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12677 (SFD)CV P.O. BOX 1504 Building 54-060 Avenida Ramirez 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Viumbils Inc Mailing Address P.O. Box 1555 City Zip Tel. La Quinta, U 92253 564-1335 cM M`.011, Inc . Ad r4We City lZip ITel. State LiaB 537333 (City 2526 & Classif. Lic. # Arch., Engr., Designer Address I Tel City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed un0er provisions of Chapter 9 (commencing with Section 7000) o piyis io rpf th siness and Professions Code, and my license is in full j rce 9df / effec �iV lG�' f o SIGNATUREf (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). ❑ 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, 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 or proving that he did not build or improve for the purpose of sale.) ❑ 1, 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.) ❑ 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 o. Company opy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if 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 I hereby 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 sof this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. BUILDING: TYPE CONST. OCC. GRP.. A.P. Number 774-222--003 12677 Legal Description .? Lot 22 Block 284 Project Description SPI) REMARKS 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 INSPECTOR Issued by: Date Permit \ Validated by: Validation: /1l i 1 Sq. Ft. 1419 No. Size Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Permit includes rear south, and front garden walls. Pool permit to be obtained separately prior to construction of 50 front walls. Estimated Valuation $90,216.00 PERMIT AMOUNT Plan Chk. Dep. '' vu Plan Chk. Bal. 2509.87 Const. 599.00 Mech. 62.00 Electrical 123.33 Plumbing 141.100 s.M.l. 9.10 Grading 20.00 Driveway Enc. .00 Infrastructure 1,882.42. TOTAL '7dI• G W-0 -1d. REMARKS 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 INSPECTOR Issued by: Date Permit \ Validated by: Validation: /1l i 1 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES , 1ST FL. SQ. FT. ® $ UNITS ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK YARD SPKLR SYSTEM 2ND FL. SQ. FT. DUCT WORK ROCK STORAGE FOUND. REINF. 1 MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® REINF. STEEL GAS (FINAL) TEMP. POLE POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® FINAL INSP. BOND BEAM WATER SYSTEM DRAINAGE PIPING CAR P. I SO. FT. ® LUMBER GR. I WALL SQ. FT. FINAL INSP./(�_Gj( /(, c DRINKING FOUNTAIN. kyr /( URINAL SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB FINAL INSPECTION G L SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. r SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL FENCE FINAL SQ.FT.GAR ® 3/ac HOUSE SEWER INSPECTOR'S SIGNATURES/INITIALS GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE EH� DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK La GROUND PLUMBING %�I?-� (PUNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. 1 GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP./(�_Gj( /(, c ROOFING I, ZgP—gq 140 kyr /( REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL'`/p...rillz P `! L LATHING MESH INSULATIONISOUND.Z FINISH GRADING FINAL INSPECTION G L CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Tit,/ �rw . P.O. BOX 1504 APPLICATION ONLY Building �� /�f ad CALLIDO Address LAQ.DINTA,CALIFORNIA 9 2253 Owner .