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99080020 APPLICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY CIkGD OFRTINO BUILDING-ELECTRICAL -PERMIT ND. ISION APPLICATION/PERMIT PLUMBING-MECHANICAL. ;,a(r.rq•{, BUILDINGPBOJECT;IDENTIFICATION'1.,jit',•' ts• BU :� Dv _ _ - SANITARY NO. APPLICATION SUBMITTAL DATE W P NE: CO RS NAME: LIC NO: yk v NIC CONTROL#^^y/ ER: - LIC NO: ADDRESS: ❑ CONTACT: PHONE: - - - - "k:ilt"'(I.!BUILDINGPERMTTINPG,t; ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MMECCIH . LICENSED CONTRACT(IRS DECLARATION QTY Rt I ELECTRIC PP,RMIT s to'i .iittt FEE -1 hereby affirm that Iran licensed and pr.i,i n. f Chafer 9(exmme g r,.. .i. ._... •/ 70B DESCRIPTION QOZ Section"1000)of Division 3oRheBusn s .fes ono Code,and my l'censets RESIDENTIAL, Hen nrfull fora de c . 6 PERMIT ISSUANCE d:jdFDWL ❑KITCHEN REMODEL �UEpp" I,icenseC Lia.# APPLIANCES-RESIDENTIAL ❑ADDITION El PLUMBING RE-PIPE h W� Dore QtnlDECL ARCHITECT"S DECL El MULTI-UNIT ❑STRUCTURAL PANELS Z p m ZF 1 undervtana my plans Snell be used as public records - MODIFICATION OZ-G UP TO 200 AMPS El INTERIOR El CHIMNEY REPAIR Pj Licensed Professional 201-IOCOAMPS IMPROVEMENT [I SWIMMING POOLS ff Oat I am exempt I DECLARATION OVER IWOAMYS 0.w 6 I heresy affmm that I am exempt Isco ma Cnnnecmr's License Low for m. E)BATH REMODEL/EEPAIR �DEMOLITION O y U following reveman(Section 9031.5.Business and Profesomis Code:Any city or Iranty SIGNS ELECTRICAL ❑OTHER pE' which requires a permit to construct,alter,improve,demolish,or repair any structure ww6 prior,.its issoenee,00k.aquiresthe applicant omsmch permit to file asigcd,wtement SPECIAL CIRCUIT/MISC. pr's that heolicensed pursuammine provisions of the Comrecmr's License Law(Chapter 9 _ w OO (wmmencing cats Smlon 1000)of Divisian3 of Ne aunness end Yrofesinns Cwe)nr TEMRMHTERORPOLEINST COMMERCIAL: dLiy5 yrthat he is exempt therefrom and the basis Inn the alleged exemption.Any violation.f El BLDG/ADDITION ❑DEMOLITION nl�m Se,Stion 90.31.5 by any applicant lar a permit subjects the applicant to acivil penalty of POWER DEVICES 1:1 TENANT ❑FOOD SERVICE EOe{more than five hundred dollars($500). IMPROVEMENT 1.asownerofthe property,army employees with wagesas their sale compensation, SWIMMING POOL ELECTRIC WW1- wra do the work,and thestmmare is not intenicalmoffered Wrsale(so,.9044.Buslness ❑OTHER ant}°Professions Code The Connector's License Law does aot apply to an aware of OUTLETS-SWITCHES-FIXTURES pmpeny who builds or improves thereon,and who drew such work himself or Enough his own employees,provided that such impnwement,are a.,Intended.r.R'erod for NEW RESIDENTIAL ELECTR SQ sale.If,however the building.,improvement is sold within one year M completion,the SQ.Up FLOOR AREA $1SQ.EL her-builder will have the burden of pro proving that he did not build or improve for put- Pose ut- / Poeofsale,. 