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B-2016-1678CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21101 TAMARIND CT CUPERTINO, CA 95014-1638 (326 08 016) OWNER'S NAME: PANDEYANAND KUMARAND POONAM TRUSTEE OWNER'S PHONE: 408-718-1718 LICENSED CONTRACTOR'S DECLARATION License Class GENERAL BUILDING CONTRACTOR Lic. #681633 Contractor JONATHAN WEI CHIH SU Date 12/31/2017 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. hereby affirm under penalty of perjury one of the following two declarations: s. 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 perfbrmance of the work for which this permit is issued. 2 `I have and will maintain Worker's Compensation Insurance, as provided for by C 111 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per t_4 Cupertino Municipal Code, Section 9.18. ignature Date 10/4/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations:. 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. 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. 3. I certify that in the performance of the work for which this permit is issued, I ` shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. f APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 10/4/2016 CONTRACTOR: PERMIT NO: B-2016-1678 JONATHAN WEI CHIH SU CUPERTINO, CA 95014 DATE PHONI BUILDING PERMIT INFO; ISSUED: 08/24/2016 NO: (408) 255-8999 BLDG —ELECT _ PLUMB MECH X RESIDENTIAL _ COMMERCIAL DESCRIPTION: CONSTRUCT N DETACHED 2ND UNIT (753 S.F.) WITH COVERED PORCH (64 S.F.) REV #1 (9/22/16) - CHANGE WINDOW IN LNINGROOM AND ADD MORE KITCHEN CABINET ISSUED 10/4/2016 Ft Floor Area: 753 Valuation: $96000.00 APN Number: Occupancy Type: 326 08 016 1 Deferred Submittal (R -3),R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: ABBY AYENDE RE - ROOFS -All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 10/4/2016 ALL ROOF COVERINGS TO BE CLASS "A" HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 10/4/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued' (Sec. 3097, Civ C.) Lender's Name Lender's Address ARC'HITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPERTI NO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build ingQcupertino.org ❑NEW CONSTRUCTION , ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # ii -6, ' PROJECT ADDRESS I p o 1 AAAA RMY c I® C; J C—r-TI A! 6 APN n OWNER NAME �iI i- S `S <` PHONE l _ / I - e E-M:AIL STREET ADDRESS 2,11 -r(uMA J)J9 CT CITY, STATE, ZIP FAX CONTACT NAME V e fi" r i4f l S e PHONE. E-MAIL STREET ADDRESS G 5t Ave CITY, STATE ZIP t; �j N r" +moi . SG l - FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNTERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER - ❑ TENANT CONTRACTOR NAME LICENSE NUMBEERray �G � LICENSE TYPE BUS. LIC � 77 ^% 3 COMPANY NAME F1 Y E-MAIL -L� 1 / FAX STREET ADDRESS CITY, STATE, ZIP r PHONE ARCHITECT/ENGINEER NAME�Q LICENSE NUMBERC =y y ) �. BUS. LIC .C. K.�' b COMPANY N?NIE E -MATT" FAX .STREET ADDRESS CITY, STATE, ZIP Ii i-?_ t 6 GL o g �i4 q1 P"g"F PHONE DESCRIPTION OF wORIC a it 401 h"USIE11(i Usb PRUPUSED USE CONSTR. TYPE I Y STORIES - - - -- USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL - AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER - REMODELAREA REMODEL AREA REMODELAREA PORCH AREA I DECK AREA I TOTALDECKTORCHAREA- I GARAGEAREA: nDETACH DWELLING UNITS: IS ASECOND UNIT LJ YES SECOND. STORY ❑YES _ - BEIN.GADDED? []NO ADDITION? []NO PRE -APPLICATION FI -YES IF YES; PROVIDE COPY of IS THE BLDG AN ❑ YES •RECJ TOTAL VALUATION: PLAN'NLNG APPL ❑ NO PLANNING APPROVAL LETTER EICHLER. HOME? NO By my signature below, I certify to each of the following: I am the property owner or authorized agent 4 act on A 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 build'_ a construction. authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date:!'Jld SUPPLEMENTAL INFORMATION REQUIRED Q PLS N CHECK TI PE „ : y ROUTING SLIP ; y New SFD or Multifamily dwellings: Apply for demolition permit for ❑ ❑ existing building s). Demolition permit Is required prior to issuance of building OC ER THF COUNTER BUILDL\G PLATS RESHEVi' ?