06-0100 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
(Z�06--00000�
Property Address:
80752yHERMITAGE
APN:
762-210-021- -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2909
Tit!t 4 4 Qum&
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 nd my License is in full force and effect.
License Class: C20 ,LicenseN .: _374937
Dated � V �� Contra— cto ��
OWNS EWILDER DECLARATION
I hereby affirm under penalty of perjury that I am empt 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 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.).
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 contractors) 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
mer:
LL ROBERT D
752 HERMITAGE
(QUINTA, CA 92253
P.Artff DESERT AIR CONDITIONING
42081 BEACON HILL
PALM DESERT, CA 92211
(760)346-0677
Lic. No.: 374937
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/10/06
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fallowing 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 STATE FUND Policy Number 1795546-2006
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 tot 2rkers' compensation laws of California,
and agree that, if I should becom subjec a workcompensation of Section
3700 of the Labor Cade, I shal ith complywithose tons.
Date:' -Applicant:
WARNING: FAILURE TO SECURE ORKERS' COMP ON COVERAGE IS UNLAWFU AN
SUBJECT AN EMPLOYER TO CRIMINAL PENALTI CIVIL FINES UP TO ONE HUN 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 in n is cetrii is ree to comply with all
city and county ordinances and state laws relating to buildi nstruction, and hereby auth rize representatives
i°offtthiis`county to enter upon the above-mentioned prop nspection purposes.
Coate:- ate ` 1 U —01 Signature (Applicant or Agen
Application Number . . . . . 06-00000100
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 24.00
Plan Check
Fee
6.00
Issue Date . . . .
Valuation
. . .
.
0
Expiration Date . . 7/09/06
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 3.5 TON AMANA 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 #
Qty of La QumtQ
Building 8t Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
10 b ��
Project Addres
Owner's Name:
Address: 0 O
A. P. Number:
Legal Description:
City, ST, Z•
Contractor:
Telephone: /
'•T:O:•:{v" i'fi'.vi`iSY:ai'i :•:4:K4'l.Ti
r:>.•:•.;,,ts:,, y, vn.<<
Address: O�F
Project Description:
City, ST, Zip: I�
Telephone: O'��(p .��>u`><•.:•..:.:::..::::::.:...:::::.::..<•::.
3
State Lie. # :37`V93'1*
City Lie. #
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
Construction Type: Occupancy:
Demo
ProJect tyPa circle one : New Addn Re air
Lie. #:
«'
,
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: &C)
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2,d Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
INSTALLATION CERTIFICATE (Page 1 of 12) CF -6R
Sit /ddress /� W Permit Number
\A;�Z"7
Installation certificates (CF -6R) are required fbeacFi and every dwelling unit. When the installation of measures that require
field verification and diagnostic testing is complete, the builder or the builder's subcontractor shall complete diagnostic
testing and the procedures specified in this section. When the installation is complete, the builder or the builder's
subcontractor shall complete the CF -6R (Installation Certificate), and keep it at the building site for review by the building
department. The builder also shall provide a copy of the Installation Certificate to the HERS rater for any measures requiring
field verification and diagnostic testing, per Section 10-1.03(a).
WATER HEATING SYSTEMS:
Distribution
CEC Certified Type If # of Rated Input
Heater Mfr Name & (Std, Point- Recirculation, Identical (kW or Tank Volume
Type Model Number of -Use, etc) Control Type Systems Btu/hr)'(gallons)
External
Efficiency Standby Insulation
(EF, RE) Loss (%)Z R-valueZ
Signature: P,Date:
�� 9
5 AV 11L
1 For small gas storage (rated input of less than or equal to 75,000 Btu/hr), electric resin tante and heat pump water
heaters, list Energy Factor (EF). For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list
Recovery (RE), Thermal Efficiency, Standby Loss and Rated Input. For instantaneous gas water heaters, list Thermal .
Efficiency and Rated Input.
