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11-0805 (AR)P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT "FLACaUNTA 28/11 Application Number: :11-00000805 Owner:Property Address: 49814 COACHELLA DR RAVEN JOELAPN: 646-250-015-15 =4275 - 49814 COACHELLA DRIVEApplication description: ADDITION - RESIDENTIAL LA QUINTA, CA 92253Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 100000Contractor: Applicant: Architect or Engineer: EDWARDS CONSTRUCTION INC, BOB 51455 DESERT CLUB DRIVE LA QUINTA, CA 92253 (760)777-8202 Lic. No.: 684857 -------------------------------------------------'------------------------------------------------ LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury at 1 aJJ1 licensed under provisions of Chapter 9 (commencing with Section 7040)Pf Division 3 of the B mss afid1Projgae�s Code, and my License is in full force and effect. License CI s: B I I � (// License No.: 68A857 v Date: ntraILI ctor: t 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 70001 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 _ 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 I, 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: ,^1 Lender's Address: (`+ LQPERMIT 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 GRANITE STATE Policy Number WC1914223 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 Id b ome j ct to the workers' compensation provisions of Section I 13700 of theLabor e, I h h� comply with t se provisions. ate: ` ` 4 pplicant: 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 bo inf ma o is orrect. 1 agree to comply with all city and unt ordinances and state laws relating to buil ing ons uc�i ereby authorize representatives ofthisco I,1,ty oVIISignature enter upon the above-mentioned property, ins c pur o S. gate: l►t (Applicant or Agentl: Application Number . . . . . 11-00000805 Permit PLUMBING Additional desc'. . LQPERMIT Structure Information Construction Type . . . . TYPE V, UNPROTECTED Occupancy Type . . . . . DWELLG/LODGING/CONE <=10 Other struct info . . . . . CODE EDITION 2010 # BEDROOMS .00 FLOOD ZONE NO -------------------------------------------7-------------------------------- 1ST FLOOR SQUARE FOOTAGE 190.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 36.80 Plan Check Fee 9.20 Issue Date . . . . 10/10/11 Valuation 0 Expiration Date . . 4/07/12 Qty Unit Charge Per Extension BASE FEE 15.00 190.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 6.65 1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 .75 32.00 .4500 ----------------------------------- EA ELEC DEVICE/FIXTURE >20 ---------------------------------------- 14.40 - Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 639.50 Plan Check Fee 415.68 Issue Date . . . . 10/10/11 Valuation 100000 Expiration Date 4/07/12 - Qty Unit Charge Per Extension BASE FEE 414.50 50.00 4.5000 ---------------------------------------------------------------------------- THOU BLDG 50,001-100,000 .225.00 Permit MECHANICAL Additional desc . Permit Fee 50.00 Plan Check Fee 12.50 Issue Date 10/10/11 Valuation 0 Expiration'Date 4/07/12 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 4.5000 EA MECH VENT INST/ DUCT ALT 9.00 4.00 6.5000 -----=---------------------------------------------------------------------- EA MECH VENT FAN 26.00 Permit PLUMBING Additional desc'. . LQPERMIT r . _ -b Application Number Permit Permit Fee Issue Date . . . . Expiration Date . . . . . . . 11-00000805 PLUMBING 100.50 Plan Check Fee 25.13 10/10/11 Valuation .. . . . 0 4/07/12 Qty Unit Charge Per Extension BASE FEE 15.00 12.00 6.0000 EA PLB FIXTURE 72.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 3.0000 EA PLB FIXTURE DRAIN/VENT REP/ALT 3.00 ---------------------------------------------------------------------------- Special Notes and Comments REMODEL OF 3 BATHROOMS, ENTRY, NEW LAUNDRY AREA AND 190 SF PATIO CONVERSION TO LIVING AREA PER ENGINEERED DESIGN. 2010 CODES. PER OWNER REQUEST CONTRACTOR OF RECORD HAS BEEN CHANGED TO BOB EDWARDS CONSTRUCTION. November 28,' 2011 9:00:30 AM khensel. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 4.00 CHANGE OF CONTRACTOR 4.50 ENERGY REVIEW FEE 41.57 STRONG MOTION (SMI) - RES 10.00 Fee summary Charged Paid Credited Due Permit Fee Total 826.80 826.80 .00 .00 P1an.Check Total 462.51 462:51 .00 .00 Other Fee Total 60.07 55.57 .00 4.50 Grand Total 1349.38 1344.88 .00 4.50 LQPERMIT P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address:. APN: Application description: Property Zoning: Application valuation: Applican V1= 00 8 5 49814 COACHELLA DR 646-250-015-15 -4275 - ADDITION - RESIDENTIAL LOW DENSITY.RESIDENTIAL 100000 Architect or Engineer: nF�Q�w 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 . nse N ._805021 rDate:� vontractor.-, 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 ($500).: C (_ 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 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 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: C LQPERMIT Owner: RAVEN JOEL 49814 COACHELLA DRIVE LA QUINTA, CA 92253 Contractor: WHITLEY'S CONSTRUCTION 77775 -JACKAL DRIVE PALM DESERT, CA 92211 (760)341-9480 LiC. No.:'805021 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/07/11 --------------------------------------------.— 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 GRANITE STATE Policy Number 007200169 _ 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 forthwitose provisions. —Dateo-�lJ/'a/�/ Applicant: WARNING" FAILURE TO CURE 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 count to enter upon the above-mentioned property for inspection p oses ^-Date:- - _ 1 Signa i re (Applicant or Agent _a Application Number . . . . . 11-00000805 Structure Information Construction -Type . . . .. . TYPE V, UNPROTECTED Occupancy Type . . . . . DWELLG/LODGING/CONG <=10 Other struct info CODE EDITION 2010 # BEDROOMS .00 FLOOD ZONE NO ---------------------------------------------------------------------------= 1ST FLOOR SQUARE FOOTAGE 190.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 639.50 Plan Check Fee 415.68 Issue Date Valuation 100000 Expiration Date 4/04/12 Qty Unit Charge •Per Extension BASE FEE 414.50 -- 50.00 4.5000 -------------------------- THOU BLDG 50,001-100,000 --------------------------------------- 225.00 ----------- Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee 36.80 Plan Check Fee 9.20 Issue Date Valuation . . . . 0 Expiration Date. 4/04/12 Qty Unit Charge Per Extension BASE FEE 15.00 190.00 .035.0 ELEC NEW RES - 1 OR 2 FAMILY 6.65 1.00 .7500 PER ELEC DEVICE/FIXTURE'1ST 20 .75 32.00 .4500 - --------------------------------------------------------- EA ELEC .DEVICE/FIXTURE >20. ------------------- 14.40 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 50.00 Plan Check Fee 12.50 Issue Date Valuation . . . . 0 Expiration Date 4/04/12 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 4:5000 EA MECH VENT INST/ DUCT ALT 9.00 4.00 6.5000 --------------------------------- EA MECH VENT FAN ------------------------------------------- 26.00 Permit PLUMBING Additional desc . LQPERAI[T s Application Number . . . . 11-00000805 Permit . . . . PLUMBING Permit Fee . . . . 100.50 Plan Check Fee 25.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/04/12 Qty Unit Charge Per Extension BASE FEE 15.00 12.00• 6.0000 EA PLB FIXTURE 72.00 .1.00 7,.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 3.0000 EA PLB FIXTURE DRAIN/VENT REP/ALT 3.00 ---------------------------------------------------------------------------- Special Notes and Comments REMODEL OF3 BATHROOMS, ENTRY, NEW LAUNDRY AREA AND 190 SF PATIO CONVERSION TO LIVING AREA PER ENGINEERED DESIGN. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . BLDG STDS ADMIN (SB1473) 4.00 ENERGY REVIEW FEE 41.57 STRONG MOTION (SMI) - RES 10.00 Fee summary Charged Paid Credited Due : ------------------------------------------'--------------- Permit Fee Total 826.80 .00 .00 826.80 Plan Check Total 462.51 .00. .00 462.51 Other Fee Total 55.57 .00 .00 55.57 Grand Total 1344.88 .00 ..00 1344.88 LQPERMI`C Bin # City Of 1a Quinta Building Br Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # (1 / V Project Address: -4 qC01kU( 0,LL-& Owner's Name: J0 6 C A. P. Number: _ Z22 _ Address: 4c? C 0 j ,& )4 61- L(t t�iZ Legal Description: City, ST, Zip: L A C A Z 3 Contractor: `-j �j , e `f ti �Y A4Y:%� � :ini.