09-0054 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
r 09-00000054 .
Property Address:
81189 RED"ROCK RD
APN:
764-270-999-59 -300233-
Application description:
MECHANICAL
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
1685
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: C2g0-38 License No.: 374657
Date: " a'�-� / Contractor:
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 Codel 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 contractors) licensed
pursuant.to the Contractors' State License Law.).
I 1 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 Name:
Lender's Address:
LQPERMIT
Owner:
KER, KEITH
81189 RED ROCK RD
LA QUINTA, CA 92253
Contractor:
DANCY HVACR, MIKE
81171 ;AREOMA COR
INDIO, CA 92201
(760)775-0750
Lic. No.: 374657
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/22/09
u' n�
JAN 2
2 2009
Gdrr�'�
-----------------------------------------------
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 EXEMPT Policy Number EXEMPT
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 shall fo ith comply with those provisions.
Date` 2'V Applicant: 1;0;e
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 information is correct. 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 upon the above-mentioned property fo inspecJti/or�l�Ipurrp�o�ses.
Date:/- Signature (Applicant or Agent): •
"= cs
. Application Number . . . . . 09=00000054
Permit . . . MECHANICAL
Additional desc .
Permit Fee. .._.-. 24.00 ...
Plan Check Fee
6.00
Issue'Date . . . .
Valuation . . .
. 0
Expiration.Date 7/21/09
Qty Unit ChargePer
Extension
BASE
FEE
15.00
1.00'.. 9.0000 EA MECH'B/C
<=3HP/100K BTU
9.00:
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE EXISTING AIR CONDITIONER
WITH -3
TON A/C UNIT 13 SEER.
- ------------------------
Other Fees . .. . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee `summary Charged
Paid. Credited
Due'
Permit Fee Total 24.00
.00.E '.00
24.00
Plan Check Total 6.00 -
.00 .00
6.00
Other Fee Total 1.00
.00' 00
1.00
Grand Total. 31.00
.00 .00
31.00
LQPERHIIT
✓ D Alternative Component Package Method: (check one) C D D (Alternative)
Package C and Package D choices require HERS rater field verification and/or diagnostic testing (see CF -1R page 3)
For Package D Alternative see Appendix•B Table 151-0 Footnotes 7-14.
GENERAL INFORMATION
Total Conditioned Floor Area (CFA) f
Average Ceiling Height: ft
Maximum Allowed West Facing Fenestration Products Per Table' 151-B or 1"51-C ---- (5% X CFA) ft
Maximum Allowed Total Fenestration Products Per Table 151-B or 151-0 ----(20°x6 X CFA) fe
✓ 0 Budding Type: (check one or more) Single Family Multifamily Addition Alteration
(If adding fenestration fill out WS -4R, Fenestration Maximum Allowed Area Worksheet and see Section 8.32
for Additions and 8.3.3 for Alterations.)
Number of Stories: Number of Dwelling Units:
Floor Construction Type: Slab/Raised Floor (circle one or both)
Front Orientation: North / South / East / West / All Orientations (input front orientation in degrees from True North
and circle one).
✓ DI_ANT BA_RR R (reauire<d in c imate &q= 2.4- 8-151
OPAQUE SURFACES INCLUDING OPAQUE DOORS
Component
Type (Wall,
Roof, Floor,
Slab Edge,
DoorsR-Value
Frame
Type
(Wood or
Cavity Continuous
Insulation Insulation
R -Value
Assembly U -
factor (for wood, Joint
metal frame and Appendix
mass IV
assemblies)' Reference
Roof Radiant
Barrier
Installed
Yes or No
Location
Comments
(attic, garage,
1, etc.
1) am joint AppenWX 1 v in N=uon 1 v.L, 1 v.3 aria 1 v.4, wmcn is the Dams Ior the U -Tactor criterion U -tactors can not exceed
prescriptive value to show equivalence to R -values.
Residential Compliance Forms
April 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page iof5) CF -1R
Trite
FENESTRATION PRODUCTS—U-FACTOR AND SHGC
✓ 13FENESTRATION MAX[MUM ALLOWED AREA WORKSHEET WS4R —must be included for New
Construction, Additions and Alterations.
