S 2734 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUI'I3RTIN(l BUILDING-ELECTRICAL PERMrf N0.
BUILDING DIVISION APPLICATIONIVERMIT
PLUMB C' _2734 7 3 A
I4UILI4ING PROJBf=1'IDEMI'14'ICA'L{IIh'- O 1 .7�F
ISDILDING A�DDIt/ESS�. �� OTX_ �T u ' SANITARY NO. API'3 /q Bytll'I'Aq)ATIi
Ifi' 640-'E3'& / 1y^
OWNER611111 PH NH: CONTRACTOR'S NAME: LIC NO:
NIC CONTNOLM
CIHTElj G PER: IC NO: ADDRESS: ❑
CONTACT: PHONE: _ BUILDING PERMIT INFO
_ ❑ Consultant Fees Paid by Applicant(Initial) BLge ELECT', PLUMB MECIIt
rl�
"]INS U LO ACTORS DECLARATION Q)y ELECTRIC PERMIT FEE
'LFJI �ODLr]D•F/SCR(LIy1QION 'L7d
Ill by t II I 1 hernial u d p '.'ons of Ch to )( ntcnu ng
�apz w'uM1S f ]Ogll t 9 ftle Boom " t yl"c w'r I'hltMl'T ISSUANCE R
Fyt W F in li II font A Jf e s 'FDWL 0 KITCHEN RHMODEI,
QUV IlmnsoC Llc.k APPLIANCES-It HSIDENTIAL. ❑ADDITION ❑PLUMBIN!IIH-PRIE
H 2 W Dmc Cunlro or
HQa ANCIII'IP.C'PSD CL ❑MULTI-UNIT GS'TRUCIURAI.
FSK lundc's and' y Plnnvnhall he used ns Iicre..Ns PANICS MODIIlCA1'ION
OZ4� UPT0200AMI'S ❑INTERIOR OCHIMNEY REPAIR
F� M Liceoaal Pool...oral 201-10n)AMPS IMPROVEMENT OSWIMMING POLLS
UWNIiR-BUILDER DECLARATION
Y� J OVER IINX)AMPS 0 BATH RI3MGDELIREPAIR El DEMOLI'I ION
p:Cad 1 hereby lotion that I mm aeotpl from the Conme...r's License Law liar the
X d U following reumn.(Section 7031.5,Biomass and Not..mot Com:An,cily or county SIGNS L•LI[CfRICAL ❑OTHER
3 y when myaircs a per'IJI In enmarint,alter,impm�e demmt.n,me ama'r any elmcftlre
4'�'�g Pri�rmiry issu:ume,oBn nyuims the applicam fir such pennif mflca,o,aadsmamcm SI'CCIAL CIRCUIT/AfISC.
Thal he is llcamed portend In the provisions of the Cnntacmis license Law(Chapter 9
W�00 Ivnmmuncingwith Scmion]INXgnf Divisionlnf lheeusiness and Rnfes.inm G,Je7 nr 'HINM METER OR POLE INST. COMMERCIAL'
a a e z that he is exand thcmfmm and the basis for the surged exemption.Any violation of 0 NEW RLUG/ADDITION 0 DEMOLITION
Wim Section 7031.5 by anyapplicanl(.,a .it suhjemn the applicam u+a civil penally of POWER DEVICES
❑TENANT POOU SERVICE
+rc Than f ft h promo dollars my
IMPROVEMENT
Sp} Fl I Its owner of the progeny,nnny employees with urges as their xJc cnmpanxnlioq SWIMMING POOL ELECI'k IC
4. will dnlhewnns.node: he Contractor's
License
sal apply
to to Insular
If ❑O"fHER
3m pandro Professions Calc:improves
thereo License Laws sucnotapplyaunr throof Ol1TLET5-SWITCHES-PIXTURIiS
progeny who milds or Improves t....hn,and who al, such work dal ,,amnio for
ht
his own e'npinyccs,pn+viAW that such improvements ore not In¢nded nr nRereJ Ino NEW RESIDENTIAL ELECTk SQ FT, i
sale lL however,the building or improvement is sold within One year of C'undaliun the SQ.Ff.FLOOR AREA e 5/SQ.IT.
er-huildr,will hove the harden of pawing that he did one hold or inanwa for pm-
five Talc.) Or'J
1] 1,see nwnm nl the Popery,;....rsda'mclY annual ling with I'mcnsnl amlmcamx
aorsonel l project(STWd Basin—andProf Code) he I- f I' )
I he'
r11lyt fp pry h b 'Id. p tl t d QTY. .' PLUMBING PERMI'P t ' PEC'
w �7 0
l t' f
earn JI u.
us Wah a an owam,)lia,u,dp pursuant dw d Dors -
Licutx l,uw. PERMITISSUANCE
O lone exe'np rnI Sec. ,B&P C forth is rues....
