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15080194
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18600 BARNHART AVE CONTRACTOR:WINGON PERMIT NO: 15080194 CONSTRUCTION'CO OWNER'S NAME: GOLDSILVERISLAND HOME LLC P O BOX 31983 DATE ISSUED: 10/22/2015 OWNER'S PHONE: 4088963369 OAKLAND,CA 84604 PHONE NO:(510)228-6665 0 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT(N)Z STORY sFD WITH 2,972 S.F.LIVING License ClassLic.# AREA,428 S.F.ATTACHED GARAGE&639 S.F. __ [ PORCH/DECK AREA Contractor` 4�i'1 67F Date 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 i I hereby affirm under penalty of perjury one of the following two declarations: 1. i have and will maintain a certificate of consent to self-insure for Worker's Sq.Ft Floor Area:; Valuation:$440000 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:37123014.00 Occupancy Type: 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. PERMIT'EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN, D PERMIT ISSUANCE OR 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 180 D T CALLED INSPECTION. 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, ss Date:�d 2 Z/— costs, and expenses w ich may accrue against said City in consequence of the granting of this erm t. Additionally, a applicant understands and will comply with all non-pointsations perCupertino Municipal Code,Section 9.18;. RE-ROOFS: SignatureDate 2� 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. ® 0"E -BUILDER DECLARATION NJ Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER �. 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 HAZARDOUS MATERIALS DISCLOSURE sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project(Sec.7044,Business&Professions Code). California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I hereby affirm under penalty of perjury one of the following three declarations: Safety Code,Section 25532(a)should I store or handle hazardous material. t. I have and will maintain a Certificate of Consent to self insure for Worker's Additionally,shouild I use equipment or devices which emit hazardous air Compensation,as provided for by Section 3700 of the Labor Code,for the 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 performance of the work for which this permit is issued. Health Safe 'ode,Sections k5O5,25533,and 25534. 2. I have and will maintain Worker's Compensation Insurance,as provided for by j Section 3700 of the Labor Code,for the performance of the work for which this Own"ro aut ed age permit is issued. ate: 3. I certify that in the performance of the work for which this permit is issued,I shall ttt not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I a become subject to the Worker's Compensation provisions of the Labor Code,I I hereby affirm that there is a construction lending agency for the performance of work's p p for which this permit is issued(Sec.3097,Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Addresst APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct.I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Licensed Professional 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15080194 18600 BARNHART AVE CUPERTINO CA 95014(375 23 014) WINGON CONSTRUCTION CO PO BOX 31893 OAKLAND CA 94604 OWNER'S NAME: GOLDSILVERISLAND HOME LLC DATE ISSUED: 10/22/2015 OWNER'S PHONE:4088963369 PHONE NO:510-228-6665 LICENSED CONTR ACTOR'S DECLARATION BUILDING PERMIT INFO: License Class @ Lic.#949206 BLDG —ELECT —PLUMB Contractor WINGON CONSTRUCTION CO Date 06/30/2016 — I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH—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: CONSTRUCT(N)2 STORY SFD WITH 2,972 S.F.LIVING I hereby affirm under penalty of perjury one of the following two declarations: AREA,428 S.F.ATTACHED GARAGE&639 S.F. 1. I have and will maintain a certificate of consent to self-insure for Worker's PORCH/DECK AREA Compensation,as provided for by Section 3700 of the Labor Code,for the REVISION#1 -REMOVE OVERFLOW DRAIN FROM 2ND STORY performance of the work for which this permit is issued. DECK AT MASTER BEDROOM-ISSUED 9/15/2016 2. 