B-2016-2687 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2687
18485 CHELMSFORD DR CUPERTINO,CA 95014-6406(375 22 048) RANDO AAA HVAC
INC
SAN JOSE,CA 95125
OWNER'S NAME: YASUKAWA DANIEL G AND LINDA L DATE ISSUED:09/09/2016
OWNER'S PHONE:408-242-0554 PHONE NO,(408)293-4717
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-M Lic.#7 71
Contractor BANDO AAA HVAC INC Date 09/30/2017 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 Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: REPLACE FURNACE(SAME LOCATION)
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.
z. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. I Sq.Ft Floor Area: Valuation:$6309.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
information is correct.l agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 375 22 048
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. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additio4regul
p icant underst ds and will comply with all non-point
sources er th Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
SignatDate 09/09/2016 Issued by:Kim Dunbar
Date:09/09/2016
OWNER-BLTTf DER 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 of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:09/09/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE GLASS"A"OR BETTER
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. 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
3. 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,atter making this certificate of will maintain compliance with the Cup tino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions.of the the Health&SafettCodel S tions 25505,2553
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. 'Owner or authorized agen
APPLICANT CERTIFICATION Date:09/09/2016
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. I understand my plans shall be used as public records.
SiSignature Date 09/09/2016 Licensed
g Professional
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMiENT DEPARTMENT•BUILDING DIVISION M E
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildin (a)cuoertino.orMISC
❑PLUMBING CnA'NIC-AL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS �� APN
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STREETADDRESS CITY,STATE,ZIP FAX
❑ OATER ❑ OR7,-E2.BUTIIAER ❑ O-A ER AGEn T �q CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGN`EtR ❑ DE\ELOPER ❑ TENANT
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ARCHITECT'EN"GLNEER NAME I LICENSE NL.BER BL'S.LIC= J
COMPANY NAII4E E-hWL
STREET.ADDRESS CITY,STATE,ZIP I PHONE
USE OF -0SFT;.,DUPLEX ❑ mmi.Tl-FAMILY' PROTECT LIN R'ILDLANT ❑ YES PROJECT A ❑YES IS THE BLDG AN ❑YBs
BUIMIN'G: ❑COME,.ERCLAL "UP.BAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLERHOME? ❑ N'0
DESCRIPTION,OF WORT t, ( -t
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TOTAL VALUATIO_ RECF D 1
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By my si=nature belot;,I cerify to each of the followi_ng: I am the preueriy 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 lWork and verify it is accurate. I agree to comply with all applicable local
ordinances and sate laws relating to building onstr-uction. I authorize r epresentatives of Cupertino to enter the above-identi f d .0 'rty for inspection purposes.
Signature of Applicant'Agent: Date: � I(
IPPLE.\lE\'TAL -' ORMATION REQUIRED OFFICE LSE`oI.L�;
P-0 TRTI�7fpP UX-ff
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--A EPA%iscZpp_2011.doc revised 06/21/11
CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC), (Page 1 of 3)
Project Name: DAN YASUKAWA Date Prepared: 2016-08-29
A.General Information
CFIR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented,
use one MR-ALT-02 document for each dwelling unit.
01 Project Name DAN YASUKAWA 02 Date Prepared 2016-08-29
03 Project Location 18485 CHELMSFORD DRIVE 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name DAN YASUKAWA
07 Zip Code 95014 08 Dwelling Unit Conditioned 2741
Floor Area(ft2)
Number of space conditioning
09 Climate Zone 4 10 (SC)systems in this dwelling 1
unit.
s
I
D.Space;Conditioning(SC)System Information
. ro
01 02 03 04 07` 08 # 09 10
OSl 06
c
IS the SC IiStalling a j
SC System SC System CFA served , ystem a refrigerant Installing nev°f ry Tsta,ing ,installing ;> Installing
,. �.
Identification or Location or Area by this SC ducted containing system f more than 40` entirely new entirely new
Name Served System(ft2) system? component? components? feet of ducts? duct system?' SC system? Alteration Type
BRYANT WHOLE HOUSE 2741 Yes No Yes No No No Altered space
conditioning system
C.Extension of Existing Duct System,Greater Than 40 Feet(Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number:216-A0322286A-000000000-0000 Registration Date/Time: 2016-08-29 15:52:34 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2016-08-29 15:52:45
Schema Version:0.555SDD
CERTIFICATE OF COMPLIANCE CFIR-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)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
Central gas Gas furnace No cooling This field or This field or This field or This field or
BRYANT furnace AHU AFUE 78 No cooling component section is not section is not Setback section is not section is not
altered applicable applicable applicable applicable
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums:R6.
