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B-2017-1551 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1551 20552 SHADY OAK LN CUPERTINO,CA 950140496(323 44 042) PELLE HEATING& AiR INC SAN JOSE,CA 95111 OWNER'S NAME: KODANDARAMAiAR RAVISHANKAR AND VENKATESH SU DATE ISSUED:09/12/2017 OWNER'S PHONE:408-393-2314 , PRONE NO:(408)978-7060 i fr_ENCEn(AtYT1tA OR'c nFcr1ARATff BUILDING PERMIT INFO: License Class C20 Lic.#809887 Contractor PELLEHEATING&AIR INC Date 10131/2017 X BLDG _ELECT _PLUMB X i hereby affirm that I am licensed under the'provislons,of Chapter 9(commenclug MLrCH X RESIDENTIAL_COMMERCIAL., with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: ADD(N)AC UNIT I hereby affirm under penalty of perjury one of the following two declarations: L I haveand 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 whioh this permit is issued. Sq.Ft Floor Area: Valuation:$5163.00 APPLiCANT.CERTIFICATION I certify tint I have read tilts application and state that the.above . Information is correct.i agree to comply with ail city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 323 44 042 representatives of the city to enter upon the above mentioned property for inspection purposes. (We)agree to,save Indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City In consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE O R Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.16. 180 DAYS FROM LAST CALLED INSPECTION. ti r //y� Signatu: . .1G c re—%�. " ' ' e$-12-2017 Issued by:Kim Dunlnr , ,, Dale:ill/ 2/2017 �RILILDER DECLARATIQB 1 hereby affirm that I ens 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 fast 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. i sate(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to constrict the project(Sec.7044,Business&Professions Code). Date:0-12-7017 I hereby affirm under pcnalty,;of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER s. I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as previdcd for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISG.OSURR 2. I have and will maintain Worker's Compensation Insurance,as provided for by 1 have read the hazardous materials requirements under Chapter 6.95 of the • Section 3700 of the Labor Code,for the perfonnance of the wcrk 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 a. I certify that in the performance atlas work for which this permit is issued,I Health&Safety Code,Section 25532(a)should i store or handle hazardous to an shall not employ y yperson in any manner so as to become subject to the air contaminants as defined bydhe Bay Area Air Quality Management District I Worker's Compensation-lawsof California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Cltnpter 3R.and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 255 • / Labor Code,I must forthwith comply with such provisions or this permit shall ( � c ,, ' be deemed revoked. Owner or authorized agent: .-- , -� rte'`: 6' Ap ICANTSERTJITICATIONi; Date:842-2017 /'� I certify that I have read this application and state that the above information is CONSTT, [ft T ,TIONLFNDING AGENCY correct.I agree tocomply with all city and county ordinances and state laws I hereby affirm that there is nstruction 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 grantinglot this permit.Additionally,the applicant understands CHITECT'SDES�kO$AT(QLK and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 916. I understand my plans shell Le uac,J aa publl.t ec.utde. Signature Date 2:12-_,•21L7 2 Proceed Professional \`' % GENERAL PERMIT APPLICATION MEP ..c, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ;-,f 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building(a-cupertino.orb MISC Ci)P.IERTIrio 8 l -,r B 5"5 1 0 PLUMBING 'I I�MECHANTCAL 0 ELECTRICAL + ❑MISCELLANEOUS PROJECT ADDRESS 2Oj�2 (S-t14c kI °a� Lrl APN1 r2 2 3 r if I -„ D l 11 OWNER NAME a PHONE G aJ E-MAIL �,�� S11c�v�� l0�'+-313~231y SIREETADDRESS20s 2 (1�_�A k oo Ln- caTY,STATE,ZIP S+v fnTi llCC, ew (351)1,4 FAX CONTACT NAME)essi CA V of`to CL , I PHONE go?, �V 6 ,qic 1O L•MALJ ..5 at, 11t�oI 4ci t,fit'f FAX YDO' fa /18OSREETADDRESS pg!