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13-0406 (RER)P.O. BOX 1504 78-495 CA,LLE TAMPICO LA QUINTA, CALIFORNIA 92253 ceiht 4 B ✓���J BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 13-00000406, Property Address: 79975 RANCHO LA QUINTA DR APN: 6.49-740-011- - - Application description: REMODEL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 35000 Applicant: Architect or Engineer: 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: •13 LicenseNo.: 746930 Date: _contractor: 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 7b31.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: _ 1 _ I 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.). - I 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: LOPEIRMIT Owner: KEN ROBERTSON 79-975 RANCHO LA QUINTA LA QUINTA, CA 92253 !D Contractor: RAWLINGS CUSTOM CONTRACTING P.O. BOX 3216 PALM SPRINGS, CA 92263 (760)322-8788 Lic. No.: 746930 — VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/11/13 JUN i El 2013 CITY OF LA QUINTA FINANCE DEPT. -------------------------------------- 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. 1 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 EXEMPT Policy Number EXEMPT 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 de, I shall forthwith co ply with those provisions. . Dater Applicant: 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 1$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned proppLk for inspection purpos Date�7a3 Signature (Applicant or Agent): �% . Application Number . . . . . 13-00000406 ------ Structure Information 166 SQ FT ADDITION & REMODEL ----- Other struct info . . . . . CODE EDITION 2010 ---------------------------------------------------------------------------- Permit BUILDING PERMIT Additional desc . Permit Fee . . . . 317.00 Plan Check Fee 206.05 Issue Date . . . . Valuation . . . . 35000 Expiration Date 12/08/13 Qty Unit Charge Per Extension BASE FEE 252.00 10.00 6.5000 THOU BLDG 25,001-50,000 65.00 -------------------------------------------- m . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 23.49 Plan Check Fee 5.87 .Issue Date . . . . Valuation 0 Expiration Date . . 12/08/13 Qty Unit Charge Per Extension BASE FEE 15.00 166.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 5.81 134.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 2.68 ---------------------------------------------------------------------------- Permit . . . MECHANICAL Additional desc . . Permit Fee 19.50 Plan Check Fee 4.88 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/08/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 ---------------------------------------------------------------------------- Special Notes and Comments 166 SQ FT ADD, REMODEL KITCHEN, REMOVE FIREPLACE,134 SQ FT PATIO ADDITION, REMODEL FAMILY ROOM. PER 2010 CODES. June 11, 2013 8:38:44 AM jjohnson. -----------------------------------------------------------=---------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 2.00 ENERGY REVIEW FEE 20.61 STRONG MOTION (SMI) - RES 3.50 Fee summary Charged Paid Credited Due fir'1 IAI'F..RM 1T ' Application Number . . . . . 13-00000406 --------------------------- Permit Fee Total 359.99 -------------------- .00 ---------- .00 359.99 Plan Check Total 216.80 .00 .00 216.80 Other Fee Total 26.11 .00 .00 26.11 Grand Total 602.90 .00 .00 602.90 IAI'F..RM 1T ' 08/15/2011 MON 11:42 FAX La 4uinta Bldg & Safety 2001/001 ��t1) ar Safety mdm ` # 9:0 Soot.1W4, 7"PS Tallow La Qrra4 CA 92253 - (A* 77746il- App 2dw mrd ?'iacfg Shm . Adams S w wow=es Nmme: EAI /e1J6Zi/� BnI A. P. Nom. 602 —3 7o- o // Address: 1,qt Dm;tWm- Ll AG /Lr Mia 33io ig. ciln ST, Zip: JQAcJ�IrJ �� Td � - Address -752 -VI Desaipii0a: Chy, S', CIO- � 3 Y E5P LA Rbl✓ i -A" (L- o 76o z ,sb8 .o A"Do �Jjo eolwi)w PA-1to State iic. # : OA/ i=/ toPOAlr O.'J67/Z.49'0L.W MiSr1xJCr Conl o CA '12-,7&2 Te#ePw= (,0 .778 I65z c, -rte v stift Lir #: • .4�Pmject typo{circle one}: New Add'n Atha Repair Demo t bfco et P+asq� EA k) SQ: FC (Co �v : ( l �ieY zPam76o 7W l(oSZ spa dvame�f .3�-D ' Fly APPIJGANT: DO NOT VMM U M TM UM d iter d MUCKM - p 'ftgpg PbaSett igueed. Aad SOradmaiCalts $evtea�d, ooaaVieas Plea(9odcl3epeeit Ti'rmatSln. ' "•'• r"Chu* t3dnee. vaZI> I�m 3 Ph=bft : Gr=tafte rte, pr�ota,p saga. �co,�. Appy ruubmf&d . . CAWA.U.P. . sehW 1O.. Ir Total Renin Fees 13 R%1 - Ib - %W. Date 5/13/13 No. 31635 CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 Owner Winnie Robertson Trust Address 79-975 Rancho La Quinta Dr. City La Quinta Zip Tract # Type Residential Addition Lot # No. Street S.F. Unit 1 79975 Rancho La Quinta 166 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments APN # Jurisdiction Permit # No. of Units Lot # No. 4����FIEDs��O o BERMUDA DUNES r En RANCHO MIRAGE INDIAN WELLS b ,�. PALM DESERT, 1, LA QUINTA INDIO Py� a 602-270-011 La Quinta Street S.F. 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 Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 166 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- Dean Carlson Check No. Bank Name/Recipient of Certificate Telephone 760/778-1652 Funding Exempt e , By Dr. Gary Rutherford `'V' `'' Superintendent -' Fee collected /exe p ed by P ricia Barbuzza Payment Recd -: $0.00 ?^Over/Under �G'Y r ' Signature NOTICE: Pursuant to Government Code SeKfion 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 RANCHO LA QUINTA MASTER ASSOCIATION Arckitectural Control Committee March 28, 2013 Mr. Ken Robertson 79-975 Rancho La Quinta Dr La Quinta, CA 92253 Re: 79-975 Rancho La Quinta Dr 8 } k Approval of Submission The Architectural Committee reviewed your submission for an addition to your family room, extend patio area and other remodeling. The submission as presented Is approved upon condition of. The Committee requires the following: • All work is to be done in accordance with all applicable requirements of governmental entities, including the City of La Quinta and in accordance with all Homeowners Association architectural guidelines and governing documents. • A City of La Quanta building'permit be obtained and copy furnished to the Association prior to commencement of work. • All elevations of the extension must match existing elevations. • No materials can be stored in the street or block mailboxes. When the work has been finished, please return the -Notice of 6mpledonn to the Association Office; the notice should be in your architectural packet or you may get another one in our office. The Association's architectural consultant will perform a final inspection; upon approval of final inspection, the deposit will be processed. Thanking you in advance and if any questions please do not hesitate to call me at the on-site office 777.880 . ce Mary E. Wal r, cccAM Association General Manager 760.777.8807 - fax 760.777.8961 Email: mwalker@drminternet.com - www.rlgma.com cc: Architectural Comm. P.O. BOX 6419 - LA QUINTA, CA 92248-6419 - 760-777-8807 - FAX 760-777-8961 Tdf 4 . 40" Building & Safety Department 78-495 Calle Tampico PO Box 1504 La Quinta, CA 92253 (760). 777-7012 voice — (760) 777-7011 fax To: Greg Butler, Building Official From: Les Johnson, CDD Director To PD: June 11, 2013 Due date: ASAP. Permit # - 13-406 Status: �1 st Re eiv w Building Plans Approval (This is an approval to issue a Building Permit) The Planning Division has reviewed the Building Plans for the following project: Description: Enlarge Family Room and- Interior Remodel (Kitchen/Family Room) Address or general location: 79-975 Rancho La Quinta Applicant Contact: Dean Carlson 760-778-1652 The Planning Division finds that: ❑ ...these Building Plans do not require Planning Division approval. .these Building Plans are approved by the Planning Division. ❑ ...these Building Plans require corrections., Please