BPLB2014-1047. 0
78-495 CALLEJTAM IP CO
LA QUINTA, CALIFORNIA 92253
c&tit 4 aw
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPLB2014-1047
Property Address: 52385 AVENIDA RUBIO .
APN: 773252017
Application Description: WATER HEATER CHANGE OUT
Property Zoning:
Application Valuation: $1;500.00
Applicant:
MASCO CONTRACTOR SERVICES OF C
260 JIMMY ANN DRIVE
DAYTONA BEACH, FL 32114
LICENSED CONTRACTOR'S DECLARATION
40GALLON/ELECTRIC
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect. c
Licenn%ssefClass: C33, C-2, D28, D24. B. 0655//, C20 Licensee No.: 22151/777
Date:;;Ya2/y Contractor:/ C2.;_ t
i
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 s
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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/4/2014
Owner:
ANGELA QUINTANA
52385 AVENIDA RUBIO
LA QUINTA, CA 92253
Contractor:
MASCO CONTRACTOR SERVICES 0
260 JIMMY ANN DRIVE
DAYTONA BEACH, FL 32114
(386)304-2222
Llc. No.: 221517
WORKER'S COMPENSATION DECLARATION
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' .
ompensation, as provided for by Section'3700 of the Labor Code, for the performance
oPthe wok for which this permit is issued.
-1•4ve. and will maintain workers' compensation insurance, as required.by
Sectio63700 of the.Labor Code; for the performance of the work for which this permit
s issued. My workers' compensation insurance carrier and policy number are:
Carrier /—MvP01 cy Number:
`1I certify that in the performance of. the work for which this permit is issued, I
hall 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 f rthwith
co�with those provisions. /w►
Date: 1z/y/�6r Applicant•:"�/
1/ 1
permit subjects the applicant to a civil penalty of not more than five hundred dollars WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(_) I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES:
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 I
within one year of completion, the owner -builder will have the burden of proving,that". t
he or she did not build or improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors r
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' i
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.). f
(_) 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:
APPLICANT ACKNOWLEDGEMENT
MPORTANT:Application is hereby made to the Building Official for a permit subject to
he conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
equest'and for whose benefit work is performed under or pursuant to any permit
ssued 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
ollowing issuance of this permit. ;
2. Any permit issued as a result of this application becomes null and void if work is
iot commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
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
:onstruction, and hereby authorize representatives of this city to enter upon the above-
nentioned property for inspection purposes. -.4
)at o1' 1)—/ I Signature (Applicant orAgent)
z
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WORKER'S COMPENSATION DECLARATION
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' .
ompensation, as provided for by Section'3700 of the Labor Code, for the performance
oPthe wok for which this permit is issued.
-1•4ve. and will maintain workers' compensation insurance, as required.by
Sectio63700 of the.Labor Code; for the performance of the work for which this permit
s issued. My workers' compensation insurance carrier and policy number are:
Carrier /—MvP01 cy Number:
`1I certify that in the performance of. the work for which this permit is issued, I
hall 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 f rthwith
co�with those provisions. /w►
Date: 1z/y/�6r Applicant•:"�/
1/ 1
permit subjects the applicant to a civil penalty of not more than five hundred dollars WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(_) I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES:
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 I
within one year of completion, the owner -builder will have the burden of proving,that". t
he or she did not build or improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors r
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' i
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.). f
(_) 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:
APPLICANT ACKNOWLEDGEMENT
MPORTANT:Application is hereby made to the Building Official for a permit subject to
he conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
equest'and for whose benefit work is performed under or pursuant to any permit
ssued 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
ollowing issuance of this permit. ;
2. Any permit issued as a result of this application becomes null and void if work is
iot commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
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
:onstruction, and hereby authorize representatives of this city to enter upon the above-
nentioned property for inspection purposes. -.4
)at o1' 1)—/ I Signature (Applicant orAgent)
.}; '�' '; 7Al : .:%a XIIaA}i.� > �" A$',` tc' , .' T • ., `j`ri�,i}"5ti"�Y�'4�Y`j ' �}�z 't t;Yn71�+. , c 1 i�fi •s�^'GS}' S r+..,. &:�f'tii D}Ts�'tEa`� �i �l•' daYirt.' f:f�s'l CvN`4
iDESCRIPTLONi : ��� ACCOUNT QTflY�AMOUNT . +=PAIDPAIf)DATE
.t7..S•Av.t'?^7[3setk._N.JY9�if+s'z,_'ele_+i%[}.+9i..�.,':..t.)ca{
BSAS SB1473 FEE
0-20306 r' 0� '. '$1'.00
$0:00
y
.A�$�'�NN
.)••':+.y�'��y`.'@z�. '��
JFy,"{
��4'wE �''j;j#,+Y�.;?�iM-E"�Tc.H�ur�O:6}D;J�'`.�� �v�'i:, +�Y,��,Y: �,'�9"+ 'y,••�$.RifE-C,f.^E.`�`3iF'Tt�j#R,j,s��Y ` �R, .SR -II
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R-."_'.!*f4,V.Ei[A'b"1�3v�...U..Y.: c.Y NLS:i4b N)..✓wXa +i
Total Paid forBUILDING`STANDARDS ADMINISTRATION
BSA: ..$1.00 $0:00
''iXt'3,ahY1S`i-"2x'g'•-"`ae., a. :� •i'Y,i"'pj
m �. xDESCRIP.T110Ny �4`. .,.
