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04-5016 (SFD)c7 oz BUILDING & SAFETY DEPARTMENT c `�'IDw4 P.O. Box 1504 (760) 777-7012 OF e78-495 CALLAMPICO FAX (760) 777-7011 A -lul TA, �A LIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 .JUL 2 3 2004 � BUILDING PERMIT CITY OF I.A QUINTA FINANPIE DEP App on lr�rrrber q4L"-_00005016,= Date 6/25/04 Property Address . . . . . 50305_VIP, AMANTE APN: 772-390-037- - - Application description DWELLING— SINGLE FAMILY ATTACHED Property Zoning . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 187754 Owner Contractor R J T HOMES RJT HOMES LLC 1425 E UNIVERSITY DR 1425 E. UNIVERSITY DRIVE PHOENIX, AZ 85034 PHOENIX AZ 85034 WCC: STATE FUND WC: 1583906 10/01/04 CSLB: 690645 06/30/04 CCC: A -B --------------------------- Structure Information ------------------------- Construction Type TYPE V - NON RATED Occupancy Type . . . . . . .DWELLG/LODGING/CONG <=10 Flood Zone . . . . . . . .. NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION. 2001 CBC FLOOD ZONE NO GARAGE SQ FTG. 457.00 PATIO SQ FTG 997.00 TOT ELIGIBLE NO NUMBER OF UNITS 1.00 FIRST FLOOR SQ FTG .2894.00 ----------- .------------------------------------------ ,--------------------- --- Permit . . . . . . .BUILDING PERMIT Additional desc Permit Fee . . . . 947.50 Plan Check Fee 615.88 Issue Date Valuation . . . . 187754 Qty Unit Charge Per Extension BASE FEE 639.50 88.00 3.5000 THOU BLDG 1.00,001-500,000 308.00 ------------------------------------------------------- -;--'---------------- Permit' MECHANICAL Additional desc Permit Fee 72.00 Plan .Check Fee 18.00 Issue Date Valuation 0 Qty Unit Charge Per Extension P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0 TSO/& Date: Applicant. Applicant's Mailing Address: -Architect or Engineer: IArchitect or Engineer's Address: t3UILUING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I herebyaffirm 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 Lice se is in ull force and effect. -t' D License Class�i� � icense No. �7 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).): U 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 or 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.). U 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.). U I am exempt under Sec. , BA P.C. for this reason Date WORKERS' 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 C' issu d. My ers' cp�npensation ms ce Cartier and poli number are: , Carrier J I, _ y �/ PMcy Number 6•i e Z! j L _ I certify that, in the performance of the work for which this pe'rmiit iis"isgueed I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. WARNING: FAILURE TO SECURE WORKERS' COMPENSATI N COVERAG61S UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS -61 00,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 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 Ouinta, 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 correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above mentioned pro rty for inspection purposes. ate ZIgnature (Applicant or Agent): Page 2 Application -Number . . . . .. 04-00005016 Date 6/25/04 Qty Unit Charge, Per Extension BASE FEE .15.00. 1.00 9.0000 EA' MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 5.0.0 6.5000 EA MECH VENT FAN 32.50 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 --------------------------------------------------------=------------------- Permit . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee" 125.43 Plan Check Fee - 31.36 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 2894.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 101.29 t, 457.00 .0200 ELEC GARAGE OR NON=RESIDENTIAL 9.14 -----------------------------------------------------=----------------------- Permit . . . . PLUMBING " Additional desc Permit Fee . . . 213.00 Plan Check Fee 53.25. Issue Date Valuation . . . . 0. Qty Unit.Charge Per Extension BASE FEE 15.00 23.00 6.0000 EA PLB FIXTURE 138.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00- 6.0000 EA PLB ROOF DRAIN 6.00 1.007.5000 EA PLB WATER HEATER/VENT 7.50 11.00 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 Qty Unit Charge Per Extension BASE FEE 15.00 ------------------------------------------------------------------------------ Special Notes and Comments SFA - LOT 138, PLAN P1A. PERMIT DOES i Page 3 Application -Number . . . . . 