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14090118-F
I CITY OF CUPERTINO BUILDING PERMIT I 1 BUILDING ADDRESS: 10711 GASCOIGNE DR I CONT G.C. RACTOR: GILBERT FERNANDEZ I PERMIT NO: 14090118 I OWNER'S NAME: JING SHEN AND YANG FEIFEI 1 1821 S BASCOM AVE STE 258 I DATE ISSUED: 11/12/2014 1 OWNER'S PHONE: 4088383897 1 CAMPBELL, CA 95008 1 PHONE NO: (408) 500 -8511 1 a- LICENSED CONTRACTOR'S Pj DECLARATION License Class __a_ Lic. #_�S!IQ 77 Contractor 6 dbm-' Ter as ( Dat � 11— 1z, Z ()t 4 1 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: 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. APPLICANT CERTIFICATION 1 certify that 1 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- poin source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date — I Z- Zo KJ ❑ OWNER- BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I 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. 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. 1 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 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 9.18. Date JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL CONSTRUCT FIRST STORY ADDITION (100 SQ FT); ATTACHED GARAGE (471 SQ FT); FRONT PORCH (110 SQ FT); 2ND STORY ADDITION (777 SQ FT); REMODEL (E) Sq. Ft Floor Area: 1 Valuation: 5185600 APN Number: 37531018.00 1 Occupancy Type: PER IT EXPIRES IF WORK IS NOT STARTED WITH 80 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST,CALLED INSPECTION. Issued Date: /� 12-1 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 Appl 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 1 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 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Secfioq&�5505, 33, and 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional U F. M_1 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10711 gascoigne dr DATE: 09/18/2014 REVIEWED BY: melissa APN: 375 31 018 BP #: 1 LL zA <L)7 'VALUATION: 1$185,600 ^PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? OTC? Yes No 0 Yes (F) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK ADD 2ND STORY 777 S.F.), REMODEL (E) GROUND LEVEL SFD, INCLUDING GARAGE TOTAL SCOPE 2,090 S.F.) UPGRADE (E) PANEL TO 200AMPS, RE -ROOF (E) 18 SQ'S), REPLACE (E) HVAC p OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Custom) II- B,III- B,IV,V -B 777 $2,654.00 IR3PLNCK $1,666.00 IR3INSP $0.00 PME Plan Check: $0.00 200 1 amps $48.00 Electrical IBELEC200 Services Permit Fee: $1,666.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 0 # Mechanical $143.00 IMFR = <100 Furnace, Forced -Air PME Unit Fee: $0.00 PME Permit Fee: $96.00 TOTALS: 777 $2,654.00 $1,666.00 MECH, HOURLY 0 Yes G No PLUMB, HOURLY 0 Yes Q No ELEC, HOURLY Q Yes Q No Mech. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 1 hrs $0.00 Mech. Permit Fee: IMPERMIT $2,654.00 Elec. Permit Fee: IEPERMIT Other Mech. Insp. Ehns t $48.00 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 Dept.for addn'1 info. FEE ITEMS dI cfe Resolution 11-053 Eff I,`131 FEE QTY /FEE MISC ITEMS Plan Check Fee: $2,654.00 2,090 s. f. $5,456.00 Remodel, Other IREMRES2 Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 200 1 amps $48.00 Electrical IBELEC200 Services Permit Fee: $1,666.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 0 # Mechanical $143.00 IMFR = <100 Furnace, Forced -Air PME Unit Fee: $0.00 PME Permit Fee: $96.00 0 # Mechanical $72.00 IBREMAIR A/C Units ( < =10K cfm) 1,800 s.f. $306.00 Re -roof IREROOFRES E) Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: IPLLONGR $108.78 Select a Non - Residential Building or Structure i Travel Documentation Fee: ITRAVDOC $48.00 Strom Motion Fee: IBSEISMICR $24.13 Select an Administrative Item Bldn; Stds Commission Fee: IBCBSC $8.00 SUBTOTALS: $4,604.91 $6,025.00 TOTAL FEE: 1 $10,629.91 Revised: 08/20/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10711 GASCOIGNE DR CONTRACTOR: GILBERT FERNANDEZ PERMIT NO: 14090118 JR G.C. OWNER'S NAME: JING SHEN AND YANG FEIFEI 1821 S BASCOM AVE STE 258 DATE ISSUED: 11/12/2014 OWNER'S PHONE: 4088383897 CAMPBELL, CA 95008 PHONE NO: (408) 500 -8511 ❑ LICENSED CONTRACTOR'S DECLARATION License Class/s__ Lic. #_ _/ Contractor C'7, �L c r� / t rnOn d_-7 Date n 2. 2 . _LL 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: 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. II l�1have 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 regula ions per the Cupertino Municipal Code, Section 9.18. Signature //' Date 0,2. ❑ OWNER- BUILDER DECLARATION I hereby affirm that I 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I 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. 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. 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 l 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 9.18. Signature Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT FIRST STORY ADDITION (100 SQ FT); ATTACHED GARAGE (471 SQ FT); FRONT PORCH (110 SQ FT); 2ND STORY ADDITION (777 SQ FT); REMODEL (E) REVISION #1- KITCHEN LAYOUT; REPLACE EXTERIOR WALLS AND RAISE ROOF @ BEDROOMS. ISSD OTC 2/24/2015 Sq. Ft Floor Area: I Valuation: $185600 APN Number: 37531018.