BMCH2017-0102_78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&h4 . 6& QUIR&
t _41
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BMCH2O17-0102
Property Address: 48810 VIA LINDA
APN: 658200025
Application Description: GRUND / HVAC CHANGE OUT - (4) 16SEER/13EER SPLIT SYSTEMS
Property Zoning:
Application Valuation: $2,200.00
Applicant:
SAN'S AIR CONDITIONING & HEATING
51 -530 JACKSON STREET MAR 2 9 2017
COACHELLA, CA 92236-2737
CITY OF LA QUINTA
DESIGN AND DEVELOPMENT DEPARTMENT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/29/2017
Owner:
RICHARD GRUND
1115N97THST
SEATTLE, WA 92253
Contractor:
SAN'S AIR CONDITIONING & HEATING
51-530 JACKSON STREET
COACHELLA, CA 92236-2737
(760)398-4287
Llc. No.: 522775
-----------------------------------------------------------=--'------------------------------
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 Professions Code, and
my License is in full force and effect.
License Class: C20 License No.: 522775
Date� � Gontcactor.:9
V4�4" �e_z 101
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l 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).:
(� 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.).
(� 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:
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'
compensa,"n, as provided for by Section 3700 of the Labor Code, for the performance
of or which this permit is issued.
- II 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 COMPENSATION INSURANCE FUND Policy Number: 9074503
_ 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 he Labor de, I shall forthwith
comply with t ose provisions. 1V
D�tV Appy
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 Building Official for a permit subject to
the conditions and restrictions set forth on this application. N
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 statelaws r ting o building
construction, and hereby authorize representatives of this city toe r upo t e a ove-
mentioned property for inspection purposes. '
�.
Date Si ature (Applicant orAge� `�`�
Date: 3/29/2017
`Application Number: BMCH2O17-0102
Owner:
Property Address: 48810 VIA LINDA
RICHARD GRUND
APN: 658200025
1115 N 97TH ST
.Application Description: GRUND / HVAC CHANGE OUT - (4) 16SEER/13EER SPLIT SYSTEMS
SEATTLE, WA 92253
Property Zoning:
Application Valuation: $2,200.00
Applicant:
Contractor:
SAN'S AIR CONDITIONING & 14EATING
SAN'S AIR CONDITIONING & HEATING
51-530 JACKSON STREET
51-530 JACKSON STREET
COACHELLA, CA 92236-2737
COACHELLA, CA 92236-2737
(760)398-4287
Llc. No.: 522775
Detail: HVAC CHANGE OUT- (4) 16SEER/13EER SPLIT SYSTEMS (2, 2.5, 3, 5 TON). CARBON MONOXIDE ALARM(S) TO'BE INSTALLED PRIOR TO FINAL
INSPECTION. 2016 CALIFORNIA BUILDING CODES.
i
{
77 7.BSAS
SCRIPTION ACCOUNT QTY
SB1473 FEE 101-0000-20306 0
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
K
DESCRIPTION ,,ACCOUNT QTY
HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0
DESCRIPTION ACCOUNT QTY
HVACCHANGEOUT- SPLIT -SYSTEM PC 101-0000-42600 0
Total Paid for CHAN'GEOUT:
AMOUNT
$1.00
$1.00
AMOUNT
$304.00
AMOUNT
$152.00
$456.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Bin tt
Permit ;'
Project_ A� ddtess
Qty of La Qi *Eta,
Building 8r Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701:2
'[ding Permit Application and Tracking Sheet
A. P. Number:Address:
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Legal Description:
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State Lic. # :
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Arch.,-Engr., Designer:
Address:
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APPLICANT: DO NOT WRITE BELOW THIS .LINE
t✓
Submittal
Req'd
Rcc'd
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 '
Floodplain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrcclionsrissue
Electrical .
Subcontactor List
Called Contact Person
Plumbing
Grant Aced
Plans picked up
S.M.I.
'
II.O'.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person' ''
A.I.P.P. +.
Pub. Ms_ Appr
Date of permit issue
School Tees,
Total Permit Fees
ALTERATIONS - HVAC
CEC CFIR ALT -04-E (Revised 01116) CALIFORNIf. ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (Page 1 -of 1)
Site Addres , �`
Enforcement Agency:
Dat repay d:
L
Permit#:
Equipment Type
Equipment Efficiency
New Ducting or Lineset:
Required R -value
ndAio ed
Floor Area (ft).
