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07-0890 (MECH)1m P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: C79115 KAYE CT, APN: 604-371-010-102 -27899 07-00000890 Property Address: Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION _ I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 -C10 LicenseNo.: 286936 Date 1Contracto : �.�ii.(�G IICA4 46 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 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT 9 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 ID 1, &.—ftbutme-7-1 qn/ 26/07 Owner: RANDY KE I L . MAR 2 6 2001 79115 KAYE CT - LA QUINTA, CA 92253 CITY OF LA QUINT/ Contractor: CAVANAUGH ELECTRIC & AIR GOND 83231 HIGHWAY 111 INDIO, CA 92201 (760)347-3608 Lic. No.: 286936 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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 ENDURANCE WC. Policy Number WEN0014468-01 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 7` —o3!700 of the Labor Code, I shall firth ith comply with those provisions. Date-z6--?APPlicant: IC. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspectiqp purposes. �7 Datei)� Cb v7Signature (Applicant or Agent):) - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1000 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION _ I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 -C10 LicenseNo.: 286936 Date 1Contracto : �.�ii.(�G IICA4 46 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 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT 9 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 ID 1, &.—ftbutme-7-1 qn/ 26/07 Owner: RANDY KE I L . MAR 2 6 2001 79115 KAYE CT - LA QUINTA, CA 92253 CITY OF LA QUINT/ Contractor: CAVANAUGH ELECTRIC & AIR GOND 83231 HIGHWAY 111 INDIO, CA 92201 (760)347-3608 Lic. No.: 286936 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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 ENDURANCE WC. Policy Number WEN0014468-01 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 7` —o3!700 of the Labor Code, I shall firth ith comply with those provisions. Date-z6--?APPlicant: IC. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspectiqp purposes. �7 Datei)� Cb v7Signature (Applicant or Agent):) Application Number . . . . . 07-00000890 Permit . . . MECHANICAL Additional desc . Permit Fee . . . 24.00 Plan Check Fee 6.00 Issue Date Valuation . . . . 0 Expiration Date 9/22/07 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH APPL REP/ALT/ADD 9.00 ---------------------------------------------------------------------------- Special Notes and Comments REPLACE A/C CONDENSER Fee summary Charged --------------------------- Paid Credited Due ---------- Permit Fee Total 24.00 ---------- .00 ---------- .00 24.00 Plan Check Total 6.00 .00 .00 6.00 Grand Total 30.00 .00 .00 30.00 LQPERMIT Bin # City of LaQ uinta Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 't �� Project Address: _ //.�,./Ia e Coal -t Owner's Name: fi7c7L 11 -Cl /- A. P. Number: Address: '79_ Legal Description: City, ST, Zip: Contractor: Ca vonaw h tzeCtr,-ana Alc Telephone: * Project Description: Address: 3 — 3 I �W _ •! City, ST, Zip: I d10 CA- gggoI R 2 / olt^2 a X/$11Y Telephone: 71 j _ 397 6 State Lic. # : 28 (p 9 City Lic. #: Arch., Engr., Designer: A/C CB`1 a/eh Srn Sec �ioN Address: City, ST, Zip: Telephone: State Lic. #: Construction Type: Occupancy: P cY: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: ?pd clow1/c3/9'31or - Sq. Ft.: #Stories: # Units: Telephone # of Contact Person: ./C — 5ie-Q/ 4 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Reed TRACKING . PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. 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 Subcoutactor 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 correctionsrssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees ^ Total Permit Fees ✓ ❑ Alternative Component Package Method: (check one) C D D (Alternative) ' Package C and Package D choices require HERS rater field verification and/or diagnostic testing (see CF -1R page 3) For Package D Alternative see Appendix B Table 151-C Footnotes 7-14 GENERAL INFORMATION Total Conditioned Floor Area (CFA) fte Average Ceiling Height: ft Maximum Allowed West Facing Fenestration Products Per Table 15'1-B or. 151=C ---- (5% X CFA) ft Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C ---(20% X CFA) g2 ✓ 0 Building Type: (check one or