10-0607 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
10-00000607
79105 VIA CORTA
602-140-013- - -
ADDITION - RESIDENTIAL
LOW DENSITY RESIDENTIAL
25000
Tiht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
fili'CAa../ C4 so °�y
7 3/ s'ce
-----------------
LICENSED CONTRACTOR'S 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 Class: B License No.: 792381
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 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).:
(_) 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 and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed
pursuant to the Contractors' State License Law.).
(_) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
BANNISTER,
79-105 VIA
LA QUINTAir
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/01/10
JAMES & JOANNE
CORTA
Contractor: fU SE( l 01 210
RISEN CO ST UCTION
82775 C LES'W" INTI
INDIO, C 220]F(11Vpa,1;,Er5EPT.
(760)347-6399
Lic. No.: 792381
--------------- - - -
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.
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
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 those provisions.
Date — Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO 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 Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related_to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
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 county to enter upon the above-mentioned property for inspection purposes. . '
Date: - Signature (Applicant or Agent):
Application Number . . . . . 10-00000607
------ Structure Information 2635 SF EXIST SFD
--_--
Construction Type . .
. . . TYPE V, UNPROTECTED
Occupancy Type . .
. . . DWELLG/LODGING/LONG <=10
Other struct info . .
. . . CODE EDITION 2007/08
ENERGY
# BEDROOMS
.00
FLOOD ZONE NO
GARAGE SQ FTG
.00
PATIO SQ FTG
260.00
1ST FLOOR SQUARE FOOTAGE
192.00
- ----------------------------------------------------------------------------
2ND FLOOR SQUARE FOOTAGE
.00
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee
252.00 Plan Check Fee
163.80
Issue Date . . . .
Valuation
25000
Expiration Date . .
2/28/11
Qty Unit Charge
Per
Extension
BASE FEE
45.00
23.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
207.00
_ Permit . . .
ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee . . . .
41.17 Plan Check Fee
10.29
Issue Date . . . .
Valuation
0
Expiration Date . .
2/28/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
192.00 .0350
ELEC NEW RES - 1 OR 2 FAMILY
6.72'
260.00 .0200
ELEC GARAGE OR NON-RESIDENTIAL
5.20
19.00 .7500
----------------------------------------------------------------------------
PER ELEC DEVICE/FIXTURE 1ST 20
14.25
Permit . . .
PLUMBING
Additional desc . .
Permit Fee . . . .
18.00 Plan Check Fee
4.50
Issue Date . . . .
Valuation . . . .
0
Expiration Date . .
2/28/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
REMODEL TO EXISTING SFD:192
SF PATIO
LQPERMIT
I
Application Number . . . . . 10-00000607
----------------------------------------------------------------------------
Special Notes and Comments
CONVERSION TO LIVING. 260 SF LATTICE
COVER WITH OUTDOOR FIREPLACE ADDITION AT
REAR ELEVATION. R-3 OCCUPANCY, TYPE V -B
CONSTRUCTION PER ENGINEERED PLANS.2007
CODES / 2008 ENERGY.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
ENERGY REVIEW FEE 16.38
STRONG MOTION (SMI) - RES 2.50
Fee summary Charged
Permit Fee Total 311.17
Plan Check Total 178.59
Other Fee Total 19.88
Grand Total 509.64
LQPERMIT
Paid Credited Due
.00 .00 311.17
.00 .00 178.59
.00 .00 19.88
.00 .00 509.64
1
Date
8/17/10
No.
30798
Owner
M/M James Bannister
Address
79105 Via Corta
City
La Quinta Zip
Tract #
Type
Residential Addition
Lot # No. Street
Unit 1 79105 Via Corta
Unit 2
Unit 3
Unit 4
Unit 5
Comments
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
S.F.
192 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
4�.'3��tFAscyo
Q BERMUDA DUNES
En RANCHO MIRAGE CJ
INDIAN WELLS
PALM DESERT .y
LA QUINTA
�QINDIO yJ
0
APN # 602--40-013
Jurisdiction La Quinta
Permit #
No. of Units 1
Lot # No. Street
S.F.
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 192 S.F. or $0.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By Exempt - Siji Fernandez Check No.
