HomeMy WebLinkAbout021-070-089i
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.1 OK
O=Not OK
Not Applicable MOBILE HOMES
'
Not Ready � .
Date MOBILE HOME UTILITIES (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Soils; Special MH Support Sketch
3. Sewer; Location -Test -Fall -C/O Concrete
4. Water; Location -Test -Easement Needed (Sketch)
5. Electricity; Location-Clearences-Grnd-/ /Amp -Concrete
6. Gas; Location -Test -Wrap: / P'L"ft.
/ /"Nat. or/ /"L"ft./ /"LPG
7. Well Clearance & Disconnect
8. Utility Clearance
Date _ Card B-1 Date Card B -1 -
Date Card B-1 Date Card B-1 ."•,
Date MOBILE HOME INSTALLATION (Plans) OK except #'s j
J. Zoning Requirements -Setbacks Easements 1J
2. Footings; Size -Spacing -Marriage Line -
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fall -Flex Connectorl
6. Water; MH Test -Regulator -Connector
7. Water and Sewer Connected -C/O to Grade -HD Approval
8. Gas and Electricity Tagged
9. Exits; Insp.-Sketch v
10. Cert. of Occupancy
Date Card B-1 Date Card 6-•1
Date Card B-1 Date Card B-1 `4
,T
MISCELLANEOUS
Date DECKS, COVERS, CARPORTS, GARAGES, (Plans)OK except #'s
1. Zoning Requirements -Setbacks -Easements
2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel
3. Decks; Griders and/or Joists -Decking -Bracing -Stairs -Rails
4. Wood Awn.; Posts- Bea ms- Rftrs.-Connectors
Shthg.-Rfg.-Bracing
5. Alum. Awn.; Columns -Connections -Splice -Decal -Enclosures
6. Carports; Windows -Doors
7. Electric
8. Frmg; Sils-Anchors-Studs-Rftrs-Trusses
9. Siding; Nailing -Veneer -Stucco -Mesh
10. Roof; Shthg-Roofing
11. Ext.; Steps -Doors -Landings
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date POOLS (Plans) OK except #'s
1. Setbacks -Easements
2. Soils; Compaction -Structure Stability
3. Pool Structure; Steel -Connections -Thickness
Dead Men -Lining
4. Elec.; Receptacles and Lighting, Distances-GFI
5. Elec.; Pool Lighting; 15 volts-GFI
6. Elec.;Enclosures; Conduit Entries -Terminals -Listed C f
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8. Elec.; Grounding; Equip. w/5' Circulating Equip.-Pool'Lgntg.
_
Boxes-Enclosu res-Panelboards- Ins. to Main in Conduit
9. Health Department Approval
10. Plumb.; Cir. Test -Water Supply Test
Date Card B-1 Date Card B-1
Date Card B-1 Date Card B-1
J=OK
O=Not OK
=Not Ready
RESIDENTIAL
' =Not Readdy
Date Up6ERFLOOR (Plans) OK except If's
1. ning-Setbacks-Easements-Flo d -Slope
Main; Soils-Elec. Grnd.-/ f V`Ffg.. Depth
3. Fig., Garage; Soils-Steel-Elec. Grnd.- " Ftg. Depth
4. Fig.. Porches & Decks; Soils -Steel-/ tg. Depth
5. Stemwalls, Main; Steel-Blockouts-Wrapped
6. Stemwalls, Garage; Steel-Blockouts-Wrapped
6a. Hold Downs and Special Anchors
7. Slab; Steel -Wrapped
8. iers-Fireplace Ftg.-Steel
L.49. D .V.; Fall -Fitting -Test- C/O -Sewer Test
UF. Gas Pipe; Size -Anchors - yard gas piping: size -w
i/ . Water Pipe; Test-Anchor-Regulator-Servicel�t
-•E4ectric; Underground -�
enums & Ducts; Clearance -Material -Support -Ins.
. Gi ders-Sills-Anchor Bolts -Joists -Vents -Cripples
l 5. Access & Ventilation
16. Insulation
Date - Card 13-1 Date Card B-1
Dat (Card B-1 Date Card B-1
Date PLUMBING (Perm t),OK except ti's
16. Water Htr.: Vent -Access -Combustion Air -Baffle
------- ---------------------
-----
Water Pipe; Test &Anchor -Nail Protection-
-V.: Test -Fittings & Anchor -Nail Protecti(
)ower Pan: Test. First Floor -Tub Access
b & Shower, Second Floor -Tub Access
1. Gas Pipe: Size & Anchors
N
Date - - -Card B_1 --- Date - Card B_1
Date Card B-1 Date Card B-1
Date -fA-ECTRICAL (Permit) OK except H's
---- 22. F' ture & Transformer Clearance -Ins. Protection
-- 3. E�lec. Receptacles Spacing -Lights _& Switches at Doors
-- i/t4. Size Boxes & No. of Conductors -Stapled
e_x_ Installed Close to Edge of Studs & C.J.
---------- --------------------------------------
-- - - - - - - -
- ---
--- - - --- ----- - --- --- - - --- --- --- ------ --
6. E round made up w/Meth. Fastners-Bond Gas & Water
------- ---------------------------------------------------------------
7. 2 Appliance Circuts in Kitchen & Conductor SizerGFI
-----------------------------------------------------
28. Subfeed Wire Size / r ga. Cu or AI-A.C. Wire Size ga.
Cu or AI
-------------- - ---------------------- ----- -- ------ ----------- ---- ------------ - ---
29. Range Circ. / ga. Cu or AI -Oven Circ. / / ga. Cu or Al.
�In ulated Neutral ❑ Yes ❑ No
X50. -w 2 -Riser Conductors & Ground -Main Disconnect
-------- -------------------- -- -- -
-----------------------
1. p. Clearances Panels-Motors-Mech. Equip.
-------------------------------------------------------------- -
3elothes Closet Light -Shower Light -Spa Light
------------ ------------------------------------------------------------------
33. Smoke - Detector
--------------------------------------------------------
------------------------------------------------------------------------------
Date Card B-1 Date Card B-1
---------------- ----------------- -- ----------------------------------- -----------
Date Card B-1 Date Card B-1
Date M HANICAL (Permit) OK except u's
Ducts insulation & Support
--------- --- -----------------------------------------------------------------
ent Fan: Exhaust above insulation
.......... 36. ensate Drain & Overflow: Size & Grade
Furnance-Vent: Access -Comb. Air -Return Air Vent -115 outlet
- - ------------------------------------------ - -
c Access & Platform if Furnance in Attic
-------------------------------- - -- - --- --- ------------------------ --------- --- -
Date Card B-1 Date Card B-1
---------------- ----- - ----- - ----------------------------------------
Date Card B-1 Date Card B-1
Date FRAMING (Plans) OK except a's
ils. Proper Material & Anchors
40. alts Studs -Nailing Spacing & Bracing-Plates_Sound----
---------/-�-{-V---------------------------------- - -
L/ Bearing Walls over Girders & Floor Nailing
----- 4 raft Stop in Walls (rat proof)--------- - - -- ------ - -- -- --
---
-- - ----- - - -- -----------------------------------------------
4 ire Stops: Furred Ceilings -Stairs -Chases -Tub
-- -- - -------------------- -------------------------------------
44. Headers & Beam -Size & Bearing
(Single & Duplex)
Date /FRAMING (Continued) `
45. Hangers -Post Caps -Anchors -Connectors
Ing. Joist-Rftr. ties-Purlin-roof Brac-Truss-Shthng.-Rfng.
eplace Ties or Type A Flue -Fireplace Throat clearance
48 Attic Access; Size & Romex Protection -Draft Stop -Ins. Baffles
drm. Windows or Exiting Doors -Sill Hgt. & Dimensions
- 50. rage Fire Protection Framing
LProperty Line Firewall & Openings
xt_Doors-One -3'-Check Garage -3rd Story, 2 Exits
_ I 5 Stairs -Width -Headroom -Rise -Run -Landing -Fire Protection
on Roof Overhang -Attic Vents -Rafter Outriggers
______ _ ailing Veneer . I
-- __ ucco Mesh -Drip Screed -Fd. Vents -Under r. Access
zing Area -Glass Protection-Skylights-ESlasticj'
___ 5_8.Enfiltration-Walls-Winclows
ails: Nailing -Bolts
---- 9.9. n -Walls -Ceilings J�- `i60.
Date /ard B-1 Date Card B-1
Date Card B-1 Date Card B-1
Date FINAL (Plans) OK except N's
->� Ext. Steps -Door & Sidelight Protection -Landings
--b[. Smoke Detector
3. Furnace: Vents -Clearance -Comb. Air -Connector -
In Garage: Above Floor -Ducts -Meth. Protection
-------------- -------- -
64.
