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12080275CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22717 SAN JUAN RD CONTRACTOR: 7130 - 1(3 BE PERMIT NO: 12080275 DINED OWNER'S NAME: HOMA & MEHRDAD MOJGANI 5U C 4 l CU N YU( DATE ISSUED: 12/07/2012 OWNER'S PHONE: 4084822628 1 , I PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic.E #� 2 Contractor 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. 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. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that l have read this application and state that the above information is correct. 1 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 Cu ertino Municipal Code, Section 9.18. Signature - Date ❑ 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) 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. 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. Date JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT NEW TWO(2)STORY HOUSE WITH BASEMENT, 5278 SQFT; GARAGE 431 SQFT.;DECKS AND PORCH, 618 SQFT, TOTAL 6,327 SQ FT Sq. Ft Floor Area: I Valuation: $700000 APN Number: 34217025.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FR CALLED INSPECTION. Issued by: Date: P L-7 1t;i- RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I 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 MunicipOCode, Chapter 9.12 and the Health & Safety Code, Sections 255 , 3 , nd 25534. % Owner or authorized agent: ate: 7/i, 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 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (406) 777 -322A • FAX (408) 777 -3333 • hlliIrfinrl()r.iinPrtinrl nrn CtIPERTINO I NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS / �1 -[ ��� I APN # 3 _ f _ 0 2 �^ fl/lell OWNERNAME �1� 14& G„ i PHONE 410 i 629 E -MAIL 11�Gi• /1`i�VV�ill� h�1 (' "I`t //Jvnul 1 STREET ADDRESS 'Z 37 C` ��Yl eCl `f- CITY, STATE, ZIP �1' C� FAX I l CONTACT NAME G� G °i PHONE . E -MAIL STREET ADDRESS `;0. 1E- CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME /// LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANYNAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NA C'I�s / LICENSE NUMBER BUS. LIC # ///ME COMPANY NAME / /u� f1 , SP' Gt �) . E -MAIL' VG � 1 _1— �.4� F _2 6f 2,22 STREET ADDRESS CITY, STATE, ZIP p 2� PHONE ( fh, DESCRIPTION OF WORK x , 41 E2USTING USE 5� PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXI.STG AREA NEW FLOOR AREA 7 2. 7 DEMO AREA // TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORyCHH7AREA DECK AREA TOTALDECIIRCH AREA GARAGE AREA: DETACH /, ATTACH l / •✓ ( :'� 3 # DWELLING UNITS: IS A SECOND UNrr ❑ YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? []NO PRE - APPLICATION UYES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES ; R_EgE1VEDBY, TOTAL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER U, EICHLER HOME? ,❑ NO ..� �'� ►'l'' By my signature below, I certify to each of the 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 construction. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: v G Date: SUPPLEMENTAL INFORMATION REQUIRED XN CHECK TYPE , :> .-', ROUTUVG SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for OVER-rHE `BUILDING REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. E RESS- VLANNINGP RE VIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure . L"T;STANDARD LICWORKS _ form i y Hazardous Materials are being used as part of this project. ❑ ' " e� Copy Of Planning Approval Letter or Meeting with Planning prior to LARGE aTAJOR FIRE DEP T snwITARYSEwER nISTRICT submittal of Building Permit application. ❑, ENVIRONMENTAtHEALTH° B1dgApp_2011.doc revised 05/21/11 FM__7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION imADDRESS: lot 168, san juan rd. DATE: 08/27/2012 REVIEWED BY: bobs. PC FEE ID APN: BP #: "VALUATION: 1$700,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? Yes No PENTAMATION 1 R3SFDW PERMIT TYPE: WORK construct new 2 storV with basement 5278 s.f. , gara a 431 s.f. , decks and porch, 618 s.f. SCOPE 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 6,327 $3,389.32 IR3PLNCK $4,602.52 IR3INSP $0.00 PME Plan Check: $0.00 Permit Fee: $4,602.52 Suppl. Insp. Fee -0 Reg. 0 OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 6,327 $3,389.32 $4,602.52 1 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'l info. FEE ITEMS (Fee Resolution 11 -053 Ef: 7/1/11) FEE QTY /FEE MISC ITEMS Plan Check Fee: $3,389.32 E3 11c"b L_/,, Vc,", Suppl. PC Fee: 0 Reg. OT 0.0 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'l info. FEE ITEMS (Fee Resolution 11 -053 Ef: 7/1/11) FEE QTY /FEE MISC ITEMS Plan Check Fee: $3,389.32 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $4,602.52 Suppl. Insp. Fee -0 Reg. 0 OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONST,XR 1 # new units $595.41 lcfiriir �ir.rtibe /'c>c 0 0 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: IPLLONGR $822.51 Select a Non - Residential Building or Structure 0 Strong Motion Fee: IBSEISMICR $70.00 Select an Administrative Itern Bldg Stds Commission Fee: 1BCBSC $28.00 SUBTOTALgi $9,507.76 $0.00 TOTAL FEE: $9,507.76 Revised: 07/01/2012 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22717 SAN JUAN RD CONTRACTOR: SUCALA PERMIT NO: 12080275 CONSTRUCTION OWNER'S NAME: HOMA & MEHRDAD MOJGANI 20394 ALMADEN RD DATE ISSUED: 