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BRES2015-016778-495 CALLE TAMPICO. LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: Applicant: . GIORGIO BRESANI 78930 SONTESTA WAY LA QUINTA, CA 92253 &t1t 4 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT VOICE (760) 777-7125 FAX (760) 777-701_ INSPECTIONS (760) 777-715• . BRES2015-0167 Owner: 78930 SON ESTA WAY GIORGIO BRESANI 604151027 78930 SONTESTA WAY BRESANI / ADD (2) CLOSETS 232 SQUARE FEET REMODEL (1) BATH LA QUINTA, CA 92253 $13,270.40 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 Professions Code, and my License is in full force and effect. LicenseClass:Class: _ License No.: 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 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)-.:6 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,6did not build or improve for the purpose of sale.). f(_11;95I, 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 ��he ontractors' State License Law.). l.am exempt under Sec. B.&P.C. for this reason Date:' i0 Owner:'`/ Me 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 Lender's Contractor: GIORGIO BRESANI 78930 SONTESTA WAY LA QUINTA, CA 92253 (760)610-3435 Llc. No.: Date: 6/10/201E 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. 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:.= Polity Number: L Ijcertify that in the performance of the work for which this permit is issued, sha'H notme ploy any person In any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. OXE u Applicant: Ji e, �p WARNING: FAILURE TO SECURE WORKERS' COMPENSATI N 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'Building Official 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, anc 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 city to enter upon the a ove mentioned property for inspection purposes. 0117 Da e f j Signature (Applicant or Agenfl •� _ - DESCRIPTION ': ,x ACCOUNT ` rQTY AMOUNT 2� PAID PAIDDATE', ADDITION, EA ADDITIONAL 500 SF 101-0000-42400 0 $62.36 $0.00 $0.00 PAID,BY ,' 3 METHOD ' .:RECEIPT*. _' 'CHECK #-->v rr CLTD BY, `CLTDBY METHOD " `RECEIPT # DESCRIPTION' �. '• =: k "" ,ACCOUNT : „QTY :. AMOUNT ,., ,PAID PAID:DATEr ADDITION, EA ADDITIONAL 500 SF PC 101-0000-42600. 0 $17.40 $0.00 $0.00 PAID BY° METHOD ". 4 `RECEIPT :# s� a CHECK # CLTD BYE:: r€CLTD BY 'DESCRIPTION „. ACCOUNT A ,QTY i; AMOUNT - F::: PARD ' PAID; DATIE ADDITION, FIRST 100 SF 101-0000-42400 0 $120.83 $0.00 ^PAID BY c`, . ; * METHOD , - RECEIPT # k �-Yv CHECK # CC7D BY DESCRIPTION,. ,.. tt. : .,F.�, I%. ACCOUNT QTY ` ,.. AMOUNT ,r 4R i _ PAID � �, � _ PAID'DATE F ADDITION, FIRST 100 SF PC 101-0000-42600 0 $171.14 $0.00 " PABY .v '"METHOD .. rF .' F`'RE CEIPT#ID CLTD BY ti Total Paid forADDITION: $371.73 $0.00 R DESCRIPTION ACCOUNT QTY 4' AMOUNT t` p Y PAID ., PAIDyDATE' HOURLY PLAN CHECK - YES 101-0000-42600 2.5 $175.00 $0.00 .PAID BY.;":: METHOD �.:,` `s RECEIPT# r #'`£CHECI(#�*r `CLTDBY METHOD " `RECEIPT # r CHECK # DESCRIPTION. ,; ACCOUNT.` „ . QTY x° .AMOUNT PAID , 4' -PL AID DATE:. HOURLY PLAN CHECK - YES 101-0000-42600 1 $70.00 $0.00 PAID.BY,..; `r ;$ ., c.: �, - uMETHOD* n t ..RECEIPT.