Loading...
SFD (07404).g Adin ldrress • 53-9$5 Meroftza Owner Andy Ulm T4',ht 4 4Q*rw Mailing Address PO Box sn City I fQ Zip 922i}1 Tel. Address Zip Tel. P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 & Classif. SON67 I Lic. # Ii15 Arch., Engr., Designer Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION �-► I hgreby affirm 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. _SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for -such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he 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, 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, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) O 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent 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 i1 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, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. • 07404 BUILDING: TYPE CONST. OCC. GRP. A.P. Number 774-112.021 Legal Description Lot 11 Project Description Single family DwIling Sq. Ft. No. No. Dw. Size 16M Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ IEstimated Valuation $89.309 f PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTA,_ REM) RI ST 4/ r AMOUNT 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 IN�,CLTQ Issued by: Date Permit Validated Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL SO. FT. POR. SO, FT, ® GAR. SO. FT. ® CAR P. I SO. FT. WALL SO. FT. SO FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES q FORMS �!/ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE `4 -Ilk KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRU6.�RE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR c 'R 1J /-,1— .i4 SETBACK GROUND PLUMBIN a UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK q FORMS �!/ SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE `4 -Ilk I/W GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. GRADING cu. yd. $ plus x$ =$ LUMBER GR. FRAMING // / 0 114 t FINAL INSP. ROOFING `y REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING Y A MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL ANDY YSIANO CONSTRUCTION P. O. BOX. 582 PH' ,.619-584-6898 INDIO OA iaw eachella Va11�y Vjiier'j.) ct 4 $j3p� tr '°r ff:(J ,�. •� i'rC .... '., I r r. � dup`r r Jus .. r 39✓r. C IND AN FAR//y'FFICE ' � DpIVE I,'L �S" 51 9957 146hdo xa I 1 'Ya C - ,,yy��I2�,r 1 ,' ``��iillww t L 1 1� /'� �j'l�■l �{,♦.�\p i4yPeiYe. j '.y E�Y'Ar��y�V. tiµ\'' '11 'I) 1,4.11 Y�y !'• I 5 t t X113 J),r� �t ' ; !F � i {: ;. . .e ��{ ' ;�nrctsir�+L�lLvrry ,4 y Il 4T rF' r •.[jYTkd� JI Ir k,b^tt1 fT. �,�i.�. , « r +r a'. J; :r A a. } , '' N� , t' • w�v , f ,§,' A t rwrvT� r r +���rr 'fffi'jjyy , {.ST,, FAR//y'FFICE ' � DpIVE I,'L �S" C - ,,yy��I2�,r ,' ``��iillww t L 1 1� /'� �j'l�■l �{,♦.�\p j '.y E�Y'Ar��y�V. tiµ\'' '11 'I) 1,4.11 Y�y !'• I 5 t t X113 J),r� �t ' ; !F � i {: ;. . .e ��{ . � � ✓t 1.: � �it 1' ! � rt. J dl r 'i'I,' , 7 [ o4t. } s�11�F��♦� .,�a. i{"`a (( ` q�i '1;�`v.��5f. r{.dYi?:.F�: •S .f ullcr.'r�i19�iF�.4'F3,"_4•tb"M.�''�.:i31T2NS'�:^.".39^�k•AwY.��...ai.�_`:_ fT. �,�i.�. , 4 Jyf� � �,� .. �..1 .. r ,�.F `.�,Yf'lit�tr, r..��.1: t ° i att Zr t c"days:;�R� t'3�iia�1 iiia`y '54 ' 1 ` ♦�tj%�(�j�7"' i : ! {(;,,� 7 Ni. � �f yl�i ^��� 1 < 'i ... � , rJ 4 rr ., _}�l,i J l r 1 L I �'jf�Tt � '+ 't ��ai L t 1 •' '� t tlb> t ,F,� i ,1 .r 13 a .J i '• t,— rNV,'�t L �`,�♦L µ��i..�Ju�f �t Ly.:<,J t. :. ° '.4��,�y�A .�Z' 3 S. -"n 1� �.•,. ,!lr.