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11-0771 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 1-1-0000077-1 Property Address: 518.00 AVENIDA MONTEZUMA APN: 773-151-001-1 -000000- Application description: MECHANICAL Property Zoning: q,COVE RESIDENTIAL Application valuation: 11900 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: BRAWNING TOBY 51800 AVENIDA-MONTEZUMA LA QUINTA, CA 92253 Contractor: Applicant: Architect or Engineer: VIC' S AIR CONDITIONING P.O. BOX.215 W� THOUSAND PALMS, CA 922 (760)343-5033 Lic. No.: 756658 LICENSED CONTRACTOR'S DECLARATION I hereby affirm underpenalty 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 Class: C20 License No.: 756658 Date!'/.(t6ntractor. - ----- . ' 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 Code1 or that he or she is exempt therefrom and the basis for the alleged exemption.' Any Molation 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)•: ( ) 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 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.). ' . 1 _ 1 I am exempt under Sec.' , BAP.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 . VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/i5/11 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 STAR INS CO Policy Number WCMSTR0509169 _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I forthwith c ply with those rovisions. Date: Applicant: 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 1$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. 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 incorrect. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter u on the above-mentioned property fo ' pection purposes. r .Date: tJgnature(Applicant-or-Agent):�� Application Number 11-00000771 Permit- MECHANICAL Additional desc . Permit Fee. 40.50 Plan Check Fee 10.13 Issue Date - Valuation 0 Expiration Date 1/11/12 Qty. Unit Charge. Per. Extension - BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00. 16.5006 EA MECH B/C >3L15HP/>100K-500KBTU 16.50 Special Notes and Comments HVAC CHANGE OUT PACKAGED UNIT. 16 SEER 3 TON UNIT.2010 CODES. -"CARBON MONOXIDE ALARM(S)TO BE INSTALLED PRIOR'TO FINAL INSPECTION." -----------------_--------------------------------- Other Fees BLDG "STDS ADMIN (SB1473). 1.00 Fee summary Charged Paid Credited ---------- --- Due. - ----------- - - - -- Permit Fee Total 40.50 .00 .00 40.50 Plan Check Total 10.13 .00 .00 10:13 Other Fee Total 1.00 .00 .00 1.00 Grand Total 51.63 ..00 .00 51.63 . LQPERMIT Simplified Prescriptive -Cer-tific-ato of Coen liance: 2008•Residentiil `HVAC 4lteration.s CF -IR -ALT' Climate Zones •10 to 15. Site Addresr.. Enforcement Agency: Dater Permit #: Conditioned Floor -Equipment T List Minimum Efficient Z Duct iruulation re uirement Packaged Unit Area Thermostat ❑Fu—mace ❑ AFUE_ ❑ COP Over 40 ft of duds added or . etback O Indoor Coil _ER O HSPF replaced in unconditioned space Served by system lfnot already O Resistance O Condensing Unit O EER ❑ R 6 (CZ 10-13) m sf present. mus, be ❑ Other ❑ R 8 (CZ 14-15) j� installed) 1. Equipment T)Pe: Choose the equipment being installed; if more than ore system, use another CF -1 R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78Y. AFUE, 7.7HSPF or f typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted A copy of the forms shall be left on site for fatal inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fad the work completed by the installer. The inspector also verifies that each appropriate CF -6R and re eredsi innin October 1, 2010 " a r tered co of the CF -1R and CF -6R shall alsobe on an led f4R forms (no hdor final Insa! doh) are filled out"and n. 1. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF-61tforms: MECH-04, MECH-21-HERS and (for split systems) MECH- 25 -HERS • Condenser Coil "and /or CF -4R forms: MECH- 21 and fors lit sy stems MECH-25 • Indoor Coil and/or CF-61kforms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Furnace CF4R forms: MECH- 21 and (for split systems). MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage <.15 percent Exempted from duct leakage testing if - 0 1 Duct system was documented to have been previously sealed and confirmed through HERS"verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or O 3. Existing ducts stems are constructed, insulated or sealed with asbestos O 2. New HVAC System' Required Forms: • Cut sall new ducting and all msChang with new ducts: (alCF-6R forms: MECH-04, MECH-20-HERS,and for split systems) MECH-22-HERS, and MECH-25-HERS : new equipment) CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25 For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent " O 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFMhon, TMAH For Packaged Units: Duct leakage <6 percent O 4. New Ducting over 40 feet Required Forms: • Include: addine or replacing more than 40 linear feet of duct in unconditioned space. CF 6R forms: MECH-04, MECH-2I-HERS CF4R forms: "MECH-21 For split system or packaged units: Duct leakage < t5 percent ❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • 1 cenifi• that this Certificate of Compliance documentation is accurate and complete. • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. 