HomeMy WebLinkAboutPR17-7168....,,III
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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES =�®�
21810 Copley Drive, Diamond Bar, CA 91765
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027
BUILDING PERMIT APPLICATION www.ci"fdiamondbar.com ,building@diamondbarca.gov
JOB SITE ADDRESS 1 h Lam^ "
APN LOT TRACT
OWNER 1-1-4
ADDR k!- .
e
CITY t v C o- I 'EL. �lr? �- — b G. li—:�
APPLICANT i l— TEL. { 4 ellC- 7
CONTRACTOR e——v" (
ADDRESf
CITY ZIP V�EL.
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I hereby affirm under penalfy of perjury that I am exempt from the Contractor's State License Law for the reason{sl
indicated below by the checkmark(sl, I have placed next to the app€icahle €terl [Section 7031.5, Business and
Professions Code: Any city or county that requires a permit to construct, after, improve, demolish, or repalr, any
structure, prior to its issuance, also requires the applicant for the permit to fife 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 at the Business and Professions Code] orthaf he or she is exempt from licensure and the basis for
the alleged exemption. Any violation of Sectlon 7031.5 by anyapplicantfor a permitsubjects the applicantto a clvll penalty
of not more than five hundred dollars ($500).
U 1, as owner of the property, or my employees with wages as their sole compensation, will do U all of or O portions
of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds
or improves the property, 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-Bullder will have the burden of proving that it was not built
or improved tar the purpose of sale.).
U i, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section
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 forth@ projects with a licensed Contractor pursuanttothe Contractors' State
License Law.),
U I am exempt from licensure under the Contractor's State License law for the following reason(s):
Date: _Sign:
By my signature helow I acknowledge that, except for my personal restored rc which I must have resided for at least one
year prior to completion of the improvements covered by thls pormit,l cannot legally sell a structure that i have built as an
owner -builder if it has not been constructed In Its entirety by licensed contractors. I understand that a copy of the
applicable law, Section 7044 of the Business and Professions Code Is available upon request when this application is
submitted or at the following Web site http/vmw.leginfo.:a.gov/calavv.htrnl,
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
-mmyyLlicense
Is In full force and effect,
LICENSE CLASS: �� i NO.: / 1 ,
EXP. DATE: -!T NTRACTOR:
WORKER'S COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by
ectlon 3700 of the Labor Code, for the performance of the work for which this permit Is Issued.
I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for
the performance of the work for which this permit Is Issued. My Worker's Compensation Insurance Carrier and
Policy Number ar
CARRIER
POLICY NUMBER L2 �_3
gHIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS).
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 Worker's Compensation Laws of California And agree that if I should become subject to the Worker's
Compensation provisions of Section 3700 of the labor Code, I shall forthwith comply with those provisions,
DATE: APPLICANT'S
WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal
penalties and civil fines up to one hundred thousand dollars (5100,000), In addition to the cast of the compensation,
damages as provided for in section 3708 of the labor code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for
which this permit is issued (Sec. 3097, Civ. C.).
LENDER'S NAME
LENDER'S ADDRESS.
I certify that I have ad this application and state that the above information Is correct. I agree to comply with all city and
county ordinanc rid slate laws felating to building construction, and hereby authorize representatives of this county to
enter upon thmentioned property for Inspec purposes.
PERMfTTEE NAME (PRIM -
L"
SIGNATURE OF P E DAT
APPLICATION DATE: ! P//C# 2 R I TPP M Ti (08
ISSUE DATE: �� PERMIT# : P K i - - I (J
TYPE CONST. OCC GROUP:
Scope of Work
U,
f C3 r� J e Cts
# DWEL. UNITS # STORIES # BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
LO
Paho/Dock
Lu
LL
PooVSpa
ZRe
-Roof
Commercial
O]
valuation: Adj. Area:
QUANTITY DESCRIPTION FEE
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mm
IN a
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gA A. L't -4-0 Tc�s
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CONSTRUCTION:
PLAN RFVIFW:
ELECTRIC:
PLUMBING:
MECHANICAL: 19_0_
INSPECTION FEE:
ISSUANCE: -2
SMIP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES 1.5
COMMENTS:
P/C: PAID BY: �t VALIDATION:
RECEIPT # 2 5 '.3 PAID BY: 0 _ VALIDATION: LC
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
SETBACK/LETTER
FOOTINGS FORMS
SLAB
UG. PLUMBING
UG. ELECTRICAL
UFFR GROUND
SEWER LATERAL
MAIN WATER LINE
SEWER CLEANOUT
ROOF SHFATI IING
FLOOR SHFATI IING
SHEAR WALLS EXERIOR
SHEAR WALLS INFERIOR
....................
