14-0586 (RER)T-ihf
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed,under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and ProfessionalsCode, and my License is in full force and effect.
License 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
peV.'
signed statement that he or she is licensed pursuant to -the provisions of the Contractor's State
Lichapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
thas exempttherefromand the basis for the alleged exemption. Any violation of Section 7031.5 by
anoa permitsubjectsthe applicant to a civil penalty of not more than five hundred dollars ($500).:
ner 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.).
(_) 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 contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State Li
. (_) I am exempt under Sec. �. for s reason,
7�D t Owner•
/ CONSTRUCTION LEDING AGENCY
I hereby affirm under penalty of perjury the there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
RICHARD VARGE
P.O. BOX 451
LA QUINTA, CA 92247
(540)272-6699
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/07/-14
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have a ill maintain a certificate of consent to self -insure for workers' compensation, as provided
f y Section 3700 of the Labor Code, for the performance of the work for which this permit is
SSued.
_ I 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 - - - - - - - - - - - - - - - - - - - - - -- Policy Number
I certify that, in the performance of the work for which this permit' i sued, I shall not employ any
person in any marine come subject to the worker compensation laws of California,
and agree th Isho come su ect to the rs' ompensation provisions of Section
3700 a Labo de, I shall f with com h
Applicant:
WARNING: FAILURE TO SECUR ORKERS' COM , NSATION COVERAGE IS ALL
SUBJECT AN EMPLOYER TO C MINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN A ITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application, _
the owner, .and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that theon and state that the "on is correct. I agree to comply with all
city and county ordinances and state laws relati wilding cons on, d hereby authorize representatives
of this county to enter upon the above -m ned proper mspectio rposes. -
Date/ Signature (Applicant or
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 '
Application. Number:
14-000 00586
Property Address:
77780 CALLE SI�j
APN:
773-,141-011-11 -000000-
Application description:
REMODEL - RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
5525
T-ihf
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed,under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and ProfessionalsCode, and my License is in full force and effect.
License 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
peV.'
signed statement that he or she is licensed pursuant to -the provisions of the Contractor's State
Lichapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
thas exempttherefromand the basis for the alleged exemption. Any violation of Section 7031.5 by
anoa permitsubjectsthe applicant to a civil penalty of not more than five hundred dollars ($500).:
ner 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.).
(_) 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 contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State Li
. (_) I am exempt under Sec. �. for s reason,
7�D t Owner•
/ CONSTRUCTION LEDING AGENCY
I hereby affirm under penalty of perjury the there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
RICHARD VARGE
P.O. BOX 451
LA QUINTA, CA 92247
(540)272-6699
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/07/-14
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have a ill maintain a certificate of consent to self -insure for workers' compensation, as provided
f y Section 3700 of the Labor Code, for the performance of the work for which this permit is
SSued.
_ I 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 - - - - - - - - - - - - - - - - - - - - - -- Policy Number
I certify that, in the performance of the work for which this permit' i sued, I shall not employ any
person in any marine come subject to the worker compensation laws of California,
and agree th Isho come su ect to the rs' ompensation provisions of Section
3700 a Labo de, I shall f with com h
Applicant:
WARNING: FAILURE TO SECUR ORKERS' COM , NSATION COVERAGE IS ALL
SUBJECT AN EMPLOYER TO C MINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN A ITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application, _
the owner, .and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that theon and state that the "on is correct. I agree to comply with all
city and county ordinances and state laws relati wilding cons on, d hereby authorize representatives
of this county to enter upon the above -m ned proper mspectio rposes. -
Date/ Signature (Applicant or
Application Number . . . 14-00000586
Permit
MECHANICAL 2013
Additional desc .
Permit Fee . . . .
71.50 Plan Check Fee
00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
.11/03/14
Qty Unit Charge
Per
Extension
1.00 35.7500
EA MECH FURNACE
35.75
1.00 35.7500
----------------------------------------------------------------------------
EA MECH CONDENSER/COMP
35.75
Permit . . .
PLUMBING 2013
Additional desc .
Permit Fee . . . .
