B-2017-1146CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: i PERMIT NO: B-2017-1146
20195 JOHN DR CUPERTINO, CA 95014-4414 (369 33 042) �BAYHILL HEAT & AIR
OWNER'S NAME: THOM JAMES C TR AND JUNE F TRUSTEE
OWNER'S PHONE: 408-262-7161
LICENSED CONTRACTOR'S DECLARATION
License Class CM- Lie. #21Z225
Contractor BAYHILL HEAT & AIR Date 06/30/2018
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.
I hereby affirm under penalty of perjury one of the following two declarations:
r. I have and will maintain a certificate of consent to self -insure for Worker's
SAN MATEO, CA
94402-1835
DATE ISSUED: 07/17/2017
PHONE NO: (650) 212-7600
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE FURNACE (SAME LOCATION -MECHANICAL CLOSET);
INSTALL NEW ACIUNIT
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
�t2. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. Sq. Ft Floor Area: Valuation: $13000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned property for
inspection purposes. (VVe) agree to save indemnify and keep harmless the
City of Cupertino against liabilities, judgments, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cj0pertinQp,Dkanicipal Code, Section 9.18.
Signature Date 7/17/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three declarations:
t. 1 have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation htsurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
3. 1 certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, 1 must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 and state laws
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature — Date 7/17/2017
APN Number: Occupancy Type:
369 33 042
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Jasmine Archbold
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 7/17/2017
"A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 05, 25533, and 25534.
Owner or authorized agent:
Date: 7/17/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
13 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO 1 (408) 777-3228 • FAX (408) 777-3333 • buildin cu ertino.or
�
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OWNER NAME TAkc,�
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STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMEB A , ;gj CL_
LICENSE NUMBER ,9/LICEN
BUS. LIC #
COMPANY NAME Gl ^
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COMPANY NAME
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STREET ADDRESS /
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CITY, STATE, ZIP
PHONF_------------._
DESCRIPTION OF WORK /,�J �! /1�X�'
EXISTING USE
PROPOSED USE CONSTR.
TYPE
I # STORIES
USE
TYPE OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
I
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
H ATTACH
# DWELLING UNITS:
IS A SECOND UNIT OYES
SECOND STORY YES
BEING ADDED? ONO
ADDITION? ONO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
EIVED BY: T T VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
4b.�alC
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the propertyowner 1 Lave read this
application and the information I have provided is,941rect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building c uthorize representatives of Cupertino to enter the above-identi rope for inspection purposes.
61�?IlHlr�-
Signature of Applicant/Agent Date:
SUPPLEMENTAWORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-TH&COUNTER
❑ BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
1-1 MAJOR
El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
T604-1.1 If--,
PWT PLAN CHEC ED B3
DATE I =J
PLANNING DEPT
CUPERTINO
CERTIFICATE OF COMPLIANCE
CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3)
Project Name:
JOHN I Date Prepared:
2017-07-17
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
JOHN
02
Date Prepared
2017-07-17
03
Project Location
20195 John Drive
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
JOHN
SC System
SC System
CFA served
system a
Dwelling Unit Conditioned
Installing new SC
07
Zip Code
95014
08
Floor Area (ft2)
1780
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
Installing a
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Entirely new or
complete
System 1
Location 1
1780
Yes
Yes
Yes
Yes
Yes
Yes
replacement space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)iDiib)
This section does not apply to this project.
Registration Number: 217-A020242521A-000-000-0000000-0000 Registration Date/Time: 2017-07-17 13:46:57 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-07-17 13:45:51
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3)
D. Altered Space Conditioning System (Sections 150.2(b)lE and F)
This section does not apply to this project.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia and 150.2(b)lE, F)
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
O1
02
03
04
05
06
07
08
09
10
11
Heating
Cooling
System
Heating
Minimum
Cooling
Minimum
Required
identification or
Heating System
Altered Heating
Efficiency
Efficiency
Cooling
Altered Cooling
Efficiency
Efficiency
Thermostat
New Duct
Name
Type
Component
Type
Value
System Type
Component
Type
Value
Type
R -Value
Annual Fuel
Central gas
All new heating
Utilization
Central split
All new cooling
SetbackTher
System 1
furnace
components
Efficiency
81
AC
components
SEER
14
mostat
R-6
(AFUE)
leauired Documentation:
-F2R-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, 12 and 13) and R8 (CZ 11 and 14-16)
:F2R and CF3R-MCH-20-H Duct Leakage Test required
Leakage rate compliance: <= 5%.
