14120044CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 20283 PINNTAGE PKWY CONTRACTOR: VALLEY HEATING & PERMIT NO: 14120044
COOLING
OWNER'S NAME: STEPHENS CYNTHIA U TRUSTEE 1171 N 4TH ST DATE ISSUED: 12/08/2014
OWNER'S PHONE: 4082571618 SAN JOSE, CA 95112 PHONE NO: (408)294-6290
LICENSED CONTRACTOR'S DECLL7A�R/ATION
License Class Lic. #
Contractor
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
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
Vection 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
omply/with all non -point source regulations per the Cupertino Municipal Code, SectiS it
9 18. ySignature4Date
❑ 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
918.
Signature
Date
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPLACE (E) FURNACE IN GARAGE & (E) A/C UNIT IN
SIDE YARD
Sq. Ft Floor Area:
Valuation: $6320
APN Number: 36947039-D 0 I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF Ujn4T ISSUANCE OR
180 DAYSRQAQ-I�SAcLLED INSPECTION.
r�/ RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(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 Cutino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 5, 25533, and 25534.
Owner or authorized agent: Date: 2�
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C )
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profess
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(o-kupertino.org
00 �MEP
MISC
❑PLUMBING ❑MECHANICAL (� UELECTRICAL /1 UMISCELLANEOUS
PROJECT ADDRESS i 7 /)? (7 _ f�� n �C/ APN # 7
OWNER NAME/ ,In� S {/ ft j
PHO g ��-7 /1,6/
E-MAIL
STREET ADDRESS1_�^
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CITY, STATE, ZIP
FAX
CONTACT NAME
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PHONE 1 J Cj I/!v
DCS l
E-MAIL
STREET ADDRESS % % �jq h C
[[OWNER
CITY, STATE, ZIPV
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FAX
❑ OWNER ❑ OWNER -BUILDER ❑ AGENT) CONTRACTOR 11 CONTRACTOR AGENT 11 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �� L
V024
LICENSE NUMBER /
LICENSE TYPE /
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
\
J l
�^
CITY, STATE, ZIP \
(,/1
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
tll /•C/hc/l� �ti�c �'�&/Fb�l Va
TOTAL VALUATION: 2 G
By my signature below, I certify to each of the following: I am the property owner or authorized agent to the property oy ner's a .
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I greet mply with all applicable local
ordinances and state laws relating to bui g constructi uthorize representatives of Cupertino to enter the above -i nt property for inspection purposes.
Signature of Applicant/Agent: Date: ' /9-// Y
SUPPLEMENTAL INFORMATION REQUIRED Uzi -' OFFICE usE oivLx
MEPMiscApp_201 1. doc revised 06/21/11
CITY OF CUPERTINO
wo FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 20283 PINNTAGE PKWY
DATE: 12/08/2014
REVIEWED BY: MELISSA
UNITS
APN: 369 47 039
BP#:
*VALUATION: 1$6,320
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
#
PENTAMATION
PERMIT TYPE: FURN/A
WORK
REPLACE E FURNACE IN GARAGE & E A/C UNIT IN SIDE YARD
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
A/C Units (<=10K cfm)
113REMAIR
1
#
$72
Furnace, Forced -Air
1MFR=<100
1
#
$143
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes 0 No
$0.00
TOTALS:
7
1 $215.00
Strom Motion Fee: 1BSEISMICR
Mech. Plan Check 10.0 1 hrs $0.00 ('lump. Parr Cl`jcok I I?:11ec. Pian ec!(
Mech. Permit Fee: 1MPERMIT F'unb� Pertnid Fee:
Other Mech. Insp. 0.0 hrs $48.00 Oche, Plumb lrtsp. OiOer 1ae:e. h7'V"'
phinih, Insp. Fee: Alec hn'r,
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are haled on the nreliminary information availahle and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan
PC.. J`ee
PME Plan Check:
$0.00
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes 0 No
$0.00
s Ea'1,'i11iG`c'U /CfYllf(Y14;' %"ees:
Travel Documentation Fee: ITRAVDOC
$48.00
Strom Motion Fee: 1BSEISMICR
$0.82
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
:. �t
$357.82
$0.00 TOTAL FEE:
$357.82
Revised: 10/01/2014
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT-03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-03-E
Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -IR -ALT -HVAC) (Page 1 of 1)
Site Address:
P;
Enforcement Agency:
Date Prepared:
P rmit#:
Jq,00qq
X
C ef44rO
12
f`�
Equipment Type
Equipment Efficiency
Ne4- Ducting, Plenums, Lineset
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
VEvaporator Coil
FUE
COP
R-6 (CZ 1,3-7) Ducts
Se -1 d by system
Setback
❑ Split System
13 Condensing Unit
SEER
❑ R-8' (CZ 16) Ducts
O sq ft
(If not already
HSPF
❑ R-6 (all CZ's) Plenums
present must
Furnace
❑ Uneset
fER
❑ R-5 or R7.5 Uneset3
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.
