14070143 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21851 MCCLELLAN RD CONTRACTOR:CALIFORNIA DELTA PERMIT NO: 14070143
MECHANICAL INC
OWNER'S NAME: BENJAMIN LIU 6056 E BASELINE RD STE 155 DATE ISSUED:07/31/2014
OWNER'S PHONE: 6692229475 MESA,AZ 85206 PHONE NO:(866)692-5273
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
l REMOVE AND REPLACE(2)A/C UNITS.
License Class `/`2� Li,.# t�1//1
Contractor O 4!(a - Wfg74 'en/Date..
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7715
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 APN Number:35714083 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 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, /
costs,and expenses which may accrue against said City in consequence of the Issued b � N �� Date:
granting of this permit. Additionally,the applicant understands and will comply y
with all non-point source r ations per the Cupertino Municipal Code,Section
9 18.
ROOFS:
any r
Signature Date All roofs shall be inspected prior to y 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. twill
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cu
pertin unicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 5533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen • Date:
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 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18,
Signature Date
GENERAL PERMIT APPLICATION M E P
F,�z7y-�W. COMMUNITY DEVELOPMENT DEPARTNiEN t • BUILDING DIVISION
10300 T ORRE AVENUE- CUPERTINO, CA 55014-3255
(408) 777-3228- FAX(403)777-3333•building.5cuc?gino.ora
eIJP��i t�,tt}
❑PLUI✓u3I1�G
1,SCIIA2,7CAL, ❑ELECTPICaZ � ❑1��5CBLLAI��OUiS
e o 3--.- 7 (/
0*,W°_P,IiAN I P"4159-022-9
ao 7`02 •9 7:4JCk-u.
S' ZDPS IFA
21*0,-rl
sB
CONTACT KILI'M"4v O.T _
S ?==i SDDIR S c7y,SZIP FAX
Qf ��
❑ Oarn ❑ O;? -3i?LD ❑ OJ�a-ZACT? ❑ COT?4C OR ❑COTiAtiCCORAC=T? ❑ A?C-�T=CS ❑ 1CTt=?. ❑ DP=e ❑ -AAT
CGI�TP�Ci 0R I�hJ✓s / ,C I L CrTSH 1vZT1Js R !J I ?�C SSE T?E I BUS.LIC r
CO?✓9A-X'KSI r c-}JyA1L 7 I FAX
STI2'_il i)DRES I
. TYTATZev ,,ZIPCIZ s Pg& a 76
p�ChiiBCT/i~G TtER1QAIJ" I LiCr'TTSEI'L7!rR. I BUS.LIC'
COI�3A�dYNA1�' I E-WiSII. ( FA:,
S7TUM-7 ADDRE: S I CIIY,STATr,ZIP I PHois
USE OF .D- L,--X ❑ muLTI-W my I PROJECT DZ WIIAI..A.T'D ❑ YES I PROTE.G7 IN, ❑YES I IS I=-BIZO AN ❑1 S
BUII-D1-RG CONap mkL IMBA.'N A T.0 FLOOD ZONE NO BIC- -LHOIE7 NO
DESCRIPTIOTT OF WORK / /S al B
TOTAL V;A r UATI0N.,
By ny si la Ire beloVa, ce ij e�h ofths follo;;�ng: I am the property e;,ger or auihoriwd 2pnt to act en the grope o•,,mef s behalf I h a;-e read this
application and the info-nation I have provided is coI?P^ wn read the Description of VVork and venfv it is accurate. I?Eree to comply vrith all applicable local
ordinances and state lad's relatfiv t0 bull," CO J 1 I authorize representatives - pei:n0 to enter the above-lderiti-led pro=—ty for L.SDect:On purposes.
