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B-2016-1788CITY OF CUPERTINO BUILDING PERMIT 1091UNOVEMBE DR CUPERTINO, CA 95014-4129 (362 16 025) CONTRACTOR: PERFECT HOMES PERMIT NO: B-2016-1788 CONSTRUCTION SAN JOSE, CA 95136 OWNER'S NAME: HUANG MICHAEL CW AND YIH-SHIN DATE ISSUED: 09/12//2016 OWNER'S PHONE: 408-513-5646 PHONE NO: (408) 910-0779 LICENSED CONTRACIOR'S CONTRACTOR'SD ARATION BUILDING PERMIT INFO: License Class B Lic. #556533 Contractor PERFECT HQM S CONSTRUCTION Date 02/28/2017 X BLDG —ELECT —PLUMB I hereby h t I am, licensed under the provisions of Chapter 9 (commencing — MECH X RESIDENTL&L _ COMMERCIAL Sectiaffirm on 700 Division 3 of thed withBusiness & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: CONSTRUCT (1) 2 STORY SFD (2,430 S.F.), ATTACHED GARAGE i. I have and will maintain a certificate of consent to self -insure for Worker's (433 S.F.) & FRONT/REAR PORCH AREA (314 S.F.) Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. i I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Cede, for the performance of the work for which this permit is issued. NT Sq. Ft Floor Area: 2863 Valuation: $430000.00 APPL.IC CERTIFICATION certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 362 16 025 R-3 (Custom),R-3 (Custom),U (Private Gar /Ag Bldg),U representatives of this city to enter upon the above mentioned property for (Private Gar /Ag Bldg) 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 PERMIT EXPIRES IF WORK IS NOT STARTED source regulations per the Cupertin ! unicipal Code, Section 9.18.. WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Signature;` Date 09/12/2016 r I Issued by: MELISSA OWNE"- UILDE ECLARU4 Date: 09/12/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: t. I, as owner of the property, or, my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed. If a roof is compensation, will do the work, and the structure is not intended or offered for installed without first obtaining an inspection, I agree to remove all new materials for sale (Sec.7044, Business & Professions Code) inspection. 2. I, as owner of the property, an exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Signature of Applicant:. Date: 09/12/2016 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by HAZARDOUS MATERIALS DISCLOSURE Section 3700 of the Labor Code, for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the permit is issued. Safety California Health & Safe Code, Sections 25505, 25533, and 25534. I will 3. 1 certify that in the performance of the work for which this permit is issued, I maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the shall not employ any person inany manner so as to become subject to the Health & Safety Code, Section 25532(a) should I store or handle hazardous Worker's Compensation laws! of California. If, after making this certificate of material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject }o the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Sections 7,5505, 25533, a d 25534. be deemed revoked. i // APPLICANT CERTIFICATION �- Owner or authorized agent _, I certify that I have read this application and state that the above information is Date: 09/12/2016 correct. I agree to comply with all city, and county ordinances and state laws CON TRUCTICW LENDING A�LY' relating to building construction, and hereby authorize representatives of this city I hereby affirm that there is a construction lending agency for the performance to enter upon the above mentioned property for inspection purposes. (We) agree of work's for which this permit is issued (Sec. 3097, Civ C.) to save indemnify and keep harmlessthe City of Cupertino against liabilities, Lender's Name judgments, costs, and expenses whih may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands Lender's Address and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date 09/12/2016 Licensed Professional CONSTRUCTION PERMIT APPLICA'rf� -' COVWUN(`CY DEVELOPMENT DEPARTMENT - BUILDING E AIISF' '10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 - (408} 777-8228 - FAX (408) 777-3333 - build Ingecuoeriino,orc i CUPERi -N� -? — LO- 19'3 I V J .I;nw CONSTPUCTION ❑ ADDITION ❑ iLTERATION / TI ❑ REVISION! DEFERRED ORIGE\T LLL PERMIT Y PROTECT ADDRESS �} AM, 9 44✓! �z t/ Ol>rNERh.g74E1 PCS ` � l Jc 1 f.A r Vj-aA f1 j � PHO?1'E I T -7+VUL STREET ADDRESSy� � y� CITY, STATE, ZIP - I FAX CONTACT HARE T-PkTX (i � � -1� PHo!'m /-Id`s 61515 -3t:rl J E_h24IL AROR-trET AD ml m STREET ADDRESS vt/qe 51 IKV I CI i f', STATE, ZIP L � - �' I + X FAX { O�'_M1'ER ❑ OtY rR-BUILDER ❑ 0M ER AGENT E1 CO';iP 4CTOR ❑ COIiTR4CTOR AGE)tT L! ARCHITECT ❑ E r IWEFR ❑ DEVELOPER ❑ '(E? k T f CONTRACTOR KAYE � � LICENSEEE�,y7 LICENSE TYPE SUS• LIC R COMPANY N ,'M I E,-IWL PaY STREETADDRESS CITY, STATE, ZIP PH02 E ?.RCHITECTIENGLN7M NA AE Av 1" n K tkK u - .r ec LICENSE 1,1111, BER G � � I BLS. LIC r�— — �yj�j /� ��k{"' CO1,1PANY NAME im �1� 1`t "1 � s ' -�-�����–G E A�ikIL . -( i • G � � FAX 5TREB7 ADDRESS Y !I { CITY, STATE, ZIP � PYOINM — EXISTINGt:SE - PROPOSED USE CO\STK+ STORIES �n-PH Y USE 7YPF ( OCC. I SQ.Fl-. VALliAT10N (S) E?:ISTG I:E\11FLOOR DEMO TOTAL —-- — ---- AREA I AREA � I ! AREA Ax7.4P> A � I V V I �� 01 I Y,1� BATI3ROOI+, J OMN OTIMR f RMAODELAREA {I REMMELAREA REMODELAREA I PORC}3 AREA - DECi: AREA. TOTAL VECKI.P,ORC-I AREA GAP kGE AREA: D;TACH 4 ! I MWELUNG UNITS: 19 A SECOIiD UNIT YES SECOND STORY []YES \ EEL\GAflDEI 0 ADDITION? I PFS 4PPLICATIO,N' l'ES IF i YS. PROVIDE COPY OF IS THE BLDG A\ ©tom �CBjj EI3 h PLA'KNMAPPL' [3i:0 PLAA �K-G APPROVAL LETTER EICHUR ROKM7 -M �r��Q1. ego0 By my signature below; I certify to each of the 5011owing: I Z -11w1 the property oter or authorized agent ,o act odtbt property owi er's behalf, I ha\`e med this appltcabion and the Inforrnatioi) I,have pro\�ided is correct. I have read the Descriptio:t of Warl: and verify it is accurate. I agiee to comply u`ilh all applicable loczl ordinances ud state )a\t- ielating to buil ing constmetion. I authorize repiesentatives of Cupet Lino to enter the above :demi*,"]ed property for inspection pill-Doses. Y' - bate: l 6 e S1 PLEA�El;Ir L.I:\; 0R MAT ON REQUIRED ..._ R01.TI\G,`SL7 P New SFD or Aiultifamily d7 elfin gs: Apply for delmolidon permit for ❑ OI�R T# -`E COLITER T'LILDI\G r existing building(s). Dtmiolition per -mit is required prior w issuznce o.t building ,. \ sl ,� P��\ RI:\ IEi; _ i permit for new buildi .g. K: E�aRl ss � iMAE + 4 I4 COnmiercial Bldgs:Provide a completed Hazardous 2\48tenals Disclosme; tl�ater'�a15 �L.