BRER2016-0026Applicant:
JUAN FONSECA D
52860 AVENIDA.MENDOZA
LA QUINTA, CA 92253
/1 Contractor.
JUAN FONSECA.
.52860 AVENIDA MENDOZA
LA QUINTA, CA 92253
APR -1 j 2096
(760)771-1942
Llc. No.::C6NV:140528101254114272
CITYOFLA QUINTA
(_®�ftPMENToEo PARTMENT
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 Professions Code,
and my License is in full force and effect.
License Class: _ License No.::CONV:140528101254114272
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).:
(_) 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
lie, or she did not build or improve for the purpose of sale.).
(_) 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.).
(_) I am exempt under Sec. . B.&P.C. for this reason
Date:
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
Lender's Address:
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 and policy number are:
Carrier: _ Policy Number:
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: 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 Building Official 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 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 city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
Q�i oubts
VOICE (760) 777-7125
78-495 CALLE TAMPICO
. D
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 4/11/20145
Application Number:
BRER2016-0026
Owner:
Property Address:
52860 AVENIDA MENDOZA
JUAN FONSECA
APN:
773333007
52860 AVENIDA MENDOZA
Application Description:
JUAN FONSECA / RE- ROOF
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$4,000.00
Applicant:
JUAN FONSECA D
52860 AVENIDA.MENDOZA
LA QUINTA, CA 92253
/1 Contractor.
JUAN FONSECA.
.52860 AVENIDA MENDOZA
LA QUINTA, CA 92253
APR -1 j 2096
(760)771-1942
Llc. No.::C6NV:140528101254114272
CITYOFLA QUINTA
(_®�ftPMENToEo PARTMENT
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 Professions Code,
and my License is in full force and effect.
License Class: _ License No.::CONV:140528101254114272
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).:
(_) 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
lie, or she did not build or improve for the purpose of sale.).
(_) 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.).
(_) I am exempt under Sec. . B.&P.C. for this reason
Date:
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
Lender's Address:
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 and policy number are:
Carrier: _ Policy Number:
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: 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 Building Official 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 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 city to enter upon the
above-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
I
FINANCIAL • • { .
p ` y 'DESCRIPTION;
i, ACCOUNT X, ° ` QTY` AMOUNTPAIYD' fs`PAIU BATE
,
BSAS SB1473 FEE
.101-0000-20306 0 $1.00
$1.00.
4/11/16
PAID'BY`
� cRECEIPS #� `CHECK #€ '
CLT.D BY.
METHOD ;=-
JUAN FONSECA
CASH R14658
RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00'
$1.00
DESCRIPTION S
ACCOUNT S `
TY
AMOUNT y
PAICYDATE`
N;,�
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$49.31
$49.31
4/11/16
A _ PAID BY
METHOD <F x�
3 CHECK #}
CLTD BY
ay-�RECEIPT
#
.
JUAN FONSECA
CASH
R14658
RSE
M
�Y wDESCRIPTION ; _
ACCOUNTS
QTYCAMOUNT,
AID DATE,,,,
x
.p
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$98.62
$98.62
4/11/16
PAID:BY
CHECK#�
CLTDBY,,
...
JUAN FONSECA
CASH
R14658
RSE
Total Paid for RE -ROOF: $147.93
$147.93
TOTALS:4:
I
Description: JUAN FONSECA / RE- ROOF
Type: RE -ROOF Subtype:
Status: APPROVED
Applied: 4/11/2016 RSE
Approved: 4/11/2016 RSE
Parcel No: 773333007 Site Address: 52860 AVENIDA MENDOZA LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 147
Lot: 20
Issued:
UNIT 15
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $4,000.00 Occupancy Type:
Construction Type:
Expired:
No: Buildings: 0 No. Stories: 0
No. Unites: 0
Details:
CONb1TIdNS
FINANCIAL INFORMATION ....., ,.....,..
