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13120009CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19732 BIXBY DR CONTRACTOR: BAY AREA CUSTOM PERMIT NO: 13120009 BUILDERS INC OWNER'S NAME: NIU RAN AND ZHANG SHUHAN 1002 S DE ANZA BLVD STE Al DATE ISSUED: 03/21/2014 OWNER'S PHONE: 4082073606 SAN JOSE, CA 95129 PHONE NO: (408) 446-1200 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ( LICENSED CONTRACTOR'S DECLARATION Class Lie. # Q '� n REVISION #1 (7/7/2014) ADD NEW FURNACE TO PROJECT License Contractor��✓ �e7 Date ® .D 1 TO SERVE ADDITION. I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I ereby Arm 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 Valuation: $100000 performance of the work for which this permit is issued. Sq. Ft Floor Area: 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 APN Number: 36909019 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION Irti ythat have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAYS FROM LAST CALLED INSPECTION. 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 j Issued by: ����✓ �%l�/ Date: �X granting of this permit. Additionally, the applicant understands and will comply �— with all non-point source regulations per the Cupertino Municipal Code, Section 9 18. f Date © `9/! y RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature �� installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS' OR BETTER the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, do the work, and the structure is not intended or offered for sale (Sec.7044, will Business & Professions Code) HAZARDOUS MATERIALS DISCLOSURE I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous Additionally, should I use equipment or devices which emit hazardous I have and will maintain a Certificate of Consent to self-insure material. as defined by the Bay Area Air Quality Management District I Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. & Safety aety Code, Sections 25505, 25533, and 25534. the Health f I have and will maintain Worker's Compensation Insurance, as provided for by for this O Lf Section 3700 of the Labor Code, for the performance of the work which Owner or authorized agent: Date: O permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of become subject forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9 18. Signature Date GENERAL PERMIT APPLICATION, [aid COMMUNITY DEVELOPMENT DEPARTMENT MENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3253 (408) 777-3228 • FAX (408) 777-3333 - buildino(cDcuoe flno.ora M I cu'p7tAylko / PROTaCT ADDRESS 3 61, x h Or PHOT E I E 1JikII OZ 'ICER �p In U //t %I I PHOA'E C4 E-.NiSII STR=T,iDDPMS - I CIT1, STATE, ZIP I FPX COINTrACT NAI �t PHOT E I E 1JikII ST?.czi ADDRZSS CITY, STAT B, ZIPI FAX Wiest ❑ OWI-.=R-BUR.DER ❑ OartMA(—=K7 ❑ CONipACTOR ❑COhTRRCTORAG=AT 11ARc-- -CT 13ENGDZ—a ❑ D1=IOPsR ❑ 7---k COIN-?.ACTOR."Al'-134 �&-^ l ICIQ�'MER �CM'ZSETYPE l sf I BUS. LIC: COyJ-]-.X'Y N.A r—R I E-JvCAJ . I FAX 9 /✓ (� _ 6 6-12 � STRrTADDPESS j(�C' Z'd , ) STA!£ ZIP I PiiOl Ai2CPIlT CT/ENGIhE R N 41J ^ I LICrTSE I.rGI✓3ER I BUS. LIC n COIJ,PFNYls''Ahm- E 1JAII I FAX STREET ADDRESS CrrY, STATE, ZIP PHONT- USE OF ❑ sr -D or DUPL-.x BUII DIlVG: ❑ COt✓1JERCL4I ❑ i=-FAmiY I PRO= LN WIIALA \M ❑ YES I PROTECT IN ❑ YES URBAN n\== ACE AREA ❑ NO FLOOD zollm ❑ NO I IS nM BLDG AN ❑ YES EICFII-FR HOI ? ❑ NO DESCRIPTION Or WORK TOTALW.LUATTON: li �s 0fD ' � By ny si=nature below, I certi:f + to each of the follo-,i.,in;: I un the property owmzer or authorized agent to act on the property 01YIer's behalf. I have read this application and the iemrmation I have. provided is correct. I have read the Description of Work and verify it is acvx, ate. I agree to comply vrith all applicable local ordinances and state la-,qs relating to buildine consi,uction. I autho" re -sentatives of Cupertino to enter the abov- identiued propejy for inspection puiposes. S i gnablre of : _pplicmty kzmt: Date: O SUPPLEMIF-NTAL E\TFORMATION REQTJ=D ffl-WEREsaw— p FIN -0 �3 IPPA isc1pp_2011.doc revised 06/21/11 JJ CITY OF CUPERTINO UU1V T'i cTTMA'TnR _ RITII .IIINfi' nIVICION ADDRESS: 19732 Bixby Dr FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) DATE: 07/07/2014 REVIEWED BY: Sean APN: BP#: EVALUATION: $6,000 *PERMIT TYPE: Mechanical Permit suppl, PC Fee- PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC PERMIT TYPE: USE: Pe i'mir F,e: WORK Revision #1: Add new furnace to prouect to serve addition. SCOPE $139.00 PME Permit Fee: Mech. Plan Check 10.0 1 hrs $0.00 F'tvalb. Na"I t'fw Mech. Permit Fee: IMPERMIT 11114MI), Pe " ­"nil Pee Other Mech. Insp. Fo.0 hrs $47.00 Other I'turnh 7risp. 14eci7. fns�z heec: 1117unb, h1sh. Vee: 1 r- 1,e C1lhe L-r'e'C.Insp. I Pae(.. if s,.. hese: 1 NOTE: This estimate does not include fees due to other uepartments (i.e. riammng, ruuuc rr urna, tic, ---y ,�..�, .�.