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13070089 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19681 VICKSBURG DR CONTRACTOR:EVERSPRING PERMIT NO: 13070089 CONSTRUCTION INC OWNER'S NAME: SHITANSHUE AND PRACHI SHAH 1131 S DE ANZA BLVD DATE ISSUED: 10/10/2013 OWNER'S PHONE: 4089961254 SAN JOSE,CA 95129 PHONE NO:(408)446-8398 kLICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIALE] License Class_ Lic.d&CO 1 2 STORY ADDITION(994 S.F.), 1 STORY ADDITION(229 Contractor ""4c ' S.F.). REMODEL(E) IST FLR AREA(1,351 S.F.) ��.��+r�� G�S cP�'jjate l I-' �}� I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$300000 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36908018.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 80 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA PROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the �p/G granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: l with all non-point ource regulations per the Cupertino Municipal Code,Section 9.18. 1 RE-ROOFS: Sign Daft �O �" l3 All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which thisice, t r3 permit is issued. Owner or authorized agent: Date:_�� I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date _ l CONSTRUCTION PERMIT APPLICATION �O% COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION O 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 1 CUP1`aTINO (408)777-3228• FAX (408)777-3333• building aQcupertino.org �-� [:1 NEW CONSTRUCTION Y(ADDITION [OALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECTADDRESSI 661 �I�y ,�� , `' APNd 3c;9. OWN'ERNAME 11 .4 N SU A FKA601 s RAN P60 996- 12 P7MAIL STREET ADDRESS crrY' STATE,ZIP FAX CONTACT NAME PHONE _6 .)34. & &MA n�� STREET ADDRESS CITY,STATE,ZIP F'�ra FAXi6s4 �A Mi. Suite, cAgS�So o - ❑ OWNER ❑ OR'N'ER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT VARCHITEcT ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME , LICENSE NUMBER LICENSETYPE BUS.LIC K COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE P.RCHITECT/ENGINEER NAME � 11 �� LICENSENUMBER C 62 3Op BUS.LIC N COMPANY NAME �7 E-MAIL FAX C I / tIV lIV 1�1408- 261 J STREET ADDRESS Z� CITY,STATE,Zlan r PHONE 12 I -0114- DESCRIPTION OF WORK t'3S F 1 Z'W° .�.r.. ADD 2Z4 % TCS (t) f-1 KSI- -F�6VK, EXISTING USEPROPOSED US CONSTR TYPE k STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL _ AREA NZ AREA 2607 AREA NET AREA )2 3 BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: JEETA/CH ATTACH I DWELLI:G UNITS: iS A SECOND UNIT rJ yES SECOND STORY NrM BEINGADDED? O ADDITION? []NO PRE-APPLICATION MIYES IF YES,PROVIDE COPY OF IS THE BLDG AN YES RECEI - SY' - TOTAL VALUATION: PLANNING APPL 9 ❑NO PLANNING APPROVAL LEITER EICHLER HOME? ZNO By my signature below,I certify to each of the following: I am the property owner or author agen ct o t 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 cons ction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applican;/Agent: Date: 12 i 201 SUPPLEMENTAL INFORMATION REQUIRED IL nNCHE"CI{TYPE KJ_ I ROUTiNG,SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for [] OVER-THE-COUNTER u'st a DINc PL:1N REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. Cl EXPRESS PLANNING PLAN RE'NIENY _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C� s TANDARD1 Pt sLlcwoRls form if any Hazardous Materials are being used as part of this project. ❑ LARcr FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to I✓ 11AdOR, SANrrARY SF.NI'ERDISTRICF- submittal of Building Permit application. 1.L1 LNAgRONNIENTALHEALTH ., BldgApp 2011.doc revised 06/21/11 - CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 19681 VICKSBURG DR DATE: 07/12/2013 REVIEWED BY: MELISSA APN: 369 08 018 BP#: EVALUATION: 1$300,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY 2nd Unit? Yes No PERMIT TYPE:PENTAMATION USE: SFD or Duplex OTC? 0 Yes 1 R3SFDADD No � WORK 2 STORY ADDITION 994 S.F. 1 STORY ADDITION 229 S.F. . REMODEL E 1 ST FLR AREA SCOPE (1,351 S.F.) OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,III-B,IV,V-B 1,223 $2,637.09 IR3PLNCK $1,832.25 IR31NSP TOTALS: 1,223 j $2,637.09 $1,832.25 MECH,HOURLY Yes 0 