BRES2016-008078-495 CALLE TAMPICO 44 Quil4a VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/29/2016
Application Number: BRES2016-0080 Owner:
Property Address: 78600 BOTTLEBRUSH DR SLOAN. EGORELLI
APN: 646311041 7860, EBR /QTR
Application Description: PEGORELLI / WINDOW CHANGE OUT LA Q A 922,C���
Property Zoning:
Application Valuation: $3,000.00
MAR 2 9 lC;'o
Applicant: Con ractor:
SLOANE PEGORELLI SLOfNE PEGORELL .
78600 BOTTLEBRUSH DR 78fi TILE IITJf`,1@01A QUINTA
LA QUINTA, CA 92253 LA - §,01hD,1Are1r?% - ._. _
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 Professions Code,
and my License is in full force and effect.
License Class: License No.:
4. � r
Date: "� — (o Contracto
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
( 00).:
WJ 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.).
I, as owner of the property, am exclusively contracting with licensed contractors
o 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
n
Date: 3 ' '(4i owner: -,L:",
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:
(.760)413-7722
Llc. No.:
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: _ Policy Number: _
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 Building Official 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 city to enter upon the
above-mentioned property for inspection purposes:
Date: (7 Signature (Applicant or Agent
FINANCIAL •• •
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00. 3/29/16
PAID BY METHOD RECEIPT # CHECK # CLTD BY
SLOANE PEGORELLI CHECK R14309 571 RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE.
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
$0.50
3/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
SLOANE PEGORELLI
CHECK
R14309
571
RSE
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50 $0.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT.
PAID
PAID. DATE.
DOOR/WINDOW, REPLACE FIRST 7
101-0000-02400
0
$60.91
$60.91-
3/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY,
SLOANE PEGORELLI
CHECK
R14309
571
RSE
DESCRIPTION
ACCOUNT ..
QTY
AMOUNT.
PAID
PAID DATE.
DOOR/WINDOW, REPLACE, EA ADDITION 5
101-0000-42400
0
$10.15
$10.15
3/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
SLOANE PEGORELLI
CHECK
R14309
571
RSE
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID'
PAID DATE
DOOR/WINDOW, REPLACE, EA ADDITION 5
PC
101-0000-42600
0
$11.60
$11.60
3/29/16
PAID BY
METHOD
RECEIPT # =
CHECK #
CLTD BY
SLOANE PEGORELLI
CHECK
R14309
571
RSE
DESCRIPTION
ACCOUNT
QTY
:. AMOUNT
PAID
PAID DATE
DOOR/WINDOW, REPLACE, FIRST 7 PC
101-0000-42600
0
$110.22
$110.22
3/29/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
SLOANE PEGORELLI
CHECK
R14309
571
RSE
Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $192.88 $192.88
TOTALS:•,
Description: PEGORELLI / WINDOW CHANGE OUT
CONDITIONS
Type: BUILDING, RESIDENTIAL Subtype: REMODEL
Status: UNDER REVIEW
Applied: 3/24/2016 RSE
Approved:
Parcel No: 646311041 Site Address: 78600 BOTTLEBRUSH DR LA QUINTA,CA 92253
Subdivision: DESERT CLUB MANOR TR 1 Block:
Lot: 41
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $3,000.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
FAX
Details: CHANGE OUT OF 10 DOUBLE PANE WINDOW. 2013 CALIFORNIA ENERGY CODE.
APPLICANT.
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT.
SLOANE PEGORELLI
78600 BOTTLEBRUSH
LA QUINTA
CA
92253
(760)413-7722
DR
CONTRACTOR
SLOANE PEGORELLI
78600 BOTTLEBRUSH
LA QUINTA
CA
92253
(760)413-7722
DR
OWNER
SLOANE PEGORELLI
78600 BOTTLEBRUSH
I LA QUINTA
CA
92253
(760)413-7722
DR
Printed: Tuesday, March 29, 2016 12:30:31 PM 1 of 2
C9?SYS TERAS •
PARENT PROJECTS
ATTACHMENTS
Printed: Tuesday, March 29, 2016 12:30:31 PM2 of 2 ,-
SYSTEMS
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$1.00
3/29/16
R14309
571
CHECK
SLOANE PEGORELLI
RSE
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
$0.50.
3/29/16
R14309
571
CHECK
SLOANE PEGORELLI
RSE
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50 $0.50
DOOR/WINDOW,
101-0000-42400
0
$60.91
$60.91
3/29/16
R14309
571
CHECK
SLOANE PEGORELLI
.RSE
REPLACE FIRST 7
DOOR/WINDOW,
REPLACE, EA ADDITION
101-0000-42400
0
$10.15
$10.15
3/29/16
R14309
571
CHECK
SLOANE PEGORELLI
RSE
5
DOOR/WINDOW,
REPLACE;<EA ADDITION
101-0000-42600
0
$11.60
$11.60
3/29/16
R14309
571
CHECK
SLOANE PEGORELLI
RSE
5 PC
DOOR/WINDOW,
101-0000-42600
0
$110.22
$110.22
3/29/16
R14309
571
CHECK
SLOANE PEGORELLI
RSE
REPLACE, FIRST 7 PC
Total Paid for WINDOW/SLIDING GLASS
$192.88 $192.88
DOOR/FENESTRATION:
TOTALS: $194.38 $19438
PARENT PROJECTS
ATTACHMENTS
Printed: Tuesday, March 29, 2016 12:30:31 PM2 of 2 ,-
SYSTEMS
Bin #
City of La Quinta
Building Sz- Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
g Permit Application -and Tracking Sheet
Permit #
V1Buildin*
Proje�t*Ad� dress: g (� 60 V-44- *)-11
.211rer=s Name: I v 44-L(2_ DYE
A. P. Number:�Addressi
Legal Description:
City, TZtP: 2253
ontra r
C cto . a.. i
Te leh
Addrero
ecl Rescri [ion:
City, ST, Zip:
�. "� `, 10_.- GLV
,-= �/YV2�,
l
10 Ndcw$ SATelePhone. S o 2
State Lc #
City Lie. #.:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:h
one:
n Type: e: Occu aneY
Constructiontrueti •
State Lie.
Project tYPe�cit le one • New A dd'n Alter Repairair Demo
Name of Contact Person:
Sq. Ft.:
# Stories: # Units:
Telephone # of Contact Person:
estimated Value of_P,roject:-"
APPLICANT: DO NOT WRITE BELOW THIS LINE
it
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance,
Title 24 Calcs.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'rd Revietiv, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760)777-7012
FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE .
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a build* eimit,has, een,� ubmiitted in your name listin*,gg yourself as the builder of the property
improvements specified af!/5�5e(e�`�'43'� YuiY
We are providing you with an Owner -Builder Acknowledgment and Info tion Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute- this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signer you understand or verify this information.
F` 1L, I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
din permit that erroneously lies that the roe owner is providing his or her own labor and material ersomll . I as
g P Y �P property rtY P g P Y
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
� I understand building permits are not required to be signed by property owners unless they are responsible for the
c'o'nstruction and are not hiring a licensed Contractor to assume this responsibility.
9TY-trs—e-If
3'I understand as an "Owner -Builder" I am the responsible party of record on the permit I understand that I may protect
from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
is and contracts.
o05I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
yVonstruction is at least five hundred dollars ($500), including labor and materials, I. may be.considered an "ernployer"
under state and federal law.
*,6. I understand if'I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to.serious financial
risk.
eT I understand under California Contractors' State License Law, an'O.wner-Builder who builds single-family residential
tructures cannot legally build them with the intent. to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, _or all of the work is performed
under contract with a licensed general building Contractor. .
1\
4
. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
ficial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
9. 1 understand I may obtain more information regarding my bbligations as an "employer" from the Internal Revenue
Sefvice, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
w10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
arty legally, and financially responsible for proposed " construction activity at 'the following address:
Ida11. I agree that, as the party all and financially responsible for this proposed construction activity, will abide by all
applicable laws and requirements that govern Owner -Builders asmell as employers.
12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and. wish to hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or
other verification acceptable to th agency is required to be presented when the permit is issued to verify the property
owner's signature.
ftg�e of property ovvn�er �� +Date
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act as my agent(s) to apply for, sign, and file, the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
infoation and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
armcceptable to the agency is required to be presented when the permit is issued to verify the property owners signature.
Property Owner's Signature: Date:
imperial Horizontal Sliding Window I Value Windows & Doors Page 2 of 7
Features & Options
Hardware (#details -i)
Color (#details -2)
Glass
Grid (#details -4)
Frame (#details -S)
"rt(#details-g)
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Dualpane Glass Diagram
GLASS TINT & TEXTURE
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STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 06114
CERTIFICATE.OF COMPLIANCE
Prescriptive Residential Alterations
Project Name:
Date Prepared:
IA ENERGY COMMISSION
C F 1 R -ALT -01- E
(Pane 1 of 41
;A: GENERALrINFORIVIATION't'
01
Xhi -Project Name:, -P, ,.,
02
Date Prepared:
'03' 'Project Location-'— 5 72 &-60 r
04
Building Front oiieritation'(deg or cardinal):
r5 ;CA'City w{��
06
Number of Altered,Dwelling Units: "�A
07" Zip Code:, ,:.'w -4 ZZS3
08
Fuel Type: Q A "
109 Sr 1CIimate Zorie: t '- 7
10
Total,COndlti6( ed FloorxArea (ft2) )
11 :Building,Type.
