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04991 (SFD)TIC -"Olt a&affix& Building At1tlrPcc 52-98.5 Eisenhower Owner Coachella Val P.O. BOX 1504 "AN ADEQUATELY JIM DEBRISMSMI ` 78.105 CALLE ESTADO LA QUINTA, CALIFORNIA 922531S REQUIRED QN THE JOB -SITE DURING ALL PHASES OF CONSTRUCTION'' BUILDING: •TYPE CONST. OCC: GRP. Address 247 E. Tahqultz Way y2 "" A.P.,Number. . 273--326--024 City Zip Tel. Palm Sorinns 1 92262 1 322-'102€3 Address Mr State Lic. City & Classif. 387934 Lic. # 895 Arch., Engr., Designer Address Tel. City lZipStateI LIC. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7of Division 3 of the Business and Professions Code, and my license is in full force and effect. � ' ,nom'-�._.�...r .�'„,✓.' �_d=• f -k" .i / � ,ir u; ./ S 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 Prolessfons Code: Any city or county which requires a permit to construct, alter, improve, derrorah, or repair any structure, prior to its issuance also requires the applicant for such permit to ft a signed statement that he is licensed pursuant to the -provisions of the Contractors 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 penally of not more than five hundred dollars ($500). ❑ 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, Buisness and Professions Code: The Contractors License Law does not apply to an owner or 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 -budder will have the burden of proving that he did not build or improve for the purpose of safe.) 0 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Buskmess and Prolessions 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 a_ & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION p 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 --e) �% ❑ 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 or one hundred dollars (E100) valuation or less.) ' I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation laws of California Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subjectto the Workers' compensationprovisionsof the Labor Code, you must forthwith comply with such provisions or this permit shag 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, CivaCode.) 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. 1 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 Legal Description Project Description Sq. Ft. 1463 Size No. No. Dw. Stories' Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $79,51 PERMIT AMOUNT Plan Chk. Dep. tq Plan Chk. Bal. $ 70-.98 Const. 373.00 Mech. 36.00 Electrical 76..19 Plumbing 105.00 S.M.I. 3.57 Grading 20.p0 Driveway Enc. 20.00 Infrastructure 1.73 5.14 TOTAL S2.711.88 ✓ �. C�'"r REMARKS /� ,0 a-7a`3%r.::i1 i vl' :eivs ry a avoery:., 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 12 / 1 3 / Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS �VlslLAB GRADE \ ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL SO. FT. @ STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. g0, FT, ® ROCK STORAGE FOUND. REINF. GAR. SO, FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEQU1P. DRAINAGE PIPING CAR P. SO. FT. ® GAS (FINAL) TEMP. POLE WALL SO. FT. DRINKING FOUNTAIN WATER HEATER URINAL