05-4128 (SFD)r:1r
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00004128
Property Address: 53663 VIA DONA
APN: 772-420-999-36 -298944-
Application description: DWELLING - SINGLE FAMILY
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 391894
Applicant:
T4ht 4 e(P Qgmm
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
KASHI ANOOSHEN
14840 LAS FLORES LANE
DETACHED LOS GATOS
LSO GATOS, CA 95032
Architect or Engineer
Lic. No.: OOR
D I& U
Contractor:
NOV O J 2005 LINK GENERAL CONSTRACTOR, J C
45120 SAN PABLO, STE #2-I
CITY OF LAQUINTA PALM DESERT, CA 92260
FINANCE DEPT (760) 568-6070
RE—FOOT— Lic. No.: 565847
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 Claps: A@ a License No.: 565847
Date: Contracto
OWNER -BUILDER DECLARATION
I hereby affirm under nalty of perjury t at I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Busine and Professions Code: Any city or county that requires a permit to
construct, alter, impro , demolish, repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed sta at 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 _ 1 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, 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.).
(_ 1 1, 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 contractor(s) 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:
LQPER.AIIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/20/05
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1423538
_ 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
370�0f the Labor Code, I shall fghwith comply with those provisions.
Date: ti�OTHEOR
WARNING: FAILUKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMP PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,0O THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OFINTEREST, 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 relatin tobuilding construction, and hereby authorize representatives
of this/coy�ty ent8/Cpon the above -mention pr er r i n purposes.
Date: l Signature (Applicant or t):
Application Number . . . . . 05-00004128
Permit . . .
. .
BUILDING PERMIT
Additional desc
.
Permit Fee . .
. .
1234.50
Plan Check Fee
1059.61
Issue Date . .
. .
Valuation . . . .
269942
Expiration Date
. .
4/18/06
Qty Unit
Charge
Per
Extension
BASE
FEE
639.50
170.00
----------------------------------------------------------------------------
3.5000
THOU BLDG
100,001-500,000
595.00
Permit .
. .
ELEC-NEW RESIDENTIAL
Additional desc
. .
Permit Fee . .
. .
202.70
Plan Check Fee
97.20
Issue Date . .
. .
Valuation . . . .
0
Expiration Date
. .
4/18/06
Qty Unit
Charge
Per
Extension
BASE
FEE
15.00
4465.00
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
156.28
821.00
.0200
ELEC
GARAGE OR NON-RESIDENTIAL
16.42
1.00 15.0000
----------------------------------------------------------------------------
EA ELEC
TEMPORARY POWER POLE
15.00
Permit .
. . GRADING PERMIT
Additional desc
. .
Permit Fee . .
. .
15.00
Plan Check Fee
.00
Issue Date . .
. .
Valuation . . . .
0
Expiration Date
4/18/06 .
Qty Unit
Charge
Per
Extension
----------------------------------------------------------------------------
BASE
FEE.
15.00
Permit .
. . MECHANICAL
Additional desc
.
Permit Fee.
. .
132.50
Plan Check Fee
66.26
Issue Date . .
. .
Valuation . . . .
0
Expiration Date
. .
4/18/06
Qty Unit
Charge
Per
Extension
BASE
FEE
15.00
4.00
9.0000
EA MECH
FURNACE <=100K
36.00
4.00
9.0000
EA MECH
B/C <=3HP/100K BTU
36.00
6.00
6.5000
EA MECH
VENT FAN
39.00
1.00
----------------------------------------------------------------------------
6.5000
EA MECH
EXHAUST HOOD
6.50
LQPERMIT
Application Number . . . . . 05-00004128
Permit . . . . .• PLUMBING
Additional desc . .
Permit Fee . . . . 212.25 Plan Check Fee
107.62
Issue Date . . . . Valuation . . .
. 0
Expiration Date 4/18/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
21.00 6.0000 EA PLB FIXTURE
126.00
1.00 15.0000 EA PLB BUILDING SEWER
15.00
2.00 6.0000 EA PLB ROOF riRATid
12.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
1.00 3.0000 EA PLB WATER INST/ALT/REP
3.00
1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM
9.00
13.00 .7500 EA PLB GAS PIPE >=5
9.75
1.00 15.0000 EA PLB GAS METER
-
15.00
----------------------------------------------------------------------------
Special Notes and Comments
4465 SQ. FT. SFD THIS PERMIT DOES NOT
INCLUDE POOL & SPA BLOCK WALLS OR
DRIVEWAY APPROACH.October 3, 2005
2:24:15 PM JJOHNSON AN ADDITIONAL PLAN
CHECK WAS ADDED TO PERMIT FOR PLAN
CHECK DUE WHEN PRIOR PLAN CHECK WAS
PERFORMED ON P/C 04-8023
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES
479.73
DIF COMMUNITY CENTERS -RES
74.00
DIF CIVIC CENTER - RES
480:00
ENERGY REVIEW FEE
105.96
DIF FIRE PROTECTION -RES
140.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
355.00
DIF PARK MAINT FAC - RES
22.00
DIF PARKS/REC - RES
892.00
STRONG MOTION (SMI) - RES
39.18
DIF STREET MAINT FAC -RES
67.00
DIF TRANSPORTATION - RES
1666.00
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 1796.95 .00 .00
1796.95
Plan Check Total 1330.69 750.00 .00
580.69
Other Fee Total 4320.87 .00 .00
4320.87
Grand Total 7448.51 750.00 .00
6698.51
LQPERAIIT
TUT 4 4 a" v 5-- �/Z:s
PO. BOX 1504 APPLICATION ONLY
Building 5 ✓ _j_/ ti /� .I- m� 7UINT CALLE CALIFORNIATAMPIO
Address ✓ i710 V x/1,1 LA QUINTA, ORNIA 92253
uwner 4elacl ll MOOD f'V I
r
Addreessss UG ores Lcule1
Add'1 I Gt
City - Zip T .
l..�s cam- j'3032- o$) 3: �) 6--27qr-?
& Classif. I Lic. #
Designer
121M, P-NNTI!R-6 PATI1r 9P_A (-7106) TZ(a-1fD68
City
ZState
�iNp 7,pC7 ?,
LICENSED CONTRACTOR'S DECLARATION
I 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, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) 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, Business and Profes-
sions 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 im-
provement is sold within one year of completion, the owner -builder will have the burden of
proving that he did not build or improve for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct
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. ti P.C. for this reason
Date Owner
WORKER'S COMPENSATION DECLARATION
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
❑ 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 any person in any manner so as to become subject to 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 cf 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
WHITE = BUILDING DEPARTMENT
BUILDING: TYPE CONST. ii �)P— OCC. GRP. EVECAVEAMM-
A.P. Number �, �'� g10 --00q
Legal Description LOT 30-9 TPPIGi 2-g9q4 —j+
Project Description CUSiV M b1 NGl.F, )=AM 114
ZONE: BY:
Minimum Setback Distances:
Front Setback f-om Center Line
Rear Setback frim Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
YELLOW = APPLICANT PINK = FINANCE
Sq. Ft. J r
Size t '"✓
No. /% No. Dw. I
Stories -A— Units
Newy Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
p
qN
or
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback f-om Center Line
Rear Setback frim Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
YELLOW = APPLICANT PINK = FINANCE
DEC 02 2004 12:54 FR FIRST AMERICAN TITLE
1
F1DE1:1"fY NATIONAL TITLE COMPANY
sUHI)IVISION DEPARTMENT
WHEN RECORDED MAIL TO:
Mr. and t$s . Kbashayar Anwwheh
14840 LaS Flores ZZ3�t
cathedral City.
MAIL TAX STATEMENT TO:
SAME AS ABOVE
TO 917607764298 P.02i06
COOC esiaes�,j awe 60 Fee 9-"
pate f of S Deo S Tax; POld
ft,,,C�IY of Dlvsrside
Wil t. Orso
pasassor, County Clerle Record+,
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DOCUMENT TRANSFER TAX S519.7-5
XX Computed on the consideration or value of property conveyed-- OR
_ Computed on the consideration or value less heps or encumbrances
remaining at the time of sale.