ALL ER-DRAIN&VENT-WATER(EA) VALUATION
Owner Who
WORKERSCOMPENSATION DECLARATION RACK FLOW PROTECT'.DEVICE i?', & 'Q3
'
I Armee following dcclanni__
J I h II girt ri f oleo ¢ u If os f W A ':COmpan DRAINS FLOOR,R00F.AREA,COND. STORIES 'I'YPH CON ULRUCI'[ON
L
mun, bu P,.)o l Lad ,Q ,for Ihe pert cr of the
is " r 41XTURGS-PER MAP
T 30700h1e f!ok IICw 1�1Ittin W AIIJQQ. Cnn Pc 1 "!�r wh hlh'! dhnSection
rsueJ. CAS-PLA SYSTEM-1 INC.a OUTLETS
My 'or n th^ ml 1. Ty I P OCG GROUP AI'N
C. far: Ca um ora GAS-EA.SYSTEM-OVER4(EA)
CIiNTII'ICATI:OF EXE FI'10 WORKERS' GNEASI%INDUSTRL WASTE INIiRCCPI'OR
pp COMPENSATION INSURAN F. UILDING ON FIIIiS
f logylin'It n e d'- ilia n ehundreddollarn($100) GNBASC'I'NAP
u ccnn
orlcsv.) PLA '1117 PE •�
In cit Lli't..am th ,h - a iica r'he Wokersual,lshall SHWF.R-SANITARY-STORM EA.2g)17,
nm enlpiny ratty person'n'uny n'mmvv sn nsm heanne subleeunthe Wndelv'Cnn'pe". E Y IE Y" �-
z 'all nm LuwenfCallfnrnla Dane WATT II EMIR W/VENT/ELEC'IR
yZy 2 Applleanl GRAD( i FEE
r7 ti NOI'I CH'I'D APPLICAN'E 11;otter making Ihle Land..te of EXantplinn,you should WATER SYS'FENUTRENTING
F~ hecmne subject la the Worker's Compemanno provisions of the Lannr Code,you must SOILS '.P.
WFimhwilll mntply with euchprovisinna nr Into permit shall he dcan'W revoked. WA'I'HR SERVICE
Q
7z QONSre is as ON LENDING AGENCY NEW RES IUF.NTIALPLM B. SQ.17. PAID Necciplp
U OIhcrehy off nn that there isoameWdian lending agency for paHimmmnco or
E-' the work for which this genu,i......d(Sea 3097,Ca.C.)
LamI Name TOTAL:
Lender's Address TOTAL: Or ..
1 sonify dood I have read Thi,applicmton and dale that the nMrve information to
h ntnecl.l agree In comply with all city and roomy ordinances ana.ame laws relating to Q'TY. MECHANICAL PERMIT PI31? / 7
U ,Z building connlrucuna,and hereby authorzm representatives of this city to enter urymfhc aMrve-mentioned pmlwnY far llmpcmion putpn¢. PERMIT ISSUANCE(We)ugrcerot save,indemnify and keep harmless the City of Copeman against ^[.�,liobilities,j mm�ln,cost.and expcnw,which may in any way accmcagaimlsaid City ALTER OR ADD TO MECH.
th eon
seg, n of the graining of tris permit.
N'PLPC. INDIiNS'1'ANDS AND WILL COMPLY WITH ALI NfN-POINT AIR HANDLING UNIT(TO IU,QMICPM)
MECHANICAL FEE
SOU I. IF. ULATIONS.
