9604-018 (SFD)LICENSED CONTRACTOR DECLARATION PERMIT# CONTROL#
I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT
6t�i)l 3 56
�- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE VALUATION LOT TRACT
C\1 W Professionals Code, and my License is in full force and effect. ; /249/N ){S►�.41iZ.94 �{}3 >hl
0 c') License # Lic. Class Exp. Date
C3 ul3 JOB SITE APN
rte• r l R 12f31r�)7 ADDRESS 47-•325 VIA CvLiRi3OVA
ZO r . Date Si at, of Contractor OWNER CONTRACTOR /DESIGNER /ENGINEER
~ OWNER -BUILDER DECLARATION l.l.�'A +.1�e-1,.C, INIP.f-,fl l AJ, 81IN1 ��r ),1,4Q 1'[,11 It �'��-:�t
_J U
H � I hereby affirm under penalty of perjury that I am exempt from the Contractor's 11.0. liOX 1.723 2823 `l`Fil�itf�.+l. iZ' _:Aa'iii'+Jt,�1 ))I71
U License Law for the following reason: 1>AI,�,�1 S I;, NGS CA 92261 PALM : PRINt eS CA ,4220
Z_ ( ) I, as owner of the property, or my employees with wages as their sole e� �i , t y
compensation, will do the work, and the structure is not intended or offered for 77
{cel ' );`� 21,11 (til )";�'''{'� 3 ,R
sale (Sec. 7044, Business & Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals `iNt03-t' FAMILY I)WI-JAANO
Code).
ce) () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
rn
U Q WORKER'S COMPENSATION DECLARATION
CL Z `f'f(AC-`i° 4<'(:t t� Cti.lrC 3 iOl.4 ,: 41,(}1 its
C) I hereby affirm under penalty of perjury one of the following declarations:
IX
O I have and will maintain a.certificate of consent to self -insure for workers' Pc-lttf `1if['di'),f3 its Ub S
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the tA4ZAti>"'lt�'AI�PC)t�12(i(9t
O J Q perfor ance of the work for which this permit is issued.
Co Q U V10 l have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
fiLOH permit is Issued;, My. workers' compensation insurance carrier ,& policy no. are:;'.31i��11;8�+rSr1"C)d`i kJC.:aS Jr3h��i„vai.9U
1* Z Carrier ' 1 R r�_a {ts:r�{ Policy No. We-•tti �t.+
Q (This section need not be completed if the permit valuation is for $100.00 or less).`t€x�ci�,li -�SCr !
_J ( ) I certify that in the performance of the work for which this permit is issued, i> -XN 111'(,1K Fisai 101.-{){30-'3'39.31.9 UV 61
I shall not employ any person in any manner so as to become subject to the ruf;+iuS"T{t%iL1";,Etta t=°ri 1i�l�fliil}»+SIR-t)()i) arir2.l+if
workers' compensation laws of California, and"ag oe-t,at if I should become X1.K '{MNIC`ALFVff,- !UI.O{1i)-1x.1-Uut). $9.ti€1 y
3 subject to the workers' compensation /p� soviioRs�Iof Sect on 3700 of the Labor LIC,- t t_ i�P.1:1 F ii•. - : . •' l t) t mUtiU 2t)at)Cti) S194,31
Code, I shall forthwith comply with those prsi fis.
\Date: Applicant 1 ft1!NW1. Nf-i Ff-IT (40.10.000
Warning: Failure to secure Work s' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in L'1RALIJt(i P"Vi% I0 I.ittA),42A-0UU $20 00
addition to the cost of compensation, damages as provided for in Section 3706 1NE1)A v'i`}2[tt111RE H`V. 27a 1100.44-1-3l1;' $4,2-11X0
of the Labor Code, interest and attorney's fees. IRT i°: its:; }11 '401 �{�i.��t,{tt�if C;'.'.•�.` t.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant toI-!1►, "1tYi'.l1 f'Gi+l#'Pw �t"`1'.CUI+{ �.i`il) PLAN{'T{j (1r;{� -1 10
any permit issued as a result of this applicaton agrees to, & shall, indemnify LESS 11R PA1t.) 1'}
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void. if ';<'6>TAL PERN1111, VIEWS DUE NOW %, ,15471.60
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propefor n`spec I
rty pur, oses. � ,r
RECEIPT DATE y BY. j > DATE FINALED INSPECTOR
r ...__.. _.__._
Si ature (Owner/Agent) ' — Date
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
ZZ&Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O.K to Wrap
8
F.A.U.
Framing
Compressor
Insulation
ZM
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
/ y
•
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
G
Approval to Cover
Equipment location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
8
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping ,
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power -Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service:
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
P.O. BOX 1504 APPLICATION, ONLY
Building 417JJRr , /� �0f �O �� 7&105 CALLE ESTADORNIA 9
j Address '7 !/� LA'QUINTA, CALIFORNIA 92253
It 3r`" I W &_A5 ^ BUILDING: TYPE CONST. OCC. GRP.