Thermostat
❑ Packaged
❑ Eva or Coil
AFUE
COP
❑ R-6 (CZ 1-10, 12&13) Ducts
Served by system
❑ Setback
Syst
@ ondensing Unit
❑ R 8' (CZ I1, 14-16) Ducts
ft
(If not already
present, must
Split System
❑Compressor .
SEER
HSPF
❑ >_ R-2.8 Lineset"
❑ Mini Split '
ace
❑� Lineset
f11'fXV
EER
/ �- Q�
be installed)
HERS VERIFICATION SUMMARY Installer determines wo.rk to be completed and matches to one of the options below. At permit application this
form i owed to be filled out by hand. For final inspection all forms are to be registered (no hand. filled forms allow 2d) and a copy left on site.
HVAC Changeout/Repair
Required Compliance Documents to be left on site for -Final:
All Equipment,
CF1R-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)Z -H, MCH -2S -HZ
Compressor, TXV, Lineset,
CF3R-MCH-20-H, MCH -(23 or24)-HZ, MCH -25-H2
Air Handler/FurnaceZ (Can include new ducting)
Installer Requirement: Duct leakage (<.15%, or <_10% to outside, or seal all accessible leaks), Air Flow >_ 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Dud system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of dud in unconditioned space, or
❑ 3'. Existing dud systems are constructed, insulated or sealed with asbestos (list manufacture date of building
❑ 2: New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Duds3 CF1R-ALT-02-E
including Mini Split CF2R-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H', MCH -?5 -HZ
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H2, MCH=25-H2
Mini Splits require CF1R-ALT-02-E, CF2R-MCH-01-E, and (CF2R-CF31t) MCH -25-H
Installer Requirement: Duct leakage :< S%, Fan Efficacy (0.S8W/CFM), Air Flow ;-> 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts3 and one or more of the following CF1R-ALT-02-E
replaced: Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)-H, MCH -2S -H
Compressor, TXV, Lineset, Furnace' CF3R-MCH-20-H, MCH -(23 or 24)-H, MCH -2S -H
Installer Requirement: Duct leakage -:< 5%, Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing dud systems are constructed, insulated or sealed with asbestos.
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts3 CF19-ALT-02-E, CF2R-MCH-20-H, CF3R-MCH-20-H
Installer Required to: Duct leakage LSS% or, <_10% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
'All new ducting requires R-8 insulation when more than 40 ft installed in 'CZs 11 & 14-16 and R-6 in CZs.1-10, 12 &13, and R-6 insulation when less
.than 40 ft installed. This. includes in walls, between floors etc.
2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MCH -(23 or 24), or Refrigerant Charge verification MCH -25
3 All New Ducts is when at least 75%of the duct system is new duct material,. and up to 25%may consist of reused pa -ts from the dwelling.unit's
existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
° R-2.8 (1" thick insulation) for linesets 1" and less.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. lam eligible under Division 3 of the California Business and Professions Code to accept responsibility for the inffirmation on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials; components, and manufactured devices fc r the building design or .
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Fart 6 of the CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submit=ed to the enforcement
agency for approval with this building permit application.
Responsible Designer Name:
Responsible Designer Signature:
D e ned: Lipfmse
Compan
A e s: /
ate• /
pn�_�� / ` ��
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772,3300
ALTERATIONS - HVAC
NMI
CEC CF1R ALT 04 E (Revised 01h6) GALIFUKNIP. tNtKGY GUMMISSIUN -Mg.-
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (Page 1 of 1)
Site Addres � s �'
Enforcement Agency:
Dat repar d:
Permit#:
Equipment Type
Equipment Efficiency
New Ducting or Lineset:
Required R -value
nditio ed
Floor Area (ftz)
Thermostat
❑ Packa ed
❑ Evaor Coil
AFUE
COP
❑ R-6 (CZ 1-10, 12&13) Ducts
Served by system
❑ Setback
Sys
System
Q ondensing Unit
❑ Compressor
SEER
HSPF
❑ R-8' (CZ 11, 14-16) Ducts
z
ft
(If not already
present must
Split
'
❑ > R-2.8 Lineset°
be installed) -
❑ Mini Split
ace
set
=V
/S_EER
/ r-
r
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below At permit application this
form i owed to be filled out by hand.. For final inspection all forms are to be registered (no hand.filled forms allowed) and a copy left on site.
HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
All Equipment, CF1R-ALT-02-E
Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)'-H, MCH -25-H'
Compressor, TXV, Lineset, CF3R-MCH-20-H, MCH -(23 or 24)-H', MCH -25-H'
Air Handler/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage (:-S.15%, or <10% to outside, or seal all accessible leaks), Air Flow >_ 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of dud in unconditioned space, or
❑ 3'. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building
❑ 2.' New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' CF1R-ALT-02-E
including Mini Split CF2R-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H', MCH -35-H'
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H', MCH -25-H'
Mini Splits require CF1R-ALT-02-E, CF2R-MCH-01-E, and (CF2R-CF3R) MCH -2S -H'
Installer Requirement: Duct leakage:S 5%, Fan Efficacy (0.58W/CFM), Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts3 and one or more of the following CF1R-ALT-02-E
replaced: Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)-H, MCH -25-H
Compressor, TXV, Lineset, Furnace' CF3R-MCH-20-H, MCH -(23 or 24)-H, MCH -25-H
Installer Requirement: Duct leakage -:S 5%, Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestox
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts3 CF11R-ALT-02-E, CF2R-MCH-20-H, CF3R-MCH-20-H
Installer Required to: Duct leakage (< 15% or, :510% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
'All new ducting requires R-8 insulation when more than 40 ft installed in CZs 11 & 14-16 and R-6 in CZs_1-10, 12 &13, and R-6 insulation when less
.than 40 ft installed. This includes in walls, between floors etc.
-' Heating only systems and Air Handler/Furnace changes do not require Air Flow MCH -(23 or 24), or Refrigerant Charge verification MCH -25
3 All New Ducts is when at least 75%of the duct system is new duct material,.and up to 25%may consist of reused pats from the dwelling.unit's
existing dud system (e.g., registers, grilles, boots; air handler, coil, plenums, duct material)
" R-2.8 (1" thick insulation) for linesets 1" and less.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the inf-Drmation on this document:
3. That the energy features and performance specifications for the,design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials; components, and manufactured devices fc r the building design or .
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Fart 6 of the CCR.
S. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submit=ed to the enforcement
agency for approval with this building permit application.
Responsible Designer Name:
Responsible Designer Signature:e
ned:UrAmse
Compan ,�
A e s: � �
ate �• � ��
J�n� �X/ � � ��
For assistance or questions regarding the Energy Standards, contact the Energy. Hotline at: 1-800-772=3300
J i A It Ur GFlLIrUMINIA
ALTERATIONS - HVAC
F-47
CEC-CFI1R-ALT-04-E (Revised 01/16) CALIFORNI, ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (Page 1 of 1)
Site Addres e
Enforcement Agency:
Dat 'repar d:
Permittl:
Equipment Type
Equipment Efficiency
New Ducting Lineset:
Required R -value
nd do ed
Floor Area (ft)
Thermostat
❑ Packaged
❑ Eva or Coil
AFUE
COP
❑ R-6 (CZ 1-10, 12&13) Ducts
Served by system
❑Setback
Sys
N ondensing Unit
❑ Compressor
/
❑ R-8' (CZ 11, 14-16) Ducts
ft
(If not already
present must
Split System
SEER
HSPF
❑'a R-2.8 Lineset'
❑ Mini Split
,- r ce
''�T" ace
❑ Liset
EER
+
/ ^ Z
be installed)
HERS VERIFICATION SUMMARY installer determines work to be completed and matches to one of the options below-. At permit application this
form isMKowed to be filled out by hand. For final inspection all forms are to be registered (no hand.filled forms allowed) and a copy left on site.
HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
All Equipment, CFIR-ALT-02-E
Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)2-H, MCH -25-H2
Compressor, TXV, Lineset, CF3R-MCH-20-H, MCH -(23 or 24)-H', MCH -25-H2
Air Handler/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage (< 15%, or <_10% to outside, or seal all accessible leaks), Air Flow >_ 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
111. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building J
❑ 2. New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' CFIR-ALT-02-E
including Mini Split CF2R-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H2, MCH -25-1-1'
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H', MCH -25-H'
Mini Splits require CFIR-ALT-02-E, CF2R-MCH-01-E, and (CF2R-CF3R) MCH -25-H
Installer Requirement: Duct leakage:S 5%, Fan Efficacy (O.SBW/CFM), Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts' and one or more of the following CFIR-ALT-02-E
replaced: Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)-H, MCH -25-H
Compressor, TXV, Lineset, Furnace' CF3R-MCH-20-H, MCH -(23 or 24)-H, MCH -25-H
Installer Requirement: Duct leakage -:S 5%, Air Flow 2 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts' I CF19-ALT-02-E, CF2R-MCH-20-H, CF3R-MCH-20-H
Installer Required to: Duct leakage (<_15% or, <_10% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
'All new ducting requires R-8 insulation when more than 40 ft installed in CZs 11 & 14-16 and R-6 in CZs.1-10, 12 &13, and R-6 insulation when less
than 40 ft installed. This includes in walls, between floors etc.
