13050216 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10521 SAN FELIPE RD CONTRACTOR:CALIFORNIA DELTA PERMIT NO: 13050216
MECHANICAL INC
OWNER'S NAME: DEVENDRA RAUT 6056 E BASELINE RD STE 155 DATE ISSUED:05/31/2013
OWNER'S PHONE: 4082397804 MESA,AZ 85206 PHONE NO:(866)692-5273
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG� ELECT r PLUMB
License Class Lic.#
MECH F RESIDENTIAL r COMMERCIAL F
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:GAS WATER HEATER CHANGE OUT
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area:0 Valuation:$1171
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:34222073.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date'
9.18.
Signature Date
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued.
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's Owner or authorized agent:
Compensation laws of California. If,after making this certificate of exemption,I Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(See.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
INSTALLATION CERTIFICATE CF-6R-LTG-01
Residential Lighting a e 2 of 3
Site Address: Enforcement Agency: Permit Number:
�! (nom�fC. B1(� 219 0,7
3.Installed Devices and Components Have Been Certified to the Energy Commission
Does the project include any of the devices or components listed below?WYes,complete section 3 ❑No,go on to section 4
EA Yes 2'14-1
§119 and§150(k)7(F):Any.,of the following devices and components which have been installed have been certif1 f
m on
according to the applicable provisions of§119:All LED lighting systems that are classified as high efficacy,ball is us s- luaires,
vacancysensors(automatic off/manual on occupant sensors),dimmers,track lighting integral current limiters,an ou o ' soram
4.Lighting Controls Complete section 4
Q�Yes ❑ NA §150(k)7A:Permanently installed low efficacy luminaires are controlled by switches separate from those controlling high
efficacy luminaires.
12. Yes ❑ 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.
151,Yes ❑ NA §I50(k)7C:All permanently installed luminaires are switched with readily accessible controls that permit the luminaires to be
manually switched on and off
lj� Yes ❑ NA §150(k)7D:All lighting controls have been installed in accordance with the manufacturer's instructions.
QL Yes ❑ NA §I50(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)?
l kYes,complete section 5 ❑No,go on to section 6
U�Yes,high efficacy luminaire classification has been determined according to§150(k)1,and low efficacy luminaire classification has been
determined according to§150(k)2.
❑ Yes M NA §150(k)4:"Fluorescent lamps rated 13 watts or greater have an electronic ballasts having an output frequency no less than 20
kHz.
❑ Yes I�L NA §150(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.
$1 Yes ❑ NA §150(k)6: Lighting integral to exhaust fans,in rooms other than kitchens,meet the applicable requirements of§150(k).
Yes ❑ NA 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?
Yes,complete the rest of section 5 ❑No,go onto section 6
'fel Yes,§150(k)12: Luminaires that are recessed into insulated ceilings meet all of the following conditions:
19 Yes,are listed,as defined in§101,for zero clearance insulation contact(IC)by UL or other nationally recognized testing/rating
laboratory,and
Yes,have labels that certify the luminaires are 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
*Jq Yes,are sealed.with agasket-or caulk between luminaire 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
]l 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?
Yes,complete section 6 p No,go on to section 7
❑ Yes j71 NA §150(k)10:Permanently installed luminaires in bathrooms,garages,laundry rooms,closets>70 ft2,and utility rooms are high
efficacy luminaires OR are controlled by a vacancy sensor.
9,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 are high efficacy luminaires,OR are controlled by a dimmer switch OR are controlled by
a vacancy sensor.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-611-MECH-05
Indoor Air Quality and Mechanical Ventilation (Page 1 of 5
Site ddress: ,^ k
Enforcement Agency: Permit �be
Ventilation for Indoor Air Quality(IAQ): All dwelling units shall meet the requirements of ANSI/ASHRAE standard 62.2.
Ref Title 24 Part 6 Section 150(o). Equation and table numbering on this CF-6R corresponds to the numbering for that
information in the published ASHRAE Standard 62.2.
WHOLE-BUILDING VENTILATION
Ventilation Rate: A mechanical supply system,exhaust system,or combination thereof shall provide whole-building
ventilation with outdoor air each hour at no less than the rate in equation 4.1 a. For dwelling occupant densities known to be
greater than(Nb,+ 1),the rate shall be increased by 7.5 cfin for each additional person.
Where: Enter Eq 4.1 a Calculation:
(Eq.4.1 a) Qf.=0.0 lAnoor+7.5(Nbr+ 1) Afloor=conditioned floor area,ft2 Afloor=
Nb,=number of bedrooms;not to be less than one Nbr=
Qfan=ventilation air requirement=fan flow rate,(cfm) Qfan=
Delivered Ventilation: The effective ventilation rate of an intermittent system is the combination of its delivered
capacity,its fractional on-time,cycle time,and the ventilation effectiveness from Table 4.2. This calculation only applies
to intermittent systems.
