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04-3407 (SFD)0 IA 92253 PERMIT BUILDING & SAFETY DEPARTMENT (760) .777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number 04-00003407 Date 6/01/04 Property Address . . . . . . 52320 AVENIDA MONTEZUMA APN: 773-241-012-21 - - Application description . . . DWELLING - SINGLE FAMILY DETACHED Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 136195 Owner Contractor --------------- SHIVELY JEFFERY J SHIVEY CONSTRUCTION INC., JEFF 52810 AVENIDA MONTEZUMA 41625 ECLECTRIC STREET, F-2 LA QUINTA CA 92253 PALM -DESERT CA 92260 (760) 776-8290 WCC: CLARENDON INS WC: 06KR0016704 07/15/04 CSLB: 440810 07/31/04 CCC: B-HIC -------------------------- Structure Information ------------------------- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10 Flood Zone . . . . . NON -AO FLOOD ZONE Other struct info CODE EDITION 2001 CBC # BEDROOMS ' 3.00 FIRE SPRINKLERS NO GARAGE SQ FTG 489.00 PATIO SQ FTG 144.00 NUMBER! OF`UNITS 1.00 ----------------------------------------------------------------------------- FIRST FLOOR SQ FTG 2180.00 Permit . . . . . . BUILDING PERMIT Additional desc . . ' Permit Fee . . . . 769.00 Plan Check Fee 499.85 Issue Date Valuation 136195 Qty Unit Charge Per Extension BASE FEE 639.50 37.00 3.5000 ---------------------------------------------------------------------------- THOU BLDG 100,001-500,000 129.50 Permit . . . . . . MECHANICAL Additional desc Permit Fee . . . . 59.00 Plan Check Fee 14.75 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension r=� P.O. Box 1504 • VOICE (760) 7774012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 40Al- 'y0? Applicant: Applicant's Mailing Address: Date: 6p-/,40'/ Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Licensej, in full force and effect. O 8/O License Class t License No. Date Q Contractor CA �' %sjf//(/� p�yS ?, /Nc i OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she 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 ($500).): U I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason Date WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers'.compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and p"�o"�licyy number ar$: Carrier,e:5_' L,�/OwV/ Policy Number ���G/[ 00 / 1p _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date O 0 Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENS ON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work -is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. 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 county to enter upon the above-mentioned property for inspection purposes. Dat Signature (Applicant or Agent): • . ;:'�C;• 1. *, rti,;-: �4:•"(` y J � Page 2 Application Number . . . . . 04-00003407 Date 6/01/04 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 3.00 6.5000 EA MECH VENT FAN 19.50 1.00 ---------------------------------------------------------------------------- 6.5000 EA MECH EXHAUST HOOD 6.50 Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 116.08 Plan Check Fee 29.02 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 2180.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 76.30 489.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 9.78 1.00 ---------------------------------------------------------------------------- 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 Permit . . . . . . PLUMBING Additional desc . . Permit Fee . . . . 138.00 Plan Check Fee 34.50 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 14.00 6.0000 EA PLB FIXTURE 84.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9:0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 6.00 .7500 EA PLB GAS PIPE >=5 4.50 1.00 -------------------------------------------- 15.0000 EA PLB GAS METER 15.00 Permit . . . . . . -------------------------------- GRADING PERMIT Additional desc Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension -------7-------------------------------------------------------------------- BASE FEE 15.00 Special Notes and Comments 2180 S.F. SFD PERMIT DOES NOT INCLUDE 1, Fee summary ----------------- Permit Fee Total Plan Check Total Other Fee Total Grand Total Charged Paid 1097.08 Page 3 Application Number . . . . . 04-00003407 Date 6/01/04 ---------------------------------------------------y------------------------- 250.00 Special Notes and Comments BLOCK WALL, POOL/SPA OR DRIVEWAY APPROACH ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES .00 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 49.99 DIF FIRE PROTECTION -RES 97.00 GRADING PLAN CHECK FEE .00 DIF LIBRARIES - RES 225.00 DIF PARK MAINT FAC - RES 5.00 DIF PARKS/REC - RES 502.00 COVE PRECISE PLAN FEE 100.00 STRONG MOTION (SMI) - RES 13.61 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary ----------------- Permit Fee Total Plan Check Total Other Fee Total Grand Total Charged Paid 1097.08 .00 578.12 250.00 2568.60 .00 4243.80 250.00 Credited Due .00 1097.08 .00 328.12 .00 2568.60 .00 3993.80 Building Address �7 Owner ! "' JxAd vELy Mailing Address City Zip -1r775? 