07-1597 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-00001597
Property Address: 52700 AVENIDA RAMIREZ
APN: 773-292-009-14 -000000-
Application description: MECHANICAL
Prnparty 7nninf0• . f'.OVR RESIDENTIAL
Application valuation: 4000
T4hf 4 e(A Qum&
Applicant: Architect or Engineer:
pip-.
CIO
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that:) 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: C20 NLicense No.: 596456
�t- f✓—Q ontractor:
�n� asl_,
OWNER -BUILDER DECLARATION
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 ($5001.:
1 _ 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 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 1 I am exempt under Sec. BAP.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: AM`
Lender's Address:
LQPER,1IT
Owner:
HILDEBRAND HENRY R
P O BOX 1115
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/30/07
Contractor: ?
J & J INCORPORATED. MAY U ZOO77
P.O. BOX 966
PALM DESERT, CA 92 60 I
(760) 346-4477 COTyA��OUINTA
Lic. No.: 596456 FO�i Ce c%.
------------------
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 VIRGINIA Policy Number WVS0001918801
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 subje t to the workers' compensation provisions of Section
�r 3700 of the Labor Co , I shall forthw' comply with those provisions.
�V "Q . PPlicant:or
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 isnot 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 county to enter upon the above-mentioned property or inspection 7puoses,
te:� 36lWature (Applicant or Agent):
Application Number. 07-00001597
Permit . . . MECHANICAL
'
Additional desc .
.Permit Fee . . . . 33.00
Plan Check Fee
-8.25
Issue Date
Valuation . .
. .
.0
Expiration Date.. 11/26/07
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 9.0000 EA MEC14
D/C <=3HP/iOUK SSU
9.00
----------------------------------------------------------------------------
Special• Notes and Comments-
ommentsREPLACE
REPLACEHEAT PUMP, SPLIT,SYSTEM
C
Fee summary Charged
Paid Credited
Due
Permit Fee Total 33'.00
.00 .00
33.00
Plan Check Total 8,25
00 .00
8.25
Grand Total 41.25
.00 .00
41.25
LQPERDIIT
Bin #
City Of La Quinta
Building 8E Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
.Building Permit Appl.ication and Tracking Sheet
Permit #
Project Address:'– �&A
Owner's Name: �XJ 1`
A. P. Number:
Address: 1 i Cr,
Legal Description:
Contractor:
_ f
City, ST, Zip:Oa
Telephone: �—
Address: l
Project Description:
City, ST, Zip: ��N� V — ez 0 -
Telephone:
State Lie. # : City Lic. #:
Arch., Engr., Designer:
Address:
City, ST; Zip:
Telephone:
State Lic. #:
Name of Contact Person:.
Construction Type: S Occupancy:
Project type (circle one): New Ade' Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
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
Pian Cheek Deposit
Truss Calcs.
Called Contact Person
Plan Cheek Balance
Energy Cales.
Plans picked up
Construcion
Flood plain plan
Plans. resubmitted
Mechanical
Grading, plan
2°' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
N HOUSE:=
Review, ready for corrections/issue
Developw Impact Fee
Planning Approval
Called Contact Person
A,I p,p,
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
A
Ak?
v
V4
I , f .
RE
fist.:;�CERTIFICATTE QFTOM1KIANC-E-.,,
4
�w
%
i�, "PrPj&tTitle i
V AN I
"A j
L
P*ect-Address
A Building Permitil IN
":s t
A�(
Yu
Plan Checki Date, 4.
it
i2h? It Field Checkl; Date:
ADoZ_uHifitdfion�Authk -,N
NIS LIZI
Enforcement Agency Use Only -e,
Compliance Method (PrescriptivpYS4,4.5
(check one) ji, tD (Alternative)
ComponentVackep-Meth6di
I*.-- A
1. !, ., , lj-,.�AA_ % �V4 Y
A 1 4-1'
require AERS' r ;--AffiQi4owandfcr� CF -1R page 3)
Package C and P�ckdie aafdlces i rate field llignostic testing
6ee CF'
rnauvesee4e�ppendix B Table 1 1'
For Package D Al Footnotes
te
4
indiddhid"Flo'or
. unj -A I 1116--wedNesi
in, A I I o,76d4,,T'6 ti
.;�Jttt , 1,,4-,� *-xk—i
i I d in'S''TyIp evi!
