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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
68-3967 I3141C 8131/04
Date' _ I' ' �- Signature of Contractor"
�I
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 EXFhtPT 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 provisions of Section 3700 of the Labor
.Code, I shall forthwith comply with those provisions. 1 `
Date: ! "� : ► ry Applicant �. J-, I' i ,,\� - r., 1't l,l,C.) F ,
v
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 representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) ``d '�J - �✓'� �. al -'r.1.3 tUDate
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 03051-184 TRACT
549,404.50
7 106
JOB SITE
ADDRESS �f {i�i.
APN
�� ti�-
OWNER
CONTRACTOR/DESIGNER/EN INEER
AL.AW 61:Ir��i sI C.M
�:�AI.eT CTT DR. A,01•�.tfit +T �"��3f.FE ?IL 3lie b
1?3C7UKFvd'EUIS CA 9^6210
(?60p?3`9:5'14 CBTA 3919
USE OF PERMIT
19 -NIX -IE I'':f OULY DWMT L11e,1t.1
VD -PERMIT DORS 140T I` CLUDL? BL<UC K'4'rr.At..f1PC')0LAPA ORAPPROACH
TtPJVFWAV";C0t1PWANC WITH ALL f'1;J7&�;I't,AL &STATs LAW'.%' INCLU
THR L'l11;)P':Tti Iti?1a SPECIES ACT OF 197.3 (16 U.&C. § 7331, FT
CUOTOM C.0YNSTRUC;TION f 564,00 SF
PC1IEc. HOIATiO 1,209.00 Su
C1AR40VIC;ARFORT I,Irno w
,�:��'i�t���� i;U'�"� ��I.1;;'C�.t��yil'�I7C.'iIt7.F�
�•�'���•.'�
CON OTI111,14 TION F U 101 -000 -418 -Wo $2,189.50
PLAN Cf FI %X Ptit, 1011-001 -439-:318 SI,761.4'I
FRE DF,POSIT 101 -00-439- y 18-st,"a/i oo
)3RURII HAIL I AL FE% 101-000-421-000
IfLU'?t,' T RICAL FRE 101.OVi-420-000
PLUMBING FEE 10i-000-419-000
`3TR 3. O MOTTON WE • MSID 101.000.2.491- 30
fJMDINOIT— 101-000-423-000
DEVELOPER IMPACT FEg++'. $i,405.GU
AItT IN PUBLIC PL&CES . PESIr 270-000-44.5-000 �lli3.^16
e'YTJB 3.'0AX, 6.O. S7, W7�.�:J,l.!lV ARD PL.XT Cor WLCX
LESS PUI -FAQ MES
-$1,250.00
e
'I'C' TA -1, 1?lW9T 3! + X Ii1% NONA?
$6"7A9
DEC 161003
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT DATE
BY
DATE 51NALW
JINSPECTO
I
INSPECTION RECORD
OPERATION
DATE
I.INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
�G( _
Underground Ducts
Ducts
Slab Grade
/
Return Air
Steel
_
c
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framin
��
��
F.A.U.
Compressor
Vents
—Fireplace PX.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
P Firewall
rywa - Int-Lath-�—
--4,;L
Final '46W
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
Waste Lines-4/�(
Gas Test
Electric Final
Heater Final
• Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
-
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final WE
Utility Notice (Gas) I
ELECTRICAL oAP�R GALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
— 4
Final / D
Utility Notice (Perm)
COMMENTS:
�/-�.GS 3-64� 4�( �
��"INTOGiI%W1L(--�
�2r
�f
v3 l8�
P.O. BOX 1504 APPLICATION ONLY
Building 53 -moo � � UINT CALLE CALIFORNIATAMPIO
Address - LA QUINTA, ORNIA 92253
Owner m TWT
Of J
Mailing BUILDING: TYPE'CONST. V OCC. GRPC� �id`vYvv�
A.P. Number �no — V-10 f W�
_ I�
"� Legal Description 1/� 1
Contractor Drninr} flocrrinfinn
Address
State Lic. City
& Classif. Lic. q Sq. Ft. No. I No. Dw.
Arch., Engr., Size Stories Units
Designer �. N Add ❑ Alter ❑ Repair ❑ Demolition ❑
A Ile Tel., —
Ill AA f,iJ�t� Zlp�i�.is%� Lic.tflr��2�4rrl
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 em licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness 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 thathe 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).
