09-0964 (MECH)P.O. BOX 1504 VOICE (760) 777-7012
-4
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Dater 9/09/09
Application Number: -09-00000964 - ' - Owner:
Property Address: !--"78505 AVENIDA TUJUNGA SEAN WALKER rl d
APN: 770-096-006-75 -000000- 78505 AVENIDA TUJUNGA
Application description: MECHANICAL LA QUINTA, CA 92253 O
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 25000 O
. �nro 9 �d9
Contractor: R,r1yqp L4Qp
Applicant: Architect or Engineer: HYDES rEOFPT�4
77825 WILDCAT STREET
PALM DESERT, CA 92211.
I'^/ (760) 360-2202
t�T Lic. No.: 906115
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
!.hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: '
Section 7000) of Division 3 of the Business and Professionals Code and my License is in full force and effect. _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License a s: C20 C36 ,� 'cert No.: 906115 for by Section 3700, of the Labor Code, for the performance of the work for which this permit is
g 9 /% issued.
ate: ` / +' - ntracto �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
OWNER-ILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier DELOS INS Policy Number 02DKRM12004084
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, f
permit to file a signed statement that he or she is licensed pursuant to theprovisionsof the Contractor's State and agree that, if I should become subject to the rkers' compensation provisions of Section -
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith rTlpVwith those provisions.
that he or she is exempt therefrom andthe 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).: ' plicant:
(_ 1 1, 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 WARNING: FAI URE TO SECURE WORKERS' COMPE TION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon; SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES -AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, providedthatthe DOLLARS ($100,000)' IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN -
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one year of completion, the owner -builder will have the burden of proving that he or she did not build or - -
J improve for the purpose of,sale.). APPLICANT ACKNOWLEDGEMENT r+
1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a 4ermit subject to the
7044; Business and Professions Code: The Contractors' State license Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1-, Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I—) I am exempt under Sec. - , 8.&P.C. for this reason - the owner, and the applicant,'each agrees to, and shall defend, indemnify and hold harmless the City .
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
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 her y a Rorize representatives "
of this court to nter upon the above-mentioned property for inspection purpos
Dat Signat a (Applicant or Agent):
Application Number 09-00000964
Permit . . . MECHANICAL
Additional desc .
Permit Fee-...-. 51.00
Plan Check Fee
12.75
Issue Date
Valuation
0
Expiration Date
Qty Unit Charge Per
Extension
BASE
FEE
15.00.
2.00. 9.0000 EA MECH
FURNACE<=100K
18.00
2.00 9.0000'EA MECH
B/C <=3HP/100K BTU.
18'.00 _
=------------------------------------------
Special Notes and .Comments
------------
----
REPLACE 2 COMPLETE SPLIT SYSTEMS
(18
SEER, 80% AFUE). 2007 CODES.
---------------------------------------- - - - -
--Other Fees BLDG STDS ADMIN (SB1413)
-- - - -
1.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total 51.00
----------------------------
.00 .00
51..00
Plan Check Total 12.75
.00 .00
12.75.
Other Fee Total 1.00
.00 .00
1.00
Grand Total 64.75
.00 .00"
-64:75
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 1) CF -1R -A
Project Title (l n 1 Date ` q Building Permit # r'
Project Address
Configuration
(split or package)
Documentation Author
Telephone
Plan Check/ Date
Refrigerant Charge (Climate Zones 2 and 8-15) - Installer testing and HERS Rater field verification required'
❑
ALTERNTAVE to Duct Testing: High EER as indicated in Table 8-3 of the Residential Compliance Manual (SEE Table.8-3 for
Field Check/ Date
Compliance Method (Prescriptive – HVAC and/
Climate Zone
Enforcement Agency Use Only
or Duct System Alteration - § 152(b)IC, D, and E)
❑
High EER
HVAC SYSTEMS
Heating Equipment Type
and Capacity (fumace, heat
—r— hniler, etc.)
