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S 2846 AP4^LICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. BUILDING DIVISION APPLICATION/PFRMIT PLUMBING-MECHANICAL. BUILDING PROJECT 1111[NT'IRICATII3N BUILDING ADDRESS: �� 51 jSNkV NO. A PLICA'I10 Il MI' ,UATF:NIi CONT'RACTORS NOMI?: LIC N(l: 77 CONT Rol.0 ARCHI'Ii R: LIC NO: ADDRESS:IL Q � 15— CONUAC17. PHONE: BUILDINO PERMIT INFO _6� 11 Consultant Fees Paid by Applicant(Initial) It[DO ELECT' PLUMB MECII 8 ,GF.NSEDCo 'RALTOR'S DEChnRATION QTY. ELECTRIC PERM IT FEE bereny,dfirtm that Turn Iiacasm aadar nradtJaaa nrenupter 9(emamenot i, x OB D14SCRIPTION DOz with Scere](XXIIoct. 'nn3of thcllusinessa 1 -•.', de.ane mylicense in - F�� in In, l tome and eRect. PERMI'I'LSSIIANCE J-SO RESIIJENTIAI: N�9 License C, / Lic.;Y ❑SFDWL ❑KITCHEN REMODEL HQy Ume�Comrudnr APPLIANCES-It1151DI5NfIAL ❑AIIDHION El PLUMBING RE-PIPIT an ARCHITECTS DECLAR PANELS ❑MULTI-UNIT ❑5'IRUCTURAI. zoiaz I undersand myplane,lidl te,assails puhlicreconk MODIFICATION O'2'-p UP TO 200 AMPS F-�FW Laensea Pmfesumal El INTERIOR El CHIMNEY REPAIR OWNER-BUILDER DECLARATION 201-1000AMPS IMPROVEMENT E]SWIMMING POOLS ti 1 hereby aB1rn that I:nn exams tru n Inn,Conn.chain License Law far the OVER I(NXIAMPS BATH ODELBEPAIR ID DEMOLITION X 3,LL E. Following reason.(Section 90315,Hai inesr and paramount,Code:Any city or county SIGNS Ii1.ECl'HICAI. 4 tL 9 ti¢n which requires a permit m construct.eller,improve,demolish,or repair any stmnurc pr:ortoiaissuana.alsorequim,thmtpplicant for such permino file a signed waterome SPECIAI.CIRC41rr/MISC. 2�} tha he is licensed pursuannothe pnrvinions of the Contmoors License Law lCoapaNJ OW go (rommcncing wish Scation7000yaf Division3 aflhe Business'and Pmfesnions Gde)ar TEMP.METER OR PDLE INST. 6 y rB that he is exempt therefrom and the basis for the alleged exemption.Any violation of •W BLDG/ADI)ITION' y Sarson 7031.5 ny any nPPlic:mt Dv v pcmot nu'l.,Tho uppllcant m a O'd 'e ally of POWER DEVICES ❑DEMOi.I'fION It not mnrc Wan file hundred dollars($$WI. El TENANT ❑FOOD SERVICE �En ❑T,as owner of the propecola'my employees with wagesas theirmle emori' mtime. SWIMMING POOL ELECTRIC , IMPROVEMENT F will dothework,aad thearucmre is nm imm�JCA ar offered foraale(Sec.70uH,Business C..o ❑OTI I IiR a 3 m and Pry%he b Cts or The Conuhereo License Lew such misapply s if owner of OU'f1.liTS-SWITCHES-1gXTl1RE5 pmpeny who builds or improves thereon,and who arcs such work himself or Waugh his awn employees,provided that such improvements are not ithaded or offered for NEW R17SIDENTIAL m.uc rR SQ FP. 9 I sale.ll',however,lhebuildingerimprovemenl is sold within one yearofem,delion,the D SO�I•T.fL(N)R AREA S/SQ IT er-builder will have the buNen of paving that he did nm build or improve for pur- Ele of14%wle). 0 ❑ I,us owner nr the propary,am exclusively nnnmaing with Ikcnsea contruuom m 'TOTAL .