BRES2016-036978-495 CALLE TAMPICOU VOICE (760) 777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 12/23/2016
Application Number: BRES2016-0369 Owner:
Property Address: 81020 GOLF VIEW DR CORY MCCULLOCH
APN: 762280031
Property Zoning:
Application Valuation: $32,000.00
Applicant: 0 a Contractor:
ALL DAY HEATING & COOLING INC D ALL DAY HEATING & COOLING INC
82=578 PISA LANE 2 3 2016 82-578 PISA LANE
INDIO, CA 92203 DEC INDIO, CA 92203
CITY pF �,QUINT�EpARTMENT (760)834-1064
pESIGN AND
DEVEI.�pMENT Llc. No.: 1008011
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Busines and Professions Code, and
my License is in full force and effect.
Liceen�n`se,Class: C20 License No.: 100088011
De: 23 I L Contractor:
V
OWNER -BUILDER DECLARATIO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any
structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions_of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the
alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_) 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.).
(_) 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.).
(_) I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's
Lender's Address:
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 Jhg work for which this permit is issued.
wave 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: NORGUARD INSURANCE COMPANY Policy Number: ALWC784110
_ 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 shouldbecome subject to the
workers' compensation provisions of Section 37 0 of the or ode, I shall forthwith
comply with those provisions.
11112e:! %Zt25 t C� 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 ($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 Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit issued
as a result of this application , the owner, and the applicant, each agrees to, and shall
defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not
commenced within 180 days from date of issuance of such permit, or cessation of work
for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances ands to laws rel in building
construction, and hereby authorize representatives of this ty to en te 'the above-
mentioned property for inspection ppurposes.
: k Signature (Applicant or Agent):
I
Date: 12/23/2016
Application Number: BRES2016-0369 Owner:
Property Address: 81020 GOLF VIEW DR CORY MCCULLOCH
APN: 762280031
Property Zoning:
Application Valuation: $32;000.00
Applicant: Contractor:
ALL DAY HEATING & COOLING INC ALL DAY HEATING & COOLING INC
82-578 PISA LANE 82-578 PISA LANE
INDIO, CA 92203 INDIO, CA 92203
(760)834-1064
Llc. No.: 1008011
-.------------------------------------------------------------------------------------------
Detail: HVAC CHANGE OUT - 4 SPLIT SYSTEM HVAC UNITL 16EER/80AFUE, 1 TANKLESS WATER HEATER [2013 ENERGY] CARBON MONOXIDE ALARM(S)
TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES.
0
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR
101-0000-42402
0
$152.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR PC
101-0000-42600
0
$101.32
Total Paid for MECHANICAL: $253.32
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER CHANGEOUT
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER CHANGEOUT PC
101-0000-42600
0
$7.60
Total Paid for PLUMBING FEES: $20.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$4.16
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $4.16
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
G'
Bin
Qty of La Qu«nta
Building 8£ Safety Division
Permit # 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Project Address: 1 — v t� ��, .� wner's Name:
A. P. Number:
Address: G oL—:p
Legal Description:
Contractor: >L�
City, ST, Zip: Z
Tel h n
G T O e o e:
C P
Address: �Z .5
Project Description:
City_ ST, Zip:��7
O 3
Tele6
P hn e: �—1 a G
z
State Lic. # : (L(c� 'F—Cj i
Arch.,'Engr., Designer:
City Lie. #.. �J
Address:
tS
City, ST, Zip:
Telephone:
one:
a to ,.
St Lie. i�.
L •
Name of Contact Person:
tru ane
Cons c t ion TY Occupancy:
P O P Y=
Pr Ject type circle one): New Add'n Alter Repair Demo.
Sq. Ft.:#Stories: #Units:
Telephone # of Contact Person:
stimated Value of Project: a' pC_,--)cD
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
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 corrcctions/issue
Electrical .
SubcontactorList
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IlY ROUSE:-
Jrd Reyiew, 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
.N
CERTIFICATE OF COMPLIANCE
CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 4 )
Project Name: 81-020 Golf View Drive I Date Prepared: 2016-12-19
A. General Information
CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
use one CF1R-ALT-02 document for each dwelling unit.
O3
Project Name
81-020 Golf View Drive
02
Date Prepared
2016-12-19
03
Project Location
81-020 Golf View Drive
04
Building Type -
Single family
05
CA City
La Quinta
06
Dwelling Unit Name
81-020 Golf View Drive
07
Zip Code
92253
08
Dwelling Unit Conditioned
3400
nstallirig I
I stalli g
`Installing
Floor Area (ft2)
Location or Area
by this SC
`ducted
containing M
fs 16
system
Number of space conditioning
enn ely w
09
Climate Zone
15
10
(SC) systems in this dwelling
4
component?
components?
feet of ducts?
duct system?
unit.
