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06-3992 (SFD)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tit�t 4 XP Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT '�_, Application Number: 06-00003992 - Property Address: 79785 WESTWARD HO DR APN: 649-061-003-3 -2190 - Application description: DWELLING - SINGLE FAMILY DETACHED Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 235245 Applicant: Architect or Engineer: Lic. No.: OOR SQUARE FOOT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that Iam licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: B License_blef.�136708 Date:/ /7M I Contr ctor. / OWNER -BUILDER RATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500): (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner- .builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. B.AP.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LOPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/23/07 Owner: ENGLE JAMES N 79-785 WESTWARD HO LA QUINTA, CA 92253 a Contractor: FPL CONSTRUCTION t1l P.O. BOX 311OCT 23 2007 PALM DESERT, CA 9I(760)36.0-3500Ft4:4 U1�yT� Lic. No.: 736708 Dl�n, WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is,issued. My workers' compensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 0460005295 _ j certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the L ode, I hall forthwith comply with provisions. Date: APpli WARNING: FAILURE TO SEC ORKERS' COMPENSATION COVER S UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. " 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 elating to b ilding construction, and hereby authorize representatives of this cou ty toe er upon the above en[ioned pro rty for inspection pur DaR�'%��nature (Applicant or �� Application Number . . . . . 06-00003992 Permit . . . BUILDING PERMIT " Additional desc . . Permit Fee . . . . 1115.50 Plan Check Fee 725.08 Issue Date . . . . Valuation . . . . 235245 tom.. Expiration Date 4/20/08 Qty Unit Charge Per Extension BASE FEE 639.50 136.00 ---------------------------------------------------------------------------- 3.5000 THOU BLDG 100,001-500,000 476.00 Permit . . . ELEC-NEW RESIDENTIAL Additional desc . Permit Fee 172.36 Plan Check Fee 43.09 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/20/08 Qty Unit Charge Per Extension BASE FEE 15.00 3692.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 129.22 657.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 13.14 1.00 ---------------------------------------------------------------------------- 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 ` Permit . . . GRADING PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration Date 4/20/08 Qty Unit Charge Per Extension ------ --------------------------------------------------------------------- BASE FEE 15.00 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 101.50 Plan Check Fee 25.38 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/20/08 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 9.0000 EA MECH FURNACE <=100K 27.00 3.00 9.0000 EA MECH B/C <=3HP/100K BTU 27.00 4.00 6.5000 EA MECH VENT FAN - 26.00 1.00 ---------------------------------------------------------------------------- 6.5000 EA MECH EXHAUST HOOD 6.50 LQPERMIT Application Number 06-00003992 Permit . . . PLUMBING Additional desc . Permit Fee 184.50 Plan Check Fee 46.13 Issue Date . . . . Valuation_ 0 •°_ Expiration Date 4/20/08 Qty Unit Charge Per Extension BASE FEE 15.00 20.00 6.0000 EA PLB FIXTURE 120.00 2.00 7.5000 EA PLB WATER HEATER/VENT 15.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN•SPRINKLER SYSTEM 9.00 10.00 .7500 EA PLB GAS PIPE >=5 7.50 1.00 15.0000 EA PLB GAS METER 15.00 ---------------------------------------------------------------------------- Special Notes and Comments NEW SFD . DEMO EXISTING 1872 SQ. FT. HOUSE, 440 SQ. FT. GARAGE AND REBUILD 3692 SQ. FT. HOME June 28, 2007 8:41:07 AM jjohnson ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 72.51 GRADING PLAN CHECK FEE .00 STRONG MOTION (SMI) - RES 23.52 Fee summary Charged Paid Credited Due Permit.Fee Total 1588.86 .00 ..00 .1588.86 Plan Check Total 839.68 500.00 .00 339.68 Other Fee Total 96.03 .00 .00 96.03 Grand Total 2524.57 500.00 .00 2024.57 LQPERMIT P.O. BOX 1504 r 78-495 CALLE TAMPICO APPLICATION ONLY wilding ' AddressZ65W&L)Af�jbLA QUINTA, CALIFORNIA 92253 Owner `/ L BUILDING: TYPE CONST. 01 OCC. GRP. Lk Mailing -(� , Q1, ^ W3 Address 70o �U W� J , �C � P. A.Number h / Cit; ` Zip el. Legal Description / 3 7/G,�:f L� Contractor Project Description Address City Zip Tel. State Lic. City Sq. Ft. [ No. No. Dw. & Classif. Lic. # Size 364 z Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition Address Tel. rite lin Pqtnto Ak Lic. # LICENSED CONTRACTOR'S DECLARATION 1 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 Code, or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 703 1. 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, Business and Profes- sions 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 im- provement 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). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct 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 WORKER'S 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 (5100) 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 Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT If, after making this Certificate of Exemption you should become subject to the Workers' Compensation Provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter the above-mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT Estimated Valuation 01 P_ _ PERMIT AMOUNT Plan Chk. Dep. 0010C) Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure RI LUJ TOTAL CITY OF QUINTA REMARKS FI �.•— 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: Validated by: Validation: Date YELLOW = APPLICANT PINK = FINANCE RECORDING REQUESTED BY F.f,D -VHEN RECORDED MAIL THIS DEED AND, UNLESS _ T7HERWISE SHOWN BELOW; MAIL TAX STATEMENTS TO, ,feces Neal 'Engle .and Gi nloer L... Engle -9-785 I,testward Ho Drive -nd o; California 92201 Order No.17113_ _R Escro« No.. •107-906 This space for Recorder's use �. 'Grant. Deed L'1MERSIGNED GF-A34-TOR(s) DECLAU(s) DOCUMENTARY TRANSFER TAX is $ 51.70' . 12.^ unincorporated area Q City Of Pa;ceI Xo. ratior compu:ed on full valcalof property Conti -eyed, o- r_^Pu'es on full value less value of Picas e- encumbrances remaining at time of sale, and OR A VALUABLE CONSIDERATION, receipt of "which is hereby acknowledged, UrS T. ADAMS. and MARJORIE F', ADAMS, husband End Tsi fe, 6t'i.i\T(S) to ENC ._, husband and 1-7ife, as described real property in the Riverside , state of Ca?ifornia: Tract 2190, ss per xE? recorded in Boot{ 41, Pages 55 to 57 of Maps, _r the Office of the County Recorder of said County, S U -B -TEC T TO: 1: All General and Special Taxes for the.fiscal year1974-75, 2- Conditions, restrictions, reservations, covenants, easements, rights and rights of way, of record, if any. Dated_ May 10.197_4 'STATE OF CALIFORNIA ) I COUNTY OF Riverside } _SS. On May 10, 1974 1 before me, the under• signed, a Notary Public in and -for said County. and State, personally appeared - - - Chsrles T Ada'tns and Mariorie W. Adams, - - - - - - - - - - - - - - - - - - - - - - - - - ' =—, known to me to be the persons whose names are subscribed to the within i instrument and acknowledged thar theme executed the same. , Name (Typed or Printed) Notary Public in and for said County and State nmlmnlnmrtnmmmmminnmm)nmmtnm,mnmrtamnlmm � , s OFFICIAL SEAL PHYLLIS L REESE n NOTARY PUBLIC=CALIFORNIA' PRI.Y^.IPAL, OFFICE IN RIVERSIDE COUNTY My. Colrimission Expires Jan 113, 1975 (Space above- for official notarial seal) MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE; IF NO PARTY SO SHOWN, MAIL AS DIRECTED ABOVE Name Street Address :!oi (3-71) City & Sate 3 91 O 0�// ii. � ]` M CY• � 40 -Wus < M tY � r-' — Q t�-f p= Ti o0P 0 O 0 0 C7 o t COO a O a ai' J ILLI ¢ 41 W v t- C.3 t Am g 3 to This space for Recorder's use �. 'Grant. Deed L'1MERSIGNED GF-A34-TOR(s) DECLAU(s) DOCUMENTARY TRANSFER TAX is $ 51.70' . 12.