� r f r A. if', 1 • r 4 ,� M, JA. ' �4 1l,i Q� � 1 -e•L% v tC'�n J �� r- � r {. Lw ,�. - }u(ti¢tt' ¢ :t A � ., r• S.! � r - tiH' �t,. � (( r�- rrV.y.,l' � �.� c,, t t'l t a*, " i r 3r r AI-; r z4 t , ..dklai as t� • f v' st, 1 { r4 'r,v � 6 7,J-- 0 c'� C ' J , r �- � :r A a. } t ° i att Zr t c"days:;�R� t'3�iia�1 iiia`y '54 ' 1 ` ♦�tj%�(�j�7"' i : ! {(;,,� 7 Ni. � �f yl�i ^��� 1 < 'i ... � , rJ 4 rr ., _}�l,i J l r 1 L I �'jf�Tt � '+ 't ��ai L t 1 •' '� t tlb> t ,F,� i ,1 .r 13 a .J i '• t,— rNV,'�t L �`,�♦L µ��i..�Ju�f �t Ly.:<,J t. :. ° '.4��,�y�A .�Z' 3 S. -"n 1� �.•,. ,!lr.� r f r A. if', 1 • r 4 ,� M, JA. ' �4 1l,i Q� � 1 -e•L% v tC'�n J �� r- � r {. Lw ,�. - }u(ti¢tt' ¢ :t A � ., r• S.! � r - tiH' �t,. � (( r�- rrV.y.,l' � �.� c,, t t'l t a*, " i r 3r r AI-; r z4 t , ..dklai as t� • f v' st, 1 { r4 'r,v � 6 7,J-- 0 c'� .YW'���^T^C`��-•aV_T=JT-��'�J ?.!t •_. ,.•J'1 ��-'V^�V�}�f•Mnr /..�'�T� � �.r�'��� may^ RECEIPT NO. ``^' Issued By Avid— Date DISTRICT: ❑ Riverside, O~lio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant - PINK - Bldg. Dept GOLDENROD - Plans/Records r7 COUNTY OF RIVERSIDE ENVIRONMENTAL Asesee ra Parch Nm HEALTH SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County speculations as indicated on the attached check IlsL _aa A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval. Q 12, VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG G+ O Agent Contractor, Contact Pe rte"' % Phone Address 8 Firm J / s,� / U UJ / /A' -� r Pese o i� G St City r Stat Zip Job Pr rty Add Description Prop. (PM, Tract ) v,� as�� Lot sizeter A nc 1- Use of Permit P/P, CU, etc. Other H ' Prep,etC. well' e / Signature of Applicant Date CA ORY: - r • REV CODE FE _ - CATEGORY: REV CODE FEE Cgy SUBSURFACE DISPOSAL 12 7.00 ' ❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00 Ib ❑ MULTIP,LE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION -''°"❑ SEWER/SEPTIC VERIFICATION 7348 $ 17.00 Z O a. 1 st 4 Parcels (Each) 1238 $ 57.00 (Less than 1 year) b. Each Parcel after 4 .' 7344 $.24.00;x.,. ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 U W ❑ Rerevie_w (2nd review same parcel) ' 7344 $ .24.00. EVALUATION (Attach DOH SAN 53) U)'11Site Evaluation in Conjunction with -it ❑ HOLDING TANK 7351 $ 47.00 Critical Area @ __1 ' • .7346 $111.00 ❑, ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $ 87.00- ' DATE �ITIAL Holding Tank Agreements Completed ❑ Yes RoNo v Certification of Existing S.D. System Required ❑ YesRO �Noo WOCB Clearance required. (Attach Form ❑ Yes s DOH SAN 007, Santa Ana Region Only) _ Soils Percolation Report Required. ❑ Yes 1; Special Feasibility Boring Report Required. ❑ Yes Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes Other - J/yo• Staff Staff Specialist tot Inspection Required ❑ Yes FJ No Lot Inspection Date Soils boring report by Prof Date Soils Map Page Soil Type Approved by - Date ` / G� f 40 U - No. of Systems Typ&lof System(.) ❑� ng Tank isting No. Dwelling Un I _ � (1) Septic Tank Soil Rate Grease/Sand O -New O ped rrwnt P� ~ 13Q /�1L(k (V r' v 4 % U Gel Gal p to Leech Line Sq. Ft Sidewall allowance Lxie(s) It. long ft wide with Bed Sq. ft. trench area _ k rock/ sq. ft per running ft min. below dreinitnea or of bdtom L.eachlines/bed special design for slope: � (3) Pit Diameter No. Pits Pit Below (TD) Seep Ph� Depth Other: Applicable le Inlet (BI) - N/A � Overburden factor ft&LSI' 6 1 ' �(�� Max. Nlovv b�e Depth l7L No. 2 System REMARKS: %jam E2'�.'�-•cry.. .�'�..