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0210-095 (RR)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. 1. License # Lic. Class Exp. Date Date ' Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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 & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section - B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) 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 & policy no. are: Carrier &,T,A;p*_ pLrNp Policy No. 04604701 (This section need not be completed if the permit valuation is for $100.00 or less). ( ) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation. provisions of Section 3700 of the Labor O`Code, I `s'hall forthwith comply with those provisioeis. Date:' r7 Applicant - /dr . !r •Warning: Failure to secure Workers'/Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety i" for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize, representatives of this City to enter upon tKe above-mentioned property for inspection purposes. ; Signature (Owner/Agent) l Date BUILDING PERMIT PERMIT# / ' VALUATION P LOT TRACT DATE r r JOB SITE ADDRESS 49_48 +,A -t1 l� VJ+SJVh4L_3offffA APN OWNER CONTRACTOR/DESIGNER/EN (NEER 49-41K�AN'.l:�^`t-TB DA.WM'.ABON,i'T'A,, 6340011JOC„AW.AD 42.60 LA `41MTrA C.' -.A 92253 101A.. S1,561 - -- Ci6 )S11-1 3:D MUf 2.84 USE OF PERMIT CkiA1�1t ;;afA€DTH �E«L iA[lCJZd•NL+' iOD2Sf137iN�iYJWS PER.APSPRMw STUCTUR.Ab C.PrWNITL,A34WENE+'# N CAUS. 'V'AE.•?)F`.`a ION MAN Ile, xffnm'A17.D COW OF C ON MU (M.1014 15.0001AD 1" ER UM li EN SUMMARY PIAN CH C 11C FEE? 1014000-439-318 $105,34 C'ONSO°RUCITION My, iol-000-118-000 0n3.00 S'I'i1owo hfoiaL91+11 • REBID 101-000441-000 " 17 • A Ci°ifi G 1<I:1'1 ' CF" '1` �a I? P3L I%T MWIC ti $268.80 CITY OF LA QUINTA ' FINANCEDE11. f•�''�% RECEIPT DATE /`� BY �_._ DATE FIND INSPECTOR j �' U� INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs - Z-02 Underground Ducts Forms & Footings Ducts Slab Grade r Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing — — Compressor Insulation 4.2 z 57 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ Final v? BLOCKWALL APPROVALS Final POOLS - SPAS 1 Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric. Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice(Perm) COMMENTS: J 'JOHNSON & NIELSEN ASSOCIATES G.L. Scrivens Construction c 647 North Main St. Suite 4B 49 657 AvenidgVista Bonita Job # 7.005 "'- Riverside, California 92501 Santa Rosa C.C. Phone 909-686-5122 Date ......... FAX 909-686-6752 La Quints. Ca. Sheet of > ver. 11-16-99 _ = = > wk4 Filespec: C:\J&NCALC\7005F.WK4 Retrieve/Save crive work C: wowo rk di di r 7.005 taad LOADING Load drive C: = Flat Roof Dead Load Sloped Roof Dead Load Roofing 6.5 psf Roofing 10.0 psf Sheathing 1.5 Sheathing 1.5 Rafters 2.5 Ceiling Rafters 2.5 oFessfo QP 2.6 Ceiling 2.5VX P MOGy�Fy� Insulation 1.0 Insulation 1.0 2 Misc. 1.5 Misc. 1.5 co to Beams 3.5 Total Beams 3.5 Z5 w P.3312004/ 19 psf Total 22.5 psf cc # Q' l9 Roof Live Load 20 psf Roof Live Load 16 psf *S� U