09-0994 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
0.9100000.9 94
Property Address:
79145 BIG HORN DR
APN:
772-030-012-19 -25429 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
8182
Applicant'
T,i-t(t 1 4 4Q"
Architect or Engineer:
A/J,%y%%_
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 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License CI ss: C20 License No.: 489046
5 S v ,�-
te:^+ ♦�C ntractOr:
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 ISec. 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.).
1 _ I I am exempt under Sec. , B.AP.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
n
Owner:
WOODCOX KEITH
79145 BIG HORN
LA QUINTA, CA
(
TRAIL
92253
Contractor:
ESSER AIR CONDITION
P.O. BOX 1636
CATHEDRAL CITY, CA
(760)324-0550
Lic. No.: 489046
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/16/09
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 1891568-2009
_ 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
�1 19to3I7700 of the Labor Code, I shallfoirthwthcompllywiith those provisions.
Date: ! A`pplicant:'^.! AJ
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 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 i tion is correct. I agree to comply with all
city and cou ty ordinances and state laws relating to buildin nstruction and I reby authorize represen Lives
of this coun to nter upon the above-mentioned propert or inspectio ur
O1 �
Date L L� L C )Signature (AFplicant-or-Agent) i
Application Number . . . . . 09-00000994
Permit . . . MECHANICAL
Additional desc .
Permit Fee 33.00 Plan Check Fee
8.25
Issue Date . . . . Valuation . . .
. 0
Expiration Date 3/15/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1.00 9.0000 EA MECH B/C <=3HP/100K BTU
9.00
-----------------------------------------------------------------------------
Special Notes and Comments
REPLCAE EXISTING A/C & .HEATING SYSTEM
WITH NEW 15 SEER SYSTEM. 5 TON SPLIT
SYSTEM.
----------------------------------------------------------------------------
Other.Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
---------------------
Due
-------------------------------------
Permit Fee Total 33.00 .00 .00
33.00
Plan Check Total 8.25 .00 .00
8.25
Other Fee Total 1.00 .00 .00
1.00
Grand Total 42.25 .00 .00
42.25
LQPEfN11T
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 5) CF -IR '
Project Title Qate
FENESTRATION PRODUCTS — U -FACTOR AND SHGC
❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WSAR — must be included for New
-Construction, Additions, and Alterations.
Fenestration
#nype/Pos..(Front, Orien-
Left, Rear, Right, talion, Area U -factor
Skylight N, S, E W� fiz U-factorz Source SHGC°
Exterior
Shading/Overhangs 6• I
SHGC box if WS -3R is
Sources included
Distribution
Type and Location ' Duct or Piping Thermostat Configuration
ducts, attic, etc. ` R -Value T lit or. e
13
13
V b L? L/
13
El
C LA ') U
t7J. P
❑.
1) Skylights are now included in West -facing fenestration area if the skylights are tilted to the west or tilted in any direction when
the pitch is less than 1:12. See § 1.51(f)3C and in Section 3.2.3 of the Residential Manual.
2) Enter values in this column from either NERC Certified Label or from Standards Default Table 116-A.
3) Indicate source either from NFRC or Table 116-A,
4) Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from WS -3R-
5) Indicate source either from NFRC, Table 1168 or WS -3R
6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS -3R to calculate Exterior.Shading devices.
7) See Section 3.2.4 in the Residential Manual.
HVAC SYSTEMS
IS s SAM
Heating Equipment Minimum Distribution
Type and Capacity Efficiency -Type and Location Duct or. Piping Thermostat . Configuration
(furnace, heat Duma, boiler. etc.) (AFUE or HSPF) (duets. attic. etc.l R -Value Type (split or l ac kage)____ _
Cooling Equipment
Type and Capacity
(A1C, heat pump, evap.
cooling)
Minimum
Efficiency
(SEER or
EER)
Distribution
Type and Location ' Duct or Piping Thermostat Configuration
ducts, attic, etc. ` R -Value T lit or. e
V b L? L/
C LA ') U
t7J. P
Residential Compliance Forms December 2005
CERTIFICATE OF COMPLIANCE: { SIDENTIAL
' (Page 4 of S) CF -1
Project 77(lev p�D CC, - Date o
9
•
SPECIAL FEATURES REOUIItING BUILDING OFFICAL or HERS RATER VERMCATIO-N
Indicate which special features are parts of this project. The list below only represents special features relevant to the prescriptive method.