�"`•�J�-�-m- f rJ ,a�'�/o"r-�C„Qer1 in This applicationAPPROVER, . IED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompan n, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the Z above -designed system. No construction is permitted in the required reserved 100% expansion area. 0 (i) Septic tank and sewer lines must be 50' minimum from any wellsc// V U � Leach lines must be 100' minimum from any wells, including expansion rea (3) Seepage pits must be 1 minimum from any wells,including expans' • n /area /O ML Signature. of Health Official LiCi /C G'<:lipate / RECEIPT NO. ``^' Issued By Avid— Date DISTRICT: ❑ Riverside, O~lio ❑ Hemet q Perris ❑ Rancho Calif. ❑ Blythe DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant - PINK - Bldg. Dept GOLDENROD - Plans/Records r7 .� �fi�0 LAND TITLE COMP -Mi AND WHER RECORDED MAIL THIS DEED AND UNLESS OTHERWISE SHOWN BELOW MAIL TAX STATEMENT TO: Name Andy Ysiano et ndd�eas eBOX 582 ci,ra Indio State Ca. 92201 411-4 ®, same as Re I MAIL TAX STATEMENTS TO above address TITLE ORDER NO. 202507 ESCROW N0. 3810—JC X J X ` UJ Z ^ FJ Q O U E2 1x1 E2 f� oQ� SPACE ABOVEZHIS LINE FOR RECORDER'S USE GRANT DEED THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX is $ .4, 6 computed on full value of property conveyed, or O computed on full value less value of liens or encumbrances remaining at time of sale. O unincorporated area & city of La Quinta AND FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Leo Howard, a married man, as his sole and separate property hereby GRANT(s) to Andy Ysiano, a married man, as his sole and separate property the following described real property in the City of La Quinta ,State or California: Lots 11 and 12 in Block 248 of SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 23, as shown by Map on file in Book 20 Page 25 of Maps, Records of Riverside County, California. Dated Oct. 29, 1989 �= S SSS. On this Q Day of , in theyear 'l9 �, before me, the undersigned, a Notary Public in and fof siid State, personally appeared zz: O , personally known to me (or proved to me on the basis of satisfactory evidence) to be the person_ whose name is subscribed to the within instrument, and acknowledged to me that_ he-_ executed it. WITNESS my hand and official seal. Signature �'.varz%_. "r,✓�Z�"_.___ NOTAPY PGBUC :Ij AND ::Of,' SAID STATE Leo Howar OFFICIAL SEAL RHODORA E FRANK NOTARY PUBLIC - CALIFORNIA I( LOS ANGELES COUNTY My comm. expires AUG 28, 192 (This area for official nolar'al snal) CO -441 (REV 4/85) T — - —' 9:3Ait•3:�r ..';-c;;`'F?,�F l;,'E.T�.�� e;: zs,:es• °f.'£. + of 0, o. ;t=..,. 4,4 ,s • JAMES O. WALLACE AgrIculturol Commissioner f)treclor of Weights a Measures OFFICE OF AGRICULTURAL COMMISSIONER AND WEIGHTS & MEASURES CALVIN C. KAMINSKAS 4080 LEMON STREET, ROOM 19 Asslslanl Commissioner RIVERSIDE, CALIFORNIA 92501 CLEMENT BENVENISiE (71 14) 787-256Sealer 49613 Highway 86, Suite B12 Coachella, Ca. 92236 (619) 342-8291 t` PATE /—/7-90 CASE ND. C Q 1 17 970 i, ./1 DEVELOPER' S NAME: H 1x A,-, 1 S \ ADDRESS: CA TELEPHONE: Lok l 1 five Dear Developer: After reviewing your landscaping plans, all plant material listed is not in violation of quarantine laws governing the Coachella Valley. If substitutions do occur and they differ fran plant material listed, this office must be notified"' inTlediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agricul al CaTmissioner's Office cc: Indio and Riverside Office TWT 4 4(4j Q" 78-105 CALLE ESTADO - LA QUINTA, .CALIFORNIA 92253 - (619) 564-.2246 FAX (619) 564-5617 July 30, 1991 Andy Ysiano P. O.Box 582 Indio, CA 92201 Dear Mr. Ysiano: It has come to the attention of the.City of La Quinta Department of Building and Safety that, your building permits #07,404 and 407296 for single family dwellings located at 53-985 and. 53-995 Mendoza have expired. According to the Uniform Building Code, Section 303(d)., no further work shall be performed on the above permitted job -site until a new permit has been issued or an extension granted. Should you wish an extension of this permit you must request, in writing, for an extension within 14 days of the. date of this letter. Once a permit has expired a new permit must be obtained prior -to any further work or inspections to take place. The fees for a new permit would be as listed in Section 303(d). We appreciate your immediate attention to this matter. Sincerely, BUILDING AND SAFETY DEPARTMENT Tom Hartung Director of Building a Safety TH/lc MAILING ADDRESS - P.O: BOX 1504 - LA QUINTA, CALIFORNIA 92253 I Point System Summary: Climate Zone 15 BUILDING DATA Conditioned Floor Area 30 Number of Stories Slab/Raised Floor SLA M Check all applicabie Unit Type condition(s): }, Single Family Detached (S)~"D) [ ] Addition Alone [ ] Single Family Attached (SFA) [ ] Existing Building [) Multi. -Family (MF) [ ] Existing-Plus-Addijon P -2.R S SCORECARD Measures Point Scores 1. Ceiling Insulation ) or Q R -value (381 U -value (0.030] 2. Walllrsul:tion -13 or R -value (191 U -value (0.056] 3. Raised Floor Insulation JA or O R-value[191 U -value [0.0371 4. Slab Edge Insulation �_ or V R -value [01 F2 factor [0.771 5. In 3ltra_ion Standard p 6. � class Heat Loss Type [double] U -value (0.6.:1 % Total Glass [ 1 ] Sum 1-5 7. Shading (Shade Open) % Glass SC EIf. % Glass a. North _ x V4 _ b. East . e5 X `' = E 1 c. South x 8 = d. West_ x e. Skylight O x = p 0 8. S' iading (Sh2de C losed) a. . NorthZ Glass Area % Glass North 49 East $ South West p l Skylight Total X p 'i SCORECARD Measures Point Scores 1. Ceiling Insulation ) or Q R -value (381 U -value (0.030] 2. Walllrsul:tion -13 or R -value (191 U -value (0.056] 3. Raised Floor Insulation JA or O R-value[191 U -value [0.0371 4. Slab Edge Insulation �_ or V R -value [01 F2 factor [0.771 5. In 3ltra_ion Standard p 6. � class Heat Loss Type [double] U -value (0.6.:1 % Total Glass [ 1 ] Sum 1-5 7. Shading (Shade Open) % Glass SC EIf. % Glass a. North _ x V4 _ b. East . e5 X `' = E 1 c. South x 8 = d. West_ x e. Skylight O x = p 0 8. S' iading (Sh2de C losed) a. . NorthZ % Glass � U7 x `�\ SC . _ Eff. % Glass J %Z. a � C. Soutlh i X _ d. 'Yes" X LA t5 — �lO e. Skylig%zi x o =. p �'°• 9. Interh-sr Thermal Moss •� 10. Tsxterior Wall Mass Interior Mass/CVA 0— © + 11. Heating System Exterior Wall Mass —1.Ces x Sum 7-10 Zonal Control? ( Y / N) r— SE or HSP F [0.72/ti Tic Duct Efficiency [0.78] Effective SE or HSPF 12. Cool; ---,g System IW -50 x . r.45, = (0.56/5.15] Q2)1 15 Zonal Control? ( Y / N) SEER 19.51 Duct Efficiency [0.74] Effective SEER [7.03] 13. Water heating S 0 -- Type Credit [ncne] " Point Total. Form Revised March 1988 Certificate of Compliance: Residential (Page 1 of 2) CF -1R Z�s 1 ZXQ0 Q AQ vN �S � � A 1 �} AQ cw ProjectTlUe Date , (1 Ln, �,., v ��_t.:k Project Addr �_ `L� ��� � � _ S (^� ` � Building Permit it Doc enta�t on Author TeleQhone r `,�3x S �' Checked By /Date Compliance Method (Package, Point System or Computer) Climate Zone Enforcement Agency Use Only GENERAL INFORMATION