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06-3363 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 06-00003363 Property Address: 78154 CALLE NORTE APN: 770-011-030-. - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 13000 Applicant: T.ity/ Qu� BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 tcense No.: 752180 Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Cade: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_ I I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/19/06 Owner: PRIVATE ESCAPES OF L.Q.1 L1 78154 CALLE NORTE LA QUINTA, CA 92253 Contractor: O� 006 PRIORITY ONE A/ EAT�7t�bS�G� O P.O. BOX 1681 PALM DESERT, CA 22 1 �Q P1- (760)773-081i C� F�NA�CE Dfpj'� Lic. No.: 752180 ------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is _ issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the "performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 0460012854 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 Q3700 of the Labor Code, e�I�shall forthwith comply ith those provisions. Date: %r) 7 Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENdTIONCOVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. ' 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work 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 c rrect. I agree to comply with all city and county ordinances and state laws relating to building construction, and reby authorize representatives of this county to enter upon the above-mentioned property for inspection purpo s. Date: / / 7 Signature (Applicant or Agent): Application Number 06-00003363 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 55.00 Plan Check Fee 13.75 Issue Date . . . Valuation . . . . 0 Expiration Date 3/18/07 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 4.5000 EA MECH VENT INST/ DUCT ALT 9.00 2.00 9.0000 EA MECH APPL REP/ALT/ADD 18.00 2.00 6.5000 EA MECH AH <=10K CFM 13.00 ---------------------------------------------------------------------------- Special Notes.and Comments REPLACE EXISTING A/C WITH 2 NEW 14 SEER UNITS Fee summary Charged Paid Credited Due ------------------------------------- Permit Fee Total 55.00 -------------------- .00 .00 55.00 Plan Check Total 13.75 .00 .00 13.75 Grand Total 68.75 .00 .00 -68.75 LQPERMIT INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R Site Address -7%1.5q Galle ffo-rk L, Outq �d (Qct Permit Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT The building was: ✓ gTested at Final ✓ ❑ Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: ❑ Remove at least one supply and one return register, and verify that the spaces between the register boot and the interior finishing wall are properly sealed. ❑ If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points between the air handler and the supply and return plenums to verify that the connection'points are properly sealed. ❑ Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used ✓ ❑ DUCT LEAKAGE REDUCTION Procedures for field verification and diagnostic testine of air distribution systeme-are availahlo In Ra!'7N e.,no.A,- 3214 x NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values t� 1 Enter Tested Leakage Flow in CFM:'1� Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfm/ton x number of. tons or as 21.7 cfm/(kBtu/hr) x Heating Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here: ✓ ✓ 3 Pass if Leakage Percentages 6% for Final or <— 4% at Rough -in: 100 x ine # 1 /_(Line # 2)11 ❑ Pass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out,, 4 Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct System Alteration,and/or Equipment Change -Out Enter Tested Leakage Flow in CFM from Final Test ofNew Duct System or Altered Duct5 W110101 S stem for Duct S stem Alteration and/or E ui ment Change -Out.. Enter Reduction in Leakage for Altered Duct System °� as .o-at�'��.�'=:•v--, 6 ine # 4 Minus ine # 5 — (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) Entire New Duct System - Pass if Leakage Percentage :5 6% for Final or <— 4% at Rough -in 8 100 x L - (Line# 5)/ Line # 2 ❑ Pass ❑ Fail TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change- ✓ ✓ Out Use one of the following four Test or Verification Standards for com liaince: 9 Pass if Leakage Percentage <-15% [100 x [ (Line # 5) / (Line # 2)]] (3.7 °� �( Pass ❑Fail 10 Pass if Leakage to Outside Percentage <-10% [100 x L_(Line # 7) / (Line # 2)]] ❑Pass ❑Fail Pass if Leakage Reduction Percentage >t 60% [100 x L _(Line # 6) / (Line # 4)]] 11 and Verification b Smoke Test and Visual Inspection ❑Pass . ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection �,� ❑Pass IJ Fail Pass if One of Lines # 9 through # IZ pass?b 13 Pass El Fail ✓ LJ I, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for compliance credit. L the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply with Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency standards. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Signature: Date: Q 2 57 0. (0 Copies to: BUILDING DEPARTMENT,.HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 of 8) CF -4R Project Address 7 q -p Builder Name Builder ContactTelephone Plan Number HERS Rater r Telephone Sample Group Number Values Compliance Method (Prescriptive Climate Zone Certifying Signature Date �w• X10(, Sample House Number FirmHERS _Rc4 Grn�a►►� - Provider C�I� Street Address: A631 SC4'41yk 5�� -- City/State/Z,ip: urr; e h 9 G %_opJes 1o: JDU1L r.tc, rr. "r.Kuv1uER ANju BLjILDPgG DEPARTMENT 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 house identified on this form complies with the diagnostic tested compliance requirements as checked ✓ on this form. The HERS rater must check and veriffyy that the new distribution system is fully ducted and correct tape is used before a CF4R may be released on every tested building. The HERS rater must not release the CF4R until a properly completed and signed CF -6R has been received for the sample and tested buildings. .❑ The installer has providdd a copy of CF -6R (Installation Certificate). ❑ New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts). ❑ New systems where cloth backed, rubber adhesive duct tape is installed, mastic and draw bands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. ✓ ❑ MWEV[UM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Procedures for field verification and diagnostic testing of air distribution systems are available in RA CM, Appendix RC4.3. Duct Diagnostic Leakage Testing Results NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Meas uredf Values I Enter Tested Leakage Flow in CFM: 2 Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured Enter Total Fan Flow in CFM: V/ v/ 3 Pass if Leakage Percentage':5 6% ( 100 x L_(Line # 1) / _(Line # 2)]] 0 Pass ❑ Fail ALTERATIONS: Duct System and/or RVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 01.1 Ig 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System'. for Duct System a 9 3r Alteration and/or E ui ment Change -Out. Y, ; Enter Reduction in Leakage for Altere&Duct System. (__(Line# 4) Minus (Line # 5)] `"`. 6 (Only if Applicable) F 7 Enter Tested Leakage Flow in CFM to Outside (Only -if Applicable) �/ V Entire New Duct System - Pass if Leakage Percentage 5 6% 8 100 x ine ## 5)/__Line # 2)11 ❑ p ❑Fail TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out Use one of the following four Test or Verification Standards for compliance: 9 Pass if Leakage Percentage 5.15% [100 x L (Line # 5) / (Line # 2 )]] ' " ��- Jo Pass ❑ Fail 10 Pass if Leakage to Outside Percentage S 10% [100 x [__(Line # 7) / (Line.#2)]) ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage >_ 60% [100 x [ L (Line # 6) / (Line # 4)]] 11 and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and •Verification by Smoke Tesf and Visual Inspection' at�N �°.. . ❑ Pass ❑ Fail Pass if One of Lines # 9 through # I ass P -C =-< - fffl', �t - ❑ Pass ❑ Fag t CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3 of 8)-: CF+ -41Z Project Address 7%15q Cd►1 e NOr-k l 0 Cru �t4 <[-Vkt) Builder Name Builder ContactTelephone F, M -e ln n45i 7oo-a15-ta6aL Plan Number HERS Rater .Rex Gra�aw� Telephone Sample Group Number Date of Verification Compliance Method (Prescriptive) ✓ Climate Zone 1 Certifying Signature Date 19q E0to Sample House Number FirmIbex HERS Provider CD r Street Address: a�bb'.yq S�a-N- rad Su► D 130 City/State/ ip:. . Mtor i e-ta 9Qt563 `.oples 10: DUMMV K, r Ktl rKU V1MF kr, AVUJ J51JEU VINO MXAKYWILINT ]ETERS 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 house identified on this form complies with the diagnostic tested compliance requirements as checked on this form. ✓ 159 The installer has provided a copy of CF -6R (Installation Certificate). ✓ ❑ THERMOSTATIC EXPANSION VALVE (TXV) Procedures for field verification of thermostatic expansion valves are available in RACK Appendix R1 ✓ ❑REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valvac . tdoor Unit Serial # Location Outdoor Unit Make Outdoor Unit Model Cooling Capacity Access.is provided for inspection. The procedure shall consist of Date of Verification ✓ Yes ❑ No visual verification that the TXV is installed on the system and 0 0 installation of the specific equipment shall be verified. Yes is a pass Pass Fail ✓ ❑REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valvac . tdoor Unit Serial # Location Outdoor Unit Make Outdoor Unit Model Cooling Capacity Btu/hr Date of Verification Date of Refrigerant Gauge Calibration (must be checked monthly) Date of Thermocouple Calibration (must be checked monthly) Standard Charge Measurement (outdoor air dry-bulb 55 'F. and above): Note: The system should be installed and charged'in accordance with the manufacturer's specifications and installer verification shall be documented on CF -6R before starting this procedure. If outdoor air dry-bulb is below 55 °F rater shall use the Alternative Charge Measure Procedure 'rocedures for Determining Refrigerant. Charge using the Standard Method are available in RACK Appendix RD2 ✓ ❑ Yes ❑ No A copy of CF -6R (Installation Certificate) has been provided with refrigerant charge measurement documented. INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R Site Address -79 cg a le I�OY% La Q4; v11.y A X_�Q Permit Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE Copies to: Builder, HERS Rater, Building Owner at Occupancy and Building Department INSTALLER COMPLIANCE STATEMENT The building was: ✓ 1ATested at Final ✓ ❑ Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: ❑ Remove at least one supply and one return register, and verify that the spaces between the register boot and the interior finishing wall are properly sealed. ❑ If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points between the air handler and the supply and return plenums to verify that the connection points are properly sealed. ❑ Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used ✓ ❑ DUCT LEAKAGE REDUCTION Procedures for held verification and diaQnovd-r ro_rr,nar Ara& ,lic/r;h,.Nnw c.�.ye».� ----- ------ --"" — .... ....... ...»».... .. ...w•o s•c urusauuac sr /llf a,lr( H enact /((:9.3 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM Q 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM: Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21.7 cfm/(kBtu/hr) x Heating Capacity in Thousands of Bughr, enter total calculated or measured fan flow in CFM here: ✓ ✓ 3 Pass if Leakage Percentage5 6% for Final or:— 4% at Rough -in: 100 x ine # 1 / ine # 2)11 ❑Pass ❑Fait ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 1 116 5 Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct OI J System for Duct S stem Alteration and/or Equipment Change -Out. Enter Reduction in Leakage for Altered Dud System 6 ine # 4 Minus_(Line # 5 —(Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) 8 Entire New Duct System - Pass if Leakage Percentage 5 6% for Final or:5 4% at Rough -in f 100 x F ine # 5 / Line # 2 ❑ Pass ❑ Fail TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out ✓ ✓ Use one of the following four Test or Verification Standards for compliance: 9 'Pass if Leakage Percentage 515% [100 x [ (Line # 5) / (Line # 2)]] (o, 5'f o PS Pass ❑ Fail 10 Pass if Leakage to Outside Percentage 5 10% [100 x [__(Line # 7) / (Line # 2)]] ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage >:60%.