0309-195 (SFD)LICENSED CONTRACTOR 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 # Lic. Class Exp. Date
818121 I3RIC , f 03/31.12(
Date•' 'd`/ Signature of Contractor ,/K. ""'
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).
( ) 1, 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&RC. 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 EXEMPT 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 agree that if I should become
subject to the workers' compensation pro sionsof Section 3700.of the Labor
,Code, I shall forthwith comply with those rovi Prons.
Date4d d tla .a< Applicant /.. Vis,
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. ,
_ ^r
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. L
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 reoresentatives of this City to enter upon
the above-mentioned property for in 4ectio purposes.
0
Signature (Owner/Agents_ r Date
BUILDING PERMIT PERMIT#
DATE _� VALUATION LOT -1� TRACT
;I tS1272.20 31 28867
JOB SITE r
ADDRESS 4y�b-73fF U1!.Is CmT4 D1 i
APN
770-33"15
OWNER
CONTRACTOR/DESIGNER/EN (NEER -
BOB & LWI. : CABBY w
IFUDSOX CONMRUC M01.6'
PA1,M DESERT CA 92211
t
(760)345-5154 CZLO 51,185
r �
USE OF PERMIT
�1
RAMUDW p N
4971 5.1� SFD P'!?F~A+iIT Ir) ►L,.,`"'NOT 114CI.,UDE HLOCK WALL, POWSPA ;
OR DRIVEWAY APPROACH
CUSTOM CONSTRUCTION 4,571.00 SP
POP.CHIPATIO 419.00 SF
0ARAGE/C.Al3I ORT 986.00 3F
EfIr EW5E D COST QV C0X.V1.ETCI"i0JN
412,272 20
PERWr Tf'F. 8U74r.MARY
C-ONST RUCTIO14 FEE 101-000,438-000 $11735A0
PLAN CHECK F'.LZ 101.000.439-318 $1,409.r
FEE DEPOSIT 101-000-439-318 -$ 40"i.00
F.9Wra.F NiCAL FEE 101-000-42.1-000 $181.50
ELECTI3](:AL P7.9 101.000.420.000 $268,71
PLUMHIN 11 YZE 101-000-419-000 $226.113
STP.000MOTION FEE - RESID 101-000.241.000 141.23
CIRAD1140 FEL i. €i l wi'ltrfl-+112 3-(100 $13.00
DEV PER IMPACT FUE . $2;403.00
PRECISE PLAN $100.00
!AI%.T IN PUBLIC PLACES - R&SK 270.0410.445.0041 $530.68
SUB- AL CQl MItUC1 ON #Alm PLAN (.'.0
$6,913,64
a LEUS ARE -PAID FF,F..�
41,000.041
TOUAL PKR -'0+11±'.1 r, KES DU$ NOW
:FEB2 2004
CITY OF LA Q61NTA
FINANCE DEPT. ,
RECEIPT
DATE -y <'[
BY
l J
DATE FI/ } O�
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck -
Exhaust Fans
OX 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
Final
Final Ej
BLOCKWALL APPROVALS
POOLS - SPAS
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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Y
Gas Test
Appliances
Final
Final
Utility Notice (Gas)AW
ELECTRICAL APPROVALS %,
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)
COMMENTS:
Af
2/
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road Q BERMUDA DUNES r
Date 2/2/04 La Quinta, CA 92253 rn RANCHO MIRAGE C7
Y INDIAN WELLSLM DESERT
No. 25443 (760) 771-8515 �.y> PALA QUINTA �y
11�1QINDIO L�
.G
Owner
Bob & Leslie Casey
APN #
770-330-015
Address
4052 Ellington
Jurisdiction
La Quinta
City
Western Sgs Zip 60558
Permit #
0309-195
Tract #
28867
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street S.F.
Lot # No.
Street S.F.
Unit 1 51
52730 Del Gato Drive 4971
Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under
500 square feet, detached "accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. 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 $2.14 X 4,971 S.F. or $10,637.94 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 CC/Community Bk of Western Sgs-Ken Hudson Check No. 201564
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGiLvjey Payment Recd
$10,637.94 Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), t 's 'll serve to notify you that the 90 -day approval period in which you may protest the fees or
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
,•-15-2002 1212 TRADITION GOLF CLUB
Axe 1N49w gW$1006. .TNt4 DeAO.wY uw F,w rvruwwiruomwN
wW WQVfA,Y %TATm{pyrtn
Tr idition Club Assoc}
78-505 Old Ave. 52
La Quinta, CA 92253
(No too. Government Code 61 o3
MAIL TAX STAT6MPNi8 To
Tradition Club Assoc.
78-SOS.•Old'Avte: 52 • �•
La Quinti, CA 92253
760 564 2356 P.02
DOC a 2002-034077
12/20/2001 08:00A Foo:12. N
Page t of 3
Rocardad !n OffLclal Records
County of Rlveraldo
Gory L. Orso
Aoeeaeor, County Clerk d Recorder
11111111111111111111111l�1111111111111111111
APN 170-33.0-030 (fb2Tvef4i ) GRANT DEED --Mp 07-0- 01 to
THE UNDERSTANDING GRANTORS) DECLARES) �
DOCUMENTARY TRANSFER TAX is S `
❑ computed on full value of property conveyed, or r
❑ computed on full value less value of liens or encumbrances remaining at time of sale. C2
❑ unincorporated area (City of La Quinta , AND
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged.