more) Single Family Multifamily Addition Alteration (If adding fenestration fill out WS -4R, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2 for Additions and 8.3.3 for Alterations.) Number of Stories: Number of Dwelling Units: Floor Construction Type; Slab/Raised Floor (circle one or both). Front Orientation: North / South / East / West / All Orientations (input front orientation in degrees from True North and circle one). ✓ ❑RADIANT BARRIER (required in climate zones 2.4..8-L51 OPAQUE SURFACES INCLUDING OPAQUE DOORS Component Type (Wall, Roof, Floor, Slab Edge, Doors). Frame Type Cavity (Wood or Insulation Metal) R -Value Assembly U - factor (for wood, Continuous metal frame and Insulation mass R -Value assemblies Joint Appendix IV Reference Roof Radiant Barrier Installed Yes or No Location Comments.. (attic, garage, typical, etc. _ �•_ _ �� _ T T .0- 1) 1) See Joint Appendix IV in Section IV.2, Iv.3 anal VA, wnlcn is me' oasis iur uic U -L" Us Vi+�V=1V�• prescriptive value to show equivalence to R -values. Residential Compliance Forms Apru zuv.) CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 5) CF -1R 7;_._ a _ ✓�� Date 3- —107 FENESTRATION PRODUCTS — U- FACTOR AND SHGC ✓ ❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS -4R —must be included for New rnnctnirtinn_ Additions and Alterations. Fenestration W ype/Pos. (Front, Left, Rear, Right, S li t Orien- talion. N, S, E, W Area U -factor U -factor Source SHGC" SHGC Sources Exterior Shading/Overhangsb'' ✓ box if WS -3R is included1313 O13 1) Skylights are now Included in West -facing fenestration area it ute sxyugrns arc --u we direction when when the pitch is less than •1:12. See §151(f)3C and in Section 3.2.3 of the Residential Manual 2) Enter values in this column are either NFRC Rated value or from Standards default Table 116A. 3) Indicate source either from NFRC or Table 116A, 4) Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from WS -3R. 5) Indicate source either from NFRC or Table 116B. 6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS -3R to calculate Exterior Shading devices. 7) See Section 3.2.4 in the Residential Manual. HVAC SYSTEMS Heating Equipment Type and Capacity Cooling Equipment Type and Capacity (A/C, heat pump, evap. Minimum I Distnbutton I l Configuration , Efficiency Type and Location Duct or PipingThermostat ---nv% fa.. . onflr etr. R -Value a slit or package) Minimum Efficiency SEER or EER 3 Duct Location attic etc. Hie Duct R -Value R4. 0 Thermostat e Configuration (split or Ec e Lie April 200: Residential Compliance Forms CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 5) CF -IR Date 5 :20 ®% A signed CF -4R Form must be provided to the building department for each home for which the following. are re wired. ❑ Sealed Ducts tiniz and certification and HERS rater field verification required 0 TXVs, readily accessible (climate zones 2 and 8-15 only) taller testing and certification and HERS Rater field verification required.) ❑ Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field verification re uired. OR ❑ Alternative to Sealed Ducts and Refrigerant Charge flXVs (See Package D Alternative Package Features for Proiect Climate Zone in the RM Appendix B Table 1.51-C Footnotes 7-I4. OR For additions and. alterations, duct systems that are not documented to have been.previously sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the Residential ACM Manual and duct systems with more than -40 linear feet in unconditioned s aces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D. WATER HEATING SYSTEMS Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per O dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is not allowed. ❑ Check box when using Preapproved Altemative Water Heating table, Table 5-4 in Chapter 5 in the Residential Manual. No water heating calculations are required, and the system complies automatically.. Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved ❑ Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the submittal. ❑ Check box to verify that a time control is required for a recirculating system pump for a system serving multiple units S stems -serving single Water Heater Type/Fuel Type aweuua UA"AA Distribution Type Number in System Rated utiTank (kW or Btu/hr(gallons) Capacity EnerTank Factor Thermal Efficient Standby' Loss % External Insulation R -Value Insulation -11-N Efficiencv Loss (%) R -Value multiple dwelling units Rated Inputl Water Heater Distribution Number (kW or 1%,—. Tvne in Svstem Btu/hr) 1) For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water heaters, list Rated Input and Thermal Efficiencies. Pipe Insulation (kitchen lines >_ 3/4 inches) All hot water pipes from the hearing source to the kitchen fixtures that are 1/4 inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2 B' - Apru 200. Residential Compliance Forms Enemy Tank Tank Factor or External apacity Thermal Standby' Insulation -11-N Efficiencv Loss (%) R -Value 1) For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water heaters, list Rated Input and Thermal Efficiencies. Pipe Insulation (kitchen lines >_ 3/4 inches) All hot water pipes from the hearing source to the kitchen fixtures that are 1/4 inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2 B' - Apru 200. Residential Compliance Forms CERTIFICATE OF COMPLIAN Proiect TYele/Qdkei RESIDENTIAL (Page 4 of'5) CF -IR Date SPECLAL FEATURES NOT REQUIRING HERS VERIFICATION (add extra sheets if necessary) Indicate which special features are part of this project. The list below only represents special features relevant to the )resCf. ✓ AVG MI;ULVu. Feature Re aired Forms if a llcable Description CF -1R CF -1R WS4R N/A; Attach CRRC Label to Forms. ❑ Metal Framed Walls Radiant Barriers Exterior Shades Cool Roof ❑ ❑ ❑ ❑ Dedicated Hydronic Heating' system Performance Calculation Required; Attach Run to Forms. Combined Hydronic System Gas Cooling Performance Calculation Required- Attach Run to Forms. ❑ Performance Calculation Required. ❑ ❑ Buried Ducts N/A- Indicate on building lans. Kitchen Pipe Insulation See Section 5.6.2 Distribution S stems in Residential Manual. ❑ ❑ Multiple Water Heaters Per Dwelling Unit See Table 5-13 or use Performance Calculation and attach Run to Forms. Central Water Heating System Serving Multi le Dwellings Non-NAECA Large Water Heater Performance Calculation and attach Run to Forms. CF -1R ❑ ❑ ❑ Indirect Water Heater See Table 5-13 or use Performance Calculation and attach Run to Forms ❑ Instantaneous Gas Water Heater Solar Water Heating System See Table 5-13 or use PerformanceCalculation and attach Run to Forms ' See Table 5-13 or use Performance Calculation and attach Run to Forms ❑ ❑ Wood Stove Boiler Performance Calculation and attach Run to Forms SPECIAL FEATURES REQUIRING HERS RATER VERIFICATION (arlri Prue sheets if necessary) Indicate to the HERS Rater which credits are part of this project and -6R part 4 of 12 -6R nart 5 of 12 Thermostatic Expansion Valve j CF -6R part 6 verification. Residential Compliance Forms April 2005 CERTIFICATE OF COMMIANCE: RESIDENTIAL Date (Page 5 of 5) CF -1R project Title 3 —®' 0-7 COMPLIANCE STATEMENT This certificate of compliance lists the building features �� the adlmiritstrativetions r regulations t implemed to comply with ele nt 24, parts l and 6 of the California Code of Regulations, them. This certificate has been signed by the individual with overall design responsibility. The undersigned recognizes that compliance using duct design, duct sealing, verification of refrigerant charge and TXVs, insulation installation cation baht approveuilding d HERS enveraterlope sealing require installer testing and certification and field Designer or Owner(per Business and Name: Title/Firm: 01,Vh e, - SS: 179- 115 Kaye Z,9 01,(In' -,� trone: AQOnev Documentation Author 11 dame: `L La/ -e c T/ %c 3riG�ij/E=- C.; van a; ,F eIf :ss: ..z'ndio, CA• 9201 hone: di s A 3 -ted -- 0-' April 2005 Residential Compliance Forms voi i ,-/tvvv v r. v i r nn oou000avao INSTALLATION CER^ T� IFICA ` Slto Addrv�ss � /S.e/C �jr(_ a 4 otnno onn v.icuu + nv nin +� Tage 3 0(12) CF -6R t Number An installation certificate Is required to be posted at the building site or made avallable for all appropriate inspocdons. (Tho Information provided on this form is required) After completion offinal inspactlon, a copy must be provided to the building depament (upon request) and the building owner at occupancy, per Section 10-10a(a). HVAC SYSTEMS: KeatbV Equomen.1 Equip 'Typo (pkg. heat urn CSC t;estitte4 Mfi, Name and Model Number #o f [dMUCCI S stanu (AFIIF+ eta.)' XCF•1Rvwue Duct Looution attic etc, puM' or Piping R -vacuo Heating Load Sturm Heating Capacity Bui/hr cods t.1.214 A i 0 AIR 0-? Cooling Equipment Equip Type heat um CEC Certified Mfr. Name and Modal Number 0 of IdonbCnl systems Efficiency (861511 or Etat) , LCF•IRvalue Duct Location ic, ctc,) Duct -vsilue Cooling I Load hAr Cooling Capaoity SM/hr cods t.1.214 A i 0 AIR 0-? 