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09-0899 (MECH)
4 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) 777-7153 BUILDING PERMIT Date: 8/25/09 Application Number: 09-00000899 Owner: Property Address: 54920 AVENIDA DIAZ ROBIN FOULON APN: 774-291-009-16 -000000- 54920 AVENIDA DIAZ Application description: MECHANICAL LA QUINTA, CA 92253 Property. Zoning: COVE RESIDENTIAL Application valuation: 5000 �7 Contractor: Applicant: Architect or Engineer: TELFORDJONES, INC. L7 r ; p )� 25 . % r Zuuy , s : 9 25920 IRIS AVE, STE 13A-4'OO MORENO VALLEY, CA 92551 _ (951) 486-0337 C:6eYC1� '=`�;=ii?:F11Ii Lic. No.. 856936 �'�r_`„ ��=f -------------------------------------------------- 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: B -C10 -C20- LicenseNo.: 856936 G c ate:0 f7ntractor: 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—) 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 ----------------------------------------------— 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. have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 238-0005911 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 s/yip/a_11 forthwith comply with those provisions. /Datek 2--plicanC 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 he above-mentioned propert ins ction purposes. . D/ate: gnature (Applicant or Agent): l/l/l/l/l/l/- !%•-..._ LQPERMIT Application Number. . . . . . 09-00000899 Permit MECHANICAL Additional desc . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date Valuation . . . . 0 Expiration Date 2/21/10 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 CHANGE OUT HVAC SYSTEM,INSTALLING AIR HANDLER AND OUTDOOR CONDENSING UNIT (4 TON). 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 .0,0 .00 42.25. TelfordJones Inc. JONES PLUMBING IIEATINC6 AND AIR CONDITIONING License # 856936 - B. CIO, C20, & C36 25920 Iris Ave. Ste. 13A-400 Moreno Valley, Ca 92551 Bus: 951486-0337 Fax: 951486-0393 August 25, 2009 City of La Quinta Building & Safety 78-495 Calle Tampico La Quinta, Ca 92253 We here by grant Permission to Carlos Marin to obtain permits on our behalf. Kenneth Telfor - ompany Officer 08/21/2009 15:17 FAX 18585880883 ..�,e„I►,oteb ui t..urnpllanee r SEARS_HOME_IMdPROVEMENT a JONES Prescriptive- Method - HVAC -only Alteration IM 004/005 (;F -IR -At -7 Pra)et:x Title: r Date; 6► CdlCl"5 2D05 f j'D 'I11 PrtsiPct Address1R18t@ O�� Budlp: Pacini/ 4�1:' D=m tWHOM Author F13i 40 6 ter:.: •, ,,V.rt -� •!.'4P,:L.l.;.,�.i•.�,r :, ILS;•, ,ti,. w,•I .,, 5�'k ',.fir: •� ,a1i;•., pl''" ;',�' 9 •a . o mid IMPORTANT; This CF -1 RALT ferrr is only for uae when an HAD n1y elterad= is meads to an asting hom e U one fprm for each s a beln i a0wed. ' hig le Ustem of toms altered In this hliusp- CheCk all finesi that an*. CbRek 201110es thatapbly. Scope of Alterations: 1 An AIr Handlaris to ba lnsrmud or r•&+add Dug ne lto be dorwmhtad. CcnOnua ton l 2 Fum two Heat asehanger 1e to he Imi ailed or replaced. Duet seailtsg to be delaanln�kt Coaillnueto ns Me kA 3 An vuldowcondensingunrtistobeIra tailedarraplaeed• DuctSealln ettdlor7XV(RCA)totwdeto 4Inmd ConUniwtcAvid11h& 4 L3 or ri@L"np sell to to In Ir,atsellt d or n1gat Duet SeVIn and/or TXV C4 to loo determined• Goodnue to neg Imo 5 ❑ Mwe than 40 feet arr,ew or repracemerd oust am to be Irmtelled in ductInp is ba defannittad ❑ Check here If the dta k systtmn is also to be naw or rephcad. 1 CAnfi w to hma rhr. 6 nen® orlinas 1.8 �ra chadmd. neiom r Did sawng nor -'?CV-(RCA) are Go to Seat n r% Section 1 - Dud Sealing (Only if any of U1101-1,2 4 or 5 are ed Skip if Urie 6 is rhe&ed• 7 Q Thle*dem Is In Climate Zrx1a 1 3 A S 3.7 or e. No dua 68BUma is FMIMd, Cao tq to 8 A Mt. hoc i.oa Ih.n 4o hat yr dum M ympi ptimetl spaM No duct ssafincj ie nucpimd Go to Section 2• 9 D This wrOwn flims previously s aW ad and tau t4 and waa aadlAad by a HERS rear. No d W seal/ nq is Aftch P re* ;CF-4Rfo►m. Co to Section 2. 7n ❑ duct mytiam 0 mWcd a Inaulaaea wtul esbestft ria ductaes4l res. Go s lanl Note if the Satre system is to be low or replaced, Vnes 11-14 do not 8 11 D ,duct In Glmerte Zones Z 12 en : An 0.e2 AP UE furnace wilt be-Iaetalled In Uou of�uct rr I 17 ❑ In Cllmplo Urns 10, 15 and 10; An SEER 14 9NaEER 12 candenoprwUl t» in hftd whh 1XVIRW ANO added dud insuWort A wmp on w iati R-9 aw duals In Up of dud =Ong. Gs to Sadtm 2. 13 ❑ In Climate Zones 8.10,11,13, 14, or 13: t n SWA14 &M EER 12 0 w111 be irttdeiled Vii, rAV(RCA) D s o,og ArVC funumm wot bo tnatatlod n Ileo Of duet "00G0 to Seaft 7- ` 14 ❑ In Cranarm Zones Z, G, 11, 12, 14 or 18: An SF R 14 AUU EER 12 wndm Lw will be installed wtQ11XVMEA) D ran 0.82 AFUE fumam will be Inateltao With it wWfied duct Insulation In Oeu of duet MLOW. *at* SwIlm b IS o None of tines 7-14 a ary cht:i:tctdr earls Requlmd. Continua Sedlon 2 - n RCA(Only itUnes3pr4areqhq(*pd, otherwise riot io Section 3 16 ❑ The systemIn altsfed Is a erJra a unft No 7XV(RCA " >n..etlon 9. 17 O This sysiorn is In CGmale 2" a and a 74 5 EER Wr cand)Ucnw w U2 AFUE kmece is being irtF *& No TXV RCA la rwuaed.. Ga to SaWOM 9. 18 ❑ iliumiam Isin Cllnlale 1 9 x 5 7 R u1rMi MbbSwfigne— Tmissystefa in 0mate Izu 18 and Ilse 11 Is not checked No TXv It iniad Ge 10 c&tn 3. 