BRES2017-003778-495 CALLCTAMPICO
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LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BRES2017-0037
Property Address: 48720 SANTA URSULA ST ST
APN: 646130008
Application Description: LQ GOLF ESTATES / ADDITION 81 SQ FT BAR AREA REMODEL
Property Zoning:
Application Valuation: $100,000.00
Applicant:,
SOUTH WEST CONCEPTS, INC.
78115 CALLE ESTADO, SUITE 1Q5
LA QUINTA, CA 92253
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: B License No.: 1011202
Date: C, 1 ' Contractor:'
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any
structure, prior to its issuance, also requires the applicant for the permit tofile a signed
statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the
alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( ) 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 thatthe 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, 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.).
U 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 Na
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/7/2017
Owner:
MORGAN WILLIAM FONG AND DANIEL JOHN
KOBUSSEN
300 BEALE ST 4312'�� z
SAN FRANCISCO, CA 94105 ' ki
Contractor:
I B Y CONSTRLCTION INC
84-802 SUNDC'WN LANE
COACHELLA, CA 9.2236
(951)634-908C
Llc. No.: 1011202
WORKER'S COMPENSATION DECLARATION.
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certific.-te of consent to self -insure for workers'
compensation, as provided for by Section 37 )0 of the Labor Code, for the performance
of tf�e yyork for which this permit is issued.
d�*\�Y — 1 have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the perfcrmance of the work for which this permit is
issued. My workers' compensation insurance carrier andpolicynumber are:
Carrier: STATE COMPENSATION INSURANCE:UND Polity Number: 9212645
1 certify that in the performance o: the work for which this permit is issued, I
shall not employ any person in any manner s-) as to become subject to the workers'
compensation laws of California, and agree teat, if I should become subjectto the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: Applicant:
WARNING: FAILURE TOSECUREWORKERS' C MPENSATIONCOVERAGEISUNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMlVAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,GD0). 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 vie Building Official for a permit subject to
the conditions and restrictions set forth on the application.
1. Each person upon whose behalf this appl cation 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 cancellatio.a.
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: _Signature (Applicant arAgent):
C. O~o
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WORKER'S COMPENSATION DECLARATION.
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certific.-te of consent to self -insure for workers'
compensation, as provided for by Section 37 )0 of the Labor Code, for the performance
of tf�e yyork for which this permit is issued.
d�*\�Y — 1 have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the perfcrmance of the work for which this permit is
issued. My workers' compensation insurance carrier andpolicynumber are:
Carrier: STATE COMPENSATION INSURANCE:UND Polity Number: 9212645
1 certify that in the performance o: the work for which this permit is issued, I
shall not employ any person in any manner s-) as to become subject to the workers'
compensation laws of California, and agree teat, if I should become subjectto the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: Applicant:
WARNING: FAILURE TOSECUREWORKERS' C MPENSATIONCOVERAGEISUNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMlVAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,GD0). 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 vie Building Official for a permit subject to
the conditions and restrictions set forth on the application.
1. Each person upon whose behalf this appl cation 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 cancellatio.a.
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: _Signature (Applicant arAgent):
Date: 8/7/2017
ApplicationiNumber: - ,i, 8RES2017-0037
Owner.
Property Address: 48720 SANTA URSULA ST ST
MORGAN WILLIAM FONG AND DANIEL JOHN
APN: 646130008
KOBUSSEN
Application Description: LQ GOLF ESTATES / ADDITION 81 SQ FT BAR AREA & REMODEL
300 BEALE ST #312
Property Zoning:
SAN FRANCISCO, CA 94105
Application Valuation: $100,000.00
Applicant:
Contractor:
SOUTH WEST CONCEPTS, INC.
I B Y CONSTRUCTION INC
78115 CALLE ESTADO, SUITE 105
84-802 SUNDOWN LANE
LA QUINTA, CA 92253
COACHELLA, CA 92236 .
(951)634-9080 .
----------=------------------------------
Llc. No.: 1011202
----------------------------------
-------------
Detail: 81 SF LIVING ADDITION, 338 SF COV. PATIO ADDITION AND INTERIOR REMODEL, 3
----
- SL.GL. FRENCH DOOR CHANGEOUTS @ FRONT ELEV. 2016
CODES. **ADJUSTMENT OF EXISTING SEPTIC SYSTEM DUE TO LANDCAPE WORK AT FRONT
YARD APPROVED CONDITIONALLY BY HEALTH DEPT.- LETTER
ON FILE IN TRAKIT.**
INFORMATION
" MI=SCRIPTION ACCOUNT- QTY AMOUNT
ADDITION, FIRST 100 SF
101-0000-42400 0 $127.68
DESCRIPTION
ACCOUNT QTY AMOUNT
ADDITION, FIRST 100 SF PC
101-0000-42600 0. $179.36
Total Paid for ADDITION: $307.04
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HOURLY CHARGE - YES ADMINISTRATIVE STAFF
101-0000-42600
0.25
$10.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HOURLY CHARGE - YES ADMINISTRATIVE STAFF
101-000042600
0.25
$10.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HOURLY CHARGE - YES STRUCTURAL PLAN REVIEW ENGINEER
101-0000-42600
1.5
$142.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HOURLY CHARGE - YES STRUCTURAL PLAN REVIEW ENGINEER
101-0000-42600
0.5
$47.50
Total Paid for BLDG CITY STAFF - PER HOUR: $210.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$4.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $4.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$152.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,000SF, PC
101-0000-421600
0
$50.16
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $202.16
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER EA ADDITIONAL .
101-0000-42400
0
$101.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER EA ADDITIONAL PC
101-0000-42600
0
$76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER, DESIGNED
101-0000-42404
0
$139.84.