�'i ST\77AIiD ; PLELIC ti ORI: -. W � r ° - '� i0i_11 ii..al;V 1':2ZardOL� OTC b,,.itg 1?sCd 2S part OS 11175.i'OCCt. - j i LkRGE FR.—t r r FIP t.DEPT € _ Copy of Plaimiritr Approval Letter or Meeting \; ith Pl2tining prior to'� •• + sublllittai of Building Permit application, LI Y�yk.IOR ? ,�'S\IT.RY �..� �RE\YZRO\.liE I.4LHELTH B1d&yp_'OII.doc revised 06121111 FILEIC GreenBluEarth, Inc. 117 Bernal Rd. #70-336, San Jose, CA 95119 Ph.: 408.772.4381 Email: osunaengineering@gmail.com September 27, 2016 Job No. 1298 Building Department City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 Re: 1091 November Dr., Cupertino CA— New House TQ--Wb m_Lt Mav C^nfer-n This is to certify that the house foundation for the property mentioned above, was staked according to the approved Plans and that the setbacks are per the approved Plans. The elevations of the forms for the living area are 334.03 (+/-0.05') on target for the calculated FF 334.77 (mud sill + floor Joists + plywood). Sincerely, a Oscar Osuna, M.S., P,E., P.L.S. President RCE C70829 PLS L8921 117 Bernal Rd. #70-336, San Jose, CA 95119 • 408.772.4381 • Email: osunaengineering@gmail.com ',-2a c6 -- f `7 ,7- f— Ft 1 - M-0 DAILY PROGRESS REPORT'l c Project No. 0'7`7 - i Page of Report Sequence No. Project Name Weather (1,1-4v Project Address (knl' ;e „ Purpose of Site Visit f ;�� v' 1, f�glt'ld'zl 'n"bot-wrte 4 Project Activity Today Comments t tl f '#'i S s°°€ic fr � �'e`y°Yf ��✓i I���'t��e d� t r�r p¢g � �, � ��� It�i L� �'. G!!?d114fw0V1'1GE/j &wfs"`k_wt',t tti olil7,'% I�jr 9=t� jtiY �1 Pi r 04MO a� f'rMM s"'t 1f qtr"'fe 5 €s{' E arm{` t llc To I, ;, r.'/„ 14111.1 i &fC41 r el '{N �if� a�E ;�d`✓/Fs t rtt fm f" , pfk 1? A f - mi t7 a %s '`W" .fit # f— i 7 1 r > R r { �r� �r � �ej � Ch,`:�1,t�. 1iR-gl.`I � �v�°'git' ��i',Ftf✓^s'�°t�,��It'o,''z'e��{'�;�`J�t"l�r`°�r''f,��;t` u' 101 ((a fill', {'if t°ri-eef t t`t 'r Y' `l f§' t ,f ' av t ;'t`1�'r >{ Etf' '-€ v-//' 't f r f `1—z'" / ar S =a r fhf k d '" t' pd- klwh > I✓ a d P .d � t y_U,HSSI 'r 1 ol ff k int t"r 1�1"11 '''"'lflf }{7i e-" d 4y' €..)•c r V Next Visit(s) /le-ii44 NOTE: PLEASE NOTIFY US 48 HOURS IN ADVANCE OF ANY EARTHWORK AND FOUNDATION CONSTRUCTION TO BE OBSERVED Equipment in Use X'//-' Client`_' `' v''%' Contact Contractor Contactx Copy to t7 mmIt Reportby at�c f tt ROMIG 1390 EI Camino Real, Second Floor, San Carlos, California 94070 ENGMErERS(650) 591-5224 Fax (650) 591-5251 JDN ENGINEERING, INC. RESIDENTIAL • COMMERCIAL STRUCTURAL DESIGN P.O. BOX 1382 PH. 510-415-2809 UNION CITY, CA. 94587 EMAIL: jdnguyen30@gmaii.com City of Cupertino Building Department 10300 Torre Avenue Cupertino, Ca. 95014 Phone: (408) 777-3228 Fax: (408) 777-3333 2&1b -- January 3Q, 2017 Subject: Huang Residence at 1091 November Dr., Cupertino, CA To Whom It May Concern: Please accept this letter as our certification that we have made a review of the following items and found them to be in accordance with the overall structural design: 1. At plan sheet S2 where N26 specified for the horizontal ceiling di phragm above the entry and living room, it is acceptable to install 1/2" CDX plywood over the top of the ceiling joists instead of at the bottom. Same condition at ceiling between bedroom #1 and Study room. 2. At Study room right side top of exterior wall, it is acceptable to install double 2x4 blocking above double top plate and fasten together using 1/4" x -1/2" Simpson SDS screws at 8" on center. If you have any question concerning this matter, please do not hesitate to call our office. s �L 1" VV-- JDN ENGINEERING, INC. RESIDENTIAL•COMMERCIAL STRUCTURAL DESIGN P.O.BOX 1382 PH. 510-415-2809 UNION CITY,CA.94587 EMAIL:jdnguyen30@gmaiicom IL E i City of Cupertino December 20, 2016 Building Department 10300 Torre Avenue Cupertino, Ca. 95014 Phone: (408) 777-3228 Fax: (408) 777-3333 Subject: Huang Residence at 1091 November Dr., Cupertino, CA To Whom It May Concern: Please accept this letter as our certification that we have made field observations as defined in Section 1702 for Structural Observation of t e International Building Code and Section 1701.1 of the California Buildin• Code. We, JDN Engineering, Inc., have observed the final structural framings, connections, and found them to be in general compliance with the approved structural plan. Our certification was based on a visual inspection of the construction, as it existed at the time of our inspection. The inspection was made to verify compliance with the basic parameters of the design. No measurements were taken, nor did we attempt to verify the overall quality of the work. Uniform compliance with the designs and specifications is the responsibility of the contractor and is not guaranteed by this letter. Exclusion of warranties: Our services consist of professional opinion only. No WARRANTY, EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED WAIRRANTY OF MERCHANTABILITY OR FITNESS FOR THE PURPOSES is made or intended. Very truly yours, ce / �. 71): Art. 11* 451 CIVIL Joseph Nguyen, PE CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: ff pV _ PERMIT # OWNER'S NAME: Ings} PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE #(p ADDRESS: ice, CITY/ZIPCODE:SA-Vs r— *Our municipal code requires all bdsinesses working in the city to have a City of Cupertino business Iicense. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Ob , o Ugnaure Date Please check applicable subcontractors and complete the following information: W)�- �/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile / gontr)ctor Signature D to { Building Department City Of Cupertino 10300 Torre Avenue 01-J94:p Cupertino, CA 95014-3255 C lJ P E IZT 111 O Telephone 408-777-3228 Fax. 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS /09/ 106 M OWNER'S NAME. �-.