# r ;e CHECK # t.. r€CLTD BY Total Paid forBLDG CITY STAFF - PER HOUR: $245.00 $0.00 DESCRIPTION "' "" 'ACCOUNT ' QTY. '` AMOUNT PAID PAID'DATE'' RESIDENTIAL, FIRST 1,000SF 101=0000-42403 .0 $145.03 �� BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 METHOD " `RECEIPT # r CHECK # CLTD BYr': Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 ` DESCRIPTION (rtE , ACCOUNT _" ' .QTY;' `` AMOUNT c PAID PAID.DATE RESIDENTIAL, FIRST 1,000SF 101=0000-42403 .0 $145.03 $0.00 ` & PAID BY-= t' „ "; METHOD: ; " r'Fry RECEIPT # ' `; CHECK #'= 24 CLTD BY$ I ra' DESCRIPTION ", ' , ACCOUNT :QTY AMOUNT _ , : _.PAID 1: PAID4DATE .>.Y RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $47.86 $0.00 PAID BY ` z' METHOD' RECEIPT # ". CHECK # CLTD EtY Total Paid forELECTRICAL - NEW CONSTRUCTION: $192.89 $0.00 Total Paid forMECHANICAL: $33.84 $0.00 tr, r� `xx'DESCRIPTION :' ` %;ACCOUNT', ` ; `YgTY AMOUNT �W` :PAID abPAIDDATE. .m ' PAI D FIXTURE/TRAP 101-0000-42401 0 $36.27 $0.00 w METHOD `'' APPLIANCE REPAIR/ALTERATION 101-0000-42402 0 $12.09 $0.00 101-0000-20308 0 `PAIDBY �: ? € METHOD '' 4 RECEIPT # `� CHECK # CLTD BYE fi PAID &,! 4 't, 47'1 101-0000-42600 a $36.27 $0.00 b a.PAID BY �p-4 , - t a.: a METHOD ;: RECEIPT #� � .F t ` _ + '-=,CHECK # CLTD BYYj r ry ,- DESCRIPTION N. ACCOUNTS; AQTY AMOUNTS t r, PAID' PAIDDATE.'. ACCOUNT,,.,, APPLIANCE. REPAIR/ALTERATION PC 101-0000-42600 0 $4.83 $0.00. 101-0000-42401 0 SPAID BY4 = METHOD ' '-"RECEIP.T# r `' CHECK ##; CLTD BY: ECEIRT # ;R� u y 4 y S. L r s, DESCRIPTION F :: es -q c ACCOUNT QTY "µ AMOUNT ,_f rba p �. PAI - ..4. ... DESCRIPTION, t- a w _.. ... a. '' ACCOUNT qTY. ..`; AMOUNT r,. PAID '+ ="r P AID DATE: P. 0 w _PAID BY a r t' 3 ` "'. 4 METHOD ..T RECEIPT #'''mNfa„ CHECK # �_fCLT.D x w.s VENT FAN 101-0000-42402 0 $12.09 $0.00 -41a PAID BY N,b11 �.., .. ,_ METHOD ; , f p z"'RECEIPT # b CHECK # z4 A" CLTD BY `�°�DESCRIQTION'ACCOUNT �QTY� AMOUNT PAID; PAID;DATE ,"._ VENT FAN PC 101-0000-42600 0 $4.83 $0.00 PAID BY ' .r METHOD h,'RECEIPT #R CHECK # `CLTD BY . .s i' Total Paid forMECHANICAL: $33.84 $0.00 i, : i; t = ACCOUNT ti', :QTY =., AMOUNT f �W` :PAID abPAIDDATE. .m ' 4ACCOUNT FIXTURE/TRAP 101-0000-42401 0 $36.27 $0.00 w METHOD `'' 'RECEIPT . k # CHECK # CLTD BY,' SMI - RESIDENTIAL 101-0000-20308 0 $1.73 ,, ,DESCRIPTION .: i ACCOUNT QTY �a q AMOUNT fi PAID PAID DATE FIXTURE/TRAP PC 101-0000-42600 0 $36.27 $0.00 b a.PAID BY �p-4 , - t a.: a METHOD ;: RECEIPT #� � .F t ` _ + '-=,CHECK # CLTD BYYj ry DESCRIPTION ACCOUNT,,.,, QTY: , AMOUNT �I. PAI D:.,3 PAID DATE WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09 $0.00 'PAID BYM > F . ' „ �X `;<METHOD ECEIRT # ;R� f r HECK # nC ., sn CLTD BY, s, DESCRIPTION F :: es -q c ACCOUNT QTY "µ AMOUNT ,_f rba p �. PAI PAID DATE,' WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.09 $0.00 P. 0 w _PAID BY a r t' 3 ` "'. 4 METHOD ..T RECEIPT #'''mNfa„ CHECK # �_fCLT.D BY:fl . 1 Total Paid forSTRONG MOTION INSTRUMENTATION SMI $1.73 $0.00 Total Paid forPLUMBING FEES: $96.72 $0.00 DESCRIPTION , 4ACCOUNT QTY' AMOUNT PAID PAIDDATE: x- SMI - RESIDENTIAL 101-0000-20308 0 $1.73 $0.00 x rx PAID; BY `. w �< _ « ` METHOD -� w RECEIRT# o ��; `CHECK # CLTD BY:':t 1 Total Paid forSTRONG MOTION INSTRUMENTATION SMI $1.73 $0.00 Bin # City of La Quinta Building 8T Safety Division D` �� P.O. Box 1504, 78-495 Calle Tampico Quinta, CA 92253 - (760) 777-7012. Building Permit Application and Tracking Sheet Permit #�� C C&9La Project Address: 0 5bm^5 Owner's Name: ID A. P. Number: &D 2 '7 Address: 119?3v Legal Description: Contractor: fl - City, ST, Zip: N-616 2 2 r C7 Tele h 0 ne P Z -34 Address: Project Description: City, ST, Zip: • Telephone: p State