� �, n permit for new building. ❑iPREss z' n ❑ PLAx\IItiiGPLAxRE�IE�! Commercial Bldss: Provide a completed Hazardous Materials Disclosure rJ, �� sTANDA`RD } x . ❑ rLBilci� oRKs _ form if any Hazardous Materials are being used as part of this project. LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ Submittal Of Building Permit application. �L4JOR :SAAITAR2 SERERDISTRICT BldgApp_201120c revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1678 21101 TAMARIND CT CUPERTINO, CA 95014-1638 (326 08 016) JONATHAN WEI CHIN OWNER'S NAME: PANDEYANAND KUMAR AND POONAM TRUSTEE OWNER'S PHONE: 408-718-1718 WENSED CONTRACTOR' DECLARATION License Class B Lic. #681633 Contractor JONATHAN WEI CHIH SU Date 12/31/2017 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: i. 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. 2. I have and will maintain Worker's Compensation Insurance, as provided for by t" Section 3700 of the Labor Code, for the performance of the work for which this ? permit is issued. I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupert–i o Municipal C ection 9.18. Signature Date28/ 4/2016 hereby affirm that I am exempt from the Contractor's License Law for one of the two reasons: I, as owner of the property, or my employees with wages as their sole compensation,will do the work, and the structure isnot intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: i. 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. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply, with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 8/24/2016 CUPERTINO, CA 95014 DATE ISSUED: 08/24/2016 PHONE NO: (408) 255-8999 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCL&L JOB DESCRIPTION: CONSTRUCT (I) DETACHED 2ND UNIT (753 S.F.) WITH COVERED PORCH (64 S.F.) Sq. Ft Floor Area: 753 1 Valuation: $96000.00 APN Number: Occupancy Type: 326 08 016 1 Deferred Submittal (R -3),R-3 (Custom) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: Kim Dunbar RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree'to remove all new materials for inspection. Signature of Applicant: Date: 8/24/2016 TO BE CLASS "A" OR HAZARDOUS MATERIALS DISCLOSURE' I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 255 5, 25 25534.. Owner or authorizedagent: Date: 8/24/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed CONSTRUCTION PERMIT APPLICATION El COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255' G J P)=RTtNO (406) 777-3228 FAX (408) 777.3333 s bulldinci(8cuaerflno.orq u -EW col,, ucroN ❑ ADDITION ❑ .ALTERATION 1 TI ❑ REVISION J DEFERRED ORIGINAL. PERMIT 4 PRQJECTADDRESS 2 � r � `� �'"�'. �1 I APN R I [✓. u OWNERNAME ( 'Jj EMAIL STRE'ETADDRESS } y�� � CITY, STATE,Z�hrP.. -- FAX I CONTACT NAME PHQNE E-MAIL t .STREET ADDRESS CITY, STATE, JP FAX — a yam14- / El 11OtVN'ER.BUJLDER ❑ OWNTERAOEN'T Q CONTRACTOR ❑.CON'TRACTORAGENT Ad'ARCHITECT C.l ENGINEER DEVELOPER. TENANT ICENSE NUMBER LICENSE TYPE CONTRACTOR NAMEr w BUS. LIC R ., Q�l CO114PANY11A11L _ E-<4AIL u(': f (SCJ. .',�7 FAX STREET ADDRESS �3 . CITY, STATE, ZIP CEJ �J(C PHONEf;� !f G✓ � �% 4 � RCHITCT G��IttNEERNAME LICENSE NUMBER�j j Bus, LIC COMPANY NAME E -h -J AR. FArX STREET ADDRESS CITY, STATE, ZIP PHONE DESCTuPnoN OF WORK EXISTING USE PROPOSED USE - CONSTR. TYPE -- y.' STORIES I USE € [[[- TYPE OCC. E SQXT. I VALUATIONS) EXISTG AREA. NEWFLOOR AREA —1'5 !2 DEIAO AREA 1 TOTAL NETAREA c.y / 1 •.