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04-6770 (SFD)78-495 C� nr i SLA UQkNT !VV Esu' �,^.¢y�456u86� �iFfd3�9�� CeEF�T. 4 . 4'a''a" BUILDING & SAFETy DEPARTMENT 4 (760).777-7012 TAMPICO ' FAX (760) 7,77-7011 ALiFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT App li.cat.ion.Number Date 10/13/04 Property Address . . . 48820 EISENHOWER DR APN: 658-310-02.1- - - Appli:,cation description . . . DWELLING - SINGLE FAMILY DETACHED Property Zoning . . . . . . LOW DENSITY RESIDENTIAL. Application Application valuation . . . . 26382.2. Owner Contractor CORONEL LUCAS CORONEL CONSTRUCTION 5.3200 AVENUE VILLA P.O. BOX 389 LA QU.INTA, CA 9225-3 LA QUINTA, CA 92247 (760)564-4604 • WCC: ;STATE FUND WC: 1744453 01/01/0.5 CSLB: 634981 01/31/06 CCC: B -C13 P.O. Box 1504 • VOICE (760) 777-7012 78-495 C'ALLE TAMPICO FAX (760) 777-:7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (7.60) 777-7153 Application Number: 04-(0-710 Applicant: Applicants Mailing Address: BUILDING & SAFETY DEPARTMENT Date: /D`/f/. o ArChitect.or Engineer: 1_!itrChitect 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 Lical fs in full force and effect. �Ucense Class Y <oense No. .er1 A 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 sheis licensed pursuanfto 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 or she is exempt therefrom and the basis for thealleged 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 orimproves thereon, and who does the work himself or herself or through his or her own employees, provided thatthe 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 orshe did rnot butid 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 bullds or improves thereon; and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.), U I am exemptunderSec. , BA P.C. for this reason Date. Owner. 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 hd of the work for which this permit is, issued. JL'Oave and will maintain workers' compensation insurance, asrequired by Section 3700 of the Labor Code; for the performance of the.work for which this permit 'is. -w C�rke`r ' compensation i nce carrier and policynu m are: amer L oiicy Number tai �t�t�{ S _.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 Califo 'a, and agree that, if I should subject to the workers' compensation provisions of Section 3700 of the Labor Code, l shall forthwith camply�with those isions ,,-[iate �V"��i (Applicant WARNING: FAILURE TO SE CURE. WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UPTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN, ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR.IN SECTION 3706 OF THE.t.ABOR 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 thisappiication 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 Le Quints; 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 isnot need within 180 days from date of issuance of such permit, or cessation of work.fdr 180 days. will subject,perrnit to cancellation. I certify that 1 heve.read this application and state thatthe a e information 'is correct. I egree to co ply. with all city and county_ ordinances and state laws relating to building construction, and hereby authorize representatives of thisco to enter upon a e -mention party for Inspection purposes. /oats �U•-1, 1 - 0 �ature (Applicant or Agent): IV ------ PP - -- - - - - - - - - - - - -------------------------------------------------- Application Number . . . 04-0000.6770 ------ Structure Information 2'992 ,SQ. FT'. SFD ----- Construction Type . . .. . . TYPE V - NON RATED Occupancy Type . . DWELLG/LODGING/CONG <=10 Flood Zone . . . . . NON -AO FLOOD ZONE Other struc.t info . . . . CODE EDITION 2001 CBC FIRE SPRfiNKLERS NO GARAGE SQ FTG 773.0'0 PATIO SQ FTG 514.00 NUMBER OF UNITS 1.00 ,F,IRST FLOOR SQ FTG 2993..00 Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 1213.50 Plan Check Fee 38.78 Issue. Date . . . Valuation 263822 Qty Unit Charge Per Extension BASK FEE 639.50 164.00 3,5000 THOU BLDG 100,001-500,000 574.0.0 ----------------------------------------------------------- Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc . . Permit Fee . . . . 