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B-2017-0530CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0530 22535 SALEM AVE CUPERTINO, CA 95014-5648 (342 12 097) ON-TIME AIR CONDITIONING & HEATING INC PLEASANTON,CA 94588 OWNER'S NAME: ONORATO STEVEN J DATE ISSUED: 04/03/2017 OWNER'S PHONE: 631-949-7580 PHONE NO: (925) 444 4444 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC-20 Lic. # 18 7040 Contractor ON-TIME AIR CONDITIONING & HEATING INC Date 09/30/2017 X BLDG —ELECT _PLUMB X MECH 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 license is in full force and effect. JOB DESCRIPTION: REPLACE FURNACE/AC UNIT/COIL & DUCT - SAME LOCATION I hereby affirm under penalty of perjury one of the following two declarations: CITY OF CUPERTINO BUS LIC #401210 EXP 6-30-2.017 1. 'd will maintain a certificate of consent to self-insure for Worker's ation, as provided for by Section 3700 of the Labor Code, for the /have nce of the work for which this permit is issued. d 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: $19000.00 permit is issued. 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 34212 097 342 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify an eep harmless the City of Cupertino against liabilities, judgments, cost , and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of �e granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and w comply with all non-point source regulations per the Cu ertino Muni ' al Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatures Date 04-03-2017 Issued by: Kim Dunbar 1 � OWNER-B liLDFR DECLARATION Date: 04/03/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: m. 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: 04-03-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER m. 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. I 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 'the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 an permit is issued. s. 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 haza ous material. Additionally, should I use equipment or devices which emit azardouI 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 Manage nt District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, apter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sectio 25505, 25533, d 25534. Labor Code, I must forthwith comply with such provisions or this permit shall ,t? be deemed revoked. Owner or authorized age APPLICANT RTIFICATION Date: 04-03-2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY 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 to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name 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 ARATION T'S and will comply with all non-point source regulations per the Cupertino Municipal used as public records. u I understand my plans shhallall bbe e u Code, Section 9.18. Licensed Signature Date 04-03-2017 GENERAL PERMIT APPLICATION E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION j ( 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 G P F�ZT[i� 7 (408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino.org misc —�zc)f03� ❑PLUMBING CHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 2.�+� J` APN OWNER NAME J�© P _Sao E-MAIL STREET ADDRESS CITY, STATE, ZIP Lr FAX CONTACT NAME � .s STRr ' C(AGENT CITY, ATE, �1 s FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER WN` El CONTRACTOR A!5 TOR AGENT ElARCHITECT ❑ ENGAGER ❑ DEVELOPER ❑ TENANT CONT TOR NA LICENSE NUlk: _ i C) LICENSE TYPE (f --U BUS. LIC ft COMPANY NAMFe7 E-MAIL FAX STREET)� a - j CITY, Az W / O® ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC ;'_ COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF. 91ZFD.,DUPLEX ❑ muLT1-FP.MILY BUILDING: ❑CONIMERCW. PROJECT IN WI DLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLERHOME? ❑ NO A DESCRIPTION OF WORK 3 TOTAL VALUATION:O D ED Y By my signature below, I certi to each of the following: Iain erty owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided " correct. I havthe ad the Description of Work and verify it is accurate. I agree to omply with all applicable local ordinances and state laws relating to buil i o tion. I horize representatives of Cupertino to enter the above-ide fled foperty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIREDoFFTc USE ONLY - W�- OVER:THE-COUNTER. �. ElEXPRESS v: �►.- ,,E1 .:STANDARD'...- ., Z' :- ❑ LARGE 0 MAJOR MEPMiscApp 2011.doc revised 06121/11 .0% CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) Project Name: STEVE ONORATO I Date Prepared: CF1R-ALT-02-E (Page 1 of 3) 2017-04-03 A. General Information CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one CF1R-ALT-02 document for each dwelling unit. 01 Project Name STEVE ONORATO 02 Date Prepared 2017-04-03 03 Project Location 22535 SALEM AVENUE 04 Building Type Single family 05 CA City CUPERTINO 06 Dwelling Unit Name HOUSE SC System SC System CFA served systema Dwelling U(ft) -Installing new SC ` 07 Zip Code 95014 08 ZConditioned Floor Area (ft ) 2870 by this SC ducted containing system Number of Space entirely new 09 Climate Zone 4 10 Conditioning (SC) Systems in 1 component? components? feet of ducts? duct system? this Dwelling Unit: Alteration Type B. Space Conditioning (SC) System Information 01 02 03 04 ' '.