Total Conditioned Floor Area: 1 oft2 Building Type: Single Family Hotel/Motel (check one or more) Multi -Family (less than 4 stones) Addition Multi -Family (4 or more stories) Existing -Plus -Addition :Front Entry Orientation: North / East / South / West / All Orientations (circle one or more) Number of Dwelling Units: 1 Floor Construction Type:Slab Raised Floor (circle one or both) Infiltration Control: Standard/14ight (circle one) BUILDING SHELL INSULATION Component Insulation Location/Comments Type R -Value (attic, to garage, typical, etc.) Wall .............. 1,13 �:���1 i.>�A�I.S► Wan.......... Roof ......... Roof ......... Floor......... Floor......... Slab Edge. Com: ` � `'� -► GLAZING Shading Devices Glazing Area Glass Type Interior Exterior Overhang Framing Type Orientation (Sf) (single, double) (roller blind, etc.) (shadescreen, etc.) (yes/no) (metal/wood) Front.... (EF) IJ' pQ V-1 1-1C70r._. 1J o i" 1GT,&t,_ Front.... Left...... (S)_ Left...... ( ) �_ Rear..... (14 Rear..... ( ) Right.... (1�) Right.... ( ) Skylight....... Skylight....... THERMAL MASS Type/Covering Area Thickness (slab/exposed, tile, etc.) (Sf) (inches) Location/Description (kitchen, bath, etc.) 't -I LZ 3 Z Certificate of Compliance! Residential (Page 2 of 2) CF -IR Project Title Date HVAC SYSTEMS Minimum Duct Type (furnace, air Efficiency Location Duct Output Manufacturer / Model # //conditioner, heat pump) (SE, SEER.ILPF) (attic etc.)) R -Value (Btuh) (or aDuroved equal) t-�y fL KA 43> %- � -1 . �pS - 1 \ w'�. S IR 0 0 d L91'.161 OX C. Q J Maximum Furnace Heating Output: SR Cea Btuh HOT WATER SYSTEMS Tank Manufacturer/Model # System Type (storage gas, etc.) Capacity (or approved equal) Soecial Feature(s) SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, Chapter 2-53 and Title 20, Chapter 2, Subchapter 4, Article 1 of the.Califolnia Administrative code. This certificate has been signed by the individual with overall design responsibility and the building owner, who shall retain a copy of it and transmit the certificate to any subsequent purchaser of the building. When this certificate of compliance is submitted for a single building plan to be built in multiple orientations, all building conservation features which vary are indicated in the Special Features/Remarks section. Designer Building Owner Name: Name: Title/Firm: Title/Firm: Address: Address: Telephone: Telephone: Lic. #: (signature) (date) (signature) (date) Documetion Author Enforcement Agency Name: favC.r Name: Title/Firm: ' SSS U 1.iA<. l ` 1 �� ice. Agency: Address: _y v ja;'QM34C)A Telephone: • 1 �� C� �t�z z.� c Telephone:-("-> —&LA- Z 1 Z U 3 N N". WW: OWI M� M1� Form Revised March 1988 (date). - (signature or stamp) (al�� (date) Mandatory Measures Checklist: Residential MF -IR NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. Items marked with an asterisk (*) may be superseded by more stringent compliance requirements listed on the Certificate of Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as binding minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. DESCRUMON Building Envelope Measures \* §2-5352(a): Minimum ceiling:insulation R-19 weighted average. §2-5352(b): Loose fill insulation manufacturer's labeled R -Value. §2-5352(c): Minimum wall insulation in framed walls R-11 weighted average (does not apply to exterior mass walls). §2-5352(k): Slab edge insulation - water absorption rate no greater than 0.3%, water vapor transmission rate no greater than 2.0 perm/inch. §2-5311: Insulation specified or installed meets California Energy Commission (CEC) quality standards. Indicate type and form. §2-5352(f): Vapor barriers mandatory in Climate Zones 14 and 16 only. §2-5317: Infiltration/Exfiltradon Controls a. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. b. Doors and windows certified. c. Doors and windows weatherstripped; all joints and penetrations caulked and sealed. §2-5352(e): Special infiltration barrier installed to comply with §2-5351 meets CEC quality standards. §2-5352(d): Installation of Fireplaces 1. Masonry and factory -built fireplaces have: a. Tight fitting, closeable metal or glass door b. Outside air intake with damper and control c. Flue damper and control 2. No continuous burning gas pilots allowed. \ HVAC and Plumbing System Measures §2-5352(8) and 2-5303: Space conditioning equipment sizing: attach calculations. §2-5352(h) and 2-5315: Setback thermostat on all applicable heating systems. §2-5316(a): Ducts constructed, installed and insulated per Chapter 10, 1976 UMC. §2-5316(b): Exhaust systems have damper controls. §2-5314(c): Gas-fired space heating equipment has intermittent ignition devices. §2-5314: HVAC equipment. water heaters, showerheads and faucets certified by the CEC. §2-5352(1): Water heater insulation blanket (R-12 or greater) or combined interior/exterior insulation (R-16 or greater); first 5 feet of pipes closest to tank insulated (R-3 or greater). §2-5312(Exception n: Pipe insulation on steam and steam condensate return & recirculating piping. §2-5318(d): Swimming Pool Heating 1. System has: a. On/off switch on heater. b. Weatherproof instruction plate on heater. c. Plumbed to allow for solar. 2. 75 percent thermal efficiency. 3. Pool cover. 4. Time clock. 5. Directional water inlet. Lighting and Appliance Measures §2-53520: Lighting - 25 lumens/watt or greater for general lighting in kitchens and bathrooms. §2-5314(c): Gas fired appliances equipped with intermittent ignition devices. §2-5314(a): Refrigerators, refrigerator -freezers, freezers and fluorescent lamp ballasts certified by the CEC. Indicate make and model number. Form Revised December 1987 DESIGNER I ENFORCEMENT Insulation Ce:-tiiicate Number and Street County ROOF Material Thickness (inches) E=, RIOR WALL Material Thickness (inches) Subdivision Description of Installation Brand Name Thermal Resistance (R -Value) Brand Name Thermal Resistance (R -Value) CEILING Batt or Blanket Type Brand Name Thickness (inches) Thermal Resistance (R -Value) _ Loose Fill Type Brand Name Contractor's'minimum installed weight/ft lb Minimum thickness inches Manufacturer's installed weight per square foot to acheive Thermal Resistance (R -Value) _ RAISED FLOOR Material Brand Name Thickness (inches) Thermal Resistance (R -Value) SLAB FLOOR Material Brand Name Thickness (inches) Thermal Resistance (R -Value) _ Width (inches) FOUNDATION WALL Material Thickness (inches) = Brand Name Thermal Resistance (R -Value) Declaration Lot Number I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the California Administrative Code. General Contractor (Builder) Signature and Title Sub -Contractor (Insulation Installer) Signature and Title License Number Date License Number Date Proposed Construction Assembly: Residential' ProlectTiUe Date (� • •Pro ,d �r � ?:C�k3414 3 Building PermitM •• Te! h Form 3R rr Documentation Author ep o e Checked By / Date Assembly.Name Enforcmnent Agency Use Only 2 .