S 2850 (2) APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO - BUILDING-ELECTRICAL PERMIT NO.
'BUILDING DIVISION APPLICATIONTERMIT PLUMBING-MECIIANICAL
f •BUILDING PRopthur IDENTIFICATION SANITAkV NO. APPLICATIO 'U M A UA'I'F.
BUILDING AUlfiSo i /q S � / .ij '—' S [n I / Z 4
CAC T
OWNER'S NApq�'w. CO
_ PHONE NTRACTOK:S NAME: LIC NO:
U
NEC CONTQROL p/
HITF. ER: LI NO: ADDRESS: _ ❑ / ( n
CON'T'ACT: PHONE: - - BUILDING PERMIT INFO
❑ Consultant Peea Paid by,Applicant(Initial) BLDG ELECT PLUMB MECH
L ENS ED CUN KACT SDECLARAFION QTY. F.LECTRICPERMIT, PEE
I hereby aBr thtI r I d p ns or Chapler9(e.mme ung ' JOB DESCRIPTION
M%SZ waNsterimlido 3ofthaft, csr an sand mylw rein • �J`� BESIDE_ TIAL
-
I. PERMIT ISSUANCE J
F�aj 'n full force a of ,ton 'UWL ❑KITCHEN REMODEL
QUt) Liwnse
Fire, APPLIANCES-RESIDENTIAL ❑ADDITION El PLUMBING RE-PIPE
FZ{i1 Dan Can in
o'Q4 El MULTI-UNIT ❑STRUCTURAL.
❑❑ ARCHITECTS DF.CLAR
E'.Z 1 understand my plans shall be used as public records PANELS MODIFICATION
C)O 4o' UP'f O 200 AMPS
C)Z..q El INTERIOR El CHIMNEY REPAIR
F.,4[.'fe Licensed Professional 201-1000AMP.S IMPROVEMENT EJ SWIMMING POOLS
'a @,v -
OWNER BUILDER DHCUARATION OVER Taro AMPS [D HATH REMODEUREPAIR El DEMOLITION
. d 1 made,nfrom that 1 mn exempt from the Cnno-aemr's License Law for the
ippi((,�04U following reason.!Swains]03 L5,Ruvincs and Professions Gtde:Any city ar wunty SIGNS ELECTRICAL. ❑OTHER
fL3fLh whih carries a madima amorard, Iter improve,d l.n p' y.tucmm
priortc,itse,also requipersthepplic t for suchpermit tfile a signal.tnment SPECIAL CIRCUIT/MISC.
d� that he is licensed pursut to the provisions of the Contractor License L (Chapter 9
(commedc'nKwitb Swron]0W)of Divisin 13.1 do,Busted and Professions Code).- TEMP METBR OLB INS'P. M
4 o q
that he is exempt therefrom and Ne basis for the alleged exemption.Any violation of ❑ RIA. DDITION ❑DEMOI.II'ION
�..m
Section 9031.5 by any sentiment for a permit subjects the applicant n a civil pemtlty of POWER DEVICES TENA ❑FOODSERVICE:
nal mare than live hundred dollars($510).
- IMP V:. ENT
C�d� ❑Las owner of the prnpe<[y,ar my unplayees with wages os Neirsolewmpens.tion, SWIMMING POOL ELEcTRI ❑ 3R
will do be work,and l fortunate is nm intended nrnBervd Russo(Site 704......nese
41`ei and Professions Cade:The Commands License Law does not apply to an owner of OUTLETS-SWI'FCIIBs-
FOXTDRES
43 property who builds or improves thereon,and who doesxuch work himself or through
his own employees,provided that such improvements are not Intended in related for NEW RESIDENTIAL ELECTR SQ FT
sale,BE however,the building orimpmvemeat is sold within oneyearolcompletion,the SQ.FT.FLOOR AREA $ISQ.Pr.
p"er-builder will have the burden of provin.that he did not build or imp r,ve In,por-
nfsale.) 30
-7 -7
E] 1,is owner,I the",)Fort,.y,aexelurively rentraceng with licensed contrenrsn
a "TOTAL:
.usntctthe Critical(So,.7GH,Business sad Prafesxier,Cadw)no Contracture Li-
actre Law does not applytoan ownerofproperty who n ildr or improvesthervern and Q'ry '- PLUMBING PERMIT, FEE -
whr t .-for such projects with aconmdro)licensed pu n t C mt
t : - - ' �
Lewdso Ler. PERMIT ISSUANCE.
