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B-2016-1480CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:, CONTRACTOR: PERMIT NO: B-2016-1480 10714 LA RODA DR CUPERTINO, CA 95014-4444 (369 34 042) ( AIR QUALITY HEATING & AIR CONDITIONING INCORPORATED) SAN JOSE, CA 95126` OWNER'S NAME: PARBHAKAR SATISH AND POONITA TRUSTEE DATE ISSUED: 03/08/2016 OWNER'S PHONE: 408-497-0597 PHONE No: 408-293-7138 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO, - License Class C-20 Lic. #ZQ244f Contractor (AIR QUALITY HEATING &AIR CONDITIONING INCORPORATED) X BLDG —ELECT -PLUMB X MECH X RESIDENTIAL — COMMERCIAL Date 03/08/2016 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 JOB DESCRIPTION: license is in full force and effect. REPLACE (E) FURNACE, (NEW) A/C I hereby affirm under penalty of perjury one of the following two declarations: r. 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. / z ,%' 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 Sq. Ft Floor Area: Valuation: $10000.00 this permit is issued. APPLICANT CERTIFICATION APN Number: Occupancy Type: 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 369 34 042 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 PERMIT EXPIRES IF WORK IS NOT STARTED harmless the City of Cupertino against liabilities, judgments, costs, and WITHIN 180 DAYS OF PERMIT ISSUANCE OR expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will 180 DAYS FROM LAST CALLED INSPECTION. comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Issued by: ABBYAYENDE y�. Date: 03/08/2016 $ignature Date 03/08/2016 OWNER -BUILDER DECL TION RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of the installed without first obtaining an inspection, I agree to remove all new materials for following two reasons: inspection. 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 Signature of Applicant: for sale (Sec.7044, Business & Professions Code) Date: 03/08/2016 2. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: r. I have and will maintains Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health: & Safety Code, Sections 25505, 25533, and 25534, I will 2. I have and will maintain Worker's Compensation Insurance, as provided for maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the by Section 3700 of the Labor Code, for the performance of the work for which Health & Safety Code, Section 25532(a) should I store or handle hazardous this permit is issued. material. Additionally, should T use equipment or devices which emit hazardous a. I certify that in the performance of the work for which this permit is issued, I air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, ections 25505, 25533, and 25534. Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the , -Owner or authorized agent: Labor Code, I must forthwith comply with such provisions or this permit shalt Date: 03/08/2016 Vi be deemed revoked. CONSTR T N LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a cons uction lending agency for the performance I certify that I have read this application and state that the above information is of work's for which this permit is issued (Sec. 3097, Civ C.) correct. I agree to comply with all city and county ordinances and state laws Lender's Name relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Address to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally, the applicant I understand my plans shall be used as public records. understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed CUPEF TIN© GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino.om numBING MECHANICAL ;ELECTRICAL ❑MISCELLANEOUS t✓ `�"�t L4ou PROJECT ADDRESS rf j,, jD APN r 24, O�VNERNAME t-K*AL- PH 0 E-MAIL. STREET ADDRESS 1 , / CITY, STATE, ZIP FAX CONTACTNAME J P 0 ,,� ,„� � <� � E-MAIL STREET ADDRESS p CITY, STA IP l FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGEN'T ❑ CONTRACTOR ❑ CONTTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N LICE LICENSE TYP BUS. LIC 4 y t COMPANY NAME E-MAIL FAX STREET ADDRESS y CITY, ST I PHONE ARCHITECT/ENGrNEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ TNLTI-FAmmy I PROJECT I\ WILDLAN'D ❑ YES PROJECT IN ❑ YES BUILDING: ❑ CONaIERCLAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: RECEREDBY ,+ id"� By my signature below, I certify o each of the following: I am the property owner or authorized agent to act on the property Aner's b half. I have read this application and the information I have provide is correct. I have 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 sixuction. I authorize representatives of Cupertino to enter the above -identified p perry for inspection purposes. Signature of Applicant/Agent: Date: SUPP M AL INFORMATION REQUIRED oFics usE oi�, 4 k ; .STAI�'D4RD ,w. Y< 0 R�IAJOR " , z MEPttliscApp__MJ.doc remised 06121111 COivlifiiIJElf G��'EL�')P',P,ENTDEPARTk]ENT , RI Y VE f pli and spoci�ris xtions K I T �3 rC@ r l the d'u0nip, r ansivue Jon. it is unlawful to make any or ns on same, or to doviMe t:, smfrcm, without approval from the Building Official. ii� y E 9 g of tfsis Akan and specifications SHALL NU i, "ry sa ao;'3r,r ilt or to be ain E,,,pp oval of the violation cv. ,%ny p ov; ciCon3 of any City 11,dinance or e"", Yia, LaW. ` '.jkAl .— P� lsAw s r Pmp CUPERTIN Building Departm, -'Q 'R, 0 8 2 015 REVIEWED FOR CODE CON Reviewed By; T`.0 pW-,)ff441K M5611074ic- — /0 CU/.,�-7oVOY 'CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E Alterations to Space Conditioning Systems (formerly CF-IR-ALT HVAC) (Page 1 of 3 Project Name: 10714 La Roda Dr Date Prepared: 2016-03-08 A. General Information CFIR-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one CFIR-ALT-02 document for each dwelling unit. 01 Project Name 10714 La Roda Dr 02 Date Prepared 2016-03-08 03 Project Location 10714 La Roda Dr 04 : 'Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 10714 La Roda Dr 07 Zip Code 95014 08 Dwelling Unit Conditioned 2022 Floor Area (ft2) Number of space conditioning 09 Climate Zone 4 10 (SC) systems in this dwelling 1 unit. B. Space Conditioning (SC) -System Information ;B�Oi a' �9i:��' �� ��ll (� 11,1101 ,���0��66m ,�����' ,� p� 01 02 03 � 041,11igii . 0 ��tii�ll�i�,..� � � 061,ii 11���i, 07° ��' , ! ;� �;4, '�i 09 10 ����� i .�, Is the SC q'ql Ins aping a iipii_pi„� °Rlop,� 111 �Ep ��, I l rr SC System y Scsystem x CFA served W stem ty qm �� refri e a t �m '� a nstalli nev��S " �� �� ��, . �. I sta iig �' ,� nstalh g=nstallin 5'7 � Identification or Location or Area by this SC ducted r,.g .�" contammg � system F more than 40 w� entirely new entirely new Name Served System (ft2)-; system? component? components? feet of ducts? duct system? $C system? Alteration Type System 1 Location 1 _ 2022 Yes Yes Yes No No No Altered space conditioning system C. Extension of Existing'Duct System, Greater Than 40 Feet (Section1S0.2(b)1Diib) This section does not apply to this project. Registration Number: 216-A0089192A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-03-08 07:20:51 'HERS Provider: CaICERTS Report Version 2013 Rev 1.007 Report Generated: 2016-03-08 07:20:50 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E Alterations to Space Conditioning Systems (formerly CF-1R-ALT-HVAC) (Page 2 of 3 D. Altered Space Conditioning System (Sections 150.2(b)1E and F) 01 02 03 04 05 06 07 08 09 10 11 12 Heating Cooling System Heating Altered Heating Minimum Altered Cooling Minimum Required New or Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct or Name Type Components Type Value System Type Components Type Value Type Duct Length R-Value Central gas All new, Central split All new This field or This field or