06-2735 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253.
Application Number: 06-00002735
Property Address: 81867 THOROUGHBRED TR
APN: 767-200-999-23 -312024-
Application description: DWELLING - SINGLE FAMILY
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 285785
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DESERT ELITE,
78401 HIGHWAY
DETACHED LA QUINTA, CA
(760)777-9920
Applicant: Architect or Engineer: hi
----------------
ISENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury th m licensed under provisions of Chapter 9 (commencing with
Section 70 1 of Division 3 of the Business d Professionals Code, and my License is in full force and effect.
Lice/ns�e CI s: License No.: 753190
atm 1 ' L ntmctor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I m exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and rofessions Code: Any city or county that requires a permit to
construct, atter, 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 _ 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.).
(_) 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.).
1 _ 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:.
IOQ-
Lender's Address: ri
LQPERMIT
INC.
111, SUITE
92253 ID
Contractor:
HERINGTON DEVELOPMENT, J1
40960 CALIFORNIA OAKS RD,
MURRIETA, CA 92562
(951)677-8415
Lic. No.: 753190
VOICE (760) 777-7012
FAX'(760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/14/06
fur 2 5 2006
O �WrrA
-----------------------------'-----------------—
WORKER'S COMPENSATION DECLARATION
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 ofthework for which this permit is
issued.
Y_ 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' 1542746-2005
I certify that, in the pe or nce of the work for which this permit is issued, I shall not employ any
person in any marine s to become subject to the workers' compensation laws of California,
a d agree that, ' I sh I become subject to the workers' compensation provisions of Section
700 of th abor Co t, shall forthwith comply with those provisions.
at1 pplicant:
WARNING: FA LURE TO SECURE W KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 15100,0001. 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 appticonstruction,
s null and void if work is not commenced
within 180 days from date of issuance or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state thrmation is correct. 1 agree to comply with all
city and co my o dmances and state laws relating touction, and hereby authorize representatives
of this ty enter upon above-mentioned prction purposes.
at� ' 6 'nature (Applicant or Agent):
Application Number .
. . 06-00002735
Permit
BUILDING PERMIT
_ Additional desc-.
Permit Fee
1290.50
Plan Check Fee
838.83
'Issue Date
Valuation . . . .
285785
Expiration Date
1/22/07
Qty Unit Charge
Per
Extension.
BASE
FEE
639.50
186.00 3.5000
THOU BLDG
100,001-500,000.
•651:00
Permit
MECHANICAL
Additional desc .
Permit Fee
114:50
Plan Check Fee
28:63
Issue Date.
Valuation
.0
Expiration Fate
1/2,2/07..
Qty Unit Charge
Per.
Extension
BASE
FEE
15.00
.3.00 9.0000
EA MECH
FURNACE <=100K
27.00
.3.00 9:0000
EA MECH
B/C <=3HP/100K'BTU
27.00-
6.00 6.5000
EA MECH.VENT
FAN
.39.00
1.00 6.5000
EA MECH
EXHAUST HOOD
6.50
Permit . . . ELEC-NEW RESIDENTIAL
Additional desc
Permit Fee
187.83
Plan Check Fee
48.66 .
Issue Date
Valuation.,
.0
Expiration Date
1/22/07
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
4475:00 .03.50
ELEC.NEW
RES - 1 OR 2 FAMILY
156.63
810.00 .0200
ELEC
GARAGE OR NON_RESIDENTIAL
16.20
Permit PLUMBING
Additional desc .
Permit Fee
236.25
Plan Check Fee
59.06
Issue Date
Valuation . . . .
0
Expiration Date
1/22/07
Qty Unit Charge
Per
Extension
BASE
FEE
15.00-
26.00' 6.00'00
EA PLB FIXTURE
156.00
1.00 15.00'00.EA
PLB BUILDING SEWER
15.00
Application Number ^-06-00002735 '
v Permit, . . . PLUMBING a
'
-QtY= Unit Charge Per w =, T Extension—
2:00. 7.5000 EA PLB WATER HEATER/VENT `r
15.00 e .,
'r 1.00 3.0000• EA ',:.PLB WATER INST/ALT/REP "'
3.00 -
`1'00 9.0000 EA PLB. LAWN SPRINKLER SYSTEM
9.00 »
,11.00 .7500 EA PLB GAS.PIPE >=5
•8.25" ,
1.PLB,GAS
.,
-------------,--------------------------------------,-----------------------
15.00 "
..