� PERMIT# �()�� �-- �'�—� �` �` � PHONE# 9"(0 '-- 7 9 �� GENERAL CONTRACTOR. Peg =c HONE-3 BUSINESS LICENSE# �SS"s 3 � ! ADDRESS (ST „9 IJo r MA f CITY/ZIPCODE c, / *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SU G ONTRACTORS HAVE OBTAINED A CITY OF UPERTINO BUSINESS LICENSE. w I am not using any subcontractors. / iliq Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile •r f' Owner/Contractor Signature Date CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems,Ducts,and Fans (Page 1 of 11) Project Name: November Drive Residence Enforcement Agency: City of Cupertino Permit Number: ` Dwelling Address: 091 ';o ember Driv-a City: Cupertino Zip Code: "615014 A.General Information 01 Dwelling Unit Name Unit 1 02 Climate Zone 4 Dwelling Unit Total Number of Space 032430 04 Conditioning Systems in this 2 Conditioned Floor Area(ft`) Dwelling Unit. 05 Certificate of Compliance Performance(CF1R-PRF) 06 Method used to Calculate Not applicable-equipment changeout, Type HVAC Loads like-for-like 07 Calculated Dwelling Unit 0 08 Calculated Dwelling Unit 0 Sensible Cooling Load(Btuh) Heating Load(Btuh) r :• rog f; , Dwelling Unit Number of 09 4 Bedrooms k CF2R-MCH-Ola-Space Conditioning Systems Ducts#and Fanta ,Foi mise ink therformance egOifiecilaof compliance Registration Number:216-N0124911A-M0100001D-0000 Registration Date/Time: 2017-08-04 17:45:43 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:24:49 Schema Version:2013.1.008 - CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems,Ducts,and Fans (Page 2 of 11) B. Design Space Conditioning(SC)System Component Specifications from CF1R 01 02 03 04 05 06 07 08 09 10 11 12 Space =_ Low Conditioning Space Heating Space Required Leakage Cooling Cooling- Distribution Air-Handling Bypass Duct Cooling System Zone Name System Conditioning System Conditioning Thermostat Identification System Type Type System Type Fan Type System Type Type Unit Status Zoning Type Compressor or Name (LLAHU) Speed Type Status This field or Heating and PSC section is Central gas Central split Unconditione No,credit is No Bypass not System 1 " cooling system furnace AC Permanent d attic Setback not taken Duct Not Zonal Single Speed applicable other Split Capacitor This field or Heating and PSC section is Central gas Central split Unconditione No,credit is No Bypass not System 2 cooling system _furnace AC ',.a Permanent: d attic' ' Sy b ect,k,, not " ken Duct Not Zonal Single Speed other Sp ix Capacitor FE, N, d applicable - (i 044 t , e{ , 1 C. Design Space Conditioning(SC)System Compliance Requireme is frim CFR �:,' " 01 ' 02 03 04 05 06 07 08 - 09 10 • Space - Minimum Conditioning Heating Heat Pump Heat Pump Minimum Minimum Cooling System Maximum Fan Heating Minimum Duct System Minimum Heating Heating Cooling , Cooling Efficacy Efficiency TypeAirflow Rate- R-Value Identification or Efficiency Value Capacity at 47F Capacity at 17F- Efficiency SEER Efficiency EER (Watts/CFM) Name (CFM/ton) ---- -This field or-- -`This field or System 1 AFUE 80 section-isnot section is=not-- = 14 - - 11.7-= - 350 -0.58 - - - ----R-6-- -- - -- -applicable applicable-- - Registration Number:216-N0124911A-M0100001D-0000 Registration Date/Time: 2017-08-04 17:45:43 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:24:49 Schema Version:2013.1.008 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems,Ducts,and Fans (Page 3 of 11) C. Design Space Conditioning(SC)System Compliance Requirements from CF1R 01 02 03 04 05 06 07 08 09 10 Space Minimum Conditioning Heating Heat Pump Heat Pump Minimum Minimum Maximum Fan Heating Cooling System Minimum Duct SystemMinimum Heating Heating Cooling Cooling Efficacy Identification or Efficiency Type Efficiency Value Capacity at 47F Capacity at 17F Efficiency SEER Efficiency EER Airflow Rate (Watts/CFM) R-Value Name (CFM/ton) This field or This field or System 2 AFUE 80 section is not section is not 14 11.7 350 0.58 R-6 applicable applicable D. Installed Space Conditioning(SC)System Component Information 01 02 ' 03 04 05 06 07 08 09 10 11 „omte% V ooram, ouvrc •, tom. „tea 741 Conditioned i ,,,, f-., i11 Cooling Central Fan SC System SC System �g Spac �- S %System q Integrated Floor Area }leafing Cpoling 5 ,Dist(rlbution 0011 8 Zoning ?, System ) Identification Location or Served by the Syim ype ys em Type Condromr�g Sys ern Type, Tier osta Type Compressor (CFI) or Name Area Served Z Fa Type Tye ' Ventilation System(ft ) ri, type l ,, .m A,:: Speed Type System Status Central gas Central split PSC Unconditioned Not a CFI System 1 Upstairs 1000 furnace AC Permanent attic Setback Not Zonal Single Speed system Split Capacitor Central gas Central split PSC Unconditioned Not a CFI System 2 Downstairs 1430 furnace AC Permanent attic Setback Not Zonal Single Speed system Split Capacitor • Registration Number:216-N0124911A-M0100001D-0000 Registration Date/Time: 2017-08-04 17:45:43 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:24:49 Schema Version:2013.1.008 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems,Ducts,and Fans (Page 4 of 11) E.Installed Heating Equipment Information(not heat pumps) 01 02 -.03 04 05 -06 07 08 Rated Heating SC System SC System Heating Heating - Capacity, Identification Location or Efficiency " Efficiency Output or Name Area Served Type Value Heating Unit Manufacturer Heating Unit Model Number Heating Unit serial number (BTUH) System 1 Upstairs AFUE 95 Carrier 59sp5a040e14-10 4716a45206 39000 System 2 Downstairs AFUE 95 Carrier 59sp5a060e14 4916a45458 58000 Notes: F. Installed Cooling System Outdoor Condensing Unit or Package Unit Equipment Information(not heat pumps) 01 02 03 04 <A 05 f ca"..;,a ; 06 �° ,,_ , 07 08 09 6 t4 Z1 11 r ;"f SystemR ` E � 3 £„ ? Rated Condenser �" .. : fir m0. 0 t � Cooling Rated _ "' P s'��,,.,� �; "` '6:7, " E Capacity at Nominal SC System SC System Cooling Cooling Design Cooling Identificatio Location or Efficiency Efficiency Condenser or Package Unit Condenser or Package Unit Condenser or Package Unit Conditions Capacity n or Name Area Served SEER EER Manufacturer Model Number Serial Number (BTUH) (ton) System 1 Upstairs 14 12 Carrier 24aaa530a306 4916e14725 30000 2.5 System 2 Downstairs 14 12 Carrier n4a536gkc101 e154200977 36000 3 Notes: Registration Number:216-N0124911A-M0100001D-0000 Registration Date/Time: 2017-08-04 17:45:43 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:24:49 Schema Version:2013.1.008 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems,Ducts,and Fans (Page 5 of 11) G.Installed Split System Indoor Coil or Fan,Coil Unit Equipment Information(applicable-to DX or hydronic heating/cooling coils or fan coil units). 