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12-1005 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00001005 _ Property Address: -79977 RANCHO LA QUINTA DR APN: 649-740-012- - - Application description: ADDITION - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 20000 Tit!t °F 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: HERB KOSS 2643 SOUTHSHORE DRIVE LAKE OSWEGO, OR 97034 VOICE FAX (760) - INSPECTIONS (760) 777-7153 Date: 10/23/12 Contractor: Applicant: Architect or Engineer: RAWLINGS CUSTOM CONTRACT P.O. BOX 3216 D D PALM SPRINGS, CA 92263 (760)322-8788 f Lic. No.: 746930 GSI 23 212 f CIYY IMF LA QUINTA FIFdAPIC� DEl> f UCENS96 CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjurynsed under 'sions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Bu ness a Prof sion , and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: 13 Li se No.: 746930 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. at antra 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 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).: (_ 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.). (_) 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.). (_) I am exempt under Sec. , BAP.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LOPERMIT insurance carrier and policy number are: CarrierXEMPT Policy Number EXEMPT I certify that, in the performance o he work for which this permit is issued, I shall not employ any person in any manner sMbe e subject to the workers' compensation laws of California, and agree that, if I s bject to orkers' compensation provisions of Section 3700 of the Labor odw' om with those provisions. JXte: /o/p. .7 WARNING: FAI RE 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 performedunder 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 ab rmation is correct. I agree to comply with all Dat�Zcity and aunty ordinances and state laws relating to bui ng c stru tion, and hereby authorize representatives of t counn�tyy tttootenter upon a above-mentioned prop rty f nspe on ose - ; 'nature (Applicant or Ag Application Number . . . . . 12-00001005 ------ Structure Information 208SF ADDITION/VB/RES-3/CLASS A -FR [ENG] ----- Other struct info . . . . . CODE EDITION 2010 FLOOD ZONE no 1ST FLOOR SQUARE FOOTAGE -------------------------------------------- -------------------------------- 208.00 Permit . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 207.00 Plan Check Fee 134.55 Issue Date . . . . Valuation . . . . 20000 Expiration Date 4/21/13 Qty Unit Charge Per Extension BASE FEE 45.00 18.00 9..0000 THOU BLDG 2,001-25,000 ----------------------=-------------------------------------- 162.00 --------------- Permit . . . ELECT - ADD/ALT/REM Additional desc . . Permit Fee . . . . 22.28 Plan Check Fee 5.57 Issue Date . . . . Valuation 0 Expiration Date 4/21/13 Qty Unit Chargee Per Extension BASE FEE 15.00 208.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 7.28 ---------------------------------------------------------------------------- Special Notes and Comments 208SF PATIO CONVERSION/VB/RES-3/CLASS A -FR [ENGINEERED] THIS PERMIT DOES NOT INCLUDE ALTERATION TO OR INSTALLATION OF MECHANICAL OR PLUMBING. 2010 CALIFORNIA BUILDING CODES. October 16, 2012 4:53:05 PM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . ... . BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 13.46 STRONG MOTION (SMI) - RES 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 229.28 .00 .00 229.28 Plan Check Total 140.12 .00 .00 140.12 Other Fee Total 16.46 .00 .00 .16.46 Grand Total 385.86 .00 .00 385.86 LQPERMIT Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, 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 Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 20 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. Exempt - / Patrick Rawlings Check No. Bank Name/Recipient of Certificate Telephone 760-275-8568 Funding Exempt By Dr. Sharon P. McGehee Superintendent i l Fee collected /exemp by n M rey Payment Recd OvarlUnde!:: Signature l� NOTICE: Pursua�toovernment Code Section 66020(d)(1), this i erve 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 CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Road Q BERMUDA DUNES Date 10/23/12 _Palms La Quinta, CA 92253 V) RANCHO MIRAGE INDIANWELLS r No. 31450 :(760) 771-8515 �i PALM DESERT .