Printed: Monday, April 11, 2016 4:10:40 PM 1 of 2
MMJF-
C#?"WSYSTrMS
DESCRIPTION
`"ACCOUNT
. QTY
AMOUNT
- PAID T
PAID DATE'
'RECEIPT #
' CHECK'f
METHOD
'PAID BY�
CLTD
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
4/11/16
R14658
CASH
JUAN FONSECA
RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:
RE -ROOF - FIRST 2,000
101-0000-42404
0
$49.31
$49.31
4/11/16
R14658
CASH
JUAN FONSECA
RSE
SF
RE -ROOF - FIRST 2,000
101-0000-42600
0
$98.62
$98.62
4/11/16
R14658
CASH
JUAN FONSECA
RSE
SF PC
Total Paid for RE -ROOF: $147.93 $147.93
TOTALS:4:$148.93
INSPECTIONS
PARENT PROJECTS
Printed: Monday, April 11, 2016 4:10:40 PM 2 of 2
SYSTEMS
Bin #
Permit #
D�¢j— 4o
Project Address:
City of La Q uii� to
Building 8t: Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name.`
A. P. Number:
Address:
Legal Description: S
City, ST, Zip:
Contractor: W
Telephone:
7C� — I 9
Address:').2 Sfav A '( aa
of az a)
Project Description:
City, ST, Zip: U itJ G 0{5 3
Tclc -`
h ne•
P 0 D-r'-
6 !S
State Lie. # :
City Lie. #.:
Arch., Engr., Designer:
Address:, c�!1 ,/
lu r✓ra1
City., ST, Zip:'
5 -
TeleelePh0ne: - — ICl Z
Con tructio"n Pe• Occupancy: cu
TYaneY:
StateLica#:
ProJect tYPa (circle one • New Add'n Alter Repair r D emo
Name of Contact Person: h
'^ S �e�
4Estimated
Sq. Ft.: /Sw
#Stories:
# Units:
Telephone # of Contact Person: c _
7 ( _ .# `� -L,
Value of Project: i
APPLICANT: DO NOT WRITE BELOW THIS LINE
9
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Gradin Ian
Grading P
2".Review, ready for corrcclionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed.
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Jrd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees
P.O. Box 1504-
LA
504LA QUINTA, CALIFORNIA 922471504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA .92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760)777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at
We are providing you with an Owner -Builder Acknowledgment and Information Verification Fonn to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signs you understand, or verify this information.
I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
�.J t 2. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
J 4. I understand Contractors are required by law to be license
permits and contracts. d and bonded in California and to list their license numbers on
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
J�.6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
.compensation for each "employee." I also understand my failure to abide by these laws may subject me to.serious financial
risk.
7: I understand .under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
Jf_& I understand as an Owner=Builder if I sell the property for which this permit is issued, I may be held liable for any
financial or personal injuries 'sustained by any subsequent owner(s) that result from any latent construction defects in "the
workmanship or materials.
9. I understand I may obtain.more information regarding my'obligations as an "employer" from the Internal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov.for more information about licensed contractors.
JE10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and. understand that I am the
party legally, and financially responsible for proposed construction activity at the following address.:
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as.well as employers:
12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on this form. Licensed contractors are regulated by laws .designed to protect the public. If you contract with
someone who does not.have a license, the Contractors'. State License Board may be unable to assist you with any financial loss
you may sustain as a result. of a complaint. Your only remedy against unlicensed Contractors may be incivil court. It is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property, you may be held liable for damages. If you obtain a permit as Owner_Builder and. wish to hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or
other verification acceptable to the agency is requ�i► to be presented when the permit is issued to verify the property
owner's signature.
__Signature of property owner Date'
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATIONOF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following persons) to act as my agent(s) to apply for, sign; and file the documents necessary to obtain an Owner -Builder "
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the.owner's driver's license, form notarization,' or other verification
acceptable to the agency is required to be presented when the permit is issued to verify the property owners signature.
Property Owner's Signature: Date:
STATE OF CALIFORNIA
ENLtELOPE COMPONENT APPROACH
CEC-NRCC-ENV-01-E (Revised 06/13)
CERTIFICATE OF COMPLIANCE
Envelope Component Approach
P-jed Name: -
CAIIFORNI MISSION
NRCC-ENV-01-E
(Page 1 of 3)
A.
GENERAL INFORMATION
1
Project Location: ,�ti 6
.5�$c6� 1��'l�a {L{evtdO.
Compliance Method:
❑ Component 13Unconditioned (file
Affidavit
2
CA City and Zip Code: V I 'y 4-.,z 7
Building Front Orientation (deg or cardinaQ:
9
3
Climate Zone: 8
Permitted Scope of Work 1 ❑ New Construction ❑ Addition O Alteration
4
Total Conditioned Floor 9
Area: �7
Building Type(s)
❑ Nonresidential ❑ High -Rise Residential ❑ Hotel/Motel Guest Room
S
❑ Schools (Public School) ❑ Relocatable Public School. Bldg. ❑ Conditioned Spaces O Unconditioned Spaces
O Skylight Area for Large Enclosed Space >_ 5000 fe (If checked include the NRCC-ENV-04-E with submittal)
B. ENVELOPE DETAILS — Framed .
1
2
3
4
5
6
-7
8
9
10
11
Ta /ID
AssemblyType
Frame
Material
Frame
Depth
Frame
Spacing
AppendixJA4
Reference
Cavity
R -value
Continuous
Insulation
R -value
Proposed
U -Factor
Required U -Factor From
Tables, B, C, D
Comments
i
.
s
C. ENVELOPE DETAILS — Non -framed
1
2
3
4
5
6
7
8
9
10
Tag/ID
Asse*mblyType
Assembly Materials
Thickness
(inches)
Interior or
Core
Insulation
R -value
Continuous
Insulation
R -value
AppendixJA4
Reference
Proposed
U -Factor
RequiredU-Factor from
Tables, B, C, D
Comments
RequiredU-Factor from
Tables, 8, C, D'
Comments
i
.
