08-0655 (AR)54055 Avenida Martinez
08-0655
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t!t 4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 08-00000655
Property Address: 54055 AVENIDA MARTINEZ
APN: 774-221-016-4 -000000-
Application description: ADDITION - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 13156
Applicant: Architect or Engineer:
-=------------------------------------------------
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 License is in full force and effect.
License Class: - - - - - - - - - - License No.: E FOOTAGE
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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).:
(_ 1 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 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.).
(XP 1, as owner of the property, am exclusively contracting with licensed co ractors to construct the project (Sec.
\ 7044, Business and Professions Code: The Contractors' State Ae e Law does not apply to an owner of
property who builds or improves thereon, who contracts f r t rojects with a contractor(s) licensed
pursuant to the Contractors' State L.
ense L w.71 l.
(_ 1 I am exempt under Sec. , B .P C. f this re3
Date: `9 Owner:
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:
LQPERMIT
Owner:
JOHN BROCKMAN
54055 AVENIDA MARTINEZ
LA QUINTA, CA 92253
(760)342-2636
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/20,/08
D u
Contractor:
Owner MAY 212008
CITY OF LA QUINTA
Lic. No.: E FOOTAGE
-----------------------------------------------
WORKER'S 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 andpolicy number are:
Carrier 2001/2005 Policy Number NO
certify that, in the performanc f the work for ich this permit is issued, I shall not employ any
person in any manner so as o ecoma ubject a workers' compensation laws of California,
and agree that, if I o Id b c e sub t to t e rkers' com sation provisions of Section
3700 of the Labor forth om it hose rovisions.
Date —• 6% Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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.
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, indemnify 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 wL80days
ced
within 180 days from date of issuance of such permit, or cessation of woll subject
permit to cancellation.
I certify that I have read this application and state that the ove in r ation ¢ correct with all
city and uni rdinances and state laws relating to buil const tion,art l"herebyatives
of thjg c yL t_y/q ever upon the above-mentioned proper f r i p ion purp`I■sKis.
Date: /V• Signature (Applicant or Agent):
Application Number .
. . . . 08-00000655
Permit . . . . .
BUILDING PERMIT INV FEE
Additional desc . .
Permit Fee . . . .
306.00
Plan Check Fee
99.45
Issue Date . . . .
Valuation
13156
Expiration Date . .
11/16/08
Qty Unit Charge
Per
Extension
n
BASE
FEE
90.00
12.00 18.0000
----------------------------------------------------------------------------
THOU BLDG
2,001-25,000
216.00
Permit . . .
ELEC-NEW RESIDENTIAL
INV FEE
Additional desc .
Permit Fee . . . .
30.00
Plan Check Fee
3.75
Issue Date . . . .
Valuation . . .
. 0
Expiration Date . . 11/16/08
Qty Unit Charge Per Extension
BASE FEE 30.00
----------------------------------------------------------------------------
Permit . . . MECHANICAL INV FEE
Additional desc . .
Permit Fee . . . . 30.00
Issue Date . . . .
Expiration Date . . 11/16/08
Plan Check Fee . . 3.75
Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 30.00
----------------------------------------------------------------------------
Permit . . . PLUMBING INV FEE
Additional desc . .
Permit Fee 30.00 Plan Check Fee 3.75
Issue Date . . . . Valuation . . . . 0
Expiration Date 11/16/08
Qty Unit Charge Per Extension
BASE FEE 30.00
----------------------------------------------------------------------------
Special Notes and Comments
230 sq. ft. patio conversion to living
space. code case double fees were
charged.
---------------------------------- -------------------------------------------
Other Fees . . . . . . . . . ENERGY REVIEW FEE 9.95
STRONG MOTION (SMI) - RES 1.31
LQPERMIT
Application Number . . . 08-00000655
Fee summary Charged Paid Credited Due
Permit Fee Total 396.00 .00 .00 396.00
Plan Check Total 110.70 .00 .00 110.70
Other Fee Total 11.26 .00 .00 11.26
Grand Total 517.96 .00 .00 517.96
LQPERIMIT
Bin #4C
City of La Quints
Building 8t Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
04
Permit #
'
Project Address: 540w "L Owner's Name:
A. P. Number: Address: J l4V SS A -
Legal Description: City, ST, Zip:LA aoiv-rA
Contractor: Telephone: 7(00 Lf Z— Z(o :3
Address: Project Description: ,
City, ST, Zip:
Telephone:
State Lic. # : City Lic. #:
Arch., Engr., Designer:(as eI% S?'(Lis
Address: CoT 16
City, ST, Zip:
Telephone: Construction Type: Occupancy:
State Lic. #: _Pro)ect type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: v V 0-0 _'R kz 64`vh, ) q. Ft.: Z3 # Stories: # Units:
Telephone # of Contact Person: l/2 2 (03 to Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING. i
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, read for corrections
5
Plan Check Deposit
Truss Calcs.
