Loading...
10-0468 (MECH).. r t P.O. BOX 15041 78-495 CALLE TAMPICO- LA QUINTA, CALIFORNIA 92253 . Application Number: (___10a0_0_00.0468� Property Address: 80495 VIA TALAVERA APN: 772-250-999-147 -30357 Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 18000 Applicants Tiht 4 4 Q" Architect or Engineer: 14- ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 C36 ce seNo.: 906115 Date: 40P d�Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 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 Owner: WEAVER DALE 80-495 VIA TALAVERA LA QUINTA, CA 92253 (760)619-2257 _—Contractor: _. L HYDES 77825 WILDCAT STREET PALM DESERT, CA 92211 (760)360-2202 Lic. No.: 906115 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/02/10 lI1! U i! -�IjI J JUN 0 2 4010 OF -LA 1:14 F e'�_ I tea' ^Fi✓.; . _..... ------------------ WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier DELOS INS Policy Number 02DKRM12004084 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. n'/-�/ Date: '��r/G A,L pIJ icaht: /7�(i� �'��y' WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this.application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within .180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for ins ection rposes. Date: ���ig iature (Applicant or Agent): LQPERMIT Application Number . . . . . 10-00000468 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 51.00 Plan Check Fee 12.75 Issue Date. . . . . Valuation . . . . 0 Expiration Date.. 11/29/10 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B/C <=3HP/100K BTU 18.00 ---------------------------------------------------------------------------- Special Notes and Comments REPLACE(2) AIR --CONDITIONING -- -FURNACE; -& �—�`— T_ _ ... _ _.... ...._._-.. . . ..... . ... ._ ......_ ...._._ -._ ..----�-- COIL CHANGE OUT 18 SEER. Other Fees . . . ., . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ----------------------------------------------- Due i, ---------- Permit Fee Total 51.00 .00 .00 51.00 Plan Check Total 12.75 .00 .00 12.75 Other Fee Total" 1.00 .00 -.00 1.00 Grand Total 64.75 .00 .00 64.75 LQPERMIT Bin # City of La Quinta Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # '� Project Address: ?O IGvev-fi Owner's Name: 12, A. P. Number: Address: 20 — C(c;5 V Legal Description: Contractor:Cer P O14 IMe f Address: / 7 �//5 l..il �G r . City, ST, Zip: fGt/I►7 Ci ry Gl ZZ 1 City' ST, Zip:1n7 c1 N Z$ Telephone: - Project Description: G / �11Q o — Telephone:—�6CrZ-ZC7� State Lie. # : 6 Ci Lic. #: Q�,? Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: U U U APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING , PERMIT FEES Plan Sets . Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact PersonPlan Check Balance Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading, planHIE 2" 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 correctionsrssue Developer Impact Fee Planning Approval Called Contact Person eyLp p Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Pr Simplified Prescriptive Certificate of Climate Zones 10 to 15 Site Address:/) —4 q 7 v G fi t' nce: 2008 Residential HVA C Alterations CF -IR -ALT -HVAC Enforcement Agency: Date: Permit #: .6'—/-1& Conditioned Floor i Duct insulation re uirement Area Thermostat Equipment Tv e List Minimum Efficiency- Packaged Unit Over 40 ft of ducts added or , M Setback LIndoor E?AFUE rl COP replaced in unconditioned space Served by system (ynotolreadv oil RSEER� ® HSPFR 6 (CZ 10-13) 6tD sf present. must be ing Unit EER _L3-- Resistance R 8 (CZ 14-15)installed) 1. Equipment Type: Choose the equipment being installed: if more than one system, use another CF -I R-ALT-H6'AC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPFfor typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and signed. Se innin October 1, 2010, a r istered copy of the CF -IR and CF -6R shall also be on site for final inspection. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04; MECH-2I-HERS and (for split systems) MECH- 25 -HERS. CF -4R forms: MECH- 21 and (fors lit systems) MECH-25 • Condenser Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Indoor Coil and /or CF -4R forms: MECH- 21 and (for split systems) MECH-25 • Furnace For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Pxprrmnted from duct leakage testing if: ;March 1010 2008 Residential Compliance Forms P, 1. Duct system was documented to have been previously sealec anti connrmeu uuougu rncno vcruia,auvia, v, 2. Duct systems with less than 40 linear feet in unconditioned space, or rl 3. Existing duct systems are constructed. insulated or sealed with asbestos 0 2_ New HVAC System Required Forms: • Cut in or Changeout with new-22-HERS,CF-6R forms: MECH-04, MECH-20-HERS-,and (for split systems) MECH and MECH-25-HERS ducts: (all new ducting and all CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25 new equipment) For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ® 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 linear feet of duct in unconditioned space. For split s stem or packaged units: Duct leakage < 15 percent EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulati6ns. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans andspecifications submitted to the enforcement agency for approval with the permit a p cation Name: Michael Hyde II Signature: Company: Hyde's Air Conditioning Date: G= U Address: 77-899 Wildcat Drive `ice°� 906115 City/State/Zip: Palm Desert, CA 92211 Phone: (760) 360-2202 ;March 1010 2008 Residential Compliance Forms P, Sim lified Prescri tive Certificate of Compliance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC Climate Zones 10 to 15 Enforcement Agency: Date: r Permit !1: Site Address: O of G V Q''-1 Conditioned Floor Thermostat Equipment Tv er List Minimum Efficiency' Duct insulation requirement Area rl Packaged Unit Over 40 ft of ducts added orSetback umace �'AFUE •4��v COP replaced in unconditioned space Served by system ( nor already Indoor Coil SEER HSPF _ 00 sf present. must be ® R 6 (CZ 10-13) installed) Condensing Unit EER_ Resistance R 8 (CZ 14-15) : Other 1. Equipment Type: Choose the equipment being installed: if more than one system, use another CF -/R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and si ed. Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection. 1. HVAC Changeout Required Forms: CF -6R forms: MECH-04; MECH-2I-HERS and (for split systems) MECH- 25 -HERS • All HVAC Equipment replaced CF -4R forms: MECH- 21 and (fors lit s stems) MECH-25 • Condenser Coil and /or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS . • Indoor Coil and /or CF -4R forms: MECH- 21 and (for split systems) MECH-25 • Furnace For Split Systems: Duct leakage < 15 percent; RC, CCA >_ 300 CFM/ton(Minimum Air Flow Requirement); TMAH For Packaged Units: Duct -leakage < 15 percent Exempted from duct leakage testing if: M t n,irr cvctp ., vvac dnnnmented to have been previously sealed and confirmed through HERS verification, or 2008 Residential Compliance Forms March 2010 2. Duct systems with less.than 40 linear feet in unconditioned space, or 3. Existing duct systems are constructed. insulated or sealed with asbestos 2. New HVAC System Required Forms: • Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS ducts: (all new ducting and all CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25 new equipment) For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ® 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 linear feet of duct in unconditioned space. For splits stem or packaged units: Duct leakage < 15 percent EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • i am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Michael Hyde Signature: Company: Hyde's Air Conditioning Date: Address: 77-899 Wildcat Drive License: 06115 City/State/Zip: Palm Desert, CA 92211 Phone: (760) 360-2202 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Pagel of2) Site Address: Enforcement Agency: Permit Number: 80-495 Via Talavera,La Quinta,CA92253 City of La Quinta 10-00000468 Enter the Duct System Name or Identification/Tag: , Enter the Duct System Location or Area Served: Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, e1c.