--7-7a,
-r"- opo
0 R
. signswre of Dechne or Agent deWmIninB tax - Firm Name
GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowl:dre<1+ ND
LA QUINTA PARTNERS, LLC, a Delaware limited liability company ("Grantor").:,1ereby
GRANT(S)to Ithasbayar Ancosheh and Nirvana Anooaheh. Ihnband and Wife as Joint
Tenants
("Grantee"), the real property loctcted in the City of La Quinta, County of Riverside, State of
California, described as:
See Legal Description attached hereto and incorporated herein as Exhibit A
SUBJECT TO all matters of record including, without limitation. the covenants and
agreements described
�i(n' Exhibit "A" attached hereto.
Dated: '7
ND LA QUINTA PARTNERS, LLC.
a Delaware limited liability company
By: Nationwide Realty investors, Ltd -
aa Ohio limited liability co pent'+
its Managin ember
By:
J ph L. Arenson
Authorized Representative
Description: Riverside, CA Document -Year DaclD 2004.242469 Page: t of 5
Order. AT -00000000007 Comment: ATTN KI=LLY FROM AUSTIN
A
DEC 02 2004 12:54 FR FIRST AMERICAN TITLE
STATE OF _ California
COUNTY OF , Riverside
TO 917607764098 P.03i06
On Mar h 24. 2004 _ before me, K Larbv Notary Public
(Name, Title of Officer)
personally appeared Joseph L. Arens n
personally known to me (or proved to me on the basis of satisfactory evidence) to be the parson(s)
whose ngme(s) is/are subscribed to the within instrument end acknowledged to me that he/ahelthey
executed the same in his/het/their authorized capacityliss), and that by his/hedtheir signatures) on the
instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the
instrument.
WITNESS my hand and official seal.
C
(Signa ry blic)
ot:r�orat st4►
K.LARBY
COMM /1266791
Nang Pumc - Como""
Rf1RtRM COUN"
i hft 0~kwo Icpbn
ZUNI 14, 2094
(This area for notarial seal)
Description: Riverside,CA Document- Year. DocID 2004.242469 Page: 2 of 5
Order: AT -0000000000r Comment: ATTN KC-LLY FROM AUSTIN
DEC 02 2004 12=54 FR FIRST AMERICAN TITLE TO 917607764096 P.04i06
GOVERNMENT CODE 27361.7
RY THAT THE NOTARY
I HEREBY CERTIFY
CUMEN To WHI H THIS S AT1'ACFOLLOWS:
AL
ON 7HE DO ED READS S FOLLOWS
NAME OF NOTARY: K. LARBY
COMMISSION NUMBER: 1266797
DATE COMMISSION EXPIRES: JUNE 24, 2004
COUNTY WHERE BONDED: RIVERSIDE COUNTY, CALIFORNIA
PLACC OF EXECUTION: RIVERSIDE
DATE:
FIDELITY NATIONAL. TITLE
BUILDER SERVICES
Description: Riverside, CA Document-Year.DoclD 2004.242469 Page: 3 o(5
Order. Ar 0000000000T Comment: ATTN KELLY FROM AUSTIN
DEC 02 2004 12:54 FR FIRST AMERICAN TITLE TO 917607764098 P.05i06
EXHIBIT -A-
Legal Descriptio
Parcel No. 1:
Lot 36 (the "Lot") of Tract No. 29894-4, in the City of La Quinta, as shown by Map on file in
Book 351, Pages 49 to 57, inclusive, of Maps, in the Office of the County Recorder of Riverside
County, California.
EXCEPTING AND RESERVING THEREFROM TO GRANTOR, and its successors,
assigns, invitees, licensees and employees, together with the right to grant and transfer all or a
portion of the same, all easements and rights for access, ingress, egress, encroachment,
maintenance, drainage. support, and for other purposes over the Association Maintenance Areas
and other portion of the Lot, reserved to Grantor in the following instruments --
I .
1. The Amended and Restated Declaration of Covenants, Conditions and
Restrictions and Rmmtion of Easanents for The Hideaway Owners Association (as amended
or supplemented, the "Declaration'j, accorded on Docember 13, 2002, as Instrument No. 2002-
745938, of Official Records of Riverside County, California (the "Official Records");
2, The Supplementary Declaration of Annexation of Property, recorded on March 4,
2004, as Instrument No. 2004.0151981, of Official Records of Riverside Country, California.
FURTHER RESERVING THEREFROM, the right to enter the Lot for a terns of
twelve (12) months following the recordation of this Grant Deed, to complete and repair any
improvements or landscaping located thereon as determined necessary by Grantor, in its sole
discretion, in order to comply with requiramts for the recordation of the Final Tract Map, the
grading of said Tract and/or in compliance with the requirements of applicable govemmental
agencies. Such entry by Grantor shall be preceded by reasonable notice to Grantee before such
entry. If this reservation of right of entry is not complied with by Grantee, Grantor may enforce
this right of entry in a court of law. Grantee shalt be responsible for an damages arising out of
said breach including attorneys' fees and court costs. This reservation of right of entry shall
automatically expire twelve (12) months from the recordation of this Grant Deed_
ParceNo. ;
Nonexclusive easements for access, ingress, egress, drainage, maintenance, repairs and
for other purposes, all as described in the Declaration.
SUBJECT TO:
Non delinquent general, special and supplemental real property taxes and
assessments.
Description: Riverside, CA Document -Year. DocID 2004.242469 Page: 4 of 5
Order: AT-0OD0000000T Comment: ATTN KELLY FROM AUSTIN
DEC 02 2004 12:54 FR FIRST AMERICAN TITLE
TO 917607764098 P.06i06
2. All other covenants, conditions, restrictions, reservations, easements, rigits and
rights-of-way of record including, without imitation. the Declaration and the Map for T. -act No.
29894-4.
Grantee, by acceptance and recordation of this Grant Deed, hereby (a) accepts and
approves all of the foregoing in dtis Oraat Deed, (b) greats to Gramor and The Hideaway
Owners Association such powers and rights as arc set forth in the Declaration, and (c) accepts,
covenants and agrees to be bound by and assume performance of all of the applicable provisions
and requirements set forth in the Declaration, including Section 13.15 establishing the procedure
for resolving disputes with Grantor, and the notice, which provisions and requirements are
acknowledged to be reasonable and incorporated herein by this reference thereto. This grant is
conditioned upon the pofonnam of such provisions and requirements as are to be performed by
Grantee under the Declaration. The restrictions on use and occupancy of the Lot are sdt forth in
the Declaration to which this Grant Decd is specifically and expressly made subject.
GRANTEE HEREBY ACCEPTS AND APPROVES THE FOREGOING, granting unto
Grantor and The Hideaway Owners Association such powers and rights which are set forth in the
I) claration defined above, on 2 3 ,M•- c •-fin _, 2004.
Khas agar 406shCh
Nirvana Anoosheh
STATE OF Cg Ii "a )
ss.
COUNTY OF Sn,.4a
On C23 Ma 20W, before me. the undersigned, a notary
public in and for said State; personally appeared Khwhaysr and Nirvana Aaeosbeh. personally
known to me (or proved to me on the basis of satisfactory evidence) to be the persona whose
names arc subscribed to the within instrument and acknowledged to me that they executed the
sante in their authorized capacities, and that by their signature on the instrument the persons, or
the emity upon behalf of which the persons acted, executed the instrument.
WITNESS MY HAND AND OFFICIAL SEAL.
(SEAL]
My commission ot00'7
�11tAR>�►oigOoe
Dona�Yeul 11611'�s
Nyconm��ta►1e.Zo
r
oat� • a�MY so1w1
ttrttwe o
- A=VWN 01;
Description: Riverside,CA Document-Year.Doc1D 2004.242469 Page: 5 of 5
Order: AT-OOo0000000T Comment: ATTN KELLY FROM AUSTIN
** TOTAL PAGE.06 **
RECORDING REQUESTED BY:
Kristi Hanson, Inc.
72-185 Painters Path, Ste. A
Palm Desert, CA 92260
WHEN RECORDED PLEASE MAIL TO:
Kristi Hanson,. Inc.
