S 1602 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OECUPERTINO ^' 1• RUILDING-ELECTRICAL PE{J 1602
IT NO
BUILDING DIVISION APPLICATION/PERMIT' t PLTIMDING-MECHANICAL.
BUILDING PROJECT IDENTIFICATION`
HUILDING AllDI2E55:
SANITARY NO APPLICATION SUBMI ITAL DATE
� Gf
L In ap
�o
OWNER'S NAME:' PHONE: CONTRACTOR'SNA LIC NO:
-0100 Owner 691511-B — A,
ARCHITECIf/ENGINEER: LIC NO: ADDRESS: ' El
J= CONTACT: - `+198r)I'NDNIf an Mateo CA 94404 BUILDING PERMIT INFO
7OOI — u Consultant Fees!`aid by Applicant(Initial) ig AG GLP.CT PLUMB MEC[[
Carry 11 r rr.
LICENSED CONTRAGTOIiS DECLARATION QT'I -ELECTRICPERMIT FEE
I li l y affirm that j m licensed code,provisions fchsper 9 caname g - _ JOB DESCRIPTION
QaZ cams [ vl>nol fD 3nnlieBas e,,cadP lea,mr.Cade,andmyleLsc¢ RESIDENTIAL:
IA O O PERMIT ISSUANCE
In full f IIT ct. 'DWL El KITCHEN REMODEL
(Wj U
License Clss tele x APPLIANCES RHSIDENTIAL 11 ADDITION ❑PLUMBING RE-PIPE
m Z Wer Dam Commen r
ARCHII F,C'S DECLARATION ❑MULTI-UNIT ❑STRUCTURAL
yb`.zI. IunderrlanJnryplvnsanall rheostat a,Ealiemeards
- PANELS MODIFICATION
OZ- UP TO 100 AMPS ❑INTERIOR El CHIMNEY REPAIR
X74 0 Licensed Professional - 201-IOOOAMPS IMPROVEMENT E]SWIMMING POOLS
a �
OWNER-BUILDEk DF,CLARATION
NN
.� OVER IlN10 AMPS El BATH REMODEIJREPAIR El DEMOLITION
a I harebY affirm Thal 1 um eBusin from the Camas Co License Law for the
O�V following mason.(Section'Io31.5,Business and Pmfwsions Code:Any city or couvty SIGNS ELECTRICAL - ` Ll OTHER
W W which quires p L I I I 11 p d I'.I p a,ancemrr
y�' pdo t t at, q In t i If hp itf g d t rancid - SPECIAL CIRCUIT/MISE.
�P.
that he,, cal pursuantt (lie provisions of the Contractor's LicenseLa (Chapter 9
(commencing with Section]WO)ofDivision 3 or me Bus'nes.,and professions Code)or IHM P.M FTFR OR POLE INST. IAL:
d ry,o C that he is exempt therefrom and the bads for the alleged exemption.Any variation of ❑NEW BLDG/ADDITION ❑DEMOLITION
Section 7031.5 by any applicant far It dram,oar ars the applicant In a civit penally of POWER DEVICES [-]TENANT ❑FOOD SERVICE
y naunore thio rive hundred dollars(S5W). IMPROVEMENT
aQ fibs.owner ofthe property,or my employees with wages as their..,lle cmmpecousm, SWIMMING POOL ELECTRIC
LL p.d wdl do the work,and lhestricrre is not intended or offered for sale(See.7044,Business OTHER
mand Pmfirwai ns Cole:The Contractor',License I.ow Joe,not apply m m owner of out'IIII'S-SWITCHES_FIXTURHS
property who builds or improves thereon,and who does such work himself or through his awn employees,provided that such imprwemOnN aro not imamded nr offered for NEW RESIDENTIAL ELECTS SQ FT.
eale.If,however,the huildins oimpfovemenl irsold within one year of completion the w SQ.Fr.FLOOR AREA $/SQ.FI'.
