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S 2604 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY ' CITY OF CUPERTINO IIUII.DINC-ILLECIFRICAL PERMIT No. RIJII,DING DIVISION APPLICATION/PERMIT rl.usu+lNr.-sutcxnwunl. �7 O 26C70 IIUILUING I'H(IJECI'IDN:MI' 9CAf1UN lJ IFALDINGN)URESS R. SANI7AllY NU. AI'1'LICA'I'IOY SUHM TTAL DATE J k)L (L OWNER'S Ni, ! IONH: CONI RAC ,R'S NAME: LIC NO'. NIC L'ONTROLN ARCIII) 'INERIC I.ICNO. ADDRESS: ❑ 22- / JN]'neT: - PllOrve RUII,DING ERA11'I'INFOqw V / ' /�� ❑ Consultant Fees Paid by Applicant(Initial) RLI)O- ElLCd?' PI,I1Mj1 N JI Anw Ad I.IC'1iNSED ONTRACIOR'SDECI.ARATION QTY. IiLECTRICPEIGVIT FEE - LrJ-✓ TI-yJ( 1 hereby affimr mm 1 a,.licensed ender pw,smr,of Chapin,9(eranmenring JOB DESCRIPTION nC'ZIh Seaton 711001 of Uivivi ,nano Huvincls m< 4 1 ndmyliwnsels : IDP TI •va P, PERMIT'ISSUANCE Q IW-ob int full tune and effect. gyp FOWL ❑KITCHEN RCMUDEL <UU Licenm Cl. Lic.p !A API'LIA ICES-RESIDENTIAL ❑ADDITION [I PLUMBING RIi-PHIE FZ LL] Dam Cnnvoclor Na0. ❑MUITI.CNIT ❑SI'RUCFURAI. ARCIIITECI"S HECI. ) F.,ptn PANI!I,S MODIFICATION m z " 1 enderstan my pion+shall M uvea as public reconL ZO,-� UP 2W AMPS ❑IMERIOR ❑SWCHIMNEY NGREPAIR POOL oz-, I='xx61 Licensed Prnf simnel _ 201.11h111AM1'S IMI'ROVI?MENT SWIMMING POOLS <W F� br,I m BUILDIe-va,17...c h.ARAIION OVER not AMPS ❑BATH REMODEIJREPAIR ❑DEMOLITION 2Cad hmeby.(Scot, tom eBurial from me Cemer,Coe:License Law,forthe YYY222,Y5555O�U which requires a permit t 703 amen.ainusc and demi Code Any city nr cnualy SIGNS IiLP.C'IHICAL ❑(YI'HEk whi h ray permit I , all• -improve.demolish. P Y t to mrc q prion t uL+ acquires thet hp mu iesignedamement SPECIAL CIRCUIT/h11SC. q� acnethat le Jpursu n II p- vi (i Claus'ler 1' 1 (CCudr)or (commencing with Suehon 7IXllR of Divi+inn3 oftheEmtneav anA l'mfessinncCWe)or '1'P.MI'.METI?H OR POI.li IN57l COMMERCIAL mat he iv eacntpt thereliom and the basic for The alleged exemption.Any violation n1 ❑NEW Ii 1.DG/AUDITION ❑DEM01.171ON �..y Section 70315 by any epplleant lura pmmi,seb,jerye con npplic.nt at a civil penalty at POWHIt DEVICIS ❑TENANT ❑ 'UOD SERVICE ~=QImol mare than five hundred dollars Want IAIPROVEMRN'I' U ,us owner ufthe prrpcnY,nnmyemployceswimwages av meirmle amnpen+ation, SN'IM1IS11NC 1'OOLIl.iCfRIC F willAu the wnrA,and the slruclllrelsnol inlendeAnrnl'les ered lisle B&c.70M,It c, ❑OTHIiR / gym and l f.. Code:The Contain,t :1 Law does nut applyt an owner at OUTLIi IS SWITCHES FIN IVRES i 3 property who h Id:or imp :thereon, d who does such work himselfor through his Own eForkyCeS, pinividial1Iat, 1 p 1,are nor'mutinied I,,afficroalFar NEW RESIDENTIAL ELECT k