,617.00 Suppl. Insp. Fee:Q Reg. Q OT 10701 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 633 $2,577.00 rfC/1;71lfd,St!'E, "tll'i' 1'Ni': $1,617.00 MESH, HOURLY 0 Yes No ` PLUMB, HOURLY Q Yes Q No ELEC HOURLY Q, Yes QNo' MISC ITEMS Plan Check Fee: $2,577.00 78 s.f. $418.00 ---------- tJ,ile1`aP.f�,. /rn:•j� !y( �, /'. ., t: , .......................... ' ?t ... j'l;f:� 1Pt 5 {� L ............. I'll hop, Fcc. PME Plan Check: NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc ). These fees are based on the oreliminary information available and are only an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff 711,113) FEE QTY /FEE MISC ITEMS Plan Check Fee: $2,577.00 78 s.f. $418.00 Remodel, Other 1REMRESOTH Suppl. PC Fee: Q Reg. Q OT T 0.0 hrs $0.00 PME Plan Check: $0.00 56 1 s.f. $626.00 Remodel, Bath (< =300 sf) IREMRESBAT Permit Fee: $1,617.00 Suppl. Insp. Fee:Q Reg. Q OT 10701 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 rfC/1;71lfd,St!'E, "tll'i' 1'Ni': Q Q Work Without Permit? Q Yes Q No $0.00 Advanced Planning Fee: IPLLONGR $88.62 Select a Non - Residential I Building or Structure Q Q � 11 ;11'L'11)CK'riiYi!'1 "ttctltt>1! 1`�'e's. Strong Motion Fee: IBSEISMICR $11.00 Select an Administrative Item Bldg_Stds Commission Fee: 1BCBSC $5.00 SUBTOTALS: $4,298.62 1,044.00 $1,044.001' TOTAL FEE; $5,342.62 Revised: 01/15/2014 I BUILDING ENERGY ANALYSIS REPORT PROJECT: SHIXI QIU 6370 BLACKWOOD DR Cupertino, Ca 95014 CUPERTINO Building Departmenr Project Desl ner Mda Design 3705 Haven "�Ye-``'��:� ; -'` �r C;DMPLIp+NCE Menlo Park, ca by 650 - 353 -0273 Report Prepared by: Prakash Krishan pk energy 3705 HAVEN AVE MENLO PARK, CA 94025 510 - 2298193 OF Job Number: 2013 -048 1, Date: 1120/2014 ))p The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. TAproga has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2008 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC — www.energysoft.com. I EnergyPro 5.1 by EnergySoft User Number: 20522 RunCode: 2014- 01- 20T18:48:15 ID: 2013 -048 .r I TABLE OF CONTENTS I Cover Page Table of Contents Form CF -1 R Certificate of Compliance Form MF -1 R Mandatory Measures Summary EnergyPro 5.1 by EnergySoft Job Number: ID: 2013 -048 User Number: 20522 2 3 8 PERFORMANCE CERTIFICATE: Residential Part 1 of 5 CF -1 R Project Name SHIXI QIU Building Type m Single Family ❑ Addition Alone ❑ Multi Family m Existing+ Addition /Alteration Date 112012014 Project Address 6370 BLACKWOOD DR Cupertino California Energy Climate Zone CA Climate Zone 04 Total Cond. Floor Area 1,832 Addition 632 # of Stories 1 FIELD INSPECTION ENERGY CHECKLIST ❑ Yes El No HERS Measures -- If Yes, A CF -4R must be provided per Part 2 of 5 of this form. El Yes ❑ No Special Features -- If Yes, see Part 2 of 5 of this form for details. INSULATION Construction Type Area Special Cavity (ft`) Features (see Part 2 of 5) Status Floor Wood Framed w /Crawl Space R -19 1,200 Existing Wall Wood Framed R -13 1,460 Existing Roof Wood Framed Attic R -30 1,191 Existing Floor Wood Framed w /Crawl Space R -19 632 New Wall Wood Framed R -13 257 New Door Opaque Door None 21 New Roof Wood Framed Attic R -30 632 New FENESTRATION U- Orientation Area(fi`) Factor Exterior SHGC Overhang Sidefins Shades Status Front (N) 35.7 0.710 0.73 none none Bug Screen Removed Rear (S) 116.3 0.710 0.73 none none Bug Screen Existing Right (M 24.0 0.710 0.73 none none Bug Screen Existing Skylight 8.8 0.350 0.35 none none None New Front (N) 70.7 0.350 0.35 none none Bug Screen New Left (E) 70.0 0.350 0.35 none none Bug Screen New HVAC SYSTEMS Ot . Heating Min. Eff Cooling Min. Eff Thermostat Status 1 Central Furnace 78% AFUE Split Air Conditioner 13.0 SEER Setback New HVAC DISTRIBUTION Location Heating Duct Cooling Duct Location R -Value Status HVAC System Ducted Ducted Attic. Ceiling Ins, vented 8.0 New WATER HEATING Ot . Type Gallons Min. Eff Distribution Status 1 Instant Gas 0 0.82 Kitchen Pipe Ins New EnergyPro 5.1 by EnergySoft User Number: 20522 RunCode: 2014- 01- 20T18:48:15 ID: 2013 -048 Pa e 3 of 10 PERFORMANCE CERTIFICATE: Residential (Part 2 of 5) CF -1 R Project Name SHIXI QIU Building Type ® Single Family ❑ Addition Alone ❑ Multi Family 10 Existing+ Addition /Alteration Date 112012014 SPECIAL FEATURES INSPECTION CHECKLIST The enforcement agency should pay special attention to the items specified in this checklist. These items require special written justification and documentation, and special verification to be used with the performance approach. The enforcement agency determines the adequacy of the justification, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. The HVAC System Gas - Fireplace does not include a cooling system, field verification is not necessary. HERS REQUIRED VERIFICATION Items in this section require field testing and /or verification by a certified HERS Rater. The inspector must receive a completed CF -4R form for each of the measures listed below for final to be given. EnergyPro 5.1 by EnerqySoft User Number: 20522 RunCode: 2014 -01- 20718:48:15 ID: 2013 -048 Pa e 4 of 10 PERFORMANCE CERTIFICATE: Residential (Part 3 of 5) CF -1 R Project Name Building Type m Single Family ❑ Addition Alone Date SHIXI QIU ❑ Multi Family m Existing+ Addition /Alteration 112012014 ANNUAL ENERGY USE SUMMARY Standard Proposed Margin TDV (kBtu /ft2- r) Space Heating 25.17 25.44 -0.26 Space Cooling 17.45 16.81 0.64 Fans 7.95 7.81 0.14 Domestic Hot Water 19.69 14.27 5.42 Pumps 0.00 0.00 0.00 Totals 70.26 64.32 5.94 Percent Better Than Standard: 8.5 BUILDING COMPLIES - NO HERS VERIFICATION REQUIRED Fenestration Building Front Orientation: (N) 0 deg Ext. Walls /Roof Wall Area Area Number of Dwelling Units: 1.00 (N) 580 71 Fuel Available at Site: Natural Gas (E) 638 70 Raised Floor Area: 1,832 (S) 384 116 Slab on Grade Area: 0 (w) 416 24 Average Ceiling Height: 8.0 Roof 1,832 9 Fenestration Average U- Factor: 0.53 TOTAL: 290 Average SHGC: 0.54 Fenestration /CFA Ratio: 15.8% REMARKS STATEMENT OF COMPLIANCE This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 the Administrative Regulations and Part 6 the Efficiency Standards of the California Code of Regulations. The documentation author hereby certifies that the documentation is accurate and complete. Documentation Author Company pk energy 112012014 Address 3705 HAVEN AVE Name Prakash Krishan _ Y City/State/Zip City/State/Zip MENLO PARK, CA 94025 Phone 510 - 2298193 Signed Date The individual with overall design responsibility hereby certifies that the proposed building design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application, and recognizes that compliance using duct design, duct sealing, verification of refrigerant charge, insulation installation quality, and building envelope sealing require installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) Company Mda Design p 3705 Haven Ave Minerva Abad Address Name City /State /Zip Menlo Park, ca Phone 650 - 353 -0273 Signed License # Date EnerQyPro 5.1 by EnergySoft User Number: 20522 RunCode: 2014- 01- 20T18:48:15 /D: 2013 -048 Page 5 of 10 CERTIFICATE OF COMPLIANCE: Residential (Part 4 of 5) CF -1 R Project Name SHIXI QIU Building Type m Single Family ❑ Addition Alone ❑ Multi Family m Existing+ Addition /Alteration Date 112012014 OPAQUE SURFACE DETAILS Surface Type Area U- Factor Insulation Azm Tilt Status Joint Appendix 4 Location /Comments Cavity Exterior Frame Interior Frame Floor 1,200 0.037 R -19 0 180 Existing 4.4.1 -A4 Existing Wall 384 0.102 R -13 0 90 Existing 4.3.1 -A3 Existing Door 21 0.500 None 0 90 Remove 4.5.1 -A4 Existing Wall 104 0.102 R -13 0 90 Remove 4.3.1 -A3 Existing Wall 416 0.102 1 R -13 90 90 Existing 4.3.1 -A3 Existing Wall 268 0.102 R -13 180 90 Existing 4.3.1 -A3 Existing Wall 392 0.102 R -13 270 90 Existing 4.3.1 -A3 Existing Roof 1,191 0.031 R -30 0 18 Existing 4.2.1 -A20 Existing Floor 632 0.037 R -19 0 180 New 4.4.1 -A4 Addition Wall 104 0.102 R -13 0 90 New 4.3.1 -A3 Addition Door 21 0.500 None 0 90 New 4.5.1 -A4 Addition Wall 152 0.102 R -13 90 90 New 4.3.1 -A3 Addition Roof 632 0.031 R -30 0 18 New 4.2.1 -A20 Addition FENESTRATION SURFACE DETAILS ID Type Area U- Factor SHGC2 Azm Status Glazing Type Location /Comments 1 Window 35.7 0.710 Default 0.73 Default 0 Removed Double Metal Clear Existing 2 Window 116.3 0.710 Default 0.73 Default 180 Existing Double Metal Clear Existing 3 Window 24.0 0.710 Default 0.73 Default 270 Existing Double Metal Clear Existing 4 Skylight 8.8 0.350 NFRC 0.35 NFRC 0 New Classic Low -E Vinyl Existing 5 Window 70.7 0.350 NFRC 0.35 NFRC 0 New Classic Low -E Vinyl Addition 6 Window 70.0 0.350 NFRC 0.35 NFRC 90 New Classic Low -E Vinyl Addition (1) U- Factor Type: 116 -A = Default Table from Standards, NFRC = Labeled Value 2 SHGC Type: 116 -B = Default Table from Standards, NFRC = Labeled Value EXTERIOR SHADING DETAILS ID Exterior Shade Type SHGC Window Ove hang Left Fin Right Fin H t Wd Len H t LExt RExt Dist Len H t Dist Len H t 1 Bug Screen 0.76 2 Bug Screen 0.76 3 Bug Screen 0.76 4 None 1.00 5 Bug Screen 0.76 6 Bug Screen 0.76 EnergyPro 5.1 by EnergySoft User Number: 20522 RunCode: 2014- 01- 20T18:48 :15 ID: 2013 -048 Page 6 of 10 CERTIFICATE OF COMPLIANCE: Residential (Part 5 of 5) CF -1 R Project Name SHIXI QIU Building