HomeMy WebLinkAbout039-120-04439-.12-44
ZENA DELZELL
i 11063 Lone. Pirie, Chico �7
Contr °'Floyd 'St'ober'
Permit#1019-87B,E(addition/SF)
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OWNER: ��� CSI V-�� DATE:
LOCATION: '3 ( W �►� l A.P.#:. 033 — [ ;�L n fic�
CONTRACTOR: ZONING: / y
n
DATE TO INSPECTOR: 4 PERMIT HISTORY: [ NE [ "1A� FOLLOWS:
.1 . I_",
TYPE OF OCCUPANCY:
0
ig Description: _
[ ] Commercial/Usage:
[ ] Residential/# of Units: _
[ ] Currently Occupied.
[ ] Abandoned/Vacant.
N `
[ ] Yes [ ] No
Electric is currently':[ ] On
BUMDING INSPECTOR' S REPORT
[ ] Off
Condition of electrical?
Natural[ ] Propane[ ] None[ ]
Obvious problems:
anitation:
Plumbing working
Yes[ ] No[ ]
Well: Yes[ ] No[� ]
Obvious Sewage Problems:
tion of Damaged Area:
Mobile Home:,Yes[ _] No[ ]
Currently On[ ] Off[ ]
Potable water: Yes[ ] No[ ]
timate valuation of Df1paged Area:
. y
Spector;
9L
M1
rl
Date: 3
RAIN TOTAL
OPMOIJ bAiLlf INCHAWt LO#a , Go
bAVIbAtt Oftom dgad�-51 nAvmAtk tri
-
SrATION
REPORT
NO
LOGGEM
GSE NO
FIRE NO
a.
LOCATION
VEOVAtION
FALSE
ALARM
After
R.P.jo ENO
2
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FIRE KAAM WRA 6.L
VEHICLE
HAZIMT
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START LAND USE OAMAGE SAVE
REFUSE
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INCIDEWNO
WOOMBY
CASE NO FIRE NO
FtOZ,
LOCATION
VEGETATION
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ASM
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R.P. PHONE NO
STRUCTURE
PAPROVE•
ASSIST
FIRE NAME WRA 0.1
VEHICLE
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OTHER
STAFffTW CAUSE LAW USE DAMAGE SAVE
REFIUE
HAz.COI4
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REPORT TW -NCTNOxO/ yZ-LF
NO FIRE NO
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LOCATION
4>W
FALSE
AMM
PUBLIC
ASSIST
cow
FtP.
STRUCTURE
#APROVE.
ASSIST
RESCUS
41
Mr. =9 WRA ELL
VEHICLE
HAZPAAr
MEDICAL
OTHER
Mee
STARTTM CAUSE LANDUSE 5mum SAVE
REFUSE
HAZAM
STATION MLeLA /ITS OFFICER
Fo
REPORT TWA INCIDENT NO
LOGGED BV
CASENO FIRE NO
R.O.
LOCATION
VEGETATION
FALSE
ALA RM
PUBLIC
Most
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R.P.
STRUCTURE
11VIT'ROVE.
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ASSIST
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HAZMAT
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EFUSE
HAZCON
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STATION AMBLIPLANCIR REPORT TIME "WENT No
I �� I LOGGEDGY
7-14 2-
X4 0
CASE NO
AN
LOCATION
FALSE PVK= ofm:k
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STARTTW CAM LANDUSS DAMAGE SAVE
— ----- DOM 'Xoo I-00,
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PERMIT NO.
PERMIT EXPIRES
OWNER _ ZENA ��ianaa
CONTR.
39441PLOF1 PARCEL
s. LOCATION 1196-3 Lope Rine,
Signature
Temp. Power Pole
�
Called PG&E
,s
Temp. Elea Servi
Called PG&E
Temp. Gas Servic(
i,
E
l
Called PG&E.
l
JOB FINALED (D.
Signature
J OK
0 = Not OK
— = Not Applicable
= Not Ready
MOBILEHOMES
MISCELLANEOUS
Date
MOBILEHOME UTILITIES (Plans) OK except N's
1. Zoning Requirements—Setbacks—Easements
Date
DECKS, COVERS, CARPORTS, ETC. (Plans) OK except N's
1. Zoning Requirements—Setbacks—Easements
2. Soils; Special MH Support—Sketch
2. Footings; Size—Depth—Spacing—Corinectofs
3. Sewer; Location—Test—Fall-C/0—Concrete
3. Decks; Girders and/or Joists—Decking—'Bracing—Stairs—Rails
4. Water; Location—Test—Easement Needed (Sketch)
4, Wood Awn.; Posts—Beams—Rfirs. —Connec.—Shthg.—Rfg.—Bracing
5. Electricity; Location—Clearances—Grnd.—/ / Amp—Concrete
5. Alum. Awn.; Columns—Connections—Splice—Decal—Enclosures
6. Gas; Location—Test—Wrap:/ /"L"ft./ /"Nat. or/ P'L"ft./ /"LPG
6. Carports; Windows—Doors
7. Utility Clearance
7. Elec.
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date
Date Card -BI Date
MOBILEHOME INSTALLATION (Plans) OK except ll's
1. Zoning Requirements—Setbacks—Easements
Card -BI
Date
Dale Card -BI Date -
POOLS (Plans) OK except N's
1. Setbacks—Easements
2. Footings; Size—Spacing—Marriage Line
2. Soils; Compaction—Structure Stability
3. Gas; MH Test—Demand—Valve—Connector
3. Pool Structure; Steel—Connections—Thickness—Dead Men—Lining"
4. Electricity; MH Test—Crossovers—Breakers—Clearances
4, Elec.; Receptacles and Lighting; Distances—GFI
5. Drain; MH Test—Fall—Flex Connector
5. Elec.; Pool Lighting; 15 volts—GFI
6. Water; MH Test—Regulator—Connector
6. Elec.; Enclosures; Conduit Entries—Terminals—Listed
7. Water and Sewer Connected—C/O to Grade—HD Approval
7, Elec.; Bonding; Metal w/5'—CirculatingEquipment—Heater
8. Gas and Electricity Tagged
8, Elec.; Grounding; Equip. w/5'—Circulating Equip.,—Pool. Lghig.
Boxes—Enclosures—Panel boards—Ins. to Main in Conduit
9. Exits; Insp.—Sketch
10. Cert. of Occupancy
9. Health Department Approval
10. Plumb; Cir. Test -Water Supply Test
Card B-1
Date Card -BI Date
Card -BI
Date Card -BI Date
Card B-1
Date Card -BI Date
Card -BI
Date . Card -Bl. Date
J = OK
0 = Not OK
= Not Applicable
* = Not Ready RESIDENTIAL (Single and Duplex)
Date
D
LOOR Plans OK except W's
Date
FRAMING (Continued)
Zoning requirements -Setbacks -Easements
48.
Property Line Firewall & Openings
tg., Main; Soils-Steel-Elec. Grnd.- / /" Ftg. Depth
49.
Ext. Doors -One 3' -Check Garage -3rd story, 2 exits
Garage; Soils -Steel- / /" Ftg. Depth
50.
Stairs; Width -Headroom -Rise -Run -Landing -Fire Protection
g., Porches & Decks; Soils -Steel- / /" Ftg. Depth
51.
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
-3t�mwalls,
Main; Steel-Blockouts-Wrapped-Slab
52.
Siding -Nailing -Veneer
-er-S
emwalls, Garage; Steel-Blockouts-Wrapped-Slab
53.
Stucco Mesh -Drip Screed-Fdn. Vents-Underfir. Access
iers-Fireplace Ftg.-Steel
54.
Glazing Area -Glass Protection -Skylights -Plastic
-8-D-W.V.:
Fall -Fittings -Test -2 way C/0 -Sewer Test
55.
Shear IIs; Nailing Bolts
as Pipe; Size -Anchors
10.
Water Pipe; Test -Anchors -Regulator -Service Test
F✓�
Electric; Underground
-11-Plenums
& Ducts; Clearance -Material -Support -Ins.
Girders -Sills -Anchor Bolts -Joists -Vents -Cripples
Card -BI
Card -BI
CS,Date
Cdr -BI Date
Date Card -BI Date
Card -BI
Date Card -BI Date
Card -BI
Date Card -BI Date
Date
FINAL (Plans) OK except N's
56. Ext. Steps -Door Sidelight Protection -Landings
Card -BI
Date
Date Card -BI Date
PLUMBING (Permit) OK except p'
57.
Smoke Detector
_
Ht.; Vent- Access -C bustion Air
58.
Furnace; Vents Clearance -Comb. Air -Connector -
In Garage; Ab a Floor-Ducts-Mech. Protection
_14. _Water
15. Water Pipe; Test & Anchor -Nail Protection
16.
D.W.V.: Test-Fttngs & A hors -Nail Protection
59.
Bedrpdm Exit' g
_
17.
Shower Pan; Test, First loor-Tub Access
60.
j I. & Bath Fixtures & Tub Access
18.
Test Tub & Shower, 2nd loor-Tub Access
Cdr.
Elec. Trim & Subpanel; Breaker Sizes -Labels
_
19.
Gas Pipe: Size & Ancho s
62.
Stairs & Rails
63.
Fireplace or Stove; CIe rances-Hearth
Card -BI
Date Card -BI Date
64.
Elec. Outlets at Wood anel; Int. & Ext.
65.
Kit. Fixt. & ApplianQe Grnd.-Air Gap -Cooking Clearance
Card -BI
Date Card -BI Date
66.
Elec. Outlets & Rece acles at Kit. Counter
Date
ELECTRICAL Permit OK except q's
67.
Garage Fire Door; Swi g -Landing -Closer
68.
A.C. Duct in Gara a amper
-
20.
Fixture &Transformer Clearance -Ins. Protection
69.
Wtr. Htr.; Vents -C le ranee -Comb. Air-Connector-P.R.V.-
In Garage; Above FI or-Mech. Protection
-
21.
22.
Elec. Receptacles Spacing -Lights & Switches at Doors
Size Boxe No. of Conductors -Stapled
70.
Plb., Elec. &Mech. Equip. Listed for Location
71.
Elec. Receptacles ' Garage; (G.F.I.)-Romex Protec.
23. Romex I I lose to Ede tuds & C.J.
-
-
24.
Equip. 'ou' a w/Mech. Fas rs-Bond Gas & Water
72.
Insulation -Foam- ooked in Attic ❑Yes
73.
Guard Rails & De k Construction -Post Caps
-
-
Card B -I
Card B -I
_
25.
26.
27.
__
28.
29.
30.
2 Applia ircuits in Kitc en &Conductor Size
Subfeed a Size / / ga. Cu or AI-A.C. Wire Size / / ga. Cu or Al
Range Circ. / / ga. Cu or AI -Oven Circ. / / ga. Cu or Al,
Insulated Neutral _,Yes ]No
-
Service -Riser Conductors & Ground -Main Disconnect -
Equip. Clearances: Panels-Motors-Mech. Equip.
Clothes Closet Light-Showe Lig
/ --
J - r"
_
Date - Card -13 I_- Date
Date Card -BI Date
74.
Fdn. Vents & Cr 1 !-tole Door -Drainage & Wood -Earth Clearance
Looked under FI or ❑ Yes
75.
Following instld : Drive ❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters ❑Yes ❑No
76.
Stucco; Brown -Finish
77,
A.C. Unit; Disconnect-Clrnces-Brkr. & Cond. Size -115V Outlet
78.
Vents Above Roof; Plb A Rance -Fire I s.
P Clearance to O n
P 9
79.
Water Well; Disconnect, Electrical, Plumbing
, Electrical, g
80.
Exterior Elec. Trim; G.F.I. Receptacle -Underground
81,
V ilation throug out House
Glass Protection I
Date
MECHANICAL (Perrr,it) except t1's
8
_
Corrections from Pjrevious Inspections
84.
Gas Test-Meterstagged: Gas -Electric
Card -BI
Card -BI
31.
32.
33.
34.
35.
A.C. Ducts_ lrjsulatijbn & Support - - -
Vent Fan; Exhaust Sbove Insulation
Condensate Drain Overflow: Size & Grade _ __ _
Furnace -Vent: Access -Comb. Air -Return Air Vent -115V outlet
Attic Access & Platform if Furnace in Attic
-
Date Card -BI - Date -
Date Card -BI Date
85.
Water & Sewer .Co netted -C/0 to Grade -HD Approval
88,
Energy Compli' a Certificate -Other Certificates
-
-
Card-BCKYL
Date and -BI Date
Card -BI
Card -BI
Date Card -BI Date
Date Card -BI Date
Date
FRAMING(Plans) OK except p's
Comments at Final:
_
3_6.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
Sills; -Proper Mater, I & Ancho_rs _
Walls Stud - N -ling, Spacing & Bracing -Plates -Sound
Bearing W I ov it rs &Floor Nailing_
Draft Stop n all at oof)
Fire Stops: u Bilin s -Stairs -Chases -Tub
Header & Be Size & Bearing
Hangers -Post Caps -Anchors -Connectors
Cing. Joist-Rfir. Ties-Purlin-Roof Brac.-Truss-Shlhng.-Rfng.
Fireplace Ties or Type A Flue -Fireplace Throat
Attic Access: Size & Romex Protection -Draft Stop -Ins. Baffles _
Bdrm. Windows or Exiting Doors -Sill Hgt. & Dimen-sions
Garage Fire Protection Framing
(NOTE:Anenlrymust be made each time you visit jobsite)
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville, California 95065 - Telephone 916/534-4541
APPLICATION AND PERMIT
PERMIT 140� /
ASSESSOR PARCEL NUMBER
_ f ---
ZONING
BUILDING PERMI
OWNE
L PHONE
SO. FT. OCC. BUILDING VALUATION
I
0• 00
OWNER'S MAILING ADDRESS
(' o
sv
S—c3
CONTRACTOR
PHONE
3! 3 —/0 e4
`
eACO O • 0
CONTRACTS MAILING ADDRESS ,
�- I—%
Fireplace
CONST ON LENDER
UC�
UNKNOWN
Total Valuation $
40,71 v
Filing Fee
$ 10.00
LENDES MAILING ADDRESS
Permit Fee
$
ARCHITECT R ENGINEER
,T
LICENSE NO.
Plan Checking Fee tN
$ SVS
Energy Plan Checking Fee
$
ARCHIT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00
Each Trap
2.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
5,00
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF ® Duplex❑ Mobilehome❑ Other
' \ SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
5.00
Mobile Home S I G I W
10.00 ea
TYPE OF WORK
New ❑ Addition X Remodel ❑ Utilities ❑ Installation❑ Other ❑
Describe work: e o CL& —
Fe..ar- at 1;
Permit Fee
$
Contractor
ELECTRICAL PERMIT
FilingFee 10.00
•
Main service 100 AMP ORSLESS
10.00
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
�I
Iif9C—''1 I am licensed under provisions of Chapt. 9, Div. 3 of the Bu$Ines$
and Professions Code and my license is in full force and effect.
License No.0
a �� �� 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)
❑ I, as
(Sere owner, am exclusively contracting with licensed contract- 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
Main service EA. ADD'L 100 AMP
2.50
NEW CONST. DWELLING OCC UP.s /z¢sgft
C, BLDGS. SO
New CONSTR.(AMULTI-OUTLET
NON.RESID BRANCH CIRC ITS 2.50 ea
POWER APPARATUS &)
(SINGLE OUTLET CIR.
0 50t
Ex. Occup(OUTLETS OR FIXTURES 2AL@30
eALO 30
Ex. OCCUp. OUTLETS ((RESID )REA.) 1 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring 15.00
Permit Fee $ D O
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
Cooling
Hood
3.00
Ventilation
Permit Fee
$
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 Countyot
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 C unty i conq . nce f the granting of this permit.
%� �' Date 3, 3Ci ��7
Signature of A plicant — Owner ❑ Contractor K Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct-
ion of structuresstories in height.
ss7over
Mobile Home Installation Fee $
Energy Inspection Fee 113 a, 00
TOTAL PERMIT FEE $
Occup.
CONST.T7PEJ
&VJFL0P[PAR"1LJPO
ND
ISSUE
This permit is hereby issued under the applicable provi-
sions of the Butte County Code and/or resolutions to do
work indicated above for which fees have been paid.
DIRECTOF PUBLIC WORKS
BY - `� Date
PERO EXPIRES Date
•3
Receipt No. D 2.3
f
WNITE-D.P.W.. YELLOW -ASS E7SOR. PINK -INSPECTOR. GOLDENROD -APPLICANT
COUNTYIO,F,YBUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION
TCOUNTkY CENTER DRIVE - OROVILLE, CAL FORNIA 95965":"TELEPHONE: 916/534-4541
r
...� _ PERMIT APPLICATI WDATA SHEET r� /
Permit No. I/
OWNER2�t.�c�_. L� P 7c� / A P. No. -?92 Y
' Proposed Building Use SG`'+�:1t��� Building Inspector Date e7
At time of permit application, I was advised the following data must be submitted prior to permit processing
•
and:/or issuance:c�.•a rsDATE RECEIVED APPROVED
1 -..-All items have been submitted. . . . .
2.. Plot plans in duplicate./tripli--ate, signed by preparer of plans. .
J � Complete plans in dup.Ucate.Ltra,p.ticater signed by preparer of plans. SSC
4. Complete engineered plans aed calcs, with wet signature on plans.
Plans with Energy Design Ccmpliance Statement. . . . . .
CUSD ''Fees Paid" Stamp on Floor Plan . . . . . . . .
7 Statement of Intent for Non -Heated and AC Buildings.
8. Fees of $ . . , . , , . ,
9: Letter of signature authorization,. . . . . . . . . . .
Sanitation approval from ` ' r Health Dept. 30 S
1�
Planning approval for (A) Use: (B) Parking:
12. Certificate of Workmen's Com,)ensation Insurance.
13. Contractor's License Information (no., name style, classif.)
14. Owner -Builder Verification (Given to owner[], Mail to owner ❑ ),
_15. Improvements may be required. . . . . . . . . , .
16. Mobi lehome Installation Data. . . . . . . . . .
Pre-Inspec. request to (Date)
17. Pre -Inspection for Required. Building Inspector
18. Recorded copy of Agricultural Acknowledgment Statement.
19. Driveway Permit. _
20. Plot plan approval from city of
21.
22.
When yo issue the permit, process as follows: Mail to/owner, to contractor.
Telephone and hold for pickup atCj�bffice, Deliver w/inspector.
Other
.. Applicant 41iga 291e�_�7
Copy of plans sent Health Dept., Fire Dept., Other Date
The following data must be submitted prior to ermit issuance: (Circle new item not checked above).
1. Index permit for above items No.
2. Additional items required:
Contractor, designer, owner, was advised a° above required data by_phone---nail—counter by date
Contractor, designer, owner, was advised o- above required data by—phone —mal l—counter by _ date
Plans checked by
Copy—DPW
Dat -3 Plans approved by
Sets of plans on hold in File cabinet AP folder
Date
— Flours: 10:00 a.m. - 3:00 p.m.
; 6`
JO: Building Department
FROM: Environmental Health,'Chico
SUBJECT: °"'Sanitation Clearance
Owner Location AP#
C-0
Plan approved for: sewage disposal water supply
Hold final for: water supply
Final clearance O.A . for: water supply
Clearance for bedroom mobile home. Other
Note***
tarian Date
+ o' •• •� •• ~ Thps set ofpuns and� �
s ecifications MU
M•v v make anon y aob at aU times and if is unlawful +0
y changes or alterc,"Pons on same w fhftf
' : ' ` r o; written permission from the Department of Public .
V '. ° a Works, County of Butte.Wj
,.
• �i OG
7 M O Z
Lj
Q_ , AZ.
..,. isAV' �' ' {I�` ry a •O
,R40
c j
lot
— A setback af�'ft: om'ttie
property lines and-a;setback; �
i .{ , - ,=•`f� . P..� of 50ft. from the road 4�
g P �� o o centerline shall .be dear of �� \ff��
• �- ~_ !� ti, •� �, Z v
for
or equipinentekcept �'tC O•.3S%f." " �-
Q ® o a 2 ft. eave,overhang.