1. No 11.
RMATION -7 I , "Ifl,�Nt—f
Area fe ':'Average
Ceiling 'Oeliht:
Ntft -
1 _Ci i;f ;-L'
Facing Fonpstratjon Products Per, Table 15 1 -B 151• (S%;.,X. CFA)
F'ene'strationProd'ucts PetTAW 1`5 I-B*or 151 C66-- �164X
CPA)
cVoii� or �Single * mild
S) �,ddifioV"Altirati6i;h_l
06k'fill'4t,WS.'4R, fenestration Maximum *Alloi(id'A
,A"tibns.)
7
Nume 2,
lling Units:
ised Floo
hl/ 0iientition's 6
u WP tfto* 669iiton in degrees ftmliii6,
RRTvJ6,i"'.;.,,�'d in climate zones 2. 4, 8-15V
•114, , A, t %4,i.
WAV Ur, bUfUAUjWLNUZtJB11Nti OPAQUE OORSq 0, - %'t.-� I ,,, _ � 5. �. .
4.�. �rdI,
Component
Assemblyu
v",
-T)ie"(Wall; Frame
factor (for
;,'Jgiht
�,Rdof Radian OJ
R66f;F�6or,' -"*T ype
',6avi�IL
tontinuc;us d, metal
woo
pon4K.,
�O
'I,
1,6catfdn/comments'
<SlibEd "(Wbo4'-'
11
. Iniuliitidn
I Insulation frame and mass,
JV
Installed ,
* (atti4, garage,
-Doo or Metal),
R -Value Ir
%�'R-Value assemblies)' t,
Reference;
". ''. -
oriWp%
.1
typical; etc.)
A. . I."
Q�4 "i,�
All
` ir-
q
1)j SeeJ6int AI w.ppendix IV in Section JV.2,AV.3 and IVA, which is the basis, for the U4Wqr,'CTiteriqn.- 'U7ftictors cannot
5. sh`6�'e` uivalence to R -values, 0
exceed iprescri0667value tx q "AL19 i�,
- IN
'4 L
'r 41 A -k V,
4
4
$,o
qj; I .
tik
I' " r,
,
t,;; KV -v !Z "v1 ;.v 'w
V
jo,
N
'0,
065
_v
0 -Al
&I mFtlahcq 0 s
p, a
kf
T;
V
14
j
All
, Minimum
Duct Location .
"FENESTRATION, PRODUCTS�'U VACTOR'ANDSHGC
S Yt
>z`✓ •FENESTRATIONMAk"M ALLOWED AREA WORKSHEET'WS=4R-itius
SEER or EER)', attic etc.
-
',,
•
F
f
1 'It• �
,t i•
f
x 2
Rear;,Right, •
tation,: '_
,r
`Ai+ea' " • ` U factor l'`�ul"�'i�SHGC
Ix �r: - �
• ' .t. y ! 'ti>,t ar -' ,, -
4 - '. �, �l
r�L;�n+<btx�
CERT1tFICATE OFOMPLIANCE::•RESIDENT'
.;
utcluded'orNew Construction, '
IESources included
t+
COJectttle
!
r
❑-
t � ,Y'•,.
f
, Minimum
Duct Location .
"FENESTRATION, PRODUCTS�'U VACTOR'ANDSHGC
Configuration
>z`✓ •FENESTRATIONMAk"M ALLOWED AREA WORKSHEET'WS=4R-itius
SEER or EER)', attic etc.
ti
LfAddtttoris and'Alterations
Exterior.-'
(Front; Left,
Orien-
Fenestration
, Minimum
Duct Location .
'Duct Temostat :;;Efficiency'
Configuration
#/Type/Pos.
SEER or EER)', attic etc.
K -Value :: ..,
Exterior.-'
(Front; Left,
Orien-
ge.2'of4)_
':,: CF
Rear;,Right, •
tation,: '_
,r
`Ai+ea' " • ` U factor l'`�ul"�'i�SHGC
IV
Sk`li ht
N; S, -E, W''
t. x ;. U=facforz ='
.;
utcluded'orNew Construction, '
IESources included
!
Fenestration
, Minimum
Duct Location .
'Duct Temostat :;;Efficiency'
Configuration
#/Type/Pos.
