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0107-332 (AR)1"' _N N W O =) M QLn oZ� 0 c r LUa U) Z m L0 N O� U Q Z `rla0 Q J J mVU O a�� 14, Z_ ob J LICENSED CONTRACTOR 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 ano Professionals Code, and my License is in full force and effect. License # LIc. Class Exp. Date Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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 & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed tcontractors to construct the project (Sec. 7044, Business & Professionals Code). ( ),:I am exempt under Section , B&RC. fo this reason Date 11114,1 Signature of Owner ( 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 & policy no. are: Carrier Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). ( ) 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 3700 of the Labor Code, I shall forthwith comply with those projisions<!'' ,DateApplicant ' ^-= 7"Z Warning: �F i ure'to secure WorkeW-6mpensation covpTage is unlawful and shall subject an employer to criminal penalties and civil fines up to $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. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person ai'fT whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 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 State laws relating to the building construction, and hereby authorizer presentatives of this City to enter upon the above-mentioned property for insr;qcti, ...purposes!- Signature (Owner/Agent) Date�y r BUILDING PERMIT., PERMIT# DATE` VALUATION LOT 0107-4132 TRACT JOB SITE APN ADDRESS OWNER CONTRACTOR / DESIGNER / EN INEER JE ff 9MLWFk Cz - iCIIi.I�: 79.345 DIM, RT (MOT WRIVE CA USE OF PERMIT .RoJ, 10MML1`1�,i3'ti� 110 S.F. POOL HOUSE .a DDI T3t. N 1201 0 S? WMAWMAI COST OF CONi7J'..66UIr—Il IN 6151.6. 00 'PIAN CHECK 3+.E3.'' 7.01-000.439.318 $64.33 CaMSTRUC's IOW FICE, 101-000-418-000 $90.00 to ECi i IN [CAL SFFM 101-000^42.3. x000 51100 KLECTRtG,Atf PEE 101-000-420-000 $10.20 STR.0140 140TiPW - RY,S)13 IQ.1-000-24't i3tit7 $170 ,r��i pE o rte+ Y�z , f y 757 /� ��9 >� t 7 r�y�y [ � y An A � CONEY, 91J.8-1.1.ArX.. `-i�, NEY,.i i:lai.:A.A�.)Av.,�:t`�. P.i..Y'�Le c.r.S.`1�.�,.M �A�9 �y W.L�' ,25 1,.639 PRE -PAW FEE $n,(?rJ RECEIPT DATE BY DATE FINALEDINSPECTOR f ' 1 .' �r/ INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ Final BLOCKWALL APPROVALS Final POOLS -SPAS Steel Set Backs Electric Bond Footings Main Drain 'Ebnd Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: 06� 3L.oGv`.�'T,�✓5��.ifs+�,�%�"fl L sflcort �i4��o�� zoo Al -WC --1 `(/p A�Ad j /a�0 �.••�a' 'j' / 7 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) OWNER/ BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. i If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U,S. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an Owner /Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Qui CA 2253 (760) 77-701 Z7 �R'S SIGNATU�l14 PROPERTY ADDRESS PERMIT NUMBER(s) N I ' LFw. ` v Vv • le Noie 2 s�/� �� t7j 11� vt v tl \J, 11. V) i 1, (.(0 *.../ I/q CERTIFICATE OF COMPLIANCE: RESIDENTIAL (P Project T4e ICI 0r. 1 Project Add s Documen ion u{jaor Telephone ci C� `r�C, i it Compliance Method ( ackage or Computer) Climate Zone I of 3) CF -IR Building Pumit k Plan Check / Date Field Check / Date GENERAL INFORMATION Total Conditioned Floor Area 12 U ft, Average Ceiling Height: _�� it Conditioned Slab Floor Area (Z U le Building Type: Single Family t ---Addition (check one or more) Multi -Family Existing -Plus -Addition Front Orientation: ort South / East / West / All Orientations input pont oricalatim in degrees ftuin Truc Nutth and circle one) Number of Stories Number of Dwelling Units: Floor Construction Type:la�/Raised Floor (circle one ur both) f Required for this submittal_ yes —no RADIANT BARRIER (required in climate zones 2, 4, 8-15) BUILDING ENVELOPE INSULATION Component Frame Type Type wd = wood sil = stee Cavity Insulation R -Value Sheathing Insulation R -Value Total R- Assembly Value' U-Factorl