NAME Tradition Club Associates, LLC, a Delaware Limited Liability Company
hereby GRANT(s) to
NAME Leslie L. Casey, Trustee of the Leslie L. Casey Trust Dated January 23, 1985
the following described real property in the County of Riverside, State of California: `
That portion of land in Lot 123, Tract 28867 as recorded on MB 276 at Pages th ugh 78, records of side County, which is
overlayed by the reconfigured shape of Lot 51, said Tract 28867, pursuant to 001I-1�approv y e City of La Quinta. The
reconfigured lot is described in Exhibits "B" and "B-1" attached hereto an a apart hereof.
NOTE: This grant deed perfecrs the intent of Lot Line Adjustme 200- s ap oved b ity of La Quinta.
Dated • �c�o • David Chapman
STATE OF efti?ekid'tA clition Club Associate �1..1_C.
COUNTY OF
before mc, the undersigned. a Notary Public, in and for said Statc, personally
appeared V Qu t d. Cl^pQVY�p�� 4 i Sl �ei.CeSe.� Leslie L. ey,
Wrpasonally known to me Trustee of the Leslie L. Casey Trust Dated January A,
1985
❑ proved to me on the basis of satisfuctory evidence
to be the person whose name is subscribed to this insaument,
edged to me duu he (she or they) executed it.
••M
\ •.b" r-\•:.v.•Jv
RHONOA L MURRISON
NOTARY PUNUC. STATE OF KLINotS
Mr C`0M' 1gg" 9XPAES43/03,02-
.�C
CITY OF LA QUINTA SUB -CONTRACTOR LIST off- I -Z6,0 y �
JOB ADDRESS51-730 i ,L &&ra -, �. c, PERMIT NUMBER QW? -15,5 OWNER BUILDER_�Iel,..�so Cc�✓I 5)'f� CIL/ oni
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing his list or their employees are authorized 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 / Classification
Contractor
State Contractor's License
Workers Compensation Insurance
City Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
I 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 (C-12)
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CITY OF LA QUINTA
PLAN CHECK CORRECTION LIST
Kristi Hanson Inc.
44-850 Las Palmas Suite A
Palm Desert, Ca 92260
PLAN CHECK NO. 0309-195(Structural Only)
ADDRESS -52-730 Del Gato Dr.
SCOPE OF WORK 4971(R3)/889(Ul)
January 16, 2064
SECOND/FINAL CHECK
OCCUPANCY R3/U1
TYPE -OF -CONST. VN
The submitted plans and specifications have been reviewed by the VCA CODE GROUP. In our
professional opinion the plans are in substantial conformance with the building codes and regulations
adopted by the CITY OF LA QUINTAand the State of California Amendment.
APPROVAL FOR A BUILDING PERMIT IS HEREBY RECOMMENDED SUBJECT TO OBTAINING
APPROVALS/CLEARANCES FROM ALL APPLICABLE CITY DEPARTMENTS, AGENCIES, AND
ASSOCIATIONS.
Plans checked by:
nue Luu
VCA CODE GROUP
295 N. Rampart Street, Suite A
Orange, CA 92868
(714) 978-9780 ext. 114
1
VCA File No. LQ -15555
77804 Wlldcul Dr„ Palm OcKri, Ca. 92211 (760060-5770 (760) 360.5719
June 17, 2004
Tom Hartung
Building Official
City of La Quinta
Re: Casey Residence- S.? -730 Del Crab) Dr„ La prdnta, CA
Dear Tom, -'
We have performed structural observation with regards to the framing for the above referenced project
and find it to be in general conformanc; with the approved structural plans with the exception of the
following items:
1. Need to fasten HD, A hold down for shear wall #37 located at the kitchen/outdoor. room.
2. Need to fully nail MST60 strap to bottom of beam RI 1 from shear wall # 16 located at the Master
bedroom.
3. Need to provide blocking and strapping as per detail 13/S3.2 alone beam line X19. This framing
eoedition is located in the garage.
4. Need to provide horizontal and vertical strapping from shear wall # 10 to beam R22 as per detail
12/S3.2. Thjrk framing condition is located in the garage,
5. Need to provide an MST48 strap around angled corner at the Guest bedroom #2.
6. Need to continue sheathing for shear wall #18 around electrical box. Provide blocking and
strapping as per detail 6/S 1.3 around electrical box. if hold down is not present need to epoxy
5/8" diameter all thread with 7' minimum embedment into continuous footing as per Simpson
structural. set. Provide a HD2A hold down at this location.
