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B-2016-1410CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1410 18975 TUGGLE AVE CUPERTINO, CA 95014-3658 (375 34 004) (ATKINSON' CLIMATROLLERS INC) SAN JOSE, CA 95112 OWNER'S NAME: GOSWAMI DHEERAJ AND SHALINI TRUSTEE OWNER'S PHONE: 4083181073 LICENSED CONTRACTOR'S DECLARATION License Class C20 Lic. #258540 Contractor (ATKINSON CLIMATROLLER INC-) Date 2/22/2016 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1. 1 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 DATE ISSUED: 02/22/2016 NO* 4082946290 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPLACE FORCED AIR FURNACE, SAME LOCATION; ADD (N) A/C UNIT AT REAR ON PROPERTY by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $13772.00 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 permidionall , the applicant understands and will comply with all non-p in urce r gulations per the Cupertino Municipal Code, Section.9.18, Signature e_ ' VV V V Date 2/22/2016 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) z. I, as owner of the property am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's: Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor. Code; for the performance of the work for which this permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revolted. 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. Date 2/22/2016 APN Number: Occupancy Type: 375 34 004 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: PAUL O'SULLIVAN� Date: 2/22/2016 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: 2/22/2016 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 Ba re AL,25533, anagement District I will maintain compliance with the C t' o ode, Chapter 9.12 and the Health & Safety, Code, c ns 2and 25534. Owner or authorized age t : Date: 2/22/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shallbe used as public records. Licensed Professic GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408, 777-3228 • FAX (408) 777-3333 • buildina(cDcupertino.org C�JP�RTIi�l� ❑PLUNMING k34ECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS V I (r T _CA/t� Aur__ pPNj L_534CO4 OWNER NAME PHONE �� C/��iJ (� EMAIL STREET ADDRESS J CITY, STATE, ZIP G vVU V L 5_V ( FAX CONTACT NAME . � C(^" PHONE v V �% �q /Q��Z LV E-MAIL og �l✓!/ `u f v C%�` STREET ADDRESS / !I l f / V �/ / �j IWNEcR-BUILDER t CITY, STATE ZIP V7 CA FAX 4 C Z gz( "DEVELOPER ❑ OWNER El❑ OWNERAGENT N IICTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑(,'`ENGINEER ❑C ❑ TENANT CONTRACTORNANS h LICENSE NUMEER �t J LICENSE nl fo l/ BUS. LIC 9 CONPANYNAME � C E-MAIL FAX l/G STREET ADDRESS < CrrY, STATE, ZIP � C/ i 5� (/) �,,( (G !/ /I PHONE '/j -ARCHMECTIENGINEERNAME LICENSENUMBER BUS. LIC mU COWANYNANM E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WII DLAND URBAN ZITERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK p n rKA, F / oi ^ c �c�en TOTAL VALUATION: CELVEDBI w 772r m the property owner or authorized agent to act on the property owner's behalf. I have read this By my signature below, I certify to each korrect. application and the information I have ov' eve read the Description of Work and verify it is accurate. Iagreeoco ply wit all applicable local ordinances and state laws relating to b l g uthorize representatives of Cupertino to enter the above -identified pro erty forIspec ' n purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED . 1 E3515 �,caUz�T1Ir v s�— `� --- MEFMiscflp. _2011. doc revised 03/1 b/11 - MM CITY OF CUPERTINO d 1 Q, FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 18975 TUGGLE AVE DATE: 02/22/2016 REVIEWED BY: PAUL APN: 375 34 004 BP#: VALUATION: 1$13,772 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: p PENTAMATION PERMIT TYPE: TURN/AC wORK REPLACE FORCED AIR FURNACE SAME LOCATION; ADD N A/C UNIT AT REAR_ ON SCOPE PROPERTY APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $143 A/C Units (<=10K cfm) 1BREMAIR 1 # $72 TOTALS: $215.00 Mech. Plan Check 10.0 1 hrs $0.00 3 d' c:'; ._ , s �: Mech. Permit Fee: IMPERMIT Other Mech. Insp. 0.0 hrs $48.00 = _ ,_ ._.. F: r : ; } ,. _ %v ; ;.E3 NOTE: This estimate does not include fees due to other Departments (he. Planninz. Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the prelimina information available and are only an estimate. Contact the Dept or addn'l info. FEE ITEMS (Fee Resolution 11-053 L ff. 7/1/13) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 pergin r Fee. 77 PME Unit Fee: $215.00 PME Permit Fee: $48.00 T7 Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (@ No $0.00 f"s. Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: 1BSEISMICR $1.79 Select an Administrative Ite t Bldg Stds Commission Fee: IBCBSC $1.00 . SUBTOTALS ; $358.79 $0.00 TOTA.L FEE: $358.7911 Revise 1/01/2016 COMMUNITYD BUILDING Tbls set of plans end speclfl job rR3 dutdrig constaic tior changes 0-v altre,Uons therefrom, WILhout aPPrOv; t,1Mping of this plan w .�n perg-nit or to be ^ems of any C 0 - GUIIERTINO J ST b f POPQt*?� ,Wful to rnalke any 6 or to deviate � Building Official. AIV,6 ations SHALL NOT aj of the violation nce or State Law. CL m . V4am.. CUKRTINO N Building Departme, FES 16 REVIEWED FOR CODE COMPLIANCE Reviewed By. Taja`�O-V�' �� VJ WL Ave COOS �aw�.� I U��t4L,�� ANNING DEPT CUPERTINO CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF-IR-ALT HVAC) (Page 1 of 3 ) Project Name: 2015- 0577 Dheeraj Goswami Date Prepared: 2016-02-19 A. General Information MR-ALT--02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one CHR-ALT--02 document for each dwelling unit. 01 Project Name 2015- 0577 Dheeraj Goswami 02 Date Prepared 2016-02-19 03 Project Location 18975 Tuggle Ave 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2015- 0577 Dheeraj Goswami 07 Zip Code 95014 08 Dwelling Unit Conditioned Floor Area (ft2) 1100 Number of space conditioning 09 Climate Zone 4 10 (SC) systems in this dwelling 1 unit. B. Space Conditioning (SC) System Information ' r, + � 01 02 03 04^ S U6 07. 08 09 10 ... ' is the SC " "` ` Installing a :. 77 SC System SC System CIA served System a A reinge ant v pstallirt'g nev��;� Itjstatl�g � nstalhng' nstalling 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 .Furnace, A/C, whole house 1100 Yes Yes Yes No Yes No complete ace replacement s Duct Replacement p p conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib) This section does not apply to this project. Registration Number: 216-A0066679A-000000000-0000 Registration Date/Time: 2016-02-19 11:06:24 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-02-19 11:06:29 Schema Version: 0.555SDD 144 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) 01 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 Furnace, A/C, Central gas All new heating; AF7E 0 Cent -split ill rt'eu crsc�ltng SEER 14 SetbackTher R 6 Duct Replacement furnace components A compaents mostat Required Documentation:' tam CF2R-MCH-01-E -Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums: R6. 11 F CF2R & CF3R-MCH-20-H Duct Leakage Verification required. -Leakage rate compliance: 5 6%. CF211 & CF311-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. CF211 & CF311-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: 216-A0066679A-000000000-0000 CA Building Energy Efficiency Standards - 2013'Residential Compliance Registration Date/Time: 2016-02-19 11:06:24 Report Version: 2013 Rev 1.007 Schema Version: 0.555SDD HERS Provider: CalCERTS Report Generated: 2016-02-19 11:06:29 �F 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: ewc Faulkner, Cindy Cl�UG4C1i/%L�li l�l/y Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,C00LING & ELECTRICAL 2016-02-19 11:06:24 Address: CEA/ HERS Certification identification (if applicable): 1171 NORTH 4TH STREET City/State/Zip: Phone: SAN JOSE CA 95112 408-294-6290 Responsible Person's Declaration statement , I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of.the Business and Professions Code to accept: responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. That the energy features and performance specifications, materials, components, and manufact ed devices for the buildmg design system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part land Part 6 of the California Code offregulationsx 4. The building design features or system design features orilhis Certificaf f ' mpliance are nsistent wit)V1he ih1ormatioprovided o , therapplicablecoinpliance documents, worksheets, to theemenfi encyfgr app v wt)h this buil ng permit applicat5. calculations, plans and specifications submitted