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MECH (09-0375)53385 Avenida Madero 09-0375 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09 0.0000-375— Property Address: $3385 AVENIDA MADERO APN: 774-033-017-9 -000000- Application description: MECHANICAL Property Zoning: COVE RESIDENTIAL Application valuation: 2000 T4tvl 4 4 Q" Applicant: Architect or Engineer: • alp LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 -C38 LicenseNo.: 510566 Date: Contractor: . OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or - c improve for the purpose of sale.). ( "1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: r Lender's Address: ` LQPERMIT Owner: HARTUNG THOMAS A 53385 AVENIDA MADERO LA QUINTA, CA 92253 Contractor: H AND H AIR CONDITI 74991 JONI•DRIVE, #2 PALM DESERT, CA 9226 (760)340-3088 Lic. No.: 510566 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/27/09. WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier ENDURANCE REINS Policy Number WEN003665502 I certify that, in the performance of the work for which this permit is issued, I shall not employ any " person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date:! Applicant: / WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the - conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, .the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this co n er upon the above-mentioned property fo inspectio purposes. Date. D Signature (Applicant or Agent) LQPERMIT - - • Application Number 09-00000375 Permit . . . . MECHANICAL Additional desc . Permit Fee . . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation 0 Expiration Date 10/24/09 . Qty Unit'Charge Per Extension•. BASE FEE 15.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00. Special Notes and Comments REPLACE A/C,CONDENSING UNIT Other Fees . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due' Permit Fee Total 24.00 .00 .00 .24.00 Plan Check Total 6.00 .00 .00 6.00 Other Fee Total 1.00 .00 .00 1.00. Grand Total -31.00 .00 .00 31.00 LQPERMIT - - CERTIFICATE OF COMPLIANCE: RESIDENTIAL Pro ect Title 14,4It, t,4J Date ONZXA 50/4 IPZ-- ce ledv7= y' 9 0 Project Address Documentation Author --F, 94 -27W,06 - Compliance Method (Prescriptive) Telephone 54el- 3l7a Climate Zone S 1 of s) CF -1R I.. Field Check /Date r r Enforcement A enc _Use Onl ✓ ❑, Alternative Component Package Method: (check one) C v D M6 (Alternative) Package C and Package D choices require HERS rater field verification and/or diagnostic testing (see CF -1R page 3) For Package D Alternative see Appendix B Table 151-C Footnotes 7-14 .GENERAL INFORMATION Total Conditioned Floor Area (CFA) Average Ceiling Height: ft Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C ---- (5% X CFA) ftZ Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C ----(20% X CFA) ft ✓ ❑ Building Type: (check one or more) Dingle Family Multifamily Addition r''~' Alteration (If adding fenestration fill out WS -4R, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2 for Additions and 8.3.3 for Alterations.) Number of Stories: Number of Dwelling Units: ( Floor Construction Type: Slab/Raised Floor (circle one cr both), Front Orientation:-EA5 North / South / East / West / All Orientations (input front orientation in degrees from True North and circle one). ✓ ❑ RADIANT BARRIER (required in climate zones 2 4 8-15) OPAQUE SURFACES INCLUDING OPAQUE DOORS - Component Type (Wall, Roof, Floor, Slab Edge, Doors) Frame Type (Wood or Metal) -Assembly U - factor (for wood, Cavity Continuous metal frame and' Insulation Insulation' mass R -Value R -Value - assemblies Joint Appendix . IV • Reference -Roof Radiant Barrier Installed Yes or No Location Comments (attic, garage, typical, etc. I ) ace juin tippenuix i v in section 1 v.6, i