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14070037CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21749 STEVENS CREEK BLVD CONTRACTOR: CONTROLLED SYSTEMS PERMIT NO: 14070037 OF CALIF OWNER'S NAME: URI FREELAND & BATTIA FRIEDLANDER 1098 B INDEPENDENCE AVE DATE ISSUED: 07/10/2014 OWNER'S PHONE: MOUNTAIN VIEW, CA 94043 PHONE NO: (408)268-8674 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL % p —7) REPLACE EXISTING 3 TON PACKAGE HEATER/AC ON License Cl �`' Lic. # I ROOF. ) Contractor Date -7 ` I hereby of 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: $6650 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 APN Number: 32620048.21749 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 WITIIIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned prope for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the ity of Cupertino against liabilities, judgments, costs, and expense hich may ac a against said City in consequence of the^� 7. 1—` 0 Addition 1 the and will comply Issued by: i�C� Date: granting of permll. , applicant understands with all n n -p nt sou a regulati per the Cupertino MunicipalCode, ection RE -ROOFS: 9 18. f Signatur Date 4 " j 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 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) 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 require ents under Chapter 6.95 of the California Health & Safety Code, Se tions 2 05, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cup( o Mu icipal Code, Chapter 9.12 and the declarations: Health &Safety Code, Section 2 532 shoo I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, shoal e e ipm t or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined t Ba rea it Quality Management District I 12d Code, Chaptef�311 performance of the work for which this permit is issued. will maintain compliance w' h t e Cu tin unicipal I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the of the work for which this the Health & Safety Code, ect' ns 25 , 2 5 3, and 25534. performance Owner or authorized agent. Date: I permit is issued. 14 f 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 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 all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9 18. Signature Date GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3285 (40B) 777-3228 • FAX (408) 777-3333 • building.Qcuoe fino.ora 1�U7(Jv3 7 ❑PLt1NBi ING Cwiwic4L ❑ELECTRICf.L ❑MISCELLANEOUS PROTECrADDRESS -749 APN4 S+'P_ yens 62tk c PHONTTE I E-NiSII STRE_r T ADDP ESS1 1 D ® I CTTY, ATE, ZIP,F co N-rAcr Y-4"G)�o STRcz� fJDRLSS CITY, STA M, ZIP o -;x m .11 o,,Aii.BLnDER. 13 o-i—RAC=Tf 4CR,=gcO, OA1P4CTOR ❑COARRCTORAG=AT TPTU13 C - NTPA OR ' I LICETSE I LICENSE'l-u I's 13US. LIC COIJ�ANYN410- I E-IvLAII CTiY, STATE, ZIP A , ` ^ i � �I I FAX PHONE ARCETBMENGIhExERNAIJL: I LICrTTSz14[A11ER. I BUS. LIC COMPANYNA2v E-MJ,AM I FAX STREET ADDRESS CTTY, STATE, ZIP PHONE USE OF ❑ SFD . DUPLEX ❑ BUILDING COA2�9RCLAL MULTI-FAMLY I PROTECT LK WILDLAND ❑ YES I PROTECT IN ❑ YPS URBAN DArERFACEAREA ❑ NO FLOODZOl�- ❑ NO I IS ITE BLDG AN ❑ YES EIC=- HON.:'? ❑ NO . DFSCRIPTION OF WORK n n d^ ME r0T LVrs-UATION: � � ._= By my signature below, I --'tL to application and the inforrration I ordinances and state laws relating o