3( ©© ✓Aa�� E] 1 as owner of ma e pr py exclusively contracting with licensed annUact t T construct the project(Sca.9044 Business and Prof ss o Code:)The Contractor Lr- cause ase Law does not apply, fp perry, n builds or mpr.nes mere. a ,C PY - s:PLUMBINGTERMTT t t '! EE who contracts for such projectswth a cosi tors)licensed pursuant to the Contractors + `+- + • + License Law. PERMIT ISSUANCE ❑ lamexemp ruder See. .B&PCformis rearon - ALTER-DRAIN&VENT-WATER(EA) her - Data VALUATION WORKER'S COMPENSATION DECLARATION BACK PLOW PROTECT.DEVICE y mg � I hereby affirm under penalty of petjury con of me following declarations 14 V Ihvve and will mainmin aCertiflwte of Cnnsenuo self-insure for Workers Crmpen- DRAINS-FLOOR,ROOF.AREA,COND. STORIES ' TYPE CONS'1'RUCTION nation,as provided for by Section 3900 of the Labor Code,for he performance of me work fm which this permit is,,,a ed. FIXTURES-PER TRAP 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3900 of the LaMnr Code,for rfnrmnnce of the work or whicblhns permit i......d. GAS-EA.SYSTEM-IINCA011TLETS OCC.GROUP APN M Wo a h�j'y�er ce g M1er are Cmrier: n -(JFK hl� c�_ GAS-EA.SYSTEM-OVER 4(EA) CERTIFICATE OP' ION PROM WORKERS' GREASE/INUUSTRL WASTE INTERCEPTOR / 27 COMPENSATION INSURANCE - an ('rMwsediary;,Wp9 pryOlrJ�d�'(t]pyp��Irysforonc IF dredo.]1—($IW) - �" .. BvIJW[IIF�GyD{YISIQN FZBf}SA g�lg .. or less.) �1/7`yr/�//IcGL//�-1 / GREASGTRAP _. PLA KFEE Ices y troth pinto e.f Inr IF this permit is issued.Isbell x-` p yany person y J pen- SEWER-SAN Y-STD 2W FT.' not em to In an manner can an In become suh'wtm me permit EN PEE r� nation Laweof Califomia.Date .ZQ Applaud r WATER HEADR ENT ECI'R Z GR MG PEE NOTICE TO APPLICANT:If,nfier rrvnking his Certificate of Exemption,you should WATER SYST R' EA- d SO FEE abecome subject ro he Worker's Compensation provisions of Ise Lunar Code,you must r {1a fono,ilh comply wimeuch provisions or his pernitshall be deemed invoked. WATER SERVI � Z CONSem isa,ONLENDINGAGENCY NEW RESIDE IALPLMB. SQ,FT. PAID U lfohereby whichaffirm,neurite isawnswc.30lending agency forme perhnmrmce of Dam Receipt# W Hmower's for which this permit is issued(Sec.3097,Civ.C.) y U Lend Name TOTAL: Lend Addie: TOTAL: �� FI rarity chat lbe card this up,ho and score that the above nfor nm s t r�rl t i" tx BUILDING FEE ti y wneclgl agree, c spry with Y sty 'd coPnty ord'nnnces and wise laws rdanghe Q7yY } MECHANICAL PERMIT 1I , FBEtIl O L) z build secant on and hares monzere resemauves ofth sett 10 criticism .'t+4c± ( t' tit SEISMIC PEE O above-mentioned property for inspection proposes. (We)agree to save,indemnify and keep harmless the City of Copenina