BMCH2015-039278-495 CALLE`TAMPICO C 0 D �NMLI�iI/
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT IONS (760) 777-7153
BUILDING PERMIT D z
i= �]
2015
DEPAR
Application Number: BMCH2O15-0392 ' I IIIIII VIII IIII IIII Owne
Property Address: 79440 N N TOM FAZZIO 63 LANC
APN: 766031002 7944 TOM
Application Description: WALSH RESIDENCE / HVAC CHANGE OUT LA Q
Property zoning: MTYf,��ECOPMENT
Application Valuation: $46,172.00 TME
Contractor:
HARRISON ENTERPRISES INC DBA GENERAL AIR
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
VOICE (760) 777-7125
FAX (760) 777-7011
Applicant:
IE INC.
32115 LA BAYA
WESTLAKE VILLAGE, CA 91362
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, C36 License No.: 686310
Date: 10114115— Contractor:�l
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, 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
�wALs OCT 14 2015
1
COCA
M ,UNIg3���j: �q QUINiA
(760)601-3500
Llc. No.: 686310
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.
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: _ Policy Number:
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: lOf ly-1)s 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 Building Official 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 city to enter upon the
above-mentioned property for inspection purposes.
Date: lot1d+ 11-T Signature (Applicant or Agent): _C,_ t
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$2.00
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00 $0.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT-SYSTEM
101-0000-42402
0
$217.56
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT.
PAID
PAID DATE
HVAC CHANGEOUT - SPLIT-SYSTEM PC
101-0000-42600
0
$108.78
$0.00
PAID BY
METHOD
RECEIPT#.
CHECK #
CLTD BY
Total Paid for CHANGEOUT: $326.34 $0.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
�. - Permit Details PERMIT NUMBER
�:� � •it of La uinfia BMCH1201s-0392
Description: WALSH RESIDENCE / HVAC CHANGE OUT
Type: MECHANICAL Subtype: Status: APPROVED
Applied: 10/14/2015 MFA
Approved: 10/14/2015 MFA
Parcel No: 766031002 Site Address: 79440 N N TOM FAZZIO LA QUINTA,CA 92253
Subdivision: TR 28189 Block: Lot: 1
Issued:
Lot Scl Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $46,172.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: (3) THREE HVAC CHANGE OUTS - 20 SEER/80AFUE SPLIT SYSTEM [2008 ENERGY) CARBON MONOXIDE ALARM(S) TO BE INSTALLED
PRIOR TO FINAL INSPECTION. PER 2013 CALIFORNIA BUILDING CODES.
Applied to Approved
FINANCIAL INFORMATION
Printed: Wednesday, October 14, 2015 10:41:44 AM 1 of 2
COLJ 11 SY57EM5
e o e[c�f
o � o
Mum
NAME TYPE
NAME
- ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
IT INC.
32115 LA BAYA
WESTLAKE
VILLAGE
CA
91362
(760)668-5679
CONTRACTOR
HARRISON ENTERPRISES INC DBA
GENERAL AIR
31170 RESERVE DRIVE
I
THOUSAND
I PALMS
CA
92276
(760)668-5679
OWNER
LANCE WALSH
79440 TOM FAZIO N
I LA QUINTA
CA
92253
(760)668-5679
FINANCIAL INFORMATION
Printed: Wednesday, October 14, 2015 10:41:44 AM 1 of 2
COLJ 11 SY57EM5
erg r.
Permit Details PERMIT NUMBER
City of La Quinta BMCH2015270392
BOND INFORMATION
Printed: Wednesday, October 14, 2015 10:41:44 AM 2 of 2
SYSTEMS
CL
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
BSAS SB1473 FEE
101-0000-20306
0
$2.00
0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION $2.00 $0.00
BSA:
HVAC CHANGEOUT -
101-0000-42402
0
$217.56
$0.00
SPLIT -SYSTEM
HVAC CHANGEOUT -
101-0000-42600
0
$108.78
$0.00
SPLIT -SYSTEM PC
Total Paid for CHANGEOUT: $326.34 $0.00
PERMIT ISSUANCE
101-0000-42404
1 0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:• 00
BOND INFORMATION
Printed: Wednesday, October 14, 2015 10:41:44 AM 2 of 2
SYSTEMS
Bin. #
0W 0f > Quinta
Building 8L Safety Division
('�]� V P.O. Box 1504;78 495 Calle Tampico
14.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 79440 Tom Fazio Lane North
