15030146I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 21075 MANITA CT I MECHANICAL CONTRACTOR: CALIFORNIA DELTA I PERMIT NO: 15030146 I
OWNER'S NAME: RASTOGI LAXMI K AND RASHMI 16056 E BASELINE RD STE 155 1 DATE ISSUED: 03/24/2015
OWNER'S PHONE: 4084462319 I MESA, AZ 85206 1 PHONE NO: (866) 692-5273 I
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lie. #V
Contractor Date J y— 2
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
9 18. /f
Date_?AZ ��r
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
Date
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
ADD (2) AC UNITS AND REPLACE (1) FURNACE LOC
UPSTAIRS
Sq. Ft Floor Area: I Valuation: $13500
APN Number: 36223043 00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS AST CALLED INSPECTION.
Issued by: Date l S�
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 Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25533, and 25534.
Owner or authorized age.: l �Date_?—`
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 Professional
_..............
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION f
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255✓1
(408.) 777-3228 • FAX 777-3333 • buildingC@cupertino.org (� misc
CUPERTINO \
F— PLUMBING W MECHANICAL ❑ELECTRICAL `❑J MISCELLANEOUS
PROJECI ADDRESS
APN #
Uq3 U`" `
OWNE AME
PHONE
2
E-MAIL
STREET ADD'SS^_
1
CITY, STATE, ZIP FAX
CONTACT N/�E
(tee
O
E-MAIL
BEET APD S
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
- ❑ CONTRACTOR It CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACT R NAMELIC
,y
SE
LICENSE TYPE
d
BUS. LIC #
C N
E-MAIL
FAX
O ^�GiY
S ET AD RESS •
CITY, STATE, ZIP t
r
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME `
E-MAU,
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
PROJECT IN WIIALAND ❑ YES
PROJECT IN ❑ YES
IS THE BLDG AN ❑ YES
BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA ❑ NO
FLOOD ZONE ❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: 0 V
olf.
RECEIVED BY��'
tm
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the perty o 's beh . I have read this
application and the information I have provided is correc I have read the Description of Work and verify it is accura e. to comply w th all applicable local
ordinances and state laws relating to building c
on. I authorize representatives of Cupertino to enter the above-identifiedor mspectioa purposes.
Signature of Applicant/Agent:
/prope
Date:
AL INFORMATION REQUIRED
.
VER THE ON ER
EXPRESS
'0 S� l STA RIr M'\
�113t1JOR� .., w. r
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FREW z+iviv 1Vcrr111%zr A rPn7? — 1127Tlili "IT%TC nlVlCTn1V
APPLIANCE / EQUIP TYPE
Z' L
ADDRESS: 21075 manita ct
DATE: 03/24/2015
REVIEWED BY: Mendez
1w
APN:
BP#:
*VALUATION: 1$13,500
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Du lex
p
#
PENTAMATION FURN/AC
PERMIT TYPE:
USE:
Furnace, Forced -Air
1MFR=<100
WORK
add 2 ac units and replace 1 furnace loc upstairs
#
$143
SCOPE
PME Unit Fee:
APPLIANCE / EQUIP TYPE
FEE ID
-
QTY/FEE
QTY
UNITS
BP FEES
A/C Units (<=10K cfm)
1BREMAIR
2
#
$144
Furnace, Forced -Air
1MFR=<100
Suj.)171. 117S19 Fee
1
#
$143
PME Unit Fee:
$287.00
PME Permit Fee:
$48.00
(.Construction Kix:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? ® Yes (F) No
$0.00
TOTALS:
i
«� '!
$287.00
_ . a
Mech. Plan Check 0.0 hrs $0.00 Plurrrb. Plod Check LSiec..Plan Check
Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee: Elec. Pernir Fee e
Other Mech. Insp. 0.0 hrs $48.00 Other Plumb Imp.ED
t)tlzet I:Slec. Imp.
deal. Insp. Fee: Plumb. Insp. 1``ee: Elec. Insp. Fee:
n;...:_# c..r....,1
NOTE: This estimate does not mctuae fees aue ro orner ueparrrrtertts p%r_ 1-turtntles, - .. --, - •• -»•--• , --_._ _. _ ____ ___,
,.»t„ ..» !'nnmrr tho Dent fnr addn 'I info.
