HomeMy WebLinkAbout064-460-017a
JOHN J. ANDRADE
14288.Wycliff Way, Magalia Z3/y� _,�; ,
Permit#2463-89B,P,E,M(new sin2gl family) I.
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Temp. Power Pole*
•
Called PG&E
Temp. Elec. Service
'
Called PG&E
Temp. Gas Service
Called PG&E
JOB FINALED (Date) 2 `,
Signature
uw1ler C
ENEItGY Cl:ltTIFICAT10N
DESCRIPTION OF INSIIIA'TION
ROOF
Ila teria l _
Thickness(inches)
EXTERIOR WALL
1lateria.l Fiberglasss
Thickness(inches)M--
CEILING
ttn!-r ^r Blanket Type Fiberglass
']'hickness(inches)__ l'_
Loose F.111 Type Fibergi.ass
Allnimum ThicknesQ(Inclles)
Area covered(ft. )
FLOOR,
"lateri n) ^ i , I
FLOOR, SI,AIt
Material
'1:11 icicness (i.nche» )— __
Width(lnches)_ ___
FOUNDATION WALL
A. P. No.
Brand Name_
Thermal Resistance (R Value)
Brn.'nd Name CertainTeed
Thermal Resistrince(R Value) H -
Brand Nnme 'CertainTeed _
:1'liermll Resistance(It, Value)3�;5
Brcitd Name
Number. of. I ngq Wt. per Aral; 25 Lb.
"Yherrnal Renistance(R Vnlue)38
.'hernial Resistnuce(li
Brand Nnmc
Thetinal Resistnnce(it Val.r►e)
Thi.cictteas(inclles) Thermal Resistrulce(R Value)
'1 hereby ccrt:l.fy that the t►bove i.nallln tion was installed in the above bul.lclifig
in conformance with the State of California Energy Requirements.
Hawk:i.ns Insulation 379407
F:[1Ul NAME/OWNER STATE C011.1'RACTOR'S I.ICENSi; 11o.
S~I(.idA.l'UltliA , ,
[ INSTALLATION Al i LICN.U011 i DA'fl's
' a
1 her.e:.by certify the above inmilatigr► alid al.l remilre(I items an nhmj!t
ort f"i.f+
Building Depnrt111ent approved plans and attachments have been installed as
by the S tai e of iC.itl i orni.a 'litiergy' ltequi.remertts .
All erluiprltent, devices mid materials are of the quality prescribed or are
specifically approved by t11e State of California.
1. LiC( NAPE:/OIJNI ("lease — --/
print) STATE COPtl'IUWTOR'S LICENSE' 110.
LRnli.0Gw�ruiE-tibcIti%tJ
TIIIS CE,RTIFICA'1'E P1US'T BE .ON FJ.LI.: WITHTIlE;I3UILDING DEPAR'1'MI-W1' PRIOR 10 FINAL
i Ii451'IiC'T].ON APPROVAL A14ll A COPY SHALL BE POSTED WITHIN THE BUILDING .
.January 19£1,"►
0 = Not OK •_ _ . _ u,R ,. !
' = Not Readyabtet MOBILE HOMES MISCELLANEOUS
Date MOBILE HOME UTILITIES (Plans) OK except #'s
Date ' a DECKS,COVERS,CARPORTS,GARAGESrj (Plans)OK exempt #'s
',1"1.,Zoning Requirements -Setbacks -Easements 7
1. Zoning Requirements -Setbacks -Easements N
'�2..So ls; Special, MH -Support -Sketch '' 1 "`
2. Footings; Soils -Size -Depth -Spacing -Connectors -Steel
-� 3. Sewer; Location -Test -Fall -C/O -Concrete. _
3. Decks; Girders and/or Joists-Decking-Rracing-Stairs-Rails
4. Water; Location -Test -Easement Needed (Sketch)' ` .\
4. Wood Awn.; Posts-Beams-Rftrs.-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/ /"L"ft./ • /"LPG "" 4-
6. Carports; Windows -Doors
7. Utility Clearance
7. Elec. ..e••..
i-- --
8. Frmg; SIIIs-Anchors-Studs-Rftrs-Trusses �.
9. Siding; Nailing -Veneer -Stucco -Mesh
10. Roof; Shthg-Roofing
Card -B1 Date Card -B1 Date
Card -B1 Date Card -B1 Dates -""
X11. Ext.; Steps -Doors -Landings
Date MOBILEHOME INSTALLATION (Plans) OK except #'s
1. Zoning Requirements -Setbacks -Easements'
Card -B1 Date _Card -B1 Date
2. Footings; Size -Spacing -Marriage Line F
3. Gas; MH Test -Demand -Valve -Connector
4. Electricity; MH Test -Crossovers -Breakers -Clearances
5. Drain; MH Test -Fall -Flex Connector "x
_ Card -131 Date . Card -B1 t Date
!. Date POOLS (Plaris)'OK`except.#'s
1. Setbacks -Easements 1 '
6. Water; MH Test -Regulator -Connector -,,'
- • •
?
2. Soils; Compaction -Structure Stability
7. Water and Sewer Connected -C/O to Grade -HD Approval
t
3. Pool Structure; Steel -Connections= Thickness -
8. Gas and Electricity Tagged
Dead Men -Lining
9. Exits; Insp.-Sketch
4
4. Elec.; Receptacles and Lighting, Distances-GFI
10. Cert. of Occupancy
5. Elec.; Pool Lighting; 15.volts-GFI
6. Elec.; Enclosures; Conduit Entries -Terminals -Listed
7. Elec.; Bonding; Metal w/5' -Circulating Equip. -Heater
8. Elec.;Grounding; Equip. w/5' -circulating Equip. -Pool Lghtg.
Card -B1 Date Card -B1 Date
. Boxes -Enc losures-Panel boards- Ins. to Main in Conduit
Card -B1 Date Card -B1 Date
lj
9. Health Department Approval k t r
10. Plumb.; Cir. Test -Water Supply Test
L
Card -B1 Date Card -B1 Date
+
Card -B1 Date Card -B1 Date N,
.�f
r
�
Y
Y
•
,
'
= uK
0=Not WK
- = Not Applicable RESIDENTIAL (Single and Duplex)
