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11-0844 (AR)BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 11-00000844 Property Address: 79625 STAR FLOWER TR APN: 604-253-001-63 -24208, - Application description: ADDITION - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 4500 Applicant: T-i&f aF �Q�«rw Architect or Engineer: 'tilko ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ; Owner: CORA HAWLEY 79625 STAR LA QUINTA, 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 Professionals Cod , an my License is in full force and effect. License Class: B Li e : 795830 Datez , � � 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).: 1 _ 1 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 orimprovesthereon, 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 ofprovingthat he or she did not build or improve for the purpose of sale.)• (_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT FLOWER TR CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/18/11 Contractor: ;� ! �j DE GEARE BUILDERS INC E q1;"' 2011j 42335 WASHINGTON STE, F 3 4 AL' '3 a PALM DESERT, CA 92211 _.. __J - i.d�7i/satn (A (760) 345-1216 CITYO, Lic. NO.: 795830 ia'i �°u-L-1*Ff ------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty ofperjuryone 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. _ 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 STATE FUND Policy Number 0013415-2010 _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I shout ome subject to the orkers' compensation provisions of Section 3700 of the Labor C e, I hall with c w't provisions. ll(Date: eydu! Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS FUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being' performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject - permit to cancellation. I certify that I have read this application and state that the above information is correct. I to co ly with all city and county ordinances and state laws relating to building truction, and hereby orize r esentatives of this county to enter upon the above-mentioned property r ' spectio rposes. Date: gyey/ Signature (Applicant or Agent): Application Number . . . . . 11-00000844 ------ Structure Information 18SF GARAGE CONVERSION/VB/RES-3 [CONY] ----- Other struct info . . . . . CODE EDITION 2010. FLOOD ZONE NO ---------------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 18.00 Permit . . . BUILDING PERMIT INV FEE Additional desc . Permit Fee 144.00 Plan Check Fee 46.80 Issue Date . . . . Valuation . . . . 4500 Expiration Date 2/14/12 Qty Unit Charge Per Extension BASE FEE 90.00 3.00 18.0000 --------------------------------------------------------------------- THOU BLDG 2,001-25,000, 54.00 Permit . . . ELECT - ADD/ALT/REM INV FEE Additional desc . Permit Fee . . . . 31.26 Plan Check Fee.. 3.91 Issue Date . . . . Valuation . . . . 0 Expiration Date— 2/14/12 Qty Unit Charge Per 'Extension BASE FEE 30.00 18.00 .0700 ---------------------------------------------------------------------------- ELEC NEW RES - 1 OR 2 FAMILY 1.26 Permit MECHANICAL INV FEE Additional desc . Permit. Fee . . . . 39.00 Plan Check Fee 4.88 Issue Date . . . . Valuation 0 Expiration Date 2/14/12 Qty Unit Charge Per Extension BASE FEE 30.00 1.00 9.0000 -------------------------------------------- EA MECH VENT INST/ DUCT ALT -------------------------------- 9.00 Permit PLUMBING INV FEE Additional desc . Permit Fee . . . . 36.00 Plan Check Fee 4.50 Issue Date Valuation 0 Expiration Date 2/14/12 Qty Unit Charge Per Extension BASE FEE 30.00 LQPERMIT Application Number . . . . . 11-00000844 Permit . . . . . . PLUMBING INV FEE Qty Unit Charge Per Extension 1.00 6.0000 EA PLB GAS'PIPE 1-4 OUTLETS ----------------------- 6.00 -- --------------=------------------------------------ Special Notes and Comments 18SF GARAGE CONVERSION TO INCREASE SIZE OF EXISTING LAUNDRY/VB/RES-3/CLASS A -FR [CONVENTIONAL] EXISTING 2 -CAR GARAGE PARKING TO REMAIN - 20' X 20' MINIMUM ***INVESTIGATION FEE ASSESSED PER 2010 CALIFORNIA RESIDENTIAL CODE CHAPTER A §108.6 FOR WORK COMMENCING BEFORE PERMIT ISSUANCE*** 2010 CALIFORNIA BUILDING CODES. August 17, 2011 4:07:45 PM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 4.68 STRONG:MOTION (SMI) -.RES 50 Fee summary Charged Paid Credited -------------------- Due ------------------------------------- Permit Fee Total 250.26. .00 .00 250.26 Plan Check Total 60.09 .00 .00 60.09 Other Fee Total 6.18 .00 .00 6.18 Grand Total 316.53 .00 .00 316.53 LQPERMIT CERTIFICATE OF COMPLIANCE w�sc Desert Sands Unified School District 4 � 47950 Dune Palms Road ¢ BERMUDA DUNES In 'RANCHO MIRAGE Q Date 8/18/11 La Quinta, CA 92253 INDIAN WELLS NO. .