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER, DESIGNED PC
101-0000-42600
0
$176.32
Total Paid for PATIO COVER / COVERED PORCH / LATTICE: $493.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTUREITRAP
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$25.33
Total Paid for PLUMBING FEES: $63.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SW -RESIDENTIAL
101-0000-20308
0
$13.00
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $13.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43511
0
.$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
lr
:. CItY- of La QdInta... -
' Btdtdtng St Safety Ufvi &
P:O. Box 1504,:78-49S Carte Tamptoo
i. 4 -Q ?nta, CA 92253 -=(760) 777-7012
Bulldrng Penna�ppJrcation and Tracking Sheet
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i'r+oject Atldtess 7 a%
owner's Name:. G -p �.S ev'1
A. P. Number 00
Address: r✓
Leal Descxi�tian:
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Telephone (�
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State Lia : projeet 4w (ekde one): How <gn Mer R+e = Demo
Name of Contact Person; Sq.. FL: g Swries+ #Unity
TeteplionecofCautadPermn-7/ro '� 0 Rwmatod Verus of Project:
APPLICANT: DO NOT WRITE BELOW THiS LM
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Plan Me&sabid9ted- • Its - Amomrt
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CalledConhaPerson PiaaC�redcBaianec_
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flans picked up Cana mCdoa
Flow P�ft plan
Plum rcmbmittcd.- . Mccbari#ad
° plan
2"' Reritwr, ready for comectionsrmue Flectrieal
SnbooAtactor List .
COled ContactPerson Plumbing
Grant Deed
Pians 01elad up SALL
H.O.A. Approval
Plans reaabmiutsd Grading
DK II:OUSBt»
Pianotng Appel.
24 Revk% mdy for eorreetionsdssoe i)svdoper Impact Fee
Called Contact Person AIM
Pub. take. Appr' .
Date of permit issue .
School Fees
.
- ToW PetmitFas
Date: 8/7/2017
No.: 17-00683-1
Owner: Morgan Fong & Dan Kobusson
Address: 48720 Santa Ursula
City: La Quinta
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760)771-8515
Type: Residential Addition < 500 sq ft
Lot # Street No. Street Name
48720
Comments:
Santa Ursula
JN%riEo s
2y %
r
Val BERMUDA DUNES
RANCHO MIRAGE C
Y INDIAN WELLS y
d PALM DESERT y
COACHEL•a
LAOUINTA 7�
p 1N010 y
Email:
Jurisdiction: La Quinta
Tract #:
Sq. Feet APN Permit No.
81 646-130-008
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions
under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking eating, or sanitation) or replacement
mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
Exempt
This certifies that school facility fess imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 81 S.F. or $0.00 have been paid for the property listed above and that building permits
and/or Certificates of Occupancy for this square footage in the proposed project may now be issued.
Fees Paid By: Exempt - Juan Ponce Check No.:
Bank Name/Recipient of Certificate Telephone: 951-634-9080Funding: Exempt
By Scott L. Bailey
Superintendent
Fee Collected/ Exempted by: Sharon M vrey
Certificate Fe�s;_bue: 0;00 r
Original Payment(sf ke' c'd: _$0_00 ;
New PaymeA, Rec'd: } $0 00
0ver/t!n`der: 7'$0.00 `
10,
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notifUing,,tnr
the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the builtallation permit for this project is issued, or from the date on
which those amounts are paid to the District(s) or to another public entity authorizect them on the District('s) behalf, whichever is earlier.
Notice to Building Department: THIS DOCUMENT VALID ONLY IF IMPRINTED WITH EMBOSSED SEAL.
RECORDING REQUESTED BY:
Title365 Company
WHEN RECORDED MAIL THIS DEED AND, UNLESS
OTHERWISE SHOWN BELOW, MAIL TAX STATEMENT TO:
Morgan William Fong and Daniel John
Kobussen
300 Beale Street #312
San Francisco CA 94105
Escrow No.: CA0541-16300146-AC
Title Order No. CA051.0-1.6005599-50
DOC # 2016-0447830
10/12/2016,05:00 PM Fees: $31.00
Page.1 of 3
Recorded in Official Records
County of Riverside
Peter Aldana
Assessor -County Clerk -Recorder
-This document.was electronically submitted
to the County of Riverside for recording"
Receipted by: TERESA #134
.APN: 646-130-008-0 `PRA: .020-003 SPACE ABOVE THIS UNE FOR RECORDER'S USE
GRANT DEED
The undersigned grantor(s) declare(s) Documentary transfer tax Is $609,95
D computed on full value of property conveyed, or
❑ computed on full valueless bens and encumbrances remaining at time of sale,
❑ Unincorporated area: City of La Quinta
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
John D. Shepherd and Deborah Shepherd, Trustees of the John D. and Deborah Shepherd Family Trust dated August 16,
'2002
hereby GRANTS) to - Morgan William Fong and .Daniel John Kobussen, a Married Couple as
the following. described real property: Community Property with Right of Survivorship
See Exhibit W attached hereto and made a part hereof.
SITUS: 48720 Santa Ursula Street, La Quinta, CA
Dated: -September 1, 2016
rA notary public or other officer completing this
certificate verifies only the identity of , the ,
individual who signed the document to which this
rtificate is attached, and not the truthfulness,
,accuracy, or validity of that document.
State of California
County of Orange
On " I . - _ before me,
, Notary Public, personally
appeared Deborah Shepherd, who
proved to me on the basis of,satisfactory evidence to. be the-,
person(s). whose name(s) is/are subscribed to the within
instrument and acknowledged to me that . he/she/they
executed the same in his/her/their authorized capacity(ies),
and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s)
acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the
State of,California that the foregoing. paragraph ,is true and
WITNESS r4v han c Weal.
John D: Shepherd and Deborah Shepherd, Trustees of -the
John D. and Deborah Shepherd Family Trust dated August
16, 2002.
B�
Jpjtrt D. Sh pherd, T stee
BY:
Deborah Shepherd, Trustee
NIKKI B. RAMOS
Commission # 2099855
Notary Public • California
Oranp County
My Comm. Expires Mar 9.2019
r
MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING UNE; IF NO PARTY SHOWN, MAIL AS DIRECTEDABOVE.
Name StreetAddress ckyAtaterap
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 11
•_at_a ,a .c�, . S a .a . .a _ .a, <.. <.a<.a<.a .a .at.a.'. .v. .at.a<.at.a .a .a<.a _a.•. .a .cam .a _a .
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County ofk�L
G�p _)
before me,
Date , , Here Insert Name ggb Titled of the Officer
personally appeared
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the personWWhose name(s)-is/are-
subscribed to the within instrument and acknowledged to me that he/shefthery executed the same in
his/hjef/thyauthorized capacity(ies), and that by his/hewkheir signatures) -on the instrument the person( ,
or the entity upon,behalf of which the person(�acted, executed the instrument:
I certify under PENALTY OF PERJURY under the laws
of the State of California that the.foregoing paragraph.
is true and correct.
WITNESS my hand and official seal.