11.92 Plan Check -Fee
.00
Issue Date
Valuation . . .
. 0
Expiration Date
11/03/14
Qty Unit Charge
Per
Extension
1.00 11.9200
EA PLBG WATER HEATER/VENT
'11.92
Permit . . .
REMODEL 2013
Additional desc .
Permit Fee . . . .
70.07 Plan Check Fee
.00
Issue Date . . . :
Valuation . . -.
. 0
Rxgiration D tc
i i /nA /1'A
Qty Unit Charge
Per
Extension
1.00 60.0600
LS MISC DR/WIN, REPL, 1-7
60.06
1.00 10.0100
EA MISC DR/WIN, REPL, ADDL 5
10.01
----------------------------------------------------------------------------
Special Notes and Comments
WATER HEATER CHANGE•OUT,A/C
CHANGE OUT
(5)WINDOW CHANGE OUT,
(3) DOORS EXTERIOR
2013 CBC APPROVED PER
AJ.
----------------------------------------.------------------------------------
Other Fees . . . . .
. . . . PLAN CHECK, REMODEL
120.12
PLAN CHECK, MECHANICAL
47.66
r
PLAN CHECK, PLUMBING
7.15
Fee"summary Charged .Paid Credited
Due
Permit Fee Total
153.49 .00 .00
153.49
Plan Check Total
.00 .00 - .00
.00
Other Fee Total
174.93 .00 .00
174.93
Grand Total
328.42 .00 .00
328.42
LQPERMIT
Bin #
City Of La Quinta
Building 8T SafetyDivision
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building PermitApplication and Tracking Sheet
Permit #
Project Address: -7 7790 64 i~ .S/ LOQ Owner's Name: t G 14 jk qKC E I
A. P. Number: . 7 7✓ / i-. /ew Address:
Legal Description: City, Zip: � ".,r ,� Ta c,F iZ ';t-
Contractor: Q
t t � t4 v� (/ �C. 4 Telephon �, (.
d a �s c �9
<'??•`
•s.
.......................j...................
Address: 0 ya x t.� S- Project Description:. WA T AE ,c AT
City, ST, Zip:
TeleP h0 ne o-2 -L L Y
4 s Srs
State Lic. # : City Lie.
C
Arch., Engr., Designer:
Address: ,
City., ST, Zip:
Telephone:
viilil::':::;i:::;:5?>:ijp:;:%:::Y::ii:O: i�i:�i '
Construction Type: Occupancy:
yP P Y:
.4'ri�: :i:%:�
Project type (circle one): New Add'n Alter Repair Demo
tate Lic. #:
Name of Contact Person:Sq. Ft.:
#Stories:
# Units:
elt hone # of Contact Pers : 2Z Estimated Value of Project:
-
C �$ 2G it-- APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cities.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontactor 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
i
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504 BUILDING &'SAFETY DEPARTMENT
78-495 CALLE TAMPICO: (760.) 777-7:012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
PROPERTY `O"EW S PACKAGE
Disclosures & Forms for Ovc�ner- Ud&rs A. f ` for.Constructlon P.eruuis:
.Pp y .
IW_QATWV ,NQZCE TQ kRQ EftTX OW'NJER
Dear Vroperty Owner
An:. application for :a;building -permit hasp tbeea',.:aul atitw ,m your DAUIC':listing.' yourself as-,�the• builder of ,the.=;prapocty
improvements specified at
We are .providing'you-with an Owner -Builder Acimovvlbdgmeut-auid Infoima&WVeiifieation•Fdnntta make`you=awan-of your
pSasresponsibilities-andpossible.risk-you maYincurby hg name -66
O.wnei-Builder. 'We will-tiot -pemifun until �you�liave real , Wit sled your andetstmndi� of ea c1Cprovisidn,
signed, and returned this form to us at otir official address indicated. An agent of the owner'canuot ex,06UWthi"s'40tice
unless you, the property owner, obtain the prior approval of the permitting authority.