2013 is s stem Is In Cllm®te Zane 16 tin d 1 I to ohaoked WNS nd Une 18, rxv to ulisd. - Go to Sudan S. 21 t' system Is In Cfhoato Zone 2 or 8-15 and tine 11, 18 or 17 is nol chi ckmd_ 17tV(W-A4 is regWted. No w Zecdan 3, 5ectlon e - HERS Rater v8Acetion 22 0 Iff Ilno 161s cmwked. HERS verifrcatton is rd quimd for Duct Searm . 23 C1 f Urto 12, 10. 14,29 d 21 are charked and n A Ilea 16 or i?—HMW veru "thw, Is ro ulmd for TICVIRGA). 34 If Ilna 1E, 13 or 14 are chocked, HFM velffk attar is required for 12 EER Section - E ul mant Efficiencies 25 C3 n llneg 11.12, 13,14 or 17 are dhWPAd, Vog'aded equipment etfie;onotem am moulrod, List In 8kscdon 6 section 5- Duct R-Valual 26 ❑ f more than 40 fest 149ie beth ni�atled cr replaced, d& R -value enuet meat or C=aed Pebika s D hem t 27 ❑ Itt laaa-Inen 40 feet of duct is beim hmalled orar rmaiaoed. duet p +Value mut h-1 r, W=OR-42 BecliEol S - Lee n*mga Version 03-10.08 Pagel of 2 This form Can only be used orrprt)jeds being verified by CalICERTS cedill50 raters, WNW-Ceilcelts,com 0 r , I I 1 08/21/2009 15:17. FAX 18583860863 SEARS_HOME_IMPROVENENT JONES 0005/005 r.,:�MflcatP of CamoltatlCe PrescrlDbVs Method. HVAC-oniv Alteration CFAR-ALT. Pmeal Title: � �d 17ata 9 m CarCERTs zUUs IMPORTANT: This CF1 RAALT town is only for use where ail HV my alleratlon Is mads to an wdeting home Use one form for each syst®m )ein 91(eiret This Is system # 0f s stems Hkarled In thl%houas. 3mbon - 'runium RequireMeM 10r kzquipment W be lAftliezi/Aftered. I mulled v44mcm mursl inatdt aped Olen MA m-1 Cr orxaad arMdwz19A/R-vdw, 29 cone umlax ELS a9 n Pa&EgoLUI 24A- AirHnndinr OorwAmnm.AFW OMdroeIeFAU DQM So D Heel Eaeha or 31 Q DukdAvamwepalmUM% OAlO C214sawmia 7Cp 82 D oor�re arhaaenn ooa DOC IMR=D QMWMr& :i3 U Duclaitort Let�fti eUe: All mnTElterV area aures a to any attared component. See ME --JR - T for, Compliance Statement Thia cenl56ato ar CornpUenoc rrsts the bullalnll fealtlrreo and specIffon0ons needed to aomply with Tale 24, Parts f end 8 of the California Code of Regulations, and the admlr dstrittive regulations to Implemanl thOn This certlflGtste hos boon signed by the Individual with overall protect responalblllty. Trio vrldgralgned r000pnizes that complimme using ductsealing, vatlficadon of reiterant charge, and TXV require h isller tcating and-xAlicetion arta vra•i6cadon by an approvetl HERS ►0tdr, Home Owner or AuthamTroant oaurnentat en70thor .me; t� Address_ Name: A, t/r(vv "v Company Name: City t&WZap• _ ;cA,j Addmor, �G. &SM t om Phone! 36 City/3tatozip: 9A1-;-1 Ph": �-yp "Mans , sr gn-fpN&nent Aq2 AugdlnciaKmant No6�/Cwmn Name Title: Deparbrimt Phone Fax ri Signature or Stamp: f5c-Oad formc MIR -ALT: by anyone. Required at time of permit appfiratlon. Copies to nnmA owner, onforoomcnt egcnt y, HERS rotor. cF-UR,ALT; by Installing contmdor, Required to close permit. Copies to home owner, enforoament egen6y, MMS rater. CF-4R•ALT: by HERS rate. Requlmd to does P Wnit• Copies to home ower, enforoement agency, installer- The CF -4R forme for a sarn la =m shell W-0 released until A testi rpnd Y&FILeAtlom is cow leted and pagggi fy the n r u verdion oa-W-W I -�- - This form can only he used on projects being veriiled by CoICERTS Certified chem. www.calcertsmprn 08/26/2009 WED 10:39 FAX La Quinta Bldg & Safety ********************* *** FAX TX REPORT *** TRANSMISSION OK JOB NO. 0484 DESTINATION ADDRESS 91951.4860393 PSWD/SUBADDRESS DESTINATION ID ST. TIME 08/26 10:36 USAGE T 02'07 PGS.. 3 RESULT OK BUILDING DEPARTMENT CITY OF LA QUINTA OFFICE: (760) 777-7012 INSPECTION REQUESTS: (760) 777-7153 TO: Teaftimom, DATE: ADDRESS: •�� 91d� CORRECTION NOTICE INSPECTION: PERMIT NO.: j 0001 0001 OS/2?/2009 15:17 FAX 18585890863 SEARS -HOME -IMPROVEMENT # JONES . j wi t.,vinollance FrescriDtIve. Method - HVAC -only Ah—wailan 11 wvp*6 r'if"44i' lih I' F- I R -AI 7 Project Tale .Data A.- r,,o6e* 0 WCEATS 200S EnitEr-CMUni-AUDCAW Uge ONY -ori P., Protest Aclgr—ags; SYWO Am&w�- Z!7—imat Z Ud -- - : OCUrn tttonAUthor. Teleptionin Company Name! "'k 0*11 IMPORTANT: This EF--IR-ALT forrr is Only for Use When an HVAC my aftw4en Is made to an a9sunporn a ore fqrm for sect; symem-balm I aftemd. THe IsMatom a of _.4%S—Wm aftlVd In ha house ChgQk all fined that apph4 Check!2afg lines thjj anblly,, SCope of Alterations: 1 AlrHandiuristobalnsuiladorrv*uicL Daptri"Ingbobadetcernhed Conilziammili�- 2 13 3 Mumtsos Fhat raahOngtY lS to po In91311d or r6placed. Duet &eWr4tmbcde-tw1nhd Col ritaeto nerd Me outdoor condensing unit is to be Ira Vied or replaced. Duet �W�Wwmgw Wt dt*M Ina Cor�lrrir to ort ars 4 0 ar rwitlnimills taboharems dorMlawt Due15e>jt ertdlor TXV G4 to be detmmtned Candwe to n9w lira 5 C3 than 40 W of new or repl4meft r 4A em to be Insured in Wnmndfted 2pem Duct iaihv to be d6iffmins'L 0 Check here If the andw duet system is aLw b be now or Simon rtm I - DudZeallnqMmkif a96 oWnes arc Checked Ski p N ft"136 hs che-BW.) 7 )a In Climate goiji 1, 3, 4. S i, 7. cc 8. No drat oeafir-q io TwAred. Go to Saft 8 * T?d- D!n" h. t-. U' 40 in 10 d -M In Um"Mmed No duct ssaft!j is (m4ted. GO to 30dim 9 C3 Ttus system was pravioLmly waled " to tad, and was caOLpade HERS mw - CF No dW sadnq Is raw-ged �WAIET -4R ftwmm - G S Z .t := Ur at kmoicec Out ab WIM 1, 'd. 0 to aal, .