System I furnace heating AFUE 0.78 AC cooling SEER 14 Setback section is not section is not components components applicable applicable Required Documentation: CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans, -Duct insulation requirement for. new plenums: R6. CF211-MCH-20-H & MR-MCH-20-Iti — Duct Leakage testing re q6ired when heating or cooling components -are installed in ducted systems, or when more than 40 ft ofduct length is replaced. -Leakage rate compliance: 5151, or:5 10% leakage to outside, or seal all accessible leaks. CF211-MCH25-11 & CF3114ACH-25-H'Refrigerant Charge Verification required when refrigerant containing components are installed or'altered (applicable in CZ 2, 8-15), CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow z 300 Cf /t6n require ,when MCH-25 is required. Exceptions: -Duct systems registered with HERS provider as previouslyI sealed are, exempt from CH-20 Duct L age 1, m "'d r 11 m 1,60 1 o jhlll 0 eq­U1 6- r o Air Flow MC 6 -Handler/Furnace changes do n t, n -Heating-only systems and Air3 j le rig,�,,, I flill,,�L !IOU a b irorn M6 s -Existing duct systems constructed, insulated orsea s e _!1!LJ,1 ka eTes4n �,Mqui' led with sto -are exemp A "At - �!111 9 , ", X, R E. Entirely New or Complete Replacement Due 0. 2 (b) 1 E, F) 7 r7,ithout,Eql m,ent.Chan p, ut,($e,cti9,nsJ 0.2(�)J and Jem, with 1, �kmilr V, 4 Tp i4l6w 11ki � ;Ili 4`4 This section does not apply to this project. F. Entirely New or Complete Replacement $pace Conditioning System (Section 150.2(b)IC) This section does not apply to this project. Registration Number: 216-A0089192A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-03-08 07:20:51 HERS Provider: CalCERTS, Report Version: 2013 Rev 1.007; Report Generated: 2016-03-08 07:20:50 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R ALT 02-E Alterations to Space Conditioning Systems (formerly CF-IR-ALT-HVAC) (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature:_ Farber, Matt Company: Signature' Date: AIR QUALITY HEATING &,AIR CONDITIONING INCORPORATED 2016-03-08 07:20:51 Address: CEA/ HERS Certification identification (if applicable): 720 NORTHRUP STREET City/State/Zip: Phone: SAN JOSE CA'95126 1408-293-7138 Responsible Person's. Declaration statement, certify the following under penalty of perjury, under the laws of the State of California: " r 1. The information provided -on -this Certificate of Complidnce is true and correct. 2. I am eligible under Division 3 of the Business and Professions Code -to accept,responsibili"ty for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. That the energy-featuresand performance specifications, materials; components, and anufacturetl devices for the buildIn d s,ign-ci system desi n identified on this' Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part is of the California Code of " latrt ns tllh ° Ili II I( I119Ii j ti 0i"r 4. The building design features or system design feattjres identified o; his Certfrcatnpf lance are'ddsste pw:t the ocm� ,provided . nth�appLca e compliance documents,worksheets, calculations plans and specifications submitted,0 the a rcerr en :y forIt vthis bull ng pert a icat _. _. — .. ,,,., hi x i k 5:- ""I wdl"ensure thal-a registered copy i5ffhis Ceitific'q C, pliance s lijpemale.avail„ le �itliXe b�(itliy P l mrt .;, issud fon'�bUil g, an�, wife avallabinforcement agency for all applicable inspections. I understand that a'registeted copy of t2 ficate of CoTpl anc IlsyFegytr d to ; induded iwith th Ilpreocumentation theiip er p I yides t t)Ie brilding owner at occupancy. ;III„ I ,. (i Responsible Designer Name: - � � � �6 � I "�Ii ��� Responsible De �g�er S�gna �ure: � �� 1 Farber, Matt Company: Date Signed: AIR QUALITY HEATING & AIR CONDITIONING INCORPORATED 2016-03-08 07:20:51 Address - : — -- - _ - License: � ---- — - - - --- - - 720 NORTHRUP STREET 769446 City/State/Zip: Phone: SAN JOSE CA 95126 408-293-7138 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Providerresponsibility for the accuracy of the information. Registration Number: 216-A0089192A-000000000-0000 CA Building. Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-03-0807:20:51 Report Version: 2013 Rev 1.007 Schema Version: 0.555SDD HERS Provider: CaICERTS Report Generated: 2016-03-08 07:20:50 E�u 37".A&�.K7rG.Rtip�Ji"Ak7V 1 �/�'p (�yup.� B pp�� ATE OF �yA .p�r� epyY CE L'is COMMUNITY DEVELOPMENT' DEPARTMENT ® BUILDING DIVISION FILE CUPERT,INO 10300 TORRE AVENUE e CUPERTINO, CA 95014-3255 - , �3�0 (408) 777-3228 FAX (408) 777-3333 - building(a)cupertino.org �.. a e; C N q Sa 14 PFRMIT CANNOT BE VINA 11bb AND COMPLETED UNTIif THIS CIF&RT-IFICATF XN ,9�'- -M"T to ffrqWDTNGb11IBC? 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 in the following locations: AREA I SMOKE ALARM co AtAiRM Outside of each separate sleeping area in the immediate vicinity of the X X On every level of a dwelling unit including basements Wffhin each sleeping room X X X Carbon'. Monoxide alarms are not required ilz dwellings win ch do not contain fuel -burning appliances an. that dcv not have an attached garage. Carbon monoxide alarms cornbuled with smoke alarms shall comply with CBC Section 420.6i and shall be approved by the Office of the State Eire Marshal. Power Supply In. dwel+`ling: units with no commercial power• supply, ala i m(s),, maybe solely battery operated. In existing, dwellii%g un l=s alarms are permitted to be solely battery operated wl'ere repairs or alterations do not result iri, the removal of wa s i and ceiling, f lushes os there Is, nor, access by means of a '.ttrc,. baseent or, crawl', s.pace.. Refer toy CRC Section RM4 and CDC Sectzores 907.2.11.41 and 4206.2.. An electrical permit is regle fired( for` 3 alari�swhich m�xst.be co'nected to the bri�ild>Lng, wiring:.. As owner.' @,i the ab'oue-referenced property, I hereby certify that the alarm(s) referenced above has/lriave beeii; °f r sta,Nedi any accordlance with the, mwanmufac, tiarer's innsft, { e ionn+s and in, co:, = p)klance with the Cakifarri�a BuiMl R-a amd Cairifonn a, Hesident gal. Codles. The alarrms have beeiR tested' ,, ;dl are operational' as= of the date srgnied � bellow.. RinaV r_,cad+ar0 ee:fbco-,1bV1with),Fhat;iD sban,0con,dfl n!s.offtuhs,sNfemen ...!``° Dais �wFtiea; d ......... ........ s It Sirlture,_, .... ...... Ca Dail Snake an& COfbrnv. roc rei,fsectE 03/181X'4 ,W,AlT�,,E'R,.�CONSERVING,PjLutAaiN(; nxaun, OWNERCERt,*ICATE OF COMPLIANCE COWUN DEI/IEUOPUMTID-EPARIUENT-!B.UILDNGDtVISION FILE I Wi 10300 TFORR-E AVjE-fjVj E 1CLMRTJN0, CA V5014-3255 CUPERTINO elt P8,3T,7-322 o'FP'�4M777-3333.obukdinq�w Owner Nam r 00 PermitNolk Address i-L714 Lc---RJb 1. Is your real property a registered historical site E) yes Civil Code Sections 1101.1 through 1101.8, do not apply. Skip the rest of the form and sign bottom of form N-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? 0 Yes Civil Code Sections 1101.1 through 11013 donot apply. 0 The licensed plurnha'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? 0 Yes Civil Code, Sections 1.101.1 through, 1101.8 do not apply. Skip the rest of the form and sign bottom of form. L4W l KNo Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 19 9-4? 