14-0109 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t!t °F XP Q"
Application Number: 14-00000109
Property Address: 80705 CEDAR CREST
APN: 762-060-015- - -
Application description: REMODEL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1000
Appli�/: ' - Archi ct or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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_:_ B _ L_ic_ense_No.:_5-95166
C1 0vvn
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 ($5001•:
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 1, 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.).
1 _ 1 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 Name: _
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/27/14
Owner:
LAVEY TOM
80705 CEDAR CREST
LA QUINTA, CA 92253
Contractor:
DESIGNER SAS I & DOORR�+,UU14f �r
18890 SEATON r NUE `"'iii% 1
PERRIS, CA 9457
(951)830-2131 CfI`1t�I:LAQURV
Lic. No.: 595 66 ri h1,,%nCDrPT
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 INS CO OF WEST' Policy Number WSD500616301
_ 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) forthwithcomply with those provisions.
Dater_ (pplican
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 work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for'180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county-to-enter.upon-the above-mentioned property f pection purposes.
Date: � !-/L/_Signat'r a (Applicant or A� entl:�/6'
Application Number . . . . . 14-00000109
Permit . . . ELECTRICAL 2013
Additional desc . .
Permit Fee . . . . 23.83 Plan Check Fee
.00
Issue Date . . . Valuation . . .
. 0
Expiration Date 8/26/14
Qty Unit Charge .Per
Extension
1.00 23.8300 LS ELEC FIXTURES, FIRST 20
-----------------------------------------------------------------------------
23.83
Permit . . . REMODEL 2013
Additional desc . .
Permit Fee . . . . 60.06 Plan Check Fee
.00
Issue Date . . . . Valuation
0
Expiration Date . . 8/26/14
Qty Unit Charge Per
Extension
1.00 60.0600 LS MISC DR/WIN, REPL, 1-7
60.06
----------------------------------------------------------------------------
Special Notes and Comments
REMOVE 2 WINDOWS AND REPLACE HEADER AND
INSTALL NEW SLIDING DOOR AND EXT. LIGHT
PER CRC CODES.
February 27, 2014 11:54:34 AM JJOHNSON.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
HOURLY PLAN CHECK
105.00
PLAN CHECK, ELECTRICAL
23.83
PLAN CHECK, REMODEL
108.68
STRONG MOTION (SMI) - RES
.50
-Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 83.89 .00 .00
83.89
Plan Check Total .00 .00 .00
.00
Other Fee Total 239.01 .00 .00
239.01
Grand Total 322.90 .00 .00
322.90
LQPERMIT
Din #
City of La Quinta
Building 8L Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name: __O (A (*V
A. P. Number:
Address: O&IT7e)
Legal Description:
City, ST, Zip:
Contractor: DF -61100C-14 $kStt 00op S YSTF_Mt, trC•
Telephone:
Address: IMO 6FArN Avl; ,
Project Description:
City, ST, Zip: t l;l*t s cA • G i.SZ -0
2 . Co fYlA-{,l¢.- 4
Telephone: sl bs7 ' !.� ��
iti;:{::i':i"i>:ti?:;iiiy:+r: iiii'v'•;44i: iiitiv:;ii
:::>;..•;;s.::;>»<:s;:;:::;>;<s:;:: z:>::»::<;
(Jbt� Ce. �l tYl
kp to ere�l
State Lic. #
Cityd,ic. #.. /03 S
Arch., A%g*,4)e4igfter: 6eA R 1
V � Gd 611D CV16
Address: 3Jj-1400 beAA lire, ((%
City, ST, Zi w\
Telephone:
'....
tK
Constructi n ccuP an' •
Type: � cY
State Lie. #:
Project hPa circle one):: New Add'n Altcr Repair Demo
Name of Contact Person: N F1W(L
Sq. Ft.:
Telephone # of Contact Person: 66T- (%
Estimated Value Project: bob
APPLICANT: DO NOT WRITE BELOW THIS LIME,-"
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewegddor torr t'o
Plan Check Deposit
Truss Calcs.
Called Crson �^.
Plan Check Balance.
Title 24 Calcs.
Plans pi " - t �
ConstructionFlood
plain plan
Plans re
Mechanical
Grading plan
god Review, ready for correctio /issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
Grading
H.O.A. Approval
Plans resubmitted
IN HOUSE:-
'"' 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
�u `
CFI K,
Int -2-u ►s '
No ( F I l 1 OU-
\�
P
t Prescriptive Certificate of Compliance:
Residential Alterations
Project Name:
Climate Zone #
CF -IR -ALT
(Pagel of 5)
# of Stories
i1.
General Information
Site Address: at. _ _ C
Enforcement Agency:
Date:
Building Type NSingle Family [] Multi Family
Circle the Front Orientation: N, E, S, W, or degrees
Conditioned Floor Area (CFA):Project
Type: IS AlterationsR
Envelope Fenestration .. Roof , HVAC
Framed Continuous
Replacement or Change Out
Duct Replacement __ Water Heater
NOTE: This form is not to be used for Newly Constructed Buildings or Additions
Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
Q Opening of framed cavity alone—Alterations that involve the opening of the framed cavity of a wall, ceiling, or floor must install the
mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A —C and enter mandatory insulation value in Column H.
rl Replacement of entire assembly— Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component
Package- D insulation values in Table 151-C. Fill in Columns A —J.
