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Home My WebLink About1032 PALMETTO WAY - Building PermitsCITY OF COSTA fill ��`""'FS; BUILDING DIVISION a 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us . u. 4 FOR INSPECTIONS CALL: (714) 754.5626 �`°"°^°^'"` PERMIT NUMBER: BC10-00542 PERMIT TYPE: B_COMBO Sub Type: SFD_NEW JOB ADDRESS: 10 2 PALME$WMAPN: TPNO08032oning: , Vicinity: Const Type: V -B SQ. FT: 2644 STATUS: ISSUED DATE ISSUED: 01/04/2011 ISSUED BY: RMD Suite/Unit: Primary Occ: Valuation: $216,500.00 SCOPE OF WORK: PHASE 2: PLAN 1 TYPE 1 BR CONSTRUCTION OF A NEW 2,165 SF 2 -STORY SFD WITH A 54 SF PORCH AND A 425 SF ATTACHED GARAGE WITH 1 FAU < 100 K BTU, 1 REFRIG SYS < 100 K BTU WITH NEW DUCTING, 1 HOOD W/MECH EXHAUST, 1 FACTORY FIRE PLACE, 3 VENT FANS, NEW ELECTRICAL FOR A 2,165 SF SFD, ELECTRICAL FOR A/C PKG, 2 LIGHT FIXTS, 4 OUTLETS AND 1 SWITCH FOR GARAGE, 2 BATH TUBS, 1 DISHWASHER, GAS OUTLETS (1-4), 1 GAS SERVICE, 1 LANDSCAPE IRRIGATION, 1 LAUNDTRY/TUB WASHER, 1 SHOWER, 1 KITCHEN SINK, 5 WASH BASINS, 3 WATER CLOSETS, 1 WATER HEATER, 1 WATER SERVICE. FIRST FLOOR - 958 SF SECOND FLOOR - 1,207 SF REF: PA -05-29, T61917 3 BEDROOM, 1 BONUS ROOM, 2 1/2 BATHROOM SFD. OWNER: Final Block/Retaining Wall Phone: Final Factory Fire Place APPLICANT: EMERSHAW, KIRSTIN Phone: 949-873-2718 CONTRACTOR: T R CO Phone: 949-719-4975 Cell: ARCHITECT: ENGINEER: HUAN NGUYEN COMBINATION PERMIT FEE SUMMARY Building Plan Check: Building Fees: Electrical Fees: Mechanical Fees: Plumbing Fees: SMIP Residential: SMIP Commercial: Bldg Std Admin Fund TOTAL FEES: Address: City/State/Zip: Address: City/State/zZip: License No. 832198 Address: 160 NEWPORT CENTER DRIVE Unit: City/State: NEWPORT BEACH, CA License No. License No.C64238 $267.95 $1,648.95 $215.60 $110.05 $211.05 $21.65 $0.00 $9.00 $2,484.25 Unit: Unit: STE 240 ZipCode 92660 PHONE: PHONE: -Refer to fee receipts for all fees paid for project HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays. 9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays: New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) 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 must 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. CODEC INSPECTIONTWE DATE INTIri CODES INSPECTION TYPE / DATE INTITIALS r1 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy 9-b -// n I10 &( WORKERS' COMPENSATION DECLARATION: .; -ifa Owner ID verified by driver's license. El Yes ❑ No I hereby affirm under penalty of perjury one of the following declarations:Driver's License No. Expires: 14; have and will maintain a certificate of consent to self -Insure for workers' - Verification of Ownership by (type of document, i.e. - properly tax bill Jr deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a number are: person is required to descend, will be made in connection with work authorized �p,,- I - ��Q I by this permit, and that no building structure, scaffolding, falsework, or demolition S� A Gager:_ S e Gn a�lny�p cca� or dismantling thereof, will be more than thirty-six (36) feel high. (Chap. 3.2, Grp (Thrs section need no( Ce mmpleletl Me permit rs valued at one huntlretl tlollars (8f WJ or IessJ 2, Art 2, Sec. 341, Title 8, California Administrative Code). Policy,Number: I L 1 (ay \ — 032 rr ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall fo`(rt�1hwi�th, comply with these provist.ons. it Applicant's Signature Date L/ " C= 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. LICENSED CONTRACTORS 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. Lica: t✓.'n=—� 3 -2 g Class-If Contractor's Signature CONSTRUCTION LENDING 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: Signature Date OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS 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 or she is licensed pursuant to the provisions of the Contractors 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 License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her 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 or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contmctor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's Signature Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future 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 California Health and Safety Code 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 quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration tone for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all slate lavers and city ordinances regarding Haiardous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ,�.re,/S�ignature of legal er(s) Date Signature Date likytA L4I (I 005716 (3/07) ,Yra�Ablhori e.d Apphcant r_y..Date— NEWPORT -MESA UNIFIED S•CH60L DISTRICT CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND�A�,1 D To: (--) c:iry of Costa Mesa11 ( ) City of Newport Beach Q ( ) County of Orange an eck 1 OF OO�\ \ Applicant; D Y_ b c7 � I o j , LLL Gm Nh 6996 i LI OC D District �Receipt TNo. J_ Iah ? Address: 1100 O Telephone Number: gLiA - 11op�-� i'A�y-15- Tract/Parcel and Lot Number(s): V! 1 V X - dt f7�� Location of Project: i J) 3a Number of Square Feet of: Residential Space Commercial and Industrial Space CommerciaVlndustrial Project is: (Check One) x $1.84 x $ .30 Total '3CIM •o_ Total Warehouse Motel Preschool _ R 8 D Bank Auto Repair Movie Theater Neighborhood Shops Hospital Mini -storage Racquet/Health Large Office Heavy Industrial Hotel Office Bldg. Regional Shops Medical Office Restaurant Light Industrial Office Park _• Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facifity fees in compliance with Government Code sections 53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport -Mesa Unified School District. By: Audwtaed The above representation as to square footage is true. Applicant agrees that if it is latedeterrrined that such representations are not true, then this certificate shall automatically terminate and the appropriate City/County shall be notified. Date: l k ! it Applicant SHEET: G0UVISaugg"eavilm JOB 61944 1 roneidnnggro"p,mc. DATE: 03/08/11 CLIENT: TRCO Development REPLACEMENT ANCHORS FOR EA. MISSING ANCHOR BOLT--- --- - -- SIMPSON TITENHD ASTM (F568M)THREADED SIMPSON STRONG •, SCREW ANCHORS ROD INHILTI=RE SOOSD.' ' .BOLT 1 -POUR OR :. 1=POUR OR 2 -POUR W1 DOWEL t -POUR OR 2 -POUR WIO DOWEL 2 -POUR W/O DOWEL (ICCESR#2713) -(ICC ESR#2322).' (ICC ESR #1771) WALL TYPE .QUANTITY &'SIZE Le "QUANTITY &SIZE Le QUANTITY &SIZE . Le 2X4 SILL (2)3/8-V 31/4" 2 318"m 3 1/4" - N.A. - - 3X4 SILL (3) 3/8"� 31/4" (3) 318"� 3 114" N.A. jN.A.EXT. 21/2"m 4" 1516"m 5 114" N.A. N:A. N.A. (1516"m 5 1/4" N.A. INT.2k8 3X SILL21/2"m 4" 1518"m S 1/4" (2112" � EO. EO. 1. POST -INSTALLED ANCHOR 2 1 1 PER TABLE. SPACING BETWEEN ANCHORS AND MIN. DISTANCE FROM EXISTING A.B. TO BE 3 112" MISPLACED A.B. 2 � FOR TITEN HD AND HILTI 500 SD, AND 4" FOR STRONG BOLT. � 2. PLATE WASHER PER FOUNDATION NOTES ON SN1 SHEETS. NOTES: � IF DOWEL IS NOT INSTALLED EMBEDMENT Le IS INTO THE ° ( 2", 2X4 WALL FIRST POUR a 3 1/2", 2X6 WALL � (SPECIAL INSPECTION IS REQ -D. FOR ANCHOR INSTALLATION) - IF MIN. SPACING CAN NOT BE MET CONTACT GOUVIS ENGINEERING FOR SPECIFIC FIX MISSING. OR `pt'E9 r. t� Hca : a N G U�' 6$235 w 4 Ex fi C)Vlt 4TH aF MISPLACED A.B. D5103N1 C.l:3=t ,SyZ ROBIN B. HAMERS & ASSOC., INC. 234 E. 17TH ST., SUITE 205 CIVIL ENGINEERS • PLANNERS • SURVEYORS COSTA MESA, CA 92627 ... since 1981 Phone 949/548-1192 Fax 949/548-6516 June 3, 2011 