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B-2016-2177CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2177 10211 COLBY AVE CUPERTINO, CA 95014-2419 (316 28 041) F LUNA CONSTRUCTION SALINAS, CA 93915 OWNER'S NAME: SAMEER & DEEPIKA JAIN OWNER'S PHONE: 408-307-1094 LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #5335M 8530 Contractor F LUNA CONSTRUCTION Date 08/31/2016 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ith Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. hereby affirm under penalty of perjury one of the following two declarations: 1. 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 '' ,Lpgar0rmance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by l Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 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 Date 115/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. 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: s. 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. 2. 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. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city. to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence 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 1/5/2017 DATE ISSUED: 09/07/2016 PHONE NO: (831) 595-6590 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: SINGLE STORY ADDITION (778 S.F.); OTHER REMODEL AREA (932 S.F.); UNPERMTTTED COVERED PORCH AREA (340 S.F.) REV #1 - STRUCTURAL BEAM AND FOUNDATION CHANGE - ISSUED 1/5/2017 Sq. Ft Floor Area: I Valuation: $120000.00 "N Number: Occupancy Type: 316 28 041 1 R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ABBY AYENDE Date: 09/07/2016 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 1/5/2017 11A1/ 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:1/512017 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 ARRCATI'ECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional .t {UPERT"INO rC� I 1 NEW CONSTRTICTTON CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(abcupertino.org r I I AT)T)TTTi1N FI AT TFR ATTONT / TT F-1 1?T:N7TC1l1T.T 7r)T'rU•DDrn Z- Z0 I �-k3 nDT('_TMAT DU AATTJ PROJECT ADDRESS 6j / i .d lI� tI�11CZ Z --- APN # j W OWNERNAME PHONE f iR� Aj��[J� ` 0 rYn EMAILt�"��dd�� i1C il�rtl STREET ADDRESS % (j , 1 ��' °r �� , CITY, STATE, ZIPl3 (sI t fti n til J�+ j FAX cu 4-e3 i C1 1 l aP` CONTACT NAMEsR ^. 3.� �. 1 PHONE �, p 3 � F C° � g �✓ E MAII eG 13 I oJ� 6�i 11�i> C STREET ADDRESS 9_0 f) ! --1 N i , )� add % J !v tr '` CITY, STATE, ZIP c ��F G� �Q�. /'t i-��14 FAX 10 OWNER ❑ OWNER -BUILDER ❑ OWN'ERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMB R /A Z LICENSE TYPE BUS. LIC # COMPANY NAME j E-MAIL FAX STREET ADDRESSCITY, l.. STATE ZIP � HONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 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 DECKAREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH - - ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT E] YES SECOND STORY E] YES BEIIVG ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TREC.ErVED BY'f\, - TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent t& act on e property owner's behalf. I have read this application and the information I have provided is c ect. 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�bu�'���d' construction. I authorize representatives of Cupertino to enter the bove-identified property for inspection purposes. Signature of Applicant/Agent�-"/7' �is; Date: — 7 SUPP "EMENTAL INFORMATION REQUIRED PLAY CHECK zYPE xoTrriNG SLIP. - ovEiz-TFIE CotiivTER BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. I] -EXPRESS ❑ --PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a,completed Hazardous Materials Disclosure El STANDARD- El-PUBLIC-NYOBKS forni if any Hazardous Materials are being used as part of this project. 11 LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting -with Planning prior to n144OR ❑ - sANiTAI2YsE,'ERDisTRICT - submittal of Building Permit application. I]- &VTkOnIENTAL HEALTH - I BId APP_ 2011.doC revised 06121/11 g r-Oiq a CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2177 10211 COLBY AVE CUPERTINO, CA 95014-2419 (316 28 041) F LUNA CONSTRUCTION SALINAS, CA 93915 OWNER'S NAME: SAMEER & DEEPIKA JAIN I . I DATE ISSUED: 09/07/2016 I OWNER'S PHONE: 925-354-8567 I I PHONE NO: (831) 595-6590 LICENSED CONT A TOWS DECLARATION License Class B Lic. #538530 Contractor F LUNA CONSTRUCTION Date 08/31/2016 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. 