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002336 (SFD)Building Address Owner Mailing Address City Tity,,,, 4 4aabtm 51--755 Ammida iii= Zip ITel. P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 1 . Contractor aooress I Sam City lZip Tel. State Lic. I City & Classif. $Z 317340 Lic. # 655 Arch., Engr., Designer Address Tel. City IZip I State I 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 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, 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 Division 3 of the Business and Professions Cade, 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). ❑ 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 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.) 0 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 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. 3800, Labor Code.) Policy No. Company ❑ 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 ($100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owrier NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, Stale, Zip HARD COPY No. 002336 BUILDING: TYPE CONST. OCC. GRP. A.P. Number 774-151-013 Legal Description lot 1 PU? 300 Project Description S ri? farauv l -.13 7 ti's 1321 No. Sq. Ft. 432 stories No. s Size Stories - Units New ❑A koxAdd 6" Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 66,$.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 44.Jd Const. . UXU Mech. 37.W Electrical 62.Ul Plumbing 97.00 S.M.I. 4.90 Grading 20.00 Driveway Enc. 20.00 Infrastructure 1,073. rs TOTAL 1,905.41 1,65!1.41 REMARKS i VirFix.j .�.✓F*J LykV� iG s:w'w,wa►i' krv'i r. w..,r. w .aawr.+ 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 Issued by: Date 4�-22-5— Permit Validated by: Validation: A542.2 4 28 1655,41 U CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL.. SO. FT. ® $ UNITS &4LA8 GRADE O/ ROUGH PLUMB. OC BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. @ FORMS C9 yam/ R SEP CC ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. I SQ. FT. ® GROUT WATER HEATER WALL SQ. FT. ® L,�IFINAL INSF''P- DRINKING FOUNTAIN SO. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation �1 FINAL INSP. 2 5� U 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 LAUNDRYTRAY 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. SQ. FT. ® c BATH TUB LATHING G SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER FINISH GRADING GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE OBL 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 &4LA8 GRADE O/ ROUGH PLUMB. OC BONDING HEATING (ROUGH) STORAGE TANK FORMS C9 yam/ R SEP CC ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE L,�IFINAL INSF''P- BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. �1 FINAL INSP. 2 5� U . RAMING ` INAL INSP. ,} 7G/4/ HOOFING �9 REMARKS: 4^ VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING G MESH INSULATIONISOUND FINISH GRADING L/"/ --FINAL INSPECTIONO'1 if CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS, GARDEN WALL FINAL IE4D o 2 rO H BERMUDA DUNES r RANCHO MIRAGE INDIAN WELLS H PALM DESERT ,P LA OUINTA 110 INDIO ti Desert Sands Unified School District 82-879 HIGHWAY 111 • INDIO, CALIFORNIA 92201-5678 • (619) 347.8631 April 24, 1986 City of La Quinta Department of Community Development 78-105 Calle Estado La Qui'nta, CA 92253 Re: Lot 1, Avenida Diaz, La Quinta Gentlemen: The developer of the above referenced lot has mitigated its impacts on our overcrowded schools by payment of the amount of $628 per unit to be