Signature
Signature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: Document Date:
Number of Pages: Signers) Other Than Named Above:,
Capacity(ies) Claimed by Signer(s)
Signer's Name'
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — O Limited O General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
02014 National Notary Association www.NgtionaiNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907
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onlige couwity
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I certify under PENALTY OF PERJURY under the laws
of the State of California that the.foregoing paragraph.
is true and correct.
WITNESS my hand and official seal.
Signature
Signature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: Document Date:
Number of Pages: Signers) Other Than Named Above:,
Capacity(ies) Claimed by Signer(s)
Signer's Name'
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — O Limited O General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
02014 National Notary Association www.NgtionaiNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907
EXHIBIT A
Legal Description
The land hereinafter referred to is situated in the City of La Quinta, County of Riverside, State of CA, and is described -as
follows:
Parcel 1:
Lot 39 of La Quinta Golf Estates No. 1; in the City of La Quinta, County of Riverside, State of California, as per Map
recorded in Book 37, Page 96 through 98 inclusive of Maps, in the Office of the County Recorder of said County.
Parcel 2:
A non-exclusive easement for ingress and egress over that portion of lots 34, 35, 36, 37, 38 and 39 of La Quinta Golf
Estates No. 1, as shown on Map on File in Book 37, Pages 96, 97 and 98 of Maps, said County Records.
Commencing at the Southeast corner of said Lot 37;
Thence North 2 degrees 40 minutes 37 seconds West, along the East line of said Lot 37, 2.07 feet to the point of
beginning;
Thence North 87 degrees 22 minutes 22 seconds East, 30.00 feet;
Thence, at right angles thereto, South 2 degrees 37 minutes 38 seconds East, 120.00 feet;
Thence, at right angles thereto, South 87 degrees 22 minutes 22 seconds West, 60.00 feet;
Thence, at right angles thereto, North 87 degrees 22 minutes 22 seconds East, 30.00 feet to the point of beginning.
Also including the Westerly 3.00 feet of said Lot 34 and the Easterly 3.00 feet of said Lot 39.
APN: 646-130-008-0
Exhibit A I Created: 09/01/2016 1 CA0510-16005599-50
La Quinta Golf Estates
Community Association
Architectural Committee
P.O. Box 553
La Quinta, CA 92247
(760) 564-0136
iimandjqynew@verizon.net
January 31, 2017
Mr. Nick Nieto
South West Concepts, Inc,
78-115 Calle Estado, Suite 105
La Quinta, CA 92253
Dear Mr. Nieto:
The Architectural Committee for the La Quinta Golf Estates Community Association has
reviewed the plans for the remodel at 48720 San Ursula Street, La Quinta, CA 92253 that
you submitted and we have approved them.
Please remember that the approval is for these plans only and if you make changes to
your plans they will have to be resubmitted for approval.
Yours truly,
Jimmie D. Woods '
Chairman, Architectural Committee l®
MAR 0 9 2017
CITY OF LA OUINTA
COMMUNITY DEVELOPMENT
Plan submittal
Job Site
BUM1111 Permit Number.fjEff:5�j17-,OOiiq
Project Description: mall remodel
Exempt:0
(rials may cont0 hasardous wastes and
are rot subjeatto r�ewft provisions)
Construction Debris Management Plan
Owner's Name
Number, street, or PO Box
Cft Sbte, Postal Code
Owner's Phone Number
Owner's E4M Address
8/7/2017
48720 Santa Ursula
Morgan Fong 8 Dan Kobussen
48720 Sarna Ursula
La Quint$, CA. 92253
c/o 9514834-9080
Juan Ponce
Project Manders Mame
Project s Phone Number 951834-9080
-- -__ _ _?roJact.eAereg�'s E-msil.Add►�s _ — -- — - - ----- -- — --- - --- _ _ _ - - -
Builder / Cantu
Number, Street or PO
City, state, Postal C
Project square
IBY Conadud(on
84802 Sundown Ln
Coacher, CA. 92238
450 square feet
City Approval By Renato Gouldlodc-0EC/Bunbo Waste
Date of City Approval
Totals: Recycle TrashProjected Diversion:
3.5 1.8 gg,�g6
I underslattd It is the properly owneft resporariMW to submit copies of weight tickets or recetpls to the Ohft*W
Environmental Coord>robr as these hauls ocean. I hereby cmft that completion, implemern and adherence of the
Debris Management Pian (DMP) for the above named W*wt shall guarantee that at least 85% of the jobstte waste is
diverted from landli ft. The remaining material will be recycled or reused. I will divert, for recycling or reuse, all wh bg
mabrlals generated from the titer day of the project through the completion of the project in accordance with this plan. This
DMP is Rued in the name of the property owners) acrd shall remain their property throughout the construction and/or
demolition project. A contractor serving as agent of the owner may obtain a DMP for the owner. However, the DMP is still
IBM in the the property owner(s) and the owner retains legal responsibility for ensuring that the provisions of the
DMP are see The Property owners) and general contractor shall be kept informed of the diversion progress through
bimonthly rep r . self- mu ft, all refuse mebriel from this projectsite must be taken to an approved recyater or transfer
/9
To Be Discarded:
Product
Tons
Trash
1.85 Not mwcbbb
Product
Tons
Asphalt
0.00 Recyclable
Masonry (broken)
0.00
BricIdBlock
0.00 Recyclable
Plaster
0.50
Cardboard
0.00 moble
Scrap Metal
0.00
Commingled
0.00 Recyclable
Tile (floor)
0.00
Concrete
2.00 Reaycebb
Tile (rte
0.06
Drywall
0.21 Recydabb
Wood
0.75
Donated / Reuse*
0.00 Recyclable
Landscape Debris
0.00
*Describe items
Totals: Recycle TrashProjected Diversion:
3.5 1.8 gg,�g6
I underslattd It is the properly owneft resporariMW to submit copies of weight tickets or recetpls to the Ohft*W
Environmental Coord>robr as these hauls ocean. I hereby cmft that completion, implemern and adherence of the
Debris Management Pian (DMP) for the above named W*wt shall guarantee that at least 85% of the jobstte waste is
diverted from landli ft. The remaining material will be recycled or reused. I will divert, for recycling or reuse, all wh bg
mabrlals generated from the titer day of the project through the completion of the project in accordance with this plan. This
DMP is Rued in the name of the property owners) acrd shall remain their property throughout the construction and/or
demolition project. A contractor serving as agent of the owner may obtain a DMP for the owner. However, the DMP is still
IBM in the the property owner(s) and the owner retains legal responsibility for ensuring that the provisions of the
DMP are see The Property owners) and general contractor shall be kept informed of the diversion progress through
bimonthly rep r . self- mu ft, all refuse mebriel from this projectsite must be taken to an approved recyater or transfer
/9
YOUNG
6' ENGI.N'EV.:,. G1,
�
. — .k 6 .t L�
e"
a' •. r"-
Letter of Transmittal ..
