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B-2016-2054
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2054 22605 SALEM AVE CUPERTINO, CA 95014-5657 (342 12 062) A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC MEMPHIS, TN 38120 OWNER'S NAME: ALTMAIER RICHARD C AND PAULETTE I RUSTEE DATE ISSUED: 06/01/2016 OWNER'S PHONE: 408-973-1809 PHONE NO: (408) 286-8931 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC -20 Lic. #742039 Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG —ELECT —PLUMB X MECH X RESIDENTIAL _ COMMERCIAL Date 10/31/2017 I hereby affirm that I am licensed under the provisions of Chapt r 9 (commencing with Section 7000) of Division 3 of the Business & Professions Co le and that my JOB DESCRIPTION: license is in full force and effect. REPLACE A/C AND FURNACE - SAME LOCATION I hereby affirm under penalty of perjury one of the following two declarations: r. I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the La or Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insuran as provided for by ie, Section 3700 of the Labor Code, for the performance of ti e work for which this Sq. Ft Floor Area: Valuation: $11750.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the abo e APN Number: Occupancy Type: information is correct. I agree to comply with all city and count)i ordinances 342 12 062 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 expe nses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue against said City in consequence of the granting o this permit. Additionally, the applicant understands and will comply with all non -point 180 DAYS FROM LAST CALLED INSPECTION. Cupertino Municipal Code, Section source re2DER �.18. Issued by: Abby A e�nde Signature Date 6/1/2016 Date: 06/01/2016 O ER-ARATIO RE- ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: I installed without first obtaining an inspection, I agree to remove all new materials for t. I, as owner of the property, or my employees with wages 2s their sole inspection. compensation, will do the work, and the structure is not ir tended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: z. I, as owner of the property, am exclusively contracting wi 1i licensed Date: 6/1/2016 contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the z. I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(x) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous I in to becorne to the air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person any manner so as subject � maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after in . g this certificate of exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sectio 5505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall Owner or authorized agent: be deemed revoked. Date: 2016 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is CO SIRUZ LE5`DWG AGENCY I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances apd state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize represe i tatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (V1/e) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the adplicant understands ARCHITECT'S DECLARATION and will comply with all non -point source regulations per the Cupertino pertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed GENERAL PE�MIT APPLICATION W MEF CO'MMUNITY DEVELOPMIEN I DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENU • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 •FAX (408) 777-3333 • building(d)cuoerfino.org M ",I(" ❑PLUMBING �jCI59 LAICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT 4DDRESS7 > ��I G (e(ernv e, I APN / \V ONERNAh9 1 C 0,, (� /a' n C I PHONE J�('©. E-MAIL STREET ADDRESSW 6 Q; ('e�/j/j /? 3av p ,p 1. UdrfIZI C'q q S Q / I FAA CONTACT NAME PHONE � 2i _ r, � j E-KMI, (/(xQ ` `r' STREET ADDRESS� CITY, TATE, ZI z' FAX 1 OWNER ❑ 0\1 Nr72-BUIIDER ❑ Oq?ER.AGE\T ❑ CON-MIXTOR ❑ CO\TRACTOR AGE!.? ❑ ARCHITECT ❑ ENGL\EER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I LICENSE XMIBER' f f(] / ��} LICF-NSE TYPE r2-0 I BUS. LIC n COIAP.A\Y NAME E-MAIL F.AX STREET.AD a,, jZ C4 .AT ARCHITECT/ENGLNEERNAME ' LICENSE NUMBER I BUS. LIC COMPA\Y NAME E-Iv'LAIL F.kx STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD u DUPLEX ❑ MtiLTI-FAMILY PROM L'v R'1LDLA\'D ❑ YES PROJECT A ❑ YES IS THE BLDG AN ❑ 1 cS BLW NG: ❑ C01.4MERCIAL I)RB, A'TERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NU DESCRIPTION OF WORK TOTAL VALUATION: (r -TSO RECEIVED Bl iP ��/ By my signature below, I certif}, to each of the following: I ani the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information 1 have provided is — t. I hath e read the Description of'Work and ver-ifj, it is accurate. I agree to comply with all applicable local ordinances and state la%vs relating to building onstru thorize representatives of Cupertino to enter the above-identtiified/p'roperrtty for inspection purposes. SignatureofApplicant�kgent: Date: SUPP ENTAL _ -"F'70 4ATION REQUIRED � ": ❑�fl\'ER-TIiE-CO[7:\TER� z �. �„ x x_ �'' ❑ EXPRESSMR � � ySKjkN 3 4R J . AlEP.AflscApp_2011.doc revised 06121111 Address SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION i I i R'I 1ht 3 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (AOAN 777-g99.q GAY 1AMM 777_Z1Q'2 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 ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(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 manufacturer's 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. I have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent' ) Name: Signature ..... Da .. . , Contractor Name: Signature. -7—n.. :.................................................... Lic.