Minimum
Efficiency
(AFUE or HSPF)
Distribution Type Duct or Piping
and Location (ducts, Insulation Thermostat Type
attic, etc. R -Value (setback)
Configuration
(split or package)
❑
TXV (Climate Zones 2 and 8-15) - Installer testing and HERS Rater field verification required'
❑
Refrigerant Charge (Climate Zones 2 and 8-15) - Installer testing and HERS Rater field verification required'
❑
ALTERNTAVE to Duct Testing: High EER as indicated in Table 8-3 of the Residential Compliance Manual (SEE Table.8-3 for
[3Existing
additional requirements and available Compliance Options) - Installer testing and HERS Rater field verification required
ThP nrperrint;vP ran..;rP.r.n..r r— e:rl...-,. _ L:_____. _L___
❑
Duct systems with less than 40 linear feet of ducts in unconditioned space.
❑
Cooling Equipment Type Minimum
and Capacity (A/C, heat Efficiency Duct Location
Qump, evap cool in . (SEER or EER) (attic, etc.)
Duct Insulation Thermostat Type Configuration
R -Value (setback) (split or package)
t✓
Sealed Ducts (Climate Zones 2 and 9-16) - Installer testing and HERS Rater field verification required
❑
TXV (Climate Zones 2 and 8-15) - Installer testing and HERS Rater field verification required'
❑
Refrigerant Charge (Climate Zones 2 and 8-15) - Installer testing and HERS Rater field verification required'
SEALED DUCTS, REFRIGERANT. CHARGE (TXV) AND EER
Before the permit can be finalized, a signed CF -6R Form and CF -4R Form must be provided to the building department for any of the
fnllnwino rmmnlianrP ran..;ro..,o. r N...r --,. ✓ .
✓
.............b„ .....— uvw uVt aJJNry W pacKageU Units.
EXCEPTIONS
If anv of the fnllnwino thrPP Pvr—t;nnc o P ✓ +t— A.—
#
Compliance Requirements
❑
Sealed Ducts (Climate Zones 2 and 9-16) - Installer testing and HERS Rater field verification required
❑
TXV (Climate Zones 2 and 8-15) - Installer testing and HERS Rater field verification required'
❑
Refrigerant Charge (Climate Zones 2 and 8-15) - Installer testing and HERS Rater field verification required'
❑
ALTERNTAVE to Duct Testing: High EER as indicated in Table 8-3 of the Residential Compliance Manual (SEE Table.8-3 for
[3Existing
additional requirements and available Compliance Options) - Installer testing and HERS Rater field verification required
ThP nrperrint;vP ran..;rP.r.n..r r— e:rl...-,. _ L:_____. _L___
.............b„ .....— uvw uVt aJJNry W pacKageU Units.
EXCEPTIONS
If anv of the fnllnwino thrPP Pvr—t;nnc o P ✓ +t— A.—
#
✓
Exceptions
1
❑
Duct systems that are documented to have been previously sealed as confirmed through field verification and diagnostic
CF -411 page 1 of 8
❑
testing in accordance with procedures in the Residential ACM Manual.
2
[3Existing
duct systems that are extended, which are constructed, insulated or sealed with asbestos.z
3T
❑
Duct systems with less than 40 linear feet of ducts in unconditioned space.
❑
High EER
CF -6R pages 3 and 8 of 12
-------- -- -------r- »,,..,.,»...,b va..... , .. t Icy 111ccr DAUGpUVn L aDove.
SPECIAL FEATURES REQUIRING HERS RATING VERIFICATION
A ✓ mrliratpc which rnmr l;o..ro . _. _ _r--
✓
---------
Compliance Requirements.
._ .....� .. ........... 11 .cU iii:.no raicr vcnucauon.
Installer Forms (inapplicable) HERS Rater Forms (it applicable)
❑
Duct Sealing
CF -6R pages 3 and 4 of 12
CF -411 page 1 of 8
❑
Thermostatic Expansion Valve (TXV)
CF -6R pages 3 and 5 of 12
CF -4R page 3 of 8
❑
Refrigerant Charge
CF -6R pages 3, 5 and 6 of 12
CF -4R pages 3 and 4 of 8
❑
High EER
CF -6R pages 3 and 8 of 12
CF -4R page 5 of 8
�L �
Bi" #
City of La Quinta
Building at Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit .#
a
Oq
Project Address: cJ O
Owner's Name:
[' o
—1507 OA UPfW
A. P. Number:Address
Legal Description:
Contractor:�^
City, ST, ZipCL
Ulq
Telephone J ^ 5
'`' ti •
Address:
Project Description: Pj G
City, ST, ziq4m
UW
q V D, I 1
l - l G `%/ti / COir/Ji✓� .
