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MECH (10-1039) + RPL (13150) + SFD (04638)53365 Avenida Martinez 10-1039 13150 04638 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00001039 Property Address: 53365 AVENIDA MARTINEZ APN: 774-091-018-6 -000000- Application description: MECHANICAL Property Zoning: COVE RESIDENTIAL Application valuation: 4800 Applicant: T4ht 4 4a Q" Architect or Engineer: A * BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. LicenseCllaassss: C20 tr 902029 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).: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' 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 improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed pursuant to the Contractors' State License Law.). ( 1 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: _ Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/05/10 Owner: D /til BEBLA MARY ( 53365 AVENIDA MART LA QUINTA, CA 922 Q(^.j _+ (760)771-8435 iJ 0 Vt2010jP CITY OF { q QUINTq I Contractor: p' E DEpT, LA QUINTA AIR COND/HEATING INC -"- -_ 53875 AVENIDA NAVARRO LA QUINTA, CA 92253 (760)837-9344 Lic. No.: 902029 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 DESERT EMPIRE Policy Number 2387422008 _ 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 3/7/00 of the Labor Code, hal orthwith comply with those provisions. 00, Dater lU 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 1$100,0001. 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 Ouinta, 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 tocancellation. 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 he orize representatives of this c9unt to, nter upon the above-mentioned pro y f inspection pu pees. Date: I !/ Signature (Applicant or Agent) Application Number . . . . . 10-00001039 Permit . . . . . MECHANICAL Additional desc . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/03/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH APPL REP/ALT/ADD 9..00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE OUT CONDENSING UNIT & INDOOR COIL.2007 CODES. -------------------------------------------------------=-------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged ------------------------------------- Paid Credited -------------------- Due Permit Fee Total 33.00 .00 .00 -33.00 Plan Check Total 8.25 .00 .00 8.25 Other Fee Total 1.00 .00 .00 1.00 Grand Total 42.25 .00 .00 42.25 LQPERMIT I sfmplllled Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF 1R ALT HVAC I _ Climate Zones. 10 to is Jtte Address: 3-- -F(o s ArZTin Enforcement Agency: Date. Per" #: Equipment Type' ❑ Packaged Unit List Minimum Efficiency' Duct insulation requirement Conditioned Floor Area Thermostat OF =tie dooCoil ❑ AFUE ❑ Op '[QA Over 40 ft of duds added or laced Setback ondensing Unit O§EER HSPFZZ ❑EER in uncoaditiated O spas ❑ R 6 (CZ /0-13) Sgrypd ' system (/''T yO ' aat ❑ Other ❑Resistance ❑ R 8 (CZ 14-15) talready prcsenc ,mcrr be . pr must installed) !. Equipment Type: Choose the equipment being in stalled; ijmore than one system. uw anotherCF-/R-ALT-HVAC for each system. 1. Aftnitnum Equlptrtent Efildendes: /3 SEER 78%AFUE, 7.7HSPFjoropted residential rystems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS rneastires that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fee the work completed by the installer. The inspector also verifies that each appropriate CF -611 and registered CF4R fomes (no hand filled CF4Rs allowed) aro filled out and sigged. BeginningOctober 1 2010 a registered copy of the CF -IR and CF -611 shag also be on site for finaln. Rr 1. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R fortes: MECH- 21 and for split •Condenser Coil and /or .MECH-25 • Indoor Coil and/or CF -6R forms: MECH-2I-HERS -and (for split systems) MECH- 25 -HERS' • Furnace CF4R forms: MECH- 21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC,. CCA > 300 CFM/ton(Minimttm Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent f•.xempted from duct leakage testing if ❑ 1. Dud system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3• ducts stems are constructed, insulated or sealed with asbestos O 2. New HVAC System, Required Forms: with new • Cut in or Chang outducting duos: (all new ducting purr all CF -6R forms: MECH-04, MECH-20-HERS,and for lit MECH-22-HERS, and MECH-25-HERS ( system) new equipment) CF -4R forts: MECH 20- and for ht ( split systems)MECH-22, and MECH 25 For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFMhon, FWD,.TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage <6 percent O 3.. New Ducts with Replacement'' Bo7Bts: • includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,md (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent O 4. New Ducting over 40 feet R aired Forms: • Includes adding or replacing more than 40 CF linear feet of duct in unconditioned s ce. -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing due systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • 1 certify that this Certificate of Compliance documentation is accurate and complete. • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • i he design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forts, worksheets, calculations plans and specifications submitted to the enforcement agency for approval with the permit application. Name: 441e- A , Signature: Company: Ac Date: Address: 3 r T!5- "4L N License: C Z d C1 a Zo 2 9 City/State/Zip: r. A ZZ 3 L,C `, Phone: 7& a,1-2 __rf U E/ -vv --crag— %-.Vrptiance corms March 2010 Bin # Qty of La Quinta Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # ✓ Project Address: Owner's Name: iib Aa- aP. P.Number: Address: ,s 3 — I W M k r4iw ?