#...................................... Date: ................... Smoke and CO form.doc revised 03118114 Owner Name Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 t& — 32 (408 777- (408) 777-3333 • buildingna.cupertino.org r d Permit No. `✓ Z Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 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? ❑ 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 form and sign bottom of form. Xf 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. Q -No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? El 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. L; es My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1.101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. PPlea5e check ONE of the following: I'Myproperty is asingle-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 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. �f , / A j Owner or Owner Agent's Signature: Date: J"/ l UUon comnletina and signing this Certificate, please return it to the Building Division in order to final your SB4072015.doc revised 08126115 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 Project Name: Richard Altmaier Enforcement Agency: Cupertino City of Permit Number: B-2016-2054 Dwelling Address: 22605 Salem ave City: Cupertino Zip Code: 95014 A. System Information 01 Space Conditioning System Identification or Name System 1 02 Space Conditioning System Location or Area Served upstairs 03 Building Type from -CF -1R Single family 04 Verified Low Leakage Ducts in Conditioned Space No, credit is not taken 04 (VLLDCS) Credit from CFIR? Total leakage 06 Verified Low Leakage Air Handling Unit (VLLAHU) Credit No, credit is not taken 05 from CF1R? Cooling system method 06 Duct System, Compliance Category Alteration using smoke test 09 Calculated Target Allowable Duct Leakage Rate (cfm) 180 MCH -20e - Sealing All Accessible Leaks using Smoke TeSt" B. Duct Leakage Diagnostic Test ----------- 01 Condenser Nominal Cooling Capacity (ton) 3 02 Heating Capacity (kBtu/h) 66 03 Conditioned Floor Area served by this HVAC system (ft2) 1500 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 1 0.15 07 -- Air Handling Unit Airflow (AHUAirflow) Determination Method Cooling system method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage Rate (cfm) 180 10 Actual duct leakage rate from leakage test measurement (cfm) 355 Registration Number: 216-A0199390A-M2000002A-M20A CA Building Energy Efficiency Standards 2013 Residential Compliance Registration Date/Time: 2016-06-1413:42:15 HERS Provider' CaICERTS Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:40:41 Schema Version: 2013.1.007 CERTIFICATE OF VERIFICATION MR -MCH -20-H' Duct Leakage Diagnostic Test (Page 2 of 3 B. Duct Leakage Diagnostic Test Compliance Statement: System passes using smoke test of an altered HVAC system in an existing building. No visible smoke exits the accessible portions of the duct system. Smoke is only emanating from air -handling unit (AHU) cabinet and non 11 accessible portions of the duct system. Note - Accessible is defined as having access thereto, but which first may require removal or opening of access panels, doors, or moving similar obstructions. if access to the ducts requires an object to be demolished or deconstructed then sealing of those ducts is not required 12 Notes: I C. Additional Requirements for Compliance I 01 ( System was tested in its normal operation condition. No temporary taping allowed. 06 i All connection points between the air handler and the -supply and 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. I 08 I Verification Status: I Pass - all applicable requirements are met I 09 1 Correction Notes for this table: IThe responsible persons signature on this compliance document affirms that all applicable requirements in this table have been met unless otherwise noted in the Verification Status and the Corrections Notes in this table. D. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 101 I Complies: All specified verification protocol requirements on this document are met. I Registration Number: 216-A0199390A-M2000002A-M20A Registration Date/Time: 2016-06-14 13:42:15 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:40:41 2013 Residential Compliance Schema Version: 2013.1.007 4 CERTIFICATE OF VERIFICATION CF311-MCH-20-1-1 Duct Leakage Diagnostic Test (Page 3 of 3 ) Documentation Author's Declaration Statement 1.1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: � ��J � Alanna M Stoklosa v—/ Lia iiia C5T( Stoklosa Company: Date Signed: The Energuy CA LLC 2016-06-14 13:40:41 Address: CEA/ HERS Certification Identification (if applicable): 1215 K St., 17th Floor City/State/Zip: Phone: Sacramento CA 95814 877-600-0123 Responsible Person's Declaration statement I certify the following under penalty of.perjury, under the laws of the State of California: 1. The information provided,on this Certificate of Verification is true and correct. 