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15110074CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15110074 10500 CASTINE AVE CUPERTINO CA 95014 (326 41 033) THAELINE CONSTRUCTION INC SARATOGA, CA 95070 OWNER'S NAME: VASANTHARAM KARKADAAND VIIAYATRUS DATE ISSUED: 03/28/2016 OWNER'S PHONE: 408-334-7660 PHONE NO: (408) 741-3000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #508967 Contractor TIMELINE CONSTRUCTION INC Date 11/30/2017 _BLDG _ELECT _PLUMB MECH RESIDENTIAL _ COMMERCIAL 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. JOB DESCRIPTION: CREATE (l) ADDITION (589 S.F.) AT SIDE YARD; I hereby affirm under penalty, of perjury one of the following two declarations: REMODEL (E) BEDROOM TO CREATE (1) LAUNDRY ROOM 1. 1 have and will maintain a certificate of consent to self -insure for Worker's (120 S.F.) Compensation, as provided for by Section 3700 of the Labor Code, for the -performance of the work for which this permit is issued. Rev#1 - TEAR OFF; INSTALL OSB; INSTALL COMP SHINGLES (18 i. I have and will maintain Worker's Compensation Insurance, as provided for by SQ S) - Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $180000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 326 41 033 3 26 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 PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this 'Npermit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 5/27/2016 Issued by: Leggev Date: 03/2812016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) _. z. I, as owner of the property, am exclusively contracting with licensed -' Signature ofApplic contractors to construct the project (Sec.7044, Business & Professions Code). Date: 5/27/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO E CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. s. I'certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall ��4��� be deemed revoked. Owner or authorized agen APPLICANT CERTIFICATION Date: 5/27/201 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) 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 Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands ARCHITECT'S DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal 1 understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 5/27/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building,@ " cu1)ertino.org f (`� +CUPERTIiVQ t�l� OJ� ' ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI j REVISION / DEFFRRED ORIGINAL PERMIT # PROJECT ADDRESS �� ® Cc�s� APN # 2Zb— (d 1 - o33 OWNER NAME PHONE E-MAIL MOA.va C0 STREET ADDRESS ` CITY, STATE,ZIIP ® ®1 FAX CONTACT NAME, U e�_ PHONE E-MAIL IffAb'A 0 1r ri¢ a ICI 5i STREET ADDRESS ly v $j w R DWELLING UNITS: CITY, STATE, ZIP SAC SECOND STORY ❑ YES FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEq,LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME IF YES, PROVIDE COPY OF PLANNER'S NAME: E-MAIL p TO EVALUATION`. PLANNING ADPL p ❑ NO FAX STREET ADDRESS ® CITY, STATE, ZIP C9 PRONE 1$o(5—S�i2—csz 8 i ARCHITECT/ENGINEER NAME Date: -0 SUPPLEMENTAL INFORMATION RF-QLU DP LICENSE NUMBER Rouinvc SLiP. _ New SFD or Multifamily dwellings: Apply for demolition permit for BUS. LIC # COMPANY NAME existing building(s). Demolition permit is required prior to issuance of building , E-MAIL permit for new building. ❑, EXPRESS FAX STREET ADDRESS ❑_, STANDARD ❑ PUBIJ ovoRxs ` CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Ll ATTACH - - R DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ ITS IF YES, PROVIDE COPY OF PLANNER'S NAME: RECEIVED BY " $� TO EVALUATION`. PLANNING ADPL p ❑ NO PLANNING APPROVAL LETTER By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on 4 propeNy owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to builpin construction. I authorize repre matives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: -0 SUPPLEMENTAL INFORMATION RF-QLU DP a:v.cHEcxTYPE,� ' Rouinvc SLiP. _ New SFD or Multifamily dwellings: Apply for demolition permit for ❑ = ovER THE coIIxTER ❑ siJILDIxc PLAx REviEw existing building(s). Demolition permit is required prior to issuance of building , permit for new building. ❑, EXPRESS ❑ `PIANNIIVG'PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑_, STANDARD ❑ PUBIJ ovoRxs ` form if any Hazardous Materials are being used as part of this project. LARGE ❑ 4FiRE D1 P1 _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑, MAJOR ❑ SANITARYSEWER DISTRICT <- submittal of Building Permit application. :.. ❑' ENVIRONMENTAL HhJA6i . B1dgApp_2011.doc revised 03/16/11 o,I7 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15110074 10500 CASTINE AVE CUPERTINO CA 95014 (326 41 033) TIIv1ELINE CONSTRUCTION INC SARATOGA, CA 95070 OWNER'S NAME: VASANTHARAM KARKADA AND VUAYA TRUS OWNER'S PHONE: 44083347660 LICENSED CONTRACTOR'S DECLARATION e%,, , -C License Class CONCRETE Lic. #598967 Contractor TIMELINE CONSTRUCTION INC Date 11/30/2017 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. I have and will maintain a certificate of consent to self -insure for Worker's DATE ISSUED: 03/28/2016 PHONE NO: (408) 741-3000 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: CREATE (l) ADDITION (589 S.F.) AT SIDE YARD; REMODEL (E) BEDROOM TO CREATE (I) LAUNDRY ROOM (120 S.F.) Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I Sq. Ft Floor Area: I Valuation: $180000.00 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 permit.. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. (Signature N Date/23 8/20.16 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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 revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, ,judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 3/28/2016 APN Number: Occupancy Type: 326 41 033 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: 3/28/2016 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: 3/28/2016 "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(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by t e Bay Area Air Quality Management District I will maintain compliance with t e Cupertino Municipal Code, Chapter 9.12 and the Health & Safetyode, Sections 2 , 25533, and 25534. Owner or authorized agent: Date: 3/28/2016 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 shall be used as public records. Licensed Professional f CUPERTINO CONSTRUCTION PERMIT APPLICATION II I , COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.ora ❑NEW CONSTRUCTION 4R ADDITION n ALTERATION/TT n RFVTsmN/nFFFRRFn ()PT(-TKAT PFRTRTTR PROJECT ADDRESS R ` � O APN # 9 \ OWNERNAME PHONE�4bg) `"34J((® STREET ADDRESS e , �n t S V CITY, STATE, ZIPv` FAXCitMWiCISW4- CONTACT NAMEt1i SAI PHONE ( 9)i95 g E-MAIL 5C STREET ADDRESS \ S � � 4 y� %� rs, , i ('Ca "'RV CITY, STATE, ZIP c � q y� E� FAX v �+1`T�4J. ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 0 LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANYNAME E-MAIL FAX STREET ADDRESS A4 i t. `� 1 tru CITY, STATE, ZIP(� K07 CA CA Ei PHONi� �Q 14-1 �t Cy ARCHITECUENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ' EXISTING USE PROPOSED USE CONSTR. TYPE - # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEWFLOOR® AREA ®Cl DEMO AREA TOTAL NETAREA BATHROOM KITCHEN OTHER q REMODELAREA REMODEL AREA ' REMODEL AREA r�l PORCH AREA DECK AREA TOTAL DECP/PORCH AREA GARAGE AREA: DETACH ❑ATTACH # DWELLING UNITS: IS A SECOND UNIT [:]YES SECOND STORY ❑ YES BEINGADDED? []NO ADDITION? ❑NO i PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES - L 7 x x .. s x ]:OTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO C li�o ®,o® By my signature below, I certify to each of the following: I am the property owner or authorled agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -id miffed property for inspection purposes. Signature of Applicant/Agent: 1 t '� Date: 1 SUPPLEMENTAL INFORMATION REQUIRED rr �iv.c,Ll l r :#. RouinvG.WNW uiEVI, New SFD or Multifamily dwellings: Apply for demolition permit forsVIIDING existing building(s). Demolition permit is required prior to issuance of building permit for new building. 4NRET LAM 11QGL.WOW '. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure DaxD ruBLlc�oxtcs L sTAN77 _ form if any Hazardous Materials are being used as part of this project. ©' l _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. LARGE. EHtE IIEP7i `iMA.IOR 1AR SEWERDISTRIC .ft BldgApp_2011.doc revised 06121/11 ZV ADDRESS: 10500 Castine Ave DATE: 11/12/2015 REVIEWED BY: PAUL APN y 326 41 033 BP#: VALUATION: $180,000 *PERMIT; TYPE "',Building Permit II-Bj11-B,IV,V-B PLAN CHECK TYPE: Addition IR3PLNCK PRIMARY ` ' SFD or Duplex ;,-.., IR3INSP 2nd Unit? 0Yes Q No OTC., Yes (E)No PENTAMATION PERMIT TYPE: 1R3SFDADD wORK'• Create'•` N Addition 589 S.f. at sideyard; Remodel E bedroom to create N Laundry Room 120 SCOPE S f) E Suppl PGFee ,'� Reg. OT 0.0 hrs it Permit? 0 Yes (F) No $0.00 mining Fee: IPLLONGR $82.46 >n Fee IBSEISMICR $23.40 f IBCBSC $8.00"'- $4,433.86 8.00• $4,433.86 $431.00 0 • 4 ti .� , Select a Non -Residential 0-1 Building or Structure Select an Administrative Item _- TCITAL FSE $4,864.86 Revised...10/01/2015 ,/,� i n - OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom), :' II-Bj11-B,IV,V-B 589 $2,654 0,C`J IR3PLNCK $1,666.00 IR3INSP NOTE, This estimate.does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Disirict,,etc'). 