Name on the check Telephone 760-347-6399
Funding Exempt
By Dr. Sharon P. McGehee
Superintendent
Fee collected /exemp by Sh cGi rey Payment Recd $p,q
Ov4iVnde%�• .a '
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this wills ry to notify you that the 9G -day approval period m which you may protest the fees
or other payment identified above will begin to run from the date on which a building or installation permit for this project iis issued, or from the date on
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID without embossed sea]
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy -Accounting
r�
May 11, 2010
%7
RANCHO LA QUINTA
MASTER ASSOCIATION
,architectural Control Committee
Mr. and Mrs. Lyn Bannister
79-105 Via Corta
La Quinta, CA 92253
Re: 79-105 Via Corta
Approval of Submission
The Architectural Committee reviewed your submission for a great -room
addition and patio extension to the residence. The submission as presented
is approved upon condition of -
The Committee requires the following:
• All work is to be done in accordance with all applicable requirements of
governmental entities, including the City of La Quinta and in
accordance with all Homeowners Association architectural guidelines
and governing documents.
• A City of La Quinta building permit be obtained and copy fur-iished to
the Association prior to commencement of work.
• No access to residence from Golf Course.
When the work has been finished, please return "Notice ofCompie`ion"to the
Association Office. The Association's architectural consultant will perform a
final inspection after receipt of such notice; when verification of the approved
plan modifications have been concluded, your Security Deposit will be
processed for refund.
Thanking you in advance and if any questions please do not hesitate to call
me at the on-site office 777.8807.
Sin rely,
L t%V LE ger C(CAM®�/,
Association General Manager
Rancho La Quinta Master Association
760-777-8807 fax 760-777-8961
mwalker@drmintemet.com
cc: Architectural Committee
P.O. BOX 6419 • LA QUINTA, CA 92248-6419 • 760-777-8807 • FAX 760-777-8961
Prescriptive Certificate of Compliance: CF -1R ADD
Residential Additions Pae 1 of 5
Site Address:
79-105 Via Corta, La Quinta CA
Enforcement Agency:
Date:
June 17, 2010
C
D
E
General Information
Project Name
Bannister 192 S.F. Addition
Climate Zone #
15
# of Stories
1
Building Type[F] Single Family ❑ Multi Family
Circle the Front Orientation: N, E, S, W or Degrees North
Conditioned Floor Area of Addition
192
New Addition Size- Lx ess than or equal to 100 f� Less than or equal to 1000 W(CFA):
(Do not use this orm or additions eater than 1000
NOTE. • For Alterations to an existing home, submit a completed CF -IR ALT Foran
Exception: Existing HVAC stems that are replaced or altered to serve the addition may be included on the CF -1R ADD Form.
PRESCRIPTIVE ENVELOPE REQUIREMENTS FOR ADDITIONS
For standard wood and assemblies meeting the Cavity R -value only.
• For 100 ft2 additions; the Proposed values must be equal or greater than the Standard column or when indicated when using Package D,
"Pkg D ". Enter values in the shaded Proposed Columns.
• For less than 1,000 ft2additions must comply with 'Pkg D" requirements unless indicated in the Standard Column. To meet "Pkg D"minimum
ener& compliance re ruirements, see RCMAppendix B, Table 151-C or 152(b)in the RCM Enter values in the shaded Proposed Columns.
Size of Addition
100 ft2 or less
Less than 1,000 ft2
Component
Standard Proposed Comment
Standard Proposed
Comment
Ceiling Insulation
R-19 Minimum
Pkg D R-38
Table 151-C
Wall Insulation
R-13 Minimum
R-13 R-13
Minimum
Floor Insulation
R-13 Minimum
Pkg D N/A
Table 151-C
Fenestration
U- U-
factor SHGC factor SHGC
0.40 Pkg D EnterValues
From
"Fenestrationr
50 ft> � Pro Posed
— Areas"
Page 2 of 5
U-
factor
I
U-
SHGC factor
SHGC
Enter Values From
"Fenestration
Proposed Areas"
Page 2 of 5
0.40
Pkg D .40
.35
Maximum GlazingProposed
Area
Addition Alone 230.4 ft2
Enter Values From
"Addition Allowed
Fenestration Areas"
Page 3 of 5
For West -Facing 96 ft
Orientation"
Radiant Barrier
N/A
Pkg D Table 151-0
Roofing
N/A See Roofing Products Below
Pkg D See Roofing Products Below
OPAQUES ACE DETAILS For the furred portioned
of Mass Watts see Furring Stri s Construction Table below.
