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AR (13-0178)P.O: BOX 1504 78-495 CALLE TAMPICO A LA QUINTA, CALIFORNIA 92253 I I I I X11wli M6 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number:. 13-00000178; Property Address: 80166-MERION APN: 762-140-008- - - Application description: ADDITION - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 6500 Applicant: UC I hereby affirm under penalty of persiness Section 7000) of Division 3 of the License Class: B Date: j i,_!J Vcomractor Architect or Engineer: SED CONTRACTOR'S DECLARATION - licensed under provisions of Chapter (commencing with . i Prof nal? Code, and my License is in full force and°effect. LicenseNo.: 594043 v OWNER -BUILDER DECLARATION I hereby affirm under penalty of penury that m exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Busi ess a rofessions Code: Any city or county that requires a permit to construct, alter, improve,' demolish, or repa 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.). 1—) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractois' 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. , BAP.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 Name: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 77777153 Date: 3/06/13 Owner: SANDOR STEVE & NANCY 80166 MERION LA QUINTA, CA 92253 Contractor: 2013 U11 7C'S CONSTRUCTION & MAINTT i 1 rA LA Q NTA,VISTCAA 92253 <` E )e 7. LA QUINTA, (760)564-5811 Lic. No.: 594043 WORKER'S COMPENSATION DECLARATION "I hereby affirm under penalty ofperjury one of the following declarations: , 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 STATE FUNDPY- at, Policy Number 0028211-2011 I certify that, o ance of he work for which this permit. is issued, I shall not employ any person in aso as to b ome subject to the workers' compensation laws of California, and agree ouldbeco a sub• to the workers' compensation provisions of Section 3700 oof�f thode, I s fo comply with those provisions. Date:�VAppliWARNING: FAILURE TO SORK ' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER NAL NALTIES AND CIVIL FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000). INN 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 apermit 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 1B0 days from date of issuance of such mit, r cessation of work for 180 days will subject permit to cancellation. ` I certify that I have read this application and state that a above inf me ' is correct. I agree to comply with all _ city and county ordinances and state laws relating t uilding co ru ' n, and hereby authorize representatives 9 11hiscounty to enter port the above-mentioned operty f sp on purposes. Date:? Signature (Applicant or Age r v Application Number .13-00000178 ------ Structure Information EXIST. SFD ------ Construction Type . . . . . TYPE V, UNPROTECTED Occupancy Type . . . DWELLG/LODGING/CONG <=10 Other struct-info . . . . . CODE EDITION 2010 # BEDROOMS .00 GARAGE SQ FTG 137.00 1ST FLOOR SQUARE FOOTAGE ----------------------------------------------------------------------------- 137.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . 90.00 Plan Check Fee 58.50 Issue Date . . . . Valuation . . . . 6500 Expiration,Date 9/02/13 Qty Unit Charge Per Extension BASE FEE 45.00 5.00 9.0000 THOU BLDG 2,001-25,000 --------------------------------------------------------------- 45.00 Permit ELECT - ADD/ALT/REM -Additional desc . Permit Fee 22.05 Plan Check Fee Issue Date Valuation 0 Expiration Date 9/'02/13 Qty Unit Charge Per Extension. BASE FEE 15.00 137.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 4.80 3.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 2.25 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 19.50 Plan Check Fee 4.88 Issue Date . . Valuation - 0 Expiration Date 9/02/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 Special Notes and Comments 137 SF GOLF CART GARAGE CONVERSION TO LIBRARY (NO BE BE UTILIZED AS A SLEEPING ROOM). 2010 CODES.. -------------------------------------- -------------------------------- Other Fees . . _ . . BLDG STDS ADMIN (SB1473) 1.00 LQPERMIT LQPERMIT Via► Application Number . . . . . 