City of Costa Mesa Building Dept. 77 Fair Drive Costa Mesa, CA 92626 Attention: Grading Inspector Subject: Civil Engineer's Final Grading Certification Reference Project Address: 1032 Palmetto Way Lot 7, Amended Tract No. 16917 I hereby approve the final grading for the referenced project in accordance with my responsibilities under the Orange County Grading and Excavation Code. Final grading and drainage of the lot has been completed substantially in conformance with the approved Grading Plan as determined on May 31, 2011. Sincerely, h o in B. Hamers Registered Civil Engineer \{� RCE 31720 b I-5/II R INSTALLATION CERTIFICATE Spray/Loose fill) CF -6R -ENV -01 Envelope — Insulation; Roofin • Fenestration Manufacturer's installed weight per square foot to achieve (Page 1 of 3) Site Address: Lot Enforcement Agency: Exterior Foam Sheathing (rigid Insulation) Permit Number: ffmore than one person has responstbilityfor installation ofthe items on this certificate, each person: applicable to the portion of construction for which they are responsible; alternatively, the person with prepare and sign this certUcare for the entire construction All applicable Wandatory Measures with Description of Insulation L RAISED FLOOR Material: Brand Name:_ Thickness (inches): Thermal Resistance 13 § 150(d): Minimum R-13 insulation in raised wood -frame floor or equivalent Ti -factor. 2. SLAB FLOOR/PERIMETER Material: Brand Name: Thickness (inches): Thermal Resistance (R Perimeter Insulation Depth (inches): ❑ §150(1): Water absorption rate for the insulation material alone without Facings is no grot rate is no Beater than 2.0 penn/inch and shall be protected from physical damage and UV lit 3. EXTERIOR WALL a. Insulation Type (e.x. Batt, Loose Fill, Spray Foam) Batts a. Thermal Resistance b.. Insulation Type (e.x. Batt, Loose Fill, Spray Foam) b. Thermal Resistance Brand: CertainTeed Spray/Loose fill) Installed Actual Thickness Spray/Loose fill) (inches): 3 5" Contractor's min install Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Vi Cl § 150(c): Minimum R-13 insulation in wood -frame wall or equivalent U -factor. Exterior Foam Sheathing (rigid Insulation) Material: Brand Name: Thickness (inches) ; Thermal Resistance (R- 4. FOUNDATION WALL Material: Brand Name: Thickness (inches): Thermal Resistance (R- 5. CEILING Batt or Blanket Type: Batts Brand Name: certa7 Loose Fill Type: 310wn Insulsa a Thermal Resistance (R - Spray Foam Type: Brand Name: certa: Installed Actual Thickness (inches): Batt 10^/Blow 11.75^Contractor's min install Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Ve 13 §15D(a): Minimum R-19 insulation in wood -frame ceiling or equivalent U -factor. 6. ATTIC ROOF INSULATION AND/OR ATTIC RADIANT BARRIER Material: Brand Name: _ Material: Brand Name: Thickness (inches): Thermal Resistance 11 § 118(a): Insulation installed meets Standards for Insulating Material. 0 §150(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16 1'd SbESGB9916 XHd 131783SUI dH ror crmtruction shall to be checked to ensure 0.3"/a: water vapor permeance 30 13 _lb August 2009 Wass:1 0102 06 des R with no gaps or voids. Lot 7 gency: d blown in insulation to work cenectly the insulation must BII die wall caPity and touch the air bent and miscd floor batt and blown in insulation must not be comprcsseclsftclrave no gaps or voids. Q11 Insulation WALL Staile Checklist ✓ FLOOR INSULATION ® ❑ ❑ All Boor joist cavity insulation installed to uniformly fit the cavityside-to�ide m; end-to-end. (NA iffloors slab Yes No NA on grade). Ide). 