Telephone: , Cp (�
State Lic. #
City Lic. #:
Arch., Eitgr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:VM,
Name of Contact Person:
J
/ l� •?Z' C
Construction Type: Occupancy:
Project type (circle one):. New Add'n Alter Repair
Demo
Sq. Ft.:
T# Stories:
# Units:
Telephone # of Contact Person: 7PI? 3� �?/7/� ?�
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACHING
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 corrections/issue
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
CERTIFICATE OF FIELD VERIFICATION & •DIAGNOSTIC TESTING (Page.I of 8) CF -4R
5
'Duct Pressurization Test Results (CFM @ 25 Pa)
Builder or Installer Name'
78-505'Avenida Tujunga / La Quinta, CA
CERTIFICATE OF FIELD VERIFICATION & •DIAGNOSTIC TESTING (Page.I of 8) CF -4R
Project Address (Sean Walker Residence)
'Duct Pressurization Test Results (CFM @ 25 Pa)
Builder or Installer Name'
78-505'Avenida Tujunga / La Quinta, CA
�_
Hyde's Air, Conditioning_
Builder or Installer Contact
Telephone'.
Plan/Permit (Additions or Alterations) Number
Hyde's Air Conditioning` °� •
(760) 360-2202
Permit #09-00000964..
HERS Rater '; ?
Telephone
Sample GroupNumber
Christopher Mcfadden - CHEERS Rater #CCNCM275794
760 449-1308
(Group #17) +.
Compliance Method (Prescriptive)
,
Climate Zone 15 `
Certifying Signature t
Date
Sample House Number
ALTERATIONS: Duct -S stem and/or HVAC E ui ment Chan a -Out ,
y Equipment g`'�.
9/21/2009
1 of 7
Firm
. HERS Provider .,
CM Energy Consulting
��
CIHIEIEIRIS '
Street Address:
City/State/Zip:
P.O. Box 4655' - •
' `
Palm Desert, CA 92261 '
.Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT
HERS RATER COMPLIANCE STATEMENT ` x
The house was: ✓� ❑ .Tested ✓? Approved as part of sample testing; but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this'form complies with
:the diagnostic tested compliance requirements as checked ✓ on this form. -The HERS rater must check and verify that the new ,
distribution system is fully ducted and -correct tape is used before a CF -4R may be released on every tested building. The HERS
rater must not release the CF -4R until a properly completed and signed CF -6R has been received for the sample and tested
buildings. - '
M. The installer has s provided a copy of CF -6R (Installation Certificate). f
N New ducts are fully ducted (i.e.; does not use building cavities as plenums or platform returns in lieu of ducts).
(S) .New ducts with cloth backed, -rubber adhesive duct tape is installed, mastic and draw bands are used in combination with .
cloth backed; rubber adhesive duct tape to seal leaks at duct connections.). -
✓• ❑ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Procedures for field,verification and diagnostic testing of air distribution systems are `available in RACM, Appendix RC4.3:
Duct Diagnostic Leakage Testing Results •� "
NEW CONSTRUCTION: r
'Duct Pressurization Test Results (CFM @ 25 Pa)
Measured
Values
.1
Enter Tested Leakage Flow in CFM:
iw
_
2
Fan Flow: Calculated (Nominal: ✓ X) Cooling ✓ ❑ Heating) or ✓ ❑ Measured M1
1600 cfm
✓
Enter Total Fan Flow in CFM:'
,
3
Pass if Leakage Percentage < 6% [ 100x `_(Line # 1) / (Line #.2)]]
❑ Pass ❑ Fail
ALTERATIONS: Duct -S stem and/or HVAC E ui ment Chan a -Out ,
y Equipment g`'�.
Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to,
t"
4
Duct System Alteration and/or Equipment Change -Out. •,.e,�,•,^_
�r.
Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System
.,
8:
5
for Duct S stem Alteration and/or` E ui ment Chan e -Out.
165 cfm
,'
Enter Reduction in Leakage for Altered Duct System (Line # 4) Minus (Line # 5)]-
"P`�`
6
(Only if Applicable)
;,s ~
7
Enter Tested Leakage Flow in CFM.to Outside (Only if Applicable) ''
✓ ✓ .
Entire New Duct System -Pass if Leakage Percentage < 6%
❑Pass ❑Fail
8
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 followingfour Test or Verification Standards for compliance.
9
Pass if Leakage Percentage < 15% [100 x [ 165 (Line # 5) / 1600 (Line # 2)]]-
10.3% -
M Pass ❑ Fail
10
Pass if Leakage to Outside Percentage < 10%,[100 x [-(Line # 7) / (Line # 2)1]
❑ Pass ❑ Fail
Pass if Leakage Reduction Percentage > 60%•[100`x [' (Line # 6) / (Line #4)]],
❑pass ❑Fail
11'
and Verification b Smoke Test and Visual Inspection '
Pass if Sealingof all Accessible Leaks and Verification b Smoke Test and Visual Inspection
�'`�
❑Pass ❑ Fail
Pass if One of Lines'# 9 through # 12 pass
.;
DO Pass ❑ . Fail
Residential Compliance Forms
December 2005
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3 of 8) CF -4R
Project Address (Sean Walker Residence)
78-505 Avenida Tujunga / La Quinta, CA
Location
Builder Name
Hyde's Air Conditioning
Builder Contact
Hyde's Air Conditioning
Telephone
(760) 360-2202
Plan Number
Permit #09-00000964 .
HERS Rater
Christopher Mcfadden - CHEERS Rater #CCNCM275794
Telephone
760 449-1308
Sample Grou Number
(Group #17)
Compliance Method (Prescriptive) (Prescriptive - Package D)
✓
Climate Zone 15
Certifying Signature
Date
9/21/2009
Sample House Number
1 of 7
Firm
CM Energy Consulting
HERS Provider
CIHIEIEIRIS
Street Address:
P.O. Box 4655
installation of the specific equipment shall be verified.
City/State/Zip:
Palm Desert, CA 92261
Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT
HERS RATER COMPLIANCE STATEMENT
The house was: ✓® Tested ✓ ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies with
the diagnostic tested compliance requirements as checked on this form.
✓ ® The installer has provided a copy of CF -6R (Installation Certificate).
✓ ® THERMOSTATIC EXPANSION VALVE (TXV)
Procedures for field verification of thermostatic expansion valves are available in RA CM, Appendix RI.
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valves
Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity
Access is provided for inspection. The procedure shall consist of
Date of Verification
✓
Yes
❑ No
visual verification that the TXV is installed on the system and
®
❑
installation of the specific equipment shall be verified.
Yes is a pass
Pass
Fail
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valves
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 (outdoor air drv-bulb 55 °F and above): _.
Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer verification
shall be documented on CF -6R before starting this procedure. If outdoor air dry-bulb is below 55 °F rater shall use the Alternative
Charge Measure Procedure
Procedures for Determining Refrigerant Charge using the Standard Method are available in RACM, Appendix RD2.
✓ ❑ Yes ❑ No A copy, of CF -6R (Installation Certificate) has been provided with refrigerant charge
measurement documented.
Residential Compliance Forms April 2005
CERTIFICATE'OF FIELD VERIFICATION'& DIAGNOSTIC TESTING' (Page 1 hof 8) CF -4R
Project Address (Sean Walker Residence)
t
Builder or Installer Name s
78-505 Avenida Tujunga /'La Quinta, CA
t
Hyde's Air Conditioning '
Builder or Installer Contact •
Telephone
Plan/Permit (Additions or Alterations) Number
Hyde's Air Conditioning
(760) 360-2202
Permit #09-00000964'
HERS Rater '
Telephone
Sample Group Number
Christopher Mcfadden - CHEERS Rater #CCNCM275794
760 449-1308
(Group #17)
Compliance Method (Prescriptive)
✓
IV
Certifying Signature
Date
Sample House Number.