�ft 'tn2rt "Im WL GO tq Secilciri ote re dueftystft is to be ae2! 2relaced , linea 11-14 do A" 11 0 n VInnstaZommA 12 and 10: An o.12 APUFt=wln -kiataillsd)n eau offtA Nano Lr 7XV, W spolowl!). Md 17 E3 . nM1rn*92*r%*iQ, Oand ll; An SEEK 14 AWEF-R 12 cw%fenWWUl boh*W%Ah TXYROA� *M added duct insulation (RA wmp on v iadrip &OA R-6 now dj*) In OW Of rive =411r& &ta Settlm 2. 13 n 'n ClImate Zones 9, 10, 11, 13, 14, 71-1 . n 31FA 14 &a EER 12 =WwW v4 be kudelLed wiM TXvPCA) W030,o2AFVC-fun"mvAfUaWkVWl20 naria ddual vWLMc.Gct*Swft2. 1 1 140 15 C3 in Cranes Zones 2, 9. 11, 12, 14 or 1& An SM 14 MM EER 12 an 0.82 AFUff tggwlil be kwtallw OA 4wcawad duct hwWkv In Ow of eked -WIng. met* abadQnz Nano of 4nes 7-14 160M WD MOOLL DUCt owls ReqWMSL continua Section RM9U) (Only if Lines 3 or 4 are ch erwise not to Mogi 11 31 1 is El MoTXV(RMjtnSaeftm2. 17 C3 -nuv19w, is to ClImSeZan S and a 14 SEER ckwwjorwcr(L&2AFU6 Wawa kabring ir*teWd No Mto molied Go to $WOOM 3. i : 1B ❑Th -10 In camith zme 1. 3,4. 5, 0, Y 7. NQ MQ!M I& moliom Gob S.0a 'i SBD is system it in C Is rat cheaked. No TXV(RW Is mulrarL Ga to 6",, 1 ) MQ LVIO, an to swkn a. 20 0 6-4�n 4 in GameteGametez6flil 6 d rani I w floe a-1&,MRCA) in la staKis in corn" Zana 2 or 8.16 am 5m 11, 18 cc W is 2C—*Nft T)cV(RCN it '"Wtad. Ou w sacdon 1. 5 n 3 - HERS Rater ' cabon - N 22 0 lk Is Is HERS verification is ri aWwod for Duct Searmg. 23 [2 01',' 1 or 21 are chadwd end P X ba 16 or i?, dw wAn"18M is tqwrcd for 24 AN IKUm 12. Is or 14 am ClITZ;- mF.RS vett atim is nqui ned for 12 EeK Secfion,4 _-E_qu_12Ment Efficlercies 26 afj*W"i t�13,44,ar t7 are dodtod. V09 adod-&WiPment efficianci-vas ars mautftli-1 10tv-0-tion ti Section 5- Duct R-Valugg 28 U f mom ftr) 40 bit of dig (a bele v'installed !LrrrapWcwk ;�VAIW must meat . =ftd Pmjm, 0,%VmMWvtz, 27 C3 Itf lea Lhw% a tau of duel iv §jjLq instaW or rrPW=cL AM R-Alua must mcd co vcWd R-42 'Sacums-teenoxime Vmlan 03-10-W This form can only be used an prejads being vedfled by CaIGERTS mAlfled r8ters, edge i ni i WNW-cwceftcorn 08/21/2009 15:17. FAX 18585860863 SEARS_HOME_IMPROVEMENT JONES 12005/005 C&TlflCatR 0f G0MD11anCe prescriptive Method -'HVAC-only Alteration CF -1R -ALT. Protect 71tle: ,� / Date: 9 m CAGERTS 2UU5 IMPORTANT: TNrs CF1 R,ALi blot i9 only for use when an HV y 11110 tlon is made ro an %deting home ' Use one form breach system rein ellered. This Ia system # of s stems altered In lhlehouce. section 'runwm utrt:rrtertts or 'qull�fllBn edlAltefed. I mWW %**manIMuq hmk;h gpwImWen ad moci or sowed alfldarcls -nY . 26 Cane SEM q3 & systw a Pada:"Us 24 rJ. FmndMr Door. (unmet. ARU Dr Wmft RAU COLW $0 ❑ Neel Exeha W 31 13 oa,de� u�a D" cH 32 Q vrtuaell,a ad DNC id u lauo AD mandatory mea sures a to a0l altered corn anent. See MF -IR - _ foor, G rnphance atement yhia certificate ar cornplranoc W Ih0 buI1421nil taAWM land apoclloadus nestled to eorllpty WRh -Atte 24, Parisi wW 6 of the Calffomle Code of Regulations, and the adrnb datrallve regulations to Implement than This cerftsto hos beim elgned by the IndlvIdval with ovarell pivied rupoeolti ty. T"a tlndaalgned racogncea that compQutc9 using duct sealing, vadcation of refMAerent diarpe, and TXV rsqulry kuAnIar tcodm and •*rfMration and mificoUon by an approved HERS rater, Home Owner or Authartze snl nts on Author Name, Ov 0110� <qL Name: �,,, v►r�1 Company tea L4- ;9' _ ;r3 as: Sry • 4,52M(o�% - one: Ci/StatelLp: 0146,0 C* Phom. if 7 nature � � E6f&-&mentAqvncv&uQdI DMOPfrnsnO Notc-4./Currun NAmt:s e: papa.•trnant Phone tC , l Fax ;U: Sfgnahlre or Stamp: Requirforms; CR -1R -ALT: by anyone. RegUred at Um,s of perrill apDtiratbn. Copies Ic nnmfr owner, ordoroornera egan*y. NERS oder. CF -6R -ALT: by Insta ft contractor. Required to close permit. Copies to home owner, rnforooment 296W, HERS rater. CF4R•ALT: by HERS mtW. Required to doss vwIlt. Copies to home owner, ardbrOement agency, installer_ The CF -4R forma for a sem ip agM shell not be released until 211 testi r pnd v ac.Ateon is completed and cagrad for the n Verdian 0.1'10-W U. " — This form can only he used on projects being ve6lied by Ca10ERTS certified raters, www.caleerls,cam Bin #Qty of Ca Quinta BulHw 8r Safety D&Won Permit P.O. Bout 1504, 78495 Cd1c Tampico la Quanta, G4 92253 - (760) 777-7012 D Building Permit Application and Tracking Sheet Project Addreu: 5#9`2D akrA)1d a Niq 9 0,mce-, Name: NWIV F94110A1 A P. Number: :6;f1920 4711CA Aa D/R,?� p city, sr, zip: la QUTAA tC'A 92 25,3 r ccmv aor `AW A)ff Mie.- Tclephone:( D / Ale. 0JU - R Ned ellImbe may. ST Zt:mD a a 97 si ro�v 2eY Taieph,xc: 251Off - ow F Siete Lic. # : 9c3 awry Lic. #: DZDD A ch-, 'ksngr.. Designee: Address: city. ST, Zip: Telopho -oqej CansrrnrHon Type: Occapanw- Project type (fie one): New Add'n Alta Repair Demo SW* Lic. #: Name of Corrrtauet Petsan Sq, Ft; # Storie % #Unita Telephone # of coutaa Parson: E6umstcd Value of Prgjat AppucANT: DO NOT WRITE BELOW THIS LINE # snbmttnl Rena Ree- TRAtNG Fpswr FEES Plan Sefa Plan Chet& submitted Item Amoaut Strednral Calea Reviewed, rea@y for oon=tious Man Cheek bopooit Trow Cala. Caued'Oontaa Person Plan Cheek Balance. Milt 24 Calea. Plans picked ap cvnanvedou ' blood 0xin plan Plans resabmi ted Mabantcel Grading plan V, Xcvtiw, ready for corrccUoas/ismt . Electrical Subeoutaetor L&t Called contact Petaon Plumbing Groot Dud Place plcked og $ bLL MO.