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9903-155 (PLBG)LICENSED CONTRACTOR DECLARATION 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 Professionals Code, and my License is in full force and effect'. License # Lic. Class Exp. Date - Date f Signature of Contractor, !' `-------- OWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: (. ) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for Sale (Sec. 7044, Business & Professionals Code). ( ) . 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Codej. (:) I am exempt under Section B&P.C. for this reason Date , . Signature of Owner WORKER'S COMPENSATION DECLARATION - I hereby affirm under penalty of perjury one of the following declarations: ()' 1. 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. (L•)., 1 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 & policy no. are: Carrier Policy No. . /'�lr 1' p, • n (ar 4. •er arryrrar�.lae:}� � nr� (This section need not be completed if the permit valuation is for $100.00 or less). ( ) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I_shall forthwith'comply With -ft ose provisions. Date: '!i'i� > f! Applicant r°-.,_../ ts'.;,�.. . 10 AV Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil'fines up to $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. 11 IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his 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 applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 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 State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for. inspection purposes. Signature (Owner Date Date��1� BUILDING PERMIT PERMITN �S7 DATE VALUATION LOTI��-TRACT JOB SITE APN ADDRESS 52,4 2,5 EVSigil10W I&II-R DRr vT 77.W(hi^ I20 OWNER I CONTRACTOR / DESIGNER / ENGINEER a n r inrrs��i,r ry�:t�r ;1 r�t�a it in€111CY T: y(��Pf�Sr►c;'i' R ` 11,f11/ICE, a,. t. e. a r _rxc a 1 J O�r-sx.rl. ,.i r ♦x ei .. r'� .. v �. .�� .,� v • x,. �e . . i . lb 495 CALLE" `i'a1:se�il'.TC0, 84033 C-iWAZO 3 I'i. iI ii3i�, i s%� 92201 I -A QAJI t7'A CA 912.53 PALM. DWlsl,,X ' CA. 92261 (766)Wi-2793 C'Rf.4 341, USE OF PERMIT as"si)VC AReVtd"DiiN. ,391 IR ("OWN WIT i` (LAD" iC'z lao:E'R L;''f' AX,10701,Nll 1,117-110M L017 CoJ d anN oViritill) r"t, '/C9'9�Y�$4 an AlO."1t„.!0 AlU711 t l AY.1'r" .PL(Affil NG F"ff- — ;'TE Mill 3.01 -000 -41'3 -WO S-30.ot, SLfB•'E'CfCA1, Ct_'1N(;" i`RI W1110N AND PLAN CHECK (1f; Uf�.SS PRE -PAID FE S RECEIPT j D;TEJ % I BY ,Zt, •'�' DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping' PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enc'osure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) 71.. ELECTRICAL APPROVALS Temp: Power Pole Underground Conduit Rough Wiring .• . Low Voltage Wiring Fixtures Main Service Sub Panels ------------ Exterior Receptacles. G.F:I': Smoke Detector§ Temp'. Use bf Power Final Utility;Notice (Perm) T4hf " P.O. BOX 1504 APPLICATION ONLY Building2S`ljE,rJXOLO45 78-105 CALLE ESTADO Address z y LA QUINTA, CALIFORNIA 92253 /�iLGA blWl "V X-4.cJ-0 Address ,Z yfjF_ TAHa��r� WAV City Zip Tel. /J4mf .S/1191-Zics z z z 3 2.2 Contractor Address City Izip Tel.. State Lic. • City & Classif. 38 � 4� �' Lic. # Arch., Engr,, Designer Address Tel. State 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, atter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile 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 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) O 1, as owner of the property, am exclusively contracting with licensed contractors to con• struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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 O Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit Is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ anyperson in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become 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 BUILDING DIVISION BUILDING: TYPE CONST. OCC. GRP. A.P. Number $7 73 — Z &,S— — (3 Zta Legal Description G� !� �[ lC y , v , -, /e) Project Description Sq. Ft. Size Newer. Add ❑ y 46 No. Stories No. Dw. 4// Alter ❑ Repair ❑ Demolition ❑ stimated Valuation 79,1 PERMIT AMOUNT Plan Chk. Dep. —2— LPlan PlanChk. Bal. n. Const. `'it C90 Mech. 6 • Gpo Electrical ? C4 r f Plumbing 005M i p 2360 W-11.473 -d=i 3 S.M.I. 10 GHJH 1 I U 1 AL. i Grading d, c Driveway Enc. Infrastructure P_/2A1!7_0 S O 1a 8r Y3 TOTAL _ 5 Q REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validati CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. Qa BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK FOR. SQ. FT. ® DUCT WORK ROCK STORAGE GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APP.IEQUIP. DRAINAGE PIPING CAR P. SQ. FT. TEMP. POLE WALL SQ. FT. GROUT DRINKING FOUNTAIN SO. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation _$ FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB GAR. FIREWALL SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL MESH SQ.FT.GAR ® 3/ao HOUSE SEWER INSULATION/SOUND GAS PIPING PERMIT FEE FINISH GRADING PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL o� of F ICE OF E. LEON SPAUGY Q AGRICULTURAL COMMISSIONER CO�nnSaO-'EA)11ME5 o WALLACE .T , O ' O AND ASS;SiA�trhWMUcctONEP. V :' v ( ) '" WEIGHTS & MEASURES CLEMENT 6E`VENISTE SEALER 49-613 ilwy 86, Suite B-12 ��,,_ ,�,,••'� 'Coachella, CA 92236 619-342-8'L91 DATE CASE NO.8:98'A5 /0)? DEVELOPER'S NNS s S T A fz R G o.A-/ a y -2z c e rim .c1 ADDRESS: .2 -/7 /--' Til -lou i rz VIJA`l PALM 59x2 �J& 5 d/ -j 9 zZ4�2- TELEPHONE: 16./-J) 32 2- -.:5' .5" Z 5! i 6- ,40 ,.O r 9 BC.N 9 ? u,vir /o Dear Developers 7 7 3-.2 .6 s- a -Z. a After reviewing your landscaping plans, all plant material listed is not in violation of quarantine laws governing the Coachella Valley. If substitutions do occur and they differ frun plant material listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. W 1444� Agricultural CannissioTi 's Office cc: Indio and Riverside Office I Y✓ `r Q Z O U W M Z O U W U C t COUNTY OF RIVERSIDE DEPARTMENT OF HEALTHAssessors Parcel No. 77,3— , SGS"— 0 ENVIRONMENTAL HEALTH SERVICES O PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County speculations as indicated on the attached checklist. A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval. VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # Agent, Contractor, Contact Person Phone Address & Phone S� ,� Co• v S'i tJ a • Owner Phone a2 z -io Mailing Address .2 E ,4 f4,r v rrz City State Zip Job Property Address Legal Description Prop. (PM, Tract, Lot) t�7 s`l c'04 f'�Z Ze- WZ4ZS'i /S�fv Ko ' aCsel AP44g, .( Gf_J 8 uuT J■11 / Lot Size a er Agen ell, Use of Pe�rm//it P/P) CU, etc .�7LA &40417`4 Other F 'sOy—fe0, W ATB C MVq" X W// T.i Cac.1 t T" v�eilm ,, Site W Prep, etc. 1 Date Signature of Applicant CATEGORY: REV CODE FEE /SUBSURFACE CATEGORY: REV CODE FEE 60,0 DISPOSAL 1238 5.00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 a. 1 st 4 Parcels (Each) 1238 $45.004 (Less than 1 year) b. Each Parcel after 4 7344 $16.00 ❑ PRELIMINARY ELECTIVE 7352 $45.00 ❑ Rereview (2nd review same parcel) 7344 $16.00 EVALUATION (Attach DOH SAN 53) ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $45.00 Critical Area 7346 $86.00 ❑ ALTERNATIVE/EXPERIMENTAL 7345 $132.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft., 7347 $86.00 INITIA • DATE Holding Tank Agreements Completed ❑ Yes R No Certification of Existing S.D. System Required ❑ Yes N f y WQCB Clearance required. (Attach Form ❑ Yes No- DOH SAN 007, Santa Ana Region Only) Soils Percolation Report Required. ❑ Yes ' Special Feasibility Boring Report Required. ❑ Yesr Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes/ Other ❑ Yes6 Staff Specialist Lot Inspection Required ❑ Yes 7No Lot Inspection Date Soils boring report by Date fploj'ectt /#� p' Soils Map Page (J Soil Type Approved 'by (/ / C---- - DateTF- _�r No. of Systems TyIW of System(s) No. Dwelling Units f % (1) Septic Tank Soil Rate Grease/Sand ❑ HHrding Tank ❑ Existing Bedrooms, fcexcerre.laraits• 'Grease Intcp • IV ew ❑ Replacement ^ ,yr �� /,O.s¢11 �/ !/Gal\ Gal (2) Leach Line Sq. Ft. om trench area Sidewall allowance fe ft Install �6i s)) ft long ft wide with %, sch Bed sq. ft. ro�W sq. min. inches.ci;levwd inIin_r� es or of �e� per running ft. �A Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepages it T abDepth her. Applicable 11 0=06 Inlet (BI) Max. Allowable 9epth N/A Overburden factor I '1 No. 2 System A114 w REMARKS: 4Z 41Z This application i APPROVED/ - IE6vfor the category checked in..SECTION B above, regarding the design of a subsurface disposal system as indicated on the accomparned plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed system. No construction is permitted in the required reserved 100% expansion area. O`,,� 1 Septic tank and sewer lines must be 50' minimum from any wells /D iLOP.D G(/ �� "/ Leach lines must be 100' minimum from any wells, including ar a �eex�pansi Seepage pits must be 1$W.�well including expan ion area 46 /Q /-- 4 Signature Health Official of RECEIPT NO.Issued By { Date / � —� } DISTRICT: ❑ Riverside, O— Indio ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe DOH SAN 122 (Rev. 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept. GOLDENROD - Plans/Records i 'S// G ,"Z IFAS 4F/5e0VI oW&rA 7/xd��•s� Certificate of Compliance: Residential (Page 1 of 2) CF -1R Z_F 4i -<_Z �o+,-�S ir? .�:_T -,.% 1_4` Pcpl n( (a -7 l C Odd Project Title Date 14 (i_ �J .) I $$oJect Address ) \� . -,L 1 �• I Or . ? Z' �% �. Building Permit # ocumentation Author Telephone Checked By /Dace Compliance Method (Package, Point System or Computer) Climate Zone Enforcement Agency Use Only GENERAL INFORMATION Total Conditioned Floor Area: 1 4 q_ ft2 Building Type: X Single Family Hotel/Motel (check one or more) Multi -Family (less than 4 stories) Addition Multi -Family (4 or more stories) Existing -Plus -Addition Front Entry Orientation: East / South / West / All Orientations (circle one or more) Number of Dwelling Units: Floor Construction Type: Slab ailed Floor (circle one or both) Infiltration Control: tandard ight (circle one) BUILDING SHELL INSULATION Component Type . Insulation R -Value Location/Comments (attic, to garage, typical, etc.) Wall .............. (slab/exposed, tile, etc.) (sf) Wall .............. Location/Description (kitchen, bath, etc.) Roof ............. 34a 7 - Roof ............. Z Floor ............. �— Floor ............. Slab Edge ..... —M, 4' c.. n-� GLAZING Shading Devices Glazing Area Glass Type Interior Exterior Overhang Framing Type Orientation (sf) (single, double) (roller blind, etc.) (shadescreen, etc.) (yes/no) (metal/wood) Front.... ( ) 24 DD. ;?s►� Front.... ( ) Left...... Left...... ( ) Rear..... Rear..... ( ) Right.... ( ) 11 3 _%�+ Right.... ( ) _ Skylight....... o Skylight....... THERMAL MASS Type/Covering Area Thickness (slab/exposed, tile, etc.) (sf) (inches) Location/Description (kitchen, bath, etc.) T ifc Z 1G .7 Certificate of Compliance: Residential (Page 2 of 2) CF -1R Project Title Date s HVAC SYSTEMS Minimum Duct Type (furnace, air Efficiency Location Duct Output Manufacturer/ Model # conditioner, heat pump) (SE, SEER,HSPF) (attic, etc.) R -Value (Btuh) (or approved equal) JSfF /L ?.f l �Pr�rr•��, al (•��'� li �y� - - Maximum Furnace Heating Output: " a � Btuh HOT WATER SYSTEMS Tank Manufacturer/Model # System Type (storage gas, etc.) Capacity (or approved equal) Special Feature(s) SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, Chapter 2-53 and Title 20, Chapter 2, Subchapter 4, Article 1 of the California Administrative code. This certificate has been signed by the individual with overall design responsibility and the building owner, who shall retain a copy of it and transmit the certificate to any subsequent purchaser of the building. When this certificate of compliance is submitted for a single building plan to be built in multiple orientations, all building conservation features which vary are indicated in the Special Features/Remarks section. Designer Building Owner Name: Name: Title/Firm: Address: Telephone: Lic. #: (signature) Title/Firm: Address: Telephone: (date) (signature) Documentation Author Name: ' ) A L .'-�}';—L• t� Title/Firm: L-0 ;Z e:' t : •, n_ PJ v, 'To ••r „�r Address: is Telephone: (signature) (date) Forth Revised March 1988 Enforcement Agency . Name: Agency: Telephone: (signature or stamp) (date) (date) Point System Summary; Climate Zone 15 S BUILDING DATA Measures Conditioned Floor Area /4 o9 Number of Stories ] Slab/Raised Floor SL � Point Scores Check all applicable Unit Type condition(s): [ ] Single Family Detached (SFD) [ ] Addition Alone [x] Single Family Attached (SFA) [ ] Existing Building [ ] Multi -Family (MF) [) Existing -Plus -Addition SCORE CARD P -2R 711512P Date Form Revised March 1988 o - Sum 1.6 Sum 7-10 -!Z Measures Point Scores 1. Ceiling Insulation R - 3t3 or 0 R-value(38] U -value [0.030] 2. Wall Insulation 19 or O .R-value[191 U-value[o.0661 3. Raised Floor Insulation r-) 10, or v Rivalue[191 U -value [0.037] 4. Slab Edge Insulation N a or o R -value 101 F2 factor 10.771 5. Infiltration Standard 0 6. Glass Heat Loss )r.- 1S- , Gg C` Type [double] U -value (0.651 96 Total Glass [ 161 7. Shading (Shade Open) — % Glass SC Eff. % Glass a. North 1, 1 1 X -7-7 = /. 3 2 0 b. East 4. X --7-7 = 3.4s- .4Sc. c.South f , S) X , -7 d. West R , o X -7 7 e. Skylight X 8. Shading (Shade Closed) % Glass SC Eff. % Glass a. Notch ► -t 1 X Z2 = 3S o b. East X c. South 1 a X Z 2 = 'S x 40 d. West $ o o X zZ- = 1, 7 b t e. Skylight X 9. Interior Thermal Mass 1. I � —2- Interior Interior Mass/CFA 10. Exterior Wall Mass o Exterior Wall Mass 11. Heating System 7. o X 87, s, Zonal Control? (Y . N/ SE or HSPF Duct Efficiency (0.781 Effective SE or (0.72/6.6] HSPF [0.56/5.151 12. Cooling System 9. LS X 5 1 = -7. 5 -L Zonal Control? (Y SEER [9.51 Duct Efficiency [0.741 Effective SEER [7.03] 13. Water Heating 5E ►a� h�=: Type 1SG] Credit [nonel Point Total: Form Revised March 1988 o - Sum 1.6 Sum 7-10 -!Z Thermal Mass Worksheet 7 INTERIOR THERMAL MASS WS -1R Use one of the two following options for calculating interior mass as explained in Section 4.2 of the Energy Conservation Manual (ECM). Method B must be used for mass elements that have an interior unit mass capacity less than 1.7. Method A: Look up the Interior Mass/CFA value from ECM Table 4-7 reprinted on the reverse side of this page. Type 1 mass has a Unit Interior Mass Capacity (UIMC) greater than or equal to 4.2 (see ECM Tables 4-8a and 4-8b reprinted on Attachment). Type 2 mass has an UIMC greater than or equal to 1.7 and less than 4.2. Mass % is the mass surface area divided by conditioned floor area (CFA). For mass elements exposed on both (two) sides to conditioned space, enter the area of only one side to calculate the percentage. Mass % Type 1 Mass Area: Type 2 Mass Area: Interior Mass/CFA from Table 4-7: Method B: Calculate the Interior Mass/CFA value using the worksheet space below. Look up the Unit Interior Mass Capacity (UIMC) for each interior mass surface in ECM Tables 4-8a, 4-8b and 4-9 reprinted on the Attachment. Include the interior surfaces of exterior mass walls. For interior mass walls exposed on both (two) sides to conditioned space, enter the surface area of only one side. Include the inside surfaces of exterior mass walls as explained in Section 4.2 of the ECM. Unit Interior Interior Description Mass Area - re Mass Capacity Mass Capacity Cly✓>:. G.� (r7-3,�' x . t = [,119, x 1.4 . to G 'L Til E F •.i ;�� _ x X = X Total CFA Interior Mass/CFA EXTERIOR WALL THERMAL MASS Calculate the Exterior Wall Mass of all exterior walls. Look up the Exterior Mass Factor for each opaque wall element from ECM Table 4-9 reprinted on the Attachment. Only exterior mass wall surfaces may be included in this calculation. Opaque Exterior Description Wall Area Mass Factor X X = X = Conventional Walls x 0 = Total .Total Opaque Exterior Wall Area Wall Mass Form Revised March 1988 Shading Coefficient (SC) Worksheet Form S Items 1 - 9a and 10a must be completed for glazing/shading combinations not found in Table G-9 of the ECM by using documented manufacturers' data for the specific conditions indicated (#2, #8 and #11). For instructions on filling out the worksheet, see Shading in the ECM Glossary. For overhang SC values (#14 and #15), see Section 4.2 in the ECM. General Information 1. Glazing Type: J3 L: 6. Interior Shade Type: .4� 2. SCglazing alone: 8 7. SCshade open: 1.00 3. Framing Type (metal/wood): Y,�i is_•.. 8. SCshade closed: . -a 4. Mullions (yes/no): • N (SC of shade w/ clear single glass) 5. Framing/Mullion Factor. . 1!E!:8(from ) .. Table G-1 OT - Glazing, Glazing, Interior Shade & Framing 9a. [(1 . o x 0.25) + 0.75] x - El x Where: SCmax SCmin FMF (#5) SC Shade Open SCmax = larger of #2 and #7 or 9b. . -7 7 (from Table G-9) SCmin = smaller of #2 and #7 SC Shade Open 10a. [(, - -x 0.25) + 0.75] x . I -r x _e _ - 17 Where: SCmaxSCndn FMF (#5) SC Shade Closed SCmax = larger of #2 and #8 . or 10b. 22 (from Table G-9) SCmin = smaller of #2 and #8 SC Shade Closed Exterior Shade Exterior Shade Type: , r,.� s cam-, 11. SCexlerior shade: 0.34 (from Table G-11 or manufacturer's data w/ clear single glass) Where: 12. [( , 7 7 4 x 0.25) + 0.75] x _ 3 y SCmax = larger of #9a or #9b and #11 SCmax SC;n SC Shade Open SCmin = smaller of #9a or #9b and #11 Where: 13. [( . 3'f x 0.25) + 0.751 x t _ ,� SCmax = larger of #10a or #10b and #11 SCM= SC,,,in SC Shade Closed SCmin = smaller of #10a or #10b and #11 Overhang (Point System Only) Projection Ratio: 14. S 4 .i x -5 L = Overhang Factor SCS Open 2 (Shade Open) (#12) SC Shade Open (with Overhang) 15. ��; x l4 Overhang Factor SC Shade Closed (Shade Closed) (#13) SC Shade Closed (with Overhang) Form Revised March 1988 Mandatory Measures Checklist: Residential MF -1R 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 Building Envelope Measures * §2-5352(a): Minimum ceiling insulation R-19 weighted average. §2-5352(b): Loose fill insulation manufacturer's labeled R -Value. * §2-5352(c): Minimum wall insulation in framed walls R-11 weighted average (does not apply to exterior mass walls). §2-5352(k): Slab edge insulation -water absorption rate no greater, than 0.3%, water vapor transmission rate no greater than 2.0 perm/inch. §2-5311: Insulation specified or installed meets California Energy Commission (CEC) quality standards. Indicate type and form. §2-5352(f): Vapor barriers mandatory in Climate Zones 14 and 16 only. §2-5317: Infiltration/Exfiltration Controls a. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. b. Doors and windows certified. c. Doors and windows weatherstripped; all joints and p.metrations caulked and sealed. §2-5352(e): Special infiltration barrier installed to comply with §2-5351 meets CEC quality standards. §2-5352(d): Installation of Fireplaces 1. Masonry and factory -built fireplaces have: a. Tight fitting, closeable metal or glass door b. Outside air intake with damper and control c. Flue damper and control 2. No continuous burning gas pilots allowed. HVAC and Plumbing System Measures §2-5352(8) and 2-5303: Space conditioning equipment sizing: attach calculations. §2-5352(h) and 2-5315: Setback thermostat on all applicable heating systems. * §2-5316(a): Ducts constructed, installed and insulated per Chapter 10, 1976 UMC. §2-5316(b): Exhaust systems have damper controls. §2-5314(c): Gas-fired space heating equipment has intermittent ignition devices. DESIGNER I ENFORCEMENT ,It!!; �s ,lei S .�S ctlR §2-5314: HVAC equipment, water heaters, showerheads and faucets certified by the CEC. g §2-5352(i): Water heater insulation blanket (R-12 or greater) or combined interior/exterior insulation (R-16 or greater); fust 5 feet of pipes closest to tank insulated (R-3 or greater). §2-5312(Exception 1): Pipe insulation on steam and steam condensate return & recirculating piping. §2-5318(d): Swimming Pool Heating 1. System has: a. On/off switch ori heater. b. Weatherproof instruction plate on heater. c. Plumbed to allow for solar. 2. 75 percent thermal efficiency. 3. Pool cover: 4. Time clock. 5. Directional water inlet. Lighting and Appliance Measures §2-53520): Lighting - 25 lumens/watt or greater for general lighting in kitchens and bathrooms. §2-5314(c): Gas fired appliances equipped with intermittent ignition devices. . §2-5314(x): Refrigerators, refrigerator -freezers, freezers and fluorescent lamp ballasts certified by the CEC. Indicate make and model number. Form Revised December 1987 FORM J -1T (Transparent) • t - �' r V CopynBht by the ..Air Conditioning Contrxch,r> Plan No. or Amerlen•• Date 1228 17th Street N.W. w..naton. D.C. 20h76 Calculated by Pnnted.tn U.S.A. , Januery. 1967 WORKSHEET FOR MANUAL J (Thlyd EdIN n) LOAD CALCULATIONS FOR RESIDENTIAL AIR CONDITIONING For: MameS I �Z(t- l7'n J t T - t Address__ 747 It%.: ('ontractnr �_ eeao. T•. 1. ,r i _ Address -7-7t C ity�w F, 170-41k., . Cly Winter Design Conditions I i Outside Z4 F Inside - F Temperature Difference ! L __Degrees (Insert data below only after all beat loss calculations have been completed) Total Heat Loss (Btuh) _ (From Line No. 151 'Mod R�No.Sf Serial No. _ Manufactured by__1 1 Rating Data: Input_ Z.t2 Btuh Output at Bonnet_3A_, 2-341 __Btuh Description of Controls Z4 _",T Summer Design Conditions Outside -J __F 1 nside__�--F jNorth Latitude_ 3S Degrees Daily Range_ (Insert data below only after all heat gain calculations have been completed) Total Heat Gain (Btuh) 21 s�4S _(From Line No.20 or'21, if used) Equipment Capacity Multiplier--L.4-_--Model No.��y'--' S I Serial No. Manufactured by- n1 Z C Rating Data: Cooling Capacity_ 1-�Z `it Q __._Btuh Air Volume__) --Cfm Description of Controls Z 4 ✓oar-�S- Winter Construction Data (See Table 2) 1 \\'alts and Partitions? --:f `^4 rz--' 1 - ��_ Summer Construction Data (See Table 5 ) Direction House Faces_ Windows and Doors X � T f Windows arld Doors�_— _ Enter in "HTM" column, Line 21 Walls and Partitions -- Ceilings �' -1-e� Ceilings ---- eilings— Floors;_ Floors - _-" Floors— 1. Direction which window faces. 2. Total window area, sq It. .f. Width of window, ft. 4. Shaded area per foot of over- hang from Table B-1, sq ft. 5. Width of overhang, ft. 6. Total area of shaded glass, cq ft. (Line 4) x (Line 5). 7. Total area of unshaded glass, sq ft. (Line 2) -(Line 6). Table A (USE TO CALCULATE SHADED AND UNSHADED GLASS AREAS) Table B (Use to Determine Adjustment Fodor) A. Total Btuh Gain, from Line 20 -2 B. Capacity Multiplier, from Table? J ,• .- C. Equipment Standard ARI Capacity Rating, Minimum required, (Lie A) x (Line B) 7 D. Capacity of Equipment Selected, not less than Line C, Enter in "Entire House" column, Line 21 ' E. Adjustment Factor (Line D)=(Line A), Enter in "HTM" column, Line 21