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BRES2016-0192VOICE (760) 777-7125 FAX (760) 777-70x1 78-495 CALLE TAMPICO. LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-713 BUILDING PERMIT Date: . 7/11/2016 - ---------------- - - - - - - - - DECLARATION LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: _ License No.:-CONV:140528101254126821 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 s 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 therefrodohs basis for the alleged exemption. Any violation of Section 7031.5 by any applicant permit subjects the applicant to a civil penalty of not more than five hundred dollars ( 0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and.the structure is not intended or offered for sale. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder. will have the burden of proving that he o she did not build or improve for the purpose of sale.). I, as'owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contrails for the projects with a contractor(s) licensed pursuant to Ve ntractors' State License Law.). B &P C. for this reason I am exempt under Sec. • `- Owner: S� ri<1 Date: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency fo the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's N Lender's Address: WORKER'S COMPENSATION iereby affirm under penalty of perjury' one of the following declarations: 1 have and will maintain a certificate of consent to self -insure for workers' impensation, as provided for by Section 3700 of the Labor Code, for the performance the work for which this permit is issued: I have and will maintain workers' compensation insurance, as required by !ction 3700 of the Labor Code, for the performance of the work for which this permit issued. My workers' compensation insurance carrier and policy number are: amAir.•_ Policy Number: GAS I certify that in the performance of the work for which this per is is sued, I h(((al�I not employ any person in any manner so as to become subject to the works s' 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 th se rovisions. �CD/ A% Date: � f� Applicant: iFT � V WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES OF TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR ODE, 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 wF ose request and for whose benefit work is performed under or pursuant to any pernit issued as a result of this application , the owner, and the applicant, each agree= to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances -and state laws relating to building r construction, and hereby authorize representatives of this city to enter upon the above- mentioned property for inspection purposes. - i> Date: ` �'� b' Signature (Applicant of Agent): Owner: F Application Number: BRES2016-0192 ANDREW MICHEALSCOTEA Property Address: 78940 SONESTA WAY 78940 SONESTA WY d Q APN: 604151028LA /CHANGE OUT (1) SLIDING DOOR FOR FENCH DOOR QUINTA, 92253 C::, � o r Application Description:. SCORTEANU t� Property Zoning: Application Valuation: o'er' Contractor: .Applicant: ANDREW MICHEAL SCOTEANU ANDREW MICHEAL SCOTEANU 78940 SONESTA WY 7,8940 SONESTA WY LA QUINTA, 92253::. r LA QUINTA, 92253 LIc. No.::CONV:140528101254126821 ---------------- - - - - - - - - DECLARATION LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: _ License No.:-CONV:140528101254126821 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 s 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 therefrodohs basis for the alleged exemption. Any violation of Section 7031.5 by any applicant permit subjects the applicant to a civil penalty of not more than five hundred dollars ( 0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and.the structure is not intended or offered for sale. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder. will have the burden of proving that he o she did not build or improve for the purpose of sale.). I, as'owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contrails for the projects with a contractor(s) licensed pursuant to Ve ntractors' State License Law.). B &P C. for this reason I am exempt under Sec. • `- Owner: S� ri<1 Date: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency fo the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's N Lender's Address: WORKER'S COMPENSATION iereby affirm under penalty of perjury' one of the following declarations: 1 have and will maintain a certificate of consent to self -insure for workers' impensation, as provided for by Section 3700 of the Labor Code, for the performance the work for which this permit is issued: I have and will maintain workers' compensation insurance, as required by !ction 3700 of the Labor Code, for the performance of the work for which this permit issued. My workers' compensation insurance carrier and policy number are: amAir.•_ Policy Number: GAS I certify that in the performance of the work for which this per is is sued, I h(((al�I not employ any person in any manner so as to become subject to the works s' 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 th se rovisions. �CD/ A% Date: � f� Applicant: iFT � V WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES OF TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR ODE, 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 wF ose request and for whose benefit work is performed under or pursuant to any pernit issued as a result of this application , the owner, and the applicant, each agree= to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances -and state laws relating to building r construction, and hereby authorize representatives of this city to enter upon the above- mentioned property for inspection purposes. - i> Date: ` �'� b' Signature (Applicant of Agent): • � r 4 i � , r � �Y � • � ' 1 r • � � • � • .. .' i � � � Description: SCORTEANU / CHANGE OUT (1) SLIDING DOOR FOR FENCH DOOR Type: BUILDING, RESIDENTIAL • Subtype: REMODEL Status: UNDER REVIEW Applied: 7/11/2016 SKH Approved: Parcel No: 604151028 Site Address: 78940 SONESTA WAY LA QUINTA,CA 92253 Subdivision: TR 23269 Block: Lot: 39 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $0.00 Occupancy Type: Construction Type: Expired: No. Buildings:.O No. Stories: 0 No. Unites: 0 Details: CHANGE OUT (1) SLIDING GLASS DOOR FOR FRENCH DOORS/SAME SIZE. 2013 CALIFORNIA BUILDING CODES. ;r CONDITIONS Printed: Monday, July 11, 2016 2:07:19 PM 1 of 2 SYSTEMS .w 1 � .,.:�. RECEIPT � CLTD `, DESCRIPTION o .:.: � , `ACCOU:NT a CITY, ,.';.'AMOUNT •v ,PAID 9r,'r �.I PAID DATE' ' # ,CHECK-#,` METHOD PAID BY Y: �#..:� ��,:;s• � `f. .: .;J,i,�'t+ ..✓eB DOOR/WINDOW, 101-0000-42400 .0 $60.91 $0.00 REPLACE FIRST 7 .DOOR/WINDOW, 101-0000-42600 0 $110.22 $0.00 - REPLACE, FIRST 7 PC Total Paid for WINDOW/SLIDING GLASS $171.13 $0.00 DOOR/FENESTRATION: Printed: Monday, Jiuly 11, 2016 2:07:19 PM 2 of 2 SYSTEMS P.'O. Box 1504 LA QUINTA, CALIFORNIA 9224771504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760) 777-7012 FAX (760) 777-7011 PROPERTY OWNER'S PACKAGE Disclosures & Forms for Owner -Builders Applying for Construction Permits LAPORTANT.t NOTICE TO PROPERTY OWNER Dear Property Owner: An application' far a buildin peinut has been submitted in your name listing yourself as the builder of the property improvements specified at 0 e a. %V53 We are providing you with an Owner -Builder Acknowledgment an Information 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 owner, obtain the prior approval of the permitting authority. �DIIRRrECTIONS: Read and initial each statement below to signs you understand or verify this information. W' 1. 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. I, as . an Owner -Builder, may be held liable and subject to serious financial risk for 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 o�pnm. y property. 2. I understand building permits are not required to be signed by•property owners unless they are responsible for 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. 4.1 understand Contractors ate required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 9—P5. I 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 ".employer" 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 govm ernent, 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. 7. 1 -understand under California Contractors' State License Law, an Owner -:Builder who builds single-famil • 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. 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 rwor nship or materials. 