To: City of La Quinta Today's Date:
5-22-17 f'
78-495 Calle Tampico City Due Date: "
5-22-17 '
La Quinta, CA 92253 Project Address:
48720 Santa Ursula
Attn: MARY Plan Check #:
BRES2017-0037'
Submittal: 1St
❑
01
- , . ,_. .. '.. .❑, , 2nd-
` '.a
5�-
❑ 3rd.
❑
Other: "
We are forwarding:_ ❑ By Messenger ❑
By Mail
(Fed Ex or. UPS) ❑ Your Pickup
Includes: Descriptions:
Includes:
# Of Descriptions: ;
N.
Copies:
❑ Structural Plans
D
Revised Struct. Plans'
D Structural Calculations
❑
Revised Struct. Calcs
D` Truss Calcs
D'
Revised Truss Calcs
❑ Soils Report -Update
❑
Revised Soils Report
t] Structural P/C Responses
❑
Approved Structural Plans
1 /Comments
1
• O 1 Redlined Structural Plans
O ,:
2 Approved Structural Calcs
• D Redlined Structural Calcs'
❑
Approved Truss Calcs
❑ .. Redlined Truss Calcs
O
Approved Soils Report
" ❑ Redlined Soils Reports
-❑
Other:
Comments: Structural content is approvable.
,
Transit Per Diem=
t
Admin Time -= 0.25 'hrs.
"
Structural Engineer/Principal Review Time = 0.0 hrs.
.
Plan Review Engineer Time = .5 hrs.
' This - Material Sent for:
❑ Your Files
❑
Per Your Request
❑ Your Review
❑
Approval
❑ Checking
❑
At the request of:
Other: ❑'
y
%n ,4
By: Joe Venuti
Office . ❑ (760) 772-5107
Other: ❑ LQPC@VALUENGR.COM
STATE OF CALIFORNIA
Prescriptive Residential Additions That Do Not Require HERS Field Verification
CEC-CFIR-ADD-02-E (Revised 05/16) CALIFORNIA ENERGY COMMISSION �
CERTIFICATE OF COMPLIANCE CFIR-ADD-02-E
Prescriptive Residential Additions That Do Not Require HERS Field Verification (Page 1 of 9)
Project Name: Kobussen Renovation Date Prepared: 3/9/2017
This compliance document is only applicable to additions 300 ftz or less, or additions that do not require HERS field verification for compliance. When HERS verification is required, a CFIR-ADD-01
shall first be registered with a HERS Provider Data Registry.
Alterations to Space Conditioning Systems that are exempt from HERS verification requirements may use the CFIR-ADD-02 and CF2R- ADD -02 Compliance Documents. Possible exemptions from duct
leakage testing include: less than 40 ft of ducts were added or replaced; or the existing duct system was insulated with asbestos; or the existing dud system was previously tested and passed by a
HERS Rater. If space conditioning systems are altered and are not exempt from HERS verification, then a CFIR-ADD-01 must be completed and registered with a HERS Provider Data Registry.
Additions or alterations that utilize close Cell Spray Polyurethane Foam (ccSPF) with a density of 1.5 to less than 2.5 pounds per cubic foot having an R -value other than 5.8 per inch, or Open Cell
Spray Polyurethane Foam (ocSPF) with a density of 0.4 to less than 1.5 pounds per cubic foot having an R -value of 3.6 per inch, shall complete and register a CFIR ADD -01 with a HERS Provider Data
Registry.
If more than one person has responsibilityfor installation of the items on this certificate, each person shall prepare and sign a certificate applicable to the portion of construction for which they are
responsible. Alternatively, the person with chief responsibility for construction shall prepare and sign this certificate for the entire construction. All applicable Mandatory Measures shall be met.
Temporary labels shall not be removed before verification by the building inspector.
A. General Information
01
Project Name:
Kobussen Addition
02
Date Prepared:
3/9/2017
03
Project Location:
48720 Santa Ursula St.
04
Building Front Orientation (deg):
180
05
CA City:
La QUlnta
06
Number of Dwelling Units with Additions:
1
07
Zip Code:
92253
08
Fuel Type:
Natural Gas
09
Climate Zone:
15
10
Total Conditioned Floor Area (ft) (Addition):
81
11
Building Type:
Single Family
12
Slab Area (ft):
81
13
Project Scope:
81 sq. ft. addition to an existing residence
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE
<< tl
EIV®
1�9'M2o 7-t�J7MAR 0 9 2017
CITY OF LA OUINTA
COMMUNITY DEVELOPMENT
CA Building Energy Efficiency Standards - 2016 Residential Compliance May 2016 lko
STATE OF CALIFORNIA
Prescriptive Residential Additions That Do Not Require HERS Field Verification
W
CEC-CFIR-ADD-02-E (Revised 05/16) CALIFORNIA ENERGY COMMISSION "''
CERTIFICATE OF COMPLIANCE CFIR-ADD-02-E
Prescriptive Residential Additions That Do Not Require HERS Field Verification (Page 2 of 9)
Project Name: KobuSsen Renovation Date Prepared: '3/.7n /2017
B. Opaque Surface Details — Framed (Section 150.2(a))
01
02
03
04
05
06 07 08 09
10
11
Tag/ID
Assembly Type
Frame Type
Frame
Depth
(inches)
Frame
Spacing
(inches)
Proposed
Required
Comments
Cavity
R -value
Continuous
Insulation
R -value
U -Factor
AppendixJA4 Reference
U -Factor
Table
Cell
R21 -wall
Exterior Walls
Wood
5.5
16" O.C.