'u1srrrcr, ere [nese eeb are uuseu vrt aoc
FEE ITEMS (Fee Resolution 11-053 ,E f.' 711113)
FEE
-
QTY/FEE
MISC ITEMS
Plan Check h'ee:
su111 l_p( f 1f, ee
PME Plan Check:
$0.00
Permit hee:
Suj.)171. 117S19 Fee
PME Unit Fee:
$287.00
PME Permit Fee:
$48.00
(.Construction Kix:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? ® Yes (F) No
$0.00
Advanced Planning hues:
i
Travel Documentation Fee: ITRAVDOC
$48.00
Stronsz Motion Fee: IBSEISMICR
$1.76
Select an Administrative Item
Bldg Stds Commission. Fee: IBCBSC
$1.00
=�
$430.76
Air
$0.00 DOTAL FEE
,.._ .a
$430.76
Revised: 02/14/2015
Ry'
3
rr (( 4
all
n='
�f F � i
$41..
gY
old 0
ePASS- it,
<
}
918ROMANt
1 .
Ulm
o
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t
f4
ty -Air-
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MAIN
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C
Product Catalog -Air Conditioners
Page 14
April 2413
Supersedes January 2013
SPECIFICATIONS
General Model No.
Data
Nominal Tonnage
13ACX-
618
13ACX-
024
13ACX-
030
I 13ACX-
036
13ACX-
042
13ACX-
048
13ACX-
060
1.5 2 2.5 3 3.5 4
5
' Sound Rating Number (dB.)
76
76
76
76
80
80
80
Connections Liquid line o.d. -in.
(sweat) Suction line o.d. - in.,
3/8
3/8
3/8
3/8
3/8
3/8
3/8
5/8 5/8 3/4 3/4 3/4 7/8
7/8
2 Refrigerant (R -410A) furnished
,3 lbs. 15 oz. 3 lbs. 15 oz.1 5'tbs. 2 oz.
5 lbs. 4 oz.
6 tbs. 8 oz. 7 lbs. 12 oz.
9 lbs. 0 oz.
Outdoor Diameter - in.
Fan Number of blades
Motor hp
18
18
18
18
22
22
22
3 3 4 4 4 1 4 1
4
1/10 1/10 1/5 1/5 1/4 1/4
1/4
Shipping Data lbs, -1 package
138
138
144
151
188
195
218
ELECTRICAL DATA
Line voltage data - 60 hz`- 1 ph
208/230V
2Q8/230V
2081230V
I 908/230V
208/230V
208/230V
208/230V
' Maximum overcurrent protection (amps)
20
30
30
35
45
50
60
Minimum circuit ampacity
12
17.6
18.7
22.0
28.1
31.9
34.6
Compressor - Rated load amps
9.0
13.5
14.1
16.7
21.2
24.2
26.3
Condenser Fan Motor - Full load amps
0.7
03
1.1
1.1
1 1.7
1 1.7
1.7
NOTE — Extremes of operating range are plus 10% and
minus 5% of'line voltage,
Sound Rating Number rated in accordance with test.conditions included in AHRI Standard 270.
Refrigerant charge sufficient for 15 R. length of refrigerant lines,
a HACR type circuit breaker or fuse.
Refer to National or Canadian Electrical Code manual to determine wire, fuse: and disconnect size requirements
i%,
<„
CUS
OW v1HEH8E8'CUhWNY LISTED
lntertek
NOTE — Due to Lennox' ongoing commitment to quality, Specifications, Ratings and Dimensions subject to change without notice and without incurring liability.
Improper installation, adjustment, alteration, service or maintenance can cause property damage or personal injury.
Installation and service must be performed by a qualified installer and servieing:agency. 02013 Lennox Industries Inc.
PRODUCT CATALOG
FEATURES
Refrigerant System
Scroll Compressor
Non -chlorine, ozone friendly, R -410A
refrigerant.
Units applicable to expansion valve
systems or RFC systems when
matched with specific indoor coils
Copper tube construction with
enhanced ripple -edged aluminum
fins.
