HomeMy WebLinkAbout882 TOWNE ST - Building Permits�
qTY C;F COS �A MESA
4(,��pMFs'q BI/ILDING DIVISION
>�� 77 FAIR DRNE. COSTA �ESA. CA 92626 • 014) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
� � FOR INSPECTIONS CALL: (714) 754•5626
�'°'� PERMIT NUMBER: B11-00073
PERMIT TYPE B_ROOF2
APN: 42418104
JOB ADDRESS
Vicinity:
Squares: 150
STATUS:
DATE ISSUED:
ISSUED BY:
�882-TOWNE.S.T_CM Suite/Unit:
Valuation
ISSUED
03/09/2071
KJB
$3,000.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF. REPLACE SHEATHING AS NECESSARY. COVER WITH CLASS A 30 YEAR COMP
SHINGLES. APPROX 1500 SQUARE FEET. ROOF PITCH IS 3:12.
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granled until access to dwelling unit(s) is provided for
verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/Inspection Card
OWNER: LOPEZ, YUDI AND VARELA, RAUL
PHONE: 949•205-9798
APPLICANT: LOPEZ, YUDI AND VARELA, RAUL
PHONE: 949-205-9798
CONTRACTOR: OW NER-BUILDER
Address: Unit:
Ciry/State/Zip:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $8325
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
Address: 882 TOWNE ST
City/Stale/Zip: COSTA MESA, CA
Address: 882 TOWNE ST
Cily/Stale/Zip: COSTA MESA, CA
License No.
License No.
PHONE:
License No. 000000
CELL:
PHONE:
PHONE:
Unit:
UniC
TOTAL FEES - $84.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3I7812010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitietl all hours - Sundays and lhe follovnng Federal
New Years Day, Memorial Day, Independence Dav, Labor Dav. Thanksqivinq Dav and Christmas Dav
NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § t, 72-21-92) �
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work musl comply with all applicable codes, and all
required inspections and final approval must be obtained. failure to obtain inspections and final approval will result in the expiration of this permit.
CODEt. INSPECTIONTYPE ORTE INTITIALS COOEf INSPEC➢ONTYPE UAiF IN7771p1S
1676 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final {,������( /�/ 208 Final Plumbing
200 Final Re-Roof � �� /-�4I.Cf'� 210 Final Electncal
1
207 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final BuildingfOctupancy
O
WORKERS' COMPENSATION DECLARATION:
I hereby a(firm untler penalty of perjury one of Ihe following declarations: �
❑ I have antl will mainlain a Certifica[e of consent to Sel(-InSure (or workers'
compensation, as provided for by section 3700 of the Labor Cotle, /or the
peAormance o! the work !or which this permit is issuetl.
❑ I have antl will maintain v.orkers' compensation insurance, as required by
sectbn 3700 0( t�e Labor Code, fa the perfortnance of Ihe work for which Ihis
permit is issuetl. My vrorkers' compensation Insu nc carrier and policy
number are:
Carrier:
(ihs seUbn neetl rot De mmpetetl n f�e permrt is value I one huntlreOCollars (5f00) a less )
Policy Number:
�I certily that in the pedormance of [he work /or which this permit is
�-��sued, I shall not employ any person in any manner so as to become subject
ro the workers' compensation laws of California, and agree that i! I should
become subjecl to the workers' compensation provisions of Section 3700 of
\the Labor Cotle, I shall forthwith comply with these pmvisions/�
l� /�' �� V 1 •
�� AGP�����'S Signalure Dale
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
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATfORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm that I am licensed under provisions of Chapter 9(commencing
wi[h Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force antl eRect.
Lic. # Class #
Convactor's Signawre
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm thal there is a construction lending agency for lhe
performance of lhe v.ork ta wfiich this pertnit is issuetl. (Sec. 3097. Civil Cade�.
