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04409 (SFD)Building 52-705 Obregon Address ' P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 owner Coachella Talley Land Co.. y u E. 247 ETah itZ av 02 Adtlress � CityZip Tel. P�a'�m Springs 92.262 1 .322-1020 Contractor ress City lZip I Tel. State Lic. City & Classif. 387934 Lic. # Q95 Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that.l am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of'the Business and Professions Code, and my license is in full force and effect.N, ' i •v,.d s , l✓ - t ✓ :ti'l`t ! s. SIGNATURE - sr ' DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (8500). ❑ 1, 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION {' I hereby affirm that I have a certificate of consent lo'self-insure!or a certificate of Worker's Compensation Insurance, or a certified copy thereof.-(§ecc 38Q0, Labor Code.) Policy No. Company �- !J ❑ Copy is filed with the city. 0 Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation Of less.) I certify that in the performance of thg work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 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 the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, .Zip 0 BUILDING: TYPE CONST. OCC. GRP. A.P. Number 773-284-023 Legal Description Project Description A V t'1 . Sq. Ft. 1410 Size No. No. Dw. Stories " ' Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 428 sq. ft. caaratze 1701 of 6' wood fence :K Estimated Valuation Qoy �q PERMIT AMOUNT Plan Chk. Dep. $:250.00 Plan Chk. Bal. 5 39.14 Const. 364.00 Mech. 33.00 Electrical 74.17 Plumbing 105.00 S.M.I. 5,.36 Grading 20.0-00 Driveway Enc. 20.00 Infrastructure 1 * 698.86 TOTAL $2 tug .• )J � �-�,,tx 5_ REMARKS 0 ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE IIV1 578TO8R Issued by: Date 6 Permit Validated by: Validation: 1 ' WHITE - FINANCE, PINK.= APPLICANT,, GREEN - BUILDING, GOLDENROD -ASSESSOR'S OFFICE,.HARD COPY -,FILE , .. ,.. .... _. ., >, •c.:.. .. _ .. .... _ .,... ... ..._ a .. .r, 2... `p,.. :. ,.-.. „ry+. .A nti.. L' .tii.4 _. CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO F1 (p $ UNITS COLL. AREA LAB GRADE > ROUGH PLUMB SPKLR SYSTEM 2ND FL SO FT. grYARD HEATING (ROUGH) STORAGE TANK YZFORMS �� MOBILEHOME SVC. BAR SINK POR SO F7 m DUCT WORK ROCK STORAGE FOUND. REINF. POWER OUTLET ROOF DRAINS GAR SO. FT. a HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. SO FT. 0 WALL SO. FT. (a WATER HEATER DRINKING FOUNTAIN FINAL INSP. URINAL SO. FT. (a WATER SYSTEM ESTIMATED CONSTRUCTION VALUATION $ GRADING cu. yd. plus x$ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FINAL INSP..$ WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTOYDISHI APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM I KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB HING / SO. FT. g c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID 14: c SEWAGE DISPOSAL SO.FT.GAR 3i:c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE aL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR ETBACK /` jC/ V&)UND PLUMBI UNDERGROUND A.C. UNIT COLL. AREA LAB GRADE > ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK YZFORMS �� EWER OR SEP T 1� ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. plus x$ _ $ LUMBER GR. FINAL INSP. FRAMING FINAL INSP..$ ROOFING O/ -: f - T6 L�, ,'? "A^ia ` — <3r Y 1 - (,1,) 1 777��� / ly�f ��a d PI 1 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR- GAR. FIREWALL HING / MESH f INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS , GARDEN WALL FINAL 4 P.O. BOX 1504. + APPLICATION ONLY Building 78-105 CALLE ESTADO Address ���, %O.S ®.B/26Go ,cJ LA QUIN.TA, CALIFORNIA 92253 - _ ' •Owner Lors�%�C/ GLS ,A4LLQ BUILDING: TYPE CONST. OCC. GRP. ,,• Mailing ... 