06-0723 (MECH)r1
P.O. BOX 1504
78-495 CALLE TAMPICO
,—,,,LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
06-00000723
55081 INVERNESS
775 -131 -006 -
MECHANICAL
LOW DENSITY RESIDENTIAL
4500
Architect or
Td4t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License lass: C20 -C36 Lic se No.: 818759
Date: fContraao'r:
OWNER -BUILDER DECLARATION
I hereby affirm Under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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).:
(_ 1 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 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.).
(_ 1 1, 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.).
(_ 1 I am exempt under Sec. - , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
M/M SCIBELLIS
55081 INVERNESS
LA QUINTA, CA 92253
Contractor:
PREC H & A INC
P.O. BOX 10990
PALM DESERT, CA 92255
(760)776-1550
Lic. No.: 818759
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/17/06
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 and policy number are:
Carrier STATE FUND Policy Number 1750773
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 1 should become subject to the workers' compensation provisions of Section
700 of the Labor CoAde,'I shall fortwith complywIiit�th those provisions.
D�� f� ����Annlir•-ant- [ 1 -1 f -4-1.- 1/ t•�\
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.
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:''Ahy 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 county ordinances and state laws relating to building construction, and hereby authorize representatives
of this cou ty too/y�eenter upon the above-mentioned property for ins�pec`tion rposel//k
Date:W Signature (Applicant or Agent): `^ L��
t
Application Number . . . . . 06-00000723
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 30.50
Plan Check Fee
7.63
Issue Date . . . .
Valuation
0
Expiration Date 8/16/06
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 11.0000 EA MECH
FURNACE >100K
11.00
1.00 4.5000 EA MECH
VENT INST/ DUCT ALT
4.50
------------'----------------------------------------------------------------
Special Notes and Comments
REPLACE 2 FURNACES(80 AFUE) AND MISC
DUCT REPLACEMENT.
Fee summary Charged
-------------------------------------
Paid Credited
--------------------
Due
Permit.Fee Total 30.50
.00 .00
30.50
Plan Check Total 7.63
.00 .00
7.63
Grand Total 38.13
.00 .00
38.13
LQPERMU -
Bin #
City of. La Quints
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # ,L
l/
(
Project Address: SS-0,3-�J »UC✓,�1ef_5
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
i s
Address: /9d . )3v,{- lloc7 v
Project Description: Rep/GCC, L_ ccs-
CSCity,
City,ST, Zip: 1:2 117, OZ5, �(�� g Z zss
122 IX, l Lvd 1—
Telephone: 7
State Lic. # : 7S CityLic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Ov
Telephone: �� ''
P � "`
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: 44
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
.Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for. corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
INS'T'ALLA'T'ION CERTIFICATE (Page 3 of IB) CF -6R
Site Address'
Permit Number
S'r- dkl /z / 1
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 Equlpa wrd
Equip Type
(pkg. heat tun
CEC Certified Mfr.
Name and Model
Number
# of
Identical
Systems
Efficiency
(AFS et..)'
(aCF-IRvalue)
Duct
Location
attic, etc.
Duct or
Piping
R -value
Heating
Load
Btuthr
Heating
Capacity
Btuthr
Fifa occ
0A c in, hC.
9 ¢ 'c
Se)) dd d
p �Sa-3
Cooling Equipnw at `
Equip Type
(pkg. heat um
CEC Certified Mfr.
Name and Model
Number
# of
Identical
Systems
Efficiency
(SEER or EER)
(zCF-IR value)
Duct
Location
attic, etc.
Duct
R -value
Cooling
Load
Btu/hr
Cooling
Capacity
Bwft
1. > symbol reads greater than or equal to what is indicated on the CF -IR 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 Efflciency 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 (Co. Name) OR General
'�
Contractor (Co. Name) OR Owner
C c rlv)
Signature:
✓Date:
Copies to; BUILDING (DEPARTMENT, MBS RATER (IIF APPLICABLE) BUILDING OWNER AT OCCUPANCY -
Residential Compliance Forms April 2005
w'
INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R
Site Address .SS- d0
INSTALLER COMPLIANCE STA
INSTALLER COMPLIANCE STATEMENT
The building was: ✓ ❑Tested at Final ✓ ❑ Tested at Rough -in
Permit Number
FOR DUCT LEAKAGE
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
Id t' a -1 din nostic testi n o air distribution s stens are available in RACM, A endi_r RC4.3
verr r rn
Procedures or ie o
NEW CONSTRUCTION:
Signature:
Date: — //— d
Measured
Duct Pressurization Test Results (CFM ® 25 Pa)
Values
1
Enter Tested Leakage Flow in CFM:
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✓
✓
Capacity in Thousands of Btu/hr output, enter total calculated or measured fan flow in CFM herP_11�"
3
Pass if Leakage Percentage -5 6% for Final or <_ 4% at Rough -in:
❑ Pass ❑ Fail
100 x(Line # 1) / (Line # 2)11
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.
