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04410 (SFD)* ..+� •iµ4..b -• �'es Building '52-725 5 Arldracc 4r + lleio Owner P.O. BOX 1504 ' 78-105 CALLE ESTADO LA•QUINTA, CALIFORNIA 92253 y 04410 -(Voach6lla V#tllev hand Co. BUILDING: TYPE -CONST. - OCC. GRP. • iiia-�29�-�i22 " "Mailing Address 247 E- `�'ahqu�1tz Way.# #2 < ..,. � . _ A.P.'Number � .• . Legal, Description _ S `F `D' City Palm Springs Zip 9226 Tel. «� „.. aa'"x i ., _ Contractor Starr Construction Project Description Address - same ~ City Zip' Tel. State Lic. City & Classif. 387934 Lic. # � Sq: Ft. s3410 No. No. Dw. _ • G Size" • - Stories Units Arch., Engr., Designer 4. New ❑ ' Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. 428 sq. ft. enrage 1701 of 61 weed fence City State ]Zip Lic. # LICENSED CONTRACTOR'S DECLARATION 40 herebyaffirm that I am licensed under provisions of Chapter 9 (commencing with Section 00) of Division 3 of°the Business and Wofessions Code, andmylicense is in full force and • effect. SIGNATURE - - - DATE OWNER -BUILDER DECLARATION y, I hereb � affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation�� r �� reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a PERMIT ' AMOUNT ' permit to construct, alter, 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 _ plan Chk. De Dep. - p +q CA�yy A!a ' - y7:7d ♦ V $250'000•L ' Division 3 Or 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 perm8 subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal. 6 39.1.4 .. ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Const. _ 600 w do the work, and the structure is not intended or offered for sale. (Sec. 7044, Suisness and ' 'The Professions Code:Contractor's License Law does not apply to an owner of property who Mech. -1 ^' - c Q, ' 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 Electrical - 74 ,17 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.) Plumbing _ 105.00 .• , 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 S.M.I. - - - 5 .36 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 2fl • QID. ` ❑ 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc.yy 4 ' Data Owner Infrastructure rr2AE}aQID. Lyt7�Os�6.,' •f , WORKERS' COMPENSATION DECLARATION f 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" 3806. Labor Code.) - ^ ^ "• "' ^ Policy No. .Company w-%,/ 111�` ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL 47~ iry R .r,a e REMARKS CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE be if the Is for hundred dollars u j�� t�i�f�, IYP - M�� (This section need not completed permit one ($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. 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 forthwithMinimum comply with such provisions or this permit shall be deemed revoked. Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY I Side Street Setback from Center Line 1 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.) n. 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 If thereunder is for 180 days. expiration work suspended ' 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: GOLDENROD_- ASSESSOR'S OFFICE, HARD COPY - FILET City, State, Zip i : WHITE = FINANCE, PINK - APPLICANT, GREEN - BUILDING, • w CONSTRUCTION ESTIMATE NO. ELItTRICAL FEES NO. PLUMBING FEES IST FL SO FT (a $ UNITS COLL. AREA AB GRADE 4 2 ROUGH PLUMB YARD SPKLR SYSTEM 2ND FL SO FT. a HEATING (ROUGH) STORAGE TANK n D RMSEWER MOBILEHOME SVC. BAR SINK POR SO FT * DUCT WORK ROCK STORAGE GAR SO. FT. 0POWER OUTLET ROOF DRAINS METER LOOP HEATING (FINAL) DRAINAGE PIPING CAR P. SO FT. C GAS (FINAL) WALL SO. FT. 0 DRINKING FOUNTAIN GROUT WATER HEATER URINAL SO. FT. 0 FINAL INSP. ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation GRADING cu. yd. $ PIUs xE FLOOR DRAIN MECHANICAL FEES I WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER O TO %t- / yl !'