v.s ana i v.4, which is the basis Tor the U -tactor criterion. U -tactors can not exceed prescriptive value to show equivalence to R -values. - Residential Compliance Forms April 2005 FENESTRATION PRODUCTS — U -FACTOR AND SHGC ✓ ❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS -4R —must be included for New Construction, Additions and Alterations. Fenestration #/Type/Pos. Orien- (Front, Left, tation, Rear,Right, N, S, E, Area U -factor Skylight) W'(ft) U-factor2 Source SHGC° Exterior Shading/Overhangs6'' SHGC ✓ box if WS -3R is Sources included Distribution Type and Location Duct or Piping Thermostat Configuration c s; atti etc. R -Value Type r package) 13 ECIS T/!V 13 13 13 1) Skylights are now included in West -facing fenestration area if the skylights are tilted to the west or tilted in any direction when the pitch is less than 1:12. See § 151(f)3C and in Section 3.2.3 of the Residential Manual 2) Enter values in this column are either NFRC Rated value or from Standards default Table 116A. 3) Indicate source either from NFRC or Table 116A, 4)Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from. WS -3R. ' 5) Indicate source either from NFRC or Table I I6B. 6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS -311 to calculate Exterior Shading devices. 7) See Section 3.2.4 in the Residential Manual. i HVAC SYSTEMS Heating Equipment Type and Capacity f ace, heat pump, boiler, etc. Minimum Efficiency UE or HS_PF Distribution Type and Location Duct or Piping Thermostat Configuration c s; atti etc. R -Value Type r package) ECIS T/!V Cooling Equipment Type and Capacity Minimum (A/C, heat pump, evap. Efficiency Duct Location Duct Thermostat Configuration cooling) SEER or EER is tc. -Value Type or package) Residential Compliance Forms April 2005 SEALED DUCTS and TXVs (or Alternative Measures) A signed CF -4R Form must be provided to the building department for each home for which the following. are required. ❑ Sealed Ducts all climate zones Installer testing and certification and HERS rater field verification required.) ❑ TXVs, readily accessible (climate zones 2 and 8-15 only) Tank Capacity (gallons) Installer testing and certification and HERS Rater field verification required.) ❑ Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing.and certification and HERS Rater field verification required.) 1: ❑ IAlternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for Project Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14. OR For additions and alterations, duct systems that are not documented to have been previously sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D. WATER HEATING SYSTEMS Systems serving single dwelling units Water Heater Type/Fuel Type Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per ❑ dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is Tank Capacity (gallons) not allowed. ❑ Check box when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential Manual. No water heating calculations are required, and the system complies automatically. Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved ❑ Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the submittal. ❑ Check box to verify that a time control is required for a recirculating system pump for a system serving multiple units Systems serving single dwelling units Water Heater Type/Fuel Type Distribution Type Number in System Rated Input' (M or Btu/hr)- Tank Capacity (gallons) Energy Factor' orExternal Thermal Efficiency Standby' Loss % Tank Insulation R -Value System serving multiple dwelling units Water Heater Type Distribution Type Number in System Rated Input' (kw or Btu/hr(gallons) Tank Capacity Energy Factor' or Thermal Efficiency Standby Loss % Tank External Insulation R -Value 