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14090166I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21608 FLINTSHIRE ST I CONTRACTOR: HUSSEY BROS INC PERMIT NO: 14090166 OWNER'S NAME: HSU TONY K AND HUANG ANNIE ( 903 GEORGE ST I DATE ISSUED: 09/25/2014 OWNER'S PHONE: 4088746743 LICENSED CONTRACTOR'S DECLARATION License Class l Z 0 Lie. # � S6 6 J Contractor V$$ 2 h ror . 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. 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 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 918. (!; ^ Signature Date I ❑ 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. Signature Date SANTA CLARA, CA 95054 ! PHONE NO: (408)733 -6360 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REPLACE AND RELOCATE FURNACE, INSTALL NEW A/C TO SIDEYARD Sq. Ft Floor Area: I Valuation: $18521 APN Number: 35620023 00 1 Occupancy Type: PERMIT + ORK IS NOT STARTED WIT F180 DAYS OF P IT ISSUANCE OR 180 DA FROM LAST CALLED INSP CT N. Issued by: Date: RE- ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25505, 25533, and 25534. Owner or authorized agent: Z Date: 7- Zs� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C ) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed GENERAL PERMIT JA-%.PPLICATION COMMUNITY DEVELOPMENT DEPART M=-NtT - BUILDING DIVISION I wu 10300 TORRE AVENUE - CUPER—i INO, CA 95014-3255 (408) 777-3228 - FAAX (403) 777-3333 - bullding.0,cuoetino.ot a ��o (�() 71, M., C-P--,LA Isous ?P G ADDRESS 11�6,f Fh K J i k' *f-t s 35(o 2,0 OZ3. ONINWM-F-11.1---r- T,ok-1 S —_-a --T A-D D P M S C—IIY M71BJ2. PRONS CITY, STSin 7-12 OW'Z?. B'LMDML 0V71,-aAGMr ❑ CoT_AC-OR [3 COjC'j7_/,CT:)-p, A,=-hT ❑ A-?,a-=--CT ❑ LNc-2=- ❑ D1— 'PEP, colIMAM OR, Lx-, \A.W= if B-IVAIL -94reJ24 uaetilvsao I- FA *,4 T ADDR:- G7 iY, TA zip 4L y 713-0-3t-0 BUS. LIC 9 c o MUD iiry 1 WI �m FAX sl=n ADDP,:-,-Rs I CITY, STA711, ZIP I PHMS USE OF V:-qD or DUPLZX VaILTI-F-AmLy I PROTECT N WZDLA-NM ❑ as I BUMDT-NiGe. CO✓✓EMCIAl IMB.A-N7N-L=-PF%kCB A=-A ❑ NO FROM= 3NT ❑ Y=- :-LOOD za�=- ❑ 1"o I IS TT BLDG IN ❑ yz-s M=-LM-,1Mm? ❑ ?,,o DBSCp,ipTjoN, cr WORK 16ol'), Aepj Alt TOTAITYI-TUAION: 1 01!- By my signature below, I ctcrtrfy to each of the fojlo ,jng: I am the prope-ty owner or authormz--d PpTA to act On &.-a grope„ flmn--r's behalf. I have d &-:s application and the informedon I b— p Description On o f 7.7' ork- and V e ^V it is F C C-117E a S.- t t to com D h, ?-I I applicable 10 c a r�jed is I ha-,--t read tha D ordinances and S =ie 1:7,,s Y:Iatinsto bul' Ic I FuuhOrizt TeDr--sentamh-es ffap--rtino to --riter the above-idertt.ed prop 1:07 ITI-S-De=011 DUTPOS-CS. jTA c4pswurmon. Sign-Es H t/Aztnt. Date: y ST-TPPILEVER14TAL Dql-01��rl REQT= - D --M- ME g --mg: g 'k-T.Al jL,7c1pp__,201j.doc revised 06121111 WN CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ia, ADDRESS: 21608 flintshire st DATE: 09125/2014 REVIEWED BY: Mendez MISC ITEMS APN: BP #: *VALUATION: 1$18,521 -� 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Suppl. PC Fee: (j) Reg. 0 OT PENTAMATION FURN /A PERMIT TYPE: WORK lace and relocate furnace install new a/c to side and PME Plan Check: SCOPE �re 1 # $72.00 Mech. Plan Check 10. 0 1 hrs $0.00 f'? iwb. Plan Checiii L ec, 1" 'an n {`heck Mech. Permit Fee: IMPERMIT Plumb. Pe it Tee: /-:1e Perim[ ��<e Other Mech. Insp. f 070 Ns 1 $48..00 Other f1wrih trz In. { iher 1_;' c ht� V. �ikz Pa Iatsl3. Fe:: 1111w '). hap. Fee: I llzle , irt, 1­161. NOTE: This estimate does not includefees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School 1Hetr;rt ot& ) Thoco foot aro havod nn tho nrolirninani information ovailahlo and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $143.00 Mechanical IMFR = <100 Furnace, Forced -Air Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 # $72.00 Mechanical 1BREMAIR A/C Units ( < =10K cfm) Permit Fee: $0.00 Suppl. Insp. Fee :Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Construction 7,011"., r Administrative Fee: 1ADMIN $45.00 E) Work Without Permit? 0 Yes C) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential 1 Building or Structure i Travel Documentation Fee: ITRAVDOC $48.00 Std Motion Fee: IBSEISMICR $2.41 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 i $144.41 $215.00 x , k: TOTAL FED:: $359.41 Revised: 08/20/2014 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC -CF1R- 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 -1R- ALT -HVAC) (Page 1 of 1) Site Address: Enforcement Agency: Date Prepared: Permit #: ZI64 � /r;..�s1►�r,c s�. � r:e RS''o�N Equipment Type Equipment Efficiency New: Ducting, Plenums, Lineset Conditioned Thermostat Required R -value Floor Area (sq ft) ❑ Packaged System =Evaporator Coil 60 AFUE COP ❑ R -6 (CZ 1,3 -7) Ducts Served by system 11 Setback Split System - ACondensing Unit SEER ❑ R -8' (CZ 16) Ducts Z LOP sq ft (If not already Furnace fLineset EER HSPF 11 R -6 (all CZ's) Plenums , present must ❑ R -5 or R7.5 Lineset 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. . HVAC Changeout /Repair Required Compliance Documents to be left on site for Final: Can include new ducting 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 113. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building ....... 1 ❑ 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New DuctsZ 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) -HERS2 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 CF1R- ALT -02 -E DuctsZ 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 DuctsZ CF2R: MECH -20 -HERS CF3R: MECH -20 -HERS Installer Required to: Duct leakage (<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. Z 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. 3 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: 54eve-��ss< Responsi es' nerSignature: Date Signed: License: Company: A(ussc Drs. Address: V �03 Geer e-,r , City /State /Zip: 9sasY S <K><a C/^ (eq 7 Phone: W 733-0,3461 For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1- 800 - 772 -3300 PLOT PLANS CHECKED BY DATA y PL NNING DEPT. DATE Tow%, NSv knai a H v&v %3 21G68 Fitk4S Lire S�- Cv?pex ' "e, V014 408 s, 3y- 043 CUPERTINO wilding Depatnent t 5 2014 REVIEWED FOR CODE COMPLIANGt< RLOG. DEPT. DEVELOPMENT DEPAR FMENT 944 BUILDINCA DIVISION - CUPERTI O ,is set of plans a "d specifications MUST`be kept at the ob site during c- ,:xstruction. It is unlawful to make any - hanges or aiterations on same, or to deviate ',erefrom, mthcu( approval from the Building Official. "he Stamping,-f- plan and specinations SHALL NOT 7•e held to pe r.1 to he xi approval of the violation ov, J any pre or any City Ordinance or State Law. 3Y DATE o2 / HERMIT # FICE COPY rear � �.rd GIr-r.�c I ce . g�is E ' hcw 4ao�aoa ET+ $eve" to i r► 44 +- c P: vo 4kov, q�e N Sccom 3�'x3v "k31 "�4i1 SQM» -lie W.CIrc,.,� Isl�:,�tSCO�rt� ►ISY• �FZ htct��'st�C y � Ln� tyI Tb ,Ai Hsu 216o8 Flik4 skire s4. C uPQ14Ivro I 9S01 4 qo r g'3 y- G -1 y3 (po,loo tTv �'V L mtte. 4l, Codi-S Gail fr4`.V j x 11 ��tt L IttIDI L Provtwt pl4�0(41r.4 46b. r. eeeSS +o # U dow Iry fnsce rw A41' �cC . pcccss l i r � r it(o� ClOiLts drh<< 3o,�ro dtv 1 l ISr �{2.,uno acv 30" i - - A-o -t O, d Servit<< I.y*, IISV• deelicc4ed tiret-4- Lishf ,Swijc,k if 0,cces3 lv j�L Service ItsL4 t rece' + «le,. 1xG gvAled vp 24" of. UZ -�- 1' -4 n -Treve r {t I 1 �N �V!'M4ct lod,000 X Pt`eS1��! Tes+ r01w+ TINO DUPER �t.!i De ? 'T'� ldina REVIEVVEU f-tJK Ci7uQt �O�Ni /� <• A�e Y'Grn�ir Reviewed BY J� t'xer�ea� S'jd4lra' HEATING & AIR CONDITIONING ADD213100- SPEC -1 A 5" 0 SIDE PANEL CUTOUT FOR HORIZONTAL VENTING THROUGH THE CABINET, 7/8" DIA. HOLES ELECTRICAL CONNECTION Downf low / Horizontal Induced Draft Two Stage Gas Furnace Gas Furnace 1 -1/2" DIA. HOLE GAS CONNECTION ADD21310OA9482A SIDE PANEL CUTOUT FOR HORIZONTAL VENTING THROUGH THE CABINET 7/8" DIA. K.O. ELECTRICAL CONNECTION (ALTERNATE) 1 -1/2" DIA. K.O. GAS CONNECTION (ALTERNATE) FURNACE AIRFLOW (CFM) VS. EXTERNAL STATIC PRESSURE (IN. W.C.) MODEL SPEED TAP 0.10 1 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 46 4 -HIGH - Black 1767 1 1731 1669 1615 1546 1469 1392 1300 1146 ADD26100A9482A 3 -MED. -HIGH - Blue 1382 1354 1323 1292 1254 1207 1177 1108 1038 2 -MED. -LOW - Yellow 1130 1138 1 1115 1 1085 1054 1015 977 938 877 1 -LOW -Red 840 831 815 792 762 731 700 654 625 CFM VS. TEMPERATURE RISE MODEL CFM (CUBIC FEET PER MINUTE) 1200 1300 1400 1500 1600 1700 1800 ADD213100A9482A 62 57 53 49 46 44 41 © 2009 American Standard Heating & Air Conditioning 47 General Data o TYPE Downflow / Horizontal RATINGS 2 Furnaces 1st Stage Input BTUH 65,000 1st Stage Capacity BTUH (ICS) 3 52,000 2nd Stage Input BTUH 100,000 2nd Stage Capacity BTUH (ICS) 3 79,000 Temp. rise (Min. -Max.) °F. 40-70 BLOWER DRIVE DIRECT Diameter -Width (In.) 10 x 8 No. Used 1 Speeds (No.) 4 CFM vs. in. w.g. See Fan Performance Motor HP 1/3 R.P.M. 1075 Volts /Ph /Hz 115/1/60 COMBUSTION FAN - Type Centrifugal Drive - No. Speeds Direct - 2 Motor HP - RPM 1/75 - 2708 / 1868 Volts /Ph /Hz 115/1/60 F.L. Amos 0.87/0.49 FILTER — Furnished? No Type Recommended High Velocity Hi Vel. (No.