15100198 CITE'OF CUP RTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:15100198
803 CANDLEWOOD DR CUPERTINO CA 95014(369 18 021)
1128 DESERT CT
GILBERT,AZ 85236
OWNER'S NAME: YANG HUIYANG AND LOWE JEFFREY DATE ISSUED: 10/23/2015
OWNER'S PHONE:(408)859-9650 PHONE NO:None
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CONTRACTOR-PLUMBING Lic.
Contractor Date 02/28/2016 BLDG _ELECT _PLUMB
MECH_RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: REPLACE FURNACE LIKE-FOR-LIKE
1. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this perir_it is issued.
2. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$8200.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 18 021
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date Issued by:Legacy
Date: 10/23/2015
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contracior's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. 1,as owner of the property,ain exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(See.7044,Business&Professions Code). Date:
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. if,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.: Owner or authorized agent:
APPLICANT CERTIFICATION Date:
I certify that 1 have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentionedproperty for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9,18. 1 understand my plans shall be used as public records.
Licensed
Signature Date Professional
FILE
CERTIFICATE OF VERIFICATION l
CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 1 of 3)
Project Name: 803 Candlewood Dr Enforcement Agency: City of Permit Number: 15100198
Cupertino
Dwelling Address: 803 Candlewood Dr City: Cupertino Zip Code: 95014
A.System Information
01 Space Conditioning System Identification or Name 70K BTU Furnace
02 Space Conditioning System Location or Area Served Whole Home
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 isnot taken
from CF1R?
06 Duct System Compliance Category Alteration using smoke test
4
MCH-20e-Sealing All AccessibleyLeaks using Smoke Test" �� t
l
,> ..... .r—.gin. .--.-..., --. .-........ _r--..s.+. "•F _ _
B. Duct Leakage Diagnostic Test " u -- - - y _
01 Condenser Nominal Cooling Capacity(ton) 0
02 Heating Capacity(kBtu/h) 70
03 Conditioned floor Area served by this HVAC system(ft2) 1547
04 Duct Leakage Test Condition Test final
05 Duct Leakage Test Method Total leakage
06 Leakage Factor 0.15
07 Air Handling Unit Airflow(AHUAirflow) Determination Heating system method
Method
08 Measured AHUAirflow This field or section is not applicable
09 Calculated Target Allowable Duct Leakage Rate(cfm) 228
10 Actual duct leakage rate from leakage test measurement 352
(cfm)
Registration Number:215-A6360477A-M2000002A-M20A Registration Date/Time: 2016-07-28 14:01:07 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-07-28 09:33:23
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
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
r12TNo7te .
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 All supply and return register boots were sealed to the drywall.
04 Buildingcavities were ndt used as plenums or la firm returns in"lieu of tlucts.r b
p � � p�' � a
05 If cloth backed tape was used"itwas covered'with M' i is and_draw-bands' .t x
06 All connection points between the air handles andthe'supply nd 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.
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 1 Complies:All specified verification protocol requirements on this document are met.
Registration Number:215-A6360477A-M2000002A-M20A Registration Date/Time: 2016-07-28 14:01:07 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-07-28 09:33:23
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. 1 certify that this Certificate of Verification documentation is accurate and complete,.
Documentation Author Name: Documentation Author Signature:
Mike Sumner CWiCe Sumner
Company: _ Date Signed:
Mike Sumner 2016-07-28 09:34:04
Address: CEA/HERS Certification Identification(if applicable):
15360 Chateau Montelena
City/State/Zip: Phone:
Bakersfield CA 93314 661-978-8089
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. Lam 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 sectioris,ofthe Certificate(s),of Installation_(Ck2R)signedand submitted by the per (s)responsible for the
construction or installation conforms to the,requirements"".pecifiedFon'the Certificates)of Compliance(CF1R)approved bitl a enforcement agency.
5. I will ensure that a'registered copy�of this Certificate of Verification shall be posted,or made availab`Wwith the,building perrriit(s)issued for the
building,,and made availableto the'enforceme'nt-agency<for all applicable inspections.I;tunderstand that a registered�copy ofthis Certifcate,of-,
.0
Verification is required to be included with the'documentation the bwlderpr'ovides to the building owner at occupancy.
Builder Or Installer Information As-Shown On thie Certificate Of installatldn Ty'
Company Name(Installing Subcontractor,General Contractor,or Builder/Owner):
CALIFORNIA DELTA MECHANICAL INC
Responsible Builder or Installer Name: CSLB License;
Alanna Frederick 811114
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:
Mike Sumner
Responsible Rater Name: Responsible Rater Signature:
Brandon Kond ��us ran on on us
Responsible Rater Certification Number w/this HERS Provider: Date Signed:
CC2006528 2016-07-28 14:01:07
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:215-A6360477A-M2000002A-M20A Registration Date/Time: 2016-07-28 14:01:07 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-07-28 09:33:23
2013 Residential Compliance Schema Version:2013.1.007