��•.. y ��••��• District, etc.). These fees are based on the prelimina information available and are on1v an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Playa f ';' ecA suppl, PC Fee- F PME Plan Check: $0.00 Pe i'mir F,e: slip171, hrfsll PME Unit Fee: $139.00 PME Permit Fee: $47.00 Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes (j) No $0.00 A Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.60 Select an Administrative Item Bldg Stds Commission .Fee: 1BCBSC $1.00 $278.60 $0.00 TOTAA- FEE: $278.60 Revised: 07/01/2014 CITY OF CUPERTINO BUILDING PERMIT IWILDING ADDRESS: 19732 B1XBY DR I CONTRACTOR: BAY AREA CUSTOM I PERMIT NO: 13120009 OWNER'S NAME: NIU JIAN AND ZHANG SHUHAN 11002 S DE ANZA BLVD STE Al I DATE ISSUED: 03/21/2014 l OWNER'S PHONE: 4082073606 SAN JOSE, CA 95129 1 PHONE NO: (408) 446-1200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ CONSTRUCT A ONE STORY ADDITION (531 SQ FT); License Class_ Lic. k INTERIOR REMODEL (310 SQ FT). ContractorRei h -eeA Sohn r��l�� e V I hereby affirm that I am licensed under the provisions of Chapter 9 (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. 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. 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 to building construction, and hereby authorize representatives of this city to enter 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 granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. , r Signature Date c� 3� 114 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation. 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I 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. 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 to building construction, and hereby authorize representatives of this city to enter 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 granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date Sq. Ft Floor Area: I Valuation: $100000 ':PN Number: 36909019.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS F ,OMj AST CALLED INSP�CT N. Issued by: RE -ROOFS: 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 inspection. Signature of Applicant: Date: _ ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. ONN ncr or authorized agent: R le - k G'i/_oDater c4 , /3 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address - ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION dD cl� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION D 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.org \ ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Tl ❑ REVISION / DEFERRED ORIGINAL PERMIT # PRO AD DESS APN # Cl lid OWNER NAME) PHONE , E-MAIL c�J STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PH NE E- STREET ADD S CITY, S ZIP FAX A/I ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT O O 4 TOR ❑ C `TRACTOR AGENT CHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT GINEER NAME LICENSE NUMBER BUS. LIC # COM ANY N E-MAIL FAX \ STREET ADDRESS CITY, STATE, ZIP PHO 'E / 1` DESCRIPTION OF WORK t 0AAA 600- EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (5) EXISTG AREA NEW FLOORDEMO AREA AREA TOTAL O BATHROOM OTHER REMODEL AREA --70 REMODEL AREA,401 REMODEL AREA PORCH AREA DECKAREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH DWELLING UNITS:IS A SECOND UNIT ❑YES SECOND STORY YES BEING ADDED? ❑ NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIV Y: I TOTAL VA LUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? []NO Zv? By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: � SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPEel ROUTING SLIP o\-ER-THE-coU -TER REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for❑ existing building(s). Demolition permit is required prior to issuance of building DING PLAN permit for new building. EXPRESS PLAITING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC NVORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE RE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ submittal of Building Permit application. MAJOR SANITARY SENNTR DISTRICT ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 e— ,���,��,�,--,,,,�� CITY OF CUPERTINO 1�`+I'iIlJI 1PI F F.CTIN4ATOR — ]BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 19732 bixby dr FLR AREA s.f. DATE: 12/02/2013 REVIEWED BY: Mendez BP FEE ID APN: BP#: 531 `VALUATION: $100,000 *PERMIT TYPE: Building Permit IR31NSP PLAN CHECK TYPE: Addition n: C' -L-1 PRIMARY USE: SFD or Duplex Permit Fee: 2nd Unit? OTC? Yes No O Yes O(OF)No PENTAMATION PERMIT TYPE: 1 R3SFDADD WORK 531 sq ft addition to include new kitchen and quest room convert existing kitchen into quest room and SCOPE I bathroom... 310 sq ft $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 531 $2,577.00 IR3PLNCK $1,617.00 IR31NSP PME Plan Check: $0.00 n: C' -L-1 Permit Fee: $1,617.00 Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 531 $2,577.00 $1,617.00 MECH, HOURLY ® Yes O No PLUMB, HOURLY ® Yes (F) No ELEC, HOURLY O Yes Q No Me h. Flan Check Plumb. Plan Check Elec. Plan Check T1 I Plumb. Permit Fe, Elec. Permit Fee: F,)t,he'r.;kfevh. Insp Other Plumb Insp. Other Elec. Insp. Li hrs $0.00 PME Plan Check: $0.00 n: C' -L-1 NOTE: This estimate does not include fees due to other Departments (l.e.'Planning,'Public Moms, fire, Sanitary Sewe. .wwa. dro annnnhr nn octimat0_ Contact the Dent for addn7 info. Ulsrricr, erc . mese ees are au3eu Or, u -e .es�..usu. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1,%13) ... ,,,..•. ,. ».»»» FEE .- ._- -- QTY, FEE ---- ---- --- MISC ITEMS Plan Check Fee: $2,577.00 310 s.f. $488.00 Remodel, Other IREMRESOTA Suppl. PC Fee: E) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,617.00 Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consmuction Tax: Adinini.strative Fee: 0 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: IPLLONGR $74.34 Select a Non -Residential Building or Structure T_ IA E) 0 7 ravel Documentation Fees: Strong Motion Fee: IBSEISMICR $10.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $4.00 SUBTOTALS: $4,282.34 $488.00 TOTAL FEE: $4,770.34 Revised: lotov2013 10/07/2014 10:30AM FAX 4084461241 CUPERTINO BAY AREA CUSTOM BUILDERS 20001/0001 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR DIST .IDB ADDRESS: 19732 BIXBY DR. PERM1T # 13120009 OWNER'S NAME: SHUHAN ZHANG PHONE # 408-446-1200 GI NERAL CONTRACTOR: BAY AREA CUSTOM BUILDERS BUSINESS LICENSE # 31905 ADDRESS: 1002 S. DE ANZ4 BLVD. #1 Cf �,��j CI7Y/Z1PC0DE: SAN JOSE 95129 "Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using Any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: weer / Contractor Signature 10/-1 1 Iq Date SUBCONI'RAC TOR BIUSINESS NAME B[JSINESS LICENSE # Cabinets & Millwork — Cement Finishing - .................. ELECTRIC -- Electrical 34369 —. Excavation _EDEN Fencing -- Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating 1/ Insolation. PONZINI INSULATION 26001 Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering ^ ^ Plumbing V,--' _ Roofing A. 0. ROOFING 29852 Septic Tank Sheet Metal Sheet Rock Ti le weer / Contractor Signature 10/-1 1 Iq Date CUPERTINO HVAC ALTERATIONS ENERGY COMPLIANCE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buiidinaacupertino.ora WHEN IS A PERMIT REQUIRED A construction permit shall be obtained from the enforcement agency prior to the erection, construction, reconstruction, installation, relocation, or alteration of any mechanical system, except as permitted in Chapter 1, Section 112.2 of the 2010 California Mechanical Code. Projects requiring permits include, but are not limited to: • New HVAC installation • HVAC Changeout • Replacement of furnace, coil, FAU or condenser' • Relocation of an existing HVAC unit • Adding or replacing more than 40ft ducting in unconcfitioned space BUSINESS AND PROFESSIONS CODE, SECTION 7110 Willful or deliberate disregard and violation of the building laws, including the California Building Code, and local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board working in conjunction with the local building department. This action may consist of fines up to $5,000 per violation or suspension/revocation of a contractor's license. 2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24, Part 6) REQUIREMENTS INCLUDE: 1. Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room heaters). 2. Central air conditioners & heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER. 3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2. 4. A setback type thermostat (24 hr clock with four set points) is required for all alterations. 5. New or replacement ducts must meet the mandatory requirement of Section 150(m). • All joints and openings in the HVAC system must be sealed. • Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct openings. • Connections of metal ducts and the inner core of flex ducts shall. be mechanically fastened. Flex ducts must be connected using a metal sleeve/coupling. . • Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no more than 2" of sag between supports and 6 ft. max for vertical runs. 6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector will collect this form and verify that the model numbers are the same as the installed equipment. 2008 Residential Compliance Forms.doc revised 04/10/12 SWe Addrez: rJ Enforcemerd Agency: e{ Dail: ;; .:_ ev-it: 4(j C Q 1� Conditioned Duct insulation enY T List Aimimtim `Ei*icien Floor n 'iZrbr�ostat . Packaged Unit GOP �HSPF Smed b3' system Over 40 8 of dntks added or ieplacxd Setback ; 9Furnace Indoor Coil condeensiing Unit F3;R ItesisEa:ice sf v .in conditioned space R 6 I, 3-S) {Inotalreadypresentm�r�be M Other . (CZ • 1. Equipment Type: Choose the equipment being i istailed; if more than one_system, use another CF -JR -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEE?., 78%AFUE, 7.7HSPF for typical residential systems. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • 1 certify that the energy features and perfaimmce specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts i and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the infomnation documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for appro al with the permit application, Signature. Name: C 1/ G. ln9 Company f a i ✓�. L' t t �o in � Vl. t! I A f1� : ...;. Date: ,.. O , Address (©o%, 5 " -- t P /, % 7 N y F ,� ) icense: O: z CntylState/Zrp: o . S Phone: 9 2008 Residential Compliance Forms.doc revised 04/10/12