1 ceriift• that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • he deign features identif ed on this Certificate of Compliance are consistent with the"information documented on other applicable compliance forms, worksheets. calculations, pllians and s cifications submitted to the enforcement agency fora oval with the permit application. Name: Signature: Company: % Date- Address: ate Address: License: , City/Statc/Zip: 2008 Residential Compliance Forms March 2010 Bin # City Of LdQ[lin ta. Building 8i Safety Division P.O. Boz 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) •777-7012 Building Permit Application and Tracking Sheet Permit # 1 Project Address: y. P er's Name: A: P. Number: Legal Description:' Contractor: �Iy Address: �O City, ST, Zip: Telephoner rofect Description: ' Address: City, ST, Zip: �1 Tele hon State Lic. # : City Lic. #.: Arch., Engr., Designer: / Address: s � City, ST, Zip: Telephone::: •<•`:<::<z:. •.;•.:::;:::: ,t..•.. :•.s:<:;::<<a:>:.>:>:».':> Construction Type: cc pancy: State Lic. #: 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: 0� APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2' Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''d 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 t, •. Prescriptive Certificate of Compliance: Residential CF-1R-ALT Residential Alterations (Page 1 of 5) Project Name: Climate Zone # # of Stories General Information Site Address: Enforcement Agency:Date: Building Type Single Family Multi Family Circle the Front Orientation: N, E, S, W, or degrees ________ Conditioned Floor Area (CFA): _________________ Project Type: Alterations Envelope Fenestration Roof HVAC Replacement or Change Out Duct Replacement Water Heater NOTE: This form is not to be used for Newly Constructed Buildings or Additions Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below) Assembly Alteration Opening of framed cavity alone – Alterations that involve the opening of the framed cavity of a wall, ceiling, or floor must install the mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A –C and enter mandatory insulation value in Column H. Replacement of entire assembly – Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component Package- D insulation values in Table 151-C. Fill in Columns A – J. Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below. A B C D E F G H I J Proposed See Note Standard Values From JA4 Table Tag/ ID1 Assembly Name or Type1 Framing Material and Size2 Thickness, Spacing, or Other3 U- factor4 JA4 Table Number5 Framed Cavity R-value6 Continuous Insulation R-Value7 JA4 Assembly Cell Value8 Proposed Assembly U-factor9 Note: For furred assemblies, accounting for Continuous Insulation R-value, see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and Furring Construction table below. 1. For Tag/ID indicate the identification name that matches the building plans. 2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc…Indicate the Frame type and Size: For Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc… see JA4 for other possible frame type assemblies. 3. Enter the thickness for mass in inches or Spacing between framing members enter; 16”or 24”OC; or Other for all other assembly description such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel and etc…. 4. Based on the Climate Zone; enter the Standard U-factor from Table 151-B, C or D for each different assembly Name or type. 5. Enter the Table number that closely resembles the proposed assembly. 6. Enter the R-value that is being installed in the wall cavity or between the framing; otherwise, enter “0”. 7. Enter the Continuous Insulation R-value for the proposed assembly; otherwise, enter “0”. 