[100 x [—L—(Line # 6) / (Line # l)]] 11 and Verification b Smoke Test and Visual Inspection ❑Pass 11 Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑Pass ❑ Fail Pass if One of Lines # 9 through # 12 pass ❑ Pass ❑ Fail I, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for compliance credit. I, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply with Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency Standards S,=re�� ` Date I / O Installing Subcontractor (Co. Name) OR �•I General Contractor (Co Name) Residential. Compliance Forms March 2005 CERTIFICATE OF FIELD VERIFICATION &D Project Address Builder Contact p e I n i HERS Rater �D hex, GrAawx Com liance Method Trescri tive Certifying Signatur , - , l j C TESTING (PagO of 8) :CF -4R Builder Name TelephonePlan Number Telephone Sam le GroupNumber Climate Zone 15 o j Date Sample House Number Frrrr� HERS Provider hex GrahaM J Street Address:1�� City/State/Zip• aol03q Tr r4. 5_4 It b 13O in UY i c C q� 5� Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER COMPLIANCE STATEMENT The house was: ✓ VL 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 house identified on this form complies with the diagnostic tested compliance requirements as checked ✓ on this form. The HERS rater must check and verify that the new distribution system is fully ducted and correct tape is used before a CF4R may be released on every tested building. The HERS rater must not release the CF4R until a properly completed and signed CF -6R has been received for the sample and tested buildings. The installer has provided a copy of CF -6R (Installation Certificate). New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts). ❑ New systems where cloth backed, rubber adhesive duct tape is installed, mastic and draw bands are used in combination withcloth backed, rubber adhesive duct tape to seal leaks at duct connections. ❑ MMMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Procedures for field verification and diagnostic testing of air distribution systems are available in RA CM, Appendix RC4.3. Duct Diagnostic Leakage Testing Results NEW C.U1N1$1ICU%.11v1I%: Measured *•; � R ar Duct Pressurization Test Results (CFM @ 25 Pa) Values=]rl 1 Enter Tested Leakage Flow in CFM:ttk Fan Flow: Calculated (Nominal: ✓ ❑Cooling ✓ ❑Heating) or ✓ ❑Measured 2 Enter Total Fan Flow in CFM: '0 3 Pass if Leakage Percentage <_ 6% [ 100 x (__(Line # 1) / _(Line # 2)]J Pass ❑Fail Duct System and/or HVAC Equipment Change -Out ...... ..:.... ,k%, .ALTERATIONS: Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to I (� . R. 4 Duct System Alteration and/or Equipment Change-Out.ii ' Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct Systemt� for Duct System Alteration and/or Equipment Chari a-Out;�' Enter Reduction in Leakage for Altered Duct System L_(Line 4 4) Minus (Line # 5)]�" (Only if Applicable)""'`'""=`t 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) Entire New Duct System - Pass if Leakage Percentage<_ 6% ❑ Pass ❑ Fail 8 100 x ine # 5 / Line # 2 STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out TEST OR VERIFICATION Use one of the following four Test or Verification Standards for compliance Pass if Leakage Percentage:5 15% [100 x L__(Line # 5) / (Line # 2)]] G.5% Pass ❑Fail 9 Pass if Leakage to Outside Percentage <_ 10% [100 x [_(Line ..# 7) / (Line # 2)]] ❑Pass [I Fail 10 eakage Reduction Percentage >_ 60% [100 x [_(Line # 6) / (Line #'4)]] ❑ pass ❑ Fail Kandfication b Smoke Test and Visual Ins ection.ealin of all Accessible Leaks and Verification b Smoke Test and Visual Inspection aYu ❑Pass ❑ Fail Pass if One of Lines # 0 through # 12 pass ''`' 5. ❑Pass ❑Fail dnril in(11 ' ' Residential Compliance Forms CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3 of 8) , CF -4R Project Address I5 Calk Nov qd&o Builder Name Builder Contact o M e I Telephone 760 -275 - (Wa Plan Number HERS Rater hex . r�hq>M Telephone Sample Group Number Date of Verification Compliance Method (Prescriptive) ✓ Climate Zone i $ Certifying Signature Date Sample House Number FirmHERS "-Re G rG�Q ►n Provider CIS 1: S Street Address: 1a963 5cA rd. 5t,;It 1) 4 1:50ynurr City/StatdJ ip: i e+A C, 9�i 5 Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER COMPLIANCE STATEMENT The house was: ✓;g 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 house identified on this form complies with the diagnostic tested compliance requirements as -checked on this form. ✓ ❑ The installer has provided a