13-00000178 -----------------_----- Other Fees . ------------ . . . . . --------------- ENERGY REVIEW ------------ FEE -------------- 5.85 STRONG MOTION (SMI) - RES .65 Fee summary Charged Paid Credited Due Permit Fee Total 131.55 .00 .00 131.55 Plan Check Total 68.89 00 .00 68.89 Other Fee Total 7.5.0 .00 :00 7.50 Grand Total 207.94 .00 .00 207.94 LQPERMIT Bin. # Permit # � v Project Addtrss City of La QuWa BLAUng 8r Safety DivIslon P.O. Box 1504,'76-493 Calle Tampico La.QLdnt4 CA 92233 - (760) 777-7012 Building Permit Application,andTracking Sheet Owner's Name:. A P. Number. - 7�� , t o Address: Legal Description: Z, �' • 3 City. ST, Zip:Tl� c7( � Contractor. ' Telephone: Address: j Description: Pro ea �j City, ST, Trp: Telephone; Stats Lic. # : City Lir #; Amir., PAW., Designer' f --� 7 r 14 At 2 �t Address City, ST. Zip: l Tel6phone:7766- State Lic #. Name of Contact Person: L7356 F LA U INZ LJEVELOPME 7stmction Type:. Occupancy: Pmject type (circle one): New Add'n Alter Repair Demo Sq. Ft.: i # Stogies//: #Units: Telephone i of Contact Person: �j• � � Estimatod Value of Project V 5CrC ) APPLICANT: DO NOT. WRITE BELOW THIS UNE q Submittal Req•d Recd TeAcltnvG PERMITFEES. Plan Sets Plan Check Submitted f Item Amount Strgetand Coles Reviewed, ready for corrections Plan Check Deposit. Truss Cates. Called Cgotaet Person Plan Check Balance_ Titre 24 Calec. % Plans' picked up Construction ' Flood plain plea Plans resubmitted ' . Mecharilcal Girading plan Z`! Review, ready for eorrectionsrmsue Electrical Subtoataetor List Called a I ersoa Plambing Grant Deed l s dap S.M.L ILO.A. Approval la°s resubmitted Gradia , INHOUSE:- Review; ready for correction a �'� Developer Impact Fee Planning Approval Called Contact Person Z Ad.P.P. Pub. Wks. Appr ' Date of permit issue School Fees Total permit Fees -2 a t 2 Coachella Valley.Unified School' District This Box For District Use Only 83-733 Avenue 55;: Thermal, CA 92274 DEVELOPER FEES PAID. : (760) 398=5909 — Fax (760).398-1224 AREA: AMOUNT - LEVEL ONE AMOUNT: : LL•VEL TWO AMOUNT: MITIGATION AMOUNT: COMMAND: AMOUNT: DATE: RECEIPT: - CHECK #: INITIALS CERTIFICATE OF COMPLIANCE (California Education Code 1.7620) Project Namee: PGA West Date: March 4, 2013 Owner's Name; Stephen & Nancy Sander Phone No. 760-831-5212 Project Address: 80-166 Merion, LaQuinta Project Description::. -Golf Cart Garage Conversion to library APN: _ 762-140-008 Tract #: ; ..: Lot #'s: ' Type of Development:: Residential XXL Commercial Industrial Total Square Feet of Building Area: .137 Certification of Applicant/Owners: The person signing certifie that th above information incorrect and makes this statement under penalty of.perjury and further represents that he/she is authoriz to sign n behalf of the owner/developer;: r Dated: March 4, 2013 Signature:. SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE.SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) .: Education Code : Gov. Code, _ :: Project Agreement Existing Not Subject to Fee 17620 -65995 Approval Prior to 1/1/87 Requirement Note: Number of Sq.Ft. 1.37 Pursuant to AB 181:any: room additions or enclosures of 500 _. sq: ft. or less are exempt from developer fees. Any mobile Amount per Sq.Ft. $0.00 homes being.relocated within the same school district's . Amount Collected $0.00 jurisdiction are exempt from developer fees.. Building Permit Application Completed- Yes/No _. By: Elsa F. Esqueda, Director of Facilities and Maintenance Certificate issued by: Laurie Howard, Secretary 'Sig* nature:�:t,LA A lL�� NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES Section 66020 of the Government Code asserted by Assembly Bill 3081, effectiveJanuary 1, 1997, requires that this District provide (1) a,written notice to the . project appellant, at the time of payment of school fees, mitigation payment or'other exactions ("Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 90 -day protest period m regard to such Fees or the validity thereof, commences with the payment of:the fees or performance of any other requirements as described in section 66020 of the Government code: Additionally, the amount of the fees imposed is as herein setforth, whether payable at this time or in whole or in part: prior to issuance of a Certificate of Occupancy. As. in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. MV:c/mydocs/dcvfees/cen:ificatc: of compliance Form updated 3-2007 11/2010 PGA WEST II RESIDENTIAL ASSOCIATION, INC. 39755 BERKEY DRIVE STE A PALM DESERT, CA 92211 �M �' - PHONE (760) 776-5 100 • FAX (760) 776-5111 February 16, 2013 Mr. & Mrs. Sander 80-166 Merion La Quinta, CA 92253 Reference: 80-166 Merion, La Quinta Architectural Change Request - Replace Front Window on the Golf Cart Garage Dear Mr. & Mrs. Sander: The Architectural Committee met on February 14, 2013, reviewed and approved your architectural change request to replace the front window on the Golf Cart Garage at your home at 80-166 Merion. This application was approved subject to the