" e
.: fat► ' e +�.
Or
?op fir.' .,�r� i .�� *•. 'i
%4 0AILF
(JUTTE COUIN V
.. _ :,_._ • /�/� / /A n - - WILDING HEPAR ITMENI
r t e e. �/� 0, `a% i
disc IV �o7ds
S
ENERGY SHEET
FOR ,
ADDITIONS TO RESIDENTIAL BUILDINGS
PERMIT NO. /D19-8'% PACKAGE "A" (Additions)
NAME
JOB ADDRESS
TYPE OF WOR
Z. _z_ "IrL_ L
FORM 7
• SQUARE FOOTAGE
Existing Residence
New Addition 9
49,
New Total
The following information sheet, showing mandatory features and required features of
Package "A" must be completed and attached to all plans for - additions. to dwellings.
Additions to dwellings include room additions,.converti'ng garages and patios to living
areas, house moves that add footage and attic conversions, and any space that is ex-
isting non -conditioned space that is converted to conditioned space. Remodeling of
existing conditioned space is not included.
ZONE 11 ZO E 12 ONE lE
INSTALLED APPLIES TO NEW AREA
CEILING R-30 R 0 - 8
JWWALL R-11 R- 19
FLOOR R-11• R- - 9
SLAB R- 7.R 11 R- 7
GLAZING ,65 .65 .65
SHADING '
SOUTH -OPTIMUM OVERHANG
or .36 S.C. -
WEST - .36 S.C.
LOOSE FILL INSULATION (Density)
INFILTRATION CONTROL (Weatherstrip doors, certified windows, caulking)
VAPOR BARRIER (Zone 16)
DUCTS PER UMC - Ch, 10
_ LIGHTING KITCHEN & BATH NOT LESS THAN 25 LUMENS/WATT C
_I MAXIMUM -GLAZING,. 16% OF AREA PLUS REMOVED GLAZING 45
NEW HVAC AND HOT WATER IN CONJUNCTION WITH AN ADDITION SHALL COMPLY
AND FILL OUT DATA ON BACK OF THIS SHEET
7/83
*1 HEATING, VENTILATING, AIR CONDITIONING SYSTEM
(A) Heating
❑ Central Gas Furnace
(brand and model number) SE
Btu/hr
(heating capacity)
❑ Heat Pump
.(brand and model number) ACOP
Btu/hr
(heating capacity at 47°F)
❑ Active Solar
type (liquid or air) -Collector brand and
ft2
model number solar fraction collector area collector
orientation collector tilt rated y -intercept
rated slope
❑ Other
(describe)
*1 (B) Cooling
❑ Electric Air Conditioner
(brand and model number) (seasonal EER)
Btu/hr
(cooling capacity at 95°F)
❑ Electric Heat Pump
EER
Btu/hr
(cooling capacity at 95°F)
❑ Other
(describe)
DOMESTIC WATER SYSTEM
❑ (A) Gas Only Gallons
(brand and model number) (tank size)
❑ Heat Pump w/Electric Backup
(brand and model number)
Gallons
2 (tank size)
[3* Active Solar
(collector brand and model number)
(rated y -intercept) (rated slope) (solar fraction)
ft
2
(backup heater type, brand and model number) (collector area)
(collector orientation) (collector tilt)
❑ Location of Solar Panels
❑ Other
(Describe)
*1 Submit documentation of sizing heating and cooling equipment by Manual J, sizing
charts (form X64) or other approved methods, section 2-5352(8), and fill out the
following:
Heating: Winter design temperature °, elevation ', heating load BTU
elevation factor x heating load = maximum outlet capacity gas furnace
BTU
Cooling: Summer design temperature ', cooling load BTU
*2 Submit T.I,P.S.E. chart'or other approved system (form #5).to document sizing of
solar panels.
® DESIGN COMPLIANCE STATEMENT: The above building design meets the requirements.of
Title 24, Part 2, Chapter 2-53 of the California Administration Code.
SIGNATU OF BUILDING DESIGNER OR APPLICANT