1) For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water heaters, list Rated Input and Thermal Efficiencies. Pipe Insulation (kitchen lines > 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are 3/a inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2 B. Residential Compliance Forms April 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL -(Page 4 of 5) - CF -IR Project Title Date SPECIAL FEATURES NOT REQUIRING HERS VERIFICATION (add extra sheets if necessary) Indicate which special features are part of this project. The list below only represents special features relevant to the prescriptive method. ✓ I Feature Required Forms if applicable) Description ❑ Metal Framed Walls CF -1R ❑ Radiant Barriers CFA R ❑ Exterior Shades WS -4R ❑ Cool Roof N/A; Attach CRRC Label to Forms. ❑ Dedicated Hydronic Heating Performance Calculation System Required; Attach Run to Forms.. ❑ Combined Hydronic System. Performance Calculation Required; Attach Run to Forms. ❑ Gas Cooling Performance Calculation Required. i ❑ Buried Ducts N/A; Indicate on building plans. ❑ Kitchen Pipe Insulation See Section 5.6.2 Distribution \ Systems in Residential Manual. Multiple Water Heaters Per See Table 5-13 or use Dwelling Unit Performance Calculation and attach Run to Forms. ❑ Central Water Heating System Performance Calculation and Serving Multiple Dwellings attach Run to Forms. ,,❑ Non-NAECA Large Water CF -1R Heater See Table 5-13 or use ❑ Indirect Water Heater Performance Calculation and attach Run to Forms See Table 5-13 or use ❑ Instantaneous Gas Water Heater Performance Calculation and attach Run to Forms See Table 5-13 or use- ❑ Solar Water Heating System Performance Calculation and attach Run to Forms ❑ Wood Stove Boiler Performance Calculation and attach Run to Forms SPECIAL FEATURES REQUIRING HERS RATER VERIFICATION (add extra sheets if necessary) Indicate to the HERS Rater which credits are nart of this nroiect and need verificatinn l✓ Feature Required Forms if applicable) Description LO" Duct Sealing CF -6R part 4 of 12 ❑ Refrigerant Charge CF -6R part 5 of 12 ❑ Thermostatic Expansion Valve CF -6R part 6 of 12 Residential Compliance Forms April 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 5 of 5) CF -1R ti Project Title A2 jI Date 1 COMPLIANCE STATEMENT This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations .to implement them. This certificate has been signed by the individual with overall design responsibility. The undersigned recognizes that compliance using duct design, duct sealing, verification of refrigerant charge and TXVs, insulation installation quality, and building envelope sealing require installer testing and certification and field verification by an approved HERS rater. Designer or,Owner (ner Business and Professions Code) Documentation Author Name: Name: Title/Firm: Title/Firm: Address: 5 Address: Z_ Ow A_2 7,1- Telephone: --3 r 7 ) Telephone: License #: (signature) (yYyYZP© ate) (signature) fsyy (date) Enforcement Agency J Residential Compliance Forms April 2005 Apr 3.0 09 10:59a Tom Lobeck t.111% 760-365-5492 P.1 CERTIFICATE -OF FIELD . VERIFICATION & DIAGNOSTIC TESTING (Page I of 2) CF -4R )Froj,oct A" -'ss t-*-] Builder H&H Aur Condtioning, Builder I ffost-Her Contact Telephone Plan Number J FermIt Number Hu&.Bojkrd 7603403088 EMM ki6ii Tel S=pleG!oupNo.mber Thomasl4bect -CjH4EjEjRjS40'1D#CCN2642906.1 -6 Compliance I Climate zone is Certifying ate Sample House Number Firm UFAS Provider Tom Labeck R w' qHIEIEIRISS Address citylststemp 9487DeerT4_ y Yacca Valle' ICA /92284 Copies to: BU LDER, HERS PROVII)ER. AND BUELDING DEPARTMLTU. REM RATER Cf)NWLIANCE STATEMENT This house was:./ Tested As the HERS raw providing diagnostic testing and field. vesification. I certify that the house identified on this