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FRO ST CALLED INSPECTION. Issued by: Date: A.;2-1157 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 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. I 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 I 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: 0 2, 2U. /S CONSTRUCTION LENDING AGENCY I 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 FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Di.ctriet etc)- Thece fees are hated an the nreliminary information available and are only an estimate_ Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff 7/1113) ADDRESS: 10711 gascoigne dr DATE: 02/24/2015 REVIEWED BY: Mendez APN: BP #: Q "VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 0.0 ENTAMATION 1GENRES P TYPE: PERMIT WORK REVISION #1- KITCHEN LAYOUT; REPLACE EXTERIOR WALLS AND RAISE ROOF SCOPE BEDROOMS. ISSD OTC 2/24/2015 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Di.ctriet etc)- Thece fees are hated an the nreliminary information available and are only an estimate_ Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff 7/1113) FEE QTY /FEE MISC ITEMS Plan Check Fee: Hourly Only? () Yes (E) No $0.00 F_717 hours $143.00 Plan Check, Hourly ISTPLNCx Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes Q No $0.00 Suppl. Insp. Fee: Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning_Fee: $0.00 Select a Non - Residential Building or Structure Strong; Motion Fee: $0.00 2.0 hrs $286.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $429.00 TOTAL FEE: $429.00 Revised: 02/14/2015 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(alcupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI :9 REVISION / DEFERRED ORIGINAL PERMIT # ! YO 10/1 PROJECT ADDRESS d I ' J� nC APN 4 7 OWNERNAME PHONE 7� r s -3_ E -MAIL �su STREET ADDRESS ] I �� �. p CITY, STATE, ZIP n IC /ij l�S F CONTACT NAME /yea; /' T IVY l� C-f� PHONE j �y� ! V l E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME "- LICENSENUAQBER /� LIC11 SETYPE BUS, LIC N �, COMPANY NAME E -MAT FAX STREET ADDRESS � C ,STATE, ZIP _ PHQi�'E v'� n p ARCETFCTIENGINEER NAME � � LICENSE NUMBER / j (� ( / (� BUS. LIC 4 COMPANY NAME E -MAIL - .- FAX l C STREET ADDRESS �` �(ryry7 �y�� .M. ( -j CITY, STATE, ZIP �A) /� A I� �� {� PHONE DESCRIPTION OF WORK ND C :2i�i�LflG� EXISTING USE PROPOSED USE CONSTR TYPE N STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTTER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE ARP_A: DETACH ❑ ATTACH N DWELLING UN'rIS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? NO ADDITION? ❑NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED TOTAL V TION: PLANNING APPL N ❑NO PLANNDNIG APPROVAL LETTER EICHLERHONIE? ❑NO G x By my signature below, I certify to each ofthe following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construc I authorize represent 'ves of Cupertino to enter the abovee-- i-d�entified for inspection purposes. /tion. Jproperty S ignature of Applicant/Agent: — / - ---- Y'1_.�- � ` ` Date: L , / 2 /2, [ �a SUPPLEMENTAL INFORMATION REQUIRED PiAi CHECIilPE " , RoUTII.c siiP DYERT73ECOUI\TER BUILDI]1GPLANREVIEW 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. ❑ EAPRESS e y 3; AAiImG PI AI` REVIE \i > - }x Commercial Bldgs: Provide a completed Hazardous Materials Disclosure )] sTA73DAR0 PUBLICNiOItKS _ form if any Hazardous Materials are being used as part ofthis project. ` ❑ FIRE Copy of Planning Approval Letter or Meeting with Planning prior to LARGER s 3 pEPT _ submittal of Building Permit application. ❑ MAJOR ❑ SAN]TARYSEWERDISTRICT - ❑_: :EIVVII20D71IENTAL73EALTA ::: BldgApp_2011.doc revised 06121111 I CITY OF CUPERTINO BUILDING PERMIT I 1 BUILDING ADDRESS: 10711 GASCOIGNE DR I CONTRACTOR: GILBERT FERNANDEZ I PERMIT NO: 14090118 OWNER'S NAME: JING SHEN AND YANG FEIFEI OWNER'S PHONE: 4088383897 Q LICENSED CONTRACTOR'S DECLARATION License Class /2 Lic. # C i Ll1 & 7 Contractor �� .¢ / y� ,4:r�� fD>3te 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 eompensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. �y�Y15101 I have and will maintain Worker's Compensation Insurance, as provid�Irfo'r y Section 3700 of the Labor Code, for the performance of the work for wboxe .__. 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 9.18. Signature ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I 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. 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. 1 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 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 9.18. Date 1821 S BASCOM AVE STE 258 1 DATE ISSUED: 11/12/2014 CAMPBELL, CA 95008 1 PHONE NO: (408) 500 -8511 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] CONSTRUCT FIRST STORY ADDITION (100 SQ FT); ATTACHED GARAGE (471 SQ FT); FRONT PORCH (110 SQ FT); 2ND STORY ADDITION (777 SQ FT); REMODEL (E) REVISION #2- CONVERT (E) TRELLIS W/ ROOF COVERED PORCH -ISSD OTC 4/9/2015 Floor Area: Valuation: $185600 APN Number: 375310I8.00 Occupancy Type: PERMIT EXPIRES IF WQRK IS NOT STARTED WITHIN 180 D 3 RMIT ISSUANCE OR 180 DAYS F O T CALLED INSP C ION. Issued by: Date: y RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 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(x) should I store or handle hazardous material. Additionally, should I 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, 2,5,� and 25534. Owner or authorized agent: �C _� Date: CONSTRUCTION LENDING AGENCY I 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: PERMIT # 140 OWNER'S NAME: PHONE # U -- 7 Lt GENERAL CONTRACTOR: Gd60V4 rZ jnUjjej& BUSINESS LICENSE # ADDRESS: -* 2 CITY /ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 17 ' ZO i S Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME / BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(d)cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/T1 ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10711 GASCOIGNE DRIVE APN# �S —3' , 0['s OWNERNAME JING SHEN / FEIFEI YANG PHONE 408 - 838 -3897 E-MAIL jshenl @gmail.com STREET ADDRESS 10711 GASCOIGNE DRIVE CITY, STATE, ZIP CUPERTINO, CA 95014 FAx CONTACT NAME KYLE CHAN, ARCHITECT PHONE 510 - 396 -9731 E -MAIL kyle @kylechan.com STREET ADDRESS5205 PROSPECT ROAD #135 -120 CITY, STATE, ZIP SAN JOSE,, CA 95129 FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT 0 .ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME r� I LICENSE NUMBER LICENSE E BUS. LIC # COMPANY UMEE .. — I E -MAI — . Co kV'A FAX STREET ADDRESS CIT . STATE, ZI PHONE i S cwt AO (C KYLE CHAN, AIA LICENSE NUMBER C -31616 BUS. LIC# COMPANY NAME KYLE CHAN ARCHITECT E-MAIL kyle @kylechan.com FAX STREET ADDRESS 5205 PROSPECT ROAD #135 -120 CITY, STATE, ZIP SAN JOSE, CA 95129 PHONE 5(o 3q6 °C�3f DESCRIPTION OF WORK ADDITION OF SECONRD STORY STRUCTURE WITH NEW BEDROOMS AND BATHROOMS. REMODEL OF (E) KITCHEN AND BATHROOMS, PARKING GARAGE. INSTALL (2) 200AMP ELECTRICAL SERVICES. INSTALL (N) LIGHT AT (E) AREAS, REROOF EIV�I BUILDING, EXISTING USE RESIDENTIAL PROPOSED USE CONSTR. RESIDENTIAL TYPE V -B # STORIES 2 USE TYPE Occ. SQ.FT. VALUATION($> EXISTG AREA 1,671 SF NEW F AREA �D SF DEMO AREA TOTAL NETAREA2,597 SF KITCHEN 132 SF $13,200 BATHROOM REMODEL AREA 152 SF KITCHEN REMODELAREA 132 SF OTHER REMODEL AREA1, 806 SF BATHROOM 152 $15,200 PORCH AREA 109 SF DECKARE.A 264S TOTAL DECK/PORCH AREA GARAGE AREA: DETACH 468 SF ATTACH LIVING/ 1,338 S $133,800 373 SF BEDROOMS N DWELLING UNITS: 1 IS A SECOND UNIT QYES BEING ADDED? V9NO SECOND STORY YES ADDITION? ONO GARAGE 468 SF $23,400 PRE - APPLICATION E3YES IF YES, PROVIDE COPY OF Is THE BLDG AN YES REC TOTAL VALUATION: PLAPth ONO PLANNING APPROVAL LETTER �[yt'i,gP EICHLER HOME? H NO $185,600 By my signature below, [certify to each of the following: [ am the property owner orized agent to act e OWner's behalf. [have read this application and the information I have pmvid is correct. I have read the Description of Work and verify i ' accurate. I agr to comply with all applicable local ordinances and state laws relating to buildin cons[ ion. I authorize represematives of Cupertino to enter the above -id ti led pr erty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEM NFO ATION REQUIRED PLAN CHECK ROUMG SLIP ❑ OVER- THE - COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifam'd dwellings: Apply for demolition permit for existing building(s). De ition permit is required prior to issuance of building permit for new building. ❑ EXPRESS El PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE - ❑ FIRE DM 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 06/21/11 IM-7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 10711 gascoigne dr DATE: 04/09/2015 REVIEWED BY: Mendez APN: BP #: 'VALUATION: 1$12,000 `PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Suppl. PC Fee: E) Reg. ® OT PENTAMATION 1R3SFDADD PERMIT TYPE: WORK REVISION #2- CONVERT E TRELLIS W/ ROOF COVERED PORCH SCOPE NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dietrirt om 1_ Thoco foot aro hacod nn tho nroliminary infnrmntian availahlo and aro anly an octimato_ Cantart the Dont for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 Ef'. /7/1/13) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 230 s. f. $716.00 Patio Cover / Sun Room 1PATI00THE Other Suppl. PC Fee: E) Reg. ® OT F0,0Thrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT Q.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? © Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure E) i r Strong Motion Fee: IBSEISMICR $1.56 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.56 $716.00 TOTAL FEE. $718.56 Revised: 04/01/2015 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION U10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 CURERTINO (408) 777 -3228 • FAX (408) 777 -3333 • buildin cu o.or ❑ NEW CONSTRUCTION ❑ ADDITION El ALTERATION /TI ❑ f VISI / DEFERRED ORIGINAL PERMIT # PROJECf ADDRESS I ^ N # ` r OWNER NAME PHONE E -MAIL h STREET ADDRESS CITY, STATE, ZIP , KI, FAX CONTACT NAME PHONE Lln E -MAIL L , r n .4 J9Jr STREET ADDRESS / CITY ATE ZIP _ , `J FAX G. n ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT CJ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ,. Zr LICENSE NUMBER Q ��� `T LICENSE TYPE / / BUS. LIC # COMPANY NAME �-� (� " E -MAIL ` FAX t/ R r tdM STREET ADDRESS } f ` CITY, STATE, ZIP PHO n `�� JOY m . ARCHITECT/ENGINEER NAME / LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS t CITY, STATE, , PHONE ot DESCRIPTION OF WORK l v y l L, w, EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH # DWELLING UNITS: ±TOTAL ND UNIT ❑YES SECOND STORY ❑YES DED? []NO ADDITION? ❑NO PRE - APPLICATION [3-1-ES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY.' TOTAL VALUATION: PLANNING APPL # 7 NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO (Z_r By my signature below, I certify to each of the following: I am the property oviroer or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I g r e representatives of Cupertino to enter the above- identified property for inspection purposes. Signature of Applicant/Agent: _ -- "' Date: SUPPLEMENTAL INFORMATION REQUIRED . r`iAivc>�cxrYPE,n . �xo>rrmresiiP ' ❑ DING Pt AN New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building', ovER TaE wiJhTER BUII REVPEw permit for new building. ❑ EXPRESS Y ❑ PLANxINGPLANREVIEw Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTANnATiD ❑PUBLTCwoRxs� _ form if any Hazardous Materials are being used as part of this project. a y 'LARGEp X; Q FIRE DE�T x . _ Copy of Planning Approval Letter or Meeting with Plannin g p rior to ❑ � � � �� ❑ FsANTfARY � submittal of Building Permit application. :MAJOR � v sEwERDJSTRTCC '', +' ❑ ENVIRO]VMENTAL HEALTH BldgApp_2011.doe revised 06121111 ,/.