B-2016-1309 SMOKE/WATER o Off". CERTIFICATE OF COMPLL 4CE
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COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPEIt"1-INO 1t030&TOR A'VENU *VIINEki!`40,CA 35014-3255
(408)777-3228®FAX(408)777-3333•building_Q u prt�n_o.org
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PURPOSE
nlds aadais a lf certification for the installation of all required Smoke and Carbon Monoxide Al rens for
compliance with 2013 CRC Section 8314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL1,_4FO C A'i'ION
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 831:4 aid.CIBC ewetica -907J-11,.5 and 4-20-6requiee that broke Alarms axtdjar C4n
Monoxide Alarms be installed in the following locations:
AREA Sli40KE ALARM CQ ARM
Outside of each separate sleeping area in the immediate vicinity of the
bedrooms
On ever level of a dwe'Ilin�*unit including basements
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliance and that
do t havi an attached garage: Carbon monw idt,alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
P'"r Supply:h-=dwe-ll g`-nits wlthllia c0fflfftemal p€:wet-app ,alarm(s)maybe solely battery o erated.
In existing dwelling;units,alarms are permitted to be solely battery operated where repairs or after t c10
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 R3a14-and C9C See tions 97.2.114 att 420.6.2.Ari Electrical permit is reqi,.ired for
alarms which m.ust be connected to the building wining-
A-s
iring.As.owner of;the ahave-referenced property,f her-elly certify that the-allarm(s�,' kereCied above has/have been.
installed in,accordance with the manufacturer's instructions and in compliance with the Califorma B=ilding
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and CaTifommia Residential Codes.The alarms have leen tested andare operational,as of the date signed
bew
t Fra; eac1 and Wtwin iia co , t %t7fr 9*Germs,and con,di#iew:0th s_statemment
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oWNIE-v ERTIFICAT OF CO PLI t-6 F
ILE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �(
CUPERTINO
10300 TORRE AVENUE.CtUPERTINO,CA 95014-3255 � (J
(408)777-3228-FAX X408)777-3333 a bu{dinv(acupertino.oeg n
Owner Name q B\D)e Fu Permit No
AddressI C .
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1. 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 fo
: 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?
❑ 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.
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.
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.
XYes 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 sig
bottom of form..
5. Please cheek ONE of the following:
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 fix res
to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all on-
compliant plumbing fixtures shall be replaced with water-conserving plum,bing fixtures (regardless of wh ther
property undergoes alterations or improvements)
❑ My property is a-multifamily residential real properly. 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 futures to be replaced with wafer-conserving plumbing fixtures.
On or before. January 1, 2049, all non-compliant plumbing,fixtures shall be replaced with water-, conserviiig
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements
1,as the owner or o'wner'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 Sectio S1101.1
through 1101.8,,the current California Pluinbing Code and California Green Building Standards Code,and manufacturer's.
installation requirements,and that the water-conserving plumbing fixtures comply with the requireinents.as indicated in the
table on the following page.
e.
Owner or Owner Agent's Signature`. ,,;1 Date;t a to
Upon completing and signing,thus.Certificate,.please return it to the Building Division.in order to final your building—perTnit.
SB407'2011 doa revi ed'08126115
CERTIFICATE OF VERIFICATION F3R-MCH-20-H
Duct Leakage Diagnostic Test (Pa e 1 of 3)
Project Name: Fu nforcement Agency: City of Permit Number: B2016-1303
C - ertino
Dwelling Address: 19778 LaMar Dr. Cl Cupertino Zip Code: 95014
A.System lnformatlon
01 Space Conditioning System Identification or Name System 1
02 Space Conditioning System Location or Area Served Location 1
03 Building Type from CF-1R Single family
04 Verified Low Leakage Ducts in Conditioned Space Pio,credit is not taken
(VLLDCS)Credit from CEI-R?
IVerified LOW Leakage Air Handling Unit Credit from ; No,credr is not taken
1 00 CFiR? I
s 06 € Liuct System Compliance Category, replacement !
77
IVICH-20cl-Complete Replaceme,ot or Altered Duct System.