& Approval Plana reaobmitted Grading INHOt => a'' Review, ready for eon wtlonsllwm Dtveloper Impact Fee Planning Approul CaUcd Contact Person A.I.P.P. Pub. Wka. Appr Date of permit issue School Feta Total Permit Foca Change -outs! Don't Be Left -out! Continued frorn- pravious pnge When replacing space conditioning equipment (or components)in low-rise residential buildings, there are other alternatives to HERS verification of duct sealing (See Table 8-3 from the Residential Compliance Manual, Chapter 8, shown below). Tahlp R-1 _ Altpmativas to nue-,t Spalina and Rpfrirrprant Champ AApasurpmpnt 1. Increased duct insulation refers to an additional R-4 insulation wrap on existing ducts and R-8 duct insulation for all new ducts. 2. Package systems may use Option 2 or 3 without meeting the requirement for a TXV (or refrigerant charge measurement) Note - There are no duct sealing requirements in climate zones 1 and 3-8. In climate zone 8, to avoid TXV or refrigerant charge measurement requirements, a SEER 14 air conditioner or a 0.82 AFUE furnace may be used. t • In Climate Zones 2 and 12: In these two climate zones, the contractor may replace an existing air conditioner with an air conditioner with any SEER that complies with the Appliance Efficiency Regulations (SEER 10 for units manufactured prior to January 23,'2006, SEER 13 for units manufactured on or after January 23, 2006), as long as the contractor also replaces the existing furnace or heat pump with a 0.92 or higher AFUE furnace or a 9.0 or higher HSPF heat pump. When this occurs there is no requirement for duct sealing or HERS verification. • Climate Zone 16: In this climate zone the contractor may replace an existing air conditioner with an air conditioner with any SEER that complies with the Appliance " Efficiency Regulations (SEER 10 for units manufactured prior to January 23, 2006, SEER 13 for units manufactured on or after j. January 23, 2006), as long as the contractor also replaces the existing furnace or heat pump with a 0.92 or higher AFUE furnace or a 10.0 or higher HSPF heat pump. When this occurs there is no requirement for duct sealing or HERS verification. i • In Climate Zones 10, 13, and I5: In these three climate zones the contractor may replace an existing air conditioner • with an air conditioner that has a 14 or higher SEER and also has a 12 or higher EER , and • either does a refrigerant charge measurement or installs a TXV, and • adds R-4 duct wrap to all the ducts. When this occurs there is no requirement for duct sealing or HERS verification duct testing. There is, however, a requirement for HERS verification of the refrigerant charge measurement or the TXV and the EER. These measures can be HERS verified through sampling of I in 7 installations. • In Climate Zones 2 and 9 through 15: In these eight climate zones the contractor has two choices: I. The contractor may replace an existing air conditioner with an air conditioner that has a 14 or higher SEER and also has a 12 or higher EER, and • either does a refrigerant charge measurement or installs a TXV, and • replaces the existing furnace or heat pump with a,0.92 or higher AFUE furnace or with a 9.0 or higher HSPF heat pump. When this occurs there is no requirement for duct sealing or HERS verification of the duct testing. There is, however, a requirement for HERS verification of the refrigerant charge measurement or TXV and the EER. These measures can be HERS verified through sampling of I in 7 installations; or 2. the contractor • may replace an existing air Continued on next page California Energy Commission July 20, 2005 - No. 78 s?3 Option 1 Option 2 Option 3 Climate Zone 0.92 AFUE SEER -14 & EER -12, with either TXV or refrigerant charge measurement, plus Increased Duct Insulation SEER -14 & EER -12 with either TXV or refrigerant charge measurement, plus either 0.92 AFIIE or 0.82 AFUE with Increased Duct Insulation CZ2 Yes No Yes CZ9 NoNo Yes CZ10 No Yes Yes Cz11 No No Yes CZ12 Yes No Yes CZ13 No Yes Yes CZ14 No No Yes CZ15 No Yes Yes CZ16 Yes No Yes 1. Increased duct insulation refers to an additional R-4 insulation wrap on existing ducts and R-8 duct insulation for all new ducts. 2. Package systems may use Option 2 or 3 without meeting the requirement for a TXV (or refrigerant charge measurement) Note - There are no duct sealing requirements in climate zones 1 and 3-8. In climate zone 8, to avoid TXV or refrigerant charge measurement requirements, a SEER 14 air conditioner or a 0.82 AFUE furnace may be used. t • In Climate Zones 2 and 12: In these two climate zones, the contractor may replace an existing air conditioner with an air conditioner with any SEER that complies with the Appliance Efficiency Regulations (SEER 10 for units manufactured prior to January 23,'2006, SEER 13 for units manufactured on or after January 23, 2006), as long as the contractor also replaces the existing furnace or heat pump with a 0.92 or higher AFUE furnace or a 9.0 or higher HSPF heat pump. When this occurs there is no requirement for duct sealing or HERS verification. • Climate Zone 16: In this climate zone the contractor may replace