applied to the cost of district educational facilities made necessary by such new development. Sincerely, ,.L -�. John D. Brooks Assistant Superintendent Business Services JDB/crm 0 0 H 0 U w m COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM pplicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to ounty specifications required on the attached check list. A non-refundable filing fee of 30 is required when the application is submitted. Check must be made payable to the ounty of Riverside Building Department Application Log # Name (Owner, Agent, Contractor, Etc.) Mailing Address , , / State Zip Code Date *The above information must be verified *Job Property Address *City or unity I *Legal Description of Prpty. (Lot, PM, TR) *Assessor's Parcel No. Water Agency Use of I Lot Size Initial Or -Weil- SFD, MH Site Planning Case Prep Etc. # l�� S ( 7 �� X �� WQCB Clearance reqd. C V , t'D 7 - ,i 6 Soils feasibility report reqd. x rz i 0 z 0 H H w L Type of System: No. of Bedrooms) (1) Septic Tank Soil Rate Required Existing New Addition Replacement i rJ Gals. (` (2) Leach line sq. ft. Sidewall allowance jInstall Line(s) Leach bed (Bottom trench area) ft. -rock/ Sq. Ft. Ft. Long; �, Ft. wide Sq. -Ft. of per rrunhing,ft. with Min. inches rock bottom N/A C J below drain lines - area Leach lines/bed-special design (3) Pit Diamet�qr No. Pit Seepage Pit total depth '" /k for slope`Appldcable '` 6' EjA Pits BI I N/A Overburden factor /C( Max. allowable depth This application isc-appfor the design of a subsurface disposal s, -stem 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. (1) Septic tank and sewer lines must be 50' from any wells��' ''�f NR Ll! (2) Leach lines must be 100' min. from any wells including exp •si=on area (3) Seepage pits must. be 150' min. from any wells including expansion area I/V Signature of Health Official ' Date RECEIPT NO. xJ 7 2 `l •, / j Issued by Date t. District: Riverside C 7 Indio CVJ�-Hemet C 7 Perris C J Rancho Calif. [ ] Blythe[ ] Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File DOH SAN 122 (Rev. 2/86) Signature of Applicant Date *The above information must be verified from Building Application STAFF USE - DO NOT WRITE BELOW THIS LINE Initial Date Certification of Existing S.D. System reqd. Yes[ 7 No L,/]� WQCB Clearance reqd. Yes[ 7 NoC/� Soils feasibility report reqd. Yes[ ] � NoC/7 ff I Detailed boring report reqd. Yes J NoF-I zDetailed contour plot plans reqd. Yes[ 7 NoCfT 0 _ Staff Specialist approval reqd. Yes[ ] No[/] Lot Inspection Date w Soils/boring report by Proj' # - Date / Soils Map Page 1 I I ISoil Type Approved by AW/l / Date Y �S r x rz i 0 z 0 H H w L Type of System: No. of Bedrooms) (1) Septic Tank Soil Rate Required Existing New Addition Replacement i rJ Gals. (` (2) Leach line sq. ft. Sidewall allowance jInstall Line(s) Leach bed (Bottom trench area) ft. -rock/ Sq. Ft. Ft. Long; �, Ft. wide Sq. -Ft. of per rrunhing,ft. with Min. inches rock bottom N/A C J below drain lines - area Leach lines/bed-special design (3) Pit Diamet�qr No. Pit Seepage Pit total depth '" /k for slope`Appldcable '` 6' EjA Pits BI I N/A Overburden factor /C( Max. allowable depth This application isc-appfor the design of a subsurface disposal s, -stem 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. (1) Septic tank and sewer lines must be 50' from any wells��' ''�f NR Ll! (2) Leach lines must be 100' min. from any wells including exp •si=on area (3) Seepage pits must. be 150' min. from any wells including expansion area I/V Signature of Health Official ' Date RECEIPT NO. xJ 7 2 `l •, / j Issued by Date t. District: Riverside C 7 Indio CVJ�-Hemet C 7 Perris C J Rancho Calif. [ ] Blythe[ ] Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File DOH SAN 122 (Rev. 2/86) r, 058:10 R2 3/28/84 VH/dr PZ 4 I/ _Foo Foie: DA✓� GR/M/KfiTT COMPLIANCE CHECKLIST For Low -Rise Residential Buildings (except hotels and motels) Attachment 0 Form 2 (Revised 3/84) Climate Zones 2, 4. 