15110080E
r1q
5'
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS '% 8416NNA LN'
CONTRACTOR: CALIFORNIA DELTA PERMIT NO: 15110080
MECHANICAL INC
OWN . ERIS M :1 C"HERUVU'S'LTRYANARAYANA M AND V1
6056 E BASELINE RD STE 155 DATE ISSUED: 11/12/2015
OWNER'S PHONE: ,4082538642
MESA, AZ 85206 PHONE NO: (866) 692-5273
LiCENSib'CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
A..
bicefise'CIass',t-I-`;.
REMOVE AND REPLACE FURNACE.
Lic
Contractor` z�ZI12
thatTAtfiJkensed under the provisions of Chapter 9
(cominFncing'*itbS6ctibn 7000) of Division 3 of the Business & Professions
Codelanq' ' J:ihii' yjicefise;isln full force and effect.
N.
I here Affirm,'undet Oenalt f
.y.o perjury one of the following two declarations:
I have and will maintain ircertifi6atelo' f -consent to self -insure for Worker's
C mpe 1. .., tion,09*6yided 46r by Section 3700 ofthe Labor Code, for the
o ' nsa
perf6nnance of work:f6r Whi6h'ihispermit is issued.
Sq. Ft Floor Area:
Valuation: $4659
4.7ave 'And`will;m.au'iiin'W6ilrer's Compensation Insurance, as provided for by
Sectioii3700fo thb-Lib&Cb&;.fbi the performance of the work for which this
.
APN Number: 35919028.00
Occupancy Type:
permit is issu e
'I"'.APPLICANT CERTIFICATION
AV ppl ' ication and state that the above information is
I certify thatI fi; `e-_i6ad this, A
-T'
"'
PERMIT EXPIRES IF WORK IS NOT STARTED
i'
.. ., comply ith all city and county ordinances and state laws relating
correct.,'l agree,"
;�q :w I
,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building bo'n's"c6oh"ai id hereby authorize representatives of this city to enter
pon above inenti6nedproperty for inspection purposes. (We) agree to save
u 'the
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and k`eeoi,harul6ssthe 6tyof Cupertino against liabilities, judgments,
costs, and expenses ihic'fi*m' ' " i ' against said City inconsequence of the
. 1 , gy accrue again
*0
Issued by: Date: //-/c7 -/5
granting of th i§ pdrk in t. :Addi ti All y,'tlhie applicantunderstands and will comply
With "Ohon-point sourceje-ju,14ions per the Cupertino Municipal Code, Section
RE -ROOFS:
9 18
kignature
k t 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.
-d,-6WNER'-'BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm,thatJ am.'exenipt from the Contractor's License Law for one of
the following two reasons`
1_111 — I I -
I, as owner of th6'prbp6rty;i �6,4 employees with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
will do the work AndAhe, §ir"re isnot intended or offered for sale (See. 7044,
Busiiiess..&iPi6te�.si6ns"Cgd�?,.,1,
r -of he'oiopertyi am exclusively'cofitraicting with licensed contractors to
1, as '6"kv'rid'i
HAZARDOUS MATERIALS DISCLOSURE
construct the �rcje (Se&.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. 1 will
I hereby'a'ffii'n'. i.iiiideir'pe�6f perjury one of the following three
1 penalty
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
14, !
declarations ,J1 0'7!i
... i ; ,:�. , .. I. .
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have andlwill:iriaifitaiin: A Certificate of Consent to self -insure for Worker's
ir:y
material. Additionally, should I use equipment or devices which emit hazardous
Compensaiioh; as pr6v'id:ed, f6i b' Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
A _
performance of thevibikifor , -whi6h this permit is issued.
I have and will:niamia� Wo�ri er ';sCom'pe'nsation Insurance, as provided for by
. . .� I It, ; lr-
Section '37,0, 0 of the �,abor:&de,for the performance of the work for which this
will maintain .compliance with the Cupertino M * '*pal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505 and 25534.
�wner or authorized
p ermi� isjisue4.1'
I in the of the for this is issued, I shall
certify''that performance work which permit
':4
not . employ:an'y'pbrsofi'ih in,any any manne . r so as to become subject to the Worker's
- I I ,
Compen abofi�i'Asof,Cilifbhiii If.'after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become, sub�ectito; on provisions of the Labor Code, I must
0i ei. i 'le orkWs'C6mpensati
I hereby affirm that there is a construction lending agency for the performance of
.
foi-thwiih"comply-:, ith'such provisions orthis 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.fead.this Application and state that the above information is
correct. I agree,to comply whiff -all city and county ordinances and state laws relating
to buldingc'g."ni's't'r'u'c"t'i'd'n',i"ei'fid"h.'er�'eby authorize representatives of this city to enter
i
uponiheAitd piqoeity for inspection purposes. (We) agree to save
indeinnif�,!and: k6eo harm es§'thkity of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
�
costs; and p"xpenses,which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
an
grtih g . oi!thi's''p"e'r'm'it"_'Addiionhlly,'th'e applicant understands and will comply
with All n'o'�ni-'p'omt;'so11 ut'-ice; r'e; laiions per the Cupertino Municipal Code, Section
Licensed Professional
Signature Date
5'
CUPERTIt-t0
GENERAL PEPWI i APPLICATION
CC)MMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (=;08) 777-3333 • buildin0(b)WDeriinO.Org
❑PLUI,�IBING ZlIECRkNICAL, ❑ELECTRICA.L nhriISCELLA-NEE OUS
PROJECT ADDRESS
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A-RCiETECTFNGLNEERNAME
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STREET ADDRESS
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DESCRIPTION OF WORK
TOTAL VALUATION:
RICED�Y x
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information
I have provided is correct--il zve read the Description of Work and verify it is accurate. I agree to comply with all applicable local
crdtnances and state laws relating to building cBoa. I author—.7c representatives of Cupertino to enter the above -identified property for inspection purposes.
Sigh --tore of Applicpt/.Agent:
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A/FPA!iSCAPp_2011.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
iADDRESS:
al
861 LONNA LN
DATE: 11/12/2015
REVIEWED BY: SEAN
Phin ("heck I-,ee:
APN:
BPN:
*VALUATION:
1$4,659
*PERMIT TYPE:' Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
REMOVE AND REPLACE FURNACE.
SCOPE
Mech: Plan Check 0,0 1 hrs $0.00 llhvi.,b. Plan Cheek Click
Mech. Permit Fee: IMPERMIT I'lumb. "'erndi T'ee.Alec, 1'ent'll Fee:
Other Mech. Insp. 0.0 hrs 1 $48.00 h7ec. b1 p.
ech, ln;sl' 1,rtrrl�..I}f.ct=.F,'(e: lr'sp. Fee:
DOTE. 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 addnl info.
FEE ITEMS (Fee Resolution 11-053 gff. 711113
FEEQTY/FEE
MISC ITEMS
Phin ("heck I-,ee:
Supj.)L PC.Fee
PME Plan Check:
$0.00
Perinit 17ee.'
PMEE, Unit Fee:
$143.00
PMETermiffee:
$48.00
consiruellon 1ax::'.,
Administrative Fee:
]ADMIN
$45.00
Work Without Permit?
0 Yes (E) No
$0.00
nin""
g"1 ees:
Travel Documentation Fee:
ITRAVDOC
$48.00
A
Strong Motion Fee:—
IBSEISMICR
$0.61
Select an Administrative Item
Bld 'Stds Commission Fee:
IBCBSC
$1.00
�- SUBTOTALS
$285.61
As ------
$0.00 '��--VOUL Et-
$285.61
Revised: 10/01/2015
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 )
Project Name: 861 Lonna Ln Date Prepared: 2015-11-06
A. General Information
CF113-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
861 Lonna Ln
02
Date Prepared
2015-11-06
03
Project Location
861 Lonna Ln
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
861 Lonna Ln
07
Zip Code
95014
08
Dwelling Unit Conditioned
1568
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
04,11
05
06
07"
08
09
10
Is the SC
Installing a
SC System
SC System
CFA servedsystem
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
70K BTU Furnace
Whole Home
1568
Yes
No
Yes
No
No
No
Altered space
conditioning 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-A6385419A-000000000-0000 Registration Date/Time: 2015-11-06 08:20:42 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11-06 08:20:46
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)1E and F)
01
02
03
04
05
06
07
08
09
10
11
12
Heating
Cooling
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
70K BTU
Central gas
All new
No cooling
This field or
This field or
This field or
This field or
Furnace
furnace
heating
AFUE
0.8
No cooling
component
section is not
section is not
Setback
section is not
section is not
components
altered
applicable
applicable
applicable
applicable
ReQuired Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF3R-MCH-20-H — Duct Leakage testing required when heating or cooling components are installed in ducted systems, or when
more than 40 ft of duct length is replaced.
-Leakage rate compliance: <_ 15%, or <_ 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 MCH720 Duct Leakage Testing requirements,,
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH123; or Refrigerant Charge MECH-25:,
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Dud 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-A6385419A-000000000-0000 Registration Date/Time: 2015-11-06 08:20:42 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11-06 08:20:46
Schema Version: 0.555SDD
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: r�/��L%LC� �2�GL�JZGC/f
Frederick, Alanna
ov cft
Company:
Signature Date:
CALIFORNIA DELTA MECHANICAL INC
2015-11-06 08:20:42
Address:
CEA/ HERS Certification Identification (if applicable):
1235 GRAND AVE
City/State/Zip:
Phone:
SPRING VALLEY CA 91977
480-898-0007
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.