7. I have analyzed shear wall #2 a:; the sill plate has been cut for the installation of an electrical
box. Need to change length of ;;hear wall #2 from 10'-6" to 6'-6" in length.. Provide double
studs with panel edge nailing at new edge of wall. Need to epoxy 5/8" diameter all thread with
7" minimum embedment into continuous footing as per Simpson structural set_ Provide a HD2A
hold.down at this location. See shear wall layout on following paves.
This structural observation does not relive the City in any way from performing their standard structural
inspections nor is it vi lieu of any code required special inspections. The structural observation
performed should not be construed as a retailed structural inspection but as a structural observation for
general conformance as per CBC 1702,220.
If you have any questions please call.
Sincerely,
Jeffrey B. Young S.E.
Z0 39dd I3S 9NIN33NIJN3 9Nn0A 6TLS09609L bS:80 b00Z/8T/90
'
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^ m
SPECIAL INSPECTION SERVICE
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ ST U T. STEEL ASSEMBLY -S('�( `
C3 POST TENSIONED CONCRETE ❑ ASPHALT HER (�2.(Zd
O REINFORCED MASONRY ❑ FIRE PROOFING // .
JOB LOCATIONt T ^ �' Q� � � ` ��
V 1111J�\
REPORT SEQUENCE NO.
TYPURE ��
PERMIT N0.
E X
V
DAY OF WEEK
MATERIAL DESCRIPTION -36_
ARCHITE ��s��
I YT
MRS. CHARGED
_ _ / L y
ENGINEER ou
ASSISTANTS
HAS. CHARGED
INSPECTIONSUB
E GENE -CONTRACTOR �� FI v�SL-#A— CONTRACTOR
Ass F e,
(
0
4L A t48
-P PKAAU I A
COPY. SENT TO CLIENT O
CO UED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF Md
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
GNAT E OF REGIST R D INSPECTOR
5 o �' q
DA'TE OF hEPOT REGISTER NUMBER
; • F 1 1 /
NMI
mmmmmmmmlml�m
2MMEMEMMEM Em
CERTMCATE OF FIELD VERIEICATI®N AND DIAGNOSTIC TESTING (Page I of 7) CE4R
~ CASEY RESIDENCE — ZONE I JANUARY 14, 2005
Py� oject Address
nEN. HUDSON
ONT/AINE
cC ert)FyIfig Signature
r��m/ ENERGY MANAGEMENT
street Address: 41— 4 8 5 ADAM S
Copies to: Builder, HERS Provider
760-345-5154
Telephone
760-360-4631
Telephone
JAN. 14, 2005
SERVICES
ST., UNIT
Date
Date
253 HUDSON CONSTRUC
001 BtfflderName
Plan Number
Sample Group Number
Sample House Number
HERS Provider: C AL CE RT S
C -city/state/zip: BERMUDA DUNES, CA. 92203
L u
ITERS RATER COWLIANCE ST'AT'EMENT
The house was:. X D 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.
X The installer has provided a copy of CF -6R (Installation Certificate.
X Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
X Where cloth backed, rubberadhesive duct tape is installed, mastic and drawbands are used in combination with cloth
backed, rubber adhesive duct tape to seal leaks at duct connections.
X1%X MINIMUM REQUIREMENTS FOR (DUCT LEAFAGE REDUCTION COP"LIIANCE CREDIT
Duct (Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage. Flow in CFM \ 76
If fan flow is calculated as 400cfmAon x number of tons enter calculated
value here 1600
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 4.8
Check Box for Pass or Fail (Pass=60/o or less) X
Pass Fail
I RM®STATIC EXPANSION VALVE (T3fV)
X�XYes ® No Thermostatic Expansion Valve is installed and Access is
provided for inspection
Vne ie o nano
Q
XD .11
CERTIFICATE OF FIELD V..RIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
CASEY RESIDENCE— ZONE H JANUARY 14, 2005
Project Title Date
52730 DEL.GATO DR., LA OUINTA, CA. 92253 HUDSON CONSTRUCTION
Pro* Address Builder Name
�EN HUDSON 760-345-5154 001
Bu' Contact Telephone Plan Number
A K LA 0 AINE 760-360-4631
ter Telephone Sample Group Number
JAN. 14, 2005
C g Signature Date Sample house Number
ENERGYAANGEMENT 'SERVICES HERSProvider. CALCERTS
Street Address: 41-485 ADAMS ST., UNIT C City/State/Zip: . BERMUDA DUNES, CA. 92203
Copies to: Builder, HERS Provider
HERS RATER COWLLA.INCE STATEMENT
The house,was: X X U Tested El 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.
X )Q The installer has provided a copy of CF -6R (Installation Certificate.
X11 Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
XU 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.
X U MDMWUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION C®lil MLL4, o10E CREDIT
Dust Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM 71.