'r Address G ��j/�Qw1- - ,4 A.P.Number 7 7_3 - Y2 3? S/ - o Z. 3 •-r � City ZipTel. , , _ Allf. 19e/y/✓G S -/c 2- Z Z / 8 2-0 Legal DescriptionLor /©`. .GL/C . /G3 ' GGc9,,• /7 Contractor, Project Description _ r� cs 11; @x`3.e) ST eJc! In " Address r I City - Zip Tel.` - - State Lic. 1 City _ { & Classif. 36-7 tic. # -g Sq. Ft. No.' No. Dw. Size /S//p Stories Units -' .Arch., Engr., Designer' New f _ 'Add ❑ Alter ❑r Repair ❑- :Demolition-❑ Address Tel. f 2so/.+ City— - Zip State Lic. # 7'p r • . _ LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 #m licensed under provisions of-Chapter 9 (commencing with Section ! 7000) of Division 3 of he Business and Profes/sions Cod and my license is in full force and • - - + - s effect. - •.1L�/J /L // e 4?/�dtSl SIGNATURE DATE OwriER•BUILDER DECLARATION Estimated Valuation - - - • - I hereby affirm that I am exempt from the Contractor's License Law for the following - reason: (Sec. 7031.5, Business and Professions Code: Any city or county which 'requires a' permit to construct, atter, improve, demolish, or repair any structure, prior to Its issuance also - • - � ,} repuiresthe applicant for.such permit to rile asigned statement thathe is licensed pursuant to.. `PERMIT..` - .•j-.- ri/�i1f -• AMOUNT the provisions of the :Contractor's License Law, Chapter 9 (commencing with Section 7000) of _ INvislon•3 of the Business and Professions Code, or that.he is'exampt therefrom, and the basis,- for i the alleged exemption. I Any violation or Section • 7031.5 -by' any applicant . for e a • permit : P I an . C h k.. D ep. subjects the applicantto a civil penalty of not more than rive hundred doilars.($500). • , ❑ I, as owner.of the property, or my employees-with wages as.their Sole compensation, will PIBn Chk:. Bal. ' do the work, and the structure is not intended or offered for sale. (Sec.. 7044, Bufsness arid. COW. , .. Professions Code:.The Contractor's License Law-does *not. apply to an owner .of property who .1 _ builds or improves• thereon and who does such work himself or through his own employees, Mech. provided that such improvements are riot intended or.otfered for sale. If, . however, the, building .. or-improvement is sold.within one year of completion, the owner-builder will have the burden Electrical of proving. that he did not burnt or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- y ..,Plumbing _ struct the project. (Sec. 7044; Business and Professions Code: The' Contractor's License Law does not apply to an owner of property-who builds or improves, thereon, and who contracts for •-$.M:I: ' -"~ • ' ` - f' - ^° - such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading O I am exempt under Sec B. & P.C. for this reason - Driveway Enc. Date Owner I i�lnfrastructu(e e;,r•f '• t; �° - . r WORKERS' COMPENSATION DECLARATION I Hereby affirm that I have a certificate-of consent o'self•insUre, or acertificate of Worker's Compensation Insurance, or a certified copy the r�of. Se . 3800, Labor Code.) Policy No. Company �� �� '�;'71,:c! b ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL .7'f ev.✓ CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE n o .•.(This section need not be completed if the permit Is for, one hundred ($100) valuation 005182 Q Mi 08-02-58 _ -_-. 