B-2016-1866CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
20729 SHELLY DR CUPERTINO, CA 95014-2971 (359 11 028)
OWNER'S NAME: OKADA TOMOE TRUSTEE
OWNER'S PHONE: 408-472-5515
LICENSED CONTRACTOR'S DECLARATION
License Class GENERAL BUILDING CONTRACTOR Lic. #382383
Contractor ABC COOLING & HEATING SERVICES INC Date 05/31/2017
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
Compensation, as provided for by Section 3700 of the Labor Code, for the
I erfonnance of the work for which this permit is issued.
}� !P 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.
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 Cu ino Municipal Code, Section 9.18.
Signatur to 05/02/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
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 snaking 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 05/02/2016
CONTRACTOR: PERMIT NO: B-2016-1866
ABC COOLING &
HEATING SERVICES
INC
HAYWARD, CA 94545
DATE ISSUED: 05/02/2016
PHONE NO: (559) 292-9240
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE FURNACE & DUCT WORK, SAME LOCATION
Sq. Ft Floor Area: Valuation: $9126.00
APN Number: Occupancy Type:
359 11 028
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY T CA D INSPECTION.
Issued by: MELISSA NAMES
Date: 05/02/2016
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: 05/02/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Code, Chapter 9.12 and
the Health & Safety C s 25505, 2553 , nd 25534.
Owner or authorized agen .
Date: 05/02%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
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 misc
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building@cupertino.orq
13 - ?,,o 1,6 - ( ?.6 6 -
El
❑ PLUMBING 0 MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS
PROJECT ADDRESS 20729 SHELLY DR
APN # 3 S� - ! l - oz --9
OWNER NAME G RANT J OO O (.,*()0 TWO O ONE 408 472 5515
E-MAIL
STREETADDREss20729 SHELLY DR
CITY, STATE,` CUPERTINO, CA 95014
FAX
CONTACT NAMEGABRIEL ARRUDA
PHONE510 471 8181
T;TLGABEA@ABCCOOLING.COM
STREETADDRESS3266 INVESTMENT BLVD
CITY, STATE, ZIP HAYWARD CA 94545
FA"510 471 8368
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT M CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME MIKE C E EC H I N
LICENSE NUMBER 382383
LICENSE TYPE C20
BUS. LIC 024643
COMPANY NAME ABC COOLING & HEATING
E-MAILGABEA@ABCCOOLING.COM
FAX510 471 8368
STREETADDRESS3266 INVESTMENT BLVD
CITY, STATE, ZIP HAYWARD CA 94545
PHONE 510 471 8181
ARCHTTECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA Q NO
PROJECT IN ❑ YES
FLOOD ZONE ❑D NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑D NO
DESCRIPTION OF WORK
REPLACE EXISTING FURNACE IN SAME LOCATION WITH NEW HE 95.5% 100K BTU
FURNACE, AND REPLACE EXISTING DUCTWORK WITH 12 NEW R-8 DUCT RUNS.
TOTAL VALUATION: $9126.00
RECEIVED BY:
By my signature below, I certify to each of the following: I am the property owner or authorized 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 ]din o ruction. I authorize representatives of Cupertino to enter the ab d roperty for inspection purposes.
Signature of Applicant/Agent. Date:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE.ONLY
W
❑ OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
LARGE
❑ MAJOR
MEPMiscApp 2011.doc revised 06121/11
PURPOSE
SMOKE / CA.RBON RfiOROXIDE ALARMS
OWNER CERTIRCAT'E OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 6 building(a.cupertino.org
6
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.
GEN, ERAL 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 8314 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 ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroorn(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in, the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space; Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturers instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
t kave read and agree to cornply)fiththe terms and conditions of this statement
wrl 1.n
G�=�t nJ t bti? S_1` natll .t. Coate`
ffa r .
Sighature:..............................................................Lac.. .:..........................
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION FILE
OPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 m /
X777-3228 • FAX (408) 777-3333 • building(cDcupertino.org F7— r
Owner ame CST" Permit No.
Addre 2-v—7M
1. Is y r real property a registered historic site?
❑ Ye Civil Code Sections 1 W4. through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No o to Question
'�
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification;has been provided to the Building Division.
Skip the rest of the fonn and sign bottom of form.
�&_No 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.
X 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.
