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13010056CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10573 GASCOIGNE DR CONTRACTOR: HARMIN INVESTMENTS PERMIT NO: 13010056 112 LP OWNER'S NAME: HARMIN INVESTMENTS 112 LP 2162 RINGWOOD AVE DATE ISSUED: 04/29/2013 OWNER'S PHONE: 4088073636 SAN JOSE, CA 95131 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALS License Class Lie. # NEW CONSTRUCTION OF SFDWL, 2477 SQ FT TOTAL (470SQ GARAGE & 44 SQ FT PORCH Contractor Date 6/4/2013 - REVISION # I - CHANGE ROOF SYSTEM FROM I hereby affirm that I am licensed under the provisions of Chapter 9 CONVENTIONAL TO TRUSS SYSTEM-ISSD 7/16/2013 (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 Sq. Ft Floor Area: Valuation: $500000 performance of the work for which this permit is issued. 1 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: 37528009.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 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 upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. RE-ROOFS: Signature Date 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. OWNER-BUILDER DEC_ _LARA_TION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE 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. 1 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: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 1 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 the Health & Safety Code, ons 5505, 2 3, a d 25534. permit is issued. Owner or authorized agent:w Date. 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, 1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, 1 must I hereby affirm that there is a construction lending agency for the performance of 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. 1 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- oint source re ions per the Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date �1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION V 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(o)cupeltino.org CUPERTINO&REVIS`ION ❑' NEW CONSTRUCTION El ADDITION ❑ ALTERATION / TI DEFERRED ORIGINAL PERMIT tt PROJECT ADDRESS �� L..i c..c 3 C4:�9'7 -,a `UJB' APN N ` J G�J /9 —001 I OWNER NAME q,,_� PHONE U� .� !. n 1<MAIL fl f STREET ADDRESS CITY, STATE, ZIP,l ls�,00 Se ` �� / FAX \ CONTACT NAMET tuvl,� •J� PHONE N�,33 --30 3 �� 1<MAIL STREET ADDRESS CITY, STATE, ZIP FAX C� ❑ OWNER OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENUMBER LICENSETYPE BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE N STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DEC"ORCH AREA GARAGE AREA: DETACH ❑ ATTACH H DATLLING UMTS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? []NO ..°" PRE -APPLICATION YES IF YES, PROVIDE COPY OF PLANNING APPL M NO PLANNING APPROVAL LETTER IS THE BLDG AN 0 YES EICHLER HOME. NO r// �/ /�,/O` /�, TAL VALUATION: /%�/� / By my signature below, 1 certify to each oft following: 1 am the property owner or authorized agent to act property owner's behalf. I have read this application and the information 1 have Prov d is co ect. 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 bu' const ction. 1 authorize representatives of Cupertino to enter the above -i ntified roperty for inspection purposes. SignatureofApp] icant/Agent: f Date: / SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for building(s), Demolition is required to issuance of building �,� � ''• ��/�i,/,%,, i� �/,// , , aril existing permit prior permit for new building.'' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure��jr�;S;71"' form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to / / submittal ofBuilding Permit application. BidgApp_201 Ldoc revised 06/21/11 'ij - t cry CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION * ADDRESS: 10573 GASCOIGNE DR DATE: 06/04/2013 REVIEWED BY: MELISSA Plan Check Fee: Hourly Only? Q Yes Q No APN: 375 28 009 BP#: 'VALUATION: Iso %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION 1GENRE PERMIT TYPE: WORK I REVISION # 1 - CHANGE FROM SITE -BUILT ROOF SYSTEM TO IVEW TRUSS ROOF SYSTEM SCOPE _- Suppl. Insp. Fee:Q Reg. Q OT0,0 