' Heating only systems and Air Handler/Furnace changes do not require Air Flow MCH -(23 or 24), or Refrigerant Charge verification MCH -25
3 All New Ducts is when at least 75%of the duct system is new duct mate rial,.and up to 25%may consist of reused parts from the dwelling.unit's
existing ductsystem (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
' R-2.8 (1" thick insulation) for linesets 1" and less. I
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials; components, and manufactured devices foc the building design or .
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR.
S. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications Submit: ed to the enforcement
agency for approval with this building permit application.
Responsible Designer Name:
Responsible Designer Signature:
D to ned:
A72 7
Compan
_�_ ___5
For assistance or questions regarding the Energy Standards, contact the Energy.Hotline at: 1-800-772:3300
AI TFRATIONS - HVAC
MIM
'W5
--
CEG -ALT -04-E Revised 01/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-04 E
Alterations - HVAC CZ 2, and 8-15 (Page 1 of 1)
Site Addres `
Enforcement Agency:
Dat repar d:
G
Permitil:
Equipment Type
Equipment Efficiency
New Ducting or Lineset:
Required R -value
nditio ed .
Floor Area (ft)
Thermostat
❑ Packaged
❑ Eva or Coil
AFUE
COP
❑ R-6 (CZ 1-10, 12&13) Ducts
Served by system
❑ Setback
(If not already
Sys
ondensing Unit
❑ Compressor
SEER
HSPF
❑ R-8' (CZ 11, 14-16) Ducts
ftz
present, must
Split System
❑ Mini Split
P
❑` Lin set
13 > R-2.8 Lineset°
be installed)
D#'fXV
EER
I
Wo1fa—c—e
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form i owed to be filled out by hand. For final inspection all forms are to be registered (no hand.filled forms allowed) and a copy left on site.
Cgrl�HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
All Equipment, CF1R-ALT-02-E
Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)Z -H, MCH -25-H=
Compressor, TXV, Lineset, CF3R-MCH-20-H, MCH -(23 or 24) -HZ, MCH -25 -HZ
Air Handler/Furnace= (Can include new ducting)
Installer Requirement: Dud leakage (< 15%, or 510% to outside, or seal all accessible leaks), Air Flow >_ 300 CFM/ton, 2efrigerant Charge.
Exempted from dud leakage testing if:
❑ 1. Dud system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of dud i i unconditioned space, or
❑ 3'. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building --- I
❑ 2: New HVAC System Required Compliance Documents to be'left on site for Final:
All new equipment and All New Ducts' CF1R-ALT-02-E
including Mini Split CF2R-MCH-01-E, MCH -20-H; MCH -22-H, MCH -(23 or 24) -HZ, MCH -25-H2
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H2, MCH -25 -HZ
Mini Splits require CF1R-ALT-02-E, CF2R-MCH-01-E, and (CF2R-CF3F:) MCH -25-H
Installer Requirement: Duct leakage < 5%, Fan Efficacy (0.58W/CFM), Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Duds with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts' and one or more of the following CFIR-ALT-02-E
replaced: Condenser Unit, Evaporator Coil, CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)-H, MCH -25-H
Compressor, TXV, Lineset, Furnace= CF3R-MCH-20-H, MCH -(23 or 24)-H, MCH -25-H
Installer Requirement: Duct leakage < 5%, Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if. ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Duds' I CF111-ALT-02-E, CF2R-MCH-20-H, CF3R-MCH-20-H
Installer Required to: Duct leakage (:-S_15% or, s10% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
' All new ducting requires R-8 insulation when more than 40 ft installed in CZs 11 & 14-16 and R-6 in CZs.1-10, 12 &13. and R-6 insulation when less
.than 40 ft installed. This includes in walls, between floors etc.
Z Heating only systems and Air Handler/Furnace changes do not require Air Flow MCH -(23 or 24), or Refrigerant Char€;e verification MCH -25
' All New Ducts is when at least 75%of the duct system is new duct material,.and up to 25%may consist of reused par's from the dwelling, unit's
existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
R-2.8 (1" thick insulation) for linesets 1" and less. -
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliartrre conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials; components, and manufactured devices for -the building design or .
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part land Part 6 of the CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Responsible Designer Name:
Responsible Designer Signature:
e ned:_7
Lironse
7
Compan
r
JQ
/
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1 -80U -77Z-3300