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HomeMy WebLinkAbout1042 PALMETTO WAY - Building Permitsr CITY OF C016TA CA Ac�JpMFsq / BUILDING DIVISION i��Sr 77\FAIRIDRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www.ci.costa-mesa.ca.us G' FOR INSPECTIONS CALL: (714) 754-5626 � PERMIT NUMBER: BC10-00547 PERMIT TYPE: B_COMBO Sub Type: SFD_NEW JOB ADDRESS: 1042 PALMETTO WY CM APN: TPNO08037 Zoning:, Vicinity: Const Type: V -B SQ. FT: 2894 STATUS: ISSUED DATE ISSUED: 01/04/2011 ISSUED BY: RMD Suite/Unit: Primary Occ: Valuation: $238,300.00 SCOPE OF WORK: PHASE 2: PLAN 2 TYPE 2A CONSTRUCTION OF A 2,383 SF 2 -STORY SFD WITH A 56 SF PORCH AND A 455 SF ATTACHED GARAGE WITH 1 FAU < 100 K BTU, 1 REFRIG SYST < 100 K BTU WITH NEW DUCTING, 1 FIRE PLACE, 3 VENT FANS, 1 HOOD W/MECH DUCTING, EL FOR RES A/C PKG, ELECTRICAL FOR A NEW 2,383 SF SFD, 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 LAUNDRY/TUB WASHER, 2 SHOWERS, 1 KITCHEN SINK, 5 WAHS BASINS, 3 WATER CLOSETS, 1 WATER HEATER, 1 WATER SERVICE. FIRST FLOOR: 1,072 SF, SECOND FLOOR: 1,311 SF REF: PA -05-29, T61917 4 BEDROOM/3 BATHROOM SFD. OWNER: Final Re -Roof Phone: Final Electrical 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: "Refer to fee receipts for all fees paid for project 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 $287.98 $1,772.15 $228.68 $110.05 $220.85 $23.83 $0.00 $10.00 $2,653.54 Unit: Unit: STE 240 ZipCode 92660 PHONE: PHONE: HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 311812010- 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 relates 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. CODEI. INSPECTIONTYPE DATE INTITIALS CODE INSPECTION TYPE DATE INTI SS/ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing K �, d i • /,�N 200 Final Re -Roof 210 Final Electrical 201 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 Building/Occupancy su P �/ 9 • A7 Y WORKERS' COMPENSATION DECLARATION: �{ I hereby affirm under penalty of perjury one of the following declarations: W�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 --('` Ciimer:.. A cvee Co y\^ P041' jj n 1- \SUV -C Ace T .� (Thus secron new not he completed0V the perm# 4 valued at one howled dollars f$IW)w less.) Polfcy,Number: 2j ❑ 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, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. if y (t Applicant's Signaturer-Date a�-.r .. 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. Owner ID verified by driver's license. ❑ Yes ElNo 1 Driver's License No. Exdires: Verification of Ownership by (type of document, i.e. - property tax bill orlkeed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feel in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ 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. Apphcanrs 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 LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9 (commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. I� S-- 4cClass u Contractor's stgnamre ate_ CONSTRUCTION LENDING AGENCY: ❑ 1 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: 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 contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt, under sec. Business and Professions Code for this reason: Signature 3057-46(3/07) Date 2. Does or will the applicant or present or future building occupant need to file a registration form 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 fumished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this pennit 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 state lavers and city ordinances regarding Hazardous Materials and Emissions. Signature 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. Signature of Legal Owner(s) Date ,ZAtNfw Au"2tad Apphranf L ate NEWPORT -MESA UNIFI€D SCHOOL DISTRICTS 7001 CERTIFICATE OF COMPLIANCE OF DEV�W FEES PURSUANT TO AB 16 7O T h 9�1 \\'j\\� o "„.mom L'P 1061(() To: ( e) City of Costa Mesa JPN Q Q District Receipt No. ( ) City of Newport Beach ,F\\�l ►� l (�� U -7 ( ) County of Orange C�i OF GO�\Pn \ Plan CL Aos 1 / Applicant: ©)C \Doul io I I (i G C°o7:Vo._ 1�v. c� e Z4D, ilvl inA,% .Bs Address: "00 O �pr✓ P Telephone Number: q -I k - 1119 9 q 1S ' Tract/Parcel and Lot Number(s): AN 000 im Location of Project: Number of Square Feet of: Residential Space Commercial and Industrial Space Commercial/Industrial Project is: (Check One) (/ �3 x $1.84 x $30 Total vl I Total Warehouse Motel Preschool R & 