SFD (06-2732)r Kf
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tiht Qu.m& ,
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
r
.ti Application Number: 06-00002732 �,
Property Address: 52860 AVENIDA NAVARRO
APN: 773 -335 -007 -20 -'000000 -
Application description: DWELLING - SINGLE FAMILY DETACHED
Property Zoning: COVE RESIDENTIAL
Application valuation: 116384
Applicant: Architect or Engineer:
A� ) 1 VIA
Q " Lic. No.: OOR SQUARE FOOT
n6
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 Class: B License No.: 847937
Date: °3�'O Contractor:, kz- ioR.®vl'i
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 1 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.).
1 _ 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.).
(_ 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
Owner:
EDUARDO SANCHEZ
52-860 AVENIDA NAVARRO
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/13/07
Contractor: D
RC GROUP MAY 31 200
66309 PIERSON BLVD
DESERT.HOT SPRINGS,. CA 92240
(760) 272-5183 CITY OF LA QUINTA
Lic. No.: 847937 _FINANCEOr_-P .
-----------------------------------------------
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 EXEMPT Policy Number EXEMPT
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 shou become subject to the workers' compensation provisions of Section
3700 of the Labor Cod , I shall forthwith comply with those provisions.
Date: 5-31'W Applicant:
WARNING: FAILURE TO SECURE W RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIM AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (S 100,000). IN ADDITI N TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN '
SECTION 3706 OF THE LABOR C DE, 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 builonstruction, and hereby authorize representatives
of this county to enter upon the above -menti one� propert .0,inspection purposes.
Date: 531107 Signature (Applicant or Agent):
IN
I Iz
LQPERA11T
Application Number . . . . 06-00002732
Permit . .
BUILDING PERMIT
MECHANICAL
Additional desc .
Additional
desc .
Permit Fee
699:00
Plan Check Fee
454.35
Issue Date . . . .
Valuation
116384
Expiration Date
10/10/07
Issue Date
. . . .
Qty Unit Charge
Per
Extension.
Expiration
BASE
FEE
639.50
17.00 3.5000
-------------------------------------------------------=-----------=--------
THOU BLDG
100,001-500,000
59.50
Permit . . .
ELEC-NEW RESIDENTIAL
Additional desc .
BASE
Permit Fee . . . .
95.35
Plan Check Fee
23.84
Issue Date
MECH
Valuation . . . .
0
Expiration Date
10/10/07
MECH
VENT
Qty Unit Charge
Per
9.0000
Extension
MECH
BASE
FEE
15.00
1855.00 .0300
ELEC
NEW RES - MULTI FAMILY
55.65
485.00 .0200
ELEC
GARAGE OR NON-RESIDENTIAL
9.70
1.00 15.0000
----------------------------------------------------------------------------
EA ELEC
TEMPORARY POWER POLE
15.00
Permit . . GRADING PERMIT
Additional desc .
Permit Fee . . . .
15.00
Plan Check Fee
.00.
Issue Date . . . .
Valuation
0
Expiration Date
10/10/07
Qty Unit Charge
Per
-
Extension
----------------------------------=-----------------------------------------
BASE
FEE
15.00.
Permit
. . .
MECHANICAL
Additional
desc .
Permit Fee
73.50'
Plan Check Fee .
Issue Date
. . . .
Valuation . . . .
Expiration
Date
10/10/07
Qty Unit Charge
Per
BASE
FEE
1.00
9.0000
EA
MECH
FURNACE <=100K
1:00
4.5000
EA
MECH
VENT
INST/ DUCT ALT
1.00
9.0000
EA
MECH
APPL
REP/ALT/ADD
1.00
16.5000
EA
MECH
B/C
>3-15HP/>100K-500KBTU
2.00
6.5000
EA
MECH
VENT
FAN
18.38
0
Extension
15.00
9.00
4.50
9.00
16.50
13.00
r
Application Number
06-00002732
Permit . . . . . .
MECHANICAL
Qty Unit Charge
Per
Extension
1.00 6.5000.EA
-----------------------------------------=----------------------------------
MECH EXHAUST HOOD
6.50
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
150.00 Plan Check Fee
37.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
10/10/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
12.00 6.0000
EA PLB FIXTURE
72.00
1.00 '15.0000
EA PLB BUILDING SEWER
15.00
1.00 7.5000
EA PLB WATER HEATER/VENT
7.50
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1.00 9.0000
EA PLB LAWN SPRINKLER SYSTEM
9.00
4.00 3.0000
EA. PLB GAS PIPE 1-4 OUTLETS
12.00
2.00 .7500
EA PLB GAS PIPE >=5
1.50
1.00 15.0000
EA PLB GAS METER
15.00
-------------7--------------------------------------------------------------
Special Notes and Comments
1,855SF DWELLING/V-NR/RES-3/COVE.
THIS
PERMIT DOES NOT INCLUDE BLOCKWALLS,
POOL AND SPA, OR DRIVEWAY APPROACH.
