Loading...
04380 (SFD)Building 52-460 Vallejo AAA.--- Owner AA.- ... Owner mailing Address City Palm S Contractor P.O. BOX 1504 -78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 CoticY ell a Valley Land 247 E. Tahq€ itz Way #2 Zip Tel. ,r i.ngs 92262 322-1.420 Pil State Lic. Ci & Cla sif. 387934 I Lio # 895 Arch., Engr., Designer Address Tel. City ( Zip ( State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I -am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. �- el—,- .. .1 u�'.� ,J.,r1ir SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he 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). O 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement fs sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 I hereby affirm that I have a certificate of consent to; self- insure; or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec."3t�tLabor Code.) Policy No. Company ' IK" r,L, O Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit Is for one hundred dollars ($100) valuation or less.) 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. Dale Owner NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter the above- mentioned property for Inspection purposes. Signature of applicant Date Mailing Address City, State, Zip 04380 BUILDING: TYPE CONST. A.P. Number Legal Description Project Description OCC. GRP. 773-263-011 �' • •+ Sq. Ft. 1463 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 4751 Garage 1701 61 wood fence Estimated ValuationT98 PERMIT Plan Chk. Dep. $25010 Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL �' • AMOUNT W iJ R �i Y - 33 . UU l� wJ:J 1.434, t34 20.00 20 *00 REMARKS '001W. 40 AV 4.•kYlibY .i F Wr Y iYA» 8 .. 4-1 : r .._ ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR 7128/88 Issued by: Date Permit Validated by: Validation: 1 WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES \ ISI FL SO Fl (p $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL SO FT. 6 HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR SO FTa ROCK STORAGE FOUND. REINF. POWER OUTLET ROOF DRAINS GAR SO. FT. Qt OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) DRAINAGE PIPING CARP. SO FT. fa' GROUT WATER HEATER DRINKING FOUNTAIN WALL SO. FT. a BOND BEAM WATER SYSTEM URINAL SO. FT. M _$ GR. ESTIMATED CONSTRUCTION VALUATION S /LUMBER !/ //LFRAMING - 0 ���LLL WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTOXDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING -UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR - HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO. FT. c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID g 114 c SEWAGE DISPOSAL SO.FT.GAR (g 3/4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR SETBACK G//ROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE GGFLO.UGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS / n SEWER OR SEPTIC FANK OUGH WIRING/ - 111 DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ GR. FINAL INSP. /LUMBER !/ //LFRAMING - 0 ���LLL FINAL INSP. ROOFING 10 r REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR, GAR. FIREWALL ljl ATHING / ( - MESH INSULATIONISOUND FINISH GRADING AL INSPECTIO -- ?j ' CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATOR=SlINITIALS , GARDEN WALL FINAL :d P.O. BOX 1504 APPLICATION ONLY Building 78-105 CALLE ESTADO Address .r 2 A%Gn 1141 LA QUINTA, CALIFORNIA 92253 c:Q AW27 # r L t L L - ,4z Y A 4 Mailing - Address L 74 114,eo WA V�Z CityZip Tel. 4nmsPei��s 97- C. Z Contractor r. Address I Jt/? r 'reu/D.., 7 11/eJ &'2J Zip - Tel.. 9z zZ_ -, 1 32a— State Lic, City & Classif. .3 9 Lic. # RV -1-1 Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division -Sof the Business and Professions Code, and my license is in full force and effect. SIGNATURE 1 DATE 'OWNER -BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which the, a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance also requires the applicant for such permit to rile a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law, Chapter.9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he 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, 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, Buisness and Professions Code: The Contractor's License Law does not apply to .an owner of property who builds or Improves thereon and who does such work himself or through his own employees, provided that such 