8. Enter the row and column of the U-factor value based on Column F Table Number and enter the Assembly U-factor in Column J 9. The Proposed Assembly U-factor, Column J, must be equal to or less than the Standard U-factor in Column E to comply. Furring Strips Construction Table for Mass Walls Only A B C D E F G H I J K L M Proposed Properties of Masonry and Concrete Walls From Reference Joint Appendix Table 4.3.5, 4.3.6, 4.3.7 Added Interior or Exterior Insulation in Furring Space from Reference Joint Appendix Table 4.3.13 Final Assembly U-factor6,7 Comment Mass Thickness1 Assembly Name or Type2 JA4 Table Number3 JA4 -Mass Cell Value4 Mass U-Factor5 Interior or Exterior of Insulation Layer Frame Thickness Frame Type Wood or Metal Furring Cavity R-value3 JA4 -Mass Cell Value4 Effective R-value5 Registration Number: ___________________________ Registration Date/Time: _____________________ HERS Provider: __________________ 2008 Residential Compliance Forms August 2009 51800 Avenida Montazuma La Quinta CA 92253 La Quinta, City of 7/15/2011 4 O 1200 Browning,Toby 15 1 311-A0006716A-000000000-0000 07/15/2011 11:32:48 CBPCA 4 Browning,Toby 15 1 311-A0006716A-000000000-0000 07/15/2011 11:32:48 CBPCA Prescriptive Certificate of Compliance: Residential CF-1R-ALT Residential Alterations (Page 2 of 5) Project Name: Climate Zone # # of Stories Registration Number: ___________________________ Registration Date/Time: _____________________ HERS Provider: __________________ 2008 Residential Compliance Forms August 2009 Mass and Furring Strips Construction (footnotes) 1. Indicate the type of assembly to include; Hollow Unit Masonry Walls, Solid Unit Masonry, Solid Concrete Walls, Etc. Additional assemblies can be found Reference Joint Appendix JA4. 2. This is the U-Factor based on the thickness of the assembly in inches. 3. The R-value of the insulation to be added on the interior or exterior of the assembly. 4. The Calculated R-Value is the R-value of the furred out section of the assembly. 5.-6.The Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JA4. The equation is the inverse of Column D added to Column I. Column K is the inverse from column J. 7. Insert the calculated U-factor value on to the Opaque Surface Details in Column J FENESTRATION PROPOSED AREAS Replacing window alone – Replacement windows shall meet the U-Factor and SHGC Value requirements of Component Package D in Table 151-C. The Total Fenestration and West-facing Area requirements are not applicable. Adding 50ft2 or less of window area – Newly installed windows shall meet the U-Factor and SHGC Value requirements of Component Package D in Table 151-C. Adding more than 50ft2 of window area – Newly installed windows shall meet the U-Factor and SHGC Value and the Fenestration Area requirements of Component Package D in Table 151-C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF-1R-ALT Fenestration Type and Frame (Window, Glass Door or Skylight) Orientation (North, East, South, West) PropsedArea1 (ft2) Maximum U-factor2, 3 Maximum SHGC2, 3, 4 NFRC or Default Value5 1. Fenestration area is the area of total glazed product (i.e. glass plus frame). Exception: When a door is less than 50% glass, the fenestration area may be the glass area plus a “2 inch frame” around the glass. 2. Enter value from Component Package D Requirements in Table 151-C. 3. Actual fenestration products installed and as indicated in CF-6R-ENV Form shall be equivalent to or have a lower U-factor and/or a lower SHGC value than that specified on the CF-1R ALT Form. 4. Submit a completed WS-3R Form if a reduced SHGC is calculated with exterior shading. 5.If applicable at this stage enter “NFRC” for NFRC Certified windows or are CEC “Default” values found in Table 116-A or B. ALTERED FENESTRATION ALLOWED AREAS (Complete if more than 50ft2 of fenestration is added) A B C D E F G CFA of Entire Dwelling Allowed % of CFA Existing Fenestration Area Fenestration Area Removed Fenestration Area Added Total Area Allowed (A x B) Proposed Area2 (E-D) + C Total Fenestration Area (ft2) .20 ≥ West Fenestration Area1 (Required In CZ’s 2, 4 & 7 -15) .05 ≥ 1. West Fenestration Area includes west-sloping skylights and any skylights with a pitch less than 1:12. 2. West facing glazing area removed cannot be “counted” twice.” In order to distribute the west glazing area removed to the other orientations, input the west glazing area removed in the Total Fenestration Area row, column D. 3. Include the Proposed Area of the West facing fenestration in both Area columns below. 4. To meet compliance, the Proposed Area must be less than or equal to the Total Allowed Area for BOTH the Total and West Fenestration Areas. Browning,Toby 15 1 311-A0006716A-000000000-0000 07/15/2011 11:32:48 CBPCA Prescriptive Certificate of Compliance: Residential CF-1R-ALT Residential Alterations (Page 3 of 5) Project Name: Climate Zone # # of Stories Registration Number: ___________________________ Registration Date/Time: _____________________ HERS Provider: __________________ 2008 Residential Compliance Forms August 2009 ROOFING PRODUCTS (COOL ROOFS) §151(f)12 When the area of exterior roof surface to be replaced exceeds more than 50% of the existing roof area, or more than 1,000 ft2, whichever is less, the new roofing area must meet the roofing product “Cool Roof” requirements of §152(b)1Hi, 152(b)1Hii, or 152(b)1Hiii. Check applicable alternative or exception below if the roof alteration is exempt from the roofing product “Cool