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15120090CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10182 PARLETT PL CONTRACTOR: AIR AND PLUMBING PERMIT NO: 15120090 SYSTEMS OWNER'S NAME: WANG CHI-LIANG AND LI-HWA TRUSTEE 14107 CAPRI DR DATE ISSUED: 12/09/2015 OWNER'S PHONE: 6507230607 LOS GATOS, CA 95032 PHONE NO: (408) 733-2000 I� LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 1:1 COMMERCIAL E] ( REPLACE 2 (E) FURNACES & DUCTWORK, & 1 (E) A/C Q License Class r✓,@ Z d Lic. # 0 J Ol Z UNIT IN REAR YARD (SAME LOCATIONS) Contractor Al PRu / Date / f I hereby affirm that I am licensed under a 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 erformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $15000 ave and will maintain Worker's Compensation Insurance, as provided for by APN Number: 31626057.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WIT 180 D OF IT ISSUANCE 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,,;--- O DAYS FR CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issu Date: L 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. RE -ROOFS: Signat '� Date 12-19 tQ 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 stricture 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 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent _ Date: permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY 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 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 constriction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION Indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 MEP C0MMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 Alaz CUPERTtNO(408) 777-3228 • FAX (408) 777-3333 • build ina(a)ouoerJno.org M 1 U ` ❑PLUI"iiBIlNC' MECHANICAL ❑ELECTRICAL ( ObESCELLA - OUS PROJECT 4DDRESS ' ,..j.,C % AP2\ OVJIrrRNP1 // �/ {Gvl Vq jT/ I PHO -NT - (4/ STREET ADDRESS I CITY, STATE, ZIP I FAX COI\rIACTNAI✓E P�O;� OD/J/S "vZ� o E-?VLSII. STREET ADDRESS/ `/� /O 7 �^ I CITY, STATE, ZIP /1i_� �%QI FAX �` � � El0141—EER❑ OWNER--BUMDER ❑rOF'>'--ztAGEN`r CON7KACTOR ❑ CON7LkCTORAGEN''T ❑ .4aCF=1 CT ❑ ENG/INBER ❑ DF%cLOPEZ ❑ iaK-STrr CONTRACTOR N J,CE LICENSE?xUbSER `I I LICENSE TSTE( BUS. LIC 1 / COWANYN.4�iE I E -NAIL FAX STREET ADDRESS CIT, STAT, ZIPTC PHON 7 `f ARCMTECT/ENGD\'EER NAME [' LICENSE NUMBER BUS. LIC COM UNY NA? E E-MAIL I FAY, STREET ADDRESS CITY, STATE, ZIP I PHONE - USE OF ❑ Si -D or DUPLEX ❑ MULTI-FAAbULY PROJECT LN WI DLAND ❑ YES PROJECT IN ❑ YFs IS TFm BLDG AN ❑ ns B UILDItAG: ❑ COMTlmci.AL URBA?N' LNT'B ACE AREA ❑ NO FLOOD ZONZE ❑ NO EICF= HOIJE7 ❑ NO DESCkIPTION OF WORK A� ?- J41 leC?C-C ()(4C Ll kqC>f re l6c�o�s TOTAL VA LUATION: { r Q ^/ By my signature bel v,', I ce: ify 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. I have read the Description of'Work and verify it is accurate. I agree to comply Nvith all applicable local ordinances and state laws relating to'�-ns bion. I authorize re resentatives of Cupertino to enter the above -identified proppertry fes.-- spec ion purposes. SismatureofApplicant/Agent: Date: / J SUPPLEh EN T AL D\FORMATION REQUIRED 0 Ob•.F,ICE LSEO�L.i �,u x ,::... �;._?.,;.��s,.,..s_ R. '.1 •>'�,ft-EJ,St Yh:V�3( ✓�'x4x 4 ^�- �, x��3 0Wo 2i .41 �iX �� ✓..Za 'S� � ��i` �Y 3� SCS �,'K S �Y� �.... k'EPA/isc,4pp_2011.doc re>>ised 06/21/11 7 I CITY OF CUPERTINO W -,WA FF.F. F.,STTMATOR — BIJTLDING DIVISION ADDRESS: 161 --P St - eef 7DATE: 12/09/2015 REVIEWED BY: MELISSA MISC ITEMS APN: 7(6 - U -a BP#: *VALUATION: 1$15,000 I *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: PNIE Plan Check: 7 PENTAMATION FURN/AC PERMIT TYPE: A WORK REPLACE 2 (E) FURNACES & DUCTWORK, & 1 (E) A/C UNIT IN REAR YARD (SAME LOCATIONS) SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 2 # $286 A/C Units 10 K cfm) IBREMAIR 1 # $72 TOTALS - $358.0 Mech. Plan Check 0.0 1 hrs $0.00 111a Ch,.,ck Mech. Permit Fee: IMPERMIT Per n" — Other Mech. Insp. 0.0 hrs L $48.00 0i"er.11h!nib In Afeeli, In,%p. Jll`('.".'.ir'sp. llee: DOTE. This estimate does not include fees due to other Departments (i. e. Planning, PuDitc works, iire, aawrary Sewer "istrict, ochuut District, etc.). These fees are based on the preliminary information available and are only an estimate. (-'ontaetthe Dept for aaan-tinfo. FEE ITEMS 07ee Resolution 11-053 &L 711113) FEE QTY/FEE MISC ITEMS Plan Check.b`ee,' &aj IL N'TICC PNIE Plan Check: $0.00 Perwil.b"ee.' Supi.V, Insp.1"ce PME Unit Fee: $358.00 PME Permit Fee: $48.00 cf.wisirvaion 7L Administrative Fee: JADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 Advowce/ Planning ]"ecs: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $1.95 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS $501.95 $0.00 ' TOTAL FEE, $501.95 Revised: 10/01/2015 ------ -- ------ -------- ALTERATIONS - HVAC GEC -CHR -ALT -03-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CFIR-ALT-03-E Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -IR -ALT -HVAC) (Page 1 of 1) Site Address: / Q �) _ P! (.