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. 2 I have and will maintain Worker's Compensation Insurance, as provided for by 5z_ Section 3700 of the Labor Code, for the performance of the work for which this d 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. Signal - - }— --mate 09/07/2016 hereby affirm that I am exempt from the Contractor's License Law for one of the BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCLAL JOB DESCRIPTION: SINGLE STORY ADDITION (778 S.F.); OTHER REMODEL AREA (932 S.F.); UNPERMITTED COVERED PORCH AREA (340 S.F.) Sq. Ft Floor Area: I Valuation: $120000.00 APN Number: Occupancy Type: 316 28 041 1 R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: wing two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three declarations: 1. I have rand 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 2. 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. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ anyperson 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 1 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 Date 09/07/2016 Signature of Applicant: Date: 09/07/2016 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 ag Date: 09/07/2016 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 - a CUPERTI.NO ❑ NEW CONSTRUC CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3256 (408) 777-3225 • FAX (408) 777-3333 building(ftupertino.org�.- CION 21 ADDITION ❑ ALTERATION / TI ❑ REVISION / I)EFERRED ORIGINAL PERMIT ii PROJECT ADDRESSAPN 1,D1� OL&Y AVS. - # OWNER NAME6ameer'(�e i PHON `35f5a E-MAIL 5aleer scrum ' STREET ADDRESS ` t C C 1 �y A` f. �1iVn 1/ CITY, STATE, ZIP C i B P G R T! Y0 CA �'5o i I"[�ra1G FAX CONTACT NAME. f� Amon y�'4,a }� PHONE 3 P � $.7 � bw E-MAIL r1 y n1+gyp. J' • ' �y,� al/ ti�J�l- J J 3 7\.� ice'% STREETADDRESS � I.3 �.tu A Ye• CITY, STATE, ZiP s �a ase 2 FAX ❑ OWNER 0: OWNER -BUILDER 9% OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑. TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC 0 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCIIITECTYENGINEER NAME LICENSE. NUMBER y*y BUS. LIC # COMPANY NAME ^ G G F-= 'n%4,e E-MAIL R ecce . Coni FAX STREET ADDRESS /3dX t j 1`... Ii CITY, ST TEX-JMP �� FHONE//lD� ,j+y in'�1-1Y1 +c:. ti/- +� DES-C3fIPT70TI-0-FVVORK -- - __: �0� - -- - ' - h a n � �, �~ �t+'d� ,xj[la r �2lvtb �e�- ddt W -id rg Tm , s ef,�,e d ed Gedmz •(� est m e Of ktI 'fwt a C) M 1 ull1l 1a.-, 0( 13�ed rnm Por, EXISTING USE. e¢J - PROPOSED USE CONSTR —iZzee . J TYPE V-13 1 tt STORIES 1 - USE TYPE OCC. SQ FF. VALUATION {$) EXISTG AREA 13 10 NEW FLOOR AREA Q DEMO AREA TOTAL NETAREA .. BATHROOMj ILPMODELAREA NJ� KITCHEN _. REMODELAREA JV1fi OTHER - REMODELAREA Kilo -. PORCH All DECK AREA TOTAL DECKIPORCH AREA mDBTACH GARAGE 1AREA:ATTACH - - 9 DWELLING UNITS: ISASECONDUNIT []YES BEING ADDED? IPNO SECONDSTORY []YRS ADDITION? IONO PRE -APPLICATION OYES IF YES, PROVIDE COPY Or, iSTHE BLDG AN AYES RECE TOTAL VALUATION: PLANNINGAPPLR IANU PLANNINGAPPROVALLETrER EICHLERHOME? PNO • M 0o By my signature below, I certify to each of the following: I am the property owner or authorized Age—to act U the property owner's behalf. I ha a read this application and the information I have provided is correct. I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable Iocal ordinances and state laws relating to huildin construction. I au rze repres7ftatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent, Date:12�� SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER THE -COU VTER BUILDING PLAN REVIEW _ New:SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit iS Tequired prior to issuance of building permit for new building. ❑ EXPRESS. PLANNLNG PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C1 STANDARD El PiJ$i1C wOilifS Form if any hazardous Materials are being used as part of this project, ❑ LARGE IRE REPT Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR CY W`h-1� SAN1TAkSEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTALHEALTH.- ..... . BIdgApp_2011.doc revised 06121111 Pi" M American Soil Testing, Inc. 2734 S Bascom Avenue, San Jose, CA 95124 408-559-6400 - Fax 408-559-6688- wwmv. americansoiltesting. com B -06 16 --- N 77 Foundation Filed Memo [F-17- 7V3 -- Project Address: w it CA6Y AV City C(�ee�rtilo =C4 f File No.: Our firm representative has performed a foundation inspection for the above mentioned project on )6 / If / 2016 Our inspection revealed that the foundations trenches have been excavated substantially in .accordance with approved foundation plans and recommendations contained in our Soil -and Foundation Investigation Report. The City Inspector should inspect and approve the reinforcing bars prior to pouring concrete. The formal Foundation Inspection Letter will be mail to our client as soon as possible. If you have any questions regarding this inspection, please call our office after 4.30 PM today. Sincerely, American Soil Testing, Inc. ASTI, Representative, -- -- -- `=' Date: 1' 0 --) — Time: W36 AM/P G I 91,1E ER. 1 N G C l 77 Project No: 2924 Chief Building Official City of Cupertino u' Subject: _r /!pr ' uting Rod Single , arnily House 10211 Col y Ave, Cupertino, 95014 Perrnit: 13-2016-2177 Dear Sir, Based on owner representative's request we visited the above job site on December 19, 2016 and observed the progress of all -threaded rods embedment into the existing concrete footing located in dining room, garage and bed room according to the following Table: TYPE Length Diam eter(in.) HoleSlze(ln.) Min. EMBEDDED (in.) Quantity -] All -threaded Rod 36" �18!' 3/4- 12" 6 The type of epoxy was SET -XP with expiration date on 05/25/2018 - In general work was in compliance with plan sheet SD -1 dated 08/02/2016. Inspection was performed periodically and on call basis as requested by the owners representative. We claim no responsibility or liability for damages from improper use of the results or findings. We do not undertake the guarantee of construction nor do we relieve the contractor of his primary responsibility to produce a completed project in accordance with plans and specifications. Our findings refer to locations that were inspected by Achievement Engineering representative. If you have any questions or need any additional information, please feet free to call -Us at your convenience. Sincerely Yours, ND' Sq Farshad Safaian, P.E. State of California Licensed Civil Engineer ^638 f CC: The Owner AT �fte,�v. 2455AUWRVale Wive, Unit E, Sari Jose, CA 95131 - Tel-. (408) 217-9174, Fax: (4©i31217-9632 ww-wachieveng.com ForM R-1-1 CALGREEN SIGNATURE DECLARATIONS Project Name: Jain Residence -Addition & Alteration Project'Address: 10211 Colby Avenue, Cupertino, CA 95014 Project Description: Addition/Alteration SECTION 1 — DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Owner's Signature !!!!llammmdd�777 Date Owner's Name (Please Print) Design Professional's Signature ri Signature of Licensr?Profession aI responsi>teTr Ca3Sreen compliance Ken Girdley, LCC CALGreen Cspktor #8119892 Name of License Professional responsible for CalGreen compliance (Please Print) kengirdley@yahoo.com Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION Date 650-961-2324 Phone Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above waeqnstructed in accordance with this Green Building Checklist and in accordance with the requirements of the 201x3 California Green Buildina Standards Code as adopted by the Citv of Cupertino. ,, Signature of Lice se Professional responsible r CalGreen compliance ate Ken Girdley, ICC CALGree n ector #8119892 650-961-2324 Name of License Professional respon ble r CalGreen compliance (Please Print) Phone kengirdley@yahoo.com Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen 2014.doc revised 11/04/14 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: 10211 Cobly / Jain - Enforcement Agency: Cupertino City of Permit Number:- B-2016=2177 Dwelling Address: 10211 Cobly City: Cupertino Zip Code: 95014 A. System Information 01 Space Conditioning System Identification or Name Jain 02 Space Conditioning System Location or Area Served Entire Home 03 Building Type from CF -111 Single family 04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from CF1R? No, credit is not taken 05 Verified Low Leakage Air Handling Unit (VLLAHU) Credit from CF1R? No, credit is not taken 06 Duct System Compliance Category - - New MCH -20a - Completely..New Duct System B. Duct Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity (ton) 4 02 Heating Capacity (kBtu/h) 48 03 Conditioned Floor Area served by this HVAC system (ft2) 2088 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.06 07 Air Handling Unit Airflow (AHUAirflow) Determination Method Cooling system method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage (cfm) 96 10 Actual duct leakage rate from leakage test. measurement (cfm) 86 11 Compliance Statement System passes leakage test Registration Number: 217-A0079222A-M2000002A-M20A Registration Date/Time: 2017-03-13 09:48:23 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2017-03-13 09:47:22 2613 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3 ) C. Additional Requirements for Compliance 01 System was tested in its normal operation condition. No temporary taping allowed. Outside air (OA) duct connections to the 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 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 Masticanddraw bands. 06 All connection points between the air handler and the supply and return plenums are completely sealed. Visual Inspection at Final Construction Stage (applicable if system was tested at rough -in) After installing the interior' finishing wall and verifying that the above rough -in tests was completed, the following procedure must be performed 07 For all supply and return registers, verify thatthe spaces between the register boot and the interior finishing wall are properly sealed. 08 if the house rough -in duct leakage test was conducted without an_air hander installed, inspect the connection, points between the air handler and the supply and return plenums to verify that the connection,points are properly sealed. 09 Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used. The responsible persons signature on this compliance document affirms that all applicable requirements in this table have been met. Registration Number: 217-A0079222A-M2000002A-0000 Registration Date/Time: 2017-03-13 09:50:10 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2017-03-13 09:45:57 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF VERIFICATION CF311-MCW20-1-1 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: Stacie Bagnasco - Company: Date Signed: 831 Conserve dba Central Coast Energy Services 2017-03-13 09:48:23 Address: CEA/HERS Certification Identification (if applicable): PO Box 2707 CC2006315 City/State/Zip: Phone: Watsonville CA 95077 831-726-4018 Responsible Person's Declaration statement/ 1 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. I 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 submittedby 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. S. I 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): F LUNA CONSTRUCTION Responsible Builder or Installer Name: CSLB License: Francisco Luna 538530 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: 831 Conserve dba Central Coast Energy Services Responsible Rater Name: Responsible Rater Signature: &irc-- Stacie Bagnasco I Responsible Rater Certification Number w/ this HERS Provider: Date Signed:. CC2006315 2017-03-13 09:48:23 Digitally signed by EaICERTS. 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: 217-A0079222A-M2000002A-M20A Registration Date/Time: 2017-03-13 09:48:23 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2017-03-13 09:47:22 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF VERIFICATION CFIR-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 the 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 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. Visual Inspection at Final Construction Stage (applicable if system was tested.at rough -in) After installing the interior finishing wall and verifying that the above rough -in tests was completed;` the following procedure must be performed 07 For all supply and return registers, verify that the spaces between the register boot and the interior finishing wall are properly sealed. 08 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. 09 inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used. 10 Verification Status Pass 11 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. 