Permit . . GRADING -PERMIT,
Additional desc' .
_
Per Fee : ,': �. 15.00 P1aii-Check-Fee
..00
Issue Date t 'Valuation
". t '0 , r.
.,. Expiration Date 4 1/22/07
-
' Qty Unit Charge Per
%Extension,,
BASE FEE
--_ --
15-.00
--- -- ----------- -4 -
--------------------------------
a Special Notes and Comments -
-- --- --------'
'
SFD - LOT 23; PLAN 6BR/CABANA; 4475 SF
R.
- PERMIT DOES NOT INCLUDE POOL, SPA,
BLOCK'WALLS OR DRIVEWAY APPROACH.,2001
' CBC, CMC, CPC, 2004 CEC, 2005 ENERGY
CODES
+ Other Fees _'. ART IN PUBLIC PLACES -RES
233.79
" DIF COMMUNITY CENTERS -RES
74.00...• -
" DIF CIVIC CENTER -.RES
480.00,
ENERGY REVIEW FEE
83..88 '
a +. 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
a STRONG MOTION `(SMI) - RES
29.35'
.. DIF STREET MAINT FAC -RES.
.67.00'
` DIF TRANSPORTATION - RES_
1666.00'
Fee summary Charged Paid Credited
Due
a Permit Fee Total 1844.08 00 :00
1844.08
.
Plan•Check,Total 975.18 .00 00
975.,18 `
Other.Fee Total 4043.02 .00 .00
4043.02
Grand Total 6862.28 - .00 .00
6862.28
L
'. LQkRD4IT •r t
I
e
Sladden 'Engineering
Location
05704
6782 Stanton Ave., Suite A
39-725 Garand Ln., Suite G
114 S. California Ave.
15438 Cholane Road
Buena Park, CA 90621
Palm Desert, CA 92211
Beaumont, CA 92223
Victorville, CA 92392
(714) 523-0952
(760) 772-3893
(951) 845-7743
760-962-1868
Fax (714) 523-1,369
Fax (760) 772-3895
Fax (951) 845-8863
Fak-760-962-1878
Date
�% h w
FIELD MEMO Job No. Viz- -
Project Name I 7-'�---G
Client.:
Site Address S -7 --e i,2�
Job Phone
Work Done rr
I
Test Summary'/ ootin&aasp-ected-
Test
No. '
Location
Elev.
Dry y Moist
Density %
% Relative
Compaction
Ref. Max
pcf ''
Moist
%
Fkt6fd Tech. Superfor Agent
fit..
- . 24 hour. notice requested .to schedule Field Technician. Thank youfor the opportunity to be of service.
MAY -31-2007 01:36 PM
ATE
Date
Builder Name
ia
Telephoner Plan Number,
LZ,01:21?-:�7a3
Tele hoLO
Sample Group Number
ate Sample House Number
J. __. _ HERB Provider: e✓ �/Q 5
Firm:
Street Address; 7 � d SrG d'4 ot CirL /0' CItyl8tatealp: ) 6 4 q z.z'L_
Copies to: Builder, HERS Provider
HERS RATER COMP_LIANCEII T&ME
The house was: ❑ Tested proved as part of sample testing, but was not tested
As the HERS rater providing dfapnost� testing and field verification, I certify that the houses identified on this form
com I with the diagnostic Tested compllance requirements as checked on this form.
Distribution system Is fully ducted (I.e., does not use building cavities as plenums or platform return in lieu
f ducts)
Where cloth backed, rubber adhesive duct tape Is Installed; mastic and dmwbands are used in combination
with cloth backed, rubber adhesive duct tape to 9981 leaks at duct connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
P.03
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 400cfmlton 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) D
Check Box for Pass or Fall (Pass=6% or less)
Pass Fall
THERMOSTATIC EXPANSION VALVE TXV or Commission approved a uivalent
Yea ❑ No Thermostatic Expansion Valve (or Commission approvcd
equivalent) Is installed and Access Is provided for Inspection
Yes is a pass
C] MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. O Yes O No ACCA Manual D Ossign requirements have been mot
(rater has verified that actual Installation matches values in
CF -1 R and design on plan.
2, 0 Yea O No TXV Is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -1 R.
