0306-207 (SFD)' 7 LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
;Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License Is in full force and.effect
11 License #Llc. Class /� " Exp, Date
tt64 .y, 1
Date ' r Signature of Contractor
°ra -
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with .licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S 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 Issued. My workers' compensation insurance carrier & policy no. are:
Carrier ^?T ATR ?Ui'1 � Policy No. I3
(This section need not be completed if the permit valuation is for $100.00 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, 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: r • !' Applicant ' -
Warning: Failure to secure Workers' Compensation coverage is unlawful and
;;;shall subject an employer to criminal penalties and civil fines up to $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.
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 to
'any permit issued as a result of this'applicaton agrees to, & shall, indemnify-
s & 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 .
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 toycomply with,all City, acid State laws relating to the building
construction, and hereby authorize representaiives of this City to enter upon
the above-mentioned property for inspection purposes /
Signature (Owner/Agent)- - 1 1 l �' �' Date
PERMIT#
BUILDING PERMIT " - 010,&.207
r
DATE VALUATION ' $n`rlalai a LOT. r TRiACT `� �t `r!%•°�
JOB SITE F4_1.71f X511WASHNPRIIS''I.?.
APN t%h-M-{tiara \
ADDRESS
OWNEyRryry�
CONTRACTOR/ EENT 1NEE�R1,
�W7L 1.1�..✓>'.Ynll..•hJ'.L..i,el..M1! -
[DESIGNER
{ ,(/ �e
.L'�;:�1 M•i-Y.LiG�'Y.i.�P.7..iYrdYp .l:l7�v..
,'`.,A 922$3
PHOENIX AZ7, f.4:' o?A,
,? 4990
USE OFPERMIT
Ay:f=`•.lqd+'.A.�I-M�7'I''Q.L�J(i�'�3j'.S�`[I�:.l`+^J�a^Lj:��Rj_
r7F.'!J• ':.k«� i' dIJ, r7lat'1t� eY ;.t LJ o+,+. r::.rt�:el;'t powJru.?, 74 q7e.
•l FL AC `.M I.iinNS Y?•.S�,:ZllrT.✓!ON
€�lwliCii97,",1E:3:t�ti E;i�k�.fJJ 'SP'
0,ARA 3Z?4.1AR110IRT 10A 40
Ith'I'VAN11.0 CONT OF CONMUCTION1
Y�:)t��!`�T{+. '•1; tJ d':/1`� �"�iE i f{} �tu`L7Q,i.�.i �'4i�f� aA3p�b �.aSy
PR„�� CkbSl+'�Jfi f;'!?:i� $i1�.•-S.YGtD•-4�St-�t,�< `�',OG"s�5'7`
XWWICAL R-9
I'C+ICAL* YS' 2 1,,000.420-OOC
I°L`i.tli4B%K31ME 101.0.00-v.P-Ooo A3:di+,slq
: �`�'iui>`NQ MOTION �1.VND i 01-060-.241 -000 $1k 9'r
G#R�4Yza 3E; F`" L� 4f_►I tJlJti-/t' S-000
T.)EV93,:0PER;lea` a 3 , i v,.nt 5.o i
Awr I'm PUTS1LiC. MAcw • �2�.rSi�3 ,n."s t^r• ii1�3� 6,si'=13i1C; $ply. F.;#
OU AND
S5,749. 1!5
!
t941.•L�t,c� ��+ �•,�^�,�
.{1
.��� 2 0 20 :i LaF�,itIL" AJ. 7 UE Y,'*
f,'f�►e�ti'
C TY OF LA QU! c A
- FrslAi&f� DE�&1T.
RECEIPT
DATE /
BY - 7-*_
DATE FINALED
INSPECTOR
_
b�
Al
e!
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts f
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck
IV -1— 3
Combustion Air
Exhaust Fans
O.K. to Wrap
D — — 3
F.A.U.
Framing
__31
Compressor
Insulation :
—
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Of
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_//'_
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— /Q—
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:c�,�%"'
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
690645 B HIC A 6/30/04
Date Signature of Contractor
OWNER -BUILDER QECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S 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 issued. M Workers' compensation insurance carrier & policy no. are:
Carver STATE FIND Policy No. 1583906-02
(This section need not be completed if the permit valuation is for $100.00 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, 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
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $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.
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 to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& 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
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 property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT 0306-207
DATE VALUATION $279,650,60 LOT S0 TRACT 29858-1
JOB SITE
ADDRESS 50-295 VIA SIN PRISA
APN 772-390-011
OWNER CONTRACTOR / DESIGNER / EN (NEER
RTT HOMES LLC RN INVESTMENTS, INC.
