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04-8005 (SFD) Revision 1Bin # City, ofla La .Quints Building .�x Safety Division P.O: Box 1504, 78-495 Calle Tampico . la Quinta, CA 92253 - (760) 777-7012 -:8,0 Building Permit Application and Tracking Sheet Permitfl c� Project Address:' S -5/0 .4L G?1j__2) Owner's Name: 0 tel. % tj �5 N A. P. Number. cV --.37 - O4 l Address: Legal Description: 1,07 0 0 .: p i% City, ST, Zip: &,&0 «6 L O:J . 1 Contractor.: ,,l L L O M L' r-4 7S N S Telephone:. -0q) .Address:-9o,x Project Description: /V 1 -City., ST, Zip: (� n•G /0� lei f'r� .9 f ca /Nps,/ p Telephone: Q/ �D -' 70�� V State Lie. # : %'Q City Lic. #: 9 Arch., Engr., Designer: HOA UA V . E, Address:.7 J % ) . P City, ST, Zip: Zpr/� 1�N �/v` C -C �? Gia • 9� 2 Telephone: Aso) Construction Type: Occupancy: State Lic. #: q Project- type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq: Ft : # Stories: # Units: Telephone # of Contact Person: Estimated°Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets ' Plan Check submitte Item Amount Structural Calcs. Reviewed, ready for c ections 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 correctionstissue Electrical Subcontactor.List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval ' Plans resubmitted Grading . IN HOUSE:- ''' Review, ready forciorrectio7dsue 1 Developer Impact Fee. Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees ' �✓7• MAILCOM ENTERPRISES BIJILDING R ENGINEERING CONTRACTOR Lie. #597069 A&B This is'a confidential message, intended solely for the person to whom it is addressed. If you receive this message in en -or, please forward it -to the correct person or mail, it back to us. Thank you. Date: %,D 6 06 Time: A . m , PLEASE DELIVER THE FOLLOWING PAGES TO: Name: /Y%A . 11�i ^jrn(Y G1;.A1,.►fi'ono Location: G V le -- From: �) C��1 /-Y� t co M Regarding S3 - 5/0 DE"L 6(9-1-0 Lor >1- /,a A total of ages, including this cover letter, are being transmitted to you. If all pages are not received, please call us as soon as possible. NOTES:_ lflS 77/71C 2 -7 /) )aev a•r i oa i —Inc el/yl /D VEL % VT t3 cam../ -t /57/ &C - fit/ I t' t L. DN -Vl.-) C fA r L -0,,.1 ,o,»oacr --r- c(q--- 10no-,fig.�k- m ,47o4r ill -me?_. Voice: (909) 867 - 7058 (909) 336 - 3165 Fax #: (909) 867 - 94 � Telephone (909) 336-3165 • (909) 867-7058 . Fax 867-9403 2651 Secret Drive - Post Office Box 2510 < Running; Springs, California 92382 JUN -1372006 07:37 PM P. 02 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING Pae 1 of 8) CF4R Pivject Address Y - J' a 149.164711 L_ Builder Name Builder Copct Telephone Plan Number HERS.Rater Telephone �✓rn �l Sam le GMg Number iJ r Compliance Method Pres ive Climate 'Lona Certifyi g Siguat Date a Fins Sample House Number HE idrA es Street Address ` 74, �1 ✓' City/State/Zip: ��'4 a.vPIee w: nur.LUax, n&m rxuviuxK ANU SUU.DiNG ULFAKFMENT ■ I■Mr�l • u■�rr HERS RATER C PLIANCE STATEMENT The house was: ✓ Tested ✓ ❑ Approved as part of sample testing, but was not tested As the 1{Efts rater iding diagnoatfc testing and field verification, I certifcompli y that the house identified on this form as with the diagnostic tested cotnpltance requirements as checked ✓ on this form. Tho HERS rater must check and verify that the new distribution system is fully ducted and correct tape is used before a CF -4R tnay be released on every tgaw building. The HERS rater must not reteasc the CF -4R until a properly completed and signed CF -6K has been received for the sample and tested buil ings. The installer has provided a copy of CF -6R (installation Certificate), New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts). .rJ New systems where cloth backed, rubber adhesive duct tape is installed, mastic and draw bands are used in rotnbination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. we MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT dares for field verification and diagnostic: testing of air distribution systema are mailable in RACM, Appendix RC4.3. Duct Diagnostic Leakage Testing Results NEW CONSTRUCTION: Duct Pressurization Test Results (CFM (a3. 