tintified 1 will ensure that a registered copy of this Certificate ofpliance s stria°de> Yail le Ala-tlta "i1dln p tmit( );issuJ fortlt 0uild'in'g, an ' aG available othe;enforcement agency for all applicable ed to be; included with the documentation the ui er vides to the building owner at occupancy. inspections. I understand that a registered copy of thisicate of Co, pl ance,is req tr, b p P,„„, i Responsible Designer Name: ' ; ResponAble Designer Signature. a Faulkner, Cindy Company: Date Signed: ATKINSON CLIMATROLLERS INC. dba VALLEY HEATING,COOLING & ELECTRICAL 2016-02-19 11:06:24 Address: License: 1171 NORTH 4TH STREET 258540 City/State/Zip: Phone: SAN JOSE CA 95112 408-294-6290 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0066679A-000000000-0000 Registration Date/Time: 2016-02-19 11:06:24 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-02-19 11:06:29 Schema Version: 0.555SDD SMOKE I CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE a. COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION x' CU�Ry INC3 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 S (408) 777-3228 • FAX (408) 777-3333 • building(cbcupertino.org r-fZ;1,- "e r fi►lam c� � Yri�ke: ,i ide: 2 �1` 1 PERMIT CANNOT BY. F1NA L ED AND COMPLETED UNTIL THIS CERTIFICATE HAS BF-F tiC &LGM AND Ut'- j ED TO TTIE BUiLDfNG 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 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 un the following locations: AREA I SMOKE ALARM CO ALARM ffbedroom(s) ch separate sleeping area in the immediate vicinity of the X X el of a dwelling unit includingbasements 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 n � �d are operational, as of the date signed below. t have Fead and agree to comply with. the, termsand conditions of this statement CWWlay 0WW sl eta -As: i Dfe: ................... psi ' br #�ler�ne: Siq�idture...................................................................U0,1f ...................................... Datt:................... Smoke and CO form.doc remised 03118114 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPME14T DEPARTMENT • BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE • CUPERTINO. CA 95014-3255 (408) M-3228 • FAX (408) 777-3333 9 buildinQjfij upertino org Owner Name Address A 1 S� _q $-9CI(o lug o cll� 9.5'v l . 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. Cj'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 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 form and sign bottom of form. ( No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. (TNo 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. [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.. Pl ase 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 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 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). 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 a :e. Owner or Owner Agent's Signature: Date' - 1 Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit. 1.0 SB407 2015.doc revised 08126115 CERTIFICATE OF INSTALLATION CF2R MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 1 of 8 ) Project Name: 2015- 0577 Dheeraj Goswami Enforcement Agency: City of Cupertino Permit Number: B-2016-1410 Dwelling Address: 18975 Tuggle Ave City: Cupertino Zip Code: 95014 A. General Information 01 Dwelling Unit Name 2015- 0577 Dheeraj Goswami 02 Climate Zone 4 Dwelling Unit Total Conditioned Floor 1100 04 Number of Space Conditioning 1 03 Area (ft2) Systems in this Dwelling Unit. 05 Certificate of Compliance Type Prescriptive alterations (CF1R-ALT) 06 Method used to Calculate HVAC Loads ACCA_ManualJ 07 Calculated Dwelling Unit Sensible 24000 08 Calculated Dwelling Unit Heating Load 70000 Cooling Load (Btuh) (Btuh) 9 Fo — Dwelling Unit Number of Bedrooms 3 MCH-01b Prescriptive Alterations - Space Conditioning Systems Ducts Fans 7 B. Space Conditioning (SC) System Information 01 02 03 04 05 06 07 08 09 10 SC System SC System CFA served Is the SC Installing aInstalling new SC Installing more Installing Installing Identification or Location or Area by this SC a systemsystem refrigerant than 40 feet of entirely new entirely new SC Alteration Type Name Served System (ft) ducted containing components? onents? ducts? duct