Bedroom Exiting
G F.I_& Bath Fixtures & Tub Access -Spa
t- 66. Elec. Trim & Subpanel: Breaker Sizes & Labels
�-4:-Sl .s & Rails
------- --- -- ---- -- -------- -
68. Fireplace or Stove: Clearances -Hearth
lec. Outlets at Wood Panel: Int. & Ext.
Kit.Fixt. & Appliance; Grnd.-Air Gap -Cooking Clearance
71. Elec. Outlets & Receptacles at Kit. Counter --
72. Garage Fire Door_Swing-Landing-Closer
V 73. A.C. Duct in Garage -Damper
---' -- --- --------------- - -
74. Wtr. Htr Vents -Clearance -Comb. Air-Connector-P.R.V.
In Garage: Above Floor-Mech. Protection
Ib.. Flet. & M_ech._Equip. Listed for RLocation
LJ
76 lec. eceptacles in Garage; (G.F.I.)-Romex Protection
- ✓77. Insulation -Foam -Looked in Attic 'Yes
78. Guard Rails & Deck Construction -Post Caps
�dn Vents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor
---------------------------------------------
�BlrFollowing instld.: Drive es ❑ No; Walks s ❑ No;
Planters ❑ Yes No
---------------- - ----
ucco Brown -Finish
- - 82A.C. Unit: Disconnect_ Electrical, Plumbing
--
s Above Roof: Plbg.-Appliance-Fireplace.-Clearance to
penings
- 84. Water Well: -Disconnect, Electrical, Plumbing _-
Exterior Elec. Trim: G.F.I. Receptacle -Underground
- ---
d6. Ventilation Throughout House
- - - - --- --------------
-------------- -
_ ass Protection
- 88. Corrections from Previo s Ins ectio -
89. est -Meters T ged s- tnc jL ` O
--------
ater &Sewer Connected -C/O to Grade -HD Approval -
Energy Compliance Certificate -Other Certificates
- --------------
Date • �j ard 1 Date _ _Card B-1
J
Date.;R�:2-�,�'j ward B_-��-- Date Card B-1
Date Card B-1 Date Card B-1
Comments at Final:
,�,,;..,�: �•;iv'r-,irL...�=.-::-�-..;=ray,,..
COUN-TY OF. BUTTE
DEPARTMENT OF PUBLIC WORKS '
196 Memorial Way, Chico'—, -Phone: 891-2751 '.
7 County Center Drive, Oroville_'— Phone: 538-7541
747 Elliott Road, Paradise— Phone: 872-6307
CORRECTION NOTICE
VILER PERMIT NO.
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter,or need additional explanation, please contact this office immediately.
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,�f COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico.— Phon.e.:_891-2751 .G
7 County Center Drive, Oroville — Phone: 538-7541
747 Elliott Road, Paradise— Phone: 872-6307
CORRECTION NOTICE
ltd �?7 ?(
R '
OWNER PERMIT NO.
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
matter, or ne "additional explanation, please contact this office immediately.
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Date � / —�/ "" Inspector
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751:
7 County Center Drive, Orovlle — Phone:. 538-7541
747 Elliott Road, Paradise Phone: 872-6307
CORRECTION. NOTICE
OWNER PERMIT NO.
A routine inspection indicates that the following violations of County Ordinance
exist at the above address and should be corrected. Please notify this office
when correction of work is completed. If you have any question pertaining to this
m e ,jengeQcdl additional explanation,please contact this office immediately.
a
,
ss
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I
Date D v�` Inspector dola/��
Owner _ Permit No
_
NERGY CERTIFICATI-ON--
LOCATION A. P. NO. --
DESCRIPTION
OF INSULATION
—
ROOF
-
MATERIAL
BRAND NAME
-
THICKNESS
THERMAL RES.
EXTERIOR WALL
�-
MATERIAL BERGLASS
BRAND NAME
FRTAINTEED-
THICKNESS '
THERMAL RES.
-
CEILING
BATT OR BLANKET TYPE-FiberglasBRAND NAME
RTAINTEED -
THICKNESS /all
THERMAL RES.
O ---
LOOSE FILLTY �/ INSUL-SAFE IIIBRAND NAME C
TAINTEED
THICKNESS /�/Z��
THERMAL RES.
O
FLOOR,ELEVATED
-
MATERIAL FIBERGLASS
BRAND NAME
CERTAINTEED - - -
THICKNESS
THERMAL RES.
FLOOR, SLAB
--
MATERIAL
BRAND NAME
THICKNESS
THERMAL RES.
WIDTH
FOUNDATION WALL
MATERIAL z
BRAND NAME
-
THICKNESS Z.
THERMAL RES.
-i,
I HEREBY CERTIFY THAT THE ABOVE
INSULATION WAS
INSTALLED IN THE ABOVE
BUILDING IN CONFORMANCE WITH THE
STATE OF CALIF.
ENERGY REQUIREMENTS.
. SHASTA INSULATION INC. #622184
FIRM NAME OWN STATE CONTR.-LICENSE NO.
I hereby certify the above insulation .and all required items as shown
on .the Building Depart. approved plans and attachments have been installed
as required by the State of California Energy Requirements. -
All equipment, devices and materials are of the quality prescribed or
are specifically approved by the State of Calif. ci pG
FIRM NA I /UWN . ( PLEASE PRINT) STATE CONTRACTOR'S I_I (TXSF N0.
S ;NAtrIFRI: OF GENERAONYACTOR/OWNER 1)ATF. _
This certificate must be on file with the 1,I11L1)ING 1.1.1•AR'1'"11:x'1' prior io-
final inspection approval and. a copy shall be -posted b'ithin the building.
.IANI'ARY I "S4
1
A COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville. California 95965 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PERMIT NO.
2277-91
ASSESSOR PARCIEL NUMBER •
•
ZONING
A-5
i- . -"`' BUILDING PERMIT
OWNER
TELEPHONE
846-5116
$O, FT. OCC.1 BUILDING VALUATION
LOCO R 94,758
OWNER'S MAI ING ADDRESS
GRIDLEY CA
601 M 10,818
CONTRACT R'S NAME
TELEPHONE
145 C 1,885
CONTRACT 'S MA LING ADDRESS
Fireplace VA" 1,500
CONSTRUCTION LENDER
UNKNOWN
Total Valuation $ 108,961
Filing Fee $ 10,00
LENDER'S IN A S
Permit Fee $ 455.
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $ . 22T. 75
Energy Plan Checking Fee $ 15.0
AR CHI TEC NGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESS
A 95948
Permit fee $ 708.25
PLUMBING PERMIT Filing Fee 10.00
Each Trap 8 2.00 16,00
Solar or heat pump water heater 20.00
LOT N
SUBDIVISION NAM
,A✓ (
PARCEL M
Water piping 5.00 5.00
Each qas water heater or vent 5.00 5.00
USE OF ST UCTURE
SFU Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets 5.00 5.00
Building sewer 5.00 5.00
Mobile Home I S I G JW 1 10.00ea
TYPE OF WORK
NewKR Addition[] Remodel❑ Utilities [:1 Installation❑ Other❑
Describe work: 3' BDRM _
Permit Fee $ 46,00
Contractor
ELECTRICAL PERMIT Filing Fee 10.00
Main service 600V OR LESS 10.00 10.00
100 AMP OR LESS
Main service EA. ADD'L 100 AMP 2.50 2.50
CONTRACTORS LICENSE LAW
I declare under penalty p I y (check One):
of perjury
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions -Code and my license is in full force and effect.
License No. Classification.
El I, as the owner, or my employees with wages as their sole compen-
sation, will. do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
Xr I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. DWELLING OCCUP.R1
OR ADDNS. ACC. BLDGS. /20sgft 61.45
NEW R CONSTULT"OUTLET
NON.RESID BRANCH CIRCUITS) 2.50 ea
I POWER APPARATUS tr
SINGLE OUTLET CIR. )
Ex. Occup( 200sot
P OUTLETS OR FIXTURES eALO 30
FIXED APPLNS.
EX. Occup. OUTLETS (RESID )KEA.) 2.00
Temporary service 10.00 '
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $ 93.95
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ 1 have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
(V' I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT FiIingFee 10.00
Heating SPLIT SY-ST94 6_00
i
Cooling 32
Hood 3.00
Ventilation 2 1 6.U_U
permit Fee $ UU
'
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against,41[
all liabilities, judgments, sts, and expenses which may in any way accrue
aga' said County in c nseq nce of the granting of this permit.
X Date ?