01 02 03 04 05 SC System Identification or SC System Location _ Indoor Coil or Fan Coil Unit Model Name or Area Served Indoor Coil or.Fan Coil Unit Manufacturer Number Indoor Coil or Fan Coil Unit serial number System 1 Upstairs Carrier xxxxxxxx 00000000 System 2 Downstairs Carrier c36h142p036 7116j46324 Notes: - H. Installed Heat Pump System-Split System Condensing Unit or Package Unit Equipment Information This section does not apply to this project. gt5974,, 454' I.Installed Heat Pump System-Efficiency and Pcrformarice Comp fiance lnformatIDDE € ..mak hi i. WS c s e 4 • This section does not apply to this project Registration Number:216-N0124911A-M0100001D=0000 Registration Date/Time: 2017-08-04 17:45:43 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance - Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:24:49 Schema Version:2013.1.008 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems,Ducts,and Fans (Page 6 of 11) J. Installed Duct System information 01 02 03 04 05 06 07 08 09 10 11 12 Method of Exemption compliance from Mini with duct Exemption Can RA3.3 R-Value for and filter From Duct Number of Airflow SC System SC System Ducts In grille sizing Leakage Air Filter Protocols be Identification Location or Supply Duct Supply Duct Return Duct Return Duct Conditioned Req's in Requirement Bypass Duct Devices on used to test or Name Area Served Location R-Value Location R-Value Space 150.0(m)13 s Status System this system? HERS verified fan.efficacy Uncondition Uncondition No No No Bypass System 1 Upstairs ed attic - R-6 ed attic R-6 Exemption (W/cfm)and exemptions Duct 1 Yes airflow rate (cfm/ton) re. egg HERS_verifiad. 3 i i fa rt"effi cy m Uncondition Uncondition K, x Noy N No bypass System 2 Downstairs R 6 t 6' - (W/'efm)an ., H. 1 Yes ed attic �, e9 attic Exemption-� exemptto uct � . � Ott ,airflow F , ,. (cfm/to Notes: - K.Installed Air Filter Device Information - - - Mandatory requirements for air filter devices are specified Section 150.0(m)12. 01 02 03 :04 . - 05. 06 07 Determined Design Determined Design Allowable Pressure SC System SC System Location or Air Filter Identification - Air Filter Device Airflow Rate for Air Drop for Air Filter- Identification or Name Area Served or Name Air Filter Device Type _- Location Filter Device(cfm)_ Device(inch WC) System 1 Upstairs _ Filter 1 Filter Grille hallway 1200 0.02 Registration Number:216-N0124911A-M0100001D-0000 Registration Date/Time: 2017-08-04 17:45:43 HERS Provider:CaICERTS CA Building Energy Efficiency Standards—2013 Residential Compliance Report Version:2013 Rev 1.008• Report Generated:2017-08-04 14:24:49 Schema Version:2013.1.008 - CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems,Ducts,and Fans (Page 7 of 11) K.Installed Air Filter Device Information Mandatory requirements for air filter devices are.specified Section 150.0(m)12. 01 02 - - 03 04 05 06 07 Determined Design Determined Design Allowable Pressure SC System SC System Location or Air Filter Identification Air Filter Device Airflow Rate for Air Drop for Air Filter Identification or Name Area Served or Name Air Filter Device Type Location. Filter Device(cfm) Device(inch W.C.) System 2 Downstairs Filter 1 Filter Grille hallway 1200 0.02 Notes: L.Air Filter Device Requirements 01 The system shall be designed to ensure that all recirculated air and all outdoor air supplied to the occupiable space is filtered before passing through the system's - thermal conditioning components. j rt• p eftwo The system shall be designed to accommodatenhe clew filter p es,O re dr p imposed'by the .yste ,air filter'device(s TF de g airflow rate and maximum des allowable clean-filter pressure drop at the ign airflow rate;applicable to ach.93iPfilter devic sha be. stern ed,4,9411syitenTak filter device locations shall be 02 labeled to disclose the applicable design airflo rate and the maximurrt,a:llowable cleanifilterpressu,,edrop.The labels shall$be permanently affixed to the air filter device,readily legible,and visible to a person replacing the air filter media,ar.dbthe airliner devices shall be,4irovided,with a'r"filter edia that conforms to these determined or labeled maximum allowable clean-filter pressure drop values as rated using AHRI Standard 680. 03 All system air filter devices shall be located and installed in such a manner as to allow access and regular service by the system owner. 04 The system shall be provided with air filter media having a designated efficiency equal to_or greater than MERV 6 when tested;in accordance with ASHRAE Standard 52.2,or a particle size efficiency rating equal to or greater:than 50 percent in the 3.0 to10 micron range when tested in accordance with AHRI Standard 680. 05 The system shall be provided with air filter media that has_been labeled by the manufacturer to disclosethe efficiency and pressure-drop ratings that conform"to the required efficiency and pressure drop requirements for the air filter device._-_ The responsible person's signature on this compliance document affirms that all applicable requirements in this table have been met. Registration Number:216-N0124911A-M0100001D-0000 Registration Date/Time: 2017-08-04 17:45:43 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:24:49 Schema Version:2013.1.008 " " . . CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems,Ducts,and Fans (Page 8 of 11) M. HERS Verification Requirements 0102 03 04 05 06 07 08 09 10 11 12 MCH-20- MCH-21 - MCH-22 MCH\-23-- ' -MCI1-25 - - MCH-26 MCH-27 MCH-28 MCH-29 MCH-30 SC System SC System Duct Ducts AHU Fan AHU Refrigerant Rated SC IAQ Return Supply Ventilation Identificati Location or Leakage Location Efficacy Airflow Charge System Mechanical Duct Duct Cooling on or Area Test Verification (W/dm) Rate Equipment Ventilation Design Surface Credit Name Served (cfm/ton) Verification Table Area ' 150.0-C or R-Value D Buried Ducts System 1 Upstairs Yes No Yes Yes No No Yes No No No System 2 Downstairs Yes No Yes Yes No No Yes No No No :'.,,,,,' Notes: ‹..-::,:a '•_, If ,_ 11 44;\ 4 i <$.4--‘N „,t •-,-.,-,,,,t!,V,:-,V ', !:vv&AN. ,v .. - ', -- 6.* '' ''' p C: ,,.7-, n V I 0 F L. A —., • Registration Number:216-N0124911A-M0100001D-0000 Registration Date/Time: 2017-08-04 17:45:43 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2017-08-04 1424:49 Schema Version:2013.1.008 :,. CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems,Ducts,and Fans (Page 9 of 11) N.