B-2017-1604 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1604
7631 ERIN WAY CUPERTINO,CA 95014-4342(359 20 020) TRADISTONE
MOUNTAIN VIEW,CA
94043
OWNER'S NAME: MEISSNER SONYA L TRUSTEE DATE ISSUED:09/19/2017
OWNER'S PHONE:650-9382000 PHONE NO:(650)938-2000
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class I3 Lic.#981246
Contractor TRADISTONE Date 02/28/2019 BLDG X ELECT X PLUMB
X I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
INSTALL GAS FIREPLACE INSERT(CHASKA-34 LOG)INCLUDING
I hereby affirm under penalty of perjury one of the following two declarations: (N)GAS LINE AND ELECTRICAL.
t. 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.
z. 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. Sq.Ft Floor Area: Valuation:$4000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 359 20 020
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal ode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature A._ itit Date 9.19.17 Issued by:SEAN HATCH
Wr Date:09/19/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code), Date:9.19.17
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code Secti i ,5505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:9.19.17
I certify that I have read this application and state that the above information is •► : il► ►II h.
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 9.19.17 Professional
' \ / GENERAL PERMIT APPLICATION d() IT- 1 L�yl
f' M E P
—.4. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
bsl.19r10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MIS C
(408)777-3228•FAX(408)777-3333•buildings cupertino.orq
CUPERTINO
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS77.31 ar.orN f A\a. APN# �i - �
+ �
OWNER NAME Y"(Ps POSSW PHONFjrI,lo/t 58 2 _ D E-MAIL
STREET DNAME•7 I I �J o� CITY, E,ZIP(V K _ )J /'g q ,Lt FAX
CONTACTPHONE
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENTNTRACFOR 0 CONTRACTOR AGENT 0 ARCHFFECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME-MillY�ipi 64�'"1`} LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME jFilitAkkeki
in0/14 • )0_ ,�r ceP� �'VebbCcM
E;�,^I�) q FAX
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STREET ADDRESS nLt Lk1-k' 04
fa_` lIkk. 'jCITY,STATE,ZIP
evofCAI v1 I/) .,i,J fPIIONE ) 33 G
0
ARCHITECT/ENGINEER NAME LICEJSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 1IFD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT TN 0 YES IS THE BLDG AN 0 YES
BUILDING: COMMERCIAL URBAN INTERFACE AREA Tcii0 FLOOD ZONE 114NO EICHLER HOME? "t0
DESCRIPTION OF WORK
(jag b'ne ----.. -(4?,-W
6 iec-/r,rci
� �y,s cctoy--N oc, '_ �- 31A OC C) Ic6,50 6 (3lUS 040,34
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TOTAL VALUATION: :/i}CO RECEIVED BY: _...... .1a-41-1\1
l
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 kiuildin construction. I authorize representatives of Cupertino to enter the bove-identifier)property r i ec purposes.
Signature of Applicant/Agent: ''"-----.4Date:
\ , ✓
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
PAY TO THE ORDER OF
Citi Bank OVER-THE-COUNTER
608 San Antonio RA Mountain Vow CA 321171164Mit cu
cu
EXPRESS
FOR DEPOSIT ONLY x
S 0 STANDARD
200f' �134 IM1� U
0 LARGE
a
0 MAJOR
MEPMiscApp_2011.doc revised 06/21/11
'1H::: FIREPLACE ELL:::_..
x;44 Old Middlefield\rkyCO,MMUNITY DEVELOPMENT DEPARTMENT
YVlcuntain View, CA 04043 BUILDING DIVISION - CUPERTINO
(050)938-2000
APPROVED
This set of plans and specifications MUST be kept at the
SC:DAn He6S` eAr job site during construction. It is unlawful to make any
changes or alterations on same, or to deviate
the efrom, without approval from the, Building Official.
-7�31
&i n (c•, , The Stamping of th,s plan and spec;ficat.ons SHALL NOT
"'^J1 be held to permit or to be an approval of the violation
CU `r0 LA oksolq of any provisH s of any City rdinance or State Law.
DATE g• /9 •/ v.
PERMIT # 80/7-/EAOY
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KOZY I IEAT
FIREPLACES Installation and
HUSS°NGMANUFACTURING CO.,INC. Operation Manual
Io 0
CHASKA-34 LOG I ` '
Model#CSK-34-L " •
Direct Vent Gas Fireplace Insert r'
NATIONAL We suggest that our gas
FIREPLACE
AWA R N I N G: INSTITUTE hearth products be installed
TeetsO 8 - FbNend j NI and serviced by profes-
FIRE OR EXPLOSION HAZARD `l°'°°ey 0-TL Oregon USA sionals who are certified in
US - the US.by the National
Fireplace Instihrte`(NFI)as
Failure to follow safety warnings exactly ObINFTaet L.Aaalxlr,bre. aRTIFIED NFI Gas Specialists.
could result in serious injury, death, or
property damage.
—Do not store or use gasoline or other
flammable vapors and liquids in the
vicinity of this or any other appliance.
—WHAT TO DO IF YOU SMELL GAS DANGER'
• Do not try to light any appliance.
• Do not touch any electrical switch; do
not use any phone in your building. HOT GLASS WILL
• Leave the building immediately. CAUSE BURNS
• Immediately call your gas supplier from DO NOT TOUCH GLASS
a neighbor's phone. Follow the gas • UNTIL COOLED
supplier's instructions. NEVER ALLOW CHILDREN
• If you cannot reach your gas supplier, TO TOUCH GLASS
call the fire department. A barrier designed to reduce the risk of burns
—Installation and service must be performed from the hot viewing glass is provided with this
by a qualified installer, service agency or appliance and shall be installed for the protection
of children and other at-risk individuals.
the gas supplier.