ACCOUNTS �}
QT,YFAMQUNTp
wiacPAID'?PAID;UATE`
�. ,.+.rd>xt;k:�A r.9.I�.f.rr.
ft!W
PERMIT ISSUANCE
101-0000,=42404.
0$91.85
$0.00
"` ^o+.P,� .. ,; rt*` 8r .
,k - NEW,
+”ME,T;HO'
eS4:�:az Fi;&"�'4K.;:.;tt'uc.n;wnw'k71�3
•.''Es'""r .;+Y'1 ?�.. t-5 .«"�
s_l.a=.f.RECEIPT=#
a,
S ... y tai MFS-azFrr s ..'- r
gm
f_:�CHECK°yam
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ON . ' 7-f�iT•1�} •yfig.•"'i?
56y(3�.
". dk"^.'4-' .—ny,_rr„, `vs
�CLTD�BY.
.Total Paid for PERMIT ISSUANCE::: ,$91•.85 $0.00
t �'`".yi .i•'CliY3_y..t {i i ..4'�2'$41'�.?U.X1_..>' Y.(.'.t 5.re. a, 1
"DESCRIPTION^ N • , ++w`2jF
i -•. "r• : ' H4)SS^ ,i' e+"w 1' . ^nv 4. ):
q•.'ACCOUNT; �,
�%uY.�..,
u"h fj?j .�k
iQTY
r�.:ii„ClkYr
Yj' 1 L'
�{ AMOUNT
•G"'....'�..+:.l,:fiL PJnLfYrvL�...
rPAI�D
'sG.':fYDPY
PAS ID,D'ATEs
.fMxx9..w.6Y.wiT{+..: 4Yi
WATER HEATER/VENT
101-0000242401.
0
$1Y:09.,
$0.00
g -•f` 3 �'•. ZP'arSFk;. V";+;. da'� Ly
�<<
,,,,tea kzr. ✓.c3..,a s.,.n. .S•M"L
nb, t ON 11,,11r��
,.k �A �7 A' d77F rk3kJ c r #.x'a
t '�`METHOD,.n F,
-:a.r Rd° zxik.,
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r ,Y X1...3'k')sa..NkE s A
'=RECEIPT?r#�h
� �amtxscu4. u. �. �
'7 '�l?`yq ;s
CHECK #:
v k s� ������,
ssr'xzusuu..,a+tiW <ur
�CLTUBY k;
�?Ijm�b�:�
i DESCRIPTION � `�
.f_.'.[. , f1Pai`t'�'R}}r+._...,,G�/;iv.