13 Yes 13 No E3 NA insulationin full contact with the subfloor, NO gaps. (NA if floors are slab o g ® Yes ❑ No ❑ NA Insulation in comact with air barrier on all five sides. (en ds, sides, back). NA f B ors are slab on grade. ® Yes ❑ No ❑ NA Betts cut to fn around wiring and plumbing, of split (delaminated). (NA if loom II, SPF, or slab on grade). ® Yes ❑ No ❑ NA Ban insulation has continuous su pilon. (NA if loose fill, SPF, or slob on grade). j ❑ ❑ ® SPF (Spray Polyurethane Foam Medium Density) insulation the average thicia esJ is equal to or greater than that Yes No NA listed on the CF -1 R and the minimum thickness shall be no more than 'A inch I ss ithan the required thickness for Yes No NA the R -value. A for other forms of insulation)- ® Yes E3N No ® NA Insulation R -value same or greeter than listed on the CF -1 R. I ® Yes ❑ No ❑ NA SPF insulation properly adhered to avoid gaps and provide an air seal (NA for r forms of irsulation). ® ❑ ❑ Far SPF list the required floor cavityR-value from CF -IR, R— Yes No NA List tested average depth of insulation (inches) _ X 5.8 (R-value/inch for ff a density SPF)_ ® 13Special (R -value). This is the installed R -value and must be equal to or greater than lit a on CF -1R (NA for other forms Yes No of insulation). ✓ WALL INSULATION ® ❑ ❑ Standard depth cavities insulation fills cavity and touches air barrier on all sixid is. (NA if SPF used and meets Yes No NA the required R -value). ® ❑ ❑ All double walls and biunprouts, the insulation fills the cavity or additional ah 'cr installed so that the Yes No NA insulation rills the cavity. Insulation touches all six sides. (NA if SPF used m ets the required It -value). ® ❑ Behind tub/shower, walls under stairs, and fireplace, insulation touches air W ierlon five sides. Not required to Yes No fill the space. Cavity required to be air tight. 13 Yes '3 No L'BATTS, NA not n single vaid/depression deeper than'/" in ANY stud bay. (NA i to fill or SPF) B ❑ ❑ BATTS, voids/depressions less than 3/4" allowed as long as the area is not gr aler than I0%ofthe surface area Yes No NA I for each stud bay. (NA if loose fill or SPF). ❑ Yes ❑ No ® NA Loose Fill no gaps or voids of any depth allowed. (NA if butts or SPF). ❑ Yes ❑ No ® NA SPF insulation properly adhered to avoid gaps and provide an air sal (NA fat other forms of insulation). ®s NO Any gaps between studs or insulation larger than 1/9" must be filled with ins tidn or foam. ® Yes ❑ No All Rim -joists to the outside insulated. I ® 13Special attention must be paid to comer channels, wall intersections, and behi d b/shower eaclosmes Yes No insulated to proper R -Value. ® Yes ❑ No [3NAskylight NA shafts and odic gieew¢Ils insulated with minimum R-19. ® Yes ❑ No ❑ NA Insulation in fuB contact with drywall or wall finishes of skylight shafts and at ewalls. Registration Number: Registration Date/Time: 2008 Residential Compliance Forms Z'd S111643689916 XHd 1317b]ISH3 dH March 2010 Wd9G:I OTOZ 06 day INSTALLATION CERTIFICATE CF-6R.ENV-22-HERS Insulation Installation II - Insulation Stage Checklist - a 2 of 3 givaltt Site Address: Lot 7 Enforcement Agency: Yes '. Permit Number. Mi CI Wall insulation same or better than what is listed on the CF -11Z. El ' Yes No if t se fill or SPF). Yes I ❑ ❑ IN SPF list the required wall cavity R -value from CF -IR, R-_. List mst d average depth of Yes No NA insulation (inch) _ X 5.8 (R-value/inch for medium density SPF) _ Yes (I lue) This is the N for each stud bay. (NA if loose fill or SPF). installed R -value and must be equal to or greater than listed on CF -TR for other forms of ❑ NA NO gaps or voids allowed Cor loose fill and SPF. (NA if butts). insulation M ❑ ❑ ❑ 13 SPF (Spray Polyurethane Foam Medium Density) insulation the average thicloo e is equal to or greater than that Yes No NA listed on the CF -IR and the minimum thickness shall here, more then 'h inch law Yes than the requited thickness for