-- ' 05 06" ` 07 08 09 10 Is the SC Installine a SC System SC System CFA served systema 'refriger nt " -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) system? component? components? feet of ducts? duct system? SC system? Alteration Type Altered space SYSTEM 1 LOCATION 1 2870 Yes Yes Yes Yes No No conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(1b)1Diib) This section does not apply to this project. Registration Number: 417-A020088446A-000-000-0000000-0000 CA Building Energy Efficiency Standards - 2016 Residential Compliance Registration Date/Time: 2017-04-03 13:23:12 Report Version: 2016.1.005 Schema Version: rev 10/16 HERS Provider: CHEERS Report Generated: 2017-04-03 13:23:13 CERTIFICATE OF COMPLIANCE CF1R-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) 01 02 03 04 05 06 07 08 09 10 11 12 Heating Cooling System Heating Altered Heating Minimum Altered Cooling Minimum Required New or Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct or Name Type Components Type Value System Type Components Type Value Type Duct Length R -Value SYSTEM 1 Central gas All new heating AFUE 0.8 Central split All new cooling SEER 14 Setback Greater than 40 feet R-6 furnace components AC components Required Documentation: CF211-MCH-01-E - Space Conditioning Systems - Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: 'R6 (CZ 1-10, 17 and '13) and R8 (CZ 11 and 14-16) CF2R and CF3R-MCH-20-H - Duct Leakage Test required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced -Leakage rate compliance: <= 15% or <= 10% leakage to outside, or seal all accessible leaks. CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing componentsi are installed or altered (applicable in CZ 2, 8-15). CF2R and CF3R-MCH-23 Airflow Rate >= 300 CFM per ton required when MCH -25 is required. Exceptions: Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements. Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MCH -25. -Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements. E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)1E, F) This section' �does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) This section does not apply to this project. Registration Number: 417-A020088446A-000-000-0000000-0000 Registration Date/Time: 2017-04-03 13:23:12 HERS Provider: CHEERS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-03 13:23:13 Schema Version: rev 10/16 CERTIFICATE OF COMPLIANCE CF111-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (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: April Rodriguez April Rodriguez Company: Signature Date: I Permit E Raters 2017-04-03 Address: CEA/ HERS Certification Identification (if applicable): 31225 La Baya Drive City/State/Zip: Phone: Westlake Village CA 93291 818=735-7886 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 Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. 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 California Code of Regulations. 4. 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 submitted to the enforcement agency for -approval withAhis building permit application. 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: J ResponsibleDesignerSignature: Lyndy Rose Lyndy Rose'" Company: Date Signed: On -Time Air Conditioning & Heating Inc dba Service Champions 2017-04-03 Address: License: 7020 Commerce Drive 817040 City/State/Zip: Phone: Pleasanton CA 94588 925-444-4444 Digitally signed by CHEERSTM. 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: 417-A020088446A-000-000-0000000-0000 Registration Date/Time: 2017-04-03 13:23:12 HERS Provider: CHEERS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-03 13:23:13 Schema Version: rev 10/16 PURPOSE SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinq(c�cupertino.org PERMIT CANNOT BE FINTALED UNTIL THIS CERTIFICATE I3AS BEEN f'/ln,TTr rmP.71 C'rn ATT, T-% A NT" -T- r�r wTr rTc rt car ��a. This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314; R315, 2016 CBC Sections 420.6 and 907.2.11.2. where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314, R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALAR_ M Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door) X X On every level of a dwelling unit including basements and habitable attics X X Within each sleeping room I X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC -Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below. /n� Address: 22 535 SA LF m AVC Permit No.(7 - ©530 Specify Number of Alarms: 0 # Smoke Alarms: I _ # Carbon Monoxide Detectors• = I have read and agree to comply with the terms and conditions of this stntamant Owner (or Owner Agent's) Name: Steven Onar"fo Si nature.... . ................................................................................................... Date:7h Contractor Name: Signature...................................................................... Lic.#........................................ Date:................... Smoke and CO forni.doc revised 01/1012017 CUPERTINO WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) P_ 777-328 • FAX (408) 777-3333 • buildingA-cupertino.org _ 20 -7 53 Owner Name �Vein vn © N e - - - o Permit N o. Address 22 .3 S sc&tm AVE 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. VNo Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. fir No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Q0"No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonrn. i�Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Pl se check ONE of the following: iMy property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non- compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. I Owner or Owner Agent's Signature: ,dt% z16— Date: ? Z o 1 % I Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit. SB40 7 2015. doc revised 01/05117 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems,.Ducts, and Fans rage 1 of 8) Project,Name: 22535 Salem Avenue Enforcement A ncy: y of Cupertino Permit Number: B -201M530 Dwelling Address: 22535 Salem Avenue C1 Cupertino Zip Code: 95014 h0q A..Genera.1 Information 01 Dwelling Unit Name 22535 Salem Avenue 02 Climate Zone 4 03 Dwelling Unit Total Conditioned Floor 2870 04 Number of Space Conditioning 1 CFA served Area- (ft2) Installing a Systems in this Dwelling, Unit. Installing 015 -Certificate of Compliance Type Prescriptive alterations (CF1R_ALT 06 Method Used to Calculate HVAC Loads NotApplicableEquipmentChangeout 07 Calculated Dwelling Unit Sensible This field or section is not applicable 08 Calcu'lated Dwelling Unit Heating Load This field or section is not applicable Identification or Cooling Load (Btu/h) System ducted (Btu/h) system Fo-91 Dwelling Unit Number of Bedrooms 3 Name Served �'�7 MCH -01b - Spate Conditioning Sys"teinn's.1366ti and Fans A' ei"ations"',",""' ""-f B. Space Conditioning (SC) Systerh Information 5", 01 02 03 04 05 06 07 08 09 io CFA served Is the SC Installing a Installing SC System- SC System by this SC system a refrigerant Installing new SC Installing more entirely Installing Identification or Location or Area System ducted containing system than 40 feet of new duct entirely new Name Served W) system? component? components? ducts? system? SC system? Alteration Type Entirely new or complete System 1 Location 1 2870 Yes Yes - Yes Yes Yes Yes replacement space system Registration Number: 2z7rAuzV1o7y*6A-oon*U1-Moznnzx-0oVn oABuilding Energy Efficiency Standards 'zozsResidential Compliance Registration Date/Time: Report Version: 20161.005 Schema Version: rev 10/16 2017-06-20 13:41:29 HERS Provider: caICEms Report -Generated: 2017-06-20 10:46s6 CERTIFICATE OPINSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 2 of 8) Ci Space Conditioning (SC) -System Alterations Compliance Information 01 -02 03 04 05 06_ 07 08 09 10 -11 12 :. 13 Heating Efficiency{ Heating Unit Heating Unit Heatmg,Unit Serial Rated Heating Capacity, SC Identification or. Name HeatingEfficiency Type Value Manufacturter Model Number Number Centra [ Fa n System 1 SEER :-16 amana asxl60371aa 0000. 36000 System 1. AFUE 81 amana��, aevc960603bnaa Integrated 58000 Heating 1,7 i Cooling New or (CFI) " 'SC Altered Heating Minimum Altered Cooling Minimum Required Replaced New Ventilation Identification -Heating Heating Efficiency Efficiency Cooling- Cooling Efficiency 'Efficiency Thermostat Duct Duct System or Name ' System Type Component Type Value System Type Component Type 'Value Type Length R -Value Status . All new All new System 1 Central gas heating AFUE 81 Central cooling SEER 14 Setback GT40Ft R6 Not a CFI furnace componen split AC components system - is D. Installed Heating Equipment :Information ' 01 02 ', 03 w 04. 05 06 07 Heating Efficiency{ Heating Unit Heating Unit Heatmg,Unit Serial Rated Heating Capacity, SC Identification or. Name HeatingEfficiency Type Value Manufacturter Model Number Number Output (Btu/h) System 1 SEER :-16 amana asxl60371aa 0000. 36000 System 1. AFUE 81 amana��, aevc960603bnaa 0000 58000 1,7 i Notes: E. Installed Cooling Equipment Information 01 02 03 04 05 06 07 08 Condenser or Package Unit' SC Identification or Name Cooling, Efficiency Type Cooling Efficiency Value Condenser or Package Unit Manufacturer Condenser or Package Unit- Model Number Condenser or Package Unit Serial Number System Rated Cooling Capacity at Design Conditions (Btu/h) Condenser Rated Nominal Capacity (ton) System 1 SEER :-16 amana asxl60371aa 0000. 36000 3 - Registration Number:217-A020187966A-000-001-M01001A-0000 Registration Date/Time: 2017-06-20 13:41:29 HERS Provider: CaICERTS CA BuildingEnergy Efficiency Standards- 2016 Residential Compliance Report Version:.2016.1.005 Report Generated: 2017-06-20 10:46:56 Schema Version: rev 10/16 CERTIFICATE OF INSTALLATION CF2R-MCH-01; E Space Conditioning Systems, Ducts, and Fans (Page 3 of 8) . E. Installed Cooling Equipment Information 01 02 03 04 05 06 07 08 02 Condenser or Package Unit 04� SC Identification or Name Cooling Efficiency Type Cooling Efficiency Value Condenser or Package Unit Manufacturer Condenser or _ Package Unit Model Number Condenser or Package Unit Serial Number System Rated Cooling Capacity at Design Conditions (Btu/h) Condenser -Rated Nominal Capacity (ton)- Notes: F. Extension of Existing Duct System, Greater Than 40 Feet This section.does not apply to this project. Registration Number: 217-A020187966A-000-001-M01001A-0000 