- Size -Thk.) Shipped 2 - 16 x 20 - 1 in. VENT COLLAR — Size (in.) 4 Round HEAT EXCHANGER Furnaces Type -Fired Alum. Steel - Unfired ADD2 Gauge (Fired) 20 ORIFICES — Main Nat.Gas. Qty. — Drill Size 5-45 L.P. Gas Qty. — Drill Size 5-56 GAS VALVE Redundant - Two Stage PILOT SAFETY DEVICE Type Hot Surface Ignition BURNERS — Type Multiport Inshot Number 5 POWER CONN. — V/Ph/Hz (D 115/1/60 Ampacity (In Amps) 9.2 Max. Overcurrent Protection (amps) 15 PIPE CONN. SIZE (IN.) 1/2 DIMENSIONS H x W x D Crated (In.) 41- 3/4 x 19 -1/2 x 30 -1/2 Uncrated (In.) 40 x 17 -1/2 x 28 -1/2 WEIGHT Shipping (Lbs.) / Net (Lbs) 156 /145 O Central Furnace heating designs are certified to ANSI Z21.47 / CSA 2.3 (D Ratings shown are for elevations up to 2000 feet. For elevations above 2000 feet; Ratings should be reduced at the rate of 4% for each 1000 feet above sea level. O Based on U.S. Government Standard Tests. O The above wiring specifications are in accordance with National Electrical Code; however, installations must comply with local codes. Mechanical Specifications NATURAL GAS MODELS — Central heat- ing furnace designs are certified to ANSI Z21.47 / CSA 2.3 for both natural and L.P. gas. Limit setting and rating data were established and approved under stan- dard rating conditions using American Na- tional Standards Institute standards. SAFE OPERATION —The Integrated Sys- tem Control has solid state devices, which continuously monitor for presence of flame, when the system is in the heating mode of operation. Dual solenoid combination gas valve and regulator provide extra safety. QUICK HEATING — Durable, cycle tested, heavy gauge aluminized steel heat ex- changer quickly transfers heat to provide warm conditioned air to the structure. Low energy power vent blower, to increase efficiency and provide discharge of gas fumes to the outside, allows common vent- ing with hot water heater. American Standard Heating& AirConditioning hasa policy of continuous product and product data improvement and it reserves the righttochange specifications and design with - outnotice. American Standard Heating & Air Conditioning 6200 Troup Highway Tyler, TX 75711 www.americanstandardair.com BURNERS — Multi -port, in -shot burners will give years of quiet and efficient service. All models can be converted to L.P. gas without changing burners. INTEGRATED SYSTEM CONTROL— Ex- clusively designed operational program pro- vides total control of furnace limit sensors, blowers, gas valve, flame control and in- cludes self diagnostics for ease of service. AIR DELIVERY —The multispeed, direct - drive blower motor, with sufficient airflow range for most heating and cooling re- quirements, will switch from heating to cooling speeds on demand from room thermostat. The blower door safety switch will prevent or terminate furnace operation when the blower door is removed. (Fan relay and 35VA control transformer is stan- dard). NNTERrFTOUS C /STE STYLING — Heavy gauge steel and "wraparound" cabinet construction is used in the cabinet with baked -on enamel finish for strength and beauty. The heat exchanger section of the cabinet is com- pletely lined with foil -faced fiberglass insu- lation. This results in quiet and efficient operation due to the excellent acoustical and insulating qualities of fiberglass. FEATURES AND GENERAL OPERA- TION — These High Efficiency Gas Fur- naces employ a Hot Surface Ignition sys- tem, which eliminates the waste of a con- stantly burning pilot. The integrated sys- tem control lights the main burners upon a demand for heat from the room thermo- stat. Complete front service access. a. Low energy power venter. b. Vent proving differential switch. Library Unitary Product Section Furnaces Product Furnace Model ADD2 Literature Type Submittal Sequence Date 08/09 File No. ADD2B100- SPEC -1A Supersedes ADD26100- SPEC -1 Amwe-aq S7iWdald HEATING & AIR CONDITIONING TAG: NOTE: All dimensions are in mm /inches. al ELECTRICAL AN Cow PORERT CLE PER PREVAILIR From Dwg. D153074 4TTB3048D- SPC- 105.02 4 Ton Split System Cooling —1 Phase 4TTB3048D Product Specifications OUTDOOR UNIT 0O 4TT830481011000B POWER CONNS. - V /PH /HZ G 208/230/1/60 MIN. BRCH. CIR. AMPACITY 28 BR. CIR. PROT. RTG. - MAX. (AMPS) 50 COMPRESSOR SCROLL NO. USED - NO.SPEEDS 1 -1 VOLTS /PH /HZ 200/230/1/60 R.L. AMPS O - L.R. AMPS 21.8-117 FACTORY INSTALLED 1 60.0 START COMPONENTS (8) NO INSULATION /SOUND BLANKET NO COMPRESSOR HEAT NO OUTDOOR FAN PROPELLER DIA. (IN.) - NO. USED 27 -1/2" - 1 TYPE DRIVE - NO. SPEEDS DIRECT - 1 CFM @ 0.0 IN. W.G. 0 3969 NO. MOTORS - HP 1 - 1/5 MOTOR SPEED R.P.M. 825 VOLTS /PH /HZ 200/230/1/60 F.L. AMPS 1.2 OUTDOOR COIL —TYPE SPINE FIN TM ROWS - F.P.I. 1-24 FACE AREA (SO. FT) 19.07 TUBE SIZE (IN.) 3/8 REFRIGERANT LBS. — R -410A (O.D. UNIT) 0 6 LBS., 13 OZ. FACTORY SUPPLIED YES LINE SIZE - IN. O.D. GAS © 7/8 LINE SIZE - IN. O.D. LIC. O 3/8 CHARGING SPECIFICATION SUBCOOLING 10 °F DIMENSIONS H X W X D CRATED (IN.) 34.4 x 35.1 x 38.7 WEIGHT SHIPPING (LBS.) 235 NET (LBS.) 203 U Certified in accordance with the Air-Source Unitary Air - conditioner Equipment certification program, which is based on AHRI standard 2101240. 7 Rated in accordance with AHRI standard 270. O Calculated in accordance with Net. Elec. Codes. Use only HACR circuit breakers or fuses. J Standard Air — Dry Coil — Outdoor 0 This value approximate. For more precise value see unit nameplate. © Max. linear length 60 ft.; Max. lift - Suction 60 ft.; Max lift - Liquid 6011. For greater length consult refrigerant piping software Pub. No. 32- 3312 -0' (' denotes latest revision). 