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B-2016-1441CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-1441 11110 SANTA TERESA DR CUPERTINO, CA 95014-4767 (35617 028) NICOLAS CONSTRUCTION SAN JOSE, CA 9513 OWNER'S NAME: PRA13HAKAR KHAN AND KALAVATI DATE ISSUED: 12/15/2016 OWNER'S PHONE: 408-981-1881 PHONE NO: (408) 712-8564 LICENSED CONTRACTOR' D . R TION BUILDING PERMIT INFO: License Class B Lic. #964671 Contractor NICOLAS CONSTRUCTION Date 08/31/2017 X BLDG X ELEC r X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH X RES EN TIAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTI N: ' 1 STORY FRONT A DDITION (495 SF); INTERIOR REMODEL (663 SF); I hereby affirm under penalty of perjury one of the following two declarations: BATHROOM REMODEL (200 SF); NEW COVERED PORCH (90 SF); 1. I have and will maintain a certificate of consent to self -insure for Worker's (1) ELECTRICAL ERVICE (200 AMP); (N) TANKLESS WATER Compensation, as provided for by Section 3700 of the Labor Code, for the HEATER performance of the work for which this permit is issued. 2. -"F-f 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. CERTIFICATION Sq. Ft Floor Area: 49 Valuation: $332000.00 APPLICANT certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 356 17 028 Deferred Submittal (R -3),k-3 (Custom) 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 E3 PIRES 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 18 DAYS OF PERMIT' ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature ,1 j_r Date 12/15/2016 Issued by: AbbyA nd OWNER-BUIELDER DECLARATION Date: 12/15/2016 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 ins ected 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: 12/15/201.6 p I hereby affirm under penalty of perjury one of the following three declarations:ALL ROOF COVERINGS TO BE CLASS "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 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. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the a. I certify that in the performance of the work for which this permit is issued, I Health & Safety C de, Section 25532(x) should.1 store or handle hazardous. shall not employ any person in any manner so as to become subject to the material. Addition air contaminants as y, should I use equipment or; devices which emit hazardous efined 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 k Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall .% be deemed revoked. _- Owner or authorize d agent: Date: 12/15/2016 APPLICANT CERTIFICATION. CONAGENCY 1 certify that 1 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 I hereby affirm that tl iere 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 HI T'S DECLARATION Code, Section 9.18. 1 understand my plat s shall be used as public records. Licensed Signature Date 12/15/2016 Professional 19 CUPERTINO ❑ NEW CONSTRUCTION CO TRUCTION PERMIT APPLICATIO COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIV SION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 77777-3228 • FAX (408) 777-3333 • building a@cuperrtino.org ,LI ADDITION ❑ ALTERATION ! TI ❑ REVISION 1 DEFE D t ILIq( ORIGINAL PERMIT # PROJECT ADDRESS "110 bi A' tat `et.e Sti Or APN # 2 r :Jff OWNERNAMk j- f� i/' PHONE c yp$ r'�!a l8O! p j fes, EMAIL kiT�iAo�ra��cl KC✓ r dp e� STREET ADDRESSI rr 4�4 Af,1 Teee 5.1 DY CITY, STATE, ZIP �v i FAX CONTACT NAMEtG"'dL/dl t�0[/iYlot/1 PHONE [�d{�/rgYq� E-11AILytdIeCC4/ChC41' STREET ADDRESS�1t ".• I-►l�l . , ,5+ 4A7OSe IC -4 -Z ... FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR. ❑ CONTRACTOR AGENT X AR IETECT Q ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME � s /�� v '�« tN LICENSE NUMBER �- Iy � � f LICE ) SE TYPE BUS. LIC # qI �r06iFi� COMPANY NAME °�'�", C,0 l .0 STWIt D N E-MAIL FAX STREET ADDRESS . /' I�,. S �` ; ..�CA D F7 CITY, STATE. ZIP ��-� a Q t�°..t e _ � � 1� � ! PHONE K 1^5J/1 Ya ARCHITECT/ENGINEERNAME rI f� jf- LICLNSENUM[1HR P�f`.�G�F u 1 BUS. LIC# ,[ S IP J !� COMPANY NAME !TOM e 1 CGi&+Ju l 1 C"t�iJ1/ Q E-MAIL J ri OM t fees1 e � 4.C a /dl FAX STREET ADDRESS �t`� � �i>'"Sf" St CITY, STATE, ZIP ��,��5e� 1 2- •� _1 5712- PHONE 4,,011115_oqa(a -DESCRIPTION oPWORK – y — 5>,•y-// a11��c(1t an o Freit,'i 2 Fterca.