Owner's Name:. Lance Walsh
A. P. Number.
Address: 79440 Tom Fazio Lane North
Legal Description:
City, ST, zip: La Quinta, CA 92253
Contractor. General Air Conditioning
qM
Telephone: 760-668-5679 ��_,
Address: 31170 Reserve Drive
Project Description: Replace (1) 5ton Complete HVAC
City, ST, zip: Thousand Palms, CA 92276
System & (2) 4ton Complete HVAC Systems
Telephone: 760-343-7488C'
State Lic. # : 686310
City Lie'. #c
Arch, Engr., Designer.
Address:
City, ST, Zip:
Telephone:
�•;.. Y f
State Lia #: wjy
Name of Contact Person: Steven Schnierer
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq.Ft.:
#Stories: #Units:
Telephone # of Contact Person: 818-735-7876 x 1
Estimated value of project: $46,172,00.
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
' Reed
TRACICTING
PERMIT FEES
Plan Seta
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Calci.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Giading plan
2'a Review, ready for correctionstisstte
Electrical
Subcontector List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
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
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT-04-E (Revised 03/15) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF111-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1)
Site Address:
29f-Ilt-FO �oz:o L(:,-,-,c-l�ar��.
Enforcement Agency:
Date Pre ared:
Permitilk
1n�rr.
D� L,. i�,,��r.�c
)o i7 15
Equipment Type
Equipment Efficien
Efficiency
New Ducting, Plenums, Lineset:
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged
J'Evaporator Coil
7 AFUE
COP
❑ R-6 (CZ2, 8-13) Ducting
Served by system
Setback
System
XSPlit System
Condensing Unit
❑ Compressor
D SEER
HSPF
❑ R-8' (CZ 11, 14, 15) Ducting
3_.'Va0 sgft
(ffnot already
❑ Mini Split
❑ Lineset
❑ R-6 (all CZ's) Plenums
present must
be installed)
,KFurnace
❑ TXV
EER
❑ R-5 or R7.5) Lineset4
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed 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.
1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CFIR-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)2 -HERS, MECH-25-HERS=
Compressor, TXV, Lineset,
CF3R: MECH-20-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS'
Air Handler/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage L15%, or < 30% to outside, or seal all accessible leaks), Air Flow 2 300 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 duct 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'
CFIR-ALT-02-E
including Mini Split
CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS'
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS'
Mini Splits require CFIR-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage :< 6%, Fan Efficacy (.58W/CFM), Air Flow Z 350 CFM/ton (or alternative), Refrigerant Charge
113. All New Ducts with Replacement
I Required Compliance Documents to be left on site for Final:
All New Ductsa and one or more of the following
CF1R-ALT-02-E
replaced: Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
I
Compressor, TXV, Lineset, Furnace'
CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Air Flow 2 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: O 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; ( CF111-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS
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 R-8 required when more than 40 ft installed and R-6 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 MECH-(23 or 24), or Refrigerant Charge verification MECH-25
' All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
4 R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%", 2.5-3T-2%", 3.5 to 4T-2'/.", 5T-4%"
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 for 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 document's, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application
Responsible Designer Name: Responsible Designer Signature: Date Signed: License:
(96310
Company: Address: Gty/State/Zip: Phone:
-7 C> Iho� d� mr: -%00-34
For assistance or questions regarding the Energy Standards, contact the Energy Hu..... a..
STATE OF CALIFORNIA' �J
ALTERATIONS - HVAC
GEGGFLR-ALT-04-E (Revised 03!15) CALIFORNIA ENERGY COMMISSION -_
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations - HVAC CZ 2; and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1)
_
Site Address:'10-q
-7 9 � 4 0
Enforcement Agency:
Date Prepared:
Permit#:
t o CJ, oyk .