system? system? system, component.? Entirely new or complete Furnace, A/C, Duct whole house 1100 Yes Yes Yes Yes Yes Yes replacement space Replacement conditioning syste m Registration Number: 216-A0066679A-M0100002B-0000 Registration Date/Time: 2016-03-22 13:10:37 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:11:20 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 2 of 8 ) C. Space Conditioning (SC) System Alterations Compliance Information 01 02 03 04 05 06 07 08 09 10 11 12 13 Central Fan Integrated 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 Components Type Value Type Length R-Value Status Furnace, A/C, All new All new Central gas heating Central Not a CFI Duct furnace componen AFUE 0.96 split AC cooling SEER 14 Setback GT40Ft R6 system Replacement components is D. Installed Heating Equipment Information 01 02 03 04 05 06 07 System Identification or Heating Efficiency Heating Unit Heating Unit fle nttserial Rated Heating Capacity, Name Heating Efficiency Type Value Manufacturer Model Number Iller Output (BTUH) Furnace, A/C, Duct AFUE 0.96 ' Lennox " EL296UH070XV36 ' 5916A1475 62000 Replacement B Notes: Registration Number: 216-A0066679A-M0100002B-0000 Registration Date/Time: 2016-03-22 13:10:37 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:11:20 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 3 of 8 ) E. Installed Cooling Equipment information 01 02 03 04 05 06 07 08 Condenser or Package Unit Condenser or Condenser or Condenser or System Rated Cooling Condenser Rated System Identification Cooling Efficiency Cooling Efficiency Package Unit Package Unit Package Unit Capacity at Design Nominal Capacity or Name Type Value Manufacturer Model Number Serial Number Conditions (BTUH) (ton) Furnace, A/C, Duct Replacement SEER 14 Lennox 14ACX-024-230 1916AO6488 24000 2 Notes: F. Extension of Existing Duct System, Greater Than 40 Feet This section does not apply to this project. G. Installed Duct System information \' O1 02 03 04t 05 06_ 07 08 09 Method of Can RA3.3 compliance with Airflow SC System SC System duct and filter Number of Air Protocols be Identification or Location or Area Supply Duct Supply Duct Return Duct Return Duct grille sizing Req's Filter Devices on used to test Name Served Location R-Value Location R-Value in 150.0(m)13 System this system? HERS verified fan Furnace, A/C, Duct Conditioned Conditioned efficacy (W/cfm) Replacement whole house space -entirely R 6 space -entirely R 6 and airflow rate 1 Yes (cfm/ton) Notes: Registration Number: 216-A0066679A-M0100002B-0000 Registration Date/Time: 2016-03-22 13:10:37 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:11:20 Schema Version: 2.013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 4 of 8 ) H. Installed Air Filter Device Information 01 02 03 04 05 06 07 Determined Design Determined Design Allowable Pressure SC System Identification or SC System Location or Air Filter Identification Air Filter Device Air Filter Device Airflow Rate for Air Drop for Air Filter Name Area Served or Name Type Location Filter Device (cfm) Device (inch W.C.) Furnace, A/C, Duct Replacement whole house Glassfloss Filter Grille Return 800 0.05 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 prey ure drlbp impo d ley Ch +stern air filter devices}wThe de grr afr4low rate and maximum allowable clean -filter pressure drop at thlesign airflow rate applicablea teach air filter device shall be detern4ped aid all syste4n air filter device locations shall be 02 labeled to disclose the applicable design airfl pp g mate and the max mum allov✓ hlP clean -fitter pressure drop. Th labels'sh'all be per'r nently affixed to the air filter device, readily legible, and visible to a person rep{acing 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 greater than 50 percent in 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: 216-A0066679A-M0100002B-0000 Registration Date/Time: 2016-03-22 13:10:37 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:11:20 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 5 of 8 ) 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 System SC System From Duct Duct Ducts In Ducts Located AHU Fan Airflow Identification or Location or Area Leakage Leakage Conditioned In Cond Space Efficacy