an existing air conditioner with an air conditioner with any SEER that complies with the Appliance " Efficiency Regulations (SEER 10 for units manufactured prior to January 23, 2006, SEER 13 for units manufactured on or after j. January 23, 2006), as long as the contractor also replaces the existing furnace or heat pump with a 0.92 or higher AFUE furnace or a 10.0 or higher HSPF heat pump. When this occurs there is no requirement for duct sealing or HERS verification. i • In Climate Zones 10, 13, and I5: In these three climate zones the contractor may replace an existing air conditioner • with an air conditioner that has a 14 or higher SEER and also has a 12 or higher EER , and • either does a refrigerant charge measurement or installs a TXV, and • adds R-4 duct wrap to all the ducts. When this occurs there is no requirement for duct sealing or HERS verification duct testing. There is, however, a requirement for HERS verification of the refrigerant charge measurement or the TXV and the EER. These measures can be HERS verified through sampling of I in 7 installations. • In Climate Zones 2 and 9 through 15: In these eight climate zones the contractor has two choices: I. The contractor may replace an existing air conditioner with an air conditioner that has a 14 or higher SEER and also has a 12 or higher EER, and • either does a refrigerant charge measurement or installs a TXV, and • replaces the existing furnace or heat pump with a,0.92 or higher AFUE furnace or with a 9.0 or higher HSPF heat pump. When this occurs there is no requirement for duct sealing or HERS verification of the duct testing. There is, however, a requirement for HERS verification of the refrigerant charge measurement or TXV and the EER. These measures can be HERS verified through sampling of I in 7 installations; or 2. the contractor • may replace an existing air Continued on next page California Energy Commission July 20, 2005 - No. 78 s?3 Certificate of Compliance Prescriptive Method - HVAC -only Alteration CF -1 R -ALT Project Title: Date: © CaICERTS 2005 Enforcement Agency Use Only Project Address: Climate Zone: Building Permit a Documentation Author: Telephone: Plan Check Date Company Name: Field Check Date IMPORTANT: This CF -1 R -ALT form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is system # of systems altered in this house. Check all lines that apply. Check only lines that anoly. Scope of Alterations: 1 ❑ An Air Handler is to be installed or replaced. Duct sealing to be determined. Continue to next line. 2 ❑ A Furnace Heat exchanger is to be installed or replaced. Duct sealing to be determined. Continue to next line. 3 ❑ An outdoor condensing unit is to be installed or replaced. Duct Sealing and/or TXV(RCA) to be determined. Continue to next line. 4 ❑ A cooling or heating coil is to be installed or replaced. Duct Sealing and/or TXV(RCA) to be determined. Continue to next line. 5 ❑ More than 40.feet of new or replacement duct are to be installed in unconditioned space. Duct sealing to be determined. ❑ Check here if the entire duct system is also to be new or replaced. Continue to next line. 6 ❑ If none of lines 1-5 are checked, neither Duct Sealing nor TXV(RCA) are required. Go to Section 5. Section 1 - Duct Sealing (Only if any of Lines 1 2 3 4 or 5 are checked. Skip if Line 6 is checked. 7 ❑ This system is in Climate Zone 1, 3, 4, 5, 6, 7, or 8. No duct sealing is required. Go to Section 2. 8 ❑ This system has less than 40 feet of ducts in unconditioned space. No duct sealing is required. Go to Section 2. 9 ❑ This system was previously sealed and tested, and was certified by a HERS rater. No duct sealing is required. Attach previous CF4R form. Go to Section 2. 10 ❑ This ducts stem is sealed or insulated with asbestos. No duct sealing is required. Go to Section 2. Note: If the entire ducts stem is.to be new or replaced, Lines 11-14 do not apply. 11 ❑ In Climate Zones 2 12 and 16: An 0.92 AFUE furnace will be installed in lieu of duct sealing and TXV, if applicable). 12 ❑ In Climate Zones 10, 13 and 15: An SEER 14 A= EER 12 condenser will be installed with TXV(RCA) AND added duct insulation (R-4 wrap on existing ducts, R-8 new ducts) in lieu of duct sealing. Go to Section 2. 13 ❑ In Climate Zones 9, 10, 11, 13, 14, or 15: An SEER 14 AND EER 12 condenser will be installed with TXV(RCA) AND a 0.92 AFUE furnace will be installed in lieu of duct sealing. Go to Section 2. 14 ❑ In Climate Zones 2, 9, 11; 12, 14 or 16: An SEER 14 AM EER 12 condenser will be installed with TXV(RCA) AND an 0.82 AFUE furnace will be installed with increased duct insulation in lieu of duct sealing. Go to Section 2. 15 ❑ INone of lines 7-14 above are checked. Duct Sealing is Required. Continue. Section 2 - TXV(RCA) (Only if Lines 3 or 4 are checked, otherwise got to Section 3 16 ❑ The system being altered is a package unit. No TXV(RCA) is required. Go to Section 3. 17 ❑ This system is in Climate Zone 8 and a 14 SEER air conditioner or 0.82 AFUE furnace is being installed. No TXV(RCA) is required. Go to Section 3. 18 ❑ This system is in Climate Zone 1 3, 4 5 6 or 7. No TXV(RCA) is required. Go to Section 3. 19 ❑ This system is in Climate Zone 16 and line 14 is not checked. No TXV(RCA) is required. Go to Section 3. 