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B-2016-1826 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1826 10228 PALO VISTA RD CUPERTINO,CA 95014-2713(357 02 060) A&H HEATING&AIR CONDITIONING SERVICE INC SAN JOSE,CA 95110 OWNER'S NAME: YAGER CHARLES T DATE ISSUED:04/25/2016 OWNER'S PHONE:408-921-7443 PHONE NO:(408)279-0722 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class WARM-AIR HEATING,VENTILATING AND AIR-CONDITIONING Lie.# 03 4472 X BLDG —ELECT —PLUMB Contractor A&H HEATING&AIR CONDITIONING SERVICE INC Date X MECH X RESIDENTIAL_COMMERCIAL 05/31/2017 I hereby affirm that I am licensed under the provisions of Chapter 9(commencing JOB DESCRIPTION: with Section 7000)of Division 3 of the Business&Professions Code and that my REPLACE FURNACE,SAME LOCATION AND ADD A/C UNIT IN license is in full force and effect. BACKYARD 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 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 Sq.Ft Floor Area: Valuation:$12150.00 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number: Occupancy Type: - I certify that I have read this application and state that the above 357 02 060 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 PERMIT EXPIRES IF WORK IS NOT STARTED inspection purposes. (We)agree to save indemnify and keep harmless the WITHIN 180 DAYS OF PERMIT ISSUANCE OR City of Cupertino against liabilities,judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. 180 DAYS FROM LAST CALLED INSPECTION. Additionally,the applicant understands and will comply with all non-point regulations per the Cupertino Municipal Code,Section 9.18. Issued by:ABBY AYENDE Signature Date:04/25/2016 (v(J(1 Date 4/25/2016 RE-ROOFS: OWNER-BUILDER DECLARATION 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 for Signature of Applicant: sale(Sec.7044,Business&Professions Code) Date:4/25/201 2. 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(See.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: 1. 1 have and will maintain a 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 by maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Section 25532(a)should I store or handle hazardous permit is issued. material. Additionally,should I use equipment or devices which emit hazardous 3. 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 Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534. 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 ner or authorized agent: be deemed revoked. 10Date:4/25/2016 CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction 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 understands I understand my plans shall be used as public records. and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-.CUPERTINO, CA 95014-3255 (408)777-3.228• FAX(408)777-3333• building(W-cupertino.org MISC CUPERTINOWIfj.r 10u, PLUMBING MECHANICAL ELECTRICAL OMSCELLANEOUS PROJECT ADDRESS 10 ?-2. 8 PALO V{5 riq ROAD APN# 3 5 7-d Z- OcoD OWNERNAHE C � � PHONEL 00 7Z)-NqTEMAIL^ a er 12 36grxa��.�o"`t STREET ADDRESS w �A. , r�S 1-;+ ROA-\' CITY STATE,ZIP /� �/� Q�O 1•+L/ FQX; - CONTACT NAME '014L r- PHONE qc)93 2! (-V 7 Z Z E MAII I��`(�t/If9'�40�•Cd/a'i STREET-ADDRESS 7 70 A ��4 TNu 1 JC 1 CITY STATE [ZIP 5V/�[��e 9$-110 FAX (I/vf z /©t 7 ❑OWNER ❑OWNER BUIIAER- Q-OWNER-AGEw dj CONTRACTOR 000NTRACTOR,AGEw ❑- ARCI3Imcr 13-anmmm ❑ DoiaoPEit ❑TENANT CO CTOR Abpr ME� jklfL `�`�� 11x�-- LICENSE NUMBER�/�[1/�7� LICENSE TYPE �J/Q BUS.LIC#I-L D COMPANY NAMEE L� LIF5 E MAII��k 1'1P�CC'I�t•I�T�a O h Ax dfo t? / lel 7 S1T2EETADDRESS-170 W-6,�Cte��` C1TY,STATE,ZIP C_iJ� q T��v gS�IO PHONE// Z 'VLZZ ARCHITEMENGDMER` NAMEE ( {` LICENSENUMBER ,J�n/cJ BUS.LIC 9 COMPANY NAME E-MAII. FAX STREET-ADDRESS =CITY STATS ZIP PHONZ -USE OF SFD m DUPLEX ❑ MULTI-FAMILY PROJECT INWIIALAND -❑ YES PROJECT IN ❑, IS THE BLDG AN BUIi.DIlvG: ❑COMMERCIAL IMANIi7TERFACEAREA dNO FLOODZONE RES EICHLBLHOM£? R/YES DESCRIPTION OF WORK 1 Z 2!� VOL. TOTALVALUATION: �J 1 �v` RECI?IVEDBY , By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property o er's half. 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 bui ding construction. authorize representatives.of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: l �/ � Date: SUPPLEMENTAL INFORMATION REQUIRED :OFFICE USE OPII:Y" •' ❑ OVER-THE-COUNTER E' ❑ ''EXPRESS. ❑ STANDARD Z a, LARGE: MAJOR•` .. MEPMiscApp_2011.doc revised 06121111 CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems(formerly CF.