BRER2017-002478-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: BRER2017-0024
Property Address: 53915 AVENIDA VILLA
APN: 774173021
Application Description: HOLL/RE-ROOF
Property Zoning:
Application Valuation: $4,000.00
Applicant:
JEFFREY J. HOLL
29600 NICHOLS STREET
LAKE ELSINORE, CA 92530
DESIGN &"DEVELOPMENT DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
I hereby affirm under penalty of perjury 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.
License Class: License No.:
Date:
Contractor:
OWNER -BUILDER DECLARATION
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 l
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
.1, as owner of the property, or my employees with wages as their sole
ompensation, 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
'thin one year of completion, the owner -builder will have the burden of proving that
she did not build or improve for the "purpose of sale.).
I, as owner of the property, am exclusively contracting with licensed contractors
o 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
t reon, and who contracts for the projects with a contractor(s) licensed pursuant to
ontractors' State License Law.).
I -am exempt under Sec. . B.&P�for this reasonIn I
CONSTRUE NLENDWAGENCY
I hereby affirm under penalty of pert ry 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:
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 iss y workers' compensation insurance carrier and policy number are:
CTentsition
Polity Number:
ertify that in the performance of the work for which this permit is issued, I
sloy any person in any manner so as to become subject to the workers'
c laws of California, and agr tat, if I should become subject to the
workers' compensation provisions of S io 3700 of the Labor Code, I shall forthwith
comply with those provisions.
WARNING: FAILURE TO SECURE WERS' COWNSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYE V0 CRIMINAL PENALTIES AND CIVIL FINES UP 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 Building Official 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.
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 st a laws relating to.building
construction, and hereby authorize representatives of thi ci to enter upon the
above-mentioned property for inspection purposes. - /7/ - A
Date: 2/17/2017
< Owner:
^ z
J1 HOLL ENTERPRISES LLC
d 1 W
29606 NICHOLS STREET
LAKE ELSINORE, CA 92530
® r. ar O
z
Co Z
!~
Contractor.
S
OWNER BUILDER
O
W
ILL U O
z
' LIc,.No.:
�
W
O -
I hereby affirm under penalty of perjury 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.
License Class: License No.:
Date:
Contractor:
OWNER -BUILDER DECLARATION
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 l
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
.1, as owner of the property, or my employees with wages as their sole
ompensation, 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
'thin one year of completion, the owner -builder will have the burden of proving that
she did not build or improve for the "purpose of sale.).
I, as owner of the property, am exclusively contracting with licensed contractors
o 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
t reon, and who contracts for the projects with a contractor(s) licensed pursuant to
ontractors' State License Law.).
I -am exempt under Sec. . B.&P�for this reasonIn I
CONSTRUE NLENDWAGENCY
I hereby affirm under penalty of pert ry 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:
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 iss y workers' compensation insurance carrier and policy number are:
CTentsition
Polity Number:
ertify that in the performance of the work for which this permit is issued, I
sloy any person in any manner so as to become subject to the workers'
c laws of California, and agr tat, if I should become subject to the
workers' compensation provisions of S io 3700 of the Labor Code, I shall forthwith
comply with those provisions.
WARNING: FAILURE TO SECURE WERS' COWNSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYE V0 CRIMINAL PENALTIES AND CIVIL FINES UP 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 Building Official 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.
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 st a laws relating to.building
construction, and hereby authorize representatives of thi ci to enter upon the
above-mentioned property for inspection purposes. - /7/ - A
Date: 2/17/2017
Application Number:
BRER2017-0024
Owner:
Property Address:
53915 AVENIDA VILLA
w A HOLL ENTERPRISES LLC
APN:
774173021
29600 NICHOLS STREET
Application Description:
HOLL / RE -ROOF
LAKE ELSINORE, CA 92530
Property Zoning
Application Valuation:
$4,000.00
i
Applicant:
Contractor:
JEFFREY J. HOLL
OWNER BUILDER .
29600 NICHOLS STREET
LAKE ELSINORE, CA 92530
Llc. No.:
Detail: REROOF WITH OWENS CORNING "COOL ROOF" SHINGLES COLOR OAKRIDGE
AMBER[CRRC: 0890-00091 PER 2016 CALIFORNIA AND ENERGY CODE.
