06-1552 (MECH)�j �
'P.O. BOX 1504. ^� ' — ' VOICE 760 777-7012;
78-495 CALLE TAMPICO `" FAX (760) 777-7011, y'
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT -
Date: '4/17/06....
Application Number: ' 0600001552 y Owner:: '
6r Property Address: 55605 PEBBLE -BEACH r M/M GIL MARINO '
' APN: 775-130-009- - s'- 55605 PEBBLE BEACH
Application description: MECHANICAL LA QUINTA, CA 92253 _
G Property Zoning: LOW DENSITY RESIDENTIAL a }
Application valuation: e r 9400
Contractor:
Applicant: Architect or Engineer: AIR EXPERTS AIR CONDITION
0 ..
4;
PO BOX 94 '
tLA QUINTA, CA 92247
(760)272-1884 A
r , Lic. No.: 725283 '
r� --- - ----- - - - - ------
------------------------------------------------'---- -- - - - --
L S CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I I hereby affirm under penalty of perjury hat I am Ised under rovisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
_ Section 7 00) f Division 3 of the Busi ss and P o ssionals od and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License ass: C2 0 `Li a No.: 7 .283 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
e' ►V/
issued.
Date: Contractor:
- - _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the LabLabor Code, for the performance of the work for which this permit is issued. My workers' compensation
•i' r OWNER -BUILDER DECLARATION _ ' insurance carrier and policy number re:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the _ Carrier EXEMPT Poli Number EXEMPT '
_ following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to, T _ I -certify that, in the performance of the rk for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the personin any manner so co a subject to the orkers' compensation laws of California, .
' permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State _ and agree that, if I shout ecome s t to the wor rs' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or of the Labor Code, I all forth ithat lie or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by s• -/OO
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).: - Dr;r Applicim,
(_ 1 I, as owner of the property, or.my employees with wages as their sole compensation, will do the work, and ,��` • _ - the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND.,
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000) IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. _
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.). . . APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
F: - NtsN�ri'r' :iho bcild6 6P Intpre•:66 there/A, and :vhQ QcncQ.QtQ fQr thq prQjgQtp ,uirh ,—mr—mr(r) lirenrori,,. , 1 - Farh nersnn unnn whns® behalf this andiGatigrl i5 made, each g0rs4n @t whose request and for - - -•
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, "~ • --
- (_) I am exempt under Sec. , B.&P.C. for this reason - 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. -
Date: Owner: _ _ 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, cessation of work for 180 days will subject
-' CONSTRUCTION LENDING AGENCY • •' " .permit to cancellation.
4 I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state th t the above inf ation is correct. agree to comply with all w -
'�r • work for which this permit is issued (Sec. -3097, Civ. C.) ` ' - - �- -i.'. - - • - city and co ty ordinances and state laws relating to uilding constr on, and hereby uthorize representatives -
• of this cou ty to enter upon the above-mentioned prop rt for i ti n purles.
r Lender's Name: ____
r
+'DaterAk& Signature (Applicant or Agent)'
Lender's Address: .. ��- ✓
LQPERMIT • - _ _ FF
Application Number . . . . 06-00001552
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 37.50
Plan Check Fee
9.38
Issue Date . . . .
Valuation . .
.
- 0
Expiration Date 10/14/06
Qty Unit Charge Per
Extension'
BASE
FEE
15.00
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 4.5000 EA MECH
VENT INST/ DUCT ALT,
4:50
1.00 9.0000 EA MECH
APPL REP/ALT/ADD
9.00
-- -------------------------•-------------------------
Special Notes and Comments
REPLACE TWO(2) 3 TON A/C
SYSTEMS -FURNACE COILS & CONDENSERS.
Fee summary Charged
Paid Credited
Due
-------------------------------------
Permit Fee Total 37.50
--------------------
.00 .00
37.50
Plan Check Total 9.38
.00 .00
9.38
Grand Total 46.88
.00 .00
•
46.88
r
LQPERMIT
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page I of 4) CF -IR
Project Title � Date
Pro, t ddress Buil ling Permit #
H/� C / /� CON�tTidnl lNG-�E,4T�n! 6
Documentation Author Telephone I Plan check /Date
Field Check / Date
Compliance Method (Prescriptive) Climate Zone Enforcement Agency Use Only .
✓ ❑ Alternative Component Package Method: (check one) C D D (Alternative)
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) Average Ceiling Height: ft
Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C ---- (5% X CFA)_ 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 2,4,8-15),
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
Bafrier Location/Comments'
Installed (attic, garage,
Yes or No typical, etc.