^ unincorporated area Q City Of Pa;ceI Xo. ratior compu:ed on full valcalof property Conti -eyed, o- r_^Pu'es on full value less value of Picas e- encumbrances remaining at time of sale, and OR A VALUABLE CONSIDERATION, receipt of "which is hereby acknowledged, UrS T. ADAMS. and MARJORIE F', ADAMS, husband End Tsi fe, 6t'i.i\T(S) to ENC ._, husband and 1-7ife, as described real property in the Riverside , state of Ca?ifornia: Tract 2190, ss per xE? recorded in Boot{ 41, Pages 55 to 57 of Maps, _r the Office of the County Recorder of said County, S U -B -TEC T TO: 1: All General and Special Taxes for the.fiscal year1974-75, 2- Conditions, restrictions, reservations, covenants, easements, rights and rights of way, of record, if any. Dated_ May 10.197_4 'STATE OF CALIFORNIA ) I COUNTY OF Riverside } _SS. On May 10, 1974 1 before me, the under• signed, a Notary Public in and -for said County. and State, personally appeared - - - Chsrles T Ada'tns and Mariorie W. Adams, - - - - - - - - - - - - - - - - - - - - - - - - - ' =—, known to me to be the persons whose names are subscribed to the within i instrument and acknowledged thar theme executed the same. , Name (Typed or Printed) Notary Public in and for said County and State nmlmnlnmrtnmmmmminnmm)nmmtnm,mnmrtamnlmm � , s OFFICIAL SEAL PHYLLIS L REESE n NOTARY PUBLIC=CALIFORNIA' PRI.Y^.IPAL, OFFICE IN RIVERSIDE COUNTY My. Colrimission Expires Jan 113, 1975 (Space above- for official notarial seal) MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE; IF NO PARTY SO SHOWN, MAIL AS DIRECTED ABOVE Name Street Address :!oi (3-71) City & Sate 3 Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) Form Aonmved. OMB No 2050-OD3q EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. ManifestTracking Number WASTE MANIFEST CACJ4t;1. sc1a�1.' 7 40t) -S 45 rs053 000789144 FLE 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) J1t1 ENG11L 5F1c - 04C.T.E ?V /MI5 WPrN WAKL) KO 19785 ?;Jl':STWAREI H0 DR IVF LA QURUA, CA Yr?'y i l,A QU114'i'A, CA 92253 Generator's Phone: am 71? -"A KtA 6. Transporter 1 Company Name U.S. EPA ID Number rAT?TrRiCIF'V r*MfTTP 0-^fWT-Tr'At. I CAR00001i1171 7. Transporter 2 Company Name U.S. EPA ID Number V t~- •r t rJRO60049064 8. Designated Facility Name and Site Address U.S. EPA ID Number 1,1 , P's? rOtpnt Y LMR)F11.1, f11vnf; ,Y t?°, 1117.F: PO: T 19.+ Pt PRC.11 , A.; 25144 Facility's Phone: tt jq F,f.v 7h' U A7; y�vE�KJ �T t 1 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit HM and Packing Group (if any)) Quantity Wt.Nol. 13. Waste Codes N( 1. R.U. A1,13FSTO S, 9 HA121?, POt[T (MG #171) �a Z 2. uu c7 3. 4. 14. Special Handling Instructions and Additional Information a) JItl FNIOLL' 0 4771; k;PA iiF•CCION D. 75 iiTiMiC-1,11fF ST. 5A81 PRLA'1C:I)W-0 CA 441.05 (41'+174A-=0$19 : i n6n r. f1TA14D1 1 PAR rA 99.76 i (409) IqC 2336 r VAN.S T)i iRMi^: 1;1V7 r. Nh3 11 . R-7 r.r'"f Sr . AK W-IM'tARD11--10 CA 9"4t 1 C)nS)) 13A -��01 0 r {9091 11L'4 74:'4 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. Generator's/Offeror's Printed/Typed Name 519nature Month Day Year f lit 7 J 16. International Shipments ❑ Import to U.S. F-1 Export from U.S. Port of entry/exit: z - Transporter si nature for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials Ll Transporter 1 Printed/Typed Name ignature Month Day Year (L U) Q Transporter 2 Printed/Typed Name Signature Month Day Year t- 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type yp El Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U Q LL Facility's Phone: Lo 18c. Signature ofAltemate Facility (or Generator) Month Day Year Q Z u, 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) G 1. 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY U.S. EPA Form 8700-22 Read all instructions before completing this form. 1. This form has been designed for use on a 12 -pitch (elite) typewriter which is also compatible with standard computer printers; a firm point pen may also be used -press down hard. 2. Federal regulations require generators and transporters of hazardous waste and owners or operators of hazardous waste treatment, storage, and disposal facilities to complete this form (EPA Form 8700-22) and, if necessary, the continuation sheet (EPA Form 8700-22A) for both inter- and intrastate transportation of hazardous waste. Public reporting burden for this collection of information is estimated to average: 30 minutes for generalors;,10 minutes for transporters, and 25 minutes for owners or operators of treatment, storage, and disposal facilities. This includes time for reviewing instructions, gathering data, completing, reviewing and transmitting the farm. Any correspondence regarding the PRA burden statement for the manifest must be sent to the Director of the Collection Strategies Division in EPA's Office of Information Collection at the following address: U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW., Washington, DC 20460. Do not send the completed form to this address. I. Instructions for Generators Item 1. Generator's U.S. EPA Identification Number Enter the generator's U.S. EPA twelve digit identification number, or the State generator identification number if the generator site does not have an EPA identification number. Item 2. Page 1 of _ Enter the total number of pages used to complete this Manifest (i.e., the first page (EPA Form 8700-22) plus the number of Continuation Sheets (EPA Form 8700-22A), if any). Item 3. Emergency Response Phone Number Enter a phone number for which emergency response information can be obtained in the event of an incident during transportation. The emergency response phone number must: 1. Be the number of the generator or the number of an agency or organization who is capable of and accepts responsibility for providing detailed information about the shipment; 2. Reach a phone that is monitored 24 hours a day at all times the waste is in transportation (including transportation related storage); and 3. Reach someone who is either knowledgeable of the hazardous waste being shipped and has comprehensive emergency response and spill cleanupffncident mitigation information for the material being shipped or has immediate access to a person who has that knowledge and information about the shipment. Note: Emergency Response phone number information should only be entered in Item 3 when there is one phone number that applies to all the waste materials described in Item 9b. If a situation (e.g., consolidated shipments) arises where more than one Emergency Response phone number applies to the various wastes listed on the manifest, the phone numbers associated with each specific material should be entered after its description in Item 9b. Item 4. Manifest Tracking Number This unique tracking number must be pre-printed on the manifest by the forms printer. Item 5. Generator's Mailing Address, Phone Number and Site Address Enter the name of the generator, the mailing address to which the completed manifest signed by the designated facility should be mailed, and the generator's telephone number. Note, the telephone number (including area code) should be the normal business number for the generator, or the number where the generator or his authorized agent may be reached to provide instructions in the event the designated and/or alternate (if any) facility rejects some or all of the shipment. Also enter the physical site address from which the shipment originates only if this address is different than the mailing address. Item 6. Transporter 1 Company Name, and U.S. EPA ID Number Enter the company name and U.S. EPA ID number of the first transporter who will transport the waste. Vehicle or driver information may not be entered here. Item 7. Transporter 2 Company Name and U.S. EPA ID Number If applicable, enter the company name and U.S. EPA ID number of the second transporter who will transport the waste. Vehicle or driver information may not be entered here. If more than two transporters are needed, use a Continuation Sheet(s) (EPA Form 8700-22A). Item 8. Designated Facility Name, Site Address, and U.S. EPA ID Number Enter the company name and site address of the facility designated to receive the waste listed on this manifest. Also enter the facility's phone number and the U.S. EPA twelve digit identification number of the facility. Item 9. U.S. DOT