If fan flow is calculated as 400cfrn/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/ran Flow) = 3.5Z
Check Box for Pass or Fail (Pass=6% or less) X®(
Pass Fail
X JITHERMOSTATIC EXPANSION VALVE (TXV)
X (�. ( Yes ® No Thermostatic Expansion Valve is installed and Access is
provided for inspection XK(
Yes is a pass Pass Fail
CERT'IFICAT'E OF FIELD VERIFICATION AND DIAGNOSTIC T'EST'ING (Page I of 7) CF4R
CASEY RESIDENCE — ZONE III JANUARY 14, 2005
Project Title Date
52-730 DEC GATo DR_, LA QuiNTA, CA 92253 H
.project ddress Builder Name
KEN �unsoN 760-345-5154 001
Bui er Contact Telephone Plan Number
c LAF N 760-380-4631
Telephone ' Sample Group Number
JAN. 14, 2005
i4 Signature Date
ENERGY MANGEMENT SERVICES
Street Address: 41-485 ADAMS ST. , U N I T C
Copies to: Builder, HERS Provider
Sample House Number
HERS Provider: CAL C E R T S
City/State/zip: -BERMUDAS DUNES, CA. 92203
HERS RATER � C®I LUNCE 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.
X XW The installer has provided a copy of CF -6R (Installation Certificate.
X XM Distribution system is fully -ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
X XW 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.
)ffiXNHN MUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION C®14MLIAb10E CREDIT
Duct: Diagnostic Leakage Testing Results (Mla�um 6% Duct Leakage)
Measured
Duct Pressurizaticin Test Results (CFM @ 25 Pa) values
i
Test Leakage Flow in CFM 39
If fan flow is calculated as 400cfm/ton x number of tons enter calculated 800
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 4.9Z
Check Box for Pass or Fail (Pass=6a/o or less) X X ZI ❑
Pass Fail
X XE THERMOSTATIC EXPANSION VALVE
D9 Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
Yes is a pass
XXX7 ❑
Pass Fail
c
CERTMCATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CIS-4It
CASEY RESIDENCE - ZONE IV
Project Title
52-730 DEL GATO DR., LA OUINTA, CA. 9225.3
Projectddress
KEN HUDSON 760-345-5154
Builder Contact - Telephone
J LAF AINE 760-360-4631
T-T'nrhT Telephone
V" lli�. I JAN. 14, 2005
JANUARY 14, 2005
Date
HUDSON CONSTRUCTION
00Builder Name
Plan Number
Sample Group Number
&ertiyink-gignature Date Sample House Number
F�\irmJJ:ENERGY MANAGEMENT SERVICES' HERSProvider: CALCERTS
Street Address: 41-485 ADAMS ST., UNIT C City/Statc/Zip: I u M U D A DUNES, CA- 9%% 03
Copies to: Builder, HERS Provider
HERS RATED CONTL NCE STATEMENT
The house was: X MIXTested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the housesidentified on this form comply
with the diagnostic tested compliance requirements as checked on this form.
X The installer has provided a copy of CF -6R (Installation Certificate.
X The
system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
X 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.
kqMIUM[ 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 38
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 Leakage/Fan Flow) = 4.8%
Check Box for Pass or Fail (Pass=6% or less) X X19k ❑
Pass Fail
X)a THERMOSTATIC EXPANSION VALVE (TXV)
X i® Yes ❑ No Thermostatic Expansion Valve is installed and Access is fi�gg,,
provided for inspection r X X J R ❑
Yes is a pass Pass Fail
1
CERTIFICATE OF FIELD VERIFICATION ANIS DIAGNOSTIC TESTING (Page I of 7) CF -411
CASEY RESIDENCE — ZONE V JANUARY 14, 2005
Pro'eet Title Date
52-730 DEL GATO DR., LA AUINTA, CA. 92253 HUDSON CONSTRUCTION
Project Address Builder Name
KEN HUDSON 760-345-5154 001
Builder Contact Telephone Plan Number
JAm LA o A NE 760-360-4631
JAN . I 1T, 005 0 5 Sample Group Number
e gnature Date LL Sample House Number
F :ENERGY MANAGEMENT SERVICES HERSProvider. CALCERTS
Street Address: 41-485 ADAMS ST., UNIT C City/State/Zip: °BERMUDA DUNES, CA. 922303
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: X 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.
X JU The installer has provided a copy of CF -6R (Installation Certificate.
X 11 Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
X H 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.
X J( MINWUM REQUIREMENTS FOR DUCT )LEAKAGE REDUCTION CONOLHANCE CREDIT
Duct (Diagnostic Leakage Testing Results (Maximum 6% (Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @.25 Pa) values
Test Leakage Flow in CFM 46
If fan flow is calculated as 400cfmhon x number of tons enter calculated
value here 800
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 53%
Check Box for Pass or Fail (Pass=60/0 or less) X )MX
Pass Fail
xikIMRM®STATIC EXPANSION VALVE (TXV)
Xk(Yes CJ No Thermostatic Expansion Valve is installed and Access is yy
provided for inspection X •�^
Yes is a pass Pass Fail
k
CERTMCATE OF FIELD VERMCATION ANIS DUGNOSTIC TESTING (Page I of 7) CF -4R
CASEY RESIDENCE — ZO
Project Title
52-730 DEL_GATO DR., LA BUINTA, CA. 92253
Project Address
KEN HUDSON 760-345-5154
Builder Contact Telephone
.JA"gAFOAAINE 760-360-4631
Telephone
.JAN. 14, 2005
JANUARY 14, 7005
Date
HUDSON CONSTRUCTION:
Builder Name
001
Plan Number
Sample Group Number
Cj�g Signature Date Sample House Number
Firm: ENERGY MANGEMENT SERVICES HERSProvider CALCERTS
StreetAddress: 41-485 ADAMS ST., UNIT C City/State/Zip: ° BERMUDA DUNES, CA. 92203
Copies to: Builder, HERS Provider
HERS RATER COWLIANCE STATEMENT
The house was: XKX 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.
