0211-152 (AR)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 E),, p. Date
31,
Date �Signature of Contractor
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 =- .p 1% FU?ID Policy No. 1640349
(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 fr which this permit is issl°i'ed,
I shall not employ any person in any manner sofas, to" become subjecaotthe
workers' compensation laws of California;rand agree'tgai 4 1 should come
subject to the workers' compensation pr/ovisionrs of Section 3700 of a Labor
Code, I sha�� forthwith comply with those provisions.,
Date: ., -7 J IKUpplicant k _ ,' I d
Warning: Failure to secure Workers' Compe,fsation coverage is P,
and
shall subject an employer to criminal penalties and civil fines up toy $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 a)
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 /t cancellation.
I certify that I have read this application'and state that the above informktion is
correct. I agree to comply with all City, and State lawt relating torhe bbilding
construction, and hereby authorize repre eritatives of this°City to en a upon
the above-mentioned property forjinspectjIn purposes. Ro
I _Signature (Owner/Agent)
r'
{BUILDING PERMIT PERMIT#
DATE VALUATION LOT Oil 4MS''u TRACT
JOB SITE APN
ADDRESS—�'4i4��
OWNER CONTRACTOR/DESIGNER/EN (NEER
81 -220 :�b"�3�0.V'A'C+1•d' E!1?f M { 180 HIGHWAY 1.11
L&QOWCA CA. 92251 PALM DEMERT {:'A 92260
('160)S41-0920 56
USE OF PERMIT
A130I9' ON OF 363 1.I':.r4 ATTACHKO C3I.?M ,t OUSE-
/
ADDITION 163,00 9F
-
FIMAUTFID COST OF CONAMRUM10H M710190
a 14RU �r.SUA"'%11
PLAN C pLr* PIR: $1 y4,
55
CIMST RMI'low Y%F1 M°f.iit3
-w�
011'.8 �'� „ CCzt��'T��xC''fi'.i X AN)PLAN HECK $363.:x:2
ff
W L'IT& -P #3 VI D0
CITY OQUINTA
F.- WEPT.
RECEIPT
DATEBY
I DATE F}}N�ALED
INSPE O
„F.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
7
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
4 IQ
Compressor
Insulation
IVents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath 0,9 6_
Final
Final v 3A
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
�8�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover .
Sewer Connection
Encapsulation
Gas Piping
/
Gas Test
7
Appliances
Final
Final 3
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:
BI� o<<—Tazt-d-t-r3 -�� cozno
�. � �P �„�„� � ,�j� �Ns� ov�o.�✓ 3��g�o3 � f/
f
a.
PA
Bin #
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:_ A'10_,7,()
�-177Zcy\fwner'sName:
A. P. Number:Address:
Legal Description:
Contractor:
City. ST. Zip:
elephone:
Project Description: Am
City. ST. Zip: PAwe -D&S G4 �2 Q
Telephone:
...
....... . ...
State Lic. #
Arch.. Engr.. Designer:
Citv Lic.
Address:
City. ST, Zip:
............
..............
Telephone: ............ .
... . ....... ..........
..............
............ X.
StateLic. ........ ... .............
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter •Repair Demo
Sq. Ft.: —Fly —Stories: # Units:
Telephone # of Contact Person:
s
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req:'d
Rec'd
i TPUCKING
PERMIT FEES
2,
Plan Sets
2_
Plan Check submitted 11 I9
Item
Amount
21
Structural CaIcs.
Reviewed. ready for corrections
Plan Check Deposit
Truss CaIcs.
2,
Called Contact Person 02,
Plan Check Balance
k
Title 24 CaIcs.
2,
Plans picked up iz
—Construction
K
—
Flood plain plan
Plans resubmitted
.Nlechanical
>(
Grading plan
t
2"' Review, readv for correcti
26ectrical ui
Subcontactor List
Called Contact Person
Plumbing
—
Grant Deedev
Plans picked up j
S.M.I.
