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14120018 STRUCTURAL CALCS & SOILCITY OF CUPERTINO BUILDING PERMIT i BUILDING ADDRESS: 871 BETTE AVE CONTRACTOR: K & M DEVELOPMENT PERMIT NO: 14120018 i INC OWNER'S NAME: FLING ANNIE AND JEFFREY PO BOX 2535 DATE ISSUED: 02/11/2015 OWNER'S PHONE: 4083400249 CUPERTINO, CA 95015 PHONE NO: (408)253 -9787 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT SINGLE STORY SFDWL 2210 SQ FT OF License Class LIVING ? ►r M Contractor /L U M h ire jV/ VV 114 Date AREA, ATTACHED GARAGE 488 SQ FT I hereby affirm that 1 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: 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 Sq. Ft Floor Area: Valuation: $450000 performance of the work for which this permit is issued. j 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 APN Number: 36927048.00 Occupancy Type: permit is issued. { APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED ' ' correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 3 upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FRO ALLED INSPECTION. j 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 Date: - -� i with all non -point source regulations per the Cupertino Municipal Code, Sect 9.18. j `� � '1 `� �t RE- ROOFS: Signatures/ to f All roofs shall be inspected prior to any roofing material being installed. If a roof is 4 installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER- BUILDER DECLARATION Signature of Applicant: Date: { 1 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 structure is not intended or offered for sale (Sec.7044, Business & Professions Code) ' i I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE 3 construct the project (Sec.7044, Business &Professions Code). 1 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.I2 and the ] declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous i 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 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Munici Code, Chapter 9.I2 and f I have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Code, Sections 25505, 25533, v 534. 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 j Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY 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 3 APPLICANT CERTIFICATION Lender's Address } 1 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 I upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION 3 indemnify and keep harmless the City of Cupertino against liabilities, judgments, j costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. j 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 s 9.18. Signature Date CUPERTINO I XNEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION oz� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildinc)CU)cupertino.org ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # �J PROJECT ADDRESS 80 �^ �j Pv APN # OWNER NAME /��/ (�p PHONE /!gyp -?Ilu- 6�� EMAIL / - . (, _,- "0 G,� -'t•( �F�AXyy+, �I'� STREETADDRESS II. �yY1 / _ { , , CITY, STATE, ZIP ['w`` SO% � ���(}� CONTACT NAME "t7/D PHO 8� I� , E -MA wt, �� , STREETADDRESS Q� /��G CITY. STATE. "L 9' FCip�-�r��, !