Not Ready
Uf DE,RFLOOR (Plans) OK except #'s t.,_r,r
/r. Zoning -Setbacks; -Easements -Flood -Slope
Ftg., Main; Soils-Steel-Elec. Grnd.-/ /" F
VFtg., Garage; Soils-Steel-/tr "' Ft . Depth
tg., Porches & Decks; Soils=Steel-/ /"FI
Stemwalls, Main; Steel-Blockouts-Wrapped
. Stemwalls, Garage; Steel-Blockouts-Wrapp(
7. Slab; Steel -Wrapped
8. Piers-Firepla .-Steel
,VD.W.V.; Fall- it Test -2 way C/O -Sewer
10. Gas Pioe: Size -Anchors
Pipe; Test -Anchors -Regulator -Service Test
12. Electric; Undergroun
l e n u m s &
V. Girders -Sills -Anchor
15. Insulation
Card -B1 GC Date/, 85 Card -131 CtC Date
Card -B1 A-0.. Date 9-2 r i Pard -131 Date
Date PLUMBING
16. Water Ht.
17. Water Pi
18. D.W.V.
19. Show F
20. Test J§b
21. Gas
Permit) OK except #'s
Jent-Acca s -Combustion Air -Baffle
st & chors-Nail Protection
st- ttn & Anchors -Nail Protection
m; a Floor -Tub Access
h er, 2nd Floor -Tub Access
Size & Anchors
Card -131 VA 0 Date Card -131 Date
Card -131 Date Card -61 Date
Date ELECTRICAL (Permit) OK except #'s
22. ture & Transformer Clearance -Ins. Protection
c.. Receptacles Spacing -Lights & Switches at Doors
e Boxes & No. of Conductors -Stapled
W. Rom x Installed Close to Edge of Studs & C.J.
uip. Ground made up w/Mech. Fasteners -19600 3tts & Water
2 Appliance Circuts in Kitchen & Conductor Size/G.F.I.
28. Subfeed Wire Size 10,OV ga. Cu or AI-A.C. Wire Size / /ga.
Cu or Al
29. Range Circ. //a/ ga. Cu or AI -Oven Circ. / / ga. Cu or Al.
Insulated Neutral _ ne No
30. Service -Riser Conductors & Ground -Main Disconnect
31. Equip. Clearances Panels-Motors-Mech. Equip.
,,32. othes Closet Light -Shower Light -Spa Light
a . Smoke Detector
Card -131 M a Date If -/3- Card -131 Date
Card -B1 Date Card -131 Date
Date MEJOAANICAL (Permit) OK except #'s
. A.C. - ucts Insulation & Support
sf:� ent Fan; Exhaust above insulation
36. Condensate Drain & Overflow; Size & Grade
37. F rnace-Vent; Access -Comb. Air -Return Air Vent -115 outlet
Attic Access & Platform if Furnace in Attic
Card -B rJ Date !- Q Card -B1 Date
Card -81 A6 Date�j,/' y Card -131 Date
Date FR*MING (Plans) OK except #'s
. i Is, Proper Material & Anchors
alls Studs -Nailing, Spacing & Bracing—Plates-Sound
• Be ing Walls over Girders & Floor Nailing
Draft Stop in Walls (rat proof)
4-6 ire Stops; Furred Ceilings -Stairs -Chases -Tub
Header & Beam -Size & Bearing
Date FR G (Continued)
. Ha ers-Post Caps -Anchors -Connector
g. Joist-Rftr. Ties-Purli of Brac. T - hthng.-Rfn
. Fi place Ties or yp Flue- ireplace Throat Clearance
kccess; Size & Romex Protection -Draft Stop -Ins.
Windows or Exiting Doors -Sill Hgt. & Dimension
e Fire Protection Framing
r_Qperty Line Firewall & Openings
xt. oors-One 3' -Check Garage -3rd story, 2 exits
irs; Width -Headroom -Rise -Run -Landing -Fire Protection
Plywood on Roof Overhang -Attic Vents -Rafter Outriggers
Siding- ailing Veneer
—±6 _r- o Mesh -Drip Screed -Fd. Vents-Underflr. Access
59-tiazing Area -Glass Protection -Skylights -Plastic
e -6B -Shear Walls; Nailin -Bolts
Inswfflon- Is- g. if
Infil tion- Is- ndws
i
Card -131 0 Date /-$fCard-B1 Date
Card -131 Aj Date/ ZLAMard-B1 Date
Date FINAL (Plans) OK except #'s j
Ext. Steps -Door & Sidelight Protection -Landings
6 . 5moke Detector )
. Furnace; Vents -Clearance -Comb. Air -Connector- j
JKGarage; Above Floor -Ducts -Mach. Protection J
V. Bedroom Exiting
. G.F.I. & Bath Fixtures & Tub Access -Spa
66. Elec. Trim & Subpanel; Breaker Sizes -Labels \
60tairs & Rails
6&4ireplace or Stove; Clearances -Hearth
69 e,fM Outlets at Wood Panel; Int. & Ext.
it. Fixt. & Appliance; Grnd. -Air Gap -Cooking Clearance j
Elec. Outlets & Receptacles at Kit. Counter
Garage Fire Door; Swing -Landing -Closer
7 uct in Garage -Damper
tr. Htr.; Vents omb. Air-Connector-P.R.V.-
In Garage ov oor Mech. Protection
Ib., Elec. & Mech. Equip. Listed for Location
76. Elec. Receptacles in Garage; (G.F.I.)-Romex Protec.
Insulation -Foam -Looked in Attic ❑ Yes
7 . Guard Rails & Deck Construction -Post Caps
7 . Fdn. Vents & Crawl Hole Door -Drainage & Wood -Earth
Clearance Looked under Floor ❑ Yes
S,P,-Following instld.; Drive -❑ Yes ❑ No; Walks ❑ Yes ❑ No;
Planters []Yes ❑ No
co; Brown -Finish
A.C. Unit; Disconnec Ele cal Plumbing
Vents Above Roof; Plbg.-Appliance-Firepl.-Clearance to
Openings.
84-WMer Well; Disconnect, Electrical, Plumbing
Exterior Elec. Trim; G.F.I. Receptacle -Underground j
YLMilation throughout House
Glass Protection
W. Corrections from Previous Inpections
89. Gas -Test -Meters Tagged; Gas -Electric
Water & Sewer Connected -C/O to Grade -HD Approval
Energy Compliance Certificate -Other Certificates
92. Roofing Certificate
Card -131 CG Date 2-6 Oro Card -B1 Date
Card -81 (r� Date2-Z3•,11) Card -131 Date
Card -131 Date Card -131 Date
Comments at Final:
r
i
(NOTE: An entry must be made each time you visit iob site)
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COUNTY OF BUTTE
• . DEPARTMENT OF PUBLIC WORKS
w� 196 Memorial Way, Chico — Phone: 891-2751.
7 County Center Drive, Oroville — Phone: 538-7541 '
747 Elliott Road, Paradise — Phone: 872-6307
' CORRECTION NOTICE
A d-)• Rq I� 24 6 3 Fs9
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 need additional explanation, please contact this office immediately.
rl o.✓S G l f .. 9 N v E 6 A 6 rz
Inspector Date_ E'1'(3-14
f COUNTY OF BUTTE
DEPARTMENT OF PUBLIC. WORKS
196 Memorial.Way, Chico — Phone: 891-2751
7 County Center Drive, Oroville — Phone: 538-7541
k 747 Elliott Road, Paradise — Phone: 872-6307
f CORRECTION NOTICE
�a
• OWNER PERMIT NO.
A routine inspection indicates that the following violations of County Ordinance
x 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.
r,
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1'
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WArr(/L 14fi.A-rff2 P. ;rAZ9n �.
Inspector /J c Date
. 3r .� .. ..- _ ix ' v..:.-«i'r'+�sfi-•_�.t.:er_".�f. rs.-n.:.rt: �..-+:...:�.r,y+ae.s:.+v. .-..:�..��•='r�..�-+a:>
I
COUNTY OF BUTTE
DEPARTMENT OF PUBLIC WORKS
196 Memorial Way, Chico — Phone: 891-2751
-�. :7 County Center Drive, Orovi Ile — 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
matter need additional explanation, please contact
/this office immediately.
Vill,-r N�f
7/2
S�,s-(all a��k►'��
Inspector Date
I
-.'''y .. x«;.-a%.x^y..4tA3�C:."..�:y;.'L`bR+S:.'�'3"';,f.""�F^.w,.'^-5n?':r.�.r"•�::r� �v..ar'w .:.yw�h'
COUNTY OF BUTTE
ra DEPARTMENT OF PUBLIC WORKS
' 196 Memorial Way, Chico — Phone: 891-2751 *'
• 7 County Center Drive, Oroville — Phone: 538-7,541
-cam 747 Elliott Road, Paradise — Phone: 872-6307 71 I
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
matter, or need additional explanation, please contact is office immediately.
4< d ��" re i t Gly-e?X / -7,� Q a,,., Q c/ Y
i
Jo %A DUB
V.
; cl, ti
91A10
. Inspector r Date r �• `�
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS
7 County Center Drive - Oroville,:California 959&5 - Telephone: 916/538-7541
APPLICATION AND PERMIT
PERMIT NO.
/
ASSE OR ARC 'UMBERZO
/
a I BUILDING PERMIT
OWNER TELEPHONE
OWNA LI AD 55
ed " &Lle=, -�S (:�_6 -7
SQ T. OC . BUILDING VA UAT10N
1V s
CONTRACTOR'S NAME TELLPHONE
�
CONTRACTOR 5 MAILING ADDRESS
Fireplace
CONS UCTIO DER UNKNOWN Total Valuation Is
LEN ER'S MAILING ADDRESS Filing Fee
j Permit Fee
$ 10.00
$
ARCHITECT O�EER
LICENSE NO. I
Plan Checking Fee
$
Energy Plan Checking Fee
$ _
ARCHITECT OR ENGINEER'S MAILING ADDRESS (
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
Filing Fee 10.00 11
(tet/
Each Tra
2.00 ,
Solar het pumpater heater
Water piping
20.00
5.00
LOT NO.