2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The installed features, materials, components, manufactured devices, or system performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with.the applicable requirements in Reference Appendices RA2, RA3, and the requirements specified on the Certificate of Compliance for the building approved by the enforcement agency. 4. The information reported on applicable section5,ofthe Certificafe(s) offttstaliatiort (CF20)"signed.and sulomifi &by the per nn(s) responsible for the construction or installation conforms to theA4quirementsspecifaed oft the Certificate(s)t f Corirpliance (CFI ) approved by he enf6Ngme#tt,�gency. 5. ]will ensure that a registered copy of thisCe :tificate of Veraficat#on fall be posted or rriacie available with the'tiuilding perrl?it( "issued for the building, and made available to th enfiorcerrtent a en fof-,, applicable insp6ctions i enders and that a registered-, copy t thr Certificate of g Verification is required to beync)udfl with the documentation the builder provides to the building owner at occupancy. e �e ,. r r. Builder Or Installer Information As '5hown On The"Certificate Of Installatio"tn Company Name (Installing Subcontractor, General Contractor, or Builder/Owner): A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC Responsible Builder or Installer Name: CSLB License: Stephanie Hawkins 742039 HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status in Sample Group (if applicable) Tested HERS Rater Information HERS Rater Company Name: The fnerguy CA LLC Responsible Rater Name: Responsible Rater Signature: Richard Cunningham 6/ Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC20D5596 2016-06-14 13:42:15 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-A0199390A-M2000002A-M20A Registration Date/Time: 2016-06-1413:42:15 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:40:41 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: Richard Altmaier Enforcement Agency: Cupertino City of Permit Number: B-2016-2054 Dwelling Address: 22605 Salem ave City: Cupertino Zip Code: 95014 A. System Information 01 Space Conditioning System Identification or Name System 1 02 Space Conditioning System Location or Area Served upstairs 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 Duet System Compliance Category Alteration using smoke test Registration Number: 216-A0199390A-M2000002A-0000 Registration Date/Time: 2016-06-14 13:41:32 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:39:45 2013 Residential Compliance Schema Version: 2013.1.007 b� CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3 B. Duct Leakage Diagnostic Test Compliance Statement: System passes using smoke test of an altered HVAC system in an existing building. No visible smoke exits the accessible portions of the duct system. Smoke is only emanating from air -handling unit (AHU) cabinet and non 11 accessible portions of the duct system. Note - Accessible is defined as having access thereto, but which first may require removal or opening of access panels, doors, or moving similar obstructions. If access to the ducts requires an object to be I demolished or deconstructed then sealing of those ducts is not required I I C. Additional Requirements for Compliance 01 1 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 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 1 If cloth backed tape was used it was covered with Mastic and clrakibandi, 06 All connection points betweert4he air 13 If the system complies using the Smoke Testmethod, tfie-smoke test was coricluicte'din"acco'r"clance with the requiriernents of 07 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. I The responsible persons signature on this compliance document affirms that all applicable requirements in this table have been met. I Registration Number: 216-A0199390A-M2000002A-0000 Registration Date/Time: 2016-06-14 13:41:32 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:39:45 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: �j /' �'t0/2LOSa Alanna M Stoklosa vA(anna LW Company: Signature Date: 2016-06-14 13:39:38 The Energuy'CA LLC Address: CEA/HERS Certification Identification (if applicable): 1215 K St., 17th Floor City/State/Zip: Phone: Sacramento CA 95814 1877-600-0123 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 ofthe 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 requiremgr)tsgiven on the plans and specifications,approved by the enforcement agency. 