Lia # : City Lie. #•: O . Arch(Engr Designer: Address• br,> 3 3 3 3 S City., ST, Zip: C)j 15MQ�,jo Telephone: State Lie. #• ' Name of Contact Person: ®� g�5�� Con tr ucti n TY e: Occupancy: P cY: Project type (circle r le one • New Add'n Alter Repairair Dem o Sq. Ft.: '2 # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: I APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes.. Reviewed, ready r corrections 15 Iq Plan Check Deposit Truss Cafes. Called Contact Pcrs s Plan Check Balance • Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2q' Review, ready for correctio /issue 6 �O Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- '^' 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 . Total Permit Fees Comments Closet and Bathroom Addition At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions undbr 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobi e 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 232 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 - Lizette Besani Check No. Bank Name/Recipient of Certificate Telephone 760-4,09-8093 Funding Exempt By Dr. Gary Rutherford Superintendent Fee collected Payment Recd $0:00 A,Over/Under. .. Signature G/ f r' f` ' II ff NOTICE: Pursuant to Government Code Section 66020(d)(1), this 7,chthe 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 onuilding or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. - NOTICE: This Document NOT VALID without embossed seal Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road ¢ BERMUDA DUNES O Date 6/10/15 La Quints CA 92253 RANCHO MIRAGE t=J INDIAN WELLS ti No. 31822 r (760) 771-8515 DESERT �� P QUINTA y z�ll INDIO 0 Owner Besani APN # 604-151-627 Address 78930 Sonesta 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 78930 Sonesta 232 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Closet and Bathroom Addition At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions undbr 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobi e 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 232 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 - Lizette Besani Check No. Bank Name/Recipient of Certificate Telephone 760-4,09-8093 Funding Exempt By Dr. Gary Rutherford Superintendent Fee collected Payment Recd $0:00 A,Over/Under. .. Signature G/ f r' f` ' II ff NOTICE: Pursuant to Government Code Section 66020(d)(1), this 7,chthe 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 onuilding 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 ..T.his Material Sent for: ' ❑ Your Files - •. YOUNG . -Per Your Request ❑ : .. ENGINEERING `_ . ❑ _ G C P v. C Checking ❑ s _¢ Other: ❑ a. ' Letter of Transmittal.; '' a To: City of La Quinta •Today's Date: 6-9-15 78-495 Calle Tampico City Due Date: - 6-11-15 i La Quinta, CA 92253 Project Addiess: 78930 Sonesta Way - Attn: 'Kay L Plan -Check #: 'BRES2015-0167 Submittal: _' ❑ 1st ❑ 4th 1 ' ® 2nd'' ❑ 5th ❑ 31d ` ❑ _ Other. M1 ' • We are forwarding: - ® By Messenger ❑' By Mail (Fed Ex or UPS) • ' - ❑ Your Pickup ' Includes:. # Of Descriptions: Includes: # Of Descriptions: • Copies: Copies: ❑ Structural Plans �' ®` 1 'Revised Structural Plans .' ® 2 Structural Calculations ®- 1 'Revised Struct. Calcs -Truss Calculations Floor Revised Truss and Roof ❑ Soils Report .. ❑ Revised Soils Report, ❑ Structural Comment List ❑ _ Approved Structural Plans '. ® 1. Redlined Structural Plans ' ❑ 'Approved