This appliance may be installed in
an aftermarket, permanently located,
manufactured home (USA only) or mobile ---- l
English and French installation manuals are
home, where not prohibited by local codes, available through your local dealer. Visit our website p•%...)1•13
www.kozyheat.com or scan the QR code for our mobile app. t#r
This appliance is only for use with the type Les manuels d'installation en frangais et en anglais sont
dis onibleschezvotredetaillantlocal.Visitezwww.k heat. f;
of gas indicated on the rating plate. This p °ry ❑
corn ou scannez ce code QR pour notre application mobile.
appliance is not convertible for use with
other gases, unless a certified kit is used.
INSTALLER: Leave this manual with the appliance.
CONSUMER: Retain this manual for future reference.
Hussong Mfg.Co.,Inc.•CSK-34-L Report No.:0216GN043S•Rev.06,October 2016
Read this manual before installation or operating this appliance.
Please retain this owner's manual for future reference.
CONGRATULATIONS!
We welcome you as a new owner of a Kozy Heat gas fireplace.Kozy Heat products are designed with superior components
and materials,and assembled by trained craftsmen who take pride in their work. To ensure you receive a quality product,
the burner and valve assembly are 100 percent test fired,and the complete fireplace is thoroughly inspected before packaging.
Our commitment to quality and customer satisfaction has remained the same for 40 years.We offer a complete line of gas and
wood fireplaces,along with stylish accessories to complement any decor.Adding a fireplace is one of the best ways to increase
the value of your home,and we are proud to offer a network of dealers throughout the country to help make your experience
everything you imagine.We pride ourselves in being dedicated not only to functionality and reliability, but also customer
safety.We offer our continual support and guidance to help you achieve the maximum benefit and enjoyment from your Kozy
Heat gas fireplace.
Jim Hussong Dudley Hussong
President Board Chairman
Homeowner Reference Information
We recommend you record the following information:
Model Name: Date purchased/installed:
Serial Number: Location of fireplace:
Dealership Purchased from: Dealer phone:
Notes:
HOMEOWNER REFERENCE 3
TABLE OF CONTENTS
TABLE OF CONTENTS 5 8.0 FACING AND FINISHING 18
1.0 INTRODUCTION 6 8.1 Clearances to Combustibles 18
1.1 Appliance Certification 6 8.2 Shroud Installation 19
1.2 Requirements for the Commonwealth of Massachusetts 6 8.3 Safety Barrier Installations 19
2.0 SPECIFICATIONS 7 9.0 FIREPLACE INSERT SETUP 20
2.1 Appliance Components 7 9.1 Glass Assembly 20
2.2 Heating Specifications 7 9.2 Light Kit 20
2.3 Appliance Dimensions 8 9.3 #CK34-500 Log Set Installation 21
2.4 Part Assembly Overview 9 9.4 Control Board Removal and Installation 22
2.5 Safety Barriers 10 10.0 ELECTRICAL INFORMATION 23
3.0 EXISTING FIREPLACE REQUIREMENTS 11 10.1 Electrical Specifications 23
3.1 Appliance Placement Considerations 11 10.2 Wiring Requirements 23
3.2 Existing Fireplace Specifications 11 11.0 OPERATING INSTRUCTIONS 24
4.0 TERMINATION LOCATION 12 11.1 Initialize the Control System 25
4.1 Vent Termination Clearances 12 11.2 Backup Battery Operation 25
5.0 INSTALLATION PREPARATION 13 11.3 IFC Module Ignition Sequence 25
11.4 Reset the System for Manual Operation 25
5.1 Inspect and Clean Existing Chimney 13 11.5 Remote Control Operation 26
5.2 Flue Damper 13
5.3 Gas Line 13 12.0 ADJUSTMENT 29
5.4 Electrical Wiring 13 12.1 Pressure Testing 29
5.5 Fireplace Conversion 13 12.2 Flame Appearance Adjustments 30
6.0 INSTALLATION 14 13.0 TROUBLESHOOTING 31
6.1 Kozy Heat#816-CL Co-Linear Vent System 14 14.0 MAINTENANCE 33
6.2 Fireplace Insert Air Duct Removal 15 14.1 Burner and Pilot System 33
6.3 Run Vent System 15 14.2 Fans 33
6.4 Connect Vent Pipe to Air Duct 16 14.3 Vent System 33
6.5 Place and Secure Appliance 16 14.4 Glass Assembly 33
7.0 GAS LINE CONNECTION 17 15.0 REPLACEMENT PARTS LIST 34
7.1 Gas Conversion(sold separately) 17 LIMITED WARRANTY 35
7.2 Gas Line Installation 17 LIFETIME WARRANTY 37
TABLE OF CONTENTS 5
1.0 INTRODUCTION`
/
1/1 Appliance Certification 1.2.4 Inspection
/laboratory: OMNI-Test Laboratories in Portland, Oregon The state or local gas inspector of the side wall horizontally
vented gas fueled equipment shall not approve the installation
Standards: unless, upon inspection,the inspector observes carbon monoxide
• ANSI Z21.88-2014/CSA 2.33-2014, Vented Gas Fireplace detectors and signage installed in accordance with the provisions
(
Heaters of 248 CMR 5.08 (2)(a) 1 through 4.
• CGA 2.17-M91 (R2014), Gas-Fired Appliances for Use at High
Altitudes 1.2.5 Exemptions
This installation must conform with local codes, or in the absence/The following equipment is exempt from 248 CMR 5.08 (2) (a) 1
of local codes, with the National Fuel Gas Code, ANSI 2223.1/ through 4:The equipment listed in Chapter 10 entitled "Equipment
NFPA 54, or the Natural Gas and Propane Installation Code, GSA Not Required To Be Vented" in the most current edition of NFPA
B149.1. 54 as adopted by the Board; and Product Approved side wall
horizontally vented gas fueled equipment installed in a room or
1�2 4equirements for the structure separate from the dwelling, building or structure used in
-- -- whole or in part for residential purposes.