13 or lel certify that in the performance of the work for which this permit is issued, I shall not V LHd H 7 I U f ftL k 1 I-?, V Vy employ any person'in any manner so as to become'subject to the Workers' Compensation Laws of California Date Owner NOTICE,TO.APPLICANT: 8,...after making this Certtticate.of.Exemption you should become. ZONE: - $Y: subject'= to the Workers' Compensation "provfsions :o/ the Labor Code, . you must forthwith - _ comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: r Front Setbackfrom:.Center.Line Rear Setback from Rear Prop.-Line •- - - - -- CONSTRUCTION LENDING AGENcrSide Street Setback from Center Line I hereby affirm that there is a construction lending agency for the performance of the - work for which this permit is issued. (Sec. 3097,'Civil Code.). Side Setback from. Property Line Lender's : Name Lender's Address w - c 1• _ y This is,a building permit when properly filled out; signed and valldated,.and is subject to FINAL 'DATE INSPECTOR' expiration if work thereunder is suspended for 180 days.-- - icertify that I hays read this application and state that the above information is correct. Issued by: Date Permit I agree to comply with all city and county ordinances ,and state laws relating to building construction, and hereby•authorizerrepresentatiyes sof this; city to enter the above-. mentioned property for inspection purposes. . Validated by: i Signature of applicant r - Date -.Mailing Address - Validation: • + - City, State: Zip BUILDING DIVISION CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. @ $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT.® GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN SQ. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB LATHING SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/. c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING CU. yd. $ -Plus-x$-=$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL AofIED S iy �\ —0 N BERMUDA DUNES r RANCHO MIRAGE INDIAN WELLS N PALM DESERT a J` lA OUINTA 'gyp INDIO ti Desert Sands . Unified School District 82-879 HIGHWAY 11 1 • INDIO. CALIFORNIA 92201 -5678 • 16191 347-8631 October 13, 1"986 City of La Quinta Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 Re: 52-74 Avenida Obregon, La Quinta, CA 92253 Gentlemen: The developer of the above referenced project has mitigated its impacts on our overcrowded schools by payment of the amount of $628 per unit. This.amount is to be applied to the cost of additional district educational facilities made necessary -by such new development. Sincerely, 4,rL i. vol Johri ` D . Brooks Assistant Superintendent Business Services JDB/vmm d z O I— U W U) z O I= U w rn Y Cr Q W X z 0 U w CO r COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH ENVIRONMENTAL HEALTH SERVICES DIVISION —a� — 63,3 PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County specifications required on the attached check list. A non-refundable filing fee of $40 is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name (Owner. Agent. Contractor. Etc.) � Mailing Address A/, 7 W S .P- (20 A>.S 1-44 LG C 1 a .Z City Stale Zip Code Telephone P.46L M SP .P ,J6 s G' 97-G Z, 3 2 Z- /02a 'Job Properly Address 'City or Community 'Legal-GiesGriplion of Property (Lot. PM. TR) 'Assessor's Parcel No Water Agency or well C vz.V A .rco- Size Use of Permit Fanning ase # / / —.Q SFD. MH Site Preparation Etc (y�,�__� (, �✓ Signature of Applicant Dale � -The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial D to El v "� ^ UV Certification of Existing S.D. System required. Yes No WOCB Clearance required. ❑ Yes I I No Soils feasibility report required. ❑ Yes No Special feasibility boring report required. ❑ Yes I D No Detailed contour plot plans required. ❑ Yes I I No Staff Specialist approval required. ❑ Yes No Lot Inspection Date Soils/boring report by \ Project # Date Soils Map Page Soil Type - Approved by Date Type of System:No... of Bedrooms (1) Septic Tank Rate Required El Existing JXNew El Additional -❑ Replacement 1v� �� , ��D Gals. `Soil q av ` 4A Z. (2) Leach line sq. ft. (Bottom trench rea) Sidewall allowance ft. rock/Sq. Ft. Install Line(s)Ft. Long, Ft. wide with In. inches Leach be Sq. Ft. of bottomper running ft. ❑ NIA rock below drain lines area 1 Leach lines/bed-special desig for slope: (3) Pit Diameter No. Pits Pit BI,, Seepage Pit total depth Applicable ❑ 5' 946'1 ' Max. allowable depth N/A Overbuy factor «: 1 1 1'vltA-W)41V O ' C Jxw, A 0 s This application is/approve • /denied for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section a ove. A building permit is necessary for the installation of the above designed system. Septic tank and sewer lines must be 50' from any wells (2) Leach lines must be 100' min. from any wells including expansion area t \ d ��"`� �'k $ � AXA �`� Y Vt r c't \f (3) Seepage "its mu Lb,,e 150' min. from any wells including expagsion ares t`" \,-A • a � Al�'�l�J �s E1 Signature of Health Official ' Date RECEIPT NO. ` District: ❑ Riverside C Indio ❑ Hemet Distribution: WHITE—Office file YELLOW—App DOH -SAN -122 (Rev. 4/88) Issued by h- r` Date 6 I 0 1 6 ❑ Perris ❑ Rancho Calif. ❑ Blythe ;ant PINK—Bldg. Dept. GOLDENROD—Pending File Buena Engineers, Inc. NUCLEAR GAGE,RELATIVE COMPACTION FIELD DATA SHEET 1731-A'Walter Street. -• • • •: NO.: Ventura, California • a0 OWNER •- s •-ER: GRADING CONTRACTOR D-BY: • • . , . • • .. .' ®�� '� J "' < • '' '',li;' fir{ Xs^' 3 A'Y,'[�w.l✓.'; ..h �. � ?. .,{ �<!.J ll:r' ;.nt` r �l_iliJ �.L .r`l.'1'' a �: ir::Qi^ '`I �•� \)'1 "1 T 1 �a4� ,�'�q^.c•!Tc �',':tiZ,:r�:`�?r�i r: :e ��K:'%rtlt- i c q';S �+�FS' '�. yG�'��;�•�"•A�,•(rs;..:, :iS:l -r •' `rW ,�4:: l • �: 7:; v' c� ��,,. ':7•' , ,I j ..r r"C r'' >>�, l;•..,. �'i� �( j; `*L"��'J �'•}'�:Z �,i,.` � `1�°.''��3.�'.,��r:��.'lJ:z.�s1.. r1k7 �:.��.^l.0 � fid; ,��f�\ }j.�- p.'1,.: t\•' �{ r � "�,®® t ®® Now OEM `?�e,";•`�r.;�•r' a���•.o,:�i'�?.,;`?':.'{.:_._.?d,': ci ` }� e.?:�. ;,'ah:'.'.'. 1t -. R '� ti/' � .1 rr %'`t' •D`�rlj`0 f '' 7 t "L!"..r�:•' �( - J G 1 L 1A .GJ. '•: -f: -1 :•N�.:1: Vit: �i>. •'!.' .A{fit �t: .;Sn � c: - �T'�: 1 �•3 -, �l ',iy lE4ra �.,q 1 C r :I.•'�F ^. /," - }y'.-�'. '..n - ®® MEN lhr w L. 0 ..:1 J, aI �. :..ti�yi �. ..=. .'{";`.+'c r. ,r. ..�1... .:. .:r 1. 1 - 11.4 �... �P.'�-r: ..Sif1 f�Y •N.h L- 'MEOWi IIII i:lillliIil IF NINE I �iiiiiiiiiiiiii:�lillillilll!:,NOF _01 -0e- �q 3'2- 7oS o 19&e-601) A. Certificate of Compliance: Residential (Page 1 of 2) CF -1R I-£ - ��ST.�I� '1",,� C�a.1 4 ? 1':7N X Y ProjectTitle Date Lf t- C' o • N" Pro ject Addresss ✓- VJ - (A I ) ) . �,J t [f i 3Z' �� 3 0 L Building Permit # Documentation Author Telephone �O r "1' 15 /s Checked By/ Date Compliance Method (Package, Point System or Computer) Climate Zone Enforcement Agency Use Only GENERAL INFORMATION Total Conditioned Floor Area: 4-4 o ft2 Building Type: Single Family Hotel/Motel (check one or more) Multi -Family (less than 4 stories) Addition Front.... Multi -Family (4 or more stories) Existing -Plus -Addition Front Entry Orientation:ort East / South / West / All Orientations (circle one or more) �� Number of Dwelling Units: Floor Construction Type: lab aised Floor (circle one or both) Infiltration Control: andard ght (circle one) BUILDING SHELL INSULATION Component Insulation Location/Comments Type R -Value (attic, to garage typical etc.) Wall .............. Q •Ki Left...... Leh...... Wall .............. Roof ............. Roof ............. Floor ............. Rear..... Floor ............. :S,� Slab Edge..... a.