❑ ❑ OwT'ER ❑ owNER- BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCI-IT 'ENG EER E LICENSE NUMBER •L BUS. LIC # COMPANY NA E- ,N garA F + STREET ADDRESS CITY, STATE, ZIP PHONE r V DESCR1PTfON F WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA U v I (A n I BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKPORCH AREA GARAGE AREA: DETACH C_/t3 ?3 ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNIT U YES SECOND STORY L] YES I /) BEING ADDED? ADDITION! LINO lY PRE - APPLICATION 4MES IF YES, PROVIDE COPY OF PLANNTNG APPL# ❑NO PIANN P}i0�'AL LETTER IS THE BLDG AN YES EICHLER HO ME' NO RECEIVET} Ek = ! '" -,ISO TOTAL VALUATION: O bC0 By my signature below, I certify to each of the follo 1 the property owner or authorized agent to ac e property owner's behalf. I have read this application and the information I have provided is rrect. ve read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building c -Xti ((.,.• authorize representatives of Cupertino to enter the above- idegt& d property for inspection purposes. Signature of Applicant/Agent: Date: 44,7P SUPPLEMENTAL INFORMATI N REQUIRED PJAIVClECKTYPE itoVltNGSt- Cj bvER raco[rHTr it tiu Du ac rJ nN xEua[>+ New SFD or Multifamily dwellings: Apply for demolition permit for eXisting building(s). Demolition permit is required prior to issuance of building permit for new building. ❑a y NNIKG PLAN REVt» _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure . STAt4DARD sLtC WORKS form if any Hazardous Materials are being used as part of this project. © ,LARGE FP _ Copy of Planning Approval Letter or Meeting with Planning prior to w ❑ MAJOR SANITAttI( SEVVE[il?JSTittCr submittal of Building Permit application. ❑ ENVIRONA3ENTAt HEALTH" B1dgApp_2011.doc revised 06121/11 FM,-7, CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 871 bette ave TYPE OF CONSTR. DATE: 12/03/2014 PC FEES REVIEWED BY: Mendez APN: BP #: R -3 (Custom) 'VALUATION: 1$450,000 'PERMIT TYPE: Building Permit $3,005.22 PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes • No PME Plan Check: PENTAMATION 1 R3SFDW PERMIT TYPE: A WORK construc single story sfdwl 2210 sq ft of living area attached garage 488 sq ft SCOPE $2,869.26 Suppl. Insp. Fee: (E) Reg. © OT FO-01 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Custom) II- B,111- B,IV,V -B 2,698 $3,005.22 IR3PLNCK $2,869.26 1R3LVSP $0.00 PME Plan Check: $0.00 Permit Fee: $2,869.26 Suppl. Insp. Fee: (E) Reg. © OT FO-01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 2,698 $3,005.22 Construction Tax: 1BCONS7AXR $2,869.26 1 new units NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info. FEE ITEMS (Fee Resolution 11 -053 F f: 7i/:'/3) FEE QTY /FEE MISC ITEMS Plan Check Fee: $3,005.22 Select a Misc Bldg /Structure or Element of a Building Suppl. PC Fee: Q) Reg. © OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,869.26 Suppl. Insp. Fee: (E) Reg. © OT FO-01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONS7AXR 1 1 new units $667.73 0 G Work Without Permit? © Yes (F) No $0.00 !advanced Planning? Fee: IPLLONGR $377.72 Select a Non - Residential Building or Structure E) 0 i Strom Motion Fee: IBSEISMICR $58.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $18.00 SUBTOTALS: $6,996.43 $0.00 TOTAL FEE: $6,996.43 Revised: 10/01/2014 CUPERTINO Alex ; yor- 3311 CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408- 777 -3228 Fax: 408-777-3333 JOB ADDRESS:871 Bette Avenue, Cupertino, CA 95014 PERMIT #14120018 OWNER'S NAME:Anne and Jeffrey Fung PHONE #408 -310 -0249 GENERAL CONTRACTORX &M Development BUSINESS LICENSE #741814 ADDRESS:20660 Stevens Creek Blvd. #239 CITY /ZIPCODE Cupertino 95014 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 10/19/15 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 10/19/15 gwfi-er'7'Co'ntractor