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11060196 (4) WILSON LAND SURVEYS INC. OVER 4800 PROJECTS SINCE 1985. CALIFORNIA SMALL BUSINESS#59923 747 Gage Court•Gilroy,CA 95020• Phone:408-847-7607•Fax:408-847-6926 email: kenw@wilsonlandsurveys.com •web: www.wilsonlandsurveys.com•Mobile:805-703-0273 -1 Friday October 14, 2011 ;:/�-f�?A9�/Lf(p To: City of Cupertino Subjec`t:'18970 New om-RI —City of Cupertino—Sampat Residence DA/ FD G T / 4- , 7.0 it Lan-4.O,0 t-orwo spa-(1e-4/5 bti /hC-,0�V Tier LoC./¢-r a'I 6F vie" 6�' sn��T Oas 02 (re) Gib) 644 s,oC yin F iS 7 . 5¢ F/t f1 '21f FLOa/1— VILE gyp-7'tI • kAN D SU la/ o O No. 5571 * /0-14-Zo i/ •0 gtr.OF CAO" • lOa Page I Client Initials Surveyor Initials 141/ ION INLAND ENGINEERING & CONSULTING, INC. ■mi 'MO Structural Design - Planning• Consulting 4883 E. La Palma Ave. Suite 501-A Anaheim, California 92807-1957 (714) 777-7700 1l06Dcr October 14, 2011 City of Cupertino Building Dept. Re: Sampat Res. Fr P._ „a f`18970'Newson—Ave Cupertino, Ca. ir-17-(i ,r-sG To Whom It May Concern: This letter is to Acknowledge that 3000 psi concrete does not need to have Structural Inspections as indicated on the notes, since it is merely to comply with minimum requirements and it is not required by calculations. Also anchor bolts and footing reinforcement need not have special inspections. Please do not hesitate to contact our office with any questions or comments. Sincerely, ti, ES310y •, 149 .7f i ''''''.%-.' i • . *ti, N,,,t. ‘6\.. if.'Q g" v, filo41,2 ti�•, c E XP. f -F:f Clz 1 -----;-- Shawn r ;Shawn Nikjoo, P.E. t:;.:79_31::-,1-41,1i;!.4� tr, Prfi, i y `kPit 1 I . • ElIVE Foundation Engineering Consultants 3984 Washington Blvd, #236, CA 94538 TEL 510-629-3768 http://www.FoundEnq.com FAX 510-619-7230 fi September 21st, 2011 Job No. 1144 Mr. Shailesh Sampat (0 6 01,ctzc 1890 Newsom Avenue Cupertino, CA 95014 Subject: Geotechnical Observation of Footings 118970 Newsom Avenue Cupertino, CA 95014 References: 1. Geotechnical Engineering Report by this firm and dated 4/15/2011 Dear Sahilesh: We have probed the footings for the subject site. The footings are per soils report recommendations. The soils are Brown CLAY that is very stiff. The soils are suitable for intended use. It is OK to pour. Respectfully submitted, FOUNDATION ENGINEERING CONSULTANTS, Inc. /9913":8% Liiban A. Affi, P.E. R.C.E. 73300, exp. 12/31/2012 C la@FoundEng.com . Bp (*JAI CMS P, 1144 footing.doc page 1 of 1 r • r - • .„ ■ ■ E TrG rt a-Tz4 INs`ncCE-APLQN CERTIFICATE -- �� '-6R-LTC-01 alential LightuI g. \ (I . .e 1 of 3) Site Address: Enforcement Agency: - Permit Number: /99-70 A/6aiomi ,,4r C:, ptr,tio /f06 0 filo 1. ' chen Lighting Does�/ protect include knenen nig ring? 63 Yes.complete section I ❑ No.go on to section 2 CYes §I50(k)3:The wattage of permanently installed luminaires(lighting fixtures)has been determined as specified by§130(d). ❑ Yes (ErNo §I50(k)3: In the kitchen.are there electrical boxes finished with a blank cover or where no electrical equipment has been installed.and where the electrical box can be used for a luminaire or a surface mounted ceiling fan?If Yes.the following row must also be yes: ❑ Yes 0 NA Wattage has been calculated as IRO watts of low efficacy lighting per blank electrical box. §I50(k)8 Kitchen Lighting must comply with either method (a), (b), or(c) below: /(a) All high efficacy luminaires 13 Yes.complies because only high efficacy luminaires have been installed in the kitchen. ❑ No.complies with method(b)or(c). (b)>_50% watts used by high efficacy luminaires ❑ Yes,complies because at least 50%of the installed watts arc from permanently installed high efficacy luminaires as demonstrated in the table below:Total A>_Total B. ❑ No.complies with method(a)or(c). Fill out the following table if complying with either method(h)or(c). Table (b) Efficacy Luminaire Type High Low Watts x Quantity = High Efficacy Watts or Low Efficacy Watts ❑ 0 x = or ❑ ❑ = or o ❑ x = or o ❑ \ = • or o ❑ x = or Complies with method (b) if A> B Total: A: > B: (c) Additional Kitchen Low Efficacy Lighting rE Yes,complies because the kitchen lighting qualifies for additional low efficacy lighting B - and as demonstrated in table in(b)(above)and the table in(c)(below)that(A+C)a ❑ No.complies with method(a)or(b). Additional kitchen low efficacy lighting