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04404 (SFD)Building T --4 4Q*& A t 52-705 Vallejo Owner coatc elia Valley 1, Mailing Address 4,0 E. Taho ltz WA c4alm Spring$( Zip92262 Contractor Starr Convtxuction Address .Sa= City Tel. Zip .. + 1Tel. -,, State Lic. & Classif. 367934 Arch., Engr., Designer Address P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 ,�v City Lic. # $ �, Tel. City(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 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE Y OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following reason: (Sec. 7031.5,Buslness.and Professions Code: Any city or county which requires a 04404 BUILDING:' TYPE CONST' ' ' " * OCC. GRP. A.P. Number 773 -292 -021 - Legal Description 73-292-021-LegalDescription Project Description Ginale mail. DwW ll.$ na w Sq. Ft.. - - x.4,09 No., Size Stories New ❑ Add ❑ Alter ❑ 00 say. ft. riga rage 370" of 64. wood f! No. Dw. Units Repair ❑ Demolition ❑ J Estimated Valuation $75 sos - 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 PERMIT e - AMOUNT' the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of ' Division 3 or the Business and Professions Code, or that. he is exempt therefrom, and the basis 'any for Plan Chk. Dep. „ $250.00 for the alleged exemption. Any violation of Section 7031.5 by applicant a permit ' subjects the applicant to a civil penally of not more than five hundred dollars ($500). ' Plan Chk. BBI. 5p 39414 • ❑ I, as owner of the property, or my employees with wages as their sole compensation, will 'do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 364 •00 Professions Code: The Contractor's License Law does not apply to an owner of property who ' - builds or improves thereon and who does such work himself or through his own employees, Mech. fv .3.3.015 ' provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year or completion, the owner -builder will have the burden - Electrical '14 1^y - w of proving that he did not build or improve for the purpose of sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing t� 105 A 00 v struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law _ t,, C does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. - 5.36. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading . - M. 0 ❑ 1 am exempt under Sec. B. & P.C. for this reason ' Driveway Enc. 2 ani .0d E Infrastructure '�.. Date Owner WORKERS' COMPENSATION DECLARATION 1 I hereby affirm that I'have a certificate of consepVto self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy th(ereofetSec. 3800, Labor Code.) Policy No. Company�'� ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL$sE?0�. ► .-2 5b T. 5!5 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE �ry (This section need not be completed if•the permit is for one hundred dollars ($100) valuation A�a�' :�t+.sn,AP or less.) w ..,.,.. W • _, _.,._. I certify that in the performance of the 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 ZONE: BY: • subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: ' comply with such provisions or this permit shall be deemed revoked. ' ?, Front Setback from Center Line • Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lenders Name Lender's Address FINAL DATE -INSPECTOR " This is a building properly filled out, signed and validated, and is subject to g permit when 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. Issued by: Date Permit 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. Validated by:' - Signature of applicant Date_ Mailing Address' Validation: City, State, Zip .WHITE - FINANCE, PINK - APPLICANT, GREEN-'BUI�DIN r ir= e . ... • . ` t'':'. � .. _ .. .. , -, yG� 4 GOf0ENi1QD ;ASSESSOR'S OFFICE,HARDCOPY -FILE y - CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING•FEES iST FL SO FT (p Z UNITS COLL. AREA LAB GRADE — y,f7f,,1'`/ ROUGH PLUMB YARD SPKLR SYSTEM 2ND FL SO FT. Q HEATING (ROUGH) STORAGE TANK RMS ��! MOBILEHOME SVC. BAR SINK POR SO FTm DUCT WORK ROCK STORAGE FOUND. REINF. POWER OUTLET ROOF DRAINS GAR SO. FT. 0 HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) DRAINAGE PIPING CARP. SO FT. 0 GROUT WATER HEATER DRINKING FOUNTAIN WALL SO. FT. rd FINAL INSP. BOND BEAM WATER SYSTEM URINAL SO. FT. a GRADING cu. yd. S plus x$ =$ ESTIMATED CONSTRUCTION VALUATION S WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES �(fit/ /✓ . I WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTONDISHI 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 11/4 c SEWAGE DISPOSAL n/ /y/tNSULATIONISOUND//-.29If ey V" SO.FT.GAR 3V c 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 ETBACK GROUND PLUMB I _ UNDERGROUND A.C. UNIT COLL. AREA LAB GRADE — y,f7f,,1'`/ ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK RMS ��! SEWER OR SEPT 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 cu. yd. S plus x$ =$ LUMBER GR. FINAL INSP. / /FRAMING ` /,�W „I //! FINAL INSP. ff(OOFING (,� �(fit/ /✓ . I �i REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING A MESH n/ /y/tNSULATIONISOUND//-.29If ey V" FINISH GRADING F DIAL INSPECTION, CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL R P.O. Box 1504' • - APPLICATION' ONLY ' Building, � ,�• 78-105 CALLE ESTADO , Address` v o 70 !% LG E.SO LA QUINTA, CALIFORNIA 92253 Owner A, L 'a''v� ✓ n - BUILDING: TYPE CONST. OCC. GRP. Mailing f — - L Address � y7 T-VA1©e? �7 � �RY � A.P. Number % 73 -- 2 City Zip Tel.- �d1 Z a z.,32 Z— /G zG Legal Description m• y Contractor Project Description Address .Z 5/7 _ T /1 TZ uti/15� E City Zip - Tel.: 04 /;l S.13 /.rJGac 9Zz, 3Zz-/a r.,0 _ State Lica City. & Classif.3 $ 7 �( Lic. # 8 .. Sq: Ft. No. No.�Dw. Size - /yrjp 9 : Stories - / Units - -+• Arch., Engr:, Designer - Newk. Add ❑ Alter ❑ 'Repair ❑ 'Demolition Address Tel. City Zip State 7 h Lic. #' " LICENSED CONTRACTOR'S DECLARATION 1 I hereby affirm that 1 JIM licensed under provisiops of Chapter 9 (commencing'with Section •7000) of Division 3 ofjtpe,Business and Professions Code, and my license is in full force and - - - effect. 9 /B�/ SIGNATURE / / DATE ' - • OWNER -BUILDER DECLARATION - Estimated Valuation + ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031, S,Buslness 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 - - PERMIT - . - AMOUNT - the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or - Divislon 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 Plan Chk: Dep.. - subjects the applicant to a bivil 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 Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COr1St 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.hls own employees, Mech. - - - 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-bulider will have.the burden Electrical ' 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= Plumbing 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 form S.W. _ ' • • � - - such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) • . 'Grading ' ❑ 1 am exempt under Sec-- B. & P.C. for this reason Driveway Enc. - Date `� owner Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm'that I have a certificate'of consent t9self insur/or a certificate of {� T Worker's Compensation Insurance; -or a certified copy the Qf. (Sec. 38 0, Labor Code.) . - Policy No. Company �����% ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. ' - - ' - TOTAL 7 -7 ti' n a CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE - . -(This section need not be completed if the permit Is for one hundred dollars ($100) valuation 0.051:: 2. 