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06-2656 (SFD)P.O. BOX 1504 78-495 CALLE TAMPICO .LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 06-00002656 61260 TOPAZ DR 764-280-999-157 -300237- DWELLING - SINGLE FAMILY MEDIUM HIGH DENSITY RES 210828 Tiht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: SHEA LA QUINTA C/O JEFF MCQUEEN DETACHED 8800 N•GAINEY CENTER 350 SCOTTSDALE, AZ 85258 _ rchjtect or Engineer: LICENSED CONTRACTOR'S 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. Licen �s B License No.: 672285 ate: ontractor: ` 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 Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged -exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($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 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an, owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_ 1 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: 7/12/06 4SHEAAn Contractor: [VAUG HOMES, INC. 81260 AVENUE 62 1006 LA QUINTA, CA 92253 (760) 777-6005 C�®F LA q(1 LiC. No.: 672285 FINAw,,,..___-A 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. _,KI 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 AMERICAN HOME Policy Number 1247619 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 shouAbecome subject te4e workers' compensation provisions of Section 79 0 of the Lab 3pr�Dd shaliVoorthir itth comiG with those provisions. 1­1ate: L wl�i-' pplicant(/y/7 1 " WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001. 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. 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city antic my ordinances and state laws relating it construction, and hereby thorize representatives of `u7t t e ter upon the above -mention prop f r insp tion rposes. ate: ature (Applicant or Ag Application Number 06-00002656 Structure Information Construction Type . . TYPE V -'MON RATED Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10 Flood Zone . . .. . . . . . NON -AO FLOOD ZONE' Other struct info . . . . .. CODE EDITION 2001 CBC FIRE SPRINKLERS NO GARAGE SQ FTG 478.00 PATIO SQ FTG 178.00 NUMBER OF. UNITS 1.00 ----------------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 2464.00 Permit . . . . BUILDING PERMIT Additional desc Permit Fee 1028.00 Plan Check Fee 668.20 Issue Date . . . . Valuation . . . . 210828 Expiration Date 1/08/07 Qty * Unit Charge Per Extension BASE FEE 639.50 111.00 .3.5000 ---------------------------------------------------------------------------- THOU BLDG 100,001-500,000 398.50 Permit . . . . . . . MECHANICAL Additional desc 'Permit Fee 77.00 Plan Check Fee 19.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/08/07 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B/C <=3HP/100K BTU 18.00 3.00 6.5000 EA MECH VENT FAN 19.50 1.00 6.5000 ---------------------------------------------------------------------------- Elk MECH EXHAUST HOOD 6.50 Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee 110.80 Plan Check Fee 27.70 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/08/07 Qty Unit Charge Per• Extension BASE FEE 15.00 2464.00 .0350 ELEC NEW RES 1 OR 2 FAMILY 86.24 478.60 .0200 ELEC GARAGE OR'NON-RESIDENTIAL 9.56 LQPERMIT Application Number 06-00002656 ---------------------------------------------------------------------------- Permit . . . PLUMBING Additional desc . Permit Fee . . . . 165.00 Plan Check Fee 41.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/08/07 Qty Unit Charge Per Extension BASE FEE 15.00 16.00 6.0000 EA PLB FIXTURE 96.