—p"Ch i er park; c' Cf1T3 ..7OSl L� �Qc _l. ❑OWNER 0 OWNER BUILDER 0 OWNERAOENT t(CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER ❑,TENANT CONTRACTOR NAME S elle - - I LlcENSETIUMRERgovrri l ucENSETYPEc2O BUS.LICti . •COMPANY NAME jtt? 1 eahny r y � yW1MuJess)ca,Pe11eh�NJiDxstoh et & . 4 STREET ADDRESS 3151—D t✓to irT(e r poi r f CI' CITY,ErATE,ZIP San R'Je,at 4s-13(i, PHONE Wet"97 706 ARCHITECIIENGINEER NAME I LICENSE NUMBER BUS.LIC N' COMPANY NAME E-MAIL FAX smut ADDRESS CITY,STATE,ZIP PHONE USE OFSFD or DUPLEX. El MULTI-FAMILY PROJL'CT IN WILDLANO 0 VES PROJECT IN 0 YES IS THE BLDG AN. 0 YlIS BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER'HOME? 0 NO. DESCRIPTION OF WOItK Pc! '. 4: a - fir\ Ib Ali TOTALVALUATION: t5p t.'/��) � :t t.37 t-R.t.....-`"tE.di I- ✓Jff / 1tEZ FLt BQ$ F5S j n r ...,,. By my signature below,I certify to each of the following: 1 a,the property owner or authorized agent to act on file prlperty owner's behalf 1 ave read this , application and the information I have p. d,.is correct. "re read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to. il', .,. J ct`,.:.. t ize presentatives of Cupertino to eater the above-Went ted p.petty for inspection purposes. Signature of Appliwwit/Agent . / ,_/I/ aJ,/// Date: 'I/ , S.-PLEMENTAL INFORMATION REQUIRED N x .t:r:;::'p'='"a'�` ti �' 6 t ' er(>rcnt ti i I Olga:f'.. MN IMIX*.kkMeitintaUttl , cv? <7MB .-+,7 irY .,,,>-aSKw $s Nwx . MEPM1scApp_2011.doe'revised 06/21/11 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3) Project Name: Shankar Ravi Date Prepared: 2017-09-01 A.General Information , CF1R-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented,use one CF1R-ALT-02 document for each dwelling unit. 01 Project Name Shankar Ravi 02 Date Prepared 2017-09-01 03 Project Location 20552 Shady oaks Ln 04 Building Type Single family 05 CA City Cupertino ., 06 Dwelling Unit Name Shankar Ravi a x ; ! V y Dwelling Unit Conditioned 07 Zip Code 95014 1 08 I 2 1598 ,._u 4 i :Floor Area(ft2) V i ; I r Number of Space • 09 Climate Zone 4 , " 10 Conditioning(SC)Systems in 1 \" ': this Dwelling Unit: B.Space Conditioning(SC)System Information •gg 01 02 03 04 `05 '; 06' `°=g,1' 07 08 09 10 Is the SC,,# ,Jnstalling a ,__,. CFA served . ' ; friabi rah.sta . . � ., SC System SC System systema refrigerant Installing new SC Installing Installing Installing Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type Ravi Shankar Whole House 1598 Yes Yes Yes No No No Altered space conditioning system C. Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Diib) This section does not apply to this project. Registration Number:417-A020113800A-000-000-0000000-0000 Registration Date/Time:2017-09-01 16:12:23 HERS Provider:CHEERS CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-09-01 16:12:23 Schema Version:rev 10/16 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 2 of 3) D.Altered Space Conditioning System (Sections 150.2(b)1E and F) 01 02 03 04 05 06 07 08 09 10 11 12 Heating Cooling System Heating Altered Heating Minimum Altered Cooling Minimum Required New or Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency- Thermostat Replaced New Duct or Name Type Components Type Value System Type Components Type Value Type Duct Length R-Value No heating This field or This field or All new This field or This field or Ravi Shankar Central gas component section is not section is not Central split cooling SEER 16 Setback section is not section is not furnace altered applicable applicable AC components applicable applicable Required Documentation: CF2R-MCH-01-E-Space Conditioning Systems ..1 ' -Duct insulation requirement for the new portions of supply-air and return-air ducts or plenums R6(CZ110f 12 and 13)and 118(CZ 11 and 14-16) CF2R and CF3R-MCH-20-H-Duct Leakage Test required when heating or cooling components are installe iii. cted systems,or when more than 40 ft of duct length is replaced -Leakage rate compliance:<=15%or<=10%leakage to outside,or seal all accessible leaks. L -t5t.,-V CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15). CF2R and CF3R-MCH-23 Airflow Rate>=300 CFM per ton required when MCH-25 is required ' "'"' Exceptions: z' -Duct systems registered with HERS provider as previously sealed are exempt from MCH-20 Duct Leakage.:Testing requirements. -Heating-only systems and Air Handler Furnace changes do not require verification of Air Flow MCH-23,or Refrigerant Charge MCH-25. -Existing duct systems constructed,insulated or sealed with asbestos are exempt from MCH-20 Duct Leakage Testing requirements. E.Entirely New or Complete Replacement Duct System,wit'�i or'without Equipment Changeoiit(Sections 150.2(b)1Diia and 150.2(b)1E, F) $lh s`sect on does rip prilyi to`ti j project. F.Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) This section does not apply to this project. Registration Number:417-A020113800A-000-000-0000000-0000 Registration Date/Time:2017-09-01 16:12:23 HERS Provider:CHEERS CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-09-01 16:12:23 Schema Version:rev 10/16 CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 3 of 3) • Documentation Author's Declaration Statement 1. I certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: - - Documentation Author Signature: Jessica Valencia Jass'.ca,Vcaenrta' Company: Signature Date: Pelle Heating and Air,Inc. 2017-09-01 Address: CEA/HERS Certification Identification(if applicable): 3751-0 Charter Park Court City/State/Zip: Phone 6 • San Jose CA 9513A087,878-7060 Responsible Person's Declaration statement I certify the following under penalty of perjury,under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. L '- 2. I am eligible under Division 3 of the Business and Professions Code to accept responsibility forthe'building design or system design identified on this Certificate of Compliance(responsible designer).. 3. .That the energy features and performance specifications,materials,components,and manufactur d devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of.Compliance are consistent with the information provided on other applicable compliance documents,worksheets, calculations,plans and specifications submitted to the enforcement agency for:approvalwithWilding this ilding permit application. 5. I will ensure that a registered copy of this Certificate of Compliance shall be madeavailable with the building permt(s )issued for the building,and made available to the enforcement agency for all applicable inspections.I understand that a registered copy of this Certificate of Cbttiplienisce regui'ied`b be mtiuded v tth the damentation the builder provides to the building owner at occupancy. Responsible Designer Name: Unmatched Responsible Des�igne Signature: Jessica Valencia ° � ' JVaexcu Company: - Date Signed: Pelle Heating and Air,Inc. 2017-09-01 Address: License: 3751-D Charter Park Court 809887 City/State/Zip: Phone: San Jose CA 95136 408-978-7060 Digitally signed by CHEERS". This digital.signature is provided in order to secure the-content-of this registered- .-- - document,and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number:417-A020113800A-000-000-0000000-0000 Registration Date/Time:2017-09-01 16:12:23 HERS Provider:CHEERS CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-09-01 16:12:23 Schema Version:rev 10/16 \� // SMOKE / CARBON MONOXIDE ALARMS LOP OWNER CERTIFICATE OF COMPLIANCE yy�;,yss COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 9501.4-3255 (408)777-3228•FAX(408)777-3333•buildinq@a cur ertino.oro ;IioL77.qN11.a:;F '.:1�►xi,ja(',nI1,1I�! .., I' fl �.;. ' I'.5�•.-a:].,i,. . � .. Rjitr... p'! ,�{iK'h' j 'fd ` I;1T<E: o{rl{1i :i�lt� ''S f.A:lD.v.:1 rIL:;° ' tj01;10. Ii ¢6. 2V; •.3tr B g ' 'ta y jL4t J, 5iPaff�tt •01, I ' I.et ', ep e'mama A/,0 y { =n •.. mnm...R•meaumR.mm.a.Numr n...v..ew.ew..n�.T. . ... _ __ _..._. ,;{q,ye: . PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,R315,2016 CSC 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 Smol<e Alarms and Carbon Monoxide alarms. When the valuation of additions,alterations,or repairs to existing dwelling units exceeds $1000.00,CRC Section R314,R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke=Alarrns and/or ' Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s)—(Smoke alarms shall not be located within 3 feet of bathroom door) On everylevel of a dwelling tint including basements and habitable attics