AIR 41ANDLINO I1NIT IOVHk 1(1,(XX1 CIM)
CONSTRUCTION TAX t
Signa ufAppl'sunllConlr;laI I rule EXHAUST HOOD(W/DUCT) •HOUSING MITIGATION FEE
HAZARDOUS MATENIAIS DISCLOSURE
Will thea"'Ia'moTForm,IFI'ling necupam store nr handle hm...I s'nale6al ((HATING UNIT'(r to inniSlooit I'U)
vs deGncd "'he Cnpen'um Mupicipal Gene,Chap r").12,and the Ha.00I anal Stokely
Cod,Smion 255]2(; A/) 1117STING UNIT(OVER I1gW01IU)
_G Yes �g�, i� VENTILA'T'ION FAN(SINGLE RESID) PAID Dlnc Rrecimto
Will the applicant or future building occupant use equipment or devices which
mil hurunlnus air cunueninum,as defined by be Buy Area Air Qualify Momgunwm BOILER-COMPOIAPOR 150,00FILFID T)..
ulntll BOILER-COMP(OVER 100,000R'I'U)
0 Yc.a Nn.
mad the h.rdo, ma n-nalslcyuiremenas under Chapterfi95 of Ne Coli- AIN CONDITIONER ISSUANCE IJAIT ^y
B+ H h.f Safety Calc,Seclion25585,25533 and 3531.I ulWenl nJ t of We NEW RESIDENTIAL MICH. SQ,PI'.
b dig mn currently have than it is my resrym.ihility m nsnl In peat
n the r�nenla rvhicM1/1)171 nm issuance uta Cemfi 's
0
there
o .— Dal TOTAL: ISSUED BY:
OFFICE
Brian Kangas Faulk
Engineers • Surveyors Planners
•
July 9, 1999
960069-50
Chuck Schoenberger
O'Brien Group
2001 Windward Way, Suite 200
San Mateo,CA 94404
Subject: Oak Valley—Foundation Verification
Dear Chuck,
On July 8, 1999 we performed a field.survey of the location of the foundation forms for the buildings being
constructed on Lot 5-40 and 6o�41_of the Oak Valley project in Cupertino.
`l
The results of that survey clearly show that the location of the foundation forms are consistent and in
conformance with the design location of the buildings, as said locations are shown on the plans prepared by
our firm.
This letter is intended to provide you with the verification of those units per our survey. If there are any
other questions conceming that location,please do not hesitate to call.
• Sincerely,
c0 LAND S
arm, U?,
AN KA K
BRADLEY A. StLB0 n \
Bradley A. Bilbo P.L.S. 6141 c EXP 3/31/02 1"IL
Project Manager .\, 110. 6141 'P
Survey Department
•
540 Price Avenue . Redwood City,CA 94063 . (6501482-6300 . FAX(6501482-6399
ENGINEERING WEST INC.
OBSERVATION CHART
OAK VA.LEY DEVELOPMENT CUPERTINO, CA,
1.24.2090 � PAGE 2 OF J
Lot len OPTION dn. la o�—hoof' n of Sec 4,r. nI aeeic Irm
5 1 t 3E 1 3 1 0 2599 Al0111 727/ 9 n 199 07 9
BMR _ U92lMg NIA
5 3 BMR 0 99 N1A
5 4 4C 2 O4.29•p9_ 07/01/99 09/24/99 10/01!99 1010,/99
A NUS 9• 06117199 9 .210 092299 10!11
5 A 111 4-09.99 00/14199 00/20/99 09120/90 0
5 7 5C 2/80NUS 2 04.29.99 06!11199 09/15/99 ' 09/15/69 tOg199
B 3 04 19/99 111! 9 09109199 09 6199 09(24/99
5 9 3D 2 04/19/93 00107199 D9/03/99 C9/03/99 09/21/99
5 10 6B 2/SONVS G4/1 D/99 0528/99 09/03/99 0910399 09/20 p
6 It 4c 05r27199 /9e —Ta—a9--/w
5 12 OD 3B0NU5 (14101199 0521199 OB2 U99 C823/90 09/1598
5 13 3C 3/80NUS (14/01199 06,17109 0 18/ 9 08/13/99 , —__ 09103199
14 6E 21EONUS 14101199 07102199 08/18199 08I181L9 0
5 15 3A 3 ON �S (14101/99 05/17/99 09/10/99 08112/99 08/23199
5 ^C 11! 19 1 9. -
117 4A 11/02109 12.23.90
5 18 = " ! 299 —Q-1 5-99
5 19 6C •itl l9 12-13-99 1-2 00
5 20 3C "1/02/9 12/02190 1-20-2000
21 58 _ 6 /16 0 1 114 p
5 22 1 7C I .2pleigg 9 7 9p 1.21• 00 ••21.2000 n. .
5 23 1C OB116/99 09117199 L2U•2000 ,•71.2000 d.n e.
1 A ^ D 9
10-4-99 1.10 2000 —1� d n.a.