—
H.O.A. Approval
-Plans resubmitted
Grading
IN HOUSE:-
3' Review, readv for correctioV,�s's�,e
Developer Impact Fee
Planning Approval
Called Contact Person +A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
A—0 Z, <
t
Total Permit Fees
Iq ITiL -/70 1) Vf, ' Y z 6/ 0Z
vt4 pf C
FACWAUA#v -1 WJ115
.i
I
Coacialley Unified School District
P.O. Box 847, ThermaR, CA 92274
(760) 398-5909 — Fax ('160) 398-1224
Project Name:
Owner's Name: Kent
Project Address: 81-2
Project Description: add
I
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMMIIND. AMOUNT:
DATE:
RECEEPT:
CHECK #:
INITIALS:
Kingston Hea
on of quest
a Quinta,
� 1
APN: 767-490-025 Tract #:
� I
Type of Development: Residential XXXXXX Commercial
I
Total Square Feet of BI ilding Area: 363 sq. ft.
Certification of Applicant/Owners: The person signing certifies that the ve ' o
under penalty of perjury and further represents that he/she is authorize o sign o e al
I
Dated: �ihL) pZ__ 'Signature• ,
I�
Lot #'s:
Industrial
Orn
Date: December 20, 2002
Phone No. 341-0920
i3
correct nd kes this statement
f of a owne dev oner_
wo**SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVEJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 11 Approval Prior to 1/1/87 Requirement
i IAs per AB -181, any addition of
Note:
Number of Sq.Ft. L363 I 500 sq. ft. or less is exempt from paying
Amount per Sq.Ft. $_ 0 i developer fees.
Amount Collected $ 0
Building Permit Application Completed: Yes/No
'i
By: Carey M. Carlson
Asst. Supt., Business Se:rv.
I
C
Certificate issued by: El V1 rd Mattson; Signature:
Office Technician
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly, Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to
the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of
these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall
serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of
any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether
payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This
Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School
District, and up to three (3) such extensions may be granted. IAt such time as this Certificate expires, if a building permit has not been issued for the project
that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
MV:c/mydocs/devfees/certificate of compliance � 09/30/02
YOUNG ENG
Engineering Archi:tecture•Surveyir�,
Lette
To: City of .La Ouinta
VG SERVICES
Building & Safety Services`
. 1r
of Transmitt"al
Date: 12/16/02
Project: 81-220 Kingston Heath
Attn: Ed Randall I PC#: 211-152(2 check)
Tel No.: (760) 777-7012 Tract No.:
We are forwarding: X By Messenger By Mail Your Pickup
No. of Copies Description:
1 Set of redlined plan
1 �i 'Set of old Calc
1 Set of new calc
1 Truss calc
1 Set of new plan
+ l
I.
('nmmn»tc• Plarc ara mannan+ohln
-ova vveiucuc "rive, Jlucee %., ruerreLesere, l.H Y6611 (rov) jou-J/lu
Bronz Young
f his Material Sent fi?r:
j Your Files
_ Your Review
Checking
Other
By: Eric A.' Frenzel
Phone # 760-360-5770
Per Your Request
x Approval
At the request of:
-ova vveiucuc "rive, Jlucee %., ruerreLesere, l.H Y6611 (rov) jou-J/lu
Bronz Young
�I-ItM (i/�`4sTrNAL
Job Name: CLAYTON ADD.
Truss ID- A3
Qty: 3 _
ARG 1 -LOC REACT SIZE REQ•D
TC 2x4 SPF 16501-1.SE
Plating Spec - ANST/TP7 - 1995
This truss is designed using the
.1 O.1 Q2 101.7 3.50" 1.50"
8C 2x4 SPF :1.6SOF-1.. SE
THIS OESIGN IS THE CIDWDSITE RESULT OF
UBC -97 Cod -
2 20- 8-12 1020 3.50' 1.50''
NEB 2x4 HF STUD
MULTIPLE LOAD CASF_5.
Bldg Enclosed = Yes
PLATE VALUFS PER ICBG RESEARCH P.EPCRT #1607.