SO FT ® BOND BEAM 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.COOL HOOD SIGN WASHER(AUTOXDISK) APPLIANCE DRYER &P 14-16 f2 W D D GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM VENTILATION 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 GAR. FIREWALL SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL SO.FT.GAR ® V4c 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 21 SETBACK j PLUMBING UNDERGROUND A.C. UNIT COLL AREA �VlslLAB GRADE \ ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS ER OR SEPTI j(t - ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQU1P. 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. FRAMINGFINAL INSP. ROOF &P 14-16 f2 W D D n � REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL THING MESH �C/&NSULATION/SOUND �- FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL n1 Z O PZ O W Cn m Z O Pz U w W U) Y tr Q W fr X COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION 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 specifications required on the attached check list. A non-refundable filing fee of $40 is required when the application is submitted. Check must be made payable to the County of Riverside. Building Department Application Log # Name (Owner. Agent, Contractor. Etc) Mailing Address City Stale Zip Code Telephone ' Job Property Address 'C1ly. or.Communny. -Legal Des criptic pe'l MI. PMdTB) 'Assessor's Parcel No y, j Aency)or'wefl Use of NFIFFIA X7.}, QW -Planning Case # Lot Size — -� t j� `� SFD MH Site Preparation EIc ' Signature of Applicant Date 'The above information must be verified from Building Application STAFF USE — DO NOT WRITE BELOW THIS LINE Initial Date Certification of Existing S.D. System required. ❑ Yes p No WQCB Clearance required. ❑ Yes ❑ No Soils feasibility report required. ElYes ❑ No . 1. Special feasibility boring report required ❑ Yes 0 No I _ Detailed contour plot plans required. ❑ Yes ❑ No I Staff Specialist approval required ❑ Yes ❑ No Lot Inspection Date Soils/boring reportby Project # Date Soils Map Page Soil Type _Approved by Dale Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required ❑ Existing ❑New El Additional El Replacement ''fir "i'.J",-r Gals. (2) Leach line sq. ft. Sidewall allowance Install Lines) Ft Long. Leach bed Sq (Botto t area) ft. rock/ Sq Ft Ft.'widewith min, —inches Ft of bottom _ per running ft. 014A rock below drain lines area Leach lines/bed-special design for slope: (3) Pit Diameter No. Pits Pit BI Seepage Pit total depth Applicable -• '= t ti x 0 6' 1 i �� f Max. allowable depth N/A Overburden r ^factor This application fs approved/-denied•for the design of a subsurface disposal system as indicated on the accompanied plot plan using the requirements set forth in Section B above. A building permit is necessary for the installation of the above -designed system. ,(1.), Septic tank and sewer lines must be 50' from any wells 7 r ? (2) Leach lines must be 100' min. from any wells including expansion area 3) Seepage pits must be 150' min_ from, any wells including expansion area;. /0� Signature of Health Official �_ •'-�� /,. . RECEIPT NO. District: ❑ Riverside O Indio Issued bd ' r� ❑ Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe YELLOW —Applicant PINK —Bldg. Dept. GOLDENROD —Pending File Distribution: WHITE —Office file DOH SAN 122 (Rev 8/87) Q Z O U W U Z 0 U W ' Z 0 c COUNTY OF RIVERSIDE DEPARTMENT OF HEALTHAssessors Parcel No. 1'773- ENVIRONMENTAL HEALTH SERVICES 3 ZG - O 2 - PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM PERMIT 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 8 Phone TR COC) r/D 32Z-/OtD Owner Phone Mailing Address z TA /fQu./ LVA'IOU City State Zip Job Property Address Legal Description Prop. (PM, Tract, Lot) �a rzi�L1G s C A Lor BG Z Lot Size M�Wf�a,t,e...,,gncY elle.._- Use of Permit P/P, CU, etc. A iQUI' rr OthAr � .moo /op 1T4� 1A 74 ��S - 'Y►�t ala a.f/ weIIin tWSita Prep, etc. Date Sig ture of Applicant CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE ❑/SUBSURFACE DISPOSAL 1238 e%V5.00 ❑ SITE EVALUATION UPON REQUEST 7349 $42.00 ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348 $11.00 a 1 at 4 Parcels (Each) 1238 $45.00 (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 $13200 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $86.00 'INITIAL �"oj � DATE Holding Tank Agreements Completed ❑ Yes pe, �lo� Certification of Existing S.D. System Required ❑ Yes IYN WQCB Clearance required. (Attach Form ❑ Yes OsNo F DOH SAN 007, Santa Ana Region Only) Solis Percolation Report Required. - -. ❑ Yes Special Feasibility Boring Report Required. ❑ Yes f Detailed Contour Plot Plans Required (1 to 5 ft interval) ❑ Yes 0>'No/ Odw ❑ Yes O� / , Staff Specialist Lot Inspection Required ❑ Yes O No Lot Inspection Date Soils boring -report by' Project # Date ' Soils Map Page �9 SOD Type Approved by / Cit///C_- Date No. of System Type of System(s) ' 'O Holding Tank ❑ Existing No. Dwelling Unita (1) Bedrooms, (1) Septic Tank Soil �reaee/Send 3New ❑ Replacement Firdura_t .�- � !!//�Gliease (T_ ;;0 IntcpL Geld. h r�Leacn (2) Leach Una Sq. Ft Sidewall allowance Install� Une(s) It. long it wide wi Bed sq. n trench area It. rock/ sq. n min. irr rock below drainlines or ofibottom area per running It. Leachllnes/bed special design for slope: (3) Pit Diameter No. Pita Pit Below Seepage Pit T /Depth ^'-/r r. Other. Applicable Overburden factor N/A t�,r/ 4475 CTi'6 f Inlet (Bq � � f Max. A ow le Depth ``� No. 2 System /(/f 4- REMARKS: C �j Lt h c2�� .� - /2.C -K sr) /ITrJ/�J�­oY This application isPPRO^ VDD 8 for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompanied plo pan, 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. (s11 1 Septic tank and sewer lines must be 50' minimum from any wells,,-? % 1!J Gi/A/'- PL- .tiQ (2 Leach lines must be 100' minimum from -any wells, including expansion/area Seepage be15 ' from including . A pits must minimum any wells, expansidn area � Signature of Health Official w• t RECEIPT NO.— V?' ?' ? �4% Issued By DISTRICT: ❑ Riverside, Cndio ❑ Hemet ❑ Perris ❑ Rancho Calif. d❑, Blythe DOH SAN 122 (Rev: 5/88) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept . GOLDENROD - Plans/Records OF q� Pcommis-f0`E14 Oft ICE OF E. LEON SPAUGY s AGRICULTURAL COMMISSIONER r AND JAMES 0 WALLACE Q d ASSsSta�l r1H�ti55W�ER v ;•,S y, ) "' � {1111 1 ��� WEIGHTS &: MEASURES CLEMENT OEtiVElrISiE SErIEq } ..r 49-613 Hwy 86, Suite D-12 ��,�q,�,,,,•'� q 'Coachella, CA 92236 r e 619-342-8.291 DATE / 2 — — CASE M. 20 6 L DEVEWPER' S NAME s s'�� If R CB /-),5 TR a e?gym cJ ADDRESS: a !J ,4 �i4Ll�l/ S'�f1 i Gs G'.¢ 9z z c. z_— TELEE'NONEs 3 Z 2 — /0 Za Dear Developers 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 frau plant material listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. I Agricultural Catlyd loner's Office ccs Indio and Riverside Office /_ o T' /3 IGLU /Co / as rT/G 773— 3 z 6. --© Z_' S4^ - •:a[.:.=.. %X.�.�-.-- ,..,'R`:.'� . ; ���ra-'-""s+_�-�c:.,,a-+'ants ��` �.�. ;�r+r—,�- w-.:.-.a+.-,.a>..,.. .'.,,�"..,.,-s Buena Engineers, Inc. f a I 79-811 Country Club Drive, Suite 4 ;! Bermuda Dunes, CA 92201 • (619) 345-1588 / 328-9131 r Client Name , ;y -Client Addre Client Phone DATE i TEST LOCATION 'j� JOB NO. %- 4 FS1 _)eb PROJECT a. P w k 5,2 /SEM 14-G J67t, SN - sPIA Est LOCATI • N I --A a , "i -1-.t,+ CONTRACTOR MOISTURE CONTENT % OWNER Sr�1�,2 CbA,67X, WEATHER MAXIMUM DRY DENSITY P. ° at AM ° at PM PRESENT AT SITE 414, 1 b8� 12.('9 lCs . TEST NUMBER TEST LOCATION 'j� LOT NO. ELEVATION FIELD TESTING REFERENCE CURVE MOISTURE CONTENT % DRY DENSITY IbsJCu. ft. MAXIMUM DRY DENSITY MAXIMUM DRY DENSITY OPTIMUM MOISTURE CONTENT 414, 1 b8� 12.('9 lCs . a a FIZ& iI. c� Iiu.2 I - y� :14.'- O ����/) ArI ^ I /W r ✓ A 7.1 ...ter'.. - Chi hi to 11ucc xtsriN�, o -- REMARKS: izo r'c t t t ` Q D llJy/� I i 'f r FIELD REPORT CLIENT REPRESENTATIVE SIGNATURE TECHNICIANS SIGNATURE �I 7"R__ ::2 1 ��EO FF_�. C-3. 'Ne ���- (0 q_p I_ dn; -Vr' 1 4:3 01h10 A 44 1 �5 JOHN H. HACKER, CIVIL ENGINEER, PALM SPRINGS 327-4565 LATITUDE 33.0 WINTER TEMP. 31 DEG SUMMER TEMP. 110 DEG NAM�� ------- GREGG KARMAN ADDRESS ---- EISENHOWER DR. | CITY ------- LA QUINTA / CALIF. REF.CAL.ENERGY CONSERVATION DESIGN'MANUAL, FORM 2, HEATING LOSSES | MANUAL J FOR COOLING LOSSES AREA BLDG 1464 SQ. FT. PERIMETER 162.6667 SQ. FT. � INSULATION R VALUES .FLOOR 0 ..CEILING 38 ,.WALL 19 AREA NORTH WINDOWS 61 SQ.FT. PERCENT OF AREA 4.166667 AREA EAST WINDOWS 33 SQ.FT. PERCENT OF AREA 2.254098 -- AREA SOUTH WINDOWS 64 SQ.FT. PERCENT OF AREA 4.371585 AREA WEST WINDOWS 0 SQ.FT. PERCENT OF AREA 0 AREA SKYLIGHTS 0 SQ.FT. PERCENT OF AREA b | TOTAL WINDOW AREA 158 SQ.FT. PERCENT OF AREA 10.79235 ` THE U VALUE OF THE WINDOWS IS .65 DUAL PANE THIS BLDG USES DRAPES & FLAT SHADING DEVICES* ON WINDOWS (*mini -blinds, rollar shades, venetian blinds or vertical blinds) THE TOTAL S.C. OF THE WINDOWS IS 0.30 SOUTH OVERHANG LENGTH 2 INTERIOR THERMAL MASS AREA = 322 SQ. FT. ' ATTIC AREA = 1464 SQ FT INFILTRATION (STD 0.018, MED 0.014, TIGHT 0.012) = .014 HEATING LOSSES . FOOTING LOSSES... 7105.281 BTU CEILING LOSSES... 1445.468 BTU WINDOW LOSSES.. 4005.3 BTU WALL LOSSES.... 2175.122 BTU INFILTRATION LOSSES... 6394.752 BTU ' TOTAL HEAT LOSSES BTU/HR.. 21125.92 GAG FURNANCE SIZE 42103.7 BTU OR 45,000 BTU . COOLING LOSSES INFILTRATION LOSSES... 6558.72 BTU FOOTING LOSSES... 7287.467 BTU CEILING LOSSES... 1482.532 BTU WINDOW LOSSES..�. 11845 BTU WALL LOSSES... . 2226.992 BTU INFILTRATION LOSSES... 6558.72 BTU NO. OF PEOPLE... 