Measured Fan Flow =
Yes for both 1 and 2 is a Pass
❑
Pass Fail
O O
Pass Fail
05-16-�07 15;13 FROM -
Empire Insulation, Inc.
3901 Carter Avenue, Suite 1
Riverside, CA 92501
T-474 P13/14' U-503
Phone: (951) 787-4844
Fax: (951) 787-4849
INSULATION CERTIFICATE
This is to certify that Insulation has been installed in conformance with the current
Energy Regulations & Building Codes of the City, County and State Governing Agencies
for the State of California.
PROJECT: THE ESTATES @ RANCHO SANTANA
SITE ADDRESS: 81-867 THOROUGHBRED TRIJ LA QUINTA CA
Number city State
Lot 23 Plan 6/CA6ANA
CEILING AREA: BLOWN
Manufacturer: GREENFIBER Thickness/Type; 8.36" R -Value R-30
CEILING AREA: BATT
Manufacturer: GUARDIAN Thickness/Type; 9 1/2 '' R -Value R-30
EXTERIOR WALLS:;
Manufacturer: GUARDIAN Thickness/Type: 3 s/8'' R -Value R-1.3
GENERAL CONTRACTOR:
BY: TITLE:
LICENSE #
DATE:
INSULATION CONTRACTOR; EMPIRE INSULATION LICENSE # 860072.
BY: )OHN MIRANDA DATE: 5/16 07
INSTALLATION CERTIFICATE (Page 3 of 12) CF -6R
Sitter `Addreess �7 _ Permit Number
O 1 ` 0 _{ _ � �0 �O L �fJIY�� i SDC T(-Otl I -
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The.
information provided on this form is required) 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(a).
HVAC SYSTEMS:
Heating Equipment
Equip Type
CEC Certified Mfr.
k of
Efficiencyt
(AFUE, etc.)
Duct
Duct or
Heating
Heating
Name and Model
Identical
Location
Piping
Load
Capacity
k . heat urn)
Number
Systems.
"(>_CF•l R value)
attic, etc.
R -value
(Bm/hr)
(Budinr)
of
of
°
_
G
Al e`
t of L
t li 0 b
1
d
d
c
Q
U
goo
NM
1R1�0.1�
�c;7
Cooling Equipment
Equip Type
CECCertified Mfr.
k of
b fficiencyt
(SEER or EER)
Duct
Coaling
Cooling
Namcand Model
Idemicel
Location
Duct
. Load
Capacity
OAg. heat um
Number
Systems
ZCF•iRvalue)
(attic,ctr.)
R -value
(Btuthr)
(Btu/hr)
of
_
1
NM
1R1�0.1�
�c;7
1. > symbol reads greater than or equal to what is indicated on.the CF -JR value.
Include both SEER and EER if compliance credit for high EER air conditioner is claimed.
✓ 011, the undersigned, verify.that equipment listed above is: t) is the actual equipment installed, 2) equivalent to or
more efficient than that specified in the certificate of compliance (Form CF -IR') submitted for compliance with the
Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable. ,
Installing Subcontractor (Co. Name) OR General
Contractor (Co. e, Owner /
Siunatur Date:
Copies
, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms April 2005
j' -Cl 8020-LTB-TS6 IeoiueyoaW IQ -1 WU92=TT L002 LT ReW
INSTALLATION CERTIFICATE . CF -6R
81-867 Thoroughbred Trail `
Site Address Permit #
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is
required; however, use of this form to provide the information is option].) 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).
r
HVAC SYSTEMS:
Headng Equipment
Equip. Type # of Efficiency Duct Duct or Heating Heating
(pkg. heat CEC Certified Mfr, Make.&Model Identical (AFUE,etc.)' Location Piping Load Capacity
purrt)etc.) Number - Systems [KF -1R value] (attic, etc.) R -value (Btu/hr) (BTU/Hr)
FAU YORK LY8S080B 16UH I 1 1 80.0% ATTIC R4.2 g0,000
FAIL YORK LY8S080C20UH 1 I I 80.0% ATTIC R=4.2 80,000
Cooling Equipment
Equip. Type
# of
Effec iency
Duct
Cooling Cooling
(pkg. heat CEC Certified Compressor Unit Mfr.
Identical
(SEER, etc)'
Location
Duct
Load Capacity
pump, etc.) Name and Model Number
Systems
[>:CF -1R value]
(attic, etc.)