R-21
N/A
.051
150.1-A
15
.051
CA Building Energy Efficiency Standards - 2016 Residential Compliance May 2016
STATE OF CALIFORNIA
Prescriptive Residential Additions That Do Not Require HERS Field Verification
"Y'61Y
CEC-CFIR-ADD-02-E (Revised 05/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ADD-02-E
Prescriptive Residential Additions That Do Not Require HERS Field Verification (Page 3 of 9)
Project Name: Kobussen Renovation Date Prepared: 3/9/2017
C. Opaque Surface Details — Non -framed (Section 150.1(c)1)
01
02
03
04
05 06 07 08 09
10
11
Tag/ID
Assembly Type
Assembly Materials
Thickness
(inches)
Proposed
Required
Comments
Core
Insulation
R -value
Continuous
Insulation
R -value
U -Factor
Appendix JA4
Reference
U -Factor from
Package A
Table
Cell
Roof
Attic Roof
48 Roof Rafters
7.5
N/A
N/A
0.32
150.1-A
15
0.32
LI -factor
Roof
Attic Roof
2x4 Ceiling Joists
3.5
R-38
N/A
0.32
150.1-A
15
0.32
N/A
N/A
N/A
N/A
N/A
D. Opaque Surface Details — Mass Walls (Section 150.1(c)1)
01
02
03
04
05
06 07 08 1 09
10 11
Tag/ID
Walls
Above
Grade
Mass Type
Mass
Thickness
(inches)
Furring Strip
Thickness
(inches)
Proposed
Required
Interior Insulation
Exterior Insulation
Appendix JA4
Reference
Interior Insulation
Exterior Insulation
R -value
U -factor
R -value
U -factor
Table
Cell
R -value
U -factor
R -value
LI -factor
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
CA Building Energy Efficiency Standards - 2016 Residential Compliance May 2016
STATE OF CALIFORNIA
Prescriptive Residential Additions That Do Not Require HERS Field Verification
CEC-CFIR-ADD-02-E (Revised 05116) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF111-ADD-02-E
Prescriptive Residential Additions That Do Not Require HERS Field Verification (Page 4 of 9)
Project Name: Kobussen Renovation Date Prepared: 3/9/2017
E. Slab Insulation (Table 150.1-A)
01
02 03
04 05
06
Floor Type
Proposed
Required
Comments
Insulation
R -value
Insulation
U -factor
Insulation
R -value
Insulation
U -factor
Slab -on -grade
N/A
N/A
N/A
N/A
Note:
• Heated slab floors require mandatory slab insulation (see Table 110.8-A).
F. Radiant Barrier (Section 150.1(c)2)
01
02
Radiant Barrier installed below the roof deck and on all gable end walls
Comments
NO
A radiant barrier is required (for Climate Zones 2-15)
• Radiant barriers shall meet specific eligibility and installation criteria to receive energy credit for compliance with the Building Energy Efficiency Standards for low-rise residential
buildings. Refer to RA4.2.1
• The emittance of the radiant barrier shall be less than or equal to 0.05 as tested in accordance with ASTM C1371 or ASTM E408.
• For Prescriptive Compliance the attic shall be ventilated to provide a minimum free ventilation area of not less than one square foot of vent area for each 300 ft2 of attic floor area with
no less than 30 percent upper vents. Ridge vents or gable end vents are recommended to achieve the best performance. The material should be cut to allow for full airflow to the venting.
CA Building Energy Efficiency Standards - 2016 Residential Compliance May 2016
STATE OF CALIFORNIA
Prescriptive Residential Additions That Do Not Require HERS Field Verification
CEC-CF I R -ADD -02-E (Revised 05/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ADD-02-E
Prescriptive Residential Additions That Do Not Require HERS Field Verification (Page 5 of 9)
Project Name: Kobussen RenovatlOn Date Prepared: 3/9/2017
G. Roofing Products (Cool Roof) (Section 150.1(c)11)
01
02
03
04
05
06 07 08 09
10 11 12
Mass Roof
25lb/ft2 or
Greater
Roof Pitch
Method of
Compliance
Product
Type
CRRC Product ID
Number
Proposed
Required
Initial Solar
Reflectance
Aged Solar
Reflectance
Thermal
Emittance
SRI
(Optional)
Aged Solar
Reflectance
Thermal
Emittance
SRI
(Optional)
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
The Greater
Addition
Allowed
Allowed
Allowed
Allowed
Comments
Type ft2
U -factor
U -factor
SHGC
SHGC
Maximum
Maximum
Calculated
Maximum
Calculated
Maximum
(Windows)
(Skylights)
(Windows)
(Skylights)
Calculated
Calculated
based on
Allowed ft
based on
Allowed ft
Allowed %
Allowed %
81 <300
24 sq. ft.
75 sq. ft.
Notes:
• Any roof area covered by building integrated photovoltaic panels and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field applied coatings must comply with installation criteria from section 110.8(i)4.
H. Fenestration/Glazing Allowed Areas and Efficiencies (Section 150.2(a)1)
01
02 1 03
04 1 05
06
07
08
09
10
Maximum Allowed
Maximum Allowed
Fenestration Area for All
West -Facing Fenestration
Orientations ftZ
Area Only ftZ
Maximum
Maximum
Maximum
Maximum
The Greater
The Greater
Addition
Allowed
Allowed
Allowed
Allowed
Comments
Type ft2
U -factor
U -factor
SHGC
SHGC
Maximum
Maximum
Calculated
Maximum
Calculated
Maximum
(Windows)
(Skylights)
(Windows)
(Skylights)
Calculated
Calculated
based on
Allowed ft
based on
Allowed ft
Allowed %
Allowed %
81 <300
24 sq. ft.
75 sq. ft.
N/A
N/A
0.32
N/A
0.25
N/A
CA Building Energy Efficiency Standards - 2016 Residential Compliance May 2016
STATE OF CALIFORNIA
Prescriptive Residential Additions That Do Not Require HERS Field Verification
CEC-CFIR-ADD-02-E (Revised 05/16) CALIFORNIA ENERGY COMMISSION �
CERTIFICATE OF COMPLIANCE CF1R-ADD-02-E
Prescriptive Residential Additions That Do Not Require HERS Field Verification (Page 6 of 9)
Project Name: Kobussen Renovation Date Prepared: 3/9/2017
I. Fenestration Proposed Areas and Efficiencies
Note: If meeting Exception 1 to 150.1(c)3A, Installing <_ 3ft2 glass in door, it is assumed to meet the minimum required U -factor (0.32) & SHGC (0.25).