� Address H �'ty.l. cD 19' z 2; —3 1Te�� — .I 33z I Con;ya�tQ U � EJ Address / ip ITel. State Lic. City & Classif. �= S3 333 Lic. # Arch., Engr., Designer L�- oc� I Zip (State Lic. # LICENSED CONTRACTOR'S DECLARATION . I hereby affirm that I am licensed under Drovisions 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.Susiness and Professions Code: Any city or countywhichrequires,.a permit to construct• after, improve. demolish, or repairany structure, prior to its issuance''also requires the applicant for such permit to file a signed statement fhaVhe is ocensed',pursuantto the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000)sof Division 3 of the Business and Professions Code. or that. he is exempt therefrom, and,fhe basis for the alleged exemption. Any violation of Section- `7031'.5 by any applicant; for 'a pefnW subjects the applicant 10 a civil penalty of not more than live hundred dollars (5500). I, as owner of the property, or my employees with wages'as their,sole compensation,; 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 oweei of properfy',who' builds of improves thereon and who does such work .himself or through his own eillpldy6e5. provided that such improvements are not intended or. offered for sale. It' however, the budding or improvement is sold within one year of completion• the owner -builder will have the burden of proving that rte did not build or improve for the purpose'o/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 'LicenseLaw does not apply to an owner of,properly who builds'or.lmproves thereon, and who contracts for such projects with a conllactorls) licensed pursuant to the Contractor's License Law.) 11 1 am exempt under Sec. B. 8 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. rt` e. CERTIFICATE OF EXEMPTION FROM, WORKERS' COMPENSATION INSURANCE (This section need nor be completed if the permit is for one hundred dollars (f 100) valuation or ress:) 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. Date Owner NOTICE TO APPLICANT: It. after making this Certificate of Exphiplion you should! pec me 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 1hereby 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 - Lendeis Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended foi180 days. I certify that I have read this application andstate that the'atiove Information is correct: I agree to comply with all city and county ordinanees'and:.State laws relating to building construction,' and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. DING: TYPE �C7ONST. OCC. GRP. Number' / 4— ?-1Z- 0JD3 II Description Low OLA, :ct Description '�r^J ZONE: BY: 77 -- 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 INSPECTOR Issued by: Date Permit Validated by: Signature of applicant ' Date I Mailing Address Validation: City, State. Zip Sq. ) Ft. (t No. f Size '[ (ol Stories J No. Dw. I Units 'New Add ❑ Alter ❑ Repair O Demolition ❑ Estimated Valuation PERMIT 1 AMOUNT Plan. Chk. Dep. U Plan' Chk: Bal. Const. Mech. Electrical -Plumbing S.M:I. Grading Diiveway Enc. Infrastructure TOTAL REMARKS .. I ZONE: BY: 77 -- 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 INSPECTOR Issued by: Date Permit Validated by: Signature of applicant ' Date I Mailing Address Validation: City, State. Zip DESERT SANDS UNIFIED SCHOOL DISTRICT Highway 111 ` w: NOTICE:. Indio; CA "92201 Document Cannot Cannot '7 - f Date :1/11`/94. L n,,;-+ No. 17610" Owner Name Mumb.4, _ 1Ac No. 54060- stieet•.,Aven Crty La;Quinfa � APN # ` # tracType of