Type ❑ Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition /Alteration Date 112012014 BUILDING ZONE INFORMATION System Name Zone Name Floor Area ft Volume Year Built New Existing Altered Removed HVAC System Existing 1,200 9,596 1960 Addition 632 5,059 Totals 6321 1,200 0 0 HVAC SYSTEMS System Name Ot . Heating Type Min. Eff. Cooling Type Min. Eff. Thermostat Type Status HVAC System 1 Central Furnace 78% AFUE Split Air Conditioner 13.0 SEER Setback New HVAC DISTRIBUTION System Name Heating Cooling Duct Location Duct R -Value Ducts Tested? Status HVAC System Ducted Ducted Attic, Ceiling Ins, vented 8.0 ❑ New WATER HEATING SYSTEMS S stem Name Qty. Type Distribution Rated Input Btuh Tank Cap. al Energy Factor or RE Standby Loss or Pilot Ext. Tank Insul. R- Value Status T -K4 1 Instant Gas Kitchen Pipe Ins 190,000 0 0.82 n/a n/a New MULTI - FAMILY WATER HEATING DETAILS HYDRONIC HEATING SYSTEM PIPING Control Hot Water Piping Length ft 0 0 - a — S stem Name Pipe Length Pipe Diameter Insul. Thick. Qty- HP Plenum Outside Buried EnergyPro 5.1 by EnergySoft User Number: 20522 RunCode: 2014 -01- 20718:48:15 ID: 2013 -048 Page 7 of 10 MANDATORY MEASURES SUMMARY: Residential (Page 1 of 3 MF -1 R Project Name SHIXI QIU Date 112012014 NOTE: Low -rise residential buildings subject to the Standards must comply with all applicable mandatory measures listed, regardless of the compliance approach used. More stringent energy measures listed on the Certificate of Compliance (CF -1 R, CF -1 R -ADD, or CF- 1 R -ALT Form) shall supersede the items marked with an asterisk ( *) below. This Mandatory Measures Summary shall be incorporated into the permit documents, and the applicable features shall be considered by all parties as minimum component performance specifications whether they are shown elsewhere in the documents or in this summary. Submit all applicable sections of the MF -1 R Form with plans. Building Envelope Measures: 116(a)l: Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage. §116(a)4: Fenestration products (except field- fabricated windows) have a label listing the certified U- Factor, certified Solar Heat Gain Coefficient SHGC , and infiltration that meets the requirements of 10 -111 (a). 117: Exterior doors and windows are weather-stripped; all 'oints and penetrations are caulked and sealed. 118(a): Insulationspecified or installed meets Standards for Insulating Material. Indicate type and include on CF -6R Form. §118(i): The thermal emittance and solar reflectance values of the cool roofing material meets the requirements of §118(i) when the installation of a Cool Roof is specified on the CF -1 R Form. *§1 50(a): Minimum R -19 insulation in wood -frame ceiling orequivalent U- factor. 150 b : Loose fill insulation shall conform with manufacturer's installed design labeled R- Value. *§1 50 c : Minimum R -13 insulation in wood -frame wall orequivalent U- factor. *§1 50 d : Minimum R -13 insulation in raised wood -frame floor orequivalent U- factor. 150(f): Air retarding wrap is tested, labeled, and installed according to ASTM E1677 -95 2000 when specified on the CF -1 R Form. 150 : Mandatory Vapor barrier installed in Climate Zones 14 or 16. §150(1): Water absorption rate for slab edge insulation material alone without facings is no greater than 0.3 %; water vapor permeance rate is no greater than 2.0 perm/inch and shall be protected from physical damage and UV light deterioration. Fireplaces, Decorative Gas Appliances and Gas Log Measures: 150 e 1 A: Masonry or factory-built fireplaces have a closable metal or glass door covering the entire opening of the firebox. §150(e)1 B: Masonry or factory -built fireplaces have a combustion outside air intake, which is at least six square inches in area and is equipped with a with a readily accessible, operable, and tight-fitting damper and or a combustion -air control device. §150(e)2: Continuous burning pilot lights and the use of indoor air for cooling a firebox jacket, when that indoor air is vented to the outside of the building, are prohibited. Space Conditioning, Water Heating and Plumbing System Measures: §110 - §113: HVAC equipment, water heaters, showerheads, faucets and all other regulated appliances are certified by the Energy Commission. §113(c)5: Water heating recirculation loops serving multiple dwelling units and High -Rise residential occupancies meet the air release valve, backflow prevention, pump isolation valve, and recirculation loop connection requirements of §1 13(c)5. §115: Continuously burning pilot lights are prohibited for natural gas: fan -type central furnaces, household cooking appliances (appliances with an electrical supply voltage connection with pilot lights that consume less than 150 Btu /hr are exempt), and pool and spa heaters. 150(h): Heating and /or cooling loads are calculated in accordance with ASHRAE, SMACNA or ACCA. 150(i): Heating systems are equipped with thermostats that meet the setback requirements of Section 112(c). §150(j)1 A: Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are externally wrapped with insulation having an installed thermal resistance of R -12 or greater. §150(j)1 B: Unfired storage tanks, such as storage tanks or backup tanks for solar water - heating system, or other indirect hot water tanks have R -12 external insulation or R -16 internal insulation where the internal insulation R -value is indicated on the exterior of the tank. §150(j)2: First 5 feet of hot and cold water pipes closest to water heater tank, non - recirculating systems, and entire length of recirculatinq sections of hot water pipes are insulated per Standards Table 150 -B. §150(j)2: Cooling system piping (suction, chilled water, or brine lines),and piping insulated between heating source and indirect hot water tank shall be insulated to Table 150 -B and Equation 150-A. §150(j)2: Pipe insulation for steam hydronic heating systems or hot water systems >15 psi, meets the requirements of Standards Table 123 -A. §150(j)3A: Insulation is protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. §150(j)3A: Insulation for chilled water piping and refrigerant suction lines includes a vapor retardant or is enclosed entirely in conditioned space. 150(j)4: Solar water-heating systems and /or collectors are certified by the Solar Rating and Certification Corporation. EnergyPro 5.1 by EnergySoft User Number: 20522 RunCode: 2014- 01- 20T18:48:15 ID: 2013 -048 Page 8 of 10 MANDATORY MEASURES SUMMARY: Residential (Page 2 of 3 MF -,I R Project Name Date SHIA QIU 112012014 §150(m)1: All air - distribution system ducts and plenums installed, are sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6 -5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R- 4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct - closure system that meets the applicable requirements of UL 181, UL 181 A, or UL 181 B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings reater than 1/4 inch, the combination of mastic and either mesh or tape shall be used §150(m)1: Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross - sectional area of the ducts. §150(m)2D: Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. 150(m)7: Exhaust fans stems have back draft or automatic dampers. §150(m)8: Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. §150(m)9: Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. 150 m 10: Flexible ducts cannot have porous inner cores. §150(o): All dwelling units shall meet the requirements of ANSI /ASHRAE Standard 62.2 -2007 Ventilation and Acceptable Indoor Air Quality in Low -Rise Residential Buildings. Window operation is not a permissible method of providing the Whole Building Ventilation required in Section 4 of that Standard. Pool and Spa Heating Systems and Equipment Measures: §114(a): Any pool or spa heating system shall be certified to have: a thermal efficiency that complies with the Appliance Efficiency Regulations; an on -off switch mounted outside of the heater; a permanent weatherproof plate or card with operating instructions; and shall not use electric resistance heating or a pilot light. §114(b)1: Any pool or spa heating equipment shall be installed with at least 36" of pipe between filter and heater, or dedicated suction and return lines, or built-up connections for future solar heating. 114(b)2: Outdoor pools ors as that have a heat pump or gas heater shall have a cover. §114(b)3: Pools shall have directional inlets that adequately mix the pool water, and a time switch that will allow all pumps to be set or programmed to run only during off-peak electric demand periods. 150 : Residential pool systems orequipment meet the pump sizing, flow rate, piping, filters, and valve requirements of §1 50 Residential Lighting Measures: §150(k)1: High efficacy luminaires or LED Light Engine with Integral Heat Sink has an efficacy that is no lower than the efficacies contained in Table 150 -C and is not a low efficacy luminaire asspecified by 150 k 2. 