Bin #
Permit #E
Project Address: 33fli10 EeOz-
arty. of La Quinta•
Building 9 Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 --(760) 777-701,2
-Building Permit Application and Tracking Sheet
f.4 af t s Otader's Name:
ES .
A. P. Nu nber:
:; a
01.
Address:0
Legal Description:
City, ST, Zip:Zq4LO L a1,S30
Contractor:
TelePhonc• /%1 773f,
Address:
Project Description: �E 4J 0 o r�T
City, ST, Zip:
h
Telephone:.
one:.
P .
State Lic. # :
City Lie. #c
Arch.,`Engr., Designer:
Address:
City, ST; Zip:
Telephone:
Construction T e: ccu ane
YP P. Y
Type -.,W
I T
a
t Li
c. Ltc. #
0roJect
P•type(circle one): New Add'n Alter Dem
• Sq. F[.:#Stories: / #Units: �
Name of Contact Person: 477459
f/p 4_4
Telephone # of Contact Person- f_
700 7 . -7 3`
Estimated Vafue of Project: 000. ea
APPLICANT: DO. NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES'
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Floodplain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for corrections/issue,
Electrical
Subcontactor List
Called'Contact Pcrson
Plumbing
Grant Deed
Plans picked up
$.M.I.
ILO.A. Approval
Plans resubmitted
Grading
INH
Review, ready for corrections/issue
Developer Impact Pee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Pees,
I
Total Permit Pees
I
rr"
W.
BUILDING & SAFETY DEPARTMENT
78-495 CALLE TAMPICO (760) 777-7012
.L•A QUINTA, CALIFORNIA 92253. FAX (760) 777=.7011
Considering Becoming an Owner -Builder?
Important information you :ne.ed to, know BEFORE pulling your permit!
The term "Owner -Builder" can mean three different things: .
"Owner as Worker", "Owner as Contractor" or "Owner as Employer"
Understand each has Benefits or Risk, and it is possible to combine them!
Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the permit is not taken
out in your name, you are not personally responsible for the. construction and you are not an Owner -Builder. Instead, you become a
"Customer" and California law provides you the benefit of protection from poor workmanship, failure to finish the job and financial
risk due to worker injury-
Benefit/Risk: Hiirhest Benefits and:the Least amount of Risk
Owner -as -Worker is a type of. Owner -Builder where you personally perform the construction. work, the permit is taken out in your
name and you are personally responsible for the construction management, knowledge, workmdnship, and completion of the job. You
benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job successfully.
Benefit/Risk: Possible Benefit with Low Financial Risk.
Owner -as -Contractor is a type of Owner -Builder where you personally act as -your own General Contractor, the permit.is taken out in
your' name and'you hire California licensed sub -contractors -to perform portions of the construction work WARNING: The benefit of
protection provided by law when you hire only California licensed sub -contractors can turn to serious financial risk if you hire
unlicensed contractors to perform any of the work.
BenefR/Risk: Possible Benefit and Significant Financial Risk
Owner -as -Employer is a type of.Owner-'Builder where you pay any unlicensed individual to perform any construction work valued at
more than $500.00, the permit is taken .out in your name and you are- personally responsible for their employment requirements,
supervision, performance, safety and welfare while on your property: WARNING: Cost savings benefit can turn"to serious financial
risk if you fail to deduct payroll taxes or provide workers, compensation insurance for each worker.
Benefit/Risk' Possible Benefit with .Significant Financial Risk
(Health and Safety Code Section 19827) The California Legislature declares an "urgent and statewide
Public interest in assuring"* that contractors comply with Contractors' License Law, Business and
Professions Code and Workers' Compensation Insurance requirements to ensure property owners are
informed about, and protected from the following when improving their property as Owner -Builders:
Fraudulent representations - Liability for worker's injuries • Liability for material and labor costs unpaid by
contractors - Licensing requirements • Employers tax liabilities
Over 20,000 consumer complaints are filed each year. Many complaints relate to owner/builder projects
and include workmanship and workers' compensation issues Homeowners suffer financial harm due to
defective workmanship and injured employees.
Following are alarming examples of what has occurred with Owner -Builder permits:
Example 1: Homeowner received insurance money to rebuild burned -down home.
■ Owner/Builder permit pulled to rebuild'structure.