Development'- Comments Type of Pernut a: a Permit #. Log 3a Ramirez E i p ;9225' " Study Area 110. Lot #.0 Square Footage - 1419. i.:.., No. of units 0 .4; At the present time; the Desert -Sands Unified- SchoolADistrict does not collect, fees on garages/carports, covered-patios/walkways,�`resid'ential,adaitions under 500 square feet, detached accessory 'structures or replacement mobileh`omes: It has been: determined the. above-named, owner is exempt" from paying school fees at this time due to the following reason: s s EXEMPTION NOT APPLICABLE This certifies that school fac 1, tyi.fees imposed pursuant to Government Code -53080 x in the amountao'f 165::• X 1419.�.o`r $ 2;34135`=, have bieenpaid to D.S.U.S.D. for the ,property listed above and that building permit`s. and%or Certificates.,of Occupancy for this square footage ifiAhis proposed project;may now U'e4ssued.- Fees Paid By-Mumbil,._Inc. x _ ;:= Telephone 564-1338 Name on�the check ' By Dolores A: Ballesteros Superintendent - U .. Fee collected /exempted by V1'Ckle J:,Durrett Payment ReceiUed LSignature l,�rE�C Check No. 6466 Collector: Attach a copy of -county ori -city. plan check:ap,plica'tion form to district copy for all waivers. Embossed Original- Building Dept./Applicant �'' Copy Applicant/..Receipt Copy' Accounting O•' ,y CIO) F- t,y AND WHEN RECORDED MAIL TO Natne Mumbil, Inc. Street c/o Mary C. Marshall Address 1 Vista del Golfo City & Long Beach, CA 90803 .State L J MAIL TAX STATEMFNTS TO F_ Natne Same as above Street Address City & 'state L CAT. NO. NNo0582 TO 1923 CA (2-83) sn.a Ofl >K �, 11C h x S d~ M .$ 0"� Qagca V _. w o Bli q LV i G~�" r C7 Q a oa a s 3 S SPACE ABOVE THIS LINE FOR RECORDER'S USE Individual Grant Deed THIS FORM FURNISHED By TICOR TITLE INSURERS I'lic undersigned grantor(s) declare(s): Documentary transfer tax is $ 75.90 aa ( X) computed on full value of property conveyed, or ) computed on full valueless value of liens and encumbrances -remaining at time of sale. ( ) Unincorporated area-.( X ) City ofLe Quinta - - , and _- IrOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, H. H. BLACK and HAZEL J. BLACK, husband and wife hereby GRANT(S) to MUMBXL, INC., a California corporation the following described real property in the City of La Quinta County of Riverside , State of California: Lots 3, 4, 21, 22,/ _ln f Bloc 284 of Santa Carmelita at Vale La Quinta, Unit No. 26, as per map re orded in B 20, page 50 of Maps, in the office of the County Recorder of Riverside County. Dated: December 12, 1988 All _ H. N. Black ~� STATE OF CALIFOIZNI _ COUNTY OF On �Cn� / 3 �' before Inc, the undersigned, a N�f ary Public in and for said State, Haz J. B1ae personally appeared personally known to nfcor proved to me on the basis of sat- isfactory evidence to be the person _..,whose name subscribes to the within instrument and acknowledged L � S: i'• chat the the same. WITNESVPy hand and fficial seal. a;, rt �•, i { �� ,(fir: t ` M1•. �,I t:�l:..9 t •. ..!.:. t;, ',r:'• Signature !�-'�`��')tQ i2r1.7�- 'TG•./L�7'i��' ��iia..e"✓� P.j �.c.. •. t'ti'F.4y.;C'q. Ai. IiX) Title Order No. Escrow or loan No. (This area for official. notarial seal) 88-1524 MAIL TAX STATEMENTS AS DIRECTED ABOVE Z COAC14ELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL . •may. Received From: f Ll r Address: Account ll • ❑ - U tot1sl 5q ill ij,� Service Address !P A�Mel9rltii .