❑ 1. 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 ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building1
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 a 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 (<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 f# installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc.
' 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-2YO, 3.5 to 4T-2%1', 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: /
Responsibi ignerSignature:
Date Signed: 9—K
2 / �/
(( O (
Licens
companAddrress:
%li Q.. t Ci9d�
/
l l I y S-
City/State/Zip: Phone:
5-4n /O !}r/r ("J & z
For `assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300
1�1; COO
CERTIFICATE OF COMPLIANCE Puma. Ce—, CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 1 of 4 )
Project Name: Cindy Stephens 2014-0353 1 Date Prepared: 2014-12-05
A. General Information
CF1R-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be
documented, use one CF1R-ALT 02 document for each dwelling unit.
01
Project Name
Cindy Step e -
02
Date Prepared
2014-12-05
03
Project Location
20283 Pinntage Parkway
04
Building Type
Multi -family
05
CA City
Cupertino
06
Dwelling Unit Name
Cindy Stephens 2014-0353
07
Zip Code
95014
08
Dwelling Unit Conditioned
1400
duct system?
SC system?
Alteration Type
Furnace and ac
Floor Area (ft2)
1400
Yes
Yes
Yes
No
Number of space conditioning
No
09
Climate Zone
4
10
(SC) systems in this dwelling
1
unit.
B. Space Conditioning (SC) System Irtforrnation
01 02 03 04:" 05 06 09 10
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
"'fsy this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Furnace and ac
Whole house
1400
Yes
Yes
Yes
No
No
No
Altered space
replacement
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 214-AO15313SA-000000000-0000 Registration Date/Time: 2014-12-05 10:13:58 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-12-05 10:13:53
Schema Version: 0.551SDD
i
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -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
it
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
Furnace and ac
Central gas
All new
Central split
All new
This field or
This field or
heating
AFUE
0.78
cooling
SEER
13
Setback
section is not
section is not
replacement
furnace
components
AC
components
applicable
applicable
Required Documentation:
CF2R-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:5 10% leakage to outside, or seal all accessible leaks.
CF211-MCH-25-1-1 & 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 CFM/tomrequired when MCH -25 isrequired
Exceptions:
-Duct systems registered with HERS provider as previously sealed are.exemptfrotn,MCH-20 Duct Leakage,Testing;r6gUireftients
-Heating-only systems and Air Handler/Furnace,.changes do not require verificaiipWofAir Flow MCN 2$;'br Refrigerant Charge MECH-25:
-Existing duct systems constructed, insulated orsealed with asbestos are exempt firm MCH 20 DucrLeakage TeStmg requirements
-
E. Entirely New or Complete Replacement Duct System; uvith or without Equipment Changeout (Sections 150.2(b)lDiia and 150.2(b)lE, F)
This section does not apply to this project.
Registration Number: 214-A0153138A-000000000-0000 Registration Date/Time: 2014-12-05 10:13:58 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-12-05 10:13:53
Schema Version: 0.551SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -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.