forward a copy of the attached corrections to the applicant. When the corrections are made please return them to the Planning Division for review. Les Johns�orf, Community Development Director ,Olt L// Date Note: PLEASE RETURN PLANS WITH GREENSHEET TO THE BUILDING DIVISION. Prescriptive Certificate of Com fiance: CF -IR ADD Residential Additions (Page 1 of Site Address: Enforcement Agency: Date: 79- J17Y1e,+A/Ce40 L6 LOA 14- D E F G I H I General Information Project Name _� O Climate Zone # is # of Stories Building T Single Family ® Multi Family Circle the Front Orientation: S, W or Degrees Conditioned Floor Area of Addition New Addition Size: Less than or equal to 100 f - Less than or equal to 1000 fe (CFS.); (Do not use this orm for additions greater than 1000 ) NOTE: For Aheradons to an existing home, submit a completed CF -IR -ALT Form. Ex tion: Existing &VAC systems that are replaced or altered to serve the addition may be included on the CF -IR ADD Form. PRESCRIPTIVE ENVELOPE REQUIREMENTS FOR ADDITIONS For standard wood and assemblies meeting the Cavity R -value only. • For 100 fiz additions; the Proposed values must be equal orgreater than the Standard column or when indicated when using Package D, "Pkg D ". Enter values in the shaded Proposed Columns. • For less than 1, 000 f? additions must comply with `Pkg D" requirements unless indicated in the Standard Column. To meet "Pkg D" minimum enmV compliance re wirements, see RCM Aepjndix A Table 151-C or V52(b) in the RCM. Enter values in the shaded Proposed Columns. Size of Addition 100 ftz or less Less than 1,000 fe. Component Standard Pro `osed- Comment Standard Pro ` Comment Ceiling Insulation R-19 Minimum Pkg D ff Table 151-0 Wall Insulation R-13 '' Minimum R-13 19.; Minimum Floor Insulation R-13 Minimum Pkg D Af A Table 151-0 U- U- U- Enter Values From Fenestration factor SHGC factor SHGC factor SHGC factor .` SHGC. "Fenestration Proposed Areas ' 0.40 Pkg D 0.40 Pkg D y �0. 3S. Enter Values Ent From "Fenestration Pa 2 of 5 e:W;C,1M%'AWJJbo Addition Alone. Z. �� Enter Values Flom Maiamum Glazing 50 fl2 > ft2i Proposed p "Addition Allowed For West -Facing 12 3.30. T Area — Areas" Fenestration Areas" Page 3 of 5 Page 2 of 5 Orientation' _ Radiant Barrier N/A Pkg D Table 151-0 Roofing N/A See Roofing Products Below. Pkg D See Roofing Products Below 10 OPA UE SURFACE DETAILS For the inrred rtioned of Mass Wallssee F Strips Construction Table below. A B C D E F G I H I J Pro d 3ft NOW Standard Values From JA4 Table Ta� ID Assembly Name or T 2 Framing Material and Size2 Thickness, Spacing, or Other' U- JA4 Table factor° Numbers Framed Cavity R-valueb Continuous Insulation R-Vahrer JA4 Assembly Cell Value$ Proposed Assembl U -facto WAL. `S 2 Jlv t oDF IS '6- 3 C BUi e:W;C,1M%'AWJJbo la ' R -value, see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and APR 0 4 2013 COMMUNITY DEVELOPMENT". Registration Number: Registration Date/Time: 2008 Residential Compliance Forms HERS Provider: March 2010 Prescriptive Certificate of.Compliance: CF -IR ADD Residential-Atididons Tage 2 of Site Address: Enforcement Agency: Date: 7 q- 47s" RAA ?,1-0 &I l� u i �:- 2 G r - 2 - /3 W - f 8 0 0 1. For Tag/ID indicate the identification name that matches the building plans. 2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ... Indicate in column G the Frame material and Size: For Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies. 3. Enter the thickness for mass in inches or Spacing between framing members enter, 16"or 24 "OC,• or Other for all other assembly description such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel, and etc.... 4. Based on the Climate Zone; enter the equivalent U factor found in JA4 Table based on the R -Value from Table 151-C S. 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 11011. 