25 Pa) #► / %l Measured iJ r Values I Enter Tested Leakage Flow in CFM: 2 Fan Flow: Calculated (Nominal: ✓ ooling ✓ Q Heating) or ✓ G Measured , Enter Total Fan Flow in CFM: ZrL� / �7 ✓ ✓ 3 Pass if leakage Percentage 5 60A j 100 x [_(Line # 1) /&Rine # 2)]] ss l7 Fail ALTERATIONS: Duct system and/or HVAC Equipment Chaa"ut 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out, Enter Tested leakage Flow in CFM: Final Test of New Duct System or Altered Duct S tem S for Duct System Alteration and/or ESHi2ment Chan -Out. Enter Reduction in Leakage for Alwrad Duct System [ # 4) Minus (L e # 5)] 6 _(Line (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) Entire New Duct System - Pass if Leakage Percentage S 6°h 8 d Pass CJ Fail .100 x Line # 5 / Line # 2 TEST OR VERIFICATION STANDARDS: For Altered Duet System and/or HVAC Eq Apment Change -Out ✓ ✓ Use one of the following four Test or Verification Standards fbr com!lancet 9 Pass if Leakage Percentage 5 15% [100 x [_(Line # 5) / (Line 0 2)]] p Pass O Fail l0 _ Pass if Leakage to Outside Percentage 5 I CPA [100 x L _(Line # 7) / (Line # 2)11 ❑ Pass O Fail l Pass if Loakago Reduction P=4nta8e Z 60% [100 x �-_,_,(Line # 6) / (Line # 4)1] O Pass D Fail and Verification by Smoke Test and Visual Inspection 12 Pass if Scaling of all Accessible Leaks and Verification by Smoke Test and Visual Ins eetion 1 Q Paas O Fail Pass If One of Lines # 9 through p 12 pass ID Pass 0 Fail Kestaenital Compliance Farms April 2003 �JUO4-13-2006 07:38 PM P.03 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3 of 8) CF4R Project Address 5 3 - -41-199 Lie Builder N &,07_a,� ✓ Builder Contact r -- Telephone Telephone Plan Number Q HER'5 Rater Telephone SAmplo Group Number Yes is !.LMS Compliance Method Prescri ive Climate Zone 75, Corti in ignature iaa Sample House umber Fi v,z. HERS Provider -- Ci /StateJLip:�,� a 1�l a, _3 � Street Address: � - � a ��� sq,� (�J Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER COMPLIANCE STATEMENT The house was: ✓O'T ted ✓ D Approved as part of sample testing, but was not tested As the HERS tater providing dispostic testing and fieldverification: ! certify that the house identified on this form complies with the diagnostic tested compliance requirumeots as checked on this form. ✓ The installer has provided a copy of CF -6R (installation Certificata), ✓ GFTHERMOSTATIC EXPANSION VALVE (FXV) Amedures jor field verification of thermostatic expansion va are aHnlJible In R4C , Appendix R1. ✓ 0 REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valves :door Unit Serial tf Location Outdoor Unit Make Outdoor Unit Model Cooling Capacity 13tu/b r Date of Verification Date of Refrigerant Gauge Calibration (must be checked monthly) Date of Thermocouple Calibration (must be checked monthly) StandardR, ChaMe Measurement )outdoor air div -bulb 55 T and above): Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer verification shalt be documented on CF -6R before startitsg this procedure, If outdoor air dry-bulb is below SS T rater shall use the Alternative Charge Moasure Procedure Procedures for Determining Refrigerant Charge using the Standard Method are available in RACM Appendix RD2. ✓ G Yes 0 No A copy of CF -6K (Installation Certificate) has been provided with reftfgerant charge measurement documented. Residential Compliance Forms April 2005 ✓ Yes O No Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Q Yes is !.LMS Paas hail ✓ 0 REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valves :door Unit Serial tf Location Outdoor Unit Make Outdoor Unit Model Cooling Capacity 13tu/b r Date of Verification Date of Refrigerant Gauge Calibration (must be checked monthly) Date of Thermocouple Calibration (must be checked monthly) StandardR, ChaMe Measurement )outdoor air div -bulb 55 T and above): Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer verification shalt be documented on CF -6R before startitsg this procedure, If outdoor air dry-bulb is below SS T rater shall use the Alternative Charge Moasure Procedure Procedures for Determining Refrigerant Charge using the Standard Method are