Registration Number: 214-A0153138A-000000000-0000
Registration Date/Time: 2014-12-05 10:13:58
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-12-05 10:13:53
Schema Version: 0.551SDD
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:
Faulkner, Cindy
(?�% C1'000Gt ii/I2P�li
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2014-12-05 10:13:58
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phone:
SAN JOSE CA 95112
1(408) 294-6290
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 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, materials, componentsI d manufactured devicesfor 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 California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent witWthe information provided'on other applicable compliance documents, worksheets,
calculations, plans and specifications submitted,to,the enforcement agency for approval with this building permit application
5. 1 will ensure that a registered copy ofths Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
Faulkner, Cindy
Company:
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2014-12-05 10:13:58
Address:
License:
1171 NORTH 4TH STREET
258540
City/State/Zip:
Phone:
SAN JOSE CA 95112
(408) 294-6290
Digitally signed by WCERTS. 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-A0153138A-000000000-0000 Registration Date/Time: 2014-12-05 10:13:58 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-12-05 10:13:53
Schema Version: 0.5515DD
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Pa
Project Name: Cindy Ste 014-
(Cy
Enforcement Agency: City of
ertino
Permit Number: 14120044
Dwelling Address: 20283 Pinntage Parkway
City: Cupertino
Zip Code:14
A. System Information
01
Space Conditioning System Identification or Name
Furnace and ac replacement
02
Space Conditioning System Location or Area Served
Whole house
03
Building Type from CF -111
Multi -family
04
Verified Low Leakage Ducts in Conditioned Space
(VLLDCS) Credit from CF1R?
No, credit is not taken
05
Verified Low Leakage Air Handling Unit Credit from
CF1R?
No, credit is not taken
06
Duct System Compliance „Category
Alteration_
MCH -20d - Complete Replacement or Altered Duct System
B. Duct Leakage Diagnostic Test
01
Condenser Nominal Cooling Capacity (ton)
2
02
Heating Capacity (kBtu/h)
52
03
Conditioned Floor Area served by this HVAC system (ft2)
1400
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)
120
10
Actual duct leakage rate from leakage test measurement
(cfm)
112
11
Compliance Statement: System passes leakage test
12
Notes:
Registration Number: 214-A0153138A-M2000002A-M20A Registration Date/Time: 2015-01-23 14:00:47 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-01-23 14:00:20
2013 Residential Compliance Schema Version: 0.51SDD
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 2 of 3 )
C. Additional Requirements for Compliance
01
System was tested in its normal operation condition. No temporary taping allowed.
02
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
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.
06
All connection points between the air handler and the supply and return plenums are completely sealed.
07
If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements
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 thistable. ,.
The responsible persons signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Corrections Notes in this table.
D. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol
requirements in order for this Certificate of Verification as a whole to be determined to be in compliance.
101 I Complies: All specified verification protocol requirements on this document are met.
Registration Number: 214-A0153138A-M2000002A-M20A Registration Date/Time: 2015-01-23 14:00:47 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-01-23 14:00:20
2013 Residential Compliance Schema Version: 0.51SDD
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:
Alfredo Baccari
e o Saccari
Company:
Date Signed:
Elements - E3
2015-01-23 14:00:47
Address:
CEA/ HERS Certification Identification (if applicable):
1718 Creek Drive
19451
City/State/Zip:
Phone:
San Jose CA 95125
408 634 6690
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 Certificate'of Compliance for the building approved by the enforcement agency.
4. The information reported on applicable sections of the Certificate(s) of Installation (MR) signed and submitted by the person(s) responsible for the
construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (MR) approved by the enforcement agency.
S. I will ensure that a registered copy of this Certificate of Verification shall be posted, or made available with the building permit(s) issued for the
building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of
Verification is required to be included With the documentation the builder provides to the building owner at occupancy.
Builder Or Installer Information As Shown On The Certificate Of Installation
Company Name (Installing Subcontractor, General Contractor, or Builder/Owner):
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
Responsible Builder or Installer Name:
CSLB License:
Cindy Faulkner
258540
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:
Elements - E3 - edo accari
Responsible Rater Name:
Responsible Rater Signature:
Alfredo Baccari
2015-01-23 14:00:47
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2006372
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-AO153138A-M2000002A-M20A Registration Date/Time: 2015-01-23 14:00:47 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-01-23 14:00:20
2013 Residential Compliance Schema Version: 0.51SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-20-H
Duct Leakage Diagnostic Test (Page 1 of 3 )
Project Name: Cindy Stephens 2014-0353
clbyrvillta-)
Enforcement Agency: City of
Cupertino
Permit Number: 14120044
Dwelling Address: 20283 Pinntage Parkway
City: Cupertino
Zip Code: 95014
A. System Information
01
Space Conditioning System Identification or Name
Furnace and ac replacement
02
Space Conditioning System Location or Area Served
Whole house
03
Building Type from CF -1R
Multi -family
04
Verified Low Leakage Ducts in Conditioned Space
(VLLDCS) Credit from CF1R?
