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B-2017-0531CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0531 7562 NEWCASTLE DR CUPERTINO, CA 95014-5221(366 17 015) SANDIUM INC SAN JOSE, CA 95134 OWNER'S NAME: BISHARAMAGDY S TRUSTEE DATE ISSUED: 04/04/2017 OWNER'S PHONE: 408-314-1702 PHONE NO: (408) 894-9072 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class f, -Z Lie. #888119 Contractor SANDIUM INC Date 12/31/2018 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X MECH X RESIDENTIAL — — COMMERCIAL with Section 7000) of Divisions 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: RELOCATE FURNACE TO ATTIC (I); I hereby affirm under penalty of perjury one of the following two declarations: REPLACE AC UNIT -SAME LOCATION - DUCT REPLACEMENT 1. I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by 1. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $18000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 36617 015 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 4/4/2017 Issued by: Kim Dunbar Date: 04/04/2017 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. 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 ofApplicant: contractors to construct the project(Sec.7044, Business & Professions Code). Date: 4/4/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER i. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 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 hazardous shall not employ any person in any manner so as to become subject to the material. Additionally should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall 1 be deemed revoked. ^ Owner or authorized agent APPLICANT CERTIFICATION Date: 4/4/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 4/4/2017 Professional s COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildina ancuperdno.ora ®5:31 [PLUMBING MECHANICAL F—RT.F.CTRT(`AT. I ITviTCf PTT AT.TF'nTTc PROJECT ADDRESS -7,;62 S EN:#3 L OWNER NAME PHONE E-MAIL STREET ADDRESS �� �S �C�.( CITY, STATE, ZIP FAX CONTACT NAME ," A A- 1 PHONE E-MAIL STREET ADDRESS�� CITY, STATE, ZIP FAX 11 OWNER ElOWNER-BUILDER❑ OWATERAGENNT XCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTTRACTORNAME LICENSE9 In 41� LICENSE TIDE BUS. LIC # COMPANY NAME H 1 E -MAIL `� S � (�. Gt1/1QL FAX 6GD44q'Or2®S STREET ADDRESS ' C) 4 S t 0(u (04-- CITY, STATE, ZIP u S 1 G2 " cup, d� PHONE 1" 914- f -7 2 ARCHITECT/ENGINEER NAME LICENSE NUMBER r BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE " USE OF R4FD or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COP,LME2CIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA NO PROJECT IN ❑ YES FLOOD ZONE NO IS THE BLDG AN ❑ STs EICHLER HOME? Rr NO DESCRIPTION OF ;YORK TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Rork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu' construction. 1��representativcs of Cupertino to enter the above-identifiedprgperty for inspection purposes. Signature of Applicant/Agent: Date: �'A i / SUPPLETvIENTAL INFORMATION REQUIRED -OFFICE usE.onLY - ©ow- R -THE -COUNTER � ❑ 'EXPRESS v' ❑.;STAND ARD. . .a -0-A-UJOR MEPMiscApp_2011.doc revised 06/21111 ------ - ----- - ------ ALTERATIONS - HVAC 0 CEC-CF1R-ALT-03-E (Revised 01116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E Alterations - HVAC CZ 1, 3 to 7 and 16 (Page 1 of 1) Site Address: 7;62. Qujcc4# Enforcement Agency: Date Prepared: Permit#: Equipment Type Equipment Efficiency New: Ducting or Lineset Required R -value Conditioned Floor Area (ft) Thermostat ❑ Packaged System Evaporator Coil AFUE COP ❑ R-6 (CZ 1-10,12&13) Ducts Served by system PrSetback Split System ,❑l L7 Condensing Unit LSEER OR -8' (CZ11,14-16)Ducts o?s D ftz - (If not already Furnace ❑ Lineset EER HSPF ❑ >_ R-2.8 Lineset' present, must be installed) HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. 04. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: (Can include new ducting) , All Equipment, CF1R-ALT-02-E € # � ia� � � Condenser Unit, Evaporator Coil, CF2R: MCH -01, MCH -20-H l Building L � partrreOt Air Handler/Furnace CF3R: MCH -20-H �., Installer Requirement: Duct leakage (515% or, <_10% to outside, or seal all accessible le 1', APP 0 4 2011 `W Exempted from duct leakage testing if: ❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There isR2sVM[nVeE1; gB[1f j g I unconditioned space, or 113. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date ofl3 lk'n OMPLlA)INi(;E ❑ 2. New HVAC System Required Compliance Documents to be left o` n'%W&fbeElr@V: All new equipment and All New Ducts2 CF1R-ALT-02-E CF2R-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H2 Installer Requirement: Duct leakage < 5%, Fan Efficacy (0.58W/CFM), Air Flow >_ 350 CFM/ton (or Standards Table 150.0-13 / C alternative) ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: Includes replacing or installing All New CF111-ALT-02-E Ducts' and one or more of the following: CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)-H Condenser Unit, Evaporator Coil, Furnace CF3R-MCH-20-H, MCH -(23 or 24)-H Installer Requirement: Duct leakage < 5%, Air Flow >_ 350 CFM/ton (or Standards Table 150.0-B / C alternative) ❑ Exempted from duct leakage testing if existing duct systems are constructed, insulated or sealed with asbestos. 