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 Chana-Out.
Enter Reduction in Leakage for Altered Duct System
6
f (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
❑Pass ❑Fail
8
f 100 x f (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
1 Pass if Leakage Percentage 515% [100 x [ (Line # 5) / (Line # 2)]]
❑ Pass ❑ Fail
10
Pass if Leakage to Outside Percentage:5 10% [100 x L_(Line # 7) / (Line # 2)]]
❑ Pass ❑ Fail
Pass if Leakage Reduction Percentage >! 60% [100 x L__(Line # 6) / (Line # 4)]]
❑ Pass ❑ Fail
11
and Verification by Smoke Test and Visual Inspection
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Ins ection
❑ Pass ❑ Fail
P
Pass if One of Lines # 9 throu h # 12 Dass
❑ 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) o the 2005 Building Energy Efficiency standards.
Installing Subcontractor (Co. Name) OR General
Contractor (Co. Name) OR Owner
'00� t C Isla /-- y—
Signature:
Date: — //— d
Copies to: BUILDING DEPARTMENT, ITERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms
September 2005
Feb 22 1
ion Heat &`"nir 7607761552
Rr�ryv_'�Ilte I WJt7N-JU/Y
(:LXf1F1CA f.T.D VILrWFICATION & DIAGNOSTIC
I'miect Address
55-081. INVERNESS. LA Au_iNTA, CA. 97253
Builder (:ontacr - ('el Pheulc "
_ ANII•.E_NELSON _......._._. 7.6.0-771=8456
aERS Rater Telephone
JACK LAF TAINE !60,-460-4631
M Pts�cn ive)
FEB. 20. 2006 Dole
P.1
p.02
iw s) Ct,~ -4R
Itoilder Name
ITSON a DrSON REAL ESTATI:
Plan Nwnber
1 - ZONE 1
\eunPln O] Wp Number
.c Zone-
� iirwcr Ncuuben
F' ., R5P nxt�
MERGY AANAGE_NFNY SERVICES CAICKI�
tt+wt AOdreslt c:iry/SCittHZip:
41-1185 ADAMS ST. UMIT C_,� BERMUDA DUNES. CA. 92203
;:e>I►ina to: OUI I.uXR, HLKS PROVYDLrR AND 1Zt Dlnt: DEPARTMFrit-1. -
HERS RATER COMPLIANCE STATF.MCN7
The house were.• ✓ WX Tested ✓ O Approved :►c pan of satnple testing, buil was not tested
As the iitllS rater ltrovi4i!&2 diNKnuatic testing and field vacirwation• 1 certify that the house identified on this (itrm =lie, with
the dinglamic tested cumpl.unee requirr nrnb a, checked r on th(s torte. Tut NL• Ks rarer must check and verify chat lln new
distrtbotnon system is fully ducted and cunect ulpe is sited beforo x Cr -11t I'lay he rcicawd vn every1�� builc6nr. The .HCR•q
MW Imtst nal retwae the CF -4R Until a Pm(,erly complctsxl and signed CF -6R has been received for I Semple and tatted
buildings.
XV The inStttllar has provndtd o copy ol'(>ZR (Installation Certifteatr:).
0 Ntw nl-st ibutiun system is fully dueled (i.e.. OM net use building cavities at plenums or plaUkaln retwus in lin, of dins).
O New syrte ns where cloth barked. tubber adhWtvc Jury tape is installed, mastic and draw WAS arc rued in
vamtri.laticm with cloth bee4ked. rubtwr adhenive dud taim to Mas( loolm It dust cgnrroetians•
✓ )QIYIIM+UMUM REQIjmv t ,mTS FOR DUCT IXAKAGE klEDUCTIOW COWLIANCE CWDrf
Ibocadnrer./nr field veiifieortpna.rr/r/i<q,wnsrlc re�r/q/�► Afar (N�'rrihurirn.ryslc�nlsurs nvailvb/r in Ri1C'A! Appr/.r/u
Duct ninnucllc Leakage Testing Keslllls
Nl:W C6111,StRII(./'ION: — -
Due, Prowurizalion Tutt Reeultc (('FM 4@ 25 Pu)
I L•.ntw..'I'cyyed Lalkl>ne Plow in CFM: �!