Fenestration
Minimum. Distribution
Efficiency Type and Location
AFUE orHSPF d attic, sea)
. Duct or Piping
R -Value
Thermostat Configuration
T slit or
#/Type/Pos. Orion-
/
4G
Exterior
(Front, Left, tation,
ShadiIIg/O Verirangg6''
Rear, Right, N. S, E,
Skylight) W
Area
U -factor SHGC
✓box if WS -3R is
fie
U-factorz Source . SHGC° Sources
included
❑
13
13O
Cl
1) 61cyltgnts 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 § 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 eohmm from NFRC or from Standards Default Table 116B or adjusted SHGC from WS -3R -
5)
S -3R5) Indicate source either from NFRC or Table 116B.-
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
Heating Equipment
Type and Capacity
host pump, boiler, etc.
Minimum. Distribution
Efficiency Type and Location
AFUE orHSPF d attic, sea)
. Duct or Piping
R -Value
Thermostat Configuration
T slit or
C ND FN
/
4G
S T
Cooling Equipment
Type and Capacity
(A/C, heat pump, evap.
cool'
Minimum
Efficiency Duct Location Duct.
SEER or EER attic etc. R -Value
Thermostat
T
Configuration
lit or k e
C ND FN
/
4G
S T
Residen" Compliance Forms April 200.5
CERTIFICATE OF
A signed CF -4R Form must be provided to
RESIDENTIAL (P 3 of s) CF -IR
Dwe
department for each home for which the following. are
18" I Sealed Ducts all climate zones and certification and HERS rater field verification uired.
TXVs, readily accessible (climate zones 2 and 8-15 only)
tesfM and certification and HERS Rater field verification
C3 Refiigerent Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
verification
OR
C3 IAlternative to Sealed Ducts and Refrigerant Charge nXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 151-0, Footnotes 7-14.
OR ,
For additions and alterations, duct systems that are not documented to have been previously
Cl sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems with more than 40 Imear feet in unconditioned
shall meet the requirements of Section 1 m and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
Water Heater
TypeNuel Type
Check box if system meets criteria of a "Standard" system Standard system is one gas-fired water heater per
O
dwelling unit If the water heater is a storage t)pe, 50 gallons is the maximum capacity and recirculation system is
Tank
City
(galona
not allowed.
Tank
External
Standby' Insulation
Loss % R -Value
Check box when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential
Manual. No water heating calculations are re and the system complies automatically.
Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved
0
Alternative Water Heating table. In this case, the Performance Method must be used and must be included m the
submittal.
C3
Check box to verify that a time control is required for a recirculating system pump for a system serving multiple
units
Water Heater
TypeNuel Type
Distribution
lype
Number
in System
Rated
Inputl
(kW or
Whr)
Tank
City
(galona
En"
Factor or
Thermal
Efficient
Tank
External
Standby' Insulation
Loss % R -Value
ov.N�a■ a Wvuasr mwunea- ■NWv 11"v 91""M
Water Hestia
Type
Distribution
Type
Number
in System
Rated Enemy
Inputl Tank Factor or
(W or Capacity Thermal Standby'
BOOM Efficient Loss/o
Tank
External
Insulation
R Value
a/ gnu bwjZ%V wxtCr n=wK3 kra= U3PUM 01 1e3S uian Or equal W -/J,UW k=tir), electric resistance, and
heat pump water heaters, list Energy Factor. For large gas storage water heaters (ratted input of greater than 75,000
Btu/br), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water
heaters, list Rated Input and Thentaal Efficiencies.
Pi0ft IUSAWOn (kitchen Imes >_ 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures
that am % inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2
B: .
Residential Compliance Forms April 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 5 of 5) CF -1R
Project Tide Date
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and specifications needed to comply with Title
24, Paas 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, verification of refrigerant charge
and TXVs, insulation installation quality, and building envelope sealing require installer testing and
certification and field verification by an approved HERS rater.