:F2R and CF3R-MCH-22 Fan Efficacy
:F2R and CF3R-MCN-23 Airflow Rate Verification
Compliance: Fan Efficacy <= 0.58 W per cfm and System Airflow >= 350 cfm per ton.
Alternative Compliance: CF2R and CF3R-MCH-28 Return Duct Design verification is an alternative to MCH -22 and MCH -23 verification.
:F2R and MR -MCH -25-1-1 Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
xceotions;
-leating-only systems are exempt from the 0.58 W per cfm and 350 cfm per ton requirements.
Vote: An "entirely new or replacement duct system" means at least 75% of the duct system is new duct material, and up to 25% may consist of reused parts from the dwelling unit's existing duct system (e.g., registers,
;rifles, boots, air handler, coil, plenums, duct material) if the reused parts are accessible and can be sealed to prevent leakage
Registration Number: 217-A020242521A-000-000-0000000-0000
Registration Date/Time: 2017-07-17 13:46:57
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-07-17 13:45:51
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
CF1R-ALT-02-E
(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: //�//��JJ
raak
Jalderrama, Ricardo
11�
-ompany:
Signature Date:
3AYHILL HEAT & AIR
2017-07-17 13:46:57
address:
CEA/ HERS Certification Identification (if applicable):
1033 S CLAREMONT STREET
=ity/State/Zip:
Phone:
RAN MATEO CA 94402
650-212-7600
Responsible Person's Declaration statement
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 with this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
✓alderrama, Ricardo
:ompany :
Date Signed:
3AYHILL HEAT & AIR
2017-07-17 13:46:57
4ddress:
License:
1033 S CLAREMONT STREET
917996
=ity/State/Zip:
Phone:
3AN MATEO CA 94402
650-212-7600
Easy to Verify
at CaICERTS.com
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility fcrthe
accuracy of the infori
Registration Number: 217-A020242521A-000-000-0000000-0000
Registration Date/Time: 2017-07-17 13:46:57
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-07-17 13:45:51
Schema Version: rev 10/16
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 • building(a)cupertino.org
"PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED, S vj ED AND RETURNED TO THE BUILDING DIVISION
PURPOSE
I
7 -4? -
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314, 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. Wheat the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000 00, CRC Section R314 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 ALARM
Outside of each separate sleeping area in the immediate vicinity of
the bedroom(s)
X
X
On every level of a dwelling unit including basements
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:, ®1 �i h �(8t7' i �'t Permit No.
Specify Number of Alarms: # Smoke Alarms. r7_1 1 # Carbon Monoxide Detectors. I / 71
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
CT �� � ��
y
Signature Date: 00/1 6
/
Contractor Name:
Signature Lic.# Date:
Smoke and CO form. doc revised 12/15/16
CERTIFICATE OF VERIFICATION
� ; CF3R-MCH-23-H
r<
Space Conditioning System Airflow Rate
(Page 1 of 4)
Project Name: JOHN
Enforcement Agency:
Cupertino
City of
Permit Number: B-2017-1146
Dwelling Address: 20195 John give
City:
Cupertino
Zip Code: 95014
A. Ducted Cooling System Information
01
System Identification or Name
System 1
02
System Location or Area Served
whole house
03
System Installation Type
Replacement
04
Nominal Cooling Capacity (tons) of Condenser
3.5
05
Condenser Speed Type ° .
