06-1252 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
06-00001252
78990 CARMEL CIR
646 -400 -044 -
MECHANICAL
LOW DENSITY RESIDENTIAL
3500
T-iht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
PARR CHERYL
78990 CARMEL CIRCLE
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/28/06
Contractor:
Applicant: Architect or Engineer: PALM DESERT AIR CONDITIONING!(CMITFINAN
42081 BEACON HILLPALM DESERT, CA 92211
(760)346-0677 AR 28 2006Lic. No.: 374937 ARYOFL A QUINTACE DEPT.
---------=---------------------------------------------------------------------------------------
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 LicenseNo.: 374937
`+, Date:��� 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 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 (55001.:
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 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 I am exempt under Sec. , BAP.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
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 1795546-2006
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 forthwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKE ' 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 for
t inspection purposes.
`Dai_, "�� F ignature-(Applicant orrAAgent):---/`�} ��4�
V �r
Application Number . . . . . 06-00001252
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . . 15.00
Plan Check
Fee
3.75
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 9/24/06
Qty Unit Charge Per
Extension
BASE FEE
-
15.00
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE 5 TON CONDENSING UNIT ONLY.
Fee summary Charged Paid
-----------------
Credited
Due
--------------------
Permit Fee Total 15.00
----------
.00
----------
.00
15.00
Plan Check Total 3.75
.00
.00
3.75
Grand Total 18.75
.00
.00
18.75
LQPERMIT
Bin #
1 /
City of La Quints
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
Permit #
Project Address:
Owner's Name: C\�R�l., Q�Q�
A. P. Number:
Address: —C$ CAb C-tNXlKI-&�1_ ZIV L.-
Legal Description:
City, ST, Zip: Qv�oS�
Contractor:
Telephone:
Address: k 1-09\ %E�wct�-j A k•_(_,
Project Description:
City, ST, Zip: �*L JA q 4-;z_\
�J \R. CcNpf^NS��I C� C9 N L�s
Telephone: 3%-\,k0--m; j T
State Lie. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
State Lie. #:
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
Recd
TRACMG _
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"' Review, ready for correctionsrssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
W HOUSE:-
''' Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
a
field verification and diagnostic testing is complete, the builder or the builder's subcontractor shall complete diagnostic
testing and the procedures specified in this section. When the installation is complete, the builder or the builder's
subcontractor shall complete the CF -6R (Installation Certificate), and keep it at the building site for review by the building
department. The builder also shall provide a copy of the Installation Certificate to the HERS rater for any measures requiring
field verification and diagnostic testing; per Section 10-1.03(a).
WATER HEATING SYSTEMS:
Distribution
CEC Certified Type If # of Rated Input
Heater Mfr Name & (Std, Point- Recirculation, Identical (kW or Tank Volume
Type Model Number of -Use, etc) Control Type Systems Btu/hr)t (gallons)
External
Efficiency Standby Insulation
(EF, RE)' Loss (%)2 R-value2
Signature:
Date ani
Ek 0
ff AL
0
AF AF IL
I For small gas storage (rated input of less than or equal to 75,000 Btu/hr), electric resis tante and heat pump water
heaters, list Energy Factor (EF). For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list
Recovery (RE), Thermal Efficiency, Standby Loss and Rated Input. For instantaneous gas water heaters, list Thermal
Efficiency and Rated Input.
2. R-12 external insulation is mandatory for storage water heaters with an energy factor of less than 0.58.
Kitchen Pipin g:
1f indicated on the CF -1 R, all hot water piping 3/4 inches in diameter that runs from the hot water source to the kitchen
fixtures is insulated.
Faucets & S hower Heads:
All faucets and showerheads installed are certified to the Energy Commission, pursuant to Title 24, Part 6, Section l 11.
Centra I Water Heating in B uildings with Multiple Dwelling Units (required for prescriptive)
[]All hot water piping in main circulating loop is insulated to requirements of § 1500)
M
❑Central hot water systems serving six or fewer dwelling units which have (l) less than 25' of distribution piping
outdoors; (2) zero distribution piping underground; (3) no recirculation pump; and (4) insulation on distribution piping
that meets the requirements of Section 1500)
❑Central hot water systems serving more than 6 dwelling units - presence of either a time control or a time/temperature
control
I1 I, the undersigned, veriA, that equipment listed above my signature is: l) 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. a OR Owner
Palm Desert Air Conditioning & Heating Company
Signature:
Date ani
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance For ms Septanber 2005
a
a
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
CEC Certified Mfr.
