B-2016-3056CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10673 MORENGO DR CUPERTINO, CA 95014-3513 34
CONTRACTOR:
PERMIT NO: B-2016-3056
(375 015)
ECO SYSTEMS
HEATING & AIR
SAN RAMON, CA
94583
OWNER'S NAME: VARSHNEYARUN AND GUPTAANURADHA
DATE ISSUED; 11/07/2016
OWNER'S PHONE: 408-461-5870
PHONE NO: (888) 483-5869
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class WARM -AIR HEATING VENTILATING AND AIR- ONDITIOMN
Lic. #924M
X BLDG —ELECT
Contractor ECO SYSTEMS HEATING & AIR Date 11/30/2018
_PLUMB
X MECII X 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
JOB DESCRIPTION:
license is in full force and effect.
REPLACE FURNACE (SAME LOBATION)
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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.
z.` 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 $3000.00
APPLICANT CFRTIFI ATION
I certify that I have read this application and state that the above
APN Number:.
Occupancy T pe:
information is correct. I agree to comply with all city and county ordinances
375 34 015
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 expenses which
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
180 DAYS FROM LAST CALLED INSPECTION.
source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date 11/7/2016
Issued by: Abby A to
Date: 11/07/2016 sle
OWNER -BUILDER D . T RATION
R_ F -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:
installed without first obtaining an inspection, I agree to remove all new materials for
1. I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 11/7/2016
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. 1 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
2. 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 & Safe Code, Section 25532 a should I store or handle hazardous
Safety t )
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
shall not employ any person in any manner so as to become subject to the
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, Sce5 , 25533, and 25534.
Labor Code, I muse forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
Date: 1 7
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) 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 applicant understands
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 11/7/2016
Professional
GENERAL PERMIT APPLICATION ROMP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERT'INO (408) 777-3228 •FAX (408) 777-3333 • building
(@-cupertino.org MISC
PROJECT ADDRESS PJ APN #
OWNERNAME y) %
1'0tQ / PHONE, wq / ;5&o E-MAIL
STREET ADDRESS tr CITY, STATE, ZIP A g. PAZ
V,
CONTACT NAME
_
` n ,l
r•l�. 4W
t:
PHONE
E-MAIL`
STREET ADDRESS
CITY, STATE, ZIP
❑ OWNER ❑ OWNER -BUILDER
❑. OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
--
CONTRACTOR NAME y -
- J/ f°' F'1
l 'J
,.. �.L� ��
�!O
LICENSE NUMBER `9
:. LICENSE TYPE
BUS. LIC
COMPANY NAME
( t_
C
cJ C %�
E�M1A)IhLl1 /tL �a
�l,,l 4+ oli dry �C9�
/{
P? 1 l"
FAX
STREET ADDRESS
CITY, STATE, ZIP- �/
PHONE 92S 3 C 9
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF E K FD or DUPLEX
BUILDING:. ❑ COMMERCIAL
❑ MULTI -FAMILY
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN
FLOOD ZONE
❑ YES
El NO
IS THE BLDG AN ❑ YES
EICULER HOME? El NO
DESCRIPTION OF WORK!
/
01 / e
J0
TOTAL VALUATION: A eC 9 llid I RECEIVED BY
By my signature below, I icJertrtifyly to each of the following: I am the property owner or authorized agent to act on the property o er's bAhalf. T have read this
application and the information I have provided is correct I have read the Description of Work and verify it is accu/ateI agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the ab%oentifi%ed /property for inspection purposes.
Signature ofApplicanUAgent. /%�Ip Date:/ / V
r r
SUPPLEMENTAL INFORMATION REQUIRED`
MEPMiscApp2011.doe revised 06/21/11
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CERTIFICATE OF COMPLIANCE GF1R-ALT-03-E
Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -1R -ALT -HVAC) (Page 1 of 1)
Site Address:
19 N�:
�
Enforcement Agency:
g cy:
Date Prepared:
Permit#
Equipment Type
Equipment Efficiency
New: Ducting, Plenums, Lineset
onditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
❑ Evaporator Coil
AFUE
COP
❑ R-6 (CZ 1,3-7) Ducts
Served by system
Setback
11 Split System
❑ Condensing Unit
SEER
❑ R-8' (CZ 16) Ducts
sq ft
(If not already
urnace
❑ Lineset
EER
HSP,F
❑ R-6 (all CZ's) Plenums
present, must
❑ R-5 or R7.5 tineset3
be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At=per-mit applicatibn_thisx
form-is-allowed-to-b`e fillea-out by hand For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
E3 1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
Can -include new ducting
All Equipment,
CFIR-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS
Air Handler/Furnace
CF3R: MECH-20-HERS
Installer Requirement: Duct leakage (:5_15% or, 5.10% to outside, or seal all accessible leaks)
Exempted from duct leakage testing if:
El 1. Duct system registered with HERS provider as previously sealed, or 2. There is less than 40 linear feet of duct in unconditioned
space, or ❑ 3. Existing duct systems are constructed, insulated or sealed wi sbestos (list manufacture date ofjbuilding 1
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts
CFIR-ALT-02-E
CF2R-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS
CF3R-MECH-20-HERS, MECH-22-HERS, MECH-(23 or24)-HERSZ ',
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow _> 350 CFM/ton (or Standards Table '150.0-C / D alternative)
❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CFIR-ALT-02-E
DuctsZ and one or more of the following: CF2R-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS
Condenser Unit, Evaporator Coil, Furnace CF3R-MECH-20-HERS, MECH-(23 or 24) -HERS
Installer Requirement: Duct leakage < 6%, Air Flow_ 350 CFM/ton (or Standards Table 150.0-C / D alternative)
❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos.
