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12110 (SFD)^� T4tyl I: &ACV P.O. BOX 1504 N o , 121:10 Building 54-3 00 Herrera78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 � r Owner Jacques Lefebvre Mailing BUILDING: TYPE CONST. OCC: GRP. Address P.O. Box 2795 A.P. Number 774-291-002 CityZip Tel. • Palm Desert, c 92260 1 Legal Description Lot 23 Black 2.91 Contractor Project Description SFD Same_ Address City Zip Tela State Lic._ 47?7 City i4 & Classif. Lic. # Sq. Ft. No.' No. Dw. - Arch., En'gr., Size 1634 Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. Pe=it does not include block. wall City ( Zip ( State ' Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed linder,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 f.. 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) or Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit 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 i do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner or 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 or pool. Date Owner Infrastructure - 2 , 31.25.61 . f(ESISE PWN 25. 00 WORKERS' COMPENSATION DECLARATION Ihereby 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 G•Cepy is filed with the city. ❑ Certified copy is hereby furnished.,' I:' TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE ~aJ `^�v s z (This section need not be completed i1 the permit is for one hundred dollars ($100) valuation £ 4 E ..r e'f T V + I^il- 7t7 10 , 136 or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate or Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line 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.) c Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to i 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-. j mentioned property for inspection purposes. i Signature of applicant Date Mailing Address City, State, Zip Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: Estimated Valuation $97,519.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. a� 7 , q 84e --"— Const. b3lh5a -26-2—.-t3— Mech. '. 55.53 Electrical 11,130.81 'Plumbing 141.00 .S.M.I. - 9.80 Grading 20.00 Driveway Enc. -0- Date Owner Infrastructure - 2 , 31.25.61 . f(ESISE PWN 25. 00 WORKERS' COMPENSATION DECLARATION Ihereby 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 G•Cepy is filed with the city. ❑ Certified copy is hereby furnished.,' I:' TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE ~aJ `^�v s z (This section need not be completed i1 the permit is for one hundred dollars ($100) valuation £ 4 E ..r e'f T V + I^il- 7t7 10 , 136 or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate or Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line 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.) c Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to i 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-. j mentioned property for inspection purposes. i Signature of applicant Date Mailing Address City, State, Zip Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL. SO. FT. @ HEATING (ROUGH) STORAGE TANK MOBILEHOME SVC. BAR SINK POR. SO. FT. ® SEWER OR SEPTIC TANK ROUGH WIRING GAR. SO. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. DRAINAGE PIPING CAR P. SO. FT. @ HEATING (FINAL) WALL SO. FT. REINF. STEEL DRINKING FOUNTAIN TEMP. POLE URINAL SO. FT. ® GROUT WATER HEATER ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation BOND BEAM FLOOR DRAIN MECHANICAL FEES $ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. ��1 GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED REMARKS: 1 qKK -17 LAUNDRY TRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING 4p UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS •(ROUGH) aL /—+� `! C q METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. plus x$ _$ LUMBER GR. FINAL INSP. —'/?—W t FRAMING �/3„ 3 FINAL INSP. ��1 ROOFING G-3 . 01Y Lb 7 4^�p REMARKS: 1 qKK -17 b. VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL7— LATHING MESH INSULATION/SOUND FINISH GRADING/o&zak FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESHNITIALS GARDEN WALL FINAL DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 - NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 4/30/93 No. 112179 Owner Name, Type of Permit Jacques Lefebvre No. 54300 Street Herrera City La Quinta Zip 92253 La Quinta Permit # Log Study Area 110 APN # 774-291-002 Tract # I Lot # 0 Square Footage 11634 Type of Development Single Family Residence No. of units Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/ carports, covered patios/ walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined 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 Government Code 53080 in the amount of 1.58 x 1634 or $ 2,581.72 have been paid to D.S.U.S.D. 