135.22 Plan Check Fee 33.81 Issue Date . . . . Valuation . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 299.3.00 .03`50 ELEC NEW RES - 1 OR.2 FAMILY 104.76 773.00 .0'200 ELEC GARAGE OR NON-RESIDENTIAL 15.46 .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 Permit . . . . . . MECHANICAL .Additional desc . Permit Fee . . 90.00 Plan Check Fee 2,2.50 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA - MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B'/C <=3HP/100K BTU 18.00 5.00 6.5000 EA MECH VENT FAN 3.2.50 1.0.0 6.5000 EA MECH EXHAUST HOOD 6.50 Permit . . . . . . PLUMBING Additional desc . . Permit Fee' 209.25 Plan Check Fee- 52.31 Issue Date Valuation . . . . 0 + ------ ------------ -------------------- ------.----------- --=-----=------I----------- Application Number . . . 04r-00006770 Permit PLUMBING Qty Unit Charge Per Extension BASE FEE 15.00 17.00 6.0000 EA PLB FIXTURE 10.2.00 1.00 45.0000 EA PLB SEPTIC 45.00 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 7.00 .7500 EA PLB GAS PIPE >=5 5.25 1.00 15.0000 EA PLB GAS METER 15.00 --------------------------------------------------------------------------- Special Notes and Comments 2993 SQ. FT. SFD .- THI:S PERMIT DOES NOT INCLUDE POOL & SPA.BLO:CK WALLS OR DRIVEWAY APPROACH. 10/1.3/04 4:24:46 PM KHENSEL.FEES WERE ADJUSTED TO SHOW $750 FOR DEP. 10/1.3/04 4:31:03 PM KHENSEL Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 159.55 DIF COMMUNITY CENTERS -RES 97.00 ENERGY REVIEW FEE 78.88 DIF FIRE PROTECTION -RES 97..00 GRADING PLAN CHECK FEE .00 DIF LIBRARIES - RES 22`5.00 DIF PARK, .MAINT FAC - RES 5..00 DIF PARKS/REC _ RES 502.00 STRONG MOTION (SMI) - RES 26.38 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary ------------------ Permit Fee Total Plan Check Total. Other Fee Total Grand Total Charged 1662.97 147.40 2303,.81 4114.18 Paid .00 .00 .00 .00 Credited .00 .00 .00 .00 Due 166.2.97 147.40 2303.81 4.114.18 6ce —6770 P.O. BOX 1504 APPLICATION ONLY Ing 78-495 GALLTAMPICO assL-< LA OUINTA, CALIFORNIA 92253 253 Owner c �r BUILDING: TYPE"CONST. OCC. GRP. Mailing Address // 1;1"\ A.P. Number Legal Description c1 City Zip Tel. d ` Project Description ' ` Contractor Address 8 �c ity Zip Tell... !+ `may'' State Lic. & Classif. City Lic. # Sq. Ft.No. c Size al�Stories \ No. Dw. Units Arch., Engr., Designer NewM Add ❑ Alter ❑ Repair ❑ Demolition 0 Address Tel. City Zip State Lic- # LICENSED CONTRACTOR'S DECLARATION 1 troreby 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. / SIC•NATL!RE DATE OWNER BUILDER DECLARATION Estimated Valuati0 1 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 AMOUNT perms to construct error, improve, demoksh, or repair any structure, prior to 'lis issuance also requires the applicant for such permit to file a arppned etatemont that he is licensed pursuant to Ne provisions of the Contractor's License Law, CAepter 9 (t:ommenclr. with Section 7000) of Plan Chk. Dep. t Division 3 of the Business and Professions Coda or that. he is exempt therefrom, and the heals 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 (11500). Pian Chk. Bal. I: 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 site. (sec. 7044, Buisness+and Const. Professions Code: The Contractor's License Lew does not apply to an owner of property who Mech. builds or improves thereon and who does such work himself or through Ns own employees; provided that such improvements are not Intended or offered for sale: If, however, the building Electrical or Improvement h is sold within one year of completion, the owner -builder wilt have the burden of of ving that he did not build or improve for the purpose of sate.) Plumbing Gl 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 