❑ lamexemptander Sec. ,B&PCforthsmu'm
Owner 'Date ALTER-DRAIN Ft VENT-WATER(EA) VALUATION
WORKER'S COMPENSATION DECLARATION RACK FLOW PROTECT.DEVICE 3og� Z6Ltw
1 6¢eby affirm under Penalty,f perlu'ry one of the following dwlannions:
I have and will maintain a Cariftcale of C,nxent to self-insure for Worker's Coupon- DRAINS-FLOOR,ROOF,AREA,COND.
/- RIES 'fYPP.CANS ION
work!r p which
this
for by section 3]W of the haMrr,Glc,for the peH.rinance of the - /V//
work for which Nis permit is issued, FIX'T'URES-PER TRAP
❑ Ihave and will Code,
Worker ance(if tiaw work
hie.h hisreqperm by Section
3]00ofthe Labor Cade,for the performance of the work for which Nis permit is Isaac). CAS-P.A.SYSTEM-I INC 40UTLEIS OCC. ,ROUP APN
My Workers Compensminn Insurance eerier and Policy number be,,,,, �I
Carrier'. Policy No.: - GAS-1A.SYSTHM-OVER 4(EA) L/s
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE. GRE.ASE/INDUSTRLWASTE INTERCEPTOR g,
(Iniesehimiewdnotbecompletedif Nepardank arouehundreddodlanpUlan - IL SD1VI510 [i7iljSy
unless) GREASC'FRAP PLANCHECK PEE
Icertifythatintheperformunceofthework hrr which this permit is issued,I shall SEWER-SANITARY-STORM EA.200ET,
nm unPlny any person in any manner so as n bacome snbjecno the Workers'Conten- ENERGY FEE
Oz srflm Laws of C.lifoml..Date WATER HEATER WNENT/ELECT IF GRADING PEE
Applicant '
N NOTICE TO APPLICANT:IL alter ranking Nis Certificate of Ewhe ora.you ad uld WATER SYS'PHM/fkP.ATING SOILS PEE
.H become subject 1. be Worker's Compensminn provisians of the Labor Cade,you ams
wforthwith comply with such provisions or this permit shall he decomd revoked. WAFER SERVICE -
Q
Z-'
CONSTRUCTION LENDING AGENCY NEW RESIUGN PIAL PLMB, SQ.FT. PAID
r�7
1 herby effort that a theas s mnsne.i30 landing agency forth,peRonnnnw of [).to Receipt q
ther
e work for which this panit is lowed(Sea.309].Civ.CJ
fendefa Name TOTAL
L) Lender's Addmu - TOTA
1 cerify that I hove rwd this apPlicvtion and state that the.hove Information is _ BUILD
iy la/] carred.)agree to unnply withall city and county ordinances and state laws relating In QTY MECHANICAL PERMIT FEE SEI. IC .
V building e.nvwction,and hereby auNnnm represcnmtivex of this city manor upon the o
above-mentioned property for inspection proposes,
(We)agree to cava,indemnify and keep harrate,,doo City of Cupertino PERMIT ISSUANCE against E FEE
liabilidev:jndganentr,cnrlcand expenses which may in any way aecme vgainst said Clty ALTERORADDTOMECH.