I7 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, 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. If, however, the building
or improvement 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.)
I I I, as owner of the properly, am exclusively contracting with licensed contractors to con-
struct 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 Contractor's License Law.)
I'! I 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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
C7 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 for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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: If, 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. 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 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
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of aQplicant Date
Mailing Address
City, State, Zip
Valuation
PERMIT AMOUNT
Plan Chk. Dep. •co
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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 = BUILDI
"'► 21 2L33
_ =7
09/09/2003 08:33 7603469918
September 8, 2003
Mr. and Mrs. Alan Cerf
Re: 53690 Del Gato Drive
Dear W. and Mrs, Cerf,
DRM
,Tradition
The Tradition Architectural Coinmittee has reviewed your third set of construction
documents for your home on Del Gato Drive. The plans were approved subject to the
following comments:
1. Please be sure that lighting will not cause a glare onto the. street (du-ect all
fixtures away from the street and adjacent lots).
2, A $5,000.00 Construction Performance Deposit is required prior to the onset
of construction. Please make this check payable to: Tra; ition Corrlrnunity
Association.
Thanlc you for your submittal and patience in our review of it. We look forwa -, d to
working with you further on the construction of your home.
Sincerely,
The Tradition Architectural Committee
Tradition Community Association
cc: Kristi Hanson
DESERT MORT MANAGEMENT 1
POST OFFICE BOX 4711 • PALM DESERT, CALIFORNIA 92261-47 72
73.550 ALESSANDRO, SUITE 5 • PALM DESYRT, CALIFORNIA 92'60
PHONE (760) 346.1161 • FAX (760) 346-9918
PAGE 02/02
SEP 10 2003 16:59 FR FIRST I;MERICgN TITLE
M
RECORDING REQU11ATED BY: ;
Fidelity Nstional Tide Company
lsoroWfwo ssev-LN gsNatafr, CwMfr CI�rR i rawrwr
Tltr Ordw No. e7.7494TNEI
Raconatoocuaant
end
T�
IA 881111 �IIIII
Mr.- and Mrs, Alan Cott M I e a mei in a a. .�w
2
J I
4 R I l CO/+ lCR1 wwo IIt110 rJiMt
GRANT DEED _...__.._ ._ .... _..... !O
The undersWed prentoris) .deders(e)
Documentary umsfer tax Is 6731.60
( X I corhputed on full value of property conveyed, or YS
[ computed on full value lase value of liens or ancumbranees rwnalning at lift of sale,
( I Unincorporated Area City of La Quints
TO 17607764098 P-02/03
fas.1��00Z-11Z89>fi�
v:'t•if,.;? Deo Z' Tex ftid
464, fn' off loCrl lts"rde
�ntyepf Ittedritds
OarY L. •.Orro
FOR A VALUASU CONSIDERATION. receipt of which Ishereby acknowledged. William L. Heckerman
L.
hereby GRANTS) to AlenlCert and Patricia R. Carf, husband and wife as .joint Tenants
the following deacrlbsd reel property In the City of Le Culma
County of )tiversidi, /hints of Californias
LOT toe OF TRACT NO. 28887, IN THE CITY OF LA CUINITA, AS SHOWN BY MAP ON FILE IN BOOK 276, PAGES
69 THROUGH 76 OF MAPS, IN THE OFFICE OF THE COUNTY.RECORDER OF RIVERSIDE COUNTY, CALIFORNIA
GATED: January 28, 2002
STATE OF 0C4I�da
COUNTY 0f
i k- before me,
�personally ;�y4 r _ penally appeared
t:.l.illi ��rMe� - --
peraonaliv known to me (or proved to me an the basis
of satiefaatoty evidence) to beAhe person(s) whose
nama(s) )stare subscribed to the within instrument and
acknowledged to me that he/shelthay executed the
same in his/her/thou suthorized bapscity(iaal, and that
by his/heritheir signsturels) on the instrument the
person(s), or the. entity upon. behalf of which the
person(s) acted, executed the instrument.
Witness my hand and official semi.