�PPnIUI31084 (760) 771-8515VQNTA. NDIO y y7� Owner Cora Hawley APN # 604-253-001 Address 79625 Star Flower Trail Jurisdiction La Quinta City La Quinta Zip 92253 Permit # Tract # No. of Units 1 Type Residential Addition . Lot # No. Street S.F. Lot # No. Street S.F. .Unit 1 . 79625 Star Flower Trail 18 Unit 6 Unit 2 Unit Z - Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities.for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. . in the amount of $0.00 X 18 S.F. or $0.00 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now,be issued. Fees Paid By Exempt -David DeGare Check No. Name on the check Telephone 760-345=1216 ,t�dva Funding Exempt ; t BY Dr. Sharon P. McGehee Superintendent Fee collected /exempted" Y b . Sharon McGilvreyFOO Payment Recd If ;IJntieri;*; y Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), th Wil serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID without embossed seal Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting Bin # ala Cit} Of La Quints Building 8T Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253- (760) 777-7012 Building Permit Application and Tracking Sheet Permit #Q Project Address: LZy� S CZ QW Owner's Name: W A. P. Number: 6 . W'; . 00 I +`..i Address: -11362-5, S r Legal Description: City, ST, Zip: Contractor:S Telephone: (o — #:::y»,•. '>.;3:« ung;:;. `<t:<:aA Address: Z?) S� P•5L-CH Sri* t' projectDescription: City, ST, Zip: �_ 2 Z(( Telephone: 1 (0 0 ?, 4 S" / ( N h`;<^":.>.>«::�::i:r;:»i:#;:si ref:; :�:<•:; .: State Lie. # Lie. #:� Arch., Engr., Designer: Address: City., ST, Zip: Telephone: :• r.Y.r..:.} hili'>v%itiigiSi'i'i::f\{: ..: i.v 3:<sra»:4u..::::sal::k<.n>»�:��,<:<^:.<: •:v:: /! ` • '�C:i4'i ,`f.iiX;: ihi:' :ii}': �h.i r. !4 �"i;<:,.,v:::n:i>,;;i;;i;:h,>.•<.a fi<;';iiif::r`$�:<; Construction Type: Occupancy: State Lie. #: Project type (circle one): New Add nAlter epair "Demo Name of Contact Person:.Q Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: 6 . 5 -7 46�- 100VYS Estimated Value of Project: 00 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets 3 Plan Check submitted 8 Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit �^+ Truss Calcs. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction �� 4o—d Flood plain plan Plans resubmitted Mechanical • Grading plan 2"' Review, ready for corrections/issue Electrical S 3 (� r 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 correction es e b n 13tlV Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue 4 School Fees Total Permit Fees 3 116. q3 - alg�rdOl slm i4eo - (.0mv hmo*- +►w'w - 5em00W 100$ sae -Kao 0"atir-4 Prescriptive Certificate of Compliance: CF -IR ADD Residential Additions (Page 1 of 5 Site Address:: 79-625 STAR FLOWER TRL - Enforcement Agency: LA QUINTA Date:` 8/17/2011 F G H I J General Information Project Name LAUNDRY ROOM REMODEL Climate Zone # 115 # of Stories 1 Building Type Single Family ® Multi Family Circle the Front Orientation: N, E, S, W or Degrees N Conditioned Floor Area of Addition (CFA): 1834 X New Addition Size: Less than or equal to 100 ft : Less than or equal to 1000 ft Do not use this ora for additions greater than •1000A NOTE: -For Alterations to an existing home, submit a completed CF -JR -ALT Form Exception: Existing HVAC systems that are replaced or altered to serve the addition may be included on the CF -IR -ADD Form PRESCRIPTIVE ENVELOPE REQUIREMENTS FOR ADDITIONS For standard wood and assemblies meeting the Cavity R -value only. • For 100 ftz additions; the Proposed values must be equal or greater than the Standard column or when indicated when using Package D, "Pkg D ". Enter values in the shaded Proposed Columns. • For less than 1,000 fl additions must comply with "Pkg D" requirements unless indicated in the Standard Column. To meet, "Pkg D" minimum energy compliance re f uirements,•see RCMAppendix B, Table 151-C or § 152 b in the RCM. Enter. values in the shaded Proposed Columns. Size of Addition 100 ft2 or less Less than 1,000 ft2 Component Standard Pro `;osed , Comment Standard Pro osed Comment Ceiling Insulation R-19 38' Minimum Pkg D Table 151-C ' Wall Insulation R-13 J- Minimum R-13 Minimum Floor Insulation R-13 SUABi Minimum Pkg D Table 151-C