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11-0705 (AR)P.O. -BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: C 1100000705 -- Property Address: 50028 CALLE OAXACA APN: 773-340-037-37 -14496 Application description: ADDITION - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 17000 TA'( t44Q" Architect or Engineer: alp BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I ani licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code,. and my License is in full force and effect. License Class: B C36 4 License No.: 746760 at 1 fi 1 ( ntractor: 51 OWN R -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 1, 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 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: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/18/11 Owner: LONDON HOLLAND'S 115 W CHEYENNE RD NO 419 COLORADO SPRINGS, CA 80906 Contractor:' B & M-CONSTRUCTION/PLJ G 1INC,- P.O. BOX 1977 LA QUINTA', CA 92247 (760) 578-0406 JUL���� Lic. No.: 746760 L6 QUINTA ---------------------------------------------- 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. 9-1 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 STATE FUND Policy Number 23811 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 �wit 'or visions of Section 3 0 of the Labor ode, I all forthwith a$ te: / /� /(Appli t: - WARNING:FAILUR TO SECURE WORKERS' COMPENS TION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application nd state that the above information is correct. I agree to comply with all city a county ordinances and state ws relating to building construction, and hereby authorize repre entatives o is county to ter upon the ove-mentioned property f 'ns�ionpos Date v 141 ure (Applicant or Agent): Application Number . . . . 11-00000705 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 180.00 Plan Check Fee 117.00 Issue Date Valuation . . . . 17000 Expiration Date 1/10/12 Qty Unit Charge Per Extension BASE FEE 45.00 15.00 9.0000 THOU BLDG 2,001-25,000 ---------------------------------------------------------------------------- 135.00 Permit . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 23.25 Plan Check Fee 5.81. Issue Date* . . . . Valuation . . . . 0 Expiration Date 1/10/12 Qty Unit Charge Per Extension BASE FEE 15.00 11.00 ..7500 PER ELEC DEVICE/FIXTURE 1ST 20 8.25 -------------------------------------------------------------------------.--- Special Notes and Comments 115 SF COVERED PATIO CONVERSION TO BEDROOM EXPANSION. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 11.70 STRONG MOTION (SMI) - RES 1.70 Fee summary Charged Paid Credited ---------- -- Due ----------------- Permit Fee Total 203.25 .00 .00 203.25 Plan Check Total 122.81 .00 .00 122.81 Other Fee Total 14.40 .00 00 14.40 Grand Total 340.46 .00 .00 340.46 LQPERMIT - ' Bin i<i ` G City of La Quinta Building ex Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 1- 01 Project Address:0 -- �ji Owner's Name: %� (` ��j „ L ACL A. P. Number: �� (� Address: �t��©2� Legal Description: City, ST, Zip: Contractor: Telephone: �- Address: Project Description: City, ST, Zip: Telephone: 7� State Lic. #: City Lic. #: , Designer. irC Address:-?7-60,0 �p�-pp� City, ST, zip: IF� V Ch � Telephone: �G��j ��jOWConistructionType: State Lic. Name of Contact Person: ( Occu an cY: ect type (circle one): New Add'n Alter Repair Demo Sq. Ft.: j l # St ries ' #Units: Telephone # of Contact Person: 6 2 Estimated Value of Project 000 APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Rcq'd Rec'd TRACKING PERMIT FEES ' Plan Sets Plan Check submitted (' Item Amount Structural Calm Reviewed, ready for corrections Plan Check Deposit Truss Coles. Called Contact Person Plan Check Balance Energy Caics. Plans picked up Construction Flood plain pian Plans resubmitted Mechanical Grading plan 2" Review, ready for correctio issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.N1.1i' II.O.A. Approval % Plans resubmitted Grading W HOUSE: ''• 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 ky � t Total Permit Fees J I?