41;hese• ees are based on the Prefintdina information available and are only an estimate. Contact the De t or addn'l in o. FEE ITEMS (Fee Rcsoliction .1.1-053 -053—ff. %'11131 FEE QTY/FEE MISC ITEMS Plan Check Fee. ; $2,654.00 120 s.f. Remodel, Other $431.00 IRENIRESOTH Suppl PGFee ,'� Reg. OT 0.0 hrs $0.00 PMEPlan Checks .. " Permit Fee $1,666.00 Suopl jnsp ,Feee Reg. 0 OT Fo,0 hrs TOTALS: 589 $2,654.00 $0.00 $1,666.00 $0.00 it Permit? 0 Yes (F) No $0.00 mining Fee: IPLLONGR $82.46 >n Fee IBSEISMICR $23.40 f IBCBSC $8.00"'- $4,433.86 8.00• $4,433.86 $431.00 0 • 4 ti .� , Select a Non -Residential 0-1 Building or Structure Select an Administrative Item _- TCITAL FSE $4,864.86 Revised...10/01/2015 ,/,� P"'U A Pian {,J"Fg L'; i £ r£:.1 -lar G..{`£'?71 IcE3 t/1hvR. i/ ;. `£3} Eft. G::� S It %.i ..E4i. f %£'? #: 6., sY,..i}. , S1,-, t"ti }ro f.gga Phoii; .Imii. ` £:. .iillj �.'. NOTE, This estimate.does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Disirict,,etc'). 41;hese• ees are based on the Prefintdina information available and are only an estimate. Contact the De t or addn'l in o. FEE ITEMS (Fee Rcsoliction .1.1-053 -053—ff. %'11131 FEE QTY/FEE MISC ITEMS Plan Check Fee. ; $2,654.00 120 s.f. Remodel, Other $431.00 IRENIRESOTH Suppl PGFee ,'� Reg. OT 0.0 hrs $0.00 PMEPlan Checks .. $0.00 Permit Fee $1,666.00 Suopl jnsp ,Feee Reg. 0 OT Fo,0 hrs $0.00 P1VIE LFnif Fee $0.00 PME,Permtt Fee:,: $0.00 ¢g s y 9 L.. noir }�fi ��fi FA f CC: i it Permit? 0 Yes (F) No $0.00 mining Fee: IPLLONGR $82.46 >n Fee IBSEISMICR $23.40 f IBCBSC $8.00"'- $4,433.86 8.00• $4,433.86 $431.00 0 • 4 ti .� , Select a Non -Residential 0-1 Building or Structure Select an Administrative Item _- TCITAL FSE $4,864.86 Revised...10/01/2015 ,/,� CUPERTINO 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: PERMIT # I l C)O OWNER'S NAME: ti PHONE # 2— GENERAL CONTRACTOR: `--evio BUSINESS LICENSE # ?-2=355C) ADDRESS: 4 ' \ (.1 CITY/ZIPCODE: CA' �� *Our municipal code requires all usinesses working ie city to have a City of Cupertino b iness license. NO BUILDING FINAL OR FINAL OCCUPANCY NSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation�— Landscaping Lathing Masonry Painting/ Wallpaper }�(✓ �, n �} r 2 Paving Plasteringr CC -0 CT V Plumbing C� L Roofing << `\�r1 �1��► n — 1 rte-- ✓. Septic Tank Sheet Metal Sheet Rock 3`o3 `/ Tile Owner / Contractor -,3 t- C -plea Date CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 1 of 8 ) Project Name: Vasantharam Enforcement Agency: City of Cupertino Permit Number: 15110074 Dwelling Address: 10500 Castine Ave City: Cupertino Zip Code: 95014 A. General Information 01 Dwelling Unit Name Vasantharam 02 Climate Zone 4 07 Dwelling Unit Total Conditioned Floor 09 10 Number of Space Conditioning 1 03 Area (ft2)1890 Installing a 04 Systems in this Dwelling Unit. Installing 05 Certificate of Compliance Type Prescriptive alterations (CF1R-ALT) 06 Method used to Calculate HVAC Loads NotApplicableEquipmentChangeout 07 Calculated Dwelling Unit Sensible This field or section is not applicable 08 Calculated Dwelling Unit Heating Load This field or section is not applicable Name Cooling Load (Btuh) System ft2 y ( ) ducted (Btuh) components? 09 Dwelling Unit Number of Bedrooms 4 MCH -01b Space Conditioning Systems Ducts and Fans - Prescriptive Alterations 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 a Installing new SC Installing more Installing Installing Identification or Location or Area by this SC system a refrigerant system than 40 feet of entirely new entirely new SC Alteration Type Name Served System ft2 y ( ) ducted containing components? ducts? duct system? system? system? component? Entirely new or complete replacement duct Bryant Whole House 1890 Yes Yes Yes Yes Yes No system with or without equipment changeout Registration Number: 216-A0335856A-M0100002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:03:35 Schema Version: 2013.1.008 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 Heating Efficiency Type Heating Efficiency Value Heating Unit Manufacturer Heating Unit Model Number Heating Unit serial number Rated Heating Capacity, Output (BTUH) Bryant AFUE 98 Bryant 926TA048080V17 1916A45984 Central Fan Notes: Condenser Rated Nominal Capacity (ton) Bryant SEER 17 Bryant 187BNA048000 5015E00623 48000 4 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 All new Central gas heating Central All new Not a CFI Bryant AFUE 98 