15120175 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10590 LA RODA DR CONTRACTOR:HOME GENERAL PERMIT NO:15120175
CONTRACTORS
OWNER'S NAME: CHAU JOEY AND CHANG SHIH-CHI 41498 TIMBER CREEK TER DATE ISSUED: 12/21/2015
OWNER'S PHONE: 4088889668 FREMONT,CA 94539 PHONE NO:(510)709-8356
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
If REMODEL BATHROOM#1 AND#2(160 S.F.);REMOVE&
License Class Lic.4 �,:) 11 1 REPLACE FURNACE/AC IN GARAGE;INSTALL 13(N)
Contractor's 0)YV gA,t< Date 1 1 ` RECESSED LIGHTS;REPLACE 3 WINDOWS,1(N)
WINDOW
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 $70000
I have and will maintain Worker's.Compensation Insurance,as provided for by
Section 3700 of Labor Code,for the performance of the work for which this APN Number:36933019.00 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 WORD IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM 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 ( l c
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
-�7 RE-ROOFS:.
Signature Date )�� All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date;
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the roe y g HAZARDOUS MATERIALS DISCLOSURE
property,rty,am exclusive) contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code;for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
the Health&Safety Code,Sections 25505,25533,and 25534.
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 ;' Date:
Owner or authorized agent: -. «-
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 CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shalt 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
CITY OF CUPERTINO 1500, 0
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10590 La Roda Dr DATE: 12/21/2015 REVIEWED BY: PAUL
APN: 369 33 019 BP#: EVALUATION: 1$70,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM
USE: pPERMIT TYPE:
WORK Remodel Bathroom#1 and#2 160 S.f. ; Remove & Replace Furnace/AC in Garage; Install 13..(N)
SCOPE Recessed Lights; Replace 3 windows, 1 (N)window in Bath#2 and (N) slider door in Bedroom#3
E�.
Mech.Plan Check 0.0 hrs $0.00 >- • . Elec.Plan Check 0.0 hrs $0.00
3 , f.�st�'n; — ,,
Mech.Permit Fee: 111PERMIT ?' F 3 , f: Elec.Permit Fee: I EPERMIT
Other Mech.Il .
nsp. 0.0 hrs $48.00 E,..,~1, # ..,T ..; Other Elec,Insp. 0.0 hrs $48.00
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These.fees are based on the preliminary information available and are only an estimate. Contact the De t or addn't info.
FEE ITEMS(Fee Resolution Il-0 3 Fff. 7/11.13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00160 s.f. Remodel,B�1a-(<=300 sf)
Suppl.PC Fee: (E) Reg. 0 OT 0.0 hrs $0'.00 $645.00 IREMRESBAT
PME Plan Check: $0.00 1 # Mechanical
Permit Fee: $0.00 $143.0.0 IMFR=<101J Furnace,Forced-Air
Suppl.Insp.Fee:E Reg. Q OT �Ohrs $0.00 13 Electrical
PME Unit Fee: $0.00 $72.00 IBREMFIXT Fixtures,Lighting
PME Permit Fee: $96.00 1 # Window/ding Glass Door
tE3. •i
$503.00 1 FiEINNEWNST New(Non-Structural)
'6X: —1777T —��--� Window/Sliding Glass Door Q
Administrative Fee: 1ADMIN /$45.00 1. 4 #
Work Without Permit? Yes E) No $0.00 $431.00 1WINREP Replacement
/advanced Planning Fee: $0.00 Select a Non-Residential
" Building or Structure 0
Travel Documentation Fee: ITRAVD0C $48.00
Strong Motion,fee: IBSEISMIGR $9.10
Select an Administrative Item
Bldg}Stds mmisslon Fee 1BCBSC $3.00
=SIISTAI, � $201.10 $1,794.00
TI�TAL FEE, $1,995
.10
Revise 1010
CONSTRUCTION PERMIT APPLICATION
COVAWNl I Y`DEVELOPIViENT DEPARTMENT•BUILDING DIVISION
10300 T ORRE AVENUE•CUPERTINO,CA 85014-3255
CUPERTihtO (408)777-3228 FAX(408)777-3333•buildingQ-cuDertino.ora
❑1tTEW CONSTRUCTION u ADDrriON ALTERATION/TI ❑ RE7,q5I0N/DEFERRED ORIGINAL PERbirf
PROI^ECTAIXA SSYa 5--) APN. 3� 331Li
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STREET ADDRESS I CRY, STATE,ZIP I FAX
CONTACT N.LVfi Z � � I PHONE
STREir ADDR'-.SS CITY,STATE,ZIP ( FAX
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CQN-iPACiOR'NAMEI .