copy of CF -6R (Installation Certificate). ✓ 5 THERMOSTATIC EXPANSION VALVE (TXV) Procedures for field verification of thermostatic expansion valves are available in RACM, Appendix RI ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valvem tdoor Unit Serial # Location Outdoor Unit Make Outdoor Unit Model Cooling Capacity Access is provided for inspection. The procedure shall consist of Date of Verification ✓ Yes 0 No Ivisual verification that the TXV is installed on the system and ❑ ❑ installation of the specific equipment shall be verified.. Yes is a pass Pass Fail ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valvem tdoor Unit Serial # Location Outdoor Unit Make Outdoor Unit Model Cooling Capacity Btu/hr Date of Verification Date of Refrigerant Gauge Calibration (must be checked monthly) Date of Thermocouple Calibration (must be checked monthly) Standard Charge Measurement (outdoor air dry-bulb 55 °F and above): Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer verification shall be documented on CF -6R before starting this procedure. If outdoor air dry-bulb is below 55 °F rater shall use the Alternative Charge Measure Procedure 'rocedures for Determining Refrigerant Charge using the Standard Method are available in RACM, Appendix RD2 ✓ 0 Yes 0 No A copy of CF -6R (Installation Certificate) has been provided with refrigerant charge measurement documented. Certificate nf Comnliance Prescriotive Method - HVAC -only Alteration • CF -1 R -ALT Project Title: Date: © CaICERTS 2005 Enforcement Agency Use Onty Project Address: • X -icy Climate Zone: Building Permit Documentation Author. Telephone: Plan check Date Company Name: Field Check Date IMPORTANT: This CF -1 R -ALT form is only for use when an HVAC -only alteration is made to an ebsting home Use one form for each system being altered. This is system # of systems altered in this house. Check all lines that apply. Check only lines that apply. Scope of Alterations: 1 Q4 Air Handler is to be instcled or m0aced. Duct searmg to be determined. Continue m nod fine. 2 ❑ A Furnace Heat exchanger is to be installed or replaced. Duct sealing to be determined. Continue to next rine. 3 ❑ An outdoor condensing unit is to be installed or replaced. Duct Sealing and/or TXV(RCA) to be determined. Continue to nerd line. 4 ❑ A cooling or heating coil is to be installed or replaced. Dud endlor TXV CA to be determined. Continue to nod rine. 5 ❑ More than 40 fact of new or replacement dud are to be metalled in unconditioned space. Dud sealing to be determined ❑ Check here if the 1mgm duct systern is also to be new or replaced. Continue to nerd One. 6 ❑ none of renes iS are checked, neither Dud Sealing nor TXV CA we required. Go to Section 5. Section 1 - Dud Sealing On if any of Lines 1 2 3.4 or 5 are checked. Skip if Line 6 is checked. 7 ❑ This system is in Comate Zo a 1, 3,4.5.6.7. or 8. No dud seating is required. Go to Section 2 8 ❑ This system has less than 4o feet of duds in unconditioned space, No dud seafng is required. Go to Section 2- 9 9 ❑ - This system was previously seced and tested, and was certified by a HERS rater. No dud seeding is required. Attach previous CF4R form. Go to Section 2 10 ❑ This duct system is sued or insulated with asbestos. No dud seating is required. Go to Section 2 Note: If the entire duct system is to be new or replaced, Lines 11-14 do not apply. 11 ❑ In Climate Zones 2.12 and 16: An 0.92 AFUE furnace win be instafted in lieu of duct sea and TXV if 12 O In Climate Zones 10, 13 and 15: An SEER 14 AM EER 12 condenser wifi be installed with TXV(RGA) AND added duct insulation on ensting duds. R-8 nEw ducts) m lieu of dud seating. Go to Section 2 13 ❑ In Climate Zones 9, 10, 11, 13, 14, or 15: An SEER 14 AILD EER 12 condenser will be installed with TXV(RCA) D a 0.92 AFUE Unice will be installed in lieu of duct sealing. Go to Section 2- 14 14 ❑ In Climate Zones Z 9, 11, 12, 14 or 16: An SEER 14 AM EER 12 condenser vnll be msWed with TXV(RCA) AND an 0.82 AFUE fumace will be inaaled with increased duct insulation in lieu of duct sealing. Go to Section 2 15 None of fines 7-14 above are checked. Duct Sealing is Required. Continue. S Ion 2 - TXV RCA) (Only if lanes 3 or 4 are checked, otherwise got to Section 3 16 ❑ The system being altered is a package unit No TXV is requinxi Go to Section 3. 