Structural Calcs El`• Redlined Structural Calcs ET Truss Calcs . ❑ Redlined Truss Calcs ❑. —Approved • Approved Soils Report El'`, Redlined Soils Reports i. ❑ ' Other: t Comments: - 'Structural content is approvable. If you have any questions, please call. Time = 1 HR ..T.his Material Sent for: ' ❑ Your Files ® -Per Your Request ❑ Your Review ❑ Approval s ❑ Checking ❑ At the request of: Other: ❑ + - By: Kathryn Samuels Palm Desert Office ® (760) 772-5107 Other: ` t 7 P:O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING &"SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures. & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building peffinit has been submi ed in y ur name listen ourself as the builder r of the property. improvements specified at. �q We are providing you with an Owner -Builder Acknowledgment and InfaYmation Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you; the property &%mer, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION . DIRECTIONS: Read and initial each statement below to signif vy6u understand or verify this information. Lj1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial riskfor any injuries sustained by an unlicensed person and his or her employees while working on my .property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. �M 2. 1 understand building permits' are not r uired to be signed b eq gne y property owners unless' they, are responsible ' foi- the construction and are not hiring a licensed Contractor to assume this responsibility.. 3. I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. �Ll 4.1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be .considered an "employee' under state and federal law. 6. I understand if'I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide' workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to.serious financial risk. L� 7. I understand under California Contractors' State License Law, an Owner -Builder who .builds single-family residential structures cannot legally build them with' the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures' does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. UA, 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 financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. LlA 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10.1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party le ally , ' and financ, lly responsible for proposed construction activit at the following address: 011. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govem Owner -Builders as.well as employers. L� 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone 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 an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed 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 issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. . 0 Signature of property owner Date: (oho19 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 BEHALF 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 above 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 presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: ....., .cTr: TE OF CALIFORNIA. Prescriptive Residential Additions 300 Ft2 or Less,.or Additions'That Do Not Require HERS Field Verification CE6-CFIR,ADD-02-E Revised 01/15. ' CALIFORNIA ENERGYC WMISSION CERTIFICATE OF COMPLIANCE - - DD 02 E Prescriptive Residential Additions 300Less, or Additions That Do Not Require HERS Field Verification: Tt 1 . 