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:$440000.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 375 23 014 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 Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature ! .' Date 09/15/2016 Issued by:PAUL O'SULLIVAN Date: 10/22/2015 OWNER-BUIL 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 fust 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) z. 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:09/15/2016 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 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,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: z APPLICANT CERTIFICATION Date:09/15/2016 1 certify that I have read this application and state that the above information is CONSTI;EcCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 09/15/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE"AVENUE CUPERTINO, CA 95014-3255 (408)777-3228 FAX(408)777-3333 buildinq((a cupertin;o:OrgCUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION!/DEFERRED ORIGINAL PERMIT# PROJECT.ADDRESS 18 6 0 0 BARNHART AVENUE APN ff 375-23-014 i F , OWNER.N"IE. _.GOLDS ILVERISLAND HOMES LLC PHONE 408-. 896 .3369 E-MAIL YINGMINLI@HOTMAIL.0 M STREETADDRESS15.25 MCCARTHY BLVD CITY,STATE,zip MILPIT,AS, 95035. FAx - . I CONTACT NAME FRANK HO PHONE 1108 . 892 .15020 E-MAIL FRANKLHO@YAHOO.COM STREET ADDREss 12 4 8 0 SARATOGA AVECrrY,STATE,zip SARATOGA CA 9 5 0 7 0 FAX OWNER El OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT i ISI ARCHITECT ❑ENGINEER ❑ DEVELOPER 0.TENANT CONTRACTOR NAME r j� LICENSE NUMBER LICENSE TYPE BUS,LIC 9 r (0 COMPANY NAME E-MAIL - _ - .. FAX - - - I i STREET ADDRESS - CITY,STATE,ZIP - - PHONE - I ARCHITECT/ENGINEER NAME FRANK HO LICENSE NUMBER C 2 9$S 9 BUS,LIC COMPANY NAME E-MAIL FAX I i STREET ADDRESS 12480 SARATOGA AVE ciTY,STATE,zip SARATOGA CA 95070 PHONE4 0 8 . 892 5020 i DESCRIPTIONOFwOR$. NEW 2 STORIES HOUSE. WITH 5 BEDROOMS ;AND 4 .5 BATHROOMS. ALL (E) i STRUCTURE AND PAVER TO REMOVE FROM SITE.? ) 219i7_ ww P,)4 Z 1150 SP VE L EXISTING USE. - PROPOSED USE - CONSTR TYPE #STORIES SFR SFR VB 2 USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL a� �� AREA 1,217 AREA 3 4 0 0 AREA 1,217 NET AREA 3 ,4 0 0 rfy V L frg: t M-0 BATHROOM - KITCHEN - - OTHER ^� -;., REMODEL AREA REMODEL AREA REMODEL AREA IAS( ®( z cl 1'2— 3. ( PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH 6 <� 489 150 639 428 ATTACH 1tOr7 #DWELLING UNITS: IS ASECOND UNIT []YES SECONDSTORY E]YES BEING ADDED? E]NO ADDITION? E]NO PRE-APPLICATION ®YES IF YES,PROVIDE COPY of IS THE BLDG AN ❑YES - -�TDTAL.:VALUATION: - PLANNING APPL9 Fl NO PLANNING APPROVAL LETTER EICHLERHOME? [ANO40 Ub By my signature below,I certify to each of the following: S am the property owner or author ent to ae property owner's.behalf. I have read this application and the information I have provided is correct. 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 construction. I auth resentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 2-77 12015 SUPPLEMENTJkL INFORMATION REQUIRED - PLA}I"CHECK'TYP& Rov`TFNG SLIP<- . New SFD or Multifamily dwellings: Apply permit for demolition it for g Q OVEW.THE-COUNTER © BUILDING PLAN!AM.EW existing building(s). Demolition permit is required prior to issuance of building I permit for new building. EXPRESS= Cf,"P.LANNR�iGPLAN,xEVIEW _Commercial Bldgs Provide a completed Hazardous Materials Disclosure STANTr`ARD Q" PUBLIC WORKS, form if any Hazardous Materials are being used as part of this project. Q;LARGE: SIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to CI SANITARYsEwERDISTRICT " [ .nrnaoti submittal of Building Permit