2. R-12 external insulation is mandatory for storage water heaters with an energy factor of less than 0.58.
Kitchen Pipin g:
If indicated on the CF -IR, all hot water piping 3/4 inches in diameter that runs from the hot water source to the kitchen
fixtures is insulated.
Faucets & S hower Heads:
All faucets and showerheads installed are certified to the Energy Commission, pursuant to Title 24, Part 6, Section 111.
Centra I Water Heating in B uildings with Multiple Dwelling Units (required for prescriptive)
VI
❑AII hot water piping in main circulating loop is insulated to requirements of §1500)
23
❑Central hot water systems serving six or fewer dwelling units which have (1) less than 25' of distribution piping
outdoors; (2) zero distribution piping underground; (3) no recirculation pump; and (4) insulation on distribution piping
that meets the requirements of Section 1500)
❑Central hot water systems serving more than 6 dwelling units - presence of either a time control or a time/temperature
control
0 I, the undersigned, verify that equipment listed above my signature is: 1) the actual equipment installed; 2)
equivalent to or more efficient than that specified in the certificate of compliance (Form CF -1R) submitted for compliance
with the Energy Efficiency Standads for residential buildings; and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable.
Installing . Subcontractor (Co. Name) OR General
Contractor (Co. a OR Owner
Palm Desert Air Conditioning & Heating Company
Signature: P,Date:
�� 9
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms Septanber 2005
a
INSTALLATION CERTIFICATE
Site dress
(Page 3 of 12) CF -6R
Permit Number
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The
information provided on this form is required) After completion of final inspection, a copy must be provided to the building
department (upon request) and the building owner at occupancy, per Section 10-103(a).
HVAC SYSTEMS:
Heating Equipment
Equip Type
(pkg. heat um
CEC Certified Mfr.
Name and Model
Number
# of
Identical
Systems
Efficiency�
(AFUE, etc.)
CF-IRvalue)
Duct
Location
attic etc.
Duct or Heating
Piping Load
R -value Btu/hr
Heating
Capacity
Btu/hr
Cooling
Capacity
Btu/hr
Cooling Equipment
Equip Type
(pkg. heat um
CEC Certified Mfr.
Name and Model
Number
# of
Identical
Systems
Efficiency
(SEER or EER)'
'CF-1Rvalue)
Duct
Location
attic etc.
Duct
R -value
Cooling
Load
tu/hr
Cooling
Capacity
Btu/hr
1. > symbol reads greater than or equal to what is indicated on the CF -IR value.
Include both SEER and EER if compliance credit for high EER air conditioner is claimed.
0 11, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or
more efficient than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the
Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable.
Installing Subcontractor (Co. Name) OR General
Contractor (Co. N R Owner
Palm Desert Air Conditioning & Heating Company
of
Signature:
Date: Q
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms
April 2005
INSTALLER
INSTALLER COMPLIAN
STATEMENT FOR DUCT LEAKAGE
INSTALLER COMPLIANCE STATEMENT
N/A The building was: ❑ Tested at Final ❑ Tested at Rough -in
INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE:
NIA ❑ Remove at least one supply and one return register, and verify that the spaces between the register boot and the interior
finishing wall are properly sealed.
If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points
between the air handler and the supply and return plenums to verify that the connection points are properly sealed.
Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used
New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platforms returns in lieu of
ducts).
0 DUCT LEAKAGE REDUCTION
Procedures for field verification and diagnostic testingof air distribution systems are available in RACM, Ap pendix RC4.3
a
is
M1
a
NEW CONSTRUCTION:
Palm Desert Air Conditioning & Heating Company
oe
Duct Pressurization Test Results (CFM @ 25 Pa)
Measured
72 ,
Values
1.
Enter Tested Leakage Flow in CFM:
i I—•,.
Fan Flow: Calculated (Nominal: ❑Cooling vilieating) or E] Measured
2
If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21.7 cfm/(kBtu/hr) x Heating
i s)tD
Capacity in Thousands of Btu/hr output, enter total calculated or measured fan flow in CFM herd:
`�
3
Pass if Leakage Percentage 6% for Final or 4% at Rough -in:
Pass Fail
100 x Line # 1 / Line # 2
ALTERATIONS: Dud System and/or HVAC Equipment Change -Out's
?'