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 facility fees in compliance with Government Code section 53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdictioi Checks are to be made payable to Newport -Mesa Unified School District. By: The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are true, then this certificate shall automatically terminate and the appropriate CAylCounty shall be notified. J Date: t ILi l It SHEET: llmp� JOB*NO.: 61944 GOUVIS��ti�d&fl�Q;u811�� DATE: 03/08/11 • I wnsultinggroup, mc. _ CLIENT: TRCO Development Qc�c> oosq-�- REPLACEMENT ANCHORS FOR ' EA. MISSING ANCHOR BOLT- - -- " SIMPSON TITEN.HD ASTM (F568M)THREADED SIMPSON STRONG �. •.. .SCREW ANCHORS ROD IN HILTI-RE SOOSD:.. BOLT 1 -POUR OR - 1 -POUR OR 2 -POUR W/ DOWEL 1 -POUR OR 2 -POUR W/O DOWEL 2 -POUR W/O DOWEL {IC6ESR#2713)' --(ICC ESR#2322) .(ICG ESR#1771) WALL TYPE SIZE Le ":QUANTITY &SIZE Le QUANTITY &SIZE , Le QUAE(2)112"O 2X4 SILL - 3114 2 -318"m 3 1/4" N.A. - N.A. 3X4 SILL 3 1/4" (3) 3/8"(P 3 1/4" N.A. N.A. EXT. 2X6 SILL 4" 1 5/8"m 5 114" N.A. N.A. FOR ANCHOR INSTALLATION) 3X6 SILL N.A. 15/8"� 5 1/4" N.A.N.A. MET CONTACT GOUVIS INT. 2X & 3X SILL - 4" 1 5/8"m 5 114" (2.1/2" 0 4 1/2" D5103N1 EO. EQ. 1. POST -INSTALLED ANCHOR 2 1 1 PER TABLE. SPACING BETWEEN ANCHORS AND MIN. DISTANCE FROM EXISTING A.B. TO BE 3112" 2 J 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 3112", 2X6 WALL � (SPECIAL INSPECTION IS REO -D. r.4�'OFE>51.0;� > ,.� N ISi, t S tw' �(, 6-235 m I� Ex ._ '30d? l s c V \9r OF C� FOR ANCHOR INSTALLATION) - IF MIN. SPACING CAN NOT BE MET CONTACT GOUVIS ENGINEERING FOR SPECIFIC FIX MISSING OR MISPLACED A.B. D5103N1 OC /o—ovJ-y �d ROBIN B. HAMERS & ASSOC., INC. !� CIVIL ENGINEERS' PLANNERS • SURVEYORS ... since 1981 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: 1042 Palmetto Way Lot 2, Amended Tract No. 16917 C12- Dc l,%e-eo & J^ y 234 E. 17TH ST., SUITE 205 COSTA MESA, CA 92627 Phone 949/548-1192 Fax 949/548-6516 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, Roo n B. Hamers Registered Civil Engineer RCE 31720 6(-b/n 6G 1v- c -q'7 INSTALLATION CERTIFICATE CF -6R -ENV -01 Envelope — Insulation• Roofin • Fenestration j (Pae 1 of 3) Site Address: Lot z Lnforcement Agency: 1 2. SLAB FLOOR/PERIMETER Permit Number: Material: Brand Name: Ifmore than one person has responsibilityfor installation ofthe items on this cerlifrcate, each persons 11 *epare and sign o certificale applicable to the portion of construction for which they are responsible; alternatively the person with cjlcjpowjbilhyftxr construction shall prepare and sign this certificate for the entire construcriom All applicable MandatoryMeasures with ch ck boxes require to be checked to ensure Description of Insulation 1. RAISED FLOOR Material: Brand Name: Thickness (inches): Thermal Resistance 13 §150(d): Minimum R-13 insulation in raised wood -frame floor or equivalent U -factor. 2. SLAB FLOOR/PERIMETER Material: Brand Name: Thickness (inches): Thermal Resistance (R-1 lalpe): Perimeter Insulation Depth (inches): ❑ §150(1): Water absorption rate for the insulation material alone without facings is no greate 0.3%; water vapor permeance rate is no greater than 2.0 perm/inch and shall be protected from physical damage and UV liglr dZlue): ioration. 3. EXTERIOR WALL a. Insulation Type (e.x. Batt, Loose Fill, Spray Foam) a. Thermal Resistance (- 13 Batts b.. Insulation Type (e.x. Batt, Loose Fill, Spray Foam) b. Thermal Resistance ( -Value): Brand: CertainTeed Spray/Loose fill) Installed Actual Thickness Spray/Loose fill) (inches): 3.5" Contractor's min installe eight/02 lb Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Val e� ❑ §150(c): Minimum R-13 insulation in wood -frame wall or equivalent U -factor. Exterior Foam Sheathing (rigid Insulation) li Material: Brand Name: Thickness (inches) : 'thermal Resistance (R -v al e) 4. FOUNDATION WALL Material: Brand Name: Thickness (inches): Thermal Resistance (R- e); 5. CEILING Batt or Blanket Type: Batts Brand Nae: certai eta m Loose Fill Type: 210wn tnsulsa a Thermal Resistance (R- I e): 30 Spray Foam Type: Brand Name: Certai Te d Installed Actual Thickness (inches): Batt 10" /BIG- 1L.75^Contractor's min instaillec meightlfi2 .a lb Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Val e) 30 ❑ § 150(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 ❑ § 118(a): Insulation installed meets Standards for Insulating Material. O § 150(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16 