X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply:In dwelling units with no commercial power supply,alarms)may be solely battery operated. In existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above-referencedproperty,I hereby certify that the alarm(s)referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below. Address: 2o5S2 Lont Permit No.13-107_/C31 I Specify Number of Alarms: #Smoke Alarms: ,;j I #Carbon Monoxide Detectors: I I 1 have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name; Signature Date: Contractor Name; xdo, 7 Signatur Llc. .... ( .. ..Date:1V.07... Smoke and COform.dac revised 01/10/2017 JCERTCATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3) Project Name: Shankar Ravi Enforcement Agency Cupertino Permit Number B-2017-1551 (City of) Dwelling Address: 20552 Shady Oak Ln City. Cupertino Zip Code: 95014 A.System Information 01 Space Conditioning System Identification or Name Ravi Shankar 02 Space Conditioning System Location or Area Served Whole House 03 Building Type from CF'-1R Single family 04 Verified Low Leakage Ducts in Conditioned Space(VLLDCS) No,credit is not taken Credit from CF1R? 05 Verified Low Leakage Air Handling Unit Credit from CF1R? No,credit is not taken 06 Duct System Compliance Category Alteration MCH-20d-Complete Replacement or Altered Duct Systerrt B. Duct Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity(ton) 3 02 Heating Capacity(kBtu/h) : This fieici or section is not applicable 03 Conditioned Floor Area served by this HVAC system(ft2) 1598 04 Duct Leakage Test Conditions Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.15 07 Air Handling Unit Airflow(AHUAirflow) Determination Cooling system method Method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage Rate(cfm) 180 10 Actual Duct Leakage Rate from Leakage Test 174 Measurement(cfm) 11 Compliance Statement: System passes leakage test 12 Notes: Registration Number. Registration Date/Time:2017-09-25 14:09:29 HERS Provider.CHEERS 417-A020116485A-002-000-M20000A-M20A CA Building Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-09-25 14:09:30 2016 Residential Compliance Schema Version:rev 03/16 ON CF3R-MCH-20-H CERTE�F-!GATE OF VERIFICATION Duct Leakage Diagnostic Test (Page 2 of 3) C.Additional Requirements for Compliance 01 System was tested in normal operation condition. No temporary taping allowed. Outside air(OA)duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage 02 testing.OA ducts used for Central Fan Integrated(CFI)Indoor Air Quality ventilation systems,or Central Fan Ventilation Cooling Systems,that utilize dampers that open only when OA is required and automatically close when OA is not required, may configure the OA damper to the closed position during duct leakage testing. 03 If a complete replacement,all supply and return register boots were sealed to the drywall. 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All connection points between the air handler and the supply and return plenums are completely sealed. If the system complies using the Smoke Test method,the smoke test was conducted in accordance with the requirements 07 of Reference Residential Appendix RA3.1.4.3.6.Systems that comply using smoke test shall not be included in sample groups for HERS verification compliance. 08 Verification Status: -: all applicable requirements are met 09 Correction Notes: The responsible person's 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 Verificatio com iance 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 tact bedOgr,0'ilned to be rn coripltarrco= 01 Complies:All specified verification protocol requirements on this document are met. Registration Number: Registration Date/Time:2017-09-25 14:09:29 HERS Provider:CHEERS 417-A020116485A-002-000-M20000A-M20A CA Building Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-09-25 14:09:30 2016 Residential Compliance Schema Version:rev 03/16 ICFRTMICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3) Documentation Author's Declaration Statement 1. I certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Ken Frazier Kerr,rai%er Company: Date Signed: Golden State Energy Efficiency Service Inc. 2017-09-25 Address: CEA/HERS Certification Identification(if applicable): 1463 Circus Court RCN10076 City/State/Zip: Phone: Turlock CA 95380 209-648-2999 Responsible Person's Declaration statement I certify the following under penalty of perjury,under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. I am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification(responsible rater). 