FRAMING/VENTING
__..... .... .
ROUGH MECHANICAL
ROUGH ELLCIRICAL W( ) C O
ROUGH PLUMBING
.............
INSULATION WAI1_
INSULATION CE7I_ING
DRYWALL
LAI H (PRL)
LATII I XTRIOR
I ATII INTLRIOR
(AAS I LS I
SCRATCH COAT
ELECTRIC METER RELEASE.
GAS METER RELEASE
SPECIAL INSPECTION
ol
FINAL BUILDING
FINAL MECHANICAL
FINAL ELECTRICAL tz
FINAL PLUMBING
T.C. of OCCUPANCY
CER€a of OCCUPANCY
COMMENTS,
1
TRACT AND LEDGER
SWITCH GEAR
COMMERCIAL HOOD
T -BAR
INTERCEPTER
............... . ..... .. .. .........
HOT MOPISHOWERPAN
-------------- .__
SEPTIGICESSPOOL
HERS REPORT RECEIVED
DEMOLITION
ROOF DRAINS
ROUGH CONDUIT
PODUSPA
ROUGH PLUMBING
ROUGH ELECTRICAL
ROUGH MECHANICAL
_... _
GAS TEST
PRE GUNITE
POOL PRE DECK BONDING
P -TRAP
- .......... ...._,_
FENCE 1 GATE/ ALARM
FINAL POOL
WALL&
WALL FOOTINGISTEEL
WALL STEEL 1ST( ) 2ND( LIFT"
WALL FIOND B[AM
WALL DRAIN/ SEAL
WAI.I. FINAL
RO, FRAMING PLANNING APPROVAL
ROUGH FIRE APPROVAL
FINIAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERING/ PIN
FINAL. COMMUNITY SERVICES
FINAL HEALTH DE'P1
FINAL INDUSTRIAL WASTE
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CERTIFICATE OF VERIFICATION
CF3R-MCH-23-H
Space Conditioning System Airflow Rate
(Page 1 of 4)
Project Name: LAURA CURTIS i
Enforcement Agency: Diamond
Bar (City of)
Permit Number:
PR17-7168
Dwelling Address: 1414 INDIAN WELL DRIVE
City: Diamond Bar
Zip Code:
91765
A. Ducted Cooling System Information
01
System Identification or Name
SYSTEM #1
02
System Location or Area Served
WHOLE HOUSE
03
System Installation Type
Alteration
04
Nominal Cooling Capacity (tons) of Condenser
3
05
Condenser Speed Type
This field or section is not applicable
06
Cooling System Zonal Control Type
This field or section is not applicable
07
Central Fan Integrated (CFI) Ventilation System Status
Not a CFI system
08
System Bypass Duct Status
No Bypass Duct
09
Date of System Airflow Rate Measurement
2017 -OS -11
10
Airflow Rate Protocol Utilized
RA3.3.3.1.5 Alternative to Compliance with Minimum
System Airflow Requirements
B. Hole for the placement of a Static Pressure Prabe''(HSPP)`and Permanently Installed Static Pressure Probe (PSPP)
in the Supply Plenum.
Procedures for installing HSPP or PSPP are specified in IiA3.3.1.1.
01 Method Used to Demonstrate Compliance with the HSPP installed and labeled consistent with Figure RA3.3-1
HSPP/PSPP Requirement
C. Airflow Rate Measurement Apparatus and Procedure Information
Instrument Specifications are given in RA3.3.1.1, and system airflow rate measurement apparatus information is given
in RA3.3.2.