5 25
• 5 _ '
5 27 iB 2 906129199 10/04/ 101 4/ g12-9-99
26 78 2 1)5/07/99 0829199 10/07/99 10114/99 5 29 1D 115.10.90 / 199 1 /18/99 ,011019 5 30 M 5 31 8AR 11 07n !99 1 2 •99 '10.2 -B 5 33 2A 3 Q 2107/99 07112199 11/0 /9 I 99 99 5 34 38 2 05/07/99 0723/99 11/08/99 12.1.9p 5 35 5 J ON ) ° 9 0 86199 ii-I 99 11.1 •99 5 363/99 078 199_ 11.12�9fi11.22.99 3F 2 9623199 0811 11.22.99 1 •99
A 3 09/18/99 1b8.99 12.6.80 12-10-99
--581J2199-
(1)
811219 -(1)LOT 6 PLAN 2A 8 LOT 7 PLAN 5C
010 NOT OOSERVE PIERS.
'(21DBL SIDED SHEAR WALLS
(3)FLR. NAILING
ENGINEERING WEST INC.
..consulting Engineers and Scientists onrE doa No.- r'g .z- E"7 o at 7-
425
425 ROLAND WAY PROJECT
OAKLAND, CA 94621 r 12�G C�c t Cr
(610) 668.4001 LOCATION
)r. rh vro
U % -Jr I C,^I l'rG"L+17 CONTRALTO OWNER
V ` Ctc�� J�rGI'IvrS '/ i%rn
Data J� Iy •3 rtt I`r99 Tl,,,,+rsda� WEATHER TEMP. .y�,PBI AM
h�'t, �O°at PM
Hours Charged To Project 2 Nuclear Density Tests �_ PREESnS�ENT AT SITE
C �ri11 Cr IG �` -7`cU � I rGr /�CY �
.Field Task Number • D%7- Concrete Cylinders
THE FOLLOWING WAS NOTED:
r7 $ rfp P_1I Co') IZ.Tt" ('X)I-1 /,ri 1 t-, 5`)F.Ct 6r I A,/'` 'Y S• 41U ati.P 5•y/l'
I n G r/C # I T /Y 7 r F r ) 'f-t•, -rc,-t z< l -�� 5/ra. �z . r^ c.cJr Yt !- a�%r r
/an 1S C1,1 `'/) Ofj . S c[ r f rnl rc - c / l hcicl GIGvJ`
jl r Cf� ITU Jf<P� Gin ,r✓ D�S�rUI'GT G // rG(l nr ' Cr r/ �,� hnr [n)rYr
i')-e/T'„ nn, ) /Cf C'/cr- r ic'rrf aFt G/al r c✓
�)G5 • � lJnlr✓ra �. �n �al '� .S-'70 C 'Lo r•, k ,rY ( oGh ,,G ) (L [
` oc_sP TZ •5 c, �2 a rc G7 /�o •TI f9,e a I
cc)1, n r. C tom=•s U_it •
•i"' C�.,�, l rrCt Ci C? 1-2,13 r.
't Oc IY If 17 L, r, ck A �Gf- •� 5 `// fe-L L, If Gfr'
r/ I
n ") S r)61- dr ) ht , iCo/ ° S• G 7, ", n r ✓ SoiS %c, � f
x Ncn� �+- �- )l `>�<iC e t - �rQ N ]P ✓i'art� rJc%>/ � r•,� = kf
t
GU. H� Ga t Z Q /✓ c' // if <n >> (crrr� -c.</ n -,r r
GGc.0✓,/ +-'l t tixCr rTi✓)i^PG X r •'I ( nr,t r'� /ICl 7 (.CP L�� r-'t 1 L:n V✓•f%1,� f
I r L CSC' t- i le-? 5 GZ,r 7GT e(C i• G/�u ,' 7 C!-Cc r-t cL•, C'F G< % f41 (-,L:, e-
CvFn r C.C,fr>Ivv� akL71QI r , t ` `x' !t r•Ir I rd TD rfl-L v- -t
�i_V1't t�.** r:v(r-rtti) ,...� ��,- Wil.(• + /Cr r r•r-t`' i...F �i�S Jt C'lllt
COPIES TO IREL � " � -TOO/ W`T
SIGNED +�,
CI IFMT
> 'BPZ EN
GROUP
4rick Burke
m, Jim Rlploy(SMTP:dploydg@pacbell,nol)
11 Monday, March 06, 1999 2:26 AM
PAT BURKE
JI ctt OAK VALLEY
Burka
Valley
anlno, CA
Irenca: Linear parkway planling,
lanungs wllhln Iho linear park sro conslsionl wllh
vectionIho documents prepared by this office and to
ndscape
vto lato d by the city
larch 1996 and conform with the preliminary approval doumonts,
es A. Ripley
y Design Group, Inc,
FINAL PLA14NIAIG s9GN 0�o
DA I E �
SIGNATURE
•
RD WAY,SUITE 200, SAN MATEO, CALIFORNIA 74404.2473 TIi EPIIONN(650)977.0300 FACSIMILC(610)3494442
p.vl�. { Marrh
I. t996
FROM CRMSJI FAX NO. : 6.313358325 Mar. 03 2000 09:18PM P6
Commercial Roof Alanakement San Jose, Inc.