Called Contact Person
5
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
S
Mechanical
Grading plan
2" Review, ready for correction/issue
-D
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`" Review, ready for corrections/issue
Developer Impact Fie
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
51S roams
Sr2a Rrws
6 Q1 Tc) LC50C-
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Q BERMUDA DUNES r
V) RANCHO MIRAGE
Date 5/21/08 La Quinta, CA 92253 N INDIANWELLS
DESERT
No. 30044 (760) 771-8515 Y PLA wolQUO y
Qo L
0
Owner John Brockman APN # 774-221-016
Address 54055 Avenida Martinez Jurisdiction La Quinta
City La Quinta Zip Permit #
Tract # No. of Units 1
Type Residential Addition
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 54055 Avenida Martinez
Unit 2
Unit 3
Unit 4
Unit 5
Comments Enclose Patio
230 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 230 S.F. or $0.00 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 Exempt - John Brockman Check No.
Name on the check Telephone 342.2636
Funding Exempt
By Dr. Sharon P. McGehee °-
Superintendent
Fee collected /exemp d by Sh n .Iv y Payment Recd y.0.00
bg'r u der
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), thisk I serve 4 notify you that the 90 -day approval period in which you may protest the fees o
r other payment identified above will begin to run from the date on whift the b ilding or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorib344o collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting
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NOTE: ALL BRACEWALL PANELS
SHALL BE EXTENDED FROM TOP
OF FOOTING TO BOTTOM OF
ROOF DIAPHRAM
....... ...
I"
-w 0
TIE —DOWN DEVICE WITH AN
APPROVED UPLIFT CAPACITY
OF 1,800 PUONDSTYPICAL AT
MEEACH END EACH PANEL.
EM
1 1
4'-0' 7 -8 -
MINIMUM MINIMUM
TYPICAL TYPICAL
3/8' THICK (MIN) WOOD STRUCTURAL PANEL
THREE ANCHOR BOLTS, ONE AT EACH SHEATHING NAILED WITH 8d COMON OR
PANEL QUARTER POINT, INSTALLED GALVANIZED BOX NAILS NAILED IN ACCIR -
IN ACCORDANCE WITH SECTION DANCE WITH TABLE 23-1-Q AND ALL PANEL
1806.6, TYPICAL EACH BRACED WALL EDGES TO BE BLOCKED, TYPICAL EACH
PANEL. BRACED WALL PANEL.
O 0 BRACE PANEL -DETAIL
BRACE WALL SCHEDULE
WOOD STRUCTURAL PANEL (4'40" MINIMUM) WIDTH
x3/8" CDX OR EQUAL W/8d NAILING, 6" @ EDGES,
O
12" @ INTERMEDIATE SUPPORTS, W/2 ANCHOR
BOLTS @ 24 O.C.
ALTERNATE BRACED PANEL (2'-8" MIN) 3/8" MINIMUM
PLYWOOD SHEATHING NAILED WITH 8d COMMON
O
AND BLOCKEDAT ALL PLYWOOD EDGES, TWO
ANCHOR BOLTS @ QUARTER PANEL POINTS.
EACH PANEL END STUD TO HAVE HPAHD22
HOLDOWN. SEE DETAIL. NAILING TO BE 6" @
EDGES OR 12" AT INTERMEDIATE SUPPORTS.
INTERIOR BRACEWALL GYPSUM BOARD '/" THICK
OSHEATHING
NAILED WITH 8d COMMON AND BLOCKED
BY 4' WIDE BOTH SIDES OR 8'-0" ON STUDS SPACED
LESS THAN 24" O.C. AND NAILED @ 7" O.C. WITH
MINIMUM #11 GAGE NAILS 1%" LONG, 7/16" HEAD,
DIAMOND POINT GALVANIZED.