C j ATF P Rafters Uniformly loaded simple span joist, rafter or beam > > sawn > > options: sawn, glb, tji, lams or steel OF CA\-��O 11-2-98 Span =' am ft. T.A. = 16 sq. ft. sawnpro size grade area sect Inerti'3 width depth Fb > i Ft mount trib = 2.00 ft. React. Momn't. Try > > 2x10#2 (df #2) 13.88 21.39 98..9 1.50 > 9.25 969 633 L. L. = 20.0 psf >> 160 320 C(D) = 1.25 fvh = 27 psi fb 3;0 psi pa'= 0 D. L. 19.0 psf > > 152 304 Ch = 1.25 Fvh =` 119 psi . Fb 12123 psi Pa= psi 5570.5 Extra 0 #/ft > > 0 0 Deflections > > LL = 0.02 in. = L / 4122ombined psi stress (dead line load) _ _ _ _ _ _ _ _ _ = Number DL = 0.02 in. = L / 4359 y 0,291 Totals > 312 • 624 pieces 1 TL = 0.05 in. = L / 2114 i USE 2x10#2 (df #2) min. bearing= 0.33 inches beaml Uniformly loaded simple span joist, rafter or beam > > sawn > > options: sawn, glb, tji, lams or steel 11-2-98 Span = 10.00 ft. T.A. = mount trib = 5.00 ft. React. 50 sq. ft. sawnpro size grade area sect Inertia width depth Fb > i Ft > L. L. = 20.0 psf >> 500 Momn't. 1250 Try > > 4x8#2 (df #2) 25.38 30.66 111.1 3.50 7.25 1050 690 D. L. = 19.0 psf > > 475 1187.5 CID) = 1.25 fvh = Ch = 1.25 Fvh = 51 psi fb 9E4 psi pa= 119 psi Fb 13113 psi Pa = 0 psi 2190.1 Extra = 0 #/ft > > 0 (dead line load) _ _ 0 Deflections > > LL = 0.13 in. = L / 948 , psi combined stress _ _ Totals > 975 _ _ _ _ _ = 2437.5 Number DL = 0.12 in. = L / 988 0.727 % pieces 1 TL = 0.25 in. = L / 486 USE 4x8#2 (df #2) min. bearing = 0.45 inches beam2 Uniformly loaded simple span joist, rafter or beam > > sawn > > options: sawn, glb, tji, lams or steel 11-2-98 Span = 10.00 ft. T.A. = mount trib = 5.00 ft. React. 50 sq. ft. sawnpro size grade area sect Inertia width depth Fb >, i Ft > L. L. = 20.0 psf >> 500 Momn't. 1250 Try > > 4x8#2 (df #2) 25.38 30.66 111.1 3.50 7.25 1050 690 D.L. 19.0 psf >> 475 1187.5 C(D) = 1.25 fvh = Ch = 11.25 Fvh = 51 psi fb 954 psi pa= 119 psi Fb 1313 psi Pa= • 0 psi 2190.1 psi Extra = 0 #/ft > > 0 (dead line load) _ _ 0 Deflections > > LL = 0.13 in. = L / 949 combined stress _ _ Totals > 975 _ _ _ _ _ = 2437.5 Number DL = 0.12 in. = L / 998 0.727 % pieces 1 TL = 0.25 in. = L / 488 USE 4x8#2 (df #2) min. bearing= 0.45 inches beam3 Uniformly loaded simple span joist, rafter or beam > > sawn > > options: sawn, glb, tji, lams or steel 11-2-98 Span = 10.00 ft. T.A. = mount trib = 12.00 ft. React. 120 sq. ft. sawnpro size grade area sect Inertia width depth Fb > i Ft >, . L.L. = 16.0 psf >> 960 Momn't. 2400 Try» 4x12#1 (df #1) 39.38 73.83 4153 3.50 11.25 1100 675 D. L. = 22.5 psf >> 1350 3375 C(D) = 1.25 fvh = Ch = 1.25 Fvh = 87 psi fb 1142 psi pa=0 119 Fb 137-5 psi Extra = 100 #/ft > > 500 1250 Deflections > > LL = psi psi Pa= 0.06 in. = L / 1961 5603 psi combined stress (dead line load) _ _ _ _ _ _ _ _ _ = Number DL = 0.12 in. = L / 1013 0.830 %' Totals > 2810 7025 pieces 1 TL = 0.18 in. = L USE 4x12#1 (df #1) min. bearing= 1.28 inches beam4 Uniformly loaded simple span joist, rafter or beam 11-2-98 Span = 10.00 ft. T.A. = 50 sq. ft. > > sawn > > options: sawn, glb, tji, lams