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0212-163 (SFD)CJ W O Q � ' W oZl� OO I— ca LLJa N Z co LO N ON U_ M Z Lo H 0 0 J J mUU O M Nt Z co Z) () J LICENSED CONTRACTOR DECLARATION I hareby 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 # Lic. Class Exp. Date s+ ✓i X31 t 101:::f 'y� ��� o8l.� Date ji ''' +Signature of Contractor`' -�' 4� 41 `,� !.. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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 & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section , B&P.C. for this reason Date Signature of Owner 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 & policy no. are: Carrier R P.c Policy No. (This section need not be completed if the permit valuation is for $100.00 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, and agreethiat if I should become subject to the workers' compensation provisions of Section 3700 of the Labor ,Code, I Sh II forthwith comply with thosVve provisions. �Date: /' ��% ; Applicant Y,t Warning: Failure to secure Workers' Compensation coverage is unlawful and ",-shall subject an employer to criminal penalties and civil fines up to $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. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his 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 applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 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 State laws relating to the building construction, and hereby authorize representative.s> of this City to enter upon the above-mentioned property for irispection purposes. Signature (Owner/Agent) t�4d-.�t ••i�''tDatel BUILDING PERMIT PERMIT# DATE '__2 i VALUATION /� C(A9,�•� LOT y� TRACT -- JOSSITE-_�r `_�••� ._.kisp ADDRESS 1tZ M&L' 1.4.�K�a�i APN OWNER CONTRACTOR/DESIGNER/EN INEER TOT_143 R MV WARM- L'141.. CON11?. LTC(Ir � K ; ; , I -0710011A1f'�.EF l s., i o r. dflD7Z USE OF PERMIT �I'l�lt�1� . t?l�a�edl(..�.1��•�i�:1.+1.�%�'�1.� vo - ;".ALIT 15:°. "tTRIAI i DOES' T40T RICLt;fD E; AV0*K 'BALI , PrX)I., VA.' OR, D111Nls�� AY fAPFR,O#i,I:)• HTE PLAY PIR,. kPl•"r'OY t?,1.21k`fii"°;C119 tiI'K .DWO i.�¢,N. @i 4.41 •;i. 4,394,00 'rSF' ar3+A! #%C3`rYCAR.P(.,,RT "I SAID ST fiV f.:1s'.SI OF 0011iSTRI•:IMON :�•''�Yti3'�:i,.PSi:R �UT.i<:[f4M. 00,Y-S'3`:?OX-ToM, li'Fy IQI-000-•41''i->+:':'t, S1,63 -,"O[} PLA]" C"J..ZCKFEE 103 R V,3$4.13 FEE LI FPOS11 101- )00.439.318 31,00v,W 1+,!t.U*H'A 111CA1, '1?K1 101-000,.421 -000 r:64, d: F v t1MilNr':ZO trT�'� t oI-.0ew-4 1;Lit;' $:%4el,50 ' MONO MOTION T•Rt •-1ILMID E 01-000-241-4`110 "MR49 i?.F�ALETf�i � Y�►r..?� b. el"!-t)c3t1-:12:;•�!� " iJ !Li ".i, ifs DETE1f*18PY i.MrgP1jYV'`}' FEE ,AR iN _Q�t,� IAC YL.&C''M - P%SIE � I V.. PE)!)-•e•VW.�i4-4 �.�© �6V d,. il� ixly. ;::Y�'.`K-p.AIL 1�1 TR � I, it•,d,o a +;•.1�'1' i 's k�J 1•T611 a `+ �hs9't{ JUN 16'2003 CITY OF LA QUINTA. °.. 'w / 'FINANCE'DM. r, RECEIPT DATA /�, j BY / DA77 7 INSPCTO ' INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 03 Ali, Ducts Slab Grade Return Air Steel A,, Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath ! - 7 ✓ Final Final o' POOLS - SPAS BLOCKWAL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 0z Encapsulation Gas Piping Gas Test / l� Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL PPOVALS IR Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) ilding 1761" ae&� ,�6�4,56 a 0ZJ2,-16 3 TAtyl 0 cA4,,-� cl�e /L— BOX 1504 APPLICATION ONLY �-� 't-- 78-495 C'ALLE TAMPICO Address YJ 1� U �u clv-glk-�fl Ci�� 14�\_ JZip 0(��,G�Tel. Contractor Address Zip I Tel. State Lic. city & Classif. I Lic . # Arch., Engr., Designer �4� UJ 4. QUINTA, CALIFORNIA 92253 BUILDING: TYPE'CONSTI�0-6m.GRP.R Addrd-ssf, Tel. ip State 1112—lzo Lic. # CT4n LICENSED CONTRACTOR'S DECLARATION I hereb affirm that I a licensed under provisions of Chapter 9 (commencing with Section 70DO) of bivision 3 of themBusiness and Professions Code, and my license is in full force and effect. 