-IR-ALT HVAC) (Page 1 of:3) Project Name: Yager Date Prepared: 2.016-04-24 A. General Information CF1R-ALT 02 is applicable to multiple space-conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one MR-ALT-02 document for each dwelling unit. 01 Project Name Yager 02 Date Prepared 2016-04-24 03 Project Location 10228 Palo Vista Road 04 Building Type Single family 05 CA,City Cupertino 06 Dwelling Unit Name Yager Dwelling Unit Conditioned 07 Zip Code 95014 08 3168 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 01 02 03 04 i$, " 05.ti. 06 07 08 09 10 >Is the SC '` Installing a SC System SC System CFA served 'system a'�- refrigerant Anstallmg new:SC Installing Installing- Installing Identification or Location or Area b this SC ducted . containing system more than 40 entirely new 'entirely new Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type System 1 Location 1 3168 Yes Yes Yes No No No Altered space conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet(Section1S0.2(b)1Di1b) This section does not apply to this project. ir Ilk P Y Registration Number:216-A0151090A-000000000-0000 Registration Date/Time: 2016-04-24 11:33:51 HERS Provider:CaICERT5 CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-24 11:34:31 Schama VPrcinn-0-5554f)h CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 2 of.3) D.Altered Space Conditioning System(Sections 150.2(b)1E and li) 01 02 03 04 05 06 07 08 09 10 11 12 Heating Cooling System Heating Altered Heating Minimum Altered Coo'ling 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 11-Value Central ga.s Gas furnace: Central split All new Less than or System 1 furnace AHU AFUE 0.8 AC cooling SEER 14 Setback equal to 40 R-6 components feet Required Documentation: CF2R-M CH-OI-E-Space Conditioning Systems Ducts,and Fans -Duct insulation requirement for new plenums:R6. CF211-MCH-20-1­1&CF311-MCH-20-1­11—Duct Leakage testing required when heating or cooling components are installed in ducted systems,or when More than 40 ft of duct length is replaced. -Leakage rate.compliance:<_15%,or 510%leakage to outside,or seal all accessible leaks. CF2R-MCH-25-H&CF3R-MCH-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,a-300 CFM/ton required;w,,hen MCH-25 is required. Exceptions: -Duct systems registered with HERS provider as`previously sealed are exempt from MCH-20 Duct Leakage Testing requirements -Heating-only systems and Air Handler/Furnace chap,ges do not require verlficatiow8fAr Flow MCH 23,or Refeigeranf Charge M ECH 25 -Existing duct systems constructed,insulated or sealed with asbestos.are exempf,from MCMI=20 DuctLeakage TestingcegwrementS , .. ., t r,y.` mak. '- .fi - . ,�,,:.:. 34 ,• ;.I> ..:': : -ex:: .:r:. �:. 'C9` ..; .. E.Entirely New or Complete Replacement Duct--System, with or without,,Equip,ment Changeout(Sections 350.2(b)1Diia.�nd 150.2(b)1E, F) This section does not.apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) This section does not apply to this project. Registration Number:216-A0151090A-000000000-0000 Registration Date/Time: 2016-04-24 11:33:51 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev.1.007 Report Generated:2016-04-24 11:34:31 Schpma Vp_rSlOn--0.555SDb CERTFICATE OF COMPLIANCE CFIR-ALT 02-E Alterations to Space Conditioning Systems(formerly CF41R-ALT HVAC} (Page 3 of 3) Documentation Author's Declaratiop Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Phelps,Dale Compary: Signature Date: A&H fIEATING&AIR CONDITIONING SERVICE INC 201604-24 11:33:51 Address: CEA/HERS Certification Identification.(if applicable): 770 CHESTNUT STREET City/staL./Zip: Phone: SAN JGSE CA 95110 408-279-0722 Responsible Person's Declaration statement I certifythe following under penalty of perjury,under the laws of the State of California: 1. The information provided onithis Certificate.of Compliance is true and correct. 2. i am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building.design or system design identified on this Certificate of Compliance(responsible designer). 