Rate Refrigerant Return Duct Design Name Served Requirements Test Space Verification (W/cfm) (cfm/ton) Charge Table 150.0-C or D Furnace, A/C, Duct No No Replacement whole house exemptions Yes Exemption No Yes Yes No No Notes: �` oT, R �e" a Registration Number: 216-A0066679A-M0100002B-0000 Registration Date/Time: 2016-03-22 13:10:37 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:11:20 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 6 of 8 ) 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: contMousIV61u l`i iict light, Section 110.5 and Section 110.2(d). Cooling Equipment a a; Equipment Efficiency: All cooling equipment mus'I=meet the, minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency 06 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 not be placed within five (5) feet of a dryer vent outlet. See Section 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: 216-A0066679A-M0100002B-0000 Registration Date/Time: 2016-03-22 13:10:37 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:11:20 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 7 of 8 ) 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 CIVIC Sections 601.0, 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 11 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 beset to come on only when the ind9or set temperature cannot be met. The responsible person signature on this compliance•:document affirm'sthat all Applicable requirements i thiita Ole have bierii lffi ** : Registration Number: 216-A0066679A-M0100002B-0000 Registration Date/Time: 2016-03-22 13:10:37 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:11:20 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 8 of 8 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Fernandez, Louis E�e�LGa'il�L�iGAia� Company: Signature Date: Elements - E3 2016-03-21 15:19:29 Address: CEA/ HERS Certification Identification (if applicable): 1718 Creek Drive City/State/Zip: Phone: San Jose CA 95125 1408-634-6690 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws `,of the State of California: 1. The information provided on this Certificate of 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. k' 3. The constructed or installed features, materials, components or m nufactured deices Ithe installation) identified this �rtifi( te, of InstallatioNcorAforn to ap applicable codes and regulations, and the installation conforms to the requirements given on the•plans and cification5 approved brV the enfo ement aged y. 4. 1 reviewed a copy of the Certificate of Comp lia n ce'app roved by the e0pfcement„a'S'ency that identiifi the specific requir ments for tFte s ope of r nstructi6n ar":installation identified on this Certificate of Installation, and I have ensured that the requirements.*kapply to the construction or installation have been met. S. I will ensure that a registered copy of this Certificate of Ins llation shall be posted, or marde available with'the bul(ding permit(s) issyold 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: Faulkner, Cindy c��GG�fy/yLP/t� Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Position With Company (Title): ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL President Address: CSLB License: 1171 NORTH 4TH STREET 258540 City/State/Zip: Phone: Date Signed: SAN JOSE CA 95112 408-294-6290 12016-03-22 13:10:37 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0066679A-M0100002B-0000 Registration Date/Time: 2016-03-22 13:10:37 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:11:20 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION F211-MCH-23-1-1 Space Conditioning System Airflow Rate (Page 1 of 3 ) Project Name: 2015- 0577 Dheeraj Goswami Enforcement Agency: City of Cupertino Permit Number: B-2016-1410 Dwelling Address: 18975 Tuggle Ave City: Cupertino Zip Code: 95014 A. Ducted Cooling System Information 01 System Identification or Name Furnace, A/C, Duct Replacement 02 System Location or Area Served whole house 03 System Installation Type New 04 Nominal Cooling Capacity (tons) of Condenser 2 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 2016-03 10 Airflow Rate Protocol utilized RA3.3 procec bs for airflow rat4 measurement B. Hole for the placement of a Static Pressure Probe (HSPP), and Permanently installed Static Pressure Probe (PSPP) in the supply plenum. Procedures for installing HSPP or PSPP are specified in RA3.3.1.1. 