CA Building Energy Efficiency Standards - 2016 Residential Compliance Registration Date/Time: 2017-06-20 13:41:29 Report Version: 2016.1.005 Schema Version: rev 10/16 HERS Provider: CalCERTS Report Generated: 2017-06-20- 10:46:56 G. Installed Duct System Information 01 02 03 04� 05 06 07 08 09 Method of Can RA3.3 -Z compliance With .. � Airflow SC System SC Systemduct and filterNumber of Air Protocols be Identification or Location or Area Supply Duct Supply Duct Return Duct Return Duct grille sizing Req's Filter Devices on used to test Name Served Location R -Value Location R -Value in 150.0(m)13 System this System? HERS verified -fan Unconditioned Unconditione efficacy (w/cfm) System 1 Location 1 attic R-8 d attic R -g and airflow rate 1 Yes (cfm/ton) Notes: Registration Number: 217-A020187966A-000-001-M01001A-0000 CA Building Energy Efficiency Standards - 2016 Residential Compliance Registration Date/Time: 2017-06-20 13:41:29 Report Version: 2016.1.005 Schema Version: rev 10/16 HERS Provider: CalCERTS Report Generated: 2017-06-20- 10:46:56 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning.Systems, Ducts, and Fans (Page 4 of 8) H. Installed Air Filter Device Information 01 02 03 04 05 06 07 allowable clean -filter pressure drop at the design airflow rate applicable;toeach air;filter device shall be determined, and all system airfilter device locations shall be 02 Y - labeled to disclose the applicable design.airflow rate and the maxirrturn§allowable clean filter pressure drop The labels shall be'permanently affixed to the air filter device, readily legible, and visible -to a person replacing the ai'r filter media, and the a'i'r filter devices shall be provided with m air filter edi:.a that conforms to these Determined Design �,. .,_ 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. Determined Design Allowable Pressure SC System Identification or SC System Location or Air Filter Device Air Filter Device Air Filter Device Airflow Rate for Air Drop for Air Filter Name Area Served Identification or Name Type Location Filter Device (cfm) Device (inch W.C.) System 1 Location 1 Filter 1 Duct Mounted RETURN 350 0.5 Notes: I. 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. gg The system shall be designed to accommodate the cleaWilter pressure drop imposed by the system air`filter device(s)5,,.The design airflow rate and maximum allowable clean -filter pressure drop at the design airflow rate applicable;toeach air;filter device shall be determined, and all system airfilter device locations shall be 02 Y - labeled to disclose the applicable design.airflow rate and the maxirrturn§allowable clean filter pressure drop The labels shall be'permanently affixed to the air filter device, readily legible, and visible -to a person replacing the ai'r filter media, and the a'i'r filter devices shall be provided with m air filter edi:.a 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. 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 04 52.2, or a particle size efficiency rating equal to or greater than 50% in the 3.0 to10 m range when tested in accordance with AHRI Standard 680. The system shall be provided with air filter -media that has been labeled by the manufacturer to disclose -the efficiency and pressure drop ratings that conform to the 05 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: 217-A020187966A-000-001-M01001A-0000 - Registration Date/Time: 2017-06-20 13:41:29 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance 'Report Version: 2016.1.005 Report Generated: 2017-06-20 10:46:56 Schema Version: rev 10/16 CERTIFICATE OF INSTALLATION CF2R-MCW01-E Space Conditioning Systems, Ducts, and Fans (Page 5 of 8) J. HERS Verification_ Requirements 01 02 03 04 05 06 07 08 09 10 Exemption h MCH -20 from MCH -23 Minimum MCH -22 MCH -25 Exemption R -Value for MCH -21 AHU MCH -28 SC System SC System From Duct Duct Ducts In AHU Fan Airflow Identification or Location or Area Leakage Leakage Conditioned Duct Location Efficacy Rate Refrigerant Return Duct Design Name Served Requirements Test Space Verification (W/cfm) (cfm/ton) Charge - Table 150A -B or C System 1 Location 1 NO Yes Not 'No Yes Yes No No exemptions applicable Notes: Registration Number: 217-A026187966A-000-001-M01001A-0000 'Registration Date/Time: 2017-06-20 13:41:29 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-20 10:46:56 Schema Version: rev 10/16 ..N, '�� T:- h Registration Number: 217-A026187966A-000-001-M01001A-0000 'Registration Date/Time: 2017-06-20 13:41:29 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-20 10:46:56 Schema Version: rev 10/16 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E- Space Conditioning Systems, Ducts, and Fans (Page 6 of 8) K. 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 temperafure'rise specificatioh:'See Section 150.0.(h)4.. 