• Resideniial Rool'Sysvcm Inspeclinn Report
Project: Oak Valley Homes Inspection Date: 312100
Address: 11.999 Sycamore Q.jv_e City: Cupertino State: CA
Client: The O'Brien Group
Contact: Pat Burke/Dan
Roofing Contractor: Rid-Ou: Boofina
CRM Inspector: Pharles Thomas
Lot Number: _241
Type of Inspection: FAA_ Final
Type of Roof: Como Shingle X Tile_ Other_
Underlayment: 301b. Slit Metal Flashing: OK Gutters: OK
Skylights: OK Attachments: 2K Vents & Pipes: QK
Valleys: OK Ridges: QK Eaves: OK
Comments/Observations:
Most flashings on this roof aria tight. There is a lot of sheet metal that is still unpainted,
but this is only aesthetic, other than that, all is acceptable. All gutters and downspouts
are in and look good. Workmanship is neat and professional looking.
cc: Rid-Out Roofing
•
POSTTHIS CARD NEAR FRONT OF BUILDING +'
CITY OF CUPERTINO PEgpIT NO. � �
BUILDING DIVISION BUILDING PROJI[CTIDENT}PICA-11 ,.�.M';
BUILDIFGADDRi. e ,., I . a/ SANITARY NO. AP4JtCjn'[ON S lhll ITAL DAI
.J U c.J'�. F✓L,.'.I'.�t �1� ;.:,'�i./��.,, C ci p lam' L �.i/��� / �/ Ll
OWNER^`JN PDONE'. CONI RACTOR'S NAME: LIC NO;
NIC x
CONTROL RCHITE NINEER: LIC NO: ADDRESS: ❑ L\CONN OL 1.
FF-,,, j,BUILDING P RMIITT INFO
INSPECTIONS - DATE.. .. INSPEC. ❑ Consultant Fees Paid by Applicant(Initial) RIDG ELECT PLUMB NIECH
FOUNDATION/PIERS/H.D.S. INSPECTION RECORD
JOB DESCRIPTION
UFERGROUNDQp NOTE: ALL GRADING AND DRAINAGE RESIDENTIAL:
PAD/SFT BACK CERT —1 SHALL BE INSTALLED TO COMPLY WITH ❑SFDWL [:)KITCHEN RENtODEL
THE APPROVED PLANS AND CITY OF ❑ADDITION ❑PLUMBING RE-PIPE
GARAGE SLABSTREGUNITE CUPERTINO STANDARDS. ❑MULTLUNIT ❑STRUCTURAL
MODIFICATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED TO ARRANGE INSPECTION ❑INTERIOR ❑CHIMNEY REPAIR
UNDERGROUND/SLAB CALL AFTERNOONS (1:00 PM J:3(1 Php IMPROVEMENT C]SWIMMING POOLS
❑BATH REMODEURF.PAIR ❑DEMOLITION
PLUMBING 777-3228 MONDAY TO FRIDAY 24 HOURS BE- ❑OTHER
ELECTRICAL FORE REQUIRED INSPECTION. JOB ADDRESS
AND PERMIT H ARE NEEDED WHEN PHONING.
DO NOT POUR FLOOR UNTIL AB VE HAS BEEN SIGNED COMMERCIAL
PLUMBING ATTENTION CONTRACTORS: D NEW BLDG/ADDITION ❑DEMOLITION
MECHANICAL NO PERSON(S)SHALL PERFORM WORK ON 01 ENANTEMENT (]FOODSERVICE
THIS JOB SITE WITHOUT BEING IN COM- BOTHER
ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION
FRAMING VENTS CL INSURANCE REQUIREMENTS.