150(k)3: The wattage of permanently installed luminaires shall be determined asspecified by 130(d). §150(k)4: Ballasts for fluorescent lamps rated 13 Watts or greater shall be electronic and shall have an output frequency no less than 20 kHz. §150(k)5: Permanently installed night lights and night lights integral to a permanently installed luminaire or exhaust fan shall contain only high efficacy lamps meeting the minimum efficacies contained in Table 150 -C and shall not contain a line- voltage socket or line - voltage lamp holder; OR shall be rated to consume no more than five watts of power as determined by §130(d), and shall not contain a medium screw -base socket. 150(k)6: Lighting integral to exhaust fans, in rooms other than kitchens, shall meet the applicable requirements of §1 50(k). 150(k)7: All switching devices and controls shall meet the requirements of §1 50(k)7. §150(k)8: A minimum of 50 percent of the total rated wattage of permanently installed lighting in kitchens shall be high efficacy. EXCEPTION: Up to 50 watts for dwelling units less than or equal to 2,500 ft2 or 100 watts for dwelling units larger than 2,500 ft2 may be exempt from the 50% high efficacy requirement when: all low efficacy luminaires in the kitchen are controlled by a manual on occupant sensor, dimmer, energy management system (EMCS), or a multi -scene programmable control system; and all permanently installed luminaries in garages, laundry rooms, closets greater than 70 square feet, and utility rooms are high efficacy and controlled by a manual -on occupant sensor. §150(k)9: Permanently installed lighting that is internal to cabinets shall use no more than 20 watts of power per linear foot of illuminated cabinet. EnergyPro 5.1 by EnergySoft User Number: 20522 RunCode: 2014 -01- 20718:48:15 ID: 2013 -048 Page 9 of 10 MANDATORY MEASURES SUMMARY: Residential (Page 3 of 3 MF -1 R Project Name Date SHIXI QI U 112012014 §150(k)l0: Permanently installed luminaires in bathrooms, attached and detached garages, laundry rooms, closets and utility rooms shall be high efficacy. EXCEPTION 1: Permanently installed low efficacy luminaires shall be allowed provided that they are controlled by a manual -on occupant sensor certified to comply with the applicable requirements of §119. EXCEPTION 2: Permanently installed low efficacy luminaires in closets less than 70 square feet are not required to be controlled by a manual -on occupancy sensor. §150(k)11: Permanently installed luminaires located in rooms or areas other than in kitchens, bathrooms, garages, laundry rooms, closets, and utility rooms shall be high efficacy luimnaires. EXCEPTION 1: Permanently installed low efficacy luminaires shall be allowed provided they are controlled by either a dimmer switch that complies with the applicable requirements of §119, or by a manual - on occupant sensor that complies with the applicable requirements of §119. EXCEPTION 2: Lighting in detached storage building less than 1000 square feet located on a residential site is not required to comply with §1 50 k 11. §150(k)l2: Luminaires recessed into insulated ceilings shall be listed for zero clearance insulation contact (IC) by Underwriters Laboratories or other nationally recognized testing /rating laboratory; and have a label that certifies the lumiunaire is airtight with air leakage less then 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283; and be sealed with a gasket or caulk between the luminaire housing and ceiling. §150(k)13: Luminaires providing outdoor lighting, including lighting for private patios in low -rise residential buildings with four or more dwelling units, entrances, balconies, and porches, which are permanently mounted to a residential building or to other buildings on the same lot shall be high efficacy. EXCEPTION 1: Permanently installed outdoor low efficacy luminaires shall be allowed provided that they are controlled by a manual on /off switch, a motion sensor not having an override or bypass switch that disables the motion sensor, and one of the following controls: a photocontrol not having an override or bypass switch that disables the photocontrol; OR an astronomical time clock not having an override or bypass switch that disables the astronomical time clock; OR an energy management control system (EMCS) not having an override or bypass switch that allows the luminaire to be always on EXCEPTION 2: Outdoor luminaires used to comply with Exceptionl to §150(k)13 may be controlled by a temporary override switch which bypasses the motion sensing function provided that the motion sensor is automatically reactivated within six hours. EXCEPTION 3: Permanently installed luminaires in or around swimming pool, water features, or other location subject to Article 680 of the California Electric Code need not be high efficacy luminaires. §150(k)14: Internally illuminated address signs shall comply with Section 148; OR not contain a screw -base socket, and consume no more than five watts of power as determined according to §130(d). §150(k)15: Lighting for parking lots and carports with a total of for 8 or more vehicles per site shall comply with the applicable requirements in Sections 130, 132, 134, and 147. Lighting for parking garages for 8 or more vehicles shall comply with the applicable requirements of Sections 130, 131, 134, and 146. §150(k)16: Permanently installed lighting in the enclosed, non - dwelling spaces of low -rise residential buildings with four or more dwelling units shall be high efficacy luminaires. EXCEPTION: Permanently installed low efficacy luminaires shall be allowed provided that they are controlled by an occupant sensors certified to comply with the applicable requirements of 119. EnergyPro 5.1 by EnergySoft User Number: 20522 RunCode: 2014- 01- 20T18:48:15 ID: 2013 -048 Page 10 of 10 CUPERTINO PURPOSE: CALGREEN RESIDENTIAL CHECKLIST - MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(acupertino.ora The 2013 CalGreen Code applies to all newly constructed hotels, motels, lodging houses, dwellings, dormitories, condominiums, shelters, congregate residences, employee housing, factory-built housing and other types of swellings with sleeping accommodations and new accessory buildings associated with such uses. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: Project Address: Shixi Qiu House S � �1, r, I!! -F _ `"'-* 6370 Blackwood Dry non Project Description: Addition and Re kt Instructions: OpE COMPLIANCE REV1E \JvE) FUR h/ro 1. The Owner or the Owner's agent shall employ a licenseq Kaf@W*A61 e erienced with the California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the 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. Paget of 5 �Q CalGreen 2014.doc revised 01115114 Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Re uirements A4.1 PLANNING AND DESIGN Planning and Design - Site Development 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during construction.` 4.106.3 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. �® Paget of 5 �Q CalGreen 2014.doc revised 01115114 A4.2 ENERGY EFFICIENCY General 4.201.1 Low -rise residential buildings shall meet or exceed the minimum, standard design required by the California Energy Standards. A4.3 WATER EFFICIENCY AND CONSERVATION Indoor Water Use 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following: ❑x 4.303.1.3.2 Water Closets. The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank -type water closets shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank -type Toilets. ❑ 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. ❑x 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. ❑ 4.303.1.3.2 Multiple Showerheads serving one shower. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and /or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. ❑x 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less than 0.8 gallons per minute at 20 psi. ❑ 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas (outside of dwellings or sleeping units) in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. ❑ 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. ❑x 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, to and shall meet the applicable standards referenced in Table 1401.1 of the California Plumbing Code. Page 2 of 5 CalCreen_2014.doc revised 01115114 Outdoor Water Use 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the time of final inspection shall be weather- based. ❑x 4.304.1.1 Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as weather conditions change. ❑x 4.304.1.2 Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. A4.4 MATERIAL Enhanced Durability and Reduced Maintenance 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a El construction waste management plan shall be submitted for approval to the enforcing agency. Building Maintenance and Operation 4.410.1 Operation and maintenance manual. At the time of final inspection, an operation and maintenance manual shall be provided to the building ® ❑ occupant or owner. A4.5 ENVIRONMENTAL QUALITY Fireplaces 4.503.1 General. Install only a direct -vent sealed- combustion gas or sealed wood - burning fireplace, or a sealed woodstove. Pollutant Control 4.504.1 Covering of duct openings and protection of mechanical equipment during construction. Duct openings and other related air distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks1 shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be compliant with VOC limits. 