Fenestration Maximum Glazing Area— U- U factor SHGC factor ' _ SHGC, 0.40 Pkg D 40 35 Enter Values From "Fenestration 50 112> 0 ftZ' Proposed Areas" Pae 2 of 5 U- factor SHGC U factor. SHGC Enter Values From "Fenestration Proposed Areas" Pae 2 of 5 0.40 Pkg D N" Addition Alone r F ftz Enter Values From " "Addition Allowed Fenestration Areas"" Page 3 of For West -Facing Orientationz `,.. ft Radiant Barrier N/A ' Pkg D Table 151-C Roofing N/A See Roofing Products Below Pkg D See Roofing Products Below OPAQUE SURFACE DETAILS For the furred portioned of Mass Walls see Furring Strips Construction Table below. A• J B I C D E F G H I J Pro posed See Note Standard Values From JA4 Table Tag/ IDS Framing Assembly Name Material or T e2 and Size2 Thickness, Spacing, or Other3 U - factor° JA4 Table Number Framed Continuous JA4 Cavity Insulation Assembly R-valueb R -Value Cell Value8 Proposed Assembly 'U -facto? 1 WOOD 2x4 16 .102 4.3.1 13 0 - - FE-TYDI PT. , a. DATE Note: For furred assemblies, accounting for Continuous Insulation R -value, see Page JA4-3 and Equation 4-1. For calculatingfirred walls use the Mass and Furring Construction table below. Registration Number: 2008 Residential Compliance Forms _ Registration Date/Time: HERS Provider: _ March 2010 Prescriptive Certificate of Compliance: CF -1R ADD Residential Additions (Page 2 of 5 Site Address: Enforcement Agency: Date: 79-625 STAR FLOWER TRL LA QUINTA 8/17/2011 Walls From Reference 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-C 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 ONLY A I B I C I D I E F I G I H I I 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 Appendix Table 4.3.5 4.3.6 4.3.7 Joint Appendix Table 4.3.13 d p' N N N N Assembly c= .2 n U F `o > Final Mass Name or JA4 Table c k Assembly Thickness' Type' Numbe? ¢ > x t' ' ¢ > U-factorb7 Comment 1. Indicate the Mass Thickness from Reference Joint Appendix JA. 2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ... Indicate the Frame type and Size: For Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies. 3. Enter the Table number that closely resembles the proposed assembly. 4. Enter the row and column of the U factor value. 5. Enter the Effective R -value listed in the JA4 Table Number. 6. The Final Assembly is calculated by using Equation 4-1 or Equation 4-4 of the Reference Joint Appendix JA4. Enter the value in Column L. 7. Insert the Final Assembly U- actor value back on to the Opaque Sur ace Details table in Column J. FENESTRATION PROPOSED AREAS Orientation Fenestration Type and Frame (North, East, ProposedArea' Maximum Maximum NFRC or (Window, Glass Door or Skylight) South, West(ft') U-factorz, 3 SHGC', 1.4 Default Values' Total 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 Fenestration Proposed Area table above. 4. Submit a completed WS -31? Form if a reduced SHGC is calculated with exterior shading. 5. Yapplicable at this stage enter "NFRC" or NFRC Certified windows or CEC "Default " valuesfound in Table 116-A or B. Registration Number: Registration DatelTime: HERS Provider: 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: CF -1R ADD Residential Additions (Page 3 of 5 Site Address: Enforcement Agency: F81a7 te: 79-625 STAR FLOWER TRL LA QUINTA /2011 ADDITION ALLOWED FENESTRATION AREAS Check applicable box below if the roof addition is exempt from the roofing product "Cool Roof' requirements. Note: If any one of the boxes are A B C D E ® Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the above Cool Roof criteria F Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance, otherwise, check CFA of Addition Allowed % Allowed Area Area Removed' Maximum Allowed Area Proposed Areas Thermal ft' of CFA (A x B) ftz C + D Reflectance',4 (Table Above) Total Fenestration Area' 0 0.20 0 0 0 > 0 West Fenestration Area 1.4 ® 13 ® ® (Required In CZ's 2, 4 & 7 -15)T0.05 ® 4 > 13 I. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12. 2. Glass removed to make way for the addition. 3. For additions less than 1,000 ft2 the standards allows glazing removed during the remodel to be added to the glazing area allowance. The maximum allowed glazing area for the addition is the CFA x 20% + glass removed to make way for the addition. 4. /n climate zones 2, 4, 7-15, no more than 5% of the CFA is allowed for west facing glazingplus west facing glass area removed to make way for the addition. The maximum allowed west facing glazing area is the CFA x 5% + west facing glass removed to make way for the addition. 