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15100199CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10142 BILICH PL I CONTRA CAL CTOR: CALIFORNIA DELTA I PERMIT NO: 15100199 OWNER'S NAME.Q40k)q V I 'KLA}U MW 000 A>- - 16056 E BASELINE RD STE 155 1 DATE ISSUED: 10/23/2015 OWNER'S PHONE: 4082553099 LICENSED CONTRACTOR'S DECLARATION license Class G 20 Li,. # (y/` ` ,�/ Contractor ------'Date I hereby a trm =hat icensed 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: t. 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 regulate per the Cupertino Municipal Code, Section 9..18. Signature Date %d ❑ 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: t. 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 MESA, AZ 85206 1 PHONE NO: (866) 692-5273 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE AND RELOCATE A NEW FURNACE TO THE ATTIC. Sq. Ft Floor Area: I Valuation: $9700 APN Number: 31621063.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS F LAST CALLED INSPECTION. 11 C�N11 �- ) �1 Issued by: � Date: 23 i 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. Ownero ' ed agent: Date: G 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION Y 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION %ALTERATION/Tl ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS � ^ � , ` • `a r n APN # D � OWNER NAME �+� r/C PHONE E-MAIL ! ` v O STREET ADDRESCITY^vA ,ZIP FAX O CONTACT NAME P 8-� 2To� E-MAIL S ET ADD Ss CITY STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEN j ycr ✓e LICENSE NUMBER n� LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET DRESS CITY> STATE, ZIP O ^ 9,0 "M bio_F �� 2 D - 9 C ,6 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK C /!5;'p -re CC EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA DETACH [jA_RAGEX_MX: ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY [3 YES BEING ADDED? ❑ NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES CEFVED TQTAI VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ N - 70 0` Q l By my signature below, I certify to each of the following: I am the property owner orAyW6FE5ed agent to a on the proper wner's behalf. II have read this application and the information I have provided is I have read the Description of Work and verify ' is a . I agree to comply with all applicable local ordinances and state laws relating to buildin ruct n. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: le) �S SUPPLEME INF N REQUIRED PLAN CHECK TYPE ROUTING SLIP OVER-THE-COUNTER BUILDING PLAN REVIEW _ New SFD or Multi amity dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE, ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to 0: -MAaoR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1. doc revised 06/21/11 CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) Project Name: 10142 Bilich PI I Date Prepared: CF1R-ALT-02-E (Page 1 of 3 ) 2015-10-09 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 10142 Bilich PI 02 Date Prepared 2015-10-09 03 Project Location 10142 Bilich PI 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 10142 Bilich PI 07 Zip Code 95014 08 Dwelling Unit Conditioned 2200 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 Entirely new or 90K BTU Furnace Whole Home 2200 Yes No Yes Yes Yes Yes complete replacement space conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib) Registration Number: 215-A6353542A-000000000-0000 This section does not apply to this project. �1( 2 S 20 15 Registration Date/Time: 2015-10-09 14:07:25 BY HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-09 14:07:31 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) This section does not apply to this project. 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) O1 02 03 04 05 06 07 08 09 10 11 Heating Cooling System Heating Minimum Cooling Minimum Required Identification or Heating System Altered Heating Efficiency Efficiency Cooling Altered Cooling Efficiency Efficiency Thermostat New Duct Name Type Component Type Value System Type Component Type Value Type R -Value This field or This field or Central gas All new heating No cooling section is section is SetbackTher 90K BTU Furnace furnace components AFUE.0.8 No cooling _; component altered not not mostat R-6 applicable= applicable Required Documentation: - CF211-MCH-01-E - Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums: R6. CF2R & CF3R-MCH-20-H Duct Leakage Verification required. -Leakage rate compliance: <_ 6%. CF2R & CF3R-MCH-22 Fan Efficacy Verification CF2R & CF3R-MCH-23 System Air Flow Rate Verification -Compliance: Fan Efficacy <_ 0.58 W/cfm and System Airflow z 350 cfm/ton. - Alternative Compliance: CF2R & CF3R-MCH-28 Return Duct Design Verification is an alternative to MCH -22 and MCH -23 verification. CF2R & CF313-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15). Exceptions: Heating -only systems are exempt from the 0.58 W/cfm and 350 cfm/ton requirements. Note: An "entirely new or replacement duct system" means at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material) if the reused parts are accessible and can be sealed to prevent leakage Registration Number: 215-A6353542A-000000000-0000 Registration Date/Time: 2015-10-09 14:07:25 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-09 14:07:31 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: Frederick, Alanna Company: Signature Date: CALIFORNIA DELTA MECHANICAL INC 2015-10-09 14:07:25 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 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: Frederick, Alanna Responsible Designer Signature: Company : Date Signed: CALIFORNIA DELTA MECHANICAL INC 2015-10-09 14:07:25 Address: License: 1235 GRAND AVE 811114 City/State/Zip: SPRING VALLEY CA 91977 r4.0-898-0007 Digitally signed by CalCERTS. 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-A6353542A-000000000-0000 Registration Date/Time: 2015-10-09 14:07:25 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-09 14:07:31 Schema Version: 0.555SDD CX0 ve� &-'V C - /ofd 2 151-11-C-4 P� i2f-P�9— cc, 744,- � -t ® c e Q �� -z� f�`a `/ �¢% /�.c C' RECEIVED OCT 128 2015 BY COMMUNITY DEVELOPMENT DEllARTMENT BUILDING DIVISION - CUPERTINO APPROVED I This set of plans and specifications MdST be kept at the job site during construction. It is unlawful to make any changes or alterations on same, or to deviate therefrom, without approval from the Building Official. The stamping of this plan and specifics -ions SHALL NOT be held to permit or to be an approval of the violation of any provisions of any City Ordinance or State Law. ByN�T/ DATE G ' •l PERMIT NO. __ 1!5 /l/D7/ I.1 ,_A- y f A/ ".