er4hadder will have the harden of proving Thal he did not bujld or improve for p r-
p se of xowne �6�
of prop I IYcontracting ra licensedcontractors m fff.��Z
�[l protect(S 9044 Bu.'n.s andProfessions Code:)The Coploadu,L
Law doc, t apply1 ani pon,cal, Iv.builds P thamorind QTY. PLUMBINCTERMIT FEE
whocontractsforsuchp jetswih a cont ttr(s)licensed puman to the Contractor s -I
Lwlro,Law. PERMIT ISSUANCE
Ll I am exempt under Soo.._.B A,P C far hjare o
Date !H_ BACKFOWPROTVENT-WATER(EA) 2�V AT10 �
WOk Lk5 COMPFNSN CCLAkAT10N I / BACK FhOW PROTECT DEVICE
Ili hY aB J p Ely fp 1 Y fm fill 61 lams
❑Ih I 11 and Crif t fC Idf W k :C pe DRAINS FLOOR,ROOF,AREA,GOND. STORIES TYPECONSTRUCHQN
soti .Provided frby5 1 3700 fib Late,Code,
,f
d t thepert 'rte d
Io
work have iill pc nissued.red. FIXTURES PER'CRAP
LII haveand will maintain Worker's Gtmphmariner, rut by
3700ofthe Lid, Code
ldr he pedonnuceitfthe ark fm which this missued
OAS-EA.SYSTEM-I INC.4OUTLETS OCC.GROUP APN
My Worker's Compensation In,umnee carrier and Policy number arc:
Cartier: Policy No.: GAS GA.SYSTBM- R4(EA) n
_
CERTIFICATE Of EXEMPTION FROM WORKERS' GRE DUST [NTE Pl'Ok
COMPENSATION INSURANCE x d BUILDINITINVl$1dNPRIS' -
(This section need no be completed Liao,gamin is porous,hundred dclfmrs($IW) GRE AP _
or less.)
PEG f
11
I torify that i u the performance of me work for which this pernit i,issued,l shall SEW SAMTARYJ S ARM_ EA V4(g Pr.
not employ any person in any mannerso m rat become subject to
Ino W.....4 Contpen- F.NPJtGY PEE �-
Q zi Nader Laws of California.Date - WATP,9 41 FATE RWIVE NT'/GLECTR
GRADING PEE
y Applicant I .
q h NOTICE TO APPLICANT.If,after making this Certificate of Exemption,You shouldWATF S 'L'M/fkP.ATING LI
becomm subject to the Workers Compensation provisions of the Labor Cade,you must SOILS FEE
fonhwilh comply with such provisions or this perionshall be created revoked. WATER SERVICE
OIQ CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.Cr, PAID
"z IhwehY off Inas mora isaeonswmion lending asrneyformeperreamtnecnr nIe Reeeiptp
Vi� the work for whirr this permit is issued(Sec.309E civ.C)
O .v U 1-tara Name TOTAL°
Lender's Address LL
FWI ce il'y Ilial I have read this application and-state that the above information ix - - RU U PGE
..fh amort.I agree in comply with an city sad countynrdinanre,amt ,an low,relating to Q'PY. - MECHANICAL PERMIT 'F'EE /.
U Z mildiagcanstmecon,and hereby cub ize representative,efmi,61y mentenrpan the I SL FEE
�r Au,smentirmedproperry far Insp jinn proposes.
(We)agrer ,m save,Indemnify and keep Initial...Ile Ca,of Cupertino against PERMIT ISSUANCE E T IC FEE
Iiabilitie,,jint,omnis,coslsandexpensns whichne,mirnyvny awrew against,aid City ALTER OR ADD TO MECH.
in n.,equencenr me gronfc,ofmjs pelma, PL M LNG FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO Iojsff CFM) 01 r
SOURCE REGULATIONS. MEC NICAL FEE
S AIR HANDLING UNIT(OVER to,"CFM) CONSTR TION'T ��/tv
Signature Applicant/ mlmetor O , EXHAUST 11001) W/DUCT-) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS CLOSURE
Will the'Plleantorfuwre building occupant stare or handle tensile.,maranal ][EATING UNIT(TO 100,000 BTU)
as defined by me Cupertino Municipal Cade,Chapter 9,12,and the Health and Safety
Code,Section 25532(x)4 I[EATING UNIT(OVER 100,000 B'I'U)
❑Yes VENTILATION BAN(SINGLERESID) PAID -
Date Receipt
WIII the air contaminants
in future building by the B use ea Air Quality
or devices which u i
emit hvardous air comeminants as defined by the Bay Area Air QmBly Mvnagrmua BOILER-COMP(3HP OR Ifl(I,IMIl18TU) TOTAL: J
DislridEl Yes BOILGR=COMP(OVER (l) OB BTU)
ihwe rend the haznrdlu enols rcyuircmena under Clmp¢r 6.95 ofthe Culi- AIRCONDHIONER - ISSUANCE DATE t
fnmlaHealth&Safety Code,Sections 25505,25533 and 255341 undenwnd mm if the NEW RESIDENTIAL MECH. SQ Fr.