D,FRECTTONS Read ail€-if44uiail'each'statemenl Belo d`ta si8n 3'3'ou underat rnd of verify` tti s RJbimat on '
/V/1- I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
buildingpermit that erroneousl lies that the r% ,. }
Y �P p operty 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
On/my:.property
q/ 2_ I understand building permits are not required to be signed by property owners .unless they are responsible for the
construction and are not-htrurg a licensed Contractor, to.assume this responsrbtlity..
I:understand as an "Owner-Buildet" Lam, 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 pante tnstead of my
o-wn/.
tl/ 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.
/V 5. 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 Iaw, I must register with the.sWe .and federal
government, . withhold, payroll .taxes, provide workers' compensation disability, insurance, and contribute to unemployment
compensation for each "employee." l .also understand my failure to abide by these laws may subject me to serious financial
ask.
l� 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
:truct6res 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
md'er.'contract with a licensed general building Contractor.
/8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be hem liable. for any
financial or personal, igjaries susi cd .by any subsequent owners) that' result from' any latent construction defects in the
woriam 'hip or materials.
9. I understand I may obtain more information regarding my obligations as an "employee, from the 3u"l Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, aind the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) •at 1-
800-32.1-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
�0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I wu the
party legally and financially responsible . for proposed construction activity at the following address:
I I. I ague that, as the party legally and futaacially responsible for this proposed construction activity, 1 will abide by all
applicable laws and icq' Wreriients that goveai 0*fier=Builders as well as employers.
2. I agree to notify the issuer of this form immediately of any additions; deletions, oc changes to Any of the infocmaticlh I
have provided on this form: Licensed contractors are regulated by laws designed to protect the public. If you -contract with
someone who does. not4ave a Iicense,. he Contractors' State. License Board maybe unable to
You may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be inicivil'ccwct It is:also
important for you to. understand,that:if an uulicaussed Contractor or employee of that individual or firm is injured Wl»le. woddag
on your property; you may be:hdd liable for datunts. If you obtaina pemrit:as Owner -Builder and ,vith,Whirc.Coniraeters,
you..wiil•be responsible for.,ver fying wheel" or not •those Contractors are:properly licensed�and,.the status of tkir workers'
cocngensation insuraaoe coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner sad returned to
the agency responsible foristuileg:t a per:na Note: �! copy of tkc Yperty owner's,drtver'slic�errsej form:nota pdaMr; or
other verification acceptabl .to-tfu ag ; ss required to be, retie ted �vhcit the Pernmit is: ssuueil to verify the:property
owner's signature. +-T -/
Signature of property own Date:
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 OP AGENT TO ACTION PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand. is my personal responsibility, I hereby authorize
•the followrri& pci� to act is. my'agent(s) to apply'for, sign, and fitAfie, documents necessary to:obta an Owner -Builder
Permit formy 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 owner's signature.
Property Owner's Signature: Date:
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations Page 1 of 5
Project Name: Climate Zone # i� # of Stories
H
General Information
Site Address:? O
Enforcement Agency:
Date:
Building Type Ingle Family O Multi Family
Circle the Front O 'entation: N, E, S, W, or de es
Conditioned Floor Area (CFA):
Project Type: _..: Alterations :^ Envelope[ _ Fenestrati Roof Ll HVAC
Framed
Replacement or Change Out :_^ Duct Replacement F.4 Water Heater
NOTE: This form is not to be used for Newly Constructed Buildings or Additions
Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
Q Opening of framed cavity alone—Alterations that involve the opening of the framed cavity ofa wall, ceiling, or floor must install the
mandatory minimum insulation value per ,§150 for the altered assembly. Fill in Columns A —C and enter mandatory insulation value in Column H.
0 Replacement of entire assembly— Replacement ofan entire wall, ceiling, or floor assembly requires the installation of Component
Package- D insulation values in Table 151-C. Fill in Columns A —J.
Opaque Surface DetailS For the furred portioned of Mass Walls see Furring Strips Construction Table below.
A B I C D E
F G I H I I J
Proposed re Note
Standard
Values From JA4
Table
Added Interior or Exterior Insulation
Framing Thickness,
Framed
Continuous
JA4 Proposed
Tag/
ID'
Assembly Name Material Spacing, U-
or Type 2 and Size or Other; factor'
JA4 Table Cavity
Numbers R-value6
Insulation
R -Value?