PO BOX 810 1425 E. UNIVERSITY DRIVE
LAQUINTA CA 92253 PHOENIX AZ 85034
'(602)257-1656 CBL4 4990
USE OF PERMIT
SINGLE FAMILY DWELLING
WALLS, POOL SPA OR DRIVEWAY APPROACH
TRACT CONSTRUCTION 4,618.00 SF
PORCH/PATIO 1,048.00 SF
GARAGEICARPORT 763.00 SF
ESTIMATED COST OF CONSTRUCTION
279,650.60
PERMIT FIRE SUMMARY
CONSTRUCTION FEE 101-000.418-000 $1,269.50
PLAN CHECK FEE 101-000-439-318 $1,092.67
MECHANICAL FEE 101-000-421.000 $170.50
ELECTRICAL FEE 101-000-420-000 $259.39
PLUMBING FEE 101.000.419-000 $310.00
STRONG MOTION FEE - RESID 101-000-241-000 $27.97
GRADING FEE 101.000.423.000 $15.00
DEVELOPER IMPACT FEE $2,405.00
ART IN PUBLIC PLACES - RESIE 270.000.445-000 $199.13
,a.
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$5,749.16
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$5,749.16
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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INSULATION -CERTIFICATE
This is to certify that insulation has been installed in conformance
with the current energy
regulation, California Administrative Code, Title 24, State of California, the
9
in building located at:
50-295 VIA SIN PRISA ,LOT 50, LA QUINTA,CALIFORNIA
1i
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CEILINGS:
.
TYP TS MANUFACTURER: CERTAINTEED
THICKNESS: R-38
WALLS:
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TYPE: BATTS MANUFACTURER: CERTAINTEED
THICKNESS: R-21
GEN LC T O: R ES LICENSE #
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TITLE :�fP��1tt
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A ON SCHMID BUILDING PRODUCTS,
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A MASCO COMPANY LI
� CENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/14/2003.
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,
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
PAMILLA, 02-24-04
Pro ect Title Date
50'TH & JEFFERSON R J T BUILDERS -
r ct�A r Builder Name -
bRGAN 760-275-8230 IRONWOOD SF3C3 3 UNITS
Builder Contact Telephone Plan.Number
GRANT RICH 760-250-2084 GROUP 1 1 OF 3
HEX Rater 0 Telephone
R # CNNGR2074391
IAL 0 LOT # 50 '"
Certifying Signature Date Sample House Number
Firm: HERS ENERGY SERVICES HERS Provider: CHEERS
P.O BOX 621 RANCHO MIRAGE CA. 92270
Street Address: City/State/Zip:
Copies to: Builder, HERS Provider ;
HERS RATER COMPLIANCE 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, I certify.that the houses identified on this form comply
l with the diagnostic tested compliance requirements as checked on this form.
' ® The installer has provided a copy of CF -6R (Installation Certificate. i
K 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
onnections MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT " -
f Duct Diagnostic Leakage Testing Results (Maximum 6% -Duct Leakage) :
Measured
Duct Pressurization Test.Results (CFM (& 25 Pa) values
Test Leakage Flow in CFM 116 .
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here 2000
If fan flow is measured enter measured value here `
- Leakage Percentage (I"00 x Test Leakage/Fan Flow) = 5.8
Check Box for Pass or Fail (Pass=6% or less) ® ❑
Pass 'Fail
® THERMOSTATIC EXPANSION VALVE (TXV)
® Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection ® 11
Yes is a pass Pass Fail
r
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
r PAMILLA
02-24-04
Pro ect Title Date
0
5'TH & JEFFERSON R J T BUILDERS
'16W 'MbRGAN 760-275-8230 Builder Name
IRONWOOD SF3C3 3 UNITS
Builder Contact Telephone Plan Number
GRANT RICH Y 760-250-2084 GROUP 1 2 OF 3
HE S Rater Telephone
# CNNGR2074391 1� p y LOT # 50
Certifying Signature Date Sample House Number
Firm: HERS ENERGY SERVICES CHEERS +
HERS Provider:
Street Address: P.O. BOX 621 City/State/Zip: RANCHO MIRAGE CA. 92270
'Copies to:,' Builder, HERS Provider
- § HERS RATER'COMPLIANCE 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 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 -611 (Installation Certificate.
