AMPR - Registration No.__________________ Accelerated Minor Permit Program Self-Certification Declaration Water Heaters _________________________________________ Job Address ______________________________ Accelerated Minor Permit Number Please check all applicable boxes below to confirm that the work performed pursuant to the issued permit was completed in accordance with the current California Plumbing Code. 1. Permits are Required for new and replacement water heaters. (2013 CPC Section 503.0) 2. Inspection is Required after the water heater is installed to verify compliance within the minimum safety requirements of the coderegarding; location of water heater, combustion air, venting & vent cap, seismic protection/strapping, access and working spa ce around water heater and other appliances, clearances to combustibles, gas piping supply with sediment trap and connections, temperature and pressure relief valve and surcharge piping to outside, water and gas hand shut off valves, water piping and connections, metallic piping continuously bonded, to meet required Energy Compliance and if required by location 18 inch elevation, vehicle damage protecting and drain pan with drain. (2013 CPC Section 504.2) 3. Prohibited Locations Fuel burning water heaters installed in bedroom or bathrooms shall be either; direct vent type, or in a closet that is vented to the outside, and used exclusively for the water heater. (2013 CPC Section 505.1) 4. Seismic Bracing System shall be installed to provide protection from displacement due to earthquake motion. Water heater shall be anchored or secured with a code approved restraint system consisting of strapping the upper and lower 1/3’s of the water heater, minimum 4 inches above gas control valve. (2013 CPC Section 508.2) 5. Temperature and pressure Relief Valve & Discharge Line Water Heaters shall be provide with a T & P relief valve, and drain installed in compliance with the manufactures instructions, and terminate not more than 2 feet nor less than 6 inches above the ground or flood level of the area receiving the discharge and pointing downward. The discharge line shall not be trapped or have a valve installed, and the terminating end shall not be threaded. (2013 CPC Section 505.6 and 608.5) 6. Combustion Air Vents within 12 inches of top and bottom of enclosure is required where enclosure has volume less than 50 C.F. per 1000 B.T.U./H of all appliances within enclosure. Minimum area per opening shall be based on 1 square inch per 4000 B.T.U./H of input capacity, with minimum screen mesh of a ¼ inch (2013 CPC Section 507) One vent within the upper 12 inches is allowed with restrictions. (2013 CPC Section 507.4) 7. Venting System shall be constructed, sized appropriately and installed to code and per manufactures installation instructions. (2013 CPC Section 510.10.3) 8. Venting Clearance Single wall metal vent connector piping shall be installed in a manor to provide 6 inch clearance from combustible materials and shall be secured together with Tek Screws or rivets. CDD-0170 Revised 04-03-2014 Page 1 of 4 AMPR- Registration No.__________________ Single wall vent connector piping shall not be installed in a confined space, and only installed below fire stop flashing. Type “B” double wall vent piping shall be installed in a manor to provide 1 inch clearance from combustibles materials and shall not be secured together with Tek screws or rivets or tape. (2013 CPC Section 510.6 and 510.7) 9. Vent Pipe Termination shall not terminate less than 12 inches above roof, additional height required if roof pitch is greater than 6:12 slope, nor shall a vent terminate less than 8 feet from and second story exterior wall. Vents larger than 12” in diameter shall not terminate any less than 2 feet above any structure within 10 feet. Other rules may apply (See 2013 CPC Section 510.6.2) 10.Gas Appliance Connectors shall not be reused per manufacturer’s installation instructions. Gas connectors shall be attached to a hand shut-off type gas valve and be properly sized to B.T.U. input rating of water heater. (2013 CPC Section 1212) 11. Sediment Trap shall be installed to gas supply at water heater control valve with a “T” fitting and a minimum 3”nipple in length with cap for sediment trap. (2013 CPC Section 1212.7) 12. When Applicable Metallic Piping to be bonded continuously with a copper bonding wire, sized per CEC Table 250.66, and bonding clamps, to cold and gas lines to tie systems together at water heater. (2013 CEC Section 250.104) 13. Water Piping Insulation shall be installed 8 feet on the cold and 8 feet on the hot water supplies at water heater when possible and to maintain 6 inches clearance from vent and flue. NOTE: if water heater has a re-circulation pump system the entire length of circulation piping loop will need to be insulated. (2008 California Energy Commission Mandatory Requirements) 14. State Energy Regulations requires the following: if the water heater has an EF of less than 0.58 and R-12 Water Heater blanket is required (internal insulation cannot be used to satisfy this mandatory requirement). For water heater with 0.58 EF or higher, no blanket is required. The blanket should be securely attached around the water heater. The top of the water heater should not be insulated and a cut out in the blanket should be provided for combustible air intake and controls. (2008 California Energy Commission Mandatory Requirements) 15. Installation Instructions for water heaters to be on site and readily available for reference. (2013 CPC Section 508.26) 16. Working Platform A level working surface not less than 30” X 30” shall be provided for service. (2013 CPC Section 509.4.4) 17. Thermal Expansion Tank System water piping systems equipped with backflow or pressure reducing device on the main shall require a thermal expansion tank to protect water heater and water piping system from excess pressure due to thermal expansion. (2013 CPC Section 608.3 and 2013 CMC Section 1005.0) 18. Water Heater Stand or built in platform is required when water heater is installed in garage to elevate burner a minimum 18” above grade. (2013 CPC Section 508.14) SCC 16.24.120 19. Vehicle Protection must be provided where subject to mechanical damage, post (2013 CPC Section 508.17) 20. Drain-Pan shall be required when a water heater and/or tank is installed in a location where it could cause damage; in case of failure/leak to floor, sub-floor, drywall. Drain pan shall be installed with a minimum ¾” drain outlet and discharge that drains to the exterior of the building or an approved location. (2013 CPC Section 508.4) Note: Discharge from a T&P relief valve cannot terminate into water heater drain pan. (2013 CPC Section 508.5) 21. Electrical Water Heater shall be provided with a disconnection. Electric water heaters require a disconnecting means within sight of, not exceeding 50’ from the appliance. (2013 CEC Section 422.31 (B)) Note: This Declaration MUST be signed by both parties listed below. Licensed Contractor CDD-0170 Revised 04-03-2014 Page 2 of 4 AMPR- Registration No.