e
omeyue c ftha graming.f Nis pernit, PL INC.FHL'
m
APPLIC IUNDERSTANDS ANDWILLCOMPLY WITH A�{LN( POINT AIR HANDLING UNIT(TO 11,000 CPM) V
SWR(': -lULATIONS. M 'HANICAL EEE
AIR HANDLING UNIT(OVER IO,IHNI CPM) y
C( STRUCTION TAX [
Signmmeof App1i1mVCcht ate EXHAUST HOOD(WDUC'1) HO NG MlFIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
WiIINevpplicant or fano hnildingoccupantsere or handle beendous motorial BEATING UNIT(TO IN0,000 B'put
as defined by the Cupertino Municipal Cale,Chapter 9.12,and the Ilath and Salhty
Code,Section 25532(u)7 HEATING UNIT(OVER 100,IX0 RTU)
�Ycs �No
VENTILATPAID
PAN(SINGLE RESID) Dae Receipt N
t Will the applicant or future huihim,wupant use ecommon or devices which BOILER-COMP(JIIP OR IIX),OW BTI,
it hvmnloes air containments as defined by the Bay Area Air Quality Management L,
Istuu7 BOILER-COMP 100,M)BTU)
El Yes Ke •
AIR CONDI'I'IONF.It
r Ihnve rwd the haaurdous materials requirunems under Gaptu 695 of the Coli- ^ISSUANCE DATE
fornix Hwlt &Safety Code,Swtion, A505,25533 and 25534.1 undert and not if the NEW RESIDENTIAL MECH. SQ.FT.
M1uildlnKjQ ' nt cunontly heveaten mUtiv my revponxibility n yll wupimt
of then ll�a 6h� sof_-Genu! e "try_
-
i
Owner or authorized agent Dn e TOrAL: ISSUED BY:
OFFICE
DEC. 1.1999 3:39PM BRIAN KRNGAS FOULK NO.189 P.2/2
. • - u U
Brian Kangas Faulk
Eo01neers • Surveyors . Plannors
•
December 1, 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 November 30, 1999 we performed afield survey of the location of the foundation forms for the
buildings being constructed on Lots 5118,5-49,and 5-50 of the Oak Valley project in Cupertino.
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.
nis letter is intended to provide you with the verification of those units per our survey. If there aro any
other questions concerning that location,please do not hesitate to call.
• Sincerely,
BRIAN KANGAS FOULK "�GRADVY A.moo
Bradley A.Bilbo P.L.S.6141 4<` Exp.:/31/02
Project Manager a\ \a. 6i41
Survey Department
F OF C fo\L W
•
640 Prico Avonuo • AedWoed City,CA 94063 • (5501402.6300 • FAX(G50)02-6399
DATE JOB NO.
Consulting Engineers and Scientists t2- z
PR �SHo -T-
WO ECT
425 ROLAND WAY
OAKLAND, CA 94621:
(510) 568.4001 LOCATION
• 1, v10
TO n l��`r��`n l_Wot.,-,�7 CONTRACT R OWN5q
d.
Dale
`�l'LC.,'�LLxX a't�IG59 7�}y5jGV WEATHER TEMP. . Lf D°at AM
Lrliat PM
Hours Charged To Project 5 Nuclear Density Tests PRESENT AT SITE -
I�c
Field Task Number os4 ,Concrete Cylinders co .�
Gr„,z.a lu of
THE FOLLOWING WAS NOTED:
Ur `� �c as rcce` kl� �or ra �rr<<z �ace�u t1- lvi�pzchU , G,1 .. � Of^g5�la
5 }9 an�ca 5"SD Q re 11 lL F- C"-) Nv, nn r�zC l o f �Jl�u i.c S V- v")l I^f t S
C\ I.c I e GI e d o v-e.c;I I' g — G —cat. OF If 0,\ev-CIt �yt ✓vl �niG
V a I S of ,c a 6,-cC l40( 'Mab Com1.0 reI-C 1'
f� 121(At t vi Q.
e &AMM c'-w jiU c.rCl5 Ine2.G+ df �aC.k cry
Are,
r L� ear �, �xr.�..� 1e Y CG` h CN\e SCI— Gtr r�.'Yc
r .
�„ 'a'P`3' 1 vC S�l/P,i, \ <^ I , ✓, ��f Y� 51 t.,�.rti,, q rQn i Cy'cn.,.� 3 /Z 'rU
I1C�.�¢ `a CJI � O� ��ror�13V.-4 Lll-t�tr£” �.��5 �.�• u 7'U . L�7_^ W��.C^r•e IY
ion a or TO Y eb �J .\ ` It.
COPIES TO IFO LD
SIGNED / J-� •1�,
• ENGINEERING WEST INC.