Signature of Applicant - Owner ® Contractor ElAgentwork
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
n of stuctures over 3 stories in height.
i27
Mobile Home Installation Fee $
Energy Inspection Fee $ .
o c
-3
cgNSWE
TOTAL FEE $ 9 .20
CUA PARK
SCHL
I
FLJ�
lr/
yC`DF
PA
PD/l
HD
Issu
This permit is hereby issued unser the applicable provi-
sions of the Butte County. Code and/or resolutions to do
indicated abov for which fees have been paid.
DI E OR F PU LIC WORKS
!�
By DteITC-D.
PER IT EXPIRES ate
�Receipt`No.511 2g7.75 gi>7(0- i/J1.;
P. W.. YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT
f
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Orovllle, California 95965 - Talephone: 016/538-7541
APPLICATION AND PERMIT
PERMIT NO.
��
ASSICSSOM L R
N N _s
BUILDING PERMIT
OWNILM
2N/VrS o�et2
MONS
g��(D_Si/(o
SO. FT. OCC. BUILDING VALUATION
OWNER'! MAI I 7 ACORMSS
l Ll0 R1e-Y1b 57 C,
58 L
CONTRACTOR'S NAMETELEPHONE
00<1 OWE
l q5 C,
CONTRACTOR'S MAILING ADDRESS
Fireplace
CONSTRUCTION LENDER
S"' AC 6AU00
UNKNOWN
Total Valuation $
LENDER'S MAILING ADDRESS
ARCHITECT OR ENGI�N�EEER LICENSE NO.
Al e
Filing Fee
$ 10.00
Permit Fee
Plan Checking Fee
$ L D
$ A5Z - 5
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Energy Plan Checking Fee
$ 15-00
Penalty
$
BUILDING ADDRESS
5p � e1� jt S o,49 eQ r't'
c�
Permit fee
$ U9•.?
exs 1B
PLUMBING PERMIT
Filing Fee 10.00!�'
Each Trap
2.00 QGt
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME PARCEL MAP
Water piping
5,00 S•oc
Each qas water heater or vent
5,00 qp
USE OF STRUCTURE
SF.2 Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00 5.
Building sewer
5.00
Mobile Home S I IS I W
10.00 ea
TYPE OF WORK
Newig Addition [I Remodel❑ Utilities❑ Installation ❑ Other❑
Describe work:
Permit Fee
$
6o
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00%
Main service 8000 AMP V OR LESS
10.00 Jo. 00
CONTRACTORS LICENSE LAW
1 declare under penalty of perjury (check one):
❑ I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification,
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
El 1,
I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ 1 am exempt under Sec. Business and Professions Code
for this reason
Main service EA. ADD•L 100 AMP
2.50 C
NEW CONST. DWELLING OCCUP.a1
OR ADONS. ACC. BLDGS.
/20SQft
NEW CONSTR. MULTI -OUTLET
NON.RESID BRANCH CIRCUITS)
2.50 ea
POWER APPARATUS e1
SINGLE OUTLET CIR. /
Ex. OCcu OUTLETS OR FIXTURES
p
z0090t
eAL930t
F9
Ex. Occup. OUTLETS FIXED P(RESIO )REA.)
1 2.010
Temporary service
10.00 Q -00
Home Facilities
15.00
Misc. Wiring
g
15.00
Permit Fee
$ 13. 2-5
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
Provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heating 5,'-T
Cooling c3 2-
0,00
Hood
3,00
Ventilation�b
Permit Fee
$
Contractor
Mobile Home Installation Fee
Energy Inspection Fee
$
$
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
XThis
Signature of Applicant — Owner❑ Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 33 stories in height.
occ
CONST TYPE
TOTAL FEE $ 1 �-I•Z�
HAz CUA I PARK scHL FLITcoF PMD• ISSUE
I I I iAR i PO �I t
permit is hereby issued unser
sions of the Butte County. Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Date
the applicable provi-
resolutions to do
have been paid -
WORKS
Date
/+
Receipt No. q<1511-6102�P-c
WNITC-O.P.W.. YELLOW- ASeCS70R. PINK -INSPECTOR. GOLDENROD-APPLICANr
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COUNTY OF BUTTE - DEPARTMENT OF PUBLIC'WORKS - BUILDING DIVISION 2,92-75
i 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965 - TELEPHONE: 916/538-7541
PERMIT APPLICATION DATA SHEET.
Permit No.
OWNER-�%� L�'A//�LS�Zalpd_ A. P. No. 0 7 0'�
Proposed Building Use WDA, Building Inspector _F�Date 7
At time of permit application, I was advised the following data must be submitted prior to permit processing and/or issuance:
DATE RECEIVED APPROVED
1. All items have been submitted. ..........
2. Plot plans in duplicate/triplicate, signed by preparer of plans ....... .
3. Complete plans in duplicate/triplicate, signed by preparer. of plans . .
4. Complete engineered -plans and calcs, with wet signature on plans ..
5. Hazardous Material Form ........................................
6. Energy Design'Compliance and supporting documentation .........
7. Statement of Intent for Non -Heated and AC Buildings ..............
8. Engineered truss details and layout in duplicate (required prior to plan check) 7 Z!5ql i
9. Mobilehome installation data including manufacturer's installation
instructions.
10. Fees of $ . ..
11. Chico Urba Area fees p ad .......................................
12. Park fees paid ..............
—� 13. Grp d I2`! School District fees paid .............. -�
4. Sanitation approval from Q eyOt11e Health Department
15. City of Chico plumbing permit .....................................
16. Plot plan and business license approval from City of
(see City for other requirements)
17. P ning approval for (A) Use: (B) Parking:
provements may be' required. Contact Land Development Section DPW rY SOL f d f',
Driveway permit (construction approval required prior to occupancy) V- 7- /
20. Pre -Inspection for required Pre-Inspec. request to
Building Inspector (Date)
21. Contractor's license information (No., Name Style, Classifications ...
22. Certificate of Workmans Compensation Insurance ..................
23. Owner -Builder Verification (Given to owner ❑, Mail to owner ❑) .....
24. Recorded copy of Agricultural Acknowledgment Statement .........
9�. I o41or of oinn�4ro o�h..ri��ti...,
a I to own6wr `p
(39=0 office
Deliver w/inspector.
✓ �/� '� 2'l8�?� Applicant4._ �� Date 718191.
F
Copy of Haz-Mat form sent Health Dept. Fire Dept. Air Pollution Date
Copy of plans sent Health Dept. Fire Dept. Other Date By.
The following.data must be submitted prior o pe�
ssuange: irclel,� item not checked above).
1. Index permit for above items No.
2. Additional items required:
Contractor, designer, owner, was advised of above required data by—phone ail counter by date
Contractor desi er, owner, was advised of above required data by—phone—mall
Plans (gec by s�S Date57;!43 Plans approved by ?
by date
Date
Sets of plans on hold ino�I —File
�jcabinet
-. l AP folder / Y
Copy—DPWu
TO 24�' lino Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
_P ✓1 /S �� AP #
Owner Location
Plan Approved for: Sewage Disposal Water Supply
Water Supply
Hold final for:
Final clearance O.K. for:
Water Supply
Clearance for _a bedroom mobi home. Other
NOTE x:
Dat®
Sanitarian
TO: Building Department
FROM: Encroachment Permie §ection
RE: Driveway'`Clearance
$ 1 •pi`s ��/c � 2,(-07D -O�y
owner
location AP #
Driveway permit %/ a Q 7 has been issued for the above property.
date
si ature
,��,yy.o .: ..: .....r.�r. _ cy.,,u-..... ,--:r�,."a+is7w'�`^c.?�arsru1�,yfY"fUi61c'._o,w,,.. -t-...---*,�_ ,-��.�.--....ryv ". ai rrdw v+--..;-.P.s.F+o'a-`W '$wn';r•!:w.s`*1s,R.y�rta►F"'t:�"'N�6+'=
BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
(One,Form per Building)
A.P. Number (��Building Department_ N.o.
C School District '� City County Jurisdiction,
Property Owner N 11% S
Project Location/Address -�. Z /S&LeWL�s: o�k
6 Q/ C�-
Subdivision Lot Number
Residential Development: I��p
Sq. Footage Q
# of Living MHI Addition (Group R)
Units
Commercial/Industrial: 0 Sq. Footage
;. New. Addition (Including Exterior
t Roofed 'Areas)
Building Department Representative Date
(.Floor Plans'reviewed�by School District Personnel)
District Id No.
School District certifies that
(Applicant Name) (Phone Number)
(S�Address)
.574 ,...
(City) (State) (Zip Code)
.has complied�wi-th the requirements of Resolution No.
bythe payment of $ S v representing, j,�S square feef.
r .1- 9
School istrict Representative Dc1te
PAID BY CHECK NO. REMARKS:
BANK NO_bb V Ig,1'J 12-
PAID
2PAID BY CASH
white -applicant, .yellow-biuil.ding department, pink -school district
SCHOOL.FEE (8/88)
.`
�
�
�
�RESIDENTIAL PLAN CHECKING GUIDE
l2/gO
(S
' ' -
,
,
jl_�A/�
BIdQ. Permitu°mEu
_ A. P..