CF2R-MCH-20-H&CF3R-MCH-20-H-Duct Leakage testing 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::5 15%,or!-10%leakage to outside,or seal all accessible leaks.
CF2R-MCH-25-H&CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
CF2RCF3R-MCH-23&CF3R-MCH-23 Air Flows 300 CFM/ton required when MCH-25 is required.
Exceotions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH-20 Duct Leakage Testing mgnts v.
-Heating-only systems and Air Handler/Furnace changes do not require verification'of Air Flow MCH 23 vvr`'Refrigaant'Chadge NTrH-25
-.
Existing duct systems constructed,insulated or sealed with asbestos,,are exemp from MCK' 0D0ut,Leakage TestYn requmbmer�rs.
<<✓ rt
e
l.$
E.Entirely New or Complete Replacement Duct S stem,with or without Equipment Changeout(Sectlans 150 2(b)1Duazand 150 2(b)1E, F)
v
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:216-A0322286A-000000000-0000 Registration Date/Time: 2016-08-2915:52:34 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2016-08-29 15:52:45
Schema Version:0.555SDD
�v
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-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:
Rando,Eric
Company: Signature Date:
RAN DO AAA HVAC INC .2016-08-29 15:52:34
Address: CEA/HERS Certification Identification(ifapplicable):
1712 STONE AVENUE N/A
City/State/Zip: Phone:
SAN JOSE CA 95125 408-293-4717
Responsible Person's Declaration statement
I certifythe 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. I 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 Regutio
lans. w
4. The building design features or system design features identified onthis Certificaf`of Compliance are cansisteht with the information provided on'th`erappllcai le'compliance documents,worksheets,
calculations,plans and specifications submitted to the`enforcement agencyfor'0br6vnl w0 this building permit application.
5. I will ensure that a registered copy of this.Certificate of Compliance shall be madgavail ble with;the budc(kng permits)issuell forithe bwldmg,and made available to khe enforcement agency for all applicable
inspections,I understand that a registered copy of this Certificate of Compliancei required to be included with theocumentatio�ri,the builder provjdes to the binding owner atoccupancy.
Y.
A7. Res onsikile Desi ner Snture: '..'
Responsible Designer Name: "� V. it"t", fl`, 1 p g�' i g'a
Rando, Eric
Company: Date Signed:
RANDO AAA HVAC INC 2016-08-29 15:52:34
Address: License:
1712 STONE AVENUE 768871
City/State/Zip: Phone:
SAN JOSE CA 95125 408-293-4717
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:216-A0322286A-000000000-0000 Registration Date/Time: 2016-08-29 15:52:34 HERS Provider:-CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance. Report Version:2013 Rev 1.008 Report Generated:2016-08-29 15:52AS
Schema Version:0.555SDD
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTit40 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buiIding(a_)cupertino.org
— - Permit No.
Address 1 t r ►S �V #of Alarms Smoke:{ "Carbon Monoxide:\.
_ PERMIT CANNOT S ,FINALED AND�COMPLETED JNTII THIS LRTIFICATE , ,
H S SREN AND iF IJ Ty3�L},7 G�1I150�
y
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 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
$1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwelling units with no commercial power supply, atarm(s)may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes.The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to cCA/y c /ywith the terms and conditions of this statement
Owner(or Owner A ent's)Name:%
Sinature,... ...... .:t.�.. ..............Date: I.. .
ontra for me:
JimLam : v � ..�............Date: .�. .Y�.
Signature.... ......... ..... . ...... Lia#...... ..
Smoke and COfonn.doe revised 03/18114
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
u(40$)7 7-3228•FAX(408)777-3333•buildingC�cupertino.or.0
Owner Name,' 1O Vt I!e_� �,t r,u,�a►P,� Permit No. fI�
Address
1, Is your real property a registered historical site?
El .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.
❑ Th&licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form:
ro Go to Question 3.
t
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 fonn and sign bottom of form.
No Go to Question 4.
4.;`IIs 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.
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).
1,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 Ater-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8,the current California Plu. g Code and California Green Building Standards Code,and manufacturer's
installation requirements,and that the wat -c nserving plumbing fixtures comply with the requirements as indicated in the
_ table_on the following page. P ---—`--
Owner or Owner Agent's Signature:, i..—�t ✓ Date:
"Upon completing and signing this Ce c ,please return it to e Building Division in order to final your building permit.
SB40 7 2015.doc revised 08126115
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to.Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 3)
Project Name: DAN YASUKAWA Date Prepared: 2016-08-29
A.General Information
CF111-ALT 02 is applicable to multiple space conditioning systems contained within:a single dwelling unit.When multiple dwelling units must be documented,
use one CFIR-ALT-02 document for each dwelling unit.