INSULATIONSPECIAL INSPECTION REQUIRED ❑
INSPECTION DATE INSP.
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SHEATH/DIAPHRAM (77
PLUMBING
TUBS&SHOWER PAN
MECHANICAL
ELECTRICAL/POOL BOND
• FRAMING/STAIRS/E.EGRESS
INS ULATION/VENTILATIONJ�ocxr...,
-COVER NO WORKNN L ABOVE AS'BEEN SIGNED'•;
EXTERIAL SHEARMOLD DOWN III
INTERIOR SHEARMOLD DOWN
SHEETWROCK/SHEFTROCK SHEAR
EXTERIOR LATH/W-SCREED
SHOWER LATH
NO TAPE'OR PLASTER'UNTIL ABOVE HAS BEEN SIGNED
SCRATCH COAT
SEWER/WATER
TEMPORARY.'APPROVAIS, _
OCCUPANCY _
ELECTRICAL
GAS (�
;FINALS"e�:�''�r,�a��4'T�..7"�"3�? ' SSE.�Ix`s�.•.lin(p�.�a'�Nn'�S��aN'�;t.��>'S
GAS TEST
GRADE
FIRE.
HANDICAP
ELECTRICAL
PLUMBING
MECHANICAL
.9116 ENERGY
VISUAL FINAL ONLY CERTIFICATE OF OCCUPANCY
BUILDING Q IMPORTANT: ISSUANCE DATE
';OCCU - ING[SNQT,¢PERMI'CPED; PLEASE READ REVERSE SIDE BEFORE
'�,UNTI L 1S SIGNED BY BUILOING`� CALLING FOR FINAL INSPECTION!!
ISSUED IM
MAR-02-00 11 33 FROM�COAST INSULA"rIUN WAN JUWC ,Uz••no zoa � roo ��•- -• -
C _ INSULATION CERTIFICATION
•.�; .. ---- s • sa:•+ •roes. ca 95,12
Ice vvith current energy
s S rmar
*.Z '� tirei�e TIde�24.1nstaici in stateeof Calffom a, the buildingeloca[ed at:
regu�aUons'
'cam'
Thlckness(TYPe �� R Valut
1
r R-Vziue
T'htcknessfrYPe�—
PL
�Ear'ctrGlK_
Thlckness/Typo.2 �R-Value
TNcknesa'TYPe `; R-Valor _ y--�.---
-��L off. # Bags U,-.ad �0
•� �'ir - - SQ. Ft CovKed_1S+y't
tiR'\F'�'RAT.Ui T NS'A11ED: YES, NO
G t ret Lam`LICENSE
DATE
TITLE: �—
COAST INSIU ATION CONTRACTORS, INC. �7 LICENSEBY #
• TITLE r`�T DATE:
•
w�c3dJ�,�s
INSTALLATION CERTIFICATE (page 1 of 4) — CF-6R
Ile Address Permit Number
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).
HVA .SYSTEMS:
Heating Equipment
Equip. N of Efficiency Duct Duct or Heating Heating
Type(pkg. CEC Certified Mfr Name Identical (AFUE,ele.)I Location Piping Load Capacity
heal um and Model Number Systems 2CF-IR value attic etc. R-value (Btu/hr) Btuthr
ISI /-rlAR/a'1dL 3.// D !%ml2 .��J0
2ND - � . o � jr-M
1� Ly0
Cooling Equipment
Equip. CEC Certified Compressor N of Efficiency Duct Cooling Cooling '
Type(pkg. Unit Mfr Name and Identical (SEER etc.)' Location Duct Load Capacity
heal um Model Number Systems [2CF-IRvaluel tattle.etc. R-value Btuthr tulhr
/O SEPL 1(BZ�i _� O
3 _0 30 _L /o S�°R
I. >_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-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.
/_�/!/ail-•�� .��-r?r i'9 `f.fEKifOKl.f /�`f'h�iR.11d. 9� /��r�
Signature, Date Installing Subcontractor(Co.Name)
OR General Contractor(Co.Name)OR Owner
WATER HEATING SYSTEMS"
Distribution If Recir- Nof Rated' Tank Etfi- External
Heater CEC Certified Mfr Type(Std, culation, Identical Input(kW Volume eiency' Standby' Insulation
Type Name&Model Number Point-or-Use) Control Type Systems or Btu/hr) (gallons) (EF,RE) .Loss(%) 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 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
111.
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
T)....:....A TR......6 1 100(. .