.�/% ��•� N` �� 6�� t1p� GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM VENTILATION 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 GAR. FIREWALL SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT. B.T.U. SO. FT. RESID g I V. c SEWAGE DISPOSAL SO.FT.GAR Ii: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 8 AIR COND. SOLAR EfBACK G OLIND PLUMBIN(97 UNDERGROUND A.C. UNIT COLL. AREA AB GRADE 4 2 ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK n D RMSEWER OR SEPI ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL i GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ PIUs xE =$ LUMBER GR. FINAL INSP. c/ FRAMING &vQ / FINAL INSP. ROOFING O TO %t- / yl !'.�/% ��•� N` �� 6�� t1p� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR, GAR. FIREWALL ATHING At" MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESJINITIALS _ GARDEN WALL FINAL 7d ' s- P.O. BOX 1504 - APPLICATIOWONLY Building _ 78-105 CALLE'ESTADO Address J-2- % �,Se f% G L /� �} LA'QUINTA, CALIFORNIA 92253 . Owner - ~ao,4a LL a 1/4!�- - /� � BUILDING: TYPE CONST. Mailing OCC. GRP. - , - Address C.) d% - 7-AI)q(57 tt il+Z• 1.09 /4 V Irl. Z A.P. Number 77-3 City ZipTel. ' 12,, 11A)GS f Z 2 G2 32 Z - /O Lp Legal Description Contractor ` Project Description Sirs c •� VAUJ L C./ _ica)F_Z_ c Address '.Z - CityZip - Tel- �i4 W .S�.e%v�Y 5;y -&.47r 22- State 2State Lic.City & Classif. 8 7`7 3 5L, Lic. # 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. • ij __ / : = / / Sq. Ft. Size New . , N No. Stories No. Dw. Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ -/Z9� e-,AX,*r l SIGNATURE "1' /- DATE - - ' OWN ER•BUILDER-DECLARATION— Estimated Valuation 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, alter, 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, ' 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 Plan Chk. Dep. .� V 4 �• subjects the applicant to a civil penally of not more than five hundred dollars.($500). Plan Chk. Bal. 0. 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 Const. 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, MBCh- - • _ - Provided that such improvements are not intended or offered for sale. If, however, the building . ' or Improvement is sold within one year o f completion, the owner -builder 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 of improves thereon, and who contracts for ; S.M.I. - - - - 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' may' WORKERS' COMPENSATION DECLARATION / ! / I hereby affirm that I have a certificate of consentito %�f•insure, or a certificate of • Worker's Compensation Insurance, or a certified copy S 3800, Labor Code.) ' Policy No. .Company ❑ Copy is filed with the city.. ❑ Certified copy is here nished. - TOTAL 7, S' r1J 1. CERTIFICATE OF EXEMPTION FROM REMARKS. WORKERS' COMPENSATION INSURANCE -.(This section need not be completed If the permit is for one hundred dollars ($100) valuation -AAK'4 Q ) 4 n- 4')A? OR -O? -88 i3 or less.) I certify that in the performance of.thp work for which this permit is issued, I shall not, iU_ _ _ %ASH i TOTAL i 2 Uu- '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 youshould become 'the ' ZONE: BY: - - subject to Workers' Compensation , provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. -I Minimum Setback Distances: • 1 - - Front SetbackfromCenter, Line Rear Setback from Rear Prop.•Line- i CONSTRUCTION.LENDING AGENCY Side Street Setback from Center Line ' 1 hereby affirm that there is a construction lending agency for the performance of the _ work for which mis'permit is issued. (Sec. 3097, Civil Code.) " Side Setback from Property Line -Lender's 'Name Lender's Address FINAL DATE + ' INSPECTOR A. - --- 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.. - - -Icertify 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., p Validated by: Signature of applicant Date Mailing, Address - Validation: - City, State, Zip.. n ' - e - - BUILDING DIVISION CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. 