� Legal Description: Contractor: CA &u f o4T—�, City, ST, Zip: 1 ZZ -6- 3 Telephone: 7(aD —?71 gy3S- Address: AiiA ()..t/L o Project Description: fj� City, ST, Zip: Li fit L v4A c q 2-2 J Telephone. -76.4 State Lic. # : i City Lie. #, Arch., Engr., Designer. Address: City., ST, Zip: ftp • "'•�":�:3�' :;.: tcM Telephone: .;. > r;M:y.MYfc: •:yc<s� :: State Lic. #: :r Name of Contact Person: Construction Type Occupancy: cy: �i Project type (circle one): New Add'n r Repair Demo Sq. Ft.: 14d d # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: 4 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Pians resubmitted Mechanical Grading plan 2ndReview, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''a Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 4• Oct 07 10 05:30p Wa'Iter trellis 760-360-3277 CERTIFICATE OF FIELD VERIFICATION G DIAGNOSTIC TESnNG CF-4k-P4ECH-21 Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Plumber: 53-365 Avenida Martinez, La Quirita CA 92253 (System City of La Qulnta 10-00001039 1) Enter the Duct Systern (dame or ldentlfication/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certifr'ccate for each duct system that must demonstrate compliance in the dweiling. This Installation certificate is required for compliance For alterations and additions in existing dwellings ro ,space conditioning systems, and duct systems. Note: For existing dwellings; ao'cpmpletely new or replacement duct system can also include existing parts of -; register boots, air handier, coil, plenums, etc.) if those oarts are accessible the original duqt$ke-tem (ei and they can be, sealcd. For a completeiv neva or replacement duct. system Installed /n an extsting dwelling, use the Installation Certiricate titled "Duct Leakage Test - Completely New or Replacement Duct System. " i naiet t s.alrana. ninannaYlr Tort - Pgisrbna duct system select one compliance rrnethoc from the following four choices, id 1. Measured leakage less than 15% of fan flow I 2. Measured leakage to outside less than 100,c of Fan Flow ID flu 3. Reduce leakage by 60% and CcnduCt smoke and fix all leaks fu a. Fix all ac:essible leaks using smoke and HEPS rater verify [Note: (One of Options 3, 2, or 3 must be attempted before utilizing Option 4.) Determine nominal Fan Flow using one of the following three calculation methods, j ✓ L Cooling system method' Size of condenser in Tons 4 _ x 4,70 = 1600 CFM I' ✓ = Heating system method: 21.7 x _ Ou;put Ca,:acity in Thousands or Btu/hr = � CFM ✓ ,, Measured system airflow t,sinry RA3.3 ai-flow test, proredures:,___ CFM Option x used then: l 1 Allowed leakace = Fan Flow 160Q_ x 0.15 = 240 CFM j Actual Leakage = 44 CFM � Pass if Leakage Actual it less than Allowed & Pass 0 Fail Option 2 used -,hen: 2 Allowed ieak2ge = Fan Flovi x 0.10 = � CFM Actual Leakage to outside = CFM Pass if Leakage Actual is less than Allowed 0 Paas -I Fail Option 3 used then: Initial leakage prior to start of work M CFM Final leakage after sealing ail accessible beak-- using smoke test = _ CFM 3 Initial leakage_- Fiflal leakage,, = Leakage reduction CFM ((Leakage reduction,/ Initial leakage x 100% _ No Reduction __j Pass if % Reduction > 6 Pass -i Fall Option 4 used then: 4 All accessible leaks repalred using smoke. HERS rater roust verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air hander and door panel. Pass if all accessible leaks have been repaired using smoke Pass Fail p•2 I pit i' Reg: 21u-ADD1.8975A-M2160007.A-M:.3A Registration pate/Timc: 2010/10!07 2D:15%43 HERS Provider.: Inc. 2005 Residential ^nmpliance Forms Ma.r:+. 2010 Oct 07 10 05:31p falter Nellis .760-360-3277 p.3 CERTIFICATE OF FIELD VERIFICATION & IDIAGNOSTIC TESTING CF-4R-MECH-21 Duct L,eakase Test - Exiisting Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Plumber: 53-365 Avenida Maitinez, La Quinta CA 92253 (System 1) City of La Quinta 10-00001039 2 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is requiredi to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may he configured to the closed position during duct leakage testing. iii All supply and return register boots must be sealed to the drywaii if smoke test is utilized for compliance - applies to duct leakage compliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible leaks) described above. 2 Rely duct installations cannot utilize building cavities as plenums or, platform returns. in lieu of ducts. h Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new dur:C connections DECLARATION STATEMENT rert•iv, under penalty of peri iry, under the lays of the State of Callrcrnia, the infomtaUon provided or. this form is b ue and c'orroc'.. • I am the certitied H.FRS ,ater+,vhn p `ormed the verifcaticn services idenrift=_d and reported on this certificate (resl:ons;ble rater;. . The installed feature, matP..ria!, componeri, or manufactured device requiring HERS veriHcaticn that is ldentir!e•y on this certifCate (CIIe installation; cornph s wI t' the aRPIICabie requirements in Reference Residential Appendices RA2 and PA3 and file requirements specified on the Certificates) o; Compliance (CF -IR) approved by the local enforcement agency. The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -IRI approved by the enforcement aaencv. Builder or Installer Information as shown on the Installation Certificate (Cf -GR) Company Name: (Installing Subcontractor or General Contractor or Bulider/Owner) LA QIIJTNTA AXR CONDITIONING & HEATING INC Responsible Person's Name: CSLFi License: Steve Garda 902029 HERS Provider Data Registry Information Sample Group # (if applicable): N/A❑riot-tested/verified Casted/verifced dwelling dwelling in a HERS Barr p!e group HERS Rater Information CaICERTS Certificate 4 CCL -1798514512 HERS Rater Company Name, Air Solutions of the Desert Responsible Rdtar's Name: Responsible Racer's Signature; Walter W Nellis Walter W Nallis Responsible Rater's Certification Number ver/ this HERS Provider: Date Signed; 10/7/2010 CC2004361 II Reg: 210-AOOla9.7SA-M21000UTA-M21A Registration Date/T-,* e: :.0_0/.0107 20:1F:43 HERS Prov-4der: CaICERTS, I.rr.. 2008 Residential _ompl.iance Forms March 2010 Oct 07 10 05:31p Walter Nellis 760-360-3277 p.4 ;ERTIFICATE OF FIELD VERIFICATION Sr DIAGNOSTIC TESTING CF-41R-MECH-21 tefriserant Charge Verification - Standard Measurement procedure (Page 1 OF—5 site Address: Enforcement Agency: Permit Number: 53-365 Avenida Martinez, La Quinta CA 92253 City of La Quinta 10-00001039 /Yore: If instaliation ofa Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compBance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verif edon requirement TMAH and STNS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems In the dwelling can be documented for compliance using this form. Attach an additional foryn(s) for any additional systems ire the dwelling as applicable. Temperature Measurement Access Ploles (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified In Reference Residential Appendix RA3.2. If refrfgen)nt charge verification is required for compliance, TMAH are also required for compliance. 