1A21iling
kddress fo A.P. Number w
"ity` Zipp Tel..fl IM _<W.-21 `/t 9 5 / �� c0 3 3, -.A&_ -PP 1 % Legal Description R 4 (�f TA A 1' ,
'ontractor., I '( Project Description
address
City Zip Tel..
State Lic. r f City
& Classif. i� 9 Lic. #
Arch., Engr., f
Designer
Address Tel.
"�JA A --1 3 L-/ 0� Sl 9 J
Ciitry /��� Zip State
("-)A144`fb-05rA� J as i 1 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I em 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
the 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).
17 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 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 did not build or improve for the purpose of sale.)
I. 1 1, 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
17 1 am exempt under Sec. B. 8 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
IWorker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
I Policy No. Company
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
I
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i1 the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
i 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. 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
BUILDING DIVISION
Sq. Ft.
Size
New ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
No.
Stories
No. Dw.
I Initc
71-1 Alter ❑ Repair ❑ Demolition ❑
AMOUNT
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
Validated by:
Validation:
Permit
CONSTRUCTION ESTIMATE
NO, ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. $
2ND FL. SO. FT, to
POR. SO. FT.
GAR. SO, FT.
CAR P. SO. FT.
WALL SO. FT.
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION is
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. Q c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1'A c
SEWAGE DISPOSAL
SO.FT.GAR @ ?/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT, OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
Notice: 82-879 Highway 111 j
Indio, CA 92201 /
Document Cannot Be Duplicated 619-775-3500 `
CERTIFICATE OF COMPLIANCE
s
Date 5/2/96 APN # 643-100-024
14429 '
No. Jurisdiction La Quinta
Owner Name Landau Development Permit #
No. 47325 street Via Cordova = Log #
City La Quints Zip 92253 Study Area 123
Tract # Lot # Square Footage '3251
Type of Development • Single Family Residence No. of Units 1
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 or
replacement mobilehomes. It has been determined the above-named owner is exempt from paying
school fees at this time due to the following reason:
F EXEMPTION NOT APPLICABLE
This certifies thatschool facility fees imposed pursuant to Government Code 53080
in the amount of 1.72 x 3,251 or $ 5,591.72
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. - �,• ::
r# r�
Fees Paid By Imperial Sun Construction -Telephone 777-1345
Name on the check
By Dolores A. Ballesteros ° a
Superintendent
Fee collected/exempted by Pauline Pearson Payment Received $5,591.72. "
Check No. 15317
SignatureaAAK'A�21AI A )3 &,^— .
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
0 0�'fit
v tea. � ..
dAF'
F� w5 78-495 CALLE TAMPICO - LA- QUINTA, CALIFORNIA 92253 - (619) 777-7000 .
,moo
y OF _ FAX (619) 777-7101
May 9, 1996 --
Mr. Robert Barckley -
Imperial Sun Burst, Incorporated
PO Box 2081
Palm Springs; CA 92263 _
SUBJECT: SETBACK. ADJUSTMENT 96410 (FOR LANDAU DEV.)
LOCATION: 47-325 VIA CORDOVA`
Dear. Mr. Barckley:
This letter is to report approval of the setback adjustment application pursuant to Chapter, 9.188 of
the City of La Quinta Planning and Zoning -regulations, subject to.Conditions and according to the
attached exhibits.
SETBACK ADJUSTMENT=REQUEST:• To reduce the side yard setbacks from 5 -feet to 3 -feet
and 4 -feet for portions of a• new house in Lake Quinta . (i: e. j .a` patio covet and southwest corner of
the house).
CONDITIONS:
A. Obtain -a building permit from the Building & Safety Department. '
After review it was determined that;
•1. This adjustment is consistent with the intent and purposeofthe Zoning Ordinance to
allow, development of single family houses in an R-1 District. There are special
circumstances applicable to this property, such as its irregular shape (i.e., tapered
back yard area),'that justifies. approval of the adjustment: Development of irregular
shaped properties with a house is more difficult than rectangular shaped lots.. The
adjustment requested is only on a portion of the house and rear yard -patio cover and
has received approval from the Lake La Quinta HOA. The orientation of the house
,has: been, situated on. the lot to take advantage. of the view, of the existing -lake- in -the"
:Lake La Quintaeveopdment.
sba96-410
' MAILING ADDRESS - P.O. -BOX 1504. - LA QUINTA, .CALIFORNIA 92253
POWER AVAILABLE : IMPERIAL IRRIGATION WATER DIST.
VOLTAGE 120 240--1-1 PHASE
WIRES: v
NORMAL LOAD SCHEDULE :
3,500 groes livable prep `
GENERAL LIGHTING AND POWER
5 W/SF
3,500. $F
17,500 watts
KITCHEN
applianco clrcults'
cooktop
30 amp
3,600 watts
watts
8 ovon/mw
20 amp
2,400 watts
i0mr.
20 amp
2,400 watts
dishf`wa3h
20 amp
2,400 watts
& mise, appl.