c1 ta,"y"tCT3.iij:•rx..F�. *�'9E'F'.�i
x�,� CCQUNT€ M�AID
.Lr3 1,::.�. .•.Avo-3...`,Y',bi.%!i +ifiC
1,�.i&•.�,�i?:'� �t''u'kY,F1'.iaa�.9 )i„x'' fi
,i i"1.,.�i:4ifs r'�e. t'Sil�?P24�fif.. .a.lx
'.�:�'�i'1�-.zt.a �o-'+°9�j.�b”-s:;.'%r9i
A
x ��PAID
lrrm h. iKii'• �i
DATE
...23+Q.:..-1{'TA'ffitYs_::
WATER HEATER/VENT PC
101-00010-42600''
0 $7.25
$0.00
tfa s :,'1`4>'0.' j n�a„*�.z,^1
RUN s
"Ir;�'b,.gxF�F�AIDBY�,�r,���
?' .;" x•: +sarc 1
:t�sM,?'"�e .. R;^r..,C.3' Sa'i:•i}Lt.4C`
�...'� �� MET�HOD.�z,� i+{v ���
s_ ahTfih%rvR.Si:.4W;6"..
��dREGC`��°`��
�•Yeq:+.bT+ j
�'�"�CHEC�# ���u�
,�;J}".". 5...-
t f ' Y
CCT�D�B�Y�,
Total Paid'forPLUIVIBING FEES $19 34 $0.
n.
.S-
J a. i �, .Iif'iy r ..- �e � �F � i `� '' s � r y,. c 5 c, < j ♦ �." - � � - �r` "s' �-n ems` E
�C P-�� •.. - „� airy - � `�,� ' .� - • 0 i> � :�� .: y�r
FM OF,Ttn'- T.r ' - � ,.��,im d ,�w*r++-.d'r�'.�r."' S•=17F
Description: WATER HEATER CHANGE OUT - 40GALLON/ELECTRIC
Type: PLUMBING Subtype: Status: APPROVED
Applied: 12/4/2014 SKH
Approved: 12/4/2014 SKH
Parcel No: 773252017 Site Address: 52385 AVENIDA RUBIO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 9 Lot: 6
Issued:
UNIT 1
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $1,500.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
MASCO CONTRACTOR SERVICES OF C
Details: WATER HEATER CHANGE OUT - 40GALLON/ELECTRIC [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
Printed: Thursday, December 04, 2014 12:11:43 PM 1 of 2 ,
SYS rEMS
CONTACTS
CITY STATE ZIP'--�: . PHONES
-
APPLICANT
MASCO CONTRACTOR SERVICES OF C
260 JIMMY ANN DRIVE
DAYTONA
FL
32114 (760)574-2114
BEACH
CONTRACTOR
MASCO CONTRACTOR SERVICES OF C
260 JIMMY ANN DRIVE
DAYTONA
FL
32114 (760)574-2114
BEACH -
OWNER
ANGELA QUINTANA
52385 AVENIDA RUBIO
LA QUINTA
CA
92253 1 (760)574-2114
Printed: Thursday, December 04, 2014 12:11:43 PM 1 of 2 ,
SYS rEMS
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to
'71
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-,'.,'-DESCR
g kx F IPTIOW
C J77
ACCOUNT
--.,AMOUN
�,,RECEIPT#.:
CHECK
'--XH
THOD'
PAID P .""5
13SAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
WATER HEATER/VENT
101-0000-42401
0
$12.09
$0.00
WATER HEATER/VENT
101-0000-412600
0
$7.25
$0.00
PC
Total Paid for PLUMBING FEES: $119.34 $0.00
Printed: Thursday, December 04, 2014 12:11:43 PM 2 of 2 CRW.,YSTEMS
;3�.y,�k, � :�� * c ti , a~` . iir`� '�-����mw o- c �>;' ,��-. e.• � ® h rF'� G �'� y .` � 3 s 'F .a [t �� � a v � � � ' "
•c T... �. r .Y, wviAl
t
F'H pp.•nt0� # +. �J.. V"3 y ;�
' fir
Description: WATER HEATER CHANGE OUT - 40GALLON/ELECTRIC
Type: PLUMBING Subtype: Status: APPROVED Applied: 12/4/2014 SKH
Parcel No: 773252017 Site Address: 52385 AVENIDA RUBIO LA QUINTA,CA 92253 Approved: 12/4/2014 SKH
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 9 Lot: 6 Issued:
UNIT 1
Lot Scl Ft: 0. Building Scl Ft: 0 Zoning: Finaled:
Valuation: $1,500.00 Occupancy Type: Construction Type: Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: WATER HEATER CHANGE OUT - 40GALLON/ELECTRIC [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO
FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
�,..,� .rx.s a. ..,n•.Y ,.. ....r. :rr.y :.�:.;w? wl!:'v.+ .,a_$:.'.s. +f:'T," .",T' .kT>F.r' "q't ,t:.i.,.,u; P53,".:,d�°a+�yy`��T%_"!".-+�`3" "'e,J" 'r?•�
9.. i r' .�' ' �..Qu :.s.,, .�,i"x. �.'� '� .j. :;� ,i, . -k �,}.. ..t., :w, .zfl_.. ti;Y, ..7�'r p.� �%'.r. •
,-...i;.FINANCIAL°INF.ORMATION au
:4�'yi�.b�'�'.'F.`.?.S'�'_'§:�!hC �`1 �Yae: i':...t .0 :�. �:.A M_ty.'.4i�.s'Y-•.'"i'�.=:�- i�.aa.. "^Yep �^::.f:^:, - ..n.L,.� ae3.e^.:-`�leu..,•.�rs:.iY..t �at�S�... '•wt�'4�`�2.�aY:t M�'J. HrL4�s+.?':A:��..-Y,:vi
Printed: Thursday, December 04, 2014 12:11:43 PM 1 of 2
SYSTEMS
0
PARENT PROJECTS
Printed: Thursday, December 04, 2014 12:11:43 PM 2 of 2 CN?WIYSTEMS
7 T-
CLT1D`
DESCRIPTION:.
-"-ACCOUN
;J; AMdU
PAI
AID'
DATE
R
METHOD
PAID
.f6l
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
WATER HEATER/VENT
101-0000-42401
0
$12.09
$0.00
WATER HEATER/VENT
101-0000-42606
0
$7.25
$0.00
PC
Total Paid for PLUMBING FEES: $19.34 $0.00
TOTALS: -$112.19 $0.00
0
PARENT PROJECTS
Printed: Thursday, December 04, 2014 12:11:43 PM 2 of 2 CN?WIYSTEMS
Bin. #
City. of La Quinta.
Building &r Safety Division
P.O. Box 1504,78-495 Calle Tampico
U.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: Sa 3 t�s Vev I_fA2 0 6'1 j)
Owner's Name:. iq
A. P. Number:
/
Address:
Legal Description:
City, ST, Zip: V}
g �v1,JT
Contactor. SC CO v +�
Telephone: ��:• yrs mak;
Address: 3
Project Description:
City, ST, Zip: re SI 5 d
`
C, 1635 4Z �e/s Ia
Telephone:
e
State Lie. # : a 5 .
City Lie.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephoner Y. a ,+
State Lic. #: , • 'yam
.<...
Name of Contact Person:
Construction Type:. L- VAt b tN Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Unit$:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Giading plan
214 Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE--
3d 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
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS '
CEC-CF1R-ALT-01-E Revised 06114 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescriptive Residential Alterations (Page 1 of 4)
Project Name: Date Prepared:
A. GENERAL INFORMATION`
Ol
02
01
Project Name: o—re,
02
Date Prepared: `
03
Project Location: -5,P 5 .J
04.
Building Front,Or,ientaQn (deg or cardinal):
05
CA City: A
06
Number of Alt re ed�U elling Units: lr
07
Zip Code:.
08
Fuel Type: a
09
Climate Zone:
10
Tot3l,Con�dtioned FloorArea
11
1 Building Type ,y 14
12
' Slab Area (ft2) A
13.
1 Project Scope:
I.... - 1, 1 � � —.% . - '.
B. BUILDING INSULATION DETAILS (Section 150.2(b)1)
Ol
02
03
04
05
06 07 _ 08g U9
10
11
Tag/ID
Assembly Type
Frame
Type
Frame
Depth
(inches)
Frame
Spacing:
(inches)
Ap-p-'r-
Required
Comments
Confinuous
Cavity Insulation
R -value R -value-> Uifactor
4A—PP JA4
Reference
U Factor
Table Cell
Pitch
Exception
Number
,,P,roductType Insulation
Reflectance_ Reflectance Emittance (Optional) Reflectance Emittance (Optional)
C
� T,
,9
NOTES '
C. ROOF REPLACEMENT (Prescriptive Alteration;°S
i,'on` , 51 0.2(b)1H
Ol
02
03
09
05 06
'0.7 08 09 10 11 12• 13
R -value
Pro osed Minimum Required
Method of
Roof
CRRCIP duct ID
D k
initial Solar Aged Solar Thermal SRI Aged Solar Thermal SRI
Compliance
Pitch
Exception
Number
,,P,roductType Insulation
Reflectance_ Reflectance Emittance (Optional) Reflectance Emittance (Optional)
C
� T,
m
NOTES '
• Roof area covered by building�ntegrated ph-oottoyoltaic panels and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field applied=coatingss must comply with nstallation criteria from section 110.8(i)4.
