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07-1839 (MECH)1 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 u�K�Gv. BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 07 -00001839 - Property Address: 49550 AVENIDA VISTA BONITA ,? APN: 773-350-007-7 -14496 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL. Application valuation: 2000 Applicant: Architect or Engineer: 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 infull force and effect. License Class: C20 -C10 License No.: 286936 Date: J 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).: ( I - I, as owner of the property, or my employees witfi 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 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 _ 1 I am exempt under Sec. B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury thatthere 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: LQPER111IT Owner: GRANT LEDFORD 49-550 AVENIDA VISTA BONITA LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/25/07 r Contractor: CAVANAUGH ELECTRIC & AIR D 7 83231 HIGHWAY 111 JUN 2-5 Z00 INDIO, CA 92201 (760) 347.-3608 Cir 4D:1-AQuINTA Lica No.: .286936 eImANCFM'.f'T. 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. - _ 1 have and will maintain workers' compensation insurance, as required by Section. 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy_ number are: Carrier ENDURANCE WC Policy Number WEN0014468-01 _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. - Date: _J Applicant: -� - 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 inspection purposes. .. . Date: Signature (Applicant or Agent): ' Application Number . . ... 07-00001839 Permit. . . . . . MECHANICAL Additional desc . Permit Fee 49.50 Plan Check Fee .. 12.38 Issue Date . . . .Valuation . . . . 0'. Expiration Date.. 12/22/07 . Qty Unit Charge Per Extension BASE FEE 15.00 ,:1.00 9.0000 EA- MECH FURNACE <=100K 9.00 i 0f1 9.0000. EA MECHAPPL HEP/ALT/ADD. 9.00 ECH B/C >3-15HP/>106K-500KBTU 1.00 16.5000 EA MECH. 16:50 Special Notes and Comments . HVAC SYSTEM CHANGE OUT - 14 SEER/2005 ENERGY. THIS PERMIT DOES NOT INCLUDE DUCTS,`DUCTS TO REMAIN. June 25, 2007 10:27:24 AM_AORTEGA Fee summary Charged Paid Credited Due Permit Fee Total 49.50 00 .00 49:50 Plan Check Total 12.38.00 .00 12.38 Grand Total 61.88• ' .00 .00 61.88 LQPE%MIT Bin # City of La Quinta Building a 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:' .4,%_ -:�;'5D 4Ve , VIS -T,4 BO/n/ fi4 Owner's Name: �ld/72't' L e r or A. P. Number: Address: 4 9 _ SSO A Ve - V/S4,g• ,QD/71�,A Legal Description: Contractor: C-, va11aijqh 191eC 7�71 G .7 rid A/ G . City, ST, Zip: L,4 Telephone: 959— 7:2D — 7'91:6(c, Address: Project Description: z ;PCe A/C City, ST, Zip: Zh01 O Cia • .5 l �%? / oN Telephone: 760 City Lie. #: 3.2 State Lie. # :078 1513)C- Arch., Engr., Designer: Address: City, ST, Zip: Telephone: I State Lie. #: Name of Contact Person: PDd Ca 47a 1 a y /"� Construction Type: Occupancy: P cy: Project type (circle one): New AddPn . Alter Repair Demo. Sq. Ft : # Stories: #Units: Telephone # of Contact Person: 'J _ •��- ''78 - D / •. m Estimated Value of Project: 2 600 � APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACIDNG . PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Coles. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construcion Flood plain plan Plans resubmitted Mechanical Grading, plan 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 correctionstiissue Develope- Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page i of 4) CF -1R Project Title Gr�r f Le Project Address 42- 550/ten, Documentation Author �'� �anay.�h CLec Compliance Method!(Prescriptive) la 13onl1G/ La &alnfit -15- Climate Zone Date Building Permit # Plan Check / Date Field Check / Date Enforcement Agency Use Only ✓ ❑ Alternative Component Package Method: (check one) C D D ('k1ternative) Package C and Package D choices require HERS rater field verification and/or diagnostic testing (see CF -1R page 3) For Package D Alternative see Appendix. B Table 151-C Footnotes 7-14 GENERAL INFORMATION Total Conditioned Floor Area (CFA) f Average Ceiling Height: ft Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C.