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06-0927 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 06-000.0.0927 Property Address: 78007 LAGO DR . APN: 658-270-004-4 -3941 Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 0 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT' LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 License No.: 350493 4Date: �'�Gonttr'—a�cto_r-: OWNER -BUILDER EON 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 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 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.1. Lender's Name: _ Lender's Address: LQPERMIT Owner: OFARRELL THOMAS 78-007 LAGO DR LA QUINTA, CA 92253 Contractor: ROMAN'S HEATING & P.O. BOX 1849' INDIO, CA 92201 (760)347-6253 Lic. No.: 350493 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 cO14 RAR2 3 2006 OF LA Date: 3/23/06 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 0000438-2005 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 ecome subject to the workers' compensation provisions of Section �� 3700 of the Lab- Codill, I shall fortith comply wi provisions. 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 tha ab ve information is correct. I agree to comply with all city and county ordinances and state laws relatin o buildin construction, and hereby auth ' representatives of this county to ent r upon the above -mention property r inspectio urpos s. Signature -(Applicant or A ntl: �/ ` Application Number . . . . . 06-00000927 Permit . . . . MECHANICAL Additional desc . Permit Fee 55.00 Plan Check Fee 13.75 Issue Date . . . . Valuation 0 ' Expiration Date .. 9/19/06 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 11.0000 EA MECH FURNACE >100K 22.00 2.00 9.0000 EA MECH APPL REP/ALT/ADD 18.00 Special Notes and Comments REPLACE FURNACES & EVAPORATOR COILS FOR 2 SYSTEMS/CONT TO USE EXISTING 3 TON CONDENSERS. Fee summary Charged Paid Credited 'Due ----------- ---------- Permit Fee Total 55.00 .00 ---------- .00 55.00 Plan Check Total 13.75 .00 .00 13.75 Grand Total 68.75 .00 .00 68.15 LQPERMIT Bin # Pe�Rr, °i z Project Address: A. P. Number: Legal Description: Aaaress. e 5e City, ST, Zip: Telephone:'7&0 j 7� State Lic. # : © e/ Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Telephone # of Contact Person: `76 # Submittal Plan Sets Structural Calcs. Truss Cales. Energy Cales. Grading, plan Subcontactor List Grant Deed H.O:A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees 'd -I Recd City of. La Quinta Building u Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit. Application and Tracking Sheet Owner's Name: Address: Y- 41-7 City , ST, Zip: :C Telephone: Project Description: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Dem( Sq. FL: # Stories: # Units: Estimated Value of Project., 3 'LICANT: DO NOT WRITE BELOW THIS LINE TRACIONG , PERMIT FEES PIan.Ctieck submitted Item Amount Reviewed; ready for corrections Plan Check Deposit Called Contact Person Plan Check Balance Plans picked up Construction Plans resubmitted Mechanical 214 Review, ready for corrections/issue Electrical Called Contact Person Plumbing Plans picked up S.M.I. Plans resubmitted Grading Review, ready for correctionAiissue Developer Impact Fee Called .Contact Person A.LP.P. Date of permit issue Total Permit Fees / �: P . 2. �; ��e. ,���ed s C�PY U� ����a� noGl��� C�`'1 r I` ., MAR -10-2006 03:37P FROM:ROMANS HTG & AIR CON 7603475317 TO:3603074 P.2/5 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Paee I of 4) CF -JR U���/�/L �=G-1 ✓�c�c/idt=�1 cis 2 0- 2 6 a� Pro ecl Title Date d Ca Pro(�,A8ddr� � 11d� �� ,� Building Permit / D e Do77c�y/�men�taSUon Author Telephone �( Plmt Check /Dale 7 y C -Z / p T�--' 114-5 f }r— Field Check / trate Compliance Method (Prescriptive) Climate Zone EnforaementAgency Use Only ✓VdAlteniative Component Package Method: (check one) C V --,D _D (Alternative) Package C and Package D choices require HERS rater field verification and/or diagnostic testing (see CF -IR page 3) For