1) See Joint Appendix IV in Section IV.2, IV.3 and IVA, which is the basis for the U -factor criterion. U -tactors can not
exceed -prescriptive value to show equivalence to R -values.
Z
2 -
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 4) CF -IR.
WS L 09W1111) o > o
Project Title Date
i
FENESTRATION PRODUCTS — U -FACTOR AND SHGC
✓ ❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS-4R—must be included for New Construction,
Additions and Alterations.
Fenestration
#/Type/Pos.
(Front, Left, Orien-
Rear, Right, tation, Area U -factor
S li t N, S, E W' (ft) U -factor' Source3 SHGC4
Exterior
Shading/Overhangs67
SHGC ✓ box if WS -3R is
Sources included
uinl�lo cJ
❑
A,4
Sme
0.
i) axyugnts are now mcmaea to west-tacmg renestratton area it the skylights are tilted to the west or tilted in any direction
when the pitch is less than 1:12:. See § 151(f)3C and in Section 3.2.3 of the Residential Manual
2) Enter values in this column are either NFRC Rated value or from Standards default Table I I6A.
3) Indicate source either from NFRC or. Table 1.16A,
4) Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from WSJ 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
Heating Equipment
Type and Capacity
furnace heat um boiler, etc.
Minimum Distribution
Efficiency Type and Location Duct or Piping 'Thermostat Configuration
UE o HSPF ducts attic etc. R -Value T e lit or ac e
uinl�lo cJ
r C' 4,z S , 7-
A,4
Sme
Cooling Equipment Minimum
Type and Capacity . Efficiency Duct Location Duct Thermostat Configuration
A/C heat pump,eva . cooling) SE or EER attic etc. R -Value T (split or package)
CZC
2- bds w,4. -rx Y
Si= 3333in�/4S3 Zo Zs�A P
Residential Compliance Forms
March 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Palle 3 of 4) CF -1R
1Q -mks f/L
Title
Date
SEALED DUCTS and TXVs (or Alternative Measures)
A signed CF -4R Form must be provided to the building department for each home for which th,- following. are
required.
vx
❑ 1Alternative to Sealed Ducts and Refrigerant Charge fMs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
❑ sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Pacxa a D.
WATER HEATING SYSTEMS
Sealed Ducts all climate zones taller testing and certification and HERS rater field verifi-ration required.)
Number
in System
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 HE2S Rater field
❑
verification required.)
vx
❑ 1Alternative to Sealed Ducts and Refrigerant Charge fMs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
❑ sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Pacxa a D.
WATER HEATING SYSTEMS
Systems serving single dwelline units
Water Heater
Type/Fuel Type
Distribution
Type
Number
in System
Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired -eater heater per
❑
dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and mcirculation system is
. Standby'
Loss %
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 with the Preapproved
❑
Alternative Water Heating table. In this case, the Performance Method must be used and must 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
Systems serving single dwelline units
Water Heater
Type/Fuel Type
Distribution
Type
Number
in System
Rated
In utl
(kW or
Bw/hr)
Tank
Capacity
(galions
Energy
Factor' or
Thermal
Efficient
. Standby'
Loss %
Tank
External
Insulation
R -Value
System serving multiple d Ring units
Water Heater
Type
Distribution
Type
Number
in System
Rated
Input'
(kW or
Btuft_(gallons)
Tank
Capacity
Energy
Factor' or
Thermal
Efficient
Standby'
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 of geeater 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 beating source to the kitchen fixtures that are 3/a
inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 G) 2 B.
Residential Compliance Forms March 2005
l
1
CERTIFICATE OF. COMPLIANCE: RESIDENTIAL (Page 4 of 4) CF -1R
Project Title Date
SPECIAL FEATURES NOT REOURUNG HERS VERIFICATION (add extra sheets if necessary)
Indicate which special features are part'of this project. The list below only represents special features relevant to the
nrescrintive methnd
✓
Feature
Required Forms if applicable)
Description
❑
Metal Framed Walls
CF -1R
CF -6R part 6 of 12
❑.
Radiant Barriers
CF -1R
❑
Exterior Shades
WS -4R
❑
Cool Roof
N/A; Attach CRRC Label to
Forms.
❑
Dedicated Hydronic Heating
Performance Calculation
System
Required; Attach Run to Forms.
❑
Combined Hydronic System .
Performance Calculation
Required; Attach Run to Forms.
❑
Gas Cooling
Performance Calculation
Required.
