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05-4791 (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: r 05-00004791 l `81554 ULRICH DR 764-270-999-98 -300234- DWELLING - SINGLE FAMILY MEDIUM'HIGH DENSITY RES 163330 Architect orrEr Vb - - Ca Tiht °F 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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. Licens1e Cs`s:e License No.: 672285 /ate: • ""' ontractorY 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'4he 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).: (_) 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 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 am exempt under Sec. , BAP.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:' t IX LQPERMIT Owner: SHEA LA QUINTA C/O JEFF MCQUEEN 8800 N.GAINEY CENTER 350 SCOTTSDALE, AZ 85258- Contractor: 5258 Contractor: SHEA HOMES, INC. 81260 AVENUE 62 LA QUINTA, CA 92253 (760)777-6005 Lic. No.: 672285 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/02/05 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 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 biect to the workers' compensation laws of California, and agree that, sh I come su t to the workers' compensation provisions of Section '31700 of abor o all fo ith comply with those provisions. at,� eY L� `moi Applicani� 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 ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above inform n is correct. I agree to comply with all city and county ordinances and state laws relating to building,co�structi n and hereby authorize representatives of t/his�-° ty t enter upon th bove-mentioned property/�/f/prin pectin ' urpos at$ e: I , ature (Applicant or Agent): �/ \i1 } LQPERMIT Application Number . . . . . 05-00004791 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 863.50 Plan Check Fee 561.28 Issue Date . . . . Valuation . . . . 163330 Expiration Date 5/01/06 Qty Unit Charge Per Extension BASE FEE 639.50 64.-00 ---------=------------- 3.5000 ----------------------------------------- THOU BLDG 100,001-500,000 224.00 ------------ Permit . . MECHANICAL Additional desc . Permit Fee . . . . 83.50 Plan Check Fee 20.88 Issue Date Valuation . . . . 0 Expiration Date 5/01/06 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 4.00 6.5000 EA MECH VENT FAN •26.00 1.00 -------------------=--------------------------------------------------------- 6.5000.EA MECH EXHAUST HOOD 6.50 Permit ELEC-NEW RESIDENTIAL Additional desc . Permit Fee 89.82 Plan Check Fee .22.46 Issue Date . . . . Valuation 0 Expiration Date 5/01/06 Qty Unit Charge Per Extension BASE FEE 15.00 1805.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 63.18 582.00 =--=---------------------------=--------"------------------------------------ .0200 ELEC GARAGE OR NON-RESIDENTIAL 11.64 Permit PLUMBING Additional desc Permit Fee 147.00 Issue Date Expiration Date 5/01/06 Qty Unit Charge Per Plan Check Fee . . Valuation . . . . BASE FEE 13.00 6.0000 EA PLB FIXTURE 1.00 15.0000 EA PLB BUILDING SEWER 36.75 0 Extension 15.00 78.00 15.00 Application Number . . . . . 05-00004791 Permit . . . . . . PLUMBING Qty Unit Charge Per Extension 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 15.0000 ---------------------------------------------------------------------------- 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,. 