}. Lw N y 't1 I Do) I - BATHROOM ._ _YITCHEEN _ - OTHER . ... _.. _ _ _. . . REMODEL AREA RRMODFL.AREA REMODEL AREA �7 _ 1.3 _ PORCgAREADECK.AJUA TOTAL DECKJPORCHARE A GARAGEAREA: } ATTACH &I 6 r� ❑ ATTACH t DWELLINGUNITS: ISA SECOND UNIT YES SECOI:ND TORY ❑ YES (j BEL\GADDED?[]NO ADDITION? fiN2 PRE -APPLICATION YES IF QTS, PROM E COPY op IS TBE BLDG AN [I YE HOTtE? T -c I - - r TOTAL VALUATION: PLANTING APPL -. Q NO PLANNING APPROVAL. LETTER EICHLER _ .�. > _ s By si_nature below, I certify to each of the following: I am she pro. 4; -1' r or autllonzed gent to r on the . o'kYne lalf. I have read this my , .application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I aeree to comply ti ' all applicable local and state laws relating o building construction. I authorize representatives of Cupertino to enter the abjo�v�e-iide��wified property, for insp purposes. ordinances Date: Signature of Applicant/Agent: SUPPLEMENT RE' UIREDY�N ag _PL4R.CIiEC�T7P,E� ��d� IWIn�� 22 New SFD or Multifamily dwellings: Apply for demolition permit for ��(]� o� ER=��s catllrE�� J��'� � C3� N -il • s � ,. t r�,` wry } . existins buildings . Demolition permit is required prior to issuance of building t •,:yu F f.�, r., ...�, :.�L�"• .�,� Pell -nit for new buiEdinQ >A, kaPr:;s :=rte"c,LLPx>;.I�zE�.,F i: 2r ttv • " S� y Commercial Bldgs: Provide a completed hazardous Materials DisclosureF PUBLICitORNS p _ Tom. .-.�_.3� tib. _ -.a i.4 •F.tS'h -1� r'ik e 2a To= if any Hazardous Materials are being used as Part of this project. ��j � �zk; t , f r ; � �' '❑ © FIREDEPTI TARGE 9 ��4. 2i; i.� Copy;, a� ,`IlARYSES\ERDI'iiyC 4X — Copy of Planning Approval Letter or h1eedng with Planning prior to F RICT EMIR, k+ subuuittal of Building Permit application. =iikF.'t c�;3"a •-_dr�7 q. E do .:Z yo i ...c.... 1 E\� IRO\l�E!\1'.4L IiEAt,TIi � ,a. - _: a.+..;s, a•,.. , ».?° ...... ..I�.. Bldg-4pp 30.I Ldoc revised 06121111 1623 Wright Avenue Sunnyvale Ca 94087 Ph#: 408-735-1524 Fax . 408-733-1548 Feb $ 2017 City of Cupertino Building Division Attn: Building Inspector. Subject: 21103/21101 Tamarind Ct, Cupertino Ca, Pandey Residence. Final Framing Observation by EOR MHA Consulting Engineers Inc. Dear Sir, Date: 2-8-17 2,00 pm. On this date, final framing observation for the above project was performed by MHA Consulting Engineers Inc, We find that in general the overall framing and construction is substantially in conformance with the approved plans and specifications. We approve of the final structural framing and construction of this project, ITEMS REQUIRING REMEDIAL WORK (NONE IF BLANK) - %0F MHA Consulting Engineers Inc. MUM.% 4 1 T4 AMRIU, 4MOMA-145 44-0 SEE TABLE M.B.M EVENLY SPACED STAGGER 0 01d 0 0 F -n SIDE PL (2 REQD, BOTH SIDE) < w A500 Grd B ry STEEL BRACKET FOR FLUSH BEAMS AT EXT WALL DETAIL (BEAM 2B2 & 2BIO) %V * 30 14-�#01 M.B. EACH SIDE G,X18,xj- SIDE PL (2 REQD, BOTH SIDE) A500 Grd B STEEL BRACKET FOR HIP BEAM LRB3 67 C058502 rn m cr- ;u Xp. 4a/31," 8 OP bAI- I DATS Ot/08/2011 aw. 21103 SCALZ - NInc.TX. MHA CONSULTING ENGINEERS CUPETAMARIND CT RTINO CALWOMIA REV. 0 1023 WPJGRr AVENUE, SUNNYVALE CA 94087 PND RESIDINCE 408-735-1524 SK -1 mhaeng*attnet STHqM= STEEL PLATE FOR NOTCHED MHA Consulting Engineers, Inc. 1623 Wright Avenue Sunnyvale Ca 94087 Ph#: 408-735-1524 Fax: 408-733-1548 February 8, 2017 City of Cupertino Building Division Attn: Building Inspector Subject: 21103 Tamarind Ct, Cupertino, Ca. Pandey Residence Epoxy Hold Down Installation Observation by MHA Consulting Engineers Inc. Dear Sir, Date of Observation: 02-8-17. Time 2.00 pm. On this date, we observed the epoxy installation of Hold Down Anchors for the above project. 