$jgv►1 — 5L39t--^4dQ "-a F>+rra4wm 1 la jzoN 1115 %=We., App CERTIFICATE OF COMPLIANCE �A Eosc Desert Sands Unified School Districtz4��y°o 47950 Dune Palms Road Q BERMUDA DUNES C4 RANCHO MIRAGE Date 7/18/11 La Quinta, CA 92253 N INDIAN WELLS PALMDESERr No. 31052 (760) 771-8515 �� LA I 4U�� > 0 OO TA y� m Owner Holland and Beverley London APN # 773-340-037 Address 50028 Calle Oaxaca 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 50028 Calle Oaxaca 115 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500. Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 115 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 - Brian Sprueill Check No. Name on the check Telephone 760-578-0406 Funding Exempt By Dr. Sharon P. McGehee Superintendent ` Fee collected /exem ed by on Gllvrey Payment Recd 3 ` $q.00 ''®.ver/Under v Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID without embossed seal Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting Expand bedroom into courtyard area, per the enclosed drawing. Once you've had a chance to look at. this information, kindly initial next to your name and return the cover page to me with any comments — via fax, email, or mail, or phone me at your convenience. Thanks very much! Comments: I o 7#g- -% q- L �o v Al 6�d� I -1 t 1/1 THE SANTA ROSA COVE ASSOCIATION 49991 Eisenhower Drive La Quinta, California 92253 760-777-7621, 760-564-8418, FAX dave@albertmgt.com' Architectural Change Request DATE:.- June 6,2011 TO:, Architectural Committee FROM: Dave Scott RE: London 150028 Calle Oaxaca. CC: Ken Gookin, Chairman Janet Barlow, Member Shirley Miles, Member 191 I VA Lou Ritenour, Member Jim Tomlinson, Member Expand bedroom into courtyard area, per the enclosed drawing. Once you've had a chance to look at. this information, kindly initial next to your name and return the cover page to me with any comments — via fax, email, or mail, or phone me at your convenience. Thanks very much! Comments: I o 7#g- -% q- L �o v Al 6�d� I -1 t 1/1 Rmdmdd*MO*fwjw 0bfambtbftjWeWJy&es Name: 14- P LOhCo LA Dat+ Low m*em S"00 Z 0 O A.)G IAC A C A(le Mmuing Aar: A�o c A_j {v tin/ Local Pham 768 ^S6 S_ -9 S-9 S G tre,sfi cK • /s i=5� 0 Other Phone. 7f ? — 6 "-- �3 720 FOR SUBSTANTIAL MODIFICATIONS, I& ROOM ADDITIONS, ROOF EXTENSIONS, ANY MODIFICATION REQUIRING PROFESSIONAL DRAWINGS ANIDIOR BLUEPRINTS, OR ANY SUBSTANTIAL CHANGE REQumm CERTAIN DESTRUCTION OF EXISTING COMMON AREA SUCH AS SKYLIGHT INSTALLATION AND PATIO EXPIINSIONS, TETE FOLLOWING FEE SCHEDULE SHALL APPLY: $500 REFUNDABLE DEPOSIT MADE PAYABLE TO THE SANTA ROSA COVE ASSOCIATION FOR ANY AND ALL Ma%NSES INCURRED BY THE ASSOCIATION DURING CONSTRUCTION/MODIFICATION ANID/OR FOR THE USE OF A CONSULTANT DURING THE APPROVAL PROCESS THROUGH COMPLETION AVID "SIGN OFF'.'. BALANCE OF DEPOSIT WILL BE RBTURNIED UPON RECEIPT OF ALL DOCUMENTATION OF COMPLETION FROM THE CITY OF LA QUINTA AND -THE FINAL INSPECTION MADE BY THE ARCEffIECrUltAL COMUTTER ORA REPRESENTATIVE IMMF MODIFICATION IS OiTI11IED AND APPROVAL IS RFSQiIaTED FOR TIS ARCHITECTURAL VARIANCE LISTED ABOVE I HAVE SUPPLIED ALL NECI SSARY DRAWINGS AND/OR RENDERINGS FOR THE PROPOSED MODIFICATION INCLUDING BUT NOT LIMITED TO, LOCATION, DIV1E NSIOX COLOR AMID MATERIXI. S AND ANY AND ALL OTHER REQUIR13ME NTS AS OUTLIIED IN TIRE ADOPTED ARCETTECTURAL GUIDELINES OF THE SANTA ROSA COVE ASSOCIATION AMOR ANY OTHER REQU REl1RENTS OR SPECIFICATIONS AS OUTLINED BY TIRE ASSOCIATIONAND D MAY BE ATTACHED TO AND A PART OF TEES APPLICATIOK - IS- . 