57MS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Suo®iv and Return Plenums of Air Handier System Name or, IdentificationTrag system 1 Systern Location or Area Served Virhole House I 1 e Yes 0 No 5/16 inch(8 mm) access hole upstream of evaporative roll in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 LR Yes L No 5/16 inch (8 mm) access hole downstream of evaporative coil In the supply plenum and iabeied according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Feil D Pass ✓ i7 Fail STMS - Sensor on the Evaporator Coil System Name or IdentificationiTag —L System 1 The sensor is factory installed, or field installed according to manufacturer's 3 D Yes = No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 4 D Yes _ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 5 0 Yes — No '17hen attached to a digRal thermometer, the sensor provides an indication of the - saturation temperature of the coil. Yes to 3, 4, and S is a pass. Enter N/A if STMS are not r,3 ✓ i, N/A .r C Pass ✓ JI) applicable. Otherivise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or IdentificationrTag System 1 The sensor is factory Installed, or field Installed accordinQ to manufacturers 6 C Yes [j No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 El Yes L 1 No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 0 Yes p No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coli. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not V 0 N/A v ] Pass V ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 210-AO018975H-t?2500001A-M25A 2006 Resider:c;.al Corepliance. Forms Registration Aare/Time.: 2,310/10/0% 20:16:3G HP.R6 Pro,Lder: Ca10ERTS, Inc. xarch 2010 Oct 07 10 05:32p Walter Nellis 760-360-3277 p.5 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -NECK -23 Refrigerant Charge Verification - Standard Iiileasurement Procedure (Page 2 of 5) Site Address: Enfareement Agency:Permit Number:. 53-365 Avenida Martinez, La Quinta CA 92253 City of La Quinta 10-00001039 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Resiriential Appendix AA3.2. As many as 4 systems in the dwelling can be documented for compliance veiny this form. Attach an addih'onal forrn(s ) for any additfonal systems In the dwelling as applicable. The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. The sysrem must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. fir outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. G...o..� /•..wAMi..w rnn G�c4nmc System Name or Identification/Tag System 1 (must be re -calibrated monthly) f)atP of Thermocouple Calibration 10/7/10 System Location or Area Served Whole House Registration Date!Time: 2010/10/07 20:10:36 HERS provider: Ca1CP.P.7S, March Outdoor Unit Serial # E09097240 outdoor Unit Make D&N Outdoor Unit Model C4H3496140200 W Nominal Enoling Capacity Btu; hr I 48000 Date of Verification 10/7/2010 caunration or oiaonostcc instruments [Date & Refrigerant Gauge Calibration 10/7/10 (must be re -calibrated monthly) f)atP of Thermocouple Calibration 10/7/10 (must be recalibrated monthly) Measured Tpmoerature-s (IFl System Name or identification/ Tag system 1 Tnc. 2010 Supply (evaporator leaving) air dry-bulb 48.2 Registration Date!Time: 2010/10/07 20:10:36 HERS provider: Ca1CP.P.7S, March Iternperalure (Tsupply, db) Return (evaporator entering) air dry-bulb 'IL_er_npr�rature 68.5 (Tretum, db) lRetl urn (evaporator entering) air wet -bulb W temperature (Treturn, wb) 55.5 (Evaporator saturation tcmperature 38 (Tevaporator, sat) Condensor saturation temperature 91 (T ondensor, sat) Suction line temperature (Tsuction) 38 Liquid Line Temperature (Tliquid) 82 Condenser (entering) air dry-bulb temperature (Tcondenser, db) 1 Tnc. 2010 .leg: 2uoe 210-:.0018975A-M2500001A-K25A Residec:lial compliance For -me Registration Date!Time: 2010/10/07 20:10:36 HERS provider: Ca1CP.P.7S, March Oct 07 10 05:33p Walter Nellis '760-360-3277 p.6 Temperature Spat Method Calculations far determining Minimum Airflow Requirement fm- Wrigerant Charge Verification. The temperature split method Is sped. fled in Reference Residential Appendix RA3.2. System Name or Identification/Tag system 1 Calculate: Actual Temperature Split = Treturn, 20.3 db ' rsupply, db Target Temperature Split from Table RA3.2-3 20.4 using Tretum, wb and Treturn, db Calculate difference: Actual Temperature Split - -0,1 Target Temperature Split - Passes if difference is between -4°F an +4°F or, upon remeasurement, if between -4°F and PASS -100°F Enter Pass or Fall Note: Temperature Split Method Calculaticn is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement proc_dure: specified in Reference Residential Appendix RA3.3. if actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (tore) X 300 (cfm/ton) System Name or identification/Tag Calculated Minimum Airflow Requirement (CFM) Measured Airtlow using RA3.3 procedures (C=M) Passes if measured airflnw is greater than or equal to the r.alrulated minimurn alrflow requirement.