cooling SEER 17 Setback GT40Ft R6 furnace componen split AC system components is D. Installed Heating Equipment Information O1 02 03 04 05 06 07 System Identification or Name Heating Efficiency Type Heating Efficiency Value Heating Unit Manufacturer Heating Unit Model Number Heating Unit serial number Rated Heating Capacity, Output (BTUH) Bryant AFUE 98 Bryant 926TA048080V17 1916A45984 78000 Notes: Condenser Rated Nominal Capacity (ton) Bryant SEER 17 Bryant E. Installed Cooling Equipment information 01 02 03 04 05 06 07 08 Condenser or Package Unit System Identification or Name Cooling Efficiency Type Cooling Efficiency Value Condenser or Package Unit Manufacturer Condenser or Package Unit Model Number Condenser or Package Unit Serial Number System Rated Cooling Capacity at Design Conditions (BTUH) Condenser Rated Nominal Capacity (ton) Bryant SEER 17 Bryant 187BNA048000 5015E00623 48000 4 Registration Number: 216-A0335856A-M0100002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version.: 2013 Rev 1.008 Report Generated: 2016-09-13 20:03:35 Schema Version: 2013.1.008 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 04 Condenser or Package Unit 06 System Identification or Name Cooling Efficiency Type Cooling Efficiency Value Condenser or Package Unit Manufacturer Condenser or Package Unit Model Number Condenser or Package Unit Serial Number System Rated Cooling Capacity at Design Conditions (BTUH) Condenser Rated Nominal Capacity (ton) Notes: F. Extension of Existing Duct System, Greater Than 40 Feet This section does not apply to this project. G. Installed Duct System information 01 02 03 04 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 Unconditioned Unconditioned efficacy (W/cfm) Bryant Whole House R-6 R-6 1 Yes crawl space attic and airflow rate (cfm/ton) Notes: Registration Number: 216-A0335856A-M0100002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:03:35 Schema Version: 2013.1.008 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 4 of 8 ) H. Installed Air Filter Device Information O1 02 03 04 05 06 07 allowable clean -filter pressure drop at the design airflow rate applicable to each air filter device shall be determined, and all system air filter device locations shall be 02 labeled to disclose the applicable design airflow rate and the maximum allowable clean -filter pressure drop. The labels shall be permanently affixed to the air filter device, readily legible, and visible to a person replacing the air filter media, and the air filter devices shall be provided with air filter media that conforms to these Determined Design 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 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.) Bryant Whole House Aprilaire Furnace Furnace 400 0.25 Mounted Notes: I. Air Filter Device Requirements 01 The system shall be designed to ensure that all recirculated air and all outdoor air supplied to the occupiable space is filtered before passing through the system's thermal conditioning components. The system shall be designed to accommodate the clean -filter pressure drop imposed by the system air filter device(s). The design airflow rate and maximum allowable clean -filter pressure drop at the design airflow rate applicable to each air filter device shall be determined, and all system air filter device locations shall be 02 labeled to disclose the applicable design airflow rate and the maximum allowable clean -filter pressure drop. The labels shall be permanently affixed to the air filter device, readily legible, and visible to a person replacing the air filter media, and the air filter devices shall be provided with air filter media that conforms to these determined or labeled maximum allowable clean -filter pressure drop values as rated using AHRI Standard 680. 03 All system air filter devices shall be located and installed in such a manner as to allow access and regular service by the system owner. 04 The system shall be provided with air filter media having a designated efficiency equal to or greater than MERV 6 when tested in accordance with ASHRAE Standard 52.2, or a particle size efficiency rating equal to or 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-A0335856A-M0100002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:03:35 Schema Version: 2013.1.008 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 Bryant Whole House No Yes No No Yes Yes No No exemptions Exemption Notes: Registration Number: 216-A0335856A-M0100002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:03:35 Schema Version: 2013.1.008 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(1), 110.2(b). 