No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No t ;i':(r, Mech. Permit Fee: Plumb. Permit Fee: Elec.Permit Fc Other h9ech.Insp. E17-- Other Plumb Insp. Lj Other Eley.Insp. Li A:&Insp. Fee: Plumb, Irrsp.Fee: Elec,Insp_Fee: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Puhlic Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS (Fee Resolulion 11-053 Eff 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,637.09 1,351 s.f. Remodel,Other Suppl. PC Fee: (F) Reg. () OT FO.Ohrs $0.00 $4,746.00 IREMRES2 PME Plan Check: $0.00 Permit Fee: $1,832.25 Suppl. Insp. Fee:Q Reg. Q OT0.0 firs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conoruc•tion Tax: Administrative Fee: Work Without Permit? C) Yes O No $0.00 0 Advanced Planning Fee: IPLLONGR $171.22 Select a Non-Residential 0 Trcnel Documentation Fees: Building or Structure i Strong Motion Fee: IBSEISMICR $30.00 Select an Administrative Item BldgStds Commission Fee: IBCBSC $12.00 SUBTOTALS: $4,682.561$4,746.00 TOTAL FEE: $9,428.56 Revised: 07/01/2013 1,01..5 6 MMMNMMM� Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST .JOB ADDRESS: (,T(69 tcv–SeK 2 G pe . PERMIT# ► V v �� OWNER'S NAME: SyIljk,4S V -5rkMA PHONE# S/ GC 2 – 6 t 8 Z GENERAL CONTRACTOR: BUSINESS LICENSE# 21 -21 ADDRESS, t-g1 S. AA n- C3t_v cfi 3 Z` *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR ANDALL SU ONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. —� I am not using any subcontractors �- Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile caner/Contractor Signature Date less iff IL M INSTALLATION CERTIFICATE (Page 1 of 12) CF-6R Site Address Permit Number 16r(L J1Gi�6t�l�t-� -PoL i-L . Installation certificates(CF-6R)are required for each and every dwelling unit.When the installation of measures that require field verification and diagnostic testing is complete,the builder or the builder's subcontractor shall complete diagnostic testing and the procedures specified in this section. When the installation is complete,the builder or the builder's subcontractor shall complete the CF-6R(Installation Certificate),and keep it at the building site for review by the building department.The builder also shall provide a copy of the Installation Certificate to the HERS rater for any measures requiring field verification and diagnostic testing,per Section 10-103(a). WATER HEATING SYSTEMS: Distribution CEC Certified Type If #of Rated Input External Heater Mfr Name& (Std,Point- Recirculation, Identical (kW or Tank Volume Efficiency Standby Insulation Type Model Number of-Use,etc) Control Type Systems BtuAr) (gallons) (EF,RE)2 Loss(%)Z R-value2 t 1 '�1i f wa O n/ 644 1 For small gas storage(rated input of less than or equal to 75,000 Btu/hr),electric resistance and heat pump water heaters,list Energy Factor(EF).For large gas storage water heaters(rated input of greater than 75,000 Btu/hr), list Recovery(RE),Thermal Efficiency,Standby Loss and Rated Input. For instantaneous gas water heaters,list Thermal Efficiency and Rated Input. 2. R-12 external insulation is mandatory for storage water heaters with an energy factor of less than 0.58. Kitchen Piping: If indicated on the CF-1R,all hot water piping>_3/4 inches in diameter that runs from the hot water source to the kitchen fixtures is insulated. Faucets&Shower Heads: All faucets and showerheads installed are certified to the Energy Commission,pursuant to Title 24,Part 6,Section 111. Central Water Heating in Buildings with Multiple Dwelling Units(required for prescriptive) ❑AII hot water piping in main circulating loop is insulated to requirements of§1500) El Central hot water systems serving six or fewer dwelling units which have(1)less than 25'of distribution piping outdoors;(2)zero distribution piping underground;(3)no recirculation pump;and(4)insulation on distribution piping that meets the requirements of Section 1500) ❑Central hot water systems serving more than 6 dwelling units-presence of either a time control or a time/temperature control ✓.