002091 (SFD)Building 79-940
Address
Owner
Jbe sir
Mailing
Address
City Zip �
Contractor
owl=.
Address
>
City` Zip
State Lic.
& Classif.
Arch., Engr.,
Designer -
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S_ DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full•force and
effect.
SIGNATURE DATE
•4
Q2144
P.O. BOX 1504 N o .
78-105 CALLE ESTADO 00209,1
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 617-121=046
Tel.
Legal Description Lot 26
Project Description.!3.
Tel..
City = 1824
Lic. # Sq. Ft. 62 No. No. Dw.
Size • -• Stories Units
I New Add ❑
0 ER DECLARATION
I hereby affirm that I am exemptpt from from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit. to construct, after, improve, demolish, or repair, any structure, prior to its issuance also
requires the applicant for such permit to file•a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with'Section 7000) of
' Division 3 of the Business and Professions' Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
' subjects the applicant to a civil'penalty of not more than five hundred dollars ($500).
• O I, as owner of the property, or my employees with wages as their sole compensation, will
r do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and.
Code: The Contractor's License Law does not apply to an owner of property, who
Estimated Valuation
- PERMIT
'
Plan Chk. Dep:
. Plan Chk. Bal.'
Const.
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for,safe. If, however, the building
Mech. .
Electrical
or improvement is sold within one year of completion, the owner -builder will'have the burden
of proving that he did.rlot build or improve for the purpose of sale.) ._
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License -Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
' such projects with a contractor(s) licensed pursuant to the Contractor's: License Law.) -
❑ 1 am exempt.under Sec. B. & P.C. for this reason
S. M. I.
Grading
Driveway Enc.
Y:~' `'"
Date Owner _- G''t_� Iso `�%'-x'._r, _
Infrastructure
yy
UZ��TT�
WORKERS' COMPENSATION DECLARATION
thereby affirm that'I have a certificate of consent to self•insure,'or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
'
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
-
(This section need not be completed if the pe:mit is for one hundred dollars ($100) valuation
or less.) - - - -
I certify that in the performance of thg work for which this permit is issued,•I shall not
employ any person in any manner so as to become subject'to the Workers' Compensation'
Laws of California.
Alter ❑ Repair ❑ Demolition ❑
94, 314 .00' - .
AMOUNT
250.00
106.45
37.00
100.32
93.00
6.62
20.00
1t414.71 ��!! X27. X00
2x531.74 1 43 s 4
a e Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become • ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days: ���$
I certify that I have read this application and stale that the above information is correct. Issued by: _ Date Permit
I agree to comply with all city and county ordinances and state laws relating 'to building
construction, and herebyauthorizerepresentatives-sof this city to enter the above•.
mentioned property for inspection purposes. 3f �" �I
Signature of applicant�iValidated by:
C. "` Date' �?!'�
Mailing Address % � Validation:
City, State, Zip '
A4464 2 28 2581,74 R
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. .@_ $
2ND FL. SO. FT.
POR. SO. FT. p
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK -
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
_ SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR'® 3/ac
HOUSE SEWER
FRAMING ��
// FINAL INSP. /I t
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
.SETBACK
AGROUND PLUMBINqja�
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
CROUGH PLUMB A/
BONDING
HEATING (ROUGH)
STORAGE TANK
F' ( FORM Gam/
SEWER OR SEPTIC TANK
/�f- ROUGH WIRING `�
r1
DUCT WORK
ROCK STORAGE
.FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL6iAS
(FINAL):% L/
'(JfEMP. POLE
!/
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
/A���/
// rE1NAL INSP.
rr�s--
FRAMING ��
// FINAL INSP. /I t
L�L ROOFING Cl/
, 7
L 01/ q/ G6
0
�� fG
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
&THING (S!
MESH
INSULATIONISOUND
V
FINISH GRADING
FINAL INSPECTION 0q,6
lJ
CERT. OCC.
FENCE FINAL -
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL
0,a/,16EP
TWyl 4 4 "
P.O. BOX 1504 APPLICATION ONLY
BuildingJ L� ` 78-105 CALLE ESTADO
Address i fl i r E. P hrv0 LA QUINTA, CALIFORNIA 92253
Mailing
Address
CityZip
,
Contractor
ress
el..
State Lic. City
& Classif. I Lic. #
Arcn., tngr.,
Designer
Address I Tel.