4.504.2.3 Aerosol paints and coatings. Aerosol paints and other coatings "04 shall be compliant with product weighted MIR Limits for ROC and other toxic El compounds. Page 3 of 5 CalCreen 2014.doc revised 01115114 4.504.2.4 Verification. Documentation shall be provided to verify that ® ❑ compliant VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with © ❑ VOC limits. 4.504.4 Resilient flooring systems. Eighty (80) percent of floor area flooring VOC- receiving resilient shall comply with the 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 Composite wood products. Particleboard, medium density} fiberboard (MDF), and hardwood plywood used in interior finish systems shall © ❑ comply with low formaldehyde emission standards. Interior Moisture Control 4.505.2 Concrete slab foundation. Required vapor retarders and capillary 1Pnh1 ® ❑ breaks are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture content of building ® ❑ materials used in wall and floor framing is checked before enclosure. Indoor Air Quality and Exhaust 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the ® ❑ building are provided in every bathroom. Environmental Comfort 4.507.2. Duct systems are sized and designed and equipment is selected using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or equivalent. ® ❑ 2. Size duct systems according to 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 Installer training. HVAC system installers are trained and certified in jt ® ❑ the proper installation of HVAC systems. 702.2 Special inspection. The Licensed Professional responsible to verify q! CALGreen compliance is qualified and able to demonstrate competence in the ® ❑ discipline they inspect and verify. Verifications 703.1 Documentation. 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. Page 4 of 5 CalGreen_2014.doe revised 01/15/14 Project Name: Project Address: CALGREEN SIGNATURE DECLARATIONS Shixi Qiu House 6370 Blackwood Drive Project Description: Addition and Remodel 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 2013 California Green Building Standards Code as adopted by the City of Cupertino. d/Xilk - (7-3e14L Owner's Si en atu re Date �,1-1 X7 1`Jit Owner's Name (PI ase Print) -[8 -201' Design Professional's Signature Date Wti V- A AW , 02/20/2014 ignature of icen a rofessional responsible mpliance Date Miles Hancock (650) 424 -1189 Name of License Professional responsible for CalGreen compliance (Please Print) Phone energy @pacbel1.net Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen 2014.doe revised 01115114 CUPERTINO STATEMENT OF SPECIAL INSPECTIONS, 2013 CBC COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building0cupertino.org SITE ADDRESS 63pp70 Blackwood Dr. APN ,'�, BP# 11+01 h OwnerVX�. 1.......' u .................................................. ............................... Contractor ................................................................................ -- .................... Address... ...... !(�PP Y.. .P.N. E .............................. Address............................................................................ ............................... ��l�..i I City/St ... .� ?.lr�l�'��.KI .........Zip.... .V.14. .....Phone ..................... City/ St... .... .......................................... Zip ................ . ..Phone........................ Applicant ...N!i....V..... ........... Engineer /Architect ................ Jing Chen Tsai Address .... .. ..k....�.!�!......�.y.......... 1� &�•• &s� 2050 Concourse Dr. # 50 Address .............................................................. ............................... City /St..... Zip.A .9.6.....Phone........� - ..'J.� City/St Jose ....................... Zip.. 95131... Phone 408.89.27.68 PROJECT DESCRIPTION: House Remodel This "STATEMENT OF SPECIAL INSPECTIONS" is submitted in fulfillment of the requirements of CBC Sections 1704 and 1705. This form is structured after and used by permission from the Structural Engineer Association of Northern California's (SEAONC) mode statement of Special Inspections. Also, included with this form is the following: ® "LIST OF SPECIAL INSPECTION AGENCIES (page 2). A list of testing a nd other speriaL ii�ppc#gr.tyo�ill be retained to conduct the tests and inspections for this project l+u bl I od ❑ "SCHEDULE OF SPECIAL INSPECTION" (page 3 — 6). The Schedule p spections Adiit�ilrge9 It Inspections and tests required. Special Inspectors will refer to the appr nd specifications for detailed special inspection requirements. Any additional tests and inspections required ved RlPg r7 s if5cations shall also be performed. Special Inspections and Testing will be performed in accordance with the approvedl i&W Sections 1704, 1705, 1706, 1707, and 1708. Interim reports will be submitted to the Build%Official and the R�Vd D � Professional in Responsible Charge in accordance with CBC Section 1704.1.2. vlewe0 by. A Final Report of Special Inspections documenting required Special Inspecti t correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use a 4.1Z. The Final Report will document:, • Required special inspections. • Correction of discrepancies noted in inspections. The Owner recognizes his or her obligation to ensure that the construction complies with the approved permit documents and to implement this program of special inspections. In partial fulfillment of these obligations, the Owner will retain and directly pay for the Special Inspections as required in CBC Section 1704.1. This plan has been developed with the understanding that the Building Official will: • Review and approve the qualifications of the Special Inspectors who will perform the inspections. • Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are performing their duties as called for in this Statement of Special Inspection. • Review submitted inspection reports. • Perform inspections as required by the local building code. I have read and aaree to como/v with the terms and conditions of this statement Prepared By: Project C1 Engineer ❑ Architect Registered Design Professional in Charge 54210 0/17/14 Si nature .....' . ............................. ..........................Lic.# ........ ............................... Date:.......................... Owner Name: ( ' ""' ' wne� A�horization 6 ti Si nature .. ............ ............................................................... ............................... Date:..... ...!.... y.. Inspection Agency/ Inspector Name: ii1 '� l O Vl ............................ 0Si nature ............ .... Lic.# ........ ............................... Date: �... Building Official or designee: Signature.. .... ....... .... ... ... ... ................... ............................... Date: ... 1...�.7�. .. SpecialnspectionFm•m_2012.doe revised 09106112 LIST OF SPECIAL INSPECTION AGENCIES APPROVAL OF SPECIAL INSPECTORS: Each special inspection agency, testing facility, and special inspector shall be recognized by the Building Official prior to performing any duties. Special Inspection agency's listed on this form must be pre- approved and listed on Cupertino's approved Special Inspector's list. Special inspectors shall carry approved identification when performing the functions of a special inspector. Identification cards shall follow the criteria set by the California Council of Testing and Inspection Agencies. No personnel changes shall be made without first obtaining the approval of the Building Official. Any unauthorized personnel changes may result in a "Stop Work Order" and possible permit revocation. To be pre- approved by the City of Cupertino, refer to the SPECIAL INSPECTION CRITERIA handout. Please allow two weeks to complete the application process. The followina are the testing and special inspection agencies that will be retained to conduct tests and inspection on this project: EXPERTISE FIRM / INSPECTOR INFORMATION 1. Special Inspection (except for Firm...... Capex En tneering Inc, Addr ...... 71 Seville Place ................. ............................... geotechnical) City....... Fremont....... ... State .. CA ........... Zip ..94539.!..... Telephone..510.668.: l...l........... Fax...... 51Q.490469.0.......... Email .......................... ............................... 2. Material Testing Firm ..................................................................... Addr.......................................................... ...........I................... City........................................................................... ............................... State .......................Zip ...................... Telephone........ ............................... Fax............. ............................... Email.......................... ............................... 3. Geotechnical Inspections Firm ..................................................................... Addr.......................................................... ............................... City........................................................................... ............................... State .......................Zip ...................... Telephone....... ............................... Fax............. ............................... Email.......................... ............................... 