❑
Buried Ducts
N/A; Indicate on building plans.
❑
Kitchen Pipe Insulation
See Section 5.6.2 Distribution
Systems in Residential Manual.
Multiple Water Heaters Per
See Table 5-13 or use
Dwelling Unit
Performance Calculation and
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
❑
Wood Stove Boiler
Performance Calculation and
attach Run to Forms
_SPECIAL FEATURES REOURUNG HERS RATER VERIFICATION
(add extra sheets if necessary) Indicate to the HERS Rater which credits are part of this project and need
verification_
✓ Feature
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
0
/
Bin #
Citybfla Quinta
Building 81 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: 'S S $� c� �k
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: ,� �j U r N 7-A
Contractor: �� G _ T ins
Telephone:
Address: �� `�xProject
Description:
City, ST, Zip: i N 'ice C 97— Z /
�f�Cf i�9/J
Telephone:Z-7 Z
State Lic. #
City Lic. #:
JIJ GA6.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
Units:
Telephone # of Contact Person:
Estimated Value of Project: 4&)
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIMG .
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
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2'd Review, ready for correctionsrssue
Electrical
Subcontactor.List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval :
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
7-1
CERTIFICATE- OF COMPLIANCE: RESIDENTIAL (Page -1 of 4) CF -1R
Project�Title:-- pate
64<
Pr oje t �jddress !L Building Permit #
9/K 6J 1 414 &0�tT/0n1 IM&
Documentation Author Telephonel Plar Check / Date
FieU Check / Date
Compliance Method (Prescriptive) Climate Zone Enforcement Agency Use only
✓ ❑ Alternative Component Package Method: (check one) C D D (Alternative)
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) fe Average Ceiling Height: ft
Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C ---- (5% X CFA) ft
Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C ---- (20% X CFA) g
✓ ❑ Building Type: (check one or more) Single Family Multifamily Additiat 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 orienta=tion in degrees from True
North and circle one).
✓ ❑ RADIANT BARRIER (required in climate zones 2.4.8-15)
OPAQUE SURFACES INCLUDING OPAQUE- DOORS
Component
Type (Wall,
Roof, Floor,
Slab Edge,
Doors)
Frame
Type
(Wood
or Metal)
Cavity Continuous
Insulation Insulation
R -Value R -Value
Assembly U -
factor (for
wood, metal
frame and mass
assemblies)'
Joint
Appendix
IV
Reference
Roof Radiant
Bamier Location/Comments
Installed (attic, garage,
Yes or No typical, etc.
1) See Joint Appendix IV in Section IV.2, iV.3 and IVA, which is the basis for the U -factor criterion. U -factors can not
exceed prescriptive value to show equivalence to R -values.
Residential Compliance Fors
March 2005
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 4) CF -1R
Project Title Date
• FENESTRATION PRODUCTS -U-FACTOR AND SHGC
✓ ❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS -4R -must be includai for New Construction,
r Additions and Alterations.
5';
Z -
Fenestration
#/I'ype/Pos.
(Front, Left, Orien-
Rear, Right, tation, Area U -factor
S li t N, S E W' ft U-factorz Source
Exterior
Shading/Overhangs 6, 7
SHGC ✓ box if WS -3R is
SHGC4 Sources included
A Al
13
0
13
i) sicyugnts are now induced in west -lacing tenestration area it the skylights are tilted to the west or -tilted in any direction
when the pitch is less than 1:12. See §151(f)3C and in Section 3.2.3 of the Residential Manual
2) Enter values in this column are either NFRC Rated value or from Standards default Table 116A.
3) Indicate source either from NFRC or Table 116A,
4) Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from WS -3R.
5) Indicate source either from NFRC or Table 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
Heating Equipment
Type and Capacity
fumace heat pump, boiler, etc.
Minimum Distribution
Efficiency Type and Location Duct or Piping Thermostat Configuration
UE o HSPF ducts attic, etc. R -Value Type lit or acka e
A Al
0
Cooling Equipment Minimum
Type and Capacity Efficiency Duct Location Duct Thermostat Configuration
A/C heat pump, eva . cooling) SE or EER attic, etc. R -Value Type split or package)
3 -r0
977,-c - ,r L, 7-
73e
Se 3333&CI4S7)� Zo 20A p
Residential Compliance Forms
j
GI
�j
CERTIFICATE OF COMPLIANCE: RESIDENTIAL
,/qo
ect Title
3 of 4) CF -1R
SEALED DUCTS and TXVs (or Alternative Measures)
A signed CF -4R Form must be provided to the building department for each home for which the following. are
required.