•, f ,Tbq l- [n ldoM �a7t/e4✓- ►'E.Hodel ♦T �)CrS I`n k,144 /-,t5fe,r el.S f. ReA%.Pve_ vwAl t'n k. i#-Ae,, C40 KICA-eri Y[...odG�1. �coe r.ans GUSSE EXISTIIrN $ Fk PROPOSBD�UfSS CONSTR.TYPH S�g V #STOlIHS USE YPE OCC. SQ.FT. VALUATION($)NEW E' AREAO f J -i. LO ARBA R. �' AREA r NETAREA 2503 _ BATHROOM REMODELAREA Z KITCHENOTHER REMODELAREA �� REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA & - GARAGE AREA: DETACH C� 3 A"ATTACH #DWELLINGUNrrS: I ISASECONDUNIT ❑YES i BEING ADDED? OVO SECONDSTORY ❑YES ADDITION? ZT40 PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF PLANNINGAPPLO 'igi NO PLANNINGAPPROVALI.ETrER Abelow, IS THE BLDG AN ❑ YESAF EICHLRR HOME? p`AO IVED BY: L I TOTAL VALUATION; By my signature I certify to each of the following: I am the property owner or authorized agent to a6r6h ilia property ownor's behalf. I have read this application and the infomlation I have provided is correct. I have read the Description of Work and verify it is a curate. I agree to comply with all applicable local ordinances and state laws relatin o building construction, I authorize representatives of Cupertino to enter the z Bove -identified property for inspection purposes. Signature of Applicant/Agent: Dates 2- Z'(! SUPPLEMENTAL INFORMATION REQUIRED PLAN CHEC. C TYPE ROUTING SLIP ❑ oVFR-THJEc ea UNTER ❑ BVILDINGPLAN 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 ❑IizE n> Px _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ' 1.0 EN ol"iMENTALHEALT11 . BldgApp_2011.doc revised 06121111 i INSPECTIONS, Inc. CONSTRUCTION INSPECTION SPECIALISTS rl City of Cupertino Building Department 10300 Torre Avenue Cupertino, CA 95014 Subject: Final Project Affidavit Special Inspection Services 11110 Santa Teresa Drive Dear Sirs, April 13, 2017 HPI Project No.: COD -1023 Permit No: 2016-1441 This Project Affidavit is submitted in accordance with the requirements of CBC Section 1704 and certifies that HP Tnspections has provided special inspection and testing services for the following work at the above -referenced project: Continuous installation inspection of 5/8" diameter epocied all -thread anchors. Based on our observations, testing and to the best of our knowledge, the work observed was performed in accordance with the approved project plans, specifications and with the applicable workmanship provisions of the California Building Code. Sincerely, HP Inspections, Inc. Basil A. Amso, CE 49998 cc: Nicolas Construction 690 SUNOL STREET, BUILDING "H 0 SAN JOSE, CA 05126 * (408) 288-8460 * FAx: (408) 271-0902 INSPECTIONS, Inc. CardS, Ruc, rosy 1NSPECT10"V SPcc usis City of Cupertino Building Department 10300 'Torre Avenue Cupertino, CA 95014 Subject: Dear Sirs, Final Project Affidavit Special Inspection Services 11110 Santa Teresa Drive April 13, 2017 HPI Project No.: COD -1023 Permit No: 2016-1441 This Project Affidavit is submitted in accordance with the requirements of CBC Section 1704 and certifies that FIP Inspections has provided special inspection and testing services for the following work at the above -referenced project: Continuous installation inspection of 5/8" diameter epocied all -thread anchors. Based on our observations, testing and to the best of our knowledge, the work observed was perforined in accordance with the approved project plans, specifications and with the applicable workmanship provisions of the California Building Code. Sincerely, HP Inspections, Inc. Basil A. Amso, CE 49998 cc: Nicolas Construction .Ilk No.49998 ri %xp. 0"01 Cf1114 r 4 690 SUNOI STREET, BUILDING H 0 SAN JOSE, CA 95126 • (408) 288-8460 * Fax; (408) 271-0902 CONTRACTOR / SUBCONTRACTOR LIST Building Department" City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB -ADDRESS: i rA- TEiZC— CA Dn.,' PERMIT #-- OWNER'S NAME: PHONE # V9 Lt - GENERAL CONTRACTOR: i U �j,Q USINESS LICENSE .# 40 ADDRESS: 265 (,,AjLCO SaM G CITY/ZIPCODE: BSc`. .. �"' *Our municipal code requires all businesses working -in- the city to, have a City- of. Cupertino business license. NO BUILDING. FINAL OR,, FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I. am not us'ing.any subcontractors: Signature Date f Please check applicable subcontractors and complete. the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &-Millwork Cement Finishing Electrical Excavation' Fencing Flooring /,Carpeting Linoleum / Wood . Glass / Glazing Heating At0 Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing WJbRN ?C-0,0�H6c Roofing Septic Tank Sheet Metal Sheet Rock Tile / Contractor Signature 071 Al 0 i1 Dat . i I . a C11PRTINQ x(408) 777-3228 - FAX (408) 777-3333 • building0-cupertino.oro P 1 i,N �. `1Z P-10—" (-i`.� Permit No. Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 Address k k 110 SQ A T A" 'i E ARCS A 2>9 C K 1-15014, 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. 9 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 form and sign bottom of form. N No Go to Question 3. 3. Is water service permanently disconnected for your building? El Yes Civil C6&.SSections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. N 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. IN 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: DZ 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 110 1. 