01 Complies: All specified verification protocol requirements on this document are met. Registration Number:217-A0079222A-M2000002A-M20A Registration Date/time: 2017-03-13 09:48:23 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2017-03-13 09:47:22 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 j Project Name: 10211 Cobly /Jain Enforcement Agency: City of Cupertino Permit Number: B-2016=2177 Dwelling Address: 10211 Cobly City: Cupertino Zip Code:. 95014 A. System Information 01 Space Conditioning System Identification or Name Jain 02 Space Conditioning System Location or Area Served Entire Home 03 Building Type from CF -1R Single family '04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from'CF1R? No, credit is not taken 05 Verified Low Leakage Air Handling Unit (VLLAHU) Credit from CF1R? No, credit is not taken 06 Duct System. Compliance Category -_: New MCH -20a - Completely New Duct System B. 'Duct Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity (ton) 4 02 Heating Capacity (kBtu/h) 48 03 Conditioned Floor Area served by this HVAC system (ft2) 2088 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage factor 0.06 07 Air Handling Unit Airflow (AHUAirflow) Determination Method Cooling system method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage (cfm) 96 10 Actual duct Leakage rate from leakage test measurement (cfm) 86 11 Compliance Statement: System passes leakage test Registration Number: 217-A0079222A-M2000002A-0000 Registration Date/Time: 2017-03-13 09:50:10 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2017-03-13 09:45:57 2013.Residential Compliance Schema Version: 2013.1.007 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR SUBCONTRACTOR LIST 4 JOB ADDRESS: 1 (j2_11 (OLIJ Y A.vii,7,j�,, 0 -K -2r" Z PERMIT# 2-cJ 4 — 2-1 -7 '1 SUBCONTRACTOR OWNER'S NAME: S A i -k 6 -f -"M :S k: t_1 PHONE# ql-5-35-1—TSC-7' BUSINESS LICENSE GENERAL CONTRACTOR: � Lui4A BUSINESS LICENSE# Cabinets & Millwork .ADDRESS:(//3 Aens:�, 5;77:1r,0 jL_CITY/ZlPCODE: "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 subcontractoirs:,--;��,���_�� Signature Date Please check applicable subcontractors and complete the following information: V 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 CALGREEN RESIDENTIAL CHECKLIST - MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 bLJ1d.i. @LL&gr1inA rB PURPOSE: The 2013 CalGreen Code applies to additions or alterations of existing residential buildings where the addition or alteration increases the building's conditioned area, volume, or size and also applies to all new low-rise residential buildings, high-rise residential buildings, or both. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: Project Address: 0 �2 1 cd2f:. Ave. Project Description: Sf- h % q:; 2-_ 5 F -1;F e tO_V_ Instructions: The Owner or the Owner's agent shall employ a licensed professional experienced with the California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. SII°tui°iiIIdi°ii I;°: g 1) e ID arh rnein't Page 1 of 5 CalGreeny 2014.dac revised 11/09/14 FVH.. ll:.[) L U'3 C[A_ C&\A['I[JA CE U ev I e e d I'� Y ': �'�'�'�'�'�'�'�'�'�'. �^���j .......... ...L.. (��::� h..°..I Date:09/0:;:'/16 4.201.1 Low-rise residential buildings shall meet or exceed the minimum standard design required by the California Energy Standards. l4',w'W'm.A69 W t'6NM(r io 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following: ❑ 4.303.1.3.2 Water Closets. The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank -type water closets shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank -type Toilets. ❑ 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. Cl 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. ❑ 4.303.1.3.2 Multiple Showerheads serving one shower. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute at 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. ❑ 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less than 0.8 gallons per minute at 20 psi. ❑ 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas (outside of dwellings or sleeping units) in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. ❑ 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. ❑ 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, and shall meet the applicable standards referenced in Table 1401.1 of the California Plumbing Code. Page 2 of 5 CU1111EIRTINO Buildhing elpar°timen't ►� 01 CalGreeu 2014.doc remised 11104114 Outdoor Water Use 