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B-2016-2191CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2191 10347 ANSON AVE CUPERTINO, CA 95014-1304 (326 41 006) AIR & PLUMBING SYSTEMS INC LOS GATOS, CA 95032 OWNER'S NAME: KATZ ARI AND DEBORAH DATE ISSUED: 06/22/2016 OWNER'S PHONE: 408-836-6647 PHONE NO: (408) 733-2000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC=20 Lic. # 09 1246 Contractor AIR & PLUMBING SYSTEMS INC Date 07/31/2017 X BLDG —ELECT —PLUMB COMMERCIAL X MECH X RESIDENTIAL 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. JOB DESCRIPTION: REPLACE FURNACE (SAME LOCATION); REPLACE AC UNIT (SIDE I hereby affirm under penalty of perjury one of the following two declarations: YARD) 1. I have and will maintain a certificate of consent to self -insure for Worker's �ompensation, as provided for by Section 3700 of the Labor Code, for the P J performance of the work for which this permit is issued. 2. 1 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 Sq. Ft Floor Area: Valuation: $12000.00 permit is issued. 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 Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 26 326 41 006 3 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 cons nting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant u ands nd will cc y with all non -point source regulations per th Cupertin unicip ode, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 6/22/2016 Issued by: Abby Ayende Date: 06/22/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS. - following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. 1, 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: 6/22/2016 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 material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the 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, Cha 12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 2 ,, and Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:6/22/2016 I certify that I have read this application and state that the above information is CONSTRV&TION 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 6/22/2016 Professional CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building()-cupertino.ora F- PLUMBING I—I MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS MEP MISC PROJECT ADDRESS `�311Z v � 0, `7APN # OWNER NAME r PHONE 4a 6-b „ .4ou E-MAIL � STREET ADDRESS ®" /, 7 _W e pA V CITY, STATE, ZIP /V elle � co FAX CONTACT NAME ��(�/ � P PHONE `. - I�/_ �7 @'�,roG -MAIL !l� /J� STREET ADDRESS/%9/O 7 CITY, STATE, ZI`P( �V �FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT VCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME A LICENSE NUMBER �, a LICENSE TYPE 70 BUS. LIC #'�� COMPANY NAME ,„ / M 11 r ` E-MAIL FAX STREET ADDRESS% / % /� 0/ t A/2 CITY, STATE, ZIP 0 S Q A C PHO o�/�� - Z ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex STRUCTURE: ❑ Commercial ❑ Multi -Family PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: / � �1 O E/ RECEIVED BY: - By my signature below, I certify to each of the following: I am the pro et authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is corre a read the Des Ion of Work and verify it is accurate. I agree to comply wi all applicable local ordinances and state laws relating to building co ction. I aut a represen Cu ertino to enter the above-e-iidentified for' sp cti purposes. Signature of Applicanb'Agent: Date: C/ 7, SUPP TAL INFORMATION REQUIRED OFFICE USE ONLY, w OVER -THE COUNTER" ' F' _ ' ❑ EaPRESS w ❑ .STANDARD a ` ❑ 6LdRGE 0. I . MAJOR ' MEPMiscApp_20 11. doc revised 03116/11 Ro / 0 X97 Xx-soA / i��e PLOT PLANS CHECKED 3", COMMUNITY DEVELOPMENT DEPAERE ✓1 t BUILDING DIVISION - CUPERTIN®ATE L ----� APPROVED PLAT NI G DEPT This set of plans and specifications MUST be kept at tCe UPERTINO job site during construction. It is unlawful to maks any therefrom, without approval from the Building Official. The 0--ing of this plan and specifications SHALL WT t:- J to permit or to he an approval of th Bio on o; provisic� of any City Ordinance or Sta _aw/�,e,,,!