06-1821 (MECH)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO . FAX (760) 777-7011
LA QUINTA,CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT, INSPECTIONS (760),777-7.153
DING
. n. BUIL PERMIT
Date: 5/08/06
Application Number: 06-00001821 Owner:
• Property Address: 54099 SOUTHERN HILLS LINDEN HAL/FRANCES
APN: 775-101-040 - - 540-99 SOUTHERN HILLS.
Application description: MECHANICAL LA QUINTA, CA .92253
Property Zoning: LOW DENS3T.Y RESIDENTIAL
Application valuation: 0
D A
Contractor:
Applicant: Architect or Engineer: DANCY HVACR, MIKE
P.O.' BOX 1567 MAY 0 8, 2006 .
INDIO, CA 92202
(760)775 -07 50
Lic. No.: 374657 CITY OF LA QUINTA
.. ....FIN
" - 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.. - _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C20-38 License'No.: 374657 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
I issued. _
Date ��(O Contractor: I �. - —.1 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 -BUILDER 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 EXEMPT-, 11 / 3 0 / 0 6olicy Number EXEMPT
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
rti 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,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State - andagreethat, if I should become subject to the workers' 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 forth 'th comply with those provisions. `
that or she exempt therefrom and the basis for the alleged exemption. Any violation Section 7031.5 by L �� �
-
any applicant
cant for a permit subjects the applicant to a civil penalty of not more than five hundd red dollars IS5001.: .Date: 6 Applicant:. ,
(_) -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: FAILURE TO SECURE WORKERS' COMPENSATION 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, provided that the - _ 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 orshe did not build or
improve for the purpose of sale.).' ' . APPLICANT ACKNOWLEDGEMENT
(_) I, 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 permit 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 orimprovesthereon, 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 am exempt under Sec. , B.&P.C. for this reason - 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. - -
Date: - Owner: 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 -
- _- CONSTRUCTION LENDING AGENCY - - - permit to cancellation.. " - - -
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that 1 have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec..3097, Civ. C.): - _ .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 inspection purposes.
Lender's Name: '
�' - • Date:0� Signature (Applicant or, Agent):
Lender's Address:
LQPERMIT
Application,Number . . . 06-00001821
Permit MECHANICAL
Additional desc_
Permit Fee 40.50
Plan Check Fee ".
10.13
Issue Date.
Valuation"
0'
Expiration Date 11/04/06
Qty Unit Charge Per
'Extension
BASE
FEE'
15.00
" 1.00: 9.0000 EA MECH
APPL REP/ALT/ADD
9.00
1.00 16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU'
16.50
Special Notes and Comments
REPLACE A/C WITH 5 TON 10 SEER UNIT..
Fee summary Charged
Paid Credited
Due.
�
Permit Fee Total -40.50
.00 .00
40.50
Plan Check Total 10.13
.00 .00
10.13
Grand Total 50.63
:00 .00
50.63
LQPERMIT
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampito
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
V
Project Address:' � a o
Owner's Name: I L N D� ti.
A. P. Number:
.
Address: 5-4c-,
Legal Description:City,
Contractor: N c y
ST, Zip:
Telephone: -T'f — p 2 i
Project Description:
lAce- .t?&,0+p . LW I
Address: D zF0 x
City, ST, Zip: O (.!4 . 91-7
Telephone: 6 S D %S O
City Li -c. #:
State Lie. # : to 7
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:c�
G .4 N G i
Construction Type: Occupancy:
Project type (circle on'e): New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person: '7 7�-- 0 75 0
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
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'correctionsrissue
Electrical . .
Subco ntactor. 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 c'orrection's/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
Certlume or, Com Nance Pti+scira We
od - HVAC-onl �41b�ra�on, CF -1 R ALT -
Project title: `
Date:
t� CaICERTS 2005Project I
Address:
9 Swrg"p «
ne:Bu&ft
POWA S
06-
DocumentationAuthor '•` • `
Mmp� � • ��'NG Y � %�l� •, ... -•
D%MCtkex* Data t
, Check Date Y • �' •
IMPORTAftdT: This CF -1R -ALT form is onlyfoi-.use when an HVAC -only alteration is made to an existing home
Usi one form for each m bent altered. This is em # of systems attered in this house.
Scope of Alterations:
1 ❑ . AR is to ba wed a . Dud to be ddwn*mmi . Continue to vert Ikhe.