is available only if all of the following are true: ❑ Yes. All low efficacy luminaires in the kitchen are controlled by a vacancy sensor Dimmer energy management control system(FMCS)or a multi-scene programmable control system. ❑ Yes. Permanently installed luminaires in garages laundry rooms closets greater than 70 square feet and utility rooms arc high efficacy luminaires AND are controlled by a vacancy sensor. Table (c) Use 50 W for dwelling units<2,500 ft2 From the Table in(b) Use 100 W for dwelling units>2.500 ft2 Add Yes/No? A B C A +C Is (A+C)> B? 2. Lighting Internal to Cabinets • Does project includes lighting internal to cabinets? ❑ Yes. complete section 2 LINO.go on to section 3 ❑ Yes.§150(k)9: Permanently installed lighting internal to cabinets uses<_20%vents of power per linear foot of illuminated cabinet. 2008 Residential Compliance Forms August 2009 • • INSTALLATION CERTIFICATE CF-6R-LTC-01 Residential Lighting (Page 2 of 3) Site Address: ,tz)d A Enforcement Agency: Permit Number: �J7 /90 'on AC CLlI2i.6i01.> (/0 1)(Q 3. Installed Devices and Components Have Been Certified to the Energy Commission Does the project include any of the devices or components listed below?VYes,complete section 3 0 No,go on to section 4 triYes *119 and§I50(k)7(F): Any of the following devices and components which have been installed have been certified to the Energy Commission according to the applicable provisions of§I19:All LED lighting systems that are classified as high efficacy.ballasts used in recessed luminaires. vacancy sensors(automatic off/manual on occupant sensors).dimmers.track lighting integral current limiters.and outdoor motion sensors. 4. Lighting Controls Complete section 4 Yes 0 NA §150(k)7A: Permanently installed low efficacy Imninaires are controlled by switches separate from those controlling high efficacy luminaires. Q1--Yes 0 NA §150(k)713: Exhaust fans with integral lighting systems are switched separately from lighting systems,OR have a lighting system that can be manually turned on and off while allowing the fan to continue to operate for an extended period of time. je Yes 0 NA §150(k)7C:All permanently installed luminaires are switched with readily accessible controls that permit the luminaires to be / manually switched on and off. gift Yes 0 NA §I50(k)7D:All lighting controls have been installed in accordance with the manufacturer's instructions. ul Yes 0 NA §150(k)7E:All lighting circuits that are controlled by more than one switch,where a dimmer or vacancy sensor has been installed to comply with§150(k).no controls bypass the dimmer or vacancy sensor functions. 5. Luminaires (Lighting Fixtures) Does the project include the installation of any luminaires(indoor or outdoor)? EreYes,complete section 5 0 No,go on to section 6 I:(Yes.high efficacy luminaire classification has been determined according to§150(k)l,and low efficacy luminaire classification has been / determined according to§I50(k)2. L9 Yes ❑ NA §I50(k)4: Fluorescent lamps rated 13 watts or greater have an electronic ballasts having an output frequency no less than 20 kHz. O Yes d NA §I50(k)5: Permanently installed night lights,and night lights integral to permanently installed luminaires or exhaust fans. contain only high efficacy lamps meeting the minimum efficacies contained in Table 150-C and do not contain a line-voltage socket or line voltage lamp holder.OR the night light is rated to consume no more than 5 watts of power and does not contain a medium screw-base socket. Of Yes 0 NA ' §I50(k)6: Lighting integral to exhaust fans, in rooms other than kitchens.meet the applicable requirements of§150(k). ❑ Yes VNA Any electrical box finished with a blank cover or where no electrical equipment has been installed,and where the electrical box can be used for a luminaire or a surface mounted ceiling fan. has been treated as low efficacy luminaires for compliance with §150(k). — Does the project include any luminaires that are recessed into insulated ceilings? Ef/Yes,complete the rest of section 5 0 No.go on to section 6 "Yes, §15,0(k)1 2: Luminaires that are recessed into insulated ceilings meet all of the following conditions: jj Yes,are listed,as defined in*101. for zero clearance insulation contact(IC)by UI.or other nationally recognized testing/rating laboratory,and Yes,have labels that certify the luminaires arc airtight with air leakage less than 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283(Exhaust fan housings are not required to be certified airtight),and it' Yes.are sealed with a gasket or caulk between Iutninairc housings and the ceiling,and all air leak paths between conditioned and unconditioned spaces have been sealed with a gasket or caulk.