The URL can be used to link to this page

04-4512 (SFD)T4hf 4 4 a" BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . Property Address . . . . APN: Application description Property Zoning . . Application valuation . . Owner DEACON AT TRADITION 04-00004512 Date 8/16/04 78371 DEACON DR W 770-210-024- - DWELLING - SINGLE FAMILY DETACHED LOW DENSITY RESIDENTIA 421808 inn — Contractor KELLY PACIFI 100 DRAKE'S GREENBRAE (415) 464-0900 CA 94904. WCC: STATE FUND WC: .3150001375 10/01/04 CSLB: 346196 08/31/05 CCC: B -------------------------- Structure Information ------------------------- 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 4.00 FIRE SPRINKLERS NO GARAGE 'SQ FTG 1002.00 PATIO SQ FTG 482.00 NUMBER OF UNITS 1.00 FIRST FLOOR SQ FTG 4898.00 ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee 1766.50 Plan -Check Fee 1148.23 Issue Date Valuation . . . . 421808 Qty Unit Charge Per Extension BASE FEE 639.50 322.00 3.5000 THOU BLDG 100,001-500,000 1127.00 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL Additional desc . . Permit Fee . . . . 157.00 Plan Check Fee 39.25 Issue Date Valuation . . . . 0 Qty Unit -Charge Per Extension Tvf 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: AW Z� Date: Applicant: Applicant's Mailing Address: 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 isJ� full force and effect. L License Class, !S License No. 3 r+ w r Datedv_�z Contractor 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 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 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 ued�/M_`,y wo compen tion insurance carni 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. Date Applicant e_ - WARNING: FAILURE TO SECURE WORKERS'COMl6`ENSAT4CN 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, thi owner, and the applicant, each agrees to, and shall, defend, indemnity 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 160 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 a/b/ovetioned property for inspection purposes. Date Signature (Applicant or Agent): 0 60 Application Number 04-00004512 Page 2 Date 8/16/04 Qty Unit Charge Per Extension BASE FEE 15.00 5.00 9.0000 EA MECH FURNACE <=100K 45.00 5.00 9.0000 EA MECH B/C <=3HP/100K BTU 45.00 7.00 6.5000 EA MECH VENT FAN 45.50 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 ---------------------------------------------=------------------------------ Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 221.47 Plan Check Fee 55.37 Issue Date . . . . Valuation . . . . 0 Qty ' Unit Charge Per Extension BASE FEE 15.00 4898..00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 171.43 1002.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 20.04 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 --------------- Permit . ----------- . . . . . -------------------------------------- PLUMBING ------------ Additional desc Permit Fee . . 215.25 Plan Check Fee 53.81 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 22.00 6.0000 EA PLB FIXTURE 132.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 2.00 7.5000 EA PLB WATER HEATER/VENT 15.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA ' PLB LAWN SPRINKLER SYSTEM 9.00 15.00 .7500 EA PLB GAS PIPE >=5 11.25 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 4898 SF.SFD PERMIT DOES NOT INCLUDE Page 3 Application Number . . . . . 04-00004512 Date 8/16/04 ----------------7----------------------------------------------------------- Special Notes and Comments BLOCK WALL, POOL/SPA. COMPLIANCE WITH ALL FEDERAL & STATE LAWS, INCLUDING THE ENDANGERED SPECIES ACT OF 1973 (16 U.S.C. 1531, ET SEQ.) IF APPLICABLE, IS REQUIRED ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 554.52 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 114.82 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 42.18 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged --------------------------- Paid Credited ------------------------------ Due Permit Fee