0 This value shown for compressor RLA on the unit nameplate and on this specification sheet is used to compute minimum branch circuit ampacity and max. fuse size. The value shown is the branch circuit selec- tion current. .� No means no start components.Yes means quick start kit components. PTC means positive temperature coefficient starter. MODELS I BASE I FIG. I A I B I C I D I E I F I G I H I J K 4TTB3048D 1 4 1 1 1741 (29-1/8)1946 (37-1/4)1870 (34-1/4)1 7/8 1 3/8 1 152 6 98 3 -7/8 219 (8-5/8)186 3 -3/8 508 20 A- WEIGHTED SOUND POWER LOVEL [dB(A)] MODELS SOUND POWER LEVEL [dB(A)] A- WEIGHTED FULL OCTOAVE SOUND POWER LEVEL Db - [dB(A)] 63 1 125 1 250 1 500 1 1000 1 2000 4000 1 8000 4TTB3048D 79 47.4 1 60.0 1 66.9 1 75.3 1 73.5 1 70.3 62.0 1 51.4 Note: Rated in accordance with AHRI Standard 270 -2008 0 2011 American Standard Heating & Air Conditioning CUPERTINO Address 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 • buildingCa cupertino.org 14nq n i Co 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. As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. I h d d ree to com ly with the terms and conditions of this statement ave rea an ag p Own r (or Owner Ag t s) me: ,' 17 ip Na Signature .... .. . ..................... ........ ...................... ............................... Date Contractor Name: Signature.................................... ............................... Licl ....... ............................... Date: ................... Smoke and CO form.doc revised 03118114 CERTIFICATE OF COMPLIANCE `� ���- / Y CF1R- ALT -02 -E Alterations to Space Conditioning Systems (formerly CF -iR -ALT HVAC) (Page 1 of 4 ) Project Name: 21608 FLINTSHIRE ST Date Prepared: 2014 -09 -24 A. General Information CF111-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one CF111-ALT -02 document for each dwelling unit. 01 Project Name 21608 FLINTSHIRE ST 02 Date Prepared 2014 -09 -24 03 Project Location 21608 FLINTSHIRE ST 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 21608 FLINTSHIRE ST 07 Zip Code 95014 08 Dwelling Unit Conditioned 1500 SC System SC System CFA served Floor Area (ft2) refrigerant Installing new SC Installing Installing Installing, Number of space conditioning Identification or 09 Climate Zone 4 10 (SC) systems in this dwelling 1 entirely new entirely new Name unit. System (ft2) r "MT, IS, B. Space Conditioning (SC) Syste ,, rmatioh # F. 01 02 0J 04 a ., OT ''' 09 10 SC System SC System CFA served system a refrigerant Installing new SC Installing Installing Installing, Identification or Location or Area . ''by.this 5C dotted containing system more than 40 entirely new entirely new Name Served System (ft2) "? component? components? feet of ducts? duct system? SC system? Alteration Type System 1 HOUSE 1500 Yes Yes Yes No No No Altered space conditioning system C. Extension of Existing Duct System, Greater "Than 40 Feet (Section150.2(b)IDiib) This section does not apply to this project. Registration Number: 214- A0100439A- 000000000 -0000 Registration Date/Time: 2014 -09 -24 09:59:07 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014 -03 -31 Report Generated: 2014 -09 -24 09:59:21 Schema Version: 0.551SDD CERTIFICATE OF COMPLIANCE CF111-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R-ALT HVAC) (Page 2 of 4 ) 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 Central gas All new Central split All new This field or This field or System 1 furnace heating AFUE 0.78 AC cooling SEER 13 Setback section is not section is not components components applicable applicable Reouired Documentation: CF211- MCH -01 -E - Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums: R6. CF2R- 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: 515 %, or 510% leakage to outside, or seal all accessible leaks. CF211- MCH -25 -H & CF3R- MCH -25 -H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8 -15). CF2RCF3R- MCH -23 & CF3R- MCH -23 Air Flow Z 300 C M/ton9i uired when H -25' ;requf - r m �' °S Exceptions: � r � -Duct systems registered with HERS provider as usly sealed a m CH -20 Duct g�ee in air nts . - Heating -only systems and Air Handler /Furnac ages do not u eve ca Air Flow fr ha'rge M Existing duct systems constructed, insulated o fed with dg MC 20 ieaT eme "�A�w ',� '�"1.=`.ixs;. ,., x.%?t�"'-'d ,,' k,.a �:;t, `' ,." �,a�''•• ..F,,, �.�X .� e•,,.,"y. E. Entirely New or Complete Replacement,,j)uct System, with or without Equipment Changeout (Sections 150.2(b)Wlla and 150.2(b)1E, F) This section does not apply to this project. Registration Number: 214- A0100439A- 000000000 -0000 Registration Date/rime: 2014 -09 -24 09:59:07 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014 -03 -31 Report Generated: 2014 -09 -24 09:59:21 Schema Version: 0.551SDD CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF-1R-ALT-HVAC) (Page 3 of 4 ) F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) This section does not apply to this project. k� Y' ro 5k Registration Number: 214-A0100439A-000000000-0000 Registration Date/Time: 2014-09-24 09:59:07 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-09-24 09:59:21 Schema Version: 0.551SDD CERTIFICATE OF COMPLIANCE CF1R- ALT -02 -E Alterations to Space Conditioning Systems (formerly CF -1R-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: /G�� Godina, Nicole ' Company: Signature Date: The Energuy CA LLC 2014 -09 -24 09:59:07 Address: CEA/ HERS Certification Identification (if applicable): 1215 K St., 17th Floor City /State /Zip: Phone: Sacramento CA 95814 1- 877 - 600 -0123 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. 