� instruct the project(See]DW,Business it 1'mficiam s Code:)The Cnmracmr's I, come Low Jrcs not apply to an owner of pmpeny who builds or impmves thereon,and QTY PLUMBINGPERMIT FEET who contracts for such p projects wilts conoaanr(s)ficnn.cdpurstlam to the Canbareis License law. ❑I am exempt under Sec. ,B&P C for this reason PERMIT ISSUANCE Owner Dale ALTER-DRAIN&VENT'-WATI3R(CA) �j VALl1AT10N WORKER'S COME-12NSATION DECLARATION BACK FLOW PROTE ICE r S / /+ ` O I I hereby affirm under Penalty nr perjury one of the following decarmiam, \! v loavc oust will nnll.ain a Cerlifaam of Condon to sclbinsum for Worker,Co O,n. DRNNS-FLO0 (A ,CUND. aalian,as provide)Inr by Section 3'!00of the labor Cad4 fur We performunve of the "ENERG""FE CONSTRUCTION work for which this pcnnit is issued. FIXTURES-PER TRAP 1 hove ons]will n fttrc Wokers Cnmpe:salinn In ann cc,m mgmmd by Seelion 3900afllm tabu'COJ',f"'Impermanence of the work l arwhich this perrat is issued GAS-HA.SYST1iM-I INC.000TLIi My Wa lot.Compensation Insurance carrier and Policy number arc: APN �— Carries PolicyNoGAS-EA.SYSTEM OVFR (EA) CERN 1FICN'I It OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE GREASFIINDUS'I'RL WASTE 1 OR (This s,eneaneed and he complied if the marrom,loose bona ildallurs($1110) S ser less) GREASE TRAP I certify tore in the pcRnrmana oRhe wok Inr which this permit is iswea,I shall not employ any person in any manner so as to become.subject to the W..kers'Canpen- SEWER-SANITARY-S FORM EA.2W 4T. /_ O z s:nion Lows of C:dil'omia.D:nc WgTlilt BEAT ER WNEN'1'/LLGCTR �� O z Applicant GRADI PEE NOTICE.TO APPLICANT.If.after maki ng this Cenificite of Exemption,you should WATER SYSTFMfIHEATING a become subject to the Worker's Campansaion pmvisloro of the Labor Cafe,you mass SOILS FE rodnwitt comply with such provisions or this permit shall be diancti revokes]. Q WATER SERVICE JX * z CONSTRUCTION LENDING AGENCYNEW RPSIDEN'I'IAL PLMII. SQ.FI'. PAIDL) C) I hereby aflirm that loam isa construction lending agency Or the perfoniance of Reseiptk F the work fur which this penail is issued(Sec.3097,Civ.CJ Q V Leudet,Name IanJe2n AAAreas TOTAL TOTAL: - a I verity that I have mad This application and stale that the-Mice infonnalinn Is _ 'U greentBUILD ( F tip cancer.l ato comply with all dry and county ordinances and sale laws relating to building entmcdon,and hereby martinis,is,representatives of this city arcruponQ mtha TY. MECHANICAL PERMIT FEE SErsMLrF ' .L above- emionm property lar inspection patposex. PERMIT SSUANCE (We)agree m save,indemnify and keep h:umlesz the Ciry of CLpcninn against ELECTRI .FEE liabilities,jadgmena,costs send expenses which may in any way acme against said City rscryc sof the gaming of this peat. ALTER ORADDIOMHCIL I'LUMI NG PER APPLIC N UNDIikSTANDS AND 1 LCOMPLY WITH ALL ON-P NT AIR HANDLING UNIT(TO IO,UXICI'M) SDU .li ULATIONS. MECHANI L FEE �J AIR IIANDLINC UNIT(OVER I(1,1X1)CFM) CONSTRUC'ION'ITX Hgwturc of ApplicanUCoftempr Doc li%IIAUST HOOD(W/DUCq HAZARDOUS MATERINA DISCLOSURE HOUSING MITIGATION FEE Will theippllcunt