R -value
(Btu/hr) (BTU/Hr)
' A/C COND. YORK 142RD042
1
13
ATTIC
R-4.2
42,000
A/C COND. YORK H2RD048
1
13
ATTIC
R-4.2
48,000
T>_ reads greater than or equal to. .
1, the undersigned, verify that the equipment listed above is: 1) is the actual equipment installed, (2) equivalent to or more efficient than that specified in the
certificate of compliance (Form CF -IR) submitted for compliance with the Energy Efficiency Standards for residential buildings, and (3) equipment that meets or
exceeds the ate requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable.
LDI Meclhanical
ndy Yates i''10/24!2006 HVAC Subcontractor (Co. Name)
OR General Contractor OR Owner
V1
B'd 2680-EbE(09L) _1d3IWlJH03W I111 WUa0=6 L00a ZZ Few
4of12)CF
- - --- Permit Number
Site Address
INSTALLER tWL - CE STATEMENT FOR DUCT LEAKAGE
INSTALLER COMPL 04M STATEMENT
The butft was; ❑ Tested at Final 1P Tested at Rough -in
INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE:
❑ Remove at last one supply and one return register, and ver* that the spaces between the register boot and the interior.
Enisbing wall Are properly seated.
❑ if the house rotes -in duct leakage test was eonducW without an air handler installed, inspect the conn n points
between the air handler and the supply and rd= plenums to verify that the connection points are proper seated.
* hasped all johns to ensure that no cloth backed rubber adhesive duct tape is used
❑ DUCT LEAKAGE REDUCTION —& i iml/mAln In RACM. Aanex4ftRC4.3____
NEW CpNBTmugnON:
1 I Enter Tested Leakage Flow in CFM:
Fan Flow: Calculated (Nomfaal; Cooling J Heating) or Measures
2 If Fan Flow is Calculated as 400 c$m/ton x number of toms or as 21.7 cW(kBtu/hr) x Heating
is Thousands of BtuJhr enter total calculated or measured Pan flow. in CFM hem:
Pass / Fail
p ff ft tentage is at or below 6% for Final or 4% at Rough -In'
3 Percent Leakage
[MOX [ (Line # 1) / lino #Z)IJ
I I System 2
9
1900 111000
Paas
0,026 0102/0
TSERMOSTATIC EXPANSION VALVE (T1M
d ver co�tan ojthennaslade atrston valves are available is RACM, AD endlx Xl 9 9
Aaxsa is provided for inspacdoa•
The procedure Thal] consist of visual
LONW1
ve l"cation that the TXV is installed on the system and installation of thespeciSc equipment shall be verified.
Yes is a pass pass—r Fail
❑ HIGH EER AM CONDMONER
,� yp.• callo� mss pvallabla in iYA A endir �
1 ✓ Yes O No EMvalues of installed systems match the CF -1 R ✓ ✓
2 ✓ illi yes ' ❑ No For spilt system, indoor coil is matched to outdoor coil
3 ✓ IPYes O No Time Delay Relay Verified (if Repired) Cl C3
Yes to 1 and 2; and 3 (If Required) is a p Pass Fal
I *at the above diagnaa* test results worn performed in conformance with the req nts far
I, fire undersigned, verrfy *8 undWAZW4 also th8t the newly installed nr retrofit Air -Distribution System ,Plenums and
°0�"' 1' in Se6tien 150 (m) of the 2005 Building Energy Eiiicien . standards.
Fans comply wit MmadatatY ��
r
Installioo8 Subconttaew (Co. Name) OR General 1 �. jSec.
Conftdor (Co, Name) OR Owner [�-
S-2z-
Copies to: HtT11. M BUJWING DEPARTMIM, VMS BATOR
Residential COmpji"Ce Forms Aprih 2005
6'd 2680-6*16(09L) -1U3INHH03W IQ -1
WUaO:6 L00a as ReW
INSTALLATION CERTIFICATE :
CF -611
81-867 Thoroughbred Trail
Site Address
Permit #
1
An installation certificate is required to be posted at the building site or
made available for
all appropriate
inspections.
(The information provided on this form is
required; however, use of this forth to provide the information is optionl.)
After comple
HVAC SYSTEMS:
Heating Equipment
Equip. Type
# of
Efficiency
Duct
Duct or
Heating
Heating
(pkg. heat CEC Certified Mfr, Make & Model •
Identical
(AFUE,ete.)'