1 am eligible under Division 3 of the BusinessMan f Professions Code to acce o slb) f e by I sign ooc a dg i n qe[4 ed on this Certificate of Compliance (responsible designer). 3. That the energy features and perfor sped tions, mai onent5�nd ufa red ce ` the bui g d m design identified on this Ce rtificate of Compliance conform to the requirements of Title 24, Part 1 and 6of the Califor ; od 4. The building design features or syst esign featur i o Certificate nce a nt with infoded%n other ap Iicable compliance documents, worksheets, 4te calculations, plans and spedficatio bmitte e n ncy for pp wfth t is mtft ap on. 5. I will ensure that a registered copy o ce fid ma ued ijabie to the enforcement agency for all applicable inspections. I understand that a registered copy of'this Certfficat of C - Nance is iced to be Inc uded wi i the documentder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature:` Godina, Nicole Company: Date Signed: The Energuy CA LLC 2014 -09 -24 09:59:07 Address: License: 1215 K St., 17th Floor City /State/Zip: Phone: Sacramento CA 95814 11-877-600-0123 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- A0100439A- 000000000 -0000 Registration Date/lime: 2014 -09 -24 09:59:07 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014 -03 -31 Report Generated: 2014 -09 -24 09:59:21 Schema Version: 0.551SDD CERTIFICATE OF INSTALLATION CF2R- MCH -01 -E Space Conditioning Systems, Ducts, and Fans (Page 1 of 7 ) Project Name: 21608 FLINTSHIRE ST Enforcement Agency: City of Cupertino Permit Number: 14090166 Dwelling Address: 21608 FLINTSHIRE ST City: Cupertino Zip Code: 95014 A. General Information 01 Dwelling Unit Name 21608 FLINTSHIRE ST 02 Climate Zone 4 07 Dwelling Unit Conditioned Floor Area 09 10 Number of space conditioning (SC) 03 (ft2) 1500 systems being altered in this dwelling 1 Are aH of the unit. 05 Certificate of Compliance Type Prescriptive, alterations (CF1R -ALT) 06 Method used to calculate HVAC loads Not applicable - equipment changeout, like- for -like 07 Calculated dwelling unit Sensible = This field or section is not applicable 08 Calculated Dwelling Unit Heating Load This field or section is not applicable Cooling Load (Btuh) components (Btuh) MCH -01b Prescriptive Alterations .Space Conditioning S!""" ms Ducts and Fans B. Space Conditioning (SC) System Information 01 02 03 04 0S 06 07 08 09 10 Are aH of the system's components and ducts CFA served Is the SC Installing a installing new or SC System SC System by this SC system a refrigerant Installing new SC Installing more entirely replaced? Identification or Location or Area System ducted containing system than 40 feet of new duct (entirely new Name Served (ft2) system? component? components? ducts? system? system) Alteration Type Altered space System 1 HOUSE 1500 Yes Yes Yes No No No conditioning system Registration Number: 214- A0300439A- M0300002A -0000 Registration Date/Time: 2014 -10 -22 11:46:40 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014 -05 -13 Report Generated: 2014 -10 -11 10:22:38 Schema Version: 0.551SDD CERTIFICATE OF INSTALLATION CF2R- MCH -01 -E Space Conditioning Systems, Ducts, and Fans (Page 2 of 7 ) C. Space Conditioning (SC) System Alterations Compliance Information 01 02 03 04 05 06 07 08 09 10 11 12 Heating Unit serial Rated Heating Capacity, Name Heating Efficiency, type ` Heating Manufacturer Mode[Numbef number Cooling System 1 New or New System ADD2B100A9482A Altered Heating Minimum Altered Cooling Minimum Required Replaced Duct Identification Heating Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Duct R- od Name System Type Component Type Value System Type Component Type Value Type Length Value This All new All new N/A - no field or System 1 Central gas heating AFUE 80 Central split cooling SEER 13 Setback ducts section furnace components AC components replaced is not is not ble D. Installed Heating Equipment information , 0102 ` 03 04- 05. 