Commonwealth-of Massachusetts
The following requirements reference various Massachusetts 1.2.6 Manufacturer Requirements
and national codes not contained in this manual. 1.2.6.1 Gas Equipment Venting System Provided
For all sidewall horizontally vented gas fueled equipment installed When the manufacturer of Product Approved side wall horizontally
in every dwelling, building or structure used in whole or in part for vented gas equipment provides a venting system design or venting
residential purposes, including those owned or operated by the system components with the equipment, the instructions provided
Commonwealth and where the side wall exhaust vent termination by the manufacturer for installation of the equipment and the
is less than(7)feet above finished grade in the area of the venting, venting system shall include:
including but not limited to decks and porches, the following
requirements shall be satisfied: •
Detailed instructions for the installation of the venting system
design or the venting system components;and
1.2.1 Installation of Carbon • A complete parts list for the venting system design or venting
Monoxide Detectors system.
At time of installation of side wall horizontally vented gas fueled 1.2.6.2 Gas Equipment Venting
equipment, the installing plumber or gas-fitter shall observe that System NOT Provided
a hard wired carbon monoxide detector with an alarm and battery When the manufacturer of Product Approved side wall horizontally
back-up is installed on the floor level where the gas equipment is vented gas equipment does not provide the parts for venting the
to be installed. In addition, the installing plumber or gas-fitter shall flue gases, but identifies "special venting systems", the following
observe that a battery operated or hard wired carbon monoxide requirements shall be satisfied by the manufacturer:
detector is installed on each additional level of the dwelling,
building or structure served by the side wall horizontal vented • The referenced "special venting systems" instructions shall
gas fueled equipment. It shall be the responsibility of the property be included with the appliance or equipment installation
owner to secure the services of qualified licensed professionals for instructions and;
the installation of hard wired carbon monoxide detectors. • The "special venting systems" shall be Product Approved by
In the event that the side wall horizontally vented gas fueled the Board, and the instructions for that system shall include a
equipment is installed in a crawl space or attic, the hard wired parts list and detailed installation instructions.
carbon monoxide detector with alarm and battery back-up may A copy of all installation instructions for all Product Approved
be installed on the next adjacent floor level. In the event that side wall horizontally vented gas fueled equipment, all venting
the requirements of this subdivision can not be met at the time instructions,all parts lists for venting instructions,and/or all venting
of completion of installation, the owner shall have a period of design instructions shall remain with the appliance or equipment at
thirty (30) days to comply with the above requirements; provided, the completion of the installation.
however,that during said thirty(30)day period,a battery operated
carbon monoxide detector with an alarm shall be installed.
1.2.2 Approved Carbon Monoxide Detectors
Each carbon monoxide detector as required in accordance with
the above provisions shall comply with NFPA 720 and be ANSI/UL
2034 listed and IAS certified.
1.2.3 Signage
A metal or plastic identification plate shall be permanently mounted
to the exterior of the building at a minimum of eight (8) feet
above grade directly in line with the exhaust vent terminal for the
horizontally vented gas fueled heating appliance or equipment.The
sign shall read, in print no less the one-half inch (1/2) in size, "GAS
VENT DIRECTLY BELOW.KEEP CLEAR OF ALL OBSTRUCTIONS".
6 INTRODUCTION
2.0 SPECIFICATIONS
2.1 Appliance Components 2.2.1.1 US Installations
Refer to the American Gas Association guidelines for the gas
Part Number Description designed appliances derating method. For elevations above 2,000
CK34L-150 Control Board Assembly ft(610 m),input ratings are to be reduced by 4%for each 1,000 ft
(305 m)above sea level.
700-203 Manual Gas Shut-off Valve
2.2.1.2 Canadian Installations
CK34L-135 Burner Assembly
When the appliance is installed at elevations above 4,500 ft(1,372
CK34-500 Log Package m),the certified high altitude rating shall be reduced at the rate of
700-001T Glass Assembly 4%for each additional 1,000 ft(305 m).
CK34-075 Fan Kit(1)-75 CFM
500-CK34 Grill Assembly
700-408 Remote Control
2.1.1 Additional Components Required
2.1.1.1 Shrouds
Part Number Description
CK34-2740 27"x 40"shroud(1 pc.)
CK34-3044 30"x 44"shroud(1 pc.)
CK34-3346 33"x 46"shroud(1 pc.)
CK34-A3444 34"x 44"shroud(1 pc.)
CK34-CUS Custom Shroud
CK34-ACUS Arched Custom Shroud
2.1.1.2 Approved Vent Systems
Kozy Heat#816-CL co-linear vent system
For use with minimum 6"x 8"I.D. masonry or 7"I.D. Class A metal
chimneys;includes 12 ft. (3.66 m)compressed, expandable co-
linear 3"x 3"flexible pipes and termination cap.
Other approved vent manufacturers
ICC, Selkirk,American Metals(Amerivent), Olympia Venting Supply,
Inc., Simpson Dura-Vent
2.2 Heating Specifications
Natural Gas LP Gas
Maximum 34,000 Btu/h(9.96 kPa) 34,000 Btu/h(9.96 kPa)
Input Rating
Minimum 18,500 Btu/h(5.42 kPa) 18,500 Btu/h(5.42 kPa)
Input Rating
Manifold Pressure 3.8"WC(.95 kPa) 11"WC(2.74 kPa)
(High)
Manifold Pressure 1.1"WC(.27 kPa) 2.9"WC(.72 kPa)
(Low)
Orifice Size(DMS) #38 #52
2.2.1 Altitude Adjustment
This appliance may be installed at higher altitudes.Please refer
to National Fuel Gas Code ANSI Z223.1/NFPA 54, CSA-B149.1
Natural Gas and Propane Installation Code, local authorities,
or codes having jurisdiction in you area regarding derate
guidelines.