72-185 Painters Path, Ste. A
Palm Desert, CA 92260
DOC a 2005-0162191
03/01/2005 08:00A Fee:NC
Page 1 of 4
Recorded in Official Records
County of Fiverside
Larry 4. Ward
...Assessor, County,Clerk 8 Recorder
;:..((IIIIIIIIIIIIIII'lllllll(IIIII(IIIIIIIII1111
(IINI�III
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SIZE
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LONG
REFUND
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EWIM
COVENANT AND AGREEMENT. RESTRICTING THE USE OF THE RESIDENCE AT
53-663 VIA DONA, LA QUINTA, CALIFORNIA
This Covenant and Agreement are made and executed this 29th day of
December, 2004 by Kashi Anoosheh, as the record owner(s) of the property
described herein. The City of La Quinta, a Municipal Corporation, is hereby made a
party to this Agreement for the purposes set forth below.
The undersigned hereby certifies that he/she is the property owner of the
following described real property in the City of. La Quinta, County of Riverside,
State of California:
LOT 36, BK. 772 PG. 41, TR 29894-2, in the City of La Quinta,
County of Riverside, State of California
In consideration of the City of La Quinta issuing a building permit for certain
improvements which will be constructed on said property, the undersigned does
hereby covenant andagree to and with said City to restrict the use of said property
as follows:
1. The guest house may not be rented nor sold independent of the main
single family residence (Minor Use Permit .No. 2004-584);
2. No kitchen or cooking facilities shall be constructed in the guest house
per the provisions of Chapter 9.30.030 (RL Zone District), and
9-.60.110 (Guest Houses) of the La Quinta Municipal Code;
3. All on-site facilities are intended for the sole occupancy of the
property owner(s), guests, and caretakers (i.e., a maid and/or
housekeeper, etc.); and,
4. The guest house shall be used primarily as a sleepirg facility,.and shall
na
5
a
be maintained in .accordance with all zoning and other codes as set
forth in the La Quinta Municipal Code, as may be amended from time
to time. t
This covenant and agreement shall run- .:.With the land and shall be binding
upon future owners, their successors, heir6;*::4r assigns, and ourselves, and shall
continue in effect while said accessory...
ccessory. building remains on the real property or
unless otherwise released by the authority of the City of La .Quinta. All leases of
said dwelling and/or property shall be subject to this restriction. This agreement
shall be entitled to the remedy of injunctive relief in addition of any remedy in law
or equity.
This covenant and agreement and the provisions hereof are irrevocable,
except by the written consent of all parties to the agreement, including the City of
La Quinta, a municipal corporation. The City shall have the right to enforce each
and every provision hereof and the parties agree that the agreement shall not be
rescinded, revoked, modified, or otherwise amended or changed, without the
expressed written consent of the City first being obtained.
In the event that the owners, their heirs, assigns or successors in interest,
shall fail to perform any obligation hereunder, they hereby agree to pay all costs
and expenses incurred by the City of La Quinta in securing performance of such
obligation, including attorney's fees.
By: 1.
2.
3.
Signature(s)
'14psN,4y14n(IAS14t,ku,',o&4 4
Printed Name of all owner(s)
Dated: 11.22/vS
Thomas P. Genovese Date
City Manager/Interim Community Development Director
City of La Quinta
ALL.PURPOSE NOTARY ACKNOWLEDGMENT(S) MUST BE ATTACHED IN 8-1/2 X
11 " FORMAT, FOR EACH SIGNATURE.
SEE ATTACHED
NOTARY CERTIFICATE
r
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
ss.
County of 5(:I-n�CA C' coo
On 22 J" 0 5 before me, L>Ay %/ A S ,
Date Name and Title of Officer (e.g., 'Jane Dae, Notary Public)
personally appeared K 4 Sh cA y Q 1�g5t,\ t) A n O OSIn e 1n.
Name(s) of Signer(s)
❑ personally known to me
proved to me on the basis of satisfactory
evidence
MRUDULA H. VYAS
Commission *136&W Z
Z Notary Public- California
r Santa Clara Count►
my comm. Expires Jun 30, 2006
to be the person($) whose name(4) is/afe
subscribed to the within instrument and
acknowledged to me that he/sh@Mey executed
the same in his/heN#ieir . authorized
capacity(ies), and that by his/her heir
signature(s) on the instrument the person(s), or
the entity upon behalf of which the person($)
acted, executed the instrument.
WITNESS my hand and official seal.
f" V4��
Signature of Notary Public
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document and could pre ht
fraudulent removal and reattachment of this form to another document.
eqof Attached Document
Title or Type of Docuftgt� /
Document Date: fjluinber of Pages:
Signer(s) Other Than Named Above:
Capacity(les) Claimed by Signer
Signer's Name:
❑ Individual
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ Geo
❑ Attorney -in -Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representi
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0 1999 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402 • www.nationalnotary.org Prod. No. 5907 Reorder: Call Toll -Free 1.900-876-6827
0.. r
1 a.
STATE OF CALIFORNIA )
COUNTY OF RIVERSIDE 1 ss.
CITY OF LA QUINTA 1
On January 3, 2005 before me, Regenia Hensley, Notary Public, personally
appeared THOMAS P. GENOVESE personally known to me to be the person whose
name is subscribed to the within instrument and acknowledged to me that he executed
the same in his authorized capacity, and that by his signature on the instrument. the
person or the entity upon behalf -of. which the person acted, executed the instrument.
WITNESS my hand -and official seal. (Seal)
dhkd
WGENA HEt WAD
(u*weslon i 121
REG IA HENSLE Notary PASC - CcAtoMo
Notary Public, rave, ,�trocr23,2ooe .
Commission # 1521423
Expiration: October 23, 2008
TITLE 24 REPORT
Title 24 Report for:
Kashi Anoosheh
53663 Via Dona, The Hideaway
La Quinta, CA 92253
Project Designer,:
Kristi Hanson Architect
72-185 Painrts Path #A
Palm Desert, CA 92260
Report Prepared By:
Gina Rose
Test Version - Not Valid for Submittals
Not a Certified Version
CITY OF LA QUANTA Job Number:
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRU TION
� Date:
DATE 101 Z,0 f 05 Rv
8/24/2005
The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. 'This program has approval and is
authorized by the California Energy Commission for use with both the Residential and Nonresidential 2005 Building Energy Efficiency Standards.
This program developed by EnergySoft, LLC - www.energysoft.com.
EnergyPro 4.0 by EnergySoft Job Number: User Number: 0000
1%
TABLE OF CONTENTS I
Cover Page
Table of Contents
Form CF -1 R Certificate of Compliance
Form MF -1 R Mandatory Measures Summary
Form WS -5R Residential Kitchen Lighting
HVAC System Heating and Cooling Loads Summary
1
2
3
8
10
11
EnergyPro 4.0 by EnergySoft Job Number: User Number 0000
Certificate Of Compliance : Residential (Part 1 of 3) CF -1 R
_B.eta_V_eTs.ion_ __Onl_y_. Calc.u.lati.on.s_not_V_al.idated.:_N_ot_f_oT_S_ub.mitta1.
8/_2412Q05
Project Title
Percent better than Standard:
35_
Data
5.6.3_Via�onalThe- ideawa_y_La_Quinta
561.
BUILDING
COMPLIES - HERS VERIFICATION REQUIRED
Project Address
Building Type: �J Single
Family ❑ Addition
Bull Jing Permit #
_T_est_V_elsion - Not_V_al.id_f_ar-Su.bm.ittal.s
ft2
❑ Multi Family ❑ Existing + Add/Alt
Plar Check/Date
Documentation Author
ft2
Telephone
(Northeast) 45 deg
_Ener_Pso
535
15
Field Check/Date
Comp ce Method
Slab on Grade Area:
Climate Zone
ft2
Source Energy Use Standard
Proposed
Compliance
11.7
(kBtu/sf-yr) Design a
Design
Margin
Number of Dwelling Units:
Space Heating 3.41
4.32
-0.91
Avg. SHGC: 0.40
Space Cooling 67.76
63.16
4.59
Not Valid for permit
Fans 9.80
9.52
0.28
Floor Area Volume
Domestic Hot Water 5.41
6.51
-1.10
applications submitted on or
Pumps 0.00
0.12
-0.12
after 01/23/06 because
Totals
86.38 83.64
2.74 Energy Budget is based on
Percent better than Standard:
35_
3.2% SEER 10.