or l'umm Withm,esca,me smon,houshe lararanus material HEAPING UNIT('TO Its)BOX)BTU as defined by the Cnpenino Municipal Cale,Chapter 9.12,and the Health and Safety Code,Section 25532(0)2 HEATING UNI"r p-t first BT1) ❑Yu 7 VE ,ATION FAN P_till» PAID Will the applicant or luta building valuation use equipment mdoctors which Dae Receipt M can hazardous air commoioana as dull aid by etc Bay Arca Air Q.altry Manugemcnt ROILEI P OFF OR I(M,0( 1 if +X DlSlrlct" r ❑Va BOILER P(O , I I(1, BTU) I have real the excitation'materials telmienants..tic,Chapter 6.95of the Cali. AIR CONI ONL'R foods I leak :Safety Cade.Sections 25505,25533 and 25534.1 unit ream at if the ISS AN DATE .11ITn eh ten •Elly hn cele Initisanym,spnnsihllityan fidytha accupam NEW RESIT IAL MECH. - FT. �' nrtbe yu et Ifiw nloissam.claCeri"t /J Y /y Own Int, -gem etc TOTAL: ISSUEDBY. OFFICE _ L - - - 21 NOY. 2.199c; 8r30r" 3P.14i KfdNuAS FOLLK NO.476 P.2/F Brian Kangas Wk Engineers • Surveyors • Planners November 1, 1999 �© 960069.50 chuck Schoenberger O'Brien Group 2001 Windward Way,SU No 200 San Masao,CA M404 Subjects OokValley—Foundation Verification Doer chuck On October 23 and 29, 1999 and November 1, 1999 we performed Is field survey of the loeallon of the foundation forme for the buildings biting constructed on Lots 5.16,5.17,5.19,5-19,ands. p`ofthi Oak Valley project In Cupertino. The results of that survey clearly show that the locadon of the foundation fortes are consistent and In conformance with the deaign locasicr of the buildings,as,said locations are shown on the plans prepared by our firm. s F. This letter Is intended to provide you with the verification of those units per our survey. If them aro gay other questions concerning that locator,please do not hesitate to call. Sincerely, LANo • ca�0 Uq� 0 f9ADLEYA.DILSO a BRIAN KANOAS FOULK 4 EN V31/02 � Bradley A.Bilbo P.L.S.6141 .r Project Manager No. 141 Survey Department PF OP OAUi 540 Price Avenues Redwood City,CA 94053 a 15501492-MM . FAX 19501492-0399 V 1 ENGINEERING WEST INC. • OBSERVATION CHART OAK VALLEY DEVELOPMENT CUPERTINO,CA. 8.1.2000 PA01520F41 UNIT Lot Plan OPTION I Fdn. 141 Boor Rootp Exl I Sae.Ar.n ash 5 1 3 325/99 /1 07210 B 5 2 1 BMR 09121199 N/A 2.8-2000 2-18-2D00 3.7-2000 5 3 BMR 09/2159 N/A 2.8-2000 2-18-2000 3.7.2000 4 4 07/0 4 1 119 10101!99 5 5 8A 21BONUS 04.29.99 08117/99 0922199 09/22199 10/11/99 5 B 2A 3 1 04-29-09 06/14/99 0920/99 09120/99 09122/99 5 7 SC 21BONUS (2)04-29-99 06/11/9909/16/99 0 / 10/01199 5 B 2B 3 0411959 06111/99 09/09199 09109199 09124/99 5 9 30 1 2 04119/99 06/07/99 09103/99 09103.50 09/21/99 5 10 88 2/BONUS 04119199 0588/99 09/03199 09/03199 F-0212212.9 5 11 4C 1 3 04-20-99 05127199 08129/99 08!29199 09128199 5 12 D IB N 04101/99 2159 08 319 15199 5 13 3C 3/BONDS 04101/99 0527/99 08/18199 08113/99 09103/99 5 14 8E 21BONUS 0410159 7 07/02/99 08118/99 08/1 199 08/29/99 5 15 3A 3/ ONUS 046159 05/1759 08110/99 0811 19 5 18 2C 116259 12.23-99 3.24.2000 3-24-2000 5.10.2000 4.27-2000 5 17 4A F08118t99 1 -2 - 3.22.2 0 1 •2 '4 5 to 5 12.15-89 3.8-2000 3.10.2000 5.10-2000 4.12.2000 5 19 BC 12-13-99 2.23-2000 2-252000 1-21.2000 4-8-2000 5 20 3C 1210259 2.18.2000 2-18.2000 1.20• 3-24.2000 5 21 58 DET.GA10/14199 2.14.2000 2-14-2000 5-10.2000 3.8.2000 5 22 7C 0912 1. 