AR (07-1945)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
~ Application Number: 07-00001945
Property Address: 56250 MUIRFIELD VILLAGE
APN: 762-390-006- - -
Application description: ADDITION - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 8351
c&ht 4 4
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
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.
License Cl Li License No.: ---------------
Dater L� elontractor: /
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 ap ant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( 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.).
(_ 1 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 contractor(s) licensed
pursuant to the Contractors' State License Law.l.
( ) 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 ISec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
ROBERTS ROY C
56250 MUIRFIELD VILLAGE
LA QUINTA, CA 92253
Other struct info . . .
Contractor:
Owner
DITION
2001/
Lic. No.: ---------------
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/20/07
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 NO Policy Number E FOOTAGE
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
37 0 of the Labor Code, I snatyrort h c mply ith ose rovisions.
Date/ ��, pplicant: r/ i
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 count to en r upon the above-mentioned property t� rpo s.
Date:Wg, azure (Applicant or Agentl:
Application Number . . . . . 07-00001945
Permit . . . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
108.00 Plan Check Fee
70.20
Issue Date . . . .
Valuation . . .
. 8351
Expiration Date
r!
2/25/08
Qty Unit Charge
Per
Extension
BASE FEE
45.00
7.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
63.00
PermitELECT
- ADD/ALT/REM
Additional desc . .
Permit Fee . . . .
20.11 Plan Check Fee
5.03
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
2/25/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
146.00 .0350
----------------------------------------------------------------------------
ELEC NEW RES - 1 OR 2 FAMILY
5.11
Permit
MECHANICAL
.Additional desc .
Permit Fee . . . .
24.00 Plan Check Fee
6.00
Issue Date . . . .
Valuation.
0
Expiration Date
2/25/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
EA MECH APPL REP/ALT/ADD
9.00
-----------------------------------------------------------
Special Notes and Comments
----------------
enlarge dinning room
146 sq. ft.August
29, 2007 10:53:44 AM
jjohnson
----------------------------------------------------------------------------
Other Fees . . . . .
. . . .. ENERGY REVIEW FEE
7.02
STRONG MOTION (SMI) - RES
.83
Fee summary Charged Paid Credited
---------------------------
Due
Permit Fee Total
------------------------------
152.11 .00 .00
152.11
Plan Check Total
81.23 .00 .00
81.23
Other Fee Total
7.85 .00 .00
7.85
Grand Total
241.19 .00 .00
241.19
LQPERMIT
# A
City of La Quinta.
Building at Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
I
Project Address:' 7 ,,5v (/Ll-- , owner's Name: NIIARYREED & ROY ROBERTS
A. P. Number: y6 Z-,390004 — / Address: 56250 MUIRFIELD VILLAGE
Legal Description:' 0. G- /N " "3 City, ST, Zip:
Contractor: Telephone: S V 6 .
Address: Project Description:j�f�,,
City, ST, Zip:
Telephone:A
J'C"
State Lie. # :
City Lie. #: -`� , a �- -- 1
Arch., Engr., Designer:• � /L��i✓
Address: 0 — S *'8 — —7 q
City, ST, Zip: 4 LiL,)Z
Telephone: onstruction Type: Occupancy:
State Lie. #: Project type (circle one): New A 'n Alter Repair Demo
Name of Contact Person: �O �l, j Sq. Ft :�1�2 # Sto 'es: #Units: /
Telephone # of Contact Person: Estimated Value of Project Ze"--'25'40
APPLICANT: DO NOT WRITE BELOW THIS LINE
Req'd
Reed
TRACMG
PERMIT FEES
F#Submitthid
Pian Check submitted
07
Item
Amount
l Ca1cS.
Reviewed, ready!corrections
` [�
Plan Check Deposit
Truss Cales.
Called Contact Person
Z4
Plan Check Balance
Energy Calcs.
Pians picked up
1731
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
V Review, ready for correcti ueq
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''° Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P. -
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Jj
September 24, 2007
Mr. & Mrs. Roy Roberts
56-250 Muirfield Village
La Quinta CA 92253
.k
P GAN
WNCE
FAIRWAYS ASSOCIATION
Re: Room Extension approval
Maintenance Agreement - roof
56-2501MMuirfield Village
Dear Mr. & Mrs. Roberts:
Per our conversation.. on Thursday, September 20th, 2007, upon receipt of the signed and
notarized roof maintenance agreement and $300 recordation fee in connection with the
building of the proposed room extension, approval is given by the Architectural/Landscape
Committee for you to proceed.