SUBDIVISION M PARCEL MAP
3J y 3
Each qas water heater or vent
5.00
USE OF STRUCTURE
SF)A 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
Ne Addition 11 emooC Utilities ❑ Installation❑ Other ❑
De cribe work: r
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 10.00
Main service 100V OR LESS
100 AMP OR LESS
10.00
Main service EA. ADD'L 100 AMP
2.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
F-1NON.RESID
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. 1v�CJ 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 the owner, am exclusively contracting with licensed contract-
ors.(Sec. 7044)
❑ 1 am exempt under Sec. , Business and Professions Code
for this reason
I NEW CONST. DWELLING WJ ,
) OR ADDNS. ACC. BLDG /zQsgft
NEW CN5TR. TI.OUTL
O 2,50 ea
BRANCH CIRC ITS
POWER APPARATUS e
SINGLE OUTLET CIR. )
Ex.00CUp(OUTLETSOR FIXTURES .200020 0 30
Ex. DCCUp. OUTLETS P(RESID )FIXED ALNS.REA.) 2.00
Temporary service 10.00
Mobile Home Facilities 15.00
Misc. Wiring
g 15.00
Permit Fee $
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
2 -4 -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 shal I be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 10.00
Heati
Cooling
g
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 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, ludg tents, costs, and expenses which may in any way accrue
again sa' oun in�nce o the granting of this permit.
X 7%
Date
S
,, A'gnature of A licant - Owner ❑ Contractor [Agent ❑
An OSHA permit is required for excavations over 5_0" dee and demolition or construct-
ion of structures over 3 stories in height.
Mobile Home Installation Fee $
Energy Inspection Fee $
TOTAL PERMIT FEE
UP.
✓a
CO ST.LTP[
IAVA
SCNoo
FL000
PARCEL
o Isso
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which
D) R OF UBLIC
BY
PERMIT EXPIRES ate
the applicable provi-
resolutions to do
fees have been paid.
WORKS
Date
Receipt I /S a
WNIT[-D. r. W..Y[LLOW-A9 O I [ 9P TOR pa R�- P CANT
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS - BUILDING DIVISION
7 COUNTY CENTER DRIVE - OROVILLE, cALIFORWIA 95965 - TELEPHONE: 916/538-7541
PERMIT APPLICATIOWDATA SHEET
Permit No.
OWNER Ad I J-) At"74�c` A. P. No. / -. /
Proposed Building Use /i/..�iCcAi Building Inspector-� Date /
/ or
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. Energy Design Compliance and supporting documentation ..........
6. Statement of Intent for Non -Heated and AC Buildings ..............
7. Engineered truss details and layout in duplicate (required prior to plan check)
8. Mobilehome installation data including manufacturer's installation
instructions.......................................................
9. Fees of $ ..........................
10. Chico Urban Area fees paid ::::::::::::::::::::::::::::::::::::::::
11.Park fees paid /
chool District fees paid ............
1.
3. Sanitation approval from dHealth Department ... —
14. City of Chico plumbing permit ..................................... .
15. Plot plan and business license approval from City of
(see City for other requirements)
16. Planning approval for (A) Use: (B) Parking: .........
1�, Improvements may be required.
rlveway permit (construction approval required prior to occupancy) .. 2"
19. Pre -Ins ection for re ulred ... _ Pre-Insperequest to
p q •Building Inspector (Date)
20. Contractor's license information (No., Name Style, Classification) .......
21. Certificate of Workmans Compensation Insurance ....................
ner-Builder Verification (Given to owner 1:1, Mail to owner ❑) ..
1 Recorded copy of Agricultural Acknowledgment Statement ............
24. Letter of signature authorization .....................................
25.
26.
�w
When you issue the permit, process as follows: � Mail to owner. Mail to contractor.
Telephone and hold for pickup at office. Deliver w/inspector.
Other
Copy of plans sent Health Dept., Fire Dept., ' Other Date -
The following data must be submittedpX
to mit is uan e: (Circle new itemno checked
1. Index permit for above ite s NO. �
2. Additional items require"27r
Contractor, designer owner was advised of above required data by_phone ail counter b date
r•
Contractor, designe , ner, was advised of above required data by—phone —mal l—count r by date
Plans checked by Date Plans approved by Date _
,t
Sets of plans on hold in_ Fist cabinet AP folder
1) FFA 1 .
11 /S. Uo Copy—DPW �. t;' rs
TO Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
ownerLoc on
plan Approved for: Sewage Disposal Water Supply
Hold final for: Water Supply �-
Final clearance O.K. for: Water Supply
Clearance ?or —J-- bedroom -fie home. other — �-
•� � .... Dat
S nitarian
TO: Building Department
• 3
FROM: Encroachment Permit Section
RE:. Dti:veway Clearance
41
owner locatioh AP #
Driveway permit
99 has been issued for the above property.
_
/ub
..,C. zz-000
sign re date
RESIDENTIAL PLAN CHECKING GUIDE 7/85
(S.F., DUPLEX & MISC. ONLY) /L
Bldg. Permit # 2T��
OWNER A.P.
GENERAL /
1. Zoning requirement : (sideyards and number of.permitted living units).
valuation.
Plans signed by designer.
f+� Energy Design and Compliance.
Existing violations on property.
PLOT PLAN
Complete parcel size and dimensions.
Setbacks, sideyards, easements, etc.
Other buildings or structures.
— --4, Grading, fills, drainage.—
Flood hazard.
Special conditions on creation map or compliance document.
FLOOR PLAN
Complete to scale plan with dimensions.
Required•windows for light.and ventilation (Sec. 1205).
Required windows for second exit (Sec. 1204).
Skylighti•(Chapter 34'& Sec. 5207).
Human impact glass (Sec. 5406).
6. Required room sizes, ceiling.heights (Sec, 1207).. '
`—� ,G,.F.C.I.:-'s �in,.baths•, garage 'and exterior outlets., (Article 210-8).
Light fixtures, switches, receptacles,- and exterior �receptacles`for maintenance of
. mechanical_ equipment.
Locations of water'heater, heating and.cooling equipment; other''electrical'or•gas'
equipment, and plumbing fixtures.
Garage`firewall, door size, and closer_ (Sec. 503(d)(3)).
i_12`3`0" exterior exit door (Sec.. 3304(e)).
Fireplace and wood stove location.
Smoke detectors (Sec. 1210).
STRUCTURAL DETAILS
Foundation plan complete enough --.to construct building.
Floor construction details complete enough:to construct building.
Elevations and wall construction details complete enough to construct building.
Roof construction details complete enough to construct building.
Fireplace construction details and calcs if necessary.
,Sufficient data and details to satisfy energy requirements (State Law) (Form 1).
MISCELLANEOUS ITEMS TO LOOK OUT FOR
Exposure I plywood on exposed locations and overhangs.
-�
Stairway details: landings, rise and run head clearance handrails Sec. 3306).
�! .Guardrail details(Sec. 1711 & 3306(j))..
Brick or stone veneer (Chapter 30) . -
Exterior plaster _weep screeds (Sec. 4706).
§� Proper roof pitch•for roof covering (Chapter 32).•
/ Rafter ties or bearing ridge beam.
RESIDENTIAL PLAN CHECKING GUIDE (CONT'D)
MISCELLANEOUS ITEMS TO LOOK OUT FOR (CONT'D)
Garage door o orc heade sizes.
Adequate bracing.
Living area over garage - complete 1 -hour separation required on garage side
including supporting walls and posts, etc.
,,l< Two exits on three-story dwellings (Sec.. 3303 & see Mezannines 1716).
Attic access and ventilation (Sec. 3205).
Underfloor access and ventilation (Sec. 2516).
Wood stoves, clearances, alcoves & 1 -hour shafts.
Comgu tion air for fuel burning appliances.
Noise requirements on duplexes.
11-71, Adobe soils - special foundation design.
Retaining walls requiring design.
Unusual shape, size or split level house requiring lateral design.
VA L-m--rc oO
t
7/85
70T+( WICO v .
?o
C-0 -F/�Z'"-
t
7/85
70T+( WICO v .
Certificate of Compliance: Residential SHEET
HVAC SYSTEMS
Minimum Duct
Type (ftmtace, air Efficiency Location Duct Output
conditioner, heat ) (SE. SEER.HSPF) (apic, etc.) • R -Value tuh
at
Maximum Furnace Heating Output: Btuh
HOT WATER SYSTEMS Tank Manufacturer/Model #
System Type (storage gas. etc.) Capacity (or approved equal)
SPECAI- FEATURES/REMARKS (Add extra sheets if n a
(Page 2 o# 2) CFAR
Date
Manufa r / Model #
ora ved a al)
Special Feature(s)
COMPLIANCE STATEMENT
This certificate of compliance lists the building fea
and performance specifications needed to comply with
Title 24, Chapter 2-53 and Title 20, Chapter 2, Su
pter 4, Article 1 of the California Administrative code. This'
certificate has been signed by the individual with oLb
esign responsibility and the building owner, who shall
retain a copy of it and transmit the certificate to
uent purchaser of the building. When this certificate of
compliance is submitted for a single building pi tilt in multiple orientations, all building conservation
features which vary are indicated in the Special eaemarks section.