Location
Piping "
'Load
Capacity
pump, etc.) Number
Systems
[aCF- I R value] • (attic, etc.)
R -value
(Btu/ u)
(BTU/Hr)
FAU YORK F4FP024H06T2A
1
80.0%
ATTIC
R-8
24,000
t
Cooling Equipment
Equip. Type,
# of
Efieciency
'Duct
Cooling
Cooling
(pkg, heat CEC Certified Compressor Unit Mfr.
Identical
(SEER, etc)"
Location
Duct
Load
Capacity
pump, etc.) Name and Model Number
Systems
[SCF -1 R value)
(attic, eta)
R -value
(Bmqu)
(BTU/Hr)
A/C COND. YORK E1RD018
1
13
ATTIC '
R-8
18,000
1 >_ reads greater than or equal to.
• 1, the undersigned, verity that the equipment listed above is: 1) is the actual equipment installed, (2) equivalent to or more efficient than that specified in the i
certificate of compli nce (Form CF -1R) submitted for compliance with the Energy Efficiency {}
LDI MechanicalOff a&
!
Cind 10/24/2006 HVAC Subcontractor (Co. Name)' _
OR General Contractor OR Owner
TE
4
- ----- Permit Number
Site Address
INSTALLER C Aa CE STATEMENT FUR DUCT' LEAKAGE
INSTALLER COMPLIANCE STATEMENT
The building was~ ❑ Tested at Final 10 Tested at Rough -in
INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE:
❑ Remo,- -1 1-9 one supply and one return rogister, and verify that the spaces between the register boot aab the interlor
finishing wall are proPcdY sealed-
If the house rough -in duct leakage tact was conducted without an air bandler installed, inspect the conneeTon points
batwoea the air b—illcr and the supply cad return plenums to verify that the connection points are proper seated.
Ig Inspect all joints to eamre that no cloth backed rubber adhesive duct tape is used - --
❑ DUCT LEAKAGE REDUCTION _ n_..L...�, _ n..efw.r.e Af0 /f17/)rr/lL to RIlWII. a,Dr>exd&Rt:4G3
NEW CONSTRUCPiorr:
s 1 `system 2
1 Enter Tested Leakage Flow is CFM:
Fan Flow: GlslWa d (Nominal: Cooling 1 Hea bW or Measured
2 If Fan Flow is Calculated as 400 ofin/oou x number of tons or as 21.7 cfm/(kAtu/l:r) x heating /cQ o
C P In ThouM& of Btnlhr, ewer total caloalsied or measured fan Sow. In CFM hem:
i ettaspPareentage is at or below 6% for Final or 4% at Rough -in: Pass / Fail �A. S.S
3 [100X [ (Lhw # 1) / (Lame # 2))J Percent Leakage d0,03_5
d THERMOSTATIC EXPANSION VALVE (TXV) Tho Appendix 9 9
procedures for vereatlorr of thmnoz nth lob vah�esp labte in RACK App
Access Is Pied on. shall consist of visual
verification the M is kstaUed on the systeaa and installation of time
Oyes ❑No that speci& equ4=ent shall be verified.
Yes is a pass ass Fail
D SIGH EER Ant CONDITIONER
Procedures or ver cation ars uvaUable In RACA4 mdir Rl match the CF• l R
1 ✓ Yea D No EER values of installed systems ✓ ✓
2 le Yes O No For split sysRem, indoor coil is matched to outdoor coil ❑
3 Ip Yes O No T'ffie Delay Relay Verified (If Required Pass Fail
Yes to 1 end 2; end 3 (If Required) is a pas
thea the abovo diagnostic test r+asulte wore performed in corsfaQmence with there cuts for
c, the �igrbd, sig" Y that Ste newly installed or retrofit Air-Distnbu6m System I) Plenums and
Fos �lY WM Manft y regaireme b gwifr-d in Section 150 (m) of the 2005 Building Energy Efficien v standards.
Ing Suboonhulor (Co. Name) OR General 1
Contactor (CO. Name) OR OWW 1�-
rl /- S o<'
S Date:
. Capin bo: BiTD jA BUQ.DING DEPARTIU NTT HERS ]RATER
R'bsidentdal Compliance Forms April 2005
TT'd 2680_6:16(09L) 3HOIWUH03W IQ1 Wd20=6 L002 22 ReW