BRES2019-029778-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
TONI CIAURI BLACKMAN
79364 CALLE VISTA VERDE
LA QUINTA, CA 92253
c&ht °i �wc2uLN*w
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BUILDING RESIDENTIAL/ADDITION
BRES2019-0297
79364 CALLE VISTA VERDE
604392033
BLACKMAN / INTERIOR REMODEL
$7,800.00 D Zk 0 1
P
NOV 0 4 2019
CITY OF LA QUINTA
DESIGN & DEVELOPMENT DEPARTMENT
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.:
Date:
Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any
structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the
all e exemption. Any violation of Section 7D31.5 by any applicant for a permit
u the applicant to a civil penalty of not more than five hundred dollars ($500).:
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
d not build or improve for the purpose of sale.).
Mj , 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 proper[ who builds or improves thereon,
and who contracts for the projects with a contra or ] licensed pursuant to the
Contractors' State License Law.).
(_) I am exempt under Sec. B.&P.C. f r th' reams
Da
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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/4/2019
Owner:
TONI CIAURI BLACKMAN
79364 CALLE VISTA VERDE
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER - TONI CIAURI BLACKMAN
Llc. No.:
WORKER'S COMPENSATION DECLARATION
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:
CasePolicy Number:
rtify 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 ome subject to the
workers' compensation provisions of Section 3700 of the b Code, I shall forthwith
comply wit thus provisions.
Date: I Applicant: C"Ale�a��
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.
certify that I have read this application and state that the above'rnfor ation is correct.
I agree to comply with all city and county ordinances and state laws a ling to building
construction, and hereby authorize representatives of this city to t upon Bove•
mentione Property for inspection purposes,
[�
Date: �, � Signature (Applicant or Agent):
11/4/2019
Application Number:
BRES2019-0297
Property Address:
79364 CALLE VISTA VERDE
APN:
604392033
Application Description
BLACKMAN / INTERIOR REMODEL
Property Zoning:
Application Valuation:
$7,800.00
Applicant:
TONI CIAURI BLACKMAN
79364 CALLE VISTA VERDE
LA QUINTA, CA 92253
Owner:
TONI CIAURI BLACKMAN
79364 CALLE VISTA VERDE
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER - TONI CIAURI BLACKMAN
Llc. No.:
Detail: 1500SF INTERIOR REMODEL AT KITCHEN AND MASTER BATH [RODRIGUEZ-FERNANDEZ ENGINEERING]. THIS INCLUDES FENESTRATION AT
KITCHEN, DINING, AND FRONT ENRTY WITH PLUMBING, MECHANICAL AND ELECTRICAL AT THESE LOCATIONS. THIS PERMIT DOES NOT INCLUDE
MODIFICATIONS TO OTHER PORTIONS OF THE DWELLING, OR WATER HEATER OR HVAC CHANGEOUT. 2016 CALIFORNIA BUILDING CODES.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
CITY
AMOUNT
101-0000-42600
($125.00)
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HOURLY CHARGE - CITY BUILDING STAFF
101-0000-42600
0.5
$80.50
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HOURLY CHARGE - INTERWEST STRUCTURAL PLAN REVIEW
101-0000-42600
0
$125.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HOURLY CHARGE - INTERWEST STRUCTURAL PLAN REVIEW
101-0000-42600
0.5
$62.50
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HOURLY CHARGE - INTERWEST STRUCTURAL PLAN REVIEW
101-0000-42600
1
$125.00
Total Paid for BLDG CITY STAFF - PER HOUR: $268.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$26.68
Total Paid for ELECTRICAL: $53.36
DESCRIPTION
ACCOUNT
QTY
AMOUNT
EXHAUST HOOD
101-0000-42402
0
$13.34
DESCRIPTION
ACCOUNT
CITY
AMOUNT
EXHAUST HOOD PC
101-0000-42600
0
$5.34
DESCRIPTION
ACCOUNT
CITY
AMOUNT
VENT FAN
101-0000-42402
0
$13.34
DESCRIPTION
ACCOUNT
CITY
AMOUNT
VENT FAN PC
101-0000-42600
0
$5.34
Total Paid for MECHANICAL: $37.36
DESCRIPTION
ACCOUNT QTY
AMOUNT
PLAN CHECK DEPOSIT - ADDITION/REMODEL
101-0000-42600 1
$125.00
Total Paid for PLAN CHECK DEPOSIT - ADDITION/REMODEL: $125.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$66.70
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$66.70
DESCRIPTION
ACCOUNT
CITY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$13.34
DESCRIPTION
ACCOUNT
CITY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600 1
0
$26.68
Total Paid for PLUMBING FEES: $173.42
DESCRIPTION
ACCOUNT
CITY
Arvn)UNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$72.03
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$57.63
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, FIRST 100 SF
101-0000-42400
0
$54.43
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$148.89
Total Paid for REMODEL: $332.98
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$1.01
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $1.01
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DOOR/WINDOW, NEW/ALT, FIRST 1
101-0000-42400
0
$106.73
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DOOR/WINDOW, NEW/ALT, FIRST 1 PC
101-0000-42600
0
$121.67
Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $228.40
T44f 44 axfa
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760)777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT. NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building p rmit has been submitted in fp r ame listing yourself as the builder of the property
improvements specified at t n* r S � af� C utjL'
We are providing you with an Owner -Builder Acknowledgment and Information Veri rcation Form to make you a- are o y
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.