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP, 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 6.00 .7500 EA PLB GAS PIPE >=5 4.50 1:00 15.00OO ----------------------------------------"------------------------------------ EA PLB GAS METER 15.00 •Permit . . .. GRADING PERMIT Additional desc . Permit Fee . . 15.00 Plan Check Fee. .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/08/07 Qty Unit Charge Per Extension ------------------------------------------------------------=--------------- BASE FEE 15.00 Special Notes and Comments SFD - LOT .157, PLAN 5515C,. 2464 SF INCLUDES 290 SF GUEST SUITE, BOX BAY MBR-26'SF &.NOOK -26 SF. PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVE WAY APPROACH. 2001 CBC, CMC, CPC, 2004 CEC, 2005 ENERGY CODES --------------------------------------------------•-------------------------- Other Fees . . . . ART IN .PUBLIC PLACES -RES 27.07 DIF COMMUNITY CENTERS -RES 74.00 DIF CIVIC CENTER - RES 480.00 ENERGY REVIEW FEE 66.82 DIF FIRE PROTECTION -RES 140.00 GRADING PLAN CHECK FEE .00 DIF LIBRARIES - RES 355.00 DIF PARK MAINT FAC - RES" 22.00 DIF PARKS/REC - RES 892.00 STRONG MOTION (SMI) - RES 21.08 DIF STREET MAINT FAC -RES 67.00 DIF TRANSPORTATION - RES 1666.00 LQPERMIT LQPERMIT Application Number 06-00002656 Fee summary Charged Paid Credited Due - Permit Fee Total ---- - - - - -- 1395.80 _---------- .00 -- - - - - - - 7 - .00 --- - - - - - - 1395.80 Plan Check Total 756.40 .00 '.00 756.40 Other Fee Total 3810.97 .00 .00 3810.97 Grand Total 5963.17 .00 .00 5963.17 LQPERMIT JCM Inspections 39725 Garand Lane Suite F Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 I N S P E C T I O N S COMPRESSION STRENGTH TEST RESULTS Client: Shea La Quinta,.LLC Date: 11/15/06 Project: Trilogy @ La Quinta -.Shea Homes Project No: 02-1109 60-800 Triolgy Parkway La Quinta, CA 92253 Set ID Structure Age of Test Compression Strength. JCM ID Location Date Cast Cylinder ID (days) (psi) Set A Phase 16A - Lot # 7157 Slab on Grade 8-23-06 Concrete 273-752 Casita Required psi: 4000 4509 7 2430 4510 28 3600 O56 4000 19 �� 56 4030 CERTIFIED: J nspections supplies the service of compression strength test results only. Per ASTMC39 Page 1 of 1 ,r- h�m. • JCM Inspections 39725 Garand Lane Suite F r Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS REINFORCED CONCRETE INSPECTION REPORT Dates: Noted Below Project Name: Project No: Trilogy @ La Quinta - Shea Homes 02-1109 Project Address: City: 60-800 Triolgy Parkway La Quinta, CA Z IBC []Title 24 Other: Client: Sub-Contractor: Shea La Quinta, LLC DCCCC General Contractor: Architect: Structural Engineer: Shea Homes for Active Adults Bassenian Lagoni Borm & Associates, Inc./ Suncoast Post Tensi Slump (inches): r„ �, Supplier: Superior Time Sampled: �� N. Mix Design: D83625P Time in Mixer (min.): �� Specified Strength (PSI): 4000 Water Added @ Jobsite (gals.):�Addmixture: POZZ 322N Concrete Temperature (F): (Z�-J Truck #: s 3ej Ticket #: I 'I 3R Ambient Air Temperature (F): r1 -7 Field ID Marking: Set A - 4 cylinders Weather: Unresolved Items: Q None ❑ See Below Location of Sample: m h �,,� Cl (-n ❑ No Samples Taken De ription of Work Inspected: PhaS Lot#—j Iro'duGt 2 Plan 1) Received mill certifications for rebar and tendons p . 2) Typical exterior Footings including Garage Footings/Door (11,12,13/SD-1), Tie Beams (20/SD-1), Typical Interior Footings/Rib including step (15,18/SD-1), Seven Strand Tendons (4,10,12,13,16/SD-1), Simpson Strong Walls (24/SD-1), Anchor Bolts and Holdowns (6,7,8/SD-1), Pad Footings and additional rebar placed as per these details and as noted on "�-;. E R lr -�rt "'A .. �. ►v..