�' Service{s] ❑ 13ackflowial ❑ House tataraltsi ❑ DetectorChack(a) p Mater Surcharge 2-uanttatlon Capacity Charge CI W.S.B.F.C. ❑ Temporary Const ructIOn Meter ❑ Tum an Charge 0 Uncollected Account - Name L7 inspection Pee - Tract - Fee - * Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A,D. - Sond ❑ Cuslomer Deposit CJ Other Remarks: FJ COPY to: Cash Check Money Order Kfi1v�Y'�"F'e :..�.. "1^ n+rr"S+wwc+n•.�.v�rT•a�•��yy..-.. _ . N 46691 LL L. c Track ., ��'• dQCJt—,- G.A. Code $ 5 tr 1 g TOTAL .�. C l L •` r – Water Service (11;83) ,ow Ull�l W14 Mp An j 0 OF. _(O'jiffit T1, lei af t, Va U This Certificate', -issued pursuant to the.requirements of S6ction'306 o0he Unif6ini. Building!"Code - certifying, that at the' tim6,of issuance thit�strdcfure.7,was' in"&o'mpiI , ance'with.M6 various. ordinances of-.thi City regulating building construction or use: e., or ifie., f611owtng:-ti ,' - Z BUILDING* ADDRESS, ' 54-060 "'.A.VENIDA RAMIREZ A". Us e, Classification Single Family, Dwelling Bldg.'Permit No. 12677 VN jR3 J Type Construction ction. Fire Zone_._.:_ Use zone --'SR 17 Box Mumb 11,,, Inc. A, 6-, P Owner, of Building �/,A�dress-. -CitLa Quint a, CA 92253 ' y - . I , , ;_ Lonnie " - '" t - I I hie �D Awo y . oo Date; March 14, 1994' of Building Officialilf'A,CoWd��JCU i POST ou .;PLACE , W1 � ®� GfiYfRAI. ALUA�/Nl/� r . a pa of Calam4sirks, November 30f 1993, TO-. ALL: U0. MUM NFRO El ppuntry, easta.., f 6J�U6, on 0 , nelrgy., ef,f the measure- window's Due to the.-ihor, intigil, � . ` , - a 10 theriba-1.,me 'it46W6 that at* meet off 0, wiae hot, window with value. 0.00*.al A.IUO. num., ,§rgy )Ur -,000 t _,ay the��' mal'ly broken ifisulaa�e,4 " 0, ass o- our -.1 "OUig. 2700/2600 window. "S or let e amount heat U P t. of' gatured ,by UVil Thetmal Oe�kformapc:e ..s material' it an .p.8 resistance CO to theoug materiel and R_ 6 f low. which can _UVal..U6,6. are, qver," !velato,4 to' :R-Va heat f 0.�Vjjlte indicates .8 V 1us be, represented Inal-datos a more W whi le-, W. higher-" V ut's-1. and R�- a ues more t , - V I tht - "U.: a eitici, .O� .,Somei.� f 4jtt6.r's,,,,t that 4 (Note ind-, oW are iminemkt,or.ria a ' not U -Values effects 'shad'ing !..c04tf i6ionts that tinted q. aa�z, an -1y or.R-va,lues.). EnclosedAluminum -of v -,VA -lues and R, -Va-lues for crdancel ,is " a �S-t with. �NFRC windows,. Thes.G value$ 'have been. -r-oced'U r'-610��.�.u6A,ng Windows 4•0 Na ona I 1_.-,on_,;ct_ noCouncilI Fenestration 0 erm a'cia'l,ysis programs, and Frame qq6ttio If have ny p7lesse Service .YOU Repres.entative'. Tb W YKubik . Dirdctdlr of 9figineirifig Enclosure 02404i1994.15I00 FROM West, 'Coast Cus4oM Finish L0 95640344 P,02 tin11101,!bg Com: 11�*It�.Irai� Fri VAL UNMmwtltm: . �.Attli�l=Qpfittlll.. � v C16tr;i/4C1er..; .do 1.2� 1.32 c1e�'r`, ,.J :a 1.41 1.49 C1esr,1/4".C1er' .9 �6; 1.21 1.33 C1ea,i/�I,lt»� ,fi. .66' 1.41 1.52 C1@6r.1/4_",C1fit 1.32 C1er;i/4';,lerr •1Z :6t 1.39 i.a9 C1p4h,1/Z",C1eh .24: :69 1.3s C-14ar,1/20:6 Ll* 1.72 the 4 1/201, 0,40 c16ar, l/ ".: (uWa, t C14ar,1/Z"-,C1sr ,60 :;: SA. 1.0 C1esr,lr/2",ltlw E C1e6M 1/4 ,C1par,i/4.",C1 sr.:r::° :49 .30. ;.4S-. 2.04 2.00 .1.72 2.11 2.08 c16a�rl/4",=C1esr,1/4.,",I:nr�':. .46:. :43 2.11 2.33 c1e�rl/4.,LnM c .40 2.33 2.50 . C16ah,1/2",Cjlear:SO •�f 1.6g i.75 clear•1/2"Ltfw .49 .4 i:o4 2:17 C1ar,a 2.00 2.0e C1�ar,1/4"! C1ear,i/4",Lcnr,=� `x/,1/4",1 :d5 'A a. H 2.11 2.33 Clpar,l/4" rlea , 43 •.40 2.33 2.50 C1�4r,1/4",C.16ah - JE .4o :39 2.5o 2.56. . 0100-3/4.",low .31 .36 2.10 2.19 ° C�c%dr` AD .tS 1.25 1.33 Cl�ar, I ' 1.41 1.52 C1lar,i/4",tlW c1�r, t-1066,4/4; i 1: 43 Al .4i ,3g .ga A A 2.33.