SQFT. � sale.If.however.lbebuddng or improvement is sold within one yearoftmopketion,lirei SQ.F..FLOOR ARE S/SQ.FF. erbuilder will have the burden of proving that he did not build or improve for pur- +�G^� sU O� �'7 pow it'ale.) G-�_ 1,as owner of the property,am exclusively avntractlng with licensed conbacm,s,yr 1(11 AI cortvwct the protect(Sec.70414,Rosiness and Professions Carol no Conlmnmz Li- ' veL,c,deux not up ply mnnownerof#,.posy w ho but ldcor 4upowes Farmc,:md QTY. 11I,UMHING PHRMI'I' PEE 4/10 Gl who commons husuch proteins with.conneen-+l licen al Inalmmno the Carolina'svl/ Licemc Law. PERMIT ISSUANCE. ❑ I um exempt under Sec. ,R.@ 1'C far hi....an ALTER-DRAIN At VIiNT-WATER Han VALUATION Owner Dam /k �o WORKER'S redly mCOMPENSATION ntent RATION SACK FLOW 1'IIOTECF.DEVICE 9J o ec dry affirm uain aCtnehy0f ltif ory anofmf.ir,cw ingdceWmanm: r It have ova will meimeinection 3c.mof Conwm m self-in.+„rcre wodels Comp'he DRAINS-1-1.00R.ROOF.ARiiA,CONE). STORIES TYPE.CONSI'k11C1'ION It l,os hicknaiiidedthis forby Section 3]ql of the Labor Corte,for Lae perfummnce of the work cir which this pcnml is i.oued. FIX'I'lIRES-I'ER'FNAP I have end will Cure. Inn Workers Compensation ofthwork hi h rcyuired by Section ' :$�� 1 37IN0dthe Lubar Calc.for the pcdomn:mm.fico.work for which this permit is is.vuul, OAS-I?A.SYSTEM-I INC.4CUBA!fS OCC.CNOUI' APN My Worker's Compensation Insurance carrier and Policy number are pp Carrier: Policy Nor: GAS-EA.SYSTE Ei :A) CERTIFICATE OF EXEMPTION PROM WORKERS' COMPENSADON INSURANCE BASIL i.WAS li NTEN'IJ+T�(It nU11,UING DIVISION fIIiliS (Thiasection nein not he completed Bear permit i+fnronc hundred dollars(51(#p F,) AI' or toxo.) :Asir ' 1 ;; 1'IANCHECK Piiii I rend,that in the Fell ance ol'Ihe watt far wbicluhispormii,ins nal,Isbell FR_�A IS YfiST((W.. 20)IT not employ any person in any manner so vvm o Na,bee subject mine Worker.V G,mlrcn- ENERGY PEE z satin.L.waofColtrunia.Dam '1'1:RiftA'I'SR WIVEM9ELECIR .� t] GRADING F z AFFlla,m - / = NOIICETOAPPLICANT.Il:Compensation this vilmasae of FLabor ion.ayneshould 'I'lik SYS'I IiM(fR1iATING ...-�� Sfl1LS hili H !� If beano¢suh,lect In the Wnrker'e Comlwrvvatino provisions n(me Labor GWe,you mint Ly fall hwith camnly win,such cu,kinurv,I i+Fcrmin'hull he decnrd rcvakcd. ng SyRY): a' z CONS'I'RUCfI(IN LENDING ACi17NCY NEW RESIDENTIAL PI.MR. SQ.i"F PAID 'J UOIherchy arrant llnll l¢micscunalrm'lnn lending ugvney lrralhe lxrinrmm�mof Dat Reveip,N F' the work for which this permit isissued(Sec.3119E Civ.C,,V - TOTAL: O U Lenders Name oll TGIAL: Lead—Address 1 cons ,c 1,ly rend Ibis application;cod+ale that lac shove Inmrelatirn is BUILD] ,yP UZcon,ea.lag,luiel .and wim allul anA urunDm1ivm,,cI and vwm law,,aaingm QTY MECHANICAL PERMIT FEE UZ nndn'rng wmm�mhom mint nonny l,wi,ad.e represemmivea grade airy manmr epan the SEISMIC IZl ahovnmentinned pmpeny fir in.vpeclian p°Twcv' PERMIT ISSUANCE (We).,are to save,indennify and keep hammdethe City of Cupertino against. :[ Iiahilkics,jmQuarals,Lot"and cxpenaca wlachnn,finally way uccm.againstsaid City AIA ITR OR ADD TO MECH. a. owyuence of the gmming of this pcnnit. PLUMBING I ;E APPI.ICNNIUNDERSTANDS AND WILL COMPLY WITH ALL NON-JOINT AIR HANDLING UNuFm lotion CPA17 SOILjC'1(1REGULAI'IONSf/) ,/ MIiC11ANIC .ITiE AIR HANDIIINGUND(OVER I0,I10OCFM) CONS]RucrO 'I'A% f 7 Sl,-WRe w ol Applicu lJ��----� )am �T EXHAUST HOOD(W/DT)UCHOUSING MITIGATIONI:F.L HAZARDOUS MATERIALS DISCLOSURE w'illme applicant or Farm building oiin aurrcar handle hteandair,mamriul HEATING UNIT F1 O joLuNI R'DH as JulineA by the Cupeeim nin"mc Glide,Chup¢r 9.12,and the Health nnJ Sufaty Codc.Senior 2553200^ l IH/d INC,UNIT(OVER 100.000 Ill U) ❑Ye, No VENTILATION FAN(SINGLE RESID), PAID Date Receipt# Will the applicant ranurc wilding omupant nw cyuipnsnl ar devius whieh BOILER-COMP(311P OR I1111.(IDO RTU) emit hamNans air lumtamina t defined by the Ray Area Air Quality Management '10FAL: )istrlcTl BOILER-COMP(OVER 100,000 ETU) El Yen ]Nn Ihmemad the haeunluu.v nnamriule requirement+ander Chapter 6.9ire the Cali- AIH CONDIIIONC.R ISSUANCE DATE f min He h h Solely Code,see 2550.5,25533 and 2.55J4. Persia I If the NEW ItF.SIDI?NTIAh MSCI I. SQ.PI'. l y builit nrncurmadyhavcy len tha it i.cnry resrym'bi y rnnlify tl m 7 r Ofit 9) cnn,' Ctllhic ml ace ofa Owner r dmd agent Date T0IAjF4q 71 ISSUED BY. OFFICE IYi. . iaJ._ iJ••.lrvl LI'.Cnll ..n11_vY� I"alLl. �1'- .SII r.L'C Brian Kangas Faulk Engineers . Surveyors s Plannens i I • Mnv7, 1P(W g600fi9-30 Chuck Schnenixrper O'Brien Uroup 2001 Wlowanl Wit v.Suite 2m) Sen Mateo,VA 94404 - Subject: halt Vnllay—Vnuo lathin YcrIRcntinn I)CAI,chuck, On May 6. 1O')'1 we perronned n Held survey of the Incadon of the ruundn(ion forms for Elie huildings being cnmtmcted nn LM 3.02 /(11. Lor 3.21. Lor 5-28. Lot 5.2q, Lot 543•nod Lot 1-14 ofthe Oak Valley Project In tbpenlnn. --- The resn ha of that survey clenrly show that the locallon of Elie fnundaliou forma are ccimlatenl and iu can fnnnonce with the derigo local inn of the Nilldings.as sAid locatlnns are she wn no the plans prepared by our lino. fids leper is intended to provide yrs wllh the verlricatinn or throe units per nor survey. If there Are Any other questlom cwnccming that locnllon.please do not hcaitnte to call. Slncereiv, �An'n r f'� EWID!EY1,B:LGO o '31J02 /fi IIRIAN KANIIAS Pl1ULK Itrndloy A. Rllho 6 14 1 Projccl Mnnnµer ,. 