2 }'an blow: <`'alclnletcxl (Nominal: toolinLr ✓ p I•teatin� eK ✓ O Mcasarell ..� .
FAllff Tullnl Flan Plow (n (:?M;
/y ('ass tf I.tuk,go Nerccalege e. 6% ^ ( IM) r ((Llr,e 4 1) / (Line N 2)]) -
AI-XCkATIONS; ..D..u..ct System o,ml/or IIVAt' Equipment Clla,et/ot _
4 Cnter'1'Well Leakage Flow in CFM Irorn CF -6K! 1'r-Te0 ul'Exis"g putt Cystcn► Privr Ip
Duct Syslean A•lleratinn aed/ur Cpuiprttent (`hangs-Oul,
Enter Tested Lcak.yle Psow in CFM: Final Tsar of Nety tr.cr Syslceo w Alterrd Duct Syslntl
S for Duct System Altcrxlio.n plrld/m tg ne:nt 0~mrsot.
!:.Iter tteducli in i'In I•eakal;c for Allared JAtet lyatem (` (Live 1t 4) Minus(bine N S)]
(Ooly if Applivable)
7 E_nior Tmtcd Lcakage F Ina in CFM to Outside (Only if Applicable) --
g Crttire stew Dunn System . Plus if Leakage Pamentarc 5 6% - _.....
-LIU* = [ Linc N 5 / Lu.t A ?)11
'PEST OK vVUFICATI(jN STAllll)A Rlri: For Altnrrld Dau system aed/ur 11 VAI: Xquipment
Use one of (be 101110wivir fuer Tutt or VerificatfoN Strnd_.rdv for wa+pl(snce_ _
v Veen if Lwkwg• flereen,ego S t.%% 100 x
(Lime N 2A)
10 !'au of Leakage to Outside PertcntaKc � IOiL (1pU x [_,•-�(l,ine fl 7) / , (t.inc ff 2)11
Pass if Leakage 1(cductlon PermmnW ? 6t)% (I(xt x (
I I and Vc7ifu;!I ion by Jmuk� Tett and Vi- In. l:rin
17. &,.it%e•llin c/fsiIIAcccssiblC1 11 -- — .�__•• ,_,
— _......—.., :�i__. _. and Vetifinxti�nA ri ierwkc lat ard Visual lnspn.Yltat
T Pass if One of tuna p 9 throngh N 12 ps�a r
kes/denrinl ('nrnplionce
Mcimmod
Velut>,
0 (1211 la Fail
lzo
O Past (3 Fail
heuKc.C)
7-52
- ---
✓ V
(Xk*t a'raii
.O Pali O Fait
011"SS n rail
O Fars D tail
Vaal 0 Fail
April
2003
Feb 22 06 O J ) -1: ;at & R i r 7607761552
1 ••. ,..,,San ►ar Vr/rpII1C- IVU-JUU-JU/4
CIEIt'1'l;Y�'ICATF, OF FI£x:l➢"i'wj`, ii'"ICAT'YON & ]DIAGNOSTIC
Vrojta Addr'e$$
55-081 lAYERENFSS.rLA QUINTA. CA. 92253
_
.ild'er i.0ntacl -- I'rlepifonc
JOANNE ME SON 760:171-8454
HP.RS Ratty Tcic none
JACx L IITAINF. _ 760-560-465.1_
c
i � ti n9t0
C5.
— Ft B _ 70. 2006
rh;ST11Y(.: (Pape 1 of
Builtdcr Name
AYSO I N 1I Drs
lryan Number
Sam IC Cirou Nmt'ger
C1i/1Mlt Ltrn�
CamPla }louse Mumhor
R
P.2
p.03
CF -4R
I-IFIIN Provider
_LM.L•RGY ,dAKAGEM 11T SFRVICFe LCFJtLi__. ,.._..._.—_.....—
Snect Ad4br.ss: --_- - CityLS[F-Rt1p
UMIT C ., s.SA. 92zA3
Collie% tn: BIIILDER. MFRS PROVIDER AND BUILDING DEPARTMENT
1.1 r RS RATIM COMPLIANCE STATEMENT �•
The lutuse w". ✓ :U 'Tested -0' U Approved as part of sllmplC lesti kq, but was not twted
As the IWAS niter providin_& dtagncr-stic testing an'd field verification, t artily that tha house identified on this form c(trnpincs with
Ills rlla�npgtic (coed cnmpllsncc requirements as checked./ ✓ tut this form. Tutt HERS rs(C► Inwt thaCk arta YCrIIy that the now
distribution syst«n's Iidly Ducted notJ CO'tcl lips iS used before a CFAR atay be rcleetsrd un c -4M lest(. building. The HERS
'girt mus' nut reJeA3C the CF' -412 until a properly.:Mnpleted and signeA CF-(jR Iras heed reccivr4 thr a %al"ple and [coed
buildings.