MAXIMUM HEIGHT FOR ALTERNATE BRACED PANELS IS 10'-0"
N EU-) I
tx1S I INC,
Mous E
New FIRE
waLL
EX IST I N5
RAFT&R.5"
1-
4x4
177-77,
ADD .Doo R Tb
NeLJ ADDIVON
2,0 t lu 5Lc-F
GARPiG
A
N
CIL
SECTION H - CONVENTIONAL LIGHT -FRAME CONSTRUCTION
"l) Conventional Light -Frame Construction incorporates the use of Braced Wall Panels that conform to the
requirements of CBC §2320 Table 23 -IV -C-1. Remove all references and information to "shear walls" and
replace with "Braced Wall Panels" references and required information.
2) At footing detail(s), specify that footings shall be not less than 12 inches wide and extend not less than 12
inches into undisturbed soil. (CBC § 1806. 1, Table 184-C).
3) Specify steel anchor bolts with a minimum nominal diameter of 5/8 inch, embedded at least 7 inches into
the foundation. (CBC § 1806.6)
I
1.2 inch by 2 inch by 3/16 inch thick) and nut at each anchor bolt. (CBC
Lt of one No. 4 bar at the top and bottom of footing. (CBC § 1806.7.1,
l ;
,.. f n
r -k P&I1 f, {2,,
R -13
1 Y19
-.....SECTION A -GENERAL
1) Note on Plans: "All construction shall comply with the 2001 California Building, Plumbing, Mechanical, 2004
Electrical, and 2005 Energy Codes and all other local codes and ordinances." Remove notes referencing other
Codes.
SECTION C - ARCHITECTURAL
1) Specify 5/8" Type "X" gypsum board from foundation to roof sheathing where trusses are parallel to
occupancy separation wall between garage and residence. (CBC §302.4, Ex. 3)
2) Specify a self-closing, tightfitting solid -wood door 1-3/8 inches in thiclmess (or a self-closing, tightfitting door
having a fire -protection rating of not less than 20 minutes) at the occupancy separation wall between garage
and residence. (CBC §302.4, Ex. 3).. 0.
3) Show chimney termination a minimum of 2 feet above any part of the building within 10 feet. (CBC Table 31 r,' t :.
4) Provide 26 -gauge minimum galvanized weep screed at foundation plate line. (CBC §2506.5)
F t -i
5) Note on Plans: "Weep screed shall
a minimum of 4 inches above the earth or 2 inches ab
areas." (CBC §2506.5) above pavedm ;
°.
6) Threshold height shall not exceed I "'for outward swinging exterior doors. Landing shall also be level except r¢r,
that exterior landings may have a slope not to exceed %4 unit vertical in 12 units horizontal 2% SI t r-
§1603.3.1.6) ( Slope) (CBC R T-3 gyp
ff %. C1 Co:
SECTION I)'- MECHANICAL G
1'ti'7
1) Show on Plans how fireplace, obtains combustion air from outside. CMC 701.1
( § ) (Required for all interior
fireplaces.)
SECTION E — ELECTRICAL (2004 Electrical Code revisions are shown In bold)
1) Note on Plans: "Aluminum conductors are permitted only if size 1/0 or larger, and only to feed main or sub -
panels. All other current carrying conductors shall be copper." (LQMC §8.03.030)
2) Telephone jacks are required in all habitable rooms except a Dining area which is immediately adjacent to it
Kitchen or Living Room. (LQMC §8.03.040) Show all telephone jack locations on Plan.
I
3) Provide in every kitchen, family room,Pinmg room Irving room, parlor, library, den, sun room, bedroom,
recreation room, or similar room or of dwellitg units, receptacle-- utlets so that no point along the floor
n- . [i
line in any wall space is more than 6 {jec lnt asmrred honzggtally, 5 °m' an outlet in that space, including any ,
wall mace 2 feet or more in width antl the waljtspace occupied by fi xedpanels in exterior wars but excluding,
sliding panels in exterior walls The:waII space fiorde'd b $Cured room {iivid s, such as freestanding` bar -type
counters or railings, shall be include in 61- t; asiaeme L (C 24032(s) 210.52(Aj).See Pian for
locations not meeting this requirement. "' = a
J
Informational item: As used in this sec(ton; a "wall sia " gball be con 4d red a wall unbroken along the flogs, `
line by doorways, fireplaces, and similar openipgs:lEach wall space 2 f or: more in width shall bb'tir ted
individually and separately from other will i$aceMthin the room. A m
a l ace shall be Perritt oanclude:two 3
or more walls of a room (around comers) where unbroken at the floor line. Receptacle outlets shalitirisofaras 4 3 01 A.