1Z 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)
Measured -
Duct Pressurization Test Results (CFM (& 25 Pa) values _
Test Leakage Flow in CFM 116
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
` value here 2000
If fan flow is measured enter measured value here
} Leakage Percentage (I 00 x Test Leakage/Fan Flow) = 5.95
Check Box for Pass or Fail (Pass=6% or less) ® ❑
y Pass Fail
®THERMOSTATIC EXPANSION VALVE (TXV) -
® Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
s Yes is a pass Pass Fail
CERTIFICATE OF•FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R -
PAMILLA 02-24-04
Pro ect Title Date
4TH & JEFFERSON R J T BUILDERS -
&W r`jbRGAN 760-275-8230 Builder Name
IRONWOOD SF3C3 3 UNITS
Builder Contact Telephone Plan Number
GRANT RICH 760-250-2084 GROUP 1 3 OF 3
HE&S Rater Telephone
R #CNNGR2074391 ,3./8_0y LOT# 50
Certifying Signature Date Sample House Number
DESERT ENERGY SERVICES CHEERS.
Firm: HERS Provider:
Street Address: P.O. BOX 621 City/State/Zip: RANCHO MIRAGE CA. 92270
Copies to: Builder, HERS Provider '
HERS. RATER COMPLIANCE STATEMENT
The house was- N Tested t ❑ Approved as part of sample testing. but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply
with the diagnostic tested compliance requirements as checked on this form.
®. The installer has provided a copy of CF -6R (Installation Certificate. _ "
N 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 tae is installed, masticand drawbands are used in combination with cloth
backed, rubber adhesive duct tape to seal leaCs at duct connections'- MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM (25 Pa), values.
Test Leakage Flow in CFM 44
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here 800
. .r
If fan flow is measured enter measured value here "
Leakage Percentage (I 00 x Test Leakage/Fan Flow) = 5.5
Check Box for Pass or Fail (Pass=6% or less) t ® ❑
` Pass Fail
N'THERMOSTATIC EXPANSION VALVE (TXV)
N Yes , ❑ No Thermostatic Expansion Valve is installed and Access is
-provided for inspection
Yes is a pass Pass Fail
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'INSULATION CERTIFICATE
.
r
This is to certify that insulation has been installed in conformance with the current energy
regulation, Califomia Administrative Code, Title 24, State of California, in'the building at
50-295 ViutSin Prisa; Lot $0, La Quinta, California
CEILINGS:
;
TYPE: Batts MANUFACTURER: Certainteed THICKNESS: ,R-38
r,
f
WAL4S -
TYPE: Batts 'MANUFACTURER: Certainteed THICKNESS: ` R-21
v
GENERAL CONTRACTOR: RJT Homes ' LICENSEM
t
BY: TITLE:
,
PARAGON SCHMID BUILDING PRODUCTS, A Masco Company LICENSE # 221517
R
�("may
BY: TITLE: ACCOUNT REPRESENTATIVE DATA=: 2/18/2004
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6.�r/J/P'/rr/ArJP'lP'lli///5'rrPvwAly/Y/lr�Il,Y�Y/Y/'Y�!%N//.'utfAY%i'7lPrAA%Piliv�lrP/lII�P7/+1ix'/�irJirs'P.+.rz�iP'/�i�7Yi�1P7/!vJR�Y7�J/7P7P7i7PSYrlr//rrr�/�n/YSPV/%'/�r�� �1. •P.•rrlP•r :'I:.�r/.:•./..':
' �:''r^•Y.>•r.('/;w:0.:'J':Pf/.:D[.'N.99.:9.`]ISS.f9.f���l.�9T..R;Y2'/.f�:*.�.tt/lP�Jt.�•TCO.'is9s!•N�YY4AY�S�N!SV.Yd4Yi�'NCMR�GdIi'0�.11Y..0'FafD7,C•!la w.fm94,nYlb'.�T(/'vm,S'lrVR7./1`/.�Y•aa�:'/.,'NmW.%1✓IN:NJ�:!/?R"✓.:II'.'/.�l':.%✓:n'r:(f,,•r.r^>
r
INSUL.ATIOR CERTIFICATE
"
This. is to -certify that insulation has en installed in conformance with the current energy,
regulation, California Administrative C de, Title 24, State of California, in the building located at
Y
CEILINGS:
TYPE: Batts . MANUFACTU ER: C ainteed THICKNESS: -
WALLS:
TYPE: Batts MANUFAC RER: ertainteed - THICKNESS:
i
//
'GENERAL CONTRACTOR: LICENSE
i
BY: TITLE:
s
PARAGON SCHMID BUILDfN PRODUCTS . A Masco Comp y . LICENSE # 221517
BY: TITLE: ACCOUNT REPR ; NTATIVE ' DATE: 2/18/2004 _
., .rr..