building docs mol currently have atenv tat historesponxihilitymnotify medccupmn
oDher Iane7lenLc wl'd t Art
eofaCertjficamof cape /7
Owne ramhnrieed�enl T ' ISSUED BY L L C
OFFICE
Brian Kangas Foulk
Engineers • Surveyors • Planners
February 12, 1999
960069.50
Chuck Schoenberger
O'Brien group
2001 Windward Way,Suite 200
San Mateo,CA 94404
Subject; OehValley—FoundationVerification
Dear Chuck,
On February 10 Ord 111 1999 we pettormcd a ACId.survey of the Iocatitnt of the foundation 1brnis for the
buildings xi:'- constmcred on Lo;4.31 and Lot 432 the Cah Va:ley project in Cupertino.
The results of teat survey clearly show dial the location of the foundatior forms are consistent rnd in
conformance with the design location of Ilia buildings, as said locations arc shown on the plans prepared by
our fmr..
This letter is intended to provide you whit the verification of thosa units per our survey. if there air any
other questions concerning that location please do not hesitate to Call.
Sincerely,
' �r
BRIAN KAN6A3 FOCLK 9 MA0tU4 k D1L80
Bradley a gP.L.5.6141 41 UP, vnUG2 at
Project Manaagar er
Survey Department Jrq` 'I0.5:41
�F CAU@fit
5401'ricoAterue iedwoodClry,CP94000 1650)45262CC . Fk%t8501482-6999
(1 w FES.12.1999 9:12Rh1 3R:HI1 KRGAS F01ULK 110.761 P.2/2
w
Brian Wpe Feulk
En0lnoers • Sur GMS • Planners
February 12, 1999
960069-SO
Chuck Schoenberger
O'Brien Group
2001 Windward Way,Suite 200
San Mateo,CA 91404
Subject: Oak Valley—roundatlon Verification
Dear Cliuck,
On February 10 and 9 I, 1999 we performed a field survey of the Iccation of the foundation forms for the
buildings being constructed on Lot 4-31 and Lot 4.32 of the Oak Va'ley project in Cupertino.
The results of that survey clearly ehow that the location of the foundation forms are consistent and in
conformance with the design location ofthe 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 am any
Other questions concerning that location please do not hesitate to call.
Sincerely,
1 nrrU
se
BRIAN ICANOAS FOULK 8RADUT A.OiLBp xr
Bradley A. Bllbo P.L.S.6141 UP 3/3!/02 4
Project Manager
Survey Department sq Ya Er141
T
FOF
r
940 Price Avenue 9edwood Clty,CA 04003 • (050)482.670C • FAX V01 482-13392
Feb- 12-99 05: 12P ENGINEERING WEST - 408 295 1570 P .01
ENGINEERING WEST INC.
OAK VALLEY DEVELOPMENT CUPERTINO, CA.
FAX TO PAT FAX TO STROUS EROS.I FAX TO GONZALO
2-12.99 2-12-99 2.1249
660 277.0075 1008) 267 -1923 408 264-9692
DATES AT WHICH EACH ELEMENT OF EACH BUILDING WAS OBSERVED
AND FOUND IN SUBSTANTIAL CONFORMANCE WITH THE DRAWINGS.
N.O. • CONSTRUCTION NOT COMPLETELY OBSERVED
NA. v NO ASPECTS OF CONSTRUCTION OBSERVED.
N.I.C. • NOT IN CONTRACT. NO ASPECTS OF CONSTRUCTION OBSERVED.
o CORRECTIONS REQ'D. LIST GIVEN TO CONTRACTOR.