not apply to an owner of;property who builds or improves thereon, and who contracts for S.M.1., suchProjects with a contractor(s) licensed pursuantto the Contractor's License taw.) Grading it 1 am exempt under Sec.. B. B.P.C. for this reason Driveway Enc.d infrastructure nrr Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a. certificate of Worker's Compensation Insurance,,or &certified copy thereof. (Sec. 3800, Labor Code-) Policy No. Company F (� Q ual (l Copy Is filed with the city. ❑.Certified copy is hereby, furnished. TOTAL FP7 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 thg work for which thispermlt is; issued, I shall not =any pparson In any manner.. so as to become subject to the Workers' Compensation Laws of Cahfornia. Date Owner NOTICE TO APPLICANT:. 11, after mating 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 permh: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. 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 it work:thereunde. 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 =%4%,f stotpI I WHITE= BUILDING DEPARTMENT REMARKS `____J ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop., Line Side Street Setback from Center Line Sjde Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: YELLOW = APPLICANT PINK = FINANCE'. menu 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: This certifies that school facility fees imposed pursuant to in the amount of $2.24 X 2,993 S.F. or $6,704.32.. 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 - Ish Comel Check No. 319699 Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Esoe Lara Payment Recd o.00 $61704.32 over/Under Signature NOTICE: Pursuant to Govemment'Code Section 66MO(d)(1), this Will serve to nobly 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 Districts) or to another public entity authorized to collecnhem on the. Districtfs) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original- Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting OV -13-20,04 WED 03:13 PM Coronel Construction FAX No. T60 564 4202 P.001/003 7603460394 STEWART TITLE PD , 387 P02 OCT 14 1, 03 0'7:53 YJntw Title Company A�°rawv .A6 ro: Luc" Cordndl 51101 Avenida V1119 - La Qaintar CA 92253 ardor N4.,: m26425344 pt>tO � �0Qd2-3d4Z� 0 Ai�rl�nP S�b a�Y Tam Paid p.a•read in dff'4ai•1 11.wr00 e"n%y a/ Rivervid. Oary 6. Oreo A�••,U1aD, .cam+�y Ct•�k' a R•oe'dar H ILII lll� lllll! IU If�4 ,+�f •u 0!� ,ape ,moos aw HP 1! M p ?lZa9- aid` DEED T. 17 1 U1 DoQuMBaVURYT1Wtar$1 T*xis$ q oomputed:on Nll.valtw of ponoparty nonmed, of A compmted aa. arull v" Lao.vilue of lime or onatoaTytruuee, retp "Ang lit dMA Of Sale. O ur►incanxMted Orae 4' dty Of La Quintle APM POR A VAUMASLB CMMI1 MAIM rax* ofw" is lmroby alalowuApad, 6wAft Bank of Cdifo"dikj A Calif drola Carporatlan hereby GRANT(B) to L*caa Coronel, A 9b*% Ma tha.followueg deaecribed mg prapa* in 00 LOOM of Pitrcn"GO Stale of C:altf wiO: Lot 102 of La Qpint 100tBatAla Ugli Ng. 1, At per Mop rmiled In book 37, PAZ" MAI Bud 99 of Mapa, lu tna afrm of me.Cbunty Warder otz1ver" Coasty. Dated, June .11, 2002 STATE 0 CAMPOMA. COEPM OF on tsttio. Z6 7 befozz a notary public, poraotoly app Wd L. Etagifffflabe or PMV04 to w on aw ba k Ormdactory► fife pereottWVhove ruewaidl aul�Crlbed to fire Within iasl><antant aid acknowW894 to rnO beJ t�ooa>dtod the Mw bt hts&hdr antlwd%W capaeity(w that by, bWoo f r srBnaf m wt tAe fstalttrmaat *0 PaOoae(a3, Or the aet w uppubd alf of wbicb the PraortO1aet4 MCaced 1b izttatrsment. wrrt m nw band aad.oillsiat out sipstom 9oariid k of Califs , a catcra s Corpa Atiun ('ills atea teat aff id. notarial' M4 91NML' Wltilit/l" pOt111A 1�'i 1*4MV tishry i't+DNt - Gd111MnW MAIL TAX STATBN>MaS TO'- SAM O; SAMB AS A13OVE eo VWM F41M QD Description: fterslde,CA DocuMnt-Year DoolD 2002.254210 Page: 1 Of 2 order., 658910021 Comment. ;t r COUNTY OF RIVERSIDE COMMUNI HEALTH AGENCY ASSESSOR'S PARCEL NUMBER �Jr S — 3/D — Ods DEPARTMENT OF ENVIRONMENTAL EALTH APPLICATION FOR WASTE. WATER DISPOSAL APPROVAL APPLICANT: Submit.this form with four copies of a SCALED plot plan (1"=20' to`1"=40' SCALE) drawn to County specifications as indicated on the attached check list: -Anon -refundable filing fee is required when the application is submitted. Check must. be made payable to the County of Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of payment. LMS # Agent, .Contractor, Contact Person G�� -� c� � � ��;�-. Address City State Zip � � � �o: a�.