2 Contractor ..JACA,r�S.ui UF[.y Address t._r -4 4 �Y_3Yo� P.O. BOX 1504 APPLICATION ONLY 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE*CONST. OCC I J,9 ,574),A.P. Number Tel. Legal Description Project Description Gr City Zip Tel. Q.*.e T1'3122&.:::) 7 I State Lic. City & Classif. O 1CD Lic. # 4:5X Arch., Engr., Designer y Address Tel. City Zip State Lic. If LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of D]yjsio the Bus' s and Pr ssions Code, and my license is in full force and effect. S=4 E Z � DATE -7� 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 or the Business and Professions Code, or that. he is exempt therefrom, and the basis for thealleged 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 ($500). l: I, 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.) I.1 I, 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 doesnot apply to an owner or property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) I'! I am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work -for which this permit is issued, I 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 1hereby 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 adplicant Dale Mailing Address City, State, Zip Ze od So400L F166 - Sq. Ft.Q No. No. Dw. Size 2leo Stories Units New ,0 Add ❑ Alter ❑ Repair ❑ Demolition ❑ L Estimated Valuation PERMIT ♦ AMOJ�NT Plan Chk. Dep. jQ �— Plan Chk. Bal. Const. Mech. Electrical - Plumbing S.M.I. Grading Driveway Enc. ' Infrastructure ` r TOTAL REMARKS 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 INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION j Certificate of Occupancy RA 4� Im �w G OF'TBuilding & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 52-320 AVENIDA MONTEZUMA Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-3607 Occupancy Group: R3 Type of Construction: V-N Land Use Zone: RC Owner of Building: JEFF SHIVELY Address: 52-810 AVENIDA MONTEZUMA City, ST, ZIP: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: January 7, 2005 Building Official POST IN A CONSPICUOUS PLACE TM Date 6/1/04 No. 25968 Owner Jeff Shively Address City Zip Tract # Type Single Family Residence CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # Study Area No. of Units 4�'3�ZFIEDSC'� Q BERMUDA DUNES r V) RANCHO MIRAGE d INDIAN WELLS PALM DESERT ,y t}� LA QUINTA INDIO Q 0 773-241-032 La Quinta 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 52320 Avenida Montezuma 2180 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.24 X 2,180 S.F. or $4,883.20 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By CcNalley Independent Bank - Jeff Shively Check No. 305600 Name on the check Telephone 275-4333 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Sharon McGilvrey Payment Recd $4,883.20 Over/Under Signat �: r) NOTICE: Pursuant to Government Code S ction 66020(d�"+rve tonotify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) r to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Depariment/Appiicant Copy - Applicant/Receipt Dopy - Accounting �r RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO: JEFF SHIVELY 52810 AVENIDA MONTEZUMA LA QUINTA, CA 92253 A.P.N.: 773-2414032 Afftd Rei✓`�e� *t' Order No.. D 0C to 2004-0334404 05/05/2004 08:00A Fee:7.00 Page 1 of 1 Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clerk 8 Recorder f I IIIIII IIIIII IIII IIIIIII IIII IIII IIIIIII III VIII IIII IIII © GRANT DEED THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY ZERO computed on full value of proppeerty conveyed, or at time of sale, computed on full value 1 o f .A hens or encs , branand � remaining unincorporated area; [ ] City FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged, JEFFREY J. SHIVELY AND JANET L. SHIVELY, HUSBAND AND WIFE AS JOINT TENANTS hereby GRANT(S) to JEFFREY J. SHIVELY AND JANET L. SHIVELY, HUSBAND AND WIFE AS JOINT TENANTS the following described property in the City of LA QUINTA, County of State of California; LOT 21 OF BLOCK 40 OF UNff NO. 3, SANTA CARMELITA AT VALE LA QUINTA, AS SHOWN ON RECORDED IN BOOK 18, PAGE 59 OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF RIVERSIDE COUNTY, CALIFORNIA Document Date: May 3. 