5. To meet compliance, the Proposed Area must be less than orequal to the Total Allowed Area or BOTH the Total and West Fenestration Areas. ROOFING PRODUCTS (COOL ROOFS) §151(1)12 Check applicable box below if the roof addition is exempt from the roofing product "Cool Roof' requirements. Note: If any one of the boxes are checked,below, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in §118(i) are not applicable. Do not fill table below. Roofing compliance Not Required in Climate Zones 1-12, 14, and 16 with a Low -Sloped. Less or 2:12 pitch. Roofing compliance Not Required in Climate Zones 1 through 9 and 16 with a Steep -Sloped. Roofs pitch greater than 2:12 and product weight less than 5lb/ft2. ' ® Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the above Cool Roof criteria Roof constructions that have thermal mass over the roof membrane with at least 25 lb/112 is exempt from the above Cool Roof criteria. Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance, otherwise, check e applicable box below if Exempt from the Roofing Products "Cool Roof' Requirement: Roof Slope Product Weight Product Aged Solar Thermal CRRC Product ID Number < 2:12 > 2:12 < 5lb/ft' > 5lb/ft' Type 2 Reflectance',4 Emittance SRI Q © D ®4 ® 13 ® ® ® 4 ® 13 ® ® ®4 0 0 D 0 ®4 ® 13 © © ®4 ® ® 0 0 ®4 1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www. cool roofs. orQ/products/search.�hp. 2. Indicate the type of product is being used for the rooftop, i.e. single ply roof, asphalt roof, metal roof, etc. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same directory and use the equation (0.2+0.7(pi„i jQ1— 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance. 4. Check box if the Aged Reflectance is a calculated value using the equation above. 5. Calculate the SRI value by using the SRI- Worksheet at http://www.energyca..zovltitle24/and enter the resulting value in the SRI Column above and attach acopy of the SRI- Worksheet to the CF -IR. To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in § 118(i)4. Select the applicable coating: Aluminum -Pigmented Asphalt Roof Coating ® Cement -Based Roof Coating Other Registration Number: Registration Date/Time: HERS Provider: 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: CF -1R ADD Residential Additions (Page 4 of 5 Site Address: 79-625 STAR FLOWER TRL Enforcement Agency: Date: 8/17/2011 LA QUINTA 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 Cooling Equipment Type and Capacity 1,2 Duct or Configuration EXISTING Minimum Distribution Piping (Central, Split, Heating Equipment Efficient Type and Insulation Thermostat Efficiency Space, Package or Type and Capacity',',' AFUE or HSPF Location' R -Value Type H dronic EXISTING Water Heater Type/Fuel Distribution Type Number In 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(6)3 exception. 3. Refer to the HERS Verification section on Pages 3 and 4 of the CF -JR -ADD Form for additional requirements and check applicable boxes. 4. Indicate Type or Location Ducts, H dronic in Floor, Radiators, etc. HVAC SYSTEMS - COOLING List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be Cooling Equipment Type and Capacity 1,2 Configuration Minimum Distribution bution Duct or Piping (Central, Split, Efficiency Type and Insulation Thermostat Space, Package or SEER/EER or COP Location R -Value Type H dronic EXISTING Heated Slab Insulation ®YES 10 NO Slab edge insulation required for heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation 1. Indicate Cooling Type (A/C, Heat pump, Evap. Cooling, etc). 2. Refer to the HERS Verification section on Pages 3 and 4 of the CF -IR -ADD Form for additional requirements and check applicable boxes. 3. Indicate Type or Location Ducts, H dronic in Floor, Radiators, etc. WATER HEATING List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be storage gas or propane fired, non -recirculating, and may not exceed 50 gallons. If no natural gas is connected to the building, an electric storage DHW heater less than 50 gallons with an energy factor greater than 0.90 may be used. Hot water pipe insulation from the DHW heater to the kitchens and on all underground hot water pipes is required in all component packa es in all climate zones. Heated Slab Insulation ®YES 10 NO Slab edge insulation required for heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation YES IM NO External