5 COOLING LOSSES... KITCHEN... 1500 BTU DUCT LOSSES INCLUDED IN TOTAL | TOTAL COOLING LOSSES 32900.71 BTU COMPLIANCE CHECK LIST PER DESIGN DATA SLAB OR FLOOR , WALL INSULATION, CEILING INSULATION, ATTIC, NORTH WINDOWS GLAZING EAST WINDOWS GLAZING SOUTH WINDOWS GLAZING WEST WINDOWS GLAZING � SKYLIGHT GLAZING EAST SHADING COEFFICIENT SOUTH SHADING COEFFICIENT WEST SHADING COEFFICIENT NORTH SHADING COEFFICENT | SKYLIGHT SHADING COEFFICIENT INFILTRATION THERMAL MASS 322 SQ.FT. | SOUTH OVERHAND 2 FT. BAS FURNANCE 71 SE AND REFRIGERATION COOLING THE EER OF THE COOLING SYSTEM IS -8.7 COOLING -4 POINTS 0 POINTS ' 0 POINTS 4 POINTS -2 POINTS 2 POINTS -2 POINTS 8 POINTS 0 POINTS -2 POINTS -1 POINTS 0 PANTS 3 POINTS O POINTS -1 POINTS 8 POINTS 0 POINTS THE ALLOWABLE POINTS PER AB163 IS -4 FOR AREA 15 THE TOTAL POINTS ARE 19. THE FOLLOWING MANDATORY FEATURES/DEVICES ARE REQUIRED PERCAC TITLE 24 ELECTRIC RESISTANCE WATER HEATING NOT PERMITTED INSULATION AS SPECIFIED: PER MANUFACTURES LABLE INFILTRATRION CONTROL. DOORS, WINDOWS FULLY WEATHERSTRIPPED OPENINGS CAULKED AND SEALED AROUND JOINTS IN WINDOW AND WALL SOLE PLATES AND ELECTRICAL OUTLET PLATE GASKETS MANUFACTURED DOORS SHALL MEET APPLICABLE STANDARDS ' BACK DRAFT DAMPERS ON EXHAUST FAN FIREPLACES MUST HAVE TIGHT FITTING, CLOSEABLE DOORS COVERING FIREBOX `PROVIDE COMUSTION AIR INTAKE DUCTS (6 SQ.IN.) WITH TIGHT FITTING DAMPER DUCTS; BUILT PER CHAPTER 10 U.M.C. ! GAS FURNANCE SIZED TO 1.3 DESIGN LOSS+10 BTUH PER SQ.FT.OR 45,000 BTU SETBACK THERMOSTATS SHALL -HAVE AUTOMATIC SETBACK CAPABILITY /2PERIODS PER 24 HR WATER HEATER TO HAVE R-12 INSULATION WRAPPING, AND R-3 ON FIRST 5' OF PIPE NAT. GAS STOVES SHALL NOT HAVE CONT. BURNING PILOTS LIGHT IN KITCHEN AND BATH TO BE FLOURECENT, EXCEPT BATH MIRROR KIT SINK, TABLE � CERTIFIED B _____________________________________________ � \ 04 Certificate of Compliance: Residential Author %771 or GENERAL INFORMATION Total Conditioned Floor Area: �}�� ft2 71.;z c, ? (Page 1 of 2) CF -111 -7 o:04 P Building Permit # Checked By / Date Enforcement Agency Use Only Building Type: 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: North/ East /Southest All Orientations (circle one or more) Number of Dwelling Units: I Floor Construction Type: lab aised Floor (circle one or both) Infiltration Control: tand- ar Fright (circle one) BUILDING SHELL INSULATION Component Insulation Location/Comments Type R -Value (attic, to earaee, tvwical. etc.) Wall .............. Wall .............. Roof ............. t - - Roof ..........:.. Floor ............. ►�1�v'�. j :l �1, .:., Floor ............. Slab Edge ..... 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.... (wI)`^`_'S ,.��:� ccs- • .4,r,.�. /�y , _ ; -- ::. Front.... ( ) Left...... ()J)S b t �" ' = 4 P a- < <- t.. N ti Q Left...... ( ) Rear..... (i ) 2_. l :: v �e ^1-�. • :, ' r ti.� - , ' i^� r_ ,; Rear..... ( ) Right.... (�) •: t `�.�. �C� .