following terms and conditions of the Association. • Please refer to all the Architectural Rules & Regulations of the PGA WEST II Residential Association revised 8/01/07, they all pertain. • . When the work is completed, please send a Notice of Completion Form into our office f&.6 nspection to verify the work has been completed. • An Agreement & Covenant Running with Land will be mailed sent to you for proper execution as soon as it is prepared by counsel. �, tv, + : . Review by the Committee is only for Qeneral conformance with the architectural Qu/defines It is the responsibility of the owner to fu//y understand and conform to the architectural guidelines criteria whether or not all deficiencies are noted during review. It is also the owner's fu// responsibility to field verify a// existing conditions The Committee's decision with regard to vroiect design will be final. Please refer to the Architectural Ru/es for a// required submittals. Approvals given by the Architectural Committee are good for only six months from the date on the approval letter. If' construction has not commenced _within six months after the project approval date, a new application must be submitted. For additional information or questions, the Board has directed that you contact Joanne Rose,.CCAM Association Manager, at 760/776-5100, Ext. 320. Sincerely, PGA WEST II esidential Association Joanne Rose, CCAM Association Manager for the Architectural Committee, Landscape Committee Cc: unit Prescriptive Certificate of Compliance: CF -111 ADD Residential Additions Pae 1 of 5 Site Address: /fe& &o & Enforcement Agency: Date: 3.S 13 Proposed See Note Standard Values From JA4 Table General Information ProjeSt,Naine JJ CE l Climate S e # # of Stories Building Type ❑ Single Family ❑ Multi Family Circle the Front Orientation: N, E, or egrees Conditioned Floor Area of Addition (CFA): New Addition Size: ❑ Less than or equal to 100 ess than or equal to 1000 Do not use thisform for additions greater than 1000f12) NOTE: For Alterations to an existing home, submit a completed CF -IR -ALT Form Exception: Existing HVAC systems that are replaced or altered to serve the addition may be included on the CF -IR -ADD Form PRESCRIPTIVE ENVELOPE REQUIREMENTS FOR ADDITIONS For standard wood and assemblies meeting the.Cavity R -value only. • For /00 ft2 additions; the Proposed values must be equal or greater than the Standard column or when indicated when using Package A "Pkg D ". Enter values in the shaded Proposed Columns. • For less than /,000 ft' additions must comply with "Pkg D" requirements unless indicated in the Standard Column. To meet "Pkg D" minimum energy compliance re uirements, see RCM A endU B, Table 151-C or §152(b) in the RCM. Enter values in the shaded Proposed Columns. Size of Addition 100 ft2 or less Less than 1,000 fe Component Standard Proposed' Comment Standard Proposed* Comment Ceiling Insulation R-19 Minimum Pkg D F- 3$ Table 151-C Wall Insulation R-13 Minimum R-13 l3 Minimum Floor Insulation R-13 Minimum Pkg D IQ Table 151-C Fenestration U- factor SHGC U- factor SHGC Enter Values From "Fenestration Proposed Areas" Pae 2 of 5 U- factor SHGC U- factor SHGC Enter Values From "Fenestration Proposed Arens" Page2of5 0.40 Pk D Pkg u 0.40 Pk D g �.�jS �.po Maximum Glazing50 Area ft, — ft Addition Alone' �zJ% tj? Enter Values From "Addition Allowed Fenestration Arens" Page 3 of 5 For West -Facing Orientation2'3 0fe Radiant Barrier N/A Pkg D Table 151-C Roofing N/A See Roofing Products Below PkgD See Roofing Products Below OPAQUE SURFACE DETAILS For the furred portioned of Mass Walls see Furring Strips Construction Table below. A B C D E F G I H I J Proposed See Note Standard Values From JA4 Table Tag/ ID' Assembly Name or T e2 Framing Material and Size Thickness, Spacing, or Othe? U- factor° Framed Continuous JA4 JA4 Table Cavity Insulation Assembly Numbers R-value6 R -Value? Cell Values Proposed Assembly U-factor9 u • Y C Note: For furred assemblies, accounting for Continuous Insulation R -value, see Page JA4-3 ndr le � a 'n the ass and FurringConstruction table below. t LFOR ~COVED �oNsrRuc nn 6 I b a, Registration Number: Registration Date/Time: , " �rij HERS Provider: 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: CF -1R ADD Residential Additions (Page 2 of 5 Site Address: Enforcement Agency: Date: M Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation 1. For Tag/ID indicate the identification name that matches the building plans. 