Assembly Assembly
Cell Value U-factor9
o
T°c
U
U m
o .a 2 n� .@
Assembly �-°+
N
O `o H H o U,a'� CC° >
O .F R N d
Final
Mass
G
Name or JA4 Table
V Z:
X h R R o
Assembbq
Thickness
Note: For furred assemblies, accounting for Continuous Insulation R -value, see Page JA4-3 and Equation 4-1. For calculating furred ivalls use the Mass and
Furring Construction table below.
1. For Tag/ID indicate the identification name that matches the building plans.
2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ... Indicate in column G the Frame
material and Size: For Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter; 16 "or 24 "OC; or Other for all other assembly description
such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel and etc....
4. Based on the Climate Zone; enter the equivalent U factor found in JA4 Table based on the R -Value from Table 151-B, C, or D
5. Enter the Table number that closely resembles the proposed assembly.
6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0".
7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter "0 ".
8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J
9. The Proposed Assembly U factor, Column J, must be equal to or less than the Standard U factor in Column E to comply.
Furring Strips Construction Table for Mass Walls 0 l
A I B I C T--D--FE—
F I G I H I J I K
L
M
Proposed Properties of Masonry and Concrete
Added Interior or Exterior Insulation
Walls From Reference
in Furring Space from Reference
Joint A pendix Table 4.3.5, 4.3.6, 4.3.7
Joint Appendix Table 4.3.13
o
T°c
U
U m
o .a 2 n� .@
Assembly �-°+
N
O `o H H o U,a'� CC° >
O .F R N d
Final
Mass
G
Name or JA4 Table
V Z:
X h R R o
Assembbq
Thickness
Type Number' Q >
3
G _ ❑ ,� ¢ >
U -factor '
Comment
Registration Number: Registration Date/Tine: HERS Provider:
2008 Residential Compliance Forms August 2009
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations Page 2 of 5
Project Name: Climate Zone # # of Stories
Mass and Furring Strips Construction(footnotes)
1. Indicate the type ofassembly to include; Hollow Unit Masonry Walls, Splid Unit Masonry, Solid Concrete Walls, Etc. Additional assemblies can
befound Reference Joint Appendix JA4.
2. This is the U -Factor based on the thickness of the assembly in inches.
3. The R -value of the insulation to be added on the interior or exterior of the assembly.
4. The Calculated R- Value is the R -value of the furred out section of the assembly.
-6. The Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JA4. The equation is the inverse of Column
added to Column L Column K is the inverse from column J.
7. Insert the calculated U- actor value on to the Opaque Sur ace Details in Column J
FENESTRATION PROPOSED AREAS
hd Replacing window alone — Replacement windows shall meet the U -Factor and SHGC Value requirements of Component Package D in
Table 151-C. The Total Fenestration and West facing Area requirements are not applicable.
Adding 50ft2 or less of window area — Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component
Package D in Table 151-C.
Adding more than 50ft2 of window area — Newly installed windows shall meet the U -Factor and SHGC Value and the Fenestration
Area requirements of Component Package D in Table 151-C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF -IR -AL T
Orientation
Fenestration Type and Frame (North, East, PropsedAreal Maximum Maximum NFRC or Default
(Window, Glass Door or Skylight) South, West) (ft') U -factor• a SHGC" 1.4 Values
1. Fenestration area is the area of total glazed product (i.e. glass plus frame). Exception: When a door is less than 50% 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 -ENV Form shall be equivalent to or have a lower U factor and/or a lower
SHGC value than that specified on the CF- I R ALT Form.
4. Submit a completed WS -3R Form if a reduced SHGC is calculated with exterior shading.
5.1fopplicable at this stage enter 'NFRC" or NFRC Certified windows or are CEC '.Default " valuesfound in Table 116-A or B.
ALTERED FENESTRATION ALLOWED AREAS
(Complete if more than 50ft2 offenestration is added)
A
B
C
D
E
F
G
Allowed
Existing
Fenestration
Total Area
CFA of Entire
%of
Fenestration
Area
Fenestration
Allowed
Proposed Areae
Dwelling
CFA
Area
Removed
Area Added.