OBSERVATION CHAR'r
OAK_VALLEY EVELOPMENTCUPERTINO, GA,
S V 1�'ERS STRAUSS E1R0 i 7 PAGE/ OF 4
E31 277-0076 (4081287.1929�1 DATE: 7-122000
T II CF61RT INDICATES THE DATES AT WHICH EACH COMPONENT OF EACH B JILOING WAS
0 V ERVED AND FOUND IN SUBSTANTIAL CONFORMANCE WITH THE DRAWINGS.
L ;( END
I.O. a CONSTRUCTION NOT COMPLETELY OBSERVED
• a CORRECTIONS REO'D. LIST GIVEN TO CON TRACTOR.
PI'I a STEEL REINFORCING,HOLDOWN ANC40R BOLT OBSERVATION
1E; FLOOR a UNDERFLOOR FRAMING OBSERVATION
R01 IF PLY. a PLYWOOD NAILING OBSERVATION
E) I -.RICR PLY. a PLYWOOD NAILING,HARDWARE OBSERVA'rION
Bl; C FRMG. a GENERAL FRAMING AND HARDWARE OBSERVATICN
-1NR Lot I=n I OPTIONn. Istfloor Sec.ft n . ssk tm .
4 2 1 7=71
4 3 1 1DD 12-2 3.2.20005-21-2000 5:1.2070 d.n.a. 5.21•— 220a
4 a I N/A
4S CB 12-21-99 3-2_2000 5.10.2000 5-21.2000 d.n.a. 5-21-2000
4 9 78 03/10/98 04! 2 I9D 0iii 08 _ 06/94199
4 6 1 7C 03/10/99 04114199 06/2499 06,24158 07
4 9 5C O 'S 3/1 4114199 07.105/90 0710999 07/19/99
4 10 2D 3 1 0.1101199 04/02/997120/99 714/89 --0-7)2F,9-9
4 ti 38 03101/99 04/02/99 D7101/9b 08130/99 07/16189
4 12 4B 3 11/1 12110/98' 01/21/99 01/21199 ___ 01/15/96
4 13 6C 2 09/28/98 10/09/98 11/00198 11113/98_ 121
4 13 6C ADDRID 1 02/09199 02/09!90 02/09199 02/09199
• 4 14 2A 2 02/02199 03/01/99 05/19(99 0721199 OB 4199
4 15 5D 2 02102/99 03108/99 05127199 06109199 06!09/99
4 17 2C 03101 9 / 1190 06130199 07106189
_ 4 18 6E 21BONUS 1 12/14198 12/24/98 03/08199 03108199 0411299
_ 4 20 1 413 31BONUS 1 12/2298 04/14/99 03718190 i 03.22199 04114/99
4 1 21 1 28 2 1 03/19/99 04/1499 0727/99 1 07t27/99 0811099
4 1 2; L
27BONUS 0371999 04/14/99 0720/99 0723!99 0811099
4 23 3A 3 1/1299 /1 9 11 9 _05-07.09 06/0199
_ a 24 60 3/BONUS 01/12/99 02/17/99 05-03.99 04.30.9905117/99
4 1 25 SC 3 1 12123198 0211699 040259 0410599 0511498
_ 4 26 20 2 O1N8/9902/1299 05/10 9 0412 0511199
_ 27 4C 3 010899 D205/99 0411459 0411299 05-07.99
_ 8 6E 318 U 121149 1/04 03 0359 0310399 03(3099
29 7A 2 11113/98 12/10/98 02110/-'9 0211098 03/03199
30 3C 3 1111398 12/10/98 02103/99 02101199 0311199
4 31 SB I 3/80NUS 02/12/99 0311 OBN —06/09/9906/17799
4 32 28 1 3 U2/12/99 03/10/09 06111,'9908/1799 0613019
4 33 SA - 1- 5.21-2000 5-21-2000 6.21-2000
4 34 7C 12.21.99 3-7-2000 8.8.2000 -20 n/ 000
NOTES:(PENDING ISSUES)
(1)'LOT 13 PLAN SC FDN. (OFFICE OPTION); CORRECTIONS NOT OBSEF VI:D.
•
*� • � n , rr' r,qs r..l. 14-1 ra ��ii '•I1'%^!lh�h A !^ ' ?T r)n-7T - In^
: : y'
• . •• • -
94
• SSS■�ai7�t•];ilC�,`���imi:+..Ta�;�f]�'� •'�E�,?a1'_•��u�
NUITITIM
tnom•� :. r .. ,. , .. ... ... ...
lummmu
���o�r�■mss ��r�■
'0' E N
/ GROUP.