No, credit is not taken
05
Verified Low Leakage Air Handling Unit (VLLAHU) Credit
from CF1R?
No, credit is not taken
06
Duct System Compliance,Category:
Alteration
MCH -20d - Complete Replacementor Altered Duct System
B. Duct Leakage Diagnostic Test
01
Condenser Nominal Cooling Capacity (ton)
2
02
Heating Capacity (kBtu/h)
52
03
Conditioned Floor Area served by this HVAC system (ft2)
1400
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 (cfm)
120
10
Actual duct leakage rate from leakage test measurement
(cfm)
112
11
Compliance Statement: System passes leakage test
Registration Number: 214-A0153138A-M2000002A-0000 Registration Date/Time: 2015-01-23 14:00:00 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-01-23 13:59:53
2013 Residential Compliance Schema Version: 0.51SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-20-H
Duct Leakage Diagnostic Test (Page 2 of 3 )
C. Additional Requirements for Compliance
01
System was tested in its normal operation condition. No temporary taping allowed.
Outside air (OA) 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.
06
All connection points between the air handler and the supply and return plenums are completely sealed.
If the system complies 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.
The responsible persons signature on this compliance document affirms that all applicable requirements in this table have
been met.
Registration Number: 214-A0153138A-M2000002A-0000 Registration Date/Time: 2015-01-23 14:00:00 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-01-23 13:59:53
2013 Residential Compliance Schema Version: 0.51SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-20-H
Duct Leakage Diagnostic Test (Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Cindy Faulkner
cf,
Company:
Signature Date: 2015-01-23 14:00:00
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING &
ELECTRICAL
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phone:
SAN JOSE CA 95112 1(408)
294-6290
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 on 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 manufactured devices (the installation) identified on this Certificate of Installation
conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by
the enforcement agency.
4. 1 understand that a HERS rater will check the. installation to verify compliance; and that if such checking identifies defects; I am required to take
corrective action at my expense. I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking
of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the
requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS
sample group will be performed at my expense.
5. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of
construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or
installation have been met.
6. 1 will ensure that a registered copy of this Certificate of Installation shall be posted, or made available with the building permit(s) issued for the
building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of
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 Signa
Cindy Faulkner
Company Name: (Installing Subcontractor or General Contractor or
Position With Company (Title):
Builder/Owner)
Owner
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING &
ELECTRICAL
Address:
1171 NORTH 4TH STREET
CSLB License:
258540 2015-01-23 14:00:00
City/State/Zip:
Phone:
Date Signed:
SAN JOSE CA 95112
(408) 294-6290
Third Party Quality Control Program (TPQCP) Status:
Name of TPQCP (if applicable):
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-A0153138A-M2000002A-0000 Registration Date/Time: 2015-01-23 14:00:00 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-01-23 13:59:53
2013 Residential Compliance Schema Version: 0.51SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 1 of 7 )
Project Name: Cindy Stephens 2014-0353
Enforcement Agency: City of Cupertino
Permit Number: 14120044
Dwelling Address: 20283 Pinntage Parkway
City: Cupertino
Zip Code: 95014
A. General Information
01
Dwelling Unit Name
Cindy Stephens 2014-0353
02
Climate Zone
4
07
08
09
10
Number of space conditioning (SC)
03
Dwelling Unit Conditioned Floor Area
1400
04
systems being altered in this dwelling
1
Are all of the
(ft2)
unit.