2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ... Indicate in column G the Frame material and Size: For Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies. 3. Enter the thickness for mass in inches or Spacing between framing members enter; 16 "or 24 "OC; or Other for all other assembly description such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel, and etc.... 4. Based on the Climate Zone; enter the equivalent U factor found in J44 Table based on the R -Value from Table 151-C 5. Enter the Table number that closely resembles the proposed assembly. 6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0 ". 7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter "0 ". 8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J. 9. The Proposed Assembly U factor, Column J, must be equal to or less than the Standard U factor in Column E to comply. FURRING STRIPS CONSTRUCTION TABLE FOR MASS WALLS ONLY A B I C I D I E F I G I H I I I J I K L M Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation Walls From Reference in Furring Space from Reference Joint Appendix Table 4.3.5, 4.3.6, 4.3.7 Joint Appendix Table 4.3.13 _ U 0 O H N d U c6 2 ld N Assembly C `o_ o • L 9 c 2 "° > > Final Mass Name or JA4 Table ' ¢ x o ° a ° ' ¢ > ' Assembl Thickness _ T e Number' > U -factor Comment /. Indicate the Mass Thickness from Reference Joint Appendix JA. 2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc... Indicate the Frame type and Size: For Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies. 3. Enter the Table number that closely resembles the proposed assembly. 4. Enter the row and column of the U factor value. 5. Enter the Effective R -value listed in the JA4 Table Number. 6. The Final Assembly is calculated by using Equation 4-1 br Equation 4-4 of the Reference Joint Appendix J44. Enter the value in Column L. 7. Insert the Final Assembly U- actor value back on to the Opaque Sur ace Details table in Column J. FENESTRATION PROPOSED AREAS Orientation Fenestration Type and Frame (North, East, ProposedArea' Window, Glass Door or Skylight) South, West(ft') Maximum Maximum U -factor"' SHGC"',' NFRC or Default Values' r14 12- Total Total 1. Fenestration area is the area of total glazed product (i.e. glass plus frame). Exception: When a door is less than 50% glass, the fenestration area may be the glass area plus a 'T inch frame " around the glass. 2. Enter value from Component Package D Requirements in Table 15/-C. 3. Actual fenestration products installed and as indicated in CF -6R -ENV Form shall be equivalent to or have a lower U factor and/or a lower SHGC value than that specified on the Fenestration Proposed Area table above. 4. Submit a completed WS -3R Form if a reduced SHGC is calculated with exterior shading. 5. If applicable at this stage enter "NFRC" or NFRC Certified windows or CEC "Default " valuesfound in Table 116-A or B. Registration Number: 2008 Residential Compliance Forms Registration Date/Time: HERS Provider: March 2010 Prescriptive Certificate of Compliance: CF -1R ADD Residential Additions (Page 3 of 5 Site Address: Enforcement Agency: Date: ADDITION ALLOWED FENESTRATION AREAS Check applicable box below if the roof addition is exempt from the roofing product "Cool Roof '.requirements. Note: If any one of the boxes are A B C D E ❑ Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the above Cool Roof criteria F Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance, otherwise, check CFA of Addition Allowed % Allowed Area Area Removed 2 Maximum Allowed Area Proposed Area s Thermal ft2 of CFA (A x B) ftz C + D^ Reflectance 3,4 (Table Above) Total Fenestratiop Area3 /:?>"7 0.20 'Z:-7• t7 ❑ 2 • 4 2z - 3 West Fenestration Area .4 0.05 ❑ ❑ > — ❑ (Required In CZ's 2, 4 & 7 -15 ❑4 ❑ ❑ 1. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12. 2. Glass removed to make way for the addition. 3. For additions less than 1,000f12 the standards allows glazing removed during the remodel to be added to the glazing area allowance. The maximum allowed glazing area for the addition is the CFA x 20% + glass removed to make way for the addition. 4. In climate zones 2, 4, 7-15, no more than 5% of the CFA is allowed for west facing glazing plus west facing glass area removed to make way for'the addition. The maximum allowed west facing glazing area is the CFA x 5% + west facing glass removed to make way for the addition. 