Designer
Building Owner
Name: Bob Metzger O.D.S.
Name:
7-aWFirim �. Draftinq Service' Owner
Tu1NFian:
Address: 717 5th St.__ 12Y5 Mangrove
Address:
Orland Ca. S$2e.0 Chico
Ca.
Telephone: 865-9688 4 2- 9 6 8 8
Teiephone:
Lic. ;t: N A
(nt;aare) (date)
(sign==) (date)
Documentation Author
Enforcement Agency
Nam= Same as s i n e r
Name:
'I' WFusn:
Agency:
Addm=:
Telephone:
Telephone:
(signanue) (date)
(signanue or stamp) (dace)
roan Revised Man:h I ggs
COUNTY OF BUTTE -'DEPARTMENT OF.PUBLIC.WORKS
7 County Center Drive, Oroville, CA 95965 PHONE-' 916-538-7541
J�y!`� V . •.��/� DATE Z�
G� NOW . RE_ �ew.4f1 61
� (J A.P. #
.7
With reference to the above.subject:
�L Attached is:
Application for. permit
Building Plans
Engr. Calcs
Owner -Builder Verification Form
OTHER
Mobilehome Utilities Installation Sheet-
Mobilehome Installation. Information Sheet
Typical -Plan Sheet
List of Codes Enforced
LL We need,the following information:
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 a
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'(DPW)
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., Orovill.e
` Skyway"&-ElYiott`Rd. , Paradise
Planning approval from Butte County Planning.Department, 7 County Center Drive,
Oroville, for
Completed Owner -Builder Verification form.
Recorded copy of deed showing
Recorded copy of agricultural acknowledgement statement.
/ OTHER�&A
Should you have any questions concerning the above, please contact
of this office.
Yours very truly,
JFG/aj
William Cheff
Director of Public Works
J.F. Glander
Chief Building Inspector
FIBUTTE COUNTY t 3
r
JOHN R. HENRY, P.E.
Building Plan Checker IV
CHICO891-2751 DEPARTMENT OF PUBLIC WORKS
OROVILLE 538-7541 7 COUNTY CENTER DRIVE
PARADISE 872-6307 OROVILLE, CALIFORNIA 95965
s --
tom,
�,
•'1
�
.L
* �
�
5
FIBUTTE COUNTY t 3
r
JOHN R. HENRY, P.E.
Building Plan Checker IV
CHICO891-2751 DEPARTMENT OF PUBLIC WORKS
OROVILLE 538-7541 7 COUNTY CENTER DRIVE
PARADISE 872-6307 OROVILLE, CALIFORNIA 95965
s --
;Y
4 1 . ..
71 7Tc�OTs
Feao�E47 f W. -W-- - - a Ai
8�is��9 �D g�2�q tv�2E llN.t�fcze -yS'Y qu�.
�L�ASE . mac- ,you 0✓ra/6' d f/
114-jvS 1Y11%f% 5hlSM/T Fa12./2E✓4Est1:
-
�2 •
Pori- �61Z CH Yxoo .
�• KI4 FTE ~p
Cl&rl&IAIC ct4
S. poTE 5'TfZ4eT' Sf�i►�ia/6 �F'1 /� F � � o , c ,
S
Jo-
�orrA/c
.49
ir
SIS 0 4
5&'12J
Mandatory Measures Checklist: Residential MF -IR
NOTE: Lowrise residential buildings subject to the Standards must conWn thew measures rcgerdlj:� ofinpIl�ance
approach used, items marked with an asterisk (') may be superseded by more stringent couirements fisted
ppr$n the Certificue of Compliance. When this checklist Is Incorporated Into the it docuthatures noted
be eonslderM by,all partly as binding minimum component performance specificallons for the mandatory tneasiaes
whether they are shown elsewhere In the documents or on this checklist only.
DESCRIPTION
Building Envelope Measures
' 12-5352(x): Minimum ceiling insulation R-19 weighted average.
42.5352(br Loose fill insulation manufacturer's labeled R -Value.
• 42-5352(c): Minimum wall insulation In Gained walls R-11 weighted average (does not apply to
exterior mass walls).
12.5352(k}. Slab edge insulation - water absorption me no greater than 0.3%. water vapor
transmission rate no grater than 2.0 pemVuich.
12.5311: Insulation specified or Installed mew California Energy Commission (CECT quality
standards. Indicate type and form.
12-5332(fr Vapor barriers mandatory In Climate Zona 14 and 16 only.
12-5317: Inf'iltration/Eardtration Controta
a. Door$ and windows between conditioned and unconditioned spaea designed to Omit sir
leakage.
b. Doors and windows certified.
e. Doors and windows weatherstriWA: all joints and penetrations caulked and soled.
12-535 2(c): Special infiltration burley Installed to comply with 12-33/",ftt,10ECq.-
I.
Ity,
12-5352(d): Installation of Fireplace)
Masonry and factory -built fimplares have:
a. Tight fitting. closeable metal or slats door
b. Outside air intake with damper and control
e. Rue damppeerr and control
2. NO continuous burning gas pilots allowed.
HVAC and Plumbing System Measures
12-5352(g) and 2.5303: Space conditioning equipment sizing: attach
12-5352(h) and 2-3313: Setback thermostat on all
applicable besting system.
• 12-3316(x): Ducts constructed. Installed and Insulated per Chapter'10,1916 UMC.
12-5316(b).- Exhaust systems have damper controls.
12-5314(c): Cas -fired space heating equipment has intermiutnt Ignition devices.
12-3314: HVAC equipment, water hestera, ahowuheads Arid faucets certified by the CFC.
42-5352(1): Water heater insulation blanket (R-12 a ga)Lla) or combined interiorkxterior
Insulation (R-16 or greater): rust 3 feet of pipes c to tank Insulated (R-3 or grater).
12-5312(Exception I): Pipe Insulation on steam and
piping.eotdensau return 6t recirculating
12-5316(d): Swimming Pool Heating
1. System hac
a. On/off switch on heater.
b. Weatherproof instruction plate on heater.
c. Plumbed to allow for solar.
2. 73 percent thermal efficiency.
3. Pool cover.
4. Time clock.
3. Directional wxtu inlet.
Lighting and Appliance Meuur/ea
12-5332(tlt Lighting - 25 u filume V it a greater for general lighting In kitchens and bathrooms.
12-5314(c): Gred applies equipped with intermittent ignition devices.
12-5314(m): Refrigerators totfrigetauw-rrmxers. rmeun and tluorewent lamp ballasu eerdried
by the CEC. Indicate iahce and model number.
tabled -9: ShadrnsColfficfentrJorf.rerferSA&URIDevices
Attic
Vented Crawl Space
R -Value
Heatins Cooling
Heating Cooling
2.1
4.2.11
.7/ .74
94
Sc
6.3
.63
.e6
.64 .97
6.3
(o�
9
sC(SA.4Chrtej)
Gt.d.e1/ t.s
Ctm
Drrperyt
ve.ed..eu.&M
7WAr
Oot7
No.wllir 71W
(W.U144
".Mn(S
oluRrn.)
(02UO.13) (eAVO-V)Stolle
Plat one
clew cur Meta
1.00
0.61
0.91 0.63
0.60 013
0.71
031
wood
0.76
0.69 0.47
064
033
0.30
036
0e011,14 has Nam
Clear clam wui(
on
0.77
0.73 0.11 �
0.66 0.41
044
033
wood
0.67
037 0.41
036
0.49
029
o23
ruble 4-11: UVAC Duct 0clemy factors
One StoryBultdfnes:
Duet
Attic
Vented Crawl Space
R -Value
Heatins Cooling
Heating Cooling
2.1
4.2.11
.7/ .74
94
.71 M
.12
6.3
.63
.e6
.64 .97
71Ma- and Miff-Simy Bulfdlnss:
Duet
Attk
Vented Crawl Space
R -Value
"citing
Cooling
Heating CooUns
2.1
4.2
.13
.111
.13
.13 .19
.90
6.3
.90
9
.91
91
OWNER'S NAME:
l7 .
PERMIT # :
v"L/ A.P.
# : ��— �f'r° — I >
RECEIVED
When approved,
process as' follows:
DATE
Mair to
owner
TIME _
'
Address)
(Address)-
Mail to
Mail
contractor
(Name and Address)
Calf
and.hold for pickup at office.