� Sketch of Construction Assembly Assembly Type: (check one) Framing Material: Framing Size: Framing Spacing: Framing Percentage: (check one) Wall Weight / sf: (Packages only) Floor Wall Ceiling/Roof T x O.C. Wall: 15% (16" o.c.) 12% (24" o.c.) Floor/Ceiling: 10% (16" o.c.) 7% (24" o.c.) List of Construction Components R -Value Outside Surface Air Film Ca vit (Re) Frame(Rf) MIS cc:o 2. 3. 4. 5. 6. 7. Inside Surface Air Film V/o Total Unadjusted R -Values: Z-- Rc Rf Framing Adjustment Calculation (if applicable): l/Rc 1-(Fr%/100) 1/Rf Fr%/100 Total U -Value lfrotal U -Value Total R -Value Proposed Construction Assembly: Residential Zi orm.3R Project Title Date 1 CkCS % 0 -%A, , CA _ Project d IR A�rp�J G C� BuildingPeanitN Documen tion Author Telephone Checked By i Date Assembly Name L Sketch of Construction Assembly List of Construction Components Enforcement Agency Use Only Assembly Type: Floor (check one) Wall_ Ceiling/Roof Framing Material: Framing Size: Z x E) Framing Spacing: `� " O.C. Framing Percentage: Wall: 15% (16" o.c.) (check one) 12% (24" o.c.) Floor/Ceiling: 10% (16" o.c.) Wall Weight / sf: (Packages only) 7% (24" o.c.) R -Value Cavity(Rc) Frame(Rf) Outside Surface Air Film 0.\1 ♦® 3. l+J S V�.,��C) 38 �� S -ez teo LJ 17- 4. T7.Zilk 5. 6: 7. f - Inside Surface Air Film • tf�e'• Total Unadjusted R -Values: Z„S • Z. Rc Rf Framing Adjustment Calculation (if applicable): ( x ) + ( x > 1 /Rc 1-(Fr%/100) 1/Rf Fr%/100 1/Total U -Value Total U -Value Total R -Value WORKSHEET ONE: STORAGE TYPE GAS OR STORAGE TYPE ELECTRIC FOR SHOWING COMPLIANCE WITH RESIDENTIAL BUILDING ENERGY EFFICIENCY STANDARDS WATER HEATING BUDGETS A EOUIPMENT DATA 1 Water heater type S 15 Enter SG or SE See Appendix D 2 Manufacturer Water heating budget From building plans 3 Model number Sc -From building plans 4 Ignition device Water main temp. GP, gas pi -.lot or IID, intermittent ignition device 5 Tank volume Daily hot water load Total'gallons.,'from CEC Appliance Directory 6 Recovery efficiency Ambient air temp Percent.from'CEC Appliance Directory x .01 7 Standby loss .q5 Percent/hou.r; from CEC Appliance Directory 8 Rated input VS Btu/hr, from CEC Appliance Directory (D2 + D3 + (1 kWh = 3413 Btu) 9 Number of Heaters From building plans (total) B OPERATING DATA 1 Climate Zone .00'12 See Appendix D 2 Water heating budget Ib -loo KBtu/yr/unit, see Table 1 3 Tank set temp. 140 °F,.fixed input 4 Water main temp. "I D OF, see Table 1 5 Daily hot water load Sa 50 or 35 gallons/unit, see Table 1 6 Ambient air temp Z OF see Table 1 7 Ad j Standby Losses .00'12 See Table 2 ,q 8 No. dwelling units 1 From building plans (total) 9 Number of pumps $ From building plans 10 Pumping energy (24 - Watt-hr/yr, see Table 3 C WATER HEATING ENERGY CREDITS x P.5 1 Credit name �3- See Table 5. 2 Annual savings _Qip KBtu/yr/dwelling unit, see Table 5 D CALCULATE ANNUAL WATER HEATING ENERGY (KBtu/vr 1 Recovery load to S ([65 x 8.25 x (140-B4) x 365 x .001] - C2) x B8 2 Recovery . energy 105$2 D1/A6 3 Standby.l.oss energy ( (24 - [(D2 x 1000)/(A8 x A9 x 365)]) x 8.25 . x P.5 x B7 x 365 x (140-B6) x .001 x A9 4 Pumping energy B9 x B10 x 3.413 x 3 x .001 5 Total energy 0 ?> GAS SYSTEMS: (D2 + D3 + D4)/B8 ELECTRIC: ([(D2.+ D3) x 3] + D4)/B8 6 Water heating budget comparison* 5`KBtu/yr/unit B2 - D5 7 Water heating budget — 1� Points (D6/conditioned floor area per dwelling unit) x 2 1 point = .5 KBt'u/yr * If positive, the system complies. If negative, the system does not comply. Water Heating 6-19 S