' 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:
N My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1,2014, building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-
compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether
property undergoes alterations.or improvements).
❑ My property is a multifamily residential real 'property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019; all non-compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements).
I, as the owner or owner's agent of this property, certify under penalty of peijury 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- onserving plumbing fixtures comply with the requirements as indicated in the
table on the followine paize. 1 ,7
Owner or Owner Agent's Signature: /,+kr,�vr 17" Date: -7/.R 117-o f 7 1
Upon completing and signing' this Certificate, please
it to the Building Division in order to final your building permit.
SB407 2015. doc revised 08/26/15
1. If the existing plumbing fixture water usage/floe rate is equal to or lower than the tigure shovel, it is not required to be upgraded.
SB407 201 S.doc revised 08126115
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture!
(Fixture Complying with Current Code Applicable to New Construction)
Maximum
Water Usage/Flow
Rate
Fixture Type
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4'
Water Usage
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
!Flow Rate
Single -Family
Multi -Family
Commercial
Residential
Residential
Water Closets
Exceed 1.6
Single flush toilets: 1.28 gallons/flush
(Toilets)
Gallons/flush
Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite,
average flush volume of two reduced flushes and one full flush
Urinals
Exceed 1.0
0.5 gallons/flush
Gallons/flush
Showerheads
Exceed 2.5
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per minute
U.S. EPA WaterSense Specification for. Showerheads
(A hand-held shower is considered a showerhead,)
For multiple showerheads serving one shower, the combined flow rate of all
showerheads and/or other shower outlets controlled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
allow only one shower outlet to be in operation at a time.
Faucets —
Exceed 2.2 gallons
Maximum 1.5 gallons per
Within units:
0.5 gallons per minute @ 60
Lavatory
per minute
minute! @ 60 psi; minimum
Maximum 1.5 gallons
psi
Faucets
0.8 gallons per minute @
per minute @ 60 psi;
20 psi
minimum 0.8 gallons
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
CcD 60 psi
Faucets—
Exceed 2.2 gallons
1.8 gallons per minute @
1.8 gallons per minute
1.8 gallons per minute @ 60
Kitchen
per minute
60 psi
@ 60 psi
psi
Faucets
May temporarily increase
May temporarily
up to 2.2 gallons per
increase up to 2.2
minute @ 60 psi, and must
gallons per minute @
default to maximum
60 psi, and must
1.8 gallons per minute @
default to maximum
60 psi
1.8 gallons per minute
Where faucets meeting
@ 60 psi
the above are unavailable,
Where faucets meeting
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction.
other means may be
used to achieve
reduction.
1. If the existing plumbing fixture water usage/floe rate is equal to or lower than the tigure shovel, it is not required to be upgraded.
SB407 201 S.doc revised 08126115
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
20729 SHELLY I Date Prepared:
CF111-ALT 02-E
(Page 1 of 3 )
2016-04-22
.r
A. General Information
MR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
use one MR -ALT -02 document for each dwelling unit.
01
Project Name
20729 SHELLY
02
Date Prepared
2016-04-22
03
Project Location
20729 SHELLY DR
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
20729 SHELLY
07
Zip Code
95014
08
Dwelling Unit Conditioned
2096
Installing
Installing
-Installing
Floor Area (ft2)
Location or Area
by this SC
8ucted
containing
system
Number of space conditioning
entirely new
09
Climate Zone
4
10
(SC) systems in this dwelling
1
component?
components?
feet of ducts?
duct system?
unit.
Alteration Type
B. Space Conditioning (SC) System Information -
01
02
-03
04,
05 `
06 ';
07
08
09
10
Is the SC
Installing a
f
SC System
SC System
CFA served
system a, -
refrige'rant
installing new SC
Installing
Installing
-Installing
Identification or
Location or Area
by this SC
8ucted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Entirely new or
complete
System 1
Location 1
2096
Yes
No
Yes
Yes
Yes
No
replacement duct
system with or
without equipment
changeout
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 216-A0149929A-000000000-0000
Registration Date/Time: 2016-04-22 12:48:57
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-22 12:49:25
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF111-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)1E and F)
This section does not apply to this project.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)iDiia and 150.2(b)1E, F)
01
02
03
04
05
06
07
08
09
10
11
Heating
Cooling
System
Heating
Minimum
Cooling
Minimum
Required
Identification or
Heating
Altered Heating
Efficiency
Efficiency
Cooling
Altered Cooling
Efficiency
Efficiency
Thermostat
New Duct
Name
System Type
Component
Type
Value
System Type
Component
Type
Value
Type
R -Value
This field or
This field or
System 1
Central gas
Gas furnace
AFUE
0.8
Central split AC
No cooling
section is
section is
SetbackTher
R-6
furnace
AHU
component altered
not
not
mostat
applicable
1 applicable
Required Documentation:
CF2R-MCH-01-E -Space Conditioning Systems Ducts and Fans l -.