(W? BUILDING ENERGY ANALYSIS REPORT PROJECT: Yang Addition 10711 Gascoigne Drive Cupertino, CA 95014 Project Designer: Kyle Chan Architect 5205 Prospect Rd. #135 -120 San Jose, CA 95129 (510) 396 -9731 QC1 % 3 2014 Report Prepared by: jY• -� Timothy Carstairs, CEA, HERS, GPR Carstairs Energy Calculations PO Box 4736 San Luis Obispo, CA 93403 L (805) 904 -9048 TINO CUPER sup _ y f3odding D©pmrtMnt Job Number: r h C 14 -09092 hAr� ff VFF1 0ft amw nil �J (;'� COFT Date: 10/13/2014 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2013 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC — www.energysoft.com. EnergyPro 6.3 by EnergySoft User Number: 6249 ID: 14 -09092 1 EnergyPro 6.3 by EnergySoft Job Number: ID: 14 -09092 User Number: 6249 RESIDENTIAL MEASURES SUMMARY RMS -1 Project Name Yang Addition Building Type m Single Family ❑ Addition Alone ❑ Multi Family m Existing+ Addition /Alteration Date 1011312014 Project Address 10711 Gascoigne Drive Cupertino California Energy Climate Zone CA Climate Zone 04 Total Cond. Floor Area 2,126 Addition 877 # of Units 2 INSULATION Construction Type Area Cavity (ft) Special Features Status Wall Wood Framed - no insulation 1,100 Existing Roof Wood Framed Attic R 30 520 Altered Slab Unheated Slab -on -Grade - no insulation 1,249 Perim = 108' Existing Wall Wood Framed R 13 1,588 New Roof Wood Framed Attic R 38 877 New Slab Unheated Slab -on -Grade - no insulation 77 Perim = 45' New Demising Wood Framed w/o Crawl Space - no insulation 777 New Demising Wood Framed w/o Crawl Space R 19 209 New FENESTRATION Total Area: 381 Glazing Percentage: 17-9%1 New /Altered Average U- Factor: 0.32 Orientation Area(ft) U -Fac SHGC Overhang Sidefins Exterior Shades Status Front (SW) 37.6 0.320 0.25 none none Bug Screen New Front (SW) 40.0 0.320 0.25 none none Bug Screen New Left (NW) 58.8 0.320 0.25 none none Bug Screen New Left (NW) 18.0 0.320 0.25 none none Bug Screen New Rear (NE) 110.2 0.320 0.25 none none Bug Screen New Right (SE) 76.8 0.320 0.25 none none Bug Screen New Right (SE) 40.0 0.320 0.25 none none Bug Screen New HVAC SYSTEMS Qty. Heating Min. Eff Cooling Min. Eff Thermostat Status 1 Central Furnace 80% 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 4.2 Existing WATER HEATING Qty. Type Gallons Min. Eff Distribution Status 1 Small Instantaneous Gas 0 0.84 Standard New Ener Pro 6.3 by EnerqySoft User Number: 6249 RunCode: 2014 -10- 13711:49:01 /D: 14 -09092 Page 11 of 14 MANDATORY MEASURES SUMMARY: Residential (Page 1 of 3 MF -1 R Project Name Date Yang Addition 1011312014 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: 110.6(a)l: Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage. §110.6(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). 110.7: Exterior doors and windows are weather-stripped; all joints and penetrations are caulked and sealed. 110.8(a): Insulation specified or installed meets Standards for Insulating Material. Indicate type and include on CF -2R Form. §110.8(i): The thermal emittance and solar reflectance values of the cool roofing material meets the requirements of §110.8(i) when the installation of a Cool Roof is specified on the CF -1 R Form. *§1 50.0(a): Minimum R -30 (R -19 for Additions /Alterations ) insulation in wood -frame ceiling orequivalent U- factor. §150.0(b): Loose fill insulation shall conform with manufacturer's installed design labeled R- Value. *§1 50.0(c): Minimum R -13 insulation in 2x4 wood -frame wall R -19 in 2x6 or equivalent U- factor. * §150.0(d): Minimum R -19 insulation in raised wood -frame floor or equivalent U- factor. 150.0 : Air retarding wrap is tested, labeled, and installed according to ASTM E1677-95(2000) when specified on the CF -1 R Form. §150.0(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16. §150.0(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. §150.0(q) Fenestration Products. Fenestration separating conditioned space from unconditioned space or outdoors shall meet the requirements of either Item 1 or 2 below: 1. Fenestration, including skylight products, must have a maximum U- factor of 0.58. 2. The weighted average U- factor of all fenestration, including skylight products, shall not exceed 0.58. EXCEPTION to Section 150.0(q)1: Up to 10 square feet of fenestration area or 0.5 percent of the Conditioned Floor Area, whichever is greater, is exempt from the maximum U- factor requirement. 