Description (Including Proper Shipping Name, Hazard Class or Division, Identification Number, and Packing Group) Item 9a. If the wastes identified in Item 9b consist of both hazardous and nonhazardous materials, then identify the hazardous materials by entering an "X" in this Item next to the corresponding hazardous material identified in Item 9b. Item 9b. Enter the U.S. DOT Proper Shipping Name, Hazard Class or Division, Identification Number (UN/NA) and Packing Group for each waste as identified in 49 CFR 172. Include technical name(s) and reportable quantity references, if applicable. Note: If additional space is needed for waste descriptions, enter these additional descriptions in Item 27 on the Continuation Sheet (EPA Form 8700-22A). Also, if more than one Emergency Response phone number applies to the various wastes described in either Item 9b or Item 27, enter applicable Emergency Response phone numbers immediately following the shipping descriptions for those Items. Item 10. Containers (Number and Type) Enter the number of containers for each waste and the appropriate •bbreviatior..from Table I (below) for the type of container. TABLE I. -TYPES OF CONTAINERS BA = Burlap, cloth, paper, or plastic bags. DT = Dump truck. CF = Fiber or plastic boxes, cartons, cases. DW = Wooden drums, barrels, kegs. CM = Metal boxes, cartons, cases (including HG = Hopper or gondola cars. roll -offs). CW = Wooden boxes, cartons, cases. TC = Tank cars. CY = Cylinders. TP = Portable tanks. DF = Fiberboard or plastic drums, barrels, kegs. TT = Cargo tanks (tank trucks). DM = Metal drums, barrels, kegs. Item 11. Total Quantity Enter, in designated boxes, the total quantity of waste. Round partial units to the nearest whole unit, and do not enter decimals or fractions. To the extent practical, report quantities using appropriate units of measure that will allow you to report quantities with precision. Waste quantities entered should be based on actual measurements or reasonably accurate estimates of actual quantities shipped. Container capacities are not acceptable as estimates. Item 12. Units of Measure (WeighWolume) Enter, in designated boxes, the appropriate abbreviation from Table II (below) for the unit of measure. TABLE II. --UNITS OF MEASURE G = Gallons (liquids only). N = Cubic Meters. K = Kilograms. P = Pounds. L = Liters (liquids only). T = Tons (2000 Pounds). M = Metric Tons (1000 kilograms). Y = Cubic Yards. Note: Tons, Metric Tons, Cubic Meters, and Cubic Yards should only be reported in connection with very large bulk shipments, such as rail cars, tank trucks, or barges. Item 13. Waste Codes Enter up to six federal and state waste codes to describe each waste stream identified in Item 9b. State waste codes that are not redundant with federal codes must be entered here, in addition to the federal waste codes which are most representative of the properties of the waste. Item 14. Special Handling Instructions and Additional Information 1. Generators may enter any special handling or shipment -specific information necessary for the proper management or tracking of the materials under the generator's or other handler's business processes, such as waste profile numbers, container codes, bar codes, or response guide numbers. Generators also may use this space to enter additional descriptive information about their shipped materials, such as chemical names, constituent percentages, physical state, or specific gravity of wastes identified with volume units in Item 12. 2. This space may be used to record limited types of federally required information for which there is no specific space provided on the manifest, including any alternate facility designations; the manifest tracking number of the original manifest for rejected wastes and residues that are re -shipped under a second manifest; and the specification of PCB waste descriptions and PCB out -of -service dates required under 40 CFR 761.207. Generators, however, cannot be required to enter information in this space to meet state regulatory requirements. Item 15. Generators/Offeror's Certifications 1. The generator must read, sign, and date the waste minimization certification statement. In signing the waste minimization certification statement, those generators who have not been exempted by statute or regulation from the duty to make a waste minimization certification under section 3002(b) of RCRA are also certifying that they have complied with the waste minimization requirements. The Generator's Certification also contains the required attestation that the shipment has been properly prepared and is in proper condition for transportation (the shipper's certification). The content of the shipper's certification statement is as follows: "I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent." When a party other than the generator prepares the shipment for transportation, this party may also sign the shipper's certification statement as the offeror of the shipment. 2. Generator or Offeror personnel may preprint the words, "On behalf or in the signature block or may hand write this statement in the signature block prior to signing the generator/offeror certification, to indicate that the individual signs as the employee or agent of the named principal. Note: All of the above information except the handwritten signature required in Item 15 may be pre-printed. NOTICE AND CERTIFICATION The waste identified on manifest number 000 _� 2 I IW -4 �U_ and bearing California Waste Code 151 is subject to land disposal restrictions contained in CCR Title 22, Chapter 18, Article I. The waste meets the definition of a treated hazardous waste pursuant to Health and Safety Code, Section 25179.3 (1)(2), which states that waste is considered treated if the waste does not contain any substances above the Soluble Thresholds Limit Concentration values established in CCR Title 22, Chapter 18, Article II; and the waste is not prohibited from land disposal as provided in Health and Safety Code, Section 25179.6 (waste analysis is attached for these wastes, where available) As required by CCR Title 22, Chapter 18, Article I, the following certification is made for these wastes: I warrant that I am an authorized representative of the generator, I certify under penalty of the law that the waste complies with the. treatment standards specified in California Code of Regulations, Title 22, Division 4.5 Chapter 18 Section 66268.114. I believe that the information I submitted is true, accurate, and complete. I am ,aware that there are significant penalties for submitting a false certification, including the possibility of a fine and imprisonment. GENERATOR: '71 H ADDRESS: � S is SIV v --,T4mt,e7 //, ielwt c Print name 4 Signature V Title A Y Date 4 6-Di2 . LY� While -Landfill Copy )'ellow-Generalors Copy Pink -Brickley s Job File ax , To -75-1 )I -P;rpSNOO HO_q 13AOHddd A13.qeS I? oNimin ELEGTRIGAL LOAD GALGULATIONS SINGLE FAMILY - RESIDENTIAL 454q 50. FT. FLOOR AREA AT 5 HATT5 PER 50. FT . ................................ = 15,041" (2) APPLIANCE GIRCUIT5 AT 1500 HATT5 EACH ...................................... = 5,000" LAUNDRY CIRCUIT ......................................... = 1,500w RANGE................................................................ = 12,000" HATER HEATER ............................................. = 4,500w 015HHA5HER................................................... = 1,200w MIGROHAVE.................................................... = I,000w REFRIGERATOR ............................................ = 300" EZER.......................................................... = 550w H TE DISPOSER .......................................... = 500w G THE5 DRYER (5,000H MIN.) ......... = 5,500w SMI G. APPLIANGE5 ........................... = 5,000w TAL.............................................................. = 41,bglw FIR5T I0,000H AT 100% ....................... = IO,000w REMAINDER AT 40% ................................ = 15,018" 5UM = 25,018w FAU.................................................................... = 2,500w AIR CONDITIONER ...................... = (q ton) 13,140w M156. LOAD5........................................ = 5,000" 5UM = 20k4Ow TOTAL = 45,118" RE5I0ENGE - NET GALGULATED DRAW: 45,118w (1.25) / 250V = 248 AMPS U5E 400 AMP ELEGTRIC PANEL 3 - PHA5E POHER �p N k REWS 9t -o9 ' 2 &0 \� b0 &0/ ELECTRICAL SERVICE ADDENDUM 1 PROJECT TrrLE: JONATHAN L. ZANE DATS' 11-26,0 7 ENGLE RESIDENCE ARCHITECTUREeDA6E 1/4•-1'4Y 79-785 WESTWARD -HO DRIVE JL LA OUINTA, CA. 92253 JONATHAN L. ZANE, ARCHITECT - UC. #C11,046 DRAwri: CAS" 958 NORTH LA CADENA DRIVE COLTON, CA. 92324-2750 (909) 825-7500 035- Igq,4 Tract # Study Area Type Single Family Residence No. of Units 1 Lot # No. Street Unit 1 79785 Westward Ho Unit 2 Unit 3 Unit 4 Unit 5 S.F. Lot # No. 3692 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 Street S.F. Comments Existing home of 1,872 sq ft being demolished. Additional 1,820 sq ft totaling 3,692 sq ft. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/Walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.63 X 3,692 S.F. or $9,709.96 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By OC/California Bank - Jim Engle Check No. 415783696 Name on the check Telephone 835.1994 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exemp ed by Shar, M it wy Payment Recd X0:00 $9,709.96 :®ver/Under= 1 Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this wl serve to ' notify tlfy you that the 90 -day approval period in which you may protest the fees o r other payment identified above will begin to run from the date on which the building or' installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building DepartmentlApplicant Copy - Applicant/Receipt Copy - Accounting CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 4�J��S��o 47950 Dune Palms Road Q BERMUDA DUNES 0 Date 10/5/07 La Quinta, CA 92253 RANCHO MIRAGE d INDIAN WELLS No. 29721 (760) 771-8515 P DESERT d%ALM LA QUINTA 4 y QINDIO y� Owner Engle APN # 649-061-003 Address 79785 Westward Ho Jurisdiction La Quinta City La Quinta Zip Permit # Tract # Study Area Type Single Family Residence No. of Units 1 Lot # No. Street Unit 1 79785 Westward Ho Unit 2 Unit 3 Unit 4 Unit 5 S.F. Lot # No. 3692 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 Street S.F. Comments Existing home of 1,872 sq ft being demolished. Additional 1,820 sq ft totaling 3,692 sq ft. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/Walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.63 X 3,692 S.F. or $9,709.96 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By OC/California Bank - Jim Engle Check No. 415783696 Name on the check Telephone 835.1994 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exemp ed by Shar, M it wy Payment Recd X0:00 $9,709.96 :®ver/Under= 1 Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this wl serve to ' notify tlfy you that the 90 -day approval period in which you may protest the fees o r other payment identified above will begin to run from the date on which the building or' installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building DepartmentlApplicant Copy - Applicant/Receipt Copy - Accounting rI CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT Form updated & effective 11/17/2006 Green Sheet approvals are forwarded to the Building & Safety Department directly by Public Works. Please DO NOT submit the Green Sheet (Public Works Clearance) Packet to the Public Works Department until ALL requirements listed below are complete. Incomplete applications or applications which cannot be processed will be returned to applicant. Date: 6•Z7.07 Developer ��IwL �NGt� Tract No.: 21010 Tract Name: Lot No.(s): Address(s): - wfte=C� EL T-'-)elVF " L—A QuitOi`A , [,A S2'ZS3 The following are the requirements for Public Works Clearance to authorize-issuance-of-a-building_permt_-Z-, from the Building & Safety Department: �� A-r'7-4&g&b — - l ��c_ CUSTO-M_HOMES'1PROVIDE ITEMS #2 #3 #4 AND #5 BELO /v� 7-� 7Tl,O :GRE.D DOW ❖ TRACT HOMES: PROVIDE ITEMS #1. #2_ #3_ #4 (AS Apps MART Fl ANn &a-RF1-nW ❖ COMMERCIAL BUILDINGS/OTHER: PROVIDE ITEMS #1, #2, #3 AND #5 BELOW ❖ WALLS: PROVIDE ITEMS #7 BELOW ❖ SIGNS: PROVIDE ITEMS #8 BELOW 1. Attach Pad Elevation Certificates in compliance with the approved design elevation for building pad (maximum allowable deviation of .+/- 0.1 foot). Pad Elevation Certificates must be current (within 6 months of current date). If a precise grading plan creates the pad for approval, please f�_withhold green sheet submittal until a Pad Elevation Certificate can be provided. ,�2►��", 2. , Attach geotechnical certification of grading plan compliance. r3 Attach recorded final map showing proposed building locations are legal lots. . i4. Attach a completed < 1 acre per lot or infill project Fugitive Dust Control project information form, PM10 plan & agreement or provide alternative & valid City approved PM10 plan set reference number or hard copy plan. PM10 plans for commercial & residential developments (beyond 1 lot) /are submitted separately with grading plans & are subject to additional requirements. Al �Attach an approved precise grading plan for the building location(s). AO flood zone developments will require an approved flood plain development plan. 6. Attach an approved rough grading plan for the building location(s). 7. Attach wall plan & related approved grading plan. 8. Attach sign layout/plan & related precise grading/landscape plan. I have reviewed and confirmed the requirements li ted above as presented and find the improvements to be sufficiently complete for construction of the r posed buildings/structures/walls/signs on the subject lot(s). Pursuant to ndings,�e abo� pro* ct ay be released for building permit issuance. Recommended by: Dated: Public Works Distribution: ( �Greeneet to Building & Safety counter (_) Green Sheet to Community Development Declined for approval for reason(s) as follow(s), please correct and resubmit: City of La Quinta - PM 10 Project Information (< 1 acre per Lot or Infill Project) Page 1 of 3 Form updated & effective 8/25/2005 Project Information Project Phase Project Contractor: Project Phase (Check One): ❑ Construction ❑ Demolition Project Name:4S���C� e0U �- N^T�C�1OhI Project Tract Number: I q O Lot Number(s): Anticipated Start Date: Anticipated Completion: Project Street Address: -7978 � C9 7-WARO � uFV ��e LA 0\1 Total acres in active construction (< 1 acre per Lot): Project Contact Information Please Note: Dust control is required 24 hours a day, 7 days a week, regardless of construction status. Person listed below is responsible for dust control during business and non- business hours. Name: L.L Title: ow Company Name: Mailing Address: 7q 7pS, Wg3rW4,go t4p City: LA 620w7 -A State: 64. Zip Code: 417-2153 Primary Telephone Number: -7&0 • 03 S • Iq% y' Fax: 03 24 Hour Access/Emergency Phone: Z�o — 3 y7_ g" Z �% Cell Phone: 7 &a.V — $ 35 — PM 10 Certificate f Number: 0 ❖ Expanded PM 10 plans for commercial and residential developments > 1 acre are required by the City of La Quinta. PM 10 (< 1 acre per lot or Infill Project) Fugitive Dust Control Plan Page 2 of 3 Plan updated & effective 8/25/2005 This plan shall take into account applicable SCAQMD Rule 403 regulations. Training may be obtained by contacting SCAQMD (Sharon Zamora - Phone: (909) 396-2183). This plan shall consist of the following action items: ❖ WATERING: 'Continuous watering is required to prevent dust and must occur a minimum of 4 times daily. Water shall be applied to dry soils to stop: • Visible dust emissions over 20% opacity • Visible dust emissions that travel over 100 feet. • Water source % hch water meter at front (south) side of pad." ❖ EDUCATION: Responsible Dust Control Individual and key personnel shall attend SCAQMD PM10 class and obtain PM 10 certificate number prior to construction activity. ❖ WEATHER MONITORING: Wind predictions shall be monitored. + SIGNAGE: Use Coachella Valley Fugitive Dust Control Plan Handbook Construction Site Signage Guidelines. ❖ TRAFFIC: Construction traffic shall not be allowed on the pad, unless absolutely necessary. If vehicles operate on pad, pad shall be kept firm and moist through hose watering or sprinklers. Fugitive Dust shall be prevented by fencing off site to prevent unauthorized traffic on pad. (15 mph maximum traffic speed). ❖ PARKING: Parking is not allowed on the pad. All vehicles must