If meeting Exception 1 to 150.1(c)3A, Installing <_ 3ft2 tubular skylight, it is assumed to meet the minimum required U -factor (0.55) & SHGC (0.30).
01
02
03
04
05
06
07
08
09
10
11
12
13
14
Tag/I
D
Fenestration
Type
Frame Type
Dynamic
Glazing
Orientation
N, S, W, E
or Roof
Number
of
Panes
Proposed
Fenestration
Area ftZ
Proposed
West Facing
Fenestration
Area ft
Proposed
U -factor
Source
Proposed
SHGC
Source
Exterior
Shading
Device
Combined
SHGC from
CF1R-ENV-03
W1
Folding GI. Drs.
Metal
None
E
2
40
0
0.32
T1 10.6-M
0.25
T1 10.6-13
NO
N/A
W2
Op. Window
Metal
None
E
2
18
0
0.32
T1 10.6-A
0.25
T110.6-13
NO
N/A
15
Total Proposed Fenestration Area
58 Sq. Ft.
16
Maximum Allowed Fenestration Area
75 Sq. Ft.
17
Compliance Statement I Total Proposed Fenestration Area 5 Maximum Allowed Fenestration Area ® Yes ❑ No
18
Total Proposed West -Facing Fenestration Area
0
19
Maximum Allowed West -Facing Fenestration Area
N/A
20
Compliance Statement I Total Proposed West -Facing Fenestration Area 5 Maximum Allowed West -Facing Fenestration Area M Yes ❑ No
21
Proposed Fenestration U -factor (Windows)
0.32
22
Required Fenestration U -factor (Windows)
0.32
23
Compliance Statement I Proposed Fenestration U -factor 5 Required Fenestration U -factor W Yes ❑ No
24
Proposed Fenestration SHGC (Windows)
0.25
25
Required Fenestration SHGC (Windows)
0,25
26
Compliance Statement I Proposed Fenestration SHGC 5 Required Fenestration SHGC ® Yes ❑ No
27
Proposed Fenestration U -factor (Skylights)
N/A
28
Required Fenestration U -factor (Skylights)
N/A
29
Compliance Statement I Proposed Fenestration LI -factor 5 Required Fenestration U -factor ❑ Yes ❑ No
30
Proposed Fenestration SHGC (Skylights)
N/A
31
Required Fenestration SHGC (Skylights)
N/A
32
Compliance Statement I Proposed Fenestration SHGC 5 Required Fenestration SHGC ❑ Yes ❑ No
CA Building Energy Efficiency Standards - 2016 Residential Compliance May 2016
STATE OF CALIFORNIA
Prescriptive Residential Additions That Do Not Require HERS Field Verification
CEC-CFIR-ADD-02-E (Revised 05/161
Ri-ItOild!
CERTIFICATE OF COMPLIANCE CF1R-ADD-02-E
Prescriptive Residential Additions That Do Not Require HERS Field Verification (Page 7 of 9)
Project Name: KDbussen Renovation Date Prepared: 3I9I2017
J. Space Conditioning (SC) Systems — Heating/Cooling (Prescriptive Section 150.2(b))
Alterations to Space Conditioning Systems shall be exempt from HERS verification requirements as prerequisite for use of the CFIR-ADD-02 and CF211-ADD-02 Compliance Documents. If new
space conditioning systems are installed or existing systems are altered and are not exempt from HERS verification, then a CFIR-ADD-01 shall be completed and registered with a HERS Provider
Data Registry. In each row below for each dwelling unit in the building, check the box that indicates.the exemption from HERS verification compliance:
❑ a: space conditioning system was not altered;
® b: less than 40 ft of ducts were added or replaced;
❑ c: (exempt from duct leakage testing) if: the existing duct system was insulated with asbestos;
❑ d: (exempt from duct leakage testing) if: the existing duct system was previously tested and passed by a HERS Rater.
01
02
03
04
Dwelling Unit Name
SC System Identification or Name
SC System Location or Area Served
Exemption from HERS Verification
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 11 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 11 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 11 0 0
CA Building Energy Efficiency Standards - 2016 Residential Compliance May 2016
STATE OF CALIFORNIA
Prescriptive Residential Additions That Do Not Require HERS Field Verification
SEC-CFIR-ADD-02-E (Revised 05/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ADD-02-E
Prescriptive Residential Additions That Do Not Require HERS Field Verification (Page 8 of 9)
Project Name: Kobussen Renovation Date Prepared: 3/9/2011
K. Water Heating Systems (Section 150.2(a)iD)
List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating.
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15 -
Dwelling Unit
Name
Water Heating
System
Identification or
Name
Water Heating
System Location
or Area Served
Water
Heating
System
Type
Water
Heater
Type
q
Water
Heaters
in System
Water
Heater
Storage
Volume
(gal)
Fuel Type
Rated
Input
Type
Rated
Input
Value
Heating
Efficiency
Type
Heating
Efficiency
Value
Standby
Loss
K
Exterior
Insulation
R -Value
Back -Up
Solar
Savings
I Fraction
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
CA Building Energy Efficiency Standards - 2016 Residential Compliance
May 2016
STATE OF CALIFORNIA
Prescriptive Residential Additions That Do Not Require HERS Field Verification
�Ys7?1f
CEC-CFIR-ADD-02-E (Revised 05/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ADD-02-E
Prescriptive Residential Additions That Do Not Require HERS Field Verification (Page 9 of 9)
Project Name: Kobussen Renovation Date Prepared: 3/9/2017
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Stephen R. Nieto
Documentation Author Signature:
Company:
South West Concepts Inc.
Signature Date:
Address: 781 15 Calle Estado Suite 105
O
CEA/ HERS Certification Identification (if applicable):
City/State/Zip:
La Quinta, CA 92253
Phone:
(760)564-4707
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible
designer).
3. That the energy features and performance specifications, materials, components, and manufactured devices 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.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency
for all applicable inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building
owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
Stephen R. Nieto
Company :Date
South West Concepts Inc.
Signed:
Address:
78115 Calle Estado Suite 105
License:
City/state/Zip. La Quinta, CA 92253
Phone. (760)564-4707
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
CA Building Energy Efficiency Standards - 2016 Residential Compliance May 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
�f
CEC-CFIR-ALT-05-E (Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification (Page 1 of 8)
Project Name: Kobussen Renovation Date Prepared: 3/9/2017
This compliance document is only applicable to simple alterations that do not require HERS verification for compliance. When HERS verification is required, a CF1R-ALT-01 shall first be registered
with a HERS Provider Data Registry.