Wall_ Wood_
561.
BUILDING
COMPLIES - HERS VERIFICATION REQUIRED
84
Building Type: �J Single
Family ❑ Addition
Total Conditioned Floor Arsa:
4,465
ft2
❑ Multi Family ❑ Existing + Add/Alt
Existing Floor Area:
n/a
ft2
Building Front Orientation:
(Northeast) 45 deg
Raised Floor Area:
535
ft2
Fuel Type:
Natural Gas
Slab on Grade Area:
3,930
ft2
Fenestration:
4.52.
Average Ceiling Height:
11.7
ft
Area: 893 ft 2
Avg. U: 0.77
Number of Dwelling Units:
1.00
.RO.OL- Wood_
Ratio: 20.0%
Avg. SHGC: 0.40
Number of Stories:
2
-0-0.7-4-
BUILDING ZONE INFORMATION
# of Thermostat
Vent
Zone Name
Floor Area Volume
Units Zone Type Type
Hgt.
Area
.Res-EVAC7-7_1
-8,866
-0_17 Sleeping _IleepingStat_
8
-nla
.Rest= VA_ C
2 326 _3.0,23.8
_0.52_ Living-Living.Stat_
8
_n/a
Res_ELVA_C
1.,.36.8 1.3,26
0.31_ Sleeping _.:I.eepingStat_
8
_n/_a
OPAQUE SURFACES
Type Frame Area U -Fac.
Roof- Wood-
666--0-029-
6__0_029_Wall_
❑New
-Wall Wood_
35_
_0074_
Wall_ Wood_
561.
_0._0.7_4_
Wall- Wood-
84
_0_07-4_
Wall_ Wood_
_266_
0..074_
_Root- Wood_
1.,8.9.6_
_0_029_
Wall- Wood-
662_
_0_074_
Door_ None-
2.4_
145.0-
45.0_Wall-
-Wall Wood_28.7_
[X
_0_0.7_4_
Wall_ Wood_
3.6_
_0_074_
Wall_ Wood-
4.52.
0_074_
Wall_ Wood-
36_
_0_074_
Wall_ Wood_
X35_
_0_0.7_4_
.RO.OL- Wood_
8.33_
_0_029
Wall_ Wood_
323_
-0-0.7-4-
-Wall Wood_
5Z9_
-0-0.7-4-
Wall_ Wood-
1.88_
_0_074_
Wall_ Wood-
366_
_0..074_
.FJo.or- Wood-
535_
_0..04.8_
Root Wood_
5.3.5_
_0_0.35_
Wall_ Wood_
31.5_
_0_.074_
Wall_ Wood_
_225_
_0_0.7-4_
Wall_ Wood_
36.6_
-0-0.7-4-
-Wall Wood_
_25.0_
_0..074_
Insulation Act. Gains Condition
Cay. Cont. Azm. Tilt Y / N Status JA IV Reference Location / Comments
_8=38__R0_0_ 0__22
Master -Bedroom
❑New
Master -Bedroom
-EZ1.9_ _80._0_ ___45 _9.0
IX
❑
New
_R_1.9__80_0_ 1.359.0.
IX
❑New
L:vingA_ r_ea
-8,.9_ _RO_0_ -225.9.0
DKI
❑
New
-8-19.0``0_0_ -315__9.0
IX
❑
New
_838_ _80.0 022
IX
❑
New
-R_A 9_ _80_0_ x.5_ 9.0
[X
❑
New
_Clone_ 0:=0_0_ 45_ 9.0
IX
❑
New
-E2_1.9 _10_.0_1.359.0
IX
❑N.ew
tsLEto.or_Zone
_R19 _80_.0_ 1.80__90
[ X
❑N.ew
2ad-Roor-Zone
-EZ1.9_ _RO_0_ -225__9.0
IXI
❑
New
Os9_ _ERO_0_ -27.0__9.0
IX
❑
New
_LZ1.9_ _R=0_0_ _315 9.0
IXI
❑
New
-83.8.0``0..0_ 022
1
❑New
019 _80.0 _45- -go
IX
❑New
019 _800_ -1359.0
[XI
❑
New
_8_1.9_ _80_0_ -225_ 9.0
[X
❑
New
-Rs9. 0'`0_0_ -315__9.0
[XI
❑
New-
ewR=11__
R- 11 __0_0_ 0_ 1.80
❑
IX
New
0=3.0_ _80_0_ -0--22
IX
❑
N.ew
-R_t9__80._0_ 45__9.0
(XI
❑N.ew
0=t9 _80_0_ 135 9.0
IX
❑
New
-B_-t9 _80.0_ _225.9.0
[X
❑
N.ew
0_.9_ _R=0_0_ -315. 9.0
1
❑
New
❑
❑
.02- 11
Master -Bedroom
_0.9=A5
Master -Bedroom
_0.9=A5
Master -Bedroom
_0.9=A5
Mastef-Bedro.om
_09=A5
Master -Bedroom
_02=A_11
L:vingA_ r_ea
_0.9=A5
L_vin. g_Area
28=A-
LvingArea
_0.9=/_A5
LvingA_rea
_0.9=A5
LvingA_ rea
_09=A5
LvingArea
_09-
LvingArea
_0.9=A5
LvingArea
_02=A11
=sLloor_Zone
_0.9=A5
_ sLE1oo.r_Zone
Q9 _5
_1st_E1oor_Zone
_0.9=A5
ssLEloor_Zone
_0.9=A5
tsLEto.or_Zone
21-
2 id_FJo.or_Zone
_02A10
2ad-Roor-Zone
_0.9=95
2nd_Eloo. r_Zone
_0.9=A5
.21Lid_E[o o rZo n e
_0.9=A5
.2nd-l.00r_Zone
_09=A5
.21nd-Eloor_Zone
I EnergyPro 4.0 by EnergySoft User Number: 0000 Job Number: Paoe:3 of 13 1
Certificate Of Compliance
: Residential
(Part 2 of 3) CFA R
Beta Version Only. Calculations not Validated.
Not for Submittal.
8/24/2005
Project Title
0.76
15 Bug Screen
0.76
Date
0.76
FENESTRATION SURFACES
0.76
18 Bug Screen
0.76
19 Buq Screen
0.76
2,076
4.00 28 0.98 0
True
Cond.
Living Area / Slab on Grade
Location/
# Type Area
U -Factor' SHGC2
Azm.
Tilt Stat.