— Enter Pass or Fail Superheat Charge Method Calculations for Rerrigerant Charge Verification. This prccedure is required to be used for fixed orifice metering device systems System Name or Identification/l•ag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, Wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference Is between -6°F and +6°F Enter Pass or Fal Reg: 210 A001E9'15A-H2500001A-V2SA Registration Pate/Time: 2010/10/0'1 20:18:36 HERS Provider: Ca]CEH.'1'S, int. March :.OIU 2008 Residential Compliance Forn'c Oct 07 10 05:34p Walter Nellis 760,=360-3277 p.7 INSTALLATION CERTIFICATE CF-4R-HECH-25 R&Hgerant Cg rge Verification - Standard Measurement Procedure (Page 4 of 5) Sita Address: Enforcement Agency: Permit Number, : 53-365 Avenida Martinez, La Quinta CA 92253 City of La Quints 10-00001039 Subcooling Charge M9eMod Calculations for Refrigerant Charge Verification. This procedure is required to be use for thermnstatic expansion valve (TM and electronic expansion valve (EXV) systems. System Name or Identlfication/Tag System 1 Calculate: Actuai Subcooling = 9 Tcondenser, sat - Tliquid Enter allowable superheat range from Target Subcooling specified by manufacturer 9 Calculate difference: o Actual Subcooling - Target Subcooling = System passes if difference is between __ -40F and +4°F PASS Enter Wass or FaIIII Metering oevice Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. ISvstem Name or Identification;Tag - System d Calculate: Actual Superheat = 0 Tsuct on - Tevaporator, sat Enter allowable superheat range from manutacturer's specifirations (or rise range o between 3°F and 26°F If manufacturer's specification is not availaale; System passes if actual superheat is within the allowable superheat range PASS Enter Pass or Fai Reg: 210-Aw01e975A-M2500001A-M25A Registration Date/Tine: 2010/10/07 20:19:36 HER3 Provider: CaicErs' Inc. March2U10 2008 Resid_ntial ComPliarce Porm= Oct 07 10 05:35p Walter Nelli.s 760-3SO-327.7 p.0 14STA,L.I-ATI®RI CERTIFICATE CF-4R-NECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of S) Site Address: Enforcement Agency: Permit Nu ezr: 53-365 Avenida Martinez, La Quinta CA 92253 City of La Quinta 10-00001039 Standard Charge Measurement Summary: System shall pass both refrigeiant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 1 Steve Garcia9m2o29 _ HERS Provider Data Registry Information _ System meets all refrigerant charge and airflow R tested/ verified dwelling ❑ not-tested/w. rifled dwelling in requirements. Enter Pass or Fal PASS HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name:Responsible Rater's Signature: DECL.ARATI®N STATEMENT I certify under penalty of perjury, under the laws of the State of California, rhe intarmation provided on this form is true and correct. I am the certified HERS rater who performed the verification services identified and repo+ted on this ce.tairate (responsible. racer). The installed `eature, mate -nal, componcnt, or manufactured drvire requiring HERS verification that is identified on this certdicate (tile installation) complies with the ap?iicabie rarinwementS in Reference Residential Aoper.aices Raz anti RA3 and the requirements specified on the Certiflcatets) of Comolance (CF -111) approved by the local enforcement agent, The information reported on applicable sections of the instaltatiurf Ct:rtifit:Ae(s) (CF -6R), signed and subrnitced by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -IR) approved by the Builder or Installer information as shown on the Installation Certificate (CF -6R) .mss Company Name: (Instating Subcontractor or General Contractor or Builder/Owner) lA QUINTA AIR CCINDMOWNG a HEATING INC Responsible Person's Name: CSLB License: Steve Garcia9m2o29 _ HERS Provider Data Registry Information _ Sample Group ae (if applicaole): N/A R tested/ verified dwelling ❑ not-tested/w. rifled dwelling in a HERS sample group mERs Rater irttormation CalCERT'S Certificate # CCL-279SS14512 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name:Responsible Rater's Signature: Walter W Nellis Wolter W I�i'ellis _ Responsible Rater's Certification Number w/ this HEMS Provider: Cale Signed: iop/2010 CCZt3o4361 Reg: X10 -ADO;. B9' 15A-N,2500001A-M25A Registrari.or.f�Le/Time: 2G10/10/D7 2G: 18:36 HERS Provider: CaiCER'r5, l!larah Zoic01.0 2GGa Recidential Compliance hoiras Oct; 07 10 05:313p Walter Nellis 700-360-3277 'p,9 =neer the Duct System Name or Identification/Tag: System 1 Enter the Duct System l.ocatidn or Area Seried: Whole House _ Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required far compliance for alteral'ions and additions in existing dwelling! space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement dud' system can also include existing parts of the original duct. system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct systern installed in an existing dwelling, use the installation Certificate tided "Duct leakage. Test - Completely New or Replacement Dud System. " Duct Leakage Plagnostic Test: - existing duct system one compliance method from the following four choices. (Select p, 1. Measured leakage less than ISwo of fan flow 2. Measured leakage to outside fess than 10% of Fan Flow 3. Reduce leakage by 60% and cunduct sr -nuke and fix all leaks 2010/10/07 20:03:07 LJ 4. Fix all accessible leaks using smoke and HERS rater verify Reg: Notc: (One of Options 1, 2 or 3 must be attempted before utilizing Option. 4.) Registrat-Ann. Date/Ti.me: Determine nominal Fan Flow using one of the following three r-elcilation methods. F.esidYnt+al Compliance Fortrs ✓ 21 Cooling system method: Size of condenser in. Tens 4 x 400 = 1500 CFM ✓ E3 Heating system method: 21.7 x Output Capacity In Thousands of Btu/fir = _ ,_FrI I ✓ `I Measured system airflow using R.A3.3 airflow test procedures: ^ CFM Option 1 used then: ^^ 1 Allowed leakage = Fan Airflow 1600 x 0.15 = 24 CFM 'Actual Leakage = 144 CFM Pass if Actual leakage Is less than allowed leakage E? Pass L Fail Caption 2 used then: 2 Allowed leakage = Fan Airflow __ x 0.10 = CFM Actual Leakaye to outside NI (Pass if Actual leakage to outside is less than Allowed leakage ❑ Pass .7 Fail Optiorn3 used there: Initial leakage prior to stare of work = CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage __ - Fnai leakage _ = Leakage reduction r CFM ((Leakage reduction—/ Initial leakage I x 1004/6 = 4g Reduction Pass If olio Rechiction > 60�/o Pass f�' Fall Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke f ;Pass I Fait tine_ 2010 2010/10/07 20:03:07 HER:,' Prcvld<-r: Ca10ERTS, March Reg: 21C-P,0018975A-[4210vODIA-0000 Registrat-Ann. Date/Ti.me: 2008 F.esidYnt+al Compliance Fortrs Oct 07 10 05:37p Walter Nellis 7GOT360-3277 P.10 L Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. All supply and return Register boots must be sealed to the drywall if smoke test is utilized for compliance - applies to rlurt leakage compliance option 3 (leakage reduction by 60n/o) and option 4 (fix aU accessible leaks) described above. I✓ New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts. Ri Mastic and draw bards must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections DECLAPATION STATEMENT . I certify under penalty of perjury, under rhe laws of the State of California, the Information provided on this fora s true and correct. . I am eligitle under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsibie persol). . 