The URL can be used to link to this page

10-1278 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: CTO=00001278- Property Address: 48517 VIA AMISTAD APN: 646-122-026- - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 12949 T4tvl,4 4 a" Applican • �✓�1 v .Architect or En neer: d -cam Al ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License C ss:C20 License No.: 686310 Date- lJ Contrac 1 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 ($500).: , (_ 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 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 I am exempt under Sec. , B.&P.C. for this reason .Date: Owner: . CONSTRUCTION LENDING AGENCY 1 hereby affirm under penalty of perjury that there is a construction lending'agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name:._ Lender's Address: LQPERMIT . - Owner.: CALHOUN GARY 48517 VIA AMISTAD LA QUINTA,. CA 92253 (760)574-2S82 lDi VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/22/10 Contractor: GENERAL AIR CONT NI r� 31170 RESERVE D IV THOUSAND PALMS,' CA 9 (760)343-7488 Lic. No.: 686310 ltiat. E �jNT�4 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 EVEREST NATL Policy Number 7600006147101 _ 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 co ply with those provisions. Applicant: WARNE TO SECURE WO KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINESUPTO 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. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this countyto tt►oo enter upon the above-mentioned property for ins ction purposes. Dater -L/ 1 Signature (Applicant or _Agentl: :I LQPERMIT Application Number . . . . . 10-00001278 Permit . . . . MECHANICAL Additional desc . Permit Fee 33.00 Plan Check Fee 8.25 Issue Date Valuation 0 Expiration Date 5/21/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH.FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 ---------------------------------------------------------------------------- Special Notes and Comments HVAC UNIT CHANGE OUT 13 SEER'2007 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due `Permit Fee Total 33.00 .00 00 33.00 Plan Check Total 8.25 .00 .00 8.25 Other Fee Total. 1.00 .00 .00 . 1.00 Grand Total 42.25 .00 .00 42.25 S 0,4ddresi. Fnforcement encv: Date: Permitl:. Equipment T e' List Minimum Efficient z Duct insulation requirement Conditioned Flooi Area Thermostat Cl Packaged Unit Furnace o ❑ AFUAW6 ❑ COP_ Over 40 ft of ducts added or II Vetback .indoor Coil I ❑SEER ❑ HSPF replaced in unconditioned space ❑ R 6 (CZ 10-13) Served by system sf (If hot already present, must be ondensing Unit ❑EER ❑Resistance ❑ Other ❑ R 8 (CZ 14-15) installed) 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and signed. Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final Inspection. 1. HVAC Changeout Required Forms: CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS • All HVAC Equipment replaced . CF -4R forms: MECH= 21 and fors lit systems) MEC4-25 • Condenser Coil and/or • Indoor Coil and /or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Furnace CF -4R forms: MECH- 21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA >_ 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: • Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS ducts: (all new ductingted all CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25 new equipment) For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 linear feet of duct in unconditioned space. For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance 'forms, worksheets, calculatiMplans ands ecifi ons submitted to the enforcement agency for approval with the i applicil (i. Name: r o t /^ Q 1 Signature: CaPKL Company: -- `" _ _ _ L/ -njDate: `1 l�� 0 Address: Le LQ (-CA A j��= e r� License: /— City/State/Zip: 71 _ Phone: 0 , "� Lun Qty of La Quinta Building 8l'• SafetyDivision Permit # P.O. Box 1504, 78-495 Calle Tampico �. La Quinta, CA 92253 - (760). 777-7012 Building Permit Application and. Tracking Sheet Project Address:8s'j V I�Q m hV Owner's Name: A. P. Number: Address: 8S� % V �`6t, TT�Yi► Legal Description: City, ST, Zip:M. G Contractor:`?'�>4 Telephone: % txr.: 1.. •:Myr f. AS �h Address: y . n� Fn• Project Description: City, ST, Zip: �� 14 V46 Telephone State Lic. # : 3 City Lic. #; Arch.,' Engr., Designer: Address: City., ST, Zip: Telephone:' t..•'{. .w :{;y:f ; ^»; ` :: %� ? . 'r� Construction Type. Occu anc State Lic. #: J%:.aWf•}''{ {,;y l,W !