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 Jacques Lefebvre Telephone Name on the check By James E. Lively Assistant Superintendent, Business Services Fee collected /exempted by Tomi Doebereiner Payment Received Check No. 3616 Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./ Applicant Copy - Applicant/Receipt Copy - Accounting AA p1 •�r CALVIN C. KAMINSKAS Assistant Commissloner 0 ' (714) 275.3000 a ' OFFICE OF AGRICULTURAL COMMISSIONER JAMES O. WALLACE, Commissloner 83-612 Avenue 45 Suite 7 Indio, CA 92201 (619) 342-8291 DATEL.*22/Z DEVELOPER'S NAME: DAN RILEY Sealer. Welghts & Measures (7141275-3030 CASE NO. / C. L � /111E 7.7 J ADDRESS: /tel TELEPHONE: (� Dear Developer: After reviewing your landscaping plans, all plant material listed is not in violation of quarantine laws governing Etre Coachella Valley. If substitutions do occur and they differ from plant material listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. Agricul ura Comniss Toner' s office co cc: Indio and Riverside -" APP GVE ® 4080 LEMON STREET, ROOM 19, RIVERSIDE, CALIFORNIA 92501 —FAX (714) 275-3012 Poirot System Summary: Climate Zone'! 15 BUILDING DATA Co itioned Floor Area Number of Stories a]sed Floor Chedc all applicable Unit Type condition(s): b4 Single Family Detached (SFD) [ ] Addition Alone [ J Single Family Attached (SFA) [ ] Existing Building [ ] Multi -Family (MF) [ J Existing -Plus -Addition P -2R SCORECARD Measures Point Scores 1. Ceiling Insulation �•Q� or 2. Wall Insulation _ R -value lie] k,u or U -value 10.0261 0 R -value 1211 U -value 10.0591 3. Raised Floor Insulation — or ! R -value 119) U -value (0.037) 4._ Slab Edge Insulation �_ or R -value 10] F2 factor 10.751 5. Infiltration Any Ducts in Unconditioned Space? (D N) (Y] 4 6. Fenestration Heat Losscao Type U -value 10.651 Total % Fenes.1161 Sum 1.6 7. Fenestration Heat Gain % Fenestration SCshade open Eff. % Fenes. Shade Eff. Ratio North1 x ,1� _ 611 ►� East _ x 3.Os M - a✓ South 01 x Ik I West 0 � — x _ 4 X Skylight 01 x —(&/—N—) _�� �,►�— . N Overhangs? 8. Interior Thermal Mass_ or .I % Exp. Slab 1201 Int. Mass/CFA 9. Exterior Wall Mass 0 0 Ext Wall Mass Sum 7-9- 10. Heating System 0 x 0 *1 U HSPF Dud Effic.11 story: Effective AFUE Zonal Control rM or 6.61 0.63; 2+ story: 0.681 or HSPF Adjustment 101 11. Cooling System 10.0 x OV _ 10 0 0 SEER 110.01 Duct Eft. 11 c Effective SEER Zonal Control 0.81; 2+ story: 0.671 Adjustment 101 12. Water Heating System 1 ��CC IL NoN� :5g -sI-) Heater Type Energy Factor Ext. Ins. R -value Auxiliary Input Distribution ISG501 [0.53] 1121 [None] [STD) System 2 p Heater Type [None] Energy Factor Ext. Ins. R -value Auxiliary Input DistnbuT'ond'ond Point Total: 4-1 Form Revised January 1992 Point Goal: It i -Certificate of Compliance: Residential or (Page 1 of 2) CF -1 R GENERAL INFORMATION Total Conditioned Floor Area: Date Building Type: . Building Permit Telenh°ne Plan Check, Date T� Feld Check / Date GENERAL INFORMATION Total Conditioned Floor Area: ft2 Building Type: . Single Family Addition (check one or more) Mufti -Family Exlsting-Plus-Addition Front Orientation: Norah / East / Southes Orientations (Input orientation in degrees and circle one.) Number of Dwelling Units:_ 1 Floor Construction Type:lab Raised Floor (circle one or both) BUILDING SHELL INSULATION Construction Component Insulation Assembly Location/Comments Wall .............. Wall .............. Roof ............. Roof ............. Floor ............. Floor ............. Slab Edge .... FENESTRATION Fenestration Area Fenestration Orientation sf U -Value Front...... (\4 Front..... ( ) Left....... (N) Left ....... ( ) Rear .... (�) Rear ..... ( ) Right..... Right..... ( ) Skylight ........ Skylight ....... THERMAL MASS Revised January 1902 Shading Devices Interior Exterior (roller blind. etc.) (shadesc qpm IQk- Lgj �o IVI UMMI L N�5 o N 41' L, rJ-�6 oN � IC' �I lea aN Area Thickness M;a '1'h. rA tAlOk r --M\ kA Overhang Framing Type (ves/no) (metal/wood/vinvl : -Certificate of Compliance: Residential (Page 2 of 2) . CF -IR -6 rroleci r rue ••■� HVAC SYSTEMS Note: Input hydronic or combined hydronic data under Water Heating Systems, except Design Heating Load. Distribution Heating Equipment Minimum Type and . I Duct or Type (furnace, heat Efficiency Location Piping Thermostat Cooling Equipment Minimum Duct Type (air conditioner, Efficiency Location 1 Duct Thermostat Configuration heat pump, evap. cooling) (SEER) (attic, etc.) R -Value Type (split or package) WATER HEATING SYSTEMS Energyl External Rated' ; Tank Factor or Tank Water Heater Distribution Number Input (kW Capacity Recovery Standby' Insulation TVDe TVDe in Svstem or Btu/hrl (oallons) Efficiencv Loss (%) R -Value 1. For small gas storage (rated input S 75,000 Btu/hr), electric resistance and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input 2 75,000 Btufir), list Rated Input, Recovery Efficiency and Standby Loss. For Instantaneous gas water heaters, list Rated Input and Recovery Efficiency. SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, 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. When this certificate of compliance is submitted for a single building plan to be built in