Alteration Type
B. Space Conditioning (SC) System Information
01
02
03
04.*�
05�
1 706 1 �N
1 1 07 )� W
08)
`� 09
10
Is the SC"""
Installin a
1l
SC System
SC System
CFA served
system a
re rf iger nt 4
Installing new SC
nstallirig I
I stalli g
`Installing
Identification or
Location or Area
by this SC
`ducted
containing M
fs 16
system
more than 40
enn ely w
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
kitchen
1200
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 2
guest bedrooms
900
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 3
master bedroom
900
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 4
casita room
400
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
Registration Number: 216-A0467098A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-12-19 09:02:27
Report Version: 2013 Rev 1.008
Schema Version: 0.555SDD
HERS Provider: Ca10ERTS
Report Generated: 2016-12-19 07:42:48
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 4 )
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
This section does not apply to this project.
D. Altered Space Conditioning System (Sections 150.2(b)lE and F)
01
02
03
04
05
06
07
08
09
10
11
12
Heating
Cooling
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Central gas
All new
Central split
All new
This field or
This field or
System 1
furnace
heating
AFUE
80
AC
cooling
SEER
16
Setback
section is not
section is not
components
components
applicable
applicable
Central gas
All new
Central split
All new
This field or
This field or
System 2
furnace
heating
AFUE
80
AC
cooling
SEER
16
Setback
section is not
section is not
components
;components'-
applicable
applicable
3
Central gas
All new
heating
AFUE
f
I
80
',1 1 € .1
^Central splitSystem
�y `-
LAII�new\►.
iEER
f
tsil
i 16
Setback
This field or
section is not
This field or
section is not
furnace
+--
.
components
components`.:•L
applicable
applicable
Central gas
All new
: !
All new
°'"
This field or
This field or
System 4
furnace
heating
AFUE
80Central_split
AC
cooling
SEER
16
Setback
section is not
section is not
components
components
I
applicable
applicable
Reouired Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF311-MCH-20-H — Duct Leakage testing required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance:!g 15%, or:5 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow 2 300 CFM/ton required when MCH -25 is required.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
Registration Number: 216-A0467098A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-12-19 09:02:27
Report Version: 2013 Rev 1.008
Schema Version: 0.555SDD
HERS Provider: CalCERTS
Report Generated: 2016-12-19 07:42:48
A. . .y
r \4
W,
CERTIFICATE OF COMPLIANCE CUR -ALT -024
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 3 of 4 )
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)iDiia and 150.2(b)1E, F)
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
. Registration Number: 216-A046709BA-000000000-0000
C ao CERTS, nc.
HERS PROi1I DER
Registration Date/Time: 2016-12-19 09:02:27
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-12-19 07:42:48
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 4 of 4
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
SANCHEZ, MIGUEL
Company:
Signature Date:
MIGUEL SANCHEZ
2016-12-19 07:42:04
Address:
CEA/ HERS Certification Identification (if applicable):
83947 Moonlit Drive
City/State/Zip:
Phone:
Coachella CA 92236
760-834-1064
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or, system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations 11 i .I k ,,,,
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the Information provided on other applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval'with this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building Permits) issued for..the building; and made available to the—enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: `+� : I tf. . r A w 7
Responsible Designer Signature: V 0 � j��� 9-N
Sanchez, Miguel
Company:
Date Signed:
ALL DAY HEATING & COOLING INC
2016-12-19 09:02:27
Address:
License:
82-578 PISA LANE
1008011
City/State/Zip: '
Phone:
INDIO CA 92203
760-834-1064 X123
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 216-A0467098A-000000000-0000
Registration Date/Time: 2016-12-19 09:02:27
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-12-19 07:42:48
Schema Version: 0.555SDD
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS — WATER HEATER
CEC-CFIR-ALT-01-E (Revised 06114) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E WATER HEATER
Prescriptive Residential Alterations for Water Heater (Page 1 of 2)
A. GENERAL INFORMATION
Site address: 8 t _
Building Type: Single Family Dwelling
❑ Multi Family Dwellings
City, Zip Code: ONTARIO, CA
Climate Zone: 10
G. WATER HEATING SYSTEMS Section 150.2 b 1G
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
Water
Water
Water
# of
Water
Fuel
Rated
Rated
Heating
Heating
Standby
Exterior
Back -Up
Central
Dwelling
Heating
Heating
Heater
Water
Heater
Type
Input
Input
Efficiency
Efficiency
Loss (%)
Insul.
Solar
DHW System
Unit DHW
System
System
Type
Heaters
Storage
Type
Value
Type
Value
R -Value
Savings
Distribution
System
Identification
Type
in
Volume
Fraction
Type
Distribution
or
system
(gal)
Type
Name
pJa Q I o,.--)
T�1 C1
o,,k
(
t3 (a
�C�.S
`�'J
I kkK 10
CaL o'fo
fJ l
V 4
N A
1
Ernck,
WATER HEATING SYSTEMS
Water heating compliance for an alteration is described in Section 150.2(b)1G. For single dwelling a gas or propane water heater, with a storage tank of 60 gallons maximum
or instantaneous (tarikless) can be used. Dwelling Unit distribution systems are limited to Standard trunk and branch or demand recirculation for gas or propane water
heater. Demand recirculation is not allowed for electric water heater. If there is no natural gas connected to the building, an electric water heater may be replaced with
another electric water heater. However, changing from gas to electric is not allowed. Multi -family central systems must use certified equipment as defined under Section
110.1 and 110.3.