1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature: Dater ®7 -012-417 I Upon completing arid, signing this Certificate, please return it to the Building Division in order to final your building ,permit. SB4072015.doc revised 08126115 1. If the existing plumbing ixtur"e water usage ow`rate`is equa to or ower t :an the figure'shown; it is not required'to be upgraded. t_ t ; ' SB407 2015.doe revised 01/05/17 Non -Compliant Water-Conserving.Plumbing Fixture . Plumbing Fixturel. (Fixture Complying with Current Code Applicable,to New Construction) Maximum Water Usa a/Flow Rate Fixture Type Water Usage 2016 CPC Ch. 4 1 2016 CPC Ch. 4 2016 CPC Ch. 4 /Flow Rate 2016 CALGreen Div. 4.3 2016 CALGreen Div. 4.3 I_, 2016 CALGreen Div. 5.3. Single -Family . Multi_ -Family Commercial Residential Residential Water Closets Exceed 1.6 Single, flush. toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets; 1.28 gallons/flush effective flush volume (the composite, average flush.volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per -minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification forShowerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving, one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @'80 psi, or the shower shall -be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units:. 0.5 gallons per minute @ 60 Lavatory - per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets b.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60; si... Faucets.— Exceed 2.2 gallons 1,8 gallons per minute @ 1.8 gallons. per minute 1.8 gallons per minute @"60 Kitchen per minute 60 psi.; @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase, up to 2.2 minute, @, 60, psi, and must gall,ors per,minute @ default to maximum 60 psi andmust . 1.8 gallons per minute @ d4fbulta6'rnaximum 60 psi 1:8;'gallons°per minute Where faucets meeting @ 60 psi the above, are unavailable, Where'faucet5'meeting aerators or other means thb'e pboye are may be used to achieve unavailable aerators or reduction # other'meansmaybe' hie e`- 1. If the existing plumbing ixtur"e water usage ow`rate`is equa to or ower t :an the figure'shown; it is not required'to be upgraded. t_ t ; ' SB407 2015.doe revised 01/05/17 PURPOSE rr; SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE n,. COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building 0_)cupertino.org 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 bedroom(s)' X X On ever level of a dwelling unit including basements X X Wiflain'ea!d.isleepirig room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burn`utg 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, base nerit 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: G�'q &_01 Permit No.2y`b ( / Specify Number. of Alarms: # Smoke Alarms: r� #Carbon Monoxide Detectors: I have read and agree to comply with the terms and conditions of this statement 1 ! Owner (or Owner Agent's) Name: Signature i/`r-............................................................,:>:Date: D 7/:?D kl��A�NAKF�(L ......................... Name: Signature.... . : 'Lic.# D..�Date: O �Contractor ` ............................................ , Smoke and COform.doe revised 09127/16 i 2-nl 7 17 CERTIFICATE OF COMPLIANCE '� CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) ' (Page 1 of 3 ) Project Name: 11110 nta Teresa Dr to Prepared• 2017-07-16 A. General Information WCFIR=ALT=02 is appiie6ble 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 11110 Santa Teresa Dr 02 Date Prepared 2017-07-16 03 Project Location 11110 Santa Teresa Dr 04 Building Type Single family OS CA City Cupertino 06 Dwelling Unit Name 11110 Santa Teresa Dr 07 Zip Code 95014 08 Dwelling Unit Conditioned 2260 !� d •� Floor Area (ft2) SC System SC System `CFA served system a t refrigerant Number of space conditioning { Installing 09 Climate Zone 4 xj g4 10 (SC) systems.in this dwelling 1 ducted . c tainin g ,: �o more than 4o unit. entirely new • ' S. Space Conditioning (SC) System Information O1 02 t ,•03 04`{a3 08 i . 09 10 Is the SC Installing a !