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06-2491 (MECH)P.O. BOX 1504 ^� VOICE (760)777-7012 78-495 CALLE TAMPICO' ` FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Application Number: �06-_00002491 Owner- Date: 6/23/0 6 Property Address: 48117 VIA HERMOSA M/M CHERNICK APN: 646-100-013- - - 48117 VIA HERMOSA Application description: MECHANICAL LA QUINTA, CA 92253 nFINANCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1900 Contractor: N 23 2006 Applicant: Architect or Engineer: DANCY HVACR, MIKE P.O- BOX 1567 DEP+TTYOFLAQU rA INDIO; CA 92202 (760_)775-0750 Lic. No%: 374657 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I. hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in fullforceand effect._ I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided License Class: C20-38 License No.: 374657 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is ! issued. i DateQ V: 'Contractor: .' - _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the.performance of the work for which this permit is issued. My workers' compensation _ OWNER-BUILDER DECLARATION insurance carrier and policy number are: - I hereby affirm under penalty of perjury that I'am exempt from the Contractor's State License Law for the Carrier EXEMPT 11 / 3 0 / 0 6olicy Number EXEMPT following reason (Sec. 7031 .5, Business andProfessions Code: Any city or county that requires a permit to- - _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any _ construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any mannee so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section . _ License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwithcomply with those provisions. 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).: Date:_4-,o2" Applicant:/ (_) 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDEDFORIN . ` improvements are not intended or offered for sale. If, however, the building or improvementis sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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.). APPLICANT ACKNOWLEDGEMENT I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. rimpartywhn hiilrls nr imnrmtet therenn and whn rnmrants fnr the nrnients with a rnntrartnr451 IinnnARd 1 , Each nerson anon whgse behalf this ag011calim is made. each wis9n at yyhw9 rggygst and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,. 1 - ) I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify 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. Date: Owner: 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all - work for which this permit is issued (Sec. 3097, Civ. C.). - - - city and county ordinances and state laws relating to building construction, and hereby authorize representatives _ of this county to enter upon the above-mentioned property for inspecti n purposes. - - • Lender's Name: - - - - Date: 'signature (Applicant or Agentl:� Lender's Address: LQPERMIT.• - .. Application Number . . 06-000024911, Permit MECHANICAL Additional desc . Permit Fee. 28.50 Plan Check Fee 7.13 " Issue Date . . Valuation 0 Expiration Date -12/20/06 Qty Unit Charge Per Extension BASE FEE 15.00 _ 1:00 4.5000 EA MECH VENT INST/ DUCT ALT - 4.50 1.00. 9.0000 EA MECH APPL REP/ALT/ADD . 9.0.0 Special Notes and Comments 4 REPLACE 5 TON CONDENSER(SPLIT) Fee.summary Charged Paid Credited Due ------------------------------------- Permit Fee Total 28.50 -------------------- .00 .00 28.50 Plan Check Total 7.13 .00 .00 7.13 Grand Total 35.63 .00 .00 35.63 a LQPERMIT -- - - r CERTIFICATE OF. COMPLIANCE: RESIDENTIAL (Page(2_"0'f 4) CF=1.R Project Title Date I, FENESTRATION PRODUCTS— U -FACTOR AND SHGC ✓ El FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS-4R—must be included for New Construction, Additions and Alterations. Fenestration WType/Pos. (Front, Left, Orien- Rear, Right, tation, Area U -factor SHGC Skylight) N.'S, E, W' (ft) U -factor' Source' SHGC' Sources Exterior Shading/Overhangs6'' ✓box if WS -3R is included Distribution Type and. Location Duct or Piping Thermostat Configuration (ducts, attic, etc.) R -Value Type (split or package) `To /7- A 7— 7 s>T -9/— ❑ I) Skylights are now included in West -teeing fenestration area it -the skylights are tilted to the west or tilted in any direction when'the pitch is less than 1: 12. See § 151(f)3C and in Section 3.2.3 of the Residential Manual 2) Enter values in this column are either NFRC Rated value or from Standards default Table 116A. 3),1,ndicate soin•ce either from NFRC or Table 116A, 4) Enter values in this column from NFRC or from Standards Default Table 1 16B or adjusted SHGC from' WS -3 R. 5), Indicate source either fi-orn NFRC or Table 116B. 6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS -3R to calculate Exterior Shading devices.