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the time of final inspection shall be weather -based. ❑ 4.304.1.1 Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as weather conditions change. ❑ 4.304.1.2 Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. A4.4 MATERIAL CONSERVATION AND RESOURCE EinhapcedDM rabilMt+ in ai Maint"ri 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. Oorrstr ct cn WW it . •diuctia rth M Pp i and 144cyclin , M 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall be submitted for approval to the enforcing agency. Building;M intenanc• and Oiler ,tjoq 4.410.1 Operation and maintenance manual. At the time of final inspection, an operation and maintenance manual shall be provided to the building jai occupant or owner. ENVIRONMENTAL QUALITY I%ll i � f� (4✓, 9wi/ i �i„ �6 M=M,� . �y 4.503.1 General. Install only a direct -vent sealed -combustion gas or sealed wood -burning fireplace, or a sealed woodstove. El PollutAnt call rill ,�,a>, 3 4.504.1 Covering of duct openings and protection of mechanical equipment during construction. Duct openings and other related air distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be ® El with VOC limits. p paints coatings. r coa,tin s 4.504.2.3 Aerosol amts and coatin s. - rots and other shall be compliant with product weighted M or R compounds. I' ill i t ire Sr rn nm Page 3 of 5 CalGreen! 1014.doc revised 11/04/14 Da°tEr� 09/ 'f'I 4.504.2.4 Verification. Documentation shall be provided to verify that p1 ❑ l� compliant VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with ED VOC limits. 4.504.4 Resilient flooring systems. Eighty (80) percent of floor area receiving resilient flooring shall comply with the VOC-emission limits defined in the Collaborative for High Performance Schools (CHPS) Low-emitting Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Composite wood products. Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall comply with low formaldehyde emission standards. Interior Moisture :Control s 4.505.2 Concrete slab foundation. Required vapor retarders and capillary breaks are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture content of building 13 materials used in wall and floor framing is checked before enclosure. z Indoor, it ua1Ity nd,9x ust , 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the r.�f �I building are provided in every bathroom. Environmental Comfort= 4.507.2. Duct systems are sized and designed and equipment is selected using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or equivalent. 2. Size duct systems according to ACCA 29-D (Manual D) or equivalent. 3. Select heating and cooling equipment according to ACCA 36-S (Manual S) or equivalent. INSTALLER AND SPECIAL INSPECTOR QUALIFICATIONS ttalif ,, Qkation � 702.1 Installer training. HVAC system installers are trained and certified in the proper installation of HVAC systems. 702.2 Special inspection. The Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the ❑ discipline they inspect and verify. Verifications. 703.1 Documentation. Verification of compliance with CALGreen may include construction documents, plans, specifications, builder or installer certification, inspection reports, or other methods acceptable to the enforcing agency which show substantial conform an enta:r II be submitted to the Building Department of enta measures and prior to final inspection apprm B"IlIIIIII"t rt Page 4 of 5 CalGreeH 2014.doc revised 11104/14 ptLWl l..D i::Oii CON CW:III..V INCE D4&1t E'. 0970!::'i �6 Project Name: Project Address: Project Description: CALGREEN SIGNATURE DECLARATIONS eA SECTION 1 DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted the City of Cupertino. Oh^ '� �O�— q'ZI 2— Signature Signature Date S AMt—.t Owner's Name (Please Design Professional's Signature Date Design Professional's Name ('Plee Print) of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Email Address for License Professional responsible for CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION Phone Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Name of License Professional responsible for CalGreen compliance (Please Print) Email Address for License Professional responsible for CalGreen compliance Building IlPellpar°tui ment Date Phone Page 5 of 5 CalGreen 2014.doc revised 11/04/14 Da°tE�P 09/0 '/'I6