SPECIFICATIONS 7
2.3 Appliance Dimensions
Table 2.1 Physical Dimensions
Description Height Width Back Width Depth Back Height Back to Gas Front to Vent Back to Vent
Line Access Center Center I
Inches 23 33-3/8 24-3/8 16 17-3/8 5-9/16 10-3/8 5-5/8
Millimeters 585 848 618 407 442 142 264 143
TOP
243/8"
(618mm)
r �'.
16" Tann al
0 i 0 \
(407mm)
53/8" 32W 103/8"
(143mm) (822mm) (264mm)
173h" 23" 263/X" 2"
(442mm) (585mm) (513mm) (51mm)
0 Iff `7
333/8" 1111111 59/u'
(848mm) (142mm)
LEFT FRONT RIGHT
Figure 2.1,CSK-34 Unit Dimensions
8 SPECIFICATIONS
2.4 Part Assembly Overview
WARNING: Failure to position these parts in accordance with
these diagrams, or failure to use only specified approved parts
with this appliance, may result in property damage or personal
injury.
D \.... G
F ,
ir,L
r_,
IloiFigure 2.2,Proper Positioning of CSK-34-L(Exploded View)
Table 2.2,Field-Assembled Parts
07 Fireplace Insert " Log set
B. Spring-loaded latch glass assembly -- Refractory panels
jt Control board with burner cover ,_„,,,!".rip` Fan kit
.rp -; Co-linear air duct
SPECIFICATIONS 9
•
2.5 Safety Barriers
WARNING:A barrier designed to reduce the risk of burns from
the hot viewing glass is provided with this appliance and shall
be installed for the protection of children and other at-risk
individuals.
If the barrier becomes damaged, the barrier shall be replaced
with Hussong Mfg.'s barriers for this appliance. Only doors
certified with the appliance shall be used.
37 me" 3913le"
(895mm) (895mm)
i
ate „' r-- ,
k �f 251524�� ;4' � ^" Mi (658m
m)-, ;(632mm)
CK34-BSF CK34-CXF
351/" 35'/" 35W
(895mm) (895mm) (895mm) -
24 �- � ( 24" L:„y'"'_, �z -1" .£.._ 24"- � `$ his '�`` ,
(609mm) , (609mm) , a - :--- (609mm) <
j
_ T
CK34-PSF CK34-RSF CK34A-MSF
35'/" 351/" 351/'
(895mm) (895mm) (895mm)
1 = ,it II it
1 11 I ;
24 24" 1 I I 24" r?
(609mm) (609mm) I, i 1' (609mm) i , '`
I - IBJ -. --,
CK34A-SF CK34A-PSF CK34A-FPDSF
10 SPECIFICATIONS
3.0 EXISTING FIREPLACE REQUIREMENTS
3.1 Appliance Placement 3.2.2 Existing Chimney Specifications
Considerations WARNING:Any chimney clean-outs must fit properly.
WARNING: Due to high surface temperatures, the fireplace This fireplace insert Is to be installed into a solid fuel masonry
insert should be located out of traffic and away from furniture or factory built non-combustible fireplace that has been
and draperies. installed in accordance with the national,provincial, state, and
local building codes.
• This fireplace must be installed on a level surface capable of
supporting the fireplace insert and venting. The existing chimney must be comprised of one of the
following:
• This fireplace insert may be installed in a bedroom.
• Factory-built solid fuel chimney: 7 in (178mm) minimum
• Please be aware of the large amount of heat this fireplace inside diameter
insert will produce when determining a location. • Masonry chimney: 6 in x 8 in (152mm x 203mm) minimum
inside diameter
3.2 Existing Fireplace Specifications
Existing chimney height:
IMPORTANT: Adequate accessibility clearances for servicing • Minimum: 12 ft(3.66 m) Maximum: 50 ft(15.24 m)
and proper operation must be maintained.
• Any smoke shelves, shields, and baffles may be removed 3.2.2.1 Determine Length of Existing Chimney
if attached by mechanical fasteners. If necessary, 1. Remove and discard existing chimney cap.
remove firebrick to obtain at least the minimum opening
requirements. 2. It is helpful to have two people complete this step.Position
one person at the fireplace and another person at the top of
• Cutting of any sheet metal parts of the existing fireplace is the chimney.
prohibited.
3. Measure from the fireplace base to the top of the chimney.
• If the metal floor is removed,the insert must be placed
directly on metal base of metal fireplace. Mechanically 4. Subtract the height of the insert from the previous
attach 'THIS UNIT HAS BEEN MODIFIED' label at bottom of measurement.This is the total length of the co-linear flexible
existing firebox so it will be visible if this gas fireplace insert aluminum pipe required for your installation.
is removed.
3.2.1 Existing Fireplace Opening
Minimum Requirements
(A) Height 23-1/2 in (597 mm)
411P
(B) Front Width 33-1/2 in (851 mm)
(C) Depth 16-3/8 in (419 mm)
(D) Back Width 24-1/2 in (622 mm)
tt
- MIN: 10 ft (3.05m)
D - MAX: 50 ft (15.24m)
•
B ---'`
A ••
Figure 3.1,Existing Opening Guide
`1
Figure 3.2,Min/Max Chimney Length
EXISTING FIREPLACE REQUIREMENTS 11
4.0 TERMINATION LOCATION
4.1 Vent Termination Clearances
WARNING:This appliance must not share or be connected to a
chimney flue serving any other appliance.
• Approved vent caps require 12 in (305mm) clearance to
intersecting walls, overhangs or eaves as verified by test.
APPROVED kt,:'
VENT CAP
MINIMUM
12"
(305mm)
I
CLEARANCE
4A
Figure 4.1,Vent Cap Clearance
12 TERMINATION LOCATION
5.0 INSTALLATION PREPARATION
NOTE: This gas fireplace insert is approved for installation in
masonry and factory-built solid fuel burning fireplaces.