available in RACM Appendix RD2. ✓ G Yes 0 No A copy of CF -6K (Installation Certificate) has been provided with reftfgerant charge measurement documented. Residential Compliance Forms April 2005 P.04 ,JUN-16—:eWe6 07:38 PM HERS RATER COMPLIANCE STATEMENT The house was: Vde"ested ✓ G Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification 1 cortify that the house identified on this form complies with tha diagnostic tt ated oompltanc a requirements as checked ✓ on this AOrm. Tho HERS rater must chock and verify that the new distribution system is fully ducted and correct tape is used before a Cl: -4R may be released on every toed building, The HERS rater must not release the CF -4R until a properly completed and signed CF -611 has been received fob the sample and tested bui dings. The installer has provided a copy of CF -6R (Installation Certificate). New Distribution system is hilly 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 arc used in Spmbination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. ✓ ff.MINIMVM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT P e& t,4 far fweld verlfrcatlon and ftnosttc testing of air distribution syslems are available in RACM, Appendix RC4.3. Duct Diagnostic Leakage Testing Results NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) uh !T Measured Values 1 Enter Tested Leakage Flow is CFM; /Cy 2 Fan Flow: Calculated (Nominal: ✓ Cooling ✓ O Heating) or ✓ G Measured ✓ Enter Total Fan Flaw in CFM; tJ'i! V a Pass if Leakage Percentage 5 6°.6 [ 100 x r iU. (Line # 1) J Line # 2)]j ass O Fail ALTERATIONS: Duct S stem and/or HVAC Equipment Cbange-Out )anter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to 4 Duct System Alteration and/or Equipment Chang&0A Enter Tested Leakage Flow in CFM; Final Test of New Duct System or Altered Duct System S for Duct System Alteration and/or i ort Chan a-C}ut, Enter Reduction ib Leakage for Altered Duct System [,_„_(Line # 4) Minus (Line # 5)] 6 (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ SEntire New Duct System - Pass if Leakage Peweatage 5 6% T ❑ pass ❑ Fail 100 x Line # 5 /Line # 2)11 - . TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out �/ ✓ Use one of the following four Test or Veritieadon Standards for eom Iiguem. 9 Pass if Leakage Percentages 15% 1100 x L -,,,-_(Line # 5) J,-„",_ (Line # 2)]] ❑ Pass ❑ Fail 10 rasa if Leakage to Qutside Percentages 104/0 [100x L.__,_,(Line #7) J (Line # 2)]] 0 Pass Q Fail Pass if Leakage Reduction Percentage a 604/a [100 x L_(Line # 6) ! (Line # 4)]J ❑Pass ❑Pail 1 l and Verification by Smoke Test and Visual 1As tion i 2 Paas if Scalina of all Accessible Leaks and Verification by Smoke Test and Visual Inspection Q Pass Q Fail Pass If One of Lines # 9 through # 12 pass O Pass ❑Fail Residential Compliance forms April 2005 P.05 JUN -13-2006 07:39 PM HERS RATER COMPLIANCE STATEMENT The house was; V001i'ested ✓ ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostio testing and Sell verification, I certify that the house identified on this form complies with tjiq diagnostic tested compliance requirements as checked on this forth. ✓Tho installer has provided a copy of CF -6R (installation Certificate), ✓Jff THERMOSTATIC EXPANSION VALVE (TXV) ;z .14 Procedums.for field verlfcation of thermowlatic eapansion valves m AACU ix Rt. ✓ 0 REFRIGERANT CHARGE MEASUREMENT Vcrifioatioa for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion door Unit Serial h Location Outdoor Unit Make Outdoor Unit Model Cooling Capacity 8 Date of Verification Date of Re9'igerant Gauge Calibration (must be checked monthly) Date of Tberrnocouple Calibration (must be checked monthly) Standard Cbar¢= Mgsurc=t (outdoor air dry -bulk 53 °k add abo%ck 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 SS °F rater shall use the Alternative Charge Measure Procedure Procedures for Determining Ret eraut Charge using the Standard Method are available in RACK Adix RDZ. ✓ G Yea M No A copy of CF -6R (Installation Certificate) furs been provided with refrigerant charge measurement documented. Residential Compliance Forms April 2005 P.06 JUN -13-2006 07:39 PM CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING Pae I of 8) CF4R Ptvject Address Q D Duct Pressurization Test Results (CFM Q 2S Pa) vyj r fi Builder Name r Buildcr_Contact Telephone Pan Number HERS tt:r / r Telephone .I Sample GroupNumber 0 Fan Flow: Calculated (Nominal; ✓ oling ✓ Cl Hosting or ✓Measured! Comoliance Method Presed ve ✓ ✓ Climate 'Lone Certlfyi I Signature Qate G Sample House Number }ri Pass if Leakage Percentage S 6% [ i00 x (Line # i) / Lino # 2)JJ HERS Provider Street dress:Zean✓ ALTERATIONS: Duct ftstens and/or HVAC Equipment Chmnge-Out Citi/State/Zip: k Coekr to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER COMPLIANCE STATEMENT The house was: ✓ ested ✓ 0 Approved as part of sample testing, but was not tested As the HERS rater pYovidTA diagnostic testing and field verification 1 certify that the house identified on this form complies with the diagnostic tested compliance requirements as checked ✓ on this i6rm. The HERS rater must check and verify that the new distribution system is fully ducted and correct tape is used before aCF-4R may be released on every tbui[ding. The ITERS rater must not release the CF -4R until a properly completed and signed CF -6K has been received fort sample and tested buil"i gs. FTThe 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). Ncw 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. ✓ IMINIiVIUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Procedures forfleld ver*atfon and diagnostic testing of air distribution systems are available In RACM Appendix RC4.3. Duct Diagnostic Leakage Testing Results NEW CONSTRUCTIONt Duct Pressurization Test Results (CFM Q 2S Pa) vyj r fi Measured Values I Enter Tested Leakage Flow in CFM: 2 0 Fan Flow: Calculated (Nominal; ✓ oling ✓ Cl Hosting or ✓Measured! ✓ ✓ Enter Total Fan Flow in CFM: 6p'D ZrID b 3 Pass if Leakage Percentage S 6% [ i00 x (Line # i) / Lino # 2)JJ a ase ❑Fail ALTERATIONS: Duct ftstens and/or HVAC Equipment Chmnge-Out Enter Tested Leakage Flow in CFM from CN -6R: PmTest of Existing Duct System Prior to 4 Duct System Alteration and/or Equipment Change -Out Eater Tested Leakage Flow in CFM: Final Teat of New Duct System or Altered Duct System S for Duct System Alteration and/or Equipment Cha a -Out• Enter Reduction in Leakage for Altered Duot System [_(Line # 4) Minus (Line # s)] 6 (Only if Applicable) 7 Enter Tested Leakage Flow In CFM to Outside (Only if Applicable) ✓ ✓ g Entire New Duct System - Pass if Leakage Percentage S 6% ❑Pass ❑Fail 100 x L1ne # 3 I Line # 2111 TEST OR VERIFICA'T'ION STANDARDS: For Altered Duct System and/or HVAC Equipment Chpnge-Out ✓ ✓ Use one of the following four Test or Veritfeation Standards for com Uance: 9 Pass if Leakage Percentage S 15% (100 x (-(Line # 3) / (Line # Z)]] ❑ Paas ❑ Fail l0 Pass if Leakage to Outside Percentage --110% (100 x L _______(Line 0 7) I (Line # 2)11 D Pass ❑ hail 11 Pass if Leakage Reduction Percentage k 60"/e [100 x L_(Lioe # 6) / (Line # 4)JJ 0 pass 0 Fail and Verificationly1mokeTcst4nd Visgolinspection 12 Pass if $tilinst of all Accessible Leaks and Verification by Smoke Test and Visual ins ection 1 0 Pass ❑ Fail Pus If One of Lines # 9 through # 1 Z pass ❑ Pass ❑ Fail Reslde►tlial Co,np/ianc+e Forrn.s April 1005 P.07 JUN -13-2006 07:40 PM HERS RATER C„QMPLIANCE STATEMENT The house was: VJZ 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 forth complies with diagnostic tested compliance requirements as checked on this form. ✓ PThe installer has provided a copy of CF -6R (Installation Certificate). J43 THERMOSTATIC EXPANSION VALVE (MV) Procedures forfield verification of thermostaile arpansion values are ✓ 13 REFRIGERANT CHARGE MEASUREMENT Verification for Required Ref'tigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valves odoor Unit Serial # Location Outdoor Unit Make Outdoor Unit Model Date of Verification Date of Rafiigerant Gauge Calibration (trust be checked monthly) Date of Thermocouple Calibration (must be checked monthly) Standard Chg=,Mg&W=nt„(gMttdoor airda-bulb -bul gS V jMd above): Note: The system should be