17 ❑ This system is in Comate Zone a and a 14 SEER air conditioner or 0.82 AFUE f tmace is being installed No PW(RCA) required. Go to Section 3. 18 ❑ This system is in Climate Zone 1 4 5 6 or 7. No TXV RCA is required. Go to Section 3. 19 ❑ This systern is in primate Zone 16 and One 14 is not checked. No TXV RCA is required. Go to Section 3. 20 ❑ is in Comate Zone 16 and fine 14 is checked and not fine 16. TXV CA Is required. Go to Section 3. is system is in Climate Zorn 2 or 8-15 and rine 11, 16 or 17 is not checked. TXV(RCA) is required. Go to Section 3. Section 3 - HERS Rater verification 221Z If fine 15 is checked, HERS verification Is required for Duct Sealing. 23 ❑ If One 12, 13.14. 20 or 21 are checked and nd One 16 or 17, HERS verification is required for TXV(RCA). 24 ❑ If line 12, 13 or 14 are checked, HERS verification is required for 12 EER_ Section 4 - Equipment Efficiencies 25 ❑ Iff lines 11, 12, 13, 14 or 17 are checked, upgraded equipment efficiencies are required. List In Section 6 Section 5- Duct R Values 26 ❑ f more than 40 fed of duct is being installed or replaced. duct R -value must meet or exceed Package D requirements. 27 ❑ Iff less than 40 fed of dud is being insWiled or rep aced, duct R -value must meet or exceed R�i.2 Section 6 - see next page Version 03-10-W Page 1 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com Certificate of Compliance Prescriptive Method - HVAC -only Alteration CF -1 R -ALT Project Title: Date: © CaICERTS 2005 IMPORTANT: This CFAR-ALT form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is system # of s tems altered in this house. Section 6 - Minimum Requirements for Equipment to be Installed/Altered. Installed equipment must match type/location and meet or exceed eificiencies6t-values. 28 Configuration: O split system 0 Package Unit 29 Handler Mas furnace, AFUE: OHeatpump FAU 01+Ammc FAU ❑Other 30� Heat Exchanger 31 Outdoor CondensingUnit C DHeatpump ffieie SEER/HSPF: ER d d : 32 Coo5ng or heating um cod aC ❑Heatpp OHydmnie 3 ❑ Ducts ovation: JLength (fl): R -name: All mandatory measures apply to'any altered component. See MF -1R - ALT form. Compliance Statement: This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall project responsibility. The undersigned recognizes that compliance using duct sealing, verification of refrigerant charge, and TXV require installer testing and certification and verification by an approved HERS rater. Home Owner or Authorized Agent Documentation Author Name: Name: Address: Company Name: City/State/Zip: Address: Phone: City/State/Zip: Phone: Signature: Signature: Enforcement Agency (Building Department) Notes/Comments: Name: Title: , Department: Phone #. Fax # Signature or Stamp: Required forms: CF -1 R -ALT: by anyone., Required at time of permit application. Copies to home owner, enforcement agency, HERS rater. CF -6R -ALT: by installing contractor. Required to close permit. Copies to home owner, enforcement agency,.HERS rater. CF -4R -ALT: by HERS rater. Requited to dose permit. Copies to home owner, enforcement agency, installer. The CF4R forms for a sample group shall not be released until all testing and verification is completed and passed for the entire group. Version 03-10-06 Page 2 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com Bin # City of La Quinta Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: /T� Owner's Name: Y A. P. Number: Address: City, ST, Zip: 6j ff-co 11 s ew A614 10 I Legal Description: Contractor: d? CLee- . Address: 0. Telephone: Project Description: City, ST, Zip: C, Telephone: -77 State Lic. # : City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. FL: # Stories. # Units: Telephone # of Contact Person: Estimated Value of Project: �j APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING. PERMIT FEES Plan Sets Plan Check submitted ()� Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Coles. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted . Grading IN HOUSE:- ''" Review, ready for corrections/issue Developer Impact Fee . Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees