11-0584 (AR)P' *O. BOX 1504
78-495 CALLE TAMPICO ;
LA QUINTA,'CALIFORNIA 92253
Application;Number. :,'s11-.000.0.0.5.84
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING`& SAFETY DEPARTMENT INSPECTIONS (760)777-7153
BUILDING PERMIT.
Owner
Date: 9/29/11
Property Address:"�56198 PALMS DR
POULIOT JASON & DIANA
AM: 764-020-020'- - -
4824 CORTLAND DR., _
Application description: ADDITION - RESIDENTIAL
CORONA DEL MAR, CA926 8 i
Property Zoning: LOW DENSITY• RESIDENTIAL-
.(949)278-7273
Application- valuation: 26606
?.. a NOV
Con trac
;. Applicant: Architect or Engineer
Owner:'
clvr O
- LICENSED CONTRACTOR'S DECLARATION " -
.
WORKER'S COMPENSATION DECLARATION"
' `l hereby ,affirm under. penalty of perjury that I,am licensed undegprovisions of; 4Chapter 9 (commencing with -
I heieoy affirm under penalty of;perjury one of the following declarations:
Section 70b0) of'Division 3 of the Businessland,Professionals Code, and my License is. in full force`and.effect. •" ..
_ I have and will maintain'a certificate of consent,t6self-insure for workers' compensation, as provided -
License Class: License No.:
,
- for by ;Section 3700 of the Labor Code, for' the performance of the w-6rk for which this permit is -
- - - -- - - ..
issued...: -• .. - ,
Date. Contractor: .._
f have and will rt aintain'workers' compensation insurance, as required by Section 3760 of the�Labor- '
- - -
_
;Code, for the performance of the-'.work.for which this permit is issued. My workers' comp6nsation '
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: - -
_
I hereby affirm under penalty of perjury that I am exempt -from the Contracior,'s State License Law for the
Carrier -,Policy Number -
following reason'(Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to '
1 certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior, to its issuance,. also requirestheapplicant for the
personin any manner so as to become subject to the workers' compensation laws of California,
,permit to file a signed statement that he or she is licensed pursuant tothe provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section•
License Law (Chapter 9 (commencing with Section -7000) of Division 3 of the Business and Professions Code) or
4700 of the Labor CodcA I shall forth i 'comply with those provisions.
.
that he or she is exempt therefrom and the -basis for the alleged exemption. Any violation of Section 7031.5 by
_
I I`
any applicant for a permit subjects the applicant to a civil penalty`of, not more than five hundred dollars ($5bo).:
mate: .h plicant:-
-of the property, or my employees with wages as their sole compensation; will do.the work, and
(_ 1 I, as owner'
" --
-
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code:- The
WARNING: FAILURE To SECURE ORK S' YIATIO�"COVERAGE IS UNLAWFUL, AND SHALL
Contractors' StateLicense Law does not apply to an owner of property who builds or.improves thereon,
SUBJECT AN.EMPLOYER TO CRI NAL�P NALTIESD CIVIL' FINES UP TO ONE HUNDRED THOUSAND
and`who does the work himself or herself through his or her own'employees, provided that the
DOLLARS ($100,000). IN'ADDIT10 T HE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706'OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one yea, of.completion'he owner -builder wilfhave'the burden of proving that he or she did not build or
improve for the purpose of sale.). i•,
APPLICANT ACKNOWLEDGEMENT
( ) I, as* owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby.made•to the Director of Building and;Safety fora permit subject to the
• 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who -builds or improves thereon, and who contracts for the projects with a contractor(s).licensed
1 . Each person upon whose behalf this' applicationis made, each person at whose request and for -
pursuant to the Contractors' State License Law.).,' -
whose benefit work is performed under or. pursuant to any permit issued as a result'of.this application,
'
(_) I am exempt underSec. , B &P.C..for this reas n -
-
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
/ate:
performed under or following issuance of this permit.
Owner:
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 1.80 days will subject
' ONST _ CTIOI LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of peri y that the a is a construction lending agency for performance of the
I certify that I have read this application and state that t above information is correct. Iagree to comply with *all ,
work for which this permit is issued Sec. 3097 Civ. C.1.
city and county ordinances and state laws relating to bu' ing construction, and hereby authorize representatives
of this count to nter upon the above-mentioned prop y for insp .tion purposes.
Lender's Name:
ate: ignature (Applicant or Agent
Lender's Address:
LQPERDiIT
Application.Number
. . 11-00000584
Structure Information
Construction TypeTYPE
V, UNPROTECTED
Occupancy Type . . .
. . . DWELLG/LODGING/CONG <=10
Other struct info .
. . CODE EDITION 2010
-FLOOD ZONE no
-------------.---------------------------------------------------------------
1ST.FLOOR.SQUARE FOOTAGE
210.00
Permit
BUILDING'PERMIT +Y
Additional desc .
_ ::Perm:i't•-°Fee :.
207;..00', Plan C•heck::F_ee
134:.55. • .
•=Issue Date
Valuation-
20000
.Expiraii_on Date '.'.
3/27/12
*
QtyUnit Charge`
Per
Extension-_
.`
BASE FEE
45:.00.`
'18:00 00.00
'THOU .-'BLDG 2,;'001-25,000
7.
162.0,0
Permit . . '.:ELECT
Additional desc
-
Permit Fee.'.
22..3,S Plan -Check Fee
.5.5.9
-Issue,"Date . ,
Valuation -
�0
:: .. Expiration•Date. -.
3./27/12: ..
Qty °Uni Charge
Per
Extension
..BASE FEE
, .:15.. 00
210.00 .0350
'ELEC NEW RES - 1 OR 2 FAMILY
7.35
Permit
MECHANICAL
Additional desc .
Permit Fee ._
24.00 Plan Check Fee
6.00
Issue Date
-Valuation
0
Expiration Date ..
3/2.7/12
Qty Unit -Charge
Per
Extension
BASE FEE
15.00
2.00 4.5000
EA MECH VENT•.INST/ DUCT ALT
9.00
Permit . .
PLUMBING
Additional desc
Permit Fee
36.0.0 Plan Check Fee
9.00
Issue Date
Valuation . . .
0
Expiration Date
3/27/12
Qty .'Unit Charge
Per
Extension
LQPERA11T
LQPEPNIIT
Application Number . . . . . 11-00000584
Permit . . . . . . PLUMBING
Qty Unit Charge. Per
Extension
BASE•FEE
.15.00
3.00 6.000.0 EA. PLB FIXTURE
18.0'0
1.00 3.0000 EA PLB WATER INST/ALT/REP'
3.00
-----
Special Notes and Comments
BATHROOM,ADDITION (10,6 SF)',TO.OFFICE AND .
REMODEL REAR LEFT,.COVERED PATIO TO
LIVING AREA (104 SF)PER• ENGINEERED
_ PLANS :`-.2010' CODES'
---------------- --
Other Fees . . . . . . BLDG'.-STDS' ADMIN .(SB1473)
.1.00
ENERGY REVIEW. FEE••
13.46
HOiTRLY PLAN CHECK
71.•:75-
STRONG M TION'.(SMI)..-.RES2.00
O
Fee"summary Charged Paid Credited
a-
Due:
------------------------------------------------------
-i`289.35' . 00 .00
P.ermt_Fee Total-
w-
289,35.