4. I understand that aHERS-rater will check the installation to uenfN,compliance, "d that tf'sgch checI4g idekifies defects hb''m req uii� d tptake'` corrective action at my expense.1,understand that Energy Cc)tnrerlssit n and HERS Provider representatives will a o perform'qualtty arance checking hcedbaHEaaltorreettl of installations,includingtheapprovedasparto#hskartt requirements of such quality assurance checking, the required corrective action and additional checkingAestmg of other installations.in that HERS sample group will be performed at myexpense 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: Stephanie Hawkins Position With Company (Title): Company Name: (installing Subcontractor or General Contractor or Builder/Owner) Owner A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC Address: CSLB Licenser 965 RIDGE LAKE BLVD STE 201 742039 City/State/Zip: MEMPHIS TN 38120 Phone: 408-286-8931 X123 Date Signed: 2016-06-14 13:41:32 Third Party Quality Control Program (TPQCP) Status: Name of TPQCP (if applicable): 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-A0199390A-M2000002A-0000 Registration Date/Time: 2016-06-14 13:41:32 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:39:45 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans ('Page 1 of 7 ) Project Name: Richard Altmaier Enforcement Agency: City of Cupertino Permit Number: B-2016-2054 Dwelling Address: 22605 Salem ave City: Cupertino Zip Code: 95014 A. General Information 01 Dwelling Unit Name Richard Altmaier 02 Climate Zone 4 03 Dwelling Unit Total Conditioned Floor 3400 04 Number of Space Conditioning 1 Area (ft2) B. Space Conditioning (SC) System information Systems in this Dwelling Unit. 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 10 Cooling Load (Btuh) SC System CFA served (Btu h) Installing a refrig refrigerant 09 Dwelling Unit Number of Bedrooms 4 Installing Identification or Registration Number: 216-A0199390A-M0100002A-0000 Registration Date/Time: 2016-06-14 13:41:32 HERS Provider: CaICERTS CA Building,Energy Efficiency Standards 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:38:35 Crhami Varcinrr )nl2 1 nn7 MCH' -01b Prescriptive Alterations -Space Cortdiyningstems D, its and Fans ." B. Space Conditioning (SC) System information 01 02 03 04 05 06 07 08 09 10 5C System SC System CFA served is the SC a Installing a refrig refrigerant Installing new SC Installing more Installing Installing Identification or Location or Area by this SC systemsystem than 40 feet of entirely new entirely new SC Alteration Type Name Served 2 System (ft) ducted containing components? P ducts? ducts stem? y system? y ? system. ? component. Altered space System 1 upstairs 1500 Yes Yes Yes No No No conditioning system Registration Number: 216-A0199390A-M0100002A-0000 Registration Date/Time: 2016-06-14 13:41:32 HERS Provider: CaICERTS CA Building,Energy Efficiency Standards 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:38:35 Crhami Varcinrr )nl2 1 nn7 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 2 of 7 ) C. Space Conditioning (SC) System Alterations Compliance Information 01 02 03 04 05 06 07 08 09 10 11 12 13 Central Fan Integrated Heating Cooling New or (CFI) System Altered Heating Minimum Altered Cooling Minimum Required Replaced New Ventilation Identification Heating Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Duct Duct System or Name System Type Component Type Value System Type Components Type Value Type Length R -Value Status This field Central gas All newor heating AFUE 80 Central All .new cooling SEER 13 Setback N/A - no ducts sectio Not a CH System 1 furnace componen split AC components replaced n is system is not applic } able 7 D. Installed Heating Equipment Information 01 02 03 04 05 06 07 System Identification or ' ' Heating Efficiency tlM,anufacturer �eating Unit � Hedting Unit ' � Heating�Unit serial Rated Heating Capacity, ,.Name Heating Efficiency Type Value Model Number number Output (BTUH) System 1 Notes AFUE 80 Lennox I IL180UHOO7OX136 I 0000 66000 Registration Number: 216-A0199390A-M0100002A-0000 Registration Date/Time: 2016-06-14 13:41:32 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:38:35 frhamn Vprcinn• )nl:z 1 [1x17 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans [Page 3 of 7 j 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) System 1 SEER 13 Lennox 14ACX036230A18 0000 36000 3 Notes: 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. Registration Number: 216-A0199390A-M0100002A-0000 Registration Date/Time: 2016-06-14 13:41:32 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:38:35 Crhnma Vorcinn• ?n1 :z 1 nn7 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 4 of 7 J. HERS Verification Requirements 01 02 03 04 05 06 07 08 09 10 MCH20 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 System 1 upstairs No exemptions Yes No Exemption No No No No No Notes: Registration Number: 216-A,0199390A-M0100002A-0000 Registration Date/Time: 2016-06-14 13:41:32 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:38:35 r,rhpmn Vprcinn- )nl:z 1 nn7 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 5 of 7 j 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. Pleating Equipment Equipment Efficiency: All heating equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency 01 Regulations. Controls: All unitary heating systems, including heat pumps, must be controlled by a setback thermostat. These thermostats must be capable of allowing the occupant 02 to program the temperature set points for at least four different periods in 24 hours. See Sections 150.0(i), 110.2(b). Sizing: Heating load calculations must be done on portions of the building served by new heating systems to prevent inadvertent undersizing or oversizing. See sections 03 150.0(h)1 and 2). furnace Temperature Rise: Central forced -air heating furnace installations must be configured to operate at or below the furnace manufacturer's maximum 04 inlet -to -outlet temperature mise specification. SeeSection 150.0(h)4. 