Sig ure E V'114 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # X Cabinets & Millwork Competitive Construction Inc. 679895 X Cement Finishing Unique Construction 890522/3yy 3 X Electrical Sure Electric Inc 615776 aa'!7 Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing X Heating Heinemann Heating 388314/-77,55; X Insulation Ponzini Insulation OLJ Landscaping Lathing Masonry X Painting / Wallpaper Andy's Construction 611780 , X Paving Unique Construction ✓ 890522 Plastering X Plumbing Bohlin Plumbing & Construction Inc. 693809/,20(- A I X Roofing Executive Roofing 595001/A &871 Septic Tank Sheet Metal Sheet Rock Tile 10/19/15 gwfi-er'7'Co'ntractor Sig ure E V'114 REDI - LETTER:, TO: CA-, C A-pe,-fina Bldci FROM: n; C12 0(d EDWARD J. HAHAMIAN 10158 RICHWOOD DRIVE CUPERTINO, CA 85014 -3314 r E SUBJECT: DATE: 1- _�o -2-opl_ MESSAGE: 1S i 0- Y e D V\��' o x.03, v vice,�c�ct �� e I�� zo 2,s- o 6 v SIGNED: 3� RMFORM , 4S468/4P468 POLYPAK (50 SETS) ❑ NO REPLY NECESSARY ❑ REPLY REQUESTED - USE REVERSE SIDE CARBONLESS SPEEDISET Project Name Project Address: Project De / CAL EN SIGNATURE DECLARATIONS 1 4 1 � ON '✓ /New Residenc6\ 871 Bette Aven e A new 1 e single family residence SECTION 1 - DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Owner's Signature Date Owner's Name (Please Print) Design Professional's Signature Date Design C!M;T� Please Print ) 11/30/2014 Signature of License Professional responsible for CalGreen compliance Date Michael Chau 650- 799 -7100 Name of License Professional responsible for CalGreen compliance (Please Print) Phone michael @msjconstruction.com Email Address for License Professional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. ,, 1, 0i 10/19/2015 Signature of License Professional responsible for CalGreen compliance Date Michael Chau 650- 799 -7100 Name of License Professional responsible for CalGreen compliance (Please Print) Phone michael @ msjconstruction. com Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen_2014.doc revised 11104114 r CC Q O LL a d A LL a V w 0 z Q J a X O v LL O w Q V H W C# N C) � x D c � o Co co r � d 4 G � O N A O E o z w � l0 � v � CL V c w .N m U (D a) F- a o � a z a ai O E= z w N � r, V a 0 U C_ F LU W U U N L 0 CL vi cit w 2 cn Q N C 0 N E m 0 c .m a a E Z c 0 CLO z m LO M m ° o o v o N CR p N a N G U � o rn Wo = o U m W rn V N Y N O to a c U) G a c s w m o c c g G O a E 0 E z o E z a O m z co m a c N 0 a G z C16 C V O `s IL U W V O O O r r r r r N C O w YI N z ai M `t N H c m coo U _T o as U ti C to U Z N o Q Z I Q z z O m Q z v m o a o a .` p m m o A v o A c< J t. a V .0 u a N c N js E a 1=, � m a o N m o U. ¢ m 0 °o LL p H Q A a m Q o LL o v O Q L m a y c -• o A 'a� o w o O o g r m m o 0 O Y Ug LL z c QJ 0G W LL' z r N !9 t0 00 O N a s0 00 O w O O O O O O r r r r r N c7 3� m U C_ F LU W U U N L 0 CL vi cit w 2 cn Q N C 0 N E m 0 c .m a a E Z c 0 CLO z m CL m ° o o N CR Wo = a t V C16 C `s U W V A C O YI � C o A 'a� o w o O o g r m m o 0 Y Ug c LL' W s 3� m " �' � cn O G m C cc AM WI a �O -- m a a O H W m I lz > o `O $ lz _ w A c m • •O r N a Co V- vii• o° n a m m LL o c m BO n o ci a E � � � � N O IL m E 0 E A w c o V $ � r+ 3 O a m o `O O c c O O C t m _ O m 0 w m a c c 9 a 'g a o �` o�p = V c s W .0 0 m m C m c w CL Ck. a gym, r a tea' o W V V z Q o 0 0 J d O v U C_ F LU W U U N L 0 CL vi cit w 2 cn Q N C 0 N E m 0 c .m a a E Z c 0 CLO z r � U. 