form complies with the'diaguostic tested compliance eqmr=cnts as checked on this foam. The HM raw must check and verify that ' the new distribution system is fully ducted and correct tape is usec before a CF -4R xnay . be released on every —maW building. The HERS rater must not release lbe.CFL4R until a properly completed* and signed CF -6R as been received for the sample and tested buildings. j/ The install Inas provided a copy of CF -6R (installation CeTtificate).. b New Ducls are my'ducted (i'.e' 'does notuse Wilding cavities as pl ,or platform returns. in lieu of ducts). .0 New ducts with cloth backed, rubber. adhesive duct tape -is installed, mastic and draw bands are used in:cambination with clothbacked, rubber adhesive dad tape to seal leaks at duct connections. I/ At DGMUMR' kQbMEbdNTS"7 FOR , DUCT . LEAKAGE REDUCTION COMPLIANCE CREDIT, Pro"4p;iocf d verifxa&n and d47&=dc fafing ofair dlmuibudon *Wenu -are avallable'In RA C Xi .AO 7tC4.1 Duct DiaposticlAmkagcTesbnR.6sulls: System # I NEW CONSIRVCTIOK: Duct Press07ation Test Results (CFM @ 25 Pa) Measured Values 11 .,Enter Test Leakage Flow in CFM .2 Fan Flow: 41culated (Nominah / Cooling 0 Healing Q Measured) -Enter Total Van Flow in CFM: 1600 3 Pass ifleak?ge Percentage -5 6% [. 100 x [ Line #.I / Line 0 Pass 13 Fail ALTERATION : Duct System and/or HVAC Equipment Change -Out - 4 . Enter I Lealcage.Flow'ia CFM Ecom CF -6R Pre -Test ofExrsling Dud System Pnor to Duch ,} System'Al tion pnmie L 5 Enter Testc4 Leakage Flow in CEM. Final Test o' fNew Duct.Systcm or Altered Duct System for Duct System Ahetation and/brEquipmem Change -Out. 203 Eater- on in Leakage for Altered Duct System [ Line #4 Mums Line #5] (Only if Applicable)- 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). Enter New "t System *7 Pass if Leakage Percentage < 6*/o [ 100 x [ Line #5 / Line #2 ] 0 Pass U Fail TEST ORVER. ICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out, Use one ofthe f owing four Test or Verification Standards for Compliance .9 11 L Pass Passif Le SoPercentage <15%[100x[Line #5/Line #2].] 12.6 (Pass El Fail 10 Pass ifLea4ge to Outside Percentage < 10*/o [ 100 x [ Line 97 f Line #2 j OPass 0 Fail 11 _ff 'Pass f Le ge Reduction Percentage >. 015/6 [ 100 x [ Line #6 1 Line #4 and Verification by Smoke Tbs= Vi inspection C) Pass Q Fail Pass if S of all Accessible Leaks and Verification by Smoke Test and Visual Inspection Pan 117One ofLines 0through -1-Pass UPass QFail jPass . El Fail org Apr. 30 09 10:59a Tom Lobeck 760-365-5492 p.2 CERTIFICATE OF FIELD VERIFICATION&DIAGNOSTIC TESTING (Page 2 of 2) . CF -AR Project Address [ 53385 Avedda Msdaro arcung..Tom l / La Quints l CA / 92253 Bauder / Idler H&H Air Condfioriing ✓ THERMOST4TIC EXPANSION VALVE (TXVj . Noceduresforfie1d verfflcatlon ofthenwaatic erpcMion valves arse available in RICM, Apper3divBL System# 1 An installation certificate is required to' -be posted at.the building site or made available for all appropriate: in spec tions: (Tire . information.provided on this form'is required) After completion of final -inspection; a copy must be provided to:the building department (upon request) and the building owner at occupancy, per Section 10-103(x). . HVAC -SYSTEMS:. . Heating. Equipment E . CEC Certified Mfr. i{ of ' Duct.- Duct or. Hearing Heating . E.qulp Type Name'and Model Identical \(AF.fficiency UE, etc.) I Location Piping '.Load Capacity. k .heat um Number System's', zCF-1R value) attic etc: R -value :(Btu/hr) Btu/Iv Cooling Equipment 1. symbol reads greater than or equal to whatis indicated on the CF -IR value.' Include both:SEER and EER if compliance credit for high EER air conditioner„is.claimed.._ IX - PRO! ✓ ❑I E the undersigned, venfy`that equipmenfhsted above is :1) is the actual equipment tnstalled,.2)'equivalent to of more. efficient than that s ecified .in the certificate of coin liance p p (EormCF=1R) submitted for compliance with the. Energy' Effciency Standards for residential buildings; and 3) equipment .thai meets.: or exceeds' the appropriate requirements for manufad ued.devices (from the Appliance Efficiency Regulations or Part 6), where applicable. Installing Subcontractor (Co. Name) OR Genera . Coptractor.