1V 1::'66 u8-u2-iiia^'� ��.i.b orleas.) .. by -. 11.E i --. Al_ a. x+11= ^+. 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. Date Owner NOTICE TO APPLICANT. If, -after, making this Certificate of Exemption .you should become ZONE: BY: ' • "- ` subject to the Workers' Compensation provisions .of the Labor Code, you must forthwith Minimum Setback Distances: + _ comply with such provisions or- this permit shall be deemed revoked: ' Front Setback Irom Center. Line Rear Setback from Rear Prop.-Line-- CONSTRUCTION rop.-Line•coNSTRucrloN LENDING AGENCY Side Street Setback from Center Line' 1hereby affirm that there is a construction lending agency for the performance of the workfor which this permit is issued. (Sec. 3097, civil code.) Side Setback from Property Line Lender's 'Name Lender's Address FINAL DATE INSPECTOR This'is.a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. Issued by: Date Permit 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. Validated by - Si gnature y-Signature of applicant Date .Mailing,Address - Validation: City, State, Zip . -• BUILDING DIVISION CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. ® GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN BOND BEAM WATER SYSTEM URINAL SQ FT. ® _$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. 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(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRYTRAY AIR HANDLING UNIT CFM FIREPLACE IKITCHEN 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. SQ. FT. ® c BATH TUB MESH SQ. FT. ®c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. Ff. RESID ® 11/. c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE IL.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 APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING Cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL `�. «� � I _' N - ..e .�, k ! .v. ��. �Y _. v +. .'• r -n. �t .��.. ; , K> . , R f r Irv: -� .. , � .: . v.;� �.`-+a:'.i"' '�w'� "` "�y y ,p:• rf r '�' i . n "'� Y. ''� y'ri^�..: ^r •r..t; .fti..h..r��..,. Z c/ rt ~t, � 7 2 z O H U W V) @7 z O U W rn U) `L Q W fr X z O 1- U W rV) A COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH ENVIRONMENTAL HEALTH SERVICES DIVISION 3- 99i Q o 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 of $40 is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name (Owner. Agent. Contractor. Etc.) Mailing Address -* R UiA1< IS -r.4 G'c, xi s faue rio 4) Z 7fleV4AI Z Z City State Zip Code Telephone 89Gw! spo,JO&S ca 7zZ4.Z. 1-341z.-/e,z-o -Job Properly Address 'Cly or Community 'Legal Description of Property (Lot. PM. TR) X dos ZA aviv-r•g .ccsT 9 //t, 1Z-3 &o.- 7- /4, 'Assessor's Parcel No water Agency or Well 4;Y (Ju 4.-r E Use of Permit Planning Case • Lot Size .. �7 a — �^� lC,.y.- • SFD. MH Site Preparation Etc Signature of Applicant f Date 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE IZfia Date Certification of Existing S.D. System required. � ❑Yes No ;1) -' WOCB Clearance required. ❑ Yes C I No Soils feasibility report required. ❑ Yes E i No Special feasibility boring report required. ❑ Yes E I No Detailed contour plot plans required. ❑ Yes No Staff Specialist approval required. ❑ Yes No Lot Inspection Date o • Soils/boring report by Project # Date Soils Map Page Soil Type Approved by Date Type of System: No. of Bedrooms -- (1) Septic Tank n�Gals. Soil Rate Required 0 Existing V New ❑Additional ❑Replacement f(� ' (2) Leach line sq. ft. Sidewall allowance In is all Lines) Ft. Long, Leach bei Sq. (Bottom trench area) ft. rock/ Sq. Ft. Ft. wide with min. inches Ft. of bottom per running ft. ❑ N/A rock below drain lines area ; Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depths