� C� Enf cement Agency: �C-( Date Prepared: Permit#: tz O� p, c) /?-/9 / E ui ment TYpe Equipment Efcienty New: Ducting, Plenums, Lineset Conditioned Thermostat Required R -value Floor Area (sq ft) ❑ Packaged System i Evaporator Coil 54AFUE COP lrR-6 (CZ 1,3-7) Ducts Served by system ❑ Setback Split Systeml(�Condensing Unit SEER b R-8' (CZ 16) Ducts sq ft (If not already Furnace°L Lineset r HSPF ❑ R-6 (all CZ's) Plenums \ present, must _,EER ❑ R-5 or R7.5 Lineset' be installed) HERS VERIFICATION tUMMARY Installer determines work to be completed and matches to one of the options below. Ap�rm�aatrpliQati�mothri� iafld6e'fPl'd' b .i t For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. 1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: an -include new ducting All Equipment, CFIR-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS Air Handler/Furnace CF3R: MECH-20-HERS Installer Requirement: Duct leakage (< 15% or, L10% to outside, or seal all accessible leaks) Exempted from duct leakage testing if: ❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or 113. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building—.... ❑ 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' CF1R-ALT-02-E CF2R-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS CF3R-MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS' Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow>_ 350 CFM/ton (or Standards Table 150.0-C / D alternative) ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: Includes replacing or installing All New CFIR-ALT-02-E Ducts' and one or more of the following: CF2R-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS Condenser Unit, Evaporator Coil, Furnace CF3R-MECH-20-HERS, MECH-(23 or 24) -HERS Installer Requirement: Duct leakage < 6%, Air Flow 2 350 CFM/ton (or Standards Table 150.0-C / D alternative) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. ❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final: Adding,or replacing ducts in unconditioned CF1R-ALT-02-E CF2R: MECH-20-HERS space but less than All New Ducts' CF3R: MECH-20-HERS Installer Required to: Duct leakage (:5_15% or, < 10% to outside, or seal all accessible leaks) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. ' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc. ' A New Duct system is when the duct system is constructed of at least 75 percent 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, plenums, duct material. 3 R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter with insulation as the following 1.5-2T-2%", 2.5-3T-2%", 3.5 to 4T -2Y.", 5T-4%" Contractor (Documentation Author's /Responsible Designer'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 California Business and Professions Code to accept responsibility for the information on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4. 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 CCR. 5. 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. Responsible Designer Name: Responsible Design e Signature:Date Signed: License: —/l 0) �, 01 012 g lJ S Address: City/State/Zip: Phone: z8J" ��f2ct e Stn (� Company : 11'7)� tial ,�� For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300 I OWNER CERTIFICATE OF COMPUMCE COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION CUPE6it1fIPE® 10300 TORRE AVENUE • CUPERTINO, CA 95014 3255 1 S De U � n,' (408) 77j-3228/FAX 408) 777-3333 building (ab.cupertino.ora�o�tr^ _ Owner Name �m /�jl/ rU�<f�� — 1 i�� Permit No. '`i �Z 06 0 Address 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. 0 No Go to Question 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. Skip the rest of the fonn and sign bottom of form. K 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. �1 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. �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. Check one of the three following statements and sign bottom of form.. Please check ONE of the following: 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 propeity. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant i 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). 