1008 Residential Compliance Forms T'd SbE56899TB %B3 1317a3S8-1 dH WdSS:l OT02 06 daS s war,cw—m taus u with no gaps or voids. Lot 2 own in insulation to work correctly the insulation must fill the walllcality and touch the air berth raised floor ban xd and blown in insulation must not be compresaid ave an gaps or voids. Qll Insulation INSULATION Stage Checklist ✓ FLOOR INSULATION 13 ❑ ❑ All floor joist cavity insulation installed to uniformly ill the cavity side-to-side anend-to-end. (NA if floors slab Yes No NA on grade). ❑ Yes ❑ No ❑ NA Insulation in full contact with the subfioor, NO gaps. (NA if floors are slab o g e). ® Yes ❑ No ❑ NA Insulation in contact with air barrier on all five sides. ( ds, sides, heck). NA nrc f 0 aslab on grade. YeaNo Ye ❑ '3NA Batts cut to fit around wiring and plumbing, or split (delaminated). (NA if loo a il, SPF, or slab w grade). '3 ❑ ❑ (NA if loose fill, SPF, or slab on grade)- 11 Bari insulation has continuous supportes ❑ No NA. Yes ❑ ❑ ® SPF (Spray Polyurethane Foam Medium Density) insulation the average thiclaa is equal m or greater than that Yes No NA listed on the CF -1 R and the minimum thickness shall be no more than 'A inch ss an die required ihickrtcss for No NA for each stud bay. (NA if loose fill or SPF). the R -value. A for other forms of insulation). ❑ m Loose Fill no gaps or voids of any depth allowed. (NA if butts or SPF), Yes ®s No Insulation R -value same or greater than listed on the CF -IR. ❑ '30 SPF insulation properlyadhered to avoid gaps and provide an air seal g p F (N.4 to of er fonts of insulation). Yes E® Yes No NA SPF insulation properly adhered in avoid gaps and provide an air seal (NA for r forms of insulation). ® ❑ ❑ For SPF list the required floor cavity R -value from CF -IR, R - Yes No NA List to,average depth of insulation (inches) _ X 5.8 (R.valuelinch for nr edam density SPF) ❑ No All Rim -joists to the outside insulated. (R -value). This is the installed R -value and must be equal to or greater than li twit on CF -IR (NA for other forms ❑ Special attention most be paid to comer channels, wall intersections, and baht d b/shower enclosures of insulation . ✓ WALL INSULATION ® ❑ ❑ Standard depth cavities insulation fills cavity and touches air barrier on all six iidds. (NA if SPF used and meets Yes No NA the roqvired R -value). ® ❑ ❑ All double walls and bump -outs, the insulation fills the cavity or additional air barrier installed an that the Yes No NA insulation rills the cavity. Insulation touches all six sides. (NA if SPF used arrid mets the required R -value). M ❑ Behind tub/shower, walls under stairs, and fireplace, insulation touches air bar icron five sides. Not required to Yes No I fill the space. Cavity required to be air tight. ® ❑ ❑ BAITS, nota sin le void/de ression dee r than Y.." in ANY stud ba g P a Y• (NA i to fill or SPF) Yes No NAI 13 ❑ ❑ BATTS, voids/depressions less than 314•' allowed as long as the area is not line to than 10%ofthe surface area Yes No NA for each stud bay. (NA if loose fill or SPF). ❑ ❑ m Loose Fill no gaps or voids of any depth allowed. (NA if butts or SPF), Yes No NA ❑ ❑ 13 SPF insulation properlyadhered to avoid gaps and provide an air seal g p F (N.4 to of er fonts of insulation). Yes No NA ® ❑ Any gaps between studs or insulation larger than 118" must be filled with insul ill n or foam. Yes No ® Yes ❑ No All Rim -joists to the outside insulated. ® ❑ Special attention most be paid to comer channels, wall intersections, and baht d b/shower enclosures Yes No insulated to proper R -Value. ® Yes ❑ No ❑ NA AU skylight shafts and attic kneewalls insulated with minimum R-19. ® Yes ❑ No ❑ NA Insulation in full contact with drywall or wall finishes of skyligh t shafts and at 'c t1covalls, Z•d Registration Number: Regisrratlon DorelTime: 2008 Residential Compliance Forms SbES6B99T6 XHd 13Ca3SH-1 dH Provider. March 2010 Wd9StT 0102 06 dos INSTALLATION CERTIFICATE I CF-6R-MV-22-11ERS uallb' Insulation Installation I -Insulation Stage Checklist a 2 of 3 Site Address: Lot 2 Enforcement Agency: ❑ Permit Number. El Y Yes ❑ No NA Wall insulation same or better than what is listed on the CF -IR. fill or SPF). ❑ ❑ M I SPF list the required wall cavity R -value from CF -IR, R•_. List t t d average depth of Yes No NA insulation (inch) _ X 5.8 (R-value/inch for medium density SPF) _ le i (R -value) This is the N No NA Insulation in contact with air barrier an all five sides. installed R -value