Fully serviceable brass service
valves.
Liquid line drier shipped with unit
High Pressure Switch
Totally enclosed, direct drive outdoor
fan motor with sleeve bearings..
Louvered steel top fan guard.
Cabinet
Heavy -gauge galvanized steel
cabinet with powder paint finish.
Steel louvered panels provide
complete coil protection
Corner patch plate allows°access to
compressor.
LIMITED WARRANTY
Compressor -five years
All covered components - five years
Refer to Lennox Equipment Limited
Warranty certificate included with
equipment for details
Model No:
A
B
13ACX-018
25-1/4
_
24-1/4
13ACX-024
(6'16)
(616)
13ACX-030
29-1/4
24-1/4
13ACX=036
(743)
(616)
13ACX-042
29-1/4
28-1/4
(743)
(718)
13ACX-048
33-1/4
28-1/4
(845)
(718)
13ACX-060
29-1/4
28-1/4
1
(743)
(718)
AIR CONDITIONERS
13ACX
MERIT® SERIES
R-41 OA
SEER - Up to 14.0
1.5 to5Tons
Page 13
April 2013
Supersedes January 2013
AHRI RATINGS
See AHRI Ratings Supplement
ACCESSORIES
See page 16
Cabinet
• Mounting Base
• Unit Stand -Off Kit
Compressor
• Compressor Crankcase Heater
• Compressor Hard Start Kit
• Compressor Low Ambient Cut -Off
• Compressor Sound Cover
• Compressor Time -Off Control
Controls
• Freezestat
• Indoor Blower Off Delay Relay
• Low Ambient Kit
• Loss of Charge Switch Kit
• Thermostat
Refrigerant System
• Expansion Valve Kits
• Refrigerant Line Kits
DIMENSIONS
NOTE— Due to Lennox' ongoing commitment to quality, Specifications, Ratings and Dimensions subject to change without notice and without incurring liability,
Improper installation, adjustment, alteration, service or maintenance can cause property damage or personal injury.
Installation and service must be performed by a qualified installer andservicing agency. @2013 Lennox industries Inc.
03/17/2015
07:57 9253031755 WATERFORB PLACE APARTMENTS #2625 P.001/003
-,/c. lwlecc
27
e i :kla M.2a r K M,
Parts I Permit CWes#tans Z -elA l4 00 tq
1J U,ps err 7r -7,,r
Service At: Customer # 284332
RASTOGI, LAXMI
21075 MANITA CT
Cupertino CA 95014
Email:
Work Order
Delta Mechanical Arizona
6056 E Baseline Rd # 155
Mesa AZ 85206
888-828-0707
Bill To: Customer # 284332
405-446-2319RASTOGI, LAXMI
21075 MANITA CT
Cupertino CA 95014
Email:
Type:
Src Type:
Zone:
Source:
2 ELEC DISCONNECTS
Map:
Subdivision:
LEAD#
Skill:
Tax:
Directions
Instructions 3/23%15 11:23 AM
INSTALL FOR 3/26/2015
(UPSTAIRS)
LENNOX' 2.5 TON AC GOND 15 SEER
LENNOX 2.5 TON COIL
LENNOX 80% FURNACE
(DOWNSTAIRS)
LENNOX 3 TON COND 13 SEER
LENNOX COIL
LEAD# 1-5043386414
STORE# 6635
LETICIA RIVAS
Open Balance:
Payment Method:
Credit Limit:
Service Customer
Job NO: 2 396,93
Rating:
408-446-2319
Taken: 3/20/15 11:03 AM
Taken by: Letiri
Cust PO:
SalesPerson: THOMRO
Claim #:
2 COPPER LINESETS
2 ELEC DISCONNECTS
LEAD#
Call Info
Job Info
Call No.:
239693 Booked by: Letiri
Job No.: 239693
Type:
GASAC Booked Date: 3/26/1.5
Class: Install/Replace
Scheduled:
3/26/15 8:OOAM Sched by: Letiri
Type: GASAC
Pri Level:
5
Src Typ
Eq Age:
Source
Src Ref
Contact:
Contract #:
Equipment:
Job NO: 2 396,93
Rating:
408-446-2319
Taken: 3/20/15 11:03 AM
Taken by: Letiri
Cust PO:
SalesPerson: THOMRO
Claim #:
CUPERTINO
Owner Name
WATER -CONSERVING PLUMBING FIXTURES
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
L P_P1C1_ H M f dG 7- &S_rM J Permit No.