ALTERATIONS: Duct System and/or HVAC. Equip merit Change -Out
9/21/2009
2 of 7
Firm
HERS Provider '
CKEnergy Consulting
Duct System Alteration and/or Equipment'Change-Out.°�
CIHIEIEIRIS
Street Address:
CERTIFICATE'OF FIELD VERIFICATION'& DIAGNOSTIC TESTING' (Page 1 hof 8) CF -4R
Project Address (Sean Walker Residence)
t
Builder or Installer Name s
78-505 Avenida Tujunga /'La Quinta, CA
t
Hyde's Air Conditioning '
Builder or Installer Contact •
Telephone
Plan/Permit (Additions or Alterations) Number
Hyde's Air Conditioning
(760) 360-2202
Permit #09-00000964'
HERS Rater '
Telephone
Sample Group Number
Christopher Mcfadden - CHEERS Rater #CCNCM275794
760 449-1308
(Group #17)
Compliance Method (Prescriptive)
✓
Climate Zone 15
Certifying Signature
Date
Sample House Number.
ALTERATIONS: Duct System and/or HVAC. Equip merit Change -Out
9/21/2009
2 of 7
Firm
HERS Provider '
CKEnergy Consulting
Duct System Alteration and/or Equipment'Change-Out.°�
CIHIEIEIRIS
Street Address:
-
City/State/Zip:
P.O. Box 4655
Palm Desert, CN 92261
Y
Copies to: BUILDER,•HERS PROVIDER AND BUILDING DEPARTMENT
HERS RATER COMPLIANCE'STATEMENT
The house was: ✓ ❑' Tested ✓ �] Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, -I certify that the house identified on this form complies with
the diagnostic tested compliance requirements as checked ✓ on this form. The HERS rater must check and verify, that the new t `
distribution system is fully ducted and'correct tape is used before a CF -4R may be released on every tested building. The HERS. .
rater must not release the CF4R until'a properly, completed and signed CF -6R has been received for the sample and tested
buildings. ,
jSJ The installer has provided a copy of CF -6R (Installation Certificate). i
M New ducts are fully ducted (i.e. does not use building cavities as plenums or platform returns in lieu of ducts).
[ New ducts with cloth backed, rubber adhesive duct tape is installed, mastic and draw bands are used in combination with
cloth backed, rubber adhesive duct tape to seal leaks at duct connections.). • -
✓ ❑ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Procedures for field verification and'diagnostic testing of air distribution systems are available in RACIVI, Appendix RC4.3.
Duct Diagnostic Leakage Testing Results
ti- •
NEW CONSTRUCTION:
Duct Pressurization Test Results (CFM @ 25 Pa)
Measured
aw-4`k '
• ;
i
Values._'.
1
Enter Tested Leakage Flow in CFM:
Fan Flow: Calculated' (Nominal: ✓ 181 Cooling ✓ ❑ Heating) or ✓,❑ Measured
,✓
2'
Enter Total Fan Flow in CFM: -
1600'cfm .
✓
3
Pass if Leakage Percentage < 6%" [ 100 x f - (Line # 1) / (Line # 2)]]
❑ Pass ❑ Fail .
ALTERATIONS: Duct System and/or HVAC. Equip merit Change -Out
,r «,.•�"
Enter Tested Leakage Flow in CFM from CCT6R: Pre -Test of Existing Duct System Prior to
4
Duct System Alteration and/or Equipment'Change-Out.°�
• ' £,
Enter Tested Leakage Flow in CFM: Ficial Test of New Duct System or Altered Duct System
for Duct System Alteration and/or Equipment Chane -Out.