Plan
Checger.
GENERAL
0-__�onin
` requirements: (aideyarda and number of�permifted living units
luation.
�ns signed by designer.
Pro
description of work on application.
^�^ ' '
fees, Health, Developer Feee,.Liceoae law, etc).'
PLOT PLAN
'
parcel size and dimensions.
Setbacks, aideyorda, easements, etc.
.� - --_~'
��---- ---_-.,
Special conditions on creation map, (ooioe, ' CDF,-fire-sprinklers,. - non-comb-
ustible, '
. ootible, aod fouodotiouo)--�
'
l,
FLOOR
< ^
,
V�omplete -to scale plan with -dimensions.
°.
equired windows for light and ventilation (Sec.,1205j.
'
m�(Sec.
4�ylights (Chapter 34 & Sec. 5207).
impact glass (Sec. 5406).
' ed room sizes, ceiling heights (Sec, I207)^ '
V. in baths,'garage, kitchen, and exterior outlets (Article 2I0-8). '
V Light fixtures, switches, receptacles, and exterior receptacles for main-' '
teoaoce of mechanical equipment.
9� Locations of water. heater, heating cooling equipment, other eIectzi*aI
or gas equipment.
firewall, c. 503(d)[3)).
zz t door (sec. 3304 ���.
wood stove location, alcoves,'�'' and clearance.
t�_Plumbing.fixtures,
ectoro (Sec. l2lO). water closet clear' eo and shower ai�. .
.
^
Ar.
Standard bracing or engineered design (Table 25V)
^^
,Flo,r cons ' truction details complete enough to Foundation plan complete enough to construct building.
construct cy
------'evations and wall construction details complete ��'
ub to construct buiIdiogof
,
construct_,Roof construction details complete.enough to building.
x1_� &ry^
e 5-
`__~ ~a^aa4~~~^ or v"^c^^ bearing
uizes,
lQ.v�tud heights.
'
~ '
o.
. -`-----� _- SIL r,-.
12/90
RESIDENTIAL PLAN CHECKING GUIDE
MISCELLANEOUS.ITEMS TO LOOK OUT FOR
4�. Stairway details: landings, rise and run, head clearance, handrails
(Sec. 3306).
• )•
:St��Pfoper roof pitch for roof convering•(Chapter 32).
3iyy// Roof covering type
t 36" halls and stairways. .
e
lnc� lt(ji n���i2^ �l l c o,+rl nnctc atr
--"Ittic access and ventilation (Sec. 3205).
1 U mebusfloor access and ventilation (Sec. 2516).
,Cation air for fuel burning appliances - L.P.G. requirements.
nergy design. ()/,�/�c%/�%CP 51
. Flashing at all exterior openings.
1 ts.
,,
a
�� �£� �
i �` S
+ �.
t
C �S£ � - L'/S�� �s✓�
�y ����
r
� � ��..
� �� . ,
��, _ � 1
S__._. .._._..__...-... ..J
/ COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Oroville, California 95965 - Telephone: 916/538-7541 2277-91
APPLICATION AND PERMIT
ASSESSOR PA L NUMBER
ZONING
A-5
BUILDING PERMIT
OWNER
TELEPHONE
846-5116
SQ. FT. OCC. BUILDING VALUATION
1858 R 94,758
R'SMAI ING ADDRESS
RIDLEY CA
601 M 10,f8118
CONTRACT R'S NAME
TTN
TELEPHONE
145 C 1,885
CONTRACT 'S MA LING ADDRESS
Fireplace ?A" 1,500
CONSTRUCTION LENDER
ARMS
UNKNOWN
Total Valuation Is 108,961
Filing Fee $ 10.00
LENDER'S §TAN91N AAA
Permit Fee $
ARCHITECT OR ENGINEER
LICENSE NO.
Plan Checking Fee $ 227.75
Energy Plan Checking Fee $ 15.0
AR CHI TEC 019NNGINEER'S MAILING ADDRESS
Penalty $
BUILDING ADDRESS
95948
p
Permit fee $ 708.25
PLUMBING PERMITFilin gFee 10.00
Each Trap 8 2.00 16,OC
Solar or heat pump water heater 20.00
LOT N�
r�
SUBDIVISION NAME. PARCEL M
C•��`���(vc �nN
Water piping 5.00 5. 1 00
Each qas water heater or vent 5.00 5.010
USE OF STRUCTURE
SFU Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets 5.00 5.010
Building sewer 5.00 5.00
Mobile Home S G W 10.00 ea
TYPE OF WORK
New n Addition ❑ Remodel ❑ Utilities[] Installation ❑ Other ❑
Describe work: 3 BDRM
Permit Fee $ 46,00
Contractor
ELECTRICAL PERMIT Filing Fee 10.00
Main service 8000 AMP ORV OR LESLESS 10.00 10.00
Main service EA. ADO'L 100 AMP 2.50 2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ I am licensed under provisions Of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification.
El I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
xr I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ i am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. ( DWELLINGoCCup"") 'Aesgft 61.45
OR ADDS. ACC. BLDGS. /
N
NEW CONSTR. r ULTI.OUTLET
NON-RESID BRANCH CIRCUITS) 2.50 ea
POWER APPARATUS e1
SINGLE OUTLET CIR(. I
Ex. Occup(OUTLETS OR FIXTURES 20®300
°ALO=Oa
FIXEDAPP LNS. OR
Ex. Occup. OUTLETS (RESID.) EA. 2.00
ic. 08
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $ 93.95
Contractor
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
1`�7 I shall I not employ any -person in any manner so as to become subject
��f! to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT Filing Fee 10.00
Heating SYSTEM
Cooling 32
Hood 3.00
Ventilation 2
permit Fee $
Contractor
1 certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the County of
Butte to enter upon the above-mentioned property for inspection purposes.
1 also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, cQsts, and expenses which may in any way accruei
a,ia said County in c nseq nce of the granting of this permit.
Date �/'
10 Signature of Applicant — Owner ® Contractor ElAgentwork
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
occ
CONST TYPE
TOTAL FEE $ 914.20
'HAZ
I CUA 1 PARK SCHL
FL11 I CDF PAR PD ', iD .: ISSJG
This permit is hereby issued unaer the applicable provr-
sions of the Butte County. Code and/or resolutions to do
indicated above for which fees have been pais.
DIRECTOR OF PUBLIC WORKS
By Date
PERMIT EXPIRES Date
Receipt No. 94=511 222 - 75
WNITE-O.r.W.. YELLOW -ASSESSOR. PINR•INSPECTOR. GOLDENROD -APPLICANT
1 -3 1926
R`turn to DPW AGRICnTLTRAL STAT`Ei�, ' .T1'
OF ACU. -NT
FOR RESIDENTIAL
DEVELOP^!aNT
Section 26-8.1 of the Butte County Code
requires this acknowledgement be recorded
prior to issuance of a building permit.
The property described herein is adjaeent-.'.,
91-031926 1 Rec Fee
to land or included wit -hi, area zoned 'in.
I Cash
-an
for agricultural purposes, and residents=�;!
Recorded
of this property may be subject to incon- `.
Official Records
veniences or discomfort arising from the '°
County of
use of agricultural chemicals, including-,,
Butte
but not limited to herbicides, pesticides;
Candace J. Grubbs
and fertilizers; and from the pursuit
Recorder
of agricultural operations including,
1:44pm 5 -Aug -91
5. 00
5. 00
X 1t
but not limited to cultivation, plowing,
spraying, pruning, and harvesting which
occasionally generate dust, smoke, noise, and odor. Butte Countv has established agricul-
tural zones which have as a priority use for productive agricultural purposes, and residents
within said zones and on adjacent property should be prepared to accept such inconvenience
or discomfort from normal, necessary farm operations.
All that real property. situate in the County of Butte, State of California, described as
follows:
the following d�urti�eed real property in the
County of
Date:
, State of California:
The South 132 feet of the Westerly 330 feet of Lot 4 of Gridley
Colony No. 9, according to the Official Map thereof, filed as
of record in the office of the Recorder of the County of Butte,
State of California, July 10, 1907 in Volume "6" of Maps, at page 58.
State
County
%— 2 lo PROPERTY OWNERS:
A
of 1� 11 COPi 119 On this the r,� day of
SS. undersigned^Notary Public
lic, personally appeared
of
OFFICIAL SEAL
SHARON E. ZUNINO
NOTMY Pr • CALFORM
BU COUNTY
Yy Cw n. Exphs Jun 18,1993
/-E)c
before me, the
F1 Personally known to me. Proved to me on the basis
of satisfactory evidence.
to be the person(s) ...-hose rame(s) 6'
subscribed to the within instrument and ackno;,iledged that j
,executed the same for the purposes therein contained. IN 44!TNESS
WHEREOF, I hereunto set my hand and official seal.