�' - C_�t qac 5 Telephone �� -<«� , Owner, Address City State Zip Telephone .Q Z,, Job Propr Address d20 -10W(k City l-o� C��\K p 4 .EeI36 U Lot Size WaterAgency/Well Use.of Permit, P/P; SUP, PUP, etc. Legal Description DBA W CO Dwelling, MH Site Prep.,.etc. Sig afore of Applicant Date ' FICE USE ONLY Q ED CHECK BOX.Lec7ke s If any box is c his application shall be considered rejected until the ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval). information.ised and the fee paid. Resubmittals later than, 90 days after date noted below may require repayment of fees. ❑ Other m Holding Tank Agreements Completed ❑ g g p ❑Staff Specialist Lot Inspection Required Z 0 ❑ Certification of Existing S.D. System.Required Thomas Bros. Page Grid W❑ WQCB Clearance Required ❑ Date Lot Inspection Completed: Initials (Attach for DOH -SAN -007, Santa Ana Region Only) Remarks: ❑ Soils Percolation Report Required Maintenance Booklet Provided ❑ Special Feasibility+Boring Report Required ❑ Final Inspection: by Department of Environmental, Health .is required.: ❑ Rereview Required Initials Date Please call 24 hours PRIOR to inspection. C/42 / Soils. Percolation Boring Report El Lic/Project # Date Soils Map Page Soil Type Approved By Date No. of Systems Type ofSystem(s) - No.. Dwelling Units ', --- (1.) Septic Tank - Soil Rate Grease/Sand Holding Tank ❑ Replacement New , ❑ Addition Bedroo Fixture Units 2 �V f $ ,� Grease'.lntcp/LinfTrap ❑ Existing ❑Connect to Sewer J 100 Gal.' t Gal. Sq. Ft. Total Linear Sidewall Allowance Leach Bed sq. ft'. Bottom Area Ft. ft. rock/ sq. ft. running ft. Install Line(s) ft. long ft: Wide of Bottom Area Inlet Tested Depth ❑°N/A with min. inches rock .below drainlines U Proposed Bottom Tested' Depth or 'Z Leach lines/bed special design for:slope: (3) Pit Diameter No. Pits Pit Below Inlet (B7)' Seepage Pit Maximum,J,Cilher: .O Applicable ( -' D Total Depth Allowable W NIA Overburden Factor ❑ F. V TD�_ Well Review Approved: Date: Well: Drilling Permit# - SIGNATURE - Grading Plan Approved: Date: _ 'SIGNATURE - Plan Check On1y�Approve& Date: ' REMARKS:., f� t� t v� 0., ` tCX U t i�O A & to, 10010 G- As �tr�.-�� + 401t, bow.v +50. t 5I. This application i APPROVED! ENIED for the category checked in SECTION B above, ardin design of a disposal system as.' indicated on the accompanied plot plan', using the requirements set forth in SECTION 5 �� C above. A building permit is'necessary for the installation of the above- .Revenue Code Fee $ 23 designed system No construction Is permitted in the reauired reserved 100° area. expansion Check_ # (1) Septic Tank must be 100' minimum from any wells. Z(2) Leach lines must. be .100' minimum from any wells, including expansion Date Initial area. L) (3) Sewer lines must be 50' minimum from any wells. W C/) (4) Seepage pits must be 1 50'minimum from any wells, including expansion RIVERSIDE: 909-955-8980 area. INDIO: 760-863-7000 SOUTHWEST. 909-600-6180 Signature 10 It19 ,Date II DEH -SAN -122 (Rev 8/01) Distribution: WHITE—Office File; YEILOW,—Applicant; PINK—Bldg. Dept:;GOLDENROD—Plans/Records ''I .. ■ 14/2:/2007 14:03 7603427052 M GALVAN PLUMBING AP'R-23-2,007 BION 01:35_ PM Car one l Cone t rue t on FAX No. 190 564 4202 ! nVS rALLA,TiON C=T ►'IGATE PAGE 01 P. 001 --- d e I of 8 CF -6R . f Ao lasoWettom aaeddrgt� is required to w postr+d u rhe 6ulld�iitp brimok eveilsbls tbrsll ' i4btsr>,tien3"vfdW an *b Jbtm IS nphsd� bowevat on Ortdjf %tomb SPP Inepea'ar�.. ( i va�oplesioo atBrrsl er bmpeebo% a OuPy mW be pcovWOd CO chs• bat'Idita dep tsoeot {r�peniequee� raA � bu,�>dhti�er t eweer t °. per 9aolten l0�14l�b)' TWO 604 CwClo IedMkM�nw. mil Ow Darier mulles Huns Lome" rrlree LoMI C�p�elq .. 