05 Standby Losses and Pilot Lights: Fan -type central furnacq ay not have a continuously burning'pilot light Section 110.S and Section 110.2(d). Cooling'Equipment ; 06 - Equipment Efficiency: All cooling equipment mutt' -meet the minimum efficiency requirements of,Section.110 1'and Section 110.;2(a) a,nd the Appliance Efficiency Regulations.,. =x', 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)3 -A. 09 Liquid Line Filter Drier: If applicable, a liquidline filter -drier shall be installed according to the manufacturer's specifications. Section 150.0(h)3B 10 Sizing: Cooling load calculations must be done on portions of the -building served by new cooling systems to prevent inadvertent undersizing or oveesizing. See Section 150.0(h)1.and 2. Air Distribution System Ducts, Plenums and Fans Registration Number: 217-A020187966A-000-001-M01001A-0000 CA Building Energy Efficiency Standards - 2016 Residential Compliance Registration Date/Time: 2017-06-20 13:41:29 Report Version: 2016.1.005 Schema Version: rev 10/16 HERS Provider: CaICERTS ReportGenerated: 2017-06-20 10:46:56 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 7 of 8) K. 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. - 11 Insulation: In all cases, unless ducts are enclosed entirely in directly conditioned space, the minimum duct insulation value is R-6. Note that higher values may be - required -by the. prescriptive or performance requirements. See -Section 150:0(m)1. Connections and Closures::All installed air -distribution system ducts and plenums must be, sealed and insulated to meet the requirements of CMC Sections 601.0, 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 Ievel'ofR-6.0 or 12 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— 13 A thermostat shall be installed that meetsthe requirements of Section 110.2(b) ;and Section 110.2(c). 14 The thermostat shall be installed in accordance with the manufacturers published installation specifications 15 First stage of heating shallbe assigned to heat pump heatin g:: 16 Second stage back up heating shall beset to come on only when the Indoor set temperature cannot be met'? a fir.,. << A i�':+ , The responsible person's signature on this compliance pdocument,affirms that all applicable requirem.;ents in'this table have'l een met ,. Registration Number:217-A020187966A-000-001-M01001A-0000 Registration Date/Time:, 2017-06-20 13:41:29 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-20. 10:46:56 Schema Version: rev_10/16 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 8 of 8) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Installation'documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: ik►GGIL�V�LSLfLfi�t�hst� Richard Cunningham - - Company: _. _ - = ._ -- -- -- Signature Date: ---- The Energuy CA LLC The 2017-06-20 10:51:10 Address: CEA/.HERS Certification Identification (if applicable): 1215 K St., 17th Floor CC2005596 City/State/Zip: Phone: Sacramento CA -95814 1877-600-0123 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. ' - 1 am either: a)''a responsible person 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, or b) I am an authorized representative of the responsible person and attest to the declarations 1n'this statement on the,responsible person's,behaif 3. The constructed or installed features, materials, components or ma ufactured devices'(the;installation) identified orYthis Certificate.of staIIation:conformsao all applicable codes and regulations and the installation conforms to the requirements given on the Certificate of Compliance plans; and specifications appioved;by the,enforcement agency: s 'In 4. 1 will ensure that a registered copy of this Certificate of Installation shall be posted or made available with;he;building permits) issued for.the building andwmadeavailable to the enforcement agency for all Y H ...,, 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: David Strugeon Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Position With Company (Title): ON-TIME AIR CONDITIONING & HEATING INC dba SERVICE CHAMPIONS MANAGER Address: - CSLB License: 7020 COMMERCE DR 817040 City/State/Zip: - Phone: Date Signed: PLEASANTON CA 94588 925-598-1911 12017-06-20 13:41:29 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: 217-A020187966A-000-001-M01001A-0000 Registration Date/Time: 2017-06-20 13:41:29 HERS Provider: CaICERTS CA Building Energy Efficiency Standards- 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-20 10:46:56 Schema Version: rev 10/16 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3) Project Name: 22535 Salem Avenue Enforcement Agency: Cupertino City of Permit Number: B-2017-0530 Dwelling Address: 22535 Salem Avenue 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 -1'R Single family 04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from CFIR? No, credit is not taken 05. Verified Low Leakage Air..'Handling Unit (VLLAHU) Credit from CF1R? No, credit is not taken 06 Leakage Factor Replacement ' . Registration Number: Registration Date/Time: M7-06-20 13:41:29 HExspm"der[xICcms 217+&20187966A700*001'M200UzA-0000 [ABuilding Energy sfficienq/Standards Report Version: z0161.UUs Report Generated: 20zM6'lO 10:47:45 zU16Residential Compliance Schema Version- rev 83/z6 � ^ . . ^ 01 Con�ens& Nom'In'al Cooling Capacity (ton) 3 02 Heating Capacity.