■ Unlicensed contractor built substandard structure — must be torn down and replaced.
■ Estimated financial injury is $225,000.
■ Additional financial injury - IRS threatened to tax insurance payout if house not completed by the end of
the year.
Example 2: Brother-in-law had active license but fled an exemption from Workers Comp.
■ Owner -Builder hires brother-in-law to install a new roof.
■ .Employee falls and sustains multiple spinal and extremity fractures as well as ahead injury and
remains in a coma to this day.
■ The Owner -Builder, who has sold the home, is now a defendant. in a lawsuit for reimbursement for
benefits paid to the injured worker.
Example 3: Employee of contractor without Workers Comp is hired by Owner -Builder to install septic
system and suffers injury that results in permanent disability.
■ The Owner -Builder did not have a homeowner's insurance policy on the house against which to submit
a claim.
■
The -Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid to the injured
worker.
Did you know — unlicensed persons frequently have the property.owner obtain an "Owner -Builder" building
permit which erroneously implies that the property owner is providing his or her own labor and material
personally?
Did you know — your homeowner's insurance may not provide coverage for injuries sustained on your
property by an unlicensed contractor and his/her employees?
Did you know — if you are considered an "employer" under state and federal law, you must register with
the state and federal government; withhold -payroll taxes, provide workers compensation and -disability
insurance and contribute to unemployment compensation for each "employee"?
Did you know —that if you fail to abide by these laws you may be subjected to serious financial risk?.
OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR
YOUR CONSTRUCTION PERMIT
'SS k• `.
. Ek v v -"I
P.O. BOX 1504
LA QUINTA, CALIFORNIA 922474504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA, 92253
BUILDING & SAFETY DEPARTMENT f. `
(760)777-7012 '
FAX (760) 777-701.1.,
r
-PROPERTY OWNER'S PACKAGE.
Disclosures &Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner: _
An application for a buildmig permit has been 'submitted in, your name listing yourself as the builder of the property
improvements specified at S �/e
We are providing you with an Owner -Builder Acknowledgmentand Information Verification Form to make you -aware of your -
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building perrnit'until you have•read, initialed your understanding of each provision,
signed, and returned this form to us at our official -address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
IRECTIONS: Read and initial each statement below to sign you understand or verify this information..
1. I understand a frequent practice of unlicensed persons is to have ~the property owner obtain" an "Owner -Builder"
uilding permit that erroneously implies that the property owner is providing his;or.,herw
:onIaboi and�maierial personally. I, as'.
an Owner -Builder, may be held`liatile and subject to serious financial risk for any injuries sustaiiied'by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide, coverage. for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
W-2. I'understand building permits are not required to be signed by property owners unless they are responsible for the
fmysection and arenot hiring a licensed'Contractor to assume this responsibility.
I understand as an "Owner -Builder" I am the responsible party of record on the permit I understand that I may protect
from potential financial risk by hiring a licensed Contractor and having, the permit filed in his or her name instead of my
own.
AC 4. I understand Contractors are required by law to be licensed and bonded in California and
to list their license numbers on
errruts and contracts.
r�_5. I understand if 1 employ or otherwise engage any persons, other than California licensed Contractors, and the total value
f_my.construction_is at -least five hundred.dollars"($500),-including-labor and'ihAt6H4ls; I'may be considered an "employer"
un*r state and federal law.
6. I understand if I am considered an "employer" under state, and federal law, I must register with -the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance; and contribute to unemployment
compensation for each "employee." I also understand.my failure to abide by these laws;may subject me to.serious financial
risk.
9L
7. I -understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does nof exceed four within any calendar year, or.all of the work is performed
under contract with a licensed general building Contractor.
8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
*orkmanship or materials.
9I understand I may obtain more information regarding my obligations as an"employer" from the Internal Revenue
ice, the United States Small -Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents.I also understand I may contact the California Contractors' State License Board (CSLB) at I-
00-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party, l a ally . and f financially responsible for proposed construction. activity at the following address:
1of
1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as.well as employers.
r12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
aveprovided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint: Your only temedy against' unlicensed Contractors may in civil court. It is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and. wish to hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for isswiqg the permit. Note. A copy of the properly owner's driver's license, form notarization, or
other verification acceptab to a agency is rf4uired to be presented when the permit is issued to verify the property
owner's signature. /� /
Signature of property
Date: C#1171.-17
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION 'OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act as my agents) to apply for, sign; and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name. of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that'I am the property owner for the address listed above and I personally filled out the above 7
information and certify its accuracy. Note: A copy of the.owner's driver's. license, form notarization, or other verification
acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature.