Should .you have any questions in regard to this, or any other correspondence relating to the
proposed room extension, please do not hesitate to contact the Association office at any
time.
c
Sincerely,
Nan\cy on CCAM, CIVICA
Facilities Manager
For the Architectural/Landscape Committee
Cc:- Architectural/Landscape Committee
File
Post Office Box 1690 • La Quinta, California 92247 • Phone (760) 776-5100 • Fax (760) 776-5111
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits. for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations include State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contracts are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760) 777-7011
OWNER'S SIGNATURE/DATE
VC, -'ePpoponq
PROPERTY ADDRESS
014- 7970
PERMIT NUMBER(S)
t '
CERTIFICATE OF COMPL ANCE; RESIDENTIAL (Pagel of 4) CF -1R
Pro eciTitle 2 —
'� FDae
Documentation Author
Telenhnnn
Building Permit #0 7-11
Plan Check / Date
Wy
raicr nets vena w,
e For Package D.Alternative see Appendix B Table IVT': Foontaff4
CF71 R page 3)
Total Conditioned Floor Area CFA 8 AvaCeiling=ldet V.
( )_. �CTIOnI
Maximum Allowed West Facing Fenestration Products Per
Maximum Allowed Total Fenestration Products Per Table
I S -B or 151 X
❑ Building Type: (check one or more) Single Fam BY
(If adding fenestration fill out WS -4R, Fenestration M W
a Alteration
u
for Additions and 8371for-Alterations.)
and see Section 8.3.2
Number of Stories; .. :�Number.of Dwelling Units•
Floor Construction Slab/Raised
Floor (circle one or both)
Front
Orientation: 1– No rth /South /East /West /AllOrientations (input front
North and circle -one).
orientation in degrees from True
•RADIANT BARRIER (required in climate zones 2.4 8-j5)
OPAQUE SURFACES INCLUDING OPAQUE DOORS
Component .
Type (Wall, Frame
Assembly U -
Roof, Floor, Type
Slab Edge, (Wood
Cavity
Insulation
factor (for Joint
Continuous wood, metal Appendix
Roof Radiant '
Barrier Location/Comments
`
Doors or Metal
R,V ue._
_
Insulation frame and mass IV
R -Value- assemblies t Reference
Installed (�O' age'
Yes or No
rfZ
typical,etc.
1) See Joint Appendix IV in Section IV 2,1V3 and IVA, which is the basis for the U -factor
exceed prescriptive value to show *ivalence to R -values:
Residential Compliance Forms
U factors can not
March 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 4) CF -1R
Project Title
13
FENESTRATION PRODUCTS — U -FACTOR ANDLSHGC
FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS4R -must be
Additions and Alterations. included for New Construction,
Fenestration
#/Type/Pos.
(Front, Left, Orien- Exterior 6.7
Rear Right, tation, Area Shading/Overhangs
' U -factor SHGC •/ box if WS -3R is
S &light)N S, E, W� ft U-factorz Source3. SHGC4 Sources included
13
E3
r1
Al
1) Skyli S ❑
ghts are now. included in West -facia fenestration area if the skylights are tilted to the west orti - in arty direction
when the pitch is less than 1:12. See § 151(f)3C and in Section 323 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 NERC 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 116B.
6) Shading Devices are.defined in Table 3-3 in the Residential Manual and see WS -3R to calculate Exterior Shading devices.
7) See Section 32.4 in the Residential ManuaL
HVAC SYSTEMS
I Heating E
Type and
Cooling Equipment
Type and Capacity.
Residential Compliance Forms
....... w--mouuon —
Efficiency Type and Location Duct or Piping Thermostat
ym or H.SPFI i t............_ — r — . —
11
Minimum
Efficiency Duct Location
Configuration I
Duct Thermostat Configuration
R -Value ypc (split orpackage)
March 2005
,
INSTALLATION CERTIFICATE
(Page] of l2) CF -6R
f
Site Address
Permit Number
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The
information provided on this form is required) After completion of final inspection, a copy must be provided to the building
the building owner at occupancy, per Section 10-103(a):
department (upon request) and
WATER HEATING SYSTEMS:
Distribution
CEC Certified Type . If # of Rated Input
Heats Mfr Name & (Std, Point- Recirculation, Identical (M or Efii • �
T Model Number of -U etc Control T Tank Volume c 5+ Smridby .. Insulation
stems EU1hr)t __Mlons (EF. RE? Loss (%)2 R -value
1 For smaD.gas storage (rated input of less than, or equal to 75,000 Btu/ electric' resistance and beat pump water
heaters, list Energy Factor (EF). For large gas storage water beaters (rated input of greater than 75,000 Btu/hr), list
Recovery (RE), "Thermal Efficiency, Standby Loss and Rated Input. For instantaneo