ATTENTION: Any removed parts must be capable of re-
installation if this insert is ever removed. Removal of rivets or
screws is acceptable.
5.1 Inspect and Clean Existing Chimney
• Verify existing chimney is constructed of non-combustible
material.
• Verify existing chimney is clean and in good working order.
Clean existing chimney and fireplace to prevent a creosote
odor from entering the home.
• Verify combustible mantel and sidewall clearances comply
with Section 8.3 Safety Barrier Installations on page 19.
• The refractory, glass doors, screen rails, screen mesh,and
log grates may be removed from existing fireplace before
installing this gas fireplace insert.
5.2 Flue Damper
• The fireplace flue damper can be fully blocked open, or
removed for installation of this gas fireplace insert. Remove
existing chimney cap.
5.3 Gas Line
• A gas line must be able to be installed to the insert. Refer to
Section 7.0 Gas Line Connection on page 17.
• If the factory-built fireplace has no gas access hole(s)
provided,an access hole of 11/2 in.(37.5 mm) or less may be
drilled through the lower sides or bottom of the firebox in a
proper workmanship like manner.The access hole must be
plugged with non-combustible insulation after the gas supply
line has been installed.
• Run gas line to the gas fireplace insert through the gas line
hole provided. Do not run gas line in a manner that would
obstruct fan operation.
• If the gas fireplace insert is to be installed into minimum
opening dimensions,the gas line may need to be run after
appliance placement due to space limitations.
5.4 Electrical Wiring
• Provisions must be made to provide electrical power for
appliance operation.
• Refer to Section 2.3 Appliance Dimensions (Figure 2.1)
on page 8 for electrical outlet box location to run any
necessary electrical wiring to the gas fireplace insert.
5.5 Fireplace Conversion
• Mechanically attach the label with the following warning to
at the bottom existing firebox so it will be visible if this gas
fireplace insert is removed.
WARNING: This fireplace has been converted for use with a
gas fireplace insert only and cannot be used for burning wood
or solid fuels unless all original parts have been replaced, and
the fireplace re-approved by the Authority Having Jurisdiction.
INSTALLATION PREPARATION 13
6.0 INSTALLATION
6.1 Kozy Heat #816-CL Co- 2. Slide the combustion air intake pipe(the end without a collar)
Linear Vent System over termination cap collar(A).Secure to termination cap(E)
y with provided (3) self-tapping screws(D).
IMPORTANT:Proper operation of this insert requires the exhaust 3. Place a bead of sealant around the inner edge at the end of
and combustion air pipes to be connected to the correct collar, the exhaust pipe (without collar/red marking)and slide onto
on both the termination kit and the gas fireplace insert air duct. the corresponding labeled collar(B) on termination cap(E).
The fireplace insert air duct exhaust collar is located on the 4. Secure the exhaust pipe to termination cap (E)with the
right side. Install termination cap with the exhaust collar on the
right side. provided (3)self-tapping screws.Apply additional sealant
around joint to ensure a proper seal.
NOTE: The exhaust pipe will have a red marking.
5. Complete vent system installation.
IMPORTANT: Maximum horizontal vent runs of 24 in(609 mm)
require a 1 in(25mm)rise per 12 in (305 mm)run.
1. Carefully extend the exhaust and combustion air intake pipes
to the total chimney length required. Refer to 3.2.2 Existing
Chimney Specifications on page 11.
#816-CL CO-LINEAR VENT SYSTEM
(A) Intake Collar(extends through bottom plate) (C) Sealant
(B) Exhaust Collar(extends through middle (D) Self-Tapping Screws-(3)total(2 shown)
divider plate) (E) Termination Cap
e-
E
❑❑❑❑❑❑❑
❑11❑❑❑❑❑
A ®L!®®®®® B
C
C
•0.11
41-4
Figure 6.1,#816-CL Termination Cap(your component may look different than the one shown)
14 INSTALLATION
6.2 Fireplace Insert Air Duct Removal
641;ATTENTION:All information outlined in Section 5.0 Installation ¢ `' " ,'
Preparation on page 13 must be completed before continuin •g : _' _� ,,,,,-;:r
with this installation. 1 t #fir
1. Remove the air duct at the top of appliance by sliding the air 1
duct back out of channels. Refer to the following instructions ;,. , :
for vent system attachment to the air duct. d _ 44t 4.
4 �qf
�`` _ ,,,44- "'mss v f ` 't
:; _:".
Il El=
- , -
1— I ll,
I= ■
._ ,VIII I
M_os-
166:1.II I I I I I 1::1:111 i 1.1 111:111:
III OM m 1110
Figure 6.2,Air Duct Removal -$' M ��
1MMO _ Ell
I■ — II
6.3 Run Vent System
NOTE: If offsets are present in existing chimney, place a
NI ��
weighted rope around the pipe ends to guide them through MM; M
the chimney. DO NOT ATTEMPT TO TIE ONE ROPE AROUND . \` 1U
BOTH PIPES.
MINI
• To prevent cold air drafts, Hussong Manufacturing !
recommends to insulate the 3"x 3"flexible vent pipes EI
and chimney using unfaced insulation products listed as mom
noncombustible per ASTM E 136. Figure 6.3,Chimney Vent Run
1. OPTIONAL: Before installing vent system down through the
chimney, place unfaced insulation around the first 3 ft(914
mm)of vent system below termination cap.Secure with wire.
2. Install the 3"x 3"flexible pipes down through existing
chimney. Guide ropes(if used)to aid installation.
3. To secure chimney termination cap to chimney, apply a liberal
bead of sealant(provided) around the top of the chimney.
Set termination cap into position as instructed by vent system
manufacturer's installation manual.
OPTIONAL Kozy Heat#816-CL:Secure termination cap to
existing chimney with 2 in (50 mm)self-tapping screws and
anchor straps(provided)through the pilot holes, located on
the sides of the termination cap.