3. The installed features,materials,components,manufactured devices,'orsystem performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with the applicable'fequtrernents in Reference Appendices RA2,RA3,and the requirements specified on the Certificate of Compliance for the buildin approved bythe,enforcement agency. 4. The information reported on applicable sections of theCwrtifi�(s inst llation(CF2R)signed and submittedi by the person(s)responsible for the construction or installation conforms to the requirementsspecrfied on l7elertificate(s)of Compliance(CF1R)approved by the enforcement agency. 5. I will ensure that a registered copy of this Certificate of Verificaior s)iall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcement agency forallp'jijable inspections.I understand that a registered copy of this Certificate of Verification is required to be included with the documentation t Guilder provides to the building owner at occupancy: Builder Or Installer Information As Shown On The Certificate Of Installation Company Name(Installing Subcontractor,General Crntractor r Builder/Owner) ``-, Pelle Heating and Air,Inc. _,,,y, Responsible Builder or Installer Name: CSLB License: Jessica Valencia _ 809887 tri HERS Provider Data Registry Information Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable) N/A HERS Rater Information HERS Rater Company Name: Golden State Energy Efficiency Service Inc. Responsible Rater Name: Responsible Rater Signature: Ken Frazier Kevt Fra j.er Responsible Rater Certification Number w/this HERS Provider: Date Signed: RCN 10076 2017-09-25 Digitally signed by CHEERSTM. This digital signature is provided in order to secure the content of this registered document,and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number: Registration Date/Time:2017-09-25 14:09:29 , HERS Provider:CHEERS 417-A020116485A-002-000-M20000A-M20A CA Building Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-09-25 14:09:30 2016 Residential Compliance Schema Version:rev 03/16 LU N. ivt •j••, 0.1 N al Le O O -1-1 Ln o o T „al 0n w p D7 V '.H ro = m o r' n c - U, •c C u ti 2 0°7,0 ,--i c0 o G +� o a f0 N ,,,c3- y. t!1N in a v +, 0 o dl y Q Q Ov n_ o Cl. C a 3 0 tit O 6 ++ N LU U ii U C a E co CB u O 01 - >. 0 c Q- ) 0 IA iH Z (7 Q `U' C 473 U t H a 0 O.. 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Tr r j. cd d N o N v n « <03el D Y v C7 4 r U H cc U a Q m U V) -17 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct'Leakage Diagnostic Test (Page 1 of 3) Project Name: Shankar Ravi Enforcement Agency: Cupertino Permit Number: B-2017-1551 (City of) Dwelling Address: 20552 Shady Oak Ln City: Cupertino Zip Code: 95014 A.System Information 01 Space Conditioning System Identification or Name Ravi Shankar 02 Space Conditioning System Location or Area Served Whole House 03 Building Type from CF-1R Single family 04 Verified Low Leakage Ducts in Conditioned Space(VLLDCS) No,credit is not taken Credit from CF1R? 05 Verified Low Leakage Air Handling Unit(VLLAHU)Credit No,credit is not taken from CF1R? 06 Duct System Compliance Category Alteration MCH-20d-Complete Replacement or Altered Duct System B.Duct Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity-(ton) _ 3 02 Heating Capacity(kBtu/h) This field or section is not applicable 03 Conditioned Floor Area served by this HVAC system(ft') 04 Duct Leakage Test Conditions Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.15 07 Air Handling Unit Airflow(AHUAirflow)Determination Cooling system method Method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage(cfm) 180 10 Actual Duct Leakage Rate from Leakage Test Measurement 174 (cfm) 11 Compliance Statement: System passes leakage test Registration Number: Registration Date/Time:2017-09-25 14:09:07 HERS Provider:CHEERS 417-A020116485A-002-000-M20000A-0000 