installed and charged in acmdaaee 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 SS °F rater shall use the Alternative Charge Men= Procedure Procedures for Determinia Refri Brant Charge using the Standard Method are available in RACK Appendix RD2, ✓ ❑ Yes D No A copy of CA -6R (Installation Certificate) has been provided with refrigerant charge measurement documented. Residential Compliance Foms April 2005 J J Access is provided for inspection. The procedure sball consist of ✓os E3 No visual verification that the TXV is installod on the system and Q installation of the specific equigMt shall be verified, Yes is a pass Pass Fail ✓ 13 REFRIGERANT CHARGE MEASUREMENT Verification for Required Ref'tigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valves odoor Unit Serial # Location Outdoor Unit Make Outdoor Unit Model Date of Verification Date of Rafiigerant Gauge Calibration (trust be checked monthly) Date of Thermocouple Calibration (must be checked monthly) Standard Chg=,Mg&W=nt„(gMttdoor airda-bulb -bul gS V jMd above): Note: The system should be installed and charged in acmdaaee 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 SS °F rater shall use the Alternative Charge Men= Procedure Procedures for Determinia Refri Brant Charge using the Standard Method are available in RACK Appendix RD2, ✓ ❑ Yes D No A copy of CA -6R (Installation Certificate) has been provided with refrigerant charge measurement documented. Residential Compliance Foms April 2005 P.08 JUN -13-2006 107:40 PM HERS RATERK PLIANCE STATEMENT The house was: ✓sted ✓ O Approved as part of sample testing, but was not tested As the HERS raterg diagnostic testing and field verification, l certif that the house idetttI i on this form complies with the diagnostic testeiance requirements as checked ✓ on this form. The HERS rater must check and verify that the new distribution system is fully ducted and correct tape is used before a CF -4R may be released on every t=W building, The HERS rater must not release the CF -4R until a properly completed and signed CF -69 has been received for tFe sample aaa tested buitdtgs. Xe insulter has provided a copy of CF -6R (Installation Certificate). ew Distribution system is fully ducted (i.e., does not use building cavities as plonurm or platform returns In lieu of ducts). It New systema 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 Piocedurnforfleldver1fication and dtagnosile testing of air distribution systema are available In RACM appendix RC4.3. Duct Diagnostic Leakage Testing Results Meaaurcd Duct Premurization Test Results (CFM @ 23 Pa) Values 1 linter Tested Leakage Flow in CFM: 2 Fan Flow: Calculated (Norninel: ✓ lin ✓ d Heating)) or ✓ 13 Measured Enter Total Fan Flow in CFM: dv /�L� '� ✓ 3 Pass if Leakage Percentage S 6% (100 x f 59.E _ (Line # 1) / Zd_QLino # 2)]] ,z ass ❑ Fail ALTERATIONS: Duet Wstem and/or HVAC E uipment Chan nt 4 Enter Tested Leakage Flow in CFM from CF -61k: )Pre•Teet of Existing Duct System Prior to Duct System Alteration and/or Equipment Cbange4)ut. Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System Se__ rn..-. LN- .-._.- A r._ .:._ -A I— u_..:y. _. r+:.---- n... Enter Reduction in Leakage for Altered Duct System L_(Line # 4) Minus (Line # 5)] 6 (Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ 8 Entire New Duct System - Pass if Leakage Ftmeontage 5 6% 100 x lino # s Line # 2 Cl Pass D Fait TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out ✓ ✓ Use one of the followlet four Tat or Verification Standards for coar Manse: 9 Pass if Leakage Percentages 15% (100 x L_(Line # 5) I (Line # 2)1] ❑ Pan ❑ Fail 10 Pass if Leakage to Outside Percentage 510% 11 00 x f (Linc # 7) ! (Linc # 2)] j ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage �t 60% 1100 x G, ,(Line # 6) ! (Line # 4)]] l1 ,._a ..._:h._.:.r �., e.�..t.. m.,a....a v:....,.: r..__......... 