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 I C I D I Eidded H I J K L M Proposed Properties of.Masoary and Concretenterior or Exterior Insulation Walls From Reference ing Space from Reference Joint A ndix Table 43.5 43.6 43.7 ndia Table 43.13 1. Fenestration area is the area of total glazed product (i.e. glass phis j-�rcep 'o : tWh�n qpr, (,S7N, glass, the fenestration area may be the glass area plus a "2 inch frame" around the glaq�sS. t v I 2. Enter value from Component PackageDRequirementsinTable�sl''c�JILDfNG&SAFETY 3. Actualfenestration products installed and as indicated in CF-6R-ENVForm sl-be�Q,u l tf r factor and/or a lower SHGC value than that specied on the Fenestration ProposedArea tablelbve. iJ 1� �/4. Submit a completed WS -3R Form ifa reduced SHGC is calculated with ex'-% s a 'OSTR S. 1 a licable at this sta a enter `WFRC" orNFRC Ce ed windows or CE "D ault" va es oI&A or B. U v d > V Assembly d `- PCd F -o d.o a, ° > d Final AssemblyThickness` Macs Nameor T JA4 Table Number' m ¢ > Eo a W Q > U -factor 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 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 number that closely resembles the proposed assembly. 4. Enter the raw and column of the U factor value. S. Enter the Effective R -value listed in the JA4 Table Number. 6. The Final Assembly is calculated 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 Opaque Surface Details table in Column J. FENESTRATION PROPOSED AREAS Fenestration Type and Frame (Window, Glass Door or Skylight) Orientation (North, East, South, West) ProposedArea' (f) Maximum U-factor2, 3 Maximum NMC or SHGC2. 3.4 Default Values's SL/ !7 i n16 ac) z W - f 8 0 0 135- N P2C- 1 c`7) &)/ AJD 10 to 4Y n '3s- l=1LC1. Ft �-Ca Door, N 2 , y o . 34' NF -2L PtaLl 1. Fenestration area is the area of total glazed product (i.e. glass phis j-�rcep 'o : tWh�n qpr, (,S7N, glass, the fenestration area may be the glass area plus a "2 inch frame" around the glaq�sS. t v I 2. Enter value from Component PackageDRequirementsinTable�sl''c�JILDfNG&SAFETY 3. Actualfenestration products installed and as indicated in CF-6R-ENVForm sl-be�Q,u l tf r factor and/or a lower SHGC value than that specied on the Fenestration ProposedArea tablelbve. iJ 1� �/4. Submit a completed WS -3R Form ifa reduced SHGC is calculated with ex'-% s a 'OSTR S. 1 a licable at this sta a enter `WFRC" orNFRC Ce ed windows or CE "D ault" va es oI&A or B. Registration Number: 2008 Residential Compliance Forms DATE C-4L� Registration Dale/Time: / HERSProvider: March 2010 Prescriptive Certificate of Compliance: CF -1R ADD Residential Additions (Page 3 of Date: Site Address: Enforcement Agency: ADDITION ALLOWED FENESTRATION AREAS Check applicable box below if the roof addition is exempt from the roofing product "Cool Roof 'requirements. Note: If anyone of the boxes are A B C D E F CFA of Addition Allowed % Allowed Area Area Removedz Maximum Allowed Area Proposed Areas Product fe of CFA (A x B) ftz .(C + D) < 2:12 > 2:12 (Table Above) Total Fenestration Area' Reflectance 020 33,7_0 AZO — 3 3, 2 o ? oZ O West Fenestration Area 16 (, 0.05 F, 30 .2,l S 22,3.3 0 '— ZZ 5 , v ,tired In CZ's 2, 4 & 7 -15) ❑ ❑ ❑ ❑4 1. West Fenestration Area includes west -sloping 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 fie the standards allows glazing removed during the remodel to be added to the glazing area allowance. The maximum allowed glazing area for the addition is the CFA x 200116 + 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 5% + west facing glass removed to make way for the addition. 