CA Building Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-09-25 14:09:08 2016 Residential Compliance Schema Version:rev 03/16 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3) C.Additional Requirements for Compliance 01 System was tested in its normal operation condition. No temporary taping allowed. Outside air(OA)duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage 02 testing.OA ducts used for Central Fan Integrated(CFI)Indoor Air Quality ventilation systems,or Central Fan Ventilation Cooling Systems,that utilize dampers that open only when OA is required and-automatically,close when OA is not required, may configure the OA damper to the closed position during duct leakage testing. 03 If a complete replacement,all supply and return register boots were sealed to the drywall. 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All connection points between the air handler and the supply and return plenums are completely sealed. If the system complies using the Smoke Test method,the smoke test was conducted in accordance with the requirements 07 of Reference Residential Appendix RA3.1.4.3 6 Systems that comply using smoke test shall not be included in sample groups for HERS verification compliance. The responsible person's signature on this compliance;do ument`aff rms that all applicable requirements in this table have been met. Registration Number: Registration Date/Time:2017-09-25 14:09:07 HERS Provider:CHEERS 417-A020116485A-002-000-M20000A-0000 CA Building Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-09-25 14:09:08 2016 Residential Compliance Schema Version:rev 03/16 F CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3) Documentation Author's Declaration Statement 1. I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Ken Frazier KewFrafde;- Company: Signature Date: Golden State Energy Efficiency Service Inc. 2017-09-25 Address: CEA/HERS Certification Identification(if applicable): 1463 Circus Court RCN10076 City/State/Zip: Phone: Turlock CA 95380 209-648-2999 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 Installation is true and correct. 2. I am either:a)a responsible person 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,orb)I am an authorized representative of the responsible person and attest to the declarations in this statement on the responsible person's behalf. 3. The constructed or installed features,materials,componentsorm:anufactured devices(the installation)identified on this Certificate of Installation conforms to all applicable codes and regulations and the frstallatro onfarms to the requirements given on the:Certificate of Compliance,plans,and e, specifications approved by the enforcement agency --5''.'16,T,',-• 4. I understand that a HERS rater will check the installat€ontoveri1'041ianceIand if such checking determines the installation fails to comply,I am required to offer any necessary corrective action at no charge tb tfiebuilding owner. 5. I will ensure that a registered copy of this Certificate of Insta'il4tion 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 understand that a registered copy of this Certificate of Installation is required to be included with the documentation the builder provides to the building owner at occupancy. a; Responsible Builder/Installer Name: Responsible Builder/Installer Signature: Jessica Valencia KervFro/1,4e' r Cauti%rorgoed) Company Name:(Installing Subcontractor or General Contractor or Position With Company(Title): Builder/Owner) Contractor/Installer Pelle Heating and Air,Inc. Address: CSLB License: 3751-D Charter Park Court 809887 City/State/Zip: Phone: Date Signed: San Jose CA 95136 408-978-7060 2017-09-25 Third Party Quality Control Program(TPQCP)Status: Name of TPQCP(if applicable): Digitally signed by CHEERSTM. This digital signature is provided in order to secure the content of this registered document,and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number: Registration Date/Time:2017-09-25 14:09:07 HERS Provider:CHEERS 417-A020116485A-002-000-M20000A-0000 CA Building Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-09-25 14:09:08 2016 Residential Compliance Schema Version:rev 03/16