{r,?' Project type (circle one): New Add"n Alter Repair Demo Name of ContactPerson: Sq. FL: #Stones: #Units: Telephone # of Contact Person: 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 Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Calcs, Called Contact Person Plan Check Balance. Title 24 Cafes. Plans picked no Construction Flood plain plan Plans resubmitted Mechanical Grading plan . 21" 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:- Jrd 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 P � { AFS� mt�ait]A INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2 Site Address: Enforcement Agency:'. Permit Number: Enter the Duct System Name or Identification/Tag; Enter the Duct System Location or Area Served: vt/l�UL Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems, and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air.handler, coil, plenums, etc) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test —Completely New or Replacement Duct System." Duct Leakage Diagnostic Test — Existing Duct Svstem Select one compliance method from the following four choices. 05C Option 1. Measured leakage less than 15% of Fan Airflow. ® Option 2. Measured leakage to outside less than 10% of Fan Airflow. 13 Option 3. Reduce leakage by 60% or more, and conduct smoke test to seal all accessible leaks. 13 Option 4. Fix all accessible leaks using smoke test, and HERS rater must verify. . Note: (Option I must be attempted before utilizing Option 4) Determine nominal Fan Airflow using one of the following three calculation methods. ® Cooling system method: Size of condenser in Tons _— x 4:00 = 2 G'�� CFM 13 Heating system method: 21.7 x Heating Output Capacity (IcBtuh) = CFM ®.Measured system airflow using RA3.3 airflow test procedures: CFM Option 1 used then: Allowed leakage = Fan Airflow `'-��n x 0.15 = Ago CFM I l Actual leakage CFM Pass if Actual leakage less than Allowed leakage 1 Pass 13 Fail -is Option 2 used then: Allowed leakage = Fan Airflow x 0.10 = CFM 2 Actual leakage to outside= CFM Pass if Actual leakage to outside is less than Allowed leakage 13 Pass ® Fail Option 3 used then: Initial leakage prior to start of work= CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 . Initial leakage - Final leakage = Leakage reduction CFM (Leakage reduction / Initial leakage ) x 100% = % Reduction Pass if % Reduction > 60% ® Pass ® Fail Option 4 used then: ' All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). 4 Pass if all accessible leaks have been sealed using Smoke Test ® Pass 13 Fail Registration Number: 2008 Residential Compliance Forms Registration Date/Time: HERSProvider: August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 2 of 2 Site Address: Enforcement Agency: Permit Number: .® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. ❑ All supply and return register boots must be sealed to the drywall if smoke test is utilized for compliance — applies to duct leakage compliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible leaks) described above. ❑ New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts. ❑ Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new. duct connections. DECLARATION STATEMENT • I certify under penalty of perjury, under the laws, of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that. the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • . I reviewed a copy of the Certificate of Compliance (CF -1R) form approved -by the enforcement agency that identifies the specific . requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand . that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. l will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) 60IW #16- Responsible Person's Name: Responsible Person's Signature: CSLB License: Date Signed: Position With Company (Title): 6 3 i 49 /i- Z z Z,6= Ar Is this installation monitored by a Third Party Quality Control Name of TPQCP (if applicable): Program (TPQCP)? 11Yes ;WNo Registration Number: Registration Date/Time: HERS Provider: 2008 Residential Compliance Forms August 2009 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and SIMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. 'Attach an additional form (s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation. Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System Location or Area Served The sensor is factory installed, or field installed according to manufacturer's 3 1 lg-Yes ONo 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and Director. labeled according to Figure in Section RA3.2.2.2.2. 