1 of Project Name: GiLS p Co�.�+ Ci` Oate Prep ` 1 I S, . 0 LU This compliance document is only applicable to additions 300 ft or less, or additions that do not require HERS field verification for compliance. When. HERS verification is required, � shall first be registered with a HERS Provider Data Registry.. ((�� W . Alterations to Space.Conditioning Systems.thot are exempt from HE verification requirements may.use the CF1R-ADD-02 and CF2.R- ADD -02.Compliance Documents. Possible ex on pocix z . leaka9e testing include: less than 40 ft of ducts were added or replaced,• or the existing duct system was insulated with asbestos; or the existing duct system Was previously tested n sso ` . HERS Rater. If space conditioning systems are altered and are not exempt from HERS verification, then a CFIR-ADD-01 must be completed and registered with a HERS Provider Dat sg Additions or alterations that utilize Closed Cell Spray Polyurethane Foam (ccSPF) with a density:of 1.5, to less than 2.5 pounds per cubic foot having an. R -value other than 5.8 per in f LL v Spray Polyurethane. Foam (ocSPF) with a density of 0.4 to less than. 1.5 pounds, per cubic foot having an R -value of 3.6 per inch, shall.complete and register a CF1R ADD 01 with a H R$P�ov�er Data Q . Registry.. v O If more thon'one person has responsibility for installation of -the items on this certificate, each person shall prepare and sign a certificate applicable to the portion of construction for which they ore responsible. Alternatively, the person with chief responsibilityfor construction shall prepare and sign this certificate for the entire construction.. All applicable Mandatory Measures shall be met. ), Temporary labels shall not be removed before verification by the building inspector: r A. GENERAL INFORMATION 01 Project Name: R� � � t "1. 01-1 CAC; 02 Date Prepared: 4-111( t Ca. s 03 Project Location: 1 gct 3o So.pes-rA . Ldp,%4 04. Building Front Orientation (deg): �4 6 05 CA City:. , t �, 06 Number of. Dwelling Units with Additions: 07 Zip Code:.� a5� 08 Fuel Type: lbs 09 Climate Zone: C 10 Total Conditioned Floor Area (ft) (Addition): b 2- 11 Building Type d� �" 12 Area (ft):. Slab A 2 : 13. Project Scope: Ac00tTl01� CA Buildirig Energy Efficiency Standards 2013 Residential Compliance 'January 2015 STATE OF CALIFORNIA. Prescriptive Residential Additions 300 Ft 2 or Less, .or Additions That Do Not Require HERS Field: Verification CEC-CFIR-ADD-02-E Revised 01/15. CALIFORNIA ENERGY COMMISSION CF1R AD CERTIFICATE OF COMPLIANCE- - Resiidential Additionnsc3.00 Ftt�or Less, or Additions That Do Not Reqdire HERS Field Verificatiori (Page 2 of 9) Prescriptive Residential-Additions ` Project Name: Date P V 4L"t D E.1N C�ic� ' . - .. .. .. repared:LLJ Q . e- B. OPACIUE SURFACE DETAILS ='Framed' (Section 150.2(a)) : e Lu ' . .01 02. 03 04 ' . 05 06 07 . 08' . 09 - . 10 • Tag/ID Assembly Type Frame Type Frame. Depth (inches) Frame Spacing (inches) Proposed Required .. Q Ir— r -Frame. c 06 � O eM Cavity R-value Continuous_ Insulation' R-value U-Factor Appendix JA4 Reference LI-Factor Table Cell LO Ar 11.4.: W o o,fl �i. t R t 9 0.0-1 4 j A- 4 �.3: I -dS o, 0 o R-oo¢ w000 . 