Package D Alternative see Appendix B Table 151-C Footnotes 7-14 GENERAL INFORMATION 1-11 1 Total Conditioned Floor Area (CFA) 0a Avenge Ceiling Height: (�9 ft Maximum Allowed West Facing Fenestration Products Per Table 15I-13 or 151-C ---- (5% X CFA) ...... W Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C ---- (20% X CFA) ft- �/ ❑ Building Type: (check one or more)V--Single Family Multifamily Addition Alteration (Ifadding fenestration fill out WS=4R, Fenestration Maximum Allowed Area Worksheetand see Section 8.3.2 for Additions and 3.3 for Alterations.) Number of Stories:Numbe Dwelling Units: _.._ Floor Construction Type:Slab/ wised Floor (circle one or both) Front Orientation: North outh / East / West/ All Orientatinns (innur fmnt nrientntinn in derrreec frnm True North and circle one). ❑RADIANT BARRIER (required in climate zones 2.4. 8-15) OPAQUE SURFACES INCLUDING OPAQUE D0014S Component Type (Wall, Ruor, Floor, Slab Edge, Doors) Frame "type Cavity (Wood Insulation or Metal) R -Value Assembly U - factor (for Joint Roof Radiant Continuous tal Appendix ter Insulation frame and mass Installed R -Value assemblies t e erence or No Location/Comments (attic, garage, typical, etc. aee join(r+ppenaix iv to section W.2, I v.3 and I VA, which is the basis for the U -factor criterion. U -factors can not exceed prescriptive value to show equivalenceto R -values. CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION, DATE; 23-o ff Residential Compliance Forms March 2005 MAR -10-2006 03:38P FROM:ROMANS HTG 8 AIR CON 7603475317 TO:3603074 P.3/5 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 4) CF -1R Prujecl Title Date FENESTRATION PRODUCTS— U -FACTOR AND SHGC ✓ ❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS-4R—must be included for New Construction, Additions and Alterations. Fenestration Minimum Efficiency (AFUE or FISPF It/Type/Po Exterior (Front, Left,Shading/Overhangs' Rear, Right, tation, U -factor SHGC ✓ box if WS -311 is Sk li lit) N, S, E Wr (ft) ctor rcea SHGC° Sources included O 13 .3fty4151,,3 air, nvw nnauuCa nt west-racntg renestration area it the saytrgnts are cited to the west or tilted in any direction when the pitch is less (Ilan 1:12. See § 151(f)3C and in Section 3.2.3 of the Residential Manual 2) Enter values in this column are either NFRC Rated value or from Standards default Table 116A. 3) Indicate source either from NFRC or Table 116A, 4) Enter values in this column from NFRC or from Standards Default Table 1168 or adiusted SHGC from WS -311. 5) Indicate source either from NFRC or Table 116B. 6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS -311 to calculate Exterior Shading devices. 7) See Section 3.2.4 in the Residential Manual. f HVAC SYSTEMS Heating Equipment Type -and Capacity (Iurm! ,hear pum , hailer, etc. Minimum Efficiency (AFUE or FISPF Distribution Type and Location Duct or Piping Thermostat ducts, altic etc. R -Value T e Configuration (split or package) Cooling,quipment Minimum Type and ap c Duct Location Duct Thermostat Configuration (A/C, heat numo. evao cooling SUER ar l -T R -Value Type or acka e Residential Compliance Forms March 2005 MAR -10-2006 03:38P FROM:ROMANS HTG & AIR CON 7603475317 TO:3603074 P.4/5 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF -1R Project Title Date SEALED DUCTS and TXVs (ot• Alternative Measures) A signed CF -411 Form must be provided to the building department for each home for which the following. are mn u i rPrl ❑Alternative to Sealed Ducts and Refrigerant Charge /TX Vs (See Package D Alternative Package Features for Proiect Climate Zone in the RMAppendix B Table 151-C, Footnotes 7-14. For additions and alterations. duct systems that are not documented to have been previously ❑ sealed as confirnted through field verification and diagnostic testing in accordance with procedures in the Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D. WATER 14F.ATTNr_ CVCTRMC Check box ifsystem meets criteria of a "Standal•O" system. Standard system is one gas -Fred waterheater per ❑ Sealed Ducts all climate zones) Installer testing and certification and HERS rater field verification required.) ❑ TXVs, readily accessible (climate zones 2 and 8, IS only) 0 (Installer testing and certification and HERS Rater field verification required.) 