---- (5% XCFA) ft Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C ---- (20% X CFA) ft ✓ ❑ Building Type: (check one or more) Single Family Multifamily Addition Alteration (If adding fenestration fill out WS -4R, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2 for Additions and 8.3.3 for Alterations.) Number of Stories: Number of Dwelling Units: Floor Construction Type: Slab/Raised Floor (circle one or both) Front Orientation: North / South / East / West / All Orientations (input front orientation in degrees from True North and circle one). ✓ ❑ RADIANT BARRIER (required in climate zones 2,4,8-U5 OPAQUE SURFACES INCLUDING OPAQUE DOORS Component Type (Wall, Roof, Floor, Slab Edge, Doors) Frame Type (Wood or Metal) Assembly U - factor (for Cavity Continuous wood, metal Insulation Insulation frame and mass R -Value R -Value assemblies Joint Appendix IV Reference Roof Radiant Barrier Location/Comments installed (attic, garage, Yes or No ty2ical, etc. 1) See Joint Appendix IV in Section IV.2, 1V.3 and IVA, which is the basis for the U -tactor criterion. U -factors can not exceed prescriptive value to show equivalence to R -values. CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION r c 13Y Residential Compliance Forms March 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 4) CF -1R y Project Title Date a FENESTRATION PRODUCTS — U -FACTOR AND SHGC - - ❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS4R -must be included for New Construction, Additions and Alterations. .Fenestration - #/Type/Pos. (Front, Left, Orien- . Rear, Right, tation, Area S li ht N, S, E, W' (ft)U-factot2 Minimum Efficiency AFUE or HSPF U -factor Source SHGC° SHG" Sour=s Exterior Shading/Overhangs6 ✓ box if WS -3R is included ❑: ❑ - O O • 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 §15l(f)3C and in Section 3.2.3 of the Residential Manual 2) Enter values in this column are either NFRC Rated value or from Standards default Table 116A.' 3) Indicate source either from NFRC or Table 116A, 4) Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from WS -3R. 5) Indicate source either from NFRC or Table 116B. 6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS -3R to calculate Exterior Shading devices. . 7) See Section 3.2.4. in the Residential Manual. - HVAC .SYSTEMS Y Heating Equipment Type and Capacity (fumacei heat pumpi boiler; etc. Minimum Efficiency AFUE or HSPF Distribution Type and Location Duct or Piping Thermost<t Configuration ducts attic; etc. R -Value Type s lit or k e ' E Cooling Equipment Type and Capacity A/C heat pump,eva . coolie Minimum Efficiency Duct Location Duct Thermostat Configuration SEER or EER attic etc. R -Value e (split or package) C ' E ' E CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 4) CF -1R -f L e $— D-7 Date SEALED DUCTS and TXVs (or Alternative Measures) A signed CF -4R Form must be provided to the building department for each home for whichae following. are r uired OR ❑ Alternative to Sealed Ducts and Refrigerant Charge [TXVs (See Package D Alternative Pah age Features for Proiect Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14. nu For additions and alterations, duct systems that are not documented to have been previousl) ❑ sealed as confirmed through field verification and diagnostic testing in accordance with prccedures in the Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned s aces shall meet the requifeffients of Section 150 iia and duct insulation requiierhents of Facka a D. We'rIPP uF.eTTN(- WSTEMS e Rated Enemy Tank Inputs Tank Factor oe External (kW or Capacity Thermal Standby Insulation Btu/hr(gallons) Efficiency Loss % R -Value Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per 0 Sealed Ducts all climate zones