Equip Type Name and Model
(pkg. heat um Number
# of
Identical
Systems
Efficiency�
(AFUE, etc.)
CF -I R value)
Duct
Location
attic, etc.
Duct or Heating Heating
Piping Load Capacity
R -value Btu/hr Btu/hr
Duct
R-value(Btu/hr)
Cooling
Load
Cooling
Capacity
Btu/hr
G
AJ
iL'
• �,
� DOD
�, o�
Cooling Equipment
Equip Type
(pkg. heat um
CEC Certified Mfr.
Name and Model
Number
g of
Identical
Systems
Efficiency'
(SEER or EER)
CF-IRvalue)
Duct
Location
attic etc.
Duct
R-value(Btu/hr)
Cooling
Load
Cooling
Capacity
Btu/hr
G
iL'
• �,
� DOD
�, o�
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.
2 11, 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. N/rrwtR Owner
Palm Desert Air Conditioning & Heating Company
Signature:
Date _ 1D/
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms April 2005
a
INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE
INSTALLER COMPLIANCE STATEMENT
N/A The building was: ❑ Tested at Final ❑ Tested at Rough -in
INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE:
N/A ❑ 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
New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platforms returns in lieu of
ducts).
[1 DUCT LEAKAGE REDUCTION
Procedures for field verification and diagnostic testingof air distribution systems are available in RACM, Ap pendix RC4.3
a
/]
M
02-
a
NEW CONSTRUCTION:
Palm Desert Air Conditioning & Heating Company
Duct Pressurization Test Results (CFM @ 25 Pa)
Measured
Values
1
Enter Tested Leakage Flow in CFM:
Fan Flow: Calculated (Nominal: JVCooling ❑ 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
200
Car)acitv in Thousands of Btu/hr output, enter total calculated or measured fan flow in CFM herd:
3
Pass if Leakage Percentage 6% for Final or 4% at Rough -in:
Pass Fail
100 x Line # 1 / Line # 2)11
ALTERATIONS: Duct System and/or HVAC Equipment Change -Out
4
Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct
('
System Alteration and/or Equipment Change -Out.
is
Enter Tested Leakage Flow in CFM from Final Tes t of New Duct System or Altered Duct
5
S stem for Duct System Alteration and/or Equipment Chan e -Out.
Enter Reduction in Leakage for Altered Duct System
6
(Line # 4) Minus (Line # 5)] —(Only if Applicable)
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
100 x Line # 5 / Line # 2
TEST OR V E R I FIC ATION STAN DAR DS: Fo r A Itered Duct System and/or H V AC Equipme nt Change -
Out U se one of the following four Test or Verification Standa rd s for compliance:
9
Pass if Leakage Percentage 1.5% [100 x [ (Line # 5) / (Line # 2)]]
Pass Fail
10
Pass if Leakage to Outside Percentage 10% [100 x [(Line # 7) / (Line # 2)]]
Pass Fail
Pass if Leakage Reduction .Percentage 60% [100 x r (Line # 6) / (Line # 4)]]
11
and Verification by Smoke Test and Visual Inspection
Pass Fail
12
PE
Pass if Sealingof all Accessible Leaks and Verification b Smoke Test and Visual Inspection
Pass Fail
Pass i f 0 ne of L ines # 9 through # 12 pass
Pass Fail
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 N e) OR Owner
Palm Desert Air Conditioning & Heating Company
Signature:
Date:
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance For ms September 2005
a
Q THERMOSTATIC EXPANSION VALVE (TXV)
Procedures for field verification of thermostatic expansion valves are available in RA CM, Appendix RI.
N/A REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
Thermostatic Expansion Valves
Outdoor Unit Serial #
Access is provided for inspection. The procedure shall
Location
consist of visual verification that the TXV is installed on
❑
V/ Q Yes
No the system and installation of the specific equipment Q
Outdoor Unit Model
shall be verified.