0 Pus ❑ Fail j Pass if One of Linea N 9 through # 12 pass 17 Pass O Fail Residen ia/ Compliance Forms April .100.1 P.09 JUN -13-2006 07:41 PM HERS RATER OMPLIANCE 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 with diagnostic tested compliance requiretrmw as checked on this form. ✓ ;The installer has provided a copy of CF -6R (Installation Certificate). ✓AIT HERMOSTATIC EXPANSION VALVE (TXV) Procedures for field verijication of thermostatic expansion VaIW4 WV available Iq M, Appendix RJ. ✓ D 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 Date of Verification Date of Refligerant Clauge Calibration (must be checked monthly) Date of Thermocouple Calibration (must be checked monthly) Standard Charge M men= (outdoor air da -bulb 35!f and shovel: Note: The system should be installed and charged in accordance with the manufacturer'& specifications and installer verification shall be documented on CF -6R before starting this ptvicedure. If outdoor air dry-bulb is below SS'F rater shall use the Alternative C!►arge Measure Procedure Procedures for Dctenmininx Re&i erant Charge using the Standard Method are available in RACM Appendix RD2. ✓ O Yes D No A copy of CF -6R (installation Certificate) has been provided with refrigerant charge measurement documented. Residential Compliance Firms April.°.005 INSTALLATION CERTIFICATE CF -6R Site Address Permit Number 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; however, use of this form to provide the information is optional.) 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(b).' HVAC SYSTEMS: Heating Equipment Equip. N of Efficiency Duct Duct or Heating Heating Type (pkg. CEC Certified Mfr Name Identical (AFUE, etc.)' Location Piping Load Capacity eat um and Mod I Number t > I v lue att' et -v lue (Btu/hr) ,,Btu//hr) Y M&f - O —A—MC Cooling Equipment Equip. CEC Certified Compressor # of Efficiency Duct Cooling Cooling Type (pkg. Unit Mfr Name and Identical . (SEER, etc.)' Location Duct Load Capacity eat u d l b t > value attic et R -vale (Btu/hr)Bt le Alf W 0011 >_ reads greater than or equal to. 1, 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. • � Q"VMALA tex Coma e Signature, Date Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner WATER HEATING SYSTEMS: Distribution If Recir- H of Rated: Tank Effi- External Heater CEC Certified Mfr Type (Std, culation, ' Identical Input (kW Volume ciency Standby Insulation Type Name & Model Number Point -of -Use) Control Type Systems or Btu/hr) (gallons) (EF, RE) Loss (%) R -value �Fi (VA 21y't ao ^nrsr.M 7 t �4Q 2 For small gas storage (rated input of less than or equal to 75,000 Btu/hr), electric resistance and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/Itr), list Recovery Efficiency, Standby Loss and Rated Input. For instantaneous gas water heaters, list Recovery Efficiency and Rated Input. 3. R-12 external insulation is mandatory for storage water heaters with an energy factor of less than 0.58. Faucets & Shower Heads: All faucets and showerheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section 111. 1, the undersigned, verify that equipment listed above my signature is: 1) the actual equipment installed; 2) equivalent to or more efficient than that specified in the certificate of compliance (Form CF - IR) 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), w licable. Signature, Date Installing Subcontractor (Co. Name OR General Contractor (Co. Name) OR Owner COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy BUILDING & SAFETY DEPARTMENT kMPICo (760) 777-7012 CITY OF LA QUINTR iFORNIA 92253 FAX (760) 777-7011 CUSTOMER RECEIPT #$ Date: 6/21/06 01 Receipt no: 14892 Description Quantity005 Amount 'ollect The'Followiniz Fees For The Services Rendered BP 00BUIILDING PERMITS 1.00 $35.00 Trans number: 56331 MALCOLM ENTERPRISES, 8005 Tender detail 26237 535.00 CK CHECK 135.00 ling Total tendered 135.00 Total payment Trans date: 6%21/06 Time: 11:37:52 ive THANK YOU FOR YOUR, PAYMENT. : ,rises, Inc. row,rororororo roroarorororomaaarorororo FOR QUESTIONS PLEASE CALL 760-777-7150. in Review of Energy Report REVISIONS TO ISSUED PERMIT. :Struction). Fees• PlanReview: ............................................. ............................... $ 35.00 (lhr X $35/hr) TOTAL FEES NOW DUE: ................................. $ 35.00 Date: _June 21, 2006 Initials: .