HomeMy WebLinkAboutPR17-17620CITY OF DIAMOND BAR
i DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES /
' 21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-71027 FIRMLY
'A 9. BUILDING PERMIT APPLICATION www.cityofdiamondbar.eom building@diamondbarea.gov
JOB SITE ADDRESS D
APN� LOT TRACT
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OWNERX {A<� , �Eecko.sz �°� ®:e Car;naa
ADDRESS a,1 f --? I
CITY OZIP 4it7G5 TEL. 610"1 .]li MP3`
APPLICANT TEL.
CONTRACTORY —+,t�j `4 r�t✓:r y oa .,
ADDRESS ; f bRI fi C. t
CITY :.jw e, 41,J ZIP 11` TEL.
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reascri
Indicated below by the eiteckmark(s), I have placed next to the applicable items) [Section 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 from licensure and the basis for
the alleged exemption. Any violation of Section 7031.5 by any appllcantfor a permit subjects the applicantio a civil penalty
of not more than five hundred dollars ($500).
U I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U 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, bullds
or Improves the property, provided that the improvements are net 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 It was not bulit
cr improved for the purpose of sale.).
{_) I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section
7044, Business and Professions Cade: The Contractors' State License Law does rot apply to an owner of property who
builds or improves thereon, and who Contracts tortheprojects with alicensed Contractor pursmirr the Contractors' State
License Law,).
U I am exempt from licensure under the Contractor's State License law for the following reasons}:
Date: Sign:
By my signature below I acknowledge that, except for my personal residence In which I must have resided for at least one
year prior to completion of the improvements covered by this permR,I cannot legally sell a structure that I have built as an
owner -builder if it has not been constructed In Its entirety ty Ilcensed contractors. I understand that a copy of the
applicable €aw, Section 7044 of the Business and Professions Code is available upon request when this application is
submitted or at the following Web site: httplwww.Ieglnfe.ea,gev/mlaw,html
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under proWslons at Chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Professions Code, and my license Is in full force and effect.
LI CENSE CLASS', - _ LIC. NO.:
XP. DATE: CONTRACTOR'S C -9..r 4" , � e.J d? -V, C e:.a
WORKER'S COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONF OF THE FOLLOWING DECLARATIONS:
I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by
Section 3700 of the Labor Cade, 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 ofthe Labor Code, for
the performance of the wcRfor which this permit is issued. My Worker's Compensation Insurance Carrier and
Policy Number are:
CARRIERi
POLICY NUMBER L ` - ' _ f
(iHlS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS 5100 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 Cade, I shall forthwith comply with those provisions.
DATE: APPLICANT:
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 ($100,000), In additlon 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 Constructlon Larding Agency for the performance of the work for
which this permit is issued (Sec. 3097, Civ. C.},
LENDER'S NAME:
LENDER'S ADDRESS:
I cerfify that I have read this applicaton and state that the above Information Is correct. I agree to comply with all city and
county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to
enter upon
�the ahove-mentioned property for inspection purposes.
°PERMITTEE NAY�,(PIRHdT'T'-"'-
IiOONATURE OF PERMITTEE DATE
APPLICATION DATE: L 5 S' P/7C# P9 17- 6f
ISSUE DATE: 2 OPERMIT# -4 - 14 (ZO
TYPE CONST. OCC GROUP:
Scope of Work
# DWEL. UNITS j # STORIES `� # BEDROOMS"'S
DESCRIPTION SQ. FT. FACTOR I AD,]. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
W
Patle/Deck
LU
LL
Pool/Spa IM IN I% 9117rn
z
Re -Roof ma mi Ln
Commercial ,..
W
.v
lfaluation: Adj. Area:
QUANTITY DESCRIPTION FEE
5 .
w
w
w
s A
co
00 u fu ii
Q
-Z - ao
¢
q a n O
x
v
CONSTRUCTION:
PLAN REVIEW: 60.00
ELECTRIC:
PLUMBING:
MECHANICAL:,
INSPECTION FEE:
ISSUANCE: LJ W
SMTP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE: -
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES 65
COMMENTS:
P/C: PAID BY: VALIDATION:
RECEIPT # PAID By:-�' VALIDATION:
1
WHITE— Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy
Emmmm
SETBACK/ LETTER
_.__..__.