4. From inside the existing fireplace, carefully pull ropes(if
used) or the flexible pipes down until both exhaust pipe and
combustion air intake are into the existing fireplace firebox.
5. OPTIONAL:To prevent heat loss up chimney, place unfaced
insulation products between the 3"x 3"flexible vent pipes
and chimney.
INSTALLATION 15
6.4 Connect Vent Pipe to Air Duct 6.5 Place and Secure Appliance
IMPORTANT: Proper operation of this appliance requires 1. Slide the gas fireplace insert into existing fireplace opening
exhaust and combustion air pipes to be connected to the until the channels on top of the appliance are aligned with
correct collar, on both the termination kit and the gas fireplace the air duct.
insert air duct. 2. Insert the air duct pull rod handle through access slot at the
1. Place previously removed air duct 6.2 on page 16 into top of appliance and place pull handle hook through the hole
existing fireplace opening. in pull rod. Simultaneously push the gas insert into existing
2. Connect exhaust vent pipe(red marking)to exhaust collar fireplace and pull the air duct forward until seated.
on air duct.Apply a bead of sealant(provided)around 3. Secure air duct to appliance by using slots at the top of
exhaust pipe and slide inside collar marked 'Exhaust:Secure the appliance to secure with (2) 1/2 in (13 mm)sheet metal
with provided (3) 1/2 in(13 mm)self-tapping screws.Apply screws(included in components packet).
additional sealant around join to ensure an air tight seal. 4. Use the pull rod handle to pull the air duct back to starting
3. Connect air intake vent pipe to intake collar on air duct. position. Remove pull handle.Verify vent system connection
Apply a liberal bead of sealant around intake collar on air 5. If necessary, level the gas insert by threading leveling bolts
duct.Slide combustion intake pipe over the collar and secure (included in components packet) into nuts at the bottom
with provided (3) 1/2 in (13 mm)self-tapping screws.Apply of the insert(2 each side).Verify appliance is properly
additional sealant around joint to ensure an air tight seal. positioned.
4. Visually check vent pipe connection to air duct..
I I i]4 I 1
1 ' I -7= I I III I = II
I I I I I I I _ I
IlI - 1 4 I 'I '
lI Ii = I
VI I I _ ;I I I I I _. 1I
L I I II �I I V I I I I I
VII I = III IIIIII II
I I �l I I 3�
I I II -_
VIII/ _ II I I
I �/ N. III IIID I
I( il;
1 I I
11 ' I ALIGNED I I - I
I I 1 . ' GAS INSERT I I I ,-i
' I
AIR DUCT I II 1 I f' ... .) _ i ' 1
I I I� 1
III
O IIII
I,
Figure 6.5,Air Duct in Existing Fireplace Figure 6.7,Aligned Gas Insert in Existing Fireplace
FLEXIBLE PIPES
Ill'.1110" SECURE WITH(2)SCREWS
, - - PULL ROD
SHEET METAL �J
SCREWS(3 TOTAL) ----=------',`_` vZ>� Figure 6.4,Seated Air Duct(shown without venting attached for clarity purposes only)
SEALANTSEALANT
Figure 6.6,Secured Vent Pipes to Air Duct
16 INSTALLATION
7.0 GAS LINE CONNECTION
7.1 Gas Conversion (sold separately)
ATTENTION:The conversion shall be carried out in accordance
with the requirements of the provincial authorities having
jurisdiction and in accordance with the requirements of the
ANSI Z223.1 installation code.
This fireplace is manufactured for use with natural gas. Follow the
instructions included with the conversion kit if converting to LP
gas.
7.2 Gas Line Installation
CAUTION: Installation of the gas line must only be done by
a qualified person in accordance with local building codes, if
any.If not,follow ANSI 223.1. Commonwealth of Massachusetts
installations must be done by a licensed plumber or gas fitter.
NOTE: The appliance and its individual shutoff valve must be
disconnected from the gas supply piping system during any
pressure testing of that system at pressures in excess of '/2
psi (3.5 kPa). For test pressures equal to or less than '/2 psi
(3.5 kPa), the appliance must be isolated from the gas supply
piping system by closing its individual manual shut-off valve.
• A listed (and Commonwealth of Massachusetts approved) 1/2
in. (13 mm)tee handle manual shut-off valve and flexible gas
connector are to be connected to the 1/2 in. (13 mm)control
valve inlet. If substituting for these components, please
consult local codes for compliance.
• If installing this insert into minimum opening dimensions,
the gas line may need to be run after placement due to
space limitations. Refer to 3.2.1 Existing Fireplace Opening
Minimum Requirements on page 11.
• This fireplace is equipped with a 3/e" (10 mm)x 18" (457 mm)
long flexible gas connector and manual shut-off valve.
• Run gas line into fireplace, preferably through left or right gas
line holes provided.The gas line should be run to the point of
connection where the shut-off valve and flexible gas line will
connect.
• Do not run gas line in a manner that would obstruct fan
operation.
• For high altitude installations, consult the local gas distributor
or the authority having jurisdiction for proper rating methods.