deck Appficable boxes)
❑
Building Official
-
HERS Rater
High EF for existing water heaters
Verification of
HERS Rater
Diagnostic
❑
Category
Special Features
Verification
Testing
Measure
Ducts
Y
Air conttitioner size
❑
�` z _ - _
100% of duds in crawlspace/basement
❑
- - =
Y
Buried duds
❑
zF
Y-
Diagnostic supply ppb! dud location, surface area, and R -value
❑
y
Dud increased R -value
t'':` _ -
Y Dud leakage
Y
Duds in attic with radiant barriers
❑_
_4
3s
Y
Less than 12 ft. of dud outside conditioned space
❑
,r
r
-Non-standard
Y
dud location
Zonal control
Water Heater
SupPly registers within two ft of floor
Enyelope
❑
�_b -
3�_>».�
pig—
Air retarding wrap
Cool roof
_=Exterior
shades
❑
,3;a -__x Rte`
*-
High thermal mass
❑Y
F# ="'_,`
Inter -zone ventilation
❑
_ `mom =
Metal framed walls
❑
<f:;
Non -default vent heights
❑:
_
`- .,;
-'
Quality insulation installation
Radiant barrier
❑'`
``
Y 'Reduced infiltration (blower door). May also require mechanical ventilation.
❑
��"�'i�:-'�—_ tom.
Solar gain targeting (for sunspaces)
❑
`.��" -„fie
q ?
Sunspace with interzone surfaces
❑
yY`--=
Combined hydronic
vent area greater than 10%
High EF for existing water heaters
❑
-" `=u
HVAC Equipment
❑
Y =.
`--
❑
- a x:
' - iC ' V. '.
Y Adequate airflow
❑,__:
Y
Air conttitioner size
❑—
--Air-handler fan -- -- --- - _
_---
Y
High EER
❑
`
i:;Z'Y:':y
Hydronic heating systems
Y
Mechanical ventilation
Y Refrigerant charge
El
Thermostatic expansion valve (TXV)
Zonal control
Water Heater
❑
yY`--=
Combined hydronic
❑
High EF for existing water heaters
❑
-" `=u
Non-NAECA water heater
❑
Y =.
`--
Non-standard water heaters (wh/unit) .
❑
' - iC ' V. '.
Water heater distribution credits
Residential Compliance Forms December 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL, (P
Project Title Date
Special Remarks
�1
5 of 5) CF -IR
`1 /d/a.0
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and specifications needed to comply with Title 24,
Parts 1 and '6 of the California Code of Regulations, and the administrative, regulations to `implement them. This
certificate has been signed by the individual with overall design responsibility. The undersigned recognizes that
compliance using duct design, duct sealing,.yerificatioa of refrigerant charge and TXVs, insulation installation
quality, and .building envelope sealing require installer testing and certification.and field verification by an
approved ITERS rater.
)esigner or Owner
Business and. Professions Code).. Documentation Author
Name:
Naive:
Title(Fitm:
TitWFirm:
ESSER S
Address:
Address:
36665 BANRSIDE DR SUITE
CATHEDRAL CITY, CA.
Telephone:'
Telephone:
License #:
License #: (if applicable)
489046
d
(signature)
(date)(s _ we)
Enforcement Agency
Residential Compliance Forms December 2005
Bin #
City Of La Quinta
Building 8z Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: i
� � 1 G j'{i�:1�t.�'
Owner's Name: v' k� i f' �r�t�•� (;�
A. P. Number:
Address: q(p'
Legal Description:
,Q�tj
l.�Cl q qzt*I,-
City, ST, Zip: A ,1 fA , `j( ` 62 5-3
n t
Contractor: or: ESSER SERVICES INC,
�;;,;,,:::.,.;,;>.t.,;:;:,.;.:,
Address:36665 BANKSIDE DR STE C
Project Description:
City, ST, Zip: CATHEDRAL CITY CA 92235
r
�,L&t>
Telephone760 324 0550:
..........................................:..........
� 5'1'E►K I�i�(N I�E� - ! ��>")tr � 5 -
State
State Lie. #: 489046
CityLic.#.: 264
3roFl• f -rD rJ 5 1
Arch., Engr., Designer:.