0 No My real, property is built and avAlable for use of occupancy after January 1, 1994 Civil Corte Sections 1101.1 th-roup ft-, 1101.8 do not apply. Skip the rest of the. fonn, and sign bottom of form. 0:11 Yes My real property is built and available for use or occupancy on or before ]anuxa-ry 1, 1994. Civil Code Sections 1101.I - thro-ag-h- 1104..8 apply. Check one of the three following statements and sign bottom, of form.. 5. Please check Mofthe following : My p#dp&4 is a s4n residenirab real property See Civil Code Section 1101,4. On aftd, after, January 1, 2014, building alterationg, Or, improvements shall require aff', MA-cOMPHaRt plumbing, fqxtures to be replaced with. water=conserving plumb -,.g, fi, i.. r, . in Itu esthuoug-hout the build mg-. Gnorbddare January 1, 2017, all non- compliant plumbing fixtures; shall be replaced, with *a -ter -conserving prIumbimig fintwes (regaTdless of whether property undergoes, alterations or impf ovetnents), 0 My property See Civil Code Section-. HMO-, - Ori and after Jarinxary I r 2014, specified iul'ding alterat ions or irnpro vements shall regain -n t � on-c compliant mplian - pluming fixtures, to, be replaced with wafer conserving p-juim.birig fixtures On or before January 1, 29119, all non compfiantpl, =.,-- hinig fixt ares shall be'Fepl'ta -16 w4h water- consewing plumbing, &tmes, throughout the b &,19,(,regaTdlessofwhethcerpreputys-,nder,,goesatterationsor improvements)}. 0, My PYGP erty iq, at commercial" Feal PEOP-64Y-- -e, Civil C ' Secti n, 1 015 & t k Gde 0'' 1, . . On and after January, 1, 201-4, specified building; all'terafio m. or improvements skaff requilre, non- compliant plum'bing, fixtures to be replaced with water -comers ,ing. plumbing fixtures. OR, or befbit& Tunuaqr It, 2919,,, A non-complimf plu%bing, fixtures shall: be replaced with water,- conserving pluins,1111g, fixtures tlzoagfio-at tTw, buildfirg (yegar&ess, of whether property undergoes; alterations or Im proVements). I 11, as the, owner or owner's; agent of this; property,,. certify under penalty of perjury that non n- c em, pRant plumbing fixzt, u.res will be replaced prior to, date speeifizdl, above., wit h water -conserving plumbing fixtures in accorda-riat wiffitClvlt Code Sections 1101.1 through � 111011. 8-,,, they current Calrfor n is Plum b Code and California G-remi, Building Standards: Codt, and, manufacturer's, installation reqpfiemptats, and, that tfte:water-conserving plum, bing fixtures comply with the requirements as indicated in, the table on the fbllbwinzimize; /-% Owner or, Owne r ftpntts Upon, co mp retffig, and sfigping- thisi Ceitffizate;, please return it to the Building Erivis-Lon, in. order to finali your.. buRAjing . per m- q, ST4.67,201,15. doc revised 08,12,611d xx7.x� rilry' CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans Project Name: 10714 La Roda Dr nforcement Agency: City of Cupertino Permit Number: B-2016-1480 Dwelling Address: 0714 La Roda City: Cupertino Zip Code: A. General Information 01 Dwelling. Unit Name 10714 La Roda Dr 02 Climate Zone 4 03 Dwelling Unit Total Conditioned floor 2022 04 Number of Space Conditioning 1 Area (ft2) Systems in this Dwelling Unit. 05 Certificate of Compliance Type Prescriptive alterations (CFIR-ALT) 06 Method used to Calculate HVAC Loads ACCA_ManuaLl 07 CalculatedDwelling Unit Sensible 38000 OS Calculated Dwelling Unit Heating Load - 75000 Cooling Load (Btuh),. (Btuh) 09 Dwelling Unit Number of Bedro*s 3 weft ., '. iki0jN. i��� s�ai r,Ed. a Fan�MCH-01b Prescriptive Alterations -Space,'Conditoning stems �tpi f ICI F klT'111 I � �I- r �or ,, � B. Space Conditioning, (SC) System" Information I� = V�- �� x.N ND, 01 02 03 04 ` 05 06 07 08 09 10 SC System SC System CFA served Is them system a refrigera t refrigerant Installing new SC Installing more Installing Installing Identification or Location or Area by this SC ducted containing system than 40 feet of entirely new entirely new SC Alteration Type Name Served System ft2 y ( ) system? component? components? ducts? duct system? system? Altered space System I Location 1 2022 Yes Yes Yes No No No conditioning system L Registration Number: 216-A0089192A-M0100002A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-03-09 08:36:48 Report Version: 2613 Rev 1.007 Schema Version: 2013.1.007 HERS Provider: CalCERTS Report Generated: 2016-03-09 08:36:31 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 2 of 7 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 This field All new All new N/A - no or System I Central gas heating AFUE 0.78 Central cooling SEER 14 Setback ducts secti6 Not a CA furnace componen split AC components replaced n is system is not applic able 1 108 . "W11K. "T' i'MR, TANI' 1111111� IMMI P D. Installed Heating Equipment Information bm Milk 01 03 4 U5 31111 '! 