Sigppna�re of Applicant%Aeert: Date:
TFORMLATION RE U=D
=z
RM
�v
IS i
— E R� �
A I FPA sclpp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ILI ADDRESS: 21851 Mcclellan Rd DATE: 07/31/2014 REVIEWED BY: Sean
APN: BP#: *VALUATION: 1$7,715
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION
USE: pPERMIT TYPE: FURN/A 19
WORK Remove and replace 2 A/C units.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=1 OK cfm) 1BREMAIR 2 # $144
TOTALS: $144.00
NMI
, wkk k i
Mech.Plan Check 10-61hrs $0.00 1'/ruuh. Pharr Cher.ir k >ck
Mech.Permit Fee: IMPERMIT Pluasb. Permit 1,er,r„=,1""',
Other Mech.Insp. 0.0 hrs $48.00 Other Phvmh Iyup. Ober Eit>c�.InSP,
Mac{z. hmp. f�e��- Phwn b, hasp. Tito: Li II:',,'(,.11sh.S c=e':
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Theseees are based on the prelinddna information available and are only an estimate. Contact the De t or addh7 info.
FEE ITEMS (Fee Resolution 11-053 E f 7/1113, FEE QTY/FEE MISC ITEMS
stippl. PC Fcc,
PME Plan Check: $0.00
PME Unit Fee: $144.00
PME Permit Fee: —77 $48.00
Coil- n-uclion
Administrative Fee: 1ADMIN $45.00
Work Without Permit? ® Yes (F) No $0.00
,JcPlaYtniny
Travel Documentation Fee: ITRAVDOC $48.00
Strom Motion.Fee: IBSEISMICR $1.00 Select an Administrative Item
Bids Stds Commission Fee: 1BCBSC $1.00
,� $287.00 $0.00 �.. TOTAL FEE, $287.00
Revised: 07/10/2014
` STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT-03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E
Alterations-HVAC CZ 1,3 to 7 and 16(formerly CF-IR-ALT-HVAC) (Page 1 of 1)
Site Address: Enforcement Agency: Date Prepared: Permit#:
of l l l /h 7-31' Al
Equipment Type Equipment Efficiency New:Ducting,Plenums,Lineset Conditioned Thermostat
Required R-value Floor Area(sq ft)
❑ Packaged System ❑Evaporator Coil AFUE COP IV R-6 (CZ 1,3-7)Ducts Served by system R-Setback
❑R-8' (CZ 16)Ducts 3fdD s ft (!f not already
❑Split System 11 Condensing Unit SEER q
HSPF 13R-6(al!CZ's)Plenums resent,must� P
❑ Furnace ❑Lineset EER ❑R-5 or R7.5 Lineset3",. be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered(no hand'iiT1 s. flowed)and a copy left on site.
�1.HVAC Changeout/Repair Required Compliance Documents to be left on ate k�
Can-include new ducting n
All Equipment, CF1R-ALT-02-E "
Condenser Unit,Evaporator Coil, CF2R:MECH-01,MECH-20-HERS
Air Handler/Furnace CF3R:MECH-20-HERS
Installer Requirement:Duct leakage(<_15%or,: 10%to outside,or seal all accessible leaks)
Exempted from duct leakage testing if:
❑1.Duct system registered with HERS provider as previously sealed,or❑2.There is less than 40 linear feet of duct in unconditioned
space,or ❑3.Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building ......
❑2.New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' CF1R-ALT-02-E
CF211-MECH-01,MECH-20-HERS,MECH-22-HERS, MECH-(23 or 24)-HERS
CF3R-MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS'
Installer Requirement:Duct leakage<6%,Fan Efficacy(.58W/CFM),Air Flow z 350 CFM/ton(or Standards Table 150.0-C/D alternative)
❑3.All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CF1R-ALT-02-E
Ducts'and one or more of the following: CF2R-MECH-01,MECH-20-HERS,MECH-(23 or 24)-HERS
Condenser Unit,Evaporator Coil,Furnace CF3R-MECH-20-HERS,MECH-(23 or 24)-HERS
Installer Requirement:Duct leakage<6%,Air Flow_350 CFM/ton(or Standards Table 150.0-C/D alternative)
❑Exempted from duct leakage testing I existing duct systems are constructed,insulated or sealed with asbestos.
❑4.New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned CF1R-ALT-02-E
space but less than All New Ducts' CF2R:MECH-20-HERS
CF3R:MECH-20-HERS
Installer Required to:Duct leakage L<15%or,<10%to outside,or seal all accessible leaks)
❑ Exempted from duct leakage testing I existing duct systems are constructed,insulated or sealed with asbestos.
'All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls,between floors etc.