` _ P -J �-+ LA -_r- ' �.1 Z-7 ,. Right.... ( ) Skylight....... o Skylight....... THERMAL MASS Type/Covering Area Thickness (slab/exposed, tile, etc.) (sf) (inches) Location/Description (kitchen, bath, etc.) 21%1 t V] Certificate of Compliance: Residential l t.S' _ 1� -,A HVAC SYSTEMS Minimum Duct Type (furnace, air Efficiency Location conditioner, heat pump) (SE, SEER,HSPF) (attic, etc.) Duct Output R -Value (Btuh) Maximum Furnace Heating Output: 18 Btuh HOT WATER SYSTEMS Tank ` . T, f�,1. (Page 2 of 2) CF -1R ---I Date Manufacturer / Model # (or approved equal) Manufacturer/Model # (or approved equal) S SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) COMPLIANCE STATEMENT Q 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.l 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: Title/Firm: Address: Address: Telephone: Telephone: Lic. #: (signature) (date) (signature) (date) Documentation Author Name: Title/Firm: V"3 ` N ri , i , ., . 3 j Address: -Z-7 —%'Z ..1 E . , ' a. C. c Telephone: (signature) - (date)` Form Revised March 1988 Enforcement Agency Name: Agency: Telephone: (signature or stamp) (date) Point System Summary: Climate Zone 15 M BUILDING DATA Conditioned Floor Area l 4- - 3 Number of Stories Slab/Raised Floor S� Check all applicable Unit Type condition(s): [ ] Single Family Detached (SFD) (] Addition Alone Single Family Attached (SFA) [ j Existing Building [ ] Multi -Family (MF). [ ] Existing -Plus -Addition 1 P -2R SCORE CARD Measures Point Scores 1. Ceiling Insulation Iz- - or o R-value(38] U-value(0.030] 2. Wall Insulation TZ, ►9 or O R-value(191 U -value (0.0661 3. Raised Floor Insulation N or O R -value 1191 U -value 10.037) 4. Slab Edge Insulation u or C) R -value (01 F2 factor (0.77] 5. Infiltration Standard 0 6. Glass Heat Loss 'AQ I �� t $ ) -{- 1 Type [double] U -value [0.651 90 Total Glass (161 Sum 1-6 7. Shading (Shade Open) - % Glass SC Eff. % Glass a. Notch -28 3 x -? -� = 2 , 5 S - b. East 3, x c. South ) , x d. West to . a x -71 = l.� • to .+- I e. Skylight l> x — _ C) 8. Shading (Shade Closed) % Glass SC Eff. % Glass a. North "3 . S '3 x b. East , �'1,a x . Lt = -► g - f - c. South ( •c x d. West x --1— e. Skylight x = _� 9. Interior Thermal Mass 2.-7q - 10. Exterior Wall Mass Interior Mass/CFA 4::) Exterior Wall Mass Sum 7-10 11. Heating System 1 _ o x Zonal Control? ( Y /6p SE or HSPF Duct Efficiency (0.78] Effective SE or (0.7216.6] HSPF [0.56/5.151 12. Cooling System �� x $ 1 Zonal Control? (Y'.:% SEER [9.51 Duct Efficiency [0.74] Effective SEER (7.03] 13. Water Heating 51;z-- r-,1 o N:; -) Z Type ISG] Credit (none) Point Total: i Form Revised March 1988 Thermal Mass Worksheet WS -1R Project Tftle Date INTERIOR THERMAL MASS 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 Intenor 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 % ' t 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. Description i. EXTERIOR WALL THERMAL MASS Interior .) Mass Capacity y G� z S�S --z Ian! = 77-.-2-1Total CFA Interior Mass/CFA 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 Conventional Walls Form Revised March 1988 X = X = X = X 0 = Total Total Opaque Exterior Wall Area Wall Mass Unit Interior Mass Area Mass Capacity 21 -7 x y.�� _ II -7Z x l.� _ 7 x X = X = EXTERIOR WALL THERMAL MASS Interior .) Mass Capacity y G� z S�S --z Ian! = 77-.