13 My property is a commercial real property. See Civil Code Section 1101.5. Z 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- consetving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or unprovements). 1, 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 curTent 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 followine nape. - 1 Owner or Owner Agent's Signature,= Upon completing and signing this Certificate, please return it Date Building Division in order to final your building permit. SB407 2015.doc revised 08/26/15 /c_ CUPERTINO Address PURPOSE 0/9 Z 83MOKE 6 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 • building(@cupertino.org � �L�,�,�-, ►2a. C /� � �{� -Peke' carr Pja C_� # of Alarms Smoke: ;� i0 I_(�-1L00,7° PERMIT CANNOT BE I:INALED AND COMPLETED UNTIL THIS CERTIFICA'T'E IIx45 BE LN 5JUM AND HLLL'HhrM TO THE BUILDING DBTIS 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 abovly�shave been installed in accordance with the manufacturer's instructions and in compliance with the Ca�f Bui and California Residential Codes. The alarms have been tested and are operational, as of t1 _ ed b below. _ I have read and agree to comply with the terms. and conditions of this statement Owner (or Qw ,er AgenVs) Name: I Si nature ........ .. ...... .. .......:(, ............................................................. Date: t Contractor Name: .. �...t. ..:.. � � ✓��Uli' %/Z - Si9oatLiree ......Lic.# ....-U( r.....y.Q::... Date: /z/_!, Smoke and CO form.doc remised 03118114 C �,,+- I S , -,b 1, CERTIFICATE OF VERIFICATION CF3R-MCH-22-H Space Conditioning System Fan Efficacy (Page 1 of 3 ) Project Name: Li -Hwa Wang Enforcement Agency: Cupertino Building Department Permit Number: 15120090 Dwelling Address: 10182 Parlett Place City: Cupertino Zip Code: 95014 A. Ducted Cooling System Information 01 System Identification or Name System 2 02 System Location or Area Served second floor 03 System Installation Type New 04 Nominal Cooling Capacity (tons) of Condenser 2.5 05 Condenser Speed Type Single Speed 06 Cooling System Zonal Control Type Not Zonal 07 Central Fan Integrated (CFI) Ventilation System Status Not a CFI system 08 System Bypass Duct Status No Bypass Duct 09 Date of System Airflow Rate Measurement 2015-12-07 10 Airflow Rate Protocol utilized RA3.3 procedures for airflow rate measurement B. Fan Watt Measurement Apparatus and ProceduriAntir+ &wergy Raters Association Instrument Specifications are given in RA3.3.1, and system fan watt measurement apparatus information is given in RA3.3.2.2. 01 1 Fan Watt Verification Device Used. I Portable watt meter MCH -22a Forced Air System Fan Efficacy Measurement - Newly Installed Non -Zoned Systems or Zoned Multi -Speed Compressor C. Forced Air System Fan Efficacy Measurement The procedures for System Fan Watt Verification are specified in Reference Residential Appendix RA3.3. 01 Actual Tested Watts 510.00 02 Actual Tested Airflow from MCH -23 (cfm) 880 03 Required Fan Efficacy (watts/cfm) .58 04 Actual Fan Efficacy (watts/cfm) .58 F05 Compliance Statement: System fan efficacy complies Registration Number: 315-A1017082A-M22001074A-M22A Registration Date/Time: 2015-12-11 00:21:05 HERS Provider: USERA CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-12-11 00:22:00 2013 Residential Compliance Schema Version: 0.51SDD CERTIFICATE OF VERIFICATION CF3R-MCH-22-H Space Conditioning System Fan Efficacy (Page 2 of 3 ) D. Additional Requirements 01 All registers were fully open during the diagnostic test. 02 System fan was set at maximum speed during the diagnostic test. 03 If fresh air duct is part of the HVAC system it was not closed during the diagnostic test. 04 Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value. 05 Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/ton) and fan efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air handier fan speed. 06 Zoned cooling air distribution systems with single speed compressors shall meet both the airflow (cfm/ton) and fan efficacy (Watt/cfm) criteria in every Zonal control mode. 07 Verification Status Pass - all applicable requirements are met 08 Correction Notes 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. E. 