__________________ Final Building Inspection: I certify that I have observed the work completed under the project permit and certify under penalty of perjury that it was completed in accordance with my design, in compliance with all applicable codes and the applicable Self-Certification Inspection Checklists. I hereby agree to defend, indemnify and release the City, its officers, employees, agents, contractors, and subcontractors from and against any and all liability. I affirm under penalty of perjury that I have reviewed and understand the requirements of the City of Sacramento’s AMPP Overview, Procedures, Checklist and Inspection Requirements and will comply with those requirements. I affirm that I am licensed by the State of California as required by applicable law and that my license is active. I further affirm that I am familiar with the applicable requirements of the California Building Standards Code as adopted and that all required documents submitted by me will be in accordance with the City of Sacramento’s AMPP requirements. Indemnity: The undersigned licensed contractor agrees to defend, hold harmless and indemnify the City of Sacramento, its officers and employees, and each and every one of them, from and against any and all actions, damages, costs, liabilities, claims, demands, losses, judgments, penalties, costs and expenses of every type and description, including, but not limited to, any fees and/or costs reasonably incurred by the City of Sacramento’s staff attorneys or outside attorneys and any fees and expenses incurred in enforcing this provision (hereafter collectively referred to as “Liabilities”), including but not limited to Liabilities arising from personal injury or death, damage to personal or real property or the environment, contractual or other economic damages, or regulatory penalties, arising out of the undersigned’s or any subcontractor or agent’s ( including anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable) participation in the AAMP whether or not (i) such Liabilities are caused in part by a party indemnified hereunder or (ii) such Liabilities are litigated, settled or reduced to judgment. ______________________________________ Signature of Licensed Contractor ___________________________________ Contractor’s Phone Number (required) ______________________________________ Print Licensed Contractor’s Name ___________________________________ Permit Number (AMP Number) ______________________________________ Contractor’s License Type and Number ___________________________________ Date ______________________________________ Mailing Address ______________________________________ Email ___________________________________ Fax Property Owner/Occupant Declaration to Home Owner/Occupant: This form verifies that the Contractor replacing your water heater has demonstrated through course of study and testing, and a City of Sacramento training course that he/she is competent in the installation of water heaters and complies with requirements to be a City of Sacramento Certified Contractor for the installation and inspection of water heaters. Your contractor’s expertise allows him to participate in this Accelerated Minor Permit Program (AMPP) in which he inspects and certifies the installation for quality and code compliance. Your contractor is authorized by the City of Sacramento to perform this work and has obtained a permit (AMP listed above). Your contractor is required to provide you this form and a signed copy of a special program inspection check list which certifies that your water heater installation complies with all applicable plumbing codes. CDD-0170 Revised 04-03-2014 Page 3 of 4 AMPR- Registration No.__________________ This program was developed to keep permit costs low while assuring a quality installation complying with current plumbing codes. An additional benefit to the contractor and to the homeowner is not having to spend additional time to schedule and be present for a City performed Inspection. For quality control purposes and to maintain the high standards of this program, randomly chosen water heater installations will be inspected by a City Building Inspector. You will be notified by the City of Sacramento if your water heater is chosen for the additional inspection. Access must be provided when this occurs. Should your certified contractor fail to pass a random inspection by the City of Sacramento they may be removed from this program. As the property owner of the project address noted above, I have read the Declaration to Home Owner/Occupant above and agree to participate in the Accelerated Minor Permit Program. I further understand that by participating in this program, the work allowed by this permit may not be inspected by a City of Sacramento Building Inspector during construction and/or completion. The permit may be among those randomly audited for quality assurance by the City of Sacramento after construction and permit final. I further agree to provide access to work performed under this program when requested by the City of Sacramento. If your water heater installation is not selected for a random inspection by the City, or if you have any installation code questions or desire to schedule an inspection by one of our City building inspectors, please contact your contractor to schedule an inspection through the Accelerated Minor Permit Program. ______________________________________ Property Owner's Signature ___________________________________ Date ______________________________________ Print Name ___________________________________ Phone (required) ______________________________________ Email Contractors: Please upload this form to the Citizen Portal-Accelerated Minor Permit: https://aca.accela.com/sacramento/Default.aspx CDD-0170 Revised 04-03-2014 Page 4 of 4