SEER or EER)', attic etc.
K -Value :: ..,
Exterior.-'
(Front; Left,
Orien-
1, s ' ;;r; Y" ;�`
Ij Shading/Overhangsb.
Rear;,Right, •
tation,: '_
,r
`Ai+ea' " • ` U factor l'`�ul"�'i�SHGC
�'.
✓box if WS -3R is `•
Sk`li ht
N; S, -E, W''
t. x ;. U=facforz ='
.;
.. .Source3 rc`'*SHtCi4kt,;:A
IESources included
!
r
❑-
t � ,Y'•,.
f
❑
t
if
1`
-13
ti
4 4
S t,�
-13
fSl�
•
re's• , ... ., ,� rxc �-•
r('!M!ray t. C,4 .i •❑r`
1) Skylights are:now included in:West=facing.fenestration area if the skylights are tilted to thg west'or t It to any direction
w f when"the pitch is less than' 1:12: tSee §151(f)3C and in Section 3.2.3 of the Restdent>€ikIVlanual Ar:
4,. r
2), Enter values in -this column are either NFRC Rated value or from Standards default Table 116A
3) Indicatelsotirce`eithei• from NFRC• oe,Table 116A,
4)_ Entervalues.;in this column from NFRC or from Standards Default Table 116B'or adjusted SHGC from WS -3R.
,5)Ind ca a so urc"'e''either from NFRC. ` Table 1168.
6):• Shading -Devices are defined in Table 1-3 in the Residential Manual and see WS -3R to'calculate Exterior Shading devices.
r: .+
7)'See;Section 3.2:4 in the Residential Manual
r
';r`HVAC==SYSTEMS
.�r
Heating:Equipment Minimum Distribution
Type;arid Capacity Efficiency Type and Location Duct or Piping ` s .'Thermostat ' Configuration
furnace heat pbrrip,boiler, etc: AFUE or HSPF(ducts,attic etc. R -Value Type :, . split or package)
13 A-
/10,:1.
1 i _
u
f
' r Y
Cooling' -,Equipment : •
and C aci ' TYPe, aP i' ':
i{- }
JE
, Minimum
Duct Location .
'Duct Temostat :;;Efficiency'
Configuration
C; h ! um ' eva .',coolin
SEER or EER)', attic etc.
K -Value :: ..,
a
lit or ka e -
Js r f.. :, t
,y, 1Y t t
t � ,Y'•,.
4.:Y'r4 r'
1 ?• t� t'FF� t� L rT P ' t
-
° _.>.,r �t}� t, } •'�i3 lis 1,•,{�� �, ,
�)1f
[Ir i! aii j^ t X�•-,,q,� ',.
�t
dim
q, . •1 t ,l,t tux. ! •�. "rt7tL .-y; �"tA,�,f• � ly �. 61.,t
f� L .t ,' ` s.,. , • Y+4` ,, r^� {,rL ty�1 �#� t,t�+ � ��,-'^Far tpi } �,t F�`r TN c
:r'^,Ftt
`2005 �# t
} it
C
1 i [ • , 4 r 9 'l a ` f l t I� TY i `.}T°i{1' t
i..Yrjil I V f e 1
l t - ,,v J7 ; f , •,. }•4y�,yl�> < t vR. +v " S o yu•+. }. ti
}, �ftrr fr '
t
,
Js r f.. :, t
,y, 1Y t t
t � ,Y'•,.
.jc
kW
t
if
1`
ti
4 4
S t,�
�)1f
[Ir i! aii j^ t X�•-,,q,� ',.
�t
dim
q, . •1 t ,l,t tux. ! •�. "rt7tL .-y; �"tA,�,f• � ly �. 61.,t
f� L .t ,' ` s.,. , • Y+4` ,, r^� {,rL ty�1 �#� t,t�+ � ��,-'^Far tpi } �,t F�`r TN c
:r'^,Ftt
`2005 �# t
} it
C
1 i [ • , 4 r 9 'l a ` f l t I� TY i `.}T°i{1' t
i..Yrjil I V f e 1
l t - ,,v J7 ; f , •,. }•4y�,yl�> < t vR. +v " S o yu•+. }. ti
}, �ftrr fr '
1•�v 1
•• , w f., ,.t
❑_
.,:Sealed Ducts all climate'"es : -stiller testin • and certification.and`HERS1&terafield verification re uired. ' -.