-% �>a GLAZING Shading Devices Glazing Orientation Area (sf) Glass Type (single, double) Interior (roller blind etc.) Exterior (shadescreen etc) Overhang (yes/no) Framing Type (metal/wood) Front.... (N VEL>~t „� s Front.... ( ) Left...... Leh...... (kE-) ( ) Rear..... iS) :S,� �a�(3}� ✓end-r��— ►JaeJ� �/ Yu-+��c�� Rear..... ( ) Right ...: (w) ',3� � � (zr t� Right .. ( ) Skylight....... o Skylight....... THERMAL MASS Type/Covering Area Thickness (slab/exposed, tile, etc.) (sf) (inches) Location/Description (kitchen, bath etc.) Ll(Z- �1rL �' x c% osc-o � ,>> L• i 4 L 3 . r K�� �r1.Trt�, , 1Z (��}r Certificate of Compliance: Residential (Page 2 of 2) CF -1R S HVAC SYSTEMS T va1R Minimum Duct Type (furnace, air Efficiency Location Duct Output Manufacturer /Model # conditioner, heat pump) (SE, SEER,HSPF) (attic, etc.) R -Value (Btuh) (or approved equal) 4�'T M i% 1. o 11t,t rz At, S. P►P 9 ,Iasslea� k Maximum Furnace Heating Output: Btuh HOT WATER SYSTEMS Tank Manufacturer/Model # System Type (storage gas, etc.) Capacity (or approved equal) Special Feature(s) SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, Chapter 2-53 and Title 20, Chapter 2, Subchapter 4, Article 1 of the California Administrative code. This certificate has been signed by the individual with overall design responsibility and the building owner, who shall retain a copy of it and transmit the certificate to any subsequent purchaser of the building. When this certificate of compliance is submitted for a single building plan to be built in multiple orientations, all building conservation features which vary are indicated in the Special Features/Remarks section. Designer Building Owner Name: Title/Firm: Address: Telephone: Lic. #: (signature) Documentation Author Name: �—z . L Title/Firm:. W 2aC�1�� Address: n"7-7 `1 Telephon . (_6` � �f _ 7!,n, L ?� (signature) Form Revised March 1988 Name: Title/Finn: Address: Telephone: (date) (signature) Enforcement Agency (date) Name: Agency: Telephone: (signature or stamp) (date) (date) Point System Summary: Climate Zone 15 BUILDING DATA Glass Area Conditioned Floor Area 1 �{-1 _ Number of Stories / Slab/RaisedFloor Z . 3 Check all applicable Unit Type condition(s): [ ] Single Family Detached (SFD) [ ] Addition Alone [y�ingle Family Attached (SFA) [ ] Existing Building [ ] Multi -Family (MF) [ ] Existing -Plus -Addition SCORE CARD MR Date Form Forth Revised March 1988 Point Scores O 0 C7 0 0 1 n +- 3 Sum 1: Sum 7-10 +5 Point Total: - 5 - Glass Area % Glass North 302- Z . 3 East �L . 8"a South _ I% - LWest West U -value [0.030] Skylight 19 or Total j 3. Form Forth Revised March 1988 Point Scores O 0 C7 0 0 1 n +- 3 Sum 1: Sum 7-10 +5 Point Total: - 5 - Measures 1. Ceiling Insulation 5 t3 or R-value[391 U -value [0.030] 2. Wall Insulation 19 or R-value[191 U -value (0.066] 3. Raised Floor Insulation 1J� to or R-value(19] U -value (0.0371 4. Slab Edge Insulation or R -value (01 F2 factor (0.771 5. Infiltration Standard 6. Glass Heat Loss i,�,R (�.r 13 ." Type (double) U -value (0.65] 90 Total Glass [ 161 7. Shading (Shade Open) J %Glass SC Eff. %Glass a. North 2 . 3 x b. East x c. South �} . (� x d. West (, .