15100149I CITY OF CUPERTINO BUILDING PERMIT I
IBUILDING ADDRESS: 19780 DRAKE DR I CONDITIONING AAA FURNACE & AIR I PERMIT NO: 15100149 I
OWNER'S NAME: SINHA SANTANU AND SUDIPTA 11712 STONE AVE ' DATE ISSUED: 10/22/2015
OWNER'S PHONE: 4088882435 SAN JOSE, CA 95125 1 PHONE NO: (408)293-4717
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
! 3/ Q Q y REPLACE A/C UNIT, SAME LOCATION; REMOVE (E)
License Class (. q C-9bLic. # -7 (o O ✓ I ( FURNACE IN CLOSET AND INSTALL IN ATTIC SPACE (WILL
L MEET ALL 2013 CA BLDG CODES FOR CLEARANCES,
Contractor 1 l� (�1�G' Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations: Sq. Ft Floor Area: Valuation: $12120
1. 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. APN Number: 31632012.00 Occupancy Type:
2. I have and will maintain Worker's Compensation Insurance, as provided for by
') tion 3700 of the Labor Code, for the performance of the work for which this
it 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, judgmen s/
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 sou K cegul ions per a Cupert. o Municipal Code, Section 9.18.
Signature Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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)
2. 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:
1. 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.
2. 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.
3. I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature
Date
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DA GtL CALLED INSPECTION.
ie Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of 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 25505, 25533, and 25534.
O n ora horized nt:,a:h
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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
�— GENERAL PERMIT APPLICATION
COC`41`0UNI TY DEVELOPI,JENT DEPARTMiiENT - BUILDING DIVISION
10300 T ORRE AVENUE - CUPERTINO, CA 05014-3255
408) 777-3228 - FAX (408) 777-3333 - buildina�cuoertino.org
CUPERTINQ
I I P .UvLLB IN G '
PROJSCT ADDRESS 0 D ^�
0WNER NAME �
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STREET -DDR SS
CONTACT ;\.4U,E
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L-1 ELEC=C— U,vfiISCELLANEEUliS
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CONTP.ACTOR N. ]dRa AAjk I ) A I LICE.I�SE ?�Zfi LICiTSE nP£ n BQUS. LIC #.
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LICEINSb NUMBER � --- I BUS. LIC
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DESCRITTION
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TOTAL VALUATION: 1 l I ? RECFIZ
By my signatu e below, I certify to each of the following. I am the property owner or authorized as Lo act on the property ow a f. I h- e read this a
application and the i-Tifonmation I have provided is correct. I have read the Description of Work and ver -Ly it is accurate. I agree t ompl all applicable local
ordinances and state laws relating to
ild.Fg CIO
tructio . ' authorize resentLtives of Cupertino to enter the above-iden'lEe el L for inspection purposes.
Signature of.Applicant/Agent:�' �--- Date: -1 r 1
SUr'PLEMENTAL L'�TFORvIATICN REQU+RSD
MFPMSC-4pp-2011. doc revised 0612.7/11
PHONE l O �•�QC/ � r � q `1 !rm
CITYT,AiT:;;,�J,� �� j
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CONTP.ACTOR N. ]dRa AAjk I ) A I LICE.I�SE ?�Zfi LICiTSE nP£ n BQUS. LIC #.
CON,P.41 N NkJVIE E-M:S.II. I FAX D�
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STRZET ADDRESS , ^ kp � l I CITY, STATE, ZIP G _ � � � �� � �� I PI-iO�:F. -
LICEINSb NUMBER � --- I BUS. LIC
C01\42ANY N:N ( E-IvLAiL I FAX - -
S?Ri=E'I' ADUF-i'.SS ..----. - � CITY, STATE, 7I:p—..----- P-1---� �---------•-•—
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USE DF ❑ SFL'i nr Dup= 0 MLiLTI-F!J,<� Y I PRC�=EC:T N WILDL Ate: D ❑ t ':-S FRO.itCT LN ❑ Y cS IS Tris BLDG AN ❑ "rS
BU 11\10: ❑ COI✓Q=- CLS -T' I UM3.=2'.' INTEr FACE ARt,P. ❑ NC , FLOOD ZOI B ❑ No I EICLLER HOME? ❑ 1:0
DESCRITTION
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TOTAL VALUATION: 1 l I ? RECFIZ
By my signatu e below, I certify to each of the following. I am the property owner or authorized as Lo act on the property ow a f. I h- e read this a
application and the i-Tifonmation I have provided is correct. I have read the Description of Work and ver -Ly it is accurate. I agree t ompl all applicable local
ordinances and state laws relating to
ild.Fg CIO
tructio . ' authorize resentLtives of Cupertino to enter the above-iden'lEe el L for inspection purposes.