Alterations to Space Conditioning Systems that are exempt from HERS verification requirements may use the CFIR-ALT-05 and CF2R- ALT -05 Compliance Documents. Possible exemptions from duct
leakage testing include: less than 40 ft of ducts were added or replaced; or the existing duct system was insulated with asbestos, or the existing duct system was previously tested and passed by a
HERS Rater. If space conditioning systems are altered and are not exempt from HERS verification, then a CFIR-ALT-02 must be completed and registered with a HERS Provider Data Registry.
Alterations that utilize close Cell Spray Polyurethane Foam (ccSPF) with a density of 1.5 to less than 2.5 pounds per cubic foot having an R -value other than 5.8 per inch, or Open Cell Spray
Polyurethane Foam (ocSPF) with a density of 0.4 to less than 1.5 pounds per cubic foot having an R -value of 3.6 per inch, shall complete and register a CFIR-ALT-01 with a HERS Provider Data
Registry.
If more than one person has responsibility for installation of the items on this certificate, each person shall prepare and sign a certificate applicable to the portion of construction for which they are
responsible. Alternatively, the person with chief responsibilityfor construction shall prepare and sign this certificate for the entire construction. All applicable Mandatory Measures shall be met.
Temporary labels shall not be removed before verification by the building inspector.
A. General Information
01
Project Name:
Kobussen Renovation
02
Date Prepared:
3/9/2017
03
Project Location:
48720 Santa Ursula St.
04
Building Front Orientation (deg or cardinal):
180
05
CA City:
La Quinta
06
Number of Altered Dwelling Units:
1
07
zip code:
92253
08
Fuel Type:
Natural Gas
09
Climate zone:
15
10
Total Conditioned Floor Area (ft):
2,654 sq. ft.
11
Building Type:
Single Family Detached
12
Slab Area (ft):
2,654 sq. ft.
13
Project Scope:
Proposed Addition & Renovations
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
YR
CEC-CFIR-ALT-05-E (Revised 04/16) CALIFORNIA ENERGY COMMISSION *6W
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive{, Residential Alterations That Do Not Require HERS Field Verification n (Page 2 of 8)
Project Name: Kobussen Renovation Date Prepared: 3/9/2017
B. Building Insulation Details (Section 150.2(b)1)
01
02
03
04
05
06 07 08 1 09
10
11
Tag/ID
Assembly Type
Frame
Type
Frame
Depth
(inches)
Frame
Spacing
(inches)
Proposed
Required
Comments
Cavity
R -value
Continuous
Insulation
R -value
LI -factor
AppendixJA4 Reference
U -Factor
Table
Cell
R-21 Wall
Exterior Wall
2xg sd
5.5
16" O.C.
R-21
N/A
.051
150.1-A
15
.051
Roof
Attic Roof
V4Ux$sd
7.5
16" O.C.
N/A
NIA
0.32
150.1-A
15
0.32
R-38
Attic
Ceilings
(Below attic)
2x4 CI'g
Joists
3.5
16" O.C.
R-38
N/A
0.32
150.1-A
15
0.32
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
ie%ivy
CEC-CFIR-ALT-05-E (Revised 04/16) CALIFORNIA ENERGY COMMISSION 'RaP1
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification (Page 3 of 8)
Project Name: Kobussen Renovation Date Prepared: 3/9/2017
C. Roof Replacement (Prescriptive Alteration, Section 150.2(b)iH)
01
02
03
04
05
06
07 08 09 10
11 12 13
Method of
Compliance
Roof
Pitch
Exception
CRRC Product ID
Number
Product Type
R -value
Deck
Insulation
Proposed
Minimum Required
Initial Solar
Reflectance
Aged Solar
Reflectance
Thermal
Emittance
SRI
(Optional)
Aged Solar
Reflectance
Thermal
Emittance
SRI
(Optional)
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Area For All
Fenestration
Area for All
Fenestration
Allowed
Allowed
Allowed
Allowed
Alteration
Orientations
Area Only
Orientations
Area
U -factor
U -factor
SHGC
SHGC
Type
1 (ft)
(ftz)
(ft)
(ft)
(Windows)
(Skylights)
1 (Windows)
(Skylights)
I Comments
Adding/
Replacing
530
132.7
493.5
72
0.32
NIA
0.25
NIA
NOTES:
• Roof area covered by building integrated photovoltaic panels and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field applied coatings must comply with installation criteria from section 110.8(i)4.
D. Fenestration/Glazing Allowed Areas and Efficiencies (Section 150.2(b)1)
01
02
03
04
05
06
07
Maximum
Maximum
Allowed
Allowed West-
Existing
Existing West -
Fenestration
Facing
Fenestration
Facing
Maximum
Maximum
Maximum
Maximum
Area For All
Fenestration
Area for All
Fenestration
Allowed
Allowed
Allowed
Allowed
Alteration
Orientations
Area Only
Orientations
Area
U -factor
U -factor
SHGC
SHGC
Type
1 (ft)
(ftz)
(ft)
(ft)
(Windows)
(Skylights)
1 (Windows)
(Skylights)
I Comments
Adding/
Replacing
530
132.7
493.5
72
0.32
NIA
0.25
NIA
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CFIR-ALT-05-E (Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification (Page 4 of 8)
Project Name: Kobu$$en Renovation Date Prepared: 3/9/2017
E. Fenestration Proposed Areas and Efficiencies — Add (Section 150.2(b)1A)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
Tag/ID
Fenestration
Type
Frame
Type
Dynamic
Glazing
Orientation
N, S, W, E
or Roof
Number
of
Panes
Proposed
Fenestration
Area ft2
Proposed West
Facing
Fenestration
Area ft
Proposed
U -factor
Source
Proposed
SHGC
Source
Exterior
Shading
Device
Combined
SHGC from
CFIR-ENV-03
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
15
Total Proposed Fenestration Area
16
Maximum Allowed Fenestration Area
17
Compliance Statement
Existing + Proposed Fenestration Area 5 Maximum Allowed Fenestration Area ❑ Yes ❑ No
18
Total Proposed West -Facing Fenestration Area
19
Maximum Allowed West -Facing Fenestration Area
20
Compliance Statement
Existing + Proposed West -Facing Fenestration Area 5 Maximum Allowed West -Facing Fenestration Area ❑ Yes ❑ No
21
Proposed Fenestration U -factor (Windows)
22
Required Fenestration U -factor (Windows)
23
Compliance Statement
Proposed Fenestration U -factor 5 Required Fenestration U -factor ❑ Yes ❑ No
24
Proposed Fenestration SHGC (Windows)
25
Required Fenestration SHGC (Windows)
26
Compliance Statement
Proposed Fenestration SHGC <_ Required Fenestration SHGC ❑ Yes ❑ No
27
Proposed Fenestration U -factor (Skylights)
28
Required Fenestration U -factor (Skylights)
29
Compliance Statement
Proposed Fenestration U -factor <_ Required Fenestration U -factor ❑Yes ❑ No
30
Proposed Fenestration SHGC (Skylights)
31
Required Fenestration SHGC (Skylights)
32
Compliance Statement
Proposed Fenestration SHGC <_ Required Fenestration SHGC ❑ Yes ❑ No
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CFIR-ALT-05-E (Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification (Page 5 of 8)
Project Name: Kobussen Renovation Date Prepared: 3/9/2017
F. Fenestration/Glazing Proposed Areas and Efficiencies — Replace (Section 150.2(b)16)
01
02
03
04
05
06
07
08
9
10
11
12
13
14
Tag/
ID
Fenestration
Type
Frame
Type
Dynamic
Glazing
Orientation
N, S, W, E
Area
Removed
(ft)
Area
Added
(ft)
Net
Added
Area (ft)
LI -factor
Source
SHGC
Source
Exterior
Shading
Device
Combined SHGC
from
CFIR-ENV-03
W1
Glass Dr.