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 did not build or Improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 0 1 am exempt under Sec. B. & P.C. for this reason Date Owner 1 WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to seldiinsure, or a certificate of Worker's Compensation Insurance, or a certified copy)'thereof. ,Sec. 3800, Labor Code.) Policy No. Company �/ �� 40 Copy is filed with the city. ❑ Certified copy Is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit Is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any parson in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT, If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's 'Name - Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. t I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating .to building construction, and hereby authorize representatives -of this city to enter the above-- mentioned property for inspection purposes. Signature of applicant - Date .Mailing Address City, State, Zip BUILDING DIVISION BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description 40-7- / L . LIL iL x .3 aA; ,'- Project Description Sq. Ft. No. Size /�f�,3 Stories New`g Add ❑ Alter ❑ No. Dw. Units Repair ❑ .�r- / , i . -O_ - -- - mated valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure -� rinc io TOTAL Demolition ❑ AMOUNT pp I <'TO 17....7-7.. 00 4 7 MTI aL f' --275.00-- REMARKS -275.00--REMARKS ZONE: BY: f Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop` Line Side Street Setback from Center Line - Side Setback from Property Line FINAL DATE INSPECTOR.:-- Issued NSPECTOR•Issued by: \ Date Permit Validated by: Validation:_ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. S0. FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. ® GROUT WATER HEATER WALL SO. FT. ® FINAL INSP. DRINKING FOUNTAIN SO. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. S0. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING U. yd. $ -Plus-X$-=$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT OF SQQJa,p��CILITY FEES NOTICE: THIS DOCUMENT `ArN BE DUPLICATED. TO: City of La Quinta DATE: Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 c. This is to certify that L / / /v , developer of ' 7 ) whic�h�s) located at j� this District, has paid schob3l facility fees imposed purs ant to the aut orit generate by Gov rnment Code, Se tion 53080 in the amo Y nt, of / $ < c ,e-- covering nomcovering a total of square feet of ( resident•al or ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction. 9 60 for DESERT ANDS UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 F1 m Z 0 H U W W m Z _ 00 U W U) Y Cr Q W cr I�t'RR4 W rn 0. a COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH x _ ENVIRONMENTAL HEALTH SERVICES DIVISION .l PERMIT APPLICATION, FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM . = Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County specifications required on the attached check'list. �• A non-refundable filing fee of70b is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # <+! Name (Owner. Agent Contrac�tor. Etc.) ac Marling Address , `! J A.e C.� eo 5 Af, Gi!/ 'd ✓ -2 % Cay ,*17 S cJ State ry ��A, Zip Code f L z 6 2.. Telephone -Job Properly Address /]„ / � 'Cn , Eomm r 'Legal Description of Properly (Lot. PMAIRI , .:S2i�{!.� �/Q�IiEJo QGI./a17'A LDi'/2 LQL .3 uW J 7 'Assessor's Parcel No W31er A en t7r:.Well ..AM 'r' Use Permrv'G�1t* w"r - `^"'r' PlArring Case # Lot Size 1 C T�r� of / 7 • 7.3 —'2 4-3 - ©�� Is T* AZ SFO. MH Site Preparation Etc ,�+©p• foo Signature of Applicant _ - �"' Date 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE - ' Initial Date, r 1�)�7rdS Certification of Existing S.D. System required. El Yes N lrT�(l2 WOCB Clearance required. ❑ Yes [❑,Nom Soils fusibility, report required. ❑'Yes LTJ,' NNgam Special feasibility boring report required. E) Yes L_d,'/No'- Detailed contour plot plans required. ❑ Yes LiJ No Staff Specialist approval required. ElYes No Lot Inspection Da/te Soils/boring report byss�� '/ r Project # Date Soils Map Page Soil Type( Approved by %C-- - �` Date -7_ ;t 7- - '1 ' Type of System:_ No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing ® New ❑ Additional ❑ Replacement tv e&x A Gals. v w/ / lw7 (2)aLeach line sq. ft. (Botf'dm,t e�nch area) Sidewall allowance ft. rock/ Sq. Ft. Install Lines) Ft. Long, Ft. wl a t. in. inches r• Leach bed Sq. Ft. o I5!o9gq, �' — per running ft. ❑'Tl/A rock below drain lines area Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI / Seepage Pit total depth Applicable`/1 factor j ! % Max. allowable depth 6/LI 40 %N�/A / � _ �O-verburden % / F' �'w-u.C1✓' �^ �..t�r � i. .. �/'�'` Y^ � (/l7ilJ .