HomeMy WebLinkAboutPR17-6904CITY OF DIAMOND BAIL I i r DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES a' 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027% FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com bugding(a�,diamondbarca.gov JOB SITE ADDRESS t✓ io APN LOT TRACT OWNER ADDR S l°l At— CITY APPLICANT 'ii, TEL. CONTRACTOR 111'5' ADDRESS '—:!> 1 V 1 i 1�� CITY ZIP 4ffSTEL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penally of perjury that I am exempt from the Contractor's State License Law for the reasons} Indicated below by the checkmarkts), 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 pursuantto 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 applicant for a permit subjects the applicant ie a civil penalty of not more than five hundred dollars {$500}. L) I, as owner of the property, or my employees with wages as their sole compensation, will do U 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 taw does not apply to an owner of property who, through employees' ar 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 for 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 Cantractors' State License Law dees not apply 10 an owner of properly who builds or improves thereon, and who contractsforthe projects with a licensed Contractor pursuantto the Contractors' State License Law. j. is I am exempt from Ilcensure under the Contractor's State License law for the following reasonts): Date: sign: By my signature below I acknowledge that, except far my personal residence in which I must have resided for at least one year priorto completion of the Improvements covered by this permit,[ 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/www.legIFfo.ca.gov/nalavv.htrnl. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am flcensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Buslness and Professions Code, and my licenseisin full force and effect. LICENSE CIASS- LIC. No,, � r / �� e % iDATE: CONTRACTOR: li S .� S WORKER'S COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by S 13700 of the Labor Code, for the performance of the work for which this permit Is Issued. have and will maintain Worker's Compensation Insurance, as required by Section 3700 efthe Labor Code, for the performance of the work for which this permit Is Issued, My Worker's Compensation Insurance Carrier and Policy Numher are', CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FGR ONE HUNDRED DOLLARS $100 Oil I cerilythat in the performance of the work for which this permit Is issued, I shall not employ any person in any manner sc es to become subject to the Worker's Compensation Laws of Callfornia. And agree that if I should become subject to the Worker's Compensation provisions of Section 37UU of the Labor Code, I shall forthwith comply with those provisions. DATE:—APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer 10 criminal penalties and civil fines up to one hundred thousand dollars (5100,000), in addition to the cost of the compensation, damages as provided for in section 3708 of the labor cede, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there Is a Construction Lending Agency for the performance of the work for which this permit is issued ($CCS 3097, Civ. C.). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordi noes and state laws relating to building construction, and hereby authorize representatives of this county to enter upc above-mentioned property for Inspection purposes. PERMITTEE NAME PRINT) SIGNATURE OF i DATE APPLICATION DATE:jV5 & ISSUE DATE: _115 Al PERMIT# TYPE CONST. P/C# : ?VZ 'i OCC GROUP: Scope of Work -no i # DWEL. UNITS # STORIES 0S 4. L% 3 # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ, AREA/VALUATION SFR/ADDi Garage/Carport en LU Patio/Deck LU LL Poo!/Spa ZRe -Roof JCommercial m Valua#font: Adj. Area: QUANTITY DESCRIPTION FEE U N U w ri r ri i i [Rrn z m a tt C 0 ZU FJ c7 x�. U w c� CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MFCHANICAL: . INSPECTION FEF: ISSUANCE: Si ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: - ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: PAID BY: VALIDATION: RECEIPT# 2S!9PAID BY:VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK —Assessor Copy CITY OF DIAMOND INSPECTION "SETRACK/LETTER SLAB UG I'LUMAIIVG UG ELECTRICAL TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD - T -BAR INTERCEPTER UFFR GROUND SFWFR LATERAL HOT MOP/SHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVE D DEMOLITION ROOF DRAINS ROUGH CONDUIT POOLISPA MAIN WATER LINE SFWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR ROUGH PLUMING ROUGH ELECTRICAL FRAMING/VENTING ROUGH MECHANICAL ROUGH MECHANICAI ROUGH ELECTRICAL. W( ) C ( ) GAS TEST ROUGH PLUMBING PRE GUMTE ... _..... .._...._. INSULATION WALL POOL PRE DFLK BONDING P -TRAP FENCE/ GATE/ ALARM FINAL. POO[ WALLS: WALL FOOTING/STEEL WALL STFF[ QST( ) 2'`0( )LIFT WALK BOND BEAM WALL DRAIN/ SEAL FINAL. ... --- 110. FR/IMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING E ENGINEERING/_ INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT - .... ELECTRIC MLI ER RELEASE GAS METER KLI ASEWALL SPECIAL. INSFEC`I1ON ........ FINAL BUILDING p FINAL MECHANICAL FINAL ELECTRICAL .... FINAL PLUMBING -- T.C. of OCCUPANCY CERT. 0 O CUPANCY FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE COMMENTS: m CD CD nr o' Z m N V D 0 N Q Ln U, 5, D O D O 0 0 O 0 ca a 0 0 0 Ln 7 70 n M rD 70 rm 0 + n 3 p o 0 m ns �. m 0 T CD ro � 0 Y 0 cn U7 x rD "o P rr c) M rD rD v m pL x m o N V O O rn (D u, � A � W m Ln (s� In cn m w in 177 0 T 0 Z n m U3 L-1 7 D W an m n 70 � N rD = M m n 7J IQ n W a n N� m 0 N� ° t Q Z;7 .,y13 rriD l m y 'o o O M ro n n n ER- N6) Z m n vm 9 �— m � � � of 3 0 $ Er N � •c' 00 1 _i m . 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CO YU � Q] W d y O ` aL+ (O itl c p a a C O7 S v O rL N O L a Ou =O m in aci O ate+ GJ m o ? +� U 4 ' 0 LA c a.+ = E c N 7, a m E a c o a.+a m w m o b0 C C 0 CC, a) c `JC C +' N Q a z C E a 0 m UC o v o a div o �� Q aC• Z L y +} j C f0 + V v d :G N C d s p y v O- N C L C m +L+ a C as m � N 3 v v — `-' ° m E v a -2 C o r- C N N *' i y o Q a o m v v 3 m 4 a Q uco W `� �^ N aq aw N stn v `^ v C m m h0 N 01 C c L a S C= dl y a L Z (U S C v a Cp +I 6J L.7 .O CC_ N N ' t i � e -I N m .O Q d1 L1 V] co fl o o^ m y N � ra c" v mcu rj Q �""" U LL Q N U 00 - s U LL 4 N U C7 L LU = N U d � N O O d C) w � = N v 41 0 t O CL cc h N M N CERTIFICATE OF VERIFICATION CF311-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3) Project Name: PAMELA DUFF Enforcement Agency: Diamond Bar (City of) Permit Number: pr17-6904 Dwelling Address: 1448 STONECREST PL 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 -1R 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 Alteration using smoke test MCH -20e - Sealing All Accessible Leaks using Smoke Tes# "; ............... . B. Duct Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity:(ton) : - 4- 02 Heating Capacity (kBtu/h) 0.1 03 Conditioned Floor Area served by this HVAC system (ft2) 2522 04 Duct Leakage Test Conditions Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.15 07 Air Handling Unit Airflow (AHUAirflow) Determination Method Cooling system method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage Rate (cfm) 240 10 Actual Duct Leakage Rate from Leakage Test Measurement (cfm) 500 Registration Number: Registration Date/Time: 2017-07-26 13:29:32 HERS Provider: CHEERS 417-AO20105660A-002-000-M20000A-M20A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-07-26 13:29:32 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 01 System was tested in its normai operation condition. No temporary taping allowed. System passes using smoke test of an altered HVAC system in an existing building. No 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'.,I:eakage testing. 03 visible smoke exits the accessible portions of the duct system. Smoke is only emanating 04 Building cavities were not used as plenums or platform returns in lieu of ducts. from air -handling unit (AHU) cabinet and non accessible portions of the duct system. Note 11 Compliance Statement: - Accessible is defined as having access thereto, but which first may require removal or 07 If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements of Reference Residential Appendix RA3.14.3.6: Systems that comply using smoke test shail not be included in sample groups for HERS verification compliance. opening of access panels, doors, or moving similar obstructions. If access to the ducts Verification Status:: Pass - all applicable requirements are met requires an object to be demolished or deconstructed then sealing of those ducts is not Correction Notes: required 12 Notes: C. Additional Requirements for Compliance 01 System was tested in its normai 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'.,I:eakage testing. 03 All supply and return register boots were sealed to the drywall' 71 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 handlQr.:and the sup ply,and return plenums are completely sealed. 07 If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements of Reference Residential Appendix RA3.14.3.6: Systems that comply using smoke test shail not be included in sample groups for HERS verification compliance. 08 Verification Status:: Pass - all applicable requirements are met 09 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. 101 I Complies: All specified verification protocol requirements on this document are met. Registration Number: Registration Date/Time: 2017-07-26 13:29:32 HERS Provider: CHEERS 417-A020105660A-002-000- M 20000A -M 20A CA Building Energy Efficiency Standards Report Version: 2016.1,006 Report Generated: 2017-07-26 13:29:32 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: Garrett Williams (5a*,-eitWia. "w Company: Date Signed: I Permit E Raters 2017-07-26 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 ofverification 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 orsystem performance diagnostic results that require HERS verificatton identified on this Certificate of Veriflcation comply with the appbcatie requirements in Reference Appendices RA2, RA3, and the requirements specified on the Certificate of Compliance far the building appraved'bythe:enforcement agency. 4. The information reported on applicable sections of the Cehjticate(s) of l)i t llaticn (CF2R) signed and submitted by the person(s) responsible for the construction or installation conforms to the requirementsspecified.wthe. eftificate(s) of Compliance {CFiR) approved by the enforcement agency. 5. 