9ArvH'I)cparlln Cll! 540 Prica Avanca . Redwood Chy.CA 94063 . 16601182.6500 . FAX 16501482'6399 • f1F+'i'. 1.1999 19��;lrlhl -'fi IFNi t:FA i3nS FGLIL6: Ii0.4ii P.GAG ...Brian Kanuns Faulk Engineers . Surveyors a Planners May 7, luau 960069-5n Chuck Schoenberger O'Brien Grralp 1001 Wlnwurd Wnv,Suite2oo San Mateo.('A 94404 Subject: (Ink Vnllev—Fmmdition !'rrificagnn I enr('hurl., On Mnv 6. 19Qo we performed n livid survey of the location of the foundalion forms for the buildings being conslntcted on Lot 5.02/01. Lor 5.11, Lor 5-28. Lot 5-29, Lot 5.13.and Lot 5.34 nl'dtc Oak Valley project In('uperthin. The resulla of i mt purvey clearly show Ihnt the location oFthc foundation focus are consistent and io conformance with the design locmimn of the buildings. ns said Iocalinns ire shown on the pleas prepared by our prim. 'this letter is iplegcled ut provide yeu wilh the veriRcalinn of dense units per nur survey. If Iliere are any other qucslinus cnncaming that locullon,please do not 1lcaitrae to call. Sincerely, • r'0 - Li1NA n ! " /E4 D:EYl,eILGO�vj `" v 11RIAN KAN(iAS F(1lILF: ��r Cltlly` ' Bradley n. Rllhm P.1-5t,6141 Project Witmer Rfll'VeY 11epN'llnell'. 540 PrIC3 Avarua a Re0W0od City,CA 34063 a ;650)462.6300 . PA1(16501 582-6329 • I 7�•. ENGINEERING WEST INC. OBSERVATION CHART • OAK VA.LEY DEVELOPMENT CUPERTINO, CA. PAGE 2 OF 3 1.744000 1 Lot ien 0 TSN dr). st aor oo I 71 vl Sec Ar. nl aeic form 5 1 3E 3 032549 04/14/99 0727/99 072 /99 2 _BMR ,9211 9 N/A 3MR 0 / 1199 N/A 10/0149 5 4 4C _ 2 0429.99 07!01/9G 09/2448 10/0149 10111 S 6A JUS '4. 9. 9 6117199 09 .2199 09/:2199 ^q '(1) 4.20.99 OBR 49 09 0199 0 0114189 5 7 5C 2/d ONUS 2 04.29.99 06!11199 09/15/99 09115199 1010149 g 3 04 19199 061111 9109/ 9J�� 09/0B199 09 49 9 3D 2 04/19/93 08107199 09/03!98 C9/03/9g 092159 5 iD 68 2/BONUS (4119199 052B1D9 O(UO3/99 09/0349 09120199 3 5 11 C 3 04.20.9 5 7199 8 0/ 09/1549 5 12 66 3/BONUS 04!01199 05121!89 OB23/99 _CB(23/98 0910349 5 13 3C 3/BONUS (14/01189 O6 7!99 06/18/99 _C'9113/EB_ 14 6E 2!EONUS (4101/99 7102199 09/18199 08/181w9 082349 5 15 3A. 3 '70/ 'S (141 1199 05/17199 09/10/99 OB/12199 g �C -- 5 17 aA ' 1/02189 5 1B 5D 15-D0 5 t9 5C tl /9 1 •13.99 1- 0-200 5 0 OC "1/02/9 12102/99 21 58 _ 0 /1 10/14 D _ n 5 2' 7C 0671 !9 09 7 99 1.21- 00 •21.200 5 23 1C 06/18199 09117199 1.20.2000 1.21.2000 d 9. g 4 q p y.3! 9 10-4.99 1-182000 d.n,e. 5 23 10111 9 5 27 t6 05I0 199 198 10/041 1010419 1 14 9 5 28 7S 05;07199 082949 10137/99 1011099 5 2S 1 D ' 05.10.99 /09/90_ 1� 10/18/9 1011849 5 30 MR5 31 — 5 32 F3 AR 3 d 193 07x8!99 lo. 2.99 -r 10.22-9 047e D 5 33 2A 3 ')5!07199 07112199 11/0 /99 r 1 9.99 1. 