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. LI ICl )( 1CALUI O1 1 Complies: All specified verification protocol requirements on this doc ent are met. Registration Number: 315-A1017082A-M22001074A-M22A Registration Date/Time: 2015-12-11 00:21:05 HERS Provider: USERA CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-12-11 00:22:00 2013 Residential Compliance Schema Version: 0.51SDD CERTIFICATE OF VERIFICATION CF3R-MCH-22-H Space Conditioning System Fan Efficacy (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: Minxuan Liu vtafv Date Signed: Company: Santa Clara HERS 2015-12-11 Address: CEA/ HERS Certification Identification (if applicable): 1181 Sundown Ln 410231431 City/State/Zip: Phone: San Jose CA 95127 408-883-3865 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 (MR) 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, orBuilderL+r9; Energy Raters Association Santa Clara HERS Responsible Builder or Installer Name: CSLB License: Minxuan Liu 410231431 HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status in Sample Group (if applicable) 315-11778 Tested HERS Rater Information HERS Rater Company Name: Santa Clara HERS Responsible Rater Name: Responsible Rater Signature: (/ / 44 Minxuan Liu / r irxka-H .1..<uan Liu (Dec 17, 2015) Responsible Rater Certification Number w/ this HERS Provider: Date Signed: 410231431 2015-12-11 TY This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for U.S. Ener9the accuracy of the information.- Y Racers Asaodatlon Registration Number: 315-A1017082A-M22001074A-M22A Registration Date/Time: 2015-12-11 00:21:05 HERS Provider: USERA CA Building Energy Efficiency Standards Report Version: 2013-1.006 Report Generated: 2015-12-11 00:22:00 2013 Residential Compliance Schema Version: 0.51SDD CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 1 of 9 ) Project Name: Li -Hwa Wang Enforcement Agency: Cupertino Building Department Permit Number: 15120090 Dwelling Address: 10182 Parlett Place City: Cupertino Zip Code: 95014 A. General Information 01 Dwelling Unit Name Li -Hwa Wang 02 Climate Zone 4 Dwelling Unit Total Conditioned Floor Number of space conditioning (SC) 03 Area (ft2) 2930 04 systems being altered in this dwelling 2 unit. 05 Certificate of Compliance Type Prescriptive alterations (CF1R-ALT) 06 Method used to calculate HVAC loads NotApplicableEquipmentChangeout 07 Calculated dwelling unit Sensible 0 08 Calculated Dwelling Unit Heating Load 0 Cooling load (Btuh) (Btuh) 09 Dwelling Unit Number of BedroomsT6 MCH -0111) Prescriptive Alterations - Space Conditioning Systems Ducts and Fans U.S. Energy Raters Association Registration Number: 315-A1017082A-M0111695A-0000 Registration Date/Time: 2015-12-10 23:10:19 HERS Provider: USERA CA Building Energy Efficiency Standards- 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-10 23:11:14 Schema Version: 2013.1.006 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 2 of 9 ) B. Space Conditioning (SC) System Information 01 02 03 04 05 06 07 08 09 10 CFA served Is the SC Installing a Installing SC System SC System by this SC system a refrigerant Installing new SC Installing more entirely Installing Identification or Location or Area System ducted containing system than 40 feet of new duct entirely new Name Served (ft2) system? component? components? ducts? system? SC system? Alteration Type Entirely new or complete System 1 floor 1500 Yes No Yes Yes Yes Yes replacement space conditioning system Entirely new or complete System 2 second floor 1430 Yes Yes Yes Yes Yes Yes replacement space conditioning system Registration Number: 315-A1017082A-M0111695A-0000 U.S. Energy Raters Association Registration Date/Time: 2015-12-10 23:10:19 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-10 23:11:14 Schema Version: 2013.1.006 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 3 of 9 ) C. Space Conditioning (SC) System Alterations Compliance Information 01 02 03 04 05 06 07 08 09 10 11 12 13 Rated Heating Capacity, Name Heating Efficiency Type Value Manufacturer Model Number number Output (BTUH) System 1 AFUE .780 Trane Central Fan 15361NS07G 76000 System 2 AFUE 95.000 Integrated TUD2A06COA9362A 15094H7J1G 57000 Heating Cooling New or (CFI) System Altered Heating Minimum Altered Cooling Minimum Required Replaced New Ventilation Identification Heating Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Duct Duct System or Name System Type Component Type Value System Type Component Type Value Type Length R -Value Status This field This field All new No cooling or or System 1 Central gas heating AFUE .780 No cooling component section section is Setback GT40Ft R6 Not a CFI furnace componen altered is not not system is applicabl applicabl e e All new System 2 Central gas heating AFUE .780 Central All new cooling SEER 13.000 Setback GT40Ft R6 Not a CFI furnace componen split AC system is components D. Installed Heating Equipment information 01 02 03 04 05 06 07 System Identification or Heating Efficiency Heating Unit Heating Unit Heating Unit serial Rated Heating Capacity, Name Heating Efficiency Type Value Manufacturer