or steel mount trib- 5.00 ft. . React. Momn't. sawnpro size grade Try > > 4x10#2 (df #2) area sect Inertia width 32.38 49.91 depth Fb > ) Ft > ' L. L. = 16.0 psf >> 400 1000 CID) = 1.25 fvh = 230:3 3.50 57 psi fb 873 psi pa= 9.25 963 633 0 D. L. = 22.5 psf >> 562.5 Extra = 100 #/ft > > 500 1406.3 Ch = 1.25 Fvh 119 psi Fb 1203 psi Pa= psi 3565.1 psi (dead line load) _ _ _ 1250 Deflections > > LL = 0.05 in. = L/ 2462 combined stress _ > 1462.5 _ _ _ _ _ = 3656.3 Number DL = 0.13 in. = L / 927 0.731 %Totals pieces 1 TL = 0,18 in. = L / 673 USE 4x10#2 (df #2) min. bearirig= 0.67 inches RIVERSIDE, CALIFORNIA 92501 -" 909-686-5122 FAX 909-686-6752 SH OF C�fEGK_ L.9 >E�E'i4C. ; fp GE i1 1N� Wi�/OdW L/ti__ 4 Z %y = 2. s /,clo Gc/ 5o kl. /2.I? _ //� 5Q3 '4-� _ -5"772 oK /92,;t li� EA• cap, y /O �L/lfl, /(`.8 PsF_ 2/0 �'/ 5772 '� �i'Ef/G CT�6/�'NS /.92 4,t//2) _ '13,v s2a /a' 7 TRI TS 6 -i23/729 3fT 3<z9az,) 4i(, 9i 100 9/ 119 T5 JPx f 4 poleftg Pole Footing Analysis mdf pasive pressure= 250 pcf 6-3-98 depth of footing(d)= 5 ft diameter of footing(b)= 2.5 ft applied load(P)= 1924 lbs height of applied load= 12 ft duration factor= 1.33 S1= 554 pcf S3= 1662.5 pcf A= 3.25 Footing depth: Constrained: d= 4.9 0. K. & NIELSEN ASSOCIATES Project GENE & B'ARBRA WADDELL Job 3- 7-020 Idsa table 80% lubc 'corner table M not req- 647 North Main St. Suite 4B 49-489 Vista Bonita @ Santa Rosa Country Club by Peery 3180 %:>>::<`> na irkJOHNSON Riverside, California 92501 La Quinta, Ca. Date 10/30/2002 PHD5 4685 :> 3>`:::?':> is 3748 Phone 909-686-5122 FAX 909-686-6752 ---- MARK VALENTINO ARCHITECT SheEt of ---- ---- ---- 98wdlatl .wk4 Save/Retrieve drive - - C: work dir = 7-020 5-6-00 Filespec: D:\J&NCALC\WORK\7-020\LAT.WK4 Load drive = C: filespec = lot Frisch HD14A :: 11080 <:::::::: 8864 LOADS Governing code (UBC or CBC 1 UBC (97 UBC or 98 CBC) 13380 z:>>::>:::< 107 4 ......... 0 Seismic HD15 Wind loading ' 12244 Seismic Zone = 4 Z = 0.400 Wind speed 70 mph Distance to fault = 10 km T = 0.156 (method A) V = Exposure = C Fault type = A C(a) = 0.44 UBC (30-4) = 2.234 W Ce = 1.19 Soil type = SID) CM = 0.77 UBC (30-5) = 0.500 W (max.) Cq = 1.3 Importance = 1.00 N(a) = 1.00 UBC (30-11 ► = 0.600 W (UBC default) qs = 12.6 psf R (table 16-N, item 1.1.a.) 2.2 NM = 1.20 UBC (30-7) = 0.175 W (min. - zone 4) q = 13.5 psf Use 0 ( UBC (30-11) = 1, UBC (30-4,5,6,7) = 0) UBC (30-6) = 0.048 W (min.) V= UBC (30-5) _ 0.500 W / 1.4 = 0.367 W (max.) ASD level forces ROOF DIAPHGRAM Roof Diaphragm Loading (excludes parallel wells) Plan dimensions in "Y" direction = 40.25 ft. "Y"direction roof loadings Plan dimensions in "X" direction = 71.00 ft. Total wind = 20067 # = 283 # / ft Sill to top plate height = 11.00 ft. Total seismic = 24801 # = 349 # ! ft governs Roof rise (plate to ridge) _ . 