673—Q-, t4 0.04 JA < .3 f-A[4 0.0*8 LL Q 0 CA Building Energy Efficiency Standards - 2013 Residential Compliance January 2015 STATE OF CALIFORNIA. F— 11 Prescriptive Residential Additions 300 Ft 2 or Less, or Additions That Do Not Require HERS Field Verification [w1 CEC-CFIR-ADD-02-E Revised 01115)'CALIFORNIA ENERGY S96 CERTIFICATE OF COMPLIANCEjE Prescriptive Residential Additions 300 Ft or Less, or Additions That Do Not Require HERS Field Verification Project Name: �- t 'D _ .. .. ,- Date Prepared: Im r2 1 m �?S z C.:OPAQUESURFACE'DETAILS='Non-framed (Section 150.1(c)1) C'3 01 02. 03 04 05 06' 07 08 .09 10. — -LL rr . Taj/ID' Assembly Type Assembly Materials Thickness (inches) Proposed Required J < O _- LL U m Comments W Q p Core Insulation. R-value Continuous Insulation R-value 'U-Factor Appendix JA4 Reference 0-Factor from Package A Table Cell STATE OF CALIFORNIA Prescriptive Residential Additions 300 Ft2 or Less, or Additions That Do Not Require:HERS Field Verification CEC-CFIR-ADD-02-E Revised 01/15 CALIFORNIA ENERFY.:Egm�ASION CERTIFICATE OF COMPLIANCE Ir ,CjtR, X02 -E Prescriptive Residential' Additions 300 Ft or Less, or Additions That Do Not Require HERS Field verification lan_ f 9) Project Name:Date Prepared: �R piJt: Q.6.St O Eye. 1 S U E. SLAB INSULATION (Table 150.1-A) U)V,1 01 02 03' 04 05 06 06 Proposed. Required . _Z. . Insulation Insulation 'Insulation'. Insulation Q Floor Type R-valueLI-factor R -value LI -factor Comments' J < O e m. . • Heated slab floors require mandatory slab insulation (see Table. 110.8-A).. F. RADIANT BARRIER (Section 150.1(c)2 01 02 Radiant Barrier installed below the roof deck and on aRgable end walls Comments A radiant barrier is required (for. Climate Zones 2-15). • . Radiant barriers shall meet specific eligibility and installation criteria to receive energy credit for compliance with the Building Energy Efficiency. Standards for low-rise residential buildings. Refer to RA4..2.1. • The emittance of_the radiant barrier shall be less than or equal'to 0.05 as tested in accordance with ASTM C1371 or ASTM E408*. For Prescriptive Compliance the attic shall be: ventilated to provide a minimum free ventilation area of not less than one square foot of vent area for each 300 ft2.of attic. floor area with no less than 30percent upper vents. Ridge vents or gable end vents are recommended to achieve the best performance.' The material should . be cut to allow for full airflow to the venting. CA Building Energy Efficiency Standards - 2013 Residential Compliance STATE OF CALIFORNIA. Prescriptive Residential Additions 300 F.t2 or Less, .or Additions That Do Not Require HERS Field Verification CE6-CFIR-ADD-02-E Revised 01/15 CALIFORNIA ENERGY CERTIFICATE OF COMPLIANCE 1 Prescriptive Residential Additions 300 Ft or Less, or Additions That Do Not Require HERS Field Verification: I PTiect Name:U' A �C �� Date Prepared: ' ,v C J E G.' ROOFING PRODUCTS (COOL ROOF) (Section 150.1(c)11)' j ox ir 01' -- 02 03 04 05 '06. 07 08 09 10' 11 17� Mass Roof 25lb/ft'or Greater Roof Pitch Method of Compliance Product Type CRRC Product ID Number Proposed Initial Solar Reflectance Aged Solar Reflectance Thermal Emittance SRI (Optional) ' Aged Solar Reflectance Ther al �SI® Emitta c (Opthinal) The Greater .' Maximum Maximum Addition Type ft2.. Allowed..' ..'Allowed Comments Maximum. Maximum Calculated Maximum Calculated Maximum LI -factor SHGC Calculated Calculated based onAllowed based. on ft? Allowed ftZ Allowed % Allowed %' NOTES:. . • Any roof area covered by building integrated photovoltaic panels and solar.thermal panels are exempt from the above Cool Roof requirements.. . • Liquid fieldapplied coatings must comply with installation criteria from section 110.8(i)4. H.