4. Other: Firm ............... ...................................................... Addr......................................................................................... City........................................................................... ............................... State .......................Zip ...................... Telephone....... ............................... Fax............. ............................... Email .......................... ............................... *All agencies specified on this form must be pre- approved and listed on the City of Cupertino's Approved Special Inspector's List. SEISMIC REQUIREMENTS (Section 1705.3.6) Description of seismic - force - resisting system and designated seismic systems subject to special inspections as per Section 1705.3: Holdown Epoxy Anchor The extent of the seismic - force - resisting system is defined in more detail in the construction documents. WIND REQUIREMENTS Section 1705.4.1 Description of main wind - force - resisting system and designated wind resisting components subject to special inspections in accordance with Section 1705.4.2: The extent of the main wind- force - resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionForm_2012.doc revised 09101112 SCHEDULE OF SPECIAL INSPECTION SITE APN Bp# ADDRESS PROJECT DESCRIPTION: Notation Used in Table: Column headers: C Indicates continuous inspection is required. P Indicates periodic inspections are required. The notes and /or contract documents should clarify. Box entries: X Is placed in the appropriate column to denote either "C" continuous or "P" periodic inspections. - -- Denotes an activity that is either a one -time activity or one whose frequency is defined in some other manner. Additional detail regarding inspections and tests are provided in the project specifications or notes on the drawings. VERIFICATION AND INSPECTION C p REFERENCED IBC REFERENCE STANDARD INSPECTION OF FABRICATORS 1. ❑ Inspect fabricator's fabrication and quality control - -- 1704.3 procedures. INSPECTION OF STEEL 1. Material verification of high- strength bolts, nuts and washers. • Identification marking to conform to ASTM stds AISC 360, specified in the approved construction documents. - -- X Section A3.3 and applicable ASTM material standards • Inspect fabricator's fabrication and quality control X procedures. - -- - -- - -- 2. Inspection of high- strength bolting: • Snug -tight joints. - -- X • Pretensioned and slip - critical joints using turn -of -nut with matchmarking, twist -off bolt or direct tension - -- X AISC 3% indicator methods of installation. Section M2.5 1704.3.3 • Pretensioned and slip - critical joints using turn -of -nut without matchmarking or calibrated wrench methods X - -- of installation. 3. Material verification of structural steel and cold- formed steel deck. ❑ For structural steel, identification markings to conform AISC 360, 0 to AISC 360. - -- X Section M2.5 ❑ For other steel, identification markings to conform to Applicable ASTM ASTM standards specified in the approved X material standards construction documents. ❑ Manufacturer's certified test reports. - -- X SpecialnspectionForm_2012.doc revised 09106112 VERIFICATION AND INSPECTION C p REFERENCED STANDARD JIBC IREFERENCE 4. Material verification of weld filler materials: ❑ Identification marking to conform to AWS specification in the approved construction documents. - -- X AISC 360, Section A3.5 and applicable AWS A5 documents - -- ❑ Manufacturer's certificate of compliance required. - -- X - -- - -- 5. Inspection of welding: a. Structural steel and cold- formed steel deck: • Complete and partial joint penetration groove welds. X - -- AWS D1.1 1704.3.1 ❑ Multipass fillet welds. X 11 Single-pass Single -pass fillet welds > 5/16" X - -- • Plug and slot welds. X - -- ❑ Single -pass fillet welds <= 5/16" - -- X • Floor and roof deck welds. - -- X AWS D1.3 b. Reinforcing steel: • Verification of weldability of reinforcing steel other than ASTM A 706. - -- X AWS D1.4 ACI 318: Section 3.5.2 • Reinforcing steel resisting flexural and axial forces in intermediate and special moment frames, and boundary elements of special structural walls of concrete and shear reinforcement. X - -- ❑ Shear reinforcement. X --- ❑ Other reinforcing steel. - -- X 6. Inspection of steel frame joints details for compliance: ❑ Details such as bracing and stiffening. - -- X - -- 1704.3.2 ❑ Member locations. - -- X ❑ Application of joint details at each connection. - -- X VERIFICATION AND INSPECTION C p REFERENCED STANDARD IBC REFERENCE INSPECTION OF WELDING 1. ❑ Welded studs when used for structural diaphragms. - -- X - -- 1704.3 2. ❑ Welding of cold- formed steel framing members. - -- X 3. 11 Welding of stairs and railing systems. - -- X SpecialnspectionForm_2012.doc revised 09106112 VERIFICATION AND INSPECTION C P REFERENCED IBC STANDARD REFERENCE INSPECTION OF CONCRETE 1. ❑ Inspection of reinforcing steel, including prestressing - -- X ACI 318: 3.5, 7.1 -7.7 1913.4 tendons and placement. 2. ❑ Inspection of reinforcing steel welding in accordance AWS D1.4 ACI 318: with Table 1704.3 Item 5b. 3.5.2 3. ❑ Inspection of bolts to be installed in concrete prior to and during placement of concrete where allowable X - -- ACI 318: 8.1.3, 1911.5, 1912.1 loads have been increased or where strength design 21:2.$ is used. 4. ❑ Inspection of anchors installed in hardened concrete. - -- X ACI 318: 1912.1 5. ❑ Verifying use of required design mix. 1904.2.2,1913.2, - -- X ACI 318: 1913.3 6. # ❑ At time fresh concrete is sampled to fabricate ASTM C 172 specimens for strength tests, perform slump and air X - -- ASTM C 31 1913.10 content tests and determine the temperature of the concrete. ACI 318: 5.6, 5.8 7. ❑ Inspection of concrete and shotcrete placement for X - -- ACI 318: 5.9, 5.10 1913.6, 1913.7, proper application techniques. 1913.8 8. ❑ Inspection for maintenance of specified curing - -- X ACI 318: 5.11 -5.13 1913.9 temperature and techniques. 9. Inspection of prestressed concrete: • Application of prestressing forces. X - -- ACI 318:18.20 • Grouting of bonded prestressing tendons in the X - -- ACI 318: 18.18.4 - -- seismic force - resisting system. 10. ❑ Erection of precast concrete members. - -- X ACI 318: Ch. 16 --- 11. ❑ Verification of in -situ concrete strength, prior to stressing of tendons in posttensioned concrete and X ACI 318: 6.2 - -- prior to removal of shores and forms from beams and structural slabs. 12. ❑ Inspect formwork for shape, location, and dimensions - -- X ACI 318: 6.6.1 - -- of the concrete member being formed. 13. ❑ Bolts Installed in Existing Masonry or Concrete • Direct tension testing of existing anchors. -- X See ICC ES Reports form special inspection requirements for proprietary • Direct tension testing of new bolts. --- X • Torque testing of new bolts. ___ X products • Prequalification test for bolts and other types of X anchors. __- 14. ❑ Other: Speci¢lnspectionForm_2012.doe revised 09106112 SpecialnspectionForm 2012.doc revised 09 106112 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402 /ACI TMS 402 /ACI SECTION 530 /ASCE 5 530 /ASCE 6 INSPECTION OF LEVEL 1 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved - -- X - -- - -- Art. 1.5 submittals shall be verified. 2. ❑ Verification of fn, and f a,ac prior to construction X - -- - -- Art. 1.413 except where specifically exempted by this code. 3. ❑ Verification of slump flow and VSI as delivered to X - -- - -- - -- Art. 1.513.1.b.3 the site for self consolidating grout. 4. As masonry construction begins, the following shall be verified to ensure compliance: • Proportions of site - prepared mortar. - -- X - -- - -- Art. 2.6A • Construction of mortar joints. - -- X - -- - -- Art.3.313 • Location of reinforcement, connectors, X - -- - -- Art. 3.4, 3.6A prestressing tendons, and anchorages. • Prestressing technique. - -- X - -- - -- Art. 3.66 • Grade and size of prestressing tendons and X - -- - -- Art. 2.413, 2.4H anchorages. 5. During construction the inspection program shall verify: • Size and location of structural elements. - -- X - -- - -- Art. 3.3F • Type, size, and location of anchors, including other details of anchorage of masonry to --- X - -- 1.16.1 structural members, frames or other construction. • Specified size, grade, and type of reinforcement, anchor bolts, prestressing tendons and - -- X - -- Sec. 1.15 Art. 2.4, 3.4 anchorages. • Welding of reinforcing bars. X - -- - -- --- ❑ Preparation, construction and protection of masonry during cold weather (temperature below ___ X Sec. 2104.3, - -- Art. 1.8C, 1.8D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing X - -- - -- - -- Art. 3.66 force. 6. Prior to grouting the following shall be verified to ensure compliance: ❑ Grout space is clean. - -- X - -- - -- Art. 3.2D ❑ Placement of reinforcement and connectors and - -- X - -- Sec. 1.3 Art. 3.4 prestressing tendons and anchorages. • Proportions of site - prepared grout and X - -- - -- Art. 2.66 prestressing grout for bonded tendons. • Construction of mortar joints. - -- X - -- - -- Art. 3.313 7. Grout placement: • Grout placement shall be verified ensure compliance. X - -- - -- - -- Art. 3.5 • Observe grouting of prestressing bonded X - -- - -- - -- Art 3.6C tendons. SpecialnspectionForm 2012.doc revised 09 106112 Specialnspectioi2Form_2012.doc revised 09106112 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402 /ACI TMS 402 /ACI SECTION 530 /ASCE 5 530 /ASCE 6 8. ❑ Preparation of any required grout specimens, Sec. mortar specimens, and /or prisms shall be - -- X 2105.2.2, - -- Art. 1.4 observed. 