115 cfm
;.•_<_rt<
Reduction in Leakage for Altered Duct System F (Line # 4) Minus (Line # 5)]
a
6
_Enter
(Only if Applicable)
7
Enter Tested Leakage Flow in CFM to Outside (Only if Applicable)
✓ ✓
Entire New Duct System - Pass if Leakage Percentage < 6%
0. Pass ❑Fail
8
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 orVerification Standards for compliance:
Pass if Leakage Percentage < 15% [100 x L___115 (Line # 5) / .1600 (Line # 2)]]
7.2%'
: 4 Pass ❑ Fail
9
10
Pass if Leakage to Outside Percentage < 10% [100 x [_(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
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection
' "' "''
❑ Pass ❑ Fail
FPass
if One of Lines # 9 through # 12 pass
" ,`,'� , _
Do Pass ❑ Fail
Residential Compliance Forms December 2005 `
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3 of 8) CF -4R
Project Address (Sean Walker Residence) -
78-505 Avenida Tujunga / La Quinta, CA
Location
Builder Name
Hyde's Air Conditioning
Builder Contact'
Hyde's Air Conditioning
Telephone
(760) 360-2202
Plan Number
Permit #09-00000964
HERS Rater
Christopher Mcfadden - CHEERS Rater #CCNCM275794
Telephone
760 449-1308
Sample Group Number
(Group #17)
Compliance Method (Prescriptive) (Prescriptive - Package D)
✓
Climate Zone 15
Certifying Signature
Date
9/21/2009
Sample House Number
'2 of 7 '
Firm
CM Energy Consulting
HERS Provider
CIHIEIEIRIS
Street Address:
P.O. Box 4655
installation of the specific equipment shall be verified:
City/State/Zip:
Palm Desert, CA 92261
Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT
HERS RATER COMPLIANCE STATEMENT
The house was: ✓® Tested ✓ ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies with
the diagnostic tested compliance requirements as checked on this form.
✓ ® The installer has provided a copy of CF -6R (Installation Certificate).
✓ ® 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 for Split System Space Cooling Systems without Thermostatic Expansion Valves
Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model -
Cooling Capacity
Access is provided for inspection. The procedure shall consist of
Date of Verification
✓
W Yes
❑ No
visual verification that the TXV is installed on the system and
®
❑
installation of the specific equipment shall be verified:
Yes is a pass
Pass
Fail
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge for Split System Space Cooling Systems without Thermostatic Expansion Valves
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 (outdoor air dry-bulb 55 °F and above):
Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer verification
shall be documented on CF -6R before starting this procedure. If outdoor air dry-bulb is below 55 T rater shall use the Alternative
Charge Measure Procedure I -
Procedures for Determining Refrigerant Charge using the Standard Method are available in RACM, Appendix RD2.
✓ ❑ Yes ❑ No A copy of CF -6R (Installation Certificate) has been provided with refrigerant charge
measurement documented.
Residential Compliance Forms April 2005
INSTALLATION CERTIFICATE (Page 3 of -12), CF -6R
Site Address (Sean Walker Residence) Permit Number
'74-849 Chateau Circle / Indian Wells, CA Permit #09-00000964
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: _ T
Heating Equipment '
Equip Type
(pkg. heat um
CEC Certified Mfr.
Name and'Model
Number
# of.Duct
Identicl
S stems>_CF-IR
Efficiency
(AFUE, etc.)
value)'
Location
attic, etc.
Duct or
•Piping
R -value
Heating
Load
Btu/hr
Heating
Capacity
(Btu/hr)'
Furnace
American Standard:
1
80% AFUE
Ducts In Attic
R - 8.0
53,200 Btu/h
90,000 Btu/h
Furnace
American Standard:
1
'80%o AFUE
Ducts 1n Attic
R - 8.0
53,200 Btu/h
90,000 Btu/h
Cooling. Equipment
Equip Type
(pkg. heat um
CEC Certified Mfr.
Name and Model,
Number
# of
Identical
S stems>_CF-1R
Efficiency '
i
(SEER or EER)
value)
Duct
Location
attic, etc.
Duct
R -value
Cooling
Load
Btu/hr
Cooling
Capacity
Btu/hr
Split System A/C
American Standard:
4A7Z0048A1000BA
1
18.0 SEER
Ducts In Attic
R:- 8.0
38,800 Btu/h
48,000,Btu/h
Split System A/C
American Standard:
'4A7Z0048A1000BA
1
18.0 SEER
Ducts In Attic
R - 8.0
38,800 Btu/h
48,000"Btulh
1. > symbol reads greater than or equal to what is indicated on the CF --]R value.