BUILDING: TYPE CONST..-7��OCC. GRP..
A.P. Number / / _ � - /� -(� 7J(O
Legal Description_ � k n-1 r --
Project Description 1�r
. 1
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
�GNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, Improve, demolish, or repair any structure, prior to its Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bulsness and
Professions Code: The Contractor's Ucense Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such Improvements are not intended or offered. for sale. If, however, the building
or Improvement is sold within one year of completion,, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)_` -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's Ucense Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's Ucense Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -Insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's 'Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
1 car lfy that I have read this application and state that the above information is correct.
I agree to.comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant _ -Date-
.Mailing
ate.Mailing Address
City, State, Zip
BUILDING DIVISION
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation t
Lt
00
PERMIT " AMOUNT
n •\
Plan Chk. Dep.
fj r7
Plan Chk. Bal. S 1.S94
Flo . 44�
L 0 6 'A -S
Const.
y 6 g i —
Mech.
Electrical
Plumbing
3`•�
S.M.I.
Grading
Driveway Enc.
O r
Infrastructure
-1
t e
�'Z V; let-
CD
TOTAL
,J,
, V� -'
REMARKS
t Z } r2 Zf
`, ,, / t -fl
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 19 Ic1?tl11 Permit
I '
Validated by:
Validation:
A 3 7 9 9 1 9
25Q00 CK
CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. $'2 SQ. FT. @$ 6-5'446' 1.0
UNITS
ROUGH PLUMB.
�►Lt
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
YARD SPKLR SYSTEM
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
MOBILEHOME SVC.
HEATING (FINAL)
BAR SINK
REINF. STEEL
POR. SQ. FT. @
TEMP. POLE
GROUT
WATER HEATER
7
GAR. SQ. FT. @
AJCLLt
POWER OUTLET
BOND BEAM
ROOF DRAINS
CAR P. SO. FT. @
_$
LUMBER GR.
DRAINAGE PIPING
FRAMING
WALL SQ. FT. @
ROOFING
DRINKING FOUNTAIN
SQ. FT. @
VENTILATION
URINAL
ESTIMATED CONSTRUCTION VALUATION $
QQ
WATER PIPING
NOTE: Not to be used as property tax valuation
SPARK ARRESTOR
FLOOR DRAIN
MECHANICAL FEES
LATHING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
INSULATION/SOUND
APPLIANCE DRYER
FINISH GRADING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSPECTION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FENCE FINAL
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.TEMP
USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
'�
AMPERES SERV ENT
24z_
SHOWER
BOILER B.T.U.
SQ. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
GAS PIPING
�.
PERMIT FEE
(Ej �.
PERMIT FEE
` .
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEE
CONST. FEE
ELECT. FEE
SMI FEE
PLUMB. FEE
3 7, ad
100.3
1 `13
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL
06%fIED
o C' o
r
-0
H BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS to
PALM DESERT a
d' LA OUINTA
110 INDIO y�
Feb. 28, 1986
Desert Sands Unihied School District
82-879 HIGHWAY 11 1 • INDIO, CALIFORNIA 92201-5678 • (619) 347.8631
City of La Quinta
Department of Community Development
78-105 Calle Estado
La Qui'nta, CA 92253
Re: Lot 26, Tract 2180 La Quinta
Gentlemen:.
The developer of the above referenced Lot 26, Tract 2180
La Quinta
has mitigated its impacts on our overcrowded schools by payment
of the amount of $628 per unit to be applied to the cost of
district educational facilities made necessary by such new
development.
Sincerely,
-'� 1. V'j j..
John D. Brooks
Assistant Superintendent
Business Services
JDB/crm
COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH
PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM
Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the
attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be
made payable to County of Riverside.
