04-6861 (SFD)0
BUILDING & SAFETY DEPARTMENT
- 4 .--- P 760
( ).. 64,'Box 1-504 77,7-7012
d
h 9C�'►1 9 794,95 CALLE TAMPICO } FAX 760 777-7011
QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)777-7153
cl CBUILDING PERMIT
Application Number 04-00006861 Date 11/24/04
Property Address . . . . . . 52840 AVENIDA VILLA
APN: 773-334-006-21-000000-
Application"description DWELLING - S.INGLE FAMILY DETACHED
Property Zoning . . . . . COVE RESIDENTIAL
Application valuation 110345.
Owner Contractor
TUVELL MARK F OWNER
72850 SOMERA RD
PALM DESERT CA 92260
------ Structure Information SINGLE FAMILY DWELLING -----
Construction Type TYPE V - NON RATED
Occupancy Type . . . . . . DWELLG/LODGING/LONG <=10
Flood Zone . . . NON -AO FLOOD ZONE
Other struct info . . . . . CODE EDITION 2001 CBC
# BEDROOMS .3.00
FIRE SPRINKLERS NO
GARAGE SQ FTG 441.00.
NUMBER OF UNITS 1.00
.1ST FLOOR SQUARE FOO -AGE 1778.00
Permit BUILDING PERMIT..
Additional desc
Permit Fee 678.00 Plan Check Fee 440.7'0
Issue. Date Valuation 110345
Qty Unit Charge Per Extension:
BASE FEE 639.50
11.00 3.5000 THOU BLDG 100,001-500,000 38.50
--------------- 7 --------------------------------- --------- - -------------
Permit
--------- --Permit . . . . . . MECHANICAL
Additional desc
Permit Fee . . . 59.00 Plan Check Fee 14.75
'Issue Date . . . . Valuation 0.
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 B'_'U 9.00
3.00 6-.5000 EA MECH VENT FAN 19.50
1.00 6.5000 EA MECH EXHAUST HOOD 6.50
------------------------------------------
Permit . . . . ELEC-NEW RESIDENTIAL
Additional desc
Permit Fee 101.05 Plan Check Fee 25.26
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: _ d q-& p(. f
Applicant:
Applicants Mailing Address:
Date:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
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�3�1,�
License Class 23 License No..
Date — —o e
A/-Ontractor ✓- ! ��c1�
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. , B.& 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
/ . sued. Myyorkers' compensation insurance carrier and policy number are:
Carrier S i 1`S 1-csAJQ Policy Number 17 CJ ,—,o 41 i- �Z Op q
_ I certify that, in the performance of the work for which this pernit is issued, I shall not employ Sny person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become su 'ect to the workers' compensafion provisions of Section 3700 of the Labor Code, 1 shall
forthwith comply with those provisions.
Date '�O - Applicant - lee
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.
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-menfioned propert inspection purposes.
Date / J6 _ d Signature (Applicant or Agent):
i
Page
2
Application Number
.04-00006861,' Date.
11/24/04
Issue Date
Valuation. _
0
Qty Unit
Charge
Per
Extension
BASE FEE
15.00
1778.00
.0350
ELEC NEW RES - 1 OR 2 FAMILY
62.23
441.00
.0200
ELEC GARAGE OR NON-RESIDENTIAL
8.82
1.00
15.0000
EA ELEC TEMPORARY POWER POLE
15.00
Permit . .
. . .
PLUMBING
Additional desc
Permit Fee
129.00 Plan Check Fee
32.25
Issue Date
Valuation
0
Qty Unit
Charge
Per
Extension
BASE FEE
15.00
10.00
6.0000
EA PLB FIXTURE
60.00
1.00 .15.0000
EA PLB BUILDING SEWER
15.00
1.00
7.5000
EA PLB WATER HEATER/VENT
7.50
1.00
3.0000
EA. PLB WATER INST/ALT/REP
3.00
1.00
9.0000
EA PLB LAWN SPRINKLER SYSTEM
9.00
6..00
.7500
EA PLB GAS PIPE >=5
4.50
1:00.
15.0000
:EA PLB.GAS METER
15.00
------------------------------------------------------------------------------
Permit .
. . .
GRADING PERMIT
Additional desc
Permit Fee
15.0.0 Plan Check Fee_.
.00
Issue Date
Valuation
0
Qty Unit.Charge
Per`
tExtension
BASE FEE -
15.00
Special Notes
and Comments
1778 S.F. SFD
PERMIT
DOES NOT INCLUDE.
BLOCK WALL, POOL/SPA
OR DRIVEWAY
APPROACH
Other Fees .
. . . .
ART IN PUBLIC PLACES -RES
.00
DIF COMMUNITY CENTERS -RES
97:00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
44.07
DIF FIRE PROTECTION -RES
97.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
225.00
DIF PARK MAINT FAC - RES
5.00
DIF PARKS/REC - RES
502.00
STRONG MOTION (SMI; - RES
11•.03
t .