9.00 ft. Avg. number of interior walls = 1 (each direction) "X" direction roof loadings Roof dead load = 19.9 psf = 56869 # total Total wind = 11376 # = 283 # /ft Avg, ext. wall dl 12.8 psf = 15664 # total (both directions) Total seismic = 22856 # = 568 # / ft governs Avg. mt. wall dl 6.6 psf = 4038.4 # total (both directions) Total mass = 76572 # cdxwall SHEAR PANEL TABLES UBC Table 23 -II -1-1 Allowable shear for wind or seismic forces for CD -X Plywood or 2 -M -W Particle board with 2x (or 3x) studs at 16"o.c 3/8" she thing wi h 8d nail table38 Wall type Allowable load per foot Sheathing Fastening Default bolt spacing Ab= 2858 sq.ft. x 1.00 = 2858 sq. ft A B C D E F 72.5 90 260 350 490 640 /8" Stu 3/8" pIv 3/8" ply 3/8" ply 3/8" ply 6d cools 11 or 1616" edge 4" edges 3" edges 2" edge 48"0. c. 48"0. c. 32"o.c. 24"0. c. 16"0. c. 16"o.c. 1/2" I 'd -CD-' or 3/8 r 1/2 O B with 8 nails tablel 8 Wall type Allowable load per foot Sheathing Fastening Default bolt spacing A B C D E F 72.5 90 260 350 490 640 1/2" /8" stu 1/2" pl 1/2" I 1/2" ly 1/2" I 6d cools 1 1 or 16 6" eil es 4" ed a 3" ed a 2" edges 48"o.c. 48"0. c. 32"o.c. 24"o.c. 16"o.c. 16"o.c. HDtable STUD ANCHORS & STRAPS sillbolt Holddown lookup table, Sim son 1998 ( 2000psi concrete, 2 pours 1 HD # lubc table 100% Idsa table 80% lubc 'corner table M not req- 0 1 00 ::>:>::>`< HPAHD2 <?<<' 3180 %:>>::<`> na 2030 PHD2 3610 : z>>:. 2888 > ':z> 3610 >:3<::>< PHD5 4685 :> 3>`:::?':> is 3748 i::::::::::««: 4685- PHD6 5860 . 4688 :::>:>>::: >> 5860 :>> HDQB 8325 >><>:> 6660 :» 8325 3:''6 HD10A 9540'<::::::::::: 7632 ::»>:>:;<:. 9540 HD14A :: 11080 <:::::::: 8864 ::?:i:: -11080 - HD20A 13380 z:>>::>:::< 107 4 ......... 0 ............... :>:::>::<>: ............... 13380 :::::......:> HD15 15305>>:> 12244 ::>::::::>::> 15305 ::>:>:>::> in stud UBC Table 25-1 Allowable shear for wird or seismicforces for vertical diaphragms of lath and plaster :)r gypsum board assemblies. Zone 4 ( 1/2 values indicated) 1/2" pl'd "CD-*" or 3/8 lor 1/e O B with 10d ijails table 110 2 - 2x4, in 6" min. stem 4x4 4x4 4x4 4x6 4x6 4x6 6x6 6x6 Sill Bolts Default bolt 5/8" 1.33 x 0.82 x 2x sill 905 #/bolt Bolt size 1/2" 1 5/8" 3/4" 1 Bolt values in pounds 7/8" 1" Single bolt in 2000 psi concrete ( 2x4 sill ) 625 1630 1300 1280 1250 Single bolt in 2000 psi concrete ( 2x6 sill) 1140 2020 1800 1750 1720 Single bolt in 1 500 psi masonry 850 1330 1780 1920 2050 Single cantilevered sill bolt in 2x sill plate 580 830 1140 1515 1930 Minimum value from table above 580 830 1140 1280 1250 o.nc aiaaor vn N, oaaura lrCaltlu ntlrn-n! sill prdies A B C 10 I E F 72.5 90 310 4601 600 770 1/2" gyp 7/8" stu 12" ply1 /2" A l /2" I w'd 1/2" 1 w' 6d coole 11 or 16.6* edges 4" e " es 3" edges, 1 2" edges, 48"0. c. 48"0. c. 32"o.c. 16"ac. 16"0. c. JOHNSON & NIELSEN ASSOCIATES Project `GENE & BARBRA WADDELL 19 647 North Main St. Suite 46Job Riverside, California 49-489 Vista Bonita " Santa Rosa Country Club byl # 7-020' Peery 92501 Qumta.•Ca. Phone 909-686-5122 FAX 909_686-6752 _La Date MARK VALENTINO ARCHITECT- 10/30/2002 - - _ Sheet of 98wdlat1.wk4 - - 5-6-00 work dir = 7-020 Frisch Redundancy factor for "Y" direction walls filespec = •,lat Ab = 2857.8 sq.ft. "Y" base shear = 24801 # ri(max) 0.7512 therefore p = 1.502 however 1.0<p<1.5 therefore p = 1.500 ri(max) = 0.751 "Y" shear wall.