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test — Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test — existing ducts ste Select one compliance method from the followingaV "6 tfopi Choi Option 1. Measured leakage less than 1�5° of Fan . o, Option 2. Measured leakage to outside` e an '' °f° o F ow Option 3. Reduce leakage by 60% Pmor. , and c educt smo>c r esk to seat all accessible leaks. Option 4. Fix all accessible leaks using smoke test, and HER rater must verify. Note: (Option 1 must be attempted befgreut 1►zin Optton Determine nominal Fan Airflow using one�ofjthe�followinthr� caliilation methods. cooling system method: Size of condenser in ;on 4400 — CFM leating system method: 21.7 x heating u Capacity, (kBtuh) = CFM ieasured system airflow using 1 3.3 airflow test procedures: CFM 4rx Option 1 used thenCwAirflov Calki Allowed leakage =9: _, CFM 1 Actual leakage Pass il Actual leakage is les than Allowed leakage Pas Fail Option 2 used then: Allowed leakage = Fan Airflow x 0.10 = CFM 2 Actual leakage to outside = CFM Pass if Actual leakage to outside is less than Allowed leakage assoFail Option 3 used then: Initial leakage prior to start of work= CFM Final leakage after sealing all accessible leaks using smoke test = ' CFM 3 Initial leakage - Final leakage = Leakage reduction CFM - (Leakage reduction / Initial leakage ) x 100% = % Reduction Pass if % Reduction > 60% assail Option 4 used then: All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). 4 Pass if all accessible leaks have been sealed usingSmoke Test _ as ail Registration Number: 110-38672BOB-0077-1-MECH21 Registration Date/Time: 08/12/2010 16:25 HERS Provider: CHEERS Ir- . V CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2 Site Address: Enforcement Agency: Permit Number: 80-495 Via Talavera,La Quinta,CA92253 City of La Quinta 10-00000468 ❑ Outside air (OA) ducts for Central Fan Integrated leakage testing. CFI OA ducts that utilize controlle�d,,,, meet ASHRAE Standard 62.2, and close wh OAS during duct leakage testing. � ❑ All supply and return register boots. t m eale duct leakage compliance option 3 (leap aeductiotf ❑ New duct installations cannot utiliuildin "1 14 ❑ Mastic and draw bands must be duct connections. ventilation systems, shall not be sealed/taped off during duct ii Jampers, that open only when OA ventilation is required to o .i not required, may be configured to the closed position test is utilized for compliance — applies to x all accessible leaks) described above. s as pleF- sror platform returns in lieu of ducts. with cloth l a 'e3iubber adhesive duct tape to seal leaks at all new DECLARATION STATEMENT • I certify under penalty of perjury, under the Ji 4the State+of @allfor�ii the information provided on this form is true and correct • 1 am the certified HERS rater who performed the`verif at'�iowseruiws identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufa ured=%leviceuiring HERS verification that is identified on this certificate (the installation) complies with the applicable requ` irements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1 R) approved by the local enforcement agency. • The information reported o ._ licabU�t s f t ta1pe ti i ca CF- R), a �nd submitted by the person(s) responsible for the install ttion norre ui ents i, to o th is e( o, ompliance (CF -IR) approved by the enforcement agency. Builder or Installer informatio show�t'>t�on tb_ I tafl.h on qerfifiew W 10* Company Name: (Installing Subcontra -tor or Generall Contractor r Builder/ wner) Hydes Air Conditioning Responsible Person's Name: CSLB License: Mike Hyde 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): ested/verified dwelling ✓ not-tested/verified dwelling Package 6 in a HERS sample group HERS Rater Information HERS Rater Company Name: CM Energy Consulting Responsible Rater's Name Responsible Rater's Signature Christopher McFadden Christopher McFadden (Signature on File) Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: CCNCM275794 8/12/2010 Registration Number: 110-38672BOB-0077-1-MECH21 Registration Date/Time: 08/12/2010 16:25 HERS Provider: CHEERS r.. 7�o'57_zzs INSTALLATION CERTIFICATE CF -6R MECH 21 -HERS Duct Leakage Test — ct stem a e 1 of 2 SMddresS��-� I n �� r� A D'1 Enforcement Agency: Permit Namber. Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served. Note: Submit one Installation Certficate for each duct system that must demonstrate compliance in the dweni ng. This installation certificate is required for compliance for alterations and additions in existing dwellings to space condidoidng systems and duct systems. Note: For existing dwelliyngs, a completely new or replacement duct system can also include existing parts of the original duct system (e g , register boots, air hmffer, coi4 plemans, etc.) if those parts are accessible and they can be sealed For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test — Coiwletely New or Replacement Duct Svstem. " Dnct Lealraffe Dia9mwzhe Teat— F.ticf no flv.