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. QL10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally, and financially re ponsible for rop9se co traction activity at the following address: "7Ral 4o �n es V�ay l.Alt,t ►� �, �t 22�s'� 1. 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 govern Owner -Builders as.well as employers. tK 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. Signature of property owner Date: %1J0 1,16 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: Qin # City of La Quin to Building & Safety Division 78-495 Caffe Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet . Permit # �1�1�7-01(o Project Address: / U ;]V 1� L� S Tfi WQ1 Owner's Name: (n� +j i ii�.reW. 1-S• �C i` �.�` A. P. Number: Address: i Legal Description: City, ST, Zip: LG Q , h LiZ 5. t Contra c0 r. P nn T le hone: o e Off. Address: i Project Description: City, ST, Zip: PP I ' I O►C� �' 0d' S (Ir� I t001� Telephone: Y State Lic. # : City Lic. #; Arch., Engr., Designer: Address: City., ST, Zip: Telephone:hone: xx ...:::.:::...........:.......::. �> Construction Type: aneY Occupancy: : . State Lic. #• w Project a circle one): Ne Add'nt Al er Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: O Estimated Value of Project: 11000-0 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review, ready for corrections/issue Electrical Subcoritactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A: Approval Plans resubmitted Grading IN 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, Total Permit Fees STATE OF CALIFORNIA _ RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised 06/14 CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations Project Narrie: CALIFORNIA ENERGY COMMISSION CF111-ALT-01-E (Page 1 of 4),, Date.Prepared: A. GENERAL INFORMATION. 01 " 01 Project Name: - 02 Date Prepared: -710 1 03 Project Location: _ 9-9 140 hG 04 'Building Front_d ientation (deg or cardinal): 05 CA City:. QI t 06 Number of Alt ed,,D elling Units: 3r" 07 Zip Code: `— 08 Fuel Type: !l. , 09 Climate Zone: 10 . T,otal,Conditioned Floor*A'rea if ,2) 3 ` 11 Building Type 12 Slab.'Area"(ft2) skew 13 Project Scope: Q '-l- , %* 1 ' .1W1 'fit. `1W B. BUILDING INSULATION DETAILS (Section 150.2(b)1) 01 02 03 04 05 06 i,� 07 08 " 09 ' 10 11 Tag/ID Assembly Type Frame Type Frame Depth (inches) Frame Spacing (inches)- Pr po ed Required Comments °"Appendix _ Continuous Cavity Insulation R -value, R -value o-1 �'U;factor JA4 Reference U -Factor Table., Cell NOTES N . • • Roof area covered by,building.ntegrated photov6I1faic panels, and solar thermal panels are exempt from the above Cool Roof requirements. • pt Liquid field appliedtingsmust comply wit hnstallation criteria from section 110.8(1)4. A r j% l; "moi'0 r _%L 74� ' • -A %. j* . . C. ROOF REPLACEMENT (Prescriptive Alteration, S tion 150.2(b)1H - . Ol ' ' , 02 03 04 ► 05)k 06 .7,0 08 09 10 11 12 13 Method of Compliance Roof Pitch Exceptiona3 CRRC P.,�oduct ID Number �`ProductType R -value D;ek Ins..lation Propos d Minimum Re wired "Initial Solar Aged Solar Thermal SRI Aged Solar Thermal SRI' Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional) NOTES N . • • Roof area covered by,building.ntegrated photov6I1faic panels, and solar thermal panels are exempt from the above Cool Roof requirements. • pt Liquid field appliedtingsmust comply wit hnstallation criteria from section 110.8(1)4. A r Registration Number:, _ '_ Registration Date/Time: CA Building Energy Efficiency Standards 2013 Residential Compliance f HERS Provider June 2014 I- . �� 4 STATE OF CALIFORNIA " RESIDENTIAL ALTERATIONS`" CEC-CF1 R -ALT -01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E Prescriptive Residential Alterations (Page 2 of 4) t Project Name: Date Prepared: D.-FENESTRATION/GLAZING AREAS ALLOWED (Section 150.2(b)1) 04 " '.01 02 03 Alteration Type Orientation Maximum Allowed ft2 Comments E. FENESTRATION/GLAZING PROPOSED AREAS AND EFFICIENCIES (Section 150.2(b)1) ` 01 02 03 04 05 06 . 07 Q8 o ,09 10 11 12 ' 13 ' 14 15 Tag/ ID" .Fenestration Type Frame Type " D nal Z' Orientation N; S, W, E, or Roof Area Removed ft2 Area Added ft2 Net Added Area ft2 . Maxiniu.Fn A Jo"wee ._ U factor oft U -factor SHGC Exterior `Shading Device Combined SHGC from CF1R-ENV-03 CO le, LAY(, 0 0�e V ZY 52 .25 N o IV O` :N IN 4. .. a Net Added WesYachg enestrationAa " • • , ; - bExisting+Add edkViL�es�t;facmgFenes�tratio.oA;rea c Maximum All wed West facingdFene Nation Area 3 v� .,. ._. d lam; .