practicable, be spaced equal distances apart: Receptacle outIEts in floors sfiail not be counted asar Wthe r t '
p egaired`M
number of receptacle outlets unless located within 18 inches of the wall. The receptacle outlets required by this
facture or appliance, located within cabiy ets
section shall be in addition to any receptacle that is part of any lighting
or cupboards, or located over 5-1/2 feet above the floor. a
Informational Item: "In dwelling units, a smoke alarm shall be installed in each sleeping room and at a point
centrally located in the corridor or area giving access to each separate sleeping area. When the dwelling unit has
more than one story and in dwelling`s with basements,.a smoke alarm shall be installed on each story and in the
ks
basement. In dwelling units where tory or basement is;splifinto two or more levels, the smoke alarm shall be
installed on the upper level, except that when Zhe,loer level conjains a sleeping area, a smoke alarm shall be
installed on each level. When sleeping rooms are, On --an upper )evel; the smoke alarms shall be placed at the ceiling
of the upper level in close proximity -to the stairway, Th dwellippinits where the ceiling height of vroom open to
the hallway serving the bedrooms ezceed's•that'of the hallway by -24 inches or morg smoke alarms shall be installed
in the hallway and in the adjacent mom. Smoke alarms shall sound an alarm audible in all -sleeping areas of the
;(C
dwelling unit in which they are located."BC §310.9.1.4) _ _ c_ -
r
When the valuation of an addition, alteration or repair to;a Group'R Occupancy exceeds 53000 and a permmt is
required, or when one or more sleeping roomns`are added:or created in existing Group R Occupancies, smoke' I
alarms shall be installed in accordance with Sections .310 9.1.3,,310.9.1.4 and 310;9.1.5: (CBC §310.9.12) Smoke
alarm may be solely battery operated when installed in existing buildings; i baildings"without commercial
power, or in buildings which undergo alterations, -repairs oradditiregu ySectiori 310.9.1.2. (CBC
§310.9.1.3)
a
Advanced Installations
81771 Oleander, Unit 1
• Indio., CA 92201
California License No. 520860
760/347-1696 fax 760/674-9048
Proposal Submitted To
John Brockman
Phone 342-2636 fax
Date 1/11/06
Street
Job Name Remodel
A'ITN:
P.O. Box 3207
City state & zip .
54055 Ave. Martinez, La
Job Phone
Palm Desert, Ca 92261
Quinta
Supply and Install
R-38 unfacedbatt insulation to ceiling of residence and garage.
R-13 unfaced batt insulation to exterior walls of residence.
R-11 unfaced batt insulation to all interior walls of residence
Caulk and Seal per Title 24 of The State of California
$2,635.00
Note; Garage exterior walls are not included in this bid.
This price includes reinstalling owners R-11 insulation to interior walls.
. — r•—r--- ••- j — _,........ tuo..ttat out tat,vt--wtuptcte to accoraance wan above speclticatlons, for the sum of,
Payment to be made as follows; D a !n
A8 material is guaranteed to be completed in a workmanlike manner avEording to standard practices. Anyafferation ordeviationfrom' above tfications involving extra costs will be execute
only upon written orders, ands will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or clays beyond our control. Owner to carry fire,
tornado, and other necessary nsurance. Our workers are fully covered by Workers Compensation insurance. In the event there is litigation between parties hereto concerning ihe-party's tights
and obligations under this contract or any dispute between the parties hereunder, the party prevailing in such dispute will be entitled to
reasonable attorney's fees. All bills and invoices are to be paid within ten (10) days from the date ofbilling. ifthe bill is not paid within that time, the account shall be overdue and accrue interest
at I S% per annum until paid in full.
Owner is required to give forty-eight (48) hours written notice specifying the time which we are to perform our obligation under this contract.