6 A I'� 07 System Identification or gow, Vjk "I&A, I' Heatli f 6 njitf eating,Unit �Iea� g,bnit 1"I" 'R'!"'mH`iati' 'iin RatedHeatingCapairity, Name Heating Efficiency Type Value Manufacturer Model Number number Output (BTUH) System I AFUE 0.97 Carrier 59MN7AO80V212 0516A47097 78000 0 Notes: Registration Number: 216-A0089192A-M0100002A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-03=0908:36:48 HERS Provider: CaICERTS Report Version: 2013 Rev 1.007 Report Generated: 2016-03-09 08:36:31 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 3 of 7 ) E. Installed Cooling Equipment information 01 _ 02 03 _ 04 05. 06 07 08 Condenser or Package Unit Condenser or Condenser or ondenser or System Rated Cooling Condenser Rated System Identification Cooing 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) System 1 SEER 16 Carrier 24ANB348A00 3715EO4216 46000 4 Notes: H. Installed Air filter Device Information This section does not apply to this project. I. Air Filter Device Requirements This section does not apply to this project. Registration Number: 216-A0089192A-M0100002A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-03-09 08:36:48 Report Version: 2013 Rev 1.007 Schema Version: 2013.1.007 HERS Provider: CalCERTS Report Generated: 2016-03-09 08:36:31 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 4 of 7 ) 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 Are Leakage eakage 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 Existing duct ,system is NO System 1 Location 1 insulated or No No No No No No sealed with Exemption asbestos �� ��' �� (I7F ,p I �I�i F ������INC�"il��ii� �i ��"I ,off �� �' 'li� Notes:r� . 1'tihp ii I�� 1 (� 4 (I {`� ' II'e` � .: @��i il, WG�� ao�6 1��Idillid:�lllltT � ��j����ial i � a �G I (I�dP i�i ..�+ h, IUr a° Dili ill ii 4111 a%ri �'Nbiw Registration Number:216-A0089192A-M0100002A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-03-09 08:36:48 HERS Provider: CaICERTS Report Version: 2013 Rev 1.007 Report Generated: 2016-03-09 08:36:31 Schema Version: 2013.1.007 Rl CERTIFICATE OF INSTALLATIONCF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 5 of 7 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 Equipment Efficiency: All heating equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency 01 Regulations. Controls: All unitary heating systems, including heat pumps, must be controlled by a setback thermostat. These thermostats must be capable of allowing the occupant 02 to program. the temperature set points for at least four different periods in 24 hours. See Sections 150.0(i), 110.2(b). 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 03 150.0(h)1 and 2). Furnace Temperature Rise: Central forced -air heating furnace installations must be configured to operate at or below the furnace manufacturer's maximum 04 inlet -to -outlet temperature rise specification. See Section 150.0(h)4 .. 05 Standby Losses and Pilot Lights: Fan�type central.fUrnac ii� hot haves c i t�n�io abut tri ilotl��� i� 9ction 110 §,and Section 110.2(d). �� I;is y 12 ill N Cooling Equipment, ���i, �1 ai � l limml ul'u , y�� l!I�'� 0, Milli!�� Q6 uil�I d, i. Equipment Efficiency: All cooling,equipment must[' eetth ` rr> irri a i�ciencjM�'require "� ���;ntsl;b' Sectid, 1 �,�and Sec�tion 1 '��2(a a;nd the Appliance Efficiency �1I �;: iillr �IIl.S, �� Regulations. .o`!I 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 07 150.0(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. 