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 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 ciioil penalty of not more than five hundred dollars ($500). (-11 1 as owner I the property, or my employees with wages as their sole compensation, will do ihe work, aond 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 employees, provided that such improvements are not intended or offered for sale. it, however, the building or imp�ovemenl is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for (he purpose of sale.) I I 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 La. 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.) 1-1 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 Worke r's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No.—Company n Copy is filed with the city. 0 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 thp 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: It, 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. 309 7. 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 it 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 con s lruction, and hereby authorize representatives -of this city to enter the above. mentioned property for inspection purposes. Signature of a0plicant —Date— Mailing Address City, State, Zip A.P. Number -57 Legal Description f Description Sq. Ft. No. No. Dw. Size + Stories Units Add 0 Alter 0 Repair 0 Demolition 0 .timated Valuati, PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway"ric. I nf rastruc W TOTAL REMARK9— AMOUNT 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 Issued by: Date_ Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION ��A Coachella Valley Unified School.District P.O. Boz 847, Thermal, CA 92274 (760) 398-5909 — Fax (760) 398-1224 This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT LEVEL ONE AMOUNT: LEVEL TWO AMOUNT: MITIGATIONAMOUNT: COMM4ND. AMOUNT: DATE: RECEIPT: CHECK #: IMTIA.LS: CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: Date June 16, 2003 Owner's Name: Weiskopf Partners, LLC / Kahuilla Constr. Phone No. (760) 771-3497 Project Address: 81-100 Chanticleer, La Quinta, CA 92253 Project Description: I Dwelling Unit APN: 761-86-011 Type of Development: Tract #: 29147-1 Residential XX Commercial Total Square Feet of Building Area: 4,594 Sq.Ft. Lot #'s: 57 Industrial 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 oA behalf of the owner/developer. Dated: June 16, 2003 Signature: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * -t*/* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 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. 4,594 Amount per Sq.Ft. $ 2.19 Amount Collected $ 10,060.86 Building Permit Application Completed: Yes/No By: Carey M. Carlson, Asst. Supt., Business Services Certificate issued by: Elsa F. Esqueda, Facilities Analyst Signat 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:cJmydocstdevfees/certificate of compliance form tables.doc 1/16/03 T Nov 14 03 02:4Gp RAYMOND FRANGIE 760 83G 0856 p.1 RAYMOND FRANGIE STRUCTURAL CONSULTANTS, INC. a. 44-100 MONTEREY Ave. SUITE 201-C, PALM DESERT, CA. 92260 PHONE (760) 836-1000 FAX (760) 836-0856 E-MAIL R.FRANGIE@VERIZON.NET NOVEMBER 