2 Yes [:]No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum ❑Yes ONo digital thermometer. The sensor mini plug is accessible to the installing technician and and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Fail ✓ Pass ✓ Fail STMS - Sensor on the Evaporator Coil System Name or Identification/Tag The sensor is factory installed, or field installed according to manufacturer's 3 ❑Yes ONO specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 4 ❑Yes ONo digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 5 OYes ONo The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter,�'N/A v,'❑Pass TT ✓ ❑Fail NIA if STMS are not applicable. Otherwise enter Pass or Fail N/A if STMS are not applicable. Otherwise enter Pass or Fail on the Condenser Coil System Name or Identification/Tag The sensor is factory installed, or field installed according to manufacturer's 6 Oyes ONo specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with.a standard mini plug suitable for connection to a 7 Oyes ONo digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 OYes ONo The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter ✓ N/A ✓ O Pass ✓ ❑ Fail N/A if STMS are not applicable. Otherwise enter Pass or Fail Registration Number: Registration Date/Time:' HERSProvider: 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of SfteAddress: Enforcement Agency: Permit Number: Standard Charge Measurement Procedure (for, use if outdoor air dry-bulb is above 55 % Procedures for determiningRe)%gerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As marry as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as appltcable, The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. e If outdoor air dry-bulb Is SS °F or below, the installer must use the Alternate Charge Measurement Procedure. Snare CnnAitinnina Rvafnmc System Name or Identificationfrag L.p�✓ % _. /G7 (must be re -calibrated monthly) System Location or Area Served�/O['is OU (,� ._ j O (must be re -calibrated monthly) Outdoor Unit Serial # �%a • �� Outdoor Unit Make .temperature (Tsu I , db) Outdoor Unit Model x•Cz�'Ol�-Z�� Nominal Cooling Capacity Btu/hr Date of Verification Z � — 49 temperature T P ( • return, db) Calibratinn of T)inanncfir inefn,monfc Date of Refrigerant Gauge Calibration _. /G7 (must be re -calibrated monthly) Date of Thermocouple Calibration (,� ._ j O (must be re -calibrated monthly) Mpacnrpri T. -- h—. tOM System Name or Identification/Tag ar✓ice- l Supply (evaporator leaving) air dry-bulb .temperature (Tsu I , db) Return (evaporator entering) air dry-bulb temperature T P ( • return, db) Return (evaporator entering) air wet -bulb _ temperature (Tretum, wb) Evaporator saturation temperature 2 (Teva orator, s.0 Condensor saturation temperature r 77 (Tcondensor, -sat) ` Suction line temperature (Tsuction)�1 Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) ' Registration Number. Registration Date/Time: 2008 Residential Compliance Forms HERSProvider: August 2009 INSTALLATION CERTIFICATE CF 6R-MECH-25RERS Refri erant Charge Verification -'Standard Measurement Procedure a e 3 of Site Address: Enforcement Agency: Permit Number: eq to Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identificationfrag Calculate: Actual Temperature Split = Tretum, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Tretum, wb and Tretum, db / Calculate difference: Actual Temperature Split — Target Temperature Split Passes if difference is between -3 °F and +3 °F or, upon remeasurement, if between -3°F and -100°F Enter Pass or Fail %! Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurementprocedures specified in Reference Residential Appendix RA3.3. Ifaetual cooling coil airflow is measured, the value must be equal to or greater than' the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/Eon) System Name or IdentificationfIag Calculated. Minimum Airflow Requirement (C)FM) Measured Airflow using RA3.3 procedures (CFM) using Tretum, wb and Tcondenser, db Passes ifmeasured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identificationfrag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Tretum, wb and Tcondenser, db Calculate difference: Actual Superheat — Target Superheat = System passes if difference is between -5°F and +5°F Enter Pass or Fail Registration Number: Registration DateJTime: HERS Provider: 2008 Residential Compliance Forms August 2009 INSTALLATI N CERTIFICATE CF-6R-MECH-25 HERS Refrigerant Charge Verification - Standard Measurement Procedure. (Page 4 of Site Address: Enforcement Agency: _ Permit