� I, the undersigned, verify that equipment listed above my signature is: 1) the actual equipment installed; 2) equivalent to or more efficient than that specified in the certificate of compliance(Form CF-1R)submitted for compliance with the Energy Efficiency Standards for residential buildings; and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices(from the Appliance Efficiency Regulations or Part 6),where applicable. Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner 15,4E04.4pp 1-.7 w zoa,t1*A--4'l t.J Signature: Date: lv I ! N Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY Residential Compliance Forms September 2005 INSTALLATION CERTIFICATE (Page 2 of 12) CF-6R Site AddressPermit Number rXo-4-4- le-1 An installation certificate is required to be posted at the building site or made available for all appropriate inspections.(The information provided on this form is required)After completion of final inspection,a copy must be provided to the building department(upon request)and the building owner at occupancy,per Section 10-103(a). FENESTRATION/GLAZING: Manufacturer/Brand Name Total Quantity of Area Exterior (GROUP LIFE Product U-factor Product SHGC #of Like Product Square Shading Device Comments/Location/ Item RODUCTS) CF-I R value)2 (<CF-1 R value) Panes (Optional) Feet or Overhang Special Features 1. aK<- vt:+•411' 6.S4J V. O 2. AAjv"tw r> t7 o-311 .V Lo 10 I/W 1, 3. MtL C-A�o O u� 5 4. Ml O t �• a 5. µa.wke-4 .15R 7. j4A tLOAP 9 0 v 8. L, .To 141,b 9. N►u,cq+o h y.D o 10. 11. 12. 13. 14. 15. Use values from a fenestration product's NERC label.For fenestration products without an NFRC label,use the default values from Section 116 of the Energy Efficiency Standards. Z) Installed U-factor must be less than or equal to values from CF-1R.Installed SHGC must be less than or equal to values from CF-1R,or a shading device(exterior or overhang)is installed as specified on the.CF-1R. Alternatively, installed weighted average U-factors for the total fenestration area are less than or equal to values from CF-1R. If using default table SHGC values from§116 identify whether tinted or not. ✓ E� I, the undersigned, verify that the fenestration/glazing listed above my signature: 1) is the actual fenestration product installed; 2) is equivalent to or has a lower U-factor and lower SHGC than that specified in the certificate of compliance(Form CF-IR)submitted for compliance with the Energy Efficiency Standards for residential buildings; and 3)the product meets or exceeds the appropriate requirements for manufactured devices(from Part 6),where applicable. Item#s Signature Date Installing Subcontractor(Co.Name)OR (if applicable) General Contractor(Co.Name)OR Owner OR Window Distributor Item#s Signature Date Installing Subcontractor(Co.Name)OR (if applicable) General Contractor(Co.Name)OR Owner OR Window Distributor Item#s Signature Date Installing Subcontractor(Co.Name)OR (if applicable) General Contractor(Co.Name)OR Owner OR Window Distributor Copies to:Building Department,HERS Rater(if applicable)Building Owner at Occupancy Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 3 of 12) CF-6R Site Address ,! ,/� Permit Number V l<►c!lkt Oe, �1G/�/'t Cw�f p-T....w c4 I An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required)After completion of final inspection,a copy must be provided to the building department(upon request)and the building owner at occupancy,per Section 10-103(a). HVAC SYSTEMS: Heating Equipment CEC Certified Mfr. #of Efficiencyt Duct Duct or Heating Heating Equip Type Name and Model Identical (AFUE,etc.) Location Piping Load Capacity k .heat um Number Systems (>_CF-IRvalue) (attic,etc.) R-value (Btu/br) (Btuhr) 60'AterL 'fuo0441t '�.c,00a►. Ji STS► 3'1O .An'1'1 Cooling Equipment CEC Certified Mfr. #of EfficiencyDuctDuct Cooling Cooling Equip Type Name and Model Identical (SEER or EER) Location Duct Load Capacity (pkg.heat um Number S stems >_CF-1 R value) (attic,etc.) R-value (Btuft) (Btu/hr) ,(OM Gw+Mw ` 414 L q• L) 1. >symbol reads greater than or equal to what is indicated on the CF-IR value. Include both SEER and EER if compliance credit for high EER air conditioner is claimed. ✓ ❑I I,the undersigned,verify that equipment listed above is: 1)is the actual equipment installed,2)equivalent to or more efficient than that specified in the certificate of compliance (Form CFAR) submitted for compliance with the Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices(from the Appliance Efficiency Regulations or Part 6),where applicable. Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner -P v jg""to 12.�a U✓i t►7s,•H Signature: Date: to LI ' Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 r� INSTALLATION CERTIFICATE (Page 5 of 12) CF-6R Site Address Y` /A- Permit Number ✓ ❑ THERMOSTATIC EXPANSION VALVE(TXV) Procedures for field verification of thermostatic expansion valves are available in RA CM,Appendix RI. Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on ✓ ❑ Yes ❑No the system and installation of the specific equipment ❑ ❑ shall be verified. Yes is a pass I Pass I Fail ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without Thermostatic Expansion Valves Outdoor Unit Serial# Location Outdoor Unit Make Outdoor Unit Model Cooling Capacity Btu/hr Date of Verification Date of Refrigerant Gauge Calibration (must be checked monthly) Date of Thermocouple Calibration (must be checked monthly) Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above): Procedures for Determining Refrigerant Charge using the Standard Method are available in RA CM,Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures Supply(evaporator leaving)air dry-bulb temperature(Tsupply,db) OF Return(evaporator entering)air dry-bulb temperature(Tretum,db) OF Return(evaporator entering)air wet-bulb temperature(Tretum,wb) °F Evaporator saturation temperature(Tevaporator,sat) OF Suction line temperature(Tsuction,db) OF Condenser(entering)air dry-bulb temperature(Tcondenser,db) OF Superheat Charge Method Calculations for Refrigerant Charge Actual Superheat =Tsuction,db—Tevaporator,sat OF Target Superheat(from Table RD-2) OF Actual Superheat—Target Superheat (System passes if between-5 and+5°F) OF Temperature Split Method Calculations for Adequate Airflow S lit Method Calculation is not necessary i Ade nate Airflow credit is taken Actual Temperature Split =T return,db Tsupply,db OF Target Temperature Split(from Table RD3) OF Actual Temperature Split Target Temperature Split (System passes if between- of 3°F and+3°F or,upon remeasurement,if between -3°F and-100°F) Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 6 of 12) CF-6R Site Address Permit Number Standard Charge Measurement Summary: System shall pass both refrigerant charge and adequate airflow calculation criteria from the same measurements. If corrective actions were taken,both criteria must be remeasured and recalculated. ✓ ❑ Yes 10 No I System Passes Alternate Charge Measurement Procedure (outdoor air dry-bulb below 55°F) Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer verification shall be documented on CF-6R before starting this procedure. If outdoor air dry-bulb is 55 OF or above, installer shall use the Standard Charge Measure Procedure: Procedures for Determining Refrigerant Charge using the Alternate Method are available in RACM,Appendix RD3. Wei h-In Charging Method for Refrigerant Charge Actual liquid line length: ft Manufacturer's Standard liquid line length: ft Difference(Actual—Standard): ft Manufacturer's correction(ounces per foot) x difference in length = ounces (+=add)(-=remove) Measured Airflow Method for Adequate Airflow Verification available in RACM, Appendix RD2.6 Calculated Airflow: Cooling Capacity(Btufhr) X 0.033 (cf n/Btu-hr)= CFM Measured Airflow is CFM(Measured airflow must be greater than the calculated airflow). Alternate Charge Measurement Summary: System shall pass both refrigerant charge and adequate airflow calculation criteria from the same measurements. If corrective actions were taken, both criteria must be remeasured and recalculated. ✓ 1 ❑ Yes 10 No I System Passes Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner Signature: Date: Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 7 of 12) CF-6R Site Address Permit Number MISCELLANEOUS CREDITS ✓ ❑ DIAGNOSTIC SUPPLY DUCT LOCATION,SURFACE AREA AND R-VALUE Procedures for field verification and diagnostic lesling for this group compliance credits are available in RA CM,Appendix RC, RE&RK. ✓ ❑ LESS THAN 12 LINEAL FEET OF SUPPLY DUCT OUTSIDE OF CONDITIONED SPACE COMPLIANCE CREDIT ✓ I []Yes ❑No I Less than 12 lineal feet of supply duct outside of conditioned space. Yes to this compliance credit is a pass I ✓ ❑ Pass ✓ ❑Fail ✓ ❑ SUPPLY DUCTS LOCATED IN CONDITIONED SPACE COMPLIANCE CREDIT ✓ ❑Yes 1 ❑No I Ducts are located within the conditioned volume of building. Yes to this compliance credit is a pass I ✓ ❑ Pass ✓ ❑ Fail Duct System Design verification is required for a compliance credit for the following: 1. Supply duct surface area reduction 2. Buried supply ducts on the ceiling 3. Deeply buried supply ducts ✓ ❑ DUCT SYSTEM DESIGN VERIFICATION ✓ ❑Yes ❑No Adequate airflow verified ✓ ❑Yes ❑No The duct system design plan meets the requirements specified in RACM,Appendix RE,Section RE.4.2 ✓ ❑Yes ❑No The duct system design plan exists on building plans ✓ ❑Yes ❑No Duct sizes,duct system layout and locations of supply&return registers match the duct system design plan Yes to all is a pass ✓ ❑ Pass ✓ ❑ Fail ✓ ❑ SUPPLY DUCTS SURFACE AREA REDUCTION COMPLIANCE CREDIT R-4.2 R-6.0 R-8.0 Crawl Deeply Duct Surface Surface Surface Attic Space Basement Covered Covered Other Diameter Area Area Area ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ I] ❑ ❑ ❑ ❑ ❑ ❑ Total Surface Area for Each R-Value= ✓ ❑ Yes I ❑ No tches Performance's CF-1 R? Yes to all is a pass ❑ Pass ❑ Fail ✓ ❑ BURIED DUCTS ON THE CEILING COMPLIANCE CREDIT ❑Yes ❑NoBuried Ducts on the Ceiling ❑ Yes 111 No I Verified High Insulation Installation Quality ✓ ✓ Yes to duct system design,supply duct surface area reduction and this compliance credit is a pass ❑ Pass ❑ Fail ✓ ❑DEEPLY BURIED DUCTS COMPLIANCE CREDIT ✓ ❑Yes ❑No Deeply Buried Ducts ./ ❑Yes ❑No Verified High Insulation Installation Quality ✓ ✓ Yes to ducts stem design,supply duct surface area reduction and this compliance credit is a pass ❑Pass ❑ Fail Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 8 of 12) CF-6R Site Address Permit Number ✓❑ FAN WATT DRAW Procedures or meamring the air handler watt draw are available in RACM,Appendix RE3.2. ✓ Method For Fan Watt Draw Measurement ❑ RE3.2.1 Portable Watt Meter Measurement ❑ RE3.2.2 Utility Revenue Meter Measurement Measured Fan Watt Draw Watts Measured Fan Flow enter total cfm from airflow verification cfm Enter results of Watts/cfm Watts/cfm ✓ ❑ Yes ❑No Measured fan watt/cfm draw is equal to or lower than the fan watt/cfm draw documented in CF-1 R ❑ ❑ Yes is a pass Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION Procedures or meastering the airflow are available in RACM,,Appendix RE3.1. ✓Method For Airflow Measurement ❑ RE4.1.1 Diagnostic Fan Flow Using Flow Capture Hood ❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement ❑ Yes ❑No Duct design exists on plans Measured Airflow: Total c Rated Tons cfm/ton cfm/ton ✓ ❑ Yes ❑No Measured airflow is greater than the criteria in Table RE-2 ✓ ✓ Yes is a pass Pass Fail ✓ ❑ MAXIMUM COOLING CAPACITY Procedures for del rmining maximum cooling load capacity are available in RACM,, Appendix RF3. I ✓ ❑ Yes ❑No Adequate airflow verified(see adequate airflow credit) 2 ✓ ❑ Yes ❑No Refrigerant charge or TXV 3 ✓ ❑ Yes ❑No Duct leakage reduction credit verified 4 ✓ ❑ Yes ❑No Cooling capacities of installed systems are<_to maximum cooling capacity indicated on the Performance's CF-1 R and RF-3. If the cooling capacities of installed systems are>than maximum ✓ ✓ 5 ✓ ❑ Yes ❑No cooling capacity in the CF-1 R,then the electrical input for the installed systems must be<_to electrical input in the CF-1 R. ❑ ❑ Yes to 1,2,and 3;and Yes to either or 5 is a pass Pass Fail ✓❑ HIGH EER AIR CONDITIONER Procedures for veri ication are available in RACM,AppendU PJ. l ✓ ❑ Yes ❑No EER values of installed systems match the CF-1 R 2 ✓ ❑ Yes ❑No Fors lit system, indoor coil is matched to outdoor coil ✓ ✓ 3 ✓ ❑ Yes ❑No Time Delay Relay Verified(If Required) ❑ ❑ Yes to 1 and 2;and 3 If Required) is a pass Pass I Fail Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner Signature: Date: Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 9 of 12) CF-6R Site Address Permit Number An installation certificate is required to be posted at the building site or made available for all appropriate inspections.