1 certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms tc all applicable cotes and regulations, and the installation Is consistent with the plans and specifications approved by the enforcemert agency. . I understand that. a HERS rater will check the installation to verify compliance, and that that if such checking Identifies defects. -I ern required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fall to meet the requirements of such quality assurance checking, the required corrective action and additional amcking/testing of other Installations in that HERS sample group will be performed at my cxpense, • I reviewed a copy or the Certificate of Compliance (CF -111) forth approved by the enforcement agency that identifies the specific requiremerits for the Installation. 1 certify that the requirements detailed nn the CFAR that apply to the Installation have been met • I viii ensure that a completed, signed copy of this Instaltatton Certineata shall be postod, or made available with the building perani t(s) issued for the building, and made available to the enforcement agency for all applicable Inspections:. I understand that a signed copy of this Installation Certificate Is required to be included with the documentation the budder provides to the building owner at aaupaney. I will ensure that all Installation Certificates will come from a HERS provider data reoistry for muttiole orientation alternatives, and beglnning October lr 201C, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) LA QUANTA AIR C0140MONING lb HEATING INC Responsible Person's Name: Responsible Person's Signature: Steve Garcia BfavO fmreia CSLB License: '902029 Date Signed: 10/6/2010 Position With Company (Title): " Is this Installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Pmgram {TPQCP)? 0 Yes r No Reg: 210-1:0018975A=M.2100001A--0000 Registratlon Date/Time. 2010/10/07 20:03:07 HERS Brovi.dery Cs1CF.RTS, Lnc. 2008 Reeidential Compliance Forms March 2010 Oct 07 10 05:38p Walter Nellis 760-360--32'77 fNSTALLATION CERTIFICATE CF -SR- ECH-2.5-H ERI tefrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5 Site Ad ass: Enforcement Agency: Pernilt Number: 53-365 Avenida Martinez, La Quinta CA 92253 City of La Quinta 1 10-00001039 Note.- If installation of a Charge Indicaror Display (UD) is utilized as an alternative to refrigerant charge verification fL,r compliance, a MECH-24 Certificate (instead of this MEC4-2.5 Certificate) should be used to demonstrate compliance with the refrigerant charge verit7cat/on requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional furm(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (SIMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. Irrefrigerant charge vetfrication is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive cornpilance method. TNIA64 - Aceeer-a 64elee in 5unnly and P.eturn Plenums of Air randier Systern Name or Identification/Tag System 1 —7 System Location or Area Served Whole douse 1 ® Yes O No 5/16 inch (8 flan) access hole upstream of evaporative coil in the return plenum and 3 !abeled according to Figure in Section RA3.2.2.2.2. 2 b Yes No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum Director. and labeled according to Figure In Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Fail ✓ :?i Pass ✓ ❑ =ail STMS •• Sensor on the Evanorator Coil System Narrre or IdentificadoniTTag I System 1 The sensor is factory installed, or field installed according to manufacturer's 3 0 Yes El No specificarions, or is Installed by methods/specifications approved by the Executive Director. The sensor wire: is terminated with: a standard mini plug su!table for connection to a 4 [-jYes0 No digital thermometer. The sensor mini plug is accessible to the installing technician 0 No digital thermometer. The sensor- mini plug is accessible to the installing technician and the HERS rater without changing the antiow through the condenser coil No The sensor measures the saturation temperature of the coil within i.3 degrees F Yes to 3, 4, and 5 is a pass. Enter NjA if STNS are not ✓ ® N/A V 0 Pass ✓ 0 Fail iapplicable. Otherwise enter Pass or Fail 0 N/A ✓ G Pass ✓ ] Fail STMS - Sensor on the. Condenser Coil System Name or IdentificationJl ag 5ystem 1 The sensor is factory installed, or field installed according to manufacturer's 6 0 Yes 0 No specifications, or is Installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 _r Yes 0 No digital thermometer. The sensor- mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 0 Yes 0 No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter NiA if STMS are not �y 0 N/A ✓ G Pass ✓ ] Fail applicable. Otherwise enter Pass or Fall I Reg: 210-A0012975?,-i12500001A-0000 Regietration Vale/Time: 2010/10/07 20:05:19 HERS Provider: C:.'ICIMTS, inc. ZUOB Reaidential Compliance Forme August 2009 Oct 07 10 05:39p Walter trellis 760-360-3277 p.12 ;NSTALLATION tCERTIFICATE CF-GR-MECH-25-HEiZ! tefriger®harge Verification - Standard Measurement Procedure (Page Z of 5 Site Address: Enforcement Agency: Permit Number: 53-365 Avenida Martinea, la Qulnta CA 92253 City of Ls Quinta 10-00001039 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Pronedure arc available in Reference Residential Apper6lx RA3.2. As many as 4 systems in the dwelling con be documented for compliance using this form. Attach an aciditinnal form(sj far any additional systeins in the dwelling as applicable. rhe system should be installed and charged in aewrdance with the manufactuier's specifications before starting this procedure. • The system must meet minimum alrflow rcvuirenrenti as prerequisite for a valid refrigerant charge test. • rt outdoor air dry-bulb is 55°F or below, the installer must use. the Alternate Charge Measurement ProcenurP.. .