7 A New Duct system is when the duct system is constructed of at least 75 percent new duct material,and up to 25 percent may consist of reused
parts from the dwelling unit's existing duct system(e.g.,registers,grilles,boots,air handler,plenums,duct material.
s R-5(1"thick insulation)for linesets 1"and less. R-7.5(1.5"thick insulation)for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%",2.5-3T-2%",3.5 to 4T-2%",5T-4%"
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts 1 and 6 of the California Code of Regulations(CCR).
4. That the energy features and performance specifications,materials,components,and manufactured devices for the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Responsible Designer Name: Responsible Designer Signature: Date Signed: License:
7 , Y 21////
Company: Address: City/State/Zip: Phone:
4�e/Aa .17Cn4,v'r6p ze&Z, &esl—ra 14
For assistance or questions regar ing the Energy Standards,contact the Energy Hotline at:1-800-772-3300
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 4)
Project Name: 21851 McClellan Rd Date Prepared: 2014-07-28
A.General Information
CFIR-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be
documented,use one CFIR-ALT 02 document for each dwelling unit.:
01 Project Name: 21851 McClellan Rd 02 Date Prepared: 2014-07-28
03 Project Location: 21851 McClellan Rd 04 Building Type: Single family
05 CA City: Cupertino 06 Dwelling Unit Name: 21851 McClellan Rd
07 Zip Code: 95Q14 08 Dwelling Unit Conditioned 3500
Floor Area(ft2):
Number of space conditioning
09 Climate Zone: 3 10 (SC)systems being altered in 2
this dwelling unit.:
B.Space Conditioning " '
p onin SC 5 s#em lifoirmation `
01 02t 03 ;:;. w.04:,; 05► 06 07'
10
s ::. 0$ :< 0
s ,. ,. 9
t�
�`lii a( n n
ems`:
�Isthe thtire
components? duct system
(packaged unit,or accessible Are all of the
condensing unit, installing for sealing, system's
Is the altered Altering or or more than 40 and is more components
or installed installing a cooling/heating linear feet of than 75%of and ducts new
SC System SC System CFA served system a refrigerant coil,or new or the duct or replaced?
Identification or Location or Area by this SC ducted containing air-handling unit, replacement system new (entirely new
Name Served System(ft2) system? co,mponent? etc) ducts? or replaced? system) Alteration Type
2.5 Ton A/C Unit& Whole Home 1500 Yes Yes Yes No No No Altered space
Coiling Coil conditioning system
4.0 Ton A/C Unit& Whole Home 2000 Yes Yes Yes No No No Altered space
Cooling Coil conditioning system
Registration Number:214-AO06333OA-000000000-0000 Registration Datepme: 2014-07-2810.21:13 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-07-28 10:22:07
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 2 of 4
C.Extension of Existing Duct System,Greater Than 40 Feet(Section1S0.2(b)1Diib)
This section does not apply to this project.
D.Altered Space Conditioning System(Sections 150.2(b)1E and F)
01 02 03 04 05 06 07 08 09 10 11 12
Heating Cooling
System Heating Altered Heating Minimum Altered Cooling Minimum Required New or
identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct
or Name Type Components Type Value System Type Components Type Value Type Duct Length R-Value
2.5 Ton A/C Unit Central as No heating This field or This field or Central spilt All new This field or
g
&Coiling Coll furnace component section is not section Is not AC cooling SEER 13 Setback section is not R-6
altered applicable applicable components applicable
No heating.;. s'This:field or �',::,:,::....:.
4.0 Ton A/C Unit Central gas This ffel.�l;or .t: ••:•'•':•: All new This field or
:Central split' °s ,�`
compone W section is not section'f'tiot 'oolfiig,: '= i::SEER 13 Setback section is not R 6
&Cooling Coil furnace n:;<:;::: C ,' - ,
alters" applicable,:' rapplltable Nrriponents applicable
docttOlg ntation:
CF2R- CH-OI-E-Sp
Space Conditioning Systems sms Ducts and,Fans
Duct ihsulation requirement for new plenums.R6. .. N.'.
CF211-MCH-20-H&CF3R-MCH-20-H—Duct Leakage testing required when heating or cooling components are installed in ducted systems,or when more than 40 ft of duct length is replaced.