Present A. P. No. d2/ -O 762 -O8
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive, Oroville, CA 95965 PHONE: 916-538-7541
Dennis Pooler
740 Nevada St.
Gridley, CA 95948
With reference to the above subject:
/ / Attached is:
Application for permit
Building Plans
Engr. Calcs
Owner -Builder Verification Form
OTHER
We need the following information:
DATE July 11. 1991
RE: BP Appl'. #2277-91
new single family home
A.P. # 21-07-89
Mobilehome Utilities Installation Sheet
Mobilehome Installation Information Sheet
Typical Plan Sheet
List of Codes Enforced
Permit application signed and completed where indicated with -all copies returned -
Fees of $ payable to Butte County Treasurer.
Certificate of Workmen's Compensation Insurance or check exemption statement.
Contractor's License Law information or check exemption statement.
Complete plans in ,. including plot plans.
Plot plans in
Structural details in
Complete plans and'calcs in by -registered engineer or architect.
Energy design including
Street and drainage improvement plan approval from Land Development Section (DPU)..
sets of plans in accordance with the changes marked in red.
Sanitation approval from Butte County Health Department at:
196 Memorial Way, Chico
7 County Center Dr., Oroville
Skyway' & Elliott_ Rd. , Paradise
Planning approval from Butte County Planning Department, 7 County Center Drive,,
Oroville, for
Completed Owner -Builder Verification form.
XXX Recorded copy of deed showing parcel legally rrented
Recorded copy of agricultural acknowledgement statement.
/XX/ OTHER 1) It appears this parcel was created in February 1976 at a time when R„ttP
County required a parcel may.
2) Property is a portion of lot 4, Gridley'Colony #9, new County nrdinanre
requires street improvements before building occupancy. Contact Land DPve1n=mPnt
section of Dept. of Public Works for requirements before permit issuance.
Should you have any questions concerning the above, please contact
of this office.
Yours very truly,
e
JFG/aj
William Cheff
Director of Public Works
J.F. Glander
Chief Building Inspector
PARCEL CHECK LIST AND REQUIREMENTS
OwnerPermit No. Z7
A.P. No.
Telephone No. Date 7—! D-
1.
-1. Parcel creation. Mao Book (a Page
Legal Parcel
✓ Creation date
60' R/W ,
Certificate of Compliance
A. Parcel fronts a publicly maintained road rte. e-) n .4 -cc
Frontage Improvements not required
Frontage Improvements are required
Frontage Improvement plans approved and improvements must be installed
prior, to building occupied
B. Parcel not fronting publicly maintained road
1. Parcel Frontage
Frontage improvements not required,
Frontage improvements are required
Frontage improvement plans approved and improvements must be
installed prior to building occupied
2. -Parcel access to publicly maintained road
Access improvements not required
Access improvements are required
Access plans approved and access improvements required prior to
building occupied
Copy of *form. sent to Land. Development -7—/ 0—?/ by r -
a e
Copy of form sent to Building Department, approved for permit issuance subject
to= items marked in 4 above other
Specify
Date __ By
Other
oec�svr
July
2.
Parcel created by subdivision.mapprior to
L./ Parcel size is. less than 5 acres
Parcel exempt from items 3 & 4gbelow
3.
Legal Access
_-----Parcel fronts on publicly'maintained road
-Le j -3
Parcel does not front on public maintained
road
Documentation on legal access submitted,
(must be by Title Co. or licensed engineer
or surveyor)
Road Improvement Standards Q11
•^•oA
0) /�2
A. Parcel fronts a publicly maintained road rte. e-) n .4 -cc
Frontage Improvements not required
Frontage Improvements are required
Frontage Improvement plans approved and improvements must be installed
prior, to building occupied
B. Parcel not fronting publicly maintained road
1. Parcel Frontage
Frontage improvements not required,
Frontage improvements are required
Frontage improvement plans approved and improvements must be
installed prior to building occupied
2. -Parcel access to publicly maintained road
Access improvements not required
Access improvements are required
Access plans approved and access improvements required prior to
building occupied
Copy of *form. sent to Land. Development -7—/ 0—?/ by r -
a e
Copy of form sent to Building Department, approved for permit issuance subject
to= items marked in 4 above other
Specify
Date __ By
OTC 97500-M-39 ,
RECORDING REOUESTED BY
GRANTEE
:�� ..�•� FEB 10 9 ?.G P!II In76
Estel M. Morris CCII'•if'f tiCCG"li I+
44 Old Douglas Road FEE
^' Bisbee, Arizona 85603
2"213
L
1
— SPACE ABOVE THIS LINE FOR RECORDER'S USE
3,.... "The undersigned grantor (s) declom (s):
Same as addressee shove. Documentary transfer to. is Nore
computed on full value of prc•perty conveyed, •,r
( ) computed on full value less value o! liens and
encumbrances remcining of time of sole.
( j Unincorporated area: ( ) City of .__.._..
GIFT
IMUM Deed
-.
!:-73: THIS FORM FURNISHED BY TITLE INBURANCE AND TRUST COMPANY
love and affection
FOIL/.•
E. D. GLOVER and BIRTIE GLOVER, husband and wife
hereby GRANTI,S) to F.STEL M. MORRIS
the following described real properly in thr
County of Butte,
state of California:
The South-132``feet of.the Westerly 330 feet of Lot 4 of Gridley Colony No. 9,
according to'the Official Map thereof, filed as of record in the office of the
Recorder of the County of Butte, State of California, July 10, 1907 in Volume "6r'
of Maps, -.at page.58.
EE EYTING'streets'as platted and rights of way for necessary irrigation end drain-
age ditches and.cnnals heretofore reserved or conveyed:.
February 18 1976 r '" '
E. D. GLOVER
s,r.\Tt: of
rnt!VTS IIF--._AU,TTE......-'------...___.._._..}.•,•, __�CSc2.E'c�_..:�,�:��,if...... ....._._......_ ....
„r,• nl,•. III,• nnd,•r. BIRTIE GLOVER
•icn,••I. a V„Lvy 1',:1,14. in I If .aid FI.I,•• I •,•pully uppr.m,l
E. D. GLC•VER and BIRTIE GLOVER
_._... __....__...---------
- ------- ----—..._:.__..._... — -- _
I,. I„• n„• ...... , ....,• ......,,.sare •e,lh.,•lib,•d I„ al, „•iddrl CrrICIAI S;
ir,-II,:,,,rnl nll.l nrl.11.,..1,•d�.•,1 ey.__,.�,,,,II„1 d,•• .alar•. ;+'"%? r_'. J:1f:(� I•;, 7:1'F:LLi; a
;I rue
\\'1'I'\t:5S nn I and r•Ilici:d --al. .•-•. r'• C1i.'�t'i`Y.:.•
0;,7 ri. Crurrtr
�i¢nal,lr.• ..._... .kms �...�,�{�-- ' r
_..._.__ ... ._.._..__..JACK ..ESTELLE__..—:
\nnn• rr>'I,r•,1 nr rrilNr,u ._ _ _ •rl,;..,.., ..m.,a r.,.r,,,
MAIL TAX STATEMENTS AS DIRECTED -ABOVE END OF DOCUMEN1
1. Ceiling Insulation
Slab Edge Insulation
Specification
Number of stories
Stab Floor Rased Fbor
R -value
One Two
Three
R-0
-103 -49
32
R-19
-8 -4
-2
R-30
.2 -1
-1
R-38
0 0
0
U -value
U -value
1
0.50
-176 44
-54
0.30
-102 -49
32
0.10
-26 -13
-8
0.08
-18 .9
..-6 .
O.C6
-11 -5
-4
0.174
-4 .2
.1
0.02
4 2
1
0.00
11 5
3
35 -75
-29
-19
2. Wall Insulation
1
10
Single- Single -
-21
-13
Family Family
Multi -
R -value
Detached Attached
Family
R-0
-68 -51
_U .
R-11
0 0
0
R-13
2 2
1
t 13 ,T
X26'
5
U -value
2
4
.114- .:..-:;:..76
-
0.50
-91 -68
-46
0.30
-47 36
.24
0.10
0 0
0
0.08
4 3
2
0.106
9 7
5
0.04
14 • 11
7
0.02
19 14
10
0.00
24 18
12
3. Raised Floor Insulation
3
3
Insulation in Floor
15
R -value
Number of stories
Orie�; _2', Two
Three
R-0
-17 -8
~.5
R-11
-3. .2
.1
R-19
0 , 0
0
= R-30.