Cooling Capacity
Yes is a pass I Pass Fail
N/A REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
Thermostatic Expansion Valves
Outdoor Unit Serial #
Location
Return (evaporator entering) air dry-bulb temperature (Treturn, db)
Outdoor Unit Make
OF
Outdoor Unit Model
Cooling Capacity
B tu/hr
Date of Verification
OF
Date of Refrigerant Gauge Calibration
(must be checked monthly)
Date of Thermocouple Calibration
I (must be checked monthly)
Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F 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 temperature (Treturn, db)
OF
Return (evaporator entering) air wet -bulb temperature (Treturn, wb)
OF
Evaporator saturation temperature (Tevaporator, sat)
OF
Suction line temperature (Tsuction, db)
°F
Condenser (entering) air dry-bulb temperature (Tcondenser, db)
OF
Superheat Charge Method Calculations for Refrigerant Charee
Actual Superheat = Tsuction, db — Tevaporator, sat
OF
Target Superheat (from Table RD -2)
j
Actual Superheat — Target Superheat (System passes if between -5 and +5°F)'
Temperature Split Method Calculations for Adequate Airflow
Split Method Calculation is not necessary if Adequate Airflow credit is taken
Actual Temperature Split = T return, db Tsupply, db
OF
Target Temperature Split (from Table RD3)
OF
Actual Temperature Split Target Temperature Split (System passes if between -
OF
3°F and +3°F or, upon remeasurement, if between -3°F and -100°F
Residential Compliance Forms April 2005
a
CERTIFICATE OF COMPLIANCE: RESIDENTIAL
(Page 1 of 5) CF -1R
Project
Date
Roof Radiant
Barrier
Installed
Yes or No
Building Permit #
Project • e
Documentation Author
Karl Brown or Robert Powell
Compliance Method (Prescriptive)
Telephone
7Q
Climate Zone
15
Plan Check / Date
Field Check / Date
Enforcement Agency Use Only
Alternative Component Package Method: (check one) N/A C N/A D N/A 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-C Footnotes 7-14
GENERAL INFORMATION
Total Conditioned Floor Area (CFA) ftZ
Average Ceiling Height: N/A ft
Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C ---- (5% X CFA) N/A ft2
Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C ----(20% X CFA) N/A ft
Q Building 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 8.3.2
for Additions and 8.3.3 for Alterations.)
Number of Stories: N/A Number of Dwelling Units: N/A
Floor Construction Type: N/A Slab/Raised Floor (circle one or both)
Front Orientation: N/A North / South / East / West / All Orientations (input front orientation in degrees from True North
and circle one).
RADIANT BARRIER (required in climate zones 2,4,8-_151
OPAOUE SURFACES INCLUDING OPAQUE DOORS
Component
Type (Wall,
Roof, Floor,
Slab Edge,
Doors)
Frame
Type
(Wood or
Metal)
Assembly U -
factor (for wood,
Cavity Continuous metal frame and
Insulation Insulation mass
R -Value R -Value assemblies
Joint
Appendix
IV
Reference
Roof Radiant
Barrier
Installed
Yes or No
Location
Comments
(attic, garage,
typical, etc.
1) See Joint Appendix 1V in Section 1v.2, 1V.3 and 1VA, which is the basis for the U -factor criterion. U -factors can not exceed
prescriptive value to show equivalence to R -values.
Residential Compliance Forms
April 2005
1
FENESTRATION PRODUCTS — U -FACTOR AND SHGC
FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS -411 —must be included for New
Construction, Additions and Alterations.
Fenestration
#/Type/Pos.
(Front, Left,
Rear, Right,
Skylight)
Orien-
tation,
N, S, E,
Exterior
Shading/Overhangs6''
Area U -factor SHGC box if WS -311 is
U -factor' Source SHGC° Sources included
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 §151(03C 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 116B or adjusted SHGC from WS -3R.
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 -3R to calculate Exterior Shading
devices.
7) See Section 3.2.4 in the Residential Manual.
HVAC SYSTEMS
Heating Equipment
Type and Capacity
fumace, heat um , boiler, etc.
Minimum
Efficiency
AFUE or HSPF
Distribution
Type and Location Duct or Piping Thermostat Configuration
ducts, attic, etc. R -Value Type (split or package)
Cooling Equipment
Type and Capacity
(A/C, heat pump, evap.
cooling)
Minimum
Efficiency Duct Location Duct Thermostat Configuration
SEER or EER attic, etc. R -Value Tylge (split or acka e
Residential Compliance Forms April 2005
a a
SEALED DUCTS and TXVs (or Alternative Measures)
A signed CF -411 Form must be provided to the building department for each home for which the following. are
required.
0
Sealed Ducts all climate zones Installer testing and certification and HERS rater field verification required.)
N/A
TXVs, readily accessible (climate zones 2 and 8-15 only)
Tank
Capacity
Installer testing and certification and HERS Rater field verification required.)
❑
Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field
A
verification required.)