(including all exhaust fan housings),and Yes,allows ballast maintenance and replacement to be readily accessible to building occupants from below the ceiling without requiring the cutting of holes in the ceiling. 6. Indoor Lighting (any indoor room that is not a kitchen) Does the project include permanently installed luminaires in any room that is not a kitchen? E'Yes,complete section 6 0 No,go on to section 7 ISKYes 0 NA §150(k)10: Permanently installed luminaires in bathrooms,garages, laundry rooms,closets>70 ft2,and utility rooms are high efficacy luminaires OR arc controlled by a vacancy sensor. ❑ Yes ®'NA §150(k)11: Permanently installed luminaires located in rooms or areas other than in kitchens,bathrooms,garages. laundry rooms.closets,and utility rooms arc high efficacy luminaires.OR arc controlled by a dimmer switch OR are controlled by a vacancy sensor. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-LTG-01 Residential Lighting (Page 3 of 3) Site Address: Enforcement Agency: Permit Number: /g 9 20 //ctssohl re( int-r) l/D to 0(9 7. Outdoor Lighting Does the project include any permanently installed outdoor lighting? ® Yes.complete section 7 ❑No.go on to section 8 Yes ❑ NA §l50(k)13: Luminaires providing oindoor lighting,including outdoor lighting for private patios on low-rise residential buildings with four or more dwelling units,entrances.balconies,and porches,and which arepermanently mounted to a residential building or to other buildings on the same lot are high efficacy luminaires OR are controlled by.a manual on/off switch.plus a motion sensor not having an override or bypass switch that disables the motion'sensor,plus one of the following three additional control methods: a. A photocontrol that does not have an override or bypass switch that.disables the photocontrol;or b. An astronomical time clock not having an override or bypass switch that disables the astronomical time clock: or c. Energy management controls systems(EMCS)not having an override or bypass switch that allows the luminaire to be always on. ❑. Yes ❑ NA Exception 2: Low efficacy outdoor luminaires used to comply with Exception Ito§150(k)13 are controlled by an override switch which temporarily bypasses the motion sensing function,and the motion sensor is automatically reactivated within six hours.The luminaire is controlled by a photocontrol,astronomical time clock,or EMCS as required by Exception I to §I50(k)13. ❑ Yes ❑ NA Exception 3: There are permanently installed luminaires in or around swimming pools.water features.or other locations subject to Article 680 of the California Electric Code which do not need to be high efficacy luminaires. ❑ Yes❑NA §150(k)14: Internally illuminated address signs comply with §I48.OR do not contain a screw-base socket and consume no more than 5 watts of power as determined accordingto §130(d). ❑ Yes ❑NA §l50(k)l5 Lighting for parking lots and carports with a total of 8 or more vehicles per site have lighting that complies with §130,132. 134. and 147. Lighting for parking garages for 8 or more vehicles comply with §130, 131. 134.and 146. If yes. the Nonresidential compliance forms must besubmitted 8. Common areas of low-rise residential buildings Does the project include the installation of any luminaires in common areas of low-rise residential buildings? ❑ Yes,complete section 8 E{No.go on to section 9 ❑ Yes.