✓ 2.44 2.44 2.56 1.10 1.27 1.33 1.45 .:IMF�uE , 619 % 778--61:11 `�^/� V St : Fax 919 / 778-6113 -11 GIS t windows, Dciitirs & QUOTA`l`10N/CONTRACT t . L�Stadli� biyn Custom \,. I:ic. # 534428 Nf :� Apish . Geri2rttl AliuruntunD�SMbUtotS We are pleased to submit our proposal. Our Interpretation of your `.. spec�ficatignstiare,indlcated below. No understanding exists other 691 Industrial Place, Potlm'.Sprlr><gs;-CA 92264 Than appears on the frolif'and/oF back>oF this form, :DATE 12- Z9-91- }BID BY: rn t ;o C TERMS: 1.:. V � NAME: 1�0� L t t��f s I' n c�. r:- JOB NAME. ADDRESS: • ADDRESS YLoA` 1 CrrY; STATE: , .ZIP. PLAN # - ELEVATION: CONTACT: PHONE:. L -' 7 _ ., f r . ❑.SINGLE ❑ BRONZE TINTED WINDOW TYPE: GLAZING 0 SPACEGL"ASS: CLEAR FRAmETYPE -a " ❑ OTHER ❑ OTHER aY 'FRAME COLOR:. WAN. 3¢E SERIES LITE GU1zINd COLOR' QTHER INFORMATION �J., - _ AMOUNT O • W b D 2 c? 0 P- 1,j 2 yF 1 o 0 QO •1I 'k r ul Sr`� INSTALLATION CERTIFICATE CF -6R Use of this form to satisfy the rsqulromanla of the Administrative Code Is optional, but the Information must be provided and posted. Site Address Permit Number An installation certificate is required to be posted at the building site prior to the issuance of the occupancy permit; this form may be used to meet these requirements. All appliance categories listed below are the actual equipment installed. Note that the efficiency and type of the appliance installed must be equivalent or better than the appliance specified on the certificate of compliance (Form CF -1 R). This certificate (or its equivalent) shall be prepared and signed by the per$on(s) assuming overall responsibility for the appliance installation. Refer to the reverse side of this certificate for an explanation of information required. I, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment installed and that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards. In addition, I have verified that the equipment is equivalent to or more efficient than the equipment specified on the Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for residential buildings. HVAC SYSTEMS: Heating Equipment Heating Equip. CEC Certified Actual Type (Packaged Manuf. Make & Efficiency �:. • u• ��.•: ► u•: Distribution Duct or Type and Piping Laaa11911—� Heating Load Heating Before Over- Equipment SJzing (Btuh) Capacity (Btuh) FAUCETS & SHOWER HEADS: All faucets and showerheads installed are listed in the Commissions Directory Of Certified Faucets And Showerheads, pursuant to Title -24, Part 6, Subchapter 2, Section 111. Signature, Date Revised Deoember 1992 Plumbing Subcontractor (Co. Name) OR General Contractor OR Owner Cooling Equipment Cooling Equipment Actual Type (Packaged CEC Certified Compressor Unit Efficiency (SEERi Duct Duct heat moo. etc) Manuf. Make &Model C4 )S' y7_ Number Lao i411 liyaltlS A-r�rt� 7 -- HVAC Subcontractor (Co. Name) Signature, Date OR General Contractor OR Owner WATER HEATING SYSTEMS Distrib. Water CEC Certified Energy Tank Insul Internal Pilot Rated Solar/ System Heater Manuf. Make & Factor/ Volume Wrap Insul. Standby Light Input Wood Iygg Type/# Model # •L Effic. (gallons) td 1 R -value Loss ('/_1 Creditsice! - FAUCETS & SHOWER HEADS: All faucets and showerheads installed are listed in the Commissions Directory Of Certified Faucets And Showerheads, pursuant to Title -24, Part 6, Subchapter 2, Section 111. Signature, Date Revised Deoember 1992 Plumbing Subcontractor (Co. Name) OR General Contractor OR Owner