park on street (at designated areas only). ❖ TRACK OUT: Provide 24 hour street cleaning and track out system as approved, by City Public Works Inspector. (No dirt on public or private roads). Track out shall be cleaned. up within one hour of incident. ❖ DIRT PILES: Dirt piles shall be limited to 50 cubic yards and built per California Building Code grading requirements. Piles shall be kept moist or covered with tarp material. Larger dirt piles will require stockpile or grading permit. FENCING: Provide PM10 fencing at perimeter of public roads and where applicable. Wood slat fencing can- be installed at rear of property and return 20 feet on either side if HOA restrictions apply. Block walls can replace PM10 fencing during the construction phase. ❖ . EQUIPMENT: Extra hoses and sprinklers shall be maintained on site. ❖ EXCAVATION MEASURES: All areas to be excavated or graded shall be pre -watered. Water shall be applied during excavation or grading operations also. ❖ DUMP TRUCKS: Open top dump trucks to be wet down, moist and tarped prior to leaving site. ❖ INACTIVE SITE: Within 10 days of ceasing of activities, re -vegetate or permanently stabilize as required. city of La Quinta. - Site Specific Construction Phase PM 1 Agreement updated & effective The signature of the property owner (or authorized representative): NTI Shall act as his/her acknowledgement of dust control requirements and their enforceability, pursuant to AQMD Rules 403 and 403.1; ❖ Shall constitute and agreement to comply with all project conditions as identified in the approved dust control plan; The property owner (or authorized representative): Acknowledges that dust control is required 24 hours a day, 7 days a week, throughout the period of project performance, regardless of project size or status; ❖ Shall ensure that each and every contractor/subcontractor and .all other persons associated with the project shall be in continuous compliance with all requirements of the approved dust control plan; ❖ .Shall take all necessary precautions to minimize dust, even if additional' measures beyond those listed in the dust control plan are necessary; ❖ Shall authorize representative of the City/County to enter upon the above mentioned property for inspection and/or abatement purposes; and • Shall hold harmless the City/County and its representatives from liability for any actions related to this dust control plan or any City/County initiated abatement activities. 7&6) S-*':�>s;-- Signa a of Property OwOF or Authorized Representative Printed Name u Title Date Company i Certificatie ofOcc'upanpy. . jHGORPORATID M1� OF I Building & Safety'"Department This Certificate is issued pursuant to the requirements of Section 109 of the California. Building Code, certifying that, of this structure was. in compliance with the the time of issuance, p provisions of the Building Code and the various ordinances of the City regulating building_ T construction and/or use. g BUILDING ADDRESS: 79 785 WESTWARD HO Use classification: SINGLE FAMILY DWELLING Building Permit No.: 06-3992 I Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RM i Owner of Building: JAMES ENGLEAddress: 79-785 WESTWARD HO �3 . City, ST, ZIP: LAQUINTA, CA 92253 a By: STEVE TRAXEL� Date: AUGUST 26, 2008 Building Official '. POST IN A CONSPICUOUS PLACE A TITLE 24 REPORT e ®� LA�P�� SAFQ1 11) E79 � ►7 FOR CONS ® VED DAT TF?-UCT►Or Title 24 Report for: • �,ENGLE RESIDENCE 35�WESTWARD-HO DRIVE =PrkA OUINTA, CA Project Designer: JONATHAN L. ZANE ARCHITECTURE 958 N. LA CADENA DRIVE COLTON, CA Report Prepared By: GINA BROWN Riverside Engineering Group 280 East "D" St. . Colton, CA 92324 (909) 254-2700 Job Number: ENGLE Date: Eing 5/2%20071.2007 The EnergyPro computer program has been used to perform the calculations summarized in this complirrograro s.a oval and is authorized by the:Caliifomia Energy Commission for use with both the Residential and Nonresidential 20Efficiency Standards. This program developed by EnergySoft, LLC - www.energysoft.com. ti n,., „fio Fair_i c U-ar Sumba: 11".0. TABLE OF CONTENTS Cover Page Table of Contents Form CF -1 R Certificate of Compliance Form MF -1 R Mandatory Measures Summary Form WS -5R Residential Kitchen Lighting HVAC System Heating and Cooling Loads Summary EnergyPr: 4.3 by Energy -Soft Job Number: ENGLE 1 2 3 7 9 10 User Number: 1160. a rw r Certificate Of Compliance: Residential ❑ Existing + Add/Alt (Part tof 4) CF:1 R, y Nr,l F R Project Title Raised Floor Area: Natural Gas Slab on Grade Area: 5/2/2007 Date 79-785.WFSTWARn-H0nRIVE Project Address I A QLJINTA Building Permit # Fnainpprinq onn (909) 254-2700 R*yprsede Documentation Author 1 Telephone Plan ChecklDate Fner pyPro15 Field Check/Date Complildee Method Climate Zone TDV Standard Proposed Compliance (kBtu/sf-yr) Design Design Margin Space Heating 2.05 2.49 -0.44 Space Cooling 54.65 50.28 4.37 Fans 7.76 9.32 -1.55 Domestic Hot Water 6.55 5.84 0.71 Pumps 0.00 0.00 0.00 Totals 71.01 67.94 3.07 an Building Type: ) ] Single Family ❑ Multi Family Building Front Orientation: Fuel Type: 4.3% ❑ Addition Total Conditioned Floor Area: ❑ Existing + Add/Alt Existing Floor Area: (N) 0 deg Raised Floor Area: Natural Gas Slab on Grade Area: Fenestration: Average Ceiling Height: Area: 558 ft2 Avg. U: 0.34 Number of Dwelling Units: Ratio: 1 5.1 % Avg. SHGC: 0.33 Number of Stories: BUILDING ZONE INFORMATION # of Thermostat Zone Name Floor Area Volume Units Zone Type Type HVAC system 1A99 336 42n 1 n() CnndjtionPd- Sathn& OPAQUE SURFACES Insulation Act. Type Frame Area U -Fac. Cay. Cont. Azm. Tilt Wall Wnnd 302 _a im R_13 _R-111E—n P Wall Wood 544 0.102 X13 R -n.0 An 90 Wall Wood 432 _0-102 _R-13_ R-0 0 180 90 Wall Wnnd 600 0.102 R_13 R_0 0 27n _ An Wall Wood 220 n ]02 R-13 _R -n -a _ n An Wall Wood 445 0.102 R-13 R 0.0 90 9 Wall Wood 207 n 10 R_13 R -o 0 —18D_ q Wall Wnnd 442 n 102 R_13 R -n n 27n A0 Roof Wood x,544 n 032 R-30 R-0-0 a Gains Condition Y /,N Status 3,692 ft2 n/a ft2 0 ft2 2,363 ft2. 10.0 ft 1.00 2 Vent Hat. Area —8 JA IV Reference Location / Comments ng -A3 1qt Flonr 09-A3 1st Floor p9 -A3 1st Floor ng -A3 let Flnor MAI 2nd Floor ()A -A3 2nd Floor 04A3 2nd Flnnr ng -A3 2nd Flnnr 01-A17 2nd Floor Run Initiation Time: 05102/07 11:18:14 Run Code: 1178129894 I EnergyPro 5.3 by EnergySoft user Number: '01 60 Job Numtar: ENGLE Page: 3 of 10 - Certificate'Of Compliance. • Residential (Part2 of 4) CF -1 R ENGLE RESIDENCE 5/2/2007 Project Title Date FENESTRATION SURFACES True Cond. Location/ # Type Area U -Factor' SHGCZ Azm. Tilt Stat. Glazing Type Comments Window Front (N) 72.0 0 34D NFRC _QM NFRC - Q _,qQ ^gyp`"' Andersen Permashield 1 St Flnnr 2 Window Front (N) 6.0 0.340 NFRC 0_33 NFRC 0 90 New Andersen Permashield 1st Floor 3 Window Left (E) 55.7 0.340 NFRC 0_33 NFRC 90 90 New Andersen Permashield 1st Floor 4 Window Rear (S) 124.0 0.340 NFRC 0_33 NFRC 180 90 New Andersen Permashield 1st Floor 5 Window Rear (S) 94.0 0.340 NFRC 0_33 NFRC 180 90 New Andersen Permashield 1st Floor Window Front (N) 59.6 0.340 NFRC 0_33 NFRC 0 90 New Andersen Permashield grid Floor Floor Z Window Left_ (E) 34.9 0.340 NFRQ 0.33 NFRC - 0 90 New Andersen Permashield 2nd 8 Window Rear (S) 53.3 0.340 NFRC 0_33 NFRC 180 90 New Andersen Permashield 2nd Floor k- Window Rear (S) 20.0 0.340 NFRC 0.33 NFRC 180 90 New Andersen Permashield 2nd Floor Flox 1Q Window Right OM 38.0 0.349 NFRQ 0.33 NFRC 270 90 New Andersen Permashield 2nd 1. Indicate source either from NFRC or Table 116A. 2. Indicate source either from NFRC or Table 1168. INTERIOR AND EXTERIOR SHADING Window Overhang Left Fin Right Fin # Exterior Shade Type SHGC Hgt. Wd. Len. Hgt. LExt. REA Dist, Len. Hgt. Dist. Len. Hgt. 1 Bug Screen 0.76- 2 Bug Screen 0.76 4.0 4.0 2.0 0.1 2.0 2.0 - 3 Bug Screen 0.76 - _ 4 Bug Screen 0.76 - 5 Bug Screen 0.76 4.0 4.0 6.0 0.1 6.0 6.0 - '6 Bug Screen 0.76 - 7 Bug Screen 0.76- 8 Bug Screen 0.76 4.0 4.0 10.0 0.1 10.0 10.0 - 9 Bug Screen 0.76 4.0 4.0 6.0 0.1 6.0 6.0 - 10 Bug Screen 0.76 - THERMAL MASS FOR HIGH MASS DESIGN Area Thick. Heat Inside Condition Location/ Type (sf) (in.) Cap. Cond. R -Val. JA IV Reference Status Comments Concrete Heavyweight 917 3.50 28 0 2 26-A1 New 1st Floor/ Slab on Grade Concrete, Heavyweight 1.446 3:50 _28 0_98 0 26-A1 New 