�_ sY « w� D: ;T PERMIT NO. OFFICE G L] SMOKE / CARBON MONOXIDE ALARMS b5 (0 9ifJAC16 OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.ora / Permit No. zo Address Jo 3 7 /1✓S OA%# of Alarms Smoke- - (nrhnn TX4n nv;,II - 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 Carb n 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 COALARM r_ Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) Contr ctor Name: On every level of a dwelling unit including basements Within each sleeping room X X ate: ................... X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning apF do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall 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 batte In existing dwelling units, alarms are permitted to be solely battery operated where repairs or ali not result.in the removal of wall and ceiling finishes or there is no access by means of attic, baser space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is 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 he installed in accordance with the manufacturer's instructions and in compliance with the Californi and California Residential Codes. The alarms have been tested and are operational, as of the date below. I have read and agree to comply with the terms and o itions of this statement and that with operated. ttions do A or crawl mired for been Owner (or ner gent's) Name: K/O/K r_ ....... ,................................................................. .Signature ..... ate: Contr ctor Name: Signature......._................................_.......................... Lic.#...................................... ate: ................... Smoke and CO form. doc revised 03118114 Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228- FAX (408) 777-3333 buitding(a)cupertino.org Permit No M Address /d 3 i % 14A)s 1. Is your real property a registered historical site? ❑ Yes Civil. Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. No Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property oj its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 1W, 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 o form. OK 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 plumbin 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 o 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- cons ruing plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvem nts). I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fn tures will be replaced prior to date specified above with water -conserving plumbin ixtures in accordance with Civil Code Se tions 1101.1 through 1101.8, the current California Plumbing Code and Californ' Green Building Standards Code, and rnanu acturer's installation requirements, and that the water7, rving xtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature: Date: g Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit. SB4072015.doc'l evised 08126115 1. if the existing plumbing fixture water usage/clow rate is equal to or lower than the tigure shown, it is not required to b upgraded. SB407 2015. dod revised 08/26/15 Non-CompliantWater-Conserving Plumbing Fixture Plumbing Fixture (Fixture Complying with Current Code Applicable to New Constriction) Maximum Water Usa . e/Flow Rate ; '- Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CP Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2.013 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 Gallons/flush 0.5 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 for Showerheads (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 ininute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 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 psi Faucets — Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per ininute @ 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 gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. if the existing plumbing fixture water usage/clow rate is equal to or lower than the tigure shown, it is not required to b upgraded. SB407 2015. dod revised 08/26/15 103qq RrlsW NE FILE CERTIFICATE OF VERIFICATION ------------------ Duct Leakage Diagnostic Test Project Name: Ari KatzI Enforcement Agency: Cupertino Permit Number: Building Department Dwelling Address: =10347 Anson Ave i City: A. System Information 01FSpaceonditioning System Identification or Name 02onditioning System Location or Area Served03g Type from CF -111 04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from