2105.3 INSPECTION OF LEVEL 2 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved - -- X - -- - -- Art. 1.5 submittals. 2. ❑ Verification of f m and f aac prior to construction and for every 5,000 square feet during - -- X - -- - -- Art. 1.413 construction. 3. ❑ Verification of proportions of materials in premixed or preblended mortar and grout as - -- X - -- - -- Art. 1.513 delivered to the site. 4. ❑ Verification of slump flow and VSI as delivered to X - -- - -- --- Art. 1.513.1.b.3 the site for self consolidating rout. 5. The following shall be verified to ensure compliance: • Proportions of site - prepared mortar, grout, and - -- X - -- - -- Art. 2.6A prestressing grout for bonded tendons. • Placement of masonry units and construction of - -- X - -- - -- Art. 3.313 mortar joints. • Placement of reinforcement, connectors and - -- X - -- Sec. 1.15 Art. 3.4, 3.6A prestressing tendons and anchorages. • Grout space prior to grouting. X - -- - -- - -- Art. 3.2D • Placement of grout. X - -- - -- - -- Art. 3.5 • Placement of prestressing grout. X - -- - -- - -- Art. 3.6C • Size and location of structural elements. - -- X - -- - -- Art. 3.3F • Type, size, and location of anchors, including other details of anchorage of masonry to X - -- - -- Sec.1.2.2(e) structural members, frames and other construction. • Specified size, grade, and type of reinforcement, anchor bolts, prestressing tendons and - -- X - -- Sec. 1.15 Art. 2.4, 3.4 anchorages. • Welding of reinforcing bars. X - -- - -- Sec. 2.1.9.7.2, - -- 3.3.3.4 (b) • Preparation, construction, and protection of masonry during cold weather (temperature below --- x Sec. 2104.3, - -- Art. 1.8C, 1.8D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). • Application and measurement of prestressing X - -- - -- - -- Art. 3.613 force. 6. ❑ Preparation of any required grout specimens, Sec. mortar specimens, and /or prisms shall be X - -- 2105.2.2, , - -- Art. 1.4 observed. 2105.3 Specialnspectioi2Form_2012.doc revised 09106112 VERIFICATION AND INSPECTION C p REFERENCED STANDARD IBC REFERENCE INSPECTION OF WOOD 1. ❑ Inspect prefabricated wood structural elements and assemblies in accordance with Section 1704.2. - -- - -- - -- 1704.6 2. ❑ Inspect site built assemblies. - -- - -- 3. Inspect high -load diaphragms: • Verify grade and thickness of sheathing. - -- - -- ❑ Verify nominal size of framing members at adjoining panel edges. - -- - -- - -- 1704.6.1 • Verify nail or staple diameter and length, - -- - -- • Verify number of fastener lines, - -- - -- ❑ Verify spacing between fasteners in each line and at edge margins. -- - -- 4. ❑ Metal- plate- connected wood trusses spanning 60 feet or greater: Verify temporary installation restraint /bracing and the permanent individual truss - -- X - -- 1704.6.2 member bracing are installed in accordance with the approved truss submittal package. REQUIRED VERIFICATION AND INSPECTION OF SOIL 1. ❑ Verify materials below footings are adequate to achieve the desired bearing capacity. -- X 2. ❑ Verify excavations are extended to proper depth and X have reached proper material. - - 3. ❑ Perform classification and testing of compacted fill materials. X - -- Table 1704.7 4. ❑ Verify use of proper materials, densities and lift thicknesses during placement and compaction of X - -- compacted fill. 5. ❑ Prior to placement of compacted fill, observe subgrade and verify that site has been prepared properly. - -- X REQUIRED VERIFICATION AND INSPECTION OF DEEP DRIVEN FOUNDATION ELEMENTS 1. ❑ Verify element materials, sizes and lengths comply X with the requirements. 2. ❑ Determine capacities of test elements and conduct X - -- additional load tests, as required. 3. ❑ Observe driving operations and maintain complete X - -- and accurate records for each element. 4. ❑ Verify locations of piles and their plumbness, confirm type and size of hammer, record number of blows per - -- Table 1704.8 foot of penetration, determine required penetrations to X - -- achieve design capacity, record tip and butt elevations and document any damage to foundation element. 5. ❑ For steel elements, perform additional inspections in accordance with Section 1704.3. 6. ❑ For concrete elements and concrete filled elements, perform additional inspections in accordance with - -- - -- Section 1704.4. SpecialnspectionForm_2 012. doe revised 09106112 VERIFICATION AND INSPECTION C P REFERENCED IBC STANDARD REFERENCE 7. ❑ For specialty piles, perform additional inspections as determined by the registered design professional in - -- - -- - -- Table 1704.8 responsible charge. REQUIRED VERIFICATION AND INSPECTION OF CAST -IN -PLACE DEEP FOUNDATION ELEMENTS 1 ❑ Observe drilling operations and maintain complete and X - -- accurate records for each element. 2. ❑ Verify placement locations and plumbness, confirm element diameters, bell diameters (if applicable), lengths, embedment into bedrock (if applicable), and X - -- - -- Table 1704.9 ' adequate end - bearing strata capacity. Record concrete or grout volumes. 3. ❑ For concrete elements, perform additional inspections in accordance with Section 1704.4. HELICAL PILE FOUNDATIONS 1. ❑ Record installation equipment used, pile dimensions, X - -- ___ 1704.10 tip elevations, final depth, final installation torque. SPRAYED FIRE - RESISTANT MATERIALS Physical and visual tests 1. Condition of substrates. • Inspect surface for accordance with the approved fire - resistance design and the approved manufacturer's - -- - -- written instructions. • Verify minimum ambient temperature before and after application. - -- X --- 1704.12.1 • Verify ventilation of area during and after application. - -- X 2. ❑ Measure average thickness per ASTM E605 and --- --- Section 1704.12.4. 3. sO Verify density of material for conformance with the approved fire- resistant design and ASTM E605. (Ref. - -- - -- Section 1704.12.5) 4. ❑ Test cohesive /adhesive bond strength per Section 1704.12.6. 5. ❑ Condition of finished application. MISCELLANEOUS 1. Mastic and Intumescent Fire - Resistant Coating. - -- - -- - -- 1704.13 2. Exterior Insulation and Finish Systems (EIFS). Water - resistive barrier coating when installed over a sheathing - -- - -- - -- 1704.14 substrate. 3. Special Cases - -- - -- - -- 1704.15 4. Smoke Control System - -- - -- - -- 1704.16 5. Seismic Resistance ' ❑ Suspended ceiling systems and their anchorage. - -- - -- - -- 1705.3 [4.3] SpecialnspectionForm_2012.doc revised 09106112 VERIFICATION AND INSPECTION � C p REFERENCED _T STANDARD IBC REFERENCE 6. Wind Resistance • Roof cladding and roof framing connections. - -- - -- --- ❑ Wall connections to roof and floor diaphragms and framing. ❑ Roof and floor diaphragm systems, including collectors, drag struts and boundary elements. • Vertical wind- force - resisting systems, including braced frames, moment frames, and shear walls. • Wind- force - resisting system connections to the foundation. , • Fabrication and installation of systems or components required to meet the impact resistance requirements - -- - -- - -- of Section 1609.1.2. SPECIAL INSPECTION FOR WIND REQUIREMENTS 1. Structural Wood • Inspect field gluing operations of elements of the main X -_ wind- force - resisting system. - -- 1706.2 • Inspect nailing, bolting, anchoring, and other fastening of components within the main windforce- resisting - -- X system, including wood shear walls, wood diaphragms, drag struts, braces and hold- downs. 2. Cold- Formed Steel Framing • Welding of elements of the main wind - force - resisting - -_ X r system. • Inspection of screw attachments, bolting, anchoring, and other fastening of components within the main - -- 1706.3 wind- force - resisting system including shear walls, - -- X braces, diaphragms, collectors (drag struts) and hold - downs. 3. Wind- resisting components ❑ Roof cladding. - -- X - -- 1706.4 ❑ Wall cladding. - -- X SPECIAL INSPECTIONS FOR SEISMIC RESISTANCE 1. ❑ Special inspection for welding in accordance with the ix ___ 1707.2 quality assurance plan requirements of AISC 341. 2. Structural Wood • Inspect field gluing operations of elements of the X - -- seismic- force - resisting system. • Inspect nailing, bolting, anchoring, and other fastening of components within the seismic - force - resisting 1707.3 system, including wood shear walls, wood - -- X diaphragms, drag struts, braces, shear panels and hold- downs. r 3. Cold- Formed steel light -frame construction ❑ Welding of elements of the seismic - force - resisting X 1707.4 system. SpeciulnspectionForm_2012.doc revised 09106112 ❑ Inspection of screw attachments, bolting, anchoring, and other fastening of components within the seismic- X force - resisting system including shear walls, braces, - -- diaphragms, collectors (drag struts) and hold- downs. 