05 p Standby Losses and Pilot Lights: Fan -type central furnaces. rrsay not have a continuously 6urning pilot Ifgh1 lection 110.Sand Section 110.2(4). CoolingEquipment s -, v Equipment Efficiency: All cooling equipment must meet the,mj0imvm efficiency requirertlents of;Sectidtj,110 1-a nd Section 1110, (a)'and the Appliance Efficiency 06 Refrigerant Line Insulation: All refrigerant line insulation in split system air conditioners and heat pumps must meet the R -value and protection requirements of Section 07 150.0(j)2 and 3, and Section 150.0(rn)9. 08 Condensing Unit Location: Condensing units shall not be placed within five (5) feet of a dryer vent outlet. See Section 150.0(h)3A. Sizing: Cooling load calculations must be done on portions of the building served by new cooling systems to prevent inadvertent undersizing or oversizing. See Section 09 150.0(h)1 and 2. Air Distribution System Ducts, Plenums and Fans Insulation: In all cases, unless ducts are enclosed entirely in directly conditioned space, the minimum duct insulation value is R-6. Note that higher values may be 10 required by the prescriptive or performance requirements. See Section 150.0(m)1. Registration Number: 216-A0199390A-M0100002A-0000 Registration Date/Time: 2016-06-14 13:41:32 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:38:35 Crhoma Vorcinn• )oi R 1 nn7 CERTIFICATE OF INSTALLATION CF211-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, 602.0, 603.0, 604.0, 605.0 and ANS I/SMAC NA -006-2006: Supply -air and return -air ducts and plenums must be insulated to a minimum installed level of R-6.0 or 11 enclosed entirely in directly conditioned space as confirmed through field verification and diagnostic testing in accordance with the requirements of Reference Residential Appendix RA3.1.4.3.8. Heat pump Thermostat 12 A thermostat shall be installed that meets the requirements of Section 110.2(b) and Section 110.2(c). 13 The thermostat shall be installed in accordance with the manufacturers published installation specifications 14 First stage of heating shall be assigned to heat pump heating. 1s Second stage back up heating shall be set to come on only when the indoor set temperature cannot be met The responsible signature on this compliance document affirms that all applicably requlremeiits an this taka9e have been mek: person ., a �. Registration Number: 216-A0199390A-M0100002A-0000 Registration Date/Time: 2016-06-14 13:41:32 HERS Provider: CaICERTS CA Building. Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:38:35 Crhema Varcinn• ?r11 4 1 nn7 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 7 of 7 ) Documentation Author's Declaration Statement 1.1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: � Stoklosa, Alanna M to� arena sa Company: Signature Date: The Energuy CA LLC 2016-06-14 13:39:38 Address: CEA/ HERS Certification Identification (if applicable): 1215 K St., 17th Floor City/State/Zips Phone: Sacramento CA 95814 1877-600-0123 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 ofthe responsible builder/installer. features, {tl installatii n) identl ted oCi'this Certificate of Installationconfortrt�to ill,applicable codes and regulations, and the 3. The constructed or installed materials, components or mAnufacturerfi>tt'eVices installation conforms to the requirements given on the plans and specifications apt" roved by the enforcement agency. 4. 1 reviewed a copy of the Certificate of Compliance appria9ed by the bhforcement,agency thattdentifies the specific requirements;fox the scope of:GonstYucti n or install tion identified on this Certificate of Installation, and I have ensured thatthe requirementsth:apply to the construction or installation have been met. b�' Ynade available with;thie building permits) issued for the ituilding, and madelavailable to the enforcement agency for all 5. I will ensure that a registered copy of this Certificate of Installation shall posted, or applicable inspections. I understand that a registered copy of this Certificate of Installation is required to 6e included with the documentation the'builder provides to the building owner at occupancy. Responsible Builder/installer Name: Responsible Builder/Installer Signature: Hawkins, Stephanie Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Position With Company (Title): A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC Owner Address: CSLB License: 965 RIDGE LAKE BLVD STE 201 742039 City/State/Zip: Phone: Date Signed: 12016-06-14 MEMPHIS TN 38120 1408-286-8931 X123 13:41:32 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-A0199390A-MO100002A-0000 Registration Date/Time: 2016-06-14 13:41:32 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-14 13:38:35 Grhama Vprcinn• 7(11 R 1 n07