3". Comad TIOW Qrar uldr lou dr kre4Cri iaelencrr deer Oesave t:oeli� �k. _._ al 7D°a Led CqPhfy Brantsi•hfl rAapsr.rpyal,c. �m*W y� �JJFVdfi 8d i4 Fes' let "4 ! jseed Wove u 1j if *9 etxrasl OqUiPmvuf inrfdlled, 2) egyivelettt co or mcm ►tea Skonala, fornr1d Cordfum of o°�'40°° Harm CM) svbmlaed for =Wltuw with ore �- A-44 d1�, land 9) eegtdepptoposoe mgWremats fn- •:qf J11b0pr�eCtpf � � . W OR Odaej Conn eotvr (Cb, No* Olt Owner jimQCCNdA—iw[F blenibmipe /lAee1F �& 71nk 6Aa TYMRSL NOWeutedae Nn„eteet Brow*W VeNme dongl si.ed6i h�wrludou tbisne6Ui Cs 1 $ mo erJs T� tr i�ec4lRjgw�"N`�r�atN%d utawlWfrs7$pQ0bAY0�WoNk�irS4Cl�dDwtDeraDrhro'awdra,gR�ulgyl;eeW•• � . '� i �+e7tae� cm.s7f.00sBde�r� WcflesS"IW q�,.2uro121mrondJtaedb�pr�. 7.A,1s�m�,,,�y ��da�mt�smObaot °�°4`��deaysetb�rem erBtae r�alDete►vFlefi llAe 03e, ' JPa�ncsb Shower gulf. AR humte end *Dweweeds bu4illed Lm.=1146d. to the Co =lUio. • -4 pLrruen! to Title:24. Pott 6, Secdoq 1 ] ]. 4 do "fidewSrted, 644 that 0414P est Uded above { Rr elRout�sf than cher fpeoi6ed in the AIY si6aastrttrt is 1 I re9WPm loswlled; Z) equivalent to or , !' sY �r0liaae et' oestpli MM wbu t el for =MpUmm W*h the End wlA i bWdiDp epd 3) o9wpaxtrc:dNt maxi of dotceeds dte ate r0' irce�iats�rg R�rleNot a Pest' d;, vt�ts�p as4uPrerq�t9 >br a Date r4etni dwl +� bomtbrabr(00,Neme)OR CUPYTO; $ ni)dr¢rstttbenC Qenetal Wshxter (Co. N*as),OR.Owrw• - MW PmWder (ff @pDljopble) Biold;gg Owm a Oooupasal lentt,uy 4,1oox APP -19-2007 INSTj 4gr- iS to AdeTi 09:04 AM P.01 DUCT ]LEAKAGE AND DESIGN DIAGNOSTICS .AKAOE REDUCTION Test Results (CFM @ 23 PA) Fan Flow Test Leakage (CFM) If Fan Flow is Calculated as 400 cfm/ton x number of tons, oras 21.7 x Heating Capacity in Thousands of Btu/ltr, 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 5 0,06 ❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed: Duct Fan Pressurization at'rough-in measured' leakage (C ) CHECK AFTER FINISHING' WALLS ) 13 yes ❑ No ❑ Pressure pan test or House pressuriution test / ❑ Yes ❑ No ❑ Visual Inspection of Duct Connections s� ❑ Pass Fail ❑ ❑ Pass Fail THERMOSTATIC EXPANSION VALVE' XV Yes ❑ No Thermostatic Expansion Valve (or'Commission approved equivalent) is installed and Access isvided.for pro inspection � ❑ Yes is a pass ass Fail ❑ DUCT DESIGN 1' ❑ Yes ❑ No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans, 4, / A 2. ❑ Yes ❑ No TXV is Installed or Fan flow has been verifled. If no T verified fan,flow matches design�,frorn CF -IR, Measured Fan Flow Yes for both 1 and 2 is a. Pass ❑ 13Pass Fall i, the undersigned, verify that the above diagnostic test results and the work I performed associated with'the test(s) is in conformance with the requirements for compliance credit, [The builder shall provide the HERS provider a copy of,the CF -6R signed by the builder employees or sub -contractors cerdfying that diagnostic testing and installation meet the requirements for compliance credit.) /' '/ ,00t. C TestsJM J�•✓'� /1ti Signature, Date Installing Subcontractor (Co. Name) OR COPY T0: Building Department ertotmed General°Contractor (Co. Name) C HERS Provider (if applicable) Building owner at Occupancy INSTALLATION CERTIFICATE (Page 4 of 8) CF -6R Site Address Permit Number 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 default assumptions match those on the plans. [The builder shall provide the HERS provider'a copy of the CF -6R signed by the builder employees or sub -contractors certifying that diagnostic testing and °�— installation meetthe 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 5 of BUILDING ENVELOPE LEAKAGE DIAGNOSTICS