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B-2017-0238CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0238 19936 BAYWOOD DR CUPERTINO, CA 95014-2317 (316 30 007) HAN'S CONSTRUCTION SAN JOSE, CA 95136 OWNER'S NAME: DONG YANG AND QIUYUAN HUANG DATE ISSUED: 02/09/2017 OWNER'S PHONE: 971-2764131 PHONE NO: (40$) 966-0885 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #938638 Contractor HAN'S CONSTRUCTION Date 10/31/2017 X BLDG X ELECT —PLUMB X MECH X RESIDENTIAL COM ME RCIAL 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: KITCHEN REMODE�I ( 10 S.F.); MASTER BEDROOM AND GUEST hereby affirm under penalty of perjury one of the following two declarations: BATHROOMS -REMOD L (110 S.F.)] UPGRADE PANEL (200AMPS); 1. I have and will maintain a certificate of consent to self -insure for Worker's INSTALL (I) FURNACE AND AC Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 7 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 Sq. Ft Floor Area: Valuation: $40000.00 permit is issued. APPLICANT CERTIFICATION I certify that I' have read this application and state that the above APN Number: 316 30 007 Occupancy Ty e: information is correct. I agree to comply with all city and county ordinances 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 WORK City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR applicant understands ano will comply source regulations pert n M id I Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 2/9/2017 Issued by: AbbyAvende OWNER DECT AR ATION Date: 02/09/2017 -BUILDER I hereby affirm that I am exempt from the Contractor's License Law for one of the RF. -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 1. I, 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. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 2/9/201_7 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TOL CLASS "A" OR BETTER t. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the 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 I have read the hazardous materials requirements DISCLOSURE under Chapter 6.95 of the 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. 3. I certify issued. hat n the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) material. Additionally, should I use equipment should I store or handle hazardous 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 M i C e, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sectio 5 3 nd 2U34. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: ,11 APPLICANT CERTIFICATION Date: 2/9/2017 LENDING AGENCY 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 and state laws CONST_Ri1CTION I hereby affirm that there i� a construct'on of work's for which this permit is issue lending agency for the performance (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lenders 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 A_RCBTl'ECT'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 2/9/2017 Professional i COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 � �����N� I (408) 777-3228 • FAX (408) 777-3333 • building(a)-cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION, ALTERATION / TI ❑ REVISION / DEFERRED i ORIGINAL PERMIT # PROJECT ADDRESS 6 6,au w( 4 I APN # 7 a� OWNER NAME 0 !{4� ea6a7 PHONE T71 1 _24 E-MAIL f % HVA,4 • 6o I ,j�% STREET ADDRESS 2, ' r CITY, STATE, ZIP®fig/�}g�j 9 a!6 iil�''i'Sd't h FAX CONTACT NAME PHONE727_4'1(4 spy (� t�Li E "a STREET ADDRESS CITY, STATE, ZIP FAX wNER OWNER -..DER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT - ❑ ARCHITECT ❑ ENG ER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME j ®^, �j LICENSE NUMBER 2� J L CENSE TYP q BUS. LIC # COMPANY NAME j SWJCt E-MAIL I FAX STREET ADDRESS % � f t � 4r ��.r l/ L CITY, STATE, ZIP ! - (�(�14, y� PHONE40g_ (lU _ / �U OgI ARCHITECT/ENGINEER NAME LICENSENUMBER, BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE t PROPOSED USE \ TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION1 ($) �\ ,jjCONSTR. EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLING UNITS: IS ASECOND UNIT E] YES SECONDSTORY []YES BEING ADDED? ❑NO ADDITION? ONO It PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES CEIVED BY: j TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO i ,.,� By my signature below, I certify to each of the following: I am the property owner or authorized agent4o act onkthe property owners behalf. I have read this Work it is I to local application and the information I have provided is correct. I have read the Description of and verify accurate. agree Comply with all applicable ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. 