5. To meet compliance, the Proposed Area must be less than orequal to the Total Allowed Area or BOTH the Total and West Fenestration Areas. ROOFING PRODUCTS (COOL ROOFS) §151(012 (")Lxq-j, a_ e Check applicable box below if the roof addition is exempt from the roofing product "Cool Roof '.requirements. Note: If any one of the boxes are checked below, the Aged Solar Reflectance and Thermal,Emittance requirements for roofing products in §118(1) are not applicable. Do not fill table below. ❑ Roofing compliance Not Required in Climate Zones 1-12, 14, and 16 with a Low -Sloped. Less or 2:12 pitch. ❑ Roofing compliance Not Required in Climate Zones 1 through 9 and 16 with a Steep -Sloped. Roofs pitch greater than 2:12 and product weight less than 5lb/ft2. ❑ Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the above Cool Roof criteria ❑ Roof constructions that have thermal mass over the roof membrane with at least 25 Ib/ft2 is exempt from the above Cool Roof criteria. Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance, otherwise, check he applicable box below if Exempt from the Roofing Products "Cool Roof' Requirement: Roof Slope Product Weight Product Aged Solar Thermal CRRC Product ID Number] < 2:12 > 2:12 < 5lb/ft2 > 5lb/ft2 Type' Reflectance 3,4 Emittance SRI ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www. cool roofs. org prod ucts/search. ph p. 2. Indicate the type of product is being used for the roof top, i.e. single -ply roof, asphalt roof, metal roof, etc. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same directory and use the equation (0.2+0.7(p;,,;,;at — 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance. 4. Check box if the Aged Reflectance is a calculated value using the equation above. 5. Calculate the SRI value by using the SRI- Worksheet at hII12://www.enertrv.ca.gov/title24/and enter the resulting value in the SRI Column above and attach acopy of the SRI- Worksheet to the CF -IR. 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 coatings manufacturer and meet minimum performance requirements listed in § 118(i)4. Select the applicable coating: 13Aluminum-PigmentedAsphalt Roof Coating 13 Cement -Based Roof Coating ::Eher Registration Number: Registration Date/Time: 2008 Residential Compliance Forms HERS Provider: March 2010 Prescriptive Certificate of Compliance: CF -1R ADD Residential Additions (Page 4 of 5 Site Address: Enforcement Agency: Date: HVAC SYSTEMS - HEATING 1 Tt tJC=, Cooling Equipment Type and Capacity 1.2 Minimum Duct or Configuration Distribution Piping (Central, Split, Heating Equipment T e and Capacity 1.2•' Efficiency AFUE or HSPF Type and Insulation Thermostat Space, Package or Location' R -value Type H dronic ❑ YES ❑ NO External Tank Water Heater Type/Fuel Distribution Type Number In 1. Indicate Heating Type (Central Furnace, Wall Furnace, Heat pump, Boiler, Electric Resistance, etc.) 2. Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental (i.e., if total capacity < 2 KW or 7,000 Btu/hr electric heating is controlled by a time -limiting device not exceeding 30 minutes). See §151(b)3 exception. 3. Refer to the HERS Verification section on Pages 3 and 4 of the CF -IR -ADD Form for additional requirements and check applicable boxes. 4. Indicate Type or Location Ducts, H dronic in Floor, Radiators, etc. HVAC SYSTEMS -COOLING ESC tS 1 4. - Cooling Equipment Type and Capacity 1.2 Minimum Distribution Efficiency Type and SEER/EER or COP Location' Duct or Piping Insulation Thermostat R -Value Type Configuration (Central, Split, Space, Package or H dronic ❑ YES 10 NO I Slab edge insulation required for heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation ❑ YES ❑ NO External Tank Water Heater Type/Fuel Distribution Type Number In 1. Indicate Cooling Type (AIC, Heat pump, Evap. Cooling, etc). 2. Refer to the HERS Verification section on Pages 3 and 4 of the CF -IR -ADD Form for additional requirements and check applicable boxes. 3. Indicate Type or Location Ducts, H dronic in Floor, Radiators, etc. WATER HEATING XA tS-rt tJ6 List water heaters and boilers for both domestic hot water (DHW) heaters and hydropic space heating. Individual dwelling DHW heaters must be storage gas or propane fired, non -recirculating, and may not exceed 50 gallons. If no natural gas is connected to the building, an electric storage DHW heater less than 50 gallons with an energyfactor greater than 0.90 maybe used. Hot water pipe insulation from the DHW heater to the kitchens and on all underground hot water pipes is required in all component packa es in all climate zones. Heated Slab Insulation ❑ YES 10 NO I Slab edge insulation required for heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation ❑ YES ❑ NO External Tank Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation Type' Standard, Recirculatin 2 System Capacity