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111.A S I I PRIs A • .
INSTALLATION CERTIFICATE (Page 3.of ata)
CF -6R
Slte Address Permit Number.
DUCTUEAKAGE AND DESIGN DIAGNOSTICS
DUCT LLAKAGA REDUCTION -
Pressurization Teit Results (CFM Q 25 PA) Test Leakage (CFM)%_ .
Fan -Flow
If Fan Flow Is.Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity
In Thousands of•Btu/hr, enter calculated value here
If fan flow Is measured, enter measured value here
Leakage Fraction - Test Leakaget(Measured or Calculated Fan Flow)
o
Pass if leakage fraction l0.06 Pass
Fail
o For AEROSOL TYPE SEALANTS ONLY' -The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FINISHiNO WALL:
O Yes 'D No . d' Pressure pan test or House pressurization- test.
0 Yes O No 0 Visual Inspection of Duct Connections o
0
Pass
Fail.
WTHE� RMOSTATIIC EXPANSION VALVE 7T)CVl
tftes O No Thermostatic Expansion Valve is installed and Access is - provided for. inspection
Yee is a pass
0
Pass
Fall
•13 -DUCT DESIGN
ACCA Manual D Design.calculations have.been
1. 0 Yes O No 90.mpleted, Duct Deslgn. s on the plans and duct Installation '
matches plans.,
._.__-------------- _..�' o
2. O Yes O No TXV is Installed or Fan flow has been verlfled. If no TXV, Pass
o
Fall
verified fan flow matches.design from CF -IR
Measured Fan Flow a.___
Yes for both. I and 2 is a Pass
D I, the undersigned, verity that the above diagnostic test results and the work I performed associated wtth.the test(s) is in conformance
the CF -6R signed by the builder
with the requirements for compliance credit. (The builder shall provide the HERS provider. a copy of
and installation meet the requirements forconipliance credit. ]
employees or sub -contractors certifying that diagnostic.testing
LA
Installing Su ontractor (Co. Name) OR
Tesp . ;: ate
Tat,
General Con ctor (Co.perfoName),
P Kd
COPY TO: - Building Department
HERS Provider (if appltcabley
Building Owner at Occupancy
A-.25
August 2001
- Compliance Forms ' : ,. •
(Page 3.of 13) CF-6R
INSTALLATION CERTIFICATE
7*7 _rr -
Site Address - Permit Number.
DUCT'AKAGE AND DESIGN DIAGNOSTICS
DUCT' LEAKA(sLr RLllUC'1'lUN
Pressurization Test Results (CFM Q 25 PA) Test Leakage (CFM)—IaL
Fan-Flow
If Fan Flow Is Calculated as 400 cf Wton x number of tons, or as 21.7 x Heating Capacity
In Thousands of-Stu/hr, enter calculated value here
If fan flow is measured, enter measured value- here
Leakage Fraction Test Leakaget(Measured or Calculated Fan Flow) _ W o
Pass if leakage fraction < 0.06 Pass Fall
O For AEROSOL TYPE SEALANTS-ONLY -The following diagnostic testing was completed:
Duct Fan Pressurization at rough-in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
O Yes .0-No . 0: Pressure pan test.or House pressurization-test.
O Yes O No 0 Visual Inspection of Duct Connections o 0
Pass 'Fall
Z Iff ERNIOSTATIC EXPANSION VALVE
l yes ❑ No Thetmostit —Expansion Valve is installed and Access is -provided for. inspection
ic
�.
0.
Yes is a pass Pass Fall
13 DUCT DE i N
ACCA Manual D Design calculations have. been .
1. 0 Yes O Nocomplated, Duct DesIgn1s on the plans and duct Installation
matches plans.,
0 0
2. O Yes O No TXV Is installed or Fan flow has been verified. If no TXV, Pass Fail
verified fan flow snatches design from CF-IR
Measured Fan Flow
Yes for both 1 and 2 is a Pass
O 1, the underslgped, verify that the above diagnostic test results and the work I peribmred 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-con
certifying that diagnostic.testing and installation meet the requirements forcompliance credit. I
a ; • ate Installing Subc ntractor (Co. Name) OR
Tan
T Sts rcd General Contractor (Co. Name)
COPY. TO: - Building Department
HERS- Provider (if applicable)
Building Owner at Occupancy
A-25
August 2001
Compiance Fortn9 0
'ALEATION CERTEFICATE (Page 3.of 13)"
CF-6R
R
n :Site Address Permit Number.
DUCT-LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGL,r RKDUCTION-
Prunrizatlon Teit Results (CFM ®25 PA) Test Leakage (CFM) t�' a
Fan Flow.