application. ( ©, EItVIROLVMENTALHEALTH E BldgApp 201 Ldoc revised 06/21/11 CITY OF CUPERTINO E01FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 18600 BARNHART AVE DATE: 08127/2016 REVIEWED BY: MELISSA APN: 375 23 014 BP#: *VALUATION: 1$440,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY 2nd Unit? 0 Yes GNo PENTAMATION USE;' SFD or Duplex PERMIT TYPE: 1 R3SFD WORK CONSTRUCT(N).2 STORY SFD WITH 2,972 S.F. LIVING AREA 428 S.F. ATTACHED GARAGE & SCOPE 639 S.F. PORCH/DECK AREA TYPE OF FLR AREA OCCUPANCY TYPE: PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-Bj11-B,IV,V-B 3,889 $3,252.54 IR3PLNCK $3,440.82 JR3INSP' i I TOTALS: 3,889 $'3,252.54 $3,440.82 .i iech. 1 laneck 1'1.1111A Picea Check lee..Plan(`heel: Wech,1' t'rttil Fee: Plt,mla. Non;(Pee: j lslec.Permit Fee: Otho, 1iz:chz Insp. Li Other PhImbInas°,.r. i Other I.Iec.Ins};>. Li Mech lrzsp� lee: Plwiib, t7sp. ret:: i J tee.Inst Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta. These ees are based on the preliminary information available and are onlyan estimate. Contact the De t or addn'l in o. FEE ITEMS (Fee Resolution 11-053 E f 7/1113) FEE QTY/FE1E MISC ITEMS Plan Check Fee: $3,252.54 Select a Misc Bldg/Structure or Element of a Building Suppl.PC Fee: Reg. 0 OT 0.0 hrs $0.00 t PME Plan Check: $0.00 Permit Feer $3,440.82 Suppl. Insp.Fee-,O Reg. OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 #new $684.98 1 Construction Tax: 1BC0NSTfIXR 1 units Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: 1PLLONGR $544.46 Select a Non-Residential Building or Structure 0 Trmlel Do umesntalion Fees: Strom Motion Fee: IBSEISMICR $57.20 Select an Administrative Item Bldg Stds Commission Fee_ IBCBSC $18.00 SUBTOTAE $7,998.00 $000 - . $7,998.00 Revised: 07/02/2015 Building Depart ent City Of pertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: n PERMIT# ITO,&1 OWNER'S NAME: V,�f pQ Q��g L L C PHONE# rr o 7�6 AP GENERAL CONTRACTOR: %A0 C446,^1 BUSINESS LICENSE# 0,646 . ADDRESS: / Ae4kCITY/ZIPCODE: CA *Our municipal coder wires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ignature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # I Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile L CIL o� Own&)/Contractor Signature Date CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of'3 Project Name: Wing On Barnhart Enforcement Agency: Cupertino Permit Number: 15080194 Building Department [Dwelling Address: 18600 Barnhart Dr City: Zip Code 95014 A.System Information 01 Space Conditioning System identification or Name System 2 02 Space Conditioning System Location or Area Served DOWNSTAIRS 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? Q5 Verified Low Leakage Air Handling Unit Credit from No,credit is not taken CF1R? 06 Duct System Compliance Category Replacement F -20d-Corplete Replacement or Altered Duct System-, t B.Duct Leakage:Dagnosfie.Test ]02 Condenser Nominal Cooling Capacity(ton) U.S. Raters Association Heating Capacity(kBtulh) 77 03 Conditioned Floor Area served by this HVAC system(ft2) 1624 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor .06 07 Air Handling Unit Airflow(AHUAirflow)Determination Heating system method Method 08 Measured AHUAirflow 0 09 Calculated Target Allowable Duct Leakage Rate(cfm) 100 10 Actual duct leakage rate from leakage test measurement 98 (cfm) 11 Compliance Statement: System passes leakage test Registration Number:316-A1034355A-M2015066A-M20A Registration Date/Time:2016-09-27 21:55:05 HERS Provider:USERA CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-09-27 21:55:24 2013 Residential Compliance Schema Version:2013.1.007 CERTIFICATE OF VERIFICATION CF3R-MCH=20-H Duct Leakage Diagnostic Test (Page 2 of 3} S.