and must be equal to or greater than listed on CF -IR for other forms of ❑ ❑ E insulation f ❑ ❑ ® SPF (Spray Polyurethane Foam Medium Density) insulation the average thicla le a equal to or greater than that Yes No NA listed on the CF -IR and the minimum thickness shall be no mote than Y2 inch less the required thickness for Yes No NA the R -value. for other forms of insulation I Yes I I BATTS there most not be a single gap/void/depresslon deeper thN". (NAI if 16Ou fol or SPF). No an ® ❑ 1 BATTS voiciddepressions less than 314" allowed as long as the area is not g st r than 10% of the surface area Yes No NA NO gaps or voids allowed for loose till and SPF. (NA if bans). fill or SPF). M Yes ❑ No NA All ceiling insulation installed to uniformly fit the cavity side-to-side and en to end. ® Yes ❑ No ❑ Insulation in full contact with the ceiling, NO gaps. le i sses. (NA for torose fill or Yes No NA Insulation in contact with air barrier an all five sides. Loose -fill insulation meets or exceeds manufacturer's minimum weight and is s requirements for the target ❑ ❑ ® R -value. Target R -value. Manufacturer's tniniroum required weigh far the g t R•value (potutdv-per-square- Yes No NA foot). Manufacturer's minimum required thickness at time of inatallatlon. M acturaes minim= required settled thickness. Note: To receive oomplianee credit the HERS rater shall ri5y that the maaufiso u ccs minimum weight and thickness has been achieved for the target R -value. (N f r hatts or SPS. Registration Number: Registration Dare/77me: 2008 Residential Compliance Farms E•d SbES669916 XH3 13C83SH-1 dH Provider: March 2010 Wd9SrT OT02 06 des Batu cut to tit around wiring and plumbing, or split (delaminated). (NA for fill or SPF). Yes No NA ® ❑ ❑ Batts taller than the tosses must expand so that they touch each other over t le i sses. (NA for torose fill or Yes No NA SPF). ❑ ❑ E Yes NO NA SPF insulation properly adhered to avoid gaps and provide an air seal (NA r other forms of insulation) ❑ ❑ ® Insulation fully fills cavity below any plywood platform or cat -walk. If SPFsod then minimum Yes No NA 3 inches. A ifno platforms or cat -walks ® ❑ Yes No Attic access gasketed M ❑ Attic access insulated with rigid foam or ban insulation using adhesive or m ch4nical fastener. Yes No R -value same as ceiling Tit -value listed on CF -IR ❑ ❑ Recessed light ftxmres covered full depth with insulation. If SPF used then othke forms of insulation used to Yes No cover or enclosed in a box fabricated from '% -inch plywood. 18 ga. sheet m , A-incb hard board ordrywall ® ❑ Roof insulation same or better than what is listed on the CF -IR Yes No ® ❑❑ Loose Fill Insulation at proper depth — insulation rulers visible and indicatin pdoper dapth aced R-vahre for Yes No NA jblown In insulation. A for tons or SPF). ❑ ❑ 1 ® 1 Loose Fill Insulation oniforarly covers the entire ceiling (or root) area from o ide of all exterior walls. (N.4 Yes No NA far Mas or spm. I Loose -fill insulation meets or exceeds manufacturer's minimum weight and is s requirements for the target ❑ ❑ ® R -value. Target R -value. Manufacturer's tniniroum required weigh far the g t R•value (potutdv-per-square- Yes No NA foot). Manufacturer's minimum required thickness at time of inatallatlon. M acturaes minim= required settled thickness. Note: To receive oomplianee credit the HERS rater shall ri5y that the maaufiso u ccs minimum weight and thickness has been achieved for the target R -value. (N f r hatts or SPS. Registration Number: Registration Dare/77me: 2008 Residential Compliance Farms E•d SbES669916 XH3 13C83SH-1 dH Provider: March 2010 Wd9SrT OT02 06 des INSTALLATION CERTIFICATE ❑ CF -6R -ENV -22 -HERS In Installation II - Insulation Stage Checklist dievcrnge (Page 3 of 3 P, Sita Address: Lot 2 Enforcement Agency: NA Permit Number: ® ❑ ❑ SPF list the required ceiling cavity, R -value from CF -I R, R- . List tes dievcrnge depth of insulation_ Yes No NA in X 5.811=_ R this is the installed R -value end must be equal to or gre ter than listed on CF -1R (NA Tor other forms of insulation ❑ ❑ 13 SPF insulation must be covered with other forms of insulation or enclosed in a x fabricated from'h inch Yes No NA plywood, 18 gauge memo''A inch hard board or drywall. The exterior ofthe may then be vrsulered with SPF. ❑ ❑ 13 SPF insulation the average thickness is equal to or greater that that listed on a;CF-IR and the minimum Yes No NA thickness shall be no more than h inch less than the required