2 Signature of Applicant/Agent:Date: SUPPLEMENTAL INFORMATION REQUIRED V PLAN CHECK TYPE ROUTING SLIP OVER-THE-COUNTER BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS © PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS _ form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR I SANITARY SEW.ERDISTRICT submittal of Building Permit application. ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121/11 V I -Ccv, CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 4408-777-3333 JOB ADDRESS: I qQ P►^ PERMIT -# OWNER'S NAME: 0 WYOOLh W1,1141 Q. PDAQj7' PHONE # GENERAL CONTRACT R: BUSINESS LICENSE # ADDRESS: e CITY/ZIPCODE: -vur municipal code requires all businesses working in the city to have a City of:Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF C_ UPERTINO BUSINESS LICENSE. I am not using any subcontractors: 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 Pleating Insulation J Landscaping bathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile / Contractor Signature Date CERTIFICATE OF VERIFICATION CHR -MCH -22-H Space Conditioning System Fan Efficacy (Page 1 of 3) Project Name: 19936 Baywood Dr Enforcement Agency: Cupertino City of Permit Number: B-2017-0238 Dwelling Address: 19936 Baywood Dr City: Cupertino Zip Code: 95014 A. Ducted Cooling System Information 01 System Identification or Name System 1 02 System Location or Area Served whole house 03 System Installation Type Replacement 04 Nominal Cooling Capacity (tons) of Condenser 3.5 05 Condenser Speed Type Single Speed 06 Cooling System Zonal Control Type Not Zonal 07 Central Fan Integrated (CFI) Ventilation System Status Not a CFI system 08 System Bypass Duct Status No Bypass Duct 09 Date of System Airflow Rate Measurement 2017-03-29 10 Airflow Rate Protocol utilized RA3.3 procedures for airflow rate measurement B. Fan Watt Measurement Apparatus and Procedure Information Instrument Specifications are given in RA3.3.1, and system fan watt measurement apparatus information is given in RA3.3.2.2. 01 Fan Watt Verification Device Used. Digital Utility Revenue Meter MCH -22a Forced Air System Fan Efficacy Measurement - Newly Installed Non -zoned Systems or Zoned Multi -Speed Compressor C. Forced Air System Fan Efficacy Measurement The procedures for System Fan Watt Verification are specified in Reference Residential Appendix RA3.3. 01 Actual Tested Watts 647 02 Actual Tested Airflow from MCH -23 (cfm) 1240 03 Required Fan Efficacy (watts/cfm) 0.58 04 Actual Fan Efficacy (watts/cfm) 0.52 05 Compliance Statement: System fan efficacy complies Registration Number: Registration Date/Time: 2017-04-02 21:46:59 HERS Provider: CaICERTS 217-A020042746A-000-001-M 22001 B -M 22 B CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-04-02 21:47:00 2016 Residential Compliance Schema Version: rev 2013-09-11 CERTIFICATE OF VERIFICATION Space Conditioning System Fan Efficacy CF3R-MCH-22-H (Page 2 of 3) D. Additional Requirements 01 All registers were fully open during the diagnostic test. 02 System fan was set at maximum speed during the diagnostic test. 03 If fresh air duct is part of the HVAC system it was not closed during the diagnostic test. 04 Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value. 05 Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/ton) and fan efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air handler fan speed. 06 Zoned cooling air distribution systems with single speed compressors shall meet both the airflow (cfm/ton) and fan efficacy (Watt/cfm) criteria in every zonal control mode. 07 Verification Status Pass - all applicable requirements are met 08 Correction Notes 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. E. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order 4 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: Registration Date/Time: 2017-04-02 21:46:59 HERS Provider: CaICERTS 217-A020042746A-000-001-M 22001 B- M 22 B CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-04-02 21:47:00 2016 Residential Compliance Schema Version: rev 2013-09-11 CERTIFICATE OF VERIFICATION CF3R-MCH-22-H Space Conditioning System Fan Efficacy (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: Minxuan Liu Documentation Author Signature: �Gflli��t Company: Date Signed: Bay Area Energy Consultants 2017-04-02 21:46:59 Address: CEA/ HERS Certification Identification (if applicable): 1181 Sundown Ln CC2006550 City/State/Zip: Phone: San Jose CA 95127 408-883-3865 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 and submitted by the person(s) responsible for the construction or installation_ conforms to the requirements specified on the Certificate(s) of Compliance (CF1R) approved by the enforcement agency. 