�C:{�yi,'�/3-�-C..LA... ./ >� S r• ^ :r+'i�' 6t� '� -'t.>� .t -•P ra'.. •r✓ . r.� %'F--a-..+-�..1-�' 5 This application �s,approve aied�tor the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section`B ove. A building permit is nect�s Msary for the installation of the above -designed system. Septic tank and sewer lines must be 50' from any wells -1 1011e. � (2 Leach lines must be 140' min. from any wells including expa ion area yy (3 Seepage pits must be 150; min. from any wells including expansion area,/ /U Signature of Health Official RECEIPT NO.Issued by S /e Date Z�_2 7�0 District: ❑ Riverside © dio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File DOH -SAN -122 (Rev. 4/88) M 'l 0 O V qyq, �S OFFICE OF AGRICULTURAL CONINUSSIONER AND WEIGHTS & MEASURES 49-613 Ilwy 86, Suite B-12 'Coaclella, CA 92236.. 619-342-8291 E. LEON SPAUGY COMMISSIONER JAMES 0 WALLACE ASSISTA.%r COMMISSIONER CLEMENT BENVEINISTE SEALER DATE . CASE N0. �7� DEVELOPER'S NAME: A C V\ �J AS -10, u C 'ADDRESS: cq CI I'I 4L1,� S, r N Q TELEPwNEs Dear Developer: After reviewing your landscaping plans, all plant material listed is not in violation of quarantine laws governing the Coachella Valley. If substitutions do occur and they differ from plant material listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agricultural rmissioner's Office cc: Indio and Riverside Office Certificate of Compliance: Residential %1:ZG/ 3Y (Page 1 of 2) CF -1R Project Title Date Project Address J • \)� . 1J li 1 Y� c — 3Z� �1 �A Building Permit# Documentation Author Telephone Checked By / Date Compliance Method (Package, Point System or Computer) Climate. Zone Enforcement Agency Use Only GENERAL INFORMATION Total Conditioned Floor Area:1 4}a 1 ft2 Building Type: Single Family Hotel/Motel (check one or more) Multi -Family (less than 4 stories) Addition Multi -Family (4 or more stories) Existing -Plus -Addition Front Entry Orientation: North/ East /South ` est All Orientations (circle one or more) Number of Dwelling Units: f Floor Construction Type:ab ailed Floor (circle one or both) Infiltration Control: tandar ,: right (circle one) BUILDING SHELL INSULATION Component Insulation Location/Comments Type R -Value (attic, to garage, typical, etc.) Wall .............. Area Thickness (slab/exposed, tile, etc.) Wall .............. (inches) Location/Description (kitchen, bath, etc.) ��J e.st-�-,.� �1..�-�. I 1 � i- I . ,� Roof r Roof ............. _ Floor ............. — Floor ............. Slab Edge ..... 71l 0 t. t✓. >.• GLAZING Shading Devices Glazing . Area Glass Type Interior Exterior Overhang Framing Type Orientation (sf) (single, double) (roller blind, etc.) (shadescreen, etc.) (yes/no) (metal/wood) Front,..: ( "` ,.� �. ��c- ?. Front.... Left...... (r1) V4.t Left...... ( ) Rear..... (C j , 1«�; 1/4!a '•� t��a M, : °�! i'1!I CP- sem. Rear..... Right.... ( S) r 'Yi ,•_ Right.... ( ) Skylight....... o Skylight....... THERMAL MASS Type/Covering Area Thickness (slab/exposed, tile, etc.) (sf) (inches) Location/Description (kitchen, bath, etc.) ��J e.st-�-,.� �1..�-�. I 1 � i- I . ,� � � ts_ , �-i� . tZ� (L• S r _ r Certificate of Compliance: Residential I S7";29-, Project Title HVAC SYSTEMS (Page 2 of 2) --I 1 \,-, �z Minimum Duct Type (furnace, air Efficiency Location Duct Output Manufacturer/ Model # conditioner, heat pump) (SE, SEER,HSPF) (attic, etc.) R -Value (Btuh) (or approved equal) Maximum Furnace Heating Output: ', $g,�,� Btuh HOT WATER SYSTEMS Tank Manufacturer/Model # System Type (storage gas, etc.) Capacity (or approved equal) Special Feature(s) SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) CF -1R' COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, Chapter 2-53 and Title 20, Chapter 2, Subchapter 4, Article 1 of the California Administrative code. This certificate has been signed by the individual with overall design responsibility and the building owner, who shall retain a copy of it and transmit the certificate to any subsequent purchaser of the building. When this certificate of compliance is submitted for a single building plan to be built in multiple orientations, all building conservation features which vary are indicated in the Special Features/Remarks section. Designer Building Owner Name: Name. Title/Firm: Title/Firm: Address: Address: Telephone: Telephone: Lic. #: (signature) (date) (signature) (date) Documentation Author Enforcement Agency Name: I _ . k.