(kBtu/h) 01'�nplete"AeplAc'ernejnt or Altered D6c 03 Condition I ed Floo r Area served by this HVAC system (ft2) 777 77 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) Dete rmination Method Heating system method 09 Measured AHUAi rflow ' . Registration Number: Registration Date/Time: M7-06-20 13:41:29 HExspm"der[xICcms 217+&20187966A700*001'M200UzA-0000 [ABuilding Energy sfficienq/Standards Report Version: z0161.UUs Report Generated: 20zM6'lO 10:47:45 zU16Residential Compliance Schema Version- rev 83/z6 � ^ . . ^ 01 Con�ens& Nom'In'al Cooling Capacity (ton) 3 02 Heating Capacity.(kBtu/h) 58 03 Condition I ed Floo r Area served by this HVAC system (ft2) 2870 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) Dete rmination Method Heating system method 09 Measured AHUAi rflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage (cfm) 63 10 —11 Actual Duct Leakage Rate from Leakage Test Measurement 53 Compliance Statement: System passes leakage test ' . Registration Number: Registration Date/Time: M7-06-20 13:41:29 HExspm"der[xICcms 217+&20187966A700*001'M200UzA-0000 [ABuilding Energy sfficienq/Standards Report Version: z0161.UUs Report Generated: 20zM6'lO 10:47:45 zU16Residential Compliance Schema Version- rev 83/z6 � ^ . . ^ CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3) C. Additional Requirements for Compliance 01 Systemwas 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 Ceriiral Fan Ventilation Cooling Systems, that utilize dampers that open only when CIA is required and automatically, close when CA is not required; may configure the OA clamperto 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 complips 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 verificati'o'n compliance..., . .... it"" The responsible person's signature on this cornpliance,clocurneofaffirMstha'll r. pq Ul' q applicable Ie cements:16 this table have beenrnet. Ya Registration Number: 217-A020187966A-000-001-M20001A-0000' CA Building Energy Efficiency Standards 2016 Residential Compliance Registration Date/Time: 2017-06-20 13:41:29 9 HERS Provider: CaICERTS Report Version: 2016.1.005 Report Generated: 2017-06-20 10:47:45 Schema Version: rev 03/16 g, j Registration Number: 217-A020187966A-000-001-M20001A-0000' CA Building Energy Efficiency Standards 2016 Residential Compliance Registration Date/Time: 2017-06-20 13:41:29 9 HERS Provider: CaICERTS Report Version: 2016.1.005 Report Generated: 2017-06-20 10:47:45 Schema Version: rev 03/16 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3) Documentation Author's Declaration Statement 1.1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature;C�000>rl�lR/(/IGjLGG�l�i Richard Cunningham . Company: Signature Date: 2017-06-20 10:51:10 The Energuy CA LLC Address: CEA/ HERS Certification Identification (if applicable): 1215 K St., 17th Floor CC2005596 City/State/Zip: Phone: Sacramento CA 95814 877-600-0123 Responsible Pe'rson's `Declaration statement I certify the following.urider penaltyof perjury, under the laws of the State of California: 1. The information provided'on this Certificate of Installation is true and correct. 2. 1 am either:'a) a responsible person 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, orb) I am an authorized representative of the responsible person and attest to the declarations in,this statement on the responsible person's behalf. 3. The const`ructe'd of 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 given on the,Certificate of Compliance, plans, and specifications approved by the enforcement agency` 4. [.understand that a HERS rater will check the installation to`weri y compliance and,if such checking determines ttj a installation fails to comply, I am required to offer any necessary corrective action at no charge to the building owner. "' i a 5. twill ensure that,a registered,copy of this Certificate oflnstailation sh'alf be"pos"ted',,or made available with,-thd building permit(s)`issued for the buildirig, and made and to the enforcement agency for all applicable inspections) understand that a registered. copy, of this Certificate of Installation is required to be included.with the documentation the builderprovides to`the building gwner at occupancy. Responsible-Builder/installer Name: Responsible Builder/Installer Signature: David StrugeoncStrueo avi Company Name: (Installing Subcohtractor or General Contractor or Position With Company (Title): Builder/Owner) MANAGER ON-TIME AIR CONDITIONING & HEATING INC dba SERVICE CHAMPIONS Address: CSLB License: 7020 COMMERCE DR 817040 City/State/Zip: Phone: PLEASANTON CA 94588 " 925-598-1911 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 noway implies , Registration Provider responsibility for the accuracy ofthe information. Registration Number: Registration Date/Time: 2017-06-20 13:41:29 HERS Provider: CalCERTS 217-A020187966A-000-001-M20001A-0000 CA Building Energy Efficiency Standards Report Version: 2016,1.005 Report Generated: 2017-06-20 10:47:45- 2016 0:47:452016 Residential Compliance Schema Version: rev 03/16 CERTIFICATE OF INSTALLATION CF2R-MCH-22-H Space Conditioning System Fan Efficacy (Page 1 of 3) Project Name: 22535 Salem Avenue Enforcement Agency: City of Cupertino Permit Number: B-2017=0530 Dwelling Address: 22535 Salem Avenue City: Cupertino Zip Code: 95014 A. Ducted Cooling System Information_ 01 System Identification or Name System 1 02 System'Location or Area Served Location 1 03 System Installation Type Replacement 041 Nominal Cooling Capacity (tons) of Condenser 3 05. Condenser Speed Type, Multi -speed 06 I Cooling System Zonal Control Type Not Zonal i 07 1 Central FanJntegrated (CFI)Ventilation System Status Not CFI system O8' System Bypass'Duet Status 6, Bypass Duct . 