}> w QUINTA _�' �QINDIO y3 0 Owner Herb Koss APN # 602-370-012 Address 79977 Rancho La Quinta Drive Jurisdiction La Quinta City La Quinta Zip Permit # Tract # No. of Units 1 Type Residential Addition Lot # No. Street S.F. Lot# No. Street S.F. Unit 1 79977 Rancho La Quinta Dr 20 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 patiostwalkways, 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 Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 20 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. Exempt - / Patrick Rawlings Check No. Bank Name/Recipient of Certificate Telephone 760-275-8568 Funding Exempt By Dr. Sharon P. McGehee Superintendent i l Fee collected /exemp by n M rey Payment Recd OvarlUnde!:: Signature l� NOTICE: Pursua�toovernment Code Section 66020(d)(1), this i erve 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 RAN mo .LA QUINTA 14agaba Aaov--uuivn Arrckitectural Control Committee October 1, zou Mr. and Mrc. Math 1(mm 79-977 Rancho la Quinta Dr . .La Quinta, CA 92253. • Re: 79-977 Rancho Ls Quints Dr Patio Enclosure Submission 2643 South Shore 'Blvd.. Cake Oswego, OR 97034 Approvai of submission This letter is confirmation that the Patio enclosure plans that you submitted for approval has noon rors—a aryl Nat t%ean eg"�avaed for your home at 79-977 Rancho La Qutnto C'r In lioncho, c. Q\•i••l�. 71w W•LrV*4,} V'A r,vwa w mock axti-aris cxccnorsur*eow er+a too aquorc rcct naeca b.dN� vxI#msLely eon sq. it. Tho Comm�ttoo requirea the FolioyOna ; • All work is to be done in accordance with all applicable requirements of governmental ArilRioC inrl�iriinQ thin � nf'l n rLdnto and In 2onorda-ea ."tk ell Llomoownare Association architectural guldelines and governing documents: A Clty of La Quints building permit to be obtained and Copy furnished to the Association E r to commencement of work. • NQ rnatesials may be stacked In the street•. fans twwdon trucks are IQ uric an only one e street, fUL,... al.., ..:..1. L,. 1.1•.. t`.. C�L._J��,1«.•� ����••.. N,.4"..� f ON•. y./�oA,� w ♦Iw ►aavWaltvn nfiiro Tho Aecnri7tlnnre er l�ltocel�rol cen UN=nt will porform a Ono1 inapeetiori offer mrclpt cof ' such notice; when verification of the approved elan modifiratinns hava hoon ennrirrrled, your Security Deposit will be processed for refund. Thanking you in advance and if any questions please do not hesitate to call me at the on-site office 777.8807: .s e rat, C%alp a§WCCAM• Association General Manager 7C,0-799-0007 row T00-777-5201 mwalker drminternet.corn cc:•Architectvral Comm. ro. Do7C 6419 -.LA QUIVrrA, CA. 9aa4o-o*1y - 1oV-111-00U1 • rax joU-:.cx-5y01 cM Prescriptive Certificate of Com fiance: CF -1R ADD Residential Additions (Page 1 of Site Address: W Enforcement Agency: Date: A B C D General Information Project Name^ss /ypeO Climate Zone �� # of Stories Building T single/F�amily ® Multi Family Circle the Front Orientation: N, E, S, W or Degrees Conditioned Floor Area of Addition (cFA): .208 New Addition Size: Less than or equal to 100 fe 911,ess than or equal W 1000 fe (Do not use thisform for additions greater than 1000 NOTE: For Alter adons to an edaing home,.submir a completed CF -IR -ALT Form. Exception: F=Winx EVAC systeins that are replaced or altered to serve the addition may be included on. the CF -IR ADD Form. PRESCRIPTIVE ENVELOPE "QUEROMMS FOR ADDITIONS For standard wood and assemblies'meetinp, the Cavity R_ -value ottly. • For 100 ft 2 additions; the Proposed values mast be equal or greater than the Standard column or when indicated when using Package A "Pkg D ". Enter values in the shaded Proposed Columns. • For less than 1,000 ftz additions must comply with `Pkg D" requirements unless indicated in the Standard Column. To meet Pkg D" minimum enaw conpliance re RArements, see RCM Appendix B, Table 151-0 or 152(b) the RCM. Enter values in the shaded Proposed Columns. Site of Addition 100. ft2 or less Less than 1,000 fe. Component Standard ;.1'ro `' Comment Standard / Comment Ceiling btsalation R-19 Minimum Pkg D j8 : ° .' , Table 151-0 Wall hon R-13 Minimum R-13 Minimum Floor Insulation R-13 minimum Pkg D �. ` ,. _ ; `: Table 151-0 Fenestration U_ factor 7 SHGC itictor _ . SHGC,.:- Fuer Values From Ferre radon Prop Areas" Paw 2 of 5 U- factor U- ,. ; , SHGC :factor::, :...- : .'r `SHGC :. Enter Vafie From Penesunttan P7DP°'r°0S" 2 of 5 0.40 D 040 A Pkg D ` j Maximum Glazing Area 50 RZ > .' fti; Addition Alone' QQ $ o'" '> "• Enter Valves From AddidonAllowed FettesoutionAreas Page 3 of For West Facia g ..