5. To meet compliance, the Proposed Area 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 roofing product "Cool Roof 'requirements. Note: If anyone of the boxes are checked below, the Aged Solar Reflectance and Thermal Emitiance requirements for roofing products in §1180) are not applicable. Do not fill table below. El Roofing compliance Not Required in Climate Zones 1-12, 14, and 16 with a Low -Sloped. Less or 2:12 pitch. ❑ Roofing compliance Not 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/ft2 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 e 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 < 51b/A2 > 51blf? Type, Reflectance 1,4 Emittance SRI' © ❑ ❑ ❑ 0 ❑ ❑ ❑ ❑ ❑4 12 0 ❑ ❑ 13 ❑ ❑ o ❑4 ❑ ❑ ❑ ❑ c4 ❑ ❑ ❑ ❑ ❑4 1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolroo s.org/products/search.". 2. Indicate the type ofproduct is being used for the roof top, i.e. single ply roof, asphalt roof, metal roof, etc. 1. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same directory and use the equation (0.2+0.7(phdjr – 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 h .-14vww.ene ev/ ' !ti value in the SRI Column above and attach atopy of the SRI- Worksheet to the CF -IR. C To apply Liquid Field Applied Coatings, the coating must be applied a ss te�� kness 4r coverage commended by the coatings manufacturer and meet minimum performan is m 1 8 app 'cable coating: ❑ Ahmrinum-Pigmented Asphalt RoofCoating 0 Cement -Based Roof Coen CON Registration Number: 2008 Residential Compliance Forms DATE Registration Date/Time: ` HERS Provider: March 2010 Prescriptive Certificate of Compliance: CF -1R ADD Residential Additions jEage 4 of Site Address: Enforcement Agency: Date: 7 - 975 6,10 &00 1-40/AL � [�� G1 `q -Z - 43 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 -recirculating, 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 10 the kitchen(s and on all and ound hot water pipes is required in Mcomponentpacka es in all climate zones. Duct or Raised Slab Insulation Configuration Cooling Equipment Type and Capacityt'2 Minimum Distribution Piping Thermostat Type (Central, Split, Heating Equipment Efficiency Type and Insulation Thermostat Space, Package or Type and Capacity'," AFUE or HSP Location R -Value Type H dronic (3>✓6— 3. Indicate Type or Location(Ducts, H dronic 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 andpipes shall be insulated to meet the requirements o 150 ' . 1. Indicate Heating Type (Central Furnace, Wall Furnace, Heat pump, Boiler, Electric Resistance, etc.) 1. 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 Btulhr electric heating is controlled by a time -limiting device not exceeding 30 minutes). See §151(b)3 exception. 3. Refer to the HERS Verification section on Pages 3 and 4 of the CF -IR -ADD Form for additional requirements and check applicable boxes. 4. Indicate Type or Location(Ducts, H dronic 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 -recirculating, 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 10 the kitchen(s and on all and ound hot water pipes is required in Mcomponentpacka es in all climate zones. ❑YES 13 NO Slab . e insulation re for heated slabs in all C ' Zones. a e 8-A Raised Slab Insulation Configuration Cooling Equipment Type and Capacityt'2 Minimum Efficiency SEER/EER or COP Distribution Type and Location'. Duct or Piping Insulation R -Value Thermostat Type .(Central, Split, Space, Package or H dronic FIX 1 S 77IJ(� Energy Factor or Thermal Efficiency Insulation R -Value' &C IS T7 1J �- 1. Indicate Cooling Type (A/C, Heat pump, Evap. Cooling; etc). 2. Refer to the HERS Verification section on Pages 3 and 4 of the CF -IR -ADD Form for additional requirements and check applicable boxes. 