1 will ensure that a registered copy of this Certificate of Veritication..sWIPbe 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 thebuilder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General Corifractor or BuilderJCwnerl Fisher Heating & Air Conditioning, Inc. Responsible Builder or Installer Name: CSLB License: Traci Johnson 519630 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: Oa*7ie t WaUa-ow Garrett Williams Responsible Rater Certification Number w/ this HERS Provider: Date Signed: RCN13056 2017-07-26 Registration Number: Registration Date/Time: 2017-07-26 13:29:32 HERS Provider: CHEERS 417-A02010S660A--002-000-M 20000A -M 20A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-07-26 13:29:32 2016 Residential Compliance Schema Version: rev 03/16 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 4 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 2017-07-21 RA33.3.1.5 Alternative to Compliance with Minimum 10 Airflow Rate Protocol Utilized System Airflow Requirements B. Hole for the placement of a Static Pressure P'robe" (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. 01 Airflow Rate Measurement Type used for this airflow rate Traditional Flow Capture Hood according to procedure in 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: 2017-07-26 13:29:43 HERS Provider: CHEERS 417-A020105 660A -002-000-M 23000A- M 23 A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-07-26 13:29:44 2016 Residential 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 870 04 media The measured Airflow Rate reported on this document is 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 Open all registers and dampers and remove any Completed 02 obstructions. 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 Clean the evaporator coil according to the manufacttsrer Completed 04 and ensure the coil is not obstructed. Air handler fan speed set to high and blower wheel and `Completed 05 motor are operating properly. If determined to be too small, replace the return duct Completed 06 with a larger one and/or add a second"ieturt;sluct If determined to be too small, replace the return grille Completed 07 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) 1200 03 Actual System Airflow Rate Measurement (cfm) 870 04 Compliance Statement: The measured Airflow Rate reported on this document is 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: Registration Date/Time: 2017-07-26 13:29:43 HERS Provider: CHEERS 417-A020105660A-002-000- M 23000A- M 23A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-07-26 13:29:44 2016 Residential Compliance 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 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 diagnoictest. .' 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 (Watticfm) with system operating in,gooling,riocle at`the m_qx1m umCompressor speed and the maximum air handler fan speed. For altered systems that do not complywith the.minimum 300 cfm penton 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. 01 I Complies: All specified verification protocol requirements on this document are met. Registration Number: Registration Date/Time: 2017-07-26 13:29:43 HERS Provider: CHEERS 417-AO2010 5 660A-002-000- M 23000A- M 2 3A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-07-26 13:29:44 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 (jawT-ettWa2 ' Company: Date Signed: I Permit E Raters 2017-07-26 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 am the certified HERS Rater who performed the verification identified and reported or this Certificate of Verification (responsible rater). 3. The installed features, materials, components, manufactured device.sIor 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 buildirg,approved by the enforcement agency. 4. The information reported on applicable sections of the Cetificate(4).bf Installatior (CF2R) signed and submitted by the person(s) responsible for the construction or installation conforms to the requirementsspecified 9:n the.Certiflcate(s) of Compliance (CF1R) approved by the enforcement agency. 5. 1 will ensure that a registered copy of this Certificate efverlhcatlon shAte posted, or made available with the building permits) issued for the building, and made available tc the enforcement agency for all appiicabte inspecttens. I understand that a registered copy of this Certificate of Verification is required to be included with the documentation the.tiuilder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General Confiractor,ar. Builder. wnerJ; Fisher Heating & Air Conditioning, Inc. Responsible Builder or Installer Name: CSLB License: Traci Johnson 519630 HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status in Sample Group (if applicable) N/A ITERS Rater Information HERS Rater Company Name: I Permit E Raters Responsible Rater Name: Responsible Rater Signatu re: Garrett Williams ga#"YPttw' 1a1*W Responsible Rater Certification Number w/this HERS Provider: Date Signed: RCN 13056 2017-07-26 Registration Number: 417-A02010566OA-002-000-M 23000A-M23A CA Building Energy Efficiency Standards 2016 Residential Compliance Registration Date/Time: 2017-07-26 13:29:43 HERS Provider: CHEERS Report Version: 2016.1.006 Report Generated: 2017-07-26 13:29:44 Schema Version: rev 10/16 CERTIFICATE OF VERIFICATION CF3R-MCH-25-H Refrigerant Charge Verification (Page 1 of 4) Project Name: PAMELA DUFF Enforcement Agency: Diamond Bar (City of) Permit Number: pr17-6904 Dwelling Address: 1448 STONECREST PL 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 