Eus gas water beaters, list Thermal
Efficiency and Rated Input
2. R-12 external insulation is mandatory for storage water heaters with an energy factor of less than 0S8.
Kitchen Piping -
'If indicated on the CF -IR, all hot water. piping > 3/4 inches in diameter that runs from the hot water source to the kitcheii
fixtures is insulated_
Faucets & Shower Heads:
All faucets and showerheads installed are certified to the Energy Commission, pursuant to Tile 24, Part 6, Section 111.
Central Water Heating in'Buildings with Multiple Dwelling Units (required for •prescriptive)
r
. ❑All hot water piping in main circulating loop is insulated to requirements of § I50G)
❑Central hot water systems serving six or fewer dwelling units which have (1) less than 25 of distnbuttionin
outdoors; (2) zero distribution piping underground; (3) no recirculation P.iP g
that meets the requirements of Section 1506) PSP: and (4) insulation on distribution, piping .
1Central hot water systems serving more than 6 dwellingunits
control -
presence of either a time control or a timehernpumb re
L. the undersigned, verify that equipment listed above m signature
or more efficient than, tbat Y is: 1) the actual equipment installed; 2) equivalent to
specified in the certificate of compliance (Form CR -1R) submitted for compliance with the
Frte V � ruy S±cnrdards for residential .buildings; and 3) equipment . that meets. or exceeds the appropriate
requir�em is for manufacttn ed devices�(from the Appliance jFoWency Re�[�onsor Part 6), where applicable.
�Signatwe,.Date / .
Installing Subcontractor (Co. Name) OR
COPY TO: Building Department General Contractor (Co. Name) OR Owner
HERS Rater (if applicable)
Building Owner at Occupancy
Residential Compliance Forms
Coachella Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
Project Name:
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
.AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMMAND. AMOUNT:
DATE:
RECEIPT:
CHECK#:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Date: September 17, 2007
Owner's Name: Roy Roberts Phone No. 564-1646
Project Address: 56-250 Murfield Village, La Quinta, CA
Project Description: Dining room addition
APN: 762-390-006
Tract #:
Lot #'s:
Type of Development: Residential XX1 Commercial Industrial
Total Square Feet of Building Area: 146 sq. ft.
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer.
Dated: 9-17-2007 Signature:
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Note:
Number of Sq.Ft. 146 Pursuant to AB -181 Any room addition that is 500 or less sq; .
Amount per Sq.Ft. $ 0.00 it. is exempt from Developer Fees
Amount Collected $ 0.00
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Support Services
Certificate issued by: Elvira Mattson, Secretary III
Signature: &Z�,�
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these
Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to
advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other
requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this
time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of
Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up
to three (3) such extensions may be granted: At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject
of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
MV:c/mydocs/devfecs/certificate of compliance form tablesTO USE.doc 1/16/03 T
ROY & MARYREED ROBERTS
56-250 MUIRFIELD VILLAGE
LA QUINTA, CALIFORNIA 92253
(760)564-1646 cell(530)848-7906
January 3, 2008
City of La Quinta
Building and Safety Department
78-495 Calle Tampico
La Quinta, CA 92253
Gentlemen;
Re: Building Permit
Appl. #07-00001945
We obtained the subject permit on December 20, 2007, as Owner -Builder.
Since that time, we have decided to turn this work over to a General
Contractor, Mr. Brian Fuller, License Number 818349, dba BK
Construction, of La Quinta, CA. He will be applying for a change of titling
of the permit in the next few days to reflect this transfer; we understand
there is a charge of $4.50 for the name change.
Thanks for your time and assistance in advancing our small addition thus far.
Roy C. Roberts
JAN _ 7 2008
WESTERN INSULATION, L.P.-
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786 F
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADM IN ISTRATIVE'CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT/PHASE: PGA WEST - LA CALA I PHASE 313 `
LOT #: 6
SITE ADDRESS: (56-250'MUIRFIELD-VILLAGE - LA-QUINTA CA.
-- --------------1
EXTERIOR WALLS: BATTS' L
- r
MANUFACTURER: JOHNS MANVILLE THICKNESS: 6 3/4" R- VALUE: R-19
CEILINGS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11" R- VALUE: R-30
GENERAL CONTRACTOR: WESTERN PACIFIC HOUSING
BY:
TITLE:
DATE:
INSULATION C NTRACTOR:. WESTERN INSULATION,'L.P.