2004 A MAP a STATE OF CALIFORNIA AS COUNTY OF RIVERSIDE ) On 1�AY 4 2004 befog me, ESTSFS—T T OPEZ , a Notary Public, personally appeared AND -TAVIRT 'L_ SLU�WX personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) islare subscribed to the within msaument and acknowledged to me that he/she/they executed the same in his/hedtheir authorized capacity(es) and that by his/her/their signature(s) on the instrument the person(s) or then behalf of which �n(s) acted, executed the instrument. wrrNESS my hand'cial seal. This area for official notarial seal. 0w...ESTHER 4 LOPEZ COMMISSION *1334076 �C pt Notary Public - CalHomia v RIVERSIDE COUNTY My Commission Expires DECEMBER 9, 2005 .._:t m..., Qr..ro.nontc in- RAVE AS ABOVE or Address Noted Below ===0=M .u■ n ---m-- ■■■ --RM--"" mnnimmmmmmm GRANT DEED THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY ZERO computed on full value of proppeerty conveyed, or at time of sale, computed on full value 1 o f .A hens or encs , branand � remaining unincorporated area; [ ] City FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged, JEFFREY J. SHIVELY AND JANET L. SHIVELY, HUSBAND AND WIFE AS JOINT TENANTS hereby GRANT(S) to JEFFREY J. SHIVELY AND JANET L. SHIVELY, HUSBAND AND WIFE AS JOINT TENANTS the following described property in the City of LA QUINTA, County of State of California; LOT 21 OF BLOCK 40 OF UNff NO. 3, SANTA CARMELITA AT VALE LA QUINTA, AS SHOWN ON RECORDED IN BOOK 18, PAGE 59 OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF RIVERSIDE COUNTY, CALIFORNIA Document Date: May 3. 2004 A MAP a STATE OF CALIFORNIA AS COUNTY OF RIVERSIDE ) On 1�AY 4 2004 befog me, ESTSFS—T T OPEZ , a Notary Public, personally appeared AND -TAVIRT 'L_ SLU�WX personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) islare subscribed to the within msaument and acknowledged to me that he/she/they executed the same in his/hedtheir authorized capacity(es) and that by his/her/their signature(s) on the instrument the person(s) or then behalf of which �n(s) acted, executed the instrument. wrrNESS my hand'cial seal. This area for official notarial seal. 0w...ESTHER 4 LOPEZ COMMISSION *1334076 �C pt Notary Public - CalHomia v RIVERSIDE COUNTY My Commission Expires DECEMBER 9, 2005 .._:t m..., Qr..ro.nontc in- RAVE AS ABOVE or Address Noted Below Sao FIDELl i YFtAi JCE CO iNLANu EMPIRE DIVISION RECORDING REQUESTED -BY: " Fideiity National Title Company (� Escrow No. 42283 -CB 1 Title Order No. 33005924 When Recorded Mail Document and Tax Statement To: Mr. Jeff Shively 52810 Avenida Montezuma La Quinta, CA 92253 DOC a 2002-564387 10/09/2002 08:00A Fee:7.00 Page 1 of 1 Doc T Tax Paid Recorded in Official Records County of Riverside Gary L. Orso Assessor, County Clerk 8 Recorder 111111 oil 1111 111111111111111111111111 M $ U PAGE SIZE DA PCOR NOCOR SMF MISC. A R L COPY tONG REFUND I NCHG I EXAM (7� GRANT DEED The undersigned grantor(s) declare(s)/ Documentary transfer tax is $60.50 I X ) computed on full value of property conveyed, or [ I computed on full value less value of liens or encumbrances remaining at time of sale, [ I Unincorporated Area City of La Quinta FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Robert M. Howe and Althea M. Howe, as Trustees under that certain Howe Family Trust dated 17 Dec 1999, hereby GRANT(S) to JJKFgEgY J. SHfVV .LY and JANET...L. ,SHIVELY, Husband and Wife as Joint Tenants the following described real property in the City of La Quinta County of Riverside, State of California: Lot 21, Block 40 of Unit No. 3, Santa Carmelita at Vale La Quinta, Unit #3, as per Map recorded in Book 18 Page 59 of Maps, in the Office of the County Recorder of said Coun y. I lhtS �2TL.�� (-eC' ^GQej 4-1::,e Cu CdKL(G'T�(I L' �O�Ce a G�g'resin �,t tsl.� rnn u e eco 61-1 0 ��6 c2 ct st Xi,4 lAo. `f 4e, -re> 17 DATED: February 23, 2001 • • a7�j j — s. personally known to n*q*r proved to me on the basis of- satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. Witness my hand and offi ial seal. Signature Robert M. Howe and Althea M. Howe, as Trustees under that qqrtain Howe F ily Trust dated December 17, 1999 By: _ A&& Ro rt M. Howe, Trustee By -A— , Althea M. Howe, Trustee DONALD H. GOLDSMITH NotaryNob01'G05021034W York Qualified in Westchester County --- Commission Expires. December 6, 2042:� MAIL TAX STATEMENTS AS DIRECTED ABOVE FD -213 (Rev 7/96) GRANT DEED CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF4R Proiect Title Date HERS Rater Telephone Certifying Firm: Street Address: Copies to: Builder, HERS Provider Builder Name Plan Number Sample Group Number Sample House Number HERS Provider: City/State/Zip: �Gt/� �se-f �'�% /�';2vU HERS RATER COMPLIANCE STATEMENT The house was: A Tested ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. The installer has provided a copy of CF -6R (Installation Certificate. Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts) Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. L MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM @ 25 Pa) values Test Leakage Flow in CFM_ If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here _ f ILIL— If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass=6% or less) ❑ Pass Fail iZ THERMOSTATIC EXPANSION VALVE (TXV) Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection �IfDI ❑ Yes is a pass ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT Pass Fail 1' ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -1R and design on plan. 2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF -1R. Measured Fan Flow = ❑ ❑ Yes for both 1 and 2 is a Pass Pass Fail Compliance Forms August 2001 A-16 .d TITLE 24 REPORT Title 24 Report for: Shively Residence Lot 21 Montezuma Ave La Quinta, CA 92253 Project Designer: Stephen R. Nieto 78-120 Calle Estado Ste. 206 La Quinta, CA 92253 760-564-4707 Report Prepared By: Stephen R. Nieto South West Concepts 78120 Calle Estado, Suite 206 La Quinta, CA 92253 (760) 564-4707 Job Number: 00104 Date: 4/9/2004 CITY OF LA QUANTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATE -l•014 BY 57 DPFir'-C The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2001 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC (415) 883.5900. EneravPro 3.1 By EnergySoft Job Number. 00104 User Number. 5970 1 Certificate of Compliance: Residential (Part 1 of 2) CFA R Shively Residence Lot 21 4/9/2004 Project Title Date Montezuma Ave La Quinta Building Permit# Project Address South West Concepts (760)564 — 07 Plan Check / Date Documentation Author Telephone Computer Performance 15 Field Check /Date Compliance Method (Package or Computer) Climate Zone Enforcement Agency Use Only GENERAL INFORMATION Total Conditioned Floor Area: 2,180 f? Average Ceiling Height: 10.0 ft Total Conditioned Slab Area: 2,180 ft2 Building Type: (check one or more) 0 Single Family Detached ❑ Addition ❑ Single Family Attached ❑ Existing Building ❑ Multi -Family ❑ Existing Plus Addition Front Orientation: (West) 270 deg Floor Construction Type: 0 Slab Floor Number of Dwelling Units: 1.00 Number of Stories: 1 ❑ Raised Floor Component Const. Frame Assembly Location/Comments R38 Roof (R.38.204.161 Wood 0.028 bderior Roof R-19 Wall (W.19.2x6.16) Wood 0.065 Exterior Wall Slab On Grade n/a 0.756 Covered Slab w/R-0.0 Perimeter Insulation CC 111 CQTD ATirVU Shadina Devices Type Orientation Area Fenestration Exterior Overhang Side Fins S U -Fac tor SHGC Shading Yes / No Yes / No Front (West) 40.0 0.87 0.70 Bug Screen 0 ❑ ❑ 0 Front (West) 21.0 0.85 0.70 Bug Screen 0 ❑ ❑ 0 Left (North) 51.0 0.87 0.70 Bug Screen 0 El El 0 Left (North) 40.0 0.85 0.70 Bug Screen X❑ ❑ ❑ 0 Rear (East) 40.0 0.55 0.65 Bug Screen 0 ❑ ❑ 0 Rear (East) 12.0 1.19 0.83 Bug Screen 0 ❑ ❑ 0 Right (South) 74.0 0.87 0.70 Bug Screen 0 ❑ ❑ 0 Right (South) 40.0 0.85 0.70 Bug Screen X❑ ❑ ❑ 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Run Initiation Time• 0410910410:49:25 Run Code: 1081532965 JE.ergVPm 3.1 ft E.ergyS.It User Number: 5970 .lob Number. W104 Pa e:3 of 13 Certificate of Compliance- Residential (Part 2 of 2) CF -1 R Shively Residence Lot 21 4/9/2004 Prniaef TRIP Date HVAC SYSTEMS Note: Input Hydronic or Combined Hydronic data under Water Heating Systems, except Design Heating Load. Distribution Heating Equipment Minimum Type and Duct or Type (furnace, heat Efficiency Location Piping Thermostat Location / pump, etc.) (AFUE/HSPF) (ducts, attic, etc.) R -Value Type Comments rental Furnace_ 92% AFUE Qucts in Attic 42 Setback Res HVAC 1 For small gas storage (rated inputs of less than or equal to 75,000 Btulhr), electric resistance and heal pump water heaters, list energy factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Rated Input, Recovery Efficiency and Standby Loss. For instantaneous gas water heaters, list Rated Input and Recovery Efficiency. REMARKS COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specmcauons neeaea w comply wnn I .RC Z--., r-01 w I o1,U W — U — California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall design responsibility. The undersigned recognize that compliance using duct sealing and TXV's requires installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) Documentation Author Name: Stephen R Nieto - Title/Firm: Stephen R Nieto Address: 78-120 Calle Estado Ste. 206 La Quints CA 92253 Duct Location Duct Thermostat Location / Cooling Equipment Minimum Type (air conditioner, Efficiency heat pump, evap. cooling) (SEER) (atfic, etc.) R -Value Type Comments Split Air Conditioner 12.0 SEER Ducts in Attic 42 Rethark Res HVAC WATER HEATING SYSTEMS Tank Energy Fact' 1 External Rated 1 Water Heater Water Heater Type Distribution Type # in Input Syst. Btu/hr Cap. (gal) or Recovery Standby Tank Insul. Efficiency