Installer testing and certification and HERS rater field verification required.) ❑ TXVs, readily accessible (climate zones 2 and 8-15 only) 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 ❑ Alternative to Sealed Ducts and Refrigerant Charge [TXVs (See Package D Alternative Pah age Features for Proiect Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14. nu For additions and alterations, duct systems that are not documented to have been previousl) ❑ sealed as confirmed through field verification and diagnostic testing in accordance with prccedures in the Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned s aces shall meet the requifeffients of Section 150 iia and duct insulation requiierhents of Facka a D. We'rIPP uF.eTTN(- WSTEMS CvetPme carvina cinale dwellinu units Water Heater Type/Fuel Type Distribution Number Type in System Rated Enemy Tank Inputs Tank Factor oe External (kW or Capacity Thermal Standby Insulation Btu/hr(gallons) Efficiency Loss % R -Value Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per ❑ dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is not allowed. Check box when using Preapproved 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 witl the Preapproved ❑ Alternative Water Heating table..In this case, the Performance Method must be used and raust be included in the submittal. ❑ Check box to verify that a time control is required for a recirculating system pump for a system serving multiple units CvetPme carvina cinale dwellinu units Water Heater Type/Fuel Type Distribution Number Type in System Rated Enemy Tank Inputs Tank Factor oe External (kW or Capacity Thermal Standby Insulation Btu/hr(gallons) Efficiency Loss % R -Value Rated Input' Tank (kW or Capacity Bft0u_(gallons) Enter Factor of Thermal Standby Efficiency- Loss % Tank External Insulation R -Value Cvetnm ePrvina multinle. dwelling units Water Heater Type Distribution e Number in System Rated Input' Tank (kW or Capacity Bft0u_(gallons) Enter Factor of Thermal Standby Efficiency- Loss % Tank External Insulation R -Value 1. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input o?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 If 0 0) 2 B. Residential Compliance Forms March 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 4 of 4) CF -1R - Graffi f L Pd�r� � -:8•-0 7 Project Title Date SPECIAL FEATURES NOT REQUIRING HERS VERIFICATION (add!extra sheets if necessarvl Indicate which special features are part of this project. The list below only represents special features relevant to the ✓ . SPECIAL FEATURES REOUIIUING HERS RATER VERIFICATION (add extra sheets if necessarv) Indicate to the HERS Rater which credits are part of this project and need ✓ Featurev Required. Forms if applicable) Description ❑ Metal Framed Walls CF -1R Refrigerant Charge Cl Radiant Barriers CF -1R CF -6R part 6 of 12 ❑ Exterior Shades WS -4R N/A; Attach CRRC Label to ❑ Cool Roof Forms. Dedicated Hydronic Heating Performance Calculation - ❑ System Required; Attach Run to Forms. Performance Calculation ❑ Combined Hydronic System Required; Attach Run to Forms. Performance Calculation ❑ Gas Cooling Required. ❑ 1 Buried Ducts N/A; Indicate on building plans. See Section 5.6.2 Distribution ❑ Kitchen Pipe Insulation Systems in Residential Manual. See Table 5-13 or use ❑ Multiple Water Heaters Per Performance Calculation and Dwelling Unit attach Run to Forms. Central Water Heating System Performance Calculation and ❑ Serving Multiple Dwellings attach Run to Forms. ❑ Non-NAECA Large Water CF -1R Heater See Table 5-13 or use ❑ Indirect Water Heater Performance Calculation and attach- Run to Forms See Table 5-13 or use ❑ Instantaneous Gas Water Heater Performance Calculation and attach Run to Forms See Table 5-13 or use ❑ Solar Water Heating System Performance Calculation and attach Run to Forms Performance Calculation and ❑ Wood Stove Boiler attach Run to Forms SPECIAL FEATURES REOUIIUING HERS RATER VERIFICATION (add extra sheets if necessarv) Indicate to the HERS Rater which credits are part of this project and need ✓ Featureyv Required Forms if applicable) Description ❑ Duct Sealing CF -6R part 4 of 12 ❑ Refrigerant Charge CF -6R part 5 of 12 ❑ Thermostatic Expansion Valve CF -6R part 6 of 12 Residential Compliance Forms • •"-flaifJill .