�: �� �fltii 4'r2�•Yi�: Telephone: Address: Project Description: bsL� Q rZ;IN b %f City, ST, Zip: Telephone: :.:":<:;;:.:;:.>:;<:>::>#:>><%.<"::<:. State Lic. # : City Lic. Arch. ngr Designer: j 0-slop,g N 10IGL4 P `fl L.L X S67' ,r1e-61l C L Address: City,ST,Zip: �(JI�Y�b"sb'2Y C� 922%012 Telephone: 7�j0— 776 `Gj� •s:<s<">,>::>:>:::f:»>>:>z<�v> ««::z:::> <:> ; Construction Type: Occupancy: State Lic. #: Project tYPa circle one): New � Alter Repair Demo Name of Contact Person: OSap)( Sq. Ft.: 20D I # Stories: # Units: Telephone # of Contact Person: Sam W Estimated Value of Project: p� APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Pian Sets 3 Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for rrections ( Plan Check Deposit Truss Calcs. Called Contact Person I t Plan Check Balance. Title 24 Calcs. C /� .3 Plans picked up Construction " Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List ✓ Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees a a Total Permit Fees 7/� - %�� O`-7 elle.11,g - �r�� � ���i� . l0 v � /� ��� ��, . ��� 11 � v ,� 2� � � �.,� . �, ,.. CERTIFICATE OF COMPLIANCE4�J�1FtEDsc�o Desert Sands Unified School District 47950 Dune Palms Road ¢ BERMUDA DUNE O RANCHO MIRAGE Date 10/7/11 La Quinta, CA 92253 INDIANWELLS PDESEFff No.- 31120 (760) 771-8515 ��� IQUIN A jy �ONDIO y� O Owner Joel Raven APN # 646-250-015 Address 49814 Coachella Dr. Jurisdiction La Quinta City La Quinta Zip 92253 Permit # Tract # No. of Units 1 Type Single Family Residence Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 49814 Coachella Dr. 190 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet,.detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to in the amount of $0.00 X 190 S.F. or $0.00 . have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Mike Whitley/Whitley Construction Check No. 0.00 Name on the check Telephone Funding Residential By Dr. Sharon P. McGehee Superintendent Fee collected /exe ted by Es Lara Payment Recd _ Over/Under, Signature NOTICE: Pursuant fo Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID without embossed seal Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting Prescriptive Certificate of Compliance: CF -1R ADD Residential AdMons (Page 1 of Site Address:! � A u� ��� , � i;;! forcement Agency- Date: I /w,, 7 2T i General Information Project t;jgmeClimax Zone # of Stories Jo&- PFwgoj 2pmLot,+w gyp, Building Type Ingle Family O Multi Family Circle the Front Orientation: N, Inor Degrees Conditioned Floor Ane of Addition New Addition Size: 13 Less than or equal to 100 ens than or equal to 1000 (CFA): )9D Do not use this arm or additionsgreater than 1000 NOTE: For Alterations to an existing home, submit a completed CF -JR -ALT Farm. EW an: EWlIng HVAC systems that are r_wlacedor allered to serve the addition maybe Included on the CF -IR ADD Form Prescriptive Envelope REguirements for Additions Option 1: Use Option I for standard wand and assemblies meeting the Cavity R-yalue only. For all other use Option 2. . For I 00fij additions; the Proposed values mart be equal or greater than the Standard column or when indicated when using Package A "Pkg D ". Enter all values In the Proposed Columns. . For less than 1,000f? additians must comply with "Pkg D " requirements fatless indicated in the Standard Column. To meet "PAg D" minimum enew compliance Pei ufrements see RCMA ndir A Table 151-C. Or 4151(b) in the RCM. Enter all values in the Proposed Columns. Size of Addition 100 fns or less Less than 1,000 fns Component Standard Pr owed Comment Standard Proposed Comment Ceiling Insulation R-19 Minimum Pkg D Table 151-0 Wall Insulation R-13 Minimum R-13 Minimum Floor Insulation R-13 Minimum Pkg D Table 151-0 U- U- U- U- Fill out Fenestration factor SHGC factor SHGC Et., p p d factor SHGC factor SHGC Fenestration 0.40 Pkg D 0.40 Pkg D values then Proed Amas Below Skip Over .4o .0 Maximum Glazing 50 fe To Roofing Pro�u package D (20 u!o 47f!t Flu out Additional Below of CFA) + Glass a Allowed Removed Fenestmilon Areas Below Radiant Barrier N/A Pkg D Table 151-C Roofing Pkg D See Roofing Products Below I Pkg D See Roofing Products Below Opaque Surface Details For the furred portioned of Mass Walls see urring Strips Construction Table below. A B C D E F G H I 1 J Proposed "r' Standard Values From JA4 Table Framing Thickness, Framed Continuous JA4 Proposed Tan/ I Assembly Name Material Spacing, U- JA4 Table Cavity insulation Assembly Assembly ID or T ' and Size or Other' factor' Number$ R -valine° R -Value' Cell Values 134=or" Note: For furred assemblies, accmmting for Contlmom Insulation R -value, see Page JA4-3 and Egvatton 4-1. For calculating feared walls use the Mars and MoWrw Cautruction table belaw. L For Tagl1D indicate the identification name that matches the bufl&ng plans. 