01 Project Name DAN YASUKAWA 02 Date Prepared 2016-08-29
03 Project Location 18485 CHELMSFORD DRIVE 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name DAN YASUKAWA
07 Zip Code 95014 08 Dwelling Unit Conditioned 2741
Floor Area(ft2)
Number of space conditioning
09 Climate Zone 4 10 (SC)systems in this dwelling 1
unit.
r
B.Space Conditioning(SC)System Information
FF
01 _ 02 03 '': 04 r r..0�s ' >9,.. 06 07 03 10
"
�r
l '7 ,crr.. s f
the SCS lr staling a '
SC System SC System CFA served system at refngerat Installing new,SC lnstallmg lnstalhngY Installing
Identification or Location or Area by this SC ducted., containing system more than 4d entirely new entirely new
Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type
BRYANT WHOLE HOUSE 2741 Yes No Yes No No No Altered space
conditioning system
C. Extension of Existing Duct System,Greater Than 40 Feet(Section 1S0.2(b)1Diib)
This section does not apply to this project.
Registration Number:216-A0322286A-000000000-0000 Registration Date/Time: 2016-08-29 15:52:34 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2016-08-29 15:52:45
Schema Version:0.555SDD
k
CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 2 of 3)
D.Altered Space Conditioning System(Sections 150.2(b)1E and F)
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
Central gas Gas furnace No cooling This field or This field or This field or This field or
BRYANT furnace AHU AFUE 78 No cooling component section is not section is not Setback section is not section is not
altered applicable applicable applicable applicable
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
Duct insulation requirement for new plenums:R6.
CF211-MCH-20-H&CF3R-MCH-20-H—Duct Leakage testing 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-MCH-25-H&CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
CF2RCF3R-MCH-23&CF3R-MCH-23 Air Flow?300 CFM/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 verificattbnrof k Flow MCH 23//' f"Refrigerant Charge MACH-25h
Existing duct systems constructed,insulated or sealed with asbesto;pare exempt`from MCH=20 Duct L kage Testing require[ne�ts. s � � � k ll
G
E. EntirelyNew or Complete Replacement Duct S stem with or without E ui merit Chan eout 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:216-A0322286A-000000000-0000 Registration Date/Time: 2016-08-29 15:52:34 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2016.08-29 15:52:45
Schema Version:'0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-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:
G
Rando,Eric
Company: Signature Date:
RANDO AAA HVAC INC 2016-08-29 15:52:34
Address: CEA/HERS Certification Identification(if applicable):
1712 STONE AVENUE N/A
City/State/Zip: Phone:
SAN JOSE CA 95125 408-293-4717
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
re uirements of Title 24,Part 1 and Part of the California Code of♦Zegu7at ons
q
4. The building design features or system design features identified on this Certificat2 of Cw6mp,(iance areconsjstei t�y�tfi the information provided on? I'll app)I —I compliance documents,worksheets,
calculations,plans and specifications submitted to the enforcement agency for djiprovai wifih this building permat application.
y=
5. Iwilf ensure that a registered copy of this Certificate of Cpmpliance s1 11Fbe matte„av„ail,e with,he bytJdmg,permit(s)issued for;fihe builc�xng and made available te?the hforcement agency for all applicable
inspections.('understand that a registered copy of this Cet ,fjcate ofCamphance,is reqt,,F�d to beincluded, the documentation the builder proyides to tl�e building owner at occupancy.
w
n Responsible Desigrfer Signature.
Responsible Designer Name: °' �✓t / .:
Rando,Eric
Company: Date Signed:
RANDO AAA HVAC INC 2016-08-29 15:52:34
Address: License:
1712 STONE AVENUE 768871
City/State/Zip: Phone:
SAN JOSE CA 95125 408-293-4717
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:216-A0322286A-000000000-0000 Registration Date/Time: 2016-08-29 15:52:34 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2016-08-29 15:52:45
Schema Version:0.555SDD
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 1 of 3
Project Name: DAN YASUKAWA Enforcement Agency: City of Permit Number: 2016-2687
Cupertino
Dwelling Address: 18485 CHELMSFORD DRIVE City: Cupertino Zip Code: 95014
A.System Information
01 Space Conditioning System Identification or Name BRYANT
02 Space Conditioning System Location or Area Served WHOLE HOUSE
03 Building Type from CF-111 Single family
04 Verified Low Leakage Ducts in Conditioned Space No,credit is not taken
(VLLDCS)Credit from CF1R?