OR
❑ 1Alternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14.
OR
❑ For additions and alterations, duct systems that are not documented to have been previously
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 linear feet in unconditioned
spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
F7-1
❑
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
N/A
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
Tank
Capacity
not allowed.
Standby
Loss %
Check box when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential
A
Manual. No water heating calculations are required, and the system complies automatically.
❑
Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved
N/A
Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the
submittal.
El
Check box to verify that a time control is required for a recirculating system pump for a system serving multiple
NIA
units
Systems serving single dwelling units
Water Heater
Type/Fuel Type
Distribution
Type
Number
in System
Rated
Input'
(kW or
Btu/hr(gallons)
Tank
Capacity
Energy
Factor' or
Thermal
Efficiency
Standby
Loss %
Tank
External
Insulation
R -Value
N/A
System serving multiple dwelling units
Water Heater
Type
Distribution
Type
Number
in System
Rated
Input'
(kW or
Btu/hr(gallons)
Tank
Capacity
Energy
Factor' or
Thermal
Efficiency
Standby
Loss %
Tank
External
Insulation
R -Value
N/A
1) For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and
heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000
Btu/hr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water
heaters, list Rated Input and Thermal Efficiencies.
Pipe Insulation (kitchen lines 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures
that are '/4 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
1a
SPECIAL FEATURES NOT REQUIRING HERS VERIFICATION(add extra sheets if necessary)
Indicate which special features are part of this project. The list below represents special features relevant to the Prescriptive
and Performance Method.
SPECIAL FEATURES REQUIRING HERS RATER VERIFICATION
(add extra sheets if neeessarv) Indicate to the HERS Rater which credits are nart of this nrniect and need verificatinn
V/ Feature
Feature
Required Forms (if applicable)
Descri ti on
❑
Metal Framed Walls
CF -1R
N/A
❑
Radiant Barriers
CF -1R
N/A
❑
Exterior Shades
WS -4R
N/A
N/A; Performance Calculation
❑
Cool Roof
Required. Attach CRRC Label to
N/A
Forms.
❑
Dedicated Hydronic Heating
Performance Calculation
N/A
System
Required; Attach Run to Forms.
❑
Combined Hydronic System
Performance Calculation
N/A
Required; Attach Run to Forms.
❑
Gas Cooling
N/A; Performance Calculation
N/A
Required.
❑
Buried Ducts
N/A; Indicate on building plans.
N/A
❑
Kitchen Pipe Insulation
See Section 5.6.2 Distribution
N/A
Systems in Residential Manual.
❑
Multiple Water Heaters Per
See Table 5-13 or use
Dwelling Unit
Performance Calculation and
N/A
attach Run to Forms.
❑
Central Water Heating System
Performance Calculation and
N/A
Serving Multiple Dwellings
attach Run to Forms.
❑
Non-NAECA Large Water
CF -1R
N/A
Heater
See Table 5-13 or use
❑
Indirect Water Heater
Performance Calculation and
N/A
attach Run to Forms
See Table 5-13 or use
❑
Instantaneous Gas Water Heater
Performance Calculation and
N/A
attach Run to Forms
See Table 5-13 or use
❑
Solar Water Heating System
Performance Calculation and
N/A
attach Run to Forms
❑
Wood Stove Boiler
Performance Calculation and
N/A
attach Run to Forms
SPECIAL FEATURES REQUIRING HERS RATER VERIFICATION
(add extra sheets if neeessarv) Indicate to the HERS Rater which credits are nart of this nrniect and need verificatinn
V/ Feature
Required Forms (if applicable) Descri ti on
0 Duct Sealing
CF -6R part 4 of 12
❑ Refri erant Charge
CF -6R part 5 of 12
0 Thermostatic Expansion Valve
CF -6R part 6 of 12
Residential Compliance Forms
September 2005
. • 1 6
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 5 of 5) CF -1R
Project Title Da::,
CV1
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, 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.
Desiener or Owner (oer Business and Professions Code) Documentation Author
Name:
Name:
Karl Brown or Robert Powell
Title/Firm:
Title/Firm:
Palm Desert Air Conditioning & Heating Co.
Address:
Address:
42081 Beacon Hill
Palm Desert, CA 92211
Telephone:
Telephone: (760) 346_0677
License #:
(signature) (date)
(signature) (date)
Enforcement Agency
Name:
Title
Agency:
Telephone:
Comments:
Residential Compliance Forms April 2005
G