HFAFUNG REQUIREMENTS shotm are based ONLY
Truss Locat•iun - Not C.NI Zone
TC FMX AYL BND CSl
Leaded for 10 PSF--c--t 90-1_-
on the truss material =t oach bearing.
Hurricane/(kern Line - No Ex Categor•X = C
1-2 -1973 0.04 0.15 0.19
2-3 -1774 0.02 0.12 0.15
3-4 0.02 0.11 0-13
Permanent bracing is required (by others) to
gyrent. rotation/toppling. See 1119-91 and
Drainage must be. provided to ...id pending.
Bldg I.cngrh m 90-00 ft, Bldg Width - 1.13 ft
Heart roof height - 10.43 ft. mph = RO
-1393
4-5
ANSIrTPI 1-1995; 10.7.4.5 and 10.3.4.6.
tbaopw.4iatersybareegmerwatoml�npandmebo¢uomaah a�veyaxmbyamesaemwlnr ellcaty
UBC Essential Facility, Ek -,„d Load 24.0 psf
-1783 0.03 0.11 0.14
S-6 -1981 0.04 0.15 0_19
F
-----------LOAD CASE #i DESIGN LOADS-
TC L)ead
14.00 psf
ep Mr Sod L.. OD
Dir L.Plf 1.1-oc R.Plf R. Loc LIII t
RC r1773 AML BHI? CSI
RC live
G.00 sf
p
TC Vert 60.00 0- 0- 0 60:00 20-10- 8 0.53
7-B 1773 0.25 0.30 0.56
Fat.;oto.ha"me.:,atarae•rscet!asnets;o«nmemvcxee,
e - 1j
8-9 139? 0.27 0.12 0.52
Colo Springs, CO 80907
&A -Sb dDodgnR.P-bihi- V-Vtx."z04TAU11IGMOMAC1.Wf-.1a-ViaTGCONNE," WOOD If*
14-'9-
4>
9-10 1?&1 0.27 0.29 OJ6
ULS 1p Sloe U8(: 9?
Trus Plus 6.0 Ver_ T5-3.7
NL Vart 20.00 ]3- 9-12 20.
Wt6 FOKCE txl WEB POKE CS!
Z-8-239 0.06 4--9 501. 0.17
TOTAL
4().( Gsf
IDEE.Ratio• L/210 TC: 1.;24
3-8 490 0.17 S 9 241 0-06
MAX DEFLECTTON (span) :
1.1999 IN METH 8-9 (LIVE)
L= 0.10•• D= -0.15' T= -0.26"
3
3.51
S
0.4-1
10-s-4 1 F 10-64 1 -- 2 - 3 4 5 -
E5.00
20: i 0-8 rl
7 8 9 10
TYPICAL PLATE: 1-3
4
Truss al Systems Plat- nee 20 gd. unless sho.vn by "18108 ga.).11(18 ga J• u '7JUCLTJda1X 20 da.), posiprxred per Jolnl OeMBS Repon.
Crrded plates mud Lake hams plates -are posda.•
iud as shown d a e. Sib ga91e UW plates to avoid overlap wrot Sa1HclUrBH plates (or sla;.lc).
} % ^�
3/4103
dI41 ®h7
ARNINGRead atlnotes on this sheet and give a Copy of it to the EreCfing Con&RCtor.
Cunt: CHERMEE IMES
tris de.gn'afor nn im4uaA,albitig nwrT,aentmrtun ararslalmn 4xnbased ae so'dafir¢aovideaMtlw cmnooav rtn,'dn ma
410: DriVe__C_SO63._L.000OS-.-)C•0001
®
rra,trmi• n acmosrn rzm me olrtcm z•Cab.6.f iPf arxe AFl`A aesgn mMarda. Np resprsera. K xpSyzlea for drlRrriooal amaary.