13 Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field verificatiun required.) ❑Alternative to Sealed Ducts and Refrigerant Charge /TX Vs (See Package D Alternative Package Features for Proiect Climate Zone in the RMAppendix B Table 151-C, Footnotes 7-14. For additions and alterations. duct systems that are not documented to have been previously ❑ sealed as confirnted through field verification and diagnostic testing in accordance with procedures in the Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D. WATER 14F.ATTNr_ CVCTRMC Water Heater LITIL4 "1111" Distribution Number T I in Svsten SvQfem adr-vinn. niu 11-1. rlv.nll:.. Rated Z Energy Inptltl Tank Factor' or r�Cw r Capacity I Thermnl Tank External Standby' insulation Loss ('%) 1 R -Value Water Heater e Check box ifsystem meets criteria of a "Standal•O" system. Standard system is one gas -Fred waterheater per ❑ welling unit. I f the water Neater is a storage type, 50 gallons is the maximum capacity and recirculation sys is Tank External InsulationT R -Value no (lowed. 0 Check x when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Idential Manual. water heating calculations are required, and the system complies automatically. Check box if s em does not meet criteria of "S(andard" system, and does not comply with a Preapproved ❑ Alte--native Water ling table. In this case, the Performance Method must be used a must be included in the submittal. O Check box to verify that a ill control is required for a recirculating system pu fol• a system serving multiple -�-- units - ----- - . Water Heater LITIL4 "1111" Distribution Number T I in Svsten SvQfem adr-vinn. niu 11-1. rlv.nll:.. Rated Z Energy Inptltl Tank Factor' or r�Cw r Capacity I Thermnl Tank External Standby' insulation Loss ('%) 1 R -Value Water Heater e Dis ution T ein Rated Ener Input' Tank Factor' or Number (kw or Capacity Thermal S stem BtuAlr (nllons Efficient [�Sta by' s Tank External InsulationT R -Value /*�er ...r..•" ., waa u.mr vi cqutu w rj,vvv Dtu/nr), electric resistance, ana neat uheaters, list Energy Factor. Fol• large gas storage water heaters (rated input of greater than 75,000 tRated Input, Recovery Efficiency, Thermal Efi iciency and Standby Loss. For instantaneous gas water , Rated Input and Thermal Efficiencids. New su ltltiolt (kitchen livres >_ 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are % 2idlntial or greater in diameter shall be thermally insulated as specified by Section 150 (i) 2 A or 150 6) 2 B. Compliance Forms March 2005 14 MAR -10-2006 03:39P FROM:ROMANS HTG & AIR CON 7603475317 TO:3603074 P.5/5 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 4 of 4) CF -IR Project Title Date SPECIAL FEATURES NOT REQUIRING HERS VERIFICATION (add extra sheets if necessary dicate which special features are part of this project. The list below only represents special features relevant to the pre. riolive method. ✓ 1 Fea`htre Required Forms if a licable Descri mtioti ❑ 1 Metal Nnied Walls CF -IR 13 1 Radiant Ba -Jets CF -IR O Exterior Shades, WS -4R ❑ Cool Roof N/A; Attnclm CRRC Label to Forms. ❑ Dedicated Hydronic lien ' Performance Calculation System Required; Attach Run to Forms. ❑ Combined Hydronic System Performance Calculation uired; Attach Run to Forms. ❑ Gns Cooling Per mance Calculation Re uir ❑ Buried Ducts N/A; Indicm on buildin ans. O Kitchen Pipe Insulation See Section 5. Dis ution Systems in ResideXial Manual. Multiple Water Heaters Per See Table 5-1)4 use [3 DwellingUnit Perfonnan Calculation m d attach n to Forums. O Central Water Heating System Perf nance Calculation and Serving Multiple Dwellings QRach Run to Forms. ❑ Non-NAECA Large Water Heater CF -IR See Table 5-13 or use ❑ Indirect Water Heater