5/01/06 Qty Unit Charge Per Extension BASE FEE 15.00 ------------------------ --------------------------------------------------- Special Notes and Comments' SFD - Lot 98, 1805 SF. Plan 4510A w/Casita (249sf), MBR.Box•Bay (26sf), Ext Garage (83sf) & Ext Patio (120sf). Permit does not include block wall, pool or driveway approach. --------------'-------------------------------------------------------------- Other Fees ART IN PUBLIC PLACES -RES 20.00 DIF COMMUNITY CENTERS -RES 74.00 DIF CIVIC CENTER - RES 480.00 . ENERGY REVIEW FEE 56.13 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 16.33 DIF STREET MAINT FAC -RES 67.00 DIF TRANSPORTATION - RES 1666.00 Fee summary Charged Paid Credited --------------------------------------------------------- Due Permit Fee Total 1198.82 .00 .00 1198.82 Plan Check Total 641.37 .00 .00 641.37 Other Fee Total 3788.46 .00 .00 3788.46 Grand Total 5628.65 .00 .00 5628.65 LQPERMTP .APR '04,2006 11:06 BCI*TESTING,ril 000-000-00000 Page 2 It C>✓WFIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 of 8) CF -4R Project Addicss TRILOGY AT LA QUiNTA- PHASE 13B Huildcl Nmiic 81554 Ulrich Drive, I.a Quinta, CA SHEA HOMES liuilituf Gunned •1•elcphonv. flan Nnntber Armando Ulloo 760-578-6819 4510 CASITA IIMS 01cr Telephone SulnpleGroupNuiuL*r William Henson, CCN# CC2004076 760-772-2954 N/A Compliamw Mutlndl (P(eW:rt dive) Climate Luue 15 (1itilvulg. Signature Date Sample (louse (Lot) Number -J 122/2006 98 Casita hi(ut 1MRS Provider SCI TESTING CALCERTS Strut Address City StattrLIp 77-760 Country Club Drive, Suite I Palm Desert, CA 92211 0icy lib: 1111:11014W 10AN I'u(►VIt►1-31 AND 111:11ANNO DEPAREWNT liIE;RS MACER COMPLIANCE STATEMENT The htnlse was: ® 1•CSIed ✓❑ Approved as purl of sumple testing. bel was not tested A.v'the HERS rotor providulq diagnostic testing and field verification, I certily that the house identified on this I'timi u+mplies with the diagnostic tested compliance rndfuirt:mcnt; as chw ked ✓ on this time. '111c i WAS rater mw'l check and souls th:d the View diXidbulinn %yxtt:nn is fully (Melted std CM-mcl 1 -ape is nscd before a CFAIR mny he released on every tested building. 1'he Ill'.RS ruler must nut release the CF -IR until a properly completed and signed CF -6R hus been received for the sample and tested buildings. ® The installer has prnvid(d u copy ol'Cl;-6k (Installation Certificate) ® Nc%v Distribution Nysten( is lolly ducted (i.t:.. does not use building eilvitle5 al, gt1e11UIIl.I• tit ;)IM ll•111 ICIIIIIIN 111 licit U1 duels). F4 New syvlem where cloth hacked, rubber adhesive duel tape is installed, mastic and draw bands aro used in combination with cloth Iutckcd, rublwr adhesive duel tape to;cal leaks at duct aunlccliuos. la MINI A7tIM tikQUIRkMI?NTS 1012 DUCT LEAKAGE RIiDUCTIONCOMPLIANCH CREDIT Prura./unacJilr field vrrifiratian said thiNno he. testin,Q nfcrir diwrihurion sywemn ern( avccilnhle iu RA('Aq, .