12/07/2012 OWNER'S PHONE: 4084822628 SAN JOSE, CA 95120 PHONE NO: (408) 497 -3746 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL License Class Lic. # CONSTRUCT NEW TWO(2)STORY HOUSE WITH BASEMENT, Contractor Date 4847 SQFT; GARAGE 431 SQFT.;DECKS AND PORCH, 618 I hereby affirm that I am licensed under the provisions of Chapter 9 SQFT, TOTAL 6,327 SQ FT (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. AW11r1ON #I- REVISE FOUNDATION PLANS -ISSD OTC 9/4/2013 I hereby affirm under penalty of perjury one of the following I have and will maintain a certificate of consent to self -insu er's Compensation, as provided for by Section 3700 of the Labor Coder t Sq. Ft Floor Area: Valuation: $700000 performance of the work for which this permit is issued. DN 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 APN Number: 34217025.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE- ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER - BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE the Business & Professions Code). construct project (Sec.7044, I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self - insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. r Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Dater I certify that in the performance of the work for which this permit is issued, I shall in to become to the Worker's / not employ any person any manner so as subject Compensation laws of California. if, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION / COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ^[ 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 1;0gb 2 ! ✓ ✓✓ (408) 777 -3228 • FAX (408) 777 -3333 • building cDcupertino.orq PROJECT ADDRESS 22-7/-7 OL' n r , `^ APN # OWNERNAME „^ �`n I VLYLVI PHONE _/� 52 _2 J E-MAIL STREET ADDRESS 1L CITY, STATE, ZIP V7 (, (-� FAX ICONTACT NAME PHONE I E -MAIL I STREET ADDRESS r CITY, STATE, ZIP I FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE I ARCHITECTIENGINEER NAME I LICENSE NUMBER BUS. LIC # I�COMPANY NAME E -MAIL FAX I STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Q-u Jal� J-),\ ! / !/� ,�F7 1/a,t1e< EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH [1ATTACH 9 DWELLING UNITS: I IS A SECOND UNIT tJYES SECONDSTORY OYES BEING ADDED? []NO ADDITION? []NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES . CEIV.gD BY: 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 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 Iocal ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. — Date: Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED PzAJrIECx rYrlw aCIIkIxIJV+ _ New SFD or Multifamily dwellings: Apply for demolition permit for 0 0` 4a1r car 1rvx I C# ,OMDINP existing building(s). Demolition permit is required prior to issuance of building = permit for new building. EXPRESS PL4NNit+Tt Al'IREV[V4i _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure] sznND�iD ('TLIC�?vc)>lkKs form if any Hazardous Materials are being used as part of this project. Gi LARGE . I d D _ Copy of Planning Approval Letter or Meeting with Planning prior to ©MA►r38. ITAIiYWERIFT3RG"1 submittal ofBuilding Permit application. , ElwlviA{tNMEI�1'M`,iT: HLII`R B1dgApp 2011.doc revised 06121111 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: y.L Su 0- (.tiO, U\ - PERMIT # r� f 0 &2 j OWNER'S NAME: BUSINESS LICENSE # PHONE # e,4 " 2 - 2 GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: 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: - Signature Please check applicable subcontractors and complete the following information: Date I ` - j 3s1�� _. %� ilz�l� Owner / Contractor Signature Date 14 3l. °c1 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork ^I S ' -, Cement Finishing Al Electrical SS � eG- �G . ��`� � b Excavation �- �� t2 -rr 3l, O Fencing p, Flooring / Carpeting NY- 4a 0. -- v\ q �L- Linoleum / Wood 79 q Glass / Glazing Heating Insulation Landscaping no La 6� t� - 3 Lathin g L��K vGi03`tI` e i Masonry cj 3 q 4 Painting / Wallpaper Paving ► �•� c�. S� N-t\.A-C 1 6�v 553 Lr �1 Plastering /✓}C V\t- V 6 gs Plumbing 41- Roofing c ` rot v� � -7 c. �) y Septic Tank Sheet Metal s rat Sheet Rock vmvv Tile Ccx�S I ` - j 3s1�� _. %� ilz�l� Owner / Contractor Signature Date 14 3l. °c1 CUPERTINO OWNER- BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 • building( - )cupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS �` -7 }7 /� \ APN BP# OWNERNAME I t..�nn �VJ/M 'OW1NEERRADDRESS DESCRIPTION OF WORK: ` We are providing you with an Owner - Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner - Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 11'M. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner - Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. /vl2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. YLI. I understand as an "Owner- Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. AL—N. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. [Ln. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. I understand if I am considered an "employer" under state and federal law, I must register with the state and ederal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. lte,7. I understand under California Contractors' State License Law, an Owner - Builder who builds single - family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. HV � S. I understand as an Owner - Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForin 2010. doe revised 04114110 i 9. 