LICENSE NUMBER: 94 84
BY:
TITLE: PRODUCT ON AANAGER
DATE: SEPTEMBER 16, 2002
S P.3C.20C2 _1.__.i ;C233 0E1 MAYER ROOFING
e �
Curporatc Office:
P.O. Rox 4621190
Escondido, CA 92046
Liunw /1 MAW
WESTERN PACIFIC .DOUSING
LA QUINTA
760-564-7022 (FAX)
Atm: JORN
43481 P.003l011
Roofing on "LEGENDS 64 P.G.A. WEST" Pts 3B LOT #2006
Phone: (760)737-8888
FAX: (760) 737-0350
09-30-02
Mayer Rooting has supplied and installed "12" O'hagin cloaked roof vents, on lot # 2006
at 56-250 MU7RFTET.,T) VIII .IAGF, '.file vents have been installed per manufacturers
specifications.
Note: Exact vent locations rare determined by builder
RESPECTFULLY SUBMITTED
SCOTT BEECHAM
OPERATTONS MANAGER
Mayer Roofing, Tnc.
Page T of I
558 Library SLrcel . San Fernando, (.,A 91.140 19.1 0", Ige Sheet . Riverside, CA 92502
(R 1 R) 83R-60611 . * AX (8 i 8) R38-44!),; 1 11909) 782-0601 . FAX (909) 782-0804
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Tight Ducts) CF
PROJECT INFORMATION '—
-4R
Project Title -
La Gala
Project Addrsas;
Lo Q4inte
Builder Nome:
Western Paoft Homes, MIChelle Lope:
Voice d :
-4
9492-6199 x 462
Builder Contact:
Projed ID #:
John Zieman
28133&1
Voice # :
760.5647555
Sample Group # :
Phase 3b
Lot #:
2008
Plan #
a
Address:
5&250 tUuWf W VBlage
HERS INFORMATION
HERS Rater:
Scott Johnson Jeyme Carden
Certification 0:
CCCSJ614037 CCN"15157
HERS Firm:
Address;
Action Now
2575 Westminster Avenue, Costa Mesa, CA 92627
Voice #:
e49-631-2274
HERS Provider:
HERS Address:
CHEERS
9400 Topangs Canyon Blvd, Chatsworth, CA 91311
Voice # :
818-407-1500
HERS RATER COMPLIANCE STATEMENT
Q T-24 Cemplionoe Credtt was Taken for Tight Duets
The house was: /
Tested [=Approved as it part of Sample, but was not tested
x The installer has prc%n d a copy of CF -6R
x Air Distrtution System is Fully Ducted *aetmetal, duaboard or flex duct)
cloth booked, rubber adhesive duct tape to seal leaks at the connections. Where cloth backed rubber adhesive duct tape is installed, mastic and drawbands are used in combined with
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE COMPLIANCE CREDIT
Duct Diagnostic Leakage Tooting Results (Max!mum 6% Dud Leakage)
CFA: CFA Leak Max Tested Leak
System
Indicate themax mum e a Is Dud Leakage and the calculation used;
0.7 x Floor Area x (0.06) fOr Climate Zone 8 through 15
0.5 it Floor Area x (0.06) for Climate Zones i through 7 916
x 400 x (Cooling Capacity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of Output BTU per hour) x (0.06)
Other
UW Pressurization Test Results (CFM CP 25 PA)
100 x Teat Leakage / Fen Flow = Ho Leakage
Check Box for Pass or Farl Pass = 8% or Lou) ppag ai
Syatamof
Indlcetn the ma um a OuCt Leakage and the caleu(alion used:
0.7x Floor Area x (0,00) for Climate Zone 8 through 15
0.5 x Floor Area x (0.08) for Climate Zones 1 through 7 & 16
x 400 x (COOIbV CalsaCity in Nominal Tons) x (0.06)
21.7 x (Heating Capacity in Thousands of OuW BTU per hour) x (0.06)
Other
D—uff Pressurization Test Results (CFM 8 25 PA)
100 x Test Leakeg0 / Fan Flow = % Leakage
Check Box for Peso or Fall Pass =15% or Less) Pass
System = of e
Indicate the
0.7 x Floor Area x
0.5 x Floor Area x
x 400 x (Cooling Ca
21.7 x (Heating C:
Other
D—Uff PressuriZation Teal
100 x Test Leakage I Fa
Check BOX for Paas or F
Raters Certifying Slgnsk
.& -1-0 -?—
-Macro.xls