%X The utSlAller hat provided a COPY nY( e -61C (Installatloll (:cnIflcate).
0 New uislribotion system is fidly ducted (i.e., does not use building, cavities as plenums or platfornt rctums in lice of ducts).
n New sy%lems where cloth backed. After adhesive duct tape is installed, mastic alld draw brutds are used in
cnmh;nrtiun w;ttt cloth backod, rubber rdhtwivc dura tar•c Its lie -&I lurks at duut uunnuutiens.
qJ MIN[MLIM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
/'r Mwd—ey for firldIrrif1elvion anid rl/OSnAtric rotting of.rir dinribvii.„r .ryritMd am available in 44CM, /Appendix RC4..I
Doot l)iegnoatic Loakn£e Tc5ting Rexuhs
NEW CONN1'1CUCTION:
t)uct Pressurization Tcbt Results (CFM [rd 25 Pa) MMsared
Values
I Eotcy T�lecl Lmkaze Flaw in urm:
_
Z F -an Flow: CMJCUIatcd (Numirlyd: _/ItAI ezfin(; ✓ L l(catinr) ur ✓ Il Mcltsurcd r 8
Cnur Total
-•--...—
ran r• Inw it, (,Fm. V
J J
1 Pass IP l.eaka�e Percentage S 6r/ (I (kl x L-0 -ine
—_
❑I4cs0haiI
AL1jERATION�: )1uc1_Syxrem nnWAr IIVA(' F 1 xnctlt l:Ilringc(Mt ~ ”— .'
--�_
4 Cies Teucd LenkngC rl0w in CTM from 4717-61t; Prr.-Test of r-xuting nucl SyalCm Prior to
r
Duet System Altcration and/or Equipment (,'hange-I.)jlt.
fnter'rected Lealta Flow in CFM; Final7estof Nmtr Duet Sycicm or Altr�cJ burl Sy�trm
bur t)uct error AIteratinn And/or Eguipmcnt C_!1 c -put.
--
--89
Entrr RCdttctiun in LCakl1,K /ltr A Ilert�A aIle[) Slcnn —•-_- . -• •• • •"' -" '
6 y L..... _(Linc s 4) Mina•, (Linc a 1))
(Ut►ly if Applicable) ..
'-
FAD 'rested Lcwkarsc Flow in CFM to Outsi fe (Onty if Applicable)
l System - Ir,�S; if I..eakage Percetitnc S fi%.
I..neNS /
'l!�'1' Olt VERIFI �Z.>m .�-... ... ..---__
CATt()tV i'1'ANl1A/;Uj: For Altered Uud Sy<t an, HVAC 1£tllripmrnl
O Pass O Fail
("Axnxr,
h,e tine Of the fnllow7eg four T_egt of Verif icAtiup SllrntlsrYl� for Ceat /ianrr;
;7-
-<15%
S15% (100 x (. _H9—_(Linc a S) / (Line u ).)11 --- - --
----
__„ _AQjL_
10 Plcis if I.C2"ec to UuW- tic Pcrucnlnre 5 10% 000 t Line n 2 ))1
Macs O Fail
P:os i f I.eakage Kcductiun i'crccnu' ; 60"d. I „ -" - - - -
1 1 I �. .., _�(i.inl; L 6) / (Linc N A)U
C] Pass O Fail
•----- • —
.�- nlnd V�.rifi000Jn by J1nOkC Tcsl vtd Visua) 1ncpCCtiOn
19 1'as: If Se911nug f all A w eyihle r.t pk. a,rd vsiiricarion
❑ 1',rrs ❑ pail
Ily �ropke rest and visnxl It1S
C7 Pae. d Pail
Pass it Qne nr Lines b 9 through ft 12 Pam%
11►titfenliul ('nalplluncC Fornrt
Pass O fail
A/irl/
]11113