00010107 (2) PUS I THIS CARO NEAR FRONT OF BUILDING
CITY OF CUPERTINO PE rt o,
BUILDING DIVISION
BUILDING PROJECT IUENT{P
BUILDING ADDRESS:
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`MriBU1LDING2UINFO
:INSPECTIONS"' DATE INSPEGf' '❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MIE�CyH
FOUNDATION/PIERS/H.D.S. , INSPECTION RECORD
JOB DESCRIPTION
UFERGROUND NOTE: ALL. GRADING AND DRAINAGE RFSIOFNTIAI:
PAD/SGT BACK-CERT SHALL BE INSTALLED TO COMPLY WITH ;C SFDWL C1 KITCHEN REMODEL
THE APPROVED PLANS AND CITY OF SLI ADDITION ❑PLUMBING RF.-PIPE
GARAGESLABS/PREGUNITE CUPERTINO STANDARDS. ❑MULTI-UNIT ❑STRUCDIRAL
MODIFICATION
•FOUR NO CONCRETE,UNTIL ABOVE HAS BEEN SIGNED', TO ARRANGE INSPECTION ❑INTERIOR ❑CHIMNEY REPAIR
UNDERGROUND/SLAB CALL AFTERNOONS (1:00 PM - 4:30 PM) IMPROVEMENT EIINGPOULS
❑BATH REMODEVREPAIR EIDEMOLDEMOLITION
PLUMBING 777-3228 MONDAY TO FRIDAY 24 HOURS BE. ❑OTHER
ELECTRICAL FORE REQUIRED INSPECTION. JOB ADDRESS
DO NOT POUR1FLOOR'UNTIL ABOVE'HAS!BEEN,SIGNED_ AND PERMIT k ARE NEEDED WHEN PHONING.
1. COMMERCIAL:
PLUMBING I ATTENTION CONTRACTORS: ❑NEW BLDG/ADDITION [I DEMOLITION
MECHANICAL �f 'NO PERSON(S)SHALL PERFORM WORK ON ❑TENANT ❑FOOD SERVICE
THIS JOB SITE WITHOUT BEING IN COM- OTHER IMPROVEMENT
ELECTRICAL PLIANCE WITH WORKERS'COMPENSATION 0oTHER
FRAMING VENTS INSURANCE.REQUIREMENTS.
INSULATION INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP.
PLACE NO
SUBFLOOR UNTIL HA EN:SIGNED:;
ROOF SHEATH/DIAPHRAM
PLUMBING
UBS&SHOWER PAN
ECHANICAL
ELECTRICAUPOOL BOND
"• FRAMING/STAIRS/E.EGRESS
INSULATIONI VENTILATION
COVER�NO-;WORK>UN7TL'ABOVWSVP
EXTERIAL SHEAR/HOLD DOW
INTERIOR SHEAR/HOLD DOWN
SHEETWROCK/SHEETROCK SHEEXTERIOR LATH/W-SCREESHOWER LATH
NOTAPE ORTCASTER.UNTIL A
SCRATCH COAT
SEWERAVATER
• ;TEMPORARY*APPROVALS s; ` tl: ;:t>yl F °."'. +,r'i '. ,,, :.
OCCUPANCY ,
ELECTRICAL
GAS
GAS TEST
GRADE
FIRE
HANDICAP
ELECTRICAL
LUMSING
MECHANICAL
ENERGY CERTIFICATE OF OCCUPANCY
VISUAL FINAL ONLY
BUILDING Z aj IMPORTANT: y ISSUANCE $1l�/Y ,
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qkSTALLATION CERTIFICATE (page 1 of 4) — CF-6R
Site Address ermtt um er
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The
information 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).
$VAC SYYSTFMS:
Heating Equipment
Equip. g of Efficiency Duct Duel or Heating Heating
Type(pkg. CEC Certlfied Mfr Name Identical (AFUE,tic.)t Location Piping Load Capacity
heat um and Model Number Systems 2CF-IR value attic etc. R-value (Btu/hr) Btu/hr
O
qe9 5^1 e- tc, z Q= .
Cooling Equipment
Equip. CEC Certified Compressor a of Efficiency Duct Cooling Cooling
Type(pkg. Unit Mfr Name and Identical (SUER ctc.)t Location Duct Load Capacity
heat um Model Number Systems CF-IR value attic etc. R-value (Btu/hr) 1Whr
'dT r
'NIS te Al2TiC ,
1. >_reads greater than or equal to.
• 1, 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-IR) 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, Date Installing Subcontractor Co.Name)
OR General Contractor(Co.Name)OR Owner
WATER HFA IN . SYSTEMS,
Distribution ItRech. Sof Rated' Tank Efts- Extemal !
Heater CEC Certified Mfr Type(Std, eulatlon. Identical Input(kW Volume eieney' Standby' Insulation
Type Name&Model Number Point-or-Use) Control Type Systems or Btuyhr) (gallons) (EF,RE) Loss('/.) R-value
2 For small gat storage(rated input of less than or equal to 75,000 Btu/hr),electric resistance and heat pump water heaters,list Energy Factor.
For large gat storage water heaters(rated input of greater than 75,000 BhAr),list Recovery Efficiency,Standby Loss and Rated Input
For Instantaneous gat 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
1, 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 of 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.
Signature, Date Installing Subcontractor(Co.Name)OR
General Contractor(Co.Name)OR Owner
COPY TO: Building Department
Building Owner at Occupancy
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