4 ; 09Date of S stem Airflow Rate IVIQasurement s 2017-0644 "A y � r lb' Airflow Rate Protocol utilized procedures for' airflow rate measurement k,w B! Fan' Watt Measurement Apparatus and Procedure Information Inlstrument Specificati'o'ns, are given in RA3.3.1, and system fan watt measurement apparatus information is given in RA3.12.2. I i ' 01 Fan Watt'lVerif cation Device Used. Analog Utility Revenue Meter (spinning wheel type) MCH -22a Forced AirSysteIm Fan Efficacy Measurement - Newly Installed Non-Zoned'Systems or Zoned Multi -Speed Compressor C Forced;Air System- Fan Efficacy Measurement •' Tf e'procedures for System Fan Watt Verification are specified, in Reference Residential Appendix RA3.3 01 Actual. Tested Watts 599 02 Actual Tested Airflow from MCH -23 (cfm) 1082 03 ':Required Fan Efficacy (watts/cfm) 0.58 04 Actua[ Fan Efficacy (watts/cfm) G 0.55 05 Compliance Statement: System fan efficacy complies Registration Number: '217-A020187966A-000-001-M22001A-0000 i 1 CA Building Energy'Efficiency Standards 2016 Residential Compliance, 1 < Registration Date/Time: 2017-06-20 13:41:29 HERS Provider: CaICERTS Report Version: 2016.1.005 Report Generated: 2017-06-20 10:50:26 Schema Version: rev 2013-09-11 CERTIFICATE OF INSTALLATION CF2R-MCH-22-H Space Conditioning System Fan Efficacy (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 clurin g 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-sp6ed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/tpn) and fan 'efficacy (Watt/cfm) with system'operating in cooling mode at the maximum compressor speed and'th6 maximum air handler fan speed. 06 Zoned cooling air d istribution systems with single speed compressors shall meet both the a irf I ow ,(cfm/ton) and fan efficacy (Watt/cfm) criteria in every zonal control mode. The, responsible person's signature on this compliance document affirms that all applicable requirement's in this table have been'met; Rejistrati'6P' Number: 217-A0201',87966A-000-,001-M22001A-0000 CA Building. Energy Efficiency Standards 2016 Residehtial Compliance Registration Date/Time: 2017-06-20 13:41:29 HERS Provider: CaICERTS Report Version: 2016.1.005 Report Generated: 2017-06-20 10:50:26 Schema Version: rev 2018-09-11 CERTIFICATE OF INSTALLATION CF2R-MCH-22-H Space Conditioning System Fan Efficacy (Page 3 of 3) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Richard Cunningham O company: , Signature Date: 2017-06-20 10:51:11 The Energuy CA,LLC Address: CEA/'HERS Certification Identification (if applicable): 1215 K St., 17th Floor CC2005596 City/State/Zip: Phone: Sacramento CA 95814 ; '' 877-600-0123 Responsible: Person's Declaration statement I certify the followiiig underpenalty. 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 eithei: a) a responsible person 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 �identiffed on this Certificate of Installation and attest to the declarations in this statement, orb) I am an authorized representative of the responsible person and attest to the declarations in this statement on the responsible person's behalf. 3. The constructed or installed features, materials; components or manufactured devices (the installation) identified on this Certificate of'installation conforms to all appiicabie!codes and regulations and the installation conformstothe requirements given on the Certificate of Compliance, plans, and specifications approved by the enforcement agency:' 1 F 4, 1 understand that a'HERS raterIll check the mstaliation to venfy compliance andkif such checking determines,the installation fails to comply, l am I required to offer any necessary corrective action at no charge to the building owner. r 51 [will ensure that a registered copy.of this Certifieat'96f•lnstallation sK fl`be posted; or made available with-thb wilding perri •CERTIFICATE OF INSTALLATION CF2R-MCH-23-H Space. Conditioning System Airflow Rate (Page 1 of 3) Project Name: 22535 Salem Avenue Enforcement Agency: City of Cupertino Permit Number: B-2017-0530 Dwelling Address: 22535 Salem Avenue City: Cupertino Zip Code: 95014 " A: Ducted Cooling System Information 01 System ldentifi'cation or:Name System 1 02, System''Location or Area Served Location 1 03 System Installation Type Replacement 04, Nominal Cooling Capacity(tons) of Condenser 3 05, Condenser SpeedTypei":;, Multi -speed. 06., Cooling System Zonal` Control Type _ Not Zonal 01,!:' Central Fan Integrated (CFI)'Ventilation System Status Not a CFI system Sys 08', System Bypass Duet Status No By ass Du �Q Pct 09 j' Date of System Airflow Rate Measurement 2017-06-14 10 r Airflow RateIProtocol'Utilized` RA3.3 procedures for'airflow'rate measurement B1'Holefor the placement of a Static Pressure Probe (HSPP), and Permanently Installed Static Pressure Probe (PSPP) in'thellSupply Plenum Priicedures for'installing HSPP'or PSPP are specified in RA3.3.1.1. Method Used to Demonstrate Compliance with the HSPP installed and labeled consistent with Figure RA3.3-1 011, ' ' SPP/PSPP Requirement CAirflow Rate Measurement Apparatus,and Procedure Information Instrument Specifications are given in RA3.3.1.1, and system airflow rate measurement apparatus information is given i n!'03.12. 