20 ❑ This s stem is in Climate Zone 16 and line 14 is checked and not line 16. TXV(RCA) is required. Go to Section 3. 21 ❑ This system is in Climate Zone 2 or 8-15 and line 11, 16 or 17 is not checked. TXV(RCA) is required. Go to Section 3. Section 3 - HERS Rater verification 22 ❑ If line 15 is checked, HERS verification is required for Duct Sealing. 23 ❑ If line 12, 13, 14, 20 or 21 are checked and not line 16 or 17, HERS verification is required for TXV(RCA). 24 ❑ If line 12, 13 or 14 are checked, HERS verification is required for 12 EER. Section 4 - Equipment Efficiencies 25 ❑ If lines 11, 12, 13, 14 or 17 are checked, upgraded equipment efficiencies are required. List in Section 6. Section 5- Duct R -Values 26 ❑ If more than 40 feet of duct is being installed or replaced, duct R -value must meet or exceed Package D requirements, 27 ❑ Ilf less than 40 feet of duct is being installed or replaced, duct R -value must meet or exceed R4.2 Section 6 - see next page Version 03-10-06 Page 1 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com Certificate of Compliance Prescriptive Method - HVAC -only Alteration CF -1R -ALT Project Title: Date: © CaICERTS 2005 IMPORTANT: This CF -1 R -ALT form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is system # of systems altered in this house. Section 6 - Minimum Requirements for Equipment to be Installed/Altered. Installed equipment must match type/location and meet or exceed efficiencies/R-values. 28 Configuration: ❑ Split system ❑ Package Unit 29 ❑ Air Handler []Gas furnace, AFUE: ❑Heatpump FAU OHydronic FAU ❑Other 30 ❑ Heat Exchanger 31 ❑ Outdoor Condensing Unit ❑AIC ❑HeatpumpE(ficienc SEER/HSPF: JEER if re d : 32 ❑ Cooling or heating coil ❑AIC OHeatpump OHydronic 33 ❑ Ducts Location: Length (ft): R -value: All mandatory measures apply to any altered component. See MF -1 R - ALT form. Compliance Statement: This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall project responsibility. The undersigned recognizes that compliance using duct sealing, verification of refrigerant charge, and TXV require installer testing and certification and verification by an approved HERS rater. Home Owner or Authorized Agent Documentation Author Name: Name: Address: Company Name: City/State/Zip: Address: Phone: City/State/Zip: Phone: Signature: Signature: Enforcement Agency (Building Department) Notes/Comments: Name: Title: Department: Phone #: Fax #: Signature or Stamp: Required forms: CF -1 R -ALT: by anyone. Required at time of permit application. Copies to home owner, enforcement agency, HERS rater. CF -6R -ALT: by installing contractor. Required to close permit. Copies to home owner, enforcement agency, HERS rater. CF -4R -ALT: by HERS rater. Required to close permit. Copies to home owner, enforcement agency, installer. The CF -4R forms for a sample group shall not be released until all testing and verification is completed and passed for the entire group. Version 03-10-06 Page 2 of 2 This form can only be used on projects being verified by CalCERTS certified raters. www.calcerts.com Certificate of Field Verification Prescriptive Method - . and Diagnostic Testing HVAC -only Alteration CF -4R -ALT Project Title: Date: © 2005 CaICERTS Enforcement Agency Use Only Project Address: Climate Zone: Building Permit # Installing Contractor: Telephone: Plan Check Date CaICERTS Rater Name: Telephone: Field Check Date Rater's Company Name: CaICERTS Rater ID #: IMPORTANT: This CF -4R -ALT form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is system # of systems altered in this house. Do not release CF-4Rs for a sample group until all verification and testing in the group is completed and passed. Copies to: Homeowner, Installer, and Building Department Hers Rater Compliance Statement: As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies with the diagnostic testing compliance requirements as checked ✓ on this form. I also certify that I have followed all protocols and procedures as required by the CaICERTS Rater Agreement. Signed: ampling ❑ First test ❑ Re -test (attach previous CF -4R -ALT) ❑ This house is NOT part of a sample group. ❑ This house passes all necessary tests. Rater to sign HERS rater compliance statement above). ❑ IThis house did NOT pass the necessary tests. Retest required. See notes below and next page. ❑ his house is part of a sample group Other houses in the group include (max 6): Home owner's last name/Street address/City 1) 2) 3) 4) 5) 6) ❑ This house passes all necessary tests. (Rater to sign HERS rater compliance statement above). All homes in sample group will be issued CF -4R certificates from CalCERTS registry. ❑F This house did NOT pass the necessary tests. Retest required. See notes below and next page. ❑ This is the first house to fail in this group. (Select one of the above homes for second test). ❑ This is the second house to fail in this group. All homes in group must be tested. Notes: Version 03-10-06 Page 1 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com Certificate of Field Verification Prescriptive Method - and Diagnostic Testing HVAC -only Alteration CF -4R -ALT Project Title: Date: © 2005 CaICERTS IMPORTANT: This CF -4R -ALT form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is system # of systems altered in this house. Copies to: Homeowner, Installer, and Building Department Rater to verify only results of test that passed on CF -6R -ALT form. See lines 26 to 29 of CF -6R -ALT form. Results must be uploaded to CaICERTS Registry for issuance of final certificate per Title 20. Step 1 - Pre-test: La a of the system before any alterations.