CF1R? 05 Verified Low Leakage Air Handling Unit Credit from CF1R? 06 Duct System Compliance Category MCH -20d - Cupertino ` Zip, Code: system 1 Whsle house Single family y� No, credit is not taken No, credit is not taken 01 Condenser Nominal Cooling Capacity (ton) U.S. Energy Raters Association 02 Heating Capacity (kBtu/h) 96 03 Conditioned Floor Area served by this HVAC system (ft2) 2146 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Leakage to the outside 06 Leakage Factor 10 07 Air Handling Unit Airflow (AHUAirflow) Determination Method Heating system method 08 Measured AHUAirfloW 09 Calculated Target Allowable Duct Leakage Rate (cfm) 208 10 Actual duct leakage rate from leakage test measurement 100 (cfm) 11 Compliance Statement: System passes leakage test (Page 1 of 3 ) 95014 Registration Number: 316-A1027640A-M2011657A-M20A Registration Date/rfme: 2016-06-22 23:20:12 CA Building Energy Efficiency Standards HERS Pro' ider: USERA Report Version: 2013 Rev 1.007 Report Generated: 2016-06- 2 2013 Residential Compliance Schema Version: 2013.1.007 23:20:24 CERTIFICATE OF VERIFICATION Duct leakage Diagnostic Test B. Duct Leakage Diagnostic Test 12 1 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 di 02 testing. OA ducts used for Central Fan Integrated (CFI) indoor Air Quality ventilation systems, or Central Fan Vi Cooling Systems, that utilize dampers that open only. when OA is required and automatically close when OA is 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. 7 Tt If the system eomplies usang the Smoke Test methods the smoke test was coitducte"d�n"ccordanc;wrththe reg 07 of Reference Residential Append►x RA3 14 3 6 Systt�ms that camply ustingm�oke tet.�f�all not 66"Q' 'A In ; groups forW RS verificai�ori� comnD�a,rru. 09 1 Correction Notes for this table US' The responsible persons signature on this compliance document affirms, that all applicable requirements in this been met unless otherwise noted in the Verification Status and the Corrections Notes in this table. M met D. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol 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: 316-A102754QA-M2011557A-M20A Registration Date/1-ime:2016-06-22 23:20:12 HERS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016- 2013 Residential Compliance Schema Version.• 2013.1.007 (Page 2 of 3 ) leakage required, have in order sr: USERA 23:20:24 CERTIFICATE OF VERIFICATION Duct Leakage Diagnostic Test Documentation Authors Declaration Statement 1.1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Minxuan Liu Company: Santa Clara HERS Address: 1181 Sundown Ln City/State/Zip: San Jose CA 95127 Responsible Person's Declaration statement Documentation Author Signature: Date Signed: 2016-06-22 (Page 3 of 3 ) IN. Wm, A N — CEA/ HERS Certification Identification (if applicable): 410231431 Phone: 408-883-3865 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 3. The installed features, materials, components, manufactured devices, or system performance diagnostic results that require HERS I identified on this Certificate of verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the re specified on the Certificate of Compliance for the building approved by the enforcement agency. 4. The infor fiion renortPrin, n i . �w�a s,. 5. I will ensure that a re istered cb g PY of this Certificate of ilenhcatf building and made availabfe to the erdforesm agency for�al`t"a Verificatiari islrequired to bhcludedwWm tatirnt A W - Builder or Insta r n o m>,001on A's Stt wn O o The C RMW Company Name (installing Subcontractor, General Contractor, or BuildeI Air & Plumbing Systems Inc a Responsible Builder or Installer Name: Mark Fridlyand HERS Provider Data Registry Information Sample Group Number (if applicable): 316-20747 HERS Rater Information the at CSLB License: 901246 Dwelling Test Status in Sample Group (if Tested HERS Rater Company Name: Santa Clara HERS Responsible Rater Name: Responsible Rater Signature: Minxuan Liu Responsible Rafter Certification Number w/ this HERS Provider. Date Signed; Minxuan Liu (Jun F2,2016) 410231431 2016-06-22 U%is digilbd SiGnattO is provided in order to se vA 2 Z'k the content of this-regfstered document and in a,�inPWORegistraiaon" roviderrr~sponsfbiy €J 9 