,,;c
Enter Tested Leakage Flow in CFM. from Pre -Test of Existing Duct System Prior to Duct
xw
aJ't�,��'
y-
��, t .;4
rr fir t'`�"
f
System Alteration and/or Equipment Change -Out.
Enter Tested Leakage Flow in CFM from Final Tes t of New Duct System or Altered Duct�
�'�T��it1
System for Duct System Alteration and/or Equipment Chan e -Out.
,,.,
Enter Reduction in Leakage for Altered Duct System?A2r'_z.
6,
Line # 4 Minus Line # 5 —(Only if Applicable)
?i:•- ., >_e `r :..
7
Enter Tested Leakage Flow in CFM to Outside (Only if Applicable)
Entire New Duct System -Pass if Leakage Percentage 6% for Final
Pass Fail
8
100 x Line # 5 / Line # 2
TEST OR V E R I FIC ATION STAN DAR DS: Fo r A Itered Du ct System and/or H V AC Equipme nt Change -
Out U se oneof the followingfour Test or Verification Standardsfor compliance:
9
Pass if Leakage Percentage 1.5% [1.00 x [ (Line # 5) / (Line # 2)1]
Pass Fail
10
Pass if Leakage to Outside Percentage 10% [100 x [ _(Line # 7) / (Line # 2)]]
Pass Fail
Pass if Leakage Reduction Percentage 60% [100 x # 6) / (Line # 4)]]
11
_(Line
and Verification by Smoke Test and Visual Inspection
Pass Fail
12
FPass
Pass if Sealing of all Accessible Leaks and Verification b Smoke Test and Visual Inspection
�'t",'s#
Pass Fail
i f 0 ne of L Ines # 9 through # 12assa`+*
Pass Fail
1, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for
compliance credit. I, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and
Fans comply with Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency standards.
Installing Subcontractor (Co. Name) OR General
Contractor (Co N e) OR Owner
Palm Desert Air Conditioning & Heating Company
oe
Signature:
Date:
e9l
..E - -
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance For ms September 2005
INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R
Site Address Permit Number
l,• o(
Q THERMOSTATIC EXPANSION VALVE (TXV)
Procedures for field verification of thermostatic expansion valves are available in RACM, Appendix RI
N/A REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
Thermostatic Expansion Valves
Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity B tu/hr
Date of Verification
Date of Refrigerant Gauge Calibration (must be checked monthly)
Date of Thermocouple Calibration (must be checked monthly)
Standard Charge Measurement Procedure (outdoor air dry-bulb 55T and above):
Procedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2.
Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this
procedure.
Measured Temperatures
Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db)
Access is provided for inspection. The procedure shall
Return (evaporator entering) air dry-bulb temperature (Treturn, db)
OF
consist of visual verification that the TXV is installed on
❑
[� Yes
No the system and installation of the specific equipment
Suction line temperature (Tsuction, db)
OF
shall be verified.
OF
Yes is a pass I Pass
I Fail
N/A REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
Thermostatic Expansion Valves
Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity B tu/hr
Date of Verification
Date of Refrigerant Gauge Calibration (must be checked monthly)
Date of Thermocouple Calibration (must be checked monthly)
Standard Charge Measurement Procedure (outdoor air dry-bulb 55T and above):
Procedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2.
Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this
procedure.