❑ IAlternative to Sealed Ducts and Refrigerant Charge !TXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
❑ sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Pacta a D.
WATER HEATING SYSTEMS
Sealed Ducts all climate zones taller testing and certification and HERS rater field verification required.)
Number
in System
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.)
❑ IAlternative to Sealed Ducts and Refrigerant Charge !TXVs (See Package D Alternative Package Features for
Project Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14.
OR
For additions and alterations, duct systems that are not documented to have been previously
❑ sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the
Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned
spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Pacta a D.
WATER HEATING SYSTEMS
Systems serving single dwelling units
Water Heater
Type/Fuel Type
Distribution
Type
Number
in System
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
Standby'
Loss %
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 with the Preapproved
❑
Alternative Water Heating table. In this case, the Performance Method must be used and must 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
Systems serving single dwelling units
Water Heater
Type/Fuel Type
Distribution
Type
Number
in System
Rated
Input'
(kW or
BWft
Tank
Capacity
Ions
Energy
Factor' or
Thermal
Efficient
Standby'
Loss %
Tank
External
Insulation
R -Value
System serving multiple dwelling units
Water Heater
Type
Distribution
Type
Number
in System
Rated
Input'
(kw or
Btuft(gallons)
Tank
Capacity
Energy
Factor' or
Thermal
Efficient
Standby
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 of greater than 75,000
Btu/hr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water
heaters, list Rated Input and Thermal Efficiencies.
Pipe Insulation (kitchen lines >_ 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are 3/4
inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 6-12 B.
Residential Compliance Forms
March 2005
CI
ki
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 4 of 4) CF -1R
Project Title Date
SPECIAL FEATURES NOT REQUIRING ITERS VERIFICATION (add ex-xa sheets if necessary)
Indicate which special features are part of this project. The list below only represents special features relevant to the
nrescrintive method_
✓
Feature
Required Forms if applicable)
Description
❑
Metal Framed Walls
CF -1R
CF -6R part 6 of 12
❑
Radiant Barriers
CF -1R
❑
Exterior Shades
WS -4R
❑
. Cool Roof
N/A; Attach CRRC Label to
Forms.
❑
Dedicated Hydronic Heating
Performance Calculation
System
Required; Attach Run to Forms.
❑
Combined Hydronic System
Performance Calculation
Required; Attach Run to Forms..
❑
Gas Cooling
Performance Calculation
Required.
01
Buried Ducts - '
N/A; Indicate on building plans.
❑
Kitchen Pipe Insulation
See Section 5.6.2 Distribution
Systems in Residential Manual.
Multiple Water Heaters Per
See Table 5-13 or use
❑
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
❑
Wood Stove Boiler
Performance Calculation and
attach Run to Forms
SPECIAL FEATURES REQUIRING HERS RATER VERIFICATION
(add extra sheets if necessary) Indicate to the HERS Rater which credits are part of this project and need
verification.
✓ Feature
Required Forms if applicable) Description
Duct Seating
CF -6R part 4 of 12
❑ Refirigerant Charge
CF -6R part 5 of 12
Thermostatic Expansion Valve
CF -6R part 6 of 12
Residential Compliance Forms March 2005
r
Ca10ERTS - Certificate
raEr� , vt c.
CERTIFICATE OF FIELD VERIFICATION 8k DIAGNOSTIC TESTING (Page 1 of 8) CF -4R
55 605 Peable Beach iof2 Air Experts Air Conditioning & Heating / 725283
Project Address Contractor Name / License No.
06-1552
Contractor Contact Telephone Permit Number
Watter.Nell s 760-275-4919 22359
NEMS if Telephone Sample Group Number
April 19 2006 CC14-1798362941
C g-_tvm Date Certificate Number
Firm: Air Solutions of the Desert HERS Provider:Ca10ERTS
Street Address: PMB 150 42-208 Washington Street City/State/Zip: Bermuda Dunes / CA / 92203
Copies to. Homeowner, ITERS Provider and Building Department
This CF -41k has been registered with the CaICERTSO registry in aocordanee with the Title 24 & TIM 20 of the CCR.
CaICERTS® is an approved HERS provider by the California Energy Commission.
HERS RATER COMPLIANCE STATEMENT
The house was LWJ Tested LJ Approved as part of sample testing, but was not tested.