` Orientation' Radiant Barrier N/A Pkg D Table I51 -C Roofing N/A See Roofing Products Below. Pkg D See Roofing Products Below OMNE. SURFACE DETAILS For the marred rtioned of Mass Walls. see S Construction, Table below. A B C D E F G H I d Proposed SeeStandard Values From JA4 Table Tags/ ID Assembly Name or T 2 Framing Material and Size2 Thickness, Spacing, or Othei3 U_ JA4 Table factor° Numbers Framed Cavity R value6 Continuous Insulation R -Value • . JA4 Assembly Cell Value$ Proposed Assembly U= - factor9 i4 LG -S' Z 4, Z% 19 0r— EX/S-17M& I APP_ _VEID Note: For furred assemblies, accoratttng jou Continuous Lcsulation R-valap, see Page JA4-3 and Equation 4-1. For ca Fw7um Construcum table below. g w use Registration Number: 2008 Residential Compliance Forms AUG 3 0 2012 BY: Registration Date/Time: HERS Provider: March 2010 R ADD 2fo 5) Site Address: Enforcement Agency: Date: —977 Rue,✓ LA -4)( /.✓rA A2. eeTt, $.9–/2r 1. For Tag/ID indicate the identification name that matches the building plans. 2. Indicate the Assembly Name or type: Roof/Ceiling Walls, Floors, Slabs, Crawl Space, Doors and etc ... Indicate in column G the Frame material and Size: For Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc.._ see JA4 for other possible frame type assemblies. 3. Enter the thickness for mass in inches or Spacing between forming members enter, 16"or 24 VC, • or Other for all other assembly description such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel, and etc.... 4. Based on the Climate Zone, enter the equivalent U factor found in JA4 Table based on the R -Value from Table 151-0 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 theframing; otherwise, enter "0". 7. Enter the Continuous Insulation R -value for the proposed assembly, otherwise, enter "0 ". 8..Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J. 9. The Proposed Assembly. U factor, Column J, must be equal to or less than the Standard U factor in Column E to comply. FURRING STRIPS CONSTRUCTION TABLE FOR MASS WALLS ONLY A B. C D E F G H I I J I K L M Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation Walls From Reference in Furring Space from Reference Joint Appendix Table 43. 43.6 4.3.7 Joint dix Table 43.13 U Assembly ' i o ; .9 E m ' Final Mass i Ihiclmess Name or T JA4 Table Number 4.3 Q> d x q c e m m 'o E> v in Q> > Assembly U -fact" Comment I. Indicate the Mass Thickness from Reference Joint Appendix.JA 2. Indicate the Assembly Name or type. Roq Meilmg Wafts, Floors, Slabs, Crawl Space, Doors and etc ... Indicate the Frame type and Size: For Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies. 3. Enter the Table monber that closely resembles the proposed assembly. 4. Enter the row and column of the U factor value. 5. Enter the Effective R -value listed in the JA4 Table Number. 6 The Final Assembly is cakadated by using Equation 4-1 or Equation 4-4 of the. Reference Joint Appendix JA4. Enter the value in Column L. 7. Insert the Final Assembly U- actor value back on to the a7ague Soface Details table in Column J FENESTRATION PROPOSED AREAS Orientation Fenestration Type and Frame (Nortk, East, ProposedArca' Maximum Maximum NFRC or (Wmdow, Glass Door or South, West) ( U-factorz' 3 SHG(:i' 3' ° Default Values -1 51-1401A)6-. 6002 ! o. t A-10 , U' r-1 X4`0 I)&,00IJ _ 30 . qo '35, boo `: �� O .r A�`XC,, Total I. Fenestration area is.the area of total glazed product (Le. glass phos frame). Exception: When a door is less than 50'/ glass, the fenestration area may be the glass area phis a "2 inch frame" around the glass. 2. Enter valuefrom Component Package D Requirements in Table 151-C. 3. Actual fenestration products installed and as indicated in CF-M-ENVForm shall be equivalent to or have a lower U. factor and/or a lower SHGC value than that specified on the Fenestration Proposed Area table above. 4. Submit a completed WS -3R Form if a reduced SHGC is calculated with exterior shading. 5. I applicable at this stage enter `NFRC" or NFRC Cireed windows or CEC "Default valuesfound in Table 116-A or B. Registration Number. Registration DatelTime. . 