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.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM 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. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/.c HOUSE SEWER FINISH GRADING 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 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 SIGNATURESIINITIALS GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT OF r q�p�° DO��t3'9-1V4f1���'isltTY FEES NOTICEr THIS - (L TO: City of La Quinta 4 'DATE: Department of Community Development,.,. 78-105 Calle Estado f t ' La Quinta, CA, 92253.• ' This is to ' ertify that l/2eG develop of- which is located within this District, has paid s fool facility'fees posed pursuant to the { authority generated by Govfr�nment Code Sectif911 53080 in the amount off) $ /0; l�vl3 BMJ ( %t.✓L covering a total of / / C Z 'square feet of ( residential or ( ) industrial/commercial development and that building permits for this yfo age in his dev lopment may now be issued by your jurisdiction. 270,,E�v� - for DESERT SANDS IFIED DISTRICT �! White - Building Department • Yellow -'Facilities Planning • Pink - Accounting i Gold - D veloper, (10)-37 ., z O F U W rn To z O FZ U w U) U) Y fr Q W Er X z O U W U) ' rt- .-'',.`..."t:•^. -+, 4,r,� r yti, .�'�"'•,k'vv� ' t (f �.. , ` , .. ,5. ..'i`r�.. 4 _ .:, !.. -%i�Y �•.rr v`. r:.�,FZ i.., COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH �i%3 U ? Z ENVIRONMENTAL HEALTH SERVICES DIVISION - z Z 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 C7'rWA A a O'd-o-Air cmc . �a � a '77� �A O' r ?',� Vii City PROM ,SP Q9Z u State R Zip Code z z zr Telephone 3 Z2 -moo z. 'Job Property Address 'City or Community a tegal-Descnption of Piopeny`(Lot. PM. TRl- S"'o? 7 Z S V14 L L QQ 444107 u i d 7°'e� L ©7'' D 44415':31_109 . e - .Assessor's Parcel No Water Agency or Well - - Use of Permit Planning Case # �/1 +� 73 �� O 2 �"" �I ST'/��G'i"� SFD. MH Site Preparation Etc fJ Signature of Applicant Date r ' • The above information must be verified from Building Application STAFF USE — 00 NOT WHITE BELOW THIS LINE {` Initial Date Certification of Existing S.D. System required. ❑ Yes No WOCB Clearance required. ❑ Yes No Soils feasibility report required. ❑ Yes No Special feasibility boring report required. ❑ Yes No Detailed contour plot plans required. ❑ Yes No Staff Specialist approval required. ❑ Yes No Lot Inspection Date Soils/boring report by G r ` Project # Date Soils Map Page Soil Type Approved by Date Type of System: .. No. of Bedrooms (1) Septic Tank Soil Rate Required I ❑ Existing 2`rNew ❑Additional ❑Replacement �',,-'�.i�, M (A X ( cx-X�I Gals. L\ `'s° I / 'f` 1 (2) Leach line sq. ft. (Bottom trench rea) ft. rock/Sq� Ft. Sidewall allowanc/NIA Install Line(s)�Ft. Long, Ft. wide with In. inches Leach bed q. Ft. of bottom per running ft. 1 , rock below drain lines area Leach lines/bed-special design for slope: Applicable (3) Pit DiameterNo. Pits I Pit BI Seepage Pit total depth ❑ 5' �6" �. r 1 141 Max. allowable depth N/A Overburden f� or '� ! This application ispprr,ved/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. t`( -14 -)Septic tank and sewer lines must be 50' from any wells �1 r (2) Leach lines must be 100' min. from any wells including expansion area j p y 2 �, S l�k I �)>eepage pits=must be 150' min. from any wells-inr�uding expansion area CA­Ct, Signature of Health Official Date RECEIPT NO. 7� 3 + Issued by 1V,— t1' Date District: ❑ Riverside ❑ Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe Distribution: WHITE—Office file YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Pending File DOH -SAN -122 (Rev. 4188) 9 IV. f R OI FILE OF E. LEON SPAUGY AGRICULTURAL COMMISSIONERWLL J s LAMES o u ALSACE I ,•, � AND V � ASS;SiANI CP. hM?nSc1°�E o V ` , WEIGI'I1 S & MEASURES CLEME�1 4E: VEhISiE su�ta 1. *� 49-613 Ilwy 86, Suite B-12 ' 1,.