• . 1. .�• i ply jql 01 :t � u .. / 4 / O 19 i i t u t x v r r 7r h. ,�25 tfv 4+� Fr tt J! _r r1 4 h 1- i '.rYhir �('� x •:r: s. 5} � � > f��-{�• > i tt } 1 JS. 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Si re 't Add ss Permit Number CF -6R e 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 z 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 t (AFUE, etc.) 2CF-IRvalue Duct Location ' attic etc. . Duct or Piping R -value Heating Load Btuft Heating . Capacity BtuAtr Ko. fl /c Carr��r / 1. �i� 9• �K 6oK q as t e a Av- 13DL- N660 90 , -77 Cooling Equipment R ' Equip Type .(pkg. heat um CEC Certified Mfr. Name and Model Number # of Identical Systems Efficiencyt (SEER or EER) 2CF-]Rvalue) Duct Location attic etc. Duct R -value Cooling Load tuft Cooling Capacity . Btu/hr Ko. fl /c Carr��r / 1. �i� 9• �K 6oK q as t e a Av- 13DL- N660 90 , -77 1. > symbol reads greater than or equal to what is indicated on the CF -1R value. Include both SEER and EER if compliance credit for high EER air conditioner is claimed. I, 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 (fro the Appliance Efficiency Regulations or Part 6), where applicable.. -g-p7✓a�1au G,Lecric and �, Signature, Date Installing Subcontractor (Co. Nane) OR General Contractor (Co. Name) OR Owner COPY TO: Building Department ' HERS Rater (if applicable) Building Owner at Occupancy } March 2005 Residential Compliance Forms INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R Site Address Permit Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE Copies to: Builder, HERS Rater, Building Owner at Occupancy and Building Department INSTALLER COMPLIANCE STATEMENT The building was: ✓ EfTested at Final ✓ ❑ Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: ❑ 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 ✓ ❑ DUCT LEAKAGE REDUCTION _ _ ,..___ _ a_► i .. -:n .s: » .»a a; .......�r:� 1ncHno nfair dictrihutinn .cuctoim are availahle in RACM. Annendix RC4.3 NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured Values 1 Enter Tested Leakage Flow in CFM: 2 Fan Flow: Calculated (Nominal: ✓ Cooling• ✓ ❑ Heating) or ✓ ❑ Measured If Fan Flow is Calculated as 400 cfhVton x number of tons or as 21.7 cfm/(kBtu/hr) x Heating Capacityin Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here: 2 00o V/ V/ 3 Pass if Leakage Percentages 6% for Final or:9 4% at Rough -in: 100 x ine # 1 / ine # 2 ❑ Pass ❑ Fail ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out.. 5 Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Chan e -Out. SO 6 Enter Reduction in Leakage for Altered Duct System ine # 4 Minus_(Line # 5 —(Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ 8 Entire New Duct System - Pass if Leakage Percentage S 6% for Final or:5 4% at Rough -in 100 x ine # 5 / Line # 2)11 ❑ Pass ❑ Fail TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out. Use one of the following four Test or Verification Standards for compliance: ✓ ✓ 9 Pass if Leakage Percentage:9 15% [100 x [ ZQnO (Line # 5) / (Line # 2)]] C?, 3 o IB Pass ❑ Fail 10 Pass if Leakage to Outside Percentage S 10% [100 x (Line # 7) / (Line # 2)]] ❑ Pass ❑ Fail 11 Pass if Leakage Reduction Percentage z 60% [100 x L_(Line # 6) / (Line # 4)]] and Verification by Smoke Test and Visual Inspection ❑ Pass ❑ Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ': ❑ Pass ❑ Fail Pass if One of Lines # 9 throu # 12 pass YPass O Fail ./ El I, 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. ►/moi) aGlG%.'FLeCf/'/G aim /e Sign4turell Date Installing Subcontractor (Co. Name) OR J �pj,,+�{ pj �o — — b % General Contractor (Co. Name) Residential Compliance Forms March 2005 INSTALLATION