150.0 r Solar Ready Buildings. Shall meet the requirements of Section 110.10 applicable to the building project. Fireplaces, Decorative Gas Appliances and Gas Log Measures: 150.0 e 1A: Masonry or facto -built fireplaces have a closable metal or glass door covering the entire opening of the firebox. §150.0(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. §150.0(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: §110.0 - §110.3: HVAC equipment, water heaters, showerheads, faucets and all other regulated appliances are certified by the Energy Commission. §110.3(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 §11 0.3(c)5. §110.5: 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. §150.0(h): Heating and /or cooling loads are calculated in accordance with ASHRAE, SMACNA or ACCA. §150.0(i): Heating systems are equipped with thermostats that meet the setback requirements of Section 11 0.2 c . §150.0(j)1A: 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. §150.00)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. EnergyPro 6.3 by EnergySoft User Number: 6249 ID: 14 -09092 Page 12 of 14 MANDATORY MEASURES SUMMARY: Residential (Page 2 of 3 MF -1 R Project Name Date Yang Addition 1011312014 §150.00)2A: All domestic hot water system piping conditions listed below, whether buried or unburied, must be insulated per TABLE 120.3 -A. i. The first 5 feet (1.5 meters) of hot and cold water pipes from the storage tank. ii. All piping with a nominal diameter of 3/4 inch (19 millimeter) or larger. iii. All piping associated with a domestic hot water recirculation system regardless of the pipe diameter. iv. Piping from the heating source to storage tank or between tanks. v. Piping buried below grade. vi. All hot water pipes from the heating source to the kitchen fixtures. §150.00)2: Pipe insulation for steam hydronic heating systems or hot water Systems >15 psi, meets the requirements of Standards Table 120.3 -A. §150.00)3A: Insulation is protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. §150.00)4: Solar water - heating systems and /or collectors are certified by the Solar Rating and Certification Corporation. §150.0(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 -6 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 181A, or UL 181B 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 §150.0(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. §150.0(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. 150.0(m)7: Exhaust fans stems have back draft or automatic dampers. §150.0(m)8: Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. §150.0(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. §150.0(m)10: Flexible ducts cannot have porous inner cores. §150.0(n)1: Systems using gas or propane water heaters, whether tank or on- demand, to serve individual dwelling units shall include all the following components : A. A 120V electrical receptacle that is within 3 feet from the water heater and accessible to the water heater with no obstructions; B. A Category III or IV vent, or a Type B vent with straight pipe between the outside termination and the space where the water heater is installed; C. A condensate drain that is no more than 2 inches higher than the base of the installed water heater, and allows natural draining without pump assist, D. A gas supely line with a capacity of at least 200,000 Btu /hr. §150.0(o): All dwelling units shall meet the requirements of ANSI/ASHRAE Standard 62.2 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: §110.4(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. §110.4(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. 110.4(b)2: Outdoor pools ors as that have a heat pump or gas heater shall have a cover. §110.4(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. 150.0 : Residential pool systems orequipment meet the pump sizing, flow rate, piping, filters, and valve requirements of §1 50.0 Residential Lighting Measures: §150.0(k)1A: Installed luminaires shall be classified as high - efficacy or low- efficacy for compliance with Section 150.0(k) in accordance with TABLE 150.0 -A or TABLE 150.0 -B, as applicable. 150.0 k 1 C: The wattage of permanently installed luminaires shall be determined asspecified by 130.0(c). 150.0 k 1 D: Ballasts for fluorescent lams rated 13 Watts or greater shall be electronic and shall have an output frequency - 20 kHz. §150.0(k)1 E: Permanently installed night lights and night lights integral to installed luminaires or exhaust fans shall be rated to consume no more than five watts of power per luminaire or exhaust fan as determined in accordance with Section 130.0(c). Night lights shall not be required to be controlled by vacancy sensors. EnergyPro 6.3 by EnergySoft User Number: 6249 ID: 14 -09092 Page 13 of 14 MANDATORY MEASURES SUMMARY: Residential (Page 3 of 3 MF -1 R Project Name Date Yang Addition 1011312014 150.0 k 1 F: Lighting integral to exhaust fans, in rooms other than kitchens, shall meet the applicable requirements of §150.0(k). §150.0(k)2: All switching devices and controls shall meet the requirements of §150.0(k)2. §150.0(k)3: 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 percent high efficacy requirement when all lighting in the kitchen is controlled in accordance with the applicable provisions in Section 150.0(k)2, and is also controlled by vacancy sensors or dimmers. §150.0(k)4: Permanently installed lighting that is internal to cabinets shall use no more than 20 watts of power per linear foot of illuminated cabinet. §150.0(k)5: Lighting installed in bathrooms shall meet the following requirements: A. A minimum of one high efficacy luminaire shall be installed in each bathroom; and B. All other lighting installed in each bathroom shall be high efficacy or controlled by vacancy sensors. §150.0(k)6: Lighting installed in attached and detached garages, laundry rooms, and utility rooms shall be high efficacy luminaires and controlled by vacancy sensors. §150.0(k)7: Lighting installed in rooms or areas other than in kitchens, bathrooms, garages, laundry rooms, and utility rooms shall be high efficacy, or shall be controlled by either dimmers or vacancy sensors. EXCEPTION 1: Luminaires in closets less than 70 square feet. EXCEPTION 2: Lighting in detached