2. indicate the Assembly Name or type. RoopCeiting, Walls, Floors, Slabs, Crawl Space, Doors and etc... indicate the Frame type and Sfze: For Wood, Metal. Metal Buildings, Mass, enter 20, 2x6, or etc.., see JA4 for other possible frame type assemblies: J. 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 ars! etc.... 4. Based on the Climate Zone; enter the Standard U factor from Table 131- C for each different assembly Name or type. 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 -valve for the proposed assembly; otherwise, enter "0 B. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor In U L 9 The Proposed Assembly l! factor, Column J. must be eq a fo or ass or -int Columns to Jy. %-,I I Tut- W UUINTA Registration Number: R ' tido' MWIR: SAFrni - E)EpH 2009 Resfdenlial Compliance Forms APPROVED P p R O V E ®` ' it FOR CONSTRUCTION DA 1 213"il BY, EJUL 0111LUII 011 r August 2009 Prescriptive Certificate of Compliance: MIR ADD Residential Additions (Page Z of 5 Site Add s EnCoreement Agency: Date: 814 L'v � D 12- 7 2W c I I Funing Strips Construction Table for Mass Walls Onl A I B I C 1 D 1 E F I G I H 1 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 Tab io 43.5.4-1 4.3.7 Joint Appendix Table 4.3.13 Total m Assembly ] e `o g can 1, 1 § Final Mass NType2ame or Table > Q > hl, Tluicicncss' Nu burA4 ' a a U-factobt"•7 Comment 1. 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 andSize: For Wood, Metal, Metal Buildings, Mass, enter 20, 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. Enter the Effective R -value listed In the JA4 Table Number. The Final Assembly is calculated by easing Equation 4-1 or Equation 4-4 of the Reference Joint Appetrdir JA4. Enter the value in Column L. 7. insert the Final Assembl IV -factor value back on to the Opaque Surface Details table in Column J. FENESTRATION PROPOSED AREAS Fenestration Type and Frame indoor Glass Door or SkyllCt Orientation (North, East, South, West PropsedAtea' Maximum Maximum NERC or f?) U-fhaor-2.3 SHGC'''' Default Values rz- 4 Total 1. Fenestration area Is the area of total glazed product (l. e. glass plus frame). Exception: When a door is less than SO% glass, the fenestration area may be the glass area phis a "2 inch frame " around the glass. 2. Enter value from Component Package D Requirements in Table 13 )-C. 3. Actual fenestration products installed and as indicated in CF -6R -ENV Form shall be equivalent to or hove a lower U factor and/or a lower SHGC value than that spec(f ed on the CF -I R ADD Form. 4. Submit a completed WS -3R Form if a reduced SHGC is calculated with exterior shading. S, livable at this stage enter "NFRC"for NFRC Certified windows or CEC 'P cult" values ourJd in Table 116-A or B. Registration Number: Registration Datell'ime: HERS Provider: 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: CF -1R ADD Residential Additions (Pont 3 of Site Add res : Enforcement Agency: Date: _ ��. ADDITION ALLOWED FENESTRATION AREAS Check applicable box below if the roof addition is exempt from the roofinf product "Cool Roof' requirements. Note: If any one of the bow are checked below, the Aged Solar Reflectance and 77rerma/ Emiltonce requlremenls for roofing products In §118(1) are not applicable. Do nol fill table below. A B C D E Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance, otherwise, check F CFA of Addition Allowed % Allowed Area AreaTotal Removed? Area Allowed Proposed Area'' CRRC Product ID Number' f of CFA {A x B) f? C + D SRI' (Table Above) Total Fenestration Area IRD 01076 -bett aodlgk> p4 a West Fenestration Area , �� ❑ 4's (b ❑ ❑ (Required In CZ's 2, 4 & 7 -15 .05 ❑ O — O l. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12. ❑° 1. 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. ❑ 2. Include the Proposed Area of the West facing fenestration in both Area columns below. O ❑ 4. To meet cora lance, the ProposiedArea must be less than or equal to the Total Allowed Area or BOTH the Total and West Fenestration Areas. ROOFING PRODUCTS (COOL ROOFS) §151(}11 pjAr Check applicable box below if the roof addition is exempt from the roofinf product "Cool Roof' requirements. Note: If any one of the bow are checked below, the Aged Solar Reflectance and 77rerma/ Emiltonce requlremenls for roofing products In §118(1) are not applicable. Do nol fill table below. O Roofing compliance Not Required in Climate Zones 1-12,14, and 16 with a Low Slope. Less or 2:12 pitch. D Roofing compliance No Required in Climate Zones 1 through 9 and 16 with a Low -Sloped. Roofs pitch greater than 2:12 and product weight less than 51b/fe. 13 Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the above Cool Roof criteria O Roof constructions that have thermal mass over the roof membrane with at least 25 IbIW 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/fir > 5lb/f? Type' Reflectance" Emittance SRI' 6-ilbA10011 Veep D Ge ❑ ❑ p4 ❑ ❑ ❑ ❑ ❑4 ❑ O ❑ O ❑° ❑ ❑ O ❑ D4 J. The CRRC Product 1D Number can be obtained from the Cool Roof Rating Council's Rated Produu Directory or ►vww.teolronlaom/nnxhrrrr/.r„arrh alrn 2. indicate the type of product is being toed for the roof tap, i.e. single ply roof, asphalt roof, acetal roof, enc. _ If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directoty then use the Initial Reflectance value from the fame directory and ure the equation (0.2+0.7(0tAM.1 — 0.2) to obtain a calculated aged value. Where p is the In/dal Solar Rdlecia me. 4. Check baa tf the Aged ReJlecuu= tr a calculated volae tering the equation above. 5. Calculate the SRI value by ruing the SRI- Worktheet at hig &ww_mv.ener>rv:ea.gov/tl& and enter the resulting value in the SRl Column above and attach atopy of the sRl- Worktheet ro the Ch -I R To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage commended by the coatings manufacturer and meet minimum performance requirements listed in § 119()4. Select the applicable coating: Aluminum -Pigmented Asphalt Roof Coating Cement -Based Roof Coating Other Registration Number: Registration Date/F'ime: HERS Provider: 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: CF -IR ADD Residential AddWns e 4 of Site Ad teas: Enforcement Agency: Date: HVAC SYSTEMS - HEATING List water heaters and boilers for both domestic hot water (DHiig heaters and hydronic space heating. Individual dwelling DHW heaters must be gas or propane f ?red and may not exceed SO gallons. Hot waterpipe insulation from the DHW heater to the kitchen(s) and on all underground hot water pipes is rmmuirrd in all mponew packages in all climate zones. Duct or Configuration Minimum Distribution Piping Number in (Central, Split, Heating Equipment Efficiency Type and Insulation 'Metmostat Space, Package or Type and aci ' AFUE or HSP Location' R -Value pe H dronic 1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.) 2 Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §I S0(n). The Prescriptive requirements do not allow the installation of recirculating water heating system for single dwelling units. 3. The water h!!mi tank and ! es shall be insulated to meet therequirements o 1 SO ' . 1. Indicate Heating 7)pe (Central Furnace, Wall Furnace, Heat pump, Boiler, Electric Resistance, etc.) 2. Electric resistance heating is allowed only in Component Package C ar except where electric heating is supplemental (i.e., if total capacity < 2 KW or 7,000 Bhdhr electric heating it controlled by a time -limiting device not exceeding 30 minutes). See §l Sl (b)3 exception. 3. Refer to the HERS tier f cation section on Pages 3 and 4 of the CF -IR -ADD Form for additional requirements and check applicable boxes 4. Indicate DE or Location Ducts, H nic In Floor, Radiators, etc. HVAC SYSTEMS - COOLING Configuration Cooling Equipment Minimum Distribution Duct ur Piping (Central, Split, Type and Capacity'-' Efficiency Type and Insulation Thermostat Space, Package or SEER/EERorCOD Location R -Value dronic 1. Indicate Cooling 7�pe (A/C, Heat pump, Evap. Cooling, etc). 2. Refer to the HERS Veri6cation section on Pages 3 and 4 ofthe CF -IR -ADD Form for additional requirements and check applicable boxes. 3. Indicate Type or Location Ducts, Hydronic in Floor, Radiators, etc WATER HEATING List water heaters and boilers for both domestic hot water (DHiig heaters and hydronic space heating. Individual dwelling DHW heaters must be gas or propane f ?red and may not exceed SO gallons. Hot waterpipe insulation from the DHW heater to the kitchen(s) and on all underground hot water pipes is rmmuirrd in all mponew packages in all climate zones. External Tank Water Heater Type/Fuel Distribution Type Number in Tank Energy Factor or Insulation Type' (Standard,Recirculatin = &stern Ca i a Thermal Eflicienc R Value? 1 tJ 4 1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.) 2 Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §I S0(n). The Prescriptive requirements do not allow the installation of recirculating water heating system for single dwelling units. 3. The water h!!mi tank and ! es shall be insulated to meet therequirements o 1 SO ' . SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written justifi2a n and documentation and special verification. Radiant Barrier (Rood 11YES C3 NO YES: Required in Climate Zones 2, 4, and 8-15 for additions er than 100 ft Slab Edge (Perimeter) Insulation 13YES EMO YES: In Climate Zoite 16 under Component ElSog D, R-7 insulation is reqatd. Heated Slab Insulation ❑ YES ONO YES: Slab edge insulation required for heated s& in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation O YES ONO YES: In Climate Zones 1, 2, 11, 13, 14 & 16 R-8 insulation is required, and in Climate Zones 12 & 15 R-4 insulation is requited under Component Package D. Thermal Mass - To obtain Compliance Coedit for the installation of thermal mass, use the Performance Approach. Registration Number: Registration Date/rime: HERS Provider - 2008 Residential Compliance Forms August 2009 Prescri tive Certificate of Compliance: CF-1RADD Residential Additions e 5 of Site Ad cess: Enfonemeat Ageoey: Datc: i � f1 HERS VERIFICATION SUMMARY - The enforcement agency should pay special attention to the HERS Measures specified in this chcoklist below. A completed and signed CF -411 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. O YES WNO YES: In all Climate Zones, if a new space -conditioning system (HVAC equipment and ducting) is installed to serve // the addition alone, the ducts are to be sealed and tested per §151(1)10. 13 YES &<O YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned space to serve the addition, the ducts are to be sealed and tested per §152(b)1D. 13 EXCEPTION- Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. —/ ❑ YES Q'NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including replacement of the air handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) and will serve the addition, the ducts are to be sealed and tested per §152(b)IE. ❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through ITERS verification is accordance with procedures in the Reference Residential Appends RA3. ❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. O EXCEPTION: Existing duct systems constructed insulated or sealed with asbestos. Refrigerantrge - Split System HERS verifmt:ation is required for this measure. ❑ YES WNO YES: 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 charge measurement shall be vcrified per §151(f)7A, ❑ YES O YES: In Climate Zones 2 and 8-15, if the existing HVAC equipment is replaced (including replacement of the air handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace (teat exchanger) and will serve the addition, a refijgerant charge measurement shalt be verified Mr § 15 1 F. Central Fan Integrated Ventilation System — Airflow and Fan Watt Draw - do not apply for additions 1,060 f? orless. Ducted Split ystems - Air Conditioners and Heat Pumps: Airflow and Fan Watt Draw HER$verfcation is required. 