2008 Residential Compliance Forms HERS Provider: March 2010 Prescriptive Certificate of Com Bance: CF -1R ADD Residential Addidonsa e� 3 of Site Address: Enforcement Agency: Date: 79-977 RW": v L4 v1A1)_,4.fin- er B-Zq-ler AMMON ALLOWED F' ESTRATTON AREAS Check applicable box below if the roof addition is exempt from the roofmg product "Cool Roof' requirements. Note: Ifany one of the boxes are A B C D less than 51b/f. F CFA of Addition Allowed % Allowed Area Area RemovedZ Roof Slope Proposed was Product f? of CFA (A x B) 82 qNMa, <— 2:12 > 2:12 (Table Above) Total Fenestration Area; �Og 0.2o 4(r (da '� 0 0 West Zo8 0.05 tO, IOO Zo8 ZZo �eneCZ'son & -15) 0 0 0 ��4 I 1. West Fenestration Area includes west-slopmg skylights and any skylights with a pitch less than 1:12. 2. Glass removed to make way for the addition. 3. For additions less than 1,000 flz the standards allows glazing removed during the remodel to be added to Ike glazing area allowance. The maximumn allowed glazing area for the addition is the CFA x 20'0 + glass removed to make way for the addition. 4. In climate zones 2, 4, 7-15, no more than 5% of the CFA is allowed for west facing glazing plus west facing glass area removed, to make way for the addition. The maximum allowed west facing glazing area is the CFA x S% + west facing glass removed to make way for the addition. 5. To meet co licence, the ProposedArea must be less than or equal to the Total Allowed Area or BOTH the Total and West Fenestration Areas. ROOFING PRODUCTS (COOL ROOFS) §151()12 Check applicable box below if the roof addition is exempt from the roofmg product "Cool Roof' requirements. Note: Ifany one of the boxes are checked below, the Aged Solar Reflectance and Thermal Emitiance requirements for roofing products in §118(1) are not applicable_ Do not fill table below. Roofing compliance Not Required in Climate Zones 1-12,14, and 16 with a Low -Sloped. Less or 2:12 pitch 0 Roofing compliance of Required in Climate Zones 1 through 9 and 16 with a Steep -Sloped Roofs pitch greater than 2:12 and product weight less than 51b/f. Roofing area covered by building integrated, photovoltaic panels and solar thermal panels are exempt from the above Cool Roof criteria Roof constructions that have thermal mass over the roof membrane with at least 25 lb/ft 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•lompliance, otherwise, check e applicable box below if Exempt from the Roofing Products -Cool Roof' Requirement: Roof Slope Product Weight Product Aged Solar Thermal CRRC Product ID Numbers <— 2:12 > 2:12 < 5lb/fl> 5lb/RZ Type2 Reflectance-" Emittance SRIS 0 0 0 0 0 0 0 0 ��4 I 0 © 0 0 13 41 13 0 .© 0 17 0 0 ® 0 0° I. The CMC Product D Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolroofs.org/p cts/search gb. 2. Indicate the type of product is being used for the roof top, ie. single ply roof, asphalt roof, metal roof,' etc- 3.If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same dbwtory and use the equation (0.2+0.7(pheud — 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance. 4. Check box if the Aged Reflectance is a calculated value using the equation above. 5. Calculate the SRI value by. using -the SRI- Worksheet at http:/hvww.energv.cagov/title24/and enter the resulting value in the SRI Column above and attach acopy of the SRI- Worksheet to the CF -IR o apply Liquid Ffield Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in §1 18(i)4. Select the applicable coating: Ahmunum-Pigmented Asphait Roof Coating IffZent-Based Roof Coating 0 Other Registration Number. Registration DalwTime. HERS Provider_ 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Com fiance: CF -1R ADD Residential Additions (Page. 4 of Site Address: Enforcement Agency: 758; te: 71-1'77 44AWO L.4- 1 /� �jsc. Cr 'Z`��12 HVAC SYSTEMS - HEATING List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be storage gas or propane fired, non-recir culahng, and may not exceed 50 gallons. If no natural gas is connected to the building, an electric storage DHW heater less than 50 gallons with an energyfactor greater than 0.90 maybe used Hot water pipe insulation from the DHW heater to the kitchens and on all and d hot water pqw is required in all co Hent Packa es in all climate zones. Duct.or ElYES ®NO Slab •edge insulation mpiirW for heated slabs in all Climate Zones. See details in Table 118-A of the standards. Configuration Cooling Equipment Type and Capacity1z Minimum Distribution Piping Thermostat Type (Central, Split, Heating Equipment Efficiency Type and Insulation Thermostat Space, Package or Type andCAVaCitV, z s AFUE or HS Location° R Value Type H dronic S 2. Refer to the LTM Verification section on Pages 3 and 4 of the CF -IR -ADD Form for additional requirements and check applicable boxes. 