6c)[? I UNDERSTAND THE ASSOCIATION REQUIRES ME TO USE ONLY LICENSED AMID DORM CONTRACDORS AND HAVE ATTACHED A COPY OF THOSE LICENSES AMID CBRMCATES OF INSURANCE, INCLUDING BUT NOT 105M TO COMP UffiENSIVE BROAD FORM LIABRM, OWNED, NON -OWNED AMID HMO AUTO, AMID WORKER'S COMPENSATION OF THE CONTRACPORI HAVE EKED AND ANYAND ALL SUBCONT8ACTOR& I UNDERSTAND I AM RESPONSIBLE FOR OBTAINING ANY AND ALL PERMITS AS REQUIRED BY THE CTIY OF LA QUINTA, AND WILL SUPPLY A COPY OF THESE PERMITS TO TAE ASSOCIATION OFFICE UPON RECEIPT. I UNDERSTAND I, AS THE HOMEOWNER, AM RESPONS®LE FOR ANY AND ALL ACTIONS AMID ACTIV117RS, WHICH ARE PERFrORMBD, BY MY CONTRACTOR AMID JR IIM EMP PEES ' OR SUBCONTRACTORS I UNDERSTAND THAT I, AND NOT MY CONTRACIIOR, AM TO MEWACE WITH TTN CON IITI'EE AMID TEE ASSOCIATION UNLESS OTHER. ARRANGEMENTS ARE MADE IN ADVANCE. ANY AND ALL DAMAGE TO ANY PORTION OF THE COMMON AREA, INCLUDING BUT NOT I 04M3D TO THE UTI ITIErk COMMON AREA, AMOR BUILDING STRUCTURES WILL BE REPA]RED AT MY EXPENSE. I AGREE TO START COWi MCITOMMODIFICATION WITIHN 30 DAYS OF RECEIPT OF APPROVAL FROM THE COAD TTEE AND WILL COMPLETE ALL ACT[VIT7ES WITHIN ISO DAYS OF THAT APPROVAL. I UNDERSTAND THE ASSOCIATIM FROM TIME TO TIME, WILL REQUIRE INSPECTION OF ONGOING AMID AGREE THAT MY CONTRACTONAGENT (S) AMID I WII.L COOPERATE FULLY WITH TiE INSPECTOR. IN ADDITION, I UNDERSTAMID THAT ANY AMID ALL CHANGES REQUIRED, BY THE CITY OF LA QUIIJTA AND NOT BEfiACTED IN THE ORIGINAL, APPROVED ARCHITECTURAL VARIANCE MUST BE REPORTED TO TETE ASSOCIATION IMMEDIATELY. UPON COMP MON OF T1E MODIFICATION, I WRL SUPPLY TTE ASSOCIATION OFFICE WITH A COPY OF TIRE FINAL INSPECNTON, WATCH HAS BEEN -XojE D OFF" FROM TIE CITY OF IA QUINTA. IN ADDTIIOAL I WIId. CONTACT TEE ASSOCIATTON OFFICE AMID MAKE ARRANCEMEM FOR TUB AA '�'Rt '�'riRAi , OR A REPRESENTATIVE TAEREOF_._ TQ MASE A FRUL INiETED JOB AND AUTHORIZE RETURN OF MY SSW DEPOs1T_ I HAVE INC MED A CHECK (S) IN TAB AMOUNT (S) OF.- TO F TSO COMPLY WITH: THE ABOVE. �fl*m (s) Date Corizxscro>� 9 -Uw M b i u . T t., r . : t3 C 3 (o 7 (Attaci evEmm atm►, was and saW ) Mal: THE SANTA ROSH COVE ASSOCIATION -or- EMd Dehvw SRC Association OF= Clo Affmt Awociatim MwqXmmt 4"1 Eismhowa Poet Oboe Banc #12920 La Qukft CA 9M PWm Dftm% C fffixnia 9Ml 5 -19- June 10, 2011 Dear Mr. & Mrs. London, I am writing to confirm our phone conversation on Friday about the Architectural Committee's having issued conditional approval of your May 30 Change Request. '! Moving ahead will require evidence of workers comp insurance for B&M Construction & Plumbing, Inc. We also need their evidence of liability insurance, naming Santa Rosa Cove Association as additionally insured. . Prior to beginning any work here, Brian Sprueill will need to sign the Contractor's Jobsite {' Rules, a copy of which we've enclosed for your reference. Thanks very much. Best regards, Dave Scott,•CCAM Community Association Manager Santa Rosa Cove Association I I 1 49-991 Eisenhower La Quints, California SRC (760)'777-7621 Fac (760) 564-84189418 : Mailing Address: I SANTA ROSA COVE ASSOCIATION Pa1mD d, Cox 12920 i Prescriptive Certificate of Compliance: CF -1R ADD Residential Additions (Page 1 of Site Address: Enforcement Agency: Date: CS0 - 0 e-XIL & �4- )d General Information Project Namy Amm 4-1 �� Climate Zone # # of Stories LCJN DD hJ Standard Building Type ❑ Single Family ❑ Multi Family Circle the Front Orientation: N, E, S, W or Degrees Conditioned Floor Areaof ddition New Addition Size: ❑ Less than or equal to 100 ess than or equal to 1000 fe (CFA): 14 1 (Do not use this orm or additions greater than 1000 NOTE: For Alterations to an existing /come, submit a completed CF -JR -ALT Form Exception: Existing HVAC systenu that are replaced or altered to serve the addition may be included on the CF -IR ADD Form Prescriptive Envelope Requirements for Additions Option 1: Use Option Ifor standard wood and assemblies meeting the Cavity R -value only. For all other use Option 2. • For I00 flz additions, the Proposed values must be equal or greater than the Standard column or when indicated when using Package A "Pkg D ". Enter all values in the Proposed Columns. • For less than 1, 000 ftt additions must comply with 'Pkg D" requirements unless indicated in the Standard Column. To meet `Pkg D" minimum ever compliance re uirements, see RCMA endiz B, Table 151-C."Or 1 SI in the RCM. Enter all values in the Proposed Columns. Size of Addition 100 fte or less Less than 1,000 fe Component Standard -::::Pro :osed:1: -': Comment Standard - . =Pro osed:'.: Comment Ceiling Insulation R-19 ............... . Minimum Pkg D 2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ... Indicate the Frame type and Size: For Table 151-C Wall Insulation R-13 Minimum R-13 �: ).. Minimum Floor Insulation R-13 Minimum Pkg D Table 151-C U- U- U- U- • .; :.:> : : _: Fill out Fenestration factor SHGC ...factor.. SHGC' Enter Proposed factor SHGC '.factor :.:;:SHGC..'