Please ref n.. eattached
.
- } _ - refer to the atsttac
hed California Civil Code Sections 1101.1-1101.8 which"are partof this Certification form.. _
1. Is your real propertya registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.` Sign below and skip the rest of the form.
Owner' Signature: Date: e /oh_!S
,�5
No Go toQ uestion 2.
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Sign below and skip the rest of the form
Owner' Signature: Date:
,N—No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 01.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: Date:
No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 throu h 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: Date:
P4 Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached.
C" My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing
fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1,
2017, all non-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless
of whether property undergoes alterations or improvements).
❑ My property is a multifamily residential real property. See Civil Code Section1101.5. jp
On and after January 1, 2014, specified building alterations or improvements shall require -, j' - lin
plumbing fixtures to be replaced with water -conserving plumbing fixtures. �a
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with er
conserving plumbing fixtures throughout the building (regardless of whether property unde , a tions or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
SB407 2014. doe revised 03/18/14
r
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
1/We, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures have been replaced
with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current
California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and
that the water -conserving plumbing fixtures corpply wi, h the requirements as indicated in the table below.
Owner's (or Owner Agent's) Signature: Date:
Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit.
1. If the existing plumbing fixture water usage/tlow rate is equal to or lower than the figure shown, it is not requirea to be upgraoeu.
SB407 2014. doc revised 03118/14
Non—Compliant_
eater -Conserving Plumbing Fixture..
PlumbingFixture;
Fixture
(_ Complying with Current Code Applicable to New. -Construction)
Maximum Water Usage/Flow Rate
Fixture Type
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
Water Usage
2013 CALGreen Div. 4.3 ..
2013 CALGreen Div. 4.3
2013-CALGreen Div. 5.3
/Flow Rate
Single=Family
Multi -Family
Commercial
Residential
Residential
Water Closets
Exceed 1.6
Single flush toilets: 1.28 gallons/flush
(Toilets)
Gallons/flush
Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite,
average flush volume of two reduced flushes and one full flush
Urinals
Exceed 1.0
0.5 gallons/flush
Gallons/flush
Showerheads
Exceed 2.5
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per minute
U.S. EPA WaterSense Specification for Showerheads
(A hand-held shower is considered a showerhead.)
For multiple showerheads serving one shower, the combined flow rate of all
showerheads and/or other shower outlets controlled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
allow only one shower outlet to be in operation at a time.
Faucets —
Exceed 2.2 gallons
Maximum 1.5 gallons per
Within units:
0.5 gallons per minute @ 60
Lavatory
per minute
minute @ 60 psi; minimum
Maximum 1.5 gallons
psi
Faucets
0.8 gallons per minute @
per minute @ 60 psi;
20 psi
minimum 0.8 gallons
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
60 psi
Faucets —
Exceed 2.2 gallons
1.8 gallons per minute @
1.8 gallons per minute
1.8 gallons per minute @ 60
Kitchen
per minute
60 psi
@ 60 psi
psi
Faucets
May temporarily increase
May temporarily
up to 2.2 gallons per
increase up to 2.2
minute @ 60 psi, and must
gallons per minute @
default to maximum
60 psi, and must '
1.8 gallons per minute @
default to maximum
60 psi
1.8 gallons per minute
Where faucets meeting
@ 60 psi
the above are unavailable,
Where faucets meeting
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction.
other means may be
used to achieve
reduction.
1. If the existing plumbing fixture water usage/tlow rate is equal to or lower than the figure shown, it is not requirea to be upgraoeu.
SB407 2014. doc revised 03118/14
M
CERTIFICATE OF VERIFICATION
Z TCF3R-MCH-20-H
Space Conditioning System Identification or Name
Duct Leakage Diagnostic Test
(Page 1 of 3 )
Project Name: 21075 Manita Ct
Enforcement Agency: City of
Permit Number:
15030146
Single family
Cupertino
Verified Low Leakage Ducts in Conditioned Space
(VLLDCS) Credit from CF1R?