Name fMailing
Address
Cit State
Zip Code
Phone
'Property Address Cit o 6emmvrs4y—
/�
'Legal Description of Property (Lot, Parcel Map, Tract)
#_QG -c'
2S�SH�� /20_6-10 /�Ll�
02- 7'k'4e T Lei J
'Assessors Parcel No. Water Se ving Property From
Lot size ,
Signal ur of Applicant • Date
'The above information must be verified from Building Application
Staff Use _ Do Not Write Below This Line
Ini1:`a Date /
`-�—�"
WQCB Clearance required Yes ❑ No •
Soils feasibility report required 'Yes ❑ Noffl
Detailed boring report required Yes ❑ No
Detailed contour plot required Yes ❑ No,
Comments: _
Soils or boring report by Date
Approved by
C% r
' �'
Soils Map PageSoil Type Tract File No. Other
Number of Bedrgoms
Z �� 13.�T11 .►wk
Se tic Tank Size (gallons),_ Rate
, �
l
Type of System
New ddition Replacement
7
0 El
Leach lineftof bottme trench / L �� Leae'K bed (sq.,ff f bottom area bed)
s01'
Z 60 u/. �i' 6 7'c - 1,)// 20 1-e L/.✓�
Seepage Pit Diameter �
Number of Pits Seepage�PitDept
Total Depth of Pit
Location of System� A10/
L�
Addition equirements / y,_ r. /OX - A: LOA`
d vl t y�' `� IYt-�s ''G C- /i.C' G Gt %C�� d
A permit ia2pprovedldefiiedforthe design of a subsurface disposal stem as indicated on the accompanied plot p
using the re ements set forth in Section B above. A building permit is necessary for the installation of the above
d7sii,l ed
ystem.i. /
�[%� ao�
�,l..�.�`�
Signature of Health Official ,/ Date. 2 _d�
I le-
147�)�1sT
District: Riverside ❑ Indio Hemet
DISTRIBUTION: WHITE - bffice File YELLOW - Applicant
3+:. d
Issued By
Date
PINK - Building Deet GOLDENROD - Fc—in- F -L.
"IS
COUNTY OF RIVERSIDE, DEPARTMENT OF HEALTH
PERMIT APPLICATION FOR A SUBSURFACE .DISPOSAL SYSTEM
Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the
attached check list. A non refundable filing fee of $15 is required when the application is submitted. Check must be
made payable to County of Riverside.
Name /[
v/. 'ST�ly�
Mailing Address
CityState
Zip Code
Phone
'Property Address
'Cit o 6rriy-
'Legal Description of Property (Lot, Parcel Map, Tract)
.
-�Q
2SFs Aeq
4 00I&A
4D/ 6 7i�AeT ,21/ct0
'Assessors Parcel No.
o
Water Se ving Property From
e al)�n-
Lot size
�T
is God
Signatur of Applicant Date r
'The above information must be verified from Building Application
Staff Use — Do Not Write Below This Line
Initi� Date
�WQCB
Clearance required Yes ❑ No
Soils feasibility report required Yes ❑ No
Detailed boring report required Yes ❑ No
Detailed contour plot required Yes ❑ Noffl
Comments:
Soils or boring report by. Date
Approved by Date
Soils Map Page Soil Type Tract File No. Other
Number of Bedrooms
3B 0/2Mr Z - 13d7XI mAv
Septic Tank Size (gallons)
�D �D
Rate Required
/ ��l
Type of System
New__,Addition Rep lace ent
a L/UAn�
1-1❑
Leach line sq. ft. of bottom area trench
Lea& bed (sq. fr4f bottom area bed)
Seepage Pit Diameter/
6 Mll-_
Number of Pits
Seepage�Pit Depth B.I.
/!/
Total Depth ofPit
Location of System
Additio V11
ex /" V, Q-Lp�
A permit i pprove d -for the design of a subsurface disposal stem as indicate on the accompanied plot plan
using the req,a:i*rements set forth in Section B above. building permit is necessary for the installation of the above
desi nedystem.
Signature of Health Official /. ' Date -
Receipt No. 7Vc2 Issued By
District: Riverside ❑ Indio Hemet ❑ Date
DISTRIBUTION: WHITE - Office File YELLOW - Applicant PINK - Building Dept. GOLDENROD - Pending File
DOH SAN 122 (Rev 10/84)
78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
December 31, 1986
To Whom It May Concern:
The dwelling at 79-940 Horseshoe Road was finaled:-by the,:
City of La Quinta on September 9, 1986.
W8JUMIRMIJ i i•
prinvaignes•� ••
Tom Hartung
Building Official
TH:psn
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
PROJECT DATA SUMMARY
®r
project
�\(\ '•�;�' y� �
.-
_
the Cl:C(I ny
system type
rl.nn
• - documentation author date
now
�
SITE INFORMATION
Heating Degree Day from Appendix C)
Z
f
..........................................................