188
OtlerCFeekTotal"l: :21 0:4 00
.188 .27` -
Gra 'a Total 532'. 70 . 00 .' : 0.0.
512`.,7 o:
; •'
LQPEPNIIT
01-17-
t.,1 Ly U1 1.d mutt 1t,d
Building 8L Safety Division
P-0. ox 1504, 78-495 Calle Tampico
1:a-Quinta, CA 92.253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit#,164
Project Address: 5 PALM -5, ®x) V6--
Owner's Name: A S O r4 P O 0 4—t o T
A. P. Number: -o kQ 09'() -��
Address: T S Z 4 e O J� I i A-14
Legal Description: S/ AJ VL,6' � 1 j V /l1
City, ST, Zip: C- C)kQ J A V L9- L Ad A - X L (va
It �%�
Contractor: Ir'""'z"'-.^ A`
CWq
Address:
' Q p
Telephon -/ �'7 d 7�7 "" /
•`f> <'»"v %<.`:.>•'• .`::<`•z',
:::W : ;`%v<•zr.>s:=:>%<:<>:>:::>:<::
Project Description: 'G1�� Q ba:r 0 o M
City, ST, Zip: FT
-1 O avt ' �Yl o b So tf1
Telephone:
JL -
•r
State Lic. # : City Lic.
Arch., Engr., Designer:
Address: :• M h
City., ST, Zip: Teal 6e-auC A- q ®7q D _
Y
:.; >::;:.>:::.::::....:
Telephone: / >«#i">��: .
P � �� � 1 � � b �i .. � .;;:.;>:.:.•;:•;:.
-
State Lic. #: I
Name of Contact Person: TAQ) DiA L( or
Construction Type: Occupancy:
Project type (circle one): Newdd'n Alter Repair Demo
Sq. Ft: /SQ # Stories: ' #Units:
Telephone # of Contact Person: (� -/�q 7 P— 797
Estimated Value of -Project: 2-0 0-o 0 O ¢7
APPLICAII(T:. DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIQNG �.
PERMIT FEES
Plan Sets
3
Plan Check submitt .,
Item
Amount
Structural Caics.
Reviewed, ready for furrectio,4Plan
Check Deposit
Truss Calcs.
Called Contact Perso yN ti 11
Plan Check Balance.
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted tl
Mechanical
Grading plan
_
2"" Review, ready for correction/issue
Electrical
Subcontactor List
f t
Called Contact Person 1,
Plumbing
Grant Deed
✓
Plans picked up
S.M.I.
H.O.A: Approval
%-ol�
Plans resubmitted
Grading
IN HOUSJE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
;ice
w
Total Permit Fees
222• 70-J
41 ob RC1. 74 RM CART' lcp�w
Of,
Coachella Valley: Unified School" District
83-733 Avenue 55; Thiprm.al EA 92274:.-
(760) 398-5909 — Fax (760) 3984224
This Box For District Use Only
DEVELOPER FEES•PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMM/IND. AMOUNT:
DATE:
RECEIPT:
CHECK N:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Educatio°n Code 176.20)`
Project Name: Date: October 19, 2011
Owner's Name: Jason & Diana -Pouliot p Phone No.
Project Address: 56-198 Palms Drive, La Quinta, CA 92.253
Project Description:
E'
APN: 764-020-020 pct #1 Lot #'s:
Type of Development:Residential XIX Commercial
L
otal-Square Feet of Building Area: 210
Industrial
Certification of Applicant/Owners: The person signing certifies thatthe;above information is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized, to, sign on behalf of p owner/devejpper.
Dated: (/ r: Signature:
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABO OJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov -Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval. Prior'to 1/1/87 Requirement
Note Pursuant to AB 181 any room additions or enclosures of
Number of Sq.Ft. 210 500 sq•ft. or less, are exempt from developer fees
Amount per Sq.Ft. $0.00
Amount Collected $0.00',
Building Permit Application Completed: Yes/No
By: Jamie T. Brown, Asst. Supt., Business Services
Certificate issued by: Marcela Valdez, Construction Analyst Signature:
Section 66020 of the Government Code"asserted by. -Assembly Bill 3081, effcctrve!January1 1997, requires that 'this"DDistrict provide (1) a written tice to the
project appellant; at the time of payment. of school fees, mitigation payment.or other exactions ("Fees"),.of the 90 -day period to protest the im esiti of these
Fees and (2) the amount,of the fees. Therefore, in accordance with secti66`66020'of,the Governmentiode and other applicable law, this Noti serve to
advise you that the 90 -day' -protest period in"regard to'such Fees orthe validity thereof,'commences with thepayment of the fees or:performance of any other
requirements asdescribed in section .66020 of the Government code. Additionally, the am"dt of the" ;fees.imposed Was herein set forth, whether payable at this
time or in whole or in part prior to issuance of a Certificate of Occupancy As; n the latter, the 90;:days starts on the date hereof. This Certificate of
Compliance is valid for thirty (30) days.from the date of issuance. Extension wlll'tie grapted only for good,cause, as determined by the School District, and up
to three (3) such extensions may be granted.
fr,.i. 11/2010
l ti:31: ;?t�:a:nil? llili:lc 1.i?I'?li ?11?L13FCt{ + -: 00 r
R8CORDING REQUESTED BY:
Fidelity National Title
AND WHEN RECORDED MAIL TO:
Mr. and Mrs. Jason J. Pouliot
4824 Cortland Drive
Corona del Mar, CA 92625
Title Order
DOC.# 2008-0561771
10/20/2008 08:00A Fee:27.00
Page 1 of 7 Doc T Tax Paid
Recorded in Official Records
County of'Riverside
Larry.U. Uard
Assessor, County Clerk 8 Recorder
I VIII) IIIIIII III IIII IIIIIIII II IIIIIIII III VIII IIII IIII
S R U PAGE SIZE DA MISC LONG
RFD
COPY
I
M A L 465 426i� COR OR SAIF
NCHG
EXAM
O
V T £',3CTY UNI
GRANT -DEED
THE UNDERSIGNED GRANTOR(S) DECLARE(S)
DOCUMENTARY TRANSFER TAX is,SA9;50: w
( ] computed on full value of= conveyed, or .
[X] computed on full value less:value of liens or encumbrances remaining at time of sale.
[ ) Unincorporated area [X] City of La Quinta AND
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged
Sean P. Steele and Carrie R. Steele, Husband and Wife and Jason J. Pouliot and Diana L. Pouliot,
Husband and Wife, as Joint Tenants
hereby GRANT(s) to:
Jason J. Pouliot and Diana L. Pouliot, Husband and Wife as Joint Tenants
the real property in the City of La Quinta, County of Riverside, State of California, described as:
Lot 20, of Tract 28983 as shown by map on file in Book 285, Pages 76 to 82 of Maps in the office of the County
Recorder of Riverside County, California.