01, 'Airflow Rate Measurement Type -used for this airflow rate Traditional Flow Capture Hood according to procedure in verification. RA3.3.3.1.4 02 ' Manufacturer of Airflow Measurement Apparatus tsi 03 J; ; Model number of Airflow Measurement Apparatus 8371 Certification Status of the Airflow Measurement Apparatus Certified by Manufacturer and listed on CEC Website at 04, ''Accuracy http://www.energy.ta.gov/title24/eqdipme.nt—Cert/ama—fas /inclex.html dex.html Registration Number: 217, A020187966A-000-001-M23001A-0000 CA Building Energy Efficiency'Standards 2016�'Residential Compliance Registration Date/Time: 2017-06-20 13:41:29 HERS Provider: CaICERTS Report Version: 2016.1.005 Report Generated: 2017-06-20 10:49:31 Schema Version: rev 10/16 CERTIFICATE OF INSTALLATION CF211-MCH-23-1-1 Space Conditioning System Airflow Rate (Page 2 of 3) 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) 1050 03 Actual System Airflow Rate Measurement (cfm) 1082 04 Compliance Statement: System airflow rate complies E. Additional Requiiements ., 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•duringsyste'm air flow.rate measurement identified on this Certificate of Installation. The airflow rate measurement:apparatu's used to perform the airflow rate measurement identified on this Certificate of 02 Installation; was &calibrated in accordance with the apparatus manufacturer's specifications and conforms to the instrumentation specification's given in RA3=31 •,,u '' A visu@li inspection shall confirm that bypass ducts that deliverconditicined supply air -directly to the space conditioning 03 system return duct airflow are not used on newly constructed zonally controlled systems unless the Performance Certificate of'Compliance i'ndicates,an allowance for use of a bypass duct. When a bypass duct is accounted for on.the Performance I 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 Systemlan was set'at maximum speed during the diagnostic test. a. 06 s If fresh air duct is partof 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) 'wi'th system operating in cooling mode at the maximum compressor speed and the maximum air handler fan speed. The responsible person's signature on this compliance document affirms that all applicable requirements in this table have been met. Registration Number: 217-A020187966A-000-001-M 23001A-0000 CA Building Energy Efficiency Standards 2016 Residential Compliahce Registration Date/Time: 2017-06-20 13:41:29 HERS Provider: CaICERTS Report Version: 2016.1.005 Report Generated: 2017-06-20 10:49.31 Schema Version: rev 10/16' CERTIFICATE OF INSTALLATION CF2R-MCH-23-H Space Conditioning System Airflow,Rate (Page 3 of 3) Documentation Author's Declaration Statement 1.1 certify that thi's Certificate of Installation documentation is accurate and complete. Documentation Author Name:" Documentation Author Signature: �r/lLlLl Richard Cunningham Company: Signature Date: 2017-06-20 10:51:11 The Energuy CA LLC Address: CEA/ HERS Certification Identification (if applicable): 1215 K St., 17th Floor CC2005596 City/State/Zip: Phone: Sacramento CA 95814 877-600-0123 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.. 1 am either:ia)' a responsible person eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, & 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, or b) I am an authorized representative of the responsible personandattest to the declarations in this statement on the responsible person's behalf. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms fo:all applicable codes and regulations and the installation conforms to the requirements given on the .Certificate �ofCompliance, plans, and specifications approved by the enforcement agency. ' 4. 1 understand that a HERS,rater.wiii check the •installation to'verify compliance and, f such checking determines the installation fatKi0 comply, I am required to' "er any necessary corrective action at no Charge to the building owner. 5. I will ensure�that a registered copy of this Certif bte`°of=installation shaltbe posted; or made available with°the`building permit(if issued for=the u=' 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 includetl,with the documentation the'builder?provides to the building owner a4 ocCupanty. ,! Responsible Builder/Installer Name: Responsible Builder/Installer Signature: David Strugeonav' cSt eon Company Name: (Installing Subcontractor or General Contractor or Position With Company (Title): Builder/owner) Manager ON-TIME AIR CONDITIONING & HEATING INC dba SERVICE CHAMPIONS Address: CSLB License: 7020 COMMERCE DR 817040 City/State/Zip: Phone: PLEASANTON CA 94588 925-598-1911 Third Party Quality Control Program (TPQCP) Status: Name of TPQCP (if applicable): Digitally signed by Ca10E4TS. 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-A020187966A-000-001-M23001A-0000 CA Building'Energy Efficiency Standards 2016 Residential Compliance I 'i Registration Date/Time: 2017-06-20 13:41:29 HERS Provider:.CaICERTS Report Version: 2016.1.005 Report Generated: 2017-06-20 10:49:31 Schema Version: rev 10/16