HDD
1
F. day
Outside Design Temperature (from Appendix C or Appendix G)......................
Tow
2 � �
OF
PROPOSED BUILDING ENVELOPE INFORMATION
Gross
' Q
1 Floor Area if Low•Risa (from Calculations)............................................
At
3 t>i
ft2
Gross Wall Area if High-Rise (from Calculations)............................................
A,,,
4
f12
Designed Glazing Area (from Calculations).........'..............................................
Ag
5 �f
ft2
Basic Glazing Area (16% of Line 3if low-rise or 40%of Line4 if high-rise) ........
Abg
6
ft2
Description of Assembly
Glazing /1t b
Ugl
�9
7
Btu/ (hr •ft2•OF)
! ni c.,, L A3� W._,
u
U92
8 I l 3
'
Btu/ (hr-ft2•OF)
`Ug3
Wall Siy<<__i 2� \ _T-)�, 6,1A t
9 C
O Fj' Lo
Btu/ (hr. ft2 •°F)
Uwl
10 ` 7
Btu/ (hr ft2 -OF)
Uw2 -
11
Btu/ (hr-ft2-°F)
Uw3
12
Btu/ (hr - ft2 •°F)
Ceiling/Roof T` ��i7L7..JJQo, \
Uw4
Ucl
13
14
Btu/ (hr.ft2•°F)
Btu/ (hr •ft2 -OF)
( ) A
Uc2
15 . D3 OD
Btu/ (hr-ft2-°F)
Floor
Ufl
16
Btu/ (hr•f12•°F)
Uf2
17
Btu/ (hr - ft2 •OF)
l�.
PROPOSED SPACE HEATING SYSTEM (Chapter 7)
Gas Furnace
f Building Design Hourly Heat Loss (from Form 2)............ :....... ..................
qn
lb _. 3 �_�2-1 —
Btu/hr
� Maximum Allowed Bonnet Capacity, 7'.5_x Line 18....................................
..
'........
19 � �
�
B:.0/hr
I Proposed Furnace
Make
Model Description 3 5 o C) O
Rated Bonnet Capacity a O J J
Electric Resistance Alone
Electric Resistance Life Cycle Cost (from Form 5)....................................
sLCC,
20
$ `
ILowest Life Cycle Cost of the Other Systems (from Form 5)...................
,LCClo,,,,21
!
$
Non- Depletable Energy w/Electric Resistance Back-Up
Percentage of Annual Heat Loss Met by Non-Depletable Energy
Source (from Calculations).....................................................:..........................
22
11 Heat Pump with Electric Resistance Supplementary Heat
Percentage of Annual Heat Loss Met by Electric Resistance
!
(from Calculations)............................................................................................
23
%
PROPOSED WATER HEATING SYSTEM INFORMATION (Chapter 8)
Elactiic Resistance Alone
{[
Electric Resistance Life Cycle Cost (from Form 6).................................
,LCC,
24
$ ;
Lowest Life Cycle Cost of the Other Systems (from Form 6)...................
wLCClOwest 25
$
PROPOSED SWIMMING POOL HEATING SYSTEM INFORMATION (Chapter
1
9)
Solar Life Cycle Cost (from Form 7).................................:...........................:
p�CCs
26
$
Natural Gas Life Cycle Cost (from Form 7)......................................................
LCC
p ng
27
.
A'
$
I
�
r
A1lF ;
it A;
0
I
" + HOURLY AND ANNUAL-
BUILDING
NNUALBUILDING HEAT LOSS RATE m 2
Check Ono: Proposed Do -sign
Standard Design
Enforcement Agency Uso Only
S I_►J�� r�-
J -nor poject
�� �� aw olnp Germrt numper
J 61 'Jy."�
project sys 2m type
*-�., checked Oy
`A,'1) I_;. I 1 J /ani ®�fl
❑ocumontation author Date data
L*3e�rrrnrF^�a�•,+�-.�. - ,,.••.. x•n—..m�.rim.v�ri�..rr+,.z..+=W:.--r.*.nom----r � r�=o-mv.-�++r_q+rm_ wc�r'^..,m--'T•• I
SITE INFORMATION
Heating Oagpea Day (from Appendix) . . . . . . . . . . . . . . . . . HOD �> -F-day
Outside Oesign Temperature (from Appendix) . . . . . . . . . . .. . . . . . Told 1 °F
Outside January Men Temperature (from Appendix)°
PROPOSED BUILDING ENVELOPE INFORMATION
Gross Floor Area (from plans) . .. .. . .... .. .. .... .. .. .. .. . Af ' ft2
Gross Wall Area (from plans) . . . .. .. .... . .. .. . . .. . . . . .. . Aw I , ft2
Designed Glazing Area (from plans) . . . . . .. . . . . . . .. . . . Ag ft2
Basic Glazing Area (16% of Af if low-rise or 40% of A,,,, if high-rise) . . .Abe 7 Q f,2
HOURLY HEAT LOSS
DESIGN TEMPERATURE DIFFERENCE 9
For All Assemblies Other Than The Three Below . ..70'F — 0 . ATh 1 ! of
Tow from above
For Insulated Floor Over Vented Unheated Space .. ....