Total 2375.22 .00 .00 2375.22 Plan Check Total 1296.66 500.00 .00 796.66 Other Fee Total 3116.52 .00 .00 3116.52 Grand Total 6788.40 500.00 .00 6288.40 1 y�9cQr P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Building _. j ii6LK_ Address (. a Owner y Mailing Address ic, .t5 LA1UiJiN City Zip Tel. GRt�N� Rc/cioq I d Contractor City [Zip State Lic. I City & Classif. Lic. # Arch., Engr,, Designer . T 0 Address /n� ✓ //1� 1 Tel. /� City (Zip (State 2t,,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 any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to tt.e provisions of the Contractor's License Law, Chapter 9 (commencing with 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). t_ 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, Buisness and Professions 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 safe. It, however, the building or improvement 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 I I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does dot 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.) 1-1 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' 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. 3900, Labor Code.) Policy No. Company fl Copy is filed 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 to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after 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 Shall 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. 3,097, 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 ateMailing Address City, State, Zip d _ f -15 -/2 -- APPLICATION ONLY JILDING: TYPE'�7C—O�NST.�OCC. GRP. /0 P. Number / lo " Z't gal Description Go T Io �L Z g Description Sq. N7 No. No. Dw. Size Stories Units NevJjQ, Add 0 Alter O Repair ❑ Demolition ❑ CvrAter _. j ii6LK_ Estimated Valuation PERMIT AMOUNTO� Plan Chk. Dep. pv Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. i Infrastructure (�1 It LA QuINIA FINANCE TOTAL REMARKS ZONE: BY: Minimum Setback Distances: 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: WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE Date 9/2/04 No. 26403 Owner Jim Kelly Address City Zip Tract # Type Single Family Residence CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # Study Area No. of Units C- Q Q BERMUDA DUNES r rn RANCHO MIRAGE C-7 INDIAN WELLS C�PALM DESERT ,y i}� LA QUINTA Q INDIO 770-210-024 La Quinta 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 78371 Deacon Drive West 4898 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 patios/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 4,898 S.F. or $10,971.52 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/Bank of Marin - Mark Powell Check No. 20633 Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent t - Fee collected /exempted by Payment Recd $0.00 1.52 Over/Under Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or 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 Tradition July 2, 2004 Kelly -Domer Development, LLC 100 Drakes Landing Road #105 Greenbrae, CA 94904 Re: 73371 Deacon Drive West Dear W. Kelly and W Domer, The Tadition Architectural Committee has reviewed and approved 3,1 = second submi W of construction documents for your lot 10 on Deacon Drive West. T.proposed pool i de and light fixtures were approved for use on your home. A check for $5,000.00 will be required prior to 'ibe onset of construct i i)rL Pleasemake your check payable to the Tradition Community Association. Thad; you for resubmitting the plans and addressing all of thelprevious comments. We look fDrward to working with you finther on the construction of this home and hope -, ou have a great Fourth of My holiday. Sincelely, The Tradition Architectural Committee Tradition Community Association CC., Kristi Hanson DESERT RESORT MANAGEMENT POST OFFICE BOX 4772. - P -41M DESERT, CALIFORNIA 92261-47; 2 73.550 ALESSANDRO, S uzTF 5 - PAL44 DmxT, CALIFORNIA 92:, PHONE (760) 346-1161 FAX (760) 346-9918 Certificate of Occupancy Building & Safety Department OF T1 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. BUILDING ADDRESS: 78-371 DEACON DRIVE WEST Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-4512 . Occupancy Group: R3 Type of Construction: V -N Land Use Zone: RL Owner of Building: KELLY DOMER DEVELOPMENT, LLC Address: 100 DRAKES LANDING RD. ST105 City, ST, ZIP: GREENBRAE, CA 94904 By: TOM MORRISON Date: DECEMBER 6. 