Glazing Type
Comments
-I- -W.indow-Left_(S.outheast)_36_.8_
-0.77-0-NERC 0_4.0 -NERC X3.5_
_9.0- New_Milgard-Dbl/.MtLC1LLo_w_E
_Mastett3.edroom
2 Window Rear Southwest 50.0
0.770 NFRC 0_40 NFRC
225
90 New
Milgard Dbl/Mtl Or Low -E
Master Bedroom
3 Window Rear (Southwest) 50.0
0.770 NFRC 0_40 NFRC
225
90 New
Milgard Dbl/Mtl Or Low -E
Master Bedroom
4 Window Right (Northwest) 45.0
0.770 NFRC 0_40 NFRC
315
90 New
Milgard Dbl/Mtl Clr Low -E
Master Bedroom
5 Window Front (Northeast) 28.0
0.770 NFRC 0_40 NFRC
45
90 New
Milgard Dbl/Mtl Clr Low -E
Living Area
6 Window Front (Northeast) 45.4
0.770 NFRC 0_40 NFRC
45
90 New
Milgard Dbl/Mtl Clr Low -E
Living Area
7 Windom FroJ]t-( Qrrth-uQ-AQ-0-
-.770 FR 040 NFRC
--A5_
90 New
ivingArea8
MilgaJ-D-bl/MtLCIr Low -E -Living-Area-
8Window Front (Northeast) 45.4
0.770 NFRC 0.40 NFRC
45
90 New
Milgard Dbl/Mtl Or Low -E
Living Area
6Window Left__-�$outl_ieast) 16.0
0.77 NFRC 0.40 NFRC 135
--K New
Milgard Dbl/M LCIr Low -E
Living Area
-oWindow L _(32utheast) 8.a
0.77 NFRC 0 40 NFRC X05
90 New
Wi gard W110 -1l Or Low -E
Living Area
11 Window Left South) 16.0
0.770 NFRC 0_40 NFRC
180
90 New
Milgard Dbl/Mtl Or Low -E
Living Area
12 Window Rear (Southwest 80.0
0.770 NFRC 0_40 NFRC
225
90 New
Milgard Dbl/Mtl Or Low -E
Living Area
13 Window Rear_(South..west)_1.6 0-0
7_7--0-NERC 0.-40. -NEE-C
_22.5_
_90- N.e_w
Milgard-Dbl/.M.tl_Clr_Low=E
_Living-_ r_ea
14 Window Rear (Southwest) 28.0
0.770 NFRC 0.40 NFRC
225
90 New
Milgard Dbl/Mtl Or Low -E
Living Area
15 Window Rear West) 16.0
0.770 NFRC 0_40 NFRC -
270
90 New
Milgard Dbl/Mtl Clr Low -E
Living Area
16 Window Right (Northwest) 16.0
0:770 NFRC 0_40 NFRC
315
90 New
Milgard Dbl/Mtl Clr Low -E
Living Area
17 Window Right Northwest 20.0
0.770 NFRC 0_40 -NFRC.
315
90 New
Milgard MIMI I Or Low -E
Living Area
18 Window Right (Northwest)8.8
0.770 NFRC 0_40 NFRC
315
90 New
Milgard Dbl/Mtl Clr Low -E
Living Area
19 Wind9w Front (IVO�hQsnet) 5 2
0.77 NERC 0.4Q NFRC ---A5
90 New
Mil gardDl I/MtLCIr Low -E
13t-El0-OLZone
1. Indicate source either from NFRC or Table 116A. 2. Indicate source either
from NFRC or Table 116B.
INTERIOR AND EXTERIOR SHADING Window
Overhang
Left Fin
Right Fin
# Exterior Shade Type SHGC
Hgt. Wd.
Len.
Hgt. LExt.
RExt. Dist. Len.
Hgt. Dist. Len. Hgt.
1 Bug Screen
0.76
2 Bug Screen
0.76
3 Bug Screen
0.76
4 Bug Screen
0.76
5 Bug Screen
0.76
6 Bug Screen
0.76
7 Bug Screen
0.76
8 Bug Screen
0.76
9 Bug Screen
0.76
10 Bua Screen
0.76
11 Bug Screen
0.76
12 Bug Screen
0.76
13 Bug Screen
0.76
14 Bug Screen
0.76
15 Bug Screen
0.76
16 Bug Screen
0.76
17 Bug Screen
0.76
18 Bug Screen
0.76
19 Buq Screen
0.76
THERMAL MASS FOR HIGH MASS DESIGN
Type
Area Thick. Heat Inside
(sf) (in.) Cap. Cond. R -Val.
JA IV Reference
Condition
Status
Location/
Comments
Concrete. He�eight
240
4.00 28 0.98 0
26-A1
New
Master Bedroom / Slab on Grade
Concrete, Heavyweight
531
4.00 28 0.98 2
26-A1
New
Master Bedroom / Slab on Grade
Concrete, He v weight
2,076
4.00 28 0.98 0
26-A1
New
Living Area / Slab on Grade
Concrete, He�eight
250
4.00 28 0.98 2
26-A1
New
Living Area /Slab on Grade .
Concrete, Heavyweight
4.00 28 0.98 0
26-A1
New
1 st Floor Zone / Slab on Grade
PERIMETER LOSSES
Insulation
Condition
Location/
Type
Length
R -Val. Location
JA IV Reference
Status
Comments
Slab Perimeter
23
None No Insulation
26-A1
New
Master Bedroom
Slab Perimeter
75
None No Insulation
26-A1
New
Master Bedroom
Slab Perimeter
163
None No Insulation
26-A1
New
Living Area
Slab Perimeter
46
None No Insulation
26-A1
New
Living Area
New
EnergyPro 4.0 by EnergySoft User Number: 0000 Job Number: Paae:4 of 13 1
Certificate Of Compliance : Residential (Part 2 of 3) CF -1 R
Beta Version Only. Calculations not Validated. Not for Submittal. 8/24/2005
Project Title Date
FENESTRATION SURFACES
True Cond. Location/
# TvDe Area U-Factorl SHGCZ Azm. Tilt Stat. Glazing Tvi)e Comments
20
21
22
Ill-indow_From-(Notihe.ast)-10.-0__0-n0-NERC_0..40-NERC--4.5_
Window Front (Northeast) 10.0
Window Front Northeast) 35.0
0.770 NFRC 0_40 NFRC 45
0.770 NFRC 0_40 NFRC 45
9.0_NewMilgard-D.b.UMtLCJr_Low_E_-st.Eloo-Zon0
90 New Milgard Dbl/Mtl Cir Low -E
90 New Milgard Dbl/Mtl Or Low -E
1st Floor Zone
1st Floor Zone
23
Window Left Southeast 6.2
0.770 NFRC 0_40 NFRC
135
90 New Milgard Dbl/Mtl Cir Lour -E
1st Floor Zone
24
Window LeftSoutheast 7.0
0.770 NFRC 0_40 NFRC
135
90 New gard Dbl/Mtl Cir Lour -E
Mil
1st Floor Zone
25
26
27
Window Rear (Southwest) 40.0
Win w i b1-(NQrthweet) 40 0_
Window Front (Northeast) 5.0
0.770 NFRC 0_40 NFRC
0770 NFRC Q,40 -N-FRC
0.770 NFRC 0.40 NFRC
225
315-
45
90 New Milgard Dbl/Mtl Clr Love -E
90 New Mi�7cl ."rr Dmf I/Mtl Ir LoN -E
90 New Milgard Dbl/Mtl Or Loy -E
1st Floor Zone
1st FlooLone
2nd Floor Zone
28
Win ow Front (N2rkLle�st) Q0
_N_FgCQ44 N�
Bug Screen
9Q New MilgardDbl/Mt rL Nr-E2ndaoorZone
28
29
Win ow Front_(NNortheast)� Q
0.77 NFRC 40 NFRC
45
90 New Milgard Dbl/MtI Cir LoH-E
2n Floor Zones
-34
Window Left Southeast) 7.5
0.770 NFRC 0_40 NFRC
135
90 New Milgard Dbl/Mtl Cir Low -E
2nd Floor Zone
31
Window LeftSoutheast 7.5
0.770 NFRC 0_40 NFRC
135
90 New Milgard Dbl/Mtl Cir Low E
2nd Floor Zone
_32.
WindovwRear (.South..west)_3.8_
-0-7-7-0 -N.EP-,C 0 40 -NERC
_22.5_
90- NewMilgar_d-Dbl/Mtl_CJr_Low--E
-2nd3ocr_Zone
1. Indicate source either from NFRC or table 116A. 2. Indicate source either from NFRC or Table 1168.
INTERIOR AND EXTERIOR SHADING Window Overhang Left Fin Right Fin
#
Exterior Shade Type
SHGC Hgt. Wd. Len. Hgt. LExt. RExt. Dist. Len. Hgt. Dist. Len. Hgt.
20
Bug Screen
0.76
21
Bug Screen
0.76
22
Bug Screen
0.76
23
Bug Screen
0.76
24
Bug Screen
0.76
25
Bug Screen
_
0.76
26
Bug Screen
0.76
27
Bug Screen
0.76
28
Bug Screen
0.76
29
Bug Screen
0.76
30
Bug Screen
0.76
31
Bug Screen
0.76
32
Buq Screen
0.76
THERMAL MASS FOR HIGH MASS DESIGN
Area Thick.Heat Inside Condition Location/
Type (so (in.) Cap. Cond. R -Val. JA IV Reference Status Comments
Concrete, Heayywg ight 567 4.00 28 0_98 2 26-A1 New 1st Floor Zone / Slab on Grade
PERIMETER LOSSES Insulation Condition Location/
Type Length R -Val. Location JA IV Reference Status Comments
Slab Perimeter 106 None No Insulation 26-A1 New 1st Floor Zone
Run Initiation Time: 08/24/05 13.38.00 Run Code: 1124915880
EnergyPro 4.0 by EnergySoft User Number: 0000 Job Number: Page:5 of 13
Certificate Of Compliance : Residential (Part 3 Of 3) CF -1 R
Beta Version Only. Calculations not Validated. Not for Submittal.