Signature of.Applicant/Agent:�' �--- Date: -1 r 1
SUr'PLEMENTAL L'�TFORvIATICN REQU+RSD
MFPMSC-4pp-2011. doc revised 0612.7/11
CITY OF CUPERTINO 151 CO)
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 19780 Drake Dr DATE: 10/19/2015 REVIEWED BY: PAUL
APN: 316 32 012 1 BP#: I *VALUATION: 1$12,120
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK Replace A/C Unit Same Location; Remove E furnace in Closet and Install in Attic Space
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
1'hwib. Pian Check
QTY
UNITS
BP FEES
l tec. Permit Fee:
A/C Units (<=10K cfm)
1 BREMAIR
' ether Elec. Imp.
1
#
$72
Furnace, Forced -Air
1MFR=<100
>S'uppl. Insp F'ee
1
#
$143
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
(.Ions'lruc ion Tax:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? Yes (F) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
1 $215.00
Strong Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, /Fire, Sanitary Sewer District, School
Mcirh-f oh- ) Thoco fooc nro hncod nn tho nrolimimyry irnfnrmatinn availah1P and nro nnhy an octimato_ fnntart tho Dont fnr addn'l infn_
FEE ITEMS (Fee Resolution I1-053 Elf 7/l/]:D
Mech. Plan Check 0.0 hrs $0.00
1'hwib. Pian Check
I'la a Check
Mech. Permit Fee: IMPERMIT
Fhimb, I'eriiit Fee.,
l tec. Permit Fee:
Other Mech. Insp. 0.0 hrs $48.00
Other Plurnh b- p.
' ether Elec. Imp.
11ech. Imp. Fee,
I'himh. Insp. Fee:
t lec. Insp. ]Fee.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, /Fire, Sanitary Sewer District, School
Mcirh-f oh- ) Thoco fooc nro hncod nn tho nrolimimyry irnfnrmatinn availah1P and nro nnhy an octimato_ fnntart tho Dont fnr addn'l infn_
FEE ITEMS (Fee Resolution I1-053 Elf 7/l/]:D
FEE
QTY/FEE
MISC ITEMS
Pkin Check Fee:
.S'llppl. P(' Hee
F71
PME Plan Check:
$0.00
Permit Fee:
>S'uppl. Insp F'ee
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
(.Ions'lruc ion Tax:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? Yes (F) No
$0.00
:4dvcmced Planning fi ees:
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$1.58
Select an Administrative Item
Bldg; Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$358.58
$0.00 TOTAL FEE:
$358.58
Revised: 10/01/2015
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
SUDIPT SINHA I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3 )
2015-10-21
A. General Information
CHR -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
SUDIPT SINHA
02
Date Prepared
2015-10-21
03
Project Location
19780 DRAKE DRIVE
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
SUDIPT SINHA
07
Zip Code
95014
08
Dwelling Unit Conditioned
2284
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
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
TRANE
WHOLE HOUSE
2284
Yes
Yes
Yes
No
No
No
Altered spaceconditioning
system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 215-A6365761A-000000000-0000
Registration Date/Time
2015-10-21 14:28:12
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-21 14:28:09
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)IE and F)
O1
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
No cooling
This field or
This field or
Less than or
TRANE
furnace
component
section is not
section is not
AC
component
section is not
section is not
Setback
equal to 40
R-6
altered
applicable
applicable
altered
applicable
applicable
feet
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 < 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 >_ 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)1E, 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-A6365761A-000000000-0000
Registration Date/Time
2015-10-21 14:28:12
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-21 14:28:09
Schema Version: 0.55SSDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -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: E
Rando, Eric
Company:
Signature Date:
RANDO AAA HVAC INC
2015-10-21 14:28:12
Address:
CEA/ HERS Certification Identification (if applicable):
1712 STONE AVENUE
N/A
City/State/Zip:
Phone:
SAN JOSE CA 95125
408-293-4717
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 enforcement agency for approval with this building permit application.
