12110145I
CITY OF CUPERTINO BUILDING PERMIT
RUILDING ADDRESS: 21240 GARDENA DR
CONTRACTOR: VALLHY II HA'Z'ING &
PEIRMITNO: 12110145
COOLING
OWNER'S NAME: Z F P COMPANY
1171 N It'll ST
DATE ISSUED: 11282012
OWNER'S PHONE: 4082452795
SAN.IOSE. CA 95112
PIIONE NO: (408)294 -6290
I .ICENS'D CONTRACT'OR'S DECLARATION
K
r ELECT r PLUMB r
.
License Clns Lic. q Z �5
BUILDING PFRi1Ill'I( 0: RI,)C
r r t
�COMRE2CIAL
r
h1ECF1 RhSIDFN1IAL
Contractor / /Cl� Date Z_
hereby affirm (hat I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: REPLACE FURNACE AT SAME LOCATION
(commencing with Section 7000) of Biyision 3 of the Business R Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following Iwo declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued,
Sq. Ft I lour Aran:
Valuation: $2280
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
APNNumber: 326,10006.00
Occupancy Type:
permit is issued.
,kl'1'IJCAN'I' CERT'IFICA'TION
I certify that l have read this application and state that the above information is
correct. l agree to comply with all city and county ordinances and state laws relating
PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities, judgments.
180 DAYS FROM LAST CALLED INSPECTION.
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 sourc gulaticns per the Cupertino Municipal Code, Section
Issued by. Da(e:�/
9.18.
Signatur Dat
—
Rh: ROOFS:
❑ OWNER- RITILDER DECLARA'T'ION
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
I hereby affirm that I am exempt from the Contractor's License Law for one of
inspection.
the following two reasons:
1, as owner of property, or my employees with wages as their sole compensation,
Signature of Applic nt: Date
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
ALI, ROOF COVERINGS TO TIE CLASS "A" OR BE1717IR
construct the project(Sec.7044, Business d Professions Code).
1 hereby affirm under penalty of perjury one of the following three
IIAZARDOUS \ ATERIAI S DISCLOSURE
declarations:
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's
California Ilea llh & Safety Code. Sections 25505, 25533, and 25534. I will maimain
Compensation, as provided for by Section 3700 of the Labor Code, for the
compliance with the Cupertino Municipal Code, Chapter 9.12 and the I Icalth S
performance of the work for which this permit is issued.
Safety Code. Section 25532(a) should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code, for the performance of the woik for which this
contaminants as defined by the Ray Area Air Quality Management District I n'ill
permit is issued.
maintain compliance w ith the Cupertino Municipal Code, Chapter 9.12 and the
Ile:dlh S Safely Code. Seclinns 25505, 25533, and 25534.
1 certify that in the performance of the work for which this permit is issued, I shall
"
not employ any person in any manner so as to become subject to the Worker's
Owner
Compensation laws ofCalifornia. If, alter making this certificate ofexemption,I
Daly. j�
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.
CONSTRIJC`fION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of work's
AI'I'I.ICA ,N1' CER- 1'IFICA'I'ION
for which this permit is issued (Sec. 3097, Civ C.)
I certify that I have read this application and state that the above information is
Lender's Name
correct. 1 agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this chy,to enter
Lender's Address
upon the above mentioned properly 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
, %RCII ITE(—I"S DECLARATION
granting of this permit. Additionally, the applicant understands and will comply
I understand my plans shall be used as public records.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Licensed Professional
Signature Date
a
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255
(408) 777 -3228 • FAX (408) 777 -3333 • building rl�. cuoerino.ora
^PLUMBING _ CrIANIC.4L I I ='=CAL ❑h= LLANcOUS
MEP
m'sc
FROis ADDRESS ` D
I AFN;
0
WN:ER NAME
I PHONE
Si REETADDRESS '% / z el'e
(—
Ci7Y SEAT° LPL
/
I FAX
CONTACT NAME
PHONE —
I E -MAIL
Si7L-_.TD.D:L'-SS
❑ OwNa ❑ OwNER.BuaoR ❑ Owxm AGT7'
❑ CONTRACTOR ❑ CONTRACTORAC-E T, ❑ ARGTSf ❑ DJG]+Zt Cl DEVELOPER. ❑ TENANT
COhTRACTORNAME
I/ol
LICENSE NtBEIt
Zr
UCiS i. E
-2a
BUS. LICC
Col"IYNYNAM: /
G
E -N1JL
FAX
ST-R— TADDZSS
C
I CITY, STA SLR
��
PHONEZ.