Model Number number Output (BTUH) System 1 AFUE .780 Trane TDH2B08BOA942VA 15361NS07G 76000 System 2 AFUE 95.000 Trane TUD2A06COA9362A 15094H7J1G 57000 Notes: Registration Number: 315-A1017082A-M0111695A-0000 Registration Date/Time: 2015-12-10 23:10:19 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-10 23:11:14 Schema Version: 2013.1.006 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 4 of 9 ) E. Installed Cooling Equipment information: This section does not apply to this project. F. Extension of Existing Duct System, Greater Than 40 Feet This section does not apply to this project. G. Installed Duct System information 01 02 03 04 0S 06 07 08 Method of compliance with duct and filter grille sizing SC System SC System Location Supply Duct Supply Duct Return Duct Return Duct requirements in Number of Air Filter Identification or Name or Area Served Location R -Value Location R -Value 150.0(m)13 Devices on System System 1 floor Unconditioned R-6 Conditioned R-6 System is exempt 0 crawl space space -entirely Unconditioned Unconditioned HERS verified fan System 2 second floor R-6 R-6 efficacy (W/cfm) and 1 ALairflow attic attic rate (cfm/ton) Notes: U.S. Energy Raters Association Registration Number: 315-A1017082A-M0111695A-0000 Registration Date/Time: 2015-12-10 23:10:19 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-10 23:11:14 Schema Version: 2013.1.006 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 5 of 9 ) H. Installed Air Filter Device Information 01 02 03 04 05 06 07 SC System Identification or Name SC System Location or Area Served Air Filter Device Identification or Name Air Filter Device Type Air Filter Device Location Determined Design Airflow Rate for Air Filter Device (cfm) Determined Design Allowable Pressure Drop for Air Filter Device (inch W.C.) System 2 second floor FILTER Filter Grille Filter Grille 800 .010 Notes: I. Air Filter Device Requirements 01 The system shall be designed to ensure that all recirculated air and all outdoor air supplied to the occupiable space is filtered before passing through the system's thermal conditioning components. The system shall be designed to accommodate the clean -filter pressure drop imposed by the system air filter device(s). The design airflow rate and maximum allowable clean -filter pressure drop at the design airflow rate applicable to each air filter device shall be determined, and all system air filter device locations shall be 02 labeled to disclose the applicable design airflow rate and the maximum allowable clean -filter pressure drop. The labels shall be permanently affixed to the air filter device, readily legible, and visible to a person replacing the air filter media, and the air filter devices shall be provided with air filter media that conforms to these determined or labeled maximum allowable clean -filter pressure drop values as rated using AHRI Standard 680. 03 All system air filter devices shall be located and installed in such a manner as to allow access and regular service by the system owner. 04 The system shall be provided with air filter media having a designated efficiency equal to or greater than MERV 6 when tested in accordance with ASHRAE Standard 52.2, or a particle size efficiency rating equal to or rea er than 50 percent'n the 3.0 to10 micron range when tested in accordance with AHRI Standard 680. 05 The system shall be provided with air filter media that has been labeled by the manufacturer to disclose the efficiency and pressure drop ratings that conform to the required efficiency and pressure drop requirements for the air filter device. The responsible persons signature on this compliance document affirms that all applicable requirements in this table have been met. Registration Number: 315-A1017082A-M0111695A-0000 Registration Date/Time: 2015-12-10 23:10:19 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-10 23:11:14 Schema Version: 2013.1.006 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 6 of 9 ) J. HERS Verification Requirements 01 02 03 04 05 06 07 08 09 10 MCH2O MCH21 MCH22 MCH23 MCH25 MCH28 Exemption from Minimum Exemption R -Value for AHU Fan AHU SC System SC System From Duct Duct Ducts In Ducts Located Efficacy Airflow Identification or Location or Area Leakage Leakage Conditioned In Cond Space (W per Rate (cfm Refrigerant Return Duct Design Name Served Requirements Test Space Verification cfm) per ton) Charge Table 150.0-C or D System 1 floor No Yes Not No No No No No exemptions applicable System 2 second floor No Yes Not No Yes Yes No No exemptions applicable Notes: U.S. Energy Raters Association Registration Number: 