Deliver
with next inspection...'
REVISED PLAN CHECK FEES AID
$30.00
AP
ddi'tional Fees Not
Required.
Return to DPW AGRICULTURAL STATEMENT OF ACKNOWLEDGEMENT
FOR RESIDENTIAL DEVELOPMENT
Section 26-8.1 of the Butte County Code
requires this acknowledgement be ' recorded NOT LohAFAREDWITK
prior to issuance ofa building permit. ORIGINAL DOCUMENT .AUG
2 2 1989
The property described herein is adjacent
to land or included within an area zoned
.for agricultural purposes, and residents 89-031654
of this property may be subject to incon-
veniences or discomfort arising from the
use of agricultural chemicals, including,
but not limited to herbicides, pesticides;
and fertilizers; and from the pursuit
of agricultural operations including,
but not limited to cultivation, plowing,.
spraying, pruning, and harvesting which
occasionally generate dust, smoke, noise, and odor. Butte County 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 disconform from normal,.necessary farm operations.
All that real property situate in the County of Butte, State of California, described as
follows:
SEE ATTACHED LDGAL DESCRIPTION AS EXHIBIT "A"
Date • 7-31-89 rnvr�ni i vwiv �.�.
O RADE
'RAFAELA H. Ai RADE
State of CALIFORNIA)
County of BUTTE )
On this the 31st day of `" almf , 19_n, before me,
SS. the undersigned Notary Public, personally' appeared
DAVID NALKOLA
NOTARY PUBIJGCAL FORNIA
0 Butte County
My Commission ExPI►es
March 22, 1991
I
E] Personally known to me. E] Proved to me on the basis
of satisfactory evidence.
to be the person(s) whose name(s) ARE
subscribed to the within instrument and acknowledged that they
executed the same for the purposes therein contained. IN WITNESS
WHEREOF, I hereunto set my hand and official sea
Present A.P. No: 64-46-17
David Halkola
,., ,. .. .., .. .. ... +v.R--r..vR - ,� .'3%res;-•-r.-.a.rYf("'r,`.""r4+^r^; rrc+wwf....,-a,..+..rcr ^.r'. ti, � ..
BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
(One/Form per Building)
A.P. Number -.��0`/� Building Department No.
School.District City County E2"""Jurisdiction
Property Owrier 4/C�CJ1�Q_
" 1
Project Location/Address . %/�) '� � i �/�� D,t L0
•Subdivision Q Lot Number
Residential Development: a' a
Sq, Footage
#-of, Living MHI Addition (Group R)
Units. ;
Commercial/Industrial: a Sq- Footage
New `Addition.(Including Exterior
Roofed Areas)-
`"Building'Department Representative Date
(Floor Plans reviewed by School", -District Personnel)'
District I,d No. S0_5
�),4AJ,, j4 School District certifies that
�7g- 3%r9�
. (Ap/plric/a/n�tINamee)) (Phone 'Number)
ed r
(Street Address)
(City) (State) (Zip Code)
has complied with the requirements of Resolution No.
by the�pa_yment of $ �'(���� � representing An -square square feet. -
School District.Representative r Date '
PAID- BY CHECK NO. REMARKS.:
BANK NO �U l� UI/h ,
PAID BY'CASH
white -applicant, yellow -building department, pink -school district*
SCHOOL.FEt. (8/88)
EXHIBIT "A"
,.`.y, ALL THAT CERTAIN LAND SITUATE IN THE STATE OF CALIFORNIA, COUNTY.,.
OF BUTTE, AND IS DESCRIBED AS FOLLOWS
PARCEL I•
LOT 108, AS SHOWN ON THAT CERTAIN MAP ENTITLED, "PARADISE PINES
UNIT NO. 61', WHICH MAP WAS RECORDED IN THE OFFICE OF THE
RECORDER OF THE COUNTY OF BUTTE, STATE OF CALIFORNIA, ON AUGUST
26, 1970, IN BOOK 35 OF MAPS, AT PAGE(S) 92, 93 AND 94.
CERTIFICATE OF CORRECTION RECORDED DECEMBER 2, 1970, IN BOOK
1648, PAGE 3, OFFICIAL RECORDS.
EXCEPTING THEREFROM ALL MINERALS, OIL, GAS, ASPHALTUM AND OTHER
HYDROCARBON SUBSTANCES, WITH PROVISION THAT ANY AND ALL MINING
OPERATIONS SHALL BEt DONE FROM ORIFICES OUTSIDE THE SURFACE AREA
OF THE LAND DESCRIBED HEREIN, AND THAT NO DAMAGE SHALL BE DONE.TO
THE SURFACE OF SAID LAND.
PARCEL II:
A NON-EXCLUSIVE EASEMENT OVER LOTS E AND F (THE COMMON AREAS) OF
SAID PARADISE PINES UNIT NO. 6, AND LOTS DESIGNATED FOR COMMON
AND RECREATION `AREAS, AS DESCRIBED IN THE DECLARATION OF
ANNEXATION FOR UNITS IV, VI; VIII AND X.
1. Ceiling Insulation
2. Wall Insulation
-4
Number of stories
0.80
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
1
-
8
0.50
-176
-84
-54
0.30
-102
-49
-02
0.10
-26
-13
-8
0.08
-18
-9
-6
0.06
-11
-5
-4
0.04
-4
-2
-1
0.02
4
2
1
0.00
11
5
3
2. Wall Insulation
-4
-3 -1
0.80
Single-
Single -
0.70
2
Family
Family
Mulli-
R-value
Detached Attached
Family
R-0
-68
-51'
-34
R-11
0
0
0
R-13
2
2
1
R-19
8
6
4
' U -value
Glass
Single
Double
I 0.80
-153
-114
-76
f 0.50
-91
-68
-46
' 0.30
-47
-36
-24
0.10
0
'0
0
' 0.08
4
3
2
0.06
9
7
5
0.04
14
11
7
0.02
19
14
10
0.00
24
18
12
3. Raised Floor -Insulation
5
12
28
Insulation
in Floor '
-10
-2
5
Number of stories
27
R -value
One
Two
Three
R-0
-17
-8
-5
R-11
-3
-2
-1
R-19
0
0
0
R-30
3
1
1
U -value
-43
-12
I
0.60
..-144
-70
-46
0.50
-120
-58
-38
0.40
-95
-46
-30
' 0.30
-69
-34
-22
0.20
-43
-21
.-14
0.10
-17
-8
-5
0.08
-11
-6
-4
0.06
-6
-3
-2
0.04
-1
0,
0
0.02
4
2
1
0.00
10
5
3
Controlled Ventilation Crawispace
17
-23
Number of stories
3
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
14
18
13,-12
Number of Stories
4
R -value
One
Two
Three
R-0
0
0
0
R-5
8
5
2
R-7
8
6
3
F2 factor
0.90
-4
-3 -1
0.80
-1
-1 0
0.70
2
2 1
0.60
6
4 - 2
0.50
9
6 3
0.40
12
8 4
5. Infiltration (Air Leakage)
Spedfication
Slab Floor Raised Floor
Mass
Points
Stories
' 12M
StarKWd
Two
Three
0
-5 -4 -2
6. Glass Heat Loss
-1
0.1 -8
-5 -3 -1
Total
0
0.3 -7
4 -2 0
1
U -value
0.5 -6
Percent
1
.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
-61
-21
-13
-4
4
12
29
'58
-20
-12
-3
5
12
28
-55
-18
-10
-2
5
13
27
-52
-17
-9
-2
6
13
26
-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
2
7
12
16
17
-23
-1
3
8
12
17
16
-20
0
4
9
13
17
15
-17
1
6
10
14
17
14
1_4,EJ3
7
10
14
18
13,-12
SE HSPF
4
8
11
15
18
12
-9
6
9
12
15
19
11
-6
7
10
13
16
19
10
-3
9
11
14
17
19
9
-1
10
13
15
17
20
8
2
12
14
16
18
20
-73 -64 -56 47
-38
-30
na 3.41
-45 -39 -34 -29
-24
-18
7..Shading
(Shade Open)
-18
-14
0.50 4.58
Effective
Percent Glass
4
0.56 5.13
0 0 0 0
(percent Plass
x SC)
0.60 5.50
Effective
3
2
0.70 6.42
17 15 - 13' 11
9
7
%Glass
North
East
South
West Skylight
32 28 24 20
18
5
1
4
19
1
na
16
4
2
5
-30
1
na
14
4
2
5
2
1
na
12 '
3
3
5
-8
2
_
na
11
3
3
5
2
na
10
2
3
5
2
1
9
2
3
5
2
2
8
2
3
5
2
2
6
Cl)
4
2
3
5
1
2
4
23
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
-1
-2
-4
-2
0
na ='not allowed
a3. Shading
(Shade Closed)
Effective
Percent Glass
(percent stass x SC)
Effective
%Glass . Norft East
South
West
Skyfpht
18
-14
-48
-69
-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
4
-1
-6
-8
-7-
-23
3
0 -
4
-5
-4
-16
2
1
-1.