If Fan Flow is Calculated as 400 cfm/ton x number of tons, or 021.7 x Heating Capacity
In Thousands of•Btu/hr,.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 <0.06 Pass
. Fail
O For AEROSOL TYPE SEALANTS ONLY -The following diagnostic testing was completed:
Duct Fan Pres'sur'ization at rough-in measured leakage (CFM)
CHECK AFTER FINISH. ING WALL:
O Ycs .O No .. d Pressure pan tesf.or House pressurization"test.
O Yes, O No O" Visual Inspection of Duct Connections o
0
Pass
Fail
THERMOSTATIC EXPANSION VALVE (TQM
`t7�Yes O No Thermostatic "Expansion Valve is installed ejtd Access is -provided for. inspection
( �
Yes'is a pass Pass
o
Fail
DUCT DEIN .
ACCA Manual D Design calculations have.been
1: O Yes O No completed, Duct Design is on the plans and duct installation
matches plans. .
0
2. O Yes O No TXV is installed or Fan flow' has been verifled. If no TXV, Pass
C
Fall.
verified fan flow matches design from CF-R
Measured Fan Flow
Yes for both 1 and 2 is a Pass
O I, the undersiggt results and the work I"perrormed associated"with"ttte test(s) is in conformance "
ed, verity that "the abRve diagnostic tes
of the. CF-6R signed by the builder
with'thc requirements for compliance credit (The builder shall provide the HERS provider.a copy
certifying that diagnostic.testing and stalla6on meet the ieguiromenu forcompliance credit. j
employees or sub-contractors
- -
O Installing Sub ontractor (Co. Name) OR
Tab Si rer"D
Clenerai Contractor (Co. Name)
Perfomxd
COPY TO: - Building Department
` HE Provider (if _applicabley
Building Owner at Occupancy
A-25
Aug 2001
Compliance FMW -
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This Certificate.' is. issued , pursuant�`to.ithe requirements. of Section 109 of the, California, Building,
'•_ 'Code,, -certifying' that; at�• the . time• of -.issuance � fhis structure `_was Lj
,in •co►r► mance with � the
provisions of `they •Builaling •Code : and, tie^ various; ^ordiriarices• of � tiie _�-City regulating' building
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BUILDING ADDRESS.
50 -295 -VIA SIN`-PRISA `� � • . - �" - - `• ,
= � ,Use _classification.' S:F.D.= � � . •, F �,'�` ' ' ` �:� •� << • -tr � Building Permit No 0306=207 ,
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`` `Owner of 'Bullding. RJT:HOMES LLC �� •� ��`' '• Address PO BOX 810�'f
•� _- ,• � ' ' �� �• City,,ST,ZIF:'`LAQUINTA;CA92253. -
�' '• � �,' _ . � . .. .' +� . - � -� , By G.'SHOWALTER; ' - -
� 6�l•� _ ; � "� � � . � . � � � , ,1 •: ?
bate:-
04/22/04
� , . Bulldirig Official:
• _ ,
`r' > POST IN A CONSPICUOUS PLACE'`-
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�oF.��w:Safety Department • y _.,, ,
This Certificate.' is. issued , pursuant�`to.ithe requirements. of Section 109 of the, California, Building,
'•_ 'Code,, -certifying' that; at�• the . time• of -.issuance � fhis structure `_was Lj
,in •co►r► mance with � the
provisions of `they •Builaling •Code : and, tie^ various; ^ordiriarices• of � tiie _�-City regulating' building
construction and/or used r = � - •` -� - ' ° � _
c, �- l - •'J moi, , - ,.%1' � r� }-�o ��. .cJ tit
BUILDING ADDRESS.
50 -295 -VIA SIN`-PRISA `� � • . - �" - - `• ,
= � ,Use _classification.' S:F.D.= � � . •, F �,'�` ' ' ` �:� •� << • -tr � Building Permit No 0306=207 ,
- - .. ` .. is .� _ � - • - y �- - ` r . a - .,
•T pe of Construction 3V -N _ `= f� • land -Use Zone: ;R L'
. Occupancy Group R-3 y y �
`` `Owner of 'Bullding. RJT:HOMES LLC �� •� ��`' '• Address PO BOX 810�'f
•� _- ,• � ' ' �� �• City,,ST,ZIF:'`LAQUINTA;CA92253. -
�' '• � �,' _ . � . .. .' +� . - � -� , By G.'SHOWALTER; ' - -
� 6�l•� _ ; � "� � � . � . � � � , ,1 •: ?
bate:-