03 Sizing: Heating load calculations must be done on portions of the building served by new heating systems to prevent inadvertent undersizing or oversizing. See sections 150.0(h)1 and 2). 04 Furnace Temperature Rise: Central forced -air heating furnace installations must be configured to operate at or below the furnace manufacturer's maximum inlet -to -outlet temperature rise specification. See Section 150.0(h)4. 05 Standby Losses and Pilot Lights: Fan -type central furnaces may not have a continuously burning pilot light. Section 110.5 and Section 110.2(d). Cooling Equipment 06 Equipment Efficiency: All cooling equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency Regulations. 07 Refrigerant Line Insulation: All refrigerant line insulation in split system air conditioners and heat pumps must meet the R -value and protection requirements of Section 150.0(j)2 and 3, and Section 150.0(m)9. 08 Condensing Unit Location: Condensing units shall 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-A0335856A-M0100002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:03:35 Schema Version: 2013.1.008 CERTIFICATE OF INSTALLATION CF211-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 CMC Sections 601.0, 11 602.0, 603.0, 604.0, 605.0 and ANSI/SMACNA-006-2006: Supply -air and return -air ducts and plenums must be insulated to a minimum installed level of R-6.0 or enclosed entirely in directly conditioned space as confirmed through field verification and diagnostic testing in accordance with the requirements of Reference Residential Appendix RA3.1.4.3.8. Heat Pump Thermostat 12 A thermostat shall be installed that meets the requirements of Section 110.2(b) and Section 110.2(c). 13 The thermostat shall be installed in accordance with the manufacturers published installation specifications 14 First stage of heating shall be assigned to heat pump heating. 15 Second stage back up heating shall be set to come on only when the indoor set temperature cannot be met. The responsible person signature on this compliance document affirms that all applicable requirements in this table have been met. Registration Number: 216-A0335856A-M0100002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:03:35 Schema Version: 2013.1.008 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: ��77 Frazier, Ken c7 cJCen razier Company: Signature Date: Golden State Energy Efficiency Services 2016-09-13 20:05:56 Address: CEA/ HERS Certification Identification (if applicable): 1463 Circus Ct. City/State/Zip: Phone: Turlock CA 95380 1209-667-2164 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Installation is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation, and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met. 5. 1 will ensure that a registered copy of this Certificate of Installation shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Installation is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: Ronald L/�Murray, Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Position With Company (Title): VINTAGE HEATING & AIR INC MANAGER Address: CSLB License: 3851 CHARTER PARK DRIVE #P 1007358 City/State/Zip: Phone: Date Signed: SAN JOSE CA 95136 408-264-0402 12016-09-15 10:26:04 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-AO335856A-M0100002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:03:35 Schema Version: 2013.1.008 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: Vasantharam Enforcement Agency: Cupertino City of Permit Number: 15110074 Dwelling Address: 10500 Castine Ave City: Cupertino Zip Code: 95014 A. System Information 01 Space Conditioning System Identification or Name Bryant 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 j Duct System Compliance Category Replacement MCH -20d - Complete Replacement or Altered Duct System B. Duct Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity (ton) 4 02 Heating Capacity (kBtu/h) 78 03 Conditioned Floor Area served by this HVAC system (ft2) 1890 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) 102 10 Actual duct leakage rate from leakage test measurement (cfm) 100 11 Compliance Statement System passes leakage test Registration Number: 216-A0335856A-M2000002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:04:36 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3 ) 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 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. If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements 07 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. The