S. I 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:
Ra n d o, Eric
Company:
Date Signed:
RANDO AAA HVAC INC
2015-10-21 14:28:12
Address:
License:
1712 STONE AVENUE
768871
City/State/Zip:
Phone:
SAN JOSE CA 95125
408-293-4717
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-A6365761A-000000000-0000 Registration Date/Time: 2015-10-21 14:28:12 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-21 14:28:09
Schema Version: 0.SS5SDD
FILE
Po-is 716
CERTIFICATE OF VERIFICATION
CF3R-MCH-20-H
Duct Leakage Diagnostic Test
(Page 1 of 3 )
Project Name: SUDIPT SINHA
Enforcement Agency: .' City of
Cupertino
Permit Number:
15100149
Dwelling Address: 19780 DRAKE DRIVE
City: Cupertino
Zip Code:
95014
A. System Information
01
Space Conditioning System Identification or Name
TRANE
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
1 Duct System Compliance Category
Alteration
MCH -20d -Complete Replacement or Altered Duct ;System.
B. Duct Leakage Diagnostic Test - -
01
Condenser Nominal Cooling Capacity (ton)
4
02
Heating Capacity (kBtu/h)
80
03
Conditioned Floor Area served by this HVAC system (ft2)
2284
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
Heating system method
08
Measured AHUAirflow
This field or section is not applicable
09
Calculated Target Allowable Duct Leakage Rate (cfm)
260
10
Actual duct leakage rate from leakage test measurement
(cfm)
223
11
Compliance Statement: System passes leakage test
Registration Number: 215-A6365761A-M2000002A-M20A Registration Date/Time: 2015-10-22 13:06:59 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-10-22 13:06:19
2013 Residential Compliance Schema Version: 2013.1.006
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 2 of 3 )
B. Duct Leakage Diagnostic Test
12 Notes:
C. Additional Requirements for Compliance
01
System was tested in its normal operation condition. No temporary taping allowed.
Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage
02
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
If a complete replacement, 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 handier and the supply and return plenums are completely sealed.
If the system complies using the SmokeTest method, thesmoke test was conducted in accordance with the requirements
07
of Reference Residential AppeYn,dix RA1.4.3.6 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
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
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 Complies: All specified verification protocol requirements on this document are met.
Registration Number: 215-A6365761A-M2000002A-M20A Registration Date/Time: 2015-10-22 13:06:59 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-10-22 13:06:19
2013 Residential Compliance Schema Version: 2013.1.006
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:
Ken Frazier
Documentation Author Signature: r7
Xen
c7razier
Company:
Date Signed:
Golden State Energy Efficiency Services
2015-10-22 13:06:59
Address:
CEA/ HERS Certification Identification (if applicable):
1463 Circus Ct.
City/State/Zip:
Phone:
Turlock CA 95380
209-667-2164
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.ofthe Certificate(s) &-Installation (CF2R)'signed and submitted by the person(s) responsible for the
construction or installation conforms to the requIrementsspecified on the CegIficate(s)=of Compliance (CF1R), approved bythe 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 thesenforcement.agency for'all applicable inspections. I'understanclthat a registered: copy of this Certificate of
Verification is required to be'inclu'ded with the documentation the builde`r'provides to the building owner at occupancy.
Builder Or Installer Information As Shown On'The Certifitate'Of Installation `
Company Name (Installing Subcontractor, General Contractor, or Builder/Owner):
RANDO AAA HVAC INC
Responsible Builder or Installer Name:
CSLB License:
Eric Rando
768871
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:
Golden State Energy Efficiency Services
Responsible Rater Name:
Ken Frazier
Responsible Rater Signature: �-
LX
LXen cTrazier
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2005910
2015-10-22 13:06:59
Digitally signed byCa/CERTS. This digital signature is provided in order to secure the content of this registered document and in no way implies Registration Provider
responsibility for the accuracy of the information.
Registration Number: 215-A6365761A-M2000002A-M20A Registration Date/Time: 2015-10-22 13:06:59 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-10-22 13:06:19
2013 Residential Compliance Schema Version: 2013.1.006