- Line 1 Trib. width = 32.00 ft. adj.'% "Y" Wind F(x) = 9044 # x 0.200 + added wind = 0 # = total "Y" USE Steel Cantilevered Columns (see calc. below) wind = "Y"seismic F(x) = 11178 # x 0.500 1809 # v / column = - - 2795 #/ ft. ` + added seismic 0 # = total "Y" seismic = 5589 # Total wall length 3.00 ft. x p = 8384 # governs Stud depth _ 5.5 in. { <>(use Wall location > > Exterior wall Left lintel Wall length Right lintel cantilevered columns) Wall ht / Crib rf di 9.00 0.00 ft. int./ext.= 0/1 Trib. dead load = 179 #/ft. 1.00 ft. 0.00 ft.. v wall = 11.0(�ff. 2795 #/ft. ri= 0.751 wall loc. 1 Wall dead load 51 #/ft. 179 #/ft. 179 #/ft. 141 #/ft. too tall Resisting couple reducion 51 #/ft. 3 ins. left right Uplift 40986 Jamb dead load # 40986 min. jamb thickness = 12.1 ins. -160 added down load (-) 0 # -160 # (based on T to grain bearing Gross down load -41146 # 0 # -41146 # Footing data Net uplift - 0.85 x dl = 40850 # 40850 # F(a) soil = 1000 psf 0 0 width = 3.25 ft. depth = 3.00 ft. eff. depth = 32 in. Wall location > > Exterior wall Left lintel Wall length Right lintel (use cantilevered column Wall ht s) trib rf dl 9.00 0.00 ft. int./ext.= 0/1 Trib. dead load = 779 #/ft. 1.00 ft. 0.00 ft. v wall = 11.00. 2795 #/ft. ri= 0.751 wall loc. 1 Wall dead load = 51 #/ft. 179, #/ft. 179 #/ft. 141 #/ft. too tall Resisting couple reduction 51 #/ft. 3 ins. left right Uplift 40986 Jamb dead load -160 # 40986 min. jamb thickness = 12.1 ins. added download W 0 # -160 # (based on T to grain bearing ► Gross down load -41146 # 0 # -41146 # Footing data Net uplift - 0.85 x dl = 40850 # 40850 # Fla) soil = 1000 psf t 0 0 width = 3.25 ft: depth = 3.00 ft. eff. depth = 32 in. Wall location > > Exterior wall Left lintel Wall length Right lintel (use cantilevered columns) Wall htv trib rf dl 9.00 0.00 ft. 0/1 int./ext. = Trib. dead load = #/ft. 1.00 ft. 0.00 ft. wall = 11.00 2795 #/ft, r'i = 0.751 ..179 wall loc. 1 Wall dead load = 51 #/ft. 179 #/ft. 179 #/ft. 141 #/ft. 51 #/ft. too tall Resisting couple reduction . left right 3 ins. Uplift 40986 Jamb dead load #' 40986 -160 min. jamb thickness = 12.1 ins. -160 added down load (-) 0 # # (based on T to grain bearing ) Gross down load -41146 # 0 # -41146 # Footing data Net uplift - 0.85 x dl = 40850 # 40850 # Fla) soil = 1000 pst 0 0 width = 3.25 ft. depth = 3.00 ft. eff. depth =' 32 in. dvw g 33S 3n8308• tlNiltlltl7 ' ° YPtI` si 9 a' a �; 1Y719070Trt.: t u C tlN[ltlltl7 AN '� ' ! - 110AHY] Stl10H7IN NYS y Ya0 E mu Y[S3H9YN ,1 s rn�ri•:,�..—..t �- ni,,Zx 9 n � c � _ nn g ul c �Z�� £[ � s 'g AIS - I N3 W7Z ! �� i r?a+cF'TQ�; a r Kde 9IkE c xM ��p�£[ is >_ `� Fit vu alsCT N- t �n g�uJJ �,� c AV c V131W eom. �/1d a31N37 ® 'L 'I Q aj � � p' • . i y .s,crl � n d a3Lv3m m ' �.I 9NI2! M eil CC n xo a 1 1 d v_ S. 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S37N3[7S , V9 ,a,, jS.. ^'�,J'�✓ ®3S/IOxBn7 '� HllY3H 3 M 49' - Y 3 - a3U137 WHOAOH ® 2 .. ..� :� �'dOp, $, : •..� 3 d? -d d u ,4i Y �' .. i O < 3N a3HONN3S13 '° ^ ']'' LH' Q N '�3 .3 ,.i ,'•w- =IW61NI15 Jl,1.