Where: Enter Eq 4.2 Calculation
Qr=ventilation air requirement from Eq.4.1a(above) (if applicable).
(Eq.4.2) Qf=Qr/(cf) f=daily fractional on-time,(%) Qr=
e=ventilation effectiveness(from Table 4.2) f
Qf=fan flow rate during the on-cycle(cfm) E
Qf=
Table 4.2—Ventilation Effectiveness for Intermittent Fans Whole-Building Ventilation Rate Summary
Select the method used to provide Whole-
Daily Fractional On-Time,f Ventilation effectiveness,E Building Ventilation and enter the required fan
f<35% 0.33 flow rate(cfin). Select one:
35%<f<60% 0.50 ❑ Continuous fan flow(cfin)_
60%:5 f<80% 0.75 ❑ Intermittent fan flow(cfin)_
Use the fan flow rate from this summary for
80%<f 1.0 selection of the whole-building ventilation fan
and for the duct design for the whole-building
Fan runs at least once every ventilation system. Provide the system design
three hours 1'0 information in applicable sections below.
LOCAL VENTILATION EXHAUST
Local mechanical exhaust fans shall be installed in each kitchen and bathroom. The minimum airflow rates shall be at least
the amount indicated in tables 5.1 and 5.2.
Table 5.1 Table 5.2
Intermittent Local Ventilation Exhaust Airflow Rates Continuous Local Ventilation Exhaust Airflow Rates
Application Airflow Notes Application Airflow Notes
Vented range hood Based on Kitchen
Kitchen 100 cfm required if exhaust fan Kitchen 5 ACH Volume
flow is less than 5 ACH
Bathroom 50 cfm Bathroom 20 cfm
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:
Pq �w P - 1
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 a flow 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 may be used to demonstrate
compliance without testing of the=airf ow of the installed system,provided the system duct sizing meets the prescriptive requirements of
Table 7.1, or manufacturer's 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
(CFI)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
(select one criteria from this column) Requirements for installer to demonstrate compliance with Airflow Test
code Required?
Enter the installed ventilation air-moving equipment
information and the installed ventilation duct system
❑ Prescriptive design(Table 7.1) information in the tables below,and certify on the CF-6R that no
the installed system conforms to the Table 7.1 prescriptive
design criteria.
Central forced air system fans used in Central Fan Integrated
ventilation systems shall demonstrate,in air distribution mode,
❑Central Fan Integrated(CFI) a watt draw less than 0.58 W/CFM per Standards§151(f)11. yes
Submit a CF-6R-MECH-22-HERS form for each forced air unit
used for a CFI system. HERS verification is required.
Enter the installed ventilation air-moving equipment
information and the installed ventilation duct system
❑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
❑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
(select one criteria from this column) Requirements for installer to demonstrate compliance with Airflow Tet
code Required?
Enter the installed ventilation air-moving equipment
information and the installed ventilation duct system
prescriptive design(Table 7.1) information in the tables below,and certify on the CF-6R that no
the installed system conforms to the Table 7.1 prescriptive
design criteria.
Enter the installed ventilation air-moving equipment
information and the installed ventilation duct system
❑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
❑ 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.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-611-MECH-05
Indoor Air Quality and Mechanical Ventilation (Page 3 of 5)
Site Address: ^ �� �,• ` _� P k � Enforcement Agency: Permit Number:
Table 7.1 Prescriptive Duct Sizing Requirements
Diameter, in Flex Duct Smooth Duct
Fan Rating cfm
0.25 in.w.g. 50 80 100 125 50 80 100 125
Maximum Allowable Duct Length(ft)
Diameter, in Flex Duct Smooth Duct
3 X X X X 5 X X X
4 70 3 X X 105 35 5 X
5 NL 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 turn,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.
NL=no limit on duct length of this size.
X=not allowed,any length of duct of this size with assumed turns,elbows,fittings will exceed the rated pressure drop.
INSTALLED VENTILATION AIR-MOVING EQUIPMENT INFORMATION
Ventilation devices and equipment shall be tested and rated by HVI procedures for airflow and sound. Sound rating maximum is 1.0
sone for all continuous duty fans; 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 fianequipment installed that meets the re uirement or whole uilding ventilation and local ventilation exhaust.
Fan or System Calculate
System Type Required Fan Certified Sound Fan
Name or (WBV Airflow3 Manufacturer Fan Airflow Rating? Fan (Watt per
Location' or LVE) (CFM) Name Model Numbers (CFM) (Sone) Watts' CFM)'
too e ,R Pi.0- 100 . � 5. �•�
1)Enter the Fan or System Identification Name or Location Name or System Identifier(e.g. "Bath02""MastBath", "Kitchen()]').