(Only if line 27 is checked on the CF -6R -ALT form. 1 Pre test leakage :1 ICFM25 From Line 1 of CF -6R -ALT form. 2 Line 1 x 0.4 = I harqet for 60% reduction Step 2 - Determine Total System Fan Flow: Use any of these methods.(Only if lines 26 27 or 28 are checked on CF -6R -ALT form 3 Cooling: Condenser tonnage: tons x 400 CFM/ton = JCFM 4 Heating: Furnace output: Btuh x.0217 CFM/Btuh = CFM 5 6 Measured: (refer to ACM Manual Appendix RE, section 4.1) = CFM Measurement method: ❑ flow hood ❑ plenum pressure matching ❑ flow grid 7 Total system fan flow value to be used: I JCFM may use highest of lines 3, 4, or 5. Step 3 - Determine Targets: (Only if lines 26 or 28 are checked on F6R-ALT form) 8a Total System fan flow (line 7 from above) x 0.06 = FM25 = 6% leakage target 8b Total System fan flow line 7 from above x 0.15 = FM25 = 15% leakage target 9 Total System fan flow line 7 from above x 0.10 = ICFM25 = 10% leakage to outside target Step 4 - Alterations: Must be consistent with the CF -1 R form. 10 ❑ IVerifv that all new connections are sealed with approved materials. 11 ❑ lNo newly constructed portions of the system can have unducted building cavities to convey system air. 12 IDuct insulation to be checked by local code enforcement agency. Step 5 - Total Leakage (Only if lines 26 or 27 are checked on CF -6R -ALT form) 13 leakage = I ICFM25 refer to 2005 ACM appendix RC, Sections RC 4.3.1 14a ❑ 14b ❑ If line 13 is less than line 8a, house passes the 6% leakage requirement. Go to Step 9 If line 13 is less than line 8b house passes the 15% leakage requirement. Go to Step 9 15 ❑ If line 13 is less than line 2 house passes the 60% reduction requirement after line 17 is checked. 16 ❑ This house does not yet pass the necessary tests. Retest required. Attach new CF -4R -ALT. See notes, below. 17 ❑ If line 15 is checked, but not 14a or 14b, Smoke Test and Visual Inspection of Accessible Duct Sealing is required. Go to Step 8 Step 6 - Leakage to Outside:(Only if line 28 is checked on CF -6R -ALT form) 18 leakage = I ICFM25 refer to 2005 ACM appendix RC, Sections RC 4.3.3 19 ❑ If line 18 is less than line 9, house passes the 10% leakage to outside requirement. 20 ❑ This house does not yet pass the necessary tests. Retest required. Attach new CF -4R -ALT. See notes, below. Step 7 - (If line 29 is checked on the CF -6R -ALT form. 21 ❑ 22 ❑ 23 ❑ Smoke Test and Visual Inspection of Accessible Duct Sealing are required. Install required label per ACM Appendix RC, Sections RC.4.3.5. House can NOT be part of a sample. ❑ This house does not yet pass the necessary tests. Retest required. Attach new CF -4R -ALT. See notes, below. Step 8 - Smoke Test and Visual Verification(Only if lines 27 or 29 are checked on CF -6R -ALT form 24 ❑ 25 11 25 26 ❑ Perform smoke test per ACM Appendix RC, Sections RC 4.3.6. Visual Inspection and verify repair of excessively damaged ducts per ACM Appendix RC, Sections RC 4.3.7. Verify that register boots are sealed to surrounding material per ACM Appendix RC, Sections RC 4.3.7. Step 9 -TXV RCA 27a ❑ If TXV is required by the CF -1 R form (line 23 on CF -1 R -ALT form), it has been installed and access has been provided for visual verification by HERS rater. 27b ❑ If "Refrigerant Charge and Airlfow" (see ACM appendix RD) was done in lieu of TXV, attach completed ages 3 of 8 and 4 of 8 from the CEC's CF -4R form. Step 10 Upgraded Equipment Efficiencies 28 ❑ Ilf upgrade equipment efficiencies are required (line 24 of CF -11R -ALT) Hers rater to verify necessary make and model number of equipment. Installing contractor to provide rater adequate documentation to verify efficiencies. Notes: refer to line numbers above Version 03-10-06 Page 2 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com "'-7 Certificate of Compliance Prescriptive Method - HVAC -only Alteration CF -1 R -ALT Project Title: Date: © CaICERTS 2005 Enforcement Agency Use Only Project Address: Climate Zone: Building Permit # Documentation Author: Telephone: Plan Check Date Company Name: Field Check Date IMPORTANT: This CF -1 R -ALT form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is system # of systems altered in this house. Check all lines that apply, Check only lines that apply. Scope of Alterations: 1 ❑ An Air Handler is to be installed or replaced. Duct sealing to be determined. Continue to next line. 2 ❑ A Furnace Heat exchanger is to be installed or replaced. Duct sealing to be determined. Continue to next line. 3 ❑ An outdoor condensing unit is to be installed or replaced. Duct Sealing and/or TXV(RCA) to be determined. Continue to next line. 4 ❑ A cooling or heating coil is to be installed or replaced. Duct Sealing and/or TXV(RCA) to be determined. Continue to next line. 5 ❑ More than 40 feet of new or replacement duct are to be installed in unconditioned space. Duct sealing to be determined. ❑ Check here if the entire duct system is also to be new or replaced. Continue to next line. 6 ❑ �If none of lines 1-5 are checked, neither Duct Sealing nor TXV(RCA) are required. Go to Section 5. Section 1 - Duct Sealin(Only if any of Lines 1 2 3 4 or 5 are checked. Skip if Line 6 is checked. 7 D Thiss stem is in Climate Zone 1, 3, 4, 5, 6, 7, or 8. No duct sealing is required. Go to Section 2. 8 ❑ This system has less than 40 feet of ducts in unconditioned space. No duct sealing is required. Go to Section 2. 9 ❑ This system was previously sealed and tested, and was certified by a HERS rater. No duct sealing is required. Attach previous CF -4R form. Go to Section 2. 10 ❑ This ducts stem is sealed or insulated with asbestos. No duct sealing is required. Go to Section 2. Note: If the entire ducts stem is to be new or replaced, Lines 11-14 do not apply. 11 ❑ In Climate Zones 2 12 and 16: An 0.92 AFUE furnace will be installed in lieu of duct sealing and TXV, if applicable). 12 ❑ In Climate Zones 10, 13 and 15: An SEER 14 AMD EER 12 condenser will be installed with TXV(RCA) AND added duct insulation R-4 wrap on existing ducts, R-8 new ducts in lieu of duct sealing. Go to Section 2. 13 ❑ In Climate Zones 9, 10, 11, 13, 14, or 15: An SEER 14 AND EER 12 condenser will be installed with TXV(RCA) D a 0.92 AFUE furnace will be installed in lieu of duct sealing. Go to Section 2. 14 ❑ In Climate Zones 2, 9, 11, 12, 14 or 16: An SEER 14 Ah Q EER 12 condenser will be installed with TXV(RCA) AND an 0.82 AFUE furnace will be installed with increased duct insulation in lieu of duct sealing. Go to Section 2. 15 ❑ INone of lines 7-14 above are checked. Duct Sealing is Required. Continue. Section 2 - TXV(RCA) (Only if Lines 3 or 4 are checked, otherwise got to Section 3 16 ❑ Thes stem being altered is a package unit. No TXV(RCA) is required. Go to Section 3. 17 ❑ This system is in Climate Zone 8 and a 14 SEER air conditioner or 0.82 AFUE furnace is being installed. No TXV(RCA) is required. Go to Section 3. 18 D Thiss stem is in Climate Zone 1 3 4 5 6 or 7. No TXV(RCA) is required. Go to Section 3. 19 ❑ This system is in Climate Zone % and line 14 is not checked. No TXV(RCA) is required. Go to Section 3. 20 1:1 This :system is in Climate Zone 16 and line 14 is checked and not line 16. TXV(RCA) is required. Go to Section 3. 21 ❑ IThis system is in Climate Zone 2 or 8-15 and line 11, 16 or 17 is not checked. TXV(RCA) is required. Go to Section 3. Section 3 - HERS Rater verification 22 ❑ If line 15 is checked, HERS verification Is required for Duct Sealing. 23 ❑ If line 12, 13, 14, 20 or 21 are checked and not line 16 or 17, HERS verMcation Is required for TXV(RCA). 24 ❑ If line 12, 13 or 14 are checked, HERS verification is required for 12 EER. Section 4 - Equipment Efficiencies 25 ❑ If lines 11, 12, 13, 14 or 17 are checked, upgraded equipment efficiencies are required. List in Section 6. Section 5- Duct R -Values 26 ❑ If more than 40 feet of duct is being installed or replaced, duct R -value must meet or exceed Package D requirements. 27 ❑ Ilf less than 40 feet of duct is being installed or replaced, duct R -value must meet or exceed R-4.2 Section 6 - see next page Version 03-10-06 Page 1 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com Certificate of Compliance Prescriptive Method - HVAC -only Alteration CF -1R -ALT Project Title: Date: © CalCERTS 2005 IMPORTANT: This CF -1 R -ALT form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is system # Of systems altered in this house. Section 6 - Minimum Requirements for Equipment to be Installed/Altered. Installed equipment must match type/location and meet or exceed efficiencies/R-values. 28 Configuration: ❑ Split system ❑ Package Unit 29 ❑ Air Handler ❑Gas furnace, AFUE: ❑Heatpump FAU ❑Hydronic FAU ❑Other 30 ❑ Heat Exchanger 31 ❑ Outdoor Condensing Unit ❑A/C ❑Heatpump lEfficiency SEER/HSPF: JEER if re d : 32 ❑ Cooling or heating cog ❑A/C ❑Heatpump ❑Hydronic 33 ❑ Ducts Location: Length (ft): R -value: All mandatory measures apply to any altered component. See MF -1R - ALT form. Compliance Statement: This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall project responsibility. The undersigned recognizes that compliance using duct sealing, verification of refrigerant charge, and TXV require installer testing and certification and verification by an approved HERS rater. Home Owner or Authorized Agent Documentation Author Name: Name: Address: Company Name: City/State/Zip: Address: Phone: City/State/Zip: Phone: Signature: Signature: Enforcement Agency (Building Department) Notes/Comments: Name: Title: Department: Phone #: - Fax #: Signature or Stamp: Required forms: CF -1 R -ALT: by anyone. Required at time of permit application. Copies to home owner, enforcement agency, HERS rater. CF -6R -ALT: by installing contractor. Required to close permit. Copies to home owner, enforcement agency, HERS rater.' CF -4R -ALT: by HERS rater. Required to close permit. Copies to home owner, enforcement agency, installer. The CF -4R forms for a sample group shall not be released until all testing and verification is completed and passed for the entire group. Version 03-10-06 Page 2 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com