Also Known as: 56198 Palms Drive, La Quinta, CA 92253
AP#: 764-020-020-3
SUBJECT TO:
(1) General and Special County and City (if any) Taxes for the current fiscal year, not due or delinquent, including any
special levies, payments for whichare included therein and collected therewith.
(2) Lien of Supplemental Taxes if any; assessed pursuant to the provisions'of Chapter 3.5 (commencing with Section
75) of the Revenue and Taxation Code of the Stale of.Califomia.
(3) Covenants, Conditions and Restrictions; reservations easements for public. utilities, districts, water companies,
alleys and streets, rights and nghts of way'of record,• if any; also exception of oil, gas', minerals and hydrocarbons,
and/or lease, if any, without the right of surface entry.
GRANT DEED CONTINUED ON NEXT PAGE
Mail Tax Statement to: SAME AS ABOVE or Address Noted Below
I(^�� Monarch Management Group
A DIVISION OF THE MANAGEMENT TRUST
Village at The Palms Homeowners Association
May 25. 2011
Jason and Diana Pouliot
4824 Cortland Drive
Corona Del Mar. CA 92625
Re: 56-198 Palms (hive
:application Approved — Bathroom. Addition
Dcar I Ionlcowner.
The Architectural Committee. at their most recent meeting is in agreement with,the application
you submitted fir the proposed. bathroom addition provided all.the new finishes match the
existing adjacent tin6hes. The Committee appreciates your cooperation in complh ing
with our Rules and Regulations. which are in place for all members.
Notwithstanding this agreement, you must comply with all requirements of the C'C&R's and all
Architectural Rules and Guidelines. unless specifically waived in writing by the Architectural
Control Committee.
The Village at cite I'alnls Homeowners Association and Architectural Control Committee
acknowledge that any and all agreed changes h1 the original design that may be a condition of this
approval will he at the homeowner's expense. The correction ofany damage caused by this
agreed construction will also be at the homeowner's expense. It is the homeowner's
responsibility to obtain any permits. which may be required.
Additionally. the Board of Directors encourages that you use a licensed and insured contractor.
This approval dues not release the homeowner from meeting ani- county. state or federal
requirements such as building permits. workmen's compensation. or other waivers or permits.
Again. we appreciate your cooperation. 'these procedures allow us to maintain our properties in a
manner to the benefit of you as the homeowner and of the community as a whole.
Sincerely.
ACC Control Committee
39755 Berkey Drive, Suite A, Palm Desert, CA 92211
CONNECTING PEOPLE TO THE PROMISE PH: 760.776.5100 FAX: 760.776.5111
www.managementtrust.com
S(o / �� �� �► �� CITY OF LA QUINTA SUB -CONTRA, O, LIST
JOB ADDRESS PERMIT NUMBER OWNER OUJJ, Q= BUILDER
This form shall be posted on the iob with the Building Inspection Card at all times in a conspicuous glace. dnly persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
r..�ao r�acc�iication Contractor St
Contractor's License Workers Comoensation Insurance C>Ity..BuSiness.:License.
POOL (C-53):
Company Name
Classification
(e.g. A, B, C -8I
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
CONCRETE (.0=8) \
liF4l.LA 17( 000gL' (L�
C S
(� p� p�
[ a'D �O
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(: vvLar AJA17&,,A-L,
Moo Q zi
P.O. BOX 1:504
LA QUINTA,* CALIFORNIA.92247-1504 BUILDING,& SAFETY. DEPARTMENT
78'-495 C-ALLE TAMPICO (7 60) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 7 77 -7011
PROPERTY, . 0MYN, R18 PACKA&G-1-F,
Disclosures & Forms for. Owner-Bullde'rs Aplynfbr C6n'struction Permitspig.
NOXI-C TO PROPE M-Y"OMMR
1)w Property Owner
An. appli Eton for a budding permit has bowh !r uame. listing yourself as the builder
of the property
impro :specifiedat
We are. providing with ah'Owner -BudderNerifi
Ackno,9,4ejgment and ldbimatim cation Form to make You aware Of your
responsibilities and possible'fisk you, may incur by having this permit J -,,'-wyourname: as
the
Owner -Builder. We w4ljl-jtot isme,a building permit. until y." -have. read, jj";jlgid
your understaadiu►g of each provision,
signed, and returned this form to us at our official addiegs,indicited, An -agent of the owner cannot,execute this notice
unless -you, the property owner, obtain the prior approval of the permitting4uthoii ty-
DIREMONS. Read and initial each statement below to sign#y-you itndeqwnd'or � verify
diis: information.
1. 1 understand a fi-equent practice of unlicensed persons js, to: (have*-: the property! owner Obtain an "Owner-Buddee,
ding permit that erroneously -implies that the property owner is pr6vidinj his , or her. own labor and material personally. 1, as
an Owner -Builder, may be held liable and subject to serious financial riAlfbi any,u'yuries sustained by an Unlicensed person
and his or her employees whd'e wooingon- my pr6perty-,,W 6�meqjA�'ner,s �jjijur&uce may provide not pvide coverage for those.
injuries. I -am,willmylactingas . I . I
an Owner -Builder and Aimaware of the limits of my insurance coverage for injuries to workers -
on my property.
orkersonmy.-pioperty-
2. 1 understand building permits are not required to be signed, property "operty owners unless they are responsible for the
.__
4Whstruction and are not hiring -a licensed Contractor toassume this"responsibility.
3. I understand-a's an "Owner-Builder"l am the responsible party_of record on therint-L-1 understand that
pe [may protect
yself tt I fj
from potentials financial risk by hiring a licensed ContiAdor and having the permijed` in his or her name instead of my
Vm4. 1 understand Contractors are required by law to be licensed and,bnded in California and to list their license numbers on
erits and contracts.
T�5. 1 understand if I employ or otherwise engage, gage any pqrsons; other'tharr� �-foriiia ticeused Contractors, and the total valui.
of my construction is at -least five hundred dollars' -($50), -t�nc-ludi4'1ab6i.�nd'inat,6ria4�*"I'ma bec'onsideredan"employer
� *-� . . .. I . y
under state and federal law.
6 understand .1 am considered an "employee' under aud'fed" law, linust register with the state and feder
government,
payroll taxes, provide workers, .'compensation" digibilkty Insurance 'and' contribute to unemPlOYme)
f
ocompensation . en 0 "employee." I also understand.my' iturt to `abide. by these la'ws'may ,sub' serious financi
subject me to
risk.
7. 1 understand under California. Contractors' State 'License Law, an Owner -Builder who builds single-family resident
tructures cannot' legally build them with the intent* to offer them for, sale, unless all work is performed by licew
ubcontractors and the number of structures does, not,.e-kceed, four within any calendar year, or all of the work is Perforn
under contract with a licensed general building Coittractor.
8. I understand'as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
ancial or personal injuries sustained. by any subsequent owner(s) that result from any latent construction defects in the
riananship or materials. . .