against PERMIT ISSUANCE ELECTRIC FEE Iiahilides,judgments,costs nrdexpenms which may in any way acemevgainst said City ALTER OR ADD TO MPRH. ^- wnseq a ofhe gmndngof this permit PLUMBING PEE APPLIC UNDERSTANDS AND L COMPLY WITHL O IB,OtNI FE CFM) MECHANICALE SOU ! rULAT1ON8. PPP � AIR HANDLING UNIT(OVER 10,00(ICFM) CONSTRUCTIONTAX cot nVC c r/''�TTTDat77tee N N-POINT AIR HANDLING UNIT f1'EXHAUST HOOD(W/DUCT) HOUSING MITIGATION FEE HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occaparname or handle hazardous medal HEATING UNIT(TO 100,000 BTU) as defined by tae Cupertino Municipal Code,Chapter,9.12,and the Health and Safety Code,Sealum 25532(x)1 ��ryyy�� HEATING UNIT(OVER 100,000 BTU) ❑ PAID fA Nn ��- VENTILATION PAN(SINGLE RESID) Date Receipt# Will the app oncrour Pow bene'by the Bay Area Air Management BOILER-COMP(3HPOR IOg000BTU) emit hazardous air cnmaminan s as defined by the Bay Area Air Anality Management TOTAL: District Yes BOILER-COMP(OVER 100,1000 BTU) ❑ I ha a read the haaallous materialsrequirements ander Chapter li95of the Cal i- AIR CONDITIONER ISSUANCE DATE formal a &Safety Code,Sections 25505,25533 and 25534.1 undetstnnd Inas if the NEW RESIDENTIAL MECH. SQ,FT. build gds .not curtently honest t,that it is my responsibility to nos ythe pont ��--- ✓- T .fm req ants ic�b n prionoissuonee nfa Cenifi $ � Ownernram1mfi,,d age wac TOTAL: ISSUED BY OFFICE , INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: christya Sec: Twp: Rug: Sub: Blk: Lot: INVOICE DATE......: 12/16/1999 REFERENCE ID k ...: 99080020 SITE ADDRESS .....: 23645 OAK VALLEY RD SUBDIVISION ....... CITY ........... .. : CUPERTINO IMPACT AREA . ...... OWNER ............ : O'BRIEN GROUP ADDRESS .......... : 23645 OAK VALLEY RD CITY/STATE/ZIP ... : CUPERTINO, CA 95014 - CONTRACTOR ... . .. . . LIC # COMPANY ADDRESS ...... .... . CITY/STATE/ZIP ... . , TELEPHONE ......... FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE 0.00 0.00 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION �e= FOUNDATION 102 PIERS _ UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 30B SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY 505 FINAL ELECTRICAL 506 GAS TEST 507 FINAL PLUMBING 508 FINAL MECHANICAL 509 FINAL GRADE 510 FINAL PLANNING 514 FINAL PUBLIC WORKS 602 ROOF PLYWOOD NAIL 643 ROOF BATTENS 604 ROOF IN-PROGRESS J[.1.. &.Iv7 4U:1ur-i1 Srii Hl'I k.Hl'ic-iiS FuLLr: Iil1..7GkJ F'.2`G Brian Kangas Faulk . Engineers SurvaVors Planners i • I Demmber.8, 1999 960069-50 Chuck Schoenberger O'Brian Group 2001 Windward Way,Suite 100 San Mateo,CA 94404 Subject; Oak Valley-Foundadou Ver kation .. I Dept Chuck, , On December 7, 1999 we performal a field survey of the location of tits foundation forms for the buikiinas i being constructed