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 thAmoke Test method,the smoke test was conductedjn taccordanc�,withAhe requirements 07 of Reference Residential Appendix RA3 14 3.6.Systems that.comply using`smoke telt shall not be included in sample groups forjE1ERS verification'compliance _ ` .....y f j ,. z 08 Verification�5iattrs � ; Pass ill applicable requirements are met ` 09 Correction Notes for this table QS". ner RatersAssociation 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 protocolrequirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 01 Fco-mpries:All specified verification protocol requirements on this document are met. Registration Number:316-A1034355A-M2015066A-M20A Registration Date/Time:2016-09-27 21:55:05 HERS Provider:USERA CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-09-27 21:55:24 2013 Residential Compliance Schema Version:2013.1.007 CERTIFICATE OF VERIFICATION MR-MCH-20-1-1 Duct Leakage Diagnostic Test (Page 3 of 3 j Documentation Author's Declaration Statement 1.1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Joe Novelo �— . � - Company: Date Signed: California Air Duct Testers 2016-09_27 Address: CEA/HERS Certification Identification(if applicable): .1630 Oakland Rd,Suite A205-3 410231432 City/State/Zip: Phone: San Jose CA 95131 408-824-0740 Responsible Person's Declaration statement 1 certify the following under penalty of perjury,under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification(responsible rater). 3. The installed features,materials,components,manufactured devices,or system performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2,RA3,and the requirements specified on the Certificate of Compliance for the building approved by the enforcement agency. 4. The mfor#ajatian reported`on applicable seen ir!s-6f thegCertifi`cate(s)af'lnstalfation(CF2RY7"s�gned and'tubmitted by the persons)responsible for the construction or installation conforms to the requirements specified on-the-Certificate(s)of'Compliance(&IR)approved by the enforcement agency. 5. I will ensure#hat a registered copy of this Certificate of Verification shall be posted,ar matle available§withthe bwlding pe mit(s)issued for the buildingandnade available to the etiforcment agency 'all apphcebyle.inspections_t unefs � nd Lhat,a registered copy of this Certificate of Verificati Rj:;:required to be74cluded withthe documentation the lde-provides to the'buildi g'o+niner at occupancy—n i- Builder Or Insta for Inforrrlation As Siiown On The Certificate Of Installation N Company Name(Installing Subcontractor,General Contractor,or Builder rg. wing on construction Inc. "a .Y EnergyR r Association Responsible Builder or Installer Name: CSLB License: yuejun Chen 8949206 HERS Provider Data Registry Information Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable) 316-26307 Tested HERS Rater Information HERS Rater Company Name: California Air Duct Testers Responsible Rater Name: Responsible Rater Signature: Otn j��o Joe NOVelO .Novelo(Sep 27,2418} Responsible Rater Certification Number w/this HERS Provider Date Signed: 410231432 2016-09-27 rM "7771,digital Signature fsproWded'in order to secure the content of this reglstemd document,and an no way implies Registradon provider responsibility for _. infonnation�' U-S. n y m Saw[6tl n fheac rocy.oft{te Registration Number:316-A1034355A M2015066A-M20A Registration Date/Time:2016-09-27 21:55:05 HERS Provider:USERA CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated`.2016-09-27 21:55:24 2013 Residential Compliance Schema Version:2013.1.007 d V.`1 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 Project Name: Wing On Barnhart Enforcement Agency: Cupertino Permit Number: 15080194 Building Department Dwelling Address: 18600 Barnhart Dr City; Zip Code: 95014 A.System Information 01 Space Conditioning System identification or Name System 2 02 Space Conditioning System Location or Area Served DOWNSTAIRS 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 Replacement W-- . 