5. 1 will ensure that a registered copy of this Certificate of,Compliance shall.be made available with the building perinit(s), issued for the°building, and made available'to the:enforcement agency for all applicable
inspections. I understand that a registered copy of thi's 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 ': n%7�CZCJ' 22CZk'/Ll(1`f
�i X
Frederick, Alanna
Company:
Date Signed:
CALIFORNIA DELTA MECHANICAL INC
2015-11-06 08:20:42
Address:
License:
1235 GRAND AVE
811114
City/State/Zip:
Phone:
SPRING VALLEY CA 91977
480-898-0007
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 215-A6385419A-000000000-0000 Registration Date/Time: 2015-11-06 08:20:42 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11-06 08:20:46
Schema Version: 0.555SDD
fCVFEP*TCNQ
SMOKE 9 CARBON MONOXIDE ALARM
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT > BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 a FAX (408) 777-3333 o building(a)cupertino.org
g6 J Z- O JV/V ti L il%E , a(E,Qi/oxima
t�e: �u>_arde:
PERMIT CANNOT BE F'INALED AND COMPLETED UNTIL 'I IiS CERTIFICATE
IAS BE E:N D ANtiD TO THE B'Uf ,DING DIVISION
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMA'T'ION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit includin basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I have read and aqree to comply with the terms and conditions of this statement
l�ui �6r' or Agents) Name:
_y�mer
Cf{� /�LiVIR rjiZjrr/v}q ty�n!A14
Si`nafure.......... •••••
Gbn{r�cfo�=Name:
SiLa_fe.......................... .......... L c 3'°J.................................... Da[e:"
Smoke and CO fonn.doc revised 03/18/14
0
i
CERTIFICATE -OF• VERIFICATION
CF3R=MCH-20-H
Duct Leakage.Diagnostic Test
(Page 1 of 3 )
Project Name:
861 Lonna Ln
Enforcement Agency: City of
Cupertino
Permit, Number: 15110080
Dwelling Address:
861 Lonna Ln .
City: Cupertino
Zip Code: 95014
:A. System Information _
"01 •
Space -Conditioning System Identification or Name"
70K BTU Furnace
02
Space Conditioning System Location or Area Served ".'Whole
Home
03
Building Type from CF -IR
Single family
04
Verified Low Leakage Ducts in Conditioned Space
(VLLDCS) Credit from CF1R?
No, credit is not taken'
05
Low Leakage -Ai. Handling Unit Credit from
Verified'r
CF1R? F
No, credit is not taken
06
Duct System'Gomplian'ce Category.- ,w J"
Alteration
MCH -20d - Complete Replacement or Altered' DuctSyAem
B. Duct Leakage Diagnostic Test -
01
Condenser Nominal Cooling Capacity (ton)
0
02
Hebting Capacity (kBtu/h);°
.55 • .....
'"03
Conditioned Floor Area served -by this HVAC system (ft2)-
1568--
568'
04
04
Duct Leakage Test Condition
Test final`
05
Duct Leakage Test Method
Total leakage
06
Leakage Factor
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)
179
10
Actual duct leakage rate from leakage test measurement
(cfm)
164
11
Compliance Statement: System passes leakage test
Reg Ntration 215-A6385419A-M2000002A-M20A Registration Date/Time: 2015-1T-241 3:38:57 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-1-1718: 18:16:39
2013 Residential Compliance Schema Version: 2013.1.006
CERTIFICATE -OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page.2 of 3 j.
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.
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
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 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 Jerification 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
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-A6385419A-M2000002A-M20A Registration Date/T-ime: 2015-11-24 13:38:57 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards. Report Version: 2013-1.006 Report Generated:. 2015-11-18 18:16:39
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:
Documentation Author Signature: �1
Trent H. Hugill
Company:
Date Signed:
Energy Raters, Inc.
2015-11-24 13:38:57
Address:
CEA/ HERS Certification Identification (if applicable):
260 Woodfield Lane
City/State/Zip: -
Phone:
Brentwood CA 94513
844-744-3637
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 ortthis Certificate bfVerification- comply with-the.applicable requirements in Reference Appendices RA2, RA3, and the requirements
specified on the Certificate of Compliance far the building approved by the enforcement agency.
4. The information feported on applicable sections ofthe Certificate(s) of Installation (CF2Rj 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.
S. I will ensure that a registered copy of this Certificate of Verification shall be posted; or made available with the building permit(s) issued for the
building, and made available to the enforcement agency for all applicable inspections. I understand that a. registered,copy of this Certificate -of
Verification is required to be included with the documentation the builder provides to the building owner at occupancy.
Builder Or Installer Information As Shown On The -Certificate Of, Installation
Company Name (installing Subcontractor, General Contractor, or Builder/Owner):
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:
Energy Raters, Inc.
Responsible Rater Name:
Responsible Rater Signature: �°-
Trent H. Hugill
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2006333
2015-11-24 13:38:57
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-A6385419A-M2000002A-M20A Registration Date/Time: 2015-11-24 13:38:57 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-11-18 18:16:39
2013 Residential Compliance Schema Version: 2013.1.006