Signatareof=-pplicant,Agent: h he follow n1g: the property owner or authorized agent to act on the proper y ovmcr-s behalf. I have read this pr ed is corre . I ve read the Description of Work and verify it is accTxate. I aures to comply - rith all applicable local wild g c nuc-• n. I a thorize representatives of Cupertino to enter the abov identi ed propeay for inspection purposes. Date: IPPLENLENTAL LNFORMATION RBQU=D of C> TSE m-RINE- 3"h'L-A7iJR Via_,. _ �-- -' IEPMlisc,pp_2011.doc revised 06/21/11 ��,--�����,,�� CITY OF CUPERTINO 1�' 1 FFF ESTIMATOR - BUILDING DIVISION ADDRESS: 21749 Stevens Creek Blvd DATE: 07/10/2014 REVIEWED BY: Sean APN: BP#: *VALUATION: 1$6,650 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building C11ke, t'fumlt ins'.. PENTAMATION FURN/A USE: $139 PERMIT TYPE: WORK lace existing 3 ton package heater/AC on roof. �Re SCOPE APPLIANCE / EQUIP TYPE FEE ID Mech. Plan Check 0.0 1 hrs $0.00 QTY UNITS BP FEES P?emb. 1'e mfr Fere: A/C Units (<=10K cfm) 1BCAIRHA C11ke, t'fumlt ins'.. 1 # $139 PME Unit Fee: $139.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? ® Yes (j) No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $139.00 Strong Motion Fee: 1BSEISMICO s f2Yg FEE Mech. Plan Check 0.0 1 hrs $0.00 I'7ttad, I'lon Cileo',� Plan C'h,�uk,"'cw: Mech. Permit Fee: IMPERMIT P?emb. 1'e mfr Fere: :` of y)l. 1'C. Fee, rt.her Mech. Insp. 0.0 hrs $48.00 C11ke, t'fumlt ins'.. Odle,' 1 tc:", . iFts z PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, Fire, Sanitary Jewer uistrict, acnoo[ n:.. .1 . Tti nro hoA,,., tho nrnliminnnr infnrmntian available and are aniv an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff 711113) FEE QTY/FEE MISC ITEMS Plan C'h,�uk,"'cw: :` of y)l. 1'C. Fee, PME Plan Check: $0.00 PME Unit Fee: $139.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? ® Yes (j) No $0.00 1c%1`c.3i1`c'Ct r fE:1F'ttti;lS %`(Ts: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: 1BSEISMICO $1.86 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ®� $282.86 $0.00 TOTAL FEE: $282.86 Revised: 07/08/2014 -ISl�1� •new. General Data MODEL. VcC0.9B ww YCC038 *" Y00042F1M68 Y RATED VOLTS/PH= 207309180 460td160 200.23011A80 206 ZI(I 0 RATINGS (COOLING) O 78% 78% 78% 70% STUH 35100 35400 42000 42000 YMoorANM(CFM) 1200 1200 1400 1400 Powerlrprd(ILW) 3.73 3.73 4.79 419 EER/SEER (BTUAMdit) &W/10.00 9.50/ 10.00 8.85/10.00 8.85 / 10.00 Now Rating No. O &0 8.0 8.0 8.0 UNIENSIM HXWXD 100000 100000 100000 1ODDDO 6 7 == go 00 80000 80000 80000 80000 AFUE 78% 78% 78% 70% Terry►►. Rise IF. (1An/Max) 45-75 45-75 45-75 45.75 80000 80000 80000 80000 Caps>AyBTtkU 550 61000 64000 64000 64000 AFUE 80% 80% BD% 8D% Tera. Rae "F. (AFxJMax) 45.75 45-75 45.75 45-75 Type Ot Gas (D NATURAL NATURAL NATURAL. NATURAL POWER CONN&-VPWHZ 206,2KiDr3160 46 VM 208 -MM 208-23CtW Min. BMK Cir. An"* 18 8 31.3 22 Sr. CIr. Max (Amps) 25 15 50 35 Prat RV. Reand. (M") 25 15 50 35 COMPRESSOR No. Used 1 1 1 1 VdafPWHz 208.2301380 46N3W 208.23 V80 20B23WM ftLAn"-LR.Amps 11-101.0 4-51.0 20.6-105 14-1015 OUTDOOR CON. -TYPE PLATE FIN PLATE FIN PLATE FIN PLATE FIN Rows lFPL 2/20 2/20 2115 2/15 Few kea ft FL) 6.34 8.34 8.62 8.62 Tube Sias 00 318 COPPER =COPPER 318 318 !DOOR COM --TYPE . PLATE FW PLATE FIN PLATE FII PLATE FIN Rows/FP.L 3115 3/15 3/15 3/15 Few Atwft FL) 3.95 3.98 4.28 4.28 Tube