A
B
C
D
E
F
G
I H
I
3
Proposed S`° Note
Standard
Values From JA4 Table
Tag/
IDS
Assembly Name
or T 2
Framing
Material
and Size2
Thickness,
Spacing,
or Other;
U-
factor°
JA4 Table
Numbers
Framed
Cavity
R-value6
Continuous
Insulation
R -Value'
JA4
Assembly
Cell Value8
Proposed
Assembly
U -factor§
Roof
Wood/Truss
24"
026
4.2.1
38
0
A
.026
Wall
Wood/2x4
16"
.102
4.3.1
13
0
A
.102
tt
--
—
Note: For furred assemblies, accounting for Continuous insulation R -value, see Pa
Furring Construction table below.
t
t ed
ILs use the Macs and
APPHUVLU
FOR CONSTRUCTION
Registration Number: Registration Datell'ime: HERS Provider:
2008 Residential Compliance Forms * o-7
March 2010
0
1
Q
G
Prescriptive Certificate of Compliance: CF -111 ADD
Residential Additions (Page 2 of 5
Site Address:
Enforcement Agency:
Date:
79-105 Via Corta, La Quinta CA
Proposed Properties of Masonry and Concrete
June 17, 2010
Walls From Reference
L For Tag/ID indicate the identification name that matches the building plans.
2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ... Indicate in column G the Frame material
and Size: For Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter; 16 or 2470C, or Other for all other assembly description
such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel, and etc....
4. Based on the Climate Zone; enter the equivalent U factor found in JA4 Table based on the R -Value from Table 151-C
5. Enter the Table number that closely resembles the proposed assembly.
6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0 ".
7. Enter the Continuous Insulation R -value for the proposed assembly: otherwise, enter "0 ".
8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J.
9. The Proposed Assembly U factor, Column J. must be equal to or less than the Standard U factor in Column E to comply.
FURRING STRIPS CONSTRUCTION TABLE
FOR MASS WALLS ONLY
A I B I C I D I E
F I G I H I I I J I K
L
M
Proposed Properties of Masonry and Concrete
Added Interior or Exterior Insulation
Walls From Reference
in Furring Space from Reference
Joint Appendix Table 4.3.5 4.3.6 4.3.7
Joint Appendix Table 4.3.13
U
m
Assembly ° e'
u
.] �? a0 m U
. o
o o• F F o m m m
u
Final
Mass
Name or JA4 Table m
o
o. y v u o
o cQ
Assembly
Thickness'
T 2 Numbed ¢ >
x m '- ° d >
U- factor 6,7
Comment
N/A
N/A N/A N/A N/A
N/A N/A N/A /A N/A /A
1. Indicate the Mass Thickness from Reference Joint Appendix JA.
2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc... Indicate the Frame type and Size: For
Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6. or etc... see JA4 for other possible frame type assemblies.
3. Enter the Table number that closely resembles the proposed assembly_
4. Enter the row and column of the U factor value.
5. Enter the Effective R -value listed in the JA4 Table Number.
6. The Final Assembly is calculated by using Equation 4-1 or Equation 4-4 of the Reference Joint Appendix JA4. Enter the value in Column L.
7. Insert the Final Assembly U- actor value back on to the Opaque Surface Details table in Column J.
FENESTRATION PROPOSED AREAS
Orientation
Fenestration Type and Frame (North, East, ProposedAreal Maximum Maximum NFRC or
(Window, Glass DoororS lit) South, West) (fie U-factor2-3 SHGC7-3•0 Default Values 5
Window South 178 .40 .35 Default
Tota[ j 178
1. Fenestration area is the area of total glazed product (i.e. glass plus frame). Exception: When a door is less than 50% glass, the fenestration
area may be the glass area plus a "2 inch frame " around the glass_
2. Enter value from Component Package D Requirements in Table 151-C.
3. Actual fenestration products installed and as indicated in CF -6R ENV Form shall be equivalent to or have a lower U factor and/or a lower
SHGC value than that specified on the Fenestration Proposed Area table above_
4. Submit a completed WS - 3R Form if a reduced SHGC is calculated with exterior shading.
5. If applicable at this stage enter `NFRC"for NFRC Certi red windows or CEC "Default " valuesfound in Table H6 -A or B.
Registration Number:
2008 Residential Compliance Forms
Registration Date/Time: HERS Provider:
March 2010
Prescriptive Certificate of Compliance: CF -1R ADD
Residential Additions (Page 3 of 5
Site Address: Enforcement Agency: Date:
79-105 Via Corta, La Quinta CA June 17, 2010
ADDITION ALLOWED FENESTRATION AREAS
Check applicable box below if the roof addition is exempt from the roofing product "Cool Roof' requirements. Note: If any one of the boxes are
A
B
C
D
E
❑ Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the above Cool Roof criteria
F
Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance, otherwise, check-
CFA of
Allowed %
Allowed Area
Area 2
Maximum
Proposed Area'
Thermal
Addition
of CFA
(A x B)
Removed
Allowed Area
Reflectance3'4
(Table Above)
SRI'
ft
❑
❑
ft(C
+ D)
N/A
4
0
Total Fenestration Area3
192
020
38.4
192
230.4
>
192
West Fenestration Area'-
192
0.05
9.6
0
9.6
>
0
(Required In CZ's 214 & 7 -15)
❑
[34
1. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:11.