04-00005016 Date 6/25/04 = -----------------------------=------------- Special Notes and Comments ----------------------------- --- NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY•APPROACH• --------------------------------------------.-------------------------------- Other Fees' . . . . . . .. . . ART IN PUBLIC PLACES -RES .00 DIF COMMUNITY CENTERS -RES 68.00 DIF CIVIC CENTER - RES 229.00 ENERGY REVIEW FEE 61.59 DIF FIRE PROTECTION -RES 78.00 • GRADING PLAN CHECK FEE 00 DIF LIBRARIES - RES 158.00 ' DIF PARK MAINT FAC - RES 3.00 DIF PARKS/REC -.RES 352.00 STRONG MOTION (SMI) - RES 18.77 DIF.STREET MAINT,'FAC-RES 15.00 DIF TRANSPORTATION -'RES 1098.00 Fee summary ----------------- Charged Paid Credited Due Permit Fee Total ---------- 1372.93 ------------------------------ .00 .00 1372.93 Plan Check Total 718.49 .00 .00 718.49' Other Fee Total.. 2081.36 .00. .00 2081.36 Grand Total 4172.78 .00 :00 4172.78 r s Desen- - ENERGY S'' -- C A 0 E C SW%ices P0. Box 621 Ph/Fax (760) 564-2044 Rancho Mirage, CA 92270 Cell: (760) 250-1852 Email: DESNRG OAOL.COM CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R PALMILLA PH 9 Project Title 50-305 VIA AMANTE LA QUINTA, CA. 92253 Project Address CHAD MEYER 760-564-6555 C Builder Contact Telephone RICHARD KROWN 760-250-2084 HERS RateTelephone #CCNRK613292 07-1405 Certifying Signature Firm: DESERT ENERGY SERVICES LLC Street Address: P.O. BOX 621 Copies to: Builder, HERS Provider Date DATE TESTED 7-07-05 Date RJT HOMES Builder Name OCOTILLO P-1 3 UNITS Plan Number GROUP 7 Sample Group Number LOT 138 1 OF 3 Sample Lot Number HERS -Provider: CHEERS City/State/Zip: RANCHO MIRAGE, CA. 92270 HERS RATER COMPLIANCE STATEMENT The house was: 0 Tested ❑ Approved as part of sample testing but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the houses. identified on this form comply with the diagnostic tested compliance requirements as checked on this form. ® The installer has provided a copy of CF -6R (Installation Certificate. ® Distribution system is fully ducted(i.e., does not use building cavities as plenums or platform returns in lieu of ducts) ® Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands'are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. ® MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Duct Pressurization Test Results (CFM @ 25'Pa) Test Leakage Flow in CFM If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = Check Box for Pass or Fail (Pass =6% or less) ® THERMOSTATIC EXPANSION VALVE Measured values 89 1600 5.5625 ® ❑ Pass Fail ® Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection 19 ❑ ENERGY �� _- ADE services PO. Box 621 Rancho Mirage, CA 92270 Email: DESNRG C&AOL.COM Ph/Fax (760) 564-2044 Cell: (760] 250-1852 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R PALMILLA PH 9 Project Title 50-305 VIA AMANTE LA QUINTA, CA. 92253 Project Address CHAD MEYER 760-064-6555 Builder Contact Telephone RICHARD KROWN 760-250-2084 HERS RaNVfA_ Telephone ((�� #CCNRK613292 07-1�5 Certifying Signature Date DATE TESTED 7-07-05 Date RJT HOMES Builder Name OCOTILLO P-1 3 UNITS Plan Number GROUP 7 Sample Group Number LOT 138 2 OF 3 Sample Lot Number Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS Street Address: P.O. BOX -621 Copies to: Builder, HERS Provider City/State/Zip: RANCHO MIRAGE, CA. 92270 HERS RATER COMPLIANCE STATEMENT The house was: ® Tested ❑ Approved as part of sample testing but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. ® The installer has provided a copy of CF -6R (Installation Certificate. ® Distribution system is fully ducted(i.e., does not use building cavities as plenums or platform returns in lieu of ducts) ® Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. ® MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM @ 25 Pa) values Test Leakage Flow in CFM 60 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here 1000 If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = 6 Check Box for Pass or Fail (Pass =6% or less) ® ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) ® Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ® ❑ D - - ENERGY S'1 -- C A 0 E C Sarvicas P0. Box 621 Rancho Mirage, CA 92270 Email: DESNRG (WAOL.COM Ph/Fax (760) 564-2044 Cell: (760] 250-1852 