Applicable ❑ 5' e6' L Max. allowable depth N/A Overburden factor tIF i ` .1 )✓d 4 PK `Al JWIV A, 00 s 42� X fir% r� This application is approved/denied for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B above. A building permit is necessary for the installation of the above -designed system. (�S.eptic'ta k and sewer lines must be 50' from any wells J Leach lines be 100' from including expansion area must min. any wells 3 Seepage pits ust b 150' in. f m any wells including expansion area / ' PJ - - Signature of -H Ith Date t A RECE1 NO. " � , t District: ❑ Riverside 1 ft Indio ❑ Hemet Distribution: WHITE -Office file YELLOW -App DOH -SAN -122 (Rev. 4/88) Issued by M 6 ❑ Perris ❑ Rancho Calif. ❑ Blythe ;ant PINK -Bldg. Dept. GOLDENROD -Pending File �J 1 ✓ � ..�b.t Of q GY �A V- -O" f omrE OF E. LEEONjSPAU AGRICULTURAL�CMMISSIONER )ARIES 0 WALLACE 0 . 1. AN v 1� ASStStA�t [)M�naclU`EP. V S-. ^ � WEIGHTS S Fc MEASURES CLEMENT 6E`VENISIE 1� SEALER .. 49-613 Ilwy 86, Suite 8-12 �\,�,,.•'' •Coachella, CA 92236 MA r 9 eq� -619-342-8291 DATE S S490" CASE NO. d 90�0� DEVELOPER'S ME t .S' 1 /7 0,t)_5 ;',O_ c to bio AJ ADDRESS t o2 'Y7 'ff ;,,/I// 47ZL i r zn t'f";o Y z 2< 6 y TELEPI (ONE t ((;19) ? 2.2 �- 1 -7o S- -7 7 -3 -- -773-- .21Z 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 .fmn plant material listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agricultural Cotmussionwr eof f ice cct Indio and Riverside Office t J_Q 7 03-- 1) Area (SO 14 Location/Description (kitchen, bath, etc.) 71-4 0/F Certificate of Compliance: Residential (Page 1 of 2) CF -1R I o -Z. -7 1 Project Title Date P- 7', 1 CL Address �N\�L T%,io *f-" , ) ., -( I L t Budding Permit # ocumentation Author Telephone zys- 7�— Checked By /Date Compliance Method (Package, Point System or Computer) Climate Zone Enforcement Agency Use Only GENERAL INFORMATION Total Conditioned Floor Area:, Building Type: >< ,Single Family Hotel/Motel (check one or more) Multi -Family (less than 4 stories) t Addition Multi -Family (4 or more stories) Existing -Plus -Addition Front Entry Orientation: 6DEast /South/ West/ All Orientations (circle one or more). Number of Dw6lling Units: Floor Construction Type: (-S_la­b'aised Floor (circle one or both) .Infiltration Control:tanda`rdight (circle one) BUILDING SHELL INSULATION Component Insulation Location/Comments Type R -Value '(attic, to garage, typical, etc.) Wall .............. je; Wall .............. Roof .............. 2 Roof ............. Floor............. . rz, Floor ............. Slab Edge..... GLAZING Shading Devices Glazing Area Glass Type Interior Exterior Overhang Framing Type Orientation (sf) (single, double) (roller blind, etc.) (shadeSCTeen, etc.) (yes/no) (metal/wood) Front..,.. 24 _b0,Tt51Q Front.... Left...... Left...... Rear...'.. Rear......( Right.... rtit0,-2; Right .... Skylight....... Skylight....... THERMAL MASS Type/Covering (slab/exposed; tile, etc.) Area (SO Thickness (inches) Location/Description (kitchen, bath, etc.) Tie I o -Z. I r Z- 43 P- 7', 1 CL T%,io *f-" Certificate -of Compliance: Residential (Page 2 of 2) CIMR S%�2i2_ CtJS7;Z.1e_7-,--,N .�,5 ii 1 -7 ) 10f) �g ' Project Title Date HVAC SYSTEMS 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) 5 • c,.fs�.. I Maximum Furnace Heating Output: L.6� � Btuh HOT WATER SYSTEMS Tank Manufacturer/Model # System Type (storage gas, etc.) Capacity (or approved equal) Special Feature(s) € l E -C, -3-7 _Ann- -- 4,3 k� � SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) 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: Title/Firm: Address: Telephone: Lic. #: (signature) (date) Documentation Author Name: n:!S , L e;4 Title/Firm: L O "%, e,17"t CD a p - 7-' 4'j , . r Address: .