9. 1, understand I may obtain more information regarding my obligations as an "employer' from the Internal Revenue
rvice, the United States Small Business Administration, the California Department of Benefit Payments, and the California
ivision of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CS -LB) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
legally and financially responsible for proposed construction activity at the following address:
I 1. [agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
;able laws and requirements that govern Owner -Builders as well as employers.
12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the' information I
ve provided on this form Licensed contractors are regulated by taws designed to protect the public. If you contract with
meone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court It is also
important for you to: understand that if animlieensed Contractor or employee of that individual or firm is infured while wortang
on your property, you may be heldd liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors,
You will be responsible for verdYing whethe€ or not those Contractors are..p"petiy Ice -used and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issulag,the.permit. Note: A copy of the property owner's driver's w f°+++r K° 14 or.
other verification acceptable to the agency is requaed to be presenter) when the permit is inwl to verify the Property
owner's signature.
Signature of property owner Date: I
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S MHMF
Excluding the Notice to Property Owner, the execution of which I understand. is my personal responsibility, I hereby authorize
the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I.personally filled out the abo
information and certify its accuracy. Note: A copy of the owner's driver's License, form notarization, or other verification
acceptable to the agency is required to be p ented when the permit is issued to verify the property wner's signature.
Property Owner's Signature: Date: 4
The EnergyPro.computer program, has been used to perform the:calculationsmm
suar¢ceed'in`this complianreport.••This program has approval and is
± authorized by the California Energy Commission for use with .6oth the `Residential and Nonresidential 2008 Building Energy Efficiency Standards.
This program developed by EnergySoft LLC www:energysoft com.
EnergyPro 5.1 by EnergySoft - User Number 6712 RunCode:201.1=08;08T092&09.- . r: ID "•>,;
PROJECT:
Jason',and-Diaria.Pouliot,
_•
56-198 Palms. Drive
La Quinta,. CA= 92234 -
..
•Project Designer:
�
Jason'Pouliot
56-1-98 Palrns Dnve> ,Y
CITY OF LA CIJINT�O
La Quanta; Ca 92253
BUILDING'8: SAFETY DEPT.
_.F
FOR CONSTRUCTION
4
pA
Report Prepared by:
Jon Scott
Scott Design and Title,24, Inc,
•77-085.Michiga`n bD i a
;.
Pal m'Desert,-.Ca, 92.211
(760) 200-47-80
=
Job N .Mber:
4
The EnergyPro.computer program, has been used to perform the:calculationsmm
suar¢ceed'in`this complianreport.••This program has approval and is
± authorized by the California Energy Commission for use with .6oth the `Residential and Nonresidential 2008 Building Energy Efficiency Standards.
This program developed by EnergySoft LLC www:energysoft com.
EnergyPro 5.1 by EnergySoft - User Number 6712 RunCode:201.1=08;08T092&09.- . r: ID "•>,;
C:
•
PERFORMANCE CERTIFICATE Residential, z A �_ Part' 1 of 5
CF -1 R
Project Name
Jason and Diana Pouliot
Building Type m Single Family,°❑ Addition "Alone
❑ Multi Family '.m Existing+ Addition/Alteration
Date
8/812011
Project Address
56-198 Palms Drive La Quinta
California Energy Climate.Zone
CA Chmate,Zone 15 `
Total Cond. Floor Area
4,840
Addition
168
# of Stories
1
FIELD'INSPECTION'ENERGY-CH.ECKLIST'
❑ Yes IZJ No HERS Measures --If Yes, A CF -413' must be provided per..Part 2 of 5 of this form.
IZI Yes ❑ No Special Features -- If Yes, see Part 2 of 5 of this form for details.
_....
INSULATION
Construction Type
Areas , 'S'pe'ci'al
-Cavity Features see Part'2 of:5 . Status,
Roof Wood Framed Attic'
R-19 4,672Existing
Wall Wood Framed
R-13 2,744 Existing
Wall Wood Framed
R-19 402 ,- New
Door Opaque Door
None 24 New
Wall Wood Framed
R-21 240 Altered
Door Opaque Door .
None 44 Existing
Slab Unheated Slab -on -Grade
None 4,672 'Perim =.354' Existing
Roof Wood Framed Attic
R-19 168 New
FENESTRATION
Orientation Area(fo
U- Exterior
_Sidefins Shades , Status
Factor SHGC Overhan ' '
Left (N) 24.3
0.550 . 0.55 none none Bug Screen Existing
Left (N) 16.0
0.720 0.59 none none Bug;Scieen. , Existing
Rear(E) 216.0
0.550 0.55. none none Bug -Screen " Existing
Right (S) 138.0
0.550 0.55 none none Bug Screen - Existing
Front (Kq 45.8
0.550 0.55 none none Bug Screen.,, Existing
Left (N) 24.0
0.550 0.55 none none „-Bug Screen , New
Rear (E) 45.0
0.550 0.55 none none _ Bug Screen; New
Right (S) 16.0
0.720 0.59 none none Bug Screen New
Front (W) 9.0
0.720 0.59 none none Bug Screen New
HVAC SYSTEMS
Ot . Heating,,
'Min. Eff Cooling Min. Eff Thermostat. Status
3 Central Furnace
80% AFUE Split Air Conditioner - 12.0 $EER Setback
Existing
HVAC DISTRIBUTION Duct
Location Heatin _ Cooling.. _D idt_Location- >, R -Value Status
HVAC Altered Ducted
Ducted Attic, Ceiling Ins, vented 4.2
Existing
' t
WATER HEATING
Ot . Type
Gallons Min. Eff, Distribution Status
Energ Pro 5. 1. by EnergySoft User Number: 6712 RunCode::2011,08-08T09:25:09 /D:
Page.3 of 12
m
C
•
i
PERFORMANCE CERTIFICATE: Residenfial I?art.1 of 5
CF -1 R
Project Name
Building Type; . `m ,Single Family ❑ :Addition Alorie '
Date
Jason and Diana Pouliot
''❑ Mujti'Family,Fm Ezistmg+Addition/Alteration
$/$/2011
Project Address
California Energy Climate Zone"I
Total%Coed Floor,Area
Addition
# of Stories
56-198 Palms Drive La QuintaCA
Cimate.Zone 15
4,840`t�
168
1
FIELD INSPECTION ENERGY CHECKLIST
❑ Yes ❑ No HERS Measures.-- If Yes, A GF -4R must.be.0r6ided per Part 2 of 5 of this form.
IZI Yes ❑ No Special Feafures -- If Yes, see Part 2 of :5 of this.'form for details.
INSULATION Area_ , Special; .'
Construction .T e Cawit f . s Features see;Parf 2of 5 Status
Slab Unheated Slab -on -Grade None 168 Penm =�46y„.': New
T�.