WQY F12temAa ii tion the accuracy ofthe irlforrmttan.0, isible for the lent agency. for the ate of Registration Number: 316-A1U27640A-M2011657A M20A Registration Date/Time: 2016-06-22 2320:12 HERS Pr eider; USERA CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-06 v 23:20:24 2013 Residential Compliance Schema Version: 2013,1.007 4 }`a FCERTIFICATE OF INSTALLATION nditioning Systems, Ducts, and Fans ame: Department Dwelling Address: 10347 Anson Ave City: Cupertino ( Zip Code: CF2R-MCH-01-E (Page 1 of 7 ) b-2016-2191 95014 Registration Number: 316-A1027640A-M0119976A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-06-22 23:15:0$ Report Version: 2013 Rev 1.007 Schema Version: 2013.1.007 HERS Provider: USERA Report Generated: 2016-06-22 23:15:20 A. General Information ry\ Its—®1 Dwelling Unit Name Arl Katz 02 Climate tone ors a SC System Identification or Name SC System Location or Area Served CFA, served by this SC 'System ft2 ( ) I t �c sy.efn � d ducted system? 4 i 11 system components? Yes 03 Dwelling Unit Total Conditioned Floor Installing entirely t ely new duct system? installing entirely new SC system? Alteration Type System 1 Whale house 2146 Yes Yes Yes No No Area (ft2) 2146 04 Number of Space Conditioning Systems in this Dwelling Unit. 1 system 05 Certificate of Compliance Type Prescriptive alterations (CF1R-ALT) 06 Method used to Calculate HVAC Loads NotApplicableEquipmentChangeout 07 Calculated Dwelling Unit Sensible Cooling Load (Stuh) 0 08 Calculated Dwelling Unit Heating Load 0 (Btuh) 09 Dwelling Unit Number of Bedrooms 4 - MCH -01b Prescriptive Alterations - Space-Condltio in g ysCemj�-Ductsand Fans, .. r , l B. Space Cond�iGNsn�Ing {5C) �Istem�(nfc>rmair i� .` 0908 Registration Number: 316-A1027640A-M0119976A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-06-22 23:15:0$ Report Version: 2013 Rev 1.007 Schema Version: 2013.1.007 HERS Provider: USERA Report Generated: 2016-06-22 23:15:20 ry\ G �0fi zo ors a SC System Identification or Name SC System Location or Area Served CFA, served by this SC 'System ft2 ( ) I t �c sy.efn � d ducted system? i �i �n� containing component? i 11 system components? Yes � - �@nore than 40 feet of ducts? Installing entirely t ely new duct system? installing entirely new SC system? Alteration Type System 1 Whale house 2146 Yes Yes Yes No No Altered space conditioning system Registration Number: 316-A1027640A-M0119976A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-06-22 23:15:0$ Report Version: 2013 Rev 1.007 Schema Version: 2013.1.007 HERS Provider: USERA Report Generated: 2016-06-22 23:15:20 CERTIFICATE OF INSTALLATION Space Conditioning Systems, Ducts, and Fans CF2R-MCH-01-E (Page 2 of 7 C. Space Conditioning (SC) SYStem Alterations COMp01 liance Information 02 03 nQ r051 06 0 - nQ 1 7 D. Installed Heating Equipment Information 01 02 03 0405 06 07 System Identification or. identification t Heating Efficiency Heating Unit Heating Unit Heating Unit serial Rated Heating Capacity, Name Heating Efficiency Type Value Manufacturer Model Number number Output (STUN) Notes: Registration Number: 316-AI027640A-M0119576A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-06-22 23:15:08 Report Version: 2013 Rev 1.007 Schema Version: 2013.1,007 15263KR77G 1 96000 HERS Provider: USERA Report Generated: 2016-06-22 23:15-20 Central Fan Heating System Altered Heating Minimum L I Altered Cooling New or Integrated (CFI) Identification Identification Heating Heating Efficiency Efficiency at n or Name Cooling Cooling Cooling Efficiency Minimum Efficiency Required Thermostat Re laced P New Ventilation TYPA Compolnent Type Value System Type Components — Type - I Value --- Type Duct Length Duct R -Value System Status —1 All new - --- System I Central gas heating furnace componen AFUE 780 Central All new split AC cooling SEER F14.000 Setback GT40Ft R6 Not a CFI is components system D. Installed Heating Equipment Information 01 02 03 0405 06 07 System Identification or. identification t Heating Efficiency Heating Unit Heating Unit Heating Unit serial Rated Heating Capacity, Name Heating Efficiency Type Value Manufacturer Model Number number Output (STUN) Notes: Registration Number: 316-AI027640A-M0119576A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-06-22 