Construction release k1
set Lot I Plan OPTION _f - Fdn, I 1st floor Roof ply ExI.plyBasic frmg.
11 12 1 48 3 11113/98 12)10)98 01/21/99 01121,199 1/2670 -
1 1 13 1 6C 2 09128/98. 1 10/09!98 11/00/98 11/13/98 12/15/98
11 11 1 2A 2 02/02/99
11 15 1 5D 2 02/02/99
11 17 1 2C
1 1 19 1 8E 3 12/14/98 12/24/98
1 20 48 3/BONUS 12/22/98 2
1 23 1 3A 3 1112/99
1 21 1 81) 3/BONUS 1/12/99
1 25 2D /08
3 12!23/99 3
1 6 2D 2 01 /99 2/12199
1 27 4C 3 7108/99 02/05/99
1 28 88 3/80NUS 12/14/98 01/04/99
1 29 A 2 11/13/98 12/10/98 02/10/99 02/10/99
1 30 3C 3 t1/13/98 12110/98 02/03/99 02/01/99 ' S
1 31 5B 3/80NUS 2/12/99
1 32 28 3-1 2112/99
(1)-LOT 13 PLAN SC FDN. (OFFICE OPTION)
CORRECTIONS NOT OBSERVED.
(2) *LOT 20 PLAN 4B; ALIGNMENT OF UNDERFLOOR POST W/3-ML REQ'D. (GONZO)
(3)-LOT 25 PLAN 5C; 3 HDI O'S NEED TO BE RE-INSTALLED. (GONZO)
(5) LOT 30 PLAN 3C; DOUBLE SIDEDED SHEAR WALLS.
FROM : LANCASTER GATE PHONE NO. 408 445 Et.14 Feb. 16 1999 09:36AN P1
ATE ero.
Consulting Engineers and Scientists , 2-12 49
.rye AND -7�
425 ROLAND WAY Mq CT
OAKLAND, CA 94621
(510) 568.4001 i0 "0n
'n
O'ari rsn C'iM..P cow&-4p
auo�sa
✓O !v�
to �G�am� /11'1949 >r.day WEI A %W. y0'at AM
Glc ✓ 1. •V-at PM
bore CtHrOetl To Pro1901 �'•' Nuclear Density Tests PRESENT u&M
.L T ,
'44Task Number T/ r� Gsvete CyliMers
F •., sr
'NE FOLLOWING WAS NOTED:
- 6n S;le g:za,*d rbv- (aol;Yla„ abaexuc.h'm Aa -* 4-31 1s3 's
adnd AO.3a.C26'� ;e% Qw-ca N I X ngce Lo;ktn d)O 04: 5f-0&"db
(braHUAr-5 amdl `mak+.•» &P ft<Z 'nGer�' e5iL-- Wee^f- oyur Cw.iirfeG.w
nTrin....., �-
s r J ZgA garo r- l LMuc�[JCJ 1 Eke./ ' A o/d dmd:?v%s 4-. d
TMhai- - eat. !f-{wins Ccnmc�I-I /hsl-nlled. :rWs.�ed :rUah all
�t71-;h a S Lyl�r2_ ISEn v-i��. ;r F,n �;r vv1 LI1,n.w�P kwn.6• yVtdle.ri a l
Q,rtd Th a h a /l 6a iu ru fxo( /►'h / uk+s ,rrr>eaeot fh,�
yrl`&^ ra;hb . concarrd 6ce in
AhOi'f(i T r�' h` 1 a/
our 1, w Ep-- w—i Ate! / omrnr andcc f�r'or+ S
x SCAB td.l l e d ra r e kA r to U -rb,+�,ar-rrny ie�n Fw� Cawe�.re l�
TlaLc ,ynl,�..l- In s oi�+
:)PIES TO
SIGNED U •
ORIGINAL i 08403/Z
1 dBPJEN
GROUP
Patrick Burke
From: Jim Ripley[SMTP:dpleydg@pacbell.net]
Sent: Monday, March 08, 1999 2:25 AM
To: PAT BURKE
Subject: OAK VALLEY
Pal Burke
Oak Valley .