{� C'� -/� `4'xi Fv' Is West -facing Fenestration Area < Maximum Allowed West -fang Fenestrari'4 IWOi Area e'. 'Pti, .. 'ria' Net Added Fe�nestratin Area (all oentations) f '%X sting + Adde�Fennestration Area (A rientaf irons) ' .4 9- - _- Maximum�A�`Ilow�ed<F.enestration Area (all orientations) h " Is Existing + Added••Fenestration Area Naximum Allowed Fenestration Area (all ' orientations) Registration Number: '• CA Building Energy Efficlency Staildafdt -2U13 Residential Compliance Registration Date/Tlme: STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E (Revised 06/14) CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations Project Name: (COMMISSIONANN CF I R -ALT -01- E (Page 3 of 4) Date Prepared: F. SPACE CONDITIONING(SC) SYSTEMS - HEATING/COOLING (Prescriptive section 1501(b)) " 01 02 03 Dwelling Unit Name Dwelling Unit CFA IFt2) Comments` *_Atr, G. WATER HEATING SYSTEMS (Section 150.2(b)1G) 01 02 03 04 05 06 07 08 09; X10 g11 3 p12 13 14 15 system Idle�itification or. { Water Heating System Alteration to the Space ay of Water (ft2) � Name AAIdentification or Name y Comments ,.. - Water Heating System Water Water Water Heater Rated Rated Heating $Heating Exterior back -Up Solar Dwelling Unit DHW Heaters Storage i "t System Identification or Heating Heater in . Volume Fuel Input InpµuV Efficiency Efficiency Standby Insul. Savings Central DHW System Name System Type Type system (gal) Type TYPe y Value Types Value Loss.(%) R -Value Fraction Distribution Type Distribution Type Y " "'OA '%, I „ 'ONO o H. SPACE CONDITIONING SYSTEMS AND WATER HE0ji ., G SYSTEMS IN�IVIIILTIFAMILY DWE'eLING'UNITS 01 02 "` 03 , 04 05 06 w Central Water„H ating Detling Unit Dwelling Unit: Dwelling�Uni� Total CFA system Idle�itification or. { Water Heating System Alteration to the Space Dwelling Unit Name (ft2) � Name AAIdentification or Name Conditioning System(s)? Comments ,.. - Registration Number CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Pate/Time; HERS Provider: June 2014 STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CF1R-ALT-01-E (Revised 06/14) 'CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations Project Name: IA. CALIFORNIA ENERGY COMMISSION CF11R-ALT-01-E (Page 4 of 4J Date Prepared: 7/11/1& DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete., Documentation Author Name: hp�✓ M- Scor4eek viL4 Documentation Author Signature:.''` . Company: Signature Date: Address: -Mz10 So nes 4z� Wal CEA/ HERS Certification Iden-tificatlo '(if applicable): City/State/Zip: U, 53 Phone: o d 68';i1-J*0 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 0 V. 1. The information this Certificate Compliance is true and provided on of correct. l ty 2. 1 am eligible under Division 3 of the Business and Professions Code to accept respons'b for the buildintde nor system design identified on this Certificate of Compliance (responsible designer). AK 3. That the energy'features and performance specifications, materials, componens�_ and manufacturre devic for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code &'Regula ions. Certificate pliance are documents, .4. The building design features or system design features identified on this' of Co consiste4,with,tlie information provided on other applicable compliance worksheets, calculations, plans and specifications submitted to the enf t ec ment agency -for pproval with this b"u ding permit application. 5. I will ensure that a registered copy of this Certificate of Corngllan e:shfall be made aqi ilable with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registereR p -of this Certiflcate�f Compliance is requ rI ed to be included with the documentation the builder provides to the building owner at occupancy. gin, Responsible Designer Name:' , ke3pon iWe Designer Signature: S ©VPS Company: y A 5 — XC Dite Signed: Address: License: City/State/Zip::. "'d Phone: For assistance or -questions regarding the Energy Standards, contact the Energy Hotline -at; 1-800-772-3304. RPeistratinn Numher: p.ggistration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014