tttn.eatbrc e m ia-ldL4 by vv: mmpamx mmwrarnra! mldHar AAgav Oesca Fnu to mbrxtaien. The bn44iQ eavym mcsl --t.. ou
Dsgn r : )OE
#LC = 14 bar: M4
the boos .kzed- thic 4.W. roost w came d.l Yp inp-d by the 1.0 Wkva c.,%eod Iw rqthA'L-. T M eezup, xzw:.z
TC Live
76.00 psf
._
urHaes 1=1.225 P-1.225
IMPERIAL VALLEY
tbaopw.4iatersybareegmerwatoml�npandmebo¢uomaah a�veyaxmbyamesaemwlnr ellcaty
F
a=t.'xdN4 u,oess atAvlrise o""' Rmdeg w ` R ".-w'-'A s,Qp.a m -q -..e, rnc.4un "m • d,- m:c sg spa. I" eom --1
TC L)ead
14.00 psf
ep Mr Sod L.. OD
(BRXSTOtY)
Vun,wm Mme:.v�y-.,.9m.�r. tom aai �.. u,. •,nuo.. Socaawn,o,.o"amo-d�oa ,sa m�awc:c. w,�ww Fra. c..o..m�.
•,toNrOETAFsgT.,err.�'msutPld•,wrcAr-wmdi;us:ao.,ca
RC live
G.00 sf
p
. C.1 c.t1 2- O (1
P"--• 9
4445 Northpark Or.
Fat.;oto.ha"me.:,atarae•rscet!asnets;o«nmemvcxee,
Colo Springs, CO 80907
&A -Sb dDodgnR.P-bihi- V-Vtx."z04TAU11IGMOMAC1.Wf-.1a-ViaTGCONNE," WOOD If*
5C. D. ad
10.00 psf
ULS 1p Sloe U8(: 9?
Trus Plus 6.0 Ver_ T5-3.7
-PdR-irt _� a.a Ida -01 aaa Wntr aHaF.!• q?p. Tho r.eor r4aea t.mrluty (FO b L.car.e m ae:,cd;� o,r,,�, ra.d:,a.,, wee,a�. serve.
-.Mh
SlmetNLR,leBG1 : d9mr� n, DC 71e:15
TOTAL
4().( Gsf
IDEE.Ratio• L/210 TC: 1.;24
4
Job Name: CLAYTON ADD.
Truss ID: A2
Qty:_ 1
HRG X-L0C RCACT SIZE REQ'D
TC 2x4 SPF '16SOF-1.5E
Platin4 p- - ANSI:/TP1 - 1995
This truss is Je.iyne.d usinq rhr-
1 0- 1-12 1017 3-50" L.50'
8C 2x4 SPF 1.650E--i-SL
THIS DtsI(-I IS THE COMPOSTTE RFSULT OF
UBC -97 lode.
2 20- 8-12 1020 3.50" 1.50'
WFB 2x4 HF STUD
NULTIPLE LOAD CASFS.
Bldg Enclosed - Yes
ad dune m aomrdarxe Wh Um wont sersnw at TR ab AEPA d nSn stadods. N0 aespmaitlity s muffwd for dhw'.i" ao-.y
FIATF. VALUES PFA 10110 RESEARCH REPORT #1607.
BEARING REQUIREMENTS shown are. Lased ONIV
'Truss Locatiun = Nut End Zone
TC FARCE AXL HHD CSI
]-2 -1973 0.04 U.15 0.19
Loaded for 10 PSF non -concurrent BCI.L.
Penaanent bracing is (by to
on the trusu material at each bearing.
Drainage be
Hurricane/Ocean Line = No Exo Category - C-
2-3 -1774 0.02 0.12 D.
re�99un red others)
prevtynC rotation/topprin0• See HIB -91 and
must provided to avoid ponding.
Bldg Longth - 80.00 ft, Hidg idth - 21.13 ft.
No- roof heighr = 111.33 ft, mph 80
3-4 -1393 0.02 0.11 0.13
ANSI(TPI 1-1.395; 10.3.4.5 and 10.3-4-6.