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DES RIPTION OF WORK
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EMSTINGUSE I PROPO FD USE I C NSTATYPE I '• P.r
STOS I
USE I TYPE I OCC. f SQ.FT. I VALUATION(S)
111
FX7CTG hcW Z00R DEMO TOTAI.
AJMA I AREA ( AREA I NET AREA I I
BAThROOM K71 CHEM OTHYX + I I
RMAODEL AREA 160 1
P-SODEL AREA I REMODEL AREA
PORCHAREA I DECKAPEA TOTAL DEMPORCH ARBA I GARAGEPR=A: LJ DETACH
[]A-"Aca
D EL.LING UNITS: ISA SEC O D unrr ❑YES SECOND STORY E]YEs
BEING ADDED? E3NO ADDP?'ION? ❑NO
PRE-e nm IC.4TION ❑YrS IF T:S,?ROVED:COPY OF I IS THE BLDG AN ❑YES r D 31 OMENS= TOTAL VALUATION:
PL AKR\'I1dG APPL.R ❑N.0 PLANNING APFROVP.LL=-ITER EICHLER,"OhIE? ❑V0 -
ME
By my signature below,I certify to each of the folloavin_: I am the property ovamer or a'thonz d agent to act on the prop owner's behalf' I have ad this
application and the information I have proeided is correct. I have read the-Description of Work and Yer17 it is accurate. I agTee to comply vith all applicable local
ordinances and State laws relating to building construction. I authorize representatives-oil Cupertino to enter the above-iaentl-sed propery for inspection purposes.
3 ys- if
Si znatur e of Applicant/Agent; DG` _
SU�PLE>lfENTAL IivIFOIZI TION REQUIRED LI s ovn�_�Lip _
New SFD or 1*fuhifanily dv�ellings Apply fordemoll ion per---nit for � rsE�cov~<TEx�
existing building(s). Demolition pernit is reau_reti prier to_ssiiance of buildirlg
permit for new building. r�ss � PI A�� ELa�Pz vE .
_Cornnercial Bldgs: Provide a completed HaZard6uS'14faterials Disclosure
-.n if uny I�azardous b4aterials are beinaa used as part.Of this project.
E�EPT
_Copy of Planning Approval Letter or I feeting with PIannin>a prior to � r
> �-nZ470R=� � 'n- AT�'i'�tY'SEii�R�I53'•RTCd .. ,
submittal of Bnildirg Perot app
Iicatica. �— s =
.. �-� _,._���_� ���:. -`T��•„�sROn�✓,EnT.�r,F�6:r..Tx.. - -
Bldg1-pp_2011.d6c revised 06/21/11
CERTIFICATE OF VERIFICATION7_� CF3R-MCH-20-H
Duct Leakage Diagnostic Test (P
Project Name: 10590 RODA DRIVE Enforcement Agency: City of Permit Number: 15120175
Cupertino
Dwelling Address: 10590 LA RODA DRIVE City: Cupertino Zip Code: 95014
A. System Information
01 Space Conditioning System Identification or Name System 1
02 Space Conditioning System Location or Area Served Location 1
03 Building Type from CF-1R Single family
04
Verified Low Leakage Ducts in Conditioned Space No, credit is not taken
(VLLDCS)Credit from CF1R?
05 Verified Low Leakage Air Handling Unit Credit from No,credit is not taken
CF1R?
