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15070213CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10744 BROOKWELL DR CONTRACTOR: VALLEY HEATING & PERMIT NO: 15070213 COOLING OWNER'S NAME: YANG XIANGYING ET AL 1171 N 4TH ST DATE ISSUED: 07/29/2015 OWNER'S PHONE: 4088961790 SAN JOSE, CA 95112 PHONE NO: (408)294-6290 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ®'a License Class Ca O Lic. # �j ADD (1) A/C UNIT IN SIDE YARD AREA 2IContractor �f_ Date =2- Ihereby 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 Sq. Ft Floor Area: Valuation: $8606 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 APN Number: 36921039.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating 80 P A�iCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree, to save 18 FROM LAS CTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ZX S__ � Z5 granting of this permit. Additionally, the applicant understands and will comply Issued by: ate: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. �� 2 7G/jam RE -ROOFS: Signature Date 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25595, 25533 and 25534. % ��" Section 3700 of the Labor Code, for the performance of the work for which this Owner l/%'% C Date: //�I permit is issued. or authorized agent: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date .................._.......... _ GENERAL PERMIT APPLICATION MEV COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION • CUPERTINO, CA 95014-3255 10300 TORRE AVENUE (408) 777-3228 • FAX (408) 777-3333 • buildina(5cuoertino.oro CUPERTINO / Z ❑ M ❑ PLUmBING ECHANICAL ❑ ELECTRICAL (❑ MISCELLANEOUS PROJECT ADDRESS (C-7yOJ o Pj OWI rRNA1JEUn I (AA PH � � (� /�� D EMAIL (� STREET ADDRESS 1 , r� r CITY, STATE, ZIP &-'*D FAX CONY TACT NAME u ` r - /� PHONE t � E MAIL � r w e �U C C1 ( 0 7 (� P17' STREET ADDRESS 1 '� I �(^jt CITY, STATE, ZIP C n � FAX ❑ OMN7ER 13ONR.iER•BMZER ❑ OWNER AGENT �COA'TRACTOR 13CON CONTRACTOR AGENT 11ARCHITECJT( ❑ ENOWEER ❑ DEVELOPER ❑ TENANTT CONTRACTOR N.AAfE 1 �1 1 ,C ! )r LICENSE NIJI 3ER (/�/� EJa LIC .SE TYPE �^ v J o� BUS. LIC r COMPANY N.A VM E-MAIL C /pV �I ��� fU�SvpL ���-l� FAX STREET ADDRESS I %j J CITY, STATE, ZIP /J / PHONE U ! (O ARMTECTIENGINEER NAME LICENSE NUMBER BUS. LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI-FAKLY . . PROJECT IN WIIDLAND ❑ YES PROJECT IN ❑ YES BUTLDNO: ❑ COMMERCIAL I URBAJN INTERFACE AREA ❑ IQO FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICI=HOME? ❑ NO 13 Tt" DESCRIPTION OF WORK AA /G /1/ TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner o orized o act o property owner's ave read this application and the infonnation I have provided is correct I have read the Description of Work and verify it is a o comply with all applicable local ordinances and state laws relating to buiM%Vonstruction. I authorize representatives of Cupertino to enter the above-identifi d for inspection purposes. Signature ofA.pplicant/Agent: / Date: 7/?, 7GG[ 7eriy SUPPLEhIENTAL INTFORMATION REQUIRED iS MEPMiSCAPP_2011.doc remised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10744 BROOKWELL DR DATE: 07/29/2015 REVIEWED BY: MELISSA UNITS APN: 369 21 039 BP#: `VALUATION: 1$8,606 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/AC PERMIT TYPE: 19 WORK ADD N A/C UNIT IN SIDE YARD AREA SCOPE S�xppl. Insp Pee APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check QTY UNITS BP FEES Gl<;�r. Perrnit Fee. A/C Units (<=10K cfm) 1 BREMAIR )cher Elec. Insp Li 1 # $72 Permit Fee: S�xppl. Insp Pee PME Unit Fee: $72.00 PME Permit Fee: $48.00 C.'onstruelion Tax. Administrative Fee: 1ADMIN $45.00 Work Without Permit? © Yes (D No $0.00 TOTALS: A Travel Documentation Fee: ITRA VDOC $72.00 Strom Motion Fee: 1BSEISMICR NOTE: Mech. Plan Check 0.p hrs $0.00 Plumb. Plan Check /:Jec. flan Check Mech. Permit Fee: 1 MPERMIT Plumb, Per+.W ? �.; Gl<;�r. Perrnit Fee. Other Mech. Insp.0.0 hrs $48.00 Other Plurnb lisp.Li )cher Elec. Insp Li h i vC . 1 Plumb. Insp. Fee: l:iec. Insp. Fee.- ee: 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 based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E( 7/U731 FEE QTY/FEE MISC ITEMS Plan (-'heck Pee: Snppl. I'C' fiee PME Plan Check: $0.00 Permit Fee: S�xppl. Insp Pee PME Unit Fee: $72.00 PME Permit Fee: $48.00 C.'onstruelion Tax. Administrative Fee: 1ADMIN $45.00 Work Without Permit? © Yes (D No $0.00 .4dwinced Planning Fees: A Travel Documentation Fee: ITRA VDOC $48.00 Strom Motion Fee: 1BSEISMICR $1.12 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $215.12 $0.00 TOTAL FEE: $215.12 Revised: 07/02/2015 CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) CF1R-ALT-02-E (Page 1 of 3 ) Project Name: 2015- 0028 Xianying Yang I Date Prepared: 2015-07-16 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 2015- 0028 Xianying Yang 02 Date Prepared 2015-07-16 03 Project Location 10744 Brookwell Drive 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2015- 0028 Xianying Yang 07 Zip Code 95014 08 Dwelling Unit Conditioned 1540 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 O1 02 03 04 05 06 07 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 Add A/C whole house 1540 Yes Yes Yes No No No Altered space 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: 215-A0196204A-000000000-0000 Registration Date/Time 2015-07-16 16:40:03 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-16 16:40:24 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 3 D. Altered Space Conditioning System (Sections 150.2(b)lE and F) 01 02 03 04 05 06 07 08 09 10 11 12 Heating Cooling System Heating Altered Heating Minimum Altered Cooling Minimum Required New or Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct or Name Type Components Type Value System Type Components Type Value Type Duct Length R -Value Central gas No heating This field or This field or Central split All new This field or This field or Add A/C furnace component section is not section is not AC cooling SEER 14 Setback section is not section is not altered applicable applicable components applicable applicable Reauired Documentation: CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums: R6. CF2R-MCH-20-H & CF311-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 <_ 10% leakage to outside, or seal all accessible leaks. CF2R-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 require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25. -Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements. E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)IE, F) This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) This section does not apply to this project. Registration Number: 215-A0196204A-000000000-0000 Registration Date/Time: 2015-07-16 16:40:03 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-16 16:40:24 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: 6• �_ Q� / ga—tGi'./4/%�J7i Faulkner, Cindy zd l� `vim Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2015-07-16 16:40:03 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, 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 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 enforcementagency for approval with this building permit application. 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be 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 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 2015-07-16 16:40:03 Address: License: 1171 NORTH 4TH STREET 258540 City/State/Zip: Phone: SAN JOSE CA 95112 (408) 294-6290 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-A0196204A-000000000-0000 Registration Date/Time: 2015-07-16 16:40:03 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-16 16:40:24 Schema Version: 0.555SDD 2is CUPERTINO SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • b0dinQi 4iSt.�91�` j CUPERTINO Owner Name i G Address Ill 7 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE FILE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION �13 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (_408) 777-3228 • FAX (408) 777-3333 • building(cDcuoertino.org�!90��3 � ( 04\ of Vf"V► e _Permit No. PERIIT CA1tNOT BE FINALED AND COMPLETED UTWIL TINS CERTIFICATE HAS BEE CI T�- I AND RE;TITRNI ED'TO THE BUILDING DIVISION Please refer to the attached California Civil Code Sections 1101.1-1101.8 which are part of this Certification form. 1. Is your real property a 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: No Go to Question 2. r 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: OS/1 3 / 20 is ® No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date: 19 No Go to Question 4. �g� 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 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date: 06/1 ® 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. * 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 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-conseiving plumbing fixtures. 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). ❑ 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. SB40 7 2 015. doc revised 02104/15 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). nVe, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 110 1. 1 through 1101.8, the current California Plumbing Code,and California Green Building Standards Code, and manufacturer's installation requirements, and that the water-consii�v' plumbing fixtures comply with the requirements as indicated in the table below. Owner's (or Owner Agent's) Signatures\ ,X12 Date: Oct/13/7-0I 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/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB4072015.doc revised 02/04/15 Non -Compliant Water -Conserving Plumbing Fixture PlumbingFixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 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/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB4072015.doc revised 02/04/15 1 r,-k"L A LZ CERTIFICATE OF VERIFICATION -1 CF3R-MCH-20-H Duct Leakage Diagnostic Test (Pa 3 Project Name: 20 - 0028 3(t nyj g Yang Enforcement Agency: City of upertino Permit Number: 15070213 Dwelling Address 10744 Brookwell Drive ty: Cupertino Zip Code: 014 A. System Inform tion 01 Space Conditioning System Identification or Name Add A/C 02 Space Conditioning System Location or Area Served whole house 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 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) 3 02 Heating Capacity (kBtu/h) 54 03 Conditioned Floor Area served by this HVAC system (ft2) 1540 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) 180 10 Actual duct leakage rate from leakage test measurement (cfm) 124 11 Compliance Statement: System passes leakage test 12 Notes: Registration Number: 215-A0196204A-M2000002A-M20A Registration Date/Time: 2015-08-10 11:50:55 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-08-10 11:50:04 2013 Residential Compliance Schema Version: 0.51SDD 1 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 this table: The responsible persons signature on this compliance document affirms that all applicable requirementsin 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. 01 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: 215-A0196204A-M2000002A-M20A Registration Date/Time: 2015-08-10 11:50:55 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-08-10 11:50:04 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: �PJfiflCL1 Louis Fernandez Company: Date Signed: Elements - E3 2015-08-10 11:50:55 Address: CEA/ HERS Certification Identification (if applicable): 1718 Creek Drive 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 (CF2R) signed and submitted by the person(s) responsible for the construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (CF1R) approved by the enforcement agency. 5. 1 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 Responsible Rater Name: Responsible Rater Signature: Q T` �PJLlI Louis Fernandez e.Qi� Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006519 2015-08-10 11:50:55 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-A0196204A-M2000002A-M20A Registration Date/Time: 2015-08-10 11:50:55 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-08-10 11:50:04 2013 Residential Compliance Schema Version: 0.51SDD