01 Method used to demonstrate compliance with the HSPP installed and labeled consistent with Figure RA3.3-1 HSPP/PSPP requirement C. Airflow Rate Measurement Apparatus and Procedure Information Instrument Specifications are given in RA3.3.1.1, and system airflow rate measurement apparatus information is given in RA3.3.2. Airflow Rate Measurement Type used for this airflow rate Traditional Flow Capture Hood according to procedure in Fol2 verification. RA3.3.3.1.4 Manufacturer of Airflow Measurement Apparatus Alnor 03 Model number of Airflow Measurement Apparatus ET721 Certification Status of the Airflow Measurement Apparatus Certified by Manufacturer and listed on CEC Website at 04 Accuracy http://www.energy.ca.gov/title24/equipment_cert/ama_fas /index.html Registration Number: 216-A0066679A-M2300002A-0000 Registration Date/Time: 2016-03-22 13:10:37 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:1S:5S 2013 Residential Compliance Schema Version: 0.55SSDD CERTIFICATE OF INSTALLATION Space Conditioning System Airflow Rate CF2R-MCH-23-H (Page 2of3) MCH-23a Forced Air System Airflow Rate Measurement - Newly Installed Non -Zoned Systems or Zoned Multi -Speed Compressor D. Forced Air System Airflow Rate Measurement The procedures for System Airflow Rate Verification are specified in Reference Residential Appendix RA3.3. 01 Required Minimum System Airflow Rate (cfm/ton) 350 02 Required Minimum System Airflow Target (cfm) 700 03 Actual System Airflow Rate Measurement (cfm) 1093 04 Compliance Statement: System airflow rate complies E. Additional Requirements 01 Air filters that meet the applicable requirements of Standards Section 150.0(m)12 or 150.0(m)13 were properly installed in the system during system air flow rate measurement identified on this Certificate of Installation. The airflow rate measurement apparatus used to`perform the airfl; ,rate measurementfdentified onthi l ertificate of 02 Installation was calibrated in accordance with the"apparat s manufacturers specifications and conforms to the -� instrumentation specificatitopsgven in RA33.1. A visual inspection shall confirm that bypass ducts that deliver conditioned supply air directly to the space conditioning 03 system return duct airflow are not used on newly constructed zonally controlled systems unless the Performance Certificate of Compliance indicates an allowance for use of a bypass duct. When a bypass duct is accounted for on the Performance Certificate of Compliance, the airflow rate shall conform to the specifications listed on the Certificate of Compliance. P015 All registers were fully open during the diagnostic test. System fan was set at maximum speed during the diagnostic test. 06 If fresh air duct is part of the HVAC system it was not closed during the diagnostic test. 07 Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value. Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/ton) and fan 08 efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air handler fan speed. The responsible person's signature on this compliance document affirms that all applicable requirements in this table have been met. Registration Number: 216-A0066679A-M2300002A-0000 Registration Date/Time: 2016-03-22 13:10:37 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:15:55 2013 Residential Compliance Schema Version: 0.555SDD CERTIFICATE OF INSTALLATION CF2R-MCH-23-H Space Conditioning System Airflow Rate (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author SignatureeyG�G�'�rNa Louis Fernandez Company: Signature Date: 2016-03-21 15:19:29 Elements - E3 Address: CEA/ HERS Certification Identification (if applicable): 1718 Creek Drive City/State/Zip: Phone: San Jose CA 95125 1408-634-6690 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of 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 andspecificationsspproved by `✓ .. """' the enforcement agency. ,, ' 4. 