06 07 System Identification or Heating Efficiency, Hieating;Unit Heating Unit Heating Unit serial Rated Heating Capacity, Name Heating Efficiency, type ` Value - Manufacturer Mode[Numbef number Output (BTUH) System 1 AFUE 80 American ADD2B100A9482A 13514SWN1G 80000 Standard D I Notes: I Registration Number: 214- A0100439A- M0100002A -0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Datefrime: 2014 -10 -22 11:46:40 Report Version: 2014 -05 -13 Schema Version: 0.551SDD HERS Provider: CalCERTS Report Generated: 2014 -10 -11 10:22:38 CERTIFICATE OF INSTALLATION CF2R- MCH -01 -E Space Conditioning Systems, Ducts, and Fans (Page 3 of 7 ) E. Installed Cooling Equipment information: 01 02 03 04 05 06 07 08 Condenser or Package Unit Condenser or Condenser or Condenser or System Rated Cooling Condenser Rated System Identification Cooling Efficiency Cooling Efficiency Package Unit Package Unit Package Unit Capacity at Design Nominal Capacity or Name Type Value Manufacturer Model Number Serial Number Conditions (BTUH) (ton) System 1 SEER 13 Trane 4TTB300C4ABD100 14324MKH3F 48000 4 Notes: H. Installed Air Filter Device Information This section does not apply to this project. I. Air Filter Device Requirements This section does not apply to this project. Registration Number: 214- A0100439A- M0100002A -0000 Registration Date/Time: 2014 -10-22 11:46:40 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014 -05 -13 Report Generated: 2014 -10 -11 10:22:38 Schema Version: 0.55101) CERTIFICATE OF INSTALLATION CF2R- MCH -01 -E Space Conditioning Systems, Ducts, and Fans (Page 4 of 7 ) J. HERS Verification Requirements 01 02 03 04 0S 06 07 08 09 10 MCH20 MCH21 MCH22 MCH23 MCH25 MCH28 Exemption from Minimum Exemption R -Value for AHU Fan AHU SC System SC System From Duct Duct Ducts In Ducts Located Efficacy Airflow Identification or Location or Area Leakage Leakage Conditioned In Cond Space (W per Rate (cfm Refrigerant Return Duct Design Name Served Requirements Test Space Verification dm) per ton) Charge Table 150.0 -C or D System 1 HOUSE Yes Not No No No No No exemptions applicable Registration Number: 214- A0100439A- M0100002A -0000 Registration Date/Time: 2014 -10-22 11:46:40 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014 -05 -13 Report Generated: 2014 -30 -11 10:22:38 Schema Version: 0.551SDD CERTIFICATE OF INSTALLATION CF2R- MCH -01 -E Space Conditioning Systems, Ducts, and Fans (Page 5 of 7 ) K. Space Conditioning Systems, Ducts and Fans Mandatory Requirements and Additional Measures Note: Additional mandatory requirements from Section 150.0 that are not listed here may be applicable to some systems. These requirements may be applicable to only newly installed equipment or portions of the system that are altered. Existing equipment may be exempt from these requirements. Heating Equipment 01 Equipment Efficiency: All heating equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency Regulations. 02 Controls: All unitary heating systems, including heat pumps, must be controlled by a setback thermostat. These thermostats must be capable of allowing the occupant to program the temperature set points for at least four different periods in 24 hours. See Sections 150.0(i), 110.2(b). 03 Sizing: Heating load calculations must be done on portions of the building served by new heating systems to prevent inadvertent undersizing or oversizing. See sections 150.0(h)1 and 2). 04 Furnace Temperature Rise: Central forced -air heating furnace installations must be configured to operate at or below the furnace manufacturer's maximum inlet -to- outlet temperature rise specification. See Section 150.0(h)4. 05 Standby Losses and Pilot Lights ;Fan -type central f m6ces�may not have�a continuggsly burning pilot light. Section 110.5 and Section 110.2(d). Cooling Equipment 06 Equipment Efficiency: All cooling equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency Regulations. 07 Refrigerant Line Insulation: All refrigerant line insulation in split system air conditioners and heat pumps must meet the R -value and protection requirements of Section 150.0(j)2 and 3, and Section 150.0(m)9. 08 Condensing Unit Location: Condensing units shall not be placed within five (5) feet of a dryer vent outlet. See Section 150.0(h)3A. 09 Sizing: Cooling load calculations must be done on portions of the building served by new cooling systems to prevent inadvertent undersizing or oversizing. See Section 150.0(h)1 and 2. Air Distribution System Ducts, Plenums and Fans 10 Insulation: In all cases, unless ducts are enclosed entirely in directly conditioned space, the minimum duct insulation value is R -6. Note that higher values may be required by the prescriptive or performance requirements. See Section 150.0(m)1. Registration Number: 214- A0100439A- M0100002A -0000 Registration Date/Time: 2014 -10 -22 11:46:40 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014 -05 -13 Report Generated: 2014 -10 -11 10:22:38 Schema Version: 0.551SDD CERTIFICATE OF INSTALLATION CF2R- MCH -01 -E Space Conditioning Systems, Ducts, and Fans (Page 6 of 7 ) K. Space Conditioning Systems, Ducts and Fans Mandatory Requirements and Additional Measures Note: Additional mandatory requirements from Section 150.0 that are not listed