storage building less than 1000 square feet located on a residential site. §150.0(k)8: 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 luminaire is airtight with air leakage less than 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. §150.0(k)9A: For single - family residential buildings, outdoor lighting permanently mounted to a residential building or other buildings on the same lot shall be high efficacy, or may be low efficacy if it meets all of the following requirements: i. Controlled by a manual ON and OFF switch that does not override to ON the automatic actions of items ii or iii below; and ii. Controlled by a motion sensor not having an override or bypass switch that disables the motion sensor, or controlled by a motion sensor having a temporary override switch which temporarily bypasses the motion sensing function and automatically reactivates the motion sensor within 6 hours iii. Controlled by one of the following methods: a. Photocontrol not having an override or bypass switch that disables the photocontrol; or b. Astronomical time clock not having an override or bypass switch that disables the astronomical time clock, and which is programmed to automatically turn the outdoor lighting OFF during daylight hours; or c. Energy management control system which meets all of the following requirements: At a minimum provides the functionality of an astronomical time clock in accordance with Section 110.9; meets the Installation Certification requirements in Section 130.4; meets the requirements for an EMCS in Section 130.5; does not have an override or bypass switch that allows the luminaire to be always ON; and, is programmed to automatically turn the outdoor lighting OFF during daylight hours. §150.0(k)9A: For low -rise multi - family residential buildings, outdoor lighting for private patios, entrances, balconies, and porches; and outdoor lighting for residential parking lots and residential carports with less than eight vehicles per site shall comply with one of the following requirements: i. Shall comply with Section 150.0(k)9A; or ii. Shall comply with the applicable requirements in Sections 110.9, 130.0, 130.2, 130.4, 140.7, and 141.0. §150.0(k)9: For low -rise residential buildings with four or more dwelling units, outdoor lighting not regulated by Section 150.0(k)9B or Section 150.0(k)9D shall comply with the applicable requirements in Sections 110.9, 130.0, 130.2, 130.4, 140.7, and 141.0. §150.0(k)9D: Outdoor lighting for residential parking lots and residential carports with a total of eight or more vehicles per site shall comply with the applicable requirements in Sections 110.9, 130.0, 130.2, 130.4, 140.7, and 141.0. §150.0(k)10: Internally illuminated address signs shall comply with Section 140.8; OR not contain a screw -base socket, and consume no more than five watts of power as determined according to §1 30.0(d). §150.0(k)11: Lighting for residential parking garages for eight or more vehicles shall comply with the applicable requirements for nonresidential garages in Sections 110.9, 130.0, 130.1, 130.4, 140.6, and 141.0. §150.0(k)12A. In a low -rise multi - family residential building where the total interior common area in a single building equals 20 percent or less of the floor area, permanently installed lighting for the interior common areas in that building shall be high efficacy luminaires or controlled by an occupant sensor. §150.0(k)12B. In a low -rise multi - family residential building where the total interior common area in a single building equals more than 20 percent of the floor area, permanently installed lighting in that building shall: i. Comply with the applicable requirements in Sections 110.9, 130.0, 130.1, 140.6, and 141.0; and ii. Lighting installed in corridors and stairwells shall be controlled by occupant sensors that reduce the lighting power in each space by at least 50 percent. The occupant sensors shall be capable of turning the light fully On and Off from all designed paths of ingress and egress. 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H C (7 O � w Q t } l6 E m (6 O Z w d l6 LL V 7 � a U c T (a C 0) Q c -* 'O N a) M (a C C O O a) 'C a> N d d Q Mc Z O w V � d > V CL` u ti W U U ,Q v � O .y w o � U C_ U) 't � N W U `•t m W N v 0 0 N Y fa a/ N N N � C O 0 d t•+ Ln 2' d W ai W _ = 6i co 0 Lo N O) Ln n O C) 0 v i6 O E a, v � C O O � N O 4 O- a) a) O m v 0 O C U a) a) E C 7 0 0 co U v � c L � Q O E (O O U a) 0 � � U V C a) n n co � - a) EO d L O O N O m a m U (D r D z6 F- = O CL N �_ O (D y n C c O U c a� ' C N E _� _U L 2 n 7 (a 0 C 7 E n 0 0 p co C C E 7 O a) = w a) a5 f c O N 8. rn U) c (D $ L rn c U O o LO E 3 (D O Q c O) d O � 0 0 d.0 - N N 0 U ur OO Ch Q .0 N Q U N m(D c w O O � CD ( a) U ..+ C O E = _ L N 01 � LO I U CO r 0 0 CO W O 0 L E a) (u 0 0 p d � m 0 C C'7 ( C O 0 U) N U d" m a aa) U N chi U d o o 0 n CO E o U O 0 0 O nU m rn N N � a) 0 w U C a) a) Cl. a) n ` U O 0 U E �O U 7 U - CO m ? 0 o (j 0 w w e c �c y o -0 0 m a) a) 0 N a) � N c m o U) C O U 6 N co _(D a) U E N y O 0 (D 0 1] Z W - C H 3 d N 7 N i Z CO a) m N 11J C C O Q C 0 W L +5 N co m a) N 7 Q 0 N Z U H D C C 'y O 0 N 7 7 d E^, n F a) Z > m - 0 N U O 7 0 C V Q N C w y a7 J W o. _n O CUD) N O N 0 U O C O ai : 0 CD O N Cl) —O m W co N C •- T (7 C 0 0 7 U IM N 0 .? O) w ,O ° m m L6 O ZO c E Z U U y U c CD CD m Z U a> -o N Q N p 'f0 1+ O 7 7 L-. U c !-'' LO Z U L +- ` n w rn w N °1 vi c L c c 2) L ` U O 0 N to d Q Q w d O W O .