�S' i S Name: Title/Firm: V�� L . T` �� N J l.o �.r ,ar Agency: Address: -?—'I ---7 -� •-� ,.a r 1^v U ti. Telephone: �4a wr S 1J It N G C . CJS g ZZ�c,1 Teleph ' ie C, -z- -=t _t "`? •> '�, (signature) (date) (signature or stamp) (date) Form Revised March 1988 n .i i Point System Summary: Climate Zone 15 L i i P -2R i M Date BUILDING DATA I Glass Area, % Glass Conditioned Floor Area l k�-kt, 3 Number of Stories Slab/Raised Floor S t� Check all applicable Unit Type condition(s): [ ] Single Family Detached (SFD) [ ] Addition Alone ['Single Family Attached (SFA) [ ] Existing Building [ ] Multi -Family (W [ ] Existing -Plus -Addition SCORE CARD Measures Point Scores 1. Ceiling Insulation or p R -value [38] U -value [0.030] 2. Wall Insulation, or O R -value [ 19] U -value [0.066] 3. Raised Floor Insulation ]J (a or O R-value[19] U -value [0.037] 4. Slab Edge Insulation 0 or R -value [0] F2 factor (0.77] S. Infiltration �. Standard p 6. Glass Heat Loss i�.•r(� �� �� t $ .� :- 1 Type [double] U -value [0.65] % Total Glass (16] Sum 1-6 7. Shading (Shade Open) % Glass SC Eff. % Glass a. North 3 x = 2 b. East 3 • So x -► _ _ 1 C. South x = F 1 D o d. West L - L x e. Skylight y x = r) 8. Shading (Shade. Closed). % Glass SC Eff. % Glass a. Notch .8 3 x Z -Z- _ Sq O b. East'�' 1 x Lam. _ -719 Z— c. South x -, �- = 3 Z + y d. West x�— e. Skylight x = 9. Interior Thermal Mass 2. -;,1 — Interior Mass/CFA 10. Exterior Wall Mass o . ; o Exterior Wall Mass Sum 7-10 11. Heating System' -1. o x g Z Zonal Control? (Y/( 1 SE or HSPF Duct Efficiency [0.78] Effective SE or A [0.7216.6] HSPF [0.56/5.15] 12. Cooling System �,� x Zonal Control? ( Y ,SEER [9.5] Duct Efficiency [0.74] Effective SEER [7.03] 13. Water Heating Type [SG] Credit (none] Point Total: t `� Form Revised March 1988 I i� Thermal Mass Worksheet Pro ject Tltle Date WS -IR INTERIOR THERMAL MASS Use one of the two following options for calculating interior mass as explained in Section 4.2 of the Energy. Conservation Manual (ECM). Method B must be used for mass elements that have an interior unit mass capacity less than 1.7. Method A: Look up the Interior Mass/CFA value from ECM Table 4-7 reprinted on the reverse side of this page. Type 1 mass has a Unit Interior Mass Capacity (UIMC) greater than or equal. to 4.2 (see ECM Tables 4-8a and 4-8b reprinted on Attachment). Type2, mass has an UIMC greater than or equal to 1.7 and less than 4.2. Mass % is the mass surface area divided by conditioned floor area (CFA). For mass elements exposed on both (two) sides to conditioned space, enter the area of only one side to calculate the percentage. Mass % Type 1 Mass Area`. Type 2 Mass Area: Interior Mass/CFA from Table 4-7: Method B: Calculate the Interior Mass/CFA value using the worksheet space below. Look up the Unit Interior Mass Capacity (UIMC) for each interior mass surface in ECM Tables 4-8a, 4-8b and 4-9 reprinted on the Attachment. Include the interior surfaces of exterior mass walls. For interior mass walls exposed on both (two) sides to conditioned space, enter the surface area of only one side. Include the inside surfaces of exterior mass walls as explained in Section 4.2 of the ECM. Unit Interior Interior T) ?e- Description Mass Area Mass Capacity Mass Capacity 21 X t2. k. = X Vol _ X = X = �7 —15 IL . ?Z33 .� y 77—.-2-1 Total CFA Interior Mass/CFA EXTERIOR WALL THERMAL MASS Calculate the Exterior Wall Mass of all exterior walls: Look up the Exterior Mass Factor for each opaque wall element from ECM Table 4-9 reprinted on the Attachment. Only exterior mass wall surfaces may be included in this calculation. Opaque Exterior Description Wall Area Mass Factor X = X = X = Conventional Walls X 0 = i Total Total Opaque Exterior Wall Area Wall Mass Form Revised March 1988 z Shading Coefficient (SC) Worksheet Form S Items 1 - 9a and 10a must be completed for glazing/shading combinations not found in Table G-9 of the ECM by using documented manufacturers' data for the specific conditions indicated (#2, #8 and #11). For instructions on filling out the worksheet, see Shading in the ECM Glossary. For overhang SC values (#14 and #15), see Section 4.2 in the ECM. General Information 1. Glazing Type: 1�) "N 