Measured Temperatures
Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db)
OF
Return (evaporator entering) air dry-bulb temperature (Treturn, db)
OF
Return (evaporator entering) air wet -bulb temperature (Treturn, wb)
OF
Evaporator saturation temperature (Tevaporator, sat)
OF
Suction line temperature (Tsuction, db)
OF
Condenser (entering) air dry-bulb temperature (Tcondenser, db)
OF
,u erheat Charge Method Calculations for Refrigerant Charge
Actual Superheat = Tsuction, db — Tevaporator, sat °F
Target Superheat (from Table RD -2) OF
Actual Superheat — Target Superheat (System passes if between -5 and +5°F) OF
Temperature Split Method Calculations for Adequate Airflow
.Snlit Method Calculation is not necessary ifAdeauate Airflrnv credit is tnkvn
Actual Temperature Split - T return, db Tsupply, db
OF
Target Temperature Split (from Table RD3)
OF
Actual Temperature Split Target Temperature Split (System passes if between -
3°F and +3°F or, upon remeasurement, if between -3°F and -100°F
OF
Residential Compliance Forms
April 2005
a
0
CERTIFICATE OF COMPLIANCE: RESIDENTIAL
(Page 1 of 5) CF -1R
Pro' t Title
Joint
Appendix
IV
Reference
Date
Location
Comments
(attic, garage,
typical etc.
MBit►ldng Permit #J�,4u
i l,,fis d,xs i+5ln
P ct Addr s
a 3
'iPlan Check / Dater ;b °'7
�• ,4
Documentation Author
Karl Powell
Telephone
�°
Brown or Robert
C'}ieck'%Date'
r`�
}'
Compliance Method(Prescriptive)
l
Climate Zone
�f.
15Enforcemerit'A
Alternative Component Package Method: (check one) N/A C N/A D N/A D (Alternative)
Package C and Package D choices require HERS rater field verification and/or diagnostic testing (see CF -111 page 3)
For Package D Alternative see Appendix B Table 151-C Footnotes 7-14
GENERAL INFORMATION
Total Conditioned Floor Area (CFA) f
Average Ceiling Height: N/A ft
Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C ---- (5% X CFA) N/A ft,
Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C ----(20% X CFA) N/A ft2
10 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: N/A Number of Dwelling Units: N/A
Floor Construction Type: N/A Slab/Raised Floor (circle one or both)
Front Orientation: N/A 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, 8-151
OPAQUE SURFACES INCLUDING OPAQUE DOORS
5
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.
1) see Joint Appendix IV in section 1V.2, 1V.3 and 1VA, which is the basis for the U -Tactor criterion. U -tactors can not exceed
prescriptive value to show equivalence to R -values.
Residential Compliance Forms
April 2005
FENESTRATION PRODUCTS — U -FACTOR AND SHGC
FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS -4R —must be included for New
Construction, Additions and Alterations.
Fenestration
#/Type/Pos.
(Front, Left,
Rear, Right,
S li ht
Orien-
tation,
N, S, E,
W
Exterior
Shading/Overhangs6''
Area U -factor SHGC box if WS -3R is
ft U-factor2 Source' SHGC° Sources included
LITA
1) Skylights are now included in West -facing fenestration area if the skylights are tilted to the west or tilted in any
direction 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 I I6B.
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
fumace heat pump,boiler, etc.
Minimum
Efficiency
AFUE or HSPF
Distribution
Type and Location Duct or Piping Thermostat Configuration
ducts attic etc. R -Value T eslit or package)
Cooling Equipment
Type and Capacity
(A/C, heat pump, evap.
cooling)
Minimum
Efficiency Duct Location Duct Thermostat Configuration
SEER or EER attic, etc. R -Value Type (split or package)
Residential Compliance Forms April 2005
a
SEALED DUCTS and TXVs (or Alternative Measures)
A signed CF -4R -Form must be provided to the building department for each home for which the following. are
required.
10
Sealed Ducts all climate zones Installer testing and certification and HERS rater field verification required.)
N/A
TXVs, readily accessible (climate zones 2 and 8-15 only)
Tank
Capacity
Installer 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 required.)
OR
❑ IAlternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14.
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
spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D.
WATER HEATING SYSTEMS
77--]
❑
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per
N/A
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is
Tank
Capacity
not allowed.