Localion/Comments (attic, garage, typical, etc.) Wall Front Front -- — Wall A_ Roof Left Roof Lh Left Floor _ Floor — ------- -- _ Slab Ed e Rear ---- -- - --- ---- --- — For Prescriptive compliance, Total 11 -Value and Assembly It-1'aclor arc not required for a wood -framed wall that nheets cavity 11 -value insulation requirements for the Prescripliye Package. FENESTRATION Shadint► Devices Fenestration Orien- #/T e/Pos. tation Area (ft2) Fenestration U-Faclor Fenestration SllGC Exterior Shading Ali. Overhangs/ bins Front Front Left Lh Left _ Rear Rear Right Right rITy 01- L Skylight ILDING & Skylight _ — - no January 5, 2001 A QUINTA ')AFETY DEPT. rpt t LL VE® ng CONSTRUCTION DATE-- BY CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 3 V.4. C re: Pro Date CF -I R HVAC SYSTEMS Note: Input hydronic or combined hydronic data under Water Heating Systems, except Design Ilealing load. ' Distribution Heating Equipment Minimum Type and Duct or tical Pump Type (furnace, heat Efficiency Location Piping Thermostat Configuration pump, etc.) (AFUE or IISPF) (ducts, attic, etc.) R -Value Type (split or package) Cooling Equipment Minimum Duct Heat Pump Type (air conditioner, Efficiency Location Duct Thermostat Configuration heatum , eva . cooling)(SEER attic Cie.)R-Value Type (split or package SEALED DUCTS and TXVs (or Alternative Measures) ❑ Sealed Ducts (all climate zones) (Installer testing and certification and HERS Cuter field verification required) ❑ TXVs or Commission approved equivalent, readily accessible (climate zoncs 2 and r 15 only) (Installer testing and certification and tfERS Rater or field verification required) OR ❑ Alternative to Sealed Ducts and TXVs (see Package Cori) Alternative Package Features for Project Climate Zone) Climate Zone Window SHGC Window U -Factor SEER heating WATER HEATING SYSTEMS Energy' External • Rated' Tank Factor or Tank Water Heater Distribution Number Input (kW Capacity Recovery Standby' Insulation Type Type in System or unt/ttr) Gallons) Efficiency Loss (%) R -Value I. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/110, electric resistance, and hat pump water heaters, list Energy Factor. For large gas storage water heatet-s (rated input of greater than 75,000 Blit/hr), list Rated Input, Recuvcry Efficiency and Standby Loss. For instantaneous gas water heatcrs, list rated input and recovery cRiciencies. SPECIAL FEATURES (add extra sheets if necessary). Package C and D: '1'XVs or Commission approved equivalent, Sealed Ducts, Radiant Barriers (see installation requirements for radiant barriers in Section 8.13 of the 1999 Residential Manual). Package C: thermal mass (thermal mass type, covering, thickness, and description). January 5, 2001 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 3) CF -111 COMPLIANCE S'1'A'FEMENT This certificate of compliance lists the building features and performance 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 design responsibility. The undersigned recognize that compliance using duct sealing and TXVs (or Commission approved equivalent) requires installer testing and certification and field verification by an approved HERS rater. Designer or Owner (per Business and Professions Code) Name: Title/Firm: Address: Yet 3t -t. se rt C✓��, r - Q,-, V -e [<< liCwr�lt� (111 Enforcement Agency Name: Title: Agency: Telephone: (signature / stamp) (date) DocumentationCAuthor Name: Title/Firm: Address: Telephone: (signature) January 5, 2001 (dale) INSTALLATION CERTIFICATE (Page I of 8) CF -612 -Tg 31-t 5- Q:5� 1--f- cr t Site Address Permit Number An installation certificate is required lube posted at lite building site or made available for all appropriate inspections. (The information provided on this form is required; however, use of [his form to provide the information is optional.) After completion of final inspection, a copy must be provided to lite building department (upon request) and the building owner at occupancy, per Section 10-103(b). HVAC SYSTEMS: Heating Equipmenl Equip. a of Efficiency Duct Duct