-I pp folfAr R(W 1 Duct Diagnostic Leakage Testing; Rexullx NEW (•:()N.VI•ItI1(71'JON: W.J4111 t't Yes is a pass System I Duct Pressurization TeNt Results (CFM (b) 25 Pa) wrilication that the'I"XV is installed on the system land installation of E1 ❑ I F:nl. r'fesled Leakage Flow ill CPM: 30 2 Fila Flow: Calcnlaly d (NilmimJ• FI rAx)litlg ✓❑ He tim..,) of ✓O Mw;urud F'.mer'fntal fan blow in ChM: Soo ✓ ✓ i f 100.Nl (Line 11 1) .' ( Line 1(2)11 3.75% EIRm ❑Fail Measured Syrdcnl 2 Duct I'resn(rrinun'1'esl Rcsuh. ((:I:m !iif 2i pa) Valles I Entcr 'fc;tcd Lwkaxc How in CFM. Ftm Flaw- Calvailaltal (Numnimll: El (Ax,)llU# ✓❑ Hca(ing) or ✓O Mcasumd 2 Tenter Toial Van flow in (TM: ✓ ✓ i Pass if l.cnkuge. Percentage 5 6% f 100 x ( (Linc i(1) % (Linc 42 #DIV/Q? IOPuxs ❑Fail 0 THERNIoSTATIC FXANSION, VALVI'. (TXV) Proc etfuresJilrfirGi vorifrratinn of t/rvrstnctalil, ifxjw ►si(>tt valvas• ort' nw71!<tbAr (Ir lLlCili. Auuctrdi c til. 16 1111.:11 EER AiR CONDITIONER Prove(luras fi)r v%wifruttiorr ure uvaihobb! ire 1L11 ':1d, : Ipimnrdix til. R1 Yes ❑ No ITER vinilcs of installed syslems match the Cdr -1 R 2 El Yes ❑ No For split syslcm, indoor aril is matched to ouldtwr coil ✓ ✓ 3 17 Yeti Ed Ivo I'ilLr. Dclity Relay Verifi dl 1112 uired) ® ❑ Yts Io I and 2: and.1 (11'Rt uirud) is it pass Pass Tail Residen hd Cwripliunev F„rm.c April 200 Awls is provided for iu4m6on. The procedure shall consist of visual ✓ ✓ Yes is a pass 6i Yes ❑ Nu wrilication that the'I"XV is installed on the system land installation of E1 ❑ lhc;pccilic cyuipmcnt shall be verified. Fail 16 1111.:11 EER AiR CONDITIONER Prove(luras fi)r v%wifruttiorr ure uvaihobb! ire 1L11 ':1d, : Ipimnrdix til. R1 Yes ❑ No ITER vinilcs of installed syslems match the Cdr -1 R 2 El Yes ❑ No For split syslcm, indoor aril is matched to ouldtwr coil ✓ ✓ 3 17 Yeti Ed Ivo I'ilLr. Dclity Relay Verifi dl 1112 uired) ® ❑ Yts Io I and 2: and.1 (11'Rt uirud) is it pass Pass Tail Residen hd Cwripliunev F„rm.c April 200 CERTIFIED: c" ��al_ JCM Inspections supplies the service of compression strength test results only. Per ASTMC39 Page 1 of 1 . JCM Inspections 39725 Garand Lane Suite F Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS COMPRESSION STRENGTH TEST RESULTS Client: Shea La Quinta, LLC Date: 3112106 Project: Trilogy @ La Quinta - Shea Homes Project No: 02-1109 81-260 Avenue 62 y La Quinta, CA 92274 i Set ID Structure Age of Test Compression Strength JCM ID Location Date Cast Cylinder ID (days) (psi) Set A Phase 13B - Lot #4098 Slab on Grade 12-2-05 Concrete 273-638 MasterBathRequired psi: 4000 1909. .7 3420 1910 28 3970 1911 28 4470 CERTIFIED: c" ��al_ JCM Inspections supplies the service of compression strength test results only. Per ASTMC39 Page 1 of 1 } I <V �} JCM Inspections 39725 Garand Lane Suite F ILM Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS PRESTRESSED CONCRETE INSPECTION REPORT Date: Project Name: Project No: Trilogy @ La Quinta - Shea Homes 02-1109 Project Address: City: �✓ 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 -Relieved Tendons Unresolved Items: Jack Machine Calibration: Received Sheet from Sun Coast -Gage Pressure in psi to Machine Load in kips K] None 5 L) qro psi to 33.04 kips/33,000 lbs ❑ see Below Calibration Date: Machine # I.;w I Ll jam, G—CS Phase 3& Lot# ori% Product.. Plan) p %ke G` "c Description of Work Inspected: Actual Elongation (in) Specified Complies within 7% +/- of specified elongation. Lot # Location Tendons Elongation (in) Reference 11 h/SN2. n Yes No Li ❑ tA art'. -a+ Q.• ❑ > r ©^ ❑ El Ll El"lin .r�^�•-�] 10- w r 1r(�7..