November 6, 2006 12:45:06
PM AORTEGA'
---------------------- -----------------------------------------------------
Other Fees . . . . .
. . . . ART IN PUBLIC PLACES -RES
20.00
DIF COMMUNITY CENTERS -RES
74.00
DIF CIVIC CENTER - RES
480.00
ENERGY REVIEW FEE
45.44
DIF FIRE PROTECTION -RES
140.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
355.00
DIF PARK MAINT FAC - RES
22.00
DIF PARKS/REC -*RES
892.00
COVE PRECISE PLAN FEE
100.00
STRONG MOTION (SMI) - RES
11.63
DIF STREET MAINT FAC -RES
67.00'
DIF TRANSPORTATION - RES
1666.00
Fee summary Charged Paid Credited
Due
--------.--
Permit Fee Total
---------- ---------- ----------
1032.85 .00 .00
1032.85
Plan Check Total
534.07 250.00 .00
284.07
Other Fee Total
3873.07 .00 .00
3873.07
LQPERMIT
Application Number . . . . . 06-00002732
Grand Total 5439.99 250.00 .00 5189.99
LQPERMIT'
Cl/
P.O. BOX 1504
Buildingn A / 78-495 CALLE TAMPICO
y
Address S�O� /`"ir'J� ' ' a ivarrO LA OUINTA, CALIFORNIA 92253
E".O c10�2.�a S A-duC f�-`G Z
Mailing
Address
2 L) DV206 ST•
City
Zip
Tel.
/NQlO
.
Alter ❑
Repair ❑ Demolition ❑
Contractor
&C /toup
/z/C�9i;,00 9-6-)utt,-P,
Address
Q Fi 4 S 0 1 L,4. %2_
663 131,uD,
City
Zip
Tel.
1). -µ..5 • C'A • 1 9'22yp I L';,2 g3
& Classif. '9'/7c?37 Lic. #
Arch., Engr.,
Designer
silty zip State I
Lic. #
LICENS CONTRACTOR'S DECLARATION
I hereby affirm that I am licens under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Busine and Professions Code, and my license is in full force and
effect. �
SICaNATUR DATE
OW ER -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 that he 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 Profes-
sions 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 employees, provided
that such improvements are not intended or offered for sale. If, however, the building or im-
provement 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).
O I, as owner of the property, am exclusively contracting with licensed contractors to construct
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 CoractorIs License Law)
❑ 1 am exempt under Sec. B. & P.C. for thi reason
Date-1—JB—btri Owner
WORKER'S COMPENSATION D CLARATION
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 / one hundred dollars ($100) valuation
or less).
I certify that in the performance of the work for ich this permit is issued, I shall not
employ any person in any manner s to becoma:sy ct to Workers' Compensation Laws of
California.
Date!—/$Z"06 Owner
NOTICE TO APPLICANT. If, a ng 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 18 days.
I certify that I have read this application and tate that the above information is correct.
I agree to comply with all city and county ordi nces and state laws relating to building
construction, and hereby authorize representativ of this city to enter the above-mentioned
property for inspection purp
Signature of applicant Date-
Mailing
ate Mailing Address 09 C
City, State, Zip tri W. S ' (sa . y 1-2,X0
WHITE = BUILDING DEPARTMENT
APPLICATION ONLY
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number—7 7 3 — -3 ;i 5�- 6>0 7
Legal Description C ^�
Project Description ✓ 1/
Sq.
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.
Issued by:—
Validated by:
Validation:
INSPECTOR
Date Permit
YELLOW = APPLICANT PINK = FINANCE
Ft* Y490
Size
No.
Stories
No. Dw.
Units
New Add ❑
Alter ❑
Repair ❑ Demolition ❑
JZL CA -1;2,
Q Fi 4 S 0 1 L,4. %2_
2-;>;2—C
g
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
Q
REMARKS
F
QUI
PT.
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.
Issued by:—
Validated by:
Validation:
INSPECTOR
Date Permit
YELLOW = APPLICANT PINK = FINANCE
Tract # Study Area
Type Single Family Residence No. of Units 1
Lot # No. Street S.F.
Unit 1 52860 Avenida Navarro 1855 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
Lot # No. Street S.F.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.63 X 1,855 S.F. or $4,878.65 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By OC/Wells Fargo - Alicia Rivera Check No. 0009703085
Name on the check Telephone 559.6107
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempt by ShO Mc I rey Payment Recd
$4,878.65 ;oyer/under
i Y
Signature G
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees o
r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
CERTIFICATE OF COMPLIANCE
J��F�Dsc
Desert Sands Unified School Districtzq
<
47950 Dune Palms Road
Q BERMUDA DUNES r
Date
1/16/07
La Quinta, CA 92253
Cn RANCHO MIRAGE CJ
N INDIAN WELLS r
No.
29173
(760) 771-8515
PDESERT
�� LA QUIOOTA �y
INDIO
�. J
o
Owner
Eduardo Sanchez
APN #
773-335-007
Address
52-860 Avenida Navarro
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
Tract # Study Area
Type Single Family Residence No. of Units 1
Lot # No. Street S.F.