-FENESTRATION/GLAZING AREAS ALLOWED (Section 150.2(a)1) . Ol .' . 02 03 04 05 06 07 08 Maximum.Allowed . Maximum Allowed Fenestration Area For All Orientations ftZ West -Facing Fenestration Area Only ft? The Greater The Greater .' Maximum Maximum Addition Type ft2.. Allowed..' ..'Allowed Comments Maximum. Maximum Calculated Maximum Calculated Maximum LI -factor SHGC Calculated Calculated based onAllowed based. on ft? Allowed ftZ Allowed % Allowed %' STATE OF CALIFORNIA. Prescriptive Residential Additions 300 Ft2 or Less, or Additions That Do Not Require HERS Field Verification CEC-CFIR-ADD-02-E Revised 01/15. CALIFORNIA ENERGY C CERTIFICATE OF COMPLIANCE CF -ADD-02-E Prescriptive Residential Additions 300 W or Less, or Additions That Do Not Require HERS Field Verification c e 5 of 9) I 1W Project Name: V ` E S I 0 E� `ik. ' . ' . Date Prepared: t 1.-? I a I. FENESTRATION PROPOSED AREAS AND EFFICIENCIES 0 w 01 .02 .' 03 . 04 . 05 06 07 oi- 09 10. .11 .' 12 <Q ' 13 rn Tag/ID Fenestration. Type Frame Type Dynamic Glazing Orientation N, S, W, E or Roof Number. of Panes . Proposed Fenestration 2 Area ft Proposed West Facing Fenestration Area ftZ Proposed, • 'U -factor Proposed SHGC Source. Exto in % r Shad n� Dev e _ w y O :14 Total Proposed Fenestration.Area .15 Maximum Allowed Fenestration Area 3 16 Compliance Statement Total -Proposed Fenestration Area 5 Maximum Allowed Fenestration Area'. Yes ❑ No. 17,Total Proposed West -Facing Fenestration Area 18 Maximum Allowed West -Facing Fenestration Area 19 Compliance Statement Total Proposed West -Facing Fenestration Area <_ Maximum Allowed West -Facing Fenestration Area es ❑ No 20 Proposed Fenestration U -factor 21 Required Fenestration U -factor 6 t� .22 Compliance Statement Proposed Fenestration U -factor 5 Required Fenestration U -factor e'Yes ❑ No 23 Proposed Fenestration SHGC , ? C .24 Required Fenestration SHGC 25 Compliance Statement Proposed Fenestration SHGC <_ Required Fenestration SHGC . . [; des ❑ No. CA Building Energy Efficiency Standards - 2013 Residential Compliance January 2015 STATE OF CALIFORNIA. Prescriptive Residential Additions 300 Ft2 or Less, .or Additions7hat Do Not Require HERS Field Verification CE6-CFIR-ADD-02-E Revised 01115)'CALIFORNIA ENERGY'COMMlS&ON CERTIFICATE OF COMPLIANCE " CF R -A D -02-E Prescriptive Residential -Additions 300 Ft or Less, or Additions That•Do.Nof Require HERS Field Verification ( ;f 9) Project Name: Date Prepared: LU . rt.SA�� 2E:S�o�L2' LU 0.. !::SPACE CONDITIONING(SC) SYSTEMS - HEATING/COOLING (Prescriptive. section 150.2(b). LL Alterations to Space Conditioning Systems shall be exempt from HERS verification requirements as prerequisite for use of the.CFiR-ADD-02 and CF2R-ADD-02 Compliance Documen s..eieVjs conditioning systems are installed or existing systems are altered and are not exempt from HERS verification, then a CF1R-ADD-01 shall be completed and registered with a HERS Pr viter %89 CC Registry.: In each row below for _each.dwelling unit in the building, check the box that indicates the exemption from HERS verification compliance: L (� O a: space conditioning system was not altered; .' Z ❑ b: less than 40 ft of ducts were added or replaced; [] ❑ c: (exempt from duct leakage testing) if.' the existing duct system was insulated with asbestos; J. ❑ d: (exempt from duct leakage testing) if: the existing duct system was previously tested and passed by a HERS Rater. LL 01 02 03 04 Dwelling Unit Name SC System Identification or Name SC System Location or Area Served Exemption from HERS Veri ica b ❑a ❑b ."0 c 0 0 0 ❑c. ❑d 0 0 ❑c 0d :. 