°`I Owu vCE m , . r,, LiA - f.1 CUPERTINO .I Owner Name moi" A. WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE E COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (�8,} 777- 28 • FAX (408) 777-3333 • building(a)cupertino.org r �_ra0 r� P Permit No. +0 / Address _ (0 f q- Z r�C4'W P, c Q . I (V f* 9 , C f+} f-ol 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. lam' No Go to Question 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 110 1. 1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. i5 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. Skip the rest of the form and sign bottom of form. �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 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. IV [Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 110 1. 1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: Eir' 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 -conserving 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 irnprovements shall require non- compliant plumbing fixtures to be replaced with water -conserving 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). I, as the owner or owner's agent 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 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 comply with the requirements as indicated in the table on the following nage. f'-. _ Owner or Owner Agent's Signatu? �_J V w ti(i � Date Upon comnletine and siEnine this Certificate. nlease it to the Rrnilrlina T)ivicinn in nrrlPr to f;. 1 ......1,,,:1.7:.,... ._.-.:, ...-...b i,......... SB407 2015. doc revised 08/26/15 BUILDENG PER11UT CA�NrINOT BE. FINALED AND GO1N_ PLETED U_4TII, THIS CERTIFICATE' TE HAS BI;Ei1T . T t �NTD BET1JR-NED TO -THE BUILDIi tG DIVISION. If the existing plumbing nxture water usagciuuw idLU 1b cLIuai LU V1 1V,'YVl --I -'--------I----- __ _ _ _ --_--_ - SB407 2015.doc revised 08/26/15 Ikon -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usa a/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 @ 50 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. If the existing plumbing nxture water usagciuuw idLU 1b cLIuai LU V1 1V,'YVl --I -'--------I----- __ _ _ _ --_--_ - SB407 2015.doc revised 08/26/15 SCUP ERCT INO PURPOSE .S � Y i i•p' j :'lr, +1) = `�. � 4, J3 � '. •S r i f,t "' It � �� !�. �� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 a FAX (408) 777-3333 • building (a.cupertino.org Ace ? �� S or� aa?iIa l! e o l 1 �2 a; _>rittalte: ��i��l��&_anQuide: / PERMIT CANNOT DE I+INAILED AND COMPLETED LINTEL THIS CEIRTIHCATE HAS HE•EN S CN 12 AN`D,RFTURb1Ejj TO THE BUILDING DIVISION 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 INFORMATION 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 including 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 agree to comply with the terms and conditions of this statement �11Gti Cl2otGt 541rla. tpe¢+t�9JI CohfFa:ctorrName: Sig— re ...................................... ...... Lid. ;.................................... Daft: Smoke and CO form.doc revised 03/18/14 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Pa Project Name: 10142 Bilich PI En orcement Agency: City of upertino Permit Number: 15100199 Dwelling Address: 10142 Bilich PI City: Cupertino Zip Code: 5014 B. Duct Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity (ton) 4 02 Heating Capacity (kBtu/h) 95 03 Conditioned Floor Area served by this HVAC system (ft2) 2200 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.06 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 (cfm) 124 10 Actual duct leakage rate from leakage test measurement (cfm) 80 11 Compliance Statement System passes leakage test Registration Number: 215-A6353542A-M2000002A-M20A Registration Date/Time: 2015-11-1107:34:42 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-11-09 06:49:31 2013 Residential Compliance Schema Version: 0.551SDD 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 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 connecttcin.=ints between the air„handler and the supply and return plenums are completely sealed. L��. Visual Inspection at Final Construction Stage (applicable if system was tested at rough in) After installing the interior finishing wall an&verifying thaf the above rough m f i&was complef "Ahe follotivmg procedure must be performed_., :verify thatthpacl etvJ' n the'register boot and the°interior finishing -.wall are For all supply and return registers e s 07 properly sealed. If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points 08 between the air handler and the supply and return plenums to verify that the connection points are properly sealed. 09 Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used. 10 Verification Status Pass 11 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-A6353542A-M2000002A-M20A Registration Date/Time: 2015-11-11 07:34:42 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-11-09 06:49:31 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: Trent H. Hugill Company: Date Signed: Energy Raters, Inc. 2015-11-11 07:34:42 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'cf:;perjury, under the laws of the State of California: 1. The information provided;ot 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 identiftetl on this Certificate of Venficatiori comply with thez:applicable requirements in Reference Appendices RA2, RA3, and the requirements specified on th,e Certificate of Compliance for.the'building approved by the enforcement agency. 4. The informatiom reported on applicabie sectiorts oft(e Certificates) pl Instailafion (CF2Rj signed;ind s( _Itted by the perSgn(s) responsible for the construction or msfallation conforms to the requirements pect#ed ;>itifthe Certlficate(s) cf Co tipliance (CFVR) approved by the enforcement agency. 5. I will ensure that a registered copy of this Certificate of Verlficataan 5ijall be poste; or ma a available with the building per6t(5} issued fo the building, and made ayaileble to tf a enforcement agency farall applir able inspectlontand that ax [ copy 8f this Certificate of Verification is required to be irici6b6d with the documentation the builder provides to the bw(d ng owner at occupancy Builder Or Installer Information As Shown On"The'Certificat "Of Installation ,r €r a � 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 2015-11-11 07:34:42 Digitally signed by Ca/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-A63S3542A-M2000002A-M20A Registration Date/Time: 2015-11-11 07:34:42 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-11-09 06:49:31 2013 Residential Compliance Schema Version: 0.551SDD