FENESTRATION U-� S Exterior 3
Orientation Area(ft) ;Factor SHGC. Overhang • Slidefins;tShades "' Status
.3�
J,
HVAC SYSTEMS
Qty. Heating Min. Eff Cooling Min,Eff r Thermostat Status
S' 6
HVAC DISTRIBUTION f,,::>,'.'' Duct
Location Heating Cooling Duct,Locatiori` _ R -Value Status
WATER HEATING
Qty. Type. Galloons - -Min. Eff, , Distribution.,. Status
w°
4 �N;
EnergyPro 5.1 by Energ Soft User Number. 6712 RunCode:'2011-08,08T09:25:09 ' ' ` ` ID.` z
Page 4 of 12
PERFORMANCE CERTIFICATE Res,id"i tial:: ,; . ; ; (Part 2-6f 5)• CF -1 R
Project Name
Jason and Diana Pouliot
1130`166g Types m Single Family ,❑'Addition Alone'' "
❑'Multi Family m Ezistmg+�Adtliteon/Alteration
Date
81812011
'SPECIAL FEATURES IMOECT-1014 CHECKLIST
The enforcement agency should pay special attention to the items `sp11 ecified ln IN6 checklist These items require special written
justification and-documentation;'and special`verification to be'used.with",fhe performance aporoach The -enforcement agency
determines the..adequacy of the justification, and -may reject a•buildingror design tlat otherwise'complies based on the adequacy of
the special justification and-documentatioh.submitted:
The DHW System Bradford White 754al. is anon-NAECA large, storage ga'swaterheater.."Venfy DHW details:
The Existing Water Heater Bradford White 75gal. has an EF less. than thio Vintage Defaults. Field verification is required. '
HERS REQUIRED. -VERIFICATION
Items in this section require.field testing and/6r verification by a. certified:HERS:Rater.. The inspector must receive a
.completed CF -413 form for each of the measures listed below for..final to, begiven','
a
r
EneMyPro 5.'1 byEnemySdft User. Number. 6712 _; Rijn Cbder:2011-im-08T09:25t09 ID:.... ' ... - Page 5 of 12
U_.�
is
PERFORMANCE :CERTIFICATE.: Residentia[ I; _ Part 3 of 5) CF. -1 R
Project Name .` '
Building Type 10'Siogle Family ❑, Addition'Alone
Date
'Jason and Diana Pouliot
❑ Multi Family ' m:Existing+Add ition/Alteration
$/$/2011
ANNUALENERGY USESUMMARY •... .
Standard Proposed Margin'`
TDV kBtu/ft2- r g,-
Space Heating 5.57 541, 0.47
Space Cooling 111.33 109.33' 2.00
Fans 24.13 23.66 0.47
Domestic Hot Water 5.07 5.07 0.00
Pumps 0.00 0.00 0.00
Totals 146.11 143.17 2.94
Percent Better Than Standard_: 2.0%_._
RUILDING„COMP:LIES -NO HERS. VERIfICATIO,N,REQUIRED
Fenestration
Building Front Orientation: (M 270 deg Ext. Walls/Roof Wall Area Area
Number of -Dwelling Units: 1.00 (M 792 55
Fuel Available at Site: Natural Gas (N) 1,196 64
Raised Floor Area: 0 (E) 900 261
Slab on Grade Area: 4,840 (S) 1,100 154
Average Ceiling Height: 11.4 Roof 4,8140 0
Fenestration Average U -Factor: 0.56. TOTAL: 534
Avera a SHGC: 0.55 Fenestration/CFA=Ratio: 11.0%
REMARKS
STATEMENT OF COMPLIANCE
This certificate of compliance lists the building features.and specifications needed.
to comply with Title 24, Parts 1 the. Administrative Regulations and Part 6 the
Efficiency, Standards of the California Code of Regulations.
The documentation author hereby certifies that the documentation is accurate and complete.
Documentation Author
Company Scott Design and Title 24, Inc, 8,B/2011
Address 77-085 Michigan Drive Name Jon Scott .
City/State/ZipCity/State/Zip Palm Desert, Ca 92211 Phone (760)200-4780 Si hed Date
The individual with overall design responsibility hereby,ce'rtifies that.the,proposed building design represented in this set
of construction documents is consistent with the other complianceformsand:wo`rksheets; with the specifications, and
with any other calculations submitted with,this permit application, and recognizes that,,compliance using duct design,
duct sealing, verification of refrigerant charge, insulation installation:quality;iand building envelope sealing require
installer testing and certification and field verification by an approved HERS' rater.
Designer or Owner (per Business & Professions Code)
Company Jason Pouliot
Address 56-198 Palms Drive Name Jason Pouliot
City/State/Zip La Quinta, Ca 92253 Phone Signed License # Date
Energ YPro5.1bYEnemYSoft. User Number 6712.-• RunCode:2011=08.08T09 25:09 /D: Page 6 of.12
•
•
r
CERTIFICATE OF COMPLIANCE:.
Residential:_.
= .(Part
41of 5) CF -1R
Project Name
Jason end Diana Pouliot
Building Type; m, Single Family 1:1Addition Alone
D Multi Family m Existing; Addition/Alteration
Date
8/8/2011
OPAQUE SURFACE DETAILS
Surface
Type Area
U- Insulation.,.-. Joint Appendix
Factor Cavity Exterior Frame Interior Frame Azm -Tilt Status, .4., Location/Comments
Roof
4,672
0.049 R-19
270 •
0 Existing 4.2.1-A4 ,
Existing Residence
Wall
980
0.102 R-13
0
90 Existing 4.3.1-A3 . t
Existing Residence
Wall
120
0.102 R-13
0
90 Rernwec 4.3.1-A3 s _.
Existing Residence
Wall
361
0.074 R-19
.0
90 New % 4.3.1-A5"
Existing Residence
Wall
300
0.102 R-13
90
90 Existin 4.3.1-A3 . `F_
Existing Residence
Door
24
1.450 None
90 -
90 New .. 4.5.1-A1
Existing Residence
Wall
120
6.102 R-13 •
90
90 Removec 4.3.1-A3
Existing Residence
Wall
240
0.069 R-21
90 .
90 Altered 4.3.1-A6 E=4.3.1 -A3 Existing Residence
Wall
882
0.102 R-13
180
90 Existing 4.3.1-A3
Existing Residence
Wall
582
0.102 R-13
270
90 Existing 4.3.1-A3
Existing Residence
Door
241
1.450 None
'270
90 Existing 4.5.1-A1 -
Existing Residence
Door
20
1.450 None
270
90 Existing 4.5.1-A1
Existing Residence
Wall
144
0.102 R-13
270
90 Removec 4.3.1-A3
Existing Residence
Slab
4,672
0.730 None
0 '180 Existing 4.4.7 -Al'
Existing Residence
Roof
• :168
0.049 R-19
"..0
0 New 4.2.1-A4
Addition
Wall
116
0.074 R-19
° - 0
90 New . 4.3.1-A5 _
Addition
FENESTRATION SURFACE DETAILS
,'Status
ID
T e
Area Ll -Factor'
SHGC
Azm
Glazing Type
Location/Comments
1
Window
2.5 0.550 Default
0.55 Default
0 Existing Double Non Metal Tinted
Existing'Residence
2
Window
16.0 0.720 NFRC
0.59 NFRC
0 Existing ."
Glass Block ' - �w
Existing Residence
3
Window
2.0 0.550 Default
0.55 Default
0 Existing Double Non Metal Tinted
Existing Residence
4
Window
13.8 0.550 Default
0.55 Default
0 Existing
Double Non Metal Tinted
Existing Residence
5
Window
24.0 0.550 Default.