responsible persons signature on this compliance document affirms that all applicable requirements in this table have been met. Registration Number: 216-A0335856A-M2000002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:04:36 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (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 Signature: �7Cen Zrazrer Ken Frazier c�u Company: Signature Date: 2016-09-13 20:05:57 Golden State Energy Efficiency Services Address: CEA/ HERS Certification Identification (if applicable): 1463 Circus Ct. City/State/Zip: Phone: Turlock CA 95380 1209-667-2164 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Installation is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4. 1 understand that a HERS rater will check the installation to verify compliance, and that if such checking identifies defects; I am required to take corrective action at my expense. I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. 5. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met. 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: Ronald Murray Company Name: (Installing Subcontractor or General Contractor or Position With Company (Title): Builder/Owner) MANAGER VINTAGE HEATING & AIR INC Address: CSLB License: 3851 CHARTER PARK DRIVE #P 1007358 City/State/Zip: Phone: Date Signed: SAN JOSE CA 95136 408-264-0402 2016-09-15 10:26:04 Third Party Quality Control Program (TPQCP) Status: Name of TPQCP (if applicable): 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-A0335856A-M2000002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:04:36 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-22-H Space Conditioning System Fan Efficacy (Page 1 of 3 ) Project Name: Vasantharam Enforcement Agency: Cupertino City of Permit Number: 15110074 Dwelling Address: 10500 Castine Ave City: Cupertino Zip Code: 95014 A. Ducted Cooling System Information 01 System Identification or Name Bryant 02 System Location or Area Served Whole House 03 System Installation Type Replacement 04 Nominal Cooling Capacity (tons) of Condenser 4 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 2016-09-13 10 Airflow Rate Protocol utilized RA3.3 procedures for airflow rate measurement 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. Portable watt meter MCH -22a Forced Air System Fan Efficacy Measurement - Newly Installed Non -Zoned Systems or Zoned Multi -Speed Compressor C. Forced Air System Fan Efficacy Measurement The procedures for System Fan Watt Verification are specified in Reference Residential Appendix RA3.3 01 Actual Tested Watts 780 02 Actual Tested Airflow from MCH -23 (cfm) 1440 03 Required Fan Efficacy (watts/cfm) 0.58 04 Actual Fan Efficacy (watts/cfm) 0.54 05 Compliance Statement: System fan efficacy complies Registration Number: 216-A0335856A-M2200002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:06:18 2013 Residential Compliance Schema Version: 0.52SDD CERTIFICATE OF INSTALLATION CF2R-MCH-22-H Space Conditioning System Fan Efficacy (Page 2 of 3 ) D. Additional Requirements O1 All registers were fully open during the diagnostic test. 02 System fan was set at maximum speed during the diagnostic test. 03 If fresh air duct is part of the HVAC system it was not closed during the diagnostic test. 04 Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value. 05 Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/ton) and fan efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air handler fan speed. 06 Zoned cooling air distribution systems with single speed compressors shall meet both the airflow (cfm/ton) and fan efficacy (Watt/cfm) criteria in every zonal control mode. The responsible person's signature on this compliance document affirms that all applicable requirements in this table have been met. ft 14" �. k,.. a Registration Number: 216-A0335856A-M2200002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:06:18 2013 Residential Compliance Schema Version: 0.52SDD CERTIFICATE OF INSTALLATION CF2R-MCH-22-H Space Conditioning System Fan Efficacy (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: T Documentation Author Signature: �7Cen Ken Frazier cJcJrazier Company: Signature Date: 2016-09-13 20:05:57 Golden State Energy Efficiency Services Address: CEA/ HERS Certification Identification (if applicable): 1463 Circus Ct. City/State/Zip: Phone: Turlock CA 95380 1209-667-2164 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Installation is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4. 