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:Fan-type central furnace may not have£a continuo sly�urnm ilot1t ection 110.5 and Section 110.2(d). Cooling Equipment �. .. n dA 06 Equipment Efficiency:All cooling equipment mu -441sth `.minimum effiyiency require " ntsToffSection 110 rand Sec'tibn 1Q;2(a atnd 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:bynew cooling systems to prevent:inadvertent undersizing-or oversizing.See Section---- --- 150.0(h)1 and 2. Air Distribution System Ducts,Plenums and Fans _ _- _- 10 Insulation:In all cases,unless ducts are enclosed entirely in directly conditioned space,the minimumduct 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-N0124911A-M0100001D-0000 Registration Date/Time: 2017-08-04 17:45:43 HERS Provider:CaICERTS CA Building Energy Efficiency Standards=2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:24:49 Schema Version:2013.1.008 CERTIFICATE OF INSTALLATION - CF2R-MCH-01-E Space Conditioning Systems,Ducts,and Fans S (Page 10 of 11) N.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 equipmentor 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 CIVIC-Sections 601.0,- 11 602.0,603.0,604.0,605.0 and ANSI/SMACNA-006-2006:Supply-air and return-air.ducts.and-plenums must be insulated to a minimum installed level.of R-6.0 or enclosed entirely in directly conditioned space as confirmed through field verification and diagnostic testing in accordance with the requirements of Reference Residential Appendix RA3.1.4.3.8. Heat Pump Thermostat 12 A thermostat shall be installed that meets the requirements of Section 110.2(b)and Section 110.2(c). 13 The thermostat shall be installed in accordance with the manufacturers published installation specifications 14 First stage of heating shall be assigned to heat pump heating. - - 15 Second stage back up heating shall be set to come on only when the indoor set temperature cannot be met. The responsible person signature on this compliance docume it affirms-tth`at a ll applicable=requitemebts inNthis4table have i erne a .k,z,Atcam. Registration Number:216-N0124911A-M0100001D-0000 - Registration Date/Time: 2017-08-04 17:45:43 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:24:49 Schema Version:2013.1.008 T , CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems,Ducts,and Fans (Page 11 of 11) Documentation Author's.Declaration Statement 1. I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: /1�d� /� . Jose Novelo Oma/ �(/ Company: Signature Date: California Air Duct Testers 2017-08-04 14:26:45 Address: - CEA/HERS Certification Identification(if applicable): 5279 Eggers Dr City/State/Zip: Phone: Fremont CA 94536 408-824-0740 • 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. I am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design,construction,or installation of features,materials, components,or manufactured devices for the scope of work identified on this Certificate of Installation and attest to the declarations in this statement(responsible builder/installer),otherwise I am an authorized representative of the responsible builder/installer. '" 3. The constructed or installed features,materials,components or manufacturedVetceCthe mstallati ''n)i nti7 d o this c rtifica of Installatio'"co form;to all'apjilicable codes and regulations,and the installation conforms to the requirements given on the`plans and s ` cification�appro ed' the enfo ftementagefrty 4. I reviewed a copy of the Certificate of Compliance appro ed by the forcem i gen th)i 'de {fieite4pecific r quire entsf ,t„(ie s ope of construction or l ion identified on this Certificate of Installation,and I have ensured that the reguirementst ;apply to the construction or installation have been met. 5. I will ensure that a registered copy of this Certificate of In ` Ilation shall4b1 posted,or Ino e a4allable with the building permit(s)issued for!the Fri made available to the enforcement agency for all applicable inspections.I understand that a registered copy of this Certificate ofin5tallation is required to be includedWith the documentation the builder provides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: Tom Tuan Nguyen few,�l li lft Pete, Company Name:(Installing Subcontractor or General Contractor or Builder/Owner) Position With Company(Title): PERFECT HOMES CONSTRUCTION mgr Address: CSLB License: 382 LASSEN PARK CIRCLE - 556533 City/State/Zip: _ _ Phone: Date Signed: SAN JOSE CA 95136 408-910-0779 2017-08-04 17:45:43 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-N0124911A-M0100001D-0000 Registration.Date/Time: 2017-08-04 17:45:43 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:24:49 Schema Version:2013.1.008 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3) Project Name: November Drive Residence Enforcement Agency: City of Permit Number: a 88, t Cupertino .r Dwelling Address: ®' .emir® Q l-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 ,(VLLDCS)Credit from CF1R? 05 'Verified Low Leakage Air Handling Unit(VLLAHU)Credit No,credit is not taken .from CF1R? 06 Duct System Compliance Category Replacement . rM MCHH2Od-Complete Repiaceme t or Altered D�Sy t m.., "A,. � r '4.4 w• s B. Duct Leakage Diagnostic Test 01 iCondenser Nominal Cooling Capacity(ton) 2.5 02 Heating Capacity(kBtu/h) 39 03 Conditioned Floor Area served by this HVAC system(ft2) 1000 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 Cooling system method Method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage(cfm) 60 10 Actual duct leakage rate from leakage test measurement 37 (cfm) 11 Compliance Statement System passes leakage test Registration Number:216-N0124911A-M2000002B-0000 Registration Date/Time: 2017-08-04 17:45:44 HERS Provider:CaICERTS CA Building Energy,Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:26:05 2013 Residential Compliance Schema Version:2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3) C.Additional Requirements for Compliance 01 System was tested in its normal operation condition.No temporary taping allowed. Outside air(OA)duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage 02 testing.OA ducts used for Central Fan Integrated(CFI)Indoor Air Quality ventilation systems,or Central Fan Ventilation Cooling Systems,that utilize dampers that open only when OA is required and automatically close when OA is not required, may configure the OA damper to the closed position during duct leakage testing. 