§I50(k)l6: Permanently installed lighting in the enclosed,non-dwelling spaces of low-rise residential buildings with four or more dwelling units shall be high efficacy luminaires OR are controlled by occupant sensor(s)certified to comply with§I 19(d). DECLARATION STATEMENT • I certify under penalty of perjury.under the laws of the State of California.the information provided on this form is true and correct. • I aim eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features.materials.components,or manufactureddevices identified on this certificate(the installation)conforms to all applicable codes and regulations.and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF-1R that apply to the installation have been met. • 1 will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building perm il(s)issu ed for the building,and made available to the enforcement agency for all applicable inspections. l understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcnntractoror General Contractor or Builder/Owner) Responsible.Person's Name: Responsib e Per;m's Signature:, e . Sl81iPYr4R 5�' 1� o0S/• � C-LB License: Date Signed: Position \Y Company(Title): 5 S 3' 7/71/2 0 uPDNEQ 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-05 Indoor Air Quality and Mechanical Ventilation (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: VENTILATION SYSTEM DESIGN— Fan selection and duct design criteria for compliance The airflow rates required refer to the delivered airflow of the system as installed and tested using aflow hood,flow grid, or other airflow measuring device. Alternatively. the airflow rating at a pressure of 0.25 in. w.c. of a certified fan mm'be used to demonstrate compliance without testing of due airflow of the installed system.provided the system duct si:ing meets the prescriptive requirements of Table 7.1, or manufacturer iv design criteria. Other methods may be used to provide the required ventilation rates when approved by a licensed design professional,subject to confirmation of delivered ventilation airflow of the installed system. Central Fan Integrated (CFO ventilation systems shall demonstrate compliance by field testing of the delivered ventilation airflow of the installed system. WHOLE-BUILDING VENTILATION SYSTEM DESIGN- Identify the ventilation system design criteria Requirements for installer to demonstrate compliance with Airflow Test (select one criteria from this column) code Required? Enter the installed ventilation air-moving equipment information and the installed ventilation duct.system O Prescriptive design (Table 7.1) information.in the tables below,and certify on the CF-6R that no the installed system conforms to the"fable 7.1 prescriptive design criteria. Central forced air system fans used in Central Fan Integrated ventilation systems shall demonstrate, in air distribution mode, 0 Central Fan Integrated(CFI) a watt draw less than 0.58 W/CFM per Standards§151(1)1 1. yes Submit a CF-6R-MECI-I-22-HERS form for each forced air unit used for a CFI system. NIERS verification is required. Enter the installed ventilation air-moving equipment information and the installed ventilation duct system O Engineered Design information in the tables below,and certify on the CF-6R that yes the installed system conforms to the engineered ventilation system design approved by the enforcement agency. Enter the installed ventilation air-moving equipment information and the installed ventilation duct system O Manufacturer's design criteria information in the tables below,and certify on the CF-6R that no the installed system conforms to the manufacturer's ventilation system duct design criteria. LOCAL VENTILATION SYSTEM DESIGN- Identify the ventilation system design criteria Requirements for installer to demonstrate compliance with Airflow Test (select one criteria front this column) code Required? Enter the installed ventilation air-moving equipment information and the installed ventilation duct system O Prescriptive design(Table 7.1) information in the tables below,and certify on the CF-6R that no the installed system conforms to the'fable 7.1 prescriptive design criteria. Enter the installed ventilation air-moving equipment information and the installed ventilation duct system O Engineered Design information in the tables below,and certify on the CF-6R that yes the installed system conforms to the engineered ventilation system design approved by the enforcement agency. Enter the installed ventilation air-moving equipment information and the installed ventilation duct system O Manufacturers design criteria information in the tables below,and certify on the CF-6R that no the installed system conforms to the manufacturer's ventilation system duct design criteria. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-05 Indoor Air Quality and Mechanical Ventilation (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: Table 7.1 Prescriptive Duet Siring Requirements Diameter.(in) Flex Duct Smooth Duct Fan Rating cfm 0.25 in.w fl 50 80 100 125 50 80 100 125 Maximum Allowable Duct Length(iI) Diameter.(ill) Flex Duct Smooth Duct 3 X X X X 5 X X X 4 70 3 X X 105 35 5 N 5 NL I 70 35 20 NL 135 85 55 6 NL NL 125 _ 95 NL NL NL 145 7 and above NL NL NL NL NL NL NL NL This table assumes no elbows. Deduct 15 ft of allowable duct length for each tuut elbow.or fitting. Interpolation and extrapolation in Table 7.1 is not allowed. For airflow values not listed,use the next higher value. This table is not applicable for airflow> 125 cfm. NI.=no limit on duct length of this size. N=not allowed.any length of duct of this size with assumed tuns.elbows.linings will exceed the rated pressure drop. INSTALLED VENTILATION AIR-MOVING EQUIPMENT INFORMATION Ventilation devices and equipment shall he tested and rated by Mg procedures for airflow and sound. Sound rating maximum is 1.0 ,sone for all continuous dutyfrsns; 1.0 sone for intermittent duty whole-building fans:and 3.0 sone for intermittent duty local exhaust fans. Refer to the Residential Compliance Manual section 4.6 for information about exclusions to these sound rating requirements. In the table below,list the fm equipment installed that meets the requirement for whole-building ventilation and local ventilation exhaust. Fan or System Calculate System Type' Required Fan Certified Sound Fan Name or (WDV Airflow3 Manufacturer Fan Airflow' Rating' Fan (Watt per Location' or LVE) (CFM) Name' Model Number' (CFM) (Sone) Watts' CFM)' ,i')6N Lt/L gPogg C?P- 5JOSS �,5o h'3 ; k' o 5 f 01 i_. //c PA NAsoiRe F✓—a i?'VsL 11116 i Ls z y y -365 gmriloz L dC ,.4i/dnot/Ic FV- ew✓SG/ 6 7 /•3 zy y -365 Q l L ✓6 fA//asoui e FV- Ofi/21- / (o .7 / ? 041. 9/ •36..5 l wvMj r_✓c efr as'owie- 6 7 Ai zV e/ .36s- 1 36s1 I)Enter the Fan or System Identification Name or Location Name or System Identifier(e.g. "Bath02"",%last/alh" "Kitc/rerr0l'9. 2)What type of ventilation requirement is the fan.specified to meet?iVII V(whole-building ventilation)or LVE(local ventilation exhaust). 3)Enter the required ventilation airflow values determined by the calculations or tables in the WHOLE-BUILDING VENTILATION and/or LOCAL PENT/L.I TION EXHAUST sections at the beginning of this Installation Certificate(CFM). At least one fan must be designated for use for compliance with the "Whole-Building Ventilation"requirement. 4)Enter the fan manufacture's name. 5)Ener the fan model number or series number. 6)Enter the fan's Certified Airflow rating at 0.25 inch w.c.(CF.tQ. Fans rated at less than 0.25 inch w.c. (e.g. 0./inch w.c.)cannot be used to comply with the ventilation requirements using Jae prescriptive design criteria in Table 7.1. This certified airflow rating value must be equal to or greater than the required airflow frons column 3 of this table when demonstrating compliance using the prescriptive design criteria in liable 7.1. 7)Enter the fan's certified sound rating(Sone)corresponding to the certified airflow rating that was entered in column 6 of this table for the fern. 8)Enter the fan IV WI draw corresponding to the certified airflow rate that was entered in cohumr 6 of this table far the jinn. 9)Divide the Watt value from column 8 by,the Certified Airflow value(COO from column 6. Fars are required to be rated for operation at less than 1.2 11'attiCFtl. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-05 Indoor Air Quality and Mechanical Ventilation (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: INSTALLED VENTILATION DUCT SYSTEM INFORMATION Airflows required by the standard refer to delivered airflow of the installed system as determined by testing with a flow hood,flow grid, or other measuring device. Alternatively, the installed equipment's lift airflow rating at a pressure of0.23 inch w.c.may be used, provided the system can be inspected to confirm the duct sizing meets the prescriptive requirements of Table 7.1, or manufacturer's duct design criteria. Fan or Compliance Required Airflow Number of Actual Allowable Pass System Name Methods Airflow) Test' Elbows and Duct Length) Duct Lengths or or Location' (l': P:or NI) (CFM) (CFM) Duct'INTO Fitting? (ft) (ft) Fail' I. Enter the Fan or System Identification Name. or Location Name, or System Identifier. These should be the same identifiers as shown in the INSTALLED VENTILATION AIR-MOWING EQUIPMENT/NFORll4T/ON table column I above. 2. Enter the method for demonstrating compliance with the ventilation airflow requirements. Enter"T"for Tested:"P"for Prescriptive Table 7.1 design criteria(inspection): "Al"for Manufacturer's duct design criteria(inspection). Note:the building official may require submittal of manufacturer's published design criteria documentation if compliance is to be demonstrated by inspection of the installation for conformance to manufacturer's design criteria. 3. Enter the required ventilation airflow valises determined by the calculations or tables in the WHOLE-BUILDING VENTILATION and/or LOCAL VENTILATION EXHAUST sections at the beginning of this Installation Certificate(CFAI,/. These should be the same airflow values that were entered for each corresponding fan in column 3 oldie INSTALLED FENT/L/17'/ON AIR-,t10WI NG EQUIPMENT INFORMATION table above. 4. If complying by a method that requires an Airflow Test of the installed system, enter the result from the Airflow Test for the installed system(CFR). 5. Enter duct type for the installed system. Choices are "Flex"or"Smooth"if using Table 7.1 for compliance. 6. Enter total number of elbows or finings or abrupt turns in the ventilation duct for the installed system. 7. Enter the installed systems actual total duct length(Ii). 8. If complying r use(Idle prescriptive design criteria or manufacturer's design criteria, enter die Maximum Allowable Duct Length U)for the system as determined by Table 7.1 or manufacturers duct design criteria. 9. If complying by airflow test, the system passes if the 'Tested Airflow'equals or exceeds the Required Airflow'. If complying by demonstrating conformance to prescriptive design criteria or manufacturer's design criteria the system passes(factual total duct length from column 7 is less than the maximum allowed length from column S. Enter: Pass or Fail 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-05 Indoor Air Quality and Mechanical Ventilation (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: I ,P9 77.6. .4/ C- WSonA A - x II nod / 77 OTHER REQUIREMENTS The items listed below(6.1 through 6.8)correspond to the information given in ASHRAE 62.2 Section 6"Other Requirements". Refer also to Chapter 4.6 of the Residential Compliance Manual(Section 4.6.5)for information describing these "Other Requirements". The signature of the Responsible Person in the declaration statement below certifies that the building complies with these requirements specified in ASHRAE 62.2 Section 6.1 through 6.8 if applicable. ❑ 6.1 Transfer Air ❑ 6.2 Instructions and Labeling ❑ 6.3 Cloths Dryers ❑ 6.4 Combustion and solid-fuel burning appliances O 6.5 Garages ❑ 6.6 Ventilation Opening Area ❑ 6.7 Minimum filtration O 6.8 Air Inlets O Prescriptive Designs: For ventilation systems that utilize prescriptive design criteria, the signature of the Responsible Person in the declaration statement below certifies that the installed system conforms to the prescriptive ventilation system design criteria from Table 7.1 of Standard 62.2 and manufacturer's installation specifications. ❑ Engineered Designs: For ventilation systems that utilize engineered design criteria, the signature of the Responsible Person in the declaration statement below certifies that the installed system conforms to the engineered ventilation system design documentation approved by the enforcement agency. ❑ Manufacturer's design criteria: For ventilation systems that utilize manufacturer's design criteria, the signature of the Responsible Person in the declaration statement below certifies that the installed system conforms to the manufacturer's published duct system design criteria and installation specifications. DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California.the information provided on this form is true and correct. • I am eligible under Division 3 of the l3usiness.and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features. materials,components,or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations.and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-I It) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the Cr-1 R that apply to the installation have been met. • 1 will ensure that a Co inpleted.signed copy of this Installation Certificate shall be posted,or made available with the building perm it(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with thedocumentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Responsible Person's Name: Rcspon Ic 'crso :Signature: 54-AP ky R Co A00541 CSI.J3 License: Date Signed: Position With 1r mpanv(Title): gS 31 CV/j.7 o uu .t/E 6Z 2008 Residential Compliance Forms August 2009 • INSTALLATION CERTIFICATE CF-6R-MECH-01 Domestic Not Water (1)11W) (Page 1 of2) Site Address: /� Enforcement Agency: Permit Number: a 70 �2J,J'dGr,t ,4 L:tiJ/`"t%i v'o //doe/96 I. WATER HEATING SYSTEMS: Distribution Rated CEC Type If #of Input(kW Tank Standby Heater Certified Mfr Name S Model (Std,Point-of- Recirculation. Identical or Volume Efficiency Loss Type Number Use.etc) Control Type Systems Btu/hr) (eallons) (EF.RE) (%)I hyhrtd C%t52/✓yG • Z6 0,0T,��cGss .51 ,too '7 `IL 92/ �ei tc./ S Note 1: For.small gas storage(rated input less than or equal to 75,000 RtJhr), electric resistance and heat pump water heaters, list Energy Factor(EF). For large gas storage water heaters(rated input of greater than 75.000 Badly), list Recovery Efciency(RE), Thermal Efficiency, Standby Loss and Rated Input. For instantaneous gas water heaters, list the Thermal Efficiency and Rated Input. 2. Mandatory Measures TO COMPLY - ALL BOXES MUST BE CHECKED §110-§113: Water heaters,showerhead and faucets are certified by the California Energy Commission. §1500): Water System Pipe and Tank Insulation. And Cooling Line Insulation I. Storage tank insulation O A. Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are externally wrapped with insulation having an installed thermal resistance of R-12 or greater;and O B. Unfired storage tanks or other indirect hot water tanks have R-12 external insulation or R-16 internal- insulation where the internal insulation R-value is indicated on the exterior of the tank. 2. Water piping and cooling system line insulation thickness and conductivity First 5 feet of hot and cold water pipes closest to water healer tank,non-recirculating systems,and entire length of recirculating sections of hot water pipes are insulated per Standards Table 150-B;and O Pipetinsulation for steam hydronic heating systems or hot water systems>15 psi, meets the requirements of Standards Table 123-A. ❑ Insulation is protected from damage, including thafdue to sunlight,moisture,equipment maintenance,and wind. ❑ §I5 (081/ If indicated on the CF-I It.all hot water piping that runs from the hot water source to the kitchen fixtures is insulated per Standards Table 150-B. 2008 Residential Compliance Forms august 2009 • INSTALLATION CERTIFICATE CF-6R-MMECI-1-01 Domestic Hot Water(D1IW) (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 4/&.,Sniz-, 41; et y--7:5-r v"to //oe0 /S& 3. Central Water Heating in Buildings with Multiple Dwelling Units(required for prescriptive) TO COMPLY- ALL BOXES MUST BE CHECKED ❑ All hot water piping in main circulating loop is insulated to requirements of§I 500) ❑ Central hot water systems serving six or fewer dwelling units which have(1) less than 25' of distribution piping outdoors; (2)zero distribution piping underground;(3)no recirculation pump;and(4) insulation on distribution piping that meets the requirements of Section 1500) O Central hot water systems serving more than 6 dwelling units-presence of either a time control or a time/temperature control DECLARATION STATEMENT • I certify under penalty of perjury.under the laws of the State of California,the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features.materials. components.or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CP-I it) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF-IR that apply to the installation have been met. • I will ensure that a completed.signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Responsible Person's Name: Responsi l,cTon's Sigi turc: fht Ai/ PY4R 50P00W CSI-13 License: Date Signed: Position Vith Con any(Title): S F5 J 27//1 Oil, A/ F J� 2008 Residential Compliance Forms August 2009 • INSTALLATION CERTIFICATE CF-6R-MECH-04 • Space Conditioning Systems, Ducts and Fans (Page I of 2) Site Address: Enforcement Agency: Permit Number: / S 9 2 o /7ir-r-as an, Ary i ( 0601 °16, '. Space Conditioning Systems //eating Equipment Duct Efficiency Location Equip (AFUE, (attic. Type ARI N of etc.)''' crawl- Heating Heating (package- CEC Certified Mfr. Name Reference Identical (aCp-IR space. Duct Load Capacity heat pump) and Model Number Number 2 Systems value)' etc.) R-value (13tu/hr) (13tuthr) 1Sr GAS FL• S,auf N713E6E017/YA1 503 9931 / 9c.$°l� CQ`�` R•Go 1o0,000nry 5frM91vH sPncf 3a tfakCr N9Msco opt 1t{10A1 56V1g3Z 1 l$•SZ cmc Rd•0 �/o,aoo61k 3gMg>v// Cooling Equipment Efficiency Duct Equip (SEER Location Type and GER) (attic. (package N of 1'} crawl- Cooling Cooling heat CEC Certified Mfr.Name ARI Reference Identical ( CI'-f 12 space. Duct Load Capacity _pump), and Model Number Number 2 Systems value)° etc.) R-value (l3tu/hr) (13tu/hr) !'sr 5kW Ale 0 N/ct1 r Iso SEW S pi, evAeli N 43K-ICA IOo 91c713 I 12a cue tin u24.o 36/arra 3 ,4oa 2 � ScRaill:USfL'(Z 4X Y 46.101 Dn /I IStH3E-fir `I I •j Ito n n-'nc R6•v 2Y,000 2ipoo 1 I. If project is new construction, see Footnotes to Standards Table 15l-U and Table 151-C for duct ceiling alternative compliance. 2. ARI Reference Number can he found by entering the equipment model number athup://tvwro.wridirectorv.org/ari/ac.plapk 3. Listed efficiency on this page must he greater than or equal(>) to the value shoran on the CF-I Rfarm. 4. When CF-1 R is reference it is also applicable to the CFI R. CFI R-AA or CF-I R-ALT IL BOXES MUST BE CHECKED TO BE A VALID FORM A0§110-§113: HVAC equipment is certified by the California Energy Commission. Ei§150(h): Heating and/or cooling loads calculated in accordance with ASI-IRAE, SMACNA,or RCCA. d§I500): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of§I 12(c). © §1500)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 110 6 0 1 SC • Ducts and Fans §150(m): Duct and Fans la 4. All air-distribution system ducts and plenums installed,sealed and insulated to meet the requirements of CMC Sections 601, 602,603,604,605 and Standard 6-5;supply-air and return-air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct-closure system that meets the applicable requirements of UL 181, UL 181 A,or UL 181B or aerosol sealant that a meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used; and C I. Building cavities,support platforms for air handlers,and plenums defined or constructed with materials other than sealed sheet.metal,duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and 'support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to c-au�se reductions in the cross-sectional area of the ducts. LJe '2D.Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive ductItapes unless such tape is used in combination with mastic and draw bands. a,�,/ 7. Exhaust fan systems have back draft or automatic dampers. Mil Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually o,_p,e}f'ated dampers. LFf 9. Protection of Insulation. Insulation shall be protected from damage, including that due tosunlight,moisture, equipment maintenance,and wind. Cellular foam insulation shall be protected as above or painted with a coating that is wat i retardant and provides shielding from solar radiation that can cause degradation of the material. 10. Flexible ducts cannot have porous inner cores. DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California the information provided on this form is truemnd correct. • I am eligible.under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of person responsible for construction(responsible person). • I certify that the installed features,materials.components.or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-1R) form approved by the enforcement agency that identifies the specific requirements forthe installation. I certify that the requirements detailed on the CF-I12 that apply to the installation havebeen met. • I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building perm it(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required tobe included with therdocumentation.the builder provides to the building owner at occupancy. Company nfflMName: Instal ing Subcontractor or General Contractor or Builder/Owner) EXf & AI/1,/N G Re onsihle Pers s Name: Responsib II! on's.. 'gnature: 5WN Pewit CSI-13 License D: e Sinned: Position tl ontpany.fitle): 017(0 .4 C--7-o 1 SJ7Lor2 ®tA4J PliC41o670r 2008 Residential Compliance Forms August 2009