6, and 8-15 Step 1: Enter on the form the values for each measure from your building plan and specifications sheet. Step 2: Enter points on this page while working through the point system Building Shell Measure Points 'Total Floor Area. . . . . . . . . 1321 ft2 1. Slab -on -Ground; Perimeter /Soft.. 0epthin. . . R. p - 4- 2. Raised Floor R -Value.. . . . . . . R- o Co 3. Ceiling Insulation or Construction Assembly . . . R-= p Attic, Percent of Roof Over Conditioned Space /040% . ft2 4. Wall Insulation or Construction Assembly, . . . . . . R- Glazing; Total f Floor Area Single Double Trlple S. North -Facing. ,t.s. ft 2 ft 2 ft2 t 6. East -Facing ft *ft ftft p 7. South -Facing. ft22#:ft2 _e5 8. West -Facing . . . ft2 a2 ft2 ft 29. Skylight. . ft ft #—Z ft c 10. Shading Coefficient (excluding overhang) a. East . . . . . . . . . . . .3o SC . . . . . . . . . . . . . =1 b. South . . . . . . . . . . . . . . . C C. West . . . . . . ... . . . . . . SC . d. North. . . . . . . . . . . . . SC . . . . . . . . . . . . . o e. Skylight. . . . D SC . . . . . . . . . . . . . o 11. Horizontal South Overhang Length. . . . 2 ft . . . . . . . . . 12. Movable Insulation. S Floor Area. O Z . . . . . . . . . 13. Infiltration (indicate Standard, Medium 07=9t) 14. Thermal Mass Exterior Wall Thermal Mass Area, Heat Capacity. R -Value . . . . . . . — ft 2, HC. R- — — Interior Thermal Mass Area, Heat Capatltyt R.Value 332 ft2, /,A HC, R. 3/ 'V- /0 HVAC System** 15. Gas Furnace without Refrigeration•Cooiing (Seasonal Efficiency). . . . . . . . . . . ... . SE — 16. Heat Pump (Energy Efficiency Ratio). . . . . . . . . . . . =E ER 17. Gas Furnace with Refrigeration Cooling Seasonal Efficiency and Seasonal Energy Efficiency Ratio. . . . . . . . . SE - SEER — 18. Active Solar (Net Solar Fraction, %). . . . . . . . %NSF 19. Zonally Controlled Electric , Resistance Space Heating . . . . . . . . . . . . . (Yes/No) - Domestic Water Heating•• 20. Solar With Gas Backup (Net Solar Fraction, %) . . . . . . . . . — S11SF 21. Other Water Heating (Describe type) Point System Compliance Total. . . . . . . . . . .i�_�_ *Lhecklistitems; not a point system measure. "Attach documentation for efficiencies and NSF. O5B:10' 0 3/28/84 VH/dr /1AN3Do Fo/�Dave C�,e/MMA�T COMPLIANCE CHECKLIST For Low -Rise Residential Buildings (except hotels and motels) Attachment D Form 2 (Revised 3/84) Climate Zones 2. 4, 6, and 8-15 Step 1: Enter on the form the values for each measure from your building plan and specifications sheet. Step 2: Enter points on this page while working through the point system Building Shell Measure Points *Total Floor Area .. . . . . . . . 1321 ft2 1. Slab -on -Ground; Perimeter /So ft.. Depth 1n. . . . . . . R.:,= 2. Raised Floor R -Value.. ... . . ... . . . R. o 0 3. Ceiling Insulation or Construction Assembly . . . . . . . . Attic. Percent of Roof Over Conditioned Space /oo % . /3 z/ ft 4. Wali Insulation or Construction Assembly. . . . . . . R.- -� Glazing; Total % Floor Area Single Double Tri le S. North -Facing. , 9 S /2 ftZ ft2 O ftZ f ¢ 6. East -Facing 3. o : =ft2 ft2 tt2 1_ 7. South -Facing. 