. Fenestration 0.40 Pkg D 0.40 Pkg D :. t - .: - , of: values then Skip Over Proposed Areas Below Fill out To Roofing Package D (20% Additional Maximum Glazing 50 fl? Products fi?: of CFA) + Glass RZ: Allinved Area , Below Removed Fenestration - " SfsE Areas Below Radiant Barrier N/A Pkg D Table 151-C Roofing Pkg D See Roofing Products Below Pkg D See Roofing Products Below O a ue Surface Details For the furred portioned. of Mass Walls see Furring Stri s Construction Table below. A B I C D E F I G I H I I J Proposed See NOte Standard Values From JA4 Table Framing Thickness, Framed Continuous JA4 Proposed Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly ID1 or Type' and Size or Other3 I factor° Numbers R-value6 R -Value Cell Values U -facto? Note: For furred assemblies, accounting for Continuous Insulation R -value, see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and Fur -ring Construction table below. 1. For Tag/ID indicate the identrcalion name that matches the building plans. 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 assembliesREC EIVED 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 Standard U factor from Table IR- C for each decent assembly Ypme or type. �� U N 28 2011 5. Enter the Table number that closely resembles the proposed assembly. �t 'C$FFl .t `t = �1 6. Enter the R -value that is being installed in the wall cavity or Wyk "0 "• s; (��� 7. Enter the Continuous Insulation R -value for the proposed ass mbl , is er L�'� Q U I �QB . . 8. Enter the row and column of the U factor value based on Col mn ��e d ssembly U fact rflgtCo un? . 9. The Proposed Assembly U factor, Column J, must be equal t or less tha 4=n1 r � E to eorrip�ly. Registration Number: 2008 Residential Compliance Forms r+r—r'rtuVtU Regis tion D tine: HERS rovider: Re FR CONSTRUCTION August 2009 i It, * . WE 7 l 4 2-0 (1 BY � • %D f7 Prescriptive Certificate of Compliance: CF -1R ADD Residential Additions (Page 2 of Site Address: Enforcement Agency: Date: ,So ® _ & 42 4-) l l Furring Strips Construction Table for Mass Walls Ont A I B I C I D I •E F G I H I J K L M Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation 140 3 P3 Walls From Reference in Furring Space from Reference i � Joint Appendix Table 4.3.5, 4.3.6, 4.3.7 Joint Appendix Table 4.3.13 u U y d H O m -a s > d y AssemblyMass o 2 FT o v > Final Thickness' Name o A4 Table Nu bei ¢ > c c ' ¢ > > Assembly U -factor ' Comment 1. Indicate the Mass Thickness from Reference Joint Appendix JA. .Indicate the Assembly Name or type: Roof7Ceiling, 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 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 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 factor value back on to the Opaque Su ace Details table in Column J. FENESTRATION PROPOSED AREAS Orientation Fenestration Type and Frame (North, East, PropsedAreal (Window, Glass Door or Skylight) South, West) ft U-factorz Maximum 3 Maximum NFRC or SHGC�l 3• ° Default Values' 140 3 P3 t� .9D i � Total 1. Fenestration area is the area of total glazed product (i. e. glass plus frame). Exception: When a door is less than 50.0 glass, the fenestration area may be the glass area plus a "2 inch frame " around the glass. 2. Enter value from Component Package D Requirements in Table 151-C. 3. Actual fenestration products installed and as indicated in CF-6R-ENYForm shall be equivalent to or have a lower U factor and/or a lower SHGC value than that specified on the CF -JR ADD Form. 4. Submit a completed WS -3R Form if a reduced SHGC is calculated with exterior shading. 