14, 2003 SOUTHERN HILLS DEVELOPMNT, INC. 8I-070 CHANTICLEER DRIVE LA QUINTA, CA. 92253 Attn.: PETER JACOBS Re.: THE SUMMIT AT PGA WEST, LOT 57 81-100 CHANTICLEER LA QUINTA, CA. FOLLOW-UP TO WALK THROUGH JOB NO.: 4034 DEAR PETER THIS LETTER ADVISES THAT WE HAVE OBSERVED THE STRUCTURAL REQUIREMENTS THAT ARE VISIBLE DURING CONSTRUCTION AT THE TIME OF OUR SITE VISIT. WE BELIEVE THAT THE AS -BUILT CONSTRUCTION AT THE TIME OF OUR VISIT IS IN GENERAL CONFORMANCE WITH OUR STRUCTURAL PLANS ANDAELEVANT CORRESPONDENCE ISSUED BY OUR OFFICE. WE OBSERVED THE BUILDING IN ITS FRAMED CONDITION PRIOR TO INSTALLATION OF DRYWALL AND STUCCO. WE OBSERVED THE VISUAL AND ACCESSIBLE STRUCTURAL REQUIREMENTS. ( EXCLUSIONS ARE ITEMS SUCH AS: FOOTING SIZE AND REINFORCEMENT, TOP PLATE SPLICES, ROOF SHEATHING, AND ANY STRAPS ABOVE THE ROOF SHEATHING.). C P t .d.CNi0IA.9 AnOU-Ftify""-. • "� � � ItO. ri('58E ------------------ NICHOLAS ABOU FADEL NOV-14-2003 FRI 02:09PM ID: PAGE:1 Just 10 04 12:08p GRIL DRVIS l 760-250-2044 p,2 Dwwn NERGYle2_�A EC S°1111'Ums PO. Box 621 Rancho Mirage, CA 92270 Email: DESNRG QAOL.COM Ph/Fax(760)564-2044 Cell: (7601250-1852 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R CUSTOM HOME Project Title 81-100 CHANTICLEER, LA QUINTA, CA. 92253 Project Address 76Q-4$5-5650 JIM AVENAL Builder Contact Telephone RICHARD KROWN 760450-1852 Certifying Signature Date Firm: DESERT ENERGY SERVICES LLC Street Address: P.O. BOX 621 Copies to: Builder, HERS Provider 06- OAA Date WEISKOPF PARTNERS I, LLC Builder Name CUSTOM Plan Number GROUP 1 Sample Group Number 81-100 1 OF 4 Sample Lot Number HERS Provider: CHEERS City/StatelZip: RANCHO MIRAGE, CA. 92270 HERS RATER COMPLIANCE STATEMENT 1 The house was: ® Tested ❑ Approved as part of sample testing but was not tested As the HERS rater providing diagnostic testing and field verification, 1 certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. ® The installer has provided a copy of CF -6R (Installation Certificate. ® Distribution system is fully ducted(i.e_, does not use building cavities as plenums or platform returns in lieu of ducts) ® Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. ® 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 95 If fan flow is calculated as 400drnflon x number of tons enter calculated value here 2000 If fan flow is measured enter measured value here Leakage Percentage (100.x Test Leakage/Fan Flow) = 4.75 Check Box for Pass or Fail (Pass=60/o or less) ® ❑ Pass Fail ® THERMOSTATIC EXPANSION VALVE (TXV) 0 Yes 0 No Thermostatic Expansion Valve is installed and Access is ® 11provided for inspection JUM 10 04 12:08p GRIL DRVIS 760-250-2044 Dawt ENERGY � C A 0 E C S 130. Box 621 Ph/Fox (760) 564-2044 Rancho Mirage, CA 92270 Cell: (7601 250-1852 Email: DESNRG IMOL.COM CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) C1F-4R CUSTOM HOME Project Title 81-100 CHANTICLEER, LA QUINTA, CA. 92253 Project Address JIM AVENAL 760-485-5650 Builder Contact Telephone RICHARD KROWN 760-250-1852 HEfjt P;y Telephone Certifying Signature Firm: DESERT ENERGY SERVICES LLC Street Address: P.O. BOX 621 Copies to: Builder, HERS Provider OAJ OCL Date WEISKOPF PARTNERS 1, LLC Builder Name CUSTOM Plan Number GROUP 1 Sample Group Number 81400 20174 Sample Lot Number HERS Provider: CHEERS City/Stateop: RANCHO MIRAGE, CA. 92270 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 comply with the diagnostic tested compliance requirements as checked on this form. ® The installer has provided a copy of CF -6R (Installation Certificate. ® Distribution system is fully ducted(Le., does