NOTE: If the proposed installation does not meet the requirements allowed specifically for alterations, use form CFIR-NCB-01 to document the water heater alteration.
Instructions for sections with column numbers are given below:
1. Water Heating System Identification or Name: enter a unique name for the Water Heating System.
2. Water heating system type: Domestic Hot Water (DHW), Hydronic, Combined Hydronic, or Central. DHW is for domestic hot water, hydronic is a water heating
system used for space heating only; combined hydronic are when the water heater will provide both space conditioning and domestic hot water.
3. Water heater type: For non -central systems only Small Storage or Small Instantaneous are allowed. For central systems pick from Large Storage, Small Storage,
Heat Pump, Boiler, Large Instantaneous, Small Instantaneous or Indirect.
CERTIFICATE OF COMPLIANCE C11`111 -ALT -01-E WATER HEATER
Prescriptive Residential Alterations for Water Heater (Page 2 of 2)
4. Number of water heaters in system: In single-family and multi -family with water heaters in each dwelling units the value is 1. For multi -family central systems
serving multiple dwelling units enter the total number of water heaters.
5. Water heater volume (gal): tank capacity in gallons. For individual water heaters for a dwelling unit this will be 60 gallons or less. If instantaneous, enter n/a. For
multi -family central systems enter the total storage volume.
6. Fuel Type: Gas, Propane, Electric (Only if natural gas is not available)
7. Rated Input Type: Enter the equipment input rating type, for gas or propane fired units are Btuh, for electric fired system the units are kW.
8. Rated Input Value: Enter the numeric value of rated input.
9. Heating Efficiency Type: Energy Factor, AFUE, or Thermal Efficiency. From product literature ora California Energy Commission directory.
10. Heating Efficiency Value: Enter the value from product literature or a California Energy Commission directory
11. Standby Loss (percent): Applies only to large storage water heaters, Enter n/a for small storage or instantaneous water heaters.
12. Exterior Insulation R -Value: Enter the R -value if exterior insulation on the storage tank is installed
13. Back-up solar savings fraction: If compliance requires a back-up solar system, indicate the solar contribution (e.g., 0.30). External calculations are required.
14. Central DHW Distribution System: For multi -family buildings with using a central distribution system a demand recirculation system with at least two distribution
loops must be installed. This requirement applies to any building with eight or more units. If the system is non -central or project is individual units enter n/a.
15. Dwelling Unit DHW Distribution Type: For a Central DHW this field shall be Standard. If non -central then pick from Standard, Demand Recirculation — Manual
Control, Demand Recirculation — Sensor Control. If non -central electric water heater this must be Standard, no recirculation system shall be installed.
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name: ❑Owner . ❑ Authorized agent -4ontractor
Signature:
Company
Contractor license #: %=,O
t�� t
Address: � Z_S
Phone:
City/State/Zip: .
Date:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
r-
STATE Old CAL�,-ORNIA
ALTERATIONS - HVAC
L2t
CEC-CFIR-ALT-04-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1)
Site Address://
61.
Enforcement Agency:
Date Prepared:.
Permit#:
,23 (_o'.).,o — T_- v< <-'v
Equipment Type
Equipment Efficiency
New Ducting, Plenums, Lineset:
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
❑ Evaporator Coil
AFUE
COP
❑ R-6 (CZ 8-13) Ducting
1,
Served by system
❑ Setback
❑ Split System
❑ Condensing Unit
❑ R-8' (CZ 11, 14, 15) Ducting
3 0tv, sgft
(if not already
P Mini Split
❑ Compressor
) 9j SEER
HSPF
❑ R-6 (all CZ's) Plenums
present must
❑ Furnace
❑ Lineset
EER
❑ R-5 or R7.5) Lineset'
be installed)
❑ TXV
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the.options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
,'1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CF111-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)2 -HERS, MECH-25-HERS2
Compressor, TXV, Lineset,
CF3R: MECH-20-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2
Air Handler/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage (< 15%, or < 10% to outside, or seal all accessible leaks), Air Flow 2 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building
❑ 2. New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' CFIR-ALT-02-E
including Mini Split CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS2
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2
Mini Splits require CFIR-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow 2 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts' and one or more of the following CF1R-ALT-02-E
replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Compressor, TXV, Lineset, Furnace2 CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts' I CF111-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS
Installer Required to: Duct leakage (!S_15% or, < 30% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
'All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc.
2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25
3 All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots,.air handler, coil, plenums, duct material)
° R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%", 2.5-3T-2%", 3.S to 4T-2%", 5T-4%."
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division.3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit applic tion.
Responsible Designer Name:
Responsible De er Sign u e:Dat
Signed:
License:
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Company:
Address:
City/State/Zip:
P ne:
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For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300