4. Storage racks and access floors ❑ Anchorage of storage racks 8 feet or greater in height X 1707.5 and access floors. 5. Architectural components ❑ Inspect erection and fastening of exterior cladding weighing more than 5 psf and higher than 30 feet - -- X above grade or walking surface. • Inspect erection and fastening of veneer weighing more than 5 psf.and higher than 30 feet above grade - -- X or walking surface. - -- 1707.6 • Inspect erection and fastening of all exterior non- bearing walls higher than 30 feet above grade or - -- X walking surface. • Inspect erection and fastening of all interior non- bearing walls weighing more than 15 psf and higher - -- X than 30 feet above grade or walking surface. 6. Mechanical and Electrical Components ❑ Inspect anchorage of electrical equipment for X emergency or stand -by power systems. - -- ❑ Inspect anchorage of non - emergency electrical - -- X equipment. ❑ Inspect installation of piping systems and associated mechanical units carrying flammable, combustible, or - -- X - -- 1707.7 highly toxic contents. ❑ Inspect installation of HVAC ductwork that contains X hazardous materials. - -_ ❑ Inspect installation of vibration isolation systems where required by Section 1707.7. _ X 7. ❑ Verify that the equipment label and anchorage or mounting conforms to the certificate of compliance ___ - -- ___ 1707.8 when mechanical and electrical equipment must be seismically qualified. 8. ❑ Seismic isolation system: Inspection of isolation - -- X - -- 1707.9 system per ASCE 7 — Section 17.2.4.8 9. ❑ Obtain mill certificates for reinforcing steel, verify compliance with approved construction documents, - -- - -- - -- 1708.2 and verify steel supplied corresponds to certificate. 10. ❑ Structural Steel: Invoke the QAP Quality Assurance ___ 1708.3 requirements in AISC 341. 11. ❑ Obtain certificate that equipment has been seismically 1708.4 qualified. ___ 12. ❑ Obtain system tests as required by ASCE 7 Section - -- - -- ___ 1708.5 17.8. SpecialnspectionForm_2012.doc revised 09106112 CUPERTINO RECOGNIZED SPECIAL INSPECTION AGENCY LIST COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 - build ingQcupertino.orq The following list of Special Inspection Agencies and their special inspectors are approved by the City of Cupertino to provide specific inspection in their respective field until the expiration date listed. Agency Name, Address and expiration date Special Inspectors Special Inspection Field RC Pc SIM SW HB FP S W 'CG Achievement Engineering Corp. 434 Camille Cir. #13 San Jose, CA 95134 Tel: (800) 653 -1397 Fax: (408) 852 -0331 Expires: 07 /22/2015 Firouz'aei, Arash X X X X Hooshdar, Sina X X X X Khodadadi, Mohammad X Safaian, Farshad Applied Materials 8 Engineering, Inc. 980 415` Street Oakland, CA 94608 Tel: (510) 420 -8190 Fax: (510) 420 -8186 Expires: 12/19/2014 Email: info(cDappmatena.com Aaron Hardy X X X Anthony Klarich X X X X X Armen Tajirian, P.E. X Bryan Jackson X X David Jackson X X X X X Diego Bertolino X X X Harold Walrath X X X X Ken Maloney X X Michael Knowles X X X X Oswaldo Dominguez X X X X Sean Guches X X X Bagg Engineers 847 West Maude Ave. Sunnyvale, CA 94085 -2911 Tel: (650) 852 -9133 Fax: (650) 852 -9138 Expires: 7/16/2015 www.baggengineers.com Brown, Christian X X X X X Cole, Michael Hep er, John X X X Knudsen, Steven J. McManus, Alvin X X X Norris, David L. X X X X O'Driscoll, Alan Salceda, Francisco Sciortino, Brandon Smith, Louis Steinbrueck, Bryan Thai, Minh Umeki, Takashi RC = Reinforced Concrete I SW = Steel & Welding S =Soils PC = Pre - stressed /Post - tensioned Concrete HB = High- Strength Bolding W = Wood SM = Structural Masonry FP = SpraymApplied Fireproofing CG = Ca /Green Code SpeciallnspectionList.doc revised 02101114 1 Agency Name, Address and expiration date Special Inspectors Special Inspection Field RC PC sM SW HB FP S W CG Biggs Cardosa Associates, Inc. 865 The Alameda San Jose, CA 95126 Tel: (408) 296 -5515 Fax: (408) 296 -8114 Expires: 7/11/2014 www.biqqscardosa.com Castro, Roberto Chan, David X X Ghorbani, Behrooz Lazzarini, Dan Rivas, Ricardo Rosales, Adolfo Rosellini, Daniel Sanchez, Adam To an, Claudiu X X Woole , Mark X X X X Yamane, Robert BSK Associates Engineers & Laboratories 324 Earhart Way Livermore, CA 94551 Tel: (925) 315 -3151 'Fax: (925) 315 -3152 Expires: 9/06/2014 www.bskassociates.com Auser, Jim X X X Bos ue, Jeff X X X Clary, Mike X X X X Evans, Keven X Minerales, Gilbert Ness, Dennis X X X Olsten, Ken X X Reeves, Ben Rodriguez, Tim X X X Schurman, Peter X Capex Engineering Inc. 571 Seville Place Fremont, CA 94539 Tel: (510) 668 -1815 Fax: (510) 490 -8690 Expires: 6/2512014 Gary Hsu X X X X X Chow, Erwin 1105 Belmont Ave. Long Beach, CA 90804 Tel: (562) 449 -7491 Expires: 4/2412014 Erwin Chow X RC = Reinforced Concrete SW = Steel & Welding S = Soils PC = Pre- stressed /Post- tensioned Concrete HB = High- Strength Bolding W = Wood SM = Structural Masonry FP = SpraywApplied Fireproofing CG = CalGreen Code SpecialhzspectionList.doc revised 02 101114 Agency Name, Address and expiration date Special Inspectors Special Inspection Field RC PC sM sw HB FP s w CG Consolidated Engineering Laboratories 2001 Crow Canyon Road, Suite 100 San Ramon, CA 94583 Tel: (925) 341 -7100 Fax: (925) 855 -7140 Expires: 6/25/2014 www.ce- labs.com Ahmed, Badaruddin Alexander, David X X X Andersen, Calvin X X Bartlett, Dennis X X Bobrovitsk , Edward X X X Bolen, Michael X X X Brooks, Brendan X X X X X Brown, Ronald X' X X X X Buchmiller, Kenn Cottin ham, Paul Currier, James X X Eschliman, Duaine Eschliman, Kevin Fuller, Mark X X Halloran, James X X X X X Harrington, Wayne X X Hassebrock, Scott X X X X X Healy, Michael X Heilmann, Mark X X X Horn ak, John X X X X Hyslop, John X X X X King, Phillip X X X X Kmitt, Stanley X X Liebold, Jeffrey X X X X X Lozano, Alfonso Art Ma, Steven X Marlik, William X X McCutcheon, Thurmond X X McKenzie, Quinten McLaughlin, Lori X X Miner, Dwight X X Murphy, Don X Pastora, George X X X X Rodriguez, Sandra X X Si mon, Josephine Sisson, James X X X X Small, Michael X X Van Horn, Bradford X X X X Walters, Michael Zuerner, Robert X X X RC = Reinforced Concrete SW= Steel & Welding S =Soils PC = Pre - stressed /Post- tensioned Concrete HB = High- Strength Bolding W = Wood SM = Structural Masonry FP = Spray - Applied Fireproofing CG = CalGreen Code SpeciallnspectionList.doc revised 02 101114 Agency Name, Address and expiration date Special Inspectors Special Inspection Field RC PC SM SW HB FP S w CG Construction Testing Services 2174 Rheem Dr., Ste. A Pleasanton, CA 94588 Tel: (925) 462 -5151 Fax: (925) 462 -5183 Expires: 6/26/2014 www.cts -1.com Brian Arnold X X X Edward Bindert X X X X X Jeremy Brown X X X James Brumley X Jared Byers X X Richard Collin X X X Robert Cortez X X X X, X Robert Criswell X X X Mark Doman X X X X Tom Edwards X X X X X Tim Farley X X X X X X Gary Fechner X X X Mike Gaunt X Ron Harr X X X X Neal Hoellwarth X Richard Jones X X X X Rick Mann X X Kevin McCurdy X X Kevin Meyers X Kevin Moore X X Craig Nagle David Puskarich X X X X William Radulovich Brian Ragan X X X X X John Rink X George Rockenstein X X Larry Rothey X Erin Salazar X X Robert Schulze X Donald Shirley X X X Tom Shuster X X X X X Larry Slater X Daryl S ieker X X Gary Stapleton X X X Matt Swope X X Travis Taylor X X Vinny Vinavong X Shawn Vucenic X John White X X X X X Isidoro Za ien X X X RC = Reinforced Concrete SW = Steel & Welding S =Soils PC = Pre- stressed /Post- tensioned Concrete HB = High- Strength Bolding W = Wood SM = Structural Masonry FP = Spray-App lied Fireproofing CG = Ca/Green Code SpeciallnspectionList.doc revised 02101114 Agency Name, Address and expiration date Special Inspectors Special Inspection Field RC PC SM SW HB FP S w cc Earth Systems Pacific 446 S. Hillview Dr. Milpitas, CA 95035 Tel: (408) 934 -9302 Fax: (831) 637 -0510 Exp: 6/28/2014 www.earthsystems.com George Barnett X X Jeff Bryan X X Norman En en X X X X Cal Hicks X X X X X Dennis Hurley X X rus Me'ia ENGEO Incorporated 2010 Crow Canyon Pl., Suite 250 San Ramon, CA 94583 Tel: (925) 866 -9000 Fax: (888) 279 -2698 Exp: 7/06/2014 www.engeo.com Tim Benton Greg Hudson X Mike Huenergardt X X X X Kevin Lecce James "Chip" Moore X X X Mues X —Randy Jonathan Parker X X X X Rich Rose X X X H P Inspection, Inc. 690 Sunol ST, Building H San Jose, CA 95126 Tel: (408) 288 -8460 Fax: (408) 271 -0902 Expires: 11/15/2014 Larry Castrence Tony Cotta X X Mark Cotter Chuck Pinkham X X X X David Pinkham X X X X P. Scott Pinkham X X X Gary Stafford X X X X X Jason Waugh X I X X X X RC = Reinforced Concrete SW = Steel & Welding S = Soils PC= Pre - stressed /Post- tensioned Concrete HB = High- Strength Bolding W = Wood SM = Structural Masonry FP = Sprat-Applied Fire roofin CG = CalGreen Code SpeciallnspectionList.doe revised 02101114 Agency Name, Address and expiration date Special Inspectors Special Inspection Field RC Pc SM SW HB FP S w cc Inspection Services, Inc. 1798 University Ave. Berkeley, CA 94703 Tel: (510) 900 -2100 Fax: (510) 900 -2101 Expires: 03/21/2015 www.inspectionseryices.net Alakbarov, Ha dar X Amos III, Jessie X Baccus, Garrett . X. X Baek, B un Gi X X X X X X Barone, Judith X X X Celik, Can X X X X X X X Colby, Paul X X Ehrsam, Gary X Falk, Andrew X X X X