3 1
.1
6 -value
11
16
- -='-0.60.•
-144.. -70
-46
0.50
-120 -58
38
:-'0.40
-95 -46
30
0.30
59 -34
.22
0.20
-13 -21
-14
0.10
-17 -8
-5
0.08
-11 5
-4
0.06
-6 .3
-2
0.04
-1, 0
0
0.02
4 2
1
• 0.00
10 5
3
Controlled Ventilation Crawlspace
k
Number of stories
12 -9
R -value
One Two
Three
R-0
-11 -7
-5
R-5 .
-4 -4
3
R-11
-2 .2
.2
R-19
.-1 .2
.2
4. Slab Edge Insulation
19
9 .1
10
13
15
NnmhArnfSlnrires'-----
20
R-value
One Two
Three
R-0
0 0
0
R-5
8 5
2
R-7
8 6
3
F2 factor
13 11 10 8
7
0.90
-4 3
-1.
0.80
.1 .1
0
0.70
2 2
1
0.60
•6s, 4
2
0.50
9. , ''6 -
:3,`'
0.40
12 8 �'
4
+15 more
0.30 2.75
•73 -64 -56 -47
-38
-30
na 3.41
5. Infiltration (Air Leakage)
Slab Edge Insulation
Specification
Effective Percent Glasa
Stab Floor Rased Fbor
Points
%Glass
Standard
East
South
:West
0
18
6. Glass Heat Loss
1
4
1
Total
16
4
.2
U -value
1
Percent
14
.51 to
.41 to
.31 to
0.30 or
Glass Single
Double
.60
.50
.40
less
50 -121
-53
-39
-24
.10
4
40 -90
37
-26
-14
3
8
35 -75
-29
-19
-9
1
10
30 31
-21
-13
-4
4
12
29 =58
-20
-12
3
5
12 -
55
28 y52
-18
-10
.2 .
,5
t 13 ,T
X26'
5
1
2
4
2
49
-15
-8
-1
7
14
25. -46
-14
-7
0
7
14
24 -43
' -12
-5
1
8
14
23 -40
-11
-4
2
8
15 '
22 37
-9
3
3
9
15
21 - 34.
-7
-2
- 4
10
15
20 31
-6
0
5
10
16
19 -29
-4
1
6
11
16
18 -26
-3
12 .-..7
5 4
12
16 -
17 -23
.1
3
8
12
17
16 '20
0
4 -
9
13
17
15 -17
1
6
10
14
17
14 -14
3
7
10
14
18
13 -12
4
8
11
15
18
12 -9
6
9
12
15
19
11 -8
7
10
13
16
19
10 3
9
it
14
17
19
9 .1
10
13
15
17
20
8 ` 2
12
14
i6
18
20
2
1
0.80 7.33
8 7 6 5
4
3
7..Shading (Shade Open)
Effective Pei c t Glass
(percent Stan x SC)
Effective
Slab Edge Insulation
Effective Percent Glasa
Stab Floor Rased Fbor
%Glass
North
East
South
:West
Skylight
18
5
1
4
1
nd
16
4
.2
5
1
na
14
4
2
5
1
na
12
_
3
3
5
2
na -
11
3
3
51
2
na
10
2
3
5
2
1
9
2
3
5
2
2
8
2
3
5
2
2
7-
1
3
4
2
2
6
1
3
4
2
3
5
1
2
4
2
3
4
0
2
3
1
3
3
0
1
2._.„
1
3
2
0
0
1
0
3
1
.1
-1
-1
.1
2-
-0
0
.1
-2
-4
-2
0
na = not allowed
�B. Shading (Shade Closed)
Slab Edge Insulation
Effective Percent Glasa
Stab Floor Rased Fbor
(percent
&law x SC)
(assurnetducts in attic) ;
Effective
ICFA One
Two Three One
Two Three
0.0 8
%Glass
North
East
Swtlt West
Sky*t
18
_14.
48
-b'9 -64�
na
16
.12
.42
-59 -55
na
14
•10
-35
-50 .46
na
12
-8
-29
-40 -37
na
11
-7
-26
-36 33
na
10
-6
-23
31 -29
-74
9
.5 .
.20
-27 -25-
-65
8
-5
- -17
-23 -21..
-56
7
-4
-14
-19 -18
-47
6
3
-11
-15 -14
-38
5'
•2
-9
-11 -10
30
3
0
-4
.5 '-4
-16
2
.1
-1 -
;-2. -1
-9.
.. a1
1
1
1 1
-4
0
2'
3
4 3
0
ne . not akwed
14
14
8.0 7
9. Interior Thermal Mass
Slab Edge Insulation
Interior
Stab Floor Rased Fbor
Mass -
Stories Stories
(assurnetducts in attic) ;
-4
ICFA One
Two Three One
Two Three
0.0 8
-5 -4 .2
-1
-1
0.1 -8
-5 3 -1
0
0
0.3 -7
-4 .2 0
1
1
• 0.5 -6
3 -1 1 '
1
2
0.7 -5
-2 -1 1
2
2
0.9 -5
.1 0 2
3
3
1.1 -4
. -1 1 3
4
4
1.3 -3
0 2 3
4
5
1.5 .3
1 2 4
5
.5
20 -1
2 4 5
6
7
ZS 0
3 5 7
-7
8
3.0 1
4 6 8.
8.
9
3.5 2
5 7 9
9"
10
4:0 3
6 8 9
10
10
4.5 3
7 8 10
11
11
5.0 4:
7 9 11
12
12-
5.5 5
8 9 11
.12
12
6.0 S.
8 10 12
13
13
6.5 6
9 10 12
13.
13
7.0 6
9 11 13
13
14
7.5 6
10 it 13
14
14
8.0 7
10 11 13
14
14
8.5 7
10 12 13
14
15
M Exterior Wall Thermal Mass
10
Exterior
Single- single -
26 23 19 15
12
Wall
Family Family
Multi
14
Mass
Detached Attached
Famillr
15
0.00
0 0
0
-5
0.20
3 2
1
3
0.40
5 4
3
5
0.110
8 6
4
4.6
0.80
10 8
5
1_
1.00
13 10
7
None
- 1.20
13 12
8
-11
1.40
12 13
9
8
1.60
10 13
11..
,
1.80
10 12
12
" -6
2.00
-10 11
13
•!
11. Heating System
units)
0.6
0.8
SE or HSPF
1.2
It (Mitt Size (sQ
-
(assumes ducts In attic)
.
699
700
Sum of 1.6
1700
_
Heater
.25or.24b -14 to .4to
+6 to 16 or
SE HSPF
less -15 -5 +5
+15
more
0.72 6.60
0 0 0 0
0
0
0.75 6.88
3 3 3 2
2
1
0.80 7.33
8 7 6 5
4
3
'0.85 7.79
13 11 10 8
7
5
0.90 8.25
17 15 .13 11
9
7
0.95 8.71
20 18 15 13
11
8
2
Effective SE or HSPF
5.6
(SE or HSPF x duct efficiency)
9
Effective •25
or -24 to -14 In -4 to +610 16 or
SE HSPF
less -15 -5 +5
+15 more
0.30 2.75
•73 -64 -56 -47
-38
-30
na 3.41
-45 -39 -34 -29
-24
-18
0.40 3.67
-34 30 -26 -22
-18
-14.
'0.50 4.58
-10 -9 -8 -7
-5
-4
0.56 5.13
0 -_0 0 0
0
0
.0.60_ 5.50
5 5- 4 3
3
2
0.70 6.42
17 15 13 it
9
7
0.80 7.33
25. 22 19 16
13
10
0.90 8.25
32 28 24 20
17
13
1.M 9.17
37 32, 7.8 24
19
15
Zonal Control Adjustment
IG
System Type
3
-4
Resistance
10 -9 7 6
4
3
Other
6 5 4 3_
2
2
1
1
15
POU `
12. Cooling Syst:m
Slab Edge Insulation
or
SEER
a. North
One
(assurnetducts in attic) ;
-4
-4
Still of 7-10
-2
-2
Two +
-25 or -24 to r•14 In -4 to
+6 to
i6 or
SEER
les& -15 1 5 +5
+15
more
8.0
-14 -12 •10 -8
-6
-4
8.5
-9 -7 -6 -5
-4
3
8.9
-5 -4 -4 3
-2
-2
9.0
-4 3 -3 -2
-2
-1
9.5
0 0 0 0
0
0
10.0
4 3 3 2
2
1
10.5
7 6 5 4
3
2
11.0
10 9 7 6
4
3
120
15 13 11 9
7
5
13.0
20 17 j 14 12
9
6
5
Effestive SEER
HP '
HWR
8
(SEER xttuct eRiciene7)
4
3
Sten of 7-10
d. WestS
WSB
Effective -25 or -24to -1410 -4b .,+6
In
16 or
SEER
less •15 5 +5
+15
more
5.0
-30. -25 -21 -17 '
-13
.9
6.0
•12 -ii -9 -7
5
4
6.6
-5 -4 .4 3
-2
.2 .