Lender's Name:
Lender's Address:
SignaWre Dale
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalry of perjury that I am E%EMP7 FROM THE
CONTRACTORS LICENSE LAW for lhe (ollowing reason (Sec. 7031.5,
Business and Pro(essions Code: Any cily or counry which requires a permit �o
cons[ruct, alter, improve, tlemolish, or repair any strucWre, prior to its
issuance, also requires the appliwnt tor such pertnit lo fle a signed statement
thal he or she is licensed pursuant to the provisions of Ihe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pmtessions Cotle) or that he or she is ezempt theretrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applica tor a permit subjecis the applicant ro a civil penalty of not more than
five ntlretl tlollars (3500).):
I, as ovmer of the property, or my employees wilh wages as their sole
c pensation, WILL DO THE WORK, antl lhe sWCNre is not intentled or
offered (or sale (Sec. 7044, Business and Professions Cotle: The Contrac[ors
License Law does not apply to an owner of property who builds or improves
thereon, antl who does such vrork himself or herself or through his or her own
employees, provided that such improvemems are not intended or offered for
sale. I(, however, ihe building or improvement is soltl within one year of
complelion, the ovmer-builder will have the burden of proving that he or she
did not build or improvelor purpose o( sale.).
❑ I, as owner of the property, am EXCWSIVELY CONTRACTING WITH
LICENSED CON7RAC70RS to constmct the project (Sec. 7044, Business and
Professbns Cotle: The contractors License Law dces not apply ro an ovmer of
propetly who builds or improves thereon, antl who cont2cts for such pmject with
a contractor(s) license pursuaN to the CoN2ctors License Laws.�.
� I am exempt under sec.
Business and Professions Cotle for this reason:
�,��,�� � ,e �
�
Ovmer ID verifed by driver's license. ❑ Ves ❑ No
Dnver's License No. Expires:
Verification o( Ownership by (type of tlocument, i.e. - property lax bill or tleed):
� �IVISION OF INDUS7RIAL SAFETY PERMIT CER7IFICATION:
❑ I hereby certify thal no excavation (rve (5) w more feet in depth inro wfiich a
person is required �o descend, will be made in connection with work authorized
by this pertnit, antl that no building slrucWre, scaffdding, falsevrork, a demolition
or dismantling �hereo(, will be more Ihan Ihiriy-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Trtle 8, Califomia Atlministrative Code).
❑ As owner-builder, I will not employ anyone to do work which vroultl
require a permit from the Division of Industrial Safery, as noted above, unless
such person has a permit to tlo such work from Ihe division.
Applifanl's $ignaWre Date
Division of Industrial Satety Permit Number
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery Cotle requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantiry of hazardous materials equal to or greater lhan a weight of
500 pounds, or a volume o( 55 gallons. or 200 cubic feet o/ compressed gas
at standard remperaWre antl pressure).
2. Does or will the applicant or present or future building occupant need ro fle
a registra[ion form for acutely hazartlous malerials? ❑ Yes ❑ No
(Section 25533 0l the Calilornia Health and Satety Code, wilh some
exceptions, requires regisiration with the Costa Mesa Fire Depahment by
each business which at any one lime has on hand a quantity of acu[ely
hazardous materials equal to or greater than a weight of 500 pountls. or a
volume of 55 gallons, or 200 cubic feet o( compressed gas at slandartl
temperaWre and pressure).
3. Does or vrill !he appliwnt or present or (u�ure building occupant need to
prepare an RMPP (Risk Management and Prevention Program for aately
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safety Code provides that che
Cosia Mesa Fire Department may require the preparatioq certification an0
filing with Ihe Fire Department of an RMPP by businesses which are required
to register awtely hazardous mate�ials wi[h the Fire Department.
4. If an RMPP is presently required, has Section 25534 0( the Cali(ornia
Health and Safery Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fNure building occupant require for
the work which is the subjecl of this application a permit for such constmction
or modifcalion from Ihe SoWh Coast Air Qualiry Management District or from
any other air pollution control district or a9ency? ❑ Yes ❑ No
(Secibn 658502 of the Califomia Govemment Code requires that the requestetl
infortnation be tumished on applications for rron-residential building permits).