on lots 3.46 and 3?; Oak Valley protect in Cupertino. The results,of that survey clearly show that the location of the foundation forms are consistent and in conformance with the design locaticn of the buildings,as said locations aro shown on the plans prepared by our flim. This letter is intondod to provide yDa with the verification of(hose units per our survey. If thaw am any a(hor questions concerning that locution,please do not bestial*to call. Sincerely, oh 0 I, �o �iJ �1•�T, ' .�� ERAO:i11..E1iC, y`•� • BRIAN KANGAS FOULK •p' 1'/:(i:a;'0I J a Bradley A. Bilbo P.L.S.6141 Project Manager Survey Department 0 i , 540 Price Avenue Redwood City,CA 94063• (650)462.6300• FAX 16501482.6398 1 ENGINEERING WEST INC. OB8SRVATION CHART OAK VALLEY DEVELOPMENT CUPERTINO,CA. PAGE 2 F 4 4-21.2000ea a 1 a n, tat or 1 - 00 5 1 4—T!4 3.7.20 0981/99 N/A 2.8.2000 2.18.2000 ,�,.,�� 5 2 BM 9 N/ •1 10/01/99 - 5 3 M 4.29.9 07101199 124 9 10/01/99 4 4 2199 09!21/90 10/11/9B 5 5 BA 2/BONU 10p429.99 0811 199 1p/01199 A b 7 5C I ONUS 2 04.29-99 081 199 0911 199 099 09 4199 5 8- 28 3 011089 811189 09/091999 00 /B9 3D 9 0911 199 5 10 69 2 ON G/t9 9 OSf2 199 0910 199 09/0 /99 5 11 4 /99 0 999 B _ 9/15199 5 12 8 3IBONUS 04101199 05/21199 OBR3/99 0829199 3/99 5 13 3C 3/BON S O�ro1190 14 2 N OOb2 109 0� BIO oe�e/�9� _- 3� 5 15 3A 318ONUS 04/01199 03117199 OB, 9 84 3199 . 2 5 18 2 •4 17 4A 11ro2199 12.23.99 122.2000 OO , 4-12.20 0 5 1B 50 11102/89 1 •15.99 -8.2000 3.10.2000 44.20 0 8C 1 19 1 . 9 00 •25.2000 1.21• 00 5 20 3C 11102199 12/02199 2.18.20 0 2.1,20002 0 3-24,20000 t 114 146.2000 S t 7C D A OBI18/99 09 7199 1-21.2000 1.21.200 C.n.a. 5 23 1C. 08/18190 09117/90 I. 0-200 11-1 00 0,n a 1.21-2000 24 3M91 y 23 10/11/99 S 28 OSI07/99 08!29199 1 104199 10/ 199 10114199 7 1B 2 S 2B 7B 2 051 199 06129199 710 10/1&19; _ 8 5 297109 9 101 199 5 30 8M 1p.27.90 y 31 BM 05/26199 07/28/99 10.22.99 10 22.99 5 13 4A 3 5ro7199 07112/99 fro 199 10.29_89 7 0 /9 1 108 B 1 -1. 9 . y 3 SB 318 N S 051261 07/26/99 11.10.99 1.1 •99 5 38 1 •99 5 7 C 0611 199 7!26199 11.12.99 11.22'99 12.14• S B 2E 2 08113!99 08112/09 11. 9 1 12.18.99 81 9 1 • 9 12-21,99 5 40 Sc N 07108199 812-t 3.99 12.13 D9 .1 5 41 3A 10 19 8 '(1)LOT 8 PLAN2A 6 LOT? PUN SC (4)A.B.'6 at 0otvh trvnl 'DID NOT 0BURVE PIERS. (5)ahtmnaya • •12)OBL$10 ED SHEAR WALLS '(3)FLR.NAILING < < _ . � �. •- ©Q'7m�TiiTl�b-1� � F' t�I:T.�kT.T��SI'S�I�7 ��d -i�f'3';�Id�� s��■��■ �� ■�ii� ��s�� ■�� s■�� r �� s�� ■r�r�� u■r��v _ . . . . JOS Na: Consulting Engineers and Scientists o"TE12- 2-99 ksqo --r 425 ROLAND WAY PRQUECT OAKLAND, CA 94621. Ca"k i l"e fes, cla.