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W V 0 3 m L ° a �' •- LL m C v D � a m N o Cc m U. J U. UN c P3 3 m E C7 a_ u- 44 O a ? F U a. a a N n m C N O U. U ni to Q Z O � Wm m .= > N Z iy N m lL W z 2 c H U) W F ip 7 r E CM N y a O z Z LL Z Q O O C Q � = E W 0 c O 00 d Gl L E Z c m 0 � o / a I ) a U. U \ \ � § _ « CN CD » 0 o / I § Q CO cn G � \ E k t Qj CN E o c 2 2 k w L z A « 2 7 a k ■ U z « ■ ■ & ■ a a � o z § q ■ § ) ■ c ■ « { z S § $IL 2 § k 04 z B ' $ ■ 0 j z k & 2 k ■ 3 7 u a J 2 r � LL Q' ao a � L a 0 IT 0 N C) if U x (D Q � C � cO m C � r CI O r r r r O m 4 o N dC 0 G o Z N � V 7 C U C N y m a N 'o ~ a� Z � a Q NC 2 W. V � 7 V a` v U C � K U C o W U m C V v C ,`O0 `a z ;o L v a y O L a, a t LA `v w c 0 AE ,o .H v V1 .v Cl) m G C C N W tz U "Z3 n o, E ` LL y y L $ m O Q C C o a m� G ` t L ti v y O l ` c ° E G c L a `c 4 o i O 4 O O � O P/ � O C h O V �0 4 z rt C I Z N O1 t � v o c cc N 6 U u U ° ` E `a aj G C LL .& e o °c y •� N = d o = z c°. 0 d y O U y ° E C U r O v F3 y c r ° Q o E U N c d C o_ ° _ m oa r 0 o y o (D CL cc w O O y C cc N O 0 c y E c O_ E fn0 d ` c E ° M p E L y D o c cr7 N to c C E� c ti c C d d •O Hy N y y Q r r 0 0 U ti c U c �- y O o ti m g w m U $ ,� � r � � N m m 0 (0 ti O O Lo L t lO M c� L LO Q N (A U d o a w N x Q N OD J d a m BCD U O CL U m rn m d aa�o 0 ui�E oc�o E = cc N y U O S � C ° m y c m U y r CD CO c w N!E �• E C J2 V y E W y c N y a H L W a �E Z W a m8 my cc `2 c d W Dtom cw y Lm o ° ~ O -' E OG y Z em N r C� W a C y lE _ a ° _ y a O m o c o 0 5 � a o N o W 42 ° c H m e a a p J2.2 ui 0 m Z C O z CD �`yOy O CD >> 'O" 'O Q Z N w o t O O T a) W U ��io�G N c O p Ct 0) o U U a O� N U Q Q c t N _U a W J o CD d r U a U C 0 N E 0) d m FA O N L O O O _ • U CO Q O — C Q E M U a C 41 C14 O 2 o U a H r p _ i i � tO 0 a Ix U U C � K U C o W U m C V v C ,`O0 `a z ;o L v a y O L a, a t LA `v w c 0 AE ,o .H v V1 .v Cl) m G C C N W tz U "Z3 n o, E ` LL y y L $ m O Q C C o a m� G ` t L ti v y O l ` c ° E G c L a `c 4 o i O 4 O O � O P/ � O C h O V �0 4 z rt C I Z N O1 t � v o c cc N 6 U u U ° ` E `a aj G C LL .& e o °c y •� N = d o = z c°. lea !■ CERTIFICATE OF VERIFICATION 10 r �I' I h CF3R- MCH -20 -H r Duct Leakage Diagnostic Test-' (Page 1 of Project Name: 871 BETTE AVE forcement Agency: City of Cupertino Permit Number: 14120018 Dwelling Address: E AVE City: Cupertino Zip Code: 95014 A. System Information 01 Space Conditioning System Identification or Name System 1 02 Space Conditioning System Location or Area Served Location 1 03 Building Type from CF -111 Single family 04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from CF1R? No, credit is not taken 05 Verified Low Leakage Air Handling Unit Credit from CF1R? No, credit is not taken 06 Duct System Compliance Category Replacement MCH -20d - Complete Replacement or Altered Duct System B. Duct Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity (ton) 0 02 Heating Capacity (kBtu /h) 79 03 Conditioned Floor Area served by this HVAC system (ft2) 2100 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 Rate (cfm) 103 10 Actual duct leakage rate from leakage test measurement (cfm) 98.7 11 Compliance Statement: System passes leakage test Registration Number: 215- A6354167A- M2000002A -M20A Registration Date/Time: 2015 -10 -11 19:49:05 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 -1.006 Report Generated: 2015 -10-11 19:47:33 2013 Residential Compliance Schema Version: 2013.1.006 CERTIFICATE OF VERIFICATION CF3R- MCH -20 -H Duct Leakage Diagnostic Test (Page 2 of 3 ) B. Duct Leakage Diagnostic Test 12 Notes: C. Additional Requirements for Compliance 01 System was tested in its normal operation condition. No temporary taping allowed. 