1• 0 d. .e. 1.28.2000 5 23 iC 09/1759 1-20.2000 1-21.2000 d.n,a. 1.21.2000 24 7A 210.4-99 1-18.2000 1-7-2000 d.n.a. 1-21.2000 5 5 -- - 5 28 5 27 18 2 QS/7/99D6/99 D6/29/99 101 4 10/04/99 10/1159 9 28 7B i 2 056759 08/2959 1010759 10114199 -TQ-114/f9- 20 01145929 1D 1 2 05.10-99 076959 10/1859 10118/99 10/18199 5 30 BMR 5 31 BMR 5 32 4A 3 712 10.22.99 10.22.99 10.27.99 5 33 2A 3 056759 07/1259 11/0259 10.29.99 11.8.99 5 34 3B 2 056759 0712359 1110859 12-1-99 12-1-99 535 5B 3180NUS 058859 07/26/99 11-10-99 11.10.99 12-8-99 5 38 5 37 2C 2 08/2359 07265 1.12.99 11.22-99 12 9.89 5 38 3E 2 06123199 08/1259 11.22.99 12.2.99 12.14.99 5 39 BA 3 088359 08/1859 12-&98 1246-B9 12-18.09 5 4 / ONUS 076859 08/1259 12.13.99 12-13-99 12.21.99 5 41 3A 076859 08/2359 1.3.2000 1.3-2000 2.18.2000 '(1)LOT 8 PLAN 2A 8 LOT 7 PLAN 5C (4)A.B's at porcn from •DID NOT OBSERVE PIERS. (5)chimneys (2)05L SIDED SHEAR WALLS '(3)FLR.NAILING • ZO'd OLST 962 Slob 1S31A ONYU33NION3 `dLS :ZO 00-ZO-unC uc�2u�iri0i lUEE11:37 F.iY 4(1 DOVE RILL ®AUL rA' immulfing Ernpineera and Scientis'ta / • N 4r ��abnG. .J CfyC-T 426 ROLAND WAY FROJ= OAKLANQ,GA"M O'k L., /I , (610)6661001 L.•AMN o ted. .u, 11n�rn„ ( r �71Si97�1ur�C1Ay WMAi x®r, ,/o oat AM TOM PAA owa Cow To P toot Q NI,dW C10n9ry T09@ rnuPeM 4 arta �^ G.c% c I o Gr ti,• cc (jrC HnGrn "Twkw ,bor •011' .us'� Cavo•aeoCNnwars G r eP • ,tiE FOLLOWING 11e48 NOIEp: . . ;2!L_C"> ,'P �` tl{ rG^ Cc,,r� eIf, • S• l(� Yhru.,rx1., S-�, ,n CIrM � 1 "� v'�1gF• 4y)1-�� ('-r:�,2(,IG ciV� '�,I•rRCy� 1,.y'C floe v'S i��P,,I- AJCy alQn•r s•, � "� `� _ �' t(C�CLd tY�c+h nL < 7 `--ij ilinitr+C, l ec•,1 ,5kt ) L `rIIIrt drlrc, -move G �.,+:a ,N M-„•L+ .1.� ,� k: rCGn, (< _SSr, •T'�'4i �•� C;fl„iH � ,(1 , 4' `..J,cLc CP �U CXt,YL, f , • `,J L.G1”[t'J• I� 1" �'TA _ I, , e _ I�lcr�e Su ,C Gil YI.� r•nuh• rS �_.+ __ 1.u1- '* 5- 17• �.��.+ C �c �, ,�i)c.l- Ll oil r..d case GI F;I;I-rte q CC( v,n,"tf .,dtd . � !! ( i,,., �:_i_r� r. e[ 'c'r 1J r', nr_ ✓'eOS< I�1c:lcx' � al "� •�:(.: we" h LJ,-n . V.c�, ., rti F i�� ,, rc.Y, c �Jv�l- G[.Crrw• • I•cr� for nil SFru.cla,. , _II J -rl tG 1- 'T•I ll SN , l,C i.,,.; L.Crr•L+('�-/./ y."iG+ +�GI I�rCa <.•• dz.vZcl .lr.() VG✓ r / ,tf ^ P 9 L+� JI' L.b1L4Y�lI �+.L�,, I<IrIL lK.Y11v'?it.. +cr reC4. 0I a4 p. ,ectc kcn . //.II 'T'l�t•'f if err ,,, eaC�N L CL•',I' c+v RPh [. -r{�r�r L 14, Jr 'rl� C,:Crrl� �yl, �drr'S (�\I to . .}� �a +.�• ''� cv. G� r "0 , YC Z(l DIS TO S GNEpyu _ • POSTTHIS CARD NEAR FRONT OF BUILDING CITY QF CUPERTINO PERMITND. BUILDING DIVISION2846 " BUILDING PROJECT I1' TINICATIOh ' BUILDING ADDRESS: 'i`, r-, It, SANITARYNO. APPLICATION SUBMIBTALC OWNEI V )E: PHONE: CONTRACTOR'S NAME: LIC NO: NIC CONTROLN RCHITE NEER: LICNO. ADDRESS: ❑ J : J .