-Duct insulation requirement for new plenums: R6..
-.
CF2R-MCH-20-H & CF3R-MCH-20-H Duct Leakage Verification required. c "
-Leakage rate compliance: 5 6%. -
-
CF2R-MCH-22 & CF3R-MCH-22 Fan Efficacy Verification
-
CF2R-MCH-23 & CF3R-MCH-23 System Air Flow Rate Verification
-Compliance: Fan Efficacy15 0.58 W/cfm and System Airflow z 350 cfm/toii.
- Alternative Compliance: CF2R-MCH-28 & CF3R-MCH-28 Return Duct Design Verification is an alternative to MCH -22 and MCH -23 verification.
CF2R-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
Exceotions:
Heating -only systems are exempt from the 0.58 W/cfm and 350 cfm/ton requirements.
Note:
An "entirely new or replacement duct system" means at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system (e.g.,
registers, grilles, boots, air handler, coil, plenums, duct material) if the reused parts are accessible and can be sealed to prevent leakage
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-A0149929A-000000000-0000 Registration Date/Time: 2016-04-22 12:48:57 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-22 12:49:25
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Cecchlin
Cecchin, Mike
t e
Company:
Signature Date:
ABC COOLING & HEATING SERVICES INC
2016-04-22 12:48:57
Address:
CEA/ HERS Certification Identification (if applicable):
3266 INVESTMENT BLVD
City/State/Zip:
Phone:
HAYWARD CA 94545
510-471-8181
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 Conipllance is true and correct.
2. lam eligible under Division 3 ofthe'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 building design orsystem design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Part 6 of the California -Code of Regulations._
4. The building design features or system design features identified on this Certificate'of Compliance are consistent.witli the mformation:provided on other'applicable_ 'coinpliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for'ipproval.`,with this building permit application,.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be riatde;availatilelwith the buildirig•pe�mit(s).issued forahe,liuilding, and made; available,to the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance isrequired to be included with the documentation.the.builder provides to the building owner at occupancy.
+':4
Responsible Designer Name: �' -.1 �__<
Responsible Designer Signature: 1.
ike Cecchin
Cecchin, Mike
Company:
Date Signed:
ABC COOLING & HEATING SERVICES INC
2016-04-22 12:48:57
Address:
License:
3266 INVESTMENT BLVD
382383
City/State/Zip:
Phone:
HAYWARD CA 94545
510-471-8181
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-A0149929A-000000000-0000 Registration Date/Time: 2016-04-22 12:48:57 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-22 12:49:25
Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-20-H
Duct Leakage Diagnostic Test
Project Name 29 SHEL
Enforcement Agency: City of
pertino
Permit Number: B-2016-1866
Dwelling Address: 20729 SHELLY DR
�ty: Cupertino
Zip Code: 95014
PVA
A. Systein Information
01
Space Conditioning System,ldentification or Name
System I
02
Space Conditioning System Location or Area Served
Location I
03
Building Type fromCF-IR
Single family
04
Veri fied Low Leakage Ducts in Conditioned Space
No, credit is not taken
04
(VLLDCS) Credit from 61117
Total leakage
06
Verified Low Lea kag�'Air;Ha nd ling Unit (VLLAHU) Credit
No, credit is not taken
05
from CF1R?