0 YES WNO YES: In Climate Zones 10 through 15, if anew space -conditioning system (HVAC equipment and ducting) is installed to serve the addition atone, the airflow and fan watt draw shall be verified per § 151(f)7B. /O ❑ YES W YES: In Climate Zones 10 through 15, if the existing space -conditioning system (RVAC equipment and ducting) is replaced and will serve the addition, the airflow and fan watt draw shall be verified per §152(b)IF. Documentation Author's Declaration Statement It • I certify that this Certificate of Compliance documentation is accn to an corn tete.. Name: o Signa Company: Date- Address: +� S If Applicable O CEA nr MIMPE f IL�'tG11 fZ (Certificationff): LO % -10 - iQ City/State/Zip • �M � � � � Phone- � 4-y aa Responsible Building Designer's Declaration Statement • t am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certifleate of Compliance, • i certify ttuit 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 aeptication. Name: Signature: Company: Date: Address: License: City/StatefLip: Phone: For assistance or questions regarding the Energy Standards, contact the EnerU Hotline at: I-800-772-3300 Registration Number: Registration Date/Time: HERSProvider 2008 Residential Compliance Forms August 2009 I RESIDENTIAL KITCHEN LIGHTING WORKSHEET WS -555 Project Title R A ✓l5'N , 9A k—o L7A I Date At least 50% of the total rated wattage of permanently installed luminaires in the kitchen must be in luminaires that are high cfi'icacy luminaires as defined in Table 150-0. Luminaires that are not high efficacy mast be switched separately. Kitchen Lighting Schedule. Provide the foilovsw•ing information for all luminaires to be installed in kitchens. i.nminaire Tvne Hieh Efficaed? Watts x Ouantity = Ilieh Efficacv Watts or Other Watts 1C22.LED G2 Yes Noor 1!J- 5 x upr34-W14 Yes){ NooZ2. i x _ Yes o No o x — or or or Yes o No o x — or Yes 0 No ❑ x — or Total: A: f 5.3. B: O COMPLIES IFA -e B Yes)( No n Rules for Determining Residential l(itchen Luminaire Wattage Screw Base Sockets §130(c) i (Not containing permanently installed ballasts) The maximum relamping rated wattage of the luminaire, as listed on a permanent factory -installed label {luminaire wattage is not based on type or wattage of lamp that is used). Permanently or Remotely Installed Ballasts §130(c) 2 The operating input wattage of the rated lamp/ballast combination based on values published in manufacturer's catalogs based on independent testing lab reports. Line Voltage Track Lighting (90 through 480 volts) §130(c) 3 1. Volt-ampere (VA) rating of the branch circuit(s) feeding the tracks; or 2. The higher of • The wattage (or VA) rating of an approved integral current limiter controlling the track system or • 15 watts per linear foot of the track; or 3. The higher of • 45 W per linear foot of the track or • The total wattage of all of the luminaires included in the system. Low Voltage Track laghting (less than 90 volts) §130(c) 4 Rated wattage of the transformer feeding the system, as shown on a permanent factory -installed label Other Lighting §130(c) 5 (Lighting systems that are not addressed in §130 (c)14) The maximum rated wattage, or operating input wattage of the system, listed on a permanent factory installed label, or published in manufacturer's catalogs, based on independent testing iao reports. EXAMPLE RESIDENTIAL KITCHEN LIGHTING WORKSHEET WS -5R Project Title bate Kitchen Lighting Schedule. Provide the following information for all luminaires to be installed in kitchens. High Efficacy Lwninaire Type (y/n) Watts x Quantity = High Efficacy Watts or Other Watts CFL -1 Yes 26 x 5 130 or MR -16 No 55 . x 2 _ or 110 x _ or x = or x = or Total:: 130 B: 110 -A. COMPLIES IF A > B Yec 0 No o Residential Compliance Forms ADr112005 LA Testing 520 Mission St Phone: (323) 254.9 reet, South Pasadena, CA 91030 960 Fax: (323) 254-5982 Email: g�<_adenalab@j_kjestinn.com % Type 01 Entrenoe hall Allm Andersen Environmental customera. 32MDM 9937 Jefferson Boulevard customer PO: Suite 200 Received: 1014M8111 9:00 AM Culver City, CA 90232 to Testing older. -321106581 Fax Phone: (310) 8545300 �� tingPte: Project: 1104.441! 