Roof” requirements. Note: If any one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in §118(i) are not applicable. Do not fill table below. Cool Roofs Not Required in Climate Zones 1-12, 14, and 16 with a Low Sloped. Less or 2:12 pitch. Cool Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs (pitch greater than 2:12) and product unit weight less than 5lb/ft2. Alternatives to §152(b)1Hi and §152(b)Hii, Steep-slope roof (pitch > 2:12) Insulation with a thermal resistance of at least 0.85 hr·ft2·°F/Btu or at least a 3/4 inch air-space is added to the roof deck over an attic; or Existing ducts in the attic are insulated and sealed according to §151(f)10; or In climate zones 10, 12 and 13, with 1 ft2 of free ventilation area of attic ventilation for every 150 ft2 of attic floor area, and where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or Building has at least R-30 ceiling insulation; or Building has radiant barrier in the attic meeting the requirements of §151(f)2; or Building has no ducts in the attic; or In climate zones 10, 11, 13 and 14, R-3 or greater roof deck insulation above vented attic. Exception to §152(b)1Hiii, Low-slope roof ( pitch ≤ 2:12) Building has no ducts in the attic. Other Exceptions Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria. Roof constructions that have thermal mass over the roof membrane with at least 25 lb/ft2 is exempt from the below Cool Roof criteria. Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance, otherwise, Check the applicable box below if Exempt from the Roofing Products “Cool Roof” Requirement: CRRC Product ID Number1 Roof Slope ≤ 2:12 > 2:12 Product Weight < 5lb/ft2 ≥ 5lb/ft2 Product Type2 Aged Solar Reflectance3,4 Thermal Emittance SRI5 4 4 4 4 4 1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council’s Rated Product Directory at www.coolroofs.org/products/search.php 2. Indicate the type of product is being used for the roof top, i.e. single-ply roof, asphalt roof, metal roof, etc. 3. If the Aged Reflectance is not available in the Cool Roof Rating Council’s Rated Product Directory then use the Initial Reflectance value from the same directory and use the equation (0.2+0.7(ρinitial – 0.2) to obtain a calculated aged value. Where ρ is the Initial Solar Reflectance. 4. Check box if the Aged Reflectance is a calculated value using the equation above. 5. Calculate the SRI value by using the SRI- Worksheet at http://www.energy.ca.gov/title24/ and enter the resulting value in the SRI Column above and attach acopy of the SRI- Worksheet to the CF-1R. To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(i)4. Select the applicable coating: Aluminum-Pigmented Asphalt Roof Coating Cement-Based Roof Coating Other ______________________ Browning,Toby 15 1 311-A0006716A-000000000-0000 07/15/2011 11:32:48 CBPCA Furnace, 80000 78 AFUE Ducted,SetBack Package AirConditioner, 36000 16 SEER Ducted,SetBack Package 4 4 4 Prescriptive Certificate of Compliance: Residential CF-1R-ALT Residential Alterations (Page 4 of 5) Project Name: Climate Zone # # of Stories Registration Number: ___________________________ Registration Date/Time: _____________________ HERS Provider: __________________ 2008 Residential Compliance Forms August 2009 HVAC SYSTEMS - HEATING Heating Equipment Type and Capacity1,2,3 Minimum Efficiency (AFUE or HSPF) Distribution Type and Location4 Duct or Piping Insulation R-Value Thermostat Type Configuration (Central, Split, Space, Package or Hydronic) 1. Indicate Heating Type (Central Furnace, Wall Furnace, Heat pump, Boiler, Electric Resistance, etc.) 2. Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental (i.e., if total capacity < 2 KW or 7,000 Btu/hr electric heating is controlled by a time-limiting device not exceeding 30 minutes). See §151(b)3 exception. 3. Refer to the HERS Verification section on Page 4 of the CF-1R-ALT Form for additional requirements and check applicable boxes. 4. Indicate Type or Location (Ducts, Hydronic in Floor, Radiators, etc.) HVAC SYSTEMS - COOLING Cooling Equipment Type and Capacity1,2 Minimum Efficiency (SEER/EER or COP) Distribution Type and Location3 Duct or Piping Insulation R-Value Thermostat Type Configuration (Central, Split, Space, Package or Hydronic) 1. Indicate Cooling Type (A/C, Heat pump, Evap. Cooling, etc) 2. Refer to the HERS Verification section on Page 4 of the CF-1R-ALT Form for additional requirements and check applicable boxes. 