not use building cavities as plenums or platform returns in lieu of ducts) ® Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. ® 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 119 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here 2000 If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = 5.95 Check Box for Pass or Fail (Pass=6% or less) ® ❑ Pass Fail ® THERMOSTATIC EXPANSION VALVE (TXV) ® Yes ❑ No Thennostatic Expansion Valve is installed and Access is provided for inspection J.un 10 04 12:08p GRIL DRVIS Dmwt ENERGYe. A 0 E C S PO. Box 621 Rancho Mirage, CA 92270 Email: DESNRG @AOL.COM 760-250-2044 p,5 Ph/Fax (760) 5642044 Cell: (7601250-1652 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R CUSTOM HOME Project Title 81-100 CHANTICLEER, LA QUINTA, CA. 92253 Project Address JIM AVENAL 760-485-5650 Builder Contact Telephone RICHARD KROWN 760-2S0-1852 HEg6 Rater, Telephone Date Firm: DESERT ENERGY SERVICES LLC Street Address: P.O. BOX 621 Copies to: Builder, HERS Provider 0640=11111 Date WEISKOPF PARTNERS 1, LLC Builder Name CUSTOM Plan Number GROUP 1 Sample Group Number 81-100 30174 Sample Lot Number HERS Provider: CHEERS City/State/Zip: 'RANCHO MIRAGE, CA. 92270 HERS RATER COMPLIANCE STATEMENT The house was: N 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 comply with the diagnostic tested compliance requirements as checked on this form. ® The installer has provided a copy of CF -6R (installation Certificate. ® Distribution system is fully ducted(i.e., does not use building cavities as plenums orplatform returns in lieu of ducts) N Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. ® 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 41 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here 800 If fan flow is measured enter mcasurcd value here Leakage Percentage (100 x Test Leakage/Fan Flow) = 5.125 Check Box for Pass or Fail (Pass --6% or less) N ❑ Pass Fail ®THERMOSTATIC EXPANSION VALVE (TXV) ® Yes ❑ NoThermostatic Expansion Valve is insliplied and Access is ❑ . provided for inspection Jun 10 04 12:08p GAIL DAVIS Dwmin ENERGY CA5EC S 00. Box 621 Rancho Mirage, CA 92270 Email: DESNRG taAOLZOM 760-250-2044 p,4 Ph/Fax(760)564-2044 Cell: (7601250-1852 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R CUSTOM HOME Project Title 81-100 CHANTICLEER, LA QUINTA, CA. 92253 Project Address JIM AVENAL 760185-5650 Builder Contact Telephone RICHARD KROWN 760-250-1852 HE9P Rater / Telephone #CCNRK613292 re Date Firm: DESERT ENERGY SERVICES LLC Street Address: P.O. BOX 621 Copies to: Builder, HERS Provider 06-t0=mt Date WEISKOPF PARTNERS 1, LLC Builder Name CUSTOM Plan Number GROUP 1 Sample Group Number 81-100 4 O F 4 Sample Lot Number HERS Provider: CHEERS CitylStateiZip: RANCHO MIRAGE, CA. 92270 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 comply with the diagnostic tested compliance requirements as checked on this form. ® The installer has provided a copy of CF -6R (Installation Certificate. ® Distribution system is fully ducted(i.e., does not use building cavities as plenums or platform returns in lieu of ducts) ® where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. ® 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 48 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here 800 If fan flow is measured enter measured value here Leakage Percentage (100 x Test LeakageiFan Flow) = 6 Check Box for Pass or Fail (Pass=6% or less) ® ❑ Pass Fail 0 THERMOSTATIC EXPANSION VALVE (TXV) ® Yes ❑ No Thermostatic Expansion Valve is installed and Access is ® ❑ provided for inspection