- 7) evices.7) See Section 3.2.4 in the Residential Manual. HVAC SYSTEMS Heating Equipment -Type and Capacity _ ffurnace. heat nun p, boiler, ctc.) Minimum Efficiency I (AFUE or HSPF) Distribution Type and. Location Duct or Piping Thermostat Configuration (ducts, attic, etc.) R -Value Type (split or package) `To /7- A 7— 7 s>T -9/— Cooling Equipment Type and Capacity (A/C, heat pump, eve ). coolie) Minimum Efficiency Duct Location (SEER or EER) attic, etc. Duct Thermostat Configuration •R -Value Type (split orpackage) `To /7- A 7— 7 s>T -9/— CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of4) CF -1R Project Title Date SCALED DUCTS and TXVs (or Alternative Measures) A signed C1=-411 Form must be provided to the building department for each home for which the following. are reu u i red. Segled Ducts (all climate zones) Installer testing and certification and HERS rater field verification required.) \Vs, readily accessible (climate zones 2'and 8-15 only) (Installer testing and certification and'HERS Rater field verification required.) ❑ Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and FIEF -S Rater field verification re aired.) OR ❑ Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for Proiect Climate Zone in the RM Aimendix B Table 151-C, Footnotes -7-14. OR For additions and alterations, duct systems that are not documented to have been previously ❑ sealed as confirmed through field verification and diagnostic testing in accordance with procec.ures in the . Residential ACNI Manual and duct systems with more than 40 linear feet in unconditioned spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D. WATER HEATING: SYSTEMS Svstems serving single dwelling units Water Heater T y ie/Fuel Type Distribution Type Number in System Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired eater heater per ❑ dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is Standby Loss (%) not allowed. ❑ Check box when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential Manual. No water heating calculations are required, and the system complies automatically. _ Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved Alternative Water Heating table. In this case, the Performance Method must be used and mus- be included in the submittal. ❑ Check box to verify that a time,control is required for a recirculating system pump for a systen serving multiple units Svstems serving single dwelling units Water Heater T y ie/Fuel Type Distribution Type Number in System Rated Input' (kw or BtLVhr) Tank Capacity (gallons) Energy Factor' or Thermal Efficiency Standby Loss (%) Tank External Insulation R -Value Svstem serving nuiltinle dwelling units Water Heater Ty Pe Distribution Type Number in System Rated Input' (kw or Btu/hr) Tank Capacity (gallons) Energy Factor' orExternal Thermal Efficiency Standby' Loss (%) Tank Insulation R -Value 1. For smal I gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water heaters, list Rated Input and The Efficiencies. Pipe Insulation (kitchen lines > 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are 3/A inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 (i) 2 B. Residential Compliance Forms March 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL 4 of .I CF -IR • X11 —7 Project Title Date SPECLAL FEATURES NOT REQUIRING HERS VERIFICATION (add ext: -a sheets if necessary) Indicate which special features are part of this project. The list below only represents special features relevant to the nreccrintive metlind ✓ Feature Required Forms if applicable) Description ❑ NIetal Framed Walls CF -IR CF -6R part 6 of 12 ❑ . Radiant Barriers CF -I R ❑ Exterior Shades WS -4R ❑ Cool Roof N/A; Attach CRRC Label to Forms. ❑ Dedicated Flydronic Heating Performance Calculation System Required; Attach Run to Forms. ❑ Combined Flydronic System Performance Calculation Required; Attach Run to Forms. ❑ Gas Cooling Performance Calculation Required. ❑ Buried Ducts N/A; Indicate on building plans. ❑ Kitchen Pipe Insulation See Section 5.6.2 Distribution Systems in Residential Manual. . Nlultiple Water Heaters Per See Table 5-13 or use ❑ Performance Calculation and Dwelling Unit attach Run to Forms. ❑ Central Water Heating System Performance Calculation and Serving Multiple Dwellings attach Rum to Forms. Non-NAECA Large Water CF - IR Heater See Table 5-13 or use 4 ❑ Indirect Nater Heater Performance Calculation and attach Run to Forms ..