2)What type of ventilation requirement is the fan specified to meet? WBV(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 VENTILATION 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)Enter the fan model number or series number.
6)Enter the fan's Certified Airflow rating at 0.25 inch w.c. (CFM). Fans rated at less than 0.25 inch w.c. (e.g. 0.finch w.c)cannot be
used to comply with the ventilation requirements using the prescriptive design criteria in Table 7.1. This certified airflow rating value
must be equal to or greater than the required airflow from column 3 of this table when demonstrating compliance using the
prescriptive design criteria in Table 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 fan.
8)Enter the fan watt draw corresponding to the certified airflow rate that was entered in column 6 of this table for the fan.
9)Divide the Watt value from column 8 by the Certified Airflow value(CFM)from column 6. Fans are required to be rated for operation
at less than 1.2 Watt/CFM.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-LTG-01
Residential Lighting (Page 3 of 3
Site Address: Enforcement Agency: Permit Number:
5g 7 q- 'Smd� L 11:)�
7. Outdoor Lighting
Does the project include any permanentlyinstalled outdoor lighting?
❑Yes,complete section 7 J:NLNo,go on to section 8
❑ Yes ❑ NA §I50(k)13:Luminaires providing outdoor lighting,including outdoor lighting for private patios on low-rise residential buildings
with four or more dwelling units,entrances,balconies,and porches,and which are permanently 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 I to§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 1 to
§150(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§148,OR do not contain a screw-base socket and consume no
more than 5 watts of power as determined according to§130(d).
❑Yes ❑NA §150(k)15 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 be submitted
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 No,go on to section 9
❑ Yes,§150(k)16: 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§119(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 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(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.
• 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 Subcontracto ror General Contractor or Builder/Owner)
Responsible Person's Name: Responsible Person's Signature:
CC&SSo•d 0V 3;eh
CSLB License: Date Signed: Position With tompany(Title):
cv� S1 16 2 1111 �
2008 Residential Compliance Forms August 2009
r
INSTALLATION CERTIFICATE CF-6R-MECH-05
Indoor Air Quality and Mechanical Ventilation (Page 5 of 5
rc
Site Address Enfoement Agency: Permit Number:
,5q 74 Sw'11p l aQ DO
OTHER REQUIREMENTS
The items listed below(6.1 through 68)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
116.3 Cloths Dryers
❑ 6.4 Combustion and solid-fuel burning appliances
❑ 6.5 Garages
❑ 6.6 Ventilation Opening Area
❑ 6.7 Minimum filtration
❑ 6.8 Air Inlets
lk 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 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(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-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)
bov�, Vk:tr4�m
Responsible Person's Name: Responsibl Person's Signature:
55C^7 vr`seV%
CSLB License: Date Signed: Positio With Company(Title):
� 1 owtq-ew
2008 Residential Compliance Forms August 2009
a
INSTALLATION CERTIFICATE CF-6R-MECH-05
Indoor Air Quality and Mechanical Ventilation (Page 4 of 5
Site Address: Enforcement Agency: Permit Number:
5g7y S 'PJC. PJ I Q0 001
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 HVI airflow rating at a pressure of 0.25 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 Method Airflow' TesO Elbows and Duct Length? Duct Length or
or Location' T;P;or M CFM CFM Duct Types Fittings 6 ft ft Fail9
5,0 %0 r@fi N 3 3 P
�n ►kms P S D 60
1. Enter the Fan or System Identification Name, or Location Name, or System Identifier. These should be the same identifiers as shown
in the INSTALLED VENTILATIONAIR-MO VING EQUIPMENT INFORMATION table column I above.
2. Enter the methodfor demonstrating compliance with the ventilation airflow requirements. Enter"T"for Tested;"P"for Prescriptive
Table 7.1 design criteria(inspection); "M"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 values determined by the calculations or tables in the WHOLE-BUILDING VENTILATION
and/or LOCAL VENTILATION EXHAUST sections at the beginning of this Installation Certificate(CFM). These should be the same
airflow values that were entered for each corresponding fan in column 3 of the INSTALLED VENTILATION AIR-MOVING
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(CFM).
S. 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 fittings or abrupt turns in the ventilation duct for the installed system.
7. Enter the installed system's actual total duct length(ft).
8. If complying by use of the prescriptive design criteria or manufacturer's design criteria, enter the Maximum Allowable Duct Length
(ft)for the system as determined by Table 7.1 or manufacturer's duct design criteria.
9. If complying by airflow test, the system passes if the Tested Airf ow4 equals or exceeds the Required Airf owj. If complying by
demonstrating conformance to prescriptive design criteria or manufacturer's design criteria, the system passes if actual total duct
len th rom column 7 is less than the maximum allowed len th rom column 8. Enter: Pass or Fail
y
2008 Residential Compliance Forms August 2009