The obligations to be performed under this contract are to be performed at Indio, California. This fact that the actual installation may occur at another place does I alter the place of performance
as provided above. Additionally, the parties acknowledge that this contract was entered into in Indio, California. f /N `l
No back charges without reasonable notice to correct. units are to be reasonably clean for safety. Authorized Signatur f/ ,/h,/ii/e/v/ 4 Cote: This
proposal will be withdrawn by us if not accepted within 2!9ays.
Acceptance of Proposal - The above prices, specifications And conditions are satisfactory and are hereby accepted. You are authorized
To do the work as specified. Payment will be made as outlined above.
Pricing - The prices above shall remain firm for 30 days after the date YOU sign this agreement. If performance of this
agreement extends beyond those 30 days, YOU agree to pay Contractor's then current pricing for the Work performed after those
30 days.
ohn Devie
I
Title
Company Name
Signature Title
Date
• -T l
CERTIFZCA:TR. Ovi onMPLZANCE:R SZD NTrAY.
rr_-(T>
Docurnentauon Author
S (( ` P T I U — , Tele bnone Ptah Ct+ak /Date
Coniplianoo Method (Prmcriptive)
te Zone Ficldp,eck/Daly.
(urina':
{ 13 Alcemativo CoDmAt«rcy cz Only
Ponent Package Method: (d,ccic one) C
Package C and Package D cboiccs r D (Altanatiire) .
• For Pa eguire i IERs rater ftOd verification and/or d'
dcage D Ahunativo see APpawix.B Tabk l s l -C F co tom" tg ( CF -I R page 3).
ootrwtcs ), 14
GENEIL L xNFORMA,TTON
. ' , - . -Total Conditioned FioocMci, (CFA . - - .
Maximptrt Allowed West.Facin FebAverage Ocilinglieijbt _ R
Maximum Allowed tal
ToF g t estratfon Products Per Table ISI$ or I3l-C-- (S:G X CFA)_ .
cn stration products Pcr Tabk 15143 or
✓ ❑Building Typo: ((chock one or more (20' X CFA) _ ft
(if adding Bion till out W ) single F nr il, MuItifamil
SAP"Tu oQ daximuin Allowed y_.I_ Addition Alteration
for Additions and 83.3 foe Alterae;ous.). . Area.Wocksbod and see Sodion 832 .
Numbs of stories
Floor Co '— - Numbs f Dwelling 13nitr_
. nstiudioa Type: - .
From Orientation: . Sla 'sect Floor (cu de one oa bo(h)
Noah and circleone --Notes '/ East /Wei /All Uricatati
ons (input front orientation indegrees fTrue
L7. RADIANT 13ARRMR
uired in dimate zones 4 8-1
OPA' IJE SURFA CICS INCLUDING OPA . UE BOORS
Componcat
TYPc (WIW p Assembly V .. .
Root, Floor, T factor (for Joint
S[ gti 3'Pe ty Continwit vgood, Inc. Roof Radiant
( ood IiuulatiOn . Luula6 d'x arr er LocationrComr nts' .
Or M ice' . nd ,r.;:a.: IV Installed
R Yalue R Vr' atti
=fmbGG: Reference ( o'8 8e,
• .. - .N (- - -. Yes or No ical, etc. -
1) See Joint Appendix'!V in Section IY.2, lV3 and IVA; vhiclr is the basis for theU-faotoc criterion. Ll -factors cannot
exceed presp iptive va]ue to show equivalence to R -values:
CITY . F LA C UINTA -
gUILDtNG &SAFETY DEPT..:..
qP P R0 ED
FOR C NSTR CTION
"TF
13
i
Residential Compliance Forms
.March 2005
CERTWICATE OF COMPLIANCE: RESIDENTIAL
10 (Page 2 ON)CF-1R
Project Title
AIb
t 3Cl F. L?+t._ Date
FEN F,STRATION PRODUCT'S - U -FACTOR ASHCC
❑FENESTRATION
MAXIMUM ALLOWED AREA WORKS
Additions and Alterations. FiEEI WS -4R -must be included for New Construction,
Feneshation
*Type pos.
(Front, Left,
Rear, Right,Orien-
tation,
Exterior..
S li t AreaU-factor'
N. S, W (ft U -factors Source'
Sources
Shading/Overfiangs667
•/ box if WS -3R is
SHGC
' ,..
incuded
1) SlrylkOts are now incl °
ndea ;a west ❑
When. the pitch is less er f on area if the skytii is are tilted b the west .