Heating system method
06
Duct Systiern.."Compliance Category
Alteration
09
Calculated Target Allowable Duct Leakage (cfm)
326
. "12qd
01
Condenser Nominal'Cooling, Capacity (ton)
0
02
Heating Capacity (k8tu/h)
100
03
Conditioned' Floor Area served by this HVAC system (ft2)
2096
04
Duct Leakage Test Condition
Test final
- Complete", Replacement
Duct Leakage Test Method
Total leakage
06
Leakage Factor
0.15
07
Air Handling Unit Airflow (AHUAirflow) Determination
Method
Heating system method
08
M6asured AHUAirflow
This field or section is not applicable
09
Calculated Target Allowable Duct Leakage (cfm)
326
10
Actual duct leakage rate from leakage test measurement
115
Coirnpliance Statement
B. Duct'Leakage biagn6stic Test RC-'
01
Condenser Nominal'Cooling, Capacity (ton)
0
02
Heating Capacity (k8tu/h)
100
03
Conditioned' Floor Area served by this HVAC system (ft2)
2096
04
Duct Leakage Test Condition
Test final
05
Duct Leakage Test Method
Total leakage
06
Leakage Factor
0.15
07
Air Handling Unit Airflow (AHUAirflow) Determination
Method
Heating system method
08
M6asured AHUAirflow
This field or section is not applicable
09
Calculated Target Allowable Duct Leakage (cfm)
326
10
Actual duct leakage rate from leakage test measurement
115
Coirnpliance Statement
System passes leakage test
nemistmtiunmumbenz neoistrativnoaue/nmc: 2016-05-17 10:15:02 HERS Provider: ca|ccms
ouBuilding �Energy Efficiency Standards Report Version: zozsRev z.00r Report Generated: 2016-05-17 10:09:28'
CERTIFICATE OF INSTALLATION CF2R-MC1H-20-1H
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
testing.. OA ducts used for Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan. Ventilation
02
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 handier and the supply and return plenums are completely sealed.
If the system compliesiusing;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 fdr:HERS�verification °compliance ,... ;
if �w }Y�• "� ;F•"'^,'F' Q �.$ l �
n'sibl'e personsisignature on this compliance documenfaffirms'that all applicable requirements "nY this table have
Ebeen
. a*
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�q fur : 4 � "'E:
• Oa;;y .tl'�� , ,. � '�,. m�a�' � :n !<.wF�` �u�' �' t, kms. 56
,Registration'Number: 216-A0149929A-M2000002A-0000 Registration Date/Time: 2016-05-17 10:15:02 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-17 10:09:28
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-20-H
Duct Leakage Diagnostic Test (Page 3 of 3 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: _/
Cecchlin
Mike Cecchin
t e
Company:
Signature Date: 2016-05-17 10:15:02
ABC COOLING & HEATING SERVICES INC
Address:
CEA/ HERS Certification Identification (if applicable):
3266INVESTMENT BLVD
City/State/Zip:
Phone:
HAYWARD CA 94545
1510-471-8181
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'S of the Business and Professions Code in the applicable classification to accept responsibility for the system design,.
construction, orinstallationof features, materials, components, or manufactured devices for the scope of work identified on this Certificate of
Installation and attest to t' e;tleclarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the
responsiblebuilder/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,gwen on#e plans and.specifications approved by
3�v 1,s X E}"?}}. i
the enforcement`agencY Fh I a
r
4. 1 understand that,a HERS rater will check the installation to venfylcomPliance, anq that if such checking identifies defects ]'am required toFtake'
corrective action at my expense. underst 41hat Energy commission and HERS Providei representatives tyillalso perform quality assurance checking
of installations including tho,'se,approved as part:ofa,sampietgrobp but not.ehecked by a^HERS=rate ;:and i those installations feiLto meefthe--,,i
other stallationsjn that. -HERS
requirements;of;such qualityassurimce checking, ti'le required corrective,action and,additional checking/testing of m
sample group'will be performed at'irlyexpenselyv, Y' a
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 registe'red '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:
Mike Cecchin
LXi� Cecchin
Company Name: (Installing Subcontractor or General Contractor or
Position With Company (Title):
Builder/Owner)
MANAGER
ABC COOLING & HEATING SERVICES INC
Address:
CSLB License:
3266 INVESTMENT BLVD
382383
City/State/Zip:
Phone:
Date Signed:
HAYWARD CA 94545
510-471-8181
2016-05-17 10:15:02
Third Party Quality Control Program (TPQCP) Status:
Name of TPQCP (if applicable):
Digitally signed by Ca/CERTS. 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-AO149929A-M2000002A-0000 Registration Date/Time: 2016-05-17 10:15:02 HERS Provider: CaICERTS'
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-17 10:09:28
2013 Residential Compliance Schema Version: 2013.1.007