5 34 35 2 05/07/99 0723199 11/09109 12-1.99 12.1.90 5 35 58 3160NU5 0 °99 0 86/99 11.10-99 11.10.99 12.6.88 5 35 12.999 5 7 3/99 07(2659 11.12_x© 11.22-99 1 14 5 3B 3E 2 ')5/13/99 OB/l�59 11.22.99 12• •99 121 6A 0 36/2!/09 Gall13 9 1Z8.9g 12.8.99 1241.89 $ 4D C 2lf30N'JS •J / 9 V12199 12.13.80_ 1 •13-99 5 41 3A 3710959 0623195 1-3.2050 1.3.200 (1)LOT 6 PLAN 2A✓l LOT 7 PLAN 5C •DID NOT OBSERVE PIERS •(21DBL SIDED SHEAR WALLS '(3)FLR. NAILING Fn!rn!NEFPWG WEST INC. kp . 617E JOB r16 Consulting Engineers and Scientists S 9 L 6)410-7 425 ROLAND WAY PROJECT 61#1L1 � / OAKLAND, CA 94621 OA`C VR1 S, ' u. o7ivr•r S • (510) 568-4001 LOCATO ^ To Q r�✓yen/ L��y uA Fie�y� Fi�S CO"T""CfOp ' oo OWNER /p SZU55 HCl.05 Dee?`n/C Date S/ 99 ( �,) cfla F✓�r i TEIAP. Cv f3 *at WiE�SENT AT SITE Hasa Charged TO Protect Z Nuclear Density TBBta/ C.�'On/z 1910 — Sr✓0 U 5 5 .v rd 5 Field Task Number l Concrete Cylinders ^r� THE FOLLOWING WAS NOTED, S,� l IE GJnJT,✓Y1LTd✓ (_ C i70 ?bJf-v S,r 6tic'� Gia ce.�a. Fo✓ 1,06rILA5 a.../ A 7 5 2g, Ste_ r . COPIES TO L/ �' � C'v rlficJ� 1� Q r SIGNED:' ` ptt R 1 1 t f fx + x+ .. C m.'x v< ..y..•.0 r s.v tt t �1 �F}l � l � ily � o � FIT rEI E' r r wt e l atelx 'm d+ V i14,141 1 ')1 1111, ¢t a l a R "if fBUl'kB � r � r � a }r„r s r o" (h# Yi' e� �` 9Yc��v)i` �' •}i r 1 t ��int R r ,�I�r SSM 4�tJ,j `tt��+ /l ..an3 'd"y1( wl., :i,3 ? 2t h 7• y t C 1. i q h xx1 E" bt Wx I � e+ `+� 1: m RI o SMTP ri lad r;�l �,I s I r� �I"r, `r r Ix, tl ski ?* d rr a) ?� Y,( P Y 9(�PacDell Hall a I aY� + �i�,` �Mondey;"March 001 1990 2:26 AWY!,' r i, 1. �+ a , I , ' xrPATBURKE it �,t i �y r I ,'~tw . S i t i,dz' rOAKEVALLEY#r„xP ,sJ vtll i'M1 +;K,i G'�i wEr"1 e itE e� [, i..,'� blr: 11C"� 1L3'l"Lf rilti I., %t)r Irl i t I +lJrpti� (. mnit}' �uar 1"1vin tsW + .!t) �. d,),1C? tl �ld Try . Ir�Ii f t) d' a 1 t y r S s� a IwoAn t61 F r t 9 k 'y �ka�/+y 41" E,a,`.,�y Ila/ H 1} I P VtY ♦ V 'r t t r { y � y OI CA11 F�8 it + tl VY VEf �t-t E"') Ibi r15 r} '"R t tri 3 i Ems. 1+ d`1 N#•P 4����y.!' yl i){ y n(V (�$i,li) �.)f`• r)7 t iat d $� m 1x+'3.W�.'t �n ,ir r ,t, 1 ti a }( ^^ 'i,r, 3 e EF b {4 a b ICO llna aR'pafkWay,plccanlln9IT t I $ LI 1k�Id 7 'ii .yvr�+8'.Fr Ph `rr rl �M f it Ik art Ings wllhln the-Ilnoar,perk erect"conalslonl wllh Iholtinclscapo" '-� � ' I' i ,a4 ) ' ' �tlon ddcumenls prepared by this office and rovlowed by the cl( l J.` I ' ' ` h 1998 antl conform wllh the pr,ollmineryapproval;doumanls I Y� r `� , YC "� ,rnl''i 1 C h"'„�a H a p r Ripley f�Pr”1176 �y r f ) ryCSiy9 WGtr ...m x .b `�.t x.belyd osignGro6pl i + t - .