XKX The installer has provided a copy of CF -6R (Installation Certificate.
X 91 Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
XR 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.
)=IifllVIMIIIVI REQUHREMENTSS FOR DUCT LEAKAGE REDUCTION C®1V1 LLALNCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum b% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM 62
If fan flow is calculated as 400chn/ton x. number of tons enter calculated 2000 O O 0
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 3. 11
Check Box for Pass or Fail (Pass=6% or less) W X ❑
Pass Fail
ITERMOSTATTC EXPANSION 'VALVE (T%V)
X Yes ❑ No Thermostatic Expansion Valve is installed and Access is X X
provided for inspection ❑
Yes is a pass Pass Fail
INSTALLATION CERTIFICATE (Part 1 Of 7) CF -6R
Address
Permit Number
An installation certificate is required to be posted at the building site or made available for all appropriate inspectors.
(The information provided on this form is required; however, use of this form to provide the information is optional).
After completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at occupancy, per Section 10-103(b).
HVAC SYSTEM:
Heating Equipment
Number of
Efficiency
Duct
Duct or
Sensible
Sensible
Equip type (pkg-split-
CEC Certified Mfr Name
identical
AFUE etc.
Location
Piping
Heating
Heating
AC or Heat Pump etc.
and Model Number
systems
[page CF -1R1
(attic etc.1
R -Value
Load
Capacity
SPLIT AC
YORK LY8SO80B16UH
1
80Z
ATTIC
R-4.2
27.2MBH
64.OMBH
SPLIT AC
YORK LY8SIOOC20UH
2
80Z
ATTIC
R-4.2
34'. 6MgH
' :'80.OMBH - F ..,._,__ 9
.SPLIT -AC - --
- YORK--LY8SO40Al2UH
3
80Z
ATTIr
R-4-2--=-11S
RMRH
32MRN17aFA
Cooling Equipment
Equip type (pkg-split-
AC or Heat Pump etc.
CEC Certified Compressor Number of
Unit Manufacturer Name identical
and Model Number systems
Efficiency Duct
SEER etc. Location Duct
[page CF -1 R1 [attic etc.1 R -Value
Sensible
Cooling
Load
Sensible
Cooling
Capacity
SPLIT AC
YORK H2RE048SO6G 1
13.5 ATTIC R-4.2
20,384BTu
25,48OBTu
SPLIT AC
YORK RRE060S0615 2
13.5 ATTIC R-4.2
25,256BTU
31,570BTU
SPLIT AC
YORK H2RE024SO6G 3
13.9 ATTIr R-4.-2
11D.nRnRTII
12.finnRTn.
I, the undersigned, verify that equipment listed above is: (1) the actual equipment installed; (2) equivalent to or more efficient than that specified in the certificate of
compliance (Form CF -1R) submitted for compliance with the Energy Efficiency Standards for residential buildings; and (3) the equipment meets or exceeds the
appropriate requirements for manufactured devices (from the Appliance Efficiency Regulations or Part B, where applicable.
ti
HUDSON CONSTRUCTION CO.
Signature and Date Installing Subcontractor or
General Contractor or Owner
DUCT LEAKAGE TEST
EMSEnergy Nanagement Services
HVAC / Energy Consulting
Date of Test: January 14, 2005 Technician: Jack LaFontaine
Test File.- Casey Res—Zone I.
Customer: Hudson Construction Building Address: Casey Res - Zone 1
75-663 Grahamstown lane 52-730 Del Gato Drive
Palm Desert, Ca. 92260 La Quinta, Ca. 92253
Phone: 760-345-5154
Fax: 760-275-6137 ,
Test Results
1. Measured Duct Leakage:
2. Duct Leakage as a Percent of System Airflow:
3. Duct Leakage as a Percent of House Floor Area:
4. Leakage Split: Supply Side:
Return Side:
5. Duct Leakage Curve
6 Test Settings:
Flow Coefficient (C):
Exponent (n):
Test Mode:
Test Pressure:
Equipment:
Test Type:
76.0 CFM / 14.3 sq. in. (+/- 0.0 %)
4.8%
7.9%
38.0 CFM / 7.2 sq. in.
38.0 CFM / 7.2 sq. in.
11.0 -
0.600 (Assumed)
Pressurization
25.0 Pa
Series B Minneapolis Duct Blaster
Total Leakage
(Duct Blaster Only)
Estimated Efficiency Loss from Duct Leakage:
1. Annual System Efficiency Loss: 3.6%
Building and System Parameters:
Floor Area: 962 sq. ft.