7.0
0 0 0 0
0
0
8.0
9 8 6 . 5
4
3
9.0_
16 14 12 9
7
5
10.0
22 19 16 13
10
7
11.0
26 23 19 15
12
8
120
30 26 22 18
14
9
13.0
33 29 24 20
15
10
IG
Zonal Control Adjustment
-5
3
10 8 7 6
4
3
29 3.2
No Cooliwq System Installed
7
-Stories
Slab Edge Insulation
or
a. North
One
•5
-4
-4
3
-2
-2
Two +
3
3
.: 2
2 y
2
1
Single -Family
j
llelached and
Attached
d. West
S : 8
3, S
6 Unit Size (SQ
-12M
Water
Type (doublel
;139
U -value (0.651
i7C0
2200
2700
Heater
Credit
or -1
b
to
to
, or
`Type
Type
less
1699
2199
2699
more
SG
None
0'
1 0
0.
0
0
or
Solar
12 *1
8
' 6
5
4
HP '
HWR
8
5
4
3
3
d. WestS
WSB
5
3
3
2
2
e.' Skylight
POU
8_
5
4
3
-3
SE
None
-37
-24
-18
-15
-12
'
Solar
. -1
-1
.1
0
0
30%
HWR
-18
-12
-9
-7 -
-6
70% 7S%
WSS
-25
-16 .
-12
-10'
-8
0%-
POU
•18
_•12
.9
.7
=6'
IG
None
-5
3
-2
•2
-2
29 3.2
Solar
7
5
4
3
2
4.6
POU
3_
2_
1_
1.'
i
IE
None
=28
•19
-14
-11
.9
.2t 23
Solar
8
5
4
T
3
4
POU
-10
" -6
-5
-4
.3
5.4
Multi-Famity (individual
units)
0.6
0.8
1
1.2
It (Mitt Size (sQ
1.6
Water
.
699
700
1200
1700
2200
Heater
Credit
of
b
to
to
or
Type'` Type
less
1199
1699
2199
more
SG " Wurro
0
0
0
0
0
or
Solar
14
7
5
4
3
HP
HWR.
9
5
3
2
2
5.6
WSB
9
4
3
2
2
-1.5
POU
9
5 -
3
2
2
SE
None'.
45'
-23
-15
-11
-9
5.1
Solar
2
1
1
0
0
1.1
HWR
-23
-12
-6
-6
'-5
IS
WSB
-25
-13
-8
-6
.5
4.4
_ EQU
-23_
_12_-8
5.3
-6
-5
IG
None
3
-4
.3
-2
-2
1.8
Solar,
6
3
2
1
1
15
POU `
10
4.3
0
0'
0
IE
None
30
_ 15
-10
-8
3
112
Solar
18 •
' 9
6
4
4
2S
POU
-6
-t
.3
.2
•2
•
Slab Edge Insulation
or
a. North
x
R -valve (01
F2 factor (0.-M
1Rterior Mass1CFA
/,,f
S.
Infiltration
'Standard
' c.. South
0.0
0
6.
Glass Heat Loss,
A0 o -hit
d. West
S : 8
3, S
�" `/
`
Type (doublel
0. t•/
U -value (0.651
90 Total Glass (161
7.
Shading (Shade Open)
�-
TYPE 1 MASS AREA
. ,
% Gkm
I L. 7M,7,C•4•2,
Eff. % Glass
--a. North
L/
x
, 77 _
�- �S-
t T"C 1 nAS9
(UI17C a 4.2. Sei eI sed1=
Slabl
N,
x
, 71
, 7 7
Z__
Sum 7.10
c. South
_.
A0
'
��•.e •lel
0. O lO v
D
. - Zonal Control? (•Y ! N)
d. WestS
-
x
, 7 7 •
= y. y
T ?i
(0.7716,61
e.' Skylight
/S. t!
x
---
-
IV -
8.
Shading (Shade Closed)
Zonal Control? (YIN)
SEER (9.51 -
Duct Efficiency (0.741 Effective SEER 17.031
0%
S%
10%
1S%
20%
25%
30%
35%
40%
45Y• 50%
55%
60%1
Oft.
70% 7S%
80%
85%
90%
95%
100% 105% 110*/.
115% 120% 125'
0%-
0
0.2
0.4
0.8
0.8
1.1
12
iS
1.7
1.9 It
27
25
27
29 3.2
14
16
3.8
4
4.2
4.4
4.6
4.8
5
53
10%
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.9
.2t 23
IS
ZI
29
11 13
15
17
4
4.2
4.4
4.6
'-4.L
5
5.2
5.4
20%
0.3
0.6
0.8
1
1.2
1.4
1.6
1.8
2
12 '24
ZI
29'
3.1
13 1S
17
19
4.1
4.3
4.5
4.8
5
5.2
5.4
56
30%
0.5
0.7
0.9
1.1
1.4
1.6
1.8
2
22
14, 26
28
3
32
15 11
39
4.1
4.3
4,5
4.7
4.9
5.1
5.3
5.6
58
40l.
0.7
0.9
1.1
12
-1.5
1.7
1.9
22
Z4
26; � 2.8 , 3
12
3.4
-16. 18
4
4.3
4.5.,
4, 7
%4.9
5.1
5.3
5.5
5.7
5.9
50%
0.9
1.1
1.3
1.5
1.7
1.9
21
23
IS
27- 3
32
14
18
:18 4
42
4.4
4.6
4.8
5.1
5.3
5.5
5.7
S.9
6.1
55%
0.9
1.1
1.4
1.6
1.8
2
22
24
26
28 3
12
15
3.7.3.9
,4.1
4.3
4.5
4.7
4.9
5.1
53
5.6
5.8
6
6.2
60%
112
1.4
1.7
1.9
21
23
2S
27
29 11
3.3
3.5
3.8
4 4.2
4.4
4.6
4.8
S
5.2
5.4
5.6
5.9
6.1
63
65%
1.1
-1.3
1.5
1.7
1.9
22
24
26
Z8
3 12
3.4
36
3.8
4 4.3
4.5
4.7
4.9
5.1
• 53
55
5.7
5.9
6.1
64
70%
1.2
1.4
1.6
1.8
2
Z2
2S
.Z1
29
11 13
15
17
19
4.1 4.3
4.6
4.8
S
5.2
5.4
5.6
58
6
62
64
75%
12
iS
1.7
1.9
21
Z3
2S
ZI
3
32 14
16
18
4
4.2 4.4
4.6
l8
5.1
S.3
5.5
5.7
5.9
6.1
6.3
6.5
WY.
1.4
1.6
1.8
2
22
24
26
28
3
13 1S
11
19
4.1
4.3' 4.S
4.7
4,9
5.1
5.4
5.6
5.8
6
62
64
66
85%
1.4
1.1
1.9
2.1
Z3
25
2.7
29
It
3.3 15
3.6
4
4.2
4.4 4.6
4.8
S
52
54
5.6
5.9
6.1
63
65
67
90%'
1.5
1.7
2
2.2
Z4
28
28
3
12
3.4 16
16
4.1
4.3
4.5 4.7
4.9
5.1
53
5.5
5.7
5.9
6.2
6.4
66
68
9S%
1.6
1.8
2
22
2S
21
29
11
33
15 11
19
4.1
4.3
4.6 4.8
5
5.2
5.4
5.6
5.8
6
6.2
6.4
6.7
6.9
loos'.
1.1
1.9
If
22
2.5
26
3
32
14
16 18
4
4.2
4.4
4.6 4.9
It
5.1
5.5
5.7
5.9
6.1
6.3
6.5
6.7
7
105%
1.8
2.
22
2.4
26
28
3
13
3S
17 '3.9
4.1
4.3
4.3
4.7 ' 4.9
S.1
5.4
56
5.8
6
6.2
6.4
6.6
6 8
7
110%
1.9
21
Z3
IS
ZI
29
11
13
.16.
3.8' 4
4.2
4.4
4.6
4.8. S
S2
5.4
5.7
5.9
6.1
6.3
6.5
6.7
69
7.1
115%
2
2.2
Z4
Z6
IS
3
3.2
14
3.6
3.8. 4.1
4.3
- 4.5
4.7
4.9 5.1
13
5.5
5.7
5.9
8.2
6.4
6.8
6.8
7
7.2
120%
2
23
2S
"2.1 •
Z9
3.1
3.3
15
11
19 - 4.1
4.4
4.6
4.6
S . 5.2
5.4
S.6
58
6
6.2
6.5
6.7
6.9
7.1
73
125%
21
Z3
IS
26
3
12,
14
16
3.6
4 4.2
l_4
4.6
4.9
5.1 5.3
15 "S.7
5.2
,. 6.1
6.3
6.5
6.1
7
7.2
•7.4
Point System Summary: Climate Zone 11
SCORE CARD
Measures Point Scores
1. Ceiling Insulation 1?_'70 or = z
R -value 1381 U -value (0.0301
2. Wall insulation or
R-value(III U-value(0.098] _.......