1 st Floor / Slab on Grade PERIMETER LOSSES Insulation Condition Location/ Type Length R -Val. Location JA IV Reference Status Comments Slab Perimeter 223 None No Insulation 26-A1 New New 1st Floor 1 st Floor Slab Perimeter 654 None No Insulation 26-A1 Erer;yFro 4.3 by EnergySo", User Number: 1160 Job NUmber: ENGLE s page:4 of 1n COP, Certificate Of Compliance • Residential (Part 3 of 4) . CF -1 R ENGLE RESIDENCE 5/2/2007 Project Title Date HVAC SYSTEMS Heating Minimum Cooling Minimum Condition Thermostat Location Type Eff _ Type Eff Status Type HVAC System Central Furnace 80% AFUE Split Air Conditioner 15.0 SEER New Setback HVAC DISTRIBUTION Duct Duct Condition Ducts Location Heating Cooling Location R -Value Status Tested? HVAC System Ducted Ducted Attic 6.0 New No Hydronic Piping pipe Pipe Insul. System Name Length Diameter Thick. WATER HEATING SYSTEMS K1 --- Rated Tank Energy Water Heater # in Input Cap. Condition Factor Stand TVDe Distribution Svst. (Btu/hr) (gal) Status or RE Loss I Rheem 41VRP50PT Small Gas No Pipe Insulation 1 40,000: 50 New 0.65 n/a Multi -Family Central Water Heating Details Hot Water Pump Hot.Water Piping rr%n+rn1 . # HP Tvpe In Plenum Outs Add 1/2" Insulation Tank Insul. R -Value Ext. n/a COMPLIANCE STATEMENT This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall design responsibility. The undersigned recognizes that compliance using duct design, duct sealing, verification of refrigerant charge and TXVs, insulation installation quality, and building envelope sealing require installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business & Professions Code) Documentation Author Name: Name: GINA BROWN Title/Firm: JONATHAN . ZANE ARCH TECTURE Title/Firm: Riverside Engineering Group Address: 958 N. LAC EN D E East"St. COLTON C 32 Telephone: Lic. #: 0 7(signature) Ae280 6--1!5VI (date) (date) Enforcement Agency Name: Title/Firm: s' ' pc - Address: Telephone: (signature) (date) Run lottlatron Time, 05/02107 11 18 14 Run Code-, 11781298.94 i EnergyPro 4.3 by E.iergySofl User Number: i 150 .lob Number. E'NGL� Pag,.S of ?�;. Certificate Of Compliance : Residential (Part 4 of 4)' CF -1 R ENGLE RESIDENCE Date 5/2/2007 - Project Title Special Features and Modeling Assumptions The local enforcement agency should pay special attention to the items specified In this checklist These items require special written justification and documentation,' -and special verification to be used with the performance approach. The local enforcement .....a ..H..... a— w.. nnnc head nn fhP- agency aezermmes we dueyuaey L,. N.O J&—U.,...—.., a........, .-,--- adequacy of the special justification and documentation submitted. Plan Field HIGH MASS Design - Verify Thermal Mass: 917 sqft Covered Slab Floor, 3.50" thick at 1 st Floor HIGH MASS Design - Verify Thermal Mass: 1446 sqft Exposed Slab Floor, 3.50" thick at 1 st Floor HERS Required Verification nnnrnv mfor ..ndpr fhB sunervision of a CEC- ILe1115 111 Ulm aG4awn .cy..n- -- ----n .-..-.-. ._....--'---- -+ - approved HERS provider using CEC approved testing and/or verification methods and must be reported on the CF4R Installation certificate. Plan Field The HVAC System "HVAC System" incorporates a HERS verified Refrigerant Charge test or a HERS verified Thermostatic Expansion Valve. The Cooling System "Bryant 550AN048-E1311 JAV048110" includes credit for a 12.5 EER Condenser. A certified HERS rater must field verify the installation of the correct Condenser. EnergyPro'4.3 by EnergySoft I User Number. 11e0 Jib N,.-rnbC.r: ENGLE Q^, -•F of 10. d-' Mandatory Measures Summary: Residential (Page 1 of 2) MF -1 R NOTE: Lowrise'residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. More stringent compliance requirements from the Certificate of Compliance supercede the items marked with an asterisk (') below. When this checklist is incorporated into the permit' documents, the features noted shall be considered by all parties as minimum component performance specifications for the mandatory measures whether thev are shown elsewhere In the documents or on this checklist only. DESCRIPTION Check or Initial applicable boxes or check NA If not applicable and included with the DESCRIPTION documentation. NIA DESIGNER ENFORCE - MENT Building Envelope Measures ❑ ❑X ❑ § 150(a): Minimum R-19 in wood ceiling insulation or equivalent U -factor in metal frame ceiling. ❑ 0 ❑ § 150(b): Loose fill insulation manufacturers labeled R -Value: ❑ R ❑ § 150(c): Minimum R-13 wall insulation in wood framed walls or equivalent U -factor in metal frame walls (does not ❑ Q ❑ apply to exterior mass walls). ❑ 0 ❑ § 150(d): Minimum R-13 raised floor insulation in framed floors or equivalent U -Tactor. ❑ ❑ ❑ § 150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs. ❑ ❑X ❑ 1. Masonry and factory -built fireplaces have: ❑ ❑X ❑ a. closable metal or glass door covering the entire opening of the firebox ❑ ❑ b. outside air intake with damper and control, flue damper and control ❑ N ❑ 2. No continuous burning gas pilot lights allowed. ❑ 0 ❑ § 150(f): Air retarding wrap Installed to comply with 9151 meets requirements specified in the ACM Residential Manual. ❑ ❑ ❑ § 150(g): Vapor barriers mandatory in Climate Zones 14 and 16 only. ❑ ❑ ❑ § 150(1): Slab edge insulation - water absorption rate for the insulation alone without facings no greater than 0.3%, water vapor ❑ ❑ ❑ permeance rate no greater than 2.0 pemdinch. ❑ ❑ ❑ § 118: Insulation specified or installed meets insulation installation quality standards. Indicate type and include ❑ ❑X ❑ CF -6R Forth: § 116-17: Fenestration Products, Exterior Doors, and Infiltration/Exttration Controls. 1. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. ❑ 0 ❑ 2. Fenestration products (except field fabricated) have label with certified U -Factor, certified Solar Heat Gain El N. ❑ Coefficient (SHGC), and infiltration certification. ❑ ❑ ❑ 3. Exterior doors and windows weatherstripped; all joints and penetrations caulked and sealed. ❑ ❑X ❑ Space Conditioning, .Water Heating and Plumbing System Measures § 110-13: HVAC equipment, water heaters, showerheads and faucets certified by the Energy Commission. ❑ ER ❑ § 150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA or ACCA. ❑ ❑X ❑ § 150(i): Setback thermostat on all applicable heating and/or cooling systems. ❑ ❑X ❑ § 150(j): Water system pipe and tank insulation and cooling systems line insulation. 1. Storage gas water heaters rated with an Energy Factor less than 0.58 must be extemally wrapped with insulation ❑ ❑ ❑ having an Installed thermal resistance of R-12 or greater. 2. Baric -up tanks for solar systems, unfired storage tanks, or other indirect hot water tanks have R-12 external ❑ ❑ ❑ insulation or R-16 internal insulation and indicated on the exterior of the tank showing the R -value. 3. The following piping is insulated according to Table 150 -AB or Equation 150-A Insulation Thickness: 1. First 5 feet of hot and cold water pipes closest'to water heater tank, non -recirculating systems, and entire ❑ ❑ ❑ length of recirculating sections of hot water pipes shall be insulated to Table 1508. ❑ ❑ ❑ 2. Cooling system piping (suction, chilled water, or brine lines), piping insulated between heating source and Indirect hot water tank shall be insulated to Table 150-B and Equation 150-A. 4. Steam hydronic heating systems or hot water systems > 15 psi, meet requirements of Table 123-A. ❑ ❑ ❑ 5. Insulation must be protected from damage, including that due to sunlight, moisture, equipment maintenance, ❑ 0 ❑ and wind. ❑ ❑ ❑ 6. Insulation for chilled water piping and refrigerant suction piping Includes a vapor retardant or is enclosed entirely In conditioned space. 7. Solar water -heating systems/collectors are certified by the Solar Rating and Certification Corporation. ❑ ❑ ❑ iEnergyPrc =;.0 ty EnarC Soft user Number: 1;160 Job Number: ENGL E Pa r, o:7 „'1. Mandatory Measures .Summary: Residential- .(Page 2 of 2) MF -IR NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. More stringent compliance requirements from the Certificate of Compliance supercede the items marked with an asterisk (') below. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. Instructions: Check or initial applicable boxes when completed or check N/A if not ENFORCE - DESCRIPTION applicable. N/A DESIGNER MENT Space Conditioning, Water Heating and Plumbing System Measures: (continued) § 150(m): Ducts and Fans 1. All ducts and plenums installed, sealed and insulated to meet the requirements of the CMC Sections 601, 602, 603, 604, ❑ ❑X ❑ 605, and Standard 6-5; supply -air and retum-air ducts and plenums are insulated to a minumum installed level of burning pilot light (Exception: Non -electrical cooking appliances with pilot < 150 Btu/hr) R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 181 B or aerosol sealant that meets the requirements § 118 (1): Cool Roof material meets specified criteria of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh Lighting Measures or tape shall be used. § 150(k)1: HIGH EFFICACY LUMINAIRES OTHER THAN OUTDOOR HID: contain only high efficacy lamps as outlined in Table 2. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than ❑ 0 ❑ sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and electric and have an output frequency no less than 20 kHz. support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause § 150(k)1: HIGH EFFICACY LUMINAIRES - OUTDOOR HID: contain only high efficacy lamps as outlined in Table 150-C, reductions in the cross-sectional area of the ducts. luminaire has factory installed HID ballast 3. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive ❑ ❑ ❑ duct tapes unless such tape is used in combination with mastic and draw bands. in Section 130(c), of permanently installed luminaires in kitchens may be in luminaires that are not high efficacy luminaires, El® ❑ 4. Exhaust fan systems have back draft or automatic dampers. 5. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operating ❑ ® ❑ dampers. § 150(k)4: Pennanenyy installed luminaires located other than in kichens, bathrooms, gareges, laundry rooms, and utility rooms shall be high efficacy luminaires (except closets less than 70 ft) OR are controlled by a dimmer switch OR are 6. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment ❑ ® ❑ maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water always on option. § 150(k)5: Luminaires that are recessed into insulated ceilings are approved for zero clearance insulation cover (IC) and are retardant and provides shielding from solar radiation that can cause degradation of the material. certified to ASTM E283 and labeled as air tight (AT) to less than 2.0 CFM at 75 Pascals. ❑ ❑ ❑ 7. Flexible ducts cannot have porous inner cores. same lot shall be high efficacy luminaires (not including lighting around swimming poolstwater features or other Article § 114: Pool and Spa Heating Systems and Equipment 680 locations) OR are controlled by occupant sensors with integral photo control certified to comply with Section 119(d). 1. A thermal efficiency that complies with the ApplianceEfficiency Regulations, on-off switch mounted outside of the ❑ ❑ ❑ heater, weatherproof operating instructions, no electric resistance heating and no pilot light re vehiclecles s Lighting for parking garages for 8 or mohall have lighting g thatcompl with Section 146. 2. System is installed with: ❑ ❑ ❑ a. At least 36" of pipe between fitter and heater for future solar heating. dwelling units shall be high efficacy luminaires OR are controlled by occupant sensor(s) certified to comply with Section b. Cover for outdoor pools or outdoor spas. ❑ .❑ ❑ 3. Pool system has directional inlets and a circulation pump time switch. ❑ ❑ ❑ § 115: Gas fired fan -type central furnaces, pool heaters, spa heaters or household cooking appliances have no continuously ❑ ® ❑ burning pilot light (Exception: Non -electrical cooking appliances with pilot < 150 Btu/hr) ❑ ❑ ❑ § 118 (1): Cool Roof material meets specified criteria Lighting Measures § 150(k)1: HIGH EFFICACY LUMINAIRES OTHER THAN OUTDOOR HID: contain only high efficacy lamps as outlined in Table ❑ ® ❑ 150-C, and do not contain a medium screw base socket (E24/E26). Ballasts for lamps 13 Watts or greater are electric and have an output frequency no less than 20 kHz. § 150(k)1: HIGH EFFICACY LUMINAIRES - OUTDOOR HID: contain only high efficacy lamps as outlined in Table 150-C, ❑ © ❑ luminaire has factory installed HID ballast ❑ ❑X ❑ § 150(k)2: Permanently installedluminaires in kitchens shall be high efficacy luminaires. Up to 50% of the Wattage, as determined in Section 130(c), of permanently installed luminaires in kitchens may be in luminaires that are not high efficacy luminaires, provided that these luminaires are controlled by switches separate from those controlling the high efficacy luminaires. § 150(k)3: Permanently installed luminaires in bathrooms, garages, laundry rooms, utility rooms shall be high efficacy luminaires. ❑ X❑ ❑ OR are controlled by an occupant sensor(s) certfied to comply with Section 119(d). § 150(k)4: Pennanenyy installed luminaires located other than in kichens, bathrooms, gareges, laundry rooms, and utility rooms shall be high efficacy luminaires (except closets less than 70 ft) OR are controlled by a dimmer switch OR are ❑ © ❑ controlled by an occupant sensor that complies with Section f19(d) that does not tum on automatically or have an always on option. § 150(k)5: Luminaires that are recessed into insulated ceilings are approved for zero clearance insulation cover (IC) and are ❑ ❑ certified to ASTM E283 and labeled as air tight (AT) to less than 2.0 CFM at 75 Pascals. § 150(k)6: Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the ❑ ® ❑ same lot shall be high efficacy luminaires (not including lighting around swimming poolstwater features or other Article 680 locations) OR are controlled by occupant sensors with integral photo control certified to comply with Section 119(d). § 150(k)7: for lots foi 8 or more have that plies Sections 0130, 132, and es ❑ ❑ ❑ re vehiclecles s Lighting for parking garages for 8 or mohall have lighting g thatcompl with Section 146. § 150(k)B: Permanently installed lighting in the enclosed, non -dwelling spaces of low-rise residential buildings with four or more ElEl ❑ dwelling units shall be high efficacy luminaires OR are controlled by occupant sensor(s) certified to comply with Section 119(d). icnargyPro ;.3 by.EnergySofi User Number: 1160' _ _ Job Numbar: ENGLE _ ' Page:B of 13 / ._�vnP26 07 01:47P Andrew L. Casas h 909-336-1297 p.2 .Residential Kitchen Lighting Worksheet WS -SR .ENGLE RESIDENCE -------- 6121/2007 Project Title Date At least 500k of the total rated wattage of pennaneritty Installed luminaires In kitchens must be in luminaires that are high efficacy luminaires as defined in Table 150-0. Lumilmalres that are not high efficacy must be switched separately. Kitchen Lighting Schedule. 'Provide the following information for all luminaires to be installed in kitchen. COMPLIES-IFA2-B YES XI. NOR EnergyPro4.3 by Ene!rgySoft User Number. 1160 Job Number: ENGLE Page: 9 of 10 R High Efficacy Luminaire Type High Efficacy? Watts Quantity Watts Other Wafts' &4�vtVw Ln g Cnip Fluorescent Twin Yes No 1 27:0 x 10 270 or ez Y,;�' 1 No x or Yes NoOf x Yes N. or No x or Yes I Nox or . .......... Yes I x or Y�S- I No X. or — ------ Yes No x or Yes- No x or Yes --�— X or ....... Yes G x or _Xes_ x = . ........ or. - ------ Yes I No x or Yes -NoX -7 or -Yes No X or Yes No x or ........... Yes No x or Yes No x or . ........ Yes No x or Total A: 270 B: 0 COMPLIES-IFA2-B YES XI. NOR EnergyPro4.3 by Ene!rgySoft User Number. 