2.0 Frt nwe heat is to be bmided or r . OWswftitobeddermined. Continue to nett Ibee.
3 i' auidoar cmdwtWM unit Is to be Welled or Dud Searmo andfor iXV(RCA) to be determined. Continue to neod tine.
4 ❑ar cal is to bs ketaled a . Duct and for TXV CJ1 to be deterinined. Continue to next tine.
5 ❑ than 40 teat d new or repboemerd dud are to be Installed In 1 space. Duct ceasing to be deter trod. ;.
O Chook here ff the SM dud am Is oleo to be new a replaced. Continue to rant line. s
6 ❑ mane of Unes 1-6 are ahscked neither Duct Seeift rwrTXVOMM are reauired. Go to section 5. r•
Section 1- Dud SedinfIlOnly if any of Vnes 1 3 4 or 5 are checked. Sldp if Line 6 is checked.
7 ❑ 018tM Is In CWn9b Ione 1, 3.4..S. ti 7 or S.. No dud sealing Is required. Go to Section 2.
8 ❑ wdern hn tale ttharn 40 feet of duds in u mm&ioned since, No dud mdrtg is reqtdred. Go to Section 2.
9 D Wdern wan ptevlauaty sealed and tasted, acrd was oertU ed by a HERS rater. '.
Is required. Attach wevibus CF4R fano CM to Section 2: ,
10 ❑ Mile, dud MMOM is whaled or irnsrdeted with asbestos-. No dud sydro is required. Go to Section 2. +
Note: If the 2pft duct system Is to be new or replaced, Lines 11-14 do not
11 ❑ ' 2 16: An 0.92 AFUE wit be to d dud Txv H
12 ❑ . n Cirrmte Zones 10, 13 end 15: An SEER 14 AM EER 12 condenser wig be Installed with TXV(RCA)
added dud Insulation -4 an R-8.new ducts In Gnu dduct . Cioto Section 2+
13 • D n CUrideZones 9; 10,11,13, 14, or 15: An SEER 14 MUEER 12 condenser win be bhstdw whh TXV(RCA).
a 0:92 AFUE fumme will the butW din leu of dual seaUng^ Cao to Sedion 2.
14 n Caste Za se 2, 9,11,12,14 or 16: An SEER 14 AEI EER 12 condentei wit be Installed with TXV(RCA)
an 0.82 AFUE home wig be Installed with InCrio ad dud insulation to tieu of dud . tic to Section 2. ;
15 2� of How 7.14 above ane cheoked. Duet Sealing Is Raped. Cardinue.
M1
Section 2 - TX O if Unes 3 or 4 are check otherwise to Section 3 r
16 D (s a anti. No'rXVMCAJISMMClo tosection 3. +
17 ❑ This system is In Cemate Zone 8 ad a 14 SEER air conditioner a< 0.82 AFUE fumace Is being bmtelled-
No TXVUtCAis Mgkod. Cao to Batton 3.
18 ❑ Ztxre 1 3 4 fi 8 a 7, NolMiMisraguired. Cao to Sediovh -
19 D TIft Wdern Is In ClimidsZone 16 and 14 is not ghmw. NoTXV is uired. Caoto Section 3. y
20 Q IThis a
latern as In Cllr ots Zane 16 amt Une 14 Is checked and rut sine 16. M(RCAllaregadred. C;ro to Section 3.
210 M eyetem Is In Climate Zone 2 or 8-18 and Une 11,16 or 17 is not checked. TXV(RCA) Is required. Go to Section 3.
Section 3 - HERS Rater verification
22 0"tf tire 15 is ohecked HMS verification IS red for hunt
23 ❑ One 12, 13;14, 20 a 21 arechecked and not One 16 or 17. HERS verllcattan Is for TXV RCA .
24 ❑ tine 12,13 or 14 are checked, HERS lrefiNcatton Is required far 12 EER.
Section4--EguigmentEfficiencies
250 Inas 11, 12.13.14 or 17 we checked, upgraded equperherd affldancies are requtred. List to Section & . .
Section 5- Duct R -Values •-Y r �.