multiple orientations, any shading feature that is varied is indicated in the Special Features/Remarks section. Designer ort Owner (per Business & Professions Code) Name: J o,e.,a,>cS L -e4Z6 V e -c - Tide/Firm: fl%j-3 1,.A . Address: A'4- Q ..K Q-7 q r Telephone: .3 y o- 3 r 3 Lie. 8: V 7 s 0'7. (signs Q (date) Enforcement Agency Name: Title: Agency'. Telephone: (signaturetstamp) (date) Revised January 1992 Documentation Author Name: Co.Q''(`1M1 A\"C WOL't Title/Finn: Address: 1411L6 5100I`i url>r� Telephone: (signature) (date) Mandatory Measures Checklist: Residential MF -1 R NOTE- Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. Items marked with an asterisk (') may be superseded by more stringent compliance requirements listed on the Certificate of Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as binding minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. DESCRIPTION DESIGNER I ENFORCEMENT 1 Building Envelope Measures * §150(a): Minimum R-19 ceiling insulation, 4 §150(b): Loose fill insulation manufacturer's labeled FI -Value. *§150(c): Minimum R-13 wall insulation in framed walls (does not apply to exterior mass walls). * §150(d): Minimum R-13 raised floor insulation in framed floors; minimum R-8 in concrete raised floors. §150(1): Slab edge insulation - water absorption rate no greater than 0.3%, water vapor transmission rate no greater than 2.0 permfinch. N §118: Insulation specified or installed meets California Energy Commission quality standards, Indicate type and form. §116.17: Fenestration Products, Exterior Doors and InfiltradordExfiltration Controls a. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. b. Manufactured fenestration products have label with certified U -value, and infiltration certification. c. Exterior doors and windows weafheistripped; all joints and penetrations caulked and sealed. §150(9): Vapor barriers mandatory in Climate Zones 14 and 16 only. N §150(f): Special infiltration barrier installed to comply with §151 meets Commission quality standards. §150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs 1. Masonry and factory -built fireplaces have: a. Closeable metal or glass door b. Outside air intake with damper and control c. Flue damper and control 2. No continuous burning gas pilots allowed. Space Conditioning, Water Heating and Plumbing System Measures §110-13: HVAC equipment, water heaters, showerheads and faucets certified by the Commission. §150(i): Setback thermostat on all applicable heating systems. §1506): Pipe and Tank Insulation 1. Indirect hot water tanks (e.g., unfired storage tanks or backup solar hot water tanks) have insulation blanket (R-12 or greater) or combined interior/exterior insulation (R-16 or greater). 2. First 5 feet of pipes closest to water heater tank, non -recirculating systems, insulated (R-4 or greater). 3. All buried or exposed piping insulated in recirculating sections of hot water system. 4. Cooling system piping below 55°F insulated. 5. Piping insulated between heating source and indirect hot water tank. / ,( * 6150(m): Ducts and Fans 1. Ducts constructed, installed and sealed to comply with UMC Sections 1002 and 1004; ducts insulated to a minimum installed value of R-4.2 or ducts enclosed entirely within conditioned space. 2. Exhaust fan systems have backdraft or automatic dampers 3. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers.., §114: Pool and Spa Heating Systems and Equipment 1. System is certified with 78% thermal efficiency, on-off switch, weatherproof operating instructions, no electric resistance heating and no pilot light. N 2. System is installed with: a. At least 36' pipe between filter and heater for future solar heating. b. Cover for outdoor pools or outdoor spa. 3. Pool system has directional inlets and a circulation pump time switch. TJ §115: Gas-fired cental furnace, pool heater, spa heater or household looking appliance have no continuously buring pilot light. (Exception: Non -electrical cooking appliance with pilot < 150 Btu/hr.) Lighting Measures / §150(k): 40 lumens/watt or greater for general lighting in kitchens and rooms with water closets; and recessed ceiling fixtures IC (insulation cover) approved. Revised January 1992 Installation Certificate: Residential i CF -613 Use of this form to satisfy the requirements of the Administrative Code Is optional, but the Information must be provided and posted. Site Address Permit Number An installation certificate is required to be posted at the building site prior to the issuance of the occupancy permit. This form may be. used to meet these requirements. All appliance categories listed below are the actual equipment installed. Note that the efficiency and type of the appliance installed must be equivalent or better than the appliance specified on the Certificate of Compliance (CF -1 R). This certificate (or its equivalent) shall be prepared and signed by the person(s) assuming overall responsibility for the appliance installation. I, the undersigned, verify that the equipment listed in the category above my signature Is the actual equipment installed and that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards. In addition, I have verified that the equipment is equivalent to or more efficient than the equipment specified on the Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for residential buildings. HVAC SYSTEMS Note: Hydronic boiler information is entered here. Water Heating Systems. Heating Equip. CEC Certified Actual Type (furnace, Manuf. Make & Efflclei heat oumc. etc.) Model Number (AFUE ru r int c, c, E, rr4sst r- J 4nrr. ! 