Address:
City., ST, Zip:
Te h le o ne:
P .....:::.:... •.......;.......:
State Lie. 'c. #:
S
Construction Type: Occupancy:
Project type (circle one). New Add n Alter Repair Demo
Name of Contact Person:
Sq. FL:
# Stories::
Units:
Telephone # of Contact Person:
n#
Estimated Value of Project: "t "6 C6(�
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACEING PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
dumbing —
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Reyiew,.ready for correctionstiissue
.Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 of 2) CF -4R
Project Address I Woodcox, Keith ]
79-145 Big Horn Trail / La Quinta / CA / 92253
Duct Pressurization Test Results (CFM @ 25 Pa) C f }
Builder / Installer
Esser A/C
Builder / Installer Contact
Tim Esser
Telephone
7603240550
Plan Number / Permit Nher
HERS Rater
Dave Bricker - CJHJEJEJRJS® ID #CC 99380828
Telephone
7605419025
Sample Group Number
10
Compliance Method (Prescri c
2000
Climate Zone 15
Certifying Signature
_ U Date
v
Sample House Number
Firm
Energy Driven Solutions Inc.
ALTERATIONS: Duct System and/or HVAC Equipment Change -Out j j
HERS Provider
CJHJEJEJRJS®
FAddress
.O. Box 6705
City/State/Zip
La Quinta /CA /92248
Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT
HERS RATER COMPLIANCE STATEMENT
This house was: ✓ Tested
As the HERS rater providing diagnostic testing and field veri
tested compliance requirements as checked on this form. The
correct tape is used before a CF -4R may be released on every
and signed CF -6R has been received for the sample and t)te
✓ The installer has provided a copy of CF -6R (Installation Cef
❑ New Ducts are fully ducted (i.e., does not -use b wilding ccaviti
❑ New ducts with cloth backed, rubber adhesive duct tape sin
adhesive duct tape to seal leaks at duct connections �}
✓ MINIMUM
FOR
the house identified on this form complies with the diagnostic
ck and verify that the new distribution system is fully ducted and
HERS rater must not release the CF -4R until a properly competed
in lieu of ducts).
in combination with cloth backed; rubber
Procedures for field verification and diagnostic.te`ingof airidistributio� n systems fre" available in RACM Appendix RC4.3.
Duct Diagnostic Leakage Testing Results
System # 1
NEW CONSTRUCTION:
Duct Pressurization Test Results (CFM @ 25 Pa) C f }
Measured Values
I
1
Enter Tested Leakage Flow in CFM
2
Fan Flow: Calculated (Nominal: ✓ Cooling ❑ Heating Measured)- �%
Enter Total Fan Flow in CFM: t �
2000
3
Pass if Leakage Percentage < 6% [ 100 x [ Line #I / Line #2 ] ]
_
❑ Pass ❑ Fail
ALTERATIONS: Duct System and/or HVAC Equipment Change -Out j j
4 Enter Tested Leakage Flow in CFM front CF -6R: Pre -Test of ExistingDucfSystem Prior -to -Duct
System Alteration and/or Equipment Change -Out.
5 Enter Tested LeakageFFlow in CFM: Final Test -of New Duct System or Altered Duc$ System for"Duct! 296
System Alteration and/or Equipment Change -Out.
6 Enter Reduction in Leakage-for'Altered Duct System [ Line -#4 -Minus Line-#5]-(OnlyN;if Applicable). I
7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable). I M I
8 Enter New Duct System - Pass if Leakage Percentage < 6% [ 100 x [ Line #5 / Line #2 ] ] ❑ Pass ❑ Fail
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 ] ]
5.9
V Pass ❑ Fail
10
Pass if Leakage to Outside Percentage < 10% [ 100 x [ Line #7 / Line #2 ] ]
❑ Pass ❑ Fail
11
Pass if Leakage Reduction Percentage > 60% [ 100 x [ Line #6 / Line #4 ] ] and Verification by Smoke
Test and Visual Inspection
❑ Pass ❑ Fail
12
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection
F_
❑ Pass ❑ Fail
Pass if One of Lines #9 through #12 Pass
✓ Pass ❑ Fail
Residential Compliance Forms Generated by CJHJEJEJRJS® http://www.CHEERS.org December 2005
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 2 of 2) CF-4R
Project Address I Woodcox, Keith J
79-145 Big Horn Trail / La Quinta / CA / 92253
Builder t Installer
Esser A/C
v/ THERMOSTATIC EXPANSION VALVE (TXV)
Procedures for field verification of thermostatic expansion valves are available in RACM, Appendix RI.
System # 1
v/ Yes ❑ No
Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on the system and
installation of the specific equipment shall be verified.