System Airflow: 1600 CFM
Supply Leakage Split: 50 %
Return Leakage Split: 50 %
Average Supply Operating Pressure: 25.0 Pa
Average Return Operating Pressure: 25.0 Pa
Supply Leakage Penalty: 1.0
Return Leakage Penalty: 0.5
Percentage of Measured Leakage Connected to Outside: 100% (76.0 CFM)
u
41-485 Adams Street, Unit C — Bermuda Dunes, Ca. 92203 — (760) 360-4631 / Fax (760) 360-3074
C20 License No. 315890 — E-mail: freon.iackA—verizon.net
Cal Title 24 Reports —HVAC Mechanical Design — Calif Certified HERS Rater — NBI Air Balance Testing — CABEC CEA
DUCT LEAKAGE TEST Page 2
Date of Test: January 14, 2005 Test File: Casey Res_Zone.l
Data Points - Data Entered Manually:
Duct Fan Fan Flow Fan
Pressure (Pa) Pressure (Pa) (CFM) % Error Configuration
0.0 n/a
25.0 144.2 76 0.0 Ring 3
0.0 n/a
Comments
This residence has 4970 sq. ft. with six separate HVAC systems
I
i
DUCT LEAKAGE TEST
Energy Management Services
HVAC / Energy Consulting
Date of Test: January 14, 2005 Technician: Jack LaFontaine
Test File: Casey Res—Zone II
Customer: Hudson Construction Building Address: Casey Res - Zone II
75-663 Grahamstown lane 52-730 Del Gato Drive
Palm Desert, Ca. 92260 La Quinta, Ca. 92253
Phone: 760-345-5154
Fax: 760-275-6137
Test Results
1. Measured Duct Leakage:
2: Duct Leakage as a Percent of System Airflow:
3. Duct Leakage as a Percent of House Floor Area:
4. Leakage Split: Supply Side:
5. Duct Leakage Curve
6 Test Settings:
Return Side:
Flow Coefficient (C):
Exponent (n):
Test Mode:
Test Pressure:
Equipment:
Test Type:
71.0 CFM / 13.4 sq. in. (+/- 0.0 %)
3.5%
5.5%
35.5 CFM / 6.7 sq. in.
35.5 CFM / 6.7 sq. in.
10.3
0.600 (Assumed)
Pressurization.
25.0 Pa
Series B Minneapolis Duct Blaster
Total Leakage
(Duct Blaster Only)
Estimated Efficiency Loss from Duct Leakage:
1. Annual System Efficiency Loss: 2.7%
Building and System Parameters:
Floor Area: 1285 sq. ft. Average Supply Operating Pressure: 25.0 Pa
System Airflow: 2000 CFM Average Return Operating Pressure: 25.0 Pa
Supply Leakage Split: 50% Supply Leakage Penalty: 1.0
Return Leakage Split: 50% Return Leakage Penalty: 0.5
Percentage of Measured Leakage Connected to Outside: 100% (71.0 CFM)
'41-485 Adams Street, Unit C — Bermuda Dunes, Ca. 92203 — (760) 360-4631 / Fax (760) 360-3074
C20 License No: 315890 — .E-mail: freon.iackQverizon.net
Cal Title 24 Reports —HVAC Mechanical Design — Calif Certified HERS Rater — NBI Air Balance Testing — CABEC CEA
DUCT LEAKAGE TEST Page 2
Date of Test: January 14, 2005 Test File: Casey Res—Zone II
Data Points - Data Entered Manually:
Duct Fan Fan Flow Fan
Pressure (Pa) Pressure (Pa) (CFM) % Error Configuration
i
0.0 n/a
25.0 125.8 71 0.0 Ring 3
0.0 n/a
Comments
This residence has 4970 sq. ft. with six separate HVAC systems.
J
r
t
I
1
1
DUCT LEAKAGE TEST
ENS. Energy Management Services
HVAC / Energy Consulting
Date of Test: January 14, 2005 Technician: Jack LaFontaine
Test File: Casey Res—Zone III
Customer: Hudson Construction Building Address: Casey Res - Zone III
75-663 Grahamstown lane 52-730 Del Gato Drive
Palm Desert, Ca. 92260 La Quinta, Ca. 92253
Phone: 760-345-5154
Fax: 760-275-6137
Test Results
1.. Measured Duct Leakage:
2. Duct Leakage as a Percent of System Airflow:
3. Duct Leakage as a Percent of House Floor Area:
4. Leakage Spiit: - Supply Side
Return Side
5. Duct Leakage Curve: Flow Coefficient (C):
Exponent (n):
6 Test Settings: Test Mode:
Test Pressure:
Equipment:
Test Type:
39.0 CFM 17.4 sq. in. (+/- 0.0 %)
4.9%
9.5%
19.5 CFM 13.7 sq. in.
19.5 CFM 13.7 sq. in.
5.7
0.600 (Assumed)
Pressurization
25.0 Pa
Series B Minneapolis Duct Blaster
Total Leakage
(Duct Blaster Only)
Estimated Efficiency Loss from Duct Leakage:
1. Annual System Efficiency Loss: 3.7%
t
Building and System Parameters:
Floor Area: 411 sq. ft.