❑
TXVs, readily accessible (c�i•�ate��onesl' and_8='15 only) ` '. f , ,`.�� tW
'testing
t
r stallef and ce tifieation and•HERS Rater field :verification” ' uired
yf
+ �. '', . l $.. •.t 1j'I .}T C T.'fi 'LI f '�
7' \
-,,1:T '•%„C2
- ` !J 1•\�frd%�' r
` -.'ff4' '� Y�.i <r', :^' +
-•,F ,tt :'i+\rf4 ;' +>•:
CERTIFICATE{OFiaCOMP= °`IANCE:
RESIDE TILA
' ? j
.
• yr ��{ 1 f f i %' � � •+.;+ �.: � 1r � �°Y'��•('f
� \. V ♦ t 1 .M
Number.
+submittal:
project Title
following. are
Standby ;
"SEALED MUCTS4ndMX'ViUkAtternative Measures, a J
It �
A�stgned CF -4R Formut,be"provided to the building department for each`h<
i
��' renuYrP.ri" , . _ s c +:,'�;9(`� <Lk�`� ?'c:�:. "i � • ' _
.. t.,,`. S .�� a:�
1•�v 1
•• , w f., ,.t
❑_
.,:Sealed Ducts all climate'"es : -stiller testin • and certification.and`HERS1&terafield verification re uired. ' -.
❑
TXVs, readily accessible (c�i•�ate��onesl' and_8='15 only) ` '. f , ,`.�� tW
'testing
t: _ I• •
r stallef and ce tifieation and•HERS Rater field :verification” ' uired
❑r
t}tefngeranf'Charge (climate zones Zdand 84S onlj+) (Installer telling=and """i.90":ah (rand HERS Rater field ,
4 r1 t Tj
'CF''1R
7
hallmeet•the requ"itcnients of Section •1S0(m) and duct insulation re"yuiF{'emutit§"of Packaee D"i"
' ? j
gCheck box if systeiridoes-not meet, criteria of "Standard" system, and does not cotnply with the Preapproved
s ❑ '{
YAlteriitid-vd Water Heating table;-, In this case, the Performance Method must lie used and must be included in the
Number.
+submittal:
Aich'the
following. are
Standby ;
,
•.•.✓
T:��. �. �.:.i.��`'„•r"c2�9'.d.l!`: :2 -r .4i n),r`;+e{S1��i.i.C{xtt�'.'S,:�.:•.• tt. -
❑_
.,:Sealed Ducts all climate'"es : -stiller testin • and certification.and`HERS1&terafield verification re uired. ' -.
❑
TXVs, readily accessible (c�i•�ate��onesl' and_8='15 only) ` '. f , ,`.�� tW
'testing
t: _ I• •
r stallef and ce tifieation and•HERS Rater field :verification” ' uired
❑r
t}tefngeranf'Charge (climate zones Zdand 84S onlj+) (Installer telling=and """i.90":ah (rand HERS Rater field ,
4 r1 t Tj
wenfiicatiori re uired �t',�t . t
..
•s f ,',^.' �. j,-7;tT`..:,?.�,,r}'r.•: ti.. _,4`f+ \ ,..Y�f. Y�'4:'++.15�.'+?�+,�': bt j_`;i�i'Ar�.2s' efax:
r. •• -.y.
ive to Sealed Ducts"and lkefngerant Charge /TXVs (See Pac e`Dx�Uternahve Package Features for
Nimate`2one mlhe RM Appendix B Table 151''-C, Footnotes.744PIIAZl
Entry ,y
Factor
..y,•'j': :i' .r' :tf" - .Lss+:'f'' . f ' '•r:. ^+�1,.t'. Y.- +1•'f•L' 1
t: _ I• •
itlons'and,alterations, duct systems that are not documented to hayo,been prc}Tviouslyt,' �4
,.
s confirmed through,field verification and diagnostic testing to accotdi itce�v�Ith pmcedures m the
4 r1 t Tj
tial ACK. and duct systems with mote than 40 linear'feet
7
hallmeet•the requ"itcnients of Section •1S0(m) and duct insulation re"yuiF{'emutit§"of Packaee D"i"
' ? j
sWAlLF
K tiL� qt?,i`r
Rated
Rated
Entry ,y
Factor
,Check boz if system meets criteiia of a "Standard" system., Standard system is one gas-fired wafer heater per,:;, -
t❑
dwelling unit If he water heater` is a storage type, 50 gallons is the maximum capacity' and rezirculafion system is
,.
not:allowed. r_, .,.;, ,,I • t'.ti <.` ,.