UBC f.-mial Facility, Dead Load -T 24.0 psi'
4-S -1723 0.03 0.3.1 0.14
ffi�and. unac amaaraa mla. fbad,g dn." is b. htm9 Wj Aa om.pmmntc n. arty I, todu bualbV tonath Thi. om,p 4
-----------LOAD CASE fl OF -SIGN LOADS ----------------
5-6 -1981 0.04 0-15 0.19
Rep Mbr Bnd 1.00
(BAR -STOW)
(
Dir L.Plf L. Lac R. P11' R -Loc LL/TL
BC F1"31KIE A26 F130 CSI
0.UU psf
-
TC Vert 60-00 0- 0•- 0 60.110 20-10- A 0.53
7-B 1773 0.26 0.30 0-56
B _rt - - - - 0 '
- 60 12
6-9 1393 0-21 0.32 0-52
9-10 1780 0.21 0.29 O -S6
ofAe-im6W dwdE-i,.reWmnbaWl ILV"140R$STN MAMHHM:IHf3GE1'ALR.AIF.CnWIECTEOWOOD TfU33ES
BC, Dead
eat - - - - -
WEB FORCE CSI NEB FMCS CSI
TrusP1us 6.0 Ver: T6..3.7
-QfI 01) wd 11115-0/ SDNMARY SHEETby TPI. Tlw Two Pim, tnstihae (M) b Y.;. cU al 00rn1kiu a1au. "n 6s nbcm,n "719
2-8 -239 D.06 4-9 501 0.17
TbeA Fom-A&aPape -intim (AFPA) is WZW at11110h straw,Nw.Ste 60d,xfttiao...002w:a.
.3-8 490 0.17 5-9 -241 0.06
40-00 psf .
DEF.Ratio: L/240 1C: L/241
WIX DEFLECTION (span) '
L/999 IN NEN 8-9 (LIVE)
L -0.10" o- -0-15' T- -0-26"
9.11-11 l I 311-11 t
1 2 31 4 5 6
[75.00I 1 -500
•
Tntgrat Sysbans Plates are 20 ga. unless shown by -18-080a.). RI'(1t1 ga.). W "MX-(IVMX 20 Ga.), p05dluned per Jo" Demos Repan.
"
CRGed pale.^, and Me carne plates are positioned as sinvm above. 511111 geble SUM plates to avoid twcAap with slfutbaat plates (a slaple).
n
3/4/03
WARNWG7Read en noes o.. am sneetand 9we it cpy ot'ft tome Erecow Cataracta.
Cust: CHEROKEF HOMES
this desRm is Ida as iimfMdod bulk a oprrpm,ma fml Inas dyfu n. H has bmn band on spec(ir Wn. prmoted by the m rv,-.m mvwrrx n-
WO: Dr i ve_C_5063_L00005.-700001
ad dune m aomrdarxe Wh Um wont sersnw at TR ab AEPA d nSn stadods. N0 aespmaitlity s muffwd for dhw'.i" ao-.y
tlo,em;ma:aamaa.nir a ah. 1,man,rm�.n.amro.mar I,bbriva;m, rho
M �� .nom-�"J�ra+nr baatoneaivncrn.n+.aa.dn�ntnd
Ds nr: JOE
9
eLC _ 14 WT: 910
d>cu.eruomem�m,.asea.m.sm.><v.aeh.to„e,paR.P.saga.t.e.ie:u.b.,w.,me.,pa,he�e..,pps�r:,,.trodo.q, ,.,a.
TC Live
16. n0 psf
_
DUrFacs L=1.25 P=1-25
IMPERIAL VALLEY
IRI= the tap dk= i 'y bound by the root pa
m text swep0 ng d dm bw- "'s htmaly tw-d by a f* 9eatling moony d:eaty
ffi�and. unac amaaraa mla. fbad,g dn." is b. htm9 Wj Aa om.pmmntc n. arty I, todu bualbV tonath Thi. om,p 4
TC Dead
14-00 psf
Rep Mbr Bnd 1.00
(BAR -STOW)
(
awl not m pmca i, .ry omi,mmma da1.a mme a..w:,m. maaem aafn.a.a m upend tea awfnr mm mm.netm love cof.nvm.