TRACT AND LEDGER
FOOTINGS FORMS
SWITCH GEAR
SLAB
COMMERCIAL HOOD
UG. PLUMBING
T -BAR
UG. ELECTRICAL
INTERCEPTER
UFER GROUND
HOT MOP/SHOWERPAN
._._... _.....
..... .... .....__
SEWER LATERAL
MAIN WATER LIN/
SEWER CLEAN0111
ROOF SHEATH€NG
FLOOR SHFATHING
SHEAR WALLS EX1 ERIOR
SEPTIC/CESSPOOL
HERS REPORT REGEIVLD
DEMOLITION
ROOF DRAINS
ROUGH GONDUIT
POOL/SPA
ROUGH PLUMBING
ELECTRICAL
ROUGH MECHANICAL
GAS TEST
PRE GUNITE
POOL PREDECK BONDING
—._.
P-THAP _
FENCE 1 GATE/ ALARM
FINAL POOL
WALLS:
WAI.I. FOOL INGISTFEL
WAI_.[.'I;'( ) 7N°( ) LIFT
WALL BOND BL AM
SHEAR WALLS INTLRIOR - >-
FRAMING/VENTINGROUGH
ROUGH MECHANICAI=-...
ROUGH ELECTRICAL W( ) C
ROUGH PLUMBINGAll
.,, ; i+, , ,dr „ _ �
--'"
INSUI ATION WALL
INSUI ATION CEILING
DRYWALL
LATH (PRE)
I.ATFI EXTERIOR
I ATH INTERIOR
GAS TEST
r
SCRATCH COAT
ELECTRIC METER RELEASE
GAS METER RELEASE
SPECIAL INSPECTIONR0.
FINAL BUILDING
FINAL MECHANICALf
FINAL ELECTRICAL
FINAL PLUMBING
T.C. of OCCUPANCY
CERT. of .0CCUPANCY
CC7MMENT&
WALL DRAIN/ SEAL
WALL FINAL
FRAMING PLANNING APPROVAL
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERINGI PW
FINAL COMMUNITY SERVICES
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
_
CERTIFICATE OF VERIFICATION
CF3R-MCH-23-H
Space Conditioning System Airflow Rate
(Page 1 of 4)
Project Name: 2917 Rising Star Dr
Enforcement Agency: City of
Diamond Bar
Permit Number:
PR -17620
Dwelling Address: 2917 Rising Star Dr
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
New
04
Nominal Cooling Capacity (tons) of Condenser
4
05
Condenser Speed Type
Single Speed
06
Cooling System Zonal Control Type
Not Zonal
07
Central Fan Integrated (CFI) Ventilation System Status
Not a CFI system
OS
System Bypass Duct Status
No13ypasDuCi
09
Date of System Airflow Rang IVlasuremt.
�• z,
2x17 08 23
10
Airflow Rate Protocol Utilized _ ' -
RA3.3 procedures far airflow rate measureMent
B. Hole for the placement of a Static Pressure Probe (HSPP), and Permanently Installed Static Pressure Probe (PSPP)
in the Supply Plenum.
Procedures for installing HSPP or PSPP are specified in RA3.3.1.1.
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
Shortridge
03
Model number of Airflow Measurement Apparatus
ADM870
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: 2017-10-02 02:08:17 HERS Provider: CaICERTS
217-A020338219A-000-001-M 23001A-M23A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:16:19
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-23-H
Space Conditioning System Airflow Rate (Page 2 of 4)
MCH -23a Forced Air System Airflow Rate Measurement - newly Installed Non -Zoned Systems or Zoned Multi -Speed
Compressor
D. Forced Air System Airflow Rate Measurement
The procedures for System Airflow Rate Verification are specified in Reference Residential Appendix RA3.3.
01
Required Minimum System Airflow Rate (cfm/tan)
350
02
Required Minimum System Airflow Target (cfm)
1400
03
Actual System Airflow Rate Measurement (cfm)
1410
04
Compliance Statement:
System airflow rate complies
E. 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 apparat- s used to 0erfothe airfl�xuratO';mo'a'surfimenti�lentified ori this,C6r ific6f�, f
02
Verification was calibrated in kcordart with the 4ppSra! s manufacturer's s recifi ations aid confortns o the
n even in 63.3,1.
instrumentatmnsp eaficati�
A visual inspection shall confirm"that bypass ducts that d'eliver`'conditioned supply air'directly to "the space conditioriing
system return duct airflow are not used on newly constructed zonally controlled systems unless the Performance Certificate
03
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 diagnostic test.