12
1 SIah;Area (ft2)
.13^ I iProject'Sco0e 2-0M, _ ,.
'I'nitial Solar • Aged Solar Thermal SRI - Aged Solar Thermal SRI
IDA
B. BUILDING INSULATION DETAILS (Section 1S0.2(b)1) Vk
01
02
03
04
05
06 a,:'$,..`'°`07 1 08�4V409
10
11
Tag/ID
Assembly Type
Frame
Type
Frame
Depth
(inches)
Frame
Spacing
(inches)
allp oposed '.
Required
Comments
'-Appendix
Continuous
g • $�
Cavity Insulation �a
R -value, R -value 40M;'U;factor
JA4
Reference
U -Factor
Tabl,e., Cell
Deck
'I'nitial Solar • Aged Solar Thermal SRI - Aged Solar Thermal SRI
Compliance
Pitch
Exception
`..
10.11W
Insulatio
Reflectance Reflectance Emittance (Optional) Reflectance Emittance• -(Optional)
41b.
P0_'%, '4
4 v
C. ROOF REPLACEMENT (Prescriptive Alteration, See&i,din150.2(b)1H)�- 'W V
01
02
03
04 r i
05,k
06
'07AV 08 09 10 11 12 '13
R -value
Propos d Minimum Required
Method of
Roof
CRRC Product ID
Deck
'I'nitial Solar • Aged Solar Thermal SRI - Aged Solar Thermal SRI
Compliance
Pitch
Exception
i ,, Number ;
ipP oductType .
Insulatio
Reflectance Reflectance Emittance (Optional) Reflectance Emittance• -(Optional)
41b.
NOTES
• Roof area covered by, building'integrated photovoltaic panels and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field applied coating must comply wi h tallation criteria from section 110.8(i)4.
Registration Number: Registration Date/Time:
CA Building Energy Efficiency Standards - 2013 Residential Compliance
HERS Provider:
June 2014 1.
• F+ r_' tt i
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescriptive Residential Alteratio43 (Page 2 of 4)
Date Prer)ared:
D. FENESTRATION/GLAZING AREAS ALLOWED (Section 150.2(b)1) AIN.
04 IN
01 02
03
Alteration Type Orientation
Maximum Allowed ft2 Go me is
06
07
08
0099
E. FENESTRATION/GLAZING PROPOSED AREAS AND. EFFICIENCIES (Section 150.2(b)1)
01
02
03
04
05
06
07
08
0099
10�'
1
12
13
14.
15
Combined
Ori Area
Area sExterior
Net
Maximum'
SHGC
Tag/
Fenestration
Frame
Dynamic
9N; S W,"E or Removed
�R
Added
J;Added
A Idwe
Shading
from .
ID
Type
Type
Glazing .
ofd ft2
t�WNC4�TN v
ft2
Area ft2
:factor qFUtfactbr,,j
Source
I SHGC;..
[Source,
Device
CFIR:ENV 03
4� t D.
V i N
.�
r. �r�`.- O
ov N
..
r • 20
S
Z� ai z •
a
Net Added West fa ng nestratio
$
nArea�
1'
b
Existing + Add ed W sf fa ng Fenestration �A�r. a
c
Maximum,A.II wed West-faciZZ Feenes"t,a,tion Area
`
d
Is West -facing Fenestration Area < Maximum Allowed We:st`fa ng Fenestrattioriy
e
Net Added Fenneestration'A ea (all orriieniations)
•
f
VExisting + Added Fe estration Area (alllor entitations)
g
MaximumrAllllo Area (all orientations)
, weatFAestration
h
Is Existing +�Addeed Fenestration Area <�`Maximum Allowed Fenestration Area (all
. orientations)
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014
am
STATE OF -CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION 0
CERTIFICATE OF COMPLIANCE CFIR-ALT-01-E
Prescriptive Residential Alterations (Page 4 of 4)
Project Name: Date Prepared:
D , T-1T4QN AUTHOR'S -D ECCARAT ION=STATM.ENT'
1. --"I certify,that this-Ce'rtificate=of=Compliance documentation is accurate and complete.#I V
'Documentation Author Name:
Documentation Author Signature:( , *t
oa.'�l Q o r l
Company:
Signature Date:
Address:CEA/
% �.bCD �ac�rct���" ''
HERS Certification Identifica"tio"n (if applicable):
City/State/Zip: Q
Phone: ,
�{ 72-2—
1i ESPON31.8LE PERSON'S`DECLARATION SIATEMEN y �`
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information on this Certificate of Compliance is true and correct.
provided
2. 1 am eligible under Division 3 of the Business and Professions Code to accept respons bility for the building°deslgr"forsystem design identified on this Certificate of Compliance (responsible
designer).