ARCS=CT/ZNGIN=. NAME
LICENSE N_uI` -t
I BUS. LC p
CONQ1'NYNA)'IE'
I E -MAIl.
FAX
STTLE;1'ADDRESS
I CTiY,ST.ATE.ZIP
PHONE'
USE OF E=DUPIFX ❑ MULT }FAMILY
BLrnZWG: ❑COMN.JlCIA1
PROTECT IN WE LAND ❑
I URBAN INTERFACE AREA ❑ NO I
N ❑YES
FLOOD ZOT= ❑ NO
is TI' BLDG AN ❑ YES
I MCKI.ER HOLE ❑ NO
DESC'AIFTION OF wORR
TOTAL VA? CATION:
RECEIVED BY: !
By my sigma =c below, I e- --5;1 m each of the :olloa Wig: I a>a :be pm openy owner or a'_thorized agent to ac' , on the pmpury ownt-'s behalf I have :cad ;his
applicxdon and the info -adon I have provided is — -. I he ad the Description o; ',Wo:L and ve:ify it is acnuz:c. I age n_ a comply will all applicable Ioca1
ordinances and state laws relating to =ildiLg _ ]C5 oriZe =rts 71m t0 Cn:Lr Lhe 260Ve- Iden1]ed pTQOJC. —• f i0i InSpeeD01 DllifO5e5.
Sig^.ann - -of Applican:fAgnt Dz' -: � �d _�2
S LE - AL INFORMATION REQUIRED
'
OFFICE USE ONLY
y
u
L
L
�
Lp 01E HE- COUNTER
❑ EXPRESS
❑ STANDARD
❑ LAROE
❑ MAJOR
.?,j '?. ! c4pp_7011.doc revsed 06/21/11
CITY OF CUPERTINO
ICI FEE ESTIMATOR - BUILDING DIVISION
L.MFADDRESS:
21240 gardena dr.
DATE:
REVIEWFD BY: bobs.
UNITS
APN:
BP #:
*VALUATION:
$2,280
*PERMIT TYPE: Mechanical Permit
PLAN CIIECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
$133
PENTAMATION
PERMITTVPE: FURN /AC
WORK
re lace furnace at same location.
SCOPE
APPLIANCE/ EQUIP TYPE
FEE ID
Plumb. Plan Check
QTY
UNITS
BP FEES
Elec. Perndh Fee:
Furnace, Forced -Air
1MFR = <100
01he'.Elce.Insp. Ll
1
#
$133
Pertnit Fee:
Suppl. Insp Fee
PME Unit Fee:
$133.00
PME Permit Fee:
$45.00
Consnvction Tat:
Administrative Fee: IADMIN
$42.00
Work Without Permit? O Yes Q No
$0.00
IOTA LS:
i
Travel Documentation Fee: ITRAVDOC
$133.00
Strone Motion Fee: IBSCISAfICR
NOTE: This estinate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based nn the treliminary information available and are onit, an estimate. Contact the Dept for ath/n7 info.
FEE ITEMS 1Fee Resolution 11 -053 F_B 711112)
Mech. Plan Check 0.0 hrs $0.00
Plumb. Plan Check
Elec. Plan Check
Mech. Permit Fee: ImPER,ifff
Plumb. Permit Fee:
Elec. Perndh Fee:
Other Mech. Insp. 0.0 hrs L$45.00
Othep- Plumb Insp.
01he'.Elce.Insp. Ll
Mech. hup. Fee:
Pluhnh. hup. Fee:
Clec. hup. Fee:
NOTE: This estinate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based nn the treliminary information available and are onit, an estimate. Contact the Dept for ath/n7 info.