Flynn, Chris X X X X X X Gaut, Tobin X X X X Llames, Fernando X X X X Lon, Rand "Roy" X X X X X X Patterson, Rodger X X Putman, Edward X X X X X Sandoval, Carlos X X X X X X Shebesta, Todd X Simonton, Cy-Leon X Solis, Winnie X X Stafford, William X Stark, Douglas X X X X Toschi, Patrick X X X X. X Wheeler, Steven X X X X X Kleinfelder 2601 Barrington Court Hayward, CA 94545 Tel: (925) 484 -1700 Exp: 7/10/2014 www.kleinfelder.com Anderson, Tim X X X X X X Brewster, Steve X Burton, Nathan X X X Craig, Cliff X X X X X X Delabriandais, Gary X X X Eres, Mark X X X X X Foster, Stephen X X X X Hammon, Robert X X X X Johnson, Josh X Kesler, Timothy X Milla e, Leonard X X X X X Nicoletti, Johnathon X X Oandason,Jose X X X X X X Rommel, Daniel X X Saber, Sam X X X Swank, Phillip X X I X RC = Reinforced Concrete SW = Steel 8 Welding S = Solls PC = Pre- stressed /Post- tensioned Concrete 7FP HB = High- Strength Bolding W = Wood SM = Structural Masonry = Spray-Applied Fire roofin CG = Ca /Green Code SpeciallnspectionList.doc revised 02101114 Agency Name, Address and expiration date Special Inspectors Special Inspection Field RC PC SM SW HB FP S W CG Krazan & Associates, Inc. 6711 Sierra Court, Ste B Dublin, CA 94568 Tel: (925) 307 -1160 Fax: (925) 307 -1161 Exp: 2/6/2014 www.krazan.com James Allen X X X James Benefeito X X X Larry Borges X X X X Ron Chandler X Van DeMent X X LGregory Gregory Fernald Matthew Fernald Lewis Franklin X X X X X Ken Hafeli X X X Andy Morris X X X X Sidney Moss X X X X Matt Romero X Gregory Ruf MatriScope Engineering Laboratories, Inc. 4730 Contractors Common Livermore, CA 94551 Tel: (925) 606 -7700 Fax: (925) 606 -7702 Expires: 7/26/2014 www.matriscope.com D'Souza, Andrew Fannin, Dana X X X Hopelian, Joseph X X X X Keller, Don X X Kohls, Kristin Lake, Adam X X Mathis, Q. Shane X X X X X Nieser, Paul X Palmer, Scott Reese, Mark X Scoble, Kod Selvage, Kevin Shelton, James X X X X X X Sta ner, Jack X X X X X X Swartz, Judy Tadlock, K. Scott X X X X X X Tadlock, Robert X X X X X X Thomas, Chris X Varella, Joe RC = Reinforced Concrete SW = Steel 8 Welding S =Soils PC = Pre - stressed /Post- tensioned Concrete HB = High- Strength Bolding W = Wood SM = Structural Masonry FP = Spray - Applied Fireproofing CG = Ca/Green Code SpeciallnspectionList.doc revised 02101114 Agency Name, Address and expiration date Special Inspectors Specialjnspection Field RC PC SM SW HB FP s w CG ' Neil O. Anderson & Associates, Inc. 902 Industrial Way Lodi, CA 95240 Tel: (209) 367 -3701 Fax: (209) 333 -8303 Expires: 2/1/2016 www.noanderson.com Allen, Eric Cozad, Mike X X X X X Dickey, David X Erickson, Rick Gray, Dave X X X X X X Hall, Rollin Johnson, Carl X X X X King, Ryan X Kort, Jason X X X X Landess, Frank X X X Lenehan, Gerry Me'orado, Aaron X Merrell, Ryan X Morgan, Daniel O as, George Oszut, Gregory X X X X Roberts, Jason Westfall, Kimmis X X X X X Whiting, John Williams, Roger X X X PacificlnterWest Bldg Consultants, Inc. 1600 South Main St, Suite 380 Walnut Creek, CA 94596 `Tel: (925) 939 -5500 Fax: (925) 939 -9561 Expires: 9/6/2013 www. acificinterwest.com Cope,Doug X PSI, Inc. 365 Victor Street, Ste. C Salinas, CA 93907 Tel: (831) 757 -3536 Fax: (831) 757 -6265 Expires: 1/10/2015 www.psiusa.com Albert George X X X X X Deborah White X Michael Winter X X William Monger X X X X X Brand Burfield X Ezekiel Robles X Stephen Ramos X Darwin Zacka X ,RC = Reinforced Concrete SW = Steel 8 Welding S = Soils PC = Pre - stressed /Post- tensioned Concrete HB = High- Strength Bolding W = Wood SM = Structural Masonry FP = SpraymApptied Fireprooting CG = Ca /Green Code Speciallnspectionbst.doc revised 02111114 Agency Name, Address and expiration date Special Inspectors Special Inspection Field RC PC sM SW HB FP s W CG RMA Group of Northern California 6296 San Ignacio Ave., Suite A San Jose, CA 95119 Tel: (408) 362 -4920 Fax: (408) 362 -4926 Expires: 04/01/2012 www.rmacompanies.com Alley, Maurice X X Bosque, Jeff X X X Carr, Greg Cecconi, Joe X Chinn, Gordon X X X X Francis, Chris X X Geraghty, Rich X X X Gillespie, John X X X X X Gundersen, Al X X X Haff, Tiffany Hughes, Dottie X X X Sondrol, Jeff X X X X Stocke, Jacob X Swain, Pat X Tellesen, Mike X X Tonkovich, Bill X X X X Walters, Chris X X X X X X Zeiher, Adam X RC = Reinforced Concrete SW= Steel 8 Welding S = Solls PC = Pre- stressed /Post- tensioned Concrete HB = High- Strength Bolding W = Wood 0 SM = Structural Masonry FP = Spray-Appfied Fireproofing CG = Ca /Green Code SpeciallnspectionList.doe revised 02101114 Agency Name, Address and expiration date Secial Insectors pp Special Inspection Field RC Pc sM SW HB FP s w cc Smith -Emery Company Corporate Office: 781 E. Washington Blvd. Los Angeles, CA 90021 Testing Facilities: 1940 Oakdale Ave. P.O. Box 880550 San Francisco, CA 94124 Tel: (415) 642 -7326 Expires: 4/09/2015 www.smithemervsf.com Allder, Scott Brunett, John X X X Caraisco, Thomas X X X X X X Chuong,Jason X Contreras, Roberto X X X X X Cross, Len Cunningham, Jim Daniels, Jodie X X Daquinag, Bonafacio Docena, Bernard Drake, Barry X X Joakimson, Robert X X X X X X Klopson, Paul X X X Mazuk, Ray X McCarron, Liam X X X Merino, Salvador X X X X X Miranda, Allen Murphy, Mike Nadler, Joel X X X Nickerson, Scott X X X X Ross, Jason X X Serrano, Ramon Sherwood, Tony X X X X X X Starkey, Raymond Stevenson, Wylie Viramontes, Keith X X X Stevens, Ferrone & Bailey 1600 Willow Pass Court Concord, CA 94520 Tel: (925) 688 -1001 Fax: (925) 688 -1005 Expires: 8/09/2014 www.sfandb.com Babione, Martin X X X Conner, Scott X X X X X X Fletcher, Brett X X X X X X X Minor, Matt X X X Quinn, Tom X X X X Thielges, Jon RC = Reinforced Concrete SW = Steel & Welding S =Soils PC = Pre- stressed /Post- tensioned Concrete HB = High- Strength Bolding W = Wood SM = Structural Masonry FP = SpraymApplied Fireproofing CG = Ca /Green Code Speciallnspectionbst.doc revised 02101114 Agency Name, Address and expiration date Special Inspectors Special Inspection Field RC PC sM SW HB FP s W CG Terracon Consultants, Inc. 3140 Gold Camp Drive, Suite 170 Rancho Cordova, CA 95670 Tel: (916) 858 -1579 Fax: (916) 858 -8277 Expires: 7/17/2015 www.terracon.com Houts, Walter X X X X X X Mears, Steven X X X X X X Testing Engineers, Inc. 2811 Teagarden Street San Leandro, CA 94577 Tel: (510) 835 -3142 Fax: (510) 834 -3777 Expires: 4/22/2015 testing- engineers.com Ardizonne, Mike X Dougherty, John X X X X Ganly, Jim Geraghty, Richard X X X X Grossman, Peter, P.E. X Gunderson, Al X X X X Hernandez, Frank X X X X X Mendosa, John X Muzika, Bruce X X Ronald, Seth X Souza, Jason X X Tellesen, Mike X X Thomas, Paul X X X X Watanabe, Dan X Williams, Brian X White, Walker X Yoka, John X X X Western Technologies, Inc. 3480 South Dodge Blvd. Tucson, AZ 85713 Tel: (520) 748 -2262 Expires: 8/29/2014 www.wt - us.com Tiedemann, Thomas X RC = Reinforced Concrete SW = Steel 8 Welding S = Solis PC = Pre - stressed /Post- tensioned Concrete HB = High- Strength Bolding W= Wood SM = Structural Masonry FP = Spray-Applied Fire roofin CG = Ca /Green Code SpeciallnspectionList.doc revised 02101114 RONG CHANG USA CORPORATION 2050 Concourse Drive, #50, San Jose, CA 95131 Phone: (408) 892 -7680 Fax: (408) 321 -9987 A R C H I T E C T U R A L P R O J E C T D E V E L O P M E N T City of Cupertino, Califomia Building & Safety Division Re: Structural Revision_ 6370 Blackwood Dr. Cupertino. CA Aug. 0714 Dear SIL P L A N N I N G M A N A G E 9 E N 1 1� This letter is to confirm that I have reviewed the structural drawings, and allow following (.hanee: V 1. Existing garage door have no footing. new 12" wide x12" thick continuous tied bear.; with (1) -#4 at top and bottom with #4x 18" long @ 18" epoxy dowels 4" into existing slab. need to be added. For existing footing cannot be used, remove the existing footing, new 14 "wide x18" thick wntinue footing with (2) -#4 top and bottom used, tied new footing with #4x 18" long @ 18" epoxv dowels 4" into existing sla.;: 3. For existing tooting do not have enough depth, new tooting add to existing tooting per detail 1 attached. If you have any questions regarding the above, please contact me at (408) 892 -7680, thank you. Jins Chen (Jesse") i s Structurai Engtn-- 1 (08, 10 -07) 3 /r-l' -0" } i. 14" �. f (E) STUD WALL 3LKG UNDER POST (HEN �+ No. S 4210 Exp. 6/30/16 TAT PF CI NEW FTG WHERE OCCUR W / #4 DWL ®12" OC kAIN EPDXY 6" INTO (E) FTG #4 @ 12" OC EA WAY TYP N)FTG TO (E)FTG M-MML RONG CHANG USA CORPORATION 2050 Concourse Drive, #50, San Jose, CA 95131 Phone: (408) 892 -7680 Fax: (408) 321 -9987 ARCHITECTURAL PROJECT DEVELOPMENT . P L A N N I N . niAIN AGEM,E NT City of Cupertino, California Building & Safety Division Re: Structural Revision 6370 Blackwood Dr. Cupertino, CA OCT. 29 14 Dear Sir, �✓ i 14 0 10 l Z2 This letter is to confirm that I have reviewed the structural drawings, and allow following change: 1. Garage framing change gable to hip framing, use 2x8 rafter @ 24" oc, 4x10 dDF #1 hip beam, supported by 3 1 /2x11 7/8 PSL ceiling beam is acceptable. See revised plan and calculation attached. If you have any questions regarding the above, please contact me at (408) 892 -7680, thank you. �QROFE S S /C�� O CHEF/ � ND. S 4210 Exp. 6/30/16 j \J Jing Chen (Jesse) Tsai Structural Engineer