Include both SEER and EER if 'compliance credit for high EER air conditioner is claimed.
✓ ®I I, 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.
i
'�' �:
Copies to: i3 D G DEP RTME T, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms April 2005
Installing Subcontractor (Co. Name) OR General
Contractor Name) O Owner-
o.
Signatur
UVID
'�' �:
Copies to: i3 D G DEP RTME T, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms April 2005
` INSTALLATION CERTIFICATE , (Page 4 of 12) CF -6R'
Site Address (Sean Walker Residence) Permit Number
74-849 Chateau Circle / Indian Wells„CA . Permit #09-00000964
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 FOR NEW DUCTS: -
10 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. ,
V) 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.
•M Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used on new ducts.
t
✓ ® DUCT LEAKAGE REDUCTION
Procedures forfield verification and diagnostic testing of air. distributions stems are available in RA CM, Appendix RC4.3
. 1
-NEW
CONSTRUCTION: `` • •
Int
•
Duct Pressurization Test Results (CFM @ 25 Pa)
Measured
Wim'
igna
Values
1
• Enter Tested Leakage Flow idCFM:
7e •�,
Fan Flow: Calculated (Nominal:,✓ N Cooling ✓ ❑ Heating) or ✓,❑ Measured '
.'
2
If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21.7 cfin/(kBtu/hr) x Heating
.1600 cfm
`✓
Capacity in .Thousands of Btu&,& enter total calculated or measured fan flow in CFM here:
✓
3
Pass if Leakage Percentage <,.6% for Final or < 4% at Rough -in without air handle:
❑Pass 11 Fail
100 x Line # 1 / Line # 2 I
ALTERATIONS:
Duct System and/or HVAC Equipment Change -Out
Enter Tested Leakage Flow in CFM from Pre -Test of Existing'Duc't System Prior to Duct
r r
4 ”
System Alteration and/or Equipment Change -Out.'
Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct
165 cfm
' •'=`�
5
System for Duct System Alteration and/or Equipment Chan e -Out.
Enter Reduction in Leakage for Altered Duct System'"•
6
Line # 4 "Minus Line # 5 (OAIif 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 VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change-
✓ ,, ✓ -
Out Use one of the following four Test or Verification Standards for compliance: 3
9
'Pass if Leakage Percentage < 15% [100 x [ 165 (Line # 5) / 1600 (Line # 2)]]
10.3%
N Pass ❑ Fail
10
Pass if Leakage to Outside Percentage < 10% [100 x r (Line # 7) / (Line # 2)]]
❑ Pass ❑ Fail
Pass if Leakage Reduction Percentage > 60% [100 x f (Line # 6) / (Line # 4)]]
❑1pass ❑Fail
11
and Verification b Smoke Test and Visual Inspection
P
Pass if Sealingof all Accessible Leaks and Verification b Smoke Test and Visual Ins ection --
'; -,.: _+:
❑ Pass ❑ Fail
• : Pass if One of Lines # 9 throw h # 12 ass
.'
M Pass. ❑ Fail
✓ ®I, 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.
k-1 v
Copies to: BUILDIN DOE T, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms December 2005
Int
(ling ubcont�raclt-or o. Na �- R General Contractor (Co. Name) OR Owner
}
igna
Date:
k-1 v
Copies to: BUILDIN DOE T, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms December 2005
INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R
Site Address (Sean Walker, Residence) Permit Number
74-849 Chateau Circle / Indian Wells,'CA Permit #09-00000964
✓ ® THERMOSTATIC EXPANSION VALVE (TXV) '
Procedures for field verification of thermostatic expansion valves are available in RACM, Appendix RI.
Access, is provided for inspection. The procedure shall
consist of visual verification that the TXV is installed on
✓ 14 Yes O No the system and installation of the specific equipment ® ❑
1. shall be verified.