3. Indicate or Location (Ducts, tunic in Floor, Radiators, etc. 1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The water heating tank and p4pas shall be insulated to meet the requirements of 150 ). 1. Indicate Heating Type (Central Furnace, Wall Furnace,. Heat pump, Boiler, Electric Resistance, etc.) 2. Electric resistance heating is allowed .only in Component Package C, or except where electric heating is supplemental (i.e., if total capacity < 2 KW or 7,000 BhAr electric heating is controlled by a time -limiting device not exceeding 30 minutes). See §151(6)3 exception. 3. Refer to the HERS Verification section on Pages 3 and.4 of the CF -JR -ADD Form for additional requirements and check applicable boxes. 4. Indicate Type or Location (Ducts, Hydromc in Floor, Radiators, etc. HVAC SYSTEMS - COOLING List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be storage gas or propane fired, non-recir culahng, and may not exceed 50 gallons. If no natural gas is connected to the building, an electric storage DHW heater less than 50 gallons with an energyfactor greater than 0.90 maybe used Hot water pipe insulation from the DHW heater to the kitchens and on all and d hot water pqw is required in all co Hent Packa es in all climate zones. Heated Slab Insulation ElYES ®NO Slab •edge insulation mpiirW for heated slabs in all Climate Zones. See details in Table 118-A of the standards. Configuration Cooling Equipment Type and Capacity1z Minimum Efficiency EER/EER or COP). Distribution Type and • Location, Duct or Piping Insulation R -Value Thermostat Type {Central, Split, Space, Package or H dronic GX/S� Energy Factor or Thermal Efficiency Insulation R -Value' IDOIS ZWk- L Indicate Cooling Type (A/C, Heat pump, Evap. Cooling, etc). 2. Refer to the LTM Verification section on Pages 3 and 4 of the CF -IR -ADD Form for additional requirements and check applicable boxes. 3. Indicate or Location (Ducts, tunic in Floor, Radiators, etc. WATER HEATING List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be storage gas or propane fired, non-recir culahng, and may not exceed 50 gallons. If no natural gas is connected to the building, an electric storage DHW heater less than 50 gallons with an energyfactor greater than 0.90 maybe used Hot water pipe insulation from the DHW heater to the kitchens and on all and d hot water pqw is required in all co Hent Packa es in all climate zones. Heated Slab Insulation ElYES ®NO Slab •edge insulation mpiirW for heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation © YES .Q NO External Tank. Water Heater Type/Fuel T Distribution Type Standard, Reckcula " )2system Number In Tank ) Energy Factor or Thermal Efficiency Insulation R -Value' IDOIS ZWk- 1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The water heating tank and p4pas shall be insulated to meet the requirements of 150 ). 'SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written justification and documentation and special verification. Applicable special features shall be marked with a YES and be specified within the plans. Radiant Barrier (Root) Cl YES1r3N70 Required in Climate Zones 2, 4, and 8-15 foradditions than 100 ft . Slab Edge (Perimeter) Insulation YES I n NO I In Climate Zone 16 under Component Package D, R-7 insulation is Heated Slab Insulation ElYES ®NO Slab •edge insulation mpiirW for heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation © YES .Q NO In Climate Zones 1, 2,11, 13,14 & 16 R-8 insulation is required, and in Climate Zones 12 & 15 R-4 insulation is required under Component Package D. Thermal Mass - To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach. Registration Number. 