•3.Y' 1g En.( - n YrLWIA [ r' ' - D n Y.31=" t • S. s,�'r .; �.�� ;rli 1l n.w� '-. _1S3a7NdIS ,'*�y'r" ,' p 53N(10 071tlH c :IgQ+I:r;A7x3FA131O:. o. a0 T' aNM tU * . on Er 33% £C®335 d` no I'^•` m` J u _ -o' o •„� .. 59xsna5 ----3 x31 •r SAN HSlN3AYM a 2 .'�! - '�i ••:yH' nda'' -'�,° c Wd W P A" mnaro$ p 5771'ig r '� � ?y �'-, ■ a b' '>, �- - �•� + s , /Ann n. 81117.Aa1N1107. r31MY HSI AY11 ;� a0 la3 < yyqq _M r' is adat n`� u -� Z �� •,11N3S3 _5 ar Iry +: '� ��.. - fi F �� ylbl�it'1�� Q rx � 30MlIN 0117xYa TJ' Com' ol.:+v`'%<a t 3!': s% �a^ a''a' 3s�4Pc•, �`' �_ 0, ..n: ai 90 !p 7 AtIIM/10J: F .:gyp • x �� 7 ANUNNA7 p. 35Y10lfHm7 - W. m i,� �,'..rc1l` 0:......._..• o � AIM! 7 laos3a 1109 yHLV l5 :.7. 7YL xrlai` n Ylxrr F ? _ t HSIx3enl ; aHnst lals3a uv� ... y S 1 s1rA - dro Jb3F . xnd v� r N M '31MJ ap Npll(N 'la3S30 1 ,uln t�s'^�s'r 'N .yN111No1:��ovn h ,c f 9E >1"' drz}„ t�+ a000t W1V11 n° I Ti .., HU CERTIFICATE OF COMPLIANCE: RESIDENTIAL, (Page I of 3) CF -1 R Project Title o Project Adckiws • � J Q Documentation Authof Telephone Compliance Method (Package or Computer) Climate, Zone GENERAL INFORMATION Total Conditioned Floor Area ft2 Average Ceiling He Conditioned Slab Floor Area ft2. Beildine Permit e PI m Check , "Date Fi ld Check/ Date briorccment . gencv se Univ ft Building Type: Single Family Addition (check one or more) Multi -Family Existing-Plus-Additi Front Orientation: North /South /East /West /All Orientati (input front orientation in degrees from True North an crtc ��®� Number of Stones Number of Dwelling Units: �0 ®�� Floor.Construction Type: Slab/Raised Floor (circle one or both)' �20 a v • RADIANT BARRIER (required in climate zones 2,4.8-15) Required�thi BUILDING ENVELOPE INSULATION �"" t�2 �0�6 Component Frame Type Cavity Sheathing Total R- Assembly �tiom s Type wd = wood Insulation. Insulation .Value Type (a[i age, tcal, etc.) stl = steel R -Value R -Value Wall Wall Roof Roof Floor Floor Slab Ed e i ••�- • -w. _�- a..... a.,., �,��_,,,�, v-rataur arc not re utrep Tor a w000-tramed wall that meets cavil R -value insulation requirements for the Prescriptive PackageFENESTRATIONShadin DeviFenestration #/T'e/Pos. Orien- tation Fenestration U -Factor FenestrationExterior SHGC Shading Overhangs/ Front so -7 Tr Front gyp Left _T o Iii C)Left Att. Fins - ••�- • -w. _�- a..... a.,., �,��_,,,�, v-rataur arc not re utrep Tor a w000-tramed wall that meets cavil R -value insulation requirements for the Prescriptive PackageFENESTRATIONShadin DeviFenestration #/T'e/Pos. Orien- tation Fenestration U -Factor FenestrationExterior SHGC Shading Overhangs/ Front so -7 Tr Front gyp Left _T o Iii C)Left Ir Rear Rear Ri ht Ri ht Sk li htSk li ht Compliance Forms August 2001 A-2 6� ' t • i ' CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 3) CF -1 R Project Title Date HVAC SYSTEMS Note: Input hydropic or combined hydropic data under Water Heating Systems, except Design Heating Load Distribution • Heating Equipment Minimum Type and, Duct or Heat Pump Type'(fumace, heat Efficiency Location Piping ThetmostEt Configuration pump. etc.) (AFUE or HSPF)' (ducts, attic, etc.) R -Value Type (split or package) A/y c ��t1.