3. Indicate Type or Location (Ducts, Hydronic in Floor, Radiators, etc.) WATER HEATING List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground hot water pipes is required in all component packages in all climate zones. Water Heater Type/Fuel Type1 Distribution Type (Standard, Recirculating)2 Number In System Tank Capacity (gal) Energy Factor or Thermal Efficiency External Tank Insulation R-Value3 1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The external water heating tank and pipes shall be insulated to meet the requirements of §150(j). SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written justification and documentation and special verification. NEW ROOF ASSEMBLY - Radiant Barrier The radiant barrier requirement of §151(f)2 does not apply to roof alterations. Slab Edge (Perimeter) Insulation YES NO YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required. Heated Slab Insulation YES NO YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation YES NO YES: In Climate Zones 1, 2, 11, 13, 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15, R-4 is required under component Package D. Thermal Mass To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach. Browning,Toby 15 1 311-A0006716A-000000000-0000 07/15/2011 11:32:48 CBPCA 4 Octavian Victoria octavio Victoria Vic's Air Conditioning 7/15/2011 215 P.O Box Thousand Palms California 92276 760-343-5033 Octavian Victoria octavio Victoria Vic's Air Conditioning 7/15/2011 215 P.O Box 756658 Thousand Palms California 92276 760-343-5033 Prescriptive Certificate of Compliance: Residential CF-1R-ALT Residential Alterations (Page 5 of 5) Project Name: Climate Zone # # of Stories Registration Number: ___________________________ Registration Date/Time: _____________________ HERS Provider: __________________ 2008 Residential Compliance Forms August 2009 HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this checklist below. A completed and signed CF-4R Form for all the measures specified shall be submitted to the building inspector before final inspection. Duct Sealing & Testing HERS verification is required for this measure. YES NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned space, the ducts are to be sealed per §152(b)1Dii and the newly installed ducts are to be insulated per §151(f)10. EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. YES NO YES: In Climate Zones 2 and 9-16, if the existing space-conditioning system (HVAC equipment and ducting) is replaced, the ducts are to be sealed per §152(b)1Di. YES NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be sealed per §152(b)1E. EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Refrigerant Charge - Split System HERS verification is required for this measure. YES NO YES: In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat exchanger) a refrigerant charge measurement shall be verified per §152(b)1F. Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw The ventilation requirements of §150(o) do not apply to existing residential homes. Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure. YES NO YES: In Climate Zones 10 through 15, when the existing space-conditioning system (HVAC equipment and ducting) is replaced, the airflow and fan watt draw shall be verified per §152(b)1Ci to meet the requirements of §151(f)7B. Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accurate and complete. Name: Signature: Company : Date: Address: If Applicable CEA or CEPE (Certification #): City/State/Zip: Phone: Responsible Building Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance are consistent with the information provided to document this building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Name: Signature: Company: Date: Address: License: City/State/Zip: Phone: For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test – Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test – Completely New or Replacement Duct System." Duct Leakage Diagnostic Test – existing duct system Select one compliance method from the following four choices.  Option 1. Measured leakage less than 15% of Fan Airflow.  Option 2. Measured leakage to outside less than 10% of Fan Airflow.  Option 3. Reduce leakage by 60% or more, and conduct smoke test to seal all accessible leaks.  Option 4. Fix all accessible leaks using smoke test, and HERS rater must verify. Note: (Option 1 must be attempted before utilizing Option 4) Determine nominal Fan Airflow using one of the following three calculation methods.  