05
System fan was set at maximum speed during the diagnostic test.
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/ton) and fan
08
efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air
handler fan speed.
09
Verification Status:
Pass- all applicable requirements are met
10
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
Registration Number: Registration Date/Time: 2017-10-02 02:08:17 HERS Provider: CaICERTS
217-A020338218A-000-001-M 23001A -M 23A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:16:19
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-23-H
Space Conditioning System Airflow Rate (Page 3 of 4)
F. 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.
01 I Complies: All specified verification protocol requirements on this document are met.
3 ,
3 1
3 [.
y
e
3„
Registration Number: Registration Date/Time: 2017-10-02 02:08:17 HERS Provider: CalCERTS
217-A020338218A-000-001-M 23001A-M23A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:16:19
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCIi-23-H
Space Conditioning System Airflow Rate (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:
Danny Bauder
Company:
Date Signed:
Baud -Air Energy Efficiency Services
2017-10-02 02:08:17
Address:
CEA/ HERS Certification Identification (if applicable):
3616 Honeyglenn way
CC2005690
City/State/Zip:
Phone:
Ontario CA 91761
951-313-2.603
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 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, or system performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with.the applicable requirements in Reference Appendices RA2, RA3, and the requirements
specified on the Certificate of Compliance for the building approved by the enforcement agency.
4. The information reported on applicahie sectigpt-6khe Certificaf0(s)= l Ilat n � F2 }+51 gdlan ti6rnt4te ibythe per5gn(s] responsible for the
_.
construction or installation conforms to the CerCif€catelsiof Ca[npllarie (CFjft) approved by $he eiff�emerxt;�gency.
" the
5. 1 will ensure that a registered cogy_of this Certificate of V.erMtatJpn #all be po�fed or rft"V yailabi with the building pertiilt(5� issugd for
building, and made avallabfg,�o thd' enforcent rlS d en for I! a lid le 1Pspe t€ons l Inder and hat a re isiere }:copy t�f th 'Certt{€caid-,of
Pp
documentation the buy der rovi
Verification is required to be"iliglftd'd with the p destothe building owner atoccupa.'hcy.
Builder Or Installer Information As Shown On The`Certifi'cate`Oflnstallation
Company Name (Installing Suhcontractor, General Contractor, or Builder/Owner):
CERTIFIED AIR SERVICES INC
Responsible Builder or Installer Name:
CSLB License:
Dan Lewis
815771
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group {If applicable)
Tested
HERS Rater Information
HERS Rater Company Name:
Baud -Air Energy Efficiency Services
Responsible Rater Name:
Responsible Rater Signature:
Danny Bauder
Responsible Rater Certification Numberw/this HERS Provider:
Date Signed:
CC2005690
2017-10-02 02:08:17
Digitally signed by CafCRRTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies
Registration Provider responsibility for the accuracy of the information.
Registration Number: Registration Date/Time: 2017-10-02 02:08:17 HERS Provider: CaICERTS
217-AD20338218A-000-001-M 23001A-M23A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:16:19
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION
CF3R-MCH-20-H
Duct Leakage Diagnostic Test
(Page 1 of 3)
Project Name: 2917 Rising Star Dr
Enforcement Agency: City of
Diamond Bar
Permit Number: PR -17620
Dwelling Address: 2917 Rising Star Dr
City: Diamond Bar
Zip Code: 91765
A. System Information
01
Space Conditioning System Identification or Name
System 1
02
Space Conditioning System Location or Area Served
Whole House
03
Building Type from CF -111
Single family
04
Verified Low Leakage Ducts in Conditioned Space (VLLDCS)
Credit from CF1R?
No, credit is not taken
05
Verified Low Leakage Air Handling Unit (VLLAHU) Credit
from CF1R?