�td4r 1� yyi ro nitl;rl , r "tt :� l",1#dC+.r� 11 i axhi„rr (yl .da {t h,,r dr.tt rF �' Ix l yt . fIi"'TO. a 4 �j rrA 0t � ntJ CL I'j-1'R C 1 � " S,�Y '1 t � L✓ kP {b b �� N�l+a � y i n �+ .1 r I �y�� °Is r�l� idQ'P�.i,x dk `�1-ISA �� 9'b'�n4 itil�� I ..,u,43 1 U x �.r3� )1" 13 � a F i •Jl n r �rYYl I�l 3 i �Ilt'f r it l '�It�.. '�r x '�[ bt e " ✓n i i t Y a � ie d M ,...L tx x ....w♦ f ...w � t n qr W7 k-FC'" "'Y <` �v1, I X P` 1 t + 4 EY ,� 1 r Eta 1 q r ;ti 7{ r E � vr 4v"frY- � It7"xa caV x qk.l b0 r trp f". "4,v F I c M V b'1,d.11,) f afj�lt� N I!iIt J+ x y r Y I , ta }i 'Y x� FINAL PLANN'o�� y x n ) W R#V j Af 'q� rP t 1 f 1 �'-i IT 1 I t ✓5t. Y) + N r W v v♦ d y ��LVn k'3 C i t�tii _. }r � I i t - t � c F n ii ri tivt tf .. I rr q.f ds. < ♦ ._ ^'�1p1 t :'o ;' i. II f 1,; ° Y I 5 r i4d ) I M1I i t gqq GI'pIQ' 'nI Ir�� y Y 't M r 11 7 '�IGNATUR7 I( + t 1 i f " I 7 r 1 1 r , v 1 tt .h f d l 'r : W ,r 4i9IA`ii t kw —4) 3 d.if 11 ell' - '� wNt s3 x q r J V 1'i <°.1 t t r uI r j 1t ti, r� V 1 +{ r d t. ld v}lI I r F Ili I „l+ xr Ifirl >♦ . Ey. i'+S i f t a l l y .s 1 I x 1 � IY 8 .7 1 nP' i` +, H IC"i 1 ° r iWfi x 1 vilyl I f p. a II hail}�" adS rtiv.i i kF- x Pl t" t ie " 1 * ae I Y I 71 n t -tr e 'sari If n { t > lit ,a y u 4, I 31P ; l r .WI {i tY o', 'ft+ j id1�6'lf Ly i Ir11��, `Ir dll i iVAY SIIiTiI lea SAN MAT40 CALIHONNIA 1�4a4 2A73� 'TIILfiPIIONH(GSD)) 7 a30o PACSlh11La(G50)S�9 249Q'i `fix y-li r" ii + t i,� p a l i v IA d + W 1 t��� �� 3 Pr ' t � f " � 1 ♦1 SA�,K h d x�v '"'ia' rv�•. - . d.ar � �.'F + . _ ." ( .. . , _ -.vfiV ,{ "f .r I a : ,; OAST Insulation Contractors, Inc. INSULATION CERTIFICATION OK86 N. 11th St. • San Jose, CA 95112 This is to certify that insulation has been installed in conformance with the current energy regulations, California Administrative Code, Title 24, State of California, the building located at: SITE ADDRESS: LOT #5-34 OAK VALLEY FLOORS: Manufacturer OWENSCORNING/MV Thickness/Type 61 ,61 R-Value 19 199cla EXYERIOR WALLS: Manufacturer OWENS CORNING/MV Thickness/Type 3,� R-Value 13 CEILINGS: BATTS: Manufacturer OWENS CORNING/MV Thickness/Type 12 ,61 R-Value 38 , 19 BLOWN: Manufacturer OWENS CORNING Thickness/Type 15* R-Value 38 Weight/Bag 35 Sq. Ft. Covered 924 # Bags Used 21 AIR INFILTRATION SEALANT INSTALLED: YES ® NO l- GENERAL CONTRACTOR THE OIHRTAN GROUP LICENSE # BY: TITLE: DATE OAST INSULATION CONTRACTORS, INC. LICENSE # 465440 C-2 BY: itz TITLE: BS DATE: 12/13/99 K. B RUM O�vk d /ley J,4104,00 U-ileoly s INSTALLATION CERTIFICATE (page I of 4) — CF-6R Ak ress ermd um er An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required;however,use of this form to provide the information is optional.) After completion of final inspection,a copy must be