Loss (%) R Value System Name Standard M 5 I or Less— mamas_ C Standard 1-- 40-000 _ o 053 n/a 12 1 For small gas storage (rated inputs of less than or equal to 75,000 Btulhr), electric resistance and heal pump water heaters, list energy factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Rated Input, Recovery Efficiency and Standby Loss. For instantaneous gas water heaters, list Rated Input and Recovery Efficiency. REMARKS COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specmcauons neeaea w comply wnn I .RC Z--., r-01 w I o1,U W — U — California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall design responsibility. The undersigned recognize that compliance using duct sealing and TXV's requires installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) Documentation Author Name: Stephen R Nieto - Title/Firm: Stephen R Nieto Address: 78-120 Calle Estado Ste. 206 La Quints CA 92253 Telephone: 760-564-47o7 Lic. #: 52- 3e� 37 (signature) U (date) Enforcement Agency Name: _ Title/Firm: _ Address: Telephone_ Name: Stephen R Nieto - Title/Firm: South West Concepts Address: 78120 Calle Estado Suite 206 La Quints CA 92253 Telephone: (760) 5644707 a -op_ o¢ (signature) (date) EnemvPro 3.1 By EnergvSoft User Number. 5970 Job Number. 00104 Page:4 of 13 Certificate of Compliance: Residential (Addendum) CF -111 Shively Residence Lot 21 4/9/2004 Date Project Title Special Features and Modeling Assumptions The local enforcement agency should pay special attention to the items specified in this checklist. These items require special written justification and documentation, and special verification to be used with the performance approach. The local ..- - --_ --#,...:. n Imaidinn nr llesinn that otherwise complies :rnOrlLe111C111 A13C114y UUM281ul—--- ---4 —Y ......-.J---...---__., --__ ____I _ . _ _ )aced on the adequacy of the special justification and documentation submitted. Plan Field The DHW System "Standard Gas 50 gal or Less" Energy Factor = 0.530. An EF below 0.58 requires an R-12 Bdemal Blanket The HVAC Svstem "Res HVAC" includes credit for a Radiant Barrier installed per Section 8.13 of the Residential Manual. HERS Required Verification These features must be confirmed and/or tested by a certified HERS rater under the supervision of a CEC approved HERS provider. The HERS rater must document the field verification and diagnostic testing of these measures on a form CF -6R. Plan I Field The HVAC System "Res HVAC" includes Refrigerant Charge and Airflow Credit (or a TXV). A certified HERS rater must provide verification of the TXV, or measure the Refrigerant Charge and Airflow - The HVAC System "Res HVAC' is using reduced duct leakage to comply and must have diagnostic site testing of duct leakage performed by a certified HERS Rater. The results of the diagnostic testing must be reported on a CF -6R Form. Run Initiation Time: 04/09/0410:49:25 Run Code: 1081532965 EnergyPro 3.1 By EnergySoft User Number. 5970 Job Number. 00104 Page:5 of 13 Mandatory Measures Checklist: Residential (Page 1 of 2) MFA R NOTE: Lowdse 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 minimum component performance specifications for the mandatory measures __— ....,. .. ei�s. h— r.. n.n.1.r..mants or on this checklist onN. DESCRIPTION Instructions: Check or initial applicable boxes or enter NIA if not applicable. DESIGNER ENFORCEMENT Building Envelope Measures Minimum R-19 ceiling insulation. § 150(b): Loose fill insulation manufacturer's labeled R -Value. '§ 150(c): Minimum R-13 wall insulation in wood framed walls or equivalent U -value in metal frame walls (does not apply to exterior mass walls). E] `§150(4): Minimum R-13 raised floor insulation in framed floors or equivalent. ❑§ 1500: Slab edge insulation - water absorption rate no greater than 0.3%. water vapor transmission rate no greater than 2.0 pemJnch. §116: Insulation specked or installed meets insulation quality standards. Indicate type and form. ® §116-17: Fenestration Products, Exterior Doors and Infiltration/E>dlhation Controls 1. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. 2. Fenestration products (except field fabricated) have label with certified U -Factor, certified Solar Heat Gain Coefficient (SHGC), and infiltration certification. 3. Exterior doors and windows weatherstripped; all joints and penetrations caulked and sealed. a§ 150(g): Vapor barriers mandatory in Climate Zones 14 and 16 only. a6160(f): Special infiltration barrier installed to comply with Section 151 meets Commission quality standards. © §150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs. 1. Masonry and factory -built fireplaces have: a. 