Cooling system method: Size of condenser in Tons x 400 = CFM  Heating system method: 21.7 x Heating Output Capacity (kBtuh) = CFM  Measured system airflow using RA3.3 airflow test procedures: CFM 1 Option 1 used then: Allowed leakage = Fan Airflow x 0.15 = CFM Actual leakage = CFM Pass if Actual leakage is less than Allowed leakage  Pass  Fail 2 Option 2 used then: Allowed leakage = Fan Airflow x 0.10 = CFM Actual leakage to outside = CFM Pass if Actual leakage to outside is less than Allowed leakage  Pass  Fail 3 Option 3 used then: Initial leakage prior to start of work= CFM Final leakage after sealing all accessible leaks using smoke test = CFM Initial leakage - Final leakage = Leakage reduction CFM (Leakage reduction / Initial leakage ) x 100% = % Reduction Pass if % Reduction > 60%  Pass  Fail 4 Option 4 used then: All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). Pass if all accessible leaks have been sealed using Smoke Test  Pass  Fail 51800 Avenida Montazuma La Quinta CA 92253 La Quinta, City of 3.00 1200.00 4 1200.00 180.00 169.00 4 311-A0006716A-M2105145A-M21A 07/24/2011 14:50:56 CBPCA 4 Vic's Air Conditioning octaviano Victoria 756658 4 MLC Home Performance Tom Bachus Tom Bachus 1095794 7/24/2011 51800 Avenida Montazuma La Quinta CA 92253 La Quinta, City of 311-A0006716A-M2105145A-M21A 07/24/2011 14:50:56 CBPCA 4 4 4 4 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test – Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009  Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing.  All supply and return register boots must be sealed to the drywall if smoke test is utilized for compliance – applies to duct leakage compliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible leaks) described above.  New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts.  Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections. DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF-1R) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF-6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF-1R) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF-6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Responsible Person's Name: CSLB License: HERS Provider Data Registry Information Sample Group # (if applicable):  tested/verified dwelling  not-tested/verified dwelling in a HERS sample group HERS Rater Information HERS Rater Company Name: Responsible Rater's Name Responsible Rater's Signature Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: INSTALLATION CERTIFICATE CF-6R-MECH-21-HERS Duct Leakage Test – Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency:Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test – Completely New or Replacement Duct System." Duct Leakage Diagnostic Test – Existing Duct System Select one compliance method from the following four choices. Option 1. Measured leakage less than 15% of Fan Airflow. Option 2. Measured leakage to outside less than 10% of Fan Airflow. Option 3. Reduce leakage by 60% or more, and conduct smoke test to seal all accessible leaks. Option 4. Fix all accessible leaks using smoke test, and HERS rater must verify. Note: (Option 1 must be attempted before utilizing Option 4) Determine nominal Fan Airflow using one of the following three calculation methods. Cooling system method: Size of condenser in Tons x 400 = CFM Heating system method: 21.7 x Heating Output Capacity (kBtuh) = CFM Measured system airflow using RA3.3 airflow test procedures: CFM 1 Option 1 used then: Allowed leakage = Fan Airflow x 0.15 = CFM Actual leakage = CFM Pass if Actual leakage is less than Allowed leakage Pass Fail 2 Option 2 used then: Allowed leakage = Fan Airflow x 0.10 = CFM Actual leakage to outside = CFM Pass if Actual leakage to outside is less than Allowed leakage Pass Fail 3 Option 3 used then: Initial leakage prior to start of work= CFM Final leakage after sealing all accessible leaks using smoke test = CFM Initial leakage - Final leakage = Leakage reduction CFM (Leakage reduction / Initial leakage ) x 100% = % Reduction Pass if % Reduction > 60% Pass Fail 4 Option 4 used then: All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). Pass if all accessible leaks have been sealed using Smoke Test Pass Fail 3 1200 1200 180 169 51800 Avenida Montazuma La Quinta CA 92253 La Quinta, City of 311-A0006716A-M2105145A-0000 07/24/2011 14:48:47 CBPCA 4 4 4 51800 Avenida Montazuma La Quinta CA 92253 La Quinta, City of Vic's Air Conditioning octaviano Victoria 756658 311-A0006716A-M2105145A-0000 07/24/2011 14:48:47 CBPCA octaviano Victoria 7/24/2011 4 4 4 4 4 INSTALLATION CERTIFICATE CF-6R-MECH-21-HERS Duct Leakage Test – Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency:Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. All supply and return register boots must be sealed to the drywall if smoke test is utilized for compliance – applies to duct leakage compliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible leaks) described above. New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts. Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections. DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF-1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF-1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Responsible Person's Name: Responsible Person's Signature: CSLB License: Date Signed: Position With Company (Title): Is this installation monitored by a Third Party Quality Control Program (TPQCP)? Yes No Name of TPQCP (if applicable):