Page .3
Application Number
04-00006861
Date 11/24/04
Other Fees
DIF STREET
MAINT FAC -RES
15.00
DIF TRANSPORTATION
- RES
1098.00
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
982.05
.00.
.00
982.05
Plan'Check Total
512.96
250.00
.00
262.96
Other Fee Total
2460.10
.00
.00
2460..10
Grand Total
3955.11
250.00
.00
3705.11
Building
Address
0
Address
City
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
f 1uT_-J-pt 1-01 2 Z v z 7:Z--4 v
&Classif. �go to ILic�.#
Arch., Engr.,
Designer
Address Tel.
City (Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5, Business and Professions Code- Any city or county which requires a
permit to construct, alter, improve, demolish, or repair Ay structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencingwith Section 7000) of
Division 3 of the Business and Professions Code, or that he 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).
O 1, 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 Profes-
sions Code: The Contractor's License Law does not apply to an owner of property who builds
or improves thereon and who does such work himself or through his own employees, provided
that.such improvements are not intended or offered for sale. If, however, the building or im-
provement is sold within one year of completion, the -owner -builder will have the burden of
proving that he 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 Contractor's License Law does
not apply to an owner of property who builds or improves thereon, and who contracts for such
projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
WORKER'S COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's
Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is riled with.the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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 td become subject to Workers' Compensation laws of
California.
Date Owner
NOTICE TO APPLICANT.. If, aher'making this Certificate of Exemption you should become
subject to the Workers' Compensation Provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shalt be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work
for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
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 city to enter the above-mentioned
property for inspection purposes.
Signature of applicant Date
Mailing Address
City, -State, Zip
WHITE = BUILDING DEPARTMENT
APPLICATION ONLY -
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number—3-2 — ...1��� .....
Legal Description L47 rArZ g< y�
Project Description Sr
Sq.. Ft. No. No. Dw.
Size Stories. Units
New ❑ Add ❑ Alter C Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.f /09
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
YELLOW = APPLICANT PINK = FINANCE
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
r Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by:. Date Permit
Validated by:
Validation:
YELLOW = APPLICANT PINK = FINANCE
Comments SF increased from amount paid on cert #26660 on 9-28-2004.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement. mobile ho
Ines. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following -reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility .fees imposed pursuant to
Education Code Section'17620 and Government Code 65995 Et Seq.
in the amount of _ .$2:2414X.257 S.F. or $575.68 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now•be is§ued.
Fees Paid By cc/Valley Independent Bank - Mark Tuvell Check No. 319783
Name on the check Telephone 272-6044
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collecte
Signature
Payment Recd
$575.68 over/Under
NOTICE: Pursuant to Government Code Section 6soSW(l ), this will serve to notify you that the 90 -day approval period in which you may protest the fees o
r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original- Building Department/Applicant Copy -Applicant/Receipt Copy -Accounting
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
< BERMUDA DUNS r
Date
_
11/30/04
La Quinta, CA 92253
Cr RANCHO MIRAGE
INDIAN WELLS
(fi PALM DESERT
No.
26660
(760) 771-8515
`?'6' �INDIOTA �y
Owner
Mark Tuvell
APN #
773-334-006
Address
Jurisdiction
La Quinta ;
City
Zip
Permit #
Tract #,
Study Area
Type
New. Residential Addition
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1
52840 Avenida Villa
257 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments SF increased from amount paid on cert #26660 on 9-28-2004.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement. mobile ho
Ines. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following -reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility .fees imposed pursuant to
Education Code Section'17620 and Government Code 65995 Et Seq.
in the amount of _ .$2:2414X.257 S.F. or $575.68 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now•be is§ued.
Fees Paid By cc/Valley Independent Bank - Mark Tuvell Check No. 319783
Name on the check Telephone 272-6044
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collecte
Signature
Payment Recd
$575.68 over/Under
NOTICE: Pursuant to Government Code Section 6soSW(l ), this will serve to notify you that the 90 -day approval period in which you may protest the fees o
r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original- Building Department/Applicant Copy -Applicant/Receipt Copy -Accounting
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered p-atios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, Eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code'Section 17620 and Government Code 65995 Et Seq.
in the amount of $2:24 X 1,521 S.F. or $3,407.04 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project'may now be issued.
Fees Paid By CC/Valley Independent Bank - Mark Tuvell Check No. 31.3667
Name on the check Telephone 272-6044
Funding Resieential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted/
Payment Recd
Q1 An7 nA Over/Under
Signatu
NOTICE: Purs nt to Government Code Section 6602 (d)(1), this will serve to no ou that the 9D -day approval period in which you may protest the fees or
other payme identified above will begin to run from the date on which the buildin r installation, permit for this project is issued, or from the date on which
those amounts are paid to the' District(s) or to another public entity authorized to collect them on the 9istrict('s) behalt whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated.