u1- I Icating Ilcaling Type (pkg. CEC Curtilicd Mit Namc Ideruical (AF'UE, c1c.)n Wcatiuu I'ipiug Load Capucity heat oumol •md Model Number sysicmn IIt valuel (allic_ c1c.1 R-valhic Iliuh/111-1 Ifilu/111-1 Cooling Equipment Equip. CEC Certified Compressor p of lifficicncy Duct Cooling Cooling Type (pkg. Unit Mfr Name and Idculical (SEER, cic.)t location Duct Load Capacity heat Dullip) Model Number Systems 120F-IIt ya_lucl hauic_ GlcA R-yal he InmAo'1 (11intfire 1. > reads greater than. or equal to. 1, the undersigned, verify that 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 CI --I R) submitted for compliance with the Energy Ef cie Standards For rest crib- I buildings, and 3) equipment that meets or exceeds the appropriate requirements for man act red de es (tion Appliance Ejjicienc:), Regulations or Part 6), whey, _pplicable. S' cure, ate Installing Subconlractor (Co. Name) OR General Contractor (Co. Natio) OR Owner WATER HEATING SYSTEMS: Distribuliun If I(e:ir- q of I(aled, Tank Etii- External Heater CL•C Certified Mfi• 'Type (Sid, culatiuo, Ideulical lupin (kW Volume ciencyz Stundb/ Insulation Type Name & Model Number Point -of --Use) Coutrul "Type Systems or mtu hr) (gallons) (EF, RE) Loss (%) It-valuct 2 For small gas storage (rated input of less than or equal to 75,000 I)lu/hr), ele'c'tric resistance and Ileat pump water hcalers, list Energy Factur. For large gas storage water healers (rated iuput of gwatcr than 75,100 lindhr), list Itecovu'y Efficiency, Standby Loss and Italed Input. Fur Instantaneous gas water heaters, list I(e:uVe y Ellicicncy and hated Input. 3. R-12 extemul insulation is mandatory fur storage water hudexs with all energy tactor of Icss luau 0.5h. Faucets & Shower Ileads: All faucets and showerheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section I 11. f, the undersigned, verify that equipment listed above my signature is: 1) the actual equipment installed; 2) equivalent to or more efficient than that specified in the certificate of compliance (Form CF -I R) submitted for compliance with the Energy Efficiency Standards for residential buildings; and 3) equipment that meets or exceeds lite appropriate requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable. Signature, Date COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner January 4, 2001 INSTALLATION CERTIFICATE (Page 2 of 8) CF -6R Site Address Permit Number FENESTRATION/GLAZING: 'total Quantity Product Product of Like LXtcrior Shading U-Factur' (5 SIiGC' (S N of Product Squarc Dcvicc ur Comments/Location/ Manufacturer/nrand Name CF -IR valuc)2 CF -IR valud Pam:s (Ovdanall Feet Overhiulk Soccial Features (GROUP • IKE P ODum). 2. 3_ 1 3. 4. _ 5. 6. _ 7. _ 8. 9. _ 10. _ l 1. 12. _ 13. 14. 15. _ ' Manufactured fenestration products use the values from the product label. Field fabricated fenestration products use the default values from Section 116 of the Energy Efficiency Standards. Installed U -Factor must be less than or equal to values from CF -1 R. Installed Sl IGC must be less than or equal to values from CF -1R, or a shading device (exterior or overhang) is installed as specified on the CF -IR. Alternatively, installed weighted average U -Factors for the total fenestration area are less than or equal to values from CF -1R. I, the undersigned, verify that the fenestration/glazing listed above my signature: 1) is the actual fenestration product installed; 2) is equivalent to or has a lower U -Factor and lower SHGC than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the Energy Efficiency Standards fur residential buildings; and 3) die product meets or exceeds the approp a quire us for faclured devices (from Part 6), where applicable. It m # Si ue, Date Installing Subcontractor (Co. Name) OR (if applicable) General Contractor (Co. Name) Olt Owner OR Window Distributor Item #s Signature, Date (if applicable) Item #s Signature, Date (if applicable) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy January 4, 2001 Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner OR Window Distributor Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) Olt Owner OR Window Distributor INSTALLA`T'ION CERTIFICATE (Page 3 of 8) CF -611 7-/ 31-r 5 (P t- ('rr s r - DUCT LEAKAGE AND DESIGN DIAGNOSTICS ❑ DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM a 25 PA) Test Leakage (CFM) Fan Flow If Fan Flow is Calculated as 400 efirdlon x number of tons, or as 21.7 x Heating Capacity in Thousands of Btu/hr, enter calculated value here If fan flow is measured, enter measured value here Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) = Pass if leakage fraction <_ 0.06 ❑ ❑ Pass Fail ❑ 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 ❑ No ❑ Pressure pan test or Ilouse pressurization test ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑ Pass Fail ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection ❑ ❑ Yes is a pass Pass Fail ❑ DUCT DESIGN 1 • ❑ Yes ❑ No ACCA Manual D Design calculations have been completed, Duct Design is on die plans and duct installation matches plans. " 2• ❑ Yes ❑ No TXV is installed or I' -'an flow has been verified. If nu "rXV; verified fan flow matches design from CF -I I2. Measured Fan Flow = ❑ ❑ Yes for both 1 and 2 is a Pass Pass Fail ❑ 1, 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 I1ERS 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 Signature, Date Installing Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy January 4, 2001 INSTALLATION CERTIFICATE (Page 4 of 8) CF -6R ` ci Ll <; Inc' S -c 1._ t- ress DUCT LOCATION AND AREA REDUCTION DIAGNOSTICS ❑ DUCT IN CONDITIONED SPACE ❑ Yes ❑ No Duct in conditioned space criteria matches CF -1R ❑ ❑ Yes is a Pass Pass Fail ❑ REDUCED DUCT SURFACE AREA Measured duct exterior surface area in the following unconditioned duct locations (square feet): Attics Crawlspaces Basements Other (e.g., garages, etc.) ❑ Yes ❑ No Duct surface area matches CF -1R? Yes is a Pass Pass Fail ❑ I, the undersigned, verify that the duct surface area and duct locations claimed for duct surface area reductions and duct location improvements beyond those covered by detault assumptions match those on the plans. (The builder shall provide the HERS provider a copy of the CF -612 signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for com ance credit.] Tests Signature, Date installing Subcontractor (Co. Name) OR Performed COPY TO: Building Department TIERS Provider (if applicable) Building Owner at Occupancy January 4, 2001 General Contractor (Co. Name) INSTALLATION CERTIFICATE (Page 5 of 8) CF -6R BUILDING ENVELOPE LEAKAGE DIAGNOSTICS ❑ ENVELOPE SEALING INFILTRATION REDUCTION Diagnostic Testing Results Pass if: a. Yes in line 1 and line 3, or b. Yes in line 1 and line2, 2a, and 2b, or c. Yes in line 1 and Yes in line 4. Otherwise fail. ❑ ❑ Pass Fail ❑ 1, the undersigned, verify that the building envelope leakage meets the requirements claimed fur building leakage reduction below default assumptions as used for compliance on the CF-] R. This is to certify 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 -611 signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the r qui ements for compliance credit.] Test Performed Signature Date Testing Subcontractor (Co. Name) OR General Contractor (Cu. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy January 4, 2001 Building Envelope Leakage (CFM @ 50 Pa) as measured by Rater 1. Is measured envelope leakage less than or equal to the required level Yes No from CF -1 R? 2. ❑ ❑ Is Mechanical Ventilalion'shown as required on the CF -1R? Yes No 2a. [] ❑ If Mechanical Ventilation is required on the CF -1R (Yes in line 2), has Yes No it been installed? 2b. ❑ ❑ Check this box yes if mechanical ventilation is required (Yes in line 2) Yes No and ventilation fan watts are no greater than shown on CF -1 R. Measured Watts = .3. ❑ ❑ Check this box yes if measured building infiltration (CFM @ 50 Pa) is Yes No greater than the CFM @ 50 values shown for an SLA of 1.5 on CF -1R (If this box is checked no, mechanical ventilation is required.) . 