3. Raised Floor Insulation IF -If or
R-value(191 U -value 10.0371
4.
Slab Edge Insulation
or
a. North
x
R -valve (01
F2 factor (0.-M
b. East
/,,f
S.
Infiltration
'Standard
' c.. South
0.0
0
6.
Glass Heat Loss,
A0 o -hit
d. West
S : 8
3, S
�" `/
`
Type (doublel
0. t•/
U -value (0.651
90 Total Glass (161
7.
Shading (Shade Open)
�-
TYPE 1 MASS AREA
. ,
% Gkm
SIC
Eff. % Glass
--a. North
L/
x
, 77 _
�- �S-
0
b. East =
N,
x
, 71
, 7 7
Z__
Sum 7.10
c. South
_.
A0
x
s 13 - G
0. O lO v
D
. - Zonal Control? (•Y ! N)
d. WestS
:
x
, 7 7 •
= y. y
T ?i
(0.7716,61
e.' Skylight
/S. t!
x
.'
0. 3/.
IV -
8.
Shading (Shade Closed)
Zonal Control? (YIN)
SEER (9.51 -
4- 7
Sum 15
ego Glass
. SC Eff. % Glass
a. North
x
b. East
/,,f
x
.66 = 3. 13
' c.. South
0.0
x
, 6 G = (9,00
D
d. West
S : 8
x "
: GG = 3, d'3
e. Skylight
0. t•/
x
. 0- r.7
-:
9. Interior Thermal Mass
�-
TYPE 1 MASS AREA
. ,
flrtetlut b' 7ssiCPA
GOND. FLOOR AREA
10. Exterior Wall Mass'
TYPE 2 MASS t AREA
Exterior Wall Mass
C ND. FLOOR AREA
Sum 7.10
11. Heating System
2
x
s 13 - G
. - Zonal Control? (•Y ! N)
SE or HSPF
Duca Elf ciency 10.781 Effective SE or
(0.7716,61
HSPF 10-6/5.151
12. Cooling System ,
Q.
x
Zonal Control? (YIN)
SEER (9.51 -
Duct Efficiency (0.741 Effective SEER 17.031
13. Water Heating
s4a_r
Type (SGl :
Credit (none]
Point Total:
��./
Ceruricate of c ompuan": nesiGenuai
Project Title
Address
Documentation Author Telephone
r --
BUILDING DATA
Conditi n oor Area .S� Number of Stories
Sia sed Floor Number of Units
Single Family Detached (SFD) [ ] Addition Alone
[ J Single Family Attached (SFA) [ ] Existing Building
[ ] Multi -Family (MF) [ ] Existing -Plus -Addition
BUILDING SHELL INSULATION
Component Insulation Location/Comments
Tvoe R-VaIue (tea, :o ganga typiczl,
Wall .............. C/
Wall
Roof .............
Roof .............
Floor .............
Floor .............
Slab Edge.....
GLAZING
Shading Devices
Cgnate Gone 11
W,77 -
Building
(decked By / Date
Enforcement ARencv Use Only
Glass Area % Glass .
Noah &71,5' y
Easti
South
West
Skylight D, y
Total
Glazing
Area
Glass Type Interior Exterior Overhang Framing Type
Orientation
(Sf)
(single, double) kollar blind, etc.) (shadescrem etc.) (yes/no) (meWlwood)
North ( )
--
conditioner, heat pump)
North
(attic, etc.) R -Value
(Btuh) (or approved equal)
East ( )
"A f`ri C v Z
East ( )
South ( )
O
_
South ( )
West ( )
West ( )
Skylight.......
THERMAL MASS
Type/Covering
Area Thickness
(slab/exposed, tile, etc.)
(so (inches) Location/Description (kitchen, bath, etc.)
HVAC SYSTEMS
Minimum
Duct
Type (furnace, air
Efficiency
Location Duct
Output Manufacturer / Model #
conditioner, heat pump)
(SE, SEER,HSPF)
(attic, etc.) R -Value
(Btuh) (or approved equal)
f s
"A f`ri C v Z
il�7 —A/
Maximum Furnace Heating Output:
HOT WATER SYSTEMS
at,
Tank Manufacturer/Model #
SPECIAL FEATURESIREMARKS (Add extra sheets if necessary)
Mandatory Measures Checklist: Residential MF -IR
NOTE: Lowrise residential buildings subject to the Standards must cocain these measures mprdless of the compliance
approach used. Items marked with an asterisk (•) may be superseded by mars stringent compliance requirements fined
on We Certificate of Compliance- Wbrn this.checklis u;ncorpor"A into the permit documents. the features notedshall
be considered by all.panies as binding minimum component perfomsance specirrAtions for the mandatory meaares
whether they arc shown elsewhere in the documents or on this cbocklist only.
DESCRIPTION DESIGNER ENMRCEMDff
Building Envelope Measures
• §2.5352(aY Minimum ceiling insulation R-19 weighted avenge.
§2.5352(bY• Loose fill insula ion manufacturer's labeled R•Valtw-
• §2-5352(cY Minimum wall insulation in framed wilts R. I I weighted average (does not apply to
exteror mass walls).
§2-5352(kY slab edge insulation - water absorption rate no greater than 0.3%, water vapor
transmission rate no greater than 2.0 perm/inch.
12.5311: Insulation specified or installed meets California Energy Comm an (CEC) quality
standards. Indicate type and form.
12.5352(r): Vapor barriers mandatory in Climate Zones 14 and 16 only.
12.5317: InfilaatiorvEsfiltnation Controls
a. Doors and windows between conditioned and unconditioned spaces designed to limit sit
leakage.
b. Doors and windows certified.
e Doors and windows weathersaipped: as joints and penetrations caulked and sealed
42-5352(eY• Special infdaation barrier installed to comply with 02-5331 moeu CEC quality
standards.
12.5352(d): Installation of Fveplaees
I. Masonry and factoxybuitt fireplaces have
x Tight fiuing• closeable metal or glass door
b. Outside air intake with damper and control
e Flue damps and contra
2- Nocominuous burning gas pilots allowed.
HVAC and Plumbing System Measures
12-5352(g) and 2-5303: Space conditioning equipment airing: attach calculations.
12-5352(h) and 2-5315: Setback thermostat on alt applicable beating systems
•
12-5316(a), Ducts constructed, installed and insulated per Chapter 14 1976 UMC -
12 -5316(b): Exhaust systems have damper controls.
§2-5314(e): Gas -rued space heating equipment has intermittent ignition devices
12-5314: HVAC equipment, water heaters, showeriseads and faucets certificd by the CEC.
§2.53520: Water heater insulation blanket (R• 12 or greater) or combined interiorlewerior
insulation (R-16 or greater): fust 5 lett of pipes closest to tank insulated (R-3 or greater).
12-5312(EzccpLion 1Y. Pipe insulation on steam and steam condensate return & recirculating
piping.
i
J2.53 18(d)- Swimming Pool Heating
I 1. System has.
a. On/off switch on heater.
t b. Weatherproof instruction plate on heater.
c. Plumbed to allow for solar.
2. 75 percent thermal efficiency.
3. Pool cover.
4. Time clock.
5. Directional water inlet.
t Lighting and Appliance Measures
t ,
12.53520): Lighting - 25 lumens/watt or greater for general lighting in kitchens and batMoomL
12.5314(c)- Gas fired appliances equipped with intermittent ignition devices.
i
42.5314(x): Refrigerators. refrigentor•freezers• freezers and fluorescent lamp ballads certified
by the CEC. Indicate make and model number.
COMPLIANCE STATEMENT
This certificate of compliance lists tlx building fca=- s and performance specifications needed to comply with
Title 24. Chapter 2-53 and Mtle 20. Chaptt r 2. Subchajr-er 4, Article 1 of the Califotma Administrative code. This
certificate has been signed by the individual with overall design rlcspattsibility and the building owner. who shall
retain a copy of it and aw=it the certificate to airy subsequent putrcllaser of the building.
Designer Building Owner
i Name: Name
Ttk4Fu= Tatk/Firm:
Addrem- Address:
l Telephone Tekphonc
lie.
(signaaue) (date) (signature) (date)
Documentation Author Enforcement Agency
Name Name:
Titk/Fum: Agenry:
Addre=: Telephone:
r