• See Table 5-13 or use ❑ Instantaneous Gas Water Heater Performance Calculation and attach Run to Forms See Table 5-13 or use ❑ Solar Water Heating System Performance Calculation and attach Rum to Forms WoodStove Boiler Performance Calculation and attach Rum to Forms SPECIAL FEATURES REQUIRING TIERS RATER. VERIFICATION (add extra sheets if necessary) Indicate to the HERS Rater which credits are part of this praject and need verification_ ✓ Feature Required Forms if applicable) Description Duct Scaling CF -6R part 4 of 12 ❑ Refrigerant Charge CF -611 part 5 of 12 W Thermostatic Expansion Valve CF -6R part 6 of 12 Residential Compliance Forms March 2005 - e i SOLAR WATER HEATING•CALCULATION FORM Pae I of.'3) 'CF -SR X -j � � /+` RE R' A�c o r lF 6 -a2� Project Title Date COMPLIANCE STATEMENT This certificate of cornpliance lists the building features and specifications needed to comply with Title 24; Parts I, and 6 of the California Code of Regulations, and the administrative regulations.to implement E thein. This certificate has been signed by the individual with overall design responsibility. The • J11dersigned'recogni-r_es that compliance using duct design, duct sealing, verification of refrigerant charge and TXVs; insulation installation quality, and building envelope sealing require installer testing and certification and field. verification by an approved HERS tater. Designer or Owner (per Business and Professions Code) Documentation Author Name: I itle/Firm: ,Title/Firm:" Address: Address: Telephone: 'Telephoner Lia #: (signature) (date) (signature) (date) Enforcement Agency r Name: Comments: litle -. Agency,: Telephone: (sinawrc / Stant) (date) INSTALLATION CERTIFICATE age 4 of 12 CF -6R Site Address Permit Number (Y- co INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT - The building was: ✓ ❑Tested at Final ✓ ❑ Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE FOR NEW DUCTS: (Remove at least one supply and one return register, and verify that the spaces between the register boot and the interior finishing wall are properly sealed. ❑ If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points between the air handler and the supply and return plenums to verify that the connection points are properly sealed. ❑ Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used on new ducts. ✓ ❑ DUCT LEAKAGE REDUCTION Prnrodnroc Mr fiold voriiiratinn and dinannctir toctina afair di.ctrihniian .cvctomv are availahle in RACM Annendix RC4.3 NEW CONSTRUCTION: - Duct Pressurization Test Results (CFM @ 25 Pa) • Measured Values Signature: 1 Enter Tested Leakage Flow in CFM: Fan Flow: Calculated (Nominal: ✓ MICooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfin/ton x number of tons or as 21.7 cfin/(kBtu/hr) x Heating ��� ✓ ✓ Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here: 3100 Pass if Leakage Percentage < 6% for Final or < 4% at Rough -in without air handle: 13 Pass 13 Fail x ine # 1 / ine # 2 ALTERATIONS: Duct System and/or HVAC Equipment Change -Out Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct 4. System Alteration and/or Equipment Change -Out. 3 v Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct 5 System for Duct System Alteration and/or Equipment Change -Out. 3 3 Enter Reduction in Leakage for Altered Duct System 6_(Line # 4 Minus_(Line # 5 –(Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) . ✓ ✓ Entire New Duct System - Pass if Leakage Percentage < 6% for Final. ❑-7---Pass ❑Fail 8 100 x Line # 5 / Line # 2 TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change- , Out Use one of the following four Test or Verification Standards for compliance:' 9 Pass if Leakage Percentage < 15% [100 x [ (Line # 5) / (Line # 2)1] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage < 10% [100 x L—_ (Line # 7) / (Line # 2)]] ❑ Pass ❑ Fail (Line # 4)]] Pass if Leakage Reduction Percentage > 60% [100 x L_(Line # 6) /77 . ❑Pass ❑Fail 11 and Verification by Smoke Test and Visual Inspection t FE Pass if Sealingof all Accessible Leaks and Verification b Smoke Test and Visual Inspection 13 Pass ❑ Fail Pass if One of Lines # 9 throw h # 12 pass ❑ Pass ❑ Fail ✓ ❑I, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for compliance credit. I, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply with Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency standards. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner - Signature: Date: 2 % —4 Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY } Residential Compliance Forms December 2005 8Y�A INSTALLATION CERTIFICATE (Page 3 of 12) CF -6R Site Address •Kermit -Number 1,4 48-117 Via Hermosa, La Quinta — .2 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 required) After completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at occupancy, per Section 10-103(a). HVAC SYSTEMS: - Heating Equipment Equip Type -(pkg. heat pump) CEC Certified Mfr. Name and Model Number # of Identical' -Systems Efficiency (AFS etc-)' (aff-1R value) Duct Location (attic, etc.) Duct or Piping R -value Heating Load (Btu/hr) Heating Capacity (Btu/hr) S 4 .5' 016610 /b / d /� Cooling Equipment Equip Type .