Tank Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation T e' Standard, Recirculatin Z System Capacity al Thermal Efficient R-Value3 EXISTING 1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The water heating lank and pipes 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 justification and documentation and special verification. Applicable special features shall be marked with a YES and be specified within the plans. Radiant Barrier (Roof) ® YES JEJ NO Required in Climate Zones 2, 4, and 8-15 for additions larger than 100 fl Slab Edge (Perimeter) Insulation ® YES JEJ NO In Climate Zone 16 under Component Package D, R-7 insulation is required. Heated Slab Insulation ®YES 10 NO Slab edge insulation required for heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation YES IM NO In Climate Zones 1, 2, 11, 13, 14 & 16 R-8 insulation is required, and in Climate Zones 12 & 15 R-4 insulation is required under Component Package D. Thermal Mass - To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach. Registration Number: Registration Date/Time: HERS Provider: 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: CF -1R ADD Residential Additions (Page 5 of 5 Site Address: 79-625 STAR FLOWER TRL Enforcement Agency: Date:8/17/2011 LA QUINTA HERS VERIFICATION SUMMARY - The enforcement agency should pay special attention to the HERS Measures specified in this checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final inspection. Duct Se ling & Testing HERS verification is re uired or this measure. YES El NO In all Climate Zones, if a new space -conditioning system (HVAC equipment and ducting) is installed to serve the addition (Certification #): alone, the ducts are to be sealed and tested per §151(010. Phone: Responsible Building Designer's Declaration Statement In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned ® YES [9 NO space to serve the addition, the ducts are to be sealed and tested per §152(b)ID.® EXCEPTION: Existing duct systems • 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 that are extended, which are constructed insulated or sealed with asbestos. Name: r Signature: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including replacement of the air handler, outdoor Com any: r le condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) and will serve the addition, the ducts Address: z- License: q s o are to be sealed and tested per §I52(b)IE. © YES El NO ® EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. ® EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Refri erant Charge - Split System HERS verification is re uired or this measure. ® YES [a NO In Climate Zones 2 and 8-15, if a newly ducted split A/C or, heat pump is installed to serve the addition alone, a refrigerant charge measurement shall be verified per §151(07A. In Climate Zones 2 and 8-15, if the existing HVAC equipment is replaced (including replacement of the air handler, outdoor © YES 19 NO condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) and will serve the addition, a refrigerant charge measurement shall be verified per § 152(b)IF. Central Fan Integrated Ventilation System — Airflow and Fan Watt Draw - do not apply for additions 1,000112 or less. Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow and Fan Watt Draw HERS verification is required. ® YES El NO In Climate Zones 10 through 15, if a new space -conditioning system (HVAC equipment and ducting) is installed to serve the addition alone, the airflow and fan watt draw shall be verified per § 151(07B. ® YES [M NO In Climate Zones 10 through 15, if the existing space -conditioning system (HVAC equipment and ducting) is replaced and will serve the addition, the airflow and fan watt draw shall be verified per § 152 b IF. Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accurate and complete. Name: Signature: Company: Date: Address: If Applicable[3CEA or®CEPE (Certification #): City/State/Zip: Phone: 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: r Signature: Com any: r le Date: Address: z- License: q s o City/State/Zip: Phone: P 2&0 ZJ G 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 March 2010 III ui WASiaG L 1-7� Cal it !�I �w.:C>:►-;.Y�:r2 V'Iz.r���f� _ 1Z.4 cr. t zi�. (z Ves �IN F-- VV 2'X-I'IWALL' 13 -r N 5 v L-A- T.L OW ID r y,,v,41 k t3 o T t -A- :51- Q�F- S N., JIT14 CY C7 Lf— G T (0-3 i ll S-'r/p EZS XY3 CSN Dmf L-J ALL L T. P CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATE BY