Opaque Surface DetailS For the furred portioned of Mass Walls see Furring Strips Construction Table below.
A B I C D E
F G I H I I J
Proposed See 01e Standard
Values From JA4
Table
Added Interior or Exterior Insulation
Framing Thickness,
Framed Continuous
JA4
Proposed
Tag/
Assembly Name
Material Spacing, U-
JA4 Table Cavity Insulation
Assembly
Assembly
ID1
or Type 2
and Size or Other -3 factor°
Numbers R-value6 R -Value?
Cell Value
U-factor9
g > U
c w
2 a
0
o to 0�
om
o :2 -. >
Final
Mass
Name or
JA4 Tabl
dR
E Eo ._X
Assembly
Thickness
Type
Number>
m
U -factor6
Comment
Note: For furred assemblies, accounting for Continuous Insulation R -value, see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and
Furring Construction table below.
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 JA4 Table based on the R -Value from Table 151-B, C, or D
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 I B I C I D I E
F I G I H 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
N
N
g > U
c w
2 a
0
o to 0�
om
o :2 -. >
Final
Mass
Name or
JA4 Tabl
dR
E Eo ._X
Assembly
Thickness
Type
Number>
m
U -factor6
Comment
Registration Number: Registration Date/Time:
2008 Residential Compliance Forms
HERS Provider:
August 2009
.,r
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations (Page 2 of 5
Project -Name: Climate Zon # J—# -of -Stories
Mass and Furring Strips Construction(footnotes)
1. Indicate the type of assembly to include; Hollow Unit Masonry Walls, Solid Unit Masonry Solid Concrete Walls, Etc. Additional assemblies can
befound Reference Joint Appendix JA4.
2. This is the U -Factor based on the thickness of the assembly in inches.
3. The R -value of the insulation to be added on the interior or exterior of the assembly.
4. The Calculated R- Value is the R -value of the furred out section of the assembly.
4 The Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint AppendixJA4. The equation is the inverse of Column
added to Column I. Column K is the inverse from column J.
7. Insert the calculated U- actor value on to the Opaque Sur ace Details in Column J
FENESTRATION PROPOSED AREAS
E3 Replacing window alone — Replacement windows shall meet the U -Factor and SHGC Value requirements of Component Package D in
Table 151-C. The Total Fenestration and West facing Area requirements are not applicable.
Adding 50ft2 or less of window area — Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component
Package D in Table 151-C.
El Adding more than 50ft2 of window area — Newly installed windows shall meet the U -Factor and SHGC Value and the Fenestration
Area requirements of Component Package D in Table 151-C Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF -IR -ALT
Orientation
Fenestration Type and Frame (North, East, PropsedAreal Maximum Maximum NFRC or Default
(Window, Glass Door or Skylight), South, West)__ (ft') U-facto►z•s SHGC's'a Value5—
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 "2 inch frame" around the glass.
2. Enter value from Component Package D Requirements in Table 151-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 CF- I R ALT Form.
4. Submit a completed WS -31? Form if a reduced SHGC is calculated with exterior shading.
5.1fapplicable at this stage enter `NFRC" or NFRC Certified windows or are CEC "Default " values ound in Table 116-A or B.
ALTERED FENESTRATION ALLOWED AREAS
(Complete if more than 50ftz
of fenestration is added)
A
B
C
D
E
F
G
Allowed
Existing
Fenestration
Total Area
CFA of Entire
% of
Fenestration
Area
Fenestration
Allowed
Proposed Areal
Dwelling
CFA
Area
Removed
Area Added
A x B)
(E -D) + C
Total Fenestration Area
20
>
West Fenestration Area
(Required In
.05
>_
CZ's 2,4&7-15)
1. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12.
2. West facing glazing area removed cannot be "counted" twice. " In order to distribute the west glazing area removed to the other orientations,
input the west glazing area removed in the Total Fenestration Area row, column D.
3. Include the Proposed Area of the West facing fenestration in both Area columns below.
4. To meet compliance, the Proposed Area must be less than orequal to the Total Allowed Area or BOTH the Total and West Fenestration Areas.
Registration Number:
2008 Residential Compliance Forms
Registration DatelTime:
HERS Provider:
August 2009
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations age 3 of 5
Project Name: Climate Zone # # of Stories
ROOFING PRODUCTS (COOL ROOFS) §151(t)12
When the area of exterior roof surface to be replaced exceeds more than 50% of the existing roof area, or more than 1,000 ftZ, whichever is
less, the new roofing area must meet the roofing product "Cool Roof 'requirements of §152(b)IHi, 152(b)IHii, or 152(b)IHiiL
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof' requirements. Note: Ifany
one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in
§118(i) are not applicable, Do not fill table below.
Cool Roofs Not Required in Climate Zones 1-12, 14, and 16 with a Low Sloped. Less or 2:12 pitch.
ool Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep -Sloped Roofs (pitch greater than 2:12) and product unit weight less
than 51b/ft2.