Performance Calculation and attach Run to Forms See Table 5-13 or use Instantaneous as Water Heater Performance Calculation and attach Run to Forms See Table 5.13 or use O Sola • ater Heating System Performance Calculation and attach Run to Forms ❑ Wood Stove Boiler Performance Calculation and attach Run to Forms SPECIAL FEATURES REOURUNG HERS RATER VERIFICATION (add extra sheets of necessary Indicate to the HERS Rater which credits are part of this project and need Feature Re uired Forms if a ' licable Description Duct Sealing CF -611 mart 4 of 12 D Refrigerant Charge CF -611 part 5 of 12 ❑ Thermostatic Expansion Valve CF -611 part 6 of 12 Residential Compliance Forms March 2005 02 INSTALLATION CERTIFICATE a (� n5 (Page 4 of 12) CF -6R Site ddress -o& Permit Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT The building was: ✓ OTested at Final ✓ O Tested at Rough -in II$.STALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: pEL-Remove at least one supply and one return register, and verify that the spaces between the register boot and the interior finishing wall are properly sealed. O If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points between the air handler and the supply and return plenums to verify that the connection points are properly sealed. O Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used VO.DUCT LEAKAGE REDUCTION Procedures for Teld verification and diagnostic testitte of air distribution systems are available in RACM. Annendix RC4.3 NEW CONSTRUCTION: ' Access is provided for inspection. The procedure shall consist of visual Duct Pressurization Test Results (CFM @ 25 Pa) Measured: Yes ❑ No verification that the TXV is installed on the system and installation of the Values I Enter Tested Leakage Flow in CFM: Fail t Fan Flow: Calculated (Nominal: Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21.7 cfm/(kBtu/hr) x Heating I'Z 0 Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here: ✓ ✓ 3 Pass if Leakage Percentage_5 6% for Final or:5 4% at Rough -in: ❑Pass ❑Fail 100 x Line # 1 / ine # 2 ALTERATIONS: Duct System and/or HVAC Equipment Change -Out Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct 4 System Alteration and/or Equipment Change -Out. Y Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct 5 System for Duct System Alteration and/or Equipment Chan a -Out. Enter Reduction in Leakage for Altered Duct System t 6 fLine # 4 Minus Line # 5 —(Only if Ap2livable 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ $ Entire New Duct System - Pass if Leakage Percentage 5 6% for Final or :5 4% at Rough -in ❑ 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 Verification Standards for compliance: if Leakage Percentage:5 15% [100 x [_(Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail r12Pass Pass if Leakage to Outside Percentage :5 10% [100 x L_(Line # 7) / (Line # 2)]] ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage >— 60% [100 x [—(Line # 6) / - (Line # 4)]] ❑Pass ❑Fail and Verification b Smoke Test and Visual tns ection Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ass ❑ Fail Pass if One of Lines # 9 through # 12 pass ass ❑ Fail ✓THERMOSTATIC EXPANSION VALVE (TXV) Procedures for field verification of thermostatic expansion valves are available in RACM, Appendix R1.. ✓ ✓ ✓ ' Access is provided for inspection. The procedure shall consist of visual Signaturer ✓ Yes ❑ No verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass Pass Fail 01, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for compliance credit. 1, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply with Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency standards. Installing Subcontractor (Co. Name) OR General Contractor ame) OR Owner LlA) /� IVY� � _ 1� N Signaturer Date: oZ� �G I INSTALLATION CERTIFICATE -(� ni L,S �1— (Page 4 of 12) CF -6R Site Address _ Permit Number 78 -�) (o7 4110- U k) 1?. ;A0 ulNo -'ZZV INSTALLER COMPLIANCIt STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT The building was: ✓ ❑Tested at Final ✓ ❑ Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: Remove at least one supply and one return register, and verify that the spaces between the register boot and the interior finishing wall are properly sealed. ❑ If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points between the air handler and the supply and return plenums to verify that the connection points are properly sealed. ❑ Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used AtODUCT LEAKAGE REDUCTION Prnrodura_c fnr field veri/icatinn and diagnostic testing of air distribution systetns are available in RACM. ADDendix RC4.3 NEW CONSTRUCTION: -L- _ Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values' � •,, : `'.�x� � ` «:n; 1 Enter Tested Leakage Flow in CFM: { __ Fan Flow: Calculated (Nominal: ✓ oling ✓ ❑ Heating) or ✓ ❑ Measured as 21.7 Heating % Z D 6 2 If Fan Flow is Calculated 400 cfm/ton x number of tons or as cfm/(kBtu/hr) x Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here: , ✓ ✓ 3 Pass if Leakage Percentages 6% for Final or:5 4% at Rough -in: ❑ Pass ❑ Fail 100 x Line # 1 /_(Line # 2)11 ALTERATIONS: Duct System and/or HVAC Equipment Change -Out g Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct 4System Alteration and/or Equipment Change -Out. Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct ' 5 System for Duct System Alteration and/or Equipment Chan a -Out. Enter Reduction in Leakage for Altered Duct System 6 Line # 4 Minus Line # 5 —(Only if Applicable) {'k" 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage 5 6% for Final or:5 4% at Rough -in ❑ Pass ❑ Fail $ f 100 xL_(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 Verification Standards for compliance: 9 Pass if Leakage Percentage <15% [100 x [_(Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage:— 10% [100 x L_(Line # 7) / (Line # 2)]] ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage >: 60% [100 x L_(Line # 6) ! (Line # 4)]] ❑ Pass ❑ Fail i l and Verification by Smoke Test and Visual Inspection 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection -v " Pass ❑ Fail Pass if One of Lines # 9 throw h # 12 pass '•. x. : * Pass ❑ Fail RMOSTATIC EXPANSION VALVE (TXV) Pro duresforfieldd verification of thermostatic expansion valves are available in RACM, Appendix R!. ✓ ✓ Access is provided for inspection. The procedure shall consist of visual ✓ ❑ Yes ❑ No verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass Pass Fail ✓ 01, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for compliance credit. 1, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply with Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency standards. Installing Subcontractor (Co. Name) OR General -L- Contr (Co. Na e) OR O wMw ^1 /t Si a Date: `� OW -2 INSTALLATION CERTIFICATE (Page 3 of 12) 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) After. completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at occupancy, per Section 10-103(a). HVAC SYSTEMS: Heating Equipment Equip Type (pkg. heat um) CEC Certified Mfr. m Nae and Model Number # of Identical Systems Efficiency (AFUEt , etc.) 2CF-1 R value) Duct Location attic, etc. Duct or Piping R -value . Heating Load tu/hr(Btu/hr) Heating Capacity IU2.IIIJU- z?n1 C 2 �� ,� - -z f 170 Cooling Equipment Equip Type (pkg. heat um CEC Certified Mfr. Name and Model Number _ # of Identical Systems Efficiency� (SEER or EER) 2,CF-1R value) Duct Location attic etc. Duct R -value Cooling Load tu/hr Cooling Capacity tuft) 1. > symbol reads greater than or equal to what is indicated on the CF -1R value. Include both SEER and EER if compliance credit for high EER'air conditioner is claimed ✓I, F(the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or more a cient 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. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Own r , Si Date: Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY ►+ V`/..' �.v..%ice � a Residential Compliance Forms April 2005 0