'orke
Jim Rlp*""TPlrlploydp®pacbelhnol�
Monday, March OB, 1999 2;28 AM
PAT BURKE
OAK VALLEY
y ,
ca
Linear parkway planllnq,
s wllhln the Ilnoar peek fife conslslonl wllh Iho londsupo
n documents probated by INS orrice and rovlowod by Iho clly
99e and.eonform whh Iho prollminary approval doumonla,
ipley
2n Group, Inc,
FINAL
PAINING SIGN OFF
DATE
200,SAN MATa0, (IALIM01t NIA )(/0(,7413 TIMP 110tifi N 16)377.0300 FA CSIAIILC I0f0)3(9•7442
p.vlu.I March I, 1996
eubi im6 UwnU IvcwH HnVH1 ur uuH_uINu
PERMIT NO.
CITY OFCUPL1,TINO
DUILDING DIV ISION RUILDINIIP OJRL7 IDEN'1'IFICATIL
• BUILUINC AOUI<I/!S�S: / I (':� SANITARY NO APPLICATION SUNMIT-IAL D.
• - UWNIiR'SN \IE: PHONE: CONTRACfUN:S NAME: LIC NO:
Al �''I NIC CONTROL
lip Ncm 11;91 NEER: CNO: ADDRESS: ❑ -/��
,;T BUILDWO PERMIT INFO
INSPECTIONS DATE INSPEC. ❑ Cumullanl Fees Paid by Applicant(Initial) BLDG ELECT PLUMB NIECE
FOUNDATION/PIERS/H.D.S. INSPECTION RECORD JOB DESCRIPTION
LIFER GROUNDNOTE: ALL GRADING AND DRAINAGE RFSIDFNTIAI:
SHALL BE INSTALLED TO COMPLY WITH ❑SFOWL ❑KITCHEN RENwuI
PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF El ADDITION El PLUMBING RE-PIP
GARAGE SLABS/PRECUNITEoaR0CUPERTINO STANDARDS. ❑MULTI-UNIT ❑MI(U(77 RAI
POUR NO CONCRETE UNTIL ABOVRHAS BEEN SIGNED TO ARRANGE INSPECTION ❑INTERIOR ❑CHIMNEY REPAIR
UNDERGROUND/SLAB CALL AFTERNOONS (I:BD PM - 4:30 PM) IMPROVEMENT
CD POW
❑BATH REMOUF.UREPAIN ❑DEMOLITION
PLUMBING 777-3228 MONDAY TO FRIDAY 24 HOURS BE- ❑OTHER
ELECTRICAL FORE REQUIRED INSPECTION. JOB ADDRESS
AND PERMIT p ARE NEEDED WHEN PHONING.
DO NOT POUR FLOOR UNTIL ABOVE HAS AEF.N SIGNED COMMERCIAL,
PLUMBINGC�f ATTENTION CONTRACTORS: C3 NEW BLDGIAODITION ❑DEMOLITION
MECHANICALPROV
NO PERSON(S)SHALL PERFORM WORK ON 0 TENANT iMIlJT ❑FOODSERVICE
THIS JOB SITE WITHOUT BEING IN COM- ❑OTHER
ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION
FRAMING VENTS O INSURANCE REQUIREMEN'T'S.
INSULATION INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSI
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SHEATWDIAPHRAM
PLUMBING (�
TUBS&SHOWER PAN -
MECHANICAL BCJ
ELECTRICAL/POOL BOND
• FRAMING/STAIRS/E.EGRESS
INSULATION/VENTILATION (�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED -
EKTERIAL SHEAWHOLD DOWN
IN'T'ERIOR SHEARMOLD DOWN
SHEEI'WROCK/SHEETROCK SHEA
EXTERIOR LATH/W-SCREED O
SHOWER LATH
NO TAPE OR PLASTER UNTIL ABO E HAS BEEN SIGNED
SCRATCH COAT
SEWER/WATER
TEMPORARY APPROVALS
OCCUPANCY
ELECTRICAL
GAS
• 'h1NALS -:1y. 1 -: r .'rt n ta...';y x. ,.