�' (a 7 L �w —a N N o C C Q U d a7 w U u> X u> m w0 7 Y E `y rn a) d m m (n O iu 0 7 ZL-. U 3 a 0 (p iii m m -� O N U c C U N m -� N cu N 0 f- U U Q a U (A U cl+ cri (D Y V Y Q cn U U) ti W U U ,Q v � O .y w o � U C_ U) 't � N W U `•t m W N v 0 0 N Y fa a/ N N N � C O 0 d t•+ Ln 2' d W ai W _ = 6i co 0 Lo N O) Ln n O C) 0 v i6 O E a, v � C O O � N O 4 O- a) a) CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate--�� (Page 1 of 4 ) Project Name: Gascoigne Dr Residence Enforcement Agency: City of Cupertino Permit Number: 14090118 Dwelling Address: 10711 Gascoigne Dr City: Cupertino Zip Code: 95014 A. Ducted Cooling System Information O1 System Identification or Name System 1 02 System Location or Area Served Whole house 03 System Installation Type New 04 Nominal Cooling Capacity (tons) of Condenser 5 05 Condenser Speed Type Single Speed 06 Cooling System Zonal Control Type Not Zonal 07 Central Fan Integrated (CFI) Ventilation System Status Not a CFI system 08 System Bypass Duct Status No Bypass Duct 09 Date of System Airflow Rate Measurement 2015-08-21 10 Airflow Rate Protocol utilized RA3.3 procedures for airflow rate measurement B. Hole for the placement of a Static Pressure Probe (HSPP), and Permanently installed Static Pressure Probe (PSPP) in the supply plenum. Procedures for installing HSPP or PSPP are specified in RA3.3.1.1. 01 I Method used to demonstrate compliance with theI HSPP installed and labeled consistent with Figure RA3.3-1 HSPP/PSPP requirement C. Airflow Rate Measurement Apparatus and Procedure Information Instrument Specifications are given in RA3.3.1.1, and system airflow rate measurement apparatus information is given in RA3.3.2. Airflow Rate Measurement Type used for this airflow rate Traditional Flow Capture Hood according to procedure in O1 verification. RA3.3.3.1.4 02 Manufacturer of Airflow Measurement Apparatus Kanomax 03 Model number of Airflow Measurement Apparatus 6710 TABmaster Certification Status of the Airflow Measurement Apparatus Certified by Manufacturer and listed on CEC Website at 04 Accuracy http://www.energy.ca.gov/title24/equipment_cert/ama_fas /index.html Registration Number: 215-A6298119A-M2300001A-M23C Registration Date/Time: 2015-09-11 11:35:01 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-09-11 11:36:29 2013 Residential Compliance Schema Version: 0.555SDD CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 2 of 4 ) MCH -23a Forced Air System Airflow Rate Measurement - Newly Installed Non -Zoned Systems or Zoned Multi -Speed Compressor D. Forced Air System Airflow Rate Measurement The procedures for System Airflow Rate Verification are specified in Reference Residential Appendix RA3.3. 01 Required Minimum System Airflow Rate (cfm/ton) 350 02 Required Minimum System Airflow Target (cfm) 1750 03 Actual System Airflow Rate Measurement (cfm) 1924 04 Compliance Statement: System airflow rate complies E. Additional Requirements Air filters that meet the applicable requirements of Standards Section 150.0(m)12 or 150.0(m)13 were properly installed in 01 the system during system air flow rate measurement identified on this Certificate of Verification. The airflow rate measurement apparatus used to perform the airflow rate measurementidentified on this Certificate of 02 Verification was calibrated in accordance with the apparatus manufacturer's specifications and conforms to the instrumentation specifications given in RA3.3.1. A visual inspection shall confirm that bypass ducts that deliver conditioned supply air directly to the space conditioning system return duct airflow are not used on newly constructed zonally controlled systems unless the Performance Certificate 03 of Compliance indicates an allowance for use of a bypass duct. When a bypass duct is accounted for on the Performance Certificate of Compliance, the airflow rate shall conform to the specifications listed on the Certificate of Compliance. 04 All registers were fully open during the diagnostic test. 05 System fan was set at maximum speed during the diagnostic test. 06 If fresh air duct is part of the HVAC system it was not closed during the diagnostic test. 07 Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value. Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/ton) and fan 08 efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air handler fan speed. 09 Verification Status Pass - all applicable requirements are met 10 Correction Notes The responsible person's 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. Registration Number: 215-A6298119A-M2300001A-M23C Registration Date/Time: 2015-09-11 11:35:01 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-09-11 11:36:29 2013 Residential Compliance Schema Version: 0.555SDD CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 3 of 4 ) F. 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. 01 I Complies: All specified verification protocol requirements on this document are met. CaICE�RTS, Inc. HERS P"RO"VIDER r► r Registration Number: 215-A6298119A-M2300001A-M23C Registration Date/Time: 2015-09-11 11:35:01 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-09-11 11:36:29 2013 Residential Compliance Schema Version: 0.555SDD CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 4 of 4 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Mark Drapere-v Company: Date Signed: FRI Energy Consultants, LLC. 2015-09-11 11:35:01 Address: CEA/ HERS Certification Identification (if applicable): 21 N. Harrison Ave, Suite 210 CC2006527 City/State/Zip: Phone: Campbell CA 95008 408-866-1620 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 (GF214) 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#e qqWWmenncy. S. I will ensure that a registered copy, of this Cettificate of Verificatton shall be posted, or made available with the building perri it(S} issuOd MY the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of thi5'.Cert0licateof .,.. 