%3 x e. Skylight x = _ 8. Shading (Shade Closed) % Glass SC Eff. % Glass a. North Z x Zti = SI b. East x c. South 4.1-1- x d. West to - o x �-v = ► • 3 z e. Skylight o x = 9. Interior Thermal Mass 2 . l ) Interior Mass/CFA 10. Exterior Wall Mass o Exterior Wall Mass 11. Heating System 7_ o x , S L = S Zonal Control? ( YAW SE or HSPF Duct Efficiency [0.781 Effective SE or 10.7216.61 HSPF (0.56/5.15] 12. Cooling System r2 , U -f x .2) _ -7.2-)_ Zonal Control? (Y No SEER 19.51 Duct Efficiency (0.74] Effective SEER [7.03] 13. Water Heating S E tzd,-%rw_ — Type (SG] Credit [none] Form Forth Revised March 1988 Point Scores O 0 C7 0 0 1 n +- 3 Sum 1: Sum 7-10 +5 Point Total: - 5 - Shading Coefficient (SC) Worksheet Form S Items 1 - 9a and 10a must be completed for ghizing/shading combinations not found in Table G-9 of the ECM by using documented manufacturers' data for the specific conditions indicated (#2, #8 and #11). For instructions on filling out the worksheet, see Shading in the ECM Glossary. For overhang SC values (#14 and #15), see Section 4.2 in the ECM. General Information 1. Glazing Type: "C�w 2. SCglazing alone: . le 3. Framing Type (metal/wood): Vt.e Q-1 4. Mullions (yes/no): yr o 5. Framing/Mullion Factor. (from Table G-10) Glazing, Interior Shade & Framing 6. Interior Shade Type: W 04,P_- y�st,-i—< L 1. 7. SCshade open: 1.00 8. SCshade closed: (SC of shade w/ clear single glass) 9a. [( l , � x 0.25) + 0.75] x `a 2 x V 9 _ , 't?y Where: SCmax SCmin FMF (#5) SC Shade Open SCmax = larger of #2 and #7 or 9b. , '71 (from Table G-9) SCmin = smaller of #2 and #7 SC Shade Open 10a. [(- 'd � x 0.25) + 0.75] x - SCmax Tc— ;;n-or IOb. , z..--.. (from Table G-9) SC Shade Closed Exterior Shade X V? _ ['1 Where: FMF (#5) SC Shade Closed SCmax = larger of #2 and #8 SCmin = smaller of #2 and #8 Exterior Shade Type: S,4 I Sc,S;A_� 11. SCexterior shade: 6 • "1Y (from Table G-11 or manufacturer's data w/ clear single glass) Where: 12. K ' 4� ,x 0.25) + 0.751 x SCmax = larger of #9a or #9b and #11 SCmax SC„dn SC Shade Open SCmin = smaller of #9a or #9b and #11 Where: 13. [( , 3 x 0.25) + 0.751 x . l'i = '(4 SCmax = larger of #10a or #lOb and #11 SCmax SC„dn SC Shade Closed SCmin = smaller of #10a or #10b and #11 Overhang (Point System Only) 14. Overhang Factor (Shade Open) 15. . �d� Overhang Factor (Shade Closed) Forth Revised March 1988 X —3L SC Shade Open (#12) X 1 `� SC Shade Closed (#13) SC Shade Open (with Overhang) SC Shade Closed (with Overhang) Projection Ratio: • 4 Thermal Mass Worksheet ovan INTERIOR THERMAL MASS *'?) 1 Date WS -1R Use one of the two following options for calculating interior mass as explained in Section 4.2 of the Energy Conservation Manual (ECM). Method B must be used for mass elements that have an interior unit mass capacity less than 1.7. Method A: Look up the Interior Mass/CFA value from ECM Table 4-7 reprinted on the reverse side of this page. Type 1 mass has a Unit Interior Mass Capacity (UIMC) greater than or equal to 4.2 (see ECM Tables 4-8a and 4-8b reprinted on Attachment). Type 2 mass has an UIMC greater than or equal to 1.7 and less than 4.2. Mass % is the mass surface area divided by conditioned floor area (CFA). For mass elements exposed on both (two) sides to conditioned space, enter the area of only one side to calculate the percentage. Mass % Type 1 Mass Area: Type 2 Mass Area: Interior Mass/CFA from Table 4-7: Method B: Calculate the Interior Mass/CFA value using the worksheet space below. Look up the Unit Interior Mass Capacity (UIMC) for each interior mass surface in ECM Tables 4-8a, 4-8b and 4-9 reprinted on the Attachment. Include the interior surfaces of exterior mass walls. For interior mass walls exposed on both (two) sides to conditioned space, enter the surface area of only one side. Include the inside surfaces of exterior mass walls as explained in Section 4.2 of the ECM. Unit