+.. Also, typical details 2, 3/SD-1 and Notes on SNA apply. Checked rebar for grade, size, placement, coverage and splices. Rebar and tendons were securely tied and supported off the earth. Accepted for concrete placement. 1) The placement of concrete for areas noted above except Garage Interior Footing and Slab on Grade. Total cubic yards placed: approx C) A mechanical vibrator was used to consolidate the concrete. Approved #4 rebar slab dowels were placed @ 18" o.c. 2) Molded 4 cylinders for compression tests with breaks at 7 days (1), 28 days (2) and one for holding purposes. 1) The placement of concrete for Garage Interior Footings and Slab on Grade Total cubic yards placed: approx ' verified correct mix design. y� Y certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved pecifications -applicable building laws. Final report issued at project completion. Inspector: Jack C. Millin ICC Certification No: 0842216-80 Contractor's Representative: v Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page I of Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page of JCM Inspections 39725 Garand Lane Suite F Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS PRESTRESSED CONCRETE INSPECTION REPORT Date: $_30_,D6 Project Name: Project No: Trilogy @ La Quinta - Shea Homes 02-1109 Project Address: City: 0✓ IBC 81-260 Avenue 62 La Quinta, CA Title 24 Client: Sub -Contractor: Shea La Quinta, LLC Sun Coast Tensioning Other: General Contractor: Architect: Structural Engineer: Shea Homes for Active Adults Bassenian Lagoni Borm & Associates, Inc./ Suncoast Post Tensi Weather: Size and Type of Tendons: 1/2" Diameter Seven Strand Stress -Related Tendons Unresolved Items: Jack Machine Calibration: Received Sheet from Sun Coast -Gage Pressure in psi to Machine Load in kips R None psi to 33.04 kips/33,000 lbs See Below Calibration Date: Machine # Phas Lot# 1 Product Plans S SC C) 1a!PN-Z- b 1'1� Q- Description of Work Inspected: Specified �ll ,CV4`'otw`�r'n"I�(b� o`\�t„�nC.�MA�`�\or Lot# Location Tendons Elongation (in) Actual Elongation (in) 11�����- ;% O 111 V A to Ll V1/�/ -a ^^J i..� e 914 1 I certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved plwpecifications _applicable building laws. Final report issued at project completion. Inspector: Jack -,C. Millin ICC Certification N 0842216-89 Contractors Represen tive: Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page of Nov 07 2006 3:49•PM HP LASERJET FAX P.12, F ` v.•/•/.-%••/I�'% H%'.!.%/!✓/!//'/!//I.YL'%/Y'I.C'l.(V/IfYYy'J•:6fAJ,r✓/J/J/J//YJ.4/f!%'/.i%//,!'•%'yYJ%/<n'/1/�t!/Il0'!>•/rydl.%lO%FA'/.Y'.fY/Y/I'Y/✓.•J4'Y.://YVI////////.'Asi////l.•J%//'%J/I/!r////!.//l/////.•/'/r!//lI/:/ j • f, f - INSULATION CERTIFICATE This is to certify that insulation has been instailed in conformance with the current energy a regulation, California Administrative Code, Title 24, State of California, In the building located at: 61-260 Topaz Drive, Lot�7,1� 7, Phase 16A, Trilogy Project, La Quinta, California CEILINGS: TYPE: BLOW' MANUFACTURER: CERTAINTEED Thickness: R-38 WALLS: f TYPE: BLOW MANUFACTURER: CERTAINTEED Thickness: R-13 > s GENERAL CONTRACTOR: SHEA HOMES LICENSE # F / BY: TITLE: PARAGON SCHMID BUILDING PRODUCTS, A tviASCO COMPANY LICENSE # 632072 s BY: TITLE: OFFICE MANAGER DATE: 11/712006 x s 1 A H r• i / .e. - // r .../.'%:/'r. /.yr,%: r,/.L•s.%:.!! /.n..J7i%/.V�:r r/ii.Y..lt/.i•/..-it�b�n•u✓.•.Ignvir:ri.ry'�n�.//�"/.