�� 1 r ! BUILDING PERMIT INFO INSPECTIONS DATE INSPE.C. ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH FOUNDATION/PIERS/H.D.S. INSPECTION RECORD JOB DESCRIPTION LIFER GROUND vt.�Q � NOTE: ALL GRADING AND DRAINAGE RESIDENTIAL: PAD/SETBACK-CERT O SHALL BE INSTALLED TO COMPLY WITH CSFDWL [I KITCHEN RF.MODI THE APPROVED PLANS AND CITY OF EI ADDITION [I PLUMBING RE PIP GARAGE SLABS/PREGUNITE CUPERTINO STANDARDS. ❑MULTI-UNIT ❑STRUCTURAL MODIFICATION POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED TO ARRANGE INSPECTION ❑INTERIOR ❑CHIMNEY REPAIR UNDERGROUNDISLAB CALL AFTERNOONS (1:00 PM 4:30 YM) IMPROVEMENT []SWIMMING POOLS ❑DATH REMODEUREPAIR ❑DEMOLITION PLUMBING 777-3228 MONDAY TO FRIDAY 24 HOURS BE. ❑OTHER ELECTRICAL FORE REQUIRED INSPECTION. JOB ADDRESS DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED AND PERMIT N ARE NEEDED WHEN PHONING. COMMERCIAL: PLUMBINGATTENTION CONTRACTORS: EINEW BLDG/ADDITION ❑DEMOLITION MECHANICAL NO PERSON(S)SHALL PERFORM WORK ON ❑TENANT ❑FOODSERVICE THIS JOB SITE WITHOUT BEING IN COM- IMPROVEMENT ELECTRICAL PLIANCE WITH WORKERS'COMPENS ATION OTHER FRAMING VENTS INSURANCE REQUIREMENTS. INSULATION INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSII PLACE NO SUBFLOOR UNTIL ABOVE'H S'BEENBIGN D ROOF SHEATH/DIAPHRAM PL NG 6v UBS& HO ER PAN RE Y50 _NjWffANICAL ELECTRICAVPOOL BOND • FRAMING/STAIRS/E.EGRESS: I N S U L AT I O NN ENTI L ATI ON 0417 COVER NO WORK UNTIL ABOVE'HAS BEENSIGNED'% EXTERIAL SHEAR/HOLD DOW INTERIOR SHEAR/HOLD DOWN. 97 SHEETWROCK/SHEETROCK SHEA EXTERIOR LATH/W-SCREF-D Cy SHOWER LATH WQPC2 !9!2 NO TAPE ORTLASTER UNTILABOVE HAS BEEN SIGNED SCRATCH COAT tj - SE W ER/WATER TEMPORARWAPPROVALS= OCCUPANCY ELECTRICAL �h GAS �FBJALS"t(Iw�ri>'?b�:F' ?"@.iI1Ry ly'}krLiy•"i GAS TEST GRADE 2 FIRE HANDICAP ELECTRICAL ' PLUMBING MECHANICAL • ENERGY VISUAL FINAL ONLY CERTIFICATE OF OCCUPANCY BUILDING CIV IMPORTANT: ISSUANCE D4rE . Y`J' PLEASE READ REVERSE SIDE BEFORE OC.VAN _ ' NG IS;NOT1PERMITTEDL�i3 UNTJLiIS§IGNED BY BUILDING;;, CALLING FOR FINAL INSPECTION!! INSRRI I3ei' d�a§ sill suenev AD01 10l1111,r 011rTlNln nnn,i 4. COAST Insulation Contractors, Inc. INSULATION CERTIFICATION • 1066 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: VIII +- S—SQ 64,IL ILMLIW //�� FLOORS:anufacturer OWENS CORNING/MV Thickness/Type c� I I R-Value �� 02.rdce. f I EXTERIOR WALLS: Manufacturer OWENS CORNING/MVThickness/Type Q I�Z R-Value CEILINGS: //� e� BATTS: Manufacturer OWENS CORNING/MV Thickness/Type to� Y- R-Value BLOWN: Manufacturer OWENS CORNING Thickness/Type 36 R-Value I IS Weight/Bag 35 Sq. Ft. Covered to # Bags Used AIR INFILTRATION SEALAN.TT IIINSTALLEDt: YES Ik NO F7GENERAL CONTRACTOR Lha UI�YtPA� (IYUW_ LICENSE # BY: TITLE: DATE : COAS INSULA9 CONTRACTORS, INC. LICENSE # 465440 C-2 •2 • BY: TITLE: DATE: / A �-- BP /GROUP Orka ------------------ Jim RIPloy(SMTP,rlploydp(:pacWll,nol( Monday, March 