2005 Building Official POST IN A CONSPICUOUS PLACE �r Apr 06 05 08i05e RF STRUCTURAL&SANTAMARIA 760 836 0856 p,1 R F STRuc,ru 2AL 00NSl1l_TANTS, INC. 77 MERI.F. ORIVF., STE. R, PAL to DES AT, CA 92211 PHONP (7Gc1) 9^6- 1000 I- AX (760) 9364)851, F;,- MALI, RAYMONI)(ri;RFS'1 RU("I'I:RAI„(.'OM APRIL 1. 2005 KRISTI W. lIANSON INC. 72-I95 PAINTERS PATH. SUI'I'F A PALM DESIAT, CA. 92260 Am,_: MARK ?8.3?/ 17G''AGoov tilt tvt/ Re.: THF, Kl ILLY DONIER DEVELOPMENT THE 'TRADITION LOT -4 10 !:A QUINTA, CA. 9 2i i FOi.I.OW-UP TO WAI..K THROUGiH JOB NO.: 4227 DEAR MARK Ti•liS I.FTTER ADVISES TI IAT WE HAVE OBSERVED THE STRUCTURAL REOUIREMENTS THAT ARE, VISIBLE DURING co-4sTRUCTION AT THE TIMI: Of; OUR SITE VISIT, WE 13F[,IF.VF THAT TI Ik AS -BUILT CONSTRUCTION AT 'I'I fE: 'rwli OF OUR VISIT IS IN GENERAL CONFORMANCE WITH OUR. STRUCTURAL PIANS AND RELI VAN'I' C'(}RRF.SI>ONDLNC'(,' ISSUED BY OUR OFFIC.F. T14E TWO SIDI-1) PLYWOOD SIIF.AR WALLS WERE NOT NA11:1-?17 AWAITING CI•I'N' INSPECTIONS. WE OBSI"'RVE D THE BUILDING IN ITS FRAMED CONDITION PRIOR 'ro INSTALLATION OF DRYWALL AND STUCCO. WE OBSERVEl)'THI., VISUAL AND ACCFSSIBLE STRUCTURAI. RIF.QUIREPAENTS. ( EXCLUSIONS ARF{ ITEMS SUCH Ati: FOOTING SIZE AND REINI"ORCEMHNT. TOP PLATE SPLICES, ROOF SHEATHING, AND ANY STRAPS ABOVE: THF ROOF SHEATHING.). Rl'SPE'.0"Tf''i11.I.1" SUE3k`�I1'L'TE'D %I:YAI') i{AQiH, PE �OQFOfESS/M. p�,q No. 5795$ % x; Exp. 05.30-0(, 0 rop-1440 low w �_ol I __� �2.� m �_ � TANDY'S INSPECTION INC. PO BOX 13766 PALM DESERT, CA 92255 SPECIAL INSPECTION DAILY REPORT OFFICE/FAX 909.769.9717 PAGER 760.776.3339 TYPE OF INSPECTION PERFORMED DESCRIPTION OF WORK INSPECTED N TICKET NUMBER DATE l� � j , . C, ` '� ISI I `tir l.. L�' -- .. C IQ ��{ . �_x I • Wo 6. 1 AI ' V • y'3 �• 1 �...,�'t Iik�.t 1.�. , -r R SLUMP TIME IN MIXER PHYSICAL ADDRESS L.A t�4 PERMIT NUMBER o t4 ~ LR 5714 -- NAME Y-� l i ` !.: "C. +c'rt t. :E Vt C i�{< � 1 {.r LOCATION TYPE O_F STRUCTURE 1��,1 IZr .` \ %I 1 ARCHITECT �_' I2 V.. S -c? fl -1 . VA ENGINEER 7-c YA a m - FA kx v� GENERAL CONTRACTOR SUB CONTRACTOR CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. est INSPECTORS SIGNATURE CC: INSPECTORS CERTIFICATION AGENCY AND NUMBER DESCRIPTION OF WORK INSPECTED N TICKET NUMBER c() i4, f i.illZ` i 1 LV� l� � j , . C, ` '� ISI I `tir l.. L�' -- .. C IQ ��{ . �_x I • Wo 6. 1 AI ' V • y'3 �• 1 �...,�'t Iik�.t 1.�. , -r R SLUMP TIME IN MIXER LOCATION a 1 WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. est INSPECTORS SIGNATURE CC: INSPECTORS CERTIFICATION AGENCY AND NUMBER ""SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER SATIPLED AIR TEMP STEPPE SLUMP TIME IN MIXER LOCATION WELDING INFORMATION PROCESS WELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED 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. est INSPECTORS SIGNATURE CC: INSPECTORS CERTIFICATION AGENCY AND NUMBER AIR TIGHT ENERGY SERVICES Duct Testing/H.E.R.S. Rating;,� ALAN WEAVER C.H.E.E.R.S. & CalCen Cenified Rater 74478 Highway I 11 4292 Phone (760) 880-5504 Palm Desert, CA 92260 Fax: (760) 202-3197 CL-R—FIFICATE OF FIEL-D VERIi:ICATION AND DIAGNOSTICTESTING(Page 1 of 7) Cr-: pL I ,'7 •, `�7�-- I� %�— o.cc: Y it!e Date Pcc: AO-Iress Builder Name cer on!act Telephone r F!an Number L✓,E-rr�f', .. igto_S-:S-oy ®� Telephone rg Si0n3lUrt 1 Date r 4Lr C05 !o: —Builder, HEMS Provider Sample Group Number ^� Sample douse Number , ) HERS Provider: L�— . Ciry/State/Zip: RO!L-/Y� 7-9Le%O`) ��a ERS P-ATER COMPLIANCE STATEMENT ruse :vas: TP 5!e ❑ Approved as pan of sample testing, but was not tested ~ - .