No, credit is not taken
Dwelling Address: 21075 Manita Ct
City: Cupertino
Zip Code:
95014
A. System Information
01
Space Conditioning System Identification or Name
3 Ton A/C Condenser & Coil
02
Space Conditioning System Location or Area Served
Downstairs
03
Building Type from CF -1R
Single 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 using smoke test
IVICH-20e - Sealing All Accessible Leaks using Smoke Test;
B. Duct Leakage Diagnostic Test
01
Condenser Nominal Cooling Capacity (ton)
2
02
Heating Capacity (kBtu/h)
0
03
Conditioned Floor Area served by this HVAC system (ft2)
1550
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)
651
Fil
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: 215-A0075988A-M2000003A-M20A Registration Date/Time: 2015-04-09 20:32:22 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-04-09 20:32:14
2013 Residential Compliance Schema Version: 0.5515DD
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
F12
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.cove red with Mastic and draw.bands.
06
All connection points.between;:the air`handler and'the supply and, return `plenums are completely sealed i -
If the system complies using the Smoke Test method, the smoke test was`conducted in accordance with the re_ quirements
07
of Reference,, Residential Appendix RA3 1.4:3 6 Systems that comply using smoke testshall not be included m sample
groups for HERS verification compliance.
08
Verification Status:
Pass - all applicable requirements are met
09
Correction Notes for this table:
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 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: 215-A0075988A-M2000003A-M20A Registration Date/Time: 2015-04-09 20:32:22 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-04-09 20:32:14
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:
Matthew Fincher
'11104*0Gf�G
Company:
Date Signed:
Mike Sumner
2015-04-09 20:32:22
Address:
CEA/ HERS Certification Identification (if applicable):
15360 Chateau Montelena
City/State/Zip:
Phone:
Bakersfield CA 93314
661-978-8089
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'(CF2R) signed and sulmifted:by the persons) responsible for the
conforms to the iequirements.spefied on the Certificate(s) of Compliance (CE1R) approved by the enforcement agency.
construction or installation a
5. 1 will ensure that a registered copy,;of this Certificate of.Verification'sfiall 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 . .
he documentation th`e builder'piovides`to the building owner at -occupancy.
Verification is'required to be'included with the -,
Builder Or Installer Information As Shown On`The'Certifcate Of Installation
Company Name (Installing Subcontractor, General Contractor, or Builder/Owner):
CALIFORNIA DELTA MECHANICAL INC
Responsible Builder or Installer Name:
CSLB License:
Alanna Frederick
811114
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:
Mike Sumner
Responsible Rater Name:
Responsible Rater Signature: �LC%N�P�
Matthew Fincher
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2006285
2015-04-09 20:32:22
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: 215-A0075988A-M2000003A-M20A Registration Date/Time: 2015-04-09 20:32:22 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-04-09 20:32:14
2013 Residential Compliance Schema Version: 0.551SDD
CERTIFICATE OF INSTALLATION
CF2R-MCH-20-H
Duct Leakage Diagnostic Test
(Page 1 of 3 )
Project Name: 21075 Manita Ct
Enforcement Agency:
Cupertino
City of
Permit Number: 15030146
Dwelling Address: 21075 Manita Ct
City:
Cupertino
Zip Code: 95014
A. System Information
01
Space Conditioning System Identification or Name
3 Ton A/C Condenser & Coil
02
Space Conditioning System Location or Area Served
Downstairs
03
Building Type from CF -111
Single family
04
Verified Low Leakage Ducts in Conditioned Space
(VLLDCS) Credit from CF:,1R?