No, credit is not taken
06
Duct System. Compliance Category
New
MCH -20a -Completely New Due,Systerr
T r
B. Duct Leakage Diagnostic Test
01
Condenser Nominal Cooling Capacity (ton)
4
02
Heating Capacity (kBtu/h)
64
03
Conditioned Floor Area served by this HVAC system (ft2)
1617
04
Duct Leakage Test Conditions
Test fina4
05
Duct Leakage Test Method
Total leakage
06
Leakage Factor
0.05
07
Air Handling Unit Airflow (AHUAir€low) Determination
Method
Cooling system method
08
Measured AHUAirflow
This field or section is not applicable
09
Calculated Target Allowable Duct Leakage (dm)
80
10
Actual Duct Leakage Rate from Leakage Test
Measurement (cfm)
79
11
F-
Compliance Statement
FSysSystempasses leakage test
Registration Number: Registration Date/Time: 2017-10-0202:08:17 HERS Provider: CaICERTS
217-A020338218A-000-001-M 20001A-M20A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:15:47
2016 Residential Compliance Schema Version: rev 03/16
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 2 of 3)
B. Duct Leakage Diagnostic Test
12 Notes:
C. Additional Requirements for Compliance
01
System was tested in its normal operation condition. No temporary taping allowed.
02
Outside air (OA) duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage
testing. OA ducts used for Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan Ventilation
Cooling Systems, that utilize dampers that open only when OA is required and automatically close when OA is not required,
may configure the OA damper to the closed position during duct leakage testing.
03
All supply and return register boots were sealed to the drywall.
04
Building cavities were not used as plenums or platform returns in lieu of ducts.
05
If cloth backed tape was used it was covered with Mastic and draw bands.
06
All connection points between the air handler and the supply and return plenums are completely sealed.
Visual Inspection at Final Construction Stago japplicab%jf system was tested at roipgh iii)
After installing the interior, finishing all and?terifyingthaVthe move ro h in ti fs�as c`mpletedT.the following procedure must
be performed
07
For all supply and return registers; verify that the -spaces between the "register boot and the snterior fi.nishing.wall are
properly sealed.
OB
if the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points
between the air handler and the supply and return plenums to verify that the connection points are properly sealed.
09
Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used.
10
Verification Status:
Pass
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.
D. 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 I Complies: All specified verification protocol requirements on this document are met.
Registration Number: Registration Date/Time: 2017-10-02 02:08:17 HERS Provider: CaICERTS
217-A 02033 821.8 A -000-001-M 20001A- M 20A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:15:47
2016 Residential Compliance Schema Version: rev 03/16
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 3 of 3)
Documentation Author's Declaration Statement
1, 1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Danny Bauder
Company:
Date Signed:
Baud -Air Energy Efficiency Services
2017-10-02 02:08:17
Address:
CEA/ HERS Certification Identification (if applicable):
3616 Honeyglenn way
CC2005690
City/State/Zip:
Phone:
Ontario CA 91761
951-313-2603
Responsible Person's Declaration statement
I certify the following under penalty of.perjury, under the laws ofthe State of California:
L The information provided on this Certificate of Verification is true and correct.
2, 13m 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, or system performance diagnostic results that require HERS verification
identified on this Certificate of Verication comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements
specified on the Certificate of Compliance forthe building approved by the enforcement agency.
4. The information reported on applicable sectionstfthe Certif:cat2(s),gf hYs#a11a_tfort ( F7 f g ed ai stfbntrthed'by the perNon(s) responsible for the
construction or installation conforms to the i 'quirementsSpeci6d �n the Cerjliicate(sj of &a pliw& (CpiR_) approved by he enfo cemeR�Igency-
5. I will ensure that a registered coLyy of this CarYificate of vert icatipn §hap be ponied or nt de yailak e with th'� E uiiding pergnrt( : iss d fpr the
building, and made availab o tit enfor em pt agen t faF Il ppliG le 1psp c# ons l inderStand' hat a re.&s -red copy of thl Certj caEg of
e
Verification is required to be inLiud¢d with the documentation tF e builder provides do the built)ing owner atoccupancy.
Builder Or Installer Information AsShown On"The"Certificate Of Installatip ''` �'�
n
Company Name (Installing Subcontractor, General Contractor, or Builder/Owner):
CERTIFIED AIR SERVICES INC
Responsihle Builder or Installer Name:
CSLB License:
Dan Lewis
815771
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
Tested
HERS Rater Information
HERS Rater Company Name:
Baud -Air Energy Efficiency Services
Responsible Rater Name:
Responsible Rater Signature:
Danny Bauder
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2005690
2017-10-02 02:08:17
Digitally signed by WCERTS. This digital signature is provided in order to secure the content of this registered document and in no way implies
Registration Provider responsibifity for the accuracy of the information.