Project Title
Dale
8/24/2005
HVAC SYSTEMS
Duct Condition
Ducts
Location
R -Value Status
Tested?
Attic
4.2 New
Heating
Minimum
Cooling
Minimum
Condition
Thermostat
Location
Type
Eff
Type
Eff
Status
Type
Res HVAC
Central Furnace
80% AFUE
Split Air Conditioner
14.0 SEER
Mew
Setback
Res HVAC
Central Furnace
80% AFUE
Split Air Conditioner
12.4 SEER
P ew
Setback
Res HVAC
Central Furnace
80% AFUE
Split Air Conditioner
12.4 SEER
New
Setback
HVAC DISTRIBUTION
Location
Heatino Cool
Res HVAC Ducted Ducted
Res HVAC Ducted Ducted
Res HVAC Ducted Ducted
Hydronic Piping Pipe Pipe Insul.
System Name Length Diameter Thick.
Duct
Duct Condition
Ducts
Location
R -Value Status
Tested?
Attic
4.2 New
Yes
Attic
4.2 New
Yes
Attic
4.2 New
Yes
WATER HEATING SYSTEMS Rated Tank Energy Standbyl Tank Insul.
Water Heater # in Input Cap. Condition Factor Loss R -Value
System Name Type Distribution Syst. (Btu/hr) (gal) Status or RE 1 (%) Ext.
A O SMITH GDVH-75 Large Gas Recirc/fime+Temp 1 76,000 71 New 0.80 2.85% 0.0
Multi -Family Central Water Heating Details
Hot Water Pump Hot Water Pi iinng Length U— Add 1/2"
Control # HP Type In Plenum Outside Buried Insulation
1 For small gas storage (rated input — 75000 Btu/hr), electric resistance and heat pump water heaters, list energy factor.
For large gas storage water heaters (rated input > 75000 Btu/hr), list Rated Input, Recovery Efficiency and Standby Loss.
For instantaneous gas water heaters, list Rated Input, and Recovery Efficiency.
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 cf the California Code of
Regulations, and the administrative regulations to implement them.This certificate has been signed by the individual with overall design responsibility.
The undersigned recognizes that compliance using duct design, duct sealing, verification of refrigerant charge and TXVs, insulation installation quality,
and building envelope sealing require installer testing and certification and field verification by an approved HERS rater.
Designer or Owner (per Business & Professions Code)
Name:
Title/Firm: Kristi Hanson Architect
Address: 72-185 Painrts Path #A
Title/Firm:
Address:
Telephone:
Documentation Author
Name: Gina Rose
Title/Firm: Test Version - Not Valid for :submittals
Address: Not a Certified Version
Telephone: 7 (—,'0
�/J
S12- y
nature) (date)
(signature/stamp) (date)
Certificate Of Compliance : Residential (Addendum) CF -1 R
Beta Version Only. Calculations not Validated. Not for Submittal. 8/24/2005
Project Title Date
Special Features and Modeling Assumptions
The local enforcement agency should pay special attention to the items specified in this checklist. These items require special
written justification and documentation, and special verification to be used with the performance approach. The local enforcement
agency determines the adequacy of the justification, and may reject a building or design that otherwise complies based on the
adequacy of the special justification and documentation submitted. I Plan I Field
Not Valid for permit applications submitted on or after 01/23/06 because Energy Budget is based on SEER 10.
The Roof "R-38 Roof(R.30.2x12.16) " includes credit for a Radiant Barrier installed per Section 3.3.3 of the Residential Manual.
The HVAC System 'Res HVAC' incorporates a HERS verified Refrigerant Charge test or a HERS verified Thermostatic Expansion
Valve.
The HVAC System 'Res HVAC' must meet all CEC Criteria for a Zonally Controlled system serving only Sleeping Abeas.
HIGH MASS Design - Verify Thermal Mass: 240 sqft Exposed Slab Floor, 4.00" thick at Master Bedroom
HIGH MASS Design - Verify Thermal Mass: 531 sqft Covered Slab Floor, 4.00" thick at Master Bedroom
The HVAC System 'Res HVAC' incorporates HERS verified Duct Leakage. Target leakage is calculated and documented on the CF -
4R.
The HVAC System 'Res HVAC' must meet all CEC Criteria for a Zonally Controlled system serving only Living Areas.
HIGH MASS Design - Verify Thermal Mass: 2076 sqft Exposed Slab Floor, 4.00" thick at Living Area
HIGH MASS Design - Verify Thermal Mass: 250 sqft Covered Slab Floor, 4.00" thick at Living Area
This building has credit for Insulation Quality Installation. A certified HERS rater must visually verify the installation o� all Insulation.
The HVAC System 'Res HVAC' must meet all CEC Criteria for a Zonally Controlled system serving only Sleeping Areas.
HIGH MASS Design - Verify Thermal Mass: 266 sqft Exposed Slab Floor, 4.00" thick at 1 st Floor Bedrooms
HIGH MASS Design -Verify Thermal Mass: 567 sqft Covered Slab Floor, 4.00" thick at 1st Floor Bedrooms
The HVAC System 'Res HVAC' incorporates a HERS verified Refrigerant Charge test or a HERS verified Thermostatic Expansion
Valve.
This building has credit for Insulation Quality Installation. A certified HERS rater must visually verify the installation of all Insulation.
HERS Required Verification
Items in this section require field testing and/or verification by a certified home energy rater under the supervision of a CEC-
approved HERS provider using CEC approved testing and/or verification methods and must be reported on the CF -4R Plan Field
installation certificate.
The HVAC System 'Res HVAC' incorporates HERS verified Duct Leakage. Target leakage is calculated and documented on the CF -
4R.
The HVAC System 'Res HVAC' incorporates a HERS verified Refrigerant Charge test or a HERS verified Thermostatic Expansion
Valve.
This building has credit for Insulation Quality Installation. A certified HERS rater must visually verify the installation or all Insulation.
The HVAC System 'Res HVAC' incorporates HERS verified Duct Leakage. Target leakage is calculated and documented on the CF -
4R.
The HVAC System 'Res HVAC' incorporates a HERS verified Refrigerant Charge test or a HERS verified Thermostatic Expansion
Valve.
This building has credit for Insulation Quality Installation. A certified HERS rater must visually verify the installation o� all Insulation.
The HVAC System 'Res HVAC' incorporates HERS verified Duct Leakage. Target leakage is calculated and documented on the CF -
4R.
The HVAC System 'Res HVAC' incorporates a HERS verified Refrigerant Charge test or a HERS verified Thermostatic Expansion
Valve.
This building has credit for Insulation Quality Installation. A certified HERS rater must visually verify the installation of all Insulation.
EnergyPro 4.0 by EnergySoft User Number: 0000 Job Number: Page:7 of 13
Mandatory Measures Summary: Residential (Page 1 of 2) MF -1 R
NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. Items marked with an asterisk
(') may be superseded by more stringent compliance requirements listed on the Certificate of Compliance. When this c iecklist is incorporated into the permit
documents, the features noted shall be considered by all parties as minimum component performance specifications for the mandatory measures whether they are
shown elsewhere in the documents or on this checklist only.
ENFORCE -
DESCRIPTION Instructions: Check or initial applicable boxes or check N/A if not applicable. N/A DESIGNER MENT
Building Envelope Measures
•§ 150(a): Minimum R-19 ceiling insulation or equivalent U -factor in metal frame ceiling.