Number: Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Superheat = System Name or Identification/Tag Tsuction — Teva orator sat L. Calculate: Actual Subcooling = Enter allowable superheat range from Tcondenser, sat - Tli aid 7 Target Subcooling specified by specification is not available manufacturer System passes -if actual superheat is within Calculate difference: the allowable superheat range Actual Subcooling — Target Subeoolin _ �, 7 - System passes if difference is between. -3°F and +3°F Enter Pass or Fail L Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Superheat = Tsuction — Teva orator sat L. Enter allowable superheat range from manufacturer's specifications (or use range between 4°F and 25°F if manufacturer's specification is not available System passes -if actual superheat is within the allowable superheat range Enter Pass or Fail Registration Nwnber: Registration Date/Time: 2008. Residential Compliance Forms INSTALLATION CERTIFICATE CF-6R-MECH-25-11ERS Refrigerant Charge Verification -Standard Measurement Procedure e 5 of Site Address: Enforcement Agency: Permit Number: Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all apphcable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System meets all refrigerant charge and J) airflow requirements. Enter Pass or Fail�� DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations.fail to meet the requirements of such qualityassurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that, identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required 'to be included with the docrmrentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for. multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Responsible Person's Name: Responsible Person's Signature:. CSLB License: �6 3l o Date Signed: Position With Company (Title): Is this installation monitored by a Third Party Quality Control Name of TPQCP (if applicable): Program (TPQCP)7 Dyes 0 Registration Number: Registration Date th7w.. HERSProviden 2008 Residential Compliance Forms August 2009 r INSTALLATION CERTIFICATE t CF-6R-MECH-04 .Space Conditioning Systems, Ducts and Fans (Pagel of2) Site Address: Enforcement Agency: Permit Number: Space Conditioning Systems Heating Equipment Equip Type (package- heat um CEC Certified Mfr. Name and Model Number ARI Reference Number Z # of Identical Systems Efficiency (AFUE, etc.)',' (>_CF -1R value)4 Duct Location (attic, crawl- space, etc. Duct R -value Heating Load Btu/hr Heating - Capacity Btu/hr L GWAo X xy.c":.39;02 7 Ile � I le y Z- 2G�:',Ico ffPe4l Equip Type (package heat Pump) CEC Certified Mfr. Name and Model Number ARI Reference Number 2 # of Identical Systems Efficiency (SEER and EER) 1,3 (>_CF -1R value)4 Duct Location (attic, crawl- space, . etc. Duct R -value 2- Cooling Load (Btu/hr(Btu/hi) Cooling . Capacity ,9 • y y j— - —r. wr.—1 —&-rio act 1 L-1-1- lu olur[uaras L note 1 JI -,U ana 1 axle 1 JI -C, Jor duct telling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number athttp://www. aridirectory.org/ari/ac.php# 3. Listed efficiency on this page must be greater than or equal (>) to the value shown on the CF -1R form. 4. When CF -JR is reference it is also applicable to the CF -IR, CF -JR -AA or CF -JR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM . § 110-§ 113: HVAC equipment is certified by the California Energy Commission. ❑ § 150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. ❑ § 150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of § 112(c). ❑ § 1500)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE i CF-6R-MECH-04 -Space Conditioning Systems, Ducts and Fans(Page 2 of 2 Site Address: Enforcement Agency: Permit Number: Ducts and Fans § 150(m): Duct and Fans ❑ 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6=5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used; and ❑ 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. ❑ 2D. Joints and seams of duct systems and their components shall .not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. ❑ 7. Exhaust fan'systems have back draft or automatic dampers. ❑ 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually. operated dampers._ ❑ 9. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. ❑ 10. Flexible ducts cannot have porous inner cores. DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance (CF -1 R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Responsible Person's Name: Responsible Person's Signature: CSLB License: Date Signed: Position With Company (Title): 2008 Residential Compliance Forms August 2009