Registration Number: Registration Date/Time: 2017-10-02 02:08:17 HERS Provider: CaICERTS
217-A020338218A-000-001-M 20001A-M20A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:15:47
2016 Residential Compliance Schema Version: rev 03/16
CERTIFICATE OF VERIFICATION
CF3R-MCH-22-H
Space Conditioning System Fan Efficacy
(Page 1 of 3)
Project Name: 2917 Rising Star Dr
Enforcement Agency: City of
Diamond Bar
Permit Number:
PR --17620
Dwelling Address: 2917 Rising Star Dr
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
New
04
Nominal Cooling Capacity (tons) of Condenser
4
05
Condenser Speed Type
Single Speed
06
Cooling System Zonal Control Type
Not Zonal
07
Central Fan Integrated (CFI) Ventilation System Status
Not a CFI system
08
System Bypass Duct Status .
Na BypassDuCt
09
Date of System Airflow Rhe llleasuremnt _-
2017 OS3
10 Airflow Rate Protocol utilized �.RA3 3rocedutes fijr arflovr`Yate'measutement
B. Fan Watt Measurement Apparatus and Procedure Information
Instrument Specifications are given in RA3.3.1, and systern fan watt measurement apparatus information is given in RA3.3.2.2.
01 1 Fan Watt Verification Device Used. Portable watt meter
MCH -22a Forced Air System Fan Efficacy Measurement - Newly Installed Non -Zoned Systems or Zoned Multi -Speed
Compressor
C. Forced Air System Fan Efficacy Measurement
The procedures for System Fan Watt Verification are specified in Reference Residential Appendix RA3.3.
01
Actual Tested Watts
510
02
Actual Tested Airflow from MCH -23 (cfm)
1410
03
Required Fan Efficacy (watts/cfm)
0.58
04
Actual Fan Efficacy (watts/cfm)
0.36
05
Compliance Statement:
System fan efficacy complies
Registration Number: Registration Date/Time: 2017-10-02 02:08:1 HERS Provider: CaICERTS
217-AO2033821SA-000-001- M 2 20O1A-M 22A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:16:49
2016 Residential Compliance Schema Version: rev 2013-09-11
CERTIFICATE OF VERIFICATION CF3R-MCH-22-H
Space Conditioning System Fan Efficacy (Page 2 of 3)
D. Additional Requirements
01
All registers were fully open during the diagnostic test.
02
System fan was set at maximum speed during the diagnostic test.
03
If fresh air duct is part of the HVAC system it was not closed during the diagnostic test.
04
Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value.
05
Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/ton) and fan
efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air
handler fan speed.
06
Zoned cooling air distribution systems with single speed compressors shall meet both the airflow (cfm/ton) and fan efficacy
(Watt/cfm) criteria in every zonal control mode.
07
Verification Status
Pass - all applicable requirements are met
08
Correction Notes
The responsible persons signature on thi 'scompliance docu ent of Tm #fatepplfeable ret irements in this table have
,,.
been met unless otherwise noted in the Ver kation vsOn& he CortectionsNotes 16"thisAiMe.
E. Determination of HERS Veriftition Compliance
All applicable sections of this document -shall intricate cbm- plian`ce wfth the specified Verifirait'on protocol reclufr-ements 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: 2017-10-02 02:08:17 HERS Provider: CaICERTS
21.7-A020338218A-000-001- M 22001A -M 2 2A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:16:49
2016 Residential Compliance Schema Version: rev 2013-09-11
CERTIFICATE OF VERIFICATION CF3R-MCH-22-H
Space Conditioning System Fan Efficacy (Page 3 of 3)
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Danny Bauder
Company:
Date Signed:
Baud -Air Energy Efficiency Services
2017-10-0202:08-.17
Address:
CEA/ HERS Certification Identification (if applicable):
3616 Honeyglenn way
CC2005690
City/State/Zip:
Phone:
Ontario CA 91761
951-313-2603
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 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, or system performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements
specified on the Certificate of Compliance forthe building approved by the enforcement agency.