Embossed Original Building Departmerit/Applicant Copy - Applicant/Receipt; Copy - Accounting.
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
�q�o
Q BERMUDA DUNES, r
_
Date
9/2$/04
La Quinta, CA 92253
RANCHO MIRAGE 0
No.
26470 -
(760) 777-8515
.INDIAN WELLS
di� PALM DESERT .y
Q INTA
.
.. .
IO
N0 Vy^
_
Owner
Mark Tuvell
APN #
773-334-006
Address
Jurisdiction
La Quinta
City
Zip
Permit #
Tract #
Study Area
Type
Bingle Family Residence
No. of Units
1
Lot # No. - Street
S.F. Lot # No.
Street S.F.
Unit 1
52840 Avenida Villa
1521 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered p-atios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, Eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code'Section 17620 and Government Code 65995 Et Seq.
in the amount of $2:24 X 1,521 S.F. or $3,407.04 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project'may now be issued.
Fees Paid By CC/Valley Independent Bank - Mark Tuvell Check No. 31.3667
Name on the check Telephone 272-6044
Funding Resieential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted/
Payment Recd
Q1 An7 nA Over/Under
Signatu
NOTICE: Purs nt to Government Code Section 6602 (d)(1), this will serve to no ou that the 9D -day approval period in which you may protest the fees or
other payme identified above will begin to run from the date on which the buildin r installation, permit for this project is issued, or from the date on which
those amounts are paid to the' District(s) or to another public entity authorized to collect them on the 9istrict('s) behalt whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated.
Embossed Original Building Departmerit/Applicant Copy - Applicant/Receipt; Copy - Accounting.
RC `DIS'TRICT =PLANNING. REVIEW FORM :.
` This form- is -to be used by.'CDD staff for -review of single family dwellings in the RC (Cove
Residential) District per -Section, 9:50:090 `of- the Zoning Code. Its purpose into determine: 1)
that -the proposed housing designdoes not duplicate the same architectural style of any house
within' 200 feet of, the applicant, .and/or 2) if there is' a need for the applicant to file ,for Master
- - Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmit
this information to the Building and Safety Department as part of your, correction list'. Please
attach'additional.explanations'as necessary.
` APPLICANT; N. ti fMT
�'Ir .f •
•SITE ADDRESS:��� D Ue. _
i
• S APN - -- 6�; CASE NO.
- LEGAL: LOT
a � BLOCK UNIT.S C.@V'L.Q:.
CHECK AND APPROVED BY` DATE:
Inform the assigned Building.plan checker upon your assignment to this case. The CDD
t Executive SecretaryYmaintains alog .book to track applications and -assign case numbers.
REQUIRED.'ITEM Y N COMMENT/CORRECTION
Verify-legal-and.APN information
Consistent with MDG on.file (asp ,
applicable) -
.MDG filing required (5_'filings
since 9/3/98)
Architectural variety within 200 =
feet of the surrounding area: '
O Planning Commission
E1.0ty Council
Commoin,�ty.Dev. Dept.
=
Architectural deInitials
V"` l t o
sign _features
, r - 4
Other Requirements: •` '' r - ..Exhibit
U With Conditions
.>
i
CERTIFICATE OF FIELD VERIFICATION AND -DIAGNOSTIC TESTING _ CF -4R
Project Title� n Ley - /1 / � Date�n
Project ddre s / L Builderr Name
Builder Contact Telephone Plan Number
J /h, Car�nd�l� �7tl,0) Z/?-
HER Rater ele hone Sample Group Number
5 Vo
rtifying�Signature ' Date Sample House Number
Firm: �1, C �f' �SSOG/a��S HERS Provider:
Street Address: ,fV4W Lo . /%'� �� City/State/Zip: L u LiJ;V714 C!%
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: • . ested ❑ 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
com with the diagnostic tested compliance requirements as checked on this form.
VADistribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu
f 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
(0
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
a 9�
Test Leakage. Flow in CFM
If fan flow is calculated as 400cfm/ton x number of tons enter on
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) ❑
Pass Fail
LR THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equival-mt
gfYes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection ❑
Yes is a pass Pass Fail
MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. ❑ Yes ❑ No • ACCA Manual D Design requirements have been met
(rater has verified that actual installation matches values in
CF -1R and design onplan.
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
Certificate'of Occupancyo
OF'i'�9�� Building & Safety Department.
' This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure. was in compliance with the .
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
t
� BUILDING ADDRESS: 52-840 AVENIDA VILLA
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-6861
Occupancy Group: R3 Type of Construction: VN Land Use Zorie: RC
Owner of Building: MARK TUVELL Address: 72850 SOMERA ROAD
- City, ST, ZIP: PALM DESERT, CA 92260
By: KIRK KIRKLAND.
'
Date: MAY 18, 2005
Building Official .
- POST IN A CONSPICUOUS PLACE
Certificate'of Occupancyo
OF'i'�9�� Building & Safety Department.