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. Space Conditioning, Water Heating and Plumbing System Measures §110-13: HVAC equipment, water heaters, showerheads and faucets certified by the Commission. ® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA or ACCA. § 1500.: Setback thermostat on all applicable heating and/or cooling systems. ❑X § 1500i : Pipe and Tank Insulation 1. Storage gas water heaters rated with an Energy Factor less than 0.58 must be ex temally wrapped with insulation having an installed thermal resistance of R-12 or greater. 2. First 5 feet of pipes closest to water heater tank, non -recirculating systems, insulated (R-4 or greater) 3. Back-up tanks for solar system, unfired storage tanks, or other indirect hot water tanks have R-12 external insulation or R-16 combined intemaUe>demal insulation. 4. All buried or exposed piping insulated in recirculating sections of hot water systems. 5. Cooling system piping below 55 degrees F_ insulated. 6. Piping insulating between heating source and indirect hot water tank. EnergyPro 3.1 By EnergySoft User Number. 5970 Job Number. 00104 Page:6 of 13 Mandatory Measures Checklist: Residential (Page 2 of 2) NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. Items marked with an asterisk (7 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 minimum component performance specifications for the mandatory measures the dmLrnentg nr nn thig checklist only. ancu a; v.cr me .�, w .... ................... -.---------. DESCRIPTION Instructions: Check or initial applicable boxes of enter NIA if not applicable. DESIGNER ENFORCEMENT Space Conditioning, Water Heating and Plumbing System Measures: (continued) a'§150(m): Ducts and Fans 1. All ducts and plenums installed, sealed and insulated to meet the requirements of the 1998 CMC Sections 601, 603, 604 and Standard 63; ducts insulated to a minimum installed level of R4.2 or enclosed entirety in conditioned space. Openings shall be sealed with mastic, tape, aerosol sealant, or other duct -closure system that meets the applicable requirements of UL181, UL181 A, or UL181 B. If mastic or tape is used to seat openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used. Building cavities shall not be used for conveying conditioned air. Joints and seams of dud systems and their components shall not be sealed with doth back rubber adhesive dud tapes unless such tape is used in combination with mastic and drawbands. 2. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, dud board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain duds. Duds installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the duds. 3. Joints and seams of duct systems and their components shall not be sealed with doth back rubber adhesive dud tapes unless such a tape is used in combination with mastic and drawbands. 4. Exhaust fan systems have back draft or automatic dampers. 5. Gravity ventilation systems serving conditioned space have eitherautomatic or readily accessible, manually operated dampers. 6. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind but not limited to the following: Insulation exposed to weather shall be suitable for outdoor service e.g., protected by aluminum, sheet metal, painted canvas, or plastic cover. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. ❑ § 114: Pool and Spa Heating Systems and Equipment 1. Certified with 78% thermal efficiency. on-off switch, weatherproof operating instructions, no electric resistance heating, and no pilot. 2. System is installed with at least 35' of pipe between fitter and heater for future solar, cover for outdoor pools or spas. a. At least 36" of pipe between fitter and heater for future solar heating. b. Cover for outdoor pools or outdoor spas. 3. Pool system has directional inlets and a circulation pump time switch. ❑ §115: Gas fined central furnaces, pool heaters, spa heaters or household cooking appliances have no continuously burning pilot fight (Exception: Non -electrical cooling appliances with pilot < 150 Btu/hr) ❑ §118 (f): Cool Roof material meet specified kriteria Lighting Measures ® §150(k)1: Luminaires for general lighting in kitchens shall have lamps with an efficacy 40 IumensMratt or greater for general lighting in kitchens. This general lighting shall be controlled by a switch on a readily accessible lighting control panel at an entrance to the kitchen. © §150(k)2: Rooms with a shower or bathtub must have either at least one luminaire with lamps with an efficacy of 40 lumensNratt or greater switched at the entrance to the room or one of the attemative to this requirement allowed in Section 150(k)2.; and recessed ceiling fixtures are IC (insulation cover) approved. 3,1 By EnefgySoft User Number. 5970 Job Number. 