�,l (510) 568.4001 tocATON TO n' C'�r Cn\ �r,rv> OWN% J 5 brau°� (3lOS Or6r,Gw1 Date l�'CCv+��,a� 2"`IICKi4 T4\ur�juGy WEATHERTww. . "@at AM t ,�f CIeGf Gdat - PM Hours Charged To Project 57 Nuclear Density Tests ?RESENT AT SITE - . Field Task NumberOS"f ,Goncrete Cylinders, THE FOLLOWING WAS NOTED: 'Or\ - S;fe aS re4ctes4e � �r t^aturc �Ia�evttA \1- 1v�5(�eeF, rr, ' fi,i' ' �h-3 � Sy3 i 5-4C1 onnd 5-5D ,; qre� l rter tom) F-t., Gr,�zcl of 5lwz�iFs V3rvlt�er5 1� d L\e Tad �.-ecla_v��l +d va -ca5 oP Co�,crelt �tw� f:nC I 0')C:F-?-v- G I 1't 1 _,< g = �.��.C�'.{G'..0 G{� oppl. r re)'C (Al 0"-.Cl S U; . (J p 10.C`e o \k I- T TGY)k 7'e� . LI Or\¢ Frr- e"G cAn r Y �;y ya r c1 s PIC, c e;cl dY' l-y'0.0 V'i'c r-\. T t. e -' eo'J r C' \e 5e r OF Tln r r C n ' t_rn�\l'k�4,i..c S1V'P \\Gid\ Cyl , ✓\ Cltv-' Slc� ,"�{� ran ,C,rt,p1: rf-yl�,•,. 3'/2 "rU a- LlJ-P-Y'C(ktY-e. Tv 69 Gt�t�-t.aved —u �e olca.cr� 1�e� �, lo.,r� T ,yoke-. r,J ' rti cr TO Y , • 1. I ,OPIES TO G O [ADD o QO SIGNED P06 CI Mb CARD NEAR FRONT OF BUILDING '' PE CITY'OF CUPERTINO 4UFER DIVISION I BUILDING PROJECTIDENTIFICATIO. �R-.; .•" - /- 4y r 4„' - SANITARY NO. APPLICATION SUBM� DATE i E: P NE: Ccywyc OR'S NAME: / LIC NO:�` 6 0 d V I . T� r0U NIC colrrROL e GINEER: LIC NO: ADDRESS: v",;BuiLDWG PsRMITFIPo�,7r7 ' NSPECTIONS l a i DATE INSPEC. ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT .; PLUMB.' MECH ON/PIERS/H.D.S. INSPECTION RECORD - JOB DESCRIPTION UND i Ge NOTE: ALL GRADING AND DRAINAGE R Slue_ _FNTIAL, SHALL BE INSTALLED TO COMPLY WITH J;,rDWL ❑KITCHEN REMODEL PAD/SETBACK-CERT THE APPROVED PLANS AND CITY OF (]ADDITION ❑PLUMBING RE-PIPE GARAGE SLABS/PREGUNITE CUPERTINO STANDARDS. ❑MULTI-UNIT OSTRUCURAL MODIFICATION 'POUR NO CONCRETE UNTIL AGOVE jiAS'PEEN SIGNED' TO ARRANGE INSPECTION ❑INTERIOR ❑CHIMNEY REPAIR IMPROVEMENT ❑SWIMMING POOLS UNDERGROUND/SLAB CALL AFTERNOONS (1:00 PM - 4:30 PM) 'p BATH REMODEL/REPAIR ODEMOLmON PLUMBING j 777-3228 MONDAY TO FRIDAY 24 HOURS BE- ❑OTHER ELECTRICAL FORE REQUIRED INSPECTION.JOB ADDRESS -DO NOT POUR FLOOR UNTIL ABOVEHAS;BBEN SIGNED AND PERMIT#ARE NEEDED WHEN PHONING. COMMERCIAL: PLUMBING ATTENTION CONTRACTORS: [I NEW BLDGJADDITIoN ❑DEMOLITION NO PERSON(S)SHALL PERFORM WORK ON ❑TENANT ❑FOOD SERVICE MECHANICAL i CU. THIS JOB SITE WITHOUT HEING IN COM- IMPROVEMENT DoTHER ELECTRICAL PLIANCE WITH WORKERCOMPENSATION S' FRAMING VENTS INSURANCE REQUIREMENTS. INSULATION INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP. PLACE NO SUBFLOOR UNTIL:ABOVE HAS,BEEN SIGNED - ROOF SHEATH/DIAPHRAM _ PLUMBING TUBS&SHOWER PAkJ - MECHANICAL - ELECTRICAL/POOL BOND vi ING/STAIRS/E.EGRESS ULATION/VENTILATION COVER NO'.WORKUNTWABOVE HAS BEEN,SIGNED:��•«�: EXTERLA /Htk�4bW Q$7 L SHEAR/HOLD DOWN INTERIOR SHEARMOLD DOWN 0 SHEETWROCK/SHEETROCK SHEAR W - EXTERIORLATH/W-SCREED SHOWER LATH NO ATCH 4 PPLASTERUNTWABOVE HAS•BEBN°SIGNED SCR SEWERIWATER i TEMPORARY.APPROVALS OCCUPANCY. . - ELECTRICAL j GAS ,MALSiYk�.