D. ENVELOPE DETAILS — Mass
1
2
3
4
5
6
7
8
9
10
11
Ta /ID
Mass
Type
Density
(Ib/ft'
Mass
Thickness
(inches)
Furring Strip
Thickness
(inches)
Interior
Insulation
R -value
Exterior
Insulation
R -value
Appendix JA4
Reference
Proposed
Insulation
U -factor
RequiredU-Factor from
Tables, 8, C, D'
Comments
s
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance
June 2013
STATE OF CALIFORNIA.
ENVELOPE COMPONENT APPROACH
CE'I; CC -CNV -01-E (Revised 06/13)
CERTIFICATE OF COMPLIANCE
Envelope Component Approach
Project Name:
Date Prepared:
CALIFORNIA ENERGY COMMISSION -
NRCC- ENV -01-E
(Page 2 of 3)
E. ROOFING PRODUCTS (COOL ROOF)
1'
2.
3
4
5 6 7
8
9 10
11
Mass Roof
Comments
Proposed
Minimum
Required
Aged Solar
Thermal
SRIZ
Aged Solar
Thermal
SRI
25 Ib ft2
CRRC Product
or greater
Roof Pitch
ID Number
Product Type
Reflectance
Emittance
(Optional)
Reflectance
Emittance
(optional)
Comments
❑
�: Z
10-0
lj 1l, ( �e'5
❑ .
'1�0
0A
❑
❑'
❑
❑i
'
❑ An aged solar reflectance less than 0.63 is allowed provided the maximum roof /ceiling U -factor in TABLE 140.3 is not exceeded
❑ High-rise residential buildings and Hotels and Motels with low -sloped roofs in Climate Zones 1 through 8, 12 and 16 are exempted from aged Solar
Reflectance and emittance requirements.
❑ High-rise residential buildings and Hotels and Motels with steep -sloped roofs in Climate Zones 1 and 16 are exempt from aged Solar Reflectance and
emittance requirements.
❑ The roof area covered by building integrated photovoltaic panels and building integrated solar thermal panels are exempt from aged Solar Reflectance
and emittance requirements
To apply liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended
by the coatin s.manufacturer and meet minimum performance requirements listed in §110.8(i)4. Select the applicable coating:
❑ Aluminum -Pigmented Asphalt Roof Coating
❑ Cement -Based Roof Coating
❑ Other
NOTES;
1. CYaeck the box if tine aged Solar reflectance was not amibble in the Cool Roof Rating Council's Rated Pfoduct Directory; Theon use the equation in Section 110.8(i)2 where the Initial Reflectance
value from dw same dinactay and use the equation (0 2+8(pi~ — 0.2) to obtain a calculated aged value ftere p is the /nidal Solar ReNaance and B is either set to 0.65for Fief&Applied
Coaffimis or it is set to 0.70for all other noofmg products other than Field -Applied Coating.
2. Cakullate the SRI Value by usnng the Siff Worksheet at (TBD) and enter thin resulting value in the SRI Colmm above and attach a capyfor the SRI -Worksheet NRIOC-ENV-03~E to the to thisform
F. Air Barrier
1.
2
3
4
5 -
Ta /ID
Air Barrier
Material Type
Air Barrier
Assembly Type
Whole Building
Air Leakage Testing
Comments
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2013
CERTIFICATE OF COMPLIANCE — DATA FIELD DEFINITIONS AND CALCULATIONS NRCC-ENV-01-Ei,
Envelope Component Approach (Page'.'of 1)'.
-
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT '
1. I certify that this Certificate of Compliance documentation is accurate and complete.
'
v
Company:
LDocumentatian
Date:
CERTIFICATE OF COMPLIANCE — DATA FIELD DEFINITIONS AND CALCULATIONS NRCC-ENV-01-Ei,
Envelope Component Approach (Page'.'of 1)'.
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DOCUMENTATION AUTHOR'S DECLARATION STATEMENT '
1. I certify that this Certificate of Compliance documentation is accurate and complete.
'Documentation Author Name:
Author Signature:
Company:
LDocumentatian
Date:
Address:
S Certification Identification (if applicable):
City/State/Zip:
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design
identified on this Certificate of Compliance (responsible designer).
3. The energy features and.performance specifications, materials, components, and manufactured devices for the building design or system
design identified on this Certificate of Compliance conform'to the requirements of Title 24, Part 1 and Part.6 of the California Code of
Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the
building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this
Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
Company:
Date Signed:
Address:
License:
City/State/Zip:
Phone:
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance
June 2013