CF -6R ❑ ENVELOPE SEALING INFILTRATION REDUCTION Diagnostic Testing Results Building Envelope Leakage. (CFM @ 50 Pa) as measured by Rater ❑ ❑ Is measured envelope leakage less than or equal to the required level Yes No from CF -1 R? 2. ❑ ❑ Is Mechanical Ventilation shown as required on the CF -1 R? Yes No 2a. ❑ ❑ If Mechanical Ventilation is required on the CF -1 R (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 wafts are no greater than shown on CF -1 R. 3. ❑ ❑ Measured Watts Checkthis 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 CFA R (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 shownfor an SLA of 1.5 on CFAR, mechanical ventilation is installed and house pressure is greater than minus 5 Pascal with all exhaust1ans operating. �... ❑ ❑ Pass if: Pass Fail 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. ❑ I, the undersigned, verify that the building envelope leakage meets the requirements claimed for building.leakage reduction below default assumptions as used for compliance on the CF -1R._ 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 -6R signed"by the builder employees or sub -contractors certifying, that diagnostic testing and installation meet the requirements for compliance credit.] Test Performed Signature Date COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy January. 4, 2001 Testing Subcontractor (Co. Name), OR General: Contractor (Co. Name) INSTALLATION CERTIFICATE (Page 6 of 8) CF -6R Site Address The following is an explanation of many of the input values required on this form: HVAC SYSTEMS Heatine Enuinment Tvne must he nne of the follnwino- .Furnace: Gas (including Liquefied Petroleum Gases) or oil -fired central furnace & space heater Boiler. Gas or oil -fired boiler PckgHeatPump: . Packagedcentral heat pump SplitHeatPump: .Split central heat pump RoomHeatPump: . Room heat pump LgPkgHeatPump: Large packaged heat pump(>_ 65,000 Btu/hr output) Electric: Electric resistance heating (fixed' HSPF = 3,413); radiant electric resistance (fixed HSPF = 3.55) CombinedHydro: Reference waterr 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 Commission approved load calculation procedure. Heating/Cooling Capacity, from the applicable Commission certified appliance directory. Note: location elevations over 2,000 ftabove sea level require a derating of output capacity (refer to manufacturer's literature). Coolinp Enuinment Tvne mime he nne of the fnllnwinv SpiiWtCond Split system ai iconditioner PckgAirCond: Packaged air conditioner Split Heat Pump: Split.system heat pump PckgHeatPump: Packaged heat pump RoomHeatPump: Room heat pump LgPkgHeatPump: Large packaged heat pump (>_ 65,000 Btu/hr output). Substitute EER for SEER when SEER is not available RoomAirCond: Room air conditioner. Minimum SEER varies' LgPkgAirCond: Large packaged air conditioner (z 65,000 Btulhr output). Substitute EER for SEER when SEER isnot 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: SEER = 13.0; duct location = attic; duct insulation.R-value = 4.2 "Keler to Jnergy Commission publication Appliance Efficiency Regulations, P400-92-029 January 4, 2001 INSTALLATION CERTIFICATE (Pa 41-W Site Address The following is an explanation of many of the input values required on this form: WATER HEATING SYSTEMS Distribution Svstems Refer to Residential Manua/ for more ttetails- 7of8 e CF -6R Standard: Standard — Supply pressure based system, no pumps Pipe4fisulation: Pipe Insulation on all 314 -inch pipes POU/HWR: Point of Use/Hot Water Recovery. System Recirc/NoControl: Recirculation loop with no controls Recirc/•Timer: Recirculation loop with a timer Recirc/Temp: Recirculation loop with temperature control Recirc/fime+Temp:. Recirculation loop with a timer and temperature control Recirc/Demand: Recirculation loop with demand.control Water Heater Tvue Storage Gas, Oil or Electric Heat Pump Instantaneous Gas Instantaneous Electric Large Storage Gas