here may be applicable to some systems. These requirements may be applicable to only newly installed equipment or portions of the system that are altered. Existing equipment may be exempt from these requirements. Connections and Closures: All installed air - distribution system ducts and plenums must be, sealed and insulated to meet the requirements of CIVIC Sections 601.0, 11 602.0, 603.0, 604.0, 605.0 and ANSI /SMACNA- 006 -2006: Supply -air and return -air ducts and plenums must be insulated to a minimum installed level of R -6.0 or enclosed entirely in directly conditioned space as confirmed through field verification and diagnostic testing in accordance with the requirements of Reference Residential Appendix RA3.1.4.3.8. Heat Pump Thermostat 12 A thermostat shall be installed that meets the requirements of Section 110.2(b) and Section 110.2(c). 13 The thermostat shall be installed in accordance with the manufacturers published installation specifications 14 First stage of heating shall be assigned to heat pump heating. 15 Second stage back up heating shall -be setto come on only,Wfien the indoor set temperature cannot be met. The responsible person's signature onah s complianc6document" "affirms tha't"all applicable,requirements'In this table have been met. �. Registration Number: 214- A0100439A- M0100002A -0000 Registration Date/Time: 2014 -10 -22 11:46:40 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014 -05 -13 Report Generated: 2014 -10-11 10:22:38 Schema Version: 0.551SDD CERTIFICATE OF INSTALLATION CF2R- MCH -01 -E Space Conditioning Systems, Ducts, and Fans (Page 7 of 7 ) Documentation Author's Declaration Statement 1.1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: 01 Chicourrat, Cody - C �GCO�I�JT.R/ Company: Signature Date: The Energuy CA LLC Address: E C ifi I ification (if applicable): 1215 K St., 17th Floor ICC2006353 City /State/Zip: Phone: Sacramento CA 95814 11-877-600-0123 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 Installation is true and correct. 2. 1 am eligible under Division 3 of the Business. and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified bn this Certificate of Installation, and attest to the declarations in this statement (responsible builder /installer), otherwise I am an authorized representative of the responsible builder /installer. 3. The constructed or installed features; materials, components or mint, ftctured devices:(the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the regwrements given on'the'plans and specifications.approvediby thee nforcement agency;,` , 4. 1 reviewed a copy of the Certificate of i pmpbance approved bythe enforcement agency that rilerttr,lo the speciflc.regf frements for the3wpa.ofconstruction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the noristruction G'r'ir stallatiori'IrWe been met. S. I will ensure that a registered copy of this Certificate of Installation shall be posted, or made available with the building permits) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that "a registered copy of this Certificate of Installation is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Builder /Installer Name: Responsible Builder /Installer Signature: Hussey, Steve Company Name: (Installing Subcontractor or General Contractor or Builder /Owner) Position With Company (Title):O�aL/ HUSSEY BROS INC Owner v Address: CSLB License: 903 GEORGE ST 675669 City/State/Zip: Phone: 1(408) Date Signed: SANTA CLARA CA 95054 733 -6360 2014 -10- 2211:46:40 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 214- A0100439A- M0100002A -0000 Registration Date/Time: 2014 -10-22 11:46:40 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014 -05 -13 Report Generated: 2014 -10 -11 10:22:38 Schema Version: 0.551SDD CERTIFICATE OF VERIFICATION CF311- MCH -20 -H Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: 21608 FLINTSHIRE ST Enforcement Agency: Cupertino City of Permit Number: 14090166 Dwelling Address: 21608 FLINTSHIRE ST City: Cupertino Zip Code: 95014 A. System Information 01 Space Conditioning System Identification or Name System 1 02 Space Conditioning System Location or Area Served HOUSE 03 Building Type from CF -111 Single family 04 Verified Low Leakage Ducts in Conditioned Space No, credit is not taken 04 (VLLDCS) Credit from CF1R? Total leakage 05 Verified Low Leakage Air Handling Unit (VLLAHU) Credit No, credit is not taken 07 from CF1R? Cooling system method 06 Duct System Compliance Category Alteration using smoke test 09 Calculated Target Allowable Duct Leakage Rate (cfm) 240 MCH -20e - Sealing All Acces'rbl `eaks using Smoke Test B. Dud Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity (ton) 4 02 Heating Capacity (kBtu /h) 80 03 Conditioned Floor Area served by this HVAC system (ft2) 1500 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.15 07 Air Handling Unit Airflow (AHUAirflow) Determination Method