-t Gbetam Sel one compliance method from the following four choices. Option 1. Measured leakage less than 15% of Fan Airflow. 0 Option 2. Measured leakage to outside less than 10% of Fan Airflow. ❑ Option 3. Reduce leakage by 60% or more, and conduct smoke test to seal all accessible leaks. D Option 4. Fix all accessible leaks using smoke test, and HERS rater must verify. Note: (Option be attempted before Wilizing Option 4)' Det5oe nominal Fan Airflow using one of the follo three calculate Q� Doling system method: Size of condenser in Tons x400 = Y� CFM 13 Heating system method 21.7 x Heating ut Capacity (kl3tuih) = CFM ❑ Measured system airflow using RA3.3 airflow test procedures: CFM Option 1 used then: Allowed leakage = FanAw = 0 x0.15 CFM I Actual leakage = CFM Pass if Actual leakage is less than Allowed leakage Pass ❑ Fail Option 2 used then: Allowed leakage = Fan Airflow X0.10= CFM 2 Actual leakage to outside = CFM Pass if Actual leakage to outside is less than Allowed leakage ❑ Pass O Fail Option 3 used then: Initial leakage prior to start of work= CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage - Final leakage = Leakage reduction CFM (Leakage reduction /Initial leakage ) x 100% _ % Reduction Pass if % Reduction > 60% 13 Pass 17 Fail Option 4 used then: All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). 4 Pass if all accessible leaks have been sealed using Smoke Test 17 Pass ❑ Fail Registration Nwnber. Registration Date/7-vne: HERS Provider. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE Duct Leakage Test — E Enforcement Agency: r CF -6R -MCH -21 -WO ventilation systems, shall not be sealed/taped off during duct ❑ Outside air (OA) ducts for Central Fan Integrated (CFn that o only when OA ventilation is required to leakage testing. CFI OA ducts that utilize controlled motorized dampers, m be configured to the closed position meet ASHRAE Standard 622, and close when OA ventilation is not required, ay during duct leakage testing. drywall if smoke test is utilized for compliance —applies to ❑ All supply and return register boots must be sealed to the duct leakage compliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible leaks) described above. ❑ New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts. ❑ Mastic and draw bands must be used in combination with cloth backed rubber adhesive dud tape to seal leaks at all new duct connections. DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct • I an eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized eve of the person responsible for construction (responsible Person). • 1 certify that the installed features, materials, compone�, or manufactured devices identified on this oertificxme (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. identifies defects, I am I understand that a HERS rater will check the installation to verify compliance, and that that if such checlang will also required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives worm qty assurance checking of installations, including those approved as part of a sample group but not checked by a HERS ants of such quay ass�nce checkmig, the t coneetive action and railer, and if those installations Earl >p meet the requirements quality w� be performed at my expense• additional checking/testing of other installations in that HERS same group that identifies the specific I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency requirements for the installation I certify flat the regoiremeats detailed on the CF -IR that apply to the bswllation have been met • I win ensure that a completed, signed copy of this Installation Certifi shall be posted, or made available with the building permits) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be -included with the docnmentation the builder der data registry for to the owner at ocenpancy. I will ensure that all Installation Certificates will come from a HERS provi multiple orientation alternatives, and begiffiing Odolier 1, 2010, for all low rise residential lnnldings Is this installation momtared by a Tbmi Program (TPQCP)? Registration Number: 2008 Residerttial Corry hwwe Forms r'Yes GNo Registration Datel7ltme: HW Provider: August 2009