3. / % �2 ft2 ft2 ft2 8. West -Facing 5.5 % .7 2 ft2 ft2 ft2 - 12 9. Skylight. . . o % ft ft ft p 10. Shading Coefficient (excluding overhang) a. East . . . . . . . . . . . . . . . • 30 Sc . . . . . . . . . . . -/ b. South . . . . . . . . . . . . . . . .3oC . . . . . . . . . c. West . . . . . . ... . . . . . 3a SC .. . . . . . . . . �_ d. North. . . . . . . . . . . . . . . -3 SC . . . . . . . . . . . . . D e. Skylight .. . . D SC . . . . . . . . . . . . . o 11. Horizontal South Overhang Length. . . . 2 tt . . . . . . . . . . o 12. Movable Insulation,' % Floor Area. off' . . . . . . . . . . . 13. Infiltration (indicate Standard, Medium 0r-7rgTit) , 14. Thermal Mass Exterior Wall Thermal Mass Area. Heat Capacity. R -Value . . . . . . ftZ, . HC, R. Interior Thermal Mass -Area, Heat Capacityt R -Value . . . . . . 3 3 2 ft2. /o./ HC, R __;.� -k10 HVAC System** 15. Gas Furnace without Refrigeration• Cooling (Seasonal Efficiency). . . . . . . . . . .'. SE 16. Heat Pump (Energy Efficiency Ratio) . . . . . . . . . . . . _E ER 17. Gas Furnace with Refrigeration Cooling Seasonal Efficiency and Seasonal, Energy Efficiency Ratio. . . . . . . . 75 SE 9.-/ SEER f 9 18. Active Solar (Net Solar Fraction. %). . . . . . . . . . . . %NSF 19. Zonally Controlled Electric Resistance Space Heating . . . . . . . . . . . . . (Yes/No) Domestic Water Heatino•• 20. Solar With Gas Backup (Net Solar Fraction. :) . . . . . . . . %NSF 21. Other Water Heating (Describe type) Point System Compliance Total . . . . . . . . . . . . . . . `- 2 *(;hecklistitems; not a point system measure. "Attach documentation for efficiencies and NSF. P�Pare� �y • ✓�� ,.lune 20, /986 056:10 R2 3/28/84 VH/dr .300 .�[ Attachment D Foie : Da✓e �7/�mmG/� Form 2 COMPLIANCE CHECKLIST For Lor -Rise Residential Buildings (except hotels and motels) Step 1: Enter on the form the values for each measure from your building plan and specifications sheet. Step 2: Enter points on this page while working through the point system Building Shell Measure Points *Total Floor Area. . . . . . . . . /-42/ft2 1. Slab -on -Ground; Perimeter /50 ft.. Depth in. . . R -_g- 2. Raised Floor R -Value. .. . . . . . R- o ]. Ceiling Insulation or Construction Assembly . . . . . . . . R - Attic. Percent of Roof Over Conditioned Space % . . . . . . / ftZ 4. Mall Insulation or Construction Assembly. . . . . . . . . . R -1L Glazing; Total % Floor Area Stngle Double Triple 5. NortMFacing. .9 S o ft2 /� ft2Ift26. East -Facing ft2 2ft2T. South -Facing. S ft ftft8. Wst•facing . rb ft2 ft2ft29. Skylight. . -�% ft ftft �• 10. Shading Coefficient (excluding overhang) a. East . . . . . .... . . . .. . .e30 SC =1� b. South . . . . . . . . . . . . . .C c. West . . . . . . . ... . . . . . . A.-IS C . . . . . . . . . . . . . d. North . . . . . . . . . . . . . .C . . . . . . . . . . . . . e. Skylight. . . . . . . . . . . . �_SC . . . . . . . . . . 11. Horizontal South Overhang Length. . . . -_eft . . . . . . . . . . . 12. Movable Insulation. % Floor Area. f _g 11. Infiltration (indicate Standard. M�dtum o g t) .4. Thermal Mass Exterior Wall Thermal Mass Area. Heat Capacity. R -Value . . . . . . . ft2, HC. R - Interior Thermal Mass Area. Neat Capacity, R -Value 332 ft2, 104 -HC. R- 3 / t� NVAC System" 15. Gas Furnace without Refrigeration•Cooling (Seasonal Efficiency)• . . . . . . . . . . . SE 16. Heat Pump (Energy EfficiencyRatio) . . . . . . . . . . . . EER 17. Gas Furnace with Refrigeration Cooling Seasonal Efficiency and Seasonal Energy Efficiency Ratio . . . .. . . . . . . . . SE 8 SEER O 18. Active Solar (Net Solar Fraction. %). . . . . . . . . . . . . %NSF 19. Zonally Controlled Electric, Resistance Space Heating . . . . . . . . . . . . . (Yes/No) Domestic Water Heating** 20. Solar With Gas Backup (Net Solar Fraction. %) . . . . . . . . %fiSF — 21. Other Water Heating (Describe type) Point System Compliance Total. . . . . . . . . . . . . 