1. Glass removed to make way for the addition.
3. For additions less than 1,000 ft1 the standards allows glazing removed during the remodel to be added to the glazing area allowance. The
maximum allowed glazing area for the addition is the CFA x 20% + glass removed to make way for the addition.
4. In climate zones 2, 4, 7-15, no more than 5% of the CFA is allowed for west facingglazing plus west facing glass area removed to make way
for the addition. The maximum allowed west facing glazing area is the CFA x 5% + west facing glass removed to make way for the addition.
5. To meet compliance, the Proposed Area must be less than orequal to the Total Allowed Area or BOTH the Total and West Fenestration Areas.
ROOFING PRODUCTS (COOL ROOFS) §151(1)12
Check applicable box below if the roof addition is exempt from the roofing product "Cool Roof' requirements. Note: If any one of the boxes are
checked below, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in §118(1) are not applicable. Do not fill
table below.
Lj Roofing compliance Not Required in Climate Zones 1-12, 14, and 16 with a Low -Sloped. Less or 2:12 pitch.
0 Roofing compliance Not Required in Climate Zones 1 through 9 and 16 with a Steep -Sloped. Roofs pitch greater than 2:12 and product weight
less than 5lb/tie.
❑ Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the above Cool Roof criteria
Roof constructions that have thermal mass over the roof membrane with at least 25 Ib/fie is exempt from the above Cool Roof criteria.
Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance, otherwise, check-
e applicable box below if Exempt from the Roofing Products "Cool Roof" Requirement:
Roof Slope
Product Weight
Product
Aged Solar
Thermal
CRRC Product ID Number'
< 2:12 > 2:12
< 51blW > 5lb/f?
Type 2
Reflectance3'4
Emittance
SRI'
N/A
❑
❑
❑
❑
N/A
4
0
N/A
N/A
N/A
❑
Q
❑
❑
0
❑
❑
❑
❑
[34
❑
D
❑
❑
E]40
❑
❑
❑
04
❑
Q
❑
D
[]4
1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at
www_coolroojs. org/products/searchpho.
2. Indicate the type of product is being used for the roof top, i.e. single ply roof, asphalt roof, metal roof, etc.
3. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the
same directory and use the equation (0.2+0.7(p; jaa — 0 2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4. Check box if the Aged Reflectance is a calculated value using the equation above-
5.Calculate the SRI value by using the SRI- Worksheet at hyp:11www.energy. ca_gov/title24/and enter the resulting value in the SRI Column above
and attach acopy of the SRI- Worksheet to the CF -1R_
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(i)4. Select the applicable coating:
❑ Aluminum -Pigmented Asphalt Roof Coating
1[] Cement -Based Roof Coating
ID Other
Registration Number:
2008 Residential Compliance Forms
Registration Date/Time: HERS Provider:
March 2010
Prescriptive Certificate of Compliance: CF -111 ADD
Residential Additions (Page 4 of 5
Site Address: Enforcement Agency: i Date:
79-105 Via Corta, La Quinta CA � June 17, 2010
HVAC SYSTEMS -HEATING
List water heaters and boilers for both domestic hot water (DH97 heaters and hydronic space heating. Individual dwelling DHW heaters must be
storage gas or propane fired, non -recirculating, and may not exceed 50 gallons. If no natural gas is connected to tike building, an electric storage
Duct or Configuration
kitchens and on all underground hot water pipes is required in all component packa es in all climate zones.
Minimum Distribution Piping (Central, Split,
Heating Equipment
Efficiency Type and Insulation Thermosta, Space, Package or
Type and Capacity,-'
AFUE or HSP Location` R -Value Type H dronic
Existing
Existing Attic R-8.0 Any Existing Split
Distribution
New Duct
1. Indicate Heating Type (Central Furnace, Wall Furnace, Heat pump, Boiler, Electric Resistance, etc-)
2. Electric resistance heating is allowed only in Component Package G or except where electric heating is supplemental (i -e-, if total capacity
< 2 KW or 7,000 Btulhr electric heating is controlled by a time -limiting device not exceeding 30 minutes). See §111(b)3 exception.
3. Refer to the HERS Verification section on Pages 3 and 4 of the CF -IR -ADD Form for additional requirements aad check applicable boxes.