114. New Ducting over 40 feet Required Compliance Documents to be left on site for Final: Adding or replacing ducts in unconditioned CF1R-ALT-02-E space but less than All New Ducts2 CF2R-MCH-20-H CF3R-MCH-20-H Installer Required to: Duct leakage (< 15% or, < 10% to outside, or seal all accessible leaks) ❑ Exempted from duct leakage testing if existing duct systems are constructed, insulated or sealed with asbestos. t All new ducting requires R-8 insulationwhen more than 40 ft installed in CZs 11 & 14-16 and R-6 in CZs 1-10, 12 & 13, and R-6 insulation when less than 40 ft installed. This includes in walls, between floors etc. 2 A New Duct system is when the duct system is constructed of at least 75 %new duct material, and up to 25%may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, plenums, duct material. ' R-2.8 (1" thick insulation) for linesets 1" and less. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on -this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR. 5. 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 with this building permit application. Responsible Desi ner ame: Responsible Desi r ignature: Date Sign d: License: cense: 9179 U L Company: tj Address:_ 104t--(,k u/t_ � City/State/Zip; 14051Q— Phone ��� ^� For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300 PURPOar. X; �gT.lyyr,- 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(a)ewertino.ora 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 CSC 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, 8315, 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 Ludt including basements and habitable attics X X Within each sleeping room 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. Address: �t e,✓� 1 (a - , �� j e ✓ f-) Y-0 Permit Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors: 1 have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: ti%>i� , Signature....... Date:. Contractor Name: Signature...................................................................... Lic.#........................................ Date:................... 0 Smoke and CO forni.doc revised 01/10/2017 SIR L WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE`., -fes COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CU` " ERTIt4O I 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408 777,-3228 • FAX (408) 777-3333 • buildingp_cupertino.org Owner Name �����®fha� Permit No Address I -S-6 P3 i ��- 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. No 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. 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. q 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 form. 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. Please check ONE of the following: My 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 pane. I Owner or Owner Agent's Signature: 11 > Date: 1�-/Z-J Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit. SB407 2015.doe revised 01105/17 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3) Project Name: Magdy Bishara Enforcement Agency: (City Cupertino of) Permit Number: B20170531 Dwelling Address: 7562 Newcastle 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 I Replacement MCH -20d - Complete Replacement or Altered Duct System B. Duct Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity (ton) 2 02 Heating Capacity (kBtu/h) 58 03 Conditioned Floor Area served by this HVAC system (ft2) 1479 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) 62.93 10 Actual Duct Leakage Rate from Leakage Test Measurement (cfm) 26 11 Compliance Statement: System passes leakage test 12 Notes: Registration Number: Registration Date/Time: 2017-04-25 17:43:39 HERS Provider: CHEERS 417-A020091096A-002-000-M20000A-M20A CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-04-25 17:43:40 2016 Residential Compliance Schema Version: rev 03/16 CERTIFICATE.OF VERIFICATION `CBR -MCH -20-1-1_ Duct Leakage Diagnostic Test _ (Page Z of.,,3) T: C. Additional Requirements for Compliance a ` 01 System was tested in its normal '- - fation.condiiion.'No temporary taping allowed., 02 Outside`6flCiA) duct connections.to.tf e 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 Buil din cavities were not __. s. - ^ g used as plenums or platfor-m returns in lieu of dnacts. 05- -1f,cloth- backed, tape wasused it was -covered with Mastic- and, draw-band5. °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 wasconducted in accordance with the;requirements of Reference 'ltesidential Appendix RA3.1.4.3.6. Systemsthat comply using""smoke test shall not`be included in sample groups for HERS verification corripliance ' 08 Verification Status: _ Pass - all applicable requirements are met 09 Correction Notes: The responsible person'ssignature on this compliance document affirms that all applicable requirements'in this table have been met unless otherwise noted in the Verification Status and the Corrections Notes in this table_.-___ D. Determination of HERS Verification Compliance All applicable sections -of this document shall indicate -compliance with the specified verification, protocol requirements in order for this Certificate of Verification as a whole to be determined, to ;be in compliance. 