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04-8140 (SFD). �IG�fiiV BUILDING & SAFETY DEPARTMENT P O4�Box1504 �i;,��� (760).777-7012 OF' , j8� 49.5 CALLE TAMPICO FAX (760) 777-7011 �'IL-A�QNT�A, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT �Appo.ication Number . . . . 04-00008140 Date 2/02/05 Property Address . . . . . . 80-7TI—V-1A TRANQUILA- APN: 772-270-010-34 -311231- Application description . DWELLING - SINGLE FAMILY DETACHED Property Zoning . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 210784 Owner Contractor VISTA LA QUINTA PARTNERS, LLC WASSERMAN CONSTRUCTION, RA 223 E. DE LA GUERRA 45520 STONEBROOK COURT LA QUINTA CA 92253 LA QUINTA CA 92253 (760) 771-8191 WCC: STATE FUND WC: 1795012. 07/01/05 CSLB: 681660 06/30/06 CCC: B -------------------------- Structure Information ------------------------- Construction Type . . . ... TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/LONG <=10 Flood Zone . . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 # BEDROOMS 4.00' FIRE SPRINKLERS NO GARAGE SQ FTG 455.00 PATIO SQ FTG 207.00 NUMBER OF UNITS 1.00 1ST FLOOR SQUARE FOOTAGE 2281.00 2ND FLOOR SQUARE FOOTAGE 1200.00 --------------------------------7------------------------------------------- Permit BUILDING PERMIT Additional desc Permit Fee . . . . 1028.00 Plan Check Fee 167.05 Issue. Date . . . . Valuation . . . . 210784 Qty Unit Charge Per Extension BASE FEE 639.50 111.00 3.5000 THOU BLDG 100,001-500,000 388.50 ---------------------------------------------------------------------------- Permit MECHANICAL Additional desc Permit Fee . . . . 96.50 Plan Check Fee 6.03 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 P.O. BOX 1504 • KW VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4 4 aINSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: I Date: o?' 10'05^ Applicant: Architect or Engineer: Applicant's Mailing Address: or Engineer's Address: GD.No.: 6 —�ri�% BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereb _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 e, and my License is full force and effect. License Class 1'3 se No. �te�lO l5d— Contractor RA 1,dA5Se4PK P1IA;'(- OWNER-BUILDER A;LOWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U 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 or improves thereon, and who does the work himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason Date 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 rJof the work for which this permit is issued. 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 i yed_ lyly worlds' corgpensation insurance carrier a71 f4lcv num are: Cartier _ .�ai� G/ Policy Number 1 /�'S Ol I certify that, in theeperformance 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 Sectibn 3700 of the Labor Code, I shall forthwith comply with those provisions. ©IMM M. A0611- WARNING: r` WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lenders Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, 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. 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 rrect. I agree comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to ent ed property for inspection purposes. /gate G /CD�t'�j Lure (Applicant or Agent): Application Number . . . . . 04-00008140 Page 2 Date 2/02/05 Qty Unit Charge Per Extension 6.00 6.5000 EA MECH VENT FAN 39.00 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 ---------------------------------------------------------------------------- Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 150.08 Plan Check Fee 9.38 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 3481.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 121.84 662.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 13.24 ---------------------------------------------------------------------------- Permit PLUMBING Additional desc Permit Fee . . . . 178.50 Plan Check Fee 11.16 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 18.00 6.0000 EA PLB FIXTURE 108.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 8.00 .7500 EA PLB GAS PIPE >=5 6.00 1.00 15.0000 EA PLB GAS METER 15.00 ---------------------------------------------------------------------------- Permit GRADING PERMIT Additional desc . . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFD - LOT 34, PLAN 5AL 3481 SQ.FT. LIVING, R-3 OCC. TYPE V -N CONSTRUCTION, 2001 CODES. PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS OR DRIVEWAY APPROACH. 75% REDUCTION TO PLAN CHECK FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE Page 3 Application Number 04-00008140 Date 2/02/05 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 26.96 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 16.71 DIF FIRE PROTECTION -RES 97.00 DIF LIBRARIES - RES 225.00 DIF PARK MAINT FAC - RES 5.00 DIF PARKS/REC - RES 502.00 STRONG MOTION (SMI) - RES 21.07 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary ----------------- Charged Paid Credited Due Permit Fee Total ---------- 1468.08 ------------------------------ .00 .00 1468.08 Plan Check Total 193.62 .00 .00 193.62 Other Fee Total 2469.74 .00 .00 2469.74 Grand Total 4131.44 .00 .00 4131.44 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 of 8) CF -4R Project Address7 Via T(An la I to � Builder Name , � L✓c,� wren Builder Contact Telephone 76r, -05a -72 Plan Number HERS Rater Telephone Sample Group Number Values Compliance Method Prescriti Climate Zone Certifying Signature Date —�61 Sample House Number Firm See HERS Provider Street Address: City/State/Zip: Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER VMPLLANCE STATEMENT The house was: ✓ F�, 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 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 convect tape is used before a CF -4R may be released on every tested building. The HERS rater must not release the CF -4R until a properly completed and signed CF -6R has been received for the sample and tested buildings. The installer has provided a copy of CF -6R (Installation Certificate). ew 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 f eld verification and diagnostic testing of air distribution systems are available in RACM, Appendix RC4.3. Duct Diagnostic Leakage Testing Results NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values I Enter Tested Leakage Flow in CFM: wa "N� KKK 2 Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured Enter Total Fan Flow in CFM: l�/G'U ✓ ✓ 3 Pass if Leakage Percentage 5 6% [ 100 x(Line # 1) /(Line # 2)]] 45/4-11 Kpass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change-Outf�' 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing g g Duct System Prior to y� Duct System Alteration and/or Equipment Change -Out.^ Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System Ar r ,.., 5 for Duct System Alteration and/or Equipment Chan e -Out. 6 Enter Reduction in Leakage for Altered Duct System [_(Line # 4) Minus (Line # 5)] ?g � (Only if Applicable)�� 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) �/ ✓ 8 Entire New Duct System - Pass if Leakage Percentage <_ 6% ❑ Pass ❑ Fail 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 ❑ Fail Pass if Leakage Reduction Percentage >_ 60% [100 x # 6) / (Line # 4)]] 11 _(Line and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑Pass ❑Fail Pass if One of Lines # 9 through # 12 pass r �.-}y^, ;x rat .„ T ❑ Pass ❑ Fail Residential Compliance Forms April 2005 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3 of 8) CF -4R Project Address Builder Name Builder Contact Telephone Plan Number HERS Rater Telephone Sample Group Number Compliance Method (Prescriptive) Climate Zone Certifying Signature Date Sample House Number Firm HERS Provider Street Address: City/State/Zip: Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER C9MPLIANCE 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 w4t a agnostic tested compliance requirements as checked on this form. The installer has provided a copy of CF -6R (Installation Certificate). ✓� HERMOSTATIC EXPANSION VALVE (TXV) Procedures for field verification of thermostatic expansion valves are available in RACM, Appendix R.I. ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valves tdoor Unit Serial # Location Outdoor Unit Make Outdoor Unit Model Cooling Capacity Access is provided for inspection. The procedure shall consist of Btu/hr Date of Verification ✓ ❑ Yes ' ❑ No visual verification that the TXV is installed on the system and ❑ ❑ (must be checked monthly) installation of the specific equipment shall be verified. Yes is a pass 1 Pass 1 Fail ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valves tdoor Unit Serial # Location Outdoor Unit Make Outdoor Unit Model Cooling Capacity Btu/hr Date of Verification Date of Refrigerant Gauge Calibration (must be checked monthly) Date of Thermocouple Calibration (must be checked monthly) Standard Charge Measurement (outdoor air dry-bulb 55 °F 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 -6R before starting this procedure. If outdoor air dry-bulb is below 55 °F rater shall use the Alternative Charge Measure Procedure Procedures for Determining Refrigerant Charge using the Standard Method are available in RACM, Appendix RD2. ✓ ❑ Yes ❑ No A copy of CF -6R (Installation Certificate) has been provided with refrigerant charge measurement documented. Residential Compliance Forms April 2005 4 - w - INSTALLATION CERTIFICATE (Page 3 of 12) CF -6R Site Address Permit Number ?V71( VA `I"�U�►���q Ga ��- 3y 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 um CEC Certified Mfr. Name and Model Number # of Identical S stems>_CF-1R Efficiency� (AFUE, etc.) value) Duct Location attic, etc. Duct or Piping R-value(Btu/hr) Heating Load Heating Capacity (Btu/hr) 5 d't w� 1 ��SSI��Zol4urlr 2— Nl R (0604-06 k /L /%¢+e- /'%L Qvv Cooling Cooling Equipment Equip Type (pkg. heat um CEC Certified Mfr. Name and Model Number # of Identical S stems>_CF-IR Efficiency (SEER or EER) value) Duct Duct Location attic, etc. Duct R -value Cooling Load Btu/hr Cooling Capacity Btu/hr 4- jwr k Nl R (0604-06 k /L /%¢+e- /'%L Qvv 1. > symbol reads greater than or equal to what is indicated on the CF -1R value. Include both SEER and EER if compliance credit for high EER air conditioner is claimed. ✓ 011, 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 Subco or Co. Name General Contra jor o. Name) O DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R Site Address IGX 3 Permit Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMIANCE STATEMENT The building was: ✓ Tested at Final ✓ ❑ Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: 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 New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platforms returns in lieu of ducts). ✓ ❑ DUCT LEAKAGE REDUCTION Procedures for field verireation and diagnostic testing of air distrihution systems are availahly i" R -41-M .4.,nendi.- 09-4 2 NEW CONSTRUCTION: S /' . ✓ C/ Duct Pressurization Test Results (CFM @ 25 Pa) Measured` a, Values �. 1 Enter Tested Leakage Flow in CFM: �G I Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ 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 2 'n Ca aci in Thousands of Btu/hr output, enter total calculated or measured fan flow in CFM her : -am✓ ✓ 3 Pass if Leakage Percentage:5 6% for Final or <_ 4% at Rough -in: 101 �O ass ❑ Fail 100 x r Line # 1 / ZoL Line # 2 v 9 ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct2aw ment System Alteration and/or Equipment ui r s 5 Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Ducta System for Duct System Alteration and/or Equipment Chan a-Out.III 11. ta 6 Enter Reduction in Leakage for Altered Duct System Line # 4 Minus Line # 5 - (Onlyif Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) _v/ Entire New Duct System - Pass if Leakage Percentage 5 6% for Final 8 100 x Line # 5 / Line # 2 ❑Pass 11 Fail 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 :5 10% [ 100 x [(Line # 7) / (Line # 2)]] ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage >_ 60% [100 x [__(Line # 6) / (Line # 4)]] 11 and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑Pass ❑Fail Pass if One of Lines # 9 through # 12asses`"'>': r �� �;,�,� .,.. ❑Pass ❑Fail ✓ UI, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for compliance credit. 1, 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 o h005 Building Energy Efficiency standards. Installing Subcontrac oma( R General Contra! -tor -(C-6. Name) O er S /' . ✓ C/ Signature: Copies o:DING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms September 2005 •/ INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R I Site Address Permit Number 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: ❑ 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 ❑ New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platforms returns in lieu of duct. ✓ ❑ DUCT LEAKAGE REDUCTION Procedures or fleld verification and diagnostic testing of air distributions stems are available in RA CM A endix RC4 3 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM: L���� Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21.7 cfm/(kBtu/hr) x Heating 1� Ca aci in Thousands of Btu/hr output, enter total calculated or measured fan flow in CFM herd: ✓ ✓ 3 Pass if Leakage Percentages 6% for Final or :5 4% at Rough -in: `lfL (Gdd r-1 Lpass ❑ Fail 100 x Line # 1 / Line # 2 ALTERATIONS: Duct System and/or HVAC Equipment Change -Out qe ` 4 Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct Alteration and/or Equipment Change -Out. 1MIR", 'System Nil �'� 5 Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct�r1 S stem for Duct S stem Alteration and/or E ui ment Chan e -Out. � �a5�� 6 Enter Reduction in Leakage for Altered Duct System Line # 4 Minus Line # 5 — (Onlyif Applicable) s -OF 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) Entire New Duct System - Pass if Leakage Percentage <_ 6% for Final 8 100 x Line # 5 / Line # 2 ❑Pass ❑Fail 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 1 Pass if Leakage Percentages 15% [100 x [ (Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage <_ 10% [100 x [(Line # 7) / (Line # 2)]] ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage >_ 60% [100 x [(Line # 6) / (Line # 4)]] 11 and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection x' ❑ Pass ❑ Fail Pass if One of Lines # 9 through # 12 pass ❑ Pass ❑ Fail ✓ UI, 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 e 2005 Building Energy Efficiency standards. Installing Subcontractor (Co. N G DEPAR Residential Compliance Forms Date: F-A"P,LICABLE) BUILDING OWNER AT OCCUPANCY September 2005 w INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R Site Address Lo - .5 y 7 Permit Number 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 Location consist of visual verification that the TXV is installed on Outdoor Unit Make OF ✓ Yes ❑ No the system and installation of the specific equipment ❑ shall be verified. Btu/hr Date of Verification Yes is a pass I Pass Fail ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without Thermostatic Expansion Valves Outdoor Unit Serial # Location Return (evaporator entering) air dry-bulb temperature (Treturn, db) Outdoor Unit Make OF Outdoor Unit Model Cooling Capacity Evaporator saturation temperature (Tevaporator, sat) Btu/hr Date of Verification Suction line temperature (Tsuction, db) Date of Refrigerant Gauge Calibration OF (must be checked monthly) Date of Thermocouple Calibration OF (must be checked monthly) Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above): Procedures for Determining Refrigerant Charge using the Standard Method are available in RACM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db) OF Return (evaporator entering) air dry-bulb temperature (Treturn, db) OF Return (evaporator entering) air wet -bulb temperature (Treturn, wb) OF Evaporator saturation temperature (Tevaporator, sat) OF Suction line temperature (Tsuction, db) OF Condenser (entering) air dry-bulb temperature (Tcondenser, db) OF Superheat Charge Method Calculations for Refrigerant Charge Actual Superheat = Tsuction, db — Tevaporator, sat OF Target Superheat (from Table RD -2) OF Actual Superheat — Target Superheat (System passes if between -5 and +5°F) OF Temperature Split Method Calculations for Adequate Airflow Split Method Calculation is not necessary ifAdeauate Airflow credit is taken Actual Temperature Split = T return, db Tsupply, db OF Target Temperature Split (from Table RD3) OF Actual Temperature Split Target Temperature Split (System passes if between - 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F OF Residential Compliance. Forms April 2005 �- Certificate of Occupancy0 o 4w OF'TYBuilding & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 80-711 VIA TRANQUILA Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-8140 Occupancy Group: R3 Type of Construction: V-N Land Use Zone: RL Owner of Building: VISTA LA QUINTA PARTNERS, LLC Address: 223 E. DE LA GUERRA City, ST, ZIP: SANTA BARBARA, CA 93140 By: GARY HARTMAN Date: MARCH 9, 2006 Building Official POST IN A CONSPICUOUS PLACE