3 *Checklist tems; not a point system measure. **Attach documentation for efficiencies and NSF. a e M ✓une 20, /986 058:10 02 7/28/84 VH/dr Al 3oo COMPLIANCE CHECKLIST For Low -Rise Residential Buildings (except hotels and motels) Attachment D Form 2 (Revised 3/84) Climate 'Zones 2. 4. 6. and 8-15 Step 1: Enter on the form the values for each measure from your building plan Glazing; Total % Floor Area Single Double Triple S. North -Facing. . 9 % o ft / � ft2 ft2 f 4 6. East -Facing . ft2 ft2 ft2 _Q 7. South -Facing. % ft ft ft 8. West -Facing % ft2 ft2 ft2 9. Skylight. . . . _QHS ft ft ft �- 10. Shading Coefficient (excluding overhang) a. East . . . . . . . . . . . . . . . i30 SC . . . . . . . . . . . . . _.[_ b. South . . . . . . . . . . . . . .L c. West . . . . . . . ... . . . . . SC . d. North . . . . . . . . . . . . . . SC . . . . . . . . . . . . e. Skylight. . . . . . . . . . . �_SC . . . . . . . . . 11. Horizontal South �Overhang Length. . . . _eft . . . . . . . . . . 12. Movable Insulation. % Floor Area. .��% . . . . . . . . . . . . . Q 13. Infiltration (indicate Standard. Rediva or TT9Ft) �L 14. Thermal Mass Exterior Wall Thermal Mass Area, Heat Capacity. R•Value . . . . . . . ft2. HC. R• r Interior Thermal Mass Area, Heat Capacity, R -Value ..... 332 ft2. 12,4_,HC. R..3/ t_a MVAC System** 15. Gas Furnace without Refrigeration Cooling (Seasonal Efficiency). . . . . . . . . . . . SE r 16. Heat Pump (Energy Efficiency Ratio) . . . . . . . . . . . . . EER 17. Gas Furnace with Refrigeration Cooling Seasonal Efficiency and Seasonal Energy Efficiency RatioSE 8_SEER O 18. Active Solar (Net Solar Fraction, %)� . . . %NSF 19. Zonally Controlled Electric, Resistance Space Heating . . . . . . . . . . . . . (Yes/No) T Domestic Water Heating" 20. Solar With Gas Backup (Net Solar Fraction. ;) . . . . . . . . %NSF 21. Other Water Heating (Describe type) Point System Compliance Total. . . . . . . . . . . . 3 *F.hecklistItems; not a point system measure. **Attach documentation for efficiencies and NS. :. IL and specifications sheet. Step 2: Enter points on this page while working through the point system Building Shell Measure Points *Total Floor Area. . . . . . . /3 2/ft2 1. Slab -on -Ground; Perimeter /50 ft., Depth in. R•_$. :- 2. Raised Floor A-Value.R• o 3. Ceiling Insulation or Construction*Assembly Attic. Percent of Roof Over Conditioned Space % R - . . . . . . / ft2 4. Wall Insulation or Construction Assembly. . . ... . . . . . . . R•�_ Glazing; Total % Floor Area Single Double Triple S. North -Facing. . 9 % o ft / � ft2 ft2 f 4 6. East -Facing . ft2 ft2 ft2 _Q 7. South -Facing. % ft ft ft 8. West -Facing % ft2 ft2 ft2 9. Skylight. . . . _QHS ft ft ft �- 10. Shading Coefficient (excluding overhang) a. East . . . . . . . . . . . . . . . i30 SC . . . . . . . . . . . . . _.[_ b. South . . . . . . . . . . . . . .L c. West . . . . . . . ... . . . . . SC . d. North . . . . . . . . . . . . . . SC . . . . . . . . . . . . e. Skylight. . . . . . . . . . . �_SC . . . . . . . . . 11. Horizontal South �Overhang Length. . . . _eft . . . . . . . . . . 12. Movable Insulation. % Floor Area. .