3. That the energy features and performance specifications,materials;components,and manufactured devices for the bplldmg design or system design Identified on this Certificate of Compliance conform to the requirements of Trtia 24,Part 1 and Part 6 of the California bode of 4. The building design faatures or system design features identified onahis Certificate of Compliance aresconsistent with the informationprovided on other applicable compliance documents,worksheets, calculations,plans and specifications submitted to the enforcement agency for'dl provaf with.this bwlding permit application. w . ,i n S. I will ensure that a registered copy of this Certificate of.Compliance shall•b, rrmade'available with.the building pe�mit(s)Jssued fortthe building,and.made available:to_the.enforcement agency for all applicable inspections.I undersand that a registered copy of this''CerElficate of Compliance i,,.I quired to be.included with the documentation the builder provides to,the building owner at occupancy, Responsble QesignerName: .`. Responsible DesigherSignature: ''s '` Phelps,Dale �����"_ Compary: Date Signed: A&H fIEATING&AIR CONDITIONING SERVICE INC 201604-2411:33:51 Address: License: 770 CHESTNUT STREET 304472 City/Stale/Zip: Phone: SAN JGSE.CA 95110 408-279-0722 Digitally signed by CaICERTS. This digital,signature is provided in order to secure the content of this registered document and in noway Implies Registration Provider responsibility for the accuracy of the information. Registration Number:216-A0151090A-000000000-0000 Registration Date/Time: 2016-04-24 11:33:51 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-24. 11:34:31 Srhama Varcinn•l).SSSSrM PA5 I T CERTIFICATE OF INSTALLATION CFZR-MCH-01-E Space Conditioning.Systems,Ducts,and Fans (Page 1 of 7) Project Name: Yager Enforcement Agency: City of Cupertino Permit Number: B-2016-1826 Dwelling Address: 10228 Palo Vista RoadCity: Cupertino Zip Code: 95014 A.General information 01 Dwelling Unit Name Yager 02 Climate Zone 4 03 Dwelling Unit Total Conditioned Floor 3168 04 Number of Space Conditioning 1 Area(W) Systems in this Dwelling Unit. 05 Certificate of Compliance Type Prescriptive alterations(CF112-ALT) 06 Method used to Calculate HVAC Loads NotApplicableEquipmentChangeout Calculated Dwelling Unit Sensible Calculated Dwelling Unit Heating Load 07 This field or section is not applicable 08 This field or section is not applicable ( Coaling Load(Btuh) 8tuh 09 Dwelling Unit Number of Bedrooms' 4 IVICH-01b Prescriptive Alterations SpaceConditGsardoynFans B.Space Conditioning(SC)System information y 01 02 03 .04 05 06 07 08 09 10 SC stent System SC S CFA served' Is the SC Installing y Y Installing new SC Installing more Installing Installing Identification or Location or Area b this SC systema refrigerant Y system than 40 feet of entirely new entirely new SC Alteration Type Name Served System(ft) ducted containing system? component? components? ducts? duct system? system? Altered space System 1 Location 1 3168 Yes Yes Yes No No No conditioning system Registration Number:216-A0151090A-M0100002A-0000 Registration Date/Time: 2016-04-28 07:44:28 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-28 07:44:05 Schema Version:2013.1.007 CERTIFICATE OF INSTALLATION CF211-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 Central gas Gas Central All new Not a CFI System 1 furnace furnace AFUE 0.8 split AC cooling SEER 14 Setback LTE40Ft R6 system AHU components D. Installed Heating Equipment Information 01 02.. 03 04 05 06 07 System Identification orHeati illf iciency> " iieating:.Unit Heating.Unit Heating Unitserial Rated Heating Capacity, Name Heating Efficient T e Valui*'n Y ,yp Ma fa Model NtaTber number nuOutput(BTUH) � „ System 1 AFUE �, ', ;':z,0. .- TRANE Tdd2c100a9v5 ��� 15226x8s`1gi 80000 a. 77 Notes: ti, ow E.Installed Cooling Equipment information 01 02 03 04 05 06 07 08 Condenser or Package Unit Condenser or Condenser or Condenser or System Rated Cooling Condenser Rated System Identification Cooling Efficiency Cooling Efficiency Package Unit Package Unit Package Unit Capacity at Design Nominal Capacity or Name Type Value Manufacturer Model Number Serial Number Conditions(BTUH) (ton) System 1 SEER 14 Trane 4ttr40481 16093yaa3f 48000 4 Notes; Registration Number:216-A0151090A-M0100002A-0000 Registration Date/Time: 2016-04-28 07:44:28 HERS Provider:CACERTS CA Building Energy Efficiency Standards 2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-28 07:44:05 Schema Version:2013.1.007 CERTIFICATE OF INSTALLATION CF211-MCH-01-E Space Conditioning Systems,Ducts,and Fans (Page 3 of 7 j F.Extension of Existing Duct System,Greater Than 40 Feet This section does not apply to this project. G.Installed Duct System information This section does not apply to this project. H. Installed Air Filter Device Information This section does not apply to this project. 