Airflow Rate Measurement Type used for this airflow rate
Traditional Flow Capture Hood according to procedure in
01
verification.
RA3.3.3.1.4
02
Manufacturer of Airflow Measurement Apparatus
ALNOR
03
Model number of Airflow Measurement Apparatus
EBT731
Certification Status of the Airflow Measurement Apparatus
Certified by Manufacturer and listed on CEC Website at
04
Accuracy
http://www.energy.ca.gov/title24/equipment_cert/ama_fas
/index.html
Registration Number: Registration Date/Time: 2017-08-15 08:55:41 HERS Provider: CHEERS
417-A020101398A-003-000- M 2 300OA-M 23 A
CA 3uilding Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-08-15 08:55:41
2016 Residentia€ Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-23-H
Space Conditioning System Airflow Rate (Page 2 of 4)
MCH23c Forced Air System Airflow Rate Measurement - Alternative to Compliance with Minimum System Airflow
Requirements for Altered Systems
D. Alternative to Compliance with Minimum System Airflow Requirements for Altered Systems
The HERS Rater shall review the information submitted on the installation certificate and perform follow-up communications with
the HVAC installer or the homeowner. The system complies if the HERS Rater determines the remedial actions have been
performed, and the information reported on the installation certificate is valid as specified in RA3.3.3.1.5
02
Determine that the air filter media is clean. If the air
Completed
01
filter media is dirty, then replace it with clean filter
520
media
The measured Airflow Rate reported on this document is
02
Open ail registers and dampers and remove any
Completed
obstructions.
procedures given in RA3.3.3.1.5. This system shall not be
Replace/Repair all accessible crushed, blocked,
Completed
03
restricted, remove excess length, and sharp bends in
ducts. Supported every 4 ft max. with a max. 2 in. sag
04
Clean the evaporator coil according to the manufacturer ;
Completed
and ensure the coil is not obstructed.
05
Air handler fan speed set to high and blower wheel and
Completed
motor are operating properly.
06
If determined to be too small, replace the return duct
Completed
with a larger one and/or add a secon&return duct
07
If determined to be too small, replace the return grille
Completed
with a larger area grille.
08
Verification Status:
System complies
09
Correction Notes:
10
Optional Notes:
E. Forced Air System Airflow Rate Measurement - Best Airflow Rate Attainable
01
Required Minimum System Airflow Rate (cfm/ton)
300
02
Required Minimum System Airflow Target (cfm)
900
03
Actual System Airflow Rate Measurement (cfm)
520
The measured Airflow Rate reported on this document is
04
Compliance Statement:
the best airflow rate attainable for compliance utilizing the
procedures given in RA3.3.3.1.5. This system shall not be
included in a sample group for HERS verification compliance
Registration Number:
417 -AO 2 0101398A-003-000- M 23000A- M 2 3 A
CA Building Energy Efficiency Standards
2016 Residential Compliance
Registration Date/Time: 2017-08--15 08:55:41 HERS Provider: CHEERS
Report Version: 2016.1.006 Report Generated: 2017-08-15 08:55:41
Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-23-H
Space Conditioning System Airflow Rate (Page 3 of 4)
E. Forced Air System Airflow Rate Measurement - Best Airflow Rate Attainable
05 HERS Sample Group Eligibility Not Eligible for HERS Sample Group for Airflow
F. Additional Requirements
Air filters that meet the applicable requirements of Standards Section 150.0(m)12 or 150.0(m)13 were properly installed in
01
the system during system air flow rate measurement identified on this Certificate of Verification.
The airflow rate measurement apparatus used to perform the airflow rate measurement identified on this Certificate of
02
Verification was calibrated in accordance with the apparatus manufacturer's specifications and conforms to the
instrumentation specifications given in RA3.3.1.
A visual inspection shall confirm that bypass ducts that deliver conditioned supply air directly to the space conditioning
03
system return duct airflow are not used on newly constructed zonally controlled systems unless the Performance Certificate
of Compliance indicates an allowance for use of a bypass duct. When a bypass duct is accounted for on the Performance
Certificate of Compliance, the airflow rate shall conform to the specifications listed on the Certificate of Compliance.