Designer or Owner (ner Business and Professions code) Documentation Antlhor
Nemo: ' /G
/V
Name:
Tide/Fum:
TiBe/F&m
Address:
Address
Telephones ��
�} G
Telephone:
License M 3
(Sig)
(date)
(sig) (dale)
Enforcement Agency
i
Residential Compliance Forms April 2005
Bin #
'
City of La Quinta .
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
pQ J S
Project Address: 7
Owner's Name:A.
P. Number:
Address: 0,11f f
Legal Description:
City, ST, Zip: Z14
Contractor: J j D /Q /✓
Telephone:
Address:
City, ST, Zip:�Np/D
Project Description: 0Cr1--z^C,0_-
3 T X e- 4w/ /
Telephone: Q
State Lic. # :
City Lic. #: 101 %*5
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req.'.d..
. Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"d Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review, ready 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
i
INSTALLATION CERTIFICATE '
Site Address Rile p REO
(Page 4 of 12) CF -6R
P Permit Nur>�be� -
° r� a t�iR. , 9 5 U "1 .
INSTALLER COMPLIANCE -STATEMENT FOR DUCT LEAKAGE
INSTALLER COMPLIANCE STATEMENT ;
The Building was: ✓ []Tested at Final ✓ ❑ Tested at Rough -in
-
INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE:
1W 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
x ❑ New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platforms returns in lieu of
ducts). -..
✓ ❑ DUCT LEAKAGE REDUCTION
Praevdu►v_c far field verifieadan and diaQnastie testing of air distribution systemc are available in RACM. Aovendix RC -T. t
NEW CONSTRUCTION: t
Installing Subcontractor (Co. Name) OR General
Contractor (Co. Name) OR Owner
Duct Pressurization Test Results (CFM @ 25 Pa)
MeasuredF
r$�
Signature:
Date: r cz
Values
I
Enter Tested Leakage Flow in CFM:.3
Fan Flow: Calculated (Nominal: ✓ Cooling ✓ ❑ Heating) or ✓ ❑ Measured
2
If Fan Flow is Calculated as 400 cfm/ton x number of tons oras 21.7 cfm/(kBtu/hr) x Heating
"✓,✓
Capacity aci in Thousands of Btu/hr output, enter total calculated or measured fan flow in CFM her
. i
sir
Pass if Leakage Perceniage_< 6% for Final or <_ 4% at Rough -in:
t' '#'
jD Pass ❑ Fail`'
3
100 x ine #.I)'/ —.L --(Line # 2
System HVAC Equipment Change-Outcx
ALTERATIONS:
Duct and/or
4
Enter Tested Leakage Flow iii CFM from Pre -Test of Existing Duct System Prior to Duct .gv
System Alteration and/or Equipment Change -Out.'
Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct
1,12012
System for Duct System Alteration and/or Equipment Chana-Out.
u R =<zw';
Enter Reduction in Leakage for Altered Duct System
= '`
fr-` @cyr
6_(Line
# 4 Minus i ine # 5 —(Only if Applicable)
w" xJ
7
Enter Tested Leakage Flow in CFM to Outside (Only if Applicable)
✓. ✓
Entire New Duct System - Pass if Leakage Percentage <— 6% for Final
❑ Pass ❑ Fail
8
1 100 x[_(Line # 5 / . Line # 2
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)]]
E Pass ❑Fail
10
Pass if Leakage to Outside Percentage :510% [100 x L (Line # 7) / (Line # 2)]]
❑Pass ❑Fail
Pass if Leakage Reduction Percentage >! 60% [100 x [ (Line # 6) / (Line # 4)]]
p pass ❑Fail
11
and Verification by Smoke Test and Visual Inspection F
12
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection
n=n uz v<;
❑ Pass ❑, Fail
Pass if One of Lines # 9 through # 12 pass
4L
ass ❑ Fail
111, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for
4 {.
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.
Copies to: BUILDING DEPARTMENT,`6RS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY -
i". a t.
Residential Compliance -Forms ' September 2005'
k
✓
Installing Subcontractor (Co. Name) OR General
Contractor (Co. Name) OR Owner
'((�� 44�Gf 17Z4�� C
Signature:
Date: r cz
Copies to: BUILDING DEPARTMENT,`6RS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY -
i". a t.