(pkg. heat pump) CEC Certified Mfr. Name and Model Number # of Identical Systems EfficiencyDuct (SEER or EER)" (ZC&IR value) Location (attic, etc.) Duct R -value Cooling Load (Btu/hr) Cooling Capacity (Btuft) S 4 .5' 016610 /b / d /� 1. > symbol reads greater than or equal to what is indicated on the CF -JR value. Include both SEER and EER if compliance credit for high EER air conditioner is claimed. ✓ [] I, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or more efficient than that specified in the certificate of compliance (Form 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 Appliance Efficiency Regulations or Part 6), -where -applicable. .Installing Subcontractor Wo. ame -OR enera Contractor(Co. Name)O Owner Mike Dancy HVAC Signature: Date: �� 06 Copies to: BUILDING 'DEPARTK NT, TRS RATER (IF APPLICABI:E) BUILDING OWNER ATOCCUPANCY t • Residential Compliance Forms April 2005 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page I of 8) CF -4R Project Address 48-117 Via Hermosa, La Quinta Builder Name Vera Chernick Builder Contact Vera Chernick Telephone 760.771.0305 Pan Number , HERS Rater Dennis Hebert - Telephone 760.779.5161 Sample Group Number Enter Tested Leakage Flow in CFM: Compliance Method (Prescriptive) Climate Zone 15 fying Signature , si 4M !GL7 Date O� Sample House Number Firm Air Management Services HERS Provider CHEERS Street Address: P. O. Box 2824 3 City/State/Zip: Palm Desert, CA 92261 Copies to: BUILDER,.HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER C_ ONPLIANCE STATEMENT - t . The house was: ✓ . Tested ✓ ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, 1 certify that the house identified on this form complies with the diagnostic tested compliance requirements as checked ✓ on this form. The HERS rater must check and verify that the new distribution system is fully ducted and correct tape is used before a CF -4R may be released on every tested building. The HER rater must not release the C04R until a properly completed and signed CF -6R. has been received for the sample and tested buildings. U, The installer has provided a copy of CF -6R (Installation Certificate). ❑ New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts). ❑ New systems where cloth backed, rubber adhesive duct tape is installed, mastic and draw bands 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 Procedures for field verification and diagnostic testing of air distribution systems are available in RACM, Appendix RC4.3. ' Duct Diagnostic Leakage Testing Results , NEW CONSTRUCTION: Measured Duct Pressurization Test Results (CFM 25 Pa) Values Enter Tested Leakage Flow in CFM: 2 Fan Flow: Calculated (Nominal: ✓ Cooling ✓ ❑ Heating) or ✓ ❑ Measured O'V Enter Total Fan Flow in CFM: 3 Pass if Leakage Percentage < 6% [ 100 x [ (Line # 1) / (Line # 2)]] ❑ Pass '❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System 6 for Duct System Alteration and/or Equipment Change -Out. d Enter Reduction in Leakage for Altered Duct System (Line # 4) Minus (Line # 5)] 6 (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) Entire New Duct System - Pass if Leakage Percentage < 6%. ❑ Pass ❑ Fail 8 [100 x [ (Line # 5) / Line # 2)]] TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out Use one of the following four Test or Verification Standards for compliance: ✓ ✓ 9 Pass if Leakage Percentage < 15% [100 x [ (Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage < 10% [100 x [ (Line # 7) / (Line # 2)]] ❑ Pass'C] Fail 1 I Pass if Leakage Reduction Percentage > 60% [100 x [_ _ (Line # 6) / p (Line # 4)11 G-70 q ❑pass Fail and Verification by Smoke Test and Visual Inspection 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test an Visual InspectionPass ❑ Fail ' Pass if One of Lines # 9 through # 12 pass '� Pass ❑ Fail Residential Compliance Forms December 2005 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3 of 8) CF -4R Project Address Builder Name 48-117 Via Hermosa, La Quinta Vera Chemick Builder Contact Telephone Plan Number Vera Chernick 760.771.0305 visual verification that the TXV is installed on the system and HERS Rater ti Telephone Sample Group Number Dennis Hebert 760.779.5161 Compliance Method (Prescriptive) Yes is a pass Pass Fail C imate Zone 15 C ' ing Signaturei ate a7 S Samp a House Number , Firm HERS Provider Air Management Services CHEERS Street Address: City/State/Zip: P. O. Box 2824. Palm Desert, CA 92261 Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER QOWLIANCE STATEMENT ° The house was: /Tested ✓ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies . wi the diagnostic tested compliance requirements as checked on this form. ✓ The installer has'provided a copy of CF -6R (Installation Certificate). ✓ THERMOSTATIC EXPANSION VALVE (TXV) Procedures for field verification of thermostatic. expansion valves are available in RACM,. Appendix RI. Access is provided for inspection. The procedure shall consist o ✓ Yes a No visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass Pass Fail