-2
-1
-9
1
1
1
1
1
-4
0
2
3
4
3.
0
na . not
allowed
9. Interior Thermal Mass
Interior
Slab Floor Raised Floor
Mass
Stories
Stories
' 12M
/CFA 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
6 2 3
4
5
1.5 -3
1" 2 4
5
5
2.0 -1
2 4 5
6
7
2.5 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 a 10
11
11
5.0 4
7 9 11
- 12
12
5.5 5
8 9 11
12
12
6.0 5
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 11 13
14
14
8.0 7
10 11 13
14
14
8.5 7
10 12 13
14
15
10. Exterior Wall Thermal Mass
7
Exterior
Single- Single -
-30
-25 -21 -17
Wall
Family Family
Multi
Mass
Detached Attached
Family
0.00
0 0
0
4 -4 -3
0.20 •
3 • 2
1
0
0.40
5 4
3
8.0
0.60
8 6
4
3
0.80
10. 8
5
7
1.00
13 10
7
19 16 13
1.20
13 12
8
26
1.40
12 13
9
12.0
1.60
10 13
11
9
1.80
10 12
12
15
2.00
10 11
13
i
11. Heating System
to
10
a 7 6
SE or HSPF
3
1199
No Cooling System Installed
(assumes ducts In aWc)
more
Stories
_ Sum of 1-6
0
0
0
-25 or -24 to -14 to 4 to
+610
16 or '
SE HSPF
less -15 75 +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
None
Effective SE or HSPF
-23 .
(SE or HSPF x duct efficiency)
-11
-9
Effective -25
or -24 to -1410 4 to .
+6 to 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' 11
9
7
0.80 7.33
25 22 19 16
13
10
0.90 8.25
32 28 24 20
17
13
1.00 9.17
37 32 28 24
19
15
Zonal Control Adjustment
0
System Type
IE
None
-30
Resistance
10 9 7 6
4
3
Other
6. 5 4 3
2
2-
12. Cooling Syst!m
Unit Size (sQ .
SEER
1199
' 12M
1700
(assume; ducts In attic)
2700
Heater
Gredit
Som of 7-10
to
, to
to
-25 of -24 to -14 to -4 b
+6 to
16 or
SEER
less
•15 -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
12.0
15
13 11 9
7
5
13.0
20
17 14 12
9
6
HWR
-18
Effective SEER
-9
-7
-6
(SEER xduct efficlency)
WSB
-25
-16
-12
-10
-8
POU
Sum of 7-1.0
-12
-9
Effective -25 or -24 to 14.6' -4 to
+6 b
16 or
SEER
less
-15 -5 +5
+15
more
-2
Solar
7
5
5.0
-30
-25 -21 -17
-13.
9
6.0
-12
-11 -9 -7
-6
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
12.0
30
73 22 18
14
9
13.0
33
23 24 20
15
10
Credit
Zonal
Control Adjustment
to
to
10
a 7 6
4
3
1199
No Cooling System Installed
2199
more
Stories
None
0
0
0
One
-5
-4 -4 -3
-2
-2
Two+
. 3
3 2 2
2
1'
Single-Famlly Detached and Attached
Interior MasslCFA
T7ve 7 PASS
(l. 7av1K•.. 71 I TYPE 1 -MASS (UIMC ' -
Ic. raecaa .1_0l 1.2, .tie: exposed slab) .
O1/- r5% 10% 15% 20Y. 25% 3011. 35% QY.1. 45% 50% 55% 6011 X65'/. 7011. '75% ,e80%:85Y. •90% 95% 1009'- 105% 110Y 115% 120% 125`
OY. 0 0.2 0.4 0.6 0.8 .1.1 1.3 1.5 1.7 1.9 2.1 2.3 2.5 2.7 2.9 3.2 3.4 3.6 3.8 4 4.2 4.4 4.6 4.8 5 5.3
1011. 0.2 0.4 0.6 0.8 '11 1.2 1.4 .1.6 1.9 2.1 2.3 2.5 2.7 2.9 3.1 3.3 3.5 . 3.7 4' - 4.2 .4.4.• 4.6 4.8 5 5.2 5.4
20% 0.3 0.6 0.8 1 1.2 . 1.4 1.6 ' 1.8" 2 2.2 24 Z7 2.9 3.1 3.3 3.5 3.7 3.9 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 2.2 2.4 2.6 2.8 3 3.2 3.5 3.7 3.9 4.1 4.3 4.5 4.7 4.9 5.1 5.3 5.6 58
401/. 0.7 0.9 1.1 1.3 1.5 1.7 1.9 2.2 Z4 2.6 2.8 3 3.2 3.4 3.6 3.8 4 4.3 4.5 4.7 4.9 5.1 5.3 5.5 5.7 5.9
50Y. .0.9 1.1 1.3 1.5 1.7 1.9 Zt Z3 Z5 Z7 3 3.2 3.4 3.6 3.8 4 42 4.4 4.6 4.8 5.1 5.3 5.5 5.7 5.9 6.1
55% 0.9 1.1 1.4 1.6 1.8 2 2.2 Z4 2.6 2.8 3 3.2 3.5 3.7 3.9 4.1 4.3 4.5 4.7 4.9 5.1 5.3 5.6 5.8 6 6.2
60% 1 1.2 1.4 1.7 1.9 Z1 2.3 2.5 2.7 2.9 3.1 3.3 3.5 3.8 4 4.2 4.4 4.6. 4.8 ' 5 5.2 5.4 '5.6 5.9 6.1 63
65% 1.1 1.3 1.5 1.7 1.9 2.2 2.4 2.6 2.8 3 3.2 3.4 3.6 3.8 4 4.3 4.5' 4.7 4.9 5.1 5.3 55 5.7 5.9 6.1 6.4
M. 1.2 1.4 1.6 1.8 2 2.2 2.5 2.7 29 3.1 3.3 3.5 3.7 3.9 4.1 4.3 '4.6 4.8 5 5.2 ,5.4 5.6 58 6 6.2 64
75% 1.3 1.5 1.7 1.9 Z1 2.3 Z5 2.7 3 3.2 3.4 3.6 3.8 4 4.2 4.4 4.6 4.6 5.1 5.3 5.5 5.7 5.9 " 6.1 6.3 6.5
80% • 1.4' 1.6 1.8 2 2.2 2.4 26 2.8 3 3.3 3.5 3.7 3.9 4.1 4.3 4.5 4.7 4.9 5.1 5.4 5.6 5.8 6 62 64 66
85% 1.4 1.7 1.9 2.1 2.3 2.5 2.7 2.9 3.1 3.3 3.5 3.8 4 4.2 4.4 4.6 4.8 5 52 54 5.6 5.9 6.1 63 65 67
809: 1.5 1.7 2 2.2 2.4 2.6 2.8 3 3.2 3.4 3.6 3.8 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
95% 1.6 1.82 2.2 2.5 2.7 2.9 3.1 33 3.5 3.7 3.9 4.1 4.3 4.6 4.6 5 5.2 5.4 5.6 5.8 6 6.2 6.4 6.7 6.9
100% • 1'7 1.9 21 2.3 2.5 2.8 3 3.2 3.4 3.8 3.8 4 4.2 4.4 4.6 4.9 5.1 5.3 5.5 5.7 5.9 6.1 6.3 6.5 6.7 7
105% 1.8: 2 2.2 2.4 2.6 2.8 3 3.3 3.5 3.7 3.9 4.1 4.3 4.5 4.7 4.9 5.1 5.4 56 5.8 6 6.2 6.4 6.6 68 7
110% 1.9 2.1 2.3 2.5 2.7 2.9 3.1 3.3 3.8 3.8 4 4.2 4.4 4.6 4.8 5 5.2 5.4 5.7 5.9 6.1 6.3 6.5 6.7 69 7.1
115% 2 2.2 2.4 2.6 2.8 3 3.2 3.4 3.6 3.8 4.1 4.3 4.5 4.7 4.9 5.1 5.3 5.5 5.7 5.9 6.2 6.4 6.6 6.8 7 72
120% 2 2.3 2.5 2.7 2.9 3.1 3.3 3.5 3.7 3.9 4.1 4.4 4.6 4.8 5 5.2 5.4 5.6 58 6 6.2 6.5 6.7 6.9 7.1 7.3
125% 2.1 2.3 2.5 2.8 3 3.2 3.4 3.6 3.8 4 4.2 4.4 4.6 •4.9 5.1 5.3 5.5 5.7 5.9 6.1 6.3 6.5 6.7 7 7.2 7.4
Point system summary: Climate Zone 11
SCORE CARD
Measures
1. Ceiling Insulation . or
R -value [38] U -value [0.030]
2. Wall Insulation" or
R -value [ l ll U -value [0.098]
3. Raised Floor Insulation - Iq or
-value 1191- . U -value [0.037]
4. Slab Edge Insulation
5.' Infiltration
6. Glass Heat Loss
7. Shading (Shade Open)
a. North
b. East
c. South
d. West
e. Skylight
8. Shading (Shade Closed)
a. North
b. East
c.. South
d. West
e. Skylight
9. Interior Thermal Mass
10. Exterior Wall Mass
11. Heating System
Zonal Control? ( Y / N )
12. Cooling System
Zonal Control? ( Y / N )
13. Water Heating
- Point Scores
0
or
R -value [0] F2 factor [0.77] J
Standard .0
Type [double] U -value [0.65] % o�] j Sum .b
%
Gass - SC Eff. % Glass;
01; - X
-- X =
X - 04
�- •rte X -
% Glass SC - Eff. % glass
X --'- _
X =
v X = 4
• X =
TYPE 1 MASS AREA
•1 GOND. FLOOR AREA $
Interior Mass/CFA
TYPE 2 MASS AREA =
Exterior Wall Mass COND. FL OR AREA
• X i% ♦ = i
E oS r HSPF Duct Effietency [0.78] Effective SE or
[0.72/6.6] //�� , HSPF [0.56615.15]
0 42. X V'4� �//�Io- a -sV y
9.5] Duct Efficiency (0.74] Effective SEER [7.03]
Type Credit [none]
a
2
A
Sum 7.10
Pnint rM.71. �1
Unit Size (sQ .