provided to the building department(upon request)and the building owner at occupancy,per Section 10-103(b). HVAC'CYTS: Heating Equipment Equip, 0 of Efficiency Duct Duct or Heating Hearing Type(pkg. CEC Certified Mfr Name Identical (AFUE,etc.)l Location Piping Load Capacity hcal um and Model Number S leets CF-IR value attic etc. R-value tuthr Btu/hr 'S/ trJgR/AECurr�ea2 060 ?ND ! Cooling Equipment Equip. CEC Certified Compressor I of Efficiency Duct Cooling Cooling Type(pk& Unit Mfr Name and Identical (SEER,etc.)' Location Duct Load Capacity heal um Model Number S stcros F-1 R value atti etc. R-value Btu/hr mmv ST r n .ND .3pelzG030 �_ /O'St�R AT/7G y�e_ s, l O 1. >_reads greater than or equal to. 1,the undersigned,verify that equipment listed above is: 1) is the actual equipment installed,2)equivalent to or more efficient than that specified in the certificate of compliance (Form CF-1R) submitted for compliance with the Energy , Efficiency Standards for residential buildings,and 3)equipment that meets or exceeds the appropriate requirements for •manufactured devices(from the Appliance Efficiency Regulations or Part.6),where applicable. i'��� �.,,.� a�.27-99 YS�ctr'on�.r �1fin'Idt st A��:. Signature,Date Installing Subcontractor(Co.Name) OR General Contractor(Co.Name)OR Owner WATER HEATING SYSTEMS• Distribution IfRecir- gor Rated' Tank Effi- External Heater CEC Certified Mrr Type(Std, culation, Identical input(kW Volume cleric? Standby' Insulation Type Name&Model Number Point-of-Use) Control Type Systems or Btu/hr) (gallons) (EF,RE) Lass(7.) R-value 2 For small gas storage(rated input of less than or equal to 75,000 Btu/hr),electric resistance and heat pump water heaters,list Energy Factor. For large gas storage water heaters(rated input of greater than 75,000 Btu/hr),list Recovery Efficiency,Standby Lou and Rated Input . For instantaneous gas water heaters,list Recovery Efficiency and Rated Input Faucets &Shower Heads: All faucets and showerheads installed are certified to the Commission,pursuant to Title 24,Part 6, Subchapter 2, Section 1 11. 1,the undersigned, verify that equipment listed above my signature: 1) is the actual equipment installed;2)is equivalent to or more efficient than that specified in the certificate of compliance(Form CF-IR) submitted for compliance with the Energy Efficiency Standards for residential buildings;and 3)the equipment meets or exceeds the appropriate requirements for manufactured devices(from the Appliance Efficiency Regulations or Part 6),where applicable. Signature, Date Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner COPY TO: Building Department Building Owner at Occupancy