Table 7.1,Inlet Gas Supply Pressures
Fa"ei a s e U[ 1Aax(RuM pressure '
Natural Gas 5"WC (1.25 kPa) 10.5"WC (2.62 kPa)
LP Gas 11"WC (2.74 kPa) 13"WC (3.24 kPa)
GAS LINE CONNECTION 17
8.0 FACING AND FINISHING
8.1 Clearances to Combustibles
is
COMBUSTIBLE 0 Li
Q
MATERIAL -
000
J6" (152mm)
CLEARANCE TO SIDEWALL
1 -
COMBUSTIBLE MANTEL COMBUSTIBLE MANTEL
} 45°
12"(305mm) 45' - - 12"(305mm)
9"(229mm) } = 9"(229mm) } -
;/4"(19mm) I - ` 'A"(19mm) 1
(406mm) I 19 (406mm)11"
(483mm) (305mm) I 1 (483mm) (305mm) mii I
1
I
•
7"(178mm)
L'
COMBUSTIBLE FLOOR--tet 1 I I COMBUSTIBLE FLOOR-_-_,_� } )
NON-COMBUSTIBLE I
1"(25mm)*
THIS APPLIANCE IS ZERO CLEARANCE TO A COMBUSTIBLE
FLOOR IF 7" (178mm) OF NON-COMBUSTIBLE FLOORING IS *IF COMBUSTIBLE FLOORING IS CONSTRUCTED IN
CONSTRUCTED IN FRONT OF THE UNIT FRONT OF THE UNIT,THE APPLIANCE MUST BE
RAISED 1" (25mm)
18 FACING AND FINISHING
8.2 Shroud Installation 8.3 Safety Barrier Installations
CAUTION: Trim panels or surrounds must not seal ventilation 1. Locate the(4)slots on the shroud (2 each side).
openings in existing fireplace that this appliance is installed in.
2. Align the tabs located on the back of the safety barrier with
WARNING:The flow of combustion and ventilation air must not the slots on the shroud.
be obstructed. 3. Raise the safety barrier slightly into the slots and allow the
For shrouds #CK34-2740, #CK34-3044, #CK34-3346, tabs to lower into position.
#CK34-A344, #CK34-CUS,and#CK34-ACUS. • To remove safety screen:lift the screen up and out of slots.
1. Remove the upper hood by lifting up and out of the mounting
flanges.
2. Remove lower louver by lifting the louver out of the slots on
the mounting bracket.
3. Remove the glass assembly.
4. Align the mounting holes on the shroud to the corresponding
mounting nuts on the sides of the insert metal cabinet.
5. Secure with (4)truss head screws(provided).
6. Reinstall all components previously removed.
r'
r- - i
..�."
d =
Figure 8.1,Upper Hood Removal
- ---_Et. maw-— i
i
, f'-'':E'll-1::::::034.." _ .
Figure 8.2,Lower Louver Removal
--
MOUNTING
NUTS
(2 EACH SIDE)
Figure 8.3,Mounting Nuts Location
FACING AND FINISHING 19
9.0 FIREPLACE INSERT SETUP
9.1 Glass Assembly 9.2 Light Kit
WARNING:Do not operate this fireplace with the glass removed, CAUTION: Disconnect all electrical power from the fireplace
cracked, or broken. Replacement of the glass assembly, #701- before performing this task.
001T,should be done by a licensed or qualified service person. ATTENTION: If converting to LP (propane) gas, complete the
9.1.1 Remove Glass Assembly conversion before installing any light kit components.Follow the
instructions provided with the conversion kit(sold separately).
WARNING:Do not remove the glass assembly when hot.
NOTE: To avoid damage and prolong the life of the halogen
1. Locate (2)spring-loaded latches securing the glass assembly bulbs, never touch with bare hands. Always use a soft cloth
at the bottom of the firebox. when handling.
2. Pull the spring-loaded latches out and down to release the
bottom of the glass assembly. 9.2.1 Install Light Kit
3. Lift glass assembly up and off of the(2)tabs located at the 1. Remove the safety barrier and glass frame assembly.
top of the firebox. 2. Remove logs.
9.1.2 Install Glass Assembly 3. Remove the burner assembly, secured with (2)screws.
1. Align the slots on top of the glass assembly over the tabs at 4. Remove side log mounting stands/refractory clips and
the top of the firebox while lowering the bottom of the glass refractory panels.
assembly into position. 5. Remove the ember panel from the firebox.
2. Pull the spring-loaded latches out and up to secure the 6. Remove burner heat shield,secured with (2)screws at the
bottom of glass to the bottom of the fireplace. back corners of the firebox.
7. Install (4) halogen bulbs(included in components packet)
into lamp bases.
TABS 8. Reinstall ember panel.
9. Place 2 lb.(0.91 kg) of crushed glass media(included with
fireplace)into ember media cavity. Randomly place klinkers
on top of glass media.
10. Reinstall burner heat shield.
11. Reinstall side log mounting stands/refractory clips and
refractory panels.
12. Reinstall burner assembly.
13. Reinstall logs, glass frame assembly, and safety barrier.
Reinstall
SPRING-LOADED LATCHES
Figure 9.1,Glass Assembly Figure 9.2,Installed Halogen Bulbs
Figure 9.3,Completed Light Kit Installation
20 FIREPLACE INSERT SETUP
9.0 FIREPLACE INSERT SETUP
9.1 Glass Assembly 9.2 Light Kit
WARNING:Do not operate this fireplace with the glass removed, CAUTION: Disconnect all electrical power from the fireplace
cracked, or broken. Replacement of the glass assembly, #701- before performing this task.
00IT,should be done by a licensed or qualified service person. ATTENTION: If converting to LP (propane) gas, complete the
9.1.1 Remove Glass Assembly conversion before installing any light kit components.Follow the
instructions provided with the conversion kit(sold separately).
WARNING:Do not remove the glass assembly when hot.
NOTE: To avoid damage and prolong the life of the halogen
1. Locate(2) spring-loaded latches securing the glass assembly bulbs, never touch with bare hands. Always use a soft cloth
at the bottom of the firebox. when handling.
2. Pull the spring-loaded latches out and down to release the
bottom of the glass assembly. 9.2.1 Install Light Kit
3. Lift glass assembly up and off of the(2)tabs located at the 1. Remove the safety barrier and glass frame assembly.
top of the firebox. 2. Remove logs.
9.1.2 Install Glass Assembly 3. Remove the burner assembly,secured with(2)screws.
1. Align the slots on top of the glass assembly over the tabs at 4. Remove side log mounting stands/refractory clips and
the top of the firebox while lowering the bottom of the glass refractory panels.
assembly into position. 5. Remove the ember panel from the firebox.