4. ❑ [� Check this box yes if measured building infiltration (CFM @ 50 Pa) is Yes No less than the CFM @ 50 values shown for an SL n of 1.5 on CF -1 R, mechanical ventilation is installed and house pressure is greater than minus 5 Pascal with all exhaust fans operating. Pass if: a. Yes in line 1 and line 3, or b. Yes in line 1 and line2, 2a, and 2b, or c. Yes in line 1 and Yes in line 4. Otherwise fail. ❑ ❑ Pass Fail ❑ 1, the undersigned, verify that the building envelope leakage meets the requirements claimed fur building leakage reduction below default assumptions as used for compliance on the CF-] R. This is to certify 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 -611 signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the r qui ements for compliance credit.] Test Performed Signature Date Testing Subcontractor (Co. Name) OR General Contractor (Cu. Name) COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy January 4, 2001 INSTALLATION CERTIFICATE (Page 6 of 8) CF -6R The following is an explanation of many of the input values required on this form: HVAC SYSTEMS Heating Equipment T e must be one of the following: Furnace: Gas (including liquefied Petroleum Gases) or oil -tired central furnace & space heater Boiler: Gas or oil -tired boiler. PckglicatPunlp: Packaged central heat pump Splitl leatPump: Split central heat pump Roo111llejltPllmp: Room heat pump LgPkgHeatPump: Large packaged heat pump (>_ 65,000 Btu/hr output) Electric: Electric resistance heating (fixed IISPF = 3.413); radiant electric resistance (fixed IISPF = 3.55) Combinedilydro: Reference water heater under water heating systems below CEC Certified Manufacturer Name & Model Number from applicable Commission approved appliance directory. # of Identical Systems is for those systems with the same efficiency, duct location, duct R -value and capacity. Efficiency from applicable Commission certified appliance directory. Duct (or Piping) Location is attic, crawl space, CVC crawl space, conditioned space, unconditioned space or none. Duct (or Piping) R -Value from Directory of Certified Insulation Materials and/or manufacturer's data. Heating/Cooling Load refer to Counnission approved .load calculation procedure. Heating/Cooling Capacity fi-oul the applicable Commission certified appliance directory. Note: location elevations over 2,000 ft above sea level require a derating of output capacity (refer to manufacturer's literature). Cooling Equipment T ie must be one of the followin SplitAirCond: Split system air conditioner PckgAirCond: Packaged air conditioner Split fleat Pump:_ Split system heat pump Pckgl leatPunlp: Packaged heat pump Roonil-leatPump: Room heat pump LgPkgHeatPump: Large packaged heat pump (Z 65,000 Btu/hr output). Substitute EER filr SEER when SEER is not available Roon1Ait-Gond: Room air conditioner. Minimum SEER varies" I-gPkgAirCond: large packaged air conditioner (2 65,000 BILI/lir output). Substitute EER for SEER when SEER is not available EvapDirect: Direct evaporative cooling system. For compliance calculation purposes, fixed values: SEER = 11.0; duct location = attic; duct insulation R -value = 4.2 Evapindirect: Indirect evaporative cooling system. For compliance calculation purposes, fixed values: SEE It = 13.0; duct location = attic; duct insulation R -value = 4.2 'Refer to Energy Commission publication Appliance Efficiency Rebalations, P400-92-029 January 4, 2001 INSTALLATION CERTIFICATE (Page 7 of 8) CF-6R 1-r �- oe C; -C r �- l k'-""'-S• � - The following is an explanation of many of the, input values required on this form: WATER HEATING SYSTEMS rll.f_tr...finn Cvefamc D. -r— 1n I?u.