-Leakage rate compliance;.-,I 15%,or 510%leakage to outside,or seal all accessible leaks.
CF2R-MCH-25-H&CF3R-MCH-2SH Refrigerant Charge Verification required when refrigerant containing components are installed or altered(applicable In CZ 2,8-15).
CF2RCF3R-MCH-23&CF311-MCH-23 Air Flow 2:300 CFM/ton required when MCH-25 Is required.
iF _tlgn&
-Duct systems registered with HERS provider as previously sealed are exempt from MCH-20 Dud Leakage Testing requirements.
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH-23,or Refrigerant Charge MECH-25.
-Existing duct systems constructed,insulated or sealed with asbestos are exempt from MCH-20 Duct Leakage Testing requirements.
E.Entirely New or Complete Replacement Duct System,with or without Equipment Changeout(Sections 150.2(b)iDiia and 150.2(b)1E,F)
This section does not apply to this project.
Registration Number:214-AO06333OA-000000000-0000 Registration Date/Time: 2014-07-2810:21:13 HERS Provider:CaiC£RTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-07-28 10:22:07
CERTIFICATE OF COMPLIANCE CF1R-ALT0q4)1
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (page 3 of
F.Entirely New or Complete Replacement Space Conditioning System(Section 150.2(b)1C)
This section does not apply to this project.
ski•„� -
Z:4h
+
K.
Registration Number:214-A0063330A-000000000-0000 Registration Date/Time: 2014-07-2810:21:19 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-07-28 10:22:07
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 4 of 4)
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete. /
Documentation Author Name: Documentation Author Signature; r✓J� cclW— &'2U
Frederick,Alanna CX1�
Company: Signature Date:
CALIFORNIA DELTA MECHANICAL INC 2014-07-28 10:21:13
Address: CEA/HERS Certification Identification(if applicable):
1235 GRAND AVE
City/State/Zip: Phone:
SPRING VALLEY CA 91977 (480)898-0007
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Compliance Is true and correct.
2. i am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building.design or system.,design identified on this Certificate of Compliance(responsible designer).
3, That the energy features and performance specifications,materlai3,cori5ponents and manufactured deVicesfortKe bulii7ng desig`or system design identified on this Certificate of Compliance conform to the
P
requirements of Title 24,Part 1 andaPart 6 of the Cal
tfornia;Codeof Ile ulations.
4. The building
� ,
design features or
e 'cle
e si n features ideti :�
B cyst, .r g fled on`tfiisCertiflcate of;Lr�tfilpliance a¢e:`tonslstent with tFieiinformatibn`"''rovided`bn other applicable
�:.... ..:.......... ... p,.:,. ppl cable compliance documents,worksheets,
;;:.:;
.iki,,.
calculations,plans and specifications submitted to;tlie enforceineniagency for a roValwith this bulidiri' ;ermit a Ifeation. •y "'`
S.p g
S. !will ensure that a registered copy of his.Certificate'iif;Coitmpliance shall:bemade,available w(thtlie:b'Ildin""ermit(s)'.issued foEtiie bu'iiiffn ;and irlade available to the enforcement agency for all applicable
Inspections.I understand that a registered copy of this Ceitificate of Compliance'is required to be included W6 the documentation the builder provides to the building owner
at occupancy.
Responsible Designer Name: Responsible Designer Signature:
Frederick,Alanna �(
Company: Date Signed:
CALIFORNIA DELTA MECHANICAL INC 201407-28 10:21:13
Address:
License:
1235 GRAND AVE 811114
City/State/Vp: Phone:
SPRING VALLEY CA 91977 (480)898-0007
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document and in no way implies Registration Provider responsibility for the accuracy of the
information.