Alternatives to §152(b)1Hi and §152(b)Hii, Steep -slope roof (pitch > 2:12)
Insulation with a thermal resistance of at least 0.85 hr -ft?? °FBtu or at least a 3/4 inch air -space is added to the roof deck
over an attic; or
Existing ducts in the attic are insulated and sealed according to §151(f)10; or
In climate zones 10, 12 and 13, with 1 ftZ of free ventilation area of attic ventilation for every 150 ftZ of attic floor area, and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or
Building has at least R-30 ceiling insulation; or
Q Building has radiant barrier in the attic meeting the requirements of § 151(f)2; or
Building has no ducts in the attic; or
In climate zones 10, 11, 13 and 14, R-3 or greater roof deck insulation above vented attic.
Exception to §152(b)1Hiii, Low -slope roof (pitch:52:12)
El Building has no ducts in the attic.
Other Exceptions
Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria.
Roof constructions that have thermal mass over the roof membrane with at least 25 lb/ftZ is exempt from the below 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 the applicable box below if Exem t from the Roofing Products "Cool Roof Requirement:
Roof Slope
Product Weight
Product
Aged
Solar
Thermal
CRRC Product ID Number[
5 2:12 > 2:12
< 5lb/ft2 > 5lb/ft2
Type 2
Reflectance
3,4
Emittance
SRI
E
El
13
E]4
0
El
U
C]4
13
E
E
El
11
El
0
13
0
11
®
U4
1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolroofs.org/prodticts/search.php
2. Indicate the type of product is being used for the rooftop, i.e. single ply roof, asphalt roof, metal roof, etc.
3. 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(pi„ iiia[ — 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 http://lvivtiv.enerev.ca.govltitle24/ 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(1)4. Select the applicable coating:
Aluminum -Pigmented Asphalt Roof Coating
0 Cement -Based Roof Coating
._ Other
Registration Number:
2008 Residential Compliance Forms
Registration Date/Time: HERS Provider:
August 2009
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations Page 4 of 5
Project Name: Climate Zone # # of Stories
HVAC SYSTEMS - HEATING
List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be
gas or propane fired. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground hot water pipes is required in all
Minimum
Duct or Piping Configuration
Heating Equipment
Efficiency Distribution
Insulation Thermostat (Central, Split,
Type and Capacity 1,2,3
AFUE or HSPF Type and Location
R -Value Tye Space, Package or Hydronic)
Distribution Type
Number In
Tank
Energy Factor or
Insulation
Type'
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(6)3 exception.
3. Refer to the HERS Verification section on Page 4 of the CF -1 R -ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location (Ducts, Hydronic in Floor, Radiators, etc.)
HVAC SYSTEMS - COOLING
Minimum
Efficiency Duct or Piping Configuration
Cooling Equipment
(SEER/EER or Distribution Insulation Thermostat (Central, Split,
Type and Ca acity',2
COP) Type and Location; R -Value Tye Space, Package or Hydronic)
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
1. Indicate Cooling Type (A/C Heat pump, Evop. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF -I R -ALT Form for additional requirements and check applicable boxes.
3. Indicate Tye or Location (Ducts, Hydronic in Floor, Radiators, etc.)
WATER HEATING
List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be
gas or propane fired. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground hot water pipes is required in all
component packages in all climate zones.
External Tank
Water Heater Type/Fuel
Distribution Type
Number In
Tank
Energy Factor or
Insulation
Type'
(Standard, Recirculating)Z
System
Capacity (gal)
Thermal Efficiency
R-Value3
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 external water heating tank and i es shall be insulated to meet the requirements o §150 ).
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items may require written 'usti ication and documentation and special verification.
NEW ROOF ASSEMBLY - Radiant Barrier
The radiant barrier requirement of §151(f)2 does not apply to roof alterations.
Slab Edge (Perimeter) Insulation 0 YES EJ NO
YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required.
Heated Slab Insulation YES rlNO
YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation. YES [] NO
YES: In Climate Zones 1, 2, 11, 13, 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15, R-4 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:
August 2009
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
rResidential Alterations Page 5 of 5
Project Name: Climate Zone # # of Stories
HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this
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 Sealing & Testing HERS verification is required for this measure.
YES NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space, the ducts are to be sealed per §152(b)IDii and the newly installed ducts are to be insulated per §151(010.
0 EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
YES NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the
ducts are to be sealed per §152(b)1Di.
YES NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler,
outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be
sealed per §152(b)IE.
EXCEPTION: 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.
Refrigerant Charge -Split System HERS verification is required for this measure.
® YES NO YES: In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per 152(b)1 F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of §150(o) do not apply to existing residential homes.
Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
YES NO YES: In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is
replaced, the airflow and fan watt draw shall be verified per § 152(b)1Ci to meet the requirements of §151(07B.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name:
Signature:
Company:
Date:
Address:
If Applicable _.. CEA or[3CEPE
(Certification #):
City/State/Zip:
Phone:
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 1 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:
2008 Residential Compliance Forms
Registration Date/Time: HERS Provider:
August 2009