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): Responsible Builder or Installer Name: Gilbert Fernandez Jr CSLB License: 954667 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: FRI Energy Consultants, LLC. Responsible Rater Name: Responsible Rater Signature: Mark Draper Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006527 2015-09-11 11:35:01 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215-A6298119A-M2300001A-M23C Registration Date/Time: 2015-09-11 11:35:01 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-09-11 11:36:29 2013 Residential Compliance Schema Version: 0.555SDD CERTIFICATE OF VERIFICATION CF3R-MCH-22-H Space Conditioning System Fan Efficacy (Page 1 of 3 ) Project Name: Gascoigne Dr Residence Enforcement Agency: City of Cupertino Permit Number: 14090118 Dwelling Address: 10711 Gascoigne Dr City: Cupertino Zip Code: 95014 A. Ducted Cooling System Information 01 System Identification or Name System 1 02 System Location or Area Served Whole house 03 System Installation Type New 04 Nominal Cooling Capacity (tons) of Condenser 5 05 Condenser Speed Type Single Speed 06 Cooling System Zonal Control Type Not Zonal 07 Central Fan Integrated (CFI) Ventilation System Status Not a CFI system 08 System Bypass Duct Status No!BypasS Duct 09 Date of System Airflow Rate Measurement 2015-0841 10 Airflow Rate Protocol utilized RA3.3 procedures for arfldw ratemeasurement B. Fan Watt Measurement Apparatus and Procedure Information Instrument Specifications are given in RA3.3.1, and system fan watt measurement apparatus information is given in RA3.3.2.2. 01 1 Fan Watt Verification Device Used. I Portable watt meter MCH -22a Forced Air System Fan Efficacy Measurement - Newly Installed Non -Zoned Systems or Zoned Multi -Speed Compressor C. Forced Air System Fan Efficacy Measurement The procedures for System Fan Watt Verification are specified in Reference Residential Appendix RA3.3. 01 Actual Tested Watts 0.4 02 Actual Tested Airflow from MCH -23 (cfm) 1924 03 Required Fan Efficacy (watts/cfm) 0.58 04 Actual Fan Efficacy (watts/cfm) 0 05 Compliance Statement: System fan efficacy complies Registration Number: 215-A6298119A-M2200001A-M22C Registration Date/Time: 2015-09-11 11:35:01 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-09-11 11:35:03 2013 Residential Compliance Schema Version: 0.51SDD CERTIFICATE OF VERIFICATION CF3R-MCH-22-H Space Conditioning System Fan Efficacy (Page 2 of 3 ) D. Additional Requirements 01 All registers were fully open during the diagnostic test. 02 System fan was set at maximum speed during the diagnostic test. 03 If fresh air duct is part of the HVAC system it was not closed during the diagnostic test. 04 Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value. 05 Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/ton) and fan efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air handler fan speed. 06 Zoned cooling air distribution systems with single speed compressors shall meet both the airflow (cfm/ton) and fan efficacy (Watt/cfm) criteria in every zonal control mode. 07 Verification Status Pass - all applicable requirements are met 08 Correction Notes 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. E. Determination of HERS Verifkat on 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. 01 Complies: All specified verification protocol requirements on this document are met. Registration Number: 215-A6298119A-M2200001A-M22C Registration Date/Time: 2015-09-11 11:35:01 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-09-11 11:35:03 2013 Residential Compliance Schema Version: 0.51SDD CERTIFICATE OF VERIFICATION CF3R-MCH-22-H Space Conditioning System Fan Efficacy (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: Draper Documentation Author Signature: le",4 rJ 6er Mark Company: Date Signed: FRI Energy Consultants, LLC. 2015-09-11 11:35:01 Address: CEA/ HERS Certification Identification (if applicable): 21 N. Harrison Ave, Suite 210 City/State/Zip: Phone: Campbell CA 95008 408-866-1620 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 ofthe 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 Certificates) of Compliance (CF1R) approved bythe 0 OoWmeot•agency. 5. 1 will ensure that a registered coof this Certificate of Verification shall be posted, or made available with the building permit(s) issued for the building, and made availabi 4"'enforcerrent a�,ency for all applicable inspections. I understand that a registered copy of this Certificate of Verification is required to be iricluiled 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): Responsible Builder or Installer Name: Gilbert Fernandez Jr CSLB license: 954667 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: FRI Energy Consultants, LLC. Responsible Rater Name: Responsible Rater Signature: Mark Draper Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006527 2015-09-11 11:35:01 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered documen4 and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215-A6298119A-M2200001A-M22C Registration Date/Time: 2015-09-11 11:35:01 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-09-11 11:35:03 2013 Residential Compliance Schema Version: 0.51SDD