- CuperUri CA
eference: Linear parkway planting.
Ta I,
All plantings within the linear park are consistent with the landscape
construction documents prepared by this office and reviewed by the city
on N'--ch 1998 and conform with the preliminary approval douments. �\
James A. Ripley
Ripley Design Group, Inc.
' c
FINAL PLANNING SIGN OFF
DATE
SIGNATURE°
Enpinesr4 • Sarve�yora ••Planners
February I:, 1999
960069.50
Chuck Schoenberger
O'Brien Group
2001 Windward Way,Suite 200
Sen Mateo,CA 94404
Subject; Oah Valley—Foundation Vorlfieation
Dear Chuck,
On February 10 and 11. 1999 we pedorrncd a field survey.of the location of the foundation i3rnis for the
buildings beiag con mored on Lo;4.31 and'Lot.1.32 of thh j k Va:ley project in Cupertiro.
The results 01`611.survey clearly dtow drat t—he'loca rof the foundation forms are consistent end in
conrormAnce widt the design Idcadon of the bulldings,as said locations aro shown an the plans prepared by
our fins .
This letter is intended to provide you with the vcrincation of those units per our suvey. If there a e any
other questions concerning that location please do not hesitate to call.
Sineetely,
cP 1Ar:0 8
G dp
BRIAN KANGAS FOL'LK 0P�D11'f,01:80
• Bradley A. Bilbo P.L.S.6141 * Up. 3/31/02 a'
Project Manager
Survey Department r� Yp 6:41 T
of
•
940 Pries Averue gedwood City,CA 94009 1650)482.82C0 • FkX 16501482-E399
•
�i lJ 1UZ--Ja U.J : L.Lh. LIVI-..1.YC.LL LIVIi WL' ii .-IUU ci_J 1�/ J 1' . .. ._
ENGINEERING WEST INC.
OBSERVATION CHART
OAK 'JALLEY DEVELOPMENT CUPERTINO, CA.
• PAT SURKE STRAUSS BIOS. PAGE 1 OF 2
07101/98 07/01/99
850 2]7-00781(408) 267.15 23
THIS CHART INDICATES THE DATES AT WHICH EACH COMPONENT OF EACH BUILDING WAS
OBSERVED AND FOUND IN SUBSTANTIAL CONFORMANCE WITH THE DRAWINGS.
LEGEND
N.O. ■ CONSTRJCTION NOT COMPLETELY OBSERVED
• CORRECTIONS REO'D. LIST GIVEN TO CONTRACTOR.
FDN. ■ STEEL R;:INFORCING, HOLDOWN ANCHOR BOLT OBSERVATION
1 ST FLOOR UNDERFLOOR FRAMING OBSERVATION
ROOF PLY. _ PLYWOOD NAILING OBSERVATION
EXTERIOR PLY. ■ PLYWOOD NAILING, HARDWARE OBSERVATION
BASIC FR G. ■ GENERA,- FRAMING AND HARDWARE OBSERVATION
NIT Lot I Plan TOPTON Fcn AB' st uor Roofpho Ext ply I Basic 1rm .