02 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed /taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. 03 If a complete replacement, all supply and return register boots were sealed to the drywall. 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All connection points between the air handler and the supply and return plenums are completely sealed. 07 If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements of Reference Residential Appendix RA3.1.4.3.6. Systems that comply using smoke test shall not be included in sample groups for HERS verification compliance. 08 Verification Status Pass - all applicable requirements are met 09 Correction Notes for this table The responsible persons signature on this compliance document affirms that all applicable requirements in this table have been met unless otherwise noted in the Verification Status and the Corrections Notes in this table. D. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 1 01 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: 215- A6354167A- M2000002A -M20A Registration Date/fime: 2015 -10 -11 19:49:05 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 -1.006 Report Generated: 2015 -10-11 19:47:33 2013 Residential Compliance Schema Version: 2013.1.006 CERTIFICATE OF VERIFICATION CF3R- MCH -20 -H Duct Leakage Diagnostic Test (Page 3 of 3 ) Documentation Author's Declaration Statement 1.1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: John Daley Documentation Author Signature: "W50 Company: Date Signed: Affordable Duct Testing 2015 -10 -11 19:49:05 Address: CEA/ HERS Certification Identification (if applicable): 16482 Severn Rd City/State /Zip: Phone: San Leandro CA 95456 510 - 754 -3960 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 (CF1R) 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, or Builder /Owner): JOE HEINEMANN Responsible Builder or Installer Name: CSLB License: Joe Heinemann 388314 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: Affordable Duct Testing Responsible Rater Name: Responsible Rater Signature: John Daley �� Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006540 2015 -10 -11 19:49:05 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215- A6354167A- M2000002A -M20A Registration Date/Time: 2015 -10 -11 19:49:05 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2013 -1.006 Report Generated: 2015 -10-11 19:47:33 2013 Residential Compliance Schema Version: 2013.1.006 V- 00 v- O li r a U a U G O H W 2 W U z Q J IL 2 O U W U Z 9 O LL W IL J g F- W N W V z a J IL 2 O U U- 0 W a U F= W IMF O N O � U X N � o � c O o m CO o T T T T O �d 4 t O N w d t0 E f7 O Z t0 LL 7 w V 7 CL V � N .N Q N U � w zt a Z Vi E M = z w. V � V a v VI m 'O LD > M M p C m IT CY N N C1 - c E m m cp 1n o O i e m n E U a, rn a ° o. 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CD V v N C) U x N N C � CO m c � N 00 d � E 3 CL C N E N U t6 N O d w O U c am W ° CL Z J c a °' � d O m V 0 W E Z C � d O E LL w 1� W M o J a H 0 W m O o a � T v W cc C N Q c V N a Z U r H 7 LU a 4) E o v 3 a a ,L a� g O Z v H m LU m IL m v a c y m V Z O O c v IL a+ 9 LU o m uj m u O V O m V 0 a` u 0 C K w U U U1 uj a 0 a H uj 2 N 0 ;t N GJ E a �O O 07 E z c 0 Y Y m z N m _ E N a VN f0 0 O O` e a E m N .y m m C 0 m ca N 7 CL Of E 8 C C An « w m E'er E ° CL z= T m c •m C C C N o a a� W a a E a U m m 3 16 a c = rn c N c E w VC O c ,o O m c U U N � m m m m O N m mm A a° U �0 w 2 a m N U @ c 0 O m CL m a ? vJ O CD w N o C C W O w Cn m a E mu N E o m La y N C O 7 O m m -• S) N v Ci « > C 0 n c N m N 0 c > E 0 p? mu. E 0 E°' •- mu. g m Mo=VT E N N W N- m a C 3 c m > > 5 m c rn— >s a m O Q c2 mu 54.2 m2 I D N C E W � V b O W L o 2- O LL> Q o Z 2 F- n m. 