518" dia rods were installed and embed 18" for HDI -15, 12.5" for HDU2 using Set -XP epoxy. All rods were Installed in conformance with manufacturer's specifications and approved plans and specifications. If you have any questions please call. Yours Sincerely, /MHA Consulting Engineersnc'. I L43 14SY 4 Exp. 0 civil 16 . ' `V 'P" �ytJ14� r4l"12=14julz Building Department City Of Cupertino 10300 Torre Avenue Cupertino. CA 95014-3255 Telephone: 408-777-3228 Fax; 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST .. . . . . ............................ PERMIT JOB ADDPES :2110$ Tamarind Ct., OWNER'S NAME:Anand & Poonam Pandey . ...... ....... PHONE #4087181718-- -;NSE GENERAL CONTRACTOR: Homestead Construction, Inc. BUSINESS LICENSE CITY171 PCODE: Cupertino, CA 95014 L 'r%nDEQQ-10080Rtam Ave Our municipal code requires all businesses working in the city to have a City of Cupertino business license. . ) WILL BE SCHEDULED UNTIL THE NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors, Q. Date �lrp j;.t Please check applicable subcontractors and complete the following information: BUSINESS LICENSE # 40654 R -P �t mog�� s/3� 35602 3/17 Ml -;O 3 a- 7 f 7914 06/26/17 Date SUBCONTRACTOR BUSINESS NAME . . ............. Cabinets & Millwork Cement Finishing ElectricalKatherina Danek . . . . . . . ........... Excavation Marcelo Hauling & Grading ..... — - - ---------- Fencing Flooring !Carpeting Golden Hardwood Floor Linoleum " Wood Glass Glazing o Bay Shower S Heating All Fresh Temp Insulation Barreras Insulation . .. ... Marcelo Hauling & Grading Landscaping jLathing Masonry Painting/ Wallpaper MS Construction Ms Construction Paving . ...... - . . . ..... . .. . ... Peninsula Fire Protecting Inc Plastering Plumbing -------- - . . ......... . . ...... .... . . .. Roofing Septic Tank Sheet Metal . . ...... . .. Sheet Rock .... ...... . ....... Tile Owner/ ractorSignature BUSINESS LICENSE # 40654 R -P �t mog�� s/3� 35602 3/17 Ml -;O 3 a- 7 f 7914 06/26/17 Date CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: Poonam Residence Enforcement Agency: Cupertino City of Permit Number: B-2016-1678 'Dwelling Address: 21101 Tamarind Ct. City: Cupertino Zip Code: 95014 A: System Information 01 Space Conditioning System Identification or Name System 02 Space Conditioning System Location or Area Served Whole Uit 03, Building Type from CF -113 Single fami 04 Verified Low Leakage Ducts in Conditioned Space No, credit is nol taken 05 (VLLDCS) Credit from CF1R? Total leakage 05 • Verified Low Leakage Air Handling Unit (VLLAHU) Credit No, credit is not taken 07 from CF1R? Heating system method 06i Duct System Compliance Category New IV16-20a - Completely New Duct System - .. B. Duct Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity (ton) 0 02 Heating Capacity (kBtu/h) 39 03 Conditioned Floor Area served by this HVAC system (ft2) 753 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.06 07 Air Handling Unit Airflow (AHUAirflow) Determination Method Heating system method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage (cfm) 51 10 — Actual duct leakage rate from leakage test measurement (cfm) 43 ri 1 Compliance Statement System passes leakage test Registration Number: 217-A0266925A-M2000002A-M20A Registration Date/Time: 2017-08-03 15:47:18 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2017-08-03 15:46:57 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. 