B.Duct Leakage Diagnostic Test r
l 01 Condenser Nominal Cooling Capacity(ton) 0
E0302Heating Capacity(kBtu/h) 75
Conditioned Floor Area served by this HVAC system(ft2) 1450
04 Duct Leakage Test Condition Test final
05 Duct Leakage Test Method Total leakage
06 Leakage Factor 0.06
07 Air Handling Unit Airflow(AHUAirflow)Determination Heating system method
Method
08 Measured AHUAirflow This field or section is not applicable
09 Calculated Target Allowable Duct Leakage Rate(cfm) 98
10 Actual duct leakage rate from leakage test measurement 83
(cfm)
11 Compliance Statement: System passes leakage test
Registration Number:216-A0234362A-M2000002A-M20A Registration Date/Time: 2016-06-24 07:42:11 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2013 Rev 1,007 Report Generated:2 16-06-24 07:01:32
2013 Residential Compliance Schema Version:2013.1.007
CERTIFICATE OF VERIFICATION 3R-MCH-213-H
Duct Leakage Diagnostic Test Page 2 of 3
B. Duct Leakage Diagnostic Test
12 dotes:
C.Additional Requirements for Compliance
01 System was tested in its normal operation condition.leo temporary taping allowed.
Outside air(OA)duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage
02 testing.OA ducts used for Central Fan Integrated(CFI)Indoor Air Quality ventilation systems,or Central fan Ventilation
Cooling Systems,that utilize dampers that open only when OA is required and automatically close when OA is not required,
may configure the OA damper to the closed position during duct leakage testing.
03 If a complete replacement,all supply and return register boots were sealed to the drywall,
04 Building cavities were not used as plenums or platform returns in lieu of ducts.
05 if cloth backed tape was used it was covered with Mastic and draw bands.
06 All connection:.,points between the air handier and the supply and return plenums are completely sealed.
if the system corn.plies using the Smok6 Test metly'od,the`smoke test was,'.- tct�d to c ordance with the eyu raments
07 of Reference Residential Appendix RA5:1.4 3.oi Sys��ms t)�at corms ly usi;i :smoke tela shall not be included r to pie
groups for HERS°,ler€ficatldn;corpiiance. ".
OB Verification Status Pass-all applicAle requirbmehts aro r et
l _ i
109 Correction Notes for this table g
l
The responsible persons signature on this compliance document affirms that all applicable requirements in this I able have
been met unless otherwise noted in the Verification Status and the Corrections Dotes 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,
01 Complies:All specified verification protocol requirements on this document are met.
Registration Number:216-A0234362A-M2000002A-M20A Registration Date/Time: 2016-06-24 07:02:99 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:20 6-06-24 03:01:32
2013 Residential Compliance Schema Version:2013.1.007
CERTIFICATE OF VERIFICATION C 3R-MCH- 0-FI
Duct Leakage Diagnostic Test (Page 3 of 3
j €cumentat on Author's Declaration Statement
1 1. 1 certify that this Certificate of*verification documentation is accurate and complete,
z �
Documentation Author Name: Documentation Author Signature:
Richard J Browningi
6 Company; Date Signed:
I
All-Star Home Inspection Services LLC 2016-06-24 07:02:11
Address: CEA/HERS Certification Identification(if applicable):
P.O.Box 1591
City/State/Zip: Phone:
Manteca CA 95336 209-914-2968
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. I am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification(responsible ter).
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 applicablesectlon's of the Certlficate(s);ofJn�tallatign(CFZR7 stoped aril submitted by the person(s)re ponsible for the
construction or installation conforms to the.requirementsspecified;o i the Certificates}of Com pliance(CF1R}.approved by theenfo Cement agency.
5. 1 will ensure that a registered copy of this Certificate of,,Ver fGcation 51 all be posted;or made;ayailabie with the building perenit(sYlss ed for the
building,and made availablQ`to the enforcement agency,for all applicable inspections,1, derstand that a registered;copy ofthis Ce tlflcite of, --
Verification is required to be iricltided with the documentation the builder`provides to the building owner at occupancy.
Builder Or Installer information As Shown On The certificate Of Installation
Company Name iinstalling Subcontractor.General Contractor,,or Builder/owner}:
TRON AIR HEATING&COOLING INC
Responsible Builder or Installer Name: CSLB License:
Jairon Melgar 980126
TIERS 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:
All-Star Home Inspection Services LLC
Responsible Rater Name: Responsible Rater Signature:
Richard J Browning
Responsible Rater Certification Number w/this HERS Provider: Date Signed'
CC2006373 2016-06-24 07:02:11
Digitally signed by CaICERTS.This digital signature is provided in order to secure the content of this registered document,and in no way implies Registrati in Provider
responsibility for the accuracy of the information.
Registration Number:216-A0234362A-M2000002A-M20A Registration Date/-Fime: 2016-06-24 07:02:11 HERSProvider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:20 6-06-24 07;01:32
2013 Residential Compliance Schema Version:2013.1.007