Sim fa) Rdrigerant Cord 3M 3/8 318 318 rd Main Can. Sim (GM.) CAPILLARY 314' FEMALE NPT CAPILLARY 314' FEMALE NPT CAPILLARY 314' FEMALE CAP01ARY 3W FEMALE Duct Caxrec#= SEEOUTLINE DRAWING SEE OUTLINE DRAWING SEE OUTLINE DRAWING SEE Ol1RM DRAWING OUTDOORFAN-TYPE PPAWELLER PROPELLER PROPEIFR PROPELLER No. Used/ Dia. (n.) 1118 1/18 1/18 1/18 Type Ddve/No. Speeds DIRECTI I DIRECT/1 DIRECT/ 1 DIRECTII No.Moans_HP 1-1/5 1-111 1-115 1-115 Motor Speed RP M. 1080 1080 1090 1080 VdtwpR iZ 230/1180 46011V60 23DAIM 230/1160 F.LAmps-LR.Aogx 1.6-3.3 1.7-3.8 1.6-3.3 1.6-3.3 WDOORFAN-TYPE CENTRIFUGAL CENTRIFUGAL. CENTRIFUGAL CENTRIFUGAL Dia, xWWM(h) 10X8 10X9 10X8 10X9 No. Used 1 1 1 1 D69/Speeds(Nm) DIRECT/2 DK-CT/2 DIRECT/2 DIRECT/2 No. Motors -HP 1-113 1-1/3 1-1/3 1-113 Motor Speed RP_M. 1080 1080 1080 1080 1/0I "*Iz 200-MISD 466M160 2OD-23WIM60 200-23WIM FLAmps 2.8/1.2-5.1 1.1-2.8 2AW-5.1 2.812.2-5.1 COMBUS71ONFRN -TYPE CENTRIFUGAL. CENTRIFUGAL CENTRIFUGAL CENTRIFUGAL Drive- Speeds @b.) DIRECT -1 DIRECT -1 DIRECT -1 DIRECT -1 Motor HP -Speed (RPAQ 1135.3480 113.5- 9480 10 -34W 11S-3480 Vda/PHIFR 24011/60 24011160 2OB-240/IM 20BM1160 F.LAmOs 0.6 0.6 0.6 0.6 FILTER -FURNISHED? NO NO _ NO NO �- Type Recormnended THROWAWAY THROWAWAY THROWAWAY THROWAWAY Wn FaDeAree•Lo (sq. It) © 4.0 4.0 4.67 4.67 REFRWERANT CtwrgeW-ofR-22)•O 5L3S,150Z 5L ISOZ 6Ia0z 6LBS, 8OZ GAS PIPE WF tdt_t 1w In- . io. UNIENSIM HXWXD HXWXD HXWXD HXWXD Crated ft) 35.1/4X3BX64-51B 35-1/4X38X643B 35.1/4X38X64518 354AX38X64-518 Urxxated SEEOU`R.INE DRAWING WELGHT SEE OUTLINE DRAWING SEE OU LINE DRAWING SEE OUTLNE DRAWING Wppirg _ 452/403 4401394 461/414 461/414 'See ua1 ne gfte for proper"e*~ Riled In accaftnas wMARUSWdmd 21WM Ndaa kakd bacconMws wb ARU Standard MARL M dudrdilQ e, B"-amc80D.B.87W.B.kMerMp ah Iohabwoo1.95 D9. ads" drb oulbacot 22-1295-05-D;iO3 (EN) Almodds=tILLkkdRdhy<s O 00MUbkbLPG. © FiskmdbehatakdkiraWairstm, O tw1gd#sdanh0kPjL shawnaebraka6marpb © Tftvdob*pwahnafe.Forms SqumbakgeskladaroWesdonMpm. ukIs=waftatobwhVW 20W&Fbr #w pracsemau w!lue,-I**Nanlepw f"wjQ*BPww1MdRM.vsareused dm w1haLarFaeaocessay1& led'a11 par'1o09 finpat pr ®8redonUS Oa�mwd per kduefsrecom onddonwkha StandkdTeds cleatr resMmnedo w W.G. �w XA �7 0 4YCC3036A-SUB-1 A ii �iiiiii i TAG: !111- I, SINGLE PACKAGED GAS HEATING 4YCC3036A1064R5/96B ELECTRIC COOLING NII= WC03MA10M 4YCC3W6A1075B 4YCC3036A1096B RATED V 208-230/1/60 208-23011/60 208-230/1/60 Perfera we Cooling KINi O 35000 35000 35000 Indoor Airflow (CFM) 1200 1200 1200 Power Input (KW) 3.284 3.284 3.284 EER/SEER (BTU/Watt-Hr.) 11.0113.0 11.0/13.0 11.0/13.0 Input BTUH (Natural Gas) ® 64000 75000 96000 AFUE 80.0 80.0 80.0 Temp. Rise — Min/Max ('F) 25/55 30/60 40/70 Min. Brch. Cir. Ampactty 25.2 25.2 25.2 Fuse Size — Max. (amps) 40 40 40 Fuer Qi n — 0- d 1-1 An An en Volts/Phft 208-2=M 208-230/1/ 208-230/1160 R.L. Am —LR.Amos 16.7/79 16.7/79 16.7/79 OUTOMCOIL —Ty" SPINE -FIN SPINE -FIN SPINE -FIN Rows/F.PI. 2/24 2/24 2/24 Face Area Aft) 13.32 13.32 13.32 mown Lim — v;rt rt}at rill thAM HN rt..Att: HN Rows/F.P.I. 4/15 4/15 4/15 Face Area (sq fQ 3.54 3.54 3.54 Tule Stee (in.) 3/8 3/8 3/8 Refrigerant Control EXPANSION VALVE EXPANSION VALVE EXPANSION VALVE Drain Conn. Size (in.) 3/4 FEMALE NPT 3/4 FEMALE NPT 3/4 FEMALE NPT 811TDDBR FIYI — TYPE PROPELLER PROPELLER PROPELLER