��% . . . . . . . . . . . . . Q 13. Infiltration (indicate Standard. Rediva or TT9Ft) �L 14. Thermal Mass Exterior Wall Thermal Mass Area, Heat Capacity. R•Value . . . . . . . ft2. HC. R• r Interior Thermal Mass Area, Heat Capacity, R -Value ..... 332 ft2. 12,4_,HC. R..3/ t_a MVAC System** 15. Gas Furnace without Refrigeration Cooling (Seasonal Efficiency). . . . . . . . . . . . SE r 16. Heat Pump (Energy Efficiency Ratio) . . . . . . . . . . . . . EER 17. Gas Furnace with Refrigeration Cooling Seasonal Efficiency and Seasonal Energy Efficiency RatioSE 8_SEER O 18. Active Solar (Net Solar Fraction, %)� . . . %NSF 19. Zonally Controlled Electric, Resistance Space Heating . . . . . . . . . . . . . (Yes/No) T Domestic Water Heating" 20. Solar With Gas Backup (Net Solar Fraction. ;) . . . . . . . . %NSF 21. Other Water Heating (Describe type) Point System Compliance Total. . . . . . . . . . . . 3 *F.hecklistItems; not a point system measure. **Attach documentation for efficiencies and NS. :. IL 9 ,./une 20, 1,791 058:10 R2 3/28/84 VH/dr f`4 N Soo Foie : Dave' C7r1rnrno-# 79- 700 Came/back ver�l�4�it dunes. G'i COMPLIANCE CHECKLIST For Low -Rise Residential Buildings (except hotels and motels) Attachment 0 Form 2 (Revised 3/84) Climate Zones 2. 4, 6. and 8-15 Step 1: Enter on the form the values for each measure from your building plan and specifications sheet. Step 2: Enter points on this page while working through the point system Building Shell Measure Points *Total Floor Area. . . . . . . . . /32/ft2 1. Slab -on -Ground; Perimeter /SD ft.. Depth in. . . . . R ca 2. Raised Floor R -Value.. . . . . . . . . . . R- o 3. Ceiling Insulation or Construction Assembly . . . . . . . . R - Attic. Percent of Roof Over Conditioned Space S . . . . . . // ft2 4. Wall Insulation or Construction Assembly. . . . . . . . . . . . Glazing; Total Z Floor Area Single Double Triple S. North -Facing. . . 0 9 f o ft2 /iZ ft2 ft2 44- 6. East -Facing ft2 ft2 ft2 7. South -Facing. : IZ ft2 �ft2 ft2 8. West -Facing 3 ft2 ft2 ft 9. Skylight. . . . g -Z ft2 ft2 ft2 p 10. Shading Coefficient (excluding overhang) a. East X30 SC =L b. South. . . . C c. West . . . . . . . ... . . SC . . . . . . . . . . . . . A— d. North. . . . . . . . . . . . SC . . . . . . . . . _0— t. Skylight .. . . . . . . . . O SC . . . . . . . . . . 11. Horizontal South Overhang Length. . . . _eft . . . . . . . . . . . 12. Movable Insulation. f Floor Area. Medi .Z _ 9� 13. Infiltration (indicate Standard, m or T'i T'o _L 14. Thermal Mass Exterior Wall Thermal Mass Area, Heat Capacity. R -Value . . . . . . ft2. HC, R - Interior Thermal Mass Area, Heat Capacity, R -Value ..... 33-Z ft2. Lej/ HC. R. 3 / -tom HVAC System** 15. Gas Furnace without Refrigeration•Cooling (Seasonal Efficiency). . . . . . . . . . . . 16. Heat Pump (Energy Efficiency Ratio) .. . . . . . . . . . . . . 17. Gas Furnace with Refrigeration Cooling Seasonal Efficiency and Seasonal Energy Efficiency Ratio . . .. . . . . . . . . SE 18. Active Solar (Net Solar Fraction, f) . . . . . . . . . . . . . 19. Zonally Controlled Electric Resistance Space Heating . . . . . . . . . . . . . (Yes/No) Domestic Water Heating•* 20. Solar With Gas Backup (Net Solar Fraction, f.) . . . . . .. . 21. Other Water Heating (Describe type) Point System Compliance Total . . . . . . . . . . . . . . . *Checklistitems; not a point system measure. *Attach documentation for efficiencies and NSF. i SE EER &ZZ SEER O ZNSF I;NSF —� -3 056:10 02 3/28/84 VH/dr PLAN 400 Fo 1e : De7ve, 6.