(The information provided on this form is required)After completion of final inspection,a copy must be provided to the building department(upon request)and the building owner at occupancy,per Section 10-103(a). BUILDING ENVELOPE LEAKAGE DIAGNOSTICS ✓ ❑ ENVELOPE SEALING INFILTRATION REDUCTION Procedures for field verification and diagnostic testing of envelope leakage are available in RACM,Appendix RC. Diagnostic Testing Results ✓ ✓ Building Envelope Leakage(CFM @ 50 Pa)as measured by Rater: 1 ❑ ❑ Measured envelope leakage less than or equal to the required level from Yes No CF-1R? 2. ❑ ❑ Is Mechanical Ventilation shown as required on the CF-IR? Yes No 2a ❑ ❑ If Mechanical Ventilation is required on the CF-1R(`Yes' in line 2),has it Yes No been installed? Check this box`yes' if mechanical ventilation is required(`Yes' in line 2) 2b. E] E] and ventilation fan watts are no greater than shown on CF-1 R. Yes No Measured Watts= Check this box"yes"if measured building infiltration(CFM @ 50 Pa) is 3. E] E] greater than the CFM @ 50 values shown for an SLA of 1.5 on CF-1R Yes No If this box is checked no,mechanical ventilation is required.) Check this box"yes"if measured building infiltration(CFM @ 50 Pa) is El El less than the CFM @ 50 values shown for an SLA of 1.5 on CF-1 R, 4. Yes No mechanical ventilation is installed and house pressure is greater than minus 5 Pascal with all exhaust fans operating. Pass if: a.Yes in line I and line 3,or ✓ ✓ b.Yes in line l and line2,2a,and 21b,or c.Yes in line 1 and Yes in line 4. ❑ ❑ Otherwise fail. Pass Fail ✓ ❑ I,the undersigned,verify that the building envelope leakage meets the requirements claimed for building leakage reduction below default assumptions as used for compliance on the CF-1R. This is to certify that the above diagnostic test results and the work I performed associated with the test(s)is in conformance with the requirements for compliance credit. (The builder shall provide the HERS provider a copy of the CF-6R signed by the builder employees or subcontractors certifying that diagnostic testing and installation meet the requirements for compliance credit.) Test Performed Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner Signature: Date: Copies to: BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 4 of 12) CF-6R Site Address Permit Number g ` INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT The building was: ✓ ❑Tested at Final ✓ 11 Tested at Rough-in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE FOR NEW DUCTS: �Q Remove at least one supply and one return register,and verify that the spaces between the register boot and the interior finishing wall are properly sealed. If the house rough-in duct leakage test was conducted without an air handler installed, inspect the connection points between the air handler and the supply and return plenums to verify that the connection points are properly sealed. Inspect all joints to ensure that no cloth backed ribber adhesive duct tape is used on new ducts. ✓ ❑ DUCT LEAKAGE REDUCTION Procedures or reld verification and diagnostic testing of air distribution systems are available in RACM,Ap pend&RC4.3 NEW CONSTRUCTION: Duct Pressurization Test Results(CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM: Fan Flow:Calculated(Nominal: ✓❑Cooling✓ ❑Heating)or✓❑Measured 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21.7 cfm/(kBtufhr) x Heating Capacity in Thousands of Btu/hr,enter total calculated or measured fan flow in CFM here: ✓ ✓ Pass if Leakage Percentage< 6%for Final or<4%at Rough-in without air handle: 3 100 x Line# I / (Line#2) ❑ Pass ❑ Fail ALTERATIONS:Duct System and/or HVAC Equipment Change-Out 4 Enter Tested Leakage Flow in CFM from Pre-Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change-Out. Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct 5 S stem for Duct System Alteration and/or Equipment Chan e-Out. Enter Reduction in Leakage for Altered Duct System 6 (Line#4) Minus Line#5) — (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside(Only if Applicable) ✓ ✓ Entire New Duct System-Pass if Leakage Percentage <6%for Final. ❑Pass ❑ Fail 8 100 x Line#5 / Line#2 TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change- ✓ ✓ Out Use one of the following four Test or Verification Standards for compliance: 9 Pass if Leakage Percentage< 15% [100 x[ (Line#5)/ (Line#2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage< 10% [100 x (Line#7)/ (Line#2)]] ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage>60% [100 x [_(Line#6)/ (Line#4)]] ❑ Pass ❑ Fail 11 and Verification by Smoke Test and Visual Inspection 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Ins ection ❑Pass ❑ Fail Pass if One of Lines#9 through# 12 ass ❑ Pass ❑ Fail ✓ 9I,the undersigned,verify that the above diagnostic test results were performed in conformance with the requirements for compliance credit.I,the undersigned,also certify that the newly installed or retrofit Air-Distribution System Ducts,Plenums and Fans comply with Mandatory requirements specified in Section 150(m)of the 2005 Building Energy Efficiency standards. Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner Signatur • Date: Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY Residential Compliance Forms December 2005 INSTALLATION CERTIFICATE (Page 10 of 12) CF-6R Site Address Permit Number L.PLW VIC,IG¢gK�G�. glic G4 l ��--c.o'lf Insulation Installation Quality Certificate ✓ 12rDescription of Insulation,(CF-6R,formerly IC-1)signed by the installer stating: insulation manufacturer's name, material identification,installed R-values,and for loose-fill insulation: minimum weight per square foot and minimum inches ✓ Q(Installation meets all applicable requirements as specified in the High Quality Insulation Installation Procedures (ACM,Appendix RH) ✓ FLOOR ❑ ❑ All floor joist cavity insulation installed to uniformly fit the cavity side-to-side and end-to-end Ye5. No NA ❑ ❑ Insulation in contact with the subfloor or rim joists insulated Ye_s, No NA ❑ ❑ Insulation properly supported to avoid gaps,voids,and compression Yes No NA ✓WALLS IV ❑ ❑ Wall stud cavities caulked or foamed to provide an air light envelope Yes No NA ❑ ❑ Wall stud cavity insulation uniformly fills the cavity side-to-side,top-to-bottom,and front-to-back Yes No NA 8 ❑ ❑ No gaps Yes No NA ❑ ❑ No voids over 3/4"deep or more than 10%of the batt surface area. Yes No NA Sr ❑ ❑ Hard to access wall stud cavities such as;comer channels,wall intersections,and behind Yes No NA tub/shower enclosures insulated to proper R-Value W ❑ ❑ Small spaces filled Yes No NA 10 ❑ ❑ Yes No NA Rim joists insulated ❑ ❑ Loose fill wall insulation meets or exceeds manufacturer's minimum weight-per-square-foot Yes I No NA I requirement ✓ ROOF/CEILING PREPARATION ❑ ❑ All draft stops in place to form a continuous ceiling and wall air barrier Yes No NA ❑ ❑ All drops covered with hard covers Yes No NA ❑ ❑ All draft stops and hard covers caulked or foamed to provide an air tight envelope Yes No NA ❑ ❑ All recessed light fixtures IC and air tight(AT)rated and sealed with a gasket or caulk between the Yes No NA housing and the ceiling ❑ ❑ Floor cavities on multiple-story buildings have air tight draft stops to all adjoining attics Yes No NA ❑ ❑ Eave vents prepared for blown insulation-maintain net free-ventilation area Yes No NA 1-1 ❑ Knee walls insulated or prepared for blown insulation Yes No NA 1-:1 ❑ Area under equipment platforms and cat-walks insulated or accessible for blown insulation Yes No NA ❑ ❑ Attic rulers installed Yes No NA Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 11 of 12) CF-6R Site Address .}� �• Permit Number (�GQ'� V IGticS�� .+� C..'