'JOIN
BC Live
0.UU psf
O.C.Spacirtg 2-- O- U
4445 Northpark Or.
Fabrate,ttvW., mshl brdOrfoe mom ssnaaWatroowT DETNLS'Ly T-dk'ANSI.TPI1', VMA l' -Wood TassC 'I
Colo Springs, CO 80907
ofAe-im6W dwdE-i,.reWmnbaWl ILV"140R$STN MAMHHM:IHf3GE1'ALR.AIF.CnWIECTEOWOOD TfU33ES
BC, Dead
10.00 psf
Design Spec UBC -97
TrusP1us 6.0 Ver: T6..3.7
-QfI 01) wd 11115-0/ SDNMARY SHEETby TPI. Tlw Two Pim, tnstihae (M) b Y.;. cU al 00rn1kiu a1au. "n 6s nbcm,n "719
TbeA Fom-A&aPape -intim (AFPA) is WZW at11110h straw,Nw.Ste 60d,xfttiao...002w:a.
TOTAL
40-00 psf .
DEF.Ratio: L/240 1C: L/241
A
J
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CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF4I1
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Project Title DateCi
Project Address Builder Name
,aA,t�� �iliP.D %� • .�'�/• L'!/s'?Dir)
Builder Contact Telephone Plan Num er
,ao S' 7G�• 772.87 / �'�
HERS Rate /f Telephone Sample Group Number
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Certi na Date Sample House
/Number
Firm: ��i-'G�/V�ii y HERS Provider: le- Ao• s -
Street Address: City/State/Zip:'%�
Copies to: Builder, HERS. Provider
HERS RATER COMPLIANCE STATEMENT
Thee oras: 1 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
wtte diagnostic tested compliance requirements as checked on this form.
M The installer has provided a copy of CF -6R (Installation Certificate.
Ea'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 J �%
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here 0
If fan flow is measured enter measured value here Y' .2�s 0
Leakage Percentage (100 x Test Leakage/Fan Flow) _
Check Box for Pass or Fail (Pass=6% or less)ISO L❑
Pass Fail
El"THERMOSTATIC EXPANSION VALVE
Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
Yes is a pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1 ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has
verified that actual installation matches values in C.F-1R and
design on plan.
2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF- I R.
Measured Fan Flow =
L;ompuance t-orms
Yes for both 1 and 2 is a Pass
August 2001
Pass Fail
❑ ❑
Pass Fail
A-16
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INSTALLATION CERTIFICATE
3 of
CF -6R
/S/90MV
F %f A4 iL�
' Site Address
I
f Permit Number
DUCT LEAFAGE AND DESIIGN
DIAGNOSTICS
[E DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM @ 25 PA) j
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 Leakage/(Measured or Calculated Fan Flow) = 4 -
Pass if leakage fraction <_ 0.06 [[C� ❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ Pressure pan test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ❑ ❑
Pass Fail
af/THERMOSTATIC EXPANSION VALVE (TXV)
*'[]No
'❑No Thermostatic Expansion'
Valve is installed and Access is
Yes
provided for inspection!'
�❑
Yes is a pass Pass Fail
❑ DUCT DESIGN
1 ❑Yes ❑ No>an�D D<�aave been
t Dns and duct installation
I2. ❑ Yes ❑ Nod, n verified. If noTXV,
mCF-1 R.
Measured Fan Flow❑
❑r
b 1 and 2 is a Pass Pass Fail
❑ I, the undersigned verify that the above diagnostic test results and the work I performed 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 -contractors certifying that diagnostic testing and installation meet the requirements
for compliance credit.] A f, _
Tests Signa) r at
Performed
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Compliance Forms
August 2001
�if OK�E 1!0O 3 - of r."o
Installing %beentre" (Co. Name) OR
General Contractor (Co. Name)
A-25