.. .. Line t =2
-,LThi 2 __::t
_ -F
For Uninsulated Floor Over Vented Unheated Space. . . . .
.. . Lino 2 — 53F
-AThu 3
s pF
For Slab -on Ground Floors . . . . .. . . . . . 70pF —
CONDUCTIVE HEAT LOSS
OmCriptlon of /A�sscmpry
Glazing 1'
Wall � i V «Jl7 �— 1 i _ -> \
e
Ceili,:/Roof
Floor
8
Cther } G1 ink \=-tT
�, ! °F -LTha
Tian from acove
Area, ft2 or
Average U
Or Assgm Cly, n
or F2 from CT
hourly heat
Lengtn, tt
3
r. Graph 4-1 !ram aoovs
x . 57S.1 x
loss, q
IZ
X �� I X
Btu/hr
�Z
Al from
aoove w6ignteo from
Th from
X x
X X
.e,
x 7T77,
a
2 7 4 I�
X X
—�---�t��{--
—�
X X
X t Q` X,
a ?�
DUCT HEAT LOSS iEnter 0 f there
are na ducts) .... . .. .. ........
0.15 x Line 7
•
171 l
volume
Subtotal 5 tw��r
INF ILTRATICN
...... I.t �
== } h= x g:_ itx' ✓ l _ x
F
Sum of the epove q
- 6
Al from
aoove w6ignteo from
Th from
Average Tapia 1-7
Celling Naeignt
Line
Li. 1
2 7 4 I�
Subtotal
7 Rtujr,r
DUCT HEAT LOSS iEnter 0 f there
are na ducts) .... . .. .. ........
0.15 x Line 7
- 8 1 1 L
TOTAL HOURLY HEAT LOSS, q
Z f
- -
L
Ij n ��.�.LL,.t:
ANNUAL HEAT LOSS, OBJ
ayiv:
;<
dtulhr x .x G4hr/dey j
.0fC.;
y,aj L-oss from '
�
tree apove
Lr.e
TaCje 3•d
I..
nine
LA
Gj
rJ
4-
LA
4-
�+ HEAT TRANSFER COEFFICIENT
iI PROPOSED CONSTRUCTION ASSEMBLY Form a�D
� 44
f
r j
Sketch of Construction Assembly
WEIGHT: Ib/ft2
Check one:
Wall _,11.
j Roof
I
Floor
I
i'
I
I
. � I
List of Construction Components R
2.
3.
4.
5.
6.
'7
8.
Inside Surface Air Film
Outside Surface Air Film
„. Total. Resistance Rt
U -Value WRQ. ► • y� 1
cooling
heating
cooling
heating
cooling
heating i
17
cooling
heating
I
.+.-...-
_
HEAT TRANSFER COEFFICIENT
ii PROPOSED CONSTRUCTION ASSEMBLY
orm o�
E
I I,
I.
a jl
List of Construction Components R j
2.
5.
`1 6.
7.
8.
—7
Inside Surface Air Film
Sketch of Construction Assembly
WEIGHT: Ib/ft2
Check one:
Wall _
Roof
Floor
a
Outside Surface Air Film
A... .
Total Resistance Rt
U -Value (14y
cooling
heating
cooling
heating
cooling
heating
c) -111
,(D
cooling
heating
rtrJ+CJlerse'- "" >'r'1'•i.ts;. .. � _. R .... _ .�_ _ _ -_1�_ _ - - �......_.��+.� a �r - .y.�w.-.