28 ❑ kfnxxe1hen40feddduotis Installed or wimped. dud R -value must meet or eocaeed Pockme O uirement&
27 D t lees than 40 feet of duct is Ihstalad or dud R-vdue must meet or mxwd R-4.2 2
Section a -see nod Deas
Version 03-10.08 Page 1 of 2
This form can only be used on projects being verified by CaICE_RTS certified raters..{ www.caicerts.com
► - /• ; .: fi. `. Y + ._ . , • 'fit• - .
Certillcate of Cofnpliance Prescriptive Method - FfVAC-only Alteration CF -IR -ALT
Project I MI.
ZIMM
® CaiCERTS 2W5
use o AchI F1 4nly for tree when an HV
Use one tixrrr for each s m altered. Ttrla is alteration Is made to an existing home
Section 8 - Regr4reme for EquEpment to be Ilitsbabrrsdalled/Aftered. akered M tilts house.
d avWsnt meet match 28 tvalusrt s O Un / O N
29 ❑
30 ❑ Gel".hA"°OD AFUF- D FAU t7 ronrc F/1tJ COther
31 td
32 ❑ OHM
OW tete Of compliance AWs the bufldirV features and epectileetions needed to enw.l.,.,
xnrn -.A- -8 e�..�u__-
• •-yNw•�• aRi UM'umffWnU re regulaboms
1110" Vft overd prviect responeiaAty, The Undersigned
ttteuga, and TXV require kwhWer testing and cerncotion and
Home Owner or AtMorkid- Agent—
Name:
5 Morose: h/ � 4 9 Sa u.T�+��t ,t� �
to impkment ijam. ,jL . w a.Rr O or me
m0gruft #0 certlflptB has been signed by the
inguct9a g� verification of refHgerart
veriRCetion by an i HERS rat".
DocumertEatiort Aubw
Name: J
► Name: { r
Phone:
7? l 2
hemp:
ND/a N �1�� o f
Phone:
0 775— 0 7•�0
Sigro
rsaturo:
mature:
NotesrCom menta:
Name:
Department:
Phone t
Fax 0:
SIgn@Iure or Stamp:
rorrns:
T: by arryone. Required at time of permit application. Copies to home owner, erdwcemert agency, HERS nater.
T. by UrstelNtg contractor. Required to dose permit Copies to home owner, enforcement agency, HERS rater.
T: by HERS rater. Required to dose permit. Copies to home owner, enforcement agency, installer. The CF4R torms for a
This form can only be used on projects be ng verified by CaiCERTS certified raters. www.calcerts.com
Certificate of CorrtDGance Ax-*k—.a —_.-- a.
--- ••••••�•••••
Title:
Date:
rauun GF -7R -ALT
®CaICERTS 2005
.sY C S�L&7w a
(mate no:
16
Peorrnil
06 - /�21
metltatton Author. Telephone:
Company Name:
im Ctaadc Date oS-$- o�
check i>de
IMPORTANT: This CF -IR -ALT form is oniyfoi use when art HVAC -only alteration is made to an existing home
Use one form for each s m being altered. This is system # of sYstems altered In this house.
Scope of Alterations:
ir Handler to to be ke tdW or . Duct 10 be deiamtned. Carttinus. to next Gni.
1 ❑EAU
2 ❑❑/ is to be k%dw dor Dud to be ddwffgned. Continue to nod tine.
3 ItlMdoar WRbtobewedor roylaoedDuctSealingendlor TXV(FtCiU to be ddeffnkmd. Con lnue to next ane.
4 D ar eaoisto be kowisd or Dud and/or TXv tobe determined. C xd"enueto nodflan.5 ❑than 40 teal or now or replaoemmal! dud are to be Installed in tmtmttd6i0tledspaoe Dud sealing to be determined.
(3 Check here ff the ydM dud system is also to be now or Continue to now line.
6 ❑ crone Of Thee 1.b are chocked neither Duct Seaft ncr TXV areMMIM t3o to sadism S.
Section 1 - Dud Sealin if anY of Lines 1 3 4 or 5 are checked. Sldp tf Une 6 is checked.
7 ❑ is In Cl nge Zone 1.3,4,5,'S, T or8.. No dent seal Is Go to Section 2.
8 ❑ tnds widen, has lees then 40 feet of ducts in wwondtbned gme, No dud easy b . Go to section 2.
9❑ system was prevt w* sealed and tested. and was cettilied by a HMS velar.
b . Attach CF -4R form. Cfo to on.2.
10 ❑ dud welem In sealed. cr LwAded with asbestos.. No dud GmAnG is mguiffld. Go to section 2.