315-A1017082A-M0111695A-0000 Registration Date/Time: 2015-12-10 23:10:19 HERS Provider: U5ERA CA Building Energy Efficiency Standards- 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-10 23:11:14 Schema Version: 2013.1.006 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 7 of 9 ) K. Space Conditioning Systems, Ducts and Fans Mandatory Requirements and Additional Measures Note: Additional mandatory requirements from Section 150.0 that are not listed here may be applicable to some systems. These requirements may be applicable to only newly installed equipment or portions of the system that are altered. Existing equipment may be exempt from these requirements. Heating Equipment 01 Equipment Efficiency: All heating equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency Regulations. 02 Controls: All unitary heating systems, including heat pumps, must be controlled by a setback thermostat. These thermostats must be capable of allowing the occupant to program the temperature set points for at least four different periods in 24 hours. See Sections 150.0(i), 110.2(b). 03 Sizing: Heating load calculations must be done on portions of the building served by new heating systems to prevent inadvertent undersizing or oversizing. See sections 150.0(h)1 and 2). 04 Furnace Temperature Rise: Central forced -air heating furnace installations must be configured to operate at or below the furnace manufacturer's maximum inlet -to -outlet temperature rise specification. See Section 150.0(h)4. 05 Standby Losses and Pilot Lights: Fan -type central furnaces may not have a continuously burning pilot light. Section 110.5 and Section 110.2(d). Cooling Equipment 06 Equipment Efficiency: All cooling equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency Regulations, 07 Refrigerant Line Insulation: All refrigerant line insulation in split system air conditioners and heat pumps must meet the R -value and protection requirements of Section 150.0(j)2 and 3, and Section 150.0(m)9. 08 Condensing Unit Location: Condensing units shall nUb&jaVr VITYeR gfgd l��Mf"lection 150.0(h)3A. 09 Sizing: Cooling load calculations must be done on portions of the building served by new cooling systems to prevent inadvertent undersizing or oversizing. See Section 150.0(h)1 and 2. Air Distribution System Ducts, Plenums and Fans 10 Insulation: In all cases, unless ducts are enclosed entirely in directly conditioned space, the minimum duct insulation value is R-6. Note that higher values may be required by the prescriptive or performance requirements. See Section 150.0(m)1. Registration Number: 315-A1017082A-M0111695A-0000 Registration Date/Time: 2015-12-10 23:10:19 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-10 23:11:14 Schema Version: 2013.1.006 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 8 of 9 ) K. Space Conditioning Systems, Ducts and Fans Mandatory Requirements and Additional Measures Note: Additional mandatory requirements from Section 150.0 that are not listed here may be applicable to some systems. These requirements may be applicable to only newly installed equipment or portions of the system that are altered. Existing equipment may be exempt from these requirements. Connections and Closures: All installed air -distribution system ducts and plenums must be, sealed and insulated to meet the requirements of CMC Sections 601.0, 11 602.0, 603.0, 604.0, 605.0 and ANSI/SMACNA-006-2006: Supply -air and return -air ducts and plenums must be insulated to a minimum installed level of R-6.0 or enclosed entirely in directly conditioned space as confirmed through field verification and diagnostic testing in accordance with the requirements of Reference Residential Appendix RA3.1.4.3.8. Heat Pump Thermostat 12 A thermostat shall be installed that meets the requirements of Section 110.2(b) and Section 110.2(c). 13 The thermostat shall be installed in accordance with the manufacturers published installation specifications 14 First stage of heating shall be assigned to heat pump heating. 15 Second stage back up heating shall be set to come on only when the indoor set temperature cannot be met. The responsible person signature on this compliance document affirms that all applicable requirements in this table have been met. Registration Number: 315-A1017082A-M0111695A-0000 U.S. Energy Raters Association Registration Date/Time: 2015-12-10 23:10:19 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-10 23:11:14 Schema Version: 2013.1.006 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 9 of 9 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Mark Fridlyand / Signature Date: Company: Air & Plumbing Systems Inc 2015-12-10 Address: CEA/ HERS Certification Identification (if applicable): 14107 Capri Dr 901246 City/State/Zip: Phone: Los Gatos CA 95032 408-733-2000 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Installation is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation, and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met. 5. 