0.55 Default
0 Removed Double Non Metal Tinted
Existing Residence
6
Window
6.0 0.550 Default
0.55 Default
0 Existing
Double Non Metal Tinted
Existing Residence
7
Window
48.0 0.550 Default
0.55 Default
90 Removed
Double Non Metal Tinted
Existing Residence
8
Window
80.0 0.550 Default
0.55 Default
90 Existing
Double Non Metal Tinted _
Existing Residence
9
Window
40.0• 0:550 Default
0.55 Default
90 Existing
Double Non Metal. Tinted
Existing Residence
10
Window
48.0 0.550 Default
0.55 Default
90 Existing
Double Non Metal Tinted
Existing Residence
11
Window
48.0 0.550 Default
0.55 Default
90 Existing
Double Non Metal Tinted
Existing Residence
12
Window
48.0 0.550 Default
0.55 Default
90 Removed
Double,Non Metal Tinted t Existing Residence
13
Window
16.0 0.550 Default
0.55 Default
180 Existing
Double Non Metal Tinted
Existing Residence
14
Window
16.0 0.550 Default
0.55 Default
180 Existing
Double Non Metal Tinted ►
Existing Residence
15
Window
30.0 0.550 Default
0.55 Default
180 Existing
Double Non Metal Tinted
Existing Residence
16
" Window
15.0 0.550 Default
0.55 Default
180 Existing
Double Non Metal Tinted
Existing Residence
(1) U -Factor Type: 116-A = Default Table from Standards, NFRC = Labeled Value
2 SHGC Type: 116'8 = Default Table from Standards, NFRC =Labeled Value
EXTERIOR SHADING DETAILS
ID
Exterior Shade Type SHGC
Window
H t Wd
Ove hang Left Fin
Len H t LExt RExt. 'Dist Len
Right Fin
H t Dist Len H t
1
Bug Screen
0.76
2
Bug Screen
0.76
3
Bug Screen
0.76
4
Bug Screen
0.76
5
Bug Screen
0.76
6
Bug Screen
0.76
7
Bug Screen
0.76
8
Bug Screen
0.76
9
Bug Screen
0.76
10
Bug Screen
0.76
11
Bug Screen
0.76
12
Bug Screen
0.76
13
Bug Screen
0.76
14
Bug Screen
0.76
15
Bug Screen
0.76
16
Bug Screen
0.76
0
EnergyPro
5.1 by EnergySoft User Number: 6712 RunCode: 2011-08-08709:25:09. ID:
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•
CERTIFICATE OF COMPLIANCE:
Residential
(Part 4 of 5) F-1 R
Project Name
Jason and Diana Pouliot
Building Type m Single Family ❑ Addition Alone
❑ Multi Family la Existing+ Addition/Alteration
Date
1 81812011
OPAQUE SURFACE DETAILS
Surface
Type Area
U- Insulation Joint Appendix
I Factor Cavity_ Exterior Frame Interior Frame Azm Tilt Status 4 Location/Comments
Wall
75
0.074 R-19
90
90 New 4.3.1-A5
Addition
Wall
64
0.074 R-19
180
90 New 4.3.1-A5
Addition
Wall
111
0.074 R-19
270
90 New 4.3.1-A5
Addition
Slab
108
0.730 None
0
180 New 4.4.7-A1
Addition
Slab
60
0.730 None
0
180 New 4.4.7-A1
Addition
FENESTRATION SURFACE DETAILS
ID
Type
Area U -Factor SHGC
Azm Status
Glazing Type
Location/Comments
17
Wndow
15.0 0.550 Default 0.55 Default
180 Existing.
Double Non Metal Tinted
Existing Residence
18
Window
15.0 0.5501 Default . 0.55 Default
180 Existing
Double Non Metal Tinted
Existing Residence
19
Window
3.0 0.5501 Default 0.55 Default
180 Existing
Double Non Metal Tinted
Existing Residence
20
Window
12.5 0.550 Default 0.55 Default
180 Existing
Double Non Metal Tinted
Existing Residence
21
Window
12.5 0.550 Default 0.55 Default
180 Existing
Double Non; Metal Tinted
Existing Residence
22
Window
3.0 0.550 Default 0.55 Default
1.80 Existing
Double Non Metal Tinted.
Existing Residence
23
Window
30.0 0.550 Default 0.55 Default
270 Existing
Double Non Metal Tinted
Existing Residence
24
Window
2.0 0.550 Default 0.55 Default
270 Existing
Double Non Metal Tinted
Existing Residence
25
Window
13.8. 0.550 Default 0.55 Default
270 Existing
Double Non Metal Tinted
Existing Residence
26
Window
24.0 0.550 Default, 0.55 Default
0 New
I Double Non Metal Tinted
Addition
27
Window
45.0 0.550 Default 0.55 Default
90 New
I Double Non Metal Tinted
Addition
28
Window
16.0 0.720 1 NFRC 0.59 NFRC
180 New
Glass Block
Addition
21L
Window
3.0 0.720 NFRC 0.59 NFRC
270 New
Glass Block
Addition
30
Window
3.0 0.720 NFRC 0.59 NFRC
270 New
Glass Block
Addition
31
Window
3.0 0.720 NFRC 0.59 NFRC
270 New
Glass Block
Addition
(1) U -Factor Type: 116-A = Default Table from Standards, NFRC = Labeled Value
2 SHGC Type: 116-B = Default Table from Standards, NFRC = Labeled Value
EXTERIOR SHADING DETAILS
ID
Window
Exterior Shade Type SHGC Hqt7 Wd
Ove hanq Left Fin Ri ht Fin
Len H t LExt RExt Dist Len H t Dist Len H t
17
Bug Screen
0.76
18
Bug Screen
0.76
19
Bug Screen
0.76
20
Bug Screen
0.76
21
Bug Screen
0.76
22
Bug Screen
0.76
23
Bug Screen
0.76
24
Bug Screen
0.76
25
Bug Screen
0.76
26
Bug Screen
0.76
27
Bug Screen
0.76
28
Bug Screen
0.76
29
Bug Screen
0.76
30
Bug Screen
0.76
31
Bug Screen
0.76
EnergyPro
5.1 by EnerqySoft User Number.' 6712 RunCode: 2011-08-08T09:25:09 ID:
Page 8 of 12
F -A
CERTIFICATE .OF COMPLIANCE: Residenflal,�, �°`�� • . (Part 5°of 5) CF=1 R
Project NameBuilding
Jason and,Diana Pouliot
_. - r.
Type lJ7;Sin6le Family ❑:Qddition'Alone
❑Multi Family m-Existing+Addition/Alteration
Date.
$/$/2011
BUILDING ZONE INFORMATION
System Name Zone Name
Floor Area ff .
NeW Bistin . ':Altered Removed= Volume Year Built .
HVAC Altered Existing Residence
4, 672 53,728 1990
Addition'
4168. 1,680
- h
MSR. u
Totals 1 168 ., 4,67'2 - 0 ` 0
HVAC SYSTEMS
. f, ..