FEE ITEMS 1Fee Resolution 11 -053 F_B 711112)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check:
$0.00
Pertnit Fee:
Suppl. Insp Fee
PME Unit Fee:
$133.00
PME Permit Fee:
$45.00
Consnvction Tat:
Administrative Fee: IADMIN
$42.00
Work Without Permit? O Yes Q No
$0.00
Advanced Planning Fces:
i
Travel Documentation Fee: ITRAVDOC
$45.00
Strone Motion Fee: IBSCISAfICR
$0.50
Select an Administrative Item
1
Bide Stds Commission Fee: IBCBSC
$1.001
SUBTOTALS:
$266.501
$0.001
TOTAL FEE:
F $266.50
Revised: 10101/2012
.a
IF
Prescriptive Certificate of Compliance: Residential CF -I R -ALT
Rev'idenfialAIterations r•y� (Page I of 5)
Project Name:ZFP Company Climate Zone 14 of Stories
General Information
SiteAddress:1613 Bittern Dr
Enforcement Agency:
Date.
Building Type❑ Single hmnily ❑>< Multi Family
Circle the Front Orientation: N. G. S. W. or degrees
1300
Project Type: Lj Alterations Bnvclopc Fenestration Roof x FIVAC
Conditioned Floor Area (CPA):
Replacement or Change Out Duct Replacement ❑ N'ater licater
A'OTF: Tltis form is not or be u.serl far Ncmd3• Gntslrntcied Builditig.v or Additions
Insulation Values For Opaque Surfaces (for Furring use the Afass and Furring Strips Construction table belong
Assembh Alteration
❑ Opening of framed cavity alune- Afterations that involve the opening ofthefranned covin'ofa troll, ceiling, or floor must install the
mandatory minimum insulation value per §I.iOfor the altered assembltt Fill in Columns 'l -C and enter mandaton' insulation value in Column 11.
❑ Replacement of entire assembly - Replacement ofan entire wall. ceiling, orfloor assembly requires the installation of Component
Package- D insulation values in T661e 151-C Fill in Columns A -J.
O a ue Surfaee Details For the furred portioned of Mass Walls see Furring Strips Construction Table below.
.\ u C D
I,
F G 1 li 1 1 .1
Pro osed "• "
Standard
Values From JA4 Table
Framing
Thickness.
Framed
Continuous
JA4
Proposed
To
ID
Assembly Name
or Tv e'-
Material
and Size'-
Spacing.
or Other
U-
factors
JA4 Table
Numbers
Cavity
R- valuer•
Insulation
R- Value
Assembly
Row /Col"
Assembly
U- factor'
Assembly
L +a
-_ o_
T
o
m
G U
_
Final
Mass
Name or
JA4 Table
o
-y
c
V
v
-r
$ ?
Assembly t
,Vote: Forfutrred assemblies, accounting for Continumus Inoda+ion R- ratite, see Page JA4 -3 and Equation 4-1. For colndating furred walls use the Afass and
Furring Consirocu n table belmr.
/. For Tag /ID indicate the identification name that matches the building plans.
2. Indicate the Assembly Nnrne or type: Roofi'Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ...indicate in colunut G the Frame
material and Si_e: For {food Metal dletal Buildings, Mass, enter 2v4, 20, or etc... see J.14 for other possible frame npe assemblies.
3. ranter the thickness for mass in inches or Spacing between framing members enter: 16 "or 24 "OC1 or Other q assembly description
such as Concrete Sasduvich Panel, Spandrel Panel, Logs, Sirmv Bale Panel and etc....
4. Based on the Climate Zone: enter the equivalent U- jactorfomtd in J,14 Table based on the R - Volue from Table 1.i , orrD�
5. Enter the Table number that closely resembles the proposed assembly. fy8• 1 U 0 1 1012
6. Enter the R -value that is being installed in the wall cavity or between the fronting: mhenvise, enter -0
7. Enter the Continuous Insulation R -value for the proposed assembly: odienwise, enter "0 ".
S. Enter the rose and column of the U factor value based on Column F Table Vwnber and enter the Assembly U factor in Co not J�
9. The Proposed Assembly U factor, Column J. must be equal to or less than the Standard Ufactor in Column E to comply.
Furring Strip s Construction Table for Mass Walls Onl a�
A B C 1) E
F G II 1 .I ti
I.
V AIlt!
Proposed Properties of Masonn. and Concrete
Added Interior or Exterior Insulation
Walls From Reference
in Furring Space from Reference
.loin! AppendixTable 4:3.5.4.3.6, 4.3.7
.loin AppendixTable 4.3.13
� �J
Assembly
L +a
-_ o_
T
o
m
G U
_
Final
Mass
Name or
JA4 Table
o
-y
c
V
v
-r
$ ?
Assembly t
Thickness'
Tv '
Number'
:5>
_ •yt =
`
_
%
—
U- ractoi °•t
omm�nt
I
J
I
I
Registra( ion t \'unnber: Registration Date l nle: IIERSProvider:
2008 Residential Compliance Forms March 2010
Prescriptive Certificate of Com liance:Residential CF -IR -ALT
Residential Alterations r� (Page 2 of 5)
Project Name:ZFP Company Climate Zone 4 4 1 Hof Stories
1. lndicate the ripe ofassembly to include: Hallow Unit ifasoinry (Palls. Solid Unit dlasonn', Solid Concrete Walls, Etc. Additional assemblies can
be found Reference Joint Appendix J.N.
2. This is the U -Facmr based on the thickness of the assembly in inches.
. The R -value of the insulation to be added on the interior or exterior of the assembly.
4. The Calculated R - Value is the R -value of the furred our section of the assembly.
-.-6.The Final Assembly is calculated using Equation 4-2 or Equation 4 -4of the Reference Joint AppendLrJA4. The equation is the inverse of Column
D added to Column L Column K is the inverse jrom column J.
7. Insert the calculated U- (actor value on to ire Opaque Surface Details in Colunat J '
FENESTRATION PROPOSED AREAS
❑ Replacing window alone — Replacement windows shall meet the U- Factor and Sl1C,C Value requirements ojComponent Package D in
Table 151 -C. The Total Fenestration and lVest facing Area requirements are net applicable.
❑ Adding 50fC or less of window area — Nenely installed windows shall meet the U- Factor and SllGC Value requirements of Component
Package D in Table 151 -C.
❑ Adding more than 50ft' of window area — Newly insmlled windows shall meet the U-1--actor and SIIGC Value and lire Fenestration
Area requirements of Component Package D in Table 151 -C. Complete due Altered Fenestration Allured Area Table on Page 2 of the CF-IR -ALT
E
Orientation
G
C17A or
Fenestration Type and Frame
(Window. Class Door or Skylight)
(North. East.
South. West)
PropsedArea
III)
Maximum
U- factor'''
Maximum
SIiGC'-'t"
NFRC or Default
Value'
Entire
°/ or
Fenestration
Area
Fenestration
Area
Proposed Area
Dwelling
CFA=-'
Area'
Removed'
Area Added'
(A x B)
(E-D) + C
Total Fenestration
Area' (ft')
1. Fenestration area is the area of total glazed product (i.e. glass plus frame). Erception: 11'hen a door is less than 50 % glass. the fenestration
area mm' be the glass area plus a -2 inch frame'• around the glass.
2. Enter value jrom Component Package D Requirements in Table 151 -C.
3. Actual fenestration products installed and as indicated in CF -6R -E VV Fonrn shall be equivalent to or have a lower U-- fitctor and /or a loner
SHGC value than that specified on the CF -I R ALT Form. "
4. Submit a completed N'S -3R Form ifa reduced SNGC is calculated wid, erterior shading.
5. Ifopplicable at this stage enter -N RC -for A'FRC Certified windows or are CF-C •'Default'• values found in Table I M -A or R.
ALTERED FENESTRATION ALLOWED AREAS (Complete if more than50ff offenesiration is added)
A
B
C
D
E
F
G
C17A or
Allowed
Existing
Allowed
Entire
°/ or
Fenestration
Area
Fenestration
Area
Proposed Area
Dwelling
CFA=-'
Area'
Removed'
Area Added'
(A x B)
(E-D) + C
Total Fenestration
Area' (ft')
—
West Fenestration Area
(Required In
>
CZ's 2.4 &7 -15)
1. The Proposed )lest Fenestration Area includes West - sloping Aylight area and any odor skylight area with o pitch less than 1:12.
2. Enter 200% when no West orientation restriction or 15% when (Vestfenesiraion it being . installed in Climate Cones 2, 4, X 7 -15. Note that the
maximum allowed fenestration can on/ j, be 5% of the CFA as indicated in Column F. Column G must be equal to or less than Column R
3. In climate cones 2, 4.. 7 -15, no more than 5% of the CFA is allowed for nest facing glaJng.
4. F-risting Fenestration area must be canted toward the maximum allowed 15% or 20% ojthe whole building and calculated in Column G. The
Proposed Area must be less than or equal to Column F.
5. Enter the fenestration removed as part of the alteration if anv in column D.
6. Enter the Fenestration area that is being added as part of the alteration.
Registration Number: _ _. Registration DalL ?ime:: IIF.XS Pmvidec.
2008 Residential Compliance Forms March 2010
Prescriptive Certificate of Compliance: Residential CF -I R -ALT
Residential Alterations (Page 3 of 5)
Pro :ct Name: Climate Zone 4 0 of Stories
ZF� Company 4 1
ROOFING PRODUCTS (COOL ROOFS) §151(1)11
When the area of exterior roof surface to be replaced exceeds more than 50 °'0 of the evisting roof area, or more than 1,000 fr, whichever is
less, the new roofing area nw.cl meet the roofing product "Cool Roof'requirertents of §I52(b)111i, 152(6) lllii, or I52(b)Mill.
Check applicable alternative or ereeption below if tire roofaheration is evempi front the roofing product "Cool Roof' requirements. Note: lfanv
one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Finithince requirements for roofing products in
§I IS(i) are not applicable. Do nor fill table below.
Cool Roofs Not Required in Climate Zones 1- 12.14, and 16 with a Low Sloped. Less or 2:12 pitch.
❑Cool Roofs Not Required in Climate Zones I through 9 and 16 with a Steep - Sloped Roofs (pitch greater than 2:12) and product unit weight less
than 5lb /R'.
Alternatives to §I52(b)IIli and §Ii2(b)Ilii, Steep -slope roof (pitch > 2:12)
❑ Insulation xvith a thermal resistance of at least 0.85 hr R' OF/Btu or at least a 3/4 inch air -space is added to the roofdcck
over an attic: or
❑ Existing ducts in the attic are insulated and sealed according to § 151(()10: or
❑ In climate zones 10. I2 and 13, with 1 R' of free ventilation area of attic ventilation for every 150 R' of attic tloor area, and
where at least 30 percent of the free ventilation area is ssithin 2 fact vertical distance of the roof ridge: or
❑ Building has at least R -30 ceiling insulation: or
❑ Building has radiant barrier in the attic meeting die requirements of § 151(02: or
❑ Building has no ducts in the attic: or
❑ In climate zones 10. 11. 13 and 14. R -3 or greater roof deck insulation above vented attic.
Exception to §I52(b)Itliii, Low -slope roof (pitch <_2 :12)
❑ Building has no ducts in the attic.
Other Exceptions
❑ Roofing area covered by building integrated: photovoltaic panels and solar thermal panels arc exempt from the below Cool Roof criteria.
Roof constructions that have thermal mass over the roof membrane with at least 25 lb/112 is exempt from the below Cool Roof criteria.
Note: If no CRRC- I label is available. this compliance method cannot be used, use the Performance Approach to show compliance, otherwise.
Check the applicable box below if llsem t from the Roofing Products "Cool Roof Requirement:
Roof Slope
Product Weight-
Product
Aged Solar
Thermal
CRRC Product ID Numberl
5 2:12 > 2:12
< 5lb /11' ? 5lb)n'
Tv c'
Reflectance
Emitiance
SRIS
❑
❑
❑
1 ❑
❑t
❑
❑
❑
❑
❑r
❑
❑
❑
❑
❑i
❑
❑
❑
❑
or
❑
❑
❑
❑
113,
1. The CRRC Product /D Nunnber ants be obtainedf va, the Cool Roof Rating Council's Rated Pro luct Direcron• at wow.cooirnn(..v.nrelnrmi icrsGenrch.nlm
2. Indicate lire npe ofproducl is being used far the rooftop, i.e. single -ply roof, asphalt roof, metal roof. etc.
. Ifthe Aged Reflectance is not available in the Coal Roof Rating Council's Rated Product Director, then use the Initial Reflectance value from the same
directory and use the equation (0.2 +0.7(p,maat - 0.2) to obtain a calculated aged value. Where pis the Initial Solar Reflectance.
. Check bar if the Aged Reflectance is a calculated value using dre equation abate.
. Calculate tire SRI mine by using due SRI- 11'orksheet at 1 urr/Arww.enerev ca. cmdtitlela /and carer the resulting value in dre SRI Column above and attach acog, of
the SRI - worksheet to the CF -I R.
o apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface acrd meet the dry mil thickness or coverage
commended by the coatings manufacturer and meet minimum performance requirements listed in § 118(i)4. Select the applicable coating:
Aluminuni- Pigmented Asphalt Roof Coating
❑Cement -Based Roof Coaling
Other
Registration Number: _ .Registration DntelTime:' lIF-RS Prowder: r
2008 Residential Compliance Fornus A4arch 2010
Prescriptive Certificate of Compliance: Residential CF-1R-ALT
Residential Alterations (Page 4 of 5)
Project Name:ZFP Company Climate 1
Zone #^ `'F #of Stories
H VAC SYSTEMS - H EATING
List water heaters and boilers for both domestic hot mater (DIM') heaters and Inxlronic space heating. Individual dwelling DHIF heaters must be
Minimum
component pack-ages in all climate canes.
Duct or Piping
Configuration
Beating Equipment
Tvpc and Ca acity1'1
Efficiency
(AFUE or HSPF)
Distribution
Tv and Location'
Insulation
R -Value
Themtostat
Tv
(Central. Split.
Space. Package or I l dronic)
Central /70k
80%
Ducts /Crwl
R -6
Setback
Central
Ca acit • (pal)
Thermal Efficienc •
R- Value
1. Indicate Heating Ttpe (Central Furnace, {Nall Fur ace, /teat pump. Boiler, Electric Resistance. etc.)
2. Electric resistance heating is allotted only in Component Package C. or except inhere electric heating is supplemental (i.e., if total capacity
< 2 Kit' or 7,000 Bttdlnr electric heating is controlled bt, a time - limiting device not exceeding 30 minutes). See §UI(b)3 exception.
3. Refer to the HERS Yerificaion section on Page 4 of the CF- I R -ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location (Ducts, Hvdronic in Floor. Radiators, etc.)
li VAC SYSTEMS - COOLING
Minimum
1. Indicate Tvpe (Storage Gas. Heat Pump, Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §I Jo(n). The Prescriptive requirements no
not allow the installation ofa recirculating water heaiing.rvstem for single thvelling units.
3. The external water heating tank andiapes shall be insulated to meet the requirements of §I50(i).
Efficiency
Net or Piping
Configuration
Cooling Equipment
•
T and Capacityis
(SEER/EER or
COP)
Distribution
TvE and Location)
Insulation
R -Value
Thermostat
Ty pe
(Central. Split.
Space. Package or livdronic)
[T Indicae Cooling Type (/I /C. Heat pump, Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF -I R-ALT Form jar additional requirements and check applicable boxes.
3. Indicate Ti a or Location (Ducts. INdronic in Floor. Radiators. etc.)
WATER HEATING
List water heaters and boilers for both domestic hot mater (DIM') heaters and Inxlronic space heating. Individual dwelling DHIF heaters must be
gas orpropane fired Hot water pipe insulation from the DHIP heater to the kirchen(s) and on all underground hot water pipes is required in till
component pack-ages in all climate canes.
,sternal Tank
Water Heater Type /Fuel
Distribution Type
Numbcr In
Tank
Energy factor or
Insulation
Type h
(Standard. Recirculatin )e
System
Ca acit • (pal)
Thermal Efficienc •
R- Value
1. Indicate Tvpe (Storage Gas. Heat Pump, Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §I Jo(n). The Prescriptive requirements no
not allow the installation ofa recirculating water heaiing.rvstem for single thvelling units.
3. The external water heating tank andiapes shall be insulated to meet the requirements of §I50(i).
SPECIAL FEATURES The enforcement agencv should pay special attention to the Special Features specified in this checklist below.
These items mat, require written justification and documentation and special verification.
NEW ROOF ASSEMBLY- Radiant Barrier
The radiant barrier requirement of ti I51(f12 does not a y to roof alterations.
Slab Edge (Perimeter) Insulation 1'ES NO
YES: In Climate Zone 16 in Component Packages D. R -7 insulation is required.
Ideated Slab Insulation ❑ YES NO
YES: Slab ed a insulation rc aired for all heated slabs in all Climate Zones. Sec details in Table 118 -A of the standards.
Raised Slab Insulation 1'ES LJNO
VES: In Climate Zones I. 2. 11. 13. 14 & 16. R -8 insulation is required: in Climate Zones 12 & Li. R -4 is required under component Packs a U.
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass. use the Performance Approach.
Registration Number: Registration DateTme: HERS Provider:
2003 Residential Compliance Fornhs 11arch 2010
Prescriptive Certificate of Compliance: Residential CF -I R -ALT
Resitlential Alterations (Page 5 of 5)
Project Name: Z F P Company Climate Zone H4 1 11 of Stories
HERS V ERI FI CATI ON SUMMARY The enforcement agenn, should par special attention to the HERS dleasures specified in this
checklist below. A completed and signed Cl--4R Form for all the measures .specif+ed shall be submitted to the building inspector before final
inspection.
Duct Sealing &Testing II ERSverificationismquiredforthisiieasure.
❑ YES x❑ NO YES: In Climate Zones 2 and 9 -16, if more than 40 linear feet of new or replacement ducts arc installed in unconditioned
space, die ducts are to be scaled per § 152(6)1 Dii and the newly installed ducts are to be insulated per §M(010.
El EXCI,'P PI-ION: Existing duct sv'stems that are extended, which are constructed, insulated or scale) with asbestos.
[I YES ❑x NO YES: In Climate -Zones 2 and 9 -16, if the existing space- conditioning system (Ii VAC equipment and ducting) is replaced. the
ducts are to be scaled per § 13 2(b) 11) i.
❑ YES ONO 1'r.s: In Climate Zones 2 and 9 -16, if the existing I I VAC equipment is replaced (including the replacement of the air handler,
outdoor condensing unit of a split system, cooling or heating coil. or the furnace heat exchanger) the ducts am to be
sealed per § 152(6) I F.
❑ ENCEP 1'1 ON: Duct systems that are documented to have been previously scaled confirmed through Ii ERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ EXCEPTION: Duct systems e'ith less than 411 linear feet in unconditioned space.
EX CE I'II ON: Exist my, duet systems constructed, insu In led or scaled n'ith asbestos.
Refrigerant Charge -Split System HERS verification is requiredfor this measure.
❑ 1'ES ❑x NO 1'ES: In Climate "Zones 2 and 8 -15, when the existing IiVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil. or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per §I52(b)I P.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation re uirements of §150(o) do not apply to existing residential homes.
Ducted Split Syst ems - Air Conditioners and Heat Pumps: Airflow TIERS verification is requiredfor this nheasure.
❑ YES Q NO 1'r..S: In Climate Zones 10 through 15, when the existing space- conditioning system (IIVAC equipment and ducting) is
replaced. the airflow and fan wait draw shall be- verified per § 152(b)I Ci to meet therequirements of § 151(0713.
Documentation Author's Declaration Statement
certifv that this Certificate of Compliance documentation is accurate and complete.
Name;
Signature:
Company: alley Heating and Cooling
Da1f
Address: 1171 N4Th Street
If Applicable CEA or CEPS
(Certification P.):
pity /Sta ""`p:San Jose,CA 95112
`'hO1e408- 294 -6290
Responsible Building Designer's Declaration Statement
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24. Parts I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Name:
Signature:
CompatlyValley Heating and Cooling
Date:
Address: 1171 N4Th Street
License: 258540
City /State /Zip:San Jose,CA,95112
Phone: 408-294-6290
For ass'is'tance or questions regarding the Energy Stantlards, contact the Energy Hotline at: 1- 800 -771 -3300.
Registration Number: Regi.rtration,DatJ(ime: TIERS Provider:
1008 Resitlential Compliance Forms Afarrch 2010