MAYTAG 04 Condenser (or package unit) model number CSABF048KC 05 Nominal Cooling Capacity (tons) of Condenser 4 06 Condenser (or package unit) serial number CSF161100820 07 Refrigerant Type R -410A 08 77 Other Refrigerant Type (if applicable) This field or section is not applicable 09 Liquid Line Filter Drier Installed According to Manufacturers Specifications (if applicable) Yes 10 System Installation Type Alteration 11 Fauit Indicator Display (FID) Status (Note: Even systems with a FII] must have refrigerant charge verified by installer) This system does not have a FID device installed 12 Is the system of a type that the minimum airflow can be verified using an approved measurement procedure (RA3.3 or RA3.3.3)? Yes, this is a ducted system and one of the system airflow rate measurement procedures in RA3.3 or RA3.3.3 can be used to verify system airflow rate requirements. 13 Is the system of a type that approved refrigerant charge verification procedures can be used to verify compliance with the refrigerant charge verification requirements when temperatures are >= 55°F (RA3.2.2, or RA1)? Yes, one of the Refrigerant charge verification procedures from RA3.2.2 or RA1 is applicable to this system and can be used to verify compliance 14 Date of Refrigerant Charge Verification for this system 2017-07-21 15 Refrigerant charge verification method used. Subcooling (outdoor temperature must be equal to or greater than 55 degF) 16 Person who performed the Refrigerant Charge Verification reported on this Certificate of Installation HERS rater 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: Registration Date/Time: 2017-07-26 13:30:06 HEMS Provider: CHEERS 417-A020105660A-002-000-M 25000A -M 25A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-07-26 13:30:07 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. 101 I Refrigerant metering device I Thermostatic Expansion Valve (TXV) 02 I Subcooling Method applicability statusI 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 2017-07-01 02 Date of Digital Thermocouple Calibration :2017-07-01 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) 1200 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 73 During the Refrigerant Charge Verification Procedure (°F) Registration Number: Registration Date/Time: 2017-07-26 13:30:06 HERS Provider: CHEERS 417-A020105660 A -002-000-M 25000A -iv! 2 5A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-07-26 13:30:07 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 ail 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 (Tcondenser,db) 138 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 (Triqufd) (°F) 80 05 Measured Liquid Line Pressure (Pliquid) (prig) 273 05 Condenser Saturation Temperature (Tcondenser, sat) from 89 06 Digital Gauge or P -T Table using Line FOS (°F) Yes, documentation to be provided upon request 07 Measured Subcooling (Line F06 - Lilne F04 ('F) 9 08 Target Subcooling from Manufacturer (°F) 10 System complies with Subcooling Method - Must also 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'(35uecor) ('F) 58 02 Measured Suction Line Pressure (P,-CfGr)'(psig) ' 138 Evaporator Saturation Temperature (Tevaporator sat) from 48 Q3 Digital Gauge or P-TTable using Line G02 ('F) 04 Measured Superheat (Line G01- Line G03) (°F) 10 Measured Superheat (Line G04) is between 3°F and 26°F Passes CEC requirement 05 (inclusive) 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 appiicable 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 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: Registration Date/Time: LUU-w-m l:j:z5u:uo ncna r,uviuci. 417-A020105660A-002-000-M25000A- M 25A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-07-26 13:30:07 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: Garrett Williams C;W-rettWaUamw Company: Date Signed: I Permit E Raters 2017-07-26 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 cf 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-al1.ppivat. in requirements in Reference Appendices RA2, RA3, and the requirements specified on the Certificate of Compliance for the building,dpprove8'1; the.ernforcement agency. 4. The information reported on applicable sections ofthe Certifrcate(s);cf Installation (CF211) signed and submitted bythe person(s) responsible for the construction or installation conformsto the requirements specified oro the:Certificate(s) of Compliance (CF1R) approved bythe enforcement agency. 5. I will ensure that a registered copy of this Certificate of VerifftafjQ shall be..posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for al applicable inspections. I understand that a registered copy of this Certificate of Verification is required to be included with the documentation the;bu.ilder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General CorAractor,,or Bui€derJO"wnerlj Fisher Heating & Air Conditioning, Inc_ Responsible Builder or Installer Name:CSLB License: Traci Johnson 519630 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 Cia1-rettWa1&1 ns - Responsible Rater Certification Number w/ this HERS Provider: i Date Signed: RCN 13056 2017-07-26 Registration Number: Registration Date/Time: 2017-07-26 13:34:06 HERS Provider: CHEERS 417-A020105660A-002-000-M25000A-M 25A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-07-26 13:30:07 2016 Residential Compliance Schema Version: rev 10/16