1 understand I may obtain more information regarding my obligations as an "employer' from the Internal evenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800 - 321 -CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. A-60. I am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. Iy1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide all applicable laws and requirements that govern Owner - Builders as well as employers. 2. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the formation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner - Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verif the property owner's signature. Property Owner's Signature: Date: --------------------------------------------------------------t-o--b- ------------------------------------------------------------------------ (NOTE: The following Authorization Form is required e completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner - Builder). AUTHORIZA "PION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner - Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderFOYm 2010.doc revised 04114110 SUBMITTAL BUILDING ENERGY ANALYSI #1 PROJECT: Mehrdad - Mojgani Residence Lot 168PM 13 d,< :; Cupertino, CA f� t Project Designer: G'Lush Design Associates, Inc. 6572 Northridge Drive San Jose, CA 95120 (408) 268 -1665 Report Prepared by: Timothy Carstairs, CEA, CEPS Carstairs Energy Calculations P.O. Box 4736 San Luis Obispo, CA 93403 (805) 904 -9048 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 2008 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC — www.energysoft.com. EnergyPro 5.1 by EnergySoft User Number: 6249 RunCode: 2012 -08- 09714:32:40 ID: 12 -0731 TABLE OF CONTENTS Cover Page Table of Contents Form CF -1 R Certificate of Compliance Form MF -1 R Mandatory Measures Summary EnergyPro 5.1 by EnergySofl Job Number: ID: 12 -0731 User Number. 6249 2 3 11 PERFORMANCE CERTIFICATE: Residential Part 1 of 5 CF -1 R Project Name Mehrdad- Mojgani Residence Building Type m Single Family ❑ Addition Alone I ❑ Multi Family ❑ Existing+ Addition /Alteration Date 81912012 Project Address Lot 168 P M 13 Cupertino California Energy Climate Zone CA Climate Zone 04 Total Cond. Floor Area 4,847 Addition n/a # of Stories 3 FIELD INSPECTION ENERGY CHECKLIST • Yes I] No HERS Measures -- If Yes, A CF -4R must be provided per Part 2 of 5 of this form. • Yes ❑ No Special Features -- If Yes, see Part 2 of 5 of this form for details. INSULATION Construction Type Area Special Cavity (ft) Features see Part 2 of 5 Status Wall Hollow Unit Masonry None 1,288 Int =R -19.0 New Wall Wood Framed R -19 3,286 New Door Opaque Door None 40 New Slab Unheated Slab -on -Grade None 1,757 Perim = 205' New Floor Wood Framed w /Crawl Space R -19 198 ^� New Roof Wood Framed Attic R -30 1,949 New FENESTRATION U- Orientation Area (ft) Factor Exterior SHGC Overhang Sidefins Shades Status Front (SW) 144.0 0.370 0.32 none none Bug Screen New Left (NW) 104.0 0.370 0.32 none none Bug Screen New Left (NW) 237.3 0.370 0.32 none none Bug Screen New Rear (NE) 163.3 0.370 Right (SE) 63.8 0 370 0.32 none none Dug Screen New 0.32 none none Bug Screen New Front (SW) 48.0 0.370 0.32 none none Bug Screen New Rear (NE) 136.0 0.370 Rear (NE) 48.0 0.370 0.32 none none Bug Screen. New 0.32 none none Bug Screen New Skylight 6.0 0.370 0.32 none none None New HVAC SYSTEMS Qty. Heating Min. Eff Cooling Min. Eff Thermostat Status 2 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 Basement 6.0 New WATER HEATING Qty. Type Gallons Min. Eff Distribution Status 1 Small Gas 75 0.62 No Pipe Insulation New EnergyPro 5.1 by EnergySoft User Number: 6249 RunCode: 2012- 08- 09T14:32 :40 ID: 12 -0731 Page 3 of 13 PERFORMANCE CERTIFICATE: Residential (Part 2 of 5 ) CF -1 R Project Name Mehrdad- Mojgani Residence Building Type m Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition /Alteration Date 81912012 SPECIAL FEATURES INSPECTION CHECKLIST The enforcement agency should pay special attention to the items specified in this checklist. These items require special written justification and documentation, and special verification to be used with the performance approach. The enforcement agency determines the adequacy of the justification, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. HERS REQUIRED VERIFICATION Items in this section require field testing and/or verification by a certified HERS Rater. The inspector must receive a completed CF -4R form for each of the measures listed below for final to be given. EnergyPro 5.1 by EnerqySoft User Number: 6249 RunCode: 2012- 08- 09T14:32:40 0: 12 -0731 Page 4 of 13 PERFORMANCE CERTIFICATE: Residential (Part 3 of 5) CF -1 R Project Name Building Type m Single Family ❑ Addition Alone Date Mehrdad- Mojgani Residence ❑ Multi Family ❑ Existing+ Addition /Alteration $1912012 ANNUAL ENERGY USE SUMMARY Standard Proposed Margin TDV kBtu /ft2 r Space Heating 22.44 18.80 3.64 Space Cooling 4.43 2.23 2.20 Fans 4.03 3.17 0.86 Domestic Hot Water 8.15 7.72 0.43 Pumps 0.00 0.00 0.00 Totals 39.05 31.92 7.13 Percent Better Than Standard: 18.3% BUILDING COMPLIES - NO HERS VERIFICATION REQUIRED Fenestration Building Front