Cooling system method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage Rate (cfm) 240 10 Actual duct leakage rate from leakage test measurement (cfm) 314 11 Compliance Statement: System passes using smoke test of an altered HVAC system in an existing building. No visible smoke exits the accessible portions of the duct system. Smoke is only emanating from air - handling unit (AHU) cabinet and non accessible portions of the duct system. Note - Accessible is defined as having access thereto, but which first may require Registration Number: 214- A0100439A- M2000002A -M20A Registration Date/Time: 2014 -10 -11 10:23:47 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2014 -05-08 Report Generated: 2014 -10 -11 10:23:59 2013 Residential Compliance Schema Version: 0.551SDD CERTIFICATE OF VERIFICATION CF3R- MCH -20 -H Duct Leakage Diagnostic Test (Page 2 of 3 ) B. Duct Leakage Diagnostic Test 01 removal or opening of access panels, doors, or moving similar obstructions. If access to the ducts requires an object to be demolished or deconstructed then sealing of those ducts is not required 12 Notes: C. Additional Requirements for Compliance 01 System was tested in its normal operation condition. No temporary taping allowed. Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed /taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet 02 ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. 03 All supply and return register boots were sealed to the drywall. 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was'Used it was covered with -,Mastic and draw bands. A4 06 All connection points betWn 'epJfl4'k e�air handler and the- tupply and return plenums are completely sealed. ....: 9 If the system coni of using the"Smoke Test "method, the smoke test was conducted in accordance with the requirements 07 of Reference Residential Appendix RA3.1.4.3.6. Systems that comply using smoke test shall not be included in sample groups for HERS verification compliance. 08 Verification Status: Pass - all applicable requirements are met 09 Correction Notes for this table: The responsible person's signature on this compliance document affirms that all applicable requirements in this table have been met unless otherwise noted in the Verification Status and the Corrections Notes in this table. I D. Determination of HERS Verification Compliance I All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 1 01 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: 214- A0100439A- M2000002A -M20A Registration Date/Time: 2014 -10 -11 10:23:47 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2014 -05 -08 Report Generated: 2014 -10-11 10:23:59 2013 Residential Compliance Schema Version: 0.551SDD CERTIFICATE OF VERIFICATION CF3R- MCH -20 -H Duct Leakage Diagnostic Test (Page 3 of 3 ) Documentation Author's Declaration Statement 1.1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Cody Chicourrat �dGLCArl'/f<� Company: Date Signed: The Energuy CA LLC 2014 -10 -11 10:23:47 Address: CEA/ HERS Certification Identification (if applicable): 1215 K St., 17th Floor 20576 City /State/Zip: Phone: Sacramento CA 95814 1- 877 - 600 -0123 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The installed features, materials, components, manufactured devices, or system performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements specified on the C�ehifckif-1 of,.Complianc� r the buddingapproved, by the enforcement agency. 4. The informationlreported on -applicable s ioet-ofthe Certificate(s) of Installation (CF211) signed and submitted by the person(s) responsible for the � construction or installation coraf$ s to he giulrements specffieil:onthe Certificate(s)'of Compliance (MR) approved by the enforcement agency. �of cis "shall S. I will ensure that'a registereco Ceficate of Verification be posted, or made available with the building permit(s) issued for the building, and made a lira 'tot e m i$ agency for all applicable inspections. I understand that a registered copy of this Certificate of Verification is regG ►e�to inc de' ; rth the "tlociimentatioWthe builder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General C, kractor, or Builder /Owner): HUSSEY BROS INC Responsible Builder or Installer Name: CSLB License: HUSSEY BROS INC 675669 HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status In Sample Group (if applicable) Tested HERS Rater Information HERS Rater Company Name: The Energuy CA LLC Responsible Rater Name: Responsible Rater Signature: Cody Chicourrat �iileGCAfUIJdif�% Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006353 2014 -10 -11 10:23:47 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 214- A0100439A- M2000002A -M20A Registration Date/Time: 2014 -10 -11 10:23:47 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2014 -05 -08 Report Generated: 2014 -10 -11 10:23:59 2013 Residential Compliance Schema Version: 0.551SDD