^Pt�-"�v►s C1g" 1'30 ✓ ROOF/CEILING BATTS ® ❑ ❑ Yes No NA No gaps ❑ ❑ Yes No NA No voids over'/4 in.deep or more than 10%of the batt surface area. Yes No NA Insulation in contact with the air-barrier ❑ ❑ Ye No NA Recessed light fixtures covered ❑ ❑ Net free-ventilation area maintained at eave vents Yes No NA 1, ✓ ROOF/CEILING LOOSE-FILL 1J Yes No NA Insulation uniformly covers the entire ceiling(or roof)area from the outside of all exterior walls. ❑ ❑ ❑ Yes No NA Baffles installed at eaves vents or soffit vents-maintain net free-ventilation area of eave vent ❑ ❑ ❑ Yes No NA Attic access insulated ❑ ❑ ❑ Yes No NA Recessed light fixtures covered ❑ ❑ ❑ Yes No NA Insulation at proper depth—insulation rulers visible and indicating proper depth and R-value ❑ ❑ ❑ Loose-fill insulation meets or exceeds manufacturer's minimum weight and thickness requirements Yes No NA for the target R-value. Target R-value . Manufacturer's minimum required weight for the target R-value (pounds-per-square-fool). Manufacturer's minimum required thickness at time of installation . Manufacturer's minimum required settled thickness . Note: To receive compliance credit the HERS rater shall verify that the manufacturer's minimum weight and thickness has been achieved for the target R-value. CF-61?only) DECLARATION ✓ I hereby certify that the installation meets all applicable requirements as specified in the Insulation Installation Procedures. Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner 04 4::0-4&-1tx 't � Signator Date: (v1 I 11-1 Copies to:BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 v INSTALLATION CERTIFICATE (Page 12 of 12) CF-6R Site Address Permit Number County Subdivision Lot Number Description of Insulation (Formerly IC-1 Form) 1. RAISED FLOOR Material (,y *"-( Brand Name Thickness(inches) Thermal Resistance(R-Value) 2. SLAB FLOOR/PERIMETER Material Brand Name Thickness (inches) Thermal Resistance(R-Value) Perimeter Insulation Depth (inches) 3. EXTERIOR WALL Frame Type .Sft.O kJ4-L/L A. Cavity Insulation Material Q W113 Brand Name k-&aA04&VL V4,0 R1 n Thickness(inches) Thermal Resistance(R-Value) ¢-'13 B . Exterior Foam Sheathing Material Brand Name Thickness (inches) Thermal Resistance(R-Value) 4. FOUNDATION WALL Material Brand Name Thickness(inches) Thermal Resistance(R-Value) 5. CEILING Batt or Blanket Type t3 mef f Brand Name �n�6k�"f ire-0 —40-071 Thickness (inches) Thermal Resistance(R-Value) IZ—3 Z) Loose Fill Type Brand Contractor's min installed weight/ft' lb Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value) 6. ROOF Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Declaration ✓ 511 hereby certify that the above insulation was installed in the building at the above location in conformance with the current Energy Efficiency Standards for residential buildings(Title 24,Part 6,California Code of Regulations)as indicated on the Certificate of Compliance,where applicable. Item#s Si afore Date Installing Subcontractor(Co.Name)OR (if applicable) General Contractor(Co.Name)OR Owner OR Window Distributor u iu �✓�sre�c L�„art�•�-� Item#s Signature Date Installing Subcontractor(Co.Name)OR (if applicable) General Contractor(Co.Name)OR Owner OR Window Distributor Item#s Signature Date Installing Subcontractor(Co.Name)OR (if applicable) General Contractor(Co.Name)OR Owner OR Window Distributor Residential Compliance Forms April 2005 Page 2 Subject: Residential Addition/Remodel (1.223SQ FT) - Submittal No. 1 Approved Name: Sbah Residence Address: 19681 Vickburg Drive APN: 369-08-018 Permit No.: 1:3070089 • District inspection is required prior to clearance for. City of Cupertino Final Inspection. Owner to call District at least 48 hours to schedule a District inspection. District to provide Building Department with written notification upon. completion of inspection. (O.C. 5.104) All conditions, requirements and recommendations are to he completed at the (Owner/Developer)'s expense. Sto.Txn water from surface or roof drains, other general surface runoff water or condensate from any residential.HVAC equipment shall not be discharged to the sanitary sewer. Yours very truly, MARK THOMAS & COMPANY, INC. District Manager-Engineer � for Richnafdanaka If you have any questions or need additional information, please call Chien Vu or Nichol Bowersox at 408-253-7071. 5;1�'JU[tf)S\CUS'Q\LF..1 fERS\BU(l..l�fNCl DF.P l'l,L"1"1'1 RS1Rl SIM NT1A1,AT)Dn TONS Rf:M0bR1.AAddi60111I 2013\130700e9_Rczidential Addn_Rcmodel_19681 Vickbarl;1)r—Sub_1_10-03-13.doc SUPPLYING SANITARY SEWERAGE SERVICES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITIES OF S4RATOGA,SUNNYVALE,LOS ALTOS AND SURROUNDING UNINCORPORATED AREAS