5. 1 will ensure that a registered copy.of this Certificate of Verification shall be posted, or made available with the building permits) 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 Verification is required to be included with the documentation the builder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder/owner): RESCUE AIR SERVICE Responsible Builder or Installer Name: CSLB License: James Kim 826201 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: Bay Area Energy Consultants. Responsible Rater Name: Responsible Rater Signature: Minxuan Liu Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006550 2017-04-02 21:46:59 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: Registration Date/Time: 2017-04-02 21:46:59 HERS Provider: CaICERTS 217-A020042746A-000-001-M 22001 B -M 22 B CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-04-02 21:47:00 2016 Residential Compliance Schema Version: rev 2013-09-11 €A CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 1 of 4) Project Name: 19936 Baywood Dr Enforcement Agency: City of Cupertino Permit Number: B-2017-0238 Dwelling Address: 19936 Baywood Dr City: Cupertino Zip Code: 95014 A. Ducted Cooling System Information 01 System Identification or Name System 1 02 System Location or Area Served whole house 03 System Installation Type Replacement 04 Nominal Cooling Capacity (tons) of Condenser 3.5 05 Condenser Speed Type Single Speed 06 Cooling System Zonal Control Type Not Zonal 07 Central Fan Integrated (CFI) Ventilation System Status Not a CFI system 08 System Bypass Duct Status No Bypass Duct 09 Date of System Airflow Rate Measurement . , . 2017-03-29 10 Airflow Rate Protocol Utilized RA3.3 procedures for airflow rate measurement B. Hole for the placement of a Static Pressure Probe (HSPP), and Permanently Installed Static Pressure Probe (PSPP) in the Supply Plenum. Procedures for installing HSPP or PSPP are specified in RA3.3.1.1. 01 Method Used to Demonstrate Compliance with the HSPP installed and labeled consistent with Figure RA3.3-1 HSPP/PSPP Requirement C. Airflow Rate Measurement Apparatus and Procedure Information Instrument Specifications are given in RA3.3.1.1, and system airflow rate measurement apparatus information is given in RA3.3.2. Airflow Rate Measurement Type used for this airflow rate Traditional Flow Capture Hood according to procedure in 10 01 verification. RA3.3.3.1.4 2 Manufacturer of Airflow Measurement Apparatus Alnor 03 Model number of Airflow Measurement Apparatus 614-513-044 Certification Status of the Airflow Measurement Apparatus Certified by Manufacturer and listed on CEC Website at 04 Accuracy http://www.energy.ca.gov/title24/equipment_cert/ama_fas /index.html Registration Number: 217-A020042746A-000-001-M 23001A -M 23A CA Building Energy Efficiency Standards 2016 Residential Compliance Registration Date/Time: 2017-04-02 15:28:32 HERS Provider: CaICERTS Report Version: 2016.1.005 Report Generated: 2017-04-02 15:27:18 Schema Version: rev 10/16 CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 2 of 4) MCH -23a Forced Air System Airflow Rate Measurement - Newly Installed Non -Zoned Systems or Zoned Multi -Speed Compressor D. Forced Air System Airflow Rate Measurement The procedures for System Airflow Rate Verification are specified in Reference Residential Appendix RA3.3. 01 Required Minimum System Airflow Rate (cfm/ton) 350 02 Required Minimum System Airflow Target (cfm) 1225 03 Actual System Airflow Rate Measurement (cfm) 1240 04 Compliance Statement: System airflow rate complies E. Additional Requirements 01 Air filters that meet the applicable requirements of Standards Section 150.0(m)12 or 150.0(m)13 were properly installed in the system during system air flow rate measurement identified on this Certificate of Verification. The airflow rate measurement apparatus used to perform the airflow rate measurement identified on this Certificate of 02 Verification was calibrated in accordance with the apparatus manufacturer's specifications and conforms to the instrumentation specifications given in RA3.3:1, A visual inspection shall confirm that bypass ducts that deliver conditioned supply air directly to the space conditioning system return duct airflow are not used on newly constructed zonally controlled systems unless the Performance Certificate 03 of Compliance indicates an allowance for use of a bypass duct. When a bypass duct is accounted for on the Performance Certificate of Compliance, the airflow rate shall conform to the specifications listed on the Certificate of Compliance, 04 All registers were fully open during the diagnostic test. 05 System fan was set at maximum speed during the diagnostic test. 06 If fresh air duct is part of the HVAC system it was not closed during the diagnostic test. 07 Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value. Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/ton) and fan 08 efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air handler fan speed. 09 Verification Status: Pass - all applicable requirements are met 10 Correction Notes: The responsible person's 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 Registration Number: Registration Date/Time: 2017-04-02 15:28:32 HERS Provider: CaICERTS 217-A020042746A-000-001-M 23001A -M 23A CA Building Energy Efficiency Standards Report Version: 2016.1.Ob5 Report Generated: 2017-04-02 15:27:18 2016 Residential Compliance Schema Version: rev 10/16 CERTIFICATE OF VERIFICATION CFMR-MCH-23-1-1 Space Conditioning System Airflow Rate (Page 3 of 4) F. 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: Registration Date/Time: 2017-04-02 15:28:32 HERS Provider: CaICERTS 217-A020042746A-000-001-M 23001A -M 23A CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-04-02 15:27:18 2016 Residential Compliance Schema Version: rev 10/16 CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 4 of 4) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Minxuan Liu Documentation Author Signature: Company: Date Signed: Bay Area Energy Consultants 2017-04-02 15:28:32 Address: CEA/ HERS Certification Identification (if applicable): 1181 Sundown Ln CC2006550 City/State/Zip: Phone: San Jose CA 95127 408-883-3865 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 and submitted by the person(s) responsible for the construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (CF1R) approved by the enforcement agency. 5. 1 will ensure that a registered copy of this Certificate of Verification 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 Verification is required to be included with the documentation the builder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder/owner): RESCUE AIR SERVICE Responsible Builder or Installer Name: CSLB License: James Kim 826201 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: Bay Area Energy Consultants Responsible Rater Name: Responsible Rater Signature: ��jj�� AAC" Minxuan Liu 116, Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006550 2017-04-02 15:28:32 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: Registration Date/Time:. 2017-04-02 15:28:32 HERS Provider: CaICERTS 217-A020042746A-000-001-M 23001A -M 23A CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-04-02 15:27:18 2016 Residential Compliance Schema Version: rev 10/16 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3) Project Name: 19936 Baywood Dr Enforcement Agency: Cupertino City of Permit Number: B-2017-0238 Dwelling Address: 19936 Baywood Dr 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 whole house 03 Building Type from CF -1R Single family 04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from CF1R? No, credit is not taken 05 Verified Low Leakage Air Handling Unit Credit from CF1R? No, credit is not taken 06 Duct System Compliance Category Replacement IVICH-20d - Complete Replacement or Altered Duct System B. Duct Leakage Diagnostic Test . 01 Condenser Nominal Cooling Capacity (ton) 3.5 02 Heating Capacity (kBtu/h) 78 03 Conditioned Floor Area served by this HVAC system (ft2) 1769 04 Duct Leakage Test Conditions Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.05 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) 85 10 Actual Duct Leakage Rate from Leakage Test Measurement (cfm) 43 11 Compliance Statement: System passes leakage test 12 Notes: Registration Number: Registration Date/Time: 2017-04-02 15:28:32 HERS Provider: CaICERTS 217-A020042746A-000-001-M 20001A- M 20A CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-04-02 15:26:47 2016 Residential Compliance Schema Version: rev 03/16 CERTIFICATE OF VERIFICATION CF3R-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. 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 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. 