04
All registers were fully open during the diagnoAc.test
05
System fan was set at maximum speed during the. dtavdstictest'.
06
If fresh air duct is part of the HVAC system it was 'not closed during the diagnostic test.
07
Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value.
Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/tan) and fan
08
efficacy (Watt/cfm) with system operating in cooling, node a):the maximum"compressor speed and the maximum air
handler fan speed.
For altered systems that do not comply -with th:e:mihiri um 300cfm peraon airflow rate requirement but opt to comply
using the remedial actions on this MCH -23 compliance document according to Section RA3.3.3.1.5 the system's thermostat
09
shall conform to the specifications in Reference Joint Appendix JA5 and shall be capable of receiving and responding to
Demand Response Signals prior to final approval of the building permit by the enforcing agency (Section 150.2(b)1Fia).
10
Verification Status:
Pass - all applicable requirements are met
11
Correction Notes:
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Corrections Notes in this table.
G. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance.
1 01 1 Complies: All specified verification protocol requirements on this document are met.
Registration Number: Registration Date/Time: 2017-08-15 08:55:41 HERS Provider: CHEERS
417-A0201013 98A-003-000- M 2 3000A- M 23A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-08-15 08:55:41
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-23-H
Space Conditioning System Airflow Rate (Page 4 of 4)
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Garrett Williams
(�"```vttWaILC"M
Company:
Date Signed:
I Permit E Raters
2017-08-15
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive
RCN13056
City/State/zip:
Phone:
Westlake Village CA 91362
818-735-7876
Responsible Person'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 Verification is true and correct.
2. 1 amthe certified HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater).
3. The installed features, materials, components, manufactured devices,. onsystem performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with the applicalls requirements in Reference Appendices RA2, RA3, and the requirements
specified on the Certificate of Compliance for the building approved' by theenforcement agency.
4. The information reported on applicabie sections of the Centificate(sj of Installation (CF2R) signed and submitted by the person(s) responsible for the
construction or installation conforms to the requirements specified on th6tertificate(s) of Compliance (CF1R1 approved by the enforcement agency.
5. 1 will ensure that a registered copy of this Certificate of VerEficatiort.s — jl.b5 posted, or made available with the building permit(s) issued for the
building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of
Verification is required to be included with the documentation the;builder provides to the building owner at occupancy.
Builder Or Installer Information As Shown On The Certificate Of Installation
Company Name (Installing Subcontractor, General Cphfractor, or Builder/Owner);. `
Service Champions
Responsible Builder or Installer Name:
CSL13 License:
Austin Smith
799170 .• .
HERS Provider Data Registry Information
Sample Group Number (if applicable): Dwelling Test Status in Sample Group Of applicable)
N/A
HERS Rater Information
HERS Rater Company Name:
I Permit E Raters
Responsible Rater Name:
Responsible Rater Signature:
Garrett Williams
GaIr-retrwalL "'k
Responsible Rater Certification Number w/this HERS Provider:
Date Signed:
RCN 13056
2017-08-15
Registration Number: Registration Date/Time: 2017-08-15 08:55:41 HERS Provider: CHEERS
417-AO2010139SA-003-000-M 23000A -M 23A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-08-15 08:55:41
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION
CF3R-INCH-25-H
Refrigerant Charge Verification
(Page 1 of 4)
Project Name: LAURA CURTIS
Enforcement Agency: Diamond
Bar (City of)
Permit Number:
PR17-7168
Dwelling Address: 1414 INDIAN WELL DRIVE
City: Diamond Bar
Zip Code:
91765
A. System Information
HERS Rater to field -verify all system information, discrepancies to be noted by overwriting entry.