-:c HERS rater providi:,g diagnostic testing and field verification, 1 certify that the houses identified or: this diagnos!ic :ester compliance requirements as checked on this form. "he instailer nas provided a copy of CF -6R (installation Cenificate. Distribution system :s fully ducted (i.e., does not use building cavities as plenums or platfo,-tri retums ;r, 1;; r•f cur. ; -,/here cioth back: d, rubber adhesive duct tape is instailed, mastic and drawbands are used in combination . !n cic:n oackeo. rubber adhesive duct tape to seal leaks at duct connections. ..^•1!Niiti :J:�I REQUIREMENTS FOR DUCT LEAKACE REDUCTION COMPLIANCE CREDIT D_:: Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) P!'ssu!'zailon 'fest iZrSl:l!'i (CFM @ 25 Pa) Measured value$ Test Leakage Flow in CFM 1P 00 if fan i?ow is calculated as 400cfm/ton x number of tons enter calculated value here If fan fiow is measured enter measured value here 7 Leakage Perceni_Se (100 x Test Leakage/Fan Flow) Check Boli for Pass or Fail (Pass=6% or less) _-t THC'RMOST:,TIC EXPANSION VALVE (TXV) :s 7 a6c Expansion Valve is ins!alled.and Access is pruvid;'d for inspacnr)n A6 `- AIR TIGHT ENERGY SERVICES Duct Testing.M.E.R.S. Rating.. ALAN WEAVER C.H.E.E.R.S. 8: CaJQert Certified Rater 74478 Hi&hway 11 1 t#292 Phone (760) 880-5504 Palm Desert, CA 92260 Fax: (760) 202-3197 ~!GATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF � zalr.sly Till- Date cizct Address Builder Name t Contact Telephone Plan dumber r L 5_zoro ®Telephone Sample Group Number ^�,n2 Sign.a[ure Date Sample House Number At-A'06J HERS Provider: d.A_�_ . e ��4 ?� 11) ' 2Z CirylState/Zip;A :es ;o 8ui1der. HERS Provider 440v QRS R-ATER COMPLIANCE STATEMENT Tn:• noise was: Tested Lii Approved as pan of sample testing, but was not tested prcivioinL diaZnostic testing and field verification, I certify that the houses identified; on this for,,, :orgy;:,. he dlaznostic tested compliance requirements as checked on this form. The installer has prwiced a copy of CF -6R (installation Certificate, e� tr.ctior: system is fully ducted (i,e., does not use building cavities as plenums or platform returns I.Vher� c'.oth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination w,i'h, c::-,.-% backec. rubber adhesive duct tape to seal leaks at duct connections. '11:N!MUN1 REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDI-' Diagnos(ic Leal;Uge Testing Results (Maximum 6% Duct Leakage) ?r._;;:.:r: .floe Test aes its (CFM V 25 ?a) Measured values Test Leakage Flow in CFMVu if "an :Iow is ca:culatrd as 400cfmr'ton x number of tons enter calculated value here 'f far: 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) " h,`R)1OST,\TIC E XPAN'SION V ALVE (TXV) c>rrrestatic Expansion Valve is installed and Access is r! ii -Ur inspection AIR TIGHT ENERGY SERVICES Duct TestinV14.E.R.S. Ratings, ALAN WEAVER C,H.E:E..R.S. & Ca3Gcrt Certified }'ester 74478 Highway I 11 #292 Phone (760) 880-5504 Palm Desert, CA 92260 Fax; (760) 202-3197 r•� Cc.i ?�IFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page l of',) CF .f; Stec, Title Cale '.cL_t .�Lt7� .� Builder ivame 1�_ Contac; Telephone Pian Number a 7•00 !'? Telephone Ir--- «o gc:..w!�5 Jion2; ;r Date _244 f _o^trs to 01.1:10, 7ERS Pravid.r Sample Group Number Sample House Number HERS Provider: dA -•t_- e41C7` Ciry/State/Zip: H' -RS ROTI R COMPLIA!�CE STATEMENT -.: noust .� asTes!ed Ci .Approved as pars of sample testing, but was not tested -s HERS rater providing diagnostic testing and field verification, l certify that the houses identiF:ed on this forty. �:•c.tr ;iN wit :; diavno tic tested compliance requirements as checked on this form. t T'r.e ::,;;Mier has provid,-d a copy of CF -611 (Installation Ceniiicwe• t D i,tri^u on _ystern is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu, of it '�-r.e;a c!Jtil bac; rd, rubb;r ad'nesive duct tape is installed, mastic and drawbands are used in combination •v,: n ch,,:- rubber adncsive duct !ape to seal leaks at duct connections, I.r.'