03 If a;complete replacement,all supply and return register boots were sealed to the drywall. • 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All connection points between the air handler and the supply and return plenums are completely sealed. If the system complies using the Smoke Test method,the smoke test was conducted in accordance with the requirements 07 of Reference Residential Appendix RA3.1.4.3.6.Systems that comply using smoke test shall not be included in sample groups fo'r HERS verification compliance. The responsible persons signature on this compliance document affirms,that a applicable requirements this table have been met ut 4 p. Registration Number:216-N0124911A-M2000002B-0000 Registration Date/Time: 2017-08-04 17:45:44 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:26:05 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.I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signaturepa��� edv JOse Novelo Company: Signature Date: 2017-08-04.14:26:45 California Air Duct Testers Address: • CEA/HERS Certification Identification(if applicable): 5279 Eggers Dr City/State/Zip: Phone: Fremont CA 94536 . 408-824-0740 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. I am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction,or installation of features,materials,components,or manufactured devices for the scope of work identified on this Certificate of Installation and attest to the declarations in this statement(responsible builder/installer),otherwise I am an authorized representative of the responsible builder/installer. , 3. The constructed or installed features,materials,components or manufactured devices(the installation)identified on this Certificate of Installation conforms to all applicable codes and regulations,and the installation confor s to the requirements grout on the plans and specifications approved by �S "x y'ts;r NiA^Q 3 dy the enforcement agency. it, 40 4. I understand that a HERS rater will check the installation to eri compliance and that ifiptictItheclOg identifies defects;l am requttfed to rake • corrective action at my expense4underst4hat Enetaeocnifilast90 and HES Provider representatives will a.§0 perform quality ass lratice checking of installations,including ttrosg,a tp oved as part of:a satrtpIa group bu nottheckediby'a:HERSraterand if those ins allatio"ris fai(to meet the.; requirements of such quality assurance,checking,the required corr�ectivea:ction and,ddditiorial checking/testing ofother installations,in that HERS sample group will be performed at myexpense. H 5. I 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. I 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: Tom Tuan Nguyen 71,;(. lf!.':. 1y j Company Name:(Installing Subcontractor or General Contractor or Position With Company(Title): Builder/Owner)V mgr PERFECT HOMES CONSTRUCTION Address: V I ;; CSLB License: 382 LASSEN PARK CIRCLE 556533 City/State/Zip:i:; Phone: Date Signed: SAN JOSE 04;95136 408-910-0779 2017-08-04 17:45:44 Third Party Quality Control Program(TPQCP)Status: Name of TPQCP(if applicable): Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document,and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number:216-N0124911A-M2000002B-0000 Registration Date/Time: 2017-08-04 17:45:44 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:26:05 2013 Residential Compliance Schema Version:2013.1.007 CERTIFICATE OF VERIFICATION C9R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3) Project Name: November Drive Residence Enforcement Agency: City of Permit Number: 2:1116:1 88', Cupertino z r Dwelling Address: . o.ember 40(11W. City: Cupertino Zip Code: 95014 A.System Information 01 Space Conditioning System Identification or Name System 2 02 Space Conditioning System Location or Area Served Downstairs 03 Building Type from CF-1R Single family 04 Verified•Low Leakage Ducts in Conditioned Space No,credit is not taken (VLLDCS)Credit from CF1R? 05 Verified Low Leakage Air Handling Unit Credit from No,credit is not taken CF1R? 06 Duct System Compliance Category, Replacement MCH-20d-Complete Replacement or Altered Dtftt�System g B.Duct Leakage Diagnostic Test F ir'%: (—) V 01 Condenser Nominal,Cooling Capacity(ton) 3 02 Heating Capacity(kBtu/h) 58 • 03 Conditioned Floor Area served by this HVAC system(ft2) 1430 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 CalculatedTarget Allowable Duct Leakage Rate(cfm) 76 10 Actual duct leakage rate from leakage test measurement 43 (cfm) 11 Compliance Statement: System passes leakage test Registration Number:216-N0124911A-M2000003B-M20D Registration Date/Time: 2017-08-04 14:28:54 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:29:07 2013 Residential Compliance Schema Version:2013.1.007 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3) B. Duct Leakage Diagnostic Test 12 Notes: C.Additional Requirements for Compliance 01 System was tested in its normal operation condition.No temporary taping allowed. Outside air(OA)duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage 02 testing.OA ducts used for Central Fan Integrated(CFI)Indoor Air Quality ventilation systems,or Central Fan Ventilation Cooling Systems,that utilize dampers that open only when OA is required and automatically close when OA is not required, may configure the OA damper to the closed position during duct leakage testing. 03 If a complete replacement,all supply and return register boots were sealed to the drywall. 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All connection points between the air handler and the supply and return plenums are completely sealed. x: ' tiro If the system complies using the Smoke Test meth d tfhe�smoke test was`conducted♦in a ordance with the requir?ments ash t.4 Ie, 07 of Reference Residential Appe dix RA 14 3 6 Syste s that comply using,smoke test shall not be included in sample groups for HERS verificatidfr compliance At-At ztZeda o sk4q. ,' , 08 Verification Status Pass-all applicable requirements are met 09 Correction Notes for this table The 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. 