Signature
.5-�—
wllllam 1. Hecke man
*6144r
�►AL1G
MAIL TAX STATlMENTS AS DIRECTED ABOVIE
- VD.218 044 7/91111'.., GRANT 0900
Descniprion; RivefWde,CA Document-Year.Doc1D 2002.112994 Page: 1 of 2
Order 00000000RAY Commend: JENJFER
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road Q BERMUDA DUNE
Date 12/15/03 La Quinta, CA 92253 � RANCHO MIRAGE d
INDIAN WELLSDESERT
No. 25279 (760) 771-8515 `yam PALM
LA QUINTA y
ZP3QINDIO
Owner
Alan & Patti Cerf
APN #
770-370-007
Address 1137 Via Di Salemo
Jurisdiction
La Quinta
City
Pleasanton Zip 94566
Permit #
0305-184
Tract #
28867
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street S.F.
Lot # No.
Street S.F.
Unit 1
106 53690 Del Gato Drive 6564
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 patios/walkways, 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 6,564 S.F. or $14,046.96 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/Wells Fargo Bank - Lori Hatzopoulos Check No. 0068925624
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by anon McGilvrey, Payment Recd $0.00
$14,046.96 Over/Under
Signature L
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 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
9 Certificate of Occupancy
i
G
0F'T9ti Building & 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
F
construction and/or use.
BUILDING ADDRESS: 53-690 Del Gato Drive
Use classification: Single Family Dwelling Building Permit No.: 0305-184
Occupancy Group: R -3/U-1 Type of Construction: VN Land Use Zone: RL
Owner of Building: Alan & Patti Cerf Address:
By: Daniel P. Crawford Jr.
Date: 1/27/05
Building Official
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La Quinta, California 92253
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La Quinta, California 92253
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Program Title 24
Participation
Builder
Builder Cal Tech Development
75352 Palm Shadow Dr.
Indian Wells, California 92210
Statistics
Status Open
Floorplans � 1
10ptional Details
Phase 1
nG.i CHHERS Questic:^5 rr Cons- ends
http://www.cheersregistry.orglindex.php?Realm=Project&Action=Detail&ProjectID=3328 12/1/2004
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF.4R
Project Title Date '—
s.�-��P�eve -1-.
Project Address Builder Name
Builder Contact Telephone Plan Number
HERS Rater: Telephone Sample Group Number
Signature
Firm:
Street Address:
Copies to: Builder, HERS Provider
a/7
Date
Sample House Number
HERS Ptbvidei:
City/State/Zip:
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
wip the diagnostic tested compliance requirements as checked on this form.
The installer has provided a copy of CF -61L (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.
Ix 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 400ctin/ton x number of tons enter calculated
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = - 's.
Check Box for Pass or Fail (Pass=6% or less) ❑
Pass Fail
ki THERMOSTATIC EXPANSION VALVE (TXV)
gYes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
Yes is a pass
❑ MINIMUM REQUIREMENTS.FOR DUCT DESIGN COMPLIANCE CREDIT
1 ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has
verified that actual installation matches values in CF -IR 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
ok ❑
Pass Fail
❑ ❑
Pass Fall
Compliance Forms August 2001 A-16
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF4R
1
Project Title Dates_
Project Address Builder Name
Builder Contact , . — , Telephone Plan Number
Firm:
Street Address: fl-
Copies
tCopies to: Builder, HERS Provider
Sample Group Number
Sample House Number
HERS Provider:
City/State/Zip: Y' ,
JAS
HERS RATEID COMPLIANCE STATEMENT
The house was: J 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
wi#i 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
If fan flow is calculated as 400et3n/ton x number of tons enter calculated
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Pan Flow) _ 17
Check Box for Pass or Fail (Pas"O/o or less)
❑
Pass
Fail
'I THERMOSTATIC EXPANSION VALVE
WYes ❑ No 'Thermostatic Expansion Valve is installed and Access is
provided for inspection
❑
Yes is a pass Pass
Fail
❑ MINIMUM REQUIREMENTS.FOR DUCT DESIGN COMPLIANCE CREDIT .
I ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has
verified that actual installation matches values in CF -1R 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 -IR
{ Measured Fan Flow =
Yes for both 1 and 2 is a Pass
❑ ❑
Pass Fail
Compliance Forms August 2001 A-16
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Ptzge 1 of 7) CF4R
Cgitf' &s,dI&ALe iI /i-7 1oq
Project Titley Date
Prosect Address Builder Name If
Builder Contact Telephone Plan Number
HERS Rater, Telephone Sample Group Number
Certifying Signature Date Sample House Number
Firm: HERS Provider: c 1//. Ile
Street Address:L%% �2 5 �/Q tfc �f City/State/Zip: �p�e,-1, ���Q 4 %94,Q
Copies to: Builder, HERS Provider
HERS RATE t�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 verifications I certify that the houses identified on this form comply
wi the diagnostic tested compliance requirements as checked on this form.
83 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
If fan flow is calculated as 400cfin/ton x number of tons enter calculated
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = S
Check Box for Pass or Fail (Pass --6% or less) ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (MV)
WYes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection [ ❑
Yes is a pass Pass Fail
❑ MINIMUM REQUIREMENTS.FOR DUCT DESIGN COMPLIANCE CREDIT .
1 • E3 Yes ❑ No ACCA Manual D Design requirements have been met (rater has
verified that actual installation matches values in CF -1R 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 Fall
Compliance Forms August 2001 A-16
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF4R
r // �I� O
C�.� 912-57 tJ(1�Lt
Project Title Date
S"3 -.(&o (:-kft c�i—
PmJect Address Builder Nene
Builder Contact , , . „ , Telephone
.Firm:
Plan Number
Sample Group Number
Sample House Number
HERS Provider:
Street Address: _ k tfc ' f City/State/Zip: �� _ Pi- ��� 15��U
Copies to: Builder, HERS Provider
HERS RATE COMPLIANCE STATEMENT
The house was: J 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
wi the diagnostic tested compliance requirements as checked on this form.
63 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.
I MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
i•...•.) 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 400efin/ton x number of tons enter calculated
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = S
Check Box for Pass or Fail (Pass=6% or less) ❑
Pass Fail
i THERMOSTATIC EXPANSION VALVE (IXV)
6TYes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection A , ❑
Yes is a pass Pass Fail
❑ MINIMUM REQUIREMENTS.FOR DUCT DESIGN COMPLIANCE CREDIT .
1 ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has
verified that actual installation matches values in CF -IR 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.
ll Measured Fan Flow =
F 13 ❑
Yes for both 1 and 2 is a Pass Pass Fall
Compliance Forms August 2001 A-16
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF4R
C'.yhr-F ge s* ud�ze i t / L01-
Project Title Date—'— )n
Prolect Address Builder Name
Builder Contact , _ • . — , Telephone
Firm:
Pian Number
Sample Group Number
Sample House Number
HERS Provider:
Street Address: Z1/--925 �l tfc -ft City/State/Zip: /,,, . �r4o4t C,4' 4;V-6'0
Copies to: Builder, HERS Provider
HERS RATECOMPLIANCESTATEMENT
The house was: J 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
vn#i 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.
i 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 6 p
If fan flow is calculated as 400cWton x number of tons enter 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
kITHERMOSTATIC EXPANSION VALVE ('IXV)
9 Yes ❑ No 'Thermostatic Expansion Valve is installed and Access is
provided for inspection
Yes is a pass
❑ MINIMUM REQUIREMENTS.FOR DUCT DESIGN COMPLIANCE CREDIT .
I - ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has
verified that actual installation matches values in CF -1R 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.
{ l Measured Fan Flow =
Yes for both 1 and 2 is a Pass
A.. ❑
Pass Fail
❑ ❑
Pass Fail
Compliance Forms August 2001 A-16
CERTIFICATE.OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page 1 of 7) CF4R
C*V47 & I.J dl�4,zo III,_110q
Project Title Date T—
T
Project Address Builder Name T—
Builder Contact Telephone Plan Number
1, ,j�//le�1 YW- 7.2tl _
HERS Rater, Telephone Sample Group Number
17
Certifying Signature Date Sample House Number
Firm: HERS Provider: Ili
Street Address: Z/--9�2S'C1Q tfc ft
Copies to: Builder, HERS Provider
City/State/Zip:
HERS RATE 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
wi the diagnostic tested compliance requirements as checked on this form.