•.N.:•/L.y�:•,/✓i/:vinr../i..•.'./c.r/i'/.•/:/./:/•:.r-%/nv:/i:..i./:,r ........,%...,/.r.In • • NOV._29,2006 16:21 BCI*TESTING,ri1 000-000-00000 CER FICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page i of 8 CF -4R 111111"roject Addrv, Builder Name - jr 61260 To Drive - La Quinta, CA 92253 Shea Homes, Inc. %Agwga Telephone Plan Number 5515 Casita HERS Rater f Telephone Sample Group Numberl Lot # (if applicable) William Henson 760-772-2954 45914/7157 Compliance Method (Prescriptive) Z Climate Zone 15 Certifying S)unature r ; '' Date Certificate Number November 28, 2006 CC3-1798386496 Firm: BCI Testing _ HERS Provider:CaICERTS, Inc. Street Address: 77-760 Country Club Drive sto I City/State/Zip:PBlrn Desertf CA / 92211 Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT A A �� C7 0 HERS RATER COMPLIANCE STATEMENT The house was R Tested ❑Approved as part of sarraple 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 CF -4R may be released on every tested, building. The ITERS rater must not release the CF -411 until a properly completed and signed CF -6R has been received for the sample and tested buildings. The installer has provided d copy of the 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 dud tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. INIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT: New System NEW_ CONSTRUCTION Measured Values _ Duct Pre.^.suriyation Test Results (CFM @ 25 Pa) 1 Enter Tested Leakage Flow in CPM Fan Flow: Calculated (Nominal `• `+Cooling `. `Heating) or'..:' Measured 24 J-~ 2 8o0 Enter Total Fan Flow in CFM: 3^^ Pas - S if Leakage Percentage-.-. 6% [ 100 x ( Line 1 /Line 2)]: 3.00% Pass ❑ Fail _ ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested leakage Row in CFM from CF -6R: Pre -Test of Existing Duct System Prior to putt System Alteration and/or Equipment Change -Out. Enter Tested Leakage Row in CFM: final Test of New Duct Sy :tem or Altered Duct System for y Duct System Alteration and/or Equipment Change -Out. 6 Enter Reduction in Leaikage for Altered Duct System [Lane 4 - Line 51 - (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outsidct (only if Applicdble) Entire New Duct System - Pass if Leakage Percentage .: 6Wo [ 100 x ( Line 5 / Line 2 )J: 8 ❑ Pass ❑ Fall TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out, use one of the following four Test or Verification Standards for compliance: 9 Pass if Leakage Percentage -.- 15% ( 100 x ( Line 5 / Line 2 )J: _ Pass Fail 10 Pass if Leakage to Outside Percentage •:- 10% ( 100 x ( Line 7 / Line 2 )l : ^ f❑ f❑ 1 Pass l I Fail 11 Pass if Leakage Reduction Percentage >= 60% [ 100 x ( Line 6 / Line 4 )j ❑Pass ❑Fail and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Vlsildl Inspection Pass if One of Lines 99 through 4F12 pass ❑ Pass n Fail Page 6 NOV 29,2006 16:21 BCI*TESTING,ri1 000-000-00000 Page 7 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3-4 of 81 CF -4R Project Address Builder Name 61260 Topaz Drive - La Quintal CA 92253 Shea Homes, Inc. Builder Contact Telephone Plan Number _ 5515 Casita HERS Rater Telephone Sample Group Number I Lot ff (if applicable) William Henson 760-772-2954 45914/7157 Compliance Method Prescri rive Climate Zone 15 Certifying Signature" , -_ Date Certificate Number �` ��' (� November 28, 2006 CC3-1798386496 Firm: BCI Testing HERS Provider:Ca10ERTS, Inc. yT Street Address: 77-760 Country Club Drive Ste I City/State/Zip:Palm Desert / CA / 92211. Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER COMPLIANCE STATEMENT The house was 2 Tested n Approved as part of sample testing, but was not tested. As the HERS rater providing diagnostic testinq and field verification, I certify that the house identified on this form complles with the diagnostic tested compliance requirements as checked on this forth. The installer has provided a copy of the CF -6R (Installation Certificate). LvIrHERMOSTATIC EXPANSION VALVE (TXV): Main System _ Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Main System HVAC System TXV R pass ^17 Fail C7 0 NOV.29,2006 16:21 BCI*TESTING,ri1 000-000-00000 Page 8 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3-4 of 8) CF -414 Project Address - '! Builder Name 61260 Topaz Drive - La Quinta, CA 92253 Shea Homes, Inc. Builder Contact Telephone Plan Number 5515 Casita HERS Rater Telephone Sample Group Number/ Lot # (if applicable) William Henson 760-77.2-2954 45914 / 7157 6;i; 6;Ce Method Prescri tive , Climate Zone 15 (7ertifying Signature pate Certificate Number _ �c-S* f,~Y•^-= November 28, 2006 CC3-1798386496 Firm: BC1 Testing HERS Provider: Ca10ERTS, Inc. Street Address: 77-760 Country Club Drive ste I _ City/State/zip:Palm Desert / CA,/ 92211 Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER COMPLIANCE STATEMENT The house was 2 Tested ❑ Approved as part of sample testing, but was not tested. As the HERS rater providing diagnostic testing and field verification. I certify lhdl the house Identified on this form complies with the diagnostic tested compliance requirements as checked on this form, The instdller has provided a copy of the CF -6R (Installation Certificate). HERMOSTATIC.EXPANSION VALVE (TXV): New System Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verlffed. New System HVAC System TXVJ ©Pass ❑Fail 0 :7 NOV 29,2006 16:21 BCI*TESTING,ri1 000-000-00000 CERTIFICATE OF FIELD VERIFICATION A DIAGNOSTIC TESTING (Page 5 of 8) CF -411 Project Address Builder Name 61260 Topaz Drive - La__ u_i_nta, CA 92253 _ Shea Homes, Inc. Builder Contact Telephone Plan Number 5515 Casita HERS Rater Telephone Sample Group Number/ Lat .f (d applicable) William Henson 760-772-2954 45914/7157 _ Compliance Method (prescriptive) Climate Zone 15 Certifying Signature �.� j r �7 �i� - Date Certificate Number November 28t:. 20.06 CC3-1798386496 _ Firm; 46 Testing I•IERS Provider:CaiCERTS, Inc. Street Address: 771760 Country Club Drive ste I City/State/Zip:Palm Desert / CA / 92211 _- Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER COMPLIANCE STATEMENT The house was 2 Tested ❑ Approved as part of sample testing, but was not tested. As the HERS rater providing diagnostic testing and field verification, 1 certify that the house identified on this form complle, with the diagnostic tested compliance requirement; as Checked on this form. The installer hds provided a Copy of the CF -6R (Installation Certificate), HIGH EER AIR CONDITIONER: Main System Procedures for verification are available in RACM, Appendix R1. 1 © Yes f❑ No EER values of installed systems match the CF-IR LJ 2 Q Yes No For split systems, indoor coil is matched to outdoor coil 3 ❑ Yes ["'IN. Time Delay Relay Verified (If Required) ( Yes to 1 and 2, and 3 (If Required) is a pas II PaSs Fail HIGH EER AIR CONDITIONER: New System Procedures for verification are available in RACM, Appendix R1. _ 1 Q Yes ❑ No tER values of installed systems match the CF -1R 2 Q Yes ]No I For split systems, indoor coil is matched to outdoor coil 3 F.) ) Yes ❑ No Time Delay Relay Verified (If Required) _ Ycs to 1 and 2; and 3 (If Required) a6 a pas Pass _ F211 Page 9