Orientation: (SW) 225 deg Ext. Walls /Roof Wall Area Area Number of Dwelling Units: 1.00 (S w) 1,476 192 Fuel Available at Site: Natural Gas (NW) 1,303 341 Raised Floor Area: 198 (NF_) 1,476 347 Slab on Grade Area: 1,757 (SE) 1,303 64 Average Ceiling Height: 8.8 Roof 1,955 6 Fenestration Average U- Factor: 0.37 TOTAL: 950 Average SHGC: 0.32 Fenestration /CFA Ratio: 19.6 io REMARKS STATEMENT OF COMPLIANCE This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 the Administrative Regulations and Part 6 the California - 11241111 14 "°°°`a°'d' °gE°e`9Ya°7= Efficiency Standards of the California Code of Regulations. Tifn °thYC —Wir. R0846 -210 The documentation author hereby certifies that the documentation is accurate and complete. Documentation Author Company Carstairs Energy Calculations 8/9/2012 P.O. Box 4736 Timothy Carstairs, CEA, C-PE Address Name y Cit /State /Zip San Luis Obispo, CA 93403 Phone (805) 904 -9048 Signed Date The individual with overall design responsibility hereby certifies that the proposed building design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application, and recognizes that compliance using duct design, duct sealing, verification of refrigerant charge, insulation installation quality, and building envelope sealing require installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) Company G'Lush Design Associates, Inc. C Address 6572 Northridge Drive Name , City /State /Zip San Jose. CA 95120 Phone (408) 268 -1665 Signed Li ense # Date EnerqvPro 5.1 by EnergySoft User Number., 6249 RunCode: 2012- 08- 09T14:32:40 ID: 12 -0731 Page 5 of 13 CERTIFICATE OF COMPLIANCE: Residential (Part 4 of 5) CF -1 R Project Name Mehrdad- Mojgani Residence Building Type m Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition /Alteration Date 8192012 OPAQUE SURFACE DETAILS Surface Type Area U- Factor Insulation Azm Tilt Status Joint Appendix 4 Location /Comments Cavity Exterior Frame Interior Frame Wall 477 0.060 None 19.0 Wood 225 90 New 4.3.5 -A 10 Basement Wall 62 0.074 R -19 225 90 New 4.3.1 -A5 Basement Wall 40 0.074 R -19 315 90 New 4.3.1 -A5 Basement Wall 230 0.060 None 19.0 Wood 315 90 New 4.3.5 -A 10 Basement Wall 214 0.074 R -19 45 90 New 4.3.1 -A5 Basement Wall 288 0.060 None 19.0 Wood 45 90 New 4.3.5 -A 10 Basement Wall 293 0.060 None 19.0 Wood 135 90 New 4.3.5 -A 10 Basement Wall 43 0.074 R -19 135 90 New 4.3.1 -A5 _ Basement Door 21 0.500 None 135 90 New 4,5.1 -A4 Basement Slab 1,757 0.730 None 0 180 New 4.4.7 -A1 Basement Floor 198 0.037 R -19 0 180 New 4.4.1 -A4 1 st Floor Wall 441 0.074 R -19 225 90 New 4.3.1 -A5 1st Floor _ Wall 341 0.074 R -19 315 90 New 4 3.1 -A5 _ 1st Floor Wall 383 0.074 R -19 45 90 New 4.3.1 -A5 1st Floor Wall 463 0.074 R -19 135 90 New 4.3.1 -A5 1st Floor Door 19 0.500 None 135 90 New 4.5.1 -A4 1 st Floor FENESTRATION SURFACE DETAILS ID Type Area LI- Factor SHGC2 Azm Status Glazing T e Location /Comments 1 Window 1.0 0.370 NFRC 0.32 NFRC 225 New Double Non Metal Clear Basement_ 2 Window 64.0 0.370 NFRC 0.32 NFRC 315 New Sliding Glass Door Basement 3 Window 40.0 0.370 NFRC 0.32 NFRC 315 New Sliding Glass Door _ Basement 4 Window 9.0 0.370 NFRC 0.32 NFRC 315 _ New Double Non Metal Clear Basement 5 Window 13.5 0.370 NFRC 0.32 NFRC 45 New Double Non Metal Clear Basement 6 Window 25.0 0.370 NFRC 0.32 NFRC 45 New Double Non Metal Clear _ Basement _ 7 Window 25.0 0.370 NFRC 0.32 NFRC 135 New Double Non Metal Clear Basement 8 Window 1.0 0.370 NFRC 0.32,NFRC 135 New Double Non Metal Clear Basement 9 Window 13.8 0.370 NFRC 0.32 NFRC 225 New Double Non Metal Clear 1st Floor 10 Window 13.8 0.370 NFRC 0.32 NFRC 225 New Double Non Metal Clear 1 st Floor 11 Window 13.8 0.370 NFRC 0.32 NFRC 225 _ New Double Non Metal Clear 1 st Floor 12 Window 13.8 0.370 NFRC 0.32 NFRC 225 New Non Metal Clear 1st Floor 13 Window 13.8 0.370 NFRC 0.32 NFRC 225 New Double Non Metal Clear 1 st Floor 14 Window 18.0 0.370 NFRC 0.32 NFRC 225 New Double Non Metal Clear 1 st Floor 15 Window 48.0 0.370 NFRC 0.32 NFRC 225 New French Door 1st Floor 16 Window 13.8 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear 1st Floor _ (1) Ll- Factor Type: 116 -A = Default Table from Standards, NFRC = Labeled Value 2 SHGC Type: 116 -B = Default Table from Standards, NFRC = Labeled Value EXTERIOR SHADING DETAILS ID Exterior Shade Type SHGC Window Ove hang Left Fin Right Fin H t Wd Len H t LExt REA Dist Len H t Dist Len H t 1 Bug Screen 0.76 2 Bug Screen 0.76 3 Bug Screen 0.76 4 Bug Screen 0.76 5 Bug Screen 0.76 6 Bug Screen 0.76 7 Bug Screen 0.76 _ 8 Bug Screen 0.76 9 Bug Screen 0.76 10 Bug Screen 0.76 11 Bug Screen 0.76 12 Bug Screen 0.76 13 Bug Screen 0.76 14 Bug Screen 0.76 15 JBug Screen 0.76 16 Bug Screen 0.76 EnergyPro 5.1 by EnerqySoft User Number- 6249 RunCode: 2012- 08- 09T14:32:40 ID: 12 -0731 Page 6 of 13 CERTIFICATE OF COMPLIANCE: Residential (Part 4 of 5) CF -1 R Project Name Mehrdad- Mojgani Residence Building Type m Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition /Alteration Date 81912012 OPAQUE SURFACE DETAILS Surface Type Area U- Factor Insulation Azm Tilt Status Joint Appendix 4 Location /Comments CavitYTExterior Frame Interior Frame Roof 820 0.031 R -30 315 18 New 4.2.1 -A20 1st Floor Wall 304 0.074 R -19 225 90 New 4.3.1 -A5 2nd Floor Wall 351 0.074 R -19 315 90 New 4.3.1 -A5 2nd Floor Wall 244 0.074 R -19 45 90 New 4.3.1 -A5 2nd Floor Wall 401 0.074 R -19 135 90 New 4.3.1 -A5 2nd Floor Roof 1,129 0.031 R -30 90 18 New 4.2.1 -A 20 2nd Floor FENESTRATION SURFACE DETAILS ID Type Area U- Factor SHGC2 Azm Status Glazing Type Location /Comments 17 Window 13.8 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear 1st Floor 18 Window 13.8 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear 1 st Floor 19 Window 13.8 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear 1st Floor 20 Window 40.3 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear 1st Floor 21 Window 40.3 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear 1st Floor 22 Window 9.0 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear 1st Floor 23 Window 18.0 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear 1st Floor 24 Window 11.7 0.370 NFRC 0.32 NFRC 45 New Double Non Metal Clear 1st Floor 25 Window 11.7 0.370 NFRC 0.32 NFRC 45 New Double Non Metal Clear 1st Floor 26 Window 11.7 0.370 NFRC 0.32 NFRC 45 New Double Non Metal Clear 1st Floor 27 Window 11.7 0.370 NFRC 0.32 NFRC 45 New Double Non Metal Clear 1st Floor 28 Window 18.0 0.370 NFRC 0.32 NFRC 45 New Double _ Non Metal Clear 1st Floor 29 Window 80.0 0.370 NFRC 0.32 NFRC 45 New Sliding Glass Door 1st Floor 30 Window 48.0 0.370 NFRC 0.32 NFRC 45 New French Door 1st Floor 31 Window 7.5 0.370 NFRC 0.32 NFRC 135 New Double Non Metal Clear 1st Floor 32 Window 7.5 0.370 NFRC 0.32 NFRC 135 New Double Non Metal Clear 1st Floor (1) U- Factor Type: 116 -A = Default Table from Standards, NFRC = Labeled Value 2 SHGC Type: 116 -13 = Default Table from Standards, NFRC = Labeled Value EXTERIOR SHADING DETAILS ID Exterior Shade Type SHGC Window Ove hanq Left Fin Ri ht Fin Hq7i Wd Len H t LExt REA Dist Len H t Dist Len H t 17 Bug Screen 0.76 18 Bug Screen 0.76 19 Bug Screen 0.76 20 Bug Screen 0.76 21 Bug Screen 0.76 22 Buq Screen 0.76 23 Bug Screen 0.76 24 Bug Screen 0.76 25 Bug Screen 0.76 26 Bug Screen 0.76 27 Bug Screen 0.76 28 Bug Screen 0.76 29 Bug Screen 0.76 30 Bu Screen 0.76 31 Bu Screen 0.76 32 JBug Screen 0.76 FE-nergypro 5.1 by EnenqySoft User Number., 6249 RunCode: 2012- 08- 09T14:32:40 ID: 12 -0731 Pa e 7 of 13 CERTIFICATE OF COMPLIANCE: Residential (Part 4 of 5) CF -1 R Project Name Mehrdad- Mojgani Residence Building Type m Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition /Alteration Date 81912012 OPAQUE SURFACE DETAILS Surface Type Area U- Factor Insulation Azrn Tilt Status Joint Appendix 4 Location /Comments Cavity Exterior Frame Interior Frame FENESTRATION SURFACE DETAILS ID Type Area U- Factor SHGC2 Azm Status Glazing Type Location/Comments 33 Window 7.5 0.370 NFRC 0.32 NFRC 135 New Double Non Metal Clear 1 st Floor 34 Window 10.0 0.370 NFRC 0.32 NFRC 225 New Double Non Metal Clear 2nd Floor 35 Window 10.0 0.370 NFRC 0.32 NFRC 225 New Double Non Metal Clear 2nd Floor 36 Window 10.0 0.370 NFRC 0.32 NFRC 225 New Double Non Metal Clear 2nd Floor 37 Window 4.0 0.370 NFRC 0.32 NFRC 225 New Double Non Metal Clear 2nd Floor _ 38 Window 4.0 0.370 NFRC 0.32 NFRC 225 New Double Non Metal Clear 2nd Floor _ 39 Window 6.0 0.370 NFRC 0.32 NFRC 225 New Double Non Metal Clear Floor 40 Window 6.0 0.370 NFRC 0.32 NFRC 225 New Double Non Metal Clear 2nd Floor 41 Window 6.0 0.370 NFRC 0.32 NFRC 225 New Double Non Metal Clear 2nd Floor 42 Window 10.0 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear 2nd Floor 43 Window 10,0 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear _ 2nd Floor 44 Window 10.0 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear _ 2nd Floor 45 Window 6.0 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear 2nd Floor 46 Window 6.0 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear 2nd Floor 47 Window 6.0 0.370 NFRC 0312 NFRC 315 New Double Non Metal Clear 2nd Floor 48 Window 4.0 0.370 NFRC 0.32 NFRC 3151 New Double Non Metal Clear 12nd Floor (1) U- Factor Type: 116 -A = Default Table from Standards, NFRC = Labeled Value 2 SHGC Type: 116 -B = Default Table from Standards, NFRC = Labeled Value EXTERIOR SHADING DETAILS ID Exterior Shade Type SHGC Window Overhanq Left Fin Ri ht Fin H t Wd Len H t LExt RExt Dist Len H t Dist Len H t 33 Bug Screen 0.76 34 Bug Screen 0.76 35 Bug Screen 0.76 36 Bug Screen 0.76 37 Bug Screen 0.76 38 Bug Screen 0.76 39 Bug Screen 0.76 40 Bug Screen 0.76 41 Bug Screen 0.76 42 Bug Screen 0.76 43 Bug Screen 0.76 44 Bug Screen 0.76 45 Bug Screen 0.76 46 Bug Screen 0.76 47 Bug Screen 0.76 48 Bug Screen 0.76 EnergyPro 5.1 by EnergySoft User Number. 6249 RunCode: 2012- 08- 09T14:32:40 ID: 12 -0731 Page 8 of 13 CERTIFICATE OF COMPLIANCE: Residential (Part 4 of 5) CF -1 R Project Name Mehrdad- Mojgani Residence Building Type m Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition /Alteration Date 81912012 OPAQUE SURFACE DETAILS Surface Tvpe Area U- Factor Insulation Azm Tilt Status Joint Appendix 4 Location /Comments Cavity Exterior Frame Interiorl Frame FENESTRATION SURFACE DETAILS ID Type Area U- Factor 'Hr(C2 Azm Status Glazing Type Location /Comments 49 Window 6.0 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear 2nd Floor 5D Window 7.5 0.370 NFRC 0.32 NFRC 315 New Double Non Metal Clear 2nd Floor 51 Window 20.0 0.370 NFRC 0.32 NFRC 45 New Double Non Metal Clear 2nd Floor 52 Window 16.0 0.370 NFRC 0.32 NFRC 45 New Double Non Metal Clear 2nd Floor 53 Window 24.0 0.370 NFRC 0.32 NFRC 45 New Double Non Metal Clear 2nd Floor 54 Window 56.0 0.370 NFRC 0.32 NFRC 45 New Sliding Glass Door _ 2nd Floor 55 Window 4.5 0.370 NFRC 0.32 NFRC 135 New Double Non Metal Clear 2nd Floor 56 Window 4.5 0.370 NFRC 0.32 NFRC 135 New Double Non Metal Clear 2nd Floor 57 r Window 6,3 0.370 NFRC 0.32 NFRC 135 New Double Non Metal Clear 2nd Floor 58 Skylight 6.0 0.370 NFRC 0.32 NFRC 90 New Double Non Metal Clear 2nd Floor (1) LI- Factor Type: 116 -A = Default Table from Standards, NFRC = Labeled Value 2 SHGC Type: 116 -B = Default Table from Standards, NFRC = Labeled Value EXTERIOR SHADING DETAILS ID Exterior Shade Type SHGC Window Ove hanq Left Fin Ri ht Fin H t Wd Len H t LExt RExt Dist Len H t Dist Len H t 49 Bug Screen 0.76 50 Bug Screen 0.76 51 Bug Screen 0.76 _ 52 Bug Screen 0.76 53 Bug Screen 0.76 54 Bug Screen 0.76 55 Bug Screen 0.76 56 Bug Screen 0.76 57 Bug Screen 0.76 58 None 1.00 EnerqyPro 5.1 by Energ ySoft User Number- 6249 RunCode: 2012- 08- 09T14 :32 :40 ID: 12 -0731 Page 9 of 13 CERTIFICATE OF COMPLIANCE: Residential (Part 5 of 5) CF -1 R Project Name Mehrdad- Mojgani Residence Building Type © Single Family ❑ Addition Alone ❑ Multi Family ❑ Existing+ Addition /Alteration Date 8192012 BUILDING ZONE INFORMATION System Name Zone Name Floor Area ft Volume Year Built New Existing Altered Removed HVAC System Basement 1,757 15,813 1st Floor 1,955 17,595 2nd Floor 1,135 9,080 Totals 1 4,8471 01 01 0 HVAC SYSTEMS System Name Qty. Heating Type Min. Eff. Cooling Type Min. Eff. Thermostat Type Status HVAC System 2 Central Furnace 80% AFUE Split Air Conditioner 13.0 SEER Setback New HVAC DISTRIBUTION System Name Heating Coolin Duct Location Duct R -Value Ducts Tested? Status HVAC System Ducted Ducted Basement 6.0 ❑ New El 0 El WATER HEATING SYSTEMS S stem Name Qty- Type Distribution Rated Input Btuh Tank Cap. al Energy Factor or RE Standby Loss or Pilot Ext. Tank Insul. R- Value Status 75 Gal. Gas 1 Small Gas No Pipe Insulation 70,000 75 0.62 n/a n/a New MULTI - FAMILY WATER HEATING DETAILS HYDRONIC HEATING SYSTEM PIPING Control Hot Water Piping Length ft 0 0 m �a 4 — System Name Pipe Length Pipe Diameter Insul. Thick. Qty. HP Plenum Outside Buried 11 1 El El El EnergyPro 5.1 by EnergySoft User Number: 6249 RunCode: 2012- 08 -09T14 :32:40 ID: 12 -0731 Page 10 of 13 MANDATORY MEASURES SUMMARY: Residential (Page 1 of 3 MF -1 R Project Name Mehrdad - Mojgani Residence Date 81912012 NOTE: Low -rise residential buildings subject to the Standards must comply with all applicable mandatory measures listed, regardless of the compliance approach used. More stringent energy measures listed on the Certificate of Compliance (CF -1 R, CF -1 R -ADD, or CF- 1 R -ALT Form) shall supersede the items marked with an asterisk ( *) below. This Mandatory Measures Summary shall be incorporated into the permit documents, and the applicable features shall be considered by all parties as minimum component performance specifications whether they are shown elsewhere in the documents or in this summary. Submit all applicable sections of the MF -1 R Form with plans. Building Envelope Measures: 116 (a)1: Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage. §116(a)4: Fenestration products (except field- fabricated windows) have a label listing the certified U- Factor, certified Solar Heat Gain Coefficient SHGC , and infiltration that meets the requirements of §10-111 (a). 117: Exterior doors and windows are weather-stripped; all joints and penetrations are caulked and sealed. 118(a): Insulation specified or installed meets Standards for Insulating Material. Indicate type and include on CF -6R Form. §118(1): The thermal emittance and solar reflectance values of the cool roofing material meets the requirements of §118(i) when the installation of a Cool Roof is specified on the CF -1 R Form. *§1 50 a : Minimum R -19 insulation in wood -frame ceiling orequivalent U- factor. 150 (b): Loose fill insulation shall conform with manufacturer's installed design labeled R- Value. *§1 50 c : Minimum R -13 insulation in wood -frame wall orequivalent U- factor. J *§1 50 d : Minimum R -13 insulation in raised wood -frame floor orequivalent U- factor. _ §150(f): Air retarding wrap is tested, labeled, and installed according to ASTM E1677-95(2000) when specified on the CF-1R Form. 150 : Mandatory Vapor barrier installed in Climate Zones 14 or 16. §150(1): Water absorption rate for slab edge insulation material alone without facings is no greater than 0.3 %; water vapor permeance rate is no greater than 2.0 perm/inch and shall be protected from physical damage and UV light deterioration. Fireplaces, Decorative Gas Appliances and Gas Log Measures: 150 e 1 A: Masonry or factory-built fireplaces have a closable metal or glass door covering the entire opening of the firebox. §150(e)1 B: Masonry or factory -built fireplaces have a combustion outside air intake, which is at least six square inches in area and is equipped with a with a readily accessible, operable, and tight-fitting damper and or a combustion -air control device. §150(e)2: Continuous burning pilot lights and the use of indoor air for cooling a firebox jacket, when that indoor air is vented to the outside of the building, are prohibited. Space Conditioning, Water Heating and Plumbing System Measures: §110 - §113: HVAC equipment, water heaters, showerheads, faucets and all other regulated appliances are certified by the Energy Commission. §113(c)5: Water heating recirculation loops serving multiple dwelling units and High -Rise residential occupancies meet the air release valve, backf low prevention, pump isolation valve, and recirculation loop connection requirements of §1 13(c)5. _ §115: Continuously burning pilot lights are prohibited for natural gas: fan type central furnaces, household cooking appliances (appliances with an electrical supply voltage connection with pilot lights that consume less than 150 Btu /hr are exempt), and pool and spa heaters. 150(h): Heating and /or cooling loads are calculated in accordance with ASHRAE, SMACNA or ACCA. 150(i): Heating systems are equipped with thermostats that meet the setback requirements of Section 112(c). §150 @1 A: Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are externally wrapped with insulation having an installed thermal resistance of R -12 or greater. §150(j)1 B: Unfired storage tanks, such as storage tanks or backup tanks for solar water - heating system, or other indirect hot water tanks have R -12 external insulation or R -16 internal insulation where the internal insulation R -value is indicated on the exterior of the tank. §150(j)2: First 5 feet of hot and cold water pipes closest to water heater tank, non - recirculating systems, and entire length of recirculating sections of hot water pipes are insulated per Standards Table 150 -B. §150(j)2: Cooling system piping (suction, chilled water, or brine lines),and piping insulated between heating source and indirect hot water tank shall be insulated to Table 150 -B and Equation 150-A. §150(j)2: Pipe insulation for steam hydronic heating systems or hot water systems >15 psi, meets the requirements of Standards Table 123 -A. 150(j)3A: Insulation is protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. §150(j)3A: Insulation for chilled water piping and refrigerant suction lines includes a vapor retardant or is enclosed entirely in conditioned s ace. 150(j)4: Solar water-heating systems and /or collectors are certified by the Solar Rating and Certification Corporation. EnergyPro 5.1 by EnergySoft User Number: 6249 RunCode: 2012- 08- 09T14:32:40 ID: 12 -0731 Page 11 of 13 MANDATORY MEASURES SUMMARY: Residential (Page 2 of 3 MF -1 R Project Name Date Mehrdad- Mojgani Residence 81912012 §150(m)1: All air - distribution system ducts and plenums installed, are sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6 -5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R- 4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct - closure system that meets the applicable requirements of UL 181, UL 181 A, or UL 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(m)1: Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross - sectional area of the ducts. §150(m)2D: Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tae is used in combination with mastic and draw bands. 150(m)7: Exhaust fans stems have back draft or automatic dampers. _ §150(m)8: Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. _ §150(m)9: Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. 150 m 10: Flexible ducts cannot have porous inner cores. §150(o): All dwelling units shall meet the requirements of ANSI /ASHRAE Standard 62.2 -2007 Ventilation and Acceptable Indoor Air Quality in Low -Rise Residential Buildings. Window operation is not a permissible method of providing the Whole Building Ventilation required in Section 4 of that Standard. Pool and Spa Heating Systems and Equipment Measures: §114(a): Any pool or spa heating system shall be certified to have: a thermal efficiency that complies with the Appliance Efficiency Regulations; an on -off switch mounted outside of the heater; a permanent weatherproof plate or card with operating instructions; and shall not use electric resistance heating or a pilot light. §114(b)1 : Any pool or spa heating equipment shall be installed with at least 36" of pipe between filter and heater, or dedicated suction and return lines, or built -up connections for future solar heating. 114(b)2: Outdoor pools ors as that have a heat pump or gas heater shall have a cover. _ §114(b)3: Pools shall have directional inlets that adequately mix the pool water, and a time switch that will allow all pumps to be set or ro rammed to run only during off -peak electric demand periods. 150 : Residential Pool systems orequipment meet the pump sizing, flow rate, piping, filters, and valve requirements of §1 50 Residential Lighting Measures: §150(k)1: High efficacy luminaires or LED Light Engine with Integral Heat Sink has an efficacy that is no lower than the efficacies contained in Table 150 -C and is not a low efficacy luminaire as specified by §150(k)2. §150(k)3: The wattage of permanently installed luminaires shall be determined as specified by §130(d). §150(k)4: Ballasts for fluorescent lamps rated 13 Watts or greater shall be electronic and shall have an output frequency no less than 20 kHz. §150(k)5: Permanently installed night lights and night lights integral to a permanently installed luminaire or exhaust fan shall contain only high efficacy lamps meeting the minimum efficacies contained in Table 150 -C and shall not contain a line- voltage socket or line - voltage lamp holder; OR shall be rated to consume no more than five watts of power as determined by §130(d), and shall not contain a medium screw -base socket. 150(k)6: Lighting integral to exhaust fans, in rooms other than kitchens, shall meet the applicable requirements of §1 50(k). 150(k)7: All switching devices and controls shall meet the requirements of §1 50(k)7. _ §150(k)8: A minimum of 50 percent of the total rated wattage of permanently installed lighting in kitchens shall be high efficacy. EXCEPTION: Up to 50 watts for dwelling units less than or equal to 2,500 ft2 or 100 watts for dwelling units larger than 2,500 ft2 may be exempt from the 50% high efficacy requirement when: all low efficacy luminaires in the kitchen are controlled by a manual on occupant sensor, dimmer, energy management system (EMCS), or a multi -scene programmable control system; and all permanently installed luminaries in garages, laundry rooms, closets greater than 70 square feet, and utility rooms are high efficacy and controlled by a manual -on occupant sensor. §150(k)9: Permanently installed lighting that is internal to cabinets shall use no more than 20 watts of power per linear foot of illuminated cabinet. EnergyPro 5.1 by EnergySoff User Number: 6249 RunCode: 2012- 08- 09T14:32:40 ID: 12 -0731 Page 12 of 13 MANDATORY MEASURES SUMMARY: Residential (Page 3 of 3 MF -1 R Project Name Date Mehrdad- Mojgani Residence 81912012 §150(k)l0: Permanently installed luminaires in bathrooms, attached and detached garages, laundry rooms, closets and utility rooms shall be high efficacy. EXCEPTION 1: Permanently installed low efficacy luminaires shall be allowed provided that they are controlled by a manual -on occupant sensor certified to comply with the applicable requirements of §119. EXCEPTION 2: Permanently installed low efficacy luminaires in closets less than 70 square feet are not required to be controlled by a manual -on occupancy sensor. §150(k)l 1: Permanently installed luminaires located in rooms or areas other than in kitchens, bathrooms, garages, laundry rooms, closets, and utility rooms shall be high efficacy luimnaires. EXCEPTION 1: Permanently installed low efficacy luminaires shall be allowed provided they are controlled by either a dimmer switch that complies with the applicable requirements of §119, or by a manual - on occupant sensor that complies with the applicable requirements of §119. EXCEPTION 2: Lighting in detached storage building less than 1000 square feet located on a residential site is not required to comply with §1 50 k 11. §150(k)l2: Luminaires recessed into insulated ceilings shall be listed for zero clearance insulation contact (IC) by Underwriters Laboratories or other nationally recognized testing /rating laboratory; and have a label that certifies the lumiunaire is airtight with air leakage less then 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283; and be sealed with a gasket or caulk between the luminaire housing and ceiling. §150(k)13: Luminaires providing outdoor lighting, including lighting for private patios in low -rise residential buildings with four or more dwelling units, entrances, balconies, and porches, which are permanently mounted to a residential building or to other buildings on the same lot shall be high efficacy. EXCEPTION 1: Permanently installed outdoor low efficacy luminaires shall be allowed provided that they are controlled by a manual on /off switch, a motion sensor not having an override or bypass switch that disables the motion sensor, and one of the following controls: a photocontrol not having an override or bypass switch that disables the photocontrol; OR an astronomical time clock not having an override or bypass switch that disables the astronomical time clock; OR an energy management control system (EMCS) not having an override or bypass switch that allows the luminaire to be always on EXCEPTION 2: Outdoor luminaires used to comply with Exceptionl to §150(k)13 may be controlled by a temporary override switch which bypasses the motion sensing function provided that the motion sensor is automatically reactivated within six hours. EXCEPTION 3: Permanently installed luminaires in or around swimming pool, water features, or other location subject to Article 680 of the California Electric Code need not be high efficacy luminaires. §150(k)14: Internally illuminated address signs shall comply with Section 148; OR not contain a screw -base socket, and consume no more than five watts of power as determined according to §130(d). §150(k)l5: Lighting for parking lots and carports with a total of for 8 or more vehicles per site shall comply with the applicable ^ requirements in Sections 130, 132, 134, and 147. Lighting for parking garages for 8 or more vehicles shall comply with the applicable require ents of Sections 130, 131, 134, and 146. §150(k)16: Permanently installed lighting in the enclosed, non - dwelling spaces of low -rise residential buildings with four or more dwelling units shall be high efficacy luminaires. EXCEPTION: Permanently installed low efficacy luminaires shall be allowed provided that they are controlled by an occupant sensor(s) certified to comply with the applicable requirements of §119. EnergyPro 5.1 by EnergySofr User Number: 6249 RunCode: 2012- 08- 09T14 :32 :40 ID: 12 -0731 Page 13 of 13