� SC System SC System `CFA served system a t refrigerant InstalUrig new 5C { Installing Installing $� 01ristallin g Identification or Location or Area b this SC y ducted . c tainin g s system �o more than 4o i entirely new entirely new • ' Name Served System (ft2) system? component? components? - .feet of ductsT duct system? SC system? Alteration Type System 1 whole house 2260 Yes No Yes Yes No No Altered space - - - - - - - -- - - - conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (SectioniSO.2(b)1Diib) This section does not apply to this project. Registration Number: 217-A0241519A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2017-07-16 14:28:10 Report Version: 2013 Rev 1.008 Schema Version: 0.555SDD HERS Provider: CalCERTS s Report Generated: 2017-07-16 14:23:19 CERTIFICATE OF COMPLIANCE UlR-ALT-024 Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 3 ) D. Altered Space Conditioning System (Sections 150.2(b)lE and F) _ - -01- -- --02- -=---03- --04- --- ____0S-=-- - 06-- -07 - - 08-- - 09 10 11 22 Heating - Cooling System Heating Altered_ Heating Minimum Altered Cooling Minimum Required New or Identification -.System Heating. -" Efficiency.. _ Efficiency_ . Cooling -_-Cooling _Efficiency __Efiiclegcy__ Thermostat- Replaced New Duct or Name Type Components Type Value System Type Components Type Value Type Duct Length R -Value' Central gas No heating This field or This field or Central split No cooling This field or This field or Greater than System 1 furnace component section is not section is not AC component section is not section is not Setback 40 feet R-6 altered applicable applicable altered applicable applicable Reauired Documentation: CFZR-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: 515%, or 510%leakage to outside; or seal all accessible leaks. CF211-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 Flowa 300 CFM/ton req' uiredmben_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 veriflption of Air Flow MCH 23, orRefrigeraiit Charge MECH 25 f, -Existing duct systems constructed, Insulated or sealed with asbestos:are exempt: from MCH 2Obuct"Leakage Testmgrequiremerits „. ,. _ ail:_ -. E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sectlons,lSO 2(b)lDna and 150.2(b)1E, F) 71' i This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 1S0.2(b)1C) This section does not apply to this project. Registration Number: 217-AO241519A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2017-07-16 14:28:10 Report Version: 2013 Rev 1.008 Schema Version: O.S55SDD HERS Provider: CaICERTS Report Generated: 2017-07-16 14:23:19 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: Liu, Minxuan`� Company: Signature Date: Bay Area Energy Consultants 2017-07-16 14:22:46 Address: CEA/ HERS Certification Identification (if applicable): 1181 Sundown Ln CC2006550 City/State/Zip: Phone: San Jose CA 95127, 408-883-3865 Responsible Person's Declaration statement\ I certify the following under penalty of perjury, under the lawsof the State of California: 1. The information provided on this.Certificatiof Compliance is true and correct. 2. 1 am eligible under Division 3 of.the Business and Profisssfons Code to acceptresponsibllity 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 Part6,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 onothersapplicable compliance documents, worksheets, calculations, plans and specifications subm)tte"d to the enforcement agency for approval with this building permd application. S. I will ensure that a registered copy offthis'Gertificate of_Ci)mpliance shall" be;made available with the Building permit(s),issued for the;bui10" , and, available to3he`enforcement agency for all applicable - w r. inspections. l understand that a registered copy of thisCertifkate of Compilanci ,is_requlred to bgjncluded,with the,documentation therbuilderprovides to,thebuildng owner at occupancy. Responsible Designer Name: Responsible Designer Signature. Mai, Hoang Company: Date Signed: H & H HEATING AND AIR CONDITIONING SERVICES INC 2017-07-16 14:28:10 Address: License: 4887 POPE JOY COURT 890399 City/State/Zip: Phone: S_AN JOSE"CA,9511$ - - - _ _. -._ . 408! 76598"XT23- - : -- — - Easy to Verify O� at CaICERTS.com Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility fc r the accuracy of the info Registration Number: 217-A0241519A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2017-07-16 14:28:10 Report Version: 2013 Rev 1.008 Schema Version: 0.555SDD HERS Provider: CaICERTS Report Generated: 2017-07-16 14:23:19 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Y Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: 11110 Santa Teresa Dr Enforcement ency: Cupertino y of Permit Number: B-2016-1441 Dwelling Address: 11110 Santa Teresa 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 No, credit is not taken 04 (VLLDCS) Credit from CF1R? Total leakage 06 Leakage Factor 0.15 07 Verified Low Leakage7Air Handling Unit Credit from No, credit is not taken 05 CF1R?