00104 Nge:7 of 13 Comuuter Method Summary (Part _1 of 3) C -2R 4/9/2004 e Project tlDate Mnntp7lima Ave I a Qllint^ Project Address Building Permit # c+_..a� We-qt/+....,.....ate (760) 564-4707 Documentation Author Telephone Plan Check/Date rmmnuter Perfnrman 15 Field Check/Date Source Energy Use (kBtu/sf-yr) Standard Design Proposed Design Compliance Margin Space Heating 0.93 0.47 0.46 Space Cooling 31.08 27.13 3.95 Domestic Hot Water 12.36 12.24 0.11 Totals 44.36 39.84 4.52 o,..,..e... k -46-r #hmn c*a..aa.,l- 10.2% Total Conditioned Floor Area: 2,180 ft2 Floor Construction Type: ❑ Raised Floor ❑X Slab Floor Building Type: Single Fam Detached Building Front Orientation: (West) 270 deg Total Fenestration Area: 14.6% Number of Dwelling Units: 1.00 Total Conditioned Volume: 21,800 ft 3 Number of Stories: 1 Total Conditioned Slab Area: 2,180 ft 2 BUILDING ZONE INFORMATION # of Thermostat Vent Zone Name Floor Area Volume Units Zone Type Type Hgt. Area Res HVAC 7 1 S 71 1 (in_ ConditionedS_ 1tra� _9 n/H OPAQUE SURFACES Act Type Area U -Fac. Azm. Tilt Location / Comments 1 st Floor 7nne let Floor 7nne I St Flnnr 7nne 1 cf Flnnr 7nne 1 ct Floor 7nne 1 ¢1 F1nnrJnne 1 st Floor Inn EnemvPro 3.1 By EnemvSoft User Number- 5970 Job Number. 00104 Page.8 of 13 Shively Residence Lot 214/9/2004 Project Title Bug Screen 0.76 6.6 Date 2.0 FENESTRATION SURFACES 2.0 U_ 2 Act. Glazing Type Location/ # Type 8.0 0.1 Area Factor SHGC Azm. Tilt Comments 1.0 3.0 2.0 0.1 2.0 2.0 4 Bug Dam, dt I st Flnnr Zone -t- 2 Window Window Frant Front (West) (West) 40 0 21.0 _ Q 870 0.850 _ 0 70 0.70 270 270 _ gn Double Metal Clear 90 Double Metal Clear Default 1st Floor Zone 2 Window Left (North) 3.0 0.870 0.70 0 90 Double Metal Clear Default 1 st Floor Zone 4 Window Left (North) 12.0 0.870 0.70 0 90 Double Metal Clear Default 1st Floor Zone 5 Window Left (North) 12.0 0.870 0.70 0 90 Double Metal Clear Default 1st Floor Zone 2 Window Left (North) 12.0 0,870_ 0.70 0 90 Muble Metal Clear Default 1st Floor Zone Floor Z 8 Window Window Left Left (North) (North) 40.0 12.0 0.850 0.870 0.70 0.70 0 0 _ 0 double Metal Clear Default 90 Double Metal Clear Default 1st Zone 1st Floor Zone BL Window Rear (F_ast) 40.0 0.550 0.65 go 90 Double NonMH Clear Default 1st Floor Zone 1st Floor Zone 2.0 Window Rear (East1 12.0 1.190 0.83 9090 sbglt' Metal Clear Default 0.1 _M J1 Window Right (~South) 8.0 0_870_U 70 - 180 90 Double Metal Clear Default 1st Floor Zone 12 Window Right (South) 40.0 0.850 0.70 180 90 Double Metal Clear Default 1st Floor Zone 1st Floor Zone -. 14 WindowhRia Window t(South) Right (South) A 0 18.0 0870 0.870 0.70 0.70 i80_ 180 gn Cntiblo Metal Clear Default 90 Double Metal Clear Default 1 st Floor Zone 15 Window Riaht (South) 8.0 0.870 0.70 180 90 Double Metal Clear Default 1st Floor Zone i¢ Window Right (South) 8.0 0.870 , 0.70 180 90 Double Metal Clear Default 1 st Floor Zone J1 Window Right (South) 8.0 0.870 0.70 180 90 Double Metal Clear Default 1 st Floor Zone J8 Window Right (South) 8.0 0.870 0.70 180 90 Double Metal Clear Default 1st Floor Zone Floor Zone JR Window Riaht (South) 8.0 0.870 0.70 180 90 nouhle Metal Clear Default 1 st INTERIOR AND EXTERIOR SHADING Bug Screen 0.76 6.6 6.0 2.0 0.1 2.0 2.0 2 Bug Screen 0.76 6.6 3.0 8.0 0.1 8.0 8.0 3 Bug Screen 0.76 1.0 3.0 2.0 0.1 2.0 2.0 4 Bug Screen 0.76 4.0 3.0 2.0 Right Fin Left Fin Overhang Window # Exterior Shade Tvae SHGC Hgt. Wd. Len. Hgt. LEA. REA. Dist. Len. Hgt. Dist. Len. Hgt. 1 Bug Screen 0.76 6.6 6.0 2.0 0.1 2.0 2.0 2 Bug Screen 0.76 6.6 3.0 8.0 0.1 8.0 8.0 3 Bug Screen 0.76 1.0 3.0 2.0 0.1 2.0 2.0 4 Bug Screen 0.76 4.0 3.0 2.0 0.1 2.0 2.0 5 Bug Screen 0.76 4.0 3.0 2.0 0.1 2.0 2.0 6 Bug Screen 0.76 4.0 3�Q 0. _JD 2-0 7 Bug Screen 0.76 6.6 6.0 2.0 0.1 2.0 2.0 8 Bug Screen 0.76 4.0 3.0 2.0 0.1 2.0 2.0 9 Bug Screen 0.76 6.6 6.0 2.0 0.1 2.0 2.0 10 Bug Screen 0.76 5.0 4.5 2.0 0.1 2.0 2.0 11 Bug Screen 0.76 4.0 2.0 2.0 0.1 2.0 2.0 12 Bug Screen 0.76 6.6 6.0 2.0 0.1 2.0 2.0 13 Bug Screen 0.76 4.0 2.0 2.0 0.1 2.0 2.0 14 Bug Screen _ 0.76 4.0 4.5 2.0 0.1 2.0 2.0 15 Bug Screen 0.76 4.0 2.0 2.0 0.1 2.0 2.0 16 Bug Screen 0.76 4.0 2.0 2.0 0.1 2.0 2.0 17 Bug Screen 0.76 4.0 2.0 2.0 0.1 2.0 2.0 18 Bug Screen 0.76 4.0 2.0 2.0 0.1 2.0 2.0 19 Bug Screen 0.76 4.0 2.0 2.0 0.1 2.0 2.0 EneravPro 3.1 By EnerovSoft User Number. 5970 Job Number. 00104 Page:9 of 13 Shively Residence Lot 21 Date 4/9/2004 Project Title THERMAL MASS FOR HIGH MASS DESIGN Inside Location Area Thick. Heat Type (sf) (m.) Cap. Cond. Form 3 Reference R Val. Comments Frame Wal Stucco 7IR 4 OQ 21 0 47" R-10 W(VV 10 N6 10 _ 2 1 st Floor 7nne I Exterior haxc Frame Wall Stucco 256 4.00 _ 21 0.47 R-19 Wall (W.19_24.116) 2 1 st Flom Zone I Exterior Mass PERIMETER LOSSES F2 Insulation Type Length Factor R -Val. Depth Location / Comments HVAC SYSTEMS Heating Equipment Minimum Distribution Type Type (furnace, heat Efficiency and Location pump, etc.) (AFUE/HSPFXducts/attic, etc.) Duct Thermostat R -Value Type Location 1 Comments Central Furnace Hydronic Piping pipe I AFUE Ducts in Attic Pipe Insul. 