01
System Identification or Name
SYSTEM #1
02
System Location or Area Served
WHOLE HOUSE
03
Condenser (or package unit) make or brand
LENNOX
04
Condenser (or package unit) model number
XC16-036-230-05
05
Nominal Cooling Capacity (tons) of Condenser
3
06
Condenser (or package unit) serial number
5317F15812
07
Refrigerant Type
. R=410A
08
Other Refrigerant Type (if applicable)
This field or section is not applicable
Liquid Line Fiter Drier Installed According to Manufactu'rers'..:
Yes
09
Specifications (if applicable)
10
System Installation Type
Alteration
Fault Indicator Display (FID) Status (Nbte: Even'systerns with "
This system does not have a FID device installed
11
a FID must have refrigerant charge verified by instailer), .
Is the system of a type that the minimum airflow can be
Yes, this is a ducted system and one of the system airflow
12
verified using an approved measurement procedure (RA3.3
rate measurement procedures in RA3.3 or RA333 can be
or RA3.3.3)?
used to verify system airflow rate requirements.
Is the system of a type that approved refrigerant charge
Yes, one of the Refrigerant charge verification procedures
verification procedures can be used to verify compilance
from RA3.2.2 or RA1 is applicable to this system and can be
13
with the refrigerant charge verification requirements when
used to verify compliance
temperatures are >= 55°F (RA3.2.2, or RA1)?
14
Date of Refrigerant Charge Verification for this system
2017-08-11
Refrigerant charge verification method used.
Subcooiing (outdoor temperature must be equal to or
15
greater than 55 degF)
16
person who performed the Refrigerant Charge Verification
HERS rater
reported on this Certificate of Installation
17
HERS Verification Compliance Requirement Status
System does not qualify for group sampling
18
Refrigerant charge verification method used by HERS Rater.
Subcooling
Registration Number:
417-A020101398A-003-000-M 25000A-M25A
CA Building Energy Efficiency Standards
2016 Residential Compliance
Registration Date/-Fime: 2017-08-15 08:55:59 HERS Provider: CHEERS
Report Version: 2016.1.006 Report Generated: 2017-08-15 08:55:59
Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-25-H
Refrigerant Charge Verification (Page 2 of 4)
MCH -25b - Refrigerant Charge Verification - Subcooling Method
S. Metering Device Verification
HERS Rater is required to visually field verify all information from CF2R. Subcooling Method can only be used on
systems that have a variable metering device.
j 01 1 Refrigerant metering device I Thermostatic Expansion Valve (TXV)
02 1 Subcooling Method applicability status 4 Subcooling Method is applicable to this system.
C. Instrument Calibration
HERS Raters are required to calibrate their diagnostic tools. Procedures for instrument calibration are given in
Reference Residential Appendix RA3.2.2 and RA3.2.2.2
01
Date of Digital Refrigerant Gauge Calibration
2017-08-01
02
Date of Digital Thermocouple Calibration
2017-08-01
03
Digital Refrigerant Gauge Calibration Status
;calibration is current
04
Digital Thermocouple Calibration Status
Calibration is current
D. Measurement Access Hole (MAH) Verification
HERS Raters are required to visually field, verify MAH.. Procedures for.installing MAH are specified in Reference
Residential Appendix RA3.2.2.3 -
01 Method Used to Demonstrate Compliance with the MAH installed and labeled consistent with Figure 3.2-1
Measurement Access Hole (MAH) Requirement
E. Minimum System Airflow Rate Verification
Procedures for verifying minimum system airflow are specified in Reference Residential Appendix RA3.3.3.