4. The information reported on applicable sect! omt>bfthe Certific4� (s) gfl the peroon(s) responsible for the
construction or installation conforms to the quirement5<ispecifed qn the Ceriaficate(s)bf CoriiplIarite (CFR approved by he e11#ssr�erne agency.
5. 1 will ensure that a registered cop,`yof this Ce�ificate of verikatlbr Miall be pa in' or r€(�` Svaila with t 3UuIlding pe"it(�) issu§l fru the
building, and made availah _ t}enforcem t a n far all plrb7e insption� L�andetandat a reps i*teredt copy of th} Cer icaftw of
g, i6.. � P aspno,
Verification is required to be'fnotti�led with the documentation tKe builder provides to the buildin owner at bccup�ncy.
p g
Builder Or Installer Information As Shown On'The Certificate`bf Installation "
Company Name (installing Subcontractor, General Contractor, or Builder/owner):
CERTIFIED AIR SERVICES INC
Responsible Builder or Installer Name:
CSLB License:
Dan Lewis
815771
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
Tested
HERS Rater Information
HERS Rater Company Name:
Baud -Air Energy Efficiency Services
Responsible Rater Name:
Responsible Rater Signature:
Danny Bander
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2005690
2017-10-02 02:08:17
Digitally signed by CaICEATS. This digital signature is provided in order to secure the content of this registered document, and in noway implies
Registration Provider responsibility for the accuracy of the information.
Registration Number: Registration Date/Time: 2017-10-02 02:08:17 HERS Provider: CaICERTS
217-A02033921SA-000-007.-M22001A-M 22A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:16:49
2016 Residential Compliance Schema Version: rev 2013-09-11
CERTIFICATE OF VERIFICATION
CF3R-MCH-25-H
Refrigerant Charge Verification
(Page 1 of 4)
Project Name: 2917 Rising Star Dr
Enforcement Agency: City of
Diamond Bar
Permit Number:
PR -17620
Dwelling Address: 2917 Rising Star Dr
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
York
04
Condenser (or package unit) model number
YCS48132SA
05.
Nominal Cooling Capacity (tons) of Condenser
4
06
Condenser (or package unit) serial. number
W1F7931685
07
Refrigerant Type
R 410
08
Other Refrigerant Type (if applicable) i
e,.
N/ e
09
Liquid Line Filter Drier InstafledAccording to Manufacturers
Yet
Specifications (if applicable)
10
System Installation Type
New
Fault Indicator Display (FID) Status (Note: Even systems with
This system does not have a FID device installed
11
a FID must have refrigerant charge verified by installer)
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 RA3.3.3 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 compliance
from RA3.2.2 or RAI is applicable to this system and can be
13
with the refrigerant charge verification requirements when
used to verify compliance
temperatures are >= 557 (RA3.2.2, or RA1)?
14
Date of Refrigerant Charge Verification for this system
2017-08-23
Refrigerant charge verification method used.
Subcooling (outdoor temperature must be equal to or
15
greater than 55 degF)
Person who performed the Refrigerant Charge Verification
HVAC system installer
16
reported on this Certificate of Installation
17
HERS Verification Compliance Requirement Status
System qualifies for group sampling
18
Refrigerant charge verification method used by HERS Rater.
I Subcooling
Registration Number: Registration Date/Time: 2017-10-02 02:08:17 HERS Provider: CaICERTS
217-A020338218A-000-001-M 25001A -M 25A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:17:22