&A
Check box when using Preapproved Alternative 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
N/A
Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the
submittal. -
NIA
Check box to verify that a time control is required for a recirculating system pump for a system serving multiple.
N/A
units
Systems serving single dwelling units
Water Heater
Type/Fuel Type
Distribution
Type
Number
in System
Rated
Input'
(kW or
Btuthr(gallons)
Tank
Capacity
Energy
Factor' or
Thermal
Efficiency
Standby
Loss %
Tank
External
Insulation
R -Value
N/A
NIA
I -
I
I
F
System serving multiple dwelling units
Water Heater
Type
Distribution
Type
Number
in System
Rated Energy
Input' Tank Factor' or
(kW or Capacity Thermal
Btu/hr(gallons) Efficiency
Tank
External
Standby Insulation
Loss % R -Value
N/A
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 heating source to the kitchen fixtures
that are '/4 inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2
B.
Residential Compliance Forms
April 2005
SPECIAL FEATURES NOT REQUIRING HERS VERIFICATION(add extra sheets if necessary)
Indicate which special features are part of this project. The list below represents special features relevant to the Prescriptive
and Performance Method.
✓
Feature
Required Forms (if applicable)
Descri ti on
❑
Metal Framed Walls
CF -1R
N/A
❑
Radiant Barriers
CF -IR
N/A
❑
Exterior Shades
WS -4R
N/A
N/A; Performance Calculation
❑
Cool Roof
Required. Attach CRRC Label to
N/A
Forms.
❑
Dedicated Hydronic Heating
Performance Calculation
N/A
System
Required; Attach Run to Forms.
❑
Combined Hydropic System
Performance Calculation
N/A
Required; Attach Run to Forms.
[]
Gas Cooling
N/A; Performance Calculation
N/A
Required.
❑
Buried Ducts
N/A; Indicate on building plans.
N/A
❑
Kitchen Pipe Insulation
See Section 5.6.2 Distribution
N/A
Systems in Residential Manual.
❑
Multiple Water Heaters Per
See Table 5-13 or usePerformance
Dwelling Unit
Calculation and
N/A
attach Run to Forms.
0
Central Water Heating System
Performance Calculation and
N/A
Serving Multiple Dwellings
attach Run to Forms.
❑
Non-NAECA Large Water
CF -1R
N/A
Heater
See Table 5-13 or use
❑
Indirect Water Heater
Performance Calculation and
N/A
attach Run to Forms
See Table 5-13 or use
❑
Iristantaneous Gas Water Heater
Performance Calculation and
N/A
attach Run to Forms
See Table 5-13 or use
❑
Solar Water Heating System
Performance Calculation and
N/A
attach Run to Forms
❑
Wood Stove Boiler
Performance Calculation and
N/A
attach Run to Forms
SPECIAL FEATURES REQUIRING HERS RATER VERIFICATION
(add extra sheets if necessary) Indicate to the HERS Rater which credits are Dart of this Droiect and need verification.
✓ Feature
Required Forms (if applicable) Descri ti on
Q Duct Sealing
CF -6R part 4 of 12
❑ Refri Brant Charge
CF -6R part 5 of 12
0 Thermostatic Expansion Valve
CF -6R part 6 of 12
Residential Compliance Forms
September 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 5 of 5) CF -1R
Project. Date.
9� Di 69 o G
COMPLIANCE STATEMENT
This certificate of compliance liststhe 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 design responsibility. The
undersigned recognizes that compliance using duct design; duct sealing, verification of refrigerant charge
and TXVs, insulation installation quality, and building envelope sealing require installer testing and
certification and field verification by an approved HERS rater.
Designer or Owner, (per Business and Professions Code) Documentation Author
Name:
Name:
Karl Brown or Robert Powell .
Title/Firm:
Title/Firm:
Palm Desert Air Conditioning 8, Heating Co.
Address-
Address:
42081 Beacon Hill
Palm Desert, CA 92211
Telephone:
Telephone: (
License #:
(signature)' .(date)
(signature) (date)
Enforcement Agency
0