thickness for tit Revalue. (NA for other forms of insulation ✓ GARAGE ROOFICEILING INSULATION FOR TWO STORIES no conditioned 5 e over ars e ® ❑ ❑ I I Insulation installed atjoists against the air barrier in the garage to house train I itipn. All wall 'insulation Yes No NA requirements above must be met (NA if conditioned space over garage). ✓ GARAGE ROOFICEILING INSULATION FOR TWO STORIES conditioned sp ce over garage) El ❑ ❑ If insulation is to be installed at subfloor then the insulation must also be inst ill4d atjoisw against the air barrier Yes No NA. in the garage to house transition. All ailing and wall insulation requirement i allove must be met. (NA if no conditioned svirce over garage). ® ❑ ❑ If insulation is to be installed at ceiling of garage then the joists to the outsidi to t be insulated and all the Yes No NA insulation requimm"ta listed above must be met. (NA if no conditioned spa44c er gam e). DECLARATION STATEMENT • 1 certify underpenelty of perjury, under the laws of the State of California, the infomtation prow • I have mad the High Quality Insulation Installation Procecares (Residential Appendix, RA3.5), ui understand that there are additional requiremenm than mum be met than those listed on this CF -61 • All rows in this document have been checked and all answers are yes or NA • 1 art eligible under Division 3 of the Business and Professions Code to accept responsibility representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on i conforms to all applicable codes and regulations, and the installation is consistent with the plans r enforcement agency. • 1 understand that a HERS rater will be checking the installation and that if such checking identifie wmctive action at my expense. If the installation is pan of a sample group far HERS verificalic the requirements of such quality assurance checking, additional checking/testing and repair of orb sample group will be required at my expense. I understand that the HERS provider, and Energy also be performing checks of the installation on jobs not tested by the HL•RS mter. • I reviewed a copy of the Certificate of Compliance (CF -IR) form approved by the enforcement al requirements for the Installation. I certify, that the requirements detailed on the CF -IR that apply • I will ensure that a completed, signed copy of this Installation Certilmste shall he posted, or permit(s) issued far the building, and made available to the enforcement agency for all appli that a signed copy of this Installation Certificate is nquired to be included with the docume. building owner at occupancy. I will ensure that all Installation Certificates will come farm a HI multiple orientation alternatives and on October 1, 2010, for all low-rise residential buildings. this form is true and comm. i d these procedures, and or an smhorized (the installation) ms approved by the cts, l am required to take the installation fails to meet illations in the HERS isslon reoresentariv+ev will that identifies the specific installation have been met. nallable with the building Inspections, 1 understand a the builder prmides to the rovider dam registry for Comptnry Nsmei (Installing Subcontracts or Geneml Contractorar Builder/Owner) Walldesign Inc. Responsible Peman's Nome: Responsible Pe ignature Fletcher Fasick CSLB License 449739 Date Signed:6. 7. 11 Posi[OI Wi omp y(Tit e jec Admin. 'Regtrrmrlon Number: Registration Dare Time: 1008 Residential Compliance Forms 4-d SbE96899I6 XHd 13CH3SHl dH Provider: March 1010 Wd9Sel 0100 OE JOS III OC 10 — olvl L j� INSTALLATION CERTIFICATE Spray/Loose fill) CF -6R -ENV -01 Envelope — Insulation; Rooffn ; Fenestration Manufacturer's installed weight per square foot to achieve (Pae 1 of 3) Site Address: Lot 3 Enforcement Agency: j 1 Permit Number: (rmore manone person nas responshaaryi4r tnstaaanon of Inc new on tins cernncate, each person. applicable to the portion of ronstn ction for which they are responsible: allerrrotively, the person with prepare and.sign this certiflicate for the entire construction. Ail applicable Mandatory.Neasures with Description of Insulation 1. RAISED FLOOR Material: Brand Name:_ Thickness (inches): Thermal Resistance 0 §I50(d): Minimum R-13 insulation in raised wood -frame floor or equivalent U -factor. 