•' 'Coachella, CA 92236 %9o5 619-342-5291 DATE - O CASE NO. k a ]DEVELOPER'S NAME:' 61e5 OC/ ADDRESS 1 7W IC4Pa I TELEP110NE: % Z S1`72,5" zj?ZZ Jc) Dear Developer: '7 7 37 -Z_ z - C-1 2 L . After reviewing your landscaping plans, all plant material listed is not in; violation of quarantine laws govetanbng the Coachella Valley. If substitutions do occur and they differ frau plant material listed, this office must be iiotified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agricultural Comniss' ner's Office cc: Indio and Riverside Office as . 4 Certificate of Compliance: Residential (Page 1 of 2) CF-1R S7'Ai rJST , yE .'i , a�1P L.,j ­2 ' (c, V Project Title ,^ Date Project Address / Building Permit M Documentation Author Telephone �O t tr S , �s Checked By / Date Compliance Method (Package, Point System or Computer) Climate Zone Enforcement Agency Use Only ` GENERAL INFORMATION Total Conditioned Floor Area:�4-1 o 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:East / South / West / All Orientations (circle one or more) Number of Dwelling Units: �T Floor Constriction Type: lab aised Floor (circle one or both) Infiltration Control: andard ght (circle one) BUILDING SHELL INSULATION Component Insulation Location/Comments Type R-Value (attic, to garage, typical etc.) Wall .............. Wall .............. Roof ............. Roof ............. Floor ............. . . Floor ............. Slab Edge ..... a P4 GLAZING Shading. Devices Glazing Area Glass Type Interior, Exterior Overhang Framing Type Orientation (SO (single, double) (roller-blind, etc.) (shadescreen, etc.) (yes/no) (metal/wood) Front.... (iA 3 2 lyem � IJ•� Front.... dr�z' Left...... (t_) 12 t��y �� t,ttt` rJ ►�� �l E S Left...... Rear..... (s) S o J f3�� ✓ !s t3- a �— tJ D aJ� ` f 1'Lr�a G� Rear..... ( ) Right.... (w) - J J t,A-.- i Skylight......: o Skylight....... THERMAL MASS Type/Covering Area Thickness (slab/exposed, tile, etc.) (SO (inches) Location/Description (kitchen, bath etc.) ew s ms—._4 t., l) Z� Ll rZ_ f2,1 n -r S x t� e sc n ,�� 1 4 L 3 . lC tT !✓ *1 T0-� R ra�� Certificate of Compliance: Residential (Page 2 of 2) CF -1R 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) r 9.1. �E'EtL Maximum Furnace Heating Output: 'S8„i Btuh HOT WATER SYSTEMS Tank . Manufacturer/Model # System Type (storage gas, etc.) Capacity (or approved equal) Special Feature(s) 17 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: Name: Title/Firm: Title/Firm: Address: Address: Telephone: Telephone: Lic. #: (signature) (date) (signature) (date) Documentation Author Enforcement Agency Name: ]tel V i . 1� Lt ! • 1 Name: Title/Firm: W (LCeVr f . N 0, T a N,4C Agency: Address: 'L�) —`7" 7 .a �`+" ..J �l' C+ A.. Telephone: LA N Telephon y ` (signature) (date). (signature or stamp) (date) Forth Revised March 1989 0 Point System Summary: Climate Zone 15 BUILDING DATA Conditioned Floor Area J !4,t Number of Stories / Slab/Raised Floor SLhra . Check`all applicable Unit Type condition(s): [ ] Single Family Detached (SFD) [ J Addition Alone [mingle Family Attached (SFA) [ j Existing Building [ ] Multi -Family (MF) [ J' Existing -Plus -Addition 3 = !nr SCORE, CARD Glass Area % Glass North 3 2 2' . 3' East South rg .44I L West_ Skylight �. Total, 2. Wall Insulation SCORE, CARD Measures 1. Ceiling Insulation a 'or R-value[38] U -value (0.0301 2. Wall Insulation or R=value (191 U -value [0.0661 , 3. Raised Floor Insulation or R-value[191 U-value(0.037.1 4. Slab Edge Insulation I,) or - R -value (0) f F2 factor (0.77) S. Infiltration . Standard 6. Glass Heat Loss —! -. �'� I j • Z$ Type (double) 11 -value [0.651 % Total Glass (16] 7. Shading (Shade Open) - -' % Glass Sc Eff. % Glass a. North b. East 5[te x .111) c. South . l Z x > 17 d. West (a o x � _ `L e. Skylight x = _ 8. Shading (Shade Closed) % Glass SC Eff. % Glass a. North Z . 3 x Z1 = SI 'b. East c. South .� • t t x 0t d. West to - x n ,, = 1 • 3 z e. Skylight ..0 x = 9., Interior Thermal Mass 10. Exterior Wall Mass Interior Mass/CFA c Exterior Wall Mass 11. Heating System; 1.0 _ x . g Z = •>L Zonal Control? (Y )o SE or HSPF Duct Efficiency 10.781 Effective SE or 12. Cooling System. [0.72/6.61- �, t.S' x 2 _ HSPF 10.5615.151 . -j, g Z ?Anal Control? (YN SEER [9.51 Duct Efficiency [0.741 Effective SEER [7.031 13. Water Heating 5 e 1Z o 4w- -- Type (SG1 Credit [none] Form Revised March 1988 A Point Scores 0 ,. c7 0 o ' 0 Point Total. +-3 3 Sum 7-10 k Shading Coefficient (SC) Worksheet. Form S i 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 r 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: !)C�f3l6. ,Interior Shade Type: W W-� 4-< < Pr k- 2. SCglazing alone: les 7. SCshade open: 1.00 3'. Framing Type (metal/wood): 8. SCshade closed: - 'z 4. 'Mullions (yes/no): ' 4-415 1 (SC of shade w/ clear single glass) 5. Framing/Mullion Factor. (from Table G-10) f - i Glazing, Interior Shade & Framing 9a. [( l' J x 0.25) + 0.75] x . x Where: SCmax SCmin FMF (#5) SC Shade Open SCmax = larger of #2 and #7 or 9b. Z1. (from Table G-9) SCmin = smaller of #2 and #7 SC Shade Open 10a. (( _ x 0.25) + 0.751 x - x Where. ' SCmax SC„dn - FMF (#5) , 'TC Shade Closed SCmax = larger of #2 and #8 or l Ob. z -z. (from Table G-9) SCmin = smaller of #2 and #8 SC Shade Closed Exterior. Shade Exterior Shade Type: S-4 a 11. SCexterior shade: 6,-14 (from Table G-11 or manufacturer's data w/ clear single glass) Where: 12. 12. x 0.25) + 0.751 x 'S _ 3 y SCmax = larger of #9a or #9b and #11 SCrnax SC„dn SC Shade Open Scndn = smaller of #9a or #9b and #11 Where- x 0.25) + 0.75] x .lam? _ , 1� SCmax = larger of #lOa or #1 Ob and #11 SC,,,= - SCmin SC Shade Closed SCmin = smaller of #10a or #10b and #11 Overhang (Point System Only) 14. Overhang Factor SC Shade Open f SC Shade Open (Shade Open) , (#12) , (with Overhang] 15. �d� x ly = Overhang Factor SC Shade Closed . SC Shade Closed (Shade Closed)(#13) (with Overhang) Forth Revised March 1988 l Projection Ratio: •• 4 Thermal Mass Worksheet s WS -1R ProjectTitle 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 I 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 D scription Mass Area Mass Capachy Interior Mass Capacity r}- / 13 ,b VEJ�."9 ►ac ► t 2to x 1- f� _ Zotto. V '12F Z gN%.4 l— x y . L, -, IE x I _ x = X _ y Total CFA Interior Mass/CFA EXTERIOR WALL THERMAL MASS Calculate the Exterior Will 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 p = 1 _ Total Total Opaque Exterior Wall Area Wall Mass Form Revised March 1988 Mlandatory Measures Checklist: Residential MF -111 NOTE: Lowrise residential buildings subject JOL 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. • 1 DESCRIPTION DESIGNER ENFORCEMENT Building Envelope Measures • §2-5352(a): Minimum ceiling insulation R-19 weighted average. §2-5352(b): Loose fill insulation'nianufacturer'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 (CEG) quality standards. Indicate type and form. §2=5352(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 barrier installed to compty 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: 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). 02-5312(Exception I): Pipe insulation on steam and steam condensate return & recirculating piping. S ` S Ki R S N §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. 1f §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 1987