-aM��. °d1Y u":"]" �'�`i�J " Y i'{;�I•�€'y" .-, GAS TEST. �.� F(REgE xerAUG 41999 HANDICAP ELECTRICAL PLUMBING - MFCHANICAL ERGY suAL FINAL ONLY CERTIFICATE OF OCCUPAN BUILDING IMPORTANT: ISSUANCEpATE �.. `,OCCUPANCY Op BI)IIDIN4IS,. O. ;PERMITT P.ZXy; PLEASE READ REVERSE SIDE BEFOR IL UNTBUILDINGFINgj.:1SSIQNEA'QYBUI ' "� CALLING ECTIONH ISSl INSPECTOR a] ��h�e ]4 Ii.?r� �'Je Ed =".'..a°"v i.,3, �.-ti'°+'i lltlY: FROM ; CRMSJI FAX NO. 8313358329 Jul. 11 2000 09:29PI1� P? .• .JUL-10-00 HE !'G3 FM CR!15.ff nwi s.ro.�ne� a ...� , Caumercial Rtlat:ltAAngcment $An JO)e.toe. • RrrldurtialRoof S}vromrbrrpdcrlau keya•r aroloot: k VA�If 061nspsctlon Date: fti`gt: Address: VB�E✓ City:lazim, state;Qd Client: TUU:.tbLQm;lA Contact:Acrt eurketpAa Rooflng Contractor: '/� j • ,F'je/Cy CRM Inspector. 6ais iP _•� Lot Number: S-51 •eiii•iiNiiiei Type of Inspection: Melt Final L-'� Type of Roof: Uhingle The_ Other Undarleyment. _ Rht Mvtat Flashing: .,_ Outlrrs: Skylights Attschmante: �. Vents & Pipes! _ Valleys: Ridges, Eaves: Ni•1eNiiiiNi • j CommentslObsarvetlone, Ore Roor 19PrLeas re yoc uo/ zwsmg4� Rs PER ma, er,• R�tlOut Roofu�A of 1 4 — CF-6R . .INSTALLATION CERTIFICATE (page ) ermtt um er.• &—e-A-ildress An installation certificate is required to be posted at the building site or made available for all appropriate inspections- (The i nformation provided on this form is required;however,use of this form to provide the information is optional.) After completion of Final inspection,a copy must be provided to the building department(upon request)and the building owner at occupancy,per Section 10-103(b). HVA CYCTE.MB: Keating Equipment Duct Duct or Heating Heating Equip. Y or EfficiencyCe col Type(pkg. CEC Certified Mfr Name Identical (AFUE,etc.), Location Piping Load Capacity heat um and Model Number S tems F-IRrslue otic etc. R-value hJhr ZgiQ L(la� �-9RsOt/eYe'/.Z �_ . G Cooling Equipment Efficiency Duct Cooling Cooling . Equip. ' CEC Certified Compressor N of Location Duct Load Capacity Type(pk& ! Unit Mir Name and Identical (SEER ete.)t R-value tuthr tuAe _ heat um Model Number Sstems CF-IRvalueOWWA attl ate. , tSt i 2 Nil s�ze�^.'i� o io ^opo' Antc S/�i2 t 9 t12 1. >_reads greater than or equal to. I,the undersigned,verify that equipment listed above is: 1)is the actual equipment installed,2)equivalent to or more efficient than that specified in the certificate of compliance(Form CF-1R)submitted for compliance with the Energy Efficiency Standards for residential buildings,and 3)equipment that meets or exceeds the appropriate requirements for • manufactured devices(from the Appliance Efficiency Regulations or Part.6),where applicable. Signature,D ate Installing Subcontractor(Co.Name) OR Gweral