49814 Coachella Dr La Quhtfa, CA 82253 Analysis DaW 4/21/2011 Test Report: Asbestos Analysis of Bulk Materials via EPA 6001R-931116 Method using Polarized light Microscopy Sample Description Appearance .. % Flbrous % Non-Rbrous % Type 01 Entrenoe hall Ten 97% Nan4brous (a her) 3% Chrysotile 321,0es81.0W1 aco sfie Rt rats Homogeneous 02 7iA� bedroorn Tan 96% Notfrous (o Cher) 4% Chrysotile 32010MI-06M�et3 6c ., .4 Fb aus Homogeneous . 03 Guest room Tan 95% Non-fitr aus (athw) 4% Chrysotite 32111 MI—OM a Fi m s JUL 2 6 2011 BY: nibs& repot from 041214011 1820:14 Analyst(s) I Ra& Valtaniart, PhD (3) or a'ther approved signatory Duo to magrxeauon Basta oes i werrt in PM esbeatw hecn In dimensrmo balew to reschgan capabaar arwae may not be detated. samptos a es <1% w none detected may require additional testing by TEM to cordfmr esbestos queMNes. The abern test report reh tes only to the items tasted and may not be reproduced In GW tam without to ureas written approval of LA Tasting. LA Teong`s OaWy la gmfted to the cost of enalyaia. LA Testlngbears no 1�rrnnibiLTyfw smnpte eaeectiotn ecdditas w ar�yb®t merited 6rnitatiars ha9lpreesuan and use oftest resrdm The testreautm oaece n*&emem at NEtAG urdem adwwlse note& samptas . reCNLlO in good amclition urdew Wwrwlso rote& Samples ceded hi good condilian radesa Wwwise noted. Samples wmhmd by LA Tesft South Pasadena,t:ANVLAPL9b Code 2WWACAELiP2783 Test Report PLW72&0 RudetY 4121=1I 620:14 PAA THIS IS THE LAST PAGE OF THE REPORT. dALA Testing 520 Mission Street, South Pasadena, CA 91030 Phone: 13231250..9960 Fax: (323) 254-9982 Email: .Las Atbr Andersen Environmental 9937 Jefferson Boulevard Suite 200 Culver City, CA 90232 Fax Phwe: (310) 854-i00 Project 1104.441149814 CoacWla Dr La 4uirda, CA 92253 Custm wr ID: 32ANOM Customer PO: Reoeitred: 04118111 9:00 AM LA Tasting Order. 321106581 LA Testing Prof: 01 AnslyIft DaW W21/201I Test Report: Asbestos Analysis of Bulk Materials via EPA 60018.931116 Method using Polarized Light Microscopy SamP18 Dmcripflon Appearance % Fnwms % Non44brous % Type 01 Erttranoe haft Ten 97% Nowrtbrous (dher) 3% Chrysotile 321108581.0001 aooustiD F(hrnus HwWwww . 02 Master bedroom Tan 96% Non4trota (dhw) 4% Chrys*We 321108581-0004 SoOltstit: F1 10!15 NornoSenem 03 Guest room Tan 96% NcrW%ms (dJw) 4% Chrysotile 3211055814= a Rwotts Homopnww � JUL 2 b 2011 Initial r epoft from 04/21/2011 1820:14 Anadyst(s) Raft V®1lanien, PhD (3) or other approved signatory DUO o magnification amtietions Inherent in PLK asbeaWs fibers In 6nrrensioam bdow the resoWtiar mpabft of PLM may not be deUCed Samyes reported as ct% o none datoQed may require addldmd tWng by 7E1M to combo asbestos quaMl m The above test report relates udy m the horns tasted and may rot bo reproduced inairy tam wfflw dm ureas wdtten approval of LA Testing. LA Testing's HaWly Is 0mited to the cost of ar+dysts. LA TeStlrgDeam no respordfl; ty for samplo collection acftbs or aradykW method timltatiotm bderpratalion and use affast nmdts ere tTo resDordbalty of dre dlmt Thor tM resu is cadabted widdn tlda reportmeat dro herds of PMLAC wdms otlmfwise rrol e I Samples . reeeivrd in good eonditton.unless odarwfse noted. Sampiea received In good ameftm udm aeuro ore now Samples wwhzed by LA TaWkV SoUffi Pasa kna, CA NVLAP Lab COO MSM CA S" 24E33 Test Report PLM -7.23.0 Printed: 4212011620:14 PM THIS IS THE LAST PAGE OF THE REPORT. 1 JCM Inspections + 39725 Garand Lane Suite F Palm Desert, CA 92211 INSPECTIONS Phone: 760-275-5020 - Fax: 760-327-8907 INSPECTIONS EPDXY INSPECTION REPORT Date: Project Name: Project No: 0211 Project Address: v ) City: qqq 14 e.� r, n l + Client: Sub -Contractor: General Contractor: Architect: Structural EnnJgineer: r V1 Anchor Bolts © Rebar Epoxy Type:Sp) , _� Epoxy Shelf Life: I�W'4 ,, QC) Hole Cleaning Method(s): n6-,sn da 1a - es -Q t a1 �./(1A jet L -Pae dey © IBC Title 24 Other: Unresolved Items: None See Below Description of Work Inspected: •7 J 1 t i 1 5 IG I/ I 1 �r _ 1' 2 0 V l-k'In J /` )- P r RLQ colaw tot et-) kpc4l CA. 1 l J Work complies with written approval from Structural Engineer and ICC Evaluation Report # I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved plans, specifications _applicable building laws. Final report issued at project completion. Inspector- Michael Rodriguez ICC Certification No: 800312 ntractor's Representative: I r v Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page I of