Residential Compliance -Forms ' September 2005'
k
✓
✓ Lid THERMOSTATIC EXPANSION VALVE (TXV)
Procedures for field verification of thermostatic expansion valves are available in RACM, Appendix Rl.
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
"mi nOntin.. FVrmn°inn U.1—
Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity Btu/hr.
Date of Verification
Date of Refrigerant Gauge Calibration (must be checked monthly)
Date of Thermocouple Calibration (must be checked monthly)
Standard Charge Measurement Procedure (outdoor air k -bulb 551 and above):
Procedures for Determining Refrigerant Charge using the Standard Method are available in RACM, Appendix RD2.
Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this
procedure.
Measured Temperatures
Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db)
OF
Return (evaporator entering) air dry-bulb temperabrre (Treturn, db)
v
Access is provided for inspection. The procedure shall
Return (evaporator entering) air wet -bulb temperature (Treturn, wb)
OF
Evaporator saturation temperature (Tevaporator, sat)
consist of visual verification that the TXV is installed on
✓M
Yes
17 No
the system and installation of the specific equipment []
shall be verified.
Yes is a VassPass Fail
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
"mi nOntin.. FVrmn°inn U.1—
Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity Btu/hr.
Date of Verification
Date of Refrigerant Gauge Calibration (must be checked monthly)
Date of Thermocouple Calibration (must be checked monthly)
Standard Charge Measurement Procedure (outdoor air k -bulb 551 and above):
Procedures for Determining Refrigerant Charge using the Standard Method are available in RACM, Appendix RD2.
Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this
procedure.
Measured Temperatures
Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db)
OF
Return (evaporator entering) air dry-bulb temperabrre (Treturn, db)
OF
Return (evaporator entering) air wet -bulb temperature (Treturn, wb)
OF
Evaporator saturation temperature (Tevaporator, sat)
OF
Suction line temperature (Tsuction, db)
OF
Condenser (entering) air dry-bulb temperature (Tcondenser, db)
OF
Superheat Charee Method Calculations for Refriverant rharae
Actual Superheat = Tsuction, db — Tevaporator, sat
OF
Target Superheat (from Table RD -2)
OF
Actual Superheat —Target Superheat (System passes if between -5 and +5°F)
OF
Temperature Split Method Calculations for Adequate Airflow
Sept Melhnd r'nlnnhltinn if not nonvconn, ArAiini t—fn A:,.n,,,.... A'# :. ♦..6 .
Actual Temperature Split = T return, db Tsupply, db
OF
Target Temperature Split (from Table RD3)
Actual Temperature Split Target Temperature Split (System passes if between -
3°F and +3°F or upon remeasurement, if between -3°F and -100°F
JOF
Residential Compliance Forms - April 2005
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 Equomew
Equip Type
k . heat •um
CEC Certified Mfr.
Name and Model
.Number
g of
Identical
S ems
Efficiency
(AFUE, etc.)I
2CF-1R value
Duct
Location
attic �,
Duct or
Piping
R -value
Cooling
Load
(Btu/hr)SBZ/Btu/Iv
-3Q9 00
Cooling
Capacity
360oo
Heating
Load
Btuhir
Heating
Capacity
BtuRtr
Coaling Equipment
Equip Type
(PkR. heat um
/ Cool
CEC Certified Mfr.
Name and Model
Number
P 13AA
# of
Identical
Systems
Efficiency
SEER or EER
� )
aCF-1R value
Dari
Location
attic ac.
Duct
R -value
. 2
Cooling
Load
(Btu/hr)SBZ/Btu/Iv
-3Q9 00
Cooling
Capacity
360oo
I. > 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 conditioneiis ;claimed.
✓
1311, 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 -IR) submitted for compliance with the
Energy Efficiency Standards for residential buildings, , and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices (from the Appliance E kiency Regulations or Part 6), where applicable.
�.
Installing Subcontractor (Co.!Name)
Contractor (Co. Name),OR Owner
Signature:
Copies to: BUILDING DEPARTMENT, J
General'R*r
- -
Date. �—
S RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms April 2005
r '