Yes is a pass Iv/ Pass ❑ Fail
92
Residential Compliance Forms Generated by CJHJEJEJRJS® http://www.CliEERS.org December 2005
INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R
Site Address Permit Nu ber
INSTALLER C MPLUNCE STATEMENT FOR DUCT LEAKAGE
INSTALLER COMPLIANCE STATEMENT
The building was: ✓ OTested at Final ✓ O 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
✓ O DUCT LEAKAGE.REDUCTION
Prarvdures-far fleld veriflcadan and dlapnostic testing of air distribution systems are avallab/e In RACM. Aoaendlx RC4.3
NEW CONSTRUCTION:
CO
Duct Pressurization Test Results (CFM25 Pa)
@
Measured
?<° >-:.:
'"'
AYes ❑ No
verification that the TXV is installed on'the system and installation of the
Values
1
Enter Tested Leakage Flow in CFM:
QFai
Fan Flow: Calculated (Nominal: ✓ ITCoolingol ❑ Heating) or ✓ ❑ Measured
2
If Fan Flow is Calculated as 40.0.cfin/ton x number of tons or as 21.7 cfm/(kBiu/hr) x Heating
^�
Capacity in Thousands of Btulhr. enter total calculated or measured fan flow in CFM here:
V
✓ ✓.
3
Pass if Leakage Percentages 6% for Final or:5 4"/o at Rough -in:
O Pass ❑ Fail
100 x Line ## 1 /(Line # 2)11
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-
han a-OutEnter
EnterTested Leakage Flow in CFM from Final Test ofNew Duct System or Altered Duct
System for Duct System Alteration and/or Equipment Chane-Out
Enter Reduction in Leakage for Altered Duct System
ine # 4 Minus ine # 5 —(Only if Applicable)
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
�Sp
13 Fail
8
100 x ine # 5) / Line # 2
'
TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change- u
✓
Out Use one of the following four Test or Verification Standards for compliance:
9
Pass if Leakage Percentage:5 15% [j 00 x [_(Line # 5) I (Line # 2)]]
❑ Pass ❑ Fail
10
Pass if Leakage to Outside Percentage 5 10% [WO x L_(Line # 7) Z (Line # 2)]]
❑ Pass ❑ Fail
Pass if Leakage Reduction Percentage z 60% [100 x _(Line # 6) / (Line # 4)]]
❑Pass ❑ Fail
I I
and Verification Smoke Test and Visual Inspection
12
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection
=°= ':
❑ P . ❑ Fail
Pass if One of Lines # 9 throw h # 12 paw
JZPass ❑ Fail
,/ -0THERMOSTATIC EXPANSION VALVE (TXV)
Procedures for field verification ofthermostatic-expansion valves are available In RACM, Appendix RI. V ✓
✓,LJ 1, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for
compliance credit. I, 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 (Co. Name) OR Owner
CO
Access is provided for inspection. The procedure shall consist of visual
Date: yZ
✓
AYes ❑ No
verification that the TXV is installed on'the system and installation of the
specific equipment shall be verified.
QFai
Yes is a s Pass
✓,LJ 1, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for
compliance credit. I, 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 (Co. Name) OR Owner
CO
Signature:
Date: yZ
INSTALLATION CERTIFICATE (Page 3 of 12) CF -6R
Site Address Permit Number
7 R -- Iq � 9l C jln�lil qp.d d[_ . l7 — 49V
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.
Name and Model
Numbgqer
# of
Identical
Systems
Efficiency
�
(AFUE, etc.)
SCF-1Rvalue)
Duct
Location
attic etc.
Duct or
Piping
R -value
Heating
Load
Btu/hr
Heating
Capacity
(Btu/hr)
' %gJ\�
i
�� s
I
tj
Cooling Equipment
Equip Type
(Pkg. heat um
CEC Certified Mfr.
Name and Model
Number
# of
.identical
Systems
Efficiency
(SEER or EER)
?CF-1Rvalue)
Duct
Location
attic etc.
Duct
R -value
Cooling
Load
tu/hr
Cooling
Capacity
Btu/hr
i
�� s
0
tj
1. > symbol reads greater than or equal to what is indicated on the CF -IR value.
Include both SEER and EER if compliance credit for high EER air conditioner is claimed.
✓
[311, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or
more efficient than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the
Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable.
Installing Subcontractor (Co. Name) OR General
Contractor (Co. Name) OR Owner
6
Signature:
Date: Z Z/D
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms April 2005