BUILDING DESIGN AND EQUIPMENT SUMMARYF®e - 2
page 1 of 2
IAttstL'
Project title climate Zone
Prolect aearess plan cnecx/permit numoer
project owner cneckea by
Cocumentation auenor Cate oa:e
`7
combrtance matnoo iPrewr:=tive or terformance. cescribe) Enforcement Agency Use Only
BUILDING 2`4YEL.r'F;E oeeiGi4
Q
Descriptien of Item Dimensicn
Points
`'�'
Total Floor Area ftp
1. Floor. Slab Perimeter, Type 1 iv'> 1 Q- 4>`J F_ =�' ° Z ft
Type 2
Type 1 T'
F. ft
'7Tri'� �1: '°_—�%'G`—,
Y I
`i
Type 2 c I..� _ ,�� }t
�4.0 E —13 ft:
c/'a=
2 Ceiling: k Type 1 —>J! 1 .., .. ..i;��i 'y 1'. -t _- c ft'
I
Type 2
ftz
!
3. Wall. Type 1 � ., .
_'� i � � � i ft=
I 6
Type 2
f 11
i
4. Glazing: West, Ty. 1 ,j i _ 1 f1arJ��
% 4- ftZ
Type 27�—
- ft,
North, Type t 11- G� L. Ani C lV � % ) -
I
Type 2
(111(, L".
77
East, Type 1 .A IJ
o— ftz
_..
Type 2i.
South, Type D I , A II C.
ftz
Z-gc/ �
1
ft=
Type 2
ft2
Skylight. Type 1—SC
_
C7 ftZ
Type 2
—SC _ ft=
5. Shading Coefficient: West
9 :;;1�I,.i;;,r - t;.c:� ':.t,J.,� 4 f,, 1-) Sc
�
North
I t� < . I'J SC
o
East
/. _ SC
b
South '' _'
'� Z•gS/, •GCS Sc
t
6. Horizontal South Overhang
ft
7. Movable Insulation
_% fit
8. Infiltration Control
S —'-,A '-J
9. Thermal Mass: Type 1 T L,. G, -.� :, _ J
- ; C P�q 2!n fir)
r r TYpe 2
_.r� HL ,^'G ft=
I r
Type 3
�� 1-C 116 ft2
y pe _.� !-II: ; rfC f .
t
Type 5 A6 MC ft= 4�
�. Point Total This Page II
�� =`ice"r,3i•t 1.
' ("r�,; tr_ tom, 1 �1•' /v
1/83 — 420 — CEC
284-66 (2/83)
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'�.Y 'L
SUMMARY
y
F®t'm`
'
page 2 of 2
i
t
- o,aNct utla climate Lane
. t oroicctaocirens
HEATING, VENTILATING, AIR CONDITIONING SYSTEM
Point
10. Heating (fill in information on proposed system)
!
I
I Central Gas Furnace
brand and model numaer
SE
(�
�
1 0 00 0 Btuihr
{ neating capacity
Heat Pump
grana and motel number- ACOP
Btu/hr
nesting capacity at 47 F
Active Solar
CYPe (liquid or air) collector brand and motel number
solar fraction
ft o
collector area collector Orientation collector tilt
- rated fatad slope
• y
-Intercept
Other
Cescriba
11. Cooling (fill in information on proposed system)
Electric Air Conditioner li 4 A Imo, '7 ��?� QC Gf�
� • �
brand ano mocel'number -
_
seasonal EER
-1.—Do ":�
. Btu/hr
ccollnq cacacry at 9-_" F
Electric Heat Pump
Btu/Sr
cooling rioaccty at 95" =-
1
T
Other
' Cescribe
1
•
12. Mechanical Ventilation
,
_ ces.rlbe
DOMESTIC WATER SYSTEM
13. Heating (fill in information on proposed system)
Gas Only i� �M 1� �� �-l`- 7t
Gallons
brand and rnocel number tank size-•'
Heat Pump w/Electric Backup
Gallons
t
i blanc ant mode! number'- ..
..
tank size
E
Active Solar
t
"{ conec:or orand and -model numoer'(aced
'rated slope solar traction
y - Intercept
.
•
fta
l
backup neater type,-brana and mocel'nurrtcer" conector'drea collector
- - '
orientation
Other
r,
- • dezcrioa
Point Total from Page 1
Total Print Score
i
' 1/91 - za - CEC