-:ori I.,1 ;" <
Check'box;when using Preaporoved Alfernative Water Heating table, Table S 4:in Chapter 5 iro the Residential :.
7
Man`uaLNo- water.heatin calculations are required, and the system! com"'lies atitoinittic Illy.� r, ;;•:• , : �''
``'
gCheck box if systeiridoes-not meet, criteria of "Standard" system, and does not cotnply with the Preapproved
s ❑ '{
YAlteriitid-vd Water Heating table;-, In this case, the Performance Method must lie used and must be included in the
Number.
+submittal:
�tapacity
�Ghe_ boz to verify !hat, time control is required for a recirculating system pump for a system serving multiple
Standby ;
,
xs T bysterns.serving sinto owe iing units-.
at
'
Rated
Rated
Entry ,y
Factor
Tank ;:-.
:External"
• T' ' ;
Tank,
r
r.•Tank,'
-:ori I.,1 ;" <
Input'
',Tank'
-FactororPt
``'
External:.
:Water Heater ":
Distribution
Number.
: (kW or
�tapacity
-.Thermal °:
Standby ;
Insulation;
' T uel e"
: T` a -- '+
in System
Btu/hr
long
Efficienc
'Los's %
: R,Value
It
Iz
•:w,arem':cervInv mnrnnIe nweinno nmra
t•
�
Rated
: y
'
Entry ,y
Factor
Tank ;:-.
:External"
• T' ' ;
Input
r.•Tank,'
-:ori I.,1 ;" <
xfi Water Heater Distribution
Number
W or
Ca aci
pto ty
` `,Ttiemi`al Standb i '
Insulation
° T ' e,, .• T e '
in S stem
9tu/hr
°
'EMc: ienc MA Loss %#t
R -Value '
.{•
� yh tr,. f.
° 1 t +.For smal1:gas storage-
.• water heaters.(rated inputs of less than or equal t6.75,0( 0'Bt'ti/hr'),elect
>�SPumpwater heaters, Iist�Energy;Factor. For large gas storage water heaters (fated input oftgir
list Rated Input, Recovery Efficiency, Thermal Efficiency and Staid Loss Ror insi
It; ,rot �� �`• heaters; list Rated°.Input and Thermal,Efficiencies.
�`xPli �nsWati n (kitchen lutes + /4.'inches 'All'hot water ' pipes from the heahn 1 urce o e x'
ftA"�S fin' ��fy ?.°{ 1 1 i7 +• .Y '4[p.a� Y• t�� j��}�
fed ar ell w , »• et �M14 c!i .'wRy � : Js a • d � N � Y
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iat1on,,----'
See Section 5.6.2 Distribution-..
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:Systems in Residential Manual'2
See Table 5-13 or use
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Pe Calculation and
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attach Run to Forms.
Central W Ater Heating System.'
Performance Calculation and,
,.46
1SdfvinA'Mu iple"Dwe'llings,
-attach Run to Forms.
[34)
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;Heater
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Performance Calculation and
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See Table 5-13 or use
Jnstantan6ous.Gas.Witei Heater
Performance Calculation and
attach Run to Forms
See Table 5-13 or use
13"!',V.-S6iar
Water Heating System.