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: The responsible person's 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: 217-A020042746A-000-001-M 20001A -M 20A CA Building Energy Efficiency Standards 2016 Residential Compliance Registration Date/Time: 2017-04-02 15:28:32 HERS Provider: CaICERTS Report Version: 2016.1.005 Report Generated: 2017-04-02 15:26:47 Schema Version: rev 03/16 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: Minxuan Liu Documentation Author Signature: �ve� Company: Date Signed: Bay Area Energy Consultants 2017-04-02 15:28:32 Address: CEA/ HERS Certification Identification (if applicable): 1181 Sundown Ln CC2006550 City/State/Zip: Phone: San Jose CA 95127 408-883-3865 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 sections of the Certificate(s) of Installation (CF2R) signed and submitted by the person(s) responsible for the construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (CF1R) approved by the enforcement. agency. 5. 1 will ensure that a registered copy of this Certificate of Verification 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 ofthis Certificate of Verification is required to be included with the documentation the builder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder/Owner): RESCUE AIR SERVICE Responsible Builder or Installer Name: CSLB License: James Kim 826201 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: Bay Area Energy Consultants Responsible Rater Name: Responsible Rater Signature: �/� pp AKOZ" tiO&- Minxuan Liu Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006550 2017-04-02 15:28:32 Digitally signed by WCERTS. 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: 217-A020042746A-000-001-M 20001A -M 20A CA Building Energy Efficiency Standards 2016 Residential Compliance Registration Date/Time: 2017-04-02 15:28:32 HERS Provider: CaICERTS Report Version: 2016.1.005 Report Generated: 2017-04-02 15:26:47 Schema Version: rev 03/16 � 3uitd+n9 pepaill FEB 0 9 IQVI ---MPL1ANLE REVIEWEf� FOR CODE �O f2eviewed BY. CERTIFICATE OF COMPLIANCE 01 0203 CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) W OS 06 (Page 1 of 3) Project Name: '09 19936 Baywood Dr Date Prepared: 2017-02-07 Isthe SCI 3i A. General Information CFIR-ALT-02 Is applicable to multiple space conditioning systems contained within a single dwelling unit, When multiple dwelling units must be documented, use one CFIR-ALT-02 document for each dwelling unit 01 Project Name 19936 Baywood Dr 02 Date Prepared 2617-02-07 03 Project Location 19936 Baywood Dr 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 19935 Baywood Dr 01 Zip Code 95014 08 Dwelling Unit Conditioned z IF loor Area [ft ) 1769 09 Cllmatezone 4 10 Number of Space Conditioning {SC) Systems In this Dwclling Unit: 1 B. Space Conditioning (SC) System Information — ..: _ .. 01 0203 04 W OS 06 m ,07 07 68 '09 10 Isthe SCI 3i SC System SCSystem CFR served system a refrigerant Installing new SC Installing Installing Installing Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new Name Served System (ft 2. system? component? components? feet of ducts? duct system? SC system? Alteration Type Entirely new or 5ystem.1 Location 1 1769 Yes Yes Yes Yes Yes Yes complete replacement space conditioning system C. Extension of Existing Duct System, Greater Than 41) Feet (Section 150.2(b)In! ib) This section does not apply to this project. Registration Number: 217-A070642746A-000-000-0600000-0000 Registration Date/Time: 2017-02-07 22'03:30 HERS Provider: C4ICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1 005 Report Generated: 2017-02-07 22:03:44 Schema Version: rev 10/16 II1I°) E III 11140 1I° uiil°ii lin II) paIrf:lllMmelin EV i l �-E. l.) FOR CODE C O NA['[J A C E Reviewed By: S''...'�'�'�'�A'^,1Jl......l eA ��...0 oIh....� - `r� �u;id,r►9 FEB t 9 2017 CQ� COMPLIANCE 441 Reviewed By.. CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 3) D. Altered Space Conditioning System (Sections 150.2(b)1E and f-) This section does pat apply to this project, E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Dila and 150,2(b)1E, F) This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.21b)1C) 01 02 03 04 05 1 07 08 09 10 11 Heating Cooling System Heating Minimum Cooling Minimum Required Identification or Heating System Altered Heating Efficiency Efficiency Cooiing Altered Cooling Efficiency Efficiency Thermostat New Duct Name Type Component Type Value System Type Component Type Value Type R -Value A'nnualRuel� Central gas All new heating Utdi4ation Can`tral split All -ii c4.4Eing SetbackTher Systema furnace cornponents-" Ef .racy 81. AC components SEER 14 mostat R-6 (AFUE') Reouired Docurngnntatlon,; CF 2R-MCH.OS-E -Space Conditioning Systems . Duct insulation requirement for the new port iors of supply -air and retum-oir ducts or plenums: R5 (CZ 1. 