2 . 1:12. See'§ 151(f)3C and in Section 3.23 of the Resideatial Manual or tilted in any direction
) values c oris column ace either'FRC
Rated value or from Standards d
3) Indicate Source either from FRC or Table 116A, effault Table.1 16A.
4) Enier values in
.
this column from'FRCor from .5) Indicate source either from NFRC.or Table l om S azdsDefault Table 116B oradjusted SUGC.f-om
WS -3R
Shading Devices are defined in Table 3-3 in the Residential
7) See Section 32A. in the Residential Manual. • Manual and see WS -3R to calculate Exterior Shading
devices.
HVAC SYSTEMS
..
Equipment Minimum Distri on.,
and Capacity
Efficien
Cyrnaoe Feat bo 7er etc. AFVfi or HSP d 1 O6on Duca or piping Thermostat'
Configuration
__R -Value
it a
Cooling Equipment •7 Minimum
Type and Capacity
Efficiency Duct Location Duct
MC heat m cva . cooli SfiER or fifiR . Thermostat. amc ac: R -Value
Configuration
litor e
Residential Compliance Forms
March 2005
' a
t
CERTIFICATE OFCOMPLANCE; ASID
T;NTIAL (Page3of4) . Cr -IR
Project Title
Date
SEALED DIJ,i f vF r` rlt E
CTS and TXVs or Alternative Measures
A signed (:F -4R Form must be provided to the building department for each home for which the
wired, following. are
Sealed Ducts all climate zones Installer testin
TXVs, readil certification and HERS rater field verification r ................
p y accessible (climate Tones 2 and 8-15 only)
staller testin and certification and HERS Rater Field verification fired:
.
Refrigerant Grarge (climate zones 2 and 8-ISbnly).(ller testing and certification and HERS Rat
verification wired.
nn er field
O . Antesnative to Sealed 1?ucs and Refrigerant
Pro ed Clirriate Zone in the RMA dix a rgnX
g Vs•(Se'Package D Akeimadive Package Features for
pR B Table 151: Footnotes 7-14.
For additions and alterations, duct
O sealed as confirmed through s n's that are not documented to. have
Residential Afield verification and diagnostic' previously
CM Manual and duct systems with ming in accordance with procedures in the
wes shall. meet the r uutnents of Section 1 mora than 40 feet in unconditioned
WATER IIEATING SYSTEMS n' and duct mstilahon r uirements of P D.
Check box if system meets criteria of a "Standard
dwelling unit. If the water heater is a storage type, S0 n system is one g s-> water heat" per
not allowed. gallons is the rnaximum ccity and recirculation syr is
13 Check box when using Preapproved Alteinative W
Manual.f'Nom heatin calculations are ater Ileating + Table 5-4 in.C apter 5 in the. Residential
Check box if system does not toed criteiia of and the "rom lies automatic aU .
Altemative Water Heating table. In this "Standard sYsi and does not comply with the Pr roved
submittaL ,the Performance Method must be used and must be ittj pro
in the
Check box to v
. units ' that a time control is required for a recalculating system '
S stems servin sin a dwellin units PualP fora system serving multiple
E° Tank
Water Heater Ratedi e .
uel Distribution Number input Tank Factor or Ewa
in. stem Ba+Ru Capacity Thermal Standby' Insulation
!ons Effioaen Loss % R -Value
S stem servi' multi le dwellin units
Rated Energy Tank
Water Heater Distribution .Number Input' Tank Factor' or External
—Type— in B .or Opacity Thermal Standby' Insulation
loos Effcien Loss % R -Val ue
1. For .small gas storage water heaters (rated inputs of less
PuMp water heaters, list Ener F than or equal to 75,000 Btu/hr),,eledric resistance, and heat
Btu/hr), list Rated Input, Recovery g c Fcer large gas storage water heaters (rated input of greater than 75,000
1 heaters; list Rated Input and Thei al Effieennal Efficiency and Standby Loss. For instantaneous gas water
PineIusulation (kitchen lines, 3/4 inches) All hot water i
rnches or greater in diameter shall be thermally insulated as specified pipes from the heating source to the kitchen fixtures that are'/
pecified by Section 15.0 (j) 2 A or 150 (j) 2 B.
Residential Compliance Forms
Marsh 2005