�✓ c � ; Cooling Equipment Minimum Duct Heat Pump Type (air conditioner. Efficiency Location Duct Thetmost2t ' Configuration heat pump, evap..cooting) (SEER) (attic, etc.) R -Value Type (Split or package) ` SEALED DUCTS and TXVs (or Alternative Measures) ❑ Sealed Ducts (all climite'zones) (Installer testing and certification and HERS rater field verification required) TXVs, readily accessible -(climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater or field verification required) ' Refrigerant Charge/Air Flow (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater or field verification required) OR , Alternative to Sealed Ducts and TXVs (see Package C or D Alternative Package Features Rr Project Climate Zone) .Climate Zone Window SHGC Window U -Factor SEER Heaths; WATER HEATING SYSTEMS - Energy External . Rated' Tank Factor or Tank Water Heater Distribution Number Input (kw Capacity Recover, Standby' Insulation - Type Type in System or Btu/hr) (gallons) Efficiency 'Loss (%) R Value I. For small gas storage water heaters (rated inputs of less than or,equal to,75,000 Btuthr), electric resistance, and hea-. pump water heaters, list Energy Factor. ,For large gas storage water heaters -(rated input of greater than 75,000 Btuthr), list Rated Input, Recovery Efficiency and Standby Loss. For instantaneous gas water heaters, list rated input and recovery efficiencies. 'SPECIAL FEATURES (add extra sheets if necessary). Package C and D:-TXVs, Sealed Ducts, Radiant Barriers (see installation requirements for radiant barriers in Section 8.13 bf the 2001 Residential Manual). Pa&age C: thermal mass'(thermal mass type, covering, thickness, and description). -5 Compliance Forms August 2001 A-3 V ' CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page.3 of 3) CF -1 R Project Title Date { COMPLIANCE STATEMENT -This certificate of compliance lists the building features and performance specifications needed to comply with Title 24, Parts 1 'and 6 of the California Code of Regulations, and the administrative reg4lations to implement them. This certificate has been signed by the individual with overall design responsibility. When this certificate of compliance is submitted for a single building plan to be built in multiple orientations. any shading feature that - is varied is indicated in the Special Features/Remarks section. The undersigned recognize that compliance using -duct sealing and TXVs requires installer testing and certification and field verification bFy an approved HERS rater. ' r, Designer or Owner (per Business and Professions Code) Documentation Authoe Name: �i?% (..�A� t Name: Title/Firm: Title/Firm: Address: / ��7 �iIS%1r� ,�. a /7 Address: Telephone: i 7• // Telephone: Lic. #/: r (signature) (date) (signature) - (date) Enforcement Agency Name: Title`. , Agency: Telephone: (signature / stamp). (date) Compliance Forms August 2001 A-4