Indirect Gas (Boiler) FENESTRATION/GLAZING Information:Needed Energy Factor RecoveU Efficiency Standby Loss Rated Input Yes No No No Yes No No No No Yes No No Yes No No No No Yes Yes Yes No Yes (AFUE) No Yes 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 -Factor must be less than or equal to value from CF -1 R OR Installed weighted average U -Factor for the total -fenestration area is less than. orequal to value from CF -IR SHGC: Installed'SHGC must be less than or equal to value from CF -1R OR Installed weighted SHGC for the total.fenestration area is less than or equal to value from CF -1R OR An:interior shading device, overhang, or exterior shading device is installed consistent with the CF -1R 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 (do not list bug screen), or an overhang .(include depth in feet) January 4, 2001 INSTALLATION CERTIFICATE (Page 8 of 8) CF -6R. 4-19A690 �i`rs �-bz 12 PV - �—` 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 the duct. Areas must be measured and verified by a HERS rater. Improved -Duct Location: Supply duct located in other than attic, as verified by location of registers (does not require HERS 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 ventilationis required for very tight house construction when credits for infiltration reduction using diagnostic 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 -1R) will contain the measured CFM target value from 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. The compliance documentation (CF -IR) will contain 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 APR -19-2007 07:24 AM Street Address: :ZLardW Eire I� Copies to: Builder, HERS Provider P.02 Plan Number Sample Group Number Sample House Number rider; City/Statelzip: d y2a& HERB BUERER COMPLIANCE aTATEMENT The house.was: /p�"Tested ❑ Approved as part of sample testing, but was not tested As the HERS rotor providing diaggnostic testing and field verification, I certify that the houses Identified on this form co with the diagnostic tasted compliance requirements as chocked on -this form.. )Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns In Ileu W, ducts) Where doth backed, rubber adhesive duct tope`Is Installed, mastic and drawbands are used In combination with cloth backed, rubber adhesive duct tape to seal leaks, at duct connections. F4000MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 0% Duct Leakage Measured Duct Pressurization Test Results (CPM ® 25 Pa) . values Test Leakage Flow in CFM If fan flow Is calculated as 400c1m/ton x number of tons enter calculated value here If fan now is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fen Flow) a Check Box for Pass or Fail (Pass=896 or less) THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent ,Fry.. ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) Is installed and Access is provlded for Inspection Yes is a pass ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. O Yes 0 No ACCA Manual D Design requirements have been met (rotor has verified that actual 'Installation matches values in CFA R and design on pian. 2. ❑ Yes ❑ No TXV Is installed or Fan Flow has been verified, if no TXV, verified fan flow matches design from. CF4 R. 'Measured Fan Flow Yes for both 1 and 2 18 0 Pass. e ❑ Pass Fail -,,&-' ❑ Pass Fail ❑ O Pass Fail Rpr 23 2007 12:0,IPM HP LASERJET FAX p.2 INSULATION CERTIFICATE This Is to certify that Insulation hiat be6h Installed in confor(hance with the current energy regulation, CallibmiaAdministrative Code, title 24, State of CalifiDmia, In the building Iodated at: 484320 Eisenhower, La QuInta, California CEILINGS: TYPE:BATTS MANUFACTURER: CERTAJNTkED Thickness: R-38 WALLS: TYPE:BATTS MANUFACTURER: CERTAINTEED Thickness: R-21 GENERAL CONTRACTOR: CORONEL CONSTRUCTION LICENSE # BY: TITLE: PARAGON SCHMID BUILDING PRODUCTS. A MASCO COMPANY LICENSE # 221517 TITLE: OFFICE MANAGER DATE: 4J23/2007 NJ