Dia. (in.) 23 23 23 Ddve/No. Speeds DIRECT/ 1 DIRECT/ 1 DIRECT/ 1 CFM 0 0.0 in. w.g. O 3240 3240 3240 Motor — HP/R.P.M. 1/5/830 1/5/830 1/5/830 Volts/Ph/liz 208-230/1/60 208-230/1/60 208-230/1/60 EL Amps/LR. Amos 1,1/1.9 1.1/1.9 1.1/1.9 NIDOORFAN—TYPE CENTRIFUGAL CENTRIFUGAL CENTRIFUGAL Dia x Width (in.) 10 X 10 10 X 10 10 X 10 Drive/No. Speeds DIRECT / 2 DIRECT / 2 DIRECT/2 CFM 0 0.0 In. w.g. OO SEE FAN PERF TBL SEE FAN PERF TOL SEE FAN PERF TBL Motor-- HP/R.P.M. 112/1075 1/2/1075 1/2/1075 Vob/Phft 200-230/1160 200-230/1/60 200-230/1160 F.L. Amns/LR. Amos 3.2/6.7 3.2/6.7 3.2/6.7 COMBUSTION FAN—TYPE CENTRIFUGAL CENTRIFUGAL. CENTRIFUGAL Drive/No. Speeds DIRECT/ 1 DIRECT / 1 DIRECT / 1 Motor — HP/R.P.M. 1/35/3480 1/35/3480 1/35/3480 Volis/PlIft 208-230/1160 208-230/1160 208-230/1/60 FLA 0.26 0.26 0.26 FLTER/ NO NO NO Type Recommended THROWAWAY THROWAWAY THROWAWAY D1N011 1011 HXWXL HXWXL HXWXL Crated (in) 45 144.5 / 52M 45,86Z40152.03_ 45.86 144 5/ 52.03 wow Shipping (lbS.) / Net (MS.) 468/392 488/392 493/397 O Rated in accordance with AM Standard 2101240. AMU standard rating conditions are: 80 D.B. 67 W.B. a rbring airto indoor coil. 95 D.B. enl ening air to outdoor coil. ® All models are certified to UL 1995. Ratings shown are for elevations up to 2000 It. For higher elevations reduce ratings at a rate of 4% per 1000 It. elevation. O Convertible to LPG O This value is approximate. For tante precise value, see Unit N mWale. 02M2TfWw ® based on U.S. Government Standard Teats. ® Fifers must be inslalied in return air stream. Square footages fisted are trased on 3W %tn. face vdocilx fl permanent fillers are used size per rnanufacturee`s recommer►dat'rem wilt a clean rtxtstance of 0.05' W.C. 0.05' W.C. O Sound Power values are not adjusted for AHRI270-95 tonal corrections. ® Slandard Air— Dry Coil — Ouldoor. The Aftnuhufterhas a policy of conanuous product and product data improvement and reserves rhe night to d -W design and spedfiCattorts without notic. STATE OF CAUFORNIA ALTERATIONS - HVAC ILI CEC-CFIR-ALT-03-E Revised 06113 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -IR -ALT -HVAC) . (Page 1 of 1) Site Address: Enforcement Agency: Date Prepared: Permit#: ��/lS E ui ment T q p Type Equipment q pment Efficiency New: Ducting, Plenums, Uneset Conditioned Thermostat Required R value Floor Area (sq ft) CKPackaged System ❑ Evaporator Coil U AFUE COP ❑ R-6 (CZ 1,3 -7),s Served by system Setback ❑ Split System ❑ Condensing Unit SEER ❑ R-8' (CZ 16) Ducts W93 9 3 sq ft (1f not already ❑ Furnace ❑ Uneset 1L_EER HSPF ❑ R-6 (all CZ's) Plenums present, must ❑ R-5 or R7.5 Lineset' I I be installed) HERS VERIFICATION SUMMARY Listed below are Four HVAC Alteration Options. The installer determines the work to be completed and matches it to one of the options below. All forms to be registered (no hand filled forms allowed). Copy of forms to be left on site for final inspection. . HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: Can include new ducting All Equipment, CF111-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS Air Handler/Furnace CF3R: MECH-20-HERS Installer Requirement: Duct leakage (<15% or, < 10% to outside, or seal all accessible leaks) Exempted from dud leakage testing if: ❑ 1. Dud system registered with HERS provider as previously sealed, of# 2. There