10,800
Kitchon power 2
2
' 20 amp
4,800 watts
4,800 watts
Laundry Circuit
1
30 amp
3,600 watts-
3,600 watts
36,700 WATTS
OTHER LOADS '
first. 10,000 Kva of oilier loads 4 100.00% 10,000 WATTS
ramalndor o1 othor 103ds . 40.00"/0 r 10.680 WATTS
TOTAL OF OTHER LOADS: 20,680 WATTS
W/ADJUST.MENTS PER NEC ,
LOAD SUMMARY AND SERVICE -CALCULATION
4 ,
OTHER LOADS.:: 20,680 WATTS
HEAT PUMPS : 12,000 WATTS
2 UNITS
50 AMPS/EA,
SWIMMING POOL & SPA 10,800 WATTS
.3 CIRC.
30 AMPS/EA TOTAL WATTAGE: - 43,480 WATTS
AMP TOTAL WATTS1240V
MIN, REQUIRED SERVICE.
SINCl.E PHA$E POWER
TCERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Pagel of 7) CF -4R
Project Title Date �T
Project Addre� � � �� Builder Name
Builder Contact Telephone Plan Number
Ayz= �1Q� ��N� �Q ��,1 qqQ 610 ` PL L QUO
HF&844ter ^ / n Telephone I Sample Group Number
Certifying Signature `_Date
Firm:
Street Address: 16 Sl IM c IP Hl--w-(�4J fc)-L)6—
Copies to: Builder, HERS Provider
Sample House Number
HERS Provider: l ,d L U=)k S
City/State/Zip: E�_n art
HERS RATER COMPLIANCE STATEMENT
The house was: Tested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing dia.gnostic testing and field verification, I certify that the houses identified on this form comply
with -the diagnostic tested compliance requirements as checked on this form.
The installer has provided a copy of CF -6R (Installation Certificate.
Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
Where cloth backed, rubber adhesive duct tape is installed,.mastic and drawbands are used in combination with cloth
backed, rubber adhesive duct tape to seal leaks at duct connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) (�I1��-► S �i S Z ��^�
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM <2.> —T'
If fan flow is calculated as 400cfrn/ton x number of tons enter calculated
value here
If fan flow is measured enter measured value here Cpm
m/
Leakage Percentage (100 x Test Leakage(Fan Flow)
b
Check Box for Pass or Fail (Pass=6% or less) ❑
ass Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No Thermostatic Expansion Valve 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 on plan. "
2- ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -1R.
Measured Fan Flow =
❑ ❑
Yes for both 1 and 2 is a Pass Pass Fail
Compliance Forms August 2001 A-16
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TES'T'ING (Page 2 of 7) CF 4R
Site Address , Permit Number
REFRIGERANT CHARGE AND AIRFLOW MEASUREMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
Thermostatic Expansion Valves
Outdoor Unit Serial # 3 D O
Location' . I .0
Outdoor Unit MakeCA jC 4Z 1_4 F AI' -t 1
Outdoor Unit Model , C loC U Cp 8
Cooling Capacity Btu/hr
Date of Verification l (OS
Date of RefrigerantGauge Calibration I S (must be checked monthly)
Date of Thermocouple Calibration I O (must be checked monthly)
Standard Charge and Airflow Measurement (outdoor air dry bulb 55 OF and above):
Note: The system should be installed and charged in accordance with the manufacturer's specifications and'installer
verification shall be documented on CF -6K before starting this procedure. If outdoor air'dry-bulb is below 55 OF rater shall
r to verify charge and airflow at a time when temperature is.55 °F or greater.
Yes ❑ No A copy of CF -6R (Installation Certificate) has been provided ��efiigerant charge anow
measurement documented.
Measured Temperatures
Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db) C OF
Return (evaporator entering) aii dry-bulb temperature (Tretum, db) F Q .
- . Return.(evaporator entering) air wet -bulb temperature (Treturn, wb) OF
Evaporator saturation temperature (Tevaporator, sat) 6 0 —F
` . Suction line temperature (Tsuction, db) 60 OF- ;6 Q
Condenser (entering) air dry-bulb temperature (Tcondenser; db) °F ( l
' Superheat Charge Method Calculations for Refrigerant Charge
T
Actual Superheat = Tsuctio°Fn, db - Tevaporator, sat -
Target Superheat (from Table 1) OF
Actual Superheat – Target Superheat b - OF
(System, passes if between -5 and +5°F)
Temperature Split Method Calculations for Adequate Airflow_
Actual Temperature Split = T return, db - Tsuppiy,'db Z OF .�
Target Temperature Split (from Table 2)017 / c
_ Actual Temperature Split - Target Temperature Split OF
(System passes if between -3°F and'+3°F or, upon
remeasurement, if between. -3°F and -25°F)
Standard Charge and Airflow Measurement Summary:
System shall pass both refrigerant charge and adequate airflow calculation criteria from
the same measurements. If corrective actions were taken, both criteria must be '
remeasured and recalculated
System Passes. yes -'s ~ or no
Compliance Forms ' - gust 2001 A-17