0 0 0 . 0 0 0 '❑c 0 c El a. 0 : ❑c ❑d- 0 0 0 ❑.d ❑a- 0 ' '*❑c ' ❑d :. ❑a ❑b ❑c ❑.d a'.. 0 b 0 c ❑a.' 0 .' ❑c ❑d Oa .. c .. ❑a'. ❑b ❑c Od m Q CTrATE OF CALIFORNIA. Prescriptive Residential Additions 300 Ft2 or Less, or Additions That Do Not Require HERS Field Verification CEC-CFIR-ADD-02-E Revised 01/15. CALIFORNIA ENERG C ISSION ADD 02. E CERTIFICATE OF COMPLIANCE _- - - Prescriptive Residential Additions 300 Ft or Less, or Additions That Do Not Require HERS Field Verification:i �9) :: Project NameDate Prepared ms 112 t E LKA 4 I t'11 t w K. WATER HEATING SYSTEMS (Section 150.1(c)8) _ �Q List water Beaters and boilers for both domestic hot water (DHW) heaters and. hydronicSpace heating'.; C/) ox 01 02 03 04 05 06 :07 08 09 10 11 .. 12 13,. '140'r 5 Dwelling Unit Name Water Heating System Identification or Name Water.Heating System Location or Area Served Water Heating System Type Water Heater Type q of Water He ' in System Water Heater Storage Volume ' (gal) Fuel Type Rated Input Type Rated Input Value Heating ., Efficiency Type Heating. Efficiency Value Standb Loss (% � twl� tion R -Value �gtk-Up '.Qolar Savings fraction " Li CA Building Energy Efficiency Standards - 2013 Residential Compliance January 2015 r -r NATE OF CALIFORNIA. Prescriptive Residential Additions 300 Ft2 or Less, or Additions'That Do Not Require HERS Field Verification CEC-CFIR-ADD=02-E Revised 01115 GALiFORNIA CIVCr(bT I.VNIMIJJIVIV CERTIFICATE OF COMPLIANCE CFIR-ADD-02-E Prescriptive Residential Additions 300 Ft or Less, or Additions That Do Not Require HERS Field Verificatiori (Page 9 of 9) Project Name: - `.` Date Prea ed: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. • I certify that this. Certificate. of Compliance documentation is accurate and complete. a .. Documentation Author Name: _ Documentation Aut or Signature:. Company: ' . .. Signature_ te. a caw>0 Address: - ` " CEA/ HERS Certification Identification (if applicable): - Q p LAS M" o WT a+� wS (Lo 11,n Sti t ,-t X -o : � W . f- City/State/Zip: - Z Phone:. -. ;" ;. :.. 00 LA - o p RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California:_J 0 1. The information provided on this Certificate of Compliance is true and correct. --- LLI 2...1 am eligible under Division 3 of the Business. and Professions Code to.accept responsibility for the building design or, system design identified on this Certificate of C mWnC@(responsible l'— designer). designer)• 3. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified. on this. Certificate o Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4... The building design features or system design features identified on. this Certificate of Compliance are consistentwith the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. S: 1 will ensure that a registered copy of this Certificate of Compliance shall.be made available with.the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: - Responsible Designer Signature: - - - _ • . D. t6 . �. Company: Date Signed: Address: ^ .' ..'. .' - ." .- License:." City/State/Zip: Phone: -