� A t kA`.. .e , 11�.. - 1, n� 2 r 2, 1 yy L "fl ©-- ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ I hereby 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 plans, specifications _applicable building laws. Final report issued at project completion. Inspector: Jack C. Millin ICC Certifijc�ation o:0842216-89 Contractor's Representative: Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency.. Page l of JCM Inspections 39725 Garand Lane Suite F 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: 81-260 Avenue 62 La Quinta, CA ❑✓ 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): S , ,eta Supplier: Superior Time Sampled: 9 Mix Design: D83625P Time in Mixer (min.): 14L) Specified Strength (PSI): 4000 Water Added @ Jobsite (gals.): �� 1 Addmixture: POZZ 322N Concrete Temperature (F): - 3 Truck #: Ticket #:M Ambient Air Temperature (F): (0'7 Field ID Marking: Set A - 4 cylinders Weather: Unresolved Items: None ❑ See Below Location of Sample: 111) r, ; r ; Q�' ,W t ❑ No Samples Taken Description of Work Inspected: Phase Lot# L4 c)9 A Product Plan LlS CSA 9 kqS 4 UN iA, f iUC. Ila -A — OS' 1) Received mill certifications for rebar and tendons placed. 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 details and as noted onQ • "A , 0 • , „ •, � , r� LA tk , C `t]hese f n (�_ ` •` (� 4\r.\131. x'1111. 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. .-;L - 0:�:- 1) The placement of concrete for areas noted above except Garage Interior Footing and Slab on Grade. Total cubic yards placed: approx q� 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. n—(" -nom 1) The placement of concrete for Garage Interior Footings and Slab on Grade Total cubic yards placed: approx t 3 Verified correct mix design. I hereby 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 plans, specifications _applicable building laws. Final report issued at project completion. Inspector: Jack C. Millin ICC Certification No: 0842216-80 eX l C.' Contractor's Rep"rese . tI ive: .�/Ig X44 / '_�_ —v Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page of 03/24/2006 10:44 FAX PARAGO'NPSCHIMID fa005/013 INSULATION CERTIFICATE This is to certify that insulation has been installed in conformance with the current energy regulation, California Administrative Code, Title 24, State of California, in the building at 81.554 ULRICH DRIVE, LOT 4098, PHASE 13B, LA QUINTA, CA CEILINGS: TYPE: BLOW MANUFACTURER: Certainteed THICKNESS: R-38 WALLS: TYPE: BATTS MANUFACTURER: BORATE THICKNESS: W-13 GENERAL CONTRACTOR: SHEA HOMES LICENSE #. - BY: TITLE: PARA)NSCHMIDS ING PRODUCTS AMASCOCompany LICENSE # 221517 BY:�L' '� TITLE: ACCOUNT REPRESENTIVE DATE:�� L.- APR 04,2006 11:06 BCI*TESTING,ril 000-000-00000 CERTIFICATE OF FIEPA) VERIFICATION & DIAGNOSTIC" ES"PING (Page I of 8) (7174R it(iiecl Address TRILOGY AT LA Qg1NTA- PHASE 13B Builder Name 81554 Ulrich Drive, La Quirila, CA SHFA HOMES Builder Contact 'Telephone Him Number Armando Ulloa 760-578-6819 4510 HERS Rawr Telephonc Sample (lranp Numher William Henson, CCN# CC2004076 760.772-2954 N/A CA)t11 tllallee Method (Freseri live) (climate /.one 15 Certilying Signalun: ikttc Sutuple Iluuse (Lut) Numinr 3/22/20)0 98 1'intt 111:ItS Provider BCI TESTING CALCERTS Street Addre.ss City: Slute'!ip 77-760 Country Club Drive, Suite I Palm Desert, CA 92211 Cupies tu: BIALDFA HERS PROVIDER AYD BUILDING DEPAR'I'>4 