Registration Number:214-AO06333OA-000000000-0000 Registration Date/Time: 2014-07-28 1021:13 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-07-28 10:22:07
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC -CFIR- ALT -03 -E !Revised 06/141 X Ao CALIFORNIA ENERGY
CERTIFICATE OF COMPLIANCE _ r CF1R- ALT -03 -E
Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF-1R-ALT-HVAC) J l:6 (Page 1 of 1)
Site Address:
Enforcement Agency:
Date Prepared:
Permit #:
i
3i. 1v
n
Equipment Type
Equipment Efficiency
New: Ducting, Plenums, Lineset
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
• Packaged System
❑ Evaporator Coil
AFUE
COP
V R -6 (CZ 1,3 -7) Ducts
Served by system
Setback
• Split System
❑ Condensing Unit
SEER
❑ R -8' (CZ 16) Ducts
�fda s ft
q
(If not already
HSPF
❑ R -6 (all CZ's) Plenums
present, must
❑ Furnace
❑ Lineset
EER
❑ R -5 or R7.5 Lineset3
I be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
Pt1. HVAC Changeout /Repair
Required Compliance Documents to be left on site for Final:
Can include new ducting
All Equipment,
CFIR- ALT -02 -E
Condenser Unit, Evaporator Coil,
CF2R: MECH -01, MECH -20 -HERS
Air Handler /Furnace
CF3R: MECH -20 -HERS
Installer Requirement: Duct leakage (: .15% or, < 10% to outside, or seal all accessible leaks)
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned
space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts'
CF1R- ALT -02 -E
CF2R- MECH -01, MECH -20 -HERS, MECH -22 -HERS, MECH -(23 or 24) -HERS
CF3R- MECH -20 -HERS, MECH -22 -HERS, MECH -(23 or 24) -HERS'
Installer Requirement: Duct leakage < 6 %, Fan Efficacy (.58W /CFM), Air Flow_ 350 CFM /ton (or Standards Table 150.0 -C / D alternative)
❑ 3. All New Ducts with Replacement
Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New
CFIR- ALT -02 -E
Ducts' and one or more of the following:
CF2R- MECH -01, MECH -20 -HERS, MECH -(23 or 24) -HERS
Condenser Unit, Evaporator Coil, Furnace
CF3R- MECH -20 -HERS, MECH -(23 or 24) -HERS
Installer Requirement: Duct leakage < 6 %, Air Flow >_ 350 CFM /ton (or Standards Table 150.0 -C / D alternative)
❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos.
❑ 4. New Ducting over 40 feet
Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned
CFIR- ALT -02 -E
space but less than All New Ducts'
CF2R: MECH -20 -HERS
CF3R: MECH -20 -HERS
Installer Required to: Duct leakage (S.15% or, < 10% to outside, or seal all accessible leaks)
❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos.
' All new ducting R -8 required when more than 40 ft installed and R -6 when less than 40 1 IIu This - lu n I�s tween floors etc.
' A New Duct system is when the duct system is constructed of at least 75 percent new d ma t a d up 25 �e may consist of reused
parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air han r, du at al.
R -5 1" thick insulation ) for linesets 1" and less. R -7.5 1.5' thick ins i se 1 f `� to I D ter
", ",(3.5 � �g " ' �
with insulation as the following 1.5- 2T -2% 2.5- 3T- 2% to 4T -2%' ;
Contractor (Documentation Author's /Responsible Designer sJDr ra ' n e t) ALL TIM
I certify the following under penalty of perjury, under the laws of the State of Californ
MCC ON
1. The information provided on this Certificate of Compliance is true and correct. DO S S I
2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Responsible Designer Name:
Responsible Designer Signature:
Date Signed:
License:
Company:
/Aa ` ep
Address:
City /State/Zip:
Phone:
3� �-
io40e
"7ec
S o
r
2 62 7
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1- 800 - 772 -3300
HX\k
:� SPI
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building aacupertino.org
• o Permit No./
Address �2J U / M �L_Lj 4, /'— # of Alarms Smoke: i Carbon Monoxide: "Z
PURPOSE
This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single - family and multi- family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring. A
As owner of the above - referenced property, I hereby certify that the alarm(s) re
installed in accordance with the manufacturer's instructions and in compliance
and California Residential Codes. The alarms have been tested and are
below.
I have read and agree to comply with the terms and conditionsW this
above has/have been
Cali fn"
F1i e
Owner (or Owner Agent's) Name:
Bev, `a."ti V1 L=,A_
Si nature....... &:::.� . ............ ..........................Date: S /2 Zat
Contras r Name:
Signature.................................... ............................... Lic.# ....... ............................... Date: ...................
Smoke and CO form.doc revised 03118114
r