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CS 9 �a O � N 0 C O Qi m % o N C 0 C t N 0 C Co Ql � f"') C�9 Crl O v CD fa w 0 No No CD CD O 0 O � 00 ao c c m CD q q Ci N C O O O O O O O V Q 0 CL r¢ O 0 (D 0 � Y U m O C? O O lY N O O 0 Dl C N O O m V N O air E 'N CD O CD c O CD N A a V I N 7 W 3 a 0 � O O � C U d' d' W V O � CL N U LL � a i 4' a O 0 0 0 O O c O c O c¢ O O c N — h H N fn N — 0 U taL r 40 M Z O Ll 0 J _Cl y N4) a .2 O th tr N W t G Q a A CD O O O O O O Z 0 0 V m E 0 m O Z A M v C h Lo W O 0 0 C a m r O m O O 0 W of O O O O d' C C O O U N 2 O O t C O O ._ V Q m v O m Q Z U_ a r E m if O C U. J. v C No r o m E o r to t W 0 C d O G m r O c b O = OI 0 00 O Y p.vim. iC �a O � N 0 T O O Qi m % o N C 0 C t N 0 C Co Ql � f"') C�9 Crl O v CD O = N O O O a O O O � 00 ao c c m CD q q Ci N O O O O O O O O V 0 CL r¢ O � O C? 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CY H CL Z V o m r = 'Q ccp W Z c U m Q w Q § N r 0 O ° 0 () a � r � CD M CD w a C Q M LL O V O — a Q 0 O LL U H LU LU U U v .j O a 2 LU 2 M 4 N 0 N 6 FE a0+ 0 O C O v v E 7 Z C O R cc v C O r o ns o ` o a U. ° gU O N 2 Q m m H O O 0 M E a Z Y A J Q M o O i W c aa) Z o � Z '- 2 � D C O a C G y a) C J Q E C _0 c C4 LL T C H o a) a� 7 •� C � rq a a O Z m C CY CL o m r = 'Q N a N O — Q CY O LL C O A W > � W T w C O �' N LU LU O w c O Z N co Z T O Z co = W C1 Z m CY W = a, W H 3 0 U H LU LU U U v .j O a 2 LU 2 M 4 N 0 N 6 FE a0+ 0 O C O v v E 7 Z C O R cc T- CO U- C o: Lo a m CL U- ti v 0 N r O � U X 0) N c d p m n CO r � o r O ei v O N w d to � D � O Z 0 m ea 7 « U CL N co >+ f0 C Q N U � N O a a3i � Z y E to O c Z V � IL` v 3c � Q o a ° C N v� e O _Q to 3 9 Q ° c Z O mV m H w ° C Z O a c O 5 a Y! Q o D Z V m CL E O U ° c ° m Z m a C O 'a+ A N c Q ° c z m CL 'a Z O Q U 0.' W LU x m •- Z o Z O W = x � R' w a 3 co '� m O O O J O Q o d u c c O) L EE O O U .a `o co oc � T o e Z IL o W > ; c G in c 3 = N 9 H N 5 c � Q O co O A m o Z• O cm m c C rn N 0 O T u c � m c LL u rn C C5 c o m W m 0 a C O Z V U W Or G m E 0 0 ° U o o > m Ln o N .- C v 0 O) C E C O 0 0 N a C 0 c T N � CL m E M � c t0 m E O Y N m x Z U C A H � T N O) C t0 E (O' L m CL N H N 0 ° U r+ m m 0 a O m � x w N T N `y t_ CL m i0 Z O U A m Q cm E x m a � o Z Li W a� N U m i0 2 o Z Q x x o w a 3 3c � Q o a ° C N v� e O _Q to 3 9 Q ° c Z O mV m H w ° C Z O a c O 5 a Y! Q o D Z V m CL E O U ° c ° m Z m a C O 'a+ A N c Q ° c z m CL 'a Z O Q U 0.' W LU x m •- Z o Z O W = x � R' w a 3 v j c u. c m Q w � m c w m C a v o CD Llyy. t� m c Ll. C U C CD C O m o_ p A 0 Z U H Om C W r N C7 Z Q W x v x 0 L m O m Q Q o O.2 V1 04 N LL O) L EE O O U .a `o A 10 O � T o e Z IL o '- G :. E .0 3 = N 9 y T N 5 O D Q O C U m N Z• m c D N E o 22% N C c c c o m 0 a O Z V U Or G 0 0 ° U s m N .- 0 O) C E C O N a C T N � ° E O O m E a o m x Z U T N O) C (O' L 2 N m a 0 ° U � a C m m x Z N T N `y t_ CL J ° O U 0 O Q cm E v m a � o Z Li W U N x = v x v j c u. c m Q w � m c w m C a v o CD Llyy. t� m c Ll. C U C CD C O m o_ p A 0 Z U H Om C W r N C7 Z Q W x v x U C F w U U `v a 0 CL N 0: LU x N n 0 a N GJ E d 0 C O cu 61 d a E Z c O m w O m 01 w O pOp o m > E �l 0 y�y O) L W T. O O U .a `o m 0f w o Z O �v 9 O O C U Z Z• m c N o W W N V C v W ° W w .