System Airflow: 800 CFM
Supply Leakage Split: 50 %
Return Leakage Split: 50 %
Average Supply Operating Pressure: 25.0 Pa
Average Return Operating Pressure:. 25.0 Pa
Supply Leakage Penalty: 1.0
Return Leakage Penalty: 0.5
Percentage of Measured Leakage Connected to Outside: 100% (39.0 CFM)
41-485 Adams Street, Unit C — Bermuda Dunes, Ca. 92203 — (760) 360-4631 I Fax (760) 360-3074
C20 License No. 315890 — E-mail: freon.iackia)verizon.net
Cal Title 24 Reports —HVAC Mechanical Design — Calif Certified HERS Rater — NBI Air Balance Testing — CABEC CEA
DUCT LEAKAGE TEST Page 2
Date of Test: January 14, 2005 Test File: Casey Res_Zone III
Data Points - Data Entered Manually:
Duct Fan Fan Flow Fan
Pressure (Pa) Pressure (Pa) (CFM). % Error Configuration
0.0 n/a
25.0 38.0 39 0.0 Ring 3
0.0 n/a
Comments
This residence has 4970 sq. ft. with six separate HVAC systems.
t
DUCT LEAKAGE TEST
ENSEnergy /{Management services
HVAC / Energy Consulting
Date of Test: January 14, 2005 Technician: Jack LaFontaine
Test File: Casey Res—Zone IV
Customer: Hudson Construction Building Address: Casey Res - Zone IV
75-663 Grahamstown lane 52-730 Del Gato Drive
Palm Desert, Ca. 92260 La Quinta, Ca. 92253
Phone: 760-345-5154
Fax: 760-275-6137
Test Results
1. Measured Duct Leakage:
2. Duct Leakage as a Percent of System Airflow:
3. Duct Leakage as a Percent of House Floor Area:
4. Leakage Split:
Supply Side:
Return Side:
5. Duct Leakage Curve:
Flow Coefficient (C):
Exponent (n):
6 Test Settings: -
Test Mode:
- Test Pressure:
Equipment:
Test Type:
38.0 CFM / 7.2 sq. in. (+/- 0.0 %)
4.8%
7.6%
19.0 CFM 13.6 sq. in.
19.0 CFM / 3.6 sq. in.
5.5
0.600 (Assumed)
Pressurization
25.0 Pa `
Series B Minneapolis Duct Blaster
Total Leakage
(Duct Blaster Only)
Estimated Efficiency Loss from Duct Leakage:
1. Annual System Efficiency Loss: 3.6%
Building and System Parameters:
Floor Area: 500 sq. ft.
System Airflow: 800 CFM
Supply Leakage Split: 50 %
Return Leakage Split: 50 %
Average Supply Operating Pressure: 25.0 Pa
Average Return Operating Pressure: 25.0 Pa
Supply Leakage Penalty: 1.0
Return Leakage Penalty: 0.5
Percentage of Measured Leakage Connected to Outside: 100% (38.0 CFM)
41-485 Adams Street, Unit C — Bermuda Dunes, Ca. 92203 — - (760) 360-46311 Fax (760) 360-3074
C20 License No. 315890 — E-mail: freon.iackOverizon.net
Cal Title 24 Reports —HVAC Mechanical Design — Calif Certified HERS Rater — NBI Air Balance Testing — CABEC CEA
DUCT LEAKAGE TEST Page 2
Date of Test: January. 14, 2005 Test File: Casey Res—Zone IV
Data Points - Data Entered Manually:
Duct Fan Fan Flow Fan
Pressure (Pa) Pressure (Pa) (CFM) % Error Configuration
0.0 n/a
25.0 36.0 38 0.0 Ring 3
0.0 n/a
Comments
This residence has 4970 sq. ft. with six separate HVAC systems.
I
r
DUCT LEAKAGE TEST
ENSE
nergy Management services
HVAC / Energy Consulting.
Date of Test: January 14, 2005 Technician: Jack.LaFontaine
Test File: Casey Res -Zone V
Customer: Hudson Construction Building Address: Casey Res - Zone V
75-663 Grahamstown lane 52-730 Del Gato Drive
Palm Desert, Ca. 92260 La Quinta, Ca. 92253
Phone: 760-345-5154
Fax: 760-275-6137
Test Results
1. Measured Duct Leakage:
2. Duct Leakage as a Percent of System Airflow:
3. Duct Leakage as a Percent of House Floor Area:
4. Leakage Split: Supply Side:
Return Side:
5. Duct Leakage Curve:
6 Test Settings:
Flow Coefficient (C):
Exponent (n):
Test Mode:
Test Pressure:
Equipment:
Test Type:
46.0 CFM / 8.7 sq. in. (+/- 0.0 %)
5.8%
8.7%
23.0 CFM / 4.3 sq. in.
23.0 CFM / 4.3 sq. in.
6.7
0.600 (Assumed)
Pressurization
25.0 Pa
Series B Minneapolis Duct Blaster
Total Leakage
(Duct Blaster Only)
Estimated Efficiency Loss from Duct Leakage:
1. Annual System Efficiency Loss: 4.3%
Building and System Parameters:
Floor Area: 527 sq. ft. Average Supply Operating Pressure: 25.0 Pa
System Airflow: 800 CFM Average Return Operating Pressure: 25.0 Pa
Supply Leakage Split: . 50 % Supply Leakage Penalty: 1.0
Return Leakage Split: 50 % Return Leakage Penalty: 0.5
Percentage of Measured Leakage Connected to Outside: 100% (46.0 CFM)
41-485 Adams Street, Unit C — Bermuda Dunes, Ca. 92203 — (760) 360-4631 / Fax (760) 360-3074
C20 License No. 315890 — E-mail: freon.iack(&verizon.net
Cal Title 24 Reports —HVAC Mechanical, Design — Calif Certified HERS Rater — NBI Air Balance Testing — CABEC CEA
DUCT LEAKAGE TEST Page 2
Date of Test: January 14, 2005 Test File: Casey Res—Zone V
Data Points - Data Entered Manually:
Duct Fan Fan Flow Fan
Pressure (Pa) Pressure (Pa) (CFM) % Error Configuration
0.0 n/a
25.0 52.8 46 0.0 Ring 3
0.0 n/a
Comments
This residence has 4970 sq. ft. with six separate HVAC systems.
DUCT LEAKAGE TEST
EN4S Energy Management services
HVAC / Energy Consulting
Date of Test: January 14, 2005 Technician: Jack LaFontaine
Test File: Casey Res—Zone VI
Customer: Hudson Construction
75-663 Grahamstown lane
Palm Desert, Ca. 92260
Phone: 760-345-5154
Fax: 760-275-6137
Building Address: Casey Res - Zone VI
52-730 Del Gato Drive
La Quinta, Ca. 92253
Test Results
1. Measured Duct Leakage:
2. Duct Leakage as a Percent of System Airflow:
3. Duct Leakage as a. Percent of House Floor Area:
4. Leakage Split:
Supply Side:
Return Side:
5. Duct Leakage Curve:
Flow Coefficient (C):
Exponent (n):
6 Test Settings:
Test Mode:
Test Pressure:
Equipment.-
quipment:Test
TestType:
62.0 CFM 111.7 sq. in. (+1- 0.0 %)
3.1%
4.8%
31.0 CFM / 5.8 sq. in.
31.0 CFM 15.8 sq. in.
9.0
0.600 (Assumed)
Pressurization
25.0 Pa
Series B Minneapolis Duct Blaster
Total Leakage
(Duct Blaster Only)
Estimated Efficiency Loss from Duct Leakage:
1. Annual System Efficiency Loss: 2.3%
Building.and System Parameters:
Floor Area: 1285 sq. ft.
System Airflow: 2000 CFM
Supply Leakage Split: 50 %
Return Leakage Split: 50 %
Average Supply Operating Pressure: 25.0 Pa
Average Return Operating Pressure: 25.0 Pa
Supply Leakage Penalty: 1.0
Return Leakage Penalty: 0.5
Percentage of Measured Leakage Connected to Outside: 100% (62.0 CFM)
41-485 Adams Street, Unit C — Bermuda Dunes, Ca. 92203 — (760) 360-4631 / Fax (760) 360-3074
C20 License No. 315890 — E-mail: freon.iack(a)_verizon.net
Cal Title 24 Reports —HVAC Mechanical Design - Calif Certified HERS Rater — NBI Air Balance Testing — CABEC CEA
DUCT LEAKAGE TEST Page 2
Date of Test: January 14, 2005 Test File: Casey Res—Zone VI
Data Points - Data Entered Manually:
Duct Fan Fan Flow Fan
Pressure (Pa) Pressure (Pa) (CFM) - % Error; Configuration
0.0 n/a
25.0 95.9 62 0.0 Ring 3
0.0 n/a
Comments
This residence has 4970 sq. ft. with six separate HVAC systems.
t
y
i
Certificate of Occupancy
U --W �r-
4
�,(
LymooatID�G�
OF'1'LBuilding & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 53-730 Del Gato Drive
Use classification: Single Family Dwelling Building Permit No.: 0309-195
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: Bob & Leslie Casey Address: 4052 Ellington
City, ST, ZIP: Western Springs, IL 60558
�- By: Daniel P. Crawford Jr.
Date: 3/11/05
Building Official
POST IN A CONSPICUOUS PLACE
ia.Temporary Certificate of Occupancy
.� .�
0 0
_
� ul�cv
4
G w5 9► Y p Building & Safety Department
of �9
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 52-730 Del Gato Drive
Use classification: Single Family Dwelling Building Permit No.: 0309-195
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: Bob & Leslie Casey Address: 4052 Ellington
City, ST, ZIP: Western Springs, IL 60558
—ret' By: Daniel P. Crawford Jr.
Date: Expires 3/11/05
Building Official
POST IN A CONSPICUOUS PLACE