Interior Interior D scripdon Mass Area Mass Ca acity Mass Capacity x Ci X T IE FnV'%VC0 '_—i 2. X X = X = 3oto�.y J y�� = 2. J 7 Total CFA Interior Mass/CFA EXTERIOR WALL THERMAL MASS Calculate the Exterior Wall Mass of all exterior walls. Look up the Exterior Mass Factor for each opaque wall element from ECM Table 4-9 reprinted on the Attachment. Only exterior mass wall surfaces may be included in this calculation. Opaque Exterior Description Wall Area Mass Factor X = X = X = Conventional Walls X Q = 1 % Total Total Opaque Exterior Wall Area Wall Mass Forth Revised March 1988 Mandatory Measures Checklist: Residential MF -111 NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. Items marked with an asterisk (*) may be superseded by more stringent compliance requirements listed on the Certificate of Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as binding minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. DESCRIPTION DESIGNER ENFORCEMENT Building Envelope Measures * §2-5352(a): Minimum ceiling insulation R-19 weighted average. §2-5352(b): Loose fill insulation manufacturer's labeled R -Value. * §2-5352(c): Minimum wall insulation in framed walls R-11 weighted average (does not apply to exterior mass walls). §2-5352(k): Slab edge insulation - water absorption rate no greater than 0.3%, water vapor transmission rate no greater than 2.0 perm/inch. §2-5311: Insulation specified or installed meets California Energy Commission (CEC) quality standards. Indicate type and form. §2-5352(f): Vapor barriers mandatory in Climate Zones 14 and 16 only. §2-5317: Infrltration/Exfiltration Controls a. Doors'and windows between conditioned and tinconditioned spaces designed to limit air leakage. b. Doors and windows certified. c. Doors and windows weatherstripped; all joints and penetrations caulked and sealed. §2-5352(e): Special infiltration barrier installed to comply with §2-5351 meets CEC quality standards. §2-5352(d): Installation of Fireplaces 1. Masonry and factory -built fireplaces have: a. Tight fitting, closeable metal or glass door b. Outside air intake with damper and control c. Flue damper and control 2. No continuous burning gas pilots allowed. HVAC and Plumbing System Measures §2-5352(8) and 2-5303: Space conditioning equipment sizing: attach calculations. §2-5352(h) and 2-5315: Setback thermostat on all applicable heating systems. * §2-5316(a): Ducts constructed, installed and insulated per Chapter 10, 1976 UMC. §2-5316(b): Exhaust systems have damper controls. §2-5314(c): Gas-fired space heating equipment has intermittent ignition devices. §2-5314: HVAC equipment, water heaters, showerheads and faucets certified by the CEC. §2-5352(1): Water heater insulation blanket (R-12 or greater) or combined interior/exterior insulation (R-16 or greater); first 5 feet of pipes closest to tank insulated (R-3 or greater). §2-5312(Exception I): Pipe insulation on steam and steam condensate return & recirculating piping. S P ; R ` S §2-5318(d): Swimming Pool Heating I. System has: a. On/off switch on heater. b. Weatherproof instruction plate on heater. C. Plumbed to allow for solar. 2. 75 percent thermal efficiency. N\� 3. Pool cover. - 4. Time clock. 5. Directional water inlet. Lighting and Appliance Measures §2-53520): Lighting - 25 lumens/watt or greater for general lighting in kitchens and bathrooms. §2-5314(c): Gas fired appliances equipped with intermittent ignition devices. §2-5314(a): Refrigerators, refrigerator -freezers, freezers and fluorescent lamp ballasts certified by the CEC. Indicate make and model number. Forth Revised December 1987