0 6. Interior Shade Type: W r1- VC -4 -}N -a, 2. SCglazing alone: 7. SCshade open: 1.00 3. Framing Type (metal/woo ft `., 8.. SCshade closed: 4. Mullions (yes/no): a (SC of shade w/ clear single glass) 5. Framing/Mullion Factor. $ (from Table G -10) - Glazing, Interior Shade & Framing 9a. [( o x 0.25) + 0.75] x x •� _ �4*71%7t. Where: SCmax SCmin FMF (#5) SC Shade Open SCmax = larger of #2 and #7 or 9b. , --Zc� (from Table G-9) SCmin = smaller of #2 and #7 SC Shdee p neve 10a. [( 4 x 0.25) + 0.75] x x _ ' 7 Where: SCmax SCdn FMF (#5) SC Shade Closed SCmax = larger of #2 and #8 or 10b' tiL (from Table G-9) SCmin = smaller of #2 and #8 SC Shade Closed , Exterior Shade Exterior Shade Type: 11. SCexrerior shade: Q 14 - (from Table. G-11 or manufacturer's data w/ clear single glass) Where: 12. x 0.25) + 0.75] x �` _ "3 �, SCmax = larger of #9a or #9b and #11 SCmax SCmin SC Shade Open SCmin = smaller of #9a or #9b and #11 Where: 13. 0.25) + 0.75] x In = < < �` SCmax, = larger of #10a or #10b and #11 SCmax a -min SC Shade Closed SCmin = smaller of #10a or #10b and #11 Overhang (Point System Only) Projection Ratio: 14. ct.� x Overhang Factor SC Shade Open SC Shade Open (Shade Open) (#12) (with Overhang) f\ Overhang Factor SC Shade Closed SC Shade Closed (Shade Closed) (#13) (with Overhang) Form Revised March 1988 Mandatory Measures Checklist: Residential MF -1R IVOTIE:' Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. Items marked with an asterisk (*) may be superseded by more stringent compliance requirements listed on the Certificate of Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as binding minimum component performance specifications. for the mandatory measures . . whether they.are shown elsewhere in the documents or on this checklist only. DESCRIPTION DESIGNER ENFORCEMENT Building Envelope Measures * §2-5352(a): Minimum ceiling insulation R-19 weighted average. §2-5352(b): Loose fill insulation rnanufacturer's labeled R -Value. * §2-5352(c): Minimum wall insulation in framed walls R-11 weighted average (does not apply to exterior mass walls). . §2-5352(k): Slab edge insulation -water absorption rate no greater than 0.3%. water vapor transmission. rate no greater than 2.0 perm/inch. §2-5311: Insulation specified or installed, meets California Energy Commission (CEC) quality standards. Indicate type and form. §2-5352(f): Vapor barriers mandatory -in Climate Zones 14 and 16 only. §2-5317: Intiltration/Exfiltration Controls a. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. b. Doors and windows certified. c. Doors and windows weatherstripped; all joints and penetrations caulked and sealed. §2-5352(e): Special infiltration barrier installed to comply with §2-5351 meets CEC quality standards. §2-5352(d): Installation of Fireplaces 1. Masonry and factory -built fireplaces have: a. Tight fitting, closeable metal or glass door b: Outside air intake- with damper and control C. Flue damper and control 2. No continuous burning gas pilots allowed. HVAC and Plumbing,System Measures §2-5352(8) and 2-5303: Space conditioning equipment sizing: attach calculations. §2-5352(h) and 2-5315: Setback thermostat on all applicable heating systems. * §2-5316(a): Ducts constructed, installed and insulated per Chapter 10, 1976 UMC. §2-5316(b): Exhaust systems have damper controls. §2-5314(c): Gas-fired space heating equipment has intermittent ignition devices.- §2-5314: evices: §2-5314: HVAC equipment, water heaters, showerheads and faucets certified by the CEC. §2-5352(1): Water heater insulation blanket (R-12 or greater) or combined interior/exterior . insulation (R-16 or.greater); first 5 feet of pipes closest to tank insulated (R-3 or greater). 92-5312(Exception I): Pipe insulation on steam and steam condensate return & recirculating piping. §2-5318(d): Swimming Pool Heating I. System has: a. On/off switch on heater. b. Weatherproof instruction plate on heater. c. Plumbed to allow for solar. 2. 75 percent thermal'efficiency. 3. Pool cover.' 4. Time clock. 5. Directional water inlet. Lighting and Appliance Measures §2-53520): Lighting - 25 lumens/watt or greater for general lighting in kitchens and bathrooms. §2-5314(c): Gas fired appliances equipped with intermittent ignition devices. §2-5314(a): Refrigerators, refrigerator -freezers, freezers and fluorescent lamp ballasts certified by the CEC. Indicate make and model number. Form Revised December 1981 . e S - -v+1Imam