6. Will any pan of the facility to be constructed untler Ihis permit be within
7000 (eet from [he outer boundaries of a school? ❑ Yes ❑ No
Q('yes", the facility must meet Ihe requiremen[ o( Sections 25534 and 42303
of the Califomia Health and Safery Cotle).
7. If a permit (rom the South Coast Air Qualiry Management District or other
air pollution control district or agency is required for the work which is the
subjecl of this application, have all of the disclosures prescribetl by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf yes", attach certifcate of compliance from the appropriate airpollution
control oKcer).
CERTIFICATE OF COMPUANCE: I certify that under penalty of perjury the
information given above is correct I agree to comply with all state laws and
city ordinances re9arding Hazardous Matenals and Emissions.
oaie
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I
certify under penalry of perjury tha� I have read this application antl state Nat
the information given is correcL I agree to comply with all state laws and ciry
ordinances relating ro building wnswction, and authorize representatives of
the Ciry ot Costa Mesa lo emer upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
au�horized by this perrpit uniil f_ inal insgaction. �`� r/ )
�!� �/�i� �
SignaWreolLeBalOwner(s) Daie
305]-46 (3/01) AnOlor Aumoraetl ApOLcant
'���`-�'�"' Cit o Costa �1esa �uiCdin 1�ivision
----_� ,, y f g
77 Fair Drive, Costa Mesa, CA 92626
Costa Mesa 714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit#����� r��
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear property Owner:
An application for a building permit has been J�mitted in_�couc name listing ou elf as the builder of the
property improvements specified at �i( �_� 0 W� D �� .
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
�`" 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder" building 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 property.
�2. I understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
�(�3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
�4. I understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
nd tfie total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
6. I understand if I am considered an "employer" under state and federal law, I must register with the state
nd federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
�7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
resid�ntial structures 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 wifhin any cafendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2
�8. I 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 workmanship or materials. • .
iL9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
�10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
that I am the party legally and financially responsible for proposed construction activity at the following address:
�11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
a i e by all applicable 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 have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarization, or other verification accepiable to the agency is required to be
presented when the permit is issued to verify ihe property owner's signature.
Signature of property owner /Jiy�,s�� Date: ��— ��I `�oZ,
�
Note. The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope ot Construction Project (or Description of Work):
Project Lqcation or Address:
Name of Authorized Agent:
Address of Autharized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature:
Date:
3148-30 CALBO Jan 1, 2009 OB Packet fempiate 2 Of 2
of
Xe,sidentiul Alteratinna�
C�imate Zone N
CF-IR-ALT
N of
i �r
� ObaOUe SU�1�aCe llCtuilS Rur the furred purtioned af Mass Wolls see Purrin� Strips Construction Table beloa•. �
Tag/ � Assembly Name + Materiat
ID orTvoe � andSi2e'
No�e: Foi;7urreAassemblies, accaun�ingfor
U E
Stand
cness,
:ing, U-
�ther� factc
vion R-value, see
' F I G � H- � �P - 0�
Values From JA4 Table
Framed Continuous JA4
JA4 Table Caviry Insulation Assembly
Number' R-value� R-Value' Cell Vatueg
�
use rhe Mass m�d
1. For' ing//D indica�c die identi�cation name lhai mntches the building plans'.
3. Indica�e �he Assenabli� Nume w' ,rype: Rooj/Cei[ing, Walls, Floas, S(abs', Craw/ Space, Doors ond e�c..Jndica�e the Frame rype and Size.' For
Wood, Meial. Metal Bui(dingat Mass, enter 3x9, 2x6, or etc... see JA4 jor o�herpossi6le frame typc assemblies.
3. Enter !He (hichness' for masr in inches or Spacine benveen (raming members enter; 1 G"or 24 "OC,- or O�herjor a!l o�her assembl�� descriprion
such as Cnncreic Sandwich Pane(, Spandrel Panel, Logs, Strae� Bale Panel and e1c....