01 Complies: All specified verification protocol requirements on this document are.rrnet: Registration Number:-,, Registration Date/Time: 2017-04-25 17:43:39 HERS Provider: CHEERS 417-A020091096A-002-000-M20000A-M20A CA Building Energy Efficiency Standards ; ; Re port 2016.1.005 Report Generated: 2017-04-25, 17:_43:40 2016 Residential Compliance _ Schema Version: rev 03/16 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H I Duct leakage Diagnostic Test (Page 3 of 3) I Documentation Author's Declaration Statement 1.1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Lorraine "Mickey" Souza L&rraZYi,& "�ICckey" So-rt✓&iw Company: Date Signed: Energineers 2017-04-25 . Address: CEA/ HERS Certification Identification (if applicable): 24015 Wilcox Lane RCN13111 City/State/Zip: Phone: Hayward CA 94541 510-29-9631 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 (CF211) 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 Shawn On The Certificate Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder/Owner): Sandium, Inc. Responsible Builder or Installer Name: CSLB License: Michael Lee 888119 HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status in Sample Group (if applicable) N/A HERS Rater Information HERS Rater Company Name: Energineers Responsible Rater Name: Lorraine "Mickey" Souza Responsible Rater Signature: L&rr "M6C,c " SL 'W,7yiW Responsible Rater Certification Number w/ this HERS Provider: Date Signed: RCN13111 2017-04-25 Digitally signed by CHEERS". 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: 2017-04-25 17:43:39 HERS Provider: CHEERS 417-A020091096A-002-000-M20000A-M20A CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-04-25 17:43:40 2016 Residential Compliance Schema Version: rev 03/16 CERTIFICATE OF VERIFICATION CF3R-MCH-22-H Space Conditioning System Fan Efficacy (Page 1 of 3) Project Name: Magdy Bishara Enforcement Agency: (City Cupertino of) Permit Number: B20170531 Dwelling Address: 7562 Newcastle 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 2 05 Condenser Speed Type This field or section is not applicable 06 Cooling System Zonal Control Type This field or section is not applicable 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 2017-04-20 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. Analog Utility Revenue Meter (spinning wheel type) MCH -22a Forced Air System Fan Efficacy Measurement - Newly Installed Non -Zoned Systems or Zoned Multi -Speed Compressor I 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 512 02 Actual Tested Airflow from MCH -23 (cfm) 1088 03 Required Fan Efficacy (watts/cfm) 0.58 04 Actual Fan Efficacy (watts/cfm) 0.47 05 Compliance Statement: System fan efficacy complies Registration Number: Registration Date/Time: 2017-04-25 17:45:15 HERS Provider: CHEERS 417-A020091096A-002-000-M 22000A- M 22A CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-04-25 17:45:17 2016 Residential Compliance Schema Version: rev 2013-09-11 CERTIFICATE OF VERIFICATION CF3R-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 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 handier fan speed. 06 Zoned cooling air distribution systems with single speed compressors shall meet both the airflow (cfm/tan) 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 for this Certificate of Verification as a whole to be determined to be in compliance. g 01 ! Complies: All specified verification protocol requirements on this document are met. 1 Registration Number: Registration Date/Time: 2017-04-25 17:45:15 HERS Provider: CHEERS 417-A020091096A-002-000-M22000A-M22A CA Building Energy Efficiency Standards Report Version: 2016,1.005 Report Generated: 2017-04-25 17:45:17 2016 Residential Compliance Schema Version: rev 2013-09-11 CERTIFICATE OF VERIFICATIONCf3R-MCH-22-H' Space Conditioning System Fan Efficacy aF- ,(Page 3 of 3). Documentation Author's Declaration Statement 1. I certify that this Certificate of Verification documentation is accurate and complete:: Documentation Author Name: Documentation Author Signatures' Lorraine MiCkey SouzaF -S Company: Date Signed: Energi neers 2017-04-25 . Address: - — - _ - - - CEA/ HERS Certification Identification (if=applicable):24015 Wilcox Lane ; " RCN13111 - .. City/State/Zip: .,Phone: Hayward CA 94541 510-29-9631 Responsible Person's Declaration statement I certify the following under penalty of perjury,.-undernthe laws of the.State of.California: 1. The information provided onthisCertificate of Verification,is true and correct. , 2.. -. 1 -am the certifiedl HERS Rater who performed the verification identified and reported on,this Certificate of Verification (responsible rater).y 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 ofihe Certifiake(s) of installation (CF2R}`signed and submitted by the person(sj responsible for the construction or installation conforms to th.e requirements specified•on the,Urtificate(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 o -f- -- . 