C:A,o �- La- ;rs�.
f a tit
Equipment TyPe
Equipment Efcienty
New Ducing, Plenums, Lineset.,
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged
Evaporator Coil
VDIAFUECOP
❑ R-6 (CZ 2, 8-13) Ducting
.Served by system
Setback
System
Split System
,Condensing Unit(If
❑ Compressor
Z p SEER
OR -8' (CZ 11, 14,15) Ducting
33foC) sgft
not already
HSPF
❑ R-6 (all CZ's) Plenums
present must
❑ Mini Split
XFurnace
❑ Lineset
❑ Tom/
EER
❑ R-5 or R7.5) Lineset'
be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed 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.
X1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CF111-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)' -HERS, MECH-25-HERS2
Compressor, TXV, Lineset,
CF3R: MECH-20-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2
Air Handier/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage (:5.15%, 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, 0 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
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts3
CF1R-ALT-02-E
including Mini Split
CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS'
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS'
Mini Splits require CF1R-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow 2 350 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
CF1R-ALT-02-E
replaced: Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Compressor, TXV, Lineset, Furnace2
CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS; MECH-25-HERS
Installer Requirement: Duct leakage < 6%, 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'
CF111-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS
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 R-8 required when more than 40 ft installed and R-6 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 MECH-(23 or 24), or Refrigerant Charge verification MECH-25
' All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
" R -S (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2MV, 2.5 -3T -2Y4", 3.5 to 4T-2%", 5T-4%"
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 for 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 submitted to the enforcement
agency for approval with this building permit application.
Responsible Designer Name: Responsible Designer Signature: Date Signe License:
eves Ir�tr /0 W Ls- (og�3tb
Phone:
Company:
P y
Address:
3�t�o zl�
City/State/Zip:
t�o�
�c,o- 34
.,.r...., .,.. -ann-, -aann
For assistance or questions regarding the Energy.Standards, wnaa« deo ilErgj
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT-04-E (Revised 03/15) CALIFORNIA ENERGY COMMISSION —
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (formerly CF-lR-ALT=HVAC) (Page 1 of 1)
Site Address:
Lo�n�
Enforcement Agency:
Date Prepared:
Permit#:
ay� M�C.zi 1�1oc�4.
o7 La vi _
70 l�F iS
Equipment Type
Equipment Efficiency
New ucting, Plenums, Lineset:
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑Packaged
Evaporator Coil
,�
$ • AFUE
v /•
COP
❑ R-6 (CZ2, 8-13) Ducting
Served by system
Setback
System
Condensing Unit
❑ R-8' (CZ 11, 14, 15) Ducting
7a fo sgft
(If not already
$Split System
❑ Compressor
Zb SEER
HSPF
❑ R-6 (all CZ's) Plenums
present, must
❑ Mini Split
❑ Lineset13
EER
R-5 or R7.5) Lineset'
be installed)
KFurnace
❑ TXV
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed 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.
K1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CF1R-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)' -HERS, MECH-25-HERS'
Compressor, TXV, Lineset, ,
CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS'
Air Handler/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage (!5.15%, or < 10% to outside, or seal all accessible leaks), Air Flow 2 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
-.❑ 1. Duct system.registered.with.HERS.provider.as previously sealed,_or-O 2 -There is_less than 40 linear.,feet of duct inunconditioned space, or ---
0 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: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS'
CF3R: MECH-20-HERS, MECH-22-HERS; MECH-(23 or 24) -HERS', MECH-25-HERS'
Mini Splits require CF1R-ALT-02-E, CF211-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage <6%, Fan Efficacy (.58W/CFM), Air Flow i 350 CFM/ton (or alternative), Refrigerant Charge
113. 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: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Compressor, TXV, Lineset, Furnace'
CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Installer Requirement' Duct leakage < 6%, 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
I Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts3
I CF1R-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS
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 R-8 required when more than 40 ft installed and R-6 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.MECH-(23 or 24), or Refrigerant Charge verification MECH-25
3 All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%", 2.5-3T-2'/.", 3.5 to 4T-2%", 5T-4%"
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. I 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 for 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 oe 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 fora proval with this building permit application.
Responsible Designer Name: Responsible Designer Signature: Date Signed: License:
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Company: Address:CitylState/Zip: � Phane:
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For assistance or questions regarding the Energy Standards, contact the Energy nUILIMe