1 understand that a HERS rater will check the installation to verify compliance, and that if such checking identifies defects; I am required to take corrective action at my expense. I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. 5. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met. 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: Ronald Murray Company Name: (Installing Subcontractor or General Contractor or Position With Company (Title): Cf Builder/Owner) MANAGER VINTAGE HEATING & AIR INC Address: CSLB License: 3851 CHARTER PARK DRIVE #P 1007358 City/State/Zip: Phone: Date Signed: SAN JOSE CA 95136 408-264-0402 2016-09-15 10:26:04 Third Party Quality Control Program (TPQCP) Status: Name of TPQCP (if applicable): 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-A0335856A-M2200002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:06:18 2013 Residential Compliance Schema Version: 0.52SDD CERTIFICATE OF INSTALLATION CF2R-MCH-23-H Space Conditioning System Airflow Rate (Page 1 of 3 ) Project Name: Vasantharam Enforcement Agency: Cupertino City of Permit Number: 15110074 Dwelling Address: 10500 Castine Ave City: Cupertino Zip Code: 95014 A. Ducted Cooling System Information 01 System Identification or Name Bryant 02 System Location or Area Served Whole House 03 System Installation Type Replacement 04 Nominal Cooling Capacity (tons) of Condenser 4 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 2016-09-13 10 Airflow Rate Protocol Utilized RA3.3 procedures for airflow rate 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. 01IMethod Used to Demonstrate Compliance with the I 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 01 verification. RA3.3.3.1.4 02 Manufacturer of Airflow Measurement Apparatus TSI 03 Model number of Airflow Measurement Apparatus ACCUBALANCE 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-A0335856A-M2300002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:05:39 2013 Residential Compliance Schema Version: 2013.1.008 CERTIFICATE OF INSTALLATION CF2R-MCH-23-H Space Conditioning System Airflow Rate (Page 2 of 3 ) 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) 1400 03 Actual System Airflow Rate Measurement (cfm) 1440 04 Compliance Statement: System airflow rate complies E. Additional Requirements Air filters that meet the applicable requirements of Standards Section 150.0(m)12 or 150.0(m)13 were properly installed in 01 the system during system air flow rate measurement identified on this Certificate of Installation. The airflow rate measurement apparatus used to perform the airflow rate; measurement identified on this Certificate of 02 Installation was calibrated in accordance with the apparatus manufacturer's specifications and conforms to the instrumentation specifications given in RA3.3.1. 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. 04 All registers were fully open during the diagnostic test. 05 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-A0335856A-M2300002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:05:39 2013 Residential Compliance Schema Version: 2013.1.008 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 Signature: ��77Cen Zazrer Ken Frazier cJcJr Company: Signature Date: 2016-09-13 20:05:57 Golden State Energy Efficiency Services Address: CEA/ HERS Certification Identification (if applicable): 1463 Circus Ct. City/State/Zip: Phone: Turlock CA 95380 209-667-2164 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Installation is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4. 1 understand that a HERS rater will check the installation to verify compliance, and that if such checking identifies defects; I am required to take corrective action at my expense. I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked -by a HERS rater, and if those installations fail to meetthe requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. 5. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met. 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: Ronald Murray Company Name: (Installing Subcontractor or General Contractor or Position With Company (Title): Builder/owner) MANAGER VINTAGE HEATING & AIR INC Address: CSLB License: 3851 CHARTER PARK DRIVE #P 1007358 City/State/Zip: Phone: Date Signed: SAN JOSE CA 95136 408-264-0402 2016-09-15 10:26:04 Third Party Quality Control Program (TPQCP) Status: Name of TPQCP (if applicable): Digitally signed by Ca10ERTS. 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-A0335856A-M2300002A-0000 Registration Date/Time: 2016-09-15 10:26:04 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-09-13 20:05:39 2013 Residential Compliance Schema Version: 2013.1.008