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CF1 R-ALT-01-ERevised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE C.1`I11=ALT-01-E
Prescriptive Residential Alterations (Page 3 of 4)
Project Name: T -Date Prepared:
F. SPACE CONDITIONING(SC) SYSTEMS — HEATING/COOLING (Prescriptive section 150.2(b))
01 02 03
AP
Dwelling Unit Name Dwelling Unit CFA (Ft2) Com nth .,
G. WATER HEATING SYSTEMS (Section 150.2(b)1G)
01 _
02
03
04
05
06
07
08
09„s ,
10
X11:
X12
13
14
15 _
System Identfication or
WaterHeating System
entiflcation
Alteration to the Space
N of
Water
(ft2`)
eA&Tame
I or Name
y
Comments
Water Heating
Water
Heater
10He
Back -Up .
_System-
Water
Water
Heaters
Storage
Rated
Rated
,
Heating
g 's
ff
Exterior
Solar
Dwelling Unit DHW
Identification or
Heating
Heater
in
'Volume
Fuel
Input
Efficiency
cciency
Standby:
Insul.
Savings
Central DHW System
System
Name
System Type
Type.
system
(gall
Type
Type
Value
Type
yalue
Loss,(%)
I -R-Value
I Fraction,
I Distribution Type
Distribution Type
A�`a.�do�
fs Lfi"�c
t
e
s
rtQ-
_. Vis:
•`�ih.�
�
.�
•.
�
H. SPACE CONDITIONING SYSTEMS AND WATER HEATING SYSTEMS IN.MULTIFAMILY DWELLING UNITS
-.
01
02U
_ 03
040`
05
06
Central W-attkQHeating
p, Yelling Unit
Dwelling Unit:
Dwelling Unit,�Total 6FA
System Identfication or
WaterHeating System
entiflcation
Alteration to the Space
Dwelling Uriit Name
(ft2`)
eA&Tame
I or Name
-Conditioning System(s)?
Comments
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CF1 R -ALT -01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE bF COMPLIANCE •CFIR-ALT-01-E
Prescriptive Residential Alterations (Page 4 of 4)
Project Name: Date Prepared: 1,2 /c
DOCUMENTATION AUTHOR'S'DECLARATION STATEMENT,
ffi
1. 1 certify that this Certificate of Compliance documentation is accurate and complete. ,, .. -
Documentation Author Name:
Documentation Author Signature:
-. Il
Company: -
Signature Date: -
k.
Address:
CEA/ HERS Certification Ideniificatign't(if applicable):
City/State/Zip;
SI a s _
Phone:
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. I am eligible under Division 3 of the Business and Professions Code.to accept responsib for the building deslgenior system design identified on this Certificate of Compliance (responsible
designer). "
3. That the energy features and performance specifications, materials; components and manufactured ewces for the building -design or system design identified,on this Certificate of
Compliance conform to the requirements of Title 24 Pait h and Part 6 ofahe Cornia'Code of Reg tions.
4. The building�design`features or system, d'esigrrfeatures Identified on this Certificate of Co gl ance are.con"sisten t t Information provided on other applicable compliance documents,
worksheets; calculations, plans and specification's submitted to f nfor_c ment age'Mor pproval with this ISu'I�I„ding permit application.
Corulia be available the
5. I.will ensure that a registered copy of this Certificate of e3shall made aua"Ilaabb.le with the bu'Idl inyg permits) issued for theibuilding,.and made to enforcement agency
for all inspections. I that Certifica`tehf Compliance is requlred'to be included with documentation the builder provides to the building
applicable understand a registered'co�pVk this the
owner at occupancy. _
Responsible Designer Name: `
Respgn�sible Designer Signature:
Company: -
Date Signed:
r
Address: N l`
License:
Clty/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: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014