2. Pull the spring-loaded latches out and up to secure the 6. Remove burner heat shield,secured with(2)screws at the
bottom of glass to the bottom of the fireplace. back corners of the firebox.
7. Install(4) halogen_bulbs(included in components packet)
into lamp bases.
TABS 8. Reinstall ember panel.
9. Place 2 lb. (0.91 kg)of crushed glass media(included with
fireplace)into ember media cavity. Randomly place klinkers
on top of glass media.
10. Reinstall burner heat shield.
11. Reinstall side log mounting stands/refractory clips and
refractory panels.
12. Reinstall burner assembly.
13. Reinstall logs, glass frame assembly,and safety barrier.
SPRING-LOADED LATCHES
Figure 9.1,Glass Assembly Figure 9.2,Installed Halogen Bulbs
F
Figure 9.3,Completed Light Kit Installation
20 FIREPLACE INSERT SETUP
9.3 #CK34-500 Log Set Installation 1. Position the ember panel in front of the burner as shown.
CAUTION: Do not place logs directly over burner port holes. 2. Align the two (2)holes in the bottom of log 1 CK with the two
Improper log placement may affect flame appearance and may (2) mounting pins at the back of the burner. Push the log
cause excessive soot to build upon the glass. down onto the pins to seat. Repeat for log 2CK.
• If converting to LP(propane)gas, complete the conversion 3. Align the holes on the bottom of logs 3CK and 4CK with
before installing the log set. Follow the conversion mounting pins on burner. Push the logs down onto the pins
instructions included with the kit. to seat.
• Log numbers are located on the bottom of each log.Refer 4. Align log 5CK with the notches in logs 1CK and 3CK.
to following instructions and illustrations for proper log 5. Align log 8CK with the notch in log 4CK.
placement. 6. Position logs 6CK and 7CK as shown in Figure 9.6.
/ ' `
''°'
�} h
.._Zi
( - i r 4 �.. e
Figure 9.4,Logs 1CK&2CK
4 1 . :":, ,-.'. all
Figure 9.5,Logs 3CK&4CK
ry ti1 I
3 ✓ ,,
kir .
41660C- ,
Figure 9.6,Completed Installation
FIREPLACE INSERT SETUP 21
9.4 Control Board Removal
and Installation
WARNING: If burner and/or pilot have been burning, use
appropriate protection to avoid burns or damage to personal
property before removing any components. DO NOT OPERATE
THIS APPLIANCE WITHOUT THE SEALING GASKET(LOCATED
UNDER THE CONTROL BOARD) IN PLACE. IF GASKETING IS
DAMAGED, IT MUST BE REPLACED.
CAUTION: Check all connections for leaks with soapy water,
whether field or factory made.
9.4.1 Control Board Removal
1. Disconnect electrical power.
2. Locate the manual valve installed by your qualified service 1
technician. III1IIII�IIII
3. Turn the manual valve clockwise to the OFF position. IIII
4. Remove the safety barrier and glass assembly.
5. Remove logs.
6. Remove the burner assembly,secured with (2)screws.
7. Remove side log mounting stands/refractory clips and
refractory panels.
8. Remove burner heat shield (secured at back corners-2
screws). CONTROL BOARD
9. Remove secondary burner heat shield resting on control
board.
10. Remove(10)screws securing control board. Remove the
control board.
9.4.2 Control Board Installation
1. Place the control board in firebox, aligning the holes in board BURNER Oi
with mounting studs at the bottom of the firebox. ASSEMBLY SECONDARY
VERIFY SEALING GASKET IS IN PLACE ON THE BOTTOM .` � HEAT SHIELD
OF THE FIREBOX. �o � ,
-;� BURNER
2. Secure the control board with screws previously removed. 'mil �• HEAT SHIELD
, /
3. Reinstall secondary burner heat shield by placing it on top of
the control board.
4. Reinstall burner heat shield. Position the cut-outs over pilot
assembly and burner orifice,centering from side-to-side and
as far back as possible.
5. Secure the burner heat shield with screws previously
removed.
6. Reinstall refractory panels,then reinstall the side log -a� , ��,
mounting plates/refractory clips. *MIS 1JNIIIIiII'
7. Reinstall burner assembly.Verify the burner tube is iliktNtorkp
�
positioned over burner orifice.Secure with screws previously
removed.
Figure 9.7,Control Board Removal and Installation
8. Reinstall log set.
9. Turn the manual valve counterclockwise to the ON position.
10. Reconnect electrical power.
11. Reinstall the glass assembly and safety barrier.
12. Verify proper log placement,operation of fireplace, and any
electrical components.
22 FIREPLACE INSERT SETUP
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE 9nUA-C6
q ft
0%19 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CIUPERTINta 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq( cupertino.orq
111'
VPERMIT CANNOT BEyINALED UNTIL THIS CERTIFICATE HASBEEN ,(���
COMPLETED SIGNED AND RETURNED TO THE BUINDI
ILDG VISIONz,=.‘-x-14‘11
'`
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section R314,R315,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon.
Monoxide alarms. When the valuation of additions, alterations,or repairs to existing dwelling units exceeds
$1000.00, CRC Section 1314,R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarins be installed in the following locations:
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level'of a dwelling unit including basements and habitable attics X ' X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420:6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
• space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below. 1
Address: `7(0,3/. �c ;,� (Ja.,1 p:.r4 v` Permit No. -aO I -11Q04
Specify Number of Alarms: #Smoke Alarms: I 5: #Carbon Monoxide Detectors: 13 1
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: !
S
°A & A/1,C-�l S':5 e - Signature.....f-y6/.� .. Datet'Q/,./L
Contractor Name: �
Signature Lic.# Date:
Smoke and COform.doc revised 01/10/2017