Insulation in full contact with the ceiling, NO gaps. the R -value. A for other forms of insulation ❑ ❑ ✓ CEILING INSULATION El ❑ BATTS dire must not be a single gap/void/depression deeper than Y. (NA if t se fill or SPF). Yes No ® ❑ BATTS voids/depressions less than 3!4" allowed as long as the ares is not giant r than 10%of the surface nes Yes No for each stud bay. (NA if loose fill or SPF). M Yes ❑ No ❑ NA NO gaps or voids allowed Cor loose fill and SPF. (NA if butts). M ❑ Al l ceiling insulation installed to uniformly fit the cavity side-to-side and en -to end. Yes No Yes ❑ No Insulation in full contact with the ceiling, NO gaps. ❑ ❑ Insulation in contact with air barrier on all five sides. f Yes No 'e ❑ Yes ❑ No El NA Batts cut to fit around wiring and plumbing, or split (delaminated). (NA for fill or SPF). M ❑ ❑ Batts taller than the trusses must expand so that they touch each other over e t saes. (NA for loose fill or Yes No NA 1 SPF). ❑ ❑ El Yes No NA SPF insulation properly adhered to avoid gaps and provide an air seal (NA fir ther forms of insulation) ❑ ❑ El Insulation fully fills cavity below any plywood platferm or cat -walk. If SPF then minimum Yes No NA 3 inches. A if no platforms or cat -walks ® ❑ Yes No Attic access gaaketed 13 ❑ Attic access insulated with rigid foam or batt insulation using adhesive or m c ical fastener. Yes No R -value same as ceiling R -value listed on CF -IR ❑ ❑ Recessed light fixtures covered full depth with insulation. If SPF used then c theforms; of insulation used in Yes No cover or enclosed in a box fabricated from %-inch plywood. II sheet m 1, /flinch hard board or drywall ® Yes ❑ No Roof insulation same or better than what is listed on the CF -IR 13 ❑ ❑ Loose Fill Insulation at proper depth - insulation mlers visible and indicatin pdoper depth and It -value for Yes No NA blown in insulation. A for batts or SPF). 1 ❑ ❑ ® Loose Fill Insulation uniformly covers the entire oeiling (or rooO area from Dulside of all exterior walls. (NA Yes No NA for bens or SPF). Loose -fill insulation meets or exceeds maoufacttuer's minimum weight mrdici n requirements for the target [30 ® R -value. Target R -value. Manufacturer's minimum required weight for the gjtt R -value (pounds -per -square - Yes No NA foot). Manufacturer's minimum required thickness at time of installation. M u acturers minimum required settled thickness. Note: To receive compliance credit the HERS rater shall d that the manufacturer's minimum weight and thickness has been achieved for the target R -value. (N f r batts or SPF). Registration Number: Registration Datelftme: ffRS Prouder; 1008 Residential Compliance Forms t March 2010 6'd SbES609916 XHA 131783SU-1 dH Wd9S--T 0102 06 daS INSTALLATION CERTIFICATE CF -6R -ENV -22 -HERS ual' Insulation installation II - Insulation Stage Checklist Pee 3 ot3 Site Atldress:Enforcement Lot 7 Agency: 1 Permit Number. 13 ❑ ❑ SPF list the required ceiling cavity R -value fmm CF -1R, R. . List tee tdeaverage depth of insulation-__ Yes No NA in X 5.SR = R this is the installed R -value and must be equal to or gra b� than listed on CF -IR (NA for • 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility ar construction, or an authorized representative of the person responsible for construction (responsible person). other forms of insulation I ❑ ❑ ® SPF insulation must be covered with other forms ofimulation or enclosed inn x fabricated fmm h inch Yes No NA plywood. 