Unit 1 52860 Avenida Navarro 1855 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
Lot # No. Street S.F.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.63 X 1,855 S.F. or $4,878.65 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By OC/Wells Fargo - Alicia Rivera Check No. 0009703085
Name on the check Telephone 559.6107
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempt by ShO Mc I rey Payment Recd
$4,878.65 ;oyer/under
i Y
Signature G
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees o
r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
II CITY OF LA QUINTA SUB -CONTRACTOR. LIST
JOB ADDRESS �a 8,yo d4\1(110 °pct , PERMIT NUMBER OWNER 1"&W -4L) f� Z 13UILDER
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are aut orized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade CI sification '.,
/ as
Co'ntraetor' :::, : ,,::.::::.;
:>:: z:'r'^°? a <. e...:.:..
» ........ St te..Contr .clot s. Ucense...
<.:.:.
sationrinsuF` `:
< ' : W9tkeis.Com en anee: `..' " .
::.. .;
^:. ,<:,
Biisne License' <:'..
Cit . 5s
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK 1C7.12
4 551
ICUh
QQ
3
CONCRETE (C-8)'.
B(32Gl
3-31.01
- 30 O
S'rOfz-COAPWSMA 1145A
VEPAIbI+� of IND. IifllCfl
046'M10'81
Q(o• I.45o3 0 3b
li•31•o7
5.3u•Zoo-4
362
A'3(•a
3 j
FRAMING (C-5) .;. 1• Ae C
SSte—
STRUCT*.. STEEL-( C 51)
MASONRY'IC-29)
`17 7 5-7
w3i-O7
---
�-31-6
PLUMBING (C-361
S yv� �.
5
.01
7- EO 1114 lN501W(E G)W*
C bbs 3410 3
2co
142
6 3® iJ 7
LATH: PLASTER (C-35)�
rUUU.
�
/7
b- 1-aq
0.�
I() 22 1
DRYWALL (C-9),.:..:
037'
rP
( 0 22 IZ
37`4
N&Aktv, N, Y
'ZQ
7
;ZP -01
S•TAiE 0M%,60x:ir.1 IlS. F"D
21C D019i 1 3
O (:01.2co$
�j
ELECTRICAL(C=7.10)' c',.',
Q '
C - I
SII
O'?JI'�yOU(�ICE 2EIdSUiU�NCF W.
cawwrlw 0,?001,
O',I)1-01 SrnTE S�
IJJEf�0004SS0OI
2.95.08 5
(o-0q•7W
Q
t3d
RQQFING'(C=39)".`iiQ✓ i Ocf C�
SHEET ETAL (-43)
—
_�
-�
-----
--'
-�
FLOORING(C"115);':`~<
r•0v
71.3
-31-09
fJ
[,0 -22 10
GLAZING
q7l,3
INSULATIORJC-21 "- 5N
y" I
C "o%.
�� �r/
0�
�camPvA OF Amu CA-
(01301 0�
1$ 1
3 31 og
SEWAGE DISP
PAINTING (C=33)' : 0 .,
1b
9q7,431
I fQ,
102211
62 31 -c
CERAMIC TILE (C-54)"�!
L-� , �.V
'�
- -O,-?
N I F
—
10 ZZII
CABINETS (C-6) •
v..
3 / S
30 0�
T(?A��Eti EhT y
CA VA z �P� w AWMLk
Tc2Jut3►Z2Do258ob
30 0
1 � 1 ol
FENCING (C=13)
LANDSCAPING fC=27.1
C N
(0 Z2� Z
S'31 07
POOL (C-53)
IN
^-J
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING :.
v �L-. '�' �iSfOC%u��S
.Firm: /
Street Address: 7D(o 6 Argel -L4 (f/YL 1e,
Copies to: Builder, HERS Provider
Name
Plan Number
Sample Group Number
CF -4R
Sample House Number
HERS Provider: C IyE R S
City/State/Zip: L u {�t/I✓I %k C/� g.,2ZT,
HERS RATER COMPLIANCE STATEMENT
The house was:Tested ❑ Approved as part of sample testing, but was not tested
As'the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form
com ith the diagnostic tested compliance requirements as checked on this form.
10 Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu
Wducts)
here cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are. used in combination
tth cloth backed, rubber adhesive duct tape to seal leaks at ductconnections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/ton x number of tons enter Z
�calculated value here '
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow)
Check Box for Pass or Fail (Pass=6% or less)
❑
Pass, Fail
T/HERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
CJ Yes ❑ No . Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection
❑
Yes is a pass
❑
ass Fail
MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. ❑ Yes [3 No ACCA Manual. D Design requirements have been met
(rater has verified that actual installation matches values in
CF -1 R and design on plan.
2. ❑ Yes ❑ No TXV is 'installed or Fan flow has been verified. If no TXV,
' verified fan flow matches design from CF -1R.
-Measured Fan Flow =
Yes for both 1 and 2 is a Pass
❑ ❑
Pass Fail