01 Complies:All specified verification protocol requirements on this document are met. Registration Number:216-N0124911A-M2000003B-M2OD Registration Date/Time: 2017-08-04 14:28:54 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:29:07 2013 Residential Compliance Schema Version:2013.1.007 • CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3) Documentation Author's Declaration Statement 1.I certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Jose Novelo f�•J ,XtV ' Company: Date Signed: California Air Duct Testers 2017-08-04 14:28:54 Address: CEA/HERS Certification Identification(if applicable): 5279 Eggers Dr City/State/Zip: Phone: Fremont CA 94536 408-824-0740 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 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 sectiopsofthe Certifica#(s)osf lnstailation'{CFZR)signed and submitteaby the perssbn(s)responsible for the construction or installation conforms to the eguirementsz'speci( dlan the Certifica� m te(s►of Co4ppliance(CF7,R approved by he enftifvmep agency. 5. I will ensure that a registered copy of this Certificate of Verificattdn Jiall be posted or ade vailab a with the permit(5)issued r the building,and made availab to the enforcement gpnCy,f ll applicable nspectipns I yndef Land that a%r reddcopy of th Cert ca{e o Verification is required to be iryciuded with the documentation the builder provioesto the building owner at occupancy. C- ri4 Builder Or Installer Information As Shown On-The Certificate Of Installation Company Name'(Installing Subcontractor,General Contractor,or Builder/Owner): PERFECT HOMES CONSTRUCTION Responsible Builder or Installer Name: CSLB License: Tom Tuan Nguyen 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: California Air:Duct Testers Responsible Rater Name: Responsible Rater Signature: Jose Novel° 36, rwieet' Responsible Rater Certification Number w/this HERS Provider: Date Signed: CC2006387 2017-08-04 14:28:54 • Digitally signed by Ca/CERTS. 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-N0124911A-M2000003B-M2OD Registration Date/Time: 2017-08-04 14:28:54 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:29:07 2013 Residential Compliance Schema Version:2013.1.007 sp • CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 Project Name: November Drive Residence Enforcement Agency: City of Permit Number: 0.6 188' Cupertino F' Dwelling Address; Nsve Mj®-r :l City: Cupertino Zip Code: 95014 timusenettromsmiam. mon,--I 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 (VLLDCS)Credit from CF1R? 05 Verified,Low Leakage Air Handling Unit Credit from No,credit is not taken CF1R?. 06 Ductystem Compliance Category Replacement • ,, MCH-20d-Ct�: v,omplete Replacement or A eyed Duct System 4 y ;.gar^-.�, }t ��,.an r�.v;a" '.a B. Duct Leakage Diagnostic Test _.,�.. 01 • Condenser Nominal Cooling Capacity(ton) 2.5 • Iii € : 02 Heatn'g,Capacity(kBtu/h) 39 03 Conldifioned Floor Area served by this HVAC system(ft2) 1000 04 DuctLeakage'Test Condition Test final 05 Duct°Leakage;Test Method Total leakage 06 LeakageiFactor . 0.06 07 Air.M'andling Unit Airflow(AHUAirflow)Determination Cooling system method Method 08 Measured AH'UAirflow This field or section is not applicable ILII . 09 Callc'ulated Target Allowable Duct Leakage Rate(cfm) 60 10 Actual;duct leakage rate from leakage test measurement 37 (cfrri)11 'f 11 Compliance Statement: System passes leakage test II 'I Registration Number:216-N0124911A-M2000002B-M20D Registration Date/Time: 2017-08-04 14:28:54 HERS Provider:CaICERTS CA Buildingienerg'y Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:28:39 2013 Residential Compliance Schema Version:2013.1.007 O CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3) B. Duct Leakage Diagnostic Test 12 Notes: C.Additional Requirements for Compliance 01 System was tested in its normal operation condition.No temporary taping allowed. Outside air(OA)duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage 02 testing.OA ducts used for Central Fan Integrated(CFI)Indoor Air Quality ventilation systems,or Central Fan Ventilation Cooling Systems,that utilize dampers that open only when OA is required and automatically close when OA is not required, may configure the OA damper to the closed position during duct leakage testing. 03 If a complete replacement,all supply and return register boots were sealed to the drywall. 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All connection points between the air handler and the supply and return plenums are completely sealed. If the system complies using the Smoke Test method, l oke test was conducted=in accordance with the requwrements 07 of,Reference Residential Appp dix RA314 3 6 Systems that comply using smoke test shall rpt be included in`;iarn ple groups,for HERS verification compliance ok. a . E it. , 08 Verification Status t Pass-all aplica�le requirements ar metes' t 09 Correction Notes for this table q The 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. 11 I! 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 CIIertificate 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-N0124911A-M2000002B-M2OD Registration Date/Time: 2017-08-04 14:28:54 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:28:39 2013 Residential Compliance Schema Version:2013.1.007 4 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3) Documentation Author's Declaration Statement 1.I certify that this Certificate Of Verification documentation is accurate and complete. • Documentation Author Name: Documentation Author Signature:. Jose Novelo fade, e4v Company: Date Signed: California Air Duct Testers 2017-08-04 14:28:54 Address CEA/HERS Certification Identification(if applicable): 5279 Eggers Dr City/State/Zip: Phone: Fremont CA 94536 408-824-0740 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 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 sectionSofthe Certificate(s)of Ii stailation(CF2)3}''sig.ped as submitted by the perspn(s)responsible for the construction or installation conforms to theKquirements:p,cifreed on the Certtficatte(s)pf Coipliart a(C4R)approved bythe enfottcementlaaency. 