2. SLAB FLOOR/PERIMETER Material: Brand Name: Thickness (inches): Thermal Resistance (F Perimeter Insulation Depth (inches): 0 §150(1): Water absorption rate for the insulation material alone without facings is no grei rate is no greater than 2.0 pemt/inch and shall be protected from physical damage and UV li, 3. EXTERIORWALL 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 . s„ Contractor's min in: Manufacturer's installed weight per square foot to achieve Thermal Resistance (A 0 §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 4. FOUNDATION WALL Material: Brand Name:_ Thickness (inches): Thermal Resistance 5. CEILING Batt or Blanket Type: Batts Brand Name: Ceri Loose Fill Type: 1310wn insulsa a Thermal Resistance Spray Foam Type: Brand Name: Cer- Installed Actual Thickness (inches): Batt 10^/131ow 11.75^Contractor's min inst Manufacturer's installed weight per square foot to achieve Thermal Resistance (R - I3 § 15D(a): Minimum R-19 insulation in wood -flame ceiling or equivalent U -factor. 6. ATTIC ROOF INSULATION AND/OR ATTIC RADIANT BARRIER Material: Brand Name: _ Material: Brand Name: _ Thickness (inches): Thermal Resistance 0 § 118(a): Insulation installed meets Standards for Insulating Material. 0 § 150(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16 1008 Residential Compliance Forms I'd Sir6S689916 XBd 13Ca3SH"1 dH 6r construction shall to be checked to ennme water vapor permeance 13 30 August 1009 Wd9S:i 0102 06 daS a I Ouatitu Insulation Installation (OII1- Insulation Staee Checklist I ` (Paee I of 311 Lot 3 Overview —In order for ban and blown m insulabon to work correctly the insulation must with me gaps or voids. Ceiling and raised floor batt and blown in insulation must not be e no gaps or voids. QII Insulation ❑ Stage Checklist ✓ FLOOR INSULATION Standard depth cavities insulation fills cavity and touches air barrier on all six idgs. ® ❑ ❑ All floor joist cavity insulation installed to unifrmtly fit the cavity side-to-side ma� end-to-end. (NA if Hoon slab Yes No NA on grade) - All double walls and bump -outs, the insulation fills the cavity or additional air 13 Yes ❑ No Ij NA Insulation in full contact with the subfloor. NO gaps. (NA if floors are slab on g). insulation fills the cavity. Insulation touches all six sides. (NA if SPF used m ® Yes 1:30 No NA Insulation in contact with air barrier on all five sides. (ends, sides, back). NA fto, sare slab on grade. ® Yes ❑ No C1 NA Bans cut to fit around wiring and plumbing, or split (delaminated). (NA if loo a II, SPF, or slab on grade). ®s O p But insulation has continuous support. (NA if loose fill, SPF, or slab on grade). I not a single le void/de ression deeper than'/4" in ANY stud ba g p Pe y. (NA i to u fill or SPF) No a BATTS, voids/depressions less than 3/4" allowed as long as the area is not grt ate ❑ ❑ No SPF (Spray Polyurethane Fosm Medium Density) insulation the average Chic a is equal m ar greater than that Yes No NA listed on the CFA R and the minimum thickness shall be no mora than 'h inch I ss�tltan the required thickness for Yes No the R -value. A for other forms of insulation). Loose Fill no gaps or voids of any depth allowed (NA if butts or SPF). ❑ ❑ ❑ Insulation R -value scone or greater than listed on the CF -I R. Prof Y B D P (:JA for of SPF insulation erl adhered to avoid a s and provide an air seal Yes No No NA M ❑ [3 1 Any gaps between studs or insulation larger than 1/8" must be filled with insu ati Yes No NA SPF insulation properly adhered to avoid gaps and provide an air seal (NA foIt.on forms of insulation). ® ❑ U For SPF list the required floor cavity R -value from CF -I R, R-_ All Rim -joists to the outside insulated. Yes No NA List tested average depth of insulation (inches) _ X 3.8 (R-value/inch fordensity SPF) M ❑ (R -value). This This is the installed R -value and must be equal to or greater than Iii CF -IR (NA for other forms b/shower enclosures Yes No of insulation). insulated to proper R-Valuc. 0 ❑ U Standard depth cavities insulation fills cavity and touches air barrier on all six idgs. (NA if SPF wed and meets Yes No NA the uired R -value). ® ❑ ❑ All double walls and bump -outs, the insulation fills the cavity or additional air 'er installed so that the Yes No NA insulation fills the cavity. Insulation touches all six sides. (NA if SPF used m is the required R -value). El ❑ Behind tub/shower, walls under stairs, and fireplace, insulation touches air bar iffon flve sides. Not required to Yes No fill the space. Cavity required to be air tight. ® Yes ❑ No Q NAI I not a single le void/de ression deeper than'/4" in ANY stud ba g p Pe y. (NA i to u fill or SPF) ® ❑ a BATTS, voids/depressions