Single Speed
06
Cooling System Zonal Control Type
Not Zonal
07
Central`Fan.Integrated (CFI) Ventilation System Status
Not a CFI system
08
System Bypass Duct Status
No Bypass.Duct�
09
Date of System Airflow Rate Measurement
2017-07-20
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 theI 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,
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
Alnor
03
Model number of Airflow Measurement Apparatus
614-513-044
Certification Status of the Airflow Measurement Apparatus
Certified by Manufacturer and listed on CEC Website at
04
Accuracy
http-//www.energy.ca.gov/title24/equipment_cert/ama_Fas
/index.html
Registration Number: Registration Date/Time: 2017-07-21 09:33:40 HERS Provider: CaICERTS
217-A020242521A-000-001-M 23001A -M 23A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-07-21 09:32:31
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION
CF3R-MCN-23-H I
I Space Conditioning System Airflow Rate (Page 2 of 4) I
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
RequiredMinimum System Airflow Target (cfm)
1225
03
Actual System Airflow Rate Measurement (cfm)
1230
04
Compliance Statement:
System airflow rate complies
E. Additional Requirements
01
Air filters that meet the applicable requirements of.Standards Section 150.0(m)12 or 150.0(m)13 were properly installed in
the system during system air flowrate 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 inaceordance with the apparatus manufacturer's specifications and eonforms,to the
instrumentation specifications given in RA13.1. "
A visual inspection shall confirm that 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 for use of a bypass duct. When a bypass duct is accounted for on the Performance
Certificate of Compliance, the airflow rate shall conform to the specifications listed on the Certificate of Compliance.
04
All registers were fully open during the diagnostic test.
05
System fan was set at maximum speed during the diagnostic test.
06
If fresh air duct is part of the HVAC system it was not closed during the diagnostic test.
07
Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value.
Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/ton) and fan
OR
efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air
handler fan speed.
09
Verification Status:
Pass - all applicable requirements are met
10
Correction Notes:
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Corrections Notes in this table
Registration Number: Registration Date/Time: 2017-07-21 09:33:40 HERS Provider: CaICERTS
217-A020242521A-000-001-M 23001A -M 23A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-07-21 09:32:31
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.
101 1 Complies: All specified verification protocol requirements on this document are met.
Registration Number: Registration Date/Time: 2017-07-21 09:33:40 HERS Provider: CalCERTS
217-A020242521A-000-001-M 23001A -M 23A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-07-21 09:32:31
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION
MR -MCH -23-H
Space Conditioning System Airflow Rate (Page 4 of 4) 1
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Minxuan Liu
Documentation Author Signature:
Company:
Date Signed:
Bay Area Energy Consultants
2017-07-2109:33:40
Address:
CEA/ HERS Certification identification (if applicable):
1181 Sundown Ln
CC2006550
City/State/Zip:
Phone:
San lose CA 95127
408-883-3865
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the 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 forthe building approved by the enforcement agency.
4. The information reported on applicable sections ofthe Certificate(s) of installation (CF2R)slgned and submitted by the persons) responsible for the
construction or installation conforms to the requirements'specified ori the Certificate(s)l of Compliance (CF1R) approved by the enforcementagency.
S. 1 will ensure that a registered copy -of this Certificate of Verification shall be posted, or made,ivailab16 with the building permits),Issued for the
building, and made available to the enforcement aenty for all applicable inspections,. i,Understand'that a reRistered;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):
BAYHILL HEAT & AIR
Responsible Builder or installer Name:
CSLB License:
Ricardo Valderrama
917996
HERS Provider Data Registry Information
Sample Group Number (if applicable):
DweilingTest Status in Sample Group (if applicable)
Tested
HERS Rater Information
HERS Rater Company Name:
Bay Area Energy Consultants,
Responsible Rater Name:
Minxuan Liu«ter'
Responsible Rater Signature:
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2006550
2017-07-21 09:33:40
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Registration Number:
217-A020242521A-000-001-M 23001A -M 23A
CA Building Energy Efficiency Standards
2016 Residential Compliance
Registration Date/Time: 2017-07-21 09:33:40 HERS Provider. CaICERTS
Report Version: 2016.1.006 Report Generated: 2017-07-21 09:32:31
Schema Version: rev 10/16