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned CFIR-ALT-02-E
CF2R: MECH-20 HERS
space but less than All New DuctsZ
CF3R: MECH-20-HERS
Installer Required to: Duct leakage L15% or, 5.10% to outside, or seal all accessible leaks)
❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos.
' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc.
Z A New Ductsystem is when the duct system is constructed of at least 75 percent new duct material, andup to. 25 percent may consist of reused
parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, plenums, duct material.
3 R-5 (1" thick insulation) for linesets 1" and less. 'R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg,4611 require Suction line Diameter
with insulation as the following 1.5-2T-2%", 2.53T-2%", 3.5 to 4T-2%", 5T-4%"
Contractor (Documentation Author's /Responsible Designer'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 Compliance is true and correct.
2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR.
S. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications subinitted to the enforcement
agency for approval with this building permit application.
Resp nsi4le Designer ame: _
Responsib Design �g ure:.
ate d•
D gne��
License:
v
Company:
Address:
City/State/Zip:
Phone: /
e G
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300
CERTIFICATE OF VERIFICATION
CF3R-MCH-20-H
Duct Leakage Diagnostic
System 1
r
Project Name: 10673 MORENGO DRIVE
Enforcement Agency:
Cupertino
City 'of
Permit Number: B-2016-3056
Q
Dwelling Address:GO DRIVE
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
Location 1
03
Building Type from CF -1R
Single family
04
Verified Low Leakage Ducts in Conditioned Space
(VLLDCS) Credit from CF1R?
No, credit is not token
05
Verified Low Leakage Air Handling Unit (VLLAHU) Credit
from CF1R?
i
No, credit is not taken
06
Duct System Compliance Category
Alteration using si';noke test
MCH -20e - Sealing All Accessible` Leaks using Smoke Test ° }
I
B. Duct Leakage Diagnostic Test ,,, _ ' ~ - .._:•
01
Condenser. Nominal Cooling Capacity (ton)
0
02
Heating Capacity (kBtu/h)
54
03
Conditioned Floor Area served by this HVAC system (ft2)
1316
04
Duct Leakage Test Condition
Test final
I
05
Duct Leakage Test Method
Total leakage
06
Leakage Factor
0.15
07
Air Handling Unit Airflow (AHUAirflow) Determination
Method
Heating system method
08
Measured AHUAirflow
This field or section
is not applicable
09
Calculated Target Allowable Duct Leakage Rate (cfm) -
176
10
Actual duct leakage rate from leakage test measurement
(cfm)
204
I
Registration Number: 216-A0454714A-M2000002A-M20A Registration Date/Time: 2016-12-08 19:01:47 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-12-08 19:01:28
2013 Residential Compliance Schema Version: 2013.1.007
I
CERTIFICATE OF VERIFICATION MR -MCH -20-H
Duct Leakage Diagnostic Test (Page 2 of 3 )
B. Duct Leakage Diagnostic Test
01
_'Compliance Statement: System passes using smoke test of an altered HVAC system in an existing building. No visible smoke
02
exits the accessible portions of the duct system. Smoke is only emanating from air -handling u�nit (AHU) cabinet and non
11
accessible portions of the duct system. Note - Accessible is defined as having access thereto, but which first may require
04
removal or opening of access panels, doors, or moving similar obstructions. If.access to the ducts requires an object to be
05
demolished or deconstructed then sealing of those ducts is not required
12
Notes:
C. Additional Requirements for Compliance
01
System was tested in its normal operation condition. No temporary taping, allowed.
02
Outside air (OA) duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage
testing. OA ducts used for.Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan Ventilation
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
If cloth backed tape was used_-it:was covered_with Mastic arid_'d"raw.bands: _-
06
--All connection points between the air Katidler and the supply -and return plenums are completely sealed:
07
If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements
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 Complies: All specified verification protocol requirements on this document are met.
Registration Number: 216-A0454714A-M200.0002A-M20A Registration Date/Time: 2016-12-0819:01:47 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-12-08 19:01:28
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:
Kristofer Owens
Documentation Author Signature:
c7na& �(
Company:
Date Signed:
Archon Energy Solutions
2016-12-08 19:01:47
Address:
CEA/ HERS Certification Identification (if applicable):
607 Elmira Road #293
City/State/Zip:
Phone:
Vacaville CA 95687
888-600-16141
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 sections of the Certificate(s) of Installation (CF2R)'signed arid, iUbmitfed:by the persons) responsible for the
construction or installation conforms to the.requirementsspecified" on the Cert'ificate(s)'of Compliance (CF1R) approved by,theenforcement agency.
5. 1 will ensure that a registered copy of this Certificate of,Verifcat onshall be posted ',or made available with the�building peri iit('s)`issued for the
building, and made available to the.enforcement agency.for,all applicable inspections. f u`riderstand that a registered copy ofth s Certificate of
Verification is required to be iincluded with the docarnentation the builder provides to the building owner at occupancy.
Builder Or Installer Information As Shown On`The°Cer#if cate'"Of Installatlow`
Company Name (Installing Subcontractor, General Contractor, or Builder/Owner):
Eco Systems Heating & Air
Responsible Builder or Installer Name:
CSLB License:
Abraham Alvarez
924909
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:
Archon Energy Solutions
Responsible Rater Name:
Responsible Rater Signature:
Kristofer Owens
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2016106
2016-12-08 19:01:47
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-A0454714A-M2000002A-M20A Registration Date/Time: 2016-12-08 19:01:47 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2016-12-08 19:01:28
2013 Residential Compliance Schema Version: 2013.1.007