- O) C C O a C O H O E aEi a N w ai N T N (O' L N � C m Z CL J ° Z U 0 O cm E v o v U x U C F w U U `v a 0 CL N 0: LU x N n 0 a N GJ E d 0 C O cu 61 d a E Z c O m w r � C y 0 U.. l00 O {� O a C 0 'a+ r+ fp O C N � LL J a `1 a N 5 Q fD LL U N O 3 Q O U m ; O 3 z p m o. z m a v O W O 3 O a � C � N M � N cr 2 c O U a: r C U m > z O N a C T ly0 O 3 -J o A U X N p u7 U 0 p � m 7 c m 0 m z L W CO C �p W O I Q r r O m N C r Cl m > Z O N C! N eCCi O J G O 7 N O Q c z m = Q 0 m U ld O 47 ccm CL O tX l�0 J w Q N V � 3 m U_ p ui CL i U HG" O w M ° c " U 'E > l9 U O N 2 a J LU N y � z O a _U N y w m c a N m O z z L U co m aEi W T m U N r m 0 z Ln O Z 0 � `°- N U O = O a L C CE a W a CL N O m cr J U. (D z > W Q N W cu a O 'IT U U Q z U U O LL J y � a m v a W N O N O N O t S LU LL. N 0 V = m N O Z 4) O Z a N Z U. 0 o V Z r m U V U � 9 (D V C Ll O O v a U W a V = Lo N c U C H w U U a O a H CC x n 0 N 0 N N E m 0 c O _N 00 d oc d E 7 z C O .m w C y l00 O a C 0 'a+ r O > ; N � LL J a a N 5 Q fD S N 3 Q O m ; O 3 w p m o. z m a v O O 3 O a � C � s Z 2 c � U LL C U p o a C T ly0 � 3 -J o A p u7 U p � m 7 m z C LL C �p r m m c m Cl m o 0 m O C! N Y O J t9 O 7 N O m m = U ld O 47 ccm CL O tX l�0 J w Q N 3 Q U_ p U U. m /9 C O 'm- d > l9 U O N 2 N LU N y � z O _U N y w m c a N m y z z L O co m aEi T m m N r m 0 C Ln O Z 0 � `°- N U O = L= a U C H w U U a O a H CC x n 0 N 0 N N E m 0 c O _N 00 d oc d E 7 z C O .m w m l00 C 0 'a+ o ` LL J a a N fD a m Q p 0 z ; 3 Q 3 w p M a O O > r N m s Z 2 c LL O O m J •� p w l7 O p � m z C LL r m m m Cl m° o 0 m O Y m 3 J O V 7 0 p m = ld O 47 Z O O tX l�0 J w Q 3 Q U_ p U. _L W > U. W 2 y � z O _U N y w m c a mo m y z L N co m N r i5 p a m 0 Q Q 0 U C H w U U a O a H CC x n 0 N 0 N N E m 0 c O _N 00 d oc d E 7 z C O .m w C 0 'a+ LL C O a+ yC. Q <O O ; 3 Q w O ° 2 LL = W C LL e m 0 m O 3 O m 0 0 W U. U. _U CD co m a m 0 0 `°- C L= p C (J' a U. p l0 a m N O � 'cr U. U. m � C Ll > 0 Lo N c m 3 E C7 a LL C4 m FT U a a w (D a N Di C LL 0 LL U Q N N Lr) a z O � U I% W m y r ti N m E L L = a Li ° z > W N 2 H LU ie m c c N f7 = c H Q z 3 z a LL z O O p L C K = a U C H w U U a O a H CC x n 0 N 0 N N E m 0 c O _N 00 d oc d E 7 z C O .m w %- U U. G F�- a d m IL U U. U d v 0 a z w T O N r O U N X 0 � � c O � m T T r� N COI !� O T T O T 0 t 4 N T T N N N o E m c z o w d O R w =' U. a E W ;; U z g o c o J +r CL O m U z W U z Q O LL W W CL J _Q z °o o W ° A °o W co C C Q O W Q N to f'7 N J � a N ~ c Z o v O N U LL (D O Z W 0 a t a`, to p U Z o � w m owl _o U a U bD z r p� U. O W a � � R LL a v O N r O � U x N � 0 � C � O m r co O r r r r O O N m d Q E C Z O N N U. V 7 � a U = N y C6 C Q N U N N O cr _a Z fOA d d Q AC Z O V � 7 O V a` u U c H u c U 0 a u i 7 � y O n L LU u a Lq U UJ 7 W i = 5 0 n u C U Z N 0 A 7 0 7 r ? 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Ea �° Z L;�m O 4 y O L y O y m a f0 a° J W a o w o c J �, c M ai n W o ui ° y 0) Q w M -•° O m v E m U C r N Z CL w c m w w aci � o w cc U C r Q Z w U O t _O " O O � Q1 W ° cvmaC w c O O O Q1 U a L a Q Q c L L U -J 4) Z G C E° m w w U C 00 N O U O$ Q Z w v~ 3 N C U Cn Q O w is o U C CL y 04 y O a o a iii fO o C.) E -0 to r i a E � N tO o a 0 U Q U c H u c U 0 a u i 7 � y O n L LU u a Lq U UJ 7 W i = 5 0 n u C U Z N 0 A 7 0 7 r ? N u 7 7 L ui u E n y � c 0 U '� O u w w L 7 L 7 U 7 7 L 7 y o � O L ° � o 0 v ° O 7f p n O 0 v O a � n ONi ti c cc W N U •• U � -0 E ° w Z a c c O ° m N O w 4 s cc