ILI
Read and initial each statement below to signify you understand or verify this information.
I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
but ding permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
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 roperty.
AZ. I understand building permits are not required to be signed by property owners unless they are responsible for the
coptrupf ion and are not hiring a licensed Contractor to assume this responsibility.
Pysel
I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
f 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
permits nd contracts.
I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
u r tate and federal law.
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
ri k.
7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
ructures 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.
4, understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
wor nship or materials.
9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
ervice, 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-
800-3 1-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
legally —- financially respogsiJ ler for, propgped constructions activity at the following address:
L I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
�ie laws and requirements that govern Owner -Builders as well 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
e 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, thi rm must be completed and signed by the property owner and returned to
the agency responsible for issuing the per, u• . Note: A copy of the property owner's driver's license, form notarization, or
other verification acceptable to the age c is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner ate: 7 1 a aL q
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. '' __rr, (� r
Scope of Construction Project (or Description of Work): dew kl �c.ke dl--d�jg C chl -', fewo�j -j
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
I declare under penalty of perjury that I am
information and certify its accuracy. Note:
acceptable to the agency is required to b/
Property Owner's Signature:
2 tecF►7 -c�q L,
=S3a�
Oerty owner for the address listed above and I personally filled out the above
of the owner's driver's license, form notarization, or other verification
rd when the permit is issued to verify the property oivner's signature.
ta
CALIFORNIA Qwkra
PERMIT# 1JeCS2(-)i"[ — 02-q-7
PLAN LOCATION:
Project Address:
Project Description: Ex. Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
1pew
Applicant Name:
Address:
�) G 4AQ6Le D U-T
City, ST, Zip: (34
?
Telephone:
Email:
Valuation of Project $
Contractor Name: —
New SFD Construction:
Address:
2 7 5-
Conditioned Space SF
City, St, Zip/
a 211 AJ
Garage SF
Telephone:
L7&0 e ?—
53 ��
Patio/Porch SF
Email:
/Y
l
Fire Sprinklers SF
State Lie: City Bus Lie:
f1
Arch/Eng Name:
Construction Type: Occupancy:.
Grading:
g
Address:
City, St, Zip
Telephone:
Bedrooms:
Stories:
# Units:
Email:
State Lie: City Bus Lie:
Property Owner's Name: (�
New Commercial / Tenant Improvements:
Address: 72-3a9cCQ`lL g(s
Total Building SF
City, ST, Zip
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO LA QUINTA, CA 92253 (760)777-7125
W W W . LAQU I NTACA. GOV
CII MI RIM MI]ILM
#
Submittal I
Req'd
Rec'd
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
Soils Report
Grading Plan (PM10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CF1R-A_T-05-E (Rewsed 07117)
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
Pmle Ct Name: ---i � . e _ . — — _ . — _
This compliance document is only applicable to
with a HERS Provider Data Registry.
ns that do not require HERS verification for compliance. When HERS
WM SION
M.
CF1R-ALT-05-E
Page 1 of 4
Z
a CFIR-ALT- 01 shall first be
Alterations to Space Conditioning Systems that ore exempt from HERS verification requirements may use the CF1R-ALT-05 and CF2R- ALT-05 Compliance Documents. Possible exemptions from duct
leakage testing include: less than 4Oft of ducts were added or replaced,• or the existing duct system was insulated with asbestos, • or the existing duct system was previcusly tested and passed by a
HERS Rater. If space conditioning systems are altered and are not exemptfrom HERS verification, then a CF1R 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 2.5pounds 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 CFI R-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 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
7
01 Project Name: ` A „ , ^ 02 Date Prepared:
V✓11�tJ /5/ 1
03 Project Location: / ml 04 Building Front Orientation (deg or cardinal):
(.p Q
05 CA City: \ 06 Number of Altered Dwelling Units:
07 Zip Code: L✓ 08 Fuel Type:
J t^
09 Climate Zone: 10 Total Condition id F€ or' pt a t
I F s I G D! ISION
11 Building Type: C� O 12 Slab Area (ftZ) REvI ENED FOR
13 Project Scope (Select all that apply):
� L1� AJ
❑ B. Insulation ❑ D. & E. Fenestration/Glazing - ADD ❑ G. Space Conditioning System (Heating, Cooling, Duct system � ❑ Lighting
' T= BY
❑ C. Roof Replacement ❑✓ D. & F. Fenestration/Glazing - REPLACE ❑ H. Water Heating System ❑ Include Mandatory Measures?
7 3 C--� V'�5�14 L16
CA Buif i.- � _ C'111_T�
Energy Efficiency Standards 2016 Residential Compliance July 2017
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CF1R-ALT-05-E Mevised 07/17)
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
Pwject Name'
D. Fenestration/Glazing Allowed Are;
01 02
Maximum
Allowed
Fenestration
Alteration for All
Type Orientations (f
and Efficiencies (Section 150.2(b)1)
03 04
Maximum Existing
Allowed Fenestration Exi
West -Facing for All West
Fenestration Orientations Fenes
Area Only (ftz) (ftz) Are
05
06
CALIFORNIA ENERGY COMMISSION
CF1R-ALT-05-E
Page 2 of 4
ar Date Preped"
sting Maximum Maximum Maximum Maximum
Facing Allowed Allowed Allowed Allowed
tration U-Factor U-Factor SHGC SHGC
a (ftz) (Windows) (Skylights) (Windows) _ (Skylights)
07
F. Fenestration/Glazing Proposed Areas and Efficiencies - Replace (Section 150.2(b)113)
01 02 03 04 05 06 07 08 09 10 11 12 13 14
Area Area Net Combined
Fenestration Dynamic Orientation Removed Added Added Exterior SHGC from
Tag/ID Type Frame Type Glazing (N, S, W, E) (ftz) (ftz) Area (ftz) U-factor Source SHGC Source Shading Device CF1R-ENV-03
W ° 1
C1 Ue, M II ' °
VA'
V` [uaj
VCA d °
0
0
Add,Row Delete Row
CA Building Energy Efficiency Standards - 20116 Residential Compliance July 2017
07
F. Fenestration/Glazing Proposed Areas and Efficiencies - Replace (Section 150.2(b)113)
01 02 03 04 05 06 07 08 09 10 11 12 13 14
Area Area Net Combined
Fenestration Dynamic Orientation Removed Added Added Exterior SHGC from
Tag/ID Type Frame Type Glazing (N, S, W, E) (ftz) (ftz) Area (ftz) U-factor Source SHGC Source Shading Device CF1R-ENV-03
W ° 1
C1 Ue, M II ' °
VA'
V` [uaj
VCA d °
0
0
Add,Row Delete Row
CA Building Energy Efficiency Standards - 20116 Residential Compliance July 2017
CA Building Energy Efficiency Standards - 20116 Residential Compliance July 2017
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CFIR-ALT-05-E (Revised 04/15) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-05-E
Prescriptive Residential Alters ions hat Do Not Require HERS Field Verification Page 2 of 3
Prolett Mime- pate Prepared;
2P �' iL [ f
r E31�C4
E. Fenestration Proposed Areas and Efficienct s - Add (Section 150.2(b)1A)
01 02 03 04 05 06 07 08 09 10 11 12 13 14
Proposed
I Proposed West Facing
Combined
Fenestration Dynamic Orientation Number Fenestration Fenestration Proposed Proposed Exterior SHGC from
Tag/ID Type Frame Type Glazing (N, S, W, E) of Panes Area (ftz) Area (ftz) U-factor Source SHGC Source Shading Device CFIR-ENV-03
F j'I
r' txJ
Add Row Delete Row
15 Total Proposed Fenestration Area
16 Maximum Allowed Fenestration Area
17 Compliance Statement
18 Total Proposed West -Facing Fenestration Area
19 Maximum Allowed West -Facing Fenestration Area
20 Compliance Statement
21 Proposed Fenestration U-factor (Windows)
22 Required Fenestration U-factor (Windows)
23 Compliance Statement
24 Proposed Fenestration SHGC (Windows)
25 Required Fenestration SHGC (Windows)
26 Compliance Statement
27 Proposed Fenestration U-factor (Skylights)
28 Required Fenestration U-factor (Skylights)
29 Compliance Statement
30 Proposed Fenestration SHGC (Skylights)
31 Required Fenestration SHGC (Skylights)
32 Compliance Statement
a
I Proposed Fenestration Area <_ Maximum Allowed Fenestration Area
otal Proposed West -Facing Fenestration Area <_ Maximum Allowed West -Facing Fenestration Area
Proposed Fenestration U-factor <_ Required Fenestration U-factor
Proposed Fenestration SHGC <_ Required Fenestration SHGC
Proposed Fenestration U-factor <_ Required Fenestration U-factor
Proposed Fenestration SHGC <_ Required Fenestration SHGC
r Yes r No
r Yes r No
r Yes r No
C Yes r No
C Yes r No
r Yes r 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 07/17
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
Pmjr[r iYartq: 7 Ic w f _ 1
llld L/ I 1 �Ta :'IQ i '—, L {
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
I. I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Auth Name: Documen
Company:
{
/fZ ,4201
Identification (If applicable]:
r � �
CALIF
COMMISSION
CFIR-ALT-05-E
Page 4 of 4
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 pe rmance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of
Compliance conform to the r uire nts of Title 24, Part 1 and Part 6 of the California Code of Regulations.
4. The building design feature or syste design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,
worksheets, calculations, lans and pecifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a regis . red cap f this Ce ca 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 inspe ions. I derstandstered cp�y of this Certificate of Compliance is required to be included with the documentation the builder provides to the building
�ier at occupancy. �� X�
ny
re557
nse:
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CA Building Energy Efficiency Standards - 2016 Residential Compliance July 2017
STATE OF CALIFORNIA
Prescriptive Residential Alterations
CE C-C F 1 R-ALT-05-E (Revised 0717 7}
CERTIFICATE OF COMPLIANCE
That Do Not Require HERS Field Verification
Prescriptive Residential Alterations That Do Not Require HERS Field Verificat
Prp7e[t 7ti m2: _ _
15
Net Added West -facing Fenestration Area
16
Is Net Added Fenestration Area <_ for west -facing fenestration?
r Yes ir` No
17
Net Added Fenestration Area (all orientations)
18
Is Net Added Fenestration Area <_ 0 for all orientations?
r Yes r No
19
Proposed Fenestration U-factor (Windows)
20
Required Fenestration U-factor (Windows)
21
Is the proposed Fenestration U-factor <_ the Required Fenestration U-factor?
C Yes r No
22
Proposed Fenestration SHGC (Windows)
23
Required Fenestration SHGC (Windows)
24
Is the Proposed Fenestration SHGC <_ the Required Fenestration SHGC?
C Yes r No
25
Proposed Fenestration U-factor (Skylights)
26
Required Fenestration U-factor (Skylights)
27
Is the proposed Fenestration U-factor <_ the Required Fenestration U-factor?
r Yes r No
28
Proposed Fenestration SHGC
29
Required Fenestration SHGC
30
Is the Proposed Fenestration SHGC <_ the Required Fenestration SHGC?
r Yes r No
NIA ENERGY
,MMISSION
CF 1 R-ALT-05-E
Page 3 of 4
July 2017
CA Buifdir�; Energy Efficiency Standards - 2016 Residential Compliance
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