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt otc 1 Thoco foot aro hacod an tho nroliminary infarmatinn availahlo and aro a"k an octimalo_ Cnnlarl tho Dont far add"V info_ FEE ITEMS (Fee Resolution 11-053 Eff 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes Q No $0.00 F-27 hours Plan Check, Hourly $266.00 isTPLNcK Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT0,0 firs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i Fcc'y: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 $0.00 $266.00 TOTAL FEEz"' $266.00 Revised: 04/29/2013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10573 GASCOIGNE DR CONTRACTOR: HARMIN INVESTMENTS PERMIT NO: 13010056 112 LP OWNER'S NAME: HARMIN INVESTMENTS 112 LP 2162 RINGWOOD AVE DATE ISSUED: 04/29/2013 OWNER'S PHONE: 4088073636 SAN JOSE, CA 95131 PHONE NO: ❑ JOB DESCRIPTION: RESIDENTIAL COMMERCIALI] LICENSED CONTRACTOR'S DECLARATION License Class Lic. g NEW CONSTRUCTION OF SFR, 2477 SQ FT TOTAL (470SQ GARAGE & 44 SQ FT PORCH Contractor Date 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 Sq. Ft Floor Area: Valuation: $500000 performance of the work for which this permit is issued. 1 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: 37528009.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I 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 AYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY M LAST CALLED INSP TI N. indemnify and keep hannless 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 Issued by: Date: l with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. RE-ROOFS: Signature Date 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. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 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: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit-.hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code ecti ns 2550;;-;q3, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Z�^ i Owner or authorized agent: Date: 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, l CONSTRUCTION LENDING AGENCY become subject 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 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 allno nt source regulati per the Cupertino Municipal Code, Section Licensed Professional 9.18, �'� 1 Signature Date CONSTRUCTION PERMIT APPLICATION° ELI] COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION",,,, "w �7 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �1 0 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org \� t CUPERTINO �I r—I FINFW CONSTRI ICTIoN F-1 ADDITION I I A1.TFRATION /Tl I I RFVNI0N / IDF.FFRRF.ID ORIGINAL. PFRMIT # PROJECT ADDRESS ©� / / d . I J� lII/ b APN d e OWNER NAME r�f HONE °"1% �Kl T E-MAIL STREET ADDI ` / j / 7 lI//C /" �l� r ITV .C7 FAX / 1� l 'U CONTACT NAME ,j / , /- j y A � I JPH E f '0 2 E-MAIL v o 'lam( Q��l/•( l,/(/��Jrl STREET f 5 pAq CITY, ATE ZIP �Lf s FAX'J ❑ OWNER ❑ OWNER-BUYLDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHrrECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK _ -- �f (3 2 EXISTING USE PROPOSED USE CONSTR.TYPE I STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG. NEW FLOOR DEMO TOTAL AREA AKEA i 7 r7 AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AI;E4( DECK AREA TOTAL DECK/PO CH AREA CH ��� AREADET CH N DWELLING UMTS'. IS A SECOND UNIT ❑ YES SECOND STORY ❑YES DMGADDED? E] NO ADDITION? []NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL9 ❑NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑NO gE' ,/�„/ „/ ,�, /�'/7 777 �t�����/"m��1111111. VALUATION: By my signature below, I certify to each of the following: I am the property o er or authorized agent to act o the p rry 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 rate. I agree to comply with all applicable local ordinances and state laws relating o build' construction. I authorize representatives of Cupertino to enter the above-identifi property for inspection purposes. Signature of Applicant/Agent tG (/u Date: SUPPLEMENTAL INFORMATION REQUIRED i iAR rfq'r,}'+%;;!%', New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. P _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. —CoPY of Planning Approval Letter or Meeting with Planning Prior to submittal of Building Permit application. 