1 understand that a HERS rater w�jcheck the installation to rerii`y cE ;ipliance, ; at ,5yrt u'checl g identifies defects; l am f qui ed totalce' "ll corrective action at my expense.'Nriderstar ;that EnefgyCommission and HEits Provider re' sentgtives will also perforrrrquality assurance checking of installations, including those approved as p"s tof a 5araplre<group btrt th y a HER rate", nd ifttwse inallatioiis fail to meet" requirements of such quality assurance checking, the required corrective action and additional checking/testingof other installations in that HERS sample group will be performed at my expense: S. I 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. 6. 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: Cindy Faulkner Company Name: (Installing Subcontractor or General Contractor or Position With Company (Title): Builder/Owner) President ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL Address: CSLB License: 1171 NORTH 4TH STREET 258540 City/State/Zip: Phone: - SAN JOSE CA 95112 408-294-6290 Third Party Quality Control Program (TPQCP) Status: Name of TPQCP (if applicable): Digitally signed by CaICERTS. 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: 216-A0066679A-M2300002A-0000 Registration Date/Time: 2016-03-22 13:10:37 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:15:55 2013 Residential Compliance Schema Version: 0.555SDD I ril- S �' CERTIFICATE OF INSTALLATION CF2R-MCH-22-H Space Conditioning System Fan Efficacy (Page 1 of 3 ) Project Name: 2015- 0577 Dheeraj Goswami Enforcement Agency: City of Permit Number: B-2016-1410 Cupertino Dwelling Address: 18975 Tuggle Ave City: Cupertino Zip Code: 95014 A. Ducted Cooling System Information 01 System Identification or Name Furnace, A/C, Duct Replacement 02 System Location or Area Served whole house 03 System Installation Type New 04 Nominal Cooling Capacity (tons) of Condenser 2 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 O8 System Bypass Duct Status No BypasTuc ,. 09 Date of System Airflow Rate Mrsurerr nt �z 2016-03-16 � s 10 Airflow Rate Protocol utilized RA3.3 procedures for airflow rats measufernent B. Fan Watt Measurement Apparatus and Procedure Information 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. Digital Utility Revenue 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 350 02 Actual Tested Airflow from MCH-23 (cfm) 1093 03 Required Fan Efficacy (watts/cfm) 0.58 04 Actual Fan Efficacy (watts/cfm) ..32 05 Compliance Statement: System fan efficacy complies Registration Number: 216-A0066679A-M2200002A-0000 Registration Date/Time: 2016-03-22 13:10:37 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:17:28 2013 Residential Compliance Schema Version: 0.52SDD CF2R-MCH-22-H CERTIFICATE OF INSTALLATION (Page 2 of 3 ) Space Conditioning System Fan Efficacy 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. Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/ton) and fan 05 efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air handler fan speed. Zoned cooling air distribution systems with single speed compressors s 06 hall meet both the airflow (cfm/ton) and fan efficacy (Watt/cfm) criteria in every zonal control mode. ment affirms that all applicable requirements in this table have The responsible person's signature on this compliance docu been met. Registration Number: 216-A0066679A-M2200002A-0000 CA Building Energy Efficiency Standards 2013 Residential Compliance Registration Date/Time: 2016-03-22 13:10:37 HERS Provider: CaICERTS Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:17:28 Schema Version: 0.52SDD N= CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: 2015- 0577 Dheeraj Goswami Enforcement Agency: Cupertino City of Permit Number: B-2016-1410 Dwelling Address: 18975 Tuggle Ave City: Cupertino Zip Code: 95014 A. System Information 01 Space Conditioning System Identification or Name Furnace, A/C, Duct Replacement 02 Space Conditioning System Location or Area Served whole house 03 Building Type from CF-1R Single family 04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from CF1R? No, credit is not taken 05 Verified Low Leakage Air Handling Unit (VLLAHU) Credit from CF1R? No, credit is not taken 06 Duct System Compliance Category New MCH-20a - Completely New Duct System`; B. Duct Leakage Diagnostic Test ry 01 Condenser Nominal Cooling Capacity (ton) 2 02 Heating Capacity (kBtu/h) 62 03 Conditioned Floor Area served by this HVAC system (ft2) 1100 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) 81 110 Actual duct