02 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 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 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. Visual Inspection at Final Construction Stage (applicable if system was tested at.rough-in) After installing the interior finishing wall and verifying that the above rough in tests was completed,.the following procedure must be performed 07 For all supply and return registers, verify that the spaces between the register boot and the interior finishing wall°are properly sealed. 08 If the house rough -in duct leakage test was conducted without an air handler installed, inspect.the connection points between the air handler and the supply and return plenums to verify that the connection points are properly sealed. 09 Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used. 10 Verification Status Pass 11 Correction -Notes for this table The responsible persons signature on this compliance document affirms that all applicable requirements in this table have been met unless otherwise noted in the Verification Status and the Corrections Notes in this table. D. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 01 I Complies: All specified verification protocol requirements on this document are met. Registration Number: 217-A0266925A-M2000002A-M20A Registration Date/Time: 2017-08-03 15:47:18 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2017-08-03 15:46:57 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: Darrel Kelly Company: • Date Signed:' Builders' Energy Services, Inc. 2017-08-03 15:47:18 Address: CEA/ HERS Certification Identification (if applicable): 1478 Bird Avenue City/State/Zip: Phone: San Jose CA 95125 408-202-9075 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The installed features;materials, components, manufactured devices, or system performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2 RA3, and the requirements specified on the Certificate of Compliance for'the building approved by the enforcement agency. 4. The information reported on applicable sections ofthe Certificate(s) of Installatioh'(CF2R)' "signed and submitted by the person(s) responsible for the construction or installation conforms to the requirements•specified on the Certificates) of Compliance (CF1R) approved by theenforcementagency. 5• 1 will ensure that'a registered copy of this Certificate of,Verification shall be posted, or made"available with the`building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I.unde`rstand that a registered copy of°this Certihcate,of Verification is required to be included with the documentation the builder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder/Owner): JONATHAN WEI CHIH SU Responsible Builder or Installer Name: CSLB License: Jonathan Su 681633 HERS Provider Data Registry Information r Sample Group Number (if applicable): Dwelling Test Status in Sample Group (if applicable) Tested HERS Rater Information HERS Rater Company Name: Builders' Energy Services, Inc. Responsible Rater Name: Responsible Rater Signature: Darrel Kelly "eell Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2005655 2017-08-03 15:47:18 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 for the accuracy of the information. Registration Number: 217-A0266925A-M2000002A-M20A Registration Date/Time: 2017-08-03 15:47:18 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2017-08-03 15:46:57 2013 Residential Compliance Schema Version: 2013.1.007