3. That the energy features and performance specifications, materials, components, and manufactured devic s°for the building design or system design identified on this Certificate of
Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of'Regulations.
features Certificate pliance wit_ formation documents,
4. The building design features or system design identified on this of Co' re consistent h provided on other applicable compliance
worksheets, calculations, plan's and specifications submitted to thef cment agenry fgpproval with this bding permit application.
`
5. 1 will ensure that a registered copy of this Certificate of Compliancesshall be made:available with the building pgrmlt(s) issued for the building, and made available to the enforcement agency
copy of ed builder building
for all applicable inspections. I understand that a registered of this Certificdt Compliance is.requ red, to be included with the documentation the provides to the
owner at occupancy..,
Responsible Designer Name: _ I0 FRespcihsible Designer Signature:
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Company: - - � '" �' � ` r Date Signed: -
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For assistance or -questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014
Imperial Horizontal Sliding Window I Value Windows & Doors Page 1 of 7
Value
WINDOWS & DOORS
Home (hnp://valuewindowsdoors.com) I Windows (htW:Ilvaluewindowsdoors.com/windows')
Horizontal Sliding Windows (http://valuewindowsdoors.com/horizontal-sliding-windows')
Imperial Horizontal Sliding Window
Imperial Horizontal Sliding Window
IMPERIAL SERIES KEY WINDOW BENEFITS
Beveled, multi-chambered extruded vinyl
improves energy efficiency while providing
an aesthetic look
Autolock for easy locking and heavy duty
hardware on casements & awnings
Integral pull rail for easy operation of moving
sash
3-1/4" Retrofit frame depth for structural
integrity
2-3/4" Nail -on frame depth for structural
integrity
OVERVIEW -
Horizontal sliding windows are.
smooth operating with right,
left, or both sash operation
options available.
Steel and aluminum reinforced sashes for
structural integrity
All metal wheel rollers on sliding models for
long lasting smooth performance
Duralite spacer enhances thermal
performance of glass components
3/4" insulated glass unit featuring LoE3 glass
Argon gas filled chambers for low heat
transfer through the glass chambers
Full weather stripping for enhanced thermal
performance
http://valuewindowsdoors.comlwindowslhorizontal-sliding-windows/imperial-horizontal-s... 3/11/2016
Value Windows & Doors, Inc.
Va`I U gg,,Ilt
rrManufacturer of High Quality Windows & Doors
MNOdws & Go
Address: 1830 Flower Ave, Duarte, CA 91010
Tel.: (626)962-7568 Toll Free: (866)216-6877 Fax: (626)962-0321
Website: http://www.valuewindowsdoors.com
Billing Address
BGW DOORS INC Tax Number: 101302382
753 EAST FRANCIS ST.
ONTARIO,. CA 91761
Phone: 909-947-8333 760-596-9732
Fax: 909-947-2333
Packing Slip (#VW0119638)
- PO# MOE LA QUI Order Date 03/11/2016
WO# D-BDI JL3-5 Due Date 03/18/2016
............-..............._._....................._....._.................-_.._...._..._-..-................._._.._.._.__......._...._..-_----.......--..._._.....................__.....
Sales Person JURI LEE Delivery Date 03/21/2016
LA QUINTA, CA
Shipping Address
Size Frame Glass Grid Molding Other
Line Series Qty . Option OBS
Width Height Type Color Type Feature Type Style Pattern Type Color U -Factor SHGC VT
1. GS -XO 10 Cpl 45" 45" Retro -Fit White Le3/Clr/Le3 None N/A N/A N/A N/A N/A N/A 0.20 0.18 0.35
Total Qrder QTY
Total Ship QTY
10 Installation of Workers Sign
Plant Manager Sign
Finished Date
Checked Date
I
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GA
CITY ®F, UINT
= BUILDING & SA DF
APPROVED
FOR CONSTRUCTION
DATE gyY t -
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