{ Y
S stem'Name Qty. Heatin Type,
Min. Eff. Coolin T" a `,, .. Min. Eff: 'Thermostat Type Status
HVAC Altered 3' Central Furnace
80% AFUE Split Air Conditioner "12.0 SEER Setback-< Existing
HVAC DISTRIBUTION,
System Name Heating
Duct ` Ducts
Cooling ;.^' Duct Location R -Value Tested? Status
HVAC Altered Ducted Ducted Attic, Ceiling Ins,` vented 4.2 ❑ Existing
13
t.
0
WATER HEATING SYSTEMS
S stem Name
Qty.
Type
Distribution t
Rated '
Input
Btuh
..Tank
,- Cap:
al
Energy
• Factor
or RE .
Standby
,Loss br
Pilot
Ext.
Tank
Insul. R-
Value
Status
Bradford White 75ga/.
1 .
Large Gas
All Pipes Ins .
76;00.0
75
0.80
-0.00%
0.0
Existing
•
f
MULTI -FAMILY WATER
HEATING:DETAILS
..: c1
HYDRONIC
HEATING SYSTEM
PIPING
Control
Hot Water Piping Length
(ft)
e`
o.
o
Q _
S •stem Name •
Pipe
= Length
Pipe
Diameter
. Insul.
' Thick.'
Qty.
FHP
Plenum Outside Buried
EnergyPro 5.1 6 Ene Soft User Number. 6712
Run Code: 2011 0848T09:25i09 ID: Page 9 of 12
4
MANDATORY MEASURES SUMMARY: Residential Pae 1 of 3 MF -1 R
Project Name
ason and Diana Pouliot
Date
8/8/2011
NOTE: Low-rise residential buildings subject to the Standards must comply with all applicable mandatory measures listed, regardless of
the compliance approach used. More stringent energy measures listed on the Certificate of Compliance (CF -1 R, CF -1 R -ADD, or CF -
1 R -ALT Form) shall supersede the items marked with an asterisk (*) below. This Mandatory Measures Summary shall be incorporated
into the permit documents, and the applicable features shall be considered by all parties as minimum component performance
specifications whether they are shown elsewhere in the documents or in this summary. Submit all applicable sections of the MF -1 R
Form with plans.
Building Envelope Measures:
116(a)l: Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage.
§116(a)4: Fenestration products (except field -fabricated windows) have a label listing the certified U -Factor, certified Solar Heat Gain
Coefficient SHGC , and infiltration that meets the requirements of 10-111 (a).
117: Exterior doors and windows are weather-stripped; all joints and penetrations are caulked and sealed.
118(a): Insulationspecified or installed meets Standards for Insulating Material. Indicate type and include on CF -613 Form.
§118(i): The thermal emittance and solar reflectance values of the cool roofing material meets the requirements of §118(i) when the
installation of a Cool Roof is specified on the CF -1 R Form.
*§1 50 a : Minimum R-19 insulation in wood -frame ceiling orequivalent U -factor.
150(b): Loose fill insulation shall conform with manufacturer's installed design labeled R -Value.
*§15 (c): Minimum R-13 insulation in wood -frame wall orequivalent U -factor.
*§1.50(d): Minimum R-13 insulation in raised wood -frame floor orequivalent U -factor.
150(f): Air retarding wrap is tested, labeled, and installed according to ASTM El677-95 2000 when specified on the CF -1 R Form.
150 : Mandatory Vapor barrier installed in Climate Zones 14 or 16.
§150(1): Water absorption rate for slab edge insulation material alone without facings is no greater than 0.3%; water vapor permeance
rate is no greater than 2.0perm/inch and shall be protected from physical damage and UV light deterioration.
Fireplaces, Decorative Gas Appliances and Gas Log Measures:
150 e 1 A: Masonry or factory -built fireplaces have a closable metal or glass door covering the entire opening of the firebox.
§150(e)1 B: Masonry or factory -built fireplaces have a combustion outside air intake, which is at least six square inches in area and is
equip ed with a with a readily accessible, operable, and tight -fitting damper and or a combustion -air control device.
§150(e)2: Continuous burning pilot lights and the use of indoor air for cooling a firebox jacket, when that indoor air is vented to the
outside of the building, are prohibited.
Space Conditioning, Water Heating and Plumbing System Measures:
§110-§113: HVAC equipment, water heaters, showerheads, faucets and all other regulated appliances are certified by the Energy
Commission.
§113(c)5: Water heating recirculation loops serving multiple dwelling units and High -Rise residential occupancies meet the air release
valve, backflow prevention, pump isolation valve, and recirculation loop connection requirements of §113(c)5.
§115: Continuously burning pilot lights are prohibited for natural gas: fan -type central furnaces, household cooking appliances
(appliances with an electrical supply voltage connection with pilot lights that consume less than 150 Btu/hr are exempt), and pool and
spa heaters.
150(h): Heating and/or cooling loads are calculated in accordance with ASHRAE, SMACNA or ACCA.
150(i): Heating systems are equipped with thermostats that meet the setback requirements of Section 112(c).
§150(j)1A: Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are externally wrapped
with insulation having an installed thermal resistance of R-12 or greater.
§1500)18: Unfired storage tanks, such as storage tanks or backup tanks for solar water -heating system, or other indirect hot water
tanks have R-12 external insulation or R-16 internal insulation where the internal insulation R -value is indicated on the exterior of the
tank.
§1500)2: First 5 feet of hot and cold water pipes closest to water heater tank, non -recirculating systems, and entire length of
recirculating sections of hot water pipes are insulated per Standards Table 150-13.
§1500)2: Cooling system piping (suction, chilled water, or brine lines),and piping insulated between heating source and indirect hot
water tank shall be insulated to Table 150-B and Equation 150-A.
§1500)2: Pipe insulation for steam hydronic heating systems or hot water systems >15 psi, meets the requirements of Standards Table
123-A.
150(j)3A: Insulation is protected from damage, including that due to sunlight, moisture, equipment maintenance and wind.
§1500)3A: Insulation for chilled water piping and refrigerant suction lines includes a vapor retardant or is enclosed entirely in
conditioned space.
150(j)4: Solar water -heating systems and/or collectors are certified by the Solar Rating and Certification Corporation.
EnergyPro 5.1 by EnergySoR User Number: 6712 RunCode: 2011-08-08709:25:09 /D: Page 10 of 12
MANDATORY MEASURES SUMMARY: Residential (Page 2 of 3 MF -1 R
Project Name
Date
ason and Diana Pouliot
8/8/2011
§150(m)1: All air -distribution system ducts and plenums installed, are sealed and insulated to meet the requirements of CMC Sections
601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-
4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the
applicable requirements of UL 181, UL 181 A, or UL 181 B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is
used to seal openings reater than 1/4 inch, the combination of mastic and either mesh or tape shall be used
§150(m)1: Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed
sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may
contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area
of the ducts.
§150(m)2D: Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes
unless such tape is used in combination with mastic and draw bands.