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R PALMILLA PH 9 Project Title 50-305 VIA AMANTE LA QUINTA, CA. 92253 Project Address CHAD MEYER 760-564-6555 Builder Contact Telephone RICHARD KROWN 760-250-2084 HERS #CCNRK613292 Telephone Certifying Signature Date Firm: DESERT ENERGY SERVICES LLC Street Address: P.O. BOX 621 Copies to: Builder, HERS Provider DATE TESTED 7-07-05 Date RJT HOMES Builder Name OCOTILLO P-1 3 UNITS Plan Number GROUP 7 Sample Group Number LOT 138 3 OF 3 Sample Lot Number HERS Provider: CHEERS City/State/Zip: RANCHO MIRAGE, CA. 92270 HERS RATER COMPLIANCE STATEMENT The house was: ® Tested . ❑ Approved as, part of sample testing but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. ® The installer has provided a copy of CF -6R (Installation Certificate. ® Distribution system is fully ducted(i.e., does not use building cavities as plenums or platform returns in lieu of ducts) ® Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. ® MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM @ 25 Pa) values Test Leakage Flow in CFM 35 If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here 800 If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = 4.375 Check Box for Pass or Fail (Pass =6% or less) ® ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) ® Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ® ❑ INSTALLATION CERTIFICATE CF -6R 50-305 Via Amante Site Address Permit # . r 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 optionl.) 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). HVAC SYSTEMS: Heating Equipment Equip. Type (pkg. heat CEC Certified Mfr, Make & pump, etc.) Model Number FAU CARRIER 58STX090116 FAU CARRIER 58STX070112 FAU CARRIER 58STX045108 Cooling Equipment # of Efficiency Duct Duct or Heating Heating Identical (AFUE,etc.)' Location Piping Load Capacity Systems [zCF-I]Zvalue] (attic, etc.) R -value (Btu/hr) (BTU/Hr) 1 80.0% ATTIC R-4.2 90,000 1 80.0% ATTIC RR -4.2 " 70,000 1 80.00/;o ATTIC R-4.2 45,000 Equip. Type # of Effeciency Duct Cooling Cooling (pkg. heat CEC Certified Compressor Unit Identical (SEER, etc)' Location - Duct Load Capacity pump, etc.) Mfr. Name and Model Number Systems [zCF-]R value] (attic, etc.) R -value (Btu/hr) (BTU/Hr) A/C COND. CARRIER 38BRE04 0000 1 12 ATTIC R-4.2 48,000 A/C COND. CARRIER 38BRC030000 1 12 ATTIC R-4.2 30,000 A/C COND. CARRIER 38BRCO24000 , 1 12 ATTIC R-4.2 24,000 1 > reads greater than or equal to I, 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 exce appropriate equirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable. AMPAM LDI Mechanical S rlenubrey 2/4/2005 HVAC Subcontractor (Co. Name) OR General Contractor OR Owner WATER HEATING SYSTEMS: Water CEC Certified Distribution If Recir- Rated Input Tank . Efficiency Standby External Heater Mfr Name & Type (Std, culation, • # of Identical (kW or Volume (EF, RE) Loss (%) Insulation R - Type/# Model Number Point -of -Use) Control Type Systems Btu/hr) (gallons) value FAUCETS & SHOWER HEADS: All faucets and showerheads installed are listed in the Commisions Directory of Certified Faucets and Showerheads, pursuant to Title -24, Part 6, Subchapter 2, Section 111. I, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment installed and that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards. In addition, I have verified that the equipment is equivalent to or more efficient than the equipment specified on the Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for residential buildings. RCR COMPANIES Signature, Date Plumbing Subcontractor (Co. Name) OR General Contractor OR Owner COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy INSTALLATION CERTIFICA Page 3 of 13) CI+ -6R DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCl''LLrAKAGE REDU&I'10N Pressurization Test Results (CFM Qo 25 PA) Test Leakage (CFM) - Fan Flow If Fan Flow is Calculated as 400 cfm/ton x number of tons, or as:21.7 x Heating Capacity In Thousands of Stu/hr, enter calculated value here If fan flow Is measured, enter measured value here Leakage Fraction @ Test Leakage/(Meisured or Calculated Fan Flow) a a Past if leakage fraction <0.06 Pass Fail O For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: - O Yes O No O Pressure pan test or House pressurization test O Yes O No O Visual Inspection of Duct Connections o a ❑ _THERMOSTATIC EXPANSION VALVE-fTXVI O Yes O No 'Thermostatic Expansion Valve is installed and Access is - provided for inspection Yes is a pass o 0 O DUCT DESIGN Pass Fall 1. O Yes O No ACCA Manual D Design calculations have been completed, Duct Design Is on the plans. and duct Installation matches plans. 