23:15:08 Report Version: 2013 Rev 1.007 Schema Version: 2013.1,007 15263KR77G 1 96000 HERS Provider: USERA Report Generated: 2016-06-22 23:15-20 CERTIFICATE OF INSTALLATION Space Conditioning Systems, Ducts, and Fans E. CF2R-MCH-01-E (Page 3 of 7 ) Condenser or Package Unit Condenser or Condenser or Condenser or System Rated Cooling Condenser Rated System Identification Cooling Efficiency Cooling Efficiency Package Unit Package Unit Package Unit Capacity at Design Nominal Capacity or Name Type Value Manufacturer Moder Number Serial Number Conditions (STUN) (ton) System 1 SEER 15.000 Trane 4TTR6048J100 OAA 161216R45F 48000 4,0 Notes: ' F Extension of Existing Duct System, Greater Than 40 Feet This section does not apply to this project. 1. Air Filter Device Requirements Registration Number: 316-A1027640A-M0119976A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance This section does not apply to this project. Registration Date/Time: 2016-06-22 23:15:08 Report Version: 2013 Rev 1,007 Schema Version: 2013.1,007 HERS Provider: USERA Report Generated: 2016-06-22 23:15:20 CERTIFICATE OF INSTALLATION j CF211-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 4 of 7 i J. HERS Verification Reauirements 01 02 03 04 05 06 07 08 09 10 MCH2O MCH21 MCH22 MCH23 MCH25 MCH28 Exemption System 5C System From Duct Duct identification or Location or Area Leakage Leakage Name Served Requirements Test Exemption from Minimum R -Value for Ducts In Conditioned Space p Ducts Located In Cond Space Verification AHU Fan Efficacy (W/cfmj AHU Airflow Rate (cfm/ton) Refrigerant Charge Return Duct Design Table 150.0 -Cor D System 1 Whole house No Yes exemptions Yes Exemption p No j No No — - No - No Notes: Registration Number: 316-A1027640A-M0119976A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-06-22 23:15:08 Report Version: 2013 Rev 1.007 Schema Version: 2013.1.007 HERS Provider: USERA Report Generated. 2016-06-22 23:15:20 I CERTIFICATE OF INSTALLATION' f Space Conditioning Systems, Ducts, and Fans CF2R-MCH-01-E (Page 5 of 7 ) K Space Conditioning Sstems ', Ducts and Fans Mandatory Requirements and Additional measures Note: Additional mandatory requirements from Section 150.0 that are not listed here maybe applicable to some systems. These requirements may be applicable to only newly installed equipment or portions ofthe system that are altered. Existing equipment may be exempt from these requirements. Heating Equipment 01 I Equipment Efficiency: All heating equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency Regulations. 02 Controls: All unitary heating systems, including heat pumps, must be controlled by a setback thermostat. These thermostats must be capable of allowing the occupant to'program the temperature set points for at least four different periods in 24 hours. See Sections 150.0(1), 110.2(b), 03 Sizing: Heating load calculations must be done on portions of the building served by new heating systems to prevent inadvertent undersizing or oversizing. See sections 150.0(h)1 and 2). 04 Furnace Temperature Rise: Central forced -air heating furnace installations must be configured to operate at or below the furnace manufacturer's maximum inlet -to -outlet temperature rise specification. See Section 150.0(h)4. 05 Standby Losses and Pilot Lights: Fan -type central furnaces may not have -a continuousl burning g pilot light. Section 110.5 and Section 110.2(4), Cooling Equipment egul tiol F_ia Li�ncy eats cooring equipment=miast meet the^mi iii Um efficiency"r`equirg, ents of ctioh 110.1 and Section 110.2(x) and the Appliance Efficiency 0fi Re ulatio i 07 �=�� ,vn fui re rigerant urte nsulatron in spilt system air conditirine s and head p ,,,1st meet the R- N and protection requirements 150.0(4)2 ail • , a4 ei�n 15,D( , p q ements of Section .F 08 Condensing Unit Location: Condensing units shall n. b lam ith5 e d a .qf J qoiWti ction 150.0(h)3A. 09 Sizing: Cooling load calculations must be done on portions of the building served by new cooling systems to prevent inadvertent undersizing or oversizing. See Section 150.0(h)1 and 2. Air Distribution System Ducts, Plenums and Fans 10 Insulation: In all cases, unless ducts are enclosed entirely in directly conditioned space, the minimum duct insulation value is R-6. Note