1. > symbol reads graoler than or equal ro what is lndtcawd on the CF -!R value, Include both SEER and ERR Lf compliance credit for high EER air conditionerls claimed. lel 1, the undersigned, verify that equipment listed above Is: 1) Is the actual equipment Installed, 2) equivalent to or CKmore efflolont than that specified in the oortiflowx of compliance (Fornt CF -1 IQ submitted for compliance with the Energy F,BIclency Standards for residential buildings, and 3) equipaicint that moats or exceeds the appropriate requirements for manufactured devices (from the Appliance Ftfflclancy Rag'tilations or Part 6), where applicable. Contractor (Co. Name) OR Owner Signature: Copies to: BUILDING DEPARTMENT; Date: _q— _?2 _ O RATER (IF APPLICABLE) BUTLDIN(: OWNER AT OCCUPANCY Residentfol Compliance Forms Apsi/ 2005 OCT 04,2005 08:44 SEARS HOME I MP 8585869098 Page 4 v,!l I It CVvv V I . ve r nn VVVJVVVVVV 1 i1a 112 INSTALLATION CERTIFICATE (Page -4 of 12 MISE Site Address Pmrtnit Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLUNCE STATEMENT The building was: ✓ I3fcswd at Final -`13 Taw at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION OTA0E: O Remove at least ono supply and one return register, and verify that the spaces between thq register boot and the interior finishing wall aro properly scaled. ❑ If the house rough -in duct loakage test was conducted without an air handler installed, inspect the connection points between the air handier and tho'supply and return plenums to verity that the connection points are properly sealod. ❑ inspect all Joints to ensure that no cloth backed rubber adhesive duct tape is used ✓ O DUCT LEAKAGE REDVCTION D-...�.A..,... t rr.tJ ..�JA....N.,» nwi! ilinrnrn etln IotNnv nire(r tNettdhuNn» eveta�ae nen nvnJrnlJe /x Ad!`M d »ne...nr D/'A ? NEW CONSTRUCTIONi Duct Pressurization Test Recruits (CPM ® 25 Pa) Measured Values Tae;;.. I Enter Tested Lcakagtt Flow in CFM: Pan Flow: Caloulated (Nominal: ✓ W Cooling ❑ Beating) or ✓ O Measured 2 If Fan Flow is Calculated as 400 cftn/ton x number of tons or as21.7 ofin/(kBtuAr) x Heating 'Capacity In T/hrhousands of Btuenter total calculated or measured fan flow in CFM here: 4. ;?C0✓ ✓ Pass !f 1 eakaga Percentages 64for Final or S 4% at Rough -in: 3 100 x (Line # 1 / -.(Line # 2 ❑ Pass O Fail ALTERATIONS: Duct System and/or HVAC E tel Ment C11111196 -Out : Irl;;'`=� 4 Enter Tested Leakage Flow In CFM from pre -Tot of Existing Duct System Prior to Duct System Alteration and/or Equipment Chang& -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 E ui mant Change -Out. 94 e, r"� �� ;a'�'`> ii • Enter Roduction In Leakage for Altered Duot System Linc # 4 Minus Line # 3 — (OnlyIf A Uoablel r87 Enter Tasted Leakage flow In CFM to Outside (Only if Applicable)Entire New Duct System - Pass if Leakage Percentage S 6% for Final or S 4% ar Routh -in 10Line # 5 / Line # 2)11 0 x El Pass 0 Fail TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change- Out Use one of following four Test or Ver fi ation Standards for compliance: ✓ 9 Pass If Leakage Percentage S 1 SVa [100 x [ (Lino. # 5) / L.9-11(Line # 2)11 /6-1 Pass ❑ Fail 10. Pass If Leakago to Outside Percentage S I0% ( 100 x L----_(Llne # 7) / __ (Line # 2)]] ❑ Pass O Fall Pass If Leakage Reduction Percentage it 606A t 10 x (_(•Line # 6) / (Line # 4)]] 11 and Verification Smoke Too and Visual Ins ection Q Pass 0 Fall 12 Pass If Sealing of all Accessible Leaks and Verification by Smoke Test and Vlst,al inspection =•. ►,`�^.3: ;'' ass O Fall Pass Ifo a of Lines # 9 tbnough # IZ pass tWpm Cl Fall 2 ✓ ❑I, the undersigned, verlt , that the above diagnostic tact results were performed In aonformanoe with the requirements for compliance credit. I, the undersigned, also certify that the newly installed or retrofit Air -Distribution System duras, Plenums and Fans comply with Mandatory requiroments specified in Section 150 (m) of the 2005 Building Energy Efficiency standards. Installing Subcontractor (Co. Nurse) OR General Contractor (Co. Name) OR Owner C a varaugh LCL e c�n G and A �G Sianstum:.O /'.. :rte l ilii Date: �2 --7^ :, 1)'7 Copla tot BUILDING DEPARTMENT, RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Formr April 2005 OCT 04,2005 08:45 SEARS HOME I MP 8585869098 Page 5 . .. Vol.I