GAS TEST
GRADE dD
FIRE
HANDICAP
ELECTRICAL
PLUMBING
MECHANICAL
•
VISUAL FINAL ONLY CERTIFICATE OF OCCUPANCY ❑VISUAL
BUILDING I co IMPORTANT: "'SUED
,..^' ISSUANCE DATE
OCCUPANCY OF BUILDING IS NOT PERMITTED,+E''r PLEASE READ REVERSE SIUNTIL BIJII:DING FINALI$SIGNER BY;BUILDINI CALLING FOR FINAL INSIDE
INSPECTQdr.
APPLICANT'S POSTING COPY
• COABT 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: L
SITE ADDRESS: �ri # Jam' 2)el DA 14 Vq//�r/ / 'tea,01L O
FLOORS: /
Manufacturer OWENS CORNING/MV Thickness/type (p 1 R-Value �%/�
EXTERIOR WALLS:
Manufacturer OWENS CORNING/MV Thickness/Type /� R-Value
CEILINGS: /
BATTS: Manufacturer OWENS CORNING/MV Thickness/rype (O R-Value3Cz-
BLOWN: Manufacturer OWENS CORNING Thicknessrrype % 1�14 R-Value �c
Weight/Bag 35 Sq. Ft. Covered /y9G # Bags Used
AIR INFILTRATION SEALANT INSTALLED: YES NO ❑
GENERAL CONTRACTOR //1P ��//�1/t� 9'GG LICENSE #
BY: TITLE: DATE
• COAST SOLATION C iJT CTORS, INC. L DENSE # 465440 C-2
BY: � TITLE: DATE: 4—
•
FR01•I CRPISJ I FAX 140. : 0313350329 Ju I. 11 2000 09:20W_PS
.7111 - IU-UU U!. 1:1 um
•
Com mrclal Ruol'jNj4hgggment Sna ,rotr. tUC
R2rn �r,;ru!RooJ�psa'1v tnfp ecrjorn7 kop;ov
Projoct: t?ALK. V..- f 0 176 inspectton Gate: l�,_0C
Addroas: u9Aln�b�, CRY: S. rtlnq. State: CA
Client: Th& Qjgjj t�
Contact; Pal 8urk ,£n
Roofing Contractor: Rlb,ll�^as�Pl�1Cr
CAM Inspector: nh'r21yvr6lz
Lot Numbor: S-(l
Type of Inspection: Fait Final b�
Typo of Roof: £shingle __ Tlla Other
Undertaymentr . Cht Mvtal Flashing: Olrtters:
Skylights: Alttachmontel_ Vents & Pipes:Valleys: F,idgoe; Eaves;
• COMmants/Observations;
zrb9atil` owk, Cenll? SNr��,tEs APPEIa� 7S /fA�E $t1N In�srA1l�D
PS Qr SP�c.
Go.
Rd-Cwt Fw0rig
•
.INSTALLATION CERTIFICATE (page 1 of 4) - CF-6R
rte A fess 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. It of Efficiency Duct Duct or Heating Heating
Type(pkg. CECCertirwd Mfr Name Identical (AFUE,cte.)t Location Piping Load Capacity
heal um and Model Number systems ?CF-IR value attic etc. R-value tu/hr Btu/hr
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 Dumol Model Number system 2CF•IR value attic etc. R-value tuthr (Btu/hr)
/AID&A
s. - spc•KAl- 2 / —
!rtD a 3Al t/re30 �_ io XLLZOJ2 A7TtC
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.
,Z7-P9 } rP14lOtJf f/ar iW&
Signature,Date Installing Subcontractor Co.Name)
OR General Contractor(Co.Name)OR Owner
WATER HEATING SYSTEMS•
Distribution If Rccir- 0 o Rated' Tank Erft- External '(
Heater CEC Certified Mfr Type(Std, culation, Identical Input(kw Volume eieney' Standby' Insulation
Type Name do Model Number PoinFor--Use) Control Type Systems or Btu/hr) (gallons) (EF,RE) Loss('/e) 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 Btutu),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
III.
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-I R) 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