As the HERS rater providing diagnostic testing and field verification, I certify that the house Identified on this form complies with the
diagnostic tested compliance requirements as checked on this form. The HERS rater must check and verify that the new distribution
system is fully ducted and correct tape Is used before a CF -4R may be released on every tested building. The HERS rater must not
release the CF -4R until a properly completed and signed CF -6R has been received for the sample and tested buildings.
The Installer has provided a copy of the CF -61t (Installation Certificate).
New Distribution system Is fully ducted (i.e., does not use building cavities as plenums or platform returns In ileu of ducts).
New systems where cloth backed, rubber adhesive duct tape is Installed, mastic and drawbands are used in combination with doth
backed rubber adhesive dud tape to seal leaks at dud connections.
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NEW CONSTRUCTION
Duct Pressurization Test Results (CFM @ 25 Pa)
MV lues
1
w/e
2
Fan Flow: Calculated (Nominal '.f. Cooling =. Heating) or'..... Measured
1208
Enter Total Fan Flow in CFM:
3
N/a.
N/A
ALTERATIONS:
Dud System and/or HVAC Equipment Change -Out
4
Enter Tested Leakage Flow In CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct
302
System Alteration and/or Equipment Change -Out.
5
Enter Tested Leakage now in CFM: Final Tort of New Dud System or Altered Duct System for Dud
284
System Alteration and/or Equipment Change -Out.
6
Enter Reduction In Leakage for Altered Duct System
18
[Line 4 - Line 5] - (Only if Applicable)
7
Enter Tested Leakage Flow In CFM to Outmode (Only if Applicable)
8
Entire New Duct System - Pass If Leakage Percentage <= 6% [ 100 x ( Line 5 / Line 2 ]]:
❑ Pass ❑ Fall
TEST OR VERIFICATION STANDARDS: For Altered Dud System and/or HVAC
Equipment Change -Out, use one of the following four Test or Verification
Standards for compliance:
9 Pass If Leakage Percentage <= 15% [ 100 x ( Line 5 / Line 2 )]:
❑ Pass ❑ Fall
10 Pass if Leakage to Outside Percentage <= 10% [ 100 x ( Line 7 / Line 2 )]:
❑ Pass a Fall
11 Pass If Leakage Reduction Percentage >= 60% [ 100 x ( Line 6 / Line 4 )]
and Verification by Smoke Test and Visual Inspection
Pass � Fall
12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual InspeWon
Pass `Fall
Pass If One of Lines #9 through 4:12 pass
� Pass Fall
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CaICERTS Certificate Page 2 of'l
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3-4 of 8) CF -4R
55 605 Peable Beach 1of2 Air Experts Air Conditioning & Heating / 725283
Project Address Contractor Name / License No -
06 -15S2
Contractor Contact Telephone Permit Number
walte Neilis,, 760-275-4919 22359
Telephone Sample Group Number
t Aril 19, 2006 CC14-1798362941
c y Wnature Date Certificate Number
Firm: Air Solutions of the Desert HERS Provider.CaICERTS
Street Address: PMB 150 42-208 Washington Street_ City/State/Zip.Bermuda Duns / CA / 92203
Copies to: Homeowner, HERS Providerand Building Deoarbinent
This CF -41k has been registered with the CaICERTS® registry In accordance with the Title 24 & Titlb 20 of the CCR.
CaICERTS® is an approved HERS provider by the California Energy Commission.
HERS RATER COMPLIANCE STATEMENT
The house was R Tested lJ Approved as part of sample testing, but was not tested.
As the HERS rater providing diagnostic testing and field verification, I certify that the house Identified an this form compiles with the
di nostic tested compliance requirements as checked on this form.
ii The Installer has provided a copy of the CF -6R (Installation Certificate).
✓THERMOSTATIC EXPANSION VALVE (TXV)-
Access is provided for inspection. The procedure shall consist of visual verification that the TXV is
installed on the system and installation of the specific equipment shall be verified.
HVAC System TXV R; Pass E) Fall
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CaICERTS - Certificate Page 1 of
CERTIFICATE OF F2ELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 of� 81 CF -4R
55 605 Peable Beach 2cf2 Air Experts Air Conditioning & Heating / 725283
Project Address Contractor Name / license No.
06-1552
Contractor Contact Telephone Permit Number
Walter N lis 760-275-4919 22354
11E ate ` Telephone Sample Group Number
A ril 19, 2006 CC14-1798362936
Citi Signature Date Certificate Number
Air Solutions of the Desert HERS Provlder:Ca{CERTS
Street Address: PMB 150 42-208 Washington Street City/State/Zlp:Bermuda Dunes / CA / 92203
Copies to: Homeowner, HERS Provider and Building Department
This CFAR has been registered with the CaiCERTSO registry In accordance with the Title 24 & Title 20 of the CCR.