Water
1199
' 12M
1700
2200
2700
Heater
Gredit
or .:
to
, to
to
or
Type
Type
less
1699
2199
2699,
more
SG
None
0
0
0.
0
0
or
Solar
12
8
6.
5
4
HP
HWR
_., 8
5
4
3
3
WSB
5
_
3
3
2
2
POU
8
5_
4
3
3
SE
None
-37
-24
-18
-15
-12
Solar
-1
-1
-1
0
0
HWR
-18
-12
-9
-7
-6
WSB
-25
-16
-12
-10
-8
POU
All
-12
-9
-7
-6
IG
None
-5
•3
-2
-2
-2
Solar
7
5
4
3
2
POU
3_
2
1
1
1
IE
None
-28
-19
-14
-11
-9
Solar
8
5
4
3
3
POU
-10
-6
-5
-4
-3
Multi
-Family
(Individual
units)
' Unit Size (sQ
Water
699.
700
1200
1700
2200
Heater
Credit
or
b
to
to
or
Type
Type
less
1199
1699
2199
more
SG
None
0
0
0
0
0'
or
Solar
14
7
5
4
3
HP
. HWR
9
5
3
2
2
-WSB
. 9
4
3
2
2
POU
9
5
3
2
2
SE
None
-45'
-23 .
-15
-11
-9
Solar
2
1
1
0
0
HWR
-23
-12
-8
-6
-5
WSB
-25
-13
-8
-6
-5
_23
12
8_ , .
, -6
-5
IG
None
8
-4
-3
-2
t -2
Solar
6
3
2
1
1
POU
1.
-0
0 _
0
0
IE
None
-30
=15
-10
-8
-6
Solar
18
9
6.
4
4
POU
-8
-4
-3
-2
-2
Interior MasslCFA
T7ve 7 PASS
(l. 7av1K•.. 71 I TYPE 1 -MASS (UIMC ' -
Ic. raecaa .1_0l 1.2, .tie: exposed slab) .
O1/- r5% 10% 15% 20Y. 25% 3011. 35% QY.1. 45% 50% 55% 6011 X65'/. 7011. '75% ,e80%:85Y. •90% 95% 1009'- 105% 110Y 115% 120% 125`
OY. 0 0.2 0.4 0.6 0.8 .1.1 1.3 1.5 1.7 1.9 2.1 2.3 2.5 2.7 2.9 3.2 3.4 3.6 3.8 4 4.2 4.4 4.6 4.8 5 5.3
1011. 0.2 0.4 0.6 0.8 '11 1.2 1.4 .1.6 1.9 2.1 2.3 2.5 2.7 2.9 3.1 3.3 3.5 . 3.7 4' - 4.2 .4.4.• 4.6 4.8 5 5.2 5.4
20% 0.3 0.6 0.8 1 1.2 . 1.4 1.6 ' 1.8" 2 2.2 24 Z7 2.9 3.1 3.3 3.5 3.7 3.9 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 2.2 2.4 2.6 2.8 3 3.2 3.5 3.7 3.9 4.1 4.3 4.5 4.7 4.9 5.1 5.3 5.6 58
401/. 0.7 0.9 1.1 1.3 1.5 1.7 1.9 2.2 Z4 2.6 2.8 3 3.2 3.4 3.6 3.8 4 4.3 4.5 4.7 4.9 5.1 5.3 5.5 5.7 5.9
50Y. .0.9 1.1 1.3 1.5 1.7 1.9 Zt Z3 Z5 Z7 3 3.2 3.4 3.6 3.8 4 42 4.4 4.6 4.8 5.1 5.3 5.5 5.7 5.9 6.1
55% 0.9 1.1 1.4 1.6 1.8 2 2.2 Z4 2.6 2.8 3 3.2 3.5 3.7 3.9 4.1 4.3 4.5 4.7 4.9 5.1 5.3 5.6 5.8 6 6.2
60% 1 1.2 1.4 1.7 1.9 Z1 2.3 2.5 2.7 2.9 3.1 3.3 3.5 3.8 4 4.2 4.4 4.6. 4.8 ' 5 5.2 5.4 '5.6 5.9 6.1 63
65% 1.1 1.3 1.5 1.7 1.9 2.2 2.4 2.6 2.8 3 3.2 3.4 3.6 3.8 4 4.3 4.5' 4.7 4.9 5.1 5.3 55 5.7 5.9 6.1 6.4
M. 1.2 1.4 1.6 1.8 2 2.2 2.5 2.7 29 3.1 3.3 3.5 3.7 3.9 4.1 4.3 '4.6 4.8 5 5.2 ,5.4 5.6 58 6 6.2 64
75% 1.3 1.5 1.7 1.9 Z1 2.3 Z5 2.7 3 3.2 3.4 3.6 3.8 4 4.2 4.4 4.6 4.6 5.1 5.3 5.5 5.7 5.9 " 6.1 6.3 6.5
80% • 1.4' 1.6 1.8 2 2.2 2.4 26 2.8 3 3.3 3.5 3.7 3.9 4.1 4.3 4.5 4.7 4.9 5.1 5.4 5.6 5.8 6 62 64 66
85% 1.4 1.7 1.9 2.1 2.3 2.5 2.7 2.9 3.1 3.3 3.5 3.8 4 4.2 4.4 4.6 4.8 5 52 54 5.6 5.9 6.1 63 65 67
809: 1.5 1.7 2 2.2 2.4 2.6 2.8 3 3.2 3.4 3.6 3.8 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
95% 1.6 1.82 2.2 2.5 2.7 2.9 3.1 33 3.5 3.7 3.9 4.1 4.3 4.6 4.6 5 5.2 5.4 5.6 5.8 6 6.2 6.4 6.7 6.9
100% • 1'7 1.9 21 2.3 2.5 2.8 3 3.2 3.4 3.8 3.8 4 4.2 4.4 4.6 4.9 5.1 5.3 5.5 5.7 5.9 6.1 6.3 6.5 6.7 7
105% 1.8: 2 2.2 2.4 2.6 2.8 3 3.3 3.5 3.7 3.9 4.1 4.3 4.5 4.7 4.9 5.1 5.4 56 5.8 6 6.2 6.4 6.6 68 7
110% 1.9 2.1 2.3 2.5 2.7 2.9 3.1 3.3 3.8 3.8 4 4.2 4.4 4.6 4.8 5 5.2 5.4 5.7 5.9 6.1 6.3 6.5 6.7 69 7.1
115% 2 2.2 2.4 2.6 2.8 3 3.2 3.4 3.6 3.8 4.1 4.3 4.5 4.7 4.9 5.1 5.3 5.5 5.7 5.9 6.2 6.4 6.6 6.8 7 72
120% 2 2.3 2.5 2.7 2.9 3.1 3.3 3.5 3.7 3.9 4.1 4.4 4.6 4.8 5 5.2 5.4 5.6 58 6 6.2 6.5 6.7 6.9 7.1 7.3
125% 2.1 2.3 2.5 2.8 3 3.2 3.4 3.6 3.8 4 4.2 4.4 4.6 •4.9 5.1 5.3 5.5 5.7 5.9 6.1 6.3 6.5 6.7 7 7.2 7.4
Point system summary: Climate Zone 11
SCORE CARD
Measures
1. Ceiling Insulation . or
R -value [38] U -value [0.030]
2. Wall Insulation" or
R -value [ l ll U -value [0.098]
3. Raised Floor Insulation - Iq or
-value 1191- . U -value [0.037]
4. Slab Edge Insulation
5.' Infiltration
6. Glass Heat Loss
7. Shading (Shade Open)
a. North
b. East
c. South
d. West
e. Skylight
8. Shading (Shade Closed)
a. North
b. East
c.. South
d. West
e. Skylight
9. Interior Thermal Mass
10. Exterior Wall Mass
11. Heating System
Zonal Control? ( Y / N )
12. Cooling System
Zonal Control? ( Y / N )
13. Water Heating
- Point Scores
0
or
R -value [0] F2 factor [0.77] J
Standard .0
Type [double] U -value [0.65] % o�] j Sum .b
%
Gass - SC Eff. % Glass;
01; - X
-- X =
X - 04
�- •rte X -
% Glass SC - Eff. % glass
X --'- _
X =
v X = 4
• X =
TYPE 1 MASS AREA
•1 GOND. FLOOR AREA $
Interior Mass/CFA
TYPE 2 MASS AREA =
Exterior Wall Mass COND. FL OR AREA
• X i% ♦ = i
E oS r HSPF Duct Effietency [0.78] Effective SE or
[0.72/6.6] //�� , HSPF [0.56615.15]
0 42. X V'4� �//�Io- a -sV y
9.5] Duct Efficiency (0.74] Effective SEER [7.03]
Type Credit [none]
a
2
A
Sum 7.10
Pnint rM.71. �1
Certificate of Compliance: Residential
'E's/0C—/V CC—
Project Title /4i?V,q W joee el
Protect AddresP RwD/S E - 6 72- 37o 0
Climate Zone 11
.2463-8?
Building Permit, J pW g0
57d -ked By / Date 7
Fnforcesnent Agency Use only
BUILDING DATA Glass ea % Glass
North
Condi ' r Area 170 Number of Stories East
J—
Sla ised Floo Number of -Units South ( as --L-�—
Stn a amity Detached (SED) [ ]Addition Alone West s• s
[ J Single Family Attached (SFA) [ ] Existing Building Skylight , 5 o.1