6 /1=9 99 U6124/990
4 8 1 7C 03/10/99 04/14/99 06124/99 08124/99 07101/99
4 9 1 SC 3IBONUS 03/10/99 04/14/99
_ 4 10 20 303/01/99 04/02/99
4 11 38 03/01/99 04102/99 07/01/99 08/30/99
4 12 4B 3 11/13/98 12/10/98 01/21/99 01/21/99 01125/99
4 13 6C 2 09128/98 10/09/38 11/00/96 11/13/98 12/15/98
4 13 6C ADDITiON • 1 02.109199 02/09/99 02/09/99 02109/99
4 14 . 2A 2 02/02/99 03101/99 05119/99 05/21/99 06/04/99
4 1 15 1 5D 2 02/02/99 03/08/99 05127/99 . 05/09/99 06109/99
4 17 1 20 1 03/01/99 03/30/99 06/17/99 06/30/99
• 4 18 1 6E2/B2NU5 12/14/28 12/24/98 03/06/99 03/08/99 04/12/99
4 20 48 3/BONUS 12/22/98 04114/99 03116/99 03/22/99 1 04/14/99
4 21 28 i 2 03119/99 04114/99
4 22 5A 2/BONUS 03/19/99 04/14/99
4 23 3A 3 01/12/99 02/16/99 05/13/99 05-07-99 06/01/99
4 24 60 3/BONUS 01/12/99 02/17/99 05.03-99 04.30-99 05/171%
4 25 5C 3 12/23/98 0216/99 04/02/99 04/05/99 05/14/99
4 26 2D 2 01/08/99 02/12/99 05/10/99 04/26/99 05/11/99
4 27 4C 3 01/08199 02/05/99 04/14/99 04/12/99 05.07.59
4 20 68 31SONUS 12/14/98 01/04/99. 03/03/99 03103/99 03/3C/99
4 29 7A 2 11/13/98 12/10/98 . 02/10/99 02/10/99 03/03/99
4 30 3C 1 3 1 11/13/98 12110/98 02/03/99 02/01/99 03/11/99
4 31 58 3/BCNUS 02/12/99 03/18/99 06/03/99 06/09/69 06/17199
4 32 28 i 3 02/12/99 03110/99 06/11/99 0&'17199 06/3C/99
NOTES:(PENDING ISSUES
(1) •LOT 13 PLAN SC FON. (OFFICE OPTION); CORRECTIONS NOT OBSERVED.
-
_ DATE IJO13 NO
:onsu/ting_Engineers and Scientists 'T
PROJECT
425 ROLAND WAY }� '
OAKLAND, CA 94621 LOCATION
(510) 568-4001 c
CONT OWNER
ri fidl �JYt'1[-a.�
Ile Fe 6gA a '�/ f� Pt'O(Qy WEATHER TEMP. y06at AM
,at PM
Glle r so
PRESENT AT SITE
xus Charged To Project �" Nuclear Density Tests
A Task Number 'r� Concrete Cylinders $r
N
-lE FOLLOWING WAS NOTED:
Dn 5*. I•e a � alr
s rceeol Fbr �F;na. obseryahrn .cops N-3t
Mt 32.! 2a'� ;'A area 0 1 '_' 5F-rt/—AA,5
1�1.0K� a.hd 441-YI OZ^ Coi �✓1� eCA-4'V% wCs�' Lt)eNLti<' bL)e�1�' C:t.{.rYItAA'��
r s , atZ&LA m kd Fav- al :5 ru.e.Fw,
"M1�a(- 'M.tst It-owls m�e.l-I � /hsl-a /fral� = Glu,cicrcl `1Lia!- al__L
an.,d 74?a /- all ba l U M l-ed /Y-,k ke4-,'9t l waa ;r,vv2clx,ed Pr.,-.
a.noearrd = be: ;n C-�•Alra n.�e._
Hn Cu rrY,>n - _ s aovtd ;=I:'caLi,`�n-1 g2/50 ;
_ „ / wr M l Our eo{•e4tvv--'*Cal /1CCom ftyi+ S
Z ScAn-t oai Le oy 7o re k i r✓1 nnwv7 onnozzz J /D sew, FR-w COM!d�
�IaCfiyYLltn.f- /nSfk-C.hiGy'►
PIES TO FOELD D 4
SIGNED
ORIGINAL
•
.INSTALLATION CERTIFICATE (page 1 of 4) — CF-6R
Site 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(6).
•HVAC SYSTEMS:
Heating Equipment
Equip. 0 o Efficiency Duct Duct or Heating Heating
Type(pkg. CEC Certified Mfr Name Identical (AFUE,ele.)t, Location Piping Load Capacity
heat um and Model Number System F-IR value attic efe. R-value tuthr Btu/hr
ZD , APO 96 C 71
Cooling Equipment
Equip. CEC Certified Compressor 0 of Efficiency Duct Cooling Cooling
Type(pkg. Unit Mfr Name and Identical (SEER etc)i Location Duct Load Capacity
heat um Model Number S stems 2CF-IRvalue attic etc. R-value (Btu/hr) (Btu/hr)
I s t / Q.Vk is SeW2 r�
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-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.