2016 Residential Compliance 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
B. 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.
01 Refrigerant metering device Thermostatic Expansion Valve (TXV)
02 Subcooling Method applicability status 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 5ttus =
zaz
Cairatio$:istrreh#
04
Digital Thermocouple Calibra n Statin°
Ca)tbratio is cUrrefit
3. 3
D. Measurement Access Hale (MAH) Verification '
HERS Raters are required to visually field verify MAH. Procedures for installing MAH are specified in Reference
Residential Appendix RA3.2.23
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)
1400
02
System Airflow Rate Verification Status
System complies with minimum airflow rate requirements
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
72
During the Refrigerant Charge Verification Procedure (°F)
02
Measured Condenser Air Entering Dry -Bulb Temperature
85
(Tcondenser, db)
Registration Number: Registration Date/Time: 2017-10-02 02:08:17 HERS Provider: CaiCERTS
217 -AO 20338218A -000-001-M 25001A -M 25A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:17:22
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
03
Outdoor Temperature Qualification Status
Outdoor temperature is within range for using Subcooling
02
Measured Suction Line Pressure (Psuction) (psig)
refrigerant charge verification method
04
Measured Liquid Line Temperature (Trq.id) (°F)
86
05
Measured Liquid Line Pressure (Piiquid) (psig)
254
06
Condenser Saturation Temperature (Tcondenser, sax) from
96
05
Digital Gauge or P-TTable using Line F05 (°F)
Passes CEC requirement
07
Measured Subcooling (Line F06 - Lilne F04 ('F)
10
08
Target Subcooling from Manufacturer (°F)
10
09
Compliance Statement:
System complies with Subcooling Method - Must also pass
07
Compliance Statement:
metering device verification, next section
G. Metering Device Verification
HERS Rater must ind.ependeWly Ilect a 'data irtt4hE sgctai9n Praiiedures fof the' erificatit�n,of prp per metegmg
device operation are specifiedi t 43.2.2.6.' „E
01
Measured Suction Line Temperature (Tsuction) (F).,....
56
02
Measured Suction Line Pressure (Psuction) (psig)
156
03
Evaporator Saturation Temperature (Tevaporator, sat) from
42
Digital Gauge or P -T Table using Line G02 ('F)
04
Measured Superheat (Line G01- Line G03) (°F)
14
05
Measured Superheat (Line G04) is between 3°F and 26°F
Passes CEC requirement
(inclusive)
Measured Superheat (Line G04) is within Manufacturer's
Not known
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.
01 I Complies: All specified verification protocol requirements on this document are met.
Registration Number: Registration Date/Time: 2017-10-02 02:08:17 HERS Provider: CaICERTS
217-A0 2033 8218A-000-001- M 2 5 i}01A-M 2 5A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:17:22
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. 1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
PALW
Danny Bauder
Company:
Date Signed:
Baud -Air Energy Efficiency Services
2017_10-02 02:08:17
Address:
CEA/ HERS Certification Identification (if applicable):
3616 Honeyglenn way
CC2005690
City/State/Zip:
Phone:
Ontario CA 91761
951-313-2603
Responsible Person's Declaration statement
I certify the following under penalty of perjury, underthe laws of the State of California:
1. The information provided on this Certificate of Verification is true and correct.
Z. 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, or system performance diagnostic results that require HERS verification
identified on this Certificate df Verification comply with the applicable requirements in Reference Appendices RAZ, RA3, and the requirements
specified on the Certificate of Compliance for the building approved by the enforcement agency.
4. The information reported on applicable sectiofs ifthe pembn(s) responsible forthe
construction or installation conforms to the,r quirements'Sgeci�jed &Ti the Certificate(s) df Coiripliarige (Ch,) approved hV�'the Anfdr, p.,emeqtigency.
S. I will ensure that a registered copy, ofthis Call nf?ferl fat t}n_ hall he poked or rl $e yaila e with tFi building per¢5iit(S issued f T the
building, and madeavailagl ot17 enforrem rflaggneyfpsallaaplr bleInspogtion5 la�nderstand1iatareg l;e' copyoftht Cert lcat_g.of
q i car p he building owner at'0"ccup,1icy.
Verification is required to 6E! qqN i with the d'dC `mentation t`fie builder " rovidesto t
Builder Or Installer Information As Shown bn'ihe"Certifcate'Of Installation
Company Name (Installing Subcontractor, General Contractor, or Builder/Owner):
CERTIFIED AIR SERVICES INC
Responsible Builder or installer Name:
CSLB License:
Dan Lewis
815771
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
Tested
HERS Rater Information
HERS Rater Company Name:
Baud -Air Energy Efficiency Services
Responsible Rater Name:
Responsible Rater Signature:
Danny Bauder
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2005690
2017-10-02 02:08:17
Digitally signed by CaICERTS. This digital signature is Provided in order to secure the content of this registered document and in noway implies
Registration Provider responsibility for the accuracy of the information.
Registration Number: Registration Date/Time: 2017-10-02 02:08:17 HERS Provider: CaICERTS
217-A0 20338218A -000-001-M 25001A -M 2 5A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-10-02 02:17:22
2016 Residential Compliance Schema Version: rev 10/16