-." Vw: Telep ne CA k �r 3 (signature) (date) Form Revised March 1988 Name: Title/Firm: . Address: Telephone: (signature) (date) Enforcement Agency . Name: Agency: Telephone: (signature or stamp) (date) L Point System Summary:. Climate Zone 15 Project BUILDING DATA P -2R Date Conditioned Floor Area /4o9 Number of Stories 1 i iV°rut e ~ I. -I/ . Slab/Raised Floor <1l p4a East (0 3 4• -4 9 Check all applicable Unit T South 1 ] . g pp Type condition(s): West00 I I (] Single Family Detached (SFD) [ ] Addition Alone Skylight -- 8 a. a [xJ Single Family Attached (SFA) [ j Existing Building Total [ ] Multi -Family (MF) (] Existing -Plus -Addition , SCORE CARD Measures Point Scores 1. Ceiling Insulation 2. Wall Insulation 3. Raised Floor Insulation 4. Slab Edge Insulation 5. Infiltration 6. Glass Heat Loss 7. Shading (Shade Open) a. North R -value [ 191 b. East U -value [0.037] c. South N d. West Duct Efficiency [0.78] e. Skylight 8. Shading (Shade Closed) F2 factor [0.77] a. North Standard b. East - c. South SEER (9.5] d. West Effective SEER (7.03] e. Skylight -7t' or R -value [381 ►. 7 � . U -value [0.030] I �-1 or R -value [ 19] o 11 -value [0.066] rZ )A or i R -value [ 191 70 U -value [0.037] N or Duct Efficiency [0.78] Effective SE or R -value [0] [0.72/6.61 F2 factor [0.77] I Standard 9:(.5 - ; SEER (9.5] Duct Efficiency [0.74] Effective SEER (7.03] 13. Water Heating Type [double] P4'I U -value [0.651 % Total Glass [ 16] % Glass Credit [none] SC , Eff. % Glass I.-)] X 7-7 = 1, 3Z 4, 4a x -7-7 X -7 -7 X =l % Glass SC a Eff. % Glass I —[ i x Z2 = x zz =� ; L . �....� x X .. Z -i. = I 71e L X _, J 9. Interior Thermal Mass ►. 7 � . Interior Mass/CFA 10. Exterior Wall Mass o Exterior Wall Mass 11. Heating System 70 x Zonal' Control? ( Y / I� SE or HSPF Duct Efficiency [0.78] Effective SE or [0.72/6.61 HSPF [0.56/5.15] 12. Cooling System 9:(.5 x 5 -L Zonal Control? ( Y SEER (9.5] Duct Efficiency [0.74] Effective SEER (7.03] 13. Water Heating 5E P4'I ; Type [SG] Credit [none] Form Revised March 1988 Point Total., Sum 7-10 f- I r 3 Thermal Mass Worksheet WS -11Z =7k ProjectTltle Date 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). Type 2 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 Description Mass AreMass Capacity Mass Capacity x t4. b — C��i (o • 'Z X X _ 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 = y _ Total Total Opaque Exterior Wall Area Wall Mass Form Revised March 1988 Shading Coefficient (SC) Worksheet If Form S 11. SCexterior shade: 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: 6. interior Shade Type: W �,) -A<- A<-2. 2. SCglazing alone: 7. SCshade open: 1.00 3. Framing Type (metal/wood): YA-t 8. SCshade closed: Z 5" 4. Mullions (yes/no): (SC of shade w/ clear single glass) 5. Framing/Mullion Factor. 1 (from Table G-10) SCmax SCmin Glazing, Interior Shade& Framing ' 9a. x 0.25) + 0:75] x l x 28 ?7 4 Where: SCmax SC„dn FMF (#5) SC Shade Open SCmax = larger of #2 and #7 or 9b. -77 (from Table 0-9) SCmin = smaller of #2 and #7 SC Shade Open .. Overhang Factor SC Shade Open 10a.[( c� x 0.25) + 0.75] x x Where:. SC„= SC„dn FMF (#5) SC Shade Closed SCmax = larger of #2 and #8 or l Ob. V& - (from Table 0-9) SCmin = smaller of #2 and #8 SC Shade Closed i� Exterior Shade Exterior shade Type: , ,.1 s cam 11. SCexterior shade: " (from Table G-11 or manufacturer's data w/ clear single glass) 12. [( , 7 7'i x 0.25) + 0.75] x . 5q _ 3 y ; Where: SCmax = larger of #9a or #9b and #11 SCmax SCmin SC Shade Open SCmin = smaller of #9a or #9b and #11 Where: . 13. [( • 3�f x 0.25) + 0.751 x t -7 = 1 SCmax = larger of #1 Oa or #10b and 411 SCmax SCmin SC Shade Closed SCmin = smaller of #10a or #lOb and #11 Overhang (Point System Only) Projection Ratio: , 14. x 151.