(Co: Nae) OR -Owner / G Signature: C Date:. Copies to:,BUI]LDI.NG`.D, ARTMENTi HERS RATER (IF APPLICABLE) BUH.DING. OWNER AT'OCCUPANCY Residential Compliance Forms April 2005 nn` - STALLATION CERTIFICATE (Page 4' of 12). U -Y;: O Ile Address Permit Number ' r. INSTALLER COMPLIANCE STATEMENT FOR DUCT. LEAKAGE INSTALLER COMPLIANCE STATEMENT The building.was: ✓Tested at Final ✓ ❑ Tested at Rough -4n :INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE FOR NEW DUCTS:. ❑ Remove at least one supply and one.return register, and verify that the spaces between the register boot and the interior.fmishing wall are properly sealed.: ❑ If the house rough4n ducfleakage test was conducted without an air handler installed, inspect the connection points between the air handler and the supply and return plenums to verify that the connection points are properly sealed. C❑:Inspect all joints to ensure that no cloth backed rubber' adhesive duct tape is used on new ducts. ' ✓.D. -DUCT LEAKAGE REDUCTION• Procedures or /seta ven rcar►on ana a,a nuum ,c s,n v u.. r•u•...•»•• •• . --••- -- _ - - - - NEW CONSTRUCTION: Measured Duct Pressurization Test Results (CFM @ 25 Pa) Values 1 Enter Tested Leakage Flow in CFM: Fan Flow: Calculated (Nominal`. ✓'❑ Cooling V ❑ Heating) or vl''❑ Measured 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21.7 cfiri/(kBtu/hr) x Heating ✓ .. Ca aci in Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here - Pass if Leakage Percentage < 6% for Final or < 4% at Rough -in without air handle:. O Pass ❑ Fail 3 100 x___,,_(Line # 1 / ine # 2 ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 0 O Enter Tested Leakage Flow.:in CFM from Final. Test of New. Duct System or Altered Duct 5S stem for Duct System Alteration and/or E ui ment Change -Out. Enter Reduction: in Leakage -for Altered Duct System 6 (Line # 4 Minus Line # 5 — ' Onl if Applicable), ' 7 Enter Tested Leakage Flow in CFM'to"Outside {Only if Applicable) Entire New Duct. System'- Pass if Leakage Percentage < 6% for Final. 0, Pass ❑.Fail 8 100 x ine # 5 / Line # 2)11 1 TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change- Out,. se.one of the followin four Test or VerlficatiOn,Standar dS for comBance _ [(Line# 5) Pass if Leakage Percentage < 15%0` [100 9 Pass if Leakage to .Outside Percentage <'10% [100.x I (Line #:7) / (Line.# 2)]] D Passe'❑ Fail 10 Pass if Leakage Reduction Percentage > 606/o [100 x [ (Line.#6) /. (Line :# 4)]] ❑ Pass' ❑ Fail 1 12 and Verification b .Smoke Test and Visual Inspection Pass if Sealingof all 'Accessible Leaks'and Verification b Smoke Test and Nisual Ins echon ; ❑Pass ❑Fail Pass if One of Lines # 9 throw h 112 ass 0 Pass ❑ Fail ✓"DI, the undersigned, verify that. the above diagnostic test results were performed.in conformance with the requirements for compliance credit. I, the undersigned, also certify that the newly installed or retrofit Air -Distribution System.Ducts, Plenums and Fans" comply with Mandatory requirements specified in Section 150 (m).of the 2005 Building Energy Efficiency standards. Installing ubco ctor(Co. Name) OR General Contractor (Co. Name) OR Owner . A, Z J. Signature: .. Date: ,, .... ,.,. ,scnc n a•rsu:nr A VVI ireR1.T.I R1 TU DING OWNER AT OCC ANCY " Lopes cu: "timu"L V Lasa raa aa.aa•a. of .- -_ •_ -__ _ _ Residential Compliance Forms t December 2005