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):"'- _ Sandium, Inc. Responsible Builder or Installer Name: CSEE License: Michael Lee 888119 HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status in Sample Group (if applicable) N/A HERS Rater Information HERS Rater Company Name: Energineers Responsible Rater Name: Responsible Rater Signature: Lorraine "Mickey" Souza L(W;'OEfYIPi "Mick, So'u z4v Responsible Rater Certification Number w/ this HERS Provider: Date Signed: RCN13111 2017-04-25 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; `.Registration Date/Time: 2017-04-25 17:45:15 HERS Provider. CHEERS 417-A020091096A-002-000-M22000A-M22A CA Building Energy,Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-0425. 17:45:17 2016 Residential Compliance Schema Version: rev 2013-09-11 CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 1 of 4) Project Name: Magdy Bishara Enforcement Agency: Cupertino (City of) Permit Number: B20170531 Dwelling Address: 7562 Newcastle 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 2 05 Condenser Speed Type This field or section is not applicable 05 Cooling System Zonal Control Type This field or section is not applicable 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 2017-04-20 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 Fan Flowmeter according to procedure in RA3.3.3.1.1 01 verification. 02 Manufacturer of Airflow Measurement Apparatus Energy Conservatory 03 Model number of Airflow Measurement Apparatus DG700 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.htmi Registration Number; Registration Date/Time, 2017-04-25 17:44:29 HERS Provider: CHEERS 417-A020091096A-002-000-M23000A-M23A CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-04-25 17:44:30 2016 Residential Compliance Schema Version: rev 10/16 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) d_r 350 02 Required Minimum System Airflow Target(cfm) 700 03 Actual System Airflow Rate Measurement (cfm) _ - 1088 04., . Compliance Statement:. _ , ­ , _ - 1_-___ _._ -System airflow rate complie's' a E. Additional Requirements . Air filters that meet the applicable requirements ofi.Standards Section 150.0(m)12 or 150A(m)13-were properly installed in. 01 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 man ufacturer's,specifications, and conforms to the _ - instrumentation specifications given in RA3.3,1.: A visual inspection shall confirm:ahat bypass ducts that -deliver conditioned 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 indicates an allowance,far use _of a -bypass duct. When a: bupass_duct is:accounted for on.the Performance Certificate of Compliance, the airflow rate shall conform tothe 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. 6_ If fresh air duct is part of the HVAC system it was not closed during the diagnostic- test_ t _ 07 Airflow rate and fan watt draw shall be simultaneous measurements when usedato 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' ` 1 09 -Verification Status: -Pass,- all applicable requirements are met 10 Correction -Notes: The responsible person's signature -ort this -compliance document affirms that all applicable- requirements in -this table have. - been met unless otherwise noted in the- Weification'Status and the Cbl rectiohs Notes in this table Registration Number: Reg-istration Date/Time: 2017 04-25 17:44:29 HERS Provider: CHEERS 417-A020091096A-002-000-M23000A-M23A - CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report -Generated: 2017-04-25 17:44:30 2016 Residential Compliance - Schema Version: rev 10/16 CERTIFICATE OF VERIFICATION CF3R-MCH-23-H 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. 1 01 ! Complies: All specified verification protocol requirements on this document are met. I Registration Number: Registration Date/Time: 2017-04-25 17:44:29 HERS Provider: CHEERS 417-A020091096A-002-000-M23000A-M23A CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-04-25 17:44:30 2016 Residential Compliance Schema Version: rev 10/16 CERTIFICATE•OF VERIFICATION F3R-Mtl4-23-H` Space Conditioning System Airflow Rate (Page'4 of # Documentation Author's. Declaration Statement 1.1 certify that this_Certificete of Verification documentation is accurate and complete. ` Documentation Author Name: -' 'Documentation Author Signature: s S ' Souza Company: Date Signed: Energineers 2017-04-25 Address: CEA/ HERS Certification Identification (if applicable): 24015 Wilcox Lane RCN13111 City/State/Zip: Phone: Hayward CA 94541 510-29-9631 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. I 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): Sandium, Inc. Responsible Builder or Installer Name: CSLB License: Michael Lee 888119 HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status in Sample Group (if applicable) N/A HERS Rater Information HERS Rater Company Name: Energineers Responsible Rater Name: Responsible Rater Signature: Lorraine "Mickey" Souza L Wr'>CXfYLer "M(,Ckey" Saar v Responsible Rater Certification Number w/ this HERS Provider: Date Signed: RCN13111 2017-04-25 Digitally signed by CHEERS'"'. 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`D'ate/Time:2017-04-25 17:44:29 HEI15Provider. CHEERS 417-A020091096A-002-000-M23000A-M23A CA -Building Energy -Efficiency Standards' 'Report Version: 2016.1.005 RepottGenerated: 2017-04-25 `17:44i3b 2016 Residential Compliance Schema Version: rev -10/16 -