Performance Calculation -and
attach Run to Forms
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Performance Calculation and
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attach Run to Forms
am&TION
it part of this pr!Djec"t and need
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*4
CERTIFICATE OF FIELD VERIFICATION-& DIAGNOSTIC TESTING (Page 1 of 2) CF4R
Project Address [ Hildebrand, Henry ]
1
Builder / Installer
52700 Avineda Ramirez /'La Quinta / CA / 92253
rt
Room Temp
Builder / Installer Contact
Telephone
Plan Number / Permit Number
Noel Woodward
7603472748
HERS Rater
Telephone
Sample Group Number
Brian Muffoletto - CjH[EtEjRjS® ID #CCN90633542
7604138333
1
Compliance Method M -scrip ' )
System Alteration and/or Equipment Change -Out. :�r
Climate Zone 15
Certifying Signature
Date
Sample House Number
Firm
TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out
HERS Provider
Brian Muffoletto
Pass if Leakage Percentage < 15% [ 100 x [ Line #5 / Line #2 ] ]
CJHJEJERS®
Address
10
City/state/Zip
73425 San Nicholas Ave
0 Pass 0 Fail
Palm Desert /CA /92260
Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT
TIFRC RATF.R rnMP1.1ANrE STATEMENT
This house was: / Tested
As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies with the diagnostic
tested compliance requirements as checked on this form. The HERS rater must check and verify that the new distribution system is filly ducted and
correct tape is used before a CF -4R may be released on every tested building. The HERS rater must not release the CF4E until a properly completed
and signed CF -6R has been received for the sample and tested buildings.
/ The installer has provided a copy of CF -6R (Installation Certificate).
0 New Ducts are fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts).
0 New ducts with cloth backed, rubber adhesive duct tape is installed, mastic and draw bands are used in combination with cloth backed, rubber
adhesive duct tape to seal leaks at duct connections -
v/ M 41MUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Procedures for field verification and diagnostic testing of air distribution systems are available in RA CA( Appendbr RC43.
Duct Diagnostic Leakage Testing Results
Cvatem it I
NEW CONSTRUCTION:
Duct Pressurization Test Results (CFM cQr 25 Pa) Measuree. Values 13 ,
1
Enter Tested Leakage Flow in CFM
rt
2
Fan Flow: Calculated (Nominal: / Cooling O Heating 0 Measured)
Enter Total Fan Flow in CFM:
3
Pass if Leakage Percentage < 61/6 [ 100 x [ Line #1 / Line #2 ] ]
0 Pass 0 Fail
ALTERATIONS: Duct System and/or HVAC Equipment Change -Out
4 Enter Tested Leakage Flow in CFM from CF -6R- Pre -Test of Existing Duct System Prior to Duct`+' " � . , x 0
e
System Alteration and/or Equipment Change -Out. :�r
5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct 5S
System Alteration and/or Equipment Change -Out£
6 Enter Reduction in a for Altered Duct Line #4 Minus Line #5 (Only if Applicable).
Leakage �m [ ] ( Y APP )
7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable).
8 Enter New Duct System -Pass if Leakage Percentage < 6% [ 100 x [ Line #5 /Line #2 ] ] 0 Pass 0 Fail
TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out
Use one of the following four Test or Verification Standards for Compliance
9
Pass if Leakage Percentage < 15% [ 100 x [ Line #5 / Line #2 ] ]
1.0
/ Pass 0 Fail
10
Pass if Leakage to Outside Percentage < 100% [ 100 x [ Line #7 / Line #2 ] ]
0 Pass 0 Fail
11
Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line #6 / Line #4 ] ] and Verification by Smoke
0 Pass 0 Fail
Test and Visual Inspection
12
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection
0 Pass 0 Fail
Pass if One of Lines #9 through #12 Pass
(Pass 0 Fail
Residential Compliance Forms Generated by CjHjEjEjRjS® http://www.CHEERS-org December 2005
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 2 of 2) CF4R
a
�`
Project Address[ H1ldebrand, Henry, j' `. ; ` t^
52700 Avineda Ramirez / La Qumta,/ CA / 92253
Builder / Installer
!Room Temp
f
I-
THERMOSTATIC EXPANSION VALVE (TXV) * -`:'t'• `
Procedures for field verification. of thermostatic expansion valves are available in RACM, Appendix RI.
System # I
a . is . ''rS's 0:'i� l''��'•� _
W � ,s•, � t � ; w
D Yes ❑ No"'
talledon the system and
Access ts'provided for;inspection. The procedure shall consist r�finsual verification that the TXV is ins14
installahouof th`e specific equipment shall be verified.
:a`s.^ ,.r,t • .., t}:r�r a#��;,:, Yes ts�sP� '✓ Pass ❑Fail
Residential Compliance Forms Generated by CIHIEIEIRIS® http://www.CHEERS.org December 2005
t