4. Uosed mi Ihe Clinm�e Zone; enter the Stondm'd U-(acior fi�om Table /5/-B, C or D for eacle different assembl�� Name w' Q pe.
5. Emer the Table number Ihai closel�� rea�emGles the praposed assembli�.
6. Lnrer /he R-value �hat is being insm!!ed rn the wal! cavirn or Letween rhe fi�mning; odrerwise, ercter "0 ".
7. En�er ihe Cnminu�us Insida�ian R-vafue fw� the proposed assembl��; olheiwise, euier "0".
b'. Lnier U�e rnw aid co(unm of ihe U fac�or value Gased an Co(umn FTab(e Numher and emer �he Assembly U-jucror in Column J
J. The Propnser! Ase'em6/n U fncior. Column J, n:usi Le equal �o or (ess �han �he Smndard U jacla' in Colunm E lo compl��.
Fm��in � Strips Constniction Table for Mass Walls Onlp
A B C I D l F G H 1 J K L M
Propnsed Yruperties of Masonrl' and Concrete Added Interior or Exterior Insulation
N'alls rrom Referencc . in Rurring Space from Referencc
doint A� �endia Tablc 4.3.5, 4.3.fi. 43.7 .Ininl A iendix 7'able 4.3.13
V �� � � — >, V
u� � p`1 � 4 L %
�• a o g 1- F'o a•.. Final
Assemhly � • j `e 'ry ^ 'u "^'
Muss Numc or JA4 Table .s = � v o � rt F o '� A Q•' u A f155eRlhly
Thickness� "I' r' Num6cr <=` j = w' ° u`. LL 5 � c 4� � C U-faC[oi'6'� Comment
I
I I I
kegia��rutlnn NurnGer: f2egis�raiat Ua�e/Tirrtc: HERS Prnvider:'
2(IOb' Resideifiial Compliunce Forms �lugusr 2(I09
rroject
.. - � ,
-. , i
ROO�ING PRODUCTS (COOL Ii00RS) §I51(n12
Zone
CF-IR-ALT
# o! Stories
Whe�v Ute areu of cr[crior roof surJace tn bc replaced rxceeds iuorc lhan 50°/u ojthe eCisting roojarea, or more lhmi 1,000 j�, �vhichever is
less, (he ne�v roofing area nursi n�eei �lac rooftng produc( "Coo/ Roof'requiremenls oj§I52(bJ1Hi, ]52(bJlHli, or751(b)IHiii.
Check applicuGle alterna�ive or e�ceptian below iJlhe roojaherntion is esempl jrom Ihe roofing produG "Cool XooJ" requiremenla'. No1e: /jany
one of Ihc a6ern�(ives or e.rception belaH� is checked, Ihe Aged Solar Reflecmnce and Thermal Emitmnce reguirements for roofing products in
¢1 /8(iJ ure not applicable. Do no� fl/ �able below.
❑ Cool Roofs Not Required in Clima�e Zones I-12, 14, and 16 with a Low Sloped. Less or 2:12 pitch.
❑Cool Roofs Not Required in Clima�e Zones 1 thmugh 9 and 16 with a Steep-Sloped Roofs (pi[ch grea[er than 2:12) and product unit weight less
Alternatives to §152(b)1Hi and §752(h)Hii, Steep-slope roof (pi�di > 2:12)
b Insulation witl� a lhermal resistance of at Ieast 0.85 hr� °F/B[u or ai least a 3/4 inch aio-space is added to Ihe roof deck
over an attic; or
[J Facisting ducts in Ihe attic are insulated and sealed according to §151(�10; or
[7 ln climate zones 10, ] 2 and 13, with I ft�.of frec ventilation area of attic ventilution for every 150 ft of attic floor area, and
where at least 30 percent of the free ventilation area is within 2 feet venical distance of the roof ridge; or
❑ Building has at least R-30 ceiling insulution; or
❑ Building has radiant bazrier in the attic meeting the requirements o( §151(�2; or
❑ Building has no ducts in Ihe anic; or
d In climate zones 1 Q I 1, 13 and 14, R3 or grea[er roof deck insulation above ven[ed attic.