Property Owner's Signature: Date:
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFI1R-ALT-01-E Revised 06/14 1
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations
Project Name: i{/E !✓ 00 ,
Date Prepared:
Y COMMISSION '(K
CF1R-ALT-01-E
(Pace 1 of 41
A. GENERAL INFORMATION
01
A4N, ..
01
Project Name: A/,V-02
05
Date Prepared: - ,, \Nl `0.
03
Project Location: 5-1 9/Y, 46,5 /ez.4
04
Building Front O`riekatiori (deg or cardinal):
05
CA City:.
Y L i .✓TA
06
Number of AlteredDwellin Units:
er '' g It -AN,
07
Zip Code: 1-'Z S3
08
Fuel Type: k A *,¢ `
09
1 Climate Zone:/57
SO
w'. '"" '( -
T,otal,Conditioned Floor_A�ea ft2)
11
Building Type
12
SIab,Area(ft2) 4% '10
13
Project Scope:ic
Deck
` i•,
B. BUILDING INSULATION DETAILS (Section 150.2(b)1) t
01
02
1 03
04
05
06 �,„q 07 08 119
10
11
Tag/ID
1 Assembly Type
! Frame
Type
Frame
Depth
1 (inches)
Frame
Spacing
1 (inches)
or Prop ed g,p
Required
Comments•
Continuous
Cavity I`risulation
R -value, R -value e,
U=factor
ppendixJA4
Reference
U Factor
TableCell
Initial Solar Aged Solar Thermal SRI
Aged Solar Thermal SRI
Method of
Roof
'
y t
Deck
Compliance
Pitch
Exception
., 'Number
oduct Type _
, InSLlation
Reflectance Reflectance Emittance (Optional)
Reflectance Emittance (Optional)
yyyy
I & ,tt'kN O ' ' V a& I& A
C. ROOF REPLACEMENT (Prescriptive Alteration, Se6t�150.21[b)1H)�
,
01
02
03
04 p
05),
,P 06
V `070 1 08 09 10
11 12 13
t
R -value
Propos d
Minimum Re uired
Initial Solar Aged Solar Thermal SRI
Aged Solar Thermal SRI
Method of
Roof
'
CRRCRProIt, ct ID
Deck
Compliance
Pitch
Exception
., 'Number
oduct Type _
, InSLlation
Reflectance Reflectance Emittance (Optional)
Reflectance Emittance (Optional)
'92- 2 L
6,20 s /G
.�.�
NOTES
Roof area covered by -building integrated phot v`olta anels and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field applied coatings -must comply with�nstallation criteria from section 110.8(1)4.
R�
0,
Registration Number:
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time:
HERS Provider:
June 2014
f
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 06/14 1
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations
Proiect Name:
Date Prepared:
IA ENERGY COMMISSION
CF111-ALT-01-E
(Page 2 of 4)
D. FENESTRATION/GLAZINGIAREAS ALLOWED (Section 150.2(b)1)
04
01 02 03.
Alteration Type Orientation Maximum Allowed ft2 Comments _ F/
E. FENESTRATION/GLAZING
IMPOSED AREAS AND EFFICIENCIES (Section 1S0.2(b)1)
.01
02
03
04
5
06
07
O8
09
0'
11
12
13
14
15
y
Combined
Orientation
Area
Area a
Net
Maxi um
Exterior
SHGC
Tag/
Fenestration
Frame
Dynamic
N, S, W, E, or
Removed
Addd
Added
Al we
Shading
from
ID
Type
Type
Glazing
Roof
ft2
ft -IN
Area ft2
gfactor
U -factor
1 Source
SHGC
Source
Device
CFIR-ENV-03
J
? _
i
a
Net Added Wesifacing FenestrationAr
L�
bI
Existing+ Added Vile t;facing fenestration Area
&
c
Maximum Allend West-facinnguF4ene tration Area
'
d
Is West -facing Fenestration Area < Max mum'Allowed Westt4iWFenestrationy
e
Net Added Fenestration Area (all oirI'` `tali � `s)
'4 h -
f�
Ezi3ting+Added4Fepestration Area (all��o,en
n, tions)'
g
aI Maximum,Allowed'Fe'estration Area (all ori tations)
�a w
h
Is Existing + A' ed=Fenesi ration Area < Maximum Allowed Fenestra ion Area (all
orientations)
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Registration Number:i Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Co, pliance . June 2014
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STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS,
CEC-CFIR-ALT-01-E Revised 06/14
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations
Project Name:
i
Date Prepared:
F. SPACE CONDITIONING(SC)SYSTEMS — HEATING/COOLING (Prescriptive section 150.2(b))
01 I 02 03 Ixf
Dwelling Unit Name I Dwelling Unit CFA (Ft2) Comm....