Metal
None
E
80
40
0
0.32
T1 10.6-A
0.25
T1 10.6-B
None
0.25
W2
Op. Window
Metal
None
E
16
18
2
0.32
T1 10.6-A
0.25
T1 10.6-B
None
0.25
W3
Glass Sldr.
Metal
None
W
24
40
16
0.32
T1 10.6-A
0.25
T1 10.6-B
None
0.25
W4
Glass Sldr.
Metal
None
W
40
40
0
0.32
T1 10.6-A
0.25
T1 10.6-B
None
0.25
W5
Glass Drs.
Metal
None
N
30
80
50
0.32
T1 10.6-A
0.25
T1 10.6-B
None
0.25
15
Net Added West -facing Fenestration Area
80
16
Is Net Added Fenestration Areas for west -facing fenestration?
M Yes
❑ No
17
Net Added Fenestration Area (all orientations)
18
Is Net Added Fenestration Area 5 0 for all orientations?
M Yes
❑ No
19
Proposed Fenestration U -factor (Windows)
0.32
20
Required Fenestration U -factor (Windows)
0.32
21
Is the proposed Fenestration LI -factor <_ the Required Fenestration U -factor?
® Yes
❑ No
22
Proposed Fenestration SHGC (Windows)
0.25
23
Required Fenestration SHGC (Windows)
0.25
24
Is the Proposed Fenestration SHGC <_ the Required Fenestration SHGC?
W Yes
❑ No
25
Proposed Fenestration U -factor (Skylights)
N/A
26
Required Fenestration LI -factor (Skylights)
N/A
27
Is the proposed Fenestration U -factor <_ the Required Fenestration U -factor?
❑ Yes
❑ No
28
Proposed Fenestration SHGC
N/A
29
Required Fenestration SHGC
N/A
30
Is the Proposed Fenestration SHGC <_ the Required Fenestration SHGC?
❑ Yes
❑ No
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
<• STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CFIR-ALT-05-E (Revised 04116) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification (� (Page 6 of 8)
Project Name: Kobussen Renovation Date Prepared: 3/9/2017
G. Space Conditioning (SC) Systems — Heating/Cooling (Prescriptive Section 150.2(b))
Alterations to Space Conditioning Systems shall be exempt from HERS verification requirements as prerequisite for use of the CF1R-ALT-05 and CF2R- ALT -05 Compliance Documents. If new space
conditioning systems are installed or existing systems are altered and are not exempt from HERS verification, then a CFI1R-ALT-01 shall be completed and registered with a HERS Provider Data
Registry. In each row below for each dwelling unit in the building, check the box that indicates the exemption from HERS verification compliance:
® a: space conditioning system was not altered;
❑ b: less than 40 ft of ducts were added or replaced;
❑ c: (exempt from duct leakage testing) if: the existing duct system was insulated with asbestos;
❑ d: (exempt from duct leakage testing) if: the existing duct system was previously tested and passed by a HERS Rater.
01
02
03
04
Dwelling Unit Name
SC System Identification or Name
SC System Location or Area Served
Exemption from HERS Verification
N/A
N/A
N/A
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 ❑d.
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 11
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
to
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEG-CFIR-ALT-05-E (Revised 04/15) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF111-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification (Page 7 of 8)
Project Name: Kobussen Renovation Date Prepared: 3/9/2017
H. Water Heating Systems (Section 150.2(b)1G)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
Dwelling Unit
Name
Water Heating
System
Identification or
Name
Water Heating
System Location
or Area Served
Water
Heating
System
Type
Water
Heater
Type
q of
Water
Heaters
in System
Water
Heater
Storage
Volume
(gal).
fuel Type
Rated
Input
Type
Rated
Input
Value
Heating
Efficiency
Type
Heating
Efficiency
Value
Standby
Loss _
W
Exterior
Insulation
R -Value
Back -Up
Solar
Savings
Fraction
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
f
CEC-CFIR-ALT-05-E Revised 04/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification (Page 8 of 8)
Project Name: Kobussen Renovation Date Prepared: 3/9/2017
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Stephen R. Nieto
Documentation Author Signature:
Company: South West Concepts Inc.
Signature Date:
Address: 78115 Calle Estado Suite 105
CEA/ HERS Certification Identification (if applicable):
City/State/Zip: La Quinta, CA 92253
Phone: (760)564-4707
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible
designer).
3. That the energy features and performance specifications, materials, components, and manufactured devices 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.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
S. I will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency
for all applicable inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building
owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
Stephen R. Nieto
Company: South West Concepts Inc.
Date Signed:
Address:
78115 Calle Estado Suite 105
License:
City/State/Zip:
Phone:
La Quinta, CA 92253
(760)5644707
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016