4_2 Setback Res HVAG - System Name Length Diameter Thick. Cooling Equipment Type (air conditioner, Minimum Duct Efficiency Location Duct Thermostat Location / heat pump, evap. cooling) (SEER) (attic, etc,) R -Value Type Comments Split Air Condlioner _ 12.0 SEER Ducts in Attic ___ 4_2 Setback Res HVAC WATER HEATING SYSTEMS1 Rated Tank 1 Energy Fact. 1 Tank Insul. Water Heater Water Heater Distribution # in Input Cap. or Recovery Standby R -Value System Name Type Type Syst (Btu/hr) (gal) Efficiency Loss (%) Ext. Standard Gas 50 gal or Less 1 For small gas storage (rated input <= 75000 Btu/hr), electric resistance and heat pump water heaters, list energy factor. For large gas storage water heaters (rated input > 75000 Btu/hr), list Rated Input, Recovery Efficiency and Standby Loss. For instantaneous gas water heaters, list Rated Input, and Recovery Efficiency. Computer Method Summary (Addendum) C -2R Shively Residence Lot 21 4/9/2004 Date Project Title Special Features and Modeling Assumptions The local enforcement agency should pay special attention to the items specified in this checklist. These items require special written justification and documentation, and special verification to be used with the performance approach. The local enforcement agency determines the adequacy of the justification, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. Plan Field The DHW System "Standard Gas 50 gal or Less" Energy Factor = 0.530. An EF below 0.58 requires an R-12 6Qemal Blanket- The lanketThe HVAC System "Res HVAC" includes credit for a Radiant Barrier installed per Section 8.13 of the Residential Manual. HERS Required Verification These features must be confirmed and/or tested by a certified HERS rater under the supervision of a CEC approved HERS provider. The HERS rater must document the field verification and diagnostic testing of these measures on a form CF -6R. Plan I Field The HVAC System "Res HVAC" includes Refrigerant Charge and Airflow Credit (or a TXV). A certified HERS rater must provide verification of the TXV, or measure the Refrigerant Charge and Airflow. The HVAC System "Res HVAC" is using reduced duct leakage to comply and must have diagnostic site testing of duct leakage performed by a certified HERS Rater. The results of the diagnostic testing must be reported on a CF -6R Form. Run Initiation Time: 04/09/0410.49.25 Run Code: 1081532965 1 Energypro 3.1 By EnergySofl User Number. 5970 Job Number: 00104 Page:11 of 13 HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY PROJECT NAME DATE 419/2004 ShivelyResidence Lot 21 SYSTEM NAME FLOOR AREA Res HVAC 2 180 CHECKS Number of Systems 1 Heating System Output per System 112,000 Total Output (Btuh) 112,000 Output (Btuh/sgft) 51.4 Cooling System Output per System 58,000 Total Output (Stuh) 58,000 Total Output (Tons) 4.8 Total Output (Btuh/sgft) 26.6 Total Output (sgftrron) 451.0 Air System CFM per System 2,055 Airflow (cfm) 2,055 Airflow (cfm/sgft) 0.94 Airflow (cfmrron) 425.2 Outside Air (%) 0.0 Outside Air (cfm/sgft) 0.00 Note: values above given at ARI conditions IEATING SYSTEM PSYCHROMETRICS 26.0 OF 69.4 OF 69.4 OF Outside Air 0 cfm Total Room Loads Return Vented Lighting Return Air Ducts Return Fan Ventilation Supply Fan Supply Air Ducts TOTAL SYSTEM LOAD i COIL COOLING PEAK COIL HTG. PEAK CFM ISengibleFLatent CFM Sensible 163p 39,886 647 723 26,915 0 1,994 1,346 0 0 0 0 0 0 0 0 0 1,994 1,346 43,8751 X47 29 BDP CO.563AN060-A 45,293 3,289 112,000 Total Adjusted System Output --719 112 000 (Adjusted for Peak Design Conditions) — TIME OF SYSTEM PEAK Aug 2 pm Jan 12 am 105.0 °F Supply Fan Heating Coil 2055 cfm 69.4 OF Supply Air Ducts 104.4 OF ROOMS 70.0 OF tip ---- DOLING SYSTEM PSYCHROMETRICS Airstream Temperatures at Time of Cooling Peak 115.0/73.50F 78.9/62.3°F 78.9/62.30F 55.0/53.50F O I supply Air Ducts Outside Air 0 cfm Supply Fan Cooling Coil _55.9 /53.9 OF 2055 cfm 40.4% R.H. ROOMS 78.9/62.3 °F 78.0/62.0°F 1 3.1 User Number. 5970 Return Air Ducts Job Number. 00104 of 13 ZOOM LOAD SUMMARY I PROJECT NAME ShivelyResidence Lot 21 SYSTEM NAME Res HVAC DATE 4/9/2004 FLOOR AREA 2,180 ROOM LOAD SUMMARY ROOM COOLING PEAK COIL COOLING PEAK COIL HTG. PEAK ZONE NAME ROOM NAME Mult. CFM SENSIBLE LATENT CFM SENSIBLE LATENT SENSIBLE 1st Floor Zone 1st Floor 1 1,630 39,886 -647 1,630 39,886 X47 n723 26,915 PAGE TOTAL 1 1.6301 39,886 -647 723 26,915 TOTAL 1 1,630 39,666 647 I 723 26,915 EnergyPro 3.1 By EnergySofl User Number. 5970 Job Number. 00104 Page:13 of 13