05 Verified Low Leakage Air Handling Unit Credit from No,credit is not taken
CF1R?
06 Duct System Compliance Category Alteration
:-a
MCH-20d-Complete Replacement or Altered Duct System.
f$ µ A
k -
B. Duct Leakage Diagnostic Test
01 Condenser Nominal Cooling Capacity(ton) 0
02 Heating Capacity(kBtu/h) 58
03 Conditioned Floor Area served by this HVAC system (ft2) 2741
04 Duct Leakage Test Condition Test final
05 Duct Leakage Test Method Total leakage
06 Leakage Factor 0.15
07 Air Handling Unit Airflow(AHUAirflow) Determination Heating system method
Method
08 Measured AHUAirflow This field or section is not applicable.
09 Calculated Target Allowable Duct Leakage Rate(cfm) 189
10 Actual duct leakage rate from leakage test measurement 39
(cfm)
11 Compliance Statement: System passes leakage test
Registration Number:216-A0322286A-M2000002A-M20A Registration Date/Time: 2016-09-28 20:45:44 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2016-09-28 20:45:24
2013 Residential Compliance Schema Version:2013.1.007
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 2 of 3
B. Duct Leakage Diagnostic Test
12 Notes:
C.Additional Requirements for Compliance
01 System was 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 Central Fan Ventilation
Cooling Systems,that utilize dampers that open only when OA is required and automatically close when OA is not required,
may configure the OA damper to the closed position during duct leakage testing.
03 if a complete replacement,all supply and return register boots were sealed to the drywall.
04 Building cavities were not used as plenums or platform returns in lieu of ducts.
05 If cloth backed tape was used it was covered with Mastic and draw bands.
06 All connection points between the air handler and the supply and return plenums are completely sealed.
If the system complies using the Smoke Test methci�l,fihe smoke test waslconO cted rn ateordance with the requyirerrients
07 of Reference Residential App dix RA3 1.4.3 6 Systems that comply usmgsmpke test shall not be mclud d m sample
groups for HERS verification.co�mpliance �._ ���� ._� - -
08 Verification Status � � � - Pass-all applicab 6 requirements are met? ' -
09 Correction Notes for this table
The responsible persons signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Corrections Notes in this table.
D. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance.
01 Complies:All specified verification protocol requirements on this document are met.
Registration Number:216-A0322286A-M2000002A-M20A Registration Date/Time: 2016-09-28 20:45:44 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2016-09.28 20:45:24
2013 Residential Compliance Schema Version:2013.1.007
i
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 3 of 3)
Documentation Author's Declaration Statement
1, 1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
Ken Frazier Xen Taz er
Company: _ Date Signed:
Golden State Energy Efficiency Services 2016-09-28 20:45:44
Address: CEA/HERS Certification Identification(if applicable):
1463 Circus Ct.
City/State/Zip: - Phone:
Turlock CA 95380 209-667-2164
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Verification is true and correct.
2. I am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification(responsible rater).
3. The installed features,materials,components,manufactured devices,or system performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2,RA3,and the requirements
specified on the Certificate of Compliance for the building approved by the enforcement agency.
4. The information reported on applicable sections o=the Certificates)of In5ta11at1!)n(CF2R)lsr ned arttl stlbmift by the persbn(s)responsible for the
construction or installation conforms to the requirementsspeafted ap the Certtficate(s)of Compliance(CF1R)approved by fhe enforpment agency.
5. 1 will ensure that a registered copy of this Certificate of Verifjkat n shall be posted or rrla'de available with the building permit(s)issued for the
building,and made available to,fK enforcementagenO.forall apphcaple inspections I ttndeotand that axegisterecixopy gth s Cerjcate of a
Verification is required to be igplluj ed with the documentation the builder provides to the buiiiling owner at occupancy.
t �>
Builder Or Installer Information As
'Shown On The`Eertificate Of Installation
Company Name(Installing Subcontractor,General Contractor,or Builder/Owner):
RANDO AAA HVAC INC
Responsible Builder or Installer Name: CSLB License:
Eric Rando 768871
HERS Provider Data Registry Information
Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable)
Tested
HERS Rater Information
HERS Rater Company Name:
Golden State Energy Efficiency Services
Responsible Rater Name: Responsible Rater Signature:
Ken Frazier c�Cenazier
Responsible Rater Certification Number w/this HERS Provider: Date Signed:
CC2005910 2016-09-28 20:45:44
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:216-A0322286A-M2000002A-M20A Registration Date/Time: 2016-09-28 20:45:44 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2016-09-28 20:45:24
2013 Residential Compliance Schema Version:2013.1.007