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 09 150.0(h)1 and 2. Air Distribution System Ducts, Plenums and Fans 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 10 required by the prescriptive or performance requirements. See Section 150.0(m)1. Registration Number: 216-A0089192A-M0100002A-0000 Registration Date/Time: 2016-03-09 08:36:48 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-09 08:36:31 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 6 of 7 ) 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. 1S Second stage back up heating shall be set to come on only when the indipor set tern erature cannot be met. io::�o�'l:o� F�a- ����f'�Qiro +�_'NhI .��.i�ii IIlC�hl ,114I�G Iip The responsible person signature on this compli nceadocume ;t affirm t t I pplicabje requi)^e tits i t this le have b e �i Ali " "' l �'� �'�i G :� � li: �Il l . 01.) i r O �i 7pMN� i7 i� ��I � 1Oi li� F �P nN `�I NNE III,a � II i� hl ( �aiu��J(���i����� ,. Registration Number: 216-A0089192A-M0100002A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-03-09 08:36:48 Report Version: 2013 Rev 1.007 Schema Version: 2013.1.007 HERS Provider: CaICERTS Report Generated: 2016-03-09 08:36:31 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 7 of 7 ) Documentation Author's Declaration Statement 1.1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: I:lf�/r Farber, Matt //'1(/I `Z Company: Signature Date: AIR QUALITY HEATING & AIR CONDITIONING INCORPORATED 2016-03-09 08:36:48 Address: CEA/ HERS Certification Identification (if applicable): 720 NORTHRUP STREET City/State/Zip: Phone: SAN JOSE CA 95126 408-293-7138 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'ofthe 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 ofthe res o,sible builder. instailer plt!t kl' fi . it t J II "I'i li ' ° ithis ertifi% Installatio co " Pr "° to; (Il6 Olicable codes and regulations, and the 3. The constructed prinstalled features, materials, components or m° ufacturedA"tiev ce, ah" °installation), itl nt ed a of p ( ii a z air !' Ii'Gr' IG I ' installation conforms to the requirements giv ri on th ` ans and sllecificatio sap ro„ d the enfor emen en .i n!.§. III+I 4� -i 4. I reviewed a copy of the Certificate of Compliancy `red by the eiif rcemerat pen tha it�e Etas t pq ific rQquire ti enis spa o Icon'Ii uctioh o, ' (a Ila on identified on this Certificate of rr,I �...,. ii�� ��+ Installation, and l have ensured that the.tequireme�Il� ;;applyto the construction or installation have been met. °111, 1" . r ,' L..(Ili. ( r- .': 4"ni't I. �ipNli�4.. ii.., h `� ( S. I will ensure thata registered copy of this Certificate of �ns llation sh; tiLbe pos.I ed, or�`, a'de avai�at le with„ the bu0dip'g p mrt s)' Is G °� fo�he puil�� ng nd ma ells vailable to the enforcement agency for all ob�uilder'provides building at occupancy. applicable inspections. I understands that a,registered copy this Certtifica a oY nstallatioK is tdgbired to be included"v` ith elf' ocumentatidn th' to the owner Responsible Builder/Installer Name: Responsible Builder/Installer Signature: Farber, Matt Company Name: (Installing Subcontractor or General Contractor or Builder/Owned Position With Company (Title): AIR QUALITY HEATING & AIR CONDITIONING INCORPORATED Installer Address: CSLB License: 720 NORTHRUP STREET 769446 City/State/Zip: Phone: Date Signed: 12016-03-09 SAN JOSE CA 95126 408-293-7138 08:36:48 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-A0089192A-M0100002A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-03-09 08:36:48 Report Version: 2013 Rev 1.007 Schema Version: 2013.1.007 HERS Provider: CaICERTS Report Generated: 2016-03-09 08:36:31