01
Minimum Required System Airflow Rate (cfm)
900
System complies using the alternative remedial actions
02
System Airflow Rate Verification Status
specified in RA3.3.3.1.5. This System does not qualify for
group sampling
F. Data Collection and Calculations
HERS Rater must independently collect all data in this section. Procedures for determining Refrigerant Charge using
the Standard Charge Verification Procedure are given in Reference Residential Appendix RA3.2.2 and RA3.2.2.2
01 Lowest Return Air Dry Bulb Temperature that Occurred 74
During the Refrigerant Charge Verification Procedure ('F)
Registration Number: Registration Date/Time: 2017-08-15 08:55:59 HERS Provider: CHEERS
417-A020101398A-003-000-M25000A-M 25A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-09-15 08:55:59
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-25-H
Refrigerant Charge Verification (Page 3 of 4)
F. Data Collection and Calculations
HERS Rater must independently collect all data in this section. Procedures for determining Refrigerant Charge using
the Standard Charge Verification Procedure are given in Reference Residential Appendix RA3.2.2 and RA3.2.2.2
01
Measured Condenser Air Entering Dry -Bulb Temperature
77
02
(Tcdnderser,db)
122
03
Evaporator Saturation Temperature (Tevaporator, sat) from
Outdoor temperature is within range for using Subcooling
03
Outdoor Temperature Qualification Status
refrigerant charge verification method
04
Measured Liquid Line Temperature (T4quid) (°F)
82
05
Measured Liquid Line Pressure (Plgwd) (prig)
268
05
Condenser Saturation Temperature (Tcondenser, Sat) from
88
06
Digital Gauge or P-TTable using Line F05 (°F)
Yes, documentation to be provided upon request
07
Measured Subcooling (Line F06 - Lilne F04 (°F)
6
08
Target Subcoohng from Manufacturer (°F)
5>
System complies with Subcooling Method -Must aiso pass
09
Compliance Statement:
metering device verification, next section
G. Metering Device Verification
HERS Rater must independently collect all data in this section. Procedures for the verification of proper metering
device operation are specified in RA3 2.2.6:2..:
01
Measured Suction Line Temperature (Tsucton) (°F)
66'
02
Measured Suction Line Pressure (Psucti 0 (psig)
122
03
Evaporator Saturation Temperature (Tevaporator, sat) from
41
Digital Gauge or P -T Table using Line G02 (°F)
04
Measured Superheat (Line G01- Line G03) (°F)
25
Measured Superheat (Line 604) is between 3°F and 26°F
Passes CEC requirement
05
(inciusive)
Measured Superheat (Line G04) is within Manufacturer's
Yes, documentation to be provided upon request
06
Specifications ( if known)
07
Compliance Statement:
Metering device verification passes
H. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance.
1 01 1 Complies: All specified verification protocol requirements an this document are met. j
Registration Number: Registration Date/Time: 2017-08-15 08:55:59 HERS Provider: CHEERS
417-A020101398A-003-000-M25000A-M25A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-08-15 08:55:59
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-25-H
Refrigerant Charge Verification (Page 4 of 4)
Documentation Author's Declaration Statement
1. I certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Garrett Williams
CjarrettWaUa,"w
Company:
Date Signed:
I Permit E Raters
2017-08-15
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Bay@ Drive
RCN13056
City/State/Zip:
Phone:
Westlake Village CA 91362
818-735-7876
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided or this Certificate of Verification is true and correct.
2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater).
3. The installed features, materials, components, manufactured devices;: ar system performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with ,tiie3pplipMe requirements in Reference Appendices RA2, RA3, and the requirements
specified on the Certificate of Compliance for the building,approved'by theenforcemert agency.
4. The information reported on applicable sections of the Certificate(s)of, Ihstailation (MR) signed and submitted by the person{s) responsible forthe
construction or installation conforms to the requirements.sgecified on.tf e Certificate(s) of Compliance (CF1R) approved by the enforcement agency.
S. I will ensure that a registered copy of this Certificate of Verificat:'ort shall'b'e:posted, or made available with the building permit(s) issued for the
building, and made available to the enforcement agency for all applitable,inspections. I understand that a registered copy of this Certificate of
Verification is required to be included with the documentation the:f wilder provides to the building owner at occupancy.
Builder Or Installer Information As Shown On The Certificate Of Installation
Company Name (Installing Subcontractor, General Contractor, or_l�uilder/Owner)
Service Champions
Responsibie Builder or Installer Name:
CSLB License:
Austin Smith
799170
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
N/A
HERS Rater Information
HERS Rater Company Name:
I Permit E Raters
Responsible Rater Name:
Responsible Rater Signature:
Garrett Williams
Ga T-eW W01iavrzx
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
RCN13056
2017-08-15
Registration Number: Registration Date/Time: 2017-08-15 08:55:59 HERS Provider: CHEERS
417-A020101398A-003-000-M25000A-M25A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-08-15 0$:55:59
2016 Residential Compliance Schema Version: rev 10/16
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