-117?rna7�' Attachment 0 Form 2 (Revised 3/84) Climate Zones 2, 4. 6, and 6-15 COMPLIANCE CHECKLIST For Low -Rise Residential Buildings (except hotels and octelt) 3 Step 1: Enter on the form the values for each measure from your building plan and specifications sheet. Step 2: Enter points on this page while working through the point system Building Shell Measure Points •Total Floor Area -./425ft2 1. Slab -on -Ground; Perimeter 172 ft., Depth* in. 2. Raised Floor R -Value. . . ... . R- _0 3. Ceiling Insulation or ConstructionAssembly R - Attic. Percent of Roof Over Conditioned Space/00% ft2 4. Wall Insulation or Construction Assembly. . . . . . . . . . . . Glazing; Total % Floor Area Single Double Triple 5. North -Facing. i ft2 Q ft2 O ft2 6. East -Facing ft2 Zft ft2 ft2 7. South -Facing. S ft2ft2 ft2 B. West -Facing . ft22 ft2 9. Skylight. . . . �S ft ft ft � , 10. Shading Coefficient (excluding overhang) a. East . . . . . . . . . . . . . . . .30 SC . . . . . . . . . . . . . b. South . . . . . . . . . . . . . . . C . . . . . . . . . . . . . c. West . . . . . . . . . . . . . . . SC . . . . . . . . . . . . . d. North . . . . . . . . . . . . . . . SC . . . . . . . . . . . e. Skylight . . . . . . . . . . . . . _SSC . . . . . . . . . . . —_ 11. Horizontal South Overhang Length. . . .ft . . . . . . . . . . . . . 12. Movable Insulation, f Floor Area. . -4—.% . . . . . . . . . . . . . 13. Infiltration (indicate Standard. Medium 07 1T6t) 1_ 14. Thermal Mass Exterior Wall Thermal Mass Area. Heat Capacity. R -Value . . . . . . . ft2. HC. R - Interior Thermal Mass Area, Heat Capacity. R -Value . . . . . . 38 7 ft2. /O./ HC. R. . 3 f /o HVAC System** 15. Gas Furnace without Refrigeration Cooling (Seasonal Efficiency). . . . . . . . . . . . . 16. Heat Pump (Energy Efficiency Ratio) . . . . . . . . . . . 17. Gas Furnace with Refrigeration Cooling Seasonal Efficiency and Seasonal Energy Efficiency Ratio SSE 18. Active Solar (Net Solar Fraction, 19. Zonally Controlled Electric, Resistance Space Heating . . . . . . . . . . . . . (Yes/No) Domestic Water Neeting•• 20. Solar With Gas Backup (Net Solar Fraction, S) . . . . . . . . . 21. Other Water Heating (Describe type) Point System Compliance Total . . . . . . . . . . . . . . . SE E ER _SEER %NSF %14 SF - -3 *Checklist Gems; not a point system measure. 4 **Attach documentation for efficiencies and NSF. •.� 4 N 058:10 R2 3/28/84 VH/dr Al 400 Foie: Dove 6,-ir7wma7�4 COMPLIANCE CHECKLIST For Low -Rise Residential Buildings (except hotels and motels) Attachment D Form 2 (Revised 3/84) Climate Zones 2, 4, 6, and 8-15 Step 1: Enter on the form the values for each measure from your building plan and specifications sheet. Step 2: Enter points on this page while working through the point system Building Shell Measure Points notal Floor Area. . 14,,25ft2 1. Slab -on -Ground; Perimeter /7a ft., Depth in. . . . . . R:' 2. Raised Floor R -Value. . . ... . . . . . . R- O 0 3. Ceiling Insulation or Construction Assembly . . . . . . Attic, Percent of Roof Over Conditioned Space /00% . . . . . . ft2 4. Wall Insulation or Construction Assembly. . . . . . . . . . . . Glazing; Total S Floor Area Single Double Triple S. North -Facing. 0% ft2 a ft2 O ft2- i 6. East -Facing =S ft -0 ft ft 7. South -Facing. . Z, S ft2 �ft2 ft2 8. West -Facing ft ft ft 9. Skylight. . . -�_S ft2 ft ft zk p 10. Shading Coefficient (excluding overhang) a. East . . . . . . . . . . . . . .30 Sc D. South. L . c. Best . . . . . . . . . . . . . Sc . d. North. SC . . . . . . . . . O e. Skylight SC . . . . . . . . . _0 11. Horizontal South Overhang Length. . . eft . . . . . . . . . . . . _0 12. Movable Insulation, S Floor Area. O S . . . . . . . . . . . . . 