less than 3/4" allowed as long as the area is not grt ate than 10% of the surface area Yes No I NA I for each stud bay. (NA if loose till or SPF). ❑ ❑ 0 Yes No NA Loose Fill no gaps or voids of any depth allowed (NA if butts or SPF). ❑ ❑ ❑ Prof Y B D P (:JA for of SPF insulation erl adhered to avoid a s and provide an air seal er forms of insulation). Yes No NA El 0 Any gaps between studs or insulation larger than 1/8" must be filled with insu ati Ia or foam. Yes ®❑ All Rim -joists to the outside insulated. Yes No M ❑ Special attention must be paid to comer channels, wall imersections, and behir d b/shower enclosures Yes No insulated to proper R-Valuc. ❑ a All skylight shafts and attic kneewalls insulated with minimum R-19. I Yes No N A 0 A Insulation in full contact with drywall or wall finishes of skylight shnBs and a 'c eewalls. z•d Registration Number: Registration NtaTime: 2008 Residential Compliance Forms Provider: March 1010 Si,ES689916 XHd 13Cb3SWl dH Wd99sT OTOS OE daS INSTALLATION CERTIFICATE CF -6R -ENV -22 -HERS nalib' Insulation Installation I/ - Insulation Stu a Checklist - (Page 2 of 3 Site Addrta: Lot 3 Enforcement Agency: Yes Permit Number. 11 El ❑ Nall insulation same or better than what is listed on the CF -1 R. I❑ Yes ❑ No Yes No if li>ose fill or SPF). ® ❑ ❑ ❑ ® SPF list the required wall cavity R -value from CF -IR, R•_. List t t d average depth of Yes No NA insulation (inch) _ X 5.8 (R-value/inch for medium density SPF) _ Yes (R -value) This is the NA NO gaps or voids allowed for loose fill and SPF. (NA if butts). installed R -value and must be equal to or greater than listed on CF -1 R Nle for other forms of All ceiling insulation installed to uniformly fit the cavity side-to-side and en -t insulation Yes No ❑ ❑ 13 SPF (Spray Polyumthane Foam Medium Density) insulation the averagethic ® Yes u equal to orgreater than that =required Yes No NA listed on the CF -IR and the minimum thickness shall be no more than 'h inch 13 required thickness for Insulation in contact with air barrier on all five sides. the R -value. A for other forms of insulation ✓ CEILING INSULATION I❑ Yes ❑ No BATTS there must not be a single gap/void/depression deeper than''/.". (NA if li>ose fill or SPF). ® ❑ BATTS voids/depicssions less than 3/4" allowed m long as the area is not gi eat r than 16%afthe surfacearea Yes No for each stud bay. (NA if loose fill or SPF). Yes C3❑ No NA NO gaps or voids allowed for loose fill and SPF. (NA if butts). ' � ® ❑ All ceiling insulation installed to uniformly fit the cavity side-to-side and en -t end. Yes No ® Yes ❑ No Insulation in full contact with the ceiling, NO gaps. 13 13 Insulation in contact with air barrier on all five sides. ❑ ❑ ® Batts cut to fit around wiring and plumbing, or split (delaminated). (NA for a fill or SPF). Yes No NA El ❑ ❑ Batts taller than the trusses must expand so that they touch each other over 9 a sses. (NA for loose fill or Yes No NA SPF). ❑ ❑ E Yes No NA SPF insulation properly adhered to avoid gaps and provide an air seal (NA r other forms of insulation) ❑ ❑ ® Insulation fully fills cavity below any plywood platform or catwalk. If SPF then minimum Yes No NA 3 inches. A if m plarthimis or cot -walks ❑ Yes No Attic access gaskcted ❑ ❑ Attic access insulated with rigid foam or ban insulation using adhesive or mt chA nical fastener. Yes No R -value same as ceilio R -value listed on CF -IR ® ❑ Recessed light fixtures covered full depth with insulation. If SPF used then othe forms of insulation used to Yes No cover or enclosed in a box fabricated from'h-inch plywood, 18 i sheet I, /4 -inch hard boarricadrywall ® Yes ❑ No Roof insulatirm same or better than what is listed on the CF -IR ® ❑ ❑ Loose Fill Insulation at proper depth — insulation rulers visible and indicatin pioper depth and R -value for Yes No NA blown in insulation. A for bats or SPF . ❑ ❑ ® Loose Fill Insulation uniformly covers the entire ceiling (or roof) area tram ide of all exterior walls. CNA Yes No NA far bens or SPF). Loose -fill insulation meets or exceeds manufacumn's minimum weight and I i f ss requirements for the target ❑ ❑ ® R -value. Target R•value. Manufacturer's minirotm required weight for the g t R -value (pounds-persquare- Yes No NA foot). Manufacturer's minimum required thickness at time of installation. 'N u actumes minimum required settled thickness. Note: To receive compliance credit the HERS rater shall v trily that the manufacturers minimum weight and thickness has been achieved for the target R -value. (N fdr batts or SPF). Registration Number. 