05
Certificate of Compliance Type
Prescriptive alterations (CF1R-ALT)
06
Method used to calculate HVAC loads
ACCA_ManualJ
07
Calculated dwelling unit Sensible
24000
08
Calculated Dwelling Unit Heating Load
66000
Cooling Load (Btuh)
components
(Btuh)
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
Are all 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
Furnace and ac
Whole house
1400
Yes
Yes
Yes
No
No
No
conditioning
replacement
system
Registration Number: 214-A0153138A-M0100002A-0000
Registration Date/Time
2014-12-23 10:51:38
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2014-12-23 10:51:26
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
number
Rated Heating Capacity,
Output (BTUH)
Furnace and ac
replacement
AFUE
Heating
Lennox
SL280UH070XV36
A
5914602297
Cooling
Notes:
New or
New
System
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
Replaced
Duct
Identification
Heating
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Duct
R -
or Name
System Type
Component
Type
Value
System Type
Component
Type
Value
Type
Length
Value
This
Furnace and ac
Central gas
All new
Central split
All new
N/A - no
field or
section
replacement
furnace
heating
AFUE
0.8
AC
cooling
SEER
13
Setback
ducts
is not
is noapplict
components
components
replaced
ble
D. Installed Heating Equipment information:,
01
02
03 -;
04 '
0S..''.06
07
System Identification or
Name
Heating Efficiency Type
Heating Efficiency
Value
Heating Unit
Manufacturer
Heating Unit
Model Number
Heating Unit serial
number
Rated Heating Capacity,
Output (BTUH)
Furnace and ac
replacement
AFUE
0.8
Lennox
SL280UH070XV36
A
5914602297
52000
Notes:
Registration Number: 214-A0153138A-M0100002A-0000
Registration Date/Time: 2014-12-23 10:51:38
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2014-12-23 10:51:26
Schema Version: 0.551SDD
CERTIFICATE OF INSTALLATION CF2R-MC1H-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)
Furnace and ac
SEER
13
Lennox
13ACX-024-230
1914K47767
24000
2
replacement
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-A0153138A-M0100002A-0000 Registration Date/Time: 2014-12-23 10:51:38 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2014-12-23 10:51:26
Schema Version: 0.551SDD
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
05
06
07
08
09
10
MCH2O
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
cfm)
per ton)
Charge
Table 150.0-C or D
Furnace and ac
Whole house
No
Yes
Not
No
No
No
No
No
replacement
exemptions
applicable
Registration Number: 214-A0153138A-M0100002A-0000
Registration Date/Time: 2014-12-23 10:51:38
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2014-12-23 10:51:26
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
Equipment Efficiency: All heating equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency
01
Regulations.
Controls: All unitary heating systems, including heat pumps, must be controlled by a setback thermostat. These thermostats must be capable of allowing the occupant
02
to program the temperature set points for at least four different periods in 24 hours. See Sections 150.0(1), 110.2(b).
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
03
150.0(h)1 and 2).
Furnace Temperature Rise: Central forced -air heating furnace installations must be configured to operate at or below the furnace manufacturer's maximum
04
inlet -to -outlet temperature rise specification. See Section
05
StandbyLosses and Pilot Lights-,, a central furnaces ma not have a continuous) bu
g Nn -type y y ruing pilot light. Section 110.5 and Section 110.2(d).
Cooling Equipment
Equipment Efficiency: All cooling equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency
06
Regulations.
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
07
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.
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
09
150.0(h)1 and 2.
Air Distribution System Ducts, Plenums and Fans
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
10
required by the prescriptive or performance requirements. See Section 150.0(m)1.
Registration Number: 214-A0153138A-M0100002A-0000
Registration Date/Time: 2014-12-23 10:51:38
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2014-12-23 10:51:26
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 CMC Sections 601.0,
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
11
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 backup heating shall be set to come on'orily when the indoor set temperature cannot be met..
The responsible person signature on this compliance document,affirms that all applicable requirements in this table have been met.
Registration Number: 214-A0153138A-M0100002A-0000
Registration Date/Time:
2014-12-23 10:51:38
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2014-12-23 10:51:26
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:�p
Faulkner, Cindy
q�i
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2014-12-23 10:51:38
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phone:
SAN JOSE CA 95112 1(408)
294-6290
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 on 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 manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the
installation conforms to the requirements given on the plans and specifications approved by the enforcement agency.