5. If applicable at this stage enter `NFRC" or NFRC Certified windows or CEC "Default " values found in Table 116 A or B. Registration Number. Registration Date/time: HERSProvider: 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: CF -1R ADD Residential Additions (Page 3 of 5 Site Address: Enforcement Agency: Date: ADDITION ALLOWED FENESTRATION AREAS Check applicable box below if the roof addition is exempt from the roofing product "Cool Roof' requirements. Note: If any one of the boxes are checked below, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in §118(1) are not applicable. Do not fill A B C D E ❑ Roof constructions that have thermal mass over the roof membrane with at least 25 lb/fig is exempt from the above Cool Roof criteria. F e applicable box below if Exempt from the Roofing Products "Cool Roof' Requirement: CFA of Addition Allowed % Allowed Area Area RemovedZ Total Area Allowed 4 Proposed Areas' fe of CFA (A x B) fe C + D Emittance (Table Above) Total Fenestration Area ❑ I ❑ 4e) 11 ❑4 West Fenestration Area � � � OS 't %_1� ❑ ❑ — (Required In CZ's 2, 4 & 7 -15 ❑ ❑ ❑ 1. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12. 2. West facing glazing area removed cannot be "counted" twice. " In order to distribute the west glazing area removed to the other orientations, input the west glazing area removed in the Total Fenestration Area row, column D. 3. Include the Proposed Area of the West facing fenestration in both Area columns below. 4. To meet compliance, the Proposed Area must be less than or equal to the Total Allowed Area for BOTH the Total and West Fenestration Areas. ROOFING PRODUCTS (COOL ROOFS) §1510922 Check applicable box below if the roof addition is exempt from the roofing product "Cool Roof' requirements. Note: If any one of the boxes are checked below, the Aged Solar Reflectance and Thermal Emittance 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 Slope. Less or 2:12 pitch. ❑ Roofing compliance Not Required in Climate Zones 1 through 9 and 16 with a Low -Sloped. Roofs pitch greater than 2:12 and product weight less than 51blif. ❑ 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/fig 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 < 5lb/ft2 2: 51b/ft T e2 Reflectance"' Emittance SRIS ❑ I ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at xninv.coolroo s.org/nroducts/search.vhp 2. Indicate the type of product is being used for the roof top, i.e. single ply roof, asphalt roof, metal roof, etc. 3. Ifthe 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(pinitial — 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___pt :/hmv)v.enerrv.ca. Row/title24/and enter the resulting value in the SRI Column above and attach acopy of the SRI- Worksheet to the CF -JR. To apply Liquid Field 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 § 118(i)4. Select the applicable coating: ❑ Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating (Other `{.1 r► v3 - Registration Number.* 2008 Residential Compliance Forms Registration DatelTume: HERSProvider: August 2009 HVAC SYSTEMS - HEATING . gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground hot water pipes is required in all com onent acka es in all climate zones. Duct or Configuration Minimum Distribution Piping (Central, Split, Heating Equipment Efficiency : Type and Insulation Thermostat Space, Package or Type and Capacity', 2.3 AFUE or HSPF i Location° R -Value Type H dronic 1 t Capacity (gal) Thermal Efficiency R -Value' I 1=41 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 7,00 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 -JR -ADD Form for additional requirements and check applicable boxes. 