06 Duct System Compliance Category Alteration
MCH-20d -Complete Replacement or Altered Duct System
B. Duct Leakage Diagnostic Test
01 Condenser Nominal Cooling Capacity(ton) 0
02 Heating Capacity(kBtu/h) 36
03 Conditioned Floor Area served by this HVAC system (ft2) 2526
04 Duct Leakage Test Condition Test final
05 Duct Leakage Test Method Total leakage
06 Leakage Factor 0.15
07 Air Handling Unit Airflow(AHUAirflow) Determination Heating system method
Method
08 Measured AHUAirflow This field or section is not applicable
09 Calculated Target Allowable Duct Leakage Rate(cfm) 117
10 Actual duct leakage rate from leakage test measurement 111
(cfm)
11 Compliance Statement: System passes leakage test
Registration Number:216-A0123806A-M2000002A-M20A Registration Date/Time: 2016-04-04 09:42:44 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-04-04 09:42:32
2013 Residential Compliance Schema Version:2013.1.007
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 2 of 3 )
B. Duct Leakage Diagnostic Test
12 Notes:
C. Additional Requirements for Compliance
01 System was tested in its normal operation condition. No temporary taping allowed.
Outside air(OA) duct connections to tho central forced air duct system shall not be sealed/taped off during duct leakage
02 testing. OA ducts used for Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan Ventilation
Cooling Systems, that utilize dampers that open only when OA is required and automatically close when OA is not required,
may configure the OA damper to the closed position during duct leakage testing.
03 If a complete replacement, all supply and return register boots were sealed to the drywall.
04 Building cavities were not used as plenums or platform returns in lieu of ducts.
05 If cloth backed tape was used it was covered with Mastic and draw bands.
06 All connection points between the air handler and the supply and return plenums are completely sealed.
If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements
07 of Reference Residential Appendix RA3.1.4.3.6. Systems that comply using smoke test shall not be included in sample
groups for HERS verification compliance.
08 Verification Status Pass-all applicable requirements are met
09 Correction Notes for this table
The responsible persons signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Corrections Notes in this table.
D. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance.
O1 Complies:All specified verification protocol requirements on this document are met.
Registration Number:216-A0123806A-M2000002A-M20A Registration Date/Time: 2016-04-04 09:42:44 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-04-04 09:42:32
2013 Residential Compliance Schema Version:2013.1.007
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 3 of 3)
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
Martin Kostrzewa /1�� �c.ivi(foze
Company: Date Signed:
Archon Energy Solutions 2016-04-04 09:42:44
Address: CEA/HERS Certification Identification(if applicable):
607 Elmira Road#293
City/State/zip: Phone:
Vacaville CA 95687 888-600-1614 1
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Verification is true and correct.
2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification(responsible rater).
3. The installed features,materials,components,manufactured devices,or system performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2,RA3,and the requirements
specified on the Certificate of Compliance for the building approved by the enforcement agency.
4. The information reported on applicable sections of the Certificate(s)of Installation(CF2R)signed and submitted by the person(s)responsible for the
construction or installation conforms to the requirements specified on the Certificate(s)of Compliance(CF1R)approved by the enforcement agency.
5. 1 will ensure that a registered copy of this Certificate of Verification shall be posted,or made available with the building permit(s)issued for the
building,and made available to the enforcement agency for all applicable inspections.I understand that a registered copy of this Certificate of
Verification is required to be included with the documentation the builder provides to the building owner at occupancy.
Builder Or Installer Information As Shown On The Certificate Of Installation
Company Name(Installing Subcontractor,General Contractor,or Builder/Owner):
HOME GENERAL CONTRACTORS
Responsible Builder or Installer Name: CSLB License:
Chris Chung 856215
HERS Provider Data Registry Information
Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable)
Tested
HERS Rater Information
HERS Rater Company Name:
Archon Energy Solutions
Responsible Rater Name: Responsible Rater Signature:
Martin Kostrzewa //���ICoO J�T�ZP.IftQi
Responsible Rater Certification Number w/this HERS Provider: Date Signed:
CC2006636 2016-04-04 09:42:44
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document,and in noway implies Registration Provider
responsibility for the accuracy of the information.
Registration Number:216-A0123806A-M2000002A-M20A Registration Date/Time: 2016-04-04 09:42:44 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-04-04 09:42:32
2013 Residential Compliance Schema Version:2013.1.007