2. O Yes O No •TXV is installed.or Fan flow has been verified. If no TXV, a o verified fan flow matches design from CF -IR Pass Fail Measured Fan Flow Yes for both I and 2 is a Pass O I, the undersigned, verify that the above diagnostic test results and the•work I performed associated with the test(s) is in conformance with the requirements for compliance credit. nle builder shall provide the HERS provider a copy of the CF -6R "signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit. ) Tests Sign ure, Date Installing Subcontractor (Co. Name) OR Perfomxd General Contractor (Co. Name) COPY M: Building Department HERS Provider (if applicable) Building Owner at Occupancy Compliance Forms August2001 A-25 ' INSTALLA'TION CERTIFICATI; (Page 3 of 13) CF-6R �Ilm 11 a Plias t: 104- t3 S Site Address Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS DUCT LJJAKAGE R-EI)Q HON Pressurization Test Results (CFM ® 25 PA) Test Leakage (CFM) Fan Flow - If Fan Flow is Calculated as 400 cWton x number of tons, or as '21.7 x Heating Capacity In Thousands of Btu/hr, enter calculated value here.T - If fan flow Is measuredi enter measured value here Leakage Fraction @ Test Leakage/(Measured or Calculated Fan Flow) p p Pass if leakage fraction <0.06 Pass Fail O For AEROSOL TYPE SEALANTS ONLY -The following diagnostic tesdng,was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: O Yes O No . O Pressure pan test or House pressurization test O Yes O No O Visual Inspection of Duct Connections o 0 Pass Fall ❑ THERMOSTATIC EXPANSION VALVE CrXVI O Yes O No Thermostatic Expansion Valve is installed and Access is - provided for inspection. Yes is a pass o o DUCT DESIGN Pass Fall I. O Yes ONO ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct Installation matches plans. 2. O Yes O No TXV is installed or Fan flow has been verified. If no TXV, o 0 verified fan flow matches design from CP -0L Pass Fall Measured Fan Flow Yes for both I and 2 is a Pass O I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance with the requirements for compliance credit (The builder shall provide the HERS provider a copy of the CF -6R signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit. J Tests ignature, Date Installing Subcontractor (Co. Name) OR Perfomud General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Compliance Forms August2001 . A-25 IN!SITALLATION CERTIFICATE (P: 3 of 13) CF -6R Permit Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS ` DUCT LEAKAGE REDUC:'1 ON Pressurization Test Results (CFM Q 15 PA) Test Leakage (CFM)-E0— Fan CFM)q 0.Fan Flow If Fan Flow is Calculated as .400 cfmhon x number of tons, or as 21.7 x Heating Capacity In Thousands -of Btulhr, enter calculated value here If fan flow Is measured, enter measured value here -J( Leakage Fraction a Test Leakage/(Measured or Calculated Fan Flow) a 0 Pass if leakage fraction <0.06 Pass Fall ❑ For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: ❑ Yes O No O Pressure pan test or House pressurization test ❑ Yes O No O Visual Inspection of Duct Connections o 0 Pass Fail O THERMOSTATIC EXPANSION VALVE (TXV1 O Yes O No Thermostatic Expansion Valve is installed and Access is - provided for inspection Yes is a pass O o O DUCT DESIGN Pass Fall. ACCA Manual D Design calculations have been 1. ❑ Yes O No completed, Duct Design Is on the plans and duct installation matches plans. 2. O Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, o verified fan flow matches design from CF-IIL Pass Fail Measured Fan Flow Yes for both 1 and 2 is a Pass O I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance with the requirements for compliance credit. (The builder shall provide the HERS provider a copy of the CF -6R signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for compliance credit. I Tests 7Signature, Date Installing Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY T0: Building Department HERS 'Provider (if applicable) Building Owner at Occupancy Compliance Forms August 2001 A-25 36�8 - 9 �9 -�zsy