— r..�.lfsiwwiww �Naawc System Name or Identification/Tag System t (r rust be re -calibrated monthly) Date of Thermocouple Calibration 10/7/2010 System Location or Area Served whole House Outdoor Unit Serial d 909097240 Outdoor Unit Make D&N Outdoor Unit Model C4H3486Kd200 Nominal Cooling Capacity Btu/hr 48000 Date of Verification 10/07J2010 Date of Refrigerant Gauge Calibration 10/7/2010 (r rust be re -calibrated monthly) Date of Thermocouple Calibration 10/7/2010 (must be re -calibrated monthly) mAnauren r r,mnerazures s -r r System Name or Identification/Tag System 1 Supply (evaporator- leaving) air dry-bulb 48.2 temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 68.5 temperature (T�iu,n, db) Return (evaporator entering) air wet -bulb 55.5 temperature (Treturn, vib) Evaporator saturation temperature 38 _ (1 evaporator, sat) Condensor saturation temperature 91 (Tcondensor, sat) Suction line temperature Crsuc{ion) 38 Liquid tine Temperature (Tliquid) 82 Condenser (entering) air dry-bulb temperature Crcondenser, db) pec: 210-A0018975A-M25000OIA-0000 Registration nate/Time: 2010)=0/07 20:05:39 HERR provider: Ca1A13ugc i009 2008 Residential Compliance Ftrmb Oct 07 10 05:40p Walter Nellis ?60-360-3277 INSTALLATION CERTIFICATE C!=-611-MECH-25-HERS Refrigerant Chare3e Verification Standard Measurement Procedure (Page 3 of 53 Site Address: Enforcement Agency: Permit Number: 53-365 Avenida Martinez, La Quinta CA 92253 Cfty if La Quints 10-00001039 Minimum Airflow Requirement Temperature Split Method Calculations for deteradning Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System I Calculate: Actual Temperature Split = Treturn, 20.3 db - Tsupply,db Target Superheat from Table RA3.2-2 using Target Temperature Split from Table RA3.2-3 20.4 using Treturn, wb and Treturn, db Calculate difference: Calculate difference. Actual Temperature Split - -0.1 Target Temperature Split = System passe= if difference is between -5°F and Passes if difference is between -3°F and +3°F or, t 5'F upon remeasurement, if between -31F and PASS -100°F Enter Pass or Fail Note: Temperature Split Method Calculation i5 not necessary ifar.Yual (.-noting Coil Airficia is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. ff actual cuuiing coil airflow is measured, the value must he equa! to or greater than the C-'dlculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity ('ton) X 300 (cfm/ton)- System Name or Identification/Tag System 1 Calculated Minimum All -flow Requirement (CFM) Measured Airflow using RA3.3 procedures (CFM) Passe if measured airflow is greater than or equal to the calculated minim�rn airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used 'fol r fixed orifice metering device systems System Name or Identification/Tag System 1 Calculate: Actual Supe -eat = Tsuction - Teva orator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passe= if difference is between -5°F and t 5'F Enter Pass or Fail Reg: 210 A0019S'15A-M�S000OlA-000D Registration Date/Time: 201Cj10/07 20:05:.39 HERS Provider: CalCEr S, T.ne. :augusr. 2009 2oriB Residential Compliance 20=0 Oct 07 10 05:41p Walter Mellis 7GO--360-3277 p.14 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 •Calculate: Calculate: Actual Subcooling = 9 Actual Superheat - Tcondenser, sat - Thquie `Tsuction-Tevaporator sat Fnter al!nwabie superheat range frorn Target Subcooling specified by manufacturer 9 manufacturer's specifications (or use range Calculate difference: �0 between 4°F and 25°F if manufacturer's specification is not available) Actual Subcooling - Target Subcooling = —i System passes if actual superheat is within the System passes if difference is between allowable superheat range -3°F and +3°F PASS I Enter Pass or Pail Enter Pass or Fail ^� teetering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermustatic expansion valve CM) and electronic expansion valve (EXV) systems. jSystem Name or Identification/Tag System I •Calculate: Actual Superheat - C `Tsuction-Tevaporator sat Fnter al!nwabie superheat range frorn manufacturer's specifications (or use range 0 between 4°F and 25°F if manufacturer's specification is not available) —i System passes if actual superheat is within the allowable superheat range PASS I Enter Pass or Pail ^� Reg: 210--A0016975A-N-,S00C01A-0000 RegisCrat'ion Dace/Time: 2010/10/07 20:C5:39 HERS Provider: Ca1CWTS• Inc. 20Ja Residential Complianco Forms August 2009 Oct 07 10 05:42p Walter Mellis 760-360-3277 io.15 ut>amary.- Standard Ch2r9e li easurement Summary.- System shall pass bath refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil System airflow criteria based on measurements taken concurrently during system operation, If corrective actions were taken, all applicable verification criteria must he re: -measured and/or recalculated. System Name or Identification/Tag System 1 System meets all refrigerant charge and airflow requirements. PASS Enter Paha or Fail oECLARATION STATEMENT . t rerrity unrier penalty of perjury, under the laws of the State of Califurnia, the information pro-oded n•.-, this form is true and correct. . 1 am ellgible under Division 3 of the Dusiness and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for constructicc (responsible person). . I ce-tify that the instatlad features, materials, components, or manufactured devices identified or.:his certificate (the installation) conforms to all aPPlicdble Ludes and regulations, and the installation is consistent with the plans and speciricabons approved by the en`orcement agency. . I understand that a HERS rater will check the installation to venfy compliance, and OWL that :f such checking identifies defects, I am required to take currective action at my expense. 