18 gauge metal,'% inch headboard or drywall. The exterior ofthe may then be btsuleted with r i4stadlations in the HERS sample group will be required at my expense. I understand that the HERS provider, and Energy (!or4misslon represematives will SPF. i ❑ ❑ ❑ SPP insulation the average thickness is equal to or greater than that listed on aICF-IR and the minimum Yes No NA thlclMS$ shall be no more than 'h inch less than the required thickness for th RFvalue. (NA for other fomrs of building owner at occupancy. I will ensure that all Installation Certificates will come from a Slprovida data registry for multiple orientation alternatives and on October 1, 2010, for all low-rise residential buildings. Insulation) ✓ GARAGE ROOF/CEILING INSULATION FOR TWO STORIES no conditionedce over garage) Z ❑ Insulation installed at joists against the air barrier in the garage to house trap iti n. All well insulation No NA requirements above must be met (NA if conditioned space over garage). ✓ GARAGE ROOF/CEILING INSULATION FOR TWO STORIES conditioned sp ce ver garage) E)❑ ❑ If insulation is to be installed at subtloorthen the insulation must also be ins II d arjois a against the air barrier Yes No NA in the garage to house transition. All ceiling and wall insulation requirement a ova must be met. (NA if no conditioned ace over a e). ® ❑ ❑ If insulation is to be installed at ceiling of garage then the joists to the ma m t be insulated and all the Yes No NA inrequirements listed above must be met. (NA if no conditioned spa4e*or garage), DECLARATION STATEMENT • 1 certify under penalty of perjury, under the laws of the State of California, the information provided an this form is true acrd comet • 1 have read the High Quality Insulation Installation Procedures (Residential Appendix, RA3.5), underitand these procedures, and understand that there are additional requirements than must be met than those listed on this CF -6R. Fletcher Fasick • All rows in this document have been checked and all answers are yes or NA • 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility ar construction, or an authorized representative of the person responsible for construction (responsible person). CSLBLiunw 449739 • i certify that the installed features, materials, components, or manufactured devices identified on it iis certificate (the installation) cord'orms to ail applicable codes and regulations, and the installation is consistent with the plans a d eci fications approved by the enforcement agency. i • I understand that a HERS rater will be checking the installation and that if such checking idemifi defects, I sm required to take ooaective action at my expense. If the installation is part of a sample group for HERS verificatio the installation fails to meet the requirements of such quality assurance checking, additional checking/testing and repair ofe r i4stadlations in the HERS sample group will be required at my expense. I understand that the HERS provider, and Energy (!or4misslon represematives will also be performing chocks of the installation on jobs not tested by the HERS rater, i • I reviewed a copy of the Certificate of Compliance (CF -IR) form approved by the enforcement agent: that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -IR that apply 1 the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or fe available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understood that a signed copy of this Installation Certificate is required to be included with the dMet' ta4 a the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a Slprovida data registry for multiple orientation alternatives and on October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Bullden'Owner) Walldesion Inc. i Responsible Person's Name: Responsible Person's aturc Fletcher Fasick CSLBLiunw 449739 Date Signed:6. 7. 11 Positi ilh Co parry(Title) PKoje min. Regi trarlon Nwnber: Registration DatelTime: 1008 Residential Compliance Forms t, -Cl SbES689916 XHj 13f7d3SUI dH Provider: March 1010 Wd99:T GIDE 06 daS