-2-1Total CFA Interior Mass/CFA 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 Conventional Walls Form Revised March 1988 X = X = X = X 0 = Total Total Opaque Exterior Wall Area Wall Mass C 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: 2. SCglazing alone:d 3. Framing Type (metal/wood): 4. Mullions (yes/no): tJ 5. Framing/Mullion Factor. 3 (from Table G-10) 6. Interior Shade Type: 7. SCshade open: 1.00 8. SCshade closed: • -7� (SC of shade w/ clear single glass) Glazing, Interior Shade & Framing = 9a. [( , o x 0.25) + 0.75] x %) x _ �7"?� Where: SCmax SCrnin FMF (#5) SC Shade Open SCmax = larger of #2 and #7 or 9b. , -� (from Table 0-9) SCmin = smaller of #2 and #7 SC Shade Open SC Shade Closed 10a. [( ,� x 0.25) + 0.751 x x Where: SCmax SCrrdn FMF (#5) SC Shade Closed SCmax = larger of #2 and #8 or 10b. -t,L (from Table G-9) SCmin = smaller of #2 and #8 SC Shade Closed Exterior Shade Exterior Shade Type: 11. SCexterior shade: 0 . `L (from Table G-11 or manufacturer's data w/ clear single glass) 12. [( "'? x 0.25) + 0.751 x`E _ Where: . '3 �� SCmax = larger of #9a or #9b and #11 SCmax SCndn SC Shade Open SCmin = smaller of #9a or #9b and #11 Where: 13. [( `�x 0.25) + 0.751 x .1'� _ ..� SCmax = larger of #10a or #10b and #11 SCmax SCrrdn SC Shade Closed SCmin =smaller of #10a or #10b and #11 Overhang (Point System Only) Form Revised Match 1988 Projection Ratio: 4 SC Shade Open _c (with Overhang) ` SC Shade Closed (with Overhang) 1 ^ C; Overhang Factor SC Shade Open (Shade Open) (#12) 15. �� 1` x Overhang Factor SC Shade Closed (Shade Closed) (#13) Form Revised Match 1988 Projection Ratio: 4 SC Shade Open _c (with Overhang) ` SC Shade Closed (with Overhang) 1 ^ C; I ,Y 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 penetrations caulked and sealed. §2-5352(e): Special infiltration barrier installed to comply with §2-5351 meets CEC quality standards. DESIGNER I ENFORCEMENT §2-5352(d): Installation of Fireplaces , 1. Masonry and factory -built fireplaces have: a. Tight fitting, closeable metal or gloss 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 j <, §2-5352(8) and 2-5303: Space conditioning equipment sizing: attach calculations. S §2-5352(h) and 2-5315: Setback thermostat on all applicable heating systems. S * §2-5316(a): Ducts constructed, installed and insulated per Chapter 10, 1976 UMC. g §2-5316(b): Exhaust systems have damper controls. fJ A §2-5314(c): Gas-fired space heating equipment has intermittent ignition devices. -S §2-5314: HVAC equipment, water heaters, showerheads and faucets certified by the CEC. §2-5352(1): Water heater insulation blanket (R-12 or greater) or combined interior/exterior insulation (R-16 or greater); first 5 feet of pipes closest to tank insulated (R-3'or greater). §2-5312(Excepdon I): Pipe insulation on steam and steam condensate return & recirculating piping. >J §2-5318(d): Swimming Pool Heating 1. System has: a. On/off switch on 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 - 251umens/watt or greater for general lighting in kitchens and bathrooms. §2-5314(c): Gas fired appliances equipped with intermittent ignition devices. §2-5314(a): Refrigerators, refrigerator -freezers, freezers and fluorescent lamp ballasts certified by the CEC. Indicate make and model number. Form Revised December 1987