EQ 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 duet 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 �iiv2
If fan flow is calculated as 400ctin/ton x number of tons enter calculated
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = . 17
Check Box for Pass or Fail (Pass ---6% or less)
❑
PassFail
THERMOSTATIC EXPANSION VALVE (TXV) '
WYes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
(G ❑
Yes is a pass
Pass Fail
❑ MINIMUM REQUIREMENTS.FOR DUCT DESIGN COMPLIANCE CREDIT .
1 ❑ Yes ❑ No ACCA Manual D Design► requirements have been met (rater has
verified that actual installation matches values in CF -IR 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 -IR
{ l Measured Fan Flow =
❑ ❑
Yes for both 1 and 2 is a Pass Pass Fail
Compliance Forms August 2001 A-16
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 O STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
O REINFORCED MASONRY ❑ FIRE PROOFING
O
OTHER 'Fe.x
JOB LOCAT
_37q— �UZI/
REPORT SEQUENCE N0.
7YP7URE `/ _G k �
��'CQ�
PERI)S O /j
U
pgjE_ /u
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INS5P5PE
MRS. CHARGED
oX� S ra uSs
ENGINE R
ova
ASSISTANTS
HRS. CHARGED
DATE INSPECTION
GENERAL SUB
CONTRACTOR CAC jL LC` CONTRACTOR S6k4:N�_I 1ov.GV
ct' e)
Yui L � �� �� l_-
I `
4� 6
t' d
vc, iVN
oy
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT 1 HAVE INSPECTED TO THE BEST OF MV
:'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.
ASI NAT E OF REGISTE ED NSPEOR
t�6���
DTEREPORREGISTER
NUMBER
,'SPECIAL INSPECTION SERYICE��
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
O REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY O -134 -p
❑ POST TENSIONED CONCRETE O ASPHALT '/OTHER��g9
O REINFORCED MASONRY ❑ FIRE PROOFING / b�
JOB LOCATION , 1 10 -e L V A \ �.F J /) A v i NSR
� �P,E/RMIT
REPORT SEOUENCE NO.
TYPE `URE �ry ,n ` ae r - - - --- -
cZ
NO.
D¢i# 1 /
DAY OF WEEK
MATERIAL DESCRIPTION
A -3G _ a _ ��
I
ARCHITECT
15 TOR
-7-
HRS. CMARGEO
t� k -, e►� ��
ENGINEER
O l)
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL SUB
DATE CONTRACTOR CAL 7E -Z-0 CONTRACTOR � �� "J �4GL
le Ass F, P uJ szL-40 k W
e- A p"5 4 fl -T7W CN 00 Fk R- „2 tcA T t ave
oL o
4
P
9- ol0
1.Q,$L (o &y- IgeAZt- 6(a AM- - L,&&S (.) r(�
Lo4kAd l'
,Jew • V Z ({k owc N 0
L.A_Ccry
L ?
COPY SENT TO CLIENT O
CONTIN 0 ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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.
a'- N-: � r -a-, k. A �
IGNATU E OF REGISTEIE INSPECTOR
OINTE OF EPOR7 REGISTER NUMBER
it.m- I-RON
1
OUR
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
O REINFORCED CONCRETE 7RUCT. STEEL ASSEMBLY O
O POST TENSIONED CONCRETE ASPHALT HER f;'v--
O REINFORCED MASONRY O FIRE PROOFING ,l/•�JO
J08 LOCATIONn.` L _
REPORT SEOUfNCE N0.
TYPE OF STRUCT RE /� _
`� CX sc-T" 4'
PERMIT NO.
DATE
DAY OF WEEK
MATERIAL DESCRIPTION T
fl 3 t� P,
ARCHITECT
INSPE TOR
HRS. CHARGED
C- L ` A ��jR
ENGINEER
ASSISTANTS
HRS. CHARGED
INSP.ECTION GENERAL SUB
DATE CONTRACTOR ` C' C CONTRACTOR
a�.larwr A S lac.) a t/. c (, S , v
l .
c.a �j
LLn Lw le
rL,LA U7s %A —(k% 0 R
COPY SENT TO CLIENT.0
CONTINIJD ON EXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF My
KNOWLEDGE ALL OF TME 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.
t
3 IGH TUBE OF REGISTE INSPECTOR
DATE F RE RT RlryfdTERN R