Contractor(Co.Name)OR Owner WATER hEATINC=cYSTEM�: External Distribution ICRecir- Y of Rateds Tank ERT- (kW Volume eieneys Standbys Insulation Heater CEC Certified Mir Type(Sid, colation, Identical Input e) R-value Type Name 6:Model Number point-of-Use) Control Type Systems or Btu/hr) (gallons) (EF RE) Loss('% 2 For small gas storage(rated input of less than or equal to 75,000 Btuthr),electric resistance and heat pump water heaters,list Energy Factor. For large gas storage water healers(rated input of greater than 75,000 Eindho,list Recovery Efficiency.Standby Loss and Rated Input For instantaneous gas water heaters,list Recovery Efficiency and Rated Input _ Faucets&Shower Heads: All faucets and showerheads installed are certified to the Commission,pursuant to Title 24,Part 6,Subchapter 2,Section Ill. I,the undersigned,verify that equipment listed above my signature: 1)is the actual equipment installed;2) is equivalent to or more efficient than that specified in the certificate compliance(Form CF-IR)submitted for compliance with the Energy,Efficiency Standards for residential buildings;and 3)the equipment meets or exceeds the appropriate requirements for manufactured devices(from the Appliance Efficiency Regulations or Part 6),where applicable. • tgnature, ate Installing Subcontractor(Co.Name)OR General Contractor(Co.Name)OR Owner COPY TO: Building Department Building Owner at Occupancy a . k i' COAST Insulation Contractors, Inc. .. INSULATION CERTIFICATION 1086 N. 11th St. • San Jose, CA 95112 This is to certify that insulation has been installed in conformance with the current energy regulations, , California Administrative Code, Title 24,,State of California, the building located at: SITE ADDRESS' 5- 5 O PSL \ Mta Geelr. ; r-! a FLOORS: OCORNING/MV Thickness/Type —� R-Value Manufacturer OWENS_WENS_ ypa i EXTERIOR WALLS: Manufacturer OWENS CORNING/MV Thickness/TypeR-Value CEILINGS:. BATTS: Manufacturer OWENS CORNING/MV Thickness/Type62 X4 R-Value t BLOWN: Manufacturer OWENS(/CORNING Thickness/Type R.-Value . Weight/Bag 35 Sq. Ft. Covered # Bags Used AIR INFILTRATION-SEALANT ,IINN�ST�ALLED:p�YES P�— NO ❑ GENERAL CONTRACTOR`�S IK' l )� fI C I� U1/P LICENSE # • TITLE: DATE COAS INSULATION O RACTORS, INC. LICENSE # 465440 C-2 BY: E: . DATE: " I i O BR EN GROUP I Jim Rlploy(SMTPlrlploydgopacbell,nolI Monday, March 00, 1990 2:26 AM PATSURKE. OAKYALLEY IyCA. Linoor parkway planllnp, s wilhln Iho Ilnoor perk uo eonslslonl wllh Iho londsoopo ',n doeumanls prepared by INS ornce and rovlowed by Iha cl(y 990 and conrorm Min Iha prollminary approval doumanls, ipley I]n Group, Inc, FINAL PLANNING SIGN OFF .DATE. . SIGNAtURE { i Sill*SANMATaQ,nALIPONNIAy{to{Q,I7S THUNIONa(6Sn)!1! 0)00 FACSIAII1.9(440))145{43 i pwlurl Mo�rh I, 1996 ..