Note: If the mg1m dud sYstem is to be new or replaced, Unes 11-14 do not
11 ❑ e 2 16: An 0 Al=t1E wig be h leu d duct TXV it
12 O Ctkreate Zones 10,13 and 15: An SEER 14 MU EER 12 ca ndanaerwig be hagalled with TXV(RCA)
added duct heaubtion an 61G R-8.reew duds In meal of duct . Go to Section 2.
13 ❑ n CYmaleZones 9, 10,11,13, 14, or 15: An SEER 14 AM EER 12 condenew wR be Frusta with TXv(RCA)
a 0.92 AFUE fumaoe wR be b dww in leu d dud aee>irg. Go to Section 2.
14 n Comate Zane 2,1:,11,12,14 or 16: An SEER 14 A[!Lt EER 12 condehs* will be kotWW with TXv(RCA)
an 0.82 AFUE furnace wll be badEMad with ireaeaeed dud inaufetion In pea of dud welky. Go to Section 2.
15 I$' of fines 7-14 above are cheoked. Duet 8eafinp k Requked. Confiinue.
Section 2 - TX RCAI (Only if Unes 3 or 4 are check otherwise got to Section 3
16 D
Is a unit. No TXv is requived. Go to Section 3.
17 ❑
This Wdwn Is In Clmede Zone 8 avid a 14 SEER air oonditw or 0.82 AFuE fumme is being kwelied.
No TXV is mpkW. Go to Section 3.
18 D
19 ❑
kNOZOM 1 3.4.6.6 or 7. No JVM is rawfired. Go to Section 3-
ThIGIVIdOm 10 in Cleats Zone 16 and pne 14 is not . NOMWAlsvegubed. Go to Section 3.
20 ❑
em b h cymete Zone 16 and fine 14 b chocked end net Ina 18. TMfM)lsreQUke& Go to Section3.
'Pnk
21 ❑
amtem b In Clmate Zana! 2 or 8-15 and One 11,16 or 17 Is not checked. TXV(RCA) is required. Cao to Section 3.
Section 3 - HERS Rater verification .'
22 W lrn 15 is Hma verrlcathar is red far Duct
23 Done 12,13,14, 20 or 21 are checked and nd line 16 ar 17, ttFM verMlmdan b MpAred for TXV RCA .
24 ❑ lvn 12,13 or 14 sae chocked, HERS vervkjg rr is required far 12 EER.
Section.4 - Equipment Efficiencies
25 D ones 1,,12, ,3,14 a 17 se ctreclred, uppreded aqu4mnra em*ncirs are requtred. teat in Secow C
Section 5- Duct R -Values
26 ❑ mai than 40 test of duct is being inetaped or . dud R -value must meet or exceed P e D mquirements.
27 ❑ kf lees than 40 fast d duct is beft knstaled or m0aced, dud R-vekve must meet or exceod R-42
action 6 - we nod owe
rwrdevri yr rv-w Page 1 of 2
This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com
Certif Ste of Compliance Prescripteve Method _ HVAC-Oraly Aitmtiooe CF -IR -ALT
5--t-4'6 ® Ce9xRTS 2005
t1dPORTANT: Tft CFIR,ALT form to ortty for use d an HV
ilea one form for each m altered. This k a�erafbn � made to an exietirtg frame
* ffmt must a for Equipmrarrt to be trattalfsd/ Syste altered in of houee.
! TT Fz eQ ' db w� ami mat a 6—" ellciaroiasIR values N 5�
290 Hend�x� that
300 'ti'"°O° - o
FAtJ F/HJ GOrrier p_.
31 17-
32 0 .,. • i7 �. , ._
oar fkute of compliance !fs the butkIkV features and specificcat one
VWtfai Ali/7 _ Y.M YIC
°' andteetk* andceitiiicatlOnand
Home Owner or ent
Name:
5 h/o 4 9 u.T,*s-t�.
/Statel7lp:
Pticne:
Tt -2 2�-
Gnpierttett them. 71ua -' ' ` •,•� ' w,a o or me
has Wen signed by the
v UWcomipliance t n9 t eeaprg, ved6catlon i n:ll rant
by an approved HERS rater.
motion A WW
Name:
Ck A A16 V
Company Name:
L
�ND/a � l�� o'(
6 0 77.5- a Iso
nature:
NotesConmerta:
TW
Department:
Doh" �
Fax t1;
Signature or Stamp:
■iw mlim
R -ALT: by wriane. Required at time of permit appliicadon. Copies to home owner, enforcement agency, HERS rater.