leakage rate from leakage test measurement (cfm) 47 11 Compliance Statement System passes leakage test Registration Number: 216-A0066679A-M2000002A-M20A Registration Date/Time: 2016-03-21 15:22:48 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:21:03 2013 Residential Compliance Schema Version: 2013.1.007 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) duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage 02 testing. OA ducts used for Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan Ventilation Cooling Systems, that utilize dampers that open only when OA is required and automatically close when OA is not required, may configure the OA damper to the closed position during duct leakage testing. 03 All supply and return register boots were sealed to the drywall. 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All connection points between the air handier and the supply and return plenums are completely sealed. Visual Inspection at Final Construction Stage (applicablt-if **n was tasted at rough -in) After installing the interior finishing wall and orifyin!r the move rough -in tests was completed the following procedure must be performed For all supply and return registei`S'sverify that the spaces'between the register bootand the interior finishing wall are 07 properly sealed. 08 if the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points 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. 1 01 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: 216-A0066679A-M2000002A-M20A Registration Date/Time: 2016-03-21 15:22:48 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:21:03 2013 Residential Compliance Schema Version: 2013.1.007 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: Louis Fernandez Documentation Author Signature: ad.PBlLG4 ��7i1�ia Company: Date Signed: Elements - E3 2016-03-21 15:22:48 Address: CEA/ HERS Certification Identification (if applicable): 1718 Creek Drive City/State/Zip: Phone: San Jose CA 95125 408-634-6690 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The installed features, materials, components, manufactured devices, or system performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements specified on the Certificate of Compliance for the building approved by the enforcement agency. 4. The information reported on applicable sectionsof the Certificate(s) off stallatjCfn (CF2 &,ed"and submitted by the person(s) responsible for the construction or installation conforms to then quiremegtsspecified on ithe Ceriificate(shtsf Con pliarn a (CP f;) approved bytheenforcementagency. 5. I will ensure that a registered copy of this Certificate of rlhcatibn shall be posfed, or nUd&, vailable with the i gilding permits issued fits the building, and madeavailabhrtq t ;enforcerr*ntagen4 fo it appli le ir7spectiI., ions. nd�a erndthat a re isttred;copy ofth Cert icate of. :. R..,,. Verification is required to be inciudid with the documentation the builder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (installing Subcontractor, General Contractor, or Builder/owner): ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL Responsible Builder or Installer Name: CSLB License: Cindy Faulkner 258540 HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status in Sample Group (if applicable) Tested HERS Rater Information HERS Rater Company Name: Elements - E3 Responsible Rater Name: Louis Fernandez Responsible Rater Signature: Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006519 2016-03-21 15:22:48 Digitally signed by CaICERTS. 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: 216-A0066679A-M2000002A-M20A Registration Date/Time: 2016-03-21 15:22:48 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:21:03 2013 Residential Compliance Schema Version: 2013.1.007 1 �AML� CF3R-MCH-22-H CERTIFICATE OF VERIFICATION Space Conditioning System Fan Efficacy Project Name: 2015- 0577 Dheeraj Goswami Enforcement Agency: City of Cupertino (Page 1 of 3 ) Permit Number: B-2016-1410 Cupertino Zip Code: Dwelling Address: 18975 Tuggle Ave City: 95014 Registration Number: 216-A0066679A-M2200002A-M22A Registration Date/Time: 2016-03-21 15:22:48 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-21 15:22:14 2013 Residential Compliance Schema Version: 0.51SDD