1 understand that Energy Commission and HERS provider representatives will also pe. form quality essurante checking of Installations, inducting those approved as part of a sample group but not checked by a HERS rater, and if those installations tail to meet the requirements of such quality assurance checking, the required corrective action and additional checkingjl.esling or other iristallations in that HERS sampit group will be performed at my expense. . I reviewed a copy of the Certificate of Compliance (CF -LR) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -LR that apply to the installation have been met. o I will emsure that a completed. signed copy of this Installatlon Certificate sh®11 be posted, or trade available with the building peacnit(s) Imsued for the building, and made available to the enforcement agency for all applicable inspeetinns. I understand that a signed copy of this Installation Certificate is required to be included with the documentation, the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider dat« regisLry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residentlal buildings. Company Name: (installing Subcontractor or General Lontraeaar or tsWloer/owner) LA QUINTA AIR CONDITIONING & HEATING INC o..—....:F.re oo�,...�e nr�...o•IIPc .nnncihlP Pp.mnn's f,ionah-ire- «« MEMORY FULL. >>>> P.O. BOX 1504 NO.' • 1 13150 Building 78-105 CALLE ESTADO t Address 53-365 Martinez LA QUINTA, CALIFORNIA 92253 ,. Owner Mailing Address Same CityZip Tel. La Quanta` CA 92253 564-6595 Contractor owner /Builder Address Zip State Lic. City & Classif. ' Lic. # Arch., Engr., - Designer Address Tel. City( Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.. ac, `SIGNATURE . DATE %i y+? i OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basts 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own r employees, provided that such improvements are not intended or offered for sale. If,, however, the building or improvement is sold within one year of completion, the I owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) I,,,,as owner of the property, am exclusively contracting with licensed contractors to con- truct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law,) _ 0 1 am exempt under Sec., B. & P.C. for this reason � ; f ate -Owner 42 P WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Date - owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions - of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 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 city to enter the above-. mentioned property for inspection purposes. Signature of applicant— Date Mailing Address City, State, Zip 11LDING: TYPE CONST. OCC: GRP. P. Number gal Description oject Description Pool ►+'� Sq. Ft. No. No. Dw. Size - Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ f Estimated Valuation $8,000.00 PERMIT AMOUNT Plan Chk-Dep. Plan Chk. Bal. 64.35 Const. 99.130 Mech. 24.00 Electrical 45.00 Plumbing 27.0 S.M.I. -.80 Grading Driveway Enc. Infrastructure a TOTAL z�3si.i5 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line 4 Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR r' Issued by: Date Permit Validated bv: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMPING FEES A.C. UNIT COLL. AREA SLAB GRADE 1ST FL. SQ. FT. ® $ UNITS HEATING (ROUGH) STORAGE TANK FORMS YARD SPKLR SYSTEM 2ND FL. SQ. FT. ® DUCT WORK ROCKSTORAGE FOUND. REINF. MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® GROUT WATER HEATER SERVICE N DRAINAGE PIPING CAR P. SQ. FT. ® WATER SYSTEM FINAL INSP. $ WALL SQ. FT. ® DRINKING FOUNTAIN FRAMING URINAL SQ. FT. ® /Gj� �—Z3 - 43 C-/;7 GG �j /� 141/' �/&Z/M 11G/L /17-11/`V /4�'%/ jw/ G11�i� ape , _ .X C� O%V12 -: Flq 1112 /J ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation VENTILATION FLOOR DRAIN MECHANICAL FEES FIRE ZONE ROOFINGVj WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/4c HOUSE SEWER FENCE FINAL GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUM BING'7'-,f-4,P� NDERGROUND;>2y: G A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. $ GRADING cu. yd. —Plus—x$—=$ LUMBER GR. FRAMING FINAL INSP. ROOFINGREMARKS: /Gj� �—Z3 - 43 C-/;7 GG �j /� 141/' �/&Z/M 11G/L /17-11/`V /4�'%/ jw/ G11�i� ape , _ .X C� O%V12 -: Flq 1112 /J VENTILATION FIRE ZONE ROOFINGVj FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Q. . i .. C = TY OF LA QiJ I NTA K Contractor Owner Address Job Address �� j�p RAI This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. It is the responsibility of the General Contractor or the owner/Builder to monitor the sub -contractors that are on this list are the same persons performing the work. Any changes of this list must be approved by the City of La Quinta Department of Building and Safety prior to work being performed by a changed sub -contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit. TRADE SUB -CONTRACTOR NAME CONTRACTOR'S LICENSE NO. WORKMAN COMP. NO. ON FILE CITY BUSINESS LICENSE NO. GRADE/ EXCAVATE PIPELINES CEMENT/ FOUNDATIONS CEMENT/WALKS & DRIVES A& P "� _ r FRAMING SA MASONRY f�7%f / L S A2 J PLUMBING =d7(p O /+� LATHING DRYWALL PLASTERING , J �%�%/-}��i/�/�%� ` I�5�7' HVAC ELECTRICAL ROOFING SHEET METAL FLOORS GLASS/ GLAZING INSULATION SEWAGE DISP PAINTING/ DECORATING TILE CABINETS/ INSTALLATION ORNAMENTAL METAL FENCES/ BLOCK WALLS LANDSCAPING OTHERS ,v, I 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 – (760) 777-7000 FAX (760) 777-7101 TDD (760) 777-1227 December 19, 1997 Eden & Mary Bebla 53-365 Avenida Martinez La Quinta, CA., 92253 RE: Pool Permit -#13150 Dear Mr. & Mrs. Bebla The purpose of this letter is to inform you that your Pool Permit #13150, for the project. 53-365 Avenida Martinez, has expired. In accordance with 1994 UBC section 106.4.4, no further work may be performed until a new permit has been issued. Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any information you need regarding a new permit and/or any required inspections. Should you choose not to complete the project, we would then have to pursue any or all of the following actions: 1) Abatement of the project through the City Attorney's Office and Code Compliance Division. 2) Notice of non -conforming structure placed upon property profile. 3) Action filed with Contractor State. License.Board. Optional if Owner/Builder. Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and for any questions you may have. Sincerely, Mark Harold Buildi & Safety Manager Daniel P. Crawford Jr. Building Inspector I cc.: file dpc 4CFy s MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA.92253 4 P.O. BOX 1504 Building 53-365 Martz 78-105 CALLE ESTADO Address- LA QUINTA, CALIFORNIA 92253 Owner Bilr1l;1ei-ter Mailing Address P. 0. D= 59 City Zip Tel. TA Q.tinta 1 92253 564-1486 Contractor GPIiwit'a i C7t Sitz Ate". MIAMM"W* Zip I Tel. State Lic. Cit 524325 I Lic. & Classif. # 1235 Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. If _ LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions.of- Chapter <9,(commencing with Section 70 00) of Division 3 of the Business and Professions Code, and my license is in full force and effect. f 1 SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or thathe 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 rive hundred dollars ($500)• O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply, to an owner or property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) 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. i(-,-*- -^:_- "�wr �� Date / Owner 'r•` NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 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 city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING: TYPE CONST. •OCC. GRP A.P. Number 774--092-018 Legal Description Project Description a•F•bo 04E3S 1 WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD ASSESSOR'S.OFFICE, HARD COPY - FILE Sq. Ft. 14135 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $799925 PERMIT AMOUNT Plan Chk. Dep.o.0i3 Plan Chk. Bal. 70.415 Const. 373.00 Mech. 36.00 Electrical 76.02 Plumbing 103.OD S.M.I. 5.57 Grading .20.40 Driveway Enc. 20.00 Infrastructure 1,760.07 TOTAL t+�+ �•sx 2.10_11-1 REMARKS #.h)'f i �..,.0 t'• ,M40 I' U -*'Pq' ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR z0fs.�/�a Issued by: Date Permit Validated by: Validation: 1 WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD ASSESSOR'S.OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO F1 rp s UNITS COLL. AREA SLAB GRADE ROUGH PLUMB Y ARD SPKLR SYSTEM 2ND FL SO FT. (d HEATING (ROUGH) STORAGE TANK , FORMS MOBILEHOME SVC. BAR SINK POR SO FT. a DUCT WORK ROCK STORAGE FOUND. REINF. OUTLET ROOF DRAINS GAR SO. FT. 0POWER HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. SO FT. C WALL SO. FT. a WATER HEATER DRINKING FOUNTAIN FINAL INSP. URINAL SO. FT. rd WATER SYSTEM ~ ESTIMATED CONSTRUCTION VALUATION $ GRADING cu. yd. $ plus x$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES GOOFING -� :-v WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRYTRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. - SO. FT. (& c BATH TUB LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT. B.T.U. SO. FT. RESID r I'A c SEWAGE DISPOSAL SO.FT.GAR rg Uc HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE 11L.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB FEE STRUCTURE I PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR SETBACK GROUND PLUMBIN � UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK , FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) EMP. POLE12 GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM ~ GRADING cu. yd. $ plus x$ - $ LUMBER GR. FINAL INSP. FRAMING .. / FINAL INSP. GOOFING -� :-v O�i� To � /-z l//Y / /�` ( Q "\e �' REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR, GAR. FIREWALL LATHING MESH C/(NSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT I/^C OF 3� NOTICE THIS DOCUm SCHOOL FACILITY FEES BE DUPLICATED, CANNOT TO: City of La Quinta DATE: /b/Z 2 Department of Community Development 78-105 Calle Estado La Quinta, CA 92253 This is certify t t �u' �WtiAl U developer ofto which is located at\ , . within this District, has paid school f lity fees imposed pursu t to the au ho >t en rate by G ernment Code .e d o 3080 in amou t o covering a total of ,r;, uare feet of ( ) residential or ( ) industrial/commercial development and that building permits for this footage in this development may rAi be issued by your jurisdiction. or/DESERT SANDS•UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer - I10► -37 LID RECORDING REOUESTED BY AND WHEN RECORDED MAIL THIS DEED AND UNLESS OTHERWISE SHOWN BELOW MAIL TAX STATEMENT TO: Name MICHAEL L. BANGERTER Street 1945 ROCKHOLLOW Address BLUFFDALE city& UTAH 94065 State MAIL T Name Address S9ME . AS ABOVE tsity & State TITLE ORDER N0. Estaowro. 207252LN O Z n ` 9a a W 00 M ° � Cn Cr O Q lid C } to LU 9 s W = '� W cc I J �e y � p a y Q t &AS 4. o' j sem- SPACE ABOVE THIS LINE FOR RECORDER'S USE GRANT DEED THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX is $ 7.70 nn IX computed on full value of property conveyed, or ❑ computed on full value less value of liens or encumbrances remaining at time of sale. 1 ❑ unincorporated area 1 IX city of LA QUINTA AND FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, MILLIE HAMPSHIRE, A SINGLE WOMAN AS HER SOLE AND SEPARATE PROPERTY. hereby GRANT(s) to MICHAEL L. BANGERTER, A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY the following described real property in the City of LA .QUINTA County of RIVERSIDE , State of California: LOT 61 BLOCK 211, OF THE SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 20, AS PER MAP RECORDED IN BOOK 19, PAGE 38 OF MAPS, RECORDS IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY. Dated • Oct. 13, 1986 STATE OF CALIFORNIA .COUNTY OF RIVERSIDE } SS. On this 17 day of OCTOBER , in the year 191 86 before me, the undersigned, a Notary Public in and for said State, personally appeared MILLIE HAMPSHIRE (or proved to me on the basis of satisfactory evidence) to be the person= whose name IS subscribed to the within instrument, and acknowledged to me that She=executed it. WITNESS my hand and Sig NOTARY PUBLIC IN AND FOR SAID MILLIE HAMPSHI :`. •. OFFICULL SEAL — TMA S. BULLOUGH ARY PUBLIC • CALIFORNIA PRMRNERR3 E� M COUAITy mon FxD. At.. 27, 19. 89 (This area for ofliciel noterial seal) CO -441 (4/85) _ MAIL TAX STATEMENTS AS DIRECTED ABOVE.