0 f� Pe-f+-LLIDI61-01tr Cooling Equip. Type (air Gond. CEC Certified Compressor Unit Actual Other hydronic or combined hydrohic equipment is listed under . Distribution Duct or Heating Load Heating Distribution Duct or riA vr.c. ^Poti 8 s A. i The building design heat loss and design heat gain rate have been determined using a method specified in Sedan 150(h) of the Energy Efficiency Standards, and are two of the criteria used for equipment sizing and selection. Signature WATER HEATING SYSTEMS Water Heating CEC Certified System Type Manuf. Make & (storage qas, etc.) Model Number Date HVAC Subontractor (Co. Name) or General Contractor or Owner Energyl External Rated' Tank Factor or Tank Input (kW Capacity Recovery Standby' Insulation or Btuh) (gallons) Efflclancv Loss (%) R -Value A -o. S 37000 410 i=(.kYo 1. For small gas storage (rated input:5 75,000 Btu/hr), electric resistance and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input >75,000 Btu/hr), list Rated Input, Recovery Efficiency and Standby Loss. For Instantaneous gas water heaters, list Rated Input and Recovery Efficiency. For Instantaneous electric water heaters, list Rated Input. FAUCETS & SHOWER HEADS All faucets and showerheads installed are listed in the Commission's Directory of Certified Faucets and Showerheads, pursuant to Title 24, Part 6, Subchapter 2, Section 111. Signature Revised January 1992 Date Plumbing Subcontractor (Co. Name) or General Contractor or Owner Installation Certificate: Hesidential CF -6R lyse of this form to satisfy the requirements of the Administrative Code Is optional, but the Information must be provided and posted. Site Address Permit Number An installation certificate is required to be posted at the building site prior to the Issuance of the occupancy permit. This form may be used to meet these requirements. All appliance categories listed below are the actual equipment installed. Note that the efficiency and type of the appliance installed must be equivalent or better than the appliance specified on the Certificate of Compliance (CF -1 R). This certificate (or its equivalent) shall be prepared and signed by the person(s) assuming overall responsibility for the appliance installation. I, the undersigned, verify that the equipment listed In the category above my signature Is the actual equipment Installed and that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards. In addition, I have verified that the equipment is equivalent to or more efficient than the equipment specified on the Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for residential buildings. HVAC SYSTEMS Note: Hydronic boiler information is entered here. Other hydronic or combined hydronic equipment is listed under Water Heating Systems. Heating Equip. CEC Certified Actual Distribution Type (furnace, Manuf. Make & Efficiency Type and heat pump, etc.) Model Number (AFUE, etc.) Location rur"ac.Q, �'re.�Rr �e4yT-..4DA6f1G Af�j FAtz U-Lf.�.C� vgo 2R o par i CEC Certified Cooling Equip. Compressor Unit Actual Distribution Type (air cond., Manuf. Make & Efficiency Type and heat pump, etc.) Model Number (SEER) Location C-^FOtif-% . Duct or Heating Load Heating Piping Before Over- Equipment Duct or The building des' heda at loss and design heat gain rate have been determined using a method specified in Sen 150(h) of Tnz,Effici cy S ndards, and are two of the criteria used f equipment sizing and selection. Ay�o�Q A t aNn. �'�d, Signature Date HVAC Subontractor (Co. Name) or General Contractor or Owner WATER HEATING SYSTEMS Water Heating CEC Cart if led System Type Manuf. Make & ('01. Energy Rated' Tank Factor or Input (kW Capacity Recovery or Btuh) (gallons) Efffchmev A -a. 40 c _ a1=caRYo External Tank Insulation 1. For small gas storage (rated inputs 75,000 Btu/hr), electric resistance and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input >75,000 Btuthr), list Rated Input, Recovery Efficiency and Standby Loss. For Instantaneous gas water heaters, list Rated Input and Recovery Efficiency. For Instantaneous electric water heaters, list Rated Input. FAUCETS & SHOWER HEADS All faucets and showerheads installed are listed in the Commission's Directory of Certified Faucets and Showerheads, pursuant to Title 24, Part 6, Subchapter 2, Section 111. Signature Date Revised January 1992 Plumbing Subcontractor (Co. Name) or General Contractor or Owner