II zvvv VI.VL rnn 0000000voo )cnna ann ulceu + AL. n1R 0. VVU/V I f ✓ THERMOSTATIC EXPANSION VALVE OPM Procedta-eifor field verooatton of thermosmt/e expansion valves are avatlabla in IUCM, Appendix Rl. I -- . Return (evaporator entering) air dry-bulb temperature gTtum, db Access i9 provided for inspection. TheIF procedureshall Return (evaporator entering) air wet -bulb temperature (Treturn, wb) OF Evaporator saturation temperature (Tevaporator, sat)'`F Suction line temperature (Tsuotion, db) consist of visual verification that the TXv Is installecl on / 'P Y_! Ur'Yes 0 No the system and installation of the speeiflo equipment o El shall be voriflad. Fait Yes is a pass Pass ✓ ❑ REFRIGERANT CNARcm MEASUREMENT Vedflcation for Requlred Ref}iaerant Charge and Adequate Airflow for Split System Space Cooling Systems without ''�-----... I a _. V.I.— Outdoor Unit Serial # Location Outdoor Unit Make Outdoor Unit Model Cooling Capaoi Btu/hr Date of Verification Date of Refrigerant Gauge Calibration (must ba nheckad monthly) Date of Thermocouple Calibration (must be cbecked monthly) Siandsrd�jipree 1►'1[eas orrtent Procedure (outdoor air dry-buib 55°F and ave): Proeeduresfor Determining Rgfrigerant Charge using the Standard Method are availaole In RRCM, Appendix RD2. Note: The system should be installed and oharlied in accordance with the manufacturer's specifications beforo starting this procedure. Measured Tom erasures Supply (evaporator leaving) air dry-bulb temperature (Tsu ly, db) OF Return (evaporator entering) air dry-bulb temperature gTtum, db OF Return (evaporator entering) air wet -bulb temperature (Treturn, wb) OF Evaporator saturation temperature (Tevaporator, sat)'`F Suction line temperature (Tsuotion, db) OF. Condenser ent¢ri ) air dry-bulb temperature Toondenser, db) 'P iperheat Charge Method Calculations for Refrigerant Charge Actual Superheat - Tsuodon, db — Tevaporator, sat °F Target Superheat (from Tabic RD -2) ap Actual Suporhow — Tarte Superheat (System passes if between •3 and +S.°F) °F Temperature Split Method Calculations for Adequate Airflow S lit Method Calculation k not neoej,;Wy i Ada to Airflow credit is taken Actual Tem orature Split - T return, db Tsupply, db of Target Temperature Split from Table RD3) "F Actual Temperature Split Target Temperature Split (System passes If between 3°F and +3'F or, upon remeasurement if betwoen -30F and -1006F i Residential Compliance Forms .aprU 2005 OCT 04,2005 08:46 SEARS HOME I MP 8585869098 Page 6 OcnnJ onn ULcav nV nln WJE , yJ�,��(yyy y,y( I'nn OJU:JVVUV VU . YNSTAUATTON CERTIFICATE a e 6 of 12i Cn Site Address Permit Number Standard Charge Measurement Summary: System shall pass both refrigerant charge and adequate airflow calculation orltotla from the same j measurements. If corrective actions were taken, both criteria trust be remeasured and recalculated. ❑ Yes ❑ No System passes Alternate .Charge Measurement Procedure (outdoor air dry-bulb below 35 °F) Note: The system should be installed and charged in accordaaee with the tnanufamuvr's specifications and installer verification shall bo documented on Cf -6R before starting this procedure. If outdoor air dry-bulb Is SS OF or above, installer shall use the Standard Charge Measuro Procedure: Procedures for Determining Refrigerant Charge using the Alternate Method are available In RACM, Appendix RDS. W e1Rh-In Charging Method for Refrigerant Charge Actual liquid line length: ft Manufacturer's Standard liquid line length: ft Difference (Actual — Standard): ft Manufacturer's correction (ounces per foot) _ x difference in length=_ounoes (+ a add) (- a remove) I feasurcd Airflow Method for Adeguata Airflow Verification avallabla in R4CM,' rtppendix RpZ..6 _ Calculated' Airflow: Cooling Capacity (Btu/hr) X 0.033 (ofin/Btu-hr) _ _ CFM Measured Airflow is CFM (Measured alrflow must be greater than the calculated airflow). Alternate Charge Measurement Summary. System shall pass both rofrigerant Margo and adequate airflow calculation criteria from the same mewuremcnts. if �nrrww�ty� anttnne wiRre taken_ both criteria must be remeasured and recalculated. installing Subcontractor (Co. Name) OR General <fayahaagA 6(e _C1r i,= �/,d A -1G Contractor (Co. Name) OR Owner l Signature: Dain 3-26-0Z Copies to: BUILDING DEPARTIAMNONIERS RATER (1P' APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms ,Ipril 2005 OCT 04,2005 08:97 SEARS HOME I MP 8585869098 Page 7