Exception to §152(b)IHiii, Low-slope roof ( pitcli <_ 2:11)
❑ Building has no ducis in Ihe attic.
C7 Roofing area covered by building integrated; photovoltaic panels end solar thermal panels are exempt from the below Cool Roof criteria.
❑ Roof construclions thai have thermal mass over the roof inembrane with at least 25 Ib/ft is exempt from the below Cool Roof criteria.
te: If no CRRC-1 label is available, Ihis compliance method cannot be used, use [h
Check the a Iicable box below if Exem t from the Roofm Products "Cool Roo!
' RoofSlope ProductWeight
CRRC Prnduct ID Number� < 2:12 > 2:12 < 516/fl2 > Slb/ft�
Performance Appmach to show compliance,
Product Aged Solar Therznal
T e2 ' Reflec[ance3' Emittana
❑4
❑4
OQ
❑4
O°
The CRRC Producl /D NumGer tmi Ge abinined from U�e Cool RoofRaling Council's HatedYrotluc! Ofreciory al �nv�v.cootrool.r.ore/produtls/.seordi ohn
Indicarc �he �ype af prnducl is Leing useAfar d�e roof rop, i.e. eing(e-ply roaJ aap/m(I rooJ, me(al roaf, CIC.
lJiHe Aged Reflec�ance is rm� avuilaGle irzU�c Cool RoofHn�ing Commi/lr Ra�ed Produc� Direcm�y tl+en use �he Ini�ial ReJlecmnce value from �he sanre
direcmp� m�d usc llie equalion (01+OJ(/)�niiial— O.IJ lo obmin n mlcu(aled aged va6re. WGere p is Ihe /nilial So(m' ReJlec�ance.
Check Loa' iflhe Aged HeJleclmrce is n calcu/aled vdue nsing Ihe equatiar above. '
CalmJo�e Ilte SR/ value Lr using Oie SRI- Worksheei n( Inm'//ivw�v enernr.ca.env/lillel4/and emer Ihe restd�ing oalne in ihe SHI CoGunrr above and armch aro
Ide SRI- IYnrks6eei m Poe CF-1 R.
� apply Liyuid �ield Applied Coatings, the coating must be applied across Ihe entire roof surface and meet the dry mil thickness or coverage
commended by Ihe coatings manutacturer and meet minimum performance requiremcnts listed in § 1 18(�. Select the applicable coating:
Aluminum-Pigmented Asphalt Roof Coating IL.! Cement-Based Roof Coating ILl Other
Regisbntinn NumGer: 2egistra�ion Da�e/I'ime: HE2SPrnvider:
2008 2esidenrial Compliance Forms August 2009
ce: 32es i d en tial
]'rujecl Nnme:
CF-1 R-ALT
(Pa��r. � 01' S)
� � oi'Sturies
H�I:S V�P�IFICAT101� SUMfl1A1ii' Tlie en(arceo�eni ugencr slimdd pq�� sueciu! nnemion m 1he HEIfSMe4su�es e�pecified m tRis
check(is� Lelon�. A comple�cd and si�ned CF-41f F�rm jor nll thc rnen.eures syecilied shall be suLmitied �o li�e 6uilding inspec�or 6eforr Jinal
DuCI $Callilb S��OStillg HGRS nerifica�ion is required lor �hi.� mcusure.
❑ 1'�S ❑ NO 1'C5: In Climate 2ones ° aud 9-16, if� mort thun 4U linear feei of ne�v or replacemeni duets nre insialled in unconditioned
' - space, the duc�s ure tn be senled per jU52fb)1Dii and the newly inswlled ducls ure �o be insulated pe� $ I51(1jl U_
❑ EXCCPTJO�: Lzisting tluc[ systems [hnl are estended; wliicL .ire cunstructed, insWuted o, sealed with asbestns.