R -ALT: by installing contractor. Required to dose permit. Copies to home owner, enforcement agency, HERS rater.
R,ALT: by HERS rater. Required to dose permit. Copies to home owner, entomemeni agency, Installer. The CF -411 tomes for a
TMs tone can only be used on projects belt verified by CaICERTS certified raters. www.catcerte.com
IF Pint Form
1
INSTALLATION CERTIFICATE (Page 3 of 12) CF -6R
Site Address Permit Number
54-099 Southern Hills, La Quinta
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The
information provided on this form is required) After completion of final inspection, a copy must be provided to the building
department (upon request) and the building owner at occupancy, per Section 10-103(a).
HVAC SYSTEMS:
Heating Equipment
Equip Type
(pkg.heatpump)
CEC Certified Mfr.
Name and Model
Number
# of
Identical
Systems
Efficiency�
('FUE, etc.)
(aCF-1Rvalue)
Duct
Location
(attic, etc.)
Duct or,
Piping
R -value
Heating
Load
'(Btu/hr)
Heating
Capacity
(Btu/hr
r-
ii
Cooling Equipment
Equip Type
(pkg. heat pump)
CEC Certified Mfr. # of
Name and Model Identical
Number Systems
Efficiency
(SEER or EER)
(aCF-1R value)
Duct Duct
Location
(attic, etc.)
Duct
R -value
Cooling
Load
(Btu/hr)
Cooling
Capacity
(Btu/hr)
6PI-t 7- Ale-
r-
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. ,
✓ �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.
Installing Subcontractor Co. Name OR Genera
Contractor (Co. Name) OR 07,,er Mike Dancy HVAC
Signature:
Date:
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms April 2005
I�
INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R
Site Address Permit Number
-e-D \ma /1-�-��TA . 0 ;Z/
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:
p' 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
✓ DUCT LEAKAGE REDUCTION
Procedures for field verifiralion and diaonnclir tvclino afair dicirihulinn cvc/amc am nvailahlo in RAd-W Annosd:v Rd -,d ?
NEW CONSTRUCTION:
Installing Subcontractor (Co. Name) OR General
Contractor (Co. Name) R Owner
Duct Pressurization Test Results (CFM @ 25 Pa)
MeasuredValues
Signature:
Date:
1
Enter Tested Leakage Flow in CFM:
Fan Flow: Calculated (Nominal: ✓ Cooling ✓ D Heating) or ✓ D Measured
2
If Fan Flow is Calculated as 400 cfin/ton x number of tons or as 21.7 cfin/(kBtu/hr) x Heating
QD Q
✓
Capacity in Thousands of Btu/hr output, enter total calculated or measured fan flow in CFM herd:
✓
3
Pass if Leakage Percentage5 6% for Final or :5 4% at Rough -in: -
❑ Pass ❑ Fail
100 x[_(Line # 1 / ine # 2
ALTERATIONS:
Duct System and/or HVAC Equipment Change -Out a
Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct
4
System Alteration and/or Equipment Change -Out.
5
Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct
System for Duct System Alteration and/or Equipment Change-Out.
Enter Reduction in Leakage for Altered Duct System
6
r ine # 4 Minus—(Line # 5 —(Only if Applicable)
7
Enter Tested Leakage Flow in CFM to Outside (Only if Applicable)
✓" ✓
8
Entire New Duct System - Pass if Leakage Percentage:5 6% for Final,
❑ -Pass ❑ Fail
rloo 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 :5 156/6 [100 x [ (Line # 5) /9QOO (Line # 2)11
3
❑ Pass 11- ail
10
Pass if Leakage to Outside Percentage :5 10% [100 x L (Line # 7) / (Line # 2)]]
❑ Pass ❑ Fail
Pass if Leakage Reduction Percentage>: 60% [100 x L_(Line # 6) / (Line # 4)]]
11
and Verification b Smoke Test and Visual Inspection
D Pass ❑Fail
12
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and,Visual Inspection
s ❑ Fail
Pass if One of Lines # 9 throu h # 12 pass
Inass ❑ Fail
✓ 101, 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.