(A x B)
(E -D) + C
Total Fenestration Area
20
>
West Fenestration Area
(Required In
.05
>
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 orequal to the Total Allowed Area for BOTH the Total and West Fenestration Areas.
Registration Number. Registration Date/Tinte: HERS Provider:
2008 Residential Compliance Forms
August 2009
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations Page 4 of 5
Project Name: Climate Zone # # of Stories
HVAC SYSTEMS - HEATING
List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be
gas or propane fired. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground hot water pipes is required in all
Minimum Duct or Piping Configuration
Heating Equipment
Type and Capacity 1,2.3
Efficiency Distribution Insulation Thermostat (Central, Split,
(AFUE or HSPF) Type and Location R -Value Type Space, Package or Hydronic)
Fur1�1
° to DJ Lq T
External Tank
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 7,000 Btu/hr 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 Page 4 of the CF -JR -AL T Form for additional requirements and check applicable boxes.
4. Indicate Type or Location (Ducts, Hydronic in Floor, Radiators, etc.)
HVAC SYSTEMS - COOLING
Typ '
(Standard, Recirculating)2
Minimum
Capacity (gal)
Thermal Efficiency
Efficiency Duct or Piping
Configuration
Cooling Equipment
Type and Capacity 1.2
(SEER/EER or Distribution Insulation
COP) Type and Location R -Value
Thermostat (Central, Split,
Tye Space, Package or Hydronic)
kWT
3 SOWL %Jut R-• to
sem~ 0**C4 . 5%f
L Indicate Cooling Type. (A/C Heat pump, Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF-IR-ALTForm for additional requirements and check applicable boxes.
3. Indicate Type or Location (Ducts, Hydronic 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. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground hot water pipes is required in all
component packages in all climate zones.
External Tank
Water Heater Type/Fuel
Distribution Type
Number In
Tank
Energy Factor or
Insulation
Typ '
(Standard, Recirculating)2
System
Capacity (gal)
Thermal Efficiency
R-Value3
IhA *41.
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 external water heating tank and i es shall be insulated to meet the requirements o §150 ).
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items may require written 'usti rcation and documentation and special verification.
NEW ROOF ASSEMBLY - Radiant Barrier
The radiant barrier requirement of §151(f)2 does not apply to roof alterations.
Slab Edge (Perimeter) Insulation [JYES [] NO
YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required.
Heated Slab Insulation [, YES rJNO
YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table- 118-A of the standards.
Raised Slab Insulation EJYES n NO
YES: In Climate Zones 1, 2, 11, 13, 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15, R-4 is required under component Package D.
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach.
Registration Number: Registration Daie/Time: HERS Provider:
2008 Residential Compliance Forms
August 2009
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations Page 5 of 5
Project Name:Climate Zone # # of Stories
HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this
checklist below. A completed and signed CF -41? 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 JZ NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space, the ducts.are to be sealed per §152(b)]Dii and the newly installed ducts are to be insulated per §151(010.
EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
S(YES 0 NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the
ducts are to be sealed per §I52(b)IDi.
SfYES E3NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler,
outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be
sealed per §152(b)IE.
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.
n EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space.
EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Refrigerant Charge -Split System HERS verification is required for this measure.
YES 13 NO YES: In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per 152(b)l F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of §150(o) do not apply to existing residential homes.
Djfited Split Systems - Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
® YES NO YES: In Climate Zones I O.through 15, when the existing space -conditioning system (HVAC equipment and ducting) is
replaced, the airflow and fan watt draw shall be verified per §152(b)ICi to meet therequirements of §151(f)7B.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
N
Signature:
_
l C /4 rZ Ce <�
Company.
Date:
Address:
If Applicable CEA orE]CEPE
.._
City/State'ip.:
Phone:
SYc�,— -> 7 2
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Name:
Signature:
Company:
Date:
Address:
License:
City/State/Zip:
Phone:
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
0
D