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 using smoke test
MCH -20e - Sealing All Accessible* Leaks using Smoke
B. Duct LeakageDiagnostic Test�0 i<<; ,
01
Condenser Nominal Cooling Capacity (ton)
2
02
Heating Capacity (kBtu/h)
0
03
Conditioned Floor Area served by this HVAC system (ft2)
1550
04
Duct Leakage Test Condition
Test final
05
Duct Leakage Test Method
Total leakage
06
Leakage Factor
0.15
Air Handling Unit Airflow (AHUAirflow) Determination
Cooling system method
07
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
651
(cfm)
Compliance Statement: System passes using smoke test of an altered HVAC system in an existing building. No visible smoke
11
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: 215-A0075988A-M2000003A-0000 Registration Date/Time: 2015-04-10 10:06:56 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-04-09 20:31:20
2013 Residential Compliance Schema Version: 0.51SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-20-H
Duct Leakage Diagnostic Test (Page 2 of 3 )
B. Duct Leakage Diagnostic Test
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
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'conductetl in accordance with the requirements of
07
Reference Residential AppendikRA3 143.6. Systems that domplyusing smoke'test`shall-notf- be;included in sample.groups
'
i.,
for HERS verification compliance:
} r }
The responsible persons signature on this compliance' document affirms that all applicable requirements in this table have
been met.
Registration Number: 215-A0075988A-M2000003A-0000 Registration Date/Time: 2015-04-10 10:06:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-04-09 20:31:20
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:
�i —/
Documentation Author Signature: Ajr e'!/T6110w �
�/(
Matthew Fincher
Company:
Signature Date: 2015-04-09 20:31:09
Mike Sumner
Address:
CEA/ HERS Certification Identification (if applicable):
15360 Chateau Montelena
City/State/Zip:
Phone:
Bakersfield CA 93314
1661-978-8089
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, materialsi components or manufactured devices (the installation) identified on this Certificate of Installation
conforms to ail 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 rafer will check the installation to'.venfy compliance and that if'such checking identifies defects 1 am required to take'
corrective action at, my expense.;,,! understand'that Energy Commission and HERS Provider representatives will also perform quality assurance checking
of installations, including those approved as paft-of a sa'mple'group 6ut.notchecked.1y a HERS:rater and if:those installations fail to meefthe
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 A my expense '
5. 1 reviewed a copy of,the Certificate of Compliance approved by the5enforcement 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 Signature:
Alanna Frederick
Company Name: (Installing Subcontractor or General Contractor or
Position With Company (Title):
Builder/owner)
Office staff
CALIFORNIA DELTA MECHANICAL INC
Address:
CSLB License:
1235 GRAND AVE
811114
City/State/Zip:
Phone:
Date Signed:
SPRING VALLEY CA 91977
(480) 898-0007
2015-04-10 10:06:56
Third Party Quality Control Program (TPQCP) Status:
Name of TPQCP (if applicable):
Digitallysigned by CalCERTS. 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: 215-A0075988A-M2000003A-0000 Registration Date/Time: 2015-04-10 10:06:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-04-09 20:31:20
2013 Residential Compliance Schema Version: 0.51SDD
CERTIFICATE OF INSTALLATION
CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans
(Page 1 of 8 )
Project Name: 21075 Manita Ct
Enforcement Agency: City of Cupertino
Permit Number:
15030146
Dwelling Address: 21075 Manita Ct
City: Cupertino
Zip Code:
95014
A. General Information
01
Dwelling Unit Name
21075 Manita Ct
02
Climate Zone
4
06
01
08"`
09
Number of space conditioning (SC)
03
Dwelling Unit Conditioned Floor Area
2900
04
systems being altered in this dwelling
2
Installing
(ft2)
SC System
unit.
by this SC
05
;4
Certificate of Compliance Type .'
',:Prescriptive alterations (CF1R-ALT)
06
Method used to calculate HVAC loads
NotApplicableEquipmentChangeout
07
Calculated dwelling unit Sensible
`T[is field or section is not applicable
08
Calculated Dwelling Unit Heating toad
This field or section is not applicable
system
Cooling Load (Btuh)
new duct
entirely new
(Btuh)
Name
Served
(ft2)
a
component?
components?
ducts?
Y F rt
+'
MCH -01b Prescriptive Alterations Space Conditioning Systems.Ducts and Fans r 3 s
r
Y, ... Yam 3 `' �-...