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms September 2005'
Installing Subcontractor (Co. Name) OR General
Contractor (Co. Name) R Owner
Signature:
Date:
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms September 2005'
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 of 8) CF -4R
Project Address
54-099 Southern Hills, La Quinta
Duct Pressurization TResults (CFM 25 Pa)
Builder Name
Hal Linden
Builder Contact
Hal Linden'
Telephone
760.771.2922
Plan Number
HERS Rater
Dennis Hebert
Telephone
760.779.5161
Sample Group Number
Fan Flow: Calculated (Nominal:" ✓ Cooling ✓ ❑ Heating) or ✓ ❑ Measured
Compliance Method (Prescriptive)
;, ✓ ✓
Climate Zone 15
Nifying Signature
0 J &�2)_
Date
%�"�
Sample House Number
Firm .
Air Management Services
Pass if Leakage Percentage <_ 6% [ 100 x [ (Line # 1) / (Line # 2)]]
HERS Provi er
CHEERS
Street Address:
73-408 Buckboard Trl.
'
City/State/Zip:
Palm Desert, CA 92260
Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT
HERS RATER CQCE 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, 1 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 HER rater
must not release the CF 4R until a properly completed and signed CF -6R has been received for the sample and tested buildings.
The installer has provided a copy of CF -6R (Installation Certificate). ,
❑ New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts).
❑ New systems where 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• with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. k
4
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:
Duct Pressurization TResults (CFM 25 Pa)
Measuredest
Values
1
Enter Tested Leakage Flow in CFM:
2
Fan Flow: Calculated (Nominal:" ✓ Cooling ✓ ❑ Heating) or ✓ ❑ Measured
��
;, ✓ ✓
Enter Total Fan Flow in CFM:
3
Pass if Leakage Percentage <_ 6% [ 100 x [ (Line # 1) / (Line # 2)]]
❑ Pass ❑ Fail
ALTERATIONS: Duct System and/or HVAC Equipment Change -Out
M
Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to
4
Duct System•AIteration and/or Equipment Change -Out.
Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System
r
5
for Duct System Alteration and/or Equipment Change -Out.
""�
Enter Reduction in Leakage for Altered Duct System (Line # 4) Minus • (Line # 5)]
6
(Only if Applicable)
7
Enter Tested .Leakage Flow in CFM to Outside (Only if Applicable)
8
Entire New Duct System = Pass if Leakage Percentage <_ 6%
❑Pass ❑Fail
[ 100 x [_(Line # 5) / Line # 2)1] .
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 [G45 (Line # 5) /x-00 C) (Line # 2)]]
3� 3
0 PassV Fail
10
Pass if Leakage to Outside Percentage s 10% [100 x [ (Line # 7) / (Line # 2)]]
❑ Pass ❑ Fail
I I
Pass if Leakage Reduction Percentage >_ 60% [100 x [ (Line # 6) / (Line # 4)]]
E] Pass E] Fail
and Verification by Smoke Test and Visual Inspection I
12
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection
NUI Pass ❑ Fail
Pass if One of Lines # 9 through # 12 pass
Pass ❑ Fail
Residential Compliance Forms April 2005
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3 of 8)
CF -4R
Project Address
54-099 Southern Hills, La Quinta'
Builder Name
Hal Linden
'
Builder Contact
Hal Linden
Telephone
760.771.2922
Plan Number
HERS Rater
Dennis Hebert
Telephone
760.779.5161
Sample Group Number
Yes is a pass Pass Fail
Compliance Metho (Prescriptive)
Climate Zone 15 '
rt fying Signature1
Date
Sample House Number
FtM
Air Management Services x
HERS Provider
CHEERS
f!
Street Address:
73-408 Buckboard Tri.
City/State/Zip: ,
Palm Desert; CA 92260
Copies to: BUJLDER, HERS PROVIDER AND BUILDING DEPARTMENT +,
HERS RATER OIVIPLIANCE 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
the diagnostic tested compliance requirements as checked'on this form.
✓ The installer has provided a copy of CF -6R (Installation Certificate):
a
✓ THERMOSTATIC EXPANSION VALVE (TXV) '
• r
Procedures for field verification of thermostatic expansion valves are available in RACM, Appendix RI.
✓ ✓
Access is provided for inspection. T e procedure shall consist o
✓ Yes
O ' 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