177 MCH-20d-Complete Replacement or`AAltered.Duct 6ystem� . B. Duct Leakage pagnostic Test ra 01 Condenser Nominal Cooling Capacity(ton) U.S. Ennergy Raters Assodation 02 Heating Capacity(kBtulh) 77 03 Conditioned Floor Area served by this HVAC system(ft2) 1624 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor .06 07 Air Handling Unit Airflow(AHUAirflow)Determination Heating system method Method 08 Measured AHUAirflow 0 09 Calculated Target Allowable Duct Leakage Rate(cfm) 100 10 Actual duct leakage rate from leakage test measurement 98 (cfm) 11 Compliance Statement: System passes leakage test Registration Number:316-A1034355A-M2015066A-M20A Registration Date/Time:2016-09-27 21:55:05 HERS Provider:USERA CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-04-27 21:55:24 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 thezSmoke Test method the smoke-test was canductedfin accordance withthe requirements 07 of Reference Residential Appendix RA314 3 6.Systems that_comply using smoke test sl fall not 4ie indud�d in sample groups for;klERS verificaiort compliance ° " t e 08 Verification,Status X, }tel x-Pass=all applicable requirements are met 09 Correction Notes for this table g0' energy Raters Association 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. 011 Complies:All specified verification protocol requirements on this document are met. Registration Number:316-A1034355A M2015066A-M20A Registration Date/Time:2016-09-27 21:55:05 HERS Provider:USERA CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-09-27 21:55:24 2013 Residential Compliance Schema Version:2013.1.007 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H. Duct Leakage Diagnostic Test (Page 3 of 3 i Documentation Author's Declaration Statement 1.1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Joe Novelo — _ Company:-—_ Date Signed: -�-- California Air Duct Testers - 2016-09-27 Address: CEA/HERS Certification Identification(if applicable): 1630 Oakland Rd,Suite A205-3 410231432 City/State/Zip: Phone: San_Jose CA 95131 408-824-0740 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. lam 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 bythe enforcement agency. 4. The infofriiation reported n a"ppl�cable'-'6---f-the-—fthe�Certifcate(s)of Installat-n K`F2R,)i4rWand`-ubmitted by the persons)responsible for the construction or installation-coiformsto the requirements specified-on-the-Certificate(s)ofFComplianee i&R)approved byth4'e enforcement agency_. S. I will ensure#hat a registered copy ofthis,Certificate-'-f Verifcation shall beposted,or made availablp'with the banlding permit'Js)issued forthe building,dnd;(nade available to the enforcement agency for,,all applicable inspection.I u4e n-d that a'�registered copy of this Certificate of Verification is required to beincluded with—the—documentation the budderp'rovides to the building owner at occupant.-- i . Builder Or Installer Inrmation AsShoInstallation vun On The Certif<cate Of nstlati W If n ati Company Name(Installing Subcontractor,General Contractor,or Builders a. ) wing on construction inc. CSLB License: Responsible Builder or Installer Name: yuejun chen 6949206 HERS Provider Data Registry Information Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable) 316-26307 Tested HERS Rater Information HERS Rater Company Name: California Air Duct Testers Responsible Rater Name: Responsible Rater Signature: Joe NOVe{O oe N�oveeloo(Sep 27,2016) Responsible Rater Certification Number w/this HERS Provider: Date Signed: 410231432 2016-09-27 :..: M Tf Mis sa1igMal Signature.,is proWded in ord'erto secure €h any t�r�A�Latlon e content of this registered document,and inn way implms Purls€ra€ioo Provider resportsr`ttrtatyfOr U-S . ._.wRAthe accuracy of the information. : Registration Number:316-A1034355A M2015066A-M20A Registration Date/Time:2016-09-27 21:55:05 HERS Provider:USERA CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-09-27 21:55:24 2013 Residential Compliance Schema Version:2013.1.007