❑ 1'�S ❑ NO 1'P5: Li Climate Zones 2 and 9-16, if tlie existi��g space-conditimiing system (HVAC equipmem and ductin�) es replaced, tl�e
- ducu arc to be sealed per § 1 S2(b)1 Di. �
❑ Y�S ❑ NO YES: In Climate Zones ^_ and 9J 6, if [he existing HVAC equipmem is repluced (includin^ ihe repiacemem of the air handler:
ouidoor condensing nni� of n splii system, cooling m� heating coil, or the furnace l�eai exchaneer) the ducts . re to be
sealed per § 152(b)1 E.
❑�XC�PTION�. Duct sYstems thnt are ducumented ta have been previousl}• sealed conf rmed thruugh H�R$
_ � verificalimi in acem�dance with prucedures in the Reference Residential Appendix ItA3.
� � ❑�XCEPT70�: Uuct systems with less thnn 40 linear teet in unconditioned space. . .
❑ L�XC�PTION: Ezistin� duc� svstems constructed, insulated or sealeJ �vit6 asbesms.
Ref'riperant Charge - Split System NE2S veriJicatron is irqairedfor thi.r measure.
❑ Y�S ❑ NO YES: ln Climate Zones 2 and S-1 i, when the existing H VAC equipmem is replaced (including the replacement of the air
handler, outdoor condensine unit of a split system A/C or l�eat pump, cooling or heating coil; or the furnace heat
exr.haneeri a refrieerant charee measurement shall be verit"ied oer i li2(b11F.
Central Fan Inteerated (CFI) Ventilation System and Fan Watt Draw
The vencila[ion reouirements oTFISO(ol do not aooh tn existine residential homes.
bucted Split Systems - Air Conditioners and Heat Pumps: Airflow HEhS »erifcoiiwi is required for this n,easurc.
❑ I'LS ❑ NO 1'ES: In Climate Zones 10 through I5, when the existing space-condicioning sysrem (H VAC equipment and ducting} is
replaced. the airflow and fan watt draw shall be verified ner § 1 S2(b)1 Ci to meet the requirements of § I51(f17B.
Documentation Author'S Declarztion Statement
I certif�� thaf this Certificate oT Compliance documentetion is accurate and comalete.
Name� Signamre:
U I
Comp ny: D '
A r� �-�p� lf Applicable � CEA or O CEPE
� �v � . (Certificauonilj:
City/S ate/Zi : � � Pion^� � ^ �
C�
Respmisible Ruilding Desi�ner's Declaratim; Siatement
• I am eligible under Division ; of t6c Calitoutiu Business und Professions Code tn accep� responsibil9ty for t6e building design identified on
this Certificate of Compliance.
• ] certify Ihai �hc energy features and perlormancc speciGcn�ion;: for ihe building desiEn identiGed on this Certifreate of Compliance conform
w the requirements of Till� 24, 1'ans 1�ind G of the Califbrniai Code of Kegulations.
• The 6uildmg desigu fe, wres IdemiGcd on �his Certificatc of Compliance are cunsisient with the infonnation provided tu documem this
building design ou th: otl�er xpplieable compliunct tonns, worl:sheets, culculations, plans and speciLcalions submitted w t6e enturcement
ueenc�' for approval with this buildim� Pennit a�plication. '
Namct Si�nawre:
Comptiny: Lale:
Address: " License:
Cnv;State(Zip: I Phone:
Tnr u.r.ri.clmiae m� que.etions regm'tling Zhe L•nerbP Strmdtu�d.c, cnmac! flic L•nergr Hotlinr «t: 7-8(/0-77Z-33b0.
Ifegia�u'nli�ur h4iniLer: I(egi.riruiinn Uuie/Pimc: HE7;8 f'roviner:
20(lf.; kea�iclenricd Compliance Forms Ai�gu.rr 3(lOJ