B. Space Conditioning (SC) System` Information
01
02
03
04
—05
06
01
08"`
09
10
CFA served
Is the SC
Installing a
Installing
SC System
SC System
by this SC
system a
refrigerant
Installing new SC
Installing more
entirely
Installing
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?
SC system?
Alteration Type
2.5 Ton A/C
Altered space
Condenser & Coil
Upstairs
1350
Yes
Yes
Yes
No
No
No
conditioning
And Furnace
system
Altered space
3 Ton A/C
Downstairs
1550
Yes
Yes
Yes
No
No
No
conditioning
Condenser & Coil
system
Registration Number: 215-A0075988A-M0100002A-0000
Registration Date/Time:
2015-04-10 10:06:23
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-04-09 20:30:36
Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 2 of 8 )
C. Space Conditioning (SC) System Alterations Compliance Information
01
02
03
04
05
06
07
08
09
10
11
12
13
Rated Heating Capacity,
Name
Heating Efficiency Type
Value
Manufacturer
Model Number
number
Output (BTUH)
2.5 Ton A/C Condenser &
AFUE
0.8
Lennox
Central Fan
5915B01954
70000
Coil And Furnace
B-01
Integrated
Heating
Cooling
New or
(CFI)
System
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
Replaced
New
Ventilation
identification
Heating
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Duct
Duct
System
or Name
System Type
Component
Type
Value
System Type
Component
Type
Value
Type
Length
R -Value
Status
This
field
2.5 Ton A/C
All new
All new
N/A - no
or
Condenser &
Central gas
heatingCentral
;,AFUE
0.8
cooling
SEER
15
Setback
ducts
sectio
Not a CFI
Coil And
furnace
componen"
.`
split AC
components
replaced
n is
system
Furnace
- - -•ts
__,._
not
applic
able
i
k`:F
f`
r
This
This field
-
field
3 Ton A/C
'j
No heating
or .4
This field,
'
All
N/A - no
or
Condenser &
Central gas
componen
section is-,:
or section
k.Centralti
cooling
SEER}
13
Sei6kk
ducts
sectio
Not a CFI
Coil
furnace
t altered
not
is not
split AC
components
replaced
n is
system
applicabl
applicable
not
e
applic
able
D. Installed Heating Equipment information
01
02
03
04
05
06
07
System Identification or
Heating Efficiency
Heating Unit
Heating Unit
Heating Unit serial
Rated Heating Capacity,
Name
Heating Efficiency Type
Value
Manufacturer
Model Number
number
Output (BTUH)
2.5 Ton A/C Condenser &
AFUE
0.8
Lennox
EL180UH070XE36
5915B01954
70000
Coil And Furnace
B-01
Registration Number: 215-A007599SA-M0100002A-0000
Registration Date/Time:
2015-04-10 10:06:23
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-04-09 20:30:36
Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION CFZR-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 3 of 8 )
D. Installed Heating Equipment information
01
02
03
04
05
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)
Notes:
E. Installed Cooling Equipment information:
01
02 03
04 05
06
07
08
Condenser or Package Unit
f
Condenser or
Condenser or
Condenser or
System Rated Cooling
Condenser Rated
System Identification
Cooling Efficiency
';'Coaling Efficiency
Package Unit
Package Unit
Package Unit
Capacity at Design
Nominal Capacity
or Name
= :,Type --
-s--= -Value-' _.-,_
-_Manufacturer
Model Number
Serial Number
Conditions (BTUH)
(ton)
2.5 Ton A/C Condenser
-{
i ' ,'
14acx 030-230-:
SEERLennox°
p
1915C03004
30000:2.5
& Coil And Furnaces
f
16
3 Ton A/C Condenser &
f
;,
4
13acxb24 230
SEER.
13
Lennox
1914k53441
24000
2
Coil
20
#
V
Notes:
F. Extension of Existing Duct System, Greater Than 40 Feet
This section does not apply to this project.
G. Installed Duct System information
This section does not apply to this project.
Registration Number: 215-A0075988A-M0100002A-0000 Registration Date/Time: 2016-04-1010:06:23 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-04-09 20:30:36
Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 4 of 8 )
H. Installed Air Filter Device Information
This section does not apply to this project.