1.Air filter Device Requirements This section does not apply to this project t E Registration Number.216-A0151090A-M0100002A-0000 Registration Date/Time: 2016-04-2807:44:28 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-28 07:44:05 Schema Version:2013.1.007 CERTIFICATE OF INSTALLATION CFZR-MCH-01-E Space Conditioning Systems,Ducts,and Fans (Page 4 of 7) 1. 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) (dm/ton) Charge Table 150.0-C or D Existing duct sYtstem is System 1 Location 1 insulated or No NO No No No No No w_ . Exemption sealed with' asbestos Notes. e, , f Registration Number:216-A0151090A-M0100002A-0000 Registration Date/Time: 2016-04-28 07:44:28 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-28 07:44:05 Schema Version:2013.1.007 CERTIFICATE OF INSTALLATION CF2R-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 01 Equipment Efficiency;All heating equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a)and the Appliance Efficiency Regulations. 02 Controls:All unitary heating systems,including heat pumps,must be controlled by a setback thermostat.These thermostats must be capable of allowing the occupant to program the temperature set points for at least four different periods in 24 hours.See Sections 150.0(i),110.2(b). 03 Sizing:Heating load calculations must be done on portions of the building served by new heating systems to prevent inadvertent undersizing or oversizing.See sections 150.0(h)1 and 2). 04 Furnace Temperature Rise:Central forced-air heating furnace installations must be configured to operate at or below the furnace manufacturer's maximum inlet-to-outlet temperature.rise specification,See`Section 150,0(h)4, . 05 Standby Losses and Pilot Lights:'FarfAvpe central furnaces n ay not have a continuously b "ng,pi of light;$ectlon 110.,,' and Section 110.2(d). Cooling Equipment 06 Equipment Efficiency:All tooting equipment must meet themmimum efficiency requirements of Sectionllt?1 and Section 110 2{a) nd'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 Distribu#ion System Ducts,Plenums and Fans 10 Insulation: in all cases,unless ducts are enclosed entirety 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-A0151090A-M0100002A-0000 Registration Date/Time: 2016-04-28 07:44:28 HERS provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-28 07:44:05 Schema Version:2013.1.007 CERTIFICATE OF INSTALLATION CFZR-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 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 backup heating shah be set to come on onlywhen the indoor set temperature cannot be met :. The responsible arson signature on this cam liance document affirms that all a u licabte re„uirem�nts in this p p g p pp q fable have been met,„ ,. :A Registration Number:216-Ao151090A-M0100002A-0000 Registration Date/Time: 2016-04-28 07:44:28 HERS Provider:CaiCERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-28 07:44:05 Schema Version:2013.1.007 CERTIFICATE OF INSTALLATION MR-MCH-01-11 Space Conditioning Systems,Ducts,and Fans (Page 7 of 7 j Documentation Author's Declaration Statement 1.1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Phelps,Dale Company: Signature Date,. A&H HEATING&AIR CONDITIONING SERVICE INC 2016-04-28 07:44:28 Address: CEA/HERS Certification Identification(if applicable): 770 CHESTNUT STREET City/State/Zip: Phone: SAN JOSE CA 95110 1408-279-0722 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 applicableclassification to accept responsibility for the system design,construction,or installation of features,materials, components,or manufactured devices for the scope of work ldentified'on this Certificate of Installation and attest to the declarations in this statement(responsible builder/installer),otherwise t am an authorized representative of the responsible builder/instaiter.' d 3. The constructed or installed features,materials,.components or mar afactured-devices,the;instailatipnj identified oniihis Certificate.of Installation°conforms to alI applicable codes and regulations,and the installation conforms to the requirements given on the plans and the enforcement agency. 