❑
❑X
❑
§ 150(b): Loose fill insulation manufacturer's labeled R -Value:
❑
❑
•§ 150(c): Minimum R-13 wall insulation in wood framed walls or equivalent U -value in metal frame walls (does not
❑
❑X
❑
apply to exterior mass walls).
•§ 150(d): Minimum R-13 raised floor insulation in framed floors or equivalent U -factor.
❑
0
❑
§ 150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs.
1. Masonry and factory -built have:
a. closable metal or glass door covering the entire opening of the firebox
❑
❑X
❑
b. outside air intake with damper an control, flue damper and control
❑
❑X
❑
2. No continuous burning gas pilots allowed.
❑
❑X
❑
§ 150(0: Air retarding wrap installed to comply with §151 meets requirements specified in the ACM Residential Manual.
0
❑
❑
§ 150(g): Vapor barriers mandatory in Climate Zones 14 and 16 only.
Fx_1
❑
❑
§ 150(1): Slab edge insulation - water absorption rate no greater than 0.3%, water vapor transmission rate no greater than
❑X
❑
❑
2.0 perm/inch.
§ 118: Insulation specified or installed meets insulation quality standards. Indicate type and form:
❑
❑X
❑
§ 116-17: Fenestration Products, Exterior Doors and Infiltration/Exfiltration Controls
1. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage.
❑
❑X
❑
2. Fenestration products (except field fabricated) have label with certified U -Factor, certified Solar Heat Gain
❑
❑X
❑
Coefficient (SHGC), and infiltration certification.
3. Exterior doors and windows weatherstripped; ail joints and penetrations caulked and sealed.
❑X
❑
❑
Space Conditioning, Water Heating and Plumbing System Measures
§ 110-13: HVAC equipment, water heaters, showerheads and faucets certified by the Energy Commission.
❑
❑X
❑
§ 150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA or ACCA.
❑
❑X
❑
§ 150(i): Setback thermostat on all applicable heating and/or cooling systems.
❑
❑X
❑
§ 1506): Water system pipe and tank insulation and cooling systems line insulation.
1. Storage gas water heaters rated with an Energy Factor less than 0.58 must be externally wrapped with insulation
❑
❑X
❑
having an installed thermal resistance of R-12 or greater.
2. Back-up tanks for solar systems, unfired storage tanks, or other indirect hot water tanks have R-12 external
❑X
❑
❑
insulation or R-16 internal insulation.
3. The following piping is insulated according to Table 150-A/B or Equation 150-A Insulation Thickness:
First 5 feet of hot and cold water pipes closest to water heater tank, non -recirculating systems, and entire
❑
QX
❑
length of recirculating sections of hot water pipes shall be insulated to Table 1508.
Cooling system piping (suction, chilled water, or brine lines), piping insulated between heating source an
❑X
❑
❑
indirect hot water tank shall be insulated to Table 150-B and Equation 150-A.
4. Steam hydronic heating systems or hot water systems > 15 psi, meet requirements of Table 123-A.
❑X
❑
❑
5. Insulation must be protected from damage, including that due to sunlight, moisture, equipment maintenance,
❑X
❑
❑
and wind.
6. Insulation for chilled water piping and refrigerant suction piping includes a vapor retardant or is enclosed
❑X
❑
❑
entirely in conditioned space.
7. Solar water -heating systems/collectors are certified by the Solar Rating and Certification Corporation.
❑X
❑
❑
EnergyPro 4.0 by EnergySoft User Number: 0000 Job Number:
Page:8 of 13
Mandatory Measures Summarv: Residential (Page 2 of 2) MF -1 R
NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approe ch 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 minimum component performance specifi.:ations for the mandatory measures
whether they are shown elsewhere in the documents or on this checklist only.
ENFORCE -
DESCRIPTION Instructions: Check or initial applicable boxes or check N/A if not applicable. N/A DESIGNER MENT
Space Conditioning, Water Heating and Plumbing System Measures: (continued)
§ 150(m): Ducts and Fans
1. All ducts and plenums installed, sealed and insulated to meet the requirements of the CMC Sections 601, 602, 603, 604, ❑ Q ❑
605, and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minumum installed level of
R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure sys0m
that meets the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the requiremen.s
of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesf- or
tape shall be used.
2. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed ❑ ❑X ❑
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 reducions
in the cross-sectional area of the ducts.
3.;Joints and seams of duct systems and their components shall not be sealed with Goth back rubber adhesive
❑X
❑
❑
duct tapes unless such a tape is used in combination with mastic and drawbands.
§ 150(k)6: Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the
❑
0
❑
4. Exhaust fan systems have back draft or automatic dampers.
5. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operating
❑
®
❑
dampers.
❑
❑
❑
6. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment
❑
❑X
❑
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.
EnergyPro 4.0 by EnergySoft User Number: 0000 Job Number:
�II��11
❑
❑
7. Flexible ducts cannot have porous inner cores.
§ 114: Pool and Spa Heating Systems and Equipment
1. A thermal efficiency that complies with the Appliance Efficiency Regulations, on-off switch mounted outside of the
n
❑
❑
heater, weatherproof operating instructions, no electric resistance heating and no pilot light.
2. System is installed with:
®
❑
❑
a. At least 36" of pipe between filter and heater for future solar heating.
b. Cover for outdoor pools or outdoor spas.
❑
❑X
❑
3. Pool system has directional inlets and a circulation pump time switch.
0
❑
❑
§ 115: Gas fired fan -type central furnaces, pool heaters, spa heaters or household cooking appliances have no continuously
❑
❑X
❑
burning pilot light. (Exception: Non -electrical cooking appliances with pilot < 150 Btu/hr) .
§ 118 (i): Cool Roof material meets specified criteria
❑
❑X
❑
Lighting Measures
§ 150(k)1: HIGH EFFICACY LUMINAIRES OTHER THAN OUTDOOR HID: contain only high efficacy lamps as outlined in Table
❑
X❑
❑
150-C, and do not contain a medium screw base socket (E24/E26). Ballasts for lamps 13 Wafts or greater are electric
and have an output frequency no less than 20 kHz.
§ 150(k)1: HIGH EFFICACY LUMINAIRES - OUTDOOR HID: contain only high efficacy lamps as outlined in Table 150-C, hardwired
❑
❑X
❑
ballasts and if the ballast is electromagnetic has a medium base socket.
§ 150(k)2: Permanently installed luminaires in kitchens shall be high efficacy luminaires.
❑
❑X
❑
§ 150(k)3: Permanently installed luminaires in bathrooms, garages, laundry rooms, utility rooms shall be high efficacy luminaires.
❑
❑X
❑
OR are controlled by an occupant-sensor(s) ceriffied to comply with Section 119(d).
§ 150(k)4: Permanently installed luminaires located other than in kichens, bathrooms, garages, laundtry rooms, and utility rooms
❑
X❑
❑
shall be high efficacy luminaires (except closets less than 70 ft ).
§ 150(k)5: Luminaires that are recessed into insulated ceilings are approved for zero clearance insulation cover (IC) and are rated
❑X
❑
❑
to ASTM E283 and labeled as air tight (AT) to less than 2.0 CFM at 75 Pascals.
§ 150(k)6: Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the
Fx1
❑
❑
same lot shall be high efficacy luminaires (not including lighting around swimming poolstwater features or other Article 630
locations)
§ 150(k)7: Lighting for parking lots for 8 or more vehicles shall have lighting that complies with Sections 130, 132, and 147.
❑
❑
❑
Lighting for parking garages for 8 or more vehicles shall have lighting that complies with Section 130, 131, and 146.
§ 150(k)8: 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 OR are controlled by occupant sensor(s) certified to comply with Section -19(d).
EnergyPro 4.0 by EnergySoft User Number: 0000 Job Number:
Page:9 of 13
r
Residential Kitchen Lighting Worksheet WS -5R
Beta Version Only. Calculations not Validated. Not for Submittal. 8/24/2005
Project Title Date
At least 50% of the total rated wattage of permanently installed luminaires in kitchens must be in luminaires tha- are high efficacy luminaires
as defined in Table 150-C. Luminaires that are not high efficacy must be switched separately.
Kitchell Lighting Schedule. Provide the following information for all luminaires to be installed in kitchers.