Yes is a pass Pass Fail
✓ ❑ 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 (Treturri, db)
Outdoor Unit Make '
OF
Outdoor Unit Model
Cooling Capacity
Btu/hr
Date of Verification'
OF
Date of Refrigerant Gauge Calibration
(must be checked monthly)
Date of Thermocouple Calibration
(must be checked monthly)
Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above):.t
'Procedures for Determining'Refrigerant Charge using the Standard Method are available in RA CM, 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 (Treturri, db)
OF
Return (evaporator eritering) 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 Charge Method Calculations for Refrigerant Charge
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
Cnlit V,,thnd Cnirvintinn iv not nPrP.c.cnry ifAdeaunte Air/lnw rrPdit i.c 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 -
eF
3°F and +3°F or, up Ion remeasurement, if between -3°F and -100°F
Residential Compliance Forms April 2005
a
• ' INSTALLATION CERTIFICATE . • (Page 4 of 12) CF -6R
Site Address (Sean Walker Residence) Permit Number "
74-849 Chateau Circle /-Indian Wells, CA • Permit #09-00000964
INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE
INSTALLER COMPLIANCE STATEMENTThe building was: ✓ OTested at Final ✓ ❑ Tested at Rough -in
INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE FOR NEW DUCTS:
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. -
N Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used on new ducts.
✓ ® DUCT LEAKAGE REDUCTION '
Procedures or geld verification and diagnostic . testinof air distribution systems are available in RA CM; Appendix RC4.3
NEW CONSTRUCTION:
'
Duct Pressurization Test Results CFM 25 Pa)Measured
( @
Signa e:
Date: ' l
Values
1' •
Enter Tested Leakage Flow in CFM:
Z
^
Fan Flow: Calculated (Nominal: ✓ N Cooling ✓ ❑ Heating) or ✓ ❑ Measured
2
If Fan Flow is Calculated as 400'cfm/ton x number of tons oras 21.7 cfim/(kBtu/hr) x Heating
1600 cfm
Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here:
✓ '
3
<
Pass if Leakage Percentage < 6% for Final or 4% at Rough -in without air handle:
❑ Pass ❑ Fail
100 x Line # 1 / Line # 2
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.
3
Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct
115
L '
5
System for Duct System Alteration and/or Equipment Chan e -Out: +
cfm
-- >
E:;:=_,`�:.�s
Enter Reduction in Leakage for Altered Duct System
''• �'
6
Line # 4 Minus Line # 5 —(Only if Applicable)
t _ ,r`
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)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 [ __-L15 (Line # 5) / .1600 (Line # 2)]]
7.2%
M 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 [.(Line # 6) / (Line # 4)]]
❑pass ❑Fail
11
and Verification by Smoke Test and Visual Inspection
rC2
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual'Ins ection'
"'',.'
❑ Pass ❑ Fail
'Pass if One of Lines # 9 through # 12 • ass
` '"
W Pass ❑ Fail
✓ ®I, 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. -
F
Ins a ng S bcontr))acto�r (C% NamMRneral Contractor (Co. Name) OR Owner
'
Signa e:
Date: ' l
Copies to: BLTiL'DING D PA TMENN, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY .
Residential Compliance Forms December 2005
INSTALLATION CERTIFICATE
(Page 5 of 12) CF -6R
Site Address(Sean Walker Residence) Permit Number
74-849 Chateau Circle / Indian Wells,"CA Permit #09-00000964
✓ '® THERMOSTATICEXPANSION VALVE (TXV)
Procedures for field verification of thermostatic expansion valves are available in RA CM, Appendix RI.
Access is provided for inspection. The procedure shall
consist of visual verification that the TXV is installed on
✓ Yes ❑ No the system and installation of the specific equipment ® ❑
shall be verified.
Yes is a pass I Pass I Fail
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
Thermostatic F.xnansinn Valves _
Outdoor Unit Serial #
Location
Return (evaporator entering) air dry-bulb temperature (Treturn, db)
Outdoor Unit Make
OF
Outdoor Unit Model
Cooling Capacity "
Btu/hr
Date of Verification
OF
Date of Refrigerant Gauge Calibration '
(must be checked monthly)
Date of Thermocouple Calibration �
(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 RA CM, 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)
°F
Superheat Charge Method Calculations for Refrieerant Charge
Actual Superheat = Tsuction, db — Tevaporator, sat
°F
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
.Snlit Method Calculation is not necessary ifAdeauate 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