4. Indicate Type or Location(Ducts, H dronic in Floor, Radiators, etc.
HVAC SYSTEMS - COOLING
List water heaters and boilers for both domestic hot water (DH97 heaters and hydronic space heating. Individual dwelling DHW heaters must be
storage gas or propane fired, non -recirculating, and may not exceed 50 gallons. If no natural gas is connected to tike building, an electric storage
DHW heater less than 50 gallons with an energy factor greater than 0.90 maybe used Hot water pipe insulation firm the DHW heater to the
kitchens and on all underground hot water pipes is required in all component packa es in all climate zones.
Heated Slab Insulation
YES 1EINO Slab edge insulation required for heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation
YES
Configuration
Cooling Equipment
Minimum
Distribution
Duct or Piping
Tank
(Central, Split,
Type and Capacity 1,2
Efficiency
Type and
Insulation
Thermostat
Space, Package or
R-Value3
5�2/F :R or COP)
Location;
R -Value
Type
Hy dronic
Existing
Existing
Attic
R-8.0 Any
Existing
Split
1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive requirements do
New Duct
3. The water heating tank and i es shall be insulated to meet the requirements o 150. .
1. Indicate Cooling Type (A/C, Heat pump, Evap. Cooling, etc).
2_ Refer to the HERS Verification section on Pages 3 and 4 of the CF -JR -ADD Form for additional requirements and check applicable boxes.
3. Indicate Type or Location(Ducts, H dronic in Floor, Radiators, etc.
WATER HEATING
List water heaters and boilers for both domestic hot water (DH97 heaters and hydronic space heating. Individual dwelling DHW heaters must be
storage gas or propane fired, non -recirculating, and may not exceed 50 gallons. If no natural gas is connected to tike building, an electric storage
DHW heater less than 50 gallons with an energy factor greater than 0.90 maybe used Hot water pipe insulation firm the DHW heater to the
kitchens and on all underground hot water pipes is required in all component packa es in all climate zones.
Heated Slab Insulation
YES 1EINO Slab edge insulation required for heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation
YES
❑x NO
External Tank
Water Heater Type/Fuel
Distribution Type
Number In
Tank
Energy Factor or
Insulation
Typel
(Standard, Recirculatin )2
System
Capacity )
Thermal Efficiency
R-Value3
N/A
N/A
N/A
N/A
N/A
N/A
1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system for single dwelling units.
3. The water heating tank and i es shall be insulated to meet the requirements o 150. .
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These
items may require written justification and documentation and special verification. Applicable special features shall tie marked with a YES and be
specified within the plans.
Radiant Barrier (Roof)
Q YES El NO Required in Climate Zones 2, 4, and 8-15 for additions larger than 100 fe.
Slab Edge (Perimeter) Insulation
YES I x❑ NO I In Climate Zone 16 under Component Package D, R-7 insulation is required.
Heated Slab Insulation
YES 1EINO Slab edge insulation required for heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation
YES
❑x NO
In Climate Zones 1, 2, 11, 13, 14 & 16 R-8 insulation is required, and in Climate Zones 12 & 15 R-4 insulation is required
under Component Package D.
Thermal Mass - To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach -
Registration Number. Registration Datetrime_• HERS Prcvider_
2008 Residential Compliance Forms March 2010
HERS VERIFICATION SUMMARY - The enforcement agency should pay special attention to the HERS Measures specified in this
checklist below. A completed and signed CFAR Form for all the measures specified shall be submitted to the building inspector before final
inspection.
Duct Sealmg &
Testin HERS verification is requiredfor this meastire_
❑ YES
:ONO NO
In all Climate Zones, if a new space -conditioning system (HVAC equipment and ducting) is installed to serve the addition
(Certification #): R V 5— — Zd
alone, the ducts are to be sealed and tested per § 151(f)10.
Phone: 760-243-3883
Responsible Building Designer's Declaration Statement
In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned
❑ YES
❑x NO
space to serve the addition, the ducts are to be sealed and tested per §152(b)ID.0 EXCEPTION: Existing duct systems
• The building design features identified on this Certificate of Compliance are consistent with the provided to document this
building design on the other applicable compliance forms, worksheets, calculations, plans and spsubmitted to the enforcement
that are extended,which are constructed,insulated or sealed with asbestos.
Name: Paul Nelson
Vte:
Company: Paul Nelson Design
In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including replacement of the air handler, outdoor
Address:
License:
condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) and will serve the addition, the ducts
Phone- 760-508-3400
are to be sealed and tested per §152(b)IE.
[]YES
QNO
❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space.
EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Refri gerattt Cha e - Split System HERS verification is re uired or this measure_
❑ YES
NO
In Climate Zones 2 and 8-15, if a newly ducted split A/C or heat pump is installed to serve the addition alone, a refrigerant
charge measurement shall be verified per §151(f)7A-
In Climate Zones 2 and 8-15, if the existing HVAC equipment is replaced (including replacement of the air handler, outdoor
[]YES
NO
condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) and will serve the addition, a
refrigerant charge measurement shall be verified per 15 1F.
Central
Fan Integrated
Ventilation System — Airflow and Fan Watt Draw - do not apply for additions 1,000 fe or less.
Ducted S lit S
stems - Air Conditioners and Heat Pumps: Airflow and Fan Watt Draw HERS veri cation is required.
❑ YES
❑x NO
in Climate Zones 10 through 15, if a new space -conditioning system (HVAC equipment and ducting) is installed to serve the
addition alone, the airflow and fan watt draw shall be verified per § 15l(f)7B_
❑ YES
Q NO
In Climate Zones 10 through 15, if the existing space -conditioning system (HVAC equipment and ducting) is replaced and
will serve the addition, the airflow and fan watt draw shall be verified per § 152(b)1F.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurde and om le
Name: David Elliott
Signature:
Company: David Elliott Energy Services
Date. 6-17-10 Nz
Address: 9013 SVL BOX,
If Applicable❑x CEA or❑CEPE
(Certification #): R V 5— — Zd
City/State/Zip: Victorville, CA 92395
Phone: 760-243-3883
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the provided to document this
building design on the other applicable compliance forms, worksheets, calculations, plans and spsubmitted to the enforcement
agency forapproval with this buildingpermit application.
Name: Paul Nelson
Vte:
Company: Paul Nelson Design
Address:
License:
City/State/Zip:
Phone- 760-508-3400
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Registration Number: Registration Date/Time:
2008 Residential Compliance Forms
HERS Provider:
March 2010
Mandatory Measures Summa MF -IR
Residential Pae 1 of 3
Site Address: Enforcement Agency: Date:
NOTE: Low-rise residential buildings subject to the Standards must comply with all applicable mandatory measures listed,
regardless of the compliance approach used. More stringent energy measures listed on the Certificate of Compliance (CF -1R,
CF -IR -ADD, or CF -JR -ALT Form) shall supersede the items marked with an asterisk(*) below. This Mandatory Measures
Summary shall be incorporated into the permit documents and the applicable features shall be considered by all parties as minimum
component performance specifications whether they are shown elsewhere in the documents or in this summary. Submit all
applicable sections of the MF -JR Form with plans.
DESCRIPTION
Building Envelope Measures:
§116(a)l: Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage.
§116(a)4: Fenestration products (except field -fabricated windows) have a label listing the certified U -Factor, certified Solar Heat Gain Coefficient
SHGC , and infiltration that meets the requirements of 10-111 a .
§117: Exterior doors and windows are weather-stripped; all joints and penetrations are caulked and scaled.
§118(a): Insulation specified or installed meets Standards for insulating Material. Indicate type and include on CF -6R Form.
§118(i): The thermal emittance and solar reflectance values of the cool roofing material meets the requirements of §118(i) when the installation of
a Cool Roof is specified on the CF -1R Form.
"§150(a): Minimum R-19 insulation in wood -frame ceiling or equivalent U -factor.
§150(b): Loose fill insulation shall conform with manufacturer's installed design labeled R -Value.
"§150(c): Minimum R-13 insulation in wood -frame wall or. equivalent U -factor.
"§150(d): Minimum R-13 insulation in raised wood -Game floor or equivalent U -£actor.
§150(f): Air retarding wrap is tested, labeled, and installed according to ASTM E1677-95(2000) when specified on the CF -1R Form.
§ 150(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16.
§150(1): Water absorption rate for slab edge insulation material alone without facings is no greater than 0.31/16; water vapor permeance rate is no
eater than 2.0perm/inch and shall be protected from physical damage and UV light deterioration.
Fireplaces, Decorative Gas Appliances and Gas Log Measures:
§ 150(e)IA: Masonry or factory -built fireplaces have a closable metal or glass door covering the entire opening of the firebox.
§150(e)IB: Masonry or factory -built fireplaces have a combustion outside air intake, which is at least six square inches in area and is equipped
with a with a readily accessible, operable, and tight -fitting damper and or a combustion -air control device.
§150(e)2: Continuous burning pilot lights and the use of indoor air for cooling a firebox jacket, when that indoor air is vented to the outside of the
building, are prohibited.
Space Conditioning, Water Heating and Plumbing System Measures:
§110-§113: HVAC equipment, water heaters, showerheads, faucets and all other regulated appliances are certified by the Energy Commission.