10, 12 and 13) and Ra {CZ 11 and 14-16} CF2R and 79R -MCH -20-H Duct Leakage Test required - Leakage rate compliance: - 5%. CF2R and CF31F:-MCH.22 Fan Efficacy CF2R and CF3R-MCH-2.3 Airflow Rate Verification - Compliance: Fan Efficacy <� 0,58 W per Out and System Airflow >= 350 clm per ton. - Alternative Compllance: MR. and MR -MCH -28 Return Duct Design verification is an alternative to MCH -22 and MCH -23 verification. MR and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in 22 2, 8451, Exceptions: Heating -only systems are exempt from the 0.58 W per cfm and 350 cfm per ton requirements. H9% An "entirely new or replacement duct system" means at least 15% of the duct system is new duct material, and up to 25% may consist of reused parts from the dwelling unit's existing duct system le.g„ (egisters, grilles, boots, air handler, call, plenums, duct material) if the reused parts are accessible and can be sealed to prevent leakage Registration Number: 217-AO20042746A-000-000-00OOOOD-0000 CA Building Energy EFlic€ency Standards - 2016 Residential Compliance Registration Date/Time: 2017-02-07 22:03:30 Report Version: 2016.1.005 Schema Version: rev 10/16 1I°°I° IiH d iii u dI1'° III m• of n t 13EWEWED FOR CODE CONA[I[JANC­ DatE` 07/06/F HERS provider: UCERTS Report Generated: 201.7-02-07 22:03:44 CERTIFICATE OF COMPLIANCE CF1R-ALT-1 Alterations to Space Conditioning Systems {formerly CF -IR -ALT -HVAC) I Page 3 of 3) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Liu, Mlnxuan Company. signature nate: Bay Area Energy eansultaocs 2017-02-07 22:03 30 Address: CEA/ HERS Certification identification lif app:€cab€el: 1181 Sundown Ln CC2005550 City/State/Zip: Phcne: San lose CA 95127 408-883-3865 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the Stare of California - 1, The information provided an this Certincal¢ of Compliance Is true and correo 2, 1 am eligible under Division 3 of the ausiness and professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance Iresponsibl¢ designer:, 3. That the energy features -and performance specifications, materials, comppnents, and manaractpred devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Fact 1 and Part 6 of the Callfomia Code of Reg6ftt€ons. e A. Thr. building design features or system design features identified ohahis Certiflcaku:rof Compliance aro cpnsistegt Wfth i-forma£on_:provided on'=pthgi.alipllcable'complia neo documents, worksheets, the calculations, plans and specifications submitted to the dWorc¢menf:agency for7eploval-with this building permit appdcaiioh 5. I will ensure that a registered copy af-FhiS=Certlflca a of C9IrJ pita nee shell be ma�e:avaf lible With=She It "llding p'ermn(3.j..lssuud far the�i"�C3ild,lflg, and�,hnatie avarfhbfe atkheaanfarc¢m¢nt agency for all applicable inspections, I understand that a registered copy of this`CMIlicate of Compliance_ is. required to be included with the dowmentallorbtiillder prizvldes !oche bUOiiing owner at occupancy. ..�:.. - l..the, Responsible Designer Name: - - - Respon5l6le neSigner S1gnaCGre: _ n Liu, Minxuan�%U Company: Date Signed: Bay Area Energy Consultants 2017-02-07 22:03:30 Address: License: 1181 Sundown Ln City/stale/Zlp: Phone: San Jose CA 95127 408-883-3865 Digilalfyeignedby CnlCFRTS This digilnl signal—a provided w .,der to secu Me conlent of this registered doeunr¢nl, and in uo way implies Aegistralion Provider responsihilify for the nccuraey of dre irllor+vlalien. Registration Number: 217-A020042746A-000-000-0000000-0000 Registration Date/Time: 2017-02-07 22,03:30 SEERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2018.1.005 Report Generated; 2017-02-07 22:03:44 Schema Version: rev 10/16 1I°°I° IiH d iii u dI13et Ir tui n t REVHEWED FOR CODE CONA[I[JANC- Revl ed By� !!!!�'�'�!AIIS^,j Il .......... lA ��...� �......�. �' qq-E E.S i._.; (�h �— 0j(?•ter heo-�r- Lko, Vwru _- Z_..il5.y, cell V)e-- J'_) -1��Cr`�G\( E'.. if) Ni\� �c- ST(j'(Cc." A_'-cc\A C)67 S 1 O -C_ (N'\, -A (- O V' 1 c E.'. - �R m�..._.�.�......_..,........ .. �__--•y -__. `>-.�;v"l flE-' ��: �' �f't \-ti '� ((i\ �, �, 1 i'� ll�b �— S �.-c� s� kl �! �A 7�0�kCUPBRTURKIrs net-, °1°�_�:; �C_i : , st�� �a (•� t ct��m IiiIII I'Q 1, Mewed