1. Air Filter Device Requirements
This section does not apply to this project.
lY
j4
N
Registration Number: 215-A0075988A-M0100002A-0000
Registration Date/Time: 2015-04-10 10:06:23
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-04-09 20:30:36
Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 5 of 8 )
J. HERS Verification Requirements
01
02
03
04
05
06
07
08
09
10
MCH20
MCH21
MCH22
MCH23
MCH2S
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
(!N per
Rate (cfm
Refrigerant
Return Duct Design
Name
Served
Requirements
Test
Space
Verification
dm)
per ton)
Charge
Table 150.0-C or D
2.5 Ton A/C
No
Not
Condenser & Coil
Upstairs
;'
r exemptions_—
Yes
applicable
No
No
No
No
No
And Furnace
_ ,
3 Ton A/C
Downstairs
NoY I
Yes.
Not>'
-
No
No
No
No
No
Condenser & Coil
exemptions
applicableF,
t
4
Registration Number: 215-A0075988A-M0100002A-0000 Registration Date/Time: 2015-04-10 10:06:23 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-04-09 20:30:36
Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION CFZR-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 6 of 8 )
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).
Furnace Temperature Ri§e._Central foi-ced-air heating -,furnace installations must be configured to operate at or below the furnace manufacturer's maximum
04
inlet -to -outlet temperaturerise-specification. See Sectio.0-150A(hA.
05
Standby Losses and Pilot Lights: Fan ,type central furnaces may not -have a continuously burning'pilot fight Section 110 5`and Section 130.2(d).
q t i
Cooling Equipment
.....2
t
Equipment Efficiency: All cooling_ equipment must`meet the mitnimum effd. entY�_'e- e uiremk., ents`of'-Section116..11 and section 11v0 a sC,aan+
d 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.
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
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: 215-A0075988A-M0100002A-0000
Registration Date/Time
2015-04-10 10:06:23
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-04-09 20:30:36
Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION CFZR-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 7 of 8 )
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 accord' ance with the manufacturers published installation specifications
14
First stage of heating shall be assigned to heat pump heating.
1s
Second stage back up heating shall be set to come on -only when the indoor set temperature cannot be met
The responsible person signature on this compliancedocument affirms that all applicableArequirements m this table have been met:+ r
Registration Number: 215-A0075988A-M0100002A-0000
Z KJ. - s....i1 4"a
Registration Date/Time: 2015-04-10 10:06:23
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-04-09 20:30:36
Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 8 of 8
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
AA?22 F"CfL
Fincher, Matthew
.ii W
Company:
Signature Date:
Mike Sumner
2015-04-09 20:33:21
Address:
CEA/ HERS Certification Identification (if applicable):
15360 Chateau Montelena
City/State/Zip:
Phone:
1661-978-8089
Bakersfield CA 93314
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 applicabWdassification to accept responsibility for the system design, construction, or installation of features, materials,
components, or manufactured devices for the scope of work 1dei@f6 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 i b ;
3. The constructed or installed features, materials,.components or mariufacturefidewces (the installation) identified obi chis Certificate of Installation°conforms to all applicable codes and regulations, and the
installation conforms to the requirements given on the plans and specifications approved b'y the enforcement agency. i; F a
Y
4. 1 reviewed a copy of the Certificate of Compliance approved by the`'enforcement agency that jdentifies the specific requirements for the scope ofconst[uction 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 Instillation shall�Q posted orT' e available with'the bwldmg per R. -W issued for the building and made available to the enforcement agency for all
applicable inspections. I understand that a registered copy df 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:
�G�i%?/%2CG
Frederick, Alanna
C1' 2E��/?2Li�fi
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Position With Company (Title):
CALIFORNIA DELTA MECHANICAL INC
Office staff
Address:
CSLB License:
1235 GRAND AVE
811114
City/State/Zip:
Phone:
Date Signed:
SPRING VALLEY CA 91977
(480) 898-0007
12015-04-10 10:06:23
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: 215-A0075988A-M0100002A-0000 Registration Date/Time: 2015-04-10 10:06:23 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-04-09 20:30:36
Schema Version: 0.555SDD