Luminaire Type
High Efficacy? Watts
Quantity
High Ef=icacy
Wats
Other Watts
(1) 18w Compact Fluorescent Quad 4 Pin
Yes X No F 25.0
x 13
325
or
150w Recessed Incandescent
Yes I No X 150.0
x 1
or 150
15w per ft Above Cabinets Flour. Lighting_
Yes X1 No 15.0
x 17
255
or
15w per ft Undercounter Flour. Lighting
Yes X No 15.0
x 17
255
or
300 Watt Chandelier
Yes No X 300.0
x 1
or 300
Yes No
x =
or
Yes No
x =
or
Yes No
x =
or
Yes No
x =
or
Yes No
.x =
or
Yes No
x =
or
Yes No
x =
or
Yes No
x =
or
Yes No
x =
or
Yes No
x =
or
Yes No
x =
or
Yes No
x =
or
Yes No
x =
or
Yes No
x =
or
Yes No
x =
or
Total A: 835 B: 450
COMPLIES IF A z 3 YES [i] NO ❑
L EnergyPro 4.0 by EnergySoft - User Number: 0000 Job Number: Paae:10 of 13 1
1HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY
PROJECT NAME DATE
Beta Version Only. Calculations not Validated. Not for Submitta . 8/24/2005
SYSTEM NAME FLOOR AREA
Res HVAC 771
ENGINEERING CHECKS SYSTEM LOAD
Number of Systems
1
Heating System
Output per System
48,000
Total Output (Btuh)
48,000
Output (Btuh/sgft)
62.3
Cooling System
Output per System
48,500
Total Output (Btuh)
48,500
Total Output (Tons)
4.0
Total Output (Btuh/sgft)
62.9
Total Output (sgft/Ton)
190.8
Air System
CFM per System
1,600
Airflow (cfm)
1,600
Airflow (cfm/sgft)
2.08
Airflow (cfm/Ton)
395.9
Outside Air (%)
0.0
Outside Air (cfm/sgft)
0.00
Note: values above given at ARI conditions
26.0 of 69.3 OF
— % -00 -11--&
Outside Air
0 cfm
Supply Fan
1600 cfm
69.3 of
Total Room Loads
Return Vented Lighting
Return Air Ducts
Return Fan
Ventilation
Supply Fan
Supply Air Ducts
TOTAL SYSTEM LOAD
COIL COOLING PEAK
I I I COIL HTG. PEAK
CFMISensiblel
441
Latent
11CFM1Sensible
0
603
14,757
-188
441
16,423
0
1,333
1,251
0
0
0
0
0
0
0
0
0
1,333
1,251
17,424 188 18 926
TRANE 4TTX4048A1
37,887
3,683
Total Adjusted System Output
(Adjusted for Peak Design Conditions)
37,887
3,683
48,000
48,000
TIME OF SYSTEM PEAK Aug 2 pm Jan 12 am
69.3 of ® 105.0 OF
Heating Coil
�% Return Air Ducts `i
Supply Air Ducts
104.3 of
ROOMS
70.0 of
DOLING SYSTEM PSYCHROMETRICS Airstream Temperatures at Time of Coolin Peak
111.0 / 72.5 of 78.8 / 62.4 of 78.8 / 62.4 of 55.0 / 53.7 of
O310S SipplyAirDucts
Outside Air
0 cfm Supply Fan Cooling Coil 55.8 / 54.0 of
1600 cfm 40.9% R.H. ROOMS
78.8/62.4 °F 78.0/62.1°F
in Return Air Ducts 4
EnergyPro 4.0 by Energysoft User Number: 0000 Job Number: Page: 11 of 13
IVAC SYSTEM HEATING AND COOLING LOADS SUMMARY
PROJECT NAME DATE
Beta Version Only. Calculations not Validated. Not for Submitta . 8/24/2005
SYSTEM NAME FLOOR AREA
Res HVAC 2,326
Number of Systems
2
Heating System
Output per System
60,000
Total Output (Btuh)
120,000
Output (Btuh/sgft)
51.6
Cooling System
Output per System
59,000
Total Output (Btuh)
118,000
Total Output (Tons)
9.8
Total Output (Btuh/sqft)
50.7
Total Output (sgft/Ton)
236.5
Air System
CFM per System
2,000
Airflow (cfm)
4,000
Airflow (cfm/sgft)
1.72
Airflow (cfm/Ton)
406.8
Outside Air (%)
0.0
Outside Air (cfm/sgft)
0.00
Note: values above given at ARI conditions
Total Room Loads
Return Vented Lighting
Return Air Ducts
Return Fan
Ventilation
Supply Fan
Supply Air Ducts
TOTAL SYSTEM LOAD
COIL COOLING PEAK
I I I COIL HTG. PEAK
CFM
I Sensiblel
Latent
I I CFM
I Sensible
1,710
41,868
-1,375
L11L8
43,872
0
3,783
3,343
0
0
0
0
0
0
0
0
0
3,783
3,343
49,4331 1.375
TRANE 4TTX406OAl 92,654 8,405
Total Adjusted System Output 82,654 8,405
(Adjusted for Peak Design Conditions)
TIME OF SYSTEM PEAK I Aug 2 pm
120,000
120,000
Jan 12 am
EATING SYSTEM PSYCHROMETRICS Airstream Tempe ra tures at Time of Heating Peak
26.0 OF 69.2 OF 69.2 OF 105.0 OF
O Supply Air Ducts
Outside Air
0 cfm 104.2 °F
Supply Fan Heating Coil
4000 cfm ROOMS
69.2 OF 70.0 °F
�% Return Air Ducts 4
ICOOLING SYSTEM PSYCHROMETRICS (Airstream Temperatures at Time of Coolina Peakl I
111.0/72.5°F 78.9/62.4°F 78.9/62.4°F . 55.0/53.6°F
Outside Air O
0 cfm
Supply Fan
4000 cfm
78.9/62.4 °F
Cooling Coil
h Return Air Ducts 1�
Supply Air Ducts
55.9 / 54.0 OF
416% R.H. ROOMS
78.0 / 62.1 OF
EnergyPro 4.0 by EnergySoft User Number: 0000 Job Number: Page: 12 W57
HVAC SYSTEM HEATING AND COOLING LOADS SUMMARY
PROJECT NAME DATE
Beta Version Only. Calculations not Validated. Not for Submitta . 8/24/2005
SYSTEM NAME FLOOR AREA
Res HVAC 1,368
LOAD
Total Room Loads
Return Vented Lighting
Return Air Ducts
Return Fan
Ventilation
Supply Fan
Supply Air Ducts
TOTAL SYSTEM LOAD
COIL COOLING PEAK
COIL HTG. PEAK
CFM
I Sensible
Latent
CFM
I Sensible
1,021
24,983
-44
807
30,041
0
2,257
2,289
0
0
0
0
0
0
0
0
0
2,257
2,289
29,4971 -44
TRANE 4TTX406OAl 46,349 4,311
Total Adjusted System Output as,349 x,311
(Adjusted for Peak Design Conditions)
TIME OF SYSTEM PEAK I Aug 2 pm
EATING SYSTEM PSYCHROMETRICS Airstream Temperatures at Time of Heating Peak
26.0 OF 68.9 OF 68.9 OF 105.0 OF
-01 O4 S°.Ipply Air Ducts
Outside Air
0 cfm 103.9 °F
Supply Fan Heating Coil
2000 cfm ROOMS
70.0 OF
68.9 OFI
�% Return Air Ducts `1
(COOLING SYSTEM PSYCHROMETRICS (Airstream Temoeratures at Time of Coolina Peak) I
111.0 / 72.5 OF 79.1 / 62.5 OF 79.1 / 62.6 °F. 55.0 / 53.6 OF
J - .0-11
Outside Air
0 cfm
79.1/62.5 °F
Supply Fan Cooling Coil
2000 cfm
Supply Air Ducts
56.1 / 54.1 OF
4.1.0% R.H. ROOMS
78.0 / 62.2 OF
Return Air Ducts 1E I
EnergyPro 4.0 by EnergySoft User Number: 0000 Job Number: Page: 13 of 13