- = ,ZC Overhang Factor SC Shade Open SC Shade Open (Shade Open) (#12) (with Overhang) 15. x . )4 Overhang Factor SC Shade Closed SC Shade Closed (Shade Closed) (#13) (with Overhang) r it Form Revised March 1988 i Mandatory Measures Checklist: Residential MF -1R NOTE: 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. DESCRIIM. ON DESIGNER ENFORCEMENT Building Envelope Measures * §2-5352(a): Minimum ceiling insulation R-19 weighted average. §2-5352(b): Loose fill insulation manufacturer'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 vapof 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. §275352(f): Vapor barriers mandatory in Climate Zones 14- and 16 only. §2-5317: Infiltration/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 bather 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, 1916. UMC. §2-5316(b): Exhaust systems have damper controls. §2-5314(c): Gas-fired space heating equipment has intermittent ignition devices. §2-5314: HVAC equipment, water heaters, showerheads and faucets certified by the.CEC. §2-5352(i): 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). y 42-5312(Exception I): Pipe insulation on steam and steam condensate return & recirculating piping. §2-5318(d): Swimming Pool Heating 1. 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(# Refrigerators, refrigerator -freezers, freezers and fluorescent lamp ballasts certified by the CEC. Indicate make and model number. Form Revised December 1987 S S FORM J -1T (Transparent) Copyright by the ` - "Air Conditioning. Contractors of Americo' 1228 17th Street N.W. Washington. D.C. 20036 Printedjin U.S.A. , January. 1967 ' Plan No. e_ Date_ (.j -Z �) 'CD � Calculated bye •-L L f ? r WORKSHEET FOR MANUAL J (Third 11ditlon) LOAD CALCULATIONS FOR RESIDENTIAL AIR CONDITIONING For: Name S7,! f±y - J17-" u. T, i � Address_ -7Q? City and Stat or Province �Oti NCS �ra _ BY: Contractnr_+A_ Addess -�� '> C J T—. J4B v City — SP_ -10.1.Cia Winter Design Conditions Outside 2- _F Inside -7" F Temperature Difference 4_Degrees (Insert data below only after all heat loss calculations have been completed) Total Heat Loss (Btuh) �41 0 (From Line No. 15) Mod No. SI 7>✓ v`12�: _ Serial No. _ Manufactured by_5) Rating Data: Input _ Btuh Output at Bonnet_!&w __Btuh Description of Controls?1,�o t_T I I7'A-r Summer Design Conditions Outside_J19_—_F Inside__X1__—F ;. -North Latitude_ 3 Degrees Daily Range_ (Insert data below only after all heat gain calculations have been completed) Total Heat Gain (Btuh) 2La45_- (From Line No. 20 or 21, if sed) Equipment Capacity Multiplier ) • J-1'__ Model No.e�R y '9\z S It Serial No. Manufactured by N o Com_ Rating Data: Cooling ___Btuh .Air Volt _—Cfm Description of Controls_Z-LYz� Winter Construction Data (See Table 2) IV,Wls_and Partitions -I-? ;ZvLL4Z�.- Summer Construction Data (See Table S ) Direction House Faces_ Windows and Doors = Windowsd Enter in "HTM" column, Line 21 Walls and Partitions Ceilings_ Z Ceilings_ _ —^ Floors' Floors_. - 1. Direction which window faces. 2. Total window area, sq ft. .3. Width of window, It. 4. Shaded area per foot of over- hang from Table B-1, sq ft. 5. Width of overhang, ft. 6. Total area of shaded glass, sq ft. (Line 4) z (Line 5). 7. Total area of unshaded glass, sq ft. (Line 2) -(Line 6). Table A (USE TO CALCULATE SHADED AND UNSHADED GLASS' AREAS) Table B (Use to Determine Adjustment Fodor) A. Total Btuh Gain, from Line 20 Z a S B. Capacity Multiplier, from Table 7 C. Equipment Standard ARI Capacity Rating, Minimum required, (Line A) z (Line B) 2 c-4-) D. Capacity of Equipment Selected, not less than Line C, Enter in "Entire House" column, Line 21 E. Adjustment Factor (Line D)=(Line A), Enter in "HTM" column, Line 21 DO NOT WRITE IN SHADED BLOCKS a Pmple 300 and Applia.— mS mSum of Lin.