t e.. ft N,
CF1R-ALT-01-E
(Pace 3 of 41
G. WATER HEATING SYSTEMS (Section 150.2(b)1G) '
01
02
03
04
05
06
07
08r
09
y y10
tfI
w 12
13
14
15
Water Heating
Dwelling
Unit�Total CFA
# of
Water
Alteration to the Space
Dwelling Unit Name
I (ft2)
��
Back -Up
Comments
Water
Heater
'Heating
�\
i
System
Identification
Water
Water
Heaters
Storage
Rated
Rated
,t sir
Heating
Standby
Exterior
Solar
Dwelling Unit DHW
or
Heating
Heater
in
Volume
Fuel
Input
drip�ut
Efficiency
Efficiency
.Value
Insul.
Savings
Central DHW System
System
Name
System Type
Type
system
(gal)
Type
Type
lue
Typed
Loss.,(%)
R -Value
Fraction
Distribution Type
Distribution Type
.
40k
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H. SPACE CONDITIONING SYSTEMS
AND WATER HEAT=�,N`G SYSTEMS IN WOLTIFAMILY R%WLING UNITS
01
I 02
03
040'
05
06
p
Central Wa erH ating
('""Water�,Heating
Dwelling Unit
System
Dwelling Unit:
Dwelling
Unit�Total CFA
System Identification or
Name
Alteration to the Space
Dwelling Unit Name
I (ft2)
��
,*Identification or Name
Conditioning System(s)?
Comments
1,V4 .0014
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Registration Number: I Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Stand - 2013 Residential Compliance June 2014
I
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 06/14 I CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-01-E
Prescriptive Residential Alterations (Page 4 of 4)
Project Name: Date Prepared:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of!Compliance documentation is accurate and complete. 4,*,.
Documentation Author Name: i
.�EFfaEy r. A04
Documentation Author ign'
Company: I
j/1 o t- ` tog a ES LGG'
Signature Date:
Address: j
CEA/ HERS Certification Ideniificatiop�(lf applicable):
'
a o r L QEC
City/State/Zip:
GfJK E E iae,26 C 9�r v
Phone:
7a,? 7 36
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury, under the laws of the State of California: OK IbIm'
1. The information provided on this Certificate of Compliance is true and correct. s
g'nn�or
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibll ty for the building de system design identified on this Certificate of Compliance (responsible
designer). I
3. That the energy features and performance specifications, materials, compone s, V manufactured`deRc�et,fowrthe building design or system design identified on this Certificate of
Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of`Reg tions
Nk
4: The building design features �r system design features identi�fed an thisCertificate of Cor�pl nce re conslster it i,' information provided on other applicable compliance documents,
worksheets, calculations, and specifications submitted o thg'enforcement agency for with this building permit application.
plans ,,approval
5. 1 will ensure that a registered copy of this Certificate of Compllanceshall be made av Mable with the building permit(s) issued for the building, and made available to the enforcement agency
for all applicable inspections. I understand that a registered cop y�of this Certificate'o Compliance is.required to be included with the documentation the builder provides to the building
owner at occupancy.
Responsible Designer Name:
AO
Responsible Designer Signature:
Company:
Date Signed:
Address:,
License:
City/State/Zip: ` Ii ° ,
Phone:
w l �
Ilk 3)
I•
For assistance orques; Ions• regarding the Energy Standards, contact the Energy Hotline. at: 1-800-772-3300.
I ,
Registration Number:Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standafrds - 2013 Residential Compliance June 2014
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