[ ] Multi -Family (NIF) ] Existing -Plus -Addition Tom 2yl, o I tie, 2
BUILDING SHELL INSULATION
Component Insulation Location/Comments
Type R -Value (attic, to guagall, r
ypical, etc.)
Wall..... ..... {�
Roof ............. 3 0
Roof .............
Floor .............
Floor .............
Slab Edge .....
GLAZING Shading Devices
Glazing
Area
Glass Type Interior Exterior Overhang
Framing Type
Orientation
(sf)
(single. double) (roller blind, etc.) (shadescreen. eta.) (yesJno)
(metallwood)
North ( )
�Bt�c
A4 (.
North ( )
_
East`
East ( )
SOUCh
Sou lh ( )
—
West ( )�
West ( )
Skylight.......
THERMAL MASS
Type/Covering
Area Thickness
(slab/exposed, tile, etc.)
(SO (inches) Loeation/Dcseription (kitchen, bath, etc.)
HVAC SYSTEMS Minimum
Type (furnace, air Efficiency
conditioner, heat pump) (SE, SEER,HSPF
1G% _
Coo L
Duct
Location Duct Output Manufacturer / Model #
tit, etc.) R -Value (Btuh) (or approved equal)
Maximum Furnace Heating Output: _
HOT WATER SYSTEMS Tank
System Type (storage gas, etc.) Capaci
aurae e Q"
5.7 :57,106
5.7 T(
Btuh
Manufacturer/Model #
SPECIAL FEATURES/REMARKS (Add extra sheets if necessary)
Mandatory Measures Checklist: Residential MF -1R
NOTE: Lowrise residential buildings subject to the Standards must contain these nwasures regardless of the cote iance
approach used. Ivens marked with an asterisk (•) may be superseded by more stringent compliance requirements listed
on the Certificate of Compliance. When this checklist is incorporated into the permit documents, the futures noted shall
be considered by all parties as binding minimum component perfomutrtce specifications for the mandatory measures
whether they arc shown elsewhere in the documents or on this checklist only.
DESCRIPTION I DESIGNER I ENFORCEMENT
Building Envelope Measures
§2.5352(a): Minimum ceiling insulation R-19 weighted average.
§2.5352(b): Loose fill insulation manufacturer's labeled R -Value.
' §2-5352(c): Minimum wall insulation in framed walls R• I 1 weighted average (does not apply to
exterior mass walls).
§2.5352(k): Slab edge insulation - water absorption rate no greater than 0.3%. water vapor
transmission rate no greater than 2.0 pcmt/inch.
§2-5311: Insulation specified or installed meets California Energy Commission (CEC) quality
standards. Indicate type and form.
§2.5352((): Vapor barriers mandatory in Clinute Zones 14 and 16 only.
§2-5317: Infiltration/Exfiltration Controls
a. Doors and windows between conditioned and unconditioned spaces designed to limit au
leakage.
b. Doors and windows certified.
c. Doors and windows .vcathdrstripped: all joints and penetrations caulked and soled.
§2-5352(c): Special inf ltradoa barrier installed to comply with 12-5351 mmu CEC quality
standards.
§2.5352(d): Installation of Futplaces
1. Masonry and factory -built fireplaecs have
a. Tight fitting, closeable metal or glass door
b. outside air intake with damper and control
e. Flue damper and control
2. No continuous burning gas pilots allowed.
HVAC and Plumbing System Measures
§2-5352(8) and 2-5303: Space conditioning equipment siting: attach calculations.
42-5352(h) and 2.5315: Setback thermoset on all applicable heating systems.
§2-5316(a): Duct& constructed. installed and insulated per Chapter 10, 1976 UMC.
§2-5316(b): Exhaust systems have damper controls.
§2-5314(c): Gas -rued space heating equipment has intermittent ignition devices.
62-5314: HVAC equipment, water heaters, showenccads and faucets certified by the CEC.
§2-5352(1): Water heater insulation blanket (R-12 or greater) or combined interior/exterior
insulation (R-16 or greater): fust 5 Icer of pipes closest to Lank insulated (R-3 or greater).
§2.5312(Excep6on 1): Pipe insulation on steam and steam condensate return & recirculating
piping.
§2-5318(d): Swimming Pool Heating
1. System has:
a On/off switch on hoar.
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.
'Lighting and Appliance Measures
§2-53520): Lighting - 25 lumcns/watt or greater for general lighting in kitchens and bathrooms.
§2.5314(c): Gas rued appliances equipped with intermittent ignition devices.
§2-5314(a): Refrigerators, refrigerator -freezers. freezers and fluorescent lamp ballasts certified
by the CEC. Indicate make and model number.
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance specifications needed to comply with
Title 24, Chapter 2-53 and Title 20. Chapter2. Subchapter 4. Article 1 of the California Administrative code. This
certificate has been signed by the individual with overall design responsibility and the building owner, who shall
retain a copy of it and transmit the certificate to any subsequent purchaser of the building.
Designer
Name:
Address:
Telephone:
tic. 0:
(signature)
Documentation Author
Name:
Ttde/Fum:
Address:
(date)
Building Owner
Name:
Titk/Ftrm-
Address:
Tekphone_
(ptnalure) (date)
Enforcement Agency
Name:
Agency:
Tekpho=