?U;N^ IZE,,Q UIRE:*,1E;q?'S FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Dt�gr.cst ; Lct,lcage Testing Results (Maximum 6% Duct Leakage) .. Pressurization Test Ptsuits (CFM @. 25 Pa) Nleasured Values Test Leakage Flow in CFM 1 Zo 0 if ian flog i; c3lcu!ated as 400cfrn/ton x number of tons enter calculated value here if fan now is measured enter ;measured value he, Le -,Rage Percentage (1,00 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass=6% or less) T,-J=•FZ49U':_i'A_!'JC F..XPANSION VALVE (TXV) Exper,sion `/rave is installed and Access is prove. ec ..r inspection AIR TIGHT ENERGY SERVICES Duct Testing/H.6.R.S. Ratings %. ALAN WEAVER C.H.E.E.R.S. 8c Ca!Cert Certified Rater 74478 Highway It 1 0292 Phone (760) 880-5504 Palm Desert, CA 92260 Fax: (760) 202-3197 cm CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTICTESTINC (Page I of 71, CF-lR HERS RATER COMPLIANCE ,STATEMENT ncu.se was: Tested ❑ Approved as part of sample testing, but was not tested ,s i.ne HERS rater oro iding diae�nostic testing and field verification, I certify that the houses identified on this form �mpl% %,,;(h mc ciiarsnostic.tesied compliance requiremems as checked on this form. irT'--- installer has provided a copy -of CF -bit. (installation Certificate. Distribution system is fu':iy Ducted (i.e., does not use building cavities as plenums or platform returns in lieu, of dur(s',, Vhere cloth backed. rubber adhesive duct tape is installed, mastic and drawbands are used in cembir.ati0n with 1+;fii rubber adh,-3ive duct tape to seal leaks at duct connections. .--IJ •'INIUM REQUIREMIENTS FOR DUCT LEAKACE REDUCTION COMPLIANCE CREDIT ):agnost c Leekuge Testing Results {Maximum 6% Duct Leakage) D II-. P , essurization res! Res jks (t_ FM @ 25 Pa) Measured values Test Leakage Flow in CFM if Can !':ow is calcula;ed as 4 i0cfm%:on x number of tons enter calculated value here i f fzn !low is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = Z--745 Check Box for Pass or Fail (Pass=64% Or less) l Pass E!: M 0 SRTIC 6c;PANSfOti' VALVE (;'XV) Fxpansion Valve is installed and Access is r:c•vit'.ed f'c. inspection ] _j Zoo .:c:ct'fite Date Project dares}' ' � �� , y 5/� Builder Nam S 3' ider Contac, Telephone Plan Number F, C -4E_00 Lf p Telephone Sample Group Number — ;rt ('yin Si,natureDate �CIj HERS Provider.. Satnpie House Number x/44P Str.:. ;-address:�� _ ---- 11tZ. ' Ciy/State/Zip: ��' _ T 0^ is to: Bui;der, HERS Provider � J HERS RATER COMPLIANCE ,STATEMENT ncu.se was: Tested ❑ Approved as part of sample testing, but was not tested ,s i.ne HERS rater oro iding diae�nostic testing and field verification, I certify that the houses identified on this form �mpl% %,,;(h mc ciiarsnostic.tesied compliance requiremems as checked on this form. irT'--- installer has provided a copy -of CF -bit. (installation Certificate. Distribution system is fu':iy Ducted (i.e., does not use building cavities as plenums or platform returns in lieu, of dur(s',, Vhere cloth backed. rubber adhesive duct tape is installed, mastic and drawbands are used in cembir.ati0n with 1+;fii rubber adh,-3ive duct tape to seal leaks at duct connections. .--IJ •'INIUM REQUIREMIENTS FOR DUCT LEAKACE REDUCTION COMPLIANCE CREDIT ):agnost c Leekuge Testing Results {Maximum 6% Duct Leakage) D II-. P , essurization res! Res jks (t_ FM @ 25 Pa) Measured values Test Leakage Flow in CFM if Can !':ow is calcula;ed as 4 i0cfm%:on x number of tons enter calculated value here i f fzn !low is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) = Z--745 Check Box for Pass or Fail (Pass=64% Or less) l Pass E!: M 0 SRTIC 6c;PANSfOti' VALVE (;'XV) Fxpansion Valve is installed and Access is r:c•vit'.ed f'c. inspection ] _j A 11 TIGHT ENERGY SERVICES Duct 'resting/H. E.R. S. Ratings. ALAN WEAVER C,H.E.E.R.S. & CalCen Certified Rater 74478 Highway 1 11 #292 Phone (760) 880-5504 Palin Desert, CA 92260 Fax: (760) 202-3197 C'E.:I 1F 11'1-E OF FIELDVERIFICATION'AND DIAGNOSTICTESTING(Page I of7) Cr -4R :fo!