4. Indicate Type or Location(Ducts, H dronic in Floor, Radiators, etc. HVAC SYSTEMS - COOLING 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. Configuration Cooling Equipment Minimum Distribution Duct or Piping (Central, Split, Type and Capacity' -2 Efficiency Type and Insulation Thermostat Space, Package or SEER/EER or COP Location' R -Value Type H dronic r✓ u I ��4-I �� 1. Indicate Cooling Type (AIC, 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 gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground hot water pipes is required in all com onent acka es in all climate zones. External Tank Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation Type' Standard, Recirculating? System Capacity (gal) Thermal Efficiency R -Value' I 1=41 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 pipes shall be insulated to meet the requirements of§506). 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. Radiant Barrier (Roof) 0 YES &NO G"d ► ` of 41 7 -,00f - YES: Required in Climate Zones 2, 4, and 8-15 for additions larger than 100 fO. Slab Edge (Perimeter) Insulation 0 YES MKO YES: In Climate Zone 16 under Component Packagrw D, R-7 insulation is required. Heated Slab Insulation 0 YESO YES: Slab edge insulation required for heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation 0 YES elvo YES: In Climate Zones 1, 2, 11, 13, 14 & 1611 8 insulation is required, and in Climate Zones 1.2 & 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: l Registration Da[eJTime: 2008 Residential Compliance Forms HERS Provider: August 2009 Prescriptive Certificate of Compliance. CF -1R ADD Residential Additions (Page 5 of Site Addreos: Enforcement Agency: Date: ._4_.:�0 - Das N'LLr, oP-x 6 )x-16 t 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 required for this measure. ❑ YES 2 NO YES: In all Climate Zones, if a new space -conditioning system (HVAC equipment and ducting) is installed to serve the addition alone, the ducts are to be sealed and tested per §151(f)10. �� C3 YES LTNU YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned space to serve the addition, the ducts are to be sealed and tested per §152(b)1D. ❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. ❑ YES C•7N0 YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including replacement of the air handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) and will serve the addition, the ducts are to be sealed and tested per §152(b)1E. ❑ 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 ducts stems constructed, insulated or sealed with asbestos. Refrigerant Qmrge -Split System HERS verification is required for this measure. ❑ YES ErNO YES: In Climate Zones 2 and 8-15, if a newly ducted split A/C or heat pump is installed to serve the addition alone, a / refrigerant charge measurement shall be verified per §151(07A. ❑ YES 0 0 YES: In Climate Zones 2 and 8-15, if the existing HVAC equipment is replaced (including replacement of the air handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) and will serve the addition a refrigerant charge measurement shall be verified per § 152 IF. Central Fan Integrated Ventilation System — Airflow and Fan Watt Draw - do not apply for additions 1,000 flor less. Ducted Split stems - Air Conditioners and Heat Pumps: Airflow and Fan Watt Draw HERS verification is required. ❑ YES EMO YES: 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. 13YES 0<0 YES: In Climate Zones 10 through 15, if the existing space -conditioning system (HVAC equipment and ducting) is replaced and will serve the addition, the airflow and fan watt draw shall be verified per §152(b)IF. Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accuratil and co Tete. Name: Signature: Company: l Ic l +ate+ L,. Date:6) a4 H Address: If Applicable ❑ CEA or CREPE. (Certification #): - 0 (i ' 1 3 City/State/Zip: IPhone: 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 Certif cate 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 wi n :16ocuwment this building design on the other applicable compliance forms, worksheets, calculation sub rcement agency for approval with this building permit application. - Name: owlmay. Si •� 7;P lco��t00000_ Comp O rW ate: 7 '' Ad s:License: • City/ W P o For assistance or questions regarding the Energy Standards, contact the Energy Hotline at. 1-800-772-3300. Registration Number: Registration Date/Time: HERS Provider: 2008 Residential Compliance Forms August 2009