4. [reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of
Installation, and I have ensured that the requirements that apply to the construction or installation have been met.
5. 1 will ensure that a registered copy of this Certificate of Installation shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all
applicable inspections. I understand that a registered copy of this Certificate of 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: �0
Faulkner, Cindyt�ClX!?/l2P/li
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Position With Company (Title):
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
President
Address:
CSLB License:
1171 NORTH 4TH STREET
258540
City/State/Zip:
Phone:
Date Signed:
SAN JOSE CA 95112
(408) 294-6290
12014-12-23 10:51:38
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Providerresponsibility for the accuracy of the information.
Registration Number: 214-A0153138A-M0100002A-0000 Registration Date/Time: 2014-12-23 10:51:38 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2014-12-23 10:51:26
Schema Version: 0.551SDD
CERTIFICATE OF COMPLIANCE
CFiR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT HVAC) (Page 1 of 4 )
Project Name: Cindy Stephens 2014-0353 Date Prepared: 2014-12-05
A. General Information
CF1R-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be
documented, use one CF1R-ALT 02 document for each dwelling unit.
01
Project Name
Cindy Stephens 2014-0353
02
Date Prepared
2014-12-05
03
Project Location
20283 Pinntage Parkway
04
Building Type
Multi -family
05
CA City
Cupertino
06
Dwelling Unit Name
Cindy Stephens 2014-0353
07
Zip Code
95014
08
Dwelling Unit Conditioned
1400
Installing
Installing
Installing
Floor Area (ft2)
Location or Area
by this SC
ducted
containing
system
Number of space conditioning
entirely new
09
Climate Zone
4
10
(SC) systems in this dwelling
1
component?
components?
feet of ducts?
duct system?
unit.
Alteration Type
B. Space Conditioning (SC) System Information
01
02
03 ; ,
04;° �,"
05,
Q607
08. °`
09
10
Is the SC -
Installing a
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Furnace and ac
Whole house
1400
Yes
Yes
Yes
No
No
No
Altered space
replacement
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 214-A0153138A-000000000-0000 Registration Date/Time: 2014-12-05 10:13:58 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-12-05 10:13:53
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
Furnace and ac
Central gas
All new
Central split
All new
This field or
This field or
replacement
furnace
heating
AFUE
0.78
AC
cooling
SEER
13
Setback
section is not
section is not
components
components
applicable
applicable
Required Documentation:
CF2R-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: <— 15%, or 510% leakage to outside, or seal all accessible leaks.
MR -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 2! 300 CFM/ton-required when MCH -25 is required.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are.exempt from MCH -20 Duct Leakage Testing requirements.
-Heating-only systems and Air Handler/Furnace changes do not requireverification 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)1Diia and 150.2(b)1E, F)
This section does not apply to this project.
Registration Number: 214-A0153138A-000000000-0000
Registration Date/Time:
2014-12-05 10:13:58
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-12-05 10:13:53
Schema Version: 0.551SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -111 -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.
Registration Number: 214-A0153138A-000000000-0000
Registration Date/Time: 2014-12-05 10:13:58
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-12-05 10:13:53
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: �� /j�
Faulkner, Cindy
C1'GG(.Giii/%2P/li
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2014-12-05 10:13:58
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phone:
SAN JOSE CA 95112
(408) 294-6290
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 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, materials, components;1and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part land Part,&of the California Code of Regulations.
4. 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 approv6twith this building permit application.
5. I will ensure that a registered copy ofthis,Certificate of Compliance shalt be madeavall'able with the building permrt(s)`issued fortlie building and made available to the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance`is required to be included withthe documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
q
Faulkner, Cindy
/
Company:
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2014-12-05 10:13:58
Address: -
License:
1171 NORTH 4TH STREET
258540
City/State/Zip:
Phone:
SAN JOSE CA 95112
(408) 294-6290
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-A0153138A-000000000-0000 Registration Date/Time: 2014-12-05 10:13:58 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-12-05 10:13:53
Schema Version: 0.551SDD