06, 1990 2:26 AM PAT SURKE OAK VALLEY y , CA, Linear parkway planting, s wllhln the HAW PIA ere oonelsloni with the londscapo n documents prepared by Ihis Once and rovlowed by the city D 996 end conform with the prollmlnery approvol doumanis, Ilar In Group, Ina FINAL PLANNING SI0GN .OFF , [SAYE; SIONIATUR�� SII I;111,S.AN MATpO,nALIMONNIA 111014.113 T"""ON"""1111-1100 FACSIMILC OM 349-2442 • p•�lu.t Mesh I, 1996 FROM CRMS31 FAX NO. : 8313358329 Nay, 26 2000 08:30AM P2 bl!N1;193G 0?:?5 4b5 i-'3n702 YA(Z 11 j • Commerolal Roof Manssement San Jbw,Inc. Ruiuienna!RoojSysreM fnspeulon Aaparr a,�I�vM.a�l T1+�ar►y Project: sa:-raanc Inspection pate: xe! 2e100 log Zg Address: 0% City: Cuoertlno State: CA Cltentt The �'Brlen Oroun Confit t:Pat Burne/pan Roofing Conoactor, IR t17p it CAM Inspector. "n*"V6010 Lot Number.9,^� Type of inspections Pelt Final Type of Root:' Shingsa T119 Air Other CO►41a.94+1N 4L46' Undanayment: _1_ Sht Metal Flashing; _W_ Outtsrs: �' Awe*" Skylights: -JL Attachments:,Q, Vents A Pipes: TD SW— Valleys: Ridges: ; I& laves:-,JLd=24roma-MOK-+ • CommonW' Obsewadons: R�-�Swt.�tls Qnfcr+�-r�} CesNLrs�+rrt�y -QJsi�r�y.a+a , Q am ,i -a e�w.o�wT a 10 FWD G. +►s_ �..L�a14"�otteJ is A, 8J t.4 P.a+rL.— C-eow e sloiv.e 6o cat- .v►-t'91' "A.n o.J co:Rltl-0ul RWMQ • INSTALLATION CERTIFICATE (page 1 of 4) — CF-6R Site Address Permit FluinDer 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 SYSTEMS* Heating Equipment Equip. g of Efficiency Duct Duct or Heating Heating Type(pkg. CEC Certified Mfr Name Identical (AFUE,etc.)' Location Piping Load Capacity heat um and Model Number Systems 2CF-IR value attic etc. R-value Btu/hr Btu/hr gj ?ND 7=7_IrNROGt/eYn-/A � . _2' 70 1QL JS 7L p6 Cooling Equipment Equip. CEC Certified Compressor 0 of Efficiency Duct .Cooling Cooling Type(pkg. Unit Mfr Name and Identical (SEER eta)t Location Duct Load Capacity heal um Model Number' Systems CF-IRvalue attic etc. R-value tu/hr tutor rST 3 � Z /D _ 2ND 3�c o ao �— ioQ 1 z.o0 1. >_reads greater than or equal to. I,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-IR) 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. ��'��u�� .�=zr-9y � rA�/9.r1✓' f/e�4�s. � ,¢/cam Signature,Date Installing Subcontractor(Co.Name) OR General Contractor(Co.Name)OR Owner WATER HEATING SYSTEMS: Distribution If Recir- g of Rated' Tank Effi- External Heater CEC Certified Mfr Type(Sid, culation, Identical Input(kW Volume elency' Standby' Insulation Type Name&Model Number Point•cf--Use) Control Type Systems or Btu/hr) (gallons) (EF,RE) Lose(%) 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 beaten,list Energy Factor. For large gas storage water heaters(rated input of greater than 75,000 Btu/hr),list Recovery Efficiency,Standby Loss and Rated Input For Instantaneous gas water beaten,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 Ill. 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 T0: Building Department Building Owner at Occupancy t '