§113(c)5: Water heating recirculation loops serving multiple dwelling units and High -Rise residential occupancies meet the air release valve,
backflow prevention, pump isolation valve, and recirculation loop connection requirements of § 113(c)5.
§ 115: Continuously burning pilot lights are prohibited for natural gas: fan -type central furnaces, household cooking appliances (appliances with an
electrical supply voltage connection with pilot lights that consume less than 150 Btu/hr are exempt), and pool and spa heaters.
§150(h): Heating and/or cooling loads are calculated in accordance with ASHRAE, SMACNA or ACCA_
§ 150(i): Heating systems are equipped with thermostats that meet the setback requirements of Section 112(c).
§ 1506)IA: Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are externally wrapped with
insulation having an installed thermal resistance of R-12 or greater.
§1506)1B: Unfired storage tanks, such as storage tanks or backup tanks for solar water -heating system, or other indirect hot water tanks have R-12
external insulation or R-16 internal insulation where the internal insulation R -value is indicated on the exterior of the tank.
§1500)2: First 5 feet of hot and cold water pipes closest to water heater tank, non -recirculating systems, and entire length of recirculating sections
of hot water pipes are insulated per Standards Table 150-B.
§1506)2: Cooling system piping (suction, chilled water, or brine lines),and piping, insulated between heating source and indirect hot water tank
shall be insulated to Table 150-B and Equation 150-A.
§1506)2: Pipe insulation for steam hydronic heating systems or hot water systems>15 psi, meets the requirements of Standards Table 123-A.
§ 1500)3A: Insulation is protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind.
§1500)3A: Insulation for chilled water piping and refrigerant suction lines includes a vapor retardant or is enclosed entirely in conditioned space.
2008 Residential Compliance Forms August 2009
Mandatory Measures Summar MF -1R
Residential (Page 2 of 3
Site Address: Enforcement. Agency: Date:
§1500)4: Solar water -heating systems and/or collectors are certified by the Solar Rating and Certification Corporation.
Ducts and Fans Measures:
§150(m)1-. All air -distribution system ducts and plenums installed, are seated and insulated to meet the requirements of CMC Sections 601, 602,
603, 604, 605 and Standard 6-5; supply -air and retum-air ducts and plenums are insulated to a minimum installed level of R-4.2 or
enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable
requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to
seal openings reater than 1/4 inch, the combination of mastic and either mesh or tape shall be used
§150(m)l: Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal,
duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts.
Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts.
§ 150(m)2D: Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape
is used in combination with mastic and draw bands_
§150(m)7: Exhaust fan systems have back draft or automatic dampers.
§1 50(m)8: Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers.
§150(m)9: Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam
insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that
can cause degradation of the material.
§150(m)10: Flexible ducts cannot have porous inner cores.
§150(o): All dwelling units shall meet the requirements of ANSVASHRAE Standard 622-2007 Ventilation and Acceptable Indoor Air Quality in
Low -Rise Residential Buildings. Window operation is not a permissible method of providing the Whole Building Ventilation required in
Section 4 of that Standard_
Pool and Spa Heating Systems and Equipment Measures:
§114(a): Any pool or spa heating system shall be certified to have: a thermal efficiency that complies with the Appliance Efficiency Regulations;
an on-off switch mounted outside of the heater, a permanent weatherproof plate or card with operating instructions; and shall not use
electric resistance heating ora pilot light.
§ 114(b)1: Any pool or spa heating equipment shall be installed with at least 36" of pipe between filter and heater, or dedicated suction and return
lines, or built-up connections for future solar heating
§1 14(b)2: Outdoor pools or spas that have a heat pump or gas heater shall have a cover.
§114(b)3: Pools shall have directional inlets that adequately mix the pool water, and a time switch that will allow all pumps to beset or
programmed to run only during oil electric demand periods.
§150(p): Residential pool systems or equipment meet the pump sizing, flow rate, piping, filters, and valve requirements of §150(p).
Residential Lighting Measures:
§150(k)l: High efficacy luminaires or LED Light Engine with Integral Heat Sink has an efficacy that is no lower than the efficacies contained in
Table 150-C and is not a low efficacy luminaire as specified by § 15
§150(k-)3: The wattage of permanently installed luminaires shall be determined as specified by § 130(d).
§150(k)4: Ballasts for fluorescent lamps rated 13 Watts or greater shall be electronic and shall have an output frequency no less than 20 kHz.
§150(k)5: Permanently installed night lights and night lights integral to a permanently installed luminaire or exhaust fan shall contain only high
efficacy lamps meeting the minimum efficacies contained in Table 150-C and shall not contain a line -voltage socket or line -voltage
lamp holder, OR shall be rated to consume no more than five watts of power as determined by §130(dj and shall not contain a medium
screw -base socket.