:7.O��JS//�/,��/l/��/•e'✓_ �=.ZrA� °/ Lbi�fO�Gif' /� '��5� �L'/
Signature,Date Installing Subcontractor(Co.Name)
OR General Contractor(Co.Name)OR Owner
WATER HEATIN • SYSTEMS:
Distribution IrRecir- g of Rated' Tank Ertl- External
• Heater CEC Certified Mfr Type(Sid, culation, Identical Input(kw Volume ciencyt Standby' Insulation
Type Name&Model Number Point-of-Use) Control Type Systems or Btu/hr) (gallons) (EF,RE) Loss(Y) P.-value
2 For small gas storage(rated input of less than or equal to 75,000 Btuthr),electric resistance and heat pump water heaters,list Energy Factor.
For large gas storage water heaters(rated input of great"than 75,000 Btu/hr),list Recovery Efficiency,Standby Loss and Rated Input.
For instan taneom 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.
A mr:en.r Mnrrh 1. 1qQ(.
AST Insulation Contractors, Inc. INSULATION CERTIFICATION
1086 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:
d
SITE ADDRESS: 'K32 C.Lx&
FLOORS:
Manufacturer OWENS CORNING Thickness/Type l9� R•Value
EXTERIOR WALLS:
Manufacturer OWENS CORNING Thickness/Type R-Value 1';5
CEILINGS:
BATTS: Manufacturer OWENS CORNING Thickness/Type R-Value
BLOWN: Manufacturer _OWENS CORNING Thickness/Type 1:2 R-Value
Weight/Bag 35 Sq. Ft. Covered # Bags Used
AIR INFILTRATION SEALANT INSTALLED: YES ] NO ❑
GENERAL CONTRACTOR d'heleZ?i Gal i�O LICENSE #
T •T
BY: TITLE: DATE
WAST INAVLATION CONTRACTORS, INC. /20 LICENSE # 46§440 C-2
BY: �e (fLL( fYl TITLE: DATE: —7
•
•
]I,44 -X2-99 01 :44P KELLER LBR SALES 530-243-5516 P-01
9297
AST
�
CERTIFICATE ' CONFORMANCE
HE UNDERSIGNED MANUFACTURER HEREBY CERTIFIES
that the products Identified below and on attached sheets Nos. are marked with
the Collective Mark of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION (AITC) and were
manufactured in conformance with applicable provisions of American National Standard ANSI/AITC
A190.1.1992, Structural Gluetl laminated Timber, and that such manufacture has been at our plant
in Urain, OR which plant has a quality control system
approved by the Inspection Bureau of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION
and inspected periodically by such Bureau.
JOB NAME:-----_-,....Keller Lumber Sales Inc. for Stock
'-.......... ... . ..... . . ....... . .. ...�__...--'—
JOB LOCATION: Redding, CA
CUSTOMER'S ORDER NO. 9297,,, OATE _ 2_l)1_97 MFGn'S OnDER NO._ 21184)
1�
SIGNATURE �1. COMPANY- .IAIC0�1 aln
TITLE Quality Wntrul ADDn[SS I.Xi-Box 297, Drain, 0RDArE __1.2-.17797
AITC HEREBY CERTIFIES that the said company at its said plant is licensed by the
AMERICAN INSTITUTE OF TIMBER CONSTRUCTION to use the AITC Collective Mark in respect
of products which comply with applicable provisions of said Standard, that the adequacy of the qual-
ity control system in effect at said plant is periodically inspected and verified by the Inspection
- Bureau of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION, and that, In the judgement
of AITC, said company is capable of complying with applicable manufacturing and testing provisions
of said Standard in respect of products manufactured at said plant. Conformance with the Standard
in respect of any specific or particular product is the sole responsibility of the manufacturer; AITC's
guarantee hereunder being that the said company is qualified to produce a product meeting the said
Standard and that its plant is periodically inspected and verified by the AITC Inspection Bureau.
AITC l artillrntra Nn. 92- n A n '7 76
AMERICAN INSTITUTE OF TIMBER CONSTRUCTION
SEAL VFX)
1� 1952
UFC ? 1997
KF L't:.R l s'N. .[SALFS
41
0 1992 AMERICAN INSTITUTE OF TIMBER CONSTt1UCTION
AI IC FOnM IBC