3. Indicate Type or Location(Ducts, H dronic 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 -recirculating, 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 10 the kitchen(s and on all and ound hot water pipes is required in Mcomponentpacka es in all climate zones. ❑YES 13 NO Slab . e insulation re for heated slabs in all C ' Zones. a e 8-A Raised Slab Insulation DYES ❑ NO In Climate Zones 1, 2, 11, 13, 14 & 16 R-8 insulation is aired, pp j4 ' tion is required under Component Package D. External Tank Water Heater Type/Fuel Typel Distribution Type Standard, Recirculating)' Number In System Tank Capacity ) Energy Factor or Thermal Efficiency Insulation R -Value' &C IS T7 1J �- 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 andpipes shall be insulated to meet the requirements o 150 ' . SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written justification and documentation and special verification. Applicable special features shall be marked with a YES and be specified within the plans. Radiant Barrier (Roof) DYES InNO I Required in Climate Zones 2, 4, and 8-15 for additions larger than 100 fe. Slab Edge (Perimeter) Insulation YES NO IIn Climate Zone 16 under Component Package D, R-7 ' la on Heated Slab Insulation t I RI iii_ i ❑YES 13 NO Slab . e insulation re for heated slabs in all C ' Zones. a e 8-A Raised Slab Insulation DYES ❑ NO In Climate Zones 1, 2, 11, 13, 14 & 16 R-8 insulation is aired, pp j4 ' tion is required under Component Package D. Thermal Mass - To obtain Compliance Credit for the installation of thermal ri's� an ch Registration Number: Registration Date/Ttme: l/ HERS Provider: 2008 Residential Compliance Forms March 2010 Presc ' tive Certificate of Compliance: CF -1R ADD Residential Additions (Page 5 of Date: Site Address: Enforcement Agency:I Ea HERS VERIFICATION SUMMARY - The enforcement agency should pay special attention to the HERS Measures specified in this checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final inspection. Duct Sealing & Testing HERS verification is requiredfor this measure. YESi0 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(f)10. In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned OYES MO space to serve the addition, the ducts are to be sealed and tested per § 152(b)1D. Q EXCEPTION: Existing duct systems that are extended which are constrnc insulated or sealed with asbestos. 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)l E. �� EE3YES 60 Q EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. 'EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. EXCEPTION: Existing duct stems constructed, insulated or sealed with asbestos. Ref ' erant Ch e - Split System HERS verification is re uired or this measure. OYES E6O 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 measurement shall be verified per § 151 i(f)7charge A-In Climate Zones 2 and 8-15, if the existing HVAC equipment is replaced (including replacement of the air handler, outdoor OYES BNO condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) and will serve the addition, a refrigerant char a measurement shall be verified per § 152 1F. Central Fan Integrated Ventilation System - Airflow and Fan Watt Draw - do not apply for additions 1,000 fly or less. Ducted Wit Systems - Air Conditioners and Heat Pumps: Airflow and Fan Watt Draw HERS verification cation is required. ©YES JagO 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 7B. EIYE$ Climate Zones 10 through 15, if the existing space -conditioning system (HVAC equipment and ducting) is replaced and M40In will serve the addition, the airflow and fan watt draw shall be verified per § 152(b)IF. Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation baccurate and CQMDlete. Name: 1J cr�8'12�C,.CO.J Company: Date: q-2 - /3 Address:/ 2 / 2S 7✓. 67 ,!'o d- If Applicable or EPE (Certification #): Ci /State/Zip: ,Pi9,e-at SPIZIn1G.3 CAL Y2-2-6, Phone: 760 77k /6,5 -- Responsible Building Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance are consistent with the information provided to document this building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building t application. Name: Signature: Company: Date: Andress: BUILDING & SAFE FY D EPT City/State/Zip: O For assistance or questions regarding the Energy Standards, c act the F e;W otl n' a t: - 72-33 . TE Registration Number. Registration 2008 Residential Compliance Forms March 2010