1160 Job Number: ENGLE Page: 9 of 10 R p • ) V HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY UECT NAME DATE ENGLE RESIDENCE 5/2/2007 TEM NAME FLOOR AREA HVAC System 3 692 CHEC Number of Systems 2 Heating System Output per System 89,000 Total Output (Btuh) 178,000 Output (Btuh/sgft) 48. Cooling System Output per System 46,500 Total Output (Btuh) 93,000 Total Output (Tons) 7.8 Total Output (Btuh/sgft) 25.2 Total Output (sgftrron) 476.4 Air System CFM per System 1,680 Airflow (cfm) 3,360 Airflow (cfm/sgft) 0.91 Airflow (dm/Ton) 433.5 Outside Air N 0.0 Outside Air (cfm/sgft) 0.00 Total Room Loads Return Vented Lighting Return Air Ducts Return Fan Ventilation Supply Fan Supply Air Ducts TOTAL SYSTEM LOAD COIL COOLING PEAK COIL HTG. PEAK CFM ISensiblel Latent CFM Sensible 3,495 45,628 6,1551,472 71,405 0 6,991 7,512 0 0 0 0 0 0 0 0 0 6,991 7,512 59,61 6,155 86,430 550AND48-FJ311JAV048110 57,854 30,236 178,000 Total Adjusted System Output 57,854 30,236 178,000 (Adjusted for Peak Design Conditions) TIME OF SYSTEM PEAK I Aug 2 pm Jan 12 am Note: values above given at ARI conditions IEATING SYSTEM PSYCHROMETRICS (Airstream Te' 26.0 of 67.9 of 67.9 of 117.70F Outside Air 0 Cirri Supply Fan Heating Coil 3360 cfm 67.9 OF 11.0 / 77.6 of Outside Air 0 cfm 80.0/68.5 of Return Air Ducts 80.0 / 68.5 of 80.0 / 68.6 of 63.8 / 62.8 of Supply Fan Cooling Coil 3360 cfm Supply Air Ducts 115.60F ROOMS 70.0 of Supply Air Ducts 65.7/63.5OF 60.2% R.H. ROOMS 78.0 / 67.9 of Return Air Ducts EnergyPro 4.3 by EnergySoft User Number 'i160 Job Number: E •lGLE c Pa3e:10 of,10 0 _ 1Aw1 1+e3bT HS' INSTALL aTION CERTIFICATE '1q - 7S5 JI[c :\ddress l� n E4 WAcf q\xx W V A I CA .. 9 S (Page I of 7) umber CF -6R .An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required: however. use of this form to Provide -the information is optional.) After completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at occupancy, per Section 10-10=(b). HV.\C SYSTEMS: Ffenting Equipment Equip. Tvpe (pkEj. CE -C Certified \1t} NameIdenOf Efficiency Duct hear numni and \label \umber (AFUE, etc.,)' Location _ LtrwOX S An4p.0 Svstcros >_CF- IRvaluel (attic. etc.) LZ 14 NN CUOI%trg Equipment Equip. CEC Certified Compressor 9 of T`pe(pk Unit ,NifrName,and heat numni Identical \label Number c....-_ E(Ticiency Duct (SEER, etc.)' Location >_CF - IR value) (attic. etc. L mZ AM-) t_ Duct or Heating Heating Piping Load Capacity k -value (Btu/hr) (Btwhr) Z21� 39i oon S.o 0 Cooling Cooling Duct Load Capacitv t -value (AtW A ... . I . > reads greaterthan or eq[ra! to. vat, 1. the undersigned, verify that equipment listed above is: I) is the actual equipment installed, 2) equivalent to 0r more efficient than that specified in the certificate of compliance (Form CF - IR) submitted for compliance with the Ener g)- q Etlicie,rct� Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate requirements for manutactured devices (from the .-lpplia,[ce Efficie,rcr-Regulations or Part 6), where applicable. rWV..\T ure. Date �ZE A 1 �jrl�iil DN i±N S 8 ' 2D ' OS Installing Subcontractor (Co. Name) Q N 11FATINr Sv,2z r S: OR General Contractor (Co. Name) OR Owner I leiterDistribution If Recir- q of CF.0 Cenitied \11'r Type ISid, culation. Rated' Tank E(Ti- External I'% lie Name Y %lodel Number Identical Input (kw Volume ciency' Standby= Insulation Pm°['ot-Ilse) Control Type Systems or Btu/hr) (gallons) , ! (EF, RC) 1_oss ('�) R -value For small !:Is storage (rated input of less than or equal to 75.000 Dtwhr)• electric resistance and heat pump water heaters, list Energy Factor. For large Pas s(nrage water heaters (rated input of greater than 75.000 Otu/hr), list Recovery Efficiency, Standby Loss and Rate For insinn[ancous gas water heaters. list Recovery EMciency and Rated Input. d Input. J. I'_ external insulation is mandator• for storage water heaters with an energy factor of less than 0.58. Faucets & Shower Heads: All (auCetS and showerheads installed are certified to the Commission, pursuant to Title 24, Pan 6, Section 1 J 1. I, the undersigned. verify (fiat equipment listed above my signature is: l) the actual equipment installed: 2) equivalent to Emore �ffcient than that soecitied in the certificate o I f compliance (Form CF -IR) submitted for compliance with the E�r'a. E�/i %!)?Ci• .Stanciards 'or residential buiidinQs: and re :'e:• er is nt for manufa'e E fci nclRegu lured devices I from the .applianc9lationhat Partwhere s orxeels applicable. appropriate Installing Subconrractor ( Co. Name) OR Generai Contractor (Co. Name) OR Owner .July 1. 1990 CERVIIF—IICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF4R G- n Gr%P i ,P GP ��� Project Titl Date Project Address Street Address: ,;7— �M/r /4 E./r', Copies to: Builder, HERS Provider Builder Name Plan Number Sample Group Number Sample House Numb HERS Provider: �/�y`f/y�1�/1� City/State/Zip:��� HERS RATER COMPLIANCE STATEMENT The house was: A Tested ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply wi the diagnostic tested compliance requirements as checked on this form. The installer has provided a copy of CF -6R (Installation Certificate. Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts) Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT 1 D ct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) / Measured Duct Pressurization Test Results (CFM @ 25 Pa) values Test Leakage Flow in CFM If fan flow is calculated as 400cfiu/ton x number of tons enter calculated value here If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) 61, 3 ChegL R.+x Fn • Pass zvr or'Fa PTs Fail THERMOSTATIC EXPANSION VALVE (TXV) Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection � ❑ Yes is apass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT l ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -1R and' design on plan. 2. ❑ Yes ❑-No TXV is installed or.Fan flow has been verified. If no TXV, verified fan flow matches design from CF -1R. s Measured Fan Flow = 13 13 Yes for both 1 and 2 is a Pass Pass Fail Compliance Forms August 2001A-16 . CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7 CF4R Project T aj� Date ,�- MC 7q - Project Address Builder Name Builder Contact HERS Rater Certifying Signature Firm: Street Address: Copies to: Builder, HERS Provider Telephone Plan Number 7z Sample Group Number Sample House Number HERSProvider: City/State/Zip: LOI "/ HERS RATER COMPLIANCE STATEMENT The house was: -V Tested ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification? I certify that the houses identified on this form comply wi the diagnostic tested compliance requirements as checked on this,form. The installer has provided a copy of CF -6R (Installation Certificate. Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts) Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Duct Pressurization Test Results (CFM @ 25 Pa) Test Leakage Flow in CFM If fan flow is calculated as 400cfin/ton x number of tons enter calculated value here If fan flow is measured enter measured value here Measured values Leakage Percentage (100 x Test Leakage/Fan Flow) Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ❑ Yes is a pass ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1 ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -1R and design on plan. 2. ❑ Yes ❑ No TXV is installed or -Fan flow has been verified. If no TXV, verified fan flow matches design from CF -IR. Measured Fan Flow = Yes for both I and 2 is a Pass P s Fail ❑ ❑ Pass Fail Compliance Forms August 2001A-16 CERTIFICAATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF4R Project Tiffs Date � v✓t Project Address Builder Name Builder Certifying Signature Firm: Street Address: /-7-�l�i�,�riq Copies to: Builder, HERS Provider Telephone Plan Number �60-Yq9 -7-2gg Telephone Sample Group Number Sample House Numbr HERS Provider: / .' e. L.0 City/State/Zip: 'A / r ty- HERS RATER COMPLIANCE STATEMENT The house wasTested ❑ Approved as part of sample testing, but was not tested As the HERS rater proJiding diagnostic testing and field verification1 I certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. The installer has provided a copy of CF -6R (Installation Certificate. Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts) Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)' Measured Duct Pressurization Test Results (CFM @ 25 Pa) values Test Leakage Flow in CFM If fan flow is calculated as 400cfrn/ton x number of tons enter calculated value here If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = , ;7 C -he-Gk Box fer Pass or Fail (Pass=i6% ol less) P Fail THERMOSTATIC EXPANSION VALVE (TXV) Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection Yes is a pass ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1 ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -IR and' design on plan. 2. ❑ Yes . ❑ No TX� is installed or. Fan flow has been verified. If no TXV, verified fan flow matches design from CF -1R. j Measured Fan Flow = Yes for both 1 and 2 is a Pass Compliance Forms August 2001 Pass Fail ❑ ❑ Pass Fail A-16