that higher values may be. requi�bye prescriptive or performance requirements. See Section 150.0(m)1. Registration Number: 316-A1027640A-M0119976A-0000 Registration Date/Time: 2016-06-22 23:15:08 HERS provider: U5ERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-22 23:15:20 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION Space Conditioning Systems, Ducts, and Fans CF2R-MCH-01-E (Page 6 of 7 ) K. Space Conditioning Systems, Ducts and Fans Mandatary Requirements and Additional Measures Note. Additional mandatory requirements from section 150.0 that are not listed here may be applicable to some systems. These requirements may be applicable to only newly installed equipment or portions of the system that are altered. Existing equipment may be exempt from these requirements. Connections and Closures: All installed air -distribution system ducts and plenums must be, sealed and insulated to meet the requirements of CMC Sections 601.0, 11 602.0, 603.0, 604.0, 605.0 and ANSI/SMACNA-006-2006: Supply -air and return -air ducts and plenums must be insulated to a minimum Installed level of R-6.0 or enclosed entirely in directly conditioned space as confirmed through field verification and diagnostic testing in accordance with the requirements of Reference Residential Appendix RA3.1.4.3.8 Heat Pump thermostat 12 A thermostat shall be installed that meets the requirements of Section 110.2(b) and Section 110.2(c). 13 The thermostat shall be installed in accordance with the manufacturers published installation specifications. 14 First stage of heating shall be assigned to heat pump heating. 1s Second stage back up heating shall be set to come on only when the indoor set temperature cannot be met. The responsible person signature on this compliance document affirms that aft applicable requirements in this table have been met. Registration Number: 316-A1027640A-M0119976A-0000 Registration Date/Time: 2016-06-22 23:15:08 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-22 23:15x20 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION Space Conditioning Systems, Ducts., and Fans 1.1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Minxuan Liu Documentation company: Santa Clara- HERS Signature ,, Address: — 2016-06-22 1181 Sundown• Ln CEA/ HERS Cert! CitV/r,tatrd71 410231431 San Jose CA 95127 Responsible Person's Declaration Statement CF2R-MCH-01-E (Page 7 of 7 ) I certify the following under penalty of perjurV, under the laws of the State of California: 1. The information Provided on this Certificate of Installation is true and correct, 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation, and attest to the declarations in this statement (responsible builder/installer), otherwise authorized representative of the responsible builder/installer, laman 3. The constructed or Installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4. 1 reviewtkid-ac9py of the Cpatifigate of Compliance.gpprovedby theenfo,rcer-n,ent, agency that ,identffies ,the specific requirements for the scope of construction or installation Identified on this Certificate of Installati6n)-'arrd I have ensured thatlh�e 0"uIre 4 n apply to ruetion) S. I will ensure that a registered met. X: .1 4* of thi's� Certificate �1 Installation all e posted, ov'm e availlable)WOWithe build applica0wip'sp,ections. I u6ti-entarifth t' na perm t(s) issued for the building, and made available to the enforcement agency for all �7 ATegj registered o o, with t, fu entation the builder provides to the building owner at occupancy. e4w of instal -Is4P-q4lred%0;We included; !sponsible Builder/Mill6r Mark Fridlyand Air& Plumbing Systems Inc 14107 Capri Dr Los Gatos CA 95032 Mark Fridlyand {Jun 22, J0 Is) sacemkofteeiatfull -- 901246 Phone- Date Signed,. 408-733-2000 12016-06-22 W Amak.- --t ITM AL-- "This d19fta13*atUrV Isproviddd in orderto secure WNW the content of this mqj8ter;ad,,d00UM9nt, and In no 'Rolow Smoot Way UnP110S Re9;S1Mt10ft PtiovWl-rosponsiblRy for Registration Number: 316-A1027640A-M0119976A-0c)c0 U -S. EiRergY Filtem Ar. the accuracy , ofthe infarmation, 0 Registration Date/Time.-.2016-06-22 23:15-08 CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Schema Version: 2013-1.007 HERS Provider: USERA Report Generated: 2016-06-22 23:15:20