-Ct Title Date rat d +cess ` !/O� q y �g Builder t�lamery)C L4 er Contact Telephone Pian Number. to to a "� ta(� � � 7 Telephone Sample Group Nun;ber ng Signa:�;c Date Sampie House Numbtr 5�!�Cm5 HERS Provider: -A 14 �— S r �.ddress: +2 18 '10 W_'Z—City/State/Zip: _r___ °5 i0' Budder MFRS Provider 9zCv "I,RS RATER CO NIPUANCE STATEMENT �, house .vas. ested ❑ Approved as part of sample testing, but was not tested 't4. -'RS rater provioin d ,,gnostic testing and field verification, I certify that the houses identified on ,his ionm compi:. iin the diaenostic :esteL ccrmphance requirements as checked on this form, The installer has provided a copy of CF -6R (Installation Certificate. " Disiribw;on system is fu:ly ducted (:.e., does not use building cavities as plenums or platrorm returns in Where cloth backer:, rubber adhesive duct tape is installed, mastic and drawbands are used in comb na:inn wi;n bac':ed. rubber achcswe duct tape to seal leaks at duct connections, 11NIN1U.Nl REQUIREMENTS FOR DCCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Pr e'un Test Results (CFM L 25 Pa) Measured values Test Leakage Flow in CFM (-Lola it fan i'iow is ca;cu:ated 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) = a S Check Sox for ?ass or Fail (Pass=6% or !est) Pass r i _7 ;'r;t_RMOS': ATTIC EXPANSION VALVE (TXV) ':'cs ❑ v Tnermosiaiic cxpar!sion Valye is installed and Access is pr. ides for inspection tt INSTALLATION CERTIFICATE (Pane 1 of 13) CF -6R Site AddrM Per®it Number 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 requited; however, use of this form to provide the information is optional.) After completion of final inspection, a copy must be provided to the trending dement (upon request) and the building owner at occupancy, per Section 10-103(b). flyer BXSTEMI MadhS Etfr 4mwnt ii Egwp• of EfficiencyDuct Duca or Heating Heating Type (pec$. CEC Certified Mfr Name Identical (AFUE, etc.)' Locattoo Piping Load Capacity jatLUcs d -..-�. LyaSg� YA-I ��y,ruwcs- ° L Cooft EgMpndent F-gwp. CEC UeMfW Compressor # of Efficiency Duct, Cooting elooting Type (pkg. Unit Mfr Nmne and Identical (SEER. etc.)l Location Duct Load Capacity wfM�dJ 1. > rte gmaw 6 nr ar eqm d to. 1, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or amore efficient than that specified eat the certificate of compliance (Form CF -1R) submitted for compliance with the Enerff E cretuy S ds for residential buildings, and 3) equipment teat meets or exceeds the appropriate requirements for d i (from the Appliame &*Iency Regulafions or Pati 6), where applicable. 94caw, Dane Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Distribution If peter of of Reied= Tank Effr External Heater CEC Cenified .Mfr Type (Std, tultetiort Ide nt" Input (kw Volatrte tiny' Standby= Insulation DM Nam & Model Numba Poiotof- W) Contras Type Systems or BhAr) (gallons) (EF. RE) Low(h) R-valLe' 2 For small gas storage (rated input of less than or equal to 75,000 StuAtr), ek-cirse resistance and heat pomp water heaters, list Energy Factor. For Une gm storage mater bearers (rated input of greettr drae 75,000 BttJhr), list Reoovery Efficiency, standby Loss and Bated InpaL For hit meoos ggts water beateva, list Recovery Effict ieocy and Rated Input. 1. R-12 external umila w is mandatory for storage wrefet heaters with an amV factor of less than 0.59. Faucets & SMwrer Wads: All faucets and showerheads instilled are certified to the Commission, pursuant to Title 24, Part 6, Section 11.1._ 1, 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 catificate of compliance (Form CF -1R) submitted for compliance with the Energy Efficiency Standards for residential buildings; and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices (from the Apphame Efficiency Regulations or Part 6), where applicable. Signature, Dazs COPY TO: Building Department HERS Providcr (if applicable) Building Owner at Occupancy Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Compliance Forma Ae Ust 2001 A-23