2008 Residential Compliance Forms Registration DatelTime: HERS Provider: March 2010 Prescriptive Certificate of Compliance: CF -1R ADD Residential AddWons Tage 5 of Site Address: Enforcement Agency: Date: HERS VERIFICATION SUMMARY - The enforcement agency should pay special attention to the HERS Measures specified in this checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final inspection. Duct Sealing & T HERS yff#lbafion is requiredfor this measum YES 090 In all Climate Zones, if a new space -conditioning system (HVAC equipment and ducting) is installed to serve the addition chaw measurement shall be verified per §151 7A OYES alone, the ducts are to be sealed and tested per §15l(f)10. OYES OYES In Climate Zones 2 and 9-16, if mole than 40 linear feet of new or replacement ducts are installed in unconditioned condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) and will serve the addition, a MO space to serve the addition, the ducts are to be sealed and tested per §152(b)1D. [3EXCEPTION: Existing duct systems refflerant charge measurement shall be verified per § 152 1F. Central that are extended, which are constructed. insulated or sealed with asbestos. Ventilation Svctem — Airftnw And Fun W9tt n.Qm - .i. --I s....k, f -a r.. , nnn aZ .,-,e.._ 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 OYES - MO Fr O are to be sealed and tested per § 152(b)IE. [ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space EXCEPTION: Faisting duct systems constructed, insulated or sealed with asbestos. Refrigerant Charge - SDlit System HERS verification is remmnd for this moac1nw DYES MO In Climate Zones 2 and &15, if a newly ducted split A/C or heat pump is installed to serve the addition alone, a refrigerant Date: Address: chaw measurement shall be verified per §151 7A OYES MO In Climate Zones 2 and 8-15, if the existing HVAC eq*ment 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, a refflerant charge measurement shall be verified per § 152 1F. Central Fan Integrated Ventilation Svctem — Airftnw And Fun W9tt n.Qm - .i. --I s....k, f -a r.. , nnn aZ .,-,e.._ Ducted Split S - Air Conditioners and Heat Pumps: Airflow and Fan Watt Draw HERS verokation is required. E3YES ONO In Climate Zones 10 through 15, if a new space -conditioning system (HVAC equipment and ducting) is installed to serve the addition alone, the airflow and fan watt draw shall be verified per §151(f)7B. In Climate Zones 10 though 15, if the existing space -conditioning system (HVAC equipment and ducting) is replaced and YES �i0 will serve the addition, the airflow and fan watt draw shall be verified ver 8152(b)1 F_ is Name: AE -4-,✓ cgAdYoj Company: Aj�1'//LiSo ` A087I If Applicable [JEA or [JEPE .WA-rhfiirafirm iA- I �4 1_�Z 7l0o 72 /!�'1-- Responsible Building Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the building design identified on this Certificate of Coi�liance conform to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance are consistent with the information provided to document this building design on the other applicable compliance foots, worksheets, calculations, plans and specifications submitted to dze enforcement a for oval with this buildin lication. Name:Signat re: Compffi3'' Date: Address: License: � City/State/Zip: Phone: For assistance or questions regarding the Energy Standards, contact the Enemy Hotline ajL- 1-800 772-3300. 1 Registration Number: Registration DX&Time: HERS Provider. 2008 Residential, Compliance Forms March 2010 Birt # Ci%/ Of Lel QUfnta Budding 9 Safety Division P.O. Box 1504,78-495 Cafte Tampico La.Quinta, CA 92253 - (760) 777-7012 Building Permit Application'and Tracking Sheet Permit # - `OC Owner's Name:. /60 A. P. Number.!p 02- - 3;7 v -,D 12- 2Legal LegalDescription:TQ.Acr- 05zAT7 -3" Go 7- /Y City, ST, Zip: L4 -K" 'y' O R- �3 Contractor. 9+1' .W 6-,S' CO e Sf Telephone Address: Project Description: City, $T, Zip: - -71/a GDSa-- eA S77 ,-�G- CDdek-cm 1%770.' Telephorre:76 D2-7S—,FJ--r,,? City Lie. 9, State Lia #: Arch, l•,�'w'"fir �2L 11 ✓ Address: 2/2.6 �J City, ST, zip: P#ZtiIYPAf I)Q7 CIA 9-12-a"Q - Telephone:7 p Construction Type:. Occupancy: Project type (circle one): New Alter Alter Repair Demo Sq. FL: �j #Stories: / # Units: State Lic. #: Name of Contact Person: Telephone # of Contact Person: Estimated Value of Project &DZi APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Reed TRACKNG PERhIIT FEES Plan Sets Plan Check sabmittedAmount Joh Win ' Structural Cates. O� Reviewed, ready for corrections el 11 Plan Cheek Deposit" Truss Cates. Called Contact Person= ',j Plan Check Balance. Title 714 Cates. Plans picked up 9 Construction Flood plain plan Plans resubmitted.,. Mechanical Grading plan r Review, ready for eorrectio N Electrical Subeontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval �" 3 Plans resubmitted Gradin' g IN HOUSE:- fr° Review; ready for correetionOsme Developer Impact Fee Planning Approval Called Contact Person Pub. Vi!ks. Appr Date of permit issue School Fees Total Pcrmit Fees