CaICERTSO is an approved HERS provider by the California Energy Commission.
HERS RATER COMPLIANCE STATEMENT
The house was 0 Tested ❑ Approved as part of sample testing, but was not tested.
As the HERS rater providing diagnostic testing and field verification, I certify that the house Identified on this form compiles with the
diagnostic tested compliance requirements as checked on this form. The HERS rater must check and verify that the new distribution
system Is fully ducted and correct tape is used before a CF -4R may be released on every tested building. The HERS rater must not
release the CF -411 until a properly completed and signed CF -6R has been received for the sample and tested bulldings.
The Installer has provided a copy of the CF -6R (Installation Certificate).
New Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns Iro lieu of ducts).
New systems where cloth backed, rubber adhesive duct tape Is Installed, mastic and drawbands are used in combination with doth
backed rubber adhesive duct tape to seal leaks at dud connections.
...u.u.■u s=�nTeru=oro =^n nud-r r =Arad_=y=■'nrrSTe%*A rAYYI TANrF rRFnIT-
NEW CONSTRUCTION
Dud Pressurization Test Results (CFM @ 25 Pa)
Measured
Values
1
N/A
2
Fan Flow: Calculated (Nominal ' fir' Cooling Heating) or '�> Measured
1200
Enter Total Fan Flow in CFM:
3
N/A
N/A
ALTERATIONS:
Duct System and/or HVAC Equipment Change -Out
4
Enter Tested Leakage' Flow In CFM from CF -6R: Pre -Test of Existing Dud System Prior to Dud
27E
System Alteration and/or Equipment Change -Out.
5
Enter Tested Leakage Flow in CFM: final Test of New Duct System or Altered Duct System for Duct 245
System Alteration and/or Equipment Change -Out.
6
Enter Reduction in Leakage for Altered Duct System ,
29
[Line 4 - Line 5] - (Only If Applicable)
7
Enter Tested Leakage Flow in CFM to Outside (Only If Applicable)
8
Entire New Duct System - Pass V Leakage Percentage <= 6019 [ 100 x ( Line 5 / Line 2 )j:
❑ 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 <- 15% [ 100 x ( Line 5 / Line 2 )]:
❑ Pass ❑ Fall
10 Pass if Leakage to Outside Percentage <= 10% 1 100 x ( Line 7 / Line 2 )]:
❑ Pass ❑ Fail
11 Pass if Leakage Reduction Percentage >= 60% [ 100 x ( Line 6 / Line 4 )]
Pass Fail
and Verification by Smoke Test and Visual Inspection
—�
12 Pass If Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection
Pass :EJ Fall
Pass if One of Lines *9 through #22 pass
!� Pass r l Fail
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Ca10ERTS - Certificate lragc u.
CERTIFICATE OF FIELD VERIFICATION r4 DIAGNOSTIC TESTING (Page 3-4 of 81 CP'
55 605 Peable Beach 2of2 Air Experts Alr Conditloning & Heating 1725283
project address contractor Name / licernse No.
06-1552
contractor contact Telephone permit Number
Walter Wills 760-275-4919 22354
HERS t Telephone Sample Group Number
April 19, 2006 CC14-1798362936
nature Date Certificate Number
Firm: Air Solutions of the Desert HERS Provider:CalCERTS
Street Address: PMB 150 42-208 Washington Street City/State/2ip:Bermuda Dunes / CA ( 92203
Copies to: Homeowner, HERS Provider and Building Department _
'this CF -4R has been registered with the CaICERTSO registry in accordance with the Title 24 & Titie 20 of the CCR.
CaICERTSO Is an approved HERS provider by the California Energy Commission.
HERS RATER COMPLIANCE STATEMENT
The house was 0 Tested ❑ Approved as part of sample testing, but was not tested.
As the HERS rater providing diagnostic testing and field verification, I certify that the house Identified on this forth complies with the
dia nostic tested compliance requirements as checked on this form.
The Installer has provided a copy of the CF -611 (Installation Certificate). - -
t6THERMOSTATIC EXPANSION VALVE
Access is provided for inspection. The procedure shall consist of visual verification that tiie TXV is
installed on the system and installation of the specific equipment shall be verified.
HVAC System TXV ® Pass' ❑ Fall
a
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