CERTIFICATE (Page: s of 12) CF -6R Site Address 5O �! • /a V� -4 ��� 1� L a ,� VIA Permit Nuanber c T Cx ✓ ff' THERMOSTATIC EXPANSION VALVE (TXV) Proeedures for field verification of thermostatic expansion valves are available in RACM Appentt z RI. V ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without , Therrnostaiic Ex_ ai iiiii Valves Outdoor Unit Serial # - Location Outdoor Unit Make Outdoor Unit Model Cooling Capacity Btu/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 55°F and above): Procedures for Determining Refrigerant Charge using the Standard Method are available in RACe.f, 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) CF consist of visual verification that the TXV is installed on T �� ✓ CS/Yes ❑ No the system and installation of the specific equipment [''r ❑ N shall be verified. -9F Yes is a pmg I Pass I Fall ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without , Therrnostaiic Ex_ ai iiiii Valves Outdoor Unit Serial # - Location Outdoor Unit Make Outdoor Unit Model Cooling Capacity Btu/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 55°F and above): Procedures for Determining Refrigerant Charge using the Standard Method are available in RACe.f, 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) `F Return (evaporator entering) air dry=bulb temperature (Treturn, db) CF Return (evaporator entering) air wet -bulb temperature (Tretum, wb) T Evaporator saturation temperature (Tevaporator, sat) `F Suction line temperature (Tsuction, db) N Condenser (entering) air dry-bulb temperature (Tcondenser, db) -9F Superheat Charge Method Calculations for Refrigerant Charge Actual Superheat = Tsuction, db - Tevaporator, sat Target Superheat (from Table RD -2) JT Actual Superheat — Target Superheat (System passes if between -5 and +5°F) Temperature Split Method Calculations for Adequate Airflow S lit Method Calculation is not necessary i Ade uate Airflow credit is taken Actual Temperature Split = T return, db Tsupply, db OF. Target Temperature Split (from Table RD3) �F Actual Temperature Split Target Temperature Split (System passes if between - , eF 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F INSTALLATION CERTIFICATE (Page 6 of 12) CF -6R Site Address Permit Number Standard Charge Measurement Summary: System shall. pass both refrigerant charge and adequate airflow calculation criteria from tze same measurements. If corrective actions were taken, both criteria must be remeasured and recalculated. ✓ ❑ Yes ❑ No System Passes Alternate Charge Measurement Procedure (outdoor air dry-bulb below 55 °F) Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer. verification shall be documented on CF -6R before starting this procedure. If outdoor air dry -bulb -is 55 OF or above, installer shall use the Standard Charge Measure Procedure: _ Procedures for Determining Refrigerant Charge using the Alternate Method are available in RACM,, Appendix RD3, Wei -In Charging Method for Refrigerant Charge Actual liquid line length: ft Manufacturer's Standard liquid line length: ft Difference (Actual — Standard): $ Manufacturer's correction (ounces per foot)' x difference in length = ounces (+ = add) (- _ remove) Measured Airflow Method for Adequate Airflow Verification available in RACM, Appendix RD2.5 Calculated Airflow: Cooling Capacity (Btu/hr) X 0.033 (cfin%Btu-hr) = CFM y Measured Airflow is CFM (Measured airflow must be greater than the calculated airflow). Alternate Charge Measurement Summary: System shall pass both refrigerant charge and adequate airflow calculation criteria from the same measurements. If corrective actions were taken both criteria must be remeasured and recalculated. ✓ D Yes ❑ No S stem Passes ' Ca(J�� S- 07 Ca ��n �u 1Le c fry arm �-Ic Signature, Date v Installing Subcontractor (Co. Naar) OR General Contractor (Co. Name) OR Owner COPY TO: Building Department HERS Rater (if applicable) Building Owner at Occupancy` Residential Compliance Forms March' 2005 .