4. 1 reviewed a copy of the Certificate of Compliance approved by the e�iforcementa�ency tl a>identifies the specific requirements;for the stripe of,constructiorr or installation identified on this Certificate of Installation,and f have ensured that the requirements tha6pply to the construction or installation have been met S. i will ensure that a registered copy of this Certificate of 1nst�llatlon shall ba posted or made availabte with th'e buridirig permit{s)issued#or the budding and made available to the enforcement agency for all applicable inspections.l understand that a registered copy of this Cerfi`ficate of'lnstallatioi is required to be included`with th'e documentation the`liuilder'pr`ovides to the building owner at occupancy. Responsible Builder/installer Name: Responsible Builder/Installer Signature: Phelps,Dale Company Name:(installing Subcontractor or General Contractor or Builder/Owner) Position With Company(Title): A&H HEATING&AIR CONDITIONING SERVICE INC Rmo Address: CSLB license: 770 CHESTNUT STREET 304472 City/State/Zip: Phone: Date Signed: SAN JOSE CA 95110 1408-279-0722 2016-04-28 07:44:28 Digitally signed by Ca10ERTS. 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 infomration. Registration Number:216-A0151090A-M0100002A-0000 'Registration Date/Time: 2016-04-28 07:44:28 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04.28 07:44:05 Schema Version:2013.1.007 SWOKE I CARBON MONOXIDE ALARMS 10T6 OWN fig ERT��ICATE -o►PF COPLIA � h Fj qw r COMMUNITY DEVELOPMENT DEPARTMENT".BUILDING D'IVISION:- CUPERTINO 10300 TORRE AVENUE,CUPERTINO,CA 95014-3255 (408)777-3228 FAX(408)777-3333•buildin40cupertino.org rla t 1'Long de: PEIIMIT CAAINOT BE PINAI}ED AIVI�COI�PLFTEI}UNTIL THIS CE1R�IEYCAIR i.� ��:.�:��, �"�'�,���':B�'�"Ti7"��*��`1e t 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 SMOKE AILARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) On every level of a dwelling unit including basements X X Within each sleeping room Carbon Monoxide alarms are not required in dwellings which do not contain fuel-bumiilg appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply:In dwelling units with no commercial power supply, alarm(s)may be solely battery operated. In existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling,finishes,or there is no access by means of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420'.6.2.An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarm(ss)referenced abo,re has/have been installed n,accordance with the manufacturer`s instructions an;!in compliance with the California Building and Califonnia Residential Codes.The alarms have been tes.ted and are operational,as of the date,signed below. 1i have,read.and a.,, fof com_/ with,tihe�terms and'cerndcfians of this statement \ ..Date ConlracfoTt`Name O 3101 k _..... ._c -"e-: ... .. Smoke andiCO.fornr.d6c rei sed.?0311±811'4 0 F I WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION GUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 c. (408)777-3228•PAX(408)777-3333•building oftupertino.org Owner Name C1� az 1 L e{i', Permit Nod`? Address cq 1. Is your real property a registered historical site? ❑ Yds Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. D16�'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 1101.8 do not apply. 11 The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. 7 P-<o Go to Question 3. 3. Is water service permanently disconnected for your building? Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Ej;?—No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. jD Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: f My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014,building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January I,2014,specified building alterations or improvements shall require non compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). El My property is'a commercial real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature 1 Date: Upon completing and signing this Certificate,please rNrnW to the Building Division in order to final your building permit. SB40 7 2015.doc revised 08126/15