§150(k)6: Lighting integral to exhaust fans, in rooms other than kitchens, shall meet the applicable requirements of §150(k).
§150(k)7: All switching devices and controls shall meet the requirements of §150(k)7.
§150(k)8: A minimum of 50 percent of the total rated wattage of permanently installed lighting in kitchens shall be high efficacy.
EXCEPTION: Up to 50 watts for dwelling units less than or equal to 2,500 fl? or 100 watts for dwelling units larger than 2,500 ft2 may be exempt
from the 50% high efficacy requirement when: all low efficacy luminaires in the kitchen are controlled by a manual on occupant
sensor, dimmer, energy management system (FMCS), or a multi -scene programmable control system; and all permanently installed
luminaries in garages, laundry rooms, closets greater than 70 square feet, and utility rooms are high efficacy and controlled by a
manual -on occu ant sensor.
§150(k)9: Permanently installed lighting that is internal to cabinets shall use no more than 20 watts of power per linear foot of illuminated
cabinet.
§150(k)10: Permanently installed luminaires in bathrooms, attached and detached garages, laundry rooms, closets and utility rooms shall be high
efficacy.
2008 Residential Compliance Forms August 2009
Mandatory Measures Summa MF -1R
Residential (Page 3 of 3
Site Address: Enforcement Agency: Date:
EXCEPTION 1: Permanently installed low efficacy luminaires shall be allowed provided that they are controlled by a manual -on
occupant sensor certified to comply with the applicable requirements of §119.
EXCEPTION 2: Permanently installed low efficacy luminaires in closets less than 70 square feet are not required to be controlled by a
manual -on occupant sensor.
§150(k)ll: Permanently installed luminaires located in rooms or areas other than in kitchens, bathrooms, garages, laundry rooms, closets, and utility
rooms shall be high efficacy luimnaires_
EXCEPTION 1: Permanently installed low efficacy luminaires shall be allowed provided they are controlled by either a dimmer switch
that complies with the applicable requirements of § 119, or by a manual -on occupant sensor that complies with the
applicable requirements of §119.
EXCEPTION 2: Lighting in detached storage building less than 1000 square feet located on a residential site is not required to comply
with §150(k)ll.
§150(k)12: Luminaires recessed into insulated ceilings shall be listed for zero clearance insulation contact (IC) by Underwriters Laboratories or
other nationally recognized testing/rating laboratory; and have a label that certifies the lumiunaire is airtight with air leakage less then
2.0 CFM at 75 Pascals when tested in accordance with ASTM E283; and be sealed with a gasket or caulk between the luminaire housing
and ceiling.
§150(k)13: Luminaires providing outdoor lighting, including lighting for private patios in low-rise residential buildings with four or more dwelling
units, entrances, balconies, and porches, which are permanently mounted to a residential building or to other buildings on the same lot
shall be high efficacy.
EXCEPTION 1: Permanently installed outdoor low efficacy luminaires shall be allowed provided that they are controlled by a manual
on/off switch, a motion sensor not having an override or bypass switch that disables the motion sensor, and one of the
following controls: a photocontrol not having an override or bypass switch that disables the photocontrol; OR an
astronomical time clock not having an override or bypass switch that disables the astronomical time clock; OR an
energy management control system (EMCS) not having an override or bypass switch that allows the luminaire to be
always on
EXCEPTION 2: Outdoor luminaires used to comply with Exception 1 to § I50(k)13 may be controlled by a temporary override switch
which bypasses the motion sensing function provided that the motion sensor is automatically reactivated within six
hours.
EXCEPTION 3: Permanently installed luminaires in or around swimming pool, water features, or other location subject to Article 680 of
the California Electric Code need not be high efficacy luminaires.
§150(k)14: Internally illuminated address signs shall comply with Section 148; OR not contain a screw -base socket, and consume no more than five
watts of power as determined according to § 130(d).
§150(k)15: Lighting for parking lots and carports with a total of for 8 or more vehicles per site shall comply with the applicable requirements in
Sections 130, 132, 134, and 147. Lighting for parking garages for 8 or more vehicles shall comply with the applicable requirements of
Sections 130, 131, 134, and 146
§ 150(k)16: Permanently installed lighting in the enclosed, non -dwelling spaces of low-rise residential buildings with four or more dwelling units
shall be high efficacy luminaires.
EXCEPTION: Permanently installed low efficacy luminaires shall be allowed provided that they are controlled by an occupant sensor(s)
certified to comply with the applicable requirements of § 119.
2008 Residential Compliance Forms August 2009