^v i2 s — . , This field or section is not applicable 06 1 Duct System Compliance Category. -6 Alteration 10 Actual duct°leakage,ratefrom leakage test measurement (dm) 214 MCH -20d - Complete�Replacement or Altered Wd System aT^t B. Duct Leakage, Diagnostic, Test O1 Condenser Nomina.I'Cooling Capacity (ton) 4 02 Heating Capacity (kg3tu/h) 97 03 Conditioned Flooe Area served by this HVAC system (ft2) 2260 04 Duct Leakage Test Condition Test final 05 Duct; Leakage Test Method Total leakage 06 Leakage Factor 0.15 07 Air Handling UnitAirflow (AHUAirflow) Determination Method Heating system method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage Rate (cfm) 316 10 Actual duct°leakage,ratefrom leakage test measurement (dm) 214 11 Compliance Statement: System passes leakage test Registration Number: 217-A0241519A-M2000002A-M20A Registration Date/Time: 3128.18.27125;62;55 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2017-07-16 14:51:47 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 testing. OA ducts used for Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan Ventilation 02 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. 04i Building cavities were: not'used as plenums or platform returns in lieu of ducts. 05; ,i� � / '•iii i If cloth backed tapeiwas�S used it was covered with Mastic and draw bands. 06. All connection.points ibetween the.air handler and the supply and return plenums are completely sealed. If the system complies using tl a SmokeFTest method, thesmoke test was conducted in accordance with the4egwrements 07 of Reference Resident al Appendix RA3.14.3 6 Systems that comply using;smoke test shall not be included insample groups for HERS verification compliance. "=_u,=�. -- . �• ..- - -,, + i 1 ' : _. LL� ? y=:. u' 01 08. Verification Status Pass - all applicable requirements are mets- 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 applicablesections of this document shall indicate compliance with the specified verification protocol requirements in order for,this Certificate of Verification as a whole to be determined to be in compliance. 01.' 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: 217-A0241519A-M2000002A-M20A Registration Date/Time: 3128.18.27125;62;55 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008Report Generated: 2017-07-16 14:51:47 2013,Residential Compliance; Schema Version: 2013.1.007 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: M rDam Liu, Minxuan Liu Company: Date Signed: Bay Area Energy Consultants 3128.18:27!25.62.55 Address: CEA/ HERS Certification Identification (if applicable): 1181 Sundown Ln CC2006SSO City/State/Zip: Phone: San Jose CA 95127 408-883-3865 Responsible Person's Declaration statement I certify the following under penalty `of perjury, under the laws of the State of California: 1. The information providedion 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 ihii.6rtificatejofVerificatio cn omply with, the applicable requirements in Reference Appendices RA2, RA3, and the requirements specified`on the Certificate' of Compliance far thi-WIding approved by the enforcement agency. 4. The information reported on applicable sections of`the Certllficate(s)iof Installation (CF2R)"signed and submitted�by the persons) responsible for the construction or installation conforms to the requirements pecified(on the Certificates) of Compliance (CFiR) approved by the enforcement"agency. S. I will ensure that a registered copy, of this Certificate of VerrFcationlshall be posted or made avallable with the building permits) issued for the building, and made available to tFe enforcement;agenry for all applicable inspections I understand'that a registered;copy of thts;Certrficate;of s'" Verification Is'required to be'induded with the docu"mentatio''n tFre builder provides to the building owner of ociup`ancy. {...� ti.�ir-V .T:.. ' ' + kf' 4P ckfi`•J Pi k�.wiM Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder/Owner): H & H HEATING AND AIR CONDITIONING SERVICES INC Responsible Builder or InstallerName: CSLB License: Hoang Mai 890399 HERS Provider Data Registry Information Sample Group Numbei (if applicable):1 Dwelling Test Status in Sample Group (if applicable) Tested HERS Rater riformation' HERS Rater Company Name: Bay Area Energy Consultants Responsible Rater Name: Responsible Rater Signature: �//�� rDam Liu Minxuan Liu' IVB Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006550 3128.18.27!25;62;55 11gitallysignedbyClaICERM 7his dg(tal stgnature isproWdedin order to secure the content of Ws mgistemIddocumml, ardin no wayiMplies . lWstration FWdermVonsibilityfortheacwracyof the infomration. Registration Number: 217-A0241519A-M2000002A-M20A CA Building Energy Efficiency Standards 2013 Residential Compliance Registration Date/Time: 3128.18.27125;62;55 HERS Provider: CalCERTS Report Version: 2013 Rev 1.008 Report Generated: 2017-07-16 14:51:47 Schema Version: 2013.1.007