1 will ensure that a registered copy of this Certificate of Installation shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Installation is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: Mark Fridlyand Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Position With Company (Title): Q�k �rOi!L Q�Of! Air & Plumbing Systems Inc Mark Fridlyand Dec 10, fol5 e Address: • •EI r GS B c Aosocoation 14107 Capri Dr 901246 City/State/Zip: Phone: Date Signed: Los Gatos CA 95032 1408-733-2000 2015-12-10 A This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for U.S. Enerthe accuracy of the inforrnation.- gy Raeas Assoeiano� Registration Number: 31S-A1017082A-M0111695A-0000 Registration Date/Time: 2015-12-10 23:10:19 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-10 23:11:14 Schema Version: 2013.1.006 CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) Project Name: Li -Hwa Wang I Date Prepared: CF1R-ALT-02-E (Page 1 of 4 ) 2015-12-10 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 Li -Hwa Wang 02 Date Prepared 2015-12-10 03 Project Location 10182 Parlett Place 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name Li -Hwa Wang 07 Zip Code 95014 08 Dwelling Unit Conditioned 2930 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 2 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 System 1 floor 1500 Yes i er�Q, R q� tersyA sso iatft Yes Yes complete replacement space conditioning system Entirely new or System 2 second floor 1430 Yes Yes Yes Yes Yes Yes complete replacement space conditioning system Registration Number: 315-A1017082A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2015-12-10 22:17:17 Report Version: 2013-1.006 Schema Version: 0.555SDD HERS Provider: USERA Report Generated: 2015-12-10 22:18:12 CERTIFICATE OF COMPLIANCE CF111-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 4 ) C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib) This section does not apply to this project. D. Altered Space Conditioning System (Sections 150.2(b)lE 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)lE, F) This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) 01 02 03 04 05 06 07 08 09 10 it 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 Central gas All new heating No cooling SetbackTher System 1 A'rUE .80 No cooling SEER 14 R-6 furnace components component altered mostat Central gas All new heating Central split All new cooling SetbackTher System 2 furnace components AFUE 80 AC components SEER 14 mostat R-6 Required Documentation: U.S. Energy Raters Association CF2R-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 >_ 350 cfm/ton. - Alternative Compliance: CF2R & CF3R-MCH-28 Return Duct Design Verification is an alternative to MCH -22 and MCH -23 verification. CF2R & CF3R-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. Registration Number: 315-A1017082A-000000000-0000 Registration Date/Time: 2015-12-10 22:17:17 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-10 22:18:12 Schema Version: 0.5555DD CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 4 ) 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 U.S. Energy Raters Association Registration Number: 315-A1017082A-000000000-0000 Registration Date/Time: 2015-12-10 22:17:17 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-10 22:18:12 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 4 of 4 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Minxuan Liu Documentation Author Signature: �VYl�xvlCbr✓ t_ Signature Date: Company: Santa Clara HERS 2015-12-10 Address: CEA/ HERS Certification Identification (if applicable): 1181 Sundown Ln 410231431 City/State/Zip: Phone: San Jose CA 95127 408-883-3865 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: Responsible Designer Signature: ,t/ Minxuan Liu ! ae niaI Fra, Company: Date Signed: Santa Clara HERS 2015-12-10 Address: 1181 Sundown Ln U.S. Energy Ra License: efo%Association City/State/Zip: Phone: San Jose CA 95127 408-883-3865 us Registration Number: 315-A1017082A-000000000-0000 RA U.S. Enemy Raters Assodatlon -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 Date/Time: 2015-12-10 22:17:17 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-10 22:18:12 Schema Version: 0.555SDD