150(m)7: Exhaust fans stems have back draft or automatic dampers.
§150(m)8: Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated
dampers.
§150(m)9: Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind.
Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar
radiation that can cause degradation of the material.
150 m 10: Flexible ducts cannot have porous inner cores.
§150(o): All dwelling units shall meet the requirements of ANSI/ASHRAE Standard 62.2-2007 Ventilation and Acceptable Indoor Air
Quality in Low -Rise Residential Buildings. Window operation is not a permissible method of providing the Whole Building Ventilation
required in Section 4 of that Standard.
Pool and Spa Heating Systems and Equipment Measures:
§114(a): Any pool or spa heating system shall be certified to have: a thermal efficiency that complies with the Appliance Efficiency
Regulations; an on-off switch mounted outside of the heater; a permanent weatherproof plate or card with operating instructions; and
shall not use electric resistance heating ora pilot light.
§114(b)1: Any pool or spa heating equipment shall be installed with at least 36" of pipe between filter and heater, or dedicated suction
and return lines, or built-up connections for future solar heating.
114(b)2: Outdoor pools ors as that have a heat um or as heater shall have a cover.
§114(b)3: Pools shall have directional inlets that adequately mix the pool water, and a time switch that will allow all pumps to be set or
ro rammed to run only during off-peak electric demand periods.
150 : Residential pool systems orequipment meet the pump sizing, flow rate, piping, filters, and valve requirements of 150
Residential Lighting Measures:
§150(k)1: High efficacy luminaires or LED Light Engine with Integral Heat Sink has an efficacy that is no lower than the efficacies
contained in Table 150-C and is not a low eff icacy luminaire as specified by §150(k)2.
150(k)3: The wattage of permanently installed luminaires shall be determined asspecified by §130(d).
§150(k)4: Ballasts for fluorescent lamps rated 13 Watts or greater shall be electronic and shall have.an output frequency no less than
20 kHz.
§150(k)5: Permanently installed night lights and night lights integral to a permanently installed luminaire or exhaust fan shall contain
only high efficacy lamps meeting the minimum efficacies contained in Table 150-C and shall not contain a line -voltage socket or line -
voltage lamp holder; OR shall be rated to consume no more than five watts of power as determined by §130(d), and shall not contain a
medium screw -base socket.
150(k)6: Lighting integral to exhaust fans, in rooms other than kitchens, shall meet the applicable requirements of §150(k).
150(k)7: All switching devices and controls shall meet the requirements of §150(k)7.
§150(k)8: A minimum of 50 percent of the total rated wattage of permanently installed lighting in kitchens shall be high efficacy.
EXCEPTION: Up to 50 watts for dwelling units less than or equal to 2,500 ft2 or 100 watts for dwelling units larger than 2,500 ft2 may be
exempt from the 50% high efficacy requirement when: all low efficacy luminaires in the kitchen are controlled by a manual on occupant
sensor, dimmer, energy management system (EMCS), or a multi -scene programmable control system; and all permanently installed
luminaries in garages, laundry rooms, closets greater than 70 square feet, and utility rooms are high efficacy and controlled by a
manual -on occupant sensor.
§150(k)9: Permanently installed lighting that is internal to cabinets shall use no more than 20 watts of power per linear foot of
illuminated cabinet.
EnergyPro 5.1 by EnergySoff User Number: 6712 RunCode: 2011-08-08T09:25:09 ID: Page 11 of 12
MANDATORY M EASU RES SUMMARY: Residential Pa a 3: of 3 MF-1 R
Project Name `. Date
ason and Diana Pouliot 8/8/2011
§150(k)10: Permanently installed luminaires in bath'room•s, attached and'detached garages, laundry rooms, closets and utility rooms
shall be high efficacy.
EXCEPTION 1: Permanently installed low efficacy,,luminaires shall be allowed provided that.they are controlled by a manual-on
.occupant sensor certified tocomply:with'the.applicable_requirements of.§119:
EXCEPTION 2: Permanently installed low efficacy.luminaires in closets less'than 70 square'feet are not required to be controlled'by a
manual-on occupancy sensor.:,
§150(k)11: Permanently, installed luminaires; located in rooms or 6reas;other than in kitchens;-bathroom's, garages,laundry rooms,
closets, and utility rooms shall be high efficacy luimnaires. EXCEPTION ,1: Permanehtly�installed low efficacy luminaires shall be
allowed provided they are controlled,by either a dimmer switch that complies with the,applicable,requi�ements of §119,-or by a manual-
on occupant sensor that complies with the applicable_ requirements' of §119:; EXCEPTION.2:.Lighting in'-detached storage building less
than 1000 square feet located on a residential site is not required to"com I with. 1'50 k 1.1:
§150(k)12: Luminaires recessed into insulated ceilings shall be listed for zero clearance irisulation•contact (IC)'by Underwriters
Laboratories or other nationally, recognized testing/rating laboratory; and have a'label thatcertifies the lumiunaire:is airtight with air
leakage less then 2.0 CFM at 75 Pascals when tested in accordance with ASTM E283; and be sealed with a gasket or caulk between
the luminaire housing and ceiling.
§150(k)13: Luminaires providing outdoor'lighting, including lighting,for private-patios.in low-rise residential buildings with four or more
dwelling units, entrances, balconies, and:porches, which are permanently mounteflo'-a residential Building or to other buildings on the
same lot shall be high efficacy, EXCEPTION 1: Permanently'installed.outdoor low effickc luminaires shall?be allowed provided that
they are controlled by a manual on/off switch, a motion sensor not.having;an:override'or bypass switch ahat'disable's the motion sensor,
and one of the following controls: a photocontrol not having an override or bypass switch that disables the photocontrol; OR an
astronomical time clock not having an override or bypass switch that disables the, astronomical time,clock; OR an energy management
control system (EMCS) not having an override or bypass switch that alldx4ls the luminaire to be always on EXCEPTION 2: Outdoor
luminaires used to comply with'Exceptioril to §150(k)13 may be controlled by a temporary override switch which bypasses the motion
sensing function provided that the motion- sensor is-automatically'reactivated within'sik hours. EXCEPTION I.Permanently installed
luminaires in or around swimming pool, water features, or other location subject to. Articlk80 of the California -Electric Code need=not
be hi h efficac luminaires.
§150(k)14: Internally illuminated address signs shall comply With Section ,t 48; OR not,contain a screw-base socket; and consume no
more-than five watts of ower as determined.accordii 'to 130 d
§150(k)15: Lighting for parking lots and,carportswith a total of for 8 or more vehicles persite shall comply with the applicable.
requirements in Sections 130, 132; 134, and 147.' Lighting for parking:garages for 8 or:more-vehicfes shall comply with the applicable
re uirements of Sections 130, 131, 134, and 146:
§150(k)16: Permanently installed lighting in the enclosed, non dwelling spaces.of low rise•,residential buildings with. four or more
dwelling units shall be high efficacy luminaires. EXCEPTION Permanently installeddow.efficacy luminaires.shall be allowed provided
that the are controlled b an occupant sensors certified to comply with the a ' licable,re uirements of 119.
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