•i.lu..finl kh/ j.nl fnr ninre de.laik- Standard: Standard — Supply pressure based system, no pumps Pipe Insulation: Pipe Insulation on all 3/4 -inch pipes POU/HWR: Point of Use/I lot Water Recovery System Recirc/NoControl: Recirculation loop with no controls Recirc/Timer: Recirculation loop with a tinier Recirc/Temp' Recirculation loop with temperature control Recirc/Time-l-Temp: Recirculation loop with a tinter and temperature control Recire/Demand: Recirculation loop with demand control Water Heater Tyne Windows, sliding glass doors, French doors, skylights, garden windows, and Information Needed any door with more than one square foot of glass Operator Type: Energy Factor Recovery Efficiency Standby Loss Rated Input Storage Gas, Oil or Electric Yes No No No Heat Pump Yes No No No Instantaneous Gas No Yes No No Instantaneous Electric Yes No No No Large Storage Gas No Yes Yes Yes Indirect Gas (Boiler) No Yes (AFUE) No Yes FENESTRATION/GLAZING Fenestration: Windows, sliding glass doors, French doors, skylights, garden windows, and any door with more than one square foot of glass Operator Type: Slider, hinged, fixed U -Factor. Installed U-Factur must be less than or equal w value lium CF -1 R OR Installed weighted average 0 -Factor for the total fenestration area is less than or equal to value from CF- I R SHGC: Installed SIIGC must be less than or equal to value from CF -I It Olt installed weighted SIIGC for [lie total Icneslration area is less than or equal to value from CF -IR Olt An interior shading device, overhang, or exterior shading device is installed consistent wi[h the CF - lit Shading Device: Include when the building complied using an exterior shading device: woven sunscreen, louvered sunscreen, low sun angle sunscreen, roll -down awning, roll -down blinds or slats (du not list bug screen), or an overhang (include depth in feet) January 4, 2001 0 INSTALLATION CERTIFICATE (Page 8 of 8) CF -6R iz:j,'f Cre-s f. Site Address Permit Number The following is an explanation of many of the input values required on the Diagnostic portion of this form (page 3 of 6): TYPE OF CREDIT Refer to Residential Manual Chapters 4 and 5 for more details: Reduced Duct Surface Area: Calculated as the outside area of dte duct. Areas must be measured and verified by a HERS rater. Improved Duct Location: Supply duct located in other than attic, as verified by localion of registers (does not require IIERS rater verification). . Catastrophic leakage: Pressure pan test readings must be less than 1.5 Pascal at a house pressure of 25 Pascal. TXV (or Commission Access cover required to facilitate verification. Eligibility criteria for approved equivalent): Commission approved equivalent, if applicable, is required to be met. Infiltration Reduction: Infiltration is measured without mechanical ventilation operating. Mechanical ventilation is required for very tight house construction when credits for infiltration reduction using diagn6sth; testing are being used for achieving compliance. These very tight houses are defined as those with SLA of less than 1.5. The compliance documentation (CF -1 R) will contain the measured CFM target value h-om a blower door test at 50 Pascal pressure difference that represents this SLA of 1.5. Mechanical ventilation is also required if the builder chooses to design the building to use mechanical ventilation and claims a credit for infiltration below an SLA of 3.0. Tile compliance documentation (CF - IR) will'contaiu the measured CFM target value that represents this 3.0 SLA. If the builder claims credit in a design for infiltration reduction that is at an SLA of 3.0.or higher, and the actual measured SLA is 1.5 or greater, then mechanical ventilation is not required. .If the SLA in this case were below 1.5, then mitigation (such as mechanical ventilation) would be required. January 4, 2001 JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 1SPECIAL INSPECTIOFax (760) 772-7193 REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING ❑ ❑ OTHER JOB 'TIN 1,AV , 1v t'PERMIT REPORT SEQUENCE N0. TYP Of T IJCTURREE NO. DATJ +� DAY OF WEEK MATERIAL DESCRIPTION ARCHITECT IuLpj J MRS. CHARGED ENGINEER ASSISTANTS HRS. CHARGED INSPECTION _ DATE GENERAL _ _ SUB CONTRACTOR CONTRACTOR JZ _ � oaG LN �-n v� . COPY SENT TO CLIENT O CONTINLKON NEXT PAGE D PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. --�/a;GNATU E OF REGISTERED SPECT/OR �P C T OF REPORT REGISTER NUMBER