2008 Residential Compliance Forms Regfsrrwion Dare?tme: E•d StiES6699T6 XU -:1 13CiN3SH-1 dH Provider: March 2010 Wd9S:T 010a 06 des INSTALLATION CERTIFICATE 1 ! CF -6R -ENV -22 -HERS ual' Insulation Installation II - Insulation Stage Cbeeldfst (Page 3 of 3 Sile Address: Lot 3 Enforcement Agency: 1 1 1 Permit Number. ® ❑ ❑ SPF list the required ailing cavity R -value from CF -IR, R- . Listacsiediaverage depth of insulation Yes No NA in X 5SR =_ R this is the installed R -value and must be equal to or gre than listed on CFAR (NA for CSLBLicense 449739 other forms of insulation Position With Company( t ) Project min. ❑ ❑ ® SPF insulation must be covered with other forms of insulation or enclosed in fabricated from' inch Yes No NA plywood. IS gauge metal, Y. inch hard board or drywell. The exterior of the t( may then 6a insulated with SPF. ❑ ❑ ❑ SPF insulation the average thickness is equal to or greater than that listed on aIICF.IR and the minimum Yes No NA thickness shall be no more than K inch less than the required thickness for th Ri valva (NA for other forms of insulation ✓ GARAGE ROOF/CEILING INSULATION FOR TWO STORIES no conditioned spice over ra e ® ❑ ❑ insulation installed at joists against the air barrier in the garage to house trop iti n. All wall insulation Yes No NA requirements above must be met (NA if conditioned space over garage). ✓ GARAGE ROOFICEILING INSULATION FOR TWO STORIES conditioned s e ver garage) M ❑ ❑ If insulation is to be Installed at subfloor then the insulation must also be inta ill at joists against the air barrier Yes No NA in the garage to house transition. All siting and wall insulation requirement a ove must be met. (NA if no conditioned space over a e. ® ❑ ❑ If insulation is to be installed at ailing of garage than the joists to the outsicit in t be insulated and all the Yes No NA insulation requirements listed above must be met. (NA if no conditioned spa4e cover garage). DECLARATION STATEMENT • I certify ander penalty of perjury, under the laws of the State of California, the information provid :e qn this form is true and correct. • I have read the High Quality Instdalion Installation Procedures (Residential Appendix, RA3.5), u II e4tand these procedures, and understand that them are additional requirements than must be met than those listed on this CF -6R • All news In this document have been checked and all answers are yes or NA • I am eligible under Division 3 of the Business and Professions Code to accept responsibility orjconstrtrction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices Identified on d is tcrtifiate (the installation) aaforms to all applicable codes and regulatiomi, and the Installation is consistent with the plans ai A specifications approved by the enforcement agency. • I understand that a HERS rater will be checking the installation and that if such checking identifi defects, I am required to take anctsive action at my ezpcnse. If the installation is part of a sample group for }TEASverifiatio the installation fails to meet the requirements of such quality assurance checking, additional checking/testing and repair of r t lations in the HERS sample group will be required at my expense. I understand that the HERS provider, and Energy orrimisslon representatives will also be performing checks of the installation on jobs not tested by the HBRS rater. i • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by Ute enforcement ag that identifies the specific requirements for the Installation. I mrtlfy that the requirements detailed on the CF -IR that apply 1 Ithe installation have been met • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or i mile available with the building permit(s) Issued for the building, and made available to the enforcement egracy for all appllae Inspections. I understand that a signed copy of this Installation Certificate is required to be included with the doeumt tIla a the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a Slprovider 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 BuilderlOwter) walldesign Inc. Responsible Person's Name: Responsible ?coon's ' attar Fletcher Fasick CSLBLicense 449739 Date Signed:6.7. 11 Position With Company( t ) Project min. Registraflon Number: Registration Dafe/fime: 2008 Residential Compliance Forms b.d StES6899T6 XUA 1317a3SH3 dH Provider: March 2010 Wd9S;l OTDZ 06 daS