5. I will'ensure that a registered copy of this Certificate of Verikcat anlsf all be posted'or made available with th" ilding permit(s)issued for the building,and made availabt o t re.enforcei t agency f ell phcable inspegTlons I understand that a registerediopy of thisCert�fic*pf, Verification is required to be riycluded with the dmt ocuentation e builder"provides to the building owner at occupancy. Builder Or Installer Information As Shown OnTheCertificate�'Of Installation 3"' Company Name(Installing Subcontractor,General Contractor,or Builder/Owner): PERFECT HOMES CONSTRUCTION Responsible,Builderor Installer Name: CSLB License: Tom Tuan Nguyen 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: California Air Duct Testers Responsible Rater Name: Responsible Rater Signature: Jose Novelo f�1P/�Ble Responsible Rater Certification Number w/this HERS Provider: Date Signed: CC2006387 2017-08-04 14:28:54 • i 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-N0124911A-M2000002B-M2OD Registration Date/Time: 2017-08-04 14:28:54 HERS Provider:CaICERTS, CA Building EnergyEfficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:28:39 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: November Drive Residence Enforcement Agency: City of Permit Number: ; .-22016-1 -88 Cupertino ~_ Dwelling'Address: 2:21,Novtmb-r DAR. City: Cupertino ZipCode: 95014 litaMPOWIC A.System Information 01 Space Conditioning System Identification or Name System 2 02 Space Conditioning System Location or Area Served Downstairs 03 Building Type from CF-1R Single family 04 Verified Low Leakage Ducts in Conditioned Space No,credit is not taken (VLLDCS)Credit from CF1R? 05 :Verified Low Leakage Air Handling Unit(VLLAHU)Credit No,credit is not taken from CF1R? 06 Duct System Compliance Category Replacement t4i• WrIft! sr,, MCH;20d-.Complete Repiacem4t or Altered Duct Sysgem B.Duct Leakage Diagnostic Test Y «s • 01 Condenser Nominal Cooling Capacity(ton) 3 02 ;Heating Capacity(kBtu/h) 58 03 Conditioned Floor Area served by this HVAC system(ft2) 1430 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(cfm) 76 10 Actual duct leakage rate from leakage test measurement 43 (cfm) • 11 Compliance Statement System passes leakage test Registration!Number:216-N0124911A-M2000003B-0000 Registration Date/Time: 2017-08-04 17:45:44 HERS Provider:CaICERTS CA BuildingEnergy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:25:34 2013 Residential!Compliance Schema Version:2013.1.007 I CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3) C.Additional Requirements for Compliance 01 System was tested in its normal operation condition.No temporary taping allowed. Outside air(OA)duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage 02 testing.OA ducts used for Central Fan Integrated(CFI)Indoor Air Quality ventilation systems,or Central Fan Ventilation Cooling Systems,that utilize dampers that open only when OA is required and automatically close when OA is not required, may configure the OA damper to the closed position during duct leakage testing. 03 If a"complete replacement,all supply and return register boots were sealed to the drywall. 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All connection points between the air handler and the supply and return plenums are completely sealed. If the system complies using the Smoke Test method,the smoke test was conducted in accordance with the requirements 07 of Reference Residential'Appendix RA3.1.4.3.6.Systems that comply using smoke test shall not be included in sample ' groups for HERS verification compliance. The responsible'persons'signature•on this compliance „ocuOent affirm that all applicable requirements this able have been n'tt. 4e0 NI . Registration Number:216-N0124911A-M2000003B-0000 Registration Date/Time: 2017-08-04 17:45:44 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:25:34 2013'Residential Compliance Schema Version:2013.1.007 • CERTIFICATEOF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3) Documentation Author's Declaration Statement 1.I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: /2 Jose Novelo Company: Signature Date: 2017-08-04 14:26:45 California Air Duct Testers Address: CEA/HERS Certification Identification(if applicable): 5279 Eggers Dr ' City/State/Zip: Phone: Fremont CA 94536 408-824-0740 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. I am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction,or installation of features,materials,components,or manufactured devices for the scope of work identified on this Certificate of Installation and attest to the declarations in this statement(responsible builder/installer),otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features,materials,components or manufactured devices(the installation)identified on this Certificate of Installation conforms to all applicable codes and regulations,,.and the installation conforms to the requirements glyen on the plans and specifications approved by the enforcement agency. i 4. I understand that a HERS rater wi)l check the nstallation toenfycaniphance andthat ifsuclschecktng ide dies defects;I'am requred to take' t n� .fix � � � corrective action at my exben�se I� nderstanthat Energy" ommissEabn and HERS Provider replesentatwes will perform Qualityassurance checking of installations,including tho app.oved as part„uf�asainpfegroup but notcheeked.by a=HERS ater,and&that u)stallations felt to meettll'� requirements of such quality assur p a checking,the requa�ed cor.ective,action an dditionalchecking/testing ofaather installations�n thatHERS sample group will be performed atri4Yexpense. ' 5. I 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. I 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: I Responsible Builder/Installer Signature: Tom Tuan Nguyen Company Name:(Installing Subcontractor or General Contractor or Position With Company(Title): Builder/Owner) mgr PERFECT HOMES CONSTRUCTION Address: CSLB License: 382 LASSENPARK CIRCLE 556533 City/State/Zip: Phone: Date Signed: SAN JOSE CA 95136 408-910-0779 2017-08-04 17:45:44 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 no way implies Registration Provider responsibility for the accuracy of the information. Registration Number:216-N0124911A-M2000003B-0000 Registration Date/Time: 2017-08-04 17:45:44 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2017-08-04 14:25:34 2013 Residential Compliance Schema Version:2013.1.007