is less than 40 linear feet of dud in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building ❑ 2. New HVAC System Required Compliance Documents to be left an site for Final: All new equipment and All New Duds' CF1R-ALT-02-E CF211-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS CF3R-MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS' Installer Requirement: Dud leakage <_ 6% Fan Efficacy (.58W/CFM), Air Flow >_ 350 CFM/ton (or Standards Table 150.0{ / D altemative) E3 3. Ad New Duds with Replacement Required Compliance Documents to be left an site for Final: includes replacing or installing All New CF111-ALT-02-E Ducts' and one or more of the following: CF211-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS Condenser Unit, Evaporator Coil, Furnace CF311-MECH-20-HERS, MECH-(23 or 24) -HERS Installer Requirement: Dud leakage:5 6%, Air Flow at 350 CFM/ton (or Standards Table 150.0-C / D alterative) ❑ Exempted from dud leakage testing if existing dud systems are constructed, insulated or sealed with asbestos. ❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site far Final: Adding or replacing duds in unconditioned CFIR-ALT-02-E space but less than All New Ducts' CF2R: MECH-20-HERS CF3R: MECH-20-HERS Installer Required to: Dud leakage L<15% or, <10%to outside, or seal all accessible leaks) ❑ Exempted from duct leakage testing if existing dud systems are constructed, insulated or sealed with asbestos. ' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in wails, between floors etc. ' A New Dud system is when the dud system is constructed of at least 75 percent new duct material, and up to 25 percent may consist of reused parts from the dwelling unit's existing dud system (e g., registers, grilles, boots, air handler, plenums, dud material. ' R-5 (1' thick insulation) for knesets 1' and less. R-7.5 (L5' thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter with insulation as the follows 1.5-2T-2%", 2.5-3T-2%*, 3.5 to 4T-236', 5T-4%' Contractor (Documentation Author's /Responsble Designer's Declaration Statement) I certify the following under penalty of perjury, under the laws of the State of Cal'ffornia: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4. That the energy featu and performance specifications, materials, components, and manufactured devices for the building design or system design identi n this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR. S. The uiiding design res or system design features identified on this Certificate of Compliance are consistent with the information p on other ppri bie compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement a fora pro 1 with is buiidin pgonitapplication. We " er Name: Responsible Designer Signature: Date signed: license: Gtv/Sbte/Zp: Phone: For assistance or questions regardiimg the Energy Standards, contact the Energy Hotline at: i-800-772-3300 COMMUNITY DRIEL'OPME BUILDING DIVISIGN - 1Up SOt of plans and specifications MUST be kept at the const rci-OtiOn. It is unlawful to MBOe an C!"31-V"'s or alievation . is on same, or to devvige y thorefrom, wiIhout approval from the Building Cf,,Ic;ial. Tho stamping of this Plan and specifications SHALL NOT ifj LO Permit or to be an &pprO'Va I 104 the i vVE,!V of any provisions of any Cit on Y�3rdinance or State By 7:77 ,L. DAT