12(`�I+lI�ErI"+I /9 G-? B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10573 GASCOIGANE DR DATE: 01/07/2013 REVIEWED BY: PC FEE 1D APN: BP#: 'i1v0Si0 "VALUATION: 1$500,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: SFD or Duplex 2nd Unit? Yes •- No PENTAMATION PERMIT TYPE: 1 R3SFD WORK NEW CONSTRUCTION OF SFR 2477 SQ FT SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE 1D BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 2,477 $2,755.70 IR3PLNCK $2,579.95 1R31NSP $0.00 PME Plan Check: $0.00 Permit Fee: $2,579.95 Suppl. Insp. Fee:O Reg. 0 OT Qp hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 2,477 $2,755.70 Construction Tax: IBCONSTAXRF,-T#wnits $2,579.95 ne NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School /lictrirl al, 1 Th—o faoc aro hncad nn tha ora/iminnnr infarmntinn availahlo and nrn nn/v nn aclimnta_ CnntnM tho Dont fnr addn'l infn_ FEE ITEMS (Fee Resolution 11-053 Eff 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,755.70 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT TO.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,579.95 Suppl. Insp. Fee:O Reg. 0 OT Qp hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXRF,-T#wnits ne $6 .29 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: 1PLLONGR $322.01 Select a Non -Residential Building or Structure 0 0 i Strong Motion Fee: IBSEISMICR $50.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $20.00 ,; ITBTUTAL $6,356.95 $0.00 TOTALP�E; $6,356.95 Revised: 1010112012 '-r T 3' NO ATTACHMENTS I PE 4"■4' PLAN 4 SIDES (TTP.) TO BE KEPT T rc AN 440" +, 180` • O EXISTING GROUND � a °: � 2 0" I %i ROCK OR EOUAI 'o 12" DIA. TIP POST ELEVATION NATES: 1. THE DEVELOPER SHALL INSTALL THE " TREE PROTECTION " DEVICES PRIOR TO THE START OF GRADING OR CLEARING WORK. 2. THE CITY RESERVES THE RIGHT TO ISSUE A "STOP WORK" NOTICE IF THE "TREE PROTECTION" DEVICES ARE NOT INSTALLED OR IF THE DEVICES ARE NOT, MAINTAINED PROPERLY. 3. SEE THE PROJECT GRADING PLAN FOR SPECIFIC TREES THAT REQUIRE PROTECTION. ALL SPECIMEN TREES REQUIRE PROTECTION UNLESS OTHERWISE NOTED. 4. NO EXCAVATIONS WITHIN THE **TREE PROTECTION AREA" ARE ALLOWED UNLESS UNDER THE SUPERVISION OF A REGISTERED TREE SERVICE COMPANY, S. ANY FILLING WITHIN THE "TREE PROTECTION AREA" SHALL BE DONE IN ACCORDANCE WITH A DETAILED IMPROVEMENT PLAN APPROVED BY THE CITY, 6. NO TRIMMING, CUTTING,OR PRUNING OF DESIGNATED TREES CAN OCCUR WITHOUT A REGISTERED TREE SERVICE COMPANY. 7. CONSULT ORDINANCE 778= OF THE CITY OF CUPERTINO FOR PERMIT REQUIREMENTS AND EXCEPTIONS. B. TEMPORARY CHAIN LINK FENCING IS AN ACCEPTABLE SUBSTITUTE TO THE WOOD CONSTRUCTION. TREE PROTECTION STANDARDS CITY OF CUPERTINO JAPPROVED BY: STANDARD" DETAILS DATE : '4} 1) INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2 Site Address: Enforcement Agency: g y: Permit u tuber: a �(_: CSLB Li"-"-- cense: p Ducts and Fans § 15�(m): Duct and Fans Q 1. 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 181A, or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the 11 corlfbination of mastic and either mesh or tape shall be used; and NJ 1. 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 cat}a;e reductions in the cross-sectional area of the ducts. Q 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive du t tapes unless such tape is used in combination with mastic and draw bands. l� 7. Exhaust fan systems have back draft or automatic dampers. 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. ® 9. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is wa it retardant and provides shielding from solar radiation that can cause degradation of the material. 8 10. Flexible ducts cannot have porous inner cores. 3LJ� L� 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 -IR) 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 or General Contractor or B ilder/Owner), �Subcontractor �„ Responsible Person's Name: Responsible Person's Signature.. ""7 , CSLB Li"-"-- cense: Date igned: Position With Company (Title):' 2008 Residential Compliance Forms August 2009