al Thermal Efficiency R -Value' 1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The water heating tank and i es shall be insulated to meet the requirements of §1500). SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written justification and documentation and special verification. Applicable special features shall be marked with a YES and be specified within the plans. Fj)C 1 C )u Radiant Barrier (Roof) ❑ YES 113 NO I Required in Climate Zones 2, 4, and 8-15 for additions larger than 100 ft Slab Edge (Perimeter) Insulation ❑ YES 1 ❑ NO In Climate Zone 16 under Component Package D, R-7 insulation is required. Heated Slab Insulation ❑ YES 10 NO I Slab edge insulation required for heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation ❑ YES ❑ NO In Climate Zones 1, 2, 11, 13, 14 & 16 R-8 insulation is required, and in Climate Zones 12 & 15 R-4 insulation is required under Component Package D. Thermal Mass - To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach. Registration Number: 2008 Residential Compliance Forms Registration Date/Time: HERS Provider: March 2010 i ( N 0 Prescriptive Certificate of Compliance: CF -IR ADD Residential Additions (Page 5 of 5 Site Address: Enforcement Agency: Date: HERS VERIFICATION SUMMARY - The enforcement agency should pay special attention to the HERS Measures specified in this Ian G / / checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final inspection. Duct Se ling & Testing HERS verification is re uired or this measure. Company: Date: In all Climate Zones, if a new space -conditioning system (HVAC equipment and ducting) is installed to serve the addition ❑ YES ❑ NO alone, the ducts are to be sealed and tested per § 151(f) 10. City/State/Zip: C$, Phone: -7g - /07 7 - In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned YES ❑ NO space to serve the addition, the ducts are to be sealed and tested per § 152(b)1 D. ❑ EXCEPTION: Existing duct systems to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance are consistent with the information provided to document this that are extended, which are constructed, insulated or sealed with asbestos. agency for approval with this building permit application. Name: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including replacement of the air handler, outdoor Company: Date: condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) and will serve the addition, the ducts License: City/State/Zip: are to be sealed and tested per § 152(b)1 E. 13YES 13NO 13EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. ❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. ❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Refri erant Charge - Split System HERS verification is re uired or this measure. In Climate Zones 2 and 8-15, if a newly ducted split A/C or heat pump is installed to serve the addition alone, a refrigerant ❑ YES ❑ NO charge measurement shall be verified per 151(07A. In Climate Zones 2 and 8-15, if the existing HVAC equipment is replaced (including replacement of the air handler, outdoor YES ❑ NO condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) and will serve the addition, a refrigerant charge measurement shall be verified per 152(b)IF. Central Fan Integrated Ventilation System — Airflow and Fan Watt Draw - do notapply for additions 1,000 ftz or less. Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow and Fan Watt Draw HERS verification is required.. In Climate Zones 10 through 15, if a new space -conditioning system (HVAC equipment and ducting) is installed to serve the ❑ YES ❑ NO addition alone, the airflow and fan watt draw shall be verified per 151 7B. In Climate Zones 10 through 15, if the existing space -conditioning system (HVAC equipment and ducting) is replaced and YES ❑ NO will serve the addition, the airflow and fan watt draw shall be verified per 152(b)IF. Documentation Author's Declaration Statement I certify that this Certificate of Compliance documentation is a Eurate and m Tete. Name: n- / !t f (�1 Signature Company: Date: Address: If Applicable ❑ CEA or ❑ CEPE (Certification #): City/State/Zip: C$, Phone: -7g - /07 7 - Responsible Building Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance are consistent with the information provided to document this building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Name: Signature: Company: Date: Address: License: City/State/Zip: Phone: For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. Registration Number: Registration Date/Time: 2008 Residential Compliance Forms HERS Provider: March 2010