E 1' HERS RATER COMPLIANCE STATEMENT The. hou:x WI!..: FJ IcS1cd -,'O Approved as part of simple testing. but was not tested As the I Il"AS rater providing diagnostic tasting and field verilication. I ctatify thud the Ituux identilied un III v; limn crunphes with lhu diugnusliu lusted cuntpliauec tatuiunttnls ;ts clicc-ked �'nn thts tnnu.'hte 111:RS rater must check and verily that the new distribution sys''lern is tillly ducted and correct tape is used before a CP -1 R ntuy be released on every tested building. The 111,16 rtlur must nllt rcluaw. 0w CF -AR until a Pitilp'n Iv cwupldul caul sigoc ki CF -(1R has been received li,r the suntphe and teswd buildings. 0 The instulkt lir• pIII%•tcl-;d a e,yily <+TC:F-c;lt (In.lnllatiun Certilionic) IA New D0,11nitiun ,}•sten, is fully ducted (i.e., discs not use building cuvilics as plenums or plallbrm returns in lieu of docls). 8 New system. when: clolh backed. ruhlka udhe_nivc dual falx: is io.lallad, mastic and drnw Winds arc usul io combination with cloth hacked, rubber adhesive duct tape to seal leaks at duct connections. A J►tl�l�tl'N RN;QI:[Rh:MI?NTS 1'[llt DI'('{' i.M;AK.1(:M: 121Cp1;<'1'ION (:OA11'L41N('h: [:Rba)1'I Prnceelurr .%r;r,ielel verificalian (incl eliagrarslic tesiwg vizir elhlriba/ian hereon• am available in IUCa/ : fppt nrlisRC4.3. Dual Diagnuslic LeakuLle Testing lteiults NEW CONS'FRI ['1'1ON: Mcamoce Yes Is a piss tivae�n I Itoculls (('FM tut 25 I',e) jAcuss verification that thtc'I'XV is installed uu dee system tuid uistulluliou ol' 0 O I P.ntcr Tuslexl l.cakugc (low in CFM: 62 2 Fan Flow:C:ulcululed (Nominal: 0 Cooling ✓❑ Healing) or ✓❑ Mctsurcd Enter Total Gun blow in CPM: 1600 ✓ t fuss if Leakage Percentage 5 6% 1 IOU x I (Linea l) r (Line 112)11 3,88% 1 Wwol Wail Mettsure;el System 2 Duel 1'ressurizalion Test Results (C HM !x125 P-0 Value. I Enter Tested Leakul:u Flow in CPM: Pan Plow: Calculatud (NOInlaal: 21 CWling ✓❑ ileauing) or ✓❑ Mcasnrcet 2 I{utcl 'T0.41 P:nl HOW in CI:M 3 Pam if I.caka c PCrcenia e S 6% j I00 � (I oic r1 t (Line a2)IJ _ 011am ❑tail 0 '111FUNIOS'I'ATIC EXANSION V I S E (l'XV) Prneedlim Jilr /held ver icarinn of 7heerrripstatic ex )amioll volvres are available. oilXICA4 rip e-PuArlil.. 0 111011 UER Alit CONDITIONER Pruceelares sir veri icaliwr art- available in 161(:11, Appenifix Id. El Yoe ❑ Net FFR vaules of installed ai;rlems match the C F-1 k 2 0 YCS ❑ No Pur split systunt. indexwr coil is mulched to outdoor coil ✓ 3 0 Yes FJ No •time Delay Relay Verified (if Required) 0 ❑ Yes to I and 2: and l (if R uirLd) is a pass Pit 5 Fail Rr.,rirlrntinl f'nmplinncc 1 imn.r .IP11120{I1 yam" m an do (�, r�UX/�- C09 Page 1 is providesd for inspex;tiun. Thu pro edure shall consist or visuai ✓ ✓ Yes Is a piss 0 Yes ❑ Nu jAcuss verification that thtc'I'XV is installed uu dee system tuid uistulluliou ol' 0 O the specific equipment shall he verified. 0 111011 UER Alit CONDITIONER Pruceelares sir veri icaliwr art- available in 161(:11, Appenifix Id. El Yoe ❑ Net FFR vaules of installed ai;rlems match the C F-1 k 2 0 YCS ❑ No Pur split systunt. indexwr coil is mulched to outdoor coil ✓ 3 0 Yes FJ No •time Delay Relay Verified (if Required) 0 ❑ Yes to I and 2: and l (if R uirLd) is a pass Pit 5 Fail Rr.,rirlrntinl f'nmplinncc 1 imn.r .IP11120{I1 yam" m an do (�, r�UX/�- C09 Page 1