0_ 13. Infiltration (indicate Standard, Medium o—r- "9 t) 14. Thermal Mass Exterior Wall Thermal Mass Area. Heat Capacity, R -Value . . . . . . . ft2, _ HC, R - Interior Thermal Mass -Area. Heat Capacity, R -Value . . . . . . 38 7 ft2, /O./ HC, R- . 3 f /Q HVAC System** 15. Gas Furnace without Refrigeration. Cooling (Seasonal Efficiency) ... . . . . . . . . . ... . SE �— 16. Heat Pump (Energy Efficiency Ratio) . . . . . . . . . . . . —E ER 17. Gas Furnace with Refrigeration Cooling Seasonal Efficiency and Seasonal Energy Efficiency Ratio . . . .. . . . . . . . . �SE 18. Active Solar (Net Solar Fraction, S) . . . . . _SEER , . . , , . %NSF 19. Zonally Controlled Electric Resistance Space Heating . . . . . . . . . . . (Yes/No) Domestic Water Heating - 20. Solar With Gas Backup (Net Solar Fraction, S) . . . . . . . . _USF — 21. 'Other Water Heating (Describe type) — Point System Compliance Total . . . . . . . . . . . . . . . —3 - *Checklist itams; not a point system measure. "Attach documentation for efficiencies and NSF. 058:10 R2 3/28/84 VH/dr 01_4 IV 400 F,o�e: Dove 6rimina7�' COMPLIANCE CHECKLIST For low -Rise Residential Buildings (except hotels and motels) Attachment 0 Form 2 (Revised 3/84) Climate Zones 2, 4. 6. and 8-15 Step 1: Enter on the form the values for each measure from your building plan and specifications sheet. Step 2: Enter points on this page while working through the point system Building Shell Measure Points *Total Floor Area . . . : .� . . . . . . . . . . . . 14251t2 1. Slab -on -Ground; Perimeter /72 ft., Depth In. . . . . . . t 2. Raised Floor R -Value 3. Ceiling Insulation or Construction. Attic. Percent of Roof Over Conditioned Space/DOS . . . . . .t2 4. Nall Insulation or Construction Assembly. . . . . . . . . . . . Glazing; Total f Floor Area Single DoubleTriple S. North•Facing.S ft2 d ft2 0 ft2 t g 6. East -facing ft2Zft2 ft2 7. South -Facing. . S ft2 ft2 ft2 8. West•Facing ft2ft2 ft2 9. Skylight. . . . . �_% ft2 ft2 ft2 10. Shading Coefficient (excluding overhang) a. East . . . . . . . . . . . . . . 030 SC . . . . . . . . . . . . b. South . . . . . . . . . . . . . . .C . . . . . . . c. West C . d. .North. SC . e. Skylight. . . . . . . . . �_SC . . . . . . . . . . . . . 11. Horizontal South �Overhang Length. . . ft . . . . . . . . . . . . 12. Movable Insulation, % Floor Area. . . . . . . . . . . . . . . 13. Infiltration (indicate Standard. Medium or Tight) 1_ 14. Thermal Mass Exterior Wall Thermal Mass Area. Heat Capacity. R•Value . . . . . . ft2. HC. R - Interior Thermal Mass Area. Heat Capacity, R -Value . . . . . . . 7 ft2. /D./ HC. R. . 3 f /O HVAC System